LAPORAN PEMAKAIAN

DANA ALOKAS

Rumah sakit : RSUD LOMBOK TIMUR

Laporan bulan :
Permintaan bulan :

No Nama Obat / BMHP Satuan Stok awal

1 2 3 4
OBAT-OBATAN
1 ALOPURINOL TABLET/KAPSUL/KAPLET 100 MG Tablet
2 AMBROKSOL 15 MG/5 ML SYR Botol
3 AMBROKSOL 30 MG Tablet
4 ASAM MEFENAMAT 500 MG Tablet
5 ASAM MEFENAMAT 50MG/5 ML SYR BOTOL
ASAM TRANEKSAMAT TABLET/KAPSUL/KAPLET SALUT SELAPUT TABLET
6 500 MG (NEXITRA)
7 ASIKLOVIR 5%/5 G KRIM Tube
8 ATAPULGIT-PEKTIN (ATTAPULGIT) TABLET
9 BETAHISTIN MESILAT 8 MG Tablet
BETAMETHASONE DIPROPIONATE BETAMETHASONE Tube
10 DIPROPIONATE/ BETAMETASON KRIM 0,05% (0,5MG/G) (G)
BISAKODIL/BISACODYL TABLET/KAPSUL/KAPLET SALUT 5 MG TABLET
11 (LAXANA)
CEFADROXIL MONOHYDRATE/ CEFADROXIL/ SEFADROKSIL BOTOL
12 SIRUP KERING 125 MG/5ML
13 CETIRIZIN 10 MG TABLET

COMBIVENT UDV IPRATROPIUM BROMIDE MONOHYDRATE ~

IPRATROPIUM BROMIDE 0,5 MG + SALBUTAMOL SULPHATE ~
SALBUTAMOL 2,5 MG/ KOMBINASI: IPRATROPIUM BROMIDA Vial
INHALASI 0,5 MG + SALBUTAMOL 2,5 MG
14
15 CONCOR 2.5 BISOPROLOL TABLET/KAPSUL/KAPLET 2,5 MG TABLET
16 DEKSAMETASON 0,5 MG Tablet
17 DEPAKOTE DIVALPROEX SODIUM / VALPROAT TAB SALUT ENTER TABLET
18 DEPAKOTE ER DIVALPROEX SODIUM - VALPROIC ACID 500 MG TABLET
19 DIKLOFENAK KALIUM 50 MG (ERPHAFLAM) Tablet
20 DULCOLAX BISAKODIL SUPPOSITORIA 10 MG SUPPO
21 DULCOLAX BISAKODIL SUPPOSITORIA 5 MG SUPPO
22 EPERISON HCL 50 MG (MYONEP) Tablet
23 FAMOTIDIN 40 MG TABLET
24 FLUNARIZIN 5 MG (VERTILON) Tablet
25 GENERIK AKARBOSE/ACARBOSE TABLET 50 MG Tablet
GENERIK AMLODIPIN/AMLODIPINE/AMLODIPINE
BESYLATE/AMLODIPINE BESILATE TABLET/KAPSUL/KAPLET 10 Tablet
26 MG
GENERIK AMLODIPIN/AMLODIPINE/AMLODIPINE
BESYLATE/AMLODIPINE BESILATE TABLET/KAPSUL/KAPLET 5 Tablet
27 MG
28 GENERIK AMOKSISILIN/AMOXICILLIN SIRUP KERING 250 MG/5 M Botol
GENERIK AMOKSISILIN/AMOXICILLIN
TABLET/KAPSUL/KAPLET/KAPTAB 500 MG, KEMASAN KAPTAB
29 STRIP/BLISTER (G)

