LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT ( LPLPO )

PUSKESMAS SAMPARA NOMOR TANGGAL

KECAMATAN SAMPARA
PROVINSI SULAWESI TENGGARA PELAPORAN BULAN Dec-23
KABUPATEN KONAWE PERMINTAAN BULAN Jan-24

No NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR PERMINTAAN PEMBERIAN KETERANGAN
1 2 3 4 5 6 7 8 10 11 12

1 Acetylsistein tablet 1400 0 1,400 - 1,400 -

2 Alopurinol tablet 100 mg Tablet 600 0 600 - 600 -
3 Alopurinol tablet 300 mg Tablet 700 0 700 - 700 -
4 Ambroksol tablet 30 mg Tablet 900 0 900 200 700 -
5 Aminofillin tablet 200 mg Tablet 0 0 - - - -
6 Amlodipin tablet 5 mg Tablet 1300 0 1,300 100 1,200 -
7 Amlodipin tablet 10 mg Tablet 600 0 600 180 420
8 Amoksilin kaplet 500 mg Kaplet 1700 1,700 300 1,400 -
9 Amoksilin sirup kering 125 mg/ 5 ml - 60 ml Botol 124 0 124 - 124 -
10 Amoksilin sirup kering 250 mg/ml - 60 ml Botol 87 0 87 - 87 -
Antasida DOEN I tablet kunyah, kombinasi : Aluminium
Tablet 1200 0 1,200 200 1,000 -
11 Hidroksida 200 mg + Magnesium Hidroksida 200 mg
12 Antasida DOEN II suspensi, kombinasi Botol 0 0 - - - -
13 Anti Hemmoroid DOEN kombinasi Supp 19 0 19 - 19 -
14 Antifungi DOEN kombinasi/SALEP WHITE FIELD Pot 0 0 - - - -
15 Antimigren : Ergotamin Tartrat 1 mg + Kofein 50 mg Tablet 0 0 - - - -
16 Aqua pro injeksi steril, bebas pirogen 25 ml Vial 119 0 119 - 119 -
17 Asam Asetilsalisilat tablet 80 mg Tablet 0 0 - - - -
18 Asam Askorbat (Vitamin C) tablet 50 mg Tablet 6700 0 6,700 100 6,600 -
19 Asam Mefenamat kaplet 500 mg Kaplet 1000 0 1,000 200 800
20 Asiklovir tablet 200 mg Botol 800 0 800 - 800 -
21 Asiklovir tablet 400 mg Tablet 400 0 400 - 400 -
22 Asiklovir salep kulit Tube 20 0 20 - 20
23 Asam Folat Tablet 500 0 500 300 200
24 Asam Traneksamat Tablet 0 0 - - - -
Besi II Sulfat 200 mg + Asam Folat 0,25 mg (tablet
Tablet 34600 0 34,600 500 34,100 -
25 tambah darah kombinasi)
26 Betahistin Mesilat tablet 6 mg Tablet 400 0 400 - 400 -
27 Betametason Krim 0.1 % (sebagai valerat) - 5 gr Tube 25 0 25 - 25
28 Bisakodil Tablet 0 0 - - - -
29 Cetirizin Tablet Tablet 900 0 900 200 700
30 Cetirizin Syrup Botol 74 0 74 - 74 -
31 Deksametason injeksi 5 mg/ml-1ml Ampul 87 0 87 - 87 -
32 Deksametason tablet 0,5 mg Tablet 900 0 900 200 700 -
33 Difenhidramin injeksi 10 mg/ml Ampul 46 0 46 - 46 -
34 Desoximetasone Krem 0,25 %/ DEXOCORT Tube 0 0 - - - -
35 Digoksin tablet 0,25 mg Tablet 0 0 - - - -
36 Domperidon Syrup Botol 18 0 18 - 18 -
37 Dulcolax Suppositoria Supp 0 0 - - - -
38 Epinefrin ( Adrenalin ) injeksi 0,1 % Ampul 20 0 20 1 19 -
39 Eritromisin kapsul 500 mg Kapsul 0 0 - - - -
40 Etakridin (Rivanol) Larutan 0,1 % - 300 ml Botol 93 0 93 - 93 -
41 Fitomenadion(Vit. K1) injeksi Ampul 0 0 - - -
42 Fitomenadion(Vit. K1) tablet salut gula 10 mg Tablet 900 0 900 - 900 -
43 Furosemid tablet 40 mg Tablet 600 0 600 - 600 -
44 Fluocuinolon salep/Synarcus Tube 40 0 40 - 40 -
45 Garam Oralit I serbuk, kombinasi / MINERAL MIX Sach 4800 0 4,800 - 4,800 -
46 Gemfibrozil 600 mg kapsul Kapsul 300 0 300 100 200 -
47 Gentamycin salep Kulit 0,1% Tube 40 0 40 20 20 -
48 Gentamycin Tetes Mata Botol 0 0 - - - -
49 Gentamycin salep mata 0,3% Tube 0 0 - - -
50 Glibenklamid tablet 5 mg Tablet 1600 0 1,600 - 1,600 -
51 Glimepirid tablet 1 mg Tablet 420 0 420 - 420 -
