R - 4, R - 7, Plpo

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NO

13 Sunar
2 Jamin

16 Kasmi
4 Sulastri

20 Pujiono
17 Markini
12 Komsah
1 Komsah

5 Ngatsini
6 Sukamin

8 Rusmanto

14 M Idris E S
7 M Angga H

10 Munjaenah
3 Saskia putri

9 Nur Khamid

19 Siti maryam
15 Wiwid Widya

18 M. Hendriansyah
11 M Lukman hakim
NAMA PASIEN

ACYCLOVIR SALEP

ALLOPURINOL 100 MG

10
10
10
10
10
10
10
10

Ambroxol 30 mg

Amlodipin 5 mg

Amoksisilin Forte 250mg/5ml

10
10
10
10
10
10
10
10
10
10

Amoxicillin 500 mg

Amoxicillin syr 125 mg

Ampicillin 500 mg

Antasida DOEN syr

10
10
10
10
10
10
10

Antasida DOEN tab

Anti fungi salep

Antibakteri DOEN salep


10
10
10

ASAM ASCORBAT 500

Asam Ascorbat 50 mg
10
10

Asam Mefenamat 500 mg

ACETYLCISTEIN
10

Captopril 12,5 mg

Captopril 25 mg

Cefadroxyl 500 mg

Chloramphenikol 250 mg caps

Chloramphenikol syr
21 Yusuf 10
22 M Aris Subkhan 10 10
23 Haryati
24 Amanda Rizqi 10 10
25 maudya A 10
26 Imam Sobari 10 10
27 Epi 10
28 Adinda
29 Mashadi 10
30 Wisnu Saputro 10
31 Rusnaji 10
32 Sutami 10 10
33 Kustini 10
34 Djuminah 10 10
35 Suminah 10
36 Esti Wahyuni 10
37 Silviana Khoirun 10 10
38 Kusnan 10 10
39 Romlah 10 10 10
40 Siti Sih 10
41 Mu'i 10
42 Ali Zuhdi 10
43 Siti Musyafaah 10
44 Ahmad Wahono 10
45 Sri Ningsih 10
46 Mashudi 10 10
47 Miyono 10 10
48 Shofiyatiningsih 10
49 Markini 10
50 Mukri 10
51 Moh Ali 10 10
52 Asroah 10
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

TOTAL 0 0 30 0 0 50 0 0 0 10 0 0 10 0 20 0 0 0 0 0 0
Chloramphenikol tetes mata

Chloramphenikol tetes telinga

Chloramphenikol zalp mata

Chlorpheniramin HCl (CTM) 4 mg

Cotrimoksasol dws 480 mg

Cotrimoksasol syrup

cyanocobalamin

10
10
10
10
10
10
10
10
Dexametason 0,5 mg

Dimenhidrinat

Domperidon syr 5 mg/ml

Furosemid 40 mg

Furosemid inj 10 mg/ml

Garam Oralit

Gentamicin SO4 salep kulit

Glibenclamid 5 mg

Gliceril Guayakolat

Guanistrep / Neo Kaominal syr / Kanina syr

Hidrocortison salp

Ibuproven 200 mg

Ibuproven 400 mg

Isosorbid Dinitrat (ISDN)

Metronidazole 500 mg

Mikonazole salep

Natrium Diklofenak 50 mg
10
10
10

Vit B Complek

OBH
10
10 10
10
10

10 1

10 10 1

10
10
10
10
10

10
10

10
10
10
10 10
10
10
10
10
10

10 10
10
10
0 0 0 0 0 0 50 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Omeprazol

10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
Paracetamol 500 mg

Paracetamol syrup

Piridoxin 10 mg

Prednison 5 mg (Obat - PKD)

Ranitidin tab

Salbutamol 2 mg

Salep 2-4

Salicil Talk 2%

Sianocobalamin 50 mcg

Simvastatin 10 mg

Tambah Darah (Obat - PKD)

