Lplpo Mei 2015

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LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

RSU/SUB-UNIT PELAYANAN KESEHATAN (LPLPO/LB1)

KODE RSU :

RSU : KecamatanKECAMATAN : Kembangan DOKUM

KAB/KODYA : Jakarta Barat RSU

PROPINSI : DKI Jakarta PERMINTAAN BULAN/PERIODE : Juni 2015 SUB-UN

N! NAMA OBATSATUAN STOK PENERI- PERSE- PEMA- SISA

A"A# MAAN DIAAN KAIAN STOK

$ % & ' ( ) * +

1 ALOPURINOL TABLET 100 MG TAB 190 0 190 15 175

2 AMINOFILIN TABLET 200 MG TAB 79 0 79 0 79

3 AMITRIPTILINHCL TABLET SALUT 25 MG TAB 0 0 0 0 0

4 AMOKSILIN SIRUP KERING 125 MG/5ML BTL 4 10 14 3 11

5 ANTALGIN (METAMPIRON) TABLET 500 MG TAB 189 0 189 10 179

ANTASI!A !OEN KOMBINASI TAB 578 300 878 30 572

7 A"UA PROIN#EKSI STERIL$ BEBAS PIROGEN 25 ML AMP 1 2 3 0 3

8 A"UA!EST STERIL 1000 ML BTL 0 0 0 0 0

9 ASAM ASKORBAT (%IT C) TABLET 50 MG TAB 713 0 713 492 221

10 BEN&ATIN BEN&IL PENISILIN IN# 2$4 #UTA IU/%IAL %IAL 3 0 3 0 3

11 BETAMETASON KRIM 0$1' TUB 0 0 0 0 0

12 !EKSAMETASON IN# 5 MG/ML 1 ML AMP 5 0 5 1 4

13 !EKSAMETASON TABLET 0$5 MG BTL 18 300 318 0 25814 !EKSTROMETORFAN HBR SIRUP 10 MG/5 ML BTL 0 0 0 0 0

15 !EKSTROMETORFAN HBR TABLET 15 MG TAB 0 0 0 0 0

1 !IA&EPAM IN# 5 MG/ML 2 ML AMP 0 0 0 0 0

17 !IA&EPAM TABLET 2 MG TAB 0 0 0 0 0

18 !IFENHI!RAMIN HCL IN#10 MG/L ML AMP 0 3 3

19 EFE!RIN HCL TABLET 25 MG TAB 0 0 0 0 0

20 EFINEFRIN HCL/BITARTRAT(A!RENALIN)IN#0$1'1ML AMP 18 0 18 1 17

21 ETAKRI!IN (RI%ANOL) LARUTAN 0$1' BTL 1 0 1 1 0

22 ETANOL 70' BTL 1 0 1 0 1

23 FENOBARBITAL TABLET 30 MG TAB 0 0 0 0 0

24 FENOL GLISEROL TETES TELINGA 10' BTL 0 0 0 0 0

25 FITOMENA!ION (%IT K1) IN#10 MG/ML 1 ML AMP 0 0 0 0 0

2 FITOMENA!ION (%IT K1) TABLET 10 MG TAB 87 0 87 57 30

27 FUROSEMI! TABLET 40 MG TAB 100 0 100 1 99

28 GARAM ORALIT UNTUK 200 ML AIR SAK 78 50 128 113 15

29 GENTIAN %IOLET LARUTAN 1' BTL 10 0 10 0 10

30 GLIBENKLAMI! TABLET 5 MG TAB 170 0 170 0 170

31 GLISERIL GUA*AKOLAT 100 MG TAB 300 0 300 10 290

32 GLUKOSA LARUTAN INFUS 5' STERIL BTL 2 0 2 0 2

33 GRISEOFULIN TABLET 125 MG$ MICRONI&E! TAB 100 0 100 0 100

34 HALOPERI!OL TABLET 1$5 MG TAB 0 0 0 0 0

35 HI!ROKLOROTIA&I! (HCT) TABLET 25 MG TAB 0 0 0 0 0

3 HI!ROKORTISON KRIM 0$5' TUB 5 24 29 3 2

37 IBUPROFEN TABLET 200 MG TAB 119 0 119 40 79

38 IBUPROFEN TABLET 400 MG TAB 120 300 420 258 12

39 ISONIA&I! TABLET 300 MG TAB 0 0 0 0 0

40 ISOSORBI! !INITRAT TABLET SUBLINGUAL 5 MG TAB 100 0 100 1 99

41 KALIUM PERMANGANAT SERBUK BTL 0 0 0 0 0

42 KALSIUM LAKTAT (KALK) TABLET 500 MG TAB 200 0 200 10 190

43 KAPAS PEMBALUT A!SORBEN 250 MG TAB 0 0 0 0 0

PELAPORAN BULAN/PERIODE :Mei 2015

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44 KASA PEMBALUT 4M + 15 CM ROL 0 0 0 0 0

