LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

( LPLPO )
KODE RSUD/PUSKESMAS :
PUSKESMAS MUARA BELITI
KECAMATAN :
KAB / KODYA : MUSI RAWAS
PROPINSI : SUMATERA SELATAN

NAMA
KODE SATUAN STOK AWAL PENERI PERSE PEMA- SISA
OBAT
MAAN DIAAN KAIAN STOK
1 2 3 4 5 6=(4+5) 7 8=(6-7)
TABLET

1 Alopurinol tablet 100 mg Tablet 1000 1000 200 800

2 Aminofilin tab 200 mg Tablet 400 400 400
3 Amlodipin 5mg tab Tablet 240 240 240 0
4 Amoksisillin kapl 500 mg Tablet 12700 12700 2200 10500
5 Antasida DOEN tablet, kombinasi : Tablet 13500 13500 2200 11300
6 Asam Askorbat ( Vit.C ) tablet 50 mg Tablet 2100 2100 700 1400
7 Asam Mefenamat 500mg Tablet 6900 6900 1900 5000
8 Asiclovir 200 mg Tablet 2100 2100 400 1700
9 Asiclovir 400 mg Tablet 2400 2400 2400
10 Atapulgit tab 600mg/Anti Diare Tablet 1900 1900 200 1700
11 Asetyl Systein tab Tablet
12 Betahistin mesilat tab 6mg Tablet 1510 1510 210 1300
13 Captopril tab. 50 mg Tablet 3200 3200 1100 2100
14 Cefadroxil 500 mg Tablet 500 500 250 250
15 Cefixime kap 100mg Tablet 900 900 100 800
16 Cetirizine tab 10mg Tablet 5100 5100 2100 3000
17 Cyprofloksasin 500 mg tablet Tablet 3700 3700 900 2800
18 Deksametason tablet 0,5 mg Tablet 2200 2200 1100 1100
19 Diazepam tablet 2 mg Tablet 0 0 0
20 Simpastatin 10 mg Tablet 750 750 310 440
21 Digoksin tablet 0.25 mg Tablet 0 0 0
22 Domperidone 10 mg Tablet 2200 2200 100 2100
23 Erythromicin 500 mg kapsul Tablet 1000 1000 1000
24 Fenitoin Natrium kapsul 100 mg kapsul 0 0 0
25 Fenoksimetil Penisilin tablet 250 mg Tablet 0 0 0
26 Fitomenadion ( Vit.K1 ) tablet salut 10 mg Tablet 1200 1200 1200
27 Glimepiride 3mg tab Tablet 2900 2900 2900
28 Grisiofulvin tablet 125 mg, micronized Tablet 1700 1700 1700
29 Haloperidol tablet 1,5 mg Tablet 3000 3000 200 2800
30 Hemafort kapsul Tablet 0 0 0
31 Hidroklortiazide (HCT) Tablet 1500 1500 1500
32 Ibuprofen tablet 200 mg Tablet 2200 2200 1500 700
33 Ibuprofen tablet 400 mg Tablet 0 0 0
34 Isosorbid Dinitrat tablet sublingual 5 mg Tablet 2400 2400 2400
35 Kalsium Laktat tablet 500 mg Tablet 4200 4200 400 3800
36 Ketokonazole 200mg tab Tablet 700 700 0 700
37 Kloramfenicol 500mg Tablet 700 700 200 500
38 Kodein tablet 10mg Tablet 0 0 0
39 Kombinasi (Pirimetamin 25 mg + Sulfadoxin 500 mg Tablet 0 0 0
40 Kotrimoksazol tablet 480 mg Tablet 4800 4800 400 4400
41 Kuinina tab 200mg Tablet 0 0 0
42 Lansoprazole 30mg tab Tablet 780 780 100 680
43 Lexavit kaplet Tablet 400 400 400 0
44 Loperamide 2mg tab Tablet 1400 1400 0 1400
45 Metilergometrin Maleat (Metilergometrin) t Tablet 1500 1500 300 1200
46 Metronidazole tablet 500mg Tablet 0 0 0
47 Molexflu Kaplet Tablet 0 0 0
48 Molaneuron tab Tablet 0 0 0
49 Na Diklofenac tab 25mg Tablet 500 0 500 500 0
50 Nipedipin tab. 10 mg Tablet 0 0 0 0
51 Nistatin tablet vagina 500.000 IU/g Tablet 1100 1100 0 1100
52 Nistatin tablet vagina 100.000 IU/g Tablet 640 640 200 440
53 Methoclopramida Tablet 900 900 100 800
54 Pehavral paket 0 0 0 0
55 Metformin paket 1300 1300 600 700
56 Metilprednison paket 2400 2400 200 2200
57 Omeprazole 30mg Tablet 1740 1740 330 1410
58 Papaverin tab Tablet 0 0 0
59 Parasetamol tablet 500 mg Tablet 2000 2000 1300 700
60 Pirantel tablet 125 mg Tablet 0 0 0
61 Piridoksin tablet 10 mg Tablet 3400 0 3400 500 2900
62 Prednison tablet 5 mg Tablet 3548 3548 1148 2400
63 Propanolol tablet 40 mg Tablet 0 0 0
64 Propiltiourasil tablet 100 mg Tablet 400 400 400
65 Ranitidin tab 150 mg Tablet 2200 2200 0 2200
66 Retinol (Vit A 100.000.IU) Tablet 0 0 0
67 Retinol (Vit A 200.000.IU) Tablet 0 0 0
68 Salbutamol tablet 2 mg Tablet 600 600 300 300
69 Hustab p Tablet 300 0 300 300 0
70 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 m Tablet 4600 4600 300 4300
71 Vitamin B Komplek tablet Tablet 5100 5100 1200 3900
72 CTM tablet 1710 1710 210 1500
73 Zink tablet
74 Furosemida tablet 200 200 200
75 Alupurinol 300 mg tablet 800 800 200 600
76 Miniaspi tablet 1000 1000 100 900
77 simvastatin 20 mg Tablet 500 500 500
78 intunal Tablet 500 500 500
79 broxal tablet 100 100 100

