Lplpo Puskesmas

NO
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395
396
NAMA OBAT-OBATAN
ALOPURINOL TABLET 100 MG

ALPRAZOLAM TABLET 0,5 MG
AMBROXOL TAB. 30 MG
AMINOFILIN TABLET 200 MG
AMITRIPTILIN HCL TABLET SALUT 25 MG
AMLODIPIN 10 MG
AMLODIPIN 5 MG
AMOKSISILIN KAPSUL 250 MG
AMPISILINA 500 MG TAB
ANTALGIN (METAMPIRON) TABLET 500 MG
ANTASIDA DOEN TABLET KOMB. (100)
ANTI MIGRAIN DOEN TABLET KOMB.
ASAM ASKORBAT(VIT.C) TAB.50 MG
ASAM MEFENAMAT 500 MG
ASAM TRANEXAMAT TAB 500MG
ASETOSAL TABLET 100 MG
ASIKLOVIR TABLET 200 MG
ATROPIN SULFAT Tablet 0,5 mg
BETAHISTIN MALEAT
CEFADROXIL TABLET 500 MG
CIPROFLOXACIN 500 MG
CITRIZINE TABLET 10 MG
CLOBAZAM TAB 10 MG
CLOPIDOGREL 75 MG
CO AMOXICLAV 625 MG
DEXAMETASON TAB.0,5MG
DIAZEPAM TABLET 2MG
DIAZEPAM TABLET 5 MG
DIGOKSIN TAB. 0,25 MG
DOKSISIKLIN 100 MG
DOMPERIDON TAB 10 MG
EFEDRIN HCL TABLET 25 MG
EKSTRAK BELLADON TAB.10 MG
ERYTROMISIN 250 MG
ERYTROMISIN 500 MG
FAMOTIDIN TABLET 20 MG
FENITOIN NATRIUM KAP. 100 MG
FENOBARBITAL TAB. 100 MG
FITOMENADION (VIT.K 1) TAB.SALUT 10 MG
FUROSEMID TAB.40 MG
GARAM ORALIT UNTUK 200 ML
GLIBENKELAMID TABLET 5 MG
GLISERIL GUAYAKOLAT TAB.100 MG
GRISEOFULVIN TAB. 125 MG
HALOPERIDOL TABLET 0.5 MG
HALOPERIDOL 2 MG
HIDROKLOROTIAZID (HCT) TAB.25 MG
IBUPROFEN TABLET 200 MG
ISOSORBIT DINITRAT TAB.SALUT 5 MG
KALIUM DIKLOFENAK TABLET 25 MG
KALSIUM LAKTAT (KALK) TAB.500 MG
KAPTOPRIL 12,5 MG
KAPTOPRIL 25 MG
KAPTOPRIL 50 MG
KARBAMAZEPIN TAB.200 MG
KETOKONAZOLE TAB 200 MG
KLINDAMSIN 150 MG
KLORAMFENIKOL KAPSUL 250 MG
KLORFENIRAMIN MALEAT (CTM) TAB.4 MG
KLOROKUIN TAB. 150 MG
KLORPROMAZIN HCL TAB.SALUT 100 MG
KOM. PIRIMETAMIN 25 MG + SULFADOXIN 500 MG
KOTRIMOKSAZOL TABLET 480 MG
KOTRIMOKSAZOL TABLET PEDIATRIK
KUININ SULFAT TAB.222 MG
LANSOPRAZOL KAP 30 MG
LOPERAMIDE HCL 2 MG
LORATADINE TAB 10 MG
METFORMIN 500 MG
METHYL PREDNISOLON TAB 4 MG
METILERGOMETRIN MALEAT TAB 0,125 MG
METOKLOPRAMID 10 MG
METRONIDAZOL TAB 500 MG
METRONIDAZOL TAB.250 MG
MULTIVITAMIN TABLET
NATRIUM BICARBONAT TABLET
NATRIUM DIKLOFENAK 25 MG
NIFEDIPINE 10 MG
NISTATIN SALUT 500.000 IU
NISTATIN TABLET VAGINAL 100.000 IU/G
OMEPRAZOL KAP 20 MG
PARASETAMOL TAB.100 MG
PIRACETAM TAB. 400 MG
PIRANTEL TABLET 125 MG
PIRIDOKSIN HCL TAB. 10 MG
PIROXICAM 10 MG
PIROXICAM 20 MG
PREDNISON TAB.5 MG
PRIMAKUIN TAB.15 MG
PROPANOLOL HCL TABLET 10 MG
PROPILTIOURASIL TABLET 100 MG
RANITIDINE TABLET 150 MG
RETINOL (VIT A) KAPSUL 100.000 IU
RIFAMPICIN 450 MG
RIFAMPICIN 600 MG
RISPERIDON TAB 2 MG
SALBUTAMOL 4 MG
SALBUTAMOL TABLET 2 MG
SIANOKOBALAMINA ( VITB 12) TABLET
SIMETIDIN TABLET
SIMVASTATIN TAB. 10 MG
TABLET TAMBAH DARAH KOMB.
TETRASIKLIN HCL KAPSUL 250 MG
THIAMPHENICOL KAP. 500 MG
THROMBO ASPILETS
TIAMIN HCL MONONITRAT (VIT B1) TAB.50 MG
TRAMADOL KAPSUL 50 MG
TRIFLUOPERAZIN 5 MG
TRIHEKSIFENIDIL HIDROKLORIDA TAB.2 MG
VITAMIN B COMPLEKS TAB
ZINC TABLET
AMBROXOL SYR 15 MG/ML
AMOKSISILIN SIRUP KERING 125 MG/ 5ML
ANTASIDA DOEN SUSPENSI
BISOLVON DROP
CITRIZINE SYRUP
DOMPERIDON SUSPENSI 5 MG/5 ML
ERYTROMISIN SYRUP
HALOPERIDOL DROP
IBUPROFEN SUSPENSI
KOTRIMOKSAZOL SUSPENSI 240 MG / 5 ML
MULTIVITAMIN SYR/ANABION SYR
OBAT BATUK HITAM (OBH) CAIRAN
PARASETAMOL DROP
PARASETAMOL SYRUP 120 MG/5 ML
THIAMFENICOL SYR
ZINK DROP
ZINK SYRUP
AMINOFILIN INJEKSI 24 MG/ML - 10
AMPISILINA SERBUK INJ 1GR
ANTALGIN INJ. 250 MG /ML-2ML
AQUA PRO INJEKSI
ASAM TRANEXAMAT INJ
ATROPIN SULFAT INJ.0,25 MG/ML -1 ML
D5 + 1/4 NS
DEXAMETASON INJ.5MG/ML-1ML
DIAZEPAM INJ.5MG/ML-2ML
DIFENHIDRAMIN INJ.10 MG /ML-1ML
DOPAMIN INJ
EFINEPRIN HCL/BITARTRAT INJ.0,1%
ETAKRIDIN (RIVANOL) LARUTAN 0,1%
ETANOL 70 %
ETIL KLORIDA SEMPROT
EUGENOL CAIRAN
FENOBARBITAL INJ. 50 MG/ML - 2 ML
FITOMENADION (VIT.K 1) INJ.10 MG/ML-1ML
FUROSEMID INJ 10 ML
GENTAMYCIN INJEKSI 80 MG/2 ML
GLUKOSA LAR,INFUS 10 % STERIL
GLUKOSA LAR.INFUS 5 % STERIL
HALOPERIDOL INJEKSI
HYOSIN N BUTYLBROMIDE INJEKSI
KETOPROFEN INJEKSI 100 MG
KETOROLAC INJEKSI 30 MG
KLORPROMAZIN HCL INJ. 5 MG / ML-2ML1ML
KUININ HIDROKLORIDA INJ.25 % -2 ML
LIDOKAIN INJ. 2%
LIDOKAIN KOMB.INJ. HCL 2%
MAGNESIUM SULFAT 20 % INJEKSI
MAGNESIUM SULFAT 40% INJEKSI
MENADION K3 INJ
METIL ERGOMETRIN MALEAT INJ.0,200 MG-1ML
NATRIUM KLORIDA LARUTAN INFUS 0,9 % STERIL
OKSITETRASIKLIN HCL INJ.50 MG /ML -10ML
OKSITOSIN INJ 10 IU/ML - 1 ML
ONDANCENTRON 4MG INJ
PEHACAIN INJ
PETIDIN INJ. 50 MG/ML -2ML
PIRACETAM INJ 1 GR
RANITIDINE INJ 25 MG/ML-2ML
RINGER LAKTAT LAR.INFUS STERIL
SEFOTAKSIM INJEKSI 0,5 G
SEFOTAKSIM SERBUK INJ. 1 G
SEFTRIAXON INJ
SERUM ANTI BISA ULAR POLIVALEN INJ. 5 ML (ABU I)
SERUM ANTI DIFTERI 20000 UI
SERUM ANTI TETANUS INJ. 1.500 IU / AMPUL (ATS)
SIANOKOBALAMINA ( VITB 12) INJ.500 MCG./ML
TIAMIN HCL (VIT B 1 ) INJ.100 MG/ML -1ML
TRAMADOL INJEKSI 50 MG/ML
VENTOLIN NEBU
ALBOTHYL
ANTI BAKTERI DOEN SALEP
ASIKLOVIR KRIM
BETAMETASON KRIM 0,1 %
BISAKODIL SUPPOSITORIA
DIAZEPAM RECTAL 10 MG
GENTAMYCIN SALEP KULIT 0,1 %
GENTAMYCIN SULFAT TETES MATA 0,3 %
GENTIAN VIOLET LARUTAN 1 %
HIDROKORTISON KRIM 2,5%
IODIUM POVIDON IODIDA 30 ML 10%
KETOKONAZOLE KRIM 2 %
KLORAMFENIKOL SALEP MATA 1%
KLORAMFENIKOL TETES MATA 0,5 %
KLORAMFENIKOL TETES TELINGA 3%
MIKONAZOLE SALEP
OKSITETRASIKLIN HCL SALEP 3 %
OKSITETRASIKLIN HCL SALEP MATA 1 %
SALEP 2-4 KOMB.
SALISIL BEDAK 2 %
SALISIL SPIRITUS 10 %
SCABIMITE KRIM
ALAT SUNTIK SEKALI PAKAI 1 ML

BISTURI NO. 12
BLOOD LANCET
BOX SLIDE
CATGUT / BENANG BEDAH NO.2/0 - 3/0
FOLLEY CATHETER JELLY
FOLLEY CATHETHER NO.12
HAND SCHOEN L NON STERIL
HAND SCHOEN M NON STERIL
HAND SCHOEN S NON STERIL
HAND SCHOEN L STERIL
HAND SCHOEN M STERIL
HAND SCHOEN S STERIL
HAND SCHOEN OBSETRIKAL
INFUS SET ANAK
INFUS SET DEWASA
IV CATHETER NO. 18
IV CATHETER NO. 20
IV CATHETER NO. 22
IV CATHETER NO. 24
IV CATHETER NO. 26
JARUM KULIT
JARUM OTOT
JELLY FOLEY CATETHER FUJI 370 ML
KACA SLIDE
KAPAS 1 KG
KAPAS ADSORBEN 500 GR
KAPAS PEMBALUT ABSORBEN 250 GR
KASA KOMPRES 40/40 STERIL
KASA PEMBALUT 2M X 80 CM
KASA PEMBALUT 36 X 80 CM
KASA PEMBALUT HIDROFIL 4M X 15 CM
KASA STERIL 16 X 16 HK
KERTAS EKG
LARUTAN AMONIUM OXALAT 1 %
LARUTAN ANISOL
LARUTAN ASAM SULFOSALISILAT 20%
LARUTAN BENEDICT
LARUTAN EDTA 100 ml

LARUTAN EOSIN 2 %
LARUTAN ETANOL ASAM
LARUTAN GIEMSA STAIN
LARUTAN H2O2
LARUTAN HCL 0,1 N
LARUTAN HAYEM
LARUTAN KARBOL FUKSIN
LARUTAN METANOL
LARUTAN METILEN BIRU
LARUTAN REAGENT ANTI A
LARUTAN REAGENT ANTI AB
LARUTAN REAGENT ANTI B
LARUTAN REAGENT ANTI D
LARUTAN REAGENT PEWARNA GRAM 1 SET
LARUTAN REAGENT ZIENIL NEELSEN
LARUTAN TURK
LEUCOPLAST 7.5 CM X 5 CM
MAAG SLANG ANAK (STOMACH TUBE NO.8)
MAAG SLANG DEWASA (STOMACH TUBE NO. 16)
MASKER KARET
MASKER TALI
MINYAK IMERSI
NEEDLE 23
NEEDLE 24
NELATON CATHETHER
PENJEPIT TALI PUSAT
PLASTER 5 YARD X 2 INCH
PROPILEN GLIKOL
RAPID TES PROTEIN
RDT TYPUS
RDT HIV/AIDS
REESECHER
SELANG OKSIGEN ANAK
SELANG OKSIGEN BAYI
SELANG OKSIGEN DEWASA
SILK(BENANG BEDAH SUTERA)NO.3/0
SUNGKUP OKSIGEN ANAK
SUNGKUP OKSIGEN DEWASA
TABUNG KAPILER + DEMPUL
TEST DENGUE DEVICE
TEST HBsAG STRIP
TEST HCG STRIP
TEST MALARIA DEVICE
TEST URINE TRIP 10 PARAMETER
THREE WAY
TRANFUSI SET
ULTRASOUND GEL 250 ML
UNDERPAD
URINAL PRIA
URINAL WANITA
URINE BAG
VASELIN
WING NEEDLE 23
WING NEEDLE 27
AIR RAKSA DENTAL USE
ARTICULATING PAPER
BONDING SINGLE BOND
CAVITON ATFLETCHER
CELLULOID STRIP
COMPOSITE PASTE (SOLARE)
ETCHING
FUJI 9 ART (MINI)
FUJI II LC
FUJI IX GC
FUJI IX GP
FUJI VII GC WHITE
MATRIX ROLL + MATRIX BOND
MICRO BRUSH
OCHO
SALIVA EJECTOR
SEMEN SENG FOSFAT SERBUK DAN CAIRAN
SILVER AMALGAM SERBUK 65-75%
SPONS GELATIN CUBICLES 1 X 1 X 1 CM
TOPICAL ANESTHESI OLES
ANTI HEMORRHOID SUPP/ SUPERHOID
AMINOFLUID
ASERING
TABUNG VENOJECT EDTA
BRONSOLVAN/TEOPHYLIN
VERAPAMIL 50 MG
BISOPPROLOL TAB 5MG
DILTIAZEM
ASAM FOLAT 1 MG
SULFASALAZINE
GLICLAZID
IRBESARTAN
GEMFIBROZIL
AMIODARON
GLIMEPIRID
MELOXICAM 15
KODEIN TABLET
COMBIVEN NEBU
CLEVER CHECK
CELL CLEAN
MASKER RESPIRATOR
HYPAFIX
PIPET TETES
THERMAROL
NOVOMIX PENFLEX
ISONIAZID TAB 30 MG
Atrovent spray/IPRATOPRIUM
OBAT ANTITUBERKULOSIS FDC SISIPAN
lipid panel test
alkohol swab
lysol
CELL PACK
STOMALYZER
BETHADINE GARGLE (OBAT KUMUR)
BIOPLACENTONE GELL 10 GRAM
JARUM AUTO CLICK
ALAT SUNTIK 0.05ML
ALAT SUNTIK 0.5ML
ANTRAIN INJ
AQUA GEL
ARTEM INJ
CITICOLLIN INJ
DIAMOND BOOR SET M
DIAMOND BOOR SET S
FEEDING TUBE
FISURE LANCIP LONG
KANDISTATIN
LARUTAN SALMONELLA PARATYPHI H
LARUTAN SALMONELLA PARATYPHI HA
LARUTAN SALMONELLA PARATYPHI HC
LARUTAN SALMONELLA PARATYPHI O
LARUTAN SALMONELLA PARATYPHI OA
LARUTAN SALMONELLA PARATYPHI OB
LARUTAN SALMONELLA PARATYPHI OC
REAGEN TEST CHLONESTERASE ACHE (DIGITAL)

REAGEN TEST CHLONESTERASE BCHE (DIGITAL)
SUAB TENGGOROKAN
MINIOCEP
PENGELUARAN OBAT DARI GUDANG OBAT KE PELA

BULAN JANUARI 2016
KEMASAN
TANGGAL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
BUNGKUS
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
KAPSUL
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
AMPUL
VIAL
AMPUL
VIAL
AMPUL
AMPUL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
BOTOL
BOTOL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
VIAL
VIAL
AMPUL
AMPUL
BOTOL
VIAL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
VIAL
VIAL
VIAL
VIAL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
VIAL
BOTOL
TUBE
TUBE
TUBE
SUPP
SUPP
TUBE
BOTOL
BOTOL
TUBE
BOTOL
BOTOL
TUBE
TUBE
BOTOL
BOTOL
TUBE
TUBE
TUBE
POT
KOTAK
BOTOL
TUBE
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
KOTAK
KOTAK
KOTAK
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
BOTOL
SET
BUNGKUS
BUNGKUS
BUNGKUS
ROLL
ROLL
ROLL
ROLL
ROLL
KOTAK
ROLL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
SET
SET
BOTOL
ROLL
SET
SET
SET
PCS
BOTOL
SET
SET
SET
SET
ROLL
BOTOL
SET
SET
SET
BOTOL
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
BOTOL
PCS
SET
SET
SET
SET
SET
SET
BOTOL
SET
SET
BOTOL
PCS
BOTOL
BOTOL
SET
SET
SET
SET
SET
ROLL
BOTOL
BOTOL
BUNGKUS
SET
SET
KOTAK
BOTOL
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
TABLET
PCS
KOTAK
PCS
PCS
BOTOL
KOTAK
SET
BOTOL
TUBE
PCS
PCS
PCS
VIAL
BOTOL
VIAL
VIAL
SET
SET
TUBE
PCS
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
PCS
BOTOL
AT KE PELAYANAN
10
11
12
PENGELUARAN HARIAN / HARI

13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
NAMA PUSTU
NAMA PUSTU
NAMA PUSTU
NAMA PUSTU
NAMA POLINDES NAMA POLINDES
PENGELUARAN PUSTU / POLINDES

NAMA POLINDES NAMA POLINDES
JUMLAH
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
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
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
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
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
25,100
LAPORAN PEMAKAIAN DA
KODE PUSKESMAS
PUSKESMAS
KECAMATAN
KABUPATEN / KOTA
NO
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
:
:
:
:
NAMA OBAT

AMBROXOL TAB. 30 MG
AMLODIPIN 10 MG
AMLODIPIN 5 MG
BETAHISTIN MALEAT
CLOBAZAM TAB 10 MG
CLOPIDOGREL 75 MG
CO AMOXICLAV 625 MG
DIAZEPAM TABLET 2MG
DOKSISIKLIN 100 MG
ERYTROMISIN 250 MG
ERYTROMISIN 500 MG
SATUAN /
STOK
KEMASAN
AWAL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
NO
40
41
42
43
44
45
46
47
49
50
48
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
NAMA OBAT

FUROSEMID TAB.40 MG
HALOPERIDOL 2 MG
KAPTOPRIL 12,5 MG
KAPTOPRIL 25 MG
KAPTOPRIL 50 MG
KLINDAMSIN 150 MG
LOPERAMIDE HCL 2 MG
METFORMIN 500 MG
METOKLOPRAMID 10 MG
MULTIVITAMIN TABLET
NIFEDIPINE 10 MG
SATUAN /
STOK
KEMASAN
AWAL
KAPSUL
TABLET
TABLET
TABLET
BUNGKUS
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
NO
NAMA OBAT
SATUAN /
STOK
KEMASAN
AWAL
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124

OMEPRAZOL KAP 20 MG
PIROXICAM 10 MG
PIROXICAM 20 MG
PREDNISON TAB.5 MG
PRIMAKUIN TAB.15 MG
RIFAMPICIN 450 MG
RIFAMPICIN 600 MG
RISPERIDON TAB 2 MG
SALBUTAMOL 4 MG
SIMETIDIN TABLET
THROMBO ASPILETS
TRIFLUOPERAZIN 5 MG
ZINC TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
KAPSUL
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
125
126
127
128
129
130
131
132

BISOLVON DROP
CITRIZINE SYRUP
ERYTROMISIN SYRUP
HALOPERIDOL DROP
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
NO
NAMA OBAT
SATUAN /
STOK
KEMASAN
AWAL
133
134
135
136
137
138
139
140
141
IBUPROFEN SUSPENSI
PARASETAMOL DROP
THIAMFENICOL SYR
ZINK DROP
ZINK SYRUP
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178

AQUA PRO INJEKSI
ASAM TRANEXAMAT INJ
D5 + 1/4 NS
DOPAMIN INJ
ETANOL 70 %
EUGENOL CAIRAN
FUROSEMID INJ 10 ML
HALOPERIDOL INJEKSI
LIDOKAIN INJ. 2%
MENADION K3 INJ
AMPUL
VIAL
AMPUL
VIAL
AMPUL
AMPUL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
BOTOL
BOTOL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
VIAL
VIAL
AMPUL
AMPUL
BOTOL
VIAL
AMPUL
NO
NAMA OBAT
SATUAN /
STOK
KEMASAN
AWAL
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194

PEHACAIN INJ
PIRACETAM INJ 1 GR
SEFTRIAXON INJ
VENTOLIN NEBU
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
VIAL
VIAL
VIAL
VIAL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
VIAL
195
196
197
198
199
200
201
202
203
204
205
206
207
208
209
210
211
212
213
214
215
216
217
ALBOTHYL
ASIKLOVIR KRIM
MIKONAZOLE SALEP
SALEP 2-4 KOMB.
SALISIL BEDAK 2 %
SCABIMITE KRIM
BOTOL
TUBE
TUBE
TUBE
SUPP
SUPP
TUBE
BOTOL
BOTOL
TUBE
BOTOL
BOTOL
TUBE
TUBE
BOTOL
BOTOL
TUBE
TUBE
TUBE
POT
KOTAK
BOTOL
TUBE
218
219
220
221
222
223

BISTURI NO. 12 (carbon steel capel)
SET
SET
SET
SET
SET
SET
NO
224
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239
240
241
242
243
244
245
246
247
248
249
250
251
252
253
254
255
256
257
258
259
260
261
262
263
264
265
266
267
268
269
270
NAMA OBAT
BLOOD LANCET
BOX SLIDE
INFUS SET ANAK
INFUS SET DEWASA
IV CATHETER NO. 18
IV CATHETER NO. 20
IV CATHETER NO. 22
IV CATHETER NO. 24
IV CATHETER NO. 26
JARUM KULIT
JARUM OTOT
KACA SLIDE
KAPAS 1 KG
KERTAS EKG
LARUTAN ANISOL
LARUTAN BENEDICT
LARUTAN EDTA 100 ml
LARUTAN EOSIN 2 %
LARUTAN ETANOL ASAM
LARUTAN H2O2
LARUTAN HCL 0,1 N
LARUTAN HAYEM
SATUAN /
STOK
KEMASAN
AWAL
SET
SET
SET
SET
SET
SET
SET
SET
KOTAK
KOTAK
KOTAK
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
BOTOL
SET
BUNGKUS
BUNGKUS
BUNGKUS
ROLL
ROLL
ROLL
ROLL
ROLL
KOTAK
ROLL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
NO
271
272
273
274
275
276
277
278
279
280
281
282
283
284
285
286
287
288
289
290
291
292
293
294
295
296
297
298
299
300
301
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
NAMA OBAT

LARUTAN METANOL
LARUTAN TURK
MASKER KARET
MASKER TALI
MINYAK IMERSI
NEEDLE 23
NEEDLE 24
NELATON CATHETHER
PENJEPIT TALI PUSAT
PROPILEN GLIKOL
RAPID TES PROTEIN
RDT TYPUS
RDT HIV/AIDS
REESECHER
SELANG OKSIGEN ANAK
SELANG OKSIGEN BAYI
TEST DENGUE DEVICE
TEST HBsAG STRIP
TEST HCG STRIP
TEST MALARIA DEVICE
THREE WAY
TRANFUSI SET
UNDERPAD
URINAL PRIA
URINAL WANITA
URINE BAG
VASELIN
WING NEEDLE 23
SATUAN /
STOK
KEMASAN
AWAL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
SET
SET
BOTOL
ROLL
SET
SET
SET
PCS
BOTOL
SET
SET
SET
SET
ROLL
BOTOL
SET
SET
SET
BOTOL
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
BOTOL
PCS
SET
SET
SET
SET
SET
NO
318
319
320
321
322
323
324
325
326
327
328
329
330
331
332
333
334
335
336
337
338
339
340
341
342
343
344
345
346
347
348
349
350
351
352
353
354
355
356
357
358
359
360
361
362
363
364
NAMA OBAT
WING NEEDLE 27
ARTICULATING PAPER
BONDING SINGLE BOND
CAVITON ATFLETCHER
CELLULOID STRIP
ETCHING
FUJI 9 ART (MINI)
FUJI II LC
FUJI IX GC
FUJI IX GP
FUJI VII GC WHITE
MICRO BRUSH
OCHO
SALIVA EJECTOR
AMINOFLUID
ASERING
VERAPAMIL 50 MG
BISOPPROLOL TAB 5MG
DILTIAZEM
ASAM FOLAT 1 MG
SULFASALAZINE
GLICLAZID
IRBESARTAN
GEMFIBROZIL
AMIODARON
GLIMEPIRID
MELOXICAM 15
KODEIN TABLET
COMBIVEN NEBU
CLEVER CHECK
CELL CLEAN
MASKER RESPIRATOR
HYPAFIX
PIPET TETES
THERMAROL
NOVOMIX PENFLEX
ISONIAZID TAB 30 MG
SATUAN /
STOK
KEMASAN
AWAL
SET
BOTOL
SET
SET
BOTOL
PCS
BOTOL
BOTOL
SET
SET
SET
SET
SET
ROLL
BOTOL
BOTOL
BUNGKUS
SET
SET
KOTAK
BOTOL
PCS
PCS
PCS
PCS
PCS
TABLET
PCS
PCS
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
VIAL
PCS
PCS
PCS
PCS
PCS
PCS
PCS
TABLET
NO
365
366
367
368
369
370
371
372
373
374
375
376
377
378
379
380
381
382
383
384
385
386
387
388
389
390
391
392
393
394
395
396
NAMA OBAT
lipid panel test
alkohol swab
lysol
CELL PACK
STOMALYZER
JARUM AUTO CLICK
ALAT SUNTIK 0.05ML
ALAT SUNTIK 0.5ML
ANTRAIN INJ
AQUA GEL
ARTEM INJ
CITICOLLIN INJ
DIAMOND BOOR SET M
DIAMOND BOOR SET S
FEEDING TUBE
FISURE LANCIP LONG
KANDISTATIN

SUAB TENGGOROKAN
MINIOCEP
SATUAN /
STOK
KEMASAN
AWAL
PCS
KOTAK
PCS
PCS
BOTOL
KOTAK
SET
BOTOL
TUBE
PCS
PCS
PCS
VIAL
BOTOL
VIAL
VIAL
SET
SET
TUBE
PCS
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
PCS
BOTOL
UMUM
JUMLAH KUNJUNGAN RESEP
Mengetahui / Menyetujui
Kepala IFK Kubu Raya
Erlin Dwisafitri, S.Si, Apt

NIP. 19830624 201001 2 007
TIDAK BAYAR
Mengetahui
Kepala Puskema
NIP.
AN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT PUSKESMAS

