Blangko Lplpo Puskesmas-2018

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LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

( L P L P O )

KODE

KODE PUSKESPUSKES MAS MAS : : ________________________ ________________________ P PUUSSKKEESSMMAASS ::________________________________________________ BBUULLAANN ::________________________________ K KEECCAAMMAATTAANN ::________________________________________________ TTAAHHUUNN ::________________________________ K KAABBUUPPAATTEEN N : : ________________________________________________ MMAASSUUK K TTGGLL.. : : _______________________________ _ PROPIN PROPIN SI SI : : ________________________ ________________________ N

NAAMMA A OOBBAATT SSAATTUUAANN _DA_D_AK_K _B_BP_PJ_JS_S PEMBERIANPEMBERIAN_P_PR_RO_OG_G _L_LA_AIIN_N--2₂ KET.KET. TOTAL TOTAL

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1 22 33 44 55 66 77 ((55++66)) 88 99((77--88)) 1100 ((88++BBllnnllaalluu 1122 1133 1144 1155 1166 1177

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1 110011 AAccoon n SSttiik k ffoor r PP!!nno o TT""##tt kkoott!!kk 2

2 110022 AAcc$$ccoo%%iir r kkrrii&& tt''(("" )

) 1100)) AAcc$$ccoo%%iir r tt!!((""t t - - 22000 0 &&** tt!!((""tt +

+ 1100++ AAcc$$ccoo%%iir r tt!!((""t t - - ++000 0 &&** tt!!((""tt ,

, 1100,, AAiir r rr!!kk##! ! ""nntt!!  ''##"" ((oottoo 

 1100 AA!!t t SS''nnttiik k 110 0 && ##""tt /

/ 1100// AA!!t t ##''nnttiik k ##""kk!!i i !!kk!!i i 1 1 && ##""tt 

 1100 AA!!t t ##''nnttiik k ##""kk!!i i !!kk!!i i 22, , && ##""tt 3

3 110033 AA!!t t ##''nnttiik k ##""kk!!i i !!kk!!i i , , && ##""tt 1

100 111100 AA((""nn!!44oo  tt!!((""t t ++000 0 &&** tt!!((""tt 1

111 1111)) AAkkoo55oo  33, , 66 ((oottoo 1

122 1111++ AAkkoo55oo  SS77!!(( oo## 1

1)) 1111,, AAoo''rriinnoo  tt!!((""tt tt!!((""tt 1

1++ 1111 A!r! A!r! t!("tt!("t 1

1,, 1111// AA&&((rroo88oo  ##iirr''  0 0 &&  ((oottoo 1

1 1111 AA&&((rroo88oo  tt!!((""t t ))0 0 &&** tt!!((""tt 1

1// 111133 AA&&iinnooffiiiinn! ! iinn99""kk##i 2i 2++&&**::&&--1100&& !!&&'' 1

1 112200 AA&&iinnooffiiiinn! ! tt!!((""t t 22000 0 &&** tt!!((""tt 1

133 112211 AA&&iittrriittiiiinn! ! ;;<<L L tt!!((""t 2t 2, , &&** tt!!((""tt 2

200 112222 AA&&ooiiiin n 110 0 &&** tt!!((""tt 2

211 1122)) AA&&ookk##iiiin n ==oorrtt" " SSiirr''  KK""rriinn** ((oottoo 2

222 1122++ AA&o&okk#i#iiin n kk!!""t t - - ,,00 00 &* &* k!k!""tt 2

2)) 1122,, AA&o&okk#i#iiin n kk!!##' ' - - 2,2,0 0 &* &* kk!!#'#' 2

2++ 1122 AA&&ookk##iiiin n SSiirr''  KK""rriinn** ((oottoo 2

2,, 1122// AA&&ii##iiiinn! ! iinn99""kk##i i 1 1 **rr!!&& %%ii!! 2

2 1122 AAnntt!!**iin n iinn99""kk##i i 22+ + &&**::&&--1100&& !!&&'' 2

2// 112233 AAnntt!!**iin n tt!!((""t t ,,0000&&** tt!!((""tt 2

2 11))00 AAnntt!!##i i DDOOEEN N III I SS''##""nn##iiKKoo&&((ii ((oottoo 2

233 11))11 AAnntt!!##ii! ! DDoo""n n tt!!((""tt tt!!((""tt )

)00 11))22 AAnntti i ;;""&&&&oorrooii  SS''oo##iittoorrii!! ##'' ) )11 11)))) tt''(("" ) )22 11))++ oott ) ))) 11)),, tt!!((""tt )

)++ 11)) Antr!in Antr!in in9"k#i 2& :,in9"k#i 2& :, !&'!&' No. No. URUT URUT No. No. KODE KODE STOK STOK A>AL A>AL PENERIMA PENERIMA AN AN PERSEDIA PERSEDIA AN AN PEMAKAI PEMAKAI AN AN SISA SISA STOK STOK STOK STOK OPT. OPT. PERMINTA PERMINTA AN AN

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NAAMMA A OOBBAATT SSAATTUUAANN _DA_D_AK_K _B_BP_PJ_JS_S PEMBERIANPEMBERIAN_P_PR_RO_OG_G _L_LA_AIIN_N--2₂ KET.KET. TOTAL TOTAL 1 1 22 33 44 55 66 77 ((55++66)) 88 99((77--88)) 1100 ((88++BBllnnllaalluu 1122 1133 1144 1155 1166 1177 No. No. URUT URUT No. No. KODE KODE STOK STOK A> A>ALAL PENERIMA PENERIMA AN AN PERSEDIA PERSEDIA AN AN PEMAKAI PEMAKAI AN AN SISA SISA STOK STOK STOK STOK OPT. OPT. PERMINTA PERMINTA AN AN )

),, 11))// AA''! ! rro o iinn99""kk##i i ##tt""rrii  - - 220 0 && !!&&'' )

) 11)) AA''!!""##t t ##tt""rrii  - - 1100000 0 && ((oottoo )

)// 11))33 AA''!!""##t t ##tt""rrii  - - ,,000 0 && ((oottoo )

) Air 'tk Iri*r! L!r Inf'# 1000 & Air 'tk Iri*r! L!r Inf'# 1000 & (oto(oto )

)33 11++00 A'!*" St"ri" J"$ 2 *r A'!*" St"ri" J"$ 2 *r t'("t'(" +

+00 11++11 AA##!!& & AA##kkoorr((!!t t ??%%iit t <<  tt!!((""t t ,,0 0 &&** tt!!((""tt +

