LPLPO Master 2016

8/17/2019 LPLPO Master 2016

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LB.2

PUSKESMAS : BULAN :

KECAMATAN : TAHUN :

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT ( LPLPO. LB.2 )

No. NAMA OBAT SATUAN

S T O K A W A L

P E N E R I M A A N

P E R S E D I A A N

P E M A K A I A N

S I S A S T O K

S T O K O P T I M U M

P E R M I N T A A N

PEMBERIAN

J K N

APBD LAIN JUMLA

1 2 3 4 5 6 7 8 1 11 14 15 16 17

I OBAT SESUAI FORMULARIUM NASIONAL (FORNAS)

1 A!" #$%#& !$'(&)! Bo%o* + + + + +

2 A*,($-/o* )#)0 2 5 * Bo%o* + + + + +

3 A*,($-/o* 4 T,*(%

4 A*o0#"!$o* %,*(% 1 T,*(% + + + + +

5 A*o0#"!$o* %,*(% 3 T,*(% + + + + +

6 A!$o!*!$ !$'(&)! 24 * A0#* + + + + +

7 A!$o!*!$ %,*(% 15 T,*(% + + + + +8 A!$o!*!$ %,*(% 2 T,*(% + + + + +

A!%"!0%!*!$ T,*(% S*#% 25 HC* T,*(% + + + + +

1 A!*o"!- %,*(% 5 T,*(% + + + + +

11 A$%)!- DOEN I T,*(% K#$9 Ko,!$)! T,*(% + + + + +

12 A$%)!- DOEN II S#)0($)! Ko,!$)! Bo%o* + + + + +

13 A$%!#$! DOEN Ko,!$)! )*(0 + + + + +

14 A$%!9(o"o!- Ko,!$)! )#0 )#00 + + + + +

15 A$%!*"! DOEN Ko,!$)! P"!(%!$ -$ S#*-o&)!$ T,*(% + + + + +

16 A$%!0"&!$)o$ &o,!$)! &0)#* &0)#* + + + + +

17 A*o-!0!$ %,*(% 5 T,*(% + + + + +18 A*o-!0!$ %,*(% 1 T,*(% + + + + +

1 Ao&)!)!*!$ T,*(% 5 T,*(% + + + + +

2 Ao&)!)!*!$ )!" o"%( 255 * o"%( Bo%o* + + + + +

21 A0!)!*!$ )(", !$' 25 ;!*


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P E M A K A

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S I S A S T

O K

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I M U M

P E R M I N T A A N

PEMBERIAN

J K N

APBD LAIN JUMLA

1 2 3 4 5 6 7 8 1 11 14 15 16 17

22 A0!)!*!$ )(", !$' 1 ;!*

23 A) )(%!* )*!)!*% )(%o)* %,*(%8 %,*(% + + + + +

24 A) )(%!* )*!)!*% )(%o)* %,*(%5 T,*(% + + + + +

25 A) A)&o",%

26 A) M(($% %,*(% 25 T,*(% + + + + +

27 A) M(($% %,*(% 5 T,*(% + + + + +

28 A) o*% .4 %,*(% + + + + +

2 A) o*% 1 %,*(% + + + + +

3 A) o*% 5 %,*(% + + + + +

31 A)!&*o;!" T,*(% 2 %,*(% + + + + +

32 A)!&*o;!" T,*(% 4 %,*(% + + + + +

33 A%"o0!$ I$'(&)! . =25 * !.. !.;. ).& A0#* + + + + +

34 A%"o0!$ S#*% T,*(% =5 T, T,*(% + + + + +

35 A%($o*o* 5 %,*(% + + + + +

36 A%0#*!% T,*(% %,*(% + + + + +

37 A) )*!)!*% )*(0 5 > T#,( + + + + +

38 A) )*!)!*% *" =1 > Bo%o* + + + + +

3 B9$ T#0%$ S(($%" Bo%o* + + + + +

4 B(%(%)o$ K"! =5 > T#,( + + + + +

