LPLPO JARINGAN & UNIT Maret 2019

PEMERINTAH KABUPATEN L
DINAS KESEHAT
UPT BLUD PUSKESMAS G
Jl. Pariwisata No. 70 Gunungsari (0370
LAPORAN PEMAKAIAN DAN LEMBAR
NAMA JARINGAN : PUSTU KEKAIT

LAPORAN PERIODE/BULAN : Maret
PERMINTAAN PERIODE/BULAN : April
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN
1 2 3 4 5
BAHAN MEDIS HABIS PAKAI (BMHP)
1 Alat Suntik Sekali Pakai - 1 cc Tuberculin 27G x 1/2" Set

0
2 Alat Suntik Sekali Pakai - 2.5 cc x 23G x 1 1/4" Set
20
3 Alat Suntik Sekali Pakai - 5 cc x 22G x 1 1/4" Set
0
0
5 Alat Suntik Sekali Pakai - 20 cc Set
0
6 Benang Operasi - Catgut Plain 2/0 + jarum 1/2 GT 35 mm Set
0
7 Benang Operasi - Catgut Chromic 2/0 + jarum 1/2 GT 35 Set
0
mm
0
0
mm
10 Benang Operasi - Silk 2/0 + jarum 1/2 GT 35 mm Set
0
0
12 Blood Lancet Pcs
0
13 Cover Glass 24 x 24 mm Pcs
0
14 Hand Scound Steril No 7 Pasang
0
15 Hand Scound Steril No 7,5 Pasang
0
16 Hand Scound Non Steril Ukuran L Lembar
0
17 Hand Scound Non Steril Ukuran M Lembar
0
18 Hand Scound Non Steril Ukuran S Lembar
0
19 Hand scound gynaecology non steril
0
20 Hand scound Obgyn Steril Pasang
0
21 Non Woven Dressing for Fixation 10 cm X 5 m (hypafix) Pasang
0
22 Infus Set, IV, Wing needle - Infusion Set Pediatric (60 set
1
drops/ml)
23 Infus Set, IV, Wing needle - Infusion Set Dewasa (20 set
2
drops/ml)
24 Infus Set, IV, Wing needle - I.V Catheter No. 18 G x 32 mm buah
0
25 Infus Set, IV, Wing needle - I.V Catheter No. 20 G x 1 1/4 " buah
2
26 Infus Set, IV, Wing needle - I.V Catheter No. 22 G x 1 " buah
2
27 Infus Set, IV, Wing needle - I.V Catheter No. 24 G x 3/4 " buah
0
0
29 Infus Set, IV, Wing needle - Wing Needle 21G set
0
0
0
0
33 Kasa, Verband, Kapas - Kasa Pembalut / absorben 250 gr Roll
0
34 Kasa, Verband, Kapas - Kasa Hydrophil 40 x 80 cm Roll
0
35 Kasa, Verband, Kapas - Kasa Hydrophil Steril 16 x 16 cm Lembar
0
0
37 Kasa, Verband, Kapas - Kasa Pembalut Hydrophil 4 x 3 cm Roll
0
0
0
40 Kasa, Verband, Kapas - Kasa Pembalut 2 x 80 cm Roll
30
41 Mess 11 pcs
0
42 Mess 21 pcs
0
43 Mess 22 pcs
0
44 Nasal Canula bayi pcs
0
45 Nasal Canula anak pcs
0
46 Nasal Canula dewasa pcs 0
47 Nebulizer with mask anak pcs 0
48 Nebulizer with mask dewasa pcs 0
49 Pembalut Gips 3 Inci buah
0
50 Plester 5 Yards X 2 inchi Roll
0
51 Surgical Mask - 3 ply Tie on (tali) pcs
0
52 Surgical Mask - 3 ply Earloop (karet) pcs
0
53 Underpad 60 cm x 90 cm pcs
0
54 Urologi - Folley Catheter 2 way No. 16 pcs
0
0
56 Urologi - Urine Bag Standard Steril 2 Lt (T Valve) pcs
0
57 Jarum Jahit Bedah Pcs
0
0
TABLET DAN SERBUK ORAL 0
0
58 Albendazol tablet/kapsul/kaplet 400 mg Tablet
0
59 Alopurinol tablet/kapsul/kaplet 100 mg Tablet
0
60 Alprazolam Tablet 1 mg Tablet
0
61 Aminofilin tablet scored 200 mg Tablet
0
62 Amitriptilin tablet salut 25 mg (HCl) Tablet
0
63 Amlodipin tablet 5 mg Tablet
0
64 Amoksisilin kapsul/kaplet/tablet scored 500 mg Kaplet
800
65 Antasida DOEN I tablet kunyah, kombinasi : Aluminium Tablet
400
Hidroksida 200 mg Magnesium Hidroksida 200 mg
66 Antimigren: Ergotamin Tartrat 1 mg + Kofein 50 mg Tablet
0
67 Asam Asetilsalisilat (asetosal) tablet 80 mg Tablet
0
0
69 Asam Askorbat (Vitamin C) tablet 250 mg Tablet
0
0
71 Asam Folat tablet/kapsul/kaplet 1 mg Tablet
0
72 Asam Mefenamat 500 mg tab Kaplet
1000
73 Asam Valproat 250 mg Tablet
0
74 Asam tranexamat tablet 500 mg Tablet
0
75 Asiklovir tablet/kapsul/kaplet 400 mg Tablet
0
76 Asetil N sistein 5 mg tablet Tablet
360
77 Attapulgit Tablet 600 mg Tablet
0
78 Betahistin Mesilat Tablet 6 mg Tablet
0
79 Bisakodil 5 mg (dulkolax) Tablet
0
80 Bisoprolol 5 mg tab Tablet
0
81 Clozapine 25 mg tab Tablet
0
0
83 D H P TAB Tablet
0
84 Deksametason tablet 0,5 mg Tablet 400
85 Diazepam 2 mg tab Tablet

0
0
87 Digoksin tablet 0,25 mg Paket
0
88 Dimenhidrinat tablet 50 mg Tablet
0
89 Domperidon tablet 10 mg Tablet
0
90 Doksisiklin tablet/kapsul/kaplet 100 mg Tablet
0
91 Erythromycin 500 mg Tablet
0
92 Fenitoin kapsul/kaplet 100 mg Tablet
0
93 Fenitoin Natrium 30 mg kapsul Kapsul
0
94 Fenobarbital tablet/kapsul/kaplet 100 mg Kapsul
0
0
96 Fitomenadion (Vit.K1) tablet salut gula 10 mg Tablet
0
97 Furosemid tablet 40 mg Tablet
0
98 Garam Oralit I serbuk, kombinasi : Natrium klorida 0,52 g Sachet
0
kalium klorida 0,30 g Trinatrium sitrat dihidrat 0,58 g
99 Glibenklamid tablet
Glukosa Anhidrat 5 mg
2,70 g Tablet
0
100 Glimepiride tablet 1 mg Tablet
0
0
102 Griseofulvin tablet 125 mg Tablet
0
103 Haloperidol tablet 0,5 mg Tablet
0
0
105 Haloperidol tablet 5 mg Tablet 0
106 Hidroklorotiazide tab 25 mg Tablet 0
107 Hyocina N Butilbromid 10 mg tab Tablet

0
108 Ibuprofen tablet 400 mg Tablet
0
109 Isoniazid 100 mg (INH) Tablet
0
110 Isosorbid Dinitrat Sub Lingual 5 mg Tablet
0
111 Kalsium Laktat 500 mg Tablet 100
112 Kaptopril tablet scored 12,5 mg Tablet
0
113 Kaptopril tablet scored 25 mg Tablet
200
114 Karbamazepin tablet 200 mg Tablet
0
115 Ketokonzol Tablet 200 mg Tablet
100
116 Kloramfenikol tablet/kapsul/kaplet 250 mg Tablet
0
0
118 Klorfeniramini maleat tab 4 mg( ctm ) Tablet
400
119 Klorpromazin 100 mg tab (hcl) Tablet
0
120 Kodeina 10 mg tab Tablet
0
121 Kombinasi tablet salut : Besi (II) Fumarat 180 mg Asam Tablet
0
folat 0,4 mg (TTD)
122 Kotrimoksazol DOEN I (dewasa) kombinasi : Tablet
0
Sulfametoksazol 400 mg Trimetoprim 80 mg
123 Kotrimoksazol DOEN I (dewasa) Forte Tablet
0
124 Kuinine tab salut selaput 222 mg Tablet
0
125 Loperamid tab 2 mg Tablet
0
126 Loratadin tablet 10 mg Tablet
0
127 Mineral mix serbuk Tablet
0
128 Metformin hcl tablet 500 mg Tablet
0
129 Metilergometrin Maleat (Metilergometrin) tablet salut Tablet
0
0,125 mg
130 Metoklopramide tablet 10 mg Tablet
100
131 Metronidazole 500 mg tab Sachet
50
132 Natrium diklofenak 50 mg tab Paket
150
133 Nifedipin tablet/kapsul 10 mg Paket
0
134 Nistatin tablet salut 500.000 IU/ g Paket
0
135 Oat Kat Anak FDC Paket
0
136 Oat Kat Anak Komb Paket
0
137 Oat Kat I Komb Paket
0
138 Oat Kat I.3 FDC kaplet
0
139 Oat Kat Ii FDC Tablet
0
140 Oat Kat Sisipan FDC Tablet
0
141 Omeprazol kapsul/kaplet 20 mg Tablet
0
142 Parasetamol tablet 500 mg Tablet
1300
143 Piridoksin (Vitamin B6) tablet/kapsul/kaplet 10 mg (HCl) Tablet
0
144 Prednison tablet/kapsul/kaplet 5 mg Tablet
0
145 Primakuin tablet 15 mg Tablet
0
146 Propanolol 40 mg tab (hcl) Tablet
0
147 Propiltiourasil 100 mg tab Tablet
0
148 Ranitidin tablet 150 mg Tablet
0
149 Risperidon Tablet 2 mg Tablet
0
150 Retinol 100 000 iu kapsul (vit a biru) Kapsul Lunak
0
151 Retinol 200 000 iu cap (vit a merah) Kapsul Lunak
0
152 Salbutamol 4 mg tab Tablet
200
153 Setirizin tablet 10 mg Tablet
0
154 Simvastatin tablet 20 mg Tablet
0
155 Siprofloksasin tablet 500 mg (sebagai HCl) Tablet 0
156 Tetrasiklin 500 kapsul Kapsul 0
157 Thiamin hcl 50 mg tab ( vit b1 ) Tablet 900
158 Triheksifenidil hcl 2 mg tab Tablet
0
159 Vit B Komplek tab Tablet
200
160 Zinc tab 20 mg Tablet
300
0
SYRUP
0
0
161 Amoksisilin sirup kering 125 mg/ 5 ml Botol 100
162 Amoksisilin sirup kering forte 250 mg/5 ml Botol

0
163 Antasida DOEN II suspensi, kombinasi : Aluminium Botol
19
Hidroksida 200 mg/5 ml Magnesium Hidroksida 200 mg/5
164 Domperidon
ml syrup Botol
0
165 Ferosulfat Syrup Botol
0
166 Ibuprofen Suspensi 100 mg/ 5ml Botol
0
167 Kaolin Pectin Syrup Botol
0
168 Kloramfenikol suspensi 125 mg/ 5 ml Botol
0
169 Kotrimoksazol Suspensi komb: Sulfametoksazol 200 mg + Botol
Trimetoprim 40 mg / 5 ml 47
170 Metoklopramide sirup 5 mg/ 5 ml Botol
5
171 Metronidazol suspensi Botol 0
172 Nistatin suspensi Botol
0
173 Parasetamol drop 100 mg/ml btl @15ml (60mg/0,6ml) Botol
0
174 Parasetamol sirup 120 mg / 5 ml Botol
100
0
INJEKSI
0
0
175 Aminofilin injeksi 24 mg/ml Ampul
0
176 Ampisilin serbuk injeksi i.v. 1000 mg/vial Vial
0
177 Artemeter Injeksi 80 Mg (artemeter injeksi 1 ml) Ampul
0
178 Asam tranexamat injeksi 50 mg / ml Ampul
0
179 Artesunate Cairan Injeksi 60 Mg Ampul
0
180 Atropin 0,25 mg/ml injeksi Ampul
0
181 Aqua Pro Inj 25 ml steril Vial
0
182 Deksametason injeksi i.v./i.m. 5 mg/ml Ampul
20
183 Diazepam injeksi i.v./i.m 5 mg/ml Ampul
0
184 Difenhidramin injeksi i.v./i.m. 10 mg/ml (HCl) Ampul
0
185 Epinefrin (Adrenalin) injeksi i.v/s.k./i.m 1 mg/ml Ampul
2
186 Fenitoin injeksi 50 mg/ml Ampul
0
187 Fenobarbital injeksi i.m./i.v. 50 mg/ml Ampul
0
188 Fitomenadion (Vitamin K1) injeksi i.m. 2 mg/ml Ampul
0
189 Flufenazin decanoate injeksi 5 mg/ml Ampul
0
190 Furosemid Inj Iv/Im 10 mg/Ml Ampul
0
191 Gentamisin injeksi 40 mg/ ml Ampul
0
192 Haloperidol Injeksi IV/IM 10 mg/ml Ampul
0
193 Hyocina N Butilbromid Inj 20 mg Ampul
0
194 Kalsium Glukonas Inj 100 mg/ml Ampul
0
195 Ketorolax Injeksi 30 mg/ ml Ampul
0
196 Kloramfenikol serb inj 1000 mg/mL Vial
0
197 Lidokain injeksi 2% (HCl) + Epinefrin 1 : 80.000 - 2ml Ampul 0
198 Lidokain injeksi 2% (HCL) Ampul 0
199 Magnesium Sulfat 20 % Inj 25 ml Vial 0
201 Metamizol inj 500 mg/ml Ampul

