Contoh Pedoman Keselamatan Pasien

LAPORAN PEMAKAIAN DAN LEMBA
( LP - LPO )
KODE PUSKESMAS :
PUSKESMAS :
KECAMATAN :
KOTA :
PROVINSI :
STOK AWAL PENERIMAAN
KELAS
NO NAMA OBAT SATUAN APBD II APBD I BUFFER PROGRA APBD II APBD I BUFFER PROGRA
TERAPI DAK (05) TOTAL DAK (05) TOTAL
(01) (02) (03) M (04) (01) (02) (03) M (04)
1 2 3 4 6 6
I OBAT GENERIK
1 Albendazol tablet 400 mg tablet - -
2 Alprozolam tab 0,25 mg tablet - -
3 Alprozolam tab 0,5 mg tablet - -
4 Acyclovir 200 mg tablet ( OGB ) tablet - -
5 Acyclovir 400 mg tablet ( OGB ) tablet - -
6 Acyclovir cream ( OGB ) tube - -
7 ACT(Atesunat 50 mg+Amodiaquin anhydrida200 mg)tab paket - -
8 Arterakine tablet paket - -
9 Arterakine (DARPLEX) paket - -
10 Allopurinol tablet 100 mg tablet - -
11 Allopurinol tablet 300 mg tablet - -
12 Ambroxol syrup ( OGB ) botol - -
13 Ambroxol 30mg tab (OGB ) tablet - -
14 Aminofilin tablet 200 mg tablet - -
15 Aminofilin injeksi 24 mg/ml - 10ml ampul - -
16 Amitriptilin HCL tablet salut 25 mg tablet - -
17 Amlodipine tablet 5 mg tablet - -
18 Amlodipine tablet 10 mg tablet - -
19 Amoksisilin sirup kering 125 mg/5 ml botol - -
20 Amoksisilin sirup kering Forte 250 mg/5ml botol - -
21 Amoksisilin kapsul 250 mg kapsul - -
Page 1
KELAS
(01) (02) (03) M (04) (01) (02) (03) M (04)
1 2 3 4 6 6
22 Amoksisilin kaplet 500 mg kaplet - -
23 Ampicillin inj 1 gr ( OGB ) vial - -
24 Antalgin (metampiron) tablet 500 mg tablet - -
25 Antalgin injeksi 250 mg/ml - 2ml ampul - -
26 Antasida DOEN I tablet kunyah tablet - -
27 Antasida DOEN II suspensi botol - -
28 Anti bakteri DOEN salep komb:Bacitracin+Polimiksin tube - -
29 Anti hemoroid DOEN kombinasi suup - -
30 Antifungi DOEN kombinasi :As Benzoat+As Salisilat pot - -
31 Antimigren tartrat 1 mg + kofein 50 mg tablet - -
32 Aqua pro injeksi steril, bebas pirogen 20 ml vial - -
33 Aquades steril 1000 ml botol - -
34 Artem (artemether 80 mg ) inj ampul - -
35 Artesunate inj 60 mg/ml vial - -
36 Asam Mefenamat tablet salut 250 mg kapsul - -
37 Asam Mefenamat tablet salut 500 mg kaplet - -
38 Asetosal tablet 80 mg/tab tablet - -
39 Asetosal tablet 100 mg tablet - -
40 Asetosal tablet 500 mg tablet - -
41 Atenolol tablet 50 mg tablet - -
42 Atropin sulfat inj 0,25 mg/ml-1 ml ampul - -
43 Atropin sulfat tablet 0,5 mg tablet - -
44 Azitromisin 1000 mg + Cefixime 400 mg (kombipak) paket - -
45 Benzatin Benzil Penisilin 2.4 juta IU/vial vial - -
46 Betametason krim 0,1% tube - -
47 Betahistin Mesilat 6 MG tablet - -
48 Bisoprolol 5 mg tablet - -
49 Bromheksin tab 8 mg tablet - -
50 Calcium gluconat injeksi vial - -
51 Calcium Lactate 500 mg tablet - -
52 Catopril tablet 12,5 mg tablet - -
Page 2
KELAS
(01) (02) (03) M (04) (01) (02) (03) M (04)
1 2 3 4 6 6
53 Catopril tablet 25 mg tablet - -
54 Catopril tablet 50 mg tablet - -
55 Cefadroxil syrup 125 mg/5ml botol - -
56 Cefadroxil kapsul 250 mg kapsul - -
57 Cefadroxil kapsul 500 mg kapsul - -
58 Cefixim syrup 100 mg/5 ml botol - -
59 Cefixim 100 mg kapsul kapsul - -
60 Cefotaxim injeksi 1 gram vial - -
61 Ceftriazone injeksi vial - -
62 Cetirizene syrup 5 mg/ 5 ml botol - -
63 Cetirizene 10 mg tablet - -
64 Chloramphenicol suspensi 60 ml botol - -
65 Chloramphenicol kapsul 250 mg kapsul - -
66 Chloramphenicol tetes Mata 0,5 % botol - -
67 Chloramphenicol salep mata 1 % tube - -
68 Chloramphenicol tetes telinga 3 % botol - -
69 Chlorfeniramin Maleat (CTM) tab 4 mg tablet - -
70 Chlorpromazine HCL 100 mg tablet salut tablet - -
71 Chlorpromazine HCL 25 mg tablet salut tablet - -
72 Chlorpromazine HCL inj 25 mg / ml - 1 ml ampul - -
73 Chlorpromazine HCL inj 5 mg / ml - 2 ml ampul - -
74 Cimetidin 200 mg tab (OGB ) tablet - -
75 Clindamisin 150 mg kapsul - -
76 Clindamisin 300 mg kapsul - -
77 Co- Amoxiclav 625 mg tab tablet - -
78 Cotrimoksazole suspensi 60 ml botol - -
79 Cotrimoksazole tablet pediatrik 120 mg tablet - -
80 Cotrimoksazole tablet Dewasa 480 mg tablet - -
81 Cyprofloxacin tab 500 mg ( OGB ) tablet - -
82 Deksametason injeksi 5 mg / ml -1ml ampul - -
83 Deksametason tablet 0,5mg tablet - -
Page 3
KELAS
(01) (02) (03) M (04) (01) (02) (03) M (04)
1 2 3 4 6 6
84 Dekstran 70 - larutan infus 6 % steril botol - -
85 Diazepam tablet 2 mg tablet - -
86 Diazepam tablet 5 mg tablet - -
87 Diazepam injeksi 5 mg/ml ampul - -
88 Diethylcarbamazine tablet 100 mg tablet - -
89 Difenhidramin HCL inj 10 mg/ml-1 ml ampul - -
90 Digoksin tablet 0,25 mg tablet - -
91 Dimenhidramin tablet 50 mg tablet - -
92 Doksisiklin kapsul 100 mg kapsul - -
93 Domperidon syrup botol - -
94 Domperidon 10 mg tab tablet - -
95 Efedrin HCl tablet 25 mg tablet - -
96 Epinefrina HCL/Bitartrat (Adrenalin ) inj 0,1 %-1 ml ampul - -
97 Ekstrak belladon tablet 10 mg tablet - -
98 Erythromycin kapsul 250 mg ( OGB ) kapsul - -
99 Erythromycin kapsul 500 mg ( OGB ) kapsul - -
100 Erythromycin syrup 200 mg/5 ml botol - -
101 Famotidine tablet 20 mg tablet - -
102 Famotidine tablet 40 mg tablet - -
103 Fenobarbital injeksi 50 mg/ml - 2 ml ampul - -
104 Fenobarbital tablet 30 mg tablet - -
105 Fenobarbital tablet 100 mg tablet - -
106 Flukonazol tablet 150 mg tablet - -
107 Folic Acid tablet 1 mg tablet - -
108 Furosemid tablet 40 mg tablet - -
109 Gameksan emulsi 1% botol - -
110 Garam oralit untuk 200 ml air sachet - -
111 Gemfibrozil kapsul 300 mg kapsul - -
112 Gentamycin salap kulit 0,1 % - 5 gr (OGB) tube - -
113 Gentamisin tetes mata botol - -
114 Gentamicyn inj 80 mg/ml vial - -
Page 4
KELAS
(01) (02) (03) M (04) (01) (02) (03) M (04)
1 2 3 4 6 6
115 Gentian violet larutan 1% botol - -
116 Glibenklamid tablet 5 mg tablet - -
117 Glimepiride tablet 2 mg tablet - -
118 Glimepiride tablet 4 mg tablet - -
119 Gliseril guayakolat tablet 100 mg tablet - -
120 Gliserin botol - -
121 Glukosa larutan infus 5% steril botol - -
122 Glukosa larutan infus 10 % steril botol - -
123 Glukosa larutan infus 40 % steril botol - -
124 Griseofulvin tablet 125 mg tablet - -
125 Haloperidol tablet 0,5 mg tablet - -
126 Haloperidol tablet 1,5 mg tablet - -
127 Haloperidol tablet 5 mg tablet - -
128 Hidroklorotiazid (HCT) tablet 25 mg tablet - -
129 Hidrokortison krim 1% pot - -
130 Hidrokortison krim 2,5 % tube - -
131 Ibuprofen suspensi 100 mg/5ml botol - -
132 Ibuprofen tablet 200 mg botol - -
133 Ibuprofen tablet 400 mg tablet - -
134 Isosorbid dinitrat tablet sublingual 5 mg tablet - -
135 Kalium Diclofenak 25 mg tablet - -
136 Kalium Permangat serbuk 5 gram pot - -
137 Ketokenazol cream 2 % tube - -
138 Ketokonazol 200 mg tab tablet - -
139 Ketoprofen tablet 100 mg tablet - -
140 Ketorolac inj. 30 mg ampul - -
141 Klonidin tablet 0,15 mg tablet - -
142 Klorokuin tablet 150 mg tablet - -
143 Klorpropamid tablet 100 mg tablet - -
144 Kodein fosfat tablet 10 mg tablet - -
145 Kuinin (kina) tablet 200 mg tablet - -
Page 5
KELAS
(01) (02) (03) M (04) (01) (02) (03) M (04)
1 2 3 4 6 6
146 Kuinin dihidroklorida inj 25 %-2 ml ampul - -
147 Lanzoprazol kapsul 30 mg kapsul - -
148 Levofloksasin tablet 500 mg tablet - -
149 Lidokain injeksi 2 % (HCl) + Epinefrin 1:80.000 - 2 ml ampul - -
150 Lidokain injeksi 2% ampul - -
151 Loperamid tablet tablet - -
152 Loratadin tablet 10 mg tablet - -
153 Lyncomicin 500 mg cap kapsul - -
154 Magnesium Sulfat Inj (IV) 20%-25 ml ampul - -
155 Magnesium Sulfat Inj (IV) 40%-25 ml ampul - -
156 Mebendazol tablet 100 mg tablet - -
157 Methochlorpamid syr 5 mg/ml botol - -
158 Metilergometrin maleat inj 0,200 mg-1 ml ampul - -
159 Metilergometrin maleat tab salut 1,125 mg tablet - -
160 Meloksikam suppositoria supp - -
161 Meloksikam tab 7,5 mg tablet - -
162 Meloksikam tab 15 mg tablet - -
163 Metformin tab 500 mg tablet - -
164 Metformin tab 850 mg tablet - -
165 Metilprednisolon 4 mg tablet - -
168 Metoclorpramid injeksi 5 mg/ml ampul - -
169 Metoclorpramid tab 10 mg tablet - -
170 Metronidazol tablet 250 mg tablet - -
171 Metronidazol tablet 500 mg tablet - -
172 Metronidazol 500 mg infus botol - -
173 Miconazol 2 % cream (OGB ) tube - -
174 Mikafungi Na serb inj 50 mg vial - -
175 Mineral Mix sachet - -
176 Natrium bikarbonat tablet 500 mg tablet - -
Page 6
KELAS
(01) (02) (03) M (04) (01) (02) (03) M (04)
1 2 3 4 6 6
177 Natrium Diklofenak tablet 50 mg tablet - -
178 Natrium Tiroksin/Eutirox 50 mg tablet - -
179 Natrium klorida larutan infus 0,9% steril botol - -
180 Nifedipin tab 10 mg tablet - -
181 Nistatin tablet salut 100.000 IU tablet - -
182 Nistatin tablet salut 500.000 IU tablet - -
183 OAT FDC Kategori Anak paket - -
184 OAT Kombipak Kategori Anak paket - -
185 OAT FDC Kategori I Dewasa paket - -
186 OAT Kombipak Kategori I Dewasa paket - -
187 OAT FDC Kategori II Dewasa paket - -
188 OAT FDC Sisipan Dewasa paket - -
189 Obat batuk hitam (OBH) cairan botol - -
190 Ofloxacin tab 200 mg tablet - -
191 Oksitetrasiklin HCl injeksi I.m.50mg/ml-10ml vial - -
192 Oksitetrasiklin HCl salep mata 1% tube - -
193 Oksitetrasiklin HCl salep 3% tube - -
194 Oksitosin injeksi 10 IU/ml-1 ml ampul - -
195 Omeprazol kapsul 20 mg kapsul - -
196 Oseltamivir 75 mg (ut flu burung) tablet - -
197 Papaverin tablet 40 mg ( OGB ) tablet - -
198 Parasetamol drop botol - -
199 Parasetamol sirup 120 mg/5 ml botol - -
200 Parasetamol tablet 100 mg tablet - -
201 Parasetamol tablet 500 mg tablet - -
202 Permetrin krim 5% 10 g tube - -
203 Phenitoin Natrium kapsul 30 mg kapsul - -
204 Phenitoin Natrium kapsul 100 mg kapsul - -
205 Phenol Gliserol tetes telinga 10 % botol - -
206 Phytomenadion (Vit K1) injeksi 10 mg/ml-1 ml ampul - -
207 Phytomenadion (Vit.K1) tablet salut gula 10 mg tablet - -
Page 7
KELAS
(01) (02) (03) M (04) (01) (02) (03) M (04)
1 2 3 4 6 6
208 Piracetam 800 mg tablet - -
209 Piracetam 1200 mg tablet - -
210 Pirantel tablet 125 mg tablet - -
211 Pirantel suspensi 125 mg/5ml botol - -
212 Piroxicam 10 mg ( OGB ) tablet - -
213 Piroxicam 20 mg ( OGB ) tablet - -
214 Prednison tablet 5 mg tablet - -
215 Primakuin tablet 15 mg tablet - -
216 Propiltiourasil tablet 100 mg tablet - -
217 Propranolol HCl tablet 10 mg tablet - -
218 Propranolol HCl tablet 40 mg tablet - -
219 Prokain Penisilin inj,3 juta IU vial - -
220 Rabies immuno globulin (human ) 150 IU/ml ampul - -
221 Ranitidin tab tablet - -
222 Ranitidin injeksi ampul - -
223 Reserpin tablet 0,10 mg tablet - -
224 Reserpin tablet 0,25 mg tablet - -
225 Ringer laktat larutan infus steril botol - -
226 Salbutamol tablet 2 mg tablet - -
227 Salbutamol tablet 4 mg tablet - -
228 Salep 2-4, komb : As.Salisilat + belerang endap pot - -
229 Salisil bedak 2% kotak - -
230 Serum anti bisa ular polivalen inj 5 ml (ABU I ) ampul - -
231 Serum anti tetanus injeksi 1.500 IU/ampul ( A T S ) ampul - -
232 Serum anti tetanus injeksi 20.000 IU/ampul ( A T S ) ampul - -
233 Simvastatin tab 10 mg tablet - -
234 Simvastatin tab 20 mg tablet - -
235 Sulfadoxin 500+Pirimetamin 25 mg tablet tablet - -
236 Tambah Darah tablet ( Ferollat ) sachet - -
237 Tetrakain HCL tetes mata 0,5% botol - -
238 Tetrasiklin HCL kapsul 250 mg kapsul - -
Page 8
KELAS
(01) (02) (03) M (04) (01) (02) (03) M (04)
1 2 3 4 6 6
239 Tetrasiklin HCL kapsul 500 mg kapsul - -
240 Thiamphenicol kapsul 500 mg tablet - -
241 Tramadol injeksi ampul - -
242 Tramadol 50 mg tablet - -
243 Triheksifenidil Hidroklorida tablet 2 mg tablet - -
244 Vaksin rabies vero ampul - -
245 Vitamin A (Retinol) 100.000 IU kapsul lunak kapsul - -
246 Vitamin A (Retinol) 200.000 IU kapsul lunak kapsul - -
247 Vitamin B1 (Thiamin HCl) injeksi 100 mg/ml-1ml ampul - -
248 Vitamin B1 (Thiamin HCl) tablet 50 mg tablet - -
249 Vitamin B6 (Piridoksin HCl) tablet 10 mg tablet - -
250 Vitamin B12 (Cyanocobalamin) injeksi 500 mcg/ml-1ml ampul - -
251 Vitamin B12 (Cyanocobalamin) tablet tablet - -
252 Vitamin B Complex tablet tablet - -
253 Vitamin C (Asam Ascorbat ) tablet 50 mg tablet - -
256 Zink 20 mg tablet Dispersibel tablet - -
- -
II OBAT GIGI - -
257 Air Raksa botol - -
258 Alkahner/Cavit/Dentorit buah - -
259 Devitalisasi pasta (non arsen) kotak - -
260 Etil klorida semprot botol - -
261 Eugenol Cairan botol - -
262 Flour tablet 0,5 mg tablet - -
263 Formokresol (pengganti TKF) botol - -
264 Glass ionomer cement (GC IX) set - -
265 Glass ionomer cement (GC I) set - -
266 Kalsium hidroksida pasta set - -
267 Klorfenol kamfer menthol (CHKM) botol - -
Page 9
KELAS
(01) (02) (03) M (04) (01) (02) (03) M (04)
1 2 3 4 6 6
268 Mummifying pasta botol - -
269 Semen seng fosfat serbuk dan cairan set - -
270 Silver amalgam serbuk 65 - 75% botol - -
271 Solare Komplete Kit (Solare A1,A2,A3/solare X/Shade Guide) set - -
272 Spons gelatin cubides 1 x 1 x 1 cm dental - -
273 Temporary stopping fletcher (Fletcher) serbuk & cairan set - -
- -
III OBAT TAMBAHAN - -
274 Amoxan drop/ Supramox drop botol - -
275 Bioplacenton Jelly tube - -
276 Borax gliserin botol - -
277 Burnazin cream pot - -
278 Chloramfecort H cream/Colipred cream tube - -
279 Counterpain cream / Molakrim tube - -
280 Dextrofen syrup 60 ml botol - -
281 Daryantul kotak - -
282 FG troches tab isap tablet - -
283 Guanestrip syr / Kanina syrup botol - -
284 HB-Vit tablet - -
285 H 2 O 2 3 % 1000 ml botol - -
286 Ictiol salep pot - -
287 Kanamycin inj 1 grm vial - -
288 Kanamycin inj 2 grm vial - -
289 Kandistatin Drop / Cazetin Drop botol - -
290 Lacto-B sachet - -
291 Lytacur syrup 60 ml botol - -
292 Microlax tube - -
293 Proris suppositoria supp - -
294 Pehavral tablet (Multivitamin & mineral) tablet - -
295 Polikresulen / Albotil concetrate 10 ml/Aptil 10 ml botol - -
296 Rhinofed tablet tablet - -
Page 10
KELAS
(01) (02) (03) M (04) (01) (02) (03) M (04)
1 2 3 4 6 6
297 Stesolit rectal 5 mg tube - -
298 Stesolit rectal 10 mg tube - -
299 Tetagam injeksi vial - -
300 Transamin tab 250 mg tablet - -
301 Trombopop gel tube - -
- -
IV OBAT TRADISIONAL/JAMU/HERBAL/FITOFARMAKA - -
302 Curcuma plus Fruit Veggie syrup botol - -
303 Diapet tablet tablet - -
304 Entrostop anak sachet - -
305 Hemorogard kapsul - -
306 Hepagard kapsul - -
307 I-flex kapsul kapsul - -
308 Lancar Asi kapsul - -
309 Maximus dietary herbal kapsul - -
310 Ocugard kapsul - -
311 Prolipid kapsul - -
312 Stimuno syrup botol - -
313 Stimuno kapsul kapsul - -
314 Tensigard kapsul - -
- -
V BAHAN HABIS PAKAI - -
315 Abbocate No. 18 set - -
319 Alat suntik sekali pakai 1 ml set - -
320 Alat suntik sekali pakai 3 ml/ 2,5 ml set - -
323 Alat suntik bias 0,5 ml set - -
Page 11
KELAS
(01) (02) (03) M (04) (01) (02) (03) M (04)
1 2 3 4 6 6
324 Alat suntik bias 0,05 ml set - -
325 Alat suntik bias 5 ml set - -
326 Alkohol Swap buah - -
327 Catgut Cromic 2/0 dengan jarum lusin - -
328 Catgut Cromic 3/0 dengan jarum lusin - -
329 Catgut plain 2/0 dengan jarum lusin - -
330 Catgut plain 3/0 dengan jarum lusin - -
331 Cotton Aplication steril kotak - -
332 Cover glass buah - -
333 Etakridin (rivanol) larutan 0,1% btl 300 ml botol - -
334 Etanol 70% 1000 ml botol - -
335 Flash back needle pcs - -
336 Foley catheter No. 18 buah - -
337 Hand Scund (Steril) No. 7 psng - -
338 Hand Scund (Steril) No. 7,5 psng - -
339 Hand Scund Size S psng - -
340 Hand Scund Size M psng - -
341 Hand Scund Size L psng - -
342 Infusion set Dewasa set - -
343 Infusion set anak set - -
344 Kapas Berlemak 500 gram bungkus - -
345 Kapas Pembalut/Absorben 250 gram bungkus - -
346 Kasa Kompres 40/40 steril rol - -
347 Kasa Pembalut 2 m x 80 cm rol - -
348 Kasa Pembalut Hidrofil 4 m x 15 cm rol - -
349 Kasa Pembalut Hidrofil 4 m x 3 cm rol - -
350 Kasa Pembalut Hidrofil 40 m x 80 cm Gulung - -
351 Kasa Pembalut Hidrifil 36 m x 80 cm rol - -
352 Kasa Hidrofil Steril uk. 16 x 16 (isi 16 lembar) Kotak - -
353 Kasa Hidrofil Steril uk. 18 x 22 cm (isi 12 lembar) Kotak - -
354 Kasa Pembalut Hidrofil 4 m x 5 cm elastic Rol - -
Page 12
KELAS
(01) (02) (03) M (04) (01) (02) (03) M (04)
1 2 3 4 6 6
355 Kasa Pembalut Hidrofil 4 m x 10 cm elastic Rol - -
356 Kertas Perkamen 75 x 100 cm lembar - -
357 Kertas Puyer Manual (uk 11.5cm x 9 cm) Kotak - -
358 Klep tali pusat pcs - -
359 Lens paper buah - -
360 Masker kotak - -
361 Masker N-95 pcs - -
362 Medicine paket paket - -
363 Needle 25 g ( Terumo / Setara ) kotak - -
364 Object Glass buah - -
365 PH paper buah - -
366 Pisau bedah (bisturi) No. 10 ujung tidak tajam pcs - -
367 Pisau bedah (bisturi) No. 11 ujung tajam pcs - -
368 Plester Hansaplas Roll (1.25 x 5 m) rol - -
369 Plaster 5 yards x 2 inch rol - -
370 Plastik Kantong Etiket Obat 8,7x13 cm (Besar) ball - -
371 Plastik Kantong Etiket Obat 7x8 cm (Kecil) ball - -
372 Pot Salep 10 gram pcs - -
373 Pot Salep 5 gram pcs - -
374 Pot Sputum/Pot Dahak pcs - -
375 Povidon Iodida 10% 30 ml botol - -
378 Rapid Test untuk siphilis test - -
379 Silk (benang bedah sutera)No. 3/0 dgn jarum bedah (PKD) lusin - -
380 Safety box pcs - -
381 Transfusion set set - -
382 Urine bag pcs - -
383 Vaselin botol - -
384 Venflon No.18 set - -
385 Wing Nedle No.23 set - -
Page 13
KELAS
(01) (02) (03) M (04) (01) (02) (03) M (04)
1 2 3 4 6 6
386 Wing Nedle No.25 G set - -
- -
VI REAGENSIA & BAHAN LABORATORIUM - -
387 Anti Dengue NS-1 Card Test tes - -
388 Anti Dengue Ig G/ Ig M/ Dengue Ig G/Ig M (Stick) tes - -
389 Blood Lancet pcs - -
390 Imersi Oil Mikroskop 100 ml botol - -
391 Kartu golongan darah lembar - -
392 Larutan Asam Klorida 0,1 N botol - -
393 Larutan Asam sulfosalisilat 20 % botol - -
394 Larutan Benedict 100 ml botol - -
395 Larutan Eosin 2 % 100 ml botol - -
396 Larutan Etanol Asam 100 ml botol - -
397 Larutan Giemsa Stain 100 ml botol - -
398 Larutan Hyem 100 ml botol - -
399 Larutan Karbol Fuksin 100 ml botol - -
400 Larutan Metilen Biru botol - -
401 Larutan Natrium Sitrat botol - -
402 Larutan Turk 100 ml botol - -
403 Latex/ Tes kehamilan test - -
404 Metanol 100 ml botol - -
405 Ose jarum buah - -
406 Reagen Zeil Nelsen BTA (Alkohol asam,methyl blue,carbol fuchsin) paket - -
407 Reagen Pemeriksaan Trombocit (Rees Echer) 500 ml set - -
408 Reagen Hematologi (mindray):deluent 20 l, Rinse 20 l, EZ set - -
409 Reagen Hematologi (sweelab):deluent 20 l, lyse 20 l set - -
410 Reagen Hematologi (Labnovition):deluent 40 l, lyse 1 l, Cleaner 2 l set - -
411 Serum Gol Darah anti A & anti B set - -
412 Serum gol Darah Anti D - -
413 Tabung Vacutainer clot activator 3 ml pcs - -
414 Tabung EDTA K3 ungu (3ml) pcs - -
Page 14
KELAS
(01) (02) (03) M (04) (01) (02) (03) M (04)
1 2 3 4 6 6
415 Test Widal set - -
416 Urine Reagen Strip 2 parameter (PH) kotak - -
417 Urine Reagen Strip 10 parameter (PH) kotak - -
418 Urine Gluco Protein Test test - -
419 K O H 10% botol - -
420 USG Ultrasonic gel botol - -
421 Ventolin Nebulizer kotak - -
- -
VI HIV / AIDS - -
422 Oncoprobe (HIV test 1 & 2 Anti body) tes - -
423 SD HIV - 1/2 3.0 (Multi) tes - -
424 Biomeriux VIKIA HIV 1/2 tes - -
425 Triline test card - one step anti-HIV (1&2) tes - -
426 Rapid 2 Tes HIV tes - -
427 Needle Venoject pcs - -
- -
VII VAKSIN - -
428 BCG (Bacille Calmette Guerin) vial - -
429 Campak vial - -
430 TT (Tetanus Toxoid) vial - -
431 DT (Dipteri Tetanus) vial - -
432 DPT-HB (Dipteri Pertusis Tetanus Hepatitis B) vial - -
433 DPT-HB-HIB vial - -
434 HB-Uniject sch - -
435 Polio vial - -
JUMLAH KUNJUNGAN RESEP UMUM BPJS JUMLAH
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YANG MENYERAHKAN
MENGETAHUI / MENYETUJUI KEPALA UPT INSTALASI FARMASI
KEPALA DINAS KESEHATAN KOTA BATAM
KOTA BATAM
(RABAINA S.Si., Apt)

