LAPORAN PEMAKAIAN DAN LEM

( LPLPO
KODE PUSKESMAS : 282002
PUSTU
KECAMATAN
KAB/KODYA
PROPINSI

SATUA Stok Peneri Persdi PEMA SISA

NO NAMA OBAT Kode
N Awal maan aan KAIAN AKHIR
1 2 3 4 5 6 [7]=(5 [8]=S( [9]=(7 1 2 3 4
+6) 10) -8)
1 ACT tab Tablet ACT 0 0 0 0 0 0 0 0 0
2 Albendazol tab 400 mg Tablet ALB 9 0 9 0 9 0 0 0 0
3 Alopurinol 100 mg Tablet ALP1 0 0 0 0 0 0 0 0 0
4 Alopurinol 300 mg Tablet ALP2 0 0 0 0 0 0 0 0 0
5 Ambroxol tablet 30 mg Tablet AMB 0 0 0 0 0 0 0 0 0
6 Aminophilin inj 24 mg/ml-10 ml Ampul AMN1 0 0 0 0 0 0 0 0 0
7 Aminophilin tab 200 mg Tablet AMN2 38 0 38 18 20 0 0 0 0
8 Amitriptilin Hcl tab 25 mg Tablet AMT 0 0 0 0 0 0 0 0 0
9 Amlodipin tab 10 mg Tablet AMD1 0 0 0 0 0 0 0 0 0
10 Amlodipin tab 5 mg Tablet AMD2 0 0 0 0 0 0 0 0 0
11 Amoksisilin 500 mg Kaplet AMOK5 52 200 252 186 66 12 0 12 0
12 Amoksisilin kaps 250 mg Kapsul AMOK2 0 0 0 0 0 0 0 0 0
13 Amoksisilin SK 125mg/5ml Botol AMOKS 0 0 0 0 0 0 0 0 0
14 Ampisilin Serbuk Injeksi 1000 mg/ml Ampul AMP 0 0 0 0 0 0 0 0 0
15 Antalgin (metampiron) tab 500 mg Tablet ANT1 0 0 0 0 0 0 0 0 0
16 Antalgin inj 250 mg/ml-2 ml Ampul ANT2 0 0 0 0 0 0 0 0 0
17 Antasida DOEN Syrup Botol AND1 0 0 0 0 0 0 0 0 0
18 Antasida DOEN tab Komb Tablet AND2 196 0 196 78 118 6 0 6 12
19 Antibakteri DOEN salep Komb Tube ATB 0 0 0 0 0 0 0 0 0
20 Antifungi DOEN salep Komb Tube ATF 0 0 0 0 0 0 0 0 0
21 Antihemoroid DOEN Komb Supposit ATM 0 0 0 0 0 0 0 0 0
22 Antimigren DOEN tab Komb Tablet ATG 0 0 0 0 0 0 0 0 0
23 Antiparkinson DOEN tab Komb Tablet ATP 0 0 0 0 0 0 0 0 0
24 Aqua proinjeksi steril bebas pirogen Vial API 0 0 0 0 0 0 0 0 0
25 Asam Askorbat (Vit C) tab 50 mg Tablet VITC 737 0 737 39 698 6 0 3 6
26 Asam folat 1 mg Tablet AFOL 256 100 356 0 356 0 0 0 0
27 Asam mefenamat 500 mg Tablet ASMEF 59 200 259 72 187 6 0 0 6
28 Asetosal tab 100 mg Tablet AST 0 0 0 0 0 0 0 0 0
29 Asiklovir 400 mg Tablet ASK1 0 0 0 0 0 0 0 0 0
30 Asiklovir 5 % krim Tube ASK2 0 0 0 0 0 0 0 0 0
31 Atropin Sulfat inj 0,25mg/ml-1 ml Ampul ATR1 0 0 0 0 0 0 0 0 0
32 Atropin Sulfat tab 0,5 mg Tablet ATR2 0 0 0 0 0 0 0 0 0
33 Atropin tetes mata 0,5% Botol ATR3 0 0 0 0 0 0 0 0 0
34 Benzatin benzil penisilin inj 2.4 jt iu/ Vial BBP 0 0 0 0 0 0 0 0 0
35 Betahistin Mesilat tablet 6 mg Tablet BMT 0 0 0 0 0 0 0 0 0
36 Betametason krim 0,1% Tube BTM 0 0 0 0 0 0 0 0 0
37 Bromheksin tablet 8 mg Tablet BRO 0 0 0 0 0 0 0 0 0
38 Dapson tab 100 mg Tablet DAP 0 0 0 0 0 0 0 0 0
39 Deksametason inj 5 mg/ml-ml Ampul DEK1 0 0 0 0 0 0 0 0 0
40 Deksametason tab 0.5 mg Tablet DEK2 0 0 0 0 0 0 0 0 0
41 Dekstrometorphan sirup 10mg/5ml Botol DET1 0 0 0 0 0 0 0 0 0
42 Dekstrometorphan tab 15 mg Tablet DET2 0 0 0 0 0 0 0 0 0
43 Diazepam inj 5 mg/ml-2ml Ampul DIAZ1 0 0 0 0 0 0 0 0 0
44 Diazepam larutan rektal 4 mg/2 ml ( Tube DIAZ2 0 0 0 0 0 0 0 0 0
45 Diazepam tab 2 mg Tablet DIAZ3 0 0 0 0 0 0 0 0 0
46 Diazepam tab 5 mg Tablet DIAZ4 0 0 0 0 0 0 0 0 0
47 Dietilkarbamazin sitrat tab 100 mg Tablet DKB 0 0 0 0 0 0 0 0 0
48 Difenhidramin Hcl Inj 10 mg/ml-1ml Ampul DIF 128 0 128 23 105 3 0 2 1
49 Digoksin tab 0.25 mg Tablet DGK1 0 0 0 0 0 0 0 0 0
50 Digoksin tab 0.5 mg Tablet DGK2 0 0 0 0 0 0 0 0 0
51 Dimenhidrinat tablet 50 mg Tablet DMD 0 0 0 0 0 0 0 0 0
52 Ekstrak Beladon 10 mg Tablet EB 0 0 0 0 0 0 0 0 0
53 Ephedrin Hcl tab 25 mg Tablet EPH 0 0 0 0 0 0 0 0 0
54 Ephinefrin Hcl (Adrenalin) inj 0,1%/ Ampul EHP 0 0 0 0 0 0 0 0 0
55 Erithromisin 500 mg tab Tablet ERI1 0 0 0 0 0 0 0 0 0
56 Eritromisin 250 mg Tablet ERI2 0 0 0 0 0 0 0 0 0
57 Erithromisin sirup 200 mg/5 ml Botol ERI3 0 0 0 0 0 0 0 0 0
58 Etakridin (Rivanol) Lart 0,1% Botol ETA1 0 0 0 0 0 0 0 0 0
59 Etambutol Hcl Tb 250 mg Tablet ETM 0 0 0 0 0 0 0 0 0
60 Fenitoin Natrium inj 50 mg/ml @ 2m Ampul FN1 0 0 0 0 0 0 0 0 0
61 Fenitoin Natrium kaps 100 mg Kapsul FN2 0 0 0 0 0 0 0 0 0
62 Fenitoin Natrium Kaps 30 mg Tablet FN3 0 0 0 0 0 0 0 0 0
63 Fenobarbital inj 50 mg/ml Ampul FBR1 0 0 0 0 0 0 0 0 0
64 Fenobarbital tab 100 mg Tablet FBR2 0 0 0 0 0 0 0 0 0
65 Fenobarbital tab 30 mg Tablet FBR3 0 0 0 0 0 0 0 0 0
66 Fenoksimetil penisilin tab 250 mg Tablet FPT1 0 0 0 0 0 0 0 0 0
67 Fenoksimetil penisilin tab 500 mg Tablet FPT2 0 0 0 0 0 0 0 0 0
68 Fenol gliserol tetes Telinga 10 % Botol FGT 0 0 0 0 0 0 0 0 0
69 Fitomenadion (VitK) inj 10mg/ml-1m Ampul VITK1 28 0 28 0 28 0 0 0 0
70 Fitomenadion (VitK) tab 10 mg Tablet VITK2 74 0 74 0 74 0 0 0 0
71 Furosemid tab 40 mg Tablet FRO1 0 0 0 0 0 0 0 0 0
72 Furosemid Inj 10 mg/ml Ampul FRO2 0 0 0 0 0 0 0 0 0
 73 Gameksan Lotion 1 % Botol GAM 0 0 0 0 0 0 0 0 0
74 Garam Oralit untuk 200 ml air Sachet GLIT1 42 0 42 42 0 0 0 6 6
75 Gemfibrozil 300 mg Tablet GEM 0 0 0 0 0 0 0 0 0
76 Gentamsin Salep Kulit 0,1% Tube GEN1 5 0 5 2 3 0 0 0 1
77 Gentamycin 80 mg/2 ml injeksi Ampul GEN2 0 0 0 0 0 0 0 0 0
78 Gentian Violet lart 1% Botol GV 0 0 0 0 0 0 0 0 0
79 Glibenklamid 5 mg Tablet GLIB 0 0 0 0 0 0 0 0 0
80 Gliseril Guaiyakolat tab 100 mg Tablet GG 723 0 723 39 684 0 0 0 6
81 Gliserin Botol GLR 0 0 0 0 0 0 0 0 0
82 Glukosa Lart Inf 10 % steril Botol GLU1 0 0 0 0 0 0 0 0 0
83 Glukosa Lart Inf 40 % steril Vial GLU2 0 0 0 0 0 0 0 0 0
84 Glukosa Lart Inf 5 % steril Botol GLU3 0 0 0 0 0 0 0 0 0
85 Grisiofulvin tab 125 mg Tablet GRI 0 0 0 0 0 0 0 0 0
86 Haloperidol tab 0.5 mg Tablet HAL1 0 0 0 0 0 0 0 0 0
87 Haloperidol tab 1.5 mg Tablet HAL2 0 0 0 0 0 0 0 0 0
88 Hidroklortiazid (HCT) tab 25 mg Tablet HCT 0 0 0 0 0 0 0 0 0
89 Hidrokortison krim 2.5 % Tube HDR 0 0 0 0 0 0 0 0 0
90 Hiosin N- Butilbromida Tab 10 mg Tablet HNB1 0 0 0 0 0 0 0 0 0
91 Hiosin N- Butilbromida Inj 20 mg/ml Ampul HNB2 0 0 0 0 0 0 0 0 0
92 Ibuprofen 200 mg Tablet IBU1 3 0 3 0 3 0 0 0 0
93 Ibuprofen 400 mg Tablet IBU2 88 100 188 102 86 18 0 12 18
94 Ichtyol salp Pot ICH 0 0 0 0 0 0 0 0 0
95 Iodiol softcaps Kapsul IOD 0 0 0 0 0 0 0 0 0
96 Isoniazid tab 300 mg Tablet ISN 0 0 0 0 0 0 0 0 0
97 Isosorbid dinitrat tab 5 mg Tablet ISO 0 0 0 0 0 0 0 0 0
98 Kalium Permanganat Pot KP 0 0 0 0 0 0 0 0 0
99 Kalium Diklofenak tab 50 mg Tablet KD 0 0 0 0 0 0 0 0 0
100 Kalsium Laktas (Kalk) tab 500 mg Tablet KALK 1011 0 1011 180 831 0 0 0 6
101 Kalsium Gluconas Injeksi Vial KGI 0 0 0 0 0 0 0 0 0
102 Kaptopril 12,5 mg Tablet KAP1 157 0 157 34 123 0 0 0 10
103 Kaptopril 25 mg Tablet KAP2 0 0 0 0 0 0 0 0 0
104 Karbamazepin tab 200 mg Tablet KAR 0 0 0 0 0 0 0 0 0
105 Ketamin inj 10 mg/ml Ampul KET 0 0 0 0 0 0 0 0 0
106 Klofazimil kaps 100 mg Kapsul KLOF 0 0 0 0 0 0 0 0 0
107 Klindamycin 150 mg Tablet KLIN 0 0 0 0 0 0 0 0 0
108 Kloramphenikol 250 mg Tablet KLOR1 0 0 0 0 0 0 0 0 0
109 Kloramphenikol salep mata 1 % Tube KLOSM 0 0 0 0 0 0 0 0 0
110 Kloramphenikol tetes telinga 3 % Botol KLOTT 6 0 6 2 4 0 0 1 0
111 Kloramfenikol Suspensi 125 mg/5 m Botol KLOS 0 0 0 0 0 0 0 0 0
112 Kloramfenikol Tetes mata 0,5% Botol KLOTM 0 0 0 0 0 0 0 0 0
113 Klorfeniramin maleat (CTM) tab 4 m Tablet CTM 116 400 516 129 387 0 0 6 18
114 Klorpromazin Hcl inj 25 mg/I ml Ampul CPZ1 0 0 0 0 0 0 0 0 0
115 Klorpromazin Hcl tab 100 mg Tablet CPZ2 0 0 0 0 0 0 0 0 0
116 Kodein 10 mg tab Tablet KOD 0 0 0 0 0 0 0 0 0
117 Kotrimoksazole Dewasa tab 480 mg Tablet KOT1 197 0 197 24 173 0 0 6 0
118 Kotrimoksazole ped tab 120 mg Tablet KOT2 0 0 0 0 0 0 0 0 0
119 Kotrimoksazole Susp Botol KOTS 1 0 1 0 1 0 0 0 0
120 Kuinin Sulfat tab 222 mg Tablet KST 0 0 0 0 0 0 0 0 0
121 Levofloksasin tab 500 mg Tablet LEV 0 0 0 0 0 0 0 0 0
122 Lidokain 2% injeksi Ampul LIDO1 0 0 0 0 0 0 0 0 0
123 Lidokain Komp Inj Ampul LIDO2 28 0 28 0 28 0 0 0 0
124 Loperamid HCl tablet 2 mg Tablet LOP 0 0 0 0 0 0 0 0 0
125 Magnesium sulf inj 20%-25 ml Ampul MGS1 0 0 0 0 0 0 0 0 0
126 Magnesium sulf inj 40%-25 ml Ampul MGS2 0 0 0 0 0 0 0 0 0
127 Mebendazole sirup 100 mg/5 ml Botol MEB1 0 0 0 0 0 0 0 0 0
128 Mebendazole tab 100 mg Tablet MEB2 0 0 0 0 0 0 0 0 0
129 Metformin HCl Tab 500 mg Tablet MET 0 0 0 0 0 0 0 0 0
130 Metil Dopa tab 250 mg Tablet MDT 0 0 0 0 0 0 0 0 0
131 Metil Ergometrin Inj 0,200 mg-1 ml Ampul ME1 10 0 10 0 10 0 0 0 0
132 Metil Ergometrin tab 0.125 mg Tablet ME2 90 0 90 0 90 0 0 0 0
133 Metil Prednisolon tab 4 mg Tablet MEP 0 0 0 0 0 0 0 0 0
134 Metoklopramid injeksi 5 mg/ml @2 ml
Ampul MTK1 0 0 0 0 0 0 0 0 0
135 Metoklopramid tab 10 mg ( Tomit tabTablet MTK2 0 0 0 0 0 0 0 0 0
136 Metronidazol Infus 500 mg/100 ml Botol 10 MTR1 0 0 0 0 0 0 0 0 0
137 Metronidazol 250 mg Tablet MTR2 0 0 0 0 0 0 0 0 0
138 Metronidazol 500 mg Tablet MTR3 0 0 0 0 0 0 0 0 0
139 Mikonazole Krim / salep 2% Tube MOK 0 0 0 0 0 0 0 0 0
140 Mineral Mix sachet 8gr Sachet MMS 0 0 0 0 0 0 0 0 0
141 Mg Sulfat Serbuk 30 gram Sachet MGSS 0 0 0 0 0 0 0 0 0
142 Na. Bikarbonat tab 500 mg Tablet NAB 0 0 0 0 0 0 0 0 0
143 Na. Diklofenac 25 mg Tablet NAD1 0 0 0 0 0 0 0 0 0
144 Na. Diklofenac 50 mg Tablet NAD2 0 0 0 0 0 0 0 0 0
145 Na. Fluoresin tetes mata 2 % Botol NAF 0 0 0 0 0 0 0 0 0
146 Na. Tiosulfat inj 25 %-10 ml Ampul NAT 0 0 0 0 0 0 0 0 0
147 Natrium Klorida lart inf 0.9% Botol NAK 0 0 0 0 0 0 0 0 0
148 Nifedipin tab 10 mg Tablet NIF 71 0 71 12 59 0 0 0 0
149 Nistatin 100.000 iu tab vag Tablet NIS1 0 0 0 0 0 0 0 0 0
150 Nistatin 500.000 iu tab Tablet NIS2 0 0 0 0 0 0 0 0 0
151 OAT-FDC Kategori 1 Paket OAT1 0 0 0 0 0 0 0 0 0
152 OAT-FDC Kategori 2 Paket OAT2 0 0 0 0 0 0 0 0 0
153 Obat Batuk hitam (OBH) sirup 100 Botol OBH 3 5 8 4 4 1 0 1 0
154 Obat Kategori Anak (kombipak anak Paket OATA 0 0 0 0 0 0 0 0 0
155 Obat Kategori Sisipan Paket OKS 0 0 0 0 0 0 0 0 0
156 Oksitetrasiklin Hcl Inj 50 mg/10 ml Ampul OKTIN 0 0 0 0 0 0 0 0 0
157 Oksitetrasiklin SK 3% Tube OKTSK 0 0 0 0 0 0 0 0 0
158 Oksitetrasiklin SM 1 % Tube OKTSM 2 5 7 2 5 1 0 0 1
159 Oksitosin inj 10 iu/1ml Ampul OTS 21 0 21 0 21 0 0 0 0
160 Oseltamivir 75 mg Tablet OSE 0 0 0 0 0 0 0 0 0
161 Papaverin Injeksi 40 mg/ml Ampul PAP1 0 0 0 0 0 0 0 0 0
162 Papaverin tab 40 mg Tablet PAP2 0 0 0 0 0 0 0 0 0
163 Paraformaldehid tab 1 gr Tablet PAR 0 0 0 0 0 0 0 0 0
164 Parasetamol Drops Botol PARAD 0 0 0 0 0 0 0 0 0
165 Parasetamol sirup 120 mg/5 ml Botol PARAS 17 0 17 3 14 1 0 1 0
166 Parasetamol tab 100 mg Tablet PARA1 0 0 0 0 0 0 0 0 0
167 Parasetamol tab 500 mg Tablet PARA5 522 0 522 257 265 0 0 33 12
168 Petidin inj 50 mg/2 ml Ampul PET 0 0 0 0 0 0 0 0 0
169 Pilokarpin tetes mata 2 % Botol PIL 0 0 0 0 0 0 0 0 0
170 Pirantel pamoat tab 125 mg Tablet PIR 0 0 0 0 0 0 0 0 0
171 Pirazinamid tab 500 mg Tablet PIZ 0 0 0 0 0 0 0 0 0
172 Piridoksin tab 10 mg Tablet B6 1006 0 1006 96 910 6 0 12 12
173 Piroksicam 10 mg Tablet PIK1 0 0 0 0 0 0 0 0 0
174 Piroksicam 20 mg Tablet PIK2 0 0 0 0 0 0 0 0 0
175 Prazikuantel 600 mg tab Tablet PRAZ 0 0 0 0 0 0 0 0 0
176 Prednison 5 mg tab Tablet PRED 821 0 821 48 773 0 0 0 6
177 Primakuin 15 mg tab Tablet PRIM 0 0 0 0 0 0 0 0 0
178 Prokain Benzil Penisilin 3 Jt inj Vial PROK 0 0 0 0 0 0 0 0 0
179 Propanolol 40 mg tab Tablet PROP 0 0 0 0 0 0 0 0 0
180 Propiltiourasil 100 mg tab Tablet PTU 0 0 0 0 0 0 0 0 0
181 Ranitidin Inj 25 mg/ 2 ml Ampul RAN1 0 0 0 0 0 0 0 0 0
182 Ranitidin tab 150 mg Tablet RAN2 0 0 0 0 0 0 0 0 0
183 Reserpin 0,10 mg tab Tablet RES1 0 0 0 0 0 0 0 0 0
184 Reserpin 0,25 mg tab Tablet RES2 0 0 0 0 0 0 0 0 0
185 Retinol ( Vit A ) 200.000 iu Kap Kapsul VITA1 0 0 0 0 0 0 0 0 0
186 Retinol ( Vit.A) 100.000 UI Kapsul VITA2 0 0 0 0 0 0 0 0 0
187 Rifampisin 300 mg kaps Tablet RIF1 0 0 0 0 0 0 0 0 0
188 Rifampisin 450 mg tab Tablet RIF2 0 0 0 0 0 0 0 0 0
189 Rifampisin 600 mg kaplet Tablet RIF3 0 0 0 0 0 0 0 0 0
190 Ringer Laktate lart infus Botol RL 10 0 10 0 10 0 0 0 0
191 S. Anti Bisa Ular poli inj 5 ml(ABU I) Vial ABU1 0 0 0 0 0 0 0 0 0
192 S. Anti Difteri inj 20.000 iu ( ADS ) Vial ADS 0 0 0 0 0 0 0 0 0
193 S. Anti Tetanus inj 1.500 iu/Amp ( A Ampul ATS1 0 0 0 0 0 0 0 0 0
194 S. Anti Tetanus inj 20.000 iu/Amp ( Vial ATS2 0 0 0 0 0 0 0 0 0
195 Salbutamol 2 mg tab Tablet SAL1 0 0 0 0 0 0 0 0 0
196 Salbutamol 4 mg tab Tablet SAL2 0 0 0 0 0 0 0 0 0
197 Salep 2-4 komb Pot S2-4 0 0 0 0 0 0 0 0 0
198 Salisil Bedak 2 % Kotak SB2 4 0 4 3 1 0 0 0 0
199 Salisil Spiritus 10 % Botol SS 0 0 0 0 0 0 0 0 0
200 Sefadroxil 500 mg kapsul Tablet SEF 0 0 0 0 0 0 0 0 0
201 Sefotaxim Injeksi 1 gram Ampul SET 0 0 0 0 0 0 0 0 0
202 Seftriaxon Inj 1 gram Ampul STR 0 0 0 0 0 0 0 0 0
203 Sianokobalamin (Vit B12) inj Ampul B12 14 20 34 10 24 1 0 2 0
204 Simetidin tab 200 mg Tablet SIM 0 0 0 0 0 0 0 0 0
205 Simvastatin 10 mg tab Tablet SIV 0 0 0 0 0 0 0 0 0
206 Siprofloksasin 500 mg tab Tablet SPRO 0 0 0 0 0 0 0 0 0
207 Streptomisin inj 1500 mg /vial Vial STREP 0 0 0 0 0 0 0 0 0
208 Sulfasetamid tts mata 15% Botol SULF 0 0 0 0 0 0 0 0 0
209 Tablet tambah darah komb Tablet FE 3030 0 3030 150 2880 0 0 30 30
210 Tetrakain tetes mata 0,5% Botol TTM 0 0 0 0 0 0 0 0 0
211 Tetrasiklin 250 mg Tablet TETR1 0 0 0 0 0 0 0 0 0
212 Tetrasiklin 500 mg Tablet TETR2 0 0 0 0 0 0 0 0 0
213 Thiamin ( Vit B1 ) 50 mg tab Tablet VB1 958 0 958 126 832 6 0 6 12
214 Thiamin ( Vit B1 ) inj 100 mg/Amp Ampul B1I 28 30 58 10 48 0 0 1 2
215 Thiamphenkol 500 mg cap Kapsul THIA1 0 0 0 0 0 0 0 0 0
216 Tiamfenikol Suspensi ( Conucol Dry Botol THAI2 0 0 0 0 0 0 0 0 0
217 Tiopental Na. Serbuk 1000 mg/Amp Ampul TNS 0 0 0 0 0 0 0 0 0
218 Tramadol 50 mg Tablet TD 0 0 0 0 0 0 0 0 0
219 Triheksipenidil Hcl 2 mg tab Tablet TPD 0 0 0 0 0 0 0 0 0
220 Vitamin B Kompleks tab Tablet VBC 866 0 866 236 630 9 0 24 6
221 Yodium povidon 10 % 30 ml Botol YOD1 3 0 3 2 1 0 0 0 1
222 Yodium Povidon 10 % 300 ml Botol YOD2 0 0 0 0 0 0 0 0 0
223 Yodium Povidon 10% 1 Liter Botol YOD3 0 0 0 0 0 0 0 0 0
224 Zink 20 mg Tablet dispersible Tablet ZNK1 0 0 0 0 0 0 0 0 0
225 Zink Syrup Botol ZNK2 0 0 0 0 0 0 0 0 0
LUAR - - - 0 0 0 0 0 0 0 0 0
1 Adona injeksi Ampul ADI 0 0 0 0 0 0 0 0 0
2 Alinamin F injeksi Ampul ALIN 0 0 0 0 0 0 0 0 0
3 Antrain inj Ampul ATR 0 0 0 0 0 0 0 0 0
4 Asering Larutan Infus Botol ASER 0 0 0 0 0 0 0 0 0
5 Attapulgite tablet komb (Diaform/Ne Tablet ATK 0 0 0 0 0 0 0 0 0
6 Bismecon Gel Tube BIS 0 0 0 0 0 0 0 0 0
7 Bufacom (Triamsinolon in oral base Tube BUF 0 0 0 0 0 0 0 0 0
8 Dulcolax supp 5 mg Supposit DUL1 0 0 0 0 0 0 0 0 0
9 Dulcolax tab Tablet DUL2 0 0 0 0 0 0 0 0 0
10 Demacolin tab Tablet DEM 0 0 0 0 0 0 0 0 0
 11 Fludane Syrup Botol FLUD1 0 0 0 0 0 0 0 0 0
12 Fludane Tablet Tablet FLUD2 0 0 0 0 0 0 0 0 0
13 Gitas Plus Inj Ampul GTP1 0 0 0 0 0 0 0 0 0
14 Gitas Plus tablet / Spasmal tablet Tablet GTP2 28 0 28 0 28 0 0 0 0
15 Ka-En 3 A Botol KN3A 0 0 0 0 0 0 0 0 0
16 Ka-En 3 B Botol KN3B 0 0 0 0 0 0 0 0 0
17 Kombivent Inhalasi Ampul KOMB 0 0 0 0 0 0 0 0 0
18 Lakto B Sachet LKB 0 0 0 0 0 0 0 0 0
19 Lynoral tab Tablet LYN 0 0 0 0 0 0 0 0 0
20 Lysmin ( Lysin ) Sirup Botol LYS 0 0 0 0 0 0 0 0 0
21 Multivitamin (Ultravita tab / Kurkume Tablet MULTF 0 0 0 0 0 0 0 0 0
22 Metioson tab Tablet METH 0 0 0 0 0 0 0 0 0
23 Neurobion tablet Tablet NUER1 0 0 0 0 0 0 0 0 0
24 Neurovit E tablet Tablet NEUR2 0 0 0 0 0 0 0 0 0
25 Opixitrol eye drop Botol OED 0 0 0 0 0 0 0 0 0
26 Pamol 125 mg Supp Supposit MOLSUP 0 0 0 0 0 0 0 0 0
27 Scabicid krim Tube SCAB 0 0 0 0 0 0 0 0 0
28 Tensigard Tablet TENSI 0 0 0 0 0 0 0 0 0
OBAT - - - 0 0 0 0 0 0 0 0 0
1 Air Raksa use Dental Botol ARD 0 0 0 0 0 0 0 0 0
2 Bonding Botol BON 0 0 0 0 0 0 0 0 0
3 Cresophen Botol CRES 0 0 0 0 0 0 0 0 0
4 Dentorit pasta ( Cavit G ) Set DEN 0 0 0 0 0 0 0 0 0
5 Devitalisasi pasta (non arsen) Botol DEV1 0 0 0 0 0 0 0 0 0
6 Devitalisasi pasta (arsen) Botol DEV2 0 0 0 0 0 0 0 0 0
7 Etching Botol ETC 0 0 0 0 0 0 0 0 0
8 Etil Klorida semprot Botol EKS 0 0 0 0 0 0 0 0 0
9 Eugenol cairan Botol EGC 0 0 0 0 0 0 0 0 0
10 Glass Ionomer cement ART / Fuji I Set GLC 0 0 0 0 0 0 0 0 0
11 Kalsium Hidroksida pasta Set KHP 0 0 0 0 0 0 0 0 0
12 Komposit A2 Anterior Set KA2A 0 0 0 0 0 0 0 0 0
13 Komposit A2 Posterior Set KA2P 0 0 0 0 0 0 0 0 0
14 Monokamper mentol cair (CHKM) Botol CHKM 0 0 0 0 0 0 0 0 0
15 Mummifying pasta Set MUMP 0 0 0 0 0 0 0 0 0
16 Polikresulen (Albothyl) Botol POLI 0 0 0 0 0 0 0 0 0
17 Semen seng fosfat serbuk & cair Set SSF 0 0 0 0 0 0 0 0 0
18 Silver Amalgam Serbuk 65-75 % Set SAS 0 0 0 0 0 0 0 0 0
19 Solare Tube SOLR 0 0 0 0 0 0 0 0 0
20 Spon Gelatin 1x1x1 cm cube SG11 0 0 0 0 0 0 0 0 0
21 Temporary stoping fletcher serbuk&cSet TSF 0 0 0 0 0 0 0 0 0
22 Trikresolformalin (TKF) cair Botol TKF 0 0 0 0 0 0 0 0 0
PERB - - - 0 0 0 0 0 0 0 0 0
1 Alat Suntik Sekali Pakai 0,05 ml Set ASS1 0 0 0 0 0 0 0 0 0
2 Alat Suntik Sekali Pakai 0,5 ml Set ASS2 0 0 0 0 0 0 0 0 0
3 Alat Suntik Sekali Pakai 1 ml Set ASS3 123 0 123 0 123 0 0 0 0
4 Alat Suntik Sekali Pakai 3 ml / 2,5 m Set ASS4 45 100 145 43 102 4 0 5 3
5 Alat Suntik Sekali Pakai 5 ml Set ASS5 43 0 43 0 43 0 0 0 0
6 Alat Suntik Sekali Pakai 10 ml Set ASS10 0 0 0 0 0 0 0 0 0
7 Aqua Gel Botol AQG 0 0 0 0 0 0 0 0 0
8 Blood set Set BLD 0 0 0 0 0 0 0 0 0
9 Catgut/Benang bedah no 3/0 (p&c) Set GUT1 8 0 8 0 8 0 0 0 0
10 Catgut Cromic no. 3/0 100 m Roll GUT2 0 0 0 0 0 0 0 0 0
11 Etanol 70 % 1 L Botol ETN 1 0 1 0 1 0 0 0 0
12 Hidrogen Peroksida ( H2O2 ) 3% Botol 10 H2O2 0 0 0 0 0 0 0 0 0
13 Infusion Set Anak Set ISA 0 0 0 0 0 0 0 0 0
14 Infusion Set Dewasa Set ISD 6 0 6 0 6 0 0 0 0
15 Jarum Jahit (Bedah) No 9 s/d 14 Biji JJB 0 0 0 0 0 0 0 0 0
16 Kapas Berlemak 500 gr Bungkus KB5 0 0 0 0 0 0 0 0 0
17 Kapas Pembalut/Absorben 250 gr Bungkus KPA 1 0 1 0 1 0 0 0 0
18 Kasa Pembalut 2 X 80 cm Roll KP1 8 0 8 1 7 0 0 0 0
19 Kasa Kompres 40/40 steril Roll KP2 0 0 0 0 0 0 0 0 0
20 Kasa Pembalut 4 X 15 cm Roll KP3 10 0 10 1 9 0 0 0 1
21 Kasa Pembalut 4 X 3 cm Roll KP4 0 0 0 0 0 0 0 0 0
22 Lisol (Kresol tersaponifikasi 50%) 1 l Botol LKT 0 0 0 0 0 0 0 0 0
23 Masker Set MAS 0 0 0 0 0 0 0 0 0
24 Mess Biji MES 0 0 0 0 0 0 0 0 0
25 Pembalut gibs 3 inchi Biji GIB 0 0 0 0 0 0 0 0 0
26 Plester 5 yard X 2 inch Roll PLES 2 0 2 0 2 0 0 0 0
27 Pot Sputum diameter 7 cm Biji POT 0 0 0 0 0 0 0 0 0
28 Sarung Tangan Steril ( Handscoun) Set STS 17 0 17 0 17 0 0 0 0
29 Sarung Tangan Non Steril Set STN 0 0 0 0 0 0 0 0 0
30 Silk ( Benang Bedah Sutera) N0 3/0 Set SILK1 0 0 0 0 0 0 0 0 0
31 Silk no. 3/0 100 m Roll SILK2 0 0 0 0 0 0 0 0 0
32 IV. Catheter no. 18 Set IV1 0 0 0 0 0 0 0 0 0
33 IV. Catheter no. 20 Set IV2 0 0 0 0 0 0 0 0 0
34 IV. Catheter no. 22 Set IV3 0 0 0 0 0 0 0 0 0
35 IV. Catheter no. 24 Set IV4 0 0 0 0 0 0 0 0 0
36 Wing nedle Set WN 0 0 0 0 0 0 0 0 0
- - - - 0 0 0 0 0 0 0 0 0
REAG - - - 0 0 0 0 0 0 0 0 0
1 Amoniak ( 100 ml ) Botol AM1 0 0 0 0 0 0 0 0 0
2 Anisol ( 100 ml ) Botol AN1 0 0 0 0 0 0 0 0 0
 3 Aquadest steril 1 liter Botol AQ1 0 0 0 0 0 0 0 0 0
4 Asam asetat 6 % ( 100 ml ) Botol AA6 0 0 0 0 0 0 0 0 0
5 Asam Klorida 0,1 N ( HCl 0,1 N ) ( 1 Botol AK1 0 0 0 0 0 0 0 0 0
6 Asam Sulfosalisilat 20 % ( 100 ml ) Botol AS2 0 0 0 0 0 0 0 0 0
7 Barium Klorida ( 100 ml ) Botol BK1 0 0 0 0 0 0 0 0 0
8 Benedict ( 100 ml ) Botol BD1 0 0 0 0 0 0 0 0 0
9 Carbol Gentian Violet ( 100 ml ) Botol CGV1 0 0 0 0 0 0 0 0 0
10 EDTA ( 100 ml ) Botol EDTA 0 0 0 0 0 0 0 0 0
11 Eosin 2 % ( 100 ml ) Botol ESN1 0 0 0 0 0 0 0 0 0
12 Etanol Asam 100ml Botol EA1 0 0 0 0 0 0 0 0 0
13 Eter Alkohol Botol EAL 0 0 0 0 0 0 0 0 0
14 Fauchet ( 100 ml ) Botol FAU1 0 0 0 0 0 0 0 0 0
15 Felling A Botol FELA 0 0 0 0 0 0 0 0 0
16 Felling B Botol FELB 0 0 0 0 0 0 0 0 0
17 Giemsa stain Botol GMS 0 0 0 0 0 0 0 0 0
18 Golongan Darah A,B,O Set GD 0 0 0 0 0 0 0 0 0
19 Hayem ( 100 ml ) Botol HAY1 0 0 0 0 0 0 0 0 0
20 Iodium akohol ( 100 ml ) Botol IA1 0 0 0 0 0 0 0 0 0
21 Karbon Fuksin Botol KF1 0 0 0 0 0 0 0 0 0
22 Kinyoun ( 100 ml ) Botol KIN1 0 0 0 0 0 0 0 0 0
23 Lugol 1 % ( 100 ml ) Botol LUG1 0 0 0 0 0 0 0 0 0
24 Metanol Botol MET1 0 0 0 0 0 0 0 0 0
25 Metilen Biru ( 100 ml ) Botol MB1 0 0 0 0 0 0 0 0 0
26 NACL 0,9% ( 100 ml ) Botol NA1 0 0 0 0 0 0 0 0 0
27 Oil Imerson ( 100 ml ) Botol OI1 0 0 0 0 0 0 0 0 0
28 Reesecher ( 100 ml ) Botol RE1 0 0 0 0 0 0 0 0 0
29 Schlesinger ( 100 ml ) Botol SC1 0 0 0 0 0 0 0 0 0
30 Spiritus Bakar ( 1 liter ) Botol SB1 0 0 0 0 0 0 0 0 0
31 Turk ( 100 ml ) Botol TUR1 0 0 0 0 0 0 0 0 0
32 Widal Set WID1 0 0 0 0 0 0 0 0 0
33 Xylol ( 100 ml ) Botol XIL1 0 0 0 0 0 0 0 0 0
34 Zeil nelson set ( ZN set ) Set XZNS1 0 0 0 0 0 0 0 0 0
REAGE - - - 0 0 0 0 0 0 0 0 0
1 Malaria Test Stik MTT 0 0 0 0 0 0 0 0 0
2 Dengue Test Stik DT 0 0 0 0 0 0 0 0 0
3 HbsAg Test Stik HBS 0 0 0 0 0 0 0 0 0
4 HIV 1/2/0 divice test whole blood te Stik HIV 0 0 0 0 0 0 0 0 0
5 HCV Test Stik HCV 0 0 0 0 0 0 0 0 0
6 Reagen Albumin Botol RA 0 0 0 0 0 0 0 0 0
7 Reagen Alkalin Fosfatase Botol RAF 0 0 0 0 0 0 0 0 0
8 Reagen Asam Urat Botol RAU 0 0 0 0 0 0 0 0 0
 9 Reagen Billirubin Total Botol RBT 0 0 0 0 0 0 0 0 0
10 Reagen Billirubin Direct Botol RBD 0 0 0 0 0 0 0 0 0
11 Reagen Glukosa Botol RG 0 0 0 0 0 0 0 0 0
12 Reagen Hb Cyanmeth Botol RHC 0 0 0 0 0 0 0 0 0
13 Reagen Kolesterol Botol RK 0 0 0 0 0 0 0 0 0
14 Reagen Kreatinin Botol RKN 0 0 0 0 0 0 0 0 0
15 Reagen SGOT Botol SGOT 0 0 0 0 0 0 0 0 0
16 Reagen SGPT Botol SGT 0 0 0 0 0 0 0 0 0
17 Reagen Total Protein Botol RTP 0 0 0 0 0 0 0 0 0
18 Reagen Trigliserida Botol RTG 0 0 0 0 0 0 0 0 0
19 Reagen Ureum Botol RU 0 0 0 0 0 0 0 0 0
20 Reagen VDRL carbon antigen Botol VDRL 0 0 0 0 0 0 0 0 0
21 Reagen TPHA Stik TPHA 0 0 0 0 0 0 0 0 0
22 Urine Strip 10 parameter Stik US1 0 0 0 0 0 0 0 0 0
Obat Tambahan 0 0 0 0 0 0 0 0 0
1 0 0 0 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0