0
202 Metoklopramide INJ 5 mg/ml Ampul
0
203 Metilergometrin Maleat injeksi 0,200 mg-1 ml Ampul
0
204 Oksitosin injeksi 10 IU/ml Ampul
0
205 Ondansetron Injeksi 2 mg/ ml (4 mg/2 ml) Ampul
0
206 Ranitidin inj 25 mg/2 ml Ampul
0
207 Sianokobalamin (vitamin B12) injeksi 500 mcg Ampul
0
0
OBAT KHUSUS
0
0
208 Antihemoroid, kombinasi: bismut subgalat 150 mg SUPP
heksaklorofen 2,5 mg lidokain 10 mg seng oksida 120 mg
0
209 Bisacodyl supp (dulcolax) 5 mg / Stolax supp SUPP 0
211 Diazepam larutan rektal 5 mg/2,5 mL (stesolid rectal) TUBE
0
212 Nistatin Vaginal tab 100 000 iu/gr TABLET
0
213 SABU I 5 ml VIAL
0
214 Salbutamol (as sulphate) 2,5 mg/2,5 ml nebuls Ampul
0
215 Serum ATS 1 500 IU VIAL
0
216 Serum ATS 20.000 IU VIAL 0
217 Vaksin Rabies Inj 2,5 IU VIAL 0
0
CAIRAN 0
0
218 Glukosa larutan infus 10 % steril Botol
0
0
0
221 Nacl 0,9% Botol
0
222 Ringer Laktat larutan infus Botol
0
0
OBAT LUAR
0
0
223 Antiseptik dan Disinfektan - alkohol 70% 100 ml Botol
4
224 Antiseptik dan Disinfektan - alkohol 70% 1 liter Botol
0
225 Bedak salisil serbuk 2% Tube
0
226 Betametason Cream 0,1 % Tube
30
227 Fenol Gliserol TT 10% TUBE
0
228 Gentamicin SK 0,1% Tube
0
229 Gentamicin Salep Mata 0,3% Tube
0
230 Gentamisin Sulfat Tetes Mata Tube
5
231 Hidrogen Peroksida Larutan 3% Botol
0
232 Hidrokortison Cream 2,5 % Tube
0
233 Ketokonazol Krim 2% Tube
0
234 Kloramfenikol Salep Kulit 2 % Tube
20
235 Kloramfenikol salep mata 1 % Tube
0
236 Kloramfenikol teter telinga 3 % Botol
5
237 Oksimetazolin tetes hidung Botol
0
238 Permetrin Cream 5%(anti scabies) tube
0
239 Povidon Iodida larutan 10% 30 ml Botol 0
241 Salep 2-4 , Kombinasi : Asam Salisilat 2% + Belerang endap Botol
4% 0
242 Sulfadiazin Silver Salep Tube
0
0
OBAT GIGI
0
0
243 Devitalisasi Pasta ( non arsen ) Pot
0
244 Etil Klorida Spray Botol
0
245 Eugenol Cairan Botol
0
246 Glass Ionomer Cement Art Botol
0
247 Kalsium Hidroksida Pasta Pot
0
248 Klorfenol Kamfer Menthol (CHKM) Botol
0
249 Polikresulen (albotyl) Botol
0
250 Semen seng fosfat serbuk +cairan Pot
0
251 Temporary stopping fketcher serbuk+cairan (caviton) Pot 0
252 Trikkresol formalin (TKF) Botol 0
0
BAHAN LABORATORIUM
0
0
253 Carik Celup / Urin Tes 3 GPH Stik
0
0
255 Hb Test Kit Set
0
256 Kartu golongan darah Lembar
0
257 Kit Gol Darah Set
0
258 Lart As Acetat Botol
0
259 Lart asam klorida 0,1% Botol
0
260 Lart Asam Klorida 0,1 N Botol
0
261 Lart Barium Chlorida 10 % Botol
0
262 Lart Benedict Botol
0
263 Lart E D T A 10 % Botol
0
264 Lart Etanol Asam Botol
0
265 Lart Koh 10 % Botol
0
266 Lart Nacl 0,9 % Botol
0
267 Lart Natrium Citrat 3,8 % Botol
0
268 Lart Rees Ecker Botol
0
269 Lart Turk Botol
0
270 Oil Emersi Botol
0
271 PP Test Stik
10
272 Reagen ABX Minidil Lmg Paket
0
273 Reagen ABC Minilyse Lmg Paket
0
274 Reagen ABX Miniclean / cleanser Paket
0
275 Reagen ABX Minotrol Paket
0
276 Stik Gula Darah Stik
0
277 Stik Asam Urat Stik
0
278 Stik Kolesterol Stik
0
279 Stik HB Stik
0
280 Stik HBSAG Stik 0
281 widal Test Set 0
0
OBAT NON FORNAS
0
0
282 Ambroxol 30 mg tablet Tablet
0
283 Gliseryl guaiakolat 100 mg tab Tablet
0
284 Multi micro nutrien Tablet 0
285 Piroksikam 20 mg tab Tablet 0
286 Thiampenikol kapsul 250 mg Kapsul 0
287 Thiampenikol kapsul 500 mg Kapsul
0
0
SIRUP
0
0
288 Ambroxol syrup 15 mg/ml Botol
20
289 Multivitamin syrup Botol
15
0
OBAT LUAR
0
0
290 Asiklovir krim 5 % Tube
0
291 Gentian violet larutan 1 % Tube
15
292 Hexachlorocyclohexane 0,5% ((Peditox) Botol
0
293 Ictyol salep hitam Pot
0
294 Oksitetrasiklin SK 3% Tube
0
295 Oksitetrasiklin sm 1% Tube
0
296 Salep luka bakar ( bioplacenton ) Tube
0
0
OBAT KHUSUS
0
0
297 Parasetamol supp 80 mg Supp 0
0
TAMBAHAN OBAT FORNAS 0
Camabion Tablet 300
Ceftriaxon injeksi 1 g Vial 0
0
0
TAMBAHAN OBAT NON FORNAS 0
0
1 Kasa, Verband, Kapas - Kasa Hydrophil 40 x 40 cm 0
4 Baby Cough Syrup 60 ml Botol 0
5 Demacolin Tablet 0
6 Rohto Tetes Mata 0
Caviplex Tablet 0
Slide pc 0
Plesterin pc 0
Klorhexidil Botol 0
Gelly USG Botol 0
0
0
326 Bisacodyl supp 10 mg Suppos 0
327 Parasetamol supp 160 mg Suppos 0
328 Plesterin PCS 0
Fe drops botol 0
Ondansentron injeksi AMPUL 0
ELASTIS BANDED 4 CM ROL 0
BABY COUGH SYRUP BOTOL 0
KLORAMFENICOL SK Tube 0
GUANISTREP SYRUP B OTOL 0
VITAMIN C 25 MG TABLET 0
SUPRAVIT TABLET 0
ERLAMYCETIN + TM BOTOL 0
MKP LANG BOTOL 0
MT HERBAL BOTOL 0
LEUKOPLAST BESAR (PLESTER) ROL 0
amoxicillin 250 mg TABLET 0
pacdin baby BOTOL 100
grafachlor TABLET 0
teosal TABLET 0
elsiron TABLET 0
cefadroxil 500 mg Kapsul 0
rivanol sol BOTOL 0
betadin salep kulit tube 0
ikadryl syrup botol 0
inadryl syrup BOTOL 0
probiokod sachet 0
kloram plus TM BOTOL
meloxicam TABLET
cefadroxil syrup 125 mg/5 ml BOTOL
caviplex TABLET
minyak telon botol
Handscoon steril no. 6,5 PCS
kloramfenikol SK Tube
tolak angin box
Neozep TABLET
Amlodipin 10 mg TABLET
ketorolac injeksi AMPUL
Manitol infus botol
betadin sol 15 ml BOTOL
vick vaporub BOTOL
G
BAYAR PHB JKNM
JUMLAH KUNJUNGAN
Mengetahui Yang Menyerahkan

PEMIMPIN UPT BLUD PUSKESMAS Pengelola Obat Puskesma
GUNUNGSARI
Ns. Akmal Rosamali, S.Kep Dady Syamri Aswal, S.Farm,

NIP : 19711119 199203 1 00 6 NIP : 19811020 200803 1 0
KETERANGAN :
LEMBAR PERTAMA (ASLI) : PUSKESMAS
LEMBAR KEDUA : ARSIP
ABUPATEN LOMBOK BARAT
AS KESEHATAN
SKESMAS GUNUNGSARI
gsari (0370) 633503 Kode Pos 83351
EMBAR PERMINTAAN OBAT (LPLPO)
TAHUN : 2019
TANGGAL
PERSEDIAAN PEMAKAIAN SISA STOK STOK OPT PERMINTAAN PEMBERIAN KET

6=4+5 7 8 = 6-7 9 10=9-8 11 12
0 0 0
20 20 27.6
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
1 1 1.38
2 2 2.76
0 0 0
2 0 2 0
2 0 2 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
30 30 41.4
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
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0 0 0
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0 0 0
800 500 300 690
400 200 200 276
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
1000 1000 1380
0 0 0
0 0 0
0 0 0
360 360 496.8
0 0 0
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0 0 0
0 0 0
0 0 0
0 0 0
200
400 200 276

0 0 0
0 0 0
0 0 0
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100 100 138
0 0 0
200 200 276
0 0 0
100 100 138
0 0 0
0 0 0
400 400 552
0 0 0
0 0 0
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0 0 0
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100 100 138
50 50 69
150 150 207
0 0 0
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1300 800 500 1104
0 0 0
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200 200 276
0 0 0
0 0 0
200
0 0 0
200 0 200 0
300 300 414
0 0 0
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0 0 0
15
100 85 117.3
0 0 0
19 19 26.22
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
47 37 10 51.06
5 5 6.9
0 0 0
0 0 0
0 0 0
100 85 15 117.3
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
20 20 27.6
0 0 0
0 0 0
2 2 2.76
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
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0 0 0
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4 4 5.52
0 0 0
0 0 0
30 30 41.4
0 0 0
0 0 0
0 0 0
5 5 6.9
0 0 0
0 0 0
0 0 0
20 10 10 13.8
0 0 0
5 5 6.9
0 0 0
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0 0 0
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10 10 13.8
0 0 0
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0 0 0
0 0 0
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20 10 10 13.8
15 15 20.7
0 0 0
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0 0 0
0 0 0
15 15 20.7
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
300 300 414
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
100 100 138
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
GRATIS
UKS JKN JAMPERSAL LAIN-LAIN TOTAL KET
Menyerahkan Yang menerima

a Obat Puskesmas PETUGAS JARINGAN PUSKESMAS
PUSTU KEKAIT
ri Aswal, S.Farm, Apt ……………………………………………………………

1020 200803 1 001 NIP : ……………………………………………………
DINAS KESEHAT
NAMA JARINGAN : PUSTU SESELA

1 2 3 4 5

0
5
0
10
0
0
0
mm
5 0
0
mm
0
0
12 Blood Lancet Pcs
0
0
0
0
0
0
0
0
0
0
0
drops/ml)
0
drops/ml)
0
0
0
0
0
0
0
0
0
0
0
0
0
0
10 0
0
10 0
41 Mess 11 pcs
0
42 Mess 21 pcs
0
43 Mess 22 pcs
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
800
100 800
0
0
0
0
1000
0
500 1000
0
0
0
30 600
100 0
0
0
0
0
0
83 D H P TAB Tablet
0

0
0
0
0
0
0
0
0
0
0
0
0
0
50 0
2,70 g Tablet
0
0
0
0
0
0

0
0
0
0
200
200 200
0
200
0
0
900
0
0
0
folat 0,4 mg (TTD)
200
0
0
0
0
0
0
0
0,125 mg
100 0
100 0
0
0
0
0
0
0
0
0
0
0
1400
0
0
0
0
0
0
0
0
0
100
0
0
0
900
400 0
0
SYRUP
0
0

0
3 0
164 Domperidon
ml syrup Botol
0
0
4 0
0
0
5
0
0
35
0
INJEKSI
0
0
0
0
0
0
0
0
0
10
0
10
0
0
0
0
0
0
0
0
0
0
0
0
198 Lidokain injeksi 2% (HCL) Ampul 15 0

0
0
0
0
0
0
0
0
OBAT KHUSUS
0
0
0
0
0
0
0
0
0
CAIRAN 0
0
0
0
0
221 Nacl 0,9% Botol
3
2
0
OBAT LUAR
0
0
4 0
0
1 0
15
0
0
6 0
10 0
0
0
0
4
3
0
0
0
239 Povidon Iodida larutan 10% 30 ml Botol 5 0
4% 0
0
0
OBAT GIGI
0
0
0
0
0
0
0
0
0
0
0
BAHAN LABORATORIUM
0
0
0
0
255 Hb Test Kit Set
0
0
0
0
0
0
0
0
0
0
0
0
0
0
269 Lart Turk Botol
0
0
271 PP Test Stik
0
0
0
0
0
0
0
0
279 Stik HB Stik
0
0
OBAT NON FORNAS
0
0
400
0
0
0
SIRUP
0
0
5
10
0
OBAT LUAR
0
0
0
0
0
5
15
0
0
0
OBAT KHUSUS
0
0
0
Camabion Tablet 0
0
0
0
Caviplex Tablet 0
Slide pc 0
Plesterin pc 0
Klorhexidil Botol 0
Gelly USG Botol 0
0
0
328 Plesterin PCS 0
Fe drops botol 0
SUPRAVIT TABLET 0
MKP LANG BOTOL 0
MT HERBAL BOTOL 0
amoxicillin 250 mg TABLET
pacdin baby BOTOL 0
grafachlor TABLET 0
teosal TABLET 0
elsiron TABLET 0
rivanol sol BOTOL 0
ikadryl syrup botol
inadryl syrup BOTOL
probiokod sachet
meloxicam TABLET
caviplex TABLET
minyak telon botol
tolak angin box
Neozep TABLET
Manitol infus botol
vick vaporub BOTOL
G
BAYAR PHB JKNM
JUMLAH KUNJUNGAN

GUNUNGSARI

NIP : 19711119 199203 1 00 6 NIP : 19811020 200803 1 0
KETERANGAN :
AS KESEHATAN
SKESMAS GUNUNGSARI
gsari (0370) 633503 Kode Pos 83351
TAHUN : 2019
TANGGAL

6=4+5 7 8 = 6-7 9 10=9-8 11 12
0 0 0
5 0 5 0
0 0 0
10 10 13.8
0 0 0
0 0 0
0 0 0
5 5 6.9
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
10 10 13.8
0 0 0
10 10 13.8
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
800 700 100 966
900 800 100 1104
0 0 0
0 0 0
0 0 0
0 0 0
1000 600 400 828
0 0 0
1500 1500 2070
0 0 0
0 0 0
0 0 0
630 570 60 786.6
100 100 138
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
300 300 414

0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
50 50 69
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
200 100 100 138
400 400 552
0 0 0
200 0 200 0
0 0 0
0 0 0
900 600 300 828
0 0 0
0 0 0
0 0 0
200 0 200 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
100 50 50 69
100 0 100 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
1400 1300 100 1794
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
100 0 100 0
0 0 0
0 0 0
0 0 0
0 0 0
500 0 500 0
0 0 0
900 700 200 966
400 0 400 0
0 0 0
0 0 0
0 0 0
10 10 13.8
0 0 0
3 0 3 0
0 0 0
0 0 0
4 4 5.52
0 0 0
0 0 0
30 25 5 34.5
5 2 3 2.76
0 0 0
0 0 0
0 0 0
35 31 4 42.78
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
10 5 5 6.9
0 0 0
10 6 4 8.28
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
15 5 10 6.9
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
3 1 2 1.38
2 0 2 0
0 0 0
0 0 0
0 0 0
4 1 3 1.38
0 0 0
1 0 1 0
15 11 4 15.18
0 0 0
0 0 0
6 3 3 4.14
10 10 13.8
0 0 0
0 0 0
0 0 0
4 0 4 0
3 0 3 0
0 0 0
0 0 0
0 0 0
5 2 3
0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
400 300 100 414
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
5 1 4 1.38
10 6 4 8.28
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
5 1 4 1.38
15 15 20.7
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
GRATIS

PUSTU SESELA
ri Aswal, S.Farm, Apt ……………………………………………………………..