BULAN
TAHUN
PENERIMAAN
PERSEDIAAN
PEMAKAIAN
-
SISA STOK
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
PENERIMAAN
PERSEDIAAN
PEMAKAIAN
-
SISA STOK
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
PENERIMAAN
PERSEDIAAN
PEMAKAIAN
SISA STOK
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
PENERIMAAN
PERSEDIAAN
PEMAKAIAN
SISA STOK
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
PENERIMAAN
PERSEDIAAN
PEMAKAIAN
SISA STOK
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
PENERIMAAN
PERSEDIAAN
PEMAKAIAN
-
SISA STOK
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
PENERIMAAN
PERSEDIAAN
PEMAKAIAN
-
SISA STOK
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
PENERIMAAN
PERSEDIAAN
PEMAKAIAN
-
SISA STOK
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
PENERIMAAN
PERSEDIAAN
PEMAKAIAN
-
UMUM
BAYAR
BPJS
SISA STOK
JUMLAH
Mengetahui
Kepala Puskemas
Yang Meminta / Melapor

Petugas Obat Puskesmas
..
NIP. ..
NIP. .
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
BAT PUSKESMAS
Terima
No. Dok
Input
B.A
STOK
PERMINTAAN
OPT
-
PEMBERIAN
-
KETERANGAN
STOK
PERMINTAAN
OPT
-
PEMBERIAN
-
KETERANGAN
STOK
PERMINTAAN
OPT
PEMBERIAN
KETERANGAN
STOK
PERMINTAAN
OPT
PEMBERIAN
KETERANGAN
STOK
PERMINTAAN
OPT
PEMBERIAN
KETERANGAN
STOK
PERMINTAAN
OPT
-
PEMBERIAN
-
KETERANGAN
STOK
PERMINTAAN
OPT
-
PEMBERIAN
-
KETERANGAN
STOK
PERMINTAAN
OPT
-
PEMBERIAN
-
KETERANGAN
STOK
PERMINTAAN
OPT
-
PEMBERIAN
-
Yang Menyerahkan
Petugas IFK Kubu Raya
Hesti Kartini, Amd.Far

NIP. 19781130 200012 2 001
KETERANGAN
LAPORAN PENGGUNAA
NAMA PUSKESMAS
ALAMAT
TELP
:
:
:
NO
NAMA OBAT
SATUAN
1
2
3
4
5
6
7
8
9
10

CLOBAZAM TAB 10 MG
DIAZEPAM TABLET 2MG
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
AMPUL
AMPUL
Kepala Puskesmas .
..
NIP. .
APORAN PENGGUNAAN OBAT PSIKOTROPIKA
BULAN
TAHUN
SALDO
AWAL
PEMASUKAN
DARI
JUMLAH
PENGGUNAAN
UNTUK
7
0
0
0
0
0
0
0
0
Penanggung Jawab
..
NIP. .
:
:
PENGGUNAAN
JUMLAH
8
0
0
0
0
0
0
0
0
Penanggung Jawab
..
NIP. .
SALDO
AKHIR
9
NO
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
NAMA OBAT-OBATAN

AMBROXOL TAB. 30 MG
AMLODIPIN 10 MG
AMLODIPIN 5 MG
BETAHISTIN MALEAT
CLOBAZAM TAB 10 MG
CLOPIDOGREL 75 MG
CO AMOXICLAV 625 MG
DIAZEPAM TABLET 2MG
DOKSISIKLIN 100 MG
ERYTROMISIN 250 MG
ERYTROMISIN 500 MG
42
43
44
45
46
47
49
50
48
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91

FUROSEMID TAB.40 MG
HALOPERIDOL 2 MG
KAPTOPRIL 12,5 MG
KAPTOPRIL 25 MG
KAPTOPRIL 50 MG
KLINDAMSIN 150 MG
LOPERAMIDE HCL 2 MG
METFORMIN 500 MG
METOKLOPRAMID 10 MG
MULTIVITAMIN TABLET
NIFEDIPINE 10 MG
OMEPRAZOL KAP 20 MG
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124

PIROXICAM 10 MG
PIROXICAM 20 MG
PREDNISON TAB.5 MG
PRIMAKUIN TAB.15 MG
RIFAMPICIN 450 MG
RIFAMPICIN 600 MG
RISPERIDON TAB 2 MG
SALBUTAMOL 4 MG
SIMETIDIN TABLET
THROMBO ASPILETS
TRIFLUOPERAZIN 5 MG
ZINC TABLET
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140

BISOLVON DROP
CITRIZINE SYRUP
ERYTROMISIN SYRUP
HALOPERIDOL DROP
IBUPROFEN SUSPENSI
PARASETAMOL DROP
THIAMFENICOL SYR
ZINK DROP
141
ZINK SYRUP
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189

AQUA PRO INJEKSI
ASAM TRANEXAMAT INJ
D5 + 1/4 NS
DOPAMIN INJ
ETANOL 70 %
EUGENOL CAIRAN
FUROSEMID INJ 10 ML
HALOPERIDOL INJEKSI
LIDOKAIN INJ. 2%
MENADION K3 INJ
PEHACAIN INJ
PIRACETAM INJ 1 GR
SEFTRIAXON INJ
190
191
192
193
194

VENTOLIN NEBU
195
196
197
198
199
200
201
202
203
204
205
206
207
208
209
210
211
212
213
214
215
216
217
ALBOTHYL
ASIKLOVIR KRIM
MIKONAZOLE SALEP
SALEP 2-4 KOMB.
SALISIL BEDAK 2 %
SCABIMITE KRIM
218
219
220
221
222
223
224
225
226
227
228
229
230
231
232
233
234
235
236
237

BISTURI NO. 12
BLOOD LANCET
BOX SLIDE
238
239
240
241
242
243
244
245
246
247
248
249
250
251
252
253
254
255
256
257
258
259
260
261
262
263
264
265
266
267
268
269
270
271
272
273
274
275
276
277
278
279
280
281
282
283
284
285
286
287

INFUS SET ANAK
INFUS SET DEWASA
IV CATHETER NO. 18
IV CATHETER NO. 20
IV CATHETER NO. 22
IV CATHETER NO. 24
IV CATHETER NO. 26
JARUM KULIT
JARUM OTOT
KACA SLIDE
KAPAS 1 KG
KERTAS EKG
LARUTAN ANISOL
LARUTAN BENEDICT
LARUTAN EDTA 100 ml
LARUTAN EOSIN 2 %
LARUTAN ETANOL ASAM
LARUTAN H2O2
LARUTAN HCL 0,1 N
LARUTAN HAYEM
LARUTAN METANOL
LARUTAN TURK
MASKER KARET
MASKER TALI
MINYAK IMERSI
NEEDLE 23
288
289
290
291
292
293
294
295
296
297
298
299
300
301
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320
321
322
323
324
325
326
327
328
329
330
331
332
333
334
335
336
337
NEEDLE 24
NELATON CATHETHER
PENJEPIT TALI PUSAT
PROPILEN GLIKOL
RAPID TES PROTEIN
RDT TYPUS
RDT HIV/AIDS
REESECHER
SELANG OKSIGEN ANAK
SELANG OKSIGEN BAYI
TEST DENGUE DEVICE
TEST HBsAG STRIP
TEST HCG STRIP
TEST MALARIA DEVICE
THREE WAY
TRANFUSI SET
UNDERPAD
URINAL PRIA
URINAL WANITA
URINE BAG
VASELIN
WING NEEDLE 23
WING NEEDLE 27
ARTICULATING PAPER
BONDING SINGLE BOND
CAVITON ATFLETCHER
CELLULOID STRIP
ETCHING
FUJI 9 ART (MINI)
FUJI II LC
FUJI IX GC
FUJI IX GP
FUJI VII GC WHITE
MICRO BRUSH
OCHO
SALIVA EJECTOR
338
339
340
341
342
343
344
345
346
347
348
349
350
351
352
353
354
355
356
357
358
359
360
361
362
363
364
365
366
367
368
369
370
371
372
373
374
375
376
377
378
379
380
381
382
383
384
385
386
387

AMINOFLUID
ASERING
VERAPAMIL 50 MG
BISOPPROLOL TAB 5MG
DILTIAZEM
ASAM FOLAT 1 MG
SULFASALAZINE
GLICLAZID
IRBESARTAN
GEMFIBROZIL
AMIODARON
GLIMEPIRID
MELOXICAM 15
KODEIN TABLET
COMBIVEN NEBU
CLEVER CHECK
CELL CLEAN
MASKER RESPIRATOR
HYPAFIX
PIPET TETES
THERMAROL
NOVOMIX PENFLEX
ISONIAZID TAB 30 MG
lipid panel test
alkohol swab
lysol
CELL PACK
STOMALYZER
JARUM AUTO CLICK
ALAT SUNTIK 0.05ML
ALAT SUNTIK 0.5ML
ANTRAIN INJ
AQUA GEL
ARTEM INJ
CITICOLLIN INJ
DIAMOND BOOR SET M
DIAMOND BOOR SET S
FEEDING TUBE
FISURE LANCIP LONG
KANDISTATIN
388
389
390
391
392
393
394
395
396


SUAB TENGGOROKAN
MINIOCEP
PENGELUARAN OBAT DARI GUDANG OBAT KE PELAYANAN

BULAN JANUARI 2016
KEMASAN
TANGGAL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
BUNGKUS
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
KAPSUL
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
AMPUL
VIAL
AMPUL
VIAL
AMPUL
AMPUL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
BOTOL
BOTOL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
VIAL
VIAL
AMPUL
AMPUL
BOTOL
VIAL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
VIAL
VIAL
VIAL
VIAL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
VIAL
BOTOL
TUBE
TUBE
TUBE
SUPP
SUPP
TUBE
BOTOL
BOTOL
TUBE
BOTOL
BOTOL
TUBE
TUBE
BOTOL
BOTOL
TUBE
TUBE
TUBE
POT
KOTAK
BOTOL
TUBE
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
KOTAK
KOTAK
KOTAK
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
BOTOL
SET
BUNGKUS
BUNGKUS
BUNGKUS
ROLL
ROLL
ROLL
ROLL
ROLL
KOTAK
ROLL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
SET
SET
BOTOL
ROLL
SET
SET
SET
PCS
BOTOL
SET
SET
SET
SET
ROLL
BOTOL
SET
SET
SET
BOTOL
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
BOTOL
PCS
SET
SET
SET
SET
SET
SET
BOTOL
SET
SET
BOTOL
PCS
BOTOL
BOTOL
SET
SET
SET
SET
SET
ROLL
BOTOL
BOTOL
BUNGKUS
SET
SET
KOTAK
BOTOL
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
TABLET
PCS
KOTAK
PCS
PCS
BOTOL
KOTAK
SET
BOTOL
TUBE
PCS
PCS
PCS
VIAL
BOTOL
VIAL
VIAL
SET
SET
TUBE
PCS
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
PCS
BOTOL
ANAN
10
11

12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
NAMA
PUSTU
NAMA
PUSTU
NAMA
PUSTU
NAMA
PUSTU
NAMA
POLINDES

NAMA
NAMA
POLINDES POLINDES
NAMA
POLINDES
JUMLAH
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
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
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
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
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
LAPORAN PEMA
KODE PUSKESMAS
PUSKESMAS
KECAMATAN
KABUPATEN / KOTA
:
:
NO
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
NAMA OBAT

AMBROXOL TAB. 30 MG
AMLODIPIN 10 MG
AMLODIPIN 5 MG
BETAHISTIN MALEAT
CLOBAZAM TAB 10 MG
CLOPIDOGREL 75 MG
CO AMOXICLAV 625 MG
DIAZEPAM TABLET 2MG
DOKSISIKLIN 100 MG
ERYTROMISIN 250 MG
ERYTROMISIN 500 MG
PUSKESMAS
KECAMATAN
43
44
45
46
47
49
50
48
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
FUROSEMID TAB.40 MG
HALOPERIDOL 2 MG
KAPTOPRIL 12,5 MG
KAPTOPRIL 25 MG
KAPTOPRIL 50 MG
KLINDAMSIN 150 MG
LOPERAMIDE HCL 2 MG
METFORMIN 500 MG
METOKLOPRAMID 10 MG
MULTIVITAMIN TABLET
NIFEDIPINE 10 MG
OMEPRAZOL KAP 20 MG
PUSKESMAS
KECAMATAN
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124

PIROXICAM 10 MG
PIROXICAM 20 MG
PREDNISON TAB.5 MG
PRIMAKUIN TAB.15 MG
RIFAMPICIN 450 MG
RIFAMPICIN 600 MG
RISPERIDON TAB 2 MG
SALBUTAMOL 4 MG
SIMETIDIN TABLET
THROMBO ASPILETS
TRIFLUOPERAZIN 5 MG
ZINC TABLET
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141

BISOLVON DROP
CITRIZINE SYRUP
ERYTROMISIN SYRUP
HALOPERIDOL DROP
IBUPROFEN SUSPENSI
PARASETAMOL DROP
THIAMFENICOL SYR
ZINK DROP
ZINK SYRUP
PUSKESMAS
KECAMATAN
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191

AQUA PRO INJEKSI
ASAM TRANEXAMAT INJ
D5 + 1/4 NS
DOPAMIN INJ
ETANOL 70 %
EUGENOL CAIRAN
FUROSEMID INJ 10 ML
HALOPERIDOL INJEKSI
LIDOKAIN INJ. 2%
MENADION K3 INJ
PEHACAIN INJ
PIRACETAM INJ 1 GR
SEFTRIAXON INJ
PUSKESMAS
KECAMATAN
192
193
194

VENTOLIN NEBU
195
196
197
198
199
200
201
202
203
204
205
206
207
208
209
210
211
212
213
214
215
216
217
ALBOTHYL
ASIKLOVIR KRIM
MIKONAZOLE SALEP
SALEP 2-4 KOMB.
SALISIL BEDAK 2 %
SCABIMITE KRIM
218
219
220
221
222
223
224
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239

BLOOD LANCET
BOX SLIDE
INFUS SET ANAK
PUSKESMAS
KECAMATAN
240
241
242
243
244
245
246
247
248
249
250
251
252
253
254
255
256
257
258
259
260
261
262
263
264
265
266
267
268
269
270
271
272
273
274
275
276
277
278
279
280
281
282
283
284
285
286
287
288
289
INFUS SET DEWASA

IV CATHETER NO. 18
IV CATHETER NO. 20
IV CATHETER NO. 22
IV CATHETER NO. 24
IV CATHETER NO. 26
JARUM KULIT
JARUM OTOT
KACA SLIDE
KAPAS 1 KG
KERTAS EKG
LARUTAN ANISOL
LARUTAN BENEDICT
LARUTAN EDTA 100 ml
LARUTAN EOSIN 2 %
LARUTAN ETANOL ASAM
LARUTAN H2O2
LARUTAN HCL 0,1 N
LARUTAN HAYEM
LARUTAN METANOL
LARUTAN TURK
MASKER KARET
MASKER TALI
MINYAK IMERSI
NEEDLE 23
NEEDLE 24
NELATON CATHETHER
PUSKESMAS
KECAMATAN
290
291
292
293
294
295
296
297
298
299
300
301
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320
321
322
323
324
325
326
327
328
329
330
331
332
333
334
PENJEPIT TALI PUSAT

PROPILEN GLIKOL
RAPID TES PROTEIN
RDT TYPUS
RDT HIV/AIDS
REESECHER
SELANG OKSIGEN ANAK
SELANG OKSIGEN BAYI
TEST DENGUE DEVICE
TEST HBsAG STRIP
TEST HCG STRIP
TEST MALARIA DEVICE
THREE WAY
TRANFUSI SET
UNDERPAD
URINAL PRIA
URINAL WANITA
URINE BAG
VASELIN
WING NEEDLE 23
WING NEEDLE 27
ARTICULATING PAPER
BONDING SINGLE BOND
CAVITON ATFLETCHER
CELLULOID STRIP
ETCHING
FUJI 9 ART (MINI)
FUJI II LC
FUJI IX GC
FUJI IX GP
FUJI VII GC WHITE
MICRO BRUSH
OCHO
SALIVA EJECTOR
ORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT PUSKESMAS

BULAN
TAHUN
SATUAN /
KEMASAN
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
KAPSUL
TABLET
TABLET
STOK
AWAL
PENERIMAAN
PERSEDIAAN
PEMAKAIAN
TAHUN
TABLET
BUNGKUS
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TAHUN
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
KAPSUL
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
TAHUN
AMPUL
VIAL
AMPUL
VIAL
AMPUL
AMPUL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
BOTOL
BOTOL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
VIAL
VIAL
AMPUL
AMPUL
BOTOL
VIAL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
VIAL
VIAL
VIAL
VIAL
AMPUL
AMPUL
AMPUL
TAHUN
AMPUL
AMPUL
VIAL
BOTOL
TUBE
TUBE
TUBE
SUPP
SUPP
TUBE
BOTOL
BOTOL
TUBE
BOTOL
BOTOL
TUBE
TUBE
BOTOL
BOTOL
TUBE
TUBE
TUBE
POT
KOTAK
BOTOL
TUBE
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
KOTAK
KOTAK
KOTAK
SET
SET
SET
SET
SET
TAHUN
SET
SET
SET
SET
SET
SET
SET
SET
BOTOL
SET
BUNGKUS
BUNGKUS
BUNGKUS
ROLL
ROLL
ROLL
ROLL
ROLL
KOTAK
ROLL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
SET
SET
BOTOL
ROLL
SET
SET
SET
PCS
BOTOL
SET
SET
SET
TAHUN
SET
ROLL
BOTOL
SET
SET
SET
BOTOL
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
BOTOL
PCS
SET
SET
SET
SET
SET
SET
BOTOL
SET
SET
BOTOL
PCS
BOTOL
BOTOL
SET
SET
SET
SET
SET
ROLL
BOTOL
BOTOL
BUNGKUS
AS
Terima
No. Dok
Input
B.A
STOK
OPT
SISA STOK
PERMINTAAN
PEMBERIAN
KETERANGAN
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
No. Dok
Input
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
No. Dok
Input
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
No. Dok
Input
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
No. Dok
Input
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
No. Dok
Input
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
No. Dok
Input
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
#VALUE!
-
LAPORAN PENGGUNAAN
NAMA PUSKESMAS
ALAMAT
TELP
:
:
:
NO
NAMA OBAT
SATUAN
1
2
3
4
5
6
7
8
9
10

CLOBAZAM TAB 10 MG
DIAZEPAM TABLET 2MG
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
AMPUL
AMPUL
Kepala Puskesmas .
..
NIP. .
PORAN PENGGUNAAN OBAT PSIKOTROPIKA
BULAN
TAHUN
SALDO
AWAL
PEMASUKAN
DARI
JUMLAH
PENGGUNAAN
UNTUK
7
0
0
0
0
0
0
0
0
Penanggung Jawab
..
NIP. .
:
:
PENGGUNAAN
JUMLAH
8
0
0
0
0
0
0
0
0
Penanggung Jawab
..
NIP. .
SALDO
AKHIR
9
NO
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
49
50
48
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
200
201
202
203
204
205
206
207
208
209
210
211
212
213
214
215
216
217
218
219
220
221
222
223
224
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239
240
241
242
243
244
245
246
247
248
249
250
251
252
253
254
255
256
257
258
259
260
261
262
263
264
265
266
267
268
269
270
271
272
273
274
275
276
277
278
279
280
281
282
283
284
285
286
287
288
289
290
291
292
293
294
295
296
297
298
299
300
301
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320
321
322
323
324
325
326
327
328
329
330
331
332
333
334
335
336
337
338
339
340
341
342
343
344
345
346
347
348
349
350
351
352
353
354
355
356
357
358
359
360
361
362
363
364
365
366
367
368
369
370
371
372
373
374
375
376
377
378
379
380
381
382
383
384
385
386
387
388
389
390
391
392
393
394
395
396
NAMA OBAT-OBATAN

AMBROXOL TAB. 30 MG
AMLODIPIN 10 MG
AMLODIPIN 5 MG
BETAHISTIN MALEAT
CLOBAZAM TAB 10 MG
CLOPIDOGREL 75 MG
CO AMOXICLAV 625 MG
DIAZEPAM TABLET 2MG
DOKSISIKLIN 100 MG

ERYTROMISIN 250 MG
ERYTROMISIN 500 MG
FUROSEMID TAB.40 MG
HALOPERIDOL 2 MG
KAPTOPRIL 12,5 MG
KAPTOPRIL 25 MG
KAPTOPRIL 50 MG
KLINDAMSIN 150 MG
LOPERAMIDE HCL 2 MG
METFORMIN 500 MG

METOKLOPRAMID 10 MG
MULTIVITAMIN TABLET
NIFEDIPINE 10 MG
OMEPRAZOL KAP 20 MG
PIROXICAM 10 MG
PIROXICAM 20 MG
PREDNISON TAB.5 MG
PRIMAKUIN TAB.15 MG
RIFAMPICIN 450 MG
RIFAMPICIN 600 MG
RISPERIDON TAB 2 MG
SALBUTAMOL 4 MG
SIMETIDIN TABLET
THROMBO ASPILETS
TRIFLUOPERAZIN 5 MG
ZINC TABLET
BISOLVON DROP
CITRIZINE SYRUP
ERYTROMISIN SYRUP
HALOPERIDOL DROP
IBUPROFEN SUSPENSI
PARASETAMOL DROP
THIAMFENICOL SYR
ZINK DROP
ZINK SYRUP
AQUA PRO INJEKSI
ASAM TRANEXAMAT INJ
D5 + 1/4 NS
DOPAMIN INJ
ETANOL 70 %
EUGENOL CAIRAN
FUROSEMID INJ 10 ML

HALOPERIDOL INJEKSI
LIDOKAIN INJ. 2%
MENADION K3 INJ
PEHACAIN INJ
PIRACETAM INJ 1 GR
SEFTRIAXON INJ
VENTOLIN NEBU
ALBOTHYL
ASIKLOVIR KRIM

MIKONAZOLE SALEP
SALEP 2-4 KOMB.
SALISIL BEDAK 2 %
SCABIMITE KRIM
BISTURI NO. 12
BLOOD LANCET
BOX SLIDE
INFUS SET ANAK
INFUS SET DEWASA
IV CATHETER NO. 18
IV CATHETER NO. 20
IV CATHETER NO. 22
IV CATHETER NO. 24
IV CATHETER NO. 26
JARUM KULIT
JARUM OTOT
KACA SLIDE
KAPAS 1 KG
KERTAS EKG
LARUTAN ANISOL
LARUTAN BENEDICT
LARUTAN EDTA 100 ml
LARUTAN EOSIN 2 %
LARUTAN ETANOL ASAM
LARUTAN H2O2
LARUTAN HCL 0,1 N
LARUTAN HAYEM
LARUTAN METANOL
LARUTAN TURK
MASKER KARET
MASKER TALI
MINYAK IMERSI
NEEDLE 23
NEEDLE 24
NELATON CATHETHER
PENJEPIT TALI PUSAT
PROPILEN GLIKOL
RAPID TES PROTEIN
RDT TYPUS
RDT HIV/AIDS
REESECHER
SELANG OKSIGEN ANAK
SELANG OKSIGEN BAYI
TEST DENGUE DEVICE
TEST HBsAG STRIP
TEST HCG STRIP
TEST MALARIA DEVICE
THREE WAY
TRANFUSI SET
UNDERPAD
URINAL PRIA
URINAL WANITA
URINE BAG
VASELIN
WING NEEDLE 23
WING NEEDLE 27
ARTICULATING PAPER
BONDING SINGLE BOND
CAVITON ATFLETCHER
CELLULOID STRIP
ETCHING
FUJI 9 ART (MINI)
FUJI II LC
FUJI IX GC
FUJI IX GP
FUJI VII GC WHITE
MICRO BRUSH
OCHO
SALIVA EJECTOR
AMINOFLUID
ASERING
VERAPAMIL 50 MG
BISOPPROLOL TAB 5MG
DILTIAZEM
ASAM FOLAT 1 MG
SULFASALAZINE
GLICLAZID
IRBESARTAN
GEMFIBROZIL
AMIODARON
GLIMEPIRID
MELOXICAM 15
KODEIN TABLET
COMBIVEN NEBU
CLEVER CHECK
CELL CLEAN
MASKER RESPIRATOR
HYPAFIX
PIPET TETES
THERMAROL
NOVOMIX PENFLEX
ISONIAZID TAB 30 MG
lipid panel test
alkohol swab
lysol
CELL PACK
STOMALYZER
JARUM AUTO CLICK
ALAT SUNTIK 0.05ML

ALAT SUNTIK 0.5ML
ANTRAIN INJ
AQUA GEL
ARTEM INJ
CITICOLLIN INJ
DIAMOND BOOR SET M
DIAMOND BOOR SET S
FEEDING TUBE
FISURE LANCIP LONG
KANDISTATIN

SUAB TENGGOROKAN
MINIOCEP
PENGELUARAN OBAT DARI GUDANG OBAT KE PELAYA

BULAN JANUARI 2016
KEMASAN
TANGGAL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
BUNGKUS
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
KAPSUL
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
AMPUL
VIAL
AMPUL
VIAL
AMPUL
AMPUL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
BOTOL
BOTOL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
VIAL
VIAL
AMPUL
AMPUL
BOTOL
VIAL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
VIAL
VIAL
VIAL
VIAL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
VIAL
BOTOL
TUBE
TUBE
TUBE
SUPP
SUPP
TUBE
BOTOL
BOTOL
TUBE
BOTOL
BOTOL
TUBE
TUBE
BOTOL
BOTOL
TUBE
TUBE
TUBE
POT
KOTAK
BOTOL
TUBE
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
KOTAK
KOTAK
KOTAK
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
BOTOL
SET
BUNGKUS
BUNGKUS
BUNGKUS
ROLL
ROLL
ROLL
ROLL
ROLL
KOTAK
ROLL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
SET
SET
BOTOL
ROLL
SET
SET
SET
PCS
BOTOL
SET
SET
SET
SET
ROLL
BOTOL
SET
SET
SET
BOTOL
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
BOTOL
PCS
SET
SET
SET
SET
SET
SET
BOTOL
SET
SET
BOTOL
PCS
BOTOL
BOTOL
SET
SET
SET
SET
SET
ROLL
BOTOL
BOTOL
BUNGKUS
SET
SET
KOTAK
BOTOL
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
TABLET
PCS
KOTAK
PCS
PCS
BOTOL
KOTAK
SET
BOTOL
TUBE
PCS
PCS
PCS
VIAL
BOTOL
VIAL
VIAL
SET
SET
TUBE
PCS
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
PCS
BOTOL
T KE PELAYANAN

10
11
12
13
14
15
/ HARI
16
17
18
19
20
21
22
23
24
25
26
27
28
29
PENGELU
30
31
NAMA
PUSTU
NAMA
PUSTU
NAMA
PUSTU
NAMA
PUSTU
NAMA
POLINDES

NAMA
NAMA
POLINDES POLINDES
NAMA
POLINDES
JUMLAH
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
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
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
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
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
LAPORAN PEMA
KODE PUSKESMAS
PUSKESMAS
KECAMATAN
KABUPATEN / KOTA
:
:
NO
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
NAMA OBAT

AMBROXOL TAB. 30 MG
AMLODIPIN 10 MG
AMLODIPIN 5 MG
BETAHISTIN MALEAT
CLOBAZAM TAB 10 MG
CLOPIDOGREL 75 MG
CO AMOXICLAV 625 MG
DIAZEPAM TABLET 2MG
DOKSISIKLIN 100 MG
ERYTROMISIN 250 MG
ERYTROMISIN 500 MG
SATUAN /
KEMASAN
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
PUSKESMAS
KECAMATAN
40
41
42
43
44
45
46
47
49
50
48
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85