52 Gliseril Guaiakolat tablet 100 mg Tablet 0 0 - - - -
53 Guafenesin Tablet 2600 0 2,600 - 2,600 -
54 Glucose Larutan Infus 5% steril - 500 ml Kolf 0 0 - - -
55 Griseofulvin tablet 125 mg Tablet 400 0 400 - 400 -
56 Hidroklortiazid (HCT) tablet 25 mg Tablet 0 0 - - - -
57 Hidrokortison krim 1 % - 5 gr Tube 108 0 108 - 108
58 Hidrokortison krim 2,5 % - 5 gr Tube 0 0 - - - -
59 Hyiosin Bromida Tablet 700 0 700 - 700 -
60 Ibuprofen Syrup Botol 0 0 - - -
61 Ibuprofen tablet 200 mg Tablet 0 0 - - - -
62 Ibuprofen tablet 400 mg Tablet 1400 0 1,400 300 1,100 -
63 Interzinc Syrup Botol 66 0 66 - 66 -
64 Isosorbid dinitrat (ISDN) tablet sublingual 5 mg Tablet 0 0 - - - -
65 Kalsium laktat (Kalk) tablet 500 mg Tablet 1200 0 1,200 200 1,000
66 Kaptopril tablet 12,5 mg Tablet 400 0 400 - 400 -
67 Kaptopril tablet 25 mg Tablet 1000 0 1,000 - 1,000 -
68 Ketokonazol tablet 200 mg Tablet 400 0 400 - 400 -
69 Ketokonazole Krem Tube 50 0 50 - 50 -
70 Ketorolak Injeksi Ampul 6 0 6 - 6 -
71 Kloramfenikol kapsul 250 mg Kapsul 0 0 - - - -
72 Kloramfenikol suspensi 125 mg/5ml - 60 ml Botol 0 0 - - - -
73 Kloramfenikol tetes telinga 3 % - 5 ml Botol 0 0 - - - -
74 Kloramfenikol Salep Kulit/bufacetin Tube 24 0 24 - 24 -
75 Klorfeniramin maleat (CTM) tablet 4 mg Tablet 500 0 500 - 500 -
Kotrimoksazol DOEN I (dewasa) kombinasi :
76 Tablet 600 0 600 - 600 -
Sulfametoksazol 400 mg + Trimetoprim 80 mg
Kotrimoksazol DOEN II (pedriatik) kombinasi :
77 Tablet - - - -
Sulfametoksazol 100 mg + Trimetoprim 20 mg 0 0
Kotrimoksazol Suspensi kombinasi : Sulfametoksazol
78 Botol 295 0 295 - 295 -
200 mg + Trimetoprim 40 mg/ 5 ml - 60 ml
Lidokain comp injeksi (Lidocain 2% (HCl) + Epinefrin 1 :
79 Ampul 55 - 55 -
80.000) - 2 ml 55 0
80 Loperamid tablet 2 mg /NOVADIUM Tablet 600 0 600 100 500 -
81 Loratadin tablet 10 mg Tablet 1000 0 1,000 - 1,000 -
82 Lansoprazole Kapsul 2600 0 2,600 - 2,600 -
83 Metampiron (Antalgin) tablet 500 mg Tablet 0 0 - - - -
84 Metformin HCl tablet 500 mg Tablet 1200 0 1,200 - 1,200 -
Metilergometrin Maleat (Metilergometrin) tablet salut
85 Tablet 700 0 700 - 700 -
0,125 mg
86 Metilergometrin Maleat (Metilergometrin) injeksi Ampul 100 0 100 - 100 -
87 Metil Prednisolon Tablet 1700 0 1,700 300 1,400 -
88 Metronidazole SIRUP Botol 0 0 - - - -
89 Metronidazol tablet 500 mg Tablet 300 0 300 - 300
90 Meloxicam 7,5 mg Tablet 600 0 600 100 500 -
91 Meloxicam 15 mg Tablet 1400 0 1,400 - 1,400 -
92 Mikonazol krim/ salep 2 % (Nitrat) - 10 gr Tube 48 0 48 24 24 -
93 Natrium Diklofenak tablet 25 mg Tablet 0 0 - - - -
94 Natrium Diklofenak tablet 50 mg Tablet 600 0 600 200 400
95 Natrium Klorida larutan infus 0,9% - 500 ml Kolf 37 0 37 5 32
96 Nifedipin tablet 10 mg Tablet 0 0 - - - -
97 Nistatin tablet salut 500.000 IU/g Tablet 0 0 - - - -
98 Nistatin vaginal tablet 100.000 IU/g Tablet 60 0 60 - 60 -
99 Obat batuk Hitam (OBH) Cairan -100 ml non Alkohol Botol 0 0 - - - -
100 Oksitetrasiklin HCl salep kulit 3 % - 5 gr Tube 50 0 50 - 50 -
101 Oksitetrasiklin HCl salep mata 1 % - 5 gr Tube 50 0 50 - 50 -
102 Oksitocin Injeksi Ampul 76 0 76 - 76 -
103 Omeprazol kapsul 20 mg Kapsul 600 0 600 - 600
104 omeprazole Injeksi Vial 28 0 28 - 27 -
105 Papaverin tablet 40 mg Tablet 0 0 - - - -
106 Parasetamol drops 15 ml Botol 25 0 25 - 25 -