1020 200803 1 001 NIP : …………………………………………………..
DINAS KESEHAT
NAMA JARINGAN : PUSTU MIDANG

1 2 3 4 5

0
10
0
0
0
0
0
mm
0
0
mm
0
0
12 Blood Lancet Pcs
0
0
0
0
0
0
100
0
0
0
0
drops/ml)
0
drops/ml)
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
8 0
41 Mess 11 pcs
0
42 Mess 21 pcs
0
43 Mess 22 pcs
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
220 0
200 400
200 600
0
0
0
0
100 0
0
400 0
0
0
0
120 0
70 0
0
0
0
0
0
83 D H P TAB Tablet
0
84 Deksametason tablet 0,5 mg Tablet 20 300

0
0
0
0
0
0
0
0
0
0
0
0
0
0
2,70 g Tablet
0
0
0
0
0
0

100
0
0
0
200
200 0
0
0
0
0
300
0
0
0
folat 0,4 mg (TTD)
110 0
0
0
0
0
0
0
0
0,125 mg
0
0
0
0
0
0
0
0
0
0
0
30 0
100 900
0
0
0
0
0
0
0
0
0
30 100
0
0
157 Thiamin hcl 50 mg tab ( vit b1 ) Tablet 100 500
0
50 100
110 0
0
SYRUP
0
0
161 Amoksisilin sirup kering 125 mg/ 5 ml Botol 8 20

0
0
164 Domperidon
ml syrup Botol
0
0
0
0
0
0
0
0
2 14
0
INJEKSI
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
3 0
0
0
0

0
0
0
0
0
4 0
0
0
OBAT KHUSUS
0
0
0
0
0
0
0
0
0
CAIRAN 0
0
0
0
0
221 Nacl 0,9% Botol
0
0
0
OBAT LUAR
0
0
0
0
2 0
0
3
3
0
0
0
0
0
0
0
3 0
0
0
4% 3 0
0
0
OBAT GIGI
0
0
0
0
0
0
0
0
0
0
0
BAHAN LABORATORIUM
0
0
0
0
255 Hb Test Kit Set
0
0
0
0
0
0
0
0
0
0
0
0
0
0
269 Lart Turk Botol
0
0
271 PP Test Stik
0
0
0
0
0
0
0
0
279 Stik HB Stik
0
0
OBAT NON FORNAS
0
0
200
0
0
0
SIRUP
0
0
13
6
0
OBAT LUAR
0
0
0
0
0
3
17
0
0
0
OBAT KHUSUS
0
0
0
Camabion Tablet 0
0
0
0
Caviplex Tablet 0
Slide pc 0
Plesterin pc 0
Klorhexidil Botol 0
Gelly USG Botol 0
0
0
328 Plesterin PCS 0
Fe drops botol 0
ELASTIS BANDED 4 CM ROL
BABY COUGH SYRUP BOTOL
KLORAMFENICOL SK Tube
GUANISTREP SYRUP B OTOL
VITAMIN C 25 MG TABLET
SUPRAVIT TABLET
ERLAMYCETIN + TM BOTOL
MKP LANG BOTOL
MT HERBAL BOTOL
LEUKOPLAST BESAR (PLESTER) ROL
pacdin baby BOTOL
grafachlor TABLET
teosal TABLET
elsiron TABLET
cefadroxil 500 mg Kapsul
rivanol sol BOTOL
betadin salep kulit tube
ikadryl syrup botol
inadryl syrup BOTOL
probiokod sachet
meloxicam TABLET
caviplex TABLET
minyak telon botol
tolak angin box
Neozep TABLET
Manitol infus botol
vick vaporub BOTOL
G
BAYAR PHB JKNM
JUMLAH KUNJUNGAN

GUNUNGSARI

NIP : 19711119 199203 1 00 6 NIP : 19811020 200803 1 0
KETERANGAN :
AS KESEHATAN
SKESMAS GUNUNGSARI
gsari (0370) 633503 Kode Pos 83351
TAHUN : 2019
TANGGAL

6=4+5 7 8 = 6-7 9 10=9-8 11 12
0 0 0
10 10 13.8
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
100 100 138
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 -6 6 -8.28
0 0 0
0 0 0
0 0 0
0 0 0
8 8 11.04
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 -6 6 -8.28
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
220 220 303.6
600 600 828
800 300 500 414
0 0 0
0 0 0
0 0 0
0 0 0
100 100 138
0 0 0
400 400 552
0 0 0
0 0 0
0 0 0
120 20 100 27.6
70 70 96.6
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
110
320 210 289.8

0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
100 100 138
0 0 0
0 0 0
0 0 0
0 0 0
200 50 150 69
200 30 170 41.4
0 0 0
0 0 0
0 0 0
0 0 0
300 300 414
0 0 0
0 0 0
0 0 0
110 110 151.8

0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
30 30 41.4
1000 600 400 828
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
130 130 179.4
0 0 0
0 0 0
0 0 0
0 0 0
600 350 250 483
0 0 0
150 30 120 41.4
110 110 151.8
0 0 0
0 0 0
0 0 0
7
28 21 28.98
0 0 0
0 -5 5 -6.9
0 -1 1 -1.38
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
16 8 8 11.04
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
3 3 4.14
0 0 0
0 0 0
0 0 0
0 0 0
0 -7 7 -9.66
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
4 4 5.52
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
2 1 1 1.38
0 0 0
3 2 1 2.76
3 1 2 1.38
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
3 2 1 2.76
0 0 0
0 0 0
3
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
200 200 276
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
13 3 10 4.14
6 2 4 2.76
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
3 0 3 0
17 9 8 12.42
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
GRATIS

PUSTU MIDANG
ri Aswal, S.Farm, Apt …………………………………………………………………….

1020 200803 1 001 NIP : …………………………………………………………..
DINAS KESEHAT
NAMA JARINGAN : POSKESDES KEKAIT

1 2 3 4 5

0
0
0
0
0
0
0
mm
0
0
mm
0
0
12 Blood Lancet Pcs
0
0
0
0
0
0
0
0
0
0
0
drops/ml)
0
drops/ml)
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
41 Mess 11 pcs
0
42 Mess 21 pcs
0
43 Mess 22 pcs
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
40 0
0
0
0
0
0
0
0
0
0
0
0
83 D H P TAB Tablet
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
2,70 g Tablet
0
0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
2160
folat 0,4 mg (TTD)
0
0
0
0
0
0
0
0
0,125 mg
0
0
0
0
0
0
0
0
0
0
0
0
0
10 0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
SYRUP
0
0

0
0
164 Domperidon
ml syrup Botol
0
0
0
0
0
0
0
0
0
0
INJEKSI
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0
OBAT KHUSUS
0
0
0
0
0
0
0
0
0
CAIRAN 0
0
0
0
0
221 Nacl 0,9% Botol
0
0
0
OBAT LUAR
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
4% 0
0
0
OBAT GIGI
0
0
0
0
0
0
0
0
0
0
0
BAHAN LABORATORIUM
0
0
0
0
255 Hb Test Kit Set
0
0
0
0
0
0
0
0
0
0
0
0
0
0
269 Lart Turk Botol
0
0
271 PP Test Stik
0
0
0
0
0
0
0
0
279 Stik HB Stik
0
0
OBAT NON FORNAS
0
0
0
0
0
0
SIRUP
0
0
0
0
0
OBAT LUAR
0
0
0
0
0
0
0
0
0
0
OBAT KHUSUS
0
0
0
Camabion Tablet 660 0
0
0
0
Caviplex Tablet 0
Slide pc 0
Plesterin pc 0
Klorhexidil Botol 0
Gelly USG Botol 0
0
0
327 Parasetamol supp 160 mg Suppos
328 Plesterin PCS
Fe drops botol
Ondansentron injeksi AMPUL
SUPRAVIT TABLET
MKP LANG BOTOL
MT HERBAL BOTOL
pacdin baby BOTOL
grafachlor TABLET
teosal TABLET
elsiron TABLET
rivanol sol BOTOL
ikadryl syrup botol
inadryl syrup BOTOL
probiokod sachet
meloxicam TABLET
caviplex TABLET
minyak telon botol
tolak angin box
Neozep TABLET
Manitol infus botol
vick vaporub BOTOL
G
BAYAR PHB JKNM
JUMLAH KUNJUNGAN

GUNUNGSARI

NIP : 19711119 199203 1 00 6 NIP : 19811020 200803 1 0
KETERANGAN :
AS KESEHATAN
SKESMAS GUNUNGSARI
gsari (0370) 633503 Kode Pos 83351
TAHUN : 2019
TANGGAL

6=4+5 7 8 = 6-7 9 10=9-8 11 12
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
40 0 40 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
2160 2160 2980.8
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
10 0 10 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
660 0 660 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
GRATIS

POSKESDES KEKAIT
ri Aswal, S.Farm, Apt ………………………………………………………………..

1020 200803 1 001 NIP : …………………………………………………..
DINAS KESEHAT
NAMA JARINGAN : POSKESDES TAMAN SARI 1

1 2 3 4 5

0
0
0
0
0
0
0
mm
0
0
mm
0
0
12 Blood Lancet Pcs
0
0
0
0
0
0
0
0
0
0
0
drops/ml)
0
drops/ml)
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
41 Mess 11 pcs
0
42 Mess 21 pcs
0
43 Mess 22 pcs
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
150 0
0
0
0
0
0
0
0
0
0
0
0
83 D H P TAB Tablet
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
2,70 g Tablet
0
0
0
0
0
0

0
0
0
0
111 Kalsium Laktat 500 mg Tablet 100 0
90 0
0
0
0
0
0
0
0
0
0
folat 0,4 mg (TTD)
0
0
0
0
0
0
0
0
0,125 mg
80 0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
SYRUP
0
0

0
0
164 Domperidon
ml syrup Botol
0
0
0
0
0
0
0
0
0
0
INJEKSI
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0
OBAT KHUSUS
0
0
0
0
0
0
0
0
0
CAIRAN 0
0
0
0
0
221 Nacl 0,9% Botol
0
0
0
OBAT LUAR
0
0
0
0
0
0
0
5 0
0
0
0
0
3 0
0
0
0
0
0
4% 0
0
0
OBAT GIGI
0
0
0
0
0
0
0
0
0
0
0
BAHAN LABORATORIUM
0
0
0
0
255 Hb Test Kit Set
0
0
0
0
0
0
0
0
0
0
0
0
0
0
269 Lart Turk Botol
0
0
271 PP Test Stik
3 0
0
0
0
0
0
0
0
279 Stik HB Stik
0
0
OBAT NON FORNAS
0
0
0
0
0
0
SIRUP
0
0
0
0
0
OBAT LUAR
0
0
0
3 0
0
0
0
0
0
0
OBAT KHUSUS
0
0
0
0
0
0
Caviplex Tablet 0
Slide pc 0
Plesterin pc 0
Klorhexidil Botol 0
Gelly USG Botol 0
0
326 Bisacodyl supp 10 mg Suppos

328 Plesterin PCS
Fe drops botol
SUPRAVIT TABLET
MKP LANG BOTOL
MT HERBAL BOTOL
pacdin baby BOTOL
grafachlor TABLET
teosal TABLET
elsiron TABLET
rivanol sol BOTOL
ikadryl syrup botol
inadryl syrup BOTOL
probiokod sachet
meloxicam TABLET
caviplex TABLET
minyak telon botol
tolak angin box
Neozep TABLET
Manitol infus botol
vick vaporub BOTOL
G
BAYAR PHB JKNM
JUMLAH KUNJUNGAN

GUNUNGSARI

NIP : 19711119 199203 1 00 6 NIP : 19811020 200803 1 0
KETERANGAN :
AS KESEHATAN
SKESMAS GUNUNGSARI
gsari (0370) 633503 Kode Pos 83351
TAHUN : 2019
TANGGAL

6=4+5 7 8 = 6-7 9 10=9-8 11 12
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
150 0 150 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
100 100 138
90 0 90 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
80 0 80 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
5 0 5 0
0 0 0
0 0 0
0 0 0
0 0 0
3 0 3 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
3 0 3 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
3 0 3 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
1530 1530 2111.4
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
GRATIS

POSKESDES TAMAN SARI 1
ri Aswal, S.Farm, Apt …………………………………………………………

1020 200803 1 001 NIP : ……………………………………………..
DINAS KESEHAT
NAMA JARINGAN : POSKESDES TAMAN SARI 2

1 2 3 4 5

mm
mm
12 Blood Lancet Pcs
drops/ml)
drops/ml)
41 Mess 11 pcs
42 Mess 21 pcs
43 Mess 22 pcs
46 Nasal Canula dewasa pcs
47 Nebulizer with mask anak pcs
48 Nebulizer with mask dewasa pcs
TABLET DAN SERBUK ORAL

