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DATA SASARAN BALITA

Provinsi :
Kabupaten/Kota :
Puskesmas :

Berat
No NIK (Nomor Induk ANAK KE NAMA ANAK TANGGAL LAHIR JENIS No Tlp/HP Orang
KELAMIN Badan
Lahir Nama Ayah NIK Orang Tua ALAMAT RT RW
Kependudukan) Tua
(Kg)

EIREN FRISTI GIRSANG 12/03/2013 Simpang Dalig Raya
1 1208295203130001 1 P 2.8 JON RUSTAM 120829240187001

MEI KENDISA PURBA 17/05/2014 Simpang Dalig Raya
2 1208295705140002 5 P 3.8 JONRI 1208290506730002

YOAN L MORANO P 19/05/2014 Simpang Dalig Raya
3 1208291905140003 3 L 3.6 BERKAT P 1208291604780002

ARIL GIDEON SARAGIH 16/05/2013 Simpang Dalig Raya
4 1208291805130001 3 L 3.5 JOSUA S 1208290112700002

ARGA SYAHPUTRA P 2/08/2014 Simpang Dalig Raya
5 1208290208140001 1 L 3.7 JHON FERITUA 1208292802830002

BRAYEN 17/03/2015 Pangalguan
6 120829173150001 1 L 3.5 JAMAL G 1208291210930001

ARGA OCTO VERLIN P 04/10/2014 Pangalguan
7 1208290410140001 3 L 3.6 TONI PURBA 1208292411720001

GIONALDO DAMANIK 02/07/2014 Pangalguan
8 1208290207140001 4 L 2.7 JAYA TUAH 1208290908740001

DAMELIA P 29/08/2012 Tumbukan Dalig
9 1208296908120001 3 P 2.8 FANTRO S 1208290601770002

CANTIKA S 24/07/2015 Pangalguan
10 120829640715001 2 P 3 SARDO 1208291707850001

FARINA PURBA 08/03/2014 Tumbukan Dalig
11 1208294802140001 1 P 2.6 JOSEP P 1209294803140001

DEOVANTY TIMOTI P 12/08/2014 Tumbukan Dalig
12 1208291208140004 3 L 3.5 ENRA H 1208290007850004

GINTA ALFANDRO G 27/07/2012 Tumbukan Dalig
13 1209292707120002 1 L 3.8 PERIALMIAH 1208292512850003

12/02/2012
14 1208295202120001 2 SELFIA P 2.8 ANDI J 1208290620210001 Tumbukan Dalig

08/02/2013
15 1208290802130001 1 JERIANDO P L 3.1 DEFIANA S 1208290912850002 Tumbukan Dalig

28/05/2012
16 1208296805120002 2 MONICA P P 3 JANDARIANSON 120829190781004 Tumbukan Dalig

07/09/2015
17 1208294709150001 2 MANUELLA S P 3.5 JAHARANTO 12082902810007 Tumbukan Dalig

01/11/2013
18 120829011130001 1 ELFANDIEGO L 3.2 EDI ALFREDO 120829120885003 Tumbukan Dalig

28/04/2012
19 1208296804120004 2 LAURA P 3 OSKAR P 120829210377001 Tumbukan Dalig

pengukuran 1=YA.5 96 2 1 1 1 1 19/04/2017 13 100 2 1 1 1 1 19/04/2017 13 90 2 1 1 1 1 19/04/2017 13 91 2 1 1 1 1 18/04/2017 13. 1=ya 2=Berdiri 2=Tidak 2=Tidak 2=Tidak 2=Tidak 2=tidak 13/04/2017 13 104 2 1 1 1 1 13/04/2017 10 89 2 1 1 1 1 13/04/2017 12 87 2 1 1 1 1 13/04/2017 14 107 2 1 1 1 1 13/04/2017 12 98 2 1 1 1 1 18/04/2017 10 89 1 1 1 1 1 18/04/2017 13 100 2 1 1 1 1 18/04/2017 13. 1=YA.5 89 2 1 1 1 1 19/04/2017 14 97 2 1 1 1 1 18/04/2017 11 87 2 1 1 1 1 19/04/2017 11.5 92 2 1 1 1 1 19/04/2017 14 100 2 1 1 1 1 19/04/2017 12. Vitamin A Vitamin A Ada Buku Cara Ukur ASI Eksklusif IMD Tanggal BB Februari Agustus KIA (Kg) TB (Cm) 1=Telentang 1=YA.5 97 2 1 1 1 1 19/04/2017 13 100 2 1 1 1 1 19/04/2017 13 90 2 1 1 1 1 . 1=YA.

