LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

( LPLPO ) DANA PKD DAN JKN

PUSKESMAS : MADURAN PELAPORAN BULAN AGUSTUS
SUB UNIT : BLUMBANG PERMINTAAN BULAN
KECAMATAN : MADURAN TAHUN : 2024
KABUPATEN : LAMONGAN
PROPINSI : JAWA TIMUR

STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PEMBERIAN

NO NAMA BARANG KEMASAN PERMINTAAN

PKD JKN PKD JKN PKD JKN PKD JKN PKD JKN PKD JKN

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
OBAT-OBATAN
1 Acyclovir Cream 5 % 25 tube @ 5 gram - 2 0 2
2 Antamen (Anti Diare) Syr Botol 0 0
3 Alopurinol tablet 100 mg 10 strips @ 10 tabl - 50 0 50
4 Alopurinol tablet 300 mg 10 blister @ 10 tab 0 0
Ambroxol tab 10 strip @ 10 tablet 0 0
5 Ambroxol sirup 15 mg/ml botol 60 ml 0 0
6 Aminofilin injeksi 24 mg/ml 30 ampul @ 10 ml 0 0
7 Amlodipin tablet 10 mg 3 strip @ 10 tablets 0 100 100 0
8 Amlodipin tablet 5 mg 3 strip @ 10 tablets 0 0 0
9 Amoksisilin sirup kering 125 mg/ 5 ml btl @ 60 ml 5 0 5
10 Amoksisilin tablet scored 500 mg 10 strip @ 10 tablet - 100 0 100
11 Antalgin tablet 500 mg dus 10 x 10 tablet 0 0
12 Antalgin/metamizol Inj Ampul 0 0
13 Antasida DOEN I tablet kunyah, kombinasi : Aluminium 10 strip @ 10 tablet 0 100 100 0
Hidroksida 200 mg Magnesium Hidroksida 200 mg
14 Antasida DOEN II suspensi, kombinasi : Aluminium botol @ 60 ml 0 0
Hidroksida 200 mg/5 ml Magnesium Hidroksida 200
mg/5ml
15 Anti influenza kaplet (Herbacold) box 150's 0 0
16 Anti mikroba + kortikosteroid tetas mata botol @ 5 ml 0 0
17 Anti Hemoroid dus/ 3 blister x 10's 0 0
18 Anti Bakteri Topikal Tetes telinga botol @ 10 ml 0 0
19 Antimigren: Ergotamin Tartrat 1 mg + Kofein 50 mg btl 100 tablet 0 0
20 Antispasmodik box 100 kaplet 0 0
21 Asam Ascorbat (vitamin C) tablet 50 mg 10 strip x 10 tab - 50 0 50
22 Asam asetilsalisilat (asetosal) tab 80 mg(MINIASPI) 10 strip x 10 tab 0 0
23 Asam Folat tablet 0,4 mg 10 strip @ 10 tablet 0 0
24 Asam Mefenamat kaplet 500 mg 10 strip x 10 tab 0 100 100 0
25 Asam traneksamat tablet 500 mg dus, 10 x 10 tablet 0 0
26 Asiklovir tablet 200 mg 10 strip @ 10 tablet 0 0
27 Asiklovir tablet 400 mg 10 strip @ 10 tablet 0 0
28 Atapulgit tablet 600 mg 5 strip @ 10 tablet 0 0
Betametason CR tube - 2 0 2
29 Bedak Salisil serbuk 2% dus @ 50 gram - 2 0 2
30 Bisakodil suppositoria 10 mg supp 0 0
31 Bisoprolol tablet 5 mg box 3 x 10 tab 0 0
32 Dexametason 0,5 mg Tablet - 100 0 100
33 Dexametason inj Ampul 0 0
34 Dimenhidrinat tablet 50 mg 10 strip @ 10 tablet 0 0
35 Diphenhidramin Inj Ampul 0 0
36 Domperidon Tab Tablet 0 0