83 D H P TAB Tablet
84 Deksametason tablet 0,5 mg Tablet

2,70 g Tablet
105 Haloperidol tablet 5 mg Tablet
106 Hidroklorotiazide tab 25 mg Tablet

111 Kalsium Laktat 500 mg Tablet
folat 0,4 mg (TTD)
0,125 mg
155 Siprofloksasin tablet 500 mg (sebagai HCl) Tablet
156 Tetrasiklin 500 kapsul Kapsul
157 Thiamin hcl 50 mg tab ( vit b1 ) Tablet
SYRUP
161 Amoksisilin sirup kering 125 mg/ 5 ml Botol

164 Domperidon
ml syrup Botol
Trimetoprim 40 mg / 5 ml
171 Metronidazol suspensi Botol
INJEKSI

197 Lidokain injeksi 2% (HCl) + Epinefrin 1 : 80.000 - 2ml Ampul
198 Lidokain injeksi 2% (HCL) Ampul
199 Magnesium Sulfat 20 % Inj 25 ml Vial

OBAT KHUSUS

209 Bisacodyl supp (dulcolax) 5 mg / Stolax supp SUPP

216 Serum ATS 20.000 IU VIAL
217 Vaksin Rabies Inj 2,5 IU VIAL
CAIRAN

221 Nacl 0,9% Botol
OBAT LUAR

239 Povidon Iodida larutan 10% 30 ml Botol
4%
OBAT GIGI

251 Temporary stopping fketcher serbuk+cairan (caviton) Pot
252 Trikkresol formalin (TKF) Botol
BAHAN LABORATORIUM

255 Hb Test Kit Set
269 Lart Turk Botol
271 PP Test Stik
279 Stik HB Stik
280 Stik HBSAG Stik
281 widal Test Set
OBAT NON FORNAS

284 Multi micro nutrien Tablet
285 Piroksikam 20 mg tab Tablet
SIRUP

OBAT LUAR
OBAT KHUSUS
297 Parasetamol supp 80 mg Supp

TAMBAHAN OBAT FORNAS

Camabion Tablet
Ceftriaxon injeksi 1 g Vial
TAMBAHAN OBAT NON FORNAS
1 Kasa, Verband, Kapas - Kasa Hydrophil 40 x 40 cm

4 Baby Cough Syrup 60 ml Botol
5 Demacolin Tablet
6 Rohto Tetes Mata
Caviplex Tablet
Slide pc
Plesterin pc
Klorhexidil Botol
Gelly USG Botol

328 Plesterin PCS
Fe drops botol
SUPRAVIT TABLET
MKP LANG BOTOL
MT HERBAL BOTOL
pacdin baby BOTOL
grafachlor TABLET
teosal TABLET
elsiron TABLET
rivanol sol BOTOL
ikadryl syrup botol
inadryl syrup BOTOL
probiokod sachet
meloxicam TABLET
caviplex TABLET
minyak telon botol
tolak angin box
Neozep TABLET
Manitol infus botol
vick vaporub BOTOL
G
BAYAR PHB JKNM
JUMLAH KUNJUNGAN

GUNUNGSARI

NIP : 19711119 199203 1 00 6 NIP : 19811020 200803 1 0
KETERANGAN :
AS KESEHATAN
SKESMAS GUNUNGSARI
gsari (0370) 633503 Kode Pos 83351
TAHUN : 2019
TANGGAL

6=4+5 7 8 = 6-7 9 10=9-8 11 12
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 -200 200 -276
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 -170 170 -234.6
0 -100 100 -138
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 -50 50 -69
0 -30 30 -41.4
0 0 0
0 0 0
0 0 0
0 -140 140 -193.2
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
60
0 -60 -82.8
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 -30 30 -41.4
0 -100 100 -138
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 -200 200 -276
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 -100 100 -138
0 0 0
0 -50 50 -69
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 -130 130 -179.4
0 0 0
0 0 0
0 0 0
0 -10 10 -13.8
0 -100 100 -138
0 0 0
0 0 0
0 0 0
6
0 -6 -8.28
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 -10 10 -13.8
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 -250 250 -345
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 -5 5 -6.9
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 -300 300 -414
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
GRATIS

POSKESDES TAMAN SARI 2
ri Aswal, S.Farm, Apt …………………………………………………………………..

1020 200803 1 001 NIP : ……………………………………………………….
DINAS KESEHAT
NAMA JARINGAN : POSKESDES GUNTUR MACAN

1 2 3 4 5

0
0
0
0
0
0
0
mm
0
0
mm
0
0
12 Blood Lancet Pcs
0
0
0
0
0
0
0
0
0
0
0
drops/ml)
0
drops/ml)
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
41 Mess 11 pcs
0
42 Mess 21 pcs
0
43 Mess 22 pcs
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
200
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
83 D H P TAB Tablet
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
2,70 g Tablet
0
0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
2160
folat 0,4 mg (TTD)
0
0
0
0
0
0
0
0
0,125 mg
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
SYRUP
0
0

0
0
164 Domperidon
ml syrup Botol
0
0
0
0
0
0
0
0
0
0
INJEKSI
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0
OBAT KHUSUS
0
0
0
0
0
0
0
0
0
CAIRAN 0
0
0
0
0
221 Nacl 0,9% Botol
0
0
0
OBAT LUAR
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
4% 0
0
0
OBAT GIGI
0
0
0
0
0
0
0
0
0
0
0
BAHAN LABORATORIUM
0
0
0
0
255 Hb Test Kit Set
0
0
0
0
0
0
0
0
0
0
0
0
0
0
269 Lart Turk Botol
0
0
271 PP Test Stik
0
0
0
0
0
0
0
0
279 Stik HB Stik
0
0
OBAT NON FORNAS
0
0
0
0
0
0
SIRUP
0
0
0
0
0
OBAT LUAR
0
0
0
0
0
0
0
0
0
0
OBAT KHUSUS
0
0
0
Camabion Tablet 900
0
0
0
Caviplex Tablet 0
Slide pc 0
Plesterin pc 0
Klorhexidil Botol 0
Gelly USG Botol 0
0
0
328 Plesterin PCS
Fe drops botol
SUPRAVIT TABLET
MKP LANG BOTOL
MT HERBAL BOTOL
pacdin baby BOTOL
grafachlor TABLET
teosal TABLET
elsiron TABLET
rivanol sol BOTOL
ikadryl syrup botol
inadryl syrup BOTOL
probiokod sachet
meloxicam TABLET
caviplex TABLET
minyak telon botol
tolak angin box
Neozep TABLET
Manitol infus botol
vick vaporub BOTOL
G
BAYAR PHB JKNM
JUMLAH KUNJUNGAN

GUNUNGSARI

NIP : 19711119 199203 1 00 6 NIP : 19811020 200803 1 0
KETERANGAN :
AS KESEHATAN
SKESMAS GUNUNGSARI
gsari (0370) 633503 Kode Pos 83351
TAHUN : 2019
TANGGAL

6=4+5 7 8 = 6-7 9 10=9-8 11 12
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
200 200 276
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
200 200 276
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
2160 540 1620 745.2
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
900 900 1242
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
GRATIS

POSKESDES GUNTUR MACAN
ri Aswal, S.Farm, Apt ……………………………………………………………….

1020 200803 1 001 NIP : ………………………………………………………
DINAS KESEHAT
NAMA JARINGAN : POSKESDES MIDANG

1 2 3 4 5

17 0
25 10
16 0
0
0
0
0
mm
0
0
mm
0
0
12 Blood Lancet Pcs
0
0
25 0
0
0
100 0
100
0
0
1 0
0
drops/ml)
10 0
drops/ml)
8 0
6 0
0
0
0
0
0
0
0
1 0
0
160 0
0
0
3
0
0
41 Mess 11 pcs
0
42 Mess 21 pcs
0
43 Mess 22 pcs
0
0
0
0
3 0
50 0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
200 400
200 600
0
0
0
0
300
100 0
500 0
0
0
0
100 0
100 0
0
0
0
0
0
83 D H P TAB Tablet
0

0
0
0
0
0
0
0
0
0
0
0
100
0
0
2,70 g Tablet
0
0
0
0
0
0

100
0
0
0
200
100 0
0
0
0
0
70 300
0
0
0
folat 0,4 mg (TTD)
100 0
0
0
0
0
0
0
0
0,125 mg
0
100 0
0
100 0
0
0
0
0
0
0
0
0
200 900
100 100
0
0
0
0
0
0
0
50 0
100
0
0
0
100
0
0
SYRUP
0
0

0
9 0
164 Domperidon
ml syrup Botol
0
0
0
3 0
0
Trimetoprim 40 mg / 5 ml 7 8
0
0
0
10 14
0
INJEKSI
0
0
0
5 0
0
0
0
0
3 0
1 0
0
5 0
3 0
0
0
0
0
0
0
0
0
1 0
0
0
200 Magnesium Sulfat 40 % Inj 25 ml Vial 1 0

0
0
0
0
0
0
0
0
OBAT KHUSUS
0
0
0
0
0
0
0
0
0
CAIRAN 0
0
0
0
2 0
221 Nacl 0,9% Botol
2 0
1 0
0
OBAT LUAR
0
0
0
0
0
5 5
3
3 3
0
0
0
0
0
2
3 0
2 5
0
0
239 Povidon Iodida larutan 10% 30 ml Botol 3 0
4% 0
0
0
OBAT GIGI
0
0
0
0
0
0
0
0
0
0
0
BAHAN LABORATORIUM
0
0
0
0
255 Hb Test Kit Set
0
0
0
0
0
0
0
0
0
0
0
0
0
0
269 Lart Turk Botol
0
0
271 PP Test Stik
0
0
0
0
0
0
0
0
279 Stik HB Stik
0
0
OBAT NON FORNAS
0
0
200
0
0
0
SIRUP
0
0
13
6 6
0
OBAT LUAR
0
0
0
0
0
1 3
17
0
0
0
OBAT KHUSUS
0
0
0
0
0
0
Caviplex Tablet 0
Slide pc 0
Plesterin pc 0
Klorhexidil Botol 0
Gelly USG Botol 0
0
0
328 Plesterin PCS 0
Fe drops botol 0
SUPRAVIT TABLET
MKP LANG BOTOL
MT HERBAL BOTOL
pacdin baby BOTOL
grafachlor TABLET
teosal TABLET
elsiron TABLET
rivanol sol BOTOL
ikadryl syrup botol
inadryl syrup BOTOL
probiokod sachet
meloxicam TABLET
caviplex TABLET 5
minyak telon botol
tolak angin box
Neozep TABLET
Manitol infus botol
vick vaporub BOTOL
G
BAYAR PHB JKNM
JUMLAH KUNJUNGAN

GUNUNGSARI

NIP : 19711119 199203 1 00 6 NIP : 19811020 200803 1 0
KETERANGAN :
AS KESEHATAN
SKESMAS GUNUNGSARI
gsari (0370) 633503 Kode Pos 83351
TAHUN : 2019
TANGGAL

6=4+5 7 8 = 6-7 9 10=9-8 11 12
17 17 23.46
35 35 48.3
16 16 22.08
0 0 0
0 0 0
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 25 34.5
0 0 0
0 0 0
100 100 138
100 100 138
0 0 0
0 0 0
1 -4 5 -5.52
0 0 0
10 10 13.8
8 8 11.04
6 6 8.28
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
1 1 1.38
0 0 0
160 32 128 44.16
0 0 0
0 0 0
3 0 3 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
3 3 4.14
50 0 50 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
600 400 200 552
800 700 100 966
0 0 0
0 0 0
0 0 0
0 0 0
300 200 100 276
100 0 100 0
500 70 430 96.6
0 0 0
0 0 0
0 0 0
100 30 70 41.4
100 0 100 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
360 360 496.8

0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
100 20 80 27.6
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
100 100 138
0 0 0
0 0 0
0 0 0
300 0 300 0
200 200 276
100 100 138
0 0 0
0 0 0
0 0 0
0 0 0
370 370 510.6
0 0 0
0 0 0
0 0 0
100 100 138

0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
100 30 70 41.4
0 0 0
100 100 138
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
1100 800 300 1104
200 0 200 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
50 50 69
100 100 138
0 0 0
0 0 0
60
0 0 0
100 100 138
0 0 0
0 0 0
0 0 0
0 0 0
2
20 18 24.84
0 0 0
9 2 7 2.76
0 0 0
0 0 0
0 0 0
3 3 4.14
0 0 0
0 0 0
0 0 0
24 13 11 17.94
0 0 0
0 0 0
0 0 0
0 0 0
5 5 6.9
0 0 0
0 0 0
0 0 0
0 0 0
3 3 4.14
1 1 1.38
0 0 0
5 2 3 2.76
3 1 2 1.38
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
1 0 1 0
0 0 0
0 0 0
1
1 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
2 0 2 0
2 0 2 0
1 0 1 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
10 3 7 4.14
3 3 4.14
6 2 4 2.76
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
2 0 2 0
3 3 4.14
7 0 7 0
0 0 0
0 0 0
3
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
200 200 276
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
13 13 17.94
12 12 16.56
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
4 4 5.52
17 17 23.46
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
3650 1220 2430 1683.6
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
5 0 5 0
0 0 0
GRATIS

POSKESDES MIDANG

1020 200803 1 001 NIP : ………………………………………………………
DINAS KESEHAT
NAMA JARINGAN : POSKESDES GUNUNGSARI

1 2 3 4 5

0
0
0
0
0
0
0
mm
0
0
mm
0
0
12 Blood Lancet Pcs
0
0
0
0
0
0
0
0
0
0
0
drops/ml)
0
drops/ml)
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
41 Mess 11 pcs
0
42 Mess 21 pcs
0
43 Mess 22 pcs
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
83 D H P TAB Tablet
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
2,70 g Tablet
0
0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
folat 0,4 mg (TTD)
0
0
0
0
0
0
0
0
0,125 mg
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
SYRUP
0
0

