Lplpo 2021
Uploaded by
May AsyariLplpo 2021
Uploaded by
May AsyariLAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
KABUPATEN : LANDAK
PUSKESMAS : SERIMBU
BULAN/TAHUN : JANUARI / 2021
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
1 Acarbose 100 mg Tab - -
2 Acetylsistein 200 mg Caps - -
3 Acyclovir 200 mg Tab - - 4000
4 Acyclovir 400 mg Tab 450 450 50 9/23 400 4000
5 Albendazole Syrup Botol 30 30 30 0 300
6 Albendazole tab 400 mg Tab 2000 2,000 100 7/21 1900
7 Allopurinol 300 mg Tab - - 1500
8 Alprazolam 0,5 mg Tab - -
9 Alprazolam 1 mg Tab - -
10 Aminophyllin Inj Ampul 0 - -
11 Amitriptilin 25 mg Tab 440 440 10 5/23 430
12 Amlodipin 10 mg Tab 4300 4,300 1,800 3/22 2500 10000
13 Amlodipin 5 mg Tab 4200 4,200 2,400 7/21 1800 10000
14 Amoxicillin Syrup 125 mg/5ml Botol 10 10 10 12/21 0 300
15 Amoxicillin Syrup Forte 250 mg/5ml Botol - - 300
16 Amoxycillin tab 500 mg Hexpharm Tab 2900 2,900 2,800 12/20 100 20000
17 Ampisillin Injeksi Vial - - 15
18 Anabion Syrup Botol - -
19 Antasida DOEN Kombinasi Tab 5700 5,700 3,000 10/20 2700 24000
20 Antasida DOEN Syrup Botol 92 92 17 7/21 75 500
21 Antifungi DOEN salep kombinasi Tube - - 300
22 Antihemorroid Suppo - -
23 Apricot Syrup 100 ml / Obat Batuk Botol - - 11/22
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
24 Asam ascorbat 50 mg/ Vit. C 50 mg Tab 3000 3,000 600 3/22 2400 10000
25 Asam Mefenamat 500 mg Tab 2400 2,400 1,500 2/22 900 20000
26 Asam Tarnexamat Inj 50mg/ml Ampul - - 100
27 Asam Tranexamat inj 100 mg/ml Ampul - - 100
28 Asering larutan infus 500 ml Botol - -
29 Asetosal 100 mg Tab - - 100
30 Atropin Injeksi 0,25 mg Vial - -
31 Bacitracin Polymicin Zalp Tube - - 100
32 Benzatin Benzyl Penisilin 2,4 juta UI Vial 0 - - 11/20
33 Betahistin Mesilat 6 mg tab 3000 3,000 100 2900 5000
34 Betamethasone krim 0,05% Tube 50 50 50 10/21 0 300
35 Betamethasone krim 0,1% Tube - - 300
36 Bioplacenton Tulle Pcs 65 65 2 12/21 63
37 BIOSAT 1,500 ( A.T.S) serum anti tetanus Vial - - 10
38 BIOSAVE ( A.B.U I) serum anti bisa ular Vial - - 5
39 Bisoprolol 5 mg Tab 1500 1,500 100 7/21 1400 1000
40 Calcii Gluconas Inj Ampul 19 19 - 12/21 19
41 Captopril 12,5 mg tab 5700 5,700 1,400 6/24 4300 5000
42 Captopril 25 mg Tab 5200 5,200 800 1/21 4400 5000
43 Cavidagel 15 gr Tube 1 1 - 10/21 1
44 Cefadroksil 250 mg Tab - -
45 Cefadroksil 500 mg Tab - - 8/20 10000
46 Cefadroxil Syrup Botol 190 190 15 11/21 175
47 Cefotaxim inj,1 gr Ampul - -
48 Ceftriaxon inj.1 gr Ampul 0 - - 10/20
49 Cetirizin 10 mg Tab 5600 5,600 1,800 7/21 3800 7000
50 Cetirizin Syrup Botol 90 90 - 7/21 90 50
51 Chloramex 500 mg Caps - - 5000
52 Chloramfenicol 125mg/5ml Syrup Botol - -
53 Chloramfenicol 250 mg caps 2600 2,600 200 4/22 2400
54 Chloramfenicol salep mata 1% Tube - - 300
55 Chlorfeniramin Maleat 4 mg (CTM) Tab 4600 4,600 2,500 8/21 2100 10000
56 Chlorpromazin 100 mg Tab 460 460 50 7/22 410
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
57 Ciprofloxacin 500 mg Tab 0 - - 9/20 5000
58 Clindamicin 150 mg Caps 250 250 - 4/22 250 8000
59 Clozapin 100 mg Tab - -
60 Clozapin 25 mg Tab 881 881 120 2/21 761
61 Codein 10 mg Tab - -
62 Combivent Nebulizer Vial 130 130 65 3/21 65
63 Cotrimoxazol 480 mg Tab 3800 3,800 500 9/22 3300 5000
64 Cotrimoxazol 960 mg forte Tab - -
65 Cotrimoxazol Syrup Botol 111 111 6 7/22 105 100
66 Curbion Kids Emulsion (Multivitamin Anak) Botol - -
67 Curviplex Syrup Botol - -
68 Daneuron Tab - - 1000
69 Dapyrin Syrup Botol - -
70 Desoximetason cream 0,25 % Tube - - 100
71 Dexamethason 0,5 mg Tab Tab 7400 7,400 1,600 5800 10000
72 Dexamethason Inj Ampul 50 50 19 7/21 31 50
73 Diazepam 5 mg Tab 455 455 45 10/22 410
74 Diazepam Injeksi 5 mg/ml Ampul 10 10 10 0 50 EXP
75 Digoxin 0,25 mg Tab 100 100 100 11/20 0 5000 EXP
76 Diltiazem 30 mg Tab - -
77 Dimenhidrinat tab 50 mg Tab 100 100 - 2/22 100 2000
78 Diphenhydramin Inj 10 mg/ml Ampul 30 30 3 7/22 27
79 Doksisiklin 100 mg Tab - -
80 Domperidon tab 10 mg Tab 5200 5,200 500 7/22 4700 5000
81 Dopamet tab Tab 1600 1,600 200 12/20 1400 5000
82 Dulcolax Suppo 10 mg Suppo 0 - - 6/21
83 Ephinefrin Inj 1 mg/ml 0,1% Ampul 11 11 - 1/21 11
84 Ergotamin Coffein/anti migraen. Tab 1000 1,000 - 8/21 1000
85 Erytromicin tab 500 mg tab 600 600 100 500
86 Erytromisin Syr Botol - -
87 Ethambutol 500 mg Botol - -
88 Euthyrox 50 mg Tab - -
89 Fenobarbital Inj 50 mg/ml Ampul 0 - -
90 Fenol Gyserol TT Botol - -
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
91 Fitomenadion ( Vit. K) injeksi Ampul 130 130 11 5/21 119 300
92 Fitomenadion ( Vit. K) tab salut 10 mg Tab 300 300 100 6/21 200 6000
93 Flixotide Nebules Vial - -
94 Framycetin Lembar 0 - - 12/20 0 100
95 Fucilex Cream Tube - -
96 Furosemid Inj 10 mg/ml Ampul 35 35 3 2/21 32 100
97 Furosemid Tab 40 mg Tab 1600 1,600 200 3/21 1400 10000
98 Garam Oralit 200 mg pcs 1300 1,300 300 1/22 1000 3000
99 Gentamicin Injeksi 40 mg/ml Ampul 0 - - 10/20
100 Gentamicin Salep Mata 0,3% Tube 72 72 24 7/23 48 100
101 Gentamicin Sulfa Tetes Mata 0,3% Botol 72 72 - 9/22 72 100
102 Glibenklamid 5 mg Tab 600 600 200 5/22 400 10000
103 Glikos 500 mg Tab - -
104 Gliquidon Tab - -
105 Glukosa 10% Infus Kolf 20 20 20 1/21 0 40 EXP
106 Glukosa 5% Infus Kolf 120 120 56 8/22 64 80
107 Glukosa 5% Infus Otsu Botol - - 80
108 Gored Tab - -
109 Grantusif Tab - - 18000
110 Griseofulvin 125 mg Tab 5000 5,000 1,300 5/21 3700
111 Guaifenesin 100 mg Tab 5500 5,500 800 4700 5000
112 Haloperidol 0,5 mg Tab - -
113 Haloperidol 1,5 mg Tab 670 670 370 3/23 300
114 Haloperidol 5 mg Tab - - 12/20 0
115 Herbakof / Obat Batuk Fitofarmaka 60 ml Botol 10 10 10 9/21 0 100
116 Hidrokortiazid 25 mg (HCT) Tab 1400 1,400 - 5/22 1400 2000
117 Hidrokortison Krim 2,5% Tube 24 24 24 5/23 0 300
118 Hufadin Tab Tab - -
119 Hufagrif TMP Botol - - 1000
120 Hufagrip Forte TB tab - -
121 Hyperhep 0,5 ml (Vaksin HbIg) Vial 2 4 6 5 8/21 1
122 HyperRAB (Rabies Immune Globulin) Vial - - 20
123 Ialuset Plus Cream Tube 1 1 - 1/22 1 100
124 Ibuprofen Suspensi 100 mg/5ml Botol 78 78 26 7/21 52 500
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
125 Ibuprofen tab Tab - - 10000
126 Iliadin Drop Tetes Hidung Botol - - 100
127 Irbesartan 150 mg Tab - -
128 Isoniazid 100 mg Tab - -
129 Isosorbit Dinitrat 5 mg Tab 1200 1,200 - 7/21 1200 5000
130 KA EN 3A Infus Kolf - -
131 KA EN 3B Infus Kolf - - 20
132 Kalsium Laktat 500 mg (Kalk) Tab 2800 2,800 2,100 8/22 700 20000
133 Karbamazepin 200 mg Tab 550 550 210 340
134 Ketokonazole 200 mg Tab 950 950 450 12/21 500 1000
135 Ketokonazole Krim Tube 0 - - 2/23 500
136 Ketorolac Inj 30mg/ml (3%) Ampul - - 300
137 Lactulosa Sir 3,335 g/5ml Botol - -
138 Lacyvir Salep Mata Tube - - 300
139 Lansoprazole caps Caps - - 12000
140 Laxadine emulsi Botol - - 50
141 Levofloxacin 500 mg Tab - - 4/21
142 Lidocain Compositum Inj Ampul 155 155 65 7/21 90 100
143 Lidocain inj 2% Inj - -
144 Livron B Plex Tab - - 10000
145 Loperamide HCl Tab - - 10000
146 Loratadine tab 10 mg tab - - 10000
147 Lytacur Syrup 60 ml / Procurma Syr Botol 150 150 12 138
148 Magnesium sulfat (MgSO4) 20% Ampul 12 12 - 6/20 12 20
149 Magnesium sulfat (MgSO4) 40% Ampul 7 7 7 11/20 0 20
150 Mersibion Inj Ampul 17 17 17 7/21 0 200
151 Mersibion Tablet 5000 Tablet - - 5000
152 Metformin tab 500 mg tab 2900 2,900 1,600 12/20 1300 15000
153 Metilergotmetrin 0,125 mg Tab 400 400 400 2/21 0 EXP
154 Metilergotmetrin Inj 0,2 mg/ml Ampul 0 - - 100
155 Metilprednisolon 16 mg Tab 2800 2,800 - 2800 5000
156 Metilprednisolon 4 mg Tab - - 10000
157 Metisol 4mg Tab - - 1000
158 Ranitidin Inj Tab - - 4/22 200
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
159 Metoklorpamid 5 mg Tab 900 1000 1,900 - 1/23 1900 5000
160 Metronidazol Infus Botol - -
161 Metronidazol Syrup Botol - - 100
162 Miniaspi 80 mg Tab 400 400 - 8/21 400 500
163 Muliavit Syrup Botol - -
164 NaCl 0,9% Infus Kolf 80 80 13 3/24 67 300
165 Natrium Diklofenak 25 mg Tab 4400 4,400 2,000 10/21 2400 10000
166 Natrium Diklofenak 50 mg Tab 5150 5,150 2,050 10/21 3100 10000
167 New Antides Tab - - 10000
168 Nifedipin 10 mg Tab - -
169 Novadryl Syrup Botol - - 200
170 Novaxicam 20 mg (Piroxicam) Caps - - 1000
171 Nystatin 100.000 IU Tab 200 200 - 3/22 200 5000
172 Nystatin 500.000 IU Tab 0 - - 4/21 5000
173 OAT Kategori Anak Paket 1 1 - 2/21 1
174 OAT Kategori I FDC Paket 20 20 - 2/21 20
175 OAT Kategori I Kombipak Paket - -
176 OAT Kategori II Paket - -
177 OBH Kaca Berlico 100ml Botol 216 216 17 199 500
178 OBH Syrup jeruk nipis Botol - - 500
179 Ofloxacin 200 mg Tab 300 300 - 12/21 300
180 Oksitetrasiklin 1% Zalp Mata Tube - - 100
181 Oksitosin Inj 10 IU/ml Ampul 10 10 9 1 300
182 Omeprazole 20 mg Caps / Lanzoprazole Caps 0 - - 15000
183 Omeroxol Syrup Botol - -
184 Ondansetron 4 mg tab Tab - -
185 Ondansetron Inj Ampul 110 110 15 4/21 95 200
186 Parasetamol 500 mg Tab 7700 7,700 3,200 4500 24000
187 Parasetamol Drop Botol - - 400
188 Parasetamol Infus btl - -
189 Parasetamol Syrup Botol 0 - - 5/22 800
190 Pasaba Baby Cough Syrup Botol - - 500
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
191 Pasaba Cough Plus Syrup Botol - - 500
192 nobar Tab - -
193 Piridoxin 10 mg (Vit. B6) Tab 3200 3,200 200 8/21 3000 5000
194 Prednison tab 5 mg Tab - - 5000
195 Primaquin Tab Tab - -
196 Primpen Syrup Botol - -
197 Pro K Inj Ampul - - 300
198 Procain Benzyl Penisilin 3 juta UI Vial - -
199 Profiltiourasil 100 mg (PTU ) Tab - - 6000
200 Profolat 0,4 mg Tab - - 10000
201 Pronazol 200 mg Tab - - 8000
202 Propanolol 10 mg Tab - - 8/20 6000
203 Pularex Tab Tab - -
204 Pulmicort Budesonid Respules Vial - -
205 Pyrantel Pamoat 125 mg Tab 100 100 100 1/24 0 8000
206 Pyrantel Pamoat susp 125mg/5ml Botol 63 63 6 57 100
207 Pyrazinamid 500 mg Tab - -
208 Ranitidin Inj Ampul 100 100 29 9/20 71 300
209 Ranitidin Tab / Radin tab Tab - - 14000
210 Reco tetes telinga Botol - - 300
211 Retinol 100.000 IU BIRU (Vit. A) Caps - -
212 Retinol 200.000 IU MERAH (Vit. A) Caps - -
213 Rifampicin 300mg Tab - -
214 Rifampicin 450 mg Tab - -
215 Rifampicin 600 mg Caps - -
216 Ringer Laktat Infus Kolf 135 135 68 8/23 67 200
217 Risperidon 1 mg Tab - -
218 Risperidon 2 mg Tab 640 640 225 2/22 415
219 Salbulin Spray Btl - -
220 Salbutamol 2 mg Tab - - 15000
221 Salbutamol 4 mg Tab 700 700 600 100 15000
222 Salbutamol Syrup Botol 150 150 150 0 200 EXP
223 Salep 2-4 Tube 0 - - 6/23 300
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
224 Selesnizol tab 500 mg / metronidazol 500 mg Tab 0 - - 3/22 12000
225 Selespurin 100 mg tab / alopurinol 100 mg Tab 1600 1,600 1,100 9/21 500 15000
226 Sianokobalamin (Vit. B12) tablet Tab -
227 Sianokobalamin Inj (Vit. B12) Ampul - -
228 Simvastatin 10 mg Tab 2640 2,640 840 5/21 1800 10000
229 Simvastatin 20 mg Tab 3000 3,000 900 6/21 2100 10000
230 Soft U Derm 10% Cream 20 gr Tube - -
231 Solinfec Tube - -
232 Spironolactone 25 mg Tab - - 6000
233 Stesolid Rect 10 mg/2,5ml Tube 4 4 2 3/22 2 20
234 Stesolid Rect 5 mg/2,5ml Tube 8 8 - 3/22 8 20
235 Sucralfat Syrup Botol 100 100 35 65 500
236 Sulfadiazine salep Pcs - - 300
237 Sulfadoxine-Pyrimethamine (Suldox) Tablet 300 300 - 3/21 300 1000
238 Tablet Tambah Darah FE Tab 1740 1,740 1,740 7/21 0 15000 EXP
239 Taracol Tab (Obat Flu kombinasi) Tab 0 - - 3/22 0 15000
240 Tetagam Inj Vial - -
241 Tetrasiklin 500 mg Tab - -
242 Thiamin (Vit B1) 50 mg Tab 3700 3,700 - 11/23 3700 10000
243 Tramadol Inj Ampul - -
244 Trifason 0,5 mg Tab - - 11/23
245 Trifluoperazin 5 mg Tab 580 580 60 6/23 520
246 Trihexylpenidil 2 mg Tab 790 790 90 6/22 700
247 Ulsidex Tab Tablet - - 10000
248 Valdimex 10 mg Inj/ Diazepam Inj DAU Ampul - -
249 Verorab (Vaksin VAR) Box - - 20
250 Vicalcin Syr Botol - -
251 Vitamin B komplek Tab 12200 12,200 200 4/22 12000 20000
252 Wormetrin Tab Tab - - 6000
253 Zevask 10mg Tab - -
254 Zinc 20 mg Tab 3000 3,000 - 9/22 3000 10000
255 Zink Drop Botol - - 300
256 Zink Syrup Botol 150 150 16 134 300
257 Flutamol syr Botol 0 - - 600
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
BAHAN MEDIS HABIS PAKAI, REAGEN DAN LARUTAN
1 Alat suntik 0,5 ml ADS Pcs - - 1000
2 Alat suntik 0,5 ml SKIFA Pcs - - 1000
3 Alat suntik 0,5 ml TP Pcs - - 1000
4 Alat suntik 1 ml Pcs 100 100 34 7/20 66 1000
5 Alat suntik 1 ml needle luer lock Pcs - -
6 Alat suntik 1 ml Tubercullin serenity Pcs - -
7 Alat suntik 10 ml ASSP TP Pcs 140 140 1 5/23 139 1000
8 Alat suntik 10 ml Aximed Pcs - -
9 Alat suntik 10 ml needle luer lock Pcs - -
10 Alat suntik 10 ml Serenity Pcs - - 1000
11 Alat suntik 3 ml needle luer lock Pcs - -
12 Alat suntik 3 ml TP Pcs 90 90 84 10/21 6 1000
13 Alat suntik 5 ml TP Pcs 0 - - 10/21 0 1000
14 Alkazym 25 mg Sachet - -
15 Alkohol 70% 1 Lt Botol 27 27 - 27 50
16 Alkohol 70% 300 mL Botol - - 100
17 Alkohol Swab Aximed Pcs 4700 4,700 1,400 5/23 3300 5000
18 Alkohol Swab Onemed Pcs - -
19 Alkohol Swab Sensi Pcs - - 5000
20 Anios Gel Botol - - 400
21 Aprone One Plastik Pcs - - 3000
22 Aqua Pro Injeksi Otsu Vial 19 19 - 3/22 19 300
23 Arm Sling Comfort (L) Pcs - -
24 Arm Sling Comfort (M) Pcs - -
25 Arm Sling Comfort (S) Pcs - -
26 Aroma Fine Normal Pack - -
27 Aseptic Gel 500 cc Botol - - 300
28 Blood Lancet 26G OM Box - - 1000
29 Blood Lancet Medillance Box - - 1000
30 Blood Lancet Serenity Pcs 300 300 200 100 1000
31 Blood Transfusion Set Abada Pcs 100 100 - 7/23 100
32 Blue Tips Bks 500's - -
33 Catgut Chromic 1 HR 26 MM Pcs - -
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
34 Catgut Chromic 1 HR 48 MM Pcs - -
35 Catgut Chromic 2/0 HR 20 MM Pcs - -
36 Catgut Chromic 3/0 DS 19 MM Pcs - -
37 Catgut Chromic 3/0, 70 cm, Violet, Reverse
Cutting, 1/2C, 26 mm Pcs - -
38 Catgut Chromic 3/0, 70 cm, Violet, Round Body,
1/2C, 22 mm Pcs - -
39 Catgut Chromic 3/0, 75 cm, 1/2 TP, 25 mm
CG344 Pcs 24 24 - 24 500
40 Catgut Chromic 3/0, 75 cm, 3/8 RC CG342 Pcs - -
41 Catgut Chromic 4/0, 45 cm, CG366 Pcs - -
42 Catgut Chromic Serenity Pcs - -
43 Catgut Nylon 5/0, 75 cm, 3/8 cc, 12 mm NY979 Pcs - -
44 Catgut Plain 2/0 DS 19 MM Pcs - -
45 Catgut Plain 3/0 75 cm, 1/2 TP 30 mm Pcs - -
46 Catgut Plain 3/0 DS 16 MM Pcs - -
47 Catgut Plain 3/0, 75 cm, 3/8 RC, 23 mm Pcs - -
48 Catgut Plain 3/0, 75 cm, Undyed, Rev Cutting,
38C, 19 mm Pcs - -
49 Catgut Plain Serenity 3/0 Pcs - -
50 Catgut Provein 5/0, 45 cm, 18 mm, PV888 Pcs - -