UMUM
JUMLAH KUNJUNGAN ASKES JUMLAH
BAYAR TIDAK BAYAR
KERJA

MENGETAHUI/MENYETUJUI YANG MEMINTA/MELAPOR

KEPALA DINKES DT. II YANG MENYERAHKAN KEPALA PUSKESMAS
(…………………………………..) (……………………………) (…………………………)
AN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
( LPLPO )

PEMEKAIAN PERTANGGAL
10
5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28

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0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

TA/MELAPOR YANG MENERIMA

PETUGAS PUSKESMAS
……………) ...................................
-
 TGL KUNJUN TEMPAT PELAYANAN KODE OBAT JUMLAH 2
11/29/2014 POL. TIGASAN WETA VB1 6 29
41972 POL. TIGASAN WETA PARA5 6 29
41972 POL. TIGASAN WETA AMOK5 6 29
41972 POL. TIGASAN WETA PRED 6 29
41972 POL. TIGASAN WETA AND2 6 29
41972 POL. TIGASAN WETA B6 6 29
41972 POL. TIGASAN WETA KALK 6 29
PERMI 41972 POL. TIGASAN WETA DIF 1 29
NTAAN 41972 POL. TIGASAN WETA ASS4 1 29
29 30 31 41972 POL. TIGASAN WETA NIF 6 29
0 0 0 41972 POL. TIGASAN WETA VBC 6 29
0 0 0 41972 POL. TIGASAN WETA PARA5 6 29
0 0 0 41972 POL. TIGASAN WETA VBC 6 29
0 0 0 41972 POL. TIGASAN WETA AMOK5 6 29
0 0 0 41972 POL. TIGASAN WETA GLIT1 6 29
0 0 0 41971 POL. TIGASAN WETA B12 1 28
0 0 0 41971 POL. TIGASAN WETA PARA5 6 28
0 0 0 41971 POL. TIGASAN WETA AMOK5 6 28
0 0 0 41971 POL. TIGASAN WETA VBC 6 28
0 0 0 41971 POL. TIGASAN WETA PARA5 6 28
12 0 0 41971 POL. TIGASAN WETA CTM 6 28
0 0 0 41971 POL. TIGASAN WETA PARA5 6 28
0 0 0 41971 POL. TIGASAN WETA ASS4 1 28
0 0 0 41971 POL. TIGASAN WETA AMOK5 6 28
0 0 0 41970 POL. TIGASAN WETA VBC 6 27
0 0 0 41970 POL. TIGASAN WETA PARA5 6 27
0 0 0 41970 POL. TIGASAN WETA KALK 6 27
6 0 0 41970 POL. TIGASAN WETA VB1 6 27
0 0 0 41970 POL. TIGASAN WETA KALK 6 27
0 0 0 41970 POL. TIGASAN WETA DIF 1 27
0 0 0 41970 POL. TIGASAN WETA ASS4 1 27
0 0 0 41970 POL. TIGASAN WETA ASMEF 6 27
0 0 0 41970 POL. TIGASAN WETA AMOK5 6 27
0 0 0 41970 POL. TIGASAN WETA B1I 1 27
0 0 0 41970 POL. TIGASAN WETA ASS4 1 27
0 0 0 41970 POL. TIGASAN WETA B1I 1 27
0 0 0 41970 POL. TIGASAN WETA KALK 6 27
0 0 0 41970 POL. TIGASAN WETA KALK 6 27
0 0 0 41970 POL. TIGASAN WETA GLIT1 6 27
0 0 0 41970 POL. TIGASAN WETA B6 6 27
0 0 0 41970 POL. TIGASAN WETA KOT1 6 27
0 0 0 41970 POL. TIGASAN WETA ASS4 1 27
0 0 0 41970 POL. TIGASAN WETA KALK 6 27
0 0 0 41970 POL. TIGASAN WETA CTM 6 27
0 0 0 41969 POL. TIGASAN WETA ASS4 1 26
0 0 0 41969 POL. TIGASAN WETA ASS4 1 26
0 0 0 41969 POL. TIGASAN WETA FE 30 26
0 0 0 41969 POL. TIGASAN WETA PARA5 6 26
0 0 0 41969 POL. TIGASAN WETA DIF 1 26
0 0 0 41969 POL. TIGASAN WETA VB1 6 26
0 0 0 41969 POL. TIGASAN WETA KALK 6 26
0 0 0 41969 POL. TIGASAN WETA VBC 6 26
0 0 0 41969 POL. TIGASAN WETA VBC 6 26
0 0 0 41969 POL. TIGASAN WETA FE 30 26
0 0 0 41969 POL. TIGASAN WETA B12 1 26
0 0 0 41969 POL. TIGASAN WETA VBC 6 26
0 0 0 41968 POL. TIGASAN WETA AMOK5 6 25
1 0 0 41968 POL. TIGASAN WETA CTM 6 25
0 0 0 41968 POL. TIGASAN WETA VB1 6 25
0 0 0 41968 POL. TIGASAN WETA KALK 6 25
0 0 0 41968 POL. TIGASAN WETA DIF 1 25
0 0 0 41968 POL. TIGASAN WETA KALK 6 25
0 0 0 41968 POL. TIGASAN WETA AND2 6 25
0 0 0 41968 POL. TIGASAN WETA ASS4 1 25
0 0 0 41968 POL. TIGASAN WETA GG 6 25
0 0 0 41968 POL. TIGASAN WETA PARA5 6 25
0 0 0 41968 POL. TIGASAN WETA B6 6 25
0 0 0 41968 POL. TIGASAN WETA AND2 6 25
0 0 0 41968 POL. TIGASAN WETA B6 6 25
0 0 0 41968 POL. TIGASAN WETA VBC 6 25
0 0 0 41968 POL. TIGASAN WETA SB2 1 25
0 0 0 41968 POL. TIGASAN WETA CTM 6 25
0 0 0 41967 POL. TIGASAN WETA CTM 6 24
0 0 0 41967 POL. TIGASAN WETA KAP1 6 24
0 0 0 41967 POL. TIGASAN WETA IBU2 6 24
0 0 0 41967 POL. TIGASAN WETA VB1 6 24
0 0 0 41967 POL. TIGASAN WETA DIF 1 24
0 0 0 41967 POL. TIGASAN WETA ASS4 1 24
0 0 0 41967 POL. TIGASAN WETA NIF 6 24
0 0 0 41967 POL. TIGASAN WETA KALK 6 24
0 0 0 41967 POL. TIGASAN WETA KALK 6 24
0 0 0 41967 POL. TIGASAN WETA ASS4 1 24
0 0 0 41967 POL. TIGASAN WETA DIF 1 24
6 0 0 41965 POL. TIGASAN WETA VB1 6 22
0 0 0 41965 POL. TIGASAN WETA ASS4 1 22
0 0 0 41965 POL. TIGASAN WETA PARA5 6 22
0 0 0 41965 POL. TIGASAN WETA VBC 6 22
0 0 0 41965 POL. TIGASAN WETA KOT1 6 22
0 0 0 41965 POL. TIGASAN WETA GLIT1 6 22
0 0 0 41965 POL. TIGASAN WETA B6 6 22
0 0 0 41965 POL. TIGASAN WETA PARA5 6 22
0 0 0 41965 POL. TIGASAN WETA VBC 6 22
0 0 0 41965 POL. TIGASAN WETA CTM 6 22
0 0 0 41965 POL. TIGASAN WETA PRED 6 22
0 0 0 41965 POL. TIGASAN WETA PARA5 6 22
0 0 0 41965 POL. TIGASAN WETA GG 6 22
0 0 0 41965 POL. TIGASAN WETA VBC 6 22
0 0 0 41965 POL. TIGASAN WETA KALK 6 22
0 0 0 41965 POL. TIGASAN WETA PARA5 6 22
0 0 0 41965 POL. TIGASAN WETA AMOK5 6 22
0 0 0 41965 POL. TIGASAN WETA DIF 1 22
0 0 0 41965 POL. TIGASAN WETA ASS4 1 22
0 0 0 41965 POL. TIGASAN WETA KALK 6 22
0 0 0 41965 POL. TIGASAN WETA DIF 1 22
0 0 0 41964 POL. TIGASAN WETA KALK 6 21
0 0 0 41964 POL. TIGASAN WETA AMOK5 6 21
0 0 0 41964 POL. TIGASAN WETA ASS4 1 21
0 0 0 41964 POL. TIGASAN WETA B12 1 21
0 0 0 41964 POL. TIGASAN WETA PARA5 6 21
6 0 0 41964 POL. TIGASAN WETA VB1 6 21
0 0 0 41964 POL. TIGASAN WETA VITC 6 21
0 0 0 41964 POL. TIGASAN WETA VBC 6 21
0 0 0 41963 POL. TIGASAN WETA B6 6 20
0 0 0 41963 POL. TIGASAN WETA VBC 6 20
0 0 0 41963 POL. TIGASAN WETA PARA5 6 20
0 0 0 41963 POL. TIGASAN WETA VBC 6 20
0 0 0 41963 POL. TIGASAN WETA VBC 6 20
0 0 0 41963 POL. TIGASAN WETA B12 1 20
0 0 0 41963 POL. TIGASAN WETA ASS4 1 20
0 0 0 41963 POL. TIGASAN WETA KALK 6 20
0 0 0 41963 POL. TIGASAN WETA VB1 6 20
0 0 0 41963 POL. TIGASAN WETA DIF 1 20
0 0 0 41963 POL. TIGASAN WETA KALK 6 20
0 0 0 41963 POL. TIGASAN WETA AND2 6 20
0 0 0 41963 POL. TIGASAN WETA VB1 6 20
0 0 0 41963 POL. TIGASAN WETA ASS4 1 20
0 0 0 41962 POL. TIGASAN WETA PARA5 6 19
0 0 0 41962 POL. TIGASAN WETA ASS4 1 19
0 0 0 41962 POL. TIGASAN WETA VBC 6 19
0 0 0 41962 POL. TIGASAN WETA IBU2 6 19
0 0 0 41962 POL. TIGASAN WETA PARA5 6 19
0 0 0 41962 POL. TIGASAN WETA VBC 6 19
0 0 0 41962 POL. TIGASAN WETA PARA5 6 19
0 0 0 41962 POL. TIGASAN WETA AMOK5 6 19
0 0 0 41962 POL. TIGASAN WETA CTM 6 19
0 0 0 41962 POL. TIGASAN WETA VBC 6 19
0 0 0 41962 POL. TIGASAN WETA DIF 1 19
0 0 0 41961 POL. TIGASAN WETA ASS4 1 18
0 0 0 41961 POL. TIGASAN WETA KOT1 6 18
0 0 0 41961 POL. TIGASAN WETA VBC 6 18
0 0 0 41961 POL. TIGASAN WETA GLIT1 6 18
0 0 0 41961 POL. TIGASAN WETA KALK 6 18
0 0 0 41961 POL. TIGASAN WETA PARA5 6 18
0 0 0 41961 POL. TIGASAN WETA IBU2 6 18
0 0 0 41961 POL. TIGASAN WETA VBC 6 18
0 0 0 41961 POL. TIGASAN WETA VB1 6 18
0 0 0 41961 POL. TIGASAN WETA KALK 6 18
0 0 0 41961 POL. TIGASAN WETA AMOK5 6 18
0 0 0 41961 POL. TIGASAN WETA PARA5 6 18
0 0 0 41961 POL. TIGASAN WETA B1I 1 18
0 0 0 41961 POL. TIGASAN WETA KALK 6 18
0 0 0 41961 POL. TIGASAN WETA ASS4 1 18
0 0 0 41961 POL. TIGASAN WETA DIF 1 18
0 0 0 41961 POL. TIGASAN WETA PARA5 6 18
0 0 0 41961 POL. TIGASAN WETA OBH 1 18
0 0 0 41961 POL. TIGASAN WETA PARA5 6 18
0 0 0 41961 POL. TIGASAN WETA PARA5 6 18
6 0 0 41961 POL. TIGASAN WETA AMOK5 6 18
0 0 0 41961 POL. TIGASAN WETA GG 6 18
0 0 0 41960 POL. TIGASAN WETA PRED 6 17
0 0 0 41960 POL. TIGASAN WETA DIF 1 17
0 0 0 41960 POL. TIGASAN WETA AMOK5 6 17
0 0 0 41960 POL. TIGASAN WETA GG 6 17
0 0 0 41960 POL. TIGASAN WETA VBC 6 17
 0 0 0 41960 POL. TIGASAN WETA ASS4 1 17
0 0 0 41960 POL. TIGASAN WETA ASS4 1 17
0 0 0 41960 POL. TIGASAN WETA B1I 1 17
0 0 0 41960 POL. TIGASAN WETA PARA5 6 17
0 0 0 41960 POL. TIGASAN WETA PARA5 6 17
0 0 0 41960 POL. TIGASAN WETA ASS4 1 17
0 0 0 41960 POL. TIGASAN WETA KALK 6 17
0 0 0 41960 POL. TIGASAN WETA VB1 6 17
0 0 0 41960 POL. TIGASAN WETA CTM 6 17
0 0 0 41960 POL. TIGASAN WETA B12 1 17
0 0 0 41960 POL. TIGASAN WETA IBU2 6 17
0 0 0 41960 POL. TIGASAN WETA AMOK5 6 17
12 0 0 41958 POL. TIGASAN WETA CTM 6 15
0 0 0 41958 POL. TIGASAN WETA VBC 6 15
0 0 0 41958 POL. TIGASAN WETA AND2 6 15
0 0 0 41958 POL. TIGASAN WETA PRED 6 15
0 0 0 41958 POL. TIGASAN WETA KAP1 6 15
6 0 0 41958 POL. TIGASAN WETA B6 6 15
0 0 0 41957 POL. TIGASAN WETA PARA5 6 14
0 0 0 41957 POL. TIGASAN WETA FE 30 14
0 0 0 41957 POL. TIGASAN WETA VBC 6 14
6 0 0 41957 POL. TIGASAN WETA KAP1 6 14
0 0 0 41956 POL. TIGASAN WETA KALK 6 13
0 0 0 41956 POL. TIGASAN WETA B1I 1 13
0 0 0 41956 POL. TIGASAN WETA ASS4 1 13
0 0 0 41956 POL. TIGASAN WETA KALK 6 13
0 0 0 41956 POL. TIGASAN WETA B1I 1 13
0 0 0 41956 POL. TIGASAN WETA VB1 6 13
0 0 0 41956 POL. TIGASAN WETA ASS4 1 13
0 0 0 41956 POL. TIGASAN WETA VBC 6 13
0 0 0 41956 POL. TIGASAN WETA B12 1 13
0 0 0 41956 POL. TIGASAN WETA ASS4 1 13
0 0 0 41956 POL. TIGASAN WETA PARA5 6 13
0 0 0 41956 POL. TIGASAN WETA KALK 6 13
0 0 0 41956 POL. TIGASAN WETA VITC 6 13
0 0 0 41955 POL. TIGASAN WETA AMOK5 6 12
0 0 0 41955 POL. TIGASAN WETA ASMEF 6 12
0 0 0 41955 POL. TIGASAN WETA ASMEF 6 12
0 0 0 41955 POL. TIGASAN WETA AMOK5 6 12
0 0 0 41955 POL. TIGASAN WETA VITC 6 12
0 0 0 41955 POL. TIGASAN WETA PARA5 6 12
 0 0 0 41955 POL. TIGASAN WETA CTM 6 12
0 0 0 41955 POL. TIGASAN WETA KALK 6 12
0 0 0 41955 POL. TIGASAN WETA VB1 6 12
0 0 0 41955 POL. TIGASAN WETA KALK 6 12
0 0 0 41955 POL. TIGASAN WETA AMOK5 6 12
0 0 0 41955 POL. TIGASAN WETA AMOK5 6 12
0 0 0 41955 POL. TIGASAN WETA ASMEF 6 12
0 0 0 41954 POL. TIGASAN WETA VBC 6 11
0 0 0 41954 POL. TIGASAN WETA KAP1 6 11
0 0 0 41954 POL. TIGASAN WETA ASS4 1 11
0 0 0 41954 POL. TIGASAN WETA B12 1 11
0 0 0 41954 POL. TIGASAN WETA VBC 6 11
0 0 0 41954 POL. TIGASAN WETA B6 6 11
0 0 0 41954 POL. TIGASAN WETA DIF 1 11
0 0 0 41954 POL. TIGASAN WETA IBU2 6 11
0 0 0 41954 POL. TIGASAN WETA ASS4 1 11
0 0 0 41954 POL. TIGASAN WETA B1I 1 11
6 0 0 41954 POL. TIGASAN WETA AMOK5 6 11
0 0 0 41954 POL. TIGASAN WETA GLIT1 6 11
0 0 0 41954 POL. TIGASAN WETA ASS4 1 11
0 0 0 41954 POL. TIGASAN WETA AND2 6 11
0 0 0 41954 POL. TIGASAN WETA IBU2 6 11
0 0 0 41953 POL. TIGASAN WETA PRED 6 10
0 0 0 41953 POL. TIGASAN WETA ASS4 1 10
12 0 0 41953 POL. TIGASAN WETA OBH 1 10
0 0 0 41953 POL. TIGASAN WETA ASMEF 6 10
0 0 0 41953 POL. TIGASAN WETA AMOK5 6 10
0 0 0 41953 POL. TIGASAN WETA AMOK5 6 10
0 0 0 41953 POL. TIGASAN WETA VBC 6 10
0 0 0 41953 POL. TIGASAN WETA CTM 6 10
0 0 0 41953 POL. TIGASAN WETA IBU2 6 10
0 0 0 41953 POL. TIGASAN WETA PARA5 6 10
0 0 0 41953 POL. TIGASAN WETA DIF 1 10
0 0 0 41953 POL. TIGASAN WETA GG 6 10
0 0 0 41953 POL. TIGASAN WETA PARA5 6 10
0 0 0 41953 POL. TIGASAN WETA AMOK5 6 10
0 0 0 41953 POL. TIGASAN WETA CTM 6 10
0 0 0 41953 POL. TIGASAN WETA AMN2 6 10
0 0 0 41953 POL. TIGASAN WETA CTM 6 10
0 0 0 41953 POL. TIGASAN WETA VBC 6 10
0 0 0 41953 POL. TIGASAN WETA AMOK5 6 10
0 0 0 41953 POL. TIGASAN WETA PARA5 6 10
0 0 0 41951 POL. TIGASAN WETA AMOKS2 1 8
0 0 0 41951 POL. TIGASAN WETA PARAS 1 8
0 0 0 41951 POL. TIGASAN WETA VBC 6 8
0 0 0 41951 POL. TIGASAN WETA VBC 6 8
0 0 0 41951 POL. TIGASAN WETA SB2 1 8
0 0 0 41951 POL. TIGASAN WETA KALK 6 8
0 0 0 41951 POL. TIGASAN WETA PRED 6 8
0 0 0 41951 POL. TIGASAN WETA VBC 3 8
0 0 0 41951 POL. TIGASAN WETA SB2 1 8
0 0 0 41951 POL. TIGASAN WETA CTM 3 8
0 0 0 41951 POL. TIGASAN WETA VB1 6 8
0 0 0 41951 POL. TIGASAN WETA ASS4 1 8
0 0 0 41951 POL. TIGASAN WETA PARA5 3 8
0 0 0 41951 POL. TIGASAN WETA DIF 1 8
0 0 0 41951 POL. TIGASAN WETA GG 3 8
0 0 0 41951 POL. TIGASAN WETA AMOKS2 1 8
0 0 0 41951 POL. TIGASAN WETA KALK 6 8
0 0 0 41951 POL. TIGASAN WETA PARA5 3 8
0 0 0 41950 POL. TIGASAN WETA VB1 6 7
0 0 0 41950 POL. TIGASAN WETA B6 6 7
0 0 0 41950 POL. TIGASAN WETA AND2 6 7
0 0 0 41950 POL. TIGASAN WETA CTM 6 7
0 0 0 41950 POL. TIGASAN WETA ASMEF 6 7
0 0 0 41950 POL. TIGASAN WETA AMOK5 6 7