(drg. CHANDRA RIZAL, MSi) NIP 19720707-200212-2-006
NIP. 1959 0524-198910-1-001
Page 16
MAKAIAN DAN LEMBAR PERMINTAAN OBAT
( LP - LPO )
PUTIH : UPT INSTALASI FARMASI

BULAN : JANUARI MERAH :
: DINAS KESEHATAN
KUNING : ARSIP
TAHUN : 2015 :
PERSEDIAAN PEMAKAIAN SISA STOK

STOK PERMIN PEMBE
APBD II APBD I BUFFER PROGRA APBD II APBD I BUFFER PROGRA APBD II APBD I BUFFER PROGRA KET
DAK (05) TOTAL DAK (05) TOTAL DAK (05) TOTAL OPTM TAAN RIAN
(01) (02) (03) M (04) (01) (02) (03) M (04) (01) (02) (03) M (04)
7=(5+6) 8=(7-9) 9 10 11 12 13
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STOK PERMIN PEMBE
(01) (02) (03) M (04) (01) (02) (03) M (04) (01) (02) (03) M (04)
7=(5+6) 8=(7-9) 9 10 11 12 13
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STOK PERMIN PEMBE
(01) (02) (03) M (04) (01) (02) (03) M (04) (01) (02) (03) M (04)
7=(5+6) 8=(7-9) 9 10 11 12 13
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STOK PERMIN PEMBE
(01) (02) (03) M (04) (01) (02) (03) M (04) (01) (02) (03) M (04)
7=(5+6) 8=(7-9) 9 10 11 12 13
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STOK PERMIN PEMBE
(01) (02) (03) M (04) (01) (02) (03) M (04) (01) (02) (03) M (04)
7=(5+6) 8=(7-9) 9 10 11 12 13
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STOK PERMIN PEMBE
(01) (02) (03) M (04) (01) (02) (03) M (04) (01) (02) (03) M (04)
7=(5+6) 8=(7-9) 9 10 11 12 13
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STOK PERMIN PEMBE
(01) (02) (03) M (04) (01) (02) (03) M (04) (01) (02) (03) M (04)
7=(5+6) 8=(7-9) 9 10 11 12 13
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STOK PERMIN PEMBE
(01) (02) (03) M (04) (01) (02) (03) M (04) (01) (02) (03) M (04)
7=(5+6) 8=(7-9) 9 10 11 12 13
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STOK PERMIN PEMBE
(01) (02) (03) M (04) (01) (02) (03) M (04) (01) (02) (03) M (04)
7=(5+6) 8=(7-9) 9 10 11 12 13
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STOK PERMIN PEMBE
(01) (02) (03) M (04) (01) (02) (03) M (04) (01) (02) (03) M (04)
7=(5+6) 8=(7-9) 9 10 11 12 13
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STOK PERMIN PEMBE
(01) (02) (03) M (04) (01) (02) (03) M (04) (01) (02) (03) M (04)
7=(5+6) 8=(7-9) 9 10 11 12 13
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(01) (02) (03) M (04) (01) (02) (03) M (04) (01) (02) (03) M (04)
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STOK PERMIN PEMBE
(01) (02) (03) M (04) (01) (02) (03) M (04) (01) (02) (03) M (04)
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(01) (02) (03) M (04) (01) (02) (03) M (04) (01) (02) (03) M (04)
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(01) (02) (03) M (04) (01) (02) (03) M (04) (01) (02) (03) M (04)
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(01) (02) (03) M (04) (01) (02) (03) M (04) (01) (02) (03) M (04)
7=(5+6) 8=(7-9) 9 10 11 12 13
YANG MENERIMA / MELAPOR YANG MEMBUAT LAPORAN

KEPALA PUSKESMAS PENGELOLA OBAT PKM
(....................................................) (....................................................)
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LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
( LP - LPO )
KODE PUSKESMAS : BULAN : JANUARI PUTIH : UPT INSTALASI FARMASI
PUSKESMAS : MERAH : DINAS KESEHATAN
KECAMATAN : TAHUN : 2015 KUNING : ARSIP
KOTA :
PROVINSI :
KELAS PENERI PERSEDIAA PEMAKAIA STOK PERMIN PEMBE

