NB

1. Obat yang tidak masuk dalam daftar, diletakkan di urutan paling bawah
2 Kolom Penerimaan dan Pemakaian merupakan rekap selama 1 tahun mulai Januari sampai Desember 2015
3 Kolom Stok Awal adalah jumlah obat per tanggal 1 Januari 2015 atau nilai stok akhir per tanggal 31 Desember 2015
4 Kolom Penerimaan adalah jumlah pembelian obat dan penerimaan obat dari instansi lain
5 Kolom Pemakaian adalah jumlah pemakaian, pengiriman obat ke instansi lain dan obat expire
6 Kolom Harga satuan merupakan harga yang sudah termasuk PPN 10 %
7 Kolom keterangan dapat diisi jumlah obat yang diterima atau yang keluar ke instansi lain dan jumlah obat expire
8 Kolom resep diisi jumlah resep selama 1 Tahun mulai Januari sampai Desember 2015

LAPORAN PERSEDIAAN OBAT TAHUN 2015

NAMA INSTANSI : RUMAH SAKIT UMUM KECAMATAN KOJA

ALAMAT : Jl. Walang Permai No.39, Kecamatan Koja, Jakarta Utara

PENERIMAAN
No. NAMA OBAT SATUAN STOK AWAL pkm kec koja dinas sudin rs pengampu blud PEMAKAIAN SISA STOK

1 2 3 4 5 6 7 8 9 10 11 (4+5+6+7+8-9)
1 Alopurinol tablet 100 mg Pcs 0 900 5,000 2,086 3,814
2 Aminofilin tablet 200 mg Pcs 0 200 0 149 51
3 Aminofilin injeksi 24 mg/ml Pcs 0 30 60 30 60
4 Amitripilin tablet salut 25 mg (HCL) Pcs 0 0 1,000 800 200
5 Amoksisilin kapsul 250 mg Pcs 0 0 50,000 1,000 49,000
6 Amoksisilin kaplet 500 mg Pcs 0 9,600 200,000 6,000 45,781 169,819
7 Amoksisilin sirup kering 125 mg/ 5 mg Pcs 0 40 5,000 40 333 4,747
8 Metampiron tablet 500 mg Pcs 0 2,000 0 2,500 3,726 774
9 Metampiron injeksi 250 mg Pcs 0 0 0 0 0

10 Antasida DOEN I tablet kunyah, kombinasi :Aluminium Hidroksida 200 mg + 3,000 90,000 3,500 4,000 18,500 82,000
Magnesium Hidroksida 200 mg Pcs 0
11 Anti Bakteri DOEN saleb kombinasi : Basitrasin 500 IU/g + polimiksin 10.000 IU/g Pcs 0 0 50 0 0 50
12 Antihemoroid DOEN kombinasi : Bismut Subgalat 150 mg + Heksaklorofen 250 mg Pcs 0 10 300 310 0
13 Antifungi DOEN Kombinasi : Asam Benzoat 6% + Asam Salisilat 3% Pcs 0 5 50 5 5 55
14 Antimigren : Ergotamin tartrat 1 mg + Kofein 50 mg Pcs 0 500 0 76 424
Antiparkinson DOEN tablet kombinasi : Karbidopa 25 mg + Levodopa 250
15 mg Pcs 0 0 0 0 0
16 Aqua Pro Injeksi Steril, bebas pirogen Pcs 0 120 500 75 695 0
17 Asam Askorbat (vitamin C) tablet 50 mg Pcs 0 0 250,000 10,250 239,750
18 Asam Asetisalisilat tablet 100 mg (Asetosal) Pcs 0 0 100 100 200 0
19 Asam Asetisalisilat tablet 500 mg (Asetosal) Pcs 0 0 0 0 0
20 Atropin sulfat tablet 0,5 mg Pcs 0 0 0 0 0
21 Atropin tetes mata 0,5% Pcs 0 0 0 0 0
22 Atropin injeksi l.m/lv/s.k. 0,25 mg/mL - 1 mL (sulfat) Pcs 0 25 250 75 200
23 Betametason krim 0,1 % Pcs 0 75 50 74 125 324 0
24 colcasetin vial 0 15 15 0
25 Cefazolin inj amp 50 50
26 Deksametason Injeksi I.v. 5 mg/ml Pcs 0 30 500 20 150 400
27 Deksametason tablet 0,5 mg Pcs 0 20,499 50,000 11,000 31,899 49,600
28 Dekstran 70-larutan infus 6% steril Pcs 0 0
29 Dekstrometorfan sirup 10 mg/5 ml (HBr) Pcs 0 0
30 Dekstrometorfan tablet 15 mg (HBr) Pcs 0 0
31 Diazepam Injeksi 5mg/ml Pcs 0 0 0 0 0
32 Diazepam tablet 2 mg Pcs 0 100 4,800 1,000 1,400 4,500
33 Diazepam tablet 5 mg Pcs 0 0
34 Difenhidramin Injeksi I.M. 10 mg/ml (HCL) Pcs 0 0 250 30 60 220
35 Digoksin tablet 0,25 mg Pcs 0 5,000 100 400 4,700
36 Efedrin tablet 25 mg (HCL) Pcs 0 500 250 250 750 250
37 Ekstrks belladona tablet 10 mg Pcs 0 Err:522 Err:522
38 Epinefrin (Adrenalin) injeksi 0,1% (sebagai HCL) Pcs 0 300 300 0
39 Etakridin larutan 0,1% Pcs 0 0 0 0 0 0 0 0
40 Fenitoin Natriun Injeksi 50 mg/ml Pcs 0 0 0 0 0 0 0 0
41 Fenobarbital Injeksi I.m/I.v 50 mg/ml Pcs 0 10 10 0
42 Fenobarbital tablet 30 mg Pcs 0 0 0 0 0 0 0 0
43 Fenoksimetil Penisilin tablet 250 mg Pcs 0 0 0 0 0 0 0 0
44 Fenoksimetil Penisilin tablet 500 mg Pcs 0 0 0
45 Fenol Gliserol tetes telinga 10% Pcs 0 Err:522 Err:522
46 Fitomenadion (Vit. K1) injeksi 10 mg/ml Pcs 0 150 95 245 0
47 Fitomenadion (Vit. K1) tablet salut gula 10 mg Pcs 0 5,000 200 1,200 4,000
48 Furosemid tablet 40 mg Pcs 0 550 Err:522 Err:522
49 Gameksan lotion 1 % Pcs 0 Err:522 Err:522