0 0 0 41950 POL. TIGASAN WETA AND2 6 7
0 0 0 41950 POL. TIGASAN WETA IBU2 6 7
0 0 0 41950 POL. TIGASAN WETA PARA5 6 7
0 0 0 41950 POL. TIGASAN WETA AMOK5 6 7
0 0 0 41950 POL. TIGASAN WETA B6 6 7
0 0 0 41949 POL. TIGASAN WETA AND2 6 6
0 0 0 41949 POL. TIGASAN WETA VITC 6 6
0 0 0 41949 POL. TIGASAN WETA CTM 6 6
0 0 0 41949 POL. TIGASAN WETA AMN2 6 6
0 0 0 41949 POL. TIGASAN WETA AMOK5 6 6
0 0 0 41949 POL. TIGASAN WETA ASMEF 6 6
0 0 0 41949 POL. TIGASAN WETA AMOK5 6 6
0 0 0 41949 POL. TIGASAN WETA ASMEF 6 6
0 0 0 41949 POL. TIGASAN WETA B6 6 6
0 0 0 41949 POL. TIGASAN WETA YOD1 1 6
0 0 0 41949 POL. TIGASAN WETA KP1 1 6
0 0 0 41949 POL. TIGASAN WETA PARA5 6 6
0 0 0 41949 POL. TIGASAN WETA CTM 6 6
0 0 0 41949 POL. TIGASAN WETA DIF 1 6
0 0 0 41949 POL. TIGASAN WETA IBU2 6 6
1 0 0 41949 POL. TIGASAN WETA ASMEF 6 6
0 0 0 41949 POL. TIGASAN WETA ASS4 1 6
0 0 0 41948 POL. TIGASAN WETA VBC 6 5
0 0 0 41948 POL. TIGASAN WETA KALK 6 5
0 0 0 41948 POL. TIGASAN WETA VBC 6 5
0 0 0 41948 POL. TIGASAN WETA PARA5 6 5
0 0 0 41948 POL. TIGASAN WETA GEN1 1 5
0 0 0 41948 POL. TIGASAN WETA CTM 6 5
0 0 0 41948 POL. TIGASAN WETA PRED 6 5
0 0 0 41948 POL. TIGASAN WETA AMOKS2 1 5
0 0 0 41948 POL. TIGASAN WETA VB1 6 5
0 0 0 41948 POL. TIGASAN WETA PARA5 2 5
0 0 0 41948 POL. TIGASAN WETA DIF 1 5
0 0 0 41948 POL. TIGASAN WETA AMN2 6 5
0 0 0 41948 POL. TIGASAN WETA PARA5 6 5
0 0 0 41948 POL. TIGASAN WETA KLOTT 1 5
0 0 0 41948 POL. TIGASAN WETA ASS4 1 5
0 0 0 41948 POL. TIGASAN WETA VB1 6 5
0 0 0 41948 POL. TIGASAN WETA AMOK5 6 5
0 0 0 41948 POL. TIGASAN WETA ASMEF 6 5
0 0 0 41948 POL. TIGASAN WETA VBC 2 5
0 0 0 41948 POL. TIGASAN WETA KALK 6 5
0 0 0 41947 POL. TIGASAN WETA B1I 1 4
0 0 0 41947 POL. TIGASAN WETA ASS4 1 4
0 0 0 41947 POL. TIGASAN WETA PRED 6 4
0 0 0 41947 POL. TIGASAN WETA CTM 6 4
0 0 0 41947 POL. TIGASAN WETA GEN1 1 4
0 0 0 41947 POL. TIGASAN WETA KALK 6 4
0 0 0 41947 POL. TIGASAN WETA CTM 6 4
0 0 0 41947 POL. TIGASAN WETA DIF 1 4
0 0 0 41947 POL. TIGASAN WETA VBC 6 4
0 0 0 41947 POL. TIGASAN WETA ASS4 1 4
0 0 0 41947 POL. TIGASAN WETA IBU2 6 4
0 0 0 41947 POL. TIGASAN WETA B1I 1 4
0 0 0 41947 POL. TIGASAN WETA ASS4 1 4
0 0 0 41947 POL. TIGASAN WETA CTM 6 4
0 0 0 41947 POL. TIGASAN WETA KAP1 10 4
0 0 0 41947 POL. TIGASAN WETA VB1 6 4
0 0 0 41947 POL. TIGASAN WETA PARA5 6 4
0 0 0 41947 POL. TIGASAN WETA YOD1 1 4
0 0 0 41947 POL. TIGASAN WETA PARA5 6 4
0 0 0 41947 POL. TIGASAN WETA KP3 1 4
0 0 0 41947 POL. TIGASAN WETA OKTSM 1 4
0 0 0 41947 POL. TIGASAN WETA ASMEF 6 4
0 0 0 41947 POL. TIGASAN WETAN 4
0 0 0 41947 POL. TIGASAN WETA IBU2 6 4
0 0 0 41947 POL. TIGASAN WETA GLIT1 6 4
0 0 0 41947 POL. TIGASAN WETA FE 30 4
0 0 0 41947 POL. TIGASAN WETA VITC 6 4
0 0 0 41947 POL. TIGASAN WETA AND2 6 4
0 0 0 41947 POL. TIGASAN WETA B6 6 4
0 0 0 41947 POL. TIGASAN WETA IBU2 6 4
0 0 0 41947 POL. TIGASAN WETA VB1 6 4
0 0 0 41947 POL. TIGASAN WETA GG 6 4
0 0 0 41947 POL. TIGASAN WETA AND2 6 4
0 0 0 41947 POL. TIGASAN WETA B6 6 4
0 0 0 41946 POL. TIGASAN WETA B6 6 3
0 0 0 41946 POL. TIGASAN WETA VITC 3 3
0 0 0 41946 POL. TIGASAN WETA AMOKS2 1 3
0 0 0 41946 POL. TIGASAN WETA PARAS 1 3
0 0 0 41946 POL. TIGASAN WETA AMOKS2 1 3
0 0 0 41946 POL. TIGASAN WETA PARA5 6 3
0 0 0 41946 POL. TIGASAN WETA AMOK5 6 3
0 0 0 41946 POL. TIGASAN WETA FE 30 3
0 0 0 41946 POL. TIGASAN WETA AMOK5 6 3
0 0 0 41946 POL. TIGASAN WETA KOT1 6 3
0 0 0 41946 POL. TIGASAN WETA ASS4 1 3
0 0 0 41946 POL. TIGASAN WETA PARA5 6 3
0 0 0 41946 POL. TIGASAN WETA VBC 6 3
0 0 0 41946 POL. TIGASAN WETA DIF 1 3
0 0 0 41946 POL. TIGASAN WETA ASS4 1 3
0 0 0 41946 POL. TIGASAN WETA PARA5 6 3
0 0 0 41946 POL. TIGASAN WETA OBH 1 3
0 0 0 41946 POL. TIGASAN WETA GLIT1 6 3
0 0 0 41946 POL. TIGASAN WETA CTM 6 3
0 0 0 41946 POL. TIGASAN WETA VBC 6 3
0 0 0 41946 POL. TIGASAN WETA B12 1 3
0 0 0 41946 POL. TIGASAN WETA ASS4 1 3
0 0 0 41946 POL. TIGASAN WETA PARA5 6 3
0 0 0 41946 POL. TIGASAN WETA VBC 6 3
0 0 0 41946 POL. TIGASAN WETA ASS4 1 3
0 0 0 41946 POL. TIGASAN WETA PARA5 6 3
0 0 0 41946 POL. TIGASAN WETA PARA5 3 3
0 0 0 41946 POL. TIGASAN WETA VB1 6 3
0 0 0 41946 POL. TIGASAN WETA VBC 6 3
0 0 0 41946 POL. TIGASAN WETA AND2 6 3
0 0 0 41946 POL. TIGASAN WETA B6 6 3
0 0 0 41946 POL. TIGASAN WETA IBU2 6 3
0 0 0 41946 POL. TIGASAN WETA B1I 1 3
0 0 0 41946 POL. TIGASAN WETA ASS4 1 3
0 0 0 41946 POL. TIGASAN WETA B12 1 3
0 0 0 41946 POL. TIGASAN WETA KLOTT 1 3
0 0 0 41946 POL. TIGASAN WETA IBU2 6 3
0 0 0 41946 POL. TIGASAN WETA DIF 1 3
0 0 0 41944 POL. TIGASAN WETA AMOK5 6 1
0 0 0 41944 POL. TIGASAN WETA B12 1 1
0 0 0 41944 POL. TIGASAN WETA ASS4 1 1
0 0 0 41944 POL. TIGASAN WETA IBU2 6 1
0 0 0 41944 POL. TIGASAN WETA DIF 1 1
0 0 0 41944 POL. TIGASAN WETA ASS4 1 1
0 0 0 41944 POL. TIGASAN WETA AND2 6 1
0 0 0 41944 POL. TIGASAN WETA B6 6 1
0 0 0 41944 POL. TIGASAN WETA IBU2 6 1
0 0 0 41944 POL. TIGASAN WETA DIF 1 1
0 0 0 41944 POL. TIGASAN WETA ASS4 1 1
0 0 0 41944 POL. TIGASAN WETA OBH 1 1
0 0 0 41944 POL. TIGASAN WETA VITC 6 1
0 0 0 41944 POL. TIGASAN WETA AMOK5 6 1
41944 POL. TIGASAN WETA OKTSM 1 1
41944 POL. TIGASAN WETA ASMEF 6 1
41944 POL. TIGASAN WETA PARAS 1 1
41944 POL. TIGASAN WETA VBC 3 1
41944 POL. TIGASAN WETA IBU2 6 1
41944 POL. TIGASAN WETA VB1 6 1
41944 POL. TIGASAN WETA DIF 1 1
41944 POL. TIGASAN WETA ASS4 1 1
41944 CTM 1
41944 1
41944 AFOL 1
41944 AMOK5 1
 41944 AMOKS2 1
- 41944 ASMEF 1
41944 ASP 1
41944 ASS4 1
41944 B12 1
41944 B1I 1
41944 POL. TIGASAN WETA VBC 6 1
41944 BYC 1
41944 UBG 1
41944 FLY 1
41944 IBU2 1
41944 KLM 1
41944 KP5 1
41944 MCS 1
41944 OBH 1
41944 OKTSM 1
41944 RPU 1
41944 STI 1
41944 YOD4 1
41944 BLO 1
41944 STO 1
30
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TGL KUNJ TEMPAT PE KODE OBATJUMLAH 1 RUANGAN KODE OBATSumOfJUMLAH 1
41944 CTM 400 K AA6 0
41944 K ABU1 0
41944 AFOL 100 K ACT 0
41944 AMOK5 200 K ADI 0
41944 AMOKS2 10 K ADS 0
41944 ASMEF 200 K AFOL 256
41944 ASP 1 K AK1 0
41944 ASS4 100 K ALB 9
41944 B12 20 K ALIN 0
41944 B1I 30 K ALP1 0
41944 BYC 1 K ALP2 0
41944 UBG 1 K AM1 0
41944 FLY 1 K AMB 0
41944 IBU2 100 K AMD1 0
41944 KLM 1 K AMD2 0
41944 KP5 40 K AMN1 0
41944 MCS 1 K AMN2 44
41944 OBH 5 K AMOK2 64
41944 OKTSM 5 K AMOK5 304
41944 RPU 1 K AMOKS 0
41944 STI 1 K AMOKS2 5
41944 YOD4 60 K AMP 0
41944 BLO 1 K AMT 0
41944 STO 6 K AN1 0
AND1 0
AND2 250
ANT1 0
ANT2 0
API 0
AQ1 0
AQG 0
ARD 0
AS2 0
ASER 0
ASK1 0
ASK2 0
ASMEF 209
ASS1 0
ASS10 0
ASS2 0
ASS3 123
ASS4 91
ASS5 43
AST 0
ATB 0
ATF 0
ATG 0
ATK 0
ATM 0
ATP 0
ATR 0
ATR1 0
ATR2 0
ATR3 0
ATS1 0
ATS2 0
B12 30
B1I 60
B6 1060
BBP 0
BD1 0
BIS 0
BK1 0
BLD 0
BMT 0
BON 0
BRO 0
BTM 0
BUF 0
CGV1 0
CHKM 0
CPZ1 0
CPZ2 0
CRES 0
CTM 254
DAP 0
DEK1 0
DEK2 0
DEM 0
DEN 0
DET1 0
DET2 0
DEV1 0
DEV2 0
DGK1 0
DGK2 0
DIAZ1 0
DIAZ2 0
DIAZ3 0
DIAZ4 0
DIF 133
DKB 0
DMD 0
DT 0
DUL1 0
DUL2 0
EA1 0
EAL 0
EB 0
EDTA 0
EGC 0
EHP 0
EKS 0
EPH 0
ERI1 0
ERI2 0
ERI3 0
ESN1 0
ETA1 0
ETC 0
ETM 0
ETN 1
FAU1 0
FBR1 0
FBR2 0
FBR3 0
FE 3180
FELA 0
FELB 0
FGT 0
FLUD1 0
FLUD2 0
FN1 0
FN2 0
FN3 0
FPT1 0
FPT2 0
FRO1 0
FRO2 0
GAM 0
GD 0
GEM 0
GEN1 8
GEN2 0
GG 771
GIB 0
GLC 0
GLIB 0
GLIT1 96
GLR 0
GLU1 0
GLU2 0
GLU3 0
GMS 0
GRI 0
GTP1 0
GTP2 28
GUT1 8
GUT2 0
GV 0
H2O2 0
HAL1 0
HAL2 0
HAY1 0
HBS 0
HCT 0
HCV 0
HDR 0
HIV 0
HNB1 0
HNB2 0
IA1 0
IBU1 3
IBU2 100
ICH 0
IOD 0
ISA 0
ISD 6
ISN 0
ISO 0
IV1 0
IV2 0
IV3 0
IV4 0
JJB 0
KA2A 0
KA2P 0
KALK 1341
KAP1 175
KAP2 0
KAR 0
KB5 0
KD 0
KET 0
KF1 0
KGI 0
KHP 0
KIN1 0
KLIN 0
KLOF 0
KLOR1 0
KLOS 0
KLOSM 0
KLOTM 0
KLOTT 7
KN3A 0
KN3B 0
KOD 0
KOMB 0
KOT1 197
KOT2 0
KOTS 5
KP 0
KP1 8
KP2 0
KP3 10
KP4 0
KPA 1
KST 0
LEV 0
LIDO1 0
LIDO2 28
LKB 0
LKT 0
LOP 0
LUG1 0
LYN 0
LYS 0
MAS 0
MB1 0
MDT 0
ME1 10
ME2 90
MEB1 0
MEB2 0
MEP 0
MES 0
MET 0
MET1 0
METH 0
MGS1 0
MGS2 0
MGSS 0
MMS 0
MOK 0
MOLSUP 0
MTK1 0
MTK2 0
MTR1 0
MTR2 0
MTR3 0
MTT 0
MULTF 0
MUMP 0
NA1 0
NAB 0
NAD1 0
NAD2 0
NAF 0
NAK 0
NAT 0
NEUR2 0
NIF 71
NIS1 0
NIS2 0
NUER1 0
OAT1 0
OAT2 0
OATA 0
OBH 10
OED 0
OI1 0
OKS 0
OKTIN 0
OKTSK 0
OKTSM 8
OSE 0
OTS 21
PAP1 0
PAP2 0
PAR 0
PARA1 0
PARA5 744
PARAD 0
PARAS 22
PET 0
PIK1 0
PIK2 0
PIL 0
PIR 0
PIZ 0
PLES 2
POLI 0
POT 0
PRAZ 0
PRED 911
PRIM 0
PROK 0
PROP 0
PTU 0
RA 0
RAF 0
RAN1 0
RAN2 0
RAU 0
RBD 0
RBT 0
RE1 0
RES1 0
RES2 0
RG 0
RHC 0
RIF1 0
RIF2 0
RIF3 0
RK 0
RKN 0
RL 10
RTG 0
RTP 0
RU 0
S2-4 0
SAL1 0
SAL2 0
SAS 0
SB1 0
SB2 5
SC1 0
SCAB 0
SEF 0
SET 0
SG11 0
SGOT 0
SGT 0
SILK1 0
SILK2 0
SIM 0
SIV 0
SOLR 0
SPRO 0
SS 0
SSF 0
STN 0
STR 0
STREP 0
STS 17
SULF 0
TD 0
TENSI 0
TETR1 0
TETR2 0
THAI2 0
THIA1 0
TKF 0
TNS 0
TPD 0
TPHA 0
TSF 0
TTM 0
TUR1 0
US1 0
VB1 982
VBC 1082
VDRL 0
VITA1 0
VITA2 0
VITC 851
VITK1 28
VITK2 74
WID1 0
WN 0
XIL1 0
XZNS1 0
YOD1 4
YOD2 0
YOD3 0
ZNK1 0
ZNK2 0
SumOfJUMLAH 2 SISA OBATKELUAR
0 0
0 0
0 0
0 0
0 0
256 0
0 0
9 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
6 38 6
64 0 64
252 52 252
0 0
5 0
0 0
0 0
0 0
0 0
54 196 54
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
150 59 150
0 0
0 0
0 0
123 0
 46 45 46
43 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
16 14 16
32 28 32
54 1006 54
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
138 116 138
0 0
0 0
0 0
0 0
0 0
0 0
0 0
 0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
5 128 5
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
1 0
0 0
0 0
0 0
0 0
150 3030 150
0 0
0 0
0 0
0 0
0 0
0 0
 0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
3 5 3
0 0
48 723 48
0 0
0 0
0 0
54 42 54
0 0
0 0
0 0
0 0
0 0
0 0
0 0
28 0
8 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
3 0
12 88 12
 0 0
0 0
0 0
6 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
330 1011 330
18 157 18
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
1 6 1
0 0
0 0
0 0
0 0
197 0
0 0
4 1 4
0 0
8 0
0 0
10 0
0 0
1 0
0 0
0 0
0 0
28 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
10 0
90 0
0 0
0 0
0 0
0 0
0 0
0 0
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0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
 0 0
0 0
0 0
0 0
0 0
0 0
71 0
0 0
0 0
0 0
0 0
0 0
0 0
7 3 7
0 0
0 0
0 0
0 0
0 0
6 2 6
0 0
21 0
0 0
0 0
0 0
0 0
222 522 222
0 0
5 17 5
0 0
0 0
0 0
0 0
0 0
0 0
2 0
0 0
0 0
0 0
90 821 90
0 0
 0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
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10 0
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1 4 1
0 0
0 0
0 0
0 0
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0 0
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0 0
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 0 0
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17 0
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0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
24 958 24
216 866 216
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0 0
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114 737 114
28 0
74 0
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1 3 1
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0 0
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0 0
KODE PUSKESMAS : 282002
PUSKESMAS :..................................
KECAMATAN : .................................
KAB/KODYA : ...................................
PROPINSI :
Kepala Puskesmas (…………………………)
NIP
Petugas Obat ...................................
NIP -
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
( LPLPO )
KODE PUSKESMAS : 282002 BULAN : JANUARI
PUSTU :.................................. TAHUN : 2013
KECAMATAN : .................................
KAB/KODYA : ...................................
PROPINSI :