No Kependudukan) NAMA IBU BB sebelum ALAMAT RT RW TANGGAL Tanggal BB TB LILA Kehamilan Tambah brp butir atau hamil LAHIR pengukuran (Kg) (Cm) (cm) ke darah) TTD NO. didapat 2=Tidak . KTP 1=YA. DATA SASARAN IBU HAMIL Provinsi : Kabupaten/Kota : Puskesmas : TTD NIK (Nomor Induk (Tablet Jika YA.

DATA SASARAN IBU HAMIL Provinsi : Kabupaten/Kota : Puskesmas : PEMATANG RAYA NIK (Nomor Induk BB No Kependudukan) NAMA IBU sebelum ALAMAT RT RW atau hamil NO. KTP 60 Merekraya 1 Santi Saragih 60 Merekraya 2 Esmiwati Saragih 57 Merekraya 3 Deni Saragih 52 Rumahbayu 4 Deviana Simamora 5 Juwita Sipahutar 55 Buahbolon 56 Buahbolon 6 Rodearni Sinaga 42 Buahbolon 7 Ierni Purba 8 Tiarma Adelina S 58 Merekraya 43 Sihubu 9 Yanti Saragih 42 Sihubu 10 Febi Sipayung 11 Lusi Sihombing 56 Bulupange 12 Astela Simatupang 52 Bulupange 13 Lisma Saragih 48 Bulupange 14 Heltina Sinaga 54 Tumbukan Dalik 15 Hotmariani Sinaga 54 Dameraya 16 Renna Sijabat 50 Dameraya 17 Desmita Damanik 47 Dameraya 18 Lasmi 52 Dameraya 19 Eliana 59 Rayabosi 20 Rosiana Hutasoit 54 Silou Buttu 21 Tuenti Purba 49 Silou Buttu 22 Agustina Saragih 41 Silou Buttu 23 Tiarma Purba 53 Silou Buttu 24 Idah Mayasari Saragih 48 Silou Buttu 25 Dewi Purba 48 Silou Buttu 26 Nelli Sriati 72 Rayabosi .

raya 48 Heni Rosdiana Sinurat 67 Gulping 49 Ance Saragih 40 Gulping 50 IcceTrisnawati Sinabariba 55 Gulping 51 Hotmauli Saragih 62 Tondang 52 Herna Saragih 63 Sondiraya 53 Ina 58 Sondiraya 54 Melen Sinaga 56 Sondiraya 55 Heppy 62 Sondiraya 56 Sinta Simarmata 44 Dologhuluan 57 Jusi 44 Dologhuluan 58 Gembira 50 Dologhuluan 59 Cici 52 Dologhuluan 60 Siska Sinaga 51 Dologhuluan 61 Evi Rodelina Sinaga 52 Dologhuluan 62 Tanti Sumbayak 51 Dologhuluan 63 Dewi 52 Dologhuluan 64 Aya Simarmata 52 Dologhuluan 65 Menanti Silalahi 42 Bittang Mariah 66 120829550113000 Hesmika Manalu 48 Bittang Mariah 67 Marta Manalu 52 Bittang Mariah 68 Lastri Purba 57 Bittang Mariah 69 Erienti Saragih 52 Bittang Mariah 70 Novasari Haloho 54 Rayabayu 71 Eva Helmawai Purba 49 Rayabayu .raya 36 Sri Irawati 62 Limag 37 Mesra 68 Limag 38 Raheni Purba 49 Limag 39 Lapmi Purba 55 Limag 40 Marni 53 Limag 41 Nuri 49 Limag 42 Rosida Tambunan 55 P.raya 35 Menny Sinaga 56 P.raya 47 Masriana Purba 54 P.raya 34 Sintamina 67 P.27 Ita Heriani 65 Rayabosi 28 Andira 65 Rayabosi 29 Zwisca Febri 70 P.raya 30 Hotmariah 52 P.raya 31 Pinda Sinaga 58 P.raya 46 Elisabet 50 P.raya 45 Mely Sipayung 46 P.raya 32 Rosna 55 P.raya 43 Sondang 47 Sibunga-bunga 44 Anris Ariani 57 P.raya 33 Eka 59 P.