51 Catgut Silk 3/0, 75 cm, 1/2 TP 26 mm Pcs - -
52 Catgut Silk 3/0, 75 cm, 3/8 CC 19 mm Pcs - -
53 Catgut Silk 4/0, 75 cm, 1/2 TP 20 mm BS690 Pcs - -
54 Catgut Silk 5/0, 45 cm BS695 Pcs - -
55 Chlor Etyl 100 ml Botol 1 1 - 7/21 1 100
56 Cuticell 7,5 cm X 20 cm oinment dressing Pcs - -
57 Cuticell Clasic 10 cm x 10 Pcs - -
58 Cutisorb Steril 10 cm x 10 Pcs - -
59 Derm Transport Dressing (Remedi) Pcs - -
60 Dermafix Pcs - -
61 Diapers Adult 10s Uk. L Molicare Pcs - - 2000
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
62 Dressing IV Cannula Non Woven (Remedi) Pcs - -
63 ECG Gel 1000 ml Botol 2 2 - 1/22 2 50
64 Endo Ice Spray 200 ml Botol - -
65 Endotracheal Tube (ETT) 6,0 Fesco Pcs - -
66 Endotracheal Tube (ETT) 7,0 Fesco Pcs - -
67 Endotracheal Tube (ETT) 7,5 Fesco Pcs - -
68 Endotracheal Tube (ETT) 8,0 Fesco Pcs - -
69 Feeding Tube 100 cm No 10 Aximed Pcs 20 20 - 2/21 20
70 Feeding Tube 100 cm No 8 Aximed Pcs 20 20 - 2/21 20
71 Feeding Tube 40 cm No 10 Aximed Pcs 20 20 - 2/21 20
72 Female Catheter No. 16 Aximed Pcs 20 20 - 3/22 20
73 Female Catheter No. 18 Aximed Pcs 23 23 - 3/22 23
74 Folley Catheter No. 16 (2 Way Standard) Pcs
Serenity - -
75 Folley Catheter No. 16 latex 2 Way ABADA Pcs 11 11 6 1/24 5
76 Folley Catheter No. 18 (2 Way Standard) Pcs
Serenity - -
77 Folley Catheter No. 18 latex 2 Way ABADA Pcs 16 16 5 1//24 11
78 Gliserol 100 ml Botol - -
79 Handrub E-Care 500 ml Botol - -
80 Handscrub E-Care 500 ml Botol - -
81 Infus Set Anak Type Y Pcs - -
82 Infus Set Dewasa Type Y Aximed Pcs - -
83 Infus Set Semilas 3D Dewasa Pcs - -
84 Infusion Set Anak Aximed Pcs 75 75 3 10/21 72
85 Infusion Set Dewasa Aximed Pcs 0 - - 8/23 0 3000
86 Infusion Set Microdrip Abada Pcs - -
87 Infusion Set Microdrip Otsu Pcs - -
88 Infusion Set Y Adaptor Otsu Pcs - -
89 Iodine Povidon 30 ml Botol 0 - - 1/21 0 500
90 Iodine Povidon 60 ml Botol 0 - - 2/22 0 300
91 IV Catheter No. 18 G Cath Pro Pcs - -
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
92 IV Catheter No. 18 G Otsu Pcs - - 100
93 IV. Catheter No. 20 G Cath Pro Pcs - -
94 IV. Catheter No. 20 G Otsu Pcs - - 100
95 IV. Catheter No. 22 G Cath Pro Pcs 200 200 - 200 200
96 IV. Catheter No. 22 G Otsu Pcs - - 200
97 IV. Catheter No. 24 G Cath Pro Pcs 155 155 48 9/23 107 200
98 IV. Catheter No. 24 G Otsu Pcs - - 100
99 IV. Catheter WP No. 18 ABADA Pcs 50 50 13 11/22 37 200
100 IV. Catheter WP No. 20 ABADA Pcs 40 40 - 11/22 40 200
101 IV. Catheter WP No. 22 ABADA Pcs - - 200
102 IV. Catheter WP No. 22 AXIMED Pcs - -
103 IV. Catheter WP No. 24 AXIMED Pcs - -
104 IV. Catheter WP No. 26 AXIMED Pcs 135 135 1 10/21 134 200
105 Kantong Limbah Biohazard kuning Uk. L
(80x100 cm) Pack 6's
0 - - 100
106 Kantong Limbah Biohazard kuning Uk. M
(60x80 cm) Pack 10's
7 7 - 7 100
107 Kantong Limbah Biohazard kuning Uk. S (40x60 Pack 20's
cm) 2 2 1 1 100
108 Kantong Plastik PE 60 x 100 cm Pack 10's - - 100
109 Kapas 100 gr Pcs - - 100
110 Kapas 250 gr Pcs 2 2 - 2 100
111 Kapas 500 gr Pcs - - 100
112 Kasa 10 x 10 Onemed Roll - - 100
113 Kasa 2 m x 80 cm Roll 3 3 - 3 10
114 Kasa 40 x 80 cm Roll - -
115 Kasa Hidropil 16 x 16 Abada Box - -
116 Kasa Hidropil 2 x 10 cm Abada Pack - -
117 Kasa Hidropil 20 x 80 cm Abada Box - -
118 Kasa Hidropil 36 x 80 cm (BIOKASA) Roll 3 3 - 3 50
119 Kasa Hidropil 4 x 15 cm Abada Pcs 110 110 50 60 500
120 Kasa Hidropil 4 x 7,5 cm Abada Pcs - -
121 Kasa Steril 7.5x7.5 Pcs - - 300
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
122 Kertas EKG BTL -08 M Line Roll 5 5 2 3
123 Kertas Perkamen Pack - -
124 Latex Powder Examination Gloves Uk. L ASAP Pcs 0 - - 7/23 3000
125 Latex Powder Examination Gloves Uk. M ASAP Pcs 0 - - 7/23 5000
126 Latex Powder Examination Gloves Uk. S ASAP Pcs 900 900 850 12/23 50 8000
127 Latex Powder Examination Gloves Uk. XS ASAP pcs - -
128 Lysol 1 Liter Botol 2 2 - 2 50
129 Masker 3 m 1870 N 95 Pcs 140 140 2 138
130 Masker ear loop ABADA Pcs - - 20000
131 Masker ear loop Aximed Pcs - - 20000
132 Masker ear loop semillas Pcs 4700 4,700 1,850 2850 20000
133 Masker Nebulizer Anak (M) Abada Pcs - -
134 Masker Nebulizer Anak Cosmo Pcs - -
135 Masker Nebulizer Anak Remedi Pcs - -
136 Masker Nebulizer Dewasa (L) Abada Pcs - -
137 Masker Nebulizer Dewasa Cosmo Pcs 40 40 16 24
138 Masker Nebulizer Dewasa Remedi Pcs - -
139 Masker Oksigen Anak Serenity Pcs 10 10 - 10
140 Masker Oksigen Bayi Pcs - -
141 Masker Oksigen Dewasa Pcs 4 4 - 4
142 Masker oksigen NRM adult elongated pcs - -
143 Masker oksigen NRM child elongated pcs 5 5 - 3/22 5
144 Medical Ultrasonic Gel Botol - -
145 Meliseptol Spray Botol - -
146 Micropipet adjust Vol. 0,5-10 UL Pcs 2 2 - 2
147 Micropipet adjust Vol. 100-1000 UL Pcs 2 2 1 1
148 Micropipet adjust Vol. 10-100 UL Pcs 1 1 - 1
149 Micropipet adjust Vol. 200-1000 UL Pcs 2 2 - 2
150 Micropipet adjust Vol. 50-200 UL Pcs 2 2 - 2
151 Micropipet Adjust Vol.0,1-2,5UL Pcs 2 2 - 2
152 Micropipet Adjust Vol.2-20 UL Pcs 2 2 - 2
153 Micropipet Adjust Vol.5-50 UL Pcs 2 2 - 2
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
154 Micropipet Fixed Vol.10 UL Pcs 1 1 - 1
155 Micropipet Fixed Vol.100 UL Pcs 2 2 - 2
156 Micropipet Fixed Vol.20 UL Pcs 2 2 - 2
157 Micropipet Fixed Vol.25 UL Pcs 2 2 - 2
158 Micropipet Fixed Vol.5 UL Pcs 2 2 - 2
159 Micropipet Fixed Vol.50 UL Pcs 2 2 - 2
160 Micropipet Fixed Vol.500 UL Pcs 2 2 - 2
161 Mikro Aplicator tips Botol - -
162 Mucus Extractor Serenity Pcs - -
163 Nasal Oksigen 'M' Aximed Pcs 4 4 - 4
164 Nasal Oksigen 'S' Aximed Pcs 10 10 3 7
165 Nasal Oksigen Uk. XS Pcs 9 9 - 9
166 Nasal Oxygen Canula anak Pcs - -
167 Nasal Oxygen Canula anak Abada Pcs - -
168 Nasal Oxygen Canula anak Serenity Pcs - -
169 Nasal Oxygen Canula Dewasa Abada Pcs 4 4 - 4
170 Needle CNV 21x1,5 ml (BD Vacutainer) Pcs - -
171 Needle CNV 22x1,5 ml MLTSMP CE Pcs - -
172 Needle Flashback 21X1 Pcs - -
173 Nitrile Powder Free Examination Globe Uk. S Pcs - -
174 Non Woven Fixtation 10 cm x 10 m Aximed Roll 11 11 1 10/20 10 50
175 Non Woven Fixtation 5 cm x 10 m Aximed Roll 11 11 - 10/20 11 100
176 Non Woven IV Dressing 6x8 cm Narafix Pcs - -
177 Nurse Cup Green Box 100's 300 300 600 340 260 2000
178 One Scrub Botol - -
179 One Step HBSAg Test Strip Pcs - - 3
180 Oxyflow nasal anak Pcs - -
181 Oxyflow nasal bayi Pcs - -
182 Paper Tape 1,25 cm X 9,14 cm Roll - -
183 Paper Tape 2,5x9,14 cm Roll - -
184 Paper Tape 7,5 cm X 9,14 cm Roll - -
185 Papsmear Kit M Pcs - -
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
186 Papsmear Kit S Pcs - -
187 Plester ZinkOxyd 1,25 x 450 cm Roll 0 - - 100
188 Plester ZinkOxyd 2,5 x 450 cm Roll 3 3 3 0 100
189 Plester ZinkOxyd 5 x 450 cm Roll 13 13 - 13 100
190 Policrepe 10 cm x 4,55 m Roll - -
191 Policrepe 15 cm x 4,55 m Roll 36 36 - 36
192 Polifix 10cmx5m Roll - - 50
193 Polifix 15cmx5m Roll - - 50
194 Polifix 15x5 cm Roll - - 50
195 Proline Cholesterol FS KIT - -
196 Proline Glucose GOD FS KIT - -
197 Proline Triglycerides FS KIT - -
198 Proline Trucal U KIT - -
199 Reagen Afinion HbA1c Box 10's - -
200 Reagen Anti A 1x10 ml KIT - -
201 Reagen Anti AB 1x10 ml KIT - -
202 Reagen Anti B 1x10 ml KIT - -
203 Reagen Anti D 1x10 ml KIT - -
204 Reagen Cleanser 1 Lt For Sumiffin Botol - -
205 Reagen Cleanser BCC 3600 Dirui Botol - -
206 Reagen Cleanser For Mindray Botol - -
207 Reagen Cleanser For Zenix Botol - -
208 Reagen Control Normal Kimia Biomaxima Vial - -
209 Reagen Control Normal Mindray KIT - -
210 Reagen Control Normal Zenix KIT - -
211 Reagen Creatinine 3x50 mL Biomaxima KIT - -
212 Reagen Diluent 20 Lt Dirui BCC -3600 Botol - -
213 Reagen Diluent For Sumiffin Botol - -
214 Reagen Diluent M-30 20 L Mindray Botol - -
215 Reagen Diluent Zenix Botol - -
216 Reagen EZ Cleanser 100 ml Mindray Botol - -
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
217 Reagen Lyse 500 ml Dirui Botol - -
218 Reagen Lyse 500 ml For Sumiffin Botol - -
219 Reagen Lyse 500 ml- Mindray M-30 Botol - -
220 Reagen Lyse 500 ml Zenix Botol - -
221 Reagen Rinse 20 Lt Mindray Botol - -
222 Reagen Salmonella Paratyphi 0 1x5 ml KIT - -
223 Reagen Salmonella Paratyphi A0 1x5 ml KIT - -
224 Reagen Salmonella Paratyphi AH 1x5 ml KIT - -
225 Reagen Salmonella Paratyphi B0 1x5 ml KIT - -
226 Reagen Salmonella Paratyphi BH 1x5 ml KIT - -
227 Reagen Salmonella Paratyphi C0 1x5 ml KIT - -
228 Reagen Salmonella Paratyphi CH 1x5 ml KIT - -
229 Reagen Salmonella Paratyphi H 1x5 ml KIT - -
230 Reagen SGOT (ASAT) 3x20 mL Biomaxima KIT - -
231 Reagen SGPT (ALAT) 3x20 mL Biomaxima KIT - -
232 Reagen Urea 3x50 mL Biomaxima KIT - -
233 ReagenTriglycerida 4x50 mL Biomaxima KIT - -
234 Rectal Tube size 22 FR Pcs - -
235 Rivanol 300 cc Botol 0 - - 12/21 500
236 Sabun Antibakteri Botol 0 - - 300
237 Safety box 5 lt kuning Pcs 24 24 - 24 300
238 Saniswiss Biosanitier L5000 ml Botol 1 1 - 6/24 1 50
239 Saniswiss Biosanitizer H1500 ml Botol - - 6/24 50
240 Saniswiss Biosanitizer L15000g Botol - - 6/24 50
241 Selang NGT No. 18 Pcs - -
242 Selang NGT No. 22 Pcs - -
243 Semillas Non Woven Medical Tape 20x500 cm Roll - -
244 SEMILLAS Non Woven Transparant Wound
Dressing with Pad 9 x 15 cm Pcs
- -
245 SEMILLAS Non-Woven Wound Dressing 6x7 Roll
cm (With Pad) - -
246 Semillas water proof medical tape 20x500 cm Roll - -
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
247 Servical Collar Serenity Pcs - -
248 Silk Black 2/0 HR 30 MM Pcs - -
249 Silk Black 3/0 HR 30 MM Pcs - -
250 Silk Black 5/0 DS 12 MM Pcs - -
251 Silk Black 6/0 DS 14 MM Pcs - -
252 Silk Black Braided Braun 3/0 + Jarum Pcs 163 163 - 163 300
253 Silk Braided USP 3/0 Pcs 48 48 24 4/23 24 300
254 Silk Plain 3/0 Pcs - - 300
255 Softaman Desinfectan Botol - -
256 Softaskin Gel Botol - -
257 Spalk First AID Pcs 18 18 - 18
258 Stomach Tube 85 cm No 14 Aximed Pcs 20 20 - 2/21 20
259 Strip test ABON Syphilis Ultra Rapid Pcs - -
260 Strip test cholesterol autocheck Box 25's 21 21 12 10/20 9 100
261 Strip test cholesterol benecheck Box 10's - -
262 Strip test Dengue NS1 Antigen Serenity Pcs - -
263 Strip test DI Anti HCV 1/2 Casette Pcs - -
264 Strip test DI Anti HIV 1/2 cassete Pcs - -
265 Strip test glucose autocheck Box 50's 7 7 2 8/21 5 100
266 Strip test glucose benecheck Box 50's - -
267 Strip test glucose On call Plus Pcs - -
268 Strip test Hb Hemoglobin Mission Pcs - -
269 Strip test HCG Fokus Pcs 0 - - 1000
270 Strip test Rapidan Dengue NS1 dan IgG/IgM Pcs - -
271 Strip test Rapidan HBsAg Test WB/S/P Pcs 0 - -
272 Strip test Rapidan Malaria Pcs 50 50 - 8/21 50 500
273 Strip test SD Dengue Duo Bioline Pcs 50 50 25 7/21 25 500
274 Strip test SD HBSAg Test Strip Pcs 25 25 - 25 500
275 Strip test SD HIV 1/2 3.0 Pcs - -
276 Strip test SD HIV Bioline Pcs 250 100 350 175 175 200
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
277 Strip test uric acid autocheck Box 50's 13 13 - 11/20 13 200
278 Strip test uric acid benecheck Box 25's - -
279 Strip test uric acid Easy Touch Box 25's - -
280 Suction Catheter No. 10 (Aximed) Pcs - -
281 Suction Catheter No. 12 ( Aximed) Pcs - -
282 Surfaces Stretch Wipes (Biosanitizer) Pack - -
283 Surgical Blade No. 10 Aesculap Pcs - -
284 Surgical Blade No. 10 Serenity Pcs - -
285 Surgical Blade No. 23 Serenity Pcs 50 50 3 47 100
286 Surgical Film 20 x 30 cm Pcs - -
287 Surgical Gloves Gyanokolog No. 6,5 (Remedi) Pairs - - 200
288 Surgical Gloves Gyanokolog No. 7 (Remedi) Pairs 50 50 16 3/23 34 200
289 Surgical Gloves No. 6 TRO Sensosurge Pairs - -
290 Surgical Gloves No. 6,5 TRO Sensosurge Pairs - -
291 Surgical Gloves No. 7 GAMEX Pairs - -
292 Surgical Gloves No.6,0 Aximed Pcs - -
293 Surgical Gloves No.6,5 Aximed Pcs 150 150 - 7/23 150 2000
294 Surgical Gloves No.7,0 Aximed Pcs 600 600 11 7/23 589 2000
295 Surgical Gloves No.7,5 Aximed Pcs 550 550 42 7/23 508 2000
296 Surgical Safeglove ST PF 6 Pcs - -
297 Surgical Safeglove ST PF 6,5 Pcs - -
298 Surgical Safeglove ST PF 7 Pcs - -
299 Tabung BD Vacutainer Tube EDTA plh 13 x 75 3. Pcs - -
300 Tabung BD Syringe Soloshot mm 0,5 ml Pcs - -
301 Tabung EDTA Tab 3 ml Pcs 1600 1,600 200 1400
302 Tabung Endo Vacuum Blood Collection tube, Pcs
Plain 3 ml - -
303 Tabung Endo Vacuum Tube Sterile K3EDTA Pcs - -
304 Tabung K3EDTA 3 ml Glass Interna Pcs - -
305 Tabung Plain 3 ml Glas Interna tabung 2300 2,300 - 2300
306 Tabung Vacuum Container Plain 3 ml Glas Pcs
Interna - -
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
307 TB AG Rapid Test KIT - -
308 Three Way with Extention Pcs - -
309 Tips For Micro MT 200 IU Pcs - -
310 Tips For Micro MT II 1 ml Pcs - -
311 Tips For Micropipet MSTP Pcs - -
312 Trigliseride Test Strip Pcs - -
313 Tube TB AG tube - -
314 Uji malaria fokus Pcs - -
315 Umbilicall Cord Clame Fesco Pcs - -
316 Umbilicall Cord Clem Pcs 200 200 10 190
317 Underpad (Soft pad 60x90) Pcs 950 950 20 930
318 Underpad Surgical Pcs - -
319 Urine bag + Hanger Pcs 10 10 - 10 100
320 Urine Collector Pead OM Pcs - -
321 Uritest Reagent Strip 11G Box 100's 2 2 - 7/21 2 8
322 USG Gel 250 Ml Pcs - -
323 Viorex Liquid Btl 500 ml - -
324 White Tips Bks 1000's - -
325 Wing Nedle 23 G Pcs - - 100
326 Wing Nedle 25 G Pcs - - 100
327 Write On ID Bracelet Child Green (Remedi) Box 100's 2 2 - 2
328 Write On ID Bracelet Child Ungu (Remedi) Box 100's 2 2 - 2
329 Write On ID Bracelet,Adult Blue (Remedi) Box 100's 2 2 - 2
330 Write On ID Bracelet,Adult Pink (Remedi) Box 100's 2 2 - 2
331 Yellow Tip Bks 1000's - -
332 Iodine Povidon 300 ml Botol 7 7 2 5 100
333 Latex Powder Free Examination Gloves Uk. M Pcs - - 2000
334 Reagen Ziehl Neelsen Paket 2 2 - 2
335 Saniswiss Biosanitier H 500 ml Botol 17 17 1 16 50
336 Surfaces Biosanitier S 750 ml Botol 11 11 - 11
337 Surfaces Biosanitier S 5000 ml Kent 4 4 - 4
338 Hand Gel H1 100 ml + Flip top Botol - - 100
Bahan Gigi
1 Alveogyl 10 gr - Septodent Ampul - -
2 Arsen / pul X-Devitalizer Pot - -
3 Articulating paper Buah - -
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
4 Bonding/Master Bond Buah - -
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
5 Calcimol LC Botol - -
6 Carpule Anastesi / Artinibsa Box - -
7 Cavit G (Ceivitron) Pot - -
8 Cavitton Pink (Ceivitron) 30 gr Buah - -
9 Celluloid Strip Box - -
10 Cemen Spatula Buah - -
11 Cement Phospat 35 gr Box - -
12 CHKM Botol - -
13 Citocarten/carpule Box - -
