LPLPO PUSKESMAS

(1)

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT PUSKESMAS :

PUSKESMAS : PPEELLAAPPOORRAAN N BBUULLAANN : : DDOOKKUUMMEENN NNOOMMOORR TTGGLL//BBLLNN/ / TTHHNN KECAMAT

KECAMATAN AN :: PPEERRMMIINNTTAAAAN N BBUULLAANN : : GGFFKK 444422/ / //LLPPLLPPOO--GGFFKK KABUPA

KABUPATEN TEN : BENGKAY: BENGKAYANGANG PUSKESMASPUSKESMAS

N

NOO NNAAMMAAOOBBAATT SSAATTUUAANN SSTTOOKK PPEENNEE-- PPEERRSSEE-- PPEEMMAA-- SSIISSAA SSTTOOKK PEPERRMMIINN-- PPEEMMBBEERRIIAANN KETKET A

AWWAALL RRIIMMAAAANN DDIIAAAANN KKAAIIAANN SSTTOOKK OOPPTTIIMMUUMM TTAAAANN IINNPPRREESS AASSKKEESS AAPPBBDD LLAAIINN JJUUMMLLAAHH 1

1 22 33 44 55 66 77 88 99 1100 1111 1122 1133 1144 1155 1166

1

1 ALBENDAZOLE 400 MGALBENDAZOLE 400 MG TABLETTABLET - -

--2

2 ALLOPURINOL 100 MGALLOPURINOL 100 MG TABLETTABLET - -

--3

3 AMBROXOL 30 MGAMBROXOL 30 MG TABLETTABLET - -

--4

4 AMBROXOL SRUPAMBROXOL SRUP BOTOLBOTOL - -

--!

! AMINOPHLLIN 200 MGAMINOPHLLIN 200 MG TABLETTABLET - -

--"

" AMINOPHLLIAMINOPHLLIN 24 N 24 MG / MG / ML ML INJEKSIINJEKSI AMPULAMPUL - - --#

# AMITRIPTILLIN 2! MGAMITRIPTILLIN 2! MG TABLETTABLET - -

--$

$ AMOKSISILLIN 2!0 MGAMOKSISILLIN 2!0 MG KAPSULKAPSUL - -

--%

% AMOKSISILLIN !00 MGAMOKSISILLIN !00 MG KAPSULKAPSUL - -

--10

10 AMOKSISILLIN 12! MG / !ML SRUPAMOKSISILLIN 12! MG / !ML SRUP BOTOLBOTOL - -

--11

11 AMPISILLIN 2!0 MGAMPISILLIN 2!0 MG KAPSULKAPSUL - -

--12

12 AMPISILLIN !00 MGAMPISILLIN !00 MG KAPSULKAPSUL - -

--13

13 AMPISILLIN SRUP KERINGAMPISILLIN SRUP KERING BOTOLBOTOL - -

--14

14 ANTALGIN & METAMPIRON ' !00 MGANTALGIN & METAMPIRON ' !00 MG TABLETTABLET - - --1!

1! ANTALGIN 2!0 MG /ML - INJEKSIANTALGIN 2!0 MG /ML - INJEKSI AMPULAMPUL - -

--1"

1" ANTASIDA SUSPENSIANTASIDA SUSPENSI BOTOLBOTOL - -

--1#

1# ANTASIDA DOEN KOMBINASIANTASIDA DOEN KOMBINASI TABLETTABLET - -

--1$

1$ ANTI BAKTERI DOEN SALEPANTI BAKTERI DOEN SALEP TUBETUBE - -

--1%

1% ANTI HEMOROID DOEN KOMBINASIANTI HEMOROID DOEN KOMBINASI SUPPSUPP - -

--20

20 ANTI FUNGI DOEN KOMBINASIANTI FUNGI DOEN KOMBINASI TUBETUBE - -

--21

21 ANTIMIGRAINANTIMIGRAIN TABLETTABLET - -

--22

22 ANTI PARKINSON KOMBINASIANTI PARKINSON KOMBINASI TABLETTABLET - -

--23

23 A(UA PRO INJEKSI) BEBAS PIROGENA(UA PRO INJEKSI) BEBAS PIROGEN *IAL*IAL - -

--24

24 ASAM ASKORBAT !0 MGASAM ASKORBAT !0 MG TABLETTABLET - -

--2!