37 Domperidon Syr Botol 0 0
38 Etil Klorida semprot 100 ml btl @ 100 ml 0 0
39 Fitomenadion (vitamin K1) injeksi i.m. 2 mg/ml dus @ 30 ampul 0 0
40 Fitomenadion (vitamin K1) tablet salut gula 10 mg dus@ 10 x 10 's 0 0
41 Fluocinolone Acetonide, Neomycin sulfat cream tube @ 5 g 0 0
42 Furosemid Inj Ampul 0 0
43 Garam Oralit I serbuk ,kombinasi : Natrium Klorida 0,52 dus @ 100 Sachet 0 0
g Kalium Klorida 0,30 g Trinatrium sitrat dihidrat 0,58 g
Glukosa Anhidrat 2,70 g
44 Gemfibrozil kapsul 300 mg 10 strip@ 10 kapsul 0 0
45 Gentamisin salep mata 0,3 % tube @ 3,5 gr 0 0
46 Glibenklamid tablet 5 mg 10 strip @ 10 tablet 0 0
47 Glikazid tablet 80mg (GLUCODEX) dus, 100 tablet 0 0
48 Glimepiride tablet 1 mg ktk 10x10 tablet 0 0
49 Glimepiride tablet 2 mg 5 strip @ 10 tablet - 50 0 50
50 Glimepiride tablet 3 mg ktk 5x10 tablet 0 0
51 Griseofulvin tablet 125 mg dus @ 10 x 10's 0 0
52 Glyseril Guaiacolat (Batuk Berdahak) botol 100 tab 0 0
53 Hidrokortison Salep kulit Tube 0 0
54 Hidroklortiazid Tablet 0 0
55 Ibuprofen 400 mg 10 strip @ 10 tablet - 50 0 50 50 - 100
56 Ibuprofen Syr Botol 0 0
57 Kalsium laktat (kalk) tab 500 mg 10 strip @ 10 tablet - 100 0 100 100 - 100
58 Kaptopril tablet scored 12,5 mg 10 strip @ 10 tablet 0 0 50
59 Kaptopril tablet scored 25 mg 10 strip @ 10 tablet 0 0 50
60 Ketokonazol krim 2 % tube 10 gr 2 0 2 2 - 5
61 Ketokonazol tablet 200 mg 5 strip @ 10 tablet 0 0
Kloramfenikol 500 mg 10 strip @ 10 tablet 0 0
62 Kloramfenikol kaplet 250 mg ktk 10 x 10 tablet 0 0
63 Kloramfenikol salep kulit (Bufacetin) tube 5 gr 0 0
Kloramfenikol tetes telinga botol 0 0
64 Kloramfenikol suspensi 125 mg/ 5 ml botol, 60 ml 0 0
65 Klorfeniramina Maleat ( CTM ) tablet 4 mg box 10 x 10 "s 0 100 100 0 100 0 100
66 Kombinasi tablet salut : Besi (II) sulfat 7H2O 200 mg dus, 100 Sachet @ 30 0 0
Asam Folat 0,25 mg tablet
67 Kotrimoksazol DOEN I (dewasa) 10 strip @ 10 tablet 0 0
kombinasi :Sulfametoksazol 400 mg Trimetoprim 80
mg
68 Kotrimoksazol tab 200mg/40 mg dus, 10 strip @ 10 0 0
tablet
69 Kotrimoksazol suspensi komb.: Sulfametoksazol 200 botol, 60 ml 0 0
mg + Trimetoprim 40 mg / 5 ml
70 Lidocain Inj Ampul 0 0
71 Lidocain + Epinefrin Inj Ampul 0 0
72 Loperamid tablet 2 mg 10 strip @ 10 tablet 0 0
73 Loratadin tablet 10 mg 5 strip @ 10 tablet 0 0
74 Metformin HCl tablet 500 mg 10 strip@ 10 tablet 0 0 50
75 Metilergometrin Maleat (metilergometrin) tablet salut ktk 10 x 10 tablet salut 0 0
0,125 mg
76 Metilergometrin inj 0,2 mg/ml 100 ampul @ 1ml 0 0
77 Metilprednisolon tablet 4 mg 10 strip @ 10 tablet 0 0
