LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT TAHUN 2023

( LPLPO )

KODE PUSKESMAS : 4.2.21 PELAPORAN BULAN : JANUARI 2023 FORM LPLPO PUSKESMA
PUSKESMAS : KEMUSU DOKUMEN
KABUPATEN :BOYOLALI PERMINTAAN BULAN : FEBRUARI 2023 PUSKESMAS
PROPINSI :JAWA TENGAH DINKES

STOCK STOCK
NO NAMA OBAT/BMHP SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN
AWAL GUDANG

1 Alat Suntik 1 cc Pcs 100 300 400 300 100 100 400
2 Alat Suntik 3 cc Pcs 0 400 400 90 310 300
3 Alat Suntik 5 cc Pcs 280 280 100 180 100 200
4 Alkohol 70 % (Etanol ) Botol 4 4 4 0 0 6
5 Alkohol Swab Pcs 278 278 10 268 268
6 Apron One New Bag Set 200 200 0 200 200
7 Aqua Pro Injeksi Vial 450 450 0 450 450
8 Auto Disp Syringe 0,05 ml ( ADS ) Pcs 0 0 0 0 0
9 Auto Disp Syringe 0,5 ml ( ADS ) Pcs 0 500 500 400 100 100 500
10 Auto Disp Syringe 5 ml ( ADS ) Pcs 0 0 0 0 0
11 Autoclic Device Pcs
12 Bedfont D-Piece Smokerlyzer 12s Unit
13 Bedfont Micro + Smokerlyzer Unit
14 Bedfont Steribreath Mouthpiece S 250S Unit
15 Bisturi ( Pisau Operasi ) No 10 Pcs 90 90 0 90 90
16 Bisturi ( Pisau Operasi ) No 11 Pcs 30 30 0 30 30
17 Blood Collection 21 G x 1 1/5 Pcs 2 2 0 2 2
18 Blood Lancet Pcs 276 276 276 0 0
19 Blood Tranfusion Set Pcs 7 20 27 14 13 13 20
20 Cartridge GenExpert ( TB TCM ) Botol
21 Cat Gut Chromic 2/0 Set 0 6 6 6 0 0 9
22 Cat Gut Chromic 3/0 Set 2 12 14 6 8 8
23 Cervical Neck Collar Set 2 2 0 2 2
24 Cotton Aplikasi Pcs
25 Dermafix T Plaster 5 x 7 cm Roll 285 285 15 270 270
26 Disinfektan Botol 1L 40 5 45 0 45 45
27 Face Shield Anak Pcs 20 20 0 20 20
28 Face Shield Dewasa Pcs 7 7 0 7 7
29 Female Catheter Set
30 Fixomul Plester 15 cm x 5 m Roll 3 3 1 2 2
31 Fixomul Plester 5 cm x 5 m Roll 4 6 10 0 10 10
32 Folley Catheter No 16 Set 22 22 0 22 22
33 Folley Catheter No 18 Set 5 5 1 4 4
34 Gelang Pasien Anak Biru Pcs 4 4 0 4 4
35 Gelang Pasien Anak Pink Pcs 9 9 0 9 9
36 Gelang Pasien Dewasa Biru Pcs 23 23 0 23 23
37 Gelang Pasien Dewasa Pink Pcs 56 56 0 56 56
38 Handschoen Latex Size L Box 4 4 0 4 4
39 Handschoen Latex Size M Box 13 13 5 8 8
40 Handschoen Latex Size S Box 7 7 2 5 5
41 Handschoen Nitril Size L Box 4 4 0 4 4
42 Handschoen Nitril Size M Box 2 13 15 10 5 5 10
43 Handschoen Nitril Size S Box 1 3 4 2 2 2 1
44 Handschoen Obsgyn Pcs
45 Handschoen Steril Pcs
46 Handscrub 500 ml Botol 10 10 0 10 10
47 Handscrub Refill 5 Liter Botol 21 21 0 21 21
48 Handsoap 250 ml Botol 20 10 30 0 30 30
49 Handspray 100 ml Botol
50 Hasmat ( Cover All ) Pcs 330 330 0 330 330
51 Infus Set Anak Set 50 50 3 47 47
52 Infus Set Dewasa Set 152 152 65 87 87 50
53 IV Catheter No 18 Pcs 19 19 12 7 7 10
54 IV Catheter No 20 Pcs 10 20 30 0 30 30
55 IV Catheter No 22 Pcs 140 140 20 120 120
56 IV Catheter No 24 Pcs 40 25 65 50 15 15 60
57 Jarum Jahit Kulit Pcs
58 Jarum Jahit Otot Besar Pcs
59 Jarum Jahit Otot Kecil Pcs
 STOCK STOCK
NO NAMA OBAT/BMHP SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN
AWAL GUDANG

60 Kacamata Google Pcs 8 8 0 8 8

61 Kantong Plastik Sampah Medis 0 0 0 0
62 Kapas Pembalut 250 gr Roll 5 5 0 5 5
63 Kassa Hydrofil 4 m x 15 cm Roll 35 35 5 30 30
64 Kassa Hydrofil 40 m x 80 cm Roll 0 0 0 0 0 5
65 Kassa Hydrofil Steril 16 x 16 Box 14 30 44 29 15 15
66 Kondom Sutra Pcs
67 Lubricant ( Pelicin ) Pcs
68 Masker 1860 N95 Pcs 382 382 0 382 382
69 Masker 1870 + aura N95 Pcs
70 Masker bx20, 180s N95 Pcs 560 560 0 560 560
71 Masker Kain Pcs 0 0 0 0 0
72 Masker KN95 Pcs 133 133 3 130 130
73 Masker Medis Earloop Pcs 2 10 12 2 10 10
74 Masker Medis Headloop Pcs 6 10 16 3 13 13 10
75 Nebulizer With Mask Anak Set 6 6 0 6 6
76 Nebulizer With Mask Dewasa Set 5 5 0 5 5
77 Nurse Cap Pcs
78 Oxycan Botol 6 6 0 6 6
79 Oxygen Mask Anak Set 35 35 0 35 35
80 Oxygen Mask Dewasa Set 33 33 0 33 33
81 Oxygen Nasal Canula Anak Set 4 4 0 4 4
82 Oxygen Nasal Canula Dewasa Set 0 10 10 0 10 10
83 Plester ( Leukoplast ) 7,5 cm x 4,5 m Roll 0 0 0 0 0 10
84 Plesterin Bulat T Pcs 500 500 300 200 200 400
85 Pot Sputum Buah 60 40 100 40 60 60 100
86 Pot Urine Buah 100 100 70 30 30 300
87 Povidon Iodida 10 % 30 ml Botol 30 30 3 27 27
88 Povidon Iodida 10 % 60 ml Botol 0 0 0 0
89 Povidon Iodida 10 % 300 ml Botol 0 0 0 0
90 Rapid Diagnostic Test ( RDT ) C-19 Antigen Test 507 507 3 504 504
91 Safety Box Set 0 10 10 10 0 0
92 Silk No 2/0 Set 0 0 0 0 0 6
93 Silk No 3/0 Set 2 2 0 2 2 6
94 Slide Kaca ( Objek Glass ) Box 2 2 0 2 2 5
95 Slide Box Box 0 0 0 0
96 Spalk Kayu Pcs 6 6 0 6 6
97 Spekulum L Pcs 0 0 0 0
98 Spekulum M Pcs 0 0 0 0
99 Underpad ( Soft Pad ) 60 X 90 Pcs 30 30 20 10 10 20
100 Uniflex Perban Elastis 7,5 cm x 4,5 cm Pcs 11 11 0 11 11
101 Urine Bag Pcs 0 10 10 1 9 9
102 Viral Transport Medium ( VTM ) Pcs

II OBAT
103 Acetosal 100 mg / 80 mg Tablet 240 240 70 170 100 300
104 Acetyl sistein 200 mg Kapsul 180 180 100 80 0 240
105 Acyclovir 200 mg Tablet
106 Acyclovir 400 mg Tablet 313 313 30 283 200
107 Acyclovir Cream 5 % Tube 39 39 7 32 32
108 Albendazole 400 mg Tablet 0 0 0 0
109 Albendazole Suspensi 200 mg / 5 ml Botol 0 0 0 0
110 Allopurinol 100 mg Tablet 320 400 720 192 528 500 200
111 Alprazolam 0,5 mg Tablet 66 66 0 66 66
112 Alprazolam 1 mg Tablet
113 Ambroxol 30 mg Tablet 1284 500 1784 716 1068 1000 500
114 Ambroxol syrup 15 mg / 5 ml Botol
115 Aminophilin 200 mg Tablet
116 Aminophyllin Injeksi 24 mg / 10 ml Ampul
117 Amitriptyline Hcl 25 mg Tablet 100 100 0 100 100
118 Amlodipine 10 mg Tablet 733 733 110 623 600
119 Amlodipine 5 mg Tablet 3637 3637 1284 2353 2100
120 Amoxycillin 500 mg Caplet 6153 6,000 12153 3396 8757 8700 5000
121 Amoxycillin Injeksi 1 gr Vial 6 90 96 21 75 75
122 Amoxycillin Syrup 125 mg / 5 ml Botol 24 24 24 0 0
123 Ampicillin Injeksi 1 gr Vial 170 170 20 150 150
124 Antacida Doen 400 mg Tablet 1068 2,000 3068 1904 1164 1100 2000
 STOCK STOCK
NO NAMA OBAT/BMHP SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN
AWAL GUDANG