NO NAMA OBAT SATUA Kode Stok Peneri Persdi PEMA SISA PEMEKAIAN PERTANGGAL
N Awal maan aan KAIAN AKHIR 10
1 2 3 4 5 6 [7]=(5 [8]=S( [9]=(7 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
+6) 10) -8)
1 ACT tab Tablet ACT 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Albendazol tab 400 mg Tablet ALB 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Alopurinol 100 mg Tablet ALP1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Alopurinol 300 mg Tablet ALP2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Ambroxol tablet 30 mg Tablet AMB 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Aminophilin inj 24 mg/ml-10 ml Ampul AMN1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Aminophilin tab 200 mg Tablet AMN2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Amitriptilin Hcl tab 25 mg Tablet AMT 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Amlodipin tab 10 mg Tablet AMD1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Amlodipin tab 5 mg Tablet AMD2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Amoksisilin 500 mg Kaplet AMOK5 50 50 0 50 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Amoksisilin kaps 250 mg Kapsul AMOK2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 Amoksisilin SK 125mg/5ml Botol AMOKS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 Ampisilin Serbuk Injeksi 1000 mg/ml Ampul AMP 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Antalgin (metampiron) tab 500 mg Tablet ANT1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 Antalgin inj 250 mg/ml-2 ml Ampul ANT2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 Antasida DOEN Syrup Botol AND1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
18 Antasida DOEN tab Komb Tablet AND2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 Antibakteri DOEN salep Komb Tube ATB 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 Antifungi DOEN salep Komb Tube ATF 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
21 Antihemoroid DOEN Komb Supposit ATM 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 Antimigren DOEN tab Komb Tablet ATG 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 Antiparkinson DOEN tab Komb Tablet ATP 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 Aqua proinjeksi steril bebas pirogen Vial API 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 Asam Askorbat (Vit C) tab 50 mg Tablet VITC 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
26 Asam folat 1 mg Tablet AFOL 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
27 Asam mefenamat 500 mg Tablet ASMEF 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
28 Asetosal tab 100 mg Tablet AST 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
29 Asiklovir 400 mg Tablet ASK1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
30 Asiklovir 5 % krim Tube ASK2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
31 Atropin Sulfat inj 0,25mg/ml-1 ml Ampul ATR1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
32 Atropin Sulfat tab 0,5 mg Tablet ATR2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
33 Atropin tetes mata 0,5% Botol ATR3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
34 Benzatin benzil penisilin inj 2.4 jt iu/ Vial BBP 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
35 Betahistin Mesilat tablet 6 mg Tablet BMT 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
36 Betametason krim 0,1% Tube BTM 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
37 Bromheksin tablet 8 mg Tablet BRO 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
38 Dapson tab 100 mg Tablet DAP 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
39 Deksametason inj 5 mg/ml-ml Ampul DEK1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
40 Deksametason tab 0.5 mg Tablet DEK2 20 20 0 20 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
41 Dekstrometorphan sirup 10mg/5ml Botol DET1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
42 Dekstrometorphan tab 15 mg Tablet DET2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
43 Diazepam inj 5 mg/ml-2ml Ampul DIAZ1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
44 Diazepam larutan rektal 4 mg/2 ml ( Tube DIAZ2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
45 Diazepam tab 2 mg Tablet DIAZ3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
46 Diazepam tab 5 mg Tablet DIAZ4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
47 Dietilkarbamazin sitrat tab 100 mg Tablet DKB 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
48 Difenhidramin Hcl Inj 10 mg/ml-1ml Ampul DIF 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
49 Digoksin tab 0.25 mg Tablet DGK1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
50 Digoksin tab 0.5 mg Tablet DGK2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
51 Dimenhidrinat tablet 50 mg Tablet DMD 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
52 Ekstrak Beladon 10 mg Tablet EB 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
53 Ephedrin Hcl tab 25 mg Tablet EPH 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
54 Ephinefrin Hcl (Adrenalin) inj 0,1%/ Ampul EHP 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
55 Erithromisin 500 mg tab Tablet ERI1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
56 Eritromisin 250 mg Tablet ERI2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
57 Erithromisin sirup 200 mg/5 ml Botol ERI3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
58 Etakridin (Rivanol) Lart 0,1% Botol ETA1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
59 Etambutol Hcl Tb 250 mg Tablet ETM 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
60 Fenitoin Natrium inj 50 mg/ml @ 2m Ampul FN1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
61 Fenitoin Natrium kaps 100 mg Kapsul FN2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
62 Fenitoin Natrium Kaps 30 mg Tablet FN3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
63 Fenobarbital inj 50 mg/ml Ampul FBR1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
64 Fenobarbital tab 100 mg Tablet FBR2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
65 Fenobarbital tab 30 mg Tablet FBR3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
66 Fenoksimetil penisilin tab 250 mg Tablet FPT1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
67 Fenoksimetil penisilin tab 500 mg Tablet FPT2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
68 Fenol gliserol tetes Telinga 10 % Botol FGT 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
69 Fitomenadion (VitK) inj 10mg/ml-1m Ampul VITK1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
70 Fitomenadion (VitK) tab 10 mg Tablet VITK2 20 20 0 20 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
71 Furosemid tab 40 mg Tablet FRO1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
72 Furosemid Inj 10 mg/ml Ampul FRO2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
73 Gameksan Lotion 1 % Botol GAM 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
74 Garam Oralit untuk 200 ml air Sachet GLIT1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
 75 Gemfibrozil 300 mg Tablet GEM 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
76 Gentamsin Salep Kulit 0,1% Tube GEN1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
77 Gentamycin 80 mg/2 ml injeksi Ampul GEN2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
78 Gentian Violet lart 1% Botol GV 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
79 Glibenklamid 5 mg Tablet GLIB 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
80 Gliseril Guaiyakolat tab 100 mg Tablet GG 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
81 Gliserin Botol GLR 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
82 Glukosa Lart Inf 10 % steril Botol GLU1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
83 Glukosa Lart Inf 40 % steril Vial GLU2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
84 Glukosa Lart Inf 5 % steril Botol GLU3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
85 Grisiofulvin tab 125 mg Tablet GRI 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
86 Haloperidol tab 0.5 mg Tablet HAL1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
87 Haloperidol tab 1.5 mg Tablet HAL2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
88 Hidroklortiazid (HCT) tab 25 mg Tablet HCT 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
89 Hidrokortison krim 2.5 % Tube HDR 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
90 Hiosin N- Butilbromida Tab 10 mg Tablet HNB1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
91 Hiosin N- Butilbromida Inj 20 mg/ml Ampul HNB2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
92 Ibuprofen 200 mg Tablet IBU1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
93 Ibuprofen 400 mg Tablet IBU2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
94 Ichtyol salp Pot ICH 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
95 Iodiol softcaps Kapsul IOD 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
96 Isoniazid tab 300 mg Tablet ISN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
97 Isosorbid dinitrat tab 5 mg Tablet ISO 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
98 Kalium Permanganat Pot KP 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
99 Kalium Diklofenak tab 50 mg Tablet KD 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
100 Kalsium Laktas (Kalk) tab 500 mg Tablet KALK 600 600 0 600 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
101 Kalsium Gluconas Injeksi Vial KGI 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
102 Kaptopril 12,5 mg Tablet KAP1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
103 Kaptopril 25 mg Tablet KAP2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
104 Karbamazepin tab 200 mg Tablet KAR 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
105 Ketamin inj 10 mg/ml Ampul KET 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
106 Klofazimil kaps 100 mg Kapsul KLOF 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
107 Klindamycin 150 mg Tablet KLIN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
108 Kloramphenikol 250 mg Tablet KLOR1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
109 Kloramphenikol salep mata 1 % Tube KLOSM 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
110 Kloramphenikol tetes telinga 3 % Botol KLOTT 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
111 Kloramfenikol Suspensi 125 mg/5 m Botol KLOS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
112 Kloramfenikol Tetes mata 0,5% Botol KLOTM 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
113 Klorfeniramin maleat (CTM) tab 4 m Tablet CTM 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
114 Klorpromazin Hcl inj 25 mg/I ml Ampul CPZ1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
115 Klorpromazin Hcl tab 100 mg Tablet CPZ2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
116 Kodein 10 mg tab Tablet KOD 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
117 Kotrimoksazole Dewasa tab 480 mg Tablet KOT1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
118 Kotrimoksazole ped tab 120 mg Tablet KOT2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
119 Kotrimoksazole Susp Botol KOTS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
120 Kuinin Sulfat tab 222 mg Tablet KST 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
121 Levofloksasin tab 500 mg Tablet LEV 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
122 Lidokain 2% injeksi Ampul LIDO1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
123 Lidokain Komp Inj Ampul LIDO2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
124 Loperamid HCl tablet 2 mg Tablet LOP 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
125 Magnesium sulf inj 20%-25 ml Ampul MGS1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
126 Magnesium sulf inj 40%-25 ml Ampul MGS2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
127 Mebendazole sirup 100 mg/5 ml Botol MEB1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
128 Mebendazole tab 100 mg Tablet MEB2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
129 Metformin HCl Tab 500 mg Tablet MET 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
130 Metil Dopa tab 250 mg Tablet MDT 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
131 Metil Ergometrin Inj 0,200 mg-1 ml Ampul ME1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
132 Metil Ergometrin tab 0.125 mg Tablet ME2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
133 Metil Prednisolon tab 4 mg Tablet MEP 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
134 Metoklopramid injeksi 5 mg/ml @2 mlAmpul MTK1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
135 Metoklopramid tab 10 mg ( Tomit tabTablet MTK2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
136 Metronidazol Infus 500 mg/100 ml Botol 10 MTR1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
137 Metronidazol 250 mg Tablet MTR2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
138 Metronidazol 500 mg Tablet MTR3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
139 Mikonazole Krim / salep 2% Tube MOK 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
140 Mineral Mix sachet 8gr Sachet MMS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
141 Mg Sulfat Serbuk 30 gram Sachet MGSS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
142 Na. Bikarbonat tab 500 mg Tablet NAB 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
143 Na. Diklofenac 25 mg Tablet NAD1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
144 Na. Diklofenac 50 mg Tablet NAD2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
145 Na. Fluoresin tetes mata 2 % Botol NAF 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
146 Na. Tiosulfat inj 25 %-10 ml Ampul NAT 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
147 Natrium Klorida lart inf 0.9% Botol NAK 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
148 Nifedipin tab 10 mg Tablet NIF 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
149 Nistatin 100.000 iu tab vag Tablet NIS1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
150 Nistatin 500.000 iu tab Tablet NIS2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
151 OAT-FDC Kategori 1 Paket OAT1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
152 OAT-FDC Kategori 2 Paket OAT2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
153 Obat Batuk hitam (OBH) sirup 100 Botol OBH 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
154 Obat Kategori Anak (kombipak anak Paket OATA 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
155 Obat Kategori Sisipan Paket OKS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
156 Oksitetrasiklin Hcl Inj 50 mg/10 ml Ampul OKTIN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
157 Oksitetrasiklin SK 3% Tube OKTSK 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
158 Oksitetrasiklin SM 1 % Tube OKTSM 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
159 Oksitosin inj 10 iu/1ml Ampul OTS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
160 Oseltamivir 75 mg Tablet OSE 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
161 Papaverin Injeksi 40 mg/ml Ampul PAP1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
162 Papaverin tab 40 mg Tablet PAP2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
163 Paraformaldehid tab 1 gr Tablet PAR 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
164 Parasetamol Drops Botol PARAD 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
165 Parasetamol sirup 120 mg/5 ml Botol PARAS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
166 Parasetamol tab 100 mg Tablet PARA1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
167 Parasetamol tab 500 mg Tablet PARA5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
168 Petidin inj 50 mg/2 ml Ampul PET 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
169 Pilokarpin tetes mata 2 % Botol PIL 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
170 Pirantel pamoat tab 125 mg Tablet PIR 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
171 Pirazinamid tab 500 mg Tablet PIZ 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
172 Piridoksin tab 10 mg Tablet B6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
173 Piroksicam 10 mg Tablet PIK1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
174 Piroksicam 20 mg Tablet PIK2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
175 Prazikuantel 600 mg tab Tablet PRAZ 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
176 Prednison 5 mg tab Tablet PRED 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
177 Primakuin 15 mg tab Tablet PRIM 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
178 Prokain Benzil Penisilin 3 Jt inj Vial PROK 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
179 Propanolol 40 mg tab Tablet PROP 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
180 Propiltiourasil 100 mg tab Tablet PTU 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
181 Ranitidin Inj 25 mg/ 2 ml Ampul RAN1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
182 Ranitidin tab 150 mg Tablet RAN2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
183 Reserpin 0,10 mg tab Tablet RES1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
184 Reserpin 0,25 mg tab Tablet RES2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
185 Retinol ( Vit A ) 200.000 iu Kap Kapsul VITA1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
186 Retinol ( Vit.A) 100.000 UI Kapsul VITA2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
187 Rifampisin 300 mg kaps Tablet RIF1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
188 Rifampisin 450 mg tab Tablet RIF2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
189 Rifampisin 600 mg kaplet Tablet RIF3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
190 Ringer Laktate lart infus Botol RL 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
191 S. Anti Bisa Ular poli inj 5 ml(ABU I) Vial ABU1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
192 S. Anti Difteri inj 20.000 iu ( ADS ) Vial ADS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
193 S. Anti Tetanus inj 1.500 iu/Amp ( A Ampul ATS1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
194 S. Anti Tetanus inj 20.000 iu/Amp ( Vial ATS2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
195 Salbutamol 2 mg tab Tablet SAL1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
196 Salbutamol 4 mg tab Tablet SAL2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
197 Salep 2-4 komb Pot S2-4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
198 Salisil Bedak 2 % Kotak SB2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
199 Salisil Spiritus 10 % Botol SS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
200 Sefadroxil 500 mg kapsul Tablet SEF 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
201 Sefotaxim Injeksi 1 gram Ampul SET 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
202 Seftriaxon Inj 1 gram Ampul STR 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
203 Sianokobalamin (Vit B12) inj Ampul B12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
204 Simetidin tab 200 mg Tablet SIM 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
205 Simvastatin 10 mg tab Tablet SIV 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
206 Siprofloksasin 500 mg tab Tablet SPRO 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
207 Streptomisin inj 1500 mg /vial Vial STREP 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
208 Sulfasetamid tts mata 15% Botol SULF 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
209 Tablet tambah darah komb Tablet FE 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
210 Tetrakain tetes mata 0,5% Botol TTM 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
211 Tetrasiklin 250 mg Tablet TETR1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
212 Tetrasiklin 500 mg Tablet TETR2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
213 Thiamin ( Vit B1 ) 50 mg tab Tablet VB1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
214 Thiamin ( Vit B1 ) inj 100 mg/Amp Ampul B1I 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
215 Thiamphenkol 500 mg cap Kapsul THIA1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
216 Tiamfenikol Suspensi ( Conucol Dry Botol THAI2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
217 Tiopental Na. Serbuk 1000 mg/Amp Ampul TNS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
218 Tramadol 50 mg Tablet TD 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
219 Triheksipenidil Hcl 2 mg tab Tablet TPD 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
220 Vitamin B Kompleks tab Tablet VBC 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
221 Yodium povidon 10 % 30 ml Botol YOD1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
222 Yodium Povidon 10 % 300 ml Botol YOD2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
223 Yodium Povidon 10% 1 Liter Botol YOD3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
224 Zink 20 mg Tablet dispersible Tablet ZNK1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
225 Zink Syrup Botol ZNK2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
LUAR - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Adona injeksi Ampul ADI 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Alinamin F injeksi Ampul ALIN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Antrain inj Ampul ATR 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Asering Larutan Infus Botol ASER 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Attapulgite tablet komb (Diaform/Ne Tablet ATK 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Bismecon Gel Tube BIS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Bufacom (Triamsinolon in oral base) Tube BUF 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Dulcolax supp 5 mg Supposit DUL1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Dulcolax tab Tablet DUL2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Demacolin tab Tablet DEM 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Fludane Syrup Botol FLUD1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Fludane Tablet Tablet FLUD2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 Gitas Plus Inj Ampul GTP1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 Gitas Plus tablet / Spasmal tablet Tablet GTP2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Ka-En 3 A Botol KN3A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 Ka-En 3 B Botol KN3B 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
 17 Kombivent Inhalasi Ampul KOMB 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
18 Lakto B Sachet LKB 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 Lynoral tab Tablet LYN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 Lysmin ( Lysin ) Sirup Botol LYS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
21 Multivitamin (Ultravita tab / Kurkume Tablet MULTF 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 Metioson tab Tablet METH 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 Neurobion tablet Tablet NUER1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 Neurovit E tablet Tablet NEUR2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 Opixitrol eye drop Botol OED 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
26 Pamol 125 mg Supp Supposit MOLSU 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
27 Scabicid krim Tube SCAB 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
28 Tensigard Tablet TENSI 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
OBAT - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Air Raksa use Dental Botol ARD 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Bonding Botol BON 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Cresophen Botol CRES 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Dentorit pasta ( Cavit G ) Set DEN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Devitalisasi pasta (non arsen) Botol DEV1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Devitalisasi pasta (arsen) Botol DEV2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Etching Botol ETC 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Etil Klorida semprot Botol EKS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Eugenol cairan Botol EGC 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Glass Ionomer cement ART / Fuji I Set GLC 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Kalsium Hidroksida pasta Set KHP 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Komposit A2 Anterior Set KA2A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 Komposit A2 Posterior Set KA2P 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 Monokamper mentol cair (CHKM) Botol CHKM 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Mummifying pasta Set MUMP 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 Polikresulen (Albothyl) Botol POLI 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 Semen seng fosfat serbuk & cair Set SSF 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
18 Silver Amalgam Serbuk 65-75 % Set SAS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 Solare Tube SOLR 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 Spon Gelatin 1x1x1 cm cube SG11 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
21 Temporary stoping fletcher serbuk&cSet TSF 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 Trikresolformalin (TKF) cair Botol TKF 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
PERB - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Alat Suntik Sekali Pakai 0,05 ml Set ASS1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Alat Suntik Sekali Pakai 0,5 ml Set ASS2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Alat Suntik Sekali Pakai 1 ml Set ASS3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Alat Suntik Sekali Pakai 3 ml / 2,5 m Set ASS4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Alat Suntik Sekali Pakai 5 ml Set ASS5 2 2 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Alat Suntik Sekali Pakai 10 ml Set ASS10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
 7 Aqua Gel Botol AQG 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Blood set Set BLD 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Catgut/Benang bedah no 3/0 (p&c) Set GUT1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Catgut Cromic no. 3/0 100 m Roll GUT2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Etanol 70 % 1 L Botol ETN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Hidrogen Peroksida ( H2O2 ) 3% Botol 10 H2O2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 Infusion Set Anak Set ISA 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 Infusion Set Dewasa Set ISD 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Jarum Jahit (Bedah) No 9 s/d 14 Biji JJB 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 Kapas Berlemak 500 gr Bungkus KB5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 Kapas Pembalut/Absorben 250 gr Bungkus KPA 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
18 Kasa Pembalut 2 X 80 cm Roll KP1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 Kasa Kompres 40/40 steril Roll KP2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 Kasa Pembalut 4 X 15 cm Roll KP3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
21 Kasa Pembalut 4 X 3 cm Roll KP4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 Lisol (Kresol tersaponifikasi 50%) 1 l Botol LKT 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 Masker Set MAS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 Mess Biji MES 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 Pembalut gibs 3 inchi Biji GIB 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
26 Plester 5 yard X 2 inch Roll PLES 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
27 Pot Sputum diameter 7 cm Biji POT 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
28 Sarung Tangan Steril ( Handscoun) Set STS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
29 Sarung Tangan Non Steril Set STN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
30 Silk ( Benang Bedah Sutera) N0 3/0 Set SILK1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
31 Silk no. 3/0 100 m Roll SILK2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
32 IV. Catheter no. 18 Set IV1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
33 IV. Catheter no. 20 Set IV2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
34 IV. Catheter no. 22 Set IV3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
35 IV. Catheter no. 24 Set IV4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
36 Wing nedle Set WN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
REAG - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Amoniak ( 100 ml ) Botol AM1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Anisol ( 100 ml ) Botol AN1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Aquadest steril 1 liter Botol AQ1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Asam asetat 6 % ( 100 ml ) Botol AA6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Asam Klorida 0,1 N ( HCl 0,1 N ) ( 1 Botol AK1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Asam Sulfosalisilat 20 % ( 100 ml ) Botol AS2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Barium Klorida ( 100 ml ) Botol BK1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Benedict ( 100 ml ) Botol BD1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Carbol Gentian Violet ( 100 ml ) Botol CGV1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 EDTA ( 100 ml ) Botol EDTA 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
 11 Eosin 2 % ( 100 ml ) Botol ESN1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Etanol Asam 100ml Botol EA1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 Eter Alkohol Botol EAL 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 Fauchet ( 100 ml ) Botol FAU1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Felling A Botol FELA 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 Felling B Botol FELB 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 Giemsa stain Botol GMS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
18 Golongan Darah A,B,O Set GD 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 Hayem ( 100 ml ) Botol HAY1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 Iodium akohol ( 100 ml ) Botol IA1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
21 Karbon Fuksin Botol KF1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 Kinyoun ( 100 ml ) Botol KIN1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 Lugol 1 % ( 100 ml ) Botol LUG1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 Metanol Botol MET1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 Metilen Biru ( 100 ml ) Botol MB1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
26 NACL 0,9% ( 100 ml ) Botol NA1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
27 Oil Imerson ( 100 ml ) Botol OI1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
28 Reesecher ( 100 ml ) Botol RE1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
29 Schlesinger ( 100 ml ) Botol SC1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
30 Spiritus Bakar ( 1 liter ) Botol SB1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
31 Turk ( 100 ml ) Botol TUR1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
32 Widal Set WID1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
33 Xylol ( 100 ml ) Botol XIL1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
34 Zeil nelson set ( ZN set ) Set XZNS1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
REAGE - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Malaria Test Stik MTT 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Dengue Test Stik DT 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 HbsAg Test Stik HBS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 HIV 1/2/0 divice test whole blood te Stik HIV 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 HCV Test Stik HCV 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Reagen Albumin Botol RA 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Reagen Alkalin Fosfatase Botol RAF 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Reagen Asam Urat Botol RAU 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Reagen Billirubin Total Botol RBT 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Reagen Billirubin Direct Botol RBD 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Reagen Glukosa Botol RG 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Reagen Hb Cyanmeth Botol RHC 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 Reagen Kolesterol Botol RK 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 Reagen Kreatinin Botol RKN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Reagen SGOT Botol SGOT 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 Reagen SGPT Botol SGT 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 Reagen Total Protein Botol RTP 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
 18 Reagen Trigliserida Botol RTG 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 Reagen Ureum Botol RU 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 Reagen VDRL carbon antigen Botol VDRL 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
21 Reagen TPHA Stik TPHA 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 Urine Strip 10 parameter Stik US1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Obat - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

