Stok Opname JUNI

DAFTAR LAMPIRAN BERITA ACARA STOCK OPNAME OBAT PUSKESMAS CISOMPET BULAN JANUARI
STOK AWAL JANUARI

2019 PENERIMAAN
No NAMA OBAT SATUAN JKN/B NON JKN/ JKN/B

NON JKN/
Kategori Puskesmas NON TOTAL NON TOTAL
LUD LUD
BLUD BLUD
1 Albendazol Tablet 400 mg ANTELMINTIK CISOMPET Tablet 460 460

2 Alopurinol Tablet 100 mg ANTIPIRAI CISOMPET Tablet 340 340 200 200
3 Aminofilin Inj 24 mg/ml-10 ml ANTIASMA CISOMPET Ampul 0 0
4 Aminofilin Tablet 200 mg ANTIASMA CISOMPET Tablet 0 0
5 Amitriptilina HCl Tablet salut 25 mg OBAT PSIKOSIS CISOMPET Tablet 250 250
6 Amlodipin Tablet 5 mg ANTIHIPERTENSI CISOMPET Tablet 355 355
7 Amoksisilin Kaplet 500 mg ANTIBAKTERI CISOMPET Kaplet 2205 2205 1500 1500
8 Amoksisilin Sirup Kering 125 mg/5 ml ANTIBAKTERI CISOMPET Botol 309 309
9 Antasida DOEN I Tablet Kunyah ANTIULKUS CISOMPET Tablet 3980 3980 1000 1000
10 Antasida II Suspensi 60 ml ANTIULKUS CISOMPET Botol 46 46 60 60
11 Anti Hemmoroid DOEN ANTIHEMOROID CISOMPET Supp 13 13 10 10
12 Antibakteri DOEN ANTIBAKTERI KULIT, MaCISOMPET Tube 39 39
13 Antifungi DOEN kombinasi ANTIFUNGI KULIT CISOMPET Pot 58 58
14 Antimigren DOEN ANTIMIGREN CISOMPET Tablet 155 155
15 Aqua Pro Inj steril bebas pirogen- 20 LAIN-LAIN CISOMPET Vial 33 33
16 ARV: Efavirenz 600 mg ARV CISOMPET Tablet 0 0
17 ARV: Lamivudine 150 mg ARV CISOMPET Tablet 0 0
18 ARV: Lovinapir 200 mg Ronavir ARV CISOMPET Tablet 0 0
19 ARV: Nevirapine 200 mg ARV CISOMPET Tablet 0 0
20 ARV: TDF(300) + 3TC(300) + EFV(600) ARV CISOMPET Tablet 0 0
21 ARV: Tenofovir 300 mg ARV CISOMPET Tablet 0 0
22 ARV: Zdvdn(60) + Lmvdn(30) + Nvrpn(ARV CISOMPET Tablet 0 0
23 ARV: Zidovudine(300) + Lamivudine(1 ARV CISOMPET Tablet 0 0
24 Asam Asetilsalisilat Tablet 80 mg (AsetANTIAGREGASI PLATELCISOMPET Tablet 261 261
25 Asam Askorbat (VIT C) Tablet 50 mg VITAMIN dan MINERALCISOMPET Tablet 190 190
26 Asam Folat Tablet 0,4 mg VITAMIN dan MINERALCISOMPET Tablet 11540 11540
27 Asam Mefenamat kaplet 500 mg ANALGESIK NON NARKCISOMPET Tablet 1610 1610 1000 1000
28 Asiklovir Krim 5%/5g ANTIVIRUS CISOMPET Tube 16 16 10 10
29 Asiklovir Tablet 400 mg ANTIVIRUS CISOMPET Tablet 196 196
30 Atapulgit Tablet 600 mg OBAT untuk DIARE CISOMPET Tablet 512 512 100 100
31 Atropin Sulfat Inj 0,25 mg/ml ANTIDOT dan OBAT LACISOMPET Ampul 30 30
32 Azithromisin Tablet 500 mg IMS CISOMPET Tablet 0 0
33 Benzatin Benzil Penisilin Inj 2,4 juta IUANTIBAKTERI CISOMPET Vial 16 16
34 Betahistin Tablet 6 mg ANTIALERGI dan ANTIPCISOMPET Tablet 61 61 60 60
35 Betametason Krim 0.1 % ANTIINFLAMASI dan A CISOMPET Tube 29 29 50 50
36 Bisoprolol Tablet 5 mg ANTIHIPERTENSI CISOMPET Tablet 68 68
37 Bromheksin Tablet 8 mg EKSPEKTORAN dan MUK CISOMPET Tablet 1500 1500
38 Clobazam Tablet 10 mg OBAT PSIKOSIS CISOMPET Tablet 0 0
39 Clozapine Tablet 25 mg OBAT PSIKOSIS CISOMPET Tablet 0 0
40 Dehidroartemisin 40 mg + Piperaquin ANTIMALARIA CISOMPET Paket 0 0
41 Deksametason Inj 5 mg/ml-1 ml ANTIALERGI dan OBAT CISOMPET Ampul 23 23
42 Deksametason Tablet 0,5 mg ANTIALERGI dan OBAT CISOMPET Tablet 324 324 1000 1000
43 Dekstrometorfan Tablet kombinasi ANTITUSIF DAN DEKO CISOMPET Tablet 398 398
44 Dektrometorfan Sirup kombinasi ANTITUSIF DAN DEKO CISOMPET Botol 35 35 30 30
45 Devitalisasi Pasta OBAT GIGI CISOMPET Botol 0 0
46 Dextrose Inj 40% ELEKTROLIT CISOMPET Vial 0 0
47 Diazepam Inj 5 mg/ml-2 ml OBAT PSIKOSIS CISOMPET Ampul 8 8
48 Diazepam Rectal 5 mg/2,5 ml OBAT PSIKOSIS CISOMPET tube 9 9
49 Diazepam Tablet 2 mg OBAT PSIKOSIS CISOMPET Tablet 203 203
50 Difenhidramin Inj 10 mg/ml ANTIALERGI dan OBAT CISOMPET Ampul 62 62
51 Digoksin Tablet 0,25 mg ANTIARITMIA CISOMPET Tablet 200 200
52 Dimenhidrinat Tablet 50 mg ANTIEMETIK CISOMPET Tablet 0 0
53 Doksisilin Tablet 100 mg ANTIMALARIA CISOMPET Tablet 0 0
54 Domperidon Suspensi 5mg/5ml ANTIEMETIK CISOMPET Botol 57 57
55 Domperidon Tablet 10 mg ANTIEMETIK CISOMPET Tablet 147 147 100 100
56 Endometason OBAT GIGI CISOMPET Botol 0 0
57 Epinefrina HCl/Bitartrat (Adrenalin) InOBAT untuk SYOK CISOMPET Ampul 8 8
58 Eritromisin Kapsul 250 mg ANTIBAKTERI CISOMPET Kapsul 1200 1200
59 Eritromisin Kapsul 500 mg ANTIBAKTERI CISOMPET Kapsul 0 0
60 Eritromisin Sirup 200 mg/5 ml ANTIBAKTERI CISOMPET Botol 3 3
61 Etakridin Larutan 0,1 % LAIN-LAIN CISOMPET Botol 0 0
62 Etanol 70 %- 1000 ml DESINFEKTAN CISOMPET Botol 3 3
63 Etil Klorida Spray ANASTETIK CISOMPET Botol 0 0
64 Eugenol Cairan OBAT GIGI CISOMPET Botol 0 0 1 1
65 Fenitoin Natrium Kapsul 100 mg OBAT PSIKOSIS CISOMPET Kapsul 285 285
66 Fenobarbital Tablet 30 mg OBAT PSIKOSIS CISOMPET Tablet 67 67
67 Fenoksimetil Penisilin Tablet 500 mg ANTIBAKTERI CISOMPET Tablet 0 0
68 Fitomenadion (Vit K1) Tablet Salut Gu OBAT yang MEMPENGACISOMPET Tablet 299 299
69 Fitomenadion(Vit K1) Inj 2 mg/ml OBAT yang MEMPENGACISOMPET Ampul 101 101
70 Fluconazol Tablet 150 mg IMS CISOMPET Tablet 0 0
71 Flufenazin Inj im 25 mg/ml (Sikzonoat OBAT PSIKOSIS CISOMPET Ampul 0 0
72 Formokresol Cair OBAT GIGI CISOMPET Botol 0 0 1 1
73 Furosemid Tablet 40 mg DIURETIK CISOMPET Tablet 227 227
74 Garam Oralit I Serbuk OBAT untuk DIARE CISOMPET Sachet 60 60 100 100
75 Gentamisin Inj 40 mg/ml (Sulfat) ANTIBAKTERI CISOMPET Vial 65 65
76 Gentamisin Salep Kulit 0,1% ANTIBAKTERI KULIT, MaCISOMPET Tube 61 61
77 Glass Ionomer Cement OBAT GIGI CISOMPET Botol 0 0
78 Glibenklamid Tablet 5 mg ANTIDIABETES CISOMPET Tablet 169 169
79 Gliseril Guaiakolat Tablet 100 mg EKSPEKTORAN dan MUK CISOMPET Tablet 424 424 1000 1000
80 Glukosa Larutan Infus 5% steril ELEKTROLIT CISOMPET Fls 19 19
81 Griseofulvin Tablet 125 mg Micronize ANTIFUNGI CISOMPET Tablet 220 220
82 Haloperidol 5 mg OBAT PSIKOSIS CISOMPET Tablet 560 560 400 400
83 Haloperidol Dekanoat Inj 50 mg/ml OBAT PSIKOSIS CISOMPET Ampul 10 10
84 Haloperidol Inj 5 mg/ml OBAT PSIKOSIS CISOMPET Ampul 0 0
85 Haloperidol Tablet 1,5 mg OBAT PSIKOSIS CISOMPET Tablet 1830 1830
86 Hidrokortison Krim 2,5 % ANTIINFLAMASI dan A CISOMPET Tube 53 53
87 Hiosina butilbromida tab 10 mg 91 CISOMPET Tablet 119 119 300 300
Human Tetanus Imunoglobulin Im

88 250UI (Tetagam) VAKSIN dan SERUM CISOMPET Set 0 0
89 Ibuprofen Tablet 400 mg ANALGESIK NON NARKCISOMPET Tablet 7 7 300 300
90 Isoniazid Tablet 100 mg ANTITUBERKULOSIS CISOMPET Tablet 500 500
91 Isosorbid Dinitrat Tablet Sublingual 5 ANTIANGINA CISOMPET Tablet 70 70
92 Kalsium glukonat inj 100 mg/ml VITAMIN dan MINERALCISOMPET Ampul 0 0 10 10
93 Kalsium hidroksida pasta OBAT GIGI CISOMPET Botol 1 1
94 Kalsium Laktat (Kalk) Tablet 500 mg VITAMIN dan MINERALCISOMPET Tablet 768 768 900 900
95 Kaptropil Tablet 25 mg ANTIHIPERTENSI CISOMPET Tablet 1171 1171
96 Karbamazepin Tablet 200 mg OBAT PSIKOSIS CISOMPET Tablet 0 0 300 300
97 Karbogliserin Tetes Telinga 10 % OBAT untuk TELINGA CISOMPET Botol 22 22
98 Karbon aktif tab 0,5 mg ANTIDOT dan OBAT LACISOMPET Tablet 0 0
99 Ketokonazol Tablet 200 mg ANTIFUNGI CISOMPET Tablet 150 150 150 150
100 Ketoprofen Supp 100 mg ANALGESIK NON NARKCISOMPET Supp 1 1
101 Kina Inj 26 % 2 ml ANTIMALARIA CISOMPET Ampul 0 0
102 Kina Tablet 222 mg ANTIMALARIA CISOMPET Tablet 0 0
103 Klindanmisin Tablet 300 mg IMS CISOMPET Tablet 0 0
104 Kloramfenikol Kapsul 250 mg ANTIBAKTERI CISOMPET Kapsul 0 0
105 Kloramfenikol Kapsul 500 mg ANTIBAKTERI CISOMPET Kapsul 390 390
106 Kloramfenikol Salep Kulit 2% ANTIBAKTERI KULIT, MaCISOMPET Tube 64 64
107 Kloramfenikol Salep Mata 1 % ANTIBAKTERI KULIT, MaCISOMPET Tube 25 25
108 Kloramfenikol Sirup 125 mg/5 ml ANTIBAKTERI CISOMPET Botol 0 0
109 Kloramfenikol Tetes Mata 0.5% ANTIBAKTERI KULIT, MaCISOMPET Botol 80 80
110 Kloramfenikol Tetes telinga 3 % ANTIBAKTERI KULIT, MaCISOMPET Tube 30 30 30 30
111 Klorfenarimin Maleat (CTM) Tablet 4 ANTIALERGI dan OBAT CISOMPET Tablet 1020 1020 1200 1200
112 Klorpropmazin HCl Tablet salut 100 mOBAT PSIKOSIS CISOMPET Tablet 190 190 300 300
113 Kotrimoksazol Susp:Sulf 200+Trim 40 ANTIBAKTERI CISOMPET Botol 33 33
114 Kotrimoksazol Tab Dws:Sulf 400+Trim ANTIBAKTERI CISOMPET Tablet 376 376
Lidokain Inj Komp : Lidokain %+
115 Epinefrin 1 : 80000-2 ml ANASTETIK CISOMPET Ampul 31 31 90 90
116 Lidokain Jelly 2 % ANASTETIK CISOMPET Tube 4 4
117 Lidokain Spray 10 % ANASTETIK CISOMPET Botol 2 2
118 Lisol DESINFEKTAN CISOMPET Botol 4 4
119 Loratadin Tablet 10 mg ANTIALERGI dan OBAT CISOMPET Tablet 289 289 900 900
120 Magnesium sulfat Inj (IV) 20 % ANTIEPILEPSI-ANTIKO CISOMPET Ampul 0 0
121 Magnesium sulfat Inj (IV) 40 % ANTIEPILEPSI-ANTIKO CISOMPET Ampul 0 0
122 MB Anak ANTILEPRA CISOMPET Blister 0 0
123 MB Dewasa ANTILEPRA CISOMPET Blister 6 6
124 Metformin HCl Tablet 500 mg ANTIDIABETES CISOMPET Tablet 750 750
125 Metildopa Tablet 250 mg ANTIHIPERTENSI CISOMPET Tablet 300 300
126 Metilergomatrin Maleat Inj 0,200 mg OKSITOSIK CISOMPET Ampul 128 128
Metilergometrin Maleat
(Metilergometrin) Tablet Salut 0,125
127 mg OKSITOSIK CISOMPET Tablet 198 198
128 Metilprednisolon Tablet 4 mg ANTIALERGI dan OBAT CISOMPET Tablet 840 840
129 Metronidazol Tablet 500 mg ANTIBAKTERI CISOMPET Tablet 151 151 500 500
130 Mikonazol Krim/Salep 2% ANTIFUNGI KULIT CISOMPET Tube 22 22 48 48
131 Mineral Mix SUPLEMEN GIZI CISOMPET Sachet 0 0
132 Monoklorkamfer mentol cairan OBAT GIGI CISOMPET Botol 0 0 1 1
133 Multivitamin + DHA + Lysin Sirup VITAMIN dan MINERALCISOMPET Botol 49 49 30 30
134 Multivitamin + Mineral Kaplet VITAMIN dan MINERALCISOMPET Kaplet 210 210 100 100
135 N-asetil sistein kaps 200 mg EKSPEKTORAN dan MUK CISOMPET Kapsul 920 920
136 Natrium Bikarbonat Tablet 500 mg ANTIDOT dan OBAT LACISOMPET Tablet 880 880
137 Natrium Diklofenak Tablet 50 mg ANALGESIK NON NARKCISOMPET Tablet 286 286 600 600
138 Natrium Hipoklorit 3% OBAT GIGI CISOMPET Botol 0 0 1 1
139 Natrium Klorida Larutan Infus 0,9% ELEKTROLIT CISOMPET Fls 48 48
140 Natrium Tiroksin Tablet 100 µg ANTITIROID CISOMPET Tablet 0 0
141 Nipedipin Tablet 10 mg ANTIHIPERTENSI CISOMPET Tablet 229 229
142 Nistatin Tablet Salut Gula 500.000 IU ANTIFUNGI CISOMPET Tablet 90 90
143 Nistatin Tablet Vaginal 100.000 IU/g ANTIFUNGI CISOMPET Tablet 15 15
144 OAT FDC Katagori 1 ANTITUBERKULOSIS CISOMPET Paket 6 6 5 5
145 OAT FDC Katagori 2 ANTITUBERKULOSIS CISOMPET Paket 3 3
146 OAT FDC Kategori Anak ANTITUBERKULOSIS CISOMPET paket 12 12
147 OAT FDC Kategori Sisipan ANTITUBERKULOSIS CISOMPET Paket 0 0
148 OAT Kombipak Kat I ANTITUBERKULOSIS CISOMPET paket 0 0
149 Obat Batuk Hitam (OBH) Cairan EKSPEKTORAN dan MUK CISOMPET Botol 55 55 50 50
150 Oksitosin Inj 10 IU/ml- 1 ml OKSITOSIK CISOMPET Ampul 99 99 200 200
151 Omeprazol Kapsul 20 mg ANTIULKUS CISOMPET Kapsul 150 150 600 600
152 Ondansetron Inj 4 mg/2 ml ANTIEMETIK CISOMPET Ampul 70 70
153 Parasetamol Sirup 120 mg / 5ml ANALGESIK NON NARKCISOMPET Botol 213 213 100 100
154 Parasetamol Tablet 500 mg ANALGESIK NON NARKCISOMPET Tablet 5290 5290
155 PB Anak ANTILEPRA CISOMPET Blister 0 0
156 PB Dewasa ANTILEPRA CISOMPET Blister 0 0
157 Permetrin 5% Krim (Scabimite) ANTISKABIES CISOMPET Tube 14 14 20 20
Phenolphtalein, Paraffin Liquidum,
158 Gliserin Sirup (Laxadin syr) KATARTIKA CISOMPET botol 30 30
159 Piridoksin HCl (Vit B6) Tablet 10 mg VITAMIN dan MINERALCISOMPET Tablet 1400 1400 1000 1000
160 Pirimetamin Tablet 25 mg ANTIBIOTIK CISOMPET Tablet 0 0
161 Polikresulen (Albotyl) Botol 5 ml ANTISEPTIK CISOMPET botol 12 12
162 Povidon Iodida 10 %-30 ml ANTISEPTIK CISOMPET Botol 12 12 2 2
163 Povidon Iodida 10 %-300 ml ANTISEPTIK CISOMPET Botol 4 4
164 Prednison Tablet 5 mg ANTIALERGI dan OBAT CISOMPET Tablet 680 680 100 100
165 Primakuin Tablet 15 mg ANTIMALARIA CISOMPET Tablet 0 0
Prokain Benzilpenisilin Serb Inj 3 juta
166 UI/vial (i.m.) ANTIBAKTERI CISOMPET Vial 0 0
167 Propanolol HCl Tablet 40 mg ANTIARITMIA CISOMPET Tablet 100 100
168 Propiltiourasil Tablet 100 mg ANTITIROID CISOMPET Tablet 0 0
169 Ranitidin Inj 25 mg/ml ANTIULKUS CISOMPET Ampul 95 95
170 Ranitidin Tablet 150 mg ANTIULKUS CISOMPET Tablet 972 972 600 600
171 Retinol (Vit A) Kapsul 100.000 IU VITAMIN dan MINERALCISOMPET Kapsul 0 0 650 650
172 Retinol (VIT A) Kapsul 200.000 IU VITAMIN dan MINERALCISOMPET Kapsul 957 957 4000 4000
173 Ringer Laktat Larutan Infus Steril ELEKTROLIT CISOMPET Fls 240 240 100 100
174 Risperidon Tablet 2 mg OBAT PSIKOSIS CISOMPET Tablet 55 55
175 Salbutamol Nebu 2,5 mg/2,5 ml NaCl ANTIASMA CISOMPET Ampul 30 30
176 Salbutamol Tablet 4 mg ANTIASMA CISOMPET Tablet 77 77 400 400
177 Salep 2-4 kombinasi : as.asal 2 % + BelANTISKABIES CISOMPET Pot 37 37
178 Salisil Bedak 2 % LAIN-LAIN CISOMPET Kotak 0 0 50 50
179 Sefadroksil Sirup 125 mg/5 ml ANTIBAKTERI CISOMPET Botol 17 17
180 Sefadroxil Kapsul 500 mg ANTIBAKTERI CISOMPET Kapsul 865 865 300 300
181 Sefiksime 200 mg + Azitromisin 500 mIMS CISOMPET Paket 0 0
182 Sefotaksim Inj 1 g ANTIBAKTERI CISOMPET Vial 20 20
183 Seftriaxon Inj 1 g ANTIBAKTERI CISOMPET Vial 5 5
184 Semen seng fosfat serbuk cairan OBAT GIGI CISOMPET Botol 0 0 1 1
185 Serum Anti Difteri (ADS) VAKSIN dan SERUM CISOMPET Vial 0 0
186 Serum anti tetanus Inj 1500 IU/vial (A VAKSIN dan SERUM CISOMPET Ampul 2 2
187 Serum antibisa ular Polivalen Inj 5 ml VAKSIN dan SERUM CISOMPET Vial 12 12
188 Setirizin Sirup 5 mg/5 ml ANTIHISTAMIN CISOMPET Botol 158 158 60 60
189 Sianokobalamin (Vit B12 ) Inj 500 mcgVITAMIN dan MINERALCISOMPET Ampul 195 195
190 Simvastatin Tablet 10 mg ANTIHIPERLIPIDEMIA CISOMPET Tablet 60 60 90 90
191 Siprofloksasin (HCl) Tablet 500 mg ANTIBAKTERI CISOMPET Kaplet 608 608
192 Tablet Tambah Darah (Camabion) ANTIANEMI CISOMPET Buah 0 0
193 Tablet Tambah Darah Kombinasi ANTIANEMI CISOMPET Tablet 15620 15620
194 Temporary Restorative Material OBAT GIGI CISOMPET Botol 0 0
195 Tetrasiklin Kapsul 500 mg ANTIBAKTERI CISOMPET Kapsul 150 150
196 Tiamin HCL (Vit B1) Tablet 50 mg VITAMIN dan MINERALCISOMPET Tablet 2650 2650
197 Triheksifenidil HCl Tablet 2 mg OBAT PSIKOSIS CISOMPET Tablet 417 417 200 200
198 Vaksin BCG + Pelarut VAKSIN dan SERUM CISOMPET Set 58 58
199 Vaksin DPT-Hb-Hib VAKSIN dan SERUM CISOMPET Vial 139 139 10 10
200 Vaksin DT VAKSIN dan SERUM CISOMPET Vial 78 78
201 Vaksin Hb-0 VAKSIN dan SERUM CISOMPET Set 136 136
202 Vaksin IPV 10 ds VAKSIN dan SERUM CISOMPET Vial 0 0
203 Vaksin IPV 5 ds VAKSIN dan SERUM CISOMPET Vial 26 26
204 Vaksin Measles Rubella (MR) VAKSIN dan SERUM CISOMPET Vial 45 45 30 30
205 Vaksin Meningitis VAKSIN dan SERUM CISOMPET Paket 0 0
206 Vaksin Papillomavirus (HPV) VAKSIN dan SERUM CISOMPET Vial 0 0
207 Vaksin Pneumococcus VAKSIN dan SERUM CISOMPET Vial 0 0
208 Vaksin Polio 10 ds bopv + Penetes VAKSIN dan SERUM CISOMPET Set 24 24 50 50
209 Vaksin Rabies Vero VAKSIN dan SERUM CISOMPET Set 12 12
210 Vaksin Td VAKSIN dan SERUM CISOMPET Vial 504 504
211 Vitamin B Kompleks Tablet VITAMIN dan MINERALCISOMPET Tablet 2036 2036
212 Zinc Tablet 20 mg OBAT untuk DIARE CISOMPET Tablet 1156 1156 1000 1000
BAHAN HABIS PAKAI 0 0
213 ADS 0.05 ml BAHAN HABIS PAKAI CISOMPET Buah 124 124
214 ADS 0.5 ml BAHAN HABIS PAKAI CISOMPET Buah 965 965 600 600
215 ADS 5 ml BAHAN HABIS PAKAI CISOMPET Buah 115 115
216 Alat Suntik Sekali Pakai 1ml BAHAN HABIS PAKAI CISOMPET Set 621 621
217 Alat Suntik Sekali Pakai 3 ml BAHAN HABIS PAKAI CISOMPET Set 593 593
218 Alat Suntik Sekali Pakai 5 ml BAHAN HABIS PAKAI CISOMPET Set 0 0
219 Alkohol Swab BAHAN HABIS PAKAI CISOMPET Buah 0 0
220 Bisturi BAHAN HABIS PAKAI CISOMPET Buah 21 21
221 Blood set BAHAN HABIS PAKAI CISOMPET Buah 0 0
Catgut/Benang Bedah No.2/0
222 dengan jarum bedah BAHAN HABIS PAKAI CISOMPET Set 16 16 24 24
Catgut/Benang Bedah No.3/0
223 dengan jarum bedah BAHAN HABIS PAKAI CISOMPET Set 0 0
224 Folley Catheter No.18 BAHAN HABIS PAKAI CISOMPET Buah 5 5
225 Infusion set anak BAHAN HABIS PAKAI CISOMPET Kantong 108 108
226 Infusion set dewasa BAHAN HABIS PAKAI CISOMPET Kantong 119 119
227 IV Catheter No.18 BAHAN HABIS PAKAI CISOMPET Set 20 20
231 Jarum kulit BAHAN HABIS PAKAI CISOMPET Buah 22 22
232 Jarum otot BAHAN HABIS PAKAI CISOMPET Buah 22 22
233 Kaca Slide BAHAN HABIS PAKAI CISOMPET Buah 142 142
234 Kantung mayat BAHAN HABIS PAKAI CISOMPET Buah 0 0
235 Kapas Pembalut/absorben 250 mg BAHAN HABIS PAKAI CISOMPET Roll 2 2 2 2
236 Kasa Hidrofil 2x80 BAHAN HABIS PAKAI CISOMPET Roll 25 25
237 Kasa Hidrofil Steril 16 X 16 BAHAN HABIS PAKAI CISOMPET Lembar 259 259
238 Kasa Pembalut Hidrofil 4 X 10 cm BAHAN HABIS PAKAI CISOMPET Roll 130 130
239 Kasa Pembalut hidrofil 4 x 5 cm BAHAN HABIS PAKAI CISOMPET Roll 19 19 10 10
240 Kassa Pembalut elastic 4 inchi BAHAN HABIS PAKAI CISOMPET Roll 14 14 5 5
241 Masker Tie on BAHAN HABIS PAKAI CISOMPET Buah 250 250
242 Masker N-95 BAHAN HABIS PAKAI CISOMPET Buah 0 0
243 Plester 5 yard x 2 inch BAHAN HABIS PAKAI CISOMPET Roll 3 3 4 4
244 Polybag Medis BAHAN HABIS PAKAI CISOMPET Lembar 0 0
245 Polybag Nonmedis BAHAN HABIS PAKAI CISOMPET Lembar 0 0
246 Polybag Ramah Lingkungan BAHAN HABIS PAKAI CISOMPET Lembar 0 0
247 Pot Dahak BAHAN HABIS PAKAI CISOMPET Buah 380 380
248 Safety box BAHAN HABIS PAKAI CISOMPET Buah 138 138
249 Sarung Tangan Non Steril Uk.S BAHAN HABIS PAKAI CISOMPET Buah 0 0
250 Sarung Tangan Non Steril Uk.M BAHAN HABIS PAKAI CISOMPET Buah 0 0
251 Sarung Tangan Non Steril Uk.L BAHAN HABIS PAKAI CISOMPET Buah 0 0
252 Sarung Tangan Steril No.6 BAHAN HABIS PAKAI CISOMPET Set 0 0
253 Sarung Tangan Steril No.6,5 BAHAN HABIS PAKAI CISOMPET Set 82 82
254 Sarung Tangan Steril No.7 BAHAN HABIS PAKAI CISOMPET Set 0 0
255 Sendok Obat BAHAN HABIS PAKAI CISOMPET Buah 37 37 200 200
Silk (Benang Bedah Sutera) No.2/0

