LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT PUSKESMAS

PUSKESMAS : TIDENG PALE PELAPORAN BULAN : JANUARI 2017

KECAMATAN : SESAYAP PERMINTAAN BULAN : FEBRUARI 2017
KAB/KOTA : TANA TIDUNG

STOCK PENERIM PERSEDIA PEMAKA SISA STOCK APT

NO NAMA OBAT SATUAN AWAL AAN AN IAN STOCK
1 2 3 4 5 6 = (4+5) 7 = (6-8) 8 9

OBAT-OBATAN

1 ACYCLOVIR CREAM TUBE 16 16 0 16

2 ACYCLOVYR 200 KOTAK @ 100 TAB 0 0 0
3 ACYCLOVYR 400 KOTAK @ 100 TAB 300 300 0 300
4 ALBENDAZOL 400 MG KOTAK @ 30 TAB 0 100 100 0 100
5 ALBENDAZOL SUSPENSI BOTOL 0 0
6 ALLOPURINOL 100 MG KOTAK @ 100 TAB 600 600 0 600
7 ALLOPURINOL 300 MG KOTAK @ 100 TAB 0 100 100 0 100
8 AMBROXOL 30 MG KOTAK @ 100 TAB 1500 1500 600 900
9 AMBROXOL SYRUP 15 MG / 5 ML BOTOL 96 96 15 81
10 AMINOPHYLLIN 200 BOTOL @ 100 TAB 100 100 200 0 200
11 AMINOPHYLLIN INJEKSI AMPUL 30 30 0 30
12 AMLODIPIN 5 MG KOTAK @ 30 TAB 120 90 210 150 60
13 AMPISILIN INJ KOTAK @ 10 VIAL 0 0
14 AMOXICILLIN 250 MG KAPSUL 600 600 0 600
15 AMOXICILLIN 500 MG KOTAK @ 100 TAB 800 800 700 100
16 AMOXYCILLIN SYRUP 60 ML BOTOL 183 183 35 148
17 ANTALGIN INJEKSI 1 MG / ML KOTAK @ 30 APM 0 30 30 0 30
18 ANTASIDA KOTAK @ 100 TAB 800 800 0 800
19 ANTASIDA SYRUP KOTAK 50 BTL @ 60 ML 70 70 10 60
20 ANTI FUNGI POT 0 0 0 0
21 ANTIHEMOROID SUPP KOTAK @ 10 SUPP 0 100 100 0 100
22 AQUA PRO INJEKSI 25 ML AMPUL 15 20 35 6 29
23 AQUADEST STERIL BOTOL 1000 ML 1 15 16 0 16
24 ARTESUNAT INJE KOTAK @8 VIAL 0 0 0 0 0
25 ASAM FOLAT KOTAK @ 100 TAB 1500 1500 500 1000
26 ASAM TRANEKSAMAT KOTAK @ 100 TAB 100 100 0 100
27 ASAM TRANEKSAMAT INJ 50 MG/ML KOTAK @ 10 AMP 0 0 0
28 ASAM MEFENAMAT 500MG KOTAK @ 100 TAB 900 900 400 500
29 ATAPULGIT TAB 600 MG (NEW ANTIDES) KOTAK @ 100 TAB 200 200 0 200
30 ATHROPHIN 0.5 MG KOTAK @ 100 TAB 0 0 0
31 ATROPINE INJEKSI 0,25 MG / ML AMPUL 30 30 0 30
32 BEDAK SALICYL KOTAK 13 13 0 13
33 BETAMETHASONE 0,1 % TUBE 20 20 0 20
34 BISAKODIL 10 MG SUPP (DULCOLAX) SUPP 50 50 5 45
35 CAPTOPRIL 12,5 MG KOTAK @ 100 TAB 1500 1000 2500 400 2100
36 CAPTOPRIL 25 MG KOTAK @ 100 TAB 200 1500 1700 200 1500
37 CAPTOPRIL 50 MG KOTAK @ 100 TAB 800 800 800 0
