Nama Puskesmas/Fasyankes/Pos Kabupaten/Kota Provinsi

Nama Puskesmas/Fasyankes/Pos : UPT Puskesmas Sedan
Kabupaten/Kota : Rembang
Provinsi : Jawa tengah
Jenis
No No. Registrasi NIK Nama Penerima Vaksin
Kelamin
1 P-2QBH3T3N 331706309960004 MUHAMMAD ULIN N. L

2 P-J816EJMX 3317065506860009 AHLIS MUAZZAROH P
3 P-2MQBUISA 3317061004030001 AIN SYAHRIYAR L
4 S-4AS1D929 3317061708510001 KASTUR L
5 S-B14F8355 3317064903520002 NASRI P
6 P-A120PAN2 3317062311010006 ISLANUL IRFAN L
7 P-IUT4A30P 3317063001960001 JEVRI ZAHRUL AHYAN L
8 P-6H9JLEMH 3317064306800001 SUPARTI P
9 P-4575QIEA 3317062304010001 MOH.SYARIF HIDAYATULLAH L
10 P-82R0N210H 3317060810820003 ROHMAN L
11 P-IBAEMF92 3317061701820006 MAFTUHIN L
12 3317062707980001 ABDUL SALAM L
13 P-IHVBPXMB 3317062104030002 MOH.LUMA'UL MU'AN L
14 P-LLDEN4WY 3317060912930003 AHMAD AHFAS L
15 P-BBRY2VPG 3317064910020001 ARDELIA NAILA KAMILA P
16 P-ICC9M0CP 3317064203700003 MUNAFAH P
17 P-DJ9BPNYQ 3317062103030008 ABDILLAH L
18 P-ID25FUNF 3317066303760002 JUMIAH P
19 P-IKPGK21Y 3317062708870005 KHAMSIN L
20 P-ISTFWDYR 331703670500001 SITI ALFIYAH P
21 P-101CKRG6 3317067012830007 SITI MAMLULU'ATUN P
22 P-IBULDXH8 3301226712920001 FERI PURNAMASARI P
23 P-IAHW05FE 3317062908970001 M.HARIS SAFI'I L
24 P-COETSSKJ 3317060205810003 ABDUL HAKIM L
25 P-41E1A3MA 3317064602650004 WARTINI P
26 P-4277GMPE 3317062311000006 ULIL ULUM L
27 P-3QFCOYK7 3317060405970008 FALIH RIKZA L
28 P-9NABBQSF 3317061012850004 ABIDIN L
29 P-EVUXAYWVV 3317061005030001 MOCH.BIRUL WALIDI L
30 P-GUXIEUO00 3317064207780002 ISTIADAH P
31 P-IUIHE5G3 3317060505860004 M.CHOSIM L
32 P-ED1383KN 3317063112620008 SUNARI L
33 P-FARGTRAZ 3317060101850001 DAKHWAN L
34 P-EMIY2T85 3317061407710006 ABDUL ROHMAN L
35 3523044904890001 SITI ALFIAH P
36 P-IF47DSQC 3317066706990007 DEWI SRI UTAMI P
37 P-LPLD136M 3317060406800013 M.KHOIRUL ANAM L
38 P-10LD8SGA 3317065203660005 SULASTRI P
39 3317051105000003 AGUNG PRAYITNO L
40 P-INS5VWRO 3317061606800002 SUJATI L
41 P-IN6IDVCS 3317065811010003 LILIK HIDAYAH P
42 P-G1KFXXQ7 3317062009950001 KHOIRUL ANAM P
43 P-BWVNJNNI 3317065005970001 AINUSSIQOTIL GHOYAH P
44 P-B2MSG308 3317066411020001 THOIFATUL HASNA P
45 P-9BTIOCUI 3317060206000004 ABDUL KAFI L
46 P-8K67TUEN 3317064708950012 ATIYATUL ULYA P
47 P-7SZ4EN4N 3317062411770001 MASYHUDI L
48 P-IQIT4DEN 3317060908980003 TIA MUSTHOFA L
49 P-6DUSWYM 3317061504860006 SUMARNO L
50 P-4W0TFCHH 3317065110720003 RAMISIH P
51 P-DSWWAPAL 3317066003970002 ISTIANAH P
52 P-CWCQCVAB 3317063107750001 SAMAD L
53 P-J2FF57ZS 3317044102030003 SITI ANISAH P
54 P-ILVDELBL 3317062807990004 MUHAMMAD SIHABUDIN L
55 P-ILLRPV8V 3317065708650001 ISTICHOMAH,SH P
56 P-ILD2HJRN 3317060909650001 SUBKHAN,SH L
57 P-112XJ911 3317060510010004 AGUS IBNU IBAD L
58 P-IEJIATUY 3317054903840001 MAKHFUDOTUN P
59 P-IUYDGPTO 3317066104940001 FENI ERLINA NUR'AINI P
60 S-56C70274 3317066004830002 TASRINI P
61 S-0064C539 352344909890001 SITI ALFIAH P
62 3317061107780001 HARIYANTO L
63 P-IT1U1GXW 3524074903880001 TITRIN NUR ISA P
64 P-GEMKDOZG 3317061605990002 ABDUR ROHMAN L
65 S-07EDEEEA 3317064702950002 LESTARI NINGSIH P
66 P-IR9V68O4 3317062711820004 TASIRIN L
67 P-IQ2W24U3 3317062805960001 NUR RAHMAD AFFANDI L
68 P-ITFVRWLH 3317065812820001 ZAIMATUN NI'MAH P
69 P-IPWXWK4M 3317101408840001 SUGENG SURYADI L
70 P-IMBNBIT2 3317066803790005 SUNDASIH P
71 P-IKD4NOZZ 3317065803990001 MUNFARIDA P
72 P-IUMX38YV 3317075509990003 MIRANTI KUSUMA PUTRI P
73 P-IKON2XAS 3317061104840004 ABD ROHIM L
74 P-IJLJEQVVVV 3317062903790001 HARIS BUDI L
75 P-GJV9AEES 3317066310990001 NUR HIDAYAH P
76 P-IALUHO24 3317064408760004 MARIYATI P
77 P-FNCC9Q8U 3317062404910004 MIFTAHUL UMAM L
78 P-19940M01 3317065009630002 MUDRIKAH P
79 P-16B0JACY 3317065202800002 ZAIMMATUL MAUIDHOH P
80 P-14QUF9QU 3523044202790002 MUTMAINNAH P
81 P-HKIT7EWA 3317062603960005 MOCH SAFUAN L
82 P-DNBC75HH 3317061803020001 NAJIH ALAIKA ABDULLAH L
83 P-1888OJUXO 3317062808000005 MUHAMMAD ALFIYAN NUR L
84 P-17FJXMC2 3317060307030003 MUHAMMAD ALFIYAN L
85 P-15NDCND7 3317062104770005 ASKURI L
86 P-CQNCI524C 3317060110780004 JAMAL L
87 P-10T0BRPA 3317112505930001 TANI NUR AFANDI L
88 P-10CQUSFH 3317060108020001 CHABIBULLAH CANDRA ARIF L
89 P-IS0CFP31 3317062809030002 DONI RIU ARDA PRATAMA L
90 P-ITLGH4TX 3317062905930001 ANSORI L
91 P-ITS2KVHN 3317061806850001 SUPRIYATNO L
92 P-IQ9X1PCR 3317061305000002 AHMAD MAHRUS MUZAKKI L
93 P-DYJHCVLZ 3317061001690001 MAHFUDH L
94 P-5C7MZDBT 3317062201970002 MUHAMMAD FAWAID L
95 P-EIN2ZMDE 3317061211810003 TARYONO L
96 P-DDQQ0123 3317060904680004 SARTUM L
97 P-AG2RUTGP 9171054811800005 SITI MUSYAFA'AH P
98 P-6KCZFG1S 3317060712720005 AH.NURNGAINI L
99 P-3H02CFPL 3317062205780002 SRI CAHYONO L
100 P-20ACJDJX 3317061808990008 HILMI BADRUTTAMM L
101 3317060206000004 ABDUL KAFI L
102 33170606704980002 MUHAMAD NUR HASIM L
103 P-4XN2RAMV 9171051707880011 M.SAKNUN NIDLOM L
104 P-590RJ610 3522170109870002 SITI KHOSIDAH P
105 P-6A6E3KLZ 3317061302990003 MOH.AINUN NAJIB L
106 P-4RM9BSDU 3317131004840005 ROFIQ MUSA L
107 P-4KXQTNSJ 3317041202990001 MUHAMMAD LUTFI HAKIM L
108 J-00008TN2 3317061104990002 AZAM KHOIRO L
109 P-HVDP2C5T 3317062201930003 NUR ROHMAN L
110 P-HFY2FCIR 3317051105000003 AGUNG PRAYITNO L
111 P-H79UMF3U 3317064203700001 SAPUNGAH P
112 S-B96ADE73 3317061406590001 KUSNEN L
113 P-IRGLHCNT 3317066911000003 SRI ANA MULIYATI P
114 3317064610760001 ISMANAH P
115 P-5QHJN431 3317050706850002 SHOFWAN L
116 S-DO209FC3 3317065505570003 MASTIAH P
117 P-4N43ELHK 3317060604790001 WARDUKI L
118 P-53HYT60W 33170663112790003 UMAR L
119 P-5N3W3GOQ 3471145206760003 SUMIASIH P
120 P-5XAVUCJP 3317106102830003 ERLIN ACMIRAL P
121 3317065302960001 DURROTUL MUNTHORIFAH P
122 P-CXXXXHHF 3317065309960003 SOFI LAILATUL ANISAH P
123 3317062310710001 NUR FANDIL L
124 3312132708960001 AHMAT SHOLIKIN L
125 P-J3LSXDLM 3317065210910001 SITI KHOIFAH P
126 P-IUGBVR01 3317060112860003 BEJO SETIAWAN L
127 S-CD0F9B4D 3317062106600004 FATKUR L
128 S-D5773E59 3317063112590012 IRUN L
129 3317066006930001 KURNIA NIHAYA P
130 3317064304550006 BADIAH P
131 3317065009510002 RUSMINAH P
132 3317061404930002 ROFI'UL HUDA L
133 S-D42CAF48 3374101803520003 SUTRISNO L
134 P-IW7UIA7U 3317061207990001 MOHAMMAD NUR FATONI L
135 3317065205860013 RATNA NINGSIH P
136 3317074406940001 AHWATUN NI'MAH P
137 3317060101970001 ACHMAD ULIN NUHA L
* Pekerjaan dikelompokkan menjadi: A = Sinovac

A = Petugas Medis dan Non Medis di Fasilitas Pelayanan KB = Lainnya (Mohon disebutkan jenis vaksin yang diterima Puskesm
B = Petugas pelayanan publik yang berhadapan langsung dengan masyarakat
C = Administrator Pemerintahan
D = Lainnya
E = Tidak Bekerja
Kelompok Umur:
18-30 66
31-45 45
46-59 17
60> 9
Total 137
Pekerjaan:
A 0
B 0
C 0
D 0
E 0
Total 137
FORMAT PENCATATAN PELAKSANAAN VAK
TINGKAT PUSKESMAS/FASYANKES/POS VAK
Umur Kelompok
Pekerjaan* Alamat
(18-59 tahun) Umur
UMUM 24 18-30 SEDAN 01/04

UMUM 35 31-45 GANDRIROJO 02/05
UMUM 18 18-30 KARANGASEM 03/01
LANSIA 70 60> PACING 05/02
LANSIA 69 60> PACING 05/02
UMUM 19 18-30 SIDOREJO 04/01
UMUM 25 18-30 SEDAN 03/01
UMUM 41 31-45 KEDUNGRINGIN 01/01
UMUM 20 18-30 SEDAN 04/02
UMUM 38 31-45 DADAPAN 05/02
UMUM 18 18-30 SEDAN 04/01
PRALANSIA 51 46-59 SEDAN 03/03
UMUM 18 18-30 SAMBONG 03/01
UMUM 21 18-30 DEMAAN 02/01
UMUM 23 18-30 MENORO 04/04
LANSIA 56 46-59 MOJOSARI 03/04
UMUM 35 31-45 MOJOSARI 03/04
UMUM 43 31-45 SEDAN 02/01
UMUM 35 31-45 MENORO 03/05
PRALANSIA 58 46-59 DADAPAN 04/01
UMUM 31 31-45 SEDAN 03/02
PRALANSIA 55 46-59 SEDAN 03/03
UMUM 21 18-30 BANJAR KERTO 03/02
UMUM 41 31-45 BOGOREJO 03/02
UMUM 19 18-30 PACING 01/01
UMUM 25 18-30 SEDAN 01/03
UMUM 21 18-30 SEDAN 05/02
UMUM 26 18-30 SEDAN 05/02
PRALANSIA 54 46-59 MOJOSARI 01/03
UMUM 18 18-30 TENGGER 02/04
PRALANSIA 56 46-59 KARAS 01/02
PRALANSIA 55 46-59 KARAS 01/02
UMUM 19 18-30 SEDAN 04/03
UMUM 37 31-45 KENONGO 02/02
UMUM 31 31-45 SEDAN 03/02
UMUM 43 31-45 LEMAH PUTIH 03/02
UMUM 26 18-30 NGULAHAN 04/01
UMUM 25 18-30 KARAS 02/03
UMUM 37 31-45 PASAR BANGGI 01/03
UMUM 42 31-45 PACING 01/01
UMUM 22 18-30 GANDRIROJO
UMUM 21 18-30 BANGUNREJO 04/02
UMUM 37 31-45 SAMBIROTO 02/01
UMUM 45 31-45 KUMBO 03/02
PRALANSIA 57 46-59 BOGOREJO 01/01
UMUM 25 18-30 PULLAUWENG 02/05
UMUM 20 18-30 SEDAN 01/06
UMUM 44 31-45 MENORO 03/02
UMUM 28 18-30 SUMBEREJO 01/01
UMUM 19 18-30 SEDAN 02/04
PRALANSIA 53 46-59 MENORO 02/03
UMUM 41 31-45 HEDAM 04/09
UMUM 43 31-45 SEDAN 03/02
UMUM 22 18-30 CANDIMULYO 02/03
UMUM 21 18-30 SEDAN 05/02
UMUM 33 31-45 HEDAM 04/09
UMUM 33 31-45 HEDAM 04/09
UMUM 22 18-30 SALE 04/06
UMUM 22 18-30 SEDAN 01/04
UMUM 21 18-30 BANJARKERTO 03/02
LANSIA 62 60> MOJOSARI 04/01
UMUM 24 18-30 KARAS 01/05
UMUM 24 18-30 KARAS 01/01
PRALANSIA 61 60> BOGOREJO 01/01
PRALANSIA 61 60> DADAPAN 05/02
LANSIA 66 60> SEDAN 01/04
LANSIA 69 60> SAMBONG 03/02
LANSIA 69 60> TANDANG 07/04
aksin yang diterima Puskesmas/Faskes)
Kepesertaan BPJS Pekerjaan

BPJS PBI A
BPJS Non PBI B
Non Anggota C
Total D
Pemberian Dosis E
Dosis 1 137 Total
Dosis 2 0
Total 137
PELAKSANAAN VAKSINASI COVID-19
ASYANKES/POS VAKSINASI
Kepesertaan BPJS (tulis

'Ya' pada kolom yang
sesuai) Tanggal
No. Hp BPJS BPJS Non Merek Vaksin***
Screening
PBI Non PBI Anggota
089618564222 YA ASTRAZENICA 8/23/2021