GENERIK ANTASIDA SUSPENSI, KOMBINASI: ALUMINIUM BOTOL

HIDROKSIDA 200 MG + MAGNESIUM HIDROKSIDA 200 MG
30
GENERIK ANTASIDA TAB KUNYAH, KOMBINASI: ALUMINIUM
TABLET
HIDROKSIDA 200 MG + MAGNESIUM HIDROKSIDA 200 MG
31
GENERIK ANTIHEMOROID, KOMBINASI SUP : BISMUT SUPPO
32 SUBGALAT HEKSAKLOROFEN
GENERIK ASAM ASKORBAT (VITAMIN C) TAB 50 MG
33
34 GENERIK ASAM TRANEKSAMAT/TRANEXAMIC ACID INJEKSI 100 Ampul
35 GENERIK ASAM TRANEKSAMAT/TRANEXAMIC ACID INJEKSI 50 Ampul
36 GENERIK ASIKLOVIR/ACYCLOVIR TABLET/KAPSUL/KAPLET 400 M TABLET
GENERIK ATORVASTATIN TABLET/KAPSUL/KAPLET SALUT
SELAPUT 10 MG (Fastor 10) Tablet
37
38 GENERIK ATORVASTATIN TABLET/KAPSUL/KAPLET SALUT SELAPUT Tablet
GENERIK AZITROMISIN/AZITHROMYCIN DIHYDRATE TABLET
39 TABLET/KAPSUL/KAPLET SALUT SELAPUT 500 MG
GENERIK BETAHISTIN/BETAHISTINE MESILATE/BETAHISTINE
MESYLATE TABLET/KAPSUL/KAPLET 6 MG Tablet
40
GENERIK BISOPROLOL/BISOPROLOL FUMARATE
TABLET/KAPSUL/KAPLET SALUT SELAPUT 5 MG Tablet
41
42 GENERIK CHLORAMPHENICOL/ KLORAMFENIKOL SALEP MATA 1 TUBE
GENERIK CHLORPHENAMINE MALEATE/KLORFENIRAMIN Tablet
43 TABLET/KAPSUL/KAPLET 4 MG
44 GENERIK CLOPIDOGREL BISULFATE/ CLOPIDOGREL/ CLOPIDOGRE Tablet
GENERIK COTRIMOXAZOLE/ COTRIMOKSAZOLE/
KOTRIMOKSAZOL (ANAK) KOMBINASI TIAP 5 ML SUSPENSI: BOTOL
SULFAMETOKSAZOL 200 MG + TRIMETOPRIM 40 MG (SUSP 240
MG)
45
GENERIK DEXAMETHASON SODIUM PHOSPHATE/
DEKSAMETHASON/ DEKSAMETASON INJEKSI 5 MG/ML AMPUL
(I.V./I.M.)
46
GENERIK DICLOFENAC SODIUM/ NATRIUM DIKLOFENAK TABLET
TABLET/KAPSUL/KAPLET SALUT ENTERIK 50 MG
47
48 GENERIK DIGOKSIN/ DIGOXIN TABLET/KAPSUL/KAPLET 0,25 MG Tablet
49 GENERIK DOMPERIDON/ DOMPERIDONE MALEATE/ DOMPERIDON Botol
50 GENERIK DOMPERIDON/ DOMPERIDONE TABLET/KAPSUL/KAPLE Tablet

GENERIK FUROSEMID/ FUROSEMIDE TABLET/KAPSUL/KAPLET

40 MG TABLET
51

GENERIK GARAM ORALIT I SERBUK, KOMBINASI: NATRIUM

KLORIDA 0,52 G + KALIUM KLORIDA 0,30 G + TRINATRIUM SACHET
SITRAT DIHIDRAT 0,58 G + GLUKOSA ANHIDRAT 2,70 G
52
53 GENERIK GLIMEPIRIDE TABLET/KAPSUL/KAPLET 2 MG TABLET
54 GENERIK GLIMEPIRIDE TABLET/KAPSUL/KAPLET 3 MG TABLET
55 GENERIK GLIMEPIRIDE TABLET/KAPSUL/KAPLET 4 MG TABLET
56 Generik Glukosa larutan infus 10% 500 mL BOTOL
57 Generik Glukosa larutan infus 5 % 500 mL Botol
58 GENERIK HIDROKORTISON/ HYDROCORTISONE KRIM 2,5% TUBE
59 GENERIK IBUPROFEN SUSP 100 MG/5 ML BOTOL
GENERIK KANDESARTAN/ CANDESARTAN/ CANDESARTAN Tablet
60 CILEXETIL TABLET/KAPSUL/KAPLET 16 MG
GENERIK KANDESARTAN/ CANDESARTAN/ CANDESARTAN
CILEXETIL TABLET/KAPSUL/KAPLET 8 MG TABLET
61
62 GENERIK KAPTOPRIL/ CAPTOPRIL TABLET/KAPLET 12,5 MG TABLET
63 GENERIK KETOKONAZOL/ KETOCONAZOLE KRIM 2% TUBE
64 GENERIK KETOKONAZOL/ KETOCONAZOLE TABLET/KAPSUL/KAPL Tablet
65 GENERIK LACTULOSE/ LAKTULOSA SIR 3,335 G/5 ML (G) Botol
GENERIK LEVOFLOXACIN HEMIHYDRATE/
LEVOFLOXACIN/LEVOFLOKSASIN TABLET/KAPSUL/KAPLET TABLET
66 SALUT SELAPUT 500 MG
GENERIK LIDOCAINE HYDROCHLORIDE/ LIDOCAINE/ LIDOCAIN/ AMPUL
67 LIDOKAIN INJEKSI 2%