50 Garam Oralit I serbuk Kombinasi : Natrium 0,70 g ,Kalium klorida 0,30 g, Tribatrium Sitrt dihidrat 1,750 10,000 1,000 5,750 7,000
0,58 g Pcs 0
51 Gentian Violet Larutan 1 % Pcs 0 100 28 128 0
52 Glibenklamida tablet 5 mg Pcs 0 0 1,000 1,000 0
53 Gliseril Gualakolat tablet 100 mg Pcs 0 200 3,000 9,000 12,200 0
54 Gliserin Pcs 0 Err:522 Err:522
55 Glukosa larutan infus 5% Pcs 0 20 80 450 530 20
56 Glukosa larutan infus 10% 500 ml Pcs 0 25 20 45 0
57 Glukosa larutan infus 40% steril (produk lokal) Pcs 0 0 Err:522 Err:522
58 Griseofulvin tablet 125 mg, micronized Pcs 0 1,000 1,000 1,000 1,000
59 Haloperidol tablet 0,5 mg Pcs 0 0 0
60 Haloperidol tablet 1,5 mg Pcs 0 Err:522 Err:522
61 Haloperidol tablet 5 mg Pcs 0 Err:522 Err:522
62 Lodomer (Haloperidol) Inj amp 0 1 0 0 0 0 1
63 Hidroklorotiazida tablet 25 mg Pcs 0 500 2,000 800 3,300
64 Hidrkortison krim 2,5% Pcs 0 120 0 120 24 0 264 528
65 Ibuprofen tablet 200 mg Pcs 0 200 90,000 1,000 91,200
66 Ibuprofen tablet 400 mg Pcs 0 1,500 90,000 3,500 13,400 108,400
67 Isosorbid Dinitrat Tablet Sublingual 5 mg Pcs 0 700 5,000 500 3,170 9,370
68 Kalsium Laktat (Kalk) tablet 500 mg Pcs 0 4,000 25,000 2,000 31,000
69 Kaptopril tablet 12,5 mg Pcs 0 5,640 48,000 2,000 9,640 65,280
70 Kaptopril tablet 25 mg Pcs 0 600 100,000 25,000 104,600 230,200
71 Karbamazepim tablet 200 mg Pcs 0 200 Err:522 Err:522
72 Ketamin Injeksi 10 mg/ml Pcs 0 0 0
73 Klofazimin kapsul 100 mg microzine Pcs 0 0 0
74 Kloramfenikol kapsul 250 mg Pcs 0 0 0 527 0 0 527 0
75 Kloramfenikol tetes telinga 3 % Pcs 0 0 0
76 Kloraniramina mealeat (CTM) tablet 4 mg Pcs 0 17,000 50,000 12,000 31,000 31,000
77 Klorpromazin injeksi i.m 5 mg/ml-2ml (HCL) Pcs 0 Err:522 Err:522
78 Klorpromazin injeksi i.m 25 mg/ml (HCL) Pcs 0 Err:522 Err:522
79 Klorpromazin tablet salut 25 mg (HCL) Pcs 0 200 Err:522 Err:522
80 Klorpromazin HCl tablet salut 100 mg (HCL) Pcs 0 Err:522 Err:522
81 Anti Malaria DOEN Kombinasi Pirimetamin 25 mg + Sulfadoxin 500 mg Pcs 0 Err:522 Err:522

82 95 750 1,000 1,245 Err:522

Kotrimosazol Suspensi Kombinasi :Sulfametoksazol 200 mg + Trimetoprim 40 mg/ 5 ml Pcs 0

83 Kotrimosazol DOEN I (dewasa) Kombinasi : Sulfametoksazol 400 mg, Trimetoprim 80 32,100 75,000 4,000 40,600 Err:522
mg Pcs 0

