FORMAT PENCATATAN PELAKSANA

TINGKAT PUSKESMAS/FASYANKES

Nama Puskesmas/Fasy: Puskesmas Kecamatan Tanah Abang

Kabupaten/Kota : Jakarta Pusat
Provinsi : DKI Jakarta
Hari/Tanggal : selasa, 23 Maret 2021

No No. Registrasi NIK Nama Penerima Vaksin

1 W-19B73799 3276056810810009 HERARYANIE PHANDAN PALUPI

2 W-8C35FA78 3603285106900008 SITI HANIFAH

3 W-C4D9B25C 1506052908900001 TOMBANG JHON PRIYADI TAMPUBOLON

4 W-D8A055E7 3603116907940002 SANTIKA KUS HERAWATI

5 W-40D27FF2 1277015207900009 ANGELA KRISTIANA INTAN

6 W-9DEF8211 3171071501740007 AGUS MARDIANSYAH
7 W-B54F9532 3171071803990002 DIKA NUR FAIZI
8 W-BDD273BC 3674030502830007 IDHAM
9 W-600F761D 3211051708940001 AGUS LESA LESMANA
10 W-18D19468 3171076710840003 EKO NUR AZIZAH
11 W-4F2B245E 3171071209860014 SUGIARTO
12 W-9ACDC00D 3674044806840004 RAHMA YULIA RIZKA
13 W-747E8600 3171036808890003 DEWI GUSTI WATI
14 W-270C38CF 3501036607930002 AGUSTIN DWI SUKMAWATI
15 W-1C675297 3276060208780003 HENDRA
16 W-49E18D79 3173034711790003 NOVITA INGRIANI
17 W-103F379D 3174105207820021 LANA MILOVA
18 MANUAL 3174095902780002 NENA TRISIA WIDIYANTI

19 MANUAL 1806096709890001 LESI YANI

20 MANUAL 1205134607950001 ELSA JULIANA PRATIWI

21 MANUAL 3171076701940002 SASKIA KARENINA LATIF

22 MANUAL 3172017007951002 STEPHANIE ELYSIA

23 W-88BD5F13 3603285106900008 SITI HANIFAH

24 MANUAL 3172044309800013 SYARAH SEVI WIHARNI

25 MANUAL 3174085701770000 ELLYASTA NURYASARI

26 MANUAL 3174035504810005 IKA PRATIWI

27 MANUAL 3276035906950005 FIXIHILLA WINEZIA

28 MANUAL 1608024305900002 IRINA FITRIANI

29 MANUAL 1207267105900003 NURUL MASHITA

30 MANUAL 3174082510980003 MUHAMMAD FAHRIZAL

31 MANUAL 3174085106900005 HASTI DWI SETIATI

32 N-AB797810 3171076112780008 SRI MULYATI

33 W-A9D8A3D8 3603116907940002 SANTIKA KUS HERAWATI

34 W-4CFEA8F1 1277015207900009 ANGELA KRISTIANA INTAN

35 W-C1BF5690 3171071501740007 AGUS MARDIANSYAH
36 W-560FD508 3171071803990002 DIKA NUR FAIZI
37 W-2F2FC2B0 3674030502830007 IDHAM
38 W-7EAD27DD 3276056810810009 HERARYANIE PHANDAN PALUPI
39 W-F16416FC 3501036607930002 AGUSTIN DWI SUKMAWATI
40 W-E1E61832 3171071209860014 SUGIARTO
41 W-506E9373 3211051708940001 AGUS LESA LESMANA