38 CARBAMAZEPIN 200 MG KOTAK @ 100 TAB 0 200 200 100 100
39 CEFADROXIL 500 MG KOTAK @ 100 TAB 200 500 700 200 500
40 CEFADROXYL SYR BOTOL 45 45 5 40
41 CEFOTAXIM INJ VIAL 10 10 2 8
42 CETERIZIN 10 MG KOTAK @ 100 TAB 1000 1000 0 1000
43 CETERIZIN SIRUP BOTOL 100 100 10 90
44 CHLORAMFENICOL 250 KAPSUL 300 100 400 0 400
45 CHLORAMFENICOL SM TUBE 0 24 24 0 24
46 CHLORAMFENIKOL SK (BUFACETIN) TUBE 0 24 24 0 24
47 CHLORAMFENICOL SYRUP BOTOL 43 0 43 0 43
48 CHLORAMFENICOL TT BOTOL 5ML 50 50 30 20
49 CHLOROQUINE BOTOL @ 1000 TAB 0 0
50 CHLORPROMAZIN TAB KOTAK @ 100 TAB 0 0
51 CHLORPROMAZINE INJEKSI 25 MG / ML AMPUL 0 0
52 CIPROFLOXACIN 500 MG KOTAK @ 100 TAB 0 1000 1000 200 800
53 CODEIN 10 MG KOTAK @ 100 TAB 68 100 168 0 168
54 COTRIMOXAZOL 480 MG KOTAK @ 100 TAB 0 0 -700 700
55 COTRIMOXAZOL SUSPENSI 60 ML BOTOL 20 20 5 15
56 CTM 4 MG (ORPHEN) TABLET 1000 4000 5000 1400 3600
57 CYANOCOBALAMINE INJEKSI AMPUL 10 10 3 7
58 DEXAMETHASON INJEKSI KOTAK @ 100 AMP 10 10 0 10
59 DEXAMETHASON TAB KOTAK @ 100 TAB 1200 1000 2200 1000 1200
60 DIAZEPAM REKTAL/STESOLID TUBE 20 20 0 20
61 DIFENHIDRAMIN INJ KOTAK @ 30 AMP 0 0 0
62 DIGOXIN 0,25 MG KOTAK @ 100 TAB 100 100 0 100
63 DIMENHIDRINAT 50 BOTOL @ 100 TAB 200 200 0 200
64 DOMPEIDONE SYRUP 5 MG / 5 ML KOTAK 50 BTL @ 60 ML 30 30 0 30
65 DOMPERIDON 10 KOTAK @ 100 TAB 100 100 0 100
66 DOXYCYCLINE 100 MG KOTAK @ 100 CAP 200 200 0 200
67 DUMIN RT 125 MG KOTAK @ 5 TUBE 10 10 0 10
68 EPINEPHRINE INJEKSI AMPUL 0 0 0
69 ERYTHROMYCIN 60 ML 200 MG / 5 ML BOTOL 20 20 0 20
70 ERYTHROMYCIN 500 MG TABLET @ 100 TAB 100 100 100 0
71 ETAMBUTOL TAB SALUT 500 MG KOTAK @ 100 TAB 0 0 0
72 ETHYL CHLORIDE BOTOL 5 5 1 4
73 FENITOIN INJ 50 MG/ML AMPUL 0 0 0
74 FENITOIN CAPS 100 MG BOTOL @ 100 CAPS 100 100 0 100
75 FENOL GLYCEROL TT 10 % BOTOL 0 72 72 0 72
76 FUROSEMIDE INJEKSI 10 MG / ML KOTAK @ 25 AMP 0 0 0
77 GARAM ORALIT SACHET 0 -90 90
78 GENTAMICIN INJEKSI 40 MG/ML KOTAK @5 AMP 5 5 0 5
79 GENTAMICIN SM (GENOINT) TUBE 0 0 0
80 GENTAMICYN TM BOTOL 72 72 27 45
81 GENTAMICYN SK TUBE 4 4 -1 5
82 GENTIAN VIOLET BOTOL 0 0
82 GLUCOSA INFUS 10% KOTAK @ 20 FLACON 0 0 0
83 GLUKOSA 5% INFUS KOTAK @ 20 FLACON 10 10 0 10