Tetrasiclin 500 mg

10
10
10
10

Thiamin 50 mg

Zink

SPUIT 3ML
10
10

10
10
10
10

10
10
10
10
10

10
10
10
10
10
10
10
10
10
10

10
10 10
10
10
10
0 60 0 0 0 0 0 0 0 0 0 0 0 10 0 0
SALDO PENERIM PERSEDI
NO NAMA OBAT SATUAN
AWAL AAN AAN

1 2 3 4 5 6
1 Asam traneksamat tab 0
2 Acyclovir 400 mg tab 0
3 Acyclovir salep tube 0
4 Albendazol (Obat - PKD) tab 0
5 Albendazol 200 mg/5 ml syr btl 0
6 Allupurinol 100 mg tab 0
7 Alprazolam tab 0
8 Ambroxol 30 mg tab 0
9 Ambroxol syr btl 0
10 Aminophyllin 200 mg tab tab 0
11 Aminophyllin inj 24 mg/ml ampul 0
12 Amitriptillin 25 mg tab 0
13 Amlodipin 5 mg tablet 0
14 Amoksisilin Forte 250mg/5ml botol 0
15 Amoxicillin 250 mg cap 0
16 Amoxicillin 500 mg tab 0
17 Amoxicillin injeksi vial 0
18 Amoxicillin syr 125 mg botol 0
19 Ampicillin 500 mg tab 0
20 Ampicillin inj 1000 mg vial 0
21 Ampicillin syr 125 mg botol 0
22 Antalgin 500 mg tab 0
23 Antalgin inj ampul 0
24 Antasida DOEN syr botol 0
25 Antasida DOEN tab tab 0
26 Anti fungi salep tube 0
27 Anti Haemoroid DOEN biji 0
28 Antibakteri DOEN salep tube 0
29 Aquadest 20 lt galon 0
30 Aqua Pro inj vial 0
31 Asam Ascorbat 500mg botol 0
32 Asam Ascorbat 50 mg tab 0
33 Asam Folat 1 MG tab 0
34 Asam Mefenamat 500 mg tab 0
35 Asetosal 80 mg tab 0
36 Asam tranexamat 500 mg tab 0
37 Attapulgit 700 mg + Pectin 50 tablet 0
38 Betahistin tablet 0
39 Bionicom tablet 0
40 Berotex Sol btotol 0
41 Betametason cream 0,1% tube 0
42 Bioplacenton Jelly/ Neocenta tube 0
43 Acetylcistein 200 mg tab 0
44 Bisacodyl tab tablet 0
45 Bisoprolol 2,5 mg tab 0
46 Borak Gliserin (GOM) botol 0
47 Bromhexin Drop botol 0
48 Bromhexin tab tab 0
49 Ca Gluconas ampul 0
50 Captopril 12,5 mg tab 0
51 Captopril 25 mg tab 0
52 Carbamazepine 100 mg tab 0
53 Carbamazepine 200 mg tab 0
54 Cefadroxyl 500 mg cap 0
55 Cefotaxime inj 1g vial 0
56 Cetirizin syrup botol 0
57 Chloramphenicol salep Kulit TUBE 0
58 Chloramphenikol 250 mg caps caps 0
59 Chloramphenikol syr botol 0
60 Chloramphenikol tetes mata botol 0
61 Chloramphenikol tetes telinga botol 0
62 Chloramphenikol zalp mata tube 0
63 Chlorpheniramin HCl (CTM) 4 tab 0
64 Chlorpromazin 100 mg tab 0
65 Chlorpromazin 25 mg tab 0
66 Chlorpromazin HCL inj ampul 0
67 Cimetidin tab 0
68 Ciprofloxacin 500 mg tab 0
69 Clindamicin 300 mg tab 0
70 Clobazem 10 mg tab 0
71 Clonidin 0,15 mg tab 0
72 Clozapin tab 0
73 Co Amoxiclav 625 mg tab 0
74 Cotrimoksasol ANAK 120 mg tab 0
75 Cotrimoksasol dws 480 mg tab 0
76 Cotrimoksasol syrup botol 0