0
0
164 Domperidon
ml syrup Botol
0
0
0
0
0
0
0
0
0
0
INJEKSI
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0
OBAT KHUSUS
0
0
0
0
0
0
0
0
0
CAIRAN 0
0
0
0
0
221 Nacl 0,9% Botol
0
0
0
OBAT LUAR
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
4% 0
0
0
OBAT GIGI
0
0
0
0
0
0
0
0
0
0
0
BAHAN LABORATORIUM
0
0
0
0
255 Hb Test Kit Set
0
0
0
0
0
0
0
0
0
0
0
0
0
0
269 Lart Turk Botol
0
0
271 PP Test Stik
0
0
0
0
0
0
0
0
279 Stik HB Stik
0
0
OBAT NON FORNAS
0
0
0
0
0
0
SIRUP
0
0
0
0
0
OBAT LUAR
0
0
0
0
0
0
0
0
0
0
OBAT KHUSUS
0
0
0
0
0
0
Caviplex Tablet 0
Slide pc 0
Plesterin pc 0
Klorhexidil Botol 0
Gelly USG Botol 0
0
0
328 Plesterin PCS
Fe drops botol
SUPRAVIT TABLET
MKP LANG BOTOL
MT HERBAL BOTOL
pacdin baby BOTOL
grafachlor TABLET
teosal TABLET
elsiron TABLET
rivanol sol BOTOL
ikadryl syrup botol
inadryl syrup BOTOL
probiokod sachet
meloxicam TABLET
caviplex TABLET
minyak telon botol
tolak angin box
Neozep TABLET
Manitol infus botol
vick vaporub BOTOL
G
BAYAR PHB JKNM
JUMLAH KUNJUNGAN

GUNUNGSARI

NIP : 19711119 199203 1 00 6 NIP : 19811020 200803 1 0
KETERANGAN :
AS KESEHATAN
SKESMAS GUNUNGSARI
gsari (0370) 633503 Kode Pos 83351
TAHUN : 2019
TANGGAL

6=4+5 7 8 = 6-7 9 10=9-8 11 12
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
60 0 60 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
990 900 90 1242
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
GRATIS

POSKESDES GUNUNGSARI

1020 200803 1 001 NIP : ………………………………………………………
DINAS KESEHAT
NAMA JARINGAN : POSKESDES SESELA 1

1 2 3 4 5

0
0
0
0
0
0
0
mm
0
0
mm
0
0
12 Blood Lancet Pcs
0
0
0
0
0
0
0
0
0
0
0
drops/ml)
0
drops/ml)
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
41 Mess 11 pcs
0
42 Mess 21 pcs
0
43 Mess 22 pcs
0
0
0
0
0
0
0
0
0
0
0
0
0
0
58 0
0
0
0
0
0
50 0
70 0
0
0
0
0
30 0
0
150 0
0
0
0
180 0
90 0
0
0
0
0
0
83 D H P TAB Tablet
0

0
0
0
0
0
0
0
0
0
0
0
0
0
25 0
2,70 g Tablet
0
0
0
0
0
0

100 0
0
0
0
0
0
0
100 0
0
0
0
0
0
0
folat 0,4 mg (TTD)
60 0
0
0
0
0
0
0
0
0,125 mg
0
0
0
0
0
0
0
0
0
0
0
0
200 0
0
0
0
0
0
0
0
0
0
50 0
80 0
0
0
0
0
0
SYRUP
0
0

0
0
164 Domperidon
ml syrup Botol
5 0
0
0
0
0
6 0
0
0
0
0
INJEKSI
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0
OBAT KHUSUS
0
0
0
0
0
0
0
0
0
CAIRAN 0
0
0
0
0
221 Nacl 0,9% Botol
0
0
0
OBAT LUAR
0
0
0
0
0
0
0
0
3 0
0
0
0
0
0
0
2 0
0
0
4% 1 0
0
0
OBAT GIGI
0
0
0
0
0
0
0
0
0
0
0
BAHAN LABORATORIUM
0
0
0
0
255 Hb Test Kit Set
0
0
0
0
0
0
0
0
0
0
0
0
0
0
269 Lart Turk Botol
0
0
271 PP Test Stik
0
0
0
0
0
0
0
0
279 Stik HB Stik
0
0
OBAT NON FORNAS
0
0
0
0
0
0
SIRUP
0
0
0
0
0
OBAT LUAR
0
0
0
0
0
0
1 0
0
0
0
OBAT KHUSUS
0
0
0
0
0
0
Caviplex Tablet 0
Slide pc 0
Plesterin pc 0
Klorhexidil Botol 0
Gelly USG Botol 0
0
0
328 Plesterin PCS 0
Fe drops botol 0
SUPRAVIT TABLET 0
MKP LANG BOTOL 0
MT HERBAL BOTOL 0
pacdin baby BOTOL 0
grafachlor TABLET 0
teosal TABLET 0
elsiron TABLET 0
rivanol sol BOTOL 0
probiokod sachet 0
kloram plus TM BOTOL 0
meloxicam TABLET 0
caviplex TABLET
minyak telon botol
tolak angin box
Neozep TABLET
Manitol infus botol
vick vaporub BOTOL
G
BAYAR PHB JKNM
JUMLAH KUNJUNGAN

GUNUNGSARI

NIP : 19711119 199203 1 00 6 NIP : 19811020 200803 1 0
KETERANGAN :
AS KESEHATAN
SKESMAS GUNUNGSARI
gsari (0370) 633503 Kode Pos 83351
TAHUN : 2019
TANGGAL

6=4+5 7 8 = 6-7 9 10=9-8 11 12
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
58 5 53 6.9
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
50 50 69
70 20 50 27.6
0 0 0
0 0 0
0 0 0
0 0 0
30 0 30 0
0 0 0
150 50 100 69
0 0 0
0 0 0
0 0 0
180 120 60 165.6
90 10 80 13.8
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
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 10 15 13.8
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
100 20 80 27.6
0 0 0
0 0 0
0 0 0
0 -50 50 -69
0 0 0
0 0 0
0 0 0
100 100 138
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
60 20 40 27.6
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
200 170 30 234.6
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
50 0 50 0
80 10 70 13.8
0 0 0
0 0 0
0 0 0
120 0 120 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
4 4 5.52
0 0 0
0 0 0
5 0 5 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
6 0 6 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
13 3 10 4.14
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
3 0 3 0
0 -3 3 -4.14
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
2 2 2.76
0 0 0
0 0 0
0 0 0
0 0 0
1 0 1 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
1 0 1 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
1300 1300 1794
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
GRATIS

POSKESDES SESELA 1

1020 200803 1 001 NIP : ………………………………………………………
DINAS KESEHAT
NAMA JARINGAN : POSKESDES SESELA 2

1 2 3 4 5

0
10
0
0
0
0
0
mm
0
0
mm
0
0
12 Blood Lancet Pcs
0
0
6
0
0
0
0
0
0
0
0
drops/ml)
3
drops/ml)
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
41 Mess 11 pcs
0
42 Mess 21 pcs
0
43 Mess 22 pcs
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
50 0
80 0
0
0
0
0
200 0
0
100 100
0
0
0
60 120
130 0
0
0
0
0
0
83 D H P TAB Tablet
0

0
0
0
0
80 0
0
0
0
0
0
0
0
0
20 0
2,70 g Tablet
0
0
0
0
0
0

100
100 0
0
0
0
70 0
0
50
0
0
70 100
0
0
2160
folat 0,4 mg (TTD)
200 0
0
0
0
0
0
0
0
0,125 mg
70 0
50 0
0
0
0
0
0
0
0
0
0
0
200
70 0
0
0
0
0
0
0
0
0
0
0
0
0
80 100
90 0
0
SYRUP
0
0

0
0
164 Domperidon
ml syrup Botol
3 0
0
0
0
0
4 0
0
0
3 6
0
INJEKSI
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

0
0
0
8 0
0
0
0
0
OBAT KHUSUS
0
0
0
0
0
0
0
0
0
CAIRAN 0
0
0
0
0
221 Nacl 0,9% Botol
0
0
0
OBAT LUAR
0
0
0
0
3
3
0
3 0
7 0
0
0
0
0
4 0
0
0
0
0
4% 0
0
0
OBAT GIGI
0
0
0
0
0
0
0
0
0
0
0
BAHAN LABORATORIUM
0
0
0
0
255 Hb Test Kit Set
0
0
0
0
0
0
0
0
0
0
0
0
0
0
269 Lart Turk Botol
0
0
271 PP Test Stik
0
0
0
0
0
0
0
0
279 Stik HB Stik
0
0
OBAT NON FORNAS
0
0
100
0
0
0
SIRUP
0
0
0
0
0
OBAT LUAR
0
0
0
0
0
0
0
3 3
0
0
OBAT KHUSUS
0
0
0
Camabion Tablet 0
0
0
0
Caviplex Tablet 0
Slide pc 0
Plesterin pc 0
Klorhexidil Botol 0
Gelly USG Botol 0
0
0
328 Plesterin PCS
Fe drops botol
SUPRAVIT TABLET
MKP LANG BOTOL
MT HERBAL BOTOL
pacdin baby BOTOL
grafachlor TABLET
teosal TABLET
elsiron TABLET
rivanol sol BOTOL
ikadryl syrup botol
inadryl syrup BOTOL
probiokod sachet
meloxicam TABLET
caviplex TABLET
minyak telon botol
tolak angin box
Neozep TABLET
Manitol infus botol
vick vaporub BOTOL
G
BAYAR PHB JKNM
JUMLAH KUNJUNGAN

GUNUNGSARI

NIP : 19711119 199203 1 00 6 NIP : 19811020 200803 1 0
KETERANGAN :
AS KESEHATAN
SKESMAS GUNUNGSARI
gsari (0370) 633503 Kode Pos 83351
TAHUN : 2019
TANGGAL

6=4+5 7 8 = 6-7 9 10=9-8 11 12
0 0 0
10 10 13.8
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
6 6 8.28
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
3 3 4.14
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
50 50 69
80 40 40 55.2
0 0 0
0 0 0
0 0 0
0 0 0
200 0 200 0
0 0 0
200 140 60 193.2
0 0 0
0 0 0
0 0 0
180 0 180 0
130 10 120 13.8
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
50 50 69
0 0 0
0 0 0
0 0 0
0 0 0
80 80 110.4
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
20 20 27.6
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
100 100 138
100 20 80 27.6
0 0 0
0 0 0
100 0 100 0
0 0 0
70 30 40 41.4
0 0 0
50 50 69
0 0 0
0 0 0
170 120 50 165.6
0 0 0
0 0 0
2160 2160 2980.8
200 0 200 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
70 70 96.6
50 0 50 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
200 160 40 220.8
70 70 96.6
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 -70 70 -96.6
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
180 170 10 234.6
90 90 124.2
0 0 0
0 0 0
0 0 0
12 12 16.56
0 0 0
0 0 0
3 3 4.14
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
4 2 2 2.76
0 0 0
0 0 0
0 0 0
9 9 12.42
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
8 8 11.04
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
3 0 3 0
3 0 3 0
0 0 0
3 3 4.14
7 7 9.66
0 -5 5 -6.9
0 0 0
0 0 0
0 -2 2 -2.76
4 1 3 1.38
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
100 100 138
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 -1 1 -1.38
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
6 6 8.28
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
GRATIS

POSKESDES SESELA 2

1020 200803 1 001 NIP : ………………………………………………………
DINAS KESEHAT
NAMA JARINGAN : POSKESDES JATISELA

1 2 3 4 5

15 0
20 0
5 0
5 0
7 0
15 0
0
mm
0
0
mm
0
0
12 Blood Lancet Pcs
0
0
17 0
0
0
100 0
0
0
8 0
2 0
0
drops/ml)
15 0
drops/ml)
14 0
0
0
0
0
4 0
0
0
0
2 0
0
0
0
0
10 0
0
5 0
41 Mess 11 pcs
0
42 Mess 21 pcs
0
43 Mess 22 pcs
0
0
0
0
2 0
0
0
0
0
4 0
0
0
0
0
0
0
0
0
0
0
140 0
240 0
0
0
0
0
100 0
0
400 0
0
0
0
30 0
0
0
0
0
0
0
83 D H P TAB Tablet
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
2,70 g Tablet
0
0
0
0
0
0

0
0
0
0
0
100 0
0
0
0
0
0
0
0
0
folat 0,4 mg (TTD)
100 0
0
0
0
0
0
0
0
0,125 mg
100 0
110 0
0
16 0
0
0
0
0
0
0
0
0
40 0
0
0
0
0
0
0
0
0
48 0
0
0
0
0
70 0
0
0
SYRUP
0
0

0
6 0
164 Domperidon
ml syrup Botol
0
0
0
0
0
Trimetoprim 40 mg / 5 ml 6 0
0
0
4 0
0
0
INJEKSI
0
0
0
4 0
0
0
0
0
4 0
0
0
0
2 0
0
0
4 0
0
0
0
0
0
8 0
0
0
200 Magnesium Sulfat 40 % Inj 25 ml Vial 2 0

0
0
6 0
14 0
0
0
0
0
OBAT KHUSUS
0
0
0
0
10 0
0
0
0
0
CAIRAN 0
0
0
0
0
221 Nacl 0,9% Botol
1 0
16 0
0
OBAT LUAR
0
0
2 0
0
0
3 0
0
0
5 0
0
0
0
0
0
5 0
0
0
0
4% 0
0
0
OBAT GIGI
0
0
0
0
0
0
0
0
0
0
0
BAHAN LABORATORIUM
0
0
0
0
255 Hb Test Kit Set
0
0
0
0
0
0
0
0
0
0
0
0
0
0
269 Lart Turk Botol
0
0
271 PP Test Stik
0
0
0
0
0
0
0
0
279 Stik HB Stik
0
0
OBAT NON FORNAS
0
0
130 0
0
0
0
SIRUP
0
0
2 0
0
0
OBAT LUAR
0
0
0
0
0
0
5 0
0
0
0
OBAT KHUSUS
0
0
0
0
0
0
Caviplex Tablet 0
Slide pc 0
Plesterin pc 0
Klorhexidil Botol 0
Gelly USG Botol 1 0
0
0
328 Plesterin PCS
Fe drops botol
SUPRAVIT TABLET
MKP LANG BOTOL
MT HERBAL BOTOL
pacdin baby BOTOL
grafachlor TABLET
teosal TABLET
elsiron TABLET
rivanol sol BOTOL
ikadryl syrup botol
inadryl syrup BOTOL
probiokod sachet
meloxicam TABLET
caviplex TABLET
minyak telon botol
tolak angin box
Neozep TABLET
Manitol infus botol
vick vaporub BOTOL
G
BAYAR PHB JKNM
JUMLAH KUNJUNGAN