NO NAMA OBAT SATUAN STOK AWAL
N N
SISA STOK
TERAPI MAAN OPTM TAAN RIAN
1 2 3 4 10 11 12
I OBAT GENERIK
1 Albendazol tablet 400 mg tablet - - - - -
2 Alprozolam tab 0,25 mg tablet - - - - -
3 Alprozolam tab 0,5 mg tablet - - - - -
4 Acyclovir 200 mg tablet ( OGB ) tablet - - - - -
5 Acyclovir 400 mg tablet ( OGB ) tablet - - - - -
6 Acyclovir cream ( OGB ) tube - - - - -
7 ACT(Atesunat 50 mg+Amodiaquin anhydrida200 mg)tab paket - - - - -
8 Arterakine tablet paket - - - - -
9 Arterakine (DARPLEX) paket - - - - -
10 Allopurinol tablet 100 mg tablet - - - - -
11 Allopurinol tablet 300 mg tablet - - - - -
12 Ambroxol syrup ( OGB ) botol - - - - -
13 Ambroxol 30mg tab (OGB ) tablet - - - - -
14 Aminofilin tablet 200 mg tablet - - - - -
15 Aminofilin injeksi 24 mg/ml - 10ml ampul - - - - -
16 Amitriptilin HCL tablet salut 25 mg tablet - - - - -
17 Amlodipine tablet 5 mg tablet - - - - -
18 Amlodipine tablet 10 mg tablet - - - - -
19 Amoksisilin sirup kering 125 mg/5 ml botol - - - - -
20 Amoksisilin sirup kering Forte 250 mg/5ml botol - - - - -
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NO NAMA OBAT SATUAN STOK AWAL SISA STOK
TERAPI MAAN N N OPTM TAAN RIAN
1 2 3 4 10 11 12
21 Amoksisilin kapsul 250 mg kapsul - - - - -
22 Amoksisilin kaplet 500 mg kaplet - - - - -
23 Ampicillin inj 1 gr ( OGB ) vial - - - - -
24 Antalgin (metampiron) tablet 500 mg tablet - - - - -
25 Antalgin injeksi 250 mg/ml - 2ml ampul - - - - -
26 Antasida DOEN I tablet kunyah tablet - - - - -
27 Antasida DOEN II suspensi botol - - - - -
28 Anti bakteri DOEN salep komb:Bacitracin+Polimiksin tube - - - - -
29 Anti hemoroid DOEN kombinasi suup - - - - -
30 Antifungi DOEN kombinasi :As Benzoat+As Salisilat pot - - - - -
31 Antimigren tartrat 1 mg + kofein 50 mg tablet - - - - -
32 Aqua pro injeksi steril, bebas pirogen 20 ml vial - - - - -
33 Aquades steril 1000 ml botol - - - - -
34 Artem (artemether 80 mg ) inj ampul - - - - -
35 Artesunate inj 60 mg/ml vial - - - - -
36 Asam Mefenamat tablet salut 250 mg kapsul - - - - -
37 Asam Mefenamat tablet salut 500 mg kaplet - - - - -
38 Asetosal tablet 80 mg/tab tablet - - - - -
39 Asetosal tablet 100 mg tablet - - - - -
40 Asetosal tablet 500 mg tablet - - - - -
41 Atenolol tablet 50 mg tablet - - - - -
42 Atropin sulfat inj 0,25 mg/ml-1 ml ampul - - - - -
43 Atropin sulfat tablet 0,5 mg tablet - - - - -
44 Azitromisin 1000 mg + Cefixime 400 mg (kombipak) paket - - - - -
45 Benzatin Benzil Penisilin 2.4 juta IU/vial vial - - - - -
46 Betametason krim 0,1% tube - - - - -
47 Betahistin Mesilat 6 MG tablet - - - - -
48 Bisoprolol 5 mg tablet - - - - -
49 Bromheksin tab 8 mg tablet - - - - -
50 Calcium gluconat injeksi vial - - - - -
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1 2 3 4 10 11 12
51 Calcium Lactate 500 mg tablet - - - - -
52 Catopril tablet 12,5 mg tablet - - - - -
53 Catopril tablet 25 mg tablet - - - - -
54 Catopril tablet 50 mg tablet - - - - -
55 Cefadroxil syrup 125 mg/5ml botol - - - - -
56 Cefadroxil kapsul 250 mg kapsul - - - - -
57 Cefadroxil kapsul 500 mg kapsul - - - - -
58 Cefixim syrup 100 mg/5 ml botol - - - - -
59 Cefixim 100 mg kapsul kapsul - - - - -
60 Cefotaxim injeksi 1 gram vial - - - - -
61 Ceftriazone injeksi vial - - - - -
62 Cetirizene syrup 5 mg/ 5 ml botol - - - - -
63 Cetirizene 10 mg tablet - - - - -
64 Chloramphenicol suspensi 60 ml botol - - - - -
65 Chloramphenicol kapsul 250 mg kapsul - - - - -
66 Chloramphenicol tetes Mata 0,5 % botol - - - - -
67 Chloramphenicol salep mata 1 % tube - - - - -
68 Chloramphenicol tetes telinga 3 % botol - - - - -
69 Chlorfeniramin Maleat (CTM) tab 4 mg tablet - - - - -
70 Chlorpromazine HCL 100 mg tablet salut tablet - - - - -
71 Chlorpromazine HCL 25 mg tablet salut tablet - - - - -
72 Chlorpromazine HCL inj 25 mg / ml - 1 ml ampul - - - - -
73 Chlorpromazine HCL inj 5 mg / ml - 2 ml ampul - - - - -
74 Cimetidin 200 mg tab (OGB ) tablet - - - - -
75 Clindamisin 150 mg kapsul - - - - -
76 Clindamisin 300 mg kapsul - - - - -
77 Co- Amoxiclav 625 mg tab tablet - - - - -
78 Cotrimoksazole suspensi 60 ml botol - - - - -
79 Cotrimoksazole tablet pediatrik 120 mg tablet - - - - -
80 Cotrimoksazole tablet Dewasa 480 mg tablet - - - - -
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1 2 3 4 10 11 12
81 Cyprofloxacin tab 500 mg ( OGB ) tablet - - - - -
82 Deksametason injeksi 5 mg / ml -1ml ampul - - - - -
83 Deksametason tablet 0,5mg tablet - - - - -
84 Dekstran 70 - larutan infus 6 % steril botol - - - - -
85 Diazepam tablet 2 mg tablet - - - - -
86 Diazepam tablet 5 mg tablet - - - - -
87 Diazepam injeksi 5 mg/ml ampul - - - - -
88 Diethylcarbamazine tablet 100 mg tablet - - - - -
89 Difenhidramin HCL inj 10 mg/ml-1 ml ampul - - - - -
90 Digoksin tablet 0,25 mg tablet - - - - -
91 Dimenhidramin tablet 50 mg tablet - - - - -
92 Doksisiklin kapsul 100 mg kapsul - - - - -
93 Domperidon syrup botol - - - - -
94 Domperidon 10 mg tab tablet - - - - -
95 Efedrin HCl tablet 25 mg tablet - - - - -
96 Epinefrina HCL/Bitartrat (Adrenalin ) inj 0,1 %-1 ml ampul - - - - -
97 Ekstrak belladon tablet 10 mg tablet - - - - -
98 Erythromycin kapsul 250 mg ( OGB ) kapsul - - - - -
99 Erythromycin kapsul 500 mg ( OGB ) kapsul - - - - -
100 Erythromycin syrup 200 mg/5 ml botol - - - - -
101 Famotidine tablet 20 mg tablet - - - - -
102 Famotidine tablet 40 mg tablet - - - - -
103 Fenobarbital injeksi 50 mg/ml - 2 ml ampul - - - - -
104 Fenobarbital tablet 30 mg tablet - - - - -
105 Fenobarbital tablet 100 mg tablet - - - - -
106 Flukonazol tablet 150 mg tablet - - - - -
107 Folic Acid tablet 1 mg tablet - - - - -
108 Furosemid tablet 40 mg tablet - - - - -
109 Gameksan emulsi 1% botol - - - - -
110 Garam oralit untuk 200 ml air sachet - - - - -
Page 39
1 2 3 4 10 11 12
111 Gemfibrozil kapsul 300 mg kapsul - - - - -
112 Gentamycin salap kulit 0,1 % - 5 gr (OGB) tube - - - - -
113 Gentamisin tetes mata botol - - - - -
114 Gentamicyn inj 80 mg/ml vial - - - - -
115 Gentian violet larutan 1% botol - - - - -
116 Glibenklamid tablet 5 mg tablet - - - - -
117 Glimepiride tablet 2 mg tablet - - - - -
118 Glimepiride tablet 4 mg tablet - - - - -
119 Gliseril guayakolat tablet 100 mg tablet - - - - -
120 Gliserin botol - - - - -
121 Glukosa larutan infus 5% steril botol - - - - -
122 Glukosa larutan infus 10 % steril botol - - - - -
123 Glukosa larutan infus 40 % steril botol - - - - -
124 Griseofulvin tablet 125 mg tablet - - - - -
125 Haloperidol tablet 0,5 mg tablet - - - - -
126 Haloperidol tablet 1,5 mg tablet - - - - -
127 Haloperidol tablet 5 mg tablet - - - - -
128 Hidroklorotiazid (HCT) tablet 25 mg tablet - - - - -
129 Hidrokortison krim 1% pot - - - - -
130 Hidrokortison krim 2,5 % tube - - - - -
131 Ibuprofen suspensi 100 mg/5ml botol - - - - -
132 Ibuprofen tablet 200 mg botol - - - - -
133 Ibuprofen tablet 400 mg tablet - - - - -
134 Isosorbid dinitrat tablet sublingual 5 mg tablet - - - - -
135 Kalium Diclofenak 25 mg tablet - - - - -
136 Kalium Permangat serbuk 5 gram pot - - - - -
137 Ketokenazol cream 2 % tube - - - - -
138 Ketokonazol 200 mg tab tablet - - - - -
139 Ketoprofen tablet 100 mg tablet - - - - -
140 Ketorolac inj. 30 mg ampul - - - - -
Page 40
1 2 3 4 10 11 12
141 Klonidin tablet 0,15 mg tablet - - - - -
142 Klorokuin tablet 150 mg tablet - - - - -
143 Klorpropamid tablet 100 mg tablet - - - - -
144 Kodein fosfat tablet 10 mg tablet - - - - -
145 Kuinin (kina) tablet 200 mg tablet - - - - -
146 Kuinin dihidroklorida inj 25 %-2 ml ampul - - - - -
147 Lanzoprazol kapsul 30 mg kapsul - - - - -
148 Levofloksasin tablet 500 mg tablet - - - - -
149 Lidokain injeksi 2 % (HCl) + Epinefrin 1:80.000 - 2 ml ampul - - - - -
150 Lidokain injeksi 2% ampul - - - - -
151 Loperamid tablet tablet - - - - -
152 Loratadin tablet 10 mg tablet - - - - -
153 Lyncomicin 500 mg cap kapsul - - - - -
154 Magnesium Sulfat Inj (IV) 20%-25 ml ampul - - - - -
155 Magnesium Sulfat Inj (IV) 40%-25 ml ampul - - - - -
156 Mebendazol tablet 100 mg tablet - - - - -
157 Methochlorpamid syr 5 mg/ml botol - - - - -
158 Metilergometrin maleat inj 0,200 mg-1 ml ampul - - - - -
159 Metilergometrin maleat tab salut 1,125 mg tablet - - - - -
160 Meloksikam suppositoria supp - - - - -
161 Meloksikam tab 7,5 mg tablet - - - - -
162 Meloksikam tab 15 mg tablet - - - - -
163 Metformin tab 500 mg tablet - - - - -
164 Metformin tab 850 mg tablet - - - - -
165 Metilprednisolon 4 mg tablet - - - - -
168 Metoclorpramid injeksi 5 mg/ml ampul - - - - -
169 Metoclorpramid tab 10 mg tablet - - - - -
170 Metronidazol tablet 250 mg tablet - - - - -
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1 2 3 4 10 11 12
171 Metronidazol tablet 500 mg tablet - - - - -
172 Metronidazol 500 mg infus botol - - - - -
173 Miconazol 2 % cream (OGB ) tube - - - - -
174 Mikafungi Na serb inj 50 mg vial - - - - -
175 Mineral Mix sachet - - - - -
176 Natrium bikarbonat tablet 500 mg tablet - - - - -
177 Natrium Diklofenak tablet 50 mg tablet - - - - -
178 Natrium Tiroksin/Eutirox 50 mg tablet - - - - -
179 Natrium klorida larutan infus 0,9% steril botol - - - - -
180 Nifedipin tab 10 mg tablet - - - - -
181 Nistatin tablet salut 100.000 IU tablet - - - - -
182 Nistatin tablet salut 500.000 IU tablet - - - - -
183 OAT FDC Kategori Anak paket - - - - -
184 OAT Kombipak Kategori Anak paket - - - - -
185 OAT FDC Kategori I Dewasa paket - - - - -
186 OAT Kombipak Kategori I Dewasa paket - - - - -
187 OAT FDC Kategori II Dewasa paket - - - - -
188 OAT FDC Sisipan Dewasa paket - - - - -
189 Obat batuk hitam (OBH) cairan botol - - - - -
190 Ofloxacin tab 200 mg tablet - - - - -
191 Oksitetrasiklin HCl injeksi I.m.50mg/ml-10ml vial - - - - -
192 Oksitetrasiklin HCl salep mata 1% tube - - - - -
193 Oksitetrasiklin HCl salep 3% tube - - - - -
194 Oksitosin injeksi 10 IU/ml-1 ml ampul - - - - -
195 Omeprazol kapsul 20 mg kapsul - - - - -
196 Oseltamivir 75 mg (ut flu burung) tablet - - - - -
197 Papaverin tablet 40 mg ( OGB ) tablet - - - - -
198 Parasetamol drop botol - - - - -
199 Parasetamol sirup 120 mg/5 ml botol - - - - -
200 Parasetamol tablet 100 mg tablet - - - - -
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1 2 3 4 10 11 12
201 Parasetamol tablet 500 mg tablet - - - - -
202 Permetrin krim 5% 10 g tube - - - - -
203 Phenitoin Natrium kapsul 30 mg kapsul - - - - -
204 Phenitoin Natrium kapsul 100 mg kapsul - - - - -
205 Phenol Gliserol tetes telinga 10 % botol - - - - -
206 Phytomenadion (Vit K1) injeksi 10 mg/ml-1 ml ampul - - - - -
207 Phytomenadion (Vit.K1) tablet salut gula 10 mg tablet - - - - -
208 Piracetam 800 mg tablet - - - - -
209 Piracetam 1200 mg tablet - - - - -
210 Pirantel tablet 125 mg tablet - - - - -
211 Pirantel suspensi 125 mg/5ml botol - - - - -
212 Piroxicam 10 mg ( OGB ) tablet - - - - -
213 Piroxicam 20 mg ( OGB ) tablet - - - - -
214 Prednison tablet 5 mg tablet - - - - -
215 Primakuin tablet 15 mg tablet - - - - -
216 Propiltiourasil tablet 100 mg tablet - - - - -
217 Propranolol HCl tablet 10 mg tablet - - - - -
218 Propranolol HCl tablet 40 mg tablet - - - - -
219 Prokain Penisilin inj,3 juta IU vial - - - - -
220 Rabies immuno globulin (human ) 150 IU/ml ampul - - - - -
221 Ranitidin tab tablet - - - - -
222 Ranitidin injeksi ampul - - - - -
223 Reserpin tablet 0,10 mg tablet - - - - -
224 Reserpin tablet 0,25 mg tablet - - - - -
225 Ringer laktat larutan infus steril botol - - - - -
226 Salbutamol tablet 2 mg tablet - - - - -
227 Salbutamol tablet 4 mg tablet - - - - -
228 Salep 2-4, komb : As.Salisilat + belerang endap pot - - - - -
229 Salisil bedak 2% kotak - - - - -
230 Serum anti bisa ular polivalen inj 5 ml (ABU I ) ampul - - - - -
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1 2 3 4 10 11 12
231 Serum anti tetanus injeksi 1.500 IU/ampul ( A T S ) ampul - - - - -
232 Serum anti tetanus injeksi 20.000 IU/ampul ( A T S ) ampul - - - - -
233 Simvastatin tab 10 mg tablet - - - - -
234 Simvastatin tab 20 mg tablet - - - - -
235 Sulfadoxin 500+Pirimetamin 25 mg tablet tablet - - - - -
236 Tambah Darah tablet ( Ferollat ) sachet - - - - -
237 Tetrakain HCL tetes mata 0,5% botol - - - - -
238 Tetrasiklin HCL kapsul 250 mg kapsul - - - - -
239 Tetrasiklin HCL kapsul 500 mg kapsul - - - - -
240 Thiamphenicol kapsul 500 mg tablet - - - - -
241 Tramadol injeksi ampul - - - - -
242 Tramadol 50 mg tablet - - - - -
243 Triheksifenidil Hidroklorida tablet 2 mg tablet - - - - -
244 Vaksin rabies vero ampul - - - - -
245 Vitamin A (Retinol) 100.000 IU kapsul lunak kapsul - - - - -
246 Vitamin A (Retinol) 200.000 IU kapsul lunak kapsul - - - - -
247 Vitamin B1 (Thiamin HCl) injeksi 100 mg/ml-1ml ampul - - - - -
248 Vitamin B1 (Thiamin HCl) tablet 50 mg tablet - - - - -
249 Vitamin B6 (Piridoksin HCl) tablet 10 mg tablet - - - - -
250 Vitamin B12 (Cyanocobalamin) injeksi 500 mcg/ml-1ml ampul - - - - -
251 Vitamin B12 (Cyanocobalamin) tablet tablet - - - - -
252 Vitamin B Complex tablet tablet - - - - -
253 Vitamin C (Asam Ascorbat ) tablet 50 mg tablet - - - - -
256 Zink 20 mg tablet Dispersibel tablet - - - - -
- - - - -
II OBAT GIGI - - - - -
257 Air Raksa botol - - - - -
258 Alkahner/Cavit/Dentorit buah - - - - -
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1 2 3 4 10 11 12
259 Devitalisasi pasta (non arsen) kotak - - - - -
260 Etil klorida semprot botol - - - - -
261 Eugenol Cairan botol - - - - -
262 Flour tablet 0,5 mg tablet - - - - -
263 Formokresol (pengganti TKF) botol - - - - -
264 Glass ionomer cement (GC IX) set - - - - -
265 Glass ionomer cement (GC I) set - - - - -
266 Kalsium hidroksida pasta set - - - - -
267 Klorfenol kamfer menthol (CHKM) botol - - - - -
268 Mummifying pasta botol - - - - -
269 Semen seng fosfat serbuk dan cairan set - - - - -
270 Silver amalgam serbuk 65 - 75% botol - - - - -
271 Solare Komplete Kit (Solare A1,A2,A3/solare X/Shade Guide) set - - - - -
272 Spons gelatin cubides 1 x 1 x 1 cm dental - - - - -
273 Temporary stopping fletcher (Fletcher) serbuk & cairan set - - - - -
- - - - -
III OBAT TAMBAHAN - - - - -
274 Amoxan drop/ Supramox drop botol - - - - -
275 Bioplacenton Jelly tube - - - - -
276 Borax gliserin botol - - - - -
277 Burnazin cream pot - - - - -
278 Chloramfecort H cream/Colipred cream tube - - - - -
279 Counterpain cream / Molakrim tube - - - - -
280 Dextrofen syrup 60 ml botol - - - - -
281 Daryantul kotak - - - - -
282 FG troches tab isap tablet - - - - -
283 Guanestrip syr / Kanina syrup botol - - - - -
284 HB-Vit tablet - - - - -
285 H 2 O 2 3 % 1000 ml botol - - - - -
286 Ictiol salep pot - - - - -
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1 2 3 4 10 11 12
287 Kanamycin inj 1 grm vial - - - - -
288 Kanamycin inj 2 grm vial - - - - -
289 Kandistatin Drop / Cazetin Drop botol - - - - -
290 Lacto-B sachet - - - - -
291 Lytacur syrup 60 ml botol - - - - -
292 Microlax tube - - - - -
293 Proris suppositoria supp - - - - -
294 Pehavral tablet (Multivitamin & mineral) tablet - - - - -
295 Polikresulen / Albotil concetrate 10 ml/Aptil 10 ml botol - - - - -
296 Rhinofed tablet tablet - - - - -
297 Stesolit rectal 5 mg tube - - - - -
298 Stesolit rectal 10 mg tube - - - - -
299 Tetagam injeksi vial - - - - -
300 Transamin tab 250 mg tablet - - - - -
301 Trombopop gel tube - - - - -
- - - - -
IV OBAT TRADISIONAL/JAMU/HERBAL/FITOFARMAKA - - - - -
302 Curcuma plus Fruit Veggie syrup botol - - - - -
303 Diapet tablet tablet - - - - -
304 Entrostop anak sachet - - - - -
305 Hemorogard kapsul - - - - -
306 Hepagard kapsul - - - - -
307 I-flex kapsul kapsul - - - - -
308 Lancar Asi kapsul - - - - -
309 Maximus dietary herbal kapsul - - - - -
310 Ocugard kapsul - - - - -
311 Prolipid kapsul - - - - -
312 Stimuno syrup botol - - - - -
313 Stimuno kapsul kapsul - - - - -
314 Tensigard kapsul - - - - -
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1 2 3 4 10 11 12
- - - - -
V BAHAN HABIS PAKAI - - - - -
315 Abbocate No. 18 set - - - - -
316 Abbocate No. 20 set - - - - -
317 Abbocate No. 22 set - - - - -
318 Abbocate No. 24 set - - - - -
319 Alat suntik sekali pakai 1 ml set - - - - -
320 Alat suntik sekali pakai 3 ml/ 2,5 ml set - - - - -
323 Alat suntik bias 0,5 ml set - - - - -
324 Alat suntik bias 0,05 ml set - - - - -
325 Alat suntik bias 5 ml set - - - - -
326 Alkohol Swap buah - - - - -
327 Catgut Cromic 2/0 dengan jarum lusin - - - - -
328 Catgut Cromic 3/0 dengan jarum lusin - - - - -
329 Catgut plain 2/0 dengan jarum lusin - - - - -
330 Catgut plain 3/0 dengan jarum lusin - - - - -
331 Cotton Aplication steril kotak - - - - -
332 Cover glass buah - - - - -
333 Etakridin (rivanol) larutan 0,1% btl 300 ml botol - - - - -
334 Etanol 70% 1000 ml botol - - - - -
335 Flash back needle pcs - - - - -
336 Foley catheter No. 18 buah - - - - -
337 Hand Scund (Steril) No. 7 psng - - - - -
338 Hand Scund (Steril) No. 7,5 psng - - - - -
339 Hand Scund Size S psng - - - - -
340 Hand Scund Size M psng - - - - -
341 Hand Scund Size L psng - - - - -
342 Infusion set Dewasa set - - - - -
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1 2 3 4 10 11 12
343 Infusion set anak set - - - - -
344 Kapas Berlemak 500 gram bungkus - - - - -
345 Kapas Pembalut/Absorben 250 gram bungkus - - - - -
346 Kasa Kompres 40/40 steril rol - - - - -
347 Kasa Pembalut 2 m x 80 cm rol - - - - -
348 Kasa Pembalut Hidrofil 4 m x 15 cm rol - - - - -
349 Kasa Pembalut Hidrofil 4 m x 3 cm rol - - - - -
350 Kasa Pembalut Hidrofil 40 m x 80 cm Gulung - - - - -
351 Kasa Pembalut Hidrifil 36 m x 80 cm rol - - - - -
352 Kasa Hidrofil Steril uk. 16 x 16 (isi 16 lembar) Kotak - - - - -
353 Kasa Hidrofil Steril uk. 18 x 22 cm (isi 12 lembar) Kotak - - - - -
354 Kasa Pembalut Hidrofil 4 m x 5 cm elastic Rol - - - - -
355 Kasa Pembalut Hidrofil 4 m x 10 cm elastic Rol - - - - -
356 Kertas Perkamen 75 x 100 cm lembar - - - - -
357 Kertas Puyer Manual (uk 11.5cm x 9 cm) Kotak - - - - -
358 Klep tali pusat pcs - - - - -
359 Lens paper buah - - - - -
360 Masker kotak - - - - -
361 Masker N-95 pcs - - - - -
362 Medicine paket paket - - - - -
363 Needle 25 g ( Terumo / Setara ) kotak - - - - -
364 Object Glass buah - - - - -
365 PH paper buah - - - - -
366 Pisau bedah (bisturi) No. 10 ujung tidak tajam pcs - - - - -
367 Pisau bedah (bisturi) No. 11 ujung tajam pcs - - - - -
368 Plester Hansaplas Roll (1.25 x 5 m) rol - - - - -
369 Plaster 5 yards x 2 inch rol - - - - -
370 Plastik Kantong Etiket Obat 8,7x13 cm (Besar) ball - - - - -
371 Plastik Kantong Etiket Obat 7x8 cm (Kecil) ball - - - - -
372 Pot Salep 10 gram pcs - - - - -
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373 Pot Salep 5 gram pcs - - - - -
374 Pot Sputum/Pot Dahak pcs - - - - -
375 Povidon Iodida 10% 30 ml botol - - - - -
378 Rapid Test untuk siphilis test - - - - -
379 Silk (benang bedah sutera)No. 3/0 dgn jarum bedah (PKD) lusin - - - - -
380 Safety box pcs - - - - -
381 Transfusion set set - - - - -
382 Urine bag pcs - - - - -
383 Vaselin botol - - - - -
384 Venflon No.18 set - - - - -
385 Wing Nedle No.23 set - - - - -
386 Wing Nedle No.25 G set - - - - -
- - - - -
VI REAGENSIA & BAHAN LABORATORIUM - - - - -
387 Anti Dengue NS-1 Card Test tes - - - - -
388 Anti Dengue Ig G/ Ig M/ Dengue Ig G/Ig M (Stick) tes - - - - -
389 Blood Lancet pcs - - - - -
390 Imersi Oil Mikroskop 100 ml botol - - - - -
391 Kartu golongan darah lembar - - - - -
392 Larutan Asam Klorida 0,1 N botol - - - - -
393 Larutan Asam sulfosalisilat 20 % botol - - - - -
394 Larutan Benedict 100 ml botol - - - - -
395 Larutan Eosin 2 % 100 ml botol - - - - -
396 Larutan Etanol Asam 100 ml botol - - - - -
397 Larutan Giemsa Stain 100 ml botol - - - - -
398 Larutan Hyem 100 ml botol - - - - -
399 Larutan Karbol Fuksin 100 ml botol - - - - -
400 Larutan Metilen Biru botol - - - - -
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401 Larutan Natrium Sitrat botol - - - - -
402 Larutan Turk 100 ml botol - - - - -
403 Latex/ Tes kehamilan test - - - - -
404 Metanol 100 ml botol - - - - -
405 Ose jarum buah - - - - -
406 Reagen Zeil Nelsen BTA (Alkohol asam,methyl blue,carbol fuchsin) paket - - - - -
407 Reagen Pemeriksaan Trombocit (Rees Echer) 500 ml set - - - - -
408 Reagen Hematologi (mindray):deluent 20 l, Rinse 20 l, EZ set - - - - -
409 Reagen Hematologi (sweelab):deluent 20 l, lyse 20 l set - - - - -
410 Reagen Hematologi (Labnovition):deluent 40 l, lyse 1 l, Cleaner 2 l set - - - - -
411 Serum Gol Darah anti A & anti B set - - - - -
412 Serum gol Darah Anti D - - - - -
413 Tabung Vacutainer clot activator 3 ml pcs - - - - -
414 Tabung EDTA K3 ungu (3ml) pcs - - - - -
415 Test Widal set - - - - -
416 Urine Reagen Strip 2 parameter (PH) kotak - - - - -
417 Urine Reagen Strip 10 parameter (PH) kotak - - - - -
418 Urine Gluco Protein Test test - - - - -
419 K O H 10% botol - - - - -
420 USG Ultrasonic gel botol - - - - -
421 Ventolin Nebulizer kotak - - - - -
- - - - -
VI HIV / AIDS - - - - -
422 Oncoprobe (HIV test 1 & 2 Anti body) tes - - - - -
423 SD HIV - 1/2 3.0 (Multi) tes - - - - -
424 Biomeriux VIKIA HIV 1/2 tes - - - - -
425 Triline test card - one step anti-HIV (1&2) tes - - - - -
426 Rapid 2 Tes HIV tes - - - - -
427 Needle Venoject pcs - - - - -
- - - - -
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VII VAKSIN - - - - -
428 BCG (Bacille Calmette Guerin) vial - - - - -
429 Campak vial - - - - -
430 TT (Tetanus Toxoid) vial - - - - -
431 DT (Dipteri Tetanus) vial - - - - -
432 DPT-HB (Dipteri Pertusis Tetanus Hepatitis B) vial - - - - -
433 DPT-HB-HIB vial - - - - -
434 HB-Uniject sch - - - - -
435 Polio vial - - - - -
JUMLAH KUNJUNGAN RESEP UMUM BPJS JUMLAH
0 0 0
MENGETAHUI / MENYETUJUI YANG MENYERAHKAN YANG MENERIMA / MELAPOR YANG MEMBUAT LAPORAN
KEPALA DINAS KESEHATAN KEPALA UPT INSTALASI FARMASI KEPALA PUSKESMAS PENGELOLA OBAT PKM
KOTA BATAM KOTA BATAM
(drg. CHANDRA RIZAL, MSi) (RABAINA S.Si., Apt) (....................................................) (....................................................

