DINAS KESEHATAN

KABUPATEN KEP. ARU FORM : LPLPO

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT ( LB2 )
PUS
PUSKESMAS MARLASI
PUSKESMAS PEMBANTU YANG ADA : .....................Yang Melapor ............... Bulan : JULI
POLINDES YANG ADA : 3 Yang Melapor 3 Tahun : 2018
KECAMATAN : ARU UTARA
KABUAPTEN : KEPULAUAN ARU
PROPINSI : MALUKU
Penerimaa Persediaa Pemakaia Permintaa Pemberian
No Nama Obat Satuan Stock awal stock akhir Stock OPT KET
n n n n PKD BUFFER APBD Lain Jmlh
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1 Alopurinol tablet 100 mg Tab 1180 1180 50 1130
2 Alpha lipoic acid (Ala 600 ) Tab 280 280 0 280
3 Albendazole Tab 0 0 0 0
4 Ambroxol sirup 15 mg/ml Btl 0 0 0 0
5 Ambroxol tablet 30mg Tab 1000 1000 200 800
6 Aminofilin injeksi 24 mg/ml Amp 45 45 3 42
7 Aminofilin Tablet 200 mg Tab 410 410 240 170
8 Amlodipin tablet 5 mg Tab 0 0 0 0
9 Amoxicilin kaplet 500 mg Tab 0 0 0 0
10 Amoxicilin sirup kering 125 mg/5ml Btl 156 156 19 137
11 Ampicilin sirup kering 125 mg/5ml Btl 0 0 0 0
12 Antalgin 500 mg tablet Tab 930 930 370 560
13 Antalgin injeksi Amp 84 84 0 84
14 Antasida DOEN tablet Tab 2090 2090 350 1740
15 Antasida DOEN suspensi Btl 96 96 11 85
16 Anti Fungi Doen Salep 30gr Pot 71 71 10 61
17 Asam askorbat (Vitamin C) tablet 50 mg Tab 10963 10963 410 10553
18 Asam folat tablet Tab 320 320 200 120
19 Asam mefenamat kaplet 500 mg Tab 2180 2180 480 1700
20 Asiklovir krim 5 % Tube 255 255 0 255
21 Asiklofir tablet 200 mg Tab 1350 1350 0 1350
22 Asiklofir tablet 400 mg Tab 1990 1990 0 1990
23 Atapulgit tablet 650 mg Tab 840 840 120 720
 Pemberian
Stock Penerim Persedia Pemaka stock Stock Perminta
No Nama Obat Satuan KET
awal aan an ian akhir OPT an PKD BUFFER APBD Lain Jmlh
1 2 3 4 5 7 8 9 10 12 13 14 15 16 17 18
24 Betahistin mesilat 6 mg Tab 0 0 0 0
25 Betametason krim 0,1 % Tube 205 205 8 197
26 Betametason tablet 8 mg Tab 945 945 40 905
27 Bromheksin HCl 8 mg Tab 0 0 0 0
28 Ceftriaxone injeksi Amp 0 0 0 0
29 Cetirizin sirup Btl 0 0 0 0
30 Cetirizin tablet 10 mg Tab 0 0 0 0
31 Cimetidin tablet Tab 2083 2083 80 2003
32 Deksametason tablet 0,5 mg Tab 12620 12620 560 12060
33 Deksametason krim 0,25 % Tube 0 0 0 0
34 Difenhidramin injeksi I.m. 10 mg/ml Amp 237 237 0 237
35 Doxicilin kapsul 100 mg Kapsul 2570 2570 80 2490
36 Domperidon suspensi 5 mg/5ml Btl 48 48 5 43
37 Domperidon Tablet Tab 1126 1126 120 1006
38 Eritromisin kapsul Kapsul 0 0 0 0
39 Eritromisin sirup 200 mg/5ml Btl 0 0 0 0
40 Fenilbutason tablet 200 mg Tab 890 890 110 780
41 Fitomenadion (Vit.K) tablet salut gula Tab 0 0 0 0
42 Fluconazole tablet Tab 0 0 0 0
43 Furosemid tablet 40 mg Tab 1649 1649 0 1649
44 Gameksan lotion 1 % (peditok) Btl 0 0 0 0
45 Gemfibrozil Kapsul 2000 2000 0 2000