256 Dengan Jarum Bedah BAHAN HABIS PAKAI CISOMPET Set 69 69
257 Urin Bag BAHAN HABIS PAKAI CISOMPET Buah 11 11
258 REAGEN CISOMPET 0 0
259 Cybow 10 Reagent Strip REAGEN CISOMPET Set 0 0
260 Golongan darah anti A - 10 ml REAGEN CISOMPET Botol 3 3
261 Golongan darah anti A-B - 10 ml REAGEN CISOMPET Botol 3 3
262 Golongan darah anti B - 10 ml REAGEN CISOMPET Botol 3 3
263 Humasens Plus REAGEN CISOMPET Set 0 0
264 Humasens Plus Strip Uric Acid REAGEN CISOMPET Kotak 51 51
265 Humasens Strip Glucose REAGEN CISOMPET Kotak 51 51
266 Humasens Strip Kolesterol REAGEN CISOMPET Kotak 21 21
267 Iodin test REAGEN CISOMPET Botol 8 8
268 Larutan Asam Asetat 6% 100 ml REAGEN CISOMPET Botol 0 0
269 Larutan Benedict 100 ml REAGEN CISOMPET Botol 0 0
270 Larutan EDTA 10 % 100 ml REAGEN CISOMPET Botol 0 0
271 Larutan HCl 0,1 N 100 ml REAGEN CISOMPET Botol 0 0
272 Larutan Natrium Citrat 3,13 % REAGEN CISOMPET Botol 0 0
273 Larutan Rees Ecker 100 ml REAGEN CISOMPET Botol 0 0
274 Larutan Turk 100 ml REAGEN CISOMPET Botol 0 0
275 Larutan Ziehl Neelsen REAGEN CISOMPET Botol 15 15
276 Rapid HIV 1/2 Device REAGEN CISOMPET test 0 0
277 Rapid HIV 2 Fokus REAGEN CISOMPET test 0 0
278 Rapid HIV Biomedika REAGEN CISOMPET Sachet 0 0
279 Rapid HIV Biomeriux REAGEN CISOMPET Sachet 25 25
280 Rapid HIV Intec REAGEN CISOMPET Sachet 0 0
281 Rapid HIV Oncoprobe REAGEN CISOMPET Sachet 0 0
282 Rapid HIV SD REAGEN CISOMPET Sachet 1100 1100
283 Rapid Malaria REAGEN CISOMPET Sachet 0 0
284 Rapid Syphilis SD REAGEN CISOMPET Sachet 100 100
285 Reagen CD4 kontrol REAGEN CISOMPET test 0 0
286 Reagen CD4 tipe 1 (Alere Pima CD4) REAGEN CISOMPET test 0 0
287 RPR Syphilis REAGEN CISOMPET Sachet 0 0
288 Salmonella Thyphi H - 5 ml REAGEN CISOMPET Botol 0 0
289 Salmonella Thyphi O - 5 ml REAGEN CISOMPET Botol 0 0
290 Test Kehamilan BAHAN HABIS PAKAI CISOMPET Buah 0 0
LAIN-LAIN 0 0
291 Tiamin HCL (Vit B1) Inj 100 mg/ml-1mlVITAMIN dan MINERALCISOMPET Ampul 105 105
BARANG PKM
292 Amlodipine 10 mg Antihipertensi CISOMPET Blister 1736 1736
293 Ambroxol syr Mukolitik CISOMPET Botol 64 64
294 Mucus Extractor 110 110
295 Gel USG 250 mL 47 47
296 Oxygen Mask Dewasa 69 69
297 Oxygen Mask Anak 69 69
298 Oxygen mask bayi 70 70
299 Sarung Tangan Non Steril Uk.S 100 100
300 Sarung Tangan Non Steril Uk.M 3000 3000
301 Sarung tangan obgyn steril 56 56
302 Kassa Hidrofil DRC 36 m x 80 cm 0 0
303 Parasetamol Infus 288 288
304 Amoxicillin syr 250 mg 889 889
ESMAS CISOMPET BULAN JANUARI 2019
SISA STOK ( KARTU

PENYALURAN BARANG ) SELISIH
KEADAAN
PERSEDIA NON JKN/ NON JKN/
JKN/B JKN/B FISIK KET
AN NON TOTAL NON TOTAL
LUD LUD BARANG ( + ) ( - )
BLUD BLUD
460 10 10 450 450 450

540 204 204 336 336 336
0 0 0 0 0 0
0 0 0 0 0 0
250 0 0 250 250 250
355 247 247 108 108 108
3705 2048 2048 1657 1657 1657
309 78 78 231 231 231
4980 2925 2925 2055 2055 2055
106 64 64 42 42 42
23 0 0 23 23 23
39 0 0 39 39 39
58 33 33 25 25 25
155 38 38 117 117 117
33 4 4 29 29 29
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
261 5 5 256 256 256
190 65 65 125 125 125
11540 2760 2760 8780 8780 8780
2610 2040 2040 570 570 570
26 2 2 24 24 24
196 12 12 184 184 184
612 261 261 351 351 351
30 14 14 16 16 16
0 0 0 0 0 0
16 0 0 16 16 16
121 1 1 120 120 120
79 35 35 44 44 44
68 4 4 64 64 64
1500 130 130 1370 1370 1370
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
23 10 10 13 13 13
1324 687 687 637 637 637
398 398 398 0 0 0
65 65 65 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
8 0 0 8 8 8
9 2 2 7 7 7
203 18 18 185 185 185
62 10 10 52 52 52
200 0 0 200 200 200
0 0 0 0 0 0
0 0 0 0 0 0
57 9 9 48 48 48
247 104 104 143 143 143
0 0 0 0 0 0
8 0 0 8 8 8
1200 10 10 1190 1190 1190
0 0 0 0 0 0
3 0 0 3 3 3
0 0 0 0 0 0
3 0 0 3 3 3
0 0 0 0 0 0
1 1 1 0 0 0
285 90 90 195 195 195
67 0 0 67 67 67
0 0 0 0 0 0
299 16 16 283 283 283
101 5 5 96 96 96
0 0 0 0 0 0
0 0 0 0 0 0
1 1 1 0 0 0
227 65 65 162 162 162
160 103 103 57 57 57
65 15 15 50 50 50
61 17 17 44 44 44
0 0 0 0 0 0
169 40 40 129 129 129
1424 887 887 537 537 537
19 19 19 0 0 0
220 182 182 38 38 38
960 560 560 400 400 400
10 0 0 10 10 10
0 0 0 0 0 0
1830 0 0 1830 1830 1830
53 30 30 23 23 23
419 259 259 160 160 160
0 0 0 0 0 0
307 236 236 71 71 71
500 0 0 500 500 500
70 10 10 60 60 60
10 0 0 10 10 10
1 1 1 0 0 0
1668 1050 1050 618 618 618
1171 922 922 249 249 249
300 30 30 270 270 270
22 3 3 19 19 19
0 0 0 0 0 0
300 153 153 147 147 147
1 1 1 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
390 212 212 178 178 178
64 12 12 52 52 52
25 19 19 6 6 6
0 0 0 0 0 0
80 40 40 40 40 40
60 23 23 37 37 37
2220 1169 1169 1051 1051 1051
490 265 265 225 225 225
33 15 15 18 18 18
376 20 20 356 356 356
121 51 51 70 70 70
4 0 0 4 4 4
2 0 0 2 2 2
4 0 0 4 4 4
1189 524 524 665 665 665
0 0 0 0 0 0
0 12 12 28 28 28
0 0 0 0 0 0
6 1 1 5 5 5
750 230 230 520 520 520
300 20 20 280 280 280
128 128 128 0 0 0 ED
198 136 136 62 62 62

840 560 560 280 280 280
651 240 240 411 411 411
70 38 38 32 32 32
0 0 0 0 0 0
1 1 1 0 0 0
79 53 53 26 26 26
310 100 100 210 210 210
920 330 330 590 590 590
880 335 335 545 545 545
886 446 446 440 440 440
1 1 1 0 0 0
48 3 3 45 45 45
0 0 0 0 0 0
229 0 0 229 229 229
90 40 40 50 50 50
15 3 3 12 12 12
11 8 8 3 3 3
3 0 0 3 3 3
12 3 3 9 9 9
0 0 0 0 0 0
0 0 0 0 0 0
105 37 37 68 68 68
299 10 10 289 289 289
750 325 325 425 425 425
70 38 38 32 32 32
313 170 170 143 143 143
5290 3941 3941 1349 1349 1349
0 0 0 0 0 0
0 0 0 0 0 0
34 15 15 19 19 19
30 0 0 30 30 30
2400 1870 1870 530 530 530
0 0 0 0 0 0
12 0 0 12 12 12
14 11 11 3 3 3
4 2 2 2 2 2
780 465 465 315 315 315
0 0 0 0 0 0
0 0 0 0 0 0
100 0 0 100 100 100
0 0 0 0 0 0
95 91 91 4 4 4
1572 880 880 692 692 692
650 0 0 650 650 650
4957 50 50 4907 4907 4907
340 240 240 100 100 100
55 30 30 25 25 25
30 9 9 21 21 21
477 237 237 240 240 240
37 29 29 8 8 8
50 13 13 37 37 37
17 3 3 14 14 14
1165 821 821 344 344 344
0 0 0 0 0 0
20 0 0 20 20 20
5 0 0 5 5 5
1 1 1 0 0 0
0 0 0 0 0 0
2 0 0 2 2 2
12 3 3 9 9 9
218 12 12 206 206 206
195 0 0 195 195 195
150 80 80 70 70 70
608 35 35 573 573 573
0 0 0 0 0 0
15620 1310 1310 14310 14310 14310
0 0 0 0 0 0
150 10 10 140 140 140
2650 1916 1916 734 734 734
617 610 610 7 7 7
58 51 51 7 7 7
149 83 83 66 66 66
78 16 16 62 62 62
136 126 126 10 10 10
0 0 0 0 0 0
26 24 24 2 2 2
75 60 60 15 15 15
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
74 68 68 6 6 6
12 1 1 11 11 11
504 72 72 432 432 432
2036 1110 1110 926 926 926
2156 435 435 1721 1721 1721
0 0 0 0 0 0
124 67 67 57 57 57
1565 410 410 1155 1155 1155
115 52 52 63 63 63
621 237 237 384 384 384
593 214 214 379 379 379
0 0 0 0 0 0
0 0 0 0 0 0
21 13 13 8 8 8
0 0 0 0 0 0
40 20 20 20 20 20
0 0 0 0 0 0
5 5 5 0 0 0
108 8 8 100 100 100
119 72 72 47 47 47
20 20 20 0 0 0
65 65 65 0 0 0
86 1 1 85 85 85
237 28 28 209 209 209
22 0 0 22 22 22
22 0 0 22 22 22
142 0 0 142 142 142
0 0 0 0 0 0
4 0 0 4 4 4
25 15 15 10 10 10
259 12 12 247 247 247
130 10 10 120 120 120
29 21 21 8 8 8
19 1 1 18 18 18
250 150 150 100 100 100
0 0 0 0 0 0
7 3 3 4 4 4
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
380 300 300 80 80 80
138 0 0 138 138 138
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
82 13 13 69 69 69
0 0 0 0 0 0
237 207 207 30 30 30
69 33 33 36 36 36
11 6 6 5 5 5
0 0 0 0 0 0
0 0 0 0 0 0
3 0 0 3 3 3
3 0 0 3 3 3
3 0 0 3 3 3
0 0 0 0 0 0
51 0 0 51 51 51
51 0 0 51 51 51
21 0 0 21 21 21
8 0 0 8 8 8
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
15 0 0 15 15 15
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
25 0 0 25 25 25
0 0 0 0 0 0
0 0 0 0 0 0
1100 0 0 1100 1100 1100
0 0 0 0 0 0
100 0 0 100 100 100
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
105 0 0 105 105 105
0
1736 93 93 1643 1643 1643
64 1 1 63 63 63
110 10 10 100 100 100
47 8 8 39 39 39
69 27 27 42 42 42
69 0 0 69 69 69
70 0 0 70 70 70
100 0 0 100 100 100
3000 0 0 3000 3000 3000
56 4 4 52 52 52
0 0 0 0 0 0
288 0 0 288 288 288
889 23 23 866 866 866
DAFTAR LAMPIRAN BERITA ACARA STOCK OPNAME OBAT PUSKESMAS CISOMPET BULAN FEBRUARI 2019
STOK AWAL FEBRUARI 2019 PENERIMAAN PENYALURAN
NON JKN/ NON JKN/ PERSEDIA NON JKN/

No NAMA OBAT SATUAN AN
JKN/BLUD NON TOTAL JKN/BLUD NON TOTAL JKN/BLUD NON
BLUD BLUD BLUD
1 Albendazol Tablet 400 mg Tablet 450 450 12000 12000 12450 0

2 Alopurinol Tablet 100 mg Tablet 336 336 200 200 536 88
3 Aminofilin Inj 24 mg/ml-10 ml Ampul 0 0 0 0 0 0
4 Aminofilin Tablet 200 mg Tablet 0 0 0 0 0 0
5 Amitriptilina HCl Tablet salut 25 mg Tablet 250 250 0 0 250 0
6 Amlodipin Tablet 5 mg Tablet 108 108 300 300 408 233
7 Amoksisilin Kaplet 500 mg Kaplet 1657 1657 2500 2500 4157 1983
8 Amoksisilin Sirup Kering 125 mg/5 ml Botol 231 231 60 60 291 53
9 Antasida DOEN I Tablet Kunyah Tablet 2055 2055 3000 3000 5055 2510
10 Antasida II Suspensi 60 ml Botol 42 42 50 50 92 73
11 Anti Hemmoroid DOEN Supp 23 23 0 0 23 12
12 Antibakteri DOEN Tube 39 39 0 0 39 2
13 Antifungi DOEN kombinasi Pot 25 25 24 24 49 1
14 Antimigren DOEN Tablet 117 117 0 0 117 23
15 Aqua Pro Inj steril bebas pirogen- 20 ml Vial 29 29 0 0 29 7
16 ARV: Efavirenz 600 mg Tablet 0 0 0 0 0 0
17 ARV: Lamivudine 150 mg Tablet 0 0 0 0 0 0
18 ARV: Lovinapir 200 mg Ronavir Tablet 0 0 0 0 0 0
19 ARV: Nevirapine 200 mg Tablet 0 0 0 0 0 0
20 ARV: TDF(300) + 3TC(300) + EFV(600) Tablet 0 0 0 0 0 0
21 ARV: Tenofovir 300 mg Tablet 0 0 0 0 0 0
22 ARV: Zdvdn(60) + Lmvdn(30) + Nvrpn(50) Tablet 0 0 0 0 0 0
23 ARV: Zidovudine(300) + Lamivudine(150) Tablet 0 0 0 0 0 0
24 Asam Asetilsalisilat Tablet 80 mg (Asetosal) Tablet 256 256 0 0 256 10
25 Asam Askorbat (VIT C) Tablet 50 mg Tablet 125 125 300 300 425 315
26 Asam Folat Tablet 0,4 mg Tablet 8780 8780 0 0 8780 2880
27 Asam Mefenamat kaplet 500 mg Tablet 570 570 3000 3000 3570 1100
28 Asiklovir Krim 5%/5g Tube 24 24 25 25 49 2
29 Asiklovir Tablet 400 mg Tablet 184 184 200 200 384 121
30 Atapulgit Tablet 600 mg Tablet 351 351 200 200 551 164
31 Atropin Sulfat Inj 0,25 mg/ml Ampul 16 16 0 0 16 0
32 Azithromisin Tablet 500 mg Tablet 0 0 0 0 0 0
33 Benzatin Benzil Penisilin Inj 2,4 juta IU/vial Vial 16 16 0 0 16 0
34 Betahistin Tablet 6 mg Tablet 120 120 0 0 120 39
35 Betametason Krim 0.1 % Tube 44 44 25 25 69 34
36 Bisoprolol Tablet 5 mg Tablet 64 64 0 0 64 0
37 Bromheksin Tablet 8 mg Tablet 1370 1370 0 0 1370 610
38 Clobazam Tablet 10 mg Tablet 0 0 0 0 0 0
39 Clozapine Tablet 25 mg Tablet 0 0 0 0 0 0
40 Dehidroartemisin 40 mg + Piperaquin 320 mPaket 0 0 0 0 0 0
41 Deksametason Inj 5 mg/ml-1 ml Ampul 13 13 20 20 33 6
42 Deksametason Tablet 0,5 mg Tablet 637 637 1000 1000 1637 711
43 Dekstrometorfan Tablet kombinasi Tablet 0 0 600 600 600 576
44 Dektrometorfan Sirup kombinasi Botol 0 0 30 30 30 30
45 Devitalisasi Pasta Botol 0 0 0 0 0 0
46 Dextrose Inj 40% Vial 0 0 0 0 0 0
47 Diazepam Inj 5 mg/ml-2 ml Ampul 8 8 0 0 8 0
48 Diazepam Rectal 5 mg/2,5 ml tube 7 7 0 0 7 4
49 Diazepam Tablet 2 mg Tablet 185 185 0 0 185 8
50 Difenhidramin Inj 10 mg/ml Ampul 52 52 0 0 52 5
51 Digoksin Tablet 0,25 mg Tablet 200 200 0 0 200 0
52 Dimenhidrinat Tablet 50 mg Tablet 0 0 0 0 0 0
53 Doksisilin Tablet 100 mg Tablet 0 0 0 0 0 0
54 Domperidon Suspensi 5mg/5ml Botol 48 48 0 0 48 3
55 Domperidon Tablet 10 mg Tablet 143 143 100 100 243 223
56 Endometason Botol 0 0 0 0 0 0

No NAMA OBAT SATUAN
JKN/BLUD NON TOTAL JKN/BLUD NON TOTAL AN JKN/BLUD NON
BLUD BLUD BLUD
57 Epinefrina HCl/Bitartrat (Adrenalin) Inj 0,1 %Ampul 8 8 0 0 8 0