125 Antacida Doen Suspensi Botol

126 Antalgin ( Metamizole ) 500 mg Tablet 265 265 0 265 200
127 Antalgin 500 mg + Neurotropic Tablet 500 500 0 500 500
128 Antalgin Injeksi 250 mg / ml-2 ml Ampul 57 57 12 45 45
129 Anti Hemmoroid Supp Supp 4 4 4 0 0 20
130 Artesunate Injeksi Vial
131 Asam Ascorbat ( Vit C ) 50 mg Tablet 485 3,000 3485 2205 1280 1200 2500
132 Asam Ascorbat 500 mg (Vit C ) Tablet 100 100 100 0 0 150
133 Asam Folat 1 mg Tablet 500
134 Asam Mefenamat 500 mg Tablet 0 1,000 1000 1000 0 0 1500
135 Asam Tranexamat 500 mg Tablet 124 124 60 64 0 200
136 Asam Tranexamat Injeksi 250 mg / ml Ampul 10 10 0 10 10
137 Atropin Sulfas Injeksi 0,25 mg / ml Ampul 10 10 0 10 10
138 Azitromycin 500 mg Tablet 0 0 0 0 0 50
139 Bekarbon/Norit Tablet 200 200 0 200 200
140 Benzatin Benzil Penicillina Inj 2,4 juta IU Vial
141 Besi II Sulfat + Asam Folat Tablet 5424 5424 1500 3924 3900
142 Besi Sulfat Kombinasi Multivitamin Capsul 542 542 20 522 500
143 Betahistin Mesilat 6 mg Tablet 30 300 330 318 12 0 500
144 Betametason +Neomycin cream Tube 25 25 2 23 20
145 Betametason Cream 0,1 % Tube 0 0 0 0 0 24
146 Bisacodyl 10 mg Tablet 0 0 0 0 0
147 Borax Glycerin ( Gom ) 25 % Botol 18 18 4 14 14
148 Bromhexin 8 mg Tablet 181 181 0 181 100 300
149 Bromhexin syrup 8 mg / ml Botol 57 57 0 57 57
150 Calcium Gluconas Injeksi 10 % - 20 ml Ampul 0 34 34 0 34 34
151 Calcium Lactat ( Kalk ) 500 mg Tablet 1913 2,500 4413 1871 2542 2500 2000
152 Captopril 12,5 mg Tablet 216 216 158 58 0 500
153 Captopril 25 mg Tablet 253 700 953 394 559 500 100
154 Carbamazepine 200 mg Tablet 70 300 370 120 250 200
155 Cefadroxyl 500 mg Capsul 684 684 66 618 600
156 Cefadroxyl syrup 125 mg / 5 ml Botol 20 20 0 20 20
157 Cefixime 100 mg Capsul 727 727 602 125 100 1000
158 Cefixime syrup 100 mg / 5 ml Botol 13 13 13 0 0 20
159 Cefotaxime Injeksi 1 gr Vial 26 26 4 22 22
160 Ceftriaxone Injeksi 1 gr Vial 20 20 0 20 20
161 Cetirizine 10 mg Tablet 656 656 244 412 400 300
162 Cetirizine Syrup 5 mg / 5 ml Botol 10 10 0 10 10
163 Chloramphenicol 250 mg Capsul 516 516 6 510 480
164 Chloramphenicol Injeksi 1 gr Vial 50 50 10 40 40
165 Chloramphenicol Salep Kulit Tube 24 24 0 24 24
166 Chloramphenicol Salep Mata 1 % Tube 2 2 0 2 2 10
167 Chloramphenicol Tetes Mata 0,5 % Botol 28 28 14 14 14 24
168 Chloramphenicol Tetes Telinga 1 % Botol 4 50 54 4 50 50
169 Chlorfeniramin Maleat 4 mg ( CTM ) Tablet 134 2,000 2134 1147 987 900 1000
170 Choramphenicol Suspensi 125 mg / 5 ml Botol
171 Chorpromazine 100 mg ( CPZ ) Tablet 310 310 0 310 310
172 Ciprofloxacin Hcl 500 mg Tablet 48 400 448 448 0 0 700
173 Clindamycin 150 mg Capsul 50 50 50 0 0
174 Clindamycin 300 mg Capsul 226 226 4 222 200
175 Clobazam 10 mg Tablet
176 Clozapin 25 mg Tablet 200 200 30 170 170
177 Cotrimoxazole 480 mg Tablet 474 474 134 340 300
178 Cotrimoxazole Suspensi 240 mg / ml Botol 58 58 0 58 50
179 Dexamethasone Injeksi 5 mg / ml Ampul 0 50 50 23 27 27
180 Dexamethasone O,5 mg Tablet 9 2,500 2509 2275 234 200 3500
181 Diazepam 2 mg Tablet 78 78 10 68 68
182 Diazepam 5 mg Tablet 105 105 2 103 103
183 Diazepam Injeksi 5 mg / 2 ml Ampul 20 20 0 20 20
184 Diazepam Rectal 5 mg / 2,5 ml Supp 5 5 0 5 5
185 Digoxin 0,25 mg Tablet 315 315 28 287 200
186 Dihydro Artemisin + Piperaquine ( DHP ) Tablet
187 Dimenhidrinate 50 mg Tablet 382 382 68 314 300
188 Diphenhidramine Injeksi 10 mg / ml Ampul 40 40 0 40 40
189 Domperidon 10 mg Tablet 974 974 218 756 700
190 Domperidon Suspensi 5 mg / 5 ml Botol 0 0 0 0 0
191 Doxyciclin Hcl 100 mg Capsul
 STOCK STOCK
NO NAMA OBAT/BMHP SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN
AWAL GUDANG

192 Epinefrine ( Adrenaline ) Injeksi 0,1 % - 1 ml Ampul 14 14 0 14 14

193 Ergotamin 1 mg + Coffein 50 mg ( Anti Migren ) Tablet
194 Erytromycin 500 mg Capsul 0 200 200 26 174 100
195 Euthyrox 50 mcg Tablet
196 Extract Placenta +Neomycin Cream Tube 2 2 1 1 1
197 Fenitoin Natrium 100 mg Capsul 80 80 0 80 80
198 Fenobarbhital 30 mg Tablet 46 46 0 46 46
199 Fenobarbhital Injeksi 50 m / ml - 2 ml Ampul 94 94 0 94 94
200 Fenofibrate 100 mg Capsul
201 Fenol Glycerol Tetes Telinga 10 % Botol 3 24 27 9 18 18
202 Fitomenadion ( Vit K ) 10 mg Tablet 330 330 120 210 200
203 Fitomenadion ( Vit K ) Injeksi 2 mg / ml Ampul 210 210 0 210 210
204 Flu Anak Syrup Botol 111 3 114 0 114 114
205 Flu Batuk Dewasa Tablet 1020 1,500 2520 1654 866 800 2000
206 Flu Dewasa Tablet 1533 1533 238 1295 1200
207 Fluconazole 150 mg Kapsul
208 Fluoxetin 20 mg Kapsul 60 60 0 60 60
209 Framycetin Tulle Patch 0 0 0 0 0 20
210 Furosemide 40 mg Tablet 505 505 16 489 400
211 Furosemide Injeksi 10 mg / ml Ampul
212 Garam Oralit Sacchet 57 100 157 47 110 100
213 Gentamycin Injeksi 40 mg / 2 ml Ampul 35 35 0 35 35
214 Gentamycin Salep Kulit 0,1 % Tube 10 24 34 27 7 7 36
215 Gentamycin Salep Mata 0,3 % Tube 24 24 0 24 24
216 Gentamycin Sulfat Tetes Mata 0,3 % Botol
217 Gentian Violet Botol 13 13 1 12 12
218 Gliblenclamide 5 mg Tablet 174 174 100 74 0 100
219 Glimepiride 2 mg Tablet 16 800 816 496 320 300 600
220 Glucosa 10 % Lar Infus Botol 70 70 0 70 70
221 Glucosa 40 % Botol/25 ml 21 21 0 21 21
222 Glucosa 5 % + NaCl 0,25 % Lar Infus ( D 1/4 ) Botol
223 Glucosa 5 % Lar Infus Botol 7 7 0 7 7
224 Glyceril Guaiacolat 100 mg Tablet 831 831 266 565 500
225 Griseofulvin 125 mg Tablet
226 Halloperidol 1,5 mg Tablet 65 65 0 65 65
227 Halloperidol 5 mg Tablet
228 Halloperidol Injeksi i.m 5 mg/ml Ampul
229 Hidrocortisone Cream 1 % Tube 4 4 4 0 0 6
230 Hidrocortisone Cream 2,5 % Tube 23 24 47 20 27 24 24
231 Hydroclorotiazide ( HCT ) 25 mg Tablet 411 411 30 381 300
232 Hyosina N-Butilbromide Injeksi 20 mg / ml Ampul 10 15 25 5 20 20
233 Hyosina N-Butilromide 10 mg Tablet 600 600 20 580 500
234 Hyosina N-Butilromide 10 mg + Paracetamol Tablet
235 Iburofen 200 mg Tablet
236 Iburofen 400 mg Tablet 1014 500 1514 1444 70 0 2500
237 Iburofen Suspensi 100 mg / ml Botol
238 Ichtiyol Salep 10 % Tube 19 19 1 18 18
239 Iodium Test Botol
240 Isoniazide ( INH ) 100 mg Tablet
241 Isoniazide ( INH ) 300 mg Tablet
242 Isosorbide Dinitrat 5 mg ( ISDN ) Tablet 190 190 0 190 100
243 KA-EN 3A Larutan Infus Botol
244 KA-EN 3B Larutan Infus Botol
245 Kalamin Lotion Botol 16 16 16 16
246 Kalium Diclovenax 50 mg Tablet 280 280 22 258 250
247 Kalium Klorida+Natrium Klorida Tetes Mata Botol
248 Ketoconazole 200 mg Tablet 227 227 110 117 100 200
249 Ketoconazole Cream 2 % Tube 25 25 6 19 19
250 Ketorolac Inj ( Tromethamin 30 mg/ml ) Ampul 40 40 5 35 35
251 Lansoprazol 30 mg Kapsul 0 100 100 20 80 0 30
252 Levertran ( Minyak Ikan ) Tube 32 32 5 27 24
253 Lidocain Comp Injeksi 2 ml Ampul 70 70 10 60 60
254 Lidocain Hcl Injeksi 2 % Ampul 94 94 4 90 90
255 Lisinopril 5 mg Tablet
256 Loperamide Hcl 2 mg Tablet 430 430 0 430 400
257 Magnesium Sulfat Injeksi 20 % ( MgSO4 ) Vial 64 64 0 64 64
258 Magnesium Sulfat Injeksi 40 % ( MgSO4 ) Vial 4 4 0 4 4
 STOCK STOCK
NO NAMA OBAT/BMHP SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN
AWAL GUDANG