GENERIK LIDOKAIN INJEKSI 2% + EPINEFRIN 1: 80.000 - INJ 2 ML AMPUL

68
GENERIK LISINOPRIL DIHYDRATE/ LISINOPRIL/ LISINOPRIL
TABLET/KAPSUL/KAPLET 5 MG Tablet
69
70 GENERIK METFORMIN HYDROCHLORIDE/ METFORMIN TABLET/KAP Tablet
GENERIK METILPREDNISOLON/METHYLPREDNISOLONE Tablet
71 TABLET/KAPSUL/KAPLET 16 MG

GENERIK METILPREDNISOLON/METHYLPREDNISOLONE TABLET

72 TABLET/KAPSUL/KAPLET 4 MG
73 Generik Nacl 0,9% / Sodium Chloride 0,9%, 500 mL BOTOL
GENERIK ONDANSENTRON HYDROCHLORIDE/ ONDANSENTRON
HCL DIHYDRATE / ONDANSETRON TABLET/KAPSUL/KAPLET 4 Tablet Salut Selaput
74 MG
75 GENERIK PARACETAMOL/ PARASETAMOL SIRUP 120 MG / 5 ML BOTOL

GENERIK PYRIDOXINE/ PIRIDOKSIN (VITAMIN B6) TABLET

TAB/KAP/KAPL 10 MG (HCL)
76
77 Generik Ringer Laktat/ Ringer Lactate, @500 mL Botol
 GENERIK SIMVASTATIN TABLET/KAPLET/SALUT SELAPUT 10 MG Tablet
78
79 GENERIK SIMVASTATIN TABLET/KAPLET/SALUT SELAPUT 20 MG Tablet
80 GENERIK SUCRALFATE/ SUKRALFAT SUSP 500 MG/5 ML BOTOL
81 GENERIK TIAMIN (VITAMIN B1) TABLET/KAPSUL/KAPLET 50 MG Tablet
82 GENERIK VITAMIN B KOMPLEKS TABLET TABLET
83 GENERIK ZINC SULFATE/ ZINC SULFATE MONOHYDRATE/ ZINC/ Z Botol
GENERIK ZINC SULFATE/ ZINC SULFATE MONOHYDRATE/ZINC/
ZINC TABLET DISPERSIBLE 20 MG TABLET
84
85 GENTAMISIN 15 MG/5 G SK (GENOINT) Tube
86 GLICLAZIDE GLIKLAZID TABLET/KAPSUL/KAPLET 80 MG (G) Tablet
87 GUAIFENESIN Tablet
88 HIOSIN N-BUTILBROMIDA 10 MG (SCOPMA) Tablet
89 HIOSIN N-BUTILBROMIDA 20 MG/ML INJ (SCOPAMIN) Ampul
90 IBUPROFEN 400 MG (REPASS) Tablet
91 KAOLIN PEKTIN SYRUP Botol
92 KAPTOPRIL 25 MG TABLET
93 KLINDAMISIN 300 MG KAPSUL
94 KLORAMFENIKOL 1% TT (ERLAMYCETIN) Botol
95 KLORAMFENIKOL TM (RECO) Botol
96 KOLSISIN 0,5 MG (L-CISIN) Tablet
97 LANSOPRAZOLE 30 MG KAPSUL
LEVEMIR FLEXPEN ANALOG INSULIN LONG ACTING INJ 100 KOTAK @ 5 PEN
IU/ML, VIAL/CARTRIDGE DISPOSIBLE/PENFILL CARTRIDGE
98
99 MEKOBALAMIN 500 MG (OXICOBAL) Kapsul
100 MELOKSIKAM 15 MG (Movix 15 mg) TABLET
101 MELOKSIKAM 7,5 MG (Movix 7,5 mg) TABLET
102 METAMPIRON 1 G/2 ML INJ (NORAGES) Ampul
103 METILPREDINISOLON 4 MG Tablet
104 METRONIDAZOL 500 MG Tablet
105 MULTIVITAMIN DROP (Truvit drop) Botol
106 MULTIVITAMIN IBU HAMIL (OBDHAMIN) Kaplet
107 MULTIVITAMIN SYR (CAVIPLEX) BOTOL
108 MULTIVITAMIN TAB (CAVIPLEX tab) TABLET
109 NISTATIN 100000 IU/ML DROP Botol