84 GLIBENKLAMID 5MG KOTAK @ 100 TAB 100 500 600 0 600
85 GRISEOFULVIN 125 MG KOTAK @ 100 TAB 500 500 0 500
86 HYDROCHLORTIACID 25 MG KOTAK @ 100 TAB 1000 1000 0 1000
87 HYDROCORTISON CREAM TUBE 0 0 0 0 0
88 HYOSCINE-N-BUTILBROMIDE 10 MG KOTAK @ 50 TAB 750 750 100 650
89 HYOSCINE-N-BUTILBROMIDE INJEKSI 20 MG/ML KOTAK @ 5 AMP 0 0
90 IBU PROFEN 200 MG TABLET 100 200 300 100 200
91 IBU PROFEN 400 MG KOTAK @ 100 TAB 1600 500 2100 600 1500
92 IBUPROFEN SIRUP 100 MG/5 ML KOTAK 50 BTL @ 60 ML 40 50 90 0 90
93 ISOSORBID DINITRATE 5 MG KOTAK @ 100 TAB 100 100 0 100
94 KALSIUM GLUKONAT INJ AMPUL 0 0
95 KALSIUM LAKTAT KOTAK @ 100 TAB 2000 1000 3000 1000 2000
96 KETOKONAZOL CREAM 2 % KOTAK @ 25 TUBE 16 16 0 16
97 KETOKONAZOL 200MG KOTAK @ 50 TAB 200 200 0 200
98 KETOROLAC INJ KOTAK @ 12 AMP 0 0
99 LAXADIN EMULSI BOTOL 60 ML 55 55 0 55
100 LIDOCAIN COMP KOTAK @ 30 AMP 120 120 120 0
101 LIDOCAIN INJ KOTAK @ 100 AMP 66 66 10 56
102 LOPERAMIDE HCL KOTAK @ 100 TAB 500 500 200 300
103 LORATADINE 10 MG KOTAK @ 100 TAB 700 700 0 700
104 METFORMIN KOTAK @ 100 TAB 3000 3000 1600 1400
105 METHYL ERGOMETRIN INJ KOTAK @ 100 AMP 0 0
106 METHYL PREDNISOLON 4 MG KOTAK @ 100 TAB 200 200 0 200
107 METHYL PREDNISOLON 8 MG KOTAK @ 100 TAB 800 800 100 700
108 METHYL PREDNISOLON INJ VIAL 0 0
109 METILDOPA KOTAK @ 100 TAB 100 500 600 0 600
110 METOCLOPRAMID 10 MG KOTAK @ 100 TAB 200 200 0 200
111 METRONIDAZOL 500 MG KOTAK @ 100 TAB 0 500 500 100 400
METRONIDAZOL 500 MG (VAGIZOL) OVULA 50 50 0 50
112 METRONIDAZOL SUPP (FLAGYL) SUPP 50 50 0 50
113 MICONAZOL CREAM TUBE 27 27 10 17
114 MULTIVITAMIN SYRUP (LYTACUR) BOTOL 75 50 125 15 110
115 NaCl INFUS KOTAK @ 20 FLACON 0 0
116 NATRIUM DICLOFENAK 50 MG KOTAK @ 50 TAB 300 300 150 150
117 NATRIUM DICLOVENAK 25 MG KOTAK @ 50 TAB 150 150 50 100
118 NIFEDIPIN 10 MG KOTAK @ 100 TAB 0 400 400 100 300
119 OBH SIRUP BOTOL 6 6 2 4
120 OMEPRAZOL KOTAK @ 30 CAP 2100 2100 330 1770
121 ONDANSETRON 4 MG TABLET 372 372 0 372
122 OTSU MgSO4 BOTOL 0 0
123 OXITOCIN INJEKSI AMPUL 0 0
124 OXYTETRACYCLINE SK 3 % KOTAK @ 25 TUBE 0 0 0 0
125 OXYTETRACYCLINE SM 1 % KOTAK @ 25 TUBE 0 25 25 0 25