259 MDT MB Combi Anak Paket

260 MDT MB Combi Dewasa Paket 1 1 0 1 1
261 MDT PB Combi Anak Paket
262 MDT PB Combi Dewasa Paket
263 Meloxicam 15 mg Tablet 455 455 50 405 400
264 Metformin Hcl 500 mg Tablet 79 79 79 0 0
265 Methylergometrin Maleat 0,125 mg Tablet 0 0 0 0
266 Methylergometrin Maleat Inj 0,2 mg / ml Ampul 3 3 0 3 3
267 Methylprednisolon 4 mg Tablet 0 0 0 0 0 3000
268 Metoclopramide Hcl 10 mg Tablet
269 Metoclopramide Hcl 5 mg Tablet
270 Metoclopramide Hcl Injeksi Ampul
271 Metronidazole 250 mg Tablet
272 Metronidazole 500 mg Tablet 940 940 122 818 800
273 Metronidazole Infus 0,5 % Botol
274 Metronidazole Syrup 125 mg / 5 ml Botol
275 Miconazole Cream 2 % Tube 64 64 5 59 48
276 Microlax supp Tube 0 0 0 0 0
277 Mineral Mix Sacchet
278 Multivitamin Capsul Capsul 0 1,000 1000 1000 0 0
279 Multivitamin Capsul(Imboost Force) Capsul
280 Multivitamin Capsul(Vitamin +Zink) Capsul 100 100 0 100 100
281 Multivitamin Syrup Botol 68 68 0 68 68
282 Multivitamin Syrup(vitamin+curcuma) Botol
283 Natrium Chlorida 0,9 % - 100 ml Botol
284 Natrium Chlorida 0,9 % - 25 ml Botol
285 Natrium Chlorida 0,9 % - 500 ml (NaCl ) Botol 36 36 5 31 20
286 Natrium Diclovenax 50 mg Tablet 0 1,200 1200 566 634 600 600
287 Natrium Diclovenax Gell 1 % Tube 29 29 29 0 0 40
288 Neurotropic 5000 Injeksi Ampul 10 40 50 20 30 30
289 Neurotropic Caplet Tablet 1090 1090 120 970 900
290 Nifedipine 10 mg Tablet 160 160 30 130 100
291 Nystatin Drops 100.000 IU/ ml Botol 10 10 0 10 10
292 Nystatin Tablet Salut 500.000 IU Tablet 0 0 0 0
293 Nystatin Tablet Vagina 100.000 IU Supp 65 65 0 65 65
294 Obat ARV Abacavir/Lamivudin 120mg/60 mg Botol
295 Obat ARV Abacavir/Lamivudin 600mg/300 mg Botol
296 Obat ARV Efavirenz ( EFV ) 600 mg Tablet
297 Obat ARV FDC Triple Anak Tablet
298 Obat ARV FDC Triple Dewasa ( TDF /3TC/EFV ) Tablet 2 2 1 1 1
299 Obat ARV Lamivudine ( 3TC) 150 mg Tablet
300 Obat ARV Lamivudine + Zidovudine Tablet
301 Obat ARV Lopinavir / Ritonavir ( LPV ) 200 / 50 mg Tablet
302 Obat ARV Lopinavir / Ritonavir ( LPV ) 40 / 10 mg Sacchet
303 Obat ARV Nevirapine 200 mg Tablet
304 Obat ARV Tenofovir ( TDF ) 300 mg Tablet
305 Obat ARV Tenofovir / Emtricitabine ( FTC ) 300 / 200 Tablet
306 Obat ARV Zidovudine 100 mg Tablet
307 Obat ARV Zidovudine 50 mg / 5 ml Syrup Botol
308 Obat Batuk Dewasa(Grantusif) Tablet
309 Obat Batuk Hitam (OBH ) Botol 0 0 0 0 0
310 Obat Diare Anak Syrup Botol 57 57 0 57 57
311 Obat Diare Dewasa Tablet 1238 1238 160 1078 1000
312 Obat Pencahar Syrup ( Lactulosa ) Botol 10 10 2 8 8
313 Obat TB FDC Dosis Harian I dan III Paket
314 Obat TB FDC Kategori Anak Paket 2 2 1 1 1
315 Obat TB FDC Kategori I Paket 0 5 5 0 5 5
316 Obat TB FDC Kategori II Paket
317 Obat TB HIV Fase ( Lanjutan ) Tablet
318 Obat TB HIV Fase Awal Tablet
319 Obat TB Kombipak Kategori I Paket
320 Omeprazole 20 mg Capsul 314 1,000 1314 974 340 300 1200
321 Ondansetron 4 mg Tablet 0 0 0 0 0
322 Ondansetron Injeksi 4 mg / 2 ml Ampul 0 50 50 20 30 30
323 Oxytetracyclin Hcl Salep Kulit 3 % Tube 0 0 0 0 0 25
324 Oxytetracyclin Hcl Salep Mata 1 % Tube 194 194 1 193 193
325 Oxytocin Injeksi 10 IU / ml - 1 ml Ampul 80 80 0 80 80
 STOCK STOCK
NO NAMA OBAT/BMHP SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN
AWAL GUDANG