45 KLORAMFENIKOL KAPSUL 250 MG KAP 20 0 20 2 180

4 KLORAMFENIKOL SALEP MATA 1' TUBE 10 0 10 0 10

47 KLORAMFENIKOL TETES TELINGA 3' BTL 7 0 7 0 7

48 KLORFENIRAMIN MALEAT (CTM) TABLET 4 MG TAB 185 200 385 95 290

49 KLORPROMA&IN HCL TABLET SALUT 100 MG TAB 0 0 0 0 0

50 KO!EIN HCL TABLET 10 MG TAB 0 0 0 0 0

51 KOTRIMOKSA&OL SUSPENSI BTL 7 5 12 7 552 KOTRIMOKSA&OL !E,ASA TABLET TAB 224 100 324 133 191

53 LI!OKAIN KOMPOSITUM IN#EKSI MP 43 30 73 17 5

54 MAGNESIUM SULFAT IN# I% 45 ' 25 ML %IAL 0 2 2 0 2

55 METIL ERGOMETREIN MALEAT TABLET SALUT 0$125 MG TAB 0 0 0 0 0

5 METIL ERGOMETRIN MALEAT IN#0$200 MG 1 ML AMP 0 0 0 0 0

57 NATRIUM KLORI!A LARUTAN INFUS0$9' STERIL BTL 0 3 3 1 2

58 NISTATIN 100000 IU / G TABLET %AGINAL TAB 10 0 10 0 10

59 NISTATIN 500000 IU TABLET SALUT TAB 0 0 0 0 0

0 OBAT ANTI TUBERKOLOSIS KATEGORI 1 PKT 0 0 0 0 0

1 OBAT ANTI TUBERKOLOSIS KATEGORI 2 PKT 0 0 0 0 0

2 OBAT ANTI TUBERKOLOSIS SISIPAN ANAK PKT 0 0 0 0 0

3 OBAT BATUK HITAM (OBH) CAIRAN BTL 0 0 0 0 0

4 OKSITETRASIKLIN HCL SALEP 3 ' TUB 7 0 7 4 3

5 OKSITOSIN IN#EKSI 10 IU / ML 1 ML AMP 0 0 0 0 0

PARASETAMOL SIRUP 120 MG/5 ML BTL 7 25 32 23 9

7 PARASETAMOL TABLET 500 MG TAB 112 1800 1912 1212 700

8 PIRANTEL PAMOAT TABLET 35 MG TAB 0 0 0 0 0

9 PIRI!OKSIN HCL TABLET 10MG TAB 950 0 950 119 831

70 PRE!NISON TABLET 5 MG TAB 90 100 190 35 155

71 PROPILTIOURASIL TABLET 100 MG TAB 0 0 0 0 0

72 PROPANOLOL HCL TABLET 40 MG TAB 25 0 25 0 25

73 RETINOL (%ITAMIN A) KAPSUL 200000 IU KAP 0 0 0 0 0

74 RIFAMPISIN KAPSUL 300 MG KAP 0 0 0 0 0

75 RINGER LAKTAT LARUTAN INFUS STERIL BTL 30 300 330 189 141

7 SALBUTAMOL TABLET 2 MG TAB 0 100 100 44 5

77 SALEP 24 KOMBINASI POT 5 0 5 0 5

78 SALISIL BE!AK 24 ' KTK 1 3 4 2 2

79 SULFACETAMI!E NATRIUM TETES MATA 15' BTL 0 0 0 0 0

80 TABLET TAMBAH !ARAH KOMBINASI TAB 00 1200 1800 1155 45

81 TETRASIKLIN HCL KAPSUL 500 MG KAP 100 0 100 0 100

82 TRIHEKSIFENI!IL HI!ROKLORO!A TABLET 2MG TAB 0 0 0 0 0

83 %ITAMIN B1 TABLET TAB 1998 0 1998 10 1988

84 %ITAMIN B KOMPLEKS TABLET TAB 288 1000 1288 1015 273

85 *O!IUM PO%I!ON LARUTAN 10' 1000 ML BTL 1 0 1 1 0

8 *O!IUM PO%I!ON LARUTAN 10' 300 ML BTL 0 0 0 0 0

Pengurus Gudang ar!asi R"U #e$% #e!&anganDire'(ur R"U #e$% #e!&angan Dire'(ur R"U #e$% #e!&angan/"u& Uni( Pe)a*anan