126 PAPAVERIN 40 MG KOTAK @ 100 TAB 1200 1200 100 1100
127 PARACETAMOL 500 MG KOTAK @ 100 TAB 6100 6100 400 5700
128 PARACETAMOL DROP BOTOL 224 224 56 168
129 PARACETAMOL SYRUP BOTOL 0 184 184 36 148
130 PHENOBARBITAL INJ 50 MG/ML KOTAK @ 30 AMPUL 0 0 0
131 PIROXICAM 10 MG KOTAK @ 100 TAB 700 500 1200 600 600
132 PIROXICAM 20 MG KOTAK @ 100 TAB 0 0 0
133 PREDNISON 5 MG KOTAK @ 100 TAB 600 600 0 600
134 PRIMAQUIN 15 MG KOTAK @ 100 TAB 0 0 0
135 PROPANOLOL TAB 10 MG (HCL) KOTAK @ 100 TAB 200 200 0 200
136 PROPILTIOURASIL 100 MG BOTOL @ 100 TAB 100 100 0 100
137 PYRANTEL 125 MG KOTAK @ 100 TAB 200 50 250 50 200
138 PYRANTEL SUSPENSI BOTOL 0 -50 50
139 PYRAZINAMIDE 500 MG TABLET 0 0
140 QUININE 222 MG TABLET 3000 3000 0 3000
141 QUININE INJ KOTAK @ 100 AMP 0 0 0
142 RANITIDIN KOTAK @ 100 TAB 800 800 300 500
143 RANITIDINE INJEKSI KOTAK @ 10 AMP 114 114 0 114
144 RIFAMPICIN 450 MG KOTAK @ 100 TAB 0 0 0
145 RINGER LACTATE INFUS KOTAK @ 20 FLACON 34 34 0 34
146 SABU VIAL 0 0 0
147 SALBUTAMOL 2 MG KOTAK @ 100 TAB 500 500 0 500
148 SALBUTAMOL 4 MG KOTAK @ 100 TAB 500 500 100 400
149 SALBUTAMOL VENTOLIN NEBULES KOTAK @ 20 BTL 40 40 0 40
150 SALBUTAMOL SIRUP BOTOL 49 49 5 44
151 SALEP 24 POT 0 0 0
152 SIMVASTATIN 10 MG KOTAK @ 30 TAB 870 870 300 570
153 SIMVASTATIN 20 MG KOTAK @ 50 TAB 0 600 600 300 300
154 SPIRONOLAKTON TAB 10 MG (HCL) KOTAK @ 100 TAB 100 100 0 100
155 TETAGAM KOTAK 0 -2 2
156 TETRACYCLINE 500 KOTAK @ 100 CAPS 500 500 0 500
157 TETRACYCLINE 250 KOTAK @ 100 CAPS 100 100 0 100
158 THIAMFENICOL 500 KOTAK @ 100 TAB 800 200 1000 0 1000
159 TRAMADOL INJ AMPUL 0 0 0
160 ULSAFAT SUSP 100 ML BOTOL 50 50 30 20
161 VITAMIN B COMPLEX KOTAK @ 100 TAB 200 1000 1200 300 900
162 VITAMIN B1 BOTOL @ 1000 TAB 0 0 0
163 VITAMIN B1 50 MG KOTAK @ 100 TAB 1000 1000 0 1000
164 VITAMIN B12 KOTAK @ 100 TAB 500 500 0 500
165 VITAMIN B6 BOTOL @ 1000 TAB 0 2000 2000 1000 1000
166 VITAMIN B6 KOTAK @ 100 TAB 1000 1000 0 1000
167 VITAMIN C 50 MG KOTAK @ 100 TAB 0 0 0
168 VITAMIN C 100 MG KOTAK @ 100 TAB 0 0 0
169 VITAMIN C 250 MG KOTAK @ 100 TAB 300 300 300 0
170 VITAMIN K 10 MG TABLET 200 200 0 200