NIP. 1959 0524-198910-1-001 NIP 19720707-200212-2-006 )
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NG MEMBUAT LAPORAN
PENGELOLA OBAT PKM
.............................................
)
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LAPORAN NERACA OBAT
BULAN / TAHUN : JANUARI 2015
KODE PUSKESMAS :
PUSKESMAS :
KECAMATAN :
KOTA :
PROVINSI :
SISA STOK HARGA OBAT PERSATUAN (Rp) JUMLAH SISA STOK (Rp)
NO NAMA OBAT SATUAN APBD II APBD I BUFFER PROGRAM APBD I BUFFER APBD I BUFFER KET
(01) (02) (03) (04)
DAK (05) APBD II (01)
(02) (03)
PROGRAM (04) DAK (05) APBD II (01)
(02) (03)
PROGRAM (04) DAK (05) JUMLAH
1 2 4 5 6.00 7 8
I OBAT GENERIK
1 Albendazol tablet 400 mg tablet 0 0 0 0 0 160.00 - - - - - -
2 Alprozolam tab 0,25 mg tablet 0 0 0 0 0 - - - - - -
3 Alprozolam tab 0,5 mg tablet 0 0 0 0 0 555.62 - - - - - -
4 Acyclovir 200 mg tablet ( OGB ) tablet 0 0 0 0 0 506.71 - - - - - -
5 Acyclovir 400 mg tablet ( OGB ) tablet 0 0 0 0 0 542.64 - - - - - -
6 Acyclovir cream ( OGB ) tube 0 0 0 0 0 2,849.32 - - - - - -
7 ACT(Atesunat 50 mg+Amodiaquin anhydrida200 mg)tab paket 0 0 0 0 0 31,342.00 - - - - - -
8 Arterakine tablet paket 0 0 0 0 0 - - - - - -
9 Arterakine (DARPLEX) paket 0 0 0 0 0 31,360.00 - - - - - -
10 Allopurinol tablet 100 mg tablet 0 0 0 0 0 98.18 - - - - - -
11 Allopurinol tablet 300 mg tablet 0 0 0 0 0 295.00 - - - - - -
12 Ambroxol syrup ( OGB ) botol 0 0 0 0 0 2,361.82 - - - - - -
13 Ambroxol 30mg tab (OGB ) tablet 0 0 0 0 0 79.48 - - - - - -
14 Aminofilin tablet 200 mg tablet 0 0 0 0 0 10,761.00 - - - - - -
15 Aminofilin injeksi 24 mg/ml - 10ml ampul 0 0 0 0 0 - - - - - -
16 Amitriptilin HCL tablet salut 25 mg tablet 0 0 0 0 0 120.75 - - - - - -
17 Amlodipine tablet 5 mg tablet 0 0 0 0 0 229.09 - - - - - -
18 Amlodipine tablet 10 mg tablet 0 0 0 0 0 420.00 - - - - - -
19 Amoksisilin sirup kering 125 mg/5 ml botol 0 0 0 0 0 - - - - - -
20 Amoksisilin sirup kering Forte 250 mg/5ml botol 0 0 0 0 0 3,829.00 - - - - - -
21 Amoksisilin kapsul 250 mg kapsul 0 0 0 0 0 274.25 - - - - - -
22 Amoksisilin kaplet 500 mg kaplet 0 0 0 0 0 205.45 - - - - - -
23 Ampicillin inj 1 gr ( OGB ) vial 0 0 0 0 0 4,495.90 - - - - - -
24 Antalgin (metampiron) tablet 500 mg tablet 0 0 0 0 0 - - - - - -
25 Antalgin injeksi 250 mg/ml - 2ml ampul 0 0 0 0 0 428.20 - - - - - -
26 Antasida DOEN I tablet kunyah tablet 0 0 0 0 0 67.27 - - - - - -
27 Antasida DOEN II suspensi botol 0 0 0 0 0 1,963.64 - - - - - -
28 Anti bakteri DOEN salep komb:Bacitracin+Polimiksin tube 0 0 0 0 0 2,390.39 - - - - - -
29 Anti hemoroid DOEN kombinasi suup 0 0 0 0 0 1,800.00 - - - - - -
30 Antifungi DOEN kombinasi :As Benzoat+As Salisilat pot 0 0 0 0 0 - - - - - -
31 Antimigren tartrat 1 mg + kofein 50 mg tablet 0 0 0 0 0 117.11 - - - - - -
32 Aqua pro injeksi steril, bebas pirogen 20 ml vial 0 0 0 0 0 5,223.75 - - - - - -
33 Aquades steril 1000 ml botol 0 0 0 0 0 - - - - - -
34 Artem (artemether 80 mg ) inj ampul 0 0 0 0 0 - - - - - -
35 Artesunate inj 60 mg/ml vial 0 0 0 0 0 3,050.00 - - - - - -
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36 Asam Mefenamat tablet salut 250 mg kapsul 0 0 0 0 0 - - - - - -
37 Asam Mefenamat tablet salut 500 mg kaplet 0 0 0 0 0 100.00 - - - - - -
38 Asetosal tablet 80 mg/tab tablet 0 0 0 0 0 - - - - - -
39 Asetosal tablet 100 mg tablet 0 0 0 0 0 95.45 - - - - - -
40 Asetosal tablet 500 mg tablet 0 0 0 0 0 - - - - - -
41 Atenolol tablet 50 mg tablet 0 0 0 0 0 256.24 - - - - - -
42 Atropin sulfat inj 0,25 mg/ml-1 ml ampul 0 0 0 0 0 908.53 - - - - - -
43 Atropin sulfat tablet 0,5 mg tablet 0 0 0 0 0 - - - - - -
44 Azitromisin 1000 mg + Cefixime 400 mg (kombipak) paket 0 0 0 0 0 - - - - - -
45 Benzatin Benzil Penisilin 2.4 juta IU/vial vial 0 0 0 0 0 11,630.91 - - - - - -
46 Betametason krim 0,1% tube 0 0 0 0 0 1,772.29 - - - - - -
47 Betahistin Mesilat 6 MG tablet 0 0 0 0 0 881.82 - - - - - -
48 Bisoprolol 5 mg tablet 0 0 0 0 0 2,205.07 - - - - - -
49 Bromheksin tab 8 mg tablet 0 0 0 0 0 - - - - - -
50 Calcium gluconat injeksi vial 0 0 0 0 0 - - - - - -
51 Calcium Lactate 500 mg tablet 0 0 0 0 0 59.00 - - - - - -
52 Catopril tablet 12,5 mg tablet 0 0 0 0 0 60.00 - - - - - -
53 Catopril tablet 25 mg tablet 0 0 0 0 0 83.64 - - - - - -
54 Catopril tablet 50 mg tablet 0 0 0 0 0 128.18 - - - - - -
55 Cefadroxil syrup 125 mg/5ml botol 0 0 0 0 0 5,000.00 - - - - - -
56 Cefadroxil kapsul 250 mg kapsul 0 0 0 0 0 447.27 - - - - - -
57 Cefadroxil kapsul 500 mg kapsul 0 0 0 0 0 797.81 - - - - - -
58 Cefixim syrup 100 mg/5 ml botol 0 0 0 0 0 10,106.36 - - - - - -
59 Cefixim 100 mg kapsul kapsul 0 0 0 0 0 914.55 - - - - - -
60 Cefotaxim injeksi 1 gram vial 0 0 0 0 0 - - - - - -
61 Ceftriazone injeksi vial 0 0 0 0 0 - - - - - -
62 Cetirizene syrup 5 mg/ 5 ml botol 0 0 0 0 0 9,450.00 - - - - - -
63 Cetirizene 10 mg tablet 0 0 0 0 0 - - - - - -
64 Chloramphenicol suspensi 60 ml botol 0 0 0 0 0 4,273.98 - - - - - -
65 Chloramphenicol kapsul 250 mg kapsul 0 0 0 0 0 219.40 - - - - - -
66 Chloramphenicol tetes Mata 0,5 % botol 0 0 0 0 0 2,500.00 - - - - - -
67 Chloramphenicol salep mata 1 % tube 0 0 0 0 0 1,490.91 - - - - - -
68 Chloramphenicol tetes telinga 3 % botol 0 0 0 0 0 1,526.36 - - - - - -
69 Chlorfeniramin Maleat (CTM) tab 4 mg tablet 0 0 0 0 0 84.00 - - - - - -
70 Chlorpromazine HCL 100 mg tablet salut tablet 0 0 0 0 0 115.87 - - - - - -
71 Chlorpromazine HCL 25 mg tablet salut tablet 0 0 0 0 0 - - - - - -
72 Chlorpromazine HCL inj 25 mg / ml - 1 ml ampul 0 0 0 0 0 - - - - - -
73 Chlorpromazine HCL inj 5 mg / ml - 2 ml ampul 0 0 0 0 0 - - - - - -
74 Cimetidin 200 mg tab (OGB ) tablet 0 0 0 0 0 102.55 - - - - - -
75 Clindamisin 150 mg kapsul 0 0 0 0 0 484.38 - - - - - -
76 Clindamisin 300 mg kapsul 0 0 0 0 0 502.73 - - - - - -
77 Co- Amoxiclav 625 mg tab tablet 0 0 0 0 0 4,342.73 - - - - - -
78 Cotrimoksazole suspensi 60 ml botol 0 0 0 0 0 3,761.10 - - - - - -
79 Cotrimoksazole tablet pediatrik 120 mg tablet 0 0 0 0 0 68.18 - - - - - -
80 Cotrimoksazole tablet Dewasa 480 mg tablet 0 0 0 0 0 125.45 - - - - - -
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81 Cyprofloxacin tab 500 mg ( OGB ) tablet 0 0 0 0 0 246.94 - - - - - -
82 Deksametason injeksi 5 mg / ml -1ml ampul 0 0 0 0 0 1,901.45 - - - - - -
83 Deksametason tablet 0,5mg tablet 0 0 0 0 0 70.91 - - - - - -
84 Dekstran 70 - larutan infus 6 % steril botol 0 0 0 0 0 33,741.35 - - - - - -
85 Diazepam tablet 2 mg tablet 0 0 0 0 0 20.58 - - - - - -
86 Diazepam tablet 5 mg tablet 0 0 0 0 0 29.00 - - - - - -
87 Diazepam injeksi 5 mg/ml ampul 0 0 0 0 0 873.00 - - - - - -
88 Diethylcarbamazine tablet 100 mg tablet 0 0 0 0 0 - - - - - -
89 Difenhidramin HCL inj 10 mg/ml-1 ml ampul 0 0 0 0 0 723.83 - - - - - -
90 Digoksin tablet 0,25 mg tablet 0 0 0 0 0 135.82 - - - - - -
91 Dimenhidramin tablet 50 mg tablet 0 0 0 0 0 88.18 - - - - - -
92 Doksisiklin kapsul 100 mg kapsul 0 0 0 0 0 215.50 - - - - - -
93 Domperidon syrup botol 0 0 0 0 0 - - - - - -
94 Domperidon 10 mg tab tablet 0 0 0 0 0 168.18 - - - - - -
95 Efedrin HCl tablet 25 mg tablet 0 0 0 0 0 21.78 - - - - - -
96 Epinefrina HCL/Bitartrat (Adrenalin ) inj 0,1 %-1 ml ampul 0 0 0 0 0 1,177.72 - - - - - -
97 Ekstrak belladon tablet 10 mg tablet 0 0 0 0 0 36.36 - - - - - -
98 Erythromycin kapsul 250 mg ( OGB ) kapsul 0 0 0 0 0 470.00 - - - - - -
99 Erythromycin kapsul 500 mg ( OGB ) kapsul 0 0 0 0 0 807.27 - - - - - -
100 Erythromycin syrup 200 mg/5 ml botol 0 0 0 0 0 7,175.45 - - - - - -
101 Famotidine tablet 20 mg tablet 0 0 0 0 0 107.27 - - - - - -
102 Famotidine tablet 40 mg tablet 0 0 0 0 0 166.36 - - - - - -
103 Fenobarbital injeksi 50 mg/ml - 2 ml ampul 0 0 0 0 0 1,481.64 - - - - - -
104 Fenobarbital tablet 30 mg tablet 0 0 0 0 0 40.00 - - - - - -
105 Fenobarbital tablet 100 mg tablet 0 0 0 0 0 - - - - - -
106 Flukonazol tablet 150 mg tablet 0 0 0 0 0 21,000.00 - - - - - -
107 Folic Acid tablet 1 mg tablet 0 0 0 0 0 41.71 - - - - - -
108 Furosemid tablet 40 mg tablet 0 0 0 0 0 96.95 - - - - - -
109 Gameksan emulsi 1% botol 0 0 0 0 0 - - - - - -
110 Garam oralit untuk 200 ml air sachet 0 0 0 0 0 279.09 - - - - - -
111 Gemfibrozil kapsul 300 mg kapsul 0 0 0 0 0 259.09 - - - - - -
112 Gentamycin salap kulit 0,1 % - 5 gr (OGB) tube 0 0 0 0 0 1,335.45 - - - - - -
113 Gentamisin tetes mata botol 0 0 0 0 0 2,771.82 - - - - - -
114 Gentamicyn inj 80 mg/ml vial 0 0 0 0 0 656.20 - - - - - -
115 Gentian violet larutan 1% botol 0 0 0 0 0 427.85 - - - - - -
116 Glibenklamid tablet 5 mg tablet 0 0 0 0 0 63.00 - - - - - -
117 Glimepiride tablet 2 mg tablet 0 0 0 0 0 481.82 - - - - - -
118 Glimepiride tablet 4 mg tablet 0 0 0 0 0 953.64 - - - - - -
119 Gliseril guayakolat tablet 100 mg tablet 0 0 0 0 0 25.00 - - - - - -
120 Gliserin botol 0 0 0 0 0 4,492.87 - - - - - -
121 Glukosa larutan infus 5% steril botol 0 0 0 0 0 5,071.82 - - - - - -
122 Glukosa larutan infus 10 % steril botol 0 0 0 0 0 - - - - - -
123 Glukosa larutan infus 40 % steril botol 0 0 0 0 0 - - - - - -
124 Griseofulvin tablet 125 mg tablet 0 0 0 0 0 217.27 - - - - - -
125 Haloperidol tablet 0,5 mg tablet 0 0 0 0 0 63.25 - - - - - -
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126 Haloperidol tablet 1,5 mg tablet 0 0 0 0 0 - - - - - -
127 Haloperidol tablet 5 mg tablet 0 0 0 0 0 - - - - - -
128 Hidroklorotiazid (HCT) tablet 25 mg tablet 0 0 0 0 0 30.98 - - - - - -
129 Hidrokortison krim 1% pot 0 0 0 0 0 2,184.48 - - - - - -
130 Hidrokortison krim 2,5 % tube 0 0 0 0 0 2,235.45 - - - - - -
131 Ibuprofen suspensi 100 mg/5ml botol 0 0 0 0 0 3,307.27 - - - - - -
132 Ibuprofen tablet 200 mg botol 0 0 0 0 0 85.45 - - - - - -
133 Ibuprofen tablet 400 mg tablet 0 0 0 0 0 135.72 - - - - - -
134 Isosorbid dinitrat tablet sublingual 5 mg tablet 0 0 0 0 0 75.45 - - - - - -
135 Kalium Diclofenak 25 mg tablet 0 0 0 0 0 745.00 - - - - - -
136 Kalium Permangat serbuk 5 gram pot 0 0 0 0 0 3,440.00 - - - - - -
137 Ketokenazol cream 2 % tube 0 0 0 0 0 6,648.41 - - - - - -
138 Ketokonazol 200 mg tab tablet 0 0 0 0 0 281.82 - - - - - -
139 Ketoprofen tablet 100 mg tablet 0 0 0 0 0 580.00 - - - - - -
140 Ketorolac inj. 30 mg ampul 0 0 0 0 0 2,423.64 - - - - - -
141 Klonidin tablet 0,15 mg tablet 0 0 0 0 0 194.70 - - - - - -
142 Klorokuin tablet 150 mg tablet 0 0 0 0 0 - - - - - -
143 Klorpropamid tablet 100 mg tablet 0 0 0 0 0 - - - - - -
144 Kodein fosfat tablet 10 mg tablet 0 0 0 0 0 - - - - - -
145 Kuinin (kina) tablet 200 mg tablet 0 0 0 0 0 326.18 - - - - - -
146 Kuinin dihidroklorida inj 25 %-2 ml ampul 0 0 0 0 0 - - - - - -
147 Lanzoprazol kapsul 30 mg kapsul 0 0 0 0 0 451.82 - - - - - -
148 Levofloksasin tablet 500 mg tablet 0 0 0 0 0 534.55 - - - - - -
149 Lidokain injeksi 2 % (HCl) + Epinefrin 1:80.000 - 2 ml ampul 0 0 0 0 0 1,079.57 - - - - - -
150 Lidokain injeksi 2% ampul 0 0 0 0 0 863.64 - - - - - -
151 Loperamid tablet tablet 0 0 0 0 0 86.95 - - - - - -
152 Loratadin tablet 10 mg tablet 0 0 0 0 0 152.73 - - - - - -
153 Lyncomicin 500 mg cap kapsul 0 0 0 0 0 496.36 - - - - - -
154 Magnesium Sulfat Inj (IV) 20%-25 ml ampul 0 0 0 0 0 1,462.64 - - - - - -
155 Magnesium Sulfat Inj (IV) 40%-25 ml ampul 0 0 0 0 0 - - - - - -
156 Mebendazol tablet 100 mg tablet 0 0 0 0 0 - - - - - -
157 Methochlorpamid syr 5 mg/ml botol 0 0 0 0 0 - - - - - -
158 Metilergometrin maleat inj 0,200 mg-1 ml ampul 0 0 0 0 0 1,240.90 - - - - - -
159 Metilergometrin maleat tab salut 1,125 mg tablet 0 0 0 0 0 124.33 - - - - - -
160 Meloksikam suppositoria supp 0 0 0 0 0 - - - - - -
161 Meloksikam tab 7,5 mg tablet 0 0 0 0 0 630.00 - - - - - -
162 Meloksikam tab 15 mg tablet 0 0 0 0 0 316.36 - - - - - -
163 Metformin tab 500 mg tablet 0 0 0 0 0 100.00 - - - - - -
164 Metformin tab 850 mg tablet 0 0 0 0 0 - - - - - -
165 Metilprednisolon 4 mg tablet 0 0 0 0 0 418.42 - - - - - -
166 Metilprednisolon 8 mg tablet 0 0 0 0 0 555.62 - - - - - -
167 Metilprednisolon 16 mg tablet 0 0 0 0 0 - - - - - -
168 Metoclorpramid injeksi 5 mg/ml ampul 0 0 0 0 0 949.78 - - - - - -
169 Metoclorpramid tab 10 mg tablet 0 0 0 0 0 82.73 - - - - - -
170 Metronidazol tablet 250 mg tablet 0 0 0 0 0 - - - - - -
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171 Metronidazol tablet 500 mg tablet 0 0 0 0 0 155.45 - - - - - -
172 Metronidazol 500 mg infus botol 0 0 0 0 0 - - - - - -
173 Miconazol 2 % cream (OGB ) tube 0 0 0 0 0 2,863.64 - - - - - -
174 Mikafungi Na serb inj 50 mg vial 0 0 0 0 0 - - - - - -
175 Mineral Mix sachet 0 0 0 0 0 2,350.69 - - - - - -
176 Natrium bikarbonat tablet 500 mg tablet 0 0 0 0 0 13.58 - - - - - -
177 Natrium Diklofenak tablet 50 mg tablet 0 0 0 0 0 168.18 - - - - - -
178 Natrium Tiroksin/Eutirox 50 mg tablet 0 0 0 0 0 - - - - - -
179 Natrium klorida larutan infus 0,9% steril botol 0 0 0 0 0 4,486.36 - - - - - -
180 Nifedipin tab 10 mg tablet 0 0 0 0 0 104.55 - - - - - -
181 Nistatin tablet salut 100.000 IU tablet 0 0 0 0 0 388.18 - - - - - -
182 Nistatin tablet salut 500.000 IU tablet 0 0 0 0 0 610.91 - - - - - -
183 OAT FDC Kategori Anak paket 0 0 0 0 0 225,650.00 - - - - - -
184 OAT Kombipak Kategori Anak paket 0 0 0 0 0 205,227.00 - - - - - -
185 OAT FDC Kategori I Dewasa paket 0 0 0 0 0 378,000.00 - - - - - -
186 OAT Kombipak Kategori I Dewasa paket 0 0 0 0 0 - - - - - -
187 OAT FDC Kategori II Dewasa paket 0 0 0 0 0 1,145,363.64 - - - - - -
188 OAT FDC Sisipan Dewasa paket 0 0 0 0 0 - - - - - -
189 Obat batuk hitam (OBH) cairan botol 0 0 0 0 0 9,800.00 - - - - - -
190 Ofloxacin tab 200 mg tablet 0 0 0 0 0 393.64 - - - - - -
191 Oksitetrasiklin HCl injeksi I.m.50mg/ml-10ml vial 0 0 0 0 0 2,944.29 - - - - - -
192 Oksitetrasiklin HCl salep mata 1% tube 0 0 0 0 0 1,300.88 - - - - - -
193 Oksitetrasiklin HCl salep 3% tube 0 0 0 0 0 1,460.00 - - - - - -
194 Oksitosin injeksi 10 IU/ml-1 ml ampul 0 0 0 0 0 - - - - - -
195 Omeprazol kapsul 20 mg kapsul 0 0 0 0 0 252.73 - - - - - -
196 Oseltamivir 75 mg (ut flu burung) tablet 0 0 0 0 0 12,347.05 - - - - - -
197 Papaverin tablet 40 mg ( OGB ) tablet 0 0 0 0 0 90.00 - - - - - -
198 Parasetamol drop botol 0 0 0 0 0 4,989.09 - - - - - -
199 Parasetamol sirup 120 mg/5 ml botol 0 0 0 0 0 1,237.27 - - - - - -
200 Parasetamol tablet 100 mg tablet 0 0 0 0 0 29.96 - - - - - -
201 Parasetamol tablet 500 mg tablet 0 0 0 0 0 75.27 - - - - - -
202 Permetrin krim 5% 10 g tube 0 0 0 0 0 - - - - - -
203 Phenitoin Natrium kapsul 30 mg kapsul 0 0 0 0 0 - - - - - -
204 Phenitoin Natrium kapsul 100 mg kapsul 0 0 0 0 0 - - - - - -
205 Phenol Gliserol tetes telinga 10 % botol 0 0 0 0 0 957.69 - - - - - -
206 Phytomenadion (Vit K1) injeksi 10 mg/ml-1 ml ampul 0 0 0 0 0 1,368.17 - - - - - -
207 Phytomenadion (Vit.K1) tablet salut gula 10 mg tablet 0 0 0 0 0 646.43 - - - - - -
208 Piracetam 800 mg tablet 0 0 0 0 0 877.80 - - - - - -
209 Piracetam 1200 mg tablet 0 0 0 0 0 - - - - - -
210 Pirantel tablet 125 mg tablet 0 0 0 0 0 303.93 - - - - - -
211 Pirantel suspensi 125 mg/5ml botol 0 0 0 0 0 7,934.55 - - - - - -
212 Piroxicam 10 mg ( OGB ) tablet 0 0 0 0 0 77.00 - - - - - -