+11 11++)) AA##!!& & MM""ff""nn!!&&!!t t kk!!""t t ,,000 0 &&** kk!!""tt +

+22 11++++ AA##!!& & ttrr!!nn""88!!&&!!t t iinn99""kk##i i 110000&&**::&& !!&&'' +)

+) 1+1+,, A#A#!&!&TTrr!n!n"k"k#!#!&!&!t t ;<;<L L t!t!(("t "t ,0,00&0&** t!t!(("t"t +

+++ 11++ A#"tic G" @ Di# A#"tic G" @ Di# ,00 &,00 & (oto(oto +

+,, 11++// AA##""ttoo##!!  tt!!((""t t 11000 0 &&** tt!!((""tt +

+ 11++33 AA##""ttoo##!!  tt!!((""t t 0 0 &&** tt!!((""tt +/

+/ Att!'*it 00 &* Att!'*it 00 &* t!("tt!("t +

+ 11,,00 AAtttt!!''**iit t ))0 0 &&** tt!!((""tt +

+33 11,,11 AAttrrooiinn! ! SS''ff!!t t iinn99""kk##ii !!&&'' ,

,00 11,,)) AA''ttooii##oo##!!((" " SS$$rriinn**" " 0000, , && ##""tt ,

,11 11,,++ ##""tt ,

,22 11,,// ##""tt ,

,)) 11,, AA44iittrroo&&iicciin n 22,,0 0 &&* * tt!!(( tt!!((""tt ,

,++ 220011 B!5!n t'&!t!n #"&"nt!r!:<!%itonB!5!n t'&!t!n #"&"nt!r!:<!%iton (oto(oto ,

,,, 2200)) BB""cc""ffoorrt t tt!!((""tt tt!!((""tt ,

, 2200,, BB""nn44!!ttiin n BB""nn##ii  PP""nn..iinn9 9 22+ 9+ 9''tt! ! IIUU %%ii!! ,/

,/ 2020// B"B"t!t!5i5i#t#tiin n M"M"#i#i!t !t   &* &* t!t!(("t"t ,

, 2200 BB""tt!!&&""tt!!##oon n kkrrii&& tt''(("" ,

,33 220033 BB""tt!!&&""tt!!##oon n N N ccrr""&& tt''(("" 

00 221100 BBii##!!kkooii  SS''  1100&&** ##'' 

11 2211)) BBii##oorroooo  tt!!((""t t , , &&** tt!!((""tt 

22 2211++ BBii##t t MM""### # NNoo..22++ ##""tt 

)) 2211,, BBoooo  LL!!nncc""tt ##""tt 

++ 2211// Bonin* LiBonin* Li (oto(oto 

,, 221133 BB''nnooff! ! ++0000 kk!!""tt 

 ))0011 <<!!ccii''& & GG''ccoonn!!# # iinnff''## ((oottoo /

/ <<!!ttoorrii  tt!!((""t t 1122, , &&** tt!!((""tt 

 ))0022 <<!!ttoorrii  tt!!((""t t 22, , &&** tt!!((""tt 3

3 <<!!ttoorrii  tt!!((""t t ,,0 0 &&** tt!!((""tt /

/00 <<oo%%""r r GG!!### # 11  8 8 11  cc&& ##""tt /

/11 ))00)) <<!!rrii!!ttoon n 11000 0 &&** tt!!((""tt /2

/2 )0)0++ <!<!t*t*'t 't <5<5roro& & 2:2:0 0 @ @ 99!r!r'& '& #!#!c5c5"t"t /)

/) )0)0,, <!<!t*t*'t 't <5<5roro& & ):):0 0 @ @ 99!r!r'& '& #!#!c5c5"t"t /+

/+ )0)0 <!<!t*t*'t 't PP!i!in n 2:2:0 0 @ @ 9!9!rr'& '& #!#!c5c5"t"t /,

/, )0)0// <!<!t*t*'t 't PP!i!in n ):):0 0 @ @ 9!9!rr'& '& #!#!c5c5"t"t /

/ ))00 <<""ff!!rroo88ii  kk!!##''  ,,000 0 &&** kk!!##'' /

/// ))0033 <<""ffii88ii&&" " 110000&&** tt!!((""tt /

/ ))1100 <<""ffoott!!88ii& & iinn99""kk##ii %%ii!! /

/33 ))1111 <"ftri!8on" 1.O* in9 K"rin*<"ftri!8on" 1.O* in9 K"rin* %i! %i! 

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NAAMMA A OOBBAATT SSAATTUUAANN _DA_D_AK_K _B_BP_PJ_JS_S PEMBERIANPEMBERIAN_P_PR_RO_OG_G _L_LA_AIIN_N--2₂ KET.KET. TOTAL TOTAL 1 1 22 33 44 55 66 77 ((55++66)) 88 99((77--88)) 1100 ((88++BBllnnllaalluu 1122 1133 1144 1155 1166 1177 No. No. URUT URUT No. No. KODE KODE STOK STOK A> A>ALAL PENERIMA PENERIMA AN AN PERSEDIA PERSEDIA AN AN PEMAKAI PEMAKAI AN AN SISA SISA STOK STOK STOK STOK OPT. OPT. PERMINTA PERMINTA AN AN 

00 ))11)) <"no L$t""r <"no L$t""r (oto(oto 

11 ))11++ <<""ttiirrii44iinn" " KK!!##''  1100&&** kk!!##''  22 ))11,, ((oottoo  )) ))11 ((oottoo + + (oto(oto 

,, ))11// <<ii&&""ttiiiin n tt!!((""t t 22000 0 &&** tt!!((""tt 

 ))11 <<oorriin n : : OnOn" " <<""!!nn ((oottoo 

// ))2200 <<oo&&oo##iit t LLii**55t t <<''rriinn* * AA22 ##$$rriinn**"" 

 ))2211 <<oo&&oo##iit t LLii**55t t <<''rriinn* * AA)) ##$$rriinn**"" 