SYRUP
1 Amoksisilin sirup kering 125 mg/5 ml Botol 60 ml 208 0 208 24 184
2 Amoksisilin sirup kering 250 mg/5 ml Botol 60 ml 0 0 0
3 Cefadroxil syrup 250 mg/ml Btl 60ml 0 0 0 0
4 Cefixime Syr 100mg /5ml Btl 60ml 0 0
5 Cetirizine Syrup Btl 60ml 105 105 105
6 Erythromicin Syrup Btl 60ml 0 0 0
7 Flucetin Syrup Btl 60ml 53 53 6 47
8 Garam Oralit untuk 200 ml air sach 1000 1000 250 750
9 Klorampenikol 125mg/5ml suspensi Btl 60ml 25 25 25
10 Kotrimoksazole suspensi, kombinasi : Btl 60ml 262 262 22 240
11 Obat Batuk Hitam ( OBH ) sirup Btl 60ml 94 94 35 59
12 Parasetamol Drop btl 15ml 0 0 0
13 Parasetamol sirup 120 mg/5 ml btl 60ml 50 50 25 25
14 Dextrofen syr Btl 60ml 50 50 50
15 Vical Syrup Btl 60ml 56 56 0 56
16 Zinc (Zirkum) 20mg/5ml syrup Btl 60ml 0 36 36 6 30
17 Domperido syr Btl 60ml 0 0 0
18 Srucapat syr Btl 20 20 20
19 Metronidazole Syrup Btl 60ml 50 50 50

INJEKSI
1 Aqua pro injeksi steril, bebas Pirogen Vial 50 50 20 30
2 Aminofillin injeksi 24 mg/ml-10 ml Ampul 0 0 0
3 Asam Traneksamat inj 100mg/ml Ampul 100 100 20 80
4 Atropin Sulfat injeksi 0,25 mg/ml - 1 ml ampul 0 0 0
5 Asetyl Systein ( Flumucil) injeksi Ampul 115 115 115
6 Benzatin Penisillin inj Vial 0 0 0
7 Cefotaxim Injeksi 1 gr Vial 70 44 114 114 0
8 Deksametason injeksi 5 mg/ml - 1 ml Ampul 200 200 50 150
9 Diazepam injeksi lar 5mg/2,5ml rec Tube 5gr 0 0 0
10 Difenhidramin HCl injeksi 10 mg/ml-1 ml Ampul 470 470 470
11 Epinefrin HCl/Bitartrat (Epinefrin/Adrenalin) inj 0,1 % Tablet 116 116 93 23
12 Fitomenadion (Vit.K) injeksi 2 mg/ml - 1 ml Ampul 0 30 30 30 0
13 Furosemide injeksi Ampul 0 0 0
14 Ranitin injeksi Ampul 0 300 300 100 200
15 Gentamisin Injeksi Ampul 50 50 50
16 Lidokain injeksi Ampul 210 210 150 60
17 Metilergometrin Maleat injeksi Ampul 0 0 0
18 Oksitocin injeksi Ampul 0 0 0
19 Ondansetron 4mg/2ml injeksi Ampul 0 0 0
20 Pehacain injeksi Ampul 0 0 0
21 Serum Anti Bisa Ular Polivalen inj.5ml(ABU vial 6 6 6
22 Serum Anti Tetanus inj.1.500 IU/ampul (AT vial 8 8 8
23 Sianokobalamin (Vit.B12) inj. 500mcg/ml-1 Ampul 135 135 0 135
24 Tetagam human tetanus inj vial 0 0 0
25 Vaksin Rabies Vero vial 5 5 5
26 Natrium Klorida Larutan infus 0.9 % steril btl 500ml 90 90 36 54
27 Ringer Laktat larutan infus steril btl 500ml 125 300 325 157 168
28 Glucosa Lart infus 180 180 0 160
29 Haldol Injeksi ampul 15 15 15
30 Lodomer Injeksi ampul 19 19 19

