DAFTAR USULAN OBAT TAHUN 2014

KODE PUSKESMAS : P 2171060202

PUSKESMAS : UPT.PUSKESMAS TIBAN BARU
KECAMATAN : SEKUPANG
KOTA : BATAM
PROVINSI : KEPULAUAN RIAU

RATA-RATA KEBETUHAN USULAN

NO NAMA OBAT SATUAN SISA STOK PEMAKAIAN S/D 30-04- PERMINTAA KET
BULANAN 2015 N
1 2 3 4 5 6=(18*5) 7=(6-4) 8

I OBAT GENERIK
1 Albendazol tablet 400 mg tablet 0 100 1800 1800
2 Alprozolam tab 0,25 mg tablet 0 0 0 0
3 Alprozolam tab 0,5 mg tablet 0 100 1800 1800
4 Acyclovir 200 mg tablet ( OGB ) tablet 100 100 1800 1700
5 Acyclovir 400 mg tablet ( OGB ) tablet 100 300 5400 5300
6 Acyclovir cream ( OGB ) tube 55 100 1800 1745
7 ACT(Atesunat 50 mg+Amodiaquin anhydrida200 mg)ta paket 5 0 0 0
8 Arterakine tablet paket 0 0 0 0
9 Arterakine (DARPLEX) paket 5 0 0 0
10 Allopurinol tablet 100 mg tablet 300 300 5400 5100
11 Allopurinol tablet 300 mg tablet 100 100 1800 1700
12 Ambroxol syrup ( OGB ) botol 50 200 3600 3550
13 Ambroxol 30mg tab (OGB ) tablet 200 1000 18000 17800
14 Aminofilin tablet 200 mg tablet 200 300 5400 5200
15 Aminofilina injeksi 24 mg/ml - 10ml ampul 0 0 0 0
16 Amitriptilin HCL tablet salut 25 mg tablet 100 100 1800 1700
17 Amlodipine tablet 5 mg tablet 300 500 9000 8700

Page 1
 RATA-RATA KEBETUHAN USULAN
NO NAMA OBAT SATUAN SISA STOK PEMAKAIAN S/D 30-04- PERMINTAA KET
BULANAN 2015 N
1 2 3 4 5 6=(18*5) 7=(6-4) 8
18 Amoksisilin sirup kering 125 mg/5 ml botol 80 100 1800 1720
19 Amoksisilin kapsul 250 mg kapsul 720 100 1800 1080
20 Amoksisilin kaplet 500 mg kaplet 3300 1500 27000 23700
21 Ampicillin inj 1 gr ( OGB ) vial 0 10 180 180
22 Antalgin (metampiron) tablet 500 mg tablet 0 0 0 0
23 Antalgin injeksi 250 mg/ml - 2ml ampul 30 10 180 150
24 Antasida DOEN I tablet kunyah tablet 1200 1500 27000 25800
25 Antasida DOEN II suspensi botol 0 200 3600 3600
26 Anti bakteri DOEN salep komb:Bacitracin+Polimiksin tube 50 50 900 850
27 Anti hemoroid DOEN kombinasi suup 10 10 180 170
28 Antifungi DOEN kombinasi :As Benzoat+As Salisilat pot 0 0 0 0
29 Antimigren tartrat 1 mg + kofein 50 mg tablet 200 100 1800 1600
30 Aqua pro injeksi steril, bebas pirogen 20 ml vial 13 10 180 167
31 Aquades steril 1000 ml botol 1 2 36 35
32 Artem (artemether 80 mg ) inj ampul 0 0 0 0
33 Artesunate inj 60 mg/ml vial 0 0 0 0
34 Asam Mefenamat tablet salut 250 mg kapsul 0 0 0 0
35 Asam Mefenamat tablet salut 500 mg kaplet 900 2000 36000 35100
36 Asetosal tablet 100 mg tablet 0 0 0 0
37 Asetosal tablet 500 mg tablet 0 100 1800 1800
38 Atenolol tablet 50 mg tablet 200 100 1800 1600
39 Atropin sulfat inj 0,25 mg/ml-1 ml ampul 30 10 180 150
40 Atropin sulfat tablet 0,5 mg tablet 0 0 0 0
41 Atropin sulfat tetes mata 0,5 mg botol 0 0 0 0
42 Besi sirup botol 0 0 0 0