58 Eritromisin Kapsul 250 mg Kapsul 1190 1190 0 0 1190 30
60 Eritromisin Sirup 200 mg/5 ml Botol 3 3 0 0 3 0
61 Etakridin Larutan 0,1 % Botol 0 0 0 0 0 0
62 Etanol 70 %- 1000 ml Botol 3 3 0 0 3 0
63 Etil Klorida Spray Botol 0 0 0 0 0 0
64 Eugenol Cairan Botol 0 0 0 0 0 0
65 Fenitoin Natrium Kapsul 100 mg Kapsul 195 195 100 100 295 120
66 Fenobarbital Tablet 30 mg Tablet 67 67 0 0 67 0
67 Fenoksimetil Penisilin Tablet 500 mg Tablet 0 0 0 0 0 0
68 Fitomenadion (Vit K1) Tablet Salut Gula 10 Tablet 283 283 0 0 283 30
69 Fitomenadion(Vit K1) Inj 2 mg/ml Ampul 96 96 0 0 96 1
70 Fluconazol Tablet 150 mg Tablet 0 0 0 0 0 0
71 Flufenazin Inj im 25 mg/ml (Sikzonoate) Ampul 0 0 0 0 0 0
72 Formokresol Cair Botol 0 0 0 0 0 0
73 Furosemid Tablet 40 mg Tablet 162 162 0 0 162 51
74 Garam Oralit I Serbuk Sachet 57 57 100 100 157 51
75 Gentamisin Inj 40 mg/ml (Sulfat) Vial 50 50 0 0 50 0
76 Gentamisin Salep Kulit 0,1% Tube 44 44 0 0 44 15
77 Glass Ionomer Cement Botol 0 0 0 0 0 0
78 Glibenklamid Tablet 5 mg Tablet 129 129 0 0 129 10
79 Gliseril Guaiakolat Tablet 100 mg Tablet 537 537 1000 1000 1537 935
80 Glukosa Larutan Infus 5% steril Fls 0 0 20 20 20 5
81 Griseofulvin Tablet 125 mg Micronized Tablet 38 38 300 300 338 60
82 Haloperidol 5 mg Tablet 400 400 600 600 1000 560
83 Haloperidol Dekanoat Inj 50 mg/ml Ampul 10 10 0 0 10 0
84 Haloperidol Inj 5 mg/ml Ampul 0 0 0 0 0 0
85 Haloperidol Tablet 1,5 mg Tablet 1830 1830 0 0 1830 0
86 Hidrokortison Krim 2,5 % Tube 23 23 0 0 23 17
87 Hiosina butilbromida tab 10 mg Tablet 160 160 300 300 460 46
Human Tetanus Imunoglobulin Im 250UI
88 (Tetagam) Set 0 0 0 0 0 0
89 Ibuprofen Tablet 400 mg Tablet 71 71 300 300 371 371
90 Isoniazid Tablet 100 mg Tablet 500 500 0 0 500 0
91 Isosorbid Dinitrat Tablet Sublingual 5 mg Tablet 60 60 0 0 60 0
92 Kalsium glukonat inj 100 mg/ml Ampul 10 10 0 0 10 0
93 Kalsium hidroksida pasta Botol 0 0 0 0 0 0
94 Kalsium Laktat (Kalk) Tablet 500 mg Tablet 618 618 1500 1500 2118 814
95 Kaptropil Tablet 25 mg Tablet 249 249 1500 1500 1749 542
96 Karbamazepin Tablet 200 mg Tablet 270 270 100 100 370 90
97 Karbogliserin Tetes Telinga 10 % Botol 19 19 0 0 19 5
98 Karbon aktif tab 0,5 mg Tablet 0 0 0 0 0 0
99 Ketokonazol Tablet 200 mg Tablet 147 147 200 200 347 107
100 Ketoprofen Supp 100 mg Supp 0 0 0 0 0 0
101 Kina Inj 26 % 2 ml Ampul 0 0 0 0 0 0
102 Kina Tablet 222 mg Tablet 0 0 0 0 0 0
103 Klindanmisin Tablet 300 mg Tablet 0 0 0 0 0 0
104 Kloramfenikol Kapsul 250 mg Kapsul 0 0 0 0 0 0
106 Kloramfenikol Salep Kulit 2% Tube 52 52 0 0 52 0
107 Kloramfenikol Salep Mata 1 % Tube 6 6 24 24 30 12
108 Kloramfenikol Sirup 125 mg/5 ml Botol 0 0 20 20 20 0
109 Kloramfenikol Tetes Mata 0.5% Botol 40 40 50 50 90 26
110 Kloramfenikol Tetes telinga 3 % Tube 37 37 0 0 37 14
111 Klorfenarimin Maleat (CTM) Tablet 4 mg Tablet 1051 1051 1500 1500 2551 539
112 Klorpropmazin HCl Tablet salut 100 mg Tablet 225 225 300 300 525 320
113 Kotrimoksazol Susp:Sulf 200+Trim 40 mg/5 Botol 18 18 50 50 68 28
114 Kotrimoksazol Tab Dws:Sulf 400+Trim 80 mgTablet 356 356 0 0 356 56

No NAMA OBAT SATUAN
BLUD BLUD BLUD
Lidokain Inj Komp : Lidokain %+ Epinefrin

115 1 : 80000-2 ml Ampul 70 70 30 30 100 30
116 Lidokain Jelly 2 % Tube 4 4 0 0 4 3
117 Lidokain Spray 10 % Botol 2 2 0 0 2 1
118 Lisol Botol 4 4 0 0 4 0
119 Loratadin Tablet 10 mg Tablet 665 665 300 300 965 526
120 Magnesium sulfat Inj (IV) 20 % Ampul 0 0 0 0 0 0
122 MB Anak Blister 0 0 0 0 0 0
123 MB Dewasa Blister 5 5 0 0 5 1
124 Metformin HCl Tablet 500 mg Tablet 520 520 0 0 520 260
125 Metildopa Tablet 250 mg Tablet 280 280 0 0 280 10
126 Metilergomatrin Maleat Inj 0,200 mg Ampul 0 0 100 100 100 0
Metilergometrin Maleat (Metilergometrin)

127 Tablet Salut 0,125 mg Tablet 62 62 200 200 262 36
128 Metilprednisolon Tablet 4 mg Tablet 280 280 700 700 980 186
129 Metronidazol Tablet 500 mg Tablet 411 411 100 100 511 80
130 Mikonazol Krim/Salep 2% Tube 32 32 24 24 56 38
131 Mineral Mix Sachet 0 0 0 0 0 0
132 Monoklorkamfer mentol cairan Botol 0 0 0 0 0 0
133 Multivitamin + DHA + Lysin Sirup Botol 28 28 30 30 58 58
134 Multivitamin + Mineral Kaplet Kaplet 210 210 100 100 310 90
135 N-asetil sistein kaps 200 mg Kapsul 590 590 0 0 590 40
136 Natrium Bikarbonat Tablet 500 mg Tablet 545 545 100 100 645 46
137 Natrium Diklofenak Tablet 50 mg Tablet 440 440 400 400 840 384
138 Natrium Hipoklorit 3% Botol 0 0 0 0 0 0
139 Natrium Klorida Larutan Infus 0,9% Fls 45 45 0 0 45 5
140 Natrium Tiroksin Tablet 100 µg Tablet 0 0 0 0 0 0
141 Nipedipin Tablet 10 mg Tablet 229 229 0 0 229 0
142 Nistatin Tablet Salut Gula 500.000 IU/g Tablet 50 50 50 50 100 10
143 Nistatin Tablet Vaginal 100.000 IU/g Tablet 12 12 30 30 42 10
144 OAT FDC Katagori 1 Paket 3 3 15 15 18 6
146 OAT FDC Kategori Anak paket 9 9 5 5 14 0
147 OAT FDC Kategori Sisipan Paket 0 0 0 0 0 0
148 OAT Kombipak Kat I paket 0 0 0 0 0 0
149 Obat Batuk Hitam (OBH) Cairan Botol 68 68 100 100 168 37
150 Oksitosin Inj 10 IU/ml- 1 ml Ampul 289 289 0 0 289 0
151 Omeprazol Kapsul 20 mg Kapsul 425 425 150 150 575 471
152 Ondansetron Inj 4 mg/2 ml Ampul 32 32 40 40 72 41
153 Parasetamol Sirup 120 mg / 5ml Botol 143 143 150 150 293 192
154 Parasetamol Tablet 500 mg Tablet 1349 1349 6000 6000 7349 3659
155 PB Anak Blister 0 0 0 0 0 0
156 PB Dewasa Blister 0 0 0 0 0 0
157 Permetrin 5% Krim (Scabimite) Tube 19 19 10 10 29 11
Phenolphtalein, Paraffin Liquidum, Gliserin

158 Sirup (Laxadin syr) botol 30 30 0 0 30 0
159 Piridoksin HCl (Vit B6) Tablet 10 mg Tablet 530 530 3000 3000 3530 711
160 Pirimetamin Tablet 25 mg Tablet 0 0 0 0 0 0
161 Polikresulen (Albotyl) Botol 5 ml botol 12 12 0 0 12 0
162 Povidon Iodida 10 %-30 ml Botol 3 3 10 10 13 2
164 Prednison Tablet 5 mg Tablet 315 315 500 500 815 186
165 Primakuin Tablet 15 mg Tablet 0 0 0 0 0 0
Prokain Benzilpenisilin Serb Inj 3 juta
166 UI/vial (i.m.) Vial 0 0 0 0 0 0
167 Propanolol HCl Tablet 40 mg Tablet 100 100 0 0 100 0
168 Propiltiourasil Tablet 100 mg Tablet 0 0 100 100 100 0

No NAMA OBAT SATUAN
BLUD BLUD BLUD
169 Ranitidin Inj 25 mg/ml Ampul 4 4 200 200 204 36

170 Ranitidin Tablet 150 mg Tablet 692 692 1000 1000 1692 612
171 Retinol (Vit A) Kapsul 100.000 IU Kapsul 650 650 0 0 650 170
172 Retinol (VIT A) Kapsul 200.000 IU Kapsul 4907 4907 0 0 4907 330
173 Ringer Laktat Larutan Infus Steril Fls 149 149 300 300 449 147
174 Risperidon Tablet 2 mg Tablet 25 25 0 0 25 20
175 Salbutamol Nebu 2,5 mg/2,5 ml NaCl Ampul 21 21 0 0 21 0
176 Salbutamol Tablet 4 mg Tablet 240 240 200 200 440 109
177 Salep 2-4 kombinasi : as.asal 2 % + Bel. 4 % Pot 8 8 48 48 56 4
178 Salisil Bedak 2 % Kotak 37 37 50 50 87 64
179 Sefadroksil Sirup 125 mg/5 ml Botol 14 14 0 0 14 4
180 Sefadroxil Kapsul 500 mg Kapsul 344 344 1000 1000 1344 634
181 Sefiksime 200 mg + Azitromisin 500 mg Paket 0 0 0 0 0 0
182 Sefotaksim Inj 1 g Vial 20 20 0 0 20 2
183 Seftriaxon Inj 1 g Vial 5 5 0 0 5 4
184 Semen seng fosfat serbuk cairan Botol 0 0 1 1 1 0
185 Serum Anti Difteri (ADS) Vial 0 0 0 0 0 0
186 Serum anti tetanus Inj 1500 IU/vial (ATS) Ampul 2 2 0 0 2 0
187 Serum antibisa ular Polivalen Inj 5 ml (SABU)Vial 9 9 0 0 9 3
188 Setirizin Sirup 5 mg/5 ml Botol 206 206 0 0 206 12
189 Sianokobalamin (Vit B12 ) Inj 500 mcg/ml Ampul 195 195 0 0 195 0
190 Simvastatin Tablet 10 mg Tablet 70 70 90 90 160 60
191 Siprofloksasin (HCl) Tablet 500 mg Kaplet 573 573 0 0 573 43
192 Tablet Tambah Darah (Camabion) Buah 0 0 0 0 0 0
193 Tablet Tambah Darah Kombinasi Tablet 14310 14310 11200 11200 25510 1740
194 Temporary Restorative Material Botol 0 0 0 0 0 0
195 Tetrasiklin Kapsul 500 mg Kapsul 140 140 0 0 140 60
196 Tiamin HCL (Vit B1) Tablet 50 mg Tablet 734 734 2500 2500 3234 1224
197 Triheksifenidil HCl Tablet 2 mg Tablet 7 7 1000 1000 1007 300
198 Vaksin BCG + Pelarut Set 7 7 30 30 37 13
199 Vaksin DPT-Hb-Hib Vial 66 66 80 80 146 39
200 Vaksin DT Vial 62 62 0 0 62 2
201 Vaksin Hb-0 Set 10 10 100 100 110 38
202 Vaksin IPV 10 ds Vial 0 0 0 0 0 0
204 Vaksin Measles Rubella (MR) Vial 15 15 60 60 75 18
205 Vaksin Meningitis Paket 0 0 0 0 0 0
206 Vaksin Papillomavirus (HPV) Vial 0 0 0 0 0 0
207 Vaksin Pneumococcus Vial 0 0 0 0 0 0
208 Vaksin Polio 10 ds bopv + Penetes Set 6 6 0 0 6 6
209 Vaksin Rabies Vero Set 11 11 0 0 11 0
210 Vaksin Td Vial 432 432 0 0 432 15
211 Vitamin B Kompleks Tablet Tablet 926 926 1000 1000 1926 1121
212 Zinc Tablet 20 mg Tablet 1721 1721 0 0 1721 160
BAHAN HABIS PAKAI 0 0 0 0 0 0
213 ADS 0.05 ml Buah 57 57 100 100 157 57
214 ADS 0.5 ml Buah 1155 1155 0 0 1155 120
215 ADS 5 ml Buah 63 63 0 0 63 21
216 Alat Suntik Sekali Pakai 1ml Set 384 384 100 100 484 216
217 Alat Suntik Sekali Pakai 3 ml Set 379 379 0 0 379 134
218 Alat Suntik Sekali Pakai 5 ml Set 0 0 0 0 0 0
219 Alkohol Swab Buah 0 0 0 0 0 0
220 Bisturi Buah 8 8 10 10 18 10
221 Blood set Buah 0 0 0 0 0 0
Catgut/Benang Bedah No.2/0 dengan

222 jarum bedah Set 20 20 34 34 54 5
Catgut/Benang Bedah No.3/0 dengan
223 jarum bedah Set 0 0 0 0 0 0
224 Folley Catheter No.18 Buah 0 0 10 10 10 6

No NAMA OBAT SATUAN
BLUD BLUD BLUD
225 Infusion set anak Kantong 100 100 100 100 200 3
226 Infusion set dewasa Kantong 47 47 100 100 147 63
227 IV Catheter No.18 Set 0 0 20 20 20 20
231 Jarum kulit Buah 22 22 0 0 22 0
232 Jarum otot Buah 22 22 0 0 22 0
233 Kaca Slide Buah 142 142 0 0 142 0
234 Kantung mayat Buah 0 0 0 0 0 0
235 Kapas Pembalut/absorben 250 mg Roll 4 4 0 0 4 0
236 Kasa Hidrofil 2x80 Roll 10 10 10 10 20 13
237 Kasa Hidrofil Steril 16 X 16 Lembar 247 247 0 0 247 19
238 Kasa Pembalut Hidrofil 4 X 10 cm Roll 120 120 0 0 120 0
239 Kasa Pembalut hidrofil 4 x 5 cm Roll 8 8 30 30 38 3
240 Kassa Pembalut elastic 4 inchi Roll 18 18 0 0 18 0
241 Masker Tie on Buah 100 100 100 100 200 50
242 Masker N-95 Buah 0 0 0 0 0 0
243 Plester 5 yard x 2 inch Roll 4 4 2 2 6 4
244 Polybag Medis Lembar 0 0 0 0 0 0
245 Polybag Nonmedis Lembar 0 0 0 0 0 0
246 Polybag Ramah Lingkungan Lembar 0 0 0 0 0 0
247 Pot Dahak Buah 80 80 200 200 280 0
248 Safety box Buah 138 138 0 0 138 0
249 Sarung Tangan Non Steril Uk.S Buah 0 0 0 0 0 0
250 Sarung Tangan Non Steril Uk.M Buah 0 0 500 500 500 500
251 Sarung Tangan Non Steril Uk.L Buah 0 0 0 0 0 0
252 Sarung Tangan Steril No.6 Set 0 0 0 0 0 0
253 Sarung Tangan Steril No.6,5 Set 87 87 0 0 87 34
255 Sendok Obat Buah 30 30 400 400 430 200
Silk (Benang Bedah Sutera) No.2/0 Dengan
256 Jarum Bedah Set 36 36 20 20 56 6
257 Urin Bag Buah 5 5 10 10 15 10
258 REAGEN 0 0 0 0 0 0
259 Cybow 10 Reagent Strip Set 0 0 0 0 0 0
260 Golongan darah anti A - 10 ml Botol 3 3 0 0 3 0
261 Golongan darah anti A-B - 10 ml Botol 3 3 0 0 3 0
262 Golongan darah anti B - 10 ml Botol 3 3 0 0 3 0
263 Humasens Plus Set 0 0 0 0 0 0
264 Humasens Plus Strip Uric Acid Kotak 51 51 0 0 51 0
265 Humasens Strip Glucose Kotak 51 51 0 0 51 0
266 Humasens Strip Kolesterol Kotak 21 21 0 0 21 0
267 Iodin test Botol 8 8 0 0 8 0
268 Larutan Asam Asetat 6% 100 ml Botol 0 0 0 0 0 0
269 Larutan Benedict 100 ml Botol 0 0 0 0 0 0
270 Larutan EDTA 10 % 100 ml Botol 0 0 0 0 0 0
271 Larutan HCl 0,1 N 100 ml Botol 0 0 0 0 0 0
272 Larutan Natrium Citrat 3,13 % Botol 0 0 0 0 0 0
273 Larutan Rees Ecker 100 ml Botol 0 0 0 0 0 0
274 Larutan Turk 100 ml Botol 0 0 0 0 0 0
275 Larutan Ziehl Neelsen Botol 15 15 0 0 15 0
276 Rapid HIV 1/2 Device test 0 0 0 0 0 0
277 Rapid HIV 2 Fokus test 0 0 0 0 0 0
278 Rapid HIV Biomedika Sachet 0 0 0 0 0 0
279 Rapid HIV Biomeriux Sachet 25 25 0 0 25 0
280 Rapid HIV Intec Sachet 0 0 0 0 0 0
281 Rapid HIV Oncoprobe Sachet 0 0 0 0 0 0
282 Rapid HIV SD Sachet 1100 1100 0 0 1100 0
283 Rapid Malaria Sachet 0 0 0 0 0 0

No NAMA OBAT SATUAN
BLUD BLUD BLUD
284 Rapid Syphilis SD Sachet 100 100 0 0 100 0

285 Reagen CD4 kontrol test 0 0 0 0 0 0
286 Reagen CD4 tipe 1 (Alere Pima CD4) test 0 0 0 0 0 0
287 RPR Syphilis Sachet 0 0 0 0 0 0
288 Salmonella Thyphi H - 5 ml Botol 0 0 0 0 0 0
289 Salmonella Thyphi O - 5 ml Botol 0 0 0 0 0 0
290 Test Kehamilan Buah 0 0 0 0 0 0
LAIN-LAIN 0 0 0 0 0 0
291 Tiamin HCL (Vit B1) Inj 100 mg/ml-1ml Ampul 0 0 0 0 0 0
BARANG PKM 0 0 0 0 0 0
292 Amlodipine 10 mg Blister 1643 1643 0 0 1643 181
293 Ambroxol syr Botol 63 63 0 0 63 6
294 Mucus Extractor 100 100 0 0 100 13
295 Gel USG 250 mL 39 39 0 0 39 0
296 Oxygen Mask Dewasa 42 42 0 0 42 0
297 Oxygen Mask Anak 69 69 0 0 69 0
298 Oxygen mask bayi 70 70 0 0 70 0
299 Sarung Tangan Non Steril Uk.S 100 100 0 0 100 100
300 Sarung Tangan Non Steril Uk.M 3000 3000 0 0 3000 100
301 Sarung tangan obgyn steril 52 52 0 0 52 6
302 Kassa Hidrofil DRC 36 m x 80 cm 0 0 0 0 0 0
303 Parasetamol Infus 288 288 0 0 288 1
304 Amoxicillin syr 250 mg 866 866 0 0 866 21
Mengetahui,
Kepala Puskesmas
H. Moh Apip GS, S.IP, S.Kep, M.Si, Ners

NIP. 19680819 198803 1 001
ISOMPET BULAN FEBRUARI 2019
PENYALURAN SISA STOK ( KARTU BARANG ) SELISIH

KEADAAN
NON JKN/ FISIK KET
TOTAL JKN/BLUD NON TOTAL BARANG (+) (-)
BLUD
0 12450 12450 12450

88 448 448 448
0 0 0 0
0 0 0 0
0 250 250 250
233 175 175 175
1983 2174 2174 2174
53 238 238 238
2510 2545 2545 2545
73 19 19 19
12 11 11 11
2 37 37 37
1 48 48 48
23 94 94 94
7 22 22 22
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
10 246 246 246
315 110 110 110
2880 5900 5900 5900
1100 2470 2470 2470
2 47 47 47
121 263 263 263
164 387 387 387
0 16 16 16
0 0 0 0
0 16 16 16
39 81 81 81
34 35 35 35
0 64 64 64
610 760 760 760
0 0 0 0
0 0 0 0
0 0 0 0
6 27 27 27
711 926 926 926
576 24 24 24
30 0 0 0
0 0 0 0
0 0 0 0
0 8 8 8
4 3 3 3
8 177 177 177
5 47 47 47
0 200 200 200
0 0 0 0
0 0 0 0
3 45 45 45
223 20 20 20
0 0 0 0
KEADAAN
NON JKN/ FISIK KET
BLUD
0 8 8 8
30 1160 1160 1160
0 0 0 0
0 3 3 3
0 0 0 0
0 3 3 3
0 0 0 0
0 0 0 0
120 175 175 175
0 67 67 67
0 0 0 0
30 253 253 253
1 95 95 95
0 0 0 0
0 0 0 0
0 0 0 0
51 111 111 111
51 106 106 106
0 50 50 50
15 29 29 29
0 0 0 0
10 119 119 119
935 602 602 602
5 15 15 15
60 278 278 278
560 440 440 440
0 10 10 10
0 0 0 0
0 1830 1830 1830
17 6 6 6
46 414 414 414
0 0 0 0
371 0 0 0
0 500 500 500
0 60 60 60
0 10 10 10
0 0 0 0
814 1304 1304 1304
542 1207 1207 1207
90 280 280 280
5 14 14 14
0 0 0 0
107 240 240 240
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
98 280 280 280
0 52 52 52
12 18 18 18
0 20 20 20
26 64 64 64
14 23 23 23
539 2012 2012 2012
320 205 205 205
28 40 40 40
56 300 300 300
KEADAAN
NON JKN/ FISIK KET
BLUD
30 70 70 70
3 1 1 1
1 1 1 1
0 4 4 4
526 439 439 439
0 0 0 0
0 28 28 28
0 0 0 0
1 4 4 4
260 260 260 260
10 270 270 270
0 100 100 100 ED
36 226 226 226

186 794 794 794
80 431 431 431
38 18 18 18
0 0 0 0
0 0 0 0
58 0 0 0
90 220 220 220
40 550 550 550
46 599 599 599
384 456 456 456
0 0 0 0
5 40 40 40
0 0 0 0
0 229 229 229
10 90 90 90
10 32 32 32
6 12 12 12
0 3 3 3
0 14 14 14
0 0 0 0
0 0 0 0
37 131 131 131
0 289 289 289
471 104 104 104
41 31 31 31
192 101 101 101
3659 3690 3690 3690
0 0 0 0
0 0 0 0
11 18 18 18
0 30 30 30
711 2819 2819 2819
0 0 0 0
0 12 12 12
2 11 11 11
0 4 4 4
186 629 629 629
0 0 0 0
0 0 0 0
0 100 100 100
0 100 100 100
KEADAAN
NON JKN/ FISIK KET
BLUD
36 168 168 168

