1. NAMA PUSKESMAS
:
ALAMAT
:
KABUPATEN/KOTA
:
PROVINSI
:
2. JENIS PUSKESMAS
:
3. NAMA KEPALA PUSKESMAS
:
4. NAMA APOTEKER/PENANGGUNG JAWAB FARMASI
:
5. NO. STRA/STRTTK
:
6. NO. SIPA/SIKTTK
:
7. JUMLA APOTEKER
:
,+-
!. JUMLA TTK "S1 FARMASI# D3 FARMASI# AA$
:
,+-
%. JUMLA TENAGA NON KEFARMASIAN
:
,+-
1&. JUMLA RATA'RATA RESEP PERARI
:
L*,
11. WAKTU TUNGGU OBAT JADI
:
*+;
12. WAKTU TUNGGU OBAT RA(IKAN
:
*+;
14 JUMLA JUMLA PASIEN RAWAT RAWAT JALAN JALAN UMUM BPJS 15 UMUM BPJS
: : : :
"B* ;,+, =+;*+- "?$ ,<, 8;,8 9,, >,< *@,$
1. P*+,+--+-,0, ,+- ,, P8*, P8*, A9;*8* T*+,-, T*8+ K*,,,+ "S,,+, F,,# D3 F,,# A;*+ A9;*8*$ T*+,-, 8**>,;,+ <,+ ,;,. 8,+ 8,+ ;*+,-, 8**>,;,+ 2. A9;*8/I+;,<, ,, ,, P8*, P8*, ;*=,+; 9,, S;8; O-,+, P8*, A, 7,+ ;*;,98,+ ;*;,98,+ *+-,+ SK K*9,<, P8*, A, ;*;,96 ;67,8 ;*;,98,+ ;*;,98,+ *+-,+ SK K*9,<, P8*, T,8 *<8 S;8; -,+, 3. K,; ;8 ,; ,; ;**, -,+- +;8 ,+-',+,+-',+- ,; ,;, *+-,+ ;* 89;*, +;8 *,+;, 9*,8,+ ,+ 9*+-*<,,+ ,; ),# +;8 *;,9 *+ ,; ),# +;8 **,9, ,; ,, T,8 ,, 8,; ;8
1. P*+-- P*+--+,, +,,+ + L*, L*, R**9 R**9 L*, **9 <*+-8,9 "*+-,+ ;<,+ R/# +,, 8;*# +,, 9,*+# ,<,,;# $ L*, **9 ;,8 <*+-8,9 T,8 *+--+,8,+ <*, **9 2. P*+-8,,+ P*+-8,,+ **9 **9 <,88, <,88,+ + <*>: <*>: A9;*8*
A9;*8* 7,+/,;,. TTK "S,,+, F,,# D3 F,,# A;*+ A9;*8*$ T*+,-, 8**>,;,+ <,+ ,;, 8,+ ;*+,-, 8**>,;,+
3. P*,=8,+ ,; <,88,+ <*>: A9;*8* A9;*8* 7,+/,;,. TTK "S,,+, F,,# D3 F,,# A;*+ A9;*8*$ T*+,-, 8**>,;,+ <,+ ,;, 8,+ ;*+,-, 8**>,;,+ 4. P*+*,>,+ ,; <,88,+ <*>: A9;*8* A9;*8* 7,+/,;,. TTK "S,,+, F,,# D3 F,,# A;*+ A9;*8*$ T*+,-, 8**>,;,+ <,+ ,;, 8,+ ;*+,-, 8**>,;,+ 5. R+*/V;* 9,*+ A9;*8* *<,88,+ @;* ; A9;*8* *<,88,+ @;* ,+ B*< *<,88,+ @;*
"B* ;,+, =+;*+- "?$ 9,, >,< *@,$
1. F,<;, 9*+9,+,+ ,+- *+,+ ;,<;, ,; 2. F,<;, 9*+9,+,+ +,8;8,/98;98, 3. F,<;, 9*+9,+,+ ,>,+ *,>,,/,> ;*,8, 4. F,<;, 9*+9,+,+ -, *8 5. R,+- 9*,=8,+ ,; ,<, 8*,,,+ *> 6. P*,<,;,+ 9*,=8,+ ,; ,<, 8*,,,+ *> 7. F,<;, ,+- ;+-- !. F,<;, ,+- PIO/K+*<+%. F,<;, 9*+-,9,+ 1&. S;* 9*+9,+,+ O,; -,+- ,+- *,>8,+ 9*+=,,+ *,,8,+ ,<,*; ,;, 8*<, ;*,9 11. P*+,>,+ **9 <*+-8,9 *+-,+ *;, ,=,, "0,0,+=,,$ 12. S;* 9*+9,+,+ ,; -,+- ,+- *+,+ 8*,,+,+ ";*8+=# ,, ;*,<$ 13. O,; ,+- -+,8,+ <*> 98*, *, *+-,+ F<, N,+,<