Page 2
 RATA-RATA KEBETUHAN USULAN
NO NAMA OBAT SATUAN SISA STOK PEMAKAIAN S/D 30-04- PERMINTAA KET
BULANAN 2015 N
1 2 3 4 5 6=(18*5) 7=(6-4) 8
43 Betametason krim 0,1% tube 75 50 900 825
44 Betahistin Mesilat 6 MG tablet 210 100 1800 1590
45 Bisoprolol 5 mg tablet 150 50 900 750
46 Bromheksin tab 8 mg tablet 0 200 3600 3600
47 Calcium gluconat injeksi ampul 0 0 0 0
48 Calcium Lactate 500 mg tablet 2000 2000 36000 34000
49 Catopril 12,5 mg tablet 1000 1500 27000 26000
50 Catopril 25 mg tablet 1000 1500 27000 26000
51 Cefadroxil syrup 125 mg/5ml botol 0 50 900 900
52 Cefadroxil kapsul 500 mg kapsul 0 500 9000 9000
53 Cefixim syrup 100 mg/5 ml botol 90 40 720 630
54 Cefixim 100 mg kapsul kapsul 300 300 5400 5100
55 Cefotaxim injeksi 1 gram vial 0 10 180 180
56 Ceftriazone injeksi vial 50 10 180 130
57 Cetirizene syrup 5 mg/ 5 ml botol 50 50 900 850
58 Cetirizene 10 mg tablet 0 100 1800 1800
59 Chloramphenicol suspensi 60 ml botol 48 60 1080 1032
60 Chloramphenicol kapsul 250 mg kapsul 250 250 4500 4250
61 Chloramphenicol tetes Mata 0,5 % tube 24 60 1080 1056
62 Chloramphenicol salep mata 1 % tube 57 50 900 843
63 Chloramphenicol tetes telinga 3 % botol 24 20 360 336
64 Chlorfeniramin Maleat (CTM) tab 4 mg tablet 1000 2000 36000 35000
65 Chlorpromazine HCL 100 mg tablet salut tablet 0 0 0 0
66 Chlorpromazine HCL 25 mg tablet salut tablet 0 20 360 360
67 Chlorpromazine HCL inj 25 mg / ml - 1 ml ampul 0 5 90 90

Page 3
 RATA-RATA KEBETUHAN USULAN
NO NAMA OBAT SATUAN SISA STOK PEMAKAIAN S/D 30-04- PERMINTAA KET
BULANAN 2015 N
1 2 3 4 5 6=(18*5) 7=(6-4) 8
68 Chlorpromazine HCL inj 5 mg / ml - 2 ml ampul 0 0 0 0
69 Cimetidin 200 mg tab (OGB ) tablet 200 200 3600 3400
70 Clindamisin 150 mg kapsul 150 300 5400 5250
71 Clindamisin 300 mg kapsul 200 150 2700 2500
72 Co- Amoxiclav 625 mg tab tablet 330 200 3600 3270
73 Cotrimoksazole suspensi 60 ml botol 80 50 900 820
74 Cotrimoksazole tablet pediatrik 120 mg tablet 100 100 1800 1700
75 Cotrimoksazole tablet Dewasa 480 mg tablet 300 500 9000 8700
76 Cyprofloxacin tab 500 mg ( OGB ) tablet 500 200 3600 3100
77 Deksametason injeksi 5 mg / ml -1ml ampul 132 20 360 228
78 Deksametason tablet 0,5mg tablet 3400 1000 18000 14600
79 Dekstrometorfan sirup 10 mg/5 ml botol 80 50 900 820
80 Dekstrometorfan tablet 15 mg tablet 1200 300 5400 4200
81 Dekstran 70 - larutan infus 6 % steril botol 0 2 36 36
82 Diazepam tablet 2 mg tablet 961 100 1800 839
83 Diazepam tablet 5 mg tablet 485 70 1260 775
84 Diazepam injeksi 5 mg/ml ampul 30 20 360 330
85 Diethylcarbamazine tablet 100 mg tablet 0 0 0 0
86 Difenhidramin HCL inj 10 mg/ml-1 ml ampul 60 20 360 300
87 Digoksin tablet 0,25 mg tablet 100 20 360 260
88 Doksisiklin kapsul 100 mg kapsul 300 100 1800 1500
89 Domperidon syrup botol 28 50 900 872
90 Domperidon 10 mg tab tablet 500 100 1800 1300
91 Efedrin HCl tablet 25 mg tablet 2000 1000 18000 16000
92 Epinefrina HCL/Bitartrat (Adrenalin ) inj 0,1 %-1 ml ampul 30 20 360 330

Page 4
 RATA-RATA KEBETUHAN USULAN
NO NAMA OBAT SATUAN SISA STOK PEMAKAIAN S/D 30-04- PERMINTAA KET
BULANAN 2015 N
1 2 3 4 5 6=(18*5) 7=(6-4) 8
93 Ekstrak belladon tablet 10 mg tablet 0 100 1800 1800
94 Erythromycin kapsul 500 mg ( OGB ) kapsul 500 200 3600 3100
95 Erythromycin syrup 200 mg/5 ml botol 40 50 900 860
96 Fenitoin natrium kapsul 100 mg kapsul 0 0 0 0
97 Fenitoin natrium kapsul 30 mg kapsul 0 100 1800 1800
98 Fenobarbital injeksi 50 mg/ml - 2 ml ampul 30 40 720 690
99 Fenobarbital tablet 30 mg tablet 793 100 1800 1007
100 Fenobarbital tablet 100 mg tablet 0 0 0 0
101 Fenol Gliserol tetes telinga 10 % botol 0 20 360 360
102 Folic Acid tablet 1 mg tablet 200 100 1800 1600
103 Furosemid injeksi ampul 0 0 0 0
104 Furosemid tablet 40 mg tablet 100 30 540 440
105 Gameksan emulsi 1% botol 0 0 0 0
106 Garam oralit untuk 200 ml air sachet 0 100 1800 1800
107 Gentamycin salap kulit 0,1 % - 5 gr (OGB) tube 25 200 3600 3575
108 Gentamisin tetes mata tube 20 100 1800 1780
109 Gentamicyn inj 80 mg/ml vial 0 5 90 90
110 Gentian violet larutan 1% botol 48 20 360 312
111 Glibenklamid tablet 5 mg tablet 200 200 3600 3400
112 Gliseril guayakolat tablet 100 mg tablet 2000 1000 18000 16000
113 Gliserin pot 0 0 0 0
114 Glukosa larutan infus 5% steril botol 3 5 90 87
115 Glukosa larutan infus 10 % steril botol 0 0 0 0
116 Glukosa larutan infus 40 % steril botol 0 0 0 0
117 Griseofulvin tablet 125 mg tablet 300 100 1800 1500