14 Composite Resin A2 Pcs - -
15 Composite Resin A3 Pcs - -
16 Dental Needles 30G 16mm Box - -
17 Dycal / Hydcal Botol - -
18 Eching gel 10 ml Tube - -
19 Eugenol 10 ML Ghimas Botol - -
20 Eugenol Cair Botol - -
21 Glass ionomer Fuji IX 1-1 PKG Universal 10 gr Box - -
22 Glass ionomer Fuji IX 1-1 PKG Universal 5 gr Box - -
23 Oco / Poliren No.1 Botol - -
24 Topical anasthetic gel Pcs - -
Jumlah Kunjungan Resep Rawat Jalan Rawat Inap Total
368 368
Mengetahui, Yang meminta/Melapor
Kepala Puskesmas Serimbu Pengelola Obat Puskesmas Serimbu
Kabupaten Landak
Hengki, S.Kep Riski Christanti, A.Md.Kep
NIP. 19831204 201101 1 004 NRPTT. 132.04.22016.0096
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
KABUPATEN : LANDAK
PUSKESMAS : SERIMBU
BULAN/TAHUN : FEBRUARI / 2021
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
1 Acarbose 100 mg Tab - -
2 Acetylsistein 200 mg Caps - -
3 Acyclovir 200 mg Tab - -
4 Acyclovir 400 mg Tab 400 300 700 100 9/23 600
5 Albendazole Syrup Botol 0 - - 0
6 Albendazole tab 400 mg Tab 1900 1,900 100 7/21 1800
7 Allopurinol 300 mg Tab - -
8 Alprazolam 0,5 mg Tab - -
9 Alprazolam 1 mg Tab - -
10 Aminophyllin Inj Ampul - -
11 Amitriptilin 25 mg Tab 430 430 - 5/23 430
12 Amlodipin 10 mg Tab 2500 2,500 1,200 7/23 1300
13 Amlodipin 5 mg Tab 1800 1,800 900 01/22 900
14 Amoxicillin Syrup 125 mg/5ml Botol 0 - - 0
15 Amoxicillin Syrup Forte 250 mg/5ml Botol - -
16 Amoxycillin tab 500 mg Hexpharm Tab 100 100 100 0
17 Ampisillin Injeksi Vial - -
18 Anabion Syrup Botol - -
19 Antasida DOEN Kombinasi Tab 2700 2,700 1,600 08/23 1100
20 Antasida DOEN Syrup Botol 75 75 23 7/21 52
21 Antifungi DOEN salep kombinasi Tube - -
22 Antihemorroid Suppo - -
23 Apricot Syrup 100 ml / Obat Batuk Botol 36 36 5 03/23 31
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
24 Asam ascorbat 50 mg/ Vit. C 50 mg Tab 2400 2,400 600 3/22 1800
25 Asam Mefenamat 500 mg Tab 900 900 900 0
26 Asam Tarnexamat Inj 50mg/ml Ampul - -
27 Asam Tranexamat inj 100 mg/ml Ampul - -
28 Asering larutan infus 500 ml Botol - -
29 Asetosal 100 mg Tab - -
30 Atropin Injeksi 0,25 mg Vial - -
31 Bacitracin Polymicin Zalp Tube - -
32 Benzatin Benzyl Penisilin 2,4 juta UI Vial - -
33 Betahistin Mesilat 6 mg tab 2900 2,900 - 05/22 2900
34 Betamethasone krim 0,05% Tube 0 - - 0
35 Betamethasone krim 0,1% Tube - -
36 Bioplacenton Tulle Pcs 63 63 13 12/21 50
37 BIOSAT 1,500 ( A.T.S) serum anti tetanus Vial - -
38 BIOSAVE ( A.B.U I) serum anti bisa ular Vial - -
39 Bisoprolol 5 mg Tab 1400 1,400 - 7/21 1400
40 Calcii Gluconas Inj Ampul 19 5 24 - 12/21 24
41 Captopril 12,5 mg tab 4300 4,300 1,000 6/24 3300
42 Captopril 25 mg Tab 4400 4,400 500 08/21 3900
43 Cavidagel 15 gr Tube 1 1 2 - 10/21 2
44 Cefadroksil 250 mg Tab - -
45 Cefadroksil 500 mg Tab - -
46 Cefadroxil Syrup Botol 175 175 5 08/23 170
47 Cefotaxim inj,1 gr Ampul - -
48 Ceftriaxon inj.1 gr Ampul - -
49 Cetirizin 10 mg Tab 3800 3,800 300 10/21 3500
50 Cetirizin Syrup Botol 90 90 20 7/21 70
51 Chloramex 500 mg Caps - -
52 Chloramfenicol 125mg/5ml Syrup Botol - -
53 Chloramfenicol 250 mg caps 2400 2,400 200 4/22 2200
54 Chloramfenicol salep mata 1% Tube - -
55 Chlorfeniramin Maleat 4 mg (CTM) Tab 2100 2,100 400 8/21 1700
56 Chlorpromazin 100 mg Tab 410 410 - 7/22 410
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
57 Ciprofloxacin 500 mg Tab - -
58 Clindamicin 150 mg Caps 250 250 100 4/22 150
59 Clozapin 100 mg Tab - -
60 Clozapin 25 mg Tab 761 761 30 2/21 731
61 Codein 10 mg Tab - -
62 Combivent Nebulizer Vial 65 65 65 3/21 0 EXP
63 Cotrimoxazol 480 mg Tab 3300 3,300 500 9/22 2800
64 Cotrimoxazol 960 mg forte Tab - -
65 Cotrimoxazol Syrup Botol 105 105 5 7/22 100
66 Curbion Kids Emulsion (Multivitamin Anak) Botol - -
67 Curviplex Syrup Botol - -
68 Daneuron Tab - -
69 Dapyrin Syrup Botol - -
70 Desoximetason cream 0,25 % Tube - -
71 Dexamethason 0,5 mg Tab Tab 5800 5,800 1,600 02/22 4200
72 Dexamethason Inj Ampul 31 31 5 7/21 26
73 Diazepam 5 mg Tab 410 410 30 10/22 380
74 Diazepam Injeksi 5 mg/ml Ampul 0 - - 0
75 Digoxin 0,25 mg Tab 0 - - 0
76 Diltiazem 30 mg Tab - -
77 Dimenhidrinat tab 50 mg Tab 100 100 100 03/23 0
78 Diphenhydramin Inj 10 mg/ml Ampul 27 27 5 7/22 22
79 Doksisiklin 100 mg Tab - -
80 Domperidon tab 10 mg Tab 4700 4,700 200 7/22 4500
81 Dopamet tab Tab 1400 1,400 - 11/21 1400
82 Dulcolax Suppo 10 mg Suppo - -
83 Ephinefrin Inj 1 mg/ml 0,1% Ampul 11 10 21 11 1/21 10
84 Ergotamin Coffein/anti migraen. Tab 1000 1,000 - 8/21 1000
85 Erytromicin tab 500 mg tab 500 500 400 03/22 100
86 Erytromisin Syr Botol - -
87 Ethambutol 500 mg Botol - -
88 Euthyrox 50 mg Tab - -
89 Fenobarbital Inj 50 mg/ml Ampul - -
90 Fenol Gyserol TT Botol - -
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
91 Fitomenadion ( Vit. K) injeksi Ampul 119 119 25 9/21 94
92 Fitomenadion ( Vit. K) tab salut 10 mg Tab 200 200 - 10/21 200
93 Flixotide Nebules Vial - -
94 Framycetin Lembar 0 - - 0
95 Fucilex Cream Tube - -
96 Furosemid Inj 10 mg/ml Ampul 32 32 2 05/21 30
97 Furosemid Tab 40 mg Tab 1400 1,400 1,400 3/21 0 EXP
98 Garam Oralit 200 mg pcs 1000 1,000 125 04/23 875
99 Gentamicin Injeksi 40 mg/ml Ampul - -
100 Gentamicin Salep Mata 0,3% Tube 48 48 - 87/23 48
101 Gentamicin Sulfa Tetes Mata 0,3% Botol 72 72 - 9/22 72
102 Glibenklamid 5 mg Tab 400 400 200 5/22 200
103 Glikos 500 mg Tab - -
104 Gliquidon Tab - -
105 Glukosa 10% Infus Kolf 0 - - 1/21 0 EXP
106 Glukosa 5% Infus Kolf 64 40 104 10 3/23 94
107 Glukosa 5% Infus Otsu Botol - -
108 Gored Tab - -
109 Grantusif Tab - -
110 Griseofulvin 125 mg Tab 3700 3,700 600 5/21 3100
111 Guaifenesin 100 mg Tab 4700 4,700 1,100 08/21 3600
112 Haloperidol 0,5 mg Tab - -
113 Haloperidol 1,5 mg Tab 300 300 60 3/23 240
114 Haloperidol 5 mg Tab 0 - - 0
115 Herbakof / Obat Batuk Fitofarmaka 60 ml Botol 0 - - 0
116 Hidrokortiazid 25 mg (HCT) Tab 1400 1,400 - 5/22 1400
117 Hidrokortison Krim 2,5% Tube 0 - - 0
118 Hufadin Tab Tab - -
119 Hufagrif TMP Botol - -
120 Hufagrip Forte TB tab - -
121 Hyperhep 0,5 ml (Vaksin HbIg) Vial 1 4 5 1 8/21 4
122 HyperRAB (Rabies Immune Globulin) Vial 4 4 - 4
123 Ialuset Plus Cream Tube 1 1 - 1/22 1
124 Ibuprofen Suspensi 100 mg/5ml Botol 52 52 8 7/21 44
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
125 Ibuprofen tab Tab - -
126 Iliadin Drop Tetes Hidung Botol - -
127 Irbesartan 150 mg Tab - -
128 Isoniazid 100 mg Tab - -
129 Isosorbit Dinitrat 5 mg Tab 1200 1,200 1,200 7/21 0 EXP
130 KA EN 3A Infus Kolf - -
131 KA EN 3B Infus Kolf - -
132 Kalsium Laktat 500 mg (Kalk) Tab 700 700 700 0
133 Karbamazepin 200 mg Tab 340 340 90 250
134 Ketokonazole 200 mg Tab 500 500 100 12/21 400
135 Ketokonazole Krim Tube - -
136 Ketorolac Inj 30mg/ml (3%) Ampul - -
137 Lactulosa Sir 3,335 g/5ml Botol - -
138 Lacyvir Salep Mata Tube - -
139 Lansoprazole caps Caps - -
140 Laxadine emulsi Botol - -
141 Levofloxacin 500 mg Tab - -
142 Lidocain Compositum Inj Ampul 90 90 17 7/21 73
143 Lidocain inj 2% Inj - -
144 Livron B Plex Tab - -
145 Loperamide HCl Tab - -
146 Loratadine tab 10 mg tab - -
147 Lytacur Syrup 60 ml / Procurma Syr Botol 138 138 12 126
148 Magnesium sulfat (MgSO4) 20% Ampul 12 12 - 6/22 12
149 Magnesium sulfat (MgSO4) 40% Ampul 0 0 - - 0
150 Mersibion Inj Ampul 0 - - 0
151 Mersibion Tablet 5000 Tablet - -
152 Metformin tab 500 mg tab 1300 1,300 600 09/22 700
153 Metilergotmetrin 0,125 mg Tab 0 - - 0 EXP
154 Metilergotmetrin Inj 0,2 mg/ml Ampul - -
155 Metilprednisolon 16 mg Tab 2800 2,800 200 05/24 2600
156 Metilprednisolon 4 mg Tab - -
157 Metisol 4mg Tab - -
158 Ranitidin Inj Tab - -
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
159 Metoklorpamid 5 mg Tab 1900 1000 2,900 1,100 1/23 1800
160 Metronidazol Infus Botol - -
161 Metronidazol Syrup Botol - -
162 Miniaspi 80 mg Tab 400 400 - 8/21 400
163 Muliavit Syrup Botol - -
164 NaCl 0,9% Infus Kolf 67 67 11 3/24 56
165 Natrium Diklofenak 25 mg Tab 2400 2,400 1,500 10/22 900
166 Natrium Diklofenak 50 mg Tab 3100 3,100 750 04/22 2350
167 New Antides Tab - -
168 Nifedipin 10 mg Tab - -
169 Novadryl Syrup Botol - -
170 Novaxicam 20 mg (Piroxicam) Caps - -
171 Nystatin 100.000 IU Tab 200 200 - 5/22 200
172 Nystatin 500.000 IU Tab - -
173 OAT Kategori Anak Paket 1 1 1 2/21 0
174 OAT Kategori I FDC Paket 20 20 - 2/21 20
175 OAT Kategori I Kombipak Paket - -
176 OAT Kategori II Paket - -
177 OBH Kaca Berlico 100ml Botol 199 199 17 03/23 182
178 OBH Syrup jeruk nipis Botol - -
179 Ofloxacin 200 mg Tab 300 300 - 12/21 300
180 Oksitetrasiklin 1% Zalp Mata Tube - -
181 Oksitosin Inj 10 IU/ml Ampul 1 200 201 11 190
182 Omeprazole 20 mg Caps / Lanzoprazole Caps - -
183 Omeroxol Syrup Botol - -
184 Ondansetron 4 mg tab Tab - -
185 Ondansetron Inj Ampul 95 95 5 01/22 90
186 Parasetamol 500 mg Tab 4500 4,500 3,100 08/22 1400
187 Parasetamol Drop Botol - -
188 Parasetamol Infus btl - -
189 Parasetamol Syrup Botol - -
190 Pasaba Baby Cough Syrup Botol - -
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
191 Pasaba Cough Plus Syrup Botol - -
192 nobar Tab - -
193 Piridoxin 10 mg (Vit. B6) Tab 3000 3,000 300 8/21 2700
194 Prednison tab 5 mg Tab - -
195 Primaquin Tab Tab - -
196 Primpen Syrup Botol - -
197 Pro K Inj Ampul - -
198 Procain Benzyl Penisilin 3 juta UI Vial - -
199 Profiltiourasil 100 mg (PTU ) Tab - -
200 Profolat 0,4 mg Tab - -
201 Pronazol 200 mg Tab - -
202 Propanolol 10 mg Tab - -
203 Pularex Tab Tab - -
204 Pulmicort Budesonid Respules Vial - -
205 Pyrantel Pamoat 125 mg Tab 0 - -
206 Pyrantel Pamoat susp 125mg/5ml Botol 57 57 - 09/21 57
207 Pyrazinamid 500 mg Tab - -
208 Ranitidin Inj Ampul 71 71 6 9/21 65
209 Ranitidin Tab / Radin tab Tab - -
210 Reco tetes telinga Botol - -
211 Retinol 100.000 IU BIRU (Vit. A) Caps - -
212 Retinol 200.000 IU MERAH (Vit. A) Caps - -
213 Rifampicin 300mg Tab - -
214 Rifampicin 450 mg Tab - -
215 Rifampicin 600 mg Caps - -
216 Ringer Laktat Infus Kolf 67 67 57 4/22 10
217 Risperidon 1 mg Tab - -
218 Risperidon 2 mg Tab 415 415 120 2/22 295
219 Salbulin Spray Btl - -
220 Salbutamol 2 mg Tab - -
221 Salbutamol 4 mg Tab 100 100 - 07/24 100
222 Salbutamol Syrup Botol 0 - - 0 EXP
223 Salep 2-4 Tube - -
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
224 Selesnizol tab 500 mg / metronidazol 500 mg Tab - -
225 Selespurin 100 mg tab / alopurinol 100 mg Tab 500 500 200 9/21 300
226 Sianokobalamin (Vit. B12) tablet Tab -
227 Sianokobalamin Inj (Vit. B12) Ampul - -
228 Simvastatin 10 mg Tab 1800 1,800 330 5/21 1470
229 Simvastatin 20 mg Tab 2100 2,100 - 5/21 2100
230 Soft U Derm 10% Cream 20 gr Tube - -
231 Solinfec Tube - -
232 Spironolactone 25 mg Tab - -
233 Stesolid Rect 10 mg/2,5ml Tube 2 2 2 0
234 Stesolid Rect 5 mg/2,5ml Tube 8 8 3 3/22 5
235 Sucralfat Syrup Botol 65 65 40 06/22 25
236 Sulfadiazine salep Pcs - -
237 Sulfadoxine-Pyrimethamine (Suldox) Tablet 300 300 300 3/21 0 EXP
238 Tablet Tambah Darah FE Tab 0 - - 0
239 Taracol Tab (Obat Flu kombinasi) Tab 0 - - 0
240 Tetagam Inj Vial - -
241 Tetrasiklin 500 mg Tab - -
242 Thiamin (Vit B1) 50 mg Tab 3700 3,700 400 11/23 3300
243 Tramadol Inj Ampul - -
244 Trifason 0,5 mg Tab - -
245 Trifluoperazin 5 mg Tab 520 520 30 6/23 490
246 Trihexylpenidil 2 mg Tab 700 700 90 6/22 610
247 Ulsidex Tab Tablet - -
248 Valdimex 10 mg Inj/ Diazepam Inj DAU Ampul - -
249 Verorab (Vaksin VAR) Box - -
250 Vicalcin Syr Botol - -
251 Vitamin B komplek Tab 12000 12,000 1,700 4/22 10300
252 Wormetrin Tab Tab - -
253 Zevask 10mg Tab - -
254 Zinc 20 mg Tab 3000 3,000 400 9/22 2600
255 Zink Drop Botol - -
256 Zink Syrup Botol 134 134 5 02/23 129
257 Flutamol syr Botol 83 83 - 83
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
BAHAN MEDIS HABIS PAKAI, REAGEN DAN LARUTAN
1 Alat suntik 0,5 ml ADS Pcs
2 Alat suntik 0,5 ml SKIFA Pcs
3 Alat suntik 0,5 ml TP Pcs
4 Alat suntik 1 ml Pcs 66 66 31 10/20 35
5 Alat suntik 1 ml needle luer lock Pcs -
6 Alat suntik 1 ml Tubercullin serenity Pcs -
7 Alat suntik 10 ml ASSP TP Pcs 139 139 5 5/23 134
8 Alat suntik 10 ml Aximed Pcs - -
9 Alat suntik 10 ml needle luer lock Pcs - -
10 Alat suntik 10 ml Serenity Pcs - -
11 Alat suntik 3 ml needle luer lock Pcs - -
12 Alat suntik 3 ml TP Pcs 6 6 6 05/23 0
13 Alat suntik 5 ml TP Pcs 0 344 344 - 10/21 344
14 Alkazym 25 mg Sachet - -
15 Alkohol 70% 1 Lt Botol 27 27 - 02/24 27
16 Alkohol 70% 300 mL Botol - -
17 Alkohol Swab Aximed Pcs 3300 3,300 900 5/23 2400
18 Alkohol Swab Onemed Pcs - -
19 Alkohol Swab Sensi Pcs - -
20 Anios Gel Botol - -
21 Aprone One Plastik Pcs - -
22 Aqua Pro Injeksi Otsu Vial 19 45 64 - 3/22 64
23 Arm Sling Comfort (L) Pcs - -
24 Arm Sling Comfort (M) Pcs - -
25 Arm Sling Comfort (S) Pcs - -
26 Aroma Fine Normal Pack - -
27 Aseptic Gel 500 cc Botol - -
28 Blood Lancet 26G OM Box - -
29 Blood Lancet Medillance Box - -
30 Blood Lancet Serenity Pcs 100 100 25 08/22 75
31 Blood Transfusion Set Abada Pcs 100 100 - 7/23 100
32 Blue Tips Bks 500's - -
33 Catgut Chromic 1 HR 26 MM Pcs - -
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
34 Catgut Chromic 1 HR 48 MM Pcs - -
35 Catgut Chromic 2/0 HR 20 MM Pcs - -
36 Catgut Chromic 3/0 DS 19 MM Pcs - -
37 Catgut Chromic 3/0, 70 cm, Violet, Reverse
Cutting, 1/2C, 26 mm Pcs - -
38 Catgut Chromic 3/0, 70 cm, Violet, Round Body,
1/2C, 22 mm Pcs - -
39 Catgut Chromic 3/0, 75 cm, 1/2 TP, 25 mm
CG344 Pcs 24 24 19 01/24 5
40 Catgut Chromic 3/0, 75 cm, 3/8 RC CG342 Pcs - -
41 Catgut Chromic 4/0, 45 cm, CG366 Pcs - -
42 Catgut Chromic Serenity Pcs 10 10 - 12/22 10
43 Catgut Nylon 5/0, 75 cm, 3/8 cc, 12 mm NY979 Pcs - -
44 Catgut Plain 2/0 DS 19 MM Pcs - -
45 Catgut Plain 3/0 75 cm, 1/2 TP 30 mm Pcs - -
46 Catgut Plain 3/0 DS 16 MM Pcs - -
47 Catgut Plain 3/0, 75 cm, 3/8 RC, 23 mm Pcs - -
48 Catgut Plain 3/0, 75 cm, Undyed, Rev Cutting,
38C, 19 mm Pcs - -
49 Catgut Plain Serenity 3/0 Pcs - -
50 Catgut Provein 5/0, 45 cm, 18 mm, PV888 Pcs - -
51 Catgut Silk 3/0, 75 cm, 1/2 TP 26 mm Pcs - -
52 Catgut Silk 3/0, 75 cm, 3/8 CC 19 mm Pcs - -
53 Catgut Silk 4/0, 75 cm, 1/2 TP 20 mm BS690 Pcs - -
54 Catgut Silk 5/0, 45 cm BS695 Pcs - -
55 Chlor Etyl 100 ml Botol 1 1 1 7/21 0
56 Cuticell 7,5 cm X 20 cm oinment dressing Pcs - -
57 Cuticell Clasic 10 cm x 10 Pcs - -
58 Cutisorb Steril 10 cm x 10 Pcs - -
59 Derm Transport Dressing (Remedi) Pcs - -