326 Papaverine Hcl 40 mg Tablet 0 0 0 0 0

327 Paracetamol 500 mg Tablet 1708 5,000 6708 3430 3278 3200 1000
328 Paracetamol Drops 100 mg / ml Botol 0 0 0 0 0
329 Paracetamol Syrup 120 mg / 5 ml Botol 200 200 0 200 200
330 Permetrin ( Scabicid) Cream 5 % Tube 1 10 11 9 2 2 12
331 Piracetam 400 mg Capsul 0 200 200 66 134 100
332 Piracetam Injeksi 1 gr Ampul 0 0 0 0 0
333 Piroxicam 10 mg Tablet 1390 1390 460 930 900 500
334 Prednison 5 mg Tablet 70 300 370 111 259 200
335 Primaquine 15 mg Tablet
336 Propyltiouracyl 100 mg ( PTU ) Tablet
337 Pyrantel Syrup Botol 0 0 0 0 0
338 Pyridoxin Hcl 10 mg ( Vit B6 ) Tablet 495 200 695 83 612 600
339 Pyridoxin Hcl 25 mg ( Vit B6 ) Tablet
340 Ranitidine 150 mg Tablet 1120 1120 358 762 700 600
341 Ranitidine Injeksi 50 mg / 2 ml Ampul 20 100 120 30 90 90
342 Retinol ( Vit A ) 100.000 IU Capsul 1120 1120 300 820 820
343 Retinol ( Vit A ) 200.000 IU Capsul 1850 1850 1850 0 0
344 Ringer Lactat Larutan Infus ( RL ) Botol 200 40 240 240 0 0 360
345 Risperidon 2 mg Tablet 200 200 400 0 400 400
346 Salbutamol 2 mg Tablet 0 200 200 150 50 0 400
347 Salbutamol Nebules Ampul 20 20 10 10 10
348 Salbutamol+Ipratropium Bromida (Combivent Nebulez)
349 Salep 2 -4 Tube 4 4 4 0 0 6
350 Salycil Talk 2 % Botol 24 24 7 17 17
351 Serum Anti Bisa Ular 5 ml Inj ( ABU ) Vial 5 5 1 4 4
352 Serum Anti Rabies ( VAR ) Vial
353 Serum Anti Tetanus 1500 IU ( ATS ) Ampul 2 2 0 2 2
354 Sianocobalamin 50 mcg ( Vit B12 ) Tablet 530 530 0 530 500
355 Sianocobalamin Injeksi 500 mcg - ml Ampul 0 0 0 0 0
356 Simvastatin 10 mg Tablet 439 439 148 291 200 200
357 Sulcralfat Suspensi 100 ml Botol 11 10 21 16 5 5 6
358 Sulfadiazine Silver Cream 10 mg Tube
359 Tetracyclin Hcl 500 mg Capsul
360 Tetrahydrozolin Tetes Mata Botol 5 5 5 0 0 6
361 Thiamin Hcl ( Vit B1 ) 50 mg Tablet 1244 1244 60 1184 1100
362 Thiamphenicol 500 mg Capsul 528 528 40 488 400
363 Trifluoperazine 5 mg Tablet
364 Trihexyphenidil Hcl 2 mg Tablet 140 140 0 140 140
365 Ultrasonic Jelly Botol 5 5 1 4 4
366 Vitamin B Complex Tablet 1209 1,500 2709 1704 1005 1000 2000
367 Vitamin D3 Tablet 0 300 300 0 300 300
368 Zinc 20 mg Tablet 178 178 50 128 100
369 Zinc Syrup 20 mg / 5 ml Botol 42 42 0 42 42

III OBAT GIGI

370 3 All/3 Mix Buah 0 0 0 0 0
371 Anastesi Topical Gel Buah 0 0 0 0 0
372 Betadine Mouthwash and Gargle Buah 0 0 0 0 0
373 Bonding Buah 1 1 0 1 1
374 Celluloid Strip Buah 8 8 4 4 4 2
375 CHKM Buah 1 1 0 1 1
376 Cotton Roll Buah 1 1 0 1 1
377 Cresophen Buah 1 1 0 1 1
378 Cresotin Buah 1 1 0 1 1
379 Dentin Conditioner Buah 2 2 1 1 1
380 Ethil Cloride Buah 7 7 6 1 1 8
381 ETSA Buah 2 2 1 1 1
382 Eugenol Buah 1 1 1 0 0 1.5
383 Filtex A2 Buah 0 0 0 0 0
384 Filtex A3 Buah 2 2 1 1 1
385 Finishing Bor Buah 1 1 1 0 0 1.5
386 Fletcher Powder Buah 1 1 1 0 0 1.5
387 Glass Ionomer Cement Pack 1 1 1 0 0 1.5
388 Hemospon ( Surgispons) Buah 1 1 1 0 0 1.5
389 Iodotin Buah 1 1 1 0 0 1.5
390 Mata Bor( High Speed) Buah 0 0 0 0 0
 STOCK STOCK
NO NAMA OBAT/BMHP SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN
AWAL GUDANG

391 Microbrush Buah 1 1 1 0 0 1.5

392 Needle Citoject Buah 0 0 0 0 0
393 Pulp Caping/Ca Hidrokside Buah 1 1 0 1 1
 STOCK STOCK
NO NAMA OBAT/BMHP SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN
AWAL GUDANG

394 Pulp Devitalizer Arsen Buah 0 0 0 0 0

395 Septocain Buah 0 0 0 0 0
396 Single Bonding 2 Buah 1 1 0 1 1
397 Stain Remover Buah 0 0 0 0 0
398 TKF Buah 0 0 0 0 0
399 Tumpatan Sementara Buah 1 1 0 1 1
400 Zinc Cement Buah 0 0 0 0 0

IV VAKSIN
401 B C G + Pelarut Vial 81 81 11 70 70
402 BoPV Polio + Dropper Vial 84 84 35 49 49
403 Campak + Pelarut Vial 0 0 0 0
404 D T Vaksin Vial 31 31 0 31 31
405 D P T HB HIB ( Pentabio ) Vial 77 77 22 55 55
406 Hepatitis B ( HB Uniject ) Pcs 30 40 70 0 70 70
407 IPV Vial 69 69 0 69 69
408 M R + Pelarut Vial 88 88 5 83 83
409 PCV Vaksin Vial 46 46 45 1 1
410 T D Vaksin Vial 46 46 13 33 33
411 HBIG Vaksin ( Hiperheep ) Vial 0 0 0 0
412 Menivax ACWY Vaksin Vial 9 9 0 9 9

V REAGENT
413 Golongan Darah A Vial 0 0 0 0 0 3
414 Golongan Darah B Vial 0 0 0 0 0 3
415 Golongan Darah AB Vial 0 0 0 0 0 3
416 Golongan Darah D Vial 0 0 0 0 0 3
417 Widal Thypi H Vial 0 0 0 0 0 3
418 Widal Thypi O Vial 0 0 0 0 0 3
419 Urine Strip 3 PA Strip 0 0 0 0 0 100
420 Urine Strip 10 PA Strip 0 0 0 0 0 100
421 Reagent Glucose Stick Strip 1000 1000 100 900 900 1000
422 Reagent Asam Urat Stick Strip 50 50 0 50 50 100
423 Reagent Cholesterol Stick Strip 10 10 0 10 10 150
424 Reagent HBsAg Strip Strip 100 100 200 25 175 175
425 Reagent Syphillis Strip 0 0 0 0
426 Reagent Syphillis HIV Duo Strip 100 100 0 100 100
427 Rapid Test I HIV Strip 100 100 0 100 100
428 Rapid Test 2 HIV Strip
429 Rapid Test 3 HIV Strip
430 Rapid Test Anti HCV Test 25 25 0 25 25
431 RDT ( Combo Card ) Malaria Test
432 RDT DBD IgG/ IgM ID Dengue(SD Bioline Dengue) Test 1 1 0 1 1
433 RDT Leptospiroris Botol
 STOCK STOCK
NO NAMA OBAT/BMHP SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN
AWAL GUDANG

434 Reagent ZN Box 0 1 1 0 1 1 1

435 Abate ( Biolarvasida ) Botol
436 Malathion / ZETA Cairan Botol
437 Tuberculin PPD RT 23 Ssi Injeksi Vial
438 Vaccum Tube Steril ( Tabung EDTA ) Pcs 200 300 500 0 500 500
439 Vacuntainer Standart Yellow Holder Pcs 0 0 0
440 Yellow Tips Pcs 100 100 0 100 100
441 Katamin Botol
442 Xyla Botol

RAWAT JALAN
Jumlah
UMUM BPJS JUMLAH
Kunjungan Resep
Puskesmas 2236 2099 4335
Pustu 123 47 170
PKD 189 69 258
JUMLAH 2548 2215 4763

RAWAT INAP
Jumlah
UMUM BPJS JUMLAH
Kunjungan Resep
Rawat Inap 20 41 61
Rawat Jalan
61 0 61
Sore
JUMLAH 81 41 122

Mengetahui / Menyetujui Yang Menyerahkan Yang Meminta

Kepala Dinas Kesehatan Kasie Farmasi Makanan dan Minuman Kepala Puskesmas
Kabupaten Boyolali

dr PUJI ASTUTI,MM ANJAR KUSUMO JATI , SKM ,M.Kes dr. SUGITO

NIP. 19700822 200801 2 010 NIP.19710914 199503 2 001 NIP.19740706 201012 1 006
N DAN LEMBAR PERMINTAAN OBAT TAHUN 2023
( LPLPO )

FORM LPLPO PUSKESMAS

NOMOR TANGGAL
440/ /4.2.21/2023 6 Februari 2023

PEMBERIAN JUMLAH KET

APBD I APBD II LAIN "

 PEMBERIAN JUMLAH KET

APBD I APBD II LAIN "

 PEMBERIAN JUMLAH KET

APBD I APBD II LAIN "

 PEMBERIAN JUMLAH KET

APBD I APBD II LAIN "

 PEMBERIAN JUMLAH KET

APBD I APBD II LAIN "

 PEMBERIAN JUMLAH KET

APBD I APBD II LAIN "

 PEMBERIAN JUMLAH KET

APBD I APBD II LAIN "

 PEMBERIAN JUMLAH KET

APBD I APBD II LAIN "

 PEMBERIAN JUMLAH KET

APBD I APBD II LAIN "

Yang Menerima
Pengelola Obat Puskesmas

dr. SUGITO Apt. WATIK NURUL FAIZAH,S. Farm

NIP.19740706 201012 1 006 SIPA : 503.440/SIPA/99/4.14/IX/2020
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT TAHUN 2023
( LPLPO )