78 Metronidazol tablet 500 mg 11 strip @ 10 tablet 0 0
79 Mikonazol krim/salep 2 % (Nitrat) tube 10 gr 0 0 5
80 Mukolitik dan Ekspektoran sirup botol 60 ml 0 0
81 Multivitamin sirop botol 60 ml 0 0
82 Natrium Diklofenak tablet 25 mg dus @ 5 x 10's 0 0 100
83 Natrium Diklofenak tablet 50 mg dus @ 5 x 10's 0 100 0 100 100 - 100
84 Nifedipin tablet 10 mg 10 strip @ 10 tablet 0 0 100
85 Nistatin vaginal tablet 100.000 IU/g dus @ 10 x 10's 0 0
86 Obat Sariawan (gom) box 24 tube @ 5 gr 0 0
87 OBH sirup botol 60 ml 0 0
88 Oksitetrasiklin salep mata 1 % steril tube @ 5 g 0 0
89 Omeprazol kaps 20 mg strip 3 x 10 kapsul 0 0 - 50
90 Ondansetron inj. 4 mg/ 2 ml 5 ampul @ 2 ml 0 0
91 Parasetamol Sirup 120 mg / 5 ml botol 60 ml 5 0 5 5 - 5
92 Parasetamol tablet 500 mg 10 strip @ 10 kss 100 100 0 200 200 - 100
93 Piridoksin (vitamin B6) tab 10 mg botol@ 100 tablet 0 0 100 - 100
94 Piroxicam 10 mg kapsul 0 0 100
95 Prednison tab 5 mg kotak @ 10 x 10 tab 0 0 100
96 Propiltourasil tb 100 mg kotak @ 10 x 10 tab 0 0
97 Ranitidin Tablet 0 0 100
98 Ranitidin Inj Ampul 0 0
99 Salbutamol tablet 2 mg ( sebagai sulfat ) strip @ 10 tablet 0 0
100 Salbutamol tablet 4 mg ( sebagai sulfat ) ktk 10 x 10 tablet 0 0
101 Salep 2-4 , Kombinasi : Asam Salisilat 2 % + Belerang Pot @ 30 gram 0 0 5
endap 4 %
102 Sefadroksil kapsul 500 mg 10 strip@ 10 kapsul 0 0
103 Sefadroksil sir kering 250 mg/5 ml dus, botol 60 ml 0 0
104 Sefotaksim injeksi 1 gram dus, 10 vial @ 1g 0 0
105 Setirizin tablet 10 mg 10 strips @ 10 kap 0 50 0 50 50 - 100
106 Sianokobalamin (vitamin B12) injeksi 500 mcg ampul @ 1 ml 0 0
107 Simvastatin tablet 10 mg 10 strip @ 10 kss 100 0 100 100 - 200
Simvastatin tablet 20 mg 10 strip @ 10 kss 0 0
108 Siprofloksasin tablet 500 mg (sebagai HCl) 10 blister @ 10 tab 0 0
109 Tetes Telinga Antibiotik ( Kloramfenikol 1 % ) botol @ 10 ml 0 0
110 Terra F (Batuk Pilek) 10 strip @ 10 tablet 0 0 50
111 Tetrasiklin kapsul 500 mg 10 strip @ 10 kapsul 0 0
112 Tiamin ( Vitamin B1 ) tablet 50 mg 10 strip @ 10 tablet 0 0 100
113 Multivitamin (Recovit tetes) vial @ 20 ml 0 0
Mengetahui,
114 Vitamin B-Complex Tab botol @ 100 tablet - 100 0 100 100
Kepala
116 Zink 10 mg/5 ml sirupPuskesmas Maduran botol @ 100 ml 0 0
117 Zink tablet dispesible 20 mg 10 strip @ 10 tablet 0 0

Yang Menyerahkan,
Yang Menerima,
Petugas pengelola gudang obat
Petugas sub unit
apt. Zumatul Amilin, S.Farm
.Mauduah Sulistyowati
NIP. 199510232020122016 NIP. 16111975 200701 2 006

dr. Ema Vika Pratiwi

NIP. 198604282014122001