77 Dexametason 0,5 mg tab 0
78 Cetirizin syrup fls 0
79 Dextrophan syr botol 0
80 Diazepam 10 mg/2ml Inj ampul 0
81 Diazepam 2 mg tab 0
82 Diazepam 5 mg tab 0
83 Diazepam 5 mg/ml Inj ampul 0
84 Difenhidramin inj 10 mg/ml ampul 0
85 Digoxin 0,25 mg tab 0
86 Diltiazem 30 mg tab 0
87 Dimenhidrinat tab 0
88 Domperidon tablet 0
89 Domperidon syr 5 mg/ml botol 0
90 Dulkolak suppo 10 mg (Dws) biji 0
91 Dulkolak suppo 5 mg (Anak) biji 0
92 Ephedrin 25 mg tab 0
93 Epineprin inj ampul 0
94 Ergotamin Cofeein tab 0
95 Erphamasole tube 0
96 Erythromycin 250 mg cap 0
97 Erythromycin 500 mg tab 0
98 Erytromysin 200 mg/ml botol 0
99 Etakridina Laktat (Rivanol) 100 botol 0
100 Etakridina Laktat (Rivanol) 300 botol 0
101 Etanol 1 lt botol 0
102 Extrak Belladon tab 0
103 Famotidin 40 mg tab 0
104 Fenilbutason 200 mg tab 0
105 Fenobarbital 100 mg tab 0
106 Fenobarbital 30 mg tab 0
107 Fenobarbital inj ampul 0
108 Fenoksimetil Penisillin 500 mg tab 0
109 Fenol Glycerol tts telinga botol 0
110 Fitomenadion 10 mg tab 0
111 Fitomenadion inj (Obat - PKD) ampul 0
112 Fitomenadion inj K1 2mg/ml / iampul 0
113 Flufenazine Decanoat 25mg/mlampul 0
114 Fluoksetin 10 mg tab 0
115 Furosemid 40 mg tab 0
116 Furosemid inj 10 mg/ml ampul 0
117 Garam Oralit sachset 0
118 Gentamicin SO4 salep kulit tube 0
119 Gentamicyn SO4 TM 0,3% botol 0
120 GLUCODEX TAB 0
121 Gentian Violet 1% botol 0
122 Glibenclamid 5 mg tab 0
123 Gliceril Guayakolat tab 0
124 Glukosa infus 5% botol 0
125 Glukosa infus 10% botol 0
126 Glukosa infus 40% ampul 0
127 Griseofulvin 125 mg tab 0
128 Guanistrep / Neo Kaominal syr botol 0
129 Halloperidol 1,5 mg tab 0
130 Halloperidol 5 mg tab 0
131 Halloperidol 5mg/ml ampul 0
132 Hemafort tab 0
133 Hidrocortison salp tube 0
134 Hidroklorotiacida (HCT) tab 0
135 Hyoscin N Butyl Br inj ampul 0
136 Hyoscine N ButylBr 10 mg tab 0
137 Ibuprofen suspensi 100 mg/ml botol 0
138 Ibuproven 200 mg tab 0
139 Ibuproven 400 mg tab 0
140 Imipramine HCL 25 mg tab 0
141 Isoniazida 100 mg tab 0
142 Isoniazida 300 mg tab 0
143 Isosorbid Dinitrat (ISDN) tab 0
144 Kalium Diklofenak tab 0
145 Kalium Permanganat (PK) tube 0
146 Kalnek inj ampul 0
147 Kalsium Laktat tab 0
148 Kanamicin inj vial 0
149 Ketokonazole cream tube 0
150 Ketokonazole 200 mg tab 0
151 Ketoprofen inj ampul 0
152 Ketoprofen suppo suppo 0
153 lart HES Koloid 6% botol 0
154 Leverteran salep 10% tube 0
155 Levofloksasin 500 mg tab 0
156 Lidocain HCl 2% inj ampul 0