60 Dermafix Pcs - -
61 Diapers Adult 10s Uk. L Molicare Pcs - -
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
62 Dressing IV Cannula Non Woven (Remedi) Pcs - -
63 ECG Gel 1000 ml Botol 2 1 3 - 1/22 3
64 Endo Ice Spray 200 ml Botol - -
65 Endotracheal Tube (ETT) 6,0 Fesco Pcs - -
66 Endotracheal Tube (ETT) 7,0 Fesco Pcs - -
67 Endotracheal Tube (ETT) 7,5 Fesco Pcs - -
68 Endotracheal Tube (ETT) 8,0 Fesco Pcs - -
69 Feeding Tube 100 cm No 10 Aximed Pcs 20 20 20 2/21 0
70 Feeding Tube 100 cm No 8 Aximed Pcs 20 20 - 2/21 20
71 Feeding Tube 40 cm No 10 Aximed Pcs 20 20 40 - 2/21 40
72 Female Catheter No. 16 Aximed Pcs 20 20 - 3/22 20
73 Female Catheter No. 18 Aximed Pcs 23 23 3 3/22 20
74 Folley Catheter No. 16 (2 Way Standard) Pcs
Serenity - -
75 Folley Catheter No. 16 latex 2 Way ABADA Pcs 5 5 - 1/24 5
76 Folley Catheter No. 18 (2 Way Standard) Pcs
Serenity - -
77 Folley Catheter No. 18 latex 2 Way ABADA Pcs 11 11 - 1//24 11
78 Gliserol 100 ml Botol - -
79 Handrub E-Care 500 ml Botol - -
80 Handscrub E-Care 500 ml Botol - -
81 Infus Set Anak Type Y Pcs - -
82 Infus Set Dewasa Type Y Aximed Pcs - -
83 Infus Set Semilas 3D Dewasa Pcs - -
84 Infusion Set Anak Aximed Pcs 72 72 27 08/23 45
85 Infusion Set Dewasa Aximed Pcs 0 76 76 13 06/24 63
86 Infusion Set Microdrip Abada Pcs - -
87 Infusion Set Microdrip Otsu Pcs - -
88 Infusion Set Y Adaptor Otsu Pcs - -
89 Iodine Povidon 30 ml Botol 0 - - 1/21 0
90 Iodine Povidon 60 ml Botol 0 - - 2/22 0
91 IV Catheter No. 18 G Cath Pro Pcs - -
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
92 IV Catheter No. 18 G Otsu Pcs - -
93 IV. Catheter No. 20 G Cath Pro Pcs - -
94 IV. Catheter No. 20 G Otsu Pcs - -
95 IV. Catheter No. 22 G Cath Pro Pcs 200 57 257 18 04/22 239
96 IV. Catheter No. 22 G Otsu Pcs - -
97 IV. Catheter No. 24 G Cath Pro Pcs 107 107 37 08/22 70
98 IV. Catheter No. 24 G Otsu Pcs - -
99 IV. Catheter WP No. 18 ABADA Pcs 37 5 42 - 11/22 42
100 IV. Catheter WP No. 20 ABADA Pcs 40 40 7 11/22 33
101 IV. Catheter WP No. 22 ABADA Pcs - -
102 IV. Catheter WP No. 22 AXIMED Pcs - -
103 IV. Catheter WP No. 24 AXIMED Pcs - -
104 IV. Catheter WP No. 26 AXIMED Pcs 134 134 15 06/23 119
105 Kantong Limbah Biohazard kuning Uk. L
(80x100 cm) Pack 6's
- -
106 Kantong Limbah Biohazard kuning Uk. M
(60x80 cm) Pack 10's
7 7 - 7
107 Kantong Limbah Biohazard kuning Uk. S (40x60 Pack 20's
cm) 1 1 - 1
108 Kantong Plastik PE 60 x 100 cm Pack 10's - -
109 Kapas 100 gr Pcs 3 3 - 3
110 Kapas 250 gr Pcs 2 2 - 2
111 Kapas 500 gr Pcs - -
112 Kasa 10 x 10 Onemed Roll - -
113 Kasa 2 m x 80 cm Roll 3 3 1 2
114 Kasa 40 x 80 cm Roll - -
115 Kasa Hidropil 16 x 16 Abada Box - -
116 Kasa Hidropil 2 x 10 cm Abada Pack - -
117 Kasa Hidropil 20 x 80 cm Abada Box - -
118 Kasa Hidropil 36 x 80 cm (BIOKASA) Roll 3 3 - 07/23 3
119 Kasa Hidropil 4 x 15 cm Abada Pcs 60 60 35 25
120 Kasa Hidropil 4 x 7,5 cm Abada Pcs - -
121 Kasa Steril 7.5x7.5 Pcs - -
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
122 Kertas EKG BTL -08 M Line Roll 3 3 - 3
123 Kertas Perkamen Pack - -
124 Latex Powder Examination Gloves Uk. L ASAP Pcs - - 7/23
125 Latex Powder Examination Gloves Uk. M ASAP Pcs - - 7/23
126 Latex Powder Examination Gloves Uk. S ASAP Pcs 50 50 50 12/23 0
127 Latex Powder Examination Gloves Uk. XS ASAP pcs - -
128 Lysol 1 Liter Botol 2 2 - 08/21 2
129 Masker 3 m 1870 N 95 Pcs 138 160 298 20 278
130 Masker ear loop ABADA Pcs - -
131 Masker ear loop Aximed Pcs - -
132 Masker ear loop semillas Pcs 2850 2,850 450 2400
133 Masker Nebulizer Anak (M) Abada Pcs - -
134 Masker Nebulizer Anak Cosmo Pcs - -
135 Masker Nebulizer Anak Remedi Pcs 13 13 - 11/21 13
136 Masker Nebulizer Dewasa (L) Abada Pcs - -
137 Masker Nebulizer Dewasa Cosmo Pcs 24 24 24 0
138 Masker Nebulizer Dewasa Remedi Pcs 0 11 11 - 11
139 Masker Oksigen Anak Serenity Pcs 10 14 24 - 24
140 Masker Oksigen Bayi Pcs 18 18 - 18
141 Masker Oksigen Dewasa Pcs 4 17 21 1 07/22 20
142 Masker oksigen NRM adult elongated pcs - -
143 Masker oksigen NRM child elongated pcs 5 5 1 3/22 4
144 Medical Ultrasonic Gel Botol - -
145 Meliseptol Spray Botol - -
146 Micropipet adjust Vol. 0,5-10 UL Pcs 2 2 - 2
147 Micropipet adjust Vol. 100-1000 UL Pcs 1 1 2 - 2
148 Micropipet adjust Vol. 10-100 UL Pcs 1 1 - 1
149 Micropipet adjust Vol. 200-1000 UL Pcs 2 2 - 2
150 Micropipet adjust Vol. 50-200 UL Pcs 2 2 - 2
151 Micropipet Adjust Vol.0,1-2,5UL Pcs 2 2 - 2
152 Micropipet Adjust Vol.2-20 UL Pcs 2 2 - 2
153 Micropipet Adjust Vol.5-50 UL Pcs 2 2 1 1
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
154 Micropipet Fixed Vol.10 UL Pcs 1 1 2 - 2
155 Micropipet Fixed Vol.100 UL Pcs 2 2 1 1
156 Micropipet Fixed Vol.20 UL Pcs 2 2 - 2
157 Micropipet Fixed Vol.25 UL Pcs 2 2 - 2
158 Micropipet Fixed Vol.5 UL Pcs 2 2 - 2
159 Micropipet Fixed Vol.50 UL Pcs 2 2 - 2
160 Micropipet Fixed Vol.500 UL Pcs 2 2 - 2
161 Mikro Aplicator tips Botol - -
162 Mucus Extractor Serenity Pcs - -
163 Nasal Oksigen 'M' Aximed Pcs 4 4 8 - 8
164 Nasal Oksigen 'S' Aximed Pcs 7 7 - 7
165 Nasal Oksigen Uk. XS Pcs 9 9 18 - 18
166 Nasal Oxygen Canula anak Pcs - -
167 Nasal Oxygen Canula anak Abada Pcs - -
168 Nasal Oxygen Canula anak Serenity Pcs - -
169 Nasal Oxygen Canula Dewasa Abada Pcs 4 12 (4) 16
170 Needle CNV 21x1,5 ml (BD Vacutainer) Pcs 100 100 - 100
171 Needle CNV 22x1,5 ml MLTSMP CE Pcs 100 100 - 100
172 Needle Flashback 21X1 Pcs 250 250 - 250
173 Nitrile Powder Free Examination Globe Uk. S Pcs - -
174 Non Woven Fixtation 10 cm x 10 m Aximed Roll 10 10 - 10/20 10
175 Non Woven Fixtation 5 cm x 10 m Aximed Roll 11 11 - 10/20 11
176 Non Woven IV Dressing 6x8 cm Narafix Pcs - -
177 Nurse Cup Green Box 100's 260 300 560 311 249
178 One Scrub Botol - -
179 One Step HBSAg Test Strip Pcs - -
180 Oxyflow nasal anak Pcs - -
181 Oxyflow nasal bayi Pcs - -
182 Paper Tape 1,25 cm X 9,14 cm Roll - -
183 Paper Tape 2,5x9,14 cm Roll - -
184 Paper Tape 7,5 cm X 9,14 cm Roll - -
185 Papsmear Kit M Pcs - -
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
186 Papsmear Kit S Pcs - -
187 Plester ZinkOxyd 1,25 x 450 cm Roll - -
188 Plester ZinkOxyd 2,5 x 450 cm Roll 0 - - 0
189 Plester ZinkOxyd 5 x 450 cm Roll 13 13 2 11
190 Policrepe 10 cm x 4,55 m Roll - -
191 Policrepe 15 cm x 4,55 m Roll 36 5 41 - 41
192 Polifix 10cmx5m Roll - -
193 Polifix 15cmx5m Roll - -
194 Polifix 15x5 cm Roll - -
195 Proline Cholesterol FS KIT - -
196 Proline Glucose GOD FS KIT - -
197 Proline Triglycerides FS KIT - -
198 Proline Trucal U KIT - -
199 Reagen Afinion HbA1c Box 10's - -
200 Reagen Anti A 1x10 ml KIT - -
201 Reagen Anti AB 1x10 ml KIT - -
202 Reagen Anti B 1x10 ml KIT - -
203 Reagen Anti D 1x10 ml KIT - -
204 Reagen Cleanser 1 Lt For Sumiffin Botol - -
205 Reagen Cleanser BCC 3600 Dirui Botol - -
206 Reagen Cleanser For Mindray Botol - -
207 Reagen Cleanser For Zenix Botol - -
208 Reagen Control Normal Kimia Biomaxima Vial - -
209 Reagen Control Normal Mindray KIT - -
210 Reagen Control Normal Zenix KIT - -
211 Reagen Creatinine 3x50 mL Biomaxima KIT - -
212 Reagen Diluent 20 Lt Dirui BCC -3600 Botol - -
213 Reagen Diluent For Sumiffin Botol - -
214 Reagen Diluent M-30 20 L Mindray Botol - -
215 Reagen Diluent Zenix Botol - -
216 Reagen EZ Cleanser 100 ml Mindray Botol - -
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
217 Reagen Lyse 500 ml Dirui Botol - -
218 Reagen Lyse 500 ml For Sumiffin Botol - -
219 Reagen Lyse 500 ml- Mindray M-30 Botol - -
220 Reagen Lyse 500 ml Zenix Botol - -
221 Reagen Rinse 20 Lt Mindray Botol - -
222 Reagen Salmonella Paratyphi 0 1x5 ml KIT - -
223 Reagen Salmonella Paratyphi A0 1x5 ml KIT - -
224 Reagen Salmonella Paratyphi AH 1x5 ml KIT - -
225 Reagen Salmonella Paratyphi B0 1x5 ml KIT - -
226 Reagen Salmonella Paratyphi BH 1x5 ml KIT - -
227 Reagen Salmonella Paratyphi C0 1x5 ml KIT - -
228 Reagen Salmonella Paratyphi CH 1x5 ml KIT - -
229 Reagen Salmonella Paratyphi H 1x5 ml KIT - -
230 Reagen SGOT (ASAT) 3x20 mL Biomaxima KIT - -
231 Reagen SGPT (ALAT) 3x20 mL Biomaxima KIT - -
232 Reagen Urea 3x50 mL Biomaxima KIT - -
233 ReagenTriglycerida 4x50 mL Biomaxima KIT - -
234 Rectal Tube size 22 FR Pcs - -
235 Rivanol 300 cc Botol - -
236 Sabun Antibakteri Botol - -
237 Safety box 5 lt kuning Pcs 24 17 41 2 39
238 Saniswiss Biosanitier L5000 ml Botol 1 0 1 1 0
239 Saniswiss Biosanitizer H1500 ml Botol - -
240 Saniswiss Biosanitizer L15000g Botol - -
241 Selang NGT No. 18 Pcs - -
242 Selang NGT No. 22 Pcs - -
243 Semillas Non Woven Medical Tape 20x500 cm Roll - -
244 SEMILLAS Non Woven Transparant Wound
Dressing with Pad 9 x 15 cm Pcs
- -
245 SEMILLAS Non-Woven Wound Dressing 6x7 Roll
cm (With Pad) - -
246 Semillas water proof medical tape 20x500 cm Roll - -
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
247 Servical Collar Serenity Pcs - -
248 Silk Black 2/0 HR 30 MM Pcs - -
249 Silk Black 3/0 HR 30 MM Pcs - -
250 Silk Black 5/0 DS 12 MM Pcs - -
251 Silk Black 6/0 DS 14 MM Pcs - -
252 Silk Black Braided Braun 3/0 + Jarum Pcs 163 163 - 05/20 163
253 Silk Braided USP 3/0 Pcs 24 24 - 4/23 24
254 Silk Plain 3/0 Pcs - -
255 Softaman Desinfectan Botol - -
256 Softaskin Gel Botol - -
257 Spalk First AID Pcs 18 18 - 18
258 Stomach Tube 85 cm No 14 Aximed Pcs 20 20 - 2/21 20
259 Strip test ABON Syphilis Ultra Rapid Pcs - -
260 Strip test cholesterol autocheck Box 25's 9 9 1 10/20 8
261 Strip test cholesterol benecheck Box 10's - -
262 Strip test Dengue NS1 Antigen Serenity Pcs - -
263 Strip test DI Anti HCV 1/2 Casette Pcs - -
264 Strip test DI Anti HIV 1/2 cassete Pcs - -
265 Strip test glucose autocheck Box 50's 5 5 - 8/21 5
266 Strip test glucose benecheck Box 50's - -
267 Strip test glucose On call Plus Pcs - -
268 Strip test Hb Hemoglobin Mission Pcs - -
269 Strip test HCG Fokus Pcs - -
270 Strip test Rapidan Dengue NS1 dan IgG/IgM Pcs - -
271 Strip test Rapidan HBsAg Test WB/S/P Pcs - -
272 Strip test Rapidan Malaria Pcs 50 25 75 - 8/21 75
273 Strip test SD Dengue Duo Bioline Pcs 25 25 - 7/21 25
274 Strip test SD HBSAg Test Strip Pcs 25 25 25 0
275 Strip test SD HIV 1/2 3.0 Pcs - -
276 Strip test SD HIV Bioline Pcs 175 100 275 175 100
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
277 Strip test uric acid autocheck Box 50's 13 13 1 11/20 12
278 Strip test uric acid benecheck Box 25's - -
279 Strip test uric acid Easy Touch Box 25's - -
280 Suction Catheter No. 10 (Aximed) Pcs - -
281 Suction Catheter No. 12 ( Aximed) Pcs - -
282 Surfaces Stretch Wipes (Biosanitizer) Pack - -
283 Surgical Blade No. 10 Aesculap Pcs - -
284 Surgical Blade No. 10 Serenity Pcs 47 47 3 07/22 44
285 Surgical Blade No. 23 Serenity Pcs 47 47 47 0
286 Surgical Film 20 x 30 cm Pcs - -
287 Surgical Gloves Gyanokolog No. 6,5 (Remedi) Pairs - -
288 Surgical Gloves Gyanokolog No. 7 (Remedi) Pairs 34 34 - 3/23 34
289 Surgical Gloves No. 6 TRO Sensosurge Pairs - -
290 Surgical Gloves No. 6,5 TRO Sensosurge Pairs - -
291 Surgical Gloves No. 7 GAMEX Pairs - -
292 Surgical Gloves No.6,0 Aximed Pcs - -
293 Surgical Gloves No.6,5 Aximed Pcs 150 150 - 7/23 150
294 Surgical Gloves No.7,0 Aximed Pcs 589 589 - 7/23 589
295 Surgical Gloves No.7,5 Aximed Pcs 508 508 - 7/23 508
296 Surgical Safeglove ST PF 6 Pcs - -
297 Surgical Safeglove ST PF 6,5 Pcs - -
298 Surgical Safeglove ST PF 7 Pcs - -
299 Tabung BD Vacutainer Tube EDTA plh 13 x 75 3. Pcs - -
300 Tabung BD Syringe Soloshot mm 0,5 ml Pcs - -
301 Tabung EDTA Tab 3 ml Pcs 1400 1,400 - 1400
302 Tabung Endo Vacuum Blood Collection tube, Pcs
Plain 3 ml - -
303 Tabung Endo Vacuum Tube Sterile K3EDTA Pcs - -
304 Tabung K3EDTA 3 ml Glass Interna Pcs - -
305 Tabung Plain 3 ml Glas Interna tabung 2300 2,300 - 2300
306 Tabung Vacuum Container Plain 3 ml Glas Pcs
Interna - -
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
307 TB AG Rapid Test KIT - -
308 Three Way with Extention Pcs - -
309 Tips For Micro MT 200 IU Pcs - -
310 Tips For Micro MT II 1 ml Pcs - -
311 Tips For Micropipet MSTP Pcs - -
312 Trigliseride Test Strip Pcs - -
313 Tube TB AG tube - -
314 Uji malaria fokus Pcs - -
315 Umbilicall Cord Clame Fesco Pcs - -
316 Umbilicall Cord Clem Pcs 190 190 - 190
317 Underpad (Soft pad 60x90) Pcs 930 930 20 910
318 Underpad Surgical Pcs - -
319 Urine bag + Hanger Pcs 10 10 20 - 20
320 Urine Collector Pead OM Pcs - -
321 Uritest Reagent Strip 11G Box 100's 2 2 - 7/21 2
322 USG Gel 250 Ml Pcs - -
323 Viorex Liquid Btl 500 ml - -
324 White Tips Bks 1000's - -
325 Wing Nedle 23 G Pcs - -
326 Wing Nedle 25 G Pcs - -
327 Write On ID Bracelet Child Green (Remedi) Box 100's 2 2 - 2
328 Write On ID Bracelet Child Ungu (Remedi) Box 100's 2 2 - 2
329 Write On ID Bracelet,Adult Blue (Remedi) Box 100's 2 2 - 2
330 Write On ID Bracelet,Adult Pink (Remedi) Box 100's 2 2 - 2
331 Yellow Tip Bks 1000's - -
332 Iodine Povidon 300 ml Botol 5 5 2 3
333 Latex Powder Free Examination Gloves Uk. M Pcs - -
334 Reagen Ziehl Neelsen Paket 2 2 - 2
335 Saniswiss Biosanitier H 500 ml Botol 16 16 8 8
336 Surfaces Biosanitier S 750 ml Botol 11 11 - 11
337 Surfaces Biosanitier S 5000 ml Kent 4 2 6 - 6
338 Hand Gel H1 100 ml + Flip top Botol - -
Bahan Gigi
1 Alveogyl 10 gr - Septodent Ampul - -
2 Arsen / pul X-Devitalizer Pot - -
3 Articulating paper Buah - -
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
4 Bonding/Master Bond Buah - -
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
5 Calcimol LC Botol - -
6 Carpule Anastesi / Artinibsa Box - -
7 Cavit G (Ceivitron) Pot - -
8 Cavitton Pink (Ceivitron) 30 gr Buah - -
9 Celluloid Strip Box - -
10 Cemen Spatula Buah - -
11 Cement Phospat 35 gr Box - -
12 CHKM Botol - -
13 Citocarten/carpule Box - -
14 Composite Resin A2 Pcs - -
15 Composite Resin A3 Pcs - -
16 Dental Needles 30G 16mm Box - -
17 Dycal / Hydcal Botol - -
18 Eching gel 10 ml Tube - -
19 Eugenol 10 ML Ghimas Botol - -
20 Eugenol Cair Botol - -
21 Glass ionomer Fuji IX 1-1 PKG Universal 10 gr Box - -
22 Glass ionomer Fuji IX 1-1 PKG Universal 5 gr Box - -
23 Oco / Poliren No.1 Botol - -
24 Topical anasthetic gel Pcs - -
Jumlah Kunjungan Resep Rawat Jalan Rawat Inap Total
314 314
Mengetahui, Yang meminta/Melapor
Kepala Puskesmas Serimbu Pengelola Obat Puskesmas Serimbu
Kabupaten Landak
Hengki, S.Kep Siti Maryam, S.Farm., Apt.