33 ))2222 <<oo&&oo##iit t LLii**55t t <<''rriinn* * AA)),, ##$$rriinn**"" 3

300 ))22)) <<oorr##!!ff""n n ,,000 0 &&** kk!!##'' 3

311 ))22++ <o%"r G!##<o%"r G!## c#c# 3

322 ))22,, <<rr""##oo""n n ??oo((!!t t **ii**ii ((oottoo 3

3)) ))22 <<$$rrooffoo88!!cciin n kk!!##''  ,,000 0 &&** kk!!##'' 3+

3+ <o(!4!& 10 &*<o(!4!& 10 &* t!("tt!("t 3,

3, <o4!in 2, &*<o4!in 2, &* t!("tt!("t 3

3 ++0022 ""&&((!!rr 3

3// ++00)) DD""cc''iin n tt!!((""t t ))00&&** tt!!((""tt 3

3 ++00++ DD""kk##!!&&""tt!!##oon n IInn99""kk##i i ,,&&**::&& !!&&'' 3

333 ++00,, DD""kk##!!&&""tt!!##oon n tt!!((""t t 00, , &&** tt!!((""tt 1

10000 ++00 DD""&&!!ccooiin n tt!!((""tt tt!!((""tt 101

101 D"ntin <onition"r : Mini P!ckD"ntin <onition"r : Mini P!ck 10

1022 +0+0// D"D"o o PrPro*o*"#"#titin n InIn9"9"k#k#i i ) ) ((n n %i%i!! 1

100)) ++00 tt''(("" 1

100++ ++0033 DD""%%iitt!!ii##!!##i i !!##tt!! ((oottoo 1

100,, ++1111 DD""88ttrr!!n n iinnff''# # - - ,,000 0 && ((oottoo 1

100 ++1122 DD""88ttrrooff""n n SSiirr'' ((oottoo 1

100// ++11)) DDii!!44""!!& & IInn99""kk##i i ,,&&**::&&--22&& !!&&'' 1

100 ++11++ DDii!!44""!!& & tt!!((""t t 2 2 &&** tt!!((""tt 1

10033 ++11,, DDii!!44""!!& & tt!!((""t t , , &&** tt!!((""tt 1

11100 ++11 DDii""tt55$$cc!!rr((!!&&!!44iinn"" tt!!((""tt 1

11111 ++11// DDiiff""nn55iirr!!&&iinn! ;! ;<<L L iinn99""kk##i i 110 0 &&** !!&&'' 1

11122 ++11 DDii**ookk##iinn! ! tt!!((""t t 0022, , &&** tt!!((""tt 1

111)) ++1133 DDookk##ii##iikkiin n kk!!##''  11000 0 &&** kk!!##'' 1

111++ ++2200 DDoo&&""rriioon n tt!!((""t t 110 0 &&** tt!!((""tt 1

111,, DD''ccoo!!8 #8 #''  AA''t 1t 10 &0 &* : * : BBii##!!kk!!ii # ' # ' 1

111 ,,00++ !!&&'' 1

111// ,,00,, EErriitt55rroo&&iicciin n kk!!""t t ,,000 0 &&** kk!!""tt 1

111 ,,00 EErriitt55rroo&&iicciin n kk!!##''  22,,0 0 &&** kk!!##'' 1

11133 ,,00// EErriitt55rroo&&iicciin n ##iirr''  - - 0 0 &&  KK""rriinn** ((oottoo 1

12200 ,,0033 EEtt!!nnoo  //006 6 - - 1100000 0 && ((oottoo 1

12211 ,,1100 EEttcc55iinn**@@((oonniinn* * LLii''iit t SSDDII ##""tt 1

12222 ,,11)) EEttii  KKoorrii! ! ##""&&rroott ((oottoo 1

122)) ,,11++ EE''**""nnoo  <<!!iirr!!n n - - 110 0 && ((oottoo 1

122++ 0011 ==!!rr&&oott""n n 1122, , &&** tt!!((""tt 

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NAAMMA A OOBBAATT SSAATTUUAANN _DA_D_AK_K _B_BP_PJ_JS_S PEMBERIANPEMBERIAN_P_PR_RO_OG_G _L_LA_AIIN_N--2₂ KET.KET. TOTAL TOTAL 1 1 22 33 44 55 66 77 ((55++66)) 88 99((77--88)) 1100 ((88++BBllnnllaalluu 1122 1133 1144 1155 1166 1177 No. No. URUT URUT No. No. KODE KODE STOK STOK A>A A>ALL PENERIMA PENERIMA AN AN PERSEDIA PERSEDIA AN AN PEMAKAI PEMAKAI AN AN SISA SISA STOK STOK STOK STOK OPT. OPT. PERMINTA PERMINTA AN AN 1 122,, 0022 ==""""iinn* * tt''((" " NNoo. . 1100 ##""tt 1 122 00)) ==""""iinn* * tt''((" " NNoo. . 11 ##""tt 1 122// 00++ ==""""iinn* * tt''((" " NNoo. . ,, ##""tt 1 122 00,, ==""""iinn* * tt''((" " NNoo. .  ##""tt 1

12233 00 ==""nniittooiinn! N! N!!ttrrii''& k& k!!##'' 1 1000 &0 &** kk!!##'' 1

1))00 00// ==""nnoo((!!rr((iitt!!  IInn99""kk##i i ,,00&&**::&&--22&& !!&&'' 1

1))11 00 ==""nnoo((!!rr((iitt!!  tt!!((""t t ))0 0 &&** tt!!((""tt 1)

1)22 1100 ="="nonok#k#i&i&"t"ti i P"P"nini#i#iiin! n! t!t!(("t "t ,0,00 0 &*&* t!t!(("t"t 1

1)))) 1122 ==iittoo&&""nn!!iioon n iinn99""kk##i i 1100&&**::&& !!&&'' 1

1))++ 11)) ==iittoo&&""nn!!iioon n iinn99""kk##i i 2 2 &&**::&& !!&&'' 1

1)),, 11++ ==iittoo&&""nn!!iioon n tt!!((""t t 110 0 &&** tt!!((""tt 1)

1) 11,, ==!*!*i i : : M"tM"troronini!!4o4o  O%O%'o 'o ,0,00&* 0&* TT!(!("t"t 1)/

1)/ ='ok#"tin 10 &*='ok#"tin 10 &* t!("tt!("t 1)

1) 11 ==''cocon!n!44oo" " 1,1,0 0 &* &* t!t!(("t"t 1

1))33 11// ='ori" S"i!!n ='ori" S"i!!n TToic!:<inro >5itoic!:<inro >5it (oto(oto 1 1++00 11 ==oo""$ $ <<!!tt55""tt""r r NNoo. . 11++ ##""tt 1 1++11 1133 ==oo""$ $ <<!!tt55""tt""r r NNoo. . 11 ##""tt 1 1++22 2200 ==oo""$ $ <<!!tt55""tt""r r NNoo. . 11 ##""tt 1