157 Lincomicin 500 mg caps 0
158 Lisol 1 lt botol 0
159 Loperamid tab tab 0
160 Loratadin 10 mg tab 0
161 Magnesium SO4 20% ampul 0
162 Mebendasol 100 mg tab 0
163 Meloksikam 15 mg tab 0
164 Metformin 500 mg tab 0
165 Metoklopramid inj ampul 0
166 Metoklopramid tab tab 0
167 Metronidazole 250 mg tab
168 Metronidazole 500 mg tab 0
169 Metyl Ergometrin inj ampul 0
170 Metyl Ergometrin tab tab 0
171 Metyl Prednisolon 4 mg tab tab 0
172 Mikonazole salep tube 0
173 Minosep Gargle botol 0
174 Natrium Bicarbonat tab 0
175 Natrium Diklofenak 50 mg tab 0
176 Natrium Fluoresin tetes mata tube 0
177 Natrium Klorida infus botol 0
178 Vit B Complek tab 0
179 Neurotropic cap 0
180 Nifedipin 10 mg tab 0
181 Nistatain tab 500.000 iu tab 0
182 Nistatain vag tab 100,000 iu vag tab 0
183 Nodiar/ NEW ANTIDES tab 0
184 Novadryl botol 0
185 O B H botol 0
186 METACETIN botol 0
187 Omeprazol cap 0
188 #REF! tablet 0
189 Oralit vial 0
190 Oxytetra salep mata tube 0
191 Oxytetra salp kulit 3% tube 0
192 Oxytosin inj 10 IU/ml ampul 0
193 Papaverin 40 mg tab 0
194 Parasetamol suppo ampul 0
195 Paracetamol 500 mg tab 0
196 Paracetamol syrup botol 0
197 Piridoxin 10 mg tab 0
198 Piroxicam 20 mg cap 0
199 Polykresol Kondenstat (Albotyl)botol 0
200 Povidon Iodin 1 lt btl 1 lt 0
201 Povidon Iodin 60 cc btl 30 cc 0
202 Povidon Iodin 300 cc btl 300 cc 0
203 Prednison 5 mg (Obat - PKD) tab 0
204 Propanolol 10 mg tab 0
205 Propanolol 40 mg tab 0
206 Ranitidin 50 mg/2 ml inj ampul 0
207 Ranitidin tab tab 0
208 Reserpin 0,25 mg tab 0
209 Ringer Laktat infus botol 0
210 Risperidon tab 0
211 Salbutamol 2 mg tab 0
212 Salep 2-4 tube 0
213 Salicil Talk 2% kotak 0
214 Sianocobalamin 50 mcg tab 0
215 Sianocobalamin inj ampul 0
216 tenoflam obat hiv 0
217 Simvastatin 20 mg tab 0
218 Simvastatin 20 mg ampul 0
219 Stesolid Rectal tube tube 0
220 Streptomicin inj vial 0
221 Sufratul / Daryantul lembar 0
222 Sulfacetamid tetes mata botol 0
223 Sulfadimidin tab 0
224 Simvastatin 10 mg tab 0
225 Tambah Darah (Obat - PKD) tab 0
226 Tetracyclin 250 mg cap 0
227 Tetrasiclin 500 mg cap 0
228 Thiamin 50 mg tab 0
229 Thiamin inj vial 0
230 Thyamphenicol 500 mg cap 0
231 Trifluoperazine HCL 5mg tab 0
232 Trihexyphenidil 2 mg tab 0
233 Zink tab 0
234 Masker medis biji 0
Vitamin A 200.000 iu tab 0
236 Miniaspi tab 0
237 Asam Folat 1 mg tab 0
238 Sendok plastik 0
239 Tenovovir tab Botol 0
240 Lamivudine tab Botol 0
241 efaviren Tab Botol 0
242 ATS INJEKSI 1500 IU AMPUL 0