612 1080 1080 1080
170 480 480 480
330 4577 4577 4577
147 302 302 302
20 5 5 5
0 21 21 21
109 331 331 331
4 52 52 52
64 23 23 23
4 10 10 10
634 710 710 710
0 0 0 0
2 18 18 18
4 1 1 1
0 1 1 1
0 0 0 0
0 2 2 2
3 6 6 6
12 194 194 194
0 195 195 195
60 100 100 100
43 530 530 530
0 0 0 0
1740 23770 23770 23770
0 0 0 0
60 80 80 80
1224 2010 2010 2010
300 707 707 707
13 24 24 24
39 107 107 107
2 60 60 60
38 72 72 72
0 0 0 0
4 28 28 28
18 57 57 57
0 0 0 0
0 0 0 0
0 0 0 0
6 0 0 0
0 11 11 11
15 417 417 417
1121 805 805 805
160 1561 1561 1561
0 0 0 0
57 100 100 100
120 1035 1035 1035
21 42 42 42
216 268 268 268
134 245 245 245
0 0 0 0
0 0 0 0
10 8 8 8
0 0 0 0
5 49 49 49
0 0 0 0
6 4 4 4
KEADAAN
NON JKN/ FISIK KET
BLUD
3 197 197 197

63 84 84 84
20 0 0 0
19 11 11 11
48 37 37 37
11 198 198 198
0 22 22 22
0 22 22 22
0 142 142 142
0 0 0 0
0 4 4 4
13 7 7 7
19 228 228 228
0 120 120 120
3 35 35 35
0 18 18 18
50 150 150 150
0 0 0 0
4 2 2 2
0 0 0 0
0 0 0 0
0 0 0 0
0 280 280 280
0 138 138 138
0 0 0 0
500 0 0 0
0 0 0 0
0 0 0 0
34 53 53 53
0 0 0 0
200 230 230 230
6 50 50 50
10 5 5 5
0 0 0 0
0 0 0 0
0 3 3 3
0 3 3 3
0 3 3 3
0 0 0 0
0 51 51 51
0 51 51 51
0 21 21 21
0 8 8 8
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 15 15 15
0 0 0 0
0 0 0 0
0 0 0 0
0 25 25 25
0 0 0 0
0 0 0 0
0 1100 1100 1100
0 0 0 0
KEADAAN
NON JKN/ FISIK KET
BLUD
0 100 100 100

0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0
181 1462 1462 1462
6 57 57 57
13 87 87 87
0 39 39 39
0 42 42 42
0 69 69 69
0 70 70 70
100 0 0 0
100 2900 2900 2900
6 46 46 46
0 0 0 0
1 287 287 287
21 845 845 845
Garut, 3 Maret 2019

Yang Melaporkan,
Penanggung Jawab Obat Puskesmas
Astria Susanti Dewi, S.Farm., Apt

NIP.
DAFTAR LAMPIRAN BERITA ACARA STOCK OPNAME OBAT PUSKESMAS CISOMPET BULAN MARET 2019
STOK AWAL MARET 2019 PENERIMAAN PENYALURAN

No NAMA OBAT SATUAN AN
JKN/BLUD NON TOTAL JKN/BLUD NON TOTAL JKN/BLUD NON TOTAL
BLUD BLUD BLUD
1 Albendazol Tablet 400 mg Tablet 12450 12450 0 12450 2905 2905

2 Alopurinol Tablet 100 mg Tablet 448 448 500 500 948 272 272
3 Aminofilin Inj 24 mg/ml-10 ml Ampul 0 0 0 0 0 0
4 Aminofilin Tablet 200 mg Tablet 0 0 0 0 0 0
5 Amitriptilina HCl Tablet salut 25 mg Tablet 250 250 0 250 0 0
6 Amlodipin Tablet 5 mg Tablet 175 175 810 810 985 357 357
7 Amoksisilin Kaplet 500 mg Kaplet 2174 2174 2000 2000 4174 2375 2375
8 Amoksisilin Sirup Kering 125 mg/5 ml Botol 238 238 120 120 358 136 136
9 Antasida DOEN I Tablet Kunyah Tablet 2545 2545 3500 3500 6045 3848 3848
10 Antasida II Suspensi 60 ml Botol 19 19 100 100 119 37 37
11 Anti Hemmoroid DOEN Supp 11 11 20 20 31 0 0
12 Antibakteri DOEN Tube 37 37 0 37 0 0
13 Antifungi DOEN kombinasi Pot 48 48 0 48 6 6
14 Antimigren DOEN Tablet 94 94 0 94 32 32
15 Aqua Pro Inj steril bebas pirogen- 20 ml Vial 22 22 0 22 11 11
16 ARV: Efavirenz 600 mg Tablet 0 0 0 0 0 0
17 ARV: Lamivudine 150 mg Tablet 0 0 0 0 0 0
18 ARV: Lovinapir 200 mg Ronavir Tablet 0 0 0 0 0 0
19 ARV: Nevirapine 200 mg Tablet 0 0 0 0 0 0
20 ARV: TDF(300) + 3TC(300) + EFV(600) Tablet 0 0 0 0 0 0
21 ARV: Tenofovir 300 mg Tablet 0 0 0 0 0 0
22 ARV: Zdvdn(60) + Lmvdn(30) + Nvrpn(50) Tablet 0 0 0 0 0 0
23 ARV: Zidovudine(300) + Lamivudine(150) Tablet 0 0 0 0 0 0
24 Asam Asetilsalisilat Tablet 80 mg (Asetosal) Tablet 246 246 0 246 0 0
25 Asam Askorbat (VIT C) Tablet 50 mg Tablet 110 110 500 500 610 135 135
26 Asam Folat Tablet 0,4 mg Tablet 5900 5900 0 5900 360 360
27 Asam Mefenamat kaplet 500 mg Tablet 2470 2470 2000 2000 4470 1860 1860
28 Asiklovir Krim 5%/5g Tube 47 47 0 47 4 4
29 Asiklovir Tablet 400 mg Tablet 263 263 300 300 563 10 10
30 Atapulgit Tablet 600 mg Tablet 387 387 0 387 340 340
31 Atropin Sulfat Inj 0,25 mg/ml Ampul 16 16 0 16 0 0
32 Azithromisin Tablet 500 mg Tablet 0 0 0 0 0 0
33 Benzatin Benzil Penisilin Inj 2,4 juta IU/vial Vial 16 16 0 16 0 0
34 Betahistin Tablet 6 mg Tablet 81 81 390 390 471 176 176
35 Betametason Krim 0.1 % Tube 35 35 50 50 85 51 51
36 Bisoprolol Tablet 5 mg Tablet 64 64 0 64 0 0
37 Bromheksin Tablet 8 mg Tablet 760 760 1000 1000 1760 671 671
38 Clobazam Tablet 10 mg Tablet 0 0 0 0 0 0
39 Clozapine Tablet 25 mg Tablet 0 0 0 0 0 0
40 Dehidroartemisin 40 mg + Piperaquin 320 mgPaket 0 0 0 0 0 0
41 Deksametason Inj 5 mg/ml-1 ml Ampul 27 27 0 27 7 7
42 Deksametason Tablet 0,5 mg Tablet 926 926 1500 1500 2426 681 681
43 Dekstrometorfan Tablet kombinasi Tablet 24 24 1050 1050 1074 442 442
44 Dektrometorfan Sirup kombinasi Botol 0 0 30 30 30 26 26
45 Devitalisasi Pasta Botol 0 0 0 0 0 0
46 Dextrose Inj 40% Vial 0 0 0 0 0 0
47 Diazepam Inj 5 mg/ml-2 ml Ampul 8 8 0 8 0 0
48 Diazepam Rectal 5 mg/2,5 ml tube 3 3 0 3 0 0
49 Diazepam Tablet 2 mg Tablet 177 177 0 177 13 13
50 Difenhidramin Inj 10 mg/ml Ampul 47 47 0 47 1 1
51 Digoksin Tablet 0,25 mg Tablet 200 200 0 200 0 0
52 Dimenhidrinat Tablet 50 mg Tablet 0 0 0 0 0 0
53 Doksisilin Tablet 100 mg Tablet 0 0 0 0 0 0
54 Domperidon Suspensi 5mg/5ml Botol 45 45 0 45 11 11
55 Domperidon Tablet 10 mg Tablet 20 20 500 500 520 175 175
56 Endometason Botol 0 0 0 0 0 0

No NAMA OBAT SATUAN
JKN/BLUD NON TOTAL JKN/BLUD NON TOTAL AN JKN/BLUD NON TOTAL
BLUD BLUD BLUD
57 Epinefrina HCl/Bitartrat (Adrenalin) Inj 0,1 % Ampul 8 8 0 8 0 0

60 Eritromisin Sirup 200 mg/5 ml Botol 3 3 0 3 0 0
61 Etakridin Larutan 0,1 % Botol 0 0 0 0 0 0
62 Etanol 70 %- 1000 ml Botol 3 3 0 3 0 0
63 Etil Klorida Spray Botol 0 0 0 0 0 0
64 Eugenol Cairan Botol 0 0 0 0 0 0
65 Fenitoin Natrium Kapsul 100 mg Kapsul 175 175 100 100 275 230 230
66 Fenobarbital Tablet 30 mg Tablet 67 67 0 67 0 0
67 Fenoksimetil Penisilin Tablet 500 mg Tablet 0 0 0 0 0 0
68 Fitomenadion (Vit K1) Tablet Salut Gula 10 m Tablet 253 253 0 253 23 23
69 Fitomenadion(Vit K1) Inj 2 mg/ml Ampul 95 95 0 95 30 30
70 Fluconazol Tablet 150 mg Tablet 0 0 0 0 0 0
71 Flufenazin Inj im 25 mg/ml (Sikzonoate) Ampul 0 0 0 0 0 0
72 Formokresol Cair Botol 0 0 0 0 0 0
73 Furosemid Tablet 40 mg Tablet 111 111 200 200 311 38 38
74 Garam Oralit I Serbuk Sachet 106 106 0 106 51 51
75 Gentamisin Inj 40 mg/ml (Sulfat) Vial 50 50 0 50 2 2
76 Gentamisin Salep Kulit 0,1% Tube 29 29 24 24 53 20 20
77 Glass Ionomer Cement Botol 0 0 0 0 0 0
78 Glibenklamid Tablet 5 mg Tablet 119 119 0 119 30 30
79 Gliseril Guaiakolat Tablet 100 mg Tablet 602 602 1500 1500 2102 1103 1103
80 Glukosa Larutan Infus 5% steril Fls 15 15 0 15 0 0
81 Griseofulvin Tablet 125 mg Micronized Tablet 278 278 100 100 378 72 72
82 Haloperidol 5 mg Tablet 440 440 600 600 1040 576 576
83 Haloperidol Dekanoat Inj 50 mg/ml Ampul 10 10 0 10 0 0
84 Haloperidol Inj 5 mg/ml Ampul 0 0 0 0 0 0
85 Haloperidol Tablet 1,5 mg Tablet 1830 1830 0 1830 0 0
86 Hidrokortison Krim 2,5 % Tube 6 6 0 6 5 5
87 Hiosina butilbromida tab 10 mg Tablet 414 414 100 100 514 260 260
88 (Tetagam) Set 0 0 0 0 0 0
89 Ibuprofen Tablet 400 mg Tablet 0 0 300 300 300 264 264
90 Isoniazid Tablet 100 mg Tablet 500 500 0 500 200 200
91 Isosorbid Dinitrat Tablet Sublingual 5 mg Tablet 60 60 0 60 8 8
92 Kalsium glukonat inj 100 mg/ml Ampul 10 10 0 10 0 0
93 Kalsium hidroksida pasta Botol 0 0 0 0 0 0
94 Kalsium Laktat (Kalk) Tablet 500 mg Tablet 1304 1304 1500 1500 2804 621 621
95 Kaptropil Tablet 25 mg Tablet 1207 1207 1000 1000 2207 692 692
96 Karbamazepin Tablet 200 mg Tablet 280 280 200 200 480 30 30
97 Karbogliserin Tetes Telinga 10 % Botol 14 14 0 14 1 1
98 Karbon aktif tab 0,5 mg Tablet 0 0 0 0 0 0
99 Ketokonazol Tablet 200 mg Tablet 240 240 0 240 68 68
100 Ketoprofen Supp 100 mg Supp 0 0 0 0 0 0
101 Kina Inj 26 % 2 ml Ampul 0 0 0 0 0 0
102 Kina Tablet 222 mg Tablet 0 0 0 0 0 0
103 Klindanmisin Tablet 300 mg Tablet 0 0 0 0 0 0
105 Kloramfenikol Kapsul 500 mg Kapsul 280 280 100 100 380 100 100
106 Kloramfenikol Salep Kulit 2% Tube 52 52 0 52 5 5
107 Kloramfenikol Salep Mata 1 % Tube 18 18 24 24 42 10 10
108 Kloramfenikol Sirup 125 mg/5 ml Botol 20 20 0 20 0 0
109 Kloramfenikol Tetes Mata 0.5% Botol 64 64 0 64 23 23
110 Kloramfenikol Tetes telinga 3 % Tube 23 23 0 23 14 14
111 Klorfenarimin Maleat (CTM) Tablet 4 mg Tablet 2012 2012 1500 1500 3512 809 809
112 Klorpropmazin HCl Tablet salut 100 mg Tablet 205 205 400 400 605 285 285
113 Kotrimoksazol Susp:Sulf 200+Trim 40 mg/5 mBotol 40 40 50 50 90 28 28
114 Kotrimoksazol Tab Dws:Sulf 400+Trim 80 mg Tablet 300 300 0 300 60 60

No NAMA OBAT SATUAN
BLUD BLUD BLUD
Lidokain Inj Komp : Lidokain %+ Epinefrin 1 :

115 80000-2 ml Ampul 70 70 60 60 130 44 44
116 Lidokain Jelly 2 % Tube 1 1 0 1 0 0
117 Lidokain Spray 10 % Botol 1 1 1 1 2 0 0
118 Lisol Botol 4 4 0 4 0 0
119 Loratadin Tablet 10 mg Tablet 439 439 1000 1000 1439 586 586
123 MB Dewasa Blister 4 4 0 4 1 1
124 Metformin HCl Tablet 500 mg Tablet 260 260 500 500 760 320 320
125 Metildopa Tablet 250 mg Tablet 270 270 0 270 20 20
126 Metilergomatrin Maleat Inj 0,200 mg Ampul 100 100 0 100 95 95

127 Tablet Salut 0,125 mg Tablet 226 226 0 226 102 102
128 Metilprednisolon Tablet 4 mg Tablet 794 794 500 500 1294 518 518
129 Metronidazol Tablet 500 mg Tablet 431 431 0 431 280 280
130 Mikonazol Krim/Salep 2% Tube 18 18 48 48 66 23 23
131 Mineral Mix Sachet 0 0 0 0 0 0
132 Monoklorkamfer mentol cairan Botol 0 0 0 0 0 0
133 Multivitamin + DHA + Lysin Sirup Botol 0 0 30 30 30 17 17
134 Multivitamin + Mineral Kaplet Kaplet 220 220 300 300 520 160 160
135 N-asetil sistein kaps 200 mg Kapsul 550 550 0 550 0 0
136 Natrium Bikarbonat Tablet 500 mg Tablet 599 599 0 599 36 36
137 Natrium Diklofenak Tablet 50 mg Tablet 456 456 1000 1000 1456 650 650
138 Natrium Hipoklorit 3% Botol 0 0 0 0 0 0
139 Natrium Klorida Larutan Infus 0,9% Fls 40 40 0 40 2 2
140 Natrium Tiroksin Tablet 100 µg Tablet 0 0 0 0 0 0
141 Nipedipin Tablet 10 mg Tablet 229 229 0 229 11 11
142 Nistatin Tablet Salut Gula 500.000 IU/g Tablet 90 90 0 90 7 7
143 Nistatin Tablet Vaginal 100.000 IU/g Tablet 32 32 0 32 0 0
146 OAT FDC Kategori Anak paket 14 14 0 14 0 0
147 OAT FDC Kategori Sisipan Paket 0 0 0 0 0 0
148 OAT Kombipak Kat I paket 0 0 0 0 0 0
149 Obat Batuk Hitam (OBH) Cairan Botol 131 131 50 50 181 30 30
150 Oksitosin Inj 10 IU/ml- 1 ml Ampul 289 289 0 289 100 100
151 Omeprazol Kapsul 20 mg Kapsul 104 104 1350 1350 1454 432 432
152 Ondansetron Inj 4 mg/2 ml Ampul 31 31 20 20 51 60 60
153 Parasetamol Sirup 120 mg / 5ml Botol 101 101 300 300 401 201 201
154 Parasetamol Tablet 500 mg Tablet 3690 3690 4500 4500 8190 6253 6253
156 PB Dewasa Blister 0 0 0 0 0 0
157 Permetrin 5% Krim (Scabimite) Tube 18 18 10 10 28 9 9
Phenolphtalein, Paraffin Liquidum, Gliserin
158 Sirup (Laxadin syr) botol 30 30 0 30 0 0
159 Piridoksin HCl (Vit B6) Tablet 10 mg Tablet 2819 2819 1500 1500 4319 1426 1426
160 Pirimetamin Tablet 25 mg Tablet 0 0 0 0 0 0
161 Polikresulen (Albotyl) Botol 5 ml botol 12 12 0 12 0 0
162 Povidon Iodida 10 %-30 ml Botol 11 11 10 10 21 2 2
164 Prednison Tablet 5 mg Tablet 629 629 1000 1000 1629 255 255
165 Primakuin Tablet 15 mg Tablet 0 0 0 0 0 0
Prokain Benzilpenisilin Serb Inj 3 juta UI/vial
166 (i.m.) Vial 0 0 0 0 0 0
167 Propanolol HCl Tablet 40 mg Tablet 100 100 0 100 0 0
168 Propiltiourasil Tablet 100 mg Tablet 100 100 100 100 200 30 30
169 Ranitidin Inj 25 mg/ml Ampul 168 168 70 70 238 160 160

No NAMA OBAT SATUAN
BLUD BLUD BLUD
170 Ranitidin Tablet 150 mg Tablet 1080 1080 1000 1000 2080 1140 1140
171 Retinol (Vit A) Kapsul 100.000 IU Kapsul 480 480 0 480 0 0
172 Retinol (VIT A) Kapsul 200.000 IU Kapsul 4577 4577 0 4577 302 302
173 Ringer Laktat Larutan Infus Steril Fls 302 302 200 200 502 217 217
174 Risperidon Tablet 2 mg Tablet 5 5 0 5 0 0
175 Salbutamol Nebu 2,5 mg/2,5 ml NaCl Ampul 21 21 0 21 3 3
176 Salbutamol Tablet 4 mg Tablet 331 331 100 100 431 124 124
177 Salep 2-4 kombinasi : as.asal 2 % + Bel. 4 % Pot 52 52 0 52 4 4
178 Salisil Bedak 2 % Kotak 23 23 20 20 43 11 11
179 Sefadroksil Sirup 125 mg/5 ml Botol 10 10 15 15 25 0 0
180 Sefadroxil Kapsul 500 mg Kapsul 710 710 1000 1000 1710 860 860
181 Sefiksime 200 mg + Azitromisin 500 mg Paket 0 0 0 0 0 0
182 Sefotaksim Inj 1 g Vial 18 18 10 10 28 4 4
183 Seftriaxon Inj 1 g Vial 1 1 5 5 6 0 0
184 Semen seng fosfat serbuk cairan Botol 1 1 0 1 0 0
185 Serum Anti Difteri (ADS) Vial 0 0 0 0 0 0
186 Serum anti tetanus Inj 1500 IU/vial (ATS) Ampul 2 2 0 2 0 0
187 Serum antibisa ular Polivalen Inj 5 ml (SABU) IVial 6 6 0 6 0 0
188 Setirizin Sirup 5 mg/5 ml Botol 194 194 0 194 9 9
189 Sianokobalamin (Vit B12 ) Inj 500 mcg/ml Ampul 195 195 0 195 1 1
190 Simvastatin Tablet 10 mg Tablet 100 100 90 90 190 74 74
191 Siprofloksasin (HCl) Tablet 500 mg Kaplet 530 530 0 530 40 40
192 Tablet Tambah Darah (Camabion) Buah 0 0 0 0 0 0
193 Tablet Tambah Darah Kombinasi Tablet 23770 23770 0 23770 1480 1480
194 Temporary Restorative Material Botol 0 0 0 0 0 0
195 Tetrasiklin Kapsul 500 mg Kapsul 80 80 0 80 0 0
196 Tiamin HCL (Vit B1) Tablet 50 mg Tablet 2010 2010 1500 1500 3510 1660 1660
197 Triheksifenidil HCl Tablet 2 mg Tablet 707 707 500 500 1207 610 610
198 Vaksin BCG + Pelarut Set 24 24 100 100 124 13 13
199 Vaksin DPT-Hb-Hib Vial 107 107 100 100 207 23 23
200 Vaksin DT Vial 60 60 0 60 0 0
201 Vaksin Hb-0 Set 72 72 100 100 172 36 36
203 Vaksin IPV 5 ds Vial 28 28 30 30 58 0 0
204 Vaksin Measles Rubella (MR) Vial 57 57 100 100 157 15 15
205 Vaksin Meningitis Paket 0 0 0 0 0 0
206 Vaksin Papillomavirus (HPV) Vial 0 0 0 0 0 0
207 Vaksin Pneumococcus Vial 0 0 0 0 0 0
208 Vaksin Polio 10 ds bopv + Penetes Set 0 0 0 0 0 0
209 Vaksin Rabies Vero Set 11 11 0 11 0 0
210 Vaksin Td Vial 417 417 0 417 13 13
211 Vitamin B Kompleks Tablet Tablet 805 805 3000 3000 3805 1367 1367
212 Zinc Tablet 20 mg Tablet 1561 1561 0 1561 160 160
213 ADS 0.05 ml Buah 100 100 100 100 200 25 25
214 ADS 0.5 ml Buah 1035 1035 1000 1000 2035 450 450
215 ADS 5 ml Buah 42 42 0 42 40 40
216 Alat Suntik Sekali Pakai 1ml Set 268 268 0 268 62 62
217 Alat Suntik Sekali Pakai 3 ml Set 245 245 200 200 445 353 353
218 Alat Suntik Sekali Pakai 5 ml Set 0 0 0 0 0
219 Alkohol Swab Buah 0 0 0 0 0 0
220 Bisturi Buah 8 8 10 10 18 1 1
Catgut/Benang Bedah No.2/0 dengan jarum
222 bedah Set 49 49 12 12 61 39 39
223 bedah Set 0 0 0 0 0 0
224 Folley Catheter No.18 Buah 4 4 10 10 14 8 8
225 Infusion set anak Kantong 197 197 0 197 9 9
226 Infusion set dewasa Kantong 84 84 100 100 184 87 87