72 Henni Mirselina Saragih 48 Rayabayu 73 Camelia Purba 61 Rayabayu 74 Santi Purba 54 Rayausang 75 Sriana Sinaga 54 Rayausang 76 Nani Purba 62 Rayausang 77 120829410389000 Sri rahanum 68 Rayausang 78 120829480281000 Hesti Prba 52 Rayausang 79 Eva Siska Siagian 50 Rayahuluan 80 120829641290000 Rosdiade Saragih 40 Rayausang 81 120829680387000 Rayani Turnip 50 Rayausang 82 Nurita Sijabat 57 Rayausang 83 120829671285000 Deni Saragih 58 Rayausang 84 Ramayana Siregar 59 Bahbolon 85 Rina Saragih 52 Bahbolon 86 Dewi Sumbayak 46 Bahbolon 87 Renvita Sijabat 61 Bahbolon 88 Lasma roha Situmorang 50 Bahbolon 89 Lita Malau 53 Bahbolon 90 Murniati Ritonga 48 Bahbolon 91 Nuridah Sumbayak 49 Bahbolon 92 Mustikah Hutabarat 59 Bahbolon 93 Meliani Purba 56 Bahbolon 94 Nurselida Purba 49 Bahbolon 95 Etidiana 58 Bahbolon 96 Yanti Damanik 61 Bahbolon 97 Arta Simarmata 48 Bahbolon 98 Risa Hutasoit 48 Bahbolon 99 Rani Purba 53 Bahbolon 100 Friska P 63 Bahapal 101 Romega Pasaribu 59 Bahapal 102 Juni Erika 55 Bahapal 103 Melda 54 Bahapal 104 Sonia 58 Bahapal 105 Elpridawati 58 Bahapal 106 Eska 48 Bahapal 107 Maya 55 Bahapal 108 Minar Sinaga 48 Bahapal 109 Diana Nasution 48 Bongguron Kariahan 110 Merni Risma Lina Sumbaya 48 Bongguron Kariahan 111 Jenni Hotnani Purba 54 Bongguron Kariahan 112 Wira Saragih 50 Bongguron Kariahan 113 Romamuliani Sinaga 51 Bongguron Kariahan 114 Irma Wida Sidauruk 45 Bongguron Kariahan 115 Hotni Mariani Lingga 61 Bongguron Kariahan 116 Rista Saragih 67 Bongguron Kariahan .

117 Geopani Purba 53 Bongguron Kariahan 118 Herli Hutasoit 52 Silou Buttu 119 Renniati Saragih 40 Silou Huluan 120 Fitri Damanik 58 Silou Huluan 121 Hetty Saragih 52 Silou Huluan 122 Masrianan Saragih 53 Silou Huluan 123 Saurma Simanjuntak 45 Silou Huluan 124 Intan Hutagalung 42 Silou Huluan 125 Henrawati Purba 55 Siporkas 126 Bungaanriani 57 Siporkas 127 Lusiana 51 Mappu 128 Fitriamurni Purba 48 Mappu 129 Hotmawati Saragih 46 Mariahraya 130 Rungliensi Purba 46 Mariahraya 131 Kristina Natalia Sinaga 53 Mariahraya 132 Klararissa Siahaan 48 Mariahraya 133 Sepriani Purba 51 Mariahraya 134 Meldaria Sinaga 43 Mariahraya 135 Helrlidawati Purba 50 Bahpasussang 136 Arista Purba 49 Buttu Ganjang 137 Yeni Sitopu 50 Buttu Ganjang 138 Denni Silalahi 48 Kampungbaru 139 Lena Haloho 46 Rayabayu 140 Apriani Kristin 48 Rayabayu 141 Herlan Saragih 43 Rayabayu 142 Tria saragih 52 Bittang Mariah 143 Nikita sitopu 44 Bittang Mariah 144 120829490886000 Anna mariana siregar 50 Raya Huluan 145 120829610980000 Donna ambarita 55 Raya Huluan 146 Ennivita Purba 52 Jandi Raya 147 Riana Sinamo 5 Jandi Raya .