84 Kotrimosazol DOEN II (pediatrik) Kombinasi : Sulfametoksazol 100 mg, Trimetoprim 20 0 8,000 8,000 Err:522
mg Pcs 0
85 Kuinin (kina) tablet 200 mg Pcs 0 Err:522 Err:522
86 Kuinin Dihidrokklorida injeksi 25%-2 ml Pcs 0 Err:522 Err:522
87 Lidokain injeksi 2% (HCL) + Epinefrin 1 : 80.000-2 ml Pcs 0 150 150 Err:522
88 lisol pcs 0 4 4 Err:522
89 Lisinopril 10 mg tablet 1,000 Err:522
90 Magnesium Sulfat inj (IV) 20%-25 ml Pcs 0 50 10 10 Err:522
91 Magnesium Sulfat inj (IV) 40%-25 ml Pcs 0 216 50 384 600 Err:522
92 Magnesium Sulfat serbuk 30 gram Pcs 0 Err:522 Err:522
93 Mebendazol sirup 100 mg / 5 ml Pcs 0 Err:522 Err:522
94 Mebendazol tablet 100 mg Pcs 0 Err:522 Err:522
95 Metilergometrin Maleat (Metilergometrin) tablet salut 0,125 mg Pcs 0 Err:522 Err:522
96 Metilergometrin Maleat injeksi 0,200 mg -1 ml Pcs 0 1,780 250 450 2,230 Err:522
97 Metronidazol tablet 250 mg Pcs 0 500 500 Err:522
98 Metonidazol (Farizol) 125 mg Botol 250 Err:522
99 Natrium Bikarbonat tablet 500 mg Pcs 0 Err:522 Err:522
100 Natrium Fluoresein tetes mata 2 % Pcs 0 Err:522 Err:522
101 Natrium Klorida larutan infus 0,9 % Pcs 0 100 1,500 940 1,165 Err:522
102 Natrium Thiosulfat injeksi I.v. 25 % Pcs 0 Err:522 Err:522
103 Nistatin tablet salut 500.000 IU/g Pcs 0 Err:522 Err:522
104 Nistatin Vaginal tablet salut 100.000 IU/g Pcs 0 1,000 500 600 Err:522
105 Obat Batuk hitam ( O.B.H.) Pcs 0 824 864 384 1,932 Err:522
106 Oksitetrasiklin HCL salep mata 1 % Pcs 0 825 825 Err:522
107 Oksitetrasiklin injeksi I.m. 50 mg/ml-10 ml Pcs 0 Err:522 Err:522
108 Oksitosin injeksi 10 UI/ml-1 ml Pcs 0 0 400 400 Err:522
109 Paracetamol sirup 120 mg / 5 ml Pcs 0 924 5,500 440 1,564 Err:522
110 Paracetamol tablet 100 mg Pcs 0 Err:522 Err:522
111 Paracetamol tablet 500 mg Pcs 0 12,000 150,000 10,000 47,000 Err:522
112 Pilokarpin tetes mata 2 % (HCL/Nitrat) Pcs 0 Err:522 Err:522
113 Pirantel tab. Score (base) 125 mg Pcs 0 500 100 400 Err:522
114 Piridoksin (Vitamin B6) tablet 10 mg (HCL) Pcs 0 900 86,000 100 4,400 Err:522
115 Povidon Iodida larutan 10 % 1 l Pcs 0 2 2 Err:522
116 Povidon Iodida larutan 10 % 300 ml Pcs 0 4 4 4
117 Prednison tablet 5 mg Pcs 0 0 0
118 Primakuin tablet 15 mg Pcs 0 Err:522 Err:522
119 Propillitiourasil tablet 100 mg Pcs 0 100 Err:522 Err:522
120 Propanol tablet 40 mg (HCL) Pcs 0 0 Err:522
121 Reserpin tablet 0,10 mg Pcs 0 Err:522 Err:522
122 Reserpin tablet 0,25 mg Pcs 0 Err:522 Err:522
123 Ringer Laktat larutan infus Pcs 0 4,000 820 10,220 10,300 Err:522
124 Salep 2-4, kombinasi: Asam Salisilat 2% + Belerang endap 4% Pcs 0 293 100 50 351 Err:522
125 Salisil bedak 2% Pcs 0 1,118 5,000 105 523 Err:522
126 Serum Anti Bisa Ular Polivalen injeksi 5 ml (ABU I) Pcs 0 Err:522 Err:522
127 Serum Anti Bisa Ular Polivalen injeksi 50 ml (ABU II) Pcs 0 Err:522 Err:522
128 Serum Anti Difteri Injeksi 20.000 IU/vial (A.D.S.) Pcs 0 Err:522 Err:522
129 Serum Anti Tetanus Injeksi 1.500 IU/ampul (A.T.S.) Pcs 0 Err:522 Err:522
130 Serum Anti Tetanus Injeksi 20.000 IU/vial (A.T.S.) Pcs 0 Err:522 Err:522
131 Sianokobalamin (Vitamin B12) injeksi 500 mcg Pcs 0 Err:522 Err:522
132 Sulfasetamida Natrium tetes mata 15 % Pcs 0 Err:522 Err:522
133 Tetrakain HCL tetes mata 0,5% Pcs 0 0 0
134 Tetrasiklin kapsul 250 mg Pcs 0 0 0
135 Tetrasiklin kapsul 500 mg Pcs 0 5,000 Err:522 Err:522
136 Tiamin (vitamin B1) injeksi 100 mg/ml Pcs 0 Err:522 Err:522
137 Tiamin (vitamin B1) tablet 50 mg (HCL/Nitrat) Pcs 0 6,000 15,000 5,000 11,000 Err:522
138 Tiopental Natrium serbuk injeksi 1000 mg/amp Pcs 0 Err:522 Err:522
139 Triheksifenidil tablet 2 mg Pcs 0 Err:522 Err:522
140 Vaksin Rabies Vero Pcs 0 Err:522 Err:522
141 Vitamin B Kompleks tablet Pcs 0 5,000 68,000 7,000 25,500 Err:522
142 Ventolin rotaheler Pcs 99 Err:522
143 Ventolin rotaheler tablet Err:522
144 VAKSIN 0 Err:522 Err:522
145 BCG vial 0 Err:522 Err:522
146 TT vial 0 Err:522 Err:522
147 DT vial 0 Err:522 Err:522
148 CAMPAK 10 Dosis vial 0 Err:522 Err:522
149 POLIO 10 Dosis vial 0 Err:522 Err:522
150 DTP-HB vial 0 Err:522 Err:522
151 HEPATITIS B 0,5 ml ADS amp 0 Err:522 Err:522
152 POLIO 20 Dosis vial 0 Err:522 Err:522
153 CAMPAK 20 Dosis vial 0 Err:522 Err:522
154 ……………… Err:522 Err:522
Err:522 Err:522
Err:522 Err:522