No NAMA OBAT SATUAN
BLUD BLUD BLUD
227 IV Catheter No.18 Set 0 0 20 20 20 8 8

231 Jarum kulit Buah 22 22 0 22 0 0
232 Jarum otot Buah 22 22 0 22 0 0
233 Kaca Slide Buah 142 142 0 142 0 0
234 Kantung mayat Buah 0 0 0 0 0 0
235 Kapas Pembalut/absorben 250 mg Roll 4 4 0 4 1 1
236 Kasa Hidrofil 2x80 Roll 7 7 20 20 27 16 16
237 Kasa Hidrofil Steril 16 X 16 Lembar 228 228 64 64 292 0 0
238 Kasa Pembalut Hidrofil 4 X 10 cm Roll 120 120 0 120 1 1
239 Kasa Pembalut hidrofil 4 x 5 cm Roll 35 35 0 35 0 0
240 Kassa Pembalut elastic 4 inchi Roll 18 18 0 18 0 0
241 Masker Tie on Buah 150 150 0 150 0 0
242 Masker N-95 Buah 0 0 0 0 0 0
243 Plester 5 yard x 2 inch Roll 2 2 10 10 12 2 2
244 Polybag Medis Lembar 0 0 0 0 0 0
245 Polybag Nonmedis Lembar 0 0 0 0 0 0
246 Polybag Ramah Lingkungan Lembar 0 0 0 0 0 0
247 Pot Dahak Buah 280 280 0 280 0 0
248 Safety box Buah 138 138 0 138 0 0
249 Sarung Tangan Non Steril Uk.S Buah 0 0 0 0 0 0
250 Sarung Tangan Non Steril Uk.M Buah 0 0 900 900 900 300 300
251 Sarung Tangan Non Steril Uk.L Buah 0 0 0 0 0 0
253 Sarung Tangan Steril No.6,5 Set 53 53 0 53 10 10
255 Sendok Obat Buah 230 230 0 230 0 0
Silk (Benang Bedah Sutera) No.2/0 Dengan
256 Jarum Bedah Set 50 50 0 50 4 4
257 Urin Bag Buah 5 5 0 5 4 4
258 REAGEN 0 0 0 0 0 0
259 Cybow 10 Reagent Strip Set 0 0 0 0 0 0
260 Golongan darah anti A - 10 ml Botol 3 3 0 3 0 0
261 Golongan darah anti A-B - 10 ml Botol 3 3 0 3 0 0
262 Golongan darah anti B - 10 ml Botol 3 3 0 3 0 0
263 Humasens Plus Set 0 0 0 0 0 0
264 Humasens Plus Strip Uric Acid Kotak 51 51 0 51 0 0
265 Humasens Strip Glucose Kotak 51 51 0 51 0 0
266 Humasens Strip Kolesterol Kotak 21 21 0 21 0 0
267 Iodin test Botol 8 8 0 8 0 0
268 Larutan Asam Asetat 6% 100 ml Botol 0 0 0 0 0 0
269 Larutan Benedict 100 ml Botol 0 0 0 0 0 0
270 Larutan EDTA 10 % 100 ml Botol 0 0 0 0 0 0
271 Larutan HCl 0,1 N 100 ml Botol 0 0 0 0 0 0
272 Larutan Natrium Citrat 3,13 % Botol 0 0 0 0 0 0
273 Larutan Rees Ecker 100 ml Botol 0 0 0 0 0 0
274 Larutan Turk 100 ml Botol 0 0 0 0 0 0
275 Larutan Ziehl Neelsen Botol 15 15 0 15 0 0
276 Rapid HIV 1/2 Device test 0 0 0 0 0 0
277 Rapid HIV 2 Fokus test 0 0 0 0 0 0
278 Rapid HIV Biomedika Sachet 0 0 0 0 0 0
279 Rapid HIV Biomeriux Sachet 25 25 0 25 0 0
280 Rapid HIV Intec Sachet 0 0 0 0 0 0
281 Rapid HIV Oncoprobe Sachet 0 0 0 0 0 0
282 Rapid HIV SD Sachet 1100 1100 0 1100 0 0
283 Rapid Malaria Sachet 0 0 0 0 0 0
284 Rapid Syphilis SD Sachet 100 100 0 100 0 0
285 Reagen CD4 kontrol test 0 0 0 0 0 0

No NAMA OBAT SATUAN
BLUD BLUD BLUD
286 Reagen CD4 tipe 1 (Alere Pima CD4) test 0 0 0 0 0 0

287 RPR Syphilis Sachet 0 0 0 0 0 0
288 Salmonella Thyphi H - 5 ml Botol 0 0 0 0 0 0
289 Salmonella Thyphi O - 5 ml Botol 0 0 0 0 0 0
290 Test Kehamilan Buah 0 0 0 0 0 0
LAIN-LAIN 0 0 0 0 0 0
291 Tiamin HCL (Vit B1) Inj 100 mg/ml-1ml Ampul 0 0 0 0 0 0
BARANG PKM 0 0 0 0
294 Mucus Extractor 87 87 0 87 10 10
295 Gel USG 250 mL 39 39 0 39 2 2
304 Amoxicillin syr 250 mg 845 845 0 845 3 3
Mengetahui,
Kepala Puskesmas Penang

NIP. 19680819 198803 1 001
ET 2019
SISA STOK ( KARTU BARANG ) SELISIH

KEADAAN
NON JKN/ FISIK KET
JKN/BLUD NON TOTAL BARANG (+) (-)
BLUD
9545 9545 9545

676 676 676
0 0 0
0 0 0
250 250 250
628 628 628
1799 1799 1799
222 222 222
2197 2197 2197
82 82 82
31 31 31
37 37 37
42 42 42
62 62 62
11 11 11
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
246 246 246
475 475 475
5540 5540 5540
2610 2610 2610
43 43 43
553 553 553
47 47 47
16 16 16
0 0 0
16 16 16
295 295 295
34 34 34
64 64 64
1089 1089 1089
0 0 0
0 0 0
0 0 0
20 20 20
1745 1745 1745
632 632 632
4 4 4
0 0 0
0 0 0
8 8 8
3 3 3
164 164 164
46 46 46
200 200 200
0 0 0
0 0 0
34 34 34
345 345 345
0 0 0
KEADAAN
NON JKN/ FISIK KET
BLUD
8 8 8
1160 1160 1160
0 0 0
3 3 3
0 0 0
3 3 3
0 0 0
0 0 0
45 45 45
67 67 67
0 0 0
230 230 230
65 65 65
0 0 0
0 0 0
0 0 0
273 273 273
55 55 55
48 48 48
33 33 33
0 0 0
89 89 89
999 999 999
15 15 15
306 306 306
464 464 464
10 10 10
0 0 0
1830 1830 1830
1 1 1
254 254 254
0 0 0
36 36 36
300 300 300
52 52 52
10 10 10
0 0 0
2183 2183 2183
1515 1515 1515
450 450 450
13 13 13
0 0 0
172 172 172
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
280 280 280
47 47 47
32 32 32
20 20 20
41 41 41
9 9 9
2703 2703 2703
320 320 320
62 62 62
240 240 240
KEADAAN
NON JKN/ FISIK KET
BLUD
86 86 86
1 1 1
2 2 2
4 4 4
853 853 853
0 0 0
28 28 28
0 0 0
3 3 3
440 440 440
250 250 250
5 5 5 ED
124 124 124

776 776 776
151 151 151
43 43 43
0 0 0
0 0 0
13 13 13
360 360 360
550 550 550
563 563 563
806 806 806
0 0 0
38 38 38
0 0 0
218 218 218
83 83 83
32 32 32
9 9 9
3 3 3
14 14 14
0 0 0
0 0 0
151 151 151
189 189 189
1022 1022 1022
-9 -9 -9
200 200 200
1937 1937 1937
0 0 0
0 0 0
19 19 19
30 30 30
2893 2893 2893
0 0 0
12 12 12
19 19 19
4 4 4
1374 1374 1374
0 0 0
0 0 0
100 100 100
170 170 170
78 78 78
KEADAAN
NON JKN/ FISIK KET
BLUD
940 940 940

480 480 480
4275 4275 4275
285 285 285
5 5 5
18 18 18
307 307 307
48 48 48
32 32 32
25 25 25
850 850 850
0 0 0
24 24 24
6 6 6
1 1 1
0 0 0
2 2 2
6 6 6
185 185 185
194 194 194
116 116 116
490 490 490
0 0 0
22290 22290 22290
0 0 0
80 80 80
1850 1850 1850
597 597 597
111 111 111
184 184 184
60 60 60
136 136 136
0 0 0
58 58 58
142 142 142
0 0 0
0 0 0
0 0 0
0 0 0
11 11 11
404 404 404
2438 2438 2438
1401 1401 1401
0 0 0
175 175 175
1585 1585 1585
2 2 2
206 206 206
92 92 92
0 0 0
0 0 0
17 17 17
0 0 0
22 22 22
0 0 0
6 6 6
188 188 188
97 97 97
KEADAAN
NON JKN/ FISIK KET
BLUD
12 12 12
33 33 33
41 41 41
236 236 236
22 22 22
22 22 22
142 142 142
0 0 0
3 3 3
11 11 11
292 292 292
119 119 119
35 35 35
18 18 18
150 150 150
0 0 0
10 10 10
0 0 0
0 0 0
0 0 0
280 280 280
138 138 138
0 0 0
600 600 600
0 0 0
0 0 0
43 43 43
0 0 0
230 230 230
46 46 46
1 1 1
0 0 0
0 0 0
3 3 3
3 3 3
3 3 3
0 0 0
51 51 51
51 51 51
21 21 21
8 8 8
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
15 15 15
0 0 0
0 0 0
0 0 0
25 25 25
0 0 0
0 0 0
1100 1100 1100
0 0 0
100 100 100
0 0 0
KEADAAN
NON JKN/ FISIK KET
BLUD
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
1070
53
77
37
42
69
70
0
2600
46
0
283
842
Garut, 1 April 2019

Yang Melaporkan,

NIP.
DAFTAR LAMPIRAN BERITA ACARA STOCK OPNAME OBAT PUSKESMAS CISOMPET BULAN APRIL 20
STOK AWAL APRIL 2019 PENERIMAAN PENYALURAN
No NAMA OBAT SATUAN JKN/B NON JKN/ NON JKN/ PERSEDIA

NON TOTAL JKN/B NON TOTAL AN JKN/B
LUD BLUD LUD BLUD LUD
1 Albendazol Tablet 400 mg Tablet 9545 9545 0 0 9545

2 Alopurinol Tablet 100 mg Tablet 676 676 500 500 1176
3 Aminofilin Inj 24 mg/ml-10 ml Ampul 0 0 0 0 0
4 Aminofilin Tablet 200 mg Tablet 0 0 0 0 0
5 Amitriptilina HCl Tablet salut 25 mg Tablet 250 250 0 0 250
6 Amlodipin Tablet 5 mg Tablet 628 628 300 300 928
7 Amoksisilin Kaplet 500 mg Kaplet 1799 1799 2500 2500 4299
8 Amoksisilin Sirup Kering 125 mg/5 ml Botol 222 222 0 0 222
9 Antasida DOEN I Tablet Kunyah Tablet 2197 2197 4000 4000 6197
10 Antasida II Suspensi 60 ml Botol 82 82 100 100 182
11 Anti Hemmoroid DOEN Supp 31 31 10 10 41
12 Antibakteri DOEN Tube 37 37 0 0 37
13 Antifungi DOEN kombinasi Pot 42 42 0 0 42
14 Antimigren DOEN Tablet 62 62 0 0 62
15 Aqua Pro Inj steril bebas pirogen- 20 ml Vial 11 11 10 10 21
16 ARV: Efavirenz 600 mg Tablet 0 0 0 0 0
17 ARV: Lamivudine 150 mg Tablet 0 0 0 0 0
18 ARV: Lovinapir 200 mg Ronavir Tablet 0 0 0 0 0
19 ARV: Nevirapine 200 mg Tablet 0 0 0 0 0
20 ARV: TDF(300) + 3TC(300) + EFV(600) Tablet 0 0 0 0 0
21 ARV: Tenofovir 300 mg Tablet 0 0 0 0 0
22 ARV: Zdvdn(60) + Lmvdn(30) + Nvrpn(50) Tablet 0 0 0 0 0
23 ARV: Zidovudine(300) + Lamivudine(150) Tablet 0 0 0 0 0
24 Asam Asetilsalisilat Tablet 80 mg (Asetosal) Tablet 246 246 0 0 246
25 Asam Askorbat (VIT C) Tablet 50 mg Tablet 475 475 500 500 975
26 Asam Folat Tablet 0,4 mg Tablet 5540 5540 0 0 5540
27 Asam Mefenamat kaplet 500 mg Tablet 2610 2610 1500 1500 4110
28 Asiklovir Krim 5%/5g Tube 43 43 0 0 43
29 Asiklovir Tablet 400 mg Tablet 553 553 0 0 553
30 Atapulgit Tablet 600 mg Tablet 47 47 600 600 647
31 Atropin Sulfat Inj 0,25 mg/ml Ampul 16 16 0 0 16
32 Azithromisin Tablet 500 mg Tablet 0 0 0 0 0
33 Benzatin Benzil Penisilin Inj 2,4 juta IU/vial Vial 16 16 0 0 16
34 Betahistin Tablet 6 mg Tablet 295 295 120 120 415
35 Betametason Krim 0.1 % Tube 34 34 50 50 84
36 Bisoprolol Tablet 5 mg Tablet 64 64 0 0 64
37 Bromheksin Tablet 8 mg Tablet 1089 1089 1000 1000 2089
38 Clobazam Tablet 10 mg Tablet 0 0 0 0 0
39 Clozapine Tablet 25 mg Tablet 0 0 0 0 0
40 Dehidroartemisin 40 mg + Piperaquin 320 mg Paket 0 0 0 0 0
41 Deksametason Inj 5 mg/ml-1 ml Ampul 20 20 50 50 70
42 Deksametason Tablet 0,5 mg Tablet 1745 1745 0 0 1745
43 Dekstrometorfan Tablet kombinasi Tablet 632 632 600 600 1232
44 Dektrometorfan Sirup kombinasi Botol 4 4 60 60 64
45 Devitalisasi Pasta Botol 0 0 0 0 0
46 Dextrose Inj 40% Vial 0 0 0 0 0
47 Diazepam Inj 5 mg/ml-2 ml Ampul 8 8 550 550 558
48 Diazepam Rectal 5 mg/2,5 ml tube 3 3 0 0 3
PERSEDIA
No NAMA OBAT SATUAN JKN/B NON JKN/ NON JKN/
LUD LUD LUD
BLUD BLUD
49 Diazepam Tablet 2 mg Tablet 164 164 0 0 164

50 Difenhidramin Inj 10 mg/ml Ampul 46 46 0 0 46
51 Digoksin Tablet 0,25 mg Tablet 200 200 0 0 200
52 Dimenhidrinat Tablet 50 mg Tablet 0 0 0 0 0
53 Doksisilin Tablet 100 mg Tablet 0 0 0 0 0
54 Domperidon Suspensi 5mg/5ml Botol 34 34 0 0 34
55 Domperidon Tablet 10 mg Tablet 345 345 1000 1000 1345
56 Endometason Botol 0 0 0 0 0
57 Epinefrina HCl/Bitartrat (Adrenalin) Inj 0,1 % Ampul 8 8 0 0 8
58 Eritromisin Kapsul 250 mg Kapsul 1160 1160 0 0 1160
59 Eritromisin Kapsul 500 mg Kapsul 0 0 0 0 0
60 Eritromisin Sirup 200 mg/5 ml Botol 3 3 0 0 3
61 Etakridin Larutan 0,1 % Botol 0 0 0 0 0
62 Etanol 70 %- 1000 ml Botol 3 3 3 3 6
63 Etil Klorida Spray Botol 0 0 0 0 0
64 Eugenol Cairan Botol 0 0 0 0 0
65 Fenitoin Natrium Kapsul 100 mg Kapsul 45 45 300 300 345
66 Fenobarbital Tablet 30 mg Tablet 67 67 0 0 67
67 Fenoksimetil Penisilin Tablet 500 mg Tablet 0 0 0 0 0
68 Fitomenadion (Vit K1) Tablet Salut Gula 10 mg Tablet 230 230 0 0 230
69 Fitomenadion(Vit K1) Inj 2 mg/ml Ampul 65 65 1620 1620 1685
70 Fluconazol Tablet 150 mg Tablet 0 0 0 0 0
71 Flufenazin Inj im 25 mg/ml (Sikzonoate) Ampul 0 0 0 0 0
72 Formokresol Cair Botol 0 0 0 0 0
73 Furosemid Tablet 40 mg Tablet 273 273 200 200 473
74 Garam Oralit I Serbuk Sachet 55 55 0 0 55
75 Gentamisin Inj 40 mg/ml (Sulfat) Vial 48 48 750 750 798
76 Gentamisin Salep Kulit 0,1% Tube 33 33 0 0 33
77 Glass Ionomer Cement Botol 0 0 0 0 0
78 Glibenklamid Tablet 5 mg Tablet 89 89 0 0 89
79 Gliseril Guaiakolat Tablet 100 mg Tablet 999 999 1000 1000 1999
80 Glukosa Larutan Infus 5% steril Fls 15 15 0 0 15
81 Griseofulvin Tablet 125 mg Micronized Tablet 306 306 0 0 306
82 Haloperidol 5 mg Tablet 464 464 0 0 464
83 Haloperidol Dekanoat Inj 50 mg/ml Ampul 10 10 0 0 10
84 Haloperidol Inj 5 mg/ml Ampul 0 0 0 0 0
85 Haloperidol Tablet 1,5 mg Tablet 1830 1830 0 0 1830
86 Hidrokortison Krim 2,5 % Tube 1 1 48 48 49
87 Hiosina butilbromida tab 10 mg Tablet 254 254 300 300 554

88 (Tetagam) Set 0 0 0 0 0
89 Ibuprofen Tablet 400 mg Tablet 36 36 300 300 336
90 Isoniazid Tablet 100 mg Tablet 300 300 0 0 300
91 Isosorbid Dinitrat Tablet Sublingual 5 mg Tablet 52 52 0 0 52
92 Kalsium glukonat inj 100 mg/ml Ampul 10 10 0 0 10
93 Kalsium hidroksida pasta Botol 0 0 0 0 0
94 Kalsium Laktat (Kalk) Tablet 500 mg Tablet 2183 2183 0 0 2183
95 Kaptropil Tablet 25 mg Tablet 1515 1515 1000 1000 2515
96 Karbamazepin Tablet 200 mg Tablet 450 450 200 200 650
97 Karbogliserin Tetes Telinga 10 % Botol 13 13 0 0 13
98 Karbon aktif tab 0,5 mg Tablet 0 0 0 0 0
PERSEDIA
LUD LUD LUD
BLUD BLUD
99 Ketokonazol Tablet 200 mg Tablet 172 172 0 0 172

100 Ketoprofen Supp 100 mg Supp 0 0 0 0 0
101 Kina Inj 26 % 2 ml Ampul 0 0 0 0 0
102 Kina Tablet 222 mg Tablet 0 0 0 0 0
103 Klindanmisin Tablet 300 mg Tablet 0 0 0 0 0
104 Kloramfenikol Kapsul 250 mg Kapsul 0 0 0 0 0
105 Kloramfenikol Kapsul 500 mg Kapsul 280 280 0 0 280
106 Kloramfenikol Salep Kulit 2% Tube 47 47 0 0 47
107 Kloramfenikol Salep Mata 1 % Tube 32 32 0 0 32
108 Kloramfenikol Sirup 125 mg/5 ml Botol 20 20 0 0 20
109 Kloramfenikol Tetes Mata 0.5% Botol 41 41 0 0 41
110 Kloramfenikol Tetes telinga 3 % Tube 9 9 20 20 29
111 Klorfenarimin Maleat (CTM) Tablet 4 mg Tablet 2703 2703 1000 1000 3703
112 Klorpropmazin HCl Tablet salut 100 mg Tablet 320 320 200 200 520
113 Kotrimoksazol Susp:Sulf 200+Trim 40 mg/5 ml Botol 62 62 0 0 62
114 Kotrimoksazol Tab Dws:Sulf 400+Trim 80 mg Tablet 240 240 0 0 240
Lidokain Inj Komp : Lidokain %+ Epinefrin 1 :

115 80000-2 ml Ampul 86 86 90 90 176
116 Lidokain Jelly 2 % Tube 1 1 0 0 1
117 Lidokain Spray 10 % Botol 2 2 0 0 2
118 Lisol Botol 4 4 0 0 4
119 Loratadin Tablet 10 mg Tablet 853 853 1000 1000 1853
120 Magnesium sulfat Inj (IV) 20 % Ampul 0 0 0 0 0
121 Magnesium sulfat Inj (IV) 40 % Ampul 28 28 75 75 103
122 MB Anak Blister 0 0 0 0 0
123 MB Dewasa Blister 3 3 0 0 3
124 Metformin HCl Tablet 500 mg Tablet 440 440 200 200 640
125 Metildopa Tablet 250 mg Tablet 250 250 0 0 250
126 Metilergomatrin Maleat Inj 0,200 mg Ampul 5 5 530 530 535

127 Tablet Salut 0,125 mg Tablet 124 124 100 100 224
128 Metilprednisolon Tablet 4 mg Tablet 776 776 500 500 1276
129 Metronidazol Tablet 500 mg Tablet 151 151 100 100 251
130 Mikonazol Krim/Salep 2% Tube 43 43 48 48 91
131 Mineral Mix Sachet 0 0 0 0 0
132 Monoklorkamfer mentol cairan Botol 0 0 0 0 0
133 Multivitamin + DHA + Lysin Sirup Botol 13 13 30 30 43
134 Multivitamin + Mineral Kaplet Kaplet 360 360 300 300 660
135 N-asetil sistein kaps 200 mg Kapsul 550 550 960 960 1510
136 Natrium Bikarbonat Tablet 500 mg Tablet 563 563 0 0 563
137 Natrium Diklofenak Tablet 50 mg Tablet 806 806 500 500 1306
138 Natrium Hipoklorit 3% Botol 0 0 0 0 0
139 Natrium Klorida Larutan Infus 0,9% Fls 38 38 0 0 38
140 Natrium Tiroksin Tablet 100 µg Tablet 0 0 0 0 0
141 Nipedipin Tablet 10 mg Tablet 218 218 0 0 218
142 Nistatin Tablet Salut Gula 500.000 IU/g Tablet 83 83 0 0 83
143 Nistatin Tablet Vaginal 100.000 IU/g Tablet 32 32 0 0 32
144 OAT FDC Katagori 1 Paket 9 9 0 0 9
145 OAT FDC Katagori 2 Paket 3 3 0 0 3
146 OAT FDC Kategori Anak paket 14 14 0 0 14
147 OAT FDC Kategori Sisipan Paket 0 0 0 0 0
PERSEDIA
LUD LUD LUD
BLUD BLUD
148 OAT Kombipak Kat I paket 0 0 0 0 0

149 Obat Batuk Hitam (OBH) Cairan Botol 151 151 100 100 251
150 Oksitosin Inj 10 IU/ml- 1 ml Ampul 189 189 200 200 389
151 Omeprazol Kapsul 20 mg Kapsul 1022 1022 0 0 1022
152 Ondansetron Inj 4 mg/2 ml Ampul -9 -9 200 200 191
153 Parasetamol Sirup 120 mg / 5ml Botol 200 200 200 200 400
154 Parasetamol Tablet 500 mg Tablet 1937 1937 9000 9000 10937
155 PB Anak Blister 0 0 0 0 0
156 PB Dewasa Blister 0 0 0 0 0
157 Permetrin 5% Krim (Scabimite) Tube 19 19 20 20 39
Phenolphtalein, Paraffin Liquidum, Gliserin Sirup