213 Piroxicam 20 mg ( OGB ) tablet 0 0 0 0 0 95.00 - - - - - -
214 Prednison tablet 5 mg tablet 0 0 0 0 0 50.00 - - - - - -
215 Primakuin tablet 15 mg tablet 0 0 0 0 0 6.52 - - - - - -
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216 Propiltiourasil tablet 100 mg tablet 0 0 0 0 0 314.55 - - - - - -
217 Propranolol HCl tablet 10 mg tablet 0 0 0 0 0 73.13 - - - - - -
218 Propranolol HCl tablet 40 mg tablet 0 0 0 0 0 - - - - - -
219 Prokain Penisilin inj,3 juta IU vial 0 0 0 0 0 - - - - - -
220 Rabies immuno globulin (human ) 150 IU/ml ampul 0 0 0 0 0 - - - - - -
221 Ranitidin tab tablet 0 0 0 0 0 208.95 - - - - - -
222 Ranitidin injeksi ampul 0 0 0 0 0 1,471.82 - - - - - -
223 Reserpin tablet 0,10 mg tablet 0 0 0 0 0 77.27 - - - - - -
224 Reserpin tablet 0,25 mg tablet 0 0 0 0 0 - - - - - -
225 Ringer laktat larutan infus steril botol 0 0 0 0 0 4,963.64 - - - - - -
226 Salbutamol tablet 2 mg tablet 0 0 0 0 0 67.27 - - - - - -
227 Salbutamol tablet 4 mg tablet 0 0 0 0 0 102.36 - - - - - -
228 Salep 2-4, komb : As.Salisilat + belerang endap pot 0 0 0 0 0 1,167.43 - - - - - -
229 Salisil bedak 2% kotak 0 0 0 0 0 1,358.63 - - - - - -
230 Serum anti bisa ular polivalen inj 5 ml (ABU I ) ampul 0 0 0 0 0 - - - - - -
231 Serum anti tetanus injeksi 1.500 IU/ampul ( A T S ) ampul 0 0 0 0 0 - - - - - -
232 Serum anti tetanus injeksi 20.000 IU/ampul ( A T S ) ampul 0 0 0 0 0 - - - - - -
233 Simvastatin tab 10 mg tablet 0 0 0 0 0 171.82 - - - - - -
234 Simvastatin tab 20 mg tablet 0 0 0 0 0 462.73 - - - - - -
235 Sulfadoxin 500+Pirimetamin 25 mg tablet tablet 0 0 0 0 0 - - - - - -
236 Tambah Darah tablet ( Ferollat ) sachet 0 0 0 0 0 1,690.90 - - - - - -
237 Tetrakain HCL tetes mata 0,5% botol 0 0 0 0 0 3,225.83 - - - - - -
238 Tetrasiklin HCL kapsul 250 mg kapsul 0 0 0 0 0 - - - - - -
239 Tetrasiklin HCL kapsul 500 mg kapsul 0 0 0 0 0 244.09 - - - - - -
240 Thiamphenicol kapsul 500 mg tablet 0 0 0 0 0 585.06 - - - - - -
241 Tramadol injeksi ampul 0 0 0 0 0 5,272.73 - - - - - -
242 Tramadol 50 mg tablet 0 0 0 0 0 174.75 - - - - - -
243 Triheksifenidil Hidroklorida tablet 2 mg tablet 0 0 0 0 0 38.18 - - - - - -
244 Vaksin rabies vero ampul 0 0 0 0 0 - - - - - -
245 Vitamin A (Retinol) 100.000 IU kapsul lunak kapsul 0 0 0 0 0 248.00 - - - - - -
246 Vitamin A (Retinol) 200.000 IU kapsul lunak kapsul 0 0 0 0 0 402.00 - - - - - -
247 Vitamin B1 (Thiamin HCl) injeksi 100 mg/ml-1ml ampul 0 0 0 0 0 1,024.00 - - - - - -
248 Vitamin B1 (Thiamin HCl) tablet 50 mg tablet 0 0 0 0 0 31.82 - - - - - -
249 Vitamin B6 (Piridoksin HCl) tablet 10 mg tablet 0 0 0 0 0 16.53 - - - - - -
250 Vitamin B12 (Cyanocobalamin) injeksi 500 mcg/ml-1ml ampul 0 0 0 0 0 925.45 - - - - - -
251 Vitamin B12 (Cyanocobalamin) tablet tablet 0 0 0 0 0 12.73 - - - - - -
252 Vitamin B Complex tablet tablet 0 0 0 0 0 100.00 - - - - - -
253 Vitamin C (Asam Ascorbat ) tablet 50 mg tablet 0 0 0 0 0 90.91 - - - - - -
254 Vitamin C (Asam Ascorbat ) tablet 100 mg tablet 0 0 0 0 0 - - - - - -
255 Vitamin C (Asam Ascorbat ) tablet 250 mg tablet 0 0 0 0 0 49.09 - - - - - -
256 Zink 20 mg tablet Dispersibel tablet 0 0 0 0 0 451.82 - - - - - -
0 0 0 0 0 - - - - - -
II OBAT GIGI 0 0 0 0 0 - - - - - -
257 Air Raksa botol 0 0 0 0 0 - - - - - -
258 Alkahner/Cavit/Dentorit buah 0 0 0 0 0 115,000.00 - - - - - -
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259 Devitalisasi pasta (non arsen) kotak 0 0 0 0 0 354,545.47 - - - - - -
260 Etil klorida semprot botol 0 0 0 0 0 105,000.00 - - - - - -
261 Eugenol Cairan botol 0 0 0 0 0 41,666.67 - - - - - -
262 Flour tablet 0,5 mg tablet 0 0 0 0 0 - - - - - -
263 Formokresol (pengganti TKF) botol 0 0 0 0 0 86,500.00 - - - - - -
264 Glass ionomer cement (GC IX) set 0 0 0 0 0 592,000.00 - - - - - -
265 Glass ionomer cement (GC I) set 0 0 0 0 0 658,636.00 - - - - - -
266 Kalsium hidroksida pasta set 0 0 0 0 0 121,000.00 - - - - - -
267 Klorfenol kamfer menthol (CHKM) botol 0 0 0 0 0 55,000.00 - - - - - -
268 Mummifying pasta botol 0 0 0 0 0 159,090.92 - - - - - -
269 Semen seng fosfat serbuk dan cairan set 0 0 0 0 0 80,659.00 - - - - - -
270 Silver amalgam serbuk 65 - 75% botol 0 0 0 0 0 900,000.00 - - - - - -
271 Solare Komplete Kit (Solare A1,A2,A3/solare X/Shade Guid set 0 0 0 0 0 - - - - - -
272 Spons gelatin cubides 1 x 1 x 1 cm dental 0 0 0 0 0 1,000.00 - - - - - -
273 Temporary stopping fletcher (Fletcher) serbuk & cairan set 0 0 0 0 0 35,000.00 - - - - - -
0 0 0 0 0 - - - - - -
III OBAT TAMBAHAN 0 0 0 0 0 - - - - - -
274 Amoxan drop/ Supramox drop botol 0 0 0 0 0 20,000.00 - - - - - -
275 Bioplacenton Jelly tube 0 0 0 0 0 14,000.00 - - - - - -
276 Borax gliserin botol 0 0 0 0 0 2,300.00 - - - - - -
277 Burnazin cream pot 0 0 0 0 0 357,000.00 - - - - - -
278 Chloramfecort H cream/Colipred cream tube 0 0 0 0 0 - - - - - -
279 Counterpain cream / Molakrim tube 0 0 0 0 0 35,000.00 - - - - - -
280 Dextrofen syrup 60 ml botol 0 0 0 0 0 7,400.00 - - - - - -
281 Daryantul kotak 0 0 0 0 0 165,000.00 - - - - - -
282 FG troches tab isap tablet 0 0 0 0 0 - - - - - -
283 Guanestrip syr / Kanina syrup botol 0 0 0 0 0 - - - - - -
284 HB-Vit tablet 0 0 0 0 0 1,980.00 - - - - - -
285 H 2 O 2 3 % 1000 ml botol 0 0 0 0 0 35,000.00 - - - - - -
286 Ictiol salep pot 0 0 0 0 0 4,500.00 - - - - - -
287 Kanamycin inj 1 grm vial 0 0 0 0 0 - - - - - -
288 Kanamycin inj 2 grm vial 0 0 0 0 0 - - - - - -
289 Kandistatin Drop / Cazetin Drop botol 0 0 0 0 0 30,000.00 - - - - - -
290 Lacto-B sachet 0 0 0 0 0 3,650.00 - - - - - -
291 Lytacur syrup 60 ml botol 0 0 0 0 0 9,900.00 - - - - - -
292 Microlax tube 0 0 0 0 0 - - - - - -
293 Proris suppositoria supp 0 0 0 0 0 - - - - - -
294 Pehavral tablet (Multivitamin & mineral) tablet 0 0 0 0 0 700.00 - - - - - -
295 Polikresulen / Albotil concetrate 10 ml/Aptil 10 ml botol 0 0 0 0 0 16,357.27 - - - - - -
296 Rhinofed tablet tablet 0 0 0 0 0 1,535.00 - - - - - -
297 Stesolit rectal 5 mg tube 0 0 0 0 0 21,500.00 - - - - - -
298 Stesolit rectal 10 mg tube 0 0 0 0 0 38,000.00 - - - - - -
299 Tetagam injeksi vial 0 0 0 0 0 - - - - - -
300 Transamin tab 250 mg tablet 0 0 0 0 0 - - - - - -
301 Trombopop gel tube 0 0 0 0 0 60,000.00 - - - - - -
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0 0 0 0 0 - - - - - -
IV OBAT TRADISIONAL/JAMU/HERBAL/FITOFARMAKA 0 0 0 0 0 - - - - - -
302 Curcuma plus Fruit Veggie syrup botol 0 0 0 0 0 - - - - - -
303 Diapet tablet tablet 0 0 0 0 0 279.00 - - - - - -
304 Entrostop anak sachet 0 0 0 0 0 - - - - - -
305 Hemorogard kapsul 0 0 0 0 0 1,312.48 - - - - - -
306 Hepagard kapsul 0 0 0 0 0 2,363.13 - - - - - -
307 I-flex kapsul kapsul 0 0 0 0 0 - - - - - -
308 Lancar Asi kapsul 0 0 0 0 0 - - - - - -
309 Maximus dietary herbal kapsul 0 0 0 0 0 - - - - - -
310 Ocugard kapsul 0 0 0 0 0 3,997.26 - - - - - -
311 Prolipid kapsul 0 0 0 0 0 581.25 - - - - - -
312 Stimuno syrup botol 0 0 0 0 0 17,500.00 - - - - - -
313 Stimuno kapsul kapsul 0 0 0 0 0 2,200.00 - - - - - -
314 Tensigard kapsul 0 0 0 0 0 2,000.00 - - - - - -
0 0 0 0 0 - - - - - -
V BAHAN HABIS PAKAI 0 0 0 0 0 - - - - - -
315 Abbocate No. 18 set 0 0 0 0 0 4,600.00 - - - - - -
316 Abbocate No. 20 set 0 0 0 0 0 4,600.00 - - - - - -
317 Abbocate No. 22 set 0 0 0 0 0 4,600.00 - - - - - -
318 Abbocate No. 24 set 0 0 0 0 0 4,600.00 - - - - - -
319 Alat suntik sekali pakai 1 ml set 0 0 0 0 0 3,000.00 - - - - - -
320 Alat suntik sekali pakai 3 ml/ 2,5 ml set 0 0 0 0 0 1,443.98 - - - - - -
321 Alat suntik sekali pakai 5 ml set 0 0 0 0 0 950.00 - - - - - -
322 Alat suntik sekali pakai 10 ml set 0 0 0 0 0 3,262.80 - - - - - -
323 Alat suntik bias 0,5 ml set 0 0 0 0 0 - - - - - -
324 Alat suntik bias 0,05 ml set 0 0 0 0 0 1,895.00 - - - - - -
325 Alat suntik bias 5 ml set 0 0 0 0 0 - - - - - -
326 Alkohol Swap buah 0 0 0 0 0 410.00 - - - - - -
327 Catgut Cromic 2/0 dengan jarum lusin 0 0 0 0 0 110,200.00 - - - - - -
328 Catgut Cromic 3/0 dengan jarum lusin 0 0 0 0 0 110,200.00 - - - - - -
329 Catgut plain 2/0 dengan jarum lusin 0 0 0 0 0 110,200.00 - - - - - -
330 Catgut plain 3/0 dengan jarum lusin 0 0 0 0 0 110,200.00 - - - - - -
331 Cotton Aplication steril kotak 0 0 0 0 0 1,150.00 0.00 - - - - - -
332 Cover glass buah 0 0 0 0 0 - - - - - -
333 Etakridin (rivanol) larutan 0,1% btl 300 ml botol 0 0 0 0 0 1,500.00 - - - - - -
334 Etanol 70% 1000 ml botol 0 0 0 0 0 9,715.50 - - - - - -
335 Flash back needle pcs 0 0 0 0 0 - - - - - -
336 Foley catheter No. 18 buah 0 0 0 0 0 66,000.00 - - - - - -
337 Hand Scund (Steril) No. 7 psng 0 0 0 0 0 7,100.00 - - - - - -
338 Hand Scund (Steril) No. 7,5 psng 0 0 0 0 0 6,050.00 - - - - - -
339 Hand Scund Size S psng 0 0 0 0 0 1,400.00 - - - - - -
340 Hand Scund Size M psng 0 0 0 0 0 1,400.00 - - - - - -
341 Hand Scund Size L psng 0 0 0 0 0 1,400.00 - - - - - -
342 Infusion set Dewasa set 0 0 0 0 0 7,947.00 - - - - - -
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343 Infusion set anak set 0 0 0 0 0 3,650.00 - - - - - -
344 Kapas Berlemak 500 gram bungkus 0 0 0 0 0 - - - - - -
345 Kapas Pembalut/Absorben 250 gram bungkus 0 0 0 0 0 12,250.00 - - - - - -
346 Kasa Kompres 40/40 steril rol 0 0 0 0 0 - - - - - -
347 Kasa Pembalut 2 m x 80 cm rol 0 0 0 0 0 - - - - - -
348 Kasa Pembalut Hidrofil 4 m x 15 cm rol 0 0 0 0 0 - - - - - -
349 Kasa Pembalut Hidrofil 4 m x 3 cm rol 0 0 0 0 0 - - - - - -
350 Kasa Pembalut Hidrofil 40 m x 80 cm Gulung 0 0 0 0 0 - - - - - -
351 Kasa Pembalut Hidrifil 36 m x 80 cm rol 0 0 0 0 0 171,818.00 - - - - - -
352 Kasa Hidrofil Steril uk. 16 x 16 (isi 16 lembar) Kotak 0 0 0 0 0 8,250.00 - - - - - -
353 Kasa Hidrofil Steril uk. 18 x 22 cm (isi 12 lembar) Kotak 0 0 0 0 0 4,750.00 - - - - - -
354 Kasa Pembalut Hidrofil 4 m x 5 cm elastic Rol 0 0 0 0 0 370.00 - - - - - -
355 Kasa Pembalut Hidrofil 4 m x 10 cm elastic Rol 0 0 0 0 0 740.00 - - - - - -
356 Kertas Perkamen 75 x 100 cm lembar 0 0 0 0 0 - - - - - -
357 Kertas Puyer Manual (uk 11.5cm x 9 cm) Kotak 0 0 0 0 0 - - - - - -
358 Klep tali pusat pcs 0 0 0 0 0 1,440.00 - - - - - -
359 Lens paper buah 0 0 0 0 0 - - - - - -
360 Masker kotak 0 0 0 0 0 1,000.00 - - - - - -
361 Masker N-95 pcs 0 0 0 0 0 14,000.00 - - - - - -
362 Medicine paket paket 0 0 0 0 0 3,000,000.00 - - - - - -
363 Needle 25 g ( Terumo / Setara ) kotak 0 0 0 0 0 - - - - - -
364 Object Glass buah 0 0 0 0 0 - - - - - -
365 PH paper buah 0 0 0 0 0 - - - - - -
366 Pisau bedah (bisturi) No. 10 ujung tidak tajam pcs 0 0 0 0 0 14,000.00 - - - - - -
367 Pisau bedah (bisturi) No. 11 ujung tajam pcs 0 0 0 0 0 14,000.00 - - - - - -
368 Plester Hansaplas Roll (1.25 x 5 m) rol 0 0 0 0 0 7,000.00 - - - - - -
369 Plaster 5 yards x 2 inch rol 0 0 0 0 0 - - - - - -
370 Plastik Kantong Etiket Obat 8,7x13 cm (Besar) ball 0 0 0 0 0 65,000.00 - - - - - -
371 Plastik Kantong Etiket Obat 7x8 cm (Kecil) ball 0 0 0 0 0 35,000.00 - - - - - -
372 Pot Salep 10 gram pcs 0 0 0 0 0 400.00 - - - - - -
373 Pot Salep 5 gram pcs 0 0 0 0 0 - - - - - -
374 Pot Sputum/Pot Dahak pcs 0 0 0 0 0 1,980.00 - - - - - -
375 Povidon Iodida 10% 30 ml botol 0 0 0 0 0 1,863.64 - - - - - -
376 Povidon Iodida 10% 300 ml botol 0 0 0 0 0 - - - - - -
377 Povidon Iodida 10% 1000 ml botol 0 0 0 0 0 - - - - - -
378 Rapid Test untuk siphilis test 0 0 0 0 0 - - - - - -
379 Silk (benang bedah sutera)No. 3/0 dgn jarum bedah (PKD) lusin 0 0 0 0 0 57,136.36 - - - - - -
380 Safety box pcs 0 0 0 0 0 19,950.00 - - - - - -
381 Transfusion set set 0 0 0 0 0 - - - - - -
382 Urine bag pcs 0 0 0 0 0 2,727.28 - - - - - -
383 Vaselin botol 0 0 0 0 0 - - - - - -
384 Venflon No.18 set 0 0 0 0 0 - - - - - -
385 Wing Nedle No.23 set 0 0 0 0 0 3,934.09 - - - - - -
386 Wing Nedle No.25 G set 0 0 0 0 0 5,770.00 - - - - - -
0 0 0 0 0 - - - - - -
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VI REAGENSIA & BAHAN LABORATORIUM 0 0 0 0 0 - - - - - -
387 Anti Dengue NS-1 Card Test tes 0 0 0 0 0 117,000.00 - - - - - -
388 Anti Dengue Ig G/ Ig M/ Dengue Ig G/Ig M (Stick) tes 0 0 0 0 0 83,200.00 - - - - - -
389 Blood Lancet pcs 0 0 0 0 0 400.00 - - - - - -
390 Imersi Oil Mikroskop 100 ml botol 0 0 0 0 0 214,000.00 - - - - - -
391 Kartu golongan darah lembar 0 0 0 0 0 200.00 - - - - - -
392 Larutan Asam Klorida 0,1 N botol 0 0 0 0 0 - - - - - -
393 Larutan Asam sulfosalisilat 20 % botol 0 0 0 0 0 - - - - - -
394 Larutan Benedict 100 ml botol 0 0 0 0 0 - - - - - -
395 Larutan Eosin 2 % 100 ml botol 0 0 0 0 0 - - - - - -
396 Larutan Etanol Asam 100 ml botol 0 0 0 0 0 - - - - - -
397 Larutan Giemsa Stain 100 ml botol 0 0 0 0 0 312,000.00 - - - - - -
398 Larutan Hyem 100 ml botol 0 0 0 0 0 - - - - - -
399 Larutan Karbol Fuksin 100 ml botol 0 0 0 0 0 - - - - - -
400 Larutan Metilen Biru botol 0 0 0 0 0 - - - - - -
401 Larutan Natrium Sitrat botol 0 0 0 0 0 48,880.00 - - - - - -
402 Larutan Turk 100 ml botol 0 0 0 0 0 - - - - - -
403 Latex/ Tes kehamilan test 0 0 0 0 0 - - - - - -
404 Metanol 100 ml botol 0 0 0 0 0 - - - - - -
405 Ose jarum buah 0 0 0 0 0 - - - - - -
406 Reagen Zeil Nelsen BTA (Alkohol asam,methyl blue,carbol paket 0 0 0 0 0 - - - - - -
407 Reagen Pemeriksaan Trombocit (Rees Echer) 500 ml set 0 0 0 0 0 91,000.00 - - - - - -
408 Reagen Hematologi (mindray):deluent 20 l, Rinse 20 l, EZ set 0 0 0 0 0 - - - - - -
409 Reagen Hematologi (sweelab):deluent 20 l, lyse 20 l set 0 0 0 0 0 - - - - - -
410 Reagen Hematologi (Labnovition):deluent 40 l, lyse 1 l, Clea set 0 0 0 0 0 - - - - - -
411 Serum Gol Darah anti A & anti B set 0 0 0 0 0 120,000.00 - - - - - -
412 Serum gol Darah Anti D 0 0 0 0 0 - - - - - -
413 Tabung Vacutainer clot activator 3 ml pcs 0 0 0 0 0 - - - - - -
414 Tabung EDTA K3 ungu (3ml) pcs 0 0 0 0 0 - - - - - -
415 Test Widal set 0 0 0 0 0 - - - - - -
416 Urine Reagen Strip 2 parameter (PH) kotak 0 0 0 0 0 - - - - - -
417 Urine Reagen Strip 10 parameter (PH) kotak 0 0 0 0 0 359,000.00 - - - - - -
418 Urine Gluco Protein Test test 0 0 0 0 0 - - - - - -
419 K O H 10% botol 0 0 0 0 0 - - - - - -
420 USG Ultrasonic gel botol 0 0 0 0 0 - - - - - -
421 Ventolin Nebulizer kotak 0 0 0 0 0 158,000.00 - - - - - -
0 0 0 0 0 - - - - - -
VI HIV / AIDS 0 0 0 0 0 - - - - - -
422 Oncoprobe (HIV test 1 & 2 Anti body) tes 0 0 0 0 0 - - - - - -
423 SD HIV - 1/2 3.0 (Multi) tes 0 0 0 0 0 - - - - - -
424 Biomeriux VIKIA HIV 1/2 tes 0 0 0 0 0 - - - - - -
425 Triline test card - one step anti-HIV (1&2) tes 0 0 0 0 0 - - - - - -
426 Rapid 2 Tes HIV tes 0 0 0 0 0 - - - - - -
427 Needle Venoject pcs 0 0 0 0 0 - - - - - -
0 0 0 0 0 - - - - - -
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VII VAKSIN 0 0 0 0 0 - - - - - -
428 BCG (Bacille Calmette Guerin) vial 0 0 0 0 0 - - - - - -
429 Campak vial 0 0 0 0 0 - - - - - -
430 TT (Tetanus Toxoid) vial 0 0 0 0 0 - - - - - -
431 DT (Dipteri Tetanus) vial 0 0 0 0 0 - - - - - -
432 DPT-HB (Dipteri Pertusis Tetanus Hepatitis B) vial 0 0 0 0 0 - - - - - -
433 DPT-HB-HIB vial 0 0 0 0 0 - - - - - -
434 HB-Uniject sch 0 0 0 0 0 - - - - - -
435 Polio vial 0 0 0 0 0 - - - - - -
- - - - - -
YANG MENERIMA / MELAPOR YANG MEMBUAT LAPORAN