GUNUNGSARI

NIP : 19711119 199203 1 00 6 NIP : 19811020 200803 1 0
KETERANGAN :
AS KESEHATAN
SKESMAS GUNUNGSARI
gsari (0370) 633503 Kode Pos 83351
TAHUN : 2019
TANGGAL

6=4+5 7 8 = 6-7 9 10=9-8 11 12
15 0 15 0
20 0 20 0
5 0 5 0
5 0 5 0
7 0 7 0
15 0 15 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
17 0 17 0
0 0 0
0 0 0
100 0 100 0
0 0 0
0 0 0
8 0 8 0
2 0 2 0
0 0 0
15 0 15 0
14 0 14 0
0 0 0
0 0 0
0 0 0
0 0 0
4 0 4 0
0 0 0
0 0 0
0 0 0
2 0 2 0
0 0 0
0 0 0
0 0 0
0 0 0
10 0 10 0
0 0 0
5 0 5 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
2 0 2 0
0 0 0
0 0 0
0 0 0
0 0 0
4 0 4 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
140 0 140 0
240 0 240 0
0 0 0
0 0 0
0 0 0
0 0 0
100 0 100 0
0 0 0
400 0 400 0
0 0 0
0 0 0
0 0 0
30 0 30 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
100
100 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
100 0 100 0
0 0 0
100 0 100 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
100 0 100 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
100 0 100 0
110 0 110 0
0 0 0
16 0 16 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
40 0 40 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
48 0 48 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
70 0 70 0
0 0 0
0 0 0
0 0 0
0 0 0
5
5 0 0
0 0 0
6 0 6 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
6 0 6 0
0 0 0
0 0 0
0 0 0
4 0 4 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
4 0 4 0
0 0 0
0 0 0
0 0 0
0 0 0
4 0 4 0
0 0 0
0 0 0
0 0 0
2 0 2 0
0 0 0
0 0 0
4 0 4 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
8 0 8 0
0 0 0
0 0 0
0 0 0
10 0 10 0
0 0 0
2
2 0 0
0 0 0
0 0 0
6 0 6 0
14 0 14 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
10 0 10 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
1 0 1 0
16 0 16 0
0 0 0
0 0 0
0 0 0
2 0 2 0
0 0 0
0 0 0
3 0 3 0
0 0 0
0 0 0
5 0 5 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
5 0 5 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
130 0 130 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
2 0 2 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
5 0 5 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
2880 0 2880 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
1 0 1 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
GRATIS

POSKESDES JATISELA

1020 200803 1 001 NIP : ………………………………………………………
DINAS KESEHAT
NAMA UNIT LAYANAN : LABORATORIUM

1 2 3 4 5

137 100
189 100
0
0
0
0
0
mm
0
0
mm
0
0
12 Blood Lancet Pcs
0
0
0
0
0
0
0
0
0
0
0
drops/ml)
0
drops/ml)
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
41 Mess 11 pcs
0
42 Mess 21 pcs
0
43 Mess 22 pcs
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
0
0
0
0
0
0
0
0
0
0
0
0
0
0
83 D H P TAB Tablet
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
2,70 g Tablet
0
0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
folat 0,4 mg (TTD)
0
0
0
0
0
0
0
0
0,125 mg
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
SYRUP
0
0

0
0
164 Domperidon
ml syrup Botol
0
0
0
0
0
0
0
0
0
0
INJEKSI
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0
OBAT KHUSUS
0
0
0
0
0
0
0
0
0
CAIRAN 0
0
0
0
0
221 Nacl 0,9% Botol
0
0
0
OBAT LUAR
0
0
0
1 1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
4% 0
0
0
OBAT GIGI
0
0
0
0
0
0
0
0
0
0
0
BAHAN LABORATORIUM
0
0
407 0
0
255 Hb Test Kit Set
0
431 0
0
0
0
0
0
0
0
0
0
0
0
0
269 Lart Turk Botol
0
0
271 PP Test Stik
70 0
0
0
0
0
82 0
59 0
53 0
279 Stik HB Stik
103 250
280 Stik HBSAG Stik 410 0
0
OBAT NON FORNAS
0
0
0
0
0
0
SIRUP
0
0
0
0
0
OBAT LUAR
0
0
0
0
0
0
0
0
0
0
OBAT KHUSUS
0
0
0
Camabion Tablet 0
0
0
0
Caviplex Tablet 0
Slide pc 0
Plesterin pc 0
Klorhexidil Botol 0
Gelly USG Botol 0
0
0
328 Plesterin PCS 0
Fe drops botol 0
SUPRAVIT TABLET 0
MKP LANG BOTOL 0
MT HERBAL BOTOL 0
pacdin baby BOTOL 0
grafachlor TABLET 0
teosal TABLET 0
elsiron TABLET 0
rivanol sol BOTOL 0
probiokod sachet 0
kloram plus TM BOTOL 0
meloxicam TABLET 0
cefadroxil syrup 125 mg/5 ml BOTOL 0
caviplex TABLET 0
minyak telon botol 0
Handscoon steril no. 6,5 PCS 0
tolak angin box
Neozep TABLET
Manitol infus botol
vick vaporub BOTOL
G
BAYAR PHB JKNM
JUMLAH KUNJUNGAN

GUNUNGSARI

NIP : 19711119 199203 1 00 6 NIP : 19811020 200803 1 0
KETERANGAN :
AS KESEHATAN
SKESMAS GUNUNGSARI
gsari (0370) 633503 Kode Pos 83351
TAHUN : 2019
TANGGAL

6=4+5 7 8 = 6-7 9 10=9-8 11 12
237 100 137 138

289 100 189 138
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
1 1 1.38
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
50 50 69
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
2 1 1 1.38
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
407 0 407 0
0 0 0
0 0 0
431 0 431 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
70 0 70 0
0 0 0
0 0 0
0 0 0
0 0 0
82 0 82 0
59 0 59 0
53 0 53 0
353 250 103 345
410
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
GRATIS

a Obat Puskesmas PETUGAS LABORATORIUM

1020 200803 1 001 NIP : ………………………………………………………
DINAS KESEHAT
NAMA UNIT LAYANAN : POLI GIGI

1 2 3 4 5

0
0
0
0
0
0
0
mm
0
0
mm
0
0
12 Blood Lancet Pcs
0
0
0
0
100
100
300
0
0
0
0
drops/ml)
0
drops/ml)
0
0
0
0
0
0
0
0
0
1
0
0
0
0
25
0
0
41 Mess 11 pcs
0
42 Mess 21 pcs
0
43 Mess 22 pcs
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
0
0
0
0
0
0
0
0
0
0
0
0
0
0
83 D H P TAB Tablet
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
2,70 g Tablet
0
0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
folat 0,4 mg (TTD)
0
0
0
0
0
0
0
0
0,125 mg
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
SYRUP
0
0

0
0
164 Domperidon
ml syrup Botol
0
0
0
0
0
0
0
0
0
0
INJEKSI
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0
OBAT KHUSUS
0
0
0
0
0
0
0
0
0
CAIRAN 0
0
0
0
0
221 Nacl 0,9% Botol
0
0
0
OBAT LUAR
0
0
1
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
4% 0
0
0
OBAT GIGI
0
0
0
1
1
1
0
0
0
0
0
BAHAN LABORATORIUM
0
0
0
0
255 Hb Test Kit Set
0
0
0
0
0
0
0
0
0
0
0
0
0
0
269 Lart Turk Botol
0
0
271 PP Test Stik
0
0
0
0
0
0
0
0
279 Stik HB Stik
0
0
OBAT NON FORNAS
0
0
0
0
0
0
SIRUP
0
0
0
0
0
OBAT LUAR
0
0
0
0
0
0
0
0
0
0
OBAT KHUSUS
0
0
0
Camabion Tablet 0
0
0
0
Caviplex Tablet 0
Slide pc 0
Plesterin pc 0
Klorhexidil Botol 0
Gelly USG Botol 0
0
0
328 Plesterin PCS 0
Fe drops botol 0
SUPRAVIT TABLET
MKP LANG BOTOL
MT HERBAL BOTOL
pacdin baby BOTOL
Klorhexidil gargle TABLET 1
teosal TABLET
elsiron TABLET
rivanol sol BOTOL
ikadryl syrup botol
inadryl syrup BOTOL
probiokod sachet
meloxicam TABLET
caviplex TABLET
iodoform botol 1
tolak angin box
Neozep TABLET
Manitol infus botol
vick vaporub BOTOL
G
BAYAR PHB JKNM
JUMLAH KUNJUNGAN

GUNUNGSARI

NIP : 19711119 199203 1 00 6 NIP : 19811020 200803 1 0
KETERANGAN :
AS KESEHATAN
SKESMAS GUNUNGSARI
gsari (0370) 633503 Kode Pos 83351
TAHUN : 2019
TANGGAL

6=4+5 7 8 = 6-7 9 10=9-8 11 12
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
100 100 138
100 100 138
300 300 414
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
1 1 1.38
0 0 0
0 0 0
0 0 0
0 0 0
25 25 34.5
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
50 50 69
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
1 1 1.38
1 1 1.38
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
1 1 1.38
1 1 1.38
1 1 1.38
0 0 0
0 0 0
0 0 0
0 0 0
1 1 1.38
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
1 0 1 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
1 0 1 0
GRATIS

a Obat Puskesmas PETUGAS POLI GIGI

1020 200803 1 001 NIP : ………………………………………………………
DINAS KESEHAT
NAMA UNIT LAYANAN : KIA

1 2 3 4 5

58 50
46 100
59 30
10
3 0
0
0
mm
0
48
mm
0
0
12 Blood Lancet Pcs
0
0
100
50
300
0
0
0
0
0
0
drops/ml)
18 55
drops/ml)
18 50
20 20
10 20
0
0
0
0
0
0
0
1
0
0
0
0
0
0
41 Mess 11 pcs
0
42 Mess 21 pcs
0
43 Mess 22 pcs
0
2
0
0
0
0
0
30
0
4 15
16
0
0
0
0
0
0
0
0
0
100 400
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
83 D H P TAB Tablet
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
2,70 g Tablet
0
0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
folat 0,4 mg (TTD)
0
0
0
0
0
0
0
0
0,125 mg
0
0
0
0
0
0
0
0
0
0
0
0
700
0
0
0
0
0
0
0
0
100 200
0
0
0
0
0
0
0
SYRUP
0
0

0
0
164 Domperidon
ml syrup Botol
0
0
0
0
0
0
0
0
0
0
INJEKSI
0
0
0
30 30
0
0
0
0
10 20
0
0
0
0
0
0
28 100
0
0
0
0
0
0
0
0

0
0
0
50
0
0
0
0
OBAT KHUSUS
0
0
0
0
0
0
0
0
0
CAIRAN 0
0
0
0
11 20
221 Nacl 0,9% Botol
0
29 40
0
OBAT LUAR
0
0
0
7
0
0
0
0
0
0
0
0
0
0
0
0
0
0
4% 0
0
0
OBAT GIGI
0
0
0
0
0
0
0
0
0
0
0
BAHAN LABORATORIUM
0
0
0
0
255 Hb Test Kit Set
0
0
0
0
0
0
0
0
0
0
0
0
0
0
269 Lart Turk Botol
0
0
271 PP Test Stik
0
0
0
0
0
0
0
0
279 Stik HB Stik
0
0
OBAT NON FORNAS
0
0
0
0
0
0
SIRUP
0
0
0
0
0
OBAT LUAR
0
0
0
0
0
0
0
0
0
0
OBAT KHUSUS
0
0
0
Camabion Tablet 3000
0
0
0
Caviplex Tablet 0
Slide pc 0
Plesterin pc 0
Klorhexidil Botol 0
Gelly USG Botol 0
0
0
328 Plesterin PCS
Fe drops botol
SUPRAVIT TABLET
MKP LANG BOTOL
MT HERBAL BOTOL
pacdin baby BOTOL
grafachlor TABLET
teosal TABLET
elsiron TABLET
rivanol sol BOTOL
ikadryl syrup botol
inadryl syrup BOTOL
probiokod sachet
meloxicam TABLET
caviplex TABLET
minyak telon botol
tolak angin box
Neozep TABLET
Manitol infus botol
vick vaporub BOTOL
G
BAYAR PHB JKNM
JUMLAH KUNJUNGAN

GUNUNGSARI

NIP : 19711119 199203 1 00 6 NIP : 19811020 200803 1 0
KETERANGAN :
AS KESEHATAN
SKESMAS GUNUNGSARI
gsari (0370) 633503 Kode Pos 83351
TAHUN : 2019
TANGGAL

6=4+5 7 8 = 6-7 9 10=9-8 11 12
108 78 30 107.64
146 116 30 160.08
89 59 30 81.42
10 0 10 0
3 3 4.14
0 0 0
0 0 0
0 0 0
48 21 27 28.98
0 0 0
0 0 0
0 0 0
0 0 0
100 100 138
50 50 69
300 300 414
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
73 55 18 75.9
68 38 30 52.44
40 20 20 27.6
30 0 30 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
1 1 1.38
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
2 2 2.76
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
30 30 41.4
0 0 0
19 8 11 11.04
16 0 16 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
500 500 690
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
700 600 100 828
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
300 300 414
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
60 40 20 55.2
0 0 0
0 0 0
0 0 0
0 0 0
30 10 20 13.8
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
128 28 100 38.64
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
50 15 35 20.7
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
31 12 19 16.56
0 0 0
69 49 20 67.62
0 0 0
0 0 0
0 0 0
0 0 0
7 2 5 2.76
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
3000 2000 1000 2760
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
GRATIS

a Obat Puskesmas PETUGAS KIA

1020 200803 1 001 NIP : ………………………………………………………
PEMERINTAH KABUPATEN LOMBOK BARAT
DINAS KESEHATAN
UPT BLUD PUSKESMAS GUNUNGSARI
Jl. Pariwisata No. 70 Gunungsari (0370) 633503 Kode Pos 83351
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
NAMA UNIT LAYANAN : UGD & RAWAT INAP