KODE PUSKESMAS : 4.2.21 PELAPORAN BULAN : FEBRUARI 2023 FORM LPLPO PUSKESMA
PUSKESMAS : KEMUSU DOKUMEN
KABUPATEN : BOYOLALI PERMINTAAN BULAN : MARET 2023 PUSKESMAS
PROPINSI : JAWA TENGAH DINKES

STOCK STOCK
NO NAMA OBAT/BMHP SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN
AWAL GUDANG

1 Alat Suntik 1 cc Pcs 100 400 500 0 500 500

2 Alat Suntik 3 cc Pcs 310 310 300 10 0 300
3 Alat Suntik 5 cc Pcs 180 200 380 80 300 300
4 Alkohol 70 % (Etanol ) Botol 0 6 6 1 5 5
5 Alkohol Swab Pcs 268 268 68 200 200
6 Apron One New Bag Set 200 200 0 200 200
7 Aqua Pro Injeksi Vial 450 450 0 450 450
8 Auto Disp Syringe 0,05 ml ( ADS ) Pcs 0 200 200 0 200 200
9 Auto Disp Syringe 0,5 ml ( ADS ) Pcs 100 300 400 18 382 300
10 Auto Disp Syringe 5 ml ( ADS ) Pcs 0 0 0 0 0
11 Autoclic Device Pcs
12 Bedfont D-Piece Smokerlyzer 12s Unit
13 Bedfont Micro + Smokerlyzer Unit
14 Bedfont Steribreath Mouthpiece S 250S Unit
15 Bisturi ( Pisau Operasi ) No 10 Pcs 90 90 0 90 90
16 Bisturi ( Pisau Operasi ) No 11 Pcs 30 30 0 30 30
17 Blood Collection 21 G x 1 1/5 Pcs 2 2 2 0 0
18 Blood Lancet Pcs 0 0 0 0 0
19 Blood Tranfusion Set Pcs 13 20 33 0 33 33 20
20 Cartridge GenExpert ( TB TCM ) Botol
21 Cat Gut Chromic 2/0 Set 0 0 0 0 0
22 Cat Gut Chromic 3/0 Set 8 8 0 8 8 6
23 Cervical Neck Collar Set 2 2 0 2 2
24 Cotton Aplikasi Pcs
25 Dermafix T Plaster 5 x 7 cm Roll 270 270 20 250 250
26 Disinfektan Botol 1L 45 45 40 5 5
27 Face Shield Anak Pcs 20 20 0 20 20
28 Face Shield Dewasa Pcs 7 7 0 7 7
29 Female Catheter Set
30 Fixomul Plester 15 cm x 5 m Roll 2 2 0 2 2
31 Fixomul Plester 5 cm x 5 m Roll 10 10 0 10 10
32 Folley Catheter No 16 Set 22 22 0 22 22
33 Folley Catheter No 18 Set 4 4 0 4 4
34 Gelang Pasien Anak Biru Pcs 4 4 4 0 0
35 Gelang Pasien Anak Pink Pcs 9 9 9 0 0
36 Gelang Pasien Dewasa Biru Pcs 23 23 23 0 0
37 Gelang Pasien Dewasa Pink Pcs 56 56 56 0 0
38 Handschoen Latex Size L Box 4 4 0 4 4
39 Handschoen Latex Size M Box 8 8 0 8 8
40 Handschoen Latex Size S Box 5 5 0 5 5
41 Handschoen Nitril Size L Box 4 4 0 4 4
42 Handschoen Nitril Size M Box 5 10 15 1 14 14 10
43 Handschoen Nitril Size S Box 2 1 3 1 2 2 5
44 Handschoen Obsgyn Pcs
45 Handschoen Steril Pcs
46 Handscrub 500 ml Botol 10 10 10 0 0
47 Handscrub Refill 5 Liter Botol 21 21 0 21 21
48 Handsoap 250 ml Botol 30 30 0 30 30
49 Handspray 100 ml Botol
50 Hasmat ( Cover All ) Pcs 330 330 0 330 330
51 Infus Set Anak Set 47 47 10 37 37
52 Infus Set Dewasa Set 87 50 137 37 100 100 100
53 IV Catheter No 18 Pcs 7 10 17 0 17 17 10
54 IV Catheter No 20 Pcs 30 30 0 30 30
55 IV Catheter No 22 Pcs 120 120 20 100 100 50
56 IV Catheter No 24 Pcs 15 50 65 15 50 50 50
57 Jarum Jahit Kulit Pcs
58 Jarum Jahit Otot Besar Pcs
59 Jarum Jahit Otot Kecil Pcs
 STOCK STOCK
NO NAMA OBAT/BMHP SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN
AWAL GUDANG

60 Kacamata Google Pcs 8 8 0 8 8

61 Kantong Plastik Sampah Medis 0 0 0 0
62 Kapas Pembalut 250 gr Roll 5 5 5 0 0 5
63 Kassa Hydrofil 4 m x 15 cm Roll 30 30 0 30 30 20
64 Kassa Hydrofil 40 m x 80 cm Roll 0 0 0 0 0 5
65 Kassa Hydrofil Steril 16 x 16 Box 15 15 0 15 15
66 Kondom Sutra Pcs
67 Lubricant ( Pelicin ) Pcs
68 Masker 1860 N95 Pcs 382 382 12 370 370
69 Masker 1870 + aura N95 Pcs
70 Masker bx20, 180s N95 Pcs 560 560 0 560 560
71 Masker Kain Pcs 0 0 0 0 0
72 Masker KN95 Pcs 130 130 3 127 127
73 Masker Medis Earloop Pcs 10 10 20 0 20 20 10
74 Masker Medis Headloop Pcs 13 13 13 0 0 10
75 Nebulizer With Mask Anak Set 6 6 0 6 6
76 Nebulizer With Mask Dewasa Set 5 5 0 5 5
77 Nurse Cap Pcs
78 Oxycan Botol 6 6 0 6 6
79 Oxygen Mask Anak Set 35 35 0 35 35
80 Oxygen Mask Dewasa Set 33 33 0 33 33
81 Oxygen Nasal Canula Anak Set 4 4 0 4 4
82 Oxygen Nasal Canula Dewasa Set 10 10 0 10 10
83 Plester ( Leukoplast ) 7,5 cm x 4,5 m Roll 0 0 0 0 0 10
84 Plesterin Bulat T Pcs 200 400 600 200 400 400 600
85 Pot Sputum Buah 60 60 20 40 40
86 Pot Urine Buah 30 100 130 0 130 130 100
87 Povidon Iodida 10 % 30 ml Botol 27 27 9 18 18 30
88 Povidon Iodida 10 % 60 ml Botol 0 0 0 0
89 Povidon Iodida 10 % 300 ml Botol 0 0 0 0
90 Rapid Diagnostic Test ( RDT ) C-19 Antigen Test 504 504 309 195 195
91 Safety Box Set 0 0 0 0 0
92 Silk No 2/0 Set 0 0 0 0 0 6
93 Silk No 3/0 Set 2 2 0 2 2 6
94 Slide Kaca ( Objek Glass ) Box 2 2 0 2 2 5
95 Slide Box Box 0 0 0 0
96 Spalk Kayu Pcs 6 6 0 6 6
97 Spekulum L Pcs 0 0 0 0
98 Spekulum M Pcs 0 0 0 0
99 Underpad ( Soft Pad ) 60 X 90 Pcs 10 10 20 0 20 20
100 Uniflex Perban Elastis 7,5 cm x 4,5 cm Pcs 11 11 0 11 11
101 Urine Bag Pcs 9 9 0 9 9
102 Viral Transport Medium ( VTM ) Pcs

II OBAT
103 Acetosal 100 mg / 80 mg Tablet 170 300 470 170 300 300 300
104 Acetyl sistein 200 mg Kapsul 80 240 320 100 220 200 180
105 Acyclovir 200 mg Tablet
106 Acyclovir 400 mg Tablet 283 283 20 263 200
107 Acyclovir Cream 5 % Tube 32 32 4 28 28 10
108 Albendazole 400 mg Tablet 0 12,500 12500 12500 0 0
109 Albendazole Suspensi 200 mg / 5 ml Botol 0 0 0 0
110 Allopurinol 100 mg Tablet 528 200 728 276 452 400 200
111 Alprazolam 0,5 mg Tablet 66 66 0 66 66
112 Alprazolam 1 mg Tablet
113 Ambroxol 30 mg Tablet 1068 500 1568 203 1365 1300 1000
114 Ambroxol syrup 15 mg / 5 ml Botol
115 Aminophilin 200 mg Tablet
116 Aminophyllin Injeksi 24 mg / 10 ml Ampul
117 Amitriptyline Hcl 25 mg Tablet 100 100 0 100 100
118 Amlodipine 10 mg Tablet 623 623 190 433 400 500
119 Amlodipine 5 mg Tablet 2353 2353 820 1533 1500
120 Amoxycillin 500 mg Caplet 8757 5,000 13757 2542 11215 11200 5000
121 Amoxycillin Injeksi 1 gr Vial 75 75 26 49 49
122 Amoxycillin Syrup 125 mg / 5 ml Botol 0 0 0 0 0
123 Ampicillin Injeksi 1 gr Vial 150 150 80 70 70
124 Antacida Doen 400 mg Tablet 1164 2,000 3164 1658 1506 1500 3000
 STOCK STOCK
NO NAMA OBAT/BMHP SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN
AWAL GUDANG