FUROSEMID TAB.40 MG
HALOPERIDOL 2 MG
KAPTOPRIL 12,5 MG
KAPTOPRIL 25 MG
KAPTOPRIL 50 MG
KLINDAMSIN 150 MG
LOPERAMIDE HCL 2 MG
METFORMIN 500 MG
METOKLOPRAMID 10 MG
MULTIVITAMIN TABLET
KAPSUL
TABLET
TABLET
TABLET
BUNGKUS
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
PUSKESMAS
KECAMATAN
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
NIFEDIPINE 10 MG
OMEPRAZOL KAP 20 MG
PIROXICAM 10 MG
PIROXICAM 20 MG
PREDNISON TAB.5 MG
PRIMAKUIN TAB.15 MG
RIFAMPICIN 450 MG
RIFAMPICIN 600 MG
RISPERIDON TAB 2 MG
SALBUTAMOL 4 MG
SIMETIDIN TABLET
THROMBO ASPILETS
TRIFLUOPERAZIN 5 MG
ZINC TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
KAPSUL
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
125
126
127
128
129
130

BISOLVON DROP
CITRIZINE SYRUP
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
PUSKESMAS
KECAMATAN
131
132
133
134
135
136
137
138
139
140
141
ERYTROMISIN SYRUP
HALOPERIDOL DROP
IBUPROFEN SUSPENSI
PARASETAMOL DROP
THIAMFENICOL SYR
ZINK DROP
ZINK SYRUP
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175

AQUA PRO INJEKSI
ASAM TRANEXAMAT INJ
D5 + 1/4 NS
DOPAMIN INJ
ETANOL 70 %
EUGENOL CAIRAN
FUROSEMID INJ 10 ML
HALOPERIDOL INJEKSI
LIDOKAIN INJ. 2%
MENADION K3 INJ
AMPUL
VIAL
AMPUL
VIAL
AMPUL
AMPUL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
BOTOL
BOTOL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
VIAL
VIAL
AMPUL
AMPUL
PUSKESMAS
KECAMATAN
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194

PEHACAIN INJ
PIRACETAM INJ 1 GR
SEFTRIAXON INJ
VENTOLIN NEBU
BOTOL
VIAL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
VIAL
VIAL
VIAL
VIAL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
VIAL
195
196
197
198
199
200
201
202
203
204
205
206
207
208
209
210
211
212
213
214
215
216
217
ALBOTHYL
ASIKLOVIR KRIM
MIKONAZOLE SALEP
SALEP 2-4 KOMB.
SALISIL BEDAK 2 %
SCABIMITE KRIM
BOTOL
TUBE
TUBE
TUBE
SUPP
SUPP
TUBE
BOTOL
BOTOL
TUBE
BOTOL
BOTOL
TUBE
TUBE
BOTOL
BOTOL
TUBE
TUBE
TUBE
POT
KOTAK
BOTOL
TUBE
218
219

SET
SET
PUSKESMAS
KECAMATAN
220
221
222
223
224
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239
240
241
242
243
244
245
246
247
248
249
250
251
252
253
254
255
256
257
258
259
260
261
262
263
264
265

BLOOD LANCET
BOX SLIDE
INFUS SET ANAK
INFUS SET DEWASA
IV CATHETER NO. 18
IV CATHETER NO. 20
IV CATHETER NO. 22
IV CATHETER NO. 24
IV CATHETER NO. 26
JARUM KULIT
JARUM OTOT
KACA SLIDE
KAPAS 1 KG
KERTAS EKG
LARUTAN ANISOL
LARUTAN BENEDICT
LARUTAN EDTA 100 ml
LARUTAN EOSIN 2 %
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
KOTAK
KOTAK
KOTAK
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
BOTOL
SET
BUNGKUS
BUNGKUS
BUNGKUS
ROLL
ROLL
ROLL
ROLL
ROLL
KOTAK
ROLL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
PUSKESMAS
KECAMATAN
266
267
268
269
270
271
272
273
274
275
276
277
278
279
280
281
282
283
284
285
286
287
288
289
290
291
292
293
294
295
296
297
298
299
300
301
302
303
304
305
306
307
LARUTAN ETANOL ASAM

LARUTAN H2O2
LARUTAN HCL 0,1 N
LARUTAN HAYEM
LARUTAN METANOL
LARUTAN TURK
MASKER KARET
MASKER TALI
MINYAK IMERSI
NEEDLE 23
NEEDLE 24
NELATON CATHETHER
PENJEPIT TALI PUSAT
PROPILEN GLIKOL
RAPID TES PROTEIN
RDT TYPUS
RDT HIV/AIDS
REESECHER
SELANG OKSIGEN ANAK
SELANG OKSIGEN BAYI
TEST DENGUE DEVICE
TEST HBsAG STRIP
TEST HCG STRIP
TEST MALARIA DEVICE
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
SET
SET
BOTOL
ROLL
SET
SET
SET
PCS
BOTOL
SET
SET
SET
SET
ROLL
BOTOL
SET
SET
SET
BOTOL
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
APORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT PUSKESMAS

BULAN
TAHUN
STOK
AWAL
PENERIMAAN
PERSEDIAAN
PEMAKAIAN
SISA STOK
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
TAHUN
-
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
TAHUN
-
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
TAHUN
-
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
TAHUN
-
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
TAHUN
-
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
TAHUN
-
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
TAAN OBAT PUSKESMAS

Terima
No. Dok
Input
B.A
STOK
OPT
PERMINTAAN
-
No. Dok
Input
-
No. Dok
Input
-
No. Dok
Input
-
No. Dok
Input
-
No. Dok
Input
-
No. Dok
Input
-
LAPORAN PENGGUNAAN OB
NAMA PUSKESMAS
ALAMAT
TELP
:
:
:
NO
NAMA OBAT
SATUAN
1
2
3
4
5
6
7
8
9
10

CLOBAZAM TAB 10 MG
DIAZEPAM TABLET 2MG
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
AMPUL
AMPUL
Kepala Puskesmas .
..
NIP. .
RAN PENGGUNAAN OBAT PSIKOTROPIKA
BULAN
TAHUN
SALDO
AWAL
PEMASUKAN
DARI
JUMLAH
PENGGUNAAN
UNTUK
7
0
0
0
0
0
0
0
0
Penanggung Jawab
..
NIP. .
:
:
PENGGUNAAN
JUMLAH
8
0
0
0
0
0
0
0
0
Penanggung Jawab
..
NIP. .
SALDO
AKHIR
9
NO
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
49
50
48
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
200
201
202
203
204
205
206
207
208
209
210
211
212
213
214
215
216
217
218
219
220
221
222
223
224
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239
240
241
242
243
244
245
246
247
248
249
250
251
252
253
254
255
256
257
258
259
260
261
262
263
264
265
266
267
268
269
270
271
272
273
274
275
276
277
278
279
280
281
282
283
284
285
286
287
288
289
290
291
292
293
294
295
296
297
298
299
300
301
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320
321
322
323
324
325
326
327
328
329
330
331
332
333
334
335
336
337
338
339
340
341
342
343
344
345
346
347
348
349
350
351
352
353
354
355
356
357
358
359
360
361
362
363
364
365
366
367
368
369
370
371
372
373
374
375
376
377
378
379
380
381
382
383
384
385
386
387
388
389
390
391
392
393
394
395
396
NAMA OBAT-OBATAN

AMBROXOL TAB. 30 MG
AMLODIPIN 10 MG
AMLODIPIN 5 MG
BETAHISTIN MALEAT
CLOBAZAM TAB 10 MG
CLOPIDOGREL 75 MG
CO AMOXICLAV 625 MG
DIAZEPAM TABLET 2MG
DOKSISIKLIN 100 MG

ERYTROMISIN 250 MG
ERYTROMISIN 500 MG
FUROSEMID TAB.40 MG
HALOPERIDOL 2 MG
KAPTOPRIL 12,5 MG
KAPTOPRIL 25 MG
KAPTOPRIL 50 MG
KLINDAMSIN 150 MG
LOPERAMIDE HCL 2 MG
METFORMIN 500 MG

METOKLOPRAMID 10 MG
MULTIVITAMIN TABLET
NIFEDIPINE 10 MG
OMEPRAZOL KAP 20 MG
PIROXICAM 10 MG
PIROXICAM 20 MG
PREDNISON TAB.5 MG
PRIMAKUIN TAB.15 MG
RIFAMPICIN 450 MG
RIFAMPICIN 600 MG
RISPERIDON TAB 2 MG
SALBUTAMOL 4 MG
SIMETIDIN TABLET
THROMBO ASPILETS
TRIFLUOPERAZIN 5 MG
ZINC TABLET
BISOLVON DROP
CITRIZINE SYRUP
ERYTROMISIN SYRUP
HALOPERIDOL DROP
IBUPROFEN SUSPENSI
PARASETAMOL DROP
THIAMFENICOL SYR
ZINK DROP
ZINK SYRUP
AQUA PRO INJEKSI
ASAM TRANEXAMAT INJ
D5 + 1/4 NS
DOPAMIN INJ
ETANOL 70 %
EUGENOL CAIRAN
FUROSEMID INJ 10 ML

HALOPERIDOL INJEKSI
LIDOKAIN INJ. 2%
MENADION K3 INJ
PEHACAIN INJ
PIRACETAM INJ 1 GR
SEFTRIAXON INJ
VENTOLIN NEBU
ALBOTHYL
ASIKLOVIR KRIM

MIKONAZOLE SALEP
SALEP 2-4 KOMB.
SALISIL BEDAK 2 %
SCABIMITE KRIM
BISTURI NO. 12
BLOOD LANCET
BOX SLIDE
INFUS SET ANAK
INFUS SET DEWASA
IV CATHETER NO. 18
IV CATHETER NO. 20
IV CATHETER NO. 22
IV CATHETER NO. 24
IV CATHETER NO. 26
JARUM KULIT
JARUM OTOT
KACA SLIDE
KAPAS 1 KG
KERTAS EKG
LARUTAN ANISOL
LARUTAN BENEDICT
LARUTAN EDTA 100 ml
LARUTAN EOSIN 2 %
LARUTAN ETANOL ASAM
LARUTAN H2O2
LARUTAN HCL 0,1 N
LARUTAN HAYEM
LARUTAN METANOL
LARUTAN TURK
MASKER KARET
MASKER TALI
MINYAK IMERSI
NEEDLE 23
NEEDLE 24
NELATON CATHETHER
PENJEPIT TALI PUSAT
PROPILEN GLIKOL
RAPID TES PROTEIN
RDT TYPUS
RDT HIV/AIDS
REESECHER
SELANG OKSIGEN ANAK
SELANG OKSIGEN BAYI
TEST DENGUE DEVICE
TEST HBsAG STRIP
TEST HCG STRIP
TEST MALARIA DEVICE
THREE WAY
TRANFUSI SET
UNDERPAD
URINAL PRIA
URINAL WANITA
URINE BAG
VASELIN
WING NEEDLE 23
WING NEEDLE 27
ARTICULATING PAPER
BONDING SINGLE BOND
CAVITON ATFLETCHER
CELLULOID STRIP
ETCHING
FUJI 9 ART (MINI)
FUJI II LC
FUJI IX GC
FUJI IX GP
FUJI VII GC WHITE
MICRO BRUSH
OCHO
SALIVA EJECTOR
AMINOFLUID
ASERING
VERAPAMIL 50 MG
BISOPPROLOL TAB 5MG
DILTIAZEM
ASAM FOLAT 1 MG
SULFASALAZINE
GLICLAZID
IRBESARTAN
GEMFIBROZIL
AMIODARON
GLIMEPIRID
MELOXICAM 15
KODEIN TABLET
COMBIVEN NEBU
CLEVER CHECK
CELL CLEAN
MASKER RESPIRATOR
HYPAFIX
PIPET TETES
THERMAROL
NOVOMIX PENFLEX
ISONIAZID TAB 30 MG
lipid panel test
alkohol swab
lysol
CELL PACK
STOMALYZER
JARUM AUTO CLICK
ALAT SUNTIK 0.05ML

ALAT SUNTIK 0.5ML
ANTRAIN INJ
AQUA GEL
ARTEM INJ
CITICOLLIN INJ
DIAMOND BOOR SET M
DIAMOND BOOR SET S
FEEDING TUBE
FISURE LANCIP LONG
KANDISTATIN

SUAB TENGGOROKAN
MINIOCEP

BULAN JANUARI 2016
KEMASAN
TANGGAL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
BUNGKUS
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
KAPSUL
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
AMPUL
VIAL
AMPUL
VIAL
AMPUL
AMPUL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
BOTOL
BOTOL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
VIAL
VIAL
AMPUL
AMPUL
BOTOL
VIAL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
VIAL
VIAL
VIAL
VIAL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
VIAL
BOTOL
TUBE
TUBE
TUBE
SUPP
SUPP
TUBE
BOTOL
BOTOL
TUBE
BOTOL
BOTOL
TUBE
TUBE
BOTOL
BOTOL
TUBE
TUBE
TUBE
POT
KOTAK
BOTOL
TUBE
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
KOTAK
KOTAK
KOTAK
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
BOTOL
SET
BUNGKUS
BUNGKUS
BUNGKUS
ROLL
ROLL
ROLL
ROLL
ROLL
KOTAK
ROLL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
SET
SET
BOTOL
ROLL
SET
SET
SET
PCS
BOTOL
SET
SET
SET
SET
ROLL
BOTOL
SET
SET
SET
BOTOL
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
BOTOL
PCS
SET
SET
SET
SET
SET
SET
BOTOL
SET
SET
BOTOL
PCS
BOTOL
BOTOL
SET
SET
SET
SET
SET
ROLL
BOTOL
BOTOL
BUNGKUS
SET
SET
KOTAK
BOTOL
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
TABLET
PCS
KOTAK
PCS
PCS
BOTOL
KOTAK
SET
BOTOL
TUBE
PCS
PCS
PCS
VIAL
BOTOL
VIAL
VIAL
SET
SET
TUBE
PCS
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
PCS
BOTOL
T KE PELAYANAN

10
11
12
13
14
15
N / HARI
16
17
18
19
20
21
22
23
24
25
26
27
28
29
PENGELU
30
31
NAMA
PUSTU
NAMA
PUSTU
NAMA
PUSTU
NAMA
PUSTU
NAMA
POLINDES

NAMA
NAMA
POLINDES POLINDES
NAMA
POLINDES
JUMLAH
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
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
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
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
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
LAPORAN PE
KODE PUSKESMAS
PUSKESMAS
KECAMATAN
KABUPATEN / KOTA
:
:
NO
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
NAMA OBAT

AMBROXOL TAB. 30 MG
AMLODIPIN 10 MG
AMLODIPIN 5 MG
BETAHISTIN MALEAT
CLOBAZAM TAB 10 MG
CLOPIDOGREL 75 MG
CO AMOXICLAV 625 MG
DIAZEPAM TABLET 2MG
DOKSISIKLIN 100 MG
ERYTROMISIN 250 MG
ERYTROMISIN 500 MG
40
41
42
43
44
45
46
47
49
50
48
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88

FUROSEMID TAB.40 MG
HALOPERIDOL 2 MG
KAPTOPRIL 12,5 MG
KAPTOPRIL 25 MG
KAPTOPRIL 50 MG
KLINDAMSIN 150 MG
LOPERAMIDE HCL 2 MG
METFORMIN 500 MG
METOKLOPRAMID 10 MG
MULTIVITAMIN TABLET
NIFEDIPINE 10 MG
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
OMEPRAZOL KAP 20 MG
PIROXICAM 10 MG
PIROXICAM 20 MG
PREDNISON TAB.5 MG
PRIMAKUIN TAB.15 MG
RIFAMPICIN 450 MG
RIFAMPICIN 600 MG
RISPERIDON TAB 2 MG
SALBUTAMOL 4 MG
SIMETIDIN TABLET
THROMBO ASPILETS
TRIFLUOPERAZIN 5 MG
ZINC TABLET
125
126
127
128
129
130
131
132
133
134
135
136

BISOLVON DROP
CITRIZINE SYRUP
ERYTROMISIN SYRUP
HALOPERIDOL DROP
IBUPROFEN SUSPENSI
137
138
139
140
141
PARASETAMOL DROP
THIAMFENICOL SYR
ZINK DROP
ZINK SYRUP
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184

AQUA PRO INJEKSI
ASAM TRANEXAMAT INJ
D5 + 1/4 NS
DOPAMIN INJ
ETANOL 70 %
EUGENOL CAIRAN
FUROSEMID INJ 10 ML
HALOPERIDOL INJEKSI
LIDOKAIN INJ. 2%
MENADION K3 INJ
PEHACAIN INJ
PIRACETAM INJ 1 GR
185
186
187
188
189
190
192
193
194

SEFTRIAXON INJ
VENTOLIN NEBU
195
196
197
198
199
200
201
202
203
204
205
206
207
208
209
210
211
212
213
214
215
216
217
ALBOTHYL
ASIKLOVIR KRIM
MIKONAZOLE SALEP
SALEP 2-4 KOMB.
SALISIL BEDAK 2 %
SCABIMITE KRIM
218
219
220
221
222
223
224
225
226
227
228
229
230
231
232

BLOOD LANCET
BOX SLIDE
233
234
235
236
237
238
239
240
241
242
243
244
245
246
247
248
249
250
251
252
253
254
255
256
257
258
259
260
261
262
263
264
265
266
267
268
269
270
271
272
273
274
275
276
277
278
279
280
281

INFUS SET ANAK
INFUS SET DEWASA
IV CATHETER NO. 18
IV CATHETER NO. 20
IV CATHETER NO. 22
IV CATHETER NO. 24
IV CATHETER NO. 26
JARUM KULIT
JARUM OTOT
KACA SLIDE
KAPAS 1 KG
KERTAS EKG
LARUTAN ANISOL
LARUTAN BENEDICT
LARUTAN EDTA 100 ml
LARUTAN EOSIN 2 %
LARUTAN ETANOL ASAM
LARUTAN H2O2
LARUTAN HCL 0,1 N
LARUTAN HAYEM
LARUTAN METANOL
LARUTAN TURK
282
283
284
285
286
287
288
289
290
291
292
293
294
295
296
297
298
299
300
301
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320
321
322
323
324
325
326
327
328
329
330

MASKER KARET
MASKER TALI
MINYAK IMERSI
NEEDLE 23
NEEDLE 24
NELATON CATHETHER
PENJEPIT TALI PUSAT
PROPILEN GLIKOL
RAPID TES PROTEIN
RDT TYPUS
RDT HIV/AIDS
REESECHER
SELANG OKSIGEN ANAK
SELANG OKSIGEN BAYI
TEST DENGUE DEVICE
TEST HBsAG STRIP
TEST HCG STRIP
TEST MALARIA DEVICE
THREE WAY
TRANFUSI SET
UNDERPAD
URINAL PRIA
URINAL WANITA
URINE BAG
VASELIN
WING NEEDLE 23
WING NEEDLE 27
ARTICULATING PAPER
BONDING SINGLE BOND
CAVITON ATFLETCHER
CELLULOID STRIP
ETCHING
FUJI 9 ART (MINI)
FUJI II LC
FUJI IX GC
FUJI IX GP
FUJI VII GC WHITE
331
332
333
334
335
336
337
338
339
340
341
342
343
344
345
346
347
348
349
350
351
352
353
354
355
356
357
358
359
360
361
362
363
364
365
366
367
368
369
370
371
372
373
374
375
376
377
378
379

MICRO BRUSH
OCHO
SALIVA EJECTOR
AMINOFLUID
ASERING
VERAPAMIL 50 MG
BISOPPROLOL TAB 5MG
DILTIAZEM
ASAM FOLAT 1 MG
SULFASALAZINE
GLICLAZID
IRBESARTAN
GEMFIBROZIL
AMIODARON
GLIMEPIRID
MELOXICAM 15
KODEIN TABLET
COMBIVEN NEBU
CLEVER CHECK
CELL CLEAN
MASKER RESPIRATOR
HYPAFIX
PIPET TETES
THERMAROL
NOVOMIX PENFLEX
ISONIAZID TAB 30 MG
lipid panel test
alkohol swab
lysol
CELL PACK
STOMALYZER
JARUM AUTO CLICK
ALAT SUNTIK 0.05ML
ALAT SUNTIK 0.5ML
ANTRAIN INJ
AQUA GEL
ARTEM INJ
380
381
382
383
384
385
386
387
388
389
390
391
392
393
394
395
396
CITICOLLIN INJ
DIAMOND BOOR SET M
DIAMOND BOOR SET S
FEEDING TUBE
FISURE LANCIP LONG
KANDISTATIN
LARUTAN SALMONELLA
LARUTAN SALMONELLA
LARUTAN SALMONELLA
LARUTAN SALMONELLA
LARUTAN SALMONELLA
LARUTAN SALMONELLA
LARUTAN SALMONELLA
PARATYPHI
PARATYPHI
PARATYPHI
PARATYPHI
PARATYPHI
PARATYPHI
PARATYPHI
H
HA
HC
O
OA
OB
OC

SUAB TENGGOROKAN
MINIOCEP

NIP. 19830624 201001 2 007
APORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT PUSKESMAS

BULAN
TAHUN
SATUAN /
KEMASAN
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
STOK
AWAL
PENERIMAAN
-
PERSEDIAAN
PEMAKAIAN
-
KAPSUL
TABLET
TABLET
TABLET
BUNGKUS
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
KAPSUL
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
AMPUL
VIAL
AMPUL
VIAL
AMPUL
AMPUL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
BOTOL
BOTOL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
VIAL
VIAL
AMPUL
AMPUL
BOTOL
VIAL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
VIAL
VIAL
VIAL
VIAL
AMPUL
AMPUL
AMPUL
AMPUL
VIAL
BOTOL
TUBE
TUBE
TUBE
SUPP
SUPP
TUBE
BOTOL
BOTOL
TUBE
BOTOL
BOTOL
TUBE
TUBE
BOTOL
BOTOL
TUBE
TUBE
TUBE
POT
KOTAK
BOTOL
TUBE
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
KOTAK
KOTAK
KOTAK
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
BOTOL
SET
BUNGKUS
BUNGKUS
BUNGKUS
ROLL
ROLL
ROLL
ROLL
ROLL
KOTAK
ROLL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
SET
SET
BOTOL
ROLL
SET
SET
SET
PCS
BOTOL
SET
SET
SET
SET
ROLL
BOTOL
SET
SET
SET
BOTOL
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
BOTOL
PCS
SET
SET
SET
SET
SET
SET
BOTOL
SET
SET
BOTOL
PCS
BOTOL
BOTOL
SET
SET
SET
SET
SET
ROLL
BOTOL
BOTOL
BUNGKUS
SET
SET
KOTAK
BOTOL
PCS
PCS
PCS
PCS
PCS
TABLET
PCS
PCS
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
VIAL
PCS
PCS
PCS
PCS
PCS
PCS
PCS
TABLET
PCS
KOTAK
PCS
PCS
BOTOL
KOTAK
SET
BOTOL
TUBE
PCS
PCS
PCS
VIAL
BOTOL
VIAL
VIAL
SET
SET
TUBE
PCS
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
PCS
BOTOL
UMUM
TIDAK BAYAR
BAYAR
BPJS
JUMLAH
Mengetahui
Yang Meminta / Melap
Kepala Puskemas
Petugas Obat Puskesm
..
NIP. ..
NIP.
ESMAS
Terima
No. Dok
Input
B.A
STOK
OPT
SISA STOK
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
PERMINTAAN
-
PEMBERIAN
KETERANGAN
-
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
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
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
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
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
ng Meminta / Melapor
Yang Menyerahkan
tugas Obat Puskesmas
P. .
NIP. 19781130 200012 2 001
LAPORAN PENGGUNAAN
NAMA PUSKESMAS
ALAMAT
TELP
:
:
:
NO
NAMA OBAT
SATUAN
1
2
3
4
5
6
7
8
9
10

CLOBAZAM TAB 10 MG
DIAZEPAM TABLET 2MG
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
AMPUL
AMPUL
Kepala Puskesmas .
..
NIP. .
PORAN PENGGUNAAN OBAT PSIKOTROPIKA
BULAN
TAHUN
SALDO
AWAL
PEMASUKAN
DARI
JUMLAH
PENGGUNAAN
UNTUK
7
0
0
0
0
0
0
0
0
Penanggung Jawab
..
NIP. .
:
:
PENGGUNAAN
JUMLAH
8
0
0
0
0
0
0
0
0
Penanggung Jawab
..
NIP. .
SALDO
AKHIR
9
NO
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
49
50
48
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
200
201
202
203
204
205
206
207
208
209
210
211
212
213
214
215
216
217
218
219
220
221
222
223
224
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239
240
241
242
243
244
245
246
247
248
249
250
251
252
253
254
255
256
257
258
259
260
261
262
263
264
265
266
267
268
269
270
271
272
273
274
275
276
277
278
279
280
281
282
283
284
285
286
287
288
289
290
291
292
293
294
295
296
297
298
299
300
301
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320
321
322
323
324
325
326
327
328
329
330
331
332
333
334
335
336
337
338
339
340
341
342
343
344
345
346
347
348
349
350
351
352
353
354
355
356
357
358
359
360
361
362
363
364
365
366
367
368
369
370
371
372
373
374
375
376
377
378
379
380
381
382
383
384
385
386
387
388
389
390
391
392
393
394
395
396
NAMA OBAT-OBATAN

AMBROXOL TAB. 30 MG
AMLODIPIN 10 MG
AMLODIPIN 5 MG
BETAHISTIN MALEAT
CLOBAZAM TAB 10 MG
CLOPIDOGREL 75 MG
CO AMOXICLAV 625 MG
DIAZEPAM TABLET 2MG
DOKSISIKLIN 100 MG

ERYTROMISIN 250 MG
ERYTROMISIN 500 MG
FUROSEMID TAB.40 MG
HALOPERIDOL 2 MG
KAPTOPRIL 12,5 MG
KAPTOPRIL 25 MG
KAPTOPRIL 50 MG
KLINDAMSIN 150 MG
LOPERAMIDE HCL 2 MG
METFORMIN 500 MG

METOKLOPRAMID 10 MG
MULTIVITAMIN TABLET
NIFEDIPINE 10 MG
OMEPRAZOL KAP 20 MG
PIROXICAM 10 MG
PIROXICAM 20 MG
PREDNISON TAB.5 MG
PRIMAKUIN TAB.15 MG
RIFAMPICIN 450 MG
RIFAMPICIN 600 MG
RISPERIDON TAB 2 MG
SALBUTAMOL 4 MG
SIMETIDIN TABLET
THROMBO ASPILETS
TRIFLUOPERAZIN 5 MG
ZINC TABLET
BISOLVON DROP
CITRIZINE SYRUP
ERYTROMISIN SYRUP
HALOPERIDOL DROP
IBUPROFEN SUSPENSI
PARASETAMOL DROP
THIAMFENICOL SYR
ZINK DROP
ZINK SYRUP
AQUA PRO INJEKSI
ASAM TRANEXAMAT INJ
D5 + 1/4 NS
DOPAMIN INJ
ETANOL 70 %
EUGENOL CAIRAN
FUROSEMID INJ 10 ML

HALOPERIDOL INJEKSI
LIDOKAIN INJ. 2%
MENADION K3 INJ
PEHACAIN INJ
PIRACETAM INJ 1 GR
SEFTRIAXON INJ
VENTOLIN NEBU
ALBOTHYL
ASIKLOVIR KRIM