Menge(a+ui/!en*e(u,ui -ang !en*era+'an -ang !e!in(a !e)a.r

dr Ir!a RianiMAP

Ni. : 13420203136122001

7endra "!ara #ris(i

Ni. : 133002022018092005

drg Ru))* Dei Anggraeni

Ni. : 13430302000092005

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EN N! T,#!

: : !

T : : !

PERMIN- PEMBE-KET

TAAN RIAN

. $ $$

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Pe(ugas ar!asi R"U #e$%#e!&angan

-ang !eneri!a

7endra "!ara #ris(i

Ni. : 133002022018092005

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LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT I


KODE RSU :

RSU : Kecamatan

KECAMATAN : Kembangan

KAB/KODYA : Jakarta Barat

PROPINSI : DKI Jakarta PERMINTAAN BULAN/PERIODE : Juni 2015

NO! NAMA OBATSATUAN STOK PENERI- PERSE- PEMA-

A"A# MAAN DIAAN KAIAN

1 2 3 4 5 6=(4+5) 7=(6-8)

1 AMOKSISILIN 500 MG KAPSUL KAP 210 700 910 518

2 ANTASI!A !OEN SUSPENSI BTL 0 0 0 0

3 ASAM MEFENAMAT 500 MG TABLET SALUT SELAPUT TAB 18 200 38 1

4 ASIKLO%IR 400 MG TABLET TAB 200 0 200 40

5 ASIKLO%IR KRIM 5 ' TUB 0 0 0 0

BIOPLACENTON #ELL* TUB 10 0 10 0

7 BISACO!*L TABLET 5 MG TAB 0 0 0 0

8 BORAKS GLISEROL 5' LARUTAN BTL 7 0 7 0

9 BROMHE+IN HCL TABLET 8 MG TAB 175 0 175 140

10 !IA&EPAM 5 MG RECTAL TUBE TUB 4 0 4 1

11 !IMENH*!RINATE TABLET 50 MG TAB 100 0 100 0

12 !OPAMIN HCL 20 MG/ML IN#EKSI AMP 0 0 0 0

13 !O+*C*CLINE KAPSUL 100 MG KAP 200 0 200 2014 ER*THROM*CIN KAPSUL 250 MG KAP 17 0 17 20

15 ER*THROM*CIN 200 MG/5 ML SIRUP BTL 3 0 3 0

1 ETIKET BIRU + 3$5 CM PAK 0 0 0 0

17 ETIKET PUTIH - 3$5 CM PAK 0 0 0 0

18 FENILBUTA&ON 200 MG TABLET SALUT TAB 0 0 0 0

19 FRAMISETIN SULFAT KASA STERIL KTK 7 0 7 3

20 GENTAMICIN SULFAT SALEP 5 GRAM/TUBE TUB 0 0 0 0

21 HALOPERI!OL 5 MG TABLET TAB 0 0 0 0

22 H*OSCINE NBUT*LBROMI!E TABLET 10MG TAB 114 100 214 91

23 IKHTAMOL SALEP 10' POT 0 0 0 024 KANTONG PLASTIK 7 + 10 CM KG 0 0 0 0

25 KAOLIN 550 MG . PEKTIN 20 MG TABLET KOMBINASI TAB 231 1000 1231 335

2 KAPTOPRIL 25 MG TABLET TAB 190 0 190 32

27 KAPTOPRIL 12$5 MG TABLET TAB 173 0 173 10

28 KASA 40 *AR! + 80 CM GULUNG 0 0 0 0

29 KASA STERIL 1 + 1 CM PAK 0 0 0 0

30 KERTAS PO,!ER PAK 0 0 0 0

31 KLORAMFENIKOL TETES MATA O$5' BTL 8 0 8 1

32 KLORAMFENIKOL SUSPENSI 125 MG/5 ML BTL 9 0 9 0

33 KLORAMFENIKOL 2' . HI!ROKORTISON 25' KRIM TUB 4 5 9 4

34 LORATA!INE (MICRONI&E!) TAB 0 0 0 0

35 METHIONIN TABLET 100 MG TAB 100 0 100 0

3 METOCLOPRAMI!E HCL TABLET 10 MG TAB 188 200 388 131

37 METRONI!A&OLE TABLET 500 MG TAB 0 0 0 0

38 MICONA&OLE 2' KRIM TUB 8 0 8 2

39 NATRIUM KARBA&OKROM SULFONAT TABLET 10 MG TAB 0 0 0 0

40 NIFE!IPINE 10 MG TABLET TAB 0 7 7 11

41 OMEPRA&OLE 120 MG KAPSUL KAP 7 270 34 272

42 PAPA%ERINA HCL (PAPA%ERINA) TABLET 40 MG TAB 70 0 70 40

43 PIRO+ICAM 10 MG TABLET TAB 175 0 175 41


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44 RANITI!IN 150 MG TABLET TAB 0 0 0 0

45 SEFA!ROKSIL 250 MG KAPSUL KAP 0 0 0 0

4 SIMETI!IN TABLET 200 MG TAB 384 0 384 32

47 SIPROFLOKSASIN 500 MG TABLET TAB 90 0 90 10

48 %ITAMIN A 100000 IUTAB TAB 0 0 0 0

49 %ITAMIN B12 50 MCG TABLET TAB 470 0 470 10

Pengurus Gudang ar!asi R"U #e$% #e!&anganDire'(ur R"U #e$% #e!&angan Dire'(ur R"U #e$% #e!&angan/"u& Uni( Pe)


dr Ir!a RianiMAP

Ni. : 13420203136122001

7endra "!ara #ris(i

Ni. : 133002022018092005


Ni. : 13430302000092005

7/26/2019 Lplpo Mei 2015

7/12

D

DOKUMEN N! T,#!

RSU : : !

SUB-UNIT : : !

SISA PERMIN- PEMBE-KET

STOK TAAN RIAN

8 9 10 11

392

0

220

10

0

10

0

7

35

3

100

0

180

15

3

0

0

0

4

0

0

123

0

0

89

158

13

0

0

0

7

9

5

0

100

257

0

0

5

74

30

134

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0

0

22

80

0

40

a*ananPe(ugas ar!asi R"U #e$% #e!&angan

-ang !eneri!a

7endra "!ara #ris(i

Ni. : 133002022018092005

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9/12

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT IGD


KODE RSU :