107 Parasetamol sirup 120 mg / 5ml - 60 ml Botol 113 0 113 6 107 -
108 Parasetamol tablet 500 mg Tablet 1900 0 1,900 200 1,700 -
109 Parasetamol Infus Botol 5 0 5 - 5 -
110 Piridoksin (Vitamin B6) tablet 10 mg (HCl) Tablet 900 0 900 - 900 -
111 Polikresulen (kondensasi) 10 ml / nistatin drop Botol 0 0 - - - -
112 Povidon Iodida larutan 60 Ml Botol 299 0 299 - 299 -
113 Povidon Iodida larutan 10 % - 1 L Botol 16 0 16 - 16 -
114 Povidon Iodida larutan 10 % - 300 ml Botol 0 0 - - - -
115 Prednison tablet 5 mg Tablet 400 0 400 100 300
116 Propiltiourasil tablet 100 mg Tablet 0 0 - - - -
117 Propanolol Tablet 0 0 - - - -
118 Ranitidin tablet 150 mg Tablet 0 0 - - - -
119 Ranitidin injeksi ampul 40 0 40 - 40 -
120 Ringer Laktat larutan infus - 500 ml Kolf 80 0 80 1 79 -
121 Cairan KAEN3B Botol 0 0 - - - -
122 Salbutamol tablet 4 mg (sebagai sulfat) Tablet 700 0 700 - 700 -
Salep 2-4 kombinasi : Asam Salisilat 2 % + Belerang
123 Pot 0 0 - - -
endap 4 % - 30 gr
124 Salisil Bedak 2 % - 50 gr Kotak 179 0 179 - 179 -
125 Sefadroxil sirup 125 MG Botol 0 0 - - - -
126 Sefadroksil Kapsul 500 mg Kapsul 400 0 400 100 300
127 Sefadroxil sirup 250 MG Botol 0 0 - - - -
128 Sianokobalamin (vitamin B12) tablet 50 mcg Tablet 0 0 - - - -
129 Simvastatin tablet 10 mg Tablet 1300 0 1,300 100 1,200 -
130 Simvastatin tablet 20 mg Tablet 900 0 900 100 800 -
131 Siprofloksasin tablet 500 mg (sebagai HCl) Tablet 4100 0 4,100 - 4,100 -
132 Sulfasetamida Natrium tetes mata 15 % - 5 ml Botol 0 0 - - - -
133 Sukralfat Botol 96 0 96 - 96 -
134 Tetrasiklin Kapsul 250 mg Kapsul 0 0 - - - -
135 Tetrasiklin kapsul 500 mg Kapsul 900 0 900 - 900 -
136 Tiamin (Vitamin B1) tablet 50 mg (HCl/ Nitrat) Tablet 1200 0 1,200 - 1,200 -
137 Vitamin B Kompleks tablet Tablet 800 0 800 400 400
138 Zinc tablet 20 mg Tablet 4900 0 4,900 - 4,900 -
139 Scabimite Krim - Permetrin Krim 5 % Tube Tube 0 0 - - - -
0
OBAT PROGRAM P2M 0 0 - - - -
140 Primaquin Tablet 0 0 - - - 100
141 DHP-Prmal Tablet 0 0 - - - 100
142 RDT Malaria paket 0 0 - - - 100
143 HIV Rapid test Pcs 50 0 50 - 50 100
144 Spyilis Rapid test Pcs 75 0 75 25 50 100
145 Hepatitis rapid test/HBsAg Pcs 100 0 100 25 75 100
146 Health Mate Dengue AB Plus ( IGG & IGM ) Pcs 0 0 - - - 100
147 Health Mate Dengue Combo Plus Pcs 100 0 100 10 90 100
0
0 0 - - - -
148 Obat FDC Kategori 1 Paket 0 0 - - - 5
149 Obat FDC Kategori 2 Paket 0 0 - - - -
150 Obat FDC Anak Paket 0 0 - - - -
151 Obat FDC Sisipan (MDR) Paket 0 0 - - - -
0
OBAT PROGRAM KECACINGAN 0 0 - - - -
152 Albendazole tablet 400 mg Tablet 600 0 600 - 600 -
153 Pirantel tablet score (base) 125 mg Tablet 0 0 - - - -
154 Pirantel Syrup Botol 0 0 - - - -
0
OBAT PROGRAM GIZI
155 Retinol (Vitamin A) 100.000 IU kapsul lunak Kapsul 200 0 200 - 200
156 Retinol (Vitamin A) 200.000 IU kapsul lunak Kapsul 1100 0 1,100 - 1,100 -
0
OBAT KEJIWAAN
157 Alprazolam tablet 1 mg Tablet 0 0 - - - -
158 Diazepam tablet 5 mg Ampul 0 0 - - - -
159 Diazepam tube Rectal 5 mg/ml / STESOLID Tube rectal 7 0 7 - 7 -
160 Chlorpromazin HCL 0,25 mg Tablet 400 0 400 - 400 -
161 Trihexyphenidyl HCL tab 2 mg Tablet 195 0 195 - 195 -
162 Amitriptilin 25 mg Tablet 0 0 - - - -
163 haloperidol 5 mg Tablet 0 0 - - - -
164 haloperidol 0.5 mg Tablet 0 0 - - - -