1. P*+-*<<,,+ *,,+ ,,# *<9;: ,. P*<>,+ . P**+=,+,,+ =. P*+-,,,+ . P*+*,,+ *. P*+9,+,+ . P*+;,+ -. P*+,>,+ 2. P*<,,+,+ ,, 8<+8# *<9;: ,. P*+-8,,+ **9/+;8 9*+-,;,+ . D9*++=. P*+*<,+ 0,,; 9*+--+,,+ ,;
. P**,+ +, ,; "PIO$ *. K+*<+. R+*/V;* -. P*,+;,,+ ;*,9 ,; "PTO$ >. E@,<, 9*+--+,,+ ,; "EPO$ . M+;+- **8 ,9+- ,; "MESO$ . P*+<>,+ 8. P*<,,+,+ 8*,,,+ **+,< " >:4* 9>,24,=A =,2* $
1. P*+=,;,;,+ ,+ 9*+-,9,+ 9*<,9,+ +,8;8, 2. P*+=,;,;,+ ,+ 9*+-,9,+ 9*<,9,+ 98;98, 3. P*+=,;,;,+ ,+ 9*+-,9,+ 9*<,9,+ 8*<, ,8 ,; ,+ 9**8,<,+ 8**>,;,+ 4. P*+-,9,+ **9 5. P*+-,,9,+ =,;,;,+ 9*+-,;,+ 9,*+ 6. P*+-,9,+ >,< 9*,+;,,+ ;*,9 ,;
1. P*+<,+ **9 <,88,+ <*>: ,. D8;*/D8;* -- . P*,0,;/B,+ 2.
<,88,+ *, *+-,+: ,. P*,,;,+ ,+;,; "8*<*+-8,9,+ **9$ . K**,,+ ,,*;8 "*+;8 *,,+# 9;*+# # <<.$ =. P*;,+-,+ 8<+8 ",<*-# **8 ,9+-# +;*,8# <<.$
3. T,+9, 9**,,+ ,; ,=8,+ <*> , 1 ",;$ >, 4. T,+9, 9*+--+,,+ <*+* *,-, ,<,; ,=8,+ 5. P*+*,>,+ ,; *;, *;8*; " +;8 ,; <,# 9;> +;8 ,; ,<,$ 6. A9;*8*/9*;-, **8,+ +, ,; 8*9,, 9,*+# *<9;: ,. A;,+ 9,8, . L,, 9*+-,;,+ =. (,, 9*,8,,+ . E*8 ,9+*. I+;*,8 ,; . (,, 9*+9,+,+ ,; 7. A9;*8*/9*;-, **8,+ !. A9;*8* *<,8,+,8,+
,+- ;*8*+;, ,+- ;*8*+;,
"L,98,+ L,9,+ B<,+,+ P*<,,+,+ K*,,,+ P8*,$
%. A9;*8* *<,8,+,8,+
# *9,:
,. P**,+ +, ,; 8*9,, ;*+,-, 8**>,;,+ . M*,; <*,<*;/9;* =. M*<,88,+ P*+<>,+/9 8**>,;,+ 9,, ,,,8,; 1&. P*<,8,+,,+ 9*<,,+,+ 8*,,,+ **+,< " 11. M*<,88,+ M ,. A9;*8* *+-*+;8, 9;*+ 8*,,+ **8 ,9+- ,; . A9;*8* *<,98,+ 8* P,; MESO N,+,< 12. P*+8*+;,,+ 8*,<,>,+ 9*+-,;,+ "
$
1. E@,<, ,+- <,88,+ *<9;: ,. S* ,, ,+, . P*+-*<<,,+ *,,+ ,, =. P*<,,+,+ ,, 8<+8 2. P*+-8,+ =,9,,+ ; 9*<,,+,+ ,. S@* 8*9,,+ 8+*+ . P*+*,,+ 8;,8 ,,+ =. A; +;*+,< 3. M*++,8 <,+; >,< *@,<,
"I *, ,0,,+ *9+*+/8*,,,+ **+,+,$
1.
J<,> ,9;*8* ,+- *+-8; 8 /9*<,;>,+ ,, 8<+8 ,<, 3 ";-,$ ;, >+ ;*,8>
2.
J*+ 9*<,;>,+ ,+- 8; "*+;8, ,;, 9*<,;6>,+ 3,24,56 8<6+68 $
P*+,+--+-,0, R,+- F,,
P*;-, M+;+- K,/K;,
P*;-, M+;+- P@+