NOVOMIX 30 ANALOG INSULININTERMEDIATE ACTING

COMBINE WITH SHORT OR LONG ACTING INJ 100 IU/ML, Kotak @ 5 Pen
VIAL/CARTRIDGE DISPOSIBLE/PENFILL CARTRIDGE
110
NOVORAPID ANALOG INSULIN FAST ACTING INJ 100 IU/ML, Kotak @ 5 Pen
111 VIAL/CARTRIDGE DISPOSIBLE/PENFILL CARTRIDGE
112 OMEPRAZOL 20 MG KAPSUL
113 OTSU - WI AIR UNTUK INJEKSI / WATER FOR INJECTION 25 ML AMPUL
114 PARACETAMOL 500 MG TAB Tablet
115 PARACETAMOL 80 MG SUPPO Suppo
 116 PREDNISON/PREDNISONE TABLET/KAPSUL/KAPLET 5 MG Tablet
117 PROBIOTIK LAKTOBASILUS ASIDOFILUS (L-BIO) Sach
118 SALBUTAMOL NEBULIZER (Lasal) Ampul
119 SALEP LUKA BAKAR RINGAN (NEOSENTA) Tube
120 SEFADROKSIL 500 MG Tablet
121 SIPROFLOKSASIN 500 MG Tablet
122 SUPRAFENID KETOPROFEN SUPOSITORIA 100 MG SUPPO
123 THYROZOL 5 THIAMAZOLE/ TIAMAZOL TAB SAL SELAPUT 5 MG Tablet
124 VITAMIN NEUROTROPIK Tablet
PERBEKALAN KESEHATAN
1 Alkohol 70% 1L Botol
2 AXIMED IV-CATH NP, pen type, no. 18 Pcs
3 AXIMED CHIRURGIC GLOVES, size 6.5 Pair
4 AXIMED CHIRURGIC GLOVES, size 7.0 Pair
5 Aximed EXAMINATION GLOVES, size L Box
6 Aximed EXAMINATION GLOVES, size M Box
7 Aximed EXAMINATION GLOVES, size S Box
8 AXIMED FEEDING TUBE, 100CM, NO. 10 Pcs
9 AXIMED FEEDING TUBE, 100CM, NO. 8 Pcs
10 AXIMED FOLEYCATH 2 WAY LATEX FOLEY CATH NO.16 Pcs
11 Aximed FOLEYCATH, 2 way latex foley cath, no. 18 Pcs
12 AXIMED Infusiont Set Y-Type Pcs
13 AXIMED IV-CATH NP, pen type, no. 20 Pcs
14 AXIMED IV-CATH NP, pen type, no. 22 Pcs
15 AXIMED IV-CATH NP, pen type, no. 24 Pcs
16 AXIMED NASAL OXYGEN O2 CANNULA SIZE L Pcs
17 AXIMED NASAL OXYGEN O2 CANNULA SIZE M Pcs
18 AXIMED NASAL OXYGEN O2 CANNULA SIZE S Pcs
19 AXIMED NASAL OXYGEN O2 CANNULA SIZE XS Pcs
20 AXIMED PEDIATRIC SET Pcs
21 AXIMED STOMACH TUBE, 85CM, NO. 12 Pcs
22 AXIMED STOMACH TUBE, 85CM, NO. 14 Pcs
23 AXIMED STOMACH TUBE, 85CM, NO. 16 Pcs
24 AXIMED STOMACH TUBE, 85CM, NO. 18 Pcs
25 AXIMED SUCTION CATHETER NO. 10 Pcs
26 AXIMED SUCTION CATHETER NO. 12 Pcs
27 AXIMED SUCTION CATHETER NO. 14 Pcs
28 AXIMED SUCTION CATHETER NO. 16 Pcs
29 AXIMED SUCTION CATHETER NO. 6 Pcs
30 AXIMED SUCTION CATHETER NO. 8 Pcs
31 AXIMED Syringe 1 cc Dus
32 AXIMED Syringe 10 cc Dus
33 AXIMED SYRINGE 20 CC Dus
34 AXIMED Syringe 3 cc Dus
35 AXIMED Syringe 5 cc Dus
36 AXIMED URINE DRAINAGE BAG T VALVE WITH HANGER Pcs
DR. PRO DR. PRO MULTIFUNCTION GEL 250 ML (1 DUS ISI 36 Dus @ 36 botol
37 BOTOL) / ULTRASOUND GEL FOR USG / ECG / DOPPLER
DR. PRO DR. PRO MULTIFUNCTION GEL 5 LITER (1 DUS ISI 4 Dus @ 4 galon
38 GALON) / ULTRASOUND GEL FOR USG / ECG / DOPPLER
39 FILM RONGENT 11 x 14 inch Roll
40 FIXOMULL STRETCH 15CM X 5M Box
41 FIXOMULL STRETCH 5CM X 5M Box
42 Kantong palstik ukuran Besar (28x48 cm) Bungkus @ 50 lembar
43 Kantong plastik bersablon (Terima kasih atas kunjungan anda Bungkus @ 50 lembar
44 Kantong plastik ukuran Kecil 15x34 cm Bungkus @ 50 lembar
45 Kantong plastik ukuran Sedang (21x40 cm) Bungkus @ 50 lembar
46 kantong puyer Pack @ 720 pcs
47 Kapas Pembalut 250 gram Pcs
48 KERTAS EKG Roll
49 Kertas Puyer 500 Lembar Pack
50 KERTAS USG Roll
51 Klip Obat Sablon Besar Pack
52 Klip Obat Sablon Kecil Pack
53 Klip Obat Sablon Sedang Pack
54 Masker Jilbab Box
55 MEDICARE 2,5% 5 L Galon
56 MEDICARE 2,5% 500 Ml Botol
57 MEDIKA ANTISEPTIC HANDRUB 5 L Galon
58 MEDIKA ANTISEPTIC HANDRUB 500 ML + Pump Botol