5 1 1 20 31-12-1987 4/4/2017 64 155 26 3 1 30 31-12-1989 4/4/2017 54 157 25.5 2 1 10 31-121997 4/4/2017 56 150 24. Tanggal LILA (cm) Kehamilan Tambah brp butir TANGGAL LAHIR BB (Kg) TB (Cm) pengukuran ke darah) TTD 1=YA.5 1 1 30 31-12-1982 4/4/2017 63 152 30 3 1 40 31-12-1988 4/4/2017 64 154 26 4 1 10 31-12-1987 4/4/2017 47 150 24 3 1 50 31-13-1992 4/4/2017 63 156 26 1 1 50 31-12-1989 4/4/2017 50 156 26 2 1 20 31-12-1987 4/4/2017 45 150 26 3 1 10 31-12-1985 4/4/2017 60 152 26 3 1 10 31-12-1987 4/4/2017 50 156 25 2 1 50 31-12-1992 4/4/2017 52 150 24 3 2 31-12-1999 4/4/2017 55 154 25 2 2 31-12-1989 4/4/2017 55 152 25 1 1 20 31-12-1983 4/4/2017 51 152 24 2 1 20 31-12-1990 4/4/2017 50 150 25 1 1 10 31-12-1994 4/4/2017 55 150 24.5 2 1 10 31-12-1980 4/4/2017 55 155 25 1 1 60 31-12-1984 4/4/2017 73 157 30 2 1 80 .5 2 2 31-12-1980 4/4/2017 54 154 26 2 1 30 31-12-1985 4/4/2017 55 152 24 3 1 70 31-12-1982 4/4/2017 52 151 24 3 1 10 31-12-1999 4/4/2017 45 156 24 2 2 31-12-1978 4/4/2017 56 154 24. didapat 2=Tidak 31-12-1985 4/4/2017 65 156 26.ASARAN IBU HAMIL TTD (Tablet Jika YA.5 4 1 10 31-12-1993 4/4/2017 46 154 24.

7 2 1 70 31-12-1997 4/4/2017 67 157 25 1 1 40 31-12-1992 4/4/2017 60 152 25 2 1 40 31-12-1992 4/4/2017 63 156 26 3 2 31-12-1984 4/4/2017 70 159 27 3 1 30 31-12-1992 4/4/2017 50 156 25 2 1 10 31-12-1990 4/4/2017 56 150 25 2 2 31-12-1991 4/4/2017 60 155 26 1 2 31-12-1993 4/4/2017 58 154 26 3 1 10 31-12-1984 4/4/2017 59 153 25 2 1 70 31-12-1990 4/4/2017 54 150 25 2 1 50 31-12-1994 4/4/2017 59 154 24 1 1 30 31-12-1992 4/4/2017 50 152 24 1 1 30 31-12-1996 4/4/2017 57 156 26 1 1 50 31-12-1993 4/4/2017 60 155 24 2 1 10 31-12-1990 4/4/2017 69 158 26 2 1 60 31-12-1989 4/4/2017 46 150 24 3 1 50 31-12-1993 4/4/2017 52 151 28 2 1 20 31-12-1987 4/4/2017 65 154 30 2 1 70 31-12-1987 4/4/2017 58 154 30 3 1 20 31-12-1990 4/4/2017 60 157 28 3 1 40 31-12-1982 4/4/2017 60 156 25 2 1 30 31-12-1999 4/4/2017 65 157 25 3 1 40 31-12-1987 4/4/2017 50 150 27 2 1 30 31-12-1992 4/4/2017 54 153 24.5 3 1 70 31-12-1988 4/4/2017 57 154 24 4 1 70 31-12-1987 4/4/2017 59 154 24 3 1 70 31-12-1982 4/4/2017 59 156 25 2 2 31-12-1989 4/4/2017 60 160 25 3 1 50 31-12-1984 4/4/2017 61 156 26 3 1 40 31-12-1987 4/4/2017 52 153 24 4 1 80 31-12-1998 4/4/2017 60 150 25 3 1 40 31-12-1998 4/4/2017 48 154 24 2 1 50 31-12-1993 4/4/2017 52 153 25 1 1 40 31-12-1990 4/4/2017 60 150 26 1 1 70 31-12-1989 4/4/2017 62 156 26 1 1 50 31-12-1988 4/4/2017 60 152 25 3 1 70 11/11/2000 4/4/2017 59 158 26 1 1 30 31-12-1989 4/4/2017 52 150 28 2 1 30 .31-12-1984 4/4/2017 64 153 29 2 2 31-12-1991 4/4/2017 67 154 29 3 1 10 31-12-1984 4/4/2017 70 157 30 3 1 10 31-12-1980 4/4/2017 56 154 25 2 2 31-12-1985 4/4/2017 60 150 26 3 2 31-12-1989 4/4/2017 64 158 25 2 1 30 31-12-1998 4/4/2017 59 153 24.