42 MANUAL 7371016612870002 KHAERANI

43 MANUAL 3173080301940006 WILLIAM JEAN PAUL HARRY S

44 MANUAL 3173080211900006 FREDERICK SOLICHIN

45 MANUAL 3171065108730006 ERAWITA ENDY M

46 MANUAL 3312212007000003 DIMAS RISKI FIRDAUS

47 MANUAL 1307055903970001 YOSEFA ESTRI RATNA TIAS

48 MANUAL 3276046006830009 SHINTA YUNITA

49 MANUAL 3205411111960001 UJANG AJAT SUDRAJAT

50 MANUAL 3276057003980007 ADYURI MARISKA

51 MANUAL 3275016405960013 MEILIN DEBORA CLAWDIA

52 MANUAL 3275045805900011 SARI MARISA

53 MANUAL 3523196912950004 FARIDAH FAHANA

54 W-B7E83EA1 3276060208780003 HENDRA
55 MANUAL 7173016011970001 NOVELA THERESA
56 MANUAL 7109015903010000 EUGENE ANTEINETTE LAHEBA
57 MANUAL 3172064604670000 KARANAWATI
58 MANUAL 3172065105650000 SRIWATI
59 MANUAL 3305190511870001 JEFFRY KURNIADI ADIDHARMA
60 MANUAL 3173024211870001 AMELIA BERTONI
 61 MANUAL 3216086511950006 HAWARI ROSDIANA MAHMUDAH
62 MANUAL 6212016003910001 LILIK HANDAYANI
63 MANUAL 3171065903740002 ASIH SUPARNI
64 MANUAL 3216066402960005 ANANDA SHESA RIGITA
65 MANUAL 1651025904910001 STEVANI REZA SAPUTRI
66 MANUAL 3327034904010005 NADIYATUL ATIKA
67 MANUAL 3312126811910002 HERU PRASETYANINGSIH
68 MANUAL 3174050909720009 MURSID
69 MANUAL 3175102110950002 SATRIO CAHYADI
70 MANUAL 3275090412710005 ABDUL RACHMAN
71 MANUAL 1608036605950001 MELISA INDAH
72 MANUAL 3172020408750022 ALVIN NATHANIEL LASANUDIN
73 MANUAL 3171086703780003 CITA MARLINA
74 MANUAL 3171064103840001 ZARRABIDA IBNUSIRAD
75 MANUAL 3275096607970008 DEWANTI HAPSARI
76 MANUAL 1371020109950006 HALVIS EL YUSER
77 MANUAL 3276036711960002 KEZIA ANNISA ANINDYA PUTRI
78 MANUAL 3171074908010002 NUKE AGNA FARAHDILLA
79 MANUAL 3174045510991001 MAYUVIA BRENDA SEKAR REZKI
80 MANUAL 1674026706970002 JUNIARTA CHRISTINA SITORUS
81 MANUAL 3174056602720001 JULIA TANDJUNG
82 MANUAL 3173051601850004 ANDRY YOSHUA
83 MANUAL 3201130807950005 AHMAD FAUZI
84 MANUAL 3271037112960011 LISTIA PRATIWI
85 MANUAL 3206121502970001 ERWAN HERMAWAN
86 MANUAL 1702176905970003 MAGDALENA NAIBAHO
87 MANUAL 3275044212890013 DESI WIDYAWATI
88 MANUAL T21285234 CHIE YAGI
89 MANUAL 3276062004650004 SUNGKONO
90 MANUAL 3175104605960003 PANI MAILINA
91 MANUAL 3171061304960001 ZAHRAN A. PATAH
92 MANUAL 3216051803740005 RUDI HARTONO
94 MANUAL 3175016507900001 INDRIA RESTI TRIARTI
95 MANUAL 6302116803950002 SASMITA DWI DAYANTI
96 MANUAL 3325126804990001 LAILI NAILIL FARIH
97 MANUAL 3173064503010008 AIDA FAJRIYAH
98 MANUAL 3172035510770012 OLCE BALUKH
99 MANUAL 3275045910930006 PUJANI LAKSMITASARI
100 MANUAL 3174080901700003 RUHIMAN
101 MANUAL 3276040604890003 AHMAD KHOLANI
102 MANUAL 3175101104800013 BUDI
103 MANUAL 7315064110900004 GUSMAYA GANI
104 MANUAL 3520185807880001 RENI SISKASARI
105 MANUAL 3175066412850017 EVA ROSALIN
106 MANUAL 3174011207800010 RACHMAT SOLEH
107 MANUAL 3302024312970003 DETI WINDASARI
108 MANUAL 3276015407740013 HARYANI
109 MANUAL 3171082608850001 SUGIARTO
110 MANUAL 3172016511970006 DILLA AMALIA LARASATI
111 MANUAL 3173046704810008 ARUM ARTININGSIH
112 MANUAL 3201040607890005 ADHITYA CAHYO FAJAR
113 MANUAL 3302275502860002 AYU NINGRUM
114 MANUAL 5731021508920003 ROY ANDERSON FELAKI
115 MANUAL 3175074201820012 MARIA RESKI PERTAMAWATI
116 MANUAL 3175084501950004 RANITA ALVIANI
117 MANUAL 3175076710770011 CICILIA ROSELIN PRAJANTI
118 MANUAL 3328062705710011 SAKHRODI
119 MANUAL 3173066712951001 MUTHIARA HANDINI
121 MANUAL 3275031007900022 IRFAN JULISTIAN
122 MANUAL 3216026203830003 LINAH
123 MANUAL 3175034708910011 MONICA FELICIA
124 MANUAL 3171017005730002 ENI
125 MANUAL 3501011609800005 EDI SUPRIYANTO
126 MANUAL 3202110107870025 RIKRIK MUDRIKAH
127 MANUAL 317203501177000 FARIDAWATI
128 MANUAL 3328012206930005 SISWONDO
129 MANUAL 3329031710840008 ISMAIL
130 MANUAL 3171070712820004 DESMOND RAY PANGAU
131 MANUAL 3276071408700003 MUHAMAD YUSUF
132 MANUAL 3173056712670002 NURCHOLIZAH D
133 MANUAL 3175026912690004 TIARA ARTIKASIH
134 MANUAL 3174092001930009 RIZILI
135 MANUAL 3174015211990008 SARDA SASKIA
136 MANUAL 317107465970004 NUR FAJRIANTI
137 W-5A0B376C 3671056102830008 LILI MELINA

138 W-9080F166 3171076710840003 EKO NUR AZIZAH

139 MANUAL 3328065110930003 RISKI OKTA ORPIANA
140 MANUAL 3175073110740013 ERIC OCTAVIANUS L. TOBING
141 MANUAL 3174052105031001 SEBASTIAN GEMA PERDANA
142 MANUAL 2C21JE2971AR PIETER VAN DE MHEEN
143 MANUAL 327602474800014 ROIDA F. SIMONANGKIR
144 MANUAL 3203122706990003 ERWIN SUHERMAN
145 MANUAL 3671124711940002 HEVY AMALIA NOVIYANTI
146 MANUAL 3275082505910015 RIFKI ALIFIANTO
147 MANUAL 3205411209950001 CECENG RIZAL ANSORI
148 MANUAL 3201174310720002 FATIMAH HAYATI
149 MANUAL 3173066207910008 MONICA YULIANA
150 MANUAL 3216066006930004 NIDZMAH ADZKYATU NIDZOM
151 MANUAL 3175025206780006 AGNES AMELIA YOUWANDA
152 MANUAL 3172025310950006 DEBBY YASINTA OCTAVIA
153 MANUAL 3174025208740004 SOFIAH A.T LONTOH
154 MANUAL 3175072906010012 BRYAN REGIS HORATIUS
155 W-E14347C0 3174105207820021 LANA MILOVA
156 W-272F698B 3173034711790003 NOVITA INGRIANI
157 W-22EABBEF 3173026105930002 RAGIL MAY RINTAN
158 N-1268F963 3174024305810002 FITRI INDRIANI
159 P-1J47OAGM 3174056511780008 VALENTINA TIARASY S
160 N-CFD6FF5D 3171076701940002 SASKIA KARENINA LATIF
161 W-E3FFC516 3674065502780001 RUSIATUN
162 P-1KOZP9RG 3173075009880003 LILIES MARYANA
163 P-1KO460WE 3275101201640015 ABDUL RACHMAN
164 P-1KZLL312 3172020308961001 MAULANA ABDUL AZIS
165 N-48A931BC 3174021205930001 MUHAMMAD RIZKI FADILAH
166 N-2BF87E66 3174011509940003 AHMAD RIZQI NURRIDWAN
167 P-1M4LTAF0 3173057105810001 BERLIANA THERESIA
168 P-1LC8YCCZ 3174095902780002 NENA TRISIA WIDIYANTI
169 P-1IW0LLSR 1205134607950001 ELSA JULIANA PRATIWI BR MALAU
170 P-1LJTAV78 1806096709890001 LESIYANI
171 P-1LQAZ4WV 3172001700795100 STEPHANIE ELYSIA
172 P-1OKS2LRK 3174051910800018 MOCHAMAD ADRIANSYAH

