LAPORAN PEMAKAIAN DAN PERMINTAAN OBAT

UGD
BULAN :
TAHUN:

STOK PENERIM
NO NAMA OBAT SAT JML PEMAKAI SISA PERMINT
AWAL AAN
AN AAN
1 Alat suntik 2.5 ml-3ml set
2 Alat suntik 5 ml set
7 Aminopilin inj amp
13 Amoksilin inj vial
15 Antalgin inj amp
21 Aqua pro inj amp
31 Atrofin sulfat inj amp
36 Catgut ktk
38 Deksametason inj amp
43 Diasepam inj 5mg/ml-2ml amp
45 Difenhidramin inj amp
51 Epineprin inj amp
54 Etakridina btl
55 Etanol btl
56 Etilkloride btl
63 Fitomenadion inj amp
69 Gentamicin inj amp
76 Glukosa lar infus btl
80 Handscoen psg
83 I.V Catheter no 20 G pcs
84 I.V Catheter no 22 G pcs
85 I.V Catheter no 24 G pcs
88 Infusion set anak set
89 Infusion set dewasa set
96 Kassa elastik rol
93 Kapas bks
98 Kassa 2m x 80 cm rol
99 Kassa 4m x15cm rol
100 Kassa 4mx3cm rol
110 Klorpromazin Hcl inj / CPZ amp
118 Lidokain inj amp
119 Lisol btl
122 Masker bj
127 Metoklopramid inj amp
134 Natrium klorida lar infus btl
135 Natrium tosulfat inj amp
146 Oksitetrasiklin inj vial
157 Plester rol
158 Polikresulen btl
163 Ranitidin inj amp
168 RL btl
178 Sianokobalamin inj / B12 amp
179 Silk sak
187 Thiamin inj amp
193 Yodium pov 10% 30ml btl
194 Yodium pov 10% 300ml btl
196 Adrenalin inj amp
197 Bioneuron inj vial
200 Bioplacenton salp tube
207 Wing needle anak bj
208 Wing needle dewasa bj
210 Paraformaldehid tab
211 Kantong jenazah bj
65 Folley catheter bj
MES bj
Perhidrol/H2O2 btl
 Mengetahui
Kepala Puskesmas Kromengan Gudang Obat

drg.Herawati Sulistyaning
NIP.19790310 200604 2 028
AT

PEMBERIAN KET
Kromengan,
Petugas

Liley safitri
NIP.19840625 201101 2 007
 LAPORAN PEMAKAIAN DAN PERMINTAAN OBAT

UGD
BULAN :
TAHUN :
STOK PENERI
NO NAMA OBAT JML PEMAK SISA PERMIN PEMBE
AWAL MAAN RIAN
AIAN TAAN
Tablet
1 Allopurinol 100 mg
2 Ambroxol 30 mg
3 Amlodipin 5 mg
4 Antasida
5 Anti haemerhoid
6 Asam mefenamat 500 mg
7 Aspilet
8 Aciclovir 200 mg
9 Betahistine 5 mg
10 Dexamethason 0,5 mg
11 Digoksin 0, 25 mg
12 Domperidon 10 mg
13 Fitomenadion (vit K)
14 Furosemid
15 Gliben 5 mg
16 Metformin 500 mg
17 Ibuprofen 400 mg
18 ISDN 5 mg
19 Nifedipin 10 mg
20 Natrium diklofenac
21 Kaptropil 25 mg
22 Kaptropil 12,5 mg
23 Klorfeniramin meleat ( CTM)
24 Klopidogrel
25 Loratadin 10 mg
26 Attapugit
27 Ondancentron
28 Omeprazole ( OMZ) 20 mg
29 Paracetamol 500 mg
30 Ranitidin 150 mg
31 Salbutamol 4 mg
32 Simvastatin 10 mg
33 Vitamin B komplek
34 Zinc 10 mg

Sirup
1 Antasida
2 Ibuprofen 100mg
3 Paracetamol 120mg
4 Baby cough
5 Zinc
6 Obat batuk hitam ( OBH )

Salep
1 Aciklovir cream 5%
2 Miconazole
3 Hidrocortison krim 2,5 %
4 Kloramfenicole salep mata 1%
 Tetes
1 Gentamicin tts mata
2 Phenol glicerol tts telinga 10 %
3 Cloramfenicol tts mata
4 Sulfacetamid tts mata 15%

Serbuk
1 Oralit
2 Salicil bedak

Injeksi
1 Atropin sulfat 0,25 mg
2 Antrain
3 Cefotaxime 1 gr
4 Ceftriaxon 1gr
5 Dexametason 5 mg
6 Diazepam
7 Difenhidramin HCL 10 mg
8 Epineprin
9 Fitomenadion ( vit K)
10 Furosemid
11 Lidokain
12 Magnesium sulfat 40 % 25ml
13 Magnesium sulfat 20 % 25ml
14 Metoclopramid
15 Ondancentron
16 Piracetam 1gr
17 Ranitidine
18 Neurobion
19 Asam traneksamat
20 Ventolin
21 Glukose 40 % 25ml