1++)) 2222 ==''rroo##""&&ii! ! tt!!((""t t ++0 0 &&** tt!!((""tt 1

1++++ 22)) ='ro#"&i" 10&*:& in9"k#i='ro#"&i" 10&*:& in9"k#i !&'!&' 1

1++,, //0011 GG!!rr!!& & OOrr!!iit t ''nntt''k k 22000 0 &&  !!iirr kk!!nnttoonn** 1

1++ //00++ GG""nntt!!&&$$cciin n iinn99""kk##i i 0 0 &&**::2 2 && %%ii!! 1

1++// //00,, GG""nntt!!&&$$cciin n ##!!""  kk''iitt tt''(("" 1

1++ //00 G"nt!&$cin #!" &!t!G"nt!&$cin #!" &!t! t'("t'(" 1

1++33 //00// GG""nntt!!&&$$cciin n tt""tt""# # &&!!tt!! ((oottoo 1

1,,00 //00 GG""nnttii!!n n %%iioo""t t !!rr''tt!!n n 1166 ((oottoo 1

1,,11 //1100 GG!!### # IIoonnoo&&""r r <<""&&""nntt ##""tt 1

1,,22 //1111 GGii((""nnkk!!&&ii! ! tt!!((""t t , , &&** tt!!((""tt 1,)

1,) Gi&"iri" 1 &*Gi&"iri" 1 &* t!("tt!("t 1

1,,++ //1122 Gi&"iri" 2 &*Gi&"iri" 2 &* t!("tt!("t 1

1,,,, //11)) GGii##""rrii  GG''!!$$!!kkoo!!t t !t t !((""t t 11000 0 &&** tt!!((""tt 1

1,, //11++ GGii##""rriin n 1 1 iitt""rr ((oottoo 1

1,,// //11,, Gi#"rin 100 &Gi#"rin 100 & (oto(oto 1

1,, //2200 GG''kkoo##! ! iinnff''# # 002222,,6 6 - - ,,000 0 && ((oottoo 1

1,,33 //2211 GG''kkoo##! ! !!rr. . iinnff''# # 11006 6 ##tt""rrii ((oottoo 1

100 //2222 GG''kkoo##! ! !!rr. . iinnff''# # ++006 6 ##tt""rrii !!&&'' 1

111 //22)) GG''kkoo##! ! !!rr. . iinnff''# # ,,6 6 ##tt""rrii ((oottoo 1

122 /2/2++ GrGri#i#"o"of'f'%%in in t!t!(("t "t 1212,&,&* * t!t!(("t"t 1)

1) Gri#"of'%in t!("t ,00 &*Gri#"of'%in t!("t ,00 &* 1

1++ 0022 ;;!!oo""rriioo  tt!!((""t t 00.., , &&** tt!!((""tt 1

1,, 00)) ;;!!oo""rriioo  tt!!((""t t 11.., , &&** tt!!((""tt 1

1 00++ ;;!!oo""rriioo  tt!!((""t t 2 2 &&** tt!!((""tt 1

1// 00,, ;!o'rio t!("t , &*;!o'rio t!("t , &* t!("tt!("t 1

1 ;;!!oo  DD""cc!!nnoo!!t t ,,0 0 &&* : * : &&  iinn99 !!&&'' 13

(6)

NAMA OBAT SATUAN _DAK _BPJS PEMBERIAN_PROG _LAIN-2 KET. TOTAL 1 2 3 4 5 6 7 (5+6) 8 9(7-8) 10 (8+Blnlalu 12 13 14 15 16 17 No. URUT No. KODE STOK A>AL PENERIMA AN PERSEDIA AN PEMAKAI AN SISA STOK STOK OPT. PERMINTA AN 1/0 0 ;iro*"n P"rok#i! : ;2O2 (oto

1/1 03 ;irokorti!4i! t!( 2, &* t!("t 1/2 10 ;irokorti#on Kri& 2,6 t'(" 1/) 301 I('rof"n #'#"n#i 100 &*: ,& (oto 1/+ 302 I('rof"n t!("t 200 &* t!("t 1/, 30) I('rof"n t!("t +00 &* t!("t 1/ 30+ I&ir!&in" 2, &* t!("t 1// 30 Inf'#ion #"t !n!k #"t 1/ 30/ Inf'#ion #"t "7!#! #"t 1/3 I <!t"t5"r No.1 (i9i 10 I <!t"t5"r No.20 (i9i 11 I <!t"t5"r No.22 (i9i 12 I <!t"t5"r No.2+ (i9i 1) Ioin! T"#t T"#t Kit 1+ 303 I#oni!4i 100 &* k!"t 1, I#oni!4i )00 &* k!"t 1 310 I#o#or(i Dinitr!t t!("t , &* t!("t 1/ 1101 KA-EN )B inf'# - ,00 & (oto 1 110) K!#i'& ;irok#i! !#t! t'(" 13 110+ K!#i'& L!kt!t t!("t ,00&*. t!("t 130 110, K!!# "&(!'t !(# 2,0 *r!& ro 131 110 K!r(!&!4"in t!("t 200 &* t!("t 132 110 K!#! ;irofi 181 (o8 13) 1103 K!#! ko&r"# #t"ri +0c&:+0c& ('n*k'# 13+ 1110 K!#! "&(!'t 2 & 8 0 c& ('n*k'# 13, 1111 K!#! P"&(!'t +810 c& ro 13 1112 K!#! "&(!'t 5irofi +&8 )c& ro 13/ 111) K!#! "&(!'t 5irofi +&81,c& ro 13 111, K"tokon!4o t!("t t!("t 133 K"tokon!4o Kri& 2 6 T'(" 200 111 Kin!&$cin k!#' 1,0 &* k!#' 201 111/ Kin!&$cin k!#' )00 &* k!#' 202 1113 Kor!&f"niko k!#' 2,0 &* k!#' 20) 1120 Kor!&f"niko S!" M!t! 16 t'(" 20+ 1121 (oto

20, 1122 Kor!&f"niko t"t"# &!t! 0,6 - , & (oto 20 112) Kor!&f"niko t"t"# t"in*! )6 (oto 20/ 112+ Korf"nir!&in! M!"!t t!("t +&* t!("t 20 112, Korro&!4in! ;<L in9 2, &*:&-1& !&' 203 112 Korro&!4in! ;<L t!( #!'t 100 &* t!("t 210 112/ Korro&!4in! ;<L t!( #!'t 2, &* t!("t 211 112 Ko"in! t!("t. 10&* t!("t 212 1123 Kotri&ok#!4o #ir' (oto 21) 11)0 Kotri&ok#!4o t!("t A't t!("t 21+ Kotri&ok#!4o t!("t =ort" t!("t

