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Laporan Pemakaian Dan Lembar Permintaan Reagen (LPLPR)

This document is a report and request form for reagent use and supply from a community health center in Tabanan, Bali, Indonesia. It provides a table listing 66 different reagents with information on the initial stock, receipts, usage, and remaining stock levels for March 2022. The bottom section recaps the reagents used that month. The form is signed by the head of the health center, storekeeper, and officer to confirm the reported reagent levels and upcoming April 2022 supply requests.

Uploaded by

Juli Anggarawati Chanel
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© © All Rights Reserved
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117 views8 pages

Laporan Pemakaian Dan Lembar Permintaan Reagen (LPLPR)

This document is a report and request form for reagent use and supply from a community health center in Tabanan, Bali, Indonesia. It provides a table listing 66 different reagents with information on the initial stock, receipts, usage, and remaining stock levels for March 2022. The bottom section recaps the reagents used that month. The form is signed by the head of the health center, storekeeper, and officer to confirm the reported reagent levels and upcoming April 2022 supply requests.

Uploaded by

Juli Anggarawati Chanel
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLS, PDF, TXT or read online on Scribd
You are on page 1/ 8

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN REAGEN (LPLPR)

PUSKESMAS : SELEMADEG TIMUR II PELAPORAN PERIODE Maret 2022


KECAMATAN : SELEMADEG TIMUR PERMINTAAN PERIODE April 2022
KABUPATEN : TABANAN

Stok Penerimaa Pemakaia Permintaa Pemberia


Kode No Nama Reagen Satuan Persediaan Sisa Stok Ket
awal n n n n
1 2 3 4 5 6 7=(5+6) 8 9=(7-8) 10 11
R1 1 Blood glucose test strips Strip 0 0 0
R2 2 Uric acid test strips Strip 0 0 0
R3 3 Cholestrol test strip Strip 0 0 0
R4 4 PP.Test Strip( One Step Rapid HCG Strip ) Strip 0 0 0 50
R5 5 HB test strip Strip 0 0 0 50
R6 6 Urine Test Strip 3P Strip 0 0 0
R7 7 Urine Test Strip 10P Strip 0 0 0
R8 8 Dengue NS 1 Ag test card Test 0 0 0
R9 9 Salmonella Paratyphi Anti Bodies Test AH Test 0 0 0
R10 10 Salmonella Paratyphi Anti Bodies Test AO Test 0 0 0
R11 11 Salmonella Paratyphi Anti Bodies Test BH Test 0 0 0
R12 12 Salmonella Paratyphi Anti Bodies Test BO Test 0 0 0
R13 13 Salmonella Paratyphi Anti Bodies Test CO Test 0 0 0
R14 14 Salmonella Paratyphi Anti Bodies Test H Test 0 0 0
R15 15 Salmonella Paratyphi Anti Bodies Test O Test 0 0 0
R16 16 Salmonella Paratyphi Anti Bodies Test CH Test 0 0 0
R17 17 Dilluent Galon @ 20 L 0 0 0
R18 18 Rinse Galon @ 5,5 L 0 0 0
R19 19 Lyse Botol @500 mL 0 0 0
R20 20 E-Z Cleanser Botol @100 mL 0 0 0
R21 21 Probe Cleanser Botol @ 50 ml 0 0 0
R22 22 Control Normal Hematology Analyzer Vial @ 3 mL 0 0 0
R23 23 Antisera Golongan Darah A&B Paket @ 10mL 0 0 0 1
R24 24 HIV 1/2 Anti Body Rapid Test Oncoprobe Test 0 0 0
R25 25 HIV 1/2 Anti Body Rapid Test Intec Test 0 0 0
R26 26 HIV 1/2 Anti Body Rapid Test Vikia Test 0 0 0
R27 27 SD Bioline HIV Test 59 59 5 54
R28 28 SD HBsAg Test 23 23 5 18
R29 29 SD Biosensor Syphilis Ab Test Test 59 59 5 54
R30 30 RPR Fokus Syphilis Test 0 0 0
R31 31 Vacutube Gel Clot Activator (Kuning) Tube 0 0 0
R32 32 Vacutube Gel Clot Activator (Merah) Tube 0 0 0 100
Stok Penerimaa Pemakaia Permintaa Pemberia
Kode No Nama Reagen Satuan Persediaan Sisa Stok Ket
awal n n n n