ONEMED BLUE TIP ISI 500 PER KARTON ISI 30 BAG @ 500 Carton
59
60 ONEMED CARDIO GEL Tube
61 ONEMED KASA HYDROFIL 40X80 CM, XRAY LINE Rol
62 ONEMED KASA HYDROFIL 40X80 CM, XRAY LINE Rol

ONEMED KASA STERIL 10X10 CM, 8 PLY 1X5'S LD (1085 LD) Kotak
63
ONEMED KASA STERIL 7,5X7,5 CM 8 PLY 1X5'S LD (785 Dus
64 LD)
65 ONEMED PLESTERIN BULAT T, BOX ISI 100 Dus
66 ONEMED PLESTERIN BULAT T, BOX ISI 100 Dus
ONEMED SURGICAL GOWN NON WOVEN REINFORCE, Pouch
67 SIZE S, M, L, XL, XXL
68 ONEMED URINE CONTAINER 60 ML STERIL Pcs
69 ONEMED WHITE TIPS ISI 1000 Carton
ONEMED YELLOW TIP ISI 1000, PER KARTON 50 BAG @ ISI Carton
70 1000
71 OXYGEN MASKER NON REBREATHING DEWASA Pcs
72 PEN NEEDLE 32G 4MM Pcs
73 Povidone Iodine 300 ml Botol
74 PP TES HAMIL Pcs
 PRO-CREPE SN MEDIKA PRO CREPE PEMBALUT ELASTIS
Roll
75 UKURAN 10 CM X 4,55 M (TERENTANG)
PRO-CREPE SN MEDIKA PRO CREPE PEMBALUT ELASTIS
Roll
76 UKURAN 15 CM X 4,55 M (TERENTANG)
PRO-CREPE SN MEDIKA PRO CREPE PEMBALUT ELASTIS Roll
77 UKURAN 7,5CM X 4,55M (TERENTANG)
78 Rivanol 300 cc Botol
79 SCALVIN/WING NEEDLE 21 Pcs
80 SCALVIN/WING NEEDLE 25 Pcs
81 Sendok takar sirup pack @ 250 pcs
82 SERENITY CERVICAL COLLAR SR-N1 Pcs
83 SERENITY MASK OXYGEN ADULT Pcs
84 SERENITY MASK OXYGEN PEDIATRIC Pcs
85 SERENITY OKSIGEN MASKER NON REBREATHING ANAK Box
86 SERENITY SOFT TWIST LANCET 28 G ( BOX ) Box
87 SERENITY STERILANCE ALCOHOL SWAB ( BOX ) Box
88 SERENITY URETHRAL CATHETER 2 WAY FR 20 Box
89 SERENITY URETHRAL CATHETER 2 WAY FR 22 Box
90 SERENITY URETHRAL CATHETER 2 WAY FR 24 Box
91 SERENITY URETHRAL CATHETER 2 WAY FR 8 Box
SMI CATGUT CHROM 3/0 HR 37 MM ABSORBABLE SURGICAL
Sachet
92 SUTURE
SMI CATGUT CHROMIC 2/0 HR 37 MM ABSORBABLE SURGICAL Sachet
93 SUTURE
SMI CATGUT PLAIN 2/0 DS 24 MM ABSORBABLE SURGICAL Sachet
94 SUTURE
SMI CATGUT PLAIN 2/0 HR 37 MM ABSORBABLE SURGICAL
Sachet
95 SUTURE
SMI CATGUT PLAIN 3/0 DS 24 MM ABSORBABLE SURGICAL Sachet
96 SUTURE
SMI CATGUT PLAIN 3/0 HR 37 MM ABSORBABLE SURGICAL
Sachet
97 SUTURE
SMI SILK BLACK 2/0 HR 26 MM BRAIDED NONABSORBABLE
Sachet