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--NO NAMAOBAT SATUAN STOK PENE- PERSE- PEMA- SISA STOK PERMIN- PEMBERIAN KET

AWAL RIMAAN DIAAN KAIAN STOK OPTIMUM TAAN INPRES ASKES APBD LAIN JUMLAH

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

2# ASETOSAL 100 MG TABLET -

-2$ ASETOSAL !00 MG TABLET -

-2% ASIKLO*IR 200 MG TABLET -

-30 ATROPIN SULFAT INJEKSI 0)2! MG AMPUL -

-31 ATENOLOL !0 MG TABLET -

-32 ATROPIN SULFAT O)! MG TABLET -

-33 ATROPIN SULFAT 0)! + TETES MATA BOTOL -

-34 BENZATIN METIL PENI,ILLIN 1)2 JT IU *IAL -

-3! BETAMETHASON 0)1 + KRIM TUBE -

-3" ,EFADROXIL 2!0 MG KAPSUL -

-3# ,EFADROXIL !00 MG KAPSUL -

-3$ ,IMETIDINE 200 MG TABLET -

-3% ,IMETIDINE INJEKSI AMPUL -

-40 DEXAMETHASONE ! MG/ML INJEKSI AMPUL -

-41 DEXAMETHASONE 0)! MG TABLET -

-42 DEXTRAN #0 INFUS "+ !00 ML BOTOL -

-43 DEKSTROMETHORPHAN SRUP BOTOL -

-44 DEKSTROMETHORPHAN 1! MG TABLET -

-4! DIAZEPAM 2 MG TABLET -

-4" DIAZEPAM ! MG TABLET -

-4# DIPHENHIDRAMIN H,L INJEKSI AMPUL -

-4$ DIGOXIN 0)2! TABLET -

-4% DOKSISIKLIN 100 MG KAPSUL -

-!0 EFEDRIN H,L 2! MG TABLET -

-!1 EKSTRAK BELLADONE 10 MG TABLET -

-!2 ERITROMISIN 2!0 MG KAPSUL -

-!3 ERITROMISIN !00 MG KAPSUL -

-!4 ERITROMISIN SRUP 200 MG / ! ML BOTOL -

-!! EFINEFRIN / ADRENALIN INJEKSI AMPUL -

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-!$ ETANOL #0 + 1000 ML BOTOL -

-NO NAMAOBAT SATUAN STOK PENE- PERSE- PEMA- SISA STOK PERMIN- PEMBERIAN KET

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

!% FAMOTIDINE 20 MG TABLET -

-"0 FENITOIN NATRIUM 30 MG KAPSUL -

-"1 FENOKSIMETIL PENISILLIN 2!0 MG TABLET -

-"2 FENOKSIMETIL PENISILLIN !00 MG TABLET -

-"3 FEBOBARBITAL 30 MG TABLET -

-"4 FENOBARBITAL INJEKSI AMPUL -

-"! FENOL GLISEROL 10 + TETES TELINGA BOTOL -

-"" FERRO SULFAT 300 MG/TAMBAH DARAH TABLET -

-"# FITOMENADION / *ITAMIN K INJEKSI AMPUL -

-"$ FITOMENADION / *ITAMIN K TABLET TABLET -

-"% FLUOR TABLET -

-#0 FUROSEMIDE 40 MG TABLET -

-#1 GAMEKSAN EMULSI 1+ BOTOL -

-#2 GARAM ORALIT 200 ML SA,HET -

-#3 GENTAMI,IN 0)1+ SALEP KULIT TUBE -

-#4 GENTAMI,IN $0 MG / ML INJEKSI *IAL -

-#! GLIBENKLAMIDE ! MG TABLET -

-#" GLISERIL GUAIKOLAT 100 MG TABLET -

-## GLISERIN 100 ML BOTOL -

-#$ GLUKOSA ! + INFUS !00 ML BOTOL -

-#% GLUKOSA 10 + INFUS !00 ML BOTOL -

-$0 GRISEOFUL*IN 12! MG TABLET -

-$1 HALOPERIDOL 0)! MG TABLET -

-$2 HALOPERIDOL 1)! MG TABLET -

-$3 HALOPERIDOL ! MG TABLET -

-$4 HIDROKLOROTHIAZID & H,T ' 2! MG TABLET -

-$! HIDROKORTISON 2)! + KRIM TUBE -

-$" IBUPROFEN 200 MG TABLET -

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-$% ISOSORBID ! MG SUBLINGUAL TABLET -