171 VITAMIN K INJ AMPUL 30 30 0 30

172 ZINC 20 MG KOTAK @ 100 TAB 1100 1100 0 1100
173 ZINC SYR BOTOL 20 20 5 15

PERBEKALAN KESEHATAN
1 ALKOHOL 70% 1 L BOTOL 4 4 1 3
2 ALVOGYL 10G KOTAK / POT 1 1 1 0
3 ARTICULATING PAPER KOTAK @12BANDEL 0 0
4 AUTOCLICK LANCING DEVICE PIECES 0 0
5 BENECHECK 3 IN 1 UNIT 2 2 2 0
6 BLOOD LANCET BOX 2 5 7 4 3
7 BLOOD INFUSION SET PIECES 0 0
8 BONDING 5G BOTOL 2 2 2 0
9 BON WAX W810 BOX @24 0 0
10 BORAX RAPID TEST BOX @ 200 STRIP 0 0
11 CANULA OKSIGEN ANAK PIECES 0 0
12 CANULA OKSIGEN DEWASA PIECES 0 0
13 CAT GUT CHROMIC 3/0 100M BOX 0 0
14 CAT GUT CHROMIC 2 50 MM PCS 0 0
15 CUT GUT CHROMIC 2/0 26 MM PCS 0 0
16 CUT GUT CHROMIC 2/0 150 CM PCS 43 43 0 43
17 CATHETER KARET PED NO.6 PIECES 0 0
18 CATHETER KARET PED NO.8 PIECES 0 0
19 CATHETER KARET PED NO.10 PIECES 0 0
20 CATHETER KARET 2 WAY NO.12 PIECES 0 0
21 CATHETER KARET 2 WAY NO.14 PIECES 0 0
22 CATHETER KARET 2 WAY NO.16 PIECES 0 0
23 CATHETER KARET 2 WAY NO.18 PIECES 0 0
24 CATHETER KARET 2 WAY NO.20 PIECES 0 0
25 CATHETER KARET 2 WAY NO.22 PIECES 0 0
26 CATHETER KARET 2 WAY NO.24 PIECES 0 0
27 CATHETER KARET 3 WAY NO.20 PIECES 0 0
28 CATHETER KARET 3 WAY NO.22 PIECES 0 0
29 CATHETER KARET 3 WAY NO.24 PIECES 0 0
30 CHKM KOTAK 1 1 1 0
31 COFER GLASS 20 X 20 MM PACK 0 0
32 COTTON ROLL PACK@12IKAT 3 3 3 0
33 DENGUE RAPIT TEST BOX 0 0
34 DEVITALISASI POT 2 2 2 0
35 DISPOSIBLE 0,05 ML BOX 100 PCS 500 500 0 500
36 DISPOSIBLE 05 ML BOX 100 PCS 0 0
37 DISPOSIBLE 50 ML BOX 20 PCS 20 20 0 20
38 DISPOSIBLE 10 ML BOX 100 PCS 0 0
39 DISPOSIBLE 20 ML BOX 50 PCS 0 0
40 DISPOSIBLE 1 ML BOX 100 PCS 738 738 12 726
41 DISPOSIBLE 3 ML BOX 100 PCS 462 462 27 435
42 DISPOSIBLE 5 ML BOX 100 PCS 0 0
43 EASY TOUCH GLUCOSE STRIP KOTAK @ 50 STRIP 15 15 5 10
44 EASY TOUCH CHOLESTEROL STRIP KOTAK @ 10 STRIP 15 15 10 5
45 EASY TOUCH URIC ACID STRIP KOTAK @ 25 STRIP 15 15 7 8
46 EDTA BOTOL 0 0
47 ELASTOMUL 12CM X 4M ROLL 0 0
48 ELECTRODA ECG PACK 50 PCS 0 0
49 ENDOTRACHEAL TUBE 2,5 PIECES 0 0
50 ENDOTRACHEAL TUBE 3 PIECES 0 0
51 ENDOTRACHEAL TUBE 3,5 PIECES 0 0
52 ENDOTRACHEAL TUBE 4 PIECES 0 0
53 ENDOTRACHEAL TUBE 4,5 PIECES 0 0
54 ENDOTRACHEAL TUBE 5 PIECES 0 0
55 ENDOTRACHEAL TUBE 5,5 PIECES 0 0
56 ENDOTRACHEAL TUBE 6 PIECES 0 0
57 ENDOTRACHEAL TUBE 6,5 PIECES 0 0