41 B(%(%)o$ %(%() % 1 * Bo%o* + + + + +

42 B(-& S*!)!* )(",#& 2> Ko%& + + + + +

43 B($/%!$ P($!)!*!$ !$'(&)! 1=2 '#% UI* !.

44 B($/%!$ P($!)!*!$ !$'(&)! =2=4 '#% UI* !.

45 B!)&o-!* %,*(% 5 %,*(% + + + + +

46 B!)&o-!* )#0 5 )#00 + + + + +

47 B!)&o-!* )#0 1 )#00 + + + + +48 B!)o0"o*o* T,*(%

4 Co* %"*" 5 > Bo%o* + + + + +

5 D0)o$ %, )?o"(- 1 T,*(% + + + + +


3/15


S T O K A W A L

P E N E R I M

A A N

P E R S E D I A A N

P E M A K A

I A N

S I S A S T

O K

S T O K O P T

I M U M

P E R M I N T A A N

PEMBERIAN

J K N

APBD LAIN JUMLA

1 2 3 4 5 6 7 8 1 11 14 15 16 17

51 D(&)(%)o$ I$'(&)! 5 * !.;!. A0#* + + + + +

52 D(&)(%)o$ T,*(% =5 T,*(% + + + + +

53 D(;!%*!))! P)% No$ A")($ Bo%o* + + + + +

54 D!/(0 I$'(&)! 5 * !.;!. A0#* + + + + +

55 D!/(0 T,*(% 2 T,*(% + + + + +

56 D!/(0 T,*(% 5 T,*(% + + + + +

57 D!/(0 "(&%* 52 * )#00 + + + + +

58 D!/(0 "(&%* 12 =5* )#00 + + + + +

5 D!o&)!$ T,*(% =25 T,*(% + + + + +

6 D!*%!/( HCL 3 T,*(% + + + + +

61 D!(%!*&",/(0!$ %, 1 T,*(% + + + + +

62 D!($9!-"!$ I$'(&)! 1 * !.;!. A0#* + + + + +

63 D!($9!-"!$% %,*(% 5 T,*(% + + + + +

64 Do0("!-o$ 1 T,*(% T,*(% + + + + +

65 Do0("!-o$ 55* S!"#0 Bo%o* + + + + +

66 Do&)!)!&*!$ K0)#* 1 K0)#* + + + + +67 E0!$("!$ A-"($*!$ I$'(&)! =1 > !.;).&!. A0#* + + + + +

68 E"!%"o!)!$ K0)#* 5 K0)#* + + + + +

6 E"!%"o!)!$ S!"#0 2 5 * Bo%o* + + + + +

7 E"o%!$ %, 1 T,*(% + + + + +

71 E%$o* ?!"$ 7 > Bo%o* + + + + +

72 E%,#%o* %,*(% 25 T,*(% + + + + +

73 E%,#%o* %,*(% 4 T,*(% + + + + +

74 E%,#%o* %,*(% 5 T,*(% + + + + +

75 E%!* K*o"!- S(0"o% 1 * Bo%o* + + + + +

76 E#($o* ?!"$ Bo%o* + + + + +77 ($o,",!%* %,*(% 3 T,*(% + + + + +

78 ($o,",!%* %,*(% 1 T,*(% + + + + +

7 ($!%o!$ N &0)#* 5 T,*(% + + + + +


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PEMBERIAN

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APBD LAIN JUMLA

1 2 3 4 5 6 7 8 1 11 14 15 16 17

8 ($!%o!$ N &0)#* 1 T,*(% + + + + +

81 ($!%o!$ N !$' 5 * A0#* + + + + +

82 ($o&)!(%!* P($!)!*!$ P($!)!*!$ %,*(% 125 T,*(% + + + + +

83 ($o&)!(%!* P($!)!*!$ P($!)!*!$ %,*(% 25 T,*(% + + + + +

84 !%o($-!o$

1 #"o)(!- T,*(% 4 T,*(% + + + + +

2 o"o&"()o* C!"$ Bo%o* + + + + +

3 @(&)$ Lo%!o$ 1 > Bo%o* + + + + +

4 @#%%( 0("?9 -$ 00(" 0o!$%) 15+4 P?) + + + + +

5 @#%%( 0("?9 -$ 00(" 0o!$%) 45+8 P?) + + + + +6 @*!)("!$ %(%() 1 * Bo%o* + + + + +