NIP. 19831204 201101 1 004 NIP. 19910523 202012 2 013
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
KABUPATEN : LANDAK
PUSKESMAS : SERIMBU
BULAN/TAHUN : MARET / 2021
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
1 Acarbose 100 mg Tab - -
2 Acetylsistein 200 mg Caps - -
3 Acyclovir 200 mg Tab - - 10000
4 Acyclovir 400 mg Tab 600 500 1,100 450 08/22 650 10000
5 Albendazole Syrup Botol - -
6 Albendazole tab 400 mg Tab 1800 1,800 800 7/21 1000 10000
7 Allopurinol 300 mg Tab 1500 1,500 200 08/22 1300 15000
8 Alprazolam 0,5 mg Tab - -
9 Alprazolam 1 mg Tab - -
10 Aminophyllin Inj Ampul - -
11 Amitriptilin 25 mg Tab 430 430 - 5/23 430 300
12 Amlodipin 10 mg Tab 1300 3000 4,300 2,100 7/23 2200 21000
13 Amlodipin 5 mg Tab 900 3000 3,900 1,100 07/22 2800 21000
14 Amoxicillin Syrup 125 mg/5ml Botol 0 300 300 15 12/21 285
15 Amoxicillin Syrup Forte 250 mg/5ml Botol - -
16 Amoxycillin tab 500 mg Hexpharm Tab 0 5000 5,000 3,000 09/22 2000 24000
17 Ampisillin Injeksi Vial 10 10 1 9
18 Anabion Syrup Botol - -
19 Antasida DOEN Kombinasi Tab 1100 10000 11,100 3,900 08/23 7200 30000
20 Antasida DOEN Syrup Botol 52 300 352 130 7/21 222 500
21 Antifungi DOEN salep kombinasi Tube - -
22 Antihemorroid Suppo - -
23 Apricot Syrup 100 ml / Obat Batuk Botol 31 31 11 03/23 20
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
24 Asam ascorbat 50 mg/ Vit. C 50 mg Tab 1800 3000 4,800 1,300 08/23 3500 5000
25 Asam Mefenamat 500 mg Tab 0 5000 5,000 2,900 02/22 2100 25000
26 Asam Tarnexamat Inj 50mg/ml Ampul - - 100
27 Asam Tranexamat inj 100 mg/ml Ampul - - 100
28 Asering larutan infus 500 ml Botol - -
29 Asetosal 100 mg Tab - - 1000
30 Atropin Injeksi 0,25 mg Vial - - 100
31 Bacitracin Polymicin Zalp Tube - -
32 Benzatin Benzyl Penisilin 2,4 juta UI Vial - -
33 Betahistin Mesilat 6 mg tab 2900 2,900 300 05/22 2600 5000
34 Betamethasone krim 0,05% Tube - - 500
35 Betamethasone krim 0,1% Tube 100 100 35 05/22 65 500
36 Bioplacenton Tulle Pcs 50 50 1 12/21 49
37 BIOSAT 1,500 ( A.T.S) serum anti tetanus Vial 10 10 - 10
38 BIOSAVE ( A.B.U I) serum anti bisa ular Vial 5 5 - 5
39 Bisoprolol 5 mg Tab 1400 1,400 - 7/21 1400
40 Calcii Gluconas Inj Ampul 24 24 - 12/21 24
41 Captopril 12,5 mg tab 3300 5000 8,300 2,000 6/24 6300 10000
42 Captopril 25 mg Tab 3900 5000 8,900 1,800 07/22 7100 10000
43 Cavidagel 15 gr Tube 2 2 - 10/21 2
44 Cefadroksil 250 mg Tab - -
45 Cefadroksil 500 mg Tab - - 5000
46 Cefadroxil Syrup Botol 170 170 4 08/23 166
47 Cefotaxim inj,1 gr Ampul - -
48 Ceftriaxon inj.1 gr Ampul - -
49 Cetirizin 10 mg Tab 3500 3000 6,500 2,300 10/21 4200 10000
50 Cetirizin Syrup Botol 70 70 37 7/21 33 300
51 Chloramex 500 mg Caps 1000 1,000 - 10/21 1000
52 Chloramfenicol 125mg/5ml Syrup Botol - -
53 Chloramfenicol 250 mg caps 2200 100 2,300 200 4/22 2100
54 Chloramfenicol salep mata 1% Tube - -
55 Chlorfeniramin Maleat 4 mg (CTM) Tab 1700 10000 11,700 3,000 07/23 8700 15000
56 Chlorpromazin 100 mg Tab 410 410 120 7/22 290 300
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
57 Ciprofloxacin 500 mg Tab 1000 1,000 100 11/22 900 1000
58 Clindamicin 150 mg Caps 150 500 650 200 4/22 450 1000
59 Clozapin 100 mg Tab - -
60 Clozapin 25 mg Tab 731 731 90 2/21 641 300
61 Codein 10 mg Tab - -
62 Combivent Nebulizer Vial - - 300
63 Cotrimoxazol 480 mg Tab 2800 5000 7,800 1,300 08/22 6500 10000
64 Cotrimoxazol 960 mg forte Tab - -
65 Cotrimoxazol Syrup Botol 100 100 200 36 7/22 164 300
66 Curbion Kids Emulsion (Multivitamin Anak) Botol - -
67 Curviplex Syrup Botol - -
68 Daneuron Tab - -
69 Dapyrin Syrup Botol - -
70 Desoximetason cream 0,25 % Tube 12 12 - 05/22 12
71 Dexamethason 0,5 mg Tab Tab 4200 5000 9,200 2,000 02/22 7200 10000
72 Dexamethason Inj Ampul 26 50 76 12 7/21 64 300
73 Diazepam 5 mg Tab 380 380 - 10/22 380
74 Diazepam Injeksi 5 mg/ml Ampul 0 20 20 - 20
75 Digoxin 0,25 mg Tab - -
76 Diltiazem 30 mg Tab - -
77 Dimenhidrinat tab 50 mg Tab 0 2000 2,000 100 03/23 1900
78 Diphenhydramin Inj 10 mg/ml Ampul 22 22 - 7/22 22 300
79 Doksisiklin 100 mg Tab - -
80 Domperidon tab 10 mg Tab 4500 2000 6,500 1,500 11/22 5000 10000
81 Dopamet tab Tab 1400 1000 2,400 300 11/21 2100
82 Dulcolax Suppo 10 mg Suppo - -
83 Ephinefrin Inj 1 mg/ml 0,1% Ampul 10 10 20 10 03/22 10
84 Ergotamin Coffein/anti migraen. Tab 1000 1,000 - 8/21 1000
85 Erytromicin tab 500 mg tab 100 100 100 03/22 0 5000
86 Erytromisin Syr Botol - -
87 Ethambutol 500 mg Botol - -
88 Euthyrox 50 mg Tab - -
89 Fenobarbital Inj 50 mg/ml Ampul - -
90 Fenol Gyserol TT Botol - -
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
91 Fitomenadion ( Vit. K) injeksi Ampul 94 120 214 46 9/21 168 300
92 Fitomenadion ( Vit. K) tab salut 10 mg Tab 200 1000 1,200 300 10/21 900 10000
93 Flixotide Nebules Vial - -
94 Framycetin Lembar - -
95 Fucilex Cream Tube - -
96 Furosemid Inj 10 mg/ml Ampul 30 25 55 - 05/21 55 300
97 Furosemid Tab 40 mg Tab 0 2000 2,000 1,000 05/23 1000 8000
98 Garam Oralit 200 mg pcs 875 1000 1,875 1,135 04/23 740 10000
99 Gentamicin Injeksi 40 mg/ml Ampul - -
100 Gentamicin Salep Mata 0,3% Tube 48 96 144 47 87/23 97 300
101 Gentamicin Sulfa Tetes Mata 0,3% Botol 72 96 168 71 9/22 97 300
102 Glibenklamid 5 mg Tab 200 200 200 0 10000
103 Glikos 500 mg Tab - -
104 Gliquidon Tab - -
105 Glukosa 10% Infus Kolf 0 40 40 - 04/22 40
106 Glukosa 5% Infus Kolf 94 80 174 50 3/23 124 100
107 Glukosa 5% Infus Otsu Botol - -
108 Gored Tab - -
109 Grantusif Tab - - 10000
110 Griseofulvin 125 mg Tab 3100 3,100 200 5/21 2900 10000
111 Guaifenesin 100 mg Tab 3600 5000 8,600 1,200 08/21 7400 10000
112 Haloperidol 0,5 mg Tab - -
113 Haloperidol 1,5 mg Tab 240 240 110 3/23 130 300
114 Haloperidol 5 mg Tab - - 300
115 Herbakof / Obat Batuk Fitofarmaka 60 ml Botol 0 100 100 35 09/21 65 100
116 Hidrokortiazid 25 mg (HCT) Tab 1400 2000 3,400 100 5/22 3300 3000
117 Hidrokortison Krim 2,5% Tube 0 96 96 15 81 300
118 Hufadin Tab Tab - -
119 Hufagrif TMP Botol - - 10000
120 Hufagrip Forte TB tab - -
121 Hyperhep 0,5 ml (Vaksin HbIg) Vial 4 4 - 8/21 4
122 HyperRAB (Rabies Immune Globulin) Vial 4 4 - 4 5
123 Ialuset Plus Cream Tube 1 1 - 1/22 1
124 Ibuprofen Suspensi 100 mg/5ml Botol 44 36 80 38 01/22 42 300
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
125 Ibuprofen tab Tab 5000 5,000 1,100 10/22 3900 10000
126 Iliadin Drop Tetes Hidung Botol - - 20
127 Irbesartan 150 mg Tab - -
128 Isoniazid 100 mg Tab - -
129 Isosorbit Dinitrat 5 mg Tab - - 1500
130 KA EN 3A Infus Kolf - -
131 KA EN 3B Infus Kolf - -
132 Kalsium Laktat 500 mg (Kalk) Tab 0 10000 10,000 3,700 09/2023 6300 25000
133 Karbamazepin 200 mg Tab 250 250 250 0 0
134 Ketokonazole 200 mg Tab 400 1000 1,400 500 12/21 900 10000
135 Ketokonazole Krim Tube - - 300
136 Ketorolac Inj 30mg/ml (3%) Ampul 100 100 2 98
137 Lactulosa Sir 3,335 g/5ml Botol - -
138 Lacyvir Salep Mata Tube - -
139 Lansoprazole caps Caps 600 600 150 10/23 450 15000
140 Laxadine emulsi Botol - - 50
141 Levofloxacin 500 mg Tab - - 5000
142 Lidocain Compositum Inj Ampul 73 120 193 35 7/21 158 300
143 Lidocain inj 2% Inj 100 100 45 10/23 55
144 Livron B Plex Tab 10000 10,000 1,500 07/21 8500
145 Loperamide HCl Tab 1000 1,000 200 06/22 800 15000
146 Loratadine tab 10 mg tab 1000 1,000 300 09/24 700 15000
147 Lytacur Syrup 60 ml / Procurma Syr Botol 126 126 32 94 100
148 Magnesium sulfat (MgSO4) 20% Ampul 12 6 18 6 6/22 12
149 Magnesium sulfat (MgSO4) 40% Ampul 0 6 6 - 06/22 6
150 Mersibion Inj Ampul - - 300
151 Mersibion Tablet 5000 Tablet - - 15000
152 Metformin tab 500 mg tab 700 5000 5,700 1,400 09/22 4300 10000
153 Metilergotmetrin 0,125 mg Tab - -
154 Metilergotmetrin Inj 0,2 mg/ml Ampul 100 100 20 03/23 80
155 Metilprednisolon 16 mg Tab 2600 2000 4,600 800 05/24 3800 5000
156 Metilprednisolon 4 mg Tab 2000 2,000 - 09/22 2000 5000
157 Metisol 4mg Tab - -
158 Ranitidin Inj Tab - -
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
159 Metoklorpamid 5 mg Tab 1800 1,800 400 1/23 1400 10000
160 Metronidazol Infus Botol - -
161 Metronidazol Syrup Botol 60 60 - 02/23 60
162 Miniaspi 80 mg Tab 400 400 100 8/21 300 500
163 Muliavit Syrup Botol - -
164 NaCl 0,9% Infus Kolf 56 100 156 37 3/24 119 200
165 Natrium Diklofenak 25 mg Tab 900 6000 6,900 1,500 10/22 5400 10000
166 Natrium Diklofenak 50 mg Tab 2350 6000 8,350 2,500 04/22 5850 10000
167 New Antides Tab - - 15000
168 Nifedipin 10 mg Tab - -
169 Novadryl Syrup Botol - -
170 Novaxicam 20 mg (Piroxicam) Caps - - 15000
171 Nystatin 100.000 IU Tab 200 200 - 5/22 200
172 Nystatin 500.000 IU Tab - -
173 OAT Kategori Anak Paket 0 - - 2/21 0
174 OAT Kategori I FDC Paket 20 20 - 2/21 20
175 OAT Kategori I Kombipak Paket - -
176 OAT Kategori II Paket - -
177 OBH Kaca Berlico 100ml Botol 182 100 282 82 03/23 200
178 OBH Syrup jeruk nipis Botol - -
179 Ofloxacin 200 mg Tab 300 300 - 12/21 300
180 Oksitetrasiklin 1% Zalp Mata Tube 100 100 - 06/21 100
181 Oksitosin Inj 10 IU/ml Ampul 190 200 390 235 155
182 Omeprazole 20 mg Caps / Lanzoprazole Caps 1500 1,500 300 10/23 1200 15000
183 Omeroxol Syrup Botol - -
184 Ondansetron 4 mg tab Tab - - 1000
185 Ondansetron Inj Ampul 90 50 140 41 01/22 99 300
186 Parasetamol 500 mg Tab 1400 10000 11,400 4,600 08/22 6800 24000
187 Parasetamol Drop Botol 60 60 3 57
188 Parasetamol Infus btl - -
189 Parasetamol Syrup Botol 300 300 54 10/24 246 300
190 Pasaba Baby Cough Syrup Botol - - 300
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
191 Pasaba Cough Plus Syrup Botol - -
192 nobar Tab - -
193 Piridoxin 10 mg (Vit. B6) Tab 2700 2000 4,700 700 8/21 4000 5000
194 Prednison tab 5 mg Tab 3000 3,000 300 09/22 2700 5000
195 Primaquin Tab Tab - -
196 Primpen Syrup Botol - -
197 Pro K Inj Ampul - - 300
198 Procain Benzyl Penisilin 3 juta UI Vial - -
199 Profiltiourasil 100 mg (PTU ) Tab - -
200 Profolat 0,4 mg Tab - - 1000
201 Pronazol 200 mg Tab - -
202 Propanolol 10 mg Tab - -
203 Pularex Tab Tab - -
204 Pulmicort Budesonid Respules Vial - -
205 Pyrantel Pamoat 125 mg Tab 2000 2,000 140 1860
206 Pyrantel Pamoat susp 125mg/5ml Botol 57 100 157 37 09/21 120 300
207 Pyrazinamid 500 mg Tab - -
208 Ranitidin Inj Ampul 65 65 13 9/21 52 300
209 Ranitidin Tab / Radin tab Tab 5000 5,000 1,000 08/22 4000 15000
210 Reco tetes telinga Botol - - 300
211 Retinol 100.000 IU BIRU (Vit. A) Caps - -
212 Retinol 200.000 IU MERAH (Vit. A) Caps - -
213 Rifampicin 300mg Tab - -
214 Rifampicin 450 mg Tab - -
215 Rifampicin 600 mg Caps - -
216 Ringer Laktat Infus Kolf 10 200 210 165 4/22 45 500
217 Risperidon 1 mg Tab - -
218 Risperidon 2 mg Tab 295 295 180 2/22 115 600
219 Salbulin Spray Btl - -
220 Salbutamol 2 mg Tab - - 15000
221 Salbutamol 4 mg Tab 100 100 100 0 15000
222 Salbutamol Syrup Botol 0 200 200 29 171
223 Salep 2-4 Tube - - 300
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
224 Selesnizol tab 500 mg / metronidazol 500 mg Tab 1000 1,000 100 09/23 900 10000
225 Selespurin 100 mg tab / alopurinol 100 mg Tab 300 3000 3,300 1,600 05/23 1700 15000
226 Sianokobalamin (Vit. B12) tablet Tab -
227 Sianokobalamin Inj (Vit. B12) Ampul - -
228 Simvastatin 10 mg Tab 1470 2100 3,570 1,230 5/21 2340 10000
229 Simvastatin 20 mg Tab 2100 3000 5,100 900 5/21 4200 10000
230 Soft U Derm 10% Cream 20 gr Tube - -
231 Solinfec Tube - -
232 Spironolactone 25 mg Tab - - 10000
233 Stesolid Rect 10 mg/2,5ml Tube 0 5 5 - 12/22 5 10
234 Stesolid Rect 5 mg/2,5ml Tube 5 5 10 - 08/22 10 10
235 Sucralfat Syrup Botol 25 100 125 72 08/22 53 500
236 Sulfadiazine salep Pcs - -
237 Sulfadoxine-Pyrimethamine (Suldox) Tablet 0 500 500 - 08/21 500
238 Tablet Tambah Darah FE Tab 0 15360 15,360 3,570 07/22 11790 20000
239 Taracol Tab (Obat Flu kombinasi) Tab 0 - - 0
240 Tetagam Inj Vial - -
241 Tetrasiklin 500 mg Tab - -
242 Thiamin (Vit B1) 50 mg Tab 3300 5000 8,300 1,400 11/23 6900 5000
243 Tramadol Inj Ampul - -
244 Trifason 0,5 mg Tab - -
245 Trifluoperazin 5 mg Tab 490 490 90 6/23 400 300
246 Trihexylpenidil 2 mg Tab 610 610 150 6/22 460 300
247 Ulsidex Tab Tablet - -
248 Valdimex 10 mg Inj/ Diazepam Inj DAU Ampul - -
249 Verorab (Vaksin VAR) Box - -
250 Vicalcin Syr Botol - -
251 Vitamin B komplek Tab 10300 10000 20,300 3,900 4/22 16400 15000
252 Wormetrin Tab Tab - -
253 Zevask 10mg Tab - -
254 Zinc 20 mg Tab 2600 10000 12,600 1,900 9/22 10700 10000
255 Zink Drop Botol 50 50 10 02/22 40
256 Zink Syrup Botol 129 100 229 72 02/23 157 300
257 Flutamol syr Botol 83 300 383 29 04/23 354
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
BAHAN MEDIS HABIS PAKAI, REAGEN DAN LARUTAN
1 Alat suntik 0,5 ml ADS Pcs
2 Alat suntik 0,5 ml SKIFA Pcs 500 05/23 500
3 Alat suntik 0,5 ml TP Pcs
4 Alat suntik 1 ml Pcs 35 500 535 30 09/25 505 300
5 Alat suntik 1 ml needle luer lock Pcs -
6 Alat suntik 1 ml Tubercullin serenity Pcs -
7 Alat suntik 10 ml ASSP TP Pcs 134 200 334 20 5/23 314 300
8 Alat suntik 10 ml Aximed Pcs - -
9 Alat suntik 10 ml needle luer lock Pcs - -
10 Alat suntik 10 ml Serenity Pcs - -
11 Alat suntik 3 ml needle luer lock Pcs 800 800 325 10/21 475 2000
12 Alat suntik 3 ml TP Pcs - -
13 Alat suntik 5 ml TP Pcs 344 344 123 10/21 221 1000
14 Alkazym 25 mg Sachet - -
15 Alkohol 70% 1 Lt Botol 27 27 5 02/24 22 50
16 Alkohol 70% 300 mL Botol - - 300
17 Alkohol Swab Aximed Pcs 2400 5000 7,400 1,100 5/23 6300 5000
18 Alkohol Swab Onemed Pcs - -
19 Alkohol Swab Sensi Pcs - -
20 Anios Gel Botol - -
21 Aprone One Plastik Pcs 200 200 30 08/23 170 200
22 Aqua Pro Injeksi Otsu Vial 64 60 124 15 3/22 109
23 Arm Sling Comfort (L) Pcs - -
24 Arm Sling Comfort (M) Pcs - -
25 Arm Sling Comfort (S) Pcs - -
26 Aroma Fine Normal Pack - -
27 Aseptic Gel 500 cc Botol - -
28 Blood Lancet 26G OM Box - -
29 Blood Lancet Medillance Box - -
30 Blood Lancet Serenity Pcs 75 2000 2,075 75 08/22 2000 1000
31 Blood Transfusion Set Abada Pcs 100 100 - 7/23 100
32 Blue Tips Bks 500's - -
33 Catgut Chromic 1 HR 26 MM Pcs - -
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
34 Catgut Chromic 1 HR 48 MM Pcs - -
35 Catgut Chromic 2/0 HR 20 MM Pcs - -
36 Catgut Chromic 3/0 DS 19 MM Pcs - -
37
Catgut Chromic 3/0, 70 cm, Violet, Reverse Cutting, 1/2C, 26 mm Pcs - -
38 Catgut Chromic 3/0, 70 cm, Violet, Round Body, 1/2C, 22 mm Pcs - -
39 Catgut Chromic 3/0, 75 cm, 1/2 TP, 25 mm CG344 Pcs 5 48 53 18 01/24 35 300
40 Catgut Chromic 3/0, 75 cm, 3/8 RC CG342 Pcs - -
41 Catgut Chromic 4/0, 45 cm, CG366 Pcs - -
42 Catgut Chromic Serenity Pcs 10 10 10 12/22 0 300
43 Catgut Nylon 5/0, 75 cm, 3/8 cc, 12 mm NY979 Pcs - -
44 Catgut Plain 2/0 DS 19 MM Pcs - -
45 Catgut Plain 3/0 75 cm, 1/2 TP 30 mm Pcs 48 48 5 03/25 43
46 Catgut Plain 3/0 DS 16 MM Pcs - -
47 Catgut Plain 3/0, 75 cm, 3/8 RC, 23 mm Pcs - -
48 Catgut Plain 3/0, 75 cm, Undyed, Rev Cutting, 38C, 19 mm Pcs - -
49 Catgut Plain Serenity 3/0 Pcs - -
50 Catgut Provein 5/0, 45 cm, 18 mm, PV888 Pcs - -
51 Catgut Silk 3/0, 75 cm, 1/2 TP 26 mm Pcs - -
52 Catgut Silk 3/0, 75 cm, 3/8 CC 19 mm Pcs - -