58 ENDOTRACHEAL TUBE 7 PIECES 0 0
59 ENDOTRACHEAL TUBE 7,5 PIECES 0 0
60 ENDOTRACHEAL TUBE 8 PIECES 0 0
61 ENDOMETHASON 14GR BOTOL 0 0
62 ETSA BOX 2 2 2
63 EUGENOL BOTOL 2 2 2 0
64 EXAMINATION GLOVE L BOX 100 PCS 0 0
65 EXAMINATION GLOVE M BOX 100 PCS 900 900 200 700
66 EXAMINATION GLOVE S BOX 100 PCS 0 0
67 FLETCHER POWDER 100G BOTOL 0 0
68 FORMALIN CAIR 1 L BOTOL 4 4 1 3
69 FORMALIN RAPIT TEST BOX @ 100 STRIP 0 0
70 GEL DOPLER BOTOL 2 3 5 2 3
71 GLUCO PROTEIN RAPIT TES BOX 0 0
72 GLYCERIN SYRINGE PIECES 0 0
73 GLYCERIN 1000 ML BOTOL 1 1 0 1
74 GOLONGAN DARAH A VIAL 0 0
75 GOLONGAN DARAH A-B VIAL 0 0
76 GOLONGAN DARAH B VIAL 0 0
77 GYPSONA 3 INCH ROLL 0 0
78 GYPSONA 4 INCH ROLL 0 0
79 GYPSONA 6 INCH ROLL 0 0
80 H2O2 3% 800ML BOTOL 1 5 6 0 6
81 HbsAg RAPIT TES PIECES 5 5 1 4
82 HCl 0.1N 100 ML BOTOL 1 1 0 1
83 HIV STRIP BOX S 50 0 0
84 HYDCAL KOTAK@2TUBE 0 0
85 INFUSET MAKRO BOX 50 PCS 44 44 2 42
86 INFUSET MIKRO BOX 50 PCS 48 48 2 46
87 IV CATHETER NO. 16 (JELCO) BOX 50 PCS 0 0
88 IV CATHETER NO.18 BOX 50 PCS 0 0
89 IV CATHETER NO.24 BOX 50 PCS 0 0
90 IV CATHETER NO.26 BOX 50 PCS 0 0
91 IV CATHETER NO.22 BOX 50 PCS 0 0
92 IV CATHETER NO.20 BOX 50 PCS 0 0
93 JARUM BEDAH GR 10 DOZEN 0 0
94 JARUM BEDAH GR 11 DOZEN 20 20 0 20
95 JARUM BEDAH GR 12 DOZEN 0 0
96 JARUM BEDAH GR 13 DOZEN 0 0
97 JARUM BEDAH GR 9 DOZEN 0 0
98 JARUM BEDAH GT 10 DOZEN 0 0
99 JARUM BEDAH GT 11 DOZEN 0 0
100 JARUM BEDAH GT 12 DOZEN 0 0
101 JARUM BEDAH GT 13 DOZEN 0 0
102 JARUM BEDAH GT 9 DOZEN 0 0
103 JARUM CITOJET BOX @ 100 0 0
104 KAPAS PEMBALUT 250 G ROLL 1 50 51 0 51
105 KASA HYDROFIL 40 YARD X 80 CM 2015 ROLL 3 3 2 1
106 KASA KOMPRES STERIL 40 X 40 CM PIECES 0 0
107 KASA PEMBALUT HYDROFIL 4 YARD X 5 CM ROLL 0 0
108 KERTAS PERKAMEN PACK 0 0
109 KERTAS PUYER BERPEREKAT PACK 0 0
110 KERTAS ECG/EKG ROLL 0 0
111 LAMPU SPIRITUS SET 0 0
112 LYSOL 50% 1 L BOTOL 0 0
113 MALARIA RAPIT TES PIECES 0 0
114 MASKER EARLOOP BOX 50 PCS 100 100 0 100
115 MASKER 3 PLAY PLUS BOX 50 PCS 100 100 0 100
116 MASKER TIE ON (IKAT) BOX 50 PCS 150 150 50 100
117 METANOL BOTOL 0 0
118 MICROBRUSH PIECES 0 0
119 MITELLA PIECES 0 0
120 MULTIFILAMEN NON CUTTING NO.4/0 BOX 12 PCS 0 0
121 MULTIFILAMEN NON CUTTING NO.1 BOX 12 PCS 0 0
122 MULTIFILAMEN NON CUTTING NO.2/0 BOX 12 PCS 0 0
123 MULTIFILAMEN NON CUTTING NO.3/0 BOX 12 PCS 0 0
