LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

LPLPO
KODE PUSBAN :
PUSKESMAS : KAHALA DOKUMEN LPLPO SURAT BUKTI BARANG KELUAR (SBBK) LAPORAN BULAN : MEI
KECAMATAN : KENOHAN NOMOR NOMOR PERMINTAAN BULAN : JUNI
KABUPATEN : KUTAI KARTANEGARA TANGGAL May-21 TANGGAL TAHUN ###

KLAS STOK PENERI- PERSE- PEMA- SISA STOK PERMIN- PEMBERIAN

NO KODE OBAT NAMA SEDIAAN SATUAN KET
TERAPI AWAL MAAN DIAAN KAIAN STOK OPT TAAN APBN APBD I APBD II PROG. LAIN2 JML
1 2 3 4 5 6 7 8 (6+7) 9 10 (8-9) 11 12 13 14 15 16 17 18 19
SEDIAAN OBAT
1 Acyclovir 200 mg / 400 mg Tablet 0 0 0 0 0 30
2 Albendazole 400 mg Tablet
3 Allopurinol 100 mg / 300 mg Tablet 0 0 0 0 0 50
4 Ambroxol Tab 30 mg Tablet
5 Aminophylin 200 mg Tablet
6 Amitriptylin 25 mg Tablet
7 Amlodipin 5 mg/ 10 mg Tablet 0 0 0 0 0 20
8 Amoxicilin 250 mg / 500 mg Tablet 85 0 85 30 55 30
9 Ampicilin 500 mg Tablet
10 Antalgin / Selesgin 500 mg Tablet 0 0 0 0 0 20
11 Antasida Doen mg Tablet 40 0 40 10 30 30
12 Asam mefenamat 500 mg Tablet 30 0 30 30 0 50
13 Besi Sulfat 300 mg Tablet
14 Betahistin 6 mg Tablet
15 Captopril 12,5 mg / 25 mg Tablet 0 0 0 0 0 50
16 Furosemide 40 mg Tablet
17 Carbamazepin 200 mg Tablet
18 Cefadroxil 500 mg Tablet 0 0 0 0 0 50
19 Cefixime 100 mg Tablet 0 0 0 0 0 30
20 Cetrizine 10 mg Tablet 0 0 0 0 0 30
21 Cimetidine 200 mg Tablet 0 0 0 0 0 30
22 Ciprofloxacin 500 mg Tablet
23 Codein tab 10 mg Tablet
24 CTM 4 mg Tablet
25 Dexamethasone 0,5 mg Tablet 0 0 0 0 0 30
26 Diazepam 2 mg Tablet
27 Dietil Karbamazepin Sulfat 100 mg Tablet
28 Digoxin 0,25 mg Tablet
29 Diltiazem 30 mg Tablet
30 Dimenhidrinate 30 mg Tablet 0 0 0 0 0 30
31 Domperidon 10 mg Tablet 0 0 0 0 0 50
32 Doxycline 100 mg Tablet
33 Furosemide 40 mg Tablet
34 Geliceril Guayacolat 100mg Tablet
35 Glibenclamide 5 mg Tablet
36 Griseofulvin 125 mg Tablet 0 0 0 0 0 20
37 Halloperidol 0,5 mg / 5 mg Tablet
38 HCT 25 mg Tablet
39 Ibuprofen 200 mg / 400 mg Tablet 0 0 0 0 0 50
40 INH 100 mg Tablet
41 Isosorbit Dinitrat 5 mg Tablet
42 Kalsium Laktat 500 mg Tablet 60 0 60 30 30 20
43 Ketoconazole 200 mg Tablet
44 Kloramphenicol 250 mg Tablet
45 Klorpromazin 100 mg Tablet
46 Komb Piretamin + Sulfadoxin Tablet
47 Kotrimaksazol 250 mg / 480 mg Tablet
48 Loperamide 2 mg Tablet 0 0 0 0 0 30
49 Loratadin 10 mg Tablet 0 0 0 0 0 20
50 Metformin 500 mg Tablet 20 0 20 20 0 50
51 Metil Ergometrin 0,125 mg Tablet
52 Metoclopramida tab 5 mg Tablet 0 0 0 0 0 20
53 Metrodinazole 250 mg / 500 mg Tablet 0 0 0 0 0 20
54 Natrium Diclofenat 25 mg / 50 mg Tablet
55 Natrium Fenition 30 mg Capsul
56 Oralit 200 ml
57 Papaverine 40 mg Tablet 0 0 0 0 0 30
58 Paraformaldehida 1 gr Tablet
59 Parasetamol 500 mg Tablet 200 0 200 100 100
60 Pirantel Pamoat 365 mg Tablet
61 Piroxicam 20 mg Tablet 0 0 0 0 0 30
62 Prednison 5 mg Tablet
63 Propanolol 10 mg / 40 mg Tablet
64 Ranitidine Tab 150 mg Tablet 0 0 0 0 0 30
65 Rifampicin 450 mg Tablet
66 Salbutamol 2 mg / 4 mg Tablet
67 Simvastatin 10 mg / 20 mg Tablet 0 0 0 0 0 60
68 Tetrasiklin 250 mg / 500 mg Tablet
69 Thiamphenicol 500 mg Tablet
70 Trihexphenidyl 2 mg Tablet
71 Vit A 20.000 IU Kapsul
72 Vitamin B6 10 mg Tablet
73 Vitamin B Compleks Tablet 60 0 60 20 40 20
74 Vitamin B1 50 mg Tablet
75 Vitamin B12 Tablet
76 Vitamin C 50 mg Tablet
77 Vitamin K 10 mg Tablet
78 Zink Tablet Tablet