Mengetahui,
Kepala Puskesmas Gembong

dr. Moh. Danur Khusna


NIP. 19700420 200501 1 006
PEMAKAIAN
7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
Pengelola Obat Puskesmas Pelaksana Layanan

Drs. Kun Iskandar B., Apt Eunike Yunina Has


NIP. 19630405 199203 1 010 NIP. 19910622 20
SALDO
AKHIR

28 29 31 SELISIH TOTAL
Pelaksana Layanan Rawat Jalan

Eunike Yunina Hastari, A.Md.


NIP. 19910622 201902 2 008
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT ( LPLPO )
(LPLPO)
PUSKESMAS GEMBONG

NAMA UNIT : PUSTU SITI LUHUR BULAN :

Harga Persediaa
NO Nama obat Satuan Satuan Sisa Awal Penerima
an
n Pengeluar
an
Sisa Akhir
(Rp) Kol (5+6)
1 2 3 4 5 6 7 8 9

1 Acyclovir salep tube 2,847


2 Allupurinol 100 mg tab 99
3 Ambroxol 30 mg tab 110
4 Ambroxol syr btl 2,640
5 Aminophyllin 200 mg tab tab 91
6 Amlodipin 5 mg tablet 70
7 Amoxicillin 500 mg tab 264
8 Amoxicillin syr 125 mg botol 2,365
9 Antasida DOEN syr botol 2,025
10 Antasida DOEN tab tab 54
11 Anti fungi salep tube 4,158
12 Antibakteri DOEN salep tube 2,516
13 Asam Ascorbat 50 mg tab 105
14 Asam Folat 1 mg tab 70
15 Asam Mefenamat 500 mg tab 103
16 Betametason cream 0,1% tube 1,349
17 Borak Gliserin (GOM) botol 1,628
18 Captopril 12,5 mg tab 62
19 Captopril 25 mg tab 75
20 Chloramphenikol 250 mg caps caps 344
21 Chloramphenikol syr botol 4,700
22 Chloramphenikol tetes mata botol 7,150
23 Chloramphenikol tetes telinga botol 2,475
24 Chloramphenikol zalp mata tube 4,598
25 Chlorpheniramin HCl (CTM) 4 tab 22
26 Cotrimoksasol dws 480 mg botol 125
27 Cotrimoksasol syrup botol 2,052
28 Dexametason 0,5 mg tab 32
29 Dimenhidrinat tab 105
30 Fenol Glycerol tts telinga botol 1,008
31 Garam Oralit sachset 288
32 Gentamicin SO4 salep kulit tube 2,125
33 Gentamicyn SO4 TM 0,3% botol 4,000
34 Gentian Violet 1% botol 450
35 Glibenclamid 5 mg tab 100
36 Gliceril Guayakolat tab 95
37 Guanistrep/NeoKaominal/Kaninbotol 5,390
38 Hidrocortison salp tube 2,475
39 Ibuproven 400 mg tab 122
40 Kalium Diklofenak tab 330
41 Kalium Permanganat (PK) tube 3,575
42 Kalsium Laktat tab 59
43 Ketokonazole cream tube 2,518
44 Lisol 1 lt botol 41,000
45 Metformin 500 mg tab 96
46 Metronidazole 500 mg tab 124
47 Metyl Ergometrin tab tab 154
48 Mikonazole salep tube 3,414
49 Natrium Diklofenak 50 mg tab 115
50 OBH botol 5,940
51 Oxytetra salep mata tube 2,770
52 Papaverin 40 mg tab 184
53 Paracetamol 500 mg tab 53
54 Paracetamol syrup botol 1,107
55 Piridoxin 10 mg tab 123
56 Povidon Iodin 30 cc btl 30 cc 2,900
57 Salbutamol 2 mg tab 63
58 Salep 2-4 tube 2,429
59 Salicil Talk 2% kotak 1,025
60 Sianocobalamin 50 mg tab 46
61 Simvastatin 10 mg tab 110
62 Tambah Darah tab 354
63 Tetrasiclin 500 mg cap 310
64 Thiamin 50 mg tab 85
65 Vit B Complek tab 83
66 Chloramfenicol salep kulit tube 3,038
67 New Antides tab 145
68 Obat Batuk Pilek (Wicold) syr botol 7,040
69 Aminophylin 150 mg tab 139
70 Metacetin syr botol
71
72

ALAT KESEHATAN -
1 Kapas Pembalut 250 gr biji 24,000
2 Kassa Hidrofil Steril 16 x 16 c biji 494
3 Kassa Pembalut Hidrofil 4 m x biji 1,482
4 Kassa Pembalut Hidrofil 4 m x biji 304

VII GIZI
1 Tambah Darah tablet 352
2

Mengetahui,
Kepala Puskesmas Gembong Pengelola Obat Puskesmas Pelaksana Layanan PKD

dr. Moh Danur Khusna Apt. Dian Anggrahei DA, S.Farm Ali Muntoha, SSiT
NIP. 19700420 200501 1 006 NIP. 19890614 202012 2 016 NIP : 19680101 199003 1
OBAT ( LPLPO )

Perminta Pemberia
KET
an n

10 11 12
Pelaksana Layanan PKD

Ali Muntoha, SSiT


NIP : 19680101 199003 1 019

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