OBAT LUAR
1 Anti Haemorroid DOEN Kombinasi Supps Suppos 80 80 80
2 Asam Fusidat krim 20mg/gr Tube 5gr 105 105 105
3 Betametason krim 0.1 % Tube 5gr 100 100 99 1
4 Devitalisasi pasta ( Devitec) Tablet 0 0 0
5 Etakridin ( Rivanol ) larutan 0.1 % Btl 300ml 25 25 2 23
6 Etanol 70 % Btl 100ml 45 45 0 45
7 Etanol 70 % 1L BTl 1000ml 9 9 9
8 Etanol Swab serenity box 0 0 0
9 Etil Klorida semprot btl 100ml 0 0 0
10 Fenol Gliserol tetes telinga 10 % btl 15ml 83 83 83
11 Gentamisin sulfat tetes mata 0.3 % btl 15ml 48 48 0 48
12 Hidrokortison krim 2.5 % Tube 5gr 42 42 35 7
13 Kloramfenikol salep mata 1 % Tube 5gr 0 0 0 0
14 Kloramfenikol Salep Kulit 2% Tube 5gr 0 0 0
15 Lisol / Protektor BTl 1000ml 11 11 11
16 Lysol/Kresol 50% btl 1000ml 0 0 0
17 Mikonazol krim 2 % Tube 5gr 75 75 1 74
18 Polikresulen btl 15ml 0 0 0
19 Salep 2 - 4 kombinasi pot 90 90 17 73
20 Bioplacenton pot 8 8 8
21 Salisyl Bedak 2 % Tablet 23 23 0 23
22 Temporary Stopping Fletcher serbuk&caira Tablet 0 0 0
23 Wida WI Unicap 1000ml btl 500ml 20 20 20
24 Yodium Povidon larutan 10 % 30 ml Btl 30ml 0 0 0
25 Yodium Povidon larutan 10 % 300 ml Btl 300ml 0 0 0
26 Yodium Povidon larutan 10 % 60 ml Btl 60ml 48 48 32 16
27 Acyklovir Tube 5gr 50 50 17 33
28 Cendo Lyters btl 10 10
PERBEKALAN KESEHATAN/BMHP