(7)

-NAMA OBAT SATUAN _DAK _BPJS PEMBERIAN_PROG _LAIN-2 KET. TOTAL 1 2 3 4 5 6 7 (5+6) 8 9(7-8) 10 (8+Blnlalu 12 13 14 15 16 17 No. URUT No. KODE STOK A>AL PENERIMA AN PERSEDIA AN PEMAKAI AN SISA STOK STOK OPT. PERMINTA AN 21, 11)2 K'inin! S'f!t t!("t t!("t 21 Ko&(i!k K!t"*ori 1 P!k"t 21/ 1201 L!n4or!4o k!#' )0 &* k!#' 21 121+ L!8!in #ir' 0 & (oto 213 L"'ko!#t ;o#it! /.,0 c& 8 +., & ro 220 121, L"%ofok#!#in t!("t ,00 &* t!("t 221 121 Lioc!in 26 in9"k#i !&' 222 121/ Liok!in! <o&. In9"k#i 26 !&' 22) 121 Li#o - 1000 & (oto 22+ 1213 Lo"r!&i" t!("t - 2&* t!("t 22, 1220 Lor!t!in t!("t 22 1222 L$t!c'r 0 & (oto 22/ L"%otirok#in t!( 100&c* t!("t 22 L"8!%it K!"t k!"t 223 1)01 M!*n"#i'& S'f!t in9"k#i 206 !&' 2)0 1)02 M!*n"#i'& S'f!t in9"k#i +06 !&' 2)1 1)0) M!to"8trin t!("t : TABURIA t!("t 2)2 1)0+ M!#k"r i#o#!(" (i9i 2)) 1)0, M!#k"r Ok#i*"n D"7!#! (i9i 2)+ 1)0 M!#k"r S'r*ic! "!r oo,0 (i9i 2), 1)0/ M!#k"r S'r*ic! P'# ) P$ P'# E!ro (i9i 2) 1)0 M!#k"r S'r*ic! ti" on,0 (i9i 2)/ M!#k"r Di#o#!(" ?N3,

2) 1)03 M"("n!4o #ir' 100 &*: , & (oto 2)3 1)10 M"("n!4o t!("t 100 &* t!("t 2+0 1)1, M"ok#ik!& t!("t 1, &* t!("t 2+1 1)1 M"ok#ik!& t!("t /, &* t!("t 2+2 1)1/ M"t!&i4o" : Nor!*"# in9"k#i ,00&* !&' 2+) 1)1 M"t!n"'ron t!("t t!("t 2++ 1)20 M"tfor&in ; < t!("t ,00 &* t!("t 2+, 1)21 M"tfor&in ;<L t!("t ,0&* t!("t 2+ 1)22 M"t5$r"5i#oon  &* t!("t 2+/ 1)2+ !&' 2+ 1)2, M"ti"r*o&"trin! M!"!t t!("t t!("t 2+3 1)2 M"tocor!&i" , &* t!("t 2,0 1)2/ M"tokor!&i 10 &* t!("t 2,1 1)2 M"tokor!&i S$r' 0 & (oto 2,2 1)23 M"troni!4o ,00&* inf'# %i! 2,) 1))0 M"troni!4o t!("t 2,0 &* t!("t 2,+ 1))1 M"troni!4o t!("t ,00 &* t!("t 2,, 1))2 M"$on in9"k#i !&' 2, 1))+ Min"r! &i8 #!c5"t 2,/ 1)) Monokork!&f"r M"nto c!ir!n (oto 2, 1))/ M'&&if$in* !#t! (oto

2,3 1+01 (oto



(8)

NAMA OBAT SATUAN _DAK _BPJS PEMBERIAN_PROG _LAIN-2 KET. TOTAL 1 2 3 4 5 6 7 (5+6) 8 9(7-8) 10 (8+Blnlalu 12 13 14 15 16 17 No. URUT No. KODE STOK A>AL PENERIMA AN PERSEDIA AN PEMAKAI AN SISA STOK STOK OPT. PERMINTA AN 20 1+0) N!#!f!& 100 &* t!("t

21 1+0, N!tri'& Bik!r(on!t t!("t ,00 &* t!("t 22 1+0 N!tri'& Dikof"n!k ,0 &* t!("t 2) 1+0/ N!tri'& Kori! !r't!n inf'# 0.36 (oto 2+ 1+12 N"o K!o&in! #ir' (oto 2, 1+1) N"'ro(!t in9"k#i !&' 2 1+1, N"'ro#!n(" ,000 t!("t t!("t 2/ 1+1 Nif"iin 10 &* t!("t t!("t 2 1+1/ Ni#t!tin 100.000 IU #'#"n#i (oto 23 1+1 Ni#t!tin 100.000 IU:* t!("t %!*in! t!("t 2/0 1+13 Ni#t!tin ,00.000 IU:* t!("t or! t!("t 2/1 1,01 O(!t Antit'("rk'o#i# k!t - An!k !k"t 2/2 1,02 O(!t Antit'("rk'o#i# k!t - I !k"t 2/) 1,0) O(!t Antit'("rk'o#i# k!t -II !k"t 2/+ 1,0+ O(!t B!t'k ;it!& c!ir!n 100& (oto 2/, 1,0, OBAT KUSTA M B !n!k #tri 2/ 1,0 OBAT KUSTA M B "7!#! #tri 2// 1,0/ OBAT KUSTA P B !n!k #tri 2/ 1,0 OBAT KUSTA P B "7!#! #tri 2/3 1,03 O(!t M!!ri! t!("t t!("t 20 1,10 OB; Troic! E8t! M"nto 0 & (oto 21 1,11 OB; Troic! P'# An!k J"r'k 0 & (oto 22 1,12 OB; Troic! P'# M"nto 0 & (oto 2) 1,1) O($"k G!## c# 2+ 1,1, Ok#i*"n G!# !!& t!('n* - 1&) t!('n* 2, 1,1 Ok#i*"n G!# !!& t!('n* - &) t!('n* 2 1,1 Ok#it"tr!#ikin! ;<L #!" k'it ) 6 t'(" 2/ 1,13 Ok#it"tr!#ikin! ;<L #!" &!t! 16 t'(" 2 1,20 Ok#ito#in! in9"k#i 10 IU:&-1& !&' 23 1,21 O&"r!4o k!#' k!#' 230 1,22 On!n#"tron t!( + &* t!("t 231 1,2) On!n#"tron t!( + &*:2 & In9 - Ktk , !&' 232 O8$fo7 N!#! O8$*"n An!k (i9i 23) O8$fo7 N!#! O8$*"n D"7!#! (i9i 23+ O8$fo7 N!#! O8$*"n B!$i (i9i 23, 10) P!r!c"t!&o Dro (oto 23 10+ P!r!#"t!&o #ir' 120 &*:,& (oto 23/ 10 P!r!#"t!&o t!("t ,00 &* t!("t 23 103 P"r&"trin Kri& ,6 : Sc!(i&it" t'(" 233 110 P"tiin! ;<L in9"k#i ,0 &*:&-2& !&' )00 112 P"7!rn! i"5-N""#"n : 1 #"t (oto )01 11+ Pir!c"t!& 00 &* t!("t t!("t )02 11, Pir!c"t!& in9 1 *r!&:,& !&' )0) 11 Pir!nt" P!&o!t t!("t 12, &* t!("t