082325312460 YA ASTRAZENICA 8/23/2021
082322347153 YA ASTRAZENICA 8/23/2021
082341966693 YA ASTRAZENICA 8/23/2021
082324196693 YA ASTRAZENICA 8/23/2021
088233843408 YA ASTRAZENICA 8/23/2021
082230986279 YA ASTRAZENICA 8/23/2021
081331789304 YA ASTRAZENICA 8/23/2021
081238658750 YA ASTRAZENICA 8/23/2021
082337716477 YA ASTRAZENICA 8/23/2021
08122222134 YA ASTRAZENICA 8/23/2021
085886291622 YA ASTRAZENICA 8/23/2021
087781093197 YA ASTRAZENICA 8/23/2021
08895366710 YA ASTRAZENICA 8/23/2021
082244370023 YA ASTRAZENICA 8/23/2021
089648121487 YA ASTRAZENICA 8/23/2021
081326564280 YA ASTRAZENICA 8/23/2021
082174585080 YA ASTRAZENICA 8/23/2021
0895392298709 YA ASTRAZENICA 8/23/2021
081228980579 YA ASTRAZENICA 8/23/2021
089530858539 YA ASTRAZENICA 8/23/2021
085649580006 YA ASTRAZENICA 8/23/2021
083162250725 YA ASTRAZENICA 8/23/2021
081225234067 YA ASTRAZENICA 8/23/2021
082323722587 YA ASTRAZENICA 8/23/2021
0895800144283 YA ASTRAZENICA 8/23/2021
089521386735 YA ASTRAZENICA 8/23/2021
085200118606 YA ASTRAZENICA 8/23/2021
081225550276 YA ASTRAZENICA 8/23/2021
085290822637 YA ASTRAZENICA 8/23/2021
082323512798 YA ASTRAZENICA 8/23/2021
081227471439 YA ASTRAZENICA 8/23/2021
082111498067 YA ASTRAZENICA 8/23/2021
081392141018 YA ASTRAZENICA 8/23/2021
YA ASTRAZENICA 8/23/2021
089508857800 YA ASTRAZENICA 8/23/2021
081319204747 YA ASTRAZENICA 8/23/2021
0895361223518 YA ASTRAZENICA 8/23/2021
083869779668 YA ASTRAZENICA 8/23/2021
081227551602 YA ASTRAZENICA 8/23/2021
083195004451 YA ASTRAZENICA 8/23/2021
085311441946 YA ASTRAZENICA 8/23/2021
085813354893 YA ASTRAZENICA 8/23/2021
081227858194 YA ASTRAZENICA 8/23/2021
082242154690 YA ASTRAZENICA 8/23/2021
081367077608 YA ASTRAZENICA 8/23/2021
082380571511 YA ASTRAZENICA 8/23/2021
085238696737 YA ASTRAZENICA 8/23/2021
081229707248 YA ASTRAZENICA 8/23/2021
08816428324 YA ASTRAZENICA 8/23/2021
085292765617 YA ASTRAZENICA 8/23/2021
081249773848 YA ASTRAZENICA 8/23/2021
089668778895 YA ASTRAZENICA 8/23/2021
085225514532 YA ASTRAZENICA 8/23/2021
085225514532 YA ASTRAZENICA 8/23/2021
083171176197 YA ASTRAZENICA 8/23/2021
085641271654 YA ASTRAZENICA 8/23/2021
085290982769 YA ASTRAZENICA 8/23/2021
088214881402 YA ASTRAZENICA 8/23/2021
085257332209 YA ASTRAZENICA 8/23/2021
085228905619 YA ASTRAZENICA 8/23/2021
081903235976 YA ASTRAZENICA 8/23/2021
088238854217 YA ASTRAZENICA 8/23/2021
081225542865 YA ASTRAZENICA 8/23/2021
085232542968 YA ASTRAZENICA 8/23/2021
085201054634 YA ASTRAZENICA 8/23/2021
089530858547 YA ASTRAZENICA 8/23/2021
081326991996 YA ASTRAZENICA 8/23/2021
085325416694 YA ASTRAZENICA 8/23/2021
0895392298709 YA ASTRAZENICA 8/23/2021
081252678219 YA ASTRAZENICA 8/23/2021
082329288031 YA ASTRAZENICA 8/23/2021
085225284587 YA ASTRAZENICA 8/23/2021
0812225724200 YA ASTRAZENICA 8/23/2021
081390980779 YA ASTRAZENICA 8/23/2021
085290343543 YA ASTRAZENICA 8/23/2021
085231909327 YA ASTRAZENICA 8/23/2021
083117583032 YA ASTRAZENICA 8/23/2021
085229547748 YA ASTRAZENICA 8/23/2021
088227293566 YA ASTRAZENICA 8/23/2021
081326564280 YA ASTRAZENICA 8/23/2021
089662504825 YA ASTRAZENICA 8/23/2021
087831222538 YA ASTRAZENICA 8/23/2021
085332434411 YA ASTRAZENICA 8/23/2021
082125133393 YA ASTRAZENICA 8/23/2021
085293832645 YA ASTRAZENICA 8/23/2021
081327730984 YA ASTRAZENICA 8/23/2021
088214881402 YA ASTRAZENICA 8/23/2021
089638496097 YA ASTRAZENICA 8/23/2021
082324678028 YA ASTRAZENICA 8/23/2021
085331373233 YA ASTRAZENICA 8/23/2021
088215605802 YA ASTRAZENICA 8/23/2021
081228751078 YA ASTRAZENICA 8/23/2021
085326658283 YA ASTRAZENICA 8/23/2021
082314005238 YA ASTRAZENICA 8/23/2021
081344665397 YA ASTRAZENICA 8/23/2021
081226271644 YA ASTRAZENICA 8/23/2021
081225319964 YA ASTRAZENICA 8/23/2021
081353775235 YA ASTRAZENICA 8/23/2021
081227858194 YA ASTRAZENICA 8/23/2021
081235288910 YA ASTRAZENICA 8/23/2021
082199586471 YA ASTRAZENICA 8/23/2021
081291357375 YA ASTRAZENICA 8/23/2021
081919182180 YA ASTRAZENICA 8/23/2021
082329393865 YA ASTRAZENICA 8/23/2021
081314928086 YA ASTRAZENICA 8/23/2021
081226163727 YA ASTRAZENICA 8/23/2021
087833092030 YA ASTRAZENICA 8/23/2021
081237613684 YA ASTRAZENICA 8/23/2021
088227293566 YA ASTRAZENICA 8/23/2021
085233338237 YA ASTRAZENICA 8/23/2021
0895412634768 YA ASTRAZENICA 8/23/2021
082136018129 YA ASTRAZENICA 8/23/2021
082328409416 YA ASTRAZENICA 8/23/2021
085233338237 YA ASTRAZENICA 8/23/2021
081270574699 YA ASTRAZENICA 8/23/2021
087814454866 YA ASTRAZENICA 8/23/2021
082136299661 YA ASTRAZENICA 8/23/2021
085327804563 YA ASTRAZENICA 8/23/2021
085643606649 YA ASTRAZENICA 8/23/2021
082313836163 YA ASTRAZENICA 8/23/2021
085201462971 YA ASTRAZENICA 8/23/2021
081229713740 YA ASTRAZENICA 8/23/2021
082324392293 YA ASTRAZENICA 8/23/2021
082242880299 YA ASTRAZENICA 8/23/2021
085231909327 YA ASTRAZENICA 8/23/2021
085291080417 YA ASTRAZENICA 8/23/2021
0895380814028 YA ASTRAZENICA 8/23/2021
089650617699 YA ASTRAZENICA 8/23/2021
085229395812 YA ASTRAZENICA 8/23/2021
082133463072 YA ASTRAZENICA 8/23/2021
085233338237 YA ASTRAZENICA 8/23/2021
Pekerjaan
0
0
0
0
0
137
Dosis I Dosis 2 Keterangan
Tanggal Tanggal (Ditunda/Tidak
Tanggal Lahir
Pemberian No. Batch Pemberian No. Batch Diberikan/Lanj
Vaksinasi Vaksinasi ut)
8/23/2021 210056 LANJUT 9/3/1996
8/23/2021 210056 LANJUT 6/15/1986
8/23/2021 210056 LANJUT 4/10/2003
8/23/2021 210056 LANJUT 8/17/1951
8/23/2021 210056 LANJUT 3/9/1952
8/23/2021 210056 LANJUT 11/23/2001
8/23/2021 210056 LANJUT 1/30/1996
8/23/2021 210056 LANJUT 6/3/1980
8/23/2021 210056 LANJUT 4/23/2001
8/23/2021 210056 LANJUT 10/8/1982
8/23/2021 210056 LANJUT 1/17/1982
8/23/2021 210056 LANJUT 7/27/1998
8/23/2021 210056 LANJUT 4/21/2003
8/23/2021 210056 LANJUT 12/9/1995
8/23/2021 210056 LANJUT 5/9/2002
8/23/2021 210056 LANJUT 3/2/1970
8/23/2021 210056 LANJUT 3/21/2003
8/23/2021 210056 LANJUT 3/23/1976
8/23/2021 210056 LANJUT 8/27/1987
8/23/2021 210056 LANJUT 5/27/2000
8/23/2021 210056 LANJUT 12/30/1983
8/23/2021 210056 LANJUT 12/27/1992
8/23/2021 210056 LANJUT 8/29/1997
8/23/2021 210056 LANJUT 5/2/1981
8/23/2021 210056 LANJUT 2/6/1965
8/23/2021 210056 LANJUT 11/23/2000
8/23/2021 210056 LANJUT 5/4/1997
8/23/2021 210056 LANJUT 12/10/1985
8/23/2021 210056 LANJUT 5/10/2003
8/23/2021 210056 LANJUT 7/2/1978
8/23/2021 210056 LANJUT 5/5/1986
8/23/2021 210056 LANJUT 12/31/1962
8/23/2021 210056 LANJUT 1/1/1985
8/23/2021 210056 LANJUT 7/14/1971
8/23/2021 210056 LANJUT 9/9/1989
8/23/2021 210056 LANJUT 6/22/1999
8/23/2021 210056 LANJUT 6/4/1980
8/23/2021 210056 LANJUT 3/12/1966
8/23/2021 210056 LANJUT 5/11/2000
8/23/2021 210056 LANJUT 6/16/1980
8/23/2021 210056 LANJUT 11/18/2001
8/23/2021 210056 LANJUT 9/20/1995
8/23/2021 210056 LANJUT 5/10/1997
8/23/2021 210056 LANJUT 11/24/2002
8/23/2021 210056 LANJUT 6/2/2000
8/23/2021 210056 LANJUT 8/7/1995
8/23/2021 210056 LANJUT 11/24/1977
8/23/2021 210056 LANJUT 8/9/1998
8/23/2021 210056 LANJUT 9/15/1966
8/23/2021 210056 LANJUT 10/11/1972
8/23/2021 210056 LANJUT 3/20/1997
8/23/2021 210056 LANJUT 7/31/1975
8/23/2021 210056 LANJUT 2/1/2003
8/23/2021 210056 LANJUT 7/28/1999
8/23/2021 210056 LANJUT 8/17/1965
8/23/2021 210056 LANJUT 9/9/1965
8/23/2021 210056 LANJUT 10/5/2001
8/23/2021 210056 LANJUT 3/9/1984
8/23/2021 210056 LANJUT 4/21/1994
8/23/2021 210056 LANJUT 4/20/1983
8/23/2021 210056 LANJUT 9/9/1989
8/23/2021 210056 LANJUT 7/11/1978
8/23/2021 210056 LANJUT 3/9/1988
8/23/2021 210056 LANJUT 5/16/1999
8/23/2021 210056 LANJUT 2/7/1995
8/23/2021 210056 LANJUT 11/27/1982
8/23/2021 210056 LANJUT 5/28/1996
8/23/2021 210056 LANJUT 12/18/1982
8/23/2021 210056 LANJUT 8/14/1984
8/23/2021 210056 LANJUT 3/28/1979
8/23/2021 210056 LANJUT 3/18/1999
8/23/2021 210056 LANJUT 9/15/1999
8/23/2021 210056 LANJUT 4/11/1984
8/23/2021 210056 LANJUT 3/29/1979
8/23/2021 210056 LANJUT 10/23/1999
8/23/2021 210056 LANJUT 8/4/1976
8/23/2021 210056 LANJUT 4/24/1991
8/23/2021 210056 LANJUT 9/10/1963
8/23/2021 210056 LANJUT 2/12/1980
8/23/2021 210056 LANJUT 2/2/1979
8/23/2021 210056 LANJUT 3/26/1996
8/23/2021 210056 LANJUT 3/18/2002
8/23/2021 210056 LANJUT 8/28/2000
8/23/2021 210056 LANJUT 7/3/2003
8/23/2021 210056 LANJUT 4/21/1977
8/23/2021 210056 LANJUT 10/1/1978
8/23/2021 210056 LANJUT 5/25/1993
8/23/2021 210056 LANJUT 8/1/2002
8/23/2021 210056 LANJUT 9/28/2003
8/23/2021 210056 LANJUT 5/29/1993
8/23/2021 210056 LANJUT 6/18/1985
8/23/2021 210056 LANJUT 5/13/2000
8/23/2021 210056 LANJUT 1/10/1969
8/23/2021 210056 LANJUT 1/22/1997
8/23/2021 210056 LANJUT 11/12/1981
8/23/2021 210056 LANJUT 4/9/1968
8/23/2021 210056 LANJUT 11/8/1979
8/23/2021 210056 LANJUT 12/7/1972
8/23/2021 210056 LANJUT 5/22/1978
8/23/2021 210056 LANJUT 8/18/1999
8/23/2021 A.1024 LANJUT 6/2/2000
8/23/2021 A.1024 LANJUT 4/7/1998
8/23/2021 210056 LANJUT 7/17/1988
8/23/2021 210056 LANJUT 9/1/1987
8/23/2021 210056 LANJUT 2/13/1999
8/23/2021 210056 LANJUT 4/10/1984
8/23/2021 210056 LANJUT 2/2/1999
8/23/2021 210056 LANJUT 4/11/1999
8/23/2021 210056 LANJUT 1/22/1993
8/23/2021 210056 LANJUT 5/11/2000
8/23/2021 210056 LANJUT 3/2/1970
8/23/2021 210056 LANJUT 6/14/1959
8/23/2021 210056 LANJUT 11/29/2000
8/23/2021 210056 LANJUT 10/6/1976
8/23/2021 210056 LANJUT 5/3/1985
8/23/2021 210056 LANJUT 5/15/1957
8/23/2021 210056 LANJUT 4/6/1979
8/23/2021 210056 LANJUT 4/17/1974
8/23/2021 210056 LANJUT 6/12/1976
8/23/2021 210056 LANJUT 2/21/1983
8/23/2021 210056 LANJUT 2/13/1996
8/23/2021 210056 LANJUT 9/13/1996
8/23/2021 210056 LANJUT 10/23/1971
8/23/2021 210056 LANJUT 8/27/1996
8/23/2021 210056 LANJUT 10/12/1991
8/23/2021 A.1024 LANJUT 12/1/1986
8/23/2021 210056 LANJUT 6/21/1960
8/23/2021 210056 LANJUT 12/31/1959
8/23/2021 24202121 LANJUT 6/20/1993
8/23/2021 24004321 LANJUT 4/3/1955
8/23/2021 210056 LANJUT 9/10/1951
8/23/2021 210056 LANJUT 4/14/1993
8/23/2021 210056 LANJUT 3/18/1952
8/23/2021 210056 LANJUT 7/12/1999
8/23/2021 210056 LANJUT 5/12/1986
8/23/2021 210056 LANJUT 6/4/1994
8/23/2021 210056 LANJUT 1/1/1997
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Jenis
Kelamin
1 3317066003660002 TAMAMI L
2 3317070708910004 AKHMAD NUR WAHID L
3 3317065207660010 DJARIYATUN P
4 3317061504830009 ANANG PRIYANTO L
5 3317101212930001 NURUL DIAN SAPUTRA L
6 3317060511030001 MUHAMMAD ALI SYAFIQ L
7 3317106308710002 PUJI KARYATI P
8 3317142103860002 JAENURI L
9 3317060203700008 TAMLIKAN L
10 3317064807790001 SITI SAROH P
11 3317064609860006 SHOFWAH P
12 3317065201010001 LAILATUL FITRIA P
13 3317064804030004 RIDAUL INAYAH P
14 3317056410880003 NURUL HIKMAH P
15 3317065207690003 ROFIAH L
16 3317066708000009 ENDAH ROHMAWATI L
17 3519025205850003 RENI WURYANTI P
18 3317060408990007 TAUFIQ L
19 3317066308010001 SOFIATUN NAJAH L
20 9109090108750001 SUSANTO L
21 3317061210970002 DENI SAPUTRO P
22 3317065809010002 RISKA AYU SEPTI P
23 3317066308740002 SUAIDAH P
24 3317061612830001 KHUSEN L
25 3317064604870005 ANIQOTUL ISTIANAH P
26 3317066206790002 WATIAH P
27 3317061108850001 SETIYO UTOMO L
28 3317062501970002 M.NAJMUDDIN L
29 3317060504030003 MUHAMMAD AZAFUL ANAM L
30 3317061406000001 ALI MA'ARIF L
31 3317061102000001 MUH. AHSAN CAHYONO L
32 3317066506010004 ALFI MAHFUDZOH P
33 3317060610030005 RIFQI RAFI SANTOSA L
34 3317066412960002 DURROTUN NADLIFAH P
35 3317060505800001 ZAWAWI L
36 3317060303820004 NANANG ABDUL MUIS L
37 3317070506830010 SUPRIYONO L
38 3317060308910001 FAHRONIL MUSTOFA L
39 3317074212010003 RIZKA NUR FADHILA P
40 3317062209940002 FATAH YASIN L
41 3317064903930003 TAMSINAH P
42 3317065202800001 DERITATI P
43 3317062807840007 NUR SALIM L
44 3317066105030006 TAKMILATUN NA'MA P
45 3317066911990001 NURUL ISNAININ NAFI'AH P
46 3524051403880001 M.IHYA'MUZAKKI L
47 3317102308800009 YAKUN MUNAWAR L
48 3317066612760002 MUADIROH P
49 3317121712780001 AHMAD KHOIR L
50 3317060604010005 AHMAD MINANURROFIQ L
51 3317061611860005 ANJAR L
52 3317064701660001 SITI KHOLISOH P
53 3317066405930001 SITI ZAHROK P
54 3317066308590001 MASRIPAH P
55 3317065010950007 SITI NUR LAILA LINA P
56 3317066107590001 SUKAINAH P
57 9103011003760001 YAHYA L
58 3317060503850001 MUCHAMAD MUZAKI L
59 3317066606980005 NUR HIDAYAH P
60 3317062912790001 ABDUL ROZAK L
61 3317052912860001 MOH.SUPADI L
62 3524055506850005 TATIK SETIOWATI P
63 3317061807730004 SUNARTO L
64 3317062304000002 KAMIM L
65 3317061706870005 FATKHUR ROHMAN L
66 3317062007970003 ZAENAL MUTTAQIN L
67 5171014908010005 SHAVIRA EVI DHIA P
68 3317060409880001 MOH.SAIFUL ANWAR L
69 3317066910730001 SRI LESTARI NINGSIH P
70 3317062308950001 PAROYAN L
71 3317065301790005 SITI NUR FITRIYAH P
72 3317060512750002 PURWANTO L
73 3317066303820001 SITI JUNAIDAH P
74 3317056905930001 NUR KHOLISOH P
75 3317076509910001 SITI NUR'AINI P
76 3317061803990001 KHOIRUL ANAM L
77 3317062011920001 MISBAHUL MUNIR L
78 1173025606010002 AYU MUALIZA P
79 3317065604000001 SITI NUR JANNAH P
80 3317061406700012 JUWADI L
81 3317065409990003 NUR AZIZAH P
82 3317062811920001 KHOIRUL UMAM L
83 3523054912860002 LULUK ATUL HASANAH P
84 3317062708850005 SHOFIYUDDIN L
85 3317060707820011 ZAINI L
86 3317061010770001 UTOMO L
87 3317061004790001 MUKHLISIN L
88 3317060405920004 IKA KURNIAWAN L
89 3317064106040002 SITI ZUMROTUS SOFIAH P
90 3317060408800001 ABD.WAHID L
91 3317064709670001 HARTATIK P
92 3317122404700008 MAKMUN L
93 3521102710810001 ZAENAL ARIFIN L
94 3317141911880003 MUHAMMAD SOBIRIN L
95 3317062809970003 DANANG PRASETYO L
96 3316086908790001 LULUK NOR FADHILAH P
97 3317064101770004 ROUDLOTUL JANNAH P
98 3317061701910003 MOH.KHOIRUL ANWAR L
99 3317060507630011 SARMANI L
100 3317064603610001 WARINGAH P
101 3317060508030004 ACHMAD AGUS SETIYAWAN L
102 3317060605010005 MOH.ASHOF BARKHIYA L
103 3317063112030002 RENDY DICKY ARDIANSYAH L
104 3317064303780005 AMINAH P
105 3317060307960002 JAFAR SHODIQ L
106 3317062009770004 MAFTUCHIN L
107 3523065601890002 NINING SOFIATI P
108 3317060305570002 H.MASDUKI L
109 3317065307990007 ERMA SHOLIHATUS SA'ADAH P
110 3317062505930001 KHOIRUDDIN L
111 3317064601670001 HJ.SITI FATIMAH P
112 3317060201760006 M.ZAENAL ABIDIN L
113 3317064805020003 LAILATUL FARDAH P
114 3317064805830002 SUNARTIK P
115 3317066611740001 NIZARUL MUTI'AH P
116 3317060108000004 AGUS ABDILLAH M. L
117 3317062708840004 MUHAMMAD MUNASIR L
118 3317040404850003 IRFAN CAHYONO L
119 3317066811950001 NOFITA RUSMIYANTI P
120 3317061005520003 SUKUR L
121 3317066205830002 KHIKMATUL KHOIRIYAH P
122 3317067007700001 KUNATI P
123 3317065210020004 IMROATUL FITRIYYAH P
124 3317061206730001 SAPARDI L
125 3317062606870002 SHOLIKIN L
126 3317064405000003 LUTFIYATUL INAYAH P
127 3317064610860001 LAILATUS SA'ADAH P
128 3317062404930005 UBAIDUR ROHMAN L
129 3317066901990002 WAKHIDATUS SYARIFAH P
130 3317113110910001 TEGUH PRAYITNO L
131 3317064106920002 SRI WAHYUNI P
132 331707070980001 AKHMAD MUHLISIN L
133 3317064805700002 LASRINI P
134 3317062912000004 MUSTA'IN ABDULLAH L
135 3317065302930001 ZAIMAH P
136 3317065402690001 JAMAATUN P
137 3317061706970002 FAJAR NURUL HUDA L
138 3317061608990002 MUHAMMAD ULIN NUHA L
139 3317064703830002 UMI HANIK P
140 3317065108750001 TASLIMAH P
141 3317066110020004 IZZATUL ATHIYYAH P
142 3317066012990005 CHILYATUN NAJIBAH P
143 3317061308680001 RUSDAN L
144 3317066808000001 AYU SUKMA NINGRUM P
145 3317065402640001 ASIYAH P
146 3317061205960003 ISYQI MUHAMMAD L
147 3317062203960002 ZAINAL MUTTAROM L
148 3317062105000001 MUHAMMAD RIZAL AMRI L
149 3317064909720001 KRISTINI P
150 3317066403890010 SITI FARIHAH P
151 3317066212740004 NAFSIYAH P
152 3317066804780001 SUTIKAH P
153 3317065407670001 DASNI P
154 3317065508720003 MARIYAH P
155 3317064504850008 SUMIRAH P
156 3317060808820004 AHMAD ANSHORI L
157 3317062405830006 MISBAH L
158 3317066403910001 DARMIYATI NINGSIH P
159 3317061106660003 MUSLIH L
160 3317062101840002 NGASIMIN L
161 3317061903790003 ACHMAD MUNSIF L
162 3317065706740001 SITI MAESAROH P
163 3317062611720005 SAMSODIN L
164 3307061106010002 MOHAMMAD SHOUQI L
165 3317062301800006 MOCH.NANANG MAWARDI L
166 3317066007750001 NASMI P
167 3317064803850001 SITI MUTMAINNAH P
168 3317061605840004 SISWOYO L
169 3317065209920002 FAIQOTUL MUNIROH P
170 3317140807860004 MOHAMMAD KHABIBILAH L
171 3317062911830001 DZAWIN NADLOR L
172 3318060602840001 MOHAMMAD HERI PRANOTO L
173 3317060405870002 WAHIB L
174 3317064703960003 NURUL ISTIQOMAH P