R33 33 Tabung EDTA (Ungu) Tube 0 0 0


R34 34 AST/SGOT Reagent Kit @ 4x30 mL 0 0 0
R35 35 ALT/SGPT Reagent Kit @ 4x30 mL 0 0 0
R36 36 Creatinin Reagent Kit @ 2x250 mL 0 0 0
R37 37 Urea Nitrogent (Bun) Kit @ 4x30 mL 0 0 0
R38 38 Control Serum Normal Kimia Klinik Vial @ 5 mL 0 0 0
R39 39 Yellow Tip Pcs 0 0 0
R40 40 Blue Tip Pcs 0 0 0
R41 41 Alkohol Swab Sachet 658 1500 2158 2158 0
R42 42 Reagen TB (Ziehl Neellsen Paket @ 10 mL 0 0 0
R43 43 Safe T Pro Une Blood lancet Pcs 0 0 0
R44 44 Slide frosted Box @ 72 pcs 439 439 7 432
R45 45 Oil Imersi Botol 4 4 4
R46 46 Tissue Lensa Lembar 0 0 0
R47 47 BD Vacutaner Pcs 0 0 0
R48 48 Sarung Tangan M Pasag 0 0 0
R49 49 Sarung Tangan L Pasag 0 0 0
R50 50 Cary-Blair-Medium Tube @ 500 g 0 0 0
R51 51 Lactose Broth H Tube @ 500 g 0 0 0
R52 52 Alkohol 70 % Botol 1 Liter 0 0 0
R53 53 Cotton Swab Pcs 0 0 0
R54 54 Rapid Tes HIV 2 Fokus Test 0 0 0
R55 55 Blood Lancet Avico/semilias pcs 0 0 0
56 TP Shypilis test 0 0 0
57 VTM + swab pcs 191 191 4 187
58 Pewarna MDT (3x100 ml) botol 4 4 4
59 Pewarna Giemsa (1x100 ml) botol 4 4 4
60 Rapid Test Antigen test 862 862 131 731
61 Dengue NS1Ag +Ab Combo Test 50 50 50
62 Klip Besar 20*30 cm pak 1 1 1
63 Klip Kecil pak 1 1 1
64 HIV 1/2 (Rapid 1 RDT HIV) Virochek Test 75 75 75

Mengetahui : Yang Menyerahkan


Kepala Puskesmas Selemadeg Timur 2 Petugas Gudang Obat Puskesmas Petugas Puskesmas

( dr. Ni Putu Partini ) ( Ni Kadek Eni Mulyani ) (I Nengah Rustana )


