No anak_ tgl_lahir jenis_kelamin nomor_KK NIK nama_anak berat_lahir tinggi kia imd nama_ortu

ke

1 2 2014-09-03 P
320225 3202254309140000 SILLA
3.2 48 1 1 ABIDIN / ASRI YANTI

2 1 2014-09-14 P
320225 3202254410140001 NANDA NADILA 2.9 47 1 1 HENDRA / NURLELAH

3 1 2014-10-05 L
320225 3202250510140000 RAKA GIO 3.0 48 1 1 DERI / FERI

4 2 2014-11-25 L
320225 3202252511140001 REZA 3.5 50 1 1 YAYAN / MASITOH

5 1 2014-12-20 P
320225 3202256012140000 ALIFA 2.9 47 1 2 HUSEN / NIA

6 2 2015-02-27 P
320225 3202256702150000 SITI ADISTA 3.1 48 1 1 ADI / TITA

7 1 2015-05-05 L
320225 3202250505150000 ABDILAH 3.2 48 1 1 IYUS / SITI P

8 1 2015-06-01 P
320225 3202254106150000 ANINDITA 3.3 49 1 1 SAFTARI / SITI S

9 1 2015-08-03 L
320225 3202250308150000 PUTRA P 2.8 49 1 1 DEDI / PARIDA

10 4 2015-09-02 L
3202250905120030 3202250209150000 ALPARIZI 3.0 49 1 1 UNENG / YUNINGSIH

11 2 2015-09-02 L
320225 3202250209150001 YASA 2.2 47 1 2 NANAG / TINI

12 3 2015-10-13 P
320225 3202255310150000 TIARA 2.7 48 1 1 UGAN / ROBIAH

13 1 2015-10-22 L
320225 3202252210150000 M AZWAN 3.1 49 1 1 IYUS / AAT

14 1 2015-12-15 L
320225 3202251512150000 M RAFA AZKA 3.2 49 1 1 AMUL / NURLATIFAH

15 3 2016-02-13 P
320225 3202252412090001 SYAKILA 3.3 50 1 1 SAMSUDIN / AL YENI

16 1 2016-02-14 L
320225 3202251402160000 ALGI 3.3 48 1 1 RUDI / LIA

17 3 2016-05-08 L
3202253103110009 3202250805160001 RAMA 3.0 50 1 1 IJANG / YANTI

18 3 2016-05-20 L
320225 3202252005160000 REZA 3.6 50 1 1 DIAN / SRI

19 1 2016-07-03 L
320225 3202250307160000 AZMI 3.8 48 1 1 ANDI / LINA

20 1 2016-07-28 P
320225 3202256807160000 SALPA N 3.1 49 1 1 ISRON / TENI

21 3 2016-08-03 P
3202252706120004 3202254308160001 SULISTIA 3.3 49 1 1 TOTONG / LISNA

22 2 2016-09-22 P
320225 3202256209160000 NENG HANA 4.0 50 1 1 EVA / YUNUS
23 2 2017-02-12 P
320225 3202255202170000 FAZRUL 3.1 48 1 1 AGUS / BELA