Alkes & cairan luar

1 Spuit 1 ml
2 Spuit 3 ml
3 Spuit 5 ml
4 Spuit 10 ml
5 Alkohol swab
6 Aquadest steril
7 Alkohol 70 % 1000ml
8 Blood Tranfusion
9 Catgut chromic
10 Catgut plain
11 Bioplacenton tulle
12 Catheter no. 16
13 Catheter no. 18
14 Hanschoen ukr M
15 Hanschoen ukr L
16 Abocat no. 18
17 Abocat no. 20
18 Abocat no. 22
19 Abocat no. 24
20 Infus set anak
21 Infus set dewasa
22 Kapas pembalut
23 Kassa 2m x 80m
24 Kassa elastic 3inc
25 Kassa Hidrofik 4m x 15cm
26 Kassa hidrofik 4m x 3cm
27 Kassa steril
28 Masker breathing
29 Masker non breathing

30 Canul O2 anak
31 Canul O2 dewasa
32 NGT 7x 75
33 One med surgical blade
34 Plester
35 Hepavix
36 Lomatul
37 Urine bag
38 Plesterin
39 Betadine
40 Surgical goun
41 Polifix
42 Under pad

Infus
1 Asering
2 Glukose 5%
3 KAEN 3 B
4 KAEN 4B
5 Ringer laktat
6 Natrium klorida 0,9%

Mengetahui Kromengan,
Kepala Puskesmas Kromengan Gudang Obat Petugas

drg.Herawati Sulistyaning Liley safitri

NIP.19790310 200604 2 028 NIP.19840625 201101 2 007
 LAPORAN PEMAKAIAN OBAT UGD

BULAN :
TAHUN :
STOK
NO NAMA OBAT PEMAKAIAN SISA
AWAL
Tablet 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 Allopurinol 100 mg
2 Ambroxol 30 mg
3 Amlodipin 5 mg
4 Antasida
5 Anti haemerhoid
6 Asam mefenamat 500 mg
7 Aspilet
8 Aciclovir 200 mg
9 Betahistine 5 mg
10 Dexamethason 0,5 mg
11 Digoksin 0, 25 mg
12 Domperidon 10 mg
13 Fitomenadion (vit K)
14 Furosemid
15 Gliben 5 mg
16 Metformin 500 mg
17 Ibuprofen 400 mg
18 ISDN 5 mg
19 Nifedipin 10 mg
20 Natrium diklofenac
21 Kaptropil 25 mg
22 Loperamid
23 Klorfeniramin meleat ( CTM)
24 Klopidogrel
25 Loratadin 10 mg
26 Attapugit
27 Ondancentron
28 Omeprazole ( OMZ) 20 mg
29 Paracetamol 500 mg
30 Ranitidin 150 mg
31 Salbutamol 4 mg
32 Simvastatin 10 mg
33 Vitamin B komplek
34 Zinc 10 mg

Sirup
1 Antasida
2 Ibuprofen 100mg
3 Paracetamol 120mg
4 Baby cough
5 Zinc
6 Obat batuk hitam ( OBH )

Salep
1 Aciklovir cream 5%
2 Miconazole
3 Hidrocortison krim 2,5 %
4 Kloramfenicole salep mata 1%

Tetes
1 Gentamicin tts mata
2 Phenol glicerol tts telinga 10 %
3 Cloramfenicol tts mata
4 Sulfacetamid tts mata 15%

Serbuk
1 Oralit
2 Salicil bedak
 Injeksi
1 Atropin sulfat 0,25 mg
2 Antrain
3 Cefotaxime 1 gr
4 Ceftriaxon 1gr
5 Dexametason 5 mg
6 Diazepam
7 Diphenhidramin HCL 10 mg
8 Epineprin
9 Fitomenadion ( vit K)
10 Furosemid
11 Lidokain
12 Magnesium sulfat 40 % 25ml
13 Magnesium sulfat 20 % 25ml
14 Metoclopramid
15 Ondancentron
16 Piracetam 1gr
17 Ranitidine
18 Neurobion
19 Asam traneksamat
20 Ventolin
21 Glukose 40 % 25ml
22 Gentamicin

Alkes & cairan luar

1 Spuit 1 ml
2 Spuit 3 ml
3 Spuit 5 ml
4 Spuit 10 ml
5 Alkohol swab
6 Aquadest steril
7 Alkohol 70 % 1000ml
8 Blood Tranfusion
9 Catgut chromic
10 Catgut plain
11 Bioplacenton tulle
12 Catheter no. 16
13 Catheter no. 18
14 Hanschoen ukr M
15 Hanschoen ukr L
16 Abocat no. 18
17 Abocat no. 20
18 Abocat no. 22
19 Abocat no. 24
20 Abocat no. 24 kupu2
21 Infus set anak
22 Infus set dewasa
23 Kapas pembalut
24 Kassa 2m x 80m
25 Kassa elastic 3inc
26 Kassa Hidrofik 4m x 15cm
27 Kassa hidrofik 4m x 3cm
28 Kassa steril
29 Masker breathing
30 Masker non breathing
31 Canul O2 anak
32 Canul O2 dewasa
33 NGT 7x 75
34 One med surgical blade
35 Plester
36 Hepavix
37 Lomatul
38 Urine bag
39 Plesterin
40 Betadine
41 Surgical goun
42 Polifix
43 Under pad

Infus
1 Asering
2 Glukose 5%
3 KAEN 3 B
4 KAEN 4B
5 Ringer laktat
6 Natrium klorida 0,9%

Kromengan,
Petugas

Liley safitri. Amd, Kep

NIP.19840625 201101 2 007