-%0 IODIAL KAPSUL LUNAK KAPSUL -

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

%1 KALSIUM LAKTAT & KALK ' !00 MG TABLET -

-%2 KAPTOPRIL 12)! MG TABLET -

-%3 KAPTOPRIL 2! MG TABLET -

-%4 KARBAMAZEPIN 200 MG TABLET -

-%! KETAMIN 10 MG / ML INJEKSI *IAL -

-%" KETO,ONAZOLE 200 MG TABLET -

-%# KETOKONAZOLE 2 + KRIM 1! G TUBE -

-%$ KLORAMFENIKOL 2!0 MG KAPSUL -

-%% KLORAMFENIKOL 3+ TETES TELINGA BOTOL -

-100 KLORAMFENIKOL 0)!+ TETES MATA BOTOL -

-101 KLORFENIRAMINI MALEAT & ,TM ' TABLET -

-102 KLORPROMAZIN H,L 2! MG TABLET -

-103 KLORPROMAZIN H,L 100 MG TABLET -

-104 KLORO(UIN FOSFAT 1!0 MG TABLET -

-10! KODEIN 10 MG TABLET -

-10" KOMB PIRIMETAMIN . SULFADOXIN TABLET -

-10# KOTRIMOKSAZOLE SUSPENSI BOTOL -

-10$ KOTRIMOKSAZOLE DEWASA TABLET -

-10% KOTRIMOKSAZOLE PAEDIATRIK TABLET -

-110 KUININ & KINA ' 200 MG TABLET -

-111 KUININ DI H,L 2!+ INJEKSI AMPUL -

-112 LISOL BOTOL -

-113 MAGNESIUM SULFAT 20+ INJEKSI *IAL -

-114 MAGNESIUM SULFAT 40+ INJEKSI *IAL -

-11! MEBENDAZOLE SRUP 100 MG / ! ML BOTOL -

-11" MEBENDAZOLE 100 MG TABLET -

-11# MEBENDAZOLE !00 MG TABLET -

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-120 METO,HLORPHAMIDE SUSPENSI AMPUL -

-121 METO,HLORPHAMIDE 10 MG TABLET -

-122 METO,HLORPHAMIDE ! MG TABLET -

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

123 METRONIDAZOLE 2!0 MG TABLET -

-124 MI,ONAZOLE 2 + KRIM TUBE -

-12! NATRIUM BIKARBONAT !00 MG TABLET -

-12" NATRIUM DIKLOFENAK !0 MG TABLET -

-12# NATIURM KLORIDA 0)%+ INFUS !00 ML BOTOL -

-12$ NIFEDIPINE 10 MG TABLET -

-12% NISTATIN !00000 IU TABLET -

-130 NISTATIN *AGINAL 100000 IU SUPP -

-131 OBAT BATUK HITAM & O B H ' SRUP BOTOL -

-132 OFLOXA,IN 200 MG KAPSUL -

-133 OKSITETRASIKLIN H,L 1+ SALEP MATA TUBE -

-134 OKSITETRASIKLIN H,L 3+ SALEP KULIT TUBE -

-13! OKSITETRASIKLIN INJEKSI !0 MG / ML-10 *IAL -

-13" OMEPRAZOLE 20 MG KAPSUL -

-13# OKSITOSIN INJEKSI AMPUL -

-13$ PAPA*ERIN 40 MG TABLET -

-13% PARA,ETAMOL SRUP 120 MG/ ! ML BOTOL -

-140 PARA,ETAMOL 100 MG TABLET -

-141 PARA,ETAMOL !00 MG TABLET -

-142 PIRANTEL 12! MG KAPLET -

-143 PIROXI,AM 10 MG KAPSUL -

-144 PIRIDOKSIN H,L & *ITB" ' 10 MG TABLET -

-14! PO*IDONE 1ODIDA 30 + 10 ML BOTOL -

-14" PO*IDONE 1ODIDA 10 + 300 ML BOTOL -

-14# PREDNISONE ! MG TABLET -

-14$ PRIMAKUIN 1! MG TABLET -

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-1!1 RANITIDINE 1!0 MG TABLET -