(9)

NAMA OBAT SATUAN _DAK _BPJS PEMBERIAN_PROG _LAIN-2 KET. TOTAL 1 2 3 4 5 6 7 (5+6) 8 9(7-8) 10 (8+Blnlalu 12 13 14 15 16 17 No. URUT No. KODE STOK A>AL PENERIMA AN PERSEDIA AN PEMAKAI AN SISA STOK STOK OPT. PERMINTA AN )0+ 11/ Pir!nt" S'# 12,&* : , & (oto

)0, 11 Piriok#in! ;<L t!("t 10&* t!("t )0 Piriok#in! ;<L t!("t 2, &*

)0/ 113 Piro8ic!& 20 &* k!#' )0 121 P"#t"r , $!r 8 2 inc5 ro )03 122 P"#t"r ="8i(" non 7o%"n , 8 , ro )10 12) P"#t"r K!in Ro 12,c& 8 +,& ro )11 12+ P"#t"r K!in Ro 2,c& 8 +,& ro )12 12, PM-ASI Bi#k'it ('n*k'# )1) 12 PMT Unt'k BUMIL ('n*k'# )1+ 12/ PMT-AS (i#k'it ('n*k'#

)1, 12 (oto

)1 1)0 Pr"ni#on t!("t , &* t!("t )1/ 1), Prok!in! P"n. G in9"k#i ) 9't! IU %i! )1 1) Pro!noo ;<L t!("t 10 &* t!("t )13 1)/ Pro!noo ;<L t!("t +0 &* t!("t )20 1) Proitio'r!#i t!("t 100 &* t!("t )21 1/01 R!nitiin 1,0 &* t!("t )22 1/02 R!nitiin ,0 &* : 2 & In9 !&' )2) 1/0) RDT M!!ri! c!r )2+ 1/1 R"n!in!c 2, &* k!"t )2, 1/1 R"tino k!. 'n!k 100.000 IU k!#' )2 1/13 R"tino k!. 'n!k 200.000 IU k!#' )2/ 1/2) Rin*"r A#"t!t inf'# - ,00& (oto

)2 1/2+ (oto

)23 1/2, Rin*"r L!kt!t L!r't!n inf'# - ,00 & (oto ))0 1/2 Ri#"rion" 2 &* t!("t ))1 101 S!f" Go%" E8!& L #"t ))2 102 S!f" Go%" E8!& M #"t ))) 10) S!f" Go%" E8!& S #"t ))+ 10+ S!f"t$ (o8 #"t )), 10, S!k!n"'ron t!("t t!("t )) 10 S!('t!&o 2 &* t!("t ))/ 10/ S!('t!&o + &* t!("t )) 10 ot

))3 103 S!i#i B"!k 26 - ,0 *r!& kot!k )+0 110 S!r'n* T!n*!n O(*$n ? STERIL  #"t )+1 112 S"&"n S"n* =o#f!t #"t )+2 11) S"&i!# Non >o%"n ,8,00c& ro

Poikr"#'"n ? M"t!kr"#o#'fon!t  -10 &

Rin*"r L!kt!t @ G'co#" ,6 inf'#-,00&

S!" 2-+ DOEN ?A#.S!i#i!t 26 @B""r!n* En! +6

(10)

NAMA OBAT SATUAN _DAK _BPJS PEMBERIAN_PROG _LAIN-2 KET. TOTAL 1 2 3 4 5 6 7 (5+6) 8 9(7-8) 10 (8+Blnlal 12 13 14 15 16 17 No. URUT No. KODE STOK A>AL PENERIMA AN PERSEDIA AN PEMAKAI AN SISA STOK STOK OPT. PERMINTA AN )+) 11, S"r'& Anti Bi#! U!r in9"k#i ?ABU I %i!

)++ 11 S"r'& Anti Dit"ri in9"k#i 20.000 IU %i! )+, 11/ S"r'& Anti T"t!n'# in9"k#i 1.,00 IU !&' )+ 11 S"r'& Anti T"t!n'# in9"k#i 20.000 IU %i! )+/ 113 S"r'& Kontro kit )+ 120 Si!noko(!!&in! ?it B12 in9"k#i !&' )+3 121 Sik4ono!t" in9"k#i 2, &* :& !&' ),0 122 Sik no 2:0 2+81)80 c& #!c5"t ),1 12) Sik no ):0 2+81)80 c& #!c5"t ),2 12+ Si%"r A&!*!& #"r('k ,-/,6 (oto ),) 12, Si&%!#t!tin t!("t 10 &* t!("t ),+ S!#5i - In9"k#i !&' ),, S!#&in! t!("t t!("t ), 1)0 Sirono!cton" 2, &* t!("t ),/ 1)1 Son# G"!tin c'(ic"# 18181c& (i9i ), 1)+ St"#oi R"ct! 10 &*:2, & t'(" ),3 1), St"#oi R"ct! , &*:2, & t'(" )0 1)/ Sto!8 :Bi#!koi S' 10&* t!("t )1 1+1 S'f!#"t!&i! t"t"# &!t! 1,6 (oto )2 1+2 S'r*ic! *o%" no.  #"t )) 1+) S'r*ic! Go%" No. / #"t )+ 1++ S'r*ic! Go%" No. /, #"t ), 1+, S'r*ic! Go%" No.  #"t ) S"&i!# Non >o%"n 108 ,00c& ro

