DATA SASARAN BALITA

Provinsi : JAWA TIMUR

Kabupaten/Kota : JEMBER
Puskesmas : SABRANG

NIK (Nomor Induk TANGGAL JENIS Berat Badan No Tlp/HP Orang Tanggal BB TB Cara Ukur ASI Eksklusif IMD
No Kependudukan) ANAK KE NAMA ANAK LAHIR KELAMIN Lahir (Kg) Nama Orang Tua NIK Orang Tua Tua ALAMAT RT RW pengukuran (Kg) (Cm) 1=Telentang 1=YA, 1=YA,
2=Berdiri 2=Tidak 2=Tidak

3509121404720007
1 2 RISA F 07/05/2012 P 3100 3509124510850012 O85320260382 KRAJAN NI 55 1 12 4/4/2017 16.2 107 2 1 1
3509124705120001 FAUZI KHOTIM

2 1 CAESAR 18/06/2012 L 3300 MASRUL KRAJAN NI 55 1 12 4/4/2017 14.6 104 2 1 1

INDAYATUN

3 2 DINDA S 08/06/2012 P 3000 KHOTIB 3509120101860017 KRAJAN NI 55 2 12 4/4/2017 13.2 100 2 1 1

LILIK 3509124203870007

4 1 AZKA M 28/09/2012 L 3100 LIBAS 3509120101860017 KRAJAN NI 55 3 12 4/4/2017 13.1 101 2 1 1

QORIAH 3509124203870007

5 1 KELVIN 06/10/2012 L 3500 SUGIARTO 3509121001860004 KRAJAN NI 55 3 12 4/4/2017 15.1 100 2 2 1

YUNI 3509124410800005

6 1 VICKY A 13/10/2012 L 3200 BAGUS KRAJAN NI 55 2 12 4/4/2017 15.7 101 2 1 1

FATIN 3509122905810005

7 1 RAHMA 28/10/2012 P 2900 UDIN 3509120801780001 KRAJAN NI 55 3 12 4/4/2017 15.2 107 2 1 1

ELA 3509124403750004

8 1 AZRIL 15/12/2012 L 4200 ANDIS 35091224019100003 KRAJAN NI 55 3 12 4/4/2017 15.2 100 2 1 1

YENI 35091263039200003

9 1 QENANTIA 20/12/2012 P 2700 IMAM KRAJAN NI 55 3 12 4/4/2017 14.5 105 2 1 1

PUTRI 3509120704850008

10 1 ZIDAN A 05/01/2013 L 2700 MAKHRUS 3509121908710002 KRAJAN NI 55 2 12 4/4/2017 13.3 101 2 1 1

ROSIDAH 3509124505820011

11 2 AGAM F 06/06/2013 L 3400 HILMI KRAJAN NI 55 1 12 4/4/2017 13.6 104 2 1 1

TUTIK

12 1 IBNU HAJAR 08/09/2013 L 2900 WAHYU KRAJAN NI 55 3 12 4/4/2017 13 102 2 1 1

LAILI

13 1 RATU YAUMI 19/10/2013 P 3300 LIUKMAN KRAJAN NI 55 2 12 4/4/2017 12.7 97 2 1 1

ANIS

14 2 SALMAN 14/01/2014 L 2800 FARIS KRAJAN NI 55 3 12 4/4/2017 13.7 90 2 1 1

MARATUS

15 1 LAILA A 01/04/2014 P 3100 WAWAN 3509120506770007 KRAJAN NI 55 2 12 4/4/2017 11.6 49 2 1 1

WAHYU 3509124702950002

16 3509122405140003 1 KEEFY R 24/05/2014 L 3600 ALI YUNUS 3509121607800002 KRAJAN NI 55 2 12 4/4/2017 14.4 97 2 1 1
UMI 3509125611860004