Page 5
 RATA-RATA KEBETUHAN USULAN
NO NAMA OBAT SATUAN SISA STOK PEMAKAIAN S/D 30-04- PERMINTAA KET
BULANAN 2015 N
1 2 3 4 5 6=(18*5) 7=(6-4) 8
118 Haloperidol tablet 0,5 mg tablet 100 100 1800 1700
119 Haloperidol tablet 1,5 mg tablet 0 0 0 0
120 Hidroklorotiazid (HCT) tablet 25 mg tablet 1000 1000 18000 17000
121 Hidrokortison krim 1% tube 14 20 360 346
122 Hidrokortison krim 2,5 % tube 0 100 1800 1800
123 Insulin reguler inj 40IU/ml-10 ml (human) ampul 0 0 0 0
124 Ibuprofen suspensi 100 mg/5ml botol 30 60 1080 1050
125 Ibuprofen tablet 200 mg tablet 200 200 3600 3400
126 Ibuprofen tablet 400 mg tablet 300 300 5400 5100
127 Isosorbid dinitrat tablet sublingual 5 mg tablet 100 100 1800 1700
128 Kalium Diclofenak 25 mg tablet 0 200 3600 3600
129 Kalium Permangat serbuk 5 gram pot 9 20 360 351
130 Karbamazepin tablet 200 mg tablet 0 0 0 0
131 Ketokenazol cream 2 % tube 10 20 360 350
132 Ketokonazol 200 mg tab tablet 200 100 1800 1600
133 Klonidin tablet 0,15 mg tablet 200 100 1800 1600
134 Klorokuin tablet 150 mg tablet 0 30 540 540
135 Klorpropamid tablet 100 mg tablet 0 0 0 0
136 Kodein fosfat tablet 10 mg tablet 0 0 0 0
137 Kuinin (kina) tablet 200 mg tablet 0 25 450 450
138 Kuinin dihidroklorida inj 25 %-2 ml ampul 0 10 180 180
139 Lanzoprazol kapsul 30 mg kapsul 100 100 1800 1700
140 Lidokain komp.injeksi 2 ml ampul 120 30 540 420
141 Loperamid tablet tablet 200 200 3600 3400
142 Loratadin tablet 10 mg tablet 350 200 3600 3250

Page 6
 RATA-RATA KEBETUHAN USULAN
NO NAMA OBAT SATUAN SISA STOK PEMAKAIAN S/D 30-04- PERMINTAA KET
BULANAN 2015 N
1 2 3 4 5 6=(18*5) 7=(6-4) 8
143 Lyncomicin 500 mg cap kapsul 120 200 3600 3480
144 Magnesium Sulfat Inj (IV) 20%-25 ml ampul 4 10 180 176
145 Magnesium Sulfat Inj (IV) 40%-25 ml ampul 0 0 0 0
146 Mebendazol sirup 100 mg/5 ml botol 0 0 0 0
147 Mebendazol tablet 100 mg tablet 0 0 0 0
148 Methochlorpamid syr 5 mg/ml botol 0 20 360 360
149 Metilergometrin maleat inj 0,200 mg-1 ml ampul 0 30 540 540
150 Metilergometrin maleat tab salut 1,125 mg tablet 0 100 1800 1800
151 Meloksikam suppositoria supp 50 10 180 130
152 Meloksikam 7,5 mg tablet 140 200 3600 3460
153 Metformin tab 500 mg tablet 500 500 9000 8500
154 Metformin tab 850 mg tablet 0 0 0 0
155 Metilprednisolon 4 mg tablet 200 200 3600 3400
156 Metilprednisolon 8 mg tablet 0 0 0 0
157 Metoclorpramid injeksi 5 mg/ml ampul 0 5 90 90
158 Metoclorpramid tab 10 mg tablet 0 100 1800 1800
159 Metronidazol tablet 250 mg tablet 0 0 0 0
160 Metronidazol tablet 500 mg tablet 100 100 1800 1700
161 Metronidazol 500 mg infus botol 0 1 18 18
162 Miconazol 2 % cream (OGB ) tube 24 100 1800 1776
163 Mineral Mix sachet 120 60 1080 960
164 Natrium bikarbonat tablet 500 mg tablet 1000 100 1800 800
165 Natrium Diklofenak tab 50 mg tablet 500 300 5400 4900
166 Natrium Tiroksin tablet 0 0 0 0
167 Natrium klorida larutan infus 0,9% steril botol 0 10 180 180