UMUM
JUMLAH KUNJUNGAN ASKES JUMLAH
BAYAR TIDAK BAYAR
KERJA

MENGETAHUI/MENYETUJUI YANG MEMINTA/MELAPOR YANG MENERIMA

KEPALA DINKES DT. II YANG MENYERAHKAN KEPALA PUSKESMAS PETUGAS PUSKESMAS

(…………………………………..) (……………………………) (…………………………) ...................................

-
AN DAN LEMBAR PERMINTAAN OBAT
( LPLPO )

PEMEKAIAN PERTANGGAL PERMI

10 NTAAN
26 27 28 29 30 31

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-
 LAPORAN PEMAKAIAN DAN LEMBA
( LPLPO )
KODE PUSKESMAS : 282002
PUSTU :..................................
KECAMATAN : .................................
KAB/KODYA : ...................................
PROPINSI :

SATUA Kode Stok Peneri Persdi PEMA SISA

NO NAMA OBAT N Awal maan aan KAIAN AKHIR
1 2 3 4 5 6 [7]=(5 [8]=S( [9]=(7 1 2 3 4 5
+6) 10) -8)
1 ACT tab Tablet ACT 0 0 0 0 0 0 0 0 0 0
2 Albendazol tab 400 mg Tablet ALB 9 0 9 0 9 0 0 0 0 0
3 Alopurinol 100 mg Tablet ALP1 0 0 0 0 0 0 0 0 0 0
4 Alopurinol 300 mg Tablet ALP2 0 0 0 0 0 0 0 0 0 0
5 Ambroxol tablet 30 mg Tablet AMB 0 0 0 0 0 0 0 0 0 0
6 Aminophilin inj 24 mg/ml-10 ml Ampul AMN1 0 0 0 0 0 0 0 0 0 0
7 Aminophilin tab 200 mg Tablet AMN2 44 0 44 6 38 0 0 0 0 0
8 Amitriptilin Hcl tab 25 mg Tablet AMT 0 0 0 0 0 0 0 0 0 0
9 Amlodipin tab 10 mg Tablet AMD1 0 0 0 0 0 0 0 0 0 0
10 Amlodipin tab 5 mg Tablet AMD2 0 0 0 0 0 0 0 0 0 0
11 Amoksisilin 500 mg Kaplet AMOK5 4 300 304 252 52 6 0 0 12 0
12 Amoksisilin kaps 250 mg Kapsul AMOK2 64 0 64 64 0 0 10 16 0 0
13 Amoksisilin SK 125mg/5ml Botol AMOKS 0 0 0 0 0 0 0 0 0 0
14 Ampisilin Serbuk Injeksi 1000 mg/ml Ampul AMP 0 0 0 0 0 0 0 0 0 0
15 Antalgin (metampiron) tab 500 mg Tablet ANT1 0 0 0 0 0 0 0 0 0 0
16 Antalgin inj 250 mg/ml-2 ml Ampul ANT2 0 0 0 0 0 0 0 0 0 0
17 Antasida DOEN Syrup Botol AND1 0 0 0 0 0 0 0 0 0 0
18 Antasida DOEN tab Komb Tablet AND2 250 0 250 54 196 0 6 0 6 0
19 Antibakteri DOEN salep Komb Tube ATB 0 0 0 0 0 0 0 0 0 0
20 Antifungi DOEN salep Komb Tube ATF 0 0 0 0 0 0 0 0 0 0
21 Antihemoroid DOEN Komb Supposit ATM 0 0 0 0 0 0 0 0 0 0
22 Antimigren DOEN tab Komb Tablet ATG 0 0 0 0 0 0 0 0 0 0
23 Antiparkinson DOEN tab Komb Tablet ATP 0 0 0 0 0 0 0 0 0 0
24 Aqua proinjeksi steril bebas pirogen Vial API 0 0 0 0 0 0 0 0 0 0
25 Asam Askorbat (Vit C) tab 50 mg Tablet VITC 851 0 851 114 737 18 6 6 6 0
26 Asam folat 1 mg Tablet AFOL 256 0 256 0 256 0 0 0 0 0
27 Asam mefenamat 500 mg Tablet ASMEF 9 200 209 150 59 6 6 0 12 0
28 Asetosal tab 100 mg Tablet AST 0 0 0 0 0 0 0 0 0 0
29 Asiklovir 400 mg Tablet ASK1 0 0 0 0 0 0 0 0 0 0
30 Asiklovir 5 % krim Tube ASK2 0 0 0 0 0 0 0 0 0 0
31 Atropin Sulfat inj 0,25mg/ml-1 ml Ampul ATR1 0 0 0 0 0 0 0 0 0 0
32 Atropin Sulfat tab 0,5 mg Tablet ATR2 0 0 0 0 0 0 0 0 0 0
33 Atropin tetes mata 0,5% Botol ATR3 0 0 0 0 0 0 0 0 0 0
34 Benzatin benzil penisilin inj 2.4 jt iu/ Vial BBP 0 0 0 0 0 0 0 0 0 0
35 Betahistin Mesilat tablet 6 mg Tablet BMT 0 0 0 0 0 0 0 0 0 0
36 Betametason krim 0,1% Tube BTM 0 0 0 0 0 0 0 0 0 0
37 Bromheksin tablet 8 mg Tablet BRO 0 0 0 0 0 0 0 0 0 0
38 Dapson tab 100 mg Tablet DAP 0 0 0 0 0 0 0 0 0 0
39 Deksametason inj 5 mg/ml-ml Ampul DEK1 0 0 0 0 0 0 0 0 0 0
40 Deksametason tab 0.5 mg Tablet DEK2 0 0 0 0 0 0 0 0 0 0
41 Dekstrometorphan sirup 10mg/5ml Botol DET1 0 0 0 0 0 0 0 0 0 0
42 Dekstrometorphan tab 15 mg Tablet DET2 0 0 0 0 0 0 0 0 0 0
43 Diazepam inj 5 mg/ml-2ml Ampul DIAZ1 0 0 0 0 0 0 0 0 0 0
44 Diazepam larutan rektal 4 mg/2 ml ( Tube DIAZ2 0 0 0 0 0 0 0 0 0 0
45 Diazepam tab 2 mg Tablet DIAZ3 0 0 0 0 0 0 0 0 0 0
46 Diazepam tab 5 mg Tablet DIAZ4 0 0 0 0 0 0 0 0 0 0
47 Dietilkarbamazin sitrat tab 100 mg Tablet DKB 0 0 0 0 0 0 0 0 0 0
48 Difenhidramin Hcl Inj 10 mg/ml-1ml Ampul DIF 133 0 133 5 128 1 0 0 0 0
49 Digoksin tab 0.25 mg Tablet DGK1 0 0 0 0 0 0 0 0 0 0
50 Digoksin tab 0.5 mg Tablet DGK2 0 0 0 0 0 0 0 0 0 0
51 Dimenhidrinat tablet 50 mg Tablet DMD 0 0 0 0 0 0 0 0 0 0
52 Ekstrak Beladon 10 mg Tablet EB 0 0 0 0 0 0 0 0 0 0
53 Ephedrin Hcl tab 25 mg Tablet EPH 0 0 0 0 0 0 0 0 0 0
54 Ephinefrin Hcl (Adrenalin) inj 0,1%/ Ampul EHP 0 0 0 0 0 0 0 0 0 0
55 Erithromisin 500 mg tab Tablet ERI1 0 0 0 0 0 0 0 0 0 0
56 Eritromisin 250 mg Tablet ERI2 0 0 0 0 0 0 0 0 0 0
57 Erithromisin sirup 200 mg/5 ml Botol ERI3 0 0 0 0 0 0 0 0 0 0
58 Etakridin (Rivanol) Lart 0,1% Botol ETA1 0 0 0 0 0 0 0 0 0 0
59 Etambutol Hcl Tb 250 mg Tablet ETM 0 0 0 0 0 0 0 0 0 0
60 Fenitoin Natrium inj 50 mg/ml @ 2m Ampul FN1 0 0 0 0 0 0 0 0 0 0
61 Fenitoin Natrium kaps 100 mg Kapsul FN2 0 0 0 0 0 0 0 0 0 0
62 Fenitoin Natrium Kaps 30 mg Tablet FN3 0 0 0 0 0 0 0 0 0 0
63 Fenobarbital inj 50 mg/ml Ampul FBR1 0 0 0 0 0 0 0 0 0 0
64 Fenobarbital tab 100 mg Tablet FBR2 0 0 0 0 0 0 0 0 0 0
65 Fenobarbital tab 30 mg Tablet FBR3 0 0 0 0 0 0 0 0 0 0
66 Fenoksimetil penisilin tab 250 mg Tablet FPT1 0 0 0 0 0 0 0 0 0 0
67 Fenoksimetil penisilin tab 500 mg Tablet FPT2 0 0 0 0 0 0 0 0 0 0
68 Fenol gliserol tetes Telinga 10 % Botol FGT 0 0 0 0 0 0 0 0 0 0
69 Fitomenadion (VitK) inj 10mg/ml-1m Ampul VITK1 28 0 28 0 28 0 0 0 0 0
70 Fitomenadion (VitK) tab 10 mg Tablet VITK2 74 0 74 0 74 0 0 0 0 0
71 Furosemid tab 40 mg Tablet FRO1 0 0 0 0 0 0 0 0 0 0
72 Furosemid Inj 10 mg/ml Ampul FRO2 0 0 0 0 0 0 0 0 0 0
 73 Gameksan Lotion 1 % Botol GAM 0 0 0 0 0 0 0 0 0 0
74 Garam Oralit untuk 200 ml air Sachet GLIT1 96 0 96 54 42 0 0 0 0 0
75 Gemfibrozil 300 mg Tablet GEM 0 0 0 0 0 0 0 0 0 0
76 Gentamsin Salep Kulit 0,1% Tube GEN1 8 0 8 3 5 0 0 0 0 0
77 Gentamycin 80 mg/2 ml injeksi Ampul GEN2 0 0 0 0 0 0 0 0 0 0
78 Gentian Violet lart 1% Botol GV 0 0 0 0 0 0 0 0 0 0
79 Glibenklamid 5 mg Tablet GLIB 0 0 0 0 0 0 0 0 0 0
80 Gliseril Guaiyakolat tab 100 mg Tablet GG 771 0 771 48 723 6 0 0 0 0
81 Gliserin Botol GLR 0 0 0 0 0 0 0 0 0 0
82 Glukosa Lart Inf 10 % steril Botol GLU1 0 0 0 0 0 0 0 0 0 0
83 Glukosa Lart Inf 40 % steril Vial GLU2 0 0 0 0 0 0 0 0 0 0
84 Glukosa Lart Inf 5 % steril Botol GLU3 0 0 0 0 0 0 0 0 0 0
85 Grisiofulvin tab 125 mg Tablet GRI 0 0 0 0 0 0 0 0 0 0
86 Haloperidol tab 0.5 mg Tablet HAL1 0 0 0 0 0 0 0 0 0 0
87 Haloperidol tab 1.5 mg Tablet HAL2 0 0 0 0 0 0 0 0 0 0
88 Hidroklortiazid (HCT) tab 25 mg Tablet HCT 0 0 0 0 0 0 0 0 0 0
89 Hidrokortison krim 2.5 % Tube HDR 0 0 0 0 0 0 0 0 0 0
90 Hiosin N- Butilbromida Tab 10 mg Tablet HNB1 0 0 0 0 0 0 0 0 0 0
91 Hiosin N- Butilbromida Inj 20 mg/ml Ampul HNB2 0 0 0 0 0 0 0 0 0 0
92 Ibuprofen 200 mg Tablet IBU1 3 0 3 0 3 0 0 0 0 0
93 Ibuprofen 400 mg Tablet IBU2 0 100 100 12 88 6 0 0 0 0
94 Ichtyol salp Pot ICH 0 0 0 0 0 0 0 0 0 0
95 Iodiol softcaps Kapsul IOD 0 0 0 0 0 0 0 0 0 0
96 Isoniazid tab 300 mg Tablet ISN 0 0 0 0 0 0 0 0 0 0
97 Isosorbid dinitrat tab 5 mg Tablet ISO 0 0 0 0 0 0 0 0 0 0
98 Kalium Permanganat Pot KP 0 0 0 0 0 0 0 0 0 0
99 Kalium Diklofenak tab 50 mg Tablet KD 0 0 0 0 0 0 0 0 0 0
100 Kalsium Laktas (Kalk) tab 500 mg Tablet KALK 1341 0 1341 330 1011 12 6 6 12 0
101 Kalsium Gluconas Injeksi Vial KGI 0 0 0 0 0 0 0 0 0 0
102 Kaptopril 12,5 mg Tablet KAP1 175 0 175 18 157 0 0 0 0 0
103 Kaptopril 25 mg Tablet KAP2 0 0 0 0 0 0 0 0 0 0
104 Karbamazepin tab 200 mg Tablet KAR 0 0 0 0 0 0 0 0 0 0
105 Ketamin inj 10 mg/ml Ampul KET 0 0 0 0 0 0 0 0 0 0
106 Klofazimil kaps 100 mg Kapsul KLOF 0 0 0 0 0 0 0 0 0 0
107 Klindamycin 150 mg Tablet KLIN 0 0 0 0 0 0 0 0 0 0
108 Kloramphenikol 250 mg Tablet KLOR1 0 0 0 0 0 0 0 0 0 0
109 Kloramphenikol salep mata 1 % Tube KLOSM 0 0 0 0 0 0 0 0 0 0
110 Kloramphenikol tetes telinga 3 % Botol KLOTT 2 5 7 1 6 1 0 0 0 0
111 Kloramfenikol Suspensi 125 mg/5 m Botol KLOS 0 0 0 0 0 0 0 0 0 0
112 Kloramfenikol Tetes mata 0,5% Botol KLOTM 0 0 0 0 0 0 0 0 0 0
113 Klorfeniramin maleat (CTM) tab 4 m Tablet CTM 254 0 254 138 116 6 12 0 0 0
114 Klorpromazin Hcl inj 25 mg/I ml Ampul CPZ1 0 0 0 0 0 0 0 0 0 0
115 Klorpromazin Hcl tab 100 mg Tablet CPZ2 0 0 0 0 0 0 0 0 0 0
116 Kodein 10 mg tab Tablet KOD 0 0 0 0 0 0 0 0 0 0
117 Kotrimoksazole Dewasa tab 480 mg Tablet KOT1 97 100 197 0 197 0 0 0 0 0
118 Kotrimoksazole ped tab 120 mg Tablet KOT2 0 0 0 0 0 0 0 0 0 0
119 Kotrimoksazole Susp Botol KOTS 5 0 5 4 1 0 0 0 0 0
120 Kuinin Sulfat tab 222 mg Tablet KST 0 0 0 0 0 0 0 0 0 0
121 Levofloksasin tab 500 mg Tablet LEV 0 0 0 0 0 0 0 0 0 0
122 Lidokain 2% injeksi Ampul LIDO1 0 0 0 0 0 0 0 0 0 0
123 Lidokain Komp Inj Ampul LIDO2 28 0 28 0 28 0 0 0 0 0
124 Loperamid HCl tablet 2 mg Tablet LOP 0 0 0 0 0 0 0 0 0 0
125 Magnesium sulf inj 20%-25 ml Ampul MGS1 0 0 0 0 0 0 0 0 0 0
126 Magnesium sulf inj 40%-25 ml Ampul MGS2 0 0 0 0 0 0 0 0 0 0
127 Mebendazole sirup 100 mg/5 ml Botol MEB1 0 0 0 0 0 0 0 0 0 0
128 Mebendazole tab 100 mg Tablet MEB2 0 0 0 0 0 0 0 0 0 0
129 Metformin HCl Tab 500 mg Tablet MET 0 0 0 0 0 0 0 0 0 0
130 Metil Dopa tab 250 mg Tablet MDT 0 0 0 0 0 0 0 0 0 0
131 Metil Ergometrin Inj 0,200 mg-1 ml Ampul ME1 10 0 10 0 10 0 0 0 0 0
132 Metil Ergometrin tab 0.125 mg Tablet ME2 90 0 90 0 90 0 0 0 0 0
133 Metil Prednisolon tab 4 mg Tablet MEP 0 0 0 0 0 0 0 0 0 0
134 Metoklopramid injeksi 5 mg/ml @2 ml
Ampul MTK1 0 0 0 0 0 0 0 0 0 0
135 Metoklopramid tab 10 mg ( Tomit tabTablet MTK2 0 0 0 0 0 0 0 0 0 0
136 Metronidazol Infus 500 mg/100 ml Botol 10 MTR1 0 0 0 0 0 0 0 0 0 0
137 Metronidazol 250 mg Tablet MTR2 0 0 0 0 0 0 0 0 0 0
138 Metronidazol 500 mg Tablet MTR3 0 0 0 0 0 0 0 0 0 0
139 Mikonazole Krim / salep 2% Tube MOK 0 0 0 0 0 0 0 0 0 0
140 Mineral Mix sachet 8gr Sachet MMS 0 0 0 0 0 0 0 0 0 0
141 Mg Sulfat Serbuk 30 gram Sachet MGSS 0 0 0 0 0 0 0 0 0 0
142 Na. Bikarbonat tab 500 mg Tablet NAB 0 0 0 0 0 0 0 0 0 0
143 Na. Diklofenac 25 mg Tablet NAD1 0 0 0 0 0 0 0 0 0 0
144 Na. Diklofenac 50 mg Tablet NAD2 0 0 0 0 0 0 0 0 0 0
145 Na. Fluoresin tetes mata 2 % Botol NAF 0 0 0 0 0 0 0 0 0 0
146 Na. Tiosulfat inj 25 %-10 ml Ampul NAT 0 0 0 0 0 0 0 0 0 0
147 Natrium Klorida lart inf 0.9% Botol NAK 0 0 0 0 0 0 0 0 0 0
148 Nifedipin tab 10 mg Tablet NIF 71 0 71 0 71 0 0 0 0 0
149 Nistatin 100.000 iu tab vag Tablet NIS1 0 0 0 0 0 0 0 0 0 0
150 Nistatin 500.000 iu tab Tablet NIS2 0 0 0 0 0 0 0 0 0 0
151 OAT-FDC Kategori 1 Paket OAT1 0 0 0 0 0 0 0 0 0 0
152 OAT-FDC Kategori 2 Paket OAT2 0 0 0 0 0 0 0 0 0 0
153 Obat Batuk hitam (OBH) sirup 100 Botol OBH 10 0 10 7 3 1 0 1 0 0
154 Obat Kategori Anak (kombipak anak Paket OATA 0 0 0 0 0 0 0 0 0 0
155 Obat Kategori Sisipan Paket OKS 0 0 0 0 0 0 0 0 0 0
156 Oksitetrasiklin Hcl Inj 50 mg/10 ml Ampul OKTIN 0 0 0 0 0 0 0 0 0 0
157 Oksitetrasiklin SK 3% Tube OKTSK 0 0 0 0 0 0 0 0 0 0
158 Oksitetrasiklin SM 1 % Tube OKTSM 8 0 8 6 2 0 0 1 1 0
159 Oksitosin inj 10 iu/1ml Ampul OTS 21 0 21 0 21 0 0 0 0 0
160 Oseltamivir 75 mg Tablet OSE 0 0 0 0 0 0 0 0 0 0
161 Papaverin Injeksi 40 mg/ml Ampul PAP1 0 0 0 0 0 0 0 0 0 0
162 Papaverin tab 40 mg Tablet PAP2 0 0 0 0 0 0 0 0 0 0
163 Paraformaldehid tab 1 gr Tablet PAR 0 0 0 0 0 0 0 0 0 0
164 Parasetamol Drops Botol PARAD 0 0 0 0 0 0 0 0 0 0
165 Parasetamol sirup 120 mg/5 ml Botol PARAS 22 0 22 5 17 0 0 1 0 0
166 Parasetamol tab 100 mg Tablet PARA1 0 0 0 0 0 0 0 0 0 0
167 Parasetamol tab 500 mg Tablet PARA5 244 500 744 222 522 6 6 6 12 0
168 Petidin inj 50 mg/2 ml Ampul PET 0 0 0 0 0 0 0 0 0 0
169 Pilokarpin tetes mata 2 % Botol PIL 0 0 0 0 0 0 0 0 0 0
170 Pirantel pamoat tab 125 mg Tablet PIR 0 0 0 0 0 0 0 0 0 0
171 Pirazinamid tab 500 mg Tablet PIZ 0 0 0 0 0 0 0 0 0 0
172 Piridoksin tab 10 mg Tablet B6 1060 0 1060 54 1006 0 0 0 0 0
173 Piroksicam 10 mg Tablet PIK1 0 0 0 0 0 0 0 0 0 0
174 Piroksicam 20 mg Tablet PIK2 0 0 0 0 0 0 0 0 0 0