125 Antacida Doen Suspensi Botol

126 Antalgin ( Metamizole ) 500 mg Tablet 265 265 10 255 200
127 Antalgin 500 mg + Neurotropic Tablet 500 500 0 500 500
128 Antalgin Injeksi 250 mg / ml-2 ml Ampul 45 45 12 33 33
129 Anti Hemmoroid Supp Supp 0 10 10 6 4 4 20
130 Artesunate Injeksi Vial
131 Asam Ascorbat ( Vit C ) 50 mg Tablet 1280 2,500 3780 1659 2121 2100 3000
132 Asam Ascorbat 500 mg (Vit C ) Tablet 0 0 0 0 0
133 Asam Folat 1 mg Tablet 0 0 500
134 Asam Mefenamat 500 mg Tablet 0 1,500 1500 450 1050 1000 1500
135 Asam Tranexamat 500 mg Tablet 64 200 264 0 264 200
136 Asam Tranexamat Injeksi 250 mg / ml Ampul 10 10 0 10 10
137 Atropin Sulfas Injeksi 0,25 mg / ml Ampul 10 10 0 10 10
138 Azitromycin 500 mg Tablet 0 0 0 0 0 50
139 Bekarbon/Norit Tablet 200 200 0 200 200
140 Benzatin Benzil Penicillina Inj 2,4 juta IU Vial
141 Besi II Sulfat + Asam Folat Tablet 3924 3924 3924 0 0
142 Besi Sulfat Kombinasi Multivitamin Capsul 522 522 26 496 400 500
143 Betahistin Mesilat 6 mg Tablet 12 300 312 140 172 100 500
144 Betametason +Neomycin cream Tube 23 23 11 12 12 10
145 Betametason Cream 0,1 % Tube 0 0 0 0 0 24
146 Bisacodyl 10 mg Tablet 0 0 0 0 0
147 Borax Glycerin ( Gom ) 25 % Botol 14 14 1 13 13
148 Bromhexin 8 mg Tablet 181 200 381 10 371 300 200
149 Bromhexin syrup 8 mg / ml Botol 57 57 0 57 57
150 Calcium Gluconas Injeksi 10 % - 20 ml Ampul 34 34 0 34 34
151 Calcium Lactat ( Kalk ) 500 mg Tablet 2542 2,000 4542 1451 3091 3000 3000
152 Captopril 12,5 mg Tablet 58 500 558 18 540 500
153 Captopril 25 mg Tablet 559 100 659 268 391 300 500
154 Carbamazepine 200 mg Tablet 250 250 90 160 100 200
155 Cefadroxyl 500 mg Capsul 618 618 294 324 300 600
156 Cefadroxyl syrup 125 mg / 5 ml Botol 20 20 0 20 20
157 Cefixime 100 mg Capsul 125 125 125 0 0 200
158 Cefixime syrup 100 mg / 5 ml Botol 0 20 20 1 19 19
159 Cefotaxime Injeksi 1 gr Vial 22 22 8 14 14 10
160 Ceftriaxone Injeksi 1 gr Vial 20 20 16 4 4 24
161 Cetirizine 10 mg Tablet 412 200 612 162 450 400 300
162 Cetirizine Syrup 5 mg / 5 ml Botol 10 10 0 10 10
163 Chloramphenicol 250 mg Capsul 510 510 64 446 440
164 Chloramphenicol Injeksi 1 gr Vial 40 40 10 30 30
165 Chloramphenicol Salep Kulit Tube 24 24 2 22 22
166 Chloramphenicol Salep Mata 1 % Tube 2 2 0 2 2 10
167 Chloramphenicol Tetes Mata 0,5 % Botol 14 25 39 14 25 25 25
168 Chloramphenicol Tetes Telinga 1 % Botol 50 50 6 44 44
169 Chlorfeniramin Maleat 4 mg ( CTM ) Tablet 987 1,000 1987 436 1551 1500 2000
170 Choramphenicol Suspensi 125 mg / 5 ml Botol 0
171 Chorpromazine 100 mg ( CPZ ) Tablet 310 310 0 310 310
172 Ciprofloxacin Hcl 500 mg Tablet 0 100 100 12 88 0 600
173 Clindamycin 150 mg Capsul 0 0 0 0 0
174 Clindamycin 300 mg Capsul 222 222 16 206 200
175 Clobazam 10 mg Tablet
176 Clozapin 25 mg Tablet 170 170 0 170 170
177 Cotrimoxazole 480 mg Tablet 340 340 138 202 200 600
178 Cotrimoxazole Suspensi 240 mg / ml Botol 58 58 0 58 50
179 Dexamethasone Injeksi 5 mg / ml Ampul 27 27 2 25 25
180 Dexamethasone O,5 mg Tablet 234 2,000 2234 1652 582 500 5000
181 Diazepam 2 mg Tablet 68 68 10 58 58
182 Diazepam 5 mg Tablet 103 103 0 103 103
183 Diazepam Injeksi 5 mg / 2 ml Ampul 20 20 0 20 20
184 Diazepam Rectal 5 mg / 2,5 ml Supp 5 5 0 5 5
185 Digoxin 0,25 mg Tablet 287 287 20 267 200
186 Dihydro Artemisin + Piperaquine ( DHP ) Tablet
187 Dimenhidrinate 50 mg Tablet 314 314 52 262 200
188 Diphenhidramine Injeksi 10 mg / ml Ampul 40 40 0 40 40
189 Domperidon 10 mg Tablet 756 756 354 402 400 500
190 Domperidon Suspensi 5 mg / 5 ml Botol 0 0 0 0 0
191 Doxyciclin Hcl 100 mg Capsul
 STOCK STOCK
NO NAMA OBAT/BMHP SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN
AWAL GUDANG

192 Epinefrine ( Adrenaline ) Injeksi 0,1 % - 1 ml Ampul 14 14 0 14 14

193 Ergotamin 1 mg + Coffein 50 mg ( Anti Migren ) Tablet
194 Erytromycin 500 mg Capsul 174 174 54 120 100 300
195 Euthyrox 50 mcg Tablet
196 Extract Placenta +Neomycin Cream Tube 1 1 2 1 1 10
197 Fenitoin Natrium 100 mg Capsul 80 80 0 80 80
198 Fenobarbhital 30 mg Tablet 46 46 0 46 46
199 Fenobarbhital Injeksi 50 m / ml - 2 ml Ampul 94 94 0 94 94
200 Fenofibrate 100 mg Capsul
201 Fenol Glycerol Tetes Telinga 10 % Botol 18 18 4 14 14 10
202 Fitomenadion ( Vit K ) 10 mg Tablet 210 210 60 150 100
203 Fitomenadion ( Vit K ) Injeksi 2 mg / ml Ampul 210 210 0 210 210
204 Flu Anak Syrup Botol 114 114 0 114 114
205 Flu Batuk Dewasa Tablet 866 866 866 0 0 2000
206 Flu Dewasa Tablet 1295 1295 510 785 750 1500
207 Fluconazole 150 mg Kapsul
208 Fluoxetin 20 mg Kapsul 60 60 0 60 60
209 Framycetin Tulle Patch 0 20 20 10 10 10 20
210 Furosemide 40 mg Tablet 489 489 145 344 300 400
211 Furosemide Injeksi 10 mg / ml Ampul
212 Garam Oralit Sacchet 110 110 35 75 75 100
213 Gentamycin Injeksi 40 mg / 2 ml Ampul 35 35 0 35 35
214 Gentamycin Salep Kulit 0,1 % Tube 7 36 43 21 22 22 36
215 Gentamycin Salep Mata 0,3 % Tube 24 24 0 24 24
216 Gentamycin Sulfat Tetes Mata 0,3 % Botol
217 Gentian Violet Botol 12 12 1 11 11
218 Gliblenclamide 5 mg Tablet 74 74 0 74 0 100
219 Glimepiride 2 mg Tablet 320 600 920 406 514 500 800
220 Glucosa 10 % Lar Infus Botol 70 70 0 70 70
221 Glucosa 40 % Botol/25 ml 21 21 21 0 0
222 Glucosa 5 % + NaCl 0,25 % Lar Infus ( D 1/4 ) Botol
223 Glucosa 5 % Lar Infus Botol 7 7 1 6 6
224 Glyceril Guaiacolat 100 mg Tablet 565 565 185 380 300 300
225 Griseofulvin 125 mg Tablet
226 Halloperidol 1,5 mg Tablet 65 65 0 65 65
227 Halloperidol 5 mg Tablet
228 Halloperidol Injeksi i.m 5 mg/ml Ampul
229 Hidrocortisone Cream 1 % Tube 0 0 0 0 0
230 Hidrocortisone Cream 2,5 % Tube 27 24 51 12 39 39 24
231 Hydroclorotiazide ( HCT ) 25 mg Tablet 381 381 330 51 0 300
232 Hyosina N-Butilbromide Injeksi 20 mg / ml Ampul 20 20 10 10 10 20
233 Hyosina N-Butilromide 10 mg Tablet 580 580 10 570 500
234 Hyosina N-Butilromide 10 mg + Paracetamol Tablet
235 Iburofen 200 mg Tablet 2500
236 Iburofen 400 mg Tablet 70 100 170 170 0 0 2500
237 Iburofen Suspensi 100 mg / ml Botol 0 0
238 Ichtiyol Salep 10 % Tube 18 18 1 17 17
239 Iodium Test Botol
240 Isoniazide ( INH ) 100 mg Tablet
241 Isoniazide ( INH ) 300 mg Tablet
242 Isosorbide Dinitrat 5 mg ( ISDN ) Tablet 190 190 0 190 100
243 KA-EN 3A Larutan Infus Botol
244 KA-EN 3B Larutan Infus Botol
245 Kalamin Lotion Botol 16 16 0 16 16
246 Kalium Diclovenax 50 mg Tablet 258 258 28 230 200 200
247 Kalium Klorida+Natrium Klorida Tetes Mata Botol
248 Ketoconazole 200 mg Tablet 117 200 317 36 281 200 200
249 Ketoconazole Cream 2 % Tube 19 19 7 12 12 12
250 Ketorolac Inj ( Tromethamin 30 mg/ml ) Ampul 35 35 20 15 15 30
251 Lansoprazol 30 mg Kapsul 80 50 130 0 130 100
252 Levertran ( Minyak Ikan ) Tube 27 27 0 27 24
253 Lidocain Comp Injeksi 2 ml Ampul 60 60 20 40 40
254 Lidocain Hcl Injeksi 2 % Ampul 90 90 60 30 30 100
255 Lisinopril 5 mg Tablet
256 Loperamide Hcl 2 mg Tablet 430 430 0 430 400
257 Magnesium Sulfat Injeksi 20 % ( MgSO4 ) Vial 64 64 0 64 64
258 Magnesium Sulfat Injeksi 40 % ( MgSO4 ) Vial 4 4 0 4 4
 STOCK STOCK
NO NAMA OBAT/BMHP SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN
AWAL GUDANG