Page 7
 RATA-RATA KEBETUHAN USULAN
NO NAMA OBAT SATUAN SISA STOK PEMAKAIAN S/D 30-04- PERMINTAA KET
BULANAN 2015 N
1 2 3 4 5 6=(18*5) 7=(6-4) 8
168 Nifedipin tab 10 mg tablet 300 500 9000 8700
169 Nistatin tablet salut 100.000 IU tablet 100 100 1800 1700
170 Nistatin tablet salut 500.000 IU tablet 100 100 1800 1700
171 OAT FDC Kategori Anak paket 1 1 18 17
172 OAT Kombipak Kategori Anak paket 0 0 0 0
173 OAT FDC Kategori I Dewasa paket 7 3 54 47
174 OAT Kombipak Kategori I Dewasa paket 0 0 0 0
175 OAT FDC Kategori II Dewasa paket 0 0 0 0
176 OAT FDC Sisipan Dewasa paket 0 0 0 0
177 Obat batuk hitam (OBH) cairan botol 30 100 1800 1770
178 Oksitetrasiklin HCl injeksi I.m.50mg/ml-10ml vial 20 10 180 160
179 Oksitetrasiklin HCl salep mata 1% tube 0 20 360 360
180 Oksitetrasiklin HCl salep 3% tube 25 50 900 875
181 Oksitosin injeksi 10 IU/ml-1 ml ampul 0 10 180 180
182 Omeprazol kapsul 20 mg caps 210 100 1800 1590
183 Oseltamivir 75 mg (ut flu burung) tablet 0 0 0 0
184 Papaverin tablet 40 mg ( OGB ) tablet 2000 200 3600 1600
185 Paraformaldehid tablet 1 gram tablet 0 0 0 0
186 Parasetamol drop botol 10 10 180 170
187 Parasetamol sirup 120 mg/5 ml botol 90 200 3600 3510
188 Parasetamol tablet 100 mg tablet 100 300 5400 5300
189 Parasetamol tablet 500 mg tablet 2500 2000 36000 33500
190 Phytomenadion (Vit K1) injeksi 10 mg/ml-1 ml ampul 30 10 180 150
191 Phytomenadion (Vit.K1) tablet salut gula 10 mg tablet 0 30 540 540
192 Piracetam 800 mg tablet 0 0 0 0

Page 8
 RATA-RATA KEBETUHAN USULAN
NO NAMA OBAT SATUAN SISA STOK PEMAKAIAN S/D 30-04- PERMINTAA KET
BULANAN 2015 N
1 2 3 4 5 6=(18*5) 7=(6-4) 8
193 Piracetam 1200 mg tablet 0 0 0 0
194 Pirantel sirup 125 mg/5 ml botol 0 10 180 180
195 Pirantel tablet 125 mg tablet 100 30 540 440
196 Piroxicam 10 mg ( OGB ) tablet 500 500 9000 8500
197 Piroxicam 20 mg ( OGB ) kapsul 200 200 3600 3400
198 Prednison tablet 5 mg tablet 1000 500 9000 8000
199 Primakuin tablet 15 mg tablet 1000 100 1800 800
200 Propiltiourasil tablet 100 mg tablet 300 100 1800 1500
201 Propranolol HCl tablet 10 mg tablet 200 100 1800 1600
202 Propranolol HCl tablet 40 mg tablet 0 0 0 0
203 Prokain Penisilin inj,3 juta IU vial 0 10 180 180
204 Rabies immuni globulin (himan ) 150 IU/ml ampul 0 1 18 18
205 Ranitidin tab tablet 400 300 5400 5000
206 Ranitidin injeksi ampul 25 20 360 335
207 Reserpin tablet 0,10 mg tablet 0 0 0 0
208 Reserpin tablet 0,25 mg tablet 0 50 900 900
209 Ringer laktat larutan infus steril botol 7 20 360 353
210 Salbutamol tablet 2 mg tablet 400 200 3600 3200
211 Salbutamol tablet 4 mg tablet 100 100 1800 1700
212 Salep 2-4, komb : As.Salisilat + belerang endap pot 14 10 180 166
213 Salisil bedak 2% kotak 115 20 360 245
214 Serum anti bisa ular polivalen inj 5 ml (ABU I ) ampul 0 1 18 18
215 Serum anti difteri inj 20.000 IU/vial (A D S ) ampul 0 0 0 0
216 Serum anti tetanus injeksi 1.500 IU/ampul ( A T S ) ampul 0 2 36 36
217 Serum anti tetanus injeksi 20.00 IU/ampul ( A T S ) ampul 0 0 0 0