)/ 1301 t!("t

) 130) T"&or!r$ Stoin* ="tc5"r #"t )3 130+ T"o#! t!("t t!("t )/0 1311 T"tr!#ikin! ;< k!#' ,00 &* k!#' )/1 1312 T5i!&"nico Sir' (oto )/2 131) T5i!&5"nico ,00 &* k!#' )/) 131+ T5r"" 7!$ Sto <ock c# )/+ 131, Ti!&in! ?it B1 t!("t 100 &* t!("t )/, 131 Ti!&in! ?it B1 t!("t ,0 &* t!("t )/ 131/ Ti!&in! ;<L in9"k#i 100&*:& !&' )// 1313 Toic! An!#t"#i G":Pri&" G"

)/ 1320 Tr!&!o in9ik#i ,0 &*:& !&' )/3 1321 Tr!&!o k!#' ,0 &* t!("t )0 1322 Tr!n#f'#ion #"t #"t )1 132) Trif'o"r!4in , &* : St"#oi t!( t!("t )2 132+ Tri*i#"ri! ? )H,0 ST  kit )) 132, Tri5"k#if"nii ;c t!("t - 2 &* t!("t

T!("t T!&(!5 D!r!5 ?B"#i II S'f!t t!(.)00&*

(11)

NAMA OBAT SATUAN _DAK _BPJS PEMBERIAN_PROG _LAIN-2 KET. TOTAL 1 2 3 4 5 6 7 (5+6) 8 9(7-8) 10 (8+Blnlal 12 13 14 15 16 17 No. URUT No. KODE STOK A>AL PENERIMA AN PERSEDIA AN PEMAKAI AN SISA STOK STOK OPT. PERMINTA AN )+ 132 (oto

), 2002 U&(iic! <or (i9i

) 200) Un"r! (i9i

)/ 200+ Urin" (!* #"t ) 200, Uri#c!n G"n 11 : 10 P!r!&"t"r (oto )3 200 Uri#c!n G'co#" 1 kit )30 200/ Uri#c!n GP2 for R"'k#i @ A('&in kit )31 USG G" 2,0 & Boto )32 USG G" , it"r Boto )3) 2101 !#"in A(! (oto )3+ 2102 "ntoin : S!('t!&o In5!"r 0, 6 (oto

)3, 210) !&'

)3 o'%"n - Kooi ;ES BM 1)0.000 L! Boto )3/ 2201 it!&in B Ko&"k# t!("t t!("t )3 2)02 >i! D, 1:2 NS (oto )33 2)0) >in* N""" (!$i no.2, (i9i +00 2,01 Foi'& Po%ion 106 - )0 & (oto +01 2,02 Foi'& Po%ion 106 - )00 & (oto +02 Foi'& Po%ion 1000 &

+0) 202 IN< t!("t 20 &* t!("t +0+ 20) irc'& KID #ir' (oto

+0, 20+ or!in t!("t

+0 PROGRAM IMUNISASI

+0/ 2/01 P"!r't B<G !&' +0 2/0+ !k#in MR !&' +03 2/0 !k#in DPT ;( - ;i( : PENTABIO %i! +10 2/0/ !k#in Poio (OP 10 Do#i# !&'

+11 2/0 !k#in DT %i!

+12 2/03 !k#in ;B Uni9"ck %i! +1) !k#in Poio IP , Do#i# !&'

+1+ 2/11 !k#in T %i!

+1, 2/12 !k#in TT %i!

+1 2/1) !k#in M"nin*iti# %i! +1/ +1 +13 PROGRAM IMS +20 201 +21 202 +22 20) +2) 20+

Trikr"#o =or&!in ?=orinokr"#o c!ir!n - 10 &

"ntoin N"('"# :S!('t!&o <!ir!n 2, &*

Aco5o S7!(

<otton Aic!tor# St"ri" <o%"r G!##

(12)

NAMA OBAT SATUAN _DAK _BPJS PEMBERIAN_PROG _LAIN-2 KET. TOTAL 1 2 3 4 5 6 7 (5+6) 8 9(7-8) 10 (8+Blnlalu 12 13 14 15 16 17 No. URUT No. KODE STOK A>AL PENERIMA AN PERSEDIA AN PEMAKAI AN SISA STOK STOK OPT. PERMINTA AN +2+ 20, +2, 20 +2 20/ +2/ 20 +2 203 +23 210 +)0 211 +)1 212 +)2 21) +)) 21+ +)+ 21, +), 21

+) R"!*"n R!i #$5ii#:St!n!r Di!*n  100 +)/ P"rfor&! T"#t Stri#: Stik GDA A<<U +) S!f"-T Pro Uno

+)3 =oc'# TP;A T"#t

++0 Tot! ;!rn"##C 12-,)/ &*: L <!<O) ++1 Sti G'ko#! M"rk E!#$to'c5 ++2 Sti Uri Aci M"rk E!#$to'c5 ++) Sti <o"#t"ro M"rk E!#$to'c5 +++ A#!& <'k! 2, 6

++, A'toc5"ck tot! Ko"#t"ro 10 Stri ++ S"k''& Di#o#("

++/ <otton #7!( ++ L!r't!n <5orin"

++3 S't'& Pot ct

+,0 P!k"t A!t D"t"k#i R"#iko K"5!&i!n P!k"t +,1 <!tri*" T<M P<S +,2 G'co Prot"in Pi"c" +,) T'(" EDTA 5 1)8/, )0 ((c" !% #"t +,+ Utr! Onc" T"#t ;!&i Pi"c" +,, )002 >i! S!&on"! T5$i O Anti*"n A %i! +, )00) >i! S!&on"! T5$i O Anti*"n B %i! +,/ )00+ >i! S!&on"! T5$i O Anti*"n < %i! +, )00, >i! S!&on"! T5$i O %i! +,3 )00 >i! S!&on"! T5$i ; Anti*"n A %i! +0 )00/ >i! S!&on"! T5$i ; Anti*"n B %i! +1 )00 >i! S!&on"! T5$i ; Anti*"n < %i! +2 )003 >i! S!&on"! T5$i ; %i! +) )010 <ontro Po#iti%" Po$%!"nt %i! ++ )011 <ontro N"*!tif Po$%!"nt (o8 +, )012 ;B#A* Stri T"# (o8

I&&"r#ion Oi K"rt!# P; ) - +2 KO; 106 M"t5$!t" Sirit M"t5$"n B'" 0.)6 N!c 0.36 O(9"ct G!##