46 Gentamisin injeksi 40 mg/ml Amp 75 75 0 75
47 Gentamisin salep kulit 0,1 % Tube 3 3 3 0
48 Gentian violet larutan 1 % Btl 3 3 0 3
49 Gliseril Guakolat (GG) Tab 10172 10172 563 9609
50 Glukosa larutan infus 10 % steril Kolf 32 32 0 32
51 Glukosa larutan infus 5 % steril Kolf 90 90 3 87
52 Griseofulvin tablet 125 mg Tab 1210 1210 140 1070
53 Griseofulvin tablet 500 mg Tab 530 530 130 400
54 Hidrokortiazide tablet 25 mg Tab 230 230 80 150
55 Hidrokortizon krim 1 % Tube 61 61 14 47
56 Ibuprofen suspensi 100 mg/5ml Btl 31 31 8 23
57 ibuprofen tablet 200 mg Tab 470 470 320 150
58 Ibuprofen tablet 400 mg Tab 150 150 150 0
 Stock Penerim Persedia Pemakai stock Stock Permint Pemberian
No Nama Obat Satuan KET
awal aan an an akhir OPT aan PKD BUFFER APBD Lain Jmlh
1 2 3 4 5 7 8 9 10 12 13 14 15 16 17 18
59 Kalium diklofenat tablet 50 mg Tab 0 0 0 0
60 Kalsium Laktat ( Kalk ) Tablet 500mg Tab 1220 1220 410 810
61 Kaptopril tablet 12,5 mg Tab 340 340 0 340
62 Kaptopril tablet 25mg Tab 1200 1200 60 1140
63 Ketokonazol Cream 2% Tube 24 24 6 18
64 Ketokonazole Tablet 200mg Tab 20 20 20 0
65 Klindamisin capsul 300 mg kapsul 340 340 140 200
66 Kloramfenikol salep mata 0,5 % Tube 8 8 2 6
67 Kloramfenikol suspensi 125 mg/5ml Btl 72 72 3 69
68 Kloramfenikol tetes mata 0,5 % Btl 0 0 0 0
69 Kloramfenikol tetes telinga 3 % Btl 0 0 0 0
70 Klorfeniramini maleat (CTM) tablet 4 mg Tab 7767 7767 720 7047
71 Kotrimoksazol dewasa 480 mg Tab 2583 2583 140 2443
72 Kotrimoksazole pediatrik 120 mg Tab 310 310 60 250
73 Kotrimoksazole suspensi Btl 34 34 8 26
74 Levofloxacin tablet 500 mg Tab 740 740 60 680
75 Lidokain injeksi 2 % Amp 278 278 20 258
76 Lidokain injeksi 2 % (Hcl) + Epinerfin Amp 401 401 8 393
77 Meloxicam tablet 15 mg Tab 790 790 100 690
78 Meloxicam tablet 7,5 mg Tab 305 305 60 245
79 Metformin Hcl tablet 500 mg Tab 0 0 0 0
80 Methilprednisolon tablet 4 mg Tab 320 320 0 320
81 Methilprednisolon tablet 8 mg tab 1180 1180 40 1140
82 Metoklopramide sirup 5 mg/ml btl 32 32 6 26
83 Metronidazole tablet 500 mg Tab 400 400 220 180
84 Mikonazole krim Tube 932 932 14 918
85 Natrium diklofenat tablet 50 mg Tab 730 730 460 270
86 Natrium diklofenat tablet 25 mg Tab 485 485 140 345
87 Natrium klorida larutan infus 0,9 % kolf 43 43 4 39
88 Nifedipin tablet 10 mg Tab 980 980 340 640
89 Nistatin tablet salut 500.000 IU/gram Tab 0 0 0 0
90 Nistatin Vaginal tablet 100.000 IU/gram Tab 1160 1160 0 1160
91 Obat batuk hitam (OBH) sirup Btl 0 0 0 0
 Stock Penerim Persedia Pemakai stock Stock Permint Pemberian
No Nama Obat Satuan KET
awal aan an an akhir OPT aan PKD BUFFER APBD Lain Jmlh
1 2 3 4 5 7 8 9 10 12 13 14 15 16 17 18
92 Oksitetrasiklin HCl injeksi i.m 50 mg/ml Amp 0 0 0 0
93 Oksitetrasiklin salep kulit Tube 56 56 9 47