MIKONAZOLE SALEP
SALEP 2-4 KOMB.
SALISIL BEDAK 2 %
SCABIMITE KRIM
BISTURI NO. 12
BLOOD LANCET
BOX SLIDE
INFUS SET ANAK
INFUS SET DEWASA
IV CATHETER NO. 18
IV CATHETER NO. 20
IV CATHETER NO. 22
IV CATHETER NO. 24
IV CATHETER NO. 26
JARUM KULIT
JARUM OTOT
KACA SLIDE
KAPAS 1 KG
KERTAS EKG
LARUTAN ANISOL
LARUTAN BENEDICT
LARUTAN EDTA 100 ml
LARUTAN EOSIN 2 %
LARUTAN ETANOL ASAM
LARUTAN H2O2
LARUTAN HCL 0,1 N
LARUTAN HAYEM
LARUTAN METANOL
LARUTAN TURK
MASKER KARET
MASKER TALI
MINYAK IMERSI
NEEDLE 23
NEEDLE 24
NELATON CATHETHER
PENJEPIT TALI PUSAT
PROPILEN GLIKOL
RAPID TES PROTEIN
RDT TYPUS
RDT HIV/AIDS
REESECHER
SELANG OKSIGEN ANAK
SELANG OKSIGEN BAYI
TEST DENGUE DEVICE
TEST HBsAG STRIP
TEST HCG STRIP
TEST MALARIA DEVICE
THREE WAY
TRANFUSI SET
UNDERPAD
URINAL PRIA
URINAL WANITA
URINE BAG
VASELIN
WING NEEDLE 23
WING NEEDLE 27
ARTICULATING PAPER
BONDING SINGLE BOND
CAVITON ATFLETCHER
CELLULOID STRIP
ETCHING
FUJI 9 ART (MINI)
FUJI II LC
FUJI IX GC
FUJI IX GP
FUJI VII GC WHITE
MICRO BRUSH
OCHO
SALIVA EJECTOR
AMINOFLUID
ASERING
VERAPAMIL 50 MG
BISOPPROLOL TAB 5MG
DILTIAZEM
ASAM FOLAT 1 MG
SULFASALAZINE
GLICLAZID
IRBESARTAN
GEMFIBROZIL
AMIODARON
GLIMEPIRID
MELOXICAM 15
KODEIN TABLET
COMBIVEN NEBU
CLEVER CHECK
CELL CLEAN
MASKER RESPIRATOR
HYPAFIX
PIPET TETES
THERMAROL
NOVOMIX PENFLEX
ISONIAZID TAB 30 MG
lipid panel test
alkohol swab
lysol
CELL PACK
STOMALYZER
JARUM AUTO CLICK
ALAT SUNTIK 0.05ML

ALAT SUNTIK 0.5ML
ANTRAIN INJ
AQUA GEL
ARTEM INJ
CITICOLLIN INJ
DIAMOND BOOR SET M
DIAMOND BOOR SET S
FEEDING TUBE
FISURE LANCIP LONG
KANDISTATIN

SUAB TENGGOROKAN
MINIOCEP

BULAN JANUARI 2016
KEMASAN
TANGGAL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
BUNGKUS
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
KAPSUL
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
AMPUL
VIAL
AMPUL
VIAL
AMPUL
AMPUL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
BOTOL
BOTOL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
VIAL
VIAL
AMPUL
AMPUL
BOTOL
VIAL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
VIAL
VIAL
VIAL
VIAL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
VIAL
BOTOL
TUBE
TUBE
TUBE
SUPP
SUPP
TUBE
BOTOL
BOTOL
TUBE
BOTOL
BOTOL
TUBE
TUBE
BOTOL
BOTOL
TUBE
TUBE
TUBE
POT
KOTAK
BOTOL
TUBE
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
KOTAK
KOTAK
KOTAK
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
BOTOL
SET
BUNGKUS
BUNGKUS
BUNGKUS
ROLL
ROLL
ROLL
ROLL
ROLL
KOTAK
ROLL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
SET
SET
BOTOL
ROLL
SET
SET
SET
PCS
BOTOL
SET
SET
SET
SET
ROLL
BOTOL
SET
SET
SET
BOTOL
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
BOTOL
PCS
SET
SET
SET
SET
SET
SET
BOTOL
SET
SET
BOTOL
PCS
BOTOL
BOTOL
SET
SET
SET
SET
SET
ROLL
BOTOL
BOTOL
BUNGKUS
SET
SET
KOTAK
BOTOL
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
TABLET
PCS
KOTAK
PCS
PCS
BOTOL
KOTAK
SET
BOTOL
TUBE
PCS
PCS
PCS
VIAL
BOTOL
VIAL
VIAL
SET
SET
TUBE
PCS
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
PCS
BOTOL
T KE PELAYANAN

10
11
12
13
14
15
N / HARI
16
17
18
19
20
21
22
23
24
25
26
27
28
29
PENGELU
30
31
NAMA
PUSTU
NAMA
PUSTU
NAMA
PUSTU
NAMA
PUSTU
NAMA
POLINDES

NAMA
NAMA
POLINDES POLINDES
NAMA
POLINDES
JUMLAH
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
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
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
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
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
LAPORAN
KODE PUSKESMAS
PUSKESMAS
KECAMATAN
KABUPATEN / KOTA
NO
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
NAMA OBAT

AMBROXOL TAB. 30 MG
AMLODIPIN 10 MG
AMLODIPIN 5 MG
BETAHISTIN MALEAT
CLOBAZAM TAB 10 MG
CLOPIDOGREL 75 MG
CO AMOXICLAV 625 MG
DIAZEPAM TABLET 2MG
DOKSISIKLIN 100 MG
36
37
38
39
40
41
42
43
44
45
46
47
49
50
48
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80

ERYTROMISIN 250 MG
ERYTROMISIN 500 MG
FUROSEMID TAB.40 MG
HALOPERIDOL 2 MG
KAPTOPRIL 12,5 MG
KAPTOPRIL 25 MG
KAPTOPRIL 50 MG
KLINDAMSIN 150 MG
LOPERAMIDE HCL 2 MG
METFORMIN 500 MG
METOKLOPRAMID 10 MG
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
MULTIVITAMIN TABLET
NIFEDIPINE 10 MG
OMEPRAZOL KAP 20 MG
PIROXICAM 10 MG
PIROXICAM 20 MG
PREDNISON TAB.5 MG
PRIMAKUIN TAB.15 MG
RIFAMPICIN 450 MG
RIFAMPICIN 600 MG
RISPERIDON TAB 2 MG
SALBUTAMOL 4 MG
SIMETIDIN TABLET
THROMBO ASPILETS
TRIFLUOPERAZIN 5 MG
ZINC TABLET
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141

BISOLVON DROP
CITRIZINE SYRUP
ERYTROMISIN SYRUP
HALOPERIDOL DROP
IBUPROFEN SUSPENSI
PARASETAMOL DROP
THIAMFENICOL SYR
ZINK DROP
ZINK SYRUP
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168

AQUA PRO INJEKSI
ASAM TRANEXAMAT INJ
D5 + 1/4 NS
DOPAMIN INJ
ETANOL 70 %
EUGENOL CAIRAN
FUROSEMID INJ 10 ML
HALOPERIDOL INJEKSI
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194

LIDOKAIN INJ. 2%
MENADION K3 INJ
PEHACAIN INJ
PIRACETAM INJ 1 GR
SEFTRIAXON INJ
VENTOLIN NEBU
195
196
197
198
199
200
201
202
203
204
205
206
207
208
209
210
211
212
ALBOTHYL
ASIKLOVIR KRIM
MIKONAZOLE SALEP
213
214
215
216
217

SALEP 2-4 KOMB.
SALISIL BEDAK 2 %
SCABIMITE KRIM
218
219
220
221
222
223
224
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239
240
241
242
243
244
245
246
247
248
249
250
251
252
253
254
255
256

BLOOD LANCET
BOX SLIDE
INFUS SET ANAK
INFUS SET DEWASA
IV CATHETER NO. 18
IV CATHETER NO. 20
IV CATHETER NO. 22
IV CATHETER NO. 24
IV CATHETER NO. 26
JARUM KULIT
JARUM OTOT
KACA SLIDE
KAPAS 1 KG
257
258
259
260
261
262
263
264
265
266
267
268
269
270
271
272
273
274
275
276
277
278
279
280
281
282
283
284
285
286
287
288
289
290
291
292
293
294
295
296
297
298
299
300
301

KERTAS EKG
LARUTAN ANISOL
LARUTAN BENEDICT
LARUTAN EDTA 100 ml
LARUTAN EOSIN 2 %
LARUTAN ETANOL ASAM
LARUTAN H2O2
LARUTAN HCL 0,1 N
LARUTAN HAYEM
LARUTAN METANOL
LARUTAN TURK
MASKER KARET
MASKER TALI
MINYAK IMERSI
NEEDLE 23
NEEDLE 24
NELATON CATHETHER
PENJEPIT TALI PUSAT
PROPILEN GLIKOL
RAPID TES PROTEIN
RDT TYPUS
RDT HIV/AIDS
REESECHER
SELANG OKSIGEN ANAK
SELANG OKSIGEN BAYI
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320
321
322
323
324
325
326
327
328
329
330
331
332
333
334
335
336
337
338
339
340
341
342
343
344
345
346

TEST DENGUE DEVICE
TEST HBsAG STRIP
TEST HCG STRIP
TEST MALARIA DEVICE
THREE WAY
TRANFUSI SET
UNDERPAD
URINAL PRIA
URINAL WANITA
URINE BAG
VASELIN
WING NEEDLE 23
WING NEEDLE 27
ARTICULATING PAPER
BONDING SINGLE BOND
CAVITON ATFLETCHER
CELLULOID STRIP
ETCHING
FUJI 9 ART (MINI)
FUJI II LC
FUJI IX GC
FUJI IX GP
FUJI VII GC WHITE
MICRO BRUSH
OCHO
SALIVA EJECTOR
AMINOFLUID
ASERING
VERAPAMIL 50 MG
BISOPPROLOL TAB 5MG
DILTIAZEM
347
348
349
350
351
352
353
354
355
356
357
358
359
360
361
362
363
364
365
366
367
368
369
370
371
372
373
374
375
376
377
378
379
380
381
382
383
384
385
386
387
388
389
390
391
ASAM FOLAT 1 MG
SULFASALAZINE
GLICLAZID
IRBESARTAN
GEMFIBROZIL
AMIODARON
GLIMEPIRID
MELOXICAM 15
KODEIN TABLET
COMBIVEN NEBU
CLEVER CHECK
CELL CLEAN
MASKER RESPIRATOR
HYPAFIX
PIPET TETES
THERMAROL
NOVOMIX PENFLEX
ISONIAZID TAB 30 MG
lipid panel test
alkohol swab
lysol
CELL PACK
STOMALYZER
JARUM AUTO CLICK
ALAT SUNTIK 0.05ML
ALAT SUNTIK 0.5ML
ANTRAIN INJ
AQUA GEL
ARTEM INJ
CITICOLLIN INJ
DIAMOND BOOR SET M
DIAMOND BOOR SET S
FEEDING TUBE
FISURE LANCIP LONG
KANDISTATIN
392
393
394
395
396

SUAB TENGGOROKAN
MINIOCEP

NIP. 19830624 201001 2 007
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

:
:
:
:
SATUAN /
KEMASAN
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
STOK
AWAL
PENERIMAAN
-
TABLET
KAPSUL
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
BUNGKUS
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
KAPSUL
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
AMPUL
VIAL
AMPUL
VIAL
AMPUL
AMPUL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
BOTOL
BOTOL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
VIAL
VIAL
AMPUL
AMPUL
BOTOL
VIAL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
VIAL
VIAL
VIAL
VIAL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
VIAL
BOTOL
TUBE
TUBE
TUBE
SUPP
SUPP
TUBE
BOTOL
BOTOL
TUBE
BOTOL
BOTOL
TUBE
TUBE
BOTOL
BOTOL
TUBE
TUBE
TUBE
POT
KOTAK
BOTOL
TUBE
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
KOTAK
KOTAK
KOTAK
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
BOTOL
SET
BUNGKUS
BUNGKUS
BUNGKUS
ROLL
ROLL
ROLL
ROLL
ROLL
KOTAK
ROLL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
SET
SET
BOTOL
ROLL
SET
SET
SET
PCS
BOTOL
SET
SET
SET
SET
ROLL
BOTOL
SET
SET
SET
BOTOL
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
BOTOL
PCS
SET
SET
SET
SET
SET
SET
BOTOL
SET
SET
BOTOL
PCS
BOTOL
BOTOL
SET
SET
SET
SET
SET
ROLL
BOTOL
BOTOL
BUNGKUS
SET
SET
KOTAK
BOTOL
PCS
PCS
PCS
PCS
PCS
TABLET
PCS
PCS
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
VIAL
PCS
PCS
PCS
PCS
PCS
PCS
PCS
TABLET
PCS
KOTAK
PCS
PCS
BOTOL
KOTAK
SET
BOTOL
TUBE
PCS
PCS
PCS
VIAL
BOTOL
VIAL
VIAL
SET
SET
TUBE
PCS
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
PCS
BOTOL
UMUM
TIDAK BAYAR
BAYAR
Mengetahui
Kepala Puskemas
..
NIP. ..
R PERMINTAAN OBAT PUSKESMAS

BULAN
TAHUN
PERSEDIAAN
PEMAKAIAN
STOK
OPT
SISA STOK
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
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
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
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
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
BPJS
JUMLAH

NIP. .
0
0
0
0
0
Terima
No. Dok
Input
B.A
PERMINTAAN
PEMBERIAN
-
KETERANGAN
Yang Menyerahkan

NIP. 19781130 200012 2 001
LAPORAN PENGGUNAAN OBAT PSIKOTR

:
:
:
NAMA PUSKESMAS
ALAMAT
TELP
NO
NAMA OBAT
SATUAN
1
2
3
4
5
6
7
8
9
10

CLOBAZAM TAB 10 MG
DIAZEPAM TABLET 2MG
Kepala Puskesmas .
..
NIP. .
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
AMPUL
AMPUL
N OBAT PSIKOTROPIKA
BULAN
TAHUN
SALDO
AWAL
PEMASUKAN
DARI
JUMLAH
0
0
0
0
0
0
0
0
:
:
PENGGUNAAN
UNTUK
JUMLAH
7
0
0
0
0
0
0
0
0
Penanggung Jawab
..
NIP. .
SALDO
AKHIR
9
NO
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
49
50
48
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
200
201
202
203
204
205
206
207
208
209
210
211
212
213
214
215
216
217
218
219
220
221
222
223
224
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239
240
241
242
243
244
245
246
247
248
249
250
251
252
253
254
255
256
257
258
259
260
261
262
263
264
265
266
267
268
269
270
271
272
273
274
275
276
277
278
279
280
281
282
283
284
285
286
287
288
289
290
291
292
293
294
295
296
297
298
299
300
301
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320
321
322
323
324
325
326
327
328
329
330
331
332
333
334
335
336
337
338
339
340
341
342
343
344
345
346
347
348
349
350
351
352
353
354
355
356
357
358
359
360
361
362
363
364
365
366
367
368
369
370
371
372
373
374
375
376
377
378
379
380
381
382
383
384
385
386
387
388
389
390
391
392
393
394
395
396
NAMA OBAT-OBATAN

AMBROXOL TAB. 30 MG
AMLODIPIN 10 MG
AMLODIPIN 5 MG
BETAHISTIN MALEAT
CLOBAZAM TAB 10 MG
CLOPIDOGREL 75 MG
CO AMOXICLAV 625 MG
DIAZEPAM TABLET 2MG
DOKSISIKLIN 100 MG

ERYTROMISIN 250 MG
ERYTROMISIN 500 MG
FUROSEMID TAB.40 MG
HALOPERIDOL 2 MG
KAPTOPRIL 12,5 MG
KAPTOPRIL 25 MG
KAPTOPRIL 50 MG
KLINDAMSIN 150 MG
LOPERAMIDE HCL 2 MG
METFORMIN 500 MG
METOKLOPRAMID 10 MG
MULTIVITAMIN TABLET
NIFEDIPINE 10 MG
OMEPRAZOL KAP 20 MG
PIROXICAM 10 MG
PIROXICAM 20 MG
PREDNISON TAB.5 MG
PRIMAKUIN TAB.15 MG
RIFAMPICIN 450 MG
RIFAMPICIN 600 MG
RISPERIDON TAB 2 MG
SALBUTAMOL 4 MG
SIMETIDIN TABLET
THROMBO ASPILETS
TRIFLUOPERAZIN 5 MG

ZINC TABLET
BISOLVON DROP
CITRIZINE SYRUP
ERYTROMISIN SYRUP
HALOPERIDOL DROP
IBUPROFEN SUSPENSI
PARASETAMOL DROP
THIAMFENICOL SYR
ZINK DROP
ZINK SYRUP
AQUA PRO INJEKSI
ASAM TRANEXAMAT INJ
D5 + 1/4 NS
DOPAMIN INJ
ETANOL 70 %
EUGENOL CAIRAN
FUROSEMID INJ 10 ML

HALOPERIDOL INJEKSI
LIDOKAIN INJ. 2%
MENADION K3 INJ
PEHACAIN INJ
PIRACETAM INJ 1 GR
SEFTRIAXON INJ
VENTOLIN NEBU
ALBOTHYL
ASIKLOVIR KRIM

MIKONAZOLE SALEP
SALEP 2-4 KOMB.
SALISIL BEDAK 2 %
SCABIMITE KRIM
BISTURI NO. 12
BLOOD LANCET
BOX SLIDE
INFUS SET ANAK
INFUS SET DEWASA
IV CATHETER NO. 18
IV CATHETER NO. 20
IV CATHETER NO. 22
IV CATHETER NO. 24
IV CATHETER NO. 26
JARUM KULIT
JARUM OTOT
KACA SLIDE
KAPAS 1 KG
KERTAS EKG
LARUTAN ANISOL
LARUTAN BENEDICT
LARUTAN EDTA 100 ml
LARUTAN EOSIN 2 %
LARUTAN ETANOL ASAM
LARUTAN H2O2
LARUTAN HCL 0,1 N
LARUTAN HAYEM
LARUTAN METANOL
LARUTAN TURK
MASKER KARET
MASKER TALI
MINYAK IMERSI
NEEDLE 23
NEEDLE 24
NELATON CATHETHER
PENJEPIT TALI PUSAT

PROPILEN GLIKOL
RAPID TES PROTEIN
RDT TYPUS
RDT HIV/AIDS
REESECHER
SELANG OKSIGEN ANAK
SELANG OKSIGEN BAYI
TEST DENGUE DEVICE
TEST HBsAG STRIP
TEST HCG STRIP
TEST MALARIA DEVICE
THREE WAY
TRANFUSI SET
UNDERPAD
URINAL PRIA
URINAL WANITA
URINE BAG
VASELIN
WING NEEDLE 23
WING NEEDLE 27
ARTICULATING PAPER
BONDING SINGLE BOND
CAVITON ATFLETCHER
CELLULOID STRIP
ETCHING
FUJI 9 ART (MINI)
FUJI II LC
FUJI IX GC
FUJI IX GP
FUJI VII GC WHITE
MICRO BRUSH
OCHO
SALIVA EJECTOR
AMINOFLUID
ASERING
VERAPAMIL 50 MG
BISOPPROLOL TAB 5MG
DILTIAZEM
ASAM FOLAT 1 MG
SULFASALAZINE
GLICLAZID
IRBESARTAN
GEMFIBROZIL
AMIODARON
GLIMEPIRID
MELOXICAM 15
KODEIN TABLET
COMBIVEN NEBU
CLEVER CHECK
CELL CLEAN
MASKER RESPIRATOR
HYPAFIX
PIPET TETES
THERMAROL
NOVOMIX PENFLEX
ISONIAZID TAB 30 MG
lipid panel test
alkohol swab
lysol
CELL PACK
STOMALYZER
JARUM AUTO CLICK
ALAT SUNTIK 0.05ML
ALAT SUNTIK 0.5ML

ANTRAIN INJ
AQUA GEL
ARTEM INJ
CITICOLLIN INJ
DIAMOND BOOR SET M
DIAMOND BOOR SET S
FEEDING TUBE
FISURE LANCIP LONG
KANDISTATIN

SUAB TENGGOROKAN
MINIOCEP

BULAN JANUARI 2016
KEMASAN
TANGGAL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
BUNGKUS
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
KAPSUL
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
AMPUL
VIAL
AMPUL
VIAL
AMPUL
AMPUL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
BOTOL
BOTOL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
VIAL
VIAL
AMPUL
AMPUL
BOTOL
VIAL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
VIAL
VIAL
VIAL
VIAL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
VIAL
BOTOL
TUBE
TUBE
TUBE
SUPP
SUPP
TUBE
BOTOL
BOTOL
TUBE
BOTOL
BOTOL
TUBE
TUBE
BOTOL
BOTOL
TUBE
TUBE
TUBE
POT
KOTAK
BOTOL
TUBE
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
KOTAK
KOTAK
KOTAK
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
BOTOL
SET
BUNGKUS
BUNGKUS
BUNGKUS
ROLL
ROLL
ROLL
ROLL
ROLL
KOTAK
ROLL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
SET
SET
BOTOL
ROLL
SET
SET
SET
PCS
BOTOL
SET
SET
SET
SET
ROLL
BOTOL
SET
SET
SET
BOTOL
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
BOTOL
PCS
SET
SET
SET
SET
SET
SET
BOTOL
SET
SET
BOTOL
PCS
BOTOL
BOTOL
SET
SET
SET
SET
SET
ROLL
BOTOL
BOTOL
BUNGKUS
SET
SET
KOTAK
BOTOL
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
TABLET
PCS
KOTAK
PCS
PCS
BOTOL
KOTAK
SET
BOTOL
TUBE
PCS
PCS
PCS
VIAL
BOTOL
VIAL
VIAL
SET
SET
TUBE
PCS
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
PCS
BOTOL
T KE PELAYANAN

10
11
12
13
14
15
N / HARI
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
NAMA
PUSTU
NAMA
PUSTU
NAMA
PUSTU
NAMA
PUSTU
NAMA
POLINDES
PENGELU

NAMA
NAMA
NAMA
POLINDES POLINDES POLINDES
JUMLAH
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
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
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
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
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
LAPORAN PEM
KODE PUSKESMAS
PUSKESMAS
KECAMATAN
KABUPATEN / KOTA
NO
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
NAMA OBAT

AMBROXOL TAB. 30 MG
AMLODIPIN 10 MG
AMLODIPIN 5 MG
BETAHISTIN MALEAT
CLOBAZAM TAB 10 MG
CLOPIDOGREL 75 MG
CO AMOXICLAV 625 MG
DIAZEPAM TABLET 2MG
DOKSISIKLIN 100 MG
36
37
38
39
40
41
42
43
44
45
46
47
49
50
48
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80

ERYTROMISIN 250 MG
ERYTROMISIN 500 MG
FUROSEMID TAB.40 MG
HALOPERIDOL 2 MG
KAPTOPRIL 12,5 MG
KAPTOPRIL 25 MG
KAPTOPRIL 50 MG
KLINDAMSIN 150 MG
LOPERAMIDE HCL 2 MG
METFORMIN 500 MG
METOKLOPRAMID 10 MG
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
MULTIVITAMIN TABLET
NIFEDIPINE 10 MG
OMEPRAZOL KAP 20 MG
PIROXICAM 10 MG
PIROXICAM 20 MG
PREDNISON TAB.5 MG
PRIMAKUIN TAB.15 MG
RIFAMPICIN 450 MG
RIFAMPICIN 600 MG
RISPERIDON TAB 2 MG
SALBUTAMOL 4 MG
SIMETIDIN TABLET
THROMBO ASPILETS
TRIFLUOPERAZIN 5 MG
ZINC TABLET
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141

BISOLVON DROP
CITRIZINE SYRUP
ERYTROMISIN SYRUP
HALOPERIDOL DROP
IBUPROFEN SUSPENSI
PARASETAMOL DROP
THIAMFENICOL SYR
ZINK DROP
ZINK SYRUP
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168

AQUA PRO INJEKSI
ASAM TRANEXAMAT INJ
D5 + 1/4 NS
DOPAMIN INJ
ETANOL 70 %
EUGENOL CAIRAN
FUROSEMID INJ 10 ML
HALOPERIDOL INJEKSI
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194

LIDOKAIN INJ. 2%
MENADION K3 INJ
PEHACAIN INJ
PIRACETAM INJ 1 GR
SEFTRIAXON INJ
VENTOLIN NEBU
195
196
197
198
199
200
201
202
203
204
205
206
207
208
209
210
211
212
ALBOTHYL
ASIKLOVIR KRIM
MIKONAZOLE SALEP
213
214
215
216
217

SALEP 2-4 KOMB.
SALISIL BEDAK 2 %
SCABIMITE KRIM
218
219
220
221
222
223
224
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239
240
241
242
243
244
245
246
247
248
249
250
251
252
253
254
255

BLOOD LANCET
BOX SLIDE
INFUS SET ANAK
INFUS SET DEWASA
IV CATHETER NO. 18
IV CATHETER NO. 20
IV CATHETER NO. 22
IV CATHETER NO. 24
IV CATHETER NO. 26
JARUM KULIT
JARUM OTOT
KACA SLIDE
KAPAS 1 KG
256
257
258
259
260
261
262
263
264
265
266
267
268
269
270
271
272
273
274
275
276
277
278
279
280
281
282
283
284
285
286
287
288
289
290
291
292
293
294
295
296
297
298
299
300

KERTAS EKG
LARUTAN ANISOL
LARUTAN BENEDICT
LARUTAN EDTA 100 ml
LARUTAN EOSIN 2 %
LARUTAN ETANOL ASAM
LARUTAN H2O2
LARUTAN HCL 0,1 N
LARUTAN HAYEM
LARUTAN METANOL
LARUTAN TURK
MASKER KARET
MASKER TALI
MINYAK IMERSI
NEEDLE 23
NEEDLE 24
NELATON CATHETHER
PENJEPIT TALI PUSAT
PROPILEN GLIKOL
RAPID TES PROTEIN
RDT TYPUS
RDT HIV/AIDS
REESECHER
SELANG OKSIGEN ANAK
SELANG OKSIGEN BAYI
301
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320
321
322
323
324
325
326
327
328
329
330
331
332
333
334
335
336
337
338
339
340
341
342
343
344
345

TEST DENGUE DEVICE
TEST HBsAG STRIP
TEST HCG STRIP
TEST MALARIA DEVICE
THREE WAY
TRANFUSI SET
UNDERPAD
URINAL PRIA
URINAL WANITA
URINE BAG
VASELIN
WING NEEDLE 23
WING NEEDLE 27
ARTICULATING PAPER
BONDING SINGLE BOND
CAVITON ATFLETCHER
CELLULOID STRIP
ETCHING
FUJI 9 ART (MINI)
FUJI II LC
FUJI IX GC
FUJI IX GP
FUJI VII GC WHITE
MICRO BRUSH
OCHO
SALIVA EJECTOR
AMINOFLUID
ASERING
VERAPAMIL 50 MG
BISOPPROLOL TAB 5MG
346
347
348
349
350
351
352
353
354
355
356
357
358
359
360
361
362
363
364
365
366
367
368
369
370
371
372
373
374
375
376
377
378
379
380
381
382
383
384
385
386
387
388
389
390
DILTIAZEM
ASAM FOLAT 1 MG
SULFASALAZINE
GLICLAZID
IRBESARTAN
GEMFIBROZIL
AMIODARON
GLIMEPIRID
MELOXICAM 15
KODEIN TABLET
COMBIVEN NEBU
CLEVER CHECK
CELL CLEAN
MASKER RESPIRATOR
HYPAFIX
PIPET TETES
THERMAROL
NOVOMIX PENFLEX
ISONIAZID TAB 30 MG
lipid panel test
alkohol swab
lysol
CELL PACK
STOMALYZER
JARUM AUTO CLICK
ALAT SUNTIK 0.05ML
ALAT SUNTIK 0.5ML
ANTRAIN INJ
AQUA GEL
ARTEM INJ
CITICOLLIN INJ
DIAMOND BOOR SET M
DIAMOND BOOR SET S
FEEDING TUBE
FISURE LANCIP LONG
KANDISTATIN
391
392
393
394
395
396


SUAB TENGGOROKAN
MINIOCEP

NIP. 19830624 201001 2 007
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT PU