24 2 2017-02-17 L
320225 3202251702170001 ADEN MALIK 2.0 46 1 2 AGUS / RENI

25 1 2017-02-28 L
320225 3202252802170000 M ARFA 3.2 49 1 1 NAWAMI / SANTI

26 1 2017-03-13 L
320225 3202251303170000 BISMA 3.2 48 1 1 RAMLAN / DEWI

27 2 2017-03-20 L
3202251405100008 3202252003170003 SANWATUL HIKMAL 3.1 48 1 1 HERI / RANI

28 1 2017-03-24 P
320225 3202256403170000 AFNI NURHABIBAH 3.3 49 1 2 DIKDIK / LENI

29 2 2017-04-20 L
3202252102180008 3202252004170002 HAMIN 3.4 49 1 1 IJAM / YENI

30 3 2017-05-26 L
3202251503130001 3202252605170000 M AKBAR 3.3 50 1 1 ABIDIN / ASRI YANTI

31 2 2017-08-25 P
320225 3202256508170000 AISAH 3.4 50 1 1 HENDRA / NURLAELA

32 1 2017-11-01 P
320225 3202254111170000 TABI 3.1 49 1 1 AJI / LASTRI

33 1 2017-11-14 P
320225 3202255411170000 MAYANG 4.0 50 1 1 KARNAWAN / LATIPAH

34 3 2018-02-02 P
3202250808073751 3202254202180000 DINA 2.8 47 1 2 ABUDIN / SUKAENAH

35 3 2018-02-18 L
3202252706120004 3202251802180000 ARYA WIJAYA 3.0 48 1 1 BAENURI / YENI

36 3 2018-03-26 L
320225 3202252603180000 M SIDIK 2.9 48 1 1 CECEP / WATI

37 2 2018-06-04 P
3202251811100009 3202254406180001 SITI ZAHRA 3.0 49 1 1 DADANG / LILIS

38 2 2018-10-25 P 320225 3202256510180000 LIVINA 3.1 49 1 1 ACEP / LILIS

39 3 2018-10-23 L 3202251310100009 3202252310180000 ALBIAN 3.2 49 1 1 HENDA / RENI

40 3 2018-12-26 P 3202250104110001 3202256602180002 SIPA 3.6 50 1 1 SUEB / ITI

41 2 2018-11-27 P 320225 3202256711180000 KEILA MAULIDA 3.3 49 1 2 DODI / SUANTI

42 1 2018-06-24 L 320225 3202252406180000 M.AIPIN 3.5 50 1 1 DINDIN / YURIS

43 1 2018-10-04 L 3202250410180001 3202252812180002 YUSUP 2.9 48 1 1 UNANG / ENUR

44 2 2018-10-17 L 320225 3202251710180000 PAIZ 2.9 47 1 1 AMUY / LATIF

45 3 2019-04-12 L 320225 3202251204190001 M.ATTHAN 3.0 48 1 1 ENDAM / LILIS

46 1 2018-02-13 P 320225 3202255302180001 ANISA 3.8 50 1 1 RAHMAT / ENA

47 2 2019-03-12 P 3202252009100009 3202255203190000 ADRIANA 3.2 49 1 1 KOMAR / NENG NURAENI

48 3 2018-09-10 P 3202250410110006 3202255009180000 ANISA 3.1 49 1 1 JAEN / LELA

49 3 2018-01-20 L 320225 3202252001180000 RAMA 3.0 48 1 1 MULYANA / MAYA

50 1 2015-01-06 P 3202251305100001 3202254106150004 ALIVA 3.0 48 1 1 SEPTAJI / SAMSIAH

51 1 2019-04-13 L 320225 3202251304190000 RAKA 2.9 48 1 1 DEDE / IRMA

52 2 2018-04-01 L 3202252303100022 3202250104180000 M.AKHALIFA 3.0 48 1 1 SUHERMAN / HERNI

66

67

68

69
 nik_ortu hp_ortu alamat rt rw BB TB

320225 085692347563 CIBIHBUL 04 04

320225 085692347563 CIBIHBUL 04 04

320225 085692347563 PAMOYANAN 01 04

320225 085692347563 CIBIHBUL 04 04

320225 085692347563 PAMOYANAN 01 04

320225 085692347563 PAMOYANAN 02 04

320225 085692347563 PAMOYANAN 01 04

320225 085692347563 CIBIHBUL 04 04

320225 085692347563 PAMOYANAN 01 04

320225020172005 085692347563 PAMOYANAN 01 04

320225 085692347563 PAMOYANAN 02 04

320225 085692347563 PAMOYANAN 01 04

320225 085692347563 PAMOYANAN 02 04

320225 085692347563 PAMOYANAN 01 04

3202250707710006 085692347563 PAMOYANAN 02 04

320225 085692347563 PAMOYANAN 01 04

3202250606720006 085692347563 CIBIHBUL 04 04

320225 085692347563 PAMOYANAN 01 04

320225 085692347563 CIBIHBUL 04 04

320225 085692347563 PAMOYANAN 01 04

3202250303690002 085692347563 PAMOYANAN 01 04

320225 085692347563 PAMOYANAN 02 04

320225 085692347563 PAMOYANAN 01 04

320225 085692347563 CIBIHBUL 04 04

320225 085692347563 PAMOYANAN 01 04

320225 085692347563 PAMOYANAN 02 04

3202255405840002 085692347563 PAMOYANAN 02 04

320225 085692347563 PAMOYANAN 01 04

3202250306620003 085692347563 PAMOYANAN 01 04

3202255212870002 085692347563 CIBIHBUL 04 04

320225 085692347563 PAMOYANAN 01 04

320225 085692347563 PAMOYANAN 02 04

320225 085692347563 PAMOYANAN 01 04

3202250505740001 085692347563 PAMOYANAN 01 04

3202250107710032 085692347563 PAMOYANAN 01 04

320225 085692347563 CIBIHBUL 04 04

3202251707700006 085692347563 PAMOYANAN 01 04

320225 085692347563 PAMOYANAN 01 04

3202250910790001 085692347563 PAMOYANAN 01 04

3202251011770002 085692347563 PAMOYANAN 01 04

320225 085692347563 PAMOYANAN 01 04

320225 085692347563 PAMOYANAN 02 04

3202251003930004 085692347563 PAMOYANAN 01 04

320225 085692347563 PAMOYANAN 01 04

320225 085692347563 CIBIHBUL 04 04

320225 085692347563 CIBIHBUL 04 04

3202256002740002 085692347563 PAMOYANAN 02 04

320225 085692347563 PAMOYANAN 01 04

320225 085692347563 PAMOYANAN 01 04

3202250202820006 085692347563 PAMOYANAN 01 04

320225 085692347563 PAMOYANAN 01 04

320225 085692347563 CIBIHBUL 04 04

 DATA SASARAN IBU HAMIL

Provinsi : Nama Desa :

Kabupaten/Kota : Bulan :
Puskesmas : Tahun :
Desa/Kelurahan :

Berat
KEHA Badan Kepemili TANGGAL
TANGGAL BB
No. MILA NO KK NIK NAMA awal kian Nama Suami NIK SUAMI ALAMAT RT RW PENGUKUR (Kg)
N KE- LAHIR AN
hamil/Tri Buku KIA
mester 1

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
 27
28
29
30
31
32
33
34
Keterangan
- Kolom 9 : Jika suami tidak ada , isikan nama orang tua
- Kolom 10 : Jika suami tidak ada , isikan NIK orang tua
 TTD (Tablet
Tambah Jika Ya Jika Ya
TB LILA Darah) berapa berapa
(cm) (cm) butir TTD butir TTD
1=Ya di dapat di minum
2= Tidak
16 17 18 19 20