124 MULTIFILAMEN NON CUTTING NO.2 BOX 12 PCS 0 0
125 MONOFILAMEN CUTTING NO.3/0 BOX 12 PCS 0 0
126 MONOFILAMEN CUTTING NO.4/0 BOX 12 PCS 0 0
127 MONOFILAMEN CUTTING NO.5/0 BOX 12 PCS 0 0
128 NARKOBA TES STRIP BOX 0 0
129 NASOGASTRIC TUBE 75cm 2,5ML PIECES 0 0
130 NASOGASTRIC TUBE fr 3,5 35cm PIECES 0 0
131 NASOGASTRIC TUBE fr 5 100cm PIECES 0 0
132 NASOGASTRIC TUBE fr 5 40cm PIECES 0 0
133 NASOGASTRIC TUBE NO. 5 PIECES 0 0
134 NASOGASTRIC TUBE NO.6 PIECES 0 0
135 NASOGASTRIC TUBE fr 8 100cm PIECES 0 0
136 NASOGASTRIC TUBE fr 8 40cm PIECES 0 0
137 NASOGASTRIC TUBE DEWASA 18 PIECES 0 0
138 NASOGASTRIC TUBE fr 18 125cm PIECES 0 0
139 NASOGASTRIC TUBE fr 12 125cm PIECES 0 0
140 NASOGASTRIC TUBE fr 14 125cm PIECES 0 0
141 NASOGASTRIC TUBE fr 16 125cm PIECES 0 0
142 NATRIUM CITRAT BOTOL 1 1 0 1
143 NEEDLE NO.23 BOX 100 PCS 0 0
144 OBJECK GLASS BOX 72 PCS 0 0
145 PAPER LENS KOTAK 0 0
146 PEMBALUT ELASTIS UK. 10 CM X 4.55 M PCS 0 0
147 PEMBALUT ELASTIS UK. 15 CM X 4.55 M PCS 0 0
148 PEMBALUT ELASTIS UK. 7.5 CM X 4.55 M PCS 0 0
149 PERBAN ELASTIS ROLL 0 0
150 PLASTIK KLIP PACK @1000PCS 1 1 1 0
151 POMPA TENSIMETER STANDARD PIECES 1 1 0 1
152 POVIDON IODINE 10 % 30 ML BOTOL 9 9 2 7
153 POVIDON IODINE 10 % 300 ML BOTOL 2 2 0 2
154 POVIDON IODINE 10% 60 ML BOTOL 0 0
155 POVIDON IODINE 10 % 60 ML BOTOL 0 0
156 RAK TABUNG PIECES 0 0
157 PREGNANT TES BOX 50 PCS 50 100 150 0 150
158 REAGEN GIEMSA 10ML BOTOL 0 0
159 REGAEN GOLONGAN DARAH VIAL 0 0
160 REAGEN HAYEM BOTOL 0 0
161 REAGEN REES ECKER BOTOL 0 0
162 REAGEN TURK BOTOL 0 0
163 REAGEN WIDAL H VIAL 0 0
164 REAGEN WIDAL O VIAL 0 0
165 SAFETY BOX PIECES 50 25 75 50 25
166 SILK BLACK Pfm 3/0 100M BOX 0 0
167 SILK BLACK 2/0 DS 24 MM PCS 0 0
168 SILK BLACK 3/0 DS 24 MM PCS 0 0
169 SILK 3/0 + JARUM 1/2 GT 35 MM BOX 0 0
170 SILK 2/0 500 CM BOX 0 0
171 SILK 4/0 100M PIECES 0 0
172 SKINTRAKSI ADULT ROLL 0 0
173 SKINTRAKSI CHILD ROLL 0 0
174 SPINAL NEEDLE BOX @ 25 0 0
175 SUCTION CATHETER NO.8 PIECES 0 0
176 SUCTION CATHETER NO.10 PIECES 0 0
177 SURGICELL 5X7,5 W1913 T BOX@24 0 0
178 SURGICAL BLADE NO.13 BOX 100 PCS 0 0
179 SURGICAL BLADE NO.20 BOX@100 0 0
180 SURGICAL BLADE NO.15 BOX@100 0 0
181 SURGICAL BLADE NO.11 BOX@100 100 100 0 100
182 SURGICAL GLOVES NO 6 BOX 50 PCS 50 50 0 50