6 2 1 70 31-12-1987 4/4/2017 50 156 27 3 1 50 31-12-1992 4/4/2017 67 159 25 2 1 50 31-12-1992 4/4/2017 70 158 24 1 1 30 .19-01-1994 4/4/2017 52 152 26 3 1 10 31-12-1993 4/4/2017 70 150 27 2 1 30 31-12-1987 4/4/2017 61 152 25 1 1 70 31-12-1987 4/4/2017 60 154 24 2 1 70 31-12-1996 4/4/2017 65 153 26 3 1 40 31-12-1982 4/4/2017 70 159 22 2 1 20 31-12-1982 4/4/2017 58 156 26 3 1 10 31-12-1988 4/4/2017 55 153 28 3 1 60 31-12-1990 4/4/2017 44 150 22 2 1 40 31-12-1987 4/4/2017 55 154 26 2 1 10 31-12-1985 4/4/2017 59 152 25 3 1 50 31-12-1986 4/4/2017 60 154 26 2 1 10 31-12-1990 4/4/2017 61 154 27 2 1 10 31-12-1991 4/4/2017 60 152 27 3 1 70 31-12-1987 4/4/2017 50 150 24 2 1 20 13-02-1986 4/4/2017 62 150 28 2 2 31-12-1992 4/4/2017 53 150 26 4 1 30 31-12-1989 4/4/2017 58 150 24 2 1 10 31-12-1987 4/4/2017 50 150 24 2 1 20 31-12-1991 4/4/2017 50 152 24 4 1 30 31-12-1990 4/4/2017 62 156 24 2 1 10 31-12-1988 4/4/2017 58 154 24 3 1 10 31-12-1986 4/4/2017 56 150 27 2 1 40 31-12-1987 4/4/2017 60 153 27 3 1 10 31-12-1992 4/4/2017 63 150 27 2 1 10 31-12-1991 4/4/2017 52 151 25 2 1 40 31-12-1989 4/4/2017 50 150 24 2 1 10 31-12-1980 4/4/2017 55 153 24 3 1 10 31-12-1984 4/4/2017 67 150 26 2 1 30 31-12-1990 4/4/2017 60 153 25 1 2 31-12-1990 4/4/2017 58 153 26 1 1 20 31-12-1992 4/4/2017 60 154 26 2 1 50 31-12-1995 4/4/2017 62 153 26 2 1 30 31-12-1987 4/4/2017 65 157 27 3 1 70 31-12-1987 4/4/2017 52 157 25 2 1 30 31-13-1990 4/4/2017 59 155 27 2 1 30 31-12-1991 4/4/2017 52 150 24 1 1 30 31-12-1987 4/4/2017 55 153 25 2 1 70 31-12-1987 4/4/2017 59 156 26 2 1 70 31-12-1987 4/4/2017 62 158 24 2 1 70 31-12-1986 4/4/2017 57 155 25 3 1 30 31-12-1998 4/4/2017 59 155 26.

310-12-1993 4/4/2017 71 159 25 1 1 10 31-12-1992 4/4/2017 55 154 25 1 1 20 31-12-1987 4/4/2017 43 155 26 3 1 20 31-12-1987 4/4/2017 60 154 25 2 1 20 31-12-1987 4/4/2017 54 157 26 3 1 10 31-12-1987 4/4/2017 56 154 25 2 1 10 31-12-1987 4/4/2017 48 154 24 3 1 10 31-12-1987 4/4/2017 47 148 24 3 1 30 31-12-1995 4/4/2017 60 153 25 2 1 40 31-12-1981 4/4/2017 62 150 24.8 2 1 50 8/9/1986 13/03/17 67 150 28 1 1 40 4/29/1983 4/2/2017 56 155 27 3 1 10 8/11/1983 4/15/2017 55 152 26 1 1 30 1/31/1981 4/23/2017 62 154 28 3 1 20 .5 3 1 50 31-12-1986 4/4/2017 55 152 24 4 1 40 31-12-1987 4/4/2017 55 153 24 4 1 40 31-13-1983 4/4/2017 50 151 24 3 1 40 31-13-1982 4/4/2017 50 153 24 2 1 30 31-13-1982 4/4/2017 60 155 25 3 1 70 31-13-1991 4/4/2017 55 152 24 3 1 40 31-13-1990 4/4/2017 58 152 24 3 1 40 31-13-1987 4/4/2017 50 152 25 2 1 40 31-13-1991 4/4/2017 55 153 25 2 1 20 31-14-1991 4/4/2017 55 152 24 2 1 70 31-14-1991 4/4/2017 56 152 24 2 1 40 15-10-1988 4/4/2017 50 150 26.5 2 1 30 26/11/1988 4/4/2017 48 150 30 3 1 70 2/4/1979 4/4/2017 50 256 26 5 1 30 26/06/1984 4/4/2017 45 150 29 4 1 70 2/5/1997 4/4/2017 55 160 24 1 1 70 12/4/1996 4/4/2017 46 151 23.