94 Omeprazole kapsul 20 mg Kapsul 200 200 200 0
95 Oralit Sachet 1375 1375 80 1295
96 Papaverin tablet 40 mg Tab 2050 2050 40 2010
97 Paracetamol drops Btl 0 0 0 0
98 Paracetamol infus kolf 5 5 0 5
99 Paracetamol sirup 120 mg/5ml Btl 450 450 21 429
100 Paracetamol tablet 500 mg Tab 10808 10808 770 10038
101 Piracetam tablet 400 mg Tab 0 0 0 0
102 Pirantel sirup 125 mg/5ml Btl 85 85 3 82
103 Pirantel tablet score (base) 125 mg Tab 1360 1360 0 1360
104 Piridoksin (Vitamin B6) tablet 10 mg (HCl) Tab 850 850 140 710
105 Piroxicam kapsul 10 mg Kapsul 1150 1150 80 1070
106 Piroxicam kapsul 20 mg Kapsul 550 550 100 450
107 Prednison Tablet 5 mg Tab 1750 1750 260 1490
108 Propanolol tablet 10 mg Tab 1060 1060 20 1040
109 Ranitidin injeksi 25 mg/ml Amp 40 40 5 35
110 Ranitidin tablet 150 mg Tab 1676 1676 230 1446
111 Ringer laktat larutan infus kolf 118 118 14 104
112 Salbutamol tablet 2 mg Tab 760 760 210 550
113 Salbutamol tablet 4 mg (sebagai sulfat) Tab 125 125 350 -225
114 Salep 2-4 Pot 53 53 3 50
115 Sefadroxil sirup kering 125mg/5ml Btl 27 27 7 20
116 Sefadroxil kapsul 500 mg Kapsul 160 160 160 0
117 Sefixime kapsul 100 mg Kapsul 260 260 110 150
118 Sianokobanolamin (vitamin B12) injeksi Amp 37 37 6 31
119 Simetidin tablet 200 mg Tab 0 0 0 0
120 Simvastatin tablet 10 mg Tab 160 160 130 30
121 Siprofloxasin tablet 500 mg Tab 1040 1040 250 790
122 Tiamin (vitamin B1) injeksi 100 mg/ml Amp 493 493 8 485
123 Tiamin (vitamin B1) tablet 50 mg Tab 12890 12890 290 12600
124 Vitamin B kompleks tablet Tab 6935 6935 810 6125
 Stock Penerim Persedia Pemakai stock Stock Permint Pemberian
No Nama Obat Satuan KET
awal aan an an akhir OPT aan PKD BUFFER APBD Lain Jmlh
1 2 3 4 5 7 8 9 10 12 13 14 15 16 17 18
125 Vitamin B kompleks injeksi Amp 0 0 0 0
126 Zinc syr 20 mg Btl 0 0 0 0
127 zinc tablet 20 mg Tab 270 270 140 130
128 Abothyl Btl 0 0 0 0
129 Armacort Cream Tube 0 0 0 0
130 Beta flu Tab 0 0 0 0
131 Betadine feminime Btl 0 0 0 0
132 Biovitan multivitamin sirup Btl 0 0 0 0
133 calfera Tab 0 0 0 0
134 combantrin sirup Btl 10 10 4 6
135 Counterpain krim / Voltaren Tube 4 4 4 0
136 Curcuma tablet Tab 180 180 110 70
137 Dextaf Tab 50 50 50 0
138 Fluocart - N Cream Tube 0 0 0 0
139 Imboost sirup Btl 0 0 0 0
140 Imboost tablet Tab 0 0 0 0
141 Lexavit Tab 0 0 0 0
142 Makro -B Tab 110 110 110 0
143 Mersobion injeksi Amp 3 3 3 0
144 Nelco spesial Btl 0 0 0 0
145 Novabion Kapsul 0 0 0 0
146 Nerova Tab 0 0 0 0
147 Neurobion 5000 tablet Tab 0 0 0 0
148 Nofaprazole tab 10 10 0 10
149 Novadium Tab 0 0 0 0
150 Novatusin sirup Btl 0 0 0 0
151 Obimin -Af Tab 0 0 0 0
152 Policrol forte tablet Tab 2820 2820 270 2550
153 Propepsa Btl 0 0 0 0
154 Procurma Btl 7 7 4 3
155 Ramabion / Solvitron Tab 0 0 0 0