A = Petugas Medis dan Non Medis di Fasilitas Pel B = Lainnya (Mohon disebutkan jenis vaksin yang diterima Puskesmas/Fask
D = Lainnya
E = Tidak Bekerja
Kelompok Umur:
18-30 72
31-45 67
46-59 30
60> 5
Total 174
Pekerjaan:
A 0
B 0
C 0
D 0
E 0
Total 174
Umur Kelompok
Pekerjaan* Alamat
(18-59 tahun) Umur
RENTAN 55 46-59 BOGOREJO 01/02

RENTAN 55 46-59 SAMBONG 02/02
UMUM 49 46-59 KARAS 01/03
UMUM 34 31-45 KARAS 01/02
UMUM 20 18-30 GESIKAN 03/01
RENTAN 52 46-59 KARANGASEM 02/03
UMUM 20 18-30 KARAS 01/04
UMUM 36 31-45 SUMURJALAK 03/02
UMUM 22 18-30 MENORO 03/01
UMUM 46 46-59 NAENA MUKTIPURA 015/04
UMUM 23 18-30 KUMBO 03/02
UMUM 24 18-30 SEDAN 02/05
UMUM 17 18-30 SEDAN 05/01
UMUM 24 18-30 SEDAN 04/03
UMUM 41 31-45 KARAS 01/03
UMUM 39 31-45 SUMBERAN 07/03
UMUM 38 31-45 PACING 07/03
UMUM 30 18-30 SEDAN 04/03
UMUM 26 18-30 KUMBO 07/04
UMUM 18 18-30 SEDAN 02/05
UMUM 21 18-30 KARAS 02/03
UMUM 40 31-45 KARAS 03/03
RENTAN 55 46-59 SIDOREJO 01/02
LANSIA 61 60> SAMBIROTO 03/01
UMUM 36 31-45 SIDOMULYO 02/03
UMUM 48 46-59 KUMBO 09/05
UMUM 21 18-30 MENORO 02/02
UMUM 34 31-45 KARAS 02/02
UMUM 24 18-30 KARAS 01/01
UMUM 20 18-30 PEMOGAN 00/00
UMUM 32 31-45 SEDAN 01/03
UMUM 47 46-59 KARAS 01/03
UMUM 20 18-30 HAGU BARAT LAUT 00/00
RENTAN 51 46-59 KENONGO 01/01
UMUM 35 31-45 SEDAN 04/03
UMUM 29 18-30 KARAS 02/03
RENTAN 53 46-59 MOJOSARI 05/01
RENTAN 51 46-59 KARAS 01/03
UMUM 39 31-45 DAWU 03/02
UMUM 41 31-45 JEPON 05/08
RENTAN 58 46-59 DADAPAN 05/02
RENTAN 60 60> BOGOREJO 01/02
UMUM 32 31-45 TEGALMULYO 07/01
UMUM 22 18-30 SEDAN 04/05
UMUM 28 18-30 SEDAN 03/03
RENTAN 54 46-59 SEDAN 01/05
UMUM 45 31-45 SEDAN 03/05
UMUM 19 18-30 SEDAN 01/01
UMUM 38 31-45 JAMBEYAN 03/02
UMUM 46 46-59 KARAS 01/02
UMUM 36 31-45 MENORO 04/03
UMUM 36 31-45 SEDAN 05/03
UMUM 25 18-30 SEDAN 05/03
UMUM 34 31-45 SEDAN 02/06
UMUM 21 18-30 SEDAN 02/06
UMUM 28 18-30 SEDAN 04/03
UMUM 24 18-30 SEDAN 01/04
RENTAN 52 46-59 DADPAN 04/02
UMUM 20 18-30 KARAS 03/03
UMUM 43 31-45 PACING 03/01
UMUM 37 31-45 KARAS 03/03
UMUM 47 46-59 PACING 06/02
UMUM 41 31-45 SEDAN 02/02
UMUM 37 31-45 SEDAN 02/01
UMUM 35 31-45 SEDAN 04/02
UMUM 34 31-45 PACING 02/01
ksin yang diterima Puskesmas/Faskes)

BPJS PBI A
BPJS Non PBI B
Non Anggota C
Total D
Pemberian Dosis E
Dosis 1 174 Total
Dosis 2 0
Total 174
KSANAAN VAKSINASI COVID-19
NKES/POS VAKSINASI
Kepesertaan BPJS (tulis 'Ya' pada

kolom yang sesuai)
Merek Tanggal
No. Hp
BPJS Non Non Vaksin*** Screening
BPJS PBI
PBI Anggota
082337395803 YA SINOVAC 8/9/2021