JUMLAH

1 Albendazol 400 mg Tablet 0 100 100 0

3 Ambroxol 30 mg Tablet 0 100 30,000 1,333 2,000 800 4,233 30,000
4 Ambroxol 15 mg/5 ml Syr Botol 0 100 1,000 8 68 1,050
5 Amlodipin 5 mg Tablet 0 50,000 300 2,570 47,730
6 Amlodipin 10 mg Tablet 0 270 50,450 52 20,372 30,400
7 Antasida DOEN Suspensi 60 ml Botol 0 150 1,000 350 1,150 350
8 Aquabidest 500 ml Botol 0 500 500 0
9 Aspar K 300 mg Tablet 0 0 0
10 Asam folat 1 mg Tablet 0 100,000 1,000 1,500 99,500
11 Asam mefenamat 500 mg Tablet 0 3,000 0 1,500 2,100 6,600 0
12 Asiklovir 400 mg Tablet 0 1,000 600 1,300 300
13 Asiklovir 5% cr 5 gram Tube 0 0 10 10 0
Amitripilin 25 mg Tablet 500
14 Betahistin mesilat 6 mg Tablet 0 100 7,500 400 7,200
15 Bisolvon Sol Botol 0 0 3 3 0
16 Bisakodil 5 mg Tablet 0 0 240 240 0
17 Boraks gliserin 10% lar Botol 0 0 0
18 Bromheksin 8 mg Tablet 0 0 0
19 burnazin salep tube 0 50 3 3 0
20 clopidogrel Tablet 0 10 10 0
21 Cendo pantocain Botol 0 0 0
22 cendo xytrol Botol 0 10 10 0
23 Diazepam 5 mg/2,5 ml rectal tube 2,5 ml Rectal Tube 0 250 13 38 175
24 Dimenhidrinat 50 mg Tablet 0 10,000 1,500 8,500
25 Doksisiklin 100 mg Kapsul 0 2,000 200 1,800
26 Domperidon 10 mg Tablet 0 3,000 50,000 1,800 5,300 49,500
27 Domperidon 5 mg/5 ml Botol 0 250 250 0
Desinfectan 100 ml Botol 30
28 Eritromisin 500 mg Kapsul 0 0 0 0
29 Etambutol 500 mg Tablet 0 500 500 0
30 Etanol 70% lar 1 L Botol 0 0 108 108 0
31 Etil klorida semprot Botol 0 15 1 14
32 Enzim tablet Tablet 0 0 0 0
Ephinephrine 0,1 inj ampul
33 Flukonazol 150 mg Kapsul 0 250 250 0
34 Gemfibrozil 300 mg Kapsul 0 300 300 0
35 Gentamisin 3 mg/ml tetes mata 5 ml Botol 0 0 0
36 gentamisin salep kulit tube 0 70 70 0
Gentamisin inj 40 mg/ml ampul 100
Glikazide 80 mg Tablet 1,500
Gliquidone tab 30 mg Tablet 1,500
Glimepirid 2 mg Tablet 1,500
37 Glimepirid 1 mg Tablet 0 1,500 750 750
38 H202 larutan 800 ml Botol 0 0 0 0
39 Ichtiol 10% Pot 0 0 0 0
40 INH 100 mg Tablet 0 0 0 0
41 INH 300 mg Tablet 0 0 0 0
42 Itrakonazol 100 mg Kapsul 0 0 0 0
43 Kalium permanganat serbuk 5 gram Pot 0 0 0 0
44 Kaolin 550 mg + pektin 20 mg Tablet 0 2,000 1,000 81 200 3,300 6,081 500
45 Kaolin 550 mg + pektin 20 mg Susp 60 ml Botol 0 0 0 0
46 Kanamisin 1 gram injeksi Vial 0 0 0 0
47 Ketokonazol 2% cr 5 g Tube 0 36 20 24 80 0
48 Klindamisin 300 mg Kapsul 0 1,500 0 1,500
49 Kloramfenikol susp 60 ml Botol 0 0 1 1 0
50 Kloramfenikol 2% cr 5 g Tube 0 0 0 0
51 kloramfenicol injeksi ampul 0 15 15 0
52 Kloramfenikol 0,5% TM 5 ml Botol 0 0 0 0
53 Kloramfenikol 1% SM 3,5 g Tube 0 25 16 16 0