RSU : Kecamatan

KECAMATAN : Kembangan DOKUMEN

KAB/KODYA : Jakarta Barat RSU

PROPINSI : DKI Jakarta PERMINTAAN BULAN/PERIODE : Juni 2015 SUB-UNIT

NO! NAMA OBATSATUAN STOK PENERI- PERSE- PEMA- SISA

A"A# MAAN DIAAN KAIAN STOK

$ % & ' ( ) * +

1 ALBOTH*L BTL 0 0 0 0 0

2 ALPRA&OLAM 0$5 MG TAB 0 0 0 0 03 AMBRO+OL 30 MG TAB TAB 0 500 50 188 372

4 AMBRO+OL S*R BTL 0 0 0 0 0

5 AMLO!IPINE 10 MG TAB 10 0 10 5 5

AMLO!IPINE 5 MG TAB 80 150 230 5 15

7 ASPILET TAB TAB 100 0 100 0 100

8 BECOMBION !ROP BTL 0 0 0 0 0

9 BELLAPEN TAB TAB 0 0 0 0 0

10 BETA!INE 0 ML BTL 0 0 0 0 0

11 BETAHISTINE TAB 50 0 110 0 50

12 BUNGKUS PU*ER BERLOGO PCS 0 0 0 0 0

13 BUSCOPAN IN# AMP 0 0 0 0 0

14 CA GLUCONAS IN# AMP 0 0 0 0 0

15 CEFTRIA+ONE IN# AMP 10 10 20 5 15

1 CETIRI&INE CAPS KAP 12 50 17 88 88

17 CETIRI&INE S*R BTL 0 0 0 0 0

18 CURCUMA TAB TAB 0 0 0 0 0

19 !OMPERI!ONE TAB 122 300 422 353 9

20 !EPOGESTON IN# AMP 0 0 0 0 0

21 FAMOTI!INE TAB 100 0 100 21 79

22 FLUCONA&OLE KAP 0 0 0 0 0

23 FOLIC ACI! 1 MG TAB 0 0 0 0 0

24 FOLIC ACI! 5 MG TAB 0 0 0 0 0

25 GEMFIBRO&IL 200 MG KAP 0 0 0 0 0

2 H202 3 ' BTL 0 0 0 0 0

27 HALOPERI!OL 5 MG TAB 0 0 0 0 0

28 KALIUM !IKLOFENAK 25 MG TAB 100 0 100 0 100

29 KANTONG KLIP 12 + 10 PAK 0 0 0 0 0

30 KANTONG KLIP 15 + 10 PAK 0 0 0 0 0

31 KANTONG KLIP 7 + 10 PAK 0 0 0 0 0

32 KETOKONA&OLE 200 MG TAB 0 0 0 0 0

33 KETOKONA&OLE CR TUB 3 0 3 0 3

34 KOMBIPAK PAK 0 0 0 0 0

35 LINCOM*CIN 500 MG CAPS 3 0 3 10 2

3 M!T COMBI A!ULT MB BLISTER PKT 0 0 0 0 0

37 M!T COMBI A!ULT PB BLISTER PKT 0 0 0 0 0

38 M!T COMBI CHIL! MB BLISTER PKT 0 0 0 0 0

39 M!T COMBI CHIL! PB BLISTER PKT 0 0 0 0 0

40 METFORMIN TAB TAB 200 100 300 28 272

41 MISOPROSTOL TAB 0 0 0 0 0

42 MULTI%IT S*R BTL 0 0 0 0 0