082323432621 YA SINOVAC 8/9/2021
089510294068 YA SINOVAC 8/9/2021
081326372898 YA SINOVAC 8/9/2021
08955412565035 YA SINOVAC 8/9/2021
089515937250 YA SINOVAC 8/9/2021
082221345979 YA SINOVAC 8/9/2021
081325450111 YA SINOVAC 8/9/2021
081225745660 YA SINOVAC 8/9/2021
082310318155 YA SINOVAC 8/9/2021
085226198627 YA SINOVAC 8/9/2021
085293488185 YA SINOVAC 8/9/2021
0859166134610 YA SINOVAC 8/9/2021
085292619324 YA SINOVAC 8/9/2021
081225544038 YA SINOVAC 8/9/2021
0895380079423 YA SINOVAC 8/9/2021
089531347179 YA SINOVAC 8/9/2021
081328275639 YA SINOVAC 8/9/2021
083154876540 YA SINOVAC 8/9/2021
081271208506 YA SINOVAC 8/9/2021
081515253369 YA SINOVAC 8/9/2021
08563259399 YA SINOVAC 8/9/2021
085328395984 YA SINOVAC 8/9/2021
082335117730 YA SINOVAC 8/9/2021
082237632808 YA SINOVAC 8/9/2021
082337395803 YA SINOVAC 8/9/2021
081326455040 YA SINOVAC 8/9/2021
089506112695 YA SINOVAC 8/9/2021
0882005482388 YA SINOVAC 8/9/2021
0895396257821 YA SINOVAC 8/9/2021
081775455109 YA SINOVAC 8/9/2021
08986551589 YA SINOVAC 8/9/2021
081328849683 YA SINOVAC 8/9/2021
081326455061 YA SINOVAC 8/9/2021
082323432621 YA SINOVAC 8/9/2021
082133025799 YA SINOVAC 8/9/2021
085292151053 YA SINOVAC 8/9/2021
089601014548 YA SINOVAC 8/9/2021
08988363430 YA SINOVAC 8/9/2021
085253180652 YA SINOVAC 8/9/2021
085213265345 YA SINOVAC 8/9/2021
089680163977 YA SINOVAC 8/9/2021
081338610143 YA SINOVAC 8/9/2021
089515339270 YA SINOVAC 8/9/2021
089673836595 YA SINOVAC 8/9/2021
082234535935 YA SINOVAC 8/9/2021
082324728455 YA SINOVAC 8/9/2021
0895807838020 YA SINOVAC 8/9/2021
085754542030 YA SINOVAC 8/9/2021
081`315547045 YA SINOVAC 8/9/2021
082323080692 YA SINOVAC 8/9/2021
082225397930 YA SINOVAC 8/9/2021
081393584255 YA SINOVAC 8/9/2021
082133915917 YA SINOVAC 8/9/2021
082234535935 YA SINOVAC 8/9/2021
081227463783 YA SINOVAC 8/9/2021
082134366808 YA SINOVAC 8/9/2021
085227914322 YA SINOVAC 8/9/2021
085848617377 YA SINOVAC 8/9/2021
087746973388 YA SINOVAC 8/9/2021
085325226301 YA SINOVAC 8/9/2021
082331028336 YA SINOVAC 8/9/2021
081231322969 YA SINOVAC 8/9/2021
082136857835 YA SINOVAC 8/9/2021
089531347179 YA SINOVAC 8/9/2021
082328231197 YA SINOVAC 8/9/2021
087852035777 YA SINOVAC 8/9/2021
089668333768 YA SINOVAC 8/9/2021
085290541685 YA SINOVAC 8/9/2021
08812845075 YA SINOVAC 8/9/2021
085290116955 YA SINOVAC 8/9/2021
081217699977 YA SINOVAC 8/9/2021
083186247008 YA SINOVAC 8/9/2021
081372262386 YA SINOVAC 8/9/2021
088221408500 YA SINOVAC 8/9/2021
081227094669 YA SINOVAC 8/9/2021
085225920770 YA SINOVAC 8/9/2021
085261627140 YA SINOVAC 8/9/2021
089647569110 YA SINOVAC 8/9/2021
085328395984 YA SINOVAC 8/9/2021
085810191758 YA SINOVAC 8/9/2021
081392374657 YA SINOVAC 8/9/2021
085234795930 YA SINOVAC 8/9/2021
0895422550391 YA SINOVAC 8/9/2021
085226124783 YA SINOVAC 8/9/2021
089678271848 YA SINOVAC 8/9/2021
085211808758 YA SINOVAC 8/9/2021
081335937882 YA SINOVAC 8/9/2021
085725480005 YA SINOVAC 8/9/2021
082327288100 YA SINOVAC 8/9/2021
089678271848 YA SINOVAC 8/9/2021
085329613631 YA SINOVAC 8/9/2021
082336422744 YA SINOVAC 8/9/2021
085289656679 YA SINOVAC 8/9/2021
081215314066 YA SINOVAC 8/9/2021
085293444778 YA SINOVAC 8/9/2021
085226905653 YA SINOVAC 8/9/2021
089685425123 YA SINOVAC 8/9/2021
081393584225 YA SINOVAC 8/9/2021
0895361031276 YA SINOVAC 8/9/2021
081225924185 YA SINOVAC 8/9/2021
089649063559 YA SINOVAC 8/9/2021
0882304264242 YA SINOVAC 8/9/2021
085331182009 YA SINOVAC 8/9/2021
082226835685 YA SINOVAC 8/9/2021
085226156096 YA SINOVAC 8/9/2021
089509986415 YA SINOVAC 8/9/2021
085225219482 YA SINOVAC 8/9/2021
089663746380 YA SINOVAC 8/9/2021
0895380079409 YA SINOVAC 8/9/2021
0852225219482 YA SINOVAC 8/9/2021
085225428802 YA SINOVAC 8/9/2021
08975366633 YA SINOVAC 8/9/2021
083867030108 YA SINOVAC 8/9/2021
085201937265 YA SINOVAC 8/9/2021
081218150142 YA SINOVAC 8/9/2021
082324674748 YA SINOVAC 8/9/2021
085227608916 YA SINOVAC 8/9/2021
085227608916 YA SINOVAC 8/9/2021
089668876771 YA SINOVAC 8/9/2021
085291596010 YA SINOVAC 8/9/2021
085211808758 YA SINOVAC 8/9/2021
0895621492211 YA SINOVAC 8/9/2021
081357654433 YA SINOVAC 8/9/2021
082324945899 YA SINOVAC 8/9/2021
083843253605 YA SINOVAC 8/9/2021
085225139084 YA SINOVAC 8/9/2021
0895326369335 YA SINOVAC 8/9/2021
089669306177 YA SINOVAC 8/9/2021
085201008148 YA SINOVAC 8/9/2021
089619572257 YA SINOVAC 8/9/2021
082226093199 YA SINOVAC 8/9/2021
085226691593 YA SINOVAC 8/9/2021
088271197367 YA SINOVAC 8/9/2021
081350813135 YA SINOVAC 8/9/2021
082322722719 YA SINOVAC 8/9/2021
085288922720 YA SINOVAC 8/9/2021
081215583551 YA SINOVAC 8/9/2021
085325042552 YA SINOVAC 8/9/2021
082322722719 YA SINOVAC 8/9/2021
085326333615 YA SINOVAC 8/9/2021
085235991467 YA SINOVAC 8/9/2021
083843322970 YA SINOVAC 8/9/2021
0895391326745 YA SINOVAC 8/9/2021
082226835685 YA SINOVAC 8/9/2021
082225397930 YA SINOVAC 8/9/2021
082232052553 YA SINOVAC 8/9/2021
085226329828 YA SINOVAC 8/9/2021
085326263048 YA SINOVAC 8/9/2021
0895429611040 YA SINOVAC 8/9/2021
089678960947 YA SINOVAC 8/9/2021
081227992315 YA SINOVAC 8/9/2021
089685428123 YA SINOVAC 8/9/2021
0895360995551 YA SINOVAC 8/9/2021
085201058362 YA SINOVAC 8/9/2021
082326653493 YA SINOVAC 8/9/2021
082135612752 YA SINOVAC 8/9/2021
085640076039 YA SINOVAC 8/9/2021
085226691593 YA SINOVAC 8/9/2021
085329439878 YA SINOVAC 8/9/2021
085225558095 YA SINOVAC 8/9/2021
085290273605 YA SINOVAC 8/9/2021
082398495131 YA SINOVAC 8/9/2021
089669768183 YA SINOVAC 8/9/2021
087717091342 YA SINOVAC 8/9/2021
085326366374 YA SINOVAC 8/9/2021
089510294068 YA SINOVAC 8/9/2021
082326650191 YA SINOVAC 8/9/2021
082327292226 YA SINOVAC 8/9/2021
082335388375 YA SINOVAC 8/9/2021
082226077205 YA SINOVAC 8/9/2021
085329971539 YA SINOVAC 8/9/2021
089608998867 YA SINOVAC 8/9/2021
085326658529 YA SINOVAC 8/9/2021
kerjaan
0
0
0
0
0
174
(Ditunda/Tid
Tanggal ak Tanggal Lahir
Tanggal Pemberian Diberikan/La
No. Batch Pemberian No. Batch
Vaksinasi njut)
Vaksinasi
8/9/2021 24004721 LANJUT 3/20/1966
8/9/2021 24004721 LANJUT 8/7/1991
8/9/2021 24004721 LANJUT 7/12/1966
8/9/2021 24004721 LANJUT 4/15/1983
8/9/2021 24004721 LANJUT 12/12/1993
8/9/2021 24004721 LANJUT 11/5/2003
8/9/2021 24004721 LANJUT 8/23/1971
8/9/2021 24004721 LANJUT 3/21/1986
8/9/2021 24004721 LANJUT 3/2/1970
8/9/2021 24004721 LANJUT 7/8/1979
8/9/2021 24004721 LANJUT 9/6/1986
8/9/2021 24004721 LANJUT 1/12/2001
8/9/2021 24004721 LANJUT 4/8/2003
8/9/2021 24004721 LANJUT 10/24/1988
8/9/2021 24004721 LANJUT 7/12/1969
8/9/2021 24004721 LANJUT 8/27/2000
8/9/2021 24004721 LANJUT 5/12/1985
8/9/2021 24004721 LANJUT 8/4/1999
8/9/2021 24004721 LANJUT 8/23/2001
8/9/2021 24004721 LANJUT 8/1/1975
8/9/2021 24004721 LANJUT 10/12/1997
8/9/2021 24004721 LANJUT 9/18/2001
8/9/2021 24004721 LANJUT 8/23/1974
8/9/2021 24004721 LANJUT 12/16/1983
8/9/2021 24004721 LANJUT 4/6/1987
8/9/2021 24004721 LANJUT 6/22/1979
8/9/2021 24004721 LANJUT 4/11/1985
8/9/2021 24004721 LANJUT 1/25/1997
8/9/2021 24004721 LANJUT 4/5/2003
8/9/2021 24004721 LANJUT 6/14/2000
8/9/2021 24004721 LANJUT 2/11/2000
8/9/2021 24004721 LANJUT 6/25/2001
8/9/2021 24004721 LANJUT 10/6/2003
8/9/2021 24004721 LANJUT 12/24/1996
8/9/2021 24004721 LANJUT 5/5/1980
8/9/2021 24004721 LANJUT 3/3/1982
8/9/2021 24004721 LANJUT 6/5/1983
8/9/2021 24004721 LANJUT 8/3/1991
8/9/2021 24004721 LANJUT 12/2/2001
8/9/2021 24004721 LANJUT 9/22/1994
8/9/2021 24004721 LANJUT 3/9/1993
8/9/2021 24004721 LANJUT 2/12/1980
8/9/2021 24004721 LANJUT 7/28/1984
8/9/2021 24004721 LANJUT 5/21/2003
8/9/2021 24004721 LANJUT 11/29/1999
8/9/2021 24004721 LANJUT 3/14/1988
8/9/2021 24004721 LANJUT 8/23/1980
8/9/2021 24004721 LANJUT 12/26/1976
8/9/2021 24004721 LANJUT 12/17/1978
8/9/2021 24004721 LANJUT 4/6/2001
8/9/2021 24004721 LANJUT 11/16/1986
8/9/2021 24004721 LANJUT 1/7/1966
8/9/2021 24004721 LANJUT 5/24/1993
8/9/2021 24004721 LANJUT 8/23/1959
8/9/2021 24004721 LANJUT 10/10/1995
8/9/2021 24004721 LANJUT 7/21/1959
8/9/2021 24004721 LANJUT 3/10/1976
8/9/2021 24004721 LANJUT 3/5/1985
8/9/2021 24004721 LANJUT 6/26/1998
8/9/2021 24004721 LANJUT 12/29/1979
8/9/2021 24004721 LANJUT 12/29/1986
8/9/2021 24004721 LANJUT 6/15/1985
8/9/2021 24004721 LANJUT 7/18/1973
8/9/2021 24004721 LANJUT 4/23/2000
8/9/2021 24004721 LANJUT 7/17/1987
8/9/2021 24004721 LANJUT 7/20/1997
8/9/2021 24004721 LANJUT 8/9/2001
8/9/2021 24004721 LANJUT 9/4/1988
8/9/2021 24004721 LANJUT 10/29/1973
8/9/2021 24004721 LANJUT 8/23/1995
8/9/2021 24004721 LANJUT 1/13/1979
8/9/2021 24004721 LANJUT 12/5/1975
8/9/2021 24004721 LANJUT 3/23/1982
8/9/2021 24004721 LANJUT 5/29/1993
8/9/2021 24004721 LANJUT 9/25/1991
8/9/2021 24004721 LANJUT 3/18/1999
8/9/2021 24004721 LANJUT 11/20/1992
8/9/2021 24004721 LANJUT 6/16/2001
8/9/2021 24004721 LANJUT 4/16/2000
8/9/2021 24004721 LANJUT 6/14/1970
8/9/2021 24004721 LANJUT 9/14/1999
8/9/2021 24004721 LANJUT 11/28/1992
8/9/2021 24004721 LANJUT 12/9/1986
8/9/2021 24004721 LANJUT 8/27/1985
8/9/2021 24004721 LANJUT 7/7/1982
8/9/2021 24004721 LANJUT 10/10/1977
8/9/2021 24004721 LANJUT 4/10/1979
8/9/2021 24004721 LANJUT 5/4/1992
8/9/2021 24004721 LANJUT 6/1/2004
8/9/2021 24004721 LANJUT 8/4/1980
8/9/2021 24004721 LANJUT 9/7/1967
8/9/2021 24004721 LANJUT 4/24/1970
8/9/2021 24004721 LANJUT 10/27/1981
8/9/2021 24004721 LANJUT 11/19/1988
8/9/2021 24004721 LANJUT 9/28/1997
8/9/2021 24004721 LANJUT 8/29/1979
8/9/2021 24004721 LANJUT 1/1/1977
8/9/2021 24004721 LANJUT 1/17/1991
8/9/2021 24004721 LANJUT 7/5/1963
8/9/2021 24004721 LANJUT 3/6/1961
8/9/2021 24004721 LANJUT 8/5/2003
8/9/2021 24004721 LANJUT 5/6/2001
8/9/2021 24004721 LANJUT 12/31/2003
8/9/2021 24004721 LANJUT 3/3/1978
8/9/2021 24004721 LANJUT 7/3/1996
8/9/2021 24004721 LANJUT 9/20/1977
8/9/2021 24004721 LANJUT 1/16/1989
8/9/2021 24004721 LANJUT 5/3/1957
8/9/2021 24004721 LANJUT 7/13/1999
8/9/2021 24004721 LANJUT 5/25/1993
8/9/2021 24004721 LANJUT 1/6/1967
8/9/2021 24004721 LANJUT 1/2/1976
8/9/2021 24004721 LANJUT 5/8/2002
8/9/2021 24004721 LANJUT 5/8/1983
8/9/2021 24004721 LANJUT 11/26/1974
8/9/2021 24004721 LANJUT 8/1/2000
8/9/2021 24004721 LANJUT 8/27/1984
8/9/2021 24004721 LANJUT 4/4/1985
8/9/2021 24004721 LANJUT 11/28/1995
8/9/2021 24004721 LANJUT 5/10/1952
8/9/2021 24004721 LANJUT 5/22/1983
8/9/2021 24004721 LANJUT 7/30/1970
8/9/2021 24004721 LANJUT 10/12/2002
8/9/2021 24004721 LANJUT 6/12/1973
8/9/2021 24004721 LANJUT 6/26/1987
8/9/2021 24004721 LANJUT 5/4/2000
8/9/2021 24004721 LANJUT 7/2/1983
8/9/2021 24004721 LANJUT 4/24/1993
8/9/2021 24004721 LANJUT 1/29/1999
8/9/2021 24004721 LANJUT 10/31/1991
8/9/2021 24004721 LANJUT 6/1/1992
8/9/2021 24004721 LANJUT 9/7/1983
8/9/2021 24004721 LANJUT 5/8/1970
8/9/2021 24004721 LANJUT 12/29/2000
8/9/2021 24004721 LANJUT 2/13/1993
8/9/2021 24004721 LANJUT 2/14/1969
8/9/2021 24004721 LANJUT 6/17/1997
8/9/2021 24004721 LANJUT 8/16/1999
8/9/2021 24004721 LANJUT 3/7/1983
8/9/2021 24004721 LANJUT 8/11/1975
8/9/2021 24004721 LANJUT 10/21/2002
8/9/2021 24004721 LANJUT 12/20/1999
8/9/2021 24004721 LANJUT 8/13/1968
8/9/2021 24004721 LANJUT 8/28/2000
8/9/2021 24004721 LANJUT 2/14/1964
8/9/2021 24004721 LANJUT 5/12/1996
8/9/2021 24004721 LANJUT 3/22/1996
8/9/2021 24004721 LANJUT 5/21/2000
8/9/2021 24004721 LANJUT 9/9/1972
8/9/2021 24004721 LANJUT 3/24/1989
8/9/2021 24004721 LANJUT 12/22/1974
8/9/2021 24004721 LANJUT 4/28/1978
8/9/2021 24004721 LANJUT 7/14/1967
8/9/2021 24004721 LANJUT 8/15/1972
8/9/2021 24004721 LANJUT 4/5/1985
8/9/2021 24004721 LANJUT 8/8/1982
8/9/2021 24004721 LANJUT 5/24/1983
8/9/2021 24004721 LANJUT 3/24/1991
8/9/2021 24004721 LANJUT 6/11/1966
8/9/2021 24004721 LANJUT 1/21/1984
8/9/2021 24004721 LANJUT 3/19/1979
8/9/2021 24004721 LANJUT 6/17/1974
8/9/2021 24004721 LANJUT 11/26/1972
8/9/2021 24004721 LANJUT 6/11/2001
8/9/2021 24004721 LANJUT 1/23/1980
8/9/2021 24004721 LANJUT 7/20/1975
8/9/2021 24004721 LANJUT 3/8/1985
8/9/2021 24004721 LANJUT 5/16/1984
8/9/2021 24004721 LANJUT 9/12/1992
8/9/2021 24004721 LANJUT 7/8/1986
8/9/2021 24004721 LANJUT 11/29/1983
8/9/2021 24004721 LANJUT 2/6/1984
8/9/2021 24004721 LANJUT 6/4/1987
8/9/2021 24004721 LANJUT 3/7/1996
Tanggal Input
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Jenis
Kelamin
1 P-SUJ3E4TV 3317056807000002 JAMILATUN NISA' P