LAPORAN PERIODE/BULAN : Maret TAHUN
PERMINTAAN PERIODE/BULAN : April TANGGAL
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK STOK OPT PERMINTAAN
1 2 3 4 5 6=4+5 7 8 = 6-7 9 10=9-8

30 100 130 80 50 110.4
60 200 260 60 200 82.8
30 125 155 155 213.9
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
mm
60 60 60 82.8
0 0 0 0
mm
36 36 36 49.68
36 36 36 49.68
12 Blood Lancet Pcs
0 0 0 0
0 0 0 0
0 0 0 0
150 150 150 207
100 100 100 138
400 400 400 552
300 300 200 100 276
0 0 0 0
0 0 0 0
0 0 0 0
15 75 90 40 50 55.2
drops/ml)
20 80 100 70 30 96.6
drops/ml)
20 0 20 0 20 0
45 20 65 65 89.7
50 50 10 40 13.8
0 0 0 0
25 0 25 10 15 13.8
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
5 5 4 1 5.52
0 0 0 0
0 0 0 0
0 0 0 0
35 125 160 110 50 151.8
0 0 0 0
0 0 0 0
41 Mess 11 pcs
0 0 0 0
42 Mess 21 pcs
0 0 0 0
43 Mess 22 pcs
0 0 0 0
3 3 3 4.14
4 4 4 5.52
46 Nasal Canula dewasa pcs 4 0
47 Nebulizer with mask anak pcs 0 0
48 Nebulizer with mask dewasa pcs 0 0
0 0 0 0
4 4 4 5.52
0 0 0 0
100 100 100 138
0 0 0 0
3 3 3 4.14
3 3 3 4.14
2 2 2 2.76
0 0 0 0
0 0 0 0
0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
300 300 600 300 300 414
288 1500 1788 1588 200 2191.44
904 2200 3104 2904 200 4007.52
0 0 0 0
100 100 200 100 100 138
100 0 100 0 100 0
0 0 0 0
500 500 100 400 138
0 0 0 0
1190 0 1190 1190 1642.2
0 0 0 0
0 0 0 0
0 0 0 0
442 300 742 682 60 941.16
618 0 618 518 100 714.84
257 100 357 257 100 354.66
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
83 D H P TAB Tablet
0 0 0 0
84 Deksametason tablet 0,5 mg Tablet 573 800 300
1373 1073 1480.74

0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
435 0 435 335 100 462.3
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
100 100 0 100 0
0 0 0 0
100 100 100 138
2,70 g Tablet
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0
0 0 0
400 0 400 100 300 138
0 0 0 0
0 0 0 0
200 0 200 0 200 0
111 Kalsium Laktat 500 mg Tablet 0 0 0 0
200 300 500 200 300 276
200 400 600 300 300 414
0 0 0 0
0 0 0 0
0 0 0 0
100 100 0 100 0
573 1600 2173 1873 300 2584.74
0 0 0 0
0 0 0 0
0 0 0 0
folat 0,4 mg (TTD)
566 0 566 166 400 229.08
0 0 0 0
0 0 0 0
100 0 100 0 100 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0,125 mg
300 300 100 200 138
0 0 0 0
0 0 0 0
200 0 200 0 200 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
84 300 384 384 529.92
723 5700 6423 6123 300 8449.74
0 0 0 0
500 0 500 500 690
0 0 0 0
0 0 0 0
0 0 0 0
600 0 600 500 100 690
0 0 0 0
0 0 0 0
0 0 0 0
400 300 700 600 100 828
0 0 0 0
0 0 0 0
155 Siprofloksasin tablet 500 mg (sebagai HCl) Tablet 390 0 200
157 Thiamin hcl 50 mg tab ( vit b1 ) Tablet 90 0 200
0 0 0 0
705 1500 2205 1905 300 2628.9
215 100 315 15 300 20.7
0
0 0 0
SYRUP
0 0 0 0
0 0 0 0
65 58 80.04
0 0 0 0
12 45 57 51 6 70.38
164 Domperidon
ml syrup Botol
6 10 16 6 10 8.28
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
Trimetoprim 40 mg / 5 ml 19 25 20
20 0
0 0 0 0
0 0 0 0
4 156 160 150 10 207
0 0 0 0
INJEKSI
0 0 0 0
0 0 0 0
0 0 0 0
30 40 70 70 96.6
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
34 0 34 34 46.92
1 1 2 2 2.76
30 0 30 30 41.4
11 0 11 11 15.18
0 0 0 0
3 0 3 0 3 0
37 0 37 37 51.06
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
9 0 9 9 12.42
0 0 0 0
25 25 25 34.5
0 0 0 0
0 0 0
0 0 0 0
16 0 16 16 22.08
0 0 0 0
0 0 0 0
2 2 2 2.76
23 66 89 89 122.82
0 0 0 0
0 0 0 0
OBAT KHUSUS
0 0 0 0
0 0 0 0
0 0 0 0
209 Bisacodyl supp (dulcolax) 5 mg / Stolax supp SUPP 0 0 0 0
210 Bisacodyl supp (dulcolax) 10 mg / Stolax supp SUPP 0 0 -2 2 -2.76
0 0 0 0
0 0 0 0
2 0 2 0 2 0
90 90 74 16 102.12
0 0 0 0
216 Serum ATS 20.000 IU VIAL 0 0 0 0
217 Vaksin Rabies Inj 2,5 IU VIAL 0 0 0 0
0 0 0 0
CAIRAN 0
0 0 0
0 0 0 0
5 5 5 6.9
0 0 0 0
20 20 20 27.6
221 Nacl 0,9% Botol
40 40 40 55.2
460 460 460 634.8
0 0 0 0
OBAT LUAR
0 0 0 0
0 0 0 0
0 0 0 0
3 3 2 1 2.76
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
7 7 7 9.66
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
4% 0
0 0 0 0
0 0 0 0
OBAT GIGI
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0
BAHAN LABORATORIUM
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
255 Hb Test Kit Set
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
269 Lart Turk Botol
0 0 0 0
0 0 0 0
271 PP Test Stik
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
279 Stik HB Stik
0 0 0 0
0
OBAT NON FORNAS
0 0 0 0
0 0 0 0
300 300 300 414
0 0 0 0
0 0 0 0
0 0 0 0
SIRUP
0 0 0 0
0 0 0 0
2 27 29 22 7 30.36
2 25 27 27 37.26
0 0 0 0
OBAT LUAR
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
OBAT KHUSUS
0 0 0 0
0 0 0 0
297 Parasetamol supp 80 mg Supp 0 0 0 0
298 Parasetamol supp 125 mg Supp 35 35 30 5 41.4
0 0 0 0
TAMBAHAN OBAT FORNAS 0 0 0 0
Camabion Tablet 0 0 0 0
Ceftriaxon injeksi 1 g Vial 0 0 0 0
0 0 0 0
0 0 0 0
TAMBAHAN OBAT NON FORNAS 0 0 0 0
0 0 0 0
1 Kasa, Verband, Kapas - Kasa Hydrophil 40 x 40 cm 0 0 0 0
4 Baby Cough Syrup 60 ml Botol 0 0 0 0
5 Demacolin Tablet 0 0 0 0
6 Rohto Tetes Mata 0 0 0 0
Caviplex Tablet 0 0 0 0
Slide pc 0 0 0 0
Plesterin pc 0 0 0 0
Klorhexidil Botol 0 0 0 0
Gelly USG Botol 1 1 1 1.38
0 0 0 0
0 0 0 0
326 Bisacodyl supp 10 mg Suppos 0 0 0 0
327 Parasetamol supp 160 mg Suppos 0 0 0 0
328 Plesterin PCS 0 0 0 0
Fe drops botol 0 0 0 0
Ondansentron injeksi AMPUL 0 0 0 0
ELASTIS BANDED 4 CM ROL 0 0 0 0
ELASTIS BANDED 15 CM ROL 0 0 0 0
BABY COUGH SYRUP BOTOL 0 0 0 0
KLORAMFENICOL SK Tube 0 0 0 0
GUANISTREP SYRUP B OTOL 0 0 0 0
VITAMIN C 25 MG TABLET 0 0 0 0
SUPRAVIT TABLET 0 0 0 0
ERLAMYCETIN + TM BOTOL 0 0 0 0
MKP LANG BOTOL 0 0 0 0
MT HERBAL BOTOL 0 0 0 0
LEUKOPLAST BESAR (PLESTER) ROL 0 0 0 0
amoxicillin 250 mg TABLET 0 0 0 0
pacdin baby BOTOL 0 0 0 0
grafachlor TABLET 0 0 0 0
teosal TABLET 0 0 0 0
elsiron TABLET 0 0 0 0
cefadroxil 500 mg Kapsul 0 0 0 0
rivanol sol BOTOL 0 0 0 0
betadin salep kulit tube 0 0 0 0
ikadryl syrup botol 0 0 0 0
inadryl syrup BOTOL 0 0 0 0
probiokod sachet 0 0 0 0
kloram plus TM BOTOL 0 0 0 0
meloxicam TABLET 0 0 0 0
cefadroxil syrup 125 mg/5 ml BOTOL 0 0 0 0
caviplex TABLET 23 0 23 0 23 0
minyak telon botol 0 0 0 0
Handscoon steril no. 6,5 PCS 0 0 0
kloramfenikol SK Tube 0 0 0
tolak angin box 0 0 0
Neozep TABLET 0 0 0
Amlodipin 10 mg TABLET 0 0
ketorolac injeksi AMPUL 0 0
Manitol infus botol 0 0
vick vaporub BOTOL
GRATIS
BAYAR PHB JKNM UKS JKN JAMPERSAL LAIN-LAIN TOTAL
JUMLAH KUNJUNGAN
0
Mengetahui Yang Menyerahkan Yang menerima

PEMIMPIN UPT BLUD PUSKESMAS Pengelola Obat Puskesmas PETUGAS RAWAT INAP
GUNUNGSARI
Ns. Akmal Rosamali, S.Kep Dady Syamri Aswal, S.Farm, Apt …………………………………………………
NIP : 19711119 199203 1 00 6 NIP : 19811020 200803 1 001 NIP : …………………………………………
KETERANGAN :
: 2019
PEMBERIAN KET
11 12
PEMBERIAN KET
PEMBERIAN KET
PEMBERIAN KET
PEMBERIAN KET
PEMBERIAN KET
PEMBERIAN KET
PEMBERIAN KET
PEMBERIAN KET
PEMBERIAN KET
PEMBERIAN KET
PEMBERIAN KET
PEMBERIAN KET
PEMBERIAN KET
PEMBERIAN KET
PEMBERIAN KET
PEMBERIAN KET
KET
ang menerima
GAS RAWAT INAP
………………………………………….
…………………………………………
DINAS KESEHAT
NAMA UNIT LAYANAN : APOTEK

1 2 3 4 5

55 0
60 0
80 0
2 40
0
0
0
mm
0
0
mm
0
0
12 Blood Lancet Pcs
0
0
0
0
0
0
0
0
0
0
14 30
drops/ml)
6 30
drops/ml)
17 30
20 10
50
18 0
28 30
0
0
0
0
1
0
0
0
0
0
0
0
41 Mess 11 pcs
0
42 Mess 21 pcs
0
43 Mess 22 pcs
0
0
0
0
0
0
0
0
0
0
1 0
0
0
0
24 0
160 400
68 0
0
0
310 1200
1560 4800
1760 0
0
140 0
60 0
0
740 0
340 0
60 1000
0
0
80 400
210 2160
1800 0
40 0
30 0
10 30
0
0
83 D H P TAB Tablet
19 45

0
0
90 0
360 0
195 100
242 0
239 0
60 0
60 0
0
0
100
82 0
802 0
2,70 g Tablet
10633 0
1785 0
2430 0
0
140 0
0
105 Haloperidol tablet 5 mg Tablet 50 100
107 Hyocina N Butilbromid 10 mg tab Tablet 224

0
0
0
55 0
790 0
400 1000
85 0
70 0
700 0
633 0
2550 2000
77 0
0
0
folat 0,4 mg (TTD)
390 500
0
6 0
100 0
0
0
189 10000
94 0
0,125 mg
230 0
100 0
194 300
301 0
20 0
0
0
0
0
0
0
179 330
1405 8000
940 0
260 0
207 0
0
210 0
175 300
30 100
286 0
223 0
365 0
70 200
1500 0
100
610 3000
80 1000
0
SYRUP
0
0

0
30 0
164 Domperidon
ml syrup Botol
32 0
0
14 0
13 0
24 0
10
0
0
90 410
0
INJEKSI
0
0
0
32 0
0
0
0
0
22 0
89 0
0
41 0
0
0
0
18 0
0
38 0
16 0
0
9 0
0
3 0
0
197 Lidokain injeksi 2% (HCl) + Epinefrin 1 : 80.000 - 2ml Ampul 4 0

0
17 10
0
0
5 0
33 45
0
0
OBAT KHUSUS
0
0
40
0
0
0
2 40
0
0
CAIRAN 0
0
0
0
0
221 Nacl 0,9% Botol
0
0
0
OBAT LUAR
0
0
0
1
30 48
50
14 0
32 0
43 0
14 0
0
0
2 24
0
8 24
6 18
5 2
0
4% 24
1 0
0
OBAT GIGI
0
0
0
0
0
0
0
0
0
0
0
BAHAN LABORATORIUM
0
0
0
0
255 Hb Test Kit Set
0
0
0
0
0
0
0
0
0
0
0
0
0
0
269 Lart Turk Botol
0
0
271 PP Test Stik
0
0
0
0
0
0
0
0
279 Stik HB Stik
0
0
OBAT NON FORNAS
0
0
110 3000
0
0
0
SIRUP
0
0
2 80
4 72
0
OBAT LUAR
0
0
5 25
14 0
0
7 0
54 0
0
0
0
OBAT KHUSUS
0
0
0
0
0
0
Caviplex Tablet 0
Slide pc 0
Plesterin pc 0
Klorhexidil Botol 0
Gelly USG Botol 0
0
0
6 Vitamin C 25 mg Tablet 480 0
327 Sanmol Tablet 0
328 Amlodipin 10 mg Tablet 0
Tera F Tablet 0
Paramex Tablet 0
Orphen Tablet 0
Meloxicam 15 mg Tablet 350 0
Rivanol botol 0
Norit botol 4 0
Feminax Tablet 0
SUPRAVIT TABLET 110 0
ERLAMYCETIN + TM BOTOL 60 6
MKP LANG BOTOL 50 0
MT HERBAL BOTOL 80 0
LEUKOPLAST BESAR (PLESTER) ROL 400 0
amoxicillin 250 mg TABLET 150 0
Meloxicam 15 mg BOTOL 200 0
Klorhexidil gargle TABLET 2
Lidocain jelly TABLET 90
skizon kream TABLET
Cefadroxyl 125 mg/5 ml Kapsul
Norit BOTOL
seques tube
caviplex botol 42
iliadin drops BOTOL 7
Medrol 16 mg sachet
diaform BOTOL 0
teosal TABLET
rohto TM BOTOL
Flu tab TABLET 44
Bufacetin salep kulit botol
Dacin 150 PCS 0
lansoprazole Tube 30
FG throces box 0
Thrombopob gel TABLET 0
Manitol infus botol
vick vaporub BOTOL
G
BAYAR PHB JKNM
JUMLAH KUNJUNGAN