173 P-22CNBIOT 3172044309800013 SYARAH SEVI WIHARNI

174 P-1YCSW8O7 3174085701770000 ELLYASTA NURYASARI

175 P-1YJU2WCJ 3174035504810005 IKA PRATIWI

176 P-1YGYPPXD 3276035906950005 FIXIHILLA WINEZIA

177 P-1YJ3VT35 1608024305900002 IRINA FITRIANI

178 P-1YICPSMJ 3174082510980003 MUHAMMAD FAHRIZAL

179 N-680E1DFB 3171044403880004 PUTRI INDRATI K.
180 N-E65AFD30 3173085005670005 DR.ROSMIYATI

181 N-ECA24BDB 3174085106900005 HASTI DWI SETIATI

182 N-AB797810 3171076112780008 SRI MULYATI
183 W-747E8600 3171036808890003 DEWI GUSTI WATI
184 W-EC95086A 3174105609810007 RETI SEPTIANI
185 W-D9F0B3AB 3174056009760001 MONIKA PRASARI

186 N-2069ABBF 3171065108730006 ERAWITA ENDY M

187 P-24UJJFVT 7371016612870002 KHAERANI

188 P-24T56PJH 3173080301940006 WILLIAM JEAN PAUL HARRY S

189 P-2GIKKQFN 3173080211900006 FREDERICK SOLICHIN

190 P-688AA29B 3312212007000003 DIMAS RISKI FIRDAUS

191 P-B027A93D 1307055903970001 YOSEFA ESTRI RATNA TIAS

192 P-F8EA3FA0 3276046006830009 SHINTA YUNITA

193 P-2JIQBXAX 3205411111960001 UJANG AJAT SUDRAJAT

194 P-2JLFO7QW 3276057003980007 ADYURI MARISKA

195 P-1B962861 3275016405960013 MEILIN DEBORA CLAWDIA

196 P-2B80WTNY 3275045805900011 SARI MARISA

197 P-2JL604FP 3523196912950004 FARIDAH FAHANA

198 P-2JEZJ6U8 3276014404930003 EVA PERTIWI
199 Q-F1B47D18 3172065105650001 SRIWATI
200 P-5E8C625F 3172064604670000 KARANAWATI
201 MANUAL T21285234 CHIE YAGI
202 P-9DC831BE 3275044212890013 DESI WIDYAWATI
203 W-D98DA0DE 3305190511870001 JEFFRY KURNIADI ADIDHARMA
204 W-8A97438B 3173024211870001 AMELIA BERTONI
205 P-0F9AA66D 3174056602720001 JULIA TANDJUNG
206 P-7A2600C3 3216066402960005 ANANDA SHESA RIGITA
207 Q-D8A62B89 3206121502970001 ERWAN HERMAWAN
208 P-254UXR64 3327034904010005 NADIYATUL ATIKA
209 P-24WJRBSJ 3216086511950006 HAWARI ROSDIANA MAHMUDAH
210 P-251AT5Q7 7109015903010000 EUGENE ANTEINETTE LAHEBA
211 P-22A2KLY9 3312126811910002 HERU PRASETYANINGSIH
212 P-258RAGQ4 3171065903740002 ASIH SUPARNI
213 P-24H7WL0K 3174050909720009 MURSID
214 P-24I0QKGT 3175102110950002 SATRIO CAHYADI
215 P-24JGE7HR 3275090412710005 ABDUL RACHMAN

Kelompok Umur:
18-30 104
31-45 76
46-59 35
Total 215
Pekerjaan:
A 215
B 0
C 0
D 0
E 0
Total 0
AN PELAKSANAAN VAKSINASI COVID-19

AS/FASYANKES

Jenis
Kelami
n Pekerjaan*

Umur Umur Umur

(18-30 (31-45 (45-59
tahun) tahun) tahun) Alamat
P A 39 JL. TUNGKAL I NO.110
P A 30 JL. ROTAN I NO. 15
PerumPermata regency Blok A
No. 25 rt/rw 058/00Kel. Kenali
Besar Kec. Alam Barajo Kota
L A 28 Jambi

P A 26 SUKATANI PERMAI BLK.B-5/ 19

MEDITERANIA G R 2 TWR. K-28-
P A 30 KJ
L A 45 KARET PS BARU BARAT
L A 21 O
L A 37 KP. PONDOK PETUNG
L A 27 JLN INERBANG NO 11
P A 37 -
L A 34 -
P A 34 -
P A 32 -
P A 27 JL. TALAS II
L A 42 -
P A 41 -
P A 38 -
 Jl. Timbul III No. 14A RT/RW.
008/004 Kel. Cipedak Kec.
P A 43 Jagakarsa Jakarta Selatan
Bali matraman RT/RW. 003/009
Kel. Manggarai Kec. Tebet Jakarta
P A 31 Selatan
Jl. Pal Batu 1 No.10 Menteng
P A 19 Dalam, Tebet Jakarta Selatan
JL. BEND, WALAHAR 36 RT
05/06 BENDUNGAN HILIR
P A 26 TANAH ABANG
JL PLUIT TIMUR RAYA NO 8
006/005 PLUIT PENJARINGAN
P A 25 Jakarta Utara
P A 30 JL. ROTAN I NO. 15