158 (Laxadin syr) botol 30 30 0 0 30
159 Piridoksin HCl (Vit B6) Tablet 10 mg Tablet 2893 2893 1000 1000 3893
160 Pirimetamin Tablet 25 mg Tablet 0 0 0 0 0
161 Polikresulen (Albotyl) Botol 5 ml botol 12 12 0 0 12
162 Povidon Iodida 10 %-30 ml Botol 19 19 0 0 19
163 Povidon Iodida 10 %-300 ml Botol 4 4 0 0 4
164 Prednison Tablet 5 mg Tablet 1374 1374 500 500 1874
165 Primakuin Tablet 15 mg Tablet 0 0 0 0 0
166 Prokain Benzilpenisilin Serb Inj 3 juta UI/vial (i.m.) Vial 0 0 0 0 0

167 Propanolol HCl Tablet 40 mg Tablet 100 100 0 0 100
168 Propiltiourasil Tablet 100 mg Tablet 170 170 0 0 170
169 Ranitidin Inj 25 mg/ml Ampul 78 78 300 300 378
170 Ranitidin Tablet 150 mg Tablet 940 940 1500 1500 2440
171 Retinol (Vit A) Kapsul 100.000 IU Kapsul 480 480 0 0 480
172 Retinol (VIT A) Kapsul 200.000 IU Kapsul 4275 4275 0 0 4275
173 Ringer Laktat Larutan Infus Steril Fls 285 285 200 200 485
174 Risperidon Tablet 2 mg Tablet 5 5 0 0 5
175 Salbutamol Nebu 2,5 mg/2,5 ml NaCl Ampul 18 18 0 0 18
176 Salbutamol Tablet 4 mg Tablet 307 307 0 0 307
177 Salep 2-4 kombinasi : as.asal 2 % + Bel. 4 % Pot 48 48 0 0 48
178 Salisil Bedak 2 % Kotak 32 32 0 0 32
179 Sefadroksil Sirup 125 mg/5 ml Botol 25 25 0 0 25
180 Sefadroxil Kapsul 500 mg Kapsul 850 850 1000 1000 1850
181 Sefiksime 200 mg + Azitromisin 500 mg Paket 0 0 0 0 0
182 Sefotaksim Inj 1 g Vial 24 24 0 0 24
183 Seftriaxon Inj 1 g Vial 6 6 0 0 6
184 Semen seng fosfat serbuk cairan Botol 1 1 0 0 1
185 Serum Anti Difteri (ADS) Vial 0 0 0 0 0
186 Serum anti tetanus Inj 1500 IU/vial (ATS) Ampul 2 2 0 0 2
187 Serum antibisa ular Polivalen Inj 5 ml (SABU) I Vial 6 6 0 0 6
188 Setirizin Sirup 5 mg/5 ml Botol 185 185 0 0 185
189 Sianokobalamin (Vit B12 ) Inj 500 mcg/ml Ampul 194 194 0 0 194
190 Simvastatin Tablet 10 mg Tablet 116 116 30 30 146
191 Siprofloksasin (HCl) Tablet 500 mg Kaplet 490 490 0 0 490
192 Tablet Tambah Darah (Camabion) Buah 0 0 0 0 0
193 Tablet Tambah Darah Kombinasi Tablet 22290 22290 77760 77760 100050
194 Temporary Restorative Material Botol 0 0 0 0 0
195 Tetrasiklin Kapsul 500 mg Kapsul 80 80 0 0 80
PERSEDIA
LUD LUD LUD
BLUD BLUD
196 Tiamin HCL (Vit B1) Tablet 50 mg Tablet 1850 1850 1000 1000 2850
197 Triheksifenidil HCl Tablet 2 mg Tablet 597 597 500 500 1097
198 Vaksin BCG + Pelarut Set 111 111 20 20 131
199 Vaksin DPT-Hb-Hib Vial 184 184 15 15 199
200 Vaksin DT Vial 60 60 0 0 60
201 Vaksin Hb-0 Set 136 136 100 100 236
202 Vaksin IPV 10 ds Vial 0 0 0 0 0
203 Vaksin IPV 5 ds Vial 58 58 50 50 108
204 Vaksin Measles Rubella (MR) Vial 142 142 50 50 192
205 Vaksin Meningitis Paket 0 0 0 0 0
206 Vaksin Papillomavirus (HPV) Vial 0 0 0 0 0
207 Vaksin Pneumococcus Vial 0 0 0 0 0
208 Vaksin Polio 10 ds bopv + Penetes Set 0 0 0 0 0
209 Vaksin Rabies Vero Set 11 11 0 0 11
210 Vaksin Td Vial 404 404 0 0 404
211 Vitamin B Kompleks Tablet Tablet 2438 2438 1000 1000 3438
212 Zinc Tablet 20 mg Tablet 1401 1401 0 0 1401
BAHAN HABIS PAKAI 0 0 0 0 0
213 ADS 0.05 ml Buah 175 175 100 100 275
214 ADS 0.5 ml Buah 1585 1585 900 900 2485
215 ADS 5 ml Buah 2 2 200 200 202
216 Alat Suntik Sekali Pakai 1ml Set 206 206 200 200 406
219 Alkohol Swab Buah 0 0 0 0 0
220 Bisturi Buah 17 17 0 0 17
221 Blood set Buah 0 0 0 0 0

222 bedah Set 22 22 12 12 34

223 bedah Set 0 0 0 0 0
224 Folley Catheter No.18 Buah 6 6 10 10 16
225 Infusion set anak Kantong 188 188 0 0 188
226 Infusion set dewasa Kantong 97 97 50 50 147
227 IV Catheter No.18 Set 12 12 20 20 32
231 Jarum kulit Buah 22 22 0 0 22
232 Jarum otot Buah 22 22 0 0 22
233 Kaca Slide Buah 142 142 0 0 142
234 Kantung mayat Buah 0 0 0 0 0
235 Kapas Pembalut/absorben 250 mg Roll 3 3 5 5 8
236 Kasa Hidrofil 2x80 Roll 11 11 10 10 21
237 Kasa Hidrofil Steril 16 X 16 Lembar 292 292 0 0 292
238 Kasa Pembalut Hidrofil 4 X 10 cm Roll 119 119 0 0 119
239 Kasa Pembalut hidrofil 4 x 5 cm Roll 35 35 0 0 35
240 Kassa Pembalut elastic 4 inchi Roll 18 18 0 0 18
241 Masker Tie on Buah 150 150 100 100 250
242 Masker N-95 Buah 0 0 0 0 0
PERSEDIA
LUD LUD LUD
BLUD BLUD
243 Plester 5 yard x 2 inch Roll 10 10 5 5 15

244 Polybag Medis Lembar 0 0 0 0 0
245 Polybag Nonmedis Lembar 0 0 0 0 0
246 Polybag Ramah Lingkungan Lembar 0 0 0 0 0
247 Pot Dahak Buah 280 280 0 0 280
248 Safety box Buah 138 138 0 0 138
249 Sarung Tangan Non Steril Uk.S Buah 0 0 100 100 100
250 Sarung Tangan Non Steril Uk.M Buah 600 600 0 0 600
251 Sarung Tangan Non Steril Uk.L Buah 0 0 0 0 0
252 Sarung Tangan Steril No.6 Set 0 0 0 0 0
253 Sarung Tangan Steril No.6,5 Set 43 43 0 0 43
254 Sarung Tangan Steril No.7 Set 0 0 0 0 0
255 Sendok Obat Buah 230 230 0 0 230
Silk (Benang Bedah Sutera) No.2/0 Dengan Jarum

256 Bedah Set 46 46 24 24 70
257 Urin Bag Buah 1 1 10 10 11
258 REAGEN 0 0 0 0 0
259 Cybow 10 Reagent Strip Set 0 0 0 0 0
260 Golongan darah anti A - 10 ml Botol 3 3 0 0 3
261 Golongan darah anti A-B - 10 ml Botol 3 3 0 0 3
262 Golongan darah anti B - 10 ml Botol 3 3 0 0 3
263 Humasens Plus Set 0 0 0 0 0
264 Humasens Plus Strip Uric Acid Kotak 51 51 0 0 51
265 Humasens Strip Glucose Kotak 51 51 0 0 51
266 Humasens Strip Kolesterol Kotak 21 21 0 0 21
267 Iodin test Botol 8 8 0 0 8
268 Larutan Asam Asetat 6% 100 ml Botol 0 0 0 0 0
269 Larutan Benedict 100 ml Botol 0 0 0 0 0
270 Larutan EDTA 10 % 100 ml Botol 0 0 0 0 0
271 Larutan HCl 0,1 N 100 ml Botol 0 0 0 0 0
272 Larutan Natrium Citrat 3,13 % Botol 0 0 0 0 0
273 Larutan Rees Ecker 100 ml Botol 0 0 0 0 0
274 Larutan Turk 100 ml Botol 0 0 0 0 0
275 Larutan Ziehl Neelsen Botol 15 15 0 0 15
276 Rapid HIV 1/2 Device test 0 0 0 0 0
277 Rapid HIV 2 Fokus test 0 0 0 0 0
278 Rapid HIV Biomedika Sachet 0 0 0 0 0
279 Rapid HIV Biomeriux Sachet 25 25 0 0 25
280 Rapid HIV Intec Sachet 0 0 0 0 0
281 Rapid HIV Oncoprobe Sachet 0 0 0 0 0
282 Rapid HIV SD Sachet 1100 1100 0 0 1100
283 Rapid Malaria Sachet 0 0 0 0 0
284 Rapid Syphilis SD Sachet 100 100 0 0 100
285 Reagen CD4 kontrol test 0 0 0 0 0
286 Reagen CD4 tipe 1 (Alere Pima CD4) test 0 0 0 0 0
287 RPR Syphilis Sachet 0 0 0 0 0
288 Salmonella Thyphi H - 5 ml Botol 0 0 0 0 0
289 Salmonella Thyphi O - 5 ml Botol 0 0 0 0 0
290 Test Kehamilan Buah 0 0 0 0 0
LAIN-LAIN 0 0 0 0 0
291 Tiamin HCL (Vit B1) Inj 100 mg/ml-1ml Ampul 0 0 720 720 720
PERSEDIA
LUD LUD LUD
BLUD BLUD
BARANG PKM 0 0 0 0
294 Mucus Extractor 77 77 0 0 77 20
295 Gel USG 250 mL 37 37 0 0 37 1
304 Amoxicillin syr 250 mg 842 842 0 842 23
305 Ampicillin inj 10 mg/ml 600 600 600
306 Metronidazol Infus 25 25 25
307 Oksitetrasiklin Salep Mata 550 550 550
Mengetahui,
Kepala Puskesmas

NIP. 19680819 198803 1 001
SMAS CISOMPET BULAN APRIL 2019
SISA STOK ( KARTU

KEADAAN
NON JKN/ NON JKN/ FISIK KET
NON TOTAL JKN/B NON TOTAL
LUD BARANG ( + ) ( - )
BLUD BLUD
2141 2141 7404 7404 7404

352 352 824 824 824
0 0 0 0 0
0 0 0 0 0
15 15 235 235 235
148 148 780 780 780
2829 2829 1470 1470 1470
82 82 140 140 140
4768 4768 1429 1429 1429
50 50 132 132 132
3 3 38 38 38
0 0 37 37 37
1 1 41 41 41
62 62 0 0 0
5 5 16 16 16
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
20 20 226 226 226
400 400 575 575 575
5450 5450 90 90 90
1810 1810 2300 2300 2300
8 8 35 35 35
87 87 466 466 466
0 0 647 647 647
0 0 16 16 16
0 0 0 0 0
0 0 16 16 16
101 101 314 314 314
16 16 68 68 68
10 10 54 54 54
259 259 1830 1830 1830
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
2 2 68 68 68
796 796 949 949 949
1080 1080 152 152 152
40 40 24 24 24
0 0 0 0 0
0 0 0 0 0
0 0 558 558 558
2 2 1 1 1
SISA STOK ( KARTU
KEADAAN
BLUD BLUD
8 8 156 156 156

0 0 46 46 46
0 0 200 200 200
0 0 0 0 0
0 0 0 0 0
27 27 7 7 7
535 535 810 810 810
0 0 0 0 0
0 0 8 8 8
10 10 1150 1150 1150
0 0 0 0 0
0 0 3 3 3
0 0 0 0 0
6 6 0 0 0
0 0 0 0 0
0 0 0 0 0
185 185 160 160 160
0 0 67 67 67
0 0 0 0 0
28 28 202 202 202
35 35 1650 1650 1650
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
11 11 462 462 462
55 55 0 0 0
2 2 796 796 796
16 16 17 17 17
0 0 0 0 0
50 50 39 39 39
1049 1049 950 950 950
0 0 15 15 15
100 100 206 206 206
460 460 4 4 4
0 0 10 10 10
0 0 0 0 0
0 0 1830 1830 1830
6 6 43 43 43
30 30 524 524 524
0 0 0 0 0
276 276 60 60 60
0 0 300 300 300
5 5 47 47 47
0 0 10 10 10
0 0 0 0 0
710 710 1473 1473 1473
871 871 1644 1644 1644
90 90 560 560 560
3 3 10 10 10
0 0 0 0 0
SISA STOK ( KARTU
KEADAAN
BLUD BLUD
77 77 95 95 95
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
240 240 40 40 40
5 5 42 42 42
13 13 19 19 19
0 0 20 20 20
41 41 0 0 0
5 5 24 24 24
923 923 2780 2780 2780
317 317 203 203 203
41 41 21 21 21
40 40 200 200 200
58 58 118 118 118

0 0 1 1 1
0 0 2 2 2
0 0 4 4 4
590 590 1263 1263 1263
0 0 0 0 0
22 22 81 81 81
0 0 0 0 0
0 0 3 3 3
310 310 330 330 330
130 130 120 120 120
0 0 535 535 535 ED
50 50 174 174 174

665 665 611 611 611
220 220 31 31 31
36 36 55 55 55
0 0 0 0 0
0 0 0 0 0
40 40 3 3 3
203 203 457 457 457
30 30 1480 1480 1480
70 70 493 493 493
472 472 834 834 834
0 0 0 0 0
5 5 33 33 33
0 0 0 0 0
130 130 88 88 88
24 24 59 59 59
5 5 27 27 27
7 7 2 2 2
0 0 3 3 3
0 0 14 14 14
0 0 0 0 0
SISA STOK ( KARTU
KEADAAN
BLUD BLUD
0 0 0 0 0
156 156 95 95 95
0 0 389 389 389
314 314 708 708 708
87 87 104 104 104
201 201 199 199 199
5757 5757 5180 5180 5180
0 0 0 0 0
0 0 0 0 0
11 11 28 28 28
0 0 30 30 30
1408 1408 2485 2485 2485
0 0 0 0 0
0 0 12 12 12
7 7 12 12 12
3 3 1 1 1
359 359 1515 1515 1515
0 0 0 0 0
0 0 0 0 0
0 0 100 100 100
0 0 170 170 170
185 185 193 193 193
1079 1079 1361 1361 1361
0 0 480 480 480
104 104 4171 4171 4171
433 433 52 52 52
5 5 0 0 0
18 18 0 0 0
307 307 0 0 0
4 4 44 44 44
18 18 14 14 14
6 6 19 19 19
1018 1018 832 832 832
0 0 0 0 0
4 4 20 20 20
3 3 3 3 3
0 0 1 1 1
0 0 0 0 0
0 0 2 2 2
0 0 6 6 6
28 28 157 157 157
0 0 194 194 194
100 100 46 46 46
36 36 454 454 454
0 0 0 0 0
3790 3790 96260 96260 96260
0 0 0 0 0
50 50 30 30 30
SISA STOK ( KARTU
KEADAAN
BLUD BLUD
2118 2118 732 732 732

620 620 477 477 477
89 89 42 42 42
50 50 149 149 149
0 0 60 60 60
150 150 86 86 86
0 0 0 0 0
0 0 108 108 108
100 100 92 92 92
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 11 11 11
0 0 404 404 404
2129 2129 1309 1309 1309
671 671 730 730 730
0 0 0 0 0
100 100 175 175 175
0 0 2485 2485 2485
25 25 177 177 177
267 267 139 139 139
291 291 401 401 401
0 0 0 0 0
0 0 0 0 0
4 4 13 13 13
0 0 0 0 0
22 22 12 12 12
0 0 0 0 0
8 8 8 8 8
20 20 168 168 168
105 105 42 42 42
32 32 0 0 0
29 29 24 24 24
27 27 34 34 34
127 127 109 109 109
0 0 22 22 22
0 0 22 22 22
0 0 142 142 142
0 0 0 0 0
2 2 6 6 6
21 21 0 0 0
97 97 195 195 195
34 34 85 85 85
33 33 2 2 2
0 0 18 18 18
200 200 50 50 50
0 0 0 0 0
SISA STOK ( KARTU
KEADAAN
BLUD BLUD
4 4 11 11 11
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 280 280 280
0 0 138 138 138
0 0 100 100 100
0 0 600 600 600
0 0 0 0 0
0 0 0 0 0
0 0 43 43 43
0 0 0 0 0
0 0 230 230 230
7 7 63 63 63
6 6 5 5 5
0 0 0 0 0
0 0 0 0 0
0 0 3 3 3
0 0 3 3 3
0 0 3 3 3
0 0 0 0 0
0 0 51 51 51
0 0 51 51 51
0 0 21 21 21
0 0 8 8 8
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 15 15 15
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 25 25 25
0 0 0 0 0
0 0 0 0 0
0 0 1100 1100 1100
0 0 0 0 0
0 0 100 100 100
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0
0 720 720 720
SISA STOK ( KARTU
KEADAAN
BLUD BLUD
0
163 907 907 907
2 51 51 51
20 57 57 57
1 36 36 36
0 42 42 42
0 69 69 69
0 70 70 70
0 0 0 0
700 1900 1900 1900
5 41 41 41
0 0 0 0
1 282 282 282
23 819 819 819
600 600
25 25
550 550
Garut, 3 Mei 2019

Yang Melaporkan,

NIP.
DAFTAR LAMPIRAN BERITA ACARA STOCK OPNAME OB
STOK AWAL MEI 2019 PENERIMAAN
NAMA NON JKN/ NON JKN/

No SATUAN
OBAT JKN/BLUD NON TOTAL JKN/BLUD NON
BLUD BLUD
1 AlbendazolTablet 7404 7404 0