-1!2 RESERPIN 0)2! MG TABLET -

-1!3 RINGER LAKTAT INFUS !00 ML BOTOL -

-1!4 SALEP 2 - 4 KOMBINASI TUBE -

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

1!! SALBUTAMOL 2 MG TABLET -

-1!" SALISIL BEDAK 2+ KOTAK -

-1!# SIANOKOBALAMIN & *IT B12 ' INJEKSI AMPUL -

-1!$ SIPROFLOKSASIN !00 MG KAPSUL -

-1!% SULFADIMIDIN TABLET -

-1"0 TETRASIKLIN 0)!+ TETES MATA BOTOL -

-1"1 TETRASIKLIN H,L 2!0 MG KAPSUL KAPSUL -

-1"2 TETRASIKLIN H,L !00 MG KAPSUL KAPSUL -

-1"3 THIAMIN H,L & *IT B1 ' INJEKSI AMPUL -

-1"4 THIAMIN H,L MONONITRAT !0 MG TABLET -

-1"! *ITAMIN B KOMPLEKS TABLET -

-1"" *ITAMIN B 12 TABLET -

-ALAT KESEHATAN :

1"# ALAT SUNTIK SEKALI PAKAI 1 ML SET -

-1"$ ALAT SUNTIK SEKALI PAKAI 3 ML SET -

-1"% ALAT SUNTIK SEKALI PAKAI ! ML SET -

-1#0 ,ATETER INFUS NO 1" SET -

-1#1 ,ATETER INFUS NO 1$ SET -

-1#2 ,ATETER INFUS NO 20 SET -

-1#! ,ATGUT/BENANG BEDAH NO2/0 DENGAN JARUM SET -

-1#" ,ATGUT/BENANG BEDAH NO3/0 DENGAN JARUM SET -

-1## INFUSION SET ANAK SET -

-1#$ INFUSION SET DEWASA SET -

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-1$1 KASSA KOMPRES 40 / 40 STERIL ROL -

-1$2 KASSA PEMBALUT 2 M X $0 ,M ROL -

-1$3 KASSA PEMBALUT HIDROFIL 4 M X 3 ,M ROL -

-1$4 KASSA PEMBALUT HIDROFIL 4 M X 1! ,M ROL -

-1$! PEMBALUT GIPS ROL -

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

1$" PLESTER ! ARDS X 2 IN,H ROL -

-1$# SILK &BENANG BEDAH SUTERA' NO 3/0 DENGAN SET -

-1$$ WING NEEDLE NO 21 G SET -

-1$% WING NEEDLE NO 23 G SET -

-1%0 WING NEEDLE NO 2! G SET -

-1%1 WING NEEDLE NO 2# G SET -

-OBAT GIGI :

1%2 ETIL KLORIDA SPRA BOTOL -

-1%3 EUGINOL ,AIRAN BOTOL -

-1%4 FORMALIN ,AIRAN DRUM -

-1%! LIDO,AIN 2 + INJEKSI AMPUL -

-1%" ART PUJI %  2 SET -

-1%# LIDO,AIN 2+.EFINEFRIN INJEKSI AMPUL -

-OBAT KIA

1%$ *ITAMIN/MINERAL IBU HAMIL & SIOBION ' KAPSUL -

-1%% *ITAMIN/MINERAL UNTUK WUS & FARMABION ' KAPSUL - -OBAT PRGRAM PERBAIKAN GIZI:

200 MULTI*ITAMIN SRUP & BIONI, ' BOTOL -

-201 MULTI*ITAMIN SRUP & TALISIN ' BOTOL -

-OBAT PRGRAM TB , MALARIA, DIARE:

(8)

-20! OAT KAT ANAK PAKET -

-20" OAT SISIPAN DEWASA PAKET -

-20# A,T& ARTESUNTA.AMODIA(UIN ' PAKET -

-20$ ZIN, KAPSUL KAPSUL -

-20% ZIEHL NIELSEN PAKET -

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 REAGENSI DLL : - -210 MASKER KOTAK - -211 GIEMSA PAKET - -- -- -- --

-JUMLAH KUNJUNGAN RESEP

UMUM

ASKES JUMLAH BAAR TIDAK BAAR

   

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(9)

Dr. I Made Putra Negara & '  !  !