Page 9
 RATA-RATA KEBETUHAN USULAN
NO NAMA OBAT SATUAN SISA STOK PEMAKAIAN S/D 30-04- PERMINTAA KET
BULANAN 2015 N
1 2 3 4 5 6=(18*5) 7=(6-4) 8
218 Simvastatin tab 10 mg tablet 390 100 1800 1410
219 Sulfadoxin 500+Pirimetamin 25 mg tablet tablet 0 0 0 0
220 Sulfasetamida Natrium tetes mata 15 % botol 0 0 0 0
221 Tambah Darah tablet ( Ferollat ) tablet 1200 100 1800 600
222 Tetrakain HCL tetes mata 0,5% tube 10 1 18 8
223 Tetrasiklin HCL kapsul 250 mg kapsul 0 20 360 360
224 Tetrasiklin HCL kapsul 500 mg kapsul 200 100 1800 1600
225 Thiamphenicol kapsul 500 mg kapsul 0 40 720 720
226 Tramadol injeksi ampul 10 10 180 170
227 Tramadol 50 mg tablet 50 100 1800 1750
228 Triheksifenidil Hidroklorida tablet 2 mg tablet 0 70 1260 1260
229 Vaksin rabies vero ampul 0 0 0 0
230 Vitamin A (Retinol) 100.000 IU kapsul lunak tablet 1950 200 3600 1650
231 Vitamin A (Retinol) 200.000 IU kapsul lunak tablet 450 1000 18000 17550
232 Vitamin B1 (Thiamin HCl) injeksi 100 mg/ml-1ml ampul 0 30 540 540
233 Vitamin B1 (Thiamin HCl) tablet 50 mg tablet 0 500 9000 9000
234 Vitamin B6 (Piridoksin HCl) tablet 10 mg tablet 2000 1000 18000 16000
235 Vitamin B12 (Cyanocobalamin) injeksi 500 mcg/ml-1ml ampul 100 20 360 260
236 Vitamin B12 (Cyanocobalamin) tablet tablet 1000 1000 18000 17000
237 Vitamin B Complex tablet tablet 2000 2500 45000 43000
238 Vitamin C (Asam Ascorbat ) tablet 50 mg tablet 1000 1000 18000 17000
239 Vitamin C (Asam Ascorbat ) tablet 250 mg tablet 0 1000 18000 18000
240 Zink 20 mg tablet Dispersibel tablet 800 300 5400 4600

II OBAT GIGI

Page 10
 RATA-RATA KEBETUHAN USULAN
NO NAMA OBAT SATUAN SISA STOK PEMAKAIAN S/D 30-04- PERMINTAA KET
BULANAN 2015 N
1 2 3 4 5 6=(18*5) 7=(6-4) 8
241 Air Raksa botol 0 2 36 36
242 Alkahner/Cavit/Dentorit botol 2 2 36 34
243 Devitalisasi pasta (non arsen) botol 2 1 18 16
244 Etil klorida semprot botol 1 2 36 35
245 Eugenol Cairan set 0 2 36 36
246 Flour tablet 0,5 mg set 0 1 18 18
247 Formokresol (pengganti TKF) botol 0 1 18 18
248 Glass ionomer cement (GC IX) botol 2 2 36 34
249 Kalsium hidroksida pasta set 0 1 18 18
250 Klorfenol kamfer menthol (CHKM) botol 0 1 18 18
251 Mummifying pasta dental 0 1 18 18
252 Semen seng fosfat serbuk dan cairan set 2 1 18 16
253 Silver amalgam serbuk 65 - 75% set 1 1 18 17
254 Spons gelatin cubides 1 x 1 x 1 cm set 10 10 180 170
255 Temporary stopping fletcher (Fletcher) serbuk & cairan botol 1 1 18 17

III OBAT TAMBAHAN

256 Alphamol Drop / Otopan Drop botol 0 10 180 180
257 Amoxan/ Amobiotik drop botol 3 10 180 177
258 Armovit kapsul 0 100 1800 1800
259 Bioplacenton Jelly tube 4 5 90 86
260 Borax gliserin botol 0 24 432 432
261 Chloramfecort H cream/Colipred cream tube 0 10 180 180
262 Combantrin syr botol 0 20 360 360
263 Daryantul lbr 1 1 18 17

Page 11
 RATA-RATA KEBETUHAN USULAN
NO NAMA OBAT SATUAN SISA STOK PEMAKAIAN S/D 30-04- PERMINTAA KET
BULANAN 2015 N
1 2 3 4 5 6=(18*5) 7=(6-4) 8
264 Dettol lig 750ml botol 0 1 18 18
265 Dextamin tab tablet 0 100 1800 1800
266 Diafrom tab tablet 0 100 1800 1800
267 Dialac 1 gr/ Lacto B saset 40 40 720 680
268 Dulcolax tab tablet 0 20 360 360
269 Evion 200 soft tab kapsul 0 100 1800 1800
270 FG troches tab isap tablet 0 100 1800 1800
271 Flutamol tab tablet 0 100 1800 1800
272 Folamil tab tablet 0 100 1800 1800
273 Folavit tab 1 mg tablet 0 100 1800 1800
274 Guanestrip syr / Kanina syrup botol 0 20 360 360
275 H 2 O 2 3 % 1000 ml botol 1 3 54 53
276 Histolan tab tablet 0 100 1800 1800
277 Ictiol salep pot 14 10 180 166
278 Kanamycin inj 1 grm vial 0 0 0 0
279 Kanamycin inj 2 grm vial 0 1 18 18
280 Kandistatin Drop botol 0 20 360 360
281 Livron B Plex tablet 0 100 1800 1800
282 Molakrim/ Counterpain tube 4 20 360 356
283 Multi vitamin syr (calsidol+DHA+Lysin) botol 0 200 3600 3600
284 Novatusin syrup (PCT 120 mg,Efedrin HCl 5mg, CTM 2 botol 0 100 1800 1800
285 Polikresulen / Albotil concetrate 10 ml botol 5 10 180 175
286 Pregnollin tablet tablet 0 100 1800 1800
287 Primpran inj ampul 0 30 540 540
288 Primulut- N tablet tablet 0 30 540 540