43 NA !IKLOFENAK 50 MG TAB 200 250 450 30 420


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44 NA !IKLOFENAK 25 MG TAB 210 0 210 20 190

45 NEPROLIT CAPS KAP 0 0 0 0 0

4 ON!ANSETRON IN# AMP 10 0 10 10 0

47 PLASTIK KRESEK PAK 0 0 0 0 0

48 RANITI!IN IN# AMP 0 0

49 RISPERI!ON TAB 0 0 0 0 0

50SEFA!RO+IL S*R

BTL10

0 10 4 51 SEN!OK OBAT PCS 0 0 0 0 0

52 SIM%ASTATIN TAB 180 0 180 21 159

53 SPASMINAL TAB 0 0 0 0 0

54 SP*RAMICIN 500 MG TAB 50 0 50 0 50

55 STESOLI! RT 10 MG TUB 0 0

5 SULFACETAMI! TETES MATA BTL 0 0 0 0 0

57 SUPRABION KAP 0 0 0 0 0

58 TETRAC*CLIN 500 MG KAP 0 0 0 0 0

59 TIAMFENIKOL 500 MG KAP 74 200 274 138 13

0 TRIOMIN E TAB 0 0 0 0 0

1 %ENTOLIN NEBU RESP 0 20 20 3 17

2 &INC TAB TAB 320 0 320 121 199

3 OKSITETRASIKLIN HCL SALEP MATA TUBE 10 0 10 1 9

4 ANTIHEMOROI! SUPPO 10 0 10 0 10

5 BURNA&IN TUBE 0 0 0 0 0

ALBEN!A&OLE 400 MG TABLET 0 0 0 0 0

7 SACCARIN TABLET 0 0 0 0 0

8 METH*LPRE!NISOLON 1 MG TABLET 0 0 0 0 0

9 PAMOL SUPPO SUPPO 3 0 3 9 27

70 ATROPIN IN#EKSI 025 MG/ML AMP 14 0 14 5 19

71 APTIL POLICRESULEN BOTOL 0 0 0 0 0

72 GLUKOSA LARUTAN INFUS 10' STERIL BOTOL 0 0 0 0 0

73 CLIN!AM*CIN 300 MG KAPS 0 0 0 0 0

74 CLIN!AM*CIN 150 MG KAPS 0 0 0 0 0

Pengurus Gudang ar!asi R"U #e$% #e!&anganDire'(ur R"U #e$% #e!&angan Dire'(ur R"U #e$% #e!&angan/"u& Uni( Pe)a*ananPe(


dr Ir!a RianiMAP

Ni. : 13420203136122001

7endra "!ara #ris(i

Ni. : 133002022018092005


Ni. : 13430302000092005

7/26/2019 Lplpo Mei 2015

11/12

N! T,#!

: : !

: : !

PERMIN- PEMBE-KET

TAAN RIAN

. $ $$

7/26/2019 Lplpo Mei 2015

12/12

gas ar!asi R"U #e$% #e!&angan

-ang !eneri!a

7endra "!ara #ris(i

i. : 133002022018092005

Lplpo Mei 2015

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