:
:
:
:
SATUAN /
KEMASAN
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
STOK
AWAL
PENERIMAAN
-
TABLET
KAPSUL
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
BUNGKUS
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
KAPSUL
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
AMPUL
VIAL
AMPUL
VIAL
AMPUL
AMPUL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
BOTOL
BOTOL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
VIAL
VIAL
AMPUL
AMPUL
BOTOL
VIAL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
VIAL
VIAL
VIAL
VIAL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
VIAL
BOTOL
TUBE
TUBE
TUBE
SUPP
SUPP
TUBE
BOTOL
BOTOL
TUBE
BOTOL
BOTOL
TUBE
TUBE
BOTOL
BOTOL
TUBE
TUBE
TUBE
POT
KOTAK
BOTOL
TUBE
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
KOTAK
KOTAK
KOTAK
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
BOTOL
SET
BUNGKUS
BUNGKUS
BUNGKUS
ROLL
ROLL
ROLL
ROLL
ROLL
KOTAK
ROLL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
SET
SET
BOTOL
ROLL
SET
SET
SET
PCS
BOTOL
SET
SET
SET
SET
ROLL
BOTOL
SET
SET
SET
BOTOL
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
BOTOL
PCS
SET
SET
SET
SET
SET
SET
BOTOL
SET
SET
BOTOL
PCS
BOTOL
BOTOL
SET
SET
SET
SET
SET
ROLL
BOTOL
BOTOL
BUNGKUS
SET
SET
KOTAK
BOTOL
PCS
PCS
PCS
PCS
PCS
TABLET
PCS
PCS
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
VIAL
PCS
PCS
PCS
PCS
PCS
PCS
PCS
TABLET
PCS
KOTAK
PCS
PCS
BOTOL
KOTAK
SET
BOTOL
TUBE
PCS
PCS
PCS
VIAL
BOTOL
VIAL
VIAL
SET
SET
TUBE
PCS
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
PCS
BOTOL
UMUM
TIDAK BAYAR
BAYAR
Mengetahui
Kepala Puskemas
..
NIP. ..
ERMINTAAN OBAT PUSKESMAS

BULAN
TAHUN
PERSEDIAAN
PEMAKAIAN
STOK
OPT
SISA STOK
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
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
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
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
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
BPJS
JUMLAH

NIP. .
0
0
0
0
0
0
Terima
No. Dok
pemakaian
Input
B.A
PERMINTAAN
PEMBERIANKETERANGAN
-
Err:509
-
Err:509
Err:509
Err:509
Yang Menyerahkan

NIP. 19781130 200012 2 001
LAPORAN PENGGUNAAN OBAT

NAMA PUSKESMAS
ALAMAT
TELP
:
:
:
NO
NAMA OBAT
SATUAN
1
2
3
4
5
6
7
8
9
10

CLOBAZAM TAB 10 MG
DIAZEPAM TABLET 2MG
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
AMPUL
AMPUL
Kepala Puskesmas .
..
NIP. .
PENGGUNAAN OBAT PSIKOTROPIKA
:
:
BULAN
TAHUN
SALDO
AWAL
PEMASUKAN
DARI
JUMLAH
0
0
0
0
0
0
0
0
PENGGUNAAN
UNTUK
JUMLAH
7
0
0
0
0
0
0
0
0
Penanggung Jawab
..
NIP. .
SALDO
AKHIR
9
NO
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
49
50
48
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
200
201
202
203
204
205
206
207
208
209
210
211
212
213
214
215
216
217
218
219
220
221
222
223
224
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239
240
241
242
243
244
245
246
247
248
249
250
251
252
253
254
255
256
257
258
259
260
261
262
263
264
265
266
267
268
269
270
271
272
273
274
275
276
277
278
279
280
281
282
283
284
285
286
287
288
289
290
291
292
293
294
295
296
297
298
299
300
301
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320
321
322
323
324
325
326
327
328
329
330
331
332
333
334
335
336
337
338
339
340
341
342
343
344
345
346
347
348
349
350
351
352
353
354
355
356
357
358
359
360
361
362
363
364
365
366
367
368
369
370
371
372
373
374
375
376
377
378
379
380
381
382
383
384
385
386
387
388
389
390
391
392
393
394
395
396
NAMA OBAT-OBATAN

AMBROXOL TAB. 30 MG
AMLODIPIN 10 MG
AMLODIPIN 5 MG
BETAHISTIN MALEAT
CLOBAZAM TAB 10 MG
CLOPIDOGREL 75 MG
CO AMOXICLAV 625 MG
DIAZEPAM TABLET 2MG
DOKSISIKLIN 100 MG
ERYTROMISIN 250 MG
ERYTROMISIN 500 MG
FUROSEMID TAB.40 MG
HALOPERIDOL 2 MG
KAPTOPRIL 12,5 MG
KAPTOPRIL 25 MG
KAPTOPRIL 50 MG
KLINDAMSIN 150 MG
LOPERAMIDE HCL 2 MG
METFORMIN 500 MG
METOKLOPRAMID 10 MG
MULTIVITAMIN TABLET
NIFEDIPINE 10 MG
OMEPRAZOL KAP 20 MG
PIROXICAM 10 MG
PIROXICAM 20 MG
PREDNISON TAB.5 MG
PRIMAKUIN TAB.15 MG
RIFAMPICIN 450 MG
RIFAMPICIN 600 MG
RISPERIDON TAB 2 MG
SALBUTAMOL 4 MG
SIMETIDIN TABLET
THROMBO ASPILETS
TRIFLUOPERAZIN 5 MG
ZINC TABLET
BISOLVON DROP
CITRIZINE SYRUP
ERYTROMISIN SYRUP
HALOPERIDOL DROP
IBUPROFEN SUSPENSI
PARASETAMOL DROP
THIAMFENICOL SYR
ZINK DROP
ZINK SYRUP
AQUA PRO INJEKSI
ASAM TRANEXAMAT INJ
D5 + 1/4 NS
DOPAMIN INJ
ETANOL 70 %
EUGENOL CAIRAN
FUROSEMID INJ 10 ML
HALOPERIDOL INJEKSI
LIDOKAIN INJ. 2%
MENADION K3 INJ
PEHACAIN INJ
PIRACETAM INJ 1 GR
SEFTRIAXON INJ
VENTOLIN NEBU
ALBOTHYL
ASIKLOVIR KRIM
MIKONAZOLE SALEP
SALEP 2-4 KOMB.
SALISIL BEDAK 2 %
SCABIMITE KRIM

BISTURI NO. 12
BLOOD LANCET
BOX SLIDE
INFUS SET ANAK
INFUS SET DEWASA
IV CATHETER NO. 18
IV CATHETER NO. 20
IV CATHETER NO. 22
IV CATHETER NO. 24
IV CATHETER NO. 26
JARUM KULIT
JARUM OTOT
KACA SLIDE
KAPAS 1 KG
KERTAS EKG
LARUTAN ANISOL
LARUTAN BENEDICT
LARUTAN EDTA 100 ml

LARUTAN EOSIN 2 %
LARUTAN ETANOL ASAM
LARUTAN H2O2
LARUTAN HCL 0,1 N
LARUTAN HAYEM
LARUTAN METANOL
LARUTAN TURK
MASKER KARET
MASKER TALI
MINYAK IMERSI
NEEDLE 23
NEEDLE 24
NELATON CATHETHER
PENJEPIT TALI PUSAT
PROPILEN GLIKOL
RAPID TES PROTEIN
RDT TYPUS
RDT HIV/AIDS
REESECHER
SELANG OKSIGEN ANAK
SELANG OKSIGEN BAYI
TEST DENGUE DEVICE
TEST HBsAG STRIP
TEST HCG STRIP
TEST MALARIA DEVICE
THREE WAY
TRANFUSI SET
UNDERPAD
URINAL PRIA
URINAL WANITA
URINE BAG
VASELIN
WING NEEDLE 23
WING NEEDLE 27
ARTICULATING PAPER
BONDING SINGLE BOND
CAVITON ATFLETCHER
CELLULOID STRIP
ETCHING
FUJI 9 ART (MINI)
FUJI II LC
FUJI IX GC
FUJI IX GP
FUJI VII GC WHITE
MICRO BRUSH
OCHO
SALIVA EJECTOR
AMINOFLUID
ASERING
VERAPAMIL 50 MG
BISOPPROLOL TAB 5MG
DILTIAZEM
ASAM FOLAT 1 MG
SULFASALAZINE
GLICLAZID
IRBESARTAN
GEMFIBROZIL
AMIODARON
GLIMEPIRID
MELOXICAM 15
KODEIN TABLET
COMBIVEN NEBU
CLEVER CHECK
CELL CLEAN
MASKER RESPIRATOR
HYPAFIX
PIPET TETES
THERMAROL
NOVOMIX PENFLEX
ISONIAZID TAB 30 MG
lipid panel test
alkohol swab
lysol
CELL PACK
STOMALYZER
JARUM AUTO CLICK
ALAT SUNTIK 0.05ML
ALAT SUNTIK 0.5ML
ANTRAIN INJ
AQUA GEL
ARTEM INJ
CITICOLLIN INJ
DIAMOND BOOR SET M
DIAMOND BOOR SET S
FEEDING TUBE
FISURE LANCIP LONG
KANDISTATIN

SUAB TENGGOROKAN
MINIOCEP
PENGELUARAN OBAT DARI GUDANG OBAT KE PELA

BULAN JANUARI 2016
KEMASAN
TANGGAL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
BUNGKUS
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
KAPSUL
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
AMPUL
VIAL
AMPUL
VIAL
AMPUL
AMPUL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
BOTOL
BOTOL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
VIAL
VIAL
AMPUL
AMPUL
BOTOL
VIAL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
VIAL
VIAL
VIAL
VIAL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
VIAL
BOTOL
TUBE
TUBE
TUBE
SUPP
SUPP
TUBE
BOTOL
BOTOL
TUBE
BOTOL
BOTOL
TUBE
TUBE
BOTOL
BOTOL
TUBE
TUBE
TUBE
POT
KOTAK
BOTOL
TUBE
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
KOTAK
KOTAK
KOTAK
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
BOTOL
SET
BUNGKUS
BUNGKUS
BUNGKUS
ROLL
ROLL
ROLL
ROLL
ROLL
KOTAK
ROLL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
SET
SET
BOTOL
ROLL
SET
SET
SET
PCS
BOTOL
SET
SET
SET
SET
ROLL
BOTOL
SET
SET
SET
BOTOL
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
BOTOL
PCS
SET
SET
SET
SET
SET
SET
BOTOL
SET
SET
BOTOL
PCS
BOTOL
BOTOL
SET
SET
SET
SET
SET
ROLL
BOTOL
BOTOL
BUNGKUS
SET
SET
KOTAK
BOTOL
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
TABLET
PCS
KOTAK
PCS
PCS
BOTOL
KOTAK
SET
BOTOL
TUBE
PCS
PCS
PCS
VIAL
BOTOL
VIAL
VIAL
SET
SET
TUBE
PCS
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
PCS
BOTOL
T KE PELAYANAN

10
11
12
13
14
15
AN / HARI
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
NAMA
PUSTU
NAMA
PUSTU
NAMA
PUSTU

NAMA
PUSTU
NAMA
POLINDES
NAMA
POLINDES
NAMA
POLINDES
NAMA
POLINDES
ES
JUMLAH
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
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
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
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
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
LAPORAN PEM
KODE PUSKESMAS
PUSKESMAS
KECAMATAN
KABUPATEN / KOTA
:
:
NO
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
NAMA OBAT

AMBROXOL TAB. 30 MG
AMLODIPIN 10 MG
AMLODIPIN 5 MG
BETAHISTIN MALEAT
CLOBAZAM TAB 10 MG
CLOPIDOGREL 75 MG
CO AMOXICLAV 625 MG
DIAZEPAM TABLET 2MG
DOKSISIKLIN 100 MG
36
37
38
39
40
41
42
43
44
45
46
47
49
50
48
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80

ERYTROMISIN 250 MG
ERYTROMISIN 500 MG
FUROSEMID TAB.40 MG
HALOPERIDOL 2 MG
KAPTOPRIL 12,5 MG
KAPTOPRIL 25 MG
KAPTOPRIL 50 MG
KLINDAMSIN 150 MG
LOPERAMIDE HCL 2 MG
METFORMIN 500 MG
METOKLOPRAMID 10 MG
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
MULTIVITAMIN TABLET
NIFEDIPINE 10 MG
OMEPRAZOL KAP 20 MG
PIROXICAM 10 MG
PIROXICAM 20 MG
PREDNISON TAB.5 MG
PRIMAKUIN TAB.15 MG
RIFAMPICIN 450 MG
RIFAMPICIN 600 MG
RISPERIDON TAB 2 MG
SALBUTAMOL 4 MG
SIMETIDIN TABLET
THROMBO ASPILETS
TRIFLUOPERAZIN 5 MG
ZINC TABLET
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141

BISOLVON DROP
CITRIZINE SYRUP
ERYTROMISIN SYRUP
HALOPERIDOL DROP
IBUPROFEN SUSPENSI
PARASETAMOL DROP
THIAMFENICOL SYR
ZINK DROP
ZINK SYRUP
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168

AQUA PRO INJEKSI
ASAM TRANEXAMAT INJ
D5 + 1/4 NS
DOPAMIN INJ
ETANOL 70 %
EUGENOL CAIRAN
FUROSEMID INJ 10 ML
HALOPERIDOL INJEKSI
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194

LIDOKAIN INJ. 2%
MENADION K3 INJ
PEHACAIN INJ
PIRACETAM INJ 1 GR
SEFTRIAXON INJ
VENTOLIN NEBU
195
196
197
198
199
200
201
202
203
204
205
206
207
208
209
210
211
212
ALBOTHYL
ASIKLOVIR KRIM
MIKONAZOLE SALEP
213
214
215
216
217

SALEP 2-4 KOMB.
SALISIL BEDAK 2 %
SCABIMITE KRIM
218
219
220
221
222
223
224
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239
240
241
242
243
244
245
246
247
248
249
250
251
252
253
254
255
256

BLOOD LANCET
BOX SLIDE
INFUS SET ANAK
INFUS SET DEWASA
IV CATHETER NO. 18
IV CATHETER NO. 20
IV CATHETER NO. 22
IV CATHETER NO. 24
IV CATHETER NO. 26
JARUM KULIT
JARUM OTOT
KACA SLIDE
KAPAS 1 KG
257
258
259
260
261
262
263
264
265
266
267
268
269
270
271
272
273
274
275
276
277
278
279
280
281
282
283
284
285
286
287
288
289
290
291
292
293
294
295
296
297
298
299
300
301

KERTAS EKG
LARUTAN ANISOL
LARUTAN BENEDICT
LARUTAN EDTA 100 ml
LARUTAN EOSIN 2 %
LARUTAN ETANOL ASAM
LARUTAN H2O2
LARUTAN HCL 0,1 N
LARUTAN HAYEM
LARUTAN METANOL
LARUTAN TURK
MASKER KARET
MASKER TALI
MINYAK IMERSI
NEEDLE 23
NEEDLE 24
NELATON CATHETHER
PENJEPIT TALI PUSAT
PROPILEN GLIKOL
RAPID TES PROTEIN
RDT TYPUS
RDT HIV/AIDS
REESECHER
SELANG OKSIGEN ANAK
SELANG OKSIGEN BAYI
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320
321
322
323
324
325
326
327
328
329
330
331
332
333
334
335
336
337
338
339
340
341
342
343
344
345
346

TEST DENGUE DEVICE
TEST HBsAG STRIP
TEST HCG STRIP
TEST MALARIA DEVICE
THREE WAY
TRANFUSI SET
UNDERPAD
URINAL PRIA
URINAL WANITA
URINE BAG
VASELIN
WING NEEDLE 23
WING NEEDLE 27
ARTICULATING PAPER
BONDING SINGLE BOND
CAVITON ATFLETCHER
CELLULOID STRIP
ETCHING
FUJI 9 ART (MINI)
FUJI II LC
FUJI IX GC
FUJI IX GP
FUJI VII GC WHITE
MICRO BRUSH
OCHO
SALIVA EJECTOR
AMINOFLUID
ASERING
VERAPAMIL 50 MG
BISOPPROLOL TAB 5MG
DILTIAZEM
347
348
349
350
351
352
353
354
355
356
357
358
359
360
361
362
363
364
365
366
367
368
369
370
371
372
373
374
375
376
377
378
379
380
381
382
383
384
385
386
387
388
389
390
391
ASAM FOLAT 1 MG
SULFASALAZINE
GLICLAZID
IRBESARTAN
GEMFIBROZIL
AMIODARON
GLIMEPIRID
MELOXICAM 15
KODEIN TABLET
COMBIVEN NEBU
CLEVER CHECK
CELL CLEAN
MASKER RESPIRATOR
HYPAFIX
PIPET TETES
THERMAROL
NOVOMIX PENFLEX
ISONIAZID TAB 30 MG
lipid panel test
alkohol swab
lysol
CELL PACK
STOMALYZER
JARUM AUTO CLICK
ALAT SUNTIK 0.05ML
ALAT SUNTIK 0.5ML
ANTRAIN INJ
AQUA GEL
ARTEM INJ
CITICOLLIN INJ
DIAMOND BOOR SET M
DIAMOND BOOR SET S
FEEDING TUBE
FISURE LANCIP LONG
KANDISTATIN
392
393
394
395
396

SUAB TENGGOROKAN
MINIOCEP

NIP. 19830624 201001 2 007
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT PUSKESMAS
SATUAN /
KEMASAN
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
STOK
AWAL
PENERIMAAN
-
PERSEDIAAN
-
TABLET
KAPSUL
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
BUNGKUS
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
KAPSUL
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
AMPUL
VIAL
AMPUL
VIAL
AMPUL
AMPUL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
BOTOL
BOTOL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
VIAL
VIAL
AMPUL
AMPUL
BOTOL
VIAL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
VIAL
VIAL
VIAL
VIAL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
VIAL
BOTOL
TUBE
TUBE
TUBE
SUPP
SUPP
TUBE
BOTOL
BOTOL
TUBE
BOTOL
BOTOL
TUBE
TUBE
BOTOL
BOTOL
TUBE
TUBE
TUBE
POT
KOTAK
BOTOL
TUBE
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
KOTAK
KOTAK
KOTAK
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
BOTOL
SET
BUNGKUS
BUNGKUS
BUNGKUS
ROLL
ROLL
ROLL
ROLL
ROLL
KOTAK
ROLL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
SET
SET
BOTOL
ROLL
SET
SET
SET
PCS
BOTOL
SET
SET
SET
SET
ROLL
BOTOL
SET
SET
SET
BOTOL
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
BOTOL
PCS
SET
SET
SET
SET
SET
SET
BOTOL
SET
SET
BOTOL
PCS
BOTOL
BOTOL
SET
SET
SET
SET
SET
ROLL
BOTOL
BOTOL
BUNGKUS
SET
SET
KOTAK
BOTOL
PCS
PCS
PCS
PCS
PCS
TABLET
PCS
PCS
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
VIAL
PCS
PCS
PCS
PCS
PCS
PCS
PCS
TABLET
PCS
KOTAK
PCS
PCS
BOTOL
KOTAK
SET
BOTOL
TUBE
PCS
PCS
PCS
VIAL
BOTOL
VIAL
VIAL
SET
SET
TUBE
PCS
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
PCS
BOTOL
UMLAH KUNJUNGAN RESEP
UMUM
TIDAK BAYAR
BAYAR
Mengetahui
Kepala Puskemas
..
NIP. ..
BPJS
AN OBAT PUSKESMAS
BULAN
Terima
TAHUN
No. Dok
Input
B.A
PEMAKAIAN
STOK
OPT
SISA STOK
-
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
PERMINTAAN
-
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
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
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
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
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
JUMLAH
Yang Menyerahkan
NIP. .
NIP. 19781130 200012 2 001
PEMBERIAN
KETERANGAN
Yang Menyerahkan
IP. 19781130 200012 2 001
LAPORAN PENGGUNAAN OBAT PSIKOTROPI

NAMA PUSKESMAS
ALAMAT
TELP
:
:
:
NO
NAMA OBAT
SATUAN
SALDO
AWAL
1
2
3
4
5
6
7
8
9
10

CLOBAZAM TAB 10 MG
DIAZEPAM TABLET 2MG
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
AMPUL
AMPUL
Kepala Puskesmas .
..
NIP. .
AT PSIKOTROPIKA
BULAN
TAHUN
PEMASUKAN
DARI
JUMLAH
5
0
0
0
0
0
0
0
0
:
:
PENGGUNAAN
UNTUK JUMLAH
7
0
0
0
0
0
0
0
0
Penanggung Jawab
..
NIP. .
SALDO
AKHIR
9
NO
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
49
50
48
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
200
201
202
203
204
205
206
207
208
209
210
211
212
213
214
215
216
217
218
219
220
221
222
223
224
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239
240
241
242
243
244
245
246
247
248
249
250
251
252
253
254
255
256
257
258
259
260
261
262
263
264
265
266
267
268
269
270
271
272
273
274
275
276
277
278
279
280
281
282
283
284
285
286
287
288
289
290
291
292
293
294
295
296
297
298
299
300
301
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320
321
322
323
324
325
326
327
328
329
330
331
332
333
334
335
336
337
338
339
340
341
342
343
344
345
346
347
348
349
350
351
352
353
354
355
356
357
358
359
360
361
362
363
364
365
366
367
368
369
370
371
372
373
374
375
376
377
378
379
380
381
382
383
384
385
386
387
388
389
390
391
392
393
394
395
396
NAMA OBAT-OBATAN

AMBROXOL TAB. 30 MG
AMLODIPIN 10 MG
AMLODIPIN 5 MG
BETAHISTIN MALEAT
CLOBAZAM TAB 10 MG
CLOPIDOGREL 75 MG
CO AMOXICLAV 625 MG
DIAZEPAM TABLET 2MG
DOKSISIKLIN 100 MG

ERYTROMISIN 250 MG
ERYTROMISIN 500 MG
FUROSEMID TAB.40 MG
HALOPERIDOL 2 MG
KAPTOPRIL 12,5 MG
KAPTOPRIL 25 MG
KAPTOPRIL 50 MG
KLINDAMSIN 150 MG
LOPERAMIDE HCL 2 MG
METFORMIN 500 MG

METOKLOPRAMID 10 MG
MULTIVITAMIN TABLET
NIFEDIPINE 10 MG
OMEPRAZOL KAP 20 MG
PIROXICAM 10 MG
PIROXICAM 20 MG
PREDNISON TAB.5 MG
PRIMAKUIN TAB.15 MG
RIFAMPICIN 450 MG
RIFAMPICIN 600 MG
RISPERIDON TAB 2 MG
SALBUTAMOL 4 MG
SIMETIDIN TABLET
THROMBO ASPILETS
TRIFLUOPERAZIN 5 MG
ZINC TABLET
BISOLVON DROP
CITRIZINE SYRUP
ERYTROMISIN SYRUP
HALOPERIDOL DROP
IBUPROFEN SUSPENSI
PARASETAMOL DROP
THIAMFENICOL SYR
ZINK DROP
ZINK SYRUP
AQUA PRO INJEKSI
ASAM TRANEXAMAT INJ
D5 + 1/4 NS
DOPAMIN INJ
ETANOL 70 %
EUGENOL CAIRAN
FUROSEMID INJ 10 ML

HALOPERIDOL INJEKSI
LIDOKAIN INJ. 2%
MENADION K3 INJ
PEHACAIN INJ
PIRACETAM INJ 1 GR
SEFTRIAXON INJ
VENTOLIN NEBU
ALBOTHYL
ASIKLOVIR KRIM

MIKONAZOLE SALEP
SALEP 2-4 KOMB.
SALISIL BEDAK 2 %
SCABIMITE KRIM
BISTURI NO. 12
BLOOD LANCET
BOX SLIDE
INFUS SET ANAK
INFUS SET DEWASA
IV CATHETER NO. 18
IV CATHETER NO. 20
IV CATHETER NO. 22
IV CATHETER NO. 24
IV CATHETER NO. 26
JARUM KULIT
JARUM OTOT
KACA SLIDE
KAPAS 1 KG
KERTAS EKG
LARUTAN ANISOL
LARUTAN BENEDICT
LARUTAN EDTA 100 ml
LARUTAN EOSIN 2 %
LARUTAN ETANOL ASAM
LARUTAN H2O2
LARUTAN HCL 0,1 N
LARUTAN HAYEM
LARUTAN METANOL
LARUTAN TURK
MASKER KARET
MASKER TALI
MINYAK IMERSI
NEEDLE 23
NEEDLE 24
NELATON CATHETHER
PENJEPIT TALI PUSAT
PROPILEN GLIKOL
RAPID TES PROTEIN
RDT TYPUS
RDT HIV/AIDS
REESECHER
SELANG OKSIGEN ANAK
SELANG OKSIGEN BAYI
TEST DENGUE DEVICE
TEST HBsAG STRIP
TEST HCG STRIP
TEST MALARIA DEVICE
THREE WAY
TRANFUSI SET
UNDERPAD
URINAL PRIA
URINAL WANITA
URINE BAG
VASELIN
WING NEEDLE 23
WING NEEDLE 27
ARTICULATING PAPER
BONDING SINGLE BOND
CAVITON ATFLETCHER
CELLULOID STRIP
ETCHING
FUJI 9 ART (MINI)
FUJI II LC
FUJI IX GC
FUJI IX GP
FUJI VII GC WHITE
MICRO BRUSH
OCHO
SALIVA EJECTOR
AMINOFLUID
ASERING
VERAPAMIL 50 MG
BISOPPROLOL TAB 5MG
DILTIAZEM
ASAM FOLAT 1 MG
SULFASALAZINE
GLICLAZID
IRBESARTAN
GEMFIBROZIL
AMIODARON
GLIMEPIRID
MELOXICAM 15
KODEIN TABLET
COMBIVEN NEBU
CLEVER CHECK
CELL CLEAN
MASKER RESPIRATOR
HYPAFIX
PIPET TETES
THERMAROL
NOVOMIX PENFLEX
ISONIAZID TAB 30 MG
lipid panel test
alkohol swab
lysol
CELL PACK
STOMALYZER
JARUM AUTO CLICK
ALAT SUNTIK 0.05ML

ALAT SUNTIK 0.5ML
ANTRAIN INJ
AQUA GEL
ARTEM INJ
CITICOLLIN INJ
DIAMOND BOOR SET M
DIAMOND BOOR SET S
FEEDING TUBE
FISURE LANCIP LONG
KANDISTATIN

SUAB TENGGOROKAN
MINIOCEP

BULAN JANUARI 2016
KEMASAN
TANGGAL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
BUNGKUS
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
KAPSUL
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
AMPUL
VIAL
AMPUL
VIAL
AMPUL
AMPUL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
BOTOL
BOTOL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
VIAL
VIAL
AMPUL
AMPUL
BOTOL
VIAL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
VIAL
VIAL
VIAL
VIAL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
VIAL
BOTOL
TUBE
TUBE
TUBE
SUPP
SUPP
TUBE
BOTOL
BOTOL
TUBE
BOTOL
BOTOL
TUBE
TUBE
BOTOL
BOTOL
TUBE
TUBE
TUBE
POT
KOTAK
BOTOL
TUBE
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
KOTAK
KOTAK
KOTAK
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
BOTOL
SET
BUNGKUS
BUNGKUS
BUNGKUS
ROLL
ROLL
ROLL
ROLL
ROLL
KOTAK
ROLL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
SET
SET
BOTOL
ROLL
SET
SET
SET
PCS
BOTOL
SET
SET
SET
SET
ROLL
BOTOL
SET
SET
SET
BOTOL
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
BOTOL
PCS
SET
SET
SET
SET
SET
SET
BOTOL
SET
SET
BOTOL
PCS
BOTOL
BOTOL
SET
SET
SET
SET
SET
ROLL
BOTOL
BOTOL
BUNGKUS
SET
SET
KOTAK
BOTOL
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
TABLET
PCS
KOTAK
PCS
PCS
BOTOL
KOTAK
SET
BOTOL
TUBE
PCS
PCS
PCS
VIAL
BOTOL
VIAL
VIAL
SET
SET
TUBE
PCS
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
PCS
BOTOL
T KE PELAYANAN