OBAT GIGI
165 CHKM Botol 0 0 - - - 1
166 Devitalisasi Pasta (Non Arsen) Btl / ktk 0 0 - - - 1
167 Etil Chlorida spray - 100 ml / Lidokain spray/Xylocain Botol 10 0 10 - 10 -
168 Eugenol cairan - 15 ml Botol 0 0 - - - 1
169 Glass Ionomer Cement ART (GCIX) / FUJI IX Set 0 0 - - - 1
170 Kalsium Hidroksida pasta / CALCIDOR / DYCAL Set 0 0 - - - 1
171 Mummifying Pasta / Iodoform Btl / ktk 0 0 - - - 1
172 Semen Seng Fosfat (Powder 30 gr, Liquid 10 ml) Set 0 0 - - - 1
173 Silver Amalgam Botol 0 0 - - - 1
174 Temporary Stopping Fletcher Serbuk (Powder) Pot 0 0 - - - 1
0
PERBEKALAN KESEHATAN
175 Alat Suntik sekali pakai 0,05 ml Pcs 63 0 63 - 63
176 Alat Suntik sekali pakai 0,5 ml Pcs 600 0 600 - 600 -
177 Alat Suntik sekali pakai 1 ml Pcs 180 0 180 3 177 -
178 Alat Suntik sekali pakai 0,3 ml Pcs 300 0 300 - 300 -
179 Alat Suntik sekali pakai 3 ml Pcs 330 0 330 - 330 -
180 Alat Suntik sekali pakai 5 ml Pcs 90 0 90 - 90 -
181 Benang Bedah Catgut No. 3/0 DS 30 MM Saset 0 0 - - - -
182 Benang Bedah Catgut No. 3/0 HR 27 MM Saset 24 0 24 - 24 -
183 Benang Bedah Silk Black 3/0 DS 24 MM Cassete 0 0 - - -
184 Benang Bedah Silk Black 3/0 HR 20 MM Sach 0 0 - - - -
185 Etanol 70 % - 1 L Botol 13 0 13 - 13 -
186 Etanol 95 % - 100 ml Botol 345 0 345 - 345 -
187 Folley Cateter N0.18 Pcs 0 0 - - - -
188 Infusion Set Anak Pcs 19 0 19 - 19 -
189 Infusion Set Dewasa Pcs 105 0 105 2 103 -
190 Infus set Bayi Pcs 0 0 - - - -
191 IV. Catheter No.18 G Set 30 0 30 - 30 -
192 IV. Catheter No.20 G Set 70 0 70 2 68 -
193 IV. Catheter No.22 G Set 105 0 105 - 105 -
194 IV. Catheter No.24 G Set 48 0 48 - 48 -
195 Kapas 100 gram Bungkus 0 0 - - -
196 Kapas Pembalut / absorben 50 gram Bungkus 6 0 6 2 4
197 Kapas Pembalut / absorben 250 gram Bungkus 0 0 - - - -
198 Kassa Hidrofil Steril uk. 16 x 16 Kotak 19 0 19 10 9
199 Kassa Hidrofil uk. 36 m x 40 cm / 40 yard x 80 cm Roll 0 0 - - - -
200 Kassa pembalut hidrofil 3X15 Roll 11 0 11 - 11 -
201 Masker Kotak 0 0 - - -
202 Masker N95 Kotak 36 0 36 - 36 -
203 Masker Hijab Kotak 0 0 - - -
204 Plester 5 yard X 2 inch Roll 0 0 - - - -
205 Pot Dahak Pcs 414 0 414 - 414 -
206 Sarung Tangan M Kotak 3 0 3 1 2
207 Sarung Tangan L Kotak 6 0 6 - 6 -
208 Sarung Tangan No. 7,5 Pcs 52 0 52 - 52 -
209 Sarung Tangan No. 7 Pcs 52 0 52 - 52 -
210 Sarung Tangan No. 6,5 Pcs 41 0 41 - 41 -
211 Nebulezer Bayi (sungkup) Pcs 2 0 2 - 2 -
212 Nebulezer Anak (sungkup) Pcs 2 0 2 - 2 -
213 Nebulezer Dewasa (sungkup) Pcs 2 0 2 - 2 -
214 Urine Bag Pcs 20 0 20 - 20 -
215 Nassal Canula Child pcs 18 0 18 - 18 -
216 Nassal Canula Infant pcs 18 0 18 - 18 -
217 Nassal Canula ADULT pcs 20 0 20 - 20 -
218 Kertas EKG roll 2 0 2 - 2 -
219 USG Gel 500 mL botol 2 0 2 - 2 -
220 Ziltape paper 0.5 inch roll 23 0 23 - 23 -
221 Ziltape paper 1 inch roll 22 0 22 - 22 -
222 Ziltape paper 2 inch roll 23 0 23 1 22 -