2 P-OMOYEVE6 3317076411830001 CHAIRUL CHASANAH P
3 P-T1IEUWK4 3317066207740002 SITI ASIYAH P
4 P-T1685MYK 3317064202830006 SHOLIKAH P
5 P-SX8VTXX4 3317062201850001 AHYA 'UDIN L
6 P-85OEBLHI 3317041101850008 ROHMAT L
7 P-SVQCBB4B 3317042607980002 AHMAD MIFTAHUL ULUM L
8 P-8ADNWD11 3317040102720001 NUR ROHMAN L
9 P-T161NHYN 3317060204920008 SUSILO L
10 P-2LNXZBLB 3317072401010009 MAULANA SANDI L
11 P-SY7URMQS 3317062205820003 ZAHLI L
12 P-T0Q94YEQ 3317041610000001 DHENDY WAHYU SAPUTRA L
13 P-T0GN0UJD 3317050902710002 SARMADI L
14 Q-000JEWZI 3317050810910002 SHOLIKUL ANWAR L
15 P-T1N013D5 3317046212950001 ENDRIK SETYOWATI P
16 P-T3KW9306 3317120404810012 WINARTO L
17 P-T3UM5N7Y 3317130705000001 SUPRIYADI L
18 P-IBOEGYS3 3317072101920001 ALI NUR HAMID L
19 P-T3XLOAWN 3317030503870002 NUR KHOLIK L
20 P-T3NMJPNO 3317124706840002 SITI FAIZAH P
21 P-T3Z12QB5 3317040208020004 RAIHAN SAFIRUL L
22 P-T3J58CSS 3317132607950002 LUTFI DWI STYANTO L
23 P-T31XMDRN 3317130608920001 AHMAD KUMARTO L
24 P-T3B7CRKE 3317132110910001 MOH.MUKIDIN L
25 P-OXTO8FEY 3317066508990001 ITA PERMATA SARI P
26 P-T16Z6CNH 3317137110000001 KHOIROTIN P
27 P-T3NVJHBD 3317125010910004 KUSRINI P
28 J-0003U9VU 3317110409020001 SHOHIBUL MA'ARIF L
29 S-5A516YFB 3317061011890003 HERMAN KHUNAIVI L
30 P-SW25P63V 3317125004820006 PURWATI P
31 P-SVPV33BM 3317125606010001 SULITIYANI P
32 P-HT5ILT9A 3317065105000002 LIYANATUL MUTHOHIYAH P
33 P-GHOXUU9X 3522156102710003 SITI MARFU'AH P
34 P-FQ8XJAAC 3317064306040002 SHOLIHATI P
35 P-DWUGN6KI 2171110101759024 NGADIMIN L
36 P-DFWIFNNR 3317060804950006 YASRIL IS'AF L
37 P-SKOTWIGR 3317062910050002 AHMAD NABILUL FIKRI L
38 P-F2N1PKON 3317051011760002 SUNARI L
39 P-FONOOVQD 3317064612700002 KUNYATI P
40 P-FOVM7QO4 3317060606700003 NUR CHOZIN L
41 P-E2ESOTXC 3317061910970001 M.MUJTAHID L
42 P-7YR6KE8Y 3317062703890003 SYAIFUL ANWAR L
43 P-BG8H5XCY 3317062106980004 M.ALI MAHSUN L
44 P-DBSZSE44 3317064409690004 ZUBAIDAH P
45 P-C7U3L78D 3317061709770004 DASIRUN L
46 P-6TC6KTJ0 3317074410980001 RISTI MELIYANTI P
47 P-6D0C29ZI 3317060403880006 MUHARI L
48 P-GIKQMY4H 3317076702000009 TIARA REZA SOFIANA P
49 P-OQDUOVFJ 3317121412040004 MUHAMMAD ARDIANA RIFQI L
50 P-P1MMAR7Z 3317066505830004 KOSIDAH P
51 P-BL9COTQ4 3317061601000002 MOH.ULIL ALBAB L
52 P-AFZHII6Q 3317065508860001 ZULAIKHO P
53 P-8MZSTDRP 3604086909070004 KENY WIDYA NINGSIH P
54 P-9X7S0GUS 3317066307830003 TASRIKAH P
55 P-ABMKAOTC 3317066609820001 SUNARTI P
56 P-7D8R6ODQ 3317060909010002 JUNAIDI L
57 P-61BMTRQS 3317142302960001 MAMLUATUL HIDAYAH P
58 P-6QCQII6O 3317065808800006 MASRUHAH P
59 3317036206990001 IMROATUL MAISYAROH P
60 P-FKJENKII 3317075204010001 A'IN LATIFAH P
61 P-DMPVQMT7 3317066711800002 SITI ZUMAROH P
62 P-7PAHPKB8 3317064303750003 PAINEM P
63 P-15IVIRLO 3317031612790001 SARUTOMO L
64 P-6ZX6AJSC 3317064304040001 SITI SHOLIHAH P
65 P-OR6HCOOT 3317066511000002 SOFIATUL MILA ANGGRAENI P
66 P-EAKLF5B9 3317061812750003 TRIMO L
67 P-NEVKXOTE 3317062305000001 MOH.DARUL ULUM L
68 P-JSHEHOMS 3507031010860009 PURWANTO L
69 P-8V22DLAB 3317065010840007 LASWATI P
70 S-FC9C6EO1 3317064707500009 KARIYATI P
71 P-4LQ402VQ 3317060707850004 LATOIFUL MINAN L
72 P-J9A3KCEB 3317030510030001 AHMAD ROMLI L
73 3317066612760002 MUADIROH P
74 Q-00HQ5Y8 3317065207810007 SITI NUR MALIKAH P
75 P-BXT1H6MF 331704712950002 ITATUL KHORIDATUN NASRI P
76 P-AMWW9TBT 3317061102820003 DARYONO L
77 P-SWQIF3FI 3317070407850002 MOH.MURTANDO L
78 P-SN6KSLUI 3317071502810001 FALIH KURNIAWAN L
79 Q-00039AY7 3317065007750002 AZIZAH P
80 P-STZLYG38 3317062503650001 NARDI L
81 P-T1OCIHEO 3317046311970002 NOVITA ANGGI SIREGAR P
82 P-1IHOEQN9 3317066406790001 SITI MARFU'AH P
83 P-T11CC9E6 3317030604000002 SUKARIYONO L
84 P-T28TSMPM 3317060205930006 ABD. KHOLIL L
85 P-TIBTPLSX 3317042207890001 MUNAJAT L
86 P-T1EFOVIY 3317071007950001 YULIARDI SOFI Q.A L
87 P-SYEKCHEL 3317066301990002 NISWATUL MUFIDAH P
88 P-SJMMDTB1 3317060107660075 FASRI HUDDIN L
89 P-TOTOLOGE 3317041811010004 ANDIKA WISNU WIBOWO L
90 P-SOC81I4S 3317062509860002 MUKLISIN L
91 P-JBLQBA2J 3317061201970003 KHAIRUL ANWAR L
92 P-HURVAPCT 3317061603950001 AHMAD ROHMAN L
93 P-T1QP2Q2S 3317121007770008 SHODIQIN L
94 S-898EBF6F 3671121506590007 MULYONO L
95 P-T2TVKUJG 3317035504940001 ZUL HARTATIK P
96 P-T3PYFDLS 3317076708910001 SHERLY AGUSTINA P
97 P-8BGVUNO9 3317120101840008 MASKURI L
98 P-T18QHLZC 3317042810980001 SELAMET AMIN RUDIN L
99 P-T2E22TPH 3317131502960002 ACHMAD MUHADZIRIN L
100 P-TOJUSRP7 3317051010690001 MASHUDI L
101 P-T2ZXN4III 3317041708830004 BASONI L
102 P-TIXWOQK8 3317137112010002 EVA DESITA SARI P
103 P-SYDD3KMO 3317120703900007 SAIFURI L
104 P-82NUVTL2 3317041612880004 SUPRIYANTO L
105 P-SVBYQ8A3 3317120304960005 AHMAD NUR ALI L
106 P-8IUD2A7B 3317044205790005 SUPRIANIK P
107 P-S66P6LYS 3317065405010003 SITI 'AISYAH P
108 P-1D9I6AJO 3317041704740001 TASIMIN L
109 P-S2C1T9QA 3317075607020001 LIZZA NURDIANA P
110 P-NFSYLGEN 3317120903950001 MOH.ASY'ARI SETYOBUDI L
111 P-POBKOAAW 3317066307970002 NURUL HIDAYAH P
112 6TMSSXA9 3317040107800070 EKO WIJIANTO L
113 P-SCOGKYCQ 3317040608860002 MOCHAMAD NORCHOLIS L
114 P-IILEEOHE 3318086008890041 SURINI P
115 P-Q4A42STM 3317140308900001 PURNOMO L
116 P-KTW2C9P2 3317062010960001 ABDUL WAHID L
117 P-9DHOOCVH 3317046706750001 SUTIK P
118 P-9FXRC8QP 3317044705950001 EVA SRI REJEKI P
119 S-47991570 3317045904580003 LASMINI P
120 P-RB7UWQNC 3317061604950003 SAEFUDIN L
121 Q-000EEK9H 3317061211800007 ABD. KHAFID L
122 P-8MEKD211 3317040909780004 SUGIONO L
123 P-2TWPK9RN 3317044604790002 NURMI KASIH P
124 P-A3AL9FH2 3317044505010005 IKA RESTUTI P
125 P-644MKRF1 3317041003920001 NANANG SETIAWAN L
126 P-SRESBUQU 3317061908850003 MUHAYYAT L
127 P-SQYIWKHO 3317042306020001 AHMAD TAZAM L
128 P-SQN58657 3317040807010001 LUKMAN SAID L
129 P-08ZL4RQ3 3317073010920003 SAIFUL MUJAB L
130 P-7E4HUJ2H 3317042012870004 PUJIONO L
131 P-SQ2XJ44D 3317124301770006 DARINI L
132 Q-000L6A19 3206142303050001 MOHAMAD CEFFI L
133 P-SPOQOGEG 3317121301680004 LADIMIN L
134 P-SPCH5MQ5 3317122209690001 SUPRIONO L
135 P-SPR23GAU 3317124101720004 YANTI SUBI HANDINI P
136 P-I4FOWP6Y 3317061606950003 KHOIRONI L
137 P-6EDOG186 3317075603980001 LAYLI NUR KHOIRINA P
138 P-SP5SLB2W 3317076711000010 ARNETTA SUSMA WIDIYANTI P
139 P-SPQABYHU 3317075903770005 SRI MARYANTI P
140 P-IY677TG3 3317062110820001 MAS'ADI L
141 P-SMUUSZOC 3317061310850001 MUHTARI L
142 P-SMAVUCTN 3317043003780001 KARDI L
143 S-00B7A344 3317061212740002 SHOLEH L
144 P-4C7W4SUC 3317076305810001 RUJIYANI P
145 P-SL7MZUKD 3317045102840003 MUTMAINAH P
146 P-9ZECH37W 3317042407850004 NAIRUDIN L
147 P-SZGXSR8B 3317040302970001 WIDODO L
148 P-SGQQO6XI 3317061406000005 MUHAMMAD OKI MAMBRURI L
149 P-QF75O2OZ 3317046707010002 SITI JAZILATUN NI'MAH P
150 P-GJAMPUXP 3317065312000003 ANI NAZILATUL NIKMAH P
151 P-ITO4KRIX 3317065504750005 SITI MUNIMAH P
152 P-DYEZOHCO 3317060105990002 KHOIRUN NAJIB L
153 P-6227FIY4 3317065210010003 SITI MUINAH P
154 P-42MUORJX 3317066112000001 BUDI ASEH P
155 P-OF9NTCBP 3317062507970001 MOCH.KHOIRUL ANAM L
156 P-NOEBYF35 3317061911970001 KHOIRUN NASHOIN L
157 P-LRRFVI4Z 3318101910990002 ADIPTA KUSUMA WINATA L
158 P-LAOT7W2Q 3323030512990001 FAJAR RISTIANTO L
159 P-SVQNLFZR 3317122303010003 JAYYID ASTHOFANI L
160 P-SW2T6WX4 3317122408030003 ICHSAN DWI INSANI L
161 P-4XHDIUJX 3317074811010004 YULIYANA P
162 P-5BEAGS24 3317075509970002 IMROATU MAR'AH P
163 Q-OOOECFYS 3317064301020003 IKA NURCAHYANI P
164 P-SSW4GWBM 3317064110010005 RIYADZOTUL HIKAMAH P
165 P-SUUPRSBQ 3317121211790005 SUYANTO L
166 P-SKYUESYV 3317072010840002 JANARKO L
167 P-KN7CUPPW 3317041805980005 AHKMAD TOHA L
168 P-JPH55LZK 3317102403910003 DWI SETIAWAN L
169 P-I2EWWSI8 3317036006030001 INTAN AYU NOVITA SARI P
170 P-I62YO7PR 3317034603750001 SUCIK P
171 P-SGIDDSIH 3317061910810001 AFIF TANWIRUL ANAM L
172 P-SUUC25EU 3317074905030004 LISAMAULINA SAFITRI P
173 P-FY11LBBP 3317060512850002 MUHAMMAD SYAIKHON L
174 P-GCSS3LHA 3324166803840004 ROFIQOH P
175 P-6X7671MJG 3317042109010003 BAYU ADI SYAPUTRA L
176 P-6GKSX4HU 3317040806930003 HENDI YUNIANTO L
177 P-5QYW1SL7 3317071504030003 AJI KHABIBUN NAJAH L
178 P-00H6CEOM 3317070107030002 ABDUL MAJID MA'RUF L
179 P-20E4E7GY 3317072002010003 MUHAMMAD FEBRIANSYAH L
180 P-SW1WQCJX 3317061409030001 ZAKIYUL FIKRI L
181 P-26ZTA1SK 3317071509800003 KUSTAM L
182 P-AESIL7KM 3317042502020001 MOCH.RIZHA L
183 P-SG9LMU3X 3317142208700001 SAMAN L
184 P-SKO16GNM 3317076901890001 PUJI SETYANINGSIH P
185 S-E6OFEEA8 3317054310820001 NASYIATUR RIF'AH P
186 P-SWYAVXXU 3317071307830003 AHMAD HUSAIN L
187 J-0003512Q 3317046410740002 DEWI RIYANI P
188 P-OTHG87XC 3317074505980002 SITI MUANNIFAH P
189 P-SIXQ4JRX 3317064111010001 INDANA ZULFA P
190 P-SK4RAMWT 3317120509800009 SAUKIL AHYAR L
191 P-STRSGTSJ 3317072512950005 INDRA PRASTIYA L
192 P-SVERYHBH 3317055101010006 NUR ALFIANI WAHDAH P
193 P-SMJGOYJO 3317061003960001 AHMAD TAUFIQUR ROHMAN L
194 P-SVL33ZHC 3317065910980006 DAROJAH P
195 P-SJQ461813 3317076809890001 WIJI ASTUTI P
196 P-SSQTJF17 3317131507740001 ARIFIN EKO YULIANTO L
197 P-70HWOPHD 3317040308920004 NURROHMAN SAEPULLOH L
198 P-9AQNGNNL 3317046309880001 HADMINI P
199 P-SWSADEAN 3317072912970001 TEGUH RAHMAT CAHYONO L
200 P-97RYISIX 3317047101640004 SU'IN P
201 P-228ORTJ8 3317070606850003 IRAWAN L
202 P-SRLRPUCO 3317070605010001 MUHAMMAD KHOIRUN NAJIB L
203 P-SGCSWIOR 3317061401920001 SHOBIB KHOIRON L
204 P-TOUPJBIS 3317124107730101 BASIROH P
205 P-T3K3FOWR 3317126310990002 SITI KHOLIFAH P
206 P-T1BWKEGC 3317135207970003 VIDIYA SAFITRI P
207 P-1IMNLBMJ 3317125903660001 IDA TRI PURWENI P
208 P-7VNOXLVY 3317130704960004 ABDUL KHOLIK L
209 P-T2XSSXCP 3603120704760008 KUNDARI L
210 Q-OOOHTBTC 3317124206010003 SELVI PUTRI RACHMAWATI P
211 P-OVQSD14K 3317076812020001 FINA FITRI YANI P
212 P-T2WYF1CG 3317040709780002 SUYIKNO L
213 P-BFSRA9VV 3317046211720001 SUDARNI P
214 P-T34YL33N 3317130910000002 AHMAD SYAIFUL FAZLI L
215 P-6326HZ47 3317120406790004 SUNARNO L
216 P-510K3TFU 3317066708040004 LILLA P
217 P-TIW8RONS 3317131801910001 SUUDI L
218 P-794CVGAI 3317041401890001 BAGUS PITOYO L
219 P-23QBTZGU 3317072101970008 AHMAD IMRON ABIDIN L
220 P-6POSEOLU 3317041402960005 FEBRIYANTO L
221 P-SXDKOIG7 3317030105920002 YAJIB L
222 P-1DTKXKBL 3317072912820002 RIBUT BUDI SANTOSO L
223 P-S13DPTW 3317060504470003 KURNADI L
224 P-74KWJFMA 3317040907020005 ARIF SUGIANTO L
225 P-7NMTMZE9 3317045310000004 RIZKIA OKTAVIANA P
226 P-ST87Y4AC 3317060909010003 MUH. BASYAR DANIYAL L
227 P-2W7NJOBI 3317071611830004 TEGUH IMANTO L
228 P-087H0D00 3317064302640001 MASLAHAH P
229 P-1IS8PNEC 3317065109970002 SITI ZULAIKHA P
230 3317134604860006 SITI IFLAHAH P
D = Lainnya
E = Tidak Bekerja
Kelompok Umur:
18-30
31-45
46-59
60>
Total
Pekerjaan:
A 0
B 0
C 0
D 0
E 0
Total 150
UMUR Kelompok
Pekerjaan* Alamat
(18 - 59 TH) Umur
UMUM 21 18-30 LODAN KULON 04/01

UMUM 37 31-45 PAMOTAN 04/01
UMUM 47 46-59 SEDAN 05/01
UMUM 38 31-45 SEDAN 02/03
UMUM 36 31-45 GADING 02/01
UMUM 23 18-30 PAKIS 01/01
UMUM 49 46-59 WONOKERTO 04/04
UMUM 20 18-30 MEGAL 01/01
UMUM 39 31-45 KARAS 03/06
UMUM 20 18-30 TAHUNAN 02/08
UMUM 50 46-59 GILIS 05/02
UMUM 29 18-30 KALIPANG 04/05
UMUM 25 18-30 SUMBERMULYO 04/03
UMUM 40 31-45 SUDAN 03/02
UMUM 21 18-30 SENDANGMULYO 01/02
UMUM 34 31-45 DOWAN 01/03
UMUM 37 31-45 SUDAN 03/02
UMUM 26 18-30 LANGGAR 01/01
UMUM 29 18-30 LANGGAR 03/02
UMUM 29 18-30 LABUHAN KIDUL 01/05
UMUM 29 18-30 KENDALAGUNG 06/03
UMUM 19 18-30 SIDOWAYAH 04/01
UMUM 31 31-45 KARAS 01/03
UMUM 39 31-45 PLAWANGAN 05/03
REMAJA 17 18-30 GANDRIROJO 02/04
UMUM 26 18-30 SEDAN 04/06
REMAJA 15 18-30 SIDOREJO 03/02
UMUM 44 31-45 SELO 03/02
RENTAN 51 46-59 KENONGO 01/02
UMUM 23 18-30 MENORO 04/03
UMUM 32 31-45 KARAS 04/04
UMUM 33 31-45 MENORO 01/01
UMUM 35 31-45 SEDAN 02/05
REMAJA 13 12-17 LEBAKWANA 08/07
UMUM 38 31-45 MENORO 02/04
UMUM 41 31-45 MENORO 01/04
UMUM 20 18-30 SAMARAN 04/01
UMUM 41 31-45 DOWAN 01/01
UMUM 17 12-17 MENORO 02/04
UMUM 21 18-30 MENORO 01/01
UMUM 34 31-45 DOWAN 01/01
UMUM 36 31-45 MENORO 02/02
LANSIA 71 60> MENORO 02/04
UMUM 36 31-45 SEDAN 01/04
UMUM 17 18-30 TEGALDOWO 01/03
UMUM 25 18-30 UKIR 011/02
UMUM 40 31-45 BAMBAN 05/02
RENTAN 56 46-59 NGULAHAN 02/01
BUMIL 42 31-45 TERJAN 01/02
UMUM 21 18-30 DOWAN 03/03
UMUM 28 18-30 MENORO 04/04
UMUM 26 18-30 BAMBAN 04/02
UMUM 22 18-30 KARAS 01/04
UMUM 34 31-45 KARAS 02/01
UMUM 44 31-45 TERJAN 01/02
LANSIA 62 60> KARANG TENGAH 04/03
UMUM 27 18-30 KEBLORAN 01/01
UMUM 30 18-30 JOHO 01/01
UMUM 37 31-45 TERJAN 01/02
RENTAN 51 46-59 GILIS 02/01
UMUM 38 31-45 UKIR 07/02
UMUM 31 31-45 SUDAN 01/02
UMUM 25 18-30 PANDANGAN WETAN 03/01
UMUM 47 46-59 GADING 01/04
UMUM 19 18-30 RINGIN 01/01
UMUM 26 18-30 PANDANGAN KULON 07/04
UMUM 31 31-45 MEGAL 05/02
LANSIA 63 60> SUMBERMULYO 02/03
UMUM 26 18-30 MENORO 01/02
UMUM 40 31-45 KARAS 02/02
UMUM 42 31-45 UKIR 08/02
UMUM 20 18-30 BITINGAN 03/02
UMUM 19 18-30 UKIR 07/02
UMUM 20 18-30 UKIR 06/02
UMUM 28 18-30 MLAGEN 03/01
UMUM 44 31-45 KRAGAN 03/02
UMUM 16 12-17 CIOMAS 03/05
RENTAN 53 46-59 KRAGAN 03/02
RENTAN 51 46-59 KRAGAN 02/02
UMUM 49 46-59 KRAGAN 03/02
UMUM 23 18-30 PRAGEN 05/02
UMUM 20 18-30 RENDENG 02/01
UMUM 46 46-59 SEDAN 03/03
UMUM 22 18-30 KARAS 03/02
UMUM 21 18-30 SIDOKERTO 03/02
UMUM 21 18-30 TEMANGGUNG 03/01
UMUM 20 18-30 SENDANGWARU 03/03
UMUM 19 18-30 GAMBIRAN 03/02
UMUM 19 18-30 KARAS 03/03
UMUM 23 18-30 UKIR 02/01
UMUM 30 18-30 KEDUNGREJO 02/02
UMUM 18 18-30 DOWAN 01/01
UMUM 46 46-59 DOWAN 01/01
UMUM 35 31-45 PACING 06/02
UMUM 37 31-45 TANJUNGSARI 02/04
UMUM 18 18-30 RINGIN 01/03
UMUM 18 18-30 RINGIN 02/03
UMUM 20 18-30 PAMOTAN 02/010
UMUM 41 31-45 BANGUNREJO
UMUM 51 46-59 BINANGUN 01/01
UMUM 23 18-30 TEMPALING 01/01
UMUM 19 18-30 SEDAN 02/04
UMUM 20 18-30 LODAN WETAN 01/02
UMUM 25 18-30 PACING 02/01
UMUM 22 18-30 KUMBO 09/05
UMUM 47 46-59 SLUKE 01/02
UMUM 20 18-30 PAMOTAN 01/011
UMUM 21 18-30 KENDALAGUNG06/03
UMUM 55 46-59 SUMBERSARI 02/01
UMUM 25 18-30 BENDO 03/01
UMUM 20 18-30 MOJOKERTO 03/01
UMUM 18 18-30 JOHO 03/01
UMUM 43 31-45 UKIR 07/02
UMUM 48 46-59 JOHO 03/01
UMUM 20 18-30 MANGGAR 02/03
UMUM 17 12-17 KARAS 03/05
UMUM 24 18-30 PRAGEN 01/01
UMUM 29 18-30 DOWAN 03/02
UMUM 38 31-45 RINGIN 03/03
UMUM 20 18-30 RENDENG 04 02
UMUM 37 31-45 KARANG ANTIK 04/04
BPJS PBI A
BPJS Non PBI B
Non Anggota C
Total D
Pemberian Dosis E
Dosis 1 0 Total
Dosis 2 0
Total 149
NKES/POS VAKSINASI
Kepesertaan BPJS
(tulis 'Ya' pada Dosis I
kolom yang sesuai)
Merek Tanggal
No. Hp
Vaksin*** Screening
BPJS Non
BPJS Tanggal Pemberian
Non Angg
PBI Vaksinasi
PBI ota
083134721285 YA SINOVAC 9/16/2021 9/16/2021