10
11
12
13
14
15
N / HARI
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
NAMA
PUSTU
NAMA
PUSTU
NAMA
PUSTU
NAMA
PUSTU

NAMA
NAMA
POLINDES POLINDES
NAMA
POLINDES
NAMA
POLINDES
JUMLAH
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
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
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
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
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
LAPORAN PEMAKAIAN
KODE PUSKESMAS
PUSKESMAS
KECAMATAN
KABUPATEN / KOTA
:
:
NO
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
NAMA OBAT

AMBROXOL TAB. 30 MG
AMLODIPIN 10 MG
AMLODIPIN 5 MG
BETAHISTIN MALEAT
CLOBAZAM TAB 10 MG
CLOPIDOGREL 75 MG
CO AMOXICLAV 625 MG
DIAZEPAM TABLET 2MG
DOKSISIKLIN 100 MG
SATUAN /
KEMASAN
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
36
37
38
39
40
41
42
43
44
45
46
47
49
50
48
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80

ERYTROMISIN 250 MG
ERYTROMISIN 500 MG
FUROSEMID TAB.40 MG
HALOPERIDOL 2 MG
KAPTOPRIL 12,5 MG
KAPTOPRIL 25 MG
KAPTOPRIL 50 MG
KLINDAMSIN 150 MG
LOPERAMIDE HCL 2 MG
METFORMIN 500 MG
METOKLOPRAMID 10 MG
TABLET
KAPSUL
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
BUNGKUS
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
MULTIVITAMIN TABLET
NIFEDIPINE 10 MG
OMEPRAZOL KAP 20 MG
PIROXICAM 10 MG
PIROXICAM 20 MG
PREDNISON TAB.5 MG
PRIMAKUIN TAB.15 MG
RIFAMPICIN 450 MG
RIFAMPICIN 600 MG
RISPERIDON TAB 2 MG
SALBUTAMOL 4 MG
SIMETIDIN TABLET
THROMBO ASPILETS
TRIFLUOPERAZIN 5 MG
ZINC TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
KAPSUL
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141

BISOLVON DROP
CITRIZINE SYRUP
ERYTROMISIN SYRUP
HALOPERIDOL DROP
IBUPROFEN SUSPENSI
PARASETAMOL DROP
THIAMFENICOL SYR
ZINK DROP
ZINK SYRUP
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168

AQUA PRO INJEKSI
ASAM TRANEXAMAT INJ
D5 + 1/4 NS
DOPAMIN INJ
ETANOL 70 %
EUGENOL CAIRAN
FUROSEMID INJ 10 ML
HALOPERIDOL INJEKSI
AMPUL
VIAL
AMPUL
VIAL
AMPUL
AMPUL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
BOTOL
BOTOL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194

LIDOKAIN INJ. 2%
MENADION K3 INJ
PEHACAIN INJ
PIRACETAM INJ 1 GR
SEFTRIAXON INJ
VENTOLIN NEBU
AMPUL
AMPUL
AMPUL
VIAL
VIAL
AMPUL
AMPUL
BOTOL
VIAL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
VIAL
VIAL
VIAL
VIAL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
VIAL
195
196
197
198
199
200
201
202
203
204
205
206
207
208
209
210
211
212
ALBOTHYL
ASIKLOVIR KRIM
MIKONAZOLE SALEP
BOTOL
TUBE
TUBE
TUBE
SUPP
SUPP
TUBE
BOTOL
BOTOL
TUBE
BOTOL
BOTOL
TUBE
TUBE
BOTOL
BOTOL
TUBE
TUBE
213
214
215
216
217

SALEP 2-4 KOMB.
SALISIL BEDAK 2 %
SCABIMITE KRIM
TUBE
POT
KOTAK
BOTOL
TUBE
218
219
220
221
222
223
224
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239
240
241
242
243
244
245
246
247
248
249
250
251
252
253
254
255

BLOOD LANCET
BOX SLIDE
INFUS SET ANAK
INFUS SET DEWASA
IV CATHETER NO. 18
IV CATHETER NO. 20
IV CATHETER NO. 22
IV CATHETER NO. 24
IV CATHETER NO. 26
JARUM KULIT
JARUM OTOT
KACA SLIDE
KAPAS 1 KG
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
KOTAK
KOTAK
KOTAK
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
BOTOL
SET
BUNGKUS
BUNGKUS
BUNGKUS
ROLL
ROLL
ROLL
256
257
258
259
260
261
262
263
264
265
266
267
268
269
270
271
272
273
274
275
276
277
278
279
280
281
282
283
284
285
286
287
288
289
290
291
292
293
294
295
296
297
298
299
300

KERTAS EKG
LARUTAN ANISOL
LARUTAN BENEDICT
LARUTAN EDTA 100 ml
LARUTAN EOSIN 2 %
LARUTAN ETANOL ASAM
LARUTAN H2O2
LARUTAN HCL 0,1 N
LARUTAN HAYEM
LARUTAN METANOL
LARUTAN TURK
MASKER KARET
MASKER TALI
MINYAK IMERSI
NEEDLE 23
NEEDLE 24
NELATON CATHETHER
PENJEPIT TALI PUSAT
PROPILEN GLIKOL
RAPID TES PROTEIN
RDT TYPUS
RDT HIV/AIDS
REESECHER
SELANG OKSIGEN ANAK
SELANG OKSIGEN BAYI
ROLL
ROLL
KOTAK
ROLL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
SET
SET
BOTOL
ROLL
SET
SET
SET
PCS
BOTOL
SET
SET
SET
SET
ROLL
BOTOL
SET
SET
SET
BOTOL
SET
SET
SET
SET
301
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320
321
322
323
324
325
326
327
328
329
330
331
332
333
334
335
336
337
338
339
340
341
342
343
344
345

TEST DENGUE DEVICE
TEST HBsAG STRIP
TEST HCG STRIP
TEST MALARIA DEVICE
THREE WAY
TRANFUSI SET
UNDERPAD
URINAL PRIA
URINAL WANITA
URINE BAG
VASELIN
WING NEEDLE 23
WING NEEDLE 27
ARTICULATING PAPER
BONDING SINGLE BOND
CAVITON ATFLETCHER
CELLULOID STRIP
ETCHING
FUJI 9 ART (MINI)
FUJI II LC
FUJI IX GC
FUJI IX GP
FUJI VII GC WHITE
MICRO BRUSH
OCHO
SALIVA EJECTOR
AMINOFLUID
ASERING
VERAPAMIL 50 MG
BISOPPROLOL TAB 5MG
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
BOTOL
PCS
SET
SET
SET
SET
SET
SET
BOTOL
SET
SET
BOTOL
PCS
BOTOL
BOTOL
SET
SET
SET
SET
SET
ROLL
BOTOL
BOTOL
BUNGKUS
SET
SET
KOTAK
BOTOL
PCS
PCS
PCS
PCS
PCS
TABLET
PCS
346
347
348
349
350
351
352
353
354
355
356
357
358
359
360
361
362
363
364
365
366
367
368
369
370
371
372
373
374
375
376
377
378
379
380
381
382
383
384
385
386
387
388
389
390
DILTIAZEM
ASAM FOLAT 1 MG
SULFASALAZINE
GLICLAZID
IRBESARTAN
GEMFIBROZIL
AMIODARON
GLIMEPIRID
MELOXICAM 15
KODEIN TABLET
COMBIVEN NEBU
CLEVER CHECK
CELL CLEAN
MASKER RESPIRATOR
HYPAFIX
PIPET TETES
THERMAROL
NOVOMIX PENFLEX
ISONIAZID TAB 30 MG
lipid panel test
alkohol swab
lysol
CELL PACK
STOMALYZER
JARUM AUTO CLICK
ALAT SUNTIK 0.05ML
ALAT SUNTIK 0.5ML
ANTRAIN INJ
AQUA GEL
ARTEM INJ
CITICOLLIN INJ
DIAMOND BOOR SET M
DIAMOND BOOR SET S
FEEDING TUBE
FISURE LANCIP LONG
KANDISTATIN
PCS
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
VIAL
PCS
PCS
PCS
PCS
PCS
PCS
PCS
TABLET
PCS
KOTAK
PCS
PCS
BOTOL
KOTAK
SET
BOTOL
TUBE
PCS
PCS
PCS
VIAL
BOTOL
VIAL
VIAL
SET
SET
TUBE
PCS
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
391
392
393
394
395
396

BOTOL
BOTOL

BOTOL
BOTOL
PCS
BOTOL
SUAB TENGGOROKAN
MINIOCEP

NIP. 19830624 201001 2 007
RAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT PUSKESMAS

BULAN
TAHUN
STOK
AWAL
PENERIMAAN
PERSEDIAAN
PEMAKAIAN
UMUM
TIDAK BAYAR
BAYAR
BPJS
JUMLAH
Mengetahui
Kepala Puskemas
..
NIP. ..
NIP. .
AT PUSKESMAS
Terima
No. Dok
Input
B.A
STOK
OPT
SISA STOK
PERMINTAAN
PEMBERIANKETERANGAN
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
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
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
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
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
Yang Menyerahkan
NIP. .
NIP. 19781130 200012 2 001
LAPORAN PENGGUNAAN OBAT PSIK

NAMA PUSKESMAS
ALAMAT
TELP
:
:
:
NO
NAMA OBAT
SATUAN
SALDO
AWAL
1
2
3
4
5
6
7
8
9
10

CLOBAZAM TAB 10 MG
DIAZEPAM TABLET 2MG
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
AMPUL
AMPUL
Kepala Puskesmas .
..
NIP. .
AN OBAT PSIKOTROPIKA
:
:
BULAN
TAHUN
PEMASUKAN
DARI
JUMLAH
5
0
0
0
0
0
0
0
0
PENGGUNAAN
UNTUK
JUMLAH
7
0
0
0
0
0
0
0
0
Penanggung Jawab
..
NIP. .
SALDO
AKHIR
9
NO
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
49
50
48
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
200
201
202
203
204
205
206
207
208
209
210
211
212
213
214
215
216
217
218
219
220
221
222
223
224
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239
240
241
242
243
244
245
246
247
248
249
250
251
252
253
254
255
256
257
258
259
260
261
262
263
264
265
266
267
268
269
270
271
272
273
274
275
276
277
278
279
280
281
282
283
284
285
286
287
288
289
290
291
292
293
294
295
296
297
298
299
300
301
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320
321
322
323
324
325
326
327
328
329
330
331
332
333
334
335
336
337
338
339
340
341
342
343
344
345
346
347
348
349
350
351
352
353
354
355
356
357
358
359
360
361
362
363
364
365
366
367
368
369
370
371
372
373
374
375
376
377
378
379
380
381
382
383
384
385
386
387
388
389
390
391
392
393
394
395
396
NAMA OBAT-OBATAN

AMBROXOL TAB. 30 MG
AMLODIPIN 10 MG
AMLODIPIN 5 MG
BETAHISTIN MALEAT
CLOBAZAM TAB 10 MG
CLOPIDOGREL 75 MG
CO AMOXICLAV 625 MG
DIAZEPAM TABLET 2MG
DOKSISIKLIN 100 MG

ERYTROMISIN 250 MG
ERYTROMISIN 500 MG
FUROSEMID TAB.40 MG
HALOPERIDOL 2 MG
KAPTOPRIL 12,5 MG
KAPTOPRIL 25 MG
KAPTOPRIL 50 MG
KLINDAMSIN 150 MG
LOPERAMIDE HCL 2 MG
METFORMIN 500 MG

METOKLOPRAMID 10 MG
MULTIVITAMIN TABLET
NIFEDIPINE 10 MG
OMEPRAZOL KAP 20 MG
PIROXICAM 10 MG
PIROXICAM 20 MG
PREDNISON TAB.5 MG
PRIMAKUIN TAB.15 MG
RIFAMPICIN 450 MG
RIFAMPICIN 600 MG
RISPERIDON TAB 2 MG
SALBUTAMOL 4 MG
SIMETIDIN TABLET
THROMBO ASPILETS
TRIFLUOPERAZIN 5 MG
ZINC TABLET
BISOLVON DROP
CITRIZINE SYRUP
ERYTROMISIN SYRUP
HALOPERIDOL DROP
IBUPROFEN SUSPENSI
PARASETAMOL DROP
THIAMFENICOL SYR
ZINK DROP
ZINK SYRUP
AQUA PRO INJEKSI
ASAM TRANEXAMAT INJ
D5 + 1/4 NS
DOPAMIN INJ
ETANOL 70 %
EUGENOL CAIRAN
FUROSEMID INJ 10 ML

HALOPERIDOL INJEKSI
LIDOKAIN INJ. 2%
MENADION K3 INJ
PEHACAIN INJ
PIRACETAM INJ 1 GR
SEFTRIAXON INJ
VENTOLIN NEBU
ALBOTHYL
ASIKLOVIR KRIM

MIKONAZOLE SALEP
SALEP 2-4 KOMB.
SALISIL BEDAK 2 %
SCABIMITE KRIM
BISTURI NO. 12
BLOOD LANCET
BOX SLIDE
INFUS SET ANAK
INFUS SET DEWASA
IV CATHETER NO. 18
IV CATHETER NO. 20
IV CATHETER NO. 22
IV CATHETER NO. 24
IV CATHETER NO. 26
JARUM KULIT
JARUM OTOT
KACA SLIDE
KAPAS 1 KG
KERTAS EKG
LARUTAN ANISOL
LARUTAN BENEDICT
LARUTAN EDTA 100 ml
LARUTAN EOSIN 2 %
LARUTAN ETANOL ASAM
LARUTAN H2O2
LARUTAN HCL 0,1 N
LARUTAN HAYEM
LARUTAN METANOL
LARUTAN TURK
MASKER KARET
MASKER TALI
MINYAK IMERSI
NEEDLE 23
NEEDLE 24
NELATON CATHETHER
PENJEPIT TALI PUSAT
PROPILEN GLIKOL
RAPID TES PROTEIN
RDT TYPUS
RDT HIV/AIDS
REESECHER
SELANG OKSIGEN ANAK
SELANG OKSIGEN BAYI
TEST DENGUE DEVICE
TEST HBsAG STRIP
TEST HCG STRIP
TEST MALARIA DEVICE
THREE WAY
TRANFUSI SET
UNDERPAD
URINAL PRIA
URINAL WANITA
URINE BAG
VASELIN
WING NEEDLE 23
WING NEEDLE 27
ARTICULATING PAPER
BONDING SINGLE BOND
CAVITON ATFLETCHER
CELLULOID STRIP
ETCHING
FUJI 9 ART (MINI)
FUJI II LC
FUJI IX GC
FUJI IX GP
FUJI VII GC WHITE
MICRO BRUSH
OCHO
SALIVA EJECTOR
AMINOFLUID
ASERING
VERAPAMIL 50 MG
BISOPPROLOL TAB 5MG
DILTIAZEM
ASAM FOLAT 1 MG
SULFASALAZINE
GLICLAZID
IRBESARTAN
GEMFIBROZIL
AMIODARON
GLIMEPIRID
MELOXICAM 15
KODEIN TABLET
COMBIVEN NEBU
CLEVER CHECK
CELL CLEAN
MASKER RESPIRATOR
HYPAFIX
PIPET TETES
THERMAROL
NOVOMIX PENFLEX
ISONIAZID TAB 30 MG
lipid panel test
alkohol swab
lysol
CELL PACK
STOMALYZER
JARUM AUTO CLICK
ALAT SUNTIK 0.05ML

ALAT SUNTIK 0.5ML
ANTRAIN INJ
AQUA GEL
ARTEM INJ
CITICOLLIN INJ
DIAMOND BOOR SET M
DIAMOND BOOR SET S
FEEDING TUBE
FISURE LANCIP LONG
KANDISTATIN

SUAB TENGGOROKAN
MINIOCEP

BULAN JANUARI 2016
KEMASAN
TANGGAL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
BUNGKUS
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
KAPSUL
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
AMPUL
VIAL
AMPUL
VIAL
AMPUL
AMPUL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
BOTOL
BOTOL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
VIAL
VIAL
AMPUL
AMPUL
BOTOL
VIAL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
VIAL
VIAL
VIAL
VIAL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
VIAL
BOTOL
TUBE
TUBE
TUBE
SUPP
SUPP
TUBE
BOTOL
BOTOL
TUBE
BOTOL
BOTOL
TUBE
TUBE
BOTOL
BOTOL
TUBE
TUBE
TUBE
POT
KOTAK
BOTOL
TUBE
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
KOTAK
KOTAK
KOTAK
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
BOTOL
SET
BUNGKUS
BUNGKUS
BUNGKUS
ROLL
ROLL
ROLL
ROLL
ROLL
KOTAK
ROLL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
SET
SET
BOTOL
ROLL
SET
SET
SET
PCS
BOTOL
SET
SET
SET
SET
ROLL
BOTOL
SET
SET
SET
BOTOL
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
BOTOL
PCS
SET
SET
SET
SET
SET
SET
BOTOL
SET
SET
BOTOL
PCS
BOTOL
BOTOL
SET
SET
SET
SET
SET
ROLL
BOTOL
BOTOL
BUNGKUS
SET
SET
KOTAK
BOTOL
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
TABLET
PCS
KOTAK
PCS
PCS
BOTOL
KOTAK
SET
BOTOL
TUBE
PCS
PCS
PCS
VIAL
BOTOL
VIAL
VIAL
SET
SET
TUBE
PCS
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
PCS
BOTOL
T KE PELAYANAN

10
11
12
13
14
15
IAN / HARI
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
NAMA
PUSTU
NAMA
PUSTU
NAMA
PUSTU
NAMA
PUSTU

NAMA
NAMA
POLINDES POLINDES
NAMA
POLINDES
NAMA
POLINDES
JUMLAH
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
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
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
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
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
LAPORAN PEM
KODE PUSKESMAS
PUSKESMAS
KECAMATAN
KABUPATEN / KOTA
:
:
NO
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
NAMA OBAT

AMBROXOL TAB. 30 MG
AMLODIPIN 10 MG
AMLODIPIN 5 MG
BETAHISTIN MALEAT
CLOBAZAM TAB 10 MG
CLOPIDOGREL 75 MG
CO AMOXICLAV 625 MG
DIAZEPAM TABLET 2MG
DOKSISIKLIN 100 MG
ERYTROMISIN 250 MG
ERYTROMISIN 500 MG
PUSKESMAS
KECAMATAN
41
42
43
44
45
46
47
49
50
48
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87

FUROSEMID TAB.40 MG
HALOPERIDOL 2 MG
KAPTOPRIL 12,5 MG
KAPTOPRIL 25 MG
KAPTOPRIL 50 MG
KLINDAMSIN 150 MG
LOPERAMIDE HCL 2 MG
METFORMIN 500 MG
METOKLOPRAMID 10 MG
MULTIVITAMIN TABLET
NIFEDIPINE 10 MG
PUSKESMAS
KECAMATAN
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124

OMEPRAZOL KAP 20 MG
PIROXICAM 10 MG
PIROXICAM 20 MG
PREDNISON TAB.5 MG
PRIMAKUIN TAB.15 MG
RIFAMPICIN 450 MG
RIFAMPICIN 600 MG
RISPERIDON TAB 2 MG
SALBUTAMOL 4 MG
SIMETIDIN TABLET
THROMBO ASPILETS
TRIFLUOPERAZIN 5 MG
ZINC TABLET
125
126
127
128
129
130
131
132
133

BISOLVON DROP
CITRIZINE SYRUP
ERYTROMISIN SYRUP
HALOPERIDOL DROP
IBUPROFEN SUSPENSI
PUSKESMAS
KECAMATAN
134
135
136
137
138
139
140
141

PARASETAMOL DROP
THIAMFENICOL SYR
ZINK DROP
ZINK SYRUP
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179

AQUA PRO INJEKSI
ASAM TRANEXAMAT INJ
D5 + 1/4 NS
DOPAMIN INJ
ETANOL 70 %
EUGENOL CAIRAN
FUROSEMID INJ 10 ML
HALOPERIDOL INJEKSI
LIDOKAIN INJ. 2%
MENADION K3 INJ
PUSKESMAS
KECAMATAN
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194
PEHACAIN INJ
PIRACETAM INJ 1 GR
SEFTRIAXON INJ
VENTOLIN NEBU
195
196
197
198
199
200
201
202
203
204
205
206
207
208
209
210
211
212
213
214
215
216
217
ALBOTHYL
ASIKLOVIR KRIM
MIKONAZOLE SALEP
SALEP 2-4 KOMB.
SALISIL BEDAK 2 %
SCABIMITE KRIM
218
219
220
221
222
223
224

BLOOD LANCET
PUSKESMAS
KECAMATAN
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239
240
241
242
243
244
245
246
247
248
249
250
251
252
253
254
255
256
257
258
259
260
261
262
263
264
265
266
267
268
269
270
271
BOX SLIDE
INFUS SET ANAK
INFUS SET DEWASA
IV CATHETER NO. 18
IV CATHETER NO. 20
IV CATHETER NO. 22
IV CATHETER NO. 24
IV CATHETER NO. 26
JARUM KULIT
JARUM OTOT
KACA SLIDE
KAPAS 1 KG
KERTAS EKG
LARUTAN ANISOL
LARUTAN BENEDICT
LARUTAN EDTA 100 ml
LARUTAN EOSIN 2 %
LARUTAN ETANOL ASAM
LARUTAN H2O2
LARUTAN HCL 0,1 N
LARUTAN HAYEM
PUSKESMAS
KECAMATAN
272
273
274
275
276
277
278
279
280
281
282
283
284
285
286
287
288
289
290
291
292
293
294
295
296
297
298
299
300
301
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
318
319
LARUTAN METANOL
LARUTAN TURK
MASKER KARET
MASKER TALI
MINYAK IMERSI
NEEDLE 23
NEEDLE 24
NELATON CATHETHER
PENJEPIT TALI PUSAT
PROPILEN GLIKOL
RAPID TES PROTEIN
RDT TYPUS
RDT HIV/AIDS
REESECHER
SELANG OKSIGEN ANAK
SELANG OKSIGEN BAYI
TEST DENGUE DEVICE
TEST HBsAG STRIP
TEST HCG STRIP
TEST MALARIA DEVICE
THREE WAY
TRANFUSI SET
UNDERPAD
URINAL PRIA
URINAL WANITA
URINE BAG
VASELIN
WING NEEDLE 23
WING NEEDLE 27
PUSKESMAS
KECAMATAN
320
321
322
323
324
325
326
327
328
329
330
331
332
333
334
335
336
337
338
339
340
341
342
343
344
345
346
347
348
349
350
351
352
353
354
355
356
357
358
359
360
361
362
363
364
365
366
367
ARTICULATING PAPER
BONDING SINGLE BOND
CAVITON ATFLETCHER
CELLULOID STRIP
ETCHING
FUJI 9 ART (MINI)
FUJI II LC
FUJI IX GC
FUJI IX GP
FUJI VII GC WHITE
MICRO BRUSH
OCHO
SALIVA EJECTOR
AMINOFLUID
ASERING
VERAPAMIL 50 MG
BISOPPROLOL TAB 5MG
DILTIAZEM
ASAM FOLAT 1 MG
SULFASALAZINE
GLICLAZID
IRBESARTAN
GEMFIBROZIL
AMIODARON
GLIMEPIRID
MELOXICAM 15
KODEIN TABLET
COMBIVEN NEBU
CLEVER CHECK
CELL CLEAN
MASKER RESPIRATOR
HYPAFIX
PIPET TETES
THERMAROL
NOVOMIX PENFLEX
ISONIAZID TAB 30 MG
lipid panel test
PUSKESMAS
KECAMATAN
368
369
370
371
372
373
374
375
376
377
378
379
380
381
382
383
384
385
386
387
388
389
390
391
392
393
394
395
396
alkohol swab
lysol
CELL PACK
STOMALYZER
JARUM AUTO CLICK
ALAT SUNTIK 0.05ML
ALAT SUNTIK 0.5ML
ANTRAIN INJ
AQUA GEL
ARTEM INJ
CITICOLLIN INJ
DIAMOND BOOR SET M
DIAMOND BOOR SET S
FEEDING TUBE
FISURE LANCIP LONG
KANDISTATIN

SUAB TENGGOROKAN
MINIOCEP

NIP. 19830624 201001 2 007
PORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT PUSKESMAS

BULAN
TAHUN
SATUAN /
KEMASAN
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
KAPSUL
STOK
AWAL
PENERIMAAN
PERSEDIAAN
PEMAKAIAN
TAHUN
TABLET
TABLET
TABLET
BUNGKUS
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TAHUN
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
KAPSUL
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
TAHUN
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
AMPUL
VIAL
AMPUL
VIAL
AMPUL
AMPUL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
BOTOL
BOTOL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
VIAL
VIAL
AMPUL
AMPUL
BOTOL
VIAL
AMPUL
AMPUL
TAHUN
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
VIAL
VIAL
VIAL
VIAL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
VIAL
BOTOL
TUBE
TUBE
TUBE
SUPP
SUPP
TUBE
BOTOL
BOTOL
TUBE
BOTOL
BOTOL
TUBE
TUBE
BOTOL
BOTOL
TUBE
TUBE
TUBE
POT
KOTAK
BOTOL
TUBE
SET
SET
SET
SET
SET
SET
SET
TAHUN
SET
SET
SET
SET
SET
SET
SET
KOTAK
KOTAK
KOTAK
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
BOTOL
SET
BUNGKUS
BUNGKUS
BUNGKUS
ROLL
ROLL
ROLL
ROLL
ROLL
KOTAK
ROLL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
TAHUN
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
SET
SET
BOTOL
ROLL
SET
SET
SET
PCS
BOTOL
SET
SET
SET
SET
ROLL
BOTOL
SET
SET
SET
BOTOL
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
BOTOL
PCS
SET
SET
SET
SET
SET
SET
BOTOL
TAHUN
SET
SET
BOTOL
PCS
BOTOL
BOTOL
SET
SET
SET
SET
SET
ROLL
BOTOL
BOTOL
BUNGKUS
SET
SET
KOTAK
BOTOL
PCS
PCS
PCS
PCS
PCS
TABLET
PCS
PCS
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
VIAL
PCS
PCS
PCS
PCS
PCS
PCS
PCS
TABLET
PCS
KOTAK
PCS
TAHUN
PCS
BOTOL
KOTAK
SET
BOTOL
TUBE
PCS
PCS
PCS
VIAL
BOTOL
VIAL
VIAL
SET
SET
TUBE
PCS
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
PCS
BOTOL
UMUM
TIDAK BAYAR
BAYAR
BPJS
JUMLAH
Mengetahui
Yang Meminta / Melap
Kepala Puskemas
Petugas Obat Puskesm
..
NIP. ..
NIP.
ESMAS
Terima
No. Dok
Input
B.A
STOK
OPT
SISA STOK
PERMINTAAN
PEMBERIANKETERANGAN
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
No. Dok
Input
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
No. Dok
Input
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
No. Dok
Input
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
No. Dok
Input
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
No. Dok
Input
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
No. Dok
Input
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
No. Dok
Input
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
No. Dok
Input
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
Yang Menyerahkan
NIP. .
NIP. 19781130 200012 2 001
LAPORAN PENGGUNAAN OBAT PSIKO