Page 12
 RATA-RATA KEBETUHAN USULAN
NO NAMA OBAT SATUAN SISA STOK PEMAKAIAN S/D 30-04- PERMINTAA KET
BULANAN 2015 N
1 2 3 4 5 6=(18*5) 7=(6-4) 8
289 Rhinofed tablet tablet 0 100 1800 1800
290 Stesolit rectal 5 mg tube 3 2 36 33
291 Stesolit rectal 10 mg tube 2 3 54 52
292 Streptomisin serbuk inj I.V 1000 mg/ml vial 0 0 0 0
293 Transamin tab 250 mg kapsul 0 0 0 0
294 Trombopop gel tube 4 10 180 176
295 Urispas tab tablet 0 100 1800 1800
296 Zistic tablet 0 0 0 0
0
IV OBAT TRADISIONAL/JAMU/HERBAL/FITOFARMAKA 0
297 Curcuma plus Fruit Veggie syrup botol 40 100 1800 1760
298 Diapet tablet Tablet 300 100 1800 1500
299 Entrostop anak saset 24 24 432 408
300 Hemorogard kapsul 30 20 360 330
301 Hepagard kapsul 60 20 360 300
302 I-flex kapsul kapsul 180 100 1800 1620
303 Lancar Asi kapsul 30 100 1800 1770
304 Maximus dietary herbal kapsul 240 100 1800 1560
305 Ocugard kapsul 30 20 360 330
306 Prolipid kapsul 120 100 1800 1680
307 Prouric kapsul 0 20 360 360
308 Stimuno syrup botol 0 100 1800 1800
309 Stimuno kapsul kapsul 200 200 3600 3400
310 Tensigard Tablet 0 30 540 540
0

Page 13
 RATA-RATA KEBETUHAN USULAN
NO NAMA OBAT SATUAN SISA STOK PEMAKAIAN S/D 30-04- PERMINTAA KET
BULANAN 2015 N
1 2 3 4 5 6=(18*5) 7=(6-4) 8
V BAHAN HABIS PAKAI
311 Abbocate No. 18 set 0 5 90 90
312 Abbocate No. 20 set 0 5 90 90
313 Abbocate No. 22 set 0 5 90 90
314 Abbocate No. 24 set 5 5 90 85
315 Alat suntik sekali pakai 1 ml set 87 100 1800 1713
316 Alat suntik sekali pakai 3 ml/ 2,5 ml set 280 100 1800 1520
317 Alat suntik sekali pakai 5 ml set 60 20 360 300
318 Alat suntik sekali pakai 10 ml set 0 20 360 360
319 Alat suntik bias 0,5 ml set 0 100 1800 1800
320 Alat suntik bias 0,05 ml set 100 100 1800 1700
321 Alat suntik bias 5 ml set 0 50 900 900
322 Alkohol Swap pcs 90 100 1800 1710
323 Catgut Cromic 2/0 dengan jarum lusin 0 1 18 18
324 Catgut Cromic 3/0 dengan jarum lusin 0 1 18 18
325 Catgut plain 2/0 dengan jarum botol 2 1 18 16
326 Catgut plain 3/0 dengan jarum botol 2 1 18 16
327 Cotton Aplication steril botol 0 10 180 180
328 Cover glass buah 0 10 180 180
329 Etakridin (rivanol) larutan 0,1% btl 300 ml botol 5 10 180 175
330 Etakridin (rivanol) larutan 0,1% btl 100 ml botol 0 5 90 90
331 Etanol 70% 1000 ml botol 1 10 180 179
332 Foley catheter No. 18 set 0 10 180 51
333 Hand Scund (Steril) No. 7 psng 100 50 900 800
334 Hand Scund (Steril) No. 7,5 psng 100 100 1800 1700