OBAT PONED
223 MgSO4 20 % injeksi Botol 6 0 6 - 6
224 MgSO4 40 % injeksi Botol 6 0 6 - 6
225 Oksitosin injeksi 10 IU/ml - 1 ml Ampul 76 0 76 - 76 -
0
OBAT TAMBAHAN 0
226 Ifarsyl Syrup Botol 6 0 6 - 6
227 Febrinex Syrup Botol 19 0 19 - 19 -
228 Novakid Syrup Botol 100 0 100 - 100 -
229 Fasfit C tablet 0 0 - - - -
230 Fasfit CDEZ tablet 0 0 - - -
231 Lodecon tablet 1100 0 1,100 100 1,000 -
232 Noza tablet 5700 0 5,700 - 5,700 -
233 Aloclair Gel botol 6 0 6 - 6 -
234 Aloclair Spray botol 5 0 5 - 5 -
235 Symbicort 0 0 - - -
236 Cefotaxim injeksi Ampul 10 0 10 - 10 -
237 Cetriaxone injeksi Ampul 10 0 10 - 10 -
238 Atorvastatin tablet Tablet 420 0 420 - 420 -
239 Alpara Tablet 2550 0 2,550 - 2,550 -
240 Albuforce (Kapsul ikan gabus) Kapsul 300 0 300 100 200 -
241 OBH Molex sirup Botol 110 0 110 - 110 -
242 Widoxil sirup (Sefadroxil 125 mg) Botol 40 0 40 - 40 -
243 Striatamin Kapsul 600 0 600 - 600 -
244 Nufed Tablet 1000 0 1,000 50 950
245 Vitsap Tablet 840 0 840 390 450
246 Betametason TM (Vasoma) Tube 35 0 35 10 25 -
247 Ofloxacin tetes telinga botol 16 0 16 - 16 -
248 Phenol Glyserol Tetes Telinga botol 11 0 11 - 11 -
249 Nistatin drop botol 19 0 19 - 19 -
250 Densefion (Ondansetron injeksi) ampul 20 0 20 - 20 -
251 Gastrinal sirup botol 88 0 88 3 85 -
252 Kidyvit drop botol 15 0 15 - 15 -
253 Channafit sirup botol 27 0 27 - 27 -
254 Domperidon tab tablet 300 0 300 100 200 -