1 Abocat No. 20 G jellco Pcs 223 223 4 219

2 Abocath No. 22 G jellco Pcs 375 375 30 345
4 Abocath No. 24 G jellco Pcs 70 70 30 40
5 Abocat No. 20 G Serenity Pcs 0 0 0
 6 Abocath No. 22 G Serenity Pcs 0 0 0
7 Abocath No. 24 G Serenity Pcs 0 0 0
8 Alat Suntik sekali pakai 1 ml Pcs 0 0 0
9 Alat Suntik sekali pakai 2.5 ml Pcs 0 0 0
10 Alat Suntik sekali pakai 5 ml Pcs 0 0 0
11 Alat Suntik 1cc Aximed Pcs 0 0
12 Alat Suntik 3cc Aximed Pcs 810 810 310 500
13 Alat Suntik 5cc Aximed Pcs 1489 1489 109 1380
14 Auto Disable Syringe (ADS) 0,05ml Pcs 0 0 0
15 Auto Disable Syringe (ADS) 0,5ml Pcs 0 0 0
16 Auto Disable Syringe (ADS) 5ml Pcs 0 0 0
17 Blood Lancet Twice Serenity box 200 200 200 0
18 Benecheck plus Glucose Test 50's box 0 0 0
19 Benecheck plus Cholesterol Test 50's box 0 0 0
20 Benecheck plus Glucose Test 50's box 0 0 0
21 Catgut Chromic3/0 HR 26MM Sach 33 33 0 33
22 Catgut Plain 3/0 HR 26MM Sach 0 0 0
23 Catgut Chromic3/0 HR 26MM serenity Sach 0 0 0
24 Hand Scun 7,5 Serenity psg 0 0 0
25 Hand Scun 7,5 psg 6 6 6 0
26 Hand Scun 7 psg 50 200 250 100 150
27 Hand Scun 8 Serenity psg 0 0 0
28 Human Humansens Plus Unit 0 0 0
29 Humansens Plus Glucose Test Strip Dus 3 3 0
30 Humansens Plus Total Cholesterol Test Str Dus 0 0 0
31 Humansens Plus Total Urid Acid Test Strip Dus 0 0 0
32 Infus set anak Serenity set 0 0 0
33 Infusion set dewasa Serenity set 0 0 0
34 Infusion set anak set 50 50 50
35 Infusion set dewasa set 195 195 90 105
36 Kapas Pembalut Hydrophyl 250 gram Bungkus 8 8 8
37 Kapas Pembalut Hydrophil 250 gram Bungkus 0 0 0
38 Kapas Pembalut Hydrophil 500gram roll 0 0
39 Kasa pembalut 16 x 16cm Kotak 55 0 55 15 40
40 Kassa pembalut Hidrofil 4 m x 10 cm Rol 0 200 200 170 30
41 masker Aximed box 500 500 250 250
42 masker ktk 50 pcs 0 0
43 Plester 5 yards x 1 inch roll 41 41 29 12
44 Plester 5 yards x 2 inch/ Polifix roll 0 0 10
45 Polygyp 10 cm X2,75m roll 10 10 10
46 Polygyp 15 cm X2,75m roll 5 5 5
47 Pembalut elastis Polycrepe 10cmX4,55m roll 6 6 6
48 Pembalut elastis Polycrepe 15cmX4,55m roll 6 6 6
49 Selang Catheter No 14 pcs 0 0 0
50 Selang Catheter No 16 pcs 0 0 0
 51 Selang Catheter No 14 Serenity pcs 0 0 0
52 Selang Catheter No 16 Serenity pcs 0 0 0
53 Safety Onemed Box dus 0 0 0
54 Silk No. 3/0 serenity sach 114 114 18 96
55 Wing Needle 25 G 80 80 80
56 Wing Needle 27 G 70 70 70
57 THP tablet 1400 1400 200 600
58 Resperidon tablet 1200 1200 600 600
59 Carbomazepin tablet 600 600 200 400
60 Stelosis tablet 100 100 300
61 Penitoin tablet 300 300 300
62 Clozapin tablet 650 650 650
63 CPZ tablet 300 300 300
64 Haldol tablet 2100 2100 200 1900
65 Paper tape aximed 20 20 20

GENER NON GENERIK ESSENSIAL

IK
INJEKSI ORAL ORAL INJEKSI
A.BIO Non A. Bio Non A. Bio Non A. Bio Non.A.BIO A.BIO Non.A.BIO A.BIO GENERIK

Mengetahui / Menyetujui Yang Menyerahkan

Kepala Dinas Kesehatan Kabupaten Musi Rawas Kepala Gudang Farmasi Kab. Musi Rawas

drg. Hj. Mipta Hulummi, M.Kes Sulaiman.S, Si,Apt

NIP.1960012 198811 2 001 NIP.19760521 200604 1 006
RMINTAAN OBAT

LAPORAN BULAN DESEMBER 2018

PERMINTAAN BULAN : JANUARI 2 2019
NOMOR :
TANGGAL :

PEMBERIA
STOK PERMIN
N
OPT TAAN APBD ASKES APT LAIN JML KET
9 10 11 12 13 14 15 16

800
500
2000

3000

5000
2000 E.D FEB 2019
4000
3000
5000
100

200
2000

3000

4000
 3000

1500

2000

1500
3000
3000
3000
700

3000
1000

500
10000

1000

1000
1000

2000
3000
100

100

150
50

50
50

30
30

30

200

100

30
30
300

300
0
50
100
500
 100
50
10
60
300
40

(ED) 100
200

50

10
ED 30
50
100
100
100

50

50
50

100

100
1500

200

200
100

50
200
15

300
500

50
 50

1500
2000
500

1000

NON ESSENSIAL
TOTAL NON TOTAL
PEMAKAIA PEMAKAIA
N N
PATENT GENERIK PATENT GENERIK PATENT

Yang Menerima/ Melapor Yang Menerima

PLH RSUD Muara Beliti Koordinator IFRS

drg. Maya Kesuma SP, MARS Fitri Listiawati

NIP. 19811206 200903 2004 NIP. 19820620 200604 2 011