98 SURGICAL SUTURE
SMI SILK BLACK 3/0 HR 30 MM BRAIDED NONABSORBABLE Sachet
99 SURGICAL SUTURE
SMI SMI CATGUT CHROM 2/0 DS 30 MM ABSORBABLE Sachet
100 SURGICAL SUTURE
SMI SMI CATGUT CHROM 3/0 DS 30 MM ABSORBABLE
SURGICAL SUTURE Sachet
101
102 Spalk First Aid Set
103 Spiritus 1000 ml Bungkus
104 STERIL GUEDEL AIRWAY 0 Pcs
105 STERIL GUEDEL AIRWAY 00 Pcs
106 STERIL GUEDEL AIRWAY 1 Pcs
107 STERIL GUEDEL AIRWAY 2 Pcs
108 STERIL GUEDEL AIRWAY 3 Pcs
109 STERIL GUEDEL AIRWAY 4 Pcs
110 STERIL GUEDEL AIRWAY 5 Pcs
 STERINTECH FLAT STERILIZATION PACKAGING REELS, SIZE
Roll
111 300MM X 200M
STERINTECH FLAT STERILIZATION PACKAGING REELS, SIZE
Roll
112 350MM X 200M
STERINTECH FLAT STERILIZATION PACKAGING REELS, SIZE Roll
113 400MM X 200M
SUPERCARE UNOLAB SUPERCARE NITRILE POWDER FREE Box
114 EXAMINATION GLOVE SIZE L
SUPERCARE UNOLAB SUPERCARE NITRILE POWDER FREE
Box
115 EXAMINATION GLOVE SIZE M

JUMLAH TOTAL (LEMBAR)

JUMLAH KINJUNGAN RESEP

RAWAT INAP
JUMLAH KUNJUNGAN PASIEN ANAK DEWASA

JUMLAH RAWAT INAP

Mengetahui / Menyetujui, Yang Menyerahkan

Kepala Dinas Kesehatan Kab. Lombok Timur Kepala Seksi Kefarmasian Makanan
dan Minuman

(dr. H. M. Hasbi Sanoso, M. Kes) (Ebang Yuliastuti, S. Farm.,Apt)

NIP. 19660429 199703 1 001 NIP. 19860701 201101 2020
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT DAN PERBEKALAN KESEHATAN
DANA ALOKASI KHUSUS(DAK) & JAMINAN KESEHATAN NASIONAL(JKN)

Tanggal Datang

Jadwal Distribusi
No. Dokumen
Nama Petugas RS

Rusak /
Penerimaan Persediaan Pemakaian Kadaluarsa/TMS Sisa Stok Stok Optimum Permintaan

5 7 8 9 10 11 12
 JUMLAH TOTAL
BERSALIN RAWAT JALAN LAIN-LAIN
KUNJUNGAN PASIEN

Yang Menerima / Melaporkan Yang Meminta,

Plt. Direktur Rumah Sakit Lombok Koordinator Instalasi RS. Lombok

Timur Timur

(…………………..) (…………………………….)
NIP. ………….. NIP. ……………………….
 Disiapkan Diserahkan
: No. Dievaluasi: oleh/tgl: oleh/tgl:
wal Distribusi :
:
ma Petugas RS :

Sumber Dana Pemberian Waktu

No Batch Kadaluars
APBD RS. Buffer a
Program Bon Jumlah
Lab. Haji Provinsi
13 14 15 16 17 18 19