7 @*!)("!$ %(%() 1 * Bo%o* + + + + +

8 @" O"*!% I S(",#& Ko,!$)! )?9(% + + + + +

@*)) Io$o(" C(($% ART )(",#& ,o%o* + + + + +

1 @*)) Io$o(" C(($% ART L"#%$ ,o%o* + + + + +

11 @*)) Io$o(" C(($% ART ?o?o ,#%%(" 5 Bo%o* + + + + +

12 @*!,($&*!- T,*(% 2=5 T,*(% + + + + +

13 @*!,($&*!- T,*(% 5 T,*(% + + + + +

14 @*!)("!$ T"!$!%"% T,*(% + + + + +

15 @*!(0!"!- 1 T,*(% + + + + +16 @*!(0!"!- 2 T,*(% + + + + +

17 @*!0!/!- 5 T,*(% + + + + +

18 @"!)(o#*;!$ T,*(% 125 T,*(% + + + + +


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PEMBERIAN

J K N

APBD LAIN JUMLA

1 2 3 4 5 6 7 8 1 11 14 15 16 17

1 @"!)(o#*;!$ T,*(% 5 T,*(% + + + + +

11 H*o0("!-o* T,*(% =5 T,*(% + + + + +

111 H*o0("!-o* T,*(% 1=5 T,*(% + + + + +

112 H*o0("!-o* T,*(% 5 T,*(% + + + + +

113 H*o0("!-o* T,*(% 2 T,*(% + + + + +

114 H*o0("!-o* !$'(&)! 5 * A0#* + + + + +

115 H!-"o($ P("o&)!- C!"$ 3> Bo%o* + + + + +

116 H!-"o&*o"o%!/!- T,*(% 25 T,*(% + + + + +

117 H!-"o&o"%!)o$ K"! 2=5 > %#,( + + + + +

118 H!-"o&o"%!)o$ )(",#& !$'(&)! 1

11 Ho)?!$( +N+B#%!*,"o!-( T,*(% 1 T,*(% + + + + +

12 I,#0"o($ T,*(% 2 T,*(% + + + + +

121 I,#0"o($ T,*(% 4 T,*(% + + + + +

122 I,#0"o($ S!"#0 1 5 * Bo%o* + + + + +

123 I,#0"o($ S!"#0 1 5 * Bo%o* + + + + +

124 I)o)o",!- D!$!%"% T,*(% S#,*!$#* 5 T,*(% + + + + +125 K*!$ *o%!o Bo%o* + + + + +

126 K*)!# H!-"o&)!- ,#,#&=P)% Bo%o* + + + + +

127 K*)!# @*#&o$% !$'(&)! 1 * A0#* + + + + +

128 K*)!# K",o$% %,*(% 5 T,*(% + + + + +

12 K*)!# L&%% K*& T,*(% 5 T,*(% + + + + +

13 K0%o0"!* T,*(% 12=5 T,*(% + + + + +

131 K*o"%*!-o$ %,*(% 5 T,*(% + + + + +

132 K",/(0!$ 2 T,*(% + + + + +

133 K",/(0!$ )!" 1 5* Bo%o* + + + + +

134 K*o/!!$= !?"o$!/(- &0)#* 1 K0)#* + + + + +