085227935554 YA SINOVAC 9/16/2021 9/16/2021
085293756951 YA SINOVAC 9/16/2021 9/16/2021
0882006078754 YA SINOVAC 9/16/2021 9/16/2021
085330781268 YA SINOVAC 9/16/2021 9/16/2021
081229621116 YA SINOVAC 9/16/2021 9/16/2021
082134479174 YA SINOVAC 9/16/2021 9/16/2021
082324806521 YA SINOVAC 9/16/2021 9/16/2021
085292327558 YA SINOVAC 9/16/2021 9/16/2021
0859166043580 YA SINOVAC 9/16/2021 9/16/2021
082138585511 YA SINOVAC 9/16/2021 9/16/2021
085725007466 YA SINOVAC 9/16/2021 9/16/2021
085329856955 YA SINOVAC 9/16/2021 9/16/2021
082135801388 YA SINOVAC 9/16/2021 9/16/2021
082134347307 YA SINOVAC 9/16/2021 9/16/2021
081229883020 YA SINOVAC 9/16/2021 9/16/2021
088211005359 YA SINOVAC 9/16/2021 9/16/2021
0853294013 YA SINOVAC 9/16/2021 9/16/2021
088233019930 YA SINOVAC 9/16/2021 9/16/2021
081229883020 YA SINOVAC 9/16/2021 9/16/2021
081215175277 YA SINOVAC 9/16/2021 9/16/2021
082261542226 YA SINOVAC 9/16/2021 9/16/2021
081345373567 YA SINOVAC 9/16/2021 9/16/2021
085875363544 YA SINOVAC 9/16/2021 9/16/2021
087713233345 YA SINOVAC 9/16/2021 9/16/2021
082350658639 YA SINOVAC 9/16/2021 9/16/2021
088239928784 YA SINOVAC 9/16/2021 9/16/2021
081918583266 YA SINOVAC 9/16/2021 9/16/2021
082226943874 YA SINOVAC 9/16/2021 9/16/2021
0895410279702 YA SINOVAC 9/16/2021 9/16/2021
089696098068 YA SINOVAC 9/16/2021 9/16/2021
081215185497 YA SINOVAC 9/16/2021 9/16/2021
082337667344 YA SINOVAC 9/16/2021 9/16/2021
082335018554 YA SINOVAC 9/16/2021 9/16/2021
0812257442524 YA SINOVAC 9/16/2021 9/16/2021
0895359884528 YA SINOVAC 9/16/2021 9/16/2021
088215105091 YA SINOVAC 9/16/2021 9/16/2021
082333978768 YA SINOVAC 9/16/2021 9/16/2021
082314090240 YA SINOVAC 9/16/2021 9/16/2021
08996186622 YA SINOVAC 9/16/2021 9/16/2021
081229707185 YA SINOVAC 9/16/2021 9/16/2021
087892746748 YA SINOVAC 9/16/2021 9/16/2021
085255177417 YA SINOVAC 9/16/2021 9/16/2021
082221662317 YA SINOVAC 9/16/2021 9/16/2021
081270135088 YA SINOVAC 9/16/2021 9/16/2021
081226855440 YA SINOVAC 9/16/2021 9/16/2021
085329462882 YA SINOVAC 9/16/2021 9/16/2021
082329586158 YA SINOVAC 9/16/2021 9/16/2021
085225554730 YA SINOVAC 9/16/2021 9/16/2021
082320968775 YA SINOVAC 9/16/2021 9/16/2021
085717521812 YA SINOVAC 9/16/2021 9/16/2021
085290965707 YA SINOVAC 9/16/2021 9/16/2021
085280487116 YA SINOVAC 9/16/2021 9/16/2021
085225263135 YA SINOVAC 9/16/2021 9/16/2021
082135613610 YA SINOVAC 9/16/2021 9/16/2021
083195135503 YA SINOVAC 9/16/2021 9/16/2021
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081326919756 YA SINOVAC 9/16/2021 9/16/2021
085722905784 YA SINOVAC 9/16/2021 9/16/2021
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085803023400 YA SINOVAC 9/16/2021 9/16/2021
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089848000015 YA SINOVAC 9/16/2021 9/16/2021
085226733320 YA SINOVAC 9/16/2021 9/16/2021
081391699756 YA SINOVAC 9/16/2021 9/16/2021
087713233345 YA SINOVAC 9/16/2021 9/16/2021
082314203918 YA SINOPARM
kerjaan
0
0
0
0
0
149
Dosis I Dosis 2
Keterangan
(Ditunda/Tid
ak Tanggal Lahir Tanggal Input
Tanggal Diberikan/La
No. Batch Pemberian No. Batch njut)
Vaksinasi
2021081536 LANJUT 7/28/2000 9/16/2021

2021081536 LANJUT 11/24/1983 9/16/2021
2021081536 LANJUT 7/22/1974 9/16/2021
2021081536 LANJUT 2/2/1983 9/16/2021
2021081536 LANJUT 1/22/1985 9/16/2021
2021081536 LANJUT 1/11/1985 9/16/2021
2021081536 LANJUT 7/26/1998 9/16/2021
2021081536 LANJUT 2/1/1972 9/16/2021
2021081536 LANJUT 4/2/1992 9/16/2021
2021081536 LANJUT 1/24/2001 9/16/2021
2021081536 LANJUT 5/22/1982 9/16/2021
2021081536 LANJUT 10/16/2000 9/16/2021
2021081536 LANJUT 2/9/1971 9/16/2021
2021081536 LANJUT 10/8/1991 9/16/2021
2021081536 LANJUT 12/22/1995 9/16/2021
2021081581 LANJUT 4/4/1981 9/16/2021
2021081581 LANJUT 5/7/2000 9/16/2021
2021081536 LANJUT 1/21/1992 9/16/2021
2021081581 LANJUT 3/5/1987 9/16/2021
2021081536 LANJUT 6/30/1984 9/16/2021
2021081536 LANJUT 8/2/2002 9/16/2021
2021081536 LANJUT 7/26/1995 9/16/2021
2021081536 LANJUT 8/6/1992 9/16/2021
2021081536 LANJUT 10/21/1991 9/16/2021
2021081536 LANJUT 8/25/1999 9/16/2021
2021081536 LANJUT 10/31/2000 9/16/2021
2021081536 LANJUT 10/10/1991 9/16/2021
2021081536 LANJUT 9/4/2002 9/16/2021
2021081536 LANJUT 11/10/1989 9/16/2021
2021081536 LANJUT 4/10/1982 9/16/2021
2021081536 LANJUT 6/16/2001 9/16/2021
2021081536 LANJUT 5/11/2000 9/16/2021
2021081536 LANJUT 2/21/1971 9/16/2021
2021081536 LANJUT 6/3/2004 9/16/2021
2021081536 LANJUT 1/1/1975 9/16/2021
2021081536 LANJUT 4/8/1995 9/16/2021
2021081536 LANJUT 10/29/2005 9/16/2021
2021081536 LANJUT 11/10/1976 9/16/2021
2021081536 LANJUT 12/6/1970 9/16/2021
2021081536 LANJUT 1/5/1970 9/16/2021
2021081536 LANJUT 12/19/1997 9/16/2021
2021081536 LANJUT 3/27/1989 9/16/2021
2021081536 LANJUT 6/21/1998 9/16/2021
2021081536 LANJUT 9/4/1969 9/16/2021
2021081536 LANJUT 9/17/1977 9/16/2021
2021081536 LANJUT 10/4/1998 9/16/2021
2021081536 LANJUT 3/4/1988 9/16/2021
2021081536 LANJUT 2/27/2000 9/16/2021
2021081536 LANJUT 4/14/2004 9/16/2021
2021081536 LANJUT 4/10/1992 9/16/2021
2021081536 LANJUT 1/16/2000 9/16/2021
2021081536 LANJUT 6/15/1986 9/16/2021
2021081536 LANJUT 9/29/2007 9/16/2021
2021081536 LANJUT 7/23/1983 9/16/2021
2021081536 LANJUT 9/26/1982 9/16/2021
2021081536 LANJUT 9/9/2001 9/16/2021
2021081536 LANJUT 2/23/1996 9/16/2021
2021081536 LANJUT 8/18/1980 9/16/2021
2021081536 LANJUT 6/22/1999 9/16/2021
2021081536 LANJUT 4/12/2001 9/16/2021
2021081536 LANJUT 11/27/1980 9/16/2021
2021081536 LANJUT 3/3/1975 9/16/2021
2021081536 LANJUT 12/16/1979 9/16/2021
2021081536 LANJUT 4/3/2004 9/16/2021
2021081536 LANJUT 11/25/2000 9/16/2021
2021081536 LANJUT 12/18/1975 9/16/2021
2021081536 LANJUT 5/23/2000 9/16/2021
2021081536 LANJUT 10/10/1986 9/16/2021
2021081536 LANJUT 10/10/1984 9/16/2021
2021081536 LANJUT 7/7/1950 9/16/2021
2021081536 LANJUT 7/7/1985 9/16/2021
2021081536 LANJUT 10/5/2003 9/16/2021
2021081536 LANJUT 12/26/1976 9/16/2021
2021081536 LANJUT 7/12/1981 9/16/2021
2021081536 LANJUT 12/31/1995 9/16/2021
2021081536 LANJUT 2/11/1982 9/16/2021
2021081536 LANJUT 7/4/1985 9/16/2021
2021081536 LANJUT 2/15/1981 9/16/2021
2021081536 LANJUT 7/10/1975 9/16/2021
2021081536 LANJUT 3/25/1965 9/16/2021
2021081536 LANJUT 11/23/1997 9/16/2021
2021081536 LANJUT 6/24/1979 9/16/2021
2021081536 LANJUT 4/6/2000 9/16/2021
2021081536 LANJUT 5/2/1993 9/16/2021
2021081536 LANJUT 7/22/1989 9/16/2021
2021081536 LANJUT 7/10/1995 9/16/2021
2021081536 LANJUT 1/23/1999 9/16/2021
2021081536 LANJUT 7/1/1966 9/16/2021
2021081536 LANJUT 11/18/2001 9/16/2021
2021081536 LANJUT 9/25/1986 9/16/2021
2021081536 LANJUT 1/12/1997 9/16/2021
2021081536 LANJUT 3/16/1995 9/16/2021
2021081536 LANJUT 1/10/1977 9/16/2021
2021081536 LANJUT 6/15/1959 9/16/2021
2021081536 LANJUT 4/15/1994 9/16/2021
2021081536 LANJUT 8/27/1991 9/16/2021
2021081536 LANJUT 1/1/1984 9/16/2021
2021081536 LANJUT 10/28/1998 9/16/2021
2021081536 LANJUT 2/15/1996 9/16/2021
2021081536 LANJUT 10/10/1969 9/16/2021
2021081536 LANJUT 8/17/1983 9/16/2021
2021081536 LANJUT 12/31/2001 9/16/2021
2021081536 LANJUT 3/7/1990 9/16/2021
2021081536 LANJUT 12/16/1988 9/16/2021
2021081536 LANJUT 4/3/1996 9/16/2021
2021081536 LANJUT 5/2/1979 9/16/2021
2021081536 LANJUT 5/14/2001 9/16/2021
2021081536 LANJUT 4/17/1974 9/16/2021
2021081536 LANJUT 7/16/2002 9/16/2021
2021081536 LANJUT 3/9/1995 9/16/2021
2021081536 LANJUT 7/23/1997 9/16/2021
2021081536 LANJUT 7/1/1980 9/16/2021
2021081536 LANJUT 8/6/1986 9/16/2021
2021081536 LANJUT 8/20/1989 9/16/2021
2021081536 LANJUT 8/3/1990 9/16/2021
2021081536 LANJUT 10/20/1996 9/16/2021
2021081536 LANJUT 6/27/1975 9/16/2021
2021081536 LANJUT 5/7/1995 9/16/2021
2021081536 LANJUT 4/19/1958 9/16/2021
2021081536 LANJUT 4/16/1995 9/16/2021
9/16/2021 2021081536 LANJUT 11/12/1980 9/16/2021
2021081536 LANJUT 9/9/1978 9/16/2021
2021081536 LANJUT 4/6/1979 9/16/2021
2021081536 LANJUT 5/5/2001 9/16/2021
2021081536 LANJUT 3/10/1992 9/16/2021
2021081536 LANJUT 8/19/1985 9/16/2021
2021081536 LANJUT 6/23/2002 9/16/2021
2021081536 LANJUT 7/8/2001 9/16/2021
2021081536 LANJUT 10/30/1992 9/16/2021
2021081536 LANJUT 12/20/1987 9/16/2021
2021081536 LANJUT 1/3/1977 9/16/2021
2021081536 LANJUT 3/23/2005 9/16/2021
2021081536 LANJUT 1/13/1968 9/16/2021
2021081536 LANJUT 9/22/1969 9/16/2021
2021081536 LANJUT 1/1/1972 9/16/2021
2021081536 LANJUT 6/16/1995 9/16/2021
2021081536 LANJUT 3/16/1998 9/16/2021
2021081536 LANJUT 11/27/2000 9/16/2021
2021081536 LANJUT 3/19/1977 9/16/2021
2021081536 LANJUT 10/21/1982 9/16/2021
2021081536 LANJUT 9/6/1985 9/16/2021
2021081536 LANJUT 3/30/1978 9/16/2021
2021081536 LANJUT 12/12/1974 9/16/2021
2021081536 LANJUT 5/23/1981 9/16/2021
2021081536 LANJUT 2/11/1984 9/16/2021
2021081536 LANJUT 7/24/1985 9/16/2021
2021081536 LANJUT 2/3/1997 9/16/2021
2021081536 LANJUT 6/14/2000 9/16/2021
2021081536 LANJUT 7/27/2001 9/16/2021
2021081536 LANJUT 12/13/2000 9/16/2021
2021081536 LANJUT 4/15/1975 9/16/2021
2021081536 LANJUT 5/1/1999 9/16/2021
2021081536 LANJUT 10/12/2001 9/16/2021
2021081536 LANJUT 12/21/2000 9/16/2021
2021081536 LANJUT 7/25/1997 9/16/2021
2021081536 LANJUT 11/19/1997 9/16/2021
2021081536 LANJUT 10/19/1999 9/16/2021
2021081536 LANJUT 12/5/1999 9/16/2021
2021081536 LANJUT 3/23/2001 9/16/2021
2021081536 LANJUT 8/24/2003 9/16/2021
2021081536 LANJUT 11/8/2001 9/16/2021
2021081536 LANJUT 9/15/1997 9/16/2021
2021081536 LANJUT 1/3/2002 9/16/2021
9/16/2021 2021081536 LANJUT 10/1/2001 9/16/2021
2021081536 LANJUT 11/12/1979 9/16/2021
2021081536 LANJUT 10/20/1984 9/16/2021
2021081536 LANJUT 5/18/1998 9/16/2021
2021081536 LANJUT 3/24/1991 9/16/2021
2021081536 LANJUT 6/20/2003 9/16/2021
2021081536 LANJUT 3/6/1975 9/16/2021
2021081536 LANJUT 10/19/1981 9/16/2021
2021081536 LANJUT 5/9/2003 9/16/2021
2021081536 LANJUT 12/5/1985 9/16/2021
2021081536 LANJUT 3/28/1984 9/16/2021
2021081536 LANJUT 9/21/2001 9/16/2021
2021081536 LANJUT 6/28/1995 9/16/2021
2021081536 LANJUT 4/15/2003 9/16/2021
2021081536 LANJUT 7/1/2003 9/16/2021
2021081536 LANJUT 2/20/2001 9/16/2021
2021081536 LANJUT 9/14/2003 9/16/2021
2021081536 LANJUT 9/15/1980 9/16/2021
2021081536 LANJUT 5/2/2002 9/16/2021
2021081536 LANJUT 8/22/1970 9/16/2021
2021081536 LANJUT 1/29/1989 9/16/2021
2021081536 LANJUT 10/3/1981 9/16/2021
2021081536 LANJUT 7/13/1983 9/16/2021
2021081536 LANJUT 10/24/1974 9/16/2021
2021081536 LANJUT 5/5/1998 9/16/2021
2021081536 LANJUT 11/1/2001 9/16/2021
2021081536 LANJUT 9/5/1980 9/16/2021
2021081536 LANJUT 12/25/1995 9/16/2021
2021081536 LANJUT 1/11/2001 9/16/2021
2021081536 LANJUT 3/10/1996 9/16/2021
2021081536 LANJUT 10/19/1998 9/16/2021
2021081536 LANJUT 9/28/1989 9/16/2021
2021081536 LANJUT 7/15/1974 9/16/2021
2021081536 LANJUT 8/3/1992 9/16/2021
2021081536 LANJUT 9/23/1988 9/16/2021
2021081536 LANJUT 12/29/1997 9/16/2021
2021081536 LANJUT 1/31/1964 9/16/2021
2021081536 LANJUT 6/6/1985 9/16/2021
2021081536 LANJUT 1/19/2001 9/16/2021
2021081536 LANJUT 1/14/1992 9/16/2021
2021081536 LANJUT 12/1/1973 9/16/2021
2021081536 LANJUT 10/23/1999 9/16/2021
2021081536 LANJUT 12/.07/1997 9/16/2021
2021081536 LANJUT 3/19/1966 9/16/2021
2021081536 LANJUT 4/7/1996 9/16/2021
2021081536 LANJUT 4/7/1976 9/16/2021
2021081536 LANJUT 6/2/2001 9/16/2021
2021081536 LANJUT 12/28/2002 9/16/2021
2021081536 LANJUT 9/7/1978 9/16/2021
2021081536 LANJUT 11/22/1972 9/16/2021
2021081536 LANJUT 10/9/2000 9/16/2021
2021081536 LANJUT 6/4/1979 9/16/2021
2021081536 LANJUT 8/27/2004 9/16/2021
2021081536 LANJUT 1/18/1991 9/16/2021
2021081536 LANJUT 1/14/1989 9/16/2021
2021081536 LANJUT 1/21/1997 9/16/2021
2021081536 LANJUT 2/14/1996 9/16/2021
2021081536 LANJUT 5/1/1992 9/16/2021
2021081536 LANJUT 12/29/1982 9/16/2021
2021081536 LANJUT 1/5/1997 9/16/2021
2021081536 LANJUT 7/9/2002 9/16/2021
2021081536 LANJUT 10/13/2000 9/16/2021
2021081536 LANJUT 9/9/2001 9/16/2021
2021081536 LANJUT 11/18/1983 9/16/2021
2021081536 LANJUT 2/3/1964 9/16/2021
2021081536 LANJUT 9/11/1997 9/16/2021
9/16/2021 2021040436 LANJUT 4/6/1986 9/16/2021
Jenis
Kelamin
1 P-WKOGIVGN 3317064102020007 WIDIYA AMELIYA P