54 Kodein 15 mg Tablet 0 1,000 0 1,000
55 Kortison asetat 25 mg/ml injeksi 10 ml Vial 0 0 20 20 0
56 Levertran (salep minyak ikan) Pot 0 0 0 0
57 Lidokain 2% injeksi 2 ml Ampul 0 100 60 300 390 70
58 Linkomisin 500 mg Kapsul 0 5,000 288 288 5,000
59 Loperamid 2 mg Tablet 0 0 0 0
60 Meloksikam 15 mg Tablet 0 5,000 0 5,000
61 Metformin 500 mg Tablet 0 1,500 7,500 1,125 4,125 6,000
62 Metoklopramid 10 mg Tablet 0 1,800 3,300 3,300 1,500
63 metoklopramid inj ampul 0 27 27 0
64 Metoklopramid 5 mg/5 ml Syr 60 ml Botol 0 0 0
65 Metronidazol 500 mg Tablet 0 500 30,000 500 1,200 29,800
66 Mikonazol 2% salep kulit 10 g Tube 0 0
67 Minosep gargle 150 ml Botol 0 0
68 Natrium diklofenak 50 mg Tablet 0 19,600 2,800 16,800
69 Neoprotifed Tablet 0 0 0
70 Nifedipin 10 mg Tablet 0 0 0
Novorapid FlexPen pen 10 10
Novomix-30 pen 14 14
Nokoba injeksi ampul
71 Oksitetrasiklin 3% salep kulit 5 g Tube 0 0 24 24 0
72 Omeprazol 20 mg Kapsul 0 990 5,000 48 150 2,688 3,500
73 omeprazol serbuk inj Botol 0 48 48 0
74 Papaverin 40 mg Tablet 0 6,100 1,000 4,000 1,000 12,100 0
75 Parasetamol 60mg/ml drop Botol 0 250 229 21
76 Parasetamol 125 mg Supp Supp 0 500 60 440
77 pehacain injeksi ampul 0 20 20 0
78 Pirantel pamoat 125 mg/5 ml syr 60 ml Botol 0 50 50
79 Pirazinamid 500 mg Tablet 0 0 0
80 Piroksikam 20 mg Kapsul 0 10,000 0 10,000
81 Propanolol 10 mg Tablet 0 500 330 170
82 Ranitidin 150 mg Tablet 0 500 200,000 3,557 19,657 184,400
83 Rifampisin 300 mg Kapsul 0 500 500 0
84 Rifampisin 450 mg Tablet 0 0 0
85 Rifampisin 600 mg Tablet 0 0 0
86 Salbutamol 2 mg Tablet 0 600 15,000 400 2,800 13,200
87 Sefadroksil 500 mg Kapsul 0 2,200 5,000 500 7,700 0
88 Setirizin 10 mg Kapsul 0 8,800 30 8,830 0
89 Setirizin 5 mg/5 ml Syr 60 ml Botol 0 350 350 0
90 SF (Fe 200 mg + Asam folat 0,25 mg) Tablet 0 60,000 15,000 2,000 61,500 13,500
91 Simetidin 200 mg Tablet 0 0 0
92 Simvastatin 10 mg Tablet 0 420 390 30
Siprofloksasin infus Botol 100
93 Siprofloksasin 500 mg Tablet 0 1,100 10,000 900 600 100 3,100 9,600
94 Terbutalin 2,5 mg Tablet 0 300 300
95 Tiamfenikol 500 mg Tablet 0 5,000 1,500 1,500 5,000
96 Urispas 200 mg Tablet 0 0 0
97 Vitamin A 100.000 UI Kapsul 0 500 88 100 588 100
98 Vitamin A 200.000 UI Kapsul 0 500 99 100 349 350
99 Vitamin A 6.000 UI Tablet 0 0 0 0
100 Vitamin B12 50 mcg Tablet 0 1,000 100,000 100 6,100 0
101 Vitamin C 250 mg Tablet 0 100,000 -139,750 239,750
Valsartan 80 mg Tablet 550
Valsartan 160 mg Tablet
102 Zink 20 mg Tablet 0 600 200,000 5,850 194,750