17 1 NAZRIEL 05/06/2014 L 2900 ADI KRAJAN NI 55 2 12 4/4/2017 10.6 90 2 1 1

FAIL

18 2 NIBRAS 20/06/2014 L 3500 SUDITO KRAJAN NI 55 1 12 4/4/2017 12.4 92 2 1 1

KHOTIK

19 2 ZAHWAN 04/08/2014 L 4100 KOLIS 3509120108740003 KRAJAN NI 55 2 12 4/4/2017 13.4 83 2 1 1

ROFIK 3509125301890002

20 1 ALYA F 05/09/2014 P 3500 DIANTORO KRAJAN NI 55 1 12 4/4/2017 13.5 83 2 1 1

ASIH
21 2 ILHAM 16/09/2014 L 3300 GIANTO KRAJAN NI 55 2 12 4/4/2017 11.4 84 2 1 1
WATI

22 2 INDI N 24/09/2014 P 2900 ROKIB KRAJAN NI 55 2 12 4/4/2017 10 87 2 1 1

MERY

23 2 AQILA 07/01/2015 P 3500 YASIN KRAJAN NI 55 2 12 4/4/2017 10.9 82 2 1 1

MARPUAH

24 3 SHAFA 12/01/2015 P 3500 SUMARI KRAJAN NI 55 3 12 4/4/2017 10.6 82 2 2 1

LESTARI

25 1 SAID H 11/03/2015 L 3800 LUKMAN KRAJAN NI 55 2 12 4/4/2017 10.9 80 2 1 1

HADI

26 2 NAFIAH 07/04/2015 P 2800 MUKSIN 3509120303700003 KRAJAN NI 55 2 12 4/4/2017 10 79 2 1 1

USWATUN 3509126207860003

27 2 HASYIM 07/04/2015 L 3800 AINUL 3509123011830003 KRAJAN NI 55 2 12 4/4/2017 10.6 89 2 1 1

ASRI 3509126406900004

28 3509124704150000 1 RISKY 07/04/2015 L 1800 SULAJI KRAJAN NI 55 1 12 4/4/2017 9.2 85 2 2 1

YULIA

29 4 PUTRA N 28/04/2015 L 2500 PARMAN KRAJAN NI 55 2 12 4/4/2017 9.6 82 2 1 1

PARTIAH

30 3509122904150001 2 AL KHALIFI 29/04/2015 L 3200 ALI YUNUS 3509121607800002 KRAJAN NI 55 2 12 4/4/2017 10.5 84 2 1 1
UMI 3509125611860004
N BALITA

Vitamin A Vitamin A Ada Buku

Februari Agustus KIA
1=YA, 1=YA, 1=ya
2=Tidak 2=Tidak 2=tidak

1 1 1

1 1 1

1 1 1

1 1 1

1 1 1

1 1 1

1 1 1

1 1 1

1 1 1

1 1 1

1 1 1

1 1 1

1 1 1

1 1 1

1 1 1

1 1 1

1 1 1

1 1 1

1 1 1

1 1 1
1 1 1

1 1 1

1 1 1

1 1 1

1 1 1

1 1 1

1 1 1

1 1 1

1 1 1

1 1 1
 DATA SASARAN IBU HAMIL

Provinsi : JAWA TIMUR

Kabupaten/Kota : JEMBER
Puskesmas : SABRANG

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

1 3509125111980002 NURUL LATIFAH 39 KRAJAN 1 10 11/11/98 21/03/2017 54 148 20 1 1 90

(NI 54)
KRAJAN
2 HALIMATUS SAKDIAH 52 1 10 27/9/1992 21/03/2017 61 155 26 1 1 90
(NI 54)
KRAJAN
3 3509125612810001 LUTFIATUL HASANAH 51 16/12/1981 21/03/2017 59,5 152 27 2 1 90
(NI 54)
KRAJAN
4 FENIK RAHMAWATI 67 (NI 54) 1 12 1/7/1986 21/02/2017 72 152 33 2 1 90

5 NUNING 50 KRAJAN 2 12 1/7/1994 21/03/2017 56 156 25 1 1 60

(NI 54)

6 LAILI 66 KRAJAN 2 9 1/7/1990 21/03/2017 64 160 27 1 1 30

(NI 54)
KRAJAN
7 ERNA ISTIANAH 56 2 12 10/10/1986 4/4/2017 68 152 20 2 1 60
( NI 55 )
KRAJAN
8 3509076009920001 ANI FARIDA 44,5 3 12 9/20/1992 4/4/2017 53 146 22 1 1 60
( NI 55 )
KRAJAN
9 3509125006870003 MAIMUNAH 73 2 12 6/10/1987 4/4/2017 74 159 30.5 2 1 60
( NI 55 )
KRAJAN
10 SITI HIDAYATUT 48,5 2 12 10/4/1997 4/4/2017 45 157 26 1 1 30
( NI 55 )
KRAJAN
11 3509125911900004 KUNTI MUSLIHATUT DEWI 54 1 12 11/19/1990 4/4/2017 53 157 26 1 1 30
( NI 55 )
KRAJAN
12 3509124409850003 TAMI WULANDARI 48 3 12 9/4/1985 4/4/2017 59 158 22 1 1 60
( NI 55 )
 KRAJAN
13 3509126607930004 LULUK SUDARWATI 43 2 12 7/26/1993 4/4/2017 44 158 21.5 1 1 60
( NI 55 )
KRAJAN
14 SITI FATIMAH 61 2 12 3/23/1990 3/6/2017 74 157 29 1 1 30
( NI 55 )
KRAJAN
15 6471054502790005 SUTIMAH 36 2 12 2/5/1979 4/4/2017 54 148 22.5 7 1 60
( NI 55 )