KEPALA PUSKESMAS PENGELOLA OBAT PKM
(....................................................) (....................................................)
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PUTIH : UPT INSTALASI FARMASI
MERAH : DINAS KESEHATAN
KUNING : ARSIP
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FORMULIR PELAPORAN INDIKATOR PERESEPAN ISPA NON PNEUMONI
Puskesmas : Sei Pancur

Kab / Kota : Batam Bulan Maret
Provinsi : Kepulauan Riau Tahun 2019
Lama Sesuai
Jumlah Antibiotik
Tanggal No Nama Umur Nama Obat Dosis Obat Pemakaian Pedoman
Item Obat ya/tidak
(hari) ya/tidak
1 2 3 4 5 6 7 8 9 10
ambroxol 3x1tb 3
ctm tb 3x1tb 3
26 1 mugi 35th 4 0
pct tb 3x1tb 3
pehavral tab 1x1tb 5
ambroxol sy 3x1cth 5
ctm tab 3x1/2tb 5
27 2 agsia 11th 1 0
pct tb 3x1/2tb 5
vit c tb 1x1tb 5
28 3 tasya 2,2th 2 0
gg tb 3x1tb 3
ctm tb 3x1tb 3
1 7 natalia 58th 3 0 vit bc tb 1x1tb 5
ambroxol tab 3x1tab 3