103 Acarbose 50 mg Tablet 0 10,000 1,000 9,000

104 Asiklovir 200 mg Tablet 0 1,000 900 100
105 Albothyl 10 ml Botol 0 0 0 0
106 Amiodaron HCl 200 mg Tablet 0 100 100 0
107 Amoksilin 240 mg/5 ml 60 ml Botol 0 250 250
108 Asam traneksamat 500 mg Tablet 0 2,000 300 1,700
109 Asam traneksamat 250 mg/5 ml Injeksi Ampul 0 50 30 20
110 Asam traneksamat 500 mg/5 ml Injeksi Ampul 0
111 Asam valproat 500 mg ER Tablet 0 0 0
112 Asam valproat 250 mg/5 ml Syr Botol 0 0 0
113 Asering 500 ml Botol 0 100 100 16 84
114 Azitromisin 500 mg Tablet 0 2,500 1,000 1,500
Azitromisin sirup 200 mg/60ml Botol 100
115 Bisakodil 10 mg Supp 0 0 0
116 Bisoprolol fumarat 5 mg Tablet 0 1,000 0 1,000
Benzatin Benzil P 2,4 jt IU Inj Ampul 10
117 Calcium glukonat 100 mg/ml Ampul 0 456 50 144 602 48
118 Carbamazepine 200 mg Tablet 0 0 0
119 Carboglicerin 10% tetes telinga Botol 0 0 0
120 Cefadroxyl 125 mg/5 ml 60 ml Botol 0 500 200 300
Cefadroksil syr 250 mg/ml Botol 500
Cripsa tab Tablet 90
121 Cefixime 100 mg Kapsul 0 30,000 2,300 13,600 18,700
122 Cefixime 100 mg/5 ml Syr Botol 0 0 0
123 Cefoperazone 1 g injeksi Vial 0 0 0
124 Cefotaxime 1 g injeksi Vial 0 300 500 1,350 100 2,150 100
125 Ceftriaxone 1 g injeksi Vial 0 300 500 3,000 100 3,800 100
126 Clindamycin 300 mg Kapsul 0 100 100 0
127 Combivent nebules 2,5 ml Ampul 0 0 0 0
128 Dextrose 5% 500 ml Botol 0 80 60 20
129 Dextrose 5% 100 ml Botol 0 0 0 0
130 Diazepam 10 mg/2,5 ml 2,5 ml Rectal Tube 0 250 6 41 65
131 Diltiazem HCl 30 mg Tablet 0 0 0
132 Dobutamin 250 mg/5 ml Injeksi Ampul 0 0 0
133 Dopamine 40 mg/5 ml Injeksi Ampul 0 130 10 120
Dopamed Tablet 500
134 Eritromisin 250 mg Kapsul 0 0 0
135 flucadex sirup Botol 0 20 20 40 0
136 fludane Tablet 0 200 200 0
137 Fluticason propionat Nebules 0,5 mg/2 ml (Flixotide) Ampul 0 30 30
138 Furosemid 10 mg/ml Injeksi Ampul 0 550 57 50 107 550
139 Hyoscine butilbromid 20 mg/ml Injeksi Ampul 0 0 0
140 Ibuprofen 100 mg/5 ml Syr Botol 0 0 0
Implanon pcs 10
141 KAEN 1B Botol 0 410 0 2 157 255
142 KAEN 3A Botol 0 200 0 100 100
143 KAEN 3B Botol 0 416 0 8 234 190
144 KCl 25 mEq 25 ml Vial 0 0 62 62 0
145 Ketokonazol 200 mg Tablet 0 500 28 528 0
146 Ketoprofen 100 mg Supp Supp 0 0 0
147 Ketorolak 30 mg/ml Injeksi Ampul 0 0 96 96 0
148 Ketorolak 10 mg/ml Injeksi Ampul 0 0 0
149 KSR 600 mg Tablet 0 0 0
150 Lansoprazol 30 mg Kapsul 0 300 1,000 1,120 180
151 Lansoprazol 30 mg/ml Injeksi Vial 0 0 0
152 Laxadine Syr Botol 0 0 0
153 Lidokain Spray 10% Botol 0 0 0
154 Lidokain Gel 2% Syringe 0 0 0
155 Loratadine 10 mg Tablet 0 900 1,000 32 1,232 700
Levofloksasin inf Botol 25
Levofloxacin tab Tablet 3,000
156 Mebendazol 500 mg Tablet 0 300 74 226
157 Metformin 850 mg Tablet 0 0 0
158 Metildopa 500 mg Tablet 0 1,000 500 500
159 Metilprednison 4 mg Tablet 0 0 0 0
160 Metilprednison 16 mg Tablet 0 0 0 0
161 Metilprednison 125 mg/ml Vial 0 50 25 25
162 Metronidazole 500 mg/100 ml Botol 0 0 0 0
163 Metronidazole + Nistatin (Flagystatin) Ovula Ovula 0 0 0 0
164 Morfin HCl 10 mg/ml Ampul 0 10 10 0
165 Natrium klorida 0,9% 25 ml Vial 0 0 35 35 0
166 Natrium klorida 0,9% 500 ml Botol 0 1,500 0 125 1,375
167 Noretisteron 5 mg (Primolut N) Tablet 0 0 0
168 OAT Kategori 1 Paket 0 50 40 10
169 OAT Kategori 2 Paket 0 35 10 25
170 Ondansetron 4 mg/2 ml Ampul 0 100 1,000 2,625 3,321 404
171 Ondansetron 8 mg/2 ml Ampul 0 0 0
Ondaseton tab 8 mg Tablet 100 100
Ofloxacin 200 mg Tablet 20,000 20,000
Ofloxacin 400 mg Tablet 20,000 20,000
172 Parasetamol 1000 mg/100 ml Injeksi Botol 0 0 0
173 panaspray Botol 0 3 3 0
174 Pulmicort nebules 0,25 mg/ml Ampul 0 20 20 0
175 Ranitidin 25 mg/2 ml Injeksi Ampul 0 500 449 949 0
176 Ringer laktat 1000 ml Botol 0 180 180
177 Salbutamol 4 mg Tablet 0 100 5,000 1,300 0
178 Salbutamol nebules 2,5 mg Ampul 0 0 145 145 0
179 Simvastatin 20 mg Tablet 0 0 0
180 Spironolacton 100 mg Tablet 0 5,000 0 4,000
181 Sukralfat 500 mg/5 ml Syr Botol 0 100 100 0
182 Tramadol Injeksi Ampul 0 0 0

TOTAL NILAI PERSEDIAAN OBAT TAHUN 2015

 Mengetahui :
Direktur Rumah Sakit Umum
Kecamatan Koja

dr. Nailah
NIP. 195911061989112001
HARGA
JUMLAH KETERANGAN
SATUAN

12 13 (10x11) 14
95 362,330
88 4,488
4,200 252,000
123 24,600
232 11,368,000
287 48,738,053
2,690 12,769,430
200 154,800
3,500 0

79 6,478,000

2,516 125,800
3,350 0
3,045 167,475
 135 57,240 ed
0
2,420 0
105 25,173,750
128 0
0
0
0
1,485 297,000
1,672 0
0

1,783 713,200
75 3,720,000 ED DES15: 11.500
0
0
0
4,598 0
50 225,000
0
1,054 231,880
107 502,900
190 47,500
37 Err:522
8,910 0
11,000 0
22,275 0
1,880 0
140 0
0
0
1,361 Err:522
5,110 0
 697 2,788,000
94 Err:522
Err:522

314 2,198,000

0
62 0
67 0
Err:522
5,200 104,000
6,270 0
9,000 Err:522
241 241,000
0
Err:522
Err:522

164 541,200
3,078 1,625,184
121 11,035,200
165 17,886,000
97 908,890 ED SEPT 15: 1470 TAB
76 2,356,000
68 4,439,040 ED SEPT 15: 140 TAB
92 21,178,400
270 Err:522
0
0
324 0
0
56 1,736,000
Err:522
Err:522
68 Err:522
 Err:522
Err:522