2 P-WM4M8OA 3317064411030002 FITRIYA NOVI RAMADHANTI P
3 P-WMHOHA2W 3317066501000001 MAMLU'ATUL MA'RIFAH P
4 P-WM2FBOCI 3317120808940004 KHOIRUL ANWAR L
5 P-WJPJVVMV 3317043008000001 RENDI AGUSTONI L
6 P-WHLMWIEV 3317064408920002 NEGAWATI P
7 P-7LDMM5QO 3317064508870003 UDLHIYAH P
8 P-3CLIVXYM 3317064906950005 SITI ROHMAH P
9 P-1JGBECHI 3510080105010001 AHMAD MUNAWIR ASYAFUQ L
10 P-1YS17BQL 3317061205760001 YAKSUP L
11 P-24OGK4XB 3317061202720003 CHUMAIDI L
12 P-28CGWOIS 3317064506940001 NUR ALIYAH P
13 P-2A687BYB 3317066708630001 KHOTIMAH P
14 P-PO2RIIKD 3317125203870002 HARNITI P
15 P-2DUIYEUP 3319056706030002 DIAH RAHMAWATI P
16 P-3VGD6ID9 3317064701930001 KHUSNUL KHOTIMAH P
17 P-WJIFD1MC 3317066801970001 ROFIAH P
18 P-WNA6XFRO 3317064303000003 SAMROTUL RIZQIA P
19 S-9F49CE60 3317075805620001 SURATI P
20 P-WN9J4OAO 3317070503770003 JOKO SISWANTO L
21 P-WMNCMO8Y 3317061106950005 MUHAMMAD SIFAK L
22 P-WMI4OQN 3317052903930005 MUH.MINANUR ROHMAN L
23 P-WLRLUH3U 3317116712780004 KISWATI P
24 P-WLUQIY4K 3317063101720001 BUSIRI L
25 P-WLIYUPYP 3317065102890003 HAFIDLOH P
26 P-WKQD32BW 3317065508030003 ANIS SULFI NUGRAHENI P
27 P-WKIPCTP8 3317041103000002 SISWANTO L
28 P-WKEIOLU 3317066012000002 TRIMULYATI P
29 P-WJWEMBH 3317066206010005 SITI LUTFIYATUL AF'IDAH P
30 P-WJOX9NOR 3317061506910002 KHOERON L
31 P-WEPX8FDP 3317061010030001 WAHYU SYA'BANA I.CHAKIM L
32 P-6FKYVQU 3317061609820001 MUSTAJAB L
33 P-BU48QSL3 3317126612840001 SITI QOMARIYAH P
34 P-2FQNER19 3317062601800002 ROHMAD L
35 3317060101690011 HATO L
36 P-EE5O6ETO 3317063011970001 MUHLISUN NI'AM L
37 P-IV22GSXW 1173025606940003 NURUL SILVIA P
38 P-SKTSRVOP 3317066512970001 INAYAH P
39 P-1LCEIIG8 3317061011620007 AMIN L
40 P-4SIEXNLN 3317066511080002 NAJMA NAZLATUL JANNAH P
41 P-1KQESVD2 3317062810020004 MOHAMMAD ASHAR L
42 P-1LYD4JYD 3317064304740004 SARIYATI P
43 P-K12FLB2Z 3317062209820002 NUR AMIN L
44 P-1SJRTGT3 3317064804010001 AZIZAH P
45 P-DV82OA7V 3317064406720004 ASIYAH P
46 P-WF3CIJOJ 3317067107040003 SITI NIHLATUL ULYA P
47 P-9MPRBFSX 3317050310880003 SAIFUL ANWAR L
48 P-A6KTTIOL 3317104508970004 NUR ENDAH NOVITASARI P
49 P-3YFG6YYS 3317065009920001 QORI'AH P
50 P-LSAOJWKV 3317065012990005 AMILATUR ROSIDAH P
51 P-A9ONMJQL 3317060104970002 MUHAMMAD SUBKHAN L
52 P-WH8UHO93 3317120407800001 YONGKI VITAMINA L
53 P-WIK6MOJT 3317120305910001 EDI KUSAENI L
54 P-WKSILQ81 3317060409710002 SYAKUR L
55 P-WIPPSAU3 3317045204770004 PATMI P
56 P-WM9UOLOP 3317065206780004 MUNIKAH P
57 S-8BF2FB2B 3317065704590002 SARTI P
58 P-WNDDSGNI 3317066104690001 ASMI P
59 S-B87BAFD3 3317064607650002 KASMIJAH P
60 P-WMLB9DYT 3317065105930002 IANATUN NAFIAH P
61 P-WMSDRVTG 3317061208000001 M.ISHOMUDDIN L
62 P-WN6KISS9 3317121207970001 PUJO WANTIYO L
63 P-WNZUJNHO 3317065907630003 SUKARMI P
64 P-WEXTRDBF 3317054111030003 SITI NUR JANNAH P
65 P-CZOOQCZG 3317060607800011 AHMAD MUZAKKI L
66 P-B18SCREI 3317064204030003 NAILATUL ULYA P
67 P-7YFR4ZKP 3317066811920001 KHUMAEROH P
68 P-2JYCU3OH 3523020312980001 ROHMAD MILAL LUDIN L
69 P-3ZHE8UOC 3317061610020001 ZAINUR ROFIQ L
70 P-3ROQBFXZ 3317061204810008 MUHAMAD ARIF L
71 P-11UCT11J 3317060606000004 M.ALFUN NI'AM L
72 S-69D44AB9 3317065207570003 SARNI P
73 P-4H69GYJA 3317051107830002 HARIYANTO L
74 P-SXVMRMOR 3317064506000003 KHOZAIN NATUL MUNA P
75 P-S8O1X9DU 3317066702020007 LAILATUL MUFIDAH P
76 P-S6FIPR80 3317064607030003 LINDA NURUL FAUZIYAH P
77 S-8BD4F586 3317066104600005 SUMARNI P
78 P-43PPPMRS 3317064505690004 NAJIHAH P
79 P-3TBZCW7S 3317065908030002 SITI NUR HALIMAH P
80 P-1FMILP8W 3317064903670002 ROHMI P
81 P-1PA4FD7J 3317061409050002 RIFKI MAULANA L
82 P-1CGRHWIW 3317065207820003 ROFIATUN P
83 P-I6Q2HQ8C 3317066906950002 ITAKHATUL MINNA P
84 P-2MTNXLEU 3317066410890004 SITI MUTAMIMAH P
85 P-1GBPZ1C7 3317064104800001 NUR LAINI P
86 P-1F1Z47JM 3317064609680003 ASRIYATI P
87 P-2W6CG77Q 3317064604970001 DARIYATUN P
88 P-WFLJR885 3317066612850001 SITI KOTIJAH P
89 P-W1101Z42 3317062107900003 MUHIBUDDIN L
90 P-WIYP6S3H 3523042404880005 SUYONO L
91 P-34NL4P6K 3320042703830002 HERMAN SUSILO L
92 P-1MNPYOXJ 3317065601040003 INAYATUL FADHILAH P
93 P-WJEKETPC 3317065409630001 MASFUNGAH P
94 P-WJFGUTTS 3317066312920002 LU'LUATUS SALAMAH P
95 P-WMCWPFX 3317055401830003 IQOMATUL HASANAH P
96 P-3K68HL75 3317066507990002 YULIA RIZQI FITRIYANI P
97 P-3SMHUBKU 3317062805840001 ARIS ARIYANTO L
98 P-L62MJXOC 3317060901970001 ARI WIBOWO L
99 S-A14BCOC 3317064101600004 JULAIKHAH P
100 P-WFEY2NX9 3317062812890002 MUH ARI ZUBAIDI L
101 P-3OSXUSYI 3317060302710002 ABD.WAHID L
102 P-WKM5SIRB 3317065309000002 WAHYU ALFIO NITA DEFI P
103 S-8ACA4427 3317061901510001 SUDARMIN L
104 P-WJ32XOZE 3317066705030003 ROUDLOTUSSHOLIKHAH P
105 P-WIP2BSVX 3317115803880002 MINDIYARTI P
106 P-WITNRQ93 3317065104860002 ARIESTA WIDYAWATI P
107 P-WIC2YOMA 3317125509940005 ERICA AULIYA FAUZIYAH P
108 P-97IREOW8 3317121808870002 ZAINAL MUSTOFA L
109 P-WDDT8IEG 3317124407840001 JAMILAH P
110 P-4AQOWIP6 3317060106650002 MAHFUDZ L
111 P-1IS2EJNY 3317065406040008 ALFIATUN NI'MAH P
112 P-DAQACSM4 3317064506890006 IANATUL UMMAH P
113 P-1Q4BLY7F 3317060301710004 SUNARKO L
114 P-Z1JZ4KME 3317064809640001 SUMARTINI P
115 P-Z2QDVY57 3317061711850003 UNTUNG RIFAI L
116 P-4PAO279Z 3317061104670001 NAIM L
117 P-2BUEPIKX 3317064707860006 SITI LU'LUAH P
118 P-2HXYSXFY 3317064302900002 ANITA FITHRIYANA P
119 P-KNIT4EAJ 3317061401730002 ABDUL HADI L
120 P-3HTCUART 1807027012850003 PUTRI CANIA P
121 P-WDJIC8AH 3317040411780001 MOHAMMAD SA'DULLAH L
122 P-74GSSQYJ 3317064106860008 UMI KULSUM P
123 P-4S8NYLFY 3317065406860003 MASLIHAH P
124 P-6TCKMWVE 3317064104030002 RUQOYYAH P
125 P-76OHNTXO 3317065511000001 MUNANDIPAH P
126 P-3UXDCSLO 3317061808800003 SYIROJUDIN L
127 P-WOUOK4CP 3317064205840007 KHOIRUN NISA P
128 P-9PXZHVA 3317064812950004 IRNAWATI P
129 P-WEDMEHO 3317061703030004 SIHABBUDIN L
130 P-WIWAQHDA 3317064510840004 SITI MASRUFAH P
131 P-WJAXALK4 3317065409750004 RONDIYATI P
132 P-WJHXVJO2 3317064409850002 SITI CHOLILAH P
133 P-WKI32SEO 3317061008840006 DIMYATI L
134 P-WKARGFKY 3317065712780001 MAHMUDAH P
135 P-OOMKJSRA 3317070207020002 RACHMAT AGUNG SAPUTRA L
136 P-WL9FEFP2 3317066211040001 SITI FATIMAH P
137 P-WLGIALC2 3317062708980004 MUHAMMAD ZAINUL WAFA L
138 P-WMREKYKN 3317042210930001 FATHUR ROHMAN L
139 P-WMTNNVRE 3312226505880003 DWI SURYANI P
140 P-WJ23L7LW 3317066606920008 SITI MURNI P
141 P-WMB68WMC 3317060806000004 MUHAMMAD IZZUL WAFA L
142 P-WME4HATL 3317061908980003 RIFA'I L
143 P-WMYNSHQE 3317063008020005 MUH.ADHA JAZILUN NI'AM L
144 P-WLOIEAOV 3317065901900001 ANIQOTUN NAFIAH P
145 P-WN2IAHO9 3317072804010001 TEGUH IMAM MUSTOFA L
146 P-WLS2NDH 3317066307960002 FIKRI IDAMATUL KHOIROH P
147 P-WJW3PL22 3317060711990006 JODI ANDREYAN L
148 J-OOOOBOYY 3317060611880004 BUSYRA MUKHBITIN L
149 P-SPTRRYT6 3317074405820003 LAUNUL KABIBAH P
150 P-WLYSVPBW 3317064211800001 NARTI'AH P
151 P-MBYJNCES 3317065603980002 SITI MASNUNAH P
152 P-EJNGJPTV 3317065610950003 WAKHIDATUN NURLIYANA P
153 P-3NOVJ21J 1807022809850001 KASTURI L
154 P-OODDAHIQ 3317064706000009 KHOIFATUY YULIA P
155 P-3G2EBSUS 3317060111000004 MOHAMMAD SHOFI L
156 P-38QSUOPJ 3317060312990006 AHMAD NURUL ANWAR L
157 P-CGJGYO14 3317062106900001 MUJAHID L
158 P-3OEPEFKU 3317065706950001 MAMI' FAIZATIN NI'MAH P
159 P-2TS22E1W 3317066912050001 MELANI RAHMAWATI P
160 S-5ADSO9CO 3317060902800005 TAUFIQUR ROHMAN L
161 P-1EICYLZG 3317066404960003 KHOLIDATUN NI'MAH P
162 P-1DM3PUAF 3317066204730001 KASMINAH P
163 P-3CVYTCEK 3317062908030008 FAISAL NUR AFANDI L
164 P-EO2SNURL 3317061504980001 FAHRUL MIZAN L
165 P-26N4BL5B 3317062912020002 AGUNG MACHMUD MUSA L
166 P-20ONQULV 3317066412030001 NANDZIFATUS SHOLIKAH P
167 P-1GQOFSM7 3317062008860004 MUALIM L
168 3317064906810002 KHOTIMAH P
169 3317061009900005 MUSLIH L
170 3317042512770003 SUPRIHADI L
171 3317067112550003 PANGIR L
172 3317065312940001 SITI FATIMAH P
173 3526013001950003 SAED HARIYANTO L
174 3523022611730001 NUR KHOYIN L
175 3317065506670003 SITI UMAMAH P
176 3317065311830001 SITI SOFIYYAH P
177 3317064208870004 IMRO'AH P
178 3317066008650001 MAMIK SUSILOWATI P
179 3317061705870005 NURHASYIM L
180 3317065603820009 INAYATUL MUALLIMAH P
181 3317060709680002 JA'FAR L
182 3317061309790003 MOHAMAD AMIN L
183 3317061808980004 ABDULLAH ASROR FUADI L
184 3317062212020001 KHUMAIDI L
185 3317064503840008 KHOISSORIYAH P
186 3317064401840009 NUR FAIZAH P
187 3317066308880004 JAMILATUN P
188 3316091107940002 SUGIYANTO L
189 3317065204870001 JAMI'AH P
190 3317062003030001 KURNIAWAN DWI ANANDA L
191 3317066106780002 RUTINGAH P
192 1205030103810002 TAUFIK ISMAIL L
193 2171074308820003 SUMARSIH P
194 3317046703680001 SUNARTI P
195 3317065804030001 DELA EJELIKA DWI PUSPITA.S P
196 3317061602790005 SULTHON L
197 3317066510960003 ALFIYATURROHMANIYYAH P
198 3317061708000004 AGUS QOIRUL ANAM L
199 3317075209010003 SITI NAILUL MUNA P
200 3317064704860006 NANI BUDIARTI P
201 3317065812790002 WAHYUNI P
202 3317065002910002 LAILATUN P
203 P-BN3IQHTD 3317146209970003 FADHILA IKA SARI P
204 3317062501970002 M.NAJMUDIN L
205 P-8BJIFHMK 3317064804750002 RIYADLOTUN NAHARIYAH P
206 3317141410850001 ABDULLAH MOKHTAR ALLY L
207 3523084509890002 MU.TAMMIMAH P
208 3317060502000004 SAIFUL ANWAR L
209 3317065208610002 MUYASSAROH P
210 3313126011930001 DHIYAS DIPTANINGTYAS P
211 3317064401000003 FAJRI KAMILAINI UMMAH P
212 3317064607980001 SALSABILA YUMNA FADHILA P
213 3317064509790001 SUMAROH P
214 3317135604780002 MUHAIDAH P
215 3317065411770001 MUSYRI'AH P
216 3317066211010001 MAYA HUSNA FAUZIYAH P
217 3317066810800001 FATONAH P
218 3317065205880005 HUSNUL KHOTIMAH P
219 3317061009650001 HASAN L
220 3317106303940002 NIKMATUL FAUZIYAH P
221 3317046307850004 SITI MAKRIFAH P
222 3317065909910002 FAIQOH P
223 3317061409890006 FAHRUDIN L
224 3317062410860002 JUPRI L
225 3317061606800005 FAIQ L
226 3317106502970001 ULIN NUHA P
227 3317072805800001 LESTARI WIDODO L
228 3317062112890003 ISNADI L
229 3317061709990003 YUSUF KHOIRUDDIN L
230 3317064405990001 FITRI RESTU ARIANI P
231 331701003940002 MOCHAMMAD JOKO SAIFUL L
232 3317145006030001 DORROTUN NISA P
233 3317062711840001 MUHAMMAD ABDI MANAF L
234 3317094505030001 NANDAYANG NANTADJE P
235 3317102907790007 MASSROFI L
236 3317062802500001 MARJUKI L
237 3317045909020002 KALIMAH DIAH AYU LESTARI P
238 3317060310760001 RUSMADI L
239 3317065705930001 INTAN SULISTYA RINI P
240 3317065107980001 SITI KHOLISHOTUL ILMIAH P
241 3317124612010004 SHOIMATUL FITRIYA P
242 3317065012860002 SUMINAH P
243 3317064804920003 FARIDAH P
244 331704204910002 NIDIANING SANDI SUSENO P
245 3317045605010003 CHERLY MEITYA RIKA.K. P
246 3317044603760002 ENDANG SRI HARTINI P
247 3317043001800002 LULUS RIYADI L
248 3317047010860001 KRISWANTI P
249 3317066507880003 KHURUN'IN P
250 3317066207890004 SUYANTI P
251 3317055803970006 USWATUN KHASANAH P
252 3317066104010003 DIVANA AFRY FARCHATINA P
253 3525026104010001 LALUNA DHEA ZURRY P
254 3317064706970003 FATIMATUZ ZAHROH P
255 3317071501980002 M.AGUS FAKHRIZAL L
256 3317100207930002 UNTUNG MUJIANTO L
257 3317044405860002 SATRI P
258 3317040207870001 KOLIL NGAZIS L
259 3317075501910003 LUSIANA P
260 3317076009880002 SULISTYORINI P
261 3317061909690001 DARI L
262 3317061611000001 AFIKUL ANWAR L
263 2171040104739007 KASHADI L
264 3317061801840001 SYAFIUL MUDDATSIR L
265 3317062908860001 TAUFIQUR ROHMAN L
266 3317101711960003 ONY SUMARSONO L
267 3317065203790008 ZAENAB P
268 3317061103910004 SAIFUL ANWAR L
269 3317120402580001 ABDUL JAMIL L
270 3317120807900001 FARID ZAMAN L
271 3317061908020002 AGUS TAUFIQ L
272 3317013001980001 BAMBANG RIYADI UTOMO L
273 3317101711970002 MUHAMAD MUSTAJAB L
274 3317061909920004 AHMAD SUFYAN L
275 3317075602030003 MUANIS SOLIKAH P
276 3317061407660001 NIDLOM L
277 3317070602000007 YOSEP FERDY NUGROHO L
278 3317066609980002 AHMILATUL MAGHFIROH P
279 3317050206970001 MOH.SYIHABUDDIN L
280 3317062204010001 AHMAD AFRIADI L
281 3317070106960001 AHMAD SETYADI L
282 3317062001950005 AINUR ROFIQ L
283 3317060801870001 M.ZAMRONI L
284 3317040508000003 WILDAN ARI PRASETYA L
285 3317064709550001 LASMINAH P
286 3317061004910005 NUR BAGUS AWALA L
287 3317065606420001 TARKAMAH P
288 3317120402790008 DAE MUKHLISIN L
289 331706035980002 ROIKHUDIN L
290 3317065705710003 JUWARIYAH P