135 K(%!$ !$'(&)! 5 * A0#* + + + + +

136 K(%!$ !$'(&)! 1 * A0#* + + + + +

137 &",o @*!)("!$ %(%()%(*!$ 1 > Bo%o* + + + + +


6/15


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PEMBERIAN

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APBD LAIN JUMLA

1 2 3 4 5 6 7 8 1 11 14 15 16 17

138 K",o -)o",($ %,*(% o=5 T,*(% + + + + +

13 K(%o&o$/o* %, 2 T,*(% + + + + +

14 Ko%"!o&)/o* D() S#* + T"!(%o0"! %,*(% 48 T,*(% + + + + +

141 Ko%"!o&)/o* S#* + T"!(%o0"! )#)0($)! 24 5* Bo%o* + + + + +

142 Ko%"!o&)/o* o"%( Ko,!$)! %,*(% 6 T,*(% + + + + +

143 K*o"($!"!$ T,*(% 4 T,*(% + + + + +

144 K*o"($!&o* &0)#* 25 K0)#* + + + + +

145 K*o"($!&o* )#)0 1255* Bo%o* + + + + +

146 K*o"($!&o* S*(0 K#*!% 2 > T#,( + + + + +

147 K*o"($!&o* T(%() M% =5 > Bo%o* + + + + +

148 K*o"($!&o* T(%() M% 1 > Bo%o* + + + + +

14 K*o"($!&o* S*(0 M% 1 > Bo%o* + + + + +

15 K*o"($o* K(" M($%9o* CHKM Bo%o* + + + + +

151 K*o"9(&)!-!$ *" =2 > Bo%o* + + + + +

152 K*o"9(&)!-!$ *" 15 > Bo%o* + + + + +

153 K*o"0"o/!$ T,*(% S*#% 25 HC* T,*(% + + + + +154 K*o"0"o/!$ T,*(% S*#% 1 HC* T,*(% + + + + +

155 K*o"0"o/!$ !$'(&)! 5 * HC* A0#* + + + + +

156 Ko-(!$ %,*(% 1 T,*(% + + + + +

157 Ko-(!$ %,*(% 2 T,*(% + + + + +

158 Ko,!$)! &o*!$ 55 0(?%!$ 2 %,*(% T,*(% + + + + +

15 Ko,!$)! B($)("/!- 25 L(;o-o0 1 K0)#* + + + + +

16 Ko0o)!% "()!$ )(% + + + + +

161 K#!$!$ T,*(% 2 T,*(% + + + + +

162 K#!$!$ T,*(% 222 T,*(% + + + + +

163 K#!$!$ T,*(% 25 T,*(% + + + + +164 K#!$!$ -!9!-"o&*o"!- I$'(&)! 25 > + 2 * A0#* + + + + +

165 L#o* *"#%$ Bo%o* + + + + +

166 L!-o&!$ 2> E0!$(0"!$ 1 : 8. !$'(&)! 2 * A0#* + + + + +


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1 2 3 4 5 6 7 8 1 11 14 15 16 17

