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
 Vitamin A Vitamin A Ada Buku
Cara Ukur ASI Eksklusif IMD
Tanggal BB Februari Agustus KIA
(Kg) TB (Cm) 1=Telentang
1=YA, 1=YA,
pengukuran 1=YA, 1=YA, 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 13.5 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 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 13.5 92 2 1 1 1 1

19/04/2017 14 100 2 1 1 1 1

19/04/2017 12.5 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
 DATA SASARAN IBU HAMIL

Provinsi :
Kabupaten/Kota :
Puskesmas :

TTD
NIK (Nomor Induk (Tablet Jika 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. KTP 1=YA, didapat
2=Tidak
 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
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
32 Rosna 55 P.raya
33 Eka 59 P.raya
34 Sintamina 67 P.raya
35 Menny Sinaga 56 P.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
43 Sondang 47 Sibunga-bunga
44 Anris Ariani 57 P.raya
45 Mely Sipayung 46 P.raya
46 Elisabet 50 P.raya
47 Masriana Purba 54 P.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
 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
ASARAN IBU HAMIL

TTD
(Tablet Jika YA,
Tanggal LILA (cm) Kehamilan Tambah brp butir
TANGGAL LAHIR BB (Kg) TB (Cm)
pengukuran ke darah) TTD
1=YA, didapat
2=Tidak

31-12-1985
4/4/2017 65 156 26,5 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 24,5 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 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 24.5 4 1 10
31-12-1993 4/4/2017 46 154 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
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 24,7 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
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 26.6 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
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 24.5 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 23,8 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