paracetamol tb 3x1tab 3
2 8 marselia 15th 3 0
ctm tab 3x1tab 3
3 9
3 9
ambroxol tb 3x1tb 3
dextamin tb 3x1tb 3
4 10 betty 33th 3 0
salbutamol 2mg 3x1/2tb 3
ambroxol tb 3x1tb 3
cetirizine 2x1tb 5
5 11 irawati 33th 4 1
dexametason 3x1tb 3
amoxycillin 3x1tb 5
dextrofen sy, 3x1tb 3
amoxicillin tab 3x1tb 3
6 12 alizar 40th 3 1
paracetamol tb 3x1tb 3
7 13
ambroxol 3x1tab 5
amoxy 3x1tab 5
8 14 marsudi 55th 4 1
dexametason 3x1tab 5
pct tab 3x1tba 5
noza tab 3x1tab 3
amoxycillin 3x1tb 3
9 15 anis 39th 3 1 ambroxol tab 3x1tb 3
10 16
asam mefe 3x1tb 3

ambroxol tb 2x1tb 2
11 17 yusida 34th 3 0
methyl pred 2x1tb 3
pct tb 3x1tb 3
amoxy 3x1tb 3
12 18 m safa 19thn 4 1
betafort sy 1x1cth 5
dextamin tb 3x1tb 3
ambroxol tb 3x1tb 3
13 19 elin 44th 3 0
pehavral tab 1x1tb 10
ambroxol sy 3x1/2cth 5
amoxy 3x1cth 3
14 20 fatan 4th 3 1 betafort sy 1x1cth 5
amoxycillin 3x1tb 3
pct tb 3x1tb 3
15 21 yuli 37th 4 1
ctm tb 3x1tb 3
gg tb 3x1tb 3
amoxycillin 3x1cth 3
16 22 salman 8th 4 1
pct sy 3x1cth 3
betafort sy 1xicth 5
17 23
pct drop 3x0,4ml 5

betafort sy 1x1/4cth 5
18 24 sopiani 4bln 3 0
pct sy 3x1cth 3
19 25 rosi 4,8th 2 0
dextamin tb 3x1tb 3
ambroxol tab 3x1tb 3
20 26 elda 40th 3 0
ketokonazole sk sue
20 26 elda 40th 3 0
pct tb 3x1tab 3
ambroxol 3x1c 3
21 27 feti 27th 2 0
pct sy 3x3/4cth 5
cohistan sy 3x1cth 5
22 28 adi siregar 10bln 3 0 betafort sy 1x1cth 5
abroxol syr 3x1c 3

dextamin tb 3x1tb 3
23 29 dewi 26th 3 0 vit c tab 2x1tb 5
24 30
cohistan sy 3x1/2cth 5
betafort sy 2x1/2cth 5
25 31 april 11bl 2 0
Total Item Obat 69 8

Rerata Item Obat /
N = 27 2.5555556
Lembar Resep
Persentase AB 29.62963
Petugas Apotek
UPT Puskesmas Sei Pancur Ket :
N = jml sampel / pasien yg jd sampel

Antibiotik : ya=1 tidak=0
Deska Mayantri Irmaliza
NIP. 19690130 199203 2008
FORMULIR PELAPORAN INDIKATOR PERESEPAN DIARE NON SPESIFIK

Kab / Kota : Batam Bulan MARET
Lama Sesuai
Tanggal No Nama Umur Jumlah Antibiotik Nama Obat Dosis Obat Pemakaian Pedoman
Item Obat ya/tidak
(hari) ya/tidak
1 2 3 4 5 6 7 8 9 10
domperidon tab 3x1tb 3
zink tab 1x1tb 5
26 1 miza 8bl 2 0
pct tab 3x1tb 3

oralit suc
27 2 aldy 13th 2 0
zink tab 1x1tb 10
28 3 khaerudi 4bln 1 0
oralit suc
zinkid 1xcth 10
1 7 adinda 10bl 2 0
oralit suc
zink tab 1x1tb 10
2 8 mida 25 2 0
3 9
pct syr 4x1/2cth 3

zink tab 1x1/2tb 5
4 10 by ny hati 1,5bln 3 0
lactobe 3x1/2cth 3
oralit 2
5 11 jumari 51th 3 0 antacida tb 3
5 11 jumari 51th 3 0
ibuprofen tb 3
zink tab 1x1tb 10
laktobe 2x1sac 3
6 12 saga 2,5th 3 0
oralit suc
7 13
8 14 _
domperidon sy 3x1cth 3
oralit suc 2
9 15 furqon 3,8th 3 0
betason sue 5
10 16
zink tab 1x1tb 10

laktobe suc 3
11 17 anisa 7bln 3 0
pct syr 3x1/2cth 3
oralit suc
zink tab 1x1tb 10
12 18 suyanto 54th 3 0
pct tb 2x1tb 3
oralit suc
laktobe 1x1tb 10
13 19 sahira 4,8th 3 0
zink tab 1x1tb 10
oralit
14 20 rahmat 41 2 0
zink tab 1x1tb 10
loperamida 2x1tb 2
domperidon tab 3x1tb 3
antacida syr 3x1cth 2
15 21 wohyta 20th 5 0
15 21 wohyta 20th 5 0
pct syr 3x1cth 3

domperidon sy 3x1cth 3
16 22 muamar 11th 4 0
antacida syr 3x1cth 3
oralit suc
17 23
loperamida tb 2x1tb 2
oralit suc 2
18 24 masyitoh 34th 3 0
vit bc tab 1x1tb 5
loperamida 2x1tb 3
pehavral tb 1x1tb 10
19 25 putri 25th 2 0
molagit 3x1tb 2
ranitidin 2x1tb 5
20 26 rahmat 33th 2 0
oralit suc
zink tab 1x1tab 10
21 27 ega 3th 2 0
zink tb 1x1tb
laktobe 2x1sac
22 28 engelia 2,6th 4 0
oralit suc
domperidon sy 2x1cth
zink tab 1x1tb 10
oralt suc
betafort sy 1x1cth 5
23 29 aira 2,9th 3 0
24 30
24 30
loperamida 3x1tb 3
domperidon 3x1tb 3
25 31 ibnu 15th 3 0
oralit suc
N = 26 Rerata Item Obat / 2.3076923