2,384 Err:522

152 Err:522 ED DES15: 10.100 TAB

Err:522

737 Err:522
Err:522
1,499 Err:522
Err:522

3,200 Err:522
3,850 Err:522
Err:522
Err:522
Err:522
169 Err:522
3,025 Err:522
160 Err:522

Err:522
Err:522
5,170 Err:522
Err:522
Err:522
528 Err:522
3,870 Err:522
2,522 Err:522
Err:522
2,090 Err:522
1,582 Err:522
50 Err:522
 96 Err:522
Err:522
328 Err:522 ED OKT 15 : 100 TAB
121 Err:522
2,379 Err:522
15,623 62,492
125 0
Err:522
Err:522
118 Err:522
Err:522
Err:522
5,720 Err:522
2,200 Err:522
1,375 Err:522
Err:522
Err:522
Err:522
Err:522
Err:522
Err:522
Err:522
0
0
300 Err:522
Err:522
50 Err:522
Err:522
Err:522
Err:522
118 Err:522
 Err:522
Err:522
Err:522
Err:522
Err:522
Err:522
Err:522
Err:522
Err:522
Err:522
Err:522
Err:522
Err:522

238,387,316

378 0
152 4,560,000
4,719 4,954,950
206 9,832,380
363 11,035,200 ED OKT 15: 100 TAB
2,354 823,900
8,250 0
760 0
53 5,273,500
123 0
391 117,300
3,645 0

1,122 8,078,400
 97,023 0
1,320 0
5,005 0
252 0
0
0
26,550 0
0
12,678 2,218,650
371 3,153,500
297 534,600
184 9,108,000
3,666 0

1,023 0
496 0
34,320 0
176,000 2,464,000
530 0

5,348 0
318 0
3,513 0
0

480 360,000
41,113 0
7,380 0
72 0
174 0
 2,063 0
1,139 0
276 138,000
6,201 0
5,500 0
2,826 0
397 595,500
4,048 0
3,876 0
0
7,241 0
1,760 0
550 550,000
38,932 0
4,680 0
923 64,610
889 4,445,000
98 0
1,713 8,565,000
286 1,716,000
133 199,500
0
2,860 0
176 5,244,800
3,300 0
35,750 0
194 3,259,200
810 0
104 0

2,006 0
 232 812,000
0
244 0
5,720 120,120
12,650 5,566,000
0
9,196 0
229 0
128 1,280,000
165 28,050
132 24,340,800
670 0
869 0
1,210 0
65 858,000 ED JUNI 15 : 700 TAB
560 0
199 0
8,799 0
55 742,500
161 0
186 5,580

280 2,688,000
109 0
749 3,745,000
5,544 0
286 28,600
505 176,750
205 0
63 0
106 25,413,500
 521 101,464,750
TOTAL 254,561,640

858 7,722,000
261 26,100
19,132 0
1,320 0
4,477 0
1,130 1,921,000
3,245 64,900
6,575 0
5,995 0
44,000 0
9,900 831,600
4,950 7,425,000

6,650 0
709 709,000

8,580 411,840
270 0
2,246 0
5,386 1,615,800

935 17,484,500
9,680 0
42,350 0
3,245 324,500
3,630 363,000
608 0
9,790 0
 5,720 114,400
6,500 0
18,423 1,197,495
147 0
29,370 0
10,824 1,298,880

547 0
0
0
14,209 0
2,012 1,106,600
4,950 0
3,849 0

9,900 2,524,500
11,000 1,100,000
11,000 2,090,000
2,500 0
330 0
2,994 0
2,530 0
3,000 0
1,738 0
1,614 290,520
90,246 0
13,695 0
156,200 0
44,000 0
169 118,300

10,210 2,307,460
 218 0
2,500 1,250,000
226 0
699 0
21,450 536,250
10,945 0
21,000 0
9,240 0
5,500 0
13,500 18,562,500
2,880 0
395,989 3,959,890
1,319,890 32,997,250
2,640 1,066,560
2,640 0

85,807 0
0
9,790 0
1,254 0
19,000 0
98 0
7,260 0
534 0
990 3,960,000
14,767 0
2,634 0
TOTAL 113,379,845

606,988,801
 Jakarta, 23 Maret 2016
Yang membuat Laporan :