JL. GADING GRIYA LESTARI

P A 40 BLOK H1/44 RT 001/009 JAK-UT
JL. PERTANI NO.3 RT.005
RW.003 KEL. DUREN TIGA KEC.
P A 44 PANCORAN
JL. PONDOK KARYA BLOK F/IC
RT.005 RW.004 KEL. PELA
MAMPANG KEC. MAMPANG
P A 40 PRAPATAN

KP. KEBON RT.001 RW.007 KEL.

P A 26 CINANGKA KEC. SAWANGAN
SUMBER AGUNG RT.005
RW.003 KEL. SUMBER AGUNG
P A 31 KEC. BUAY MADANG
JL. KAYU MAS UTARA NO.29
RT.011 RW.003 KEL.
PULOGADUNG KEC.
P A 31 PULOGADUNG
JL. PERTANI GG.1/42B RT.007
RW.003 KEL. DUREN TIGA KEC.
L A 23 PANCORAN

JL. H. MUHI RAYA NO.25 RT.003

RW.004 KEL. PONDOK PINANG
P A 30 KEC. KEB.LAMA
P A 42 -

P A 26 SUKATANI PERMAI BLK.B-5/ 19

MEDITERANIA G R 2 TWR. K-28-
P A 30 KJ
L A 45 KARET PS BARU BARAT
L A 21 O
L A 37 KP. PONDOK PETUNG
P A 39 JL. TUNGKAL I NO.110
P A 27 JL. TALAS II
L A 34 -
L A 27 JLN INERBANG NO 11
JL. PAL BATU III NO. 37 RT
P A 33 012/07
JL. KEMBANG HARUM VII RT
L C 26 14/22
JL. KEMBANG HARUM VII RT
L C 30 14/22
APT, MITRA OASIS TA 1407 JL.
SENEN RAYA NO. 135 -137
P A 47 SENEN JAK PUS
JL. H ALWI NO. 40 TANNJUNG
BARAT . JAGAKARSA JAKARTA
L D 20 SELATAN
JL. OPHIR 1 NO 35 RT 09//01
GUNUNG, KEBAYORAN BARU
P A 23 JAKARTA SELATAN
JL PONDOK JAYA 1 NO, 41 RT
006/001 KEL PELA MAMPANG
KEC. MAMPANG PRAPATAN
P D 37 JAK-SEL
WISMA KARET, JL JENDRAL
L D 24 SUDIRMAN BOLOK 3-4

JL. MERDEKA KP MELATI NO. 3

P C 22 RT 05/30 MEKARV JAYA DEPOK
JL. P TERNATE IV NO. 356 RT
007/017 PERUMNAS III KOTA
P C 24 BEKASI

JLN. KOMPLEK SEKNEG BLOK

P D 30 B7 NO. 11 PINANG TANGERANG
JL. KH SYAHDAN JL. KELUARG
P D 25 NO. 32
L A 42 PKL KARET TENGSIN
P A 23 KYOAI
P A 23 KYOAI
P A 53 KYOAI
P A 55 KYOAI
L A 33 KYOAI
P A 33 KYOAI
P A 25 KYOAI
P A 29 KLINIK ZAP
P A 46 KLINIK ZAP
P A 24 KLINIK ZAP
P A 29 KLINIK ZAP
P A 20 KLINIK ZAP
P A 29 KLINIK EASTWEST
L A 48 KLINIK SSMS
L A 25 KLINIK SSMS
L A 49 KLINIK SSMS
P A 25 KLINIK SSMS
L A 45 KLINIK SSMS
P A 42 KLINIK SSMS
P A 36 KLINIK SSMS
P A 23 KLINIK SSMS
L A 25 KLINIK SSMS
P A 24 KLINIK MHDC
P A 20 KLINIK MHDC
P A 21 KLINIK MHDC
P A 23 KYOAI
P A 48 KYOAI
L A 35 KYOAI
L A 25 KYOAI
P A 24 KYOAI
L A 23 KYOAI
P A 23 KYOAI
P A 31 KYOAI
P A 48 KYOAI
L A 55 KYOAI
P A 24 KYOAI
L A 24 KYOAI
L A 46 KYOAI
P A 30 KLINIK MHDC
P A 25 KLINIK MHDC
P A 21 TAKENOKO
P A 19 TAKENOKO
P A 43 TAKENOKO
P A 27 TAKENOKO
L A 50 TAKENOKO
L A 31 TAKENOKO
L A 40 TAKENOKO
P A 30 TAKENOKO
P A 32 TAKENOKO
P A 35 TAKENOKO
L A 40 KLINIK SAHID
P A 23 KLINIK SAHID
P A 46 KLINIK SAHID
L A 35 KLINIK SAHID
P A 23 KLINIK SAHID
P A 39 MP DENTAL
L A 31 MP DENTAL
P A 34 MP DENTAL
L A 28 MP DENTAL
P A 38 MP DENTAL
P A 25 MP DENTAL
P A 43 MP DENTAL
L A 49 MP DENTAL
P A 25 MP DENTAL
L A 30 TAKENOKO
P A 37 TAKENOKO
P A 29 TAKENOKO
P A 47 TAKENOKO
L A 40 TAKENOKO
P A 32 TAKENOKO
P A 43 TAKENOKO
L A 27 TAKENOKO
L A 36 TAKENOKO
L A 38 KLINIK SSMS
L A 50 KLINIK SAHID
P A 53 KLINIK SAHID
P A 51 KLINIK SAHID
L A 28 KLINIK SAHID
P A 21 KLINIK SAHID
P A 23 KLINIK SAHID
P A -