175 Prazikuantel 600 mg tab Tablet PRAZ 0 0 0 0 0 0 0 0 0 0
176 Prednison 5 mg tab Tablet PRED 911 0 911 90 821 6 12 0 0 0
177 Primakuin 15 mg tab Tablet PRIM 0 0 0 0 0 0 0 0 0 0
178 Prokain Benzil Penisilin 3 Jt inj Vial PROK 0 0 0 0 0 0 0 0 0 0
179 Propanolol 40 mg tab Tablet PROP 0 0 0 0 0 0 0 0 0 0
180 Propiltiourasil 100 mg tab Tablet PTU 0 0 0 0 0 0 0 0 0 0
181 Ranitidin Inj 25 mg/ 2 ml Ampul RAN1 0 0 0 0 0 0 0 0 0 0
182 Ranitidin tab 150 mg Tablet RAN2 0 0 0 0 0 0 0 0 0 0
183 Reserpin 0,10 mg tab Tablet RES1 0 0 0 0 0 0 0 0 0 0
184 Reserpin 0,25 mg tab Tablet RES2 0 0 0 0 0 0 0 0 0 0
185 Retinol ( Vit A ) 200.000 iu Kap Kapsul VITA1 0 0 0 0 0 0 0 0 0 0
186 Retinol ( Vit.A) 100.000 UI Kapsul VITA2 0 0 0 0 0 0 0 0 0 0
187 Rifampisin 300 mg kaps Tablet RIF1 0 0 0 0 0 0 0 0 0 0
188 Rifampisin 450 mg tab Tablet RIF2 0 0 0 0 0 0 0 0 0 0
189 Rifampisin 600 mg kaplet Tablet RIF3 0 0 0 0 0 0 0 0 0 0
190 Ringer Laktate lart infus Botol RL 10 0 10 0 10 0 0 0 0 0
191 S. Anti Bisa Ular poli inj 5 ml(ABU I) Vial ABU1 0 0 0 0 0 0 0 0 0 0
192 S. Anti Difteri inj 20.000 iu ( ADS ) Vial ADS 0 0 0 0 0 0 0 0 0 0
193 S. Anti Tetanus inj 1.500 iu/Amp ( A Ampul ATS1 0 0 0 0 0 0 0 0 0 0
194 S. Anti Tetanus inj 20.000 iu/Amp ( Vial ATS2 0 0 0 0 0 0 0 0 0 0
195 Salbutamol 2 mg tab Tablet SAL1 0 0 0 0 0 0 0 0 0 0
196 Salbutamol 4 mg tab Tablet SAL2 0 0 0 0 0 0 0 0 0 0
197 Salep 2-4 komb Pot S2-4 0 0 0 0 0 0 0 0 0 0
198 Salisil Bedak 2 % Kotak SB2 5 0 5 1 4 0 0 0 0 0
199 Salisil Spiritus 10 % Botol SS 0 0 0 0 0 0 0 0 0 0
200 Sefadroxil 500 mg kapsul Tablet SEF 0 0 0 0 0 0 0 0 0 0
201 Sefotaxim Injeksi 1 gram Ampul SET 0 0 0 0 0 0 0 0 0 0
202 Seftriaxon Inj 1 gram Ampul STR 0 0 0 0 0 0 0 0 0 0
203 Sianokobalamin (Vit B12) inj Ampul B12 10 20 30 16 14 1 0 0 0 0
204 Simetidin tab 200 mg Tablet SIM 0 0 0 0 0 0 0 0 0 0
205 Simvastatin 10 mg tab Tablet SIV 0 0 0 0 0 0 0 0 0 0
206 Siprofloksasin 500 mg tab Tablet SPRO 0 0 0 0 0 0 0 0 0 0
207 Streptomisin inj 1500 mg /vial Vial STREP 0 0 0 0 0 0 0 0 0 0
208 Sulfasetamid tts mata 15% Botol SULF 0 0 0 0 0 0 0 0 0 0
209 Tablet tambah darah komb Tablet FE 3180 0 3180 150 3030 0 0 0 0 0
210 Tetrakain tetes mata 0,5% Botol TTM 0 0 0 0 0 0 0 0 0 0
211 Tetrasiklin 250 mg Tablet TETR1 0 0 0 0 0 0 0 0 0 0
212 Tetrasiklin 500 mg Tablet TETR2 0 0 0 0 0 0 0 0 0 0
213 Thiamin ( Vit B1 ) 50 mg tab Tablet VB1 982 0 982 24 958 0 6 0 0 0
214 Thiamin ( Vit B1 ) inj 100 mg/Amp Ampul B1I 60 0 60 32 28 2 0 1 1 0
215 Thiamphenkol 500 mg cap Kapsul THIA1 0 0 0 0 0 0 0 0 0 0
216 Tiamfenikol Suspensi ( Conucol Dry Botol THAI2 0 0 0 0 0 0 0 0 0 0
217 Tiopental Na. Serbuk 1000 mg/Amp Ampul TNS 0 0 0 0 0 0 0 0 0 0
218 Tramadol 50 mg Tablet TD 0 0 0 0 0 0 0 0 0 0
219 Triheksipenidil Hcl 2 mg tab Tablet TPD 0 0 0 0 0 0 0 0 0 0
220 Vitamin B Kompleks tab Tablet VBC 1082 0 1082 216 866 12 12 0 12 0
221 Yodium povidon 10 % 30 ml Botol YOD1 4 0 4 1 3 0 0 0 0 0
222 Yodium Povidon 10 % 300 ml Botol YOD2 0 0 0 0 0 0 0 0 0 0
223 Yodium Povidon 10% 1 Liter Botol YOD3 0 0 0 0 0 0 0 0 0 0
224 Zink 20 mg Tablet dispersible Tablet ZNK1 0 0 0 0 0 0 0 0 0 0
225 Zink Syrup Botol ZNK2 0 0 0 0 0 0 0 0 0 0
LUAR - - - 0 0 0 0 0 0 0 0 0 0
1 Adona injeksi Ampul ADI 0 0 0 0 0 0 0 0 0 0
2 Alinamin F injeksi Ampul ALIN 0 0 0 0 0 0 0 0 0 0
3 Antrain inj Ampul ATR 0 0 0 0 0 0 0 0 0 0
4 Asering Larutan Infus Botol ASER 0 0 0 0 0 0 0 0 0 0
5 Attapulgite tablet komb (Diaform/Ne Tablet ATK 0 0 0 0 0 0 0 0 0 0
6 Bismecon Gel Tube BIS 0 0 0 0 0 0 0 0 0 0
7 Bufacom (Triamsinolon in oral base Tube BUF 0 0 0 0 0 0 0 0 0 0
8 Dulcolax supp 5 mg Supposit DUL1 0 0 0 0 0 0 0 0 0 0
9 Dulcolax tab Tablet DUL2 0 0 0 0 0 0 0 0 0 0
10 Demacolin tab Tablet DEM 0 0 0 0 0 0 0 0 0 0
 11 Fludane Syrup Botol FLUD1 0 0 0 0 0 0 0 0 0 0
12 Fludane Tablet Tablet FLUD2 0 0 0 0 0 0 0 0 0 0
13 Gitas Plus Inj Ampul GTP1 0 0 0 0 0 0 0 0 0 0
14 Gitas Plus tablet / Spasmal tablet Tablet GTP2 28 0 28 0 28 0 0 0 0 0
15 Ka-En 3 A Botol KN3A 0 0 0 0 0 0 0 0 0 0
16 Ka-En 3 B Botol KN3B 0 0 0 0 0 0 0 0 0 0
17 Kombivent Inhalasi Ampul KOMB 0 0 0 0 0 0 0 0 0 0
18 Lakto B Sachet LKB 0 0 0 0 0 0 0 0 0 0
19 Lynoral tab Tablet LYN 0 0 0 0 0 0 0 0 0 0
20 Lysmin ( Lysin ) Sirup Botol LYS 0 0 0 0 0 0 0 0 0 0
21 Multivitamin (Ultravita tab / Kurkume Tablet MULTF 0 0 0 0 0 0 0 0 0 0
22 Metioson tab Tablet METH 0 0 0 0 0 0 0 0 0 0
23 Neurobion tablet Tablet NUER1 0 0 0 0 0 0 0 0 0 0
24 Neurovit E tablet Tablet NEUR2 0 0 0 0 0 0 0 0 0 0
25 Opixitrol eye drop Botol OED 0 0 0 0 0 0 0 0 0 0
26 Pamol 125 mg Supp Supposit MOLSU 0 0 0 0 0 0 0 0 0 0
27 Scabicid krim Tube SCAB 0 0 0 0 0 0 0 0 0 0
28 Tensigard Tablet TENSI 0 0 0 0 0 0 0 0 0 0
OBAT - - - 0 0 0 0 0 0 0 0 0 0
1 Air Raksa use Dental Botol ARD 0 0 0 0 0 0 0 0 0 0
2 Bonding Botol BON 0 0 0 0 0 0 0 0 0 0
3 Cresophen Botol CRES 0 0 0 0 0 0 0 0 0 0
4 Dentorit pasta ( Cavit G ) Set DEN 0 0 0 0 0 0 0 0 0 0
5 Devitalisasi pasta (non arsen) Botol DEV1 0 0 0 0 0 0 0 0 0 0
6 Devitalisasi pasta (arsen) Botol DEV2 0 0 0 0 0 0 0 0 0 0
7 Etching Botol ETC 0 0 0 0 0 0 0 0 0 0
8 Etil Klorida semprot Botol EKS 0 0 0 0 0 0 0 0 0 0
9 Eugenol cairan Botol EGC 0 0 0 0 0 0 0 0 0 0
10 Glass Ionomer cement ART / Fuji I Set GLC 0 0 0 0 0 0 0 0 0 0
11 Kalsium Hidroksida pasta Set KHP 0 0 0 0 0 0 0 0 0 0
12 Komposit A2 Anterior Set KA2A 0 0 0 0 0 0 0 0 0 0
13 Komposit A2 Posterior Set KA2P 0 0 0 0 0 0 0 0 0 0
14 Monokamper mentol cair (CHKM) Botol CHKM 0 0 0 0 0 0 0 0 0 0
15 Mummifying pasta Set MUMP 0 0 0 0 0 0 0 0 0 0
16 Polikresulen (Albothyl) Botol POLI 0 0 0 0 0 0 0 0 0 0
17 Semen seng fosfat serbuk & cair Set SSF 0 0 0 0 0 0 0 0 0 0
18 Silver Amalgam Serbuk 65-75 % Set SAS 0 0 0 0 0 0 0 0 0 0
19 Solare Tube SOLR 0 0 0 0 0 0 0 0 0 0
20 Spon Gelatin 1x1x1 cm cube SG11 0 0 0 0 0 0 0 0 0 0
21 Temporary stoping fletcher serbuk&cSet TSF 0 0 0 0 0 0 0 0 0 0
22 Trikresolformalin (TKF) cair Botol TKF 0 0 0 0 0 0 0 0 0 0
PERB - - - 0 0 0 0 0 0 0 0 0 0
1 Alat Suntik Sekali Pakai 0,05 ml Set ASS1 0 0 0 0 0 0 0 0 0 0
2 Alat Suntik Sekali Pakai 0,5 ml Set ASS2 0 0 0 0 0 0 0 0 0 0
3 Alat Suntik Sekali Pakai 1 ml Set ASS3 23 100 123 0 123 0 0 0 0 0
4 Alat Suntik Sekali Pakai 3 ml / 2,5 m Set ASS4 91 0 91 46 45 4 0 1 0 0
5 Alat Suntik Sekali Pakai 5 ml Set ASS5 43 0 43 0 43 0 0 0 0 0
6 Alat Suntik Sekali Pakai 10 ml Set ASS10 0 0 0 0 0 0 0 0 0 0
7 Aqua Gel Botol AQG 0 0 0 0 0 0 0 0 0 0
8 Blood set Set BLD 0 0 0 0 0 0 0 0 0 0
9 Catgut/Benang bedah no 3/0 (p&c) Set GUT1 8 0 8 0 8 0 0 0 0 0
10 Catgut Cromic no. 3/0 100 m Roll GUT2 0 0 0 0 0 0 0 0 0 0
11 Etanol 70 % 1 L Botol ETN 1 0 1 0 1 0 0 0 0 0
12 Hidrogen Peroksida ( H2O2 ) 3% Botol 10 H2O2 0 0 0 0 0 0 0 0 0 0
13 Infusion Set Anak Set ISA 0 0 0 0 0 0 0 0 0 0
14 Infusion Set Dewasa Set ISD 6 0 6 0 6 0 0 0 0 0
15 Jarum Jahit (Bedah) No 9 s/d 14 Biji JJB 0 0 0 0 0 0 0 0 0 0
16 Kapas Berlemak 500 gr Bungkus KB5 0 0 0 0 0 0 0 0 0 0
17 Kapas Pembalut/Absorben 250 gr Bungkus KPA 1 0 1 0 1 0 0 0 0 0
18 Kasa Pembalut 2 X 80 cm Roll KP1 8 0 8 0 8 0 0 0 0 0
19 Kasa Kompres 40/40 steril Roll KP2 0 0 0 0 0 0 0 0 0 0
20 Kasa Pembalut 4 X 15 cm Roll KP3 10 0 10 0 10 0 0 0 0 0
21 Kasa Pembalut 4 X 3 cm Roll KP4 0 0 0 0 0 0 0 0 0 0
22 Lisol (Kresol tersaponifikasi 50%) 1 l Botol LKT 0 0 0 0 0 0 0 0 0 0
23 Masker Set MAS 0 0 0 0 0 0 0 0 0 0
24 Mess Biji MES 0 0 0 0 0 0 0 0 0 0
25 Pembalut gibs 3 inchi Biji GIB 0 0 0 0 0 0 0 0 0 0
26 Plester 5 yard X 2 inch Roll PLES 2 0 2 0 2 0 0 0 0 0
27 Pot Sputum diameter 7 cm Biji POT 0 0 0 0 0 0 0 0 0 0
28 Sarung Tangan Steril ( Handscoun) Set STS 17 0 17 0 17 0 0 0 0 0
29 Sarung Tangan Non Steril Set STN 0 0 0 0 0 0 0 0 0 0
30 Silk ( Benang Bedah Sutera) N0 3/0 Set SILK1 0 0 0 0 0 0 0 0 0 0
31 Silk no. 3/0 100 m Roll SILK2 0 0 0 0 0 0 0 0 0 0
32 IV. Catheter no. 18 Set IV1 0 0 0 0 0 0 0 0 0 0
33 IV. Catheter no. 20 Set IV2 0 0 0 0 0 0 0 0 0 0
34 IV. Catheter no. 22 Set IV3 0 0 0 0 0 0 0 0 0 0
35 IV. Catheter no. 24 Set IV4 0 0 0 0 0 0 0 0 0 0
36 Wing nedle Set WN 0 0 0 0 0 0 0 0 0 0
- - - - 0 0 0 0 0 0 0 0 0 0
REAG - - - 0 0 0 0 0 0 0 0 0 0
1 Amoniak ( 100 ml ) Botol AM1 0 0 0 0 0 0 0 0 0 0
2 Anisol ( 100 ml ) Botol AN1 0 0 0 0 0 0 0 0 0 0
 3 Aquadest steril 1 liter Botol AQ1 0 0 0 0 0 0 0 0 0 0
4 Asam asetat 6 % ( 100 ml ) Botol AA6 0 0 0 0 0 0 0 0 0 0
5 Asam Klorida 0,1 N ( HCl 0,1 N ) ( 1 Botol AK1 0 0 0 0 0 0 0 0 0 0
6 Asam Sulfosalisilat 20 % ( 100 ml ) Botol AS2 0 0 0 0 0 0 0 0 0 0
7 Barium Klorida ( 100 ml ) Botol BK1 0 0 0 0 0 0 0 0 0 0
8 Benedict ( 100 ml ) Botol BD1 0 0 0 0 0 0 0 0 0 0
9 Carbol Gentian Violet ( 100 ml ) Botol CGV1 0 0 0 0 0 0 0 0 0 0
10 EDTA ( 100 ml ) Botol EDTA 0 0 0 0 0 0 0 0 0 0
11 Eosin 2 % ( 100 ml ) Botol ESN1 0 0 0 0 0 0 0 0 0 0
12 Etanol Asam 100ml Botol EA1 0 0 0 0 0 0 0 0 0 0
13 Eter Alkohol Botol EAL 0 0 0 0 0 0 0 0 0 0
14 Fauchet ( 100 ml ) Botol FAU1 0 0 0 0 0 0 0 0 0 0
15 Felling A Botol FELA 0 0 0 0 0 0 0 0 0 0
16 Felling B Botol FELB 0 0 0 0 0 0 0 0 0 0
17 Giemsa stain Botol GMS 0 0 0 0 0 0 0 0 0 0
18 Golongan Darah A,B,O Set GD 0 0 0 0 0 0 0 0 0 0
19 Hayem ( 100 ml ) Botol HAY1 0 0 0 0 0 0 0 0 0 0
20 Iodium akohol ( 100 ml ) Botol IA1 0 0 0 0 0 0 0 0 0 0
21 Karbon Fuksin Botol KF1 0 0 0 0 0 0 0 0 0 0
22 Kinyoun ( 100 ml ) Botol KIN1 0 0 0 0 0 0 0 0 0 0
23 Lugol 1 % ( 100 ml ) Botol LUG1 0 0 0 0 0 0 0 0 0 0
24 Metanol Botol MET1 0 0 0 0 0 0 0 0 0 0
25 Metilen Biru ( 100 ml ) Botol MB1 0 0 0 0 0 0 0 0 0 0
26 NACL 0,9% ( 100 ml ) Botol NA1 0 0 0 0 0 0 0 0 0 0
27 Oil Imerson ( 100 ml ) Botol OI1 0 0 0 0 0 0 0 0 0 0
28 Reesecher ( 100 ml ) Botol RE1 0 0 0 0 0 0 0 0 0 0
29 Schlesinger ( 100 ml ) Botol SC1 0 0 0 0 0 0 0 0 0 0
30 Spiritus Bakar ( 1 liter ) Botol SB1 0 0 0 0 0 0 0 0 0 0
31 Turk ( 100 ml ) Botol TUR1 0 0 0 0 0 0 0 0 0 0
32 Widal Set WID1 0 0 0 0 0 0 0 0 0 0
33 Xylol ( 100 ml ) Botol XIL1 0 0 0 0 0 0 0 0 0 0
34 Zeil nelson set ( ZN set ) Set XZNS1 0 0 0 0 0 0 0 0 0 0
REAGE - - - 0 0 0 0 0 0 0 0 0 0
1 Malaria Test Stik MTT 0 0 0 0 0 0 0 0 0 0
2 Dengue Test Stik DT 0 0 0 0 0 0 0 0 0 0
3 HbsAg Test Stik HBS 0 0 0 0 0 0 0 0 0 0
4 HIV 1/2/0 divice test whole blood te Stik HIV 0 0 0 0 0 0 0 0 0 0
5 HCV Test Stik HCV 0 0 0 0 0 0 0 0 0 0
6 Reagen Albumin Botol RA 0 0 0 0 0 0 0 0 0 0
7 Reagen Alkalin Fosfatase Botol RAF 0 0 0 0 0 0 0 0 0 0
8 Reagen Asam Urat Botol RAU 0 0 0 0 0 0 0 0 0 0
 9 Reagen Billirubin Total Botol RBT 0 0 0 0 0 0 0 0 0 0
10 Reagen Billirubin Direct Botol RBD 0 0 0 0 0 0 0 0 0 0
11 Reagen Glukosa Botol RG 0 0 0 0 0 0 0 0 0 0
12 Reagen Hb Cyanmeth Botol RHC 0 0 0 0 0 0 0 0 0 0
13 Reagen Kolesterol Botol RK 0 0 0 0 0 0 0 0 0 0
14 Reagen Kreatinin Botol RKN 0 0 0 0 0 0 0 0 0 0
15 Reagen SGOT Botol SGOT 0 0 0 0 0 0 0 0 0 0
16 Reagen SGPT Botol SGT 0 0 0 0 0 0 0 0 0 0
17 Reagen Total Protein Botol RTP 0 0 0 0 0 0 0 0 0 0
18 Reagen Trigliserida Botol RTG 0 0 0 0 0 0 0 0 0 0
19 Reagen Ureum Botol RU 0 0 0 0 0 0 0 0 0 0
20 Reagen VDRL carbon antigen Botol VDRL 0 0 0 0 0 0 0 0 0 0
21 Reagen TPHA Stik TPHA 0 0 0 0 0 0 0 0 0 0
22 Urine Strip 10 parameter Stik US1 0 0 0 0 0 0 0 0 0 0
Obat - - - 0 0 0 0 0 0 0 0 0 0
1 - - - 0 0 0 0 0 0 0 0 0 0
2 - - - 0 0 0 0 0 0 0 0 0 0
3 - - - 0 0 0 0 0 0 0 0 0 0
4 - - - 0 0 0 0 0 0 0 0 0 0
5 - - - 0 0 0 0 0 0 0 0 0 0
6 - - - 0 0 0 0 0 0 0 0 0 0
7 - - - 0 0 0 0 0 0 0 0 0 0
8 - - - 0 0 0 0 0 0 0 0 0 0
9 - - - 0 0 0 0 0 0 0 0 0 0
10 - - - 0 0 0 0 0 0 0 0 0 0
11 - - - 0 0 0 0 0 0 0 0 0 0
12 - - - 0 0 0 0 0 0 0 0 0 0
13 - - - 0 0 0 0 0 0 0 0 0 0
14 - - - 0 0 0 0 0 0 0 0 0 0
15 - - - 0 0 0 0 0 0 0 0 0 0

