PENCATATAN DAN PELAPORAN PELAYANAN VAKSINASI BAGI PEJABAT PUBLIK (TNI,POLRI,KADES) DI KABUPATEN SUMBAWA

Puskesmas : TARANO
Tanggal : 11-11- 2021

KEPERSERTAAN BPJS
(TULIS "YA" PADA KOLOM DOSIS I
YANG SESUAI)
TANGGAL TANGGAL
NO NO. REGISTRASI NIK NAMA PENERIMA VAKSIN (SESUAI KTP) JENIS KELAMIN PEKERJAAN ALAMAT (SESUAI KTP) NO. HP MEREK VAKSIN
LAHIR BPJS NON SCREENING
TGL PEMBERIAN
BPJS PBI NON ANGGO NO. BATCH
PBI TA VAKSINASI

1 5204250107780017 SYARIFUDIN M

2 5204255204780002 NUR HASNI

3 5204252202990001 AHMAD AKBAR

4 5204250707990003 TEDI ALEKSANDER

5 5204251010010002 SAIFULLAH

6 5204251507670002 SAMSUDDIN ABEK 15-07-1967

7 5204252709940001 SUNARDI

8 5204255005970004 NIA SARITA

9 5204250102920001 IRWAN SAPUTRA

10 5204251106780001 JUKARNAEN 11/6/1978

11 5204251708600002 ARSYAD IBI

12 5204253006910001 AFRIYADI

13 5204252101040002 ALFIN SAHRIN

14 5204253112510001 AMBA

15 5204255507620003 AMINAH

16 5204255012670001 HANISA

17 5204255110980001 KURNIA

18 5206042508950001 TEGUH PRIBADI

19 5204250605760001 MEDI ISMAIL

20 5204251607930002 ABDUL KHALID

21 5206184107931064 ROSITA

22 5204254107600042 MA'ANI

23 5205080107870110 ABDURAHMAN

24 5206020107831291 BAHARUDIN

25 5206024906880003 NURHAIDAH

26 5204250107840019 AGUS BAMBANG

27 5204250701930012 HERIBEN

28 5204251010850002 DARWIS
29 5205076104950003 NINI ANGGRIANINGSIH

30 5205014506950007 IIS MARIATI

31 5204254602930001 EKAWATI

32 5204256108990001 NINING SUSILAWATI

33 5204254209980001 FITA DARNIAYANTI

35 5204255208970001 JERINAWATI

36 5204254101750001 SRIANTI

37 5204255803920001 HARTATI

38 5204250107760014 MASTUR

39 5204255701900001 YENI SARTIKA

40 5204254107640014 PUTRI

41 5204251305680002 HASAN

42 5205055202920006 NURSAH

43 5204254108940001 DIAN PISESA

44 5204254101750001 SRIANTI

45 5204254107820009 ICA

46 5204253103880001 SISWOSULFAN

47 5204251506930002 JUBAIR

48 5205057112800022 ASNI ARYANA

49 5204251208650001 NASRUDDIN

50 5204255212700002 ROHANI

51 5204250207950002 SALIMUDDIN

52 5206024107681317 RUKAYAH

53 5204256207020001 DINI YULISTARI

54 5204256606980001 IDA JULIANI

55 5204252705970001 M BAHRAN

56 5204252705970001 M BAHRAN

57 5204184107810022 RABAIA

58 5203083112870596 SUANDI

59 5204257112830004 RIKAWATI

60 5204254712730003 SAHARIA

61 5204252108900002 KAMARUDDIN

62
65 5204140503960001 M SAMSUL
66 5204256404950001 AKMAL WATI
67 5204256112830003 ST HASNAH
68 5204251307910001 ISWANDI
69 5204257007970001 NITA CAHYA JULIANTI
70 5204254107780012 HARNI
71 5204255407030001 YULIANA
72 5204255709980001 RISNAWATI

73 5204253112650002 ABDUL HAMID

74 5204254304010002 KURNIAWATI

75 5204254607030001 OPIK TAMALASIA

76 5204144709950001 FANI ANGGRAINI

77 5204255206950001 ERNAWATI

78 5204256408930001 DEWI SARTIKA

79 5205020501950002 JUSMASYAH

80 5204255305780002 RIHUL JANNAH

81 5204254107620011 MASTURA

82 5204250404930001 MUHRIM NURIYADIN

83 5204251908860002 PAELORI

84 5204250506820002 JUMADIL AWAL

85 5204256503850001 SANIASAH
 DOSIS 2
KETERANGAN (DITUNDA/TIDAK
DIBERIKAN/LANJUT), JELASKAN ALASAN BILA
TANGGAL DITUNDA/TIDAK DIBERIKAN
PEMBERIAN NO BATCH
VAKSINASI
VAKSIN I
 POLISI
52040825 SYAMSUD WAKAPOL
1 S-D53D1E603640002 DIN L 25-03-1964 SEK RT 002/RW 8.24E+10