P A PUSKESMAS KARET TENGSIN

P A 27 MP DENTAL
L A 46 MP DENTAL
L A 18 MP DENTAL
L A 54 MP DENTAL
P A 40 MP DENTAL
L A 21 MP DENTAL
P A 26 MP DENTAL
L A 29 KYOAI
L A 25 KYOAI
P A 48 MP DENTAL
P A 29 MP DENTAL
P A 27 KYOAI
P A 42 KYOAI
P A 25 KYOAI
P A 46 KLINIK SUISSE
L A 19 KLINIK SUISSE
P A 38 -
P A 41 -
L A 27 -
P A 39 -
P A 42 -
P A 26 -
P A 43 -
P A 33 -
L A 57 -
L A 24 -
L A 27 -
L A 25 -
P A 39 -
P A 42 -
P A 25 -
P A 32 -
P A 25 -
L A 40 -

JL. GADING GRIYA LESTARI

P A 40 BLOK H1/44 RT 001/009 JAK-UT
JL. PERTANI NO.3 RT.005
RW.003 KEL. DUREN TIGA KEC.
P A 44 PANCORAN
JL. PONDOK KARYA BLOK F/IC
RT.005 RW.004 KEL. PELA
MAMPANG KEC. MAMPANG
P A 40 PRAPATAN

KP. KEBON RT.001 RW.007 KEL.

P A 26 CINANGKA KEC. SAWANGAN
SUMBER AGUNG RT.005
RW.003 KEL. SUMBER AGUNG
P A 31 KEC. BUAY MADANG
JL. PERTANI GG.1/42B RT.007
RW.003 KEL. DUREN TIGA KEC.
L A 23 PANCORAN
P A 32 JL. PASEBAN NO. 55
P A 54 JL. GILI SAMPENG NO. 10A

JL. H. MUHI RAYA NO.25 RT.003

RW.004 KEL. PONDOK PINANG
P A 30 KEC. KEB.LAMA
 P A 42 -
P A 32 -
P A 39 MP DENTAL
P A 44 MP DENTAL
APT, MITRA OASIS TA 1407 JL.
SENEN RAYA NO. 135 -137
P A 47 SENEN JAK PUS
JL. PAL BATU III NO. 37 RT
P A 33 012/07
JL. KEMBANG HARUM VII RT
L A 26 14/22
JL. KEMBANG HARUM VII RT
L A 30 14/22
JL. H ALWI NO. 40 TANNJUNG
BARAT . JAGAKARSA JAKARTA
L A 20 SELATAN
JL. OPHIR 1 NO 35 RT 09//01
GUNUNG, KEBAYORAN BARU
P A 23 JAKARTA SELATAN
JL PONDOK JAYA 1 NO, 41 RT
006/001 KEL PELA MAMPANG
KEC. MAMPANG PRAPATAN
P A 37 JAK-SEL
WISMA KARET, JL JENDRAL
L A 24 SUDIRMAN BOLOK 3-4

JL. MERDEKA KP MELATI NO. 3

P A 22 RT 05/30 MEKARV JAYA DEPOK
JL. P TERNATE IV NO. 356 RT
007/017 PERUMNAS III KOTA
P A 24 BEKASI

JLN. KOMPLEK SEKNEG BLOK

P A 30 B7 NO. 11 PINANG TANGERANG
JL. KH SYAHDAN JL. KELUARG
P A 25 NO. 32
P A 27 PKL KARET TENGSIN
P A 55 KYOAI
P A 53 KYOAI
P A 48 KYOAI
P A 31 KYOAI
L A 33 KYOAI
P A 33 KYOAI
P A 48 KYOAI
P A 24 KLINIK ZAP
L A 23 KYOAI
P A 20 KLINIK ZAP
P A 25 KYOAI
P A 23 KYOAI
P A 29 KLINIK EASTWEST
P A 46 KLINIK ZAP
L A 48 KLINIK SSMS
L A 25 KLINIK SSMS
L A 49 KLINIK SSMS

Keterangan
* Pekerjaan dikelompokkan menjadi:
A = Petugas Medis dan Non Medis di Fasilitas Pelayanan Kesehatan
B = Petugas pelayanan publik yang berhadapan langsung dengan masyarakat
C = Administrator Pemerintahan
D = Lainnya
E = Tidak Bekerja

Kepesertaan BPJS
BPJS PBI 0
BPJS Non PBI 0
Non Anggota 0
Total 0
Pemberian Dosis
Dosis 1 82
Dosis 2 133
Total 215 Pekerjaan
A
B
C
D
E
Total
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
sesuai) Dosis I

BPJS Non Merek Tanggal

BPJS Non Anggot Vaksin* Tanggal Pemberian
No. Hp PBI PBI a ** Screening Vaksinasi
83899736983 0 0 0 A 23/3/2021 23/3/2021
8568292267 0 0 0 A 23/3/2021 23/3/2021

81271233198 0 0 0 A 23/3/2021 23/3/2021

82297773799 0 0 0 A 23/3/2021 23/3/2021

81933219030 0 0 0 A 23/3/2021 23/3/2021

81319974841 0 0 0 A 23/3/2021 23/3/2021
89686976856 0 0 0 A 23/3/2021 23/3/2021
81289915299 0 0 0 A 23/3/2021 23/3/2021
8989448530 0 0 0 A 23/3/2021 23/3/2021
81384676842 0 0 0 A 23/3/2021 23/3/2021
82111364606 0 0 0 A 23/3/2021 23/3/2021
85222443349 0 0 0 A 23/3/2021 23/3/2021
83878770808 0 0 0 A 23/3/2021 23/3/2021
81326607783 0 0 0 A 23/3/2021 23/3/2021
85782658590 0 0 0 A 23/3/2021 23/3/2021
81382343041 0 0 0 A 23/3/2021 23/3/2021
81210200138 0 0 0 A 23/3/2021 23/3/2021
81298925946 0 0 0 A 23/3/2021 23/3/2021