183 SURGICAL GLOVES NO 6,5 BOX 50 PCS 150 150 100 50
184 SURGICAL GLOVES NO 7 BOX 50 PCS 50 50 0 50
185 SURGICAL GLOVES NO 7,5 BOX 50 PCS 50 50 0 50
186 SURGICAL GLOVES NO 8 BOX 50 PCS 50 50 0 50
187 TAMBALAN GLASS IONOMIR ANTERIOR KOTAK 0 0
188 TAMBALAN GLASS IONOMIR POSTERUOR KOTAK 0 0
189 TAMBALAN KOMPOSIT WARNA ANTERIOR A2 KOTAK / SYRINGE 4G 2 2 2
190 TAMBALAN KOMPOSIT WARNA ANTERIOR A3 KOTAK / SYRINGE 4G 2 2 2 0
191 TAMBALAN KOMPOSIT WARNA POSTERIOR A2 KOTAK 2 2 2 0
192 TAMBALAN KOMPOSIT WARNA POSTERIOR A3 KOTAK 2 2 2 0
193 TUMPATAN SEMENTARA KOTAK 2 2 2 0
194 THERMOMETER AIR RAKSA BUAH 0 0
195 TKF KOTAK 1 1 1 0
196 UMBILICAL CORD KLEM BOX@50PCS 0 0
197 URIN BAG STANDARD 2L PIECES 0 0
198 ULTRAFIX 5 M X 5 CM ROLL 1 5 6 0 6
199 URITEST REAGEN STRIP 11 G TUBE 0 0
200 WING NEEDLE 19 G x 3/4" KOTAK @ 100 PCS 0 0
201 WING NEEDLE 21 G x 3/4" KOTAK @ 100 PCS 0 0
202 WING NEEDLE 23 G x 3/4" KOTAK @ 100 PCS 100 100 0 100
203 WING NEEDLE 25 G x 3/4" KOTAK @ 100 PCS 0 0
204 WING NEEDLE 27 G x 1/2" KOTAK @ 100 PCS 0 0
205 ZINC PHOSPAT CEMENT KOTAK 2 2 2 0

UMUM
JUMLAH KUNJUNGAN RESEP BAYAR TIDAK BAYAR ASKES JUMLAH

Yang meminta Mengetahui/Menyetujui Yang Menyerahkan

Pimpinan Puskesmas, Kepala Dinkes Kab/Kota/ Petugas GF Kab/Kota,
GF Kab/Kota,

( dr.Gondhiar ) ( ............................................. ) ( ............................................. )

NIP. 19820429 201101 1009 NIP. ......................................... NIP. .........................................
\
N OBAT PUSKESMAS

Lembaran 1 : Gudang Farmasi

JANUARI 2017 NO/TGL DOKUMEN
FEBRUARI 2017 GFK KAB/KOTA
PUSK
DINKES

PERMINT PENERIMAAN
JUMLAH KET
AAN I ASKES APBD I APBD II 2012program
10 11 12 13 14 15 16 17

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0
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0
0
0
500 24
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1000 0
500 12
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 8
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 Yang Menyerahkan Yang Menerima
Petugas GF Kab/Kota, Petugas Puskesmas,

............................................. ) ( Wiwiek Muniati,S.Si.,Apt )

NIP. ......................................... NIP. 19840329 201101 2 003
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