167 L!-o&!$ I$'(&)! 2> A0#* + + + + +

168 Lo"%-!$ 1 %,*(% T,*(% + + + + +

16 M$()!# S#*% I$'(&)! 2> Bo%o* + + + + +

17 M$()!# S#*% I$'(&)! 4> Bo%o* + + + + +

171 M$()!# S#*% )(",#& &% 3 " + + + + +

172 M(%!*("o(%"!$ M*(% I$'(&)! .2 + 1* A0#* + + + + +173 M(%!*("o(%"!$ M*(% T,*(% S*#% =125 T, T,*(% + + + + +

174 M(%o&*o0"!- I$'(&)! 5 * A0#* + + + + +

175 M(%o&*o0"!- T,*(% 5 T,*(% + + + + +

176 M(%o&*o0"!- T,*(% 1 T,*(% + + + + +

177 M(%"o$!-/o* T,*(% 25 T,*(% + + + + +

178 M(%"o$!-/o* %,*(% 5 T,*(% + + + + +

17 M(%"o$!-/o* )!" 125 5* Bo%o* + + + + +

18 M(%"o$!-/o* *" !$ 5 * Bo%o* + + + + +

181 M(%"o$!-/o* o;#* 5 o;#* + + + + +

182 M(%o"!$ 5 T,*(% + + + + +183 M(%o"!$ 85 T,*(% + + + + +

184 M(%($!$ M$-(*% H(&)!$ M$-(*% %, 5 T,*(% + + + + +

185 M(,($-/o*( %,*(% 1 T,*(% + + + + +

186 M(,($-/o*( %,*(% 5 T,*(% + + + + +

187 M(,($-/o*( S!"#0 5* Bo%o* + + + + +

188 M!&o$/o* K"! 2> N!%"% T#,( + + + + +

18 M!&o$/o* S(",#& 2> N!%"% )?9(% + + + + +

1 N%"!# B!&",o$% T,*(% 5 T,*(% + + + + +

11 N%"!# D!&*o($& T,*(% 25 T,*(% + + + + +

12 N%"!# D!&*o($& T,*(% 5 T,*(% + + + + +13 N%"!# %!o)#*% !$'(&)! 25> !.; A0#* + + + + +

14 N%"!# ($!%o!$ 5 T,*(% + + + + +

15 N%"!# ($!%o!$ 1 T,*(% + + + + +


8/15


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APBD LAIN JUMLA

1 2 3 4 5 6 7 8 1 11 14 15 16 17

16 N%"!# ($!%o!$ 1 * A0#* + + + + +

17 N%"!# ($!%o!$ 5 * A0#* + + + + +

18 N%"!# H!0o&*o"!% ?!"$ &o$)(%"% 5 > Bo%o* + + + + +

1 N!(-!0!$ T,*(% 1 T,*(% + + + + +

2 N!)%%!$ 28 O*o0%-!$ %(%() % .1 > Bo%o* + + + + +

2 O&)!(%/o*!$ %(%() 9!-#$ =25 > Bo%o* + + + + +

21 O&)!(%/o*!$ %(%() 9!-#$ =5 > Bo%o* + + + + +

211 P")(%o* S!"#0 12 5 * Bo%o* + + + + +212 P")(%o* %(%() 6 =6 * Bo%o* + + + + +

213 P")(%o* T,*(% 5 T,*(% + + + + +

214 P"o"*-(9!-( %, 1 T,*(% + + + + +

215 P)% 0($!)! )*#"$ &" 0)% + + + + +

216 P("& )#*-!/!$ &"!1> %#,( + + + + +

217 P("(%"!$ &"! %#,( + + + + +

218 P("& N!%"% *" 2 > Bo%o* + + + + +

21 P!"$%(* 0o% %, )?o"( 125 T,*(% + + + + +

22 P!"$%(* 0o% %, )?o"( 25 T,*(% + + + + +

221 P!"$%(* 0o% %, 5 T,*(% + + + + +222 P!"$%(* 0o% )#)0 125 5 * Bo%o* + + + + +

223 P!"/!$!- %,*(% 5 T,*(% + + + + +

224 P!"!-o&)!$


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1 2 3 4 5 6 7 8 1 11 14 15 16 17