2 Alopurinol Tablet 824 824 300
3 Aminofilin Ampul 0 0 0
4 Aminofilin Tablet 0 0 0
5 Amitriptili Tablet 235 235 0
6 Amlodipin Tablet 780 780 600
7 Amoksisili Kaplet 1470 1470 3000
8 Amoksisili Botol 140 140 0
9 Antasida DTablet 1429 1429 5000
10 Antasida II Botol 132 132 100
11 Anti HemmSupp 38 38 0
12 AntibakterTube 37 37 0
13 Antifungi Pot 41 41 0
14 Antimigre Tablet 0 0 0
15 Aqua Pro InVial 16 16 0
16 ARV: Efavi Tablet 0 0 0
17 ARV: LamivTablet 0 0 0
18 ARV: LovinTablet 0 0 0
19 ARV: NevirTablet 0 0 0
20 ARV: TDF(3Tablet 0 0 0
21 ARV: TenofTablet 0 0 0
22 ARV: ZdvdnTablet 0 0 0
23 ARV: ZidovTablet 0 0 0
24 Asam AsetilTablet 226 226 0
25 Asam AskorTablet 575 575 200
26 Asam FolatTablet 90 90 0
27 Asam MefeTablet 2300 2300 1000
28 Asiklovir K Tube 35 35 0
29 Asiklovir T Tablet 466 466 0
30 Atapulgit Tablet 647 647 500
31 Atropin SulAmpul 16 16 0
32 AzithromisTablet 0 0 0
33 Benzatin BenVial 16 16 0
34 Betahistin Tablet 314 314 300
35 Betametaso Tube 68 68 25
36 Bisoprolol Tablet 54 54 0
37 BromheksinTablet 1830 1830 0
38 Clobazam TTablet 0 0 0
39 Clozapine Tablet 0 0 0
40 DehidroartPaket 0 0 0
41 Deksametas Ampul 68 68 0
42 Deksametas Tablet 949 949 500
43 DekstrometTablet 152 152 600
44 Dektrometo Botol 24 24 30
45 DevitalisasBotol 0 0 0
46 Dextrose InVial 0 0 0
47 Diazepam IAmpul 558 558 0
48 Diazepam Rtube 1 1 10
49 Diazepam TTablet 156 156 0
50 Difenhidra Ampul 46 46 0
51 Digoksin T Tablet 200 200 0
52 DimenhidriTablet 0 0 0
53 Doksisilin Tablet 0 0 0
54 DomperidoBotol 7 7 50
55 Domperidon Tablet 810 810 300
56 EndometasBotol 0 0 0
57 Epinefrina Ampul 8 8 0
58 Eritromisi Kapsul 1150 1150 0
59 Eritromisi Kapsul 0 0 0
60 EritromisinBotol 3 3 0
61 Etakridin L Botol 0 0 0
62 Etanol 70 Botol 0 0 2
63 Etil KloridaBotol 0 0 0
64 Eugenol CaBotol 0 0 0
65 Fenitoin N Kapsul 160 160 200
66 FenobarbitTablet 67 67 0
67 Fenoksimeti Tablet 0 0 0
68 Fitomenadio Tablet 202 202 200
69 FitomenadiAmpul 1650 1650 0
70 FluconazolTablet 0 0 0
71 Flufenazin Ampul 0 0 0
72 FormokresoBotol 0 0 0
73 Furosemid Tablet 462 462 0
74 Garam Orali Sachet 0 0 200
75 GentamisinVial 796 796 0
76 GentamisinTube 17 17 24
77 Glass Iono Botol 0 0 0
78 GlibenklamTablet 39 39 100
79 Gliseril Gu Tablet 950 950 1000
80 Glukosa LarFls 15 15 0
81 Griseofulv Tablet 206 206 200
82 HaloperidoTablet 4 4 0
83 HaloperidoAmpul 10 10 0
84 HaloperidolAmpul 0 0 0
85 HaloperidoTablet 1830 1830 0
86 Hidrokorti Tube 43 43 48
87 Hiosina buTablet 524 524 400
Human
Tetanus
Imunoglo
bulin Im
250UI
88 (Tetagam) Set 0 0 0
89 Ibuprofen Tablet 60 60 300
90 Isoniazid T Tablet 300 300 0
91 Isosorbid DTablet 47 47 0
92 Kalsium gl Ampul 10 10 10
93 Kalsium hi Botol 0 0 0
94 Kalsium LakTablet 1473 1473 500
95 Kaptropil Tablet 1644 1644 0
96 Karbamazep Tablet 560 560 0
97 KarbogliserBotol 10 10 0
98 Karbon aktiTablet 0 0 0
99 KetokonazoTablet 95 95 100
100 KetoprofenSupp 0 0 0
101 Kina Inj 26 Ampul 0 0 0
102 Kina Table Tablet 0 0 0
103 KlindanmisTablet 0 0 0
104 KloramfeniKapsul 0 0 0
105 KloramfeniKapsul 40 40 300
106 Kloramfenik Tube 42 42 0
107 KloramfeniTube 19 19 48
108 KloramfeniBotol 20 20 0
109 KloramfeniBotol 0 0 50
110 Kloramfenik Tube 24 24 20
111 Klorfenari Tablet 2780 2780 0
112 Klorpropmaz Tablet 203 203 400
113 KotrimoksaBotol 21 21 200
114 KotrimoksaTablet 200 200 0
Lidokain
Inj Komp :
Lidokain
%+
Epinefrin
1 : 80000-
115 2 ml Ampul 118 118 90
116 Lidokain JeTube 1 1 0
117 Lidokain S Botol 2 2 0
118 Lisol Botol 4 4 0
119 Loratadin Tablet 1263 1263 500
120 MagnesiumAmpul
s 0 0 0
121 MagnesiumAmpul
s 81 81 0
122 MB Anak Blister 0 0 0
123 MB DewasBlister 3 3 0
124 MetforminTablet 330 330 200
125 Metildopa Tablet 120 120 100
126 MetilergomAmpul 535 535 0
Metilergo
metrin
Maleat
(Metilerg
ometrin)
Tablet
Salut
127 0,125 mg Tablet 174 174 0
128 MetilprednTablet 611 611 500
129 MetronidazTablet 31 31 100
130 Mikonazol Tube 55 55 48
131 Mineral MiSachet 0 0 0
132 Monoklorka Botol 0 0 0
133 MultivitamiBotol 3 3 30
134 MultivitamiKaplet 457 457 200
135 N-asetil si Kapsul 1480 1480 0
136 Natrium BiTablet 493 493 0
137 Natrium DiTablet 834 834 500
138 Natrium HiBotol 0 0 0
139 Natrium KloFls 33 33 0
140 Natrium TirTablet 0 0 0
141 Nipedipin Tablet 88 88 100
142 Nistatin TaTablet 59 59 0
143 Nistatin TaTablet 27 27 0
144 OAT FDC KaPaket 2 2 10
146 OAT FDC Kapaket 14 14 0
148 OAT Kombip paket 0 0 0
149 Obat BatukBotol 95 95 100
150 Oksitosin I Ampul 389 389 0
151 OmeprazolKapsul 708 708 300
152 OndansetroAmpul 104 104 50
153 ParasetamoBotol 199 199 200
154 ParasetamoTablet 5180 5180 5000
155 PB Anak Blister 0 0 0
156 PB DewasaBlister 0 0 0
157 Permetrin Tube 28 28 10
Phenolph
talein,
Paraffin
Liquidum,
Gliserin
Sirup
(Laxadin
158 syr) botol 30 30 0
159 Piridoksin Tablet 2485 2485 500
160 PirimetamiTablet 0 0 0
161 Polikresulebotol 12 12 0
162 Povidon IoBotol 12 12 0
163 Povidon IoBotol 1 1 4
164 Prednison Tablet 1515 1515 0
165 Primakuin Tablet 0 0 0
Prokain
Benzilpen
isilin Serb
Inj 3 juta
UI/vial
166 (i.m.) Vial 0 0 0
167 PropanololTablet 100 100 0
168 PropiltiourTablet 170 170 0
169 Ranitidin I Ampul 193 193 20
170 Ranitidin Tablet 1361 1361 600
171 Retinol (Vi Kapsul 480 480 0
172 Retinol (VI Kapsul 4171 4171 0
173 Ringer LaktFls 52 52 400
174 RisperidonTablet 0 0 0
175 SalbutamolAmpul 0 0 50
176 SalbutamolTablet 0 0 200
177 Salep 2-4 kPot 44 44 0
178 Salisil Bed Kotak 14 14 0
179 SefadroksilBotol 19 19 0
180 Sefadroxil Kapsul 832 832 300
181 Sefiksime Paket 0 0 0
182 SefotaksimVial 20 20 10
183 Seftriaxon IVial 3 3 5
184 Semen seng Botol 1 1 0
185 Serum AntiVial 0 0 0
186 Serum antiAmpul 2 2 0
187 Serum antib Vial 6 6 0
188 Setirizin S Botol 157 157 0
189 Sianokobala Ampul 194 194 0
190 Simvastati Tablet 46 46 120
191 SiprofloksaKaplet 454 454 0
192 Tablet TamBuah 0 0 0
193 Tablet TamTablet 96260 96260 0
194 TemporaryBotol 0 0 0
195 Tetrasiklin Kapsul 30 30 0
196 Tiamin HCLTablet 732 732 2000
197 TriheksifenTablet 477 477 500
198 Vaksin BCGSet 42 42 100
199 Vaksin DPTVial 149 149 100
200 Vaksin DT Vial 60 60 0
201 Vaksin Hb-Set 86 86 150
202 Vaksin IPV Vial 0 0 0
203 Vaksin IPV Vial 108 108 0
204 Vaksin MeaVial 92 92 100
205 Vaksin MenPaket 0 0 0
206 Vaksin PapVial 0 0 0
207 Vaksin Pn Vial 0 0 0
208 Vaksin PoliSet 0 0 100
209 Vaksin RabSet 11 11 0
210 Vaksin Td Vial 404 404 0
211 Vitamin B Tablet 1309 1309 2000
212 Zinc Table Tablet 730 730 400
BAHAN HABIS PAKAI 0 0 0
213 ADS 0.05 mBuah 175 175 0
214 ADS 0.5 mlBuah 2485 2485 1000
215 ADS 5 ml Buah 177 177 200
216 Alat SuntikSet 139 139 300
219 Alkohol SwBuah 0 0 0
220 Bisturi Buah 13 13 10
221 Blood set Buah 0 0 0
Catgut/Be
nang
Bedah
No.2/0
dengan
jarum
222 bedah Set 12 12 12
Catgut/Be
nang
Bedah
No.3/0
dengan
jarum
223 bedah Set 0 0 0
224 Folley Cat Buah 8 8 10
225 Infusion seKantong 168 168 0
226 Infusion s Kantong 42 42 100
227 IV Cathete Set 0 0 10
231 Jarum kulitBuah 22 22 0
232 Jarum ototBuah 22 22 0
233 Kaca Slide Buah 142 142 0
234 Kantung mBuah 0 0 0
235 Kapas PemRoll 6 6 0
236 Kasa HidrofRoll 0 0 10
237 Kasa HidrofiLembar 195 195 0
238 Kasa Pemba Roll 85 85 0
239 Kasa Pembal Roll 2 2 50
240 Kassa Pemba Roll 18 18 0
241 Masker TieBuah 50 50 200
242 Masker N- Buah 0 0 0
243 Plester 5 y Roll 11 11 0
244 Polybag MeLembar 0 0 0
245 Polybag N Lembar 0 0 0
246 Polybag RaLembar 0 0 0
247 Pot Dahak Buah 280 280 0
248 Safety box Buah 138 138 0
249 Sarung TanBuah 100 100 500
252 Sarung TanSet 0 0 0
253 Sarung Tang Set 43 43 0
254 Sarung TanSet 0 0 0
255 Sendok ObBuah 230 230 300
Silk
(Benang
Bedah
Sutera)
No.2/0
Dengan
Jarum
256 Bedah Set 63 63 12
257 Urin Bag Buah 5 5 10
258 REAGEN 0 0 0
259 Cybow 10 RSet 0 0 0
260 Golongan daBotol 3 3 0
263 Humasens Set 0 0 0
264 Humasens Kotak
Pl 51 51 0
265 Humasens KSotak 51 51 0
266 Humasens KSotak 21 21 0
267 Iodin test Botol 8 8 0
268 Larutan AsBotol 0 0 0
269 Larutan BeBotol 0 0 0
270 Larutan EDBotol 0 0 0
271 Larutan HCBotol 0 0 0
272 Larutan NatBotol 0 0 0
273 Larutan ReBotol 0 0 0
274 Larutan TuBotol 0 0 0
275 Larutan Zi Botol 15 15 0
276 Rapid HIV 1test 0 0 0
277 Rapid HIV 2test 0 0 0
278 Rapid HIV Sachet 0 0 0
280 Rapid HIV ISachet 0 0 0
283 Rapid MalaSachet 0 0 0
284 Rapid SyphiSachet 100 100 0
285 Reagen CD4 test 0 0 0
286 Reagen CD4 test 0 0 0
287 RPR SyphiliSachet 0 0 0
288 SalmonellaBotol 0 0 0
289 SalmonellaBotol 0 0 0
290 Test KehamBuah 0 0 0
LAIN-LAIN 0 0
291 Tiamin HCLAmpul 720 720
BARANG PKM 0
292 AmlodipineBlister 907 907
293 Ambroxol sBotol 51 51
294 Mucus Extractor 57 57
295 Gel USG 250 mL 36 36
296 Oxygen Mask Dewasa 42 42
297 Oxygen Mask Anak 69 69
298 Oxygen mask bayi 70 70
299 Sarung Tangan Non Steril Uk.S 0 0
300 Sarung Tangan Non Steril Uk.M 1900 1900
301 Sarung tangan obgyn steril 41 41
302 Kassa Hidrofil DRC 36 m x 80 cm 0 0
303 Parasetamol Infus 282 282
304 Amoxicillin syr 250 mg 819 819
305 Ampicillin inj 10 mg/ml 600
306 Metronidazol Infus 25
307 Oksitetrasiklin Salep Mata 550
Mengetahui,
Kepala Puskesmas

NIP. 19680819 198803 1 001
CARA STOCK OPNAME OBAT PUSKESMAS CISOMPET BULAN MEI 2019
PENERIMAAN PENYALURAN SISA STOK ( KARTU BARANG ) SELISIH

KEADAAN
PERSEDIA NON JKN/ NON JKN/ FISIK
TOTAL AN JKN/BLUD NON TOTAL JKN/BLUD NON TOTAL (+)
BARANG
BLUD BLUD
0 7404 51 51 7353 7353 7353

300 1124 160 160 964 964 964
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 235 0 0 235 235 235
600 1380 494 494 886 886 886
3000 4470 2537 2537 1933 1933 1933
0 140 80 80 60 60 60
5000 6429 2594 2594 3835 3835 3835
100 232 0 0 232 232 232
0 38 7 7 31 31 31
0 37 0 0 37 37 37
0 41 0 0 41 41 41
0 0 0 0 0 0 0
0 16 15 15 1 1 1
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 226 5 5 221 221 221
200 775 177 177 598 598 598
0 90 90 90 0 0 0
1000 3300 1796 1796 1504 1504 1504
0 35 2 2 33 33 33
0 466 20 20 446 446 446
500 1147 552 552 595 595 595
0 16 0 0 16 16 16
0 0 0 0 0 0 0
0 16 0 0 16 16 16
300 614 254 254 360 360 360
25 93 22 22 71 71 71
0 54 0 0 54 54 54
0 1830 10 10 1820 1820 1820
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 68 33 33 35 35 35
500 1449 803 803 646 646 646
600 752 540 540 212 212 212
30 54 46 46 8 8 8
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 558 0 0 558 558 558
10 11 0 0 11 11 11
0 156 0 0 156 156 156
0 46 0 0 46 46 46
0 200 0 0 200 200 200
0 0 0 0 0 0 0
0 0 0 0 0 0 0
50 57 40 40 17 17 17
300 1110 1030 1030 80 80 80
0 0 0 0 0 0 0
0 8 0 0 8 8 8
0 1150 0 0 1150 1150 1150
0 0 0 0 0 0 0
0 3 3 3 0 0 0
0 0 0 0 0 0 0
2 2 2 2 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
200 360 210 210 150 150 150
0 67 0 0 67 67 67
0 0 0 0 0 0 0
200 402 86 86 316 316 316
0 1650 0 0 1650 1650 1650
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 462 30 30 432 432 432
200 200 50 50 150 150 150
0 796 0 0 796 796 796
24 41 21 21 20 20 20
0 0 0 0 0 0 0
100 139 5 5 134 134 134
1000 1950 1190 1190 760 760 760
0 15 0 0 15 15 15
200 406 85 85 321 321 321
0 4 0 0 4 4 4
0 10 0 0 10 10 10
0 0 0 0 0 0 0
0 1830 330 330 1500 1500 1500
48 91 16 16 75 75 75
400 924 284 284 640 640 640
0 0 0 0 0 0 0
300 360 248 248 112 112 112
0 300 0 0 300 300 300
0 47 5 5 42 42 42
10 20 0 0 20 20 20
0 0 0 0 0 0 0
500 1973 830 830 1143 1143 1143
0 1644 881 881 763 763 763
0 560 70 70 490 490 490
0 10 5 5 5 5 5
0 0 0 0 0 0 0
100 195 72 72 123 123 123
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
300 340 140 140 200 200 200
0 42 1 1 41 41 41
48 67 32 32 35 35 35
0 20 20 20 0 0 0
50 50 10 10 40 40 40
20 44 9 9 35 35 35
0 2780 1457 1457 1323 1323 1323
400 603 385 385 218 218 218
200 221 20 20 201 201 201
0 200 179 179 21 21 21
90 208 133 133 75 75 75
0 1 0 0 1 1 1
0 2 1 1 1 1 1
0 4 0 0 4 4 4
500 1763 573 573 1190 1190 1190
0 0 0 0 0 0 0
0 81 16 16 65 65 65
0 0 0 0 0 0 0
0 3 0 0 3 3 3
200 530 360 360 170 170 170
100 220 120 120 100 100 100
0 535 35 35 500 500 500
0 174 46 46 128 128 128

500 1111 413 413 698 698 698
100 131 90 90 41 41 41
48 103 39 39 64 64 64
0 0 0 0 0 0 0
0 0 0 0 0 0 0
30 33 19 19 14 14 14
200 657 100 100 557 557 557
0 1480 70 70 1410 1410 1410
0 493 10 10 483 483 483
500 1334 298 298 1036 1036 1036
0 0 0 0 0 0 0
0 33 11 11 22 22 22
0 0 0 0 0 0 0
100 188 8 8 180 180 180
0 59 17 17 42 42 42
0 27 1 1 26 26 26
10 12 5 5 7 7 7
0 3 0 0 3 3 3
0 14 0 0 14 14 14
0 0 0 0 0 0 0
0 0 0 0 0 0 0
100 195 57 57 138 138 138
0 389 0 0 389 389 389
300 1008 668 668 340 340 340
50 154 101 101 53 53 53
200 399 197 197 202 202 202
5000 10180 6602 6602 3578 3578 3578
0 0 0 0 0 0 0
0 0 0 0 0 0 0
10 38 11 11 27 27 27
0 30 2 2 28 28 28
500 2985 935 935 2050 2050 2050
0 0 0 0 0 0 0
0 12 0 0 12 12 12
0 12 3 3 9 9 9
4 5 1 1 4 4 4
0 1515 125 125 1390 1390 1390
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 100 0 0 100 100 100
0 170 0 0 170 170 170
20 213 213 213 0 0 0
600 1961 1181 1181 780 780 780
0 480 0 0 480 480 480
0 4171 152 152 4019 4019 4019
400 452 312 312 140 140 140
0 0 0 0 0 0 0
50 50 0 0 50 50 50
200 200 128 128 72 72 72
0 44 4 4 40 40 40
0 14 3 3 11 11 11
0 19 6 6 13 13 13
300 1132 1080 1080 52 52 52
0 0 0 0 0 0 0
10 30 17 17 13 13 13
5 8 5 5 3 3 3
0 1 0 0 1 1 1
0 0 0 0 0 0 0
0 2 0 0 2 2 2
0 6 0 0 6 6 6
0 157 77 77 80 80 80
0 194 3 3 191 191 191
120 166 26 26 140 140 140
0 454 20 20 434 434 434
0 0 0 0 0 0 0
0 96260 1260 1260 95000 95000 95000
0 0 0 0 0 0 0
0 30 0 0 30 30 30
2000 2732 1090 1090 1642 1642 1642
500 977 746 746 231 231 231
100 142 23 23 119 119 119
100 249 131 131 118 118 118
0 60 10 10 50 50 50
150 236 0 0 236 236 236
0 0 0 0 0 0 0
0 108 10 10 98 98 98
100 192 35 35 157 157 157
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
100 100 0 0 100 100 100
0 11 0 0 11 11 11
0 404 67 67 337 337 337
2000 3309 1879 1879 1430 1430 1430
400 1130 310 310 820 820 820
0 0 0 0 0 0 0
0 175 41 41 134 134 134
1000 3485 1245 1245 2240 2240 2240
200 377 236 236 141 141 141
300 439 170 170 269 269 269
200 601 363 363 238 238 238
0 0 0 0 0 0 0
0 0 0 0 0 0 0
10 23 4 4 19 19 19
0 0 0 0 0 0 0
12 24 24 24 0 0 0
0 0 0 0 0 0 0
10 18 13 13 5 5 5
0 168 27 27 141 141 141
100 142 101 101 41 41 41
10 10 10 10 0 0 0
50 74 70 70 4 4 4
15 49 48 48 1 1 1
100 209 30 30 179 179 179
0 22 0 0 22 22 22
0 22 0 0 22 22 22
0 142 0 0 142 142 142
0 0 0 0 0 0 0
0 6 2 2 4 4 4
10 10 10 10 0 0 0
0 195 80 80 115 115 115
0 85 51 51 34 34 34
50 52 0 0 52 52 52
0 18 6 6 12 12 12
200 250 150 150 100 100 100
0 0 0 0 0 0 0
0 11 7 7 4 4 4
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 280 0 0 280 280 280
0 138 0 0 138 138 138
500 600 600 600 0 0 0
0 600 600 600 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 43 13 13 30 30 30
0 0 0 0 0 0 0
300 530 0 0 530 530 530
12 75 30 30 45 45 45
10 15 8 8 7 7 7
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 3 0 0 3 3 3
0 3 0 0 3 3 3
0 3 0 0 3 3 3
0 0 0 0 0 0 0
0 51 0 0 51 51 51
0 51 0 0 51 51 51
0 21 0 0 21 21 21
0 8 0 0 8 8 8
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 15 0 0 15 15 15
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 25 0 0 25 25 25
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 1100 0 0 1100 1100 1100
0 0 0 0 0 0 0
0 100 0 0 100 100 100
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0
0 720 0 720 720 720
0 0 0
0 907 44 44 863 863 863
0 51 18 18 33 33 33
0 57 31 31 26 26 26
0 36 0 0 36 36 36
0 42 0 0 42 42 42
0 69 0 0 69 69 69
0 70 0 0 70 70 70
0 0 0 0 0 0 0
0 1900 400 400 1500 1500 1500
0 41 11 11 30 30 30
0 0 0 0 0 0 0
0 282 2 2 280 280 280
0 819 19 19 800 800 800
600 600 600 600 600
25 25 25 25 25
550 550 550 550 550
Garut, 1 Juni 2019

Yang Melaporkan,

NIP.
SELISIH
KET
(-)
ED
mas
DAFTAR LAMPIRAN BERITA ACARA STOCK OPNAME OBAT PUSKESMAS CISOMPET BULAN JUNI 2019
STOK AWAL JUNI 2019 PENERIMAAN PENYALURAN SISA STOK ( KARTU BARANG )
NAMA NON JKN/ NON JKN/ PERSEDIA NON JKN/ NON JKN/
No SATUAN
OBAT JKN/BLUD NON TOTAL JKN/BLUD NON TOTAL AN JKN/BLUD NON TOTAL JKN/BLUD NON
BLUD BLUD BLUD BLUD
1 AlbendazolTablet 7353 7353 0 7353 0 7353