NIP. 196607262002122003 NIP.- NIP.196406251987031008
REKAP PEMAKAIAN REAGEN
Maret 2022

pemakai
Kode No Nama Reagen Satuan exp
an

B1 1 Blood glucose test strips Strip 0


B2 2 Uric acid test strips Strip 0
B3 3 Cholestrol test strip Strip 0
B4 4 PP.Test Strip( One Step Rapid HCG Strip ) Strip 0
B5 5 HB test strip Strip 0
B6 6 Urine Test Strip 3P Strip 0
B7 7 Urine Test Strip 10P Strip 0
B8 8 Dengue NS 1 Ag test card Test 0
B9 9 Salmonella Paratyphi Anti Bodies Test AH Test 0
B10 10 Salmonella Paratyphi Anti Bodies Test AO Test 0
B11 11 Salmonella Paratyphi Anti Bodies Test BH Test 0
B12 12 Salmonella Paratyphi Anti Bodies Test BO Test 0
B13 13 Salmonella Paratyphi Anti Bodies Test CO Test 0
B14 14 Salmonella Paratyphi Anti Bodies Test H Test 0
B15 15 Salmonella Paratyphi Anti Bodies Test O Test 0
B16 16 Salmonella Paratyphi Anti Bodies Test CH Test 0
B17 17 Dilluent Galon @ 20 L 0
B18 18 Rinse Galon @ 5,5 L 0
B19 19 Lyse Botol @500 mL 0
B20 20 E-Z Cleanser Botol @100 mL 0
B21 21 Probe Cleanser Botol @ 50 ml 0
B22 22 Control Normal Hematology Analyzer Vial @ 3 mL 0
B23 23 Antisera Golongan Darah A&B Paket @ 10mL 0
B24 24 HIV 1/2 Anti Body Rapid Test Oncoprobe Test 0
B25 25 HIV 1/2 Anti Body Rapid Test Intec Test 0
B26 26 HIV 1/2 Anti Body Rapid Test Vikia Test 0
B27 27 SD Bioline HIV Test 5
B28 28 SD HBsAg Test 5
B29 29 SD Biosensor Syphilis Ab Test Test 5
B30 30 RPR Fokus Syphilis Test 0
B31 31 Vacutube Gel Clot Activator (Kuning) Tube 0
B32 32 Vacutube Gel Clot Activator (Merah) Tube 0
B33 33 Tabung EDTA (Ungu) Tube 0
B34 34 AST/SGOT Reagent Kit @ 4x30 mL 0
B35 35 ALT/SGPT Reagent Kit @ 4x30 mL 0
B36 36 Creatinin Reagent Kit @ 2x250 mL 0
B37 37 Urea Nitrogent (Bun) Kit @ 4x30 mL 0
B38 38 Control Serum Normal Kimia Klinik Vial @ 5 mL 0
B39 39 Yellow Tip Pcs 0
B40 40 Blue Tip Pcs 0
B41 41 Alkohol Swab Sachet 2158
B42 42 Reagen TB (Ziehl Neellsen Paket @ 10 mL 0
B43 43 Safe T Pro Une Blood lancet Pcs 0
B44 44 Slide frosted Box @ 72 pcs 7
B45 45 Oil Imersi Botol 0
B46 46 Tissue Lensa Lembar 0
B47 47 BD Vacutaner Pcs 0
B48 48 Sarung Tangan M Pasag 0
B49 49 Sarung Tangan L Pasag 0
B50 50 Cary-Blair-Medium Tube @ 500 g 0
B51 51 Lactose Broth H Tube @ 500 g 0
B52 52 Alkohol 70 % Botol 1 Liter 0
B53 53 Cotton Swab Pcs 0
54 Rapid Tes HIV 2 Fokus Test 0
55 Blood Lancet Avico pcs 0
Total
Pemakai
an

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
5
5
5
0
0
0
0
0
0
0
0
0
0
0
2158
0
0
7
0
0
0
0
0
0
0
0
0
0
0
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN REAGEN (LPLPR)
PUSKESMAS