259 MDT MB Combi Anak Paket

260 MDT MB Combi Dewasa Paket 1 1 1 0 0
261 MDT PB Combi Anak Paket
262 MDT PB Combi Dewasa Paket
263 Meloxicam 15 mg Tablet 405 405 73 332 300
264 Metformin Hcl 500 mg Tablet 0 0 0 0 0 600
265 Methylergometrin Maleat 0,125 mg Tablet 0 0 0 0
266 Methylergometrin Maleat Inj 0,2 mg / ml Ampul 3 3 0 3 3
267 Methylprednisolon 4 mg Tablet 0 0 0 0 0 3000
268 Metoclopramide Hcl 10 mg Tablet
269 Metoclopramide Hcl 5 mg Tablet
270 Metoclopramide Hcl Injeksi Ampul
271 Metronidazole 250 mg Tablet
272 Metronidazole 500 mg Tablet 818 818 75 743 700
273 Metronidazole Infus 0,5 % Botol
274 Metronidazole Syrup 125 mg / 5 ml Botol
275 Miconazole Cream 2 % Tube 59 59 5 54 54
276 Microlax supp Tube 4 4 0 4 4
277 Mineral Mix Sacchet
278 Multivitamin Capsul Capsul 0 0 0 0 0
279 Multivitamin Capsul(Imboost Force) Capsul
280 Multivitamin Capsul(Vitamin +Zink) Capsul 100 100 0 100 100
281 Multivitamin Syrup Botol 68 68 0 68 68
282 Multivitamin Syrup(vitamin+curcuma) Botol
283 Natrium Chlorida 0,9 % - 100 ml Botol
284 Natrium Chlorida 0,9 % - 25 ml Botol
285 Natrium Chlorida 0,9 % - 500 ml (NaCl ) Botol 31 31 0 31 31
286 Natrium Diclovenax 50 mg Tablet 634 600 1234 516 718 700 600
287 Natrium Diclovenax Gell 1 % Tube 0 30 30 2 28 28 10
288 Neurotropic 5000 Injeksi Ampul 30 30 10 20 20 10
289 Neurotropic Caplet Tablet 970 970 208 762 700
290 Nifedipine 10 mg Tablet 130 130 0 130 100
291 Nystatin Drops 100.000 IU/ ml Botol 10 10 0 10 10
292 Nystatin Tablet Salut 500.000 IU Tablet 0 0 0 0 0
293 Nystatin Tablet Vagina 100.000 IU Supp 65 65 35 30 30
294 Obat ARV Abacavir/Lamivudin 120mg/60 mg Botol
295 Obat ARV Abacavir/Lamivudin 600mg/300 mg Botol
296 Obat ARV Efavirenz ( EFV ) 600 mg Tablet
297 Obat ARV FDC Triple Anak Tablet
298 Obat ARV FDC Triple Dewasa ( TDF /3TC/EFV ) Tablet 1 1 0 1 1
299 Obat ARV Lamivudine ( 3TC) 150 mg Tablet
300 Obat ARV Lamivudine + Zidovudine Tablet
301 Obat ARV Lopinavir / Ritonavir ( LPV ) 200 / 50 mg Tablet
302 Obat ARV Lopinavir / Ritonavir ( LPV ) 40 / 10 mg Sacchet
303 Obat ARV Nevirapine 200 mg Tablet
304 Obat ARV Tenofovir ( TDF ) 300 mg Tablet
305 Obat ARV Tenofovir / Emtricitabine ( FTC ) 300 / 200 Tablet
306 Obat ARV Zidovudine 100 mg Tablet
307 Obat ARV Zidovudine 50 mg / 5 ml Syrup Botol
308 Obat Batuk Dewasa(Grantusif) Tablet
309 Obat Batuk Hitam (OBH ) Botol 0 0 0 0 0
310 Obat Diare Anak Syrup Botol 57 57 0 57 57
311 Obat Diare Dewasa Tablet 1078 1078 308 770 700 500
312 Obat Pencahar Syrup ( Lactulosa ) Botol 8 8 1 7 7
313 Obat TB FDC Dosis Harian I dan III Paket
314 Obat TB FDC Kategori Anak Paket 1 2 3 2 1 1
315 Obat TB FDC Kategori I Paket 5 5 1 4 4
316 Obat TB FDC Kategori II Paket
317 Obat TB HIV Fase ( Lanjutan ) Tablet
318 Obat TB HIV Fase Awal Tablet
319 Obat TB Kombipak Kategori I Paket
320 Omeprazole 20 mg Capsul 340 1,000 1340 192 1148 1000 200
321 Ondansetron 4 mg Tablet 0 0 0 0 0
322 Ondansetron Injeksi 4 mg / 2 ml Ampul 30 30 30 0 0 60
323 Oxytetracyclin Hcl Salep Kulit 3 % Tube 0 0 0 0 0 25
324 Oxytetracyclin Hcl Salep Mata 1 % Tube 193 193 9 184 184
325 Oxytocin Injeksi 10 IU / ml - 1 ml Ampul 80 80 0 80 80
 STOCK STOCK
NO NAMA OBAT/BMHP SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN
AWAL GUDANG