2 Alopurinol Tablet 964 964 200 200 1164 260 260 904
3 Aminofilin Ampul 0 0 0 0 0 0
4 Aminofilin Tablet 0 0 0 0 0 0
5 Amitriptili Tablet 235 235 0 235 0 235
6 Amlodipin Tablet 886 886 0 886 243 243 643
7 Amoksisili Kaplet 1933 1933 3000 3000 4933 2135 2135 2798
8 AmoksisilinBotol 60 60 0 60 60 60 0
9 Antasida DTablet 3835 3835 2000 2000 5835 3202 3202 2633
10 Antasida II Botol 232 232 50 50 282 20 20 262
11 Anti HemmSupp 31 31 0 31 0 31
12 AntibakterTube 37 37 0 37 0 37
13 Antifungi Pot 41 41 0 41 0 41
14 Antimigre Tablet 0 0 100 100 100 20 20 80
15 Aqua Pro InVial 1 1 30 30 31 3 3 28
16 ARV: Efavi Tablet 0 0 0 0 0 0
17 ARV: LamivTablet 0 0 0 0 0 0
18 ARV: LovinTablet 0 0 0 0 0 0
19 ARV: NevirTablet 0 0 0 0 0 0
20 ARV: TDF(3Tablet 0 0 0 0 0 0
21 ARV: TenofTablet 0 0 0 0 0 0
22 ARV: ZdvdnTablet 0 0 0 0 0 0
23 ARV: ZidovTablet 0 0 0 0 0 0
24 Asam AsetilTablet 221 221 0 221 10 10 211
25 Asam AskorTablet 598 598 0 598 72 72 526
26 Asam FolatTablet 0 0 0 0 0 0
27 Asam MefeTablet 1504 1504 1000 1000 2504 1551 1551 953
28 Asiklovir K Tube 33 33 25 25 58 1 1 57
29 Asiklovir T Tablet 446 446 0 446 40 40 406
30 Atapulgit Tablet 595 595 0 595 162 162 433
31 Atropin SulAmpul 16 16 0 16 0 16
32 AzithromisTablet 0 0 0 0 0 0
33 Benzatin BenVial 16 16 0 16 0 16
34 Betahistin Tablet 360 360 120 120 480 90 90 390
35 BetametasoTube 71 71 25 25 96 19 19 77
36 Bisoprolol Tablet 54 54 0 54 2 2 52
37 BromheksinTablet 1820 1820 0 1820 0 1820
38 Clobazam TTablet 0 0 0 0 0 0
39 Clozapine Tablet 0 0 0 0 0 0
40 DehidroartPaket 0 0 0 0 0 0
41 Deksametas Ampul 35 35 20 20 55 7 7 48
42 Deksametas Tablet 646 646 300 300 946 473 473 473
43 DekstrometTablet 212 212 600 600 812 536 536 276
44 Dektrometo Botol 8 8 0 8 8 8 0
45 DevitalisasBotol 0 0 0 0 0 0
46 Dextrose InVial 0 0 0 0 0 0
47 Diazepam IAmpul 558 558 0 558 0 558
48 Diazepam Rtube 11 11 0 11 0 11
49 Diazepam TTablet 157 157 0 157 9 9 148
50 Difenhidra Ampul 46 46 0 46 0 46
51 Digoksin T Tablet 200 200 0 200 0 200
52 DimenhidriTablet 0 0 0 0 0 0
53 Doksisilin Tablet 0 0 0 0 0 0
54 DomperidoBotol 17 17 50 50 67 0 67
55 Domperidon Tablet 80 80 1000 1000 1080 627 627 453
56 EndometasBotol 0 0 0 0 0 0
57 Epinefrina Ampul 8 8 0 8 0 8
58 Eritromisi Kapsul 1150 1150 0 1150 0 1150
59 Eritromisi Kapsul 0 0 0 0 0 0
60 EritromisinBotol 0 0 0 0 0 0
61 Etakridin L Botol 0 0 0 0 0 0
62 Etanol 70 Botol 0 0 3 3 3 2 2 1
63 Etil KloridaBotol 0 0 0 0 0 0
64 Eugenol CaBotol 0 0 0 0 0 0
65 Fenitoin N Kapsul 150 150 300 300 450 115 115 335
66 FenobarbitTablet 67 67 0 67 0 67
67 Fenoksimeti Tablet 0 0 0 0 0 0
68 Fitomenadio Tablet 316 316 100 100 416 0 416
69 FitomenadiAmpul 1650 1650 0 1650 0 1650
70 FluconazolTablet 0 0 0 0 0 0
71 Flufenazin Ampul 0 0 0 0 0 0
72 FormokresoBotol 0 0 0 0 0 0
73 Furosemid Tablet 432 432 0 432 5 5 427
74 Garam Orali Sachet 150 150 0 150 68 68 82
75 GentamisinVial 796 796 0 796 0 796
76 GentamisinTube 20 20 24 24 44 12 12 32
77 Glass Iono Botol 0 0 0 0 0 0
78 GlibenklamTablet 134 134 100 100 234 40 40 194
79 Gliseril Gu Tablet 760 760 1000 1000 1760 882 882 878
80 Glukosa LarFls 15 15 0 15 0 15
81 Griseofulv Tablet 321 321 100 100 421 20 20 401
82 HaloperidoTablet 4 4 500 500 504 270 270 234
83 HaloperidoAmpul 10 10 0 10 0 10
84 HaloperidolAmpul 0 0 0 0 0 0
85 HaloperidolTablet 1500 1500 0 1500 0 1500
86 Hidrokorti Tube 75 75 24 24 99 12 12 87
87 Hiosina bu Tablet 640 640 0 640 100 100 540
Human
Tetanus
Imunoglo
bulin Im
250UI
88 (Tetagam) Set 0 0 0 0 0 0
89 Ibuprofen Tablet 112 112 300 300 412 328 328 84
90 Isoniazid T Tablet 300 300 0 300 0 300
91 Isosorbid DTablet 42 42 0 42 42 42 0
92 Kalsium gl Ampul 20 20 0 20 0 20
93 Kalsium hidBotol 0 0 0 0 0 0
94 Kalsium LakTablet 1143 1143 500 500 1643 656 656 987
95 Kaptropil TTablet 763 763 800 800 1563 463 463 1100
96 Karbamazep Tablet 490 490 200 200 690 80 80 610
97 KarbogliserBotol 5 5 0 5 0 5
98 Karbon aktiTablet 0 0 0 0 0 0
99 KetokonazoTablet 123 123 100 100 223 0 223
100 KetoprofenSupp 0 0 0 0 0 0
101 Kina Inj 26 Ampul 0 0 0 0 0 0
102 Kina Table Tablet 0 0 0 0 0 0
103 KlindanmisTablet 0 0 0 0 0 0
104 KloramfeniKapsul 0 0 0 0 0 0
105 KloramfeniKapsul 200 200 200 200 400 40 40 360
106 Kloramfenik Tube 41 41 0 41 5 5 36
107 KloramfeniTube 35 35 24 24 59 10 10 49
108 KloramfeniBotol 0 0 0 0 0 0
109 KloramfeniBotol 40 40 25 25 65 15 15 50
110 Kloramfenik Tube 35 35 10 10 45 20 20 25
111 Klorfenari Tablet 1323 1323 1500 1500 2823 496 496 2327
112 Klorpropmaz Tablet 218 218 0 218 0 218
113 KotrimoksaBotol 201 201 100 100 301 23 23 278
114 KotrimoksaTablet 21 21 300 300 321 231 231 90
Lidokain
Inj Komp :
Lidokain
%+
Epinefrin
1 : 80000-
115 2 ml Ampul 75 75 180 180 255 19 19 236
116 Lidokain JeTube 1 1 0 1 0 1
117 Lidokain S Botol 1 1 0 1 0 1
118 Lisol Botol 4 4 0 4 0 4
119 Loratadin Tablet 1190 1190 500 500 1690 457 457 1233
120 MagnesiumAmpul
s 0 0 0 0 0 0
121 MagnesiumAmpul
s 65 65 0 65 9 9 56
123 MB DewasBlister 3 3 0 3 2 2 1
124 MetforminTablet 170 170 500 500 670 445 445 225
125 Metildopa Tablet 100 100 200 200 300 20 20 280
126 MetilergomAmpul 500 500 0 500 0 500
Metilergo
metrin
Maleat
(Metilerg
ometrin)
Tablet
Salut
127 0,125 mg Tablet 128 128 100 100 228 30 30 198
128 MetilprednTablet 698 698 100 100 798 278 278 520
129 MetronidazTablet 41 41 0 41 41 41 0
130 Mikonazol Tube 64 64 24 24 88 43 43 45
131 Mineral MiSachet 0 0 0 0 0 0
132 Monoklorka Botol 0 0 0 0 0 0
133 MultivitamiBotol 14 14 30 30 44 35 35 9
134 MultivitamiKaplet 557 557 0 557 115 115 442
135 N-asetil si Kapsul 1410 1410 0 1410 70 70 1340
136 Natrium BiTablet 483 483 0 483 145 145 338
137 Natrium DiTablet 1036 1036 500 500 1536 413 413 1123
138 Natrium HiBotol 0 0 0 0 0 0
139 Natrium KloFls 22 22 0 22 3 3 19
140 Natrium TirTablet 0 0 0 0 0 0
141 Nipedipin Tablet 180 180 0 180 18 18 162
142 Nistatin TaTablet 42 42 0 42 0 42
143 Nistatin TaTablet 26 26 0 26 0 26
144 OAT FDC KaPaket 7 7 5 5 12 2 2 10
145 OAT FDC KaPaket 3 3 0 3 0 3
146 OAT FDC Kapaket 14 14 0 14 0 14
147 OAT FDC Kat Paket 0 0 0 0 0 0
148 OAT Kombip paket 0 0 0 0 0 0
149 Obat BatukBotol 138 138 50 50 188 29 29 159
150 Oksitosin I Ampul 389 389 0 389 100 100 289
151 OmeprazolKapsul 340 340 0 340 340 340 0
152 OndansetroAmpul 62 62 150 150 212 73 73 139
153 ParasetamoBotol 202 202 200 200 402 163 163 239
154 ParasetamoTablet 3578 3578 7000 7000 10578 4327 4327 6251
156 PB DewasaBlister 0 0 0 0 0 0
157 Permetrin Tube 27 27 10 10 37 4 4 33
Phenolph
talein,
Paraffin
Liquidum,
Gliserin
Sirup
(Laxadin
158 syr) botol 28 28 0 28 1 1 27
159 Piridoksin Tablet 2050 2050 500 500 2550 865 865 1685
160 PirimetamiTablet 0 0 0 0 0 0
161 Polikresulebotol 12 12 0 12 0 12
162 Povidon IoBotol 9 9 10 10 19 1 1 18
163 Povidon IoBotol 4 4 3 3 7 1 1 6
164 Prednison Tablet 1390 1390 0 1390 180 180 1210
165 Primakuin Tablet 0 0 0 0 0 0
Prokain
Benzilpen
isilin Serb
Inj 3 juta
UI/vial
166 (i.m.) Vial 0 0 0 0 0 0
167 PropanololTablet 100 100 0 100 0 100
168 PropiltiourTablet 170 170 0 170 0 170
169 Ranitidin I Ampul 0 0 200 200 200 69 69 131
170 Ranitidin TTablet 780 780 1000 1000 1780 1080 1080 700
171 Retinol (Vi Kapsul 480 480 0 480 0 480
172 Retinol (VI Kapsul 4019 4019 0 4019 58 58 3961
173 Ringer LaktFls 140 140 400 400 540 280 280 260
174 RisperidonTablet 0 0 100 100 100 0 100
175 SalbutamolAmpul 50 50 0 50 0 50
176 SalbutamolTablet 72 72 200 200 272 128 128 144
177 Salep 2-4 kPot 40 40 24 24 64 5 5 59
178 Salisil Bed Kotak 11 11 0 11 8 8 3
179 SefadroksilBotol 13 13 0 13 13 13 0
180 Sefadroxil Kapsul 52 52 500 500 552 552 552 0
181 Sefiksime Paket 0 0 0 0 0 0
182 SefotaksimVial 13 13 20 20 33 13 13 20
183 Seftriaxon IVial 3 3 10 10 13 8 8 5
184 Semen sengBotol 1 1 0 1 0 1
185 Serum AntiVial 0 0 0 0 0 0
186 Serum antiAmpul 2 2 0 2 0 2
187 Serum antib Vial 6 6 0 6 0 6
188 Setirizin S Botol 80 80 0 80 61 61 19
189 Sianokobala Ampul 191 191 0 191 2 2 189
190 Simvastati Tablet 140 140 210 210 350 5 5 345
191 SiprofloksaKaplet 434 434 0 434 0 434
192 Tablet TamBuah 0 0 0 0 0 0
193 Tablet TamTablet 95000 95000 0 95000 1490 1490 93510
194 TemporaryBotol 0 0 0 0 0 0
195 Tetrasiklin Kapsul 30 30 100 100 130 10 10 120
196 Tiamin HCLTablet 1642 1642 1000 1000 2642 899 899 1743
197 TriheksifenTablet 231 231 1000 1000 1231 694 694 537
198 Vaksin BCGSet 119 119 0 119 46 46 73
199 Vaksin DPTVial 118 118 100 100 218 55 55 163
200 Vaksin DT Vial 50 50 0 50 0 50
201 Vaksin Hb-Set 236 236 0 236 70 70 166
202 Vaksin IPV Vial 0 0 0 0 0 0
203 Vaksin IPV Vial 98 98 0 98 9 9 89
204 Vaksin MeaVial 157 157 0 157 41 41 116
205 Vaksin Meni Paket 0 0 0 0 0 0
206 Vaksin PapVial 0 0 0 0 0 0
207 Vaksin Pn Vial 0 0 0 0 0 0
208 Vaksin PoliSet 100 100 0 100 36 36 64
209 Vaksin RabSet 11 11 0 11 0 11
210 Vaksin Td Vial 337 337 0 337 10 10 327
211 Vitamin B Tablet 1430 1430 2000 2000 3430 992 992 2438
212 Zinc Table Tablet 820 820 0 820 226 226 594
213 ADS 0.05 mBuah 134 134 0 134 105 105 29
214 ADS 0.5 mlBuah 2240 2240 700 700 2940 360 360 2580
215 ADS 5 ml Buah 141 141 0 141 0 141
216 Alat SuntikSet 269 269 200 200 469 226 226 243
217 Alat SuntikSet 238 238 400 400 638 300 300 338
218 Alat SuntikSet 0 0 0 0 0 0
219 Alkohol SwBuah 0 0 0 0 0 0
220 Bisturi Buah 19 19 10 10 29 4 4 25
Catgut/Be
nang
Bedah
No.2/0
dengan
jarum
222 bedah Set 0 0 24 24 24 1 1 23
Catgut/Be
nang
Bedah
No.3/0
dengan
jarum
223 bedah Set 0 0 12 12 12 2 2 10
224 Folley Cat Buah 5 5 10 10 15 10 10 5
225 Infusion seKantong 141 141 0 141 26 26 115
226 Infusion s Kantong 41 41 100 100 141 99 99 42
227 IV Cathete Set 0 0 10 10 10 10 10 0
228 IV Cathete Set 4 4 50 50 54 54 54 0
229 IV Cathete Set 1 1 20 20 21 10 10 11
230 IV Cathete Set 179 179 0 179 38 38 141
231 Jarum kulitBuah 22 22 10 10 32 4 4 28
232 Jarum ototBuah 22 22 0 22 0 22
233 Kaca Slide Buah 142 142 0 142 0 142
234 Kantung mBuah 0 0 0 0 0 0
235 Kapas Pemb Roll 4 4 2 2 6 0 6
236 Kasa HidrofRoll 0 0 10 10 10 10 10 0
237 Kasa HidrofiLembar 115 115 32 32 147 32 32 115
238 Kasa Pembal Roll 34 34 40 40 74 22 22 52
239 Kasa Pembal Roll 52 52 50 50 102 5 5 97
240 Kassa Pemba Roll 12 12 0 12 0 12
241 Masker TieBuah 100 100 200 200 300 100 100 200
242 Masker N- Buah 0 0 0 0 0 0
243 Plester 5 y Roll 4 4 3 3 7 5 5 2
244 Polybag MeLembar 0 0 0 0 0 0
245 Polybag N Lembar 0 0 0 0 0 0
246 Polybag RaLembar 0 0 0 0 0 0
247 Pot Dahak Buah 280 280 0 280 280 280 0
248 Safety box Buah 138 138 0 138 0 138
249 Sarung TanBuah 0 0 300 300 300 0 300
250 Sarung TanBuah 0 0 500 500 500 0 500
251 Sarung TanBuah 0 0 0 0 0 0
252 Sarung Tang Set 0 0 0 0 0 0
253 Sarung Tang Set 30 30 0 30 12 12 18
254 Sarung Tang Set 0 0 0 0 0 0
255 Sendok ObBuah 530 530 0 530 530 530 0
Silk
(Benang
Bedah
Sutera)
No.2/0
Dengan
Jarum
256 Bedah Set 45 45 12 12 57 9 9 48
257 Urin Bag Buah 7 7 10 10 17 12 12 5
258 REAGEN 0 0 0 0 0 0 0 0
259 Cybow 10 RSet 0 0 0 0 0 0 0 0
260 Golongan daBotol 3 3 0 0 3 0 0 3
263 Humasens Set 0 0 0 0 0 0 0 0
264 Humasens Kotak
Pl 51 51 0 0 51 0 0 51
265 Humasens KSotak 51 51 0 0 51 0 0 51
266 Humasens KSotak 21 21 0 0 21 0 0 21
267 Iodin test Botol 8 8 0 0 8 0 0 8
268 Larutan AsBotol 0 0 0 0 0 0 0 0
269 Larutan BeBotol 0 0 0 0 0 0 0 0
270 Larutan EDBotol 0 0 0 0 0 0 0 0
271 Larutan HCBotol 0 0 0 0 0 0 0 0
272 Larutan NatBotol 0 0 0 0 0 0 0 0
273 Larutan ReBotol 0 0 0 0 0 0 0 0
274 Larutan TuBotol 0 0 0 0 0 0 0 0
275 Larutan ZieBotol 15 15 0 0 15 0 0 15
276 Rapid HIV 1test 0 0 0 0 0 0 0 0
277 Rapid HIV 2test 0 0 0 0 0 0 0 0
278 Rapid HIV Sachet 0 0 0 0 0 0 0 0
279 Rapid HIV Sachet 25 25 0 0 25 0 0 25
280 Rapid HIV ISachet 0 0 0 0 0 0 0 0
281 Rapid HIV Sachet 0 0 0 0 0 0 0 0
282 Rapid HIV Sachet 1100 1100 0 0 1100 0 0 1100
283 Rapid MalaSachet 0 0 0 0 0 0 0 0
284 Rapid SyphiSachet 100 100 0 0 100 0 0 100
285 Reagen CD4 test 0 0 0 0 0 0 0 0
286 Reagen CD4 test 0 0 0 0 0 0 0 0
287 RPR SyphiliSachet 0 0 0 0 0 0 0 0
288 SalmonellaBotol 0 0 0 0 0 0 0 0
289 SalmonellaBotol 0 0 0 0 0 0 0 0
290 Test KehamBuah 0 0 0 0 0 0 0 0
LAIN-LAIN 0 0 0 0 0 0
291 Tiamin HCLAmpul 720 720 0 720 0 720
BARANG PKM 0 0 0 0
292 AmlodipineBlister 863 863 0 863 97 97 766
293 Ambroxol sBotol 33 33 0 33 0 0 33
294 Mucus Extractor 26 26 0 26 0 0 26
295 Gel USG 250 mL 36 36 0 36 0 0 36
296 Oxygen Mask Dewa 42 42 0 42 0 0 42
297 Oxygen Mask Anak 69 69 0 69 0 0 69
298 Oxygen mask bayi 70 70 0 70 0 0 70
299 Sarung Tangan Non S 0 0 0 0 0 0 0
300 Sarung Tangan Non S 1000 1000 0 1000 300 300 700
301 Sarung tangan obgyn 41 41 0 41 11 11 30
302 Kassa Hidrofil DRC 0 0 0 0 0 0 0
303 Parasetamol Infus 280 280 0 280 0 0 280
304 Amoxicillin syr 250 800 800 0 800 13 13 787
305 Ampicillin inj 10 mg/ml 600 600 600 600
306 Metronidazol Infus 25 25 25 25
307 Oksitetrasiklin Salep Mata 550 550 550 550
Garut, 1 Juli 2019

Mengetahui, Yang Melaporkan,
Kepala Puskesmas Penanggung Jawab Obat Puskesmas
H. Moh Apip GS, S.IP, S.Kep, M.Si, Ners Ade Maesaroh, S.Farm., Apt
NIP. 19680819 198803 1 001
BARANG ) SELISIH
KEADAAN
FISIK KET
TOTAL BARANG (+) (-)
7353 7353
904 904
0 0
0 0
235 235
643 643
2798 2798
0 0
2633 2633
262 262
31 31
37 37
41 41
80 80
28 28
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
221 221
526 526
0 0
953 953
57 57
406 406
433 433
16 16
0 0
16 16
390 390
77 77
54 54
1820 1820
0 0
0 0
0 0
48 48
473 473
276 276
0 0
0 0
0 0
558 558
11 11
148 148
46 46
200 200
0 0
0 0
67 67
453 453
0 0
8 8
1150 1150
0 0
0 0
0 0
0 0
0 0
0 0
335 335
67 67
0 0
416 416
1650 1650
0 0
0 0
0 0
427 427
82 82
796 796
32 32
0 0
194 194
878 878
15 15
401 401
234 234
10 10
0 0
1500 1500
87 87
540 540
0 0
84 84
300 300
0 0
20 20
0 0
987 987
1100 1100
610 610
5 5
0 0
223 223
0 0
0 0
0 0
0 0
0 0
360 360
36 36
49 49
0 0
50 50
25 25
2327 2327
218 218
278 278
90 90
236 236
1 1
1 1
4 4
1233 1233
0 0
56 56
0 0
1 1
225 225
280 280
500 500 ED
198 198
520 520
0 0
45 45
0 0
0 0
9 9
442 442
1340 1340
338 338
1123 1123
0 0
19 19
0 0
162 162
42 42
26 26
10 10
3 3
14 14
0 0
0 0
159 159
289 289
0 0
139 139
239 239
6251 6251
0 0
0 0
33 33
27 27
1685 1685
0 0
12 12
18 18
6 6
1210 1210
0 0
0 0
100 100
170 170
131 131
700 700
480 480
3961 3961
260 260
100 100
50 50
144 144
59 59
3 3
0 0
0 0
0 0
20 20
5 5
1 1
0 0
2 2
6 6
19 19
189 189
345 345
434 434
0 0
93510 93510
0 0
120 120
1743 1743
537 537
73 73
163 163
50 50
166 166
0 0
89 89
116 116
0 0
0 0
0 0
64 64
11 11
327 327
2438 2438
594 594
0 0
29 29
2580 2580
141 141
243 243
338 338
0 0
0 0
25 25
0 0
23 23
10 10
5 5
115 115
42 42
0 0
0 0
11 11
141 141
28 28
22 22
142 142
0 0
6 6
0 0
115 115
52 52
97 97
12 12
200 200
0 0
2 2
0 0
0 0
0 0
0 0
138 138
300 300
500 500
0 0
0 0
18 18
0 0
0 0
48 48
5 5
0 0
0 0
3 3
3 3
3 3
0 0
51 51
51 51
21 21
8 8
0 0
0 0
0 0
0 0
0 0
0 0
0 0
15 15
0 0
0 0
0 0
25 25
0 0
0 0
1100 1100
0 0
100 100
0 0
0 0
0 0
0 0
0 0
0 0
0 0
720 720
766 766
33 33
26 26
36 36
42 42
69 69
70 70
0 0
700 700
30 30
0 0
280 280
787 787
600 600
25 25
550 550
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DAFTAR LAMPIRAN BERITA ACARA STOCK OPNAME OBAT PUSKESMAS CISOMPET BULAN JANUARI

STOK AWAL JANUARI

No NAMA OBAT SATUAN JKN/B NON JKN/ JKN/B

1 Albendazol Tablet 400 mg ANTELMINTIK CISOMPET Tablet 460 460

Human Tetanus Imunoglobulin Im

Silk (Benang Bedah Sutera) No.2/0

SISA STOK ( KARTU

460 10 10 450 450 450

198 136 136 62 62 62

STOK AWAL FEBRUARI 2019 PENERIMAAN PENYALURAN

NON JKN/ NON JKN/ PERSEDIA NON JKN/

1 Albendazol Tablet 400 mg Tablet 450 450 12000 12000 12450 0

NON JKN/ NON JKN/ PERSEDIA NON JKN/

57 Epinefrina HCl/Bitartrat (Adrenalin) Inj 0,1 %Ampul 8 8 0 0 8 0

NON JKN/ NON JKN/ PERSEDIA NON JKN/

Lidokain Inj Komp : Lidokain %+ Epinefrin

Metilergometrin Maleat (Metilergometrin)

Phenolphtalein, Paraffin Liquidum, Gliserin

NON JKN/ NON JKN/ PERSEDIA NON JKN/

169 Ranitidin Inj 25 mg/ml Ampul 4 4 200 200 204 36

Catgut/Benang Bedah No.2/0 dengan

NON JKN/ NON JKN/ PERSEDIA NON JKN/

NON JKN/ NON JKN/ PERSEDIA NON JKN/

284 Rapid Syphilis SD Sachet 100 100 0 0 100 0

H. Moh Apip GS, S.IP, S.Kep, M.Si, Ners

PENYALURAN SISA STOK ( KARTU BARANG ) SELISIH

0 12450 12450 12450

36 226 226 226

36 168 168 168

3 197 197 197

0 100 100 100

Garut, 3 Maret 2019

Astria Susanti Dewi, S.Farm., Apt

STOK AWAL MARET 2019 PENERIMAAN PENYALURAN

NON JKN/ NON JKN/ PERSEDIA NON JKN/

1 Albendazol Tablet 400 mg Tablet 12450 12450 0 12450 2905 2905

NON JKN/ NON JKN/ PERSEDIA NON JKN/

57 Epinefrina HCl/Bitartrat (Adrenalin) Inj 0,1 % Ampul 8 8 0 8 0 0

NON JKN/ NON JKN/ PERSEDIA NON JKN/

Lidokain Inj Komp : Lidokain %+ Epinefrin 1 :

Metilergometrin Maleat (Metilergometrin)

NON JKN/ NON JKN/ PERSEDIA NON JKN/

NON JKN/ NON JKN/ PERSEDIA NON JKN/

227 IV Catheter No.18 Set 0 0 20 20 20 8 8

NON JKN/ NON JKN/ PERSEDIA NON JKN/

286 Reagen CD4 tipe 1 (Alere Pima CD4) test 0 0 0 0 0 0

H. Moh Apip GS, S.IP, S.Kep, M.Si, Ners

SISA STOK ( KARTU BARANG ) SELISIH

9545 9545 9545

124 124 124

940 940 940

Garut, 1 April 2019

Astria Susanti Dewi, S.Farm., Apt

STOK AWAL APRIL 2019 PENERIMAAN PENYALURAN

No NAMA OBAT SATUAN JKN/B NON JKN/ NON JKN/ PERSEDIA

1 Albendazol Tablet 400 mg Tablet 9545 9545 0 0 9545

49 Diazepam Tablet 2 mg Tablet 164 164 0 0 164

Human Tetanus Imunoglobulin Im 250UI

99 Ketokonazol Tablet 200 mg Tablet 172 172 0 0 172

Lidokain Inj Komp : Lidokain %+ Epinefrin 1 :