85710764828 0 0 0 A 23/3/2021 23/3/2021

82362235578 0 0 0 A 23/3/2021 23/3/2021

85722997711 0 0 0 A 23/3/2021 23/3/2021

85716362757 0 0 0 A 23/3/2021 23/3/2021

8568292267 0 0 0 A 23/3/2021 0

82299071202 0 0 0 A 23/3/2021 23/3/2021

81259176656 0 0 0 A 23/3/2021 23/3/2021

82125802590 0 0 0 A 23/3/2021 23/3/2021

87780468823 0 0 0 A 23/3/2021 23/3/2021

82176144718 0 0 0 A 23/3/2021 23/3/2021

85156320583 0 0 0 A 23/3/2021 23/3/2021

85591385493 0 0 0 A 23/3/2021 23/3/2021

0 0 0 A 23/3/2021 23/3/2021
85151864681 0 0 0 A 23/3/2021 23/3/2021

82297773799 0 0 0 A 23/3/2021 0

81933219030 0 0 0 A 23/3/2021 0
81319974841 0 0 0 A 23/3/2021 0
89686976856 0 0 0 A 23/3/2021 0
81289915299 0 0 0 A 23/3/2021 0
83899736983 0 0 0 A 23/3/2021 0
81326607783 0 0 0 A 23/3/2021 0
82111364606 0 0 0 A 23/3/2021 0
8989448530 0 0 0 A 23/3/2021 0

85716362757 0 0 0 A 23/3/2021 23/3/2021

0 0 0 A 23/3/2021 23/3/2021

0 0 0 A 23/3/2021 23/3/2021

0 0 0 A 23/3/2021 23/3/2021

85711568859 0 0 0 A 23/3/2021 23/3/2021

82384401761 0 0 0 A 23/3/2021 23/3/2021

81806071570 0 0 0 A 23/3/2021 23/3/2021

8987765033 0 0 0 A 23/3/2021 23/3/2021

85715330073 0 0 0 A 23/3/2021 23/3/2021

8111499624 0 0 0 A 23/3/2021 23/3/2021

812818020106 0 0 0 A 23/3/2021 23/3/2021

81358562564 0 0 0 A 23/3/2021 23/3/2021

85782658590 0 0 0 A 23/3/2021 0
82394917227 0 0 0 A 23/3/2021 23/3/2021
82189017009 0 0 0 A 23/3/2021 23/3/2021
8161616273 0 0 0 A 23/3/2021 23/3/2021
8161157222 0 0 0 A 23/3/2021 23/3/2021
89653117575 0 0 0 A 23/3/2021 23/3/2021
81382126161 0 0 0 A 23/3/2021 23/3/2021
81390246628 0 0 0 A 23/3/2021 23/3/2021
81310080509 0 0 0 A 23/3/2021 23/3/2021
81290524675 0 0 0 A 23/3/2021 23/3/2021
89637675595 0 0 0 A 23/3/2021 23/3/2021
81340404440 0 0 0 A 23/3/2021 23/3/2021
83843041894 0 0 0 A 23/3/2021 23/3/2021
87883436003 0 0 0 A 23/3/2021 23/3/2021
85747727580 0 0 0 A 23/3/2021 23/3/2021
83808077066 0 0 0 A 23/3/2021 23/3/2021
8129191343 0 0 0 A 23/3/2021 23/3/2021
82281344441 0 0 0 A 23/3/2021 23/3/2021
811807247 0 0 0 A 23/3/2021 23/3/2021
85883965460 0 0 0 A 23/3/2021 23/3/2021
8161901521 0 0 0 A 23/3/2021 23/3/2021
81382644187 0 0 0 A 23/3/2021 23/3/2021
85218005254 0 0 0 A 23/3/2021 23/3/2021
85719045525 0 0 0 A 23/3/2021 23/3/2021
895610405326 0 0 0 A 23/3/2021 23/3/2021
82110981014 0 0 0 A 23/3/2021 23/3/2021
82178501303 0 0 0 A 23/3/2021 23/3/2021
85811321048 0 0 0 A 23/3/2021 23/3/2021
81381236138 0 0 0 A 23/3/2021 23/3/2021
82125621092 0 0 0 A 23/3/2021 23/3/2021
82124251772 0 0 0 A 23/3/2021 23/3/2021
81298629254 0 0 0 A 23/3/2021 23/3/2021
895621021757 0 0 0 A 23/3/2021 23/3/2021
89604522095 0 0 0 A 23/3/2021 23/3/2021
81286229419 0 0 0 A 23/3/2021 23/3/2021
8159988661 0 0 0 A 23/3/2021 23/3/2021
82114621115 0 0 0 A 23/3/2021 23/3/2021
8118458833 0 0 0 A 23/3/2021 23/3/2021
81284706112 0 0 0 A 23/3/2021 23/3/2021
8111250790 0 0 0 A 23/3/2021 23/3/2021
81331593162 0 0 0 A 23/3/2021 23/3/2021
85225298287 0 0 0 A 23/3/2021 23/3/2021
85210883660 0 0 0 A 23/3/2021 23/3/2021
81280302839 0 0 0 A 23/3/2021 23/3/2021
87785160796 0 0 0 A 23/3/2021 23/3/2021
87889344244 0 0 0 A 23/3/2021 23/3/2021
87878662411 0 0 0 A 23/3/2021 23/3/2021
85217070850 0 0 0 A 23/3/2021 23/3/2021
85282614040 0 0 0 A 23/3/2021 23/3/2021
85691772908 0 0 0 A 23/3/2021 23/3/2021
85224203985 0 0 0 A 23/3/2021 23/3/2021
81295991810 0 0 0 A 23/3/2021 23/3/2021
87883599425 0 0 0 A 23/3/2021 23/3/2021
85280147773 0 0 0 A 23/3/2021 23/3/2021
89521048077 0 0 0 A 23/3/2021 23/3/2021
85780101041 0 0 0 A 23/3/2021 23/3/2021
81282444489 0 0 0 A 23/3/2021 23/3/2021
81290879507 0 0 0 A 23/3/2021 23/3/2021
81285960931 0 0 0 A 23/3/2021 23/3/2021
82247162892 0 0 0 A 23/3/2021 23/3/2021
81328039628 0 0 0 A 23/3/2021 23/3/2021
81280159003 0 0 0 A 23/3/2021 23/3/2021
81519004956 0 0 0 A 23/3/2021 23/3/2021
81287336295 0 0 0 A 23/3/2021 23/3/2021
81290005627 0 0 0 A 23/3/2021 23/3/2021
81286144253 0 0 0 A 23/3/2021 23/3/2021
8982688491 0 0 0 A 23/3/2021 23/3/2021
81213497978 0 0 0 A 23/3/2021 23/3/2021
83822205566 0 0 0 A 23/3/2021 23/3/2021
818838874444 0 0 0 A 23/3/2021 23/3/2021
8562078939 0 0 0 A 23/3/2021 23/3/2021
87883123520 0 0 0 A 23/3/2021 23/3/2021
82322070406 0 0 0 A 23/3/2021 23/3/2021
85711179712 0 0 0 A 23/3/2021 23/3/2021
8121044664 0 0 0 A 23/3/2021 23/3/2021
81999700750 0 0 0 A 23/3/2021 23/3/2021
81514438253 0 0 0 A 23/3/2021 23/3/2021
81316727504 0 0 0 A 23/3/2021 23/3/2021
83874563266 0 0 0 A 23/3/2021 23/3/2021
89643232289 0 0 0 A 23/3/2021 23/3/2021
87877008845 0 0 0 A 23/3/2021 23/3/2021
87782222780 0 0 0 A 23/3/2021 23/3/2021