POLRI
BABINKA
52030803 SAMSUL MTIBMAS
2 S-8515D9B05870016 LUTFI L 3/5/1987 TOLO'OI RT003/RW08.52E+10

POLRI
JUVITAR BABINKA
52050205 DWI MTIBMAS
3 N-766202011930002 RIZKY L 5/11/1993 MATA RT 001/RW 8.52E+10

POLRI
BABINKA
MTIBMAS
52041414 BAMBAN LAB.
4 S-41F36E7 12840001 G HRP L 14-12-1984 JAMBU RT 002/RW 8.22E+10

POLRI
BABINKA
MTIBMAS
52041422 BANTULA
5 S-095D7F208820001 NURJA'AN L 22-08-1982 NTEH DUSUN KA 8.23E+10

POLRI
BABINKA
MTIBMAS
LAB.
52061830 NASUTIO BONTON
6 S-3E9C9CE 12800002 N L 30-12-1980 G DUSUN TIU 8.22E+10

ABU POLRI
52010116 BAKAR BABINKA
08781000 KUSMAN MTIBMAS
7 P-63IQIK2T1 TO L 16-0801978 LAB. AJI BTN REYAN 8.13E+10

TNI
BABINSA
LAB.
52050327 BONTON
8 S-1A5C3C111840002 BIS'UD L 27-11-1984 G DUSUN LEP 8.22E+10

TNI
35160801 SYAMSUD BABINSA
9  P-63RN1HD3
10790005 DIN L 1/10/1979 MATA DESA NAN 8.23E+10

TNI
91010108 HERIYANT BABINSA
10 P-63LFLWA06840005 O L 8/6/1984 LAB. AJI DUSUN RAS8.23E+10
 POLRI
52061203 EDI BABINKA
05961000 IWANSYA MTIBMAS
11 S-6F0C47E 4 H L 3/5/1996 BANDA DUSUN SE 8.53E+10

TNI
52720331 BABINSA
12 S-3005A3F 12740036 JUNAID L 31-12-1974 PIDANG ASRAMA K 8.52E+10

TNI
BABINSA
52041805 MOCHAM BANTULA
13 P-63UBGF605770001 AD ANIF L 5/5/1977 NTEH DUSUN KA 8.53E+10
52041419 PNS
14 S-4AA4A6304710001 AHMADIN L 19-04-1971 GURU DUSUN TAL8.22E+10

ABDUL TNI
33730316 MOENTAL BABINSA
15 S-5DF615809820002 IF L 16-09-1982 TOLO'OI DUSUN KA 8.14E+10

M. POLRI
SULHAN BABINKA
52041222 YUSNI MTIBMAS
16 P-645YWE 06850004 UMAR L 22-06-1985 PIDANG LEMPEH 8.12E+10
52042531 PNS
17 S-A1ADF5912710003 MURSYID L 31-12-1971 GURU DUSUN TAR8.24E+10

PNS
52040520 BUDI KEPALA
18 S-6D6DD6 05770002 SUSILO L 20-05-1977 SEKOLAH DUSUN TEL 8.53E+10

52042524 IYAR NAKES

19 P-63DVSY812910001 SISWANDI L 24-12-1991 PERAWAT DUSUN KE 8.14E+10
52042531 PNS
20 S-4A014ED12630016 MUHDAR L 31-12-1963 GURU DUSUN PAR8.53E+10

52042556 WINDA NAKES

21 P-67WM5 10940001 NURDINA P 16-10-1994 BIDAN DUSUN PID 8.53E+10 √
52041405 PNS
22 S-F1A751C03650001 A. KHALID L 5/3/1965 SEKCAM DUSUN KER8.53E+10

KEPALA
52042501 SUKIRMA DESA
23 P-64PJNL2 07820012 N L 7/1/1982 MATA DUSUN MA 8.53E+10

KADES
LAB.
52042520 BRAMAW BONTON
24 P-655C6FH04880001 AN DHANI L 20-04-1988 G DUSUN PAR8.52E+10 √
 KEPALA
52042503 SYARIFUD DESA
25 P-65BQQSJ09820001 DIN L 3/9/1982 PIDANG DUSUN PID 8.23E+10

KEPALA
52042502 JOHANSY DESA
26 P-658QQI305770001 AH L 2/5/1977 TOLO'OI DUSUN BAT8.53E+10 √

KEPALA
DESA
52042516 ABDUL BANTULA
27 S-A9E548508660001 GANI B L 15-06-1965 NTEH DUSUN BA 8.53E+10 √

35251449 dr. IZZATI

01910002 CHOIRIYA NAKES
28 P-48F4138 2 H L 9/1/1991 DOKTER DUSUN SUN8.12E+10

KEPALA
52042503 MUSYKIL DESA LAB.
29 P-63Z9DBK03830002 HARTSHA L 3/3/1983 JAMBU DUSUN JAM8.12E+09

TNI
33082016 RUDI BABINSA
04820000 HARTON LAB.
30 P-64YS41T 4 O L 16-04-1982 JAMBU DUSUN SIP 8.52E+10

KEPALA DUSUN
52042502 DESA LAB. AMPU
31 P-65FDJM 03770005 SUPARDI L 2/3/1977 AJI LAB. AJI 8.23E+10

MOHAMA
52041402 D PNS
32 S-51E3D8304700002 NASUKHA L 2/4/1970 GURU DUSUN KER8.52E+10
52041427 M. CAMAT
33 S-8E4685C 03650001 TAHKIQ L 27-03-1965 TARANO DUSUN KER8.53E+10

KEPALA
52042507 DESA
34 P-65I7H1D03760001 JUMRIADI L 7/3/1976 BANDA DUSUN BA 8.13E+10

11710422 dr. SAIFUL NAKES

35 N-AE0DBE311810001 AKBAR L 22-11-1981 DOKTER DUSUN KER8.14E+10
52042570 HELMIAN NAKES
36 N-5FD467B03880001 A P 30-03-1988 BIDAN DUSUN GEN8.12E+10

PETUGAS
52050701 DANDI KEBERSIH
37 P-65LUCAF07980263 IRAWAN L 1/7/1998 AN PKM DUSUN JAM8.52E+10
 M. ADMIN
52041319 ISMULLA KEUANGA
38 P-665XQQ 05960002 H L 19-05-1996 N DUSUN MU8.53E+10
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BERIKAN VAKSIN KARENA CKD

TETAPI DI PCARE SUDAH DIBERIKAN

BERIKAN VAKSIN KARENA RIW PPOK