Page 14
 RATA-RATA KEBETUHAN USULAN
NO NAMA OBAT SATUAN SISA STOK PEMAKAIAN S/D 30-04- PERMINTAA KET
BULANAN 2015 N
1 2 3 4 5 6=(18*5) 7=(6-4) 8
335 Hand Scund Size S psng 0 100 1800 1800
336 Hand Scund Size M psng 0 1 18 18
337 Hand Scund Size L psng 50 50 900 850
338 Infusion set Dewasa set 0 5 90 90
339 Infusion set anak set 0 5 90 90
340 Kapas Berlemak 500 gram bungkus 0 2 36 36
341 Kapas Pembalut/Absorben 250 gram rol 5 5 90 85
342 Kasa Kompres 40/40 steril Kotak 0 1 18 18
343 Kasa Pembalut 2 m x 80 cm rol 0 2 36 36
344 Kasa Pembalut Hidrofil 4 m x 15 cm rol 0 1 18 18
345 Kasa Pembalut Hidrofil 4 m x 3 cm rol 0 1 18 18
346 Kasa Pembalut Hidrofil 40 m x 80 cm Gulung 0 2 36 36
347 Kasa Pembalut Hidrifil 36 m x 80 cm Kotak 0 2 36 36
348 Kasa Hidrofil Steril uk. 16 x 16 (isi 16 lembar) Kotak 35 30 540 505
349 Kasa Hidrofil Steril uk. 18 x 22 cm (isi 12 lembar) lembar 5 1 18 13
350 Kasa Pembalut Hidrofil 4 m x 5 cm elastic lembar 45 10 180 135
351 Kasa Pembalut Hidrofil 4 m x 10 cm elastic lembar 10 10 180 170
352 Kertas Perkamen 75 x 100 cm rim 0 0 0 0
353 Klep tali pusat pcs 0 1 18 18
354 Lens paper pcs 0 1 18 18
355 Lisol, mengandung kresol tersabun 50 % botol 0 1 18 18
356 Masker pcs 700 100 1800 1100
357 Medicine paket lusin 0 1 18 18
358 Nedle 25 g ( Terumo / Setara ) pcs 0 5 90 90
359 Nedle Heacting G 3/4 pcs 0 4 72 72

Page 15
 RATA-RATA KEBETUHAN USULAN
NO NAMA OBAT SATUAN SISA STOK PEMAKAIAN S/D 30-04- PERMINTAA KET
BULANAN 2015 N
1 2 3 4 5 6=(18*5) 7=(6-4) 8
360 Nedle Heacting G 7 - 13, 12 (segi tiga) pcs 0 2 36 36
361 Object Glass pcs 0 1 18 18
362 PH paper pcs 0 5 90 90
363 Plaster 5 yards x 2 inch / 1,25 cm x 5 m pcs 5 10 180 175
364 Plastik Kantong Etiket Obat 8,5x13,5 cm (Besar) lembar 3500 1000 18000 14500
365 Plastik Kantong Etiket Obat 6,5x8,05 cm (Kecil) lembar 3500 600 10800 7300
366 Plastik (kresek) Ukuran 15 x 33 cm (putih) ball 0 300 5400 5400
367 Plastik (kresek) Ukuran 35 x 55 cm (merah) ball 0 20 360 360
368 Pot Salep 10 gram pot 0 20 360 360
369 Pot Salep 5 gram pot 35 100 1800 1765
370 Pot Sputum/Pot Dahak pot 200 20 360 160
371 Povidon Iodida 10% 30 ml botol 10 10 180 170
372 Povidon Iodida 10% 300 ml botol 2 5 90 88
373 Povidon Iodida 10% 1000 ml botol 0 0 0 0
374 Rapid Test untuk siphilis set 0 1 18 18
375 Rol Paper set 0 6 108 108
376 Silk (benang bedah sutera)No. 3/0 dgn jarum bedah (PK buah 0 100 1800 1800
377 Safety box buah 20 20 360 340
378 Transfusion set buah 0 4 72 72
379 Urine bag buah 2 0 0 0
380 Vaselin pot 0 0 0 0
381 Venflon No.18 pcs 0 1 18 18
382 Wing Nedle No.23 pcs 0 10 180 180
383 Wing Nedle No.25 G pcs 5 10 180 175

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 RATA-RATA KEBETUHAN USULAN
NO NAMA OBAT SATUAN SISA STOK PEMAKAIAN S/D 30-04- PERMINTAA KET
BULANAN 2015 N
1 2 3 4 5 6=(18*5) 7=(6-4) 8
VI REAGENSIA & BAHAN LABORATORIUM
384 Blood Lancet set 200 100 1800 1600
385 Imersi Oil Mikroskop 100 ml botol 0 1 18 18
386 Kartu golongan darah pcs 100 100 1800 1700
387 Larutan Asam Klorida 0,1 N botol 1 1 18 17
388 Larutan Asam sulfosalisilat 20 % botol 0 1 18 18
389 Larutan Benedict 100 ml botol 0 0 0 0
390 Larutan Eosin 2 % 100 ml botol 0 1 18 18
391 Larutan Etanol Asam 100 ml botol 0 0 0 0
392 Larutan Giemsa Stain 100 ml botol 0 1 18 18
393 Larutan Hyem 100 ml botol 0 1 18 18
394 Larutan Karbol Fuksin 100 ml test 0 0 0 0
395 Larutan Metilen Biru botol 0 1 18 18
396 Larutan Natrium Sitrat botol 0 1 18 18
397 Larutan Turk 100 ml buah 0 1 18 18
398 Latex/ Tes kehamilan set 0 100 1800 1800
399 Lugol tes 0 1 18 18
400 Metanol 100 ml set 0 1 18 18
401 Ose set 0 1 18 18
402 Reagen Zeil Nelsen BTA (Alkohol asam,methyl blue,carbo test 0 1 18 18
403 Reagen Ig G/Ig M/Dengue Ig G/Ig M (Stick) set 0 1 18 18
404 Reagen Pemeriksaan Trombocit 500 ml set 0 1 18 18
405 Reagen Hematologi (mindray):deluent 20 l, Rinse 20 l, set 0 0 0 0
406 Reagen Hematologi (sweelab):deluent 20 l, lyse 20 l test 0 1 18 18
407 Serum Gol Darah anti A & anti B botol 1 1 18 17