53 Catgut Silk 4/0, 75 cm, 1/2 TP 20 mm BS690 Pcs - -
54 Catgut Silk 5/0, 45 cm BS695 Pcs - -
55 Chlor Etyl 100 ml Botol 0 2 2 1 7/21 1 10
56 Cuticell 7,5 cm X 20 cm oinment dressing Pcs - -
57 Cuticell Clasic 10 cm x 10 Pcs - -
58 Cutisorb Steril 10 cm x 10 Pcs - -
59 Derm Transport Dressing (Remedi) Pcs - -
60 Dermafix Pcs - -
61 Diapers Adult 10s Uk. L Molicare Pcs - -
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
62 Dressing IV Cannula Non Woven (Remedi) Pcs - -
63 ECG Gel 1000 ml Botol 3 3 2 1/22 1 5
64 Endo Ice Spray 200 ml Botol - -
65 Endotracheal Tube (ETT) 6,0 Fesco Pcs - -
66 Endotracheal Tube (ETT) 7,0 Fesco Pcs - -
67 Endotracheal Tube (ETT) 7,5 Fesco Pcs - -
68 Endotracheal Tube (ETT) 8,0 Fesco Pcs - -
69 Feeding Tube 100 cm No 10 Aximed Pcs - -
70 Feeding Tube 100 cm No 8 Aximed Pcs 20 20 - 2/21 20
71 Feeding Tube 40 cm No 10 Aximed Pcs 40 40 - 2/21 40
72 Female Catheter No. 16 Aximed Pcs 20 20 - 3/22 20
73 Female Catheter No. 18 Aximed Pcs 20 20 - 3/22 20
74 Folley Catheter No. 16 (2 Way Standard) Serenity Pcs - -
75 Folley Catheter No. 16 latex 2 Way ABADA Pcs 5 5 2 1/24 3
76 Folley Catheter No. 18 (2 Way Standard) Serenity Pcs - -
77 Folley Catheter No. 18 latex 2 Way ABADA Pcs 11 11 5 1//24 6
78 Gliserol 100 ml Botol - -
79 Handrub E-Care 500 ml Botol - -
80 Handscrub E-Care 500 ml Botol - -
81 Infus Set Anak Type Y Pcs - -
82 Infus Set Dewasa Type Y Aximed Pcs - -
83 Infus Set Semilas 3D Dewasa Pcs - -
84 Infusion Set Anak Aximed Pcs 45 45 24 08/23 21 300
85 Infusion Set Dewasa Aximed Pcs 63 200 263 63 04/24 200
86 Infusion Set Microdrip Abada Pcs - -
87 Infusion Set Microdrip Otsu Pcs - -
88 Infusion Set Y Adaptor Otsu Pcs 263 263 112 04/25 151 300
89 Iodine Povidon 30 ml Botol - -
90 Iodine Povidon 60 ml Botol - -
91 IV Catheter No. 18 G Cath Pro Pcs - -
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
92 IV Catheter No. 18 G Otsu Pcs 100 100 - 07/22 100 300
93 IV. Catheter No. 20 G Cath Pro Pcs - -
94 IV. Catheter No. 20 G Otsu Pcs 100 100 - 01/22 100 300
95 IV. Catheter No. 22 G Cath Pro Pcs 239 239 78 04/22 161 300
96 IV. Catheter No. 22 G Otsu Pcs 200 200 - 01/22 200 300
97 IV. Catheter No. 24 G Cath Pro Pcs 70 70 70 0 300
98 IV. Catheter No. 24 G Otsu Pcs 200 200 30 08/21 170 300
99 IV. Catheter WP No. 18 ABADA Pcs 42 42 33 11/22 9 300
100 IV. Catheter WP No. 20 ABADA Pcs 33 33 5 11/22 28 300
101 IV. Catheter WP No. 22 ABADA Pcs - - 300
102 IV. Catheter WP No. 22 AXIMED Pcs - -
103 IV. Catheter WP No. 24 AXIMED Pcs - -
104 IV. Catheter WP No. 26 AXIMED Pcs 119 100 219 13 06/23 206
105 Kantong Limbah Biohazard kuning Uk. L (80x100 cm) Pack 6's 10 10 - 12/21 10
106 Kantong Limbah Biohazard kuning Uk. M (60x80 cm) Pack 10's 7 10 17 1 16
107 Kantong Limbah Biohazard kuning Uk. S (40x60 cm) Pack 20's 1 10 11 1 10
108 Kantong Plastik PE 60 x 100 cm Pack 10's - -
109 Kapas 100 gr Pcs 3 3 1 2 100
110 Kapas 250 gr Pcs 2 20 22 6 16 100
111 Kapas 500 gr Pcs - - 100
112 Kasa 10 x 10 Onemed Roll - -
113 Kasa 2 m x 80 cm Roll 2 2 - 2
114 Kasa 40 x 80 cm Roll - -
115 Kasa Hidropil 16 x 16 Abada Box - -
116 Kasa Hidropil 2 x 10 cm Abada Pack - -
117 Kasa Hidropil 20 x 80 cm Abada Box - -
118 Kasa Hidropil 36 x 80 cm (BIOKASA) Roll 3 25 28 2 02/23 26
119 Kasa Hidropil 4 x 15 cm Abada Pcs 25 500 525 85 440
120 Kasa Hidropil 4 x 7,5 cm Abada Pcs - -
121 Kasa Steril 7.5x7.5 Pcs - - 300
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
122 Kertas EKG BTL -08 M Line Roll 3 3 - 3
123 Kertas Perkamen Pack - -
124 Latex Powder Examination Gloves Uk. L ASAP Pcs 2000 2,000 1,000 1000 5000
125 Latex Powder Examination Gloves Uk. M ASAP Pcs 2000 2,000 700 1300 5000
126 Latex Powder Examination Gloves Uk. S ASAP Pcs - - 5000
127 Latex Powder Examination Gloves Uk. XS ASAP pcs - -
128 Lysol 1 Liter Botol 2 10 12 1 08/21 11
129 Masker 3 m 1870 N 95 Pcs 278 278 3 10/21 275
130 Masker ear loop ABADA Pcs - - 4000
131 Masker ear loop Aximed Pcs - - 4000
132 Masker ear loop semillas Pcs 2400 2,400 2,400 0 4000
133 Masker Nebulizer Anak (M) Abada Pcs - -
134 Masker Nebulizer Anak Cosmo Pcs - -
135 Masker Nebulizer Anak Remedi Pcs 13 13 - 11/21 13
136 Masker Nebulizer Dewasa (L) Abada Pcs - -
137 Masker Nebulizer Dewasa Cosmo Pcs - -
138 Masker Nebulizer Dewasa Remedi Pcs 11 11 5 6 100
139 Masker Oksigen Anak Serenity Pcs 24 24 - 24
140 Masker Oksigen Bayi Pcs 18 18 - 18
141 Masker Oksigen Dewasa Pcs 20 20 - 07/22 20
142 Masker oksigen NRM adult elongated pcs - -
143 Masker oksigen NRM child elongated pcs 4 4 - 3/22 4
144 Medical Ultrasonic Gel Botol - -
145 Meliseptol Spray Botol - -
146 Micropipet adjust Vol. 0,5-10 UL Pcs 2 2 - 2
147 Micropipet adjust Vol. 100-1000 UL Pcs 2 2 - 2
148 Micropipet adjust Vol. 10-100 UL Pcs 1 1 - 1
149 Micropipet adjust Vol. 200-1000 UL Pcs 2 2 - 2
150 Micropipet adjust Vol. 50-200 UL Pcs 2 2 - 2
151 Micropipet Adjust Vol.0,1-2,5UL Pcs 2 2 - 2
152 Micropipet Adjust Vol.2-20 UL Pcs 2 2 - 2
153 Micropipet Adjust Vol.5-50 UL Pcs 1 1 - 1
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
154 Micropipet Fixed Vol.10 UL Pcs 2 2 - 2
155 Micropipet Fixed Vol.100 UL Pcs 1 1 - 1
156 Micropipet Fixed Vol.20 UL Pcs 2 2 - 2
157 Micropipet Fixed Vol.25 UL Pcs 2 2 - 2
158 Micropipet Fixed Vol.5 UL Pcs 2 2 - 2
159 Micropipet Fixed Vol.50 UL Pcs 2 2 - 2
160 Micropipet Fixed Vol.500 UL Pcs 2 2 - 2
161 Mikro Aplicator tips Botol - -
162 Mucus Extractor Serenity Pcs - -
163 Nasal Oksigen 'M' Aximed Pcs 8 8 3 5
164 Nasal Oksigen 'S' Aximed Pcs 7 7 1 6
165 Nasal Oksigen Uk. XS Pcs 18 18 1 17
166 Nasal Oxygen Canula anak Pcs - -
167 Nasal Oxygen Canula anak Abada Pcs - -
168 Nasal Oxygen Canula anak Serenity Pcs 100 100 - 100
169 Nasal Oxygen Canula Dewasa Abada Pcs 16 12 - 12
170 Needle CNV 21x1,5 ml (BD Vacutainer) Pcs 100 100 100 0
171 Needle CNV 22x1,5 ml MLTSMP CE Pcs 100 100 100 0
172 Needle Flashback 21X1 Pcs 250 250 50 08/21 200
173 Nitrile Powder Free Examination Globe Uk. S Pcs - -
174 Non Woven Fixtation 10 cm x 10 m Aximed Roll 10 10 1 10/20 9 100
175 Non Woven Fixtation 5 cm x 10 m Aximed Roll 11 10 21 6 10/20 15 100
176 Non Woven IV Dressing 6x8 cm Narafix Pcs - -
177 Nurse Cup Green Box 100's 249 5 254 247 7
178 One Scrub Botol - -
179 One Step HBSAg Test Strip Pcs - -
180 Oxyflow nasal anak Pcs - -
181 Oxyflow nasal bayi Pcs - -
182 Paper Tape 1,25 cm X 9,14 cm Roll - -
183 Paper Tape 2,5x9,14 cm Roll - -
184 Paper Tape 7,5 cm X 9,14 cm Roll - -
185 Papsmear Kit M Pcs - -
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
186 Papsmear Kit S Pcs - -
187 Plester ZinkOxyd 1,25 x 450 cm Roll - -
188 Plester ZinkOxyd 2,5 x 450 cm Roll - -
189 Plester ZinkOxyd 5 x 450 cm Roll 11 11 - 11
190 Policrepe 10 cm x 4,55 m Roll - -
191 Policrepe 15 cm x 4,55 m Roll 41 41 - 41
192 Polifix 10cmx5m Roll - -
193 Polifix 15cmx5m Roll - -
194 Polifix 15x5 cm Roll - -
195 Proline Cholesterol FS KIT - -
196 Proline Glucose GOD FS KIT - -
197 Proline Triglycerides FS KIT - -
198 Proline Trucal U KIT - -
199 Reagen Afinion HbA1c Box 10's - -
200 Reagen Anti A 1x10 ml KIT - -
201 Reagen Anti AB 1x10 ml KIT - -
202 Reagen Anti B 1x10 ml KIT - -
203 Reagen Anti D 1x10 ml KIT - -
204 Reagen Cleanser 1 Lt For Sumiffin Botol - -
205 Reagen Cleanser BCC 3600 Dirui Botol - -
206 Reagen Cleanser For Mindray Botol - -
207 Reagen Cleanser For Zenix Botol - - 10
208 Reagen Control Normal Kimia Biomaxima Vial - -
209 Reagen Control Normal Mindray KIT - -
210 Reagen Control Normal Zenix KIT - -
211 Reagen Creatinine 3x50 mL Biomaxima KIT - -
212 Reagen Diluent 20 Lt Dirui BCC -3600 Botol - -
213 Reagen Diluent For Sumiffin Botol - -
214 Reagen Diluent M-30 20 L Mindray Botol - -
215 Reagen Diluent Zenix Botol - - 10
216 Reagen EZ Cleanser 100 ml Mindray Botol - -
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
217 Reagen Lyse 500 ml Dirui Botol - -
218 Reagen Lyse 500 ml For Sumiffin Botol - -
219 Reagen Lyse 500 ml- Mindray M-30 Botol - -
220 Reagen Lyse 500 ml Zenix Botol - - 10
221 Reagen Rinse 20 Lt Mindray Botol - -
222 Reagen Salmonella Paratyphi 0 1x5 ml KIT - -
223 Reagen Salmonella Paratyphi A0 1x5 ml KIT - -
224 Reagen Salmonella Paratyphi AH 1x5 ml KIT - -
225 Reagen Salmonella Paratyphi B0 1x5 ml KIT - -
226 Reagen Salmonella Paratyphi BH 1x5 ml KIT - -
227 Reagen Salmonella Paratyphi C0 1x5 ml KIT - -
228 Reagen Salmonella Paratyphi CH 1x5 ml KIT - -
229 Reagen Salmonella Paratyphi H 1x5 ml KIT - -
230 Reagen SGOT (ASAT) 3x20 mL Biomaxima KIT - -
231 Reagen SGPT (ALAT) 3x20 mL Biomaxima KIT - -
232 Reagen Urea 3x50 mL Biomaxima KIT - -
233 ReagenTriglycerida 4x50 mL Biomaxima KIT - -
234 Rectal Tube size 22 FR Pcs - -
235 Rivanol 300 cc Botol 24 24 - 05/23 24 300
236 Sabun Antibakteri Botol - -
237 Safety box 5 lt kuning Pcs 39 39 14 25 50
238 Saniswiss Biosanitier L5000 ml Botol - -
239 Saniswiss Biosanitizer H1500 ml Botol - -
240 Saniswiss Biosanitizer L15000g Botol - -
241 Selang NGT No. 18 Pcs - -
242 Selang NGT No. 22 Pcs - -
243 Semillas Non Woven Medical Tape 20x500 cm Roll - -
244 SEMILLAS
cm
Non Woven Transparant Wound Dressing with Pad 9 x 15 Pcs
- -
245 SEMILLAS Non-Woven Wound Dressing 6x7 cm (With Pad) Roll - -
246 Semillas water proof medical tape 20x500 cm Roll - -
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
247 Servical Collar Serenity Pcs - -
248 Silk Black 2/0 HR 30 MM Pcs - -
249 Silk Black 3/0 HR 30 MM Pcs - -
250 Silk Black 5/0 DS 12 MM Pcs - -
251 Silk Black 6/0 DS 14 MM Pcs - -
252 Silk Black Braided Braun 3/0 + Jarum Pcs 163 163 34 05/20 129 300
253 Silk Braided USP 3/0 Pcs 24 11 35 11 4/23 24 300
254 Silk Plain 3/0 Pcs - -
255 Softaman Desinfectan Botol - -
256 Softaskin Gel Botol - -
257 Spalk First AID Pcs 18 18 - 18
258 Stomach Tube 85 cm No 14 Aximed Pcs 20 20 - 2/21 20
259 Strip test ABON Syphilis Ultra Rapid Pcs - -
260 Strip test cholesterol autocheck Box 25's 8 8 4 10/20 4
261 Strip test cholesterol benecheck Box 10's 10 10 1 06/21 9
262 Strip test Dengue NS1 Antigen Serenity Pcs - -
263 Strip test DI Anti HCV 1/2 Casette Pcs - -
264 Strip test DI Anti HIV 1/2 cassete Pcs - -
265 Strip test glucose autocheck Box 50's 5 5 - 8/21 5
266 Strip test glucose benecheck Box 50's 20 20 2 02/22 18
267 Strip test glucose On call Plus Pcs - -
268 Strip test Hb Hemoglobin Mission Pcs - - 500
269 Strip test HCG Fokus Pcs - - 500
270 Strip test Rapidan Dengue NS1 dan IgG/IgM Pcs - -
271 Strip test Rapidan HBsAg Test WB/S/P Pcs - -
272 Strip test Rapidan Malaria Pcs 75 75 - 8/21 75
273 Strip test SD Dengue Duo Bioline Pcs 25 25 - 7/21 25 100
274 Strip test SD HBSAg Test Strip Pcs 0 100 100 50 10/22 50 100
275 Strip test SD HIV 1/2 3.0 Pcs - -
276 Strip test SD HIV Bioline Pcs 100 100 25 06/21 75 100
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
277 Strip test uric acid autocheck Box 50's 12 12 2 11/20 10
278 Strip test uric acid benecheck Box 25's 10 10 1 08/21 9
279 Strip test uric acid Easy Touch Box 25's - -
280 Suction Catheter No. 10 (Aximed) Pcs - -
281 Suction Catheter No. 12 ( Aximed) Pcs - -
282 Surfaces Stretch Wipes (Biosanitizer) Pack - -
283 Surgical Blade No. 10 Aesculap Pcs - -
284 Surgical Blade No. 10 Serenity Pcs 44 44 7 07/22 37
285 Surgical Blade No. 23 Serenity Pcs 0 100 100 - 07/22 100
286 Surgical Film 20 x 30 cm Pcs - -
287 Surgical Gloves Gyanokolog No. 6,5 (Remedi) Pairs 154 154 5 06/24 149
288 Surgical Gloves Gyanokolog No. 7 (Remedi) Pairs 34 34 34 3/23 0
289 Surgical Gloves No. 6 TRO Sensosurge Pairs - -
290 Surgical Gloves No. 6,5 TRO Sensosurge Pairs - -
291 Surgical Gloves No. 7 GAMEX Pairs - -
292 Surgical Gloves No.6,0 Aximed Pcs - -
293 Surgical Gloves No.6,5 Aximed Pcs 150 150 16 7/23 134 300
294 Surgical Gloves No.7,0 Aximed Pcs 589 589 69 7/23 520
295 Surgical Gloves No.7,5 Aximed Pcs 508 508 4 7/23 504
296 Surgical Safeglove ST PF 6 Pcs - -
297 Surgical Safeglove ST PF 6,5 Pcs - -
298 Surgical Safeglove ST PF 7 Pcs - -
299 Tabung BD Vacutainer Tube EDTA plh 13 x 75 3.0 23 g x 1 In Pcs - -
300 Tabung BD Syringe Soloshot mm 0,5 ml Pcs - -
301 Tabung EDTA Tab 3 ml Pcs 1400 500 1,900 - 1900
302 Tabung Endo Vacuum Blood Collection tube, Plain 3 ml Pcs - -
303 Tabung Endo Vacuum Tube Sterile K3EDTA Pcs - -
304 Tabung K3EDTA 3 ml Glass Interna Pcs - -
305 Tabung Plain 3 ml Glas Interna tabung 2300 2,300 100 2200
306 Tabung Vacuum Container Plain 3 ml Glas Interna Pcs - -
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
307 TB AG Rapid Test KIT - -
308 Three Way with Extention Pcs - -
309 Tips For Micro MT 200 IU Pcs - -
310 Tips For Micro MT II 1 ml Pcs - -
311 Tips For Micropipet MSTP Pcs - -
312 Trigliseride Test Strip Pcs - -
313 Tube TB AG tube - -
314 Uji malaria fokus Pcs - -
315 Umbilicall Cord Clame Fesco Pcs - -
316 Umbilicall Cord Clem Pcs 190 190 10 180
317 Underpad (Soft pad 60x90) Pcs 910 910 30 08/22 880
318 Underpad Surgical Pcs - -
319 Urine bag + Hanger Pcs 20 100 120 11 109
320 Urine Collector Pead OM Pcs - -
321 Uritest Reagent Strip 11G Box 100's 2 5 7 - 7/21 7
322 USG Gel 250 Ml Pcs - -
323 Viorex Liquid Btl 500 ml - -
324 White Tips Bks 1000's - -
325 Wing Nedle 23 G Pcs - -
326 Wing Nedle 25 G Pcs - -
327 Write On ID Bracelet Child Green (Remedi) Box 100's 2 2 - 2
328 Write On ID Bracelet Child Ungu (Remedi) Box 100's 2 2 - 2
329 Write On ID Bracelet,Adult Blue (Remedi) Box 100's 2 2 - 2
330 Write On ID Bracelet,Adult Pink (Remedi) Box 100's 2 2 - 2
331 Yellow Tip Bks 1000's - -
332 Iodine Povidon 300 ml Botol 3 24 27 4 23
333 Latex Powder Free Examination Gloves Uk. M ASAP Pcs - -
334 Reagen Ziehl Neelsen Paket 2 2 - 2
335 Saniswiss Biosanitier H 500 ml Botol 8 8 - 8
336 Surfaces Biosanitier S 750 ml Botol 11 11 - 11
337 Surfaces Biosanitier S 5000 ml Kent 6 6 2 4
338 Hand Gel H1 100 ml + Flip top Botol - -
Bahan Gigi
1 Alveogyl 10 gr - Septodent Ampul - -
2 Arsen / pul X-Devitalizer Pot - -
3 Articulating paper Buah - -
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
4 Bonding/Master Bond Buah - -
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
5 Calcimol LC Botol - -
6 Carpule Anastesi / Artinibsa Box - -
7 Cavit G (Ceivitron) Pot - -
8 Cavitton Pink (Ceivitron) 30 gr Buah - -
9 Celluloid Strip Box - -
10 Cemen Spatula Buah - -
11 Cement Phospat 35 gr Box - -
12 CHKM Botol - -
13 Citocarten/carpule Box - -
14 Composite Resin A2 Pcs - -
15 Composite Resin A3 Pcs - -
16 Dental Needles 30G 16mm Box - -
17 Dycal / Hydcal Botol - -
18 Eching gel 10 ml Tube - -
19 Eugenol 10 ML Ghimas Botol - -
20 Eugenol Cair Botol - -
21 Glass ionomer Fuji IX 1-1 PKG Universal 10 gr Box - -
22 Glass ionomer Fuji IX 1-1 PKG Universal 5 gr Box - -
23 Oco / Poliren No.1 Botol - -
24 Topical anasthetic gel Pcs - -
Jumlah Kunjungan Resep Rawat Jalan Rawat Inap Total
490 490
Mengetahui, Yang meminta/Melapor
Kepala Puskesmas Serimbu Pengelola Obat Puskesmas Serimbu
Kabupaten Landak
Hengki, S.Kep Siti Maryam, S.Farm., Apt.