UMUM
JUMLAH KUNJUNGAN ASKES JUMLAH
BAYAR TIDAK BAYAR
KERJA

MENGETAHUI/MENYETUJUI YANG MEMINTA/MELAPOR

KEPALA DINKES DT. II YANG MENYERAHKAN KEPALA PUSKESMAS
(…………………………………..) (……………………………) (…………………………)
PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
( LPLPO )
BULAN : JANUARI
TAHUN : 2013

PEMEKAIAN PERTANGGAL
10
6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
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0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
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0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

YANG MENERIMA
PETUGAS PUSKESMAS
...................................
-
 PERMI
NTAAN
30 31

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-
 LAPORAN PEMAKAIAN DAN LEMBA
( LPLPO )
KODE PUSKESMAS : 282002
PUSTU :..................................
KECAMATAN : .................................
KAB/KODYA : ...................................
PROPINSI :

SATUA Kode Stok Peneri Persdi PEMA SISA

NO NAMA OBAT N Awal maan aan KAIAN AKHIR
1 2 3 4 5 6 [7]=(5 [8]=S( [9]=(7 1 2 3 4 5
+6) 10) -8)
1 ACT tab Tablet ACT 0 0 0 0 0 0 0 0 0 0
2 Albendazol tab 400 mg Tablet ALB 9 0 9 0 9 0 0 0 0 0
3 Alopurinol 100 mg Tablet ALP1 0 0 0 0 0 0 0 0 0 0
4 Alopurinol 300 mg Tablet ALP2 0 0 0 0 0 0 0 0 0 0
5 Ambroxol tablet 30 mg Tablet AMB 0 0 0 0 0 0 0 0 0 0
6 Aminophilin inj 24 mg/ml-10 ml Ampul AMN1 0 0 0 0 0 0 0 0 0 0
7 Aminophilin tab 200 mg Tablet AMN2 44 0 44 6 38 0 0 0 0 0
8 Amitriptilin Hcl tab 25 mg Tablet AMT 0 0 0 0 0 0 0 0 0 0
9 Amlodipin tab 10 mg Tablet AMD1 0 0 0 0 0 0 0 0 0 0
10 Amlodipin tab 5 mg Tablet AMD2 0 0 0 0 0 0 0 0 0 0
11 Amoksisilin 500 mg Kaplet AMOK5 4 300 304 252 52 6 0 0 12 0
12 Amoksisilin kaps 250 mg Kapsul AMOK2 64 0 64 64 0 0 10 16 0 0
13 Amoksisilin SK 125mg/5ml Botol AMOKS 0 0 0 0 0 0 0 0 0 0
14 Ampisilin Serbuk Injeksi 1000 mg/ml Ampul AMP 0 0 0 0 0 0 0 0 0 0
15 Antalgin (metampiron) tab 500 mg Tablet ANT1 0 0 0 0 0 0 0 0 0 0
16 Antalgin inj 250 mg/ml-2 ml Ampul ANT2 0 0 0 0 0 0 0 0 0 0
17 Antasida DOEN Syrup Botol AND1 0 0 0 0 0 0 0 0 0 0
18 Antasida DOEN tab Komb Tablet AND2 250 0 250 54 196 0 6 0 6 0
19 Antibakteri DOEN salep Komb Tube ATB 0 0 0 0 0 0 0 0 0 0
20 Antifungi DOEN salep Komb Tube ATF 0 0 0 0 0 0 0 0 0 0
21 Antihemoroid DOEN Komb Supposit ATM 0 0 0 0 0 0 0 0 0 0
22 Antimigren DOEN tab Komb Tablet ATG 0 0 0 0 0 0 0 0 0 0
23 Antiparkinson DOEN tab Komb Tablet ATP 0 0 0 0 0 0 0 0 0 0
24 Aqua proinjeksi steril bebas pirogen Vial API 0 0 0 0 0 0 0 0 0 0
25 Asam Askorbat (Vit C) tab 50 mg Tablet VITC 851 0 851 114 737 18 6 6 6 0
26 Asam folat 1 mg Tablet AFOL 256 0 256 0 256 0 0 0 0 0
27 Asam mefenamat 500 mg Tablet ASMEF 9 200 209 150 59 6 6 0 12 0
28 Asetosal tab 100 mg Tablet AST 0 0 0 0 0 0 0 0 0 0
29 Asiklovir 400 mg Tablet ASK1 0 0 0 0 0 0 0 0 0 0
30 Asiklovir 5 % krim Tube ASK2 0 0 0 0 0 0 0 0 0 0
31 Atropin Sulfat inj 0,25mg/ml-1 ml Ampul ATR1 0 0 0 0 0 0 0 0 0 0
32 Atropin Sulfat tab 0,5 mg Tablet ATR2 0 0 0 0 0 0 0 0 0 0
33 Atropin tetes mata 0,5% Botol ATR3 0 0 0 0 0 0 0 0 0 0
34 Benzatin benzil penisilin inj 2.4 jt iu/ Vial BBP 0 0 0 0 0 0 0 0 0 0
35 Betahistin Mesilat tablet 6 mg Tablet BMT 0 0 0 0 0 0 0 0 0 0
36 Betametason krim 0,1% Tube BTM 0 0 0 0 0 0 0 0 0 0
37 Bromheksin tablet 8 mg Tablet BRO 0 0 0 0 0 0 0 0 0 0
38 Dapson tab 100 mg Tablet DAP 0 0 0 0 0 0 0 0 0 0
39 Deksametason inj 5 mg/ml-ml Ampul DEK1 0 0 0 0 0 0 0 0 0 0
40 Deksametason tab 0.5 mg Tablet DEK2 0 0 0 0 0 0 0 0 0 0
41 Dekstrometorphan sirup 10mg/5ml Botol DET1 0 0 0 0 0 0 0 0 0 0
42 Dekstrometorphan tab 15 mg Tablet DET2 0 0 0 0 0 0 0 0 0 0
43 Diazepam inj 5 mg/ml-2ml Ampul DIAZ1 0 0 0 0 0 0 0 0 0 0
44 Diazepam larutan rektal 4 mg/2 ml ( Tube DIAZ2 0 0 0 0 0 0 0 0 0 0
45 Diazepam tab 2 mg Tablet DIAZ3 0 0 0 0 0 0 0 0 0 0
46 Diazepam tab 5 mg Tablet DIAZ4 0 0 0 0 0 0 0 0 0 0
47 Dietilkarbamazin sitrat tab 100 mg Tablet DKB 0 0 0 0 0 0 0 0 0 0
48 Difenhidramin Hcl Inj 10 mg/ml-1ml Ampul DIF 133 0 133 5 128 1 0 0 0 0
49 Digoksin tab 0.25 mg Tablet DGK1 0 0 0 0 0 0 0 0 0 0
50 Digoksin tab 0.5 mg Tablet DGK2 0 0 0 0 0 0 0 0 0 0
51 Dimenhidrinat tablet 50 mg Tablet DMD 0 0 0 0 0 0 0 0 0 0
52 Ekstrak Beladon 10 mg Tablet EB 0 0 0 0 0 0 0 0 0 0
53 Ephedrin Hcl tab 25 mg Tablet EPH 0 0 0 0 0 0 0 0 0 0
54 Ephinefrin Hcl (Adrenalin) inj 0,1%/ Ampul EHP 0 0 0 0 0 0 0 0 0 0
55 Erithromisin 500 mg tab Tablet ERI1 0 0 0 0 0 0 0 0 0 0
56 Eritromisin 250 mg Tablet ERI2 0 0 0 0 0 0 0 0 0 0
57 Erithromisin sirup 200 mg/5 ml Botol ERI3 0 0 0 0 0 0 0 0 0 0
58 Etakridin (Rivanol) Lart 0,1% Botol ETA1 0 0 0 0 0 0 0 0 0 0
59 Etambutol Hcl Tb 250 mg Tablet ETM 0 0 0 0 0 0 0 0 0 0
60 Fenitoin Natrium inj 50 mg/ml @ 2m Ampul FN1 0 0 0 0 0 0 0 0 0 0
61 Fenitoin Natrium kaps 100 mg Kapsul FN2 0 0 0 0 0 0 0 0 0 0
62 Fenitoin Natrium Kaps 30 mg Tablet FN3 0 0 0 0 0 0 0 0 0 0
63 Fenobarbital inj 50 mg/ml Ampul FBR1 0 0 0 0 0 0 0 0 0 0
64 Fenobarbital tab 100 mg Tablet FBR2 0 0 0 0 0 0 0 0 0 0
65 Fenobarbital tab 30 mg Tablet FBR3 0 0 0 0 0 0 0 0 0 0
66 Fenoksimetil penisilin tab 250 mg Tablet FPT1 0 0 0 0 0 0 0 0 0 0
67 Fenoksimetil penisilin tab 500 mg Tablet FPT2 0 0 0 0 0 0 0 0 0 0
68 Fenol gliserol tetes Telinga 10 % Botol FGT 0 0 0 0 0 0 0 0 0 0
69 Fitomenadion (VitK) inj 10mg/ml-1m Ampul VITK1 28 0 28 0 28 0 0 0 0 0
70 Fitomenadion (VitK) tab 10 mg Tablet VITK2 74 0 74 0 74 0 0 0 0 0
71 Furosemid tab 40 mg Tablet FRO1 0 0 0 0 0 0 0 0 0 0
72 Furosemid Inj 10 mg/ml Ampul FRO2 0 0 0 0 0 0 0 0 0 0
 73 Gameksan Lotion 1 % Botol GAM 0 0 0 0 0 0 0 0 0 0
74 Garam Oralit untuk 200 ml air Sachet GLIT1 96 0 96 54 42 0 0 0 0 0
75 Gemfibrozil 300 mg Tablet GEM 0 0 0 0 0 0 0 0 0 0
76 Gentamsin Salep Kulit 0,1% Tube GEN1 8 0 8 3 5 0 0 0 0 0
77 Gentamycin 80 mg/2 ml injeksi Ampul GEN2 0 0 0 0 0 0 0 0 0 0
78 Gentian Violet lart 1% Botol GV 0 0 0 0 0 0 0 0 0 0
79 Glibenklamid 5 mg Tablet GLIB 0 0 0 0 0 0 0 0 0 0
80 Gliseril Guaiyakolat tab 100 mg Tablet GG 771 0 771 48 723 6 0 0 0 0
81 Gliserin Botol GLR 0 0 0 0 0 0 0 0 0 0
82 Glukosa Lart Inf 10 % steril Botol GLU1 0 0 0 0 0 0 0 0 0 0
83 Glukosa Lart Inf 40 % steril Vial GLU2 0 0 0 0 0 0 0 0 0 0
84 Glukosa Lart Inf 5 % steril Botol GLU3 0 0 0 0 0 0 0 0 0 0
85 Grisiofulvin tab 125 mg Tablet GRI 0 0 0 0 0 0 0 0 0 0
86 Haloperidol tab 0.5 mg Tablet HAL1 0 0 0 0 0 0 0 0 0 0
87 Haloperidol tab 1.5 mg Tablet HAL2 0 0 0 0 0 0 0 0 0 0
88 Hidroklortiazid (HCT) tab 25 mg Tablet HCT 0 0 0 0 0 0 0 0 0 0
89 Hidrokortison krim 2.5 % Tube HDR 0 0 0 0 0 0 0 0 0 0
90 Hiosin N- Butilbromida Tab 10 mg Tablet HNB1 0 0 0 0 0 0 0 0 0 0
91 Hiosin N- Butilbromida Inj 20 mg/ml Ampul HNB2 0 0 0 0 0 0 0 0 0 0
92 Ibuprofen 200 mg Tablet IBU1 3 0 3 0 3 0 0 0 0 0
93 Ibuprofen 400 mg Tablet IBU2 0 100 100 12 88 6 0 0 0 0
94 Ichtyol salp Pot ICH 0 0 0 0 0 0 0 0 0 0
95 Iodiol softcaps Kapsul IOD 0 0 0 0 0 0 0 0 0 0
96 Isoniazid tab 300 mg Tablet ISN 0 0 0 0 0 0 0 0 0 0
97 Isosorbid dinitrat tab 5 mg Tablet ISO 0 0 0 0 0 0 0 0 0 0
98 Kalium Permanganat Pot KP 0 0 0 0 0 0 0 0 0 0
99 Kalium Diklofenak tab 50 mg Tablet KD 0 0 0 0 0 0 0 0 0 0
100 Kalsium Laktas (Kalk) tab 500 mg Tablet KALK 1341 0 1341 330 1011 12 6 6 12 0
101 Kalsium Gluconas Injeksi Vial KGI 0 0 0 0 0 0 0 0 0 0
102 Kaptopril 12,5 mg Tablet KAP1 175 0 175 18 157 0 0 0 0 0
103 Kaptopril 25 mg Tablet KAP2 0 0 0 0 0 0 0 0 0 0
104 Karbamazepin tab 200 mg Tablet KAR 0 0 0 0 0 0 0 0 0 0
105 Ketamin inj 10 mg/ml Ampul KET 0 0 0 0 0 0 0 0 0 0
106 Klofazimil kaps 100 mg Kapsul KLOF 0 0 0 0 0 0 0 0 0 0
107 Klindamycin 150 mg Tablet KLIN 0 0 0 0 0 0 0 0 0 0
108 Kloramphenikol 250 mg Tablet KLOR1 0 0 0 0 0 0 0 0 0 0
109 Kloramphenikol salep mata 1 % Tube KLOSM 0 0 0 0 0 0 0 0 0 0
110 Kloramphenikol tetes telinga 3 % Botol KLOTT 2 5 7 1 6 1 0 0 0 0
111 Kloramfenikol Suspensi 125 mg/5 m Botol KLOS 0 0 0 0 0 0 0 0 0 0
112 Kloramfenikol Tetes mata 0,5% Botol KLOTM 0 0 0 0 0 0 0 0 0 0
113 Klorfeniramin maleat (CTM) tab 4 m Tablet CTM 254 0 254 138 116 6 12 0 0 0
114 Klorpromazin Hcl inj 25 mg/I ml Ampul CPZ1 0 0 0 0 0 0 0 0 0 0
115 Klorpromazin Hcl tab 100 mg Tablet CPZ2 0 0 0 0 0 0 0 0 0 0
116 Kodein 10 mg tab Tablet KOD 0 0 0 0 0 0 0 0 0 0
117 Kotrimoksazole Dewasa tab 480 mg Tablet KOT1 97 100 197 0 197 0 0 0 0 0
118 Kotrimoksazole ped tab 120 mg Tablet KOT2 0 0 0 0 0 0 0 0 0 0
119 Kotrimoksazole Susp Botol KOTS 5 0 5 4 1 0 0 0 0 0
120 Kuinin Sulfat tab 222 mg Tablet KST 0 0 0 0 0 0 0 0 0 0
121 Levofloksasin tab 500 mg Tablet LEV 0 0 0 0 0 0 0 0 0 0
122 Lidokain 2% injeksi Ampul LIDO1 0 0 0 0 0 0 0 0 0 0
123 Lidokain Komp Inj Ampul LIDO2 28 0 28 0 28 0 0 0 0 0
124 Loperamid HCl tablet 2 mg Tablet LOP 0 0 0 0 0 0 0 0 0 0
125 Magnesium sulf inj 20%-25 ml Ampul MGS1 0 0 0 0 0 0 0 0 0 0
126 Magnesium sulf inj 40%-25 ml Ampul MGS2 0 0 0 0 0 0 0 0 0 0
127 Mebendazole sirup 100 mg/5 ml Botol MEB1 0 0 0 0 0 0 0 0 0 0
128 Mebendazole tab 100 mg Tablet MEB2 0 0 0 0 0 0 0 0 0 0
129 Metformin HCl Tab 500 mg Tablet MET 0 0 0 0 0 0 0 0 0 0
130 Metil Dopa tab 250 mg Tablet MDT 0 0 0 0 0 0 0 0 0 0
131 Metil Ergometrin Inj 0,200 mg-1 ml Ampul ME1 10 0 10 0 10 0 0 0 0 0
132 Metil Ergometrin tab 0.125 mg Tablet ME2 90 0 90 0 90 0 0 0 0 0
133 Metil Prednisolon tab 4 mg Tablet MEP 0 0 0 0 0 0 0 0 0 0
134 Metoklopramid injeksi 5 mg/ml @2 ml
Ampul MTK1 0 0 0 0 0 0 0 0 0 0
135 Metoklopramid tab 10 mg ( Tomit tabTablet MTK2 0 0 0 0 0 0 0 0 0 0
136 Metronidazol Infus 500 mg/100 ml Botol 10 MTR1 0 0 0 0 0 0 0 0 0 0
137 Metronidazol 250 mg Tablet MTR2 0 0 0 0 0 0 0 0 0 0
138 Metronidazol 500 mg Tablet MTR3 0 0 0 0 0 0 0 0 0 0
139 Mikonazole Krim / salep 2% Tube MOK 0 0 0 0 0 0 0 0 0 0
140 Mineral Mix sachet 8gr Sachet MMS 0 0 0 0 0 0 0 0 0 0
141 Mg Sulfat Serbuk 30 gram Sachet MGSS 0 0 0 0 0 0 0 0 0 0
142 Na. Bikarbonat tab 500 mg Tablet NAB 0 0 0 0 0 0 0 0 0 0
143 Na. Diklofenac 25 mg Tablet NAD1 0 0 0 0 0 0 0 0 0 0
144 Na. Diklofenac 50 mg Tablet NAD2 0 0 0 0 0 0 0 0 0 0
145 Na. Fluoresin tetes mata 2 % Botol NAF 0 0 0 0 0 0 0 0 0 0
146 Na. Tiosulfat inj 25 %-10 ml Ampul NAT 0 0 0 0 0 0 0 0 0 0
147 Natrium Klorida lart inf 0.9% Botol NAK 0 0 0 0 0 0 0 0 0 0
148 Nifedipin tab 10 mg Tablet NIF 71 0 71 0 71 0 0 0 0 0
149 Nistatin 100.000 iu tab vag Tablet NIS1 0 0 0 0 0 0 0 0 0 0
150 Nistatin 500.000 iu tab Tablet NIS2 0 0 0 0 0 0 0 0 0 0
151 OAT-FDC Kategori 1 Paket OAT1 0 0 0 0 0 0 0 0 0 0
152 OAT-FDC Kategori 2 Paket OAT2 0 0 0 0 0 0 0 0 0 0
153 Obat Batuk hitam (OBH) sirup 100 Botol OBH 10 0 10 7 3 1 0 1 0 0
154 Obat Kategori Anak (kombipak anak Paket OATA 0 0 0 0 0 0 0 0 0 0
155 Obat Kategori Sisipan Paket OKS 0 0 0 0 0 0 0 0 0 0
156 Oksitetrasiklin Hcl Inj 50 mg/10 ml Ampul OKTIN 0 0 0 0 0 0 0 0 0 0
157 Oksitetrasiklin SK 3% Tube OKTSK 0 0 0 0 0 0 0 0 0 0
158 Oksitetrasiklin SM 1 % Tube OKTSM 8 0 8 6 2 0 0 1 1 0
159 Oksitosin inj 10 iu/1ml Ampul OTS 21 0 21 0 21 0 0 0 0 0
160 Oseltamivir 75 mg Tablet OSE 0 0 0 0 0 0 0 0 0 0
161 Papaverin Injeksi 40 mg/ml Ampul PAP1 0 0 0 0 0 0 0 0 0 0
162 Papaverin tab 40 mg Tablet PAP2 0 0 0 0 0 0 0 0 0 0
163 Paraformaldehid tab 1 gr Tablet PAR 0 0 0 0 0 0 0 0 0 0
164 Parasetamol Drops Botol PARAD 0 0 0 0 0 0 0 0 0 0
165 Parasetamol sirup 120 mg/5 ml Botol PARAS 22 0 22 5 17 0 0 1 0 0
166 Parasetamol tab 100 mg Tablet PARA1 0 0 0 0 0 0 0 0 0 0
167 Parasetamol tab 500 mg Tablet PARA5 244 500 744 222 522 6 6 6 12 0
168 Petidin inj 50 mg/2 ml Ampul PET 0 0 0 0 0 0 0 0 0 0
169 Pilokarpin tetes mata 2 % Botol PIL 0 0 0 0 0 0 0 0 0 0
170 Pirantel pamoat tab 125 mg Tablet PIR 0 0 0 0 0 0 0 0 0 0
171 Pirazinamid tab 500 mg Tablet PIZ 0 0 0 0 0 0 0 0 0 0
172 Piridoksin tab 10 mg Tablet B6 1060 0 1060 54 1006 0 0 0 0 0
173 Piroksicam 10 mg Tablet PIK1 0 0 0 0 0 0 0 0 0 0
174 Piroksicam 20 mg Tablet PIK2 0 0 0 0 0 0 0 0 0 0
175 Prazikuantel 600 mg tab Tablet PRAZ 0 0 0 0 0 0 0 0 0 0
176 Prednison 5 mg tab Tablet PRED 911 0 911 90 821 6 12 0 0 0
177 Primakuin 15 mg tab Tablet PRIM 0 0 0 0 0 0 0 0 0 0
178 Prokain Benzil Penisilin 3 Jt inj Vial PROK 0 0 0 0 0 0 0 0 0 0
179 Propanolol 40 mg tab Tablet PROP 0 0 0 0 0 0 0 0 0 0
180 Propiltiourasil 100 mg tab Tablet PTU 0 0 0 0 0 0 0 0 0 0
181 Ranitidin Inj 25 mg/ 2 ml Ampul RAN1 0 0 0 0 0 0 0 0 0 0
182 Ranitidin tab 150 mg Tablet RAN2 0 0 0 0 0 0 0 0 0 0
183 Reserpin 0,10 mg tab Tablet RES1 0 0 0 0 0 0 0 0 0 0
184 Reserpin 0,25 mg tab Tablet RES2 0 0 0 0 0 0 0 0 0 0
185 Retinol ( Vit A ) 200.000 iu Kap Kapsul VITA1 0 0 0 0 0 0 0 0 0 0
186 Retinol ( Vit.A) 100.000 UI Kapsul VITA2 0 0 0 0 0 0 0 0 0 0