81384676842 0 0 0 A 23/3/2021 0
81900653404 0 0 0 A 23/3/2021 23/3/2021
811923274 0 0 0 A 23/3/2021 23/3/2021
8118899626 0 0 0 A 23/3/2021 23/3/2021
8161303531 0 0 0 A 23/3/2021 23/3/2021
82113992529 0 0 0 A 23/3/2021 23/3/2021
81546788961 0 0 0 A 23/3/2021 23/3/2021
85720152185 0 0 0 A 23/3/2021 23/3/2021
89624296123 0 0 0 A 23/3/2021 23/3/2021
89601814158 0 0 0 A 23/3/2021 23/3/2021
81293486643 0 0 0 A 23/3/2021 23/3/2021
81291866254 0 0 0 A 23/3/2021 23/3/2021
8997984033 0 0 0 A 23/3/2021 23/3/2021
81285928511 0 0 0 A 23/3/2021 23/3/2021
85156891067 0 0 0 A 23/3/2021 23/3/2021
81807801737 0 0 0 A 23/3/2021 0
818150500 0 0 0 A 23/3/2021 10-02-2021
81210200138 0 0 0 A 23/3/2021 0
81382343041 0 0 0 A 23/3/2021 0
81380291394 0 0 0 A 23/3/2021 10-02-2021
816722774 0 0 0 A 23/3/2021 10-02-2021
81296489283 0 0 0 A 23/3/2021 11-02-2021
85722997711 0 0 0 A 23/3/2021
895610354285 0 0 0 A 23/3/2021 11-02-2021
8569801001 0 0 0 A 23/3/2021
85216657747 0 0 0 A 23/3/2021 23/3/2021
87780993224 0 0 0 A 23/3/2021 23/3/2021
82112283330 0 0 0 A 23/3/2021 23/3/2021
82122828910 0 0 0 A 23/3/2021 23/3/2021
81314327670 0 0 0 A 23/3/2021 23/3/2021
81298925946 0 0 0 A 23/3/2021
82362235578 0 0 0 A 23/3/2021
85710764828 0 0 0 A 23/3/2021
811980930 0 0 0 A 23/3/2021
81933219030 0 0 0 A 23/3/2021 24/3/2021

82299071202 0 0 0 A 23/3/2021 0

81259176656 0 0 0 A 23/3/2021 0

82125802590 0 0 0 A 23/3/2021 0

87780468823 0 0 0 A 23/3/2021 0

82176144718 0 0 0 A 23/3/2021 0

85591385493 0 0 0 A 23/3/2021 0
81285195534 0 0 0 A 23/3/2021 23/3/2021
82260504545 0 0 0 A 23/3/2021 23/3/2021

81510621572 0 0 0 A 23/3/2021 0
85151864681 0 0 0 A 23/3/2021 0
83878770808 0 0 0 A 23/3/2021 0
81321528264 0 0 0 A 23/3/2021 0
8161303531 0 0 0 A 23/3/2021 0