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 RATA-RATA KEBETUHAN USULAN
NO NAMA OBAT SATUAN SISA STOK PEMAKAIAN S/D 30-04- PERMINTAA KET
BULANAN 2015 N
1 2 3 4 5 6=(18*5) 7=(6-4) 8
408 Stik Glukosa gula Darah (gluco DR) botol 0 1 18 18
409 Test Widal botol 0 1 18 18
410 Urine Reagen Strip 3 parameter (PH) botol 0 1 18 18
411 Urine Reagen Strip 10 parameter (PH) kotak 0 1 18 18
412 Urine Gluco Protein Test lembar 0 1 18 18
413 Yodium 1 % 100 ml lembar 0 1 18 18
414 K O H 1% botol 0 1 18 18
415 Xilol / Xilene botol 0 1 18 18
416 USG Ultrasonic gel botol 0 0 0 0
417 Ventolin Nebulizer strip 0 0 0 0
418 Voucher oxygen tabung 10 liter lembar 0 1 18 18
419 Voucher oxygen tabung 40 liter lembar 0 0 0 0
420 Strip NESCO - 07 Strip 0 1 18 18
421 Strip NESCO MODEL -01 Strip 0 1 18 18

VII OBAT KB
422 Kontrasepsi injeksi Progesteron depot( 3 bln) vial 0 0 0 0
423 Kontrasepsi pil kombinasi ( Microdiol ) strip 0 0 0 0
424 Implant KB 3 tahunan set 0 0 0 0

KEPALA UPT PUSKESMAS TIBAN BARU TIBAN BARU, 17 MARET 2014

KOTA BATAM YANG MEMBUAT

Dr. NUR' AINI BUTET AGUSTINA LINGGA

NIP.19760102 200604 2 028 NIP.19850824 201101 2 006

Page 18
 KEPALA UPT PUSKESMAS TIBAN BARU TIBAN BARU, 17 MARET 2014
KOTA BATAM YANG MEMBUAT
RATA-RATA KEBETUHAN USULAN
NO NAMA OBAT SATUAN SISA STOK PEMAKAIAN S/D 30-04- PERMINTAA KET
BULANAN 2015 N
1 2
Dr. NUR' AINI 3 4 5
BUTET 6=(18*5)
AGUSTINA LINGGA 7=(6-4) 8
NIP.19760102 200604 2 028 NIP.19850824 201101 2 006

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 USULAN ALAT KESEHATAN UPT.PUSKESMAS BELAKANG PADANG
TAHUN ANGGARAN 2013

NO NAMA ALAT SATUAN JUMLAH KET

1 2 3 4 5
I POLI GIGI
1 High Speed 2 hole pcs 1
2 Tensimeter / Stetoscop pcs 1
3 Phantom Gigi untuk Penyuluhan set
4 Kaca Mulut pcs 5
5 High Speed pcs 1
6 Deppend glass pcs 2
7 Bur / Mata bur Kotak 2
8 Bein Bengkok / lurus pasang 2
II POLI UMUM
1 Otoscope pcs 1
2 Timbangan Dewasa set 4
3 Senter ( Pen Light ) pcs 1
4 Tensimeter pcs 1
5 Stetoscope pcs 1
6 Termometer pcs 1
Alat Cek Gula Darah , Asam Urat,
7 set 1
Cholesterol
III POLI ANAK
1 Timbangan bayi / Anak set 6
2 Alat Ukur Panjang Anak set 12
3 Termometer pcs 6
4 Stetoscope anak Merk Litman pcs 3
5 Alat Peraga DDTK bayi/balita pcs 22
6 Otoscope pcs 2
7 Tong Spatel pcs 12
8 Center ( Pen Light ) pcs 12
IV POLI EMERGENCY ( UGD )
1 Stetoscope Merk Litman pcs 11
2 Termometer Digital pcs 5
3 Tensimeter dorong /beroda set 2

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NO NAMA ALAT SATUAN JUMLAH KET

1 2 3 4 5
4 Lampu Sorot set 3
5 Otoscope set 2
6 Nebulizer set 2
7 Hecting Set ( 3 set ) set 3
8 Sirkum set set 1
9 Nedle Otot 9,10 , 12 dan Kulit 10,12,14 Kotak 2
10 Senter pcs 2
11 Ambu Bag balita / dewasa set 1
12 Bisturi ujung runcing Kotak 2
13 Bisturi ujung tumpul Kotak 2
IV POLI KIA / KB
1 Termometer pcs 2
2 Tensimeter Air Raksa set 2
3 Stetoscope set 2
4 Tempat Tidur Periksa Ibu Hamil set 2
5 Timbangan Ibu Hamil set 1
6 Matras set 15
7 Ukuran LILA pcs 12
V LABORATORIUM
1 Sentri Fuse pcs 1
2 Rotator pcs 1
3 Mikro Lab pcs 1
4 Urino Meter pcs 1
5 Mikroskop set 1

KEPALA UPT PUSKESMAS BELAKANG PADANG

KOTA BATAM

Dr. MOHAMMAD SOLIHIN

NIP.19720225 2006041010

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