326 Papaverine Hcl 40 mg Tablet 0 0 0 0 0

327 Paracetamol 500 mg Tablet 3278 2,000 5278 2823 2455 2400 1000
328 Paracetamol Drops 100 mg / ml Botol 0 0 0 0 0
329 Paracetamol Syrup 120 mg / 5 ml Botol 200 200 0 200 200
330 Permetrin ( Scabicid) Cream 5 % Tube 2 12 14 1 13 13 6
331 Piracetam 400 mg Capsul 134 134 18 116 100
332 Piracetam Injeksi 1 gr Ampul 0 0 0 0 0
333 Piroxicam 10 mg Tablet 930 500 1430 182 1248 1200 500
334 Prednison 5 mg Tablet 259 259 259 0 0 1000
335 Primaquine 15 mg Tablet
336 Propyltiouracyl 100 mg ( PTU ) Tablet
337 Pyrantel Syrup Botol 0 0 0 0 0
338 Pyridoxin Hcl 10 mg ( Vit B6 ) Tablet 612 612 110 502 500
339 Pyridoxin Hcl 25 mg ( Vit B6 ) Tablet
340 Ranitidine 150 mg Tablet 762 600 1362 238 1124 1100 600
341 Ranitidine Injeksi 50 mg / 2 ml Ampul 90 90 50 40 40 60
342 Retinol ( Vit A ) 100.000 IU Capsul 820 820 0 820 820
343 Retinol ( Vit A ) 200.000 IU Capsul 0 0 0 0 0
344 Ringer Lactat Larutan Infus ( RL ) Botol 0 100 100 100 0 100 600
345 Risperidon 2 mg Tablet 400 400 0 400 400
346 Salbutamol 2 mg Tablet 50 200 250 104 146 100 400
347 Salbutamol Nebules Ampul 10 10 1 9 9
348 Salbutamol+Ipratropium Bromida (Combivent Nebulez)
349 Salep 2 -4 Tube 0 0 0 0 0
350 Salycil Talk 2 % Botol 17 17 8 9 9 10
351 Serum Anti Bisa Ular 5 ml Inj ( ABU ) Vial 4 4 0 4 4
352 Serum Anti Rabies ( VAR ) Vial
353 Serum Anti Tetanus 1500 IU ( ATS ) Ampul 2 2 1 1 1 2
354 Sianocobalamin 50 mcg ( Vit B12 ) Tablet 530 530 110 420 400
355 Sianocobalamin Injeksi 500 mcg - ml Ampul 0 0 0 0 0
356 Simvastatin 10 mg Tablet 291 200 491 332 159 100 800
357 Sulcralfat Suspensi 100 ml Botol 5 6 11 4 7 7
358 Sulfadiazine Silver Cream 10 mg Tube
359 Tetracyclin Hcl 500 mg Capsul
360 Tetrahydrozolin Tetes Mata Botol 0 10 10 0 10 10 6
361 Thiamin Hcl ( Vit B1 ) 50 mg Tablet 1184 1184 20 1164 1100
362 Thiamphenicol 500 mg Capsul 488 488 362 126 100 600
363 Trifluoperazine 5 mg Tablet
364 Trihexyphenidil Hcl 2 mg Tablet 140 140 0 140 140
365 Ultrasonic Jelly Botol 4 4 0 4 4
366 Vitamin B Complex Tablet 1005 2,000 3005 1515 1490 1400 3000
367 Vitamin D3 Tablet 300 300 0 300 300
368 Zinc 20 mg Tablet 128 128 30 98 0 100
369 Zinc Syrup 20 mg / 5 ml Botol 42 42 0 42 42

III OBAT GIGI

370 3 All/3 Mix Buah 0 0 0 0 0
371 Anastesi Topical Gel Buah 0 0 0 0 0
372 Betadine Mouthwash and Gargle Buah 0 0 0 0 0
373 Bonding Buah 1 1 0 1 1
374 Celluloid Strip Buah 4 4 0 4 4
375 CHKM Buah 1 1 0 1 1
376 Cotton Roll Buah 1 1 0 1 1
377 Cresophen Buah 1 1 0 1 1
378 Cresotin Buah 1 1 0 1 1
379 Dentin Conditioner Buah 1 1 0 1 1
380 Ethil Cloride Buah 1 8 9 0 9 9
381 ETSA Buah 1 1 0 1 1
382 Eugenol Buah 0 0 0 0 0
383 Filtex A2 Buah 0 0 0 0 0
384 Filtex A3 Buah 1 1 0 1 1
385 Finishing Bor Buah 0 0 0 0 0
386 Fletcher Powder Buah 0 0 0 0 0
387 Glass Ionomer Cement Pack 0 0 0 0 0
388 Hemospon ( Surgispons) Buah 0 0 0 0 0
389 Iodotin Buah 0 0 0 0 0
390 Mata Bor( High Speed) Buah 0 0 0 0 0
 STOCK STOCK
NO NAMA OBAT/BMHP SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN
AWAL GUDANG

391 Microbrush Buah 0 0 0 0 0

392 Needle Citoject Buah 0 0 0 0 0
393 Pulp Caping/Ca Hidrokside Buah 1 1 0 1 1
 STOCK STOCK
NO NAMA OBAT/BMHP SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN
AWAL GUDANG

394 Pulp Devitalizer Arsen Buah 0 0 0 0 0

395 Septocain Buah 0 0 0 0 0
396 Single Bonding 2 Buah 1 1 0 1 1
397 Stain Remover Buah 0 0 0 0 0
398 TKF Buah 0 0 0 0 0
399 Tumpatan Sementara Buah 1 1 0 1 1
400 Zinc Cement Buah 0 0 0 0 0

IV VAKSIN
401 B C G + Pelarut Vial 135 50 185 0 185 185
402 BoPV Polio + Dropper Vial 49 50 99 14 85 85
403 Campak + Pelarut Vial 0 0 0 0
404 D T Vaksin Vial 31 31 0 31 31
405 D P T HB HIB ( Pentabio ) Vial 55 55 0 55 55
406 Hepatitis B ( HB Uniject ) Pcs 70 70 0 70 70
407 IPV Vial 69 20 89 6 83 83
408 M R + Pelarut Vial 83 20 103 14 89 89
409 PCV Vaksin Vial 1 60 61 24 37 37
410 T D Vaksin Vial 33 30 63 1 62 62
411 HBIG Vaksin ( Hiperheep ) Vial 0 1 1 0 1 1
412 Menivax ACWY Vaksin Vial 0 0 0 0 0

V REAGENT
413 Golongan Darah A Vial 0 0 0 0 0 3
414 Golongan Darah B Vial 0 0 0 0 0 3
415 Golongan Darah AB Vial 0 0 0 0 0 3
416 Golongan Darah D Vial 0 0 0 0 0 3
417 Widal Thypi H Vial 0 0 0 0 0 3
418 Widal Thypi O Vial 0 0 0 0 0 3
419 Urine Strip 3 PA Strip 0 0 0 0 0 100
420 Urine Strip 10 PA Strip 0 0 0 0 0 100
421 Reagent Glucose Stick Strip 800 800 100 700 800 1000
422 Reagent Asam Urat Stick Strip 50 50 25 25 25 200
423 Reagent Cholesterol Stick Strip 0 0 0 0 0 500
424 Reagent HBsAg Strip Strip 175 100 275 125 150 150 100
425 Reagent Syphillis Strip 0 0 0 0
426 Reagent Syphillis HIV Duo Strip 100 100 50 50 50 200
427 Rapid Test I HIV Strip 100 100 0 100 100
428 Rapid Test 2 HIV Strip
429 Rapid Test 3 HIV Strip
430 Rapid Test Anti HCV Test 25 25 0 25 25
431 RDT ( Combo Card ) Malaria Test 0 0
432 RDT DBD IgG/ IgM ID Dengue(SD Bioline Dengue) Test 1 1 0 1 1 2
433 RDT Leptospiroris Botol 1 1 1
 STOCK STOCK
NO NAMA OBAT/BMHP SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN
AWAL GUDANG

434 Reagent ZN Box 1 1 1 0 1 1

435 Abate ( Biolarvasida ) Botol
436 Malathion / ZETA Cairan Botol
437 Tuberculin PPD RT 23 Ssi Injeksi Vial 1
438 Vaccum Tube Steril ( Tabung EDTA ) Pcs 500 500 0 500 500
439 Vacuntainer Standart Yellow Holder Pcs 0 0 0 0
440 Yellow Tips Pcs 100 100 0 100 100
441 Katamin Botol
442 Xyla Botol

RAWAT JALAN
Jumlah
UMUM BPJS JUMLAH
Kunjungan Resep
Puskesmas 465 999 1464
Pustu 128 39 167
PKD 170 69 239
JUMLAH 763 1107 1870

RAWAT INAP
Jumlah
UMUM BPJS JUMLAH
Kunjungan Resep
Rawat Inap 19 30 49
Rawat Jalan
59 0 59
Sore
JUMLAH 78 30 108

Mengetahui / Menyetujui Yang Menyerahkan Yang Meminta

Kepala Dinas Kesehatan Kasie Farmasi Makanan dan Minuman Kepala Puskesmas
Kabupaten Boyolali

dr PUJI ASTUTI,MM ANJAR KUSUMO JATI , SKM ,M.Kes dr. SUGITO

NIP. 19700822 200801 2 010 NIP.19710914 199503 2 001 NIP.19740706 201012 1 006
N DAN LEMBAR PERMINTAAN OBAT TAHUN 2023
( LPLPO )

FORM LPLPO PUSKESMAS

NOMOR TANGGAL
440/ /4.2.21/2023 3-Mar-23

PEMBERIAN JUMLAH KET

APBD I APBD II LAIN "

 PEMBERIAN JUMLAH KET

APBD I APBD II LAIN "

 PEMBERIAN JUMLAH KET

APBD I APBD II LAIN "

 PEMBERIAN JUMLAH KET

APBD I APBD II LAIN "

 PEMBERIAN JUMLAH KET

APBD I APBD II LAIN "

 PEMBERIAN JUMLAH KET

APBD I APBD II LAIN "

 PEMBERIAN JUMLAH KET

APBD I APBD II LAIN "

 PEMBERIAN JUMLAH KET

APBD I APBD II LAIN "

 PEMBERIAN JUMLAH KET

APBD I APBD II LAIN "

Yang Menerima
Pengelola Obat Puskesmas

dr. SUGITO Apt. WATIK NURUL FAIZAH,S. Farm

NIP.19740706 201012 1 006 SIPA : 503.440/SIPA/99/4.14/IX/2020