8158848544 0 0 0 A 23/3/2021 0

85716362757 0 0 0 A 23/3/2021 0

85945845001 0 0 0 A 23/3/2021 0

8121009600 0 0 0 A 23/3/2021 0

85711568859 0 0 0 A 23/3/2021 0

82384401761 0 0 0 A 23/3/2021 0

81806071570 0 0 0 A 23/3/2021 0

8987765033 0 0 0 A 23/3/2021 0

85715330073 0 0 0 A 23/3/2021 0

8111499624 0 0 0 A 23/3/2021 0

812818020106 0 0 0 A 23/3/2021 0

81358562564 0 0 0 A 23/3/2021 0
85778750048 0 YA 0 A 23/3/2021 23/3/2021
8161157222 0 0 0 A 23/3/2021 0
8161616273 0 0 0 A 23/3/2021 0
81286229419 0 0 0 A 23/3/2021 0
89604522095 0 0 0 A 23/3/2021 0
89653117575 0 0 0 A 23/3/2021 0
81382126161 0 0 0 A 23/3/2021 0
85811321048 0 0 0 A 23/3/2021 0
89637675595 0 0 0 A 23/3/2021 0
81298629254 0 0 0 A 23/3/2021 0
 83843041894 0 0 0 A 23/3/2021 0
81390246628 0 0 0 A 23/3/2021 0
82189017009 0 0 0 A 23/3/2021 0
87883436003 0 0 0 A 23/3/2021 0
81290524675 0 0 0 A 23/3/2021 0
85747727580 0 0 0 A 23/3/2021 0
83808077066 0 0 0 A 23/3/2021 0
8129191343 0 0 0 A 23/3/2021 0

A = Sinovac
B = Lainnya (Mohon disebutkan jenis vaksin yang diterima Puskesmas/Faskes)

Pekerjaan
215
0
0
0
0
215
Dosis I Dosis 2 Keteran
gan

(Ditund
a/Tidak
Tanggal Diberik
Pemberian an/Lanj
No. Batch Vaksinasi No. Batch ut)
202009009 0 0 LANJUT
202009009 0 0 LANJUT

202009009 0 0 LANJUT

202009009 0 0 LANJUT

202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT

202009009 0 0 LANJUT

202009009 0 0 LANJUT

202009009 0 0 LANJUT

202009009 0 0 LANJUT
0 23/3/2021 202009009 SELESAI

202009009 0 0 LANJUT

202009009 0 0 LANJUT

202009009 0 0 LANJUT

202009009 0 0 LANJUT

202009009 0 0 LANJUT

202009009 0 0 LANJUT

202009009 0 0 LANJUT

202009009 0 0 LANJUT
202009009 0 0 LANJUT

0 23/3/2021 202009009 SELESAI

0 23/3/2021 202009009 SELESAI

 0 23/3/2021 202009009 SELESAI
0 23/3/2021 202009009 SELESAI
0 23/3/2021 202009009 SELESAI
0 23/3/2021 202009009 SELESAI
0 23/3/2021 202009009 SELESAI
0 23/3/2021 202009009 SELESAI
0 23/3/2021 202009009 SELESAI

202009009 0 0 LANJUT

202009009 0 0 LANJUT

202009009 0 0 LANJUT

202009009 0 0 LANJUT

202009009 0 0 LANJUT

202009009 0 0 LANJUT

202009009 0 0 LANJUT

202009009 0 0 LANJUT

202009009 0 0 LANJUT

202009009 0 0 LANJUT

202009009 0 0 LANJUT

202009009 0 0 LANJUT
0 23/3/2021 202009009 SELESAI
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT

0 23/3/2021 202009009 SELESAI

202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202009009 0 0 LANJUT
0 23/3/2021 202009009 SELESAI
202009009 0 0 LANJUT
0 23/3/2021 202009009 SELESAI
0 23/3/2021 202009009 SELESAI
202009009 0 0 LANJUT
202009009 0 0 LANJUT
202011047 0 0 LANJUT
23/3/2021 202011047 SELESAI
202009009 0 0 LANJUT
23/3/2021 202011047 SELESAI
202011047 0 0 LANJUT
202011047 0 0 LANJUT
202011047 0 0 LANJUT
202011047 0 0 LANJUT
202011047 0 0 LANJUT
23/3/2021 202011047 SELESAI
23/3/2021 202009009 SELESAI
23/3/2021 202011047 SELESAI
23/3/2021 202011047 SELESAI
202011047 0 0 LANJUT

0 23/3/2021 202011047 SELESAI

0 23/3/2021 202011047 SELESAI

0 23/3/2021 202011047 SELESAI

0 23/3/2021 202011047 SELESAI

0 23/3/2021 202011047 SELESAI

0 23/3/2021 202011047 SELESAI

202011047 0 0 LANJUT
202009009 0 0 LANJUT

0 23/3/2021 202011047 SELESAI

 0 23/3/2021 202011047 SELESAI
0 23/3/2021 202009009 SELESAI
0 23/3/2021 202011047 SELESAI
0 23/3/2021 202011047 SELESAI

0 23/3/2021 202011047 SELESAI

0 23/3/2021 202011047 SELESAI

0 23/3/2021 202011047 SELESAI

0 23/3/2021 202011047 SELESAI

0 23/3/2021 202011047 SELESAI

0 23/3/2021 202011047 SELESAI

0 23/3/2021 202011047 SELESAI

0 23/3/2021 202011047 SELESAI

0 23/3/2021 202011047 SELESAI

0 23/3/2021 202011047 SELESAI

0 23/3/2021 202011047 SELESAI

0 23/3/2021 202011047 SELESAI

202011047 0 0 LANJUT
0 23/3/2021 202011047 SELESAI
0 23/3/2021 202011047 SELESAI
0 23/3/2021 202011047 SELESAI
0 23/3/2021 202011047 SELESAI
0 23/3/2021 202011047 SELESAI
0 23/3/2021 202011047 SELESAI
0 23/3/2021 202011047 SELESAI
0 23/3/2021 202011047 SELESAI
0 23/3/2021 202011047 SELESAI
0 23/3/2021 202011047 SELESAI
0 23/3/2021 202011047 SELESAI
0 23/3/2021 202011047 SELESAI
0 23/3/2021 202011047 SELESAI
0 23/3/2021 202011047 SELESAI
0 23/3/2021 202011047 SELESAI
0 23/3/2021 202011047 SELESAI
0 23/3/2021 202011047 SELESAI