SIRUP DAN SUSPENSI

79 Albendazole Syrup 200mg/5 ml Botol
80 Ambroxol Syr 15 mg/5 ml Botol 0 0 0 0 0 3
81 Amoxycilin Syrup kering 125mg/5ml, 250mg/5ml Botol 0 0 0 0 0 3
82 Antasida Doen Suspensi Botol 0 0 0 0 0 3
83 Cefadroxil Syr 250mg/5 ml Botol
84 Cefixime Syr 100mg/5 ml Botol
85 Domperidon Syr 5mg/5ml Botol 0 0 0 0 0 3
86 Erythromycin Dry Syr 200mg/5 ml Botol
87 Kloramphenicol Syr 125mg/5ml Botol
88 Kotrimaksazol Susp 200mg,40mg/5ml Botol
89 OBH Syr Botol
90 Parasetamol Syr 120mg/5ml Botol 5 0 5 3 2 3
91 Parasetamol Drops 100mg/ml Botol
92 Trisela Syr 5mg/5ml Botol
93 Zinkid Syr 20mg/60ml Botol 0 0 0 0 0 3

INJEKSI
94 Aminophylin Inj 24mg/ml Ampul
95 Ampicilin Inj 1g/10ml Vial
96 Antalgin Injeksi 100 mg/2ml Ampul
97 Atropin Injeksi 0,25mg/ml Ampul
98 Calcium Glukonas 100mg/ml Ampul 0 0 0 0 0 1
99 Cefotaxime Inj 1g/10ml Vial
100 Dexamethasone Inj 0,5mg/ml Ampul
101 Diazepam Injeksi Ampul
102 Dipenhidramin Inj 10mg/ml Ampul
103 Epinephrina Inj 0,1%/ml Ampul
104 Fenobarbital Injeksi Ampul
105 Kinina Injeksi 25% 2 ml Ampul
106 Klorpromazin inj 5mg/ml Ampul
107 Klorpromazin Injeksi 25mg/ml Ampul
108 Lidocain Comp Injeksi 0.02 Ampul
109 Lidocain Hcl 20mg/ml Ampul 3 0 3 0 3
110 Magnesium Sulfat Injeksi 20% 25ml Ampul
111 Metil Ergometrin 0,2mg/ml Ampul
112 Oksitetracycline Injeksi 50mg/ml Ampul
113 Oksitosin Injeksi 10UI/ml Ampul 4 0 4 2 2 2
114 Papaverine Injeksi Ampul
115 Pehakain 20mg, 0,0125/ml Ampul
116 Pethidin Inj 50mg/2ml Ampul
117 Phitomenadione Inj 2mg/ml Ampul 0 0 0 0 0 3
118 Ranitidine Injeksi 25mg/ml Ampul
119 Vit B12 Injeksi 0,5mg/ml Ampul
120 Vit K Injeksi 10mg/ml Ampul

CAIRAN
121 Aqua Pro Injeksi 25 ml Flask
122 Asam Sulfosalisilat 20 % 0.2 Flask
123 Betadine 30 ml Flask
124 Ethanol 0.7 Flask
125 Glucosa Infus 5%, 10 % Flask 6 0 6 0 6
126 Magnesium Sulfat Injeksi 40% 0.4 Flask 1 0 1 0 1
127 Natrium Klorida infus 0,9 % 0,9% Flask 0 0 0 0 0 2
128 Ringer laktat Infus 500 ml Flask 0 0 0 0 0 3
129 Ethylchloride 100 ml Flask