Nurhayati,S.Si,Apt.
NIP. 197902112007012011
 LAPORAN PERSEDIAAN ALKES P

NAMA INSTANSI : RUMAH SAKIT UMUM KECAMATAN Koja

ALAMAT : Jl. Walang Permai No.39, Kecamatan Koja, Jakarta Utara

PENERIMAAN
No. NAMA ALKES SATUAN STOK AWAL dinas

1 2 3 4 5
1 Abocath ukuran 18 Pcs 150 500
2 Abocath ukuran 20 Pcs 50
3 Abocath ukuran 22 Pcs 100
4 Abocath ukuran 26 pcs 0
5 Abocath ukuran 24 Pcs 165
6 Alkohol swab Pcs 1,000
7 Benang Jahit (Catgut Plain) 3/0 Kotak 5
8 Benang Jahit (Silkam Black) 3/0 Kotak 0
9 Calciplex jarum box 0
10 Citoject jarum box 0
11 Blood Administration Pcs 200
12 ETT NO.3 pcs 5
13 ETT NO.4 pcs 5
14 ETT NO.5 pcs 5
15 ETT NO.7 PCS 5
16 ETT NO.8 Pcs 5
17 Film USG Pcs
18 Foley catheter 2 Way No. 18 Pcs 5
19 Folley catheter no 12 Pcs 5
20 Folley catheter no 14 Pcs 5
21 Foley catheter 2 Way No. 10 Pcs 5
22 Feeding Tube No.8 Pcs 10
23 Feeding Tube No.5 Pcs 10
24 Handscoon steril No. 6,5 Pcs 100
25 Handscoon steril No. 7,5 pcs 150
26 Handscoon steril No. 7 Pcs 50
27 Handscoon Uk. L On steril Pcs 1,000
28 Handscoon Uk. M On steril Pcs 100 1,500
29 Handscoon Uk. S On steril Pcs
30 Handscoon Uk. XS On steril Pcs
31 Hub Cutter (Desfruclip) Pcs
32 IUD (coper T) Pcs
33 Infuset micro (intravix) Pcs 200
34 Infus set dewasa (Dus isi 50 pcs) Pcs 200 900
infus set anak pcs
Jarum jahit (Suture Neeedle) ukuran
Pak
35 10
Jarum jahit (Suture Neeedle) ukuran
Pak
36 11
37 Kapas Putih 250 g Gulung 2
38 Kassa gulung besar Gulung 40

Kassa gulung kecil (Pak isi 50 roll) Roll

39
40 Kassa steril (Pak isi 10 Pcs) Pcs
41 Lomatuelle (Pak isi 10 Pcs) Pcs
42 Masker Karet (Dus isi 50 Pcs) Pcs 3,400
43 Masker Tali (Dus isi 50 Pcs) Pcs 50 1,600
44 Masker Nebulizer Adult Pcs
45 Masker Neb Child Pcs
46 Nasal Canul Adult Pcs
47 Nasal Anak pcs
48 Nasal Canul Infant Pcs
49 Masker NRM Ped Pcs
50 Masker NRM Adult Pcs
51 Micropore 3M 1 Inch Pcs
52 Mucus Extractor Pcs
53 Peneng Adult - Blue Pcs
54 Peneng Adult - Pink Pcs
55 Safety Box (Dus 25 Pcs) Pcs 300
56 Spuit 1 cc (Dus 100 Pcs) Pcs 100 300
57 Spuit 2,5 cc (Dus 100 Pcs) Pcs
58 Spuit 3 cc (Dus 100 Pcs) Pcs 1,050
59 Spuit 5 cc (Dus 100 Pcs) Pcs 500
60 Spuit 10 cc Pcs 750
61 Spuit 20 cc (Dus 100 Pcs) Pcs
62 SILK 2-0 75 cm Pcs
63 SILK 4-0 75 cm Pcs
64 SILK 3-0 75 cm Pcs
65 Suction cath no.14 fr pcs
66 Suction cath no.10 fr pcs
67 Suction cath no.8 fr pcs
68 Suction cath no.6 fr pcs
69 Tabung EDTA (Pak isi 100 Pcs) Pcs
70 Tempat Sampel Darah Dus
 Wooden Tongue Spatel (Dus isi 50
Pcs
71 Pcs)
72 Wing scalp veinset no.23 Pcs
73 Wing scalp veinset no.25 Pcs

Urine Bag 2000 ml (Pak isi 100 Pcs) Pcs 3

74
75 USG jelly Pcs
76 Underpad (ibks: 10 pcs) pcs
77 Urinal Plastik pcs

Mengetahui :
Direktur Rumah Sakit
Umum
Kecamatan Koja

dr. Nailah
NIP.
RAN PERSEDIAAN ALKES PAKAI HABIS TAHUN 2015

atan Koja, Jakarta Utara

PENERIMAAN
sudin rs pengampu HARGA
PEMAKAIAN SISA STOK JUMLAH
SATUAN

6 7(4+5-6) 8 9(7x8)
520 130 11,880 1,544,400
- 50 5,940 297,000
- 100 5,940 594,000
- - 5,940 -
- 165 5,940 980,100
1,000 - 420 -
5 - 27,758 -
- - -
- - -
- - -
- 200 13,976 2,795,200
- 5 84,942 424,710
- 5 84,942 424,710
- 5 84,942 424,710
- 5 84,942 424,710
- 5 84,942 424,710
- -
- 5 80,000 400,000
5 - 26,384 -
4 1 26,384 26,384
4 1 26,384 26,384
1 9 11,000 99,000
- 10 11,000 110,000
5 95 6,325 600,875
5 145 6,325 917,125
5 45 6,325 284,625
1,000 - 46,200 -
1,600 - 46,200 -
- -
- -
- -
- -
- 200 20,592 4,118,400
100 800 400 7,000 2,800,000
100

- -

- -

- - -
40 105,000 -

- -

- 10,000 -
- -
2,950 450 30,800 13,860,000
1,500 150 30,800 4,620,000
- 33,000 -
- - -
- - 12,000 -
- 12,000 -
- 12,000 -
- 60,000 -
- 60,000 -
- - 27,600 -
- -
- -
- -
55 245 15,715 3,850,175
200 200 2,640 528,000
- - -
50 700 400 900 360,000
250 250 1,500 375,000
100 650 2,000 1,300,000
- - -
- - -
- - -
- - -
- - 8,000 -
- - 11,000 -
- - 7,500 -
- - 7,500 -
- - -
- - -
- - -

- - -
- - -

- 3 5,000 15,000

- - -
- - -
- -

TOTAL
Jakarta,
Yang membuat Laporan :

NIP.
MERK KETERANGAN

10 11
 42,625,218 -
Jakarta,
mbuat Laporan :

NIP.