NAMA PUSKESMAS
ALAMAT
TELP
:
:
:
NO
NAMA OBAT
SATUAN
SALDO
AWAL
1
2
3
4
5
6
7
8
9
10

CLOBAZAM TAB 10 MG
DIAZEPAM TABLET 2MG
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
AMPUL
AMPUL
Kepala Puskesmas .
..
NIP. .
AN OBAT PSIKOTROPIKA
:
:
BULAN
TAHUN
PEMASUKAN
DARI
JUMLAH
5
0
0
0
0
0
0
0
0
PENGGUNAAN
UNTUK
JUMLAH
7
0
0
0
0
0
0
0
0
Penanggung Jawab
..
NIP. .
SALDO
AKHIR
9
NO
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
49
50
48
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
200
201
202
203
204
205
206
207
208
209
210
211
212
213
214
215
216
217
218
219
220
221
222
223
224
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239
240
241
242
243
244
245
246
247
248
249
250
251
252
253
254
255
256
257
258
259
260
261
262
263
264
265
266
267
268
269
270
271
272
273
274
275
276
277
278
279
280
281
282
283
284
285
286
287
288
289
290
291
292
293
294
295
296
297
298
299
300
301
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320
321
322
323
324
325
326
327
328
329
330
331
332
333
334
335
336
337
338
339
340
341
342
343
344
345
346
347
348
349
350
351
352
353
354
355
356
357
358
359
360
361
362
363
364
365
366
367
368
369
370
371
372
373
374
375
376
377
378
379
380
381
382
383
384
385
386
387
388
389
390
391
392
393
394
395
396
NAMA OBAT-OBATAN

AMBROXOL TAB. 30 MG
AMLODIPIN 10 MG
AMLODIPIN 5 MG
BETAHISTIN MALEAT
CLOBAZAM TAB 10 MG
CLOPIDOGREL 75 MG
CO AMOXICLAV 625 MG
DIAZEPAM TABLET 2MG
DOKSISIKLIN 100 MG

ERYTROMISIN 250 MG
ERYTROMISIN 500 MG
FUROSEMID TAB.40 MG
HALOPERIDOL 2 MG
KAPTOPRIL 12,5 MG
KAPTOPRIL 25 MG
KAPTOPRIL 50 MG
KLINDAMSIN 150 MG
LOPERAMIDE HCL 2 MG
METFORMIN 500 MG

METOKLOPRAMID 10 MG
MULTIVITAMIN TABLET
NIFEDIPINE 10 MG
OMEPRAZOL KAP 20 MG
PIROXICAM 10 MG
PIROXICAM 20 MG
PREDNISON TAB.5 MG
PRIMAKUIN TAB.15 MG
RIFAMPICIN 450 MG
RIFAMPICIN 600 MG
RISPERIDON TAB 2 MG
SALBUTAMOL 4 MG
SIMETIDIN TABLET
THROMBO ASPILETS
TRIFLUOPERAZIN 5 MG
ZINC TABLET
BISOLVON DROP
CITRIZINE SYRUP
ERYTROMISIN SYRUP
HALOPERIDOL DROP
IBUPROFEN SUSPENSI
PARASETAMOL DROP
THIAMFENICOL SYR
ZINK DROP
ZINK SYRUP
AQUA PRO INJEKSI
ASAM TRANEXAMAT INJ
D5 + 1/4 NS
DOPAMIN INJ
ETANOL 70 %
EUGENOL CAIRAN
FUROSEMID INJ 10 ML

HALOPERIDOL INJEKSI
LIDOKAIN INJ. 2%
MENADION K3 INJ
PEHACAIN INJ
PIRACETAM INJ 1 GR
SEFTRIAXON INJ
VENTOLIN NEBU
ALBOTHYL
ASIKLOVIR KRIM

MIKONAZOLE SALEP
SALEP 2-4 KOMB.
SALISIL BEDAK 2 %
SCABIMITE KRIM
BISTURI NO. 12
BLOOD LANCET
BOX SLIDE
INFUS SET ANAK
INFUS SET DEWASA
IV CATHETER NO. 18
IV CATHETER NO. 20
IV CATHETER NO. 22
IV CATHETER NO. 24
IV CATHETER NO. 26
JARUM KULIT
JARUM OTOT
KACA SLIDE
KAPAS 1 KG
KERTAS EKG
LARUTAN ANISOL
LARUTAN BENEDICT
LARUTAN EDTA 100 ml
LARUTAN EOSIN 2 %
LARUTAN ETANOL ASAM
LARUTAN H2O2
LARUTAN HCL 0,1 N
LARUTAN HAYEM
LARUTAN METANOL
LARUTAN TURK
MASKER KARET
MASKER TALI
MINYAK IMERSI
NEEDLE 23
NEEDLE 24
NELATON CATHETHER
PENJEPIT TALI PUSAT
PROPILEN GLIKOL
RAPID TES PROTEIN
RDT TYPUS
RDT HIV/AIDS
REESECHER
SELANG OKSIGEN ANAK
SELANG OKSIGEN BAYI
TEST DENGUE DEVICE
TEST HBsAG STRIP
TEST HCG STRIP
TEST MALARIA DEVICE
THREE WAY
TRANFUSI SET
UNDERPAD
URINAL PRIA
URINAL WANITA
URINE BAG
VASELIN
WING NEEDLE 23
WING NEEDLE 27
ARTICULATING PAPER
BONDING SINGLE BOND
CAVITON ATFLETCHER
CELLULOID STRIP
ETCHING
FUJI 9 ART (MINI)
FUJI II LC
FUJI IX GC
FUJI IX GP
FUJI VII GC WHITE
MICRO BRUSH
OCHO
SALIVA EJECTOR
AMINOFLUID
ASERING
VERAPAMIL 50 MG
BISOPPROLOL TAB 5MG
DILTIAZEM
ASAM FOLAT 1 MG
SULFASALAZINE
GLICLAZID
IRBESARTAN
GEMFIBROZIL
AMIODARON
GLIMEPIRID
MELOXICAM 15
KODEIN TABLET
COMBIVEN NEBU
CLEVER CHECK
CELL CLEAN
MASKER RESPIRATOR
HYPAFIX
PIPET TETES
THERMAROL
NOVOMIX PENFLEX
ISONIAZID TAB 30 MG
lipid panel test
alkohol swab
lysol
CELL PACK
STOMALYZER
JARUM AUTO CLICK
ALAT SUNTIK 0.05ML

ALAT SUNTIK 0.5ML
ANTRAIN INJ
AQUA GEL
ARTEM INJ
CITICOLLIN INJ
DIAMOND BOOR SET M
DIAMOND BOOR SET S
FEEDING TUBE
FISURE LANCIP LONG
KANDISTATIN

SUAB TENGGOROKAN
MINIOCEP

BULAN JANUARI 2016
KEMASAN
TANGGAL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
BUNGKUS
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
KAPSUL
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
AMPUL
VIAL
AMPUL
VIAL
AMPUL
AMPUL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
BOTOL
BOTOL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
VIAL
VIAL
AMPUL
AMPUL
BOTOL
VIAL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
VIAL
VIAL
VIAL
VIAL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
VIAL
BOTOL
TUBE
TUBE
TUBE
SUPP
SUPP
TUBE
BOTOL
BOTOL
TUBE
BOTOL
BOTOL
TUBE
TUBE
BOTOL
BOTOL
TUBE
TUBE
TUBE
POT
KOTAK
BOTOL
TUBE
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
KOTAK
KOTAK
KOTAK
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
BOTOL
SET
BUNGKUS
BUNGKUS
BUNGKUS
ROLL
ROLL
ROLL
ROLL
ROLL
KOTAK
ROLL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
SET
SET
BOTOL
ROLL
SET
SET
SET
PCS
BOTOL
SET
SET
SET
SET
ROLL
BOTOL
SET
SET
SET
BOTOL
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
BOTOL
PCS
SET
SET
SET
SET
SET
SET
BOTOL
SET
SET
BOTOL
PCS
BOTOL
BOTOL
SET
SET
SET
SET
SET
ROLL
BOTOL
BOTOL
BUNGKUS
SET
SET
KOTAK
BOTOL
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
TABLET
PCS
KOTAK
PCS
PCS
BOTOL
KOTAK
SET
BOTOL
TUBE
PCS
PCS
PCS
VIAL
BOTOL
VIAL
VIAL
SET
SET
TUBE
PCS
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
PCS
BOTOL
T KE PELAYANAN

10
11
12
13
14
15
N / HARI
16
17
18
19
20
21
22
23
24
25
26
27
28
29
PENGELU
30
31
NAMA
PUSTU
NAMA
PUSTU
NAMA
PUSTU
NAMA
PUSTU
NAMA
POLINDES

NAMA
NAMA
POLINDES POLINDES
NAMA
POLINDES
JUMLAH
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
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
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
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
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
LAPORAN PE
KODE PUSKESMAS
PUSKESMAS
KECAMATAN
KABUPATEN / KOTA
NO
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
NAMA OBAT

AMBROXOL TAB. 30 MG
AMLODIPIN 10 MG
AMLODIPIN 5 MG
BETAHISTIN MALEAT
CLOBAZAM TAB 10 MG
CLOPIDOGREL 75 MG
CO AMOXICLAV 625 MG
DIAZEPAM TABLET 2MG
DOKSISIKLIN 100 MG
ERYTROMISIN 250 MG
ERYTROMISIN 500 MG
40
41
42
43
44
45
46
47
49
50
48
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87

FUROSEMID TAB.40 MG
HALOPERIDOL 2 MG
KAPTOPRIL 12,5 MG
KAPTOPRIL 25 MG
KAPTOPRIL 50 MG
KLINDAMSIN 150 MG
LOPERAMIDE HCL 2 MG
METFORMIN 500 MG
METOKLOPRAMID 10 MG
MULTIVITAMIN TABLET
NIFEDIPINE 10 MG
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124

OMEPRAZOL KAP 20 MG
PIROXICAM 10 MG
PIROXICAM 20 MG
PREDNISON TAB.5 MG
PRIMAKUIN TAB.15 MG
RIFAMPICIN 450 MG
RIFAMPICIN 600 MG
RISPERIDON TAB 2 MG
SALBUTAMOL 4 MG
SIMETIDIN TABLET
THROMBO ASPILETS
TRIFLUOPERAZIN 5 MG
ZINC TABLET
125
126
127
128
129
130
131
132
133
134

BISOLVON DROP
CITRIZINE SYRUP
ERYTROMISIN SYRUP
HALOPERIDOL DROP
IBUPROFEN SUSPENSI
135
136
137
138
139
140
141

PARASETAMOL DROP
THIAMFENICOL SYR
ZINK DROP
ZINK SYRUP
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181

AQUA PRO INJEKSI
ASAM TRANEXAMAT INJ
D5 + 1/4 NS
DOPAMIN INJ
ETANOL 70 %
EUGENOL CAIRAN
FUROSEMID INJ 10 ML
HALOPERIDOL INJEKSI
LIDOKAIN INJ. 2%
MENADION K3 INJ
PEHACAIN INJ
182
183
184
185
186
187
188
189
190
191
192
193
194
PIRACETAM INJ 1 GR
SEFTRIAXON INJ
VENTOLIN NEBU
195
196
197
198
199
200
201
202
203
204
205
206
207
208
209
210
211
212
213
214
215
216
217
ALBOTHYL
ASIKLOVIR KRIM
MIKONAZOLE SALEP
SALEP 2-4 KOMB.
SALISIL BEDAK 2 %
SCABIMITE KRIM
218
219
220
221
222
223
224
225
226
227

BLOOD LANCET
BOX SLIDE
228
229
230
231
232
233
234
235
236
237
238
239
240
241
242
243
244
245
246
247
248
249
250
251
252
253
254
255
256
257
258
259
260
261
262
263
264
265
266
267
268
269
270
271
272
273
274
275

INFUS SET ANAK
INFUS SET DEWASA
IV CATHETER NO. 18
IV CATHETER NO. 20
IV CATHETER NO. 22
IV CATHETER NO. 24
IV CATHETER NO. 26
JARUM KULIT
JARUM OTOT
KACA SLIDE
KAPAS 1 KG
KERTAS EKG
LARUTAN ANISOL
LARUTAN BENEDICT
LARUTAN EDTA 100 ml
LARUTAN EOSIN 2 %
LARUTAN ETANOL ASAM
LARUTAN H2O2
LARUTAN HCL 0,1 N
LARUTAN HAYEM
LARUTAN METANOL
276
277
278
279
280
281
282
283
284
285
286
287
288
289
290
291
292
293
294
295
296
297
298
299
300
301
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320
321
322
323

LARUTAN TURK
MASKER KARET
MASKER TALI
MINYAK IMERSI
NEEDLE 23
NEEDLE 24
NELATON CATHETHER
PENJEPIT TALI PUSAT
PROPILEN GLIKOL
RAPID TES PROTEIN
RDT TYPUS
RDT HIV/AIDS
REESECHER
SELANG OKSIGEN ANAK
SELANG OKSIGEN BAYI
TEST DENGUE DEVICE
TEST HBsAG STRIP
TEST HCG STRIP
TEST MALARIA DEVICE
THREE WAY
TRANFUSI SET
UNDERPAD
URINAL PRIA
URINAL WANITA
URINE BAG
VASELIN
WING NEEDLE 23
WING NEEDLE 27
ARTICULATING PAPER
BONDING SINGLE BOND
CAVITON ATFLETCHER
CELLULOID STRIP
324
325
326
327
328
329
330
331
332
333
334
335
336
337
338
339
340
341
342
343
344
345
346
347
348
349
350
351
352
353
354
355
356
357
358
359
360
361
362
363
364
365
366
367
368
369
370
371

ETCHING
FUJI 9 ART (MINI)
FUJI II LC
FUJI IX GC
FUJI IX GP
FUJI VII GC WHITE
MICRO BRUSH
OCHO
SALIVA EJECTOR
AMINOFLUID
ASERING
VERAPAMIL 50 MG
BISOPPROLOL TAB 5MG
DILTIAZEM
ASAM FOLAT 1 MG
SULFASALAZINE
GLICLAZID
IRBESARTAN
GEMFIBROZIL
AMIODARON
GLIMEPIRID
MELOXICAM 15
KODEIN TABLET
COMBIVEN NEBU
CLEVER CHECK
CELL CLEAN
MASKER RESPIRATOR
HYPAFIX
PIPET TETES
THERMAROL
NOVOMIX PENFLEX
ISONIAZID TAB 30 MG
lipid panel test
alkohol swab
lysol
CELL PACK
STOMALYZER
372
373
374
375
376
377
378
379
380
381
382
383
384
385
386
387
388
389
390
391
392
393
394
395
396

JARUM AUTO CLICK
ALAT SUNTIK 0.05ML
ALAT SUNTIK 0.5ML
ANTRAIN INJ
AQUA GEL
ARTEM INJ
CITICOLLIN INJ
DIAMOND BOOR SET M
DIAMOND BOOR SET S
FEEDING TUBE
FISURE LANCIP LONG
KANDISTATIN

SUAB TENGGOROKAN
MINIOCEP

NIP. 19830624 201001 2 007

:
:
:
:
SATUAN /
KEMASAN
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
STOK
AWAL
PENERIMAAN
-
KAPSUL
TABLET
TABLET
TABLET
BUNGKUS
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
KAPSUL
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
AMPUL
VIAL
AMPUL
VIAL
AMPUL
AMPUL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
BOTOL
BOTOL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
VIAL
VIAL
AMPUL
AMPUL
BOTOL
VIAL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
VIAL
VIAL
VIAL
VIAL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
VIAL
BOTOL
TUBE
TUBE
TUBE
SUPP
SUPP
TUBE
BOTOL
BOTOL
TUBE
BOTOL
BOTOL
TUBE
TUBE
BOTOL
BOTOL
TUBE
TUBE
TUBE
POT
KOTAK
BOTOL
TUBE
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
KOTAK
KOTAK
KOTAK
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
BOTOL
SET
BUNGKUS
BUNGKUS
BUNGKUS
ROLL
ROLL
ROLL
ROLL
ROLL
KOTAK
ROLL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
SET
SET
BOTOL
ROLL
SET
SET
SET
PCS
BOTOL
SET
SET
SET
SET
ROLL
BOTOL
SET
SET
SET
BOTOL
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
BOTOL
PCS
SET
SET
SET
SET
SET
SET
BOTOL
SET
SET
BOTOL
PCS
BOTOL
BOTOL
SET
SET
SET
SET
SET
ROLL
BOTOL
BOTOL
BUNGKUS
SET
SET
KOTAK
BOTOL
PCS
PCS
PCS
PCS
PCS
TABLET
PCS
PCS
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
VIAL
PCS
PCS
PCS
PCS
PCS
PCS
PCS
TABLET
PCS
KOTAK
PCS
PCS
BOTOL
KOTAK
SET
BOTOL
TUBE
PCS
PCS
PCS
VIAL
BOTOL
VIAL
VIAL
SET
SET
TUBE
PCS
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
PCS
BOTOL
UMUM
TIDAK BAYAR
BAYAR
Mengetahui
Kepala Puskemas
..
NIP. ..
RMINTAAN OBAT PUSKESMAS

BULAN
TAHUN
PERSEDIAAN
PEMAKAIAN
-
STOK
OPT
SISA STOK
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
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
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
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
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
BPJS
JUMLAH

NIP. .
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
Terima
No. Dok
Input
B.A
PERMINTAAN
PEMBERIANKETERANGAN
-
Yang Menyerahkan

NIP. 19781130 200012 2 001
LAPORAN PENGGUNAAN OBAT

NAMA PUSKESMAS
ALAMAT
TELP
:
:
:
NO
NAMA OBAT
SATUAN
1
2
3
4
5
6
7
8
9
10

CLOBAZAM TAB 10 MG
DIAZEPAM TABLET 2MG
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
AMPUL
AMPUL
Kepala Puskesmas .
..
NIP. .
AN PENGGUNAAN OBAT PSIKOTROPIKA
:
:
BULAN
TAHUN
SALDO
AWAL
PEMASUKAN
DARI
JUMLAH
0
0
0
0
0
0
0
0
PENGGUNAAN
UNTUK
JUMLAH
7
0
0
0
0
0
0
0
0
Penanggung Jawab
..
NIP. .
SALDO
AKHIR
9
NO
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
49
50
48
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
200
201
202
203
204
205
206
207
208
209
210
211
212
213
214
215
216
217
218
219
220
221
222
223
224
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239
240
241
242
243
244
245
246
247
248
249
250
251
252
253
254
255
256
257
258
259
260
261
262
263
264
265
266
267
268
269
270
271
272
273
274
275
276
277
278
279
280
281
282
283
284
285
286
287
288
289
290
291
292
293
294
295
296
297
298
299
300
301
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320
321
322
323
324
325
326
327
328
329
330
331
332
333
334
335
336
337
338
339
340
341
342
343
344
345
346
347
348
349
350
351
352
353
354
355
356
357
358
359
360
361
362
363
364
365
366
367
368
369
370
371
372
373
374
375
376
377
378
379
380
381
382
383
384
385
386
387
388
389
390
391
392
393
394
395
396
NAMA OBAT-OBATAN

AMBROXOL TAB. 30 MG
AMLODIPIN 10 MG
AMLODIPIN 5 MG
BETAHISTIN MALEAT
CLOBAZAM TAB 10 MG
CLOPIDOGREL 75 MG
CO AMOXICLAV 625 MG
DIAZEPAM TABLET 2MG
DOKSISIKLIN 100 MG

ERYTROMISIN 250 MG
ERYTROMISIN 500 MG
FUROSEMID TAB.40 MG
HALOPERIDOL 2 MG
KAPTOPRIL 12,5 MG
KAPTOPRIL 25 MG
KAPTOPRIL 50 MG
KLINDAMSIN 150 MG
LOPERAMIDE HCL 2 MG
METFORMIN 500 MG

METOKLOPRAMID 10 MG
MULTIVITAMIN TABLET
NIFEDIPINE 10 MG
OMEPRAZOL KAP 20 MG
PIROXICAM 10 MG
PIROXICAM 20 MG
PREDNISON TAB.5 MG
PRIMAKUIN TAB.15 MG
RIFAMPICIN 450 MG
RIFAMPICIN 600 MG
RISPERIDON TAB 2 MG
SALBUTAMOL 4 MG
SIMETIDIN TABLET
THROMBO ASPILETS
TRIFLUOPERAZIN 5 MG
ZINC TABLET
BISOLVON DROP
CITRIZINE SYRUP
ERYTROMISIN SYRUP
HALOPERIDOL DROP
IBUPROFEN SUSPENSI
PARASETAMOL DROP
THIAMFENICOL SYR
ZINK DROP
ZINK SYRUP
AQUA PRO INJEKSI
ASAM TRANEXAMAT INJ
D5 + 1/4 NS
DOPAMIN INJ
ETANOL 70 %
EUGENOL CAIRAN
FUROSEMID INJ 10 ML

HALOPERIDOL INJEKSI
LIDOKAIN INJ. 2%
MENADION K3 INJ
PEHACAIN INJ
PIRACETAM INJ 1 GR
SEFTRIAXON INJ
VENTOLIN NEBU
ALBOTHYL
ASIKLOVIR KRIM

MIKONAZOLE SALEP
SALEP 2-4 KOMB.
SALISIL BEDAK 2 %
SCABIMITE KRIM
BISTURI NO. 12
BLOOD LANCET
BOX SLIDE
INFUS SET ANAK
INFUS SET DEWASA
IV CATHETER NO. 18
IV CATHETER NO. 20
IV CATHETER NO. 22
IV CATHETER NO. 24
IV CATHETER NO. 26
JARUM KULIT
JARUM OTOT
KACA SLIDE
KAPAS 1 KG
KERTAS EKG
LARUTAN ANISOL
LARUTAN BENEDICT
LARUTAN EDTA 100 ml
LARUTAN EOSIN 2 %
LARUTAN ETANOL ASAM
LARUTAN H2O2
LARUTAN HCL 0,1 N
LARUTAN HAYEM
LARUTAN METANOL
LARUTAN TURK
MASKER KARET
MASKER TALI
MINYAK IMERSI
NEEDLE 23
NEEDLE 24
NELATON CATHETHER
PENJEPIT TALI PUSAT
PROPILEN GLIKOL
RAPID TES PROTEIN
RDT TYPUS
RDT HIV/AIDS
REESECHER
SELANG OKSIGEN ANAK
SELANG OKSIGEN BAYI
TEST DENGUE DEVICE
TEST HBsAG STRIP
TEST HCG STRIP
TEST MALARIA DEVICE
THREE WAY
TRANFUSI SET
UNDERPAD
URINAL PRIA
URINAL WANITA
URINE BAG
VASELIN
WING NEEDLE 23
WING NEEDLE 27
ARTICULATING PAPER
BONDING SINGLE BOND
CAVITON ATFLETCHER
CELLULOID STRIP
ETCHING
FUJI 9 ART (MINI)
FUJI II LC
FUJI IX GC
FUJI IX GP
FUJI VII GC WHITE
MICRO BRUSH
OCHO
SALIVA EJECTOR
AMINOFLUID
ASERING
VERAPAMIL 50 MG
BISOPPROLOL TAB 5MG
DILTIAZEM
ASAM FOLAT 1 MG
SULFASALAZINE
GLICLAZID
IRBESARTAN
GEMFIBROZIL
AMIODARON
GLIMEPIRID
MELOXICAM 15
KODEIN TABLET
COMBIVEN NEBU
CLEVER CHECK
CELL CLEAN
MASKER RESPIRATOR
HYPAFIX
PIPET TETES
THERMAROL
NOVOMIX PENFLEX
ISONIAZID TAB 30 MG
lipid panel test
alkohol swab
lysol
CELL PACK
STOMALYZER
JARUM AUTO CLICK
ALAT SUNTIK 0.05ML

ALAT SUNTIK 0.5ML
ANTRAIN INJ
AQUA GEL
ARTEM INJ
CITICOLLIN INJ
DIAMOND BOOR SET M
DIAMOND BOOR SET S
FEEDING TUBE
FISURE LANCIP LONG
KANDISTATIN

SUAB TENGGOROKAN
MINIOCEP

BULAN JANUARI 2016
KEMASAN
TANGGAL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
BUNGKUS
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
KAPSUL
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
AMPUL
VIAL
AMPUL
VIAL
AMPUL
AMPUL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
BOTOL
BOTOL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
VIAL
VIAL
AMPUL
AMPUL
BOTOL
VIAL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
VIAL
VIAL
VIAL
VIAL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
VIAL
BOTOL
TUBE
TUBE
TUBE
SUPP
SUPP
TUBE
BOTOL
BOTOL
TUBE
BOTOL
BOTOL
TUBE
TUBE
BOTOL
BOTOL
TUBE
TUBE
TUBE
POT
KOTAK
BOTOL
TUBE
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
KOTAK
KOTAK
KOTAK
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
BOTOL
SET
BUNGKUS
BUNGKUS
BUNGKUS
ROLL
ROLL
ROLL
ROLL
ROLL
KOTAK
ROLL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
SET
SET
BOTOL
ROLL
SET
SET
SET
PCS
BOTOL
SET
SET
SET
SET
ROLL
BOTOL
SET
SET
SET
BOTOL
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
BOTOL
PCS
SET
SET
SET
SET
SET
SET
BOTOL
SET
SET
BOTOL
PCS
BOTOL
BOTOL
SET
SET
SET
SET
SET
ROLL
BOTOL
BOTOL
BUNGKUS
SET
SET
KOTAK
BOTOL
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
TABLET
PCS
KOTAK
PCS
PCS
BOTOL
KOTAK
SET
BOTOL
TUBE
PCS
PCS
PCS
VIAL
BOTOL
VIAL
VIAL
SET
SET
TUBE
PCS
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
PCS
BOTOL
T KE PELAYANAN

10
11
12
13
14
15
AN / HARI
16
17
18
19
20
21
22
23
24
25
26
27
28
29
PENGELU
30
31
NAMA
PUSTU
NAMA
PUSTU
NAMA
PUSTU
NAMA
PUSTU
NAMA
POLINDES

NAMA
NAMA
POLINDES POLINDES
NAMA
POLINDES
JUMLAH
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
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
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
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
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
LAPORAN
KODE PUSKESMAS
PUSKESMAS
KECAMATAN
KABUPATEN / KOTA
:
:
NO
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
NAMA OBAT

AMBROXOL TAB. 30 MG
AMLODIPIN 10 MG
AMLODIPIN 5 MG
BETAHISTIN MALEAT
CLOBAZAM TAB 10 MG
CLOPIDOGREL 75 MG
CO AMOXICLAV 625 MG
DIAZEPAM TABLET 2MG
DOKSISIKLIN 100 MG
36
37
38
39
40
41
42
43
44
45
46
47
49
50
48
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80

ERYTROMISIN 250 MG
ERYTROMISIN 500 MG
FUROSEMID TAB.40 MG
HALOPERIDOL 2 MG
KAPTOPRIL 12,5 MG
KAPTOPRIL 25 MG
KAPTOPRIL 50 MG
KLINDAMSIN 150 MG
LOPERAMIDE HCL 2 MG
METFORMIN 500 MG
METOKLOPRAMID 10 MG
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
MULTIVITAMIN TABLET
NIFEDIPINE 10 MG
OMEPRAZOL KAP 20 MG
PIROXICAM 10 MG
PIROXICAM 20 MG
PREDNISON TAB.5 MG
PRIMAKUIN TAB.15 MG
RIFAMPICIN 450 MG
RIFAMPICIN 600 MG
RISPERIDON TAB 2 MG
SALBUTAMOL 4 MG
SIMETIDIN TABLET
THROMBO ASPILETS
TRIFLUOPERAZIN 5 MG
ZINC TABLET
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141