PUSKESMAS : SELEMADEG TIMUR II PELAPORAN PERIODE Maret 2022


KECAMATAN : SELEMADEG TIMUR PERMINTAAN PERIODE April 2022
KABUPATEN : TABANAN

Stok Penerimaa Pemakaia Permintaa Pemberia


Kode No Nama Reagen Satuan Persediaan Sisa Stok Ket
awal n n n n
1 2 3 4 5 6 7=(5+6) 8 9=(7-8) 10 11
R1 1 Blood glucose test strips Strip 0 0 0
R2 2 Uric acid test strips Strip 0 0 0
R3 3 Cholestrol test strip Strip 0 0 0
R4 4 PP.Test Strip( One Step Rapid HCG Strip ) Strip 0 0 0 50
R5 5 HB test strip Strip 48 48 48 50 EXP
R6 6 Urine Test Strip 3P Strip 0 0 0
R7 7 Urine Test Strip 10P Strip 0 0 0
R8 8 Dengue NS 1 Ag test card Test 0 0 0
R9 9 Salmonella Paratyphi Anti Bodies Test AH Test 0 0 0
R10 10 Salmonella Paratyphi Anti Bodies Test AO Test 0 0 0
R11 11 Salmonella Paratyphi Anti Bodies Test BH Test 0 0 0
R12 12 Salmonella Paratyphi Anti Bodies Test BO Test 0 0 0
R13 13 Salmonella Paratyphi Anti Bodies Test CO Test 0 0 0
R14 14 Salmonella Paratyphi Anti Bodies Test H Test 0 0 0
R15 15 Salmonella Paratyphi Anti Bodies Test O Test 0 0 0
R16 16 Salmonella Paratyphi Anti Bodies Test CH Test 0 0 0
R17 17 Dilluent Galon @ 20 L 0 0 0
R18 18 Rinse Galon @ 5,5 L 0 0 0
R19 19 Lyse Botol @500 mL 0 0 0
R20 20 E-Z Cleanser Botol @100 mL 0 0 0
R21 21 Probe Cleanser Botol @ 50 ml 0 0 0
R22 22 Control Normal Hematology Analyzer Vial @ 3 mL 0 0 0
R23 23 Antisera Golongan Darah A&B Paket @ 10mL 0 0 0 1
R24 24 HIV 1/2 Anti Body Rapid Test Oncoprobe Test 0 0 0
R25 25 HIV 1/2 Anti Body Rapid Test Intec Test 0 0 0
R26 26 HIV 1/2 Anti Body Rapid Test Vikia Test 0 0 0
R27 27 SD Bioline HIV Test 509 509 5 504
R28 28 SD HBsAg Test 43 43 5 38
R29 29 SD Biosensor Syphilis Ab Test Test 59 59 5 54
R30 30 RPR Fokus Syphilis Test 0 0 0
R31 31 Vacutube Gel Clot Activator (Kuning) Tube 0 0 0
R32 32 Vacutube Gel Clot Activator (Merah) Tube 0 0 0 100
Stok Penerimaa Pemakaia Permintaa Pemberia
Kode No Nama Reagen Satuan Persediaan Sisa Stok Ket
awal n n n n

R33 33 Tabung EDTA (Ungu) Tube 0 0 0


R34 34 AST/SGOT Reagent Kit @ 4x30 mL 0 0 0
R35 35 ALT/SGPT Reagent Kit @ 4x30 mL 0 0 0
R36 36 Creatinin Reagent Kit @ 2x250 mL 0 0 0
R37 37 Urea Nitrogent (Bun) Kit @ 4x30 mL 0 0 0
R38 38 Control Serum Normal Kimia Klinik Vial @ 5 mL 0 0 0
R39 39 Yellow Tip Pcs 0 0 0
R40 40 Blue Tip Pcs 0 0 0
R41 41 Alkohol Swab Sachet 658 1500 2158 2158 0
R42 42 Reagen TB (Ziehl Neellsen Paket @ 10 mL 0 0 0
R43 43 Safe T Pro Une Blood lancet Pcs 0 0 0
R44 44 Slide frosted Box @ 72 pcs 439 439 7 432
R45 45 Oil Imersi Botol 4 4 4
R46 46 Tissue Lensa Lembar 0 0 0
R47 47 BD Vacutaner Pcs 0 0 0
R48 48 Sarung Tangan M Pasag 0 0 0
R49 49 Sarung Tangan L Pasag 0 0 0
R50 50 Cary-Blair-Medium Tube @ 500 g 0 0 0
R51 51 Lactose Broth H Tube @ 500 g 0 0 0
R52 52 Alkohol 70 % Botol 1 Liter 0 0 0
R53 53 Cotton Swab Pcs 0 0 0
R54 54 Rapid Tes HIV 2 Fokus Test 0 0 0
R55 55 Blood Lancet Avico/semilias pcs 0 0 0
56 TP Shypilis test 307 307 307 exp
57 VTM + swab pcs 191 191 4 187
58 Pewarna MDT (3x100 ml) botol 4 4 4
59 Pewarna Giemsa (1x100 ml) botol 4 4 4
60 Rapid Test Antigen test 862 862 131 731
61 Dengue NS1Ag +Ab Combo Test 50 50 50
62 Klip Besar 20*30 cm pak 1 1 1
63 Klip Kecil pak 1 1 1
64 HIV 1/2 (Rapid 1 RDT HIV) Virochek Test 75 75 75

Mengetahui :
Kepala Dinas Kabupaten Tabanan Yang Menyerahkan Yang Meminta Petugas Puskesmas
Kepala Puskesmas

(………………………………………………..) (…………………………………) ( dr.NI Putu Partini ) (I Nengah Rustana )


NIP. NIP. NIP.196607262002122003 NIP.196406251987031008

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