VAKSIN
255 ATS Ampul 0 0 - - - 20
256 Anti Bisa Ular Ampul 0 0 - - - 20
257 Rabies Vero Vial 0 0 - - - 20
258 BCG Ampul 22 0 22 - 22 20
259 DPT-HB Combo Ampul 33 0 33 - 33 20
260 Polio Ampul 31 0 31 - 31 20
261 Campak + Pelarut Campak Ampul 12 0 12 - 12 20
262 TT/TD Ampul 5 0 5 - 5 20
263 IPV Ampul 20 0 20 - 20 20
264 HB Uniject Ampul 0 0 - - - 20

UMUM ASKES BPJS GRATIS JAMKESMAS JUMLAH

JUMLAH KUNJUNGAN RESEP
-
Mengetahui / Menyetujui Yang Menyerahkan , Yang Meminta , Yang Membuat ,
Kepala Dinas Kesehatan Kab.Konawe Kepala Instalasi Farmasi Kab.Konawe Kepala Puskesmas Petugas Puskesmas

drg. Mawar Taligana, M.Kes Mulyanti, S.Farm., Apt. HJ. SURIANI, SKM, M.Kes apt. Ega Tri Kutianti, S.Farm
Nip. 19660726 200212 1 001 NIP. 1986 0910 201101 2 026 NIP. 19670621 198703 2 004 SIPA: 517/010.37/SIPA_7403.2/DPM-PTSP/2023
 13 5 2
15 3 3
16 9 1
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20 3 2
22 3 1
15 6 1
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16 1 1
11 2 1
18 6 2
20 3 2
13 3 1
16 3 2
18 1 1
8 3 6
11 3 10
19 4 39
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12 3
25 2
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385 74