Lembar Resep
Persentase AB 0
Petugas Apotek

NIP. 19690130 199203 2 008
FORMULIR PELAPORAN INDIKATOR PERESEPAN MYALGIA

Kab / Kota : Batam Bulan MARET
Lama Sesuai
Jumlah Injeksi
Tanggal No Nama Umur Nama Obat Dosis Obat Pemakaian Pedoman
Item Obat ya/tidak (hari) ya/tidak
1 2 3 4 5 6 7 8 9 10
natrium dic 2x1tb 5
vit bc tab 1x1tb 10
26 1 rey monalisa 38th 3 0
nosten sk sue suc
natrium dic 2x1tb 5

neurodex 1x1tb 10
27 2 maryatun 40th 3 0
meformin tab 3c1tb 10
catopril 25mg 2x1tb 20

ibuprofen tab 3x1tb 10
28 3 nanik 45th 3 0
neurodex 1x1tb 10
natrium dic 2x1tb 5

nostren sue
1 7 siti fatimah 44th 2 0
pct tab 2x1tb 5

nosten sk sue
2 8 saroh 52th 2 0
3 9
amblodipine 1x1tb 20
ambroxol tb 3x1tb 3
4 10 kodesman 42th 4 0
amoxycillin 3x1tb 3
meloxicam 1x7,5mg 10
furosemid 1x1tb 10
piroxicam 10mg 2x1tb 5
5 11 zalenuri 59th 3 0
dexametason tb 2x1tb 5
gentamicin sue 5
natrium dic 2x1tb 5
6 12 sukarti 51th 3 0
tensigard 2x1cap 30
7 13
alupurinol 1x1tb 10
piroxicam 20mg 1x1tb 12
8 14 defrizal 41th 2 0
natrium dic 2x1tb 5

dexametason tb 3x1tb 5
9 15 nurhidayat 48th 4 0
vit bc 2x1tb 5
simvastatin tb 1x1tb 5
10 16
omz 1x1tb 10
11 17 mardiana 54th 4 0
natrium dic 1x1tb 10
ctm 1x1tb 5
12 18
natrium dic 2x1tb 5

ranitidin tab 2x1tb 5
13 19 nurlela 43th 3 0
vit bc tb 1x1tb 5

pehavral 1x1tb 5
14 20 endang 35th 2 0
glibeklamida 1x1tb 30
15 21 marliah 59 3 0
meloxicam 1x1tb 15
16 22 _
17 23

vit b6 tb 1x1tb 5
18 24 maryamah 43th 2 0

ondasetron, 3x1tb 5
19 25 sri mejeni 34 3 0

20 26 agustinus 38th 2 0
natrium dic 2x1tab 5

neurodex 1x1tab 10
21 27 catarina 45th 2 0
asam mefe 3x1tb 3

vit bc tb 1x1tb 5
22 28 mariah 39th 2 0
natrium dic 2x1tb 15

vit b12 1x1tb 30
23 29 nikmatin 41th 2 0
24 30
natrium dic 2x1tb 3

antacida tb 3x1tb 3
25 31 miati 55th 3 0
simvastatin tb 1x1tb 10
N = 22 Rerata Item Obat / 2.5909091

Lembar Resep
Persentase AB 0
Petugas Apotek

NIP. 19600130 199203 2 008
LAPORAN INDIKATOR PERESEPAN DI PUSKESMAS
Nama Puskesmas : Sei Pancur

Jenis Puskesmas : Perawatan
Jumlah Apoteker : 2
Jumlah AA/D3 Farmasi : 1
Jumlah Dokter : 15
Kabupaten / Kota : BATAM Bulan MARET
Provinsi : KEPRI Tahun : 2019
Rerata Item / Lembar Resep

% Penggunaan Antibiotk % Penggunaan Antibiotik pada % Penggunaan injeksi
pada ISPA Non-Pneumino Diare Non-Spesifik pada Myalgia
ISPA Diare Myalgia Rata-rata
1 2 3 4 5 6 7
29.6296296296 0 0 2.55555556 2.30769231 2.59090909 2.48471898
Perhitungan % indikator kunjungan POR

% Kunjungan POR = Jumlah %Pencapaian masing2 indikator peresepan /jmlh komponen indikator peresepan/jmlh komponen indikator peresepan
[(100-a)x100/80]+[(100-b)x100/92]+[(100-c)x100/99]+(100-d)x4/1,4]
4
[100-29,62)x100/80]+[100-0)x100/92]+[(100-0x100/99]+[(100-62)x4/1,4] =101.50%
4
a. % AB ISFA =
b. % AB Diare =
c . % Injecio Myalgia =
d. rerata item obat perlembar resep x100% d. 2,48x100%/4 = 62
Petugas Apotek
UPT Puskesmas Sei Pancur
DESKA MAYANTRI IRMALIZA

NIP. 19690130 199203 2 008
MONITORING PENGGUNAAN OBAT GENERIK DI SARANA PELAYANAN KESEHATAN
TAHUN 2019
PUSKESMAS
NAMA PUSKESMAS : SEI PANCUR
ALAMAT : KAV. SEI PANCUR BLOK I NO. 01
STATUS PASIEN : UMUM
Bulan: Maret 2019
ITEM OBAT DALAM RESEP NAMA OBAT

JUMLAH
TGL
RESEP TOTAL ITEM JUMLAH ITEM % OBAT
RESEP
PERHARI OBAT DALAM OBAT GENERIK = 3/2 NON GENERIK
RESEP GENERIK x 100 %
1 2 3 4 5 6
26 48 95 77 81.0526315789 betafort sy, nostren, neurodex, pehavral tab,
27 16 37 32 86.4864864865 betafort, cohistan sy, pehavral, neurodex
28 35 78 75 96.1538461538 pehavral, neurodex, cendo xitrol,
1 30 92 78 84.7826086957 neurodex, pehavral,cendo xitrol,
2 42 76 71 93.4210526316 fluocort sk,neorodex tab,
3 #DIV/0!
4 44 97 82 84.5360824742 betafort sy, pehavral tab, dextamin tb,
5 32 86 79 91.8604651163 pehavral tb, hepagard, cohistan, betafort, dextamin, dermasolon,
6 41 83 75 90.3614457831 cohistan, betafort sy, cendo xitro, dextrofen sy,
7 #DIV/0!
8 32 57 52 91.2280701754 dextamin tb, betafort sy, cohistan sy,
9 37 80 70 87.5 betafort sy, cohistan sy, noza tb, pehavral tb, dextamin tab
10 #DIV/0!
11 51 148 138 93.2432432432 cendo lytters,
12 27 56 42 75 betafort sy, cohistan sy, pehavral tab, c xitrol ttm
13 44 94 74 78.7234042553 laktobe,betafort sy, dextamin tab, pehavral tb, nostren, cohistan sy,
14 37 85 71 83.5294117647 betafort sy, cohistan sy, nostren, pehavral, neurodex
15 41 94 75 79.7872340426 neurodex, dermasolon, betafort sy, cohistan sy
16 43 84 73 86.9047619048 betafort sy, pehavral tb, dextamin syr, dermasolon sk
17 #DIV/0!
18 29 49 46 93.8775510204 betafort sy, cohistan sy, pehavral tab, c xitrol ttm
19 30 60 59 98.3333333333 cohistan sy. Neurodx tb, nostren tub, dextamin sy,
20 23 45 37 82.2222222222 cohistan sy, betafort sy, dextamin tb
21 32 57 53 92.9824561404 dermasolon, nostren, c lyters,
22 16 45 33 73.3333333333 cendo lytters, noza tab, laktobe,imudator, tensigard,
23 33 69 48 69.5652173913 imudatort sy, neurodex tb, betafort sy, cohistn sy, natavit, asifit,
24 #DIV/0!
25 35 73 56 76.7123287671 betafort sy, pehavral, noza,cohistan sy,
#DIV/0!
Batam, 2 April 2019

Mengetahui Pelapor
Kepala Puskesmas UPT Puskesmas Sei
Pengelola Obat UPT Puskesmas Sei Pancur
pancur
dr. muhammad hatta syaifulloh Deska Mayantri Irmaliza

NIP. 19840808 20110 1 001 NIP. 19690130 199203 2 008
TAHUN 2019
NAMA PUSKESMAS : SEI PANCUR

ALAMAT : KAV. SEI PANCUR BLOK I NO. 01
STATUS PASIEN : BPJS
Bulan: Maret
NO
ITEM OBAT DALAM RESEP NAMA OBAT
RESEP JUMLAH
RESEP
PERHARI TOTAL ITEM JUMLAH ITEM % OBAT
OBAT DALAM OBAT GENERIK = NON GENERIK
RESEP GENERIK 3/42x 100 %
1 2 3 4 5 6
26 78 119 88 73.9495798319 flocort sk, dextamin tb, hefagard,nostren sk
27 27 73 66 90.4109589041 pehavral, betafort, neurodex,
28 40 84 69 82.1428571429 neurodex, pehavral, betafort sy, cendo xitrol,
1 33 102 95 93.137254902 pehavral tb, zinkid sy, dermasolon,dextamin sy, nostren,
2 35 73 67 91.7808219178 pehavral, betafort syr, dextamin tb, pehavral tb,
3 #DIV/0!
4 58 129 112 86.8217054264 pehavral tab, cohistan sy, betafort syr, cendo xitro ttm, dextamin tb,
5 45 91 76 83.5164835165 neurodex, hepagard, pehavral, betafort sy, cohistan sy, dextrofen sy,
6 41 100 83 83 laktobe, cohistan sy, dextrofen sy, cendo lytter, dermasolon sk, dextamin tb, tensigard, nostren,
7 #DIV/0!
8 35 75 66 88 betafoet sy, dextamin tb, c xitrol ttm, dextamin sy, flucort sk, dermasolon,
9 76 192 179 93.2291666667 dextamin tb, betafort sy, laktafit, dextamin tb,
10 #DIV/0!
11 29 102 91 89.2156862745 laktobe,pehavral tb,
12 44 88 75 85.2272727273 neurodex tb, betafort sy, cohistan sy, dextrofen sy
13 30 59 50 84.7457627119 pehavral, betafort syr, dextamin tb, pehavral tb,
14 42 109 90 82.5688073394 neurodex tav, cohistan syr, betafort sy,
15 34 52 44 84.6153846154 cohistan sy, dextamin tab, pehavral tab, betafort syr
16 37 99 83 83.8383838384 nostren,neurodex, betafort sy,
17 #DIV/0!
18 73 142 124 87.323943662 betafort sy, dextamin tab, pehavral tab
19 43 87 71 81.6091954023 cohistan sy, pehavral,
20 31 68 57 83.8235294118 cendo lytter,dextamin sy, betafort sy, bioron tb, dextamin tb, cohistan sy,hepagard, neurodex
21 57 102 92 90.1960784314 cohistan sy, betafort sy, pehavral, neurodek,
22 33 63 46 73.0158730159 dextamin sy, pehavral tab, noza tab
23 32 54 43 79.6296296296 pehavral, tensigard, dextamin tb, neurodex,
24 #DIV/0!
25 66 127 93 73.2283464567 cohistan sy, betafort sy, phavral tb, natavit,
1019 2190 1860 84.9315068493
Batam, 2 April 2019
Mengetahui Pelapor
Kepala Puskesmas UPT Puskesmas Sei
Pengelola Obat UPT Puskesmas Sei Pancur
pancur
dr. muhammad hatta syaifulloh Deska Mayantri Irmaliza

NIP. 19670603 200701 2 021 NIP. 19690130 199203 2008
LAPORAN BULANAN PELAYANAN KEFARMASIAN DI PUSKESMAS
Nama Puskesmas : Sei Pancur

Jenis Puskesmas : Perawatan
Kab / Kota : Batam
Provinsi : Kepulauan Riau
Lap. Bulan : Maret Tahun : 2019
JENIS PELAYANAN RESEP

NO Tanggal
Rawat Jalan Rawat Inap Konseling Informasi Obat
UMUM BPJS TOTAL
1 2 3 4 5 6 7
1 2/26/2019 48 78 126 44
2 2/27/2019 16 27 43 44
3 2/28/2019 35 40 75 2 44
7 3/1/2019 30 33 63 44
8 3/2/2019 42 35 77 44
9 3/3/2019
10 3/4/2019 44 58 102 44
11 3/5/2019 32 45 77 44
12 3/6/2019 41 41 82 44
13 3/7/2019 2
14 3/8/2019 32 35 67 44
15 3/9/2019 37 76 113 44
16 3/10/2019
17 3/11/2019 51 29 80 44
18 3/12/2019 27 44 71 44
19 3/13/2019 44 30 74 2 44
20 3/14/2019 37 42 79 44
21 3/15/2019 41 34 75 44
22 3/16/2019 43 37 80 44
23 3/17/2019
24 3/18/2019 29 73 102 44
25 3/19/2019 30 43 73 44
26 3/20/2019 23 31 54 2 44
26 3/21/2019 32 57 89 44
26 3/22/2019 16 33 49 44
26 3/23/2019 33 32 65 44
26 3/24/2019 0
26 3/25/2019 35 66 101 44
TOTAL 798 1019 1817 8 1012 0
Mengetahui
Kepala Puskesmas
UPT Puskesmas Sei Pancur
dr Muhammad hatta syaifulloh

NIP. 19840808 201101 1 001
Kolom 4 : Jml lembar r/ dr rawat jalan dlm satu hari
kolom 5 : Jml lembar r/ dr rawat inap dlm satu hari
kolom 6 : pasien yg mendapat konseling dan didokumentasikan

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LAPORAN PEMAKAIAN DAN LEMBA

JUMLAH KUNJUNGAN RESEP UMUM BPJS JUMLAH

(RABAINA S.Si., Apt)

PUTIH : UPT INSTALASI FARMASI

PERSEDIAAN PEMAKAIAN SISA STOK

YANG MENERIMA / MELAPOR YANG MEMBUAT LAPORAN

KODE PUSKESMAS : BULAN : JANUARI PUTIH : UPT INSTALASI FARMASI

PUSKESMAS : MERAH : DINAS KESEHATAN

KECAMATAN : TAHUN : 2015 KUNING : ARSIP

KELAS PENERI PERSEDIAA PEMAKAIA STOK PERMIN PEMBE

JUMLAH KUNJUNGAN RESEP UMUM BPJS JUMLAH

(drg. CHANDRA RIZAL, MSi) (RABAINA S.Si., Apt) (....................................................) (....................................................

YANG MENERIMA / MELAPOR YANG MEMBUAT LAPORAN

MERAH : DINAS KESEHATAN

Puskesmas : Sei Pancur

ambroxol tab 3x1tab 3

asam mefe 3x1tb 3

pct drop 3x0,4ml 5

abroxol syr 3x1c 3

Total Item Obat 69 8

N = jml sampel / pasien yg jd sampel

Puskesmas : Sei Pancur

pct tab 3x1tb 3

zink tab 1x1tb 10

pct syr 4x1/2cth 3

zink tab 1x1tb 10

pct syr 3x1cth 3

Total Item Obat 60 0

N = 26 Rerata Item Obat / 2.3076923

N = jml sampel / pasien yg jd sampel

Puskesmas : Sei Pancur

natrium dic 2x1tb 5

catopril 25mg 2x1tb 20

natrium dic 2x1tb 5

pct tab 2x1tb 5

natrium dic 2x1tb 5

natrium dic 2x1tb 5

ibuprofen tab 3x1tb 10

ibuprofen tab 3x1tb 3

ibuprofen tab 2x1tb 5

ibuprofen tab 3x1tb 10

natrium dic 2x1tab 5

asam mefe 3x1tb 3

natrium dic 2x1tb 15

natrium dic 2x1tb 3

Total Item Obat 57 0

N = 22 Rerata Item Obat / 2.5909091

N = jml sampel / pasien yg jd sampel

Nama Puskesmas : Sei Pancur

Rerata Item / Lembar Resep

29.6296296296 0 0 2.55555556 2.30769231 2.59090909 2.48471898

Perhitungan % indikator kunjungan POR

DESKA MAYANTRI IRMALIZA

Bulan: Maret 2019

ITEM OBAT DALAM RESEP NAMA OBAT

Batam, 2 April 2019

dr. muhammad hatta syaifulloh Deska Mayantri Irmaliza

NAMA PUSKESMAS : SEI PANCUR

Batam, 2 April 2019

dr. muhammad hatta syaifulloh Deska Mayantri Irmaliza

Nama Puskesmas : Sei Pancur

JENIS PELAYANAN RESEP

dr Muhammad hatta syaifulloh