156 Renalyte Btl 10 10 0 10
157 Solvitron Sirup Btl 0 0 0 0
 Stock Penerim Persedia Pemakai stock Stock Permint Pemberian
No Nama Obat Satuan KET
awal aan an an akhir OPT aan PKD BUFFER APBD Lain Jmlh
1 2 3 4 5 7 8 9 10 12 13 14 15 16 17 18
158 Spasminal tablet Tab 780 780 130 650
159 Vical D Multivitamin sirup Btl 0 0 0 0
BAHAN HABIS PAKAI
160 Abocath No. 18 pcs 74 74 4 70
161 Abocath No. 22 pcs 70 70 8 62
162 Abocath No. 24 pcs 124 124 12 112
163 Abocath No. 26 pcs 46 46 6 40
164 Alat suntik 3 ml pcs 742 742 21 721
165 Alat suntik 1 ml pcs 1005 1005 10 995
166 Alat suntik 5 ml pcs 651 651 6 645
167 Alkohol 1 liter Btl 3 3 0 3
168 Alkohol 70 % 300 ml Btl 4 4 1 3
169 Bisturi pcs 0 0 0 0
170 Cagut plain 3/0 pcs 23 23 8 15
171 Cagut Cromik 2/0 pcs 2 2 1 1
172 Cagut Cromik 3/0 pcs 0 0 0 0
173 Cagut plain 2/0 pcs 27 27 6 21
174 Daryantule pcs 0 0 0 0
175 Etil klorida Btl 6 6 2 4
176 Gell Tube 3 3 0 3
177 Gliserin Btl 0 0 0 0
178 Hanskun pcs 0 0 0 0
179 infus set anak pcs 5 5 4 1
180 Infus set dewasa pcs 56 56 6 50
181 Kapas 100 roll 2 2 0 2
182 Kapas 250 roll 5 5 1 4
183 Kassa 4/15 roll 16 16 10 6
184 Kassa40/80 roll 0 0 0 0
185 Kassa steril pcs 0 0 0 0
186 Masker pcs 20 20 20 0
187 NGT 16 pcs 21 21 0 21
188 NGT18 pcs 12 12 0 12
189 Plester 5x 4,5 m pcs 12 12 1 11
 Stock Peneri Persediaa Pemakai stock Stock Permint Pemberian
No Nama Obat Satuan KET
awal maan n an akhir OPT aan PKD BUFFER APBD Lain Jmlh
1 2 3 4 5 7 8 9 10 12 13 14 15 16 17 18
190 Poli cateter 16 Pcs 28 28 0 28
191 Poli cateter 18 Pcs 9 9 0 9
192 Povidon iodida larutan 10 % Btl 7 7 1 6
193 Silk 2/0 Pcs 7 7 2 5
194 Stomacth slang Pcs 2 2 0 2
195 Nald hecting no 10/ jarum kulit lusin 10 10 0 10
196 Nald hecting no 10/ jarum otot lusin 14 14 0 14
197 Nald hecting no 12/ jarum kulit lusin 8 8 2 6
198 Nald hecting no 12/ jarum otot lusin 15 15 2 13
199 Nald hecting no 14/ jarum kulit lusin 26 26 2 24
200 Nald hecting no 14/jarum otot lusin 34 34 2 32
201 Nald hecting no 8 / jarum kulit lusin 25 25 0 25
202 Nald hecting no 8 / jarum otot. lusin 22 22 0 22
203 Urin Bag Pcs 12 12 0 12
OBAT PSIKOTROPIK
204 Alprazolam 0,5 mg Tab 0 0 0 0
205 Chorpromazin 25 mg Tab 0 0 0 0
206 Diazepam 2 mg Tab 410 410 0 410
207 Fenobarbital tablet Tab 500 500 0 500
208 Halloperidol 1,5 mg Tab 0 0 0 0
209 Tramadol 50 mg Tab 500 500 0 500

BAYAR BPJS JAMKESDA KIS JUMLAH

JUMLAH KUNJUNGAN RESEP
274 274

Mengetahui/menyetujui Yang Menyerahkan Yang Meminta Yang Menerima

sekertaris Kepala UPTD Instalasi Farmasi Kepala Puskesmas Petugas Apotek

dr.Wati Gunawan, M.kes Rahmi, S.Si., Apt Costantina. SKM Ido Matheus Badalwaer. S.Farm., Apt
NIP. 19711026 200212 2 004 NIP. 19790623 200804 2 001 NIP. 19840609 200904 2 003 NRPTT. 25. 2. 000. 005