NIP. 19831204 201101 1 004 NIP. 19910523 202012 2 013
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
KABUPATEN : LANDAK
PUSKESMAS : SERIMBU
BULAN/TAHUN : APRIL / 2021
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
1 Acarbose 100 mg Tab - -
2 Acetylsistein 200 mg Caps - -
3 Acyclovir 200 mg Tab - -
4 Acyclovir 400 mg Tab 650 650 50 08/22 600
5 Albendazole Syrup Botol - -
6 Albendazole tab 400 mg Tab 1000 1,000 100 7/21 900
7 Allopurinol 300 mg Tab 1300 1,300 200 08/22 1100
8 Alprazolam 0,5 mg Tab - -
9 Alprazolam 1 mg Tab - -
10 Aminophyllin Inj Ampul - -
11 Amitriptilin 25 mg Tab 430 300 730 - 5/23 730
12 Amlodipin 10 mg Tab 2200 2,200 1,400 7/23 800
13 Amlodipin 5 mg Tab 2800 2,800 1,800 07/22 1000
14 Amoxicillin Syrup 125 mg/5ml Botol 285 285 29 12/21 256
15 Amoxicillin Syrup Forte 250 mg/5ml Botol - -
16 Amoxycillin tab 500 mg Hexpharm Tab 2000 2,000 2,000 09/22 0
17 Ampisillin Injeksi Vial 9 9 - 03/23 9
18 Anabion Syrup Botol - -
19 Antasida DOEN Kombinasi Tab 7200 7,200 4,600 08/23 2600
20 Antasida DOEN Syrup Botol 222 222 49 7/21 173
21 Antifungi DOEN salep kombinasi Tube - -
22 Antihemorroid Suppo - -
23 Apricot Syrup 100 ml / Obat Batuk Botol 20 20 5 03/23 15
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
24 Asam ascorbat 50 mg/ Vit. C 50 mg Tab 3500 3,500 2,000 08/23 1500
25 Asam Mefenamat 500 mg Tab 2100 2,100 2,100 02/22 0
26 Asam Tarnexamat Inj 50mg/ml Ampul - -
27 Asam Tranexamat inj 100 mg/ml Ampul - -
28 Asering larutan infus 500 ml Botol - -
29 Asetosal 100 mg Tab - -
30 Atropin Injeksi 0,25 mg Vial 50 50 - 11/22 50
31 Bacitracin Polymicin Zalp Tube - -
32 Benzatin Benzyl Penisilin 2,4 juta UI Vial - -
33 Betahistin Mesilat 6 mg tab 2600 2,600 600 05/22 2000
34 Betamethasone krim 0,05% Tube - -
35 Betamethasone krim 0,1% Tube 65 65 15 05/22 50
36 Bioplacenton Tulle Pcs 49 49 3 12/21 46
37 BIOSAT 1,500 ( A.T.S) serum anti tetanus Vial 10 10 - 10
38 BIOSAVE ( A.B.U I) serum anti bisa ular Vial 5 5 - 5
39 Bisoprolol 5 mg Tab 1400 1,400 - 7/21 1400
40 Calcii Gluconas Inj Ampul 24 24 - 12/21 24
41 Captopril 12,5 mg tab 6300 6,300 1,400 6/24 4900
42 Captopril 25 mg Tab 7100 7,100 1,700 07/22 5400
43 Cavidagel 15 gr Tube 2 2 - 10/21 2
44 Cefadroksil 250 mg Tab - -
45 Cefadroksil 500 mg Tab - -
46 Cefadroxil Syrup Botol 166 166 13 08/23 153
47 Cefotaxim inj,1 gr Ampul - -
48 Ceftriaxon inj.1 gr Ampul - -
49 Cetirizin 10 mg Tab 4200 4,200 2,300 10/21 1900
50 Cetirizin Syrup Botol 33 33 20 7/21 13
51 Chloramex 500 mg Caps 1000 1,000 100 10/21 900
52 Chloramfenicol 125mg/5ml Syrup Botol - -
53 Chloramfenicol 250 mg caps 2100 2,100 300 4/22 1800
54 Chloramfenicol salep mata 1% Tube - -
55 Chlorfeniramin Maleat 4 mg (CTM) Tab 8700 8,700 2,200 07/23 6500
56 Chlorpromazin 100 mg Tab 290 290 60 7/22 230
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
57 Ciprofloxacin 500 mg Tab 900 900 200 11/22 700
58 Clindamicin 150 mg Caps 450 450 100 4/22 350
59 Clozapin 100 mg Tab - -
60 Clozapin 25 mg Tab 641 641 641 2/21 0 EXP
61 Codein 10 mg Tab - -
62 Combivent Nebulizer Vial - -
63 Cotrimoxazol 480 mg Tab 6500 6,500 1,200 08/22 5300
64 Cotrimoxazol 960 mg forte Tab - -
65 Cotrimoxazol Syrup Botol 164 164 11 7/22 153
66 Curbion Kids Emulsion (Multivitamin Anak) Botol - -
67 Curviplex Syrup Botol - -
68 Daneuron Tab - -
69 Dapyrin Syrup Botol - -
70 Desoximetason cream 0,25 % Tube 12 12 - 05/22 12
71 Dexamethason 0,5 mg Tab Tab 7200 7,200 1,900 02/22 5300
72 Dexamethason Inj Ampul 64 50 114 30 7/21 84
73 Diazepam 5 mg Tab 380 380 5 10/22 375
74 Diazepam Injeksi 5 mg/ml Ampul 20 20 - 20
75 Digoxin 0,25 mg Tab - -
76 Diltiazem 30 mg Tab - -
77 Dimenhidrinat tab 50 mg Tab 1900 1,900 - 03/23 1900
78 Diphenhydramin Inj 10 mg/ml Ampul 22 22 - 7/22 22
79 Doksisiklin 100 mg Tab - -
80 Domperidon tab 10 mg Tab 5000 5,000 1,700 11/22 3300
81 Dopamet tab Tab 2100 2,100 100 11/21 2000
82 Dulcolax Suppo 10 mg Suppo - -
83 Ephinefrin Inj 1 mg/ml 0,1% Ampul 10 10 - 03/22 10
84 Ergotamin Coffein/anti migraen. Tab 1000 1,000 - 8/21 1000
85 Erytromicin tab 500 mg tab - -
86 Erytromisin Syr Botol - -
87 Ethambutol 500 mg Botol - -
88 Euthyrox 50 mg Tab - -
89 Fenobarbital Inj 50 mg/ml Ampul - -
90 Fenol Gyserol TT Botol - -
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
91 Fitomenadion ( Vit. K) injeksi Ampul 168 168 58 9/21 110
92 Fitomenadion ( Vit. K) tab salut 10 mg Tab 900 900 200 10/21 700
93 Flixotide Nebules Vial - -
94 Framycetin Lembar - -
95 Fucilex Cream Tube - -
96 Furosemid Inj 10 mg/ml Ampul 55 55 55 05/21 0 EXP
97 Furosemid Tab 40 mg Tab 1000 1,000 400 05/23 600
98 Garam Oralit 200 mg pcs 740 740 480 04/23 260
99 Gentamicin Injeksi 40 mg/ml Ampul - -
100 Gentamicin Salep Mata 0,3% Tube 97 97 25 8/23 72
101 Gentamicin Sulfa Tetes Mata 0,3% Botol 97 97 45 9/22 52
102 Glibenklamid 5 mg Tab - -
103 Glikos 500 mg Tab - -
104 Gliquidon Tab - -
105 Glukosa 10% Infus Kolf 40 40 - 04/22 40
106 Glukosa 5% Infus Kolf 124 100 224 41 3/23 183
107 Glukosa 5% Infus Otsu Botol - -
108 Gored Tab - -
109 Grantusif Tab - -
110 Griseofulvin 125 mg Tab 2900 2,900 2,900 5/21 0 EXP
111 Guaifenesin 100 mg Tab 7400 7,400 1,800 08/21 5600
112 Haloperidol 0,5 mg Tab - -
113 Haloperidol 1,5 mg Tab 130 300 430 90 3/23 340
114 Haloperidol 5 mg Tab - -
115 Herbakof / Obat Batuk Fitofarmaka 60 ml Botol 65 65 17 09/21 48
116 Hidrokortiazid 25 mg (HCT) Tab 3300 3,300 100 5/22 3200
117 Hidrokortison Krim 2,5% Tube 81 81 33 07/23 48
118 Hufadin Tab Tab - -
119 Hufagrif TMP Botol - -
120 Hufagrip Forte TB tab - -
121 Hyperhep 0,5 ml (Vaksin HbIg) Vial 4 4 - 05/23 4
122 HyperRAB (Rabies Immune Globulin) Vial 4 20 24 2 05/21 22
123 Ialuset Plus Cream Tube 1 1 - 1/22 1
124 Ibuprofen Suspensi 100 mg/5ml Botol 42 42 12 01/22 30
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
125 Ibuprofen tab Tab 3900 3,900 2,000 10/22 1900
126 Iliadin Drop Tetes Hidung Botol - -
127 Irbesartan 150 mg Tab - -
128 Isoniazid 100 mg Tab - -
129 Isosorbit Dinitrat 5 mg Tab - -
130 KA EN 3A Infus Kolf - -
131 KA EN 3B Infus Kolf - -
132 Kalsium Laktat 500 mg (Kalk) Tab 6300 6,300 4,700 09/2023 1600
133 Karbamazepin 200 mg Tab 1000 1,000 60 940
134 Ketokonazole 200 mg Tab 900 900 300 12/21 600
135 Ketokonazole Krim Tube - -
136 Ketorolac Inj 30mg/ml (3%) Ampul 98 98 11 03/23 87
137 Lactulosa Sir 3,335 g/5ml Botol - -
138 Lacyvir Salep Mata Tube - -
139 Lansoprazole caps Caps 450 450 300 10/23 150
140 Laxadine emulsi Botol - -
141 Levofloxacin 500 mg Tab - -
142 Lidocain Compositum Inj Ampul 158 158 40 06/21 118
143 Lidocain inj 2% Inj 55 55 55 10/23 0
144 Livron B Plex Tab 8500 8,500 2,900 07/21 5600
145 Loperamide HCl Tab 800 800 100 06/22 700
146 Loratadine tab 10 mg tab 700 700 50 09/24 650
147 Lytacur Syrup 60 ml / Procurma Syr Botol 94 94 34 60
148 Magnesium sulfat (MgSO4) 20% Ampul 12 12 - 6/22 12
149 Magnesium sulfat (MgSO4) 40% Ampul 6 6 - 06/22 6
150 Mersibion Inj Ampul - -
151 Mersibion Tablet 5000 Tablet - -
152 Metformin tab 500 mg tab 4300 4,300 2,700 09/22 1600
153 Metilergotmetrin 0,125 mg Tab - -
154 Metilergotmetrin Inj 0,2 mg/ml Ampul 80 80 10 03/23 70
155 Metilprednisolon 16 mg Tab 3800 3,800 900 05/24 2900
156 Metilprednisolon 4 mg Tab 2000 2,000 - 09/22 2000
157 Metisol 4mg Tab - -
158 Ranitidin Inj Tab - -
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
159 Metoklorpamid 5 mg Tab 1400 1,400 300 1/23 1100
160 Metronidazol Infus Botol - -
161 Metronidazol Syrup Botol 60 60 - 02/23 60
162 Miniaspi 80 mg Tab 300 300 - 8/21 300
163 Muliavit Syrup Botol - -
164 NaCl 0,9% Infus Kolf 119 100 219 24 3/24 195
165 Natrium Diklofenak 25 mg Tab 5400 5,400 2,050 10/22 3350
166 Natrium Diklofenak 50 mg Tab 5850 5,850 1,900 04/22 3950
167 New Antides Tab - -
168 Nifedipin 10 mg Tab - -
169 Novadryl Syrup Botol - -
170 Novaxicam 20 mg (Piroxicam) Caps - -
171 Nystatin 100.000 IU Tab 200 200 - 5/22 200
172 Nystatin 500.000 IU Tab - -
173 OAT Kategori Anak Paket - - 0
174 OAT Kategori I FDC Paket 20 20 12 2/21 8
175 OAT Kategori I Kombipak Paket - -
176 OAT Kategori II Paket - -
177 OBH Kaca Berlico 100ml Botol 200 200 44 03/23 156
178 OBH Syrup jeruk nipis Botol - -
179 Ofloxacin 200 mg Tab 300 300 - 12/21 300
180 Oksitetrasiklin 1% Zalp Mata Tube 100 100 - 06/21 100
181 Oksitosin Inj 10 IU/ml Ampul 155 155 49 07/21 106
182 Omeprazole 20 mg Caps / Lanzoprazole Caps 1200 1,200 690 10/23 510
183 Omeroxol Syrup Botol - -
184 Ondansetron 4 mg tab Tab - -
185 Ondansetron Inj Ampul 99 99 4 01/22 95
186 Parasetamol 500 mg Tab 6800 6,800 5,200 08/22 1600
187 Parasetamol Drop Botol 57 57 18 11/22 39
188 Parasetamol Infus btl - -
189 Parasetamol Syrup Botol 246 246 127 10/24 119
190 Pasaba Baby Cough Syrup Botol - -
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
191 Pasaba Cough Plus Syrup Botol - -
192 nobar Tab - -
193 Piridoxin 10 mg (Vit. B6) Tab 4000 4,000 900 8/21 3100
194 Prednison tab 5 mg Tab 2700 2,700 800 09/22 1900
195 Primaquin Tab Tab - -
196 Primpen Syrup Botol - -
197 Pro K Inj Ampul - -
198 Procain Benzyl Penisilin 3 juta UI Vial - -
199 Profiltiourasil 100 mg (PTU ) Tab - -
200 Profolat 0,4 mg Tab - -
201 Pronazol 200 mg Tab - -
202 Propanolol 10 mg Tab - -
203 Pularex Tab Tab - -
204 Pulmicort Budesonid Respules Vial - -
205 Pyrantel Pamoat 125 mg Tab 1860 1,860 360 04/24 1500
206 Pyrantel Pamoat susp 125mg/5ml Botol 120 120 31 09/21 89
207 Pyrazinamid 500 mg Tab - -
208 Ranitidin Inj Ampul 52 52 39 9/21 13
209 Ranitidin Tab / Radin tab Tab 4000 4,000 1,100 08/22 2900
210 Reco tetes telinga Botol - -
211 Retinol 100.000 IU BIRU (Vit. A) Caps - -
212 Retinol 200.000 IU MERAH (Vit. A) Caps - -
213 Rifampicin 300mg Tab - -
214 Rifampicin 450 mg Tab - -
215 Rifampicin 600 mg Caps - -
216 Ringer Laktat Infus Kolf 45 500 545 105 4/22 440
217 Risperidon 1 mg Tab - -
218 Risperidon 2 mg Tab 115 115 115 2/22 0
219 Salbulin Spray Btl - -
220 Salbutamol 2 mg Tab - -
221 Salbutamol 4 mg Tab - -
222 Salbutamol Syrup Botol 171 171 34 10/21 137
223 Salep 2-4 Tube - -
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
224 Selesnizol tab 500 mg / metronidazol 500 mg Tab 900 900 400 09/23 500
225 Selespurin 100 mg tab / alopurinol 100 mg Tab 1700 1,700 1,300 05/23 400
226 Sianokobalamin (Vit. B12) tablet Tab -
227 Sianokobalamin Inj (Vit. B12) Ampul - -
228 Simvastatin 10 mg Tab 2340 2,340 2,340 5/21 0 EXP
229 Simvastatin 20 mg Tab 4200 4,200 4,200 5/21 0 EXP
230 Soft U Derm 10% Cream 20 gr Tube - -
231 Solinfec Tube - -
232 Spironolactone 25 mg Tab - -
233 Stesolid Rect 10 mg/2,5ml Tube 5 10 15 - 12/22 15
234 Stesolid Rect 5 mg/2,5ml Tube 10 10 20 1 08/22 19
235 Sucralfat Syrup Botol 53 53 53 08/22 0
236 Sulfadiazine salep Pcs - -
237 Sulfadoxine-Pyrimethamine (Suldox) Tablet 500 500 100 08/21 400
238 Tablet Tambah Darah FE Tab 11790 11,790 2,970 07/22 8820
239 Taracol Tab (Obat Flu kombinasi) Tab - -
240 Tetagam Inj Vial - -
241 Tetrasiklin 500 mg Tab - -
242 Thiamin (Vit B1) 50 mg Tab 6900 6,900 1,800 11/23 5100
243 Tramadol Inj Ampul - -
244 Trifason 0,5 mg Tab - -
245 Trifluoperazin 5 mg Tab 400 300 700 60 6/23 640
246 Trihexylpenidil 2 mg Tab 460 300 760 180 6/22 580
247 Ulsidex Tab Tablet - -
248 Valdimex 10 mg Inj/ Diazepam Inj DAU Ampul - -
249 Verorab (Vaksin VAR) Box - -
250 Vicalcin Syr Botol - -
251 Vitamin B komplek Tab 16400 16,400 3,400 4/22 13000
252 Wormetrin Tab Tab - -
253 Zevask 10mg Tab - -
254 Zinc 20 mg Tab 10700 10,700 1,500 9/22 9200
255 Zink Drop Botol 40 40 2 02/22 38
256 Zink Syrup Botol 157 157 32 02/23 125
257 Flutamol syr Botol 354 15 369 - 04/23 369
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
BAHAN MEDIS HABIS PAKAI, REAGEN DAN LARUTAN
1 Alat suntik 0,5 ml ADS Pcs
2 Alat suntik 0,5 ml SKIFA Pcs 500 05/23 500
3 Alat suntik 0,5 ml TP Pcs
4 Alat suntik 1 ml Pcs 505 505 60 09/25 445
5 Alat suntik 1 ml needle luer lock Pcs -
6 Alat suntik 1 ml Tubercullin serenity Pcs -
7 Alat suntik 10 ml ASSP TP Pcs 314 314 21 5/23 293
8 Alat suntik 10 ml Aximed Pcs - -
9 Alat suntik 10 ml needle luer lock Pcs - -
10 Alat suntik 10 ml Serenity Pcs - -
11 Alat suntik 3 ml needle luer lock Pcs 475 475 186 10/21 289
12 Alat suntik 3 ml TP Pcs - -
13 Alat suntik 5 ml TP Pcs 221 221 131 10/21 90
14 Alkazym 25 mg Sachet - -
15 Alkohol 70% 1 Lt Botol 22 22 7 02/24 15
16 Alkohol 70% 300 mL Botol - -
17 Alkohol Swab Aximed Pcs 6300 6,300 2,000 5/23 4300
18 Alkohol Swab Onemed Pcs - -
19 Alkohol Swab Sensi Pcs - -
20 Anios Gel Botol - -
21 Aprone One Plastik Pcs 170 170 60 08/23 110
22 Aqua Pro Injeksi Otsu Vial 109 109 13 3/22 96
23 Arm Sling Comfort (L) Pcs - -
24 Arm Sling Comfort (M) Pcs - -
25 Arm Sling Comfort (S) Pcs - -
26 Aroma Fine Normal Pack - -
27 Aseptic Gel 500 cc Botol - -
28 Blood Lancet 26G OM Box - -
29 Blood Lancet Medillance Box - -
30 Blood Lancet Serenity Pcs 2000 2,000 100 08/22 1900
31 Blood Transfusion Set Abada Pcs 100 100 - 7/23 100
32 Blue Tips Bks 500's - -
33 Catgut Chromic 1 HR 26 MM Pcs - -
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
34 Catgut Chromic 1 HR 48 MM Pcs - -
35 Catgut Chromic 2/0 HR 20 MM Pcs - -
36 Catgut Chromic 3/0 DS 19 MM Pcs - -
37
Catgut Chromic 3/0, 70 cm, Violet, Reverse Cutting, 1/2C, 26 mm Pcs - -
38 Catgut Chromic 3/0, 70 cm, Violet, Round Body, 1/2C, 22 mm Pcs - -
39 Catgut Chromic 3/0, 75 cm, 1/2 TP, 25 mm CG344 Pcs 35 35 35 01/24 0
40 Catgut Chromic 3/0, 75 cm, 3/8 RC CG342 Pcs 35 35 23 01/24 12
41 Catgut Chromic 4/0, 45 cm, CG366 Pcs - -
42 Catgut Chromic Serenity Pcs - -
43 Catgut Nylon 5/0, 75 cm, 3/8 cc, 12 mm NY979 Pcs - -
44 Catgut Plain 2/0 DS 19 MM Pcs - -
45 Catgut Plain 3/0 75 cm, 1/2 TP 30 mm Pcs 43 43 19 03/25 24
46 Catgut Plain 3/0 DS 16 MM Pcs - -
47 Catgut Plain 3/0, 75 cm, 3/8 RC, 23 mm Pcs - -
48 Catgut Plain 3/0, 75 cm, Undyed, Rev Cutting, 38C, 19 mm Pcs - -
49 Catgut Plain Serenity 3/0 Pcs - -
50 Catgut Provein 5/0, 45 cm, 18 mm, PV888 Pcs - -
51 Catgut Silk 3/0, 75 cm, 1/2 TP 26 mm Pcs - -
52 Catgut Silk 3/0, 75 cm, 3/8 CC 19 mm Pcs - -
53 Catgut Silk 4/0, 75 cm, 1/2 TP 20 mm BS690 Pcs - -
54 Catgut Silk 5/0, 45 cm BS695 Pcs - -
55 Chlor Etyl 100 ml Botol 1 1 - 7/21 1
56 Cuticell 7,5 cm X 20 cm oinment dressing Pcs - -
57 Cuticell Clasic 10 cm x 10 Pcs - -
58 Cutisorb Steril 10 cm x 10 Pcs - -
59 Derm Transport Dressing (Remedi) Pcs - -
60 Dermafix Pcs - -