TOPIKAL
130 Acyclovir Zalf Kulit 0.05 Tube
131 Bethametason + Neomicyn Sulfat 0,1%, 0,5% Tube
132 Bethametason Zalf 0,1% Tube
133 Gentamicin Zalf Kulit 1% 5 g Tube 1 0 1 0 1
134 Hidrocortison cream 2,5% Tube
135 Ketokenazole Cream 0.02 Tube 1 0 1 0 1
136 Kloramphenicol Salep mata 0.01 Tube 0 0 0 0 0 3
137 Ketokonazole Cream 0.02 Tube
138 Salep 2 - 4 Pot
139 Salisil Bedak 0.02 Sak 5 0 5 0 5
140 Cloramphenicol salep mata 0.01 Tube

OBAT TETES
141 Gentamicin Tetes mata 0,3% Botol
142 Kloramphenicol tetes telinga 0.03 Botol
143 Kloramphenicol tetes mata 5mg/tetes Botol
Kloramphenicol +dexamethasone 0.01
144
TM Botol
145 Phenol Gliserol 0.1 Botol

RECTAL
146 Anti Hemoroid Suppositoria Supp
147 Dulcolax 5mg/10mg 5mg/10mg Supp
148 Stesolid Rectal 5mg / 2,5 ml 5mg/2,5ml Tube
149 Dumin Rectal 125mg Tube

OVULA
150 Nistatin Tab Vaginal 100.000 IU/gr Supp 10 0 10 0 10

OBAT PROGRAM
151 MDT MD Tablet
152 OAT FCD Kat I dan III Tablet
153 OAT FCD Kat II Tablet
154 OAT Anak Tablet
155 Primaquin Tablet

ALKES - BMHP
156 Abbocath 20 pcs 4 0 4 4 0 3
157 Abbocath 22 pcs 2 0 2 2 0 3
158 Abbocath 24 pcs 4 0 4 4 0 3
159 Abbocath 26 pcs 3 0 3 3 0 3
160 ADS 1 ml pcs 0 0 0 0 0 5
161 ADS 3 ml pcs 5 0 5 5 0 5
162 ADS 5 ml pcs
163 ADS 10 ml pcs 0 0 0 0 0 3
164 Catgut Plain 2/0 pcs
165 Catgut Cromic 2/0 pcs
166 Catgut Plain 3/0 pcs 1 0 1 0 1
167 Catgut Cromic 3/0 pcs 2 0 2 0 2
168 Kasa 40 cm x 80 cm roll 1 0 1 1 0
169 Kasa 3.6 cm x 15 cm roll
170 Kasa 4 cm x 15 cm roll
171 Kasa Steril 16 x 16 cm kotak
172 Kapas 250 gram roll
173 Kapas 500 gram roll
174 Handscoon Genkologi pcs 0 0 0 0 0 5
175 Handscoon Non-Steril No. 6 pcs
176 Handscoon Non-Steril No. 7 pcs 0 0 0 0 0 50
177 Handscoon Steril No. 7 pcs
178 Pembalut Elastis(Policrepe) pcs
179 Urine Bag pcs 4 0 4 0 4
180 Mucus Extraktor pcs 0 0 0 0 0 3
181 Infusion Anak pcs
182 Infusion Dewasa pcs 3 0 3 3 0 3
183 Nasal Canula Bayi pcs 0 0 0 0 0 1
184 Nasal Canula Anak pcs 0 0 0 0 0 1
185 Nasal Canula Dewasa pcs 0 0 0 0 0 1
186 Masker Oksigen Anak pcs 0 0 0 0 0 1
187 Masker Oksigen Dewasa pcs 0 0 0 0 0 1
188 Pembalut Elastis (polifix) pcs 2 0 2 0 2
189 Plesterin bulat pcs
190 Alkohol Swab pcs 0 0 0 0 0 30
191 Alkohol 70% 1 Liter botol 0 0 0 0 0 1
192 Betadine 1 Liter botol 0 0 0 0 0 1
193 Betadine 300 ml botol
194 Folley Catheter 10 pcs
195 Folley Catheter 18 pcs
196 Masker Bedah pcs 0 0 0 0 0 1
197 Antiseptik Gel botol 0 0 0 0 0 1
198 Underpad pcs 0 0 0 0 0 5
199 Spalat Panjang pcs 0 0 0 0 0 1
200 Spalat Pendek pcs 0 0 0 0 0 1
201 Windnedlle 27 G pcs 0 0 0 0 0 3

BAYAR TIDAK BAYAR BPJS JAMKESDA JUMLAH

KUNJUNGAN PASIEN

MENGETAHUI, YANG MELAPORKAN, YANG MENERIMA,

Kepala Puskesmas UPT. Dinkes Puskesmas Tenaga Farmasi Puskesmas Petugas Pusban
Kahala

dr. H Sofyan Apt. Akbar Saputra, S. Farm Revina Syara, Amd. Keb
NIP. 19740220 200701 1 019 NIP. - NIP. -