R"!*"n Sifii# RPR:kit ?10& 'ntk ,00 t"#t R"!*"n Sifii# TP;A

!c'!(:T!('n* !r!5 !#tic t't' &"r!5 H$o

(13)

NAMA OBAT SATUAN _DAK _BPJS PEMBERIAN_PROG _LAIN-2 KET. TOTAL 1 2 3 4 5 6 7 (5+6) 8 9(7-8) 10 (8+Blnlalu 12 13 14 15 16 17 No. URUT No. KODE STOK A>AL PENERIMA AN PERSEDIA AN PEMAKAI AN SISA STOK STOK OPT. PERMINTA AN + )01) ;B#A( Stri T"# (o8

+/ )01+ D"t"r&in" ;I (o8 + )01, R!i S$5ii# (o8 +3 )01 I<T M!!ri! (o8 +/0 )01 Goon*!n D!r!5 Anti A %i! +/1 )013 Goon*!n D!r!5 Anti B %i! +/2 )020 Goon*!n D!r!5 Anti AB %i! +/) )021 Goon*!n D!r!5 Anti D %i! +/+ /03 R"!*"n Gi"&#! @ B'ff"r Gi"&# (oto +/, 1) Stick Urin" 10 PM #tick +/ 1)3 Stri Urin" 11 PM t'(" +// 1+0 Stri Urin" ) PM t'(" +/ +/3 +0 +1 +2 +) Pengecatan ++ )101 Brii!nt <r"#$ B'" 1 6 (oto +, )102 Gi"&#! (oto + )10) L!r't!n Dr!(kin (oto +/ )10+ L!r't!n Eo#in 2 6 (oto + )10, L!r't!n T'rk (oto +3 )10 Oi I&"r#ion (oto +30 )10/ P"7!rn! Gr!& #"t +31 )10 #"t +32 )103 P"7!rn! i"5 N"#"n #"t +3) )110 H$o (oto +3+ PROGRAM HIV +3, 130, T"# ;I I ?Oncoro("  #"t +3 130 T"# ;I II ? Int"c5 Triin"   #"t +3/ 130/ T"# ;I III ?iki!  #"t +3 R"!*"n I SD Bioin" ;I 1:2

+33 R"!*"n I Int"c On" St" Anti ;I Tri Lin" T"# <!rr ,00 R"!*"n P"n*5it'n* <D +

,01 R"!*"n P"n*5it'n* <D + <ontro ,02 <!tri*" T<M P<S ,0) Ef!%ir"n4 ?E= 00&*

,0+ N"%ir!in" ? NP  200&*

P"7!rn! R!i: #"i!!n !'# !r!5 t"i:MDT

(14)

NAMA OBAT SATUAN _DAK _BPJS PEMBERIAN_PROG _LAIN-2 KET. TOTAL 1 2 3 4 5 6 7 (5+6) 8 9(7-8) 10 (8+Blnlalu 12 13 14 15 16 17 No. URUT No. KODE STOK A>AL PENERIMA AN PERSEDIA AN PEMAKAI AN SISA STOK STOK OPT. PERMINTA AN ,0, ,0 ,0/ ,0 iof'in" ?D  100 &* t!("t t!("t ,03 T"nofo%ir )00 &* t!("t t!("t ,10 Ef!%ir"n4 ?E= 200 &*

,11 t!("t

,12 A(!c!%ir ?AB< )00 &* t!("t ,1) L!&i%'in" 1,0 &* t!("t t!("t ,1+ Ri*5t Si*n

"ror!( S"r'&

KUNJUNGAN RESEP

UMUM BPJS LAINLAIN JUMLAH

------M"n*"t!5'i:&"n$"t'9'i F!n* &"n$"r!5k!n F!n* &"!ork!n:&"&int! F!n* &"n"ri&! K"!! In#t!!#i =!r&!#i Si" P"n$i&!n!n  P"n$!'r!n K"!! P'#k"#&!# P"n*"o! O(!t P'#k"#&!#

K!('!t"n J"&("r I=K J"&("r 



NIP. NIP. NIP. NIP.

iof'in" ? D  )00&* @ L!&i%'in" ? )T<  1,0&* T"nofo%ir )00@L!&i%'in )00@Ef!%i"n 00 D"7!#! iof'in" ? D  0&* @ L!&i%'in" )0&*@N"%ir!in" ,0&* ? Tri" =D<  An!k

T"nofo%ir )00 &* @ E&citrit!(in" 200 ?=<T

(15)

KOP PUSKE

BERITA ACARA STOK OPNAME OBAT DAN PER

PUSKESMAS !!!!!!!!

P!! t!n**!..(n.#:.. Bn.201/ t"!5 &"!k#!n!k!n Stok On!

k"#"5!t!n #"#"'!i !ft!r i (!7!5 ini

NAMA

OBAT

SATUAN

1

2 )

+

1

101 Air

r!k#!

"nt!

'#"

(oto

-2

102 A!t

#'ntik

#"k!i

!k!i

1 &

#"t

-)

10)

A!t #'ntik #"k!i !k!i 2, &

#"t

-+

10+

A!t

#'ntik

#"k!i

!k!i

,

&

#"t

-,

10,

A("n!4o

t!("t

+00

&*

t!("t

-

10

Ao'rino

t!("t

-/

10/

A&inofiin!

t!("t

200 &*

t!("t

-

10

A&inofiin! in9"k#i 2+&*:&-10&

!&'

-3

103 A&itritiin! ;<L t!("t 2, &*

t!("t

-10

110 A&ok#iin

Sir'

K"rin*

(oto

-11

111 A&ok#iin k!#' - 2,0 &*

k!#'

-12

112 A&ok#iin k!"t - ,00 &*

k!"t

-1)

11)

A&i#iin! Sir' K"rin*

(oto

-1+

11+

Ant!*in

t!("t

,00&*

t!("t

-1,

11,

Ant!in in9"k#i 2+ &:&-10&

!&'

-1

11

Ant!#i!

Do"n

t!("t

-1/

11/

Anti(!kt"ri DOEN ?B!#itr!#in @ Poi&ik#in

t'("

-1

11

Anti ;"&&oroi S'o#itori!

#'

-13

113 ot

-20

120 Anti&ir"n DOEN ?Erot!&in! Trt @ Kof"in!

t!("t

-21

121 A'! ro in9"k#i #t"ri - 20 &

!&'

-22

122 A'!"#t

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