225 P!"!-o&)!$

226 P!"!-o&)!$

237 P"o&!$ B($/!* P($!)!*!$ @. I$'(&)! 3 J#% !#

238 R$!%!-!$ T,*(% 15 T,*(% + + + + +

23 R(%!$o*

24 R(%!$o*

242 S*,#%o* T,*(% 2 S(,! S#*% T,*(% + + + + +

243 S*,#%o* T,*(% 4 S(,! S#*% T,*(% + + + + +

244 S*,#%o* !$9*(" =5 > Bo%o* + + + + +

245 S*,#%o* !$9*(" =1 > Bo%o* + + + + +

246 S*(0 2 + 4 Ko,!$)! Po% + + + + +

247 S(%!"!/!$ S!"#0 5 5* Bo%o* + + + + +

248 S("# A$%! B!) U*" Po*!;*($ I$'(&)! 5 * ABU I

24 S("# A$%! T(%$#) I$'(&)!. 1.5 !# 1 * ATS

25 S!$o&o,*!$


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APBD LAIN JUML

1 2 3 4 5 6 7 8 1 11 14 15 16 17

254 S!0"o*o&))!$ T,*(% )?o"(- 5 T,*(% + + + + +

255 S%"(0%o!)!$ )(",#& !$'(&)! 1 ;!*

256 S0!"o$o*&%o$ 25 %,*(% T,*(% + + + + +

257 T,9 D"9 Ko,!$)! %,*(% )*#% T,*(% + + + + +

258 T(%"&!$ HC* T(%() M% =5 > Bo%o* + + + + +

25 T(%")!&*!$ K0)#* 25 K0)#* + + + + +26 T(%")!&*!$ K0)#* 5 K0)#* + + + + +

261 T!!$

263

264


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APBD LAIN J

1 2 3 4 5 6 7 8 1 11 14 15 16

4 Ao&)!)!*!$ S!"#0 K("!$ 125 5 * Bo%o* + + + + +

5 A$%*!$ I$'(&)! 25 A0#* + + + + +

6 A$%*!$ T,*(% 5 T,*(%

7 A$%!,&%("! DOEN S*(0 Ko,!$)! B?%")!$ S*(0 T#,( + + + + +

8 A$%!!"($ DOEN &o,!$)! T,*(% + + + + + A?(%o)* 1 T,*(%

1 A$%!0"&!$)o$ DOEN Ko,!$)! T,*(% + + + + +

11 A)!&*o;!" K"! 5> T#,( + + + + +

12 Co#$%("0!$ 15 T#,(

13 D#;-!*$ T,*(%

14 E&)%"&) B(**-o$ T,*(% 1 T,*(% + + + + +

15 E%&"!-!$ L"#%$ =1 Bo%o* + + + + +

16 o%!-!$( T,*(% 4 T,*(% + + + + +

17 ($o,",!%* !$' T,*(%

18 ($o* @*!)("o* T(%() T(*!$ 1 > Bo%o* + + + + +1 @($%!)!$ I$'(&)! 8 * A0#* + + + + +

2 @($%!)!$ S*(0 K#*!% =1 > %#,( + + + + +

21 @*!)("!* @#!&o*% T,*(% 1 T,*(% + + + + +

22 @*#&o) L"#%$ T,*(% 4> S%("!* &o*

23 @*#&o) L"#%$ I$#) 1 > S%("!* &o* + + + + +

24 @*#&o) L"#%$ I$#) 5 > S%("!* &o* + + + + +

25 I,#0"o($ S" 1 5 * Bo%o* + + + + +

26 I(")! O!* Bo%o* + + + + +

27 K(%o"o*? !$' 3* A0#*

28 K*o"($!&o* S*(0 M% 1 > T#,( + + + + +2 Ko%"!o&)/o* DOEN II P(-!%"!& Ko,!$)! T,*(% + + + + +

3 L"#%$ A) A)(%% Bo%o* + + + + +

31 L"#%$ A) K*o"!- =1 N Bo%o* + + + + +

32 L"#%$ B($(-!?% Bo%o* + + + + +


12/15


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33 L"#%$ Eo)!$ 2> Bo%o* + + + + +