61 Diapers Adult 10s Uk. L Molicare Pcs - -
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
62 Dressing IV Cannula Non Woven (Remedi) Pcs - -
63 ECG Gel 1000 ml Botol 1 1 - 1/22 1
64 Endo Ice Spray 200 ml Botol - -
65 Endotracheal Tube (ETT) 6,0 Fesco Pcs - -
66 Endotracheal Tube (ETT) 7,0 Fesco Pcs - -
67 Endotracheal Tube (ETT) 7,5 Fesco Pcs - -
68 Endotracheal Tube (ETT) 8,0 Fesco Pcs - -
69 Feeding Tube 100 cm No 10 Aximed Pcs - -
70 Feeding Tube 100 cm No 8 Aximed Pcs 20 20 - 2/21 20
71 Feeding Tube 40 cm No 10 Aximed Pcs 40 40 - 2/21 40
72 Female Catheter No. 16 Aximed Pcs 20 20 - 3/22 20
73 Female Catheter No. 18 Aximed Pcs 20 20 - 3/22 20
74 Folley Catheter No. 16 (2 Way Standard) Serenity Pcs - -
75 Folley Catheter No. 16 latex 2 Way ABADA Pcs 3 3 3 0
76 Folley Catheter No. 18 (2 Way Standard) Serenity Pcs - -
77 Folley Catheter No. 18 latex 2 Way ABADA Pcs 6 6 3 04/23 3
78 Gliserol 100 ml Botol - -
79 Handrub E-Care 500 ml Botol - -
80 Handscrub E-Care 500 ml Botol - -
81 Infus Set Anak Type Y Pcs - -
82 Infus Set Dewasa Type Y Aximed Pcs - -
83 Infus Set Semilas 3D Dewasa Pcs - -
84 Infusion Set Anak Aximed Pcs 21 21 12 08/23 9
85 Infusion Set Dewasa Aximed Pcs 200 200 - 04/24 200
86 Infusion Set Microdrip Abada Pcs - -
87 Infusion Set Microdrip Otsu Pcs - -
88 Infusion Set Y Adaptor Otsu Pcs 151 151 58 04/25 93
89 Iodine Povidon 30 ml Botol - -
90 Iodine Povidon 60 ml Botol - -
91 IV Catheter No. 18 G Cath Pro Pcs - -
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
92 IV Catheter No. 18 G Otsu Pcs 100 100 - 07/22 100
93 IV. Catheter No. 20 G Cath Pro Pcs - -
94 IV. Catheter No. 20 G Otsu Pcs 100 100 - 01/22 100
95 IV. Catheter No. 22 G Cath Pro Pcs 161 161 136 04/22 25
96 IV. Catheter No. 22 G Otsu Pcs 200 200 - 01/22 200
97 IV. Catheter No. 24 G Cath Pro Pcs - -
98 IV. Catheter No. 24 G Otsu Pcs 170 170 95 08/21 75
99 IV. Catheter WP No. 18 ABADA Pcs 9 9 8 11/22 1
100 IV. Catheter WP No. 20 ABADA Pcs 28 28 28 11/22 0
101 IV. Catheter WP No. 22 ABADA Pcs - -
102 IV. Catheter WP No. 22 AXIMED Pcs - -
103 IV. Catheter WP No. 24 AXIMED Pcs - -
104 IV. Catheter WP No. 26 AXIMED Pcs 206 206 6 06/23 200
105 Kantong Limbah Biohazard kuning Uk. L (80x100 cm) Pack 6's 10 10 - 12/21 10
106 Kantong Limbah Biohazard kuning Uk. M (60x80 cm) Pack 10's 16 16 3 13
107 Kantong Limbah Biohazard kuning Uk. S (40x60 cm) Pack 20's 10 10 - 10
108 Kantong Plastik PE 60 x 100 cm Pack 10's - -
109 Kapas 100 gr Pcs 2 2 1 1
110 Kapas 250 gr Pcs 16 16 5 11
111 Kapas 500 gr Pcs - -
112 Kasa 10 x 10 Onemed Roll - -
113 Kasa 2 m x 80 cm Roll 2 2 2 0
114 Kasa 40 x 80 cm Roll - -
115 Kasa Hidropil 16 x 16 Abada Box - -
116 Kasa Hidropil 2 x 10 cm Abada Pack - -
117 Kasa Hidropil 20 x 80 cm Abada Box - -
118 Kasa Hidropil 36 x 80 cm (BIOKASA) Roll 26 26 1 02/23 25
119 Kasa Hidropil 4 x 15 cm Abada Pcs 440 440 65 375
120 Kasa Hidropil 4 x 7,5 cm Abada Pcs - -
121 Kasa Steril 7.5x7.5 Pcs - -
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
122 Kertas EKG BTL -08 M Line Roll 3 3 - 3
123 Kertas Perkamen Pack - -
124 Latex Powder Examination Gloves Uk. L ASAP Pcs 1000 1,000 1,000 0
125 Latex Powder Examination Gloves Uk. M ASAP Pcs 1300 1,300 1,300 0
126 Latex Powder Examination Gloves Uk. S ASAP Pcs - -
127 Latex Powder Examination Gloves Uk. XS ASAP pcs - -
128 Lysol 1 Liter Botol 11 11 - 08/21 11
129 Masker 3 m 1870 N 95 Pcs 275 275 - 10/21 275
130 Masker ear loop ABADA Pcs - -
131 Masker ear loop Aximed Pcs - -
132 Masker ear loop semillas Pcs 0 - -
133 Masker Nebulizer Anak (M) Abada Pcs - -
134 Masker Nebulizer Anak Cosmo Pcs - -
135 Masker Nebulizer Anak Remedi Pcs 13 13 3 11/21 10
136 Masker Nebulizer Dewasa (L) Abada Pcs - -
137 Masker Nebulizer Dewasa Cosmo Pcs - -
138 Masker Nebulizer Dewasa Remedi Pcs 6 6 3 3
139 Masker Oksigen Anak Serenity Pcs 24 24 1 06/21 23
140 Masker Oksigen Bayi Pcs 18 18 - 18
141 Masker Oksigen Dewasa Pcs 20 20 - 07/22 20
142 Masker oksigen NRM adult elongated pcs - -
143 Masker oksigen NRM child elongated pcs 4 4 - 3/22 4
144 Medical Ultrasonic Gel Botol - -
145 Meliseptol Spray Botol - -
146 Micropipet adjust Vol. 0,5-10 UL Pcs 2 2 - 2
147 Micropipet adjust Vol. 100-1000 UL Pcs 2 2 - 2
148 Micropipet adjust Vol. 10-100 UL Pcs 1 1 - 1
149 Micropipet adjust Vol. 200-1000 UL Pcs 2 2 - 2
150 Micropipet adjust Vol. 50-200 UL Pcs 2 2 - 2
151 Micropipet Adjust Vol.0,1-2,5UL Pcs 2 2 - 2
152 Micropipet Adjust Vol.2-20 UL Pcs 2 2 - 2
153 Micropipet Adjust Vol.5-50 UL Pcs 1 1 - 1
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
154 Micropipet Fixed Vol.10 UL Pcs 2 2 - 2
155 Micropipet Fixed Vol.100 UL Pcs 1 1 - 1
156 Micropipet Fixed Vol.20 UL Pcs 2 2 - 2
157 Micropipet Fixed Vol.25 UL Pcs 2 2 - 2
158 Micropipet Fixed Vol.5 UL Pcs 2 2 - 2
159 Micropipet Fixed Vol.50 UL Pcs 2 2 - 2
160 Micropipet Fixed Vol.500 UL Pcs 2 2 - 2
161 Mikro Aplicator tips Botol - -
162 Mucus Extractor Serenity Pcs - -
163 Nasal Oksigen 'M' Aximed Pcs 5 5 5 0
164 Nasal Oksigen 'S' Aximed Pcs 6 6 1 5
165 Nasal Oksigen Uk. XS Pcs 17 17 4 13
166 Nasal Oxygen Canula anak Pcs - -
167 Nasal Oxygen Canula anak Abada Pcs - -
168 Nasal Oxygen Canula anak Serenity Pcs 100 100 - 100
169 Nasal Oxygen Canula Dewasa Abada Pcs 12 12 2 10
170 Needle CNV 21x1,5 ml (BD Vacutainer) Pcs - -
171 Needle CNV 22x1,5 ml MLTSMP CE Pcs - -
172 Needle Flashback 21X1 Pcs 200 200 - 08/21 200
173 Nitrile Powder Free Examination Globe Uk. S Pcs - -
174 Non Woven Fixtation 10 cm x 10 m Aximed Roll 9 9 - 10/20 9
175 Non Woven Fixtation 5 cm x 10 m Aximed Roll 15 15 2 10/20 13
176 Non Woven IV Dressing 6x8 cm Narafix Pcs - -
177 Nurse Cup Green Box 100's 7 7 1 6
178 One Scrub Botol - -
179 One Step HBSAg Test Strip Pcs - -
180 Oxyflow nasal anak Pcs - -
181 Oxyflow nasal bayi Pcs - -
182 Paper Tape 1,25 cm X 9,14 cm Roll - -
183 Paper Tape 2,5x9,14 cm Roll - -
184 Paper Tape 7,5 cm X 9,14 cm Roll - -
185 Papsmear Kit M Pcs - -
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
186 Papsmear Kit S Pcs - -
187 Plester ZinkOxyd 1,25 x 450 cm Roll - -
188 Plester ZinkOxyd 2,5 x 450 cm Roll - -
189 Plester ZinkOxyd 5 x 450 cm Roll 11 11 6 5
190 Policrepe 10 cm x 4,55 m Roll - -
191 Policrepe 15 cm x 4,55 m Roll 41 41 - 41
192 Polifix 10cmx5m Roll - -
193 Polifix 15cmx5m Roll - -
194 Polifix 15x5 cm Roll - -
195 Proline Cholesterol FS KIT - -
196 Proline Glucose GOD FS KIT - -
197 Proline Triglycerides FS KIT - -
198 Proline Trucal U KIT - -
199 Reagen Afinion HbA1c Box 10's - -
200 Reagen Anti A 1x10 ml KIT - -
201 Reagen Anti AB 1x10 ml KIT - -
202 Reagen Anti B 1x10 ml KIT - -
203 Reagen Anti D 1x10 ml KIT - -
204 Reagen Cleanser 1 Lt For Sumiffin Botol - -
205 Reagen Cleanser BCC 3600 Dirui Botol - -
206 Reagen Cleanser For Mindray Botol - -
207 Reagen Cleanser For Zenix Botol - -
208 Reagen Control Normal Kimia Biomaxima Vial - -
209 Reagen Control Normal Mindray KIT - -
210 Reagen Control Normal Zenix KIT - -
211 Reagen Creatinine 3x50 mL Biomaxima KIT - -
212 Reagen Diluent 20 Lt Dirui BCC -3600 Botol - -
213 Reagen Diluent For Sumiffin Botol - -
214 Reagen Diluent M-30 20 L Mindray Botol - -
215 Reagen Diluent Zenix Botol - -
216 Reagen EZ Cleanser 100 ml Mindray Botol - -
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
217 Reagen Lyse 500 ml Dirui Botol - -
218 Reagen Lyse 500 ml For Sumiffin Botol - -
219 Reagen Lyse 500 ml- Mindray M-30 Botol - -
220 Reagen Lyse 500 ml Zenix Botol - -
221 Reagen Rinse 20 Lt Mindray Botol - -
222 Reagen Salmonella Paratyphi 0 1x5 ml KIT - -
223 Reagen Salmonella Paratyphi A0 1x5 ml KIT - -
224 Reagen Salmonella Paratyphi AH 1x5 ml KIT - -
225 Reagen Salmonella Paratyphi B0 1x5 ml KIT - -
226 Reagen Salmonella Paratyphi BH 1x5 ml KIT - -
227 Reagen Salmonella Paratyphi C0 1x5 ml KIT - -
228 Reagen Salmonella Paratyphi CH 1x5 ml KIT - -
229 Reagen Salmonella Paratyphi H 1x5 ml KIT - -
230 Reagen SGOT (ASAT) 3x20 mL Biomaxima KIT - -
231 Reagen SGPT (ALAT) 3x20 mL Biomaxima KIT - -
232 Reagen Urea 3x50 mL Biomaxima KIT - -
233 ReagenTriglycerida 4x50 mL Biomaxima KIT - -
234 Rectal Tube size 22 FR Pcs - -
235 Rivanol 300 cc Botol 24 24 4 05/23 20
236 Sabun Antibakteri Botol - -
237 Safety box 5 lt kuning Pcs 25 25 6 19
238 Saniswiss Biosanitier L5000 ml Botol - -
239 Saniswiss Biosanitizer H1500 ml Botol - -
240 Saniswiss Biosanitizer L15000g Botol - -
241 Selang NGT No. 18 Pcs - -
242 Selang NGT No. 22 Pcs - -
243 Semillas Non Woven Medical Tape 20x500 cm Roll - -
244 SEMILLAS
cm
Non Woven Transparant Wound Dressing with Pad 9 x 15 Pcs
- -
245 SEMILLAS Non-Woven Wound Dressing 6x7 cm (With Pad) Roll - -
246 Semillas water proof medical tape 20x500 cm Roll - -
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
247 Servical Collar Serenity Pcs - -
248 Silk Black 2/0 HR 30 MM Pcs - -
249 Silk Black 3/0 HR 30 MM Pcs - -
250 Silk Black 5/0 DS 12 MM Pcs - -
251 Silk Black 6/0 DS 14 MM Pcs - -
252 Silk Black Braided Braun 3/0 + Jarum Pcs 129 5 134 - 05/20 134
253 Silk Braided USP 3/0 Pcs 24 24 15 4/23 9
254 Silk Plain 3/0 Pcs - -
255 Softaman Desinfectan Botol - -
256 Softaskin Gel Botol - -
257 Spalk First AID Pcs 18 18 - 18
258 Stomach Tube 85 cm No 14 Aximed Pcs 20 20 - 2/21 20
259 Strip test ABON Syphilis Ultra Rapid Pcs - -
260 Strip test cholesterol autocheck Box 25's 4 4 4 10/20 0
261 Strip test cholesterol benecheck Box 10's 9 9 7 06/21 2
262 Strip test Dengue NS1 Antigen Serenity Pcs - -
263 Strip test DI Anti HCV 1/2 Casette Pcs - -
264 Strip test DI Anti HIV 1/2 cassete Pcs - -
265 Strip test glucose autocheck Box 50's 5 5 - 8/21 5
266 Strip test glucose benecheck Box 50's 18 18 4 02/22 14
267 Strip test glucose On call Plus Pcs - -
268 Strip test Hb Hemoglobin Mission Pcs - -
269 Strip test HCG Fokus Pcs - -
270 Strip test Rapidan Dengue NS1 dan IgG/IgM Pcs - -
271 Strip test Rapidan HBsAg Test WB/S/P Pcs - -
272 Strip test Rapidan Malaria Pcs 75 75 - 8/21 75
273 Strip test SD Dengue Duo Bioline Pcs 25 25 - 7/21 25
274 Strip test SD HBSAg Test Strip Pcs 50 50 25 10/22 25
275 Strip test SD HIV 1/2 3.0 Pcs - -
276 Strip test SD HIV Bioline Pcs 75 75 25 06/21 50
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
277 Strip test uric acid autocheck Box 50's 10 10 - 11/20 10
278 Strip test uric acid benecheck Box 25's 9 9 6 08/21 3
279 Strip test uric acid Easy Touch Box 25's - -
280 Suction Catheter No. 10 (Aximed) Pcs - -
281 Suction Catheter No. 12 ( Aximed) Pcs - -
282 Surfaces Stretch Wipes (Biosanitizer) Pack - -
283 Surgical Blade No. 10 Aesculap Pcs - -
284 Surgical Blade No. 10 Serenity Pcs 37 37 19 07/22 18
285 Surgical Blade No. 23 Serenity Pcs 100 100 - 07/22 100
286 Surgical Film 20 x 30 cm Pcs - -
287 Surgical Gloves Gyanokolog No. 6,5 (Remedi) Pairs 149 149 - 06/24 149
288 Surgical Gloves Gyanokolog No. 7 (Remedi) Pairs - -
289 Surgical Gloves No. 6 TRO Sensosurge Pairs - -
290 Surgical Gloves No. 6,5 TRO Sensosurge Pairs - -
291 Surgical Gloves No. 7 GAMEX Pairs - -
292 Surgical Gloves No.6,0 Aximed Pcs - -
293 Surgical Gloves No.6,5 Aximed Pcs 134 134 24 7/23 110
294 Surgical Gloves No.7,0 Aximed Pcs 520 520 17 7/23 503
295 Surgical Gloves No.7,5 Aximed Pcs 504 4 508 - 7/23 508
296 Surgical Safeglove ST PF 6 Pcs - -
297 Surgical Safeglove ST PF 6,5 Pcs - -
298 Surgical Safeglove ST PF 7 Pcs - -
299 Tabung BD Vacutainer Tube EDTA plh 13 x 75 3.0 23 g x 1 In Pcs - -
300 Tabung BD Syringe Soloshot mm 0,5 ml Pcs - -
301 Tabung EDTA Tab 3 ml Pcs 1900 1,900 100 1800
302 Tabung Endo Vacuum Blood Collection tube, Plain 3 ml Pcs - -
303 Tabung Endo Vacuum Tube Sterile K3EDTA Pcs - -
304 Tabung K3EDTA 3 ml Glass Interna Pcs - -
305 Tabung Plain 3 ml Glas Interna tabung 2200 2,200 - 2200
306 Tabung Vacuum Container Plain 3 ml Glas Interna Pcs - -
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
307 TB AG Rapid Test KIT - -
308 Three Way with Extention Pcs - -
309 Tips For Micro MT 200 IU Pcs - -
310 Tips For Micro MT II 1 ml Pcs - -
311 Tips For Micropipet MSTP Pcs - -
312 Trigliseride Test Strip Pcs - -
313 Tube TB AG tube - -
314 Uji malaria fokus Pcs - -
315 Umbilicall Cord Clame Fesco Pcs - -
316 Umbilicall Cord Clem Pcs 180 180 - 180
317 Underpad (Soft pad 60x90) Pcs 880 880 40 08/22 840
318 Underpad Surgical Pcs - -
319 Urine bag + Hanger Pcs 109 109 6 103
320 Urine Collector Pead OM Pcs - -
321 Uritest Reagent Strip 11G Box 100's 7 7 - 7/21 7
322 USG Gel 250 Ml Pcs - -
323 Viorex Liquid Btl 500 ml - -
324 White Tips Bks 1000's - -
325 Wing Nedle 23 G Pcs - -
326 Wing Nedle 25 G Pcs - -
327 Write On ID Bracelet Child Green (Remedi) Box 100's 2 2 - 2
328 Write On ID Bracelet Child Ungu (Remedi) Box 100's 2 2 - 2
329 Write On ID Bracelet,Adult Blue (Remedi) Box 100's 2 2 - 2
330 Write On ID Bracelet,Adult Pink (Remedi) Box 100's 2 2 - 2
331 Yellow Tip Bks 1000's - -
332 Iodine Povidon 300 ml Botol 23 23 7 16
333 Latex Powder Free Examination Gloves Uk. M ASAP Pcs - -
334 Reagen Ziehl Neelsen Paket 2 2 - 2
335 Saniswiss Biosanitier H 500 ml Botol 8 8 2 6
336 Surfaces Biosanitier S 750 ml Botol 11 11 - 11
337 Surfaces Biosanitier S 5000 ml Kent 4 4 2 2
338 Hand Gel H1 100 ml + Flip top Botol - -
Bahan Gigi
1 Alveogyl 10 gr - Septodent Ampul - -
2 Arsen / pul X-Devitalizer Pot - -
3 Articulating paper Buah - -
4 Bonding/Master Bond Buah - -
OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
5 Calcimol LC Botol - -
6 Carpule Anastesi / Artinibsa Box - -
7 Cavit G (Ceivitron) Pot - -
8 Cavitton Pink (Ceivitron) 30 gr Buah - -
9 Celluloid Strip Box - -
10 Cemen Spatula Buah - -
11 Cement Phospat 35 gr Box - -
12 CHKM Botol - -
13 Citocarten/carpule Box - -
14 Composite Resin A2 Pcs - -
15 Composite Resin A3 Pcs - -
16 Dental Needles 30G 16mm Box - -
17 Dycal / Hydcal Botol - -
18 Eching gel 10 ml Tube - -
19 Eugenol 10 ML Ghimas Botol - -
20 Eugenol Cair Botol - -
21 Glass ionomer Fuji IX 1-1 PKG Universal 10 gr Box - -
22 Glass ionomer Fuji IX 1-1 PKG Universal 5 gr Box - -
23 Oco / Poliren No.1 Botol - -
24 Topical anasthetic gel Pcs - -
Jumlah Kunjungan Resep Rawat Jalan Rawat Inap Total
490 490
Mengetahui, Yang meminta/Melapor
Kepala Puskesmas Serimbu Pengelola Obat Puskesmas Serimbu
Kabupaten Landak
Hengki, S.Kep Siti Maryam, S.Farm., Apt.
NIP. 19831204 201101 1 004 NIP. 19910523 202012 2 013
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