GUNUNGSARI

NIP : 19711119 199203 1 00 6 NIP : 19811020 200803 1 0
KETERANGAN :
AS KESEHATAN
SKESMAS GUNUNGSARI
gsari (0370) 633503 Kode Pos 83351
TAHUN : 2019
TANGGAL

6=4+5 7 8 = 6-7 9 10=9-8 11 12
55 -88 143 -121.44

60 52 8 71.76
80 5 75 6.9
42 14 28 19.32
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
44 21 23 28.98
36 20 16 27.6
47 11 36 15.18
30 6 24 8.28
50 2 48 2.76
18 10 8 13.8
58 6 52 8.28
0 0 0
0 0 0
0 0 0
0 0 0
1 1 1.38
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0
0
0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 -1 1 -1.38
0 -3 3 -4.14
1 1 1.38
0 0 0
0 0 0
0 0 0
0 0 0
24 7 17 9.66
560 350 210 483
68 30 38 41.4
0 0 0
0 0 0
1510 1030 480 1421.4
6360 4110 2250 5671.8
1760 360 1400 496.8
0 0 0
140 90 50 124.2
60 0 60 0
0 0 0
740 130 610 179.4
340 80 260 110.4
1060 530 530 731.4
0 0 0
0 0 0
480 380 100 524.4
2370 2248 122 3102.24
1800 200 1600 276
40 38 2 52.44
30 30 41.4
40 0 40 0
0 0 0
0 0 0
64 34 30 46.92
445
1420 975 1345.5

0 0 0
0 0 0
90 0 90 0
360 180 180 248.4
295 5 290 6.9
242 2 240 2.76
239 49 190 67.62
60 0 60 0
60 60 82.8
0 0 0
0 0 0
100 82 18 113.16
82 0 82 0
802 253 549 349.14
10633 128 10505 176.64
1785 755 1030 1041.9
2430 1028 1402 1418.64
0 0 0
140 0 140 0
0 0 0
96
150 54 74.52
0 0 0
224 41 183 56.58
0 0 0
0 0 0
55 0 55 0
540 110 430 151.8
790 600 190 828
1400 440 960 607.2
85 50 35 69
70 70 96.6
700 20 680 27.6
633 633 873.54
4550 3350 1200 4623
77 5 72 6.9
0 0 0
0 0 0
890 100 790 138

0 0 0
6 0 6 0
100 10 90 13.8
0 0 0
0 0 0
10189 1269 8920 1751.22
94 0 94 0
230 40 190 55.2
100 40 60 55.2
494 417 77 575.46
301 0 301 0
20 20 27.6
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
509 239 270 329.82
9405 6965 2440 9611.7
940 430 510 593.4
260 90 170 124.2
207 7 200 9.66
0 0 0
210 100 110 138
475 320 155 441.6
130 70 60 96.6
286 116 170 160.08
223 113 110 155.94
365 95 270 131.1
270 270 372.6
1500 500 1000 690
190
100
280
100 90 10 124.2
3610 3340 270 4609.2
1080 370 710 510.6
0 0 0
0 0 0
0 0 0
54
164 110 151.8
0 0 0
30 19 11 26.22
32 10 22 13.8
0 0 0
14 0 14 0
13 13 17.94
24 24 33.12
9 3 6
10 2 8
0 0 0
0 0 0
500 400 100 552
0 0 0
0 0 0
0 0 0
0 0 0
32 15 17 20.7
0 0 0
0 0 0
0 0 0
0 0 0
22 0 22 0
89 1 88 1.38
0 0 0
41 0 41 0
0 0 0
0 0 0
0 0 0
18 0 18 0
0 0 0
38 0 38 0
16 1 15 1.38
0 0 0
9 4 5 5.52
0 0 0
3 3 4.14
0 0 0
50
70
0 0 0
0 0 0
27 7 20 9.66
0 0 0
0 0 0
5 1 4 1.38
78 74 4 102.12
0 0 0
0 0 0
0 0 0
0 0 0
40 4 36 5.52
20 1 19 1.38
0 0 0
0 0 0
0 0 0
0 0 0
42 12 30 16.56
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
1 1 1.38
78 71 7 97.98
50 23 27 31.74
14 14 19.32
32 32 44.16
43 17 26 23.46
14 6 8 8.28
0 0 0
0 0 0
26 15 11 20.7
0 0 0
32 21 11 28.98
24 11 13 15.18
7 0 7 0
0 0 0
25 31
1 0 1 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
3110 1810 1300 2497.8
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
82 63 19 86.94
76 56 20 77.28
0 0 0
0 0 0
0 0 0
30 12 18 16.56
14 7 7 9.66
0 0 0
7 0 7 0
54 4 50 5.52
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
10 9 1 12.42
15 12 3 16.56
0 0 0
0 0 0
0 0 0
0 0 0
1040 400 640 552
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
480 80 400 110.4
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
350 105 245 144.9
0 0 0
4 0 4 0
0 0 0
0 0 0
110 80 30 110.4
66 26 40 35.88
50 0 50 0
80 0 80 0
400 220 180 303.6
150 20 130 27.6
200 110 90 151.8
2 0 2 0
90 0 90 0
0 0 0
0 0 0
0 0 0
0 0 0
42 0 42 0
7 0 7 0
0 0 0
0 0 0 0
0 0 0
0 0 0
44 0 44 0
0 0 0
0 0 0
30 0 30
0 0 0
0 0 0
0 0
0 0
0 0
GRATIS

a Obat Puskesmas PETUGAS APOTEK

1020 200803 1 001 NIP : ………………………………………………………
DINAS KESEHAT
NAMA UNIT LAYANAN : PUSKEL

1 2 3 4 5

mm
mm
12 Blood Lancet Pcs
drops/ml)
drops/ml)
41 Mess 11 pcs
42 Mess 21 pcs
43 Mess 22 pcs
TABLET DAN SERBUK ORAL

83 D H P TAB Tablet
84 Deksametason tablet 0,5 mg Tablet

2,70 g Tablet
105 Haloperidol tablet 5 mg Tablet
106 Hidroklorotiazide tab 25 mg Tablet

111 Kalsium Laktat 500 mg Tablet
folat 0,4 mg (TTD)
0,125 mg
155 Siprofloksasin tablet 500 mg (sebagai HCl) Tablet
156 Tetrasiklin 500 kapsul Kapsul
157 Thiamin hcl 50 mg tab ( vit b1 ) Tablet
SYRUP
161 Amoksisilin sirup kering 125 mg/ 5 ml Botol

164 Domperidon
ml syrup Botol
Trimetoprim 40 mg / 5 ml
INJEKSI

197 Lidokain injeksi 2% (HCl) + Epinefrin 1 : 80.000 - 2ml Ampul
198 Lidokain injeksi 2% (HCL) Ampul

OBAT KHUSUS


216 Serum ATS 20.000 IU VIAL
217 Vaksin Rabies Inj 2,5 IU VIAL
CAIRAN

221 Nacl 0,9% Botol
OBAT LUAR

4%
OBAT GIGI

251 Temporary stopping fketcher serbuk+cairan (caviton) Pot
252 Trikkresol formalin (TKF) Botol
BAHAN LABORATORIUM

255 Hb Test Kit Set
269 Lart Turk Botol
271 PP Test Stik
279 Stik HB Stik
280 Stik HBSAG Stik
281 widal Test Set
OBAT NON FORNAS

284 Multi micro nutrien Tablet
285 Piroksikam 20 mg tab Tablet
SIRUP

OBAT LUAR
OBAT KHUSUS

TAMBAHAN OBAT FORNAS

Camabion Tablet
Ceftriaxon injeksi 1 g Vial
TAMBAHAN OBAT NON FORNAS
1 Kasa, Verband, Kapas - Kasa Hydrophil 40 x 40 cm

4 Baby Cough Syrup 60 ml Botol
5 Demacolin Tablet
6 Rohto Tetes Mata
Caviplex Tablet
Slide pc
Plesterin pc
Klorhexidil Botol
Gelly USG Botol

328 Plesterin PCS
Fe drops botol
SUPRAVIT TABLET
MKP LANG BOTOL
MT HERBAL BOTOL
pacdin baby BOTOL
grafachlor TABLET
teosal TABLET
elsiron TABLET
rivanol sol BOTOL
ikadryl syrup botol
inadryl syrup BOTOL
probiokod sachet
meloxicam TABLET
caviplex TABLET
minyak telon botol
tolak angin box
Neozep TABLET
Manitol infus botol
vick vaporub BOTOL
G
BAYAR PHB JKNM
JUMLAH KUNJUNGAN

GUNUNGSARI

NIP : 19711119 199203 1 00 6 NIP : 19811020 200803 1 0
KETERANGAN :
AS KESEHATAN
SKESMAS GUNUNGSARI
gsari (0370) 633503 Kode Pos 83351
TAHUN : 2019
TANGGAL

6=4+5 7 8 = 6-7 9 10=9-8 11 12
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0 -135 135 -186.3
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3
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0 -2 2 -2.76
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0 -10 10 -13.8
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0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 -2 2 -2.76
0 0 0
0 0 0
0 0 0
0 0 0
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0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 -80 80 -110.4
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 -2 2 -2.76
0 0 0
0 0 0
0 -210 210 -289.8
0 -34 34 -46.92
0 0 0
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0 -2 2 -2.76
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GRATIS

a Obat Puskesmas PETUGAS PUSKEL

1020 200803 1 001 NIP : ………………………………………………………

LPLPO JARINGAN & UNIT Maret 2019

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PEMERINTAH KABUPATEN L

LAPORAN PEMAKAIAN DAN LEMBAR

NAMA JARINGAN : PUSTU KEKAIT

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN

BAHAN MEDIS HABIS PAKAI (BMHP)

1 Alat Suntik Sekali Pakai - 1 cc Tuberculin 27G x 1/2" Set

85 Diazepam 2 mg tab Tablet

106 Hidroklorotiazide tab 25 mg Tablet 0

107 Hyocina N Butilbromid 10 mg tab Tablet

162 Amoksisilin sirup kering forte 250 mg/5 ml Botol

201 Metamizol inj 500 mg/ml Ampul

Mengetahui Yang Menyerahkan

Ns. Akmal Rosamali, S.Kep Dady Syamri Aswal, S.Farm,

EMBAR PERMINTAAN OBAT (LPLPO)

PERSEDIAAN PEMAKAIAN SISA STOK STOK OPT PERMINTAAN PEMBERIAN KET

400 200 276

Menyerahkan Yang menerima

ri Aswal, S.Farm, Apt ……………………………………………………………

LAPORAN PEMAKAIAN DAN LEMBAR

NAMA JARINGAN : PUSTU SESELA

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN

BAHAN MEDIS HABIS PAKAI (BMHP)

1 Alat Suntik Sekali Pakai - 1 cc Tuberculin 27G x 1/2" Set

85 Diazepam 2 mg tab Tablet

106 Hidroklorotiazide tab 25 mg Tablet 0

107 Hyocina N Butilbromid 10 mg tab Tablet

162 Amoksisilin sirup kering forte 250 mg/5 ml Botol

201 Metamizol inj 500 mg/ml Ampul

Mengetahui Yang Menyerahkan

Ns. Akmal Rosamali, S.Kep Dady Syamri Aswal, S.Farm,

EMBAR PERMINTAAN OBAT (LPLPO)

PERSEDIAAN PEMAKAIAN SISA STOK STOK OPT PERMINTAAN PEMBERIAN KET

300 300 414

Menyerahkan Yang menerima

ri Aswal, S.Farm, Apt ……………………………………………………………..

LAPORAN PEMAKAIAN DAN LEMBAR

NAMA JARINGAN : PUSTU MIDANG

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN

BAHAN MEDIS HABIS PAKAI (BMHP)

1 Alat Suntik Sekali Pakai - 1 cc Tuberculin 27G x 1/2" Set

85 Diazepam 2 mg tab Tablet

106 Hidroklorotiazide tab 25 mg Tablet 0

107 Hyocina N Butilbromid 10 mg tab Tablet

162 Amoksisilin sirup kering forte 250 mg/5 ml Botol

201 Metamizol inj 500 mg/ml Ampul

Mengetahui Yang Menyerahkan

Ns. Akmal Rosamali, S.Kep Dady Syamri Aswal, S.Farm,

EMBAR PERMINTAAN OBAT (LPLPO)

PERSEDIAAN PEMAKAIAN SISA STOK STOK OPT PERMINTAAN PEMBERIAN KET

320 210 289.8

110 110 151.8

Menyerahkan Yang menerima

ri Aswal, S.Farm, Apt …………………………………………………………………….

LAPORAN PEMAKAIAN DAN LEMBAR

NAMA JARINGAN : POSKESDES KEKAIT

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN

BAHAN MEDIS HABIS PAKAI (BMHP)

1 Alat Suntik Sekali Pakai - 1 cc Tuberculin 27G x 1/2" Set

85 Diazepam 2 mg tab Tablet

106 Hidroklorotiazide tab 25 mg Tablet 0

107 Hyocina N Butilbromid 10 mg tab Tablet

162 Amoksisilin sirup kering forte 250 mg/5 ml Botol

201 Metamizol inj 500 mg/ml Ampul