BISOLVON DROP
CITRIZINE SYRUP
ERYTROMISIN SYRUP
HALOPERIDOL DROP
IBUPROFEN SUSPENSI
PARASETAMOL DROP
THIAMFENICOL SYR
ZINK DROP
ZINK SYRUP
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168

AQUA PRO INJEKSI
ASAM TRANEXAMAT INJ
D5 + 1/4 NS
DOPAMIN INJ
ETANOL 70 %
EUGENOL CAIRAN
FUROSEMID INJ 10 ML
HALOPERIDOL INJEKSI
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194

LIDOKAIN INJ. 2%
MENADION K3 INJ
PEHACAIN INJ
PIRACETAM INJ 1 GR
SEFTRIAXON INJ
VENTOLIN NEBU
195
196
197
198
199
200
201
202
203
204
205
206
207
208
209
210
211
212
ALBOTHYL
ASIKLOVIR KRIM
MIKONAZOLE SALEP
213
214
215
216
217

SALEP 2-4 KOMB.
SALISIL BEDAK 2 %
SCABIMITE KRIM
218
219
220
221
222
223
224
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239
240
241
242
243
244
245
246
247
248
249
250
251
252
253
254
255
256

BLOOD LANCET
BOX SLIDE
INFUS SET ANAK
INFUS SET DEWASA
IV CATHETER NO. 18
IV CATHETER NO. 20
IV CATHETER NO. 22
IV CATHETER NO. 24
IV CATHETER NO. 26
JARUM KULIT
JARUM OTOT
KACA SLIDE
KAPAS 1 KG
257
258
259
260
261
262
263
264
265
266
267
268
269
270
271
272
273
274
275
276
277
278
279
280
281
282
283
284
285
286
287
288
289
290
291
292
293
294
295
296
297
298
299
300
301

KERTAS EKG
LARUTAN ANISOL
LARUTAN BENEDICT
LARUTAN EDTA 100 ml
LARUTAN EOSIN 2 %
LARUTAN ETANOL ASAM
LARUTAN H2O2
LARUTAN HCL 0,1 N
LARUTAN HAYEM
LARUTAN METANOL
LARUTAN TURK
MASKER KARET
MASKER TALI
MINYAK IMERSI
NEEDLE 23
NEEDLE 24
NELATON CATHETHER
PENJEPIT TALI PUSAT
PROPILEN GLIKOL
RAPID TES PROTEIN
RDT TYPUS
RDT HIV/AIDS
REESECHER
SELANG OKSIGEN ANAK
SELANG OKSIGEN BAYI
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320
321
322
323
324
325
326
327
328
329
330
331
332
333
334
335
336
337
338
339
340
341
342
343
344
345
346

TEST DENGUE DEVICE
TEST HBsAG STRIP
TEST HCG STRIP
TEST MALARIA DEVICE
THREE WAY
TRANFUSI SET
UNDERPAD
URINAL PRIA
URINAL WANITA
URINE BAG
VASELIN
WING NEEDLE 23
WING NEEDLE 27
ARTICULATING PAPER
BONDING SINGLE BOND
CAVITON ATFLETCHER
CELLULOID STRIP
ETCHING
FUJI 9 ART (MINI)
FUJI II LC
FUJI IX GC
FUJI IX GP
FUJI VII GC WHITE
MICRO BRUSH
OCHO
SALIVA EJECTOR
AMINOFLUID
ASERING
VERAPAMIL 50 MG
BISOPPROLOL TAB 5MG
DILTIAZEM
347
348
349
350
351
352
353
354
355
356
357
358
359
360
361
362
363
364
365
366
367
368
369
370
371
372
ASAM FOLAT 1 MG
SULFASALAZINE
GLICLAZID
IRBESARTAN
GEMFIBROZIL
AMIODARON
GLIMEPIRID
MELOXICAM 15
KODEIN TABLET
COMBIVEN NEBU
CLEVER CHECK
CELL CLEAN
MASKER RESPIRATOR
HYPAFIX
PIPET TETES
THERMAROL
NOVOMIX PENFLEX
ISONIAZID TAB 30 MG
lipid panel test
alkohol swab
lysol
CELL PACK
STOMALYZER
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT PUSKESMAS

BULAN
TAHUN
SATUAN /
KEMASAN
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
STOK
AWAL
PENERIMAAN
-
PERSEDIAAN
PEMAKAIAN
-
TABLET
KAPSUL
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
BUNGKUS
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
KAPSUL
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
AMPUL
VIAL
AMPUL
VIAL
AMPUL
AMPUL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
BOTOL
BOTOL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
VIAL
VIAL
AMPUL
AMPUL
BOTOL
VIAL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
VIAL
VIAL
VIAL
VIAL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
VIAL
BOTOL
TUBE
TUBE
TUBE
SUPP
SUPP
TUBE
BOTOL
BOTOL
TUBE
BOTOL
BOTOL
TUBE
TUBE
BOTOL
BOTOL
TUBE
TUBE
TUBE
POT
KOTAK
BOTOL
TUBE
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
KOTAK
KOTAK
KOTAK
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
BOTOL
SET
BUNGKUS
BUNGKUS
BUNGKUS
ROLL
ROLL
ROLL
ROLL
ROLL
KOTAK
ROLL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
SET
SET
BOTOL
ROLL
SET
SET
SET
PCS
BOTOL
SET
SET
SET
SET
ROLL
BOTOL
SET
SET
SET
BOTOL
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
BOTOL
PCS
SET
SET
SET
SET
SET
SET
BOTOL
SET
SET
BOTOL
PCS
BOTOL
BOTOL
SET
SET
SET
SET
SET
ROLL
BOTOL
BOTOL
BUNGKUS
SET
SET
KOTAK
BOTOL
PCS
PCS
PCS
PCS
PCS
TABLET
PCS
PCS
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
VIAL
PCS
PCS
PCS
PCS
PCS
PCS
PCS
TABLET
PCS
KOTAK
PCS
PCS
BOTOL
KOTAK
SET
BOTOL
USKESMAS
Terima
No. Dok
Input
B.A
STOK
OPT
SISA STOK
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
PERMINTAAN
-
PEMBERIAN
-
KETERANGAN
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
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
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
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
0
0
0
0
0
0
0
0
0
LAPORAN PENGGUNAAN OBA

NAMA PUSKESMAS
ALAMAT
TELP
:
:
:
NO
NAMA OBAT
SATUAN
1
2
3
4
5
6
7
8
9
10

CLOBAZAM TAB 10 MG
DIAZEPAM TABLET 2MG
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
AMPUL
AMPUL
Kepala Puskesmas .
..
NIP. .
ENGGUNAAN OBAT PSIKOTROPIKA

:
:
BULAN
TAHUN
SALDO
AWAL
PEMASUKAN
DARI
JUMLAH
0
0
0
0
0
0
0
0
PENGGUNAAN
UNTUK
JUMLAH
7
0
0
0
0
0
0
0
0
Penanggung Jawab
..
NIP. .
SALDO
AKHIR
9
NO
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
49
50
48
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
200
201
202
203
204
205
206
207
208
209
210
211
212
213
214
215
216
217
218
219
220
221
222
223
224
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239
240
241
242
243
244
245
246
247
248
249
250
251
252
253
254
255
256
257
258
259
260
261
262
263
264
265
266
267
268
269
270
271
272
273
274
275
276
277
278
279
280
281
282
283
284
285
286
287
288
289
290
291
292
293
294
295
296
297
298
299
300
301
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320
321
322
323
324
325
326
327
328
329
330
331
332
333
334
335
336
337
338
339
340
341
342
343
344
345
346
347
348
349
350
351
352
353
354
355
356
357
358
359
360
361
362
363
364
365
366
367
368
369
370
371
372
373
374
375
376
377
378
379
380
381
382
383
384
385
386
387
388
389
390
391
392
393
394
395
396
NAMA OBAT-OBATAN

AMBROXOL TAB. 30 MG
AMLODIPIN 10 MG
AMLODIPIN 5 MG
BETAHISTIN MALEAT
CLOBAZAM TAB 10 MG
CLOPIDOGREL 75 MG
CO AMOXICLAV 625 MG
DIAZEPAM TABLET 2MG
DOKSISIKLIN 100 MG

ERYTROMISIN 250 MG
ERYTROMISIN 500 MG
FUROSEMID TAB.40 MG
HALOPERIDOL 2 MG
KAPTOPRIL 12,5 MG
KAPTOPRIL 25 MG
KAPTOPRIL 50 MG
KLINDAMSIN 150 MG
LOPERAMIDE HCL 2 MG
METFORMIN 500 MG

METOKLOPRAMID 10 MG
MULTIVITAMIN TABLET
NIFEDIPINE 10 MG
OMEPRAZOL KAP 20 MG
PIROXICAM 10 MG
PIROXICAM 20 MG
PREDNISON TAB.5 MG
PRIMAKUIN TAB.15 MG
RIFAMPICIN 450 MG
RIFAMPICIN 600 MG
RISPERIDON TAB 2 MG
SALBUTAMOL 4 MG
SIMETIDIN TABLET
THROMBO ASPILETS
TRIFLUOPERAZIN 5 MG
ZINC TABLET
BISOLVON DROP
CITRIZINE SYRUP
ERYTROMISIN SYRUP
HALOPERIDOL DROP
IBUPROFEN SUSPENSI
PARASETAMOL DROP
THIAMFENICOL SYR
ZINK DROP
ZINK SYRUP
AQUA PRO INJEKSI
ASAM TRANEXAMAT INJ
D5 + 1/4 NS
DOPAMIN INJ
ETANOL 70 %
EUGENOL CAIRAN
FUROSEMID INJ 10 ML

HALOPERIDOL INJEKSI
LIDOKAIN INJ. 2%
MENADION K3 INJ
PEHACAIN INJ
PIRACETAM INJ 1 GR
SEFTRIAXON INJ
VENTOLIN NEBU
ALBOTHYL
ASIKLOVIR KRIM

MIKONAZOLE SALEP
SALEP 2-4 KOMB.
SALISIL BEDAK 2 %
SCABIMITE KRIM
BISTURI NO. 12
BLOOD LANCET
BOX SLIDE
INFUS SET ANAK
INFUS SET DEWASA
IV CATHETER NO. 18
IV CATHETER NO. 20
IV CATHETER NO. 22
IV CATHETER NO. 24
IV CATHETER NO. 26
JARUM KULIT
JARUM OTOT
KACA SLIDE
KAPAS 1 KG
KERTAS EKG
LARUTAN ANISOL
LARUTAN BENEDICT
LARUTAN EDTA 100 ml
LARUTAN EOSIN 2 %
LARUTAN ETANOL ASAM
LARUTAN H2O2
LARUTAN HCL 0,1 N
LARUTAN HAYEM
LARUTAN METANOL
LARUTAN TURK
MASKER KARET
MASKER TALI
MINYAK IMERSI
NEEDLE 23
NEEDLE 24
NELATON CATHETHER
PENJEPIT TALI PUSAT
PROPILEN GLIKOL
RAPID TES PROTEIN
RDT TYPUS
RDT HIV/AIDS
REESECHER
SELANG OKSIGEN ANAK
SELANG OKSIGEN BAYI
TEST DENGUE DEVICE
TEST HBsAG STRIP
TEST HCG STRIP
TEST MALARIA DEVICE
THREE WAY
TRANFUSI SET
UNDERPAD
URINAL PRIA
URINAL WANITA
URINE BAG
VASELIN
WING NEEDLE 23
WING NEEDLE 27
ARTICULATING PAPER
BONDING SINGLE BOND
CAVITON ATFLETCHER
CELLULOID STRIP
ETCHING
FUJI 9 ART (MINI)
FUJI II LC
FUJI IX GC
FUJI IX GP
FUJI VII GC WHITE
MICRO BRUSH
OCHO
SALIVA EJECTOR
AMINOFLUID
ASERING
VERAPAMIL 50 MG
BISOPPROLOL TAB 5MG
DILTIAZEM
ASAM FOLAT 1 MG
SULFASALAZINE
GLICLAZID
IRBESARTAN
GEMFIBROZIL
AMIODARON
GLIMEPIRID
MELOXICAM 15
KODEIN TABLET
COMBIVEN NEBU
CLEVER CHECK
CELL CLEAN
MASKER RESPIRATOR
HYPAFIX
PIPET TETES
THERMAROL
NOVOMIX PENFLEX
ISONIAZID TAB 30 MG
lipid panel test
alkohol swab
lysol
CELL PACK
STOMALYZER
JARUM AUTO CLICK
ALAT SUNTIK 0.05ML

ALAT SUNTIK 0.5ML
ANTRAIN INJ
AQUA GEL
ARTEM INJ
CITICOLLIN INJ
DIAMOND BOOR SET M
DIAMOND BOOR SET S
FEEDING TUBE
FISURE LANCIP LONG
KANDISTATIN

SUAB TENGGOROKAN
MINIOCEP

BULAN JANUARI 2016
KEMASAN
TANGGAL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
BUNGKUS
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
KAPSUL
KAPSUL
KAPSUL
TABLET
TABLET
KAPSUL
TABLET
TABLET
TABLET
TABLET
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
AMPUL
VIAL
AMPUL
VIAL
AMPUL
AMPUL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
BOTOL
BOTOL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
VIAL
VIAL
AMPUL
AMPUL
BOTOL
VIAL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
VIAL
VIAL
VIAL
VIAL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
VIAL
BOTOL
TUBE
TUBE
TUBE
SUPP
SUPP
TUBE
BOTOL
BOTOL
TUBE
BOTOL
BOTOL
TUBE
TUBE
BOTOL
BOTOL
TUBE
TUBE
TUBE
POT
KOTAK
BOTOL
TUBE
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
KOTAK
KOTAK
KOTAK
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
BOTOL
SET
BUNGKUS
BUNGKUS
BUNGKUS
ROLL
ROLL
ROLL
ROLL
ROLL
KOTAK
ROLL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
SET
SET
BOTOL
ROLL
SET
SET
SET
PCS
BOTOL
SET
SET
SET
SET
ROLL
BOTOL
SET
SET
SET
BOTOL
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
BOTOL
PCS
SET
SET
SET
SET
SET
SET
BOTOL
SET
SET
BOTOL
PCS
BOTOL
BOTOL
SET
SET
SET
SET
SET
ROLL
BOTOL
BOTOL
BUNGKUS
SET
SET
KOTAK
BOTOL
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
PCS
TABLET
PCS
KOTAK
PCS
PCS
BOTOL
KOTAK
SET
BOTOL
TUBE
PCS
PCS
PCS
VIAL
BOTOL
VIAL
VIAL
SET
SET
TUBE
PCS
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
PCS
BOTOL
T KE PELAYANAN

10
11
12
13
14
15
AN / HARI
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
NAMA
PUSTU
NAMA
PUSTU
NAMA
PUSTU
NAMA
PUSTU

NAMA
NAMA
POLINDES POLINDES
NAMA
POLINDES
NAMA
POLINDES
JUMLAH
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
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
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
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
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
LAPORAN PE
KODE PUSKESMAS
PUSKESMAS
KECAMATAN
KABUPATEN / KOTA
NO
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
NAMA OBAT

AMBROXOL TAB. 30 MG
AMLODIPIN 10 MG
AMLODIPIN 5 MG
BETAHISTIN MALEAT
CLOBAZAM TAB 10 MG
CLOPIDOGREL 75 MG
CO AMOXICLAV 625 MG
DIAZEPAM TABLET 2MG
DOKSISIKLIN 100 MG
35
36
37
38
39
40
41
42
43
44
45
46
47
49
50
48
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79

ERYTROMISIN 250 MG
ERYTROMISIN 500 MG
FUROSEMID TAB.40 MG
HALOPERIDOL 2 MG
KAPTOPRIL 12,5 MG
KAPTOPRIL 25 MG
KAPTOPRIL 50 MG
KLINDAMSIN 150 MG
LOPERAMIDE HCL 2 MG
METFORMIN 500 MG
METOKLOPRAMID 10 MG
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124

MULTIVITAMIN TABLET
NIFEDIPINE 10 MG
OMEPRAZOL KAP 20 MG
PIROXICAM 10 MG
PIROXICAM 20 MG
PREDNISON TAB.5 MG
PRIMAKUIN TAB.15 MG
RIFAMPICIN 450 MG
RIFAMPICIN 600 MG
RISPERIDON TAB 2 MG
SALBUTAMOL 4 MG
SIMETIDIN TABLET
THROMBO ASPILETS
TRIFLUOPERAZIN 5 MG
ZINC TABLET
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141

BISOLVON DROP
CITRIZINE SYRUP
ERYTROMISIN SYRUP
HALOPERIDOL DROP
IBUPROFEN SUSPENSI
PARASETAMOL DROP
THIAMFENICOL SYR
ZINK DROP
ZINK SYRUP
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167

AQUA PRO INJEKSI
ASAM TRANEXAMAT INJ
D5 + 1/4 NS
DOPAMIN INJ
ETANOL 70 %
EUGENOL CAIRAN
FUROSEMID INJ 10 ML
HALOPERIDOL INJEKSI
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194

LIDOKAIN INJ. 2%
MENADION K3 INJ
PEHACAIN INJ
PIRACETAM INJ 1 GR
SEFTRIAXON INJ
VENTOLIN NEBU
195
196
197
198
199
200
201
202
203
204
205
206
207
208
209
210
211
ALBOTHYL
ASIKLOVIR KRIM
MIKONAZOLE SALEP
212
213
214
215
216
217

SALEP 2-4 KOMB.
SALISIL BEDAK 2 %
SCABIMITE KRIM
218
219
220
221
222
223
224
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239
240
241
242
243
244
245
246
247
248
249
250
251
252
253
254
255

BLOOD LANCET
BOX SLIDE
INFUS SET ANAK
INFUS SET DEWASA
IV CATHETER NO. 18
IV CATHETER NO. 20
IV CATHETER NO. 22
IV CATHETER NO. 24
IV CATHETER NO. 26
JARUM KULIT
JARUM OTOT
KACA SLIDE
KAPAS 1 KG
256
257
258
259
260
261
262
263
264
265
266
267
268
269
270
271
272
273
274
275
276
277
278
279
280
281
282
283
284
285
286
287
288
289
290
291
292
293
294
295
296
297
298
299
300

KERTAS EKG
LARUTAN ANISOL
LARUTAN BENEDICT
LARUTAN EDTA 100 ml
LARUTAN EOSIN 2 %
LARUTAN ETANOL ASAM
LARUTAN H2O2
LARUTAN HCL 0,1 N
LARUTAN HAYEM
LARUTAN METANOL
LARUTAN TURK
MASKER KARET
MASKER TALI
MINYAK IMERSI
NEEDLE 23
NEEDLE 24
NELATON CATHETHER
PENJEPIT TALI PUSAT
PROPILEN GLIKOL
RAPID TES PROTEIN
RDT TYPUS
RDT HIV/AIDS
REESECHER
SELANG OKSIGEN ANAK
SELANG OKSIGEN BAYI
301
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320
321
322
323
324
325
326
327
328
329
330
331
332
333
334
335
336
337
338
339
340
341
342
343
344
345

TEST DENGUE DEVICE
TEST HBsAG STRIP
TEST HCG STRIP
TEST MALARIA DEVICE
THREE WAY
TRANFUSI SET
UNDERPAD
URINAL PRIA
URINAL WANITA
URINE BAG
VASELIN
WING NEEDLE 23
WING NEEDLE 27
ARTICULATING PAPER
BONDING SINGLE BOND
CAVITON ATFLETCHER
CELLULOID STRIP
ETCHING
FUJI 9 ART (MINI)
FUJI II LC
FUJI IX GC
FUJI IX GP
FUJI VII GC WHITE
MICRO BRUSH
OCHO
SALIVA EJECTOR
AMINOFLUID
ASERING
VERAPAMIL 50 MG
BISOPPROLOL TAB 5MG
346
347
348
349
350
351
352
353
354
355
356
357
358
359
360
361
362
363
364
365
366
367
368
369
370
371
372
373
374
375
376
377
378
379
380
381
382
383
384
385
386
387
388
389
390
DILTIAZEM
ASAM FOLAT 1 MG
SULFASALAZINE
GLICLAZID
IRBESARTAN
GEMFIBROZIL
AMIODARON
GLIMEPIRID
MELOXICAM 15
KODEIN TABLET
COMBIVEN NEBU
CLEVER CHECK
CELL CLEAN
MASKER RESPIRATOR
HYPAFIX
PIPET TETES
THERMAROL
NOVOMIX PENFLEX
ISONIAZID TAB 30 MG
lipid panel test
alkohol swab
lysol
CELL PACK
STOMALYZER
JARUM AUTO CLICK
ALAT SUNTIK 0.05ML
ALAT SUNTIK 0.5ML
ANTRAIN INJ
AQUA GEL
ARTEM INJ
CITICOLLIN INJ
DIAMOND BOOR SET M
DIAMOND BOOR SET S
FEEDING TUBE
FISURE LANCIP LONG
KANDISTATIN
391
392
393
394
395
396


SUAB TENGGOROKAN
MINIOCEP

NIP. 19830624 201001 2 007

:
:
:
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SATUAN /
KEMASAN
TABLET
TABLET
TABLET
TABLET
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STOK
AWAL
PENERIMAAN
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KAPSUL
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KAPSUL
KAPSUL
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KAPSUL
KAPSUL
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KAPSUL
KAPSUL
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TABLET
TABLET
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
AMPUL
VIAL
AMPUL
VIAL
AMPUL
AMPUL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
BOTOL
BOTOL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
BOTOL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
VIAL
VIAL
AMPUL
AMPUL
BOTOL
VIAL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
BOTOL
VIAL
VIAL
VIAL
VIAL
AMPUL
AMPUL
AMPUL
AMPUL
AMPUL
VIAL
BOTOL
TUBE
TUBE
TUBE
SUPP
SUPP
TUBE
BOTOL
BOTOL
TUBE
BOTOL
BOTOL
TUBE
TUBE
BOTOL
BOTOL
TUBE
TUBE
TUBE
POT
KOTAK
BOTOL
TUBE
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
KOTAK
KOTAK
KOTAK
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
BOTOL
SET
BUNGKUS
BUNGKUS
BUNGKUS
ROLL
ROLL
ROLL
ROLL
ROLL
KOTAK
ROLL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
SET
SET
BOTOL
ROLL
SET
SET
SET
PCS
BOTOL
SET
SET
SET
SET
ROLL
BOTOL
SET
SET
SET
BOTOL
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
SET
BOTOL
PCS
SET
SET
SET
SET
SET
SET
BOTOL
SET
SET
BOTOL
PCS
BOTOL
BOTOL
SET
SET
SET
SET
SET
ROLL
BOTOL
BOTOL
BUNGKUS
SET
SET
KOTAK
BOTOL
PCS
PCS
PCS
PCS
PCS
TABLET
PCS
PCS
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
VIAL
PCS
PCS
PCS
PCS
PCS
PCS
PCS
TABLET
PCS
KOTAK
PCS
PCS
BOTOL
KOTAK
SET
BOTOL
TUBE
PCS
PCS
PCS
VIAL
BOTOL
VIAL
VIAL
SET
SET
TUBE
PCS
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
BOTOL
PCS
BOTOL
UMUM
TIDAK BAYAR
BAYAR
Mengetahui
Kepala Puskemas
..
NIP. ..
ERMINTAAN OBAT PUSKESMAS

BULAN
TAHUN
PERSEDIAAN
PEMAKAIAN
-
STOK
OPT
SISA STOK
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
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
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
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
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
BPJS
JUMLAH

NIP. .
0
0
0
0
0
0
Terima
No. Dok
Input
B.A
PERMINTAAN
PEMBERIAN KETERANGAN
-
Yang Menyerahkan

NIP. 19781130 200012 2 001
LAPORAN PENGGUNAAN OBAT PS

NAMA PUSKESMAS
ALAMAT
TELP
:
:
:
NO
NAMA OBAT
SATUAN
1
2
3
4
5
6
7
8
9
10

CLOBAZAM TAB 10 MG
DIAZEPAM TABLET 2MG
TABLET
TABLET
TABLET
TABLET
TABLET
TABLET
AMPUL
AMPUL
Kepala Puskesmas .
..
NIP. .
ENGGUNAAN OBAT PSIKOTROPIKA

:
:
BULAN
TAHUN
SALDO
AWAL
PEMASUKAN
DARI
JUMLAH
0
0
0
0
0
0
0
0
PENGGUNAAN
UNTUK
JUMLAH
7
0
0
0
0
0
0
0
0
Penanggung Jawab
..
NIP. .
SALDO
AKHIR
9

Lplpo Puskesmas

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NO

ALOPURINOL TABLET 100 MG

ALAT SUNTIK SEKALI PAKAI 1 ML

LARUTAN EDTA 100 ml

REAGEN TEST CHLONESTERASE ACHE (DIGITAL)

PENGELUARAN OBAT DARI GUDANG OBAT KE PELA

PENGELUARAN HARIAN / HARI

NAMA POLINDES NAMA POLINDES

PENGELUARAN PUSTU / POLINDES

ALOPURINOL TABLET 100 MG

FENITOIN NATRIUM KAP. 100 MG

NISTATIN SALUT 500.000 IU

AMBROXOL SYR 15 MG/ML

AMINOFILIN INJEKSI 24 MG/ML - 10

ONDANCENTRON 4MG INJ

ALAT SUNTIK SEKALI PAKAI 1 ML

LARUTAN KARBOL FUKSIN

REAGEN TEST CHLONESTERASE ACHE (DIGITAL)

JUMLAH KUNJUNGAN RESEP

Erlin Dwisafitri, S.Si, Apt

AN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT PUSKESMAS

Yang Meminta / Melapor

Hesti Kartini, Amd.Far

ALPRAZOLAM TABLET 0,5 MG

APORAN PENGGUNAAN OBAT PSIKOTROPIKA

ALOPURINOL TABLET 100 MG

FITOMENADION (VIT.K 1) TAB.SALUT 10 MG

PIRACETAM TAB. 400 MG

AMBROXOL SYR 15 MG/ML

AMINOFILIN INJEKSI 24 MG/ML - 10

SERUM ANTI TETANUS INJ. 1.500 IU / AMPUL (ATS)

ALAT SUNTIK SEKALI PAKAI 1 ML

HAND SCHOEN OBSETRIKAL

TOPICAL ANESTHESI OLES

LARUTAN SALMONELLA PARATYPHI HC

REAGEN TEST CHLONESTERASE ACHE (DIGITAL)

PENGELUARAN OBAT DARI GUDANG OBAT KE PELAYANAN

PENGELUARAN HARIAN / HARI

PENGELUARAN PUSTU / POLINDES

ALOPURINOL TABLET 100 MG

PIRANTEL TABLET 125 MG

AMBROXOL SYR 15 MG/ML

AMINOFILIN INJEKSI 24 MG/ML - 10

TIAMIN HCL (VIT B 1 ) INJ.100 MG/ML -1ML

ALAT SUNTIK SEKALI PAKAI 1 ML

INFUS SET DEWASA

PENJEPIT TALI PUSAT

ORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT PUSKESMAS

ALPRAZOLAM TABLET 0,5 MG

PORAN PENGGUNAAN OBAT PSIKOTROPIKA

ALOPURINOL TABLET 100 MG

EFEDRIN HCL TABLET 25 MG

METILERGOMETRIN MALEAT TAB 0,125 MG

GLUKOSA LAR,INFUS 10 % STERIL

HIDROKORTISON KRIM 2,5%

ALAT SUNTIK 0.05ML

REAGEN TEST CHLONESTERASE ACHE (DIGITAL)

PENGELUARAN OBAT DARI GUDANG OBAT KE PELAYA

PENGELUARAN HARIAN / HARI

PENGELUARAN PUSTU / POLINDES

ALOPURINOL TABLET 100 MG

FENITOIN NATRIUM KAP. 100 MG

AMBROXOL SYR 15 MG/ML