34 L"#%$ #?(% Bo%o* + + + + +

35 L"#%$ @!() S%*!$ Bo%o* + + + + +

36 L"#%$ K",o* #&)!$ Bo%o* + + + + +

37 L"#%$ M(%!*($ B!"# Bo%o* + + + + +38 L"#%$ N%"!# S!%"% 3=8> Bo%o* + + + + +

3 L"#%$ R())("??(" Bo%o* + + + + +

4 L"#%$ T#"& Bo%o* + + + + +

41 L!)o* Bo%o* + + + + +

42 M(%$o* Bo%o* + + + + +

43 M#!!$ P)% Bo%o* + + + + +

44 N%"!# K*o"!- L"#%$ I$#) => Ko* + + + + +

45 O,% B%#& H!% OBH 1 * C!"$ Bo%o* + + + + +

46 O&)!%(%")!&*!$ HC* I$'(&)!. !.. 5 * + 1 *

47 O&)!%(%")!&*!$ HC* S*(0 M% 1 > %#,( + + + + +48 O&)!%(%")!&*!$ S*(0 K#*!% 3 > T#,( + + + + +

4 P(9?!$ !$' A0#*

5 P!"?(% I$'(&)! 1 5 L A0#* + + + + +

51 P"o0$o*o* %,*(% 4 T,*(% + + + + +

52 R$!%!-!$ I$'(&)! 25 2 * A0#* + + + + +

53 R(($ TB P&(% + + + + +

54 R!$(" L&%% L"#%$ I$#) S%("!* Ko* + + + + +

55 S(-"o&)!* K0)#* 5 K0)#* + + + + +

56 S(o%&)! I$'(&)! 1

57 S(%"!&)o$ I$'(&)! 1

5 S!(%!-!$ T,*(% 2 T,*(% + + + + +

6 S#*)(%!- N%"!# T(%() M% 15 > Bo%o* + + + + +

61 T(0o"" S%o00!$ *(%?9(" S(",#& -$ C!"$ )(% + + + + +


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62 T!!$

65 T"-o* 5 T,*(% + + + + +

66 P"?(%o* 1 T,*(% + + + + +67 P!"o!? 2 T,*(% + + + + +

68 S(%!"!/!$ T,*(% 1 T,*(%

6 B!)0"o*o* 5 T,*(%

7 R!)0("!-o$ 2 T,*(%

71 N(#"o,!o$ T,*(% T,*(%

72


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11 I$#)!o$ S(% A$& P?) + + + + +

12 I$#)!o$ S(% D() P?) + + + + +

13 I< C%9(%(" No. 18. @ P?) + + + + +

14 I< C%9(%(" No. 2 @ P?) + + + + +

15 I< C%9(%(" No. 22 @ P?) + + + + +16 I< C%9(%(" No. 24 @ P?) + + + + +

17 J"# J9!% K#*!% P?) + + + + +

18 J"# J9!% O%o% P?) + + + + +

1 K0) P(,*#% A,)o",($ 25 " "o* + + + + +

2 K) P(,*#% 2 8 ? "o* + + + + +

21 K) H!-"o!* 4 15 ? "o* + + + + +

22 K) H!-"o!* 4 3 ? "o* + + + + +

23 K) H!-"o!* S%("!* U&. 16 ? 16 ? "o* + + + + +

24 K) H!-"o!* U&. 36 8 ? "o* + + + + +

25 K) Ko0"() 44 S%("!* "o* + + + + +26 K) P(,*#% H!-"o!* 4 1 ? "o* + + + + +

27 K) P(,*#% H!-"o!* 4 5 ? "o* + + + + +

28 M)&(" P?) + + + + +

2 P(,*#% @!0) 4 I$?! "o* + + + + +

3 P*()%(" 5 "-) 2 !$?! P?) + + + + +

31 S!*& B($$ B(-9 S#%" No. 3 D($$ J"# B(-9 P?) + + + + +

32 U"!$( B P?) + + + + +

33 W!$ N((-*( No.27 @ P?) + + + + +

34 H$-)?oo$- 8 P?) + + + + +

JUMLAH KUNJUNGAN RESEP

UMUMKS JKN UKS KIR JUMLAH

BAYAR TIDAK BAYAR


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0

Mengetahui,

Kepala Dinas Kesehatan Ka. UPTD Gudang Farmasi Yang Melapor, Yang Menerima,Kabupaten Batang Hari Kab. Batang Hari Kepala Puskesmas Petugas Puskesmas

_______________________ _______________________

!"P. !"P. !"P. !"P.

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