187 Rifampisin 300 mg kaps Tablet RIF1 0 0 0 0 0 0 0 0 0 0
188 Rifampisin 450 mg tab Tablet RIF2 0 0 0 0 0 0 0 0 0 0
189 Rifampisin 600 mg kaplet Tablet RIF3 0 0 0 0 0 0 0 0 0 0
190 Ringer Laktate lart infus Botol RL 10 0 10 0 10 0 0 0 0 0
191 S. Anti Bisa Ular poli inj 5 ml(ABU I) Vial ABU1 0 0 0 0 0 0 0 0 0 0
192 S. Anti Difteri inj 20.000 iu ( ADS ) Vial ADS 0 0 0 0 0 0 0 0 0 0
193 S. Anti Tetanus inj 1.500 iu/Amp ( A Ampul ATS1 0 0 0 0 0 0 0 0 0 0
194 S. Anti Tetanus inj 20.000 iu/Amp ( Vial ATS2 0 0 0 0 0 0 0 0 0 0
195 Salbutamol 2 mg tab Tablet SAL1 0 0 0 0 0 0 0 0 0 0
196 Salbutamol 4 mg tab Tablet SAL2 0 0 0 0 0 0 0 0 0 0
197 Salep 2-4 komb Pot S2-4 0 0 0 0 0 0 0 0 0 0
198 Salisil Bedak 2 % Kotak SB2 5 0 5 1 4 0 0 0 0 0
199 Salisil Spiritus 10 % Botol SS 0 0 0 0 0 0 0 0 0 0
200 Sefadroxil 500 mg kapsul Tablet SEF 0 0 0 0 0 0 0 0 0 0
201 Sefotaxim Injeksi 1 gram Ampul SET 0 0 0 0 0 0 0 0 0 0
202 Seftriaxon Inj 1 gram Ampul STR 0 0 0 0 0 0 0 0 0 0
203 Sianokobalamin (Vit B12) inj Ampul B12 10 20 30 16 14 1 0 0 0 0
204 Simetidin tab 200 mg Tablet SIM 0 0 0 0 0 0 0 0 0 0
205 Simvastatin 10 mg tab Tablet SIV 0 0 0 0 0 0 0 0 0 0
206 Siprofloksasin 500 mg tab Tablet SPRO 0 0 0 0 0 0 0 0 0 0
207 Streptomisin inj 1500 mg /vial Vial STREP 0 0 0 0 0 0 0 0 0 0
208 Sulfasetamid tts mata 15% Botol SULF 0 0 0 0 0 0 0 0 0 0
209 Tablet tambah darah komb Tablet FE 3180 0 3180 150 3030 0 0 0 0 0
210 Tetrakain tetes mata 0,5% Botol TTM 0 0 0 0 0 0 0 0 0 0
211 Tetrasiklin 250 mg Tablet TETR1 0 0 0 0 0 0 0 0 0 0
212 Tetrasiklin 500 mg Tablet TETR2 0 0 0 0 0 0 0 0 0 0
213 Thiamin ( Vit B1 ) 50 mg tab Tablet VB1 982 0 982 24 958 0 6 0 0 0
214 Thiamin ( Vit B1 ) inj 100 mg/Amp Ampul B1I 60 0 60 32 28 2 0 1 1 0
215 Thiamphenkol 500 mg cap Kapsul THIA1 0 0 0 0 0 0 0 0 0 0
216 Tiamfenikol Suspensi ( Conucol Dry Botol THAI2 0 0 0 0 0 0 0 0 0 0
217 Tiopental Na. Serbuk 1000 mg/Amp Ampul TNS 0 0 0 0 0 0 0 0 0 0
218 Tramadol 50 mg Tablet TD 0 0 0 0 0 0 0 0 0 0
219 Triheksipenidil Hcl 2 mg tab Tablet TPD 0 0 0 0 0 0 0 0 0 0
220 Vitamin B Kompleks tab Tablet VBC 1082 0 1082 216 866 12 12 0 12 0
221 Yodium povidon 10 % 30 ml Botol YOD1 4 0 4 1 3 0 0 0 0 0
222 Yodium Povidon 10 % 300 ml Botol YOD2 0 0 0 0 0 0 0 0 0 0
223 Yodium Povidon 10% 1 Liter Botol YOD3 0 0 0 0 0 0 0 0 0 0
224 Zink 20 mg Tablet dispersible Tablet ZNK1 0 0 0 0 0 0 0 0 0 0
225 Zink Syrup Botol ZNK2 0 0 0 0 0 0 0 0 0 0
LUAR - - - 0 0 0 0 0 0 0 0 0 0
1 Adona injeksi Ampul ADI 0 0 0 0 0 0 0 0 0 0
2 Alinamin F injeksi Ampul ALIN 0 0 0 0 0 0 0 0 0 0
3 Antrain inj Ampul ATR 0 0 0 0 0 0 0 0 0 0
4 Asering Larutan Infus Botol ASER 0 0 0 0 0 0 0 0 0 0
5 Attapulgite tablet komb (Diaform/Ne Tablet ATK 0 0 0 0 0 0 0 0 0 0
6 Bismecon Gel Tube BIS 0 0 0 0 0 0 0 0 0 0
7 Bufacom (Triamsinolon in oral base Tube BUF 0 0 0 0 0 0 0 0 0 0
8 Dulcolax supp 5 mg Supposit DUL1 0 0 0 0 0 0 0 0 0 0
9 Dulcolax tab Tablet DUL2 0 0 0 0 0 0 0 0 0 0
10 Demacolin tab Tablet DEM 0 0 0 0 0 0 0 0 0 0
 11 Fludane Syrup Botol FLUD1 0 0 0 0 0 0 0 0 0 0
12 Fludane Tablet Tablet FLUD2 0 0 0 0 0 0 0 0 0 0
13 Gitas Plus Inj Ampul GTP1 0 0 0 0 0 0 0 0 0 0
14 Gitas Plus tablet / Spasmal tablet Tablet GTP2 28 0 28 0 28 0 0 0 0 0
15 Ka-En 3 A Botol KN3A 0 0 0 0 0 0 0 0 0 0
16 Ka-En 3 B Botol KN3B 0 0 0 0 0 0 0 0 0 0
17 Kombivent Inhalasi Ampul KOMB 0 0 0 0 0 0 0 0 0 0
18 Lakto B Sachet LKB 0 0 0 0 0 0 0 0 0 0
19 Lynoral tab Tablet LYN 0 0 0 0 0 0 0 0 0 0
20 Lysmin ( Lysin ) Sirup Botol LYS 0 0 0 0 0 0 0 0 0 0
21 Multivitamin (Ultravita tab / Kurkume Tablet MULTF 0 0 0 0 0 0 0 0 0 0
22 Metioson tab Tablet METH 0 0 0 0 0 0 0 0 0 0
23 Neurobion tablet Tablet NUER1 0 0 0 0 0 0 0 0 0 0
24 Neurovit E tablet Tablet NEUR2 0 0 0 0 0 0 0 0 0 0
25 Opixitrol eye drop Botol OED 0 0 0 0 0 0 0 0 0 0
26 Pamol 125 mg Supp Supposit MOLSU 0 0 0 0 0 0 0 0 0 0
27 Scabicid krim Tube SCAB 0 0 0 0 0 0 0 0 0 0
28 Tensigard Tablet TENSI 0 0 0 0 0 0 0 0 0 0
OBAT - - - 0 0 0 0 0 0 0 0 0 0
1 Air Raksa use Dental Botol ARD 0 0 0 0 0 0 0 0 0 0
2 Bonding Botol BON 0 0 0 0 0 0 0 0 0 0
3 Cresophen Botol CRES 0 0 0 0 0 0 0 0 0 0
4 Dentorit pasta ( Cavit G ) Set DEN 0 0 0 0 0 0 0 0 0 0
5 Devitalisasi pasta (non arsen) Botol DEV1 0 0 0 0 0 0 0 0 0 0
6 Devitalisasi pasta (arsen) Botol DEV2 0 0 0 0 0 0 0 0 0 0
7 Etching Botol ETC 0 0 0 0 0 0 0 0 0 0
8 Etil Klorida semprot Botol EKS 0 0 0 0 0 0 0 0 0 0
9 Eugenol cairan Botol EGC 0 0 0 0 0 0 0 0 0 0
10 Glass Ionomer cement ART / Fuji I Set GLC 0 0 0 0 0 0 0 0 0 0
11 Kalsium Hidroksida pasta Set KHP 0 0 0 0 0 0 0 0 0 0
12 Komposit A2 Anterior Set KA2A 0 0 0 0 0 0 0 0 0 0
13 Komposit A2 Posterior Set KA2P 0 0 0 0 0 0 0 0 0 0
14 Monokamper mentol cair (CHKM) Botol CHKM 0 0 0 0 0 0 0 0 0 0
15 Mummifying pasta Set MUMP 0 0 0 0 0 0 0 0 0 0
16 Polikresulen (Albothyl) Botol POLI 0 0 0 0 0 0 0 0 0 0
17 Semen seng fosfat serbuk & cair Set SSF 0 0 0 0 0 0 0 0 0 0
18 Silver Amalgam Serbuk 65-75 % Set SAS 0 0 0 0 0 0 0 0 0 0
19 Solare Tube SOLR 0 0 0 0 0 0 0 0 0 0
20 Spon Gelatin 1x1x1 cm cube SG11 0 0 0 0 0 0 0 0 0 0
21 Temporary stoping fletcher serbuk&cSet TSF 0 0 0 0 0 0 0 0 0 0
22 Trikresolformalin (TKF) cair Botol TKF 0 0 0 0 0 0 0 0 0 0
PERB - - - 0 0 0 0 0 0 0 0 0 0
1 Alat Suntik Sekali Pakai 0,05 ml Set ASS1 0 0 0 0 0 0 0 0 0 0
2 Alat Suntik Sekali Pakai 0,5 ml Set ASS2 0 0 0 0 0 0 0 0 0 0
3 Alat Suntik Sekali Pakai 1 ml Set ASS3 23 100 123 0 123 0 0 0 0 0
4 Alat Suntik Sekali Pakai 3 ml / 2,5 m Set ASS4 91 0 91 46 45 4 0 1 0 0
5 Alat Suntik Sekali Pakai 5 ml Set ASS5 43 0 43 0 43 0 0 0 0 0
6 Alat Suntik Sekali Pakai 10 ml Set ASS10 0 0 0 0 0 0 0 0 0 0
7 Aqua Gel Botol AQG 0 0 0 0 0 0 0 0 0 0
8 Blood set Set BLD 0 0 0 0 0 0 0 0 0 0
9 Catgut/Benang bedah no 3/0 (p&c) Set GUT1 8 0 8 0 8 0 0 0 0 0
10 Catgut Cromic no. 3/0 100 m Roll GUT2 0 0 0 0 0 0 0 0 0 0
11 Etanol 70 % 1 L Botol ETN 1 0 1 0 1 0 0 0 0 0
12 Hidrogen Peroksida ( H2O2 ) 3% Botol 10 H2O2 0 0 0 0 0 0 0 0 0 0
13 Infusion Set Anak Set ISA 0 0 0 0 0 0 0 0 0 0
14 Infusion Set Dewasa Set ISD 6 0 6 0 6 0 0 0 0 0
15 Jarum Jahit (Bedah) No 9 s/d 14 Biji JJB 0 0 0 0 0 0 0 0 0 0
16 Kapas Berlemak 500 gr Bungkus KB5 0 0 0 0 0 0 0 0 0 0
17 Kapas Pembalut/Absorben 250 gr Bungkus KPA 1 0 1 0 1 0 0 0 0 0
18 Kasa Pembalut 2 X 80 cm Roll KP1 8 0 8 0 8 0 0 0 0 0
19 Kasa Kompres 40/40 steril Roll KP2 0 0 0 0 0 0 0 0 0 0
20 Kasa Pembalut 4 X 15 cm Roll KP3 10 0 10 0 10 0 0 0 0 0
21 Kasa Pembalut 4 X 3 cm Roll KP4 0 0 0 0 0 0 0 0 0 0
22 Lisol (Kresol tersaponifikasi 50%) 1 l Botol LKT 0 0 0 0 0 0 0 0 0 0
23 Masker Set MAS 0 0 0 0 0 0 0 0 0 0
24 Mess Biji MES 0 0 0 0 0 0 0 0 0 0
25 Pembalut gibs 3 inchi Biji GIB 0 0 0 0 0 0 0 0 0 0
26 Plester 5 yard X 2 inch Roll PLES 2 0 2 0 2 0 0 0 0 0
27 Pot Sputum diameter 7 cm Biji POT 0 0 0 0 0 0 0 0 0 0
28 Sarung Tangan Steril ( Handscoun) Set STS 17 0 17 0 17 0 0 0 0 0
29 Sarung Tangan Non Steril Set STN 0 0 0 0 0 0 0 0 0 0
30 Silk ( Benang Bedah Sutera) N0 3/0 Set SILK1 0 0 0 0 0 0 0 0 0 0
31 Silk no. 3/0 100 m Roll SILK2 0 0 0 0 0 0 0 0 0 0
32 IV. Catheter no. 18 Set IV1 0 0 0 0 0 0 0 0 0 0
33 IV. Catheter no. 20 Set IV2 0 0 0 0 0 0 0 0 0 0
34 IV. Catheter no. 22 Set IV3 0 0 0 0 0 0 0 0 0 0
35 IV. Catheter no. 24 Set IV4 0 0 0 0 0 0 0 0 0 0
36 Wing nedle Set WN 0 0 0 0 0 0 0 0 0 0
- - - - 0 0 0 0 0 0 0 0 0 0
REAG - - - 0 0 0 0 0 0 0 0 0 0
1 Amoniak ( 100 ml ) Botol AM1 0 0 0 0 0 0 0 0 0 0
2 Anisol ( 100 ml ) Botol AN1 0 0 0 0 0 0 0 0 0 0
 3 Aquadest steril 1 liter Botol AQ1 0 0 0 0 0 0 0 0 0 0
4 Asam asetat 6 % ( 100 ml ) Botol AA6 0 0 0 0 0 0 0 0 0 0
5 Asam Klorida 0,1 N ( HCl 0,1 N ) ( 1 Botol AK1 0 0 0 0 0 0 0 0 0 0
6 Asam Sulfosalisilat 20 % ( 100 ml ) Botol AS2 0 0 0 0 0 0 0 0 0 0
7 Barium Klorida ( 100 ml ) Botol BK1 0 0 0 0 0 0 0 0 0 0
8 Benedict ( 100 ml ) Botol BD1 0 0 0 0 0 0 0 0 0 0
9 Carbol Gentian Violet ( 100 ml ) Botol CGV1 0 0 0 0 0 0 0 0 0 0
10 EDTA ( 100 ml ) Botol EDTA 0 0 0 0 0 0 0 0 0 0
11 Eosin 2 % ( 100 ml ) Botol ESN1 0 0 0 0 0 0 0 0 0 0
12 Etanol Asam 100ml Botol EA1 0 0 0 0 0 0 0 0 0 0
13 Eter Alkohol Botol EAL 0 0 0 0 0 0 0 0 0 0
14 Fauchet ( 100 ml ) Botol FAU1 0 0 0 0 0 0 0 0 0 0
15 Felling A Botol FELA 0 0 0 0 0 0 0 0 0 0
16 Felling B Botol FELB 0 0 0 0 0 0 0 0 0 0
17 Giemsa stain Botol GMS 0 0 0 0 0 0 0 0 0 0
18 Golongan Darah A,B,O Set GD 0 0 0 0 0 0 0 0 0 0
19 Hayem ( 100 ml ) Botol HAY1 0 0 0 0 0 0 0 0 0 0
20 Iodium akohol ( 100 ml ) Botol IA1 0 0 0 0 0 0 0 0 0 0
21 Karbon Fuksin Botol KF1 0 0 0 0 0 0 0 0 0 0
22 Kinyoun ( 100 ml ) Botol KIN1 0 0 0 0 0 0 0 0 0 0
23 Lugol 1 % ( 100 ml ) Botol LUG1 0 0 0 0 0 0 0 0 0 0
24 Metanol Botol MET1 0 0 0 0 0 0 0 0 0 0
25 Metilen Biru ( 100 ml ) Botol MB1 0 0 0 0 0 0 0 0 0 0
26 NACL 0,9% ( 100 ml ) Botol NA1 0 0 0 0 0 0 0 0 0 0
27 Oil Imerson ( 100 ml ) Botol OI1 0 0 0 0 0 0 0 0 0 0
28 Reesecher ( 100 ml ) Botol RE1 0 0 0 0 0 0 0 0 0 0
29 Schlesinger ( 100 ml ) Botol SC1 0 0 0 0 0 0 0 0 0 0
30 Spiritus Bakar ( 1 liter ) Botol SB1 0 0 0 0 0 0 0 0 0 0
31 Turk ( 100 ml ) Botol TUR1 0 0 0 0 0 0 0 0 0 0
32 Widal Set WID1 0 0 0 0 0 0 0 0 0 0
33 Xylol ( 100 ml ) Botol XIL1 0 0 0 0 0 0 0 0 0 0
34 Zeil nelson set ( ZN set ) Set XZNS1 0 0 0 0 0 0 0 0 0 0
REAGE - - - 0 0 0 0 0 0 0 0 0 0
1 Malaria Test Stik MTT 0 0 0 0 0 0 0 0 0 0
2 Dengue Test Stik DT 0 0 0 0 0 0 0 0 0 0
3 HbsAg Test Stik HBS 0 0 0 0 0 0 0 0 0 0
4 HIV 1/2/0 divice test whole blood te Stik HIV 0 0 0 0 0 0 0 0 0 0
5 HCV Test Stik HCV 0 0 0 0 0 0 0 0 0 0
6 Reagen Albumin Botol RA 0 0 0 0 0 0 0 0 0 0
7 Reagen Alkalin Fosfatase Botol RAF 0 0 0 0 0 0 0 0 0 0
8 Reagen Asam Urat Botol RAU 0 0 0 0 0 0 0 0 0 0
 9 Reagen Billirubin Total Botol RBT 0 0 0 0 0 0 0 0 0 0
10 Reagen Billirubin Direct Botol RBD 0 0 0 0 0 0 0 0 0 0
11 Reagen Glukosa Botol RG 0 0 0 0 0 0 0 0 0 0
12 Reagen Hb Cyanmeth Botol RHC 0 0 0 0 0 0 0 0 0 0
13 Reagen Kolesterol Botol RK 0 0 0 0 0 0 0 0 0 0
14 Reagen Kreatinin Botol RKN 0 0 0 0 0 0 0 0 0 0
15 Reagen SGOT Botol SGOT 0 0 0 0 0 0 0 0 0 0
16 Reagen SGPT Botol SGT 0 0 0 0 0 0 0 0 0 0
17 Reagen Total Protein Botol RTP 0 0 0 0 0 0 0 0 0 0
18 Reagen Trigliserida Botol RTG 0 0 0 0 0 0 0 0 0 0
19 Reagen Ureum Botol RU 0 0 0 0 0 0 0 0 0 0
20 Reagen VDRL carbon antigen Botol VDRL 0 0 0 0 0 0 0 0 0 0
21 Reagen TPHA Stik TPHA 0 0 0 0 0 0 0 0 0 0
22 Urine Strip 10 parameter Stik US1 0 0 0 0 0 0 0 0 0 0
Obat - - - 0 0 0 0 0 0 0 0 0 0
1 - - - 0 0 0 0 0 0 0 0 0 0
2 - - - 0 0 0 0 0 0 0 0 0 0
3 - - - 0 0 0 0 0 0 0 0 0 0
4 - - - 0 0 0 0 0 0 0 0 0 0
5 - - - 0 0 0 0 0 0 0 0 0 0
6 - - - 0 0 0 0 0 0 0 0 0 0
7 - - - 0 0 0 0 0 0 0 0 0 0
8 - - - 0 0 0 0 0 0 0 0 0 0
9 - - - 0 0 0 0 0 0 0 0 0 0
10 - - - 0 0 0 0 0 0 0 0 0 0
11 - - - 0 0 0 0 0 0 0 0 0 0
12 - - - 0 0 0 0 0 0 0 0 0 0
13 - - - 0 0 0 0 0 0 0 0 0 0
14 - - - 0 0 0 0 0 0 0 0 0 0
15 - - - 0 0 0 0 0 0 0 0 0 0

UMUM
JUMLAH KUNJUNGAN ASKES JUMLAH
BAYAR TIDAK BAYAR
KERJA

MENGETAHUI/MENYETUJUI YANG MEMINTA/MELAPOR

KEPALA DINKES DT. II YANG MENYERAHKAN KEPALA PUSKESMAS
(…………………………………..) (……………………………) (…………………………)
PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
( LPLPO )
BULAN : JANUARI
TAHUN : 2013

PEMEKAIAN PERTANGGAL
10
6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
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0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 12 18 12 0 6 0 18 18 24 12 0 18 0 12 0 30 0 12 6 0 6 12 12
38 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 6 6 0 6 0 0 0 0 0 6 0 0 0 0 0 0 0 6 0 6 6 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 6 6 6 0 0 0 12 0 0 0 0 0 0 6 0 6 6 6 0 0 6 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 6 12 18 0 0 0 12 6 0 0 6 6 0 6 0 18 0 0 0 0 0 18 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
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0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
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0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 1
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
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0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 0 6 0 6 0 0 0 0 6 0 12 0 0 0 0 0 0 0 6 0 6 6 0
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6 0 6 0 0 0 0 6 6 0 0 0 6 0 0 0 0 0 6 0 0 0 0 0
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0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
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0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
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