D = Lainnya
E = Tidak Bekerja
Kelompok Umur:
12-17 10
18-30 128
31-45 106
46-59 34
60> 12
Total 290
Pekerjaan:
A 0
B 0
C 0
D 0
E 0
Total 150
Umur Kelompok
Pekerjaan* Alamat
(18-59 tahun) Umur
UMUM 19 18-30 MENORO 04/04

UMUM 27 18-30 KARANGHARJO 01/01
UMUM 29 18-30 PACING 01/01
BUMIL 34 31-45 DADAPAN 02/01
UMUM 18 18-30 TENGGELES 02/01
UMUM 26 18-30 KARAS 04/02
UMUM 18 18-30 PACING 04/02
UMUM 21 18-30 RENDENG 05/02
UMUM 20 18-30 MENORO 03/04
UMUM 39 31-45 PACING 07/03
UMUM 36 31-45 SUMUR TAWANG 04/02
UMUM 41 31-45 KARAS 01/04
UMUM 23 18-30 SEDAN 01/03
UMUM 27 18-30 KARAS 02/03
RENTAN 58 46-59 MENORO 01/05
REMAJA 12 12-17 MENORO 03/04
UMUM 47 46-59 MENORO 01/05
UMUM 32 31-45 JAMBANGAN 05/02
UMUM 21 18-30 SEDAN 02/03
LANSIA 62 60> KARANGASEM 03/02
RENTAN 52 46-59 GANDRIROJO 02/02
LANSIA 64 60> KARANGASEM 01/03
UMUM 28 18-30 SIDOREJO 03./03
UMUM 21 18-30 SEDAN 01/05
REMAJA 17 12-17 BAJINGMEDURO 08/02
REMAJA 18 18-30 KARANGASEM 02/01
UMUM 22 18-30 BESOWO 02/01
UMUM 18 18-30 KUMBO 07/04
UMUM 40 31-45 PACING 02/01
UMUM 21 18-30 SEDAN 01/06
LANSIA 64 60> KENONGO 03/02
UMUM 21 18-30 KARAS 03/04
LANSIA 61 60> SIDOREJO 03/02
REMAJA 16 18-30 SEDAN 04/01
UMUM 24 18-30 SEDAN 04/05
UMUM 35 31-45 MENORO 02/03
UMUM 33 31-45 MENORO 04/04
UMUM 38 31-45 PELEMKEREP 02/03
REMAJA 17 12-17 KEDUNGRINGIN 04/01
UMUM 24 18-30 SEDAN 02/03
LANSIA 61 60> KENONGO 01/02
UMUM 31 31-45 SEDAN 04/05
UMUM 33 31-45 KUMBO 05/03
REMAJA 17 12-17 KEDUNGRINGIN 02/01
UMUM 50 46-59 SEDAN 04/01
UMUM 35 31-45 SEDAN 04/03
RENTAN 54 46-59 LODAN WETAN 01/02
UMUM 18 18-30 SEDAN 02/03
UMUM 36 31-45 MENORO 04/04
UMUM 19 18-30 BAMBAN 02/01
REMAJA 16 12-17 KARANGASEM 01/02
UMUM 27 18-30 SEDAN 03/03
UMUM 33 31-45 WONOKELING 01/08
UMUM 31 31-45 MENORO 04/04
UMUM 21 18-30 SEDAN 01/06
UMUM 23 18-30 SEDAN 02/06
UMUM 20 18-30 JAPEREJO 01/03
UMUM 21 18-30 MENORO 04/04
UMUM 32 31-45 SEDAN 03/01
UMUM 40 31-45 KUMBO 07/04
BUMIL 23 18-30 MENORO 01/02
UMUM 21 18-30 PACING 06/02
UMUM 31 31-45 SEDAN 02/02
UMUM 26 18-30 PELEMKEREP 02/03 MAYONG
REMAJA 15 12-17 SEDAN 03/04
REMAJA 17 12-17 SAMBONG 02/01
UMUM 43 31-45 UKIR 04/01
LANSIA 65 60> SIDOMULYO 02/03
UMUM 26 18-30 KRAMAT 01/01 BANGKALAN
UMUM 47 46-59 SUGIHAN 02/03 JATIROGO
UMUM 18 18-30 SEDAN 01/02
RENTAN 53 46-59 SUMBERMULYO 02/01
UMUM 24 18-30 KARAS 01/03
UMUM 20 18-30 NGEMPLAKREJO 02/01
UMUM 24 18-30 SUMBERGIRANG 02/08
UMUM 24 18-30 SEDAN 02/05
UMUM 35 31-45 NGEMPLAK 03/01
UMUM 32 31-45 NGEMPLAK 03/03
UMUM 21 18-30 KARAS 01/04
LANSIA 60 60> GANDRIROJO 01/04
UMUM 27 18-30 MONDOKAN 05/03
UMUM 43 31-45 MANGGAR 05/02 SLUKE
UMUM 27 18-30 TASIKAGUNG 03/03
UMUM 38 31-45 UKIR 04/01 SALE
UMUM 24 18-30 WARU 04/02
UMUM 22 18-30 KARAS 02/04
UMUM 27 18-30 MOJOREMBUN 01/01
UMUM 18 18-30 JOLOTUNDO 013/06
UMUM 18 18-30 DRESI KULON 01/01
UMUM 42 31-45 SULANG 03/05
LANSIA 71 60> SIDOMULYO 02/03
BUMIL 28 18-30 SIDOREJO 02/02
UMUM 19 18-30 BALONGMULYO 01/01
BUMIL 29 18-30 GANDRIROJO 02/03
UMUM 30 18-30 BONGKARAN 09/010
UMUM 20 18-30 GADING 02/02 SALE
UMUM 41 31-45 TAHUNAN 01/01 SALE
UMUM 34 31-45 TAHUNAN 01/01 SALE
UMUM 33 31-45 PACING 04/02
UMUM 24 18-30 LODAN KULON 04/01
UMUM 24 18-30 KUMBO 05/03
UMUM 28 18-30 KASREMAN 01/01
UMUM 35 31-45 SUMBERMULYO 02/01 SALE
RENTAN 52 46-59 SIDOMULYO 02/02
UMUM 48 46-59 KAMPUNGLAMAKABIL 01/03
UMUM 24 18-30 KETANGI 03/01
LANSIA 63 60> TANJUNGSARI 03/01
UMUM 19 18-30 SEDAN 02/03
UMUM 23 18-30 GRAWAN 03/01
UMUM 24 18-30 WARU 06/03 REMBANG
UMUM 29 18-30 MANUKAN KULON 01/04
UMUM 18 18-30 JAPEREJO 01/03
UMUM 21 18-30 SEGOROMULYO 02/02
UMUM 24 18-30 PELANG 04/02
UMUM 25 18-30 SEGOROMULYO 01/02
UMUM 26 18-30 SEDAN 02/05
LANSIA 66 60> BOGOREJO 03/02
UMUM 30 18-30 KARAS 01/01
LANSIA 79 60> BOGOREJO 03/02
UMUM 23 18-30 SEDAN 01/06
BPJS PBI A
BPJS Non PBI B
Non Anggota C
Total D
Pemberian Dosis E
Dosis 1 167 Total
Dosis 2 123
Total 290
NKES/POS VAKSINASI
Kepesertaan BPJS (tulis 'Ya' pada

kolom yang sesuai)
Merek Tanggal
No. Hp
BPJS Non Non Vaksin*** Screening
BPJS PBI
PBI Anggota
081225923290 YA SINOVAC 9/25/2021

08970561822 YA SINOVAC 9/25/2021
0895411771442 YA SINOVAC 9/25/2021
083821167378 YA SINOVAC 9/25/2021
0895414899767 YA SINOVAC 9/25/2021
081365605927 YA SINOVAC 9/25/2021
085257507209 YA SINOVAC 9/25/2021
089644748465 YA SINOVAC 9/25/2021
082325703117 YA SINOVAC 9/25/2021
0882006281000 YA SINOVAC 9/25/2021
085225434961 YA SINOVAC 9/25/2021
08982377677 YA SINOVAC 9/25/2021
082322347096 YA SINOVAC 9/25/2021
085216668305 YA SINOVAC 9/25/2021
089606153017 YA SINOVAC 9/25/2021
089673325858 YA SINOVAC 9/25/2021
089616114460 YA SINOVAC 9/25/2021
085290139366 YA SINOVAC 9/25/2021
085753364983 YA SINOVAC 9/25/2021
081225464199 YA SINOVAC 9/25/2021
089652446313 YA SINOVAC 9/25/2021
081327731665 YA SINOVAC 9/25/2021
085215670752 YA SINOVAC 9/25/2021
085867848054 YA SINOVAC 9/25/2021
085113393669 YA SINOVAC 9/25/2021
0896553219746 YA SINOVAC 9/25/2021
082323692273 YA SINOVAC 9/25/2021
085226388889 YA SINOVAC 9/25/2021
082328885695 YA SINOVAC 9/25/2021
085290095712 YA SINOVAC 9/25/2021
082138654448 YA SINOVAC 9/25/2021
089509929187 YA SINOVAC 9/25/2021
085702725464 YA SINOVAC 9/25/2021
085329690784 YA SINOVAC 9/25/2021
081213949465 YA SINOVAC 9/25/2021
089541211993 YA SINOVAC 9/25/2021
082277414724 YA SINOVAC 9/25/2021
081903238614 YA SINOVAC 9/25/2021
082225382294 YA SINOVAC 9/25/2021
085225086820 YA SINOVAC 9/25/2021
088216700392 YA SINOVAC 9/25/2021
08222532294 YA SINOVAC 9/25/2021
085329085280 YA SINOVAC 9/25/2021
081902533214 YA SINOVAC 9/25/2021
0859166066978 YA SINOVAC 9/25/2021
08990529671 YA SINOVAC 9/25/2021
083873102360 YA SINOVAC 9/25/2021
081215705170 YA SINOVAC 9/25/2021
081903891132 YA SINOVAC 9/25/2021
085806923429 YA SINOVAC 9/25/2021
085225554577 YA SINOVAC 9/25/2021
081393566635 YA SINOVAC 9/25/2021
0895412517070 YA SINOVAC 9/25/2021
088225116511 YA SINOVAC 9/25/2021
0813228908958 YA SINOVAC 9/25/2021
085878762583 YA SINOVAC 9/25/2021
081251818663 YA SINOVAC 9/25/2021
082323395722 YA SINOVAC 9/25/2021
085221692921 YA SINOVAC 9/25/2021
081327731665 YA SINOVAC 9/25/2021
083156714216 YA SINOVAC 9/25/2021
081327800199 YA SINOVAC 9/25/2021
0895422917026 YA SINOVAC 9/25/2021
081225300672 YA SINOVAC 9/25/2021
085225864512 YA SINOVAC 9/25/2021
085225864512 YA SINOVAC 9/25/2021
089539548800 YA SINOVAC 9/25/2021
081335563921 YA SINOVAC 9/25/2021
083128004402 YA SINOVAC 9/25/2021
089529732093 YA SINOVAC 9/25/2021
08992605599 YA SINOVAC 9/25/2021
0859166066978 YA SINOVAC 9/25/2021
081231921424 YA SINOVAC 9/25/2021
08895515186 YA SINOVAC 9/25/2021
083191494024 YA SINOVAC 9/25/2021
0895325431990 YA SINOVAC 9/25/2021
082144004392 YA SINOVAC 9/25/2021
085740185918 YA SINOVAC 9/25/2021
082138486475 YA SINOVAC 9/25/2021
082324200467 YA SINOVAC 9/25/2021
08817686243 YA SINOVAC 9/25/2021
083146724817 YA SINOVAC 9/25/2021
082248572410 YA SINOVAC 9/25/2021
082314205552 YA SINOVAC 9/25/2021
082324200467 YA SINOVAC 9/25/2021
082321168239 YA SINOVAC 9/25/2021
082133299222 YA SINOVAC 9/25/2021
082257031652 YA SINOVAC 9/25/2021
082335379788 YA SINOVAC 9/25/2021
085325573069 YA SINOVAC 9/25/2021
087733900624 YA SINOVAC 9/25/2021
083843390187 YA SINOVAC 9/25/2021
082323737481 YA SINOVAC 9/25/2021
082328253585 YA SINOVAC 9/25/2021
082151234524 YA SINOVAC 9/25/2021
082134806268 YA SINOVAC 9/25/2021
082314890069 YA SINOVAC 9/25/2021
085806923429 YA SINOVAC 9/25/2021
082134473187 YA SINOVAC 9/25/2021
081272271240 YA SINOVAC 9/25/2021
085257579476 YA SINOVAC 9/25/2021
082241602950 YA SINOVAC 9/25/2021
082323737481 YA SINOVAC 9/25/2021
081271314720 YA SINOVAC 9/25/2021
085540274388 YA SINOVAC 9/25/2021
082136890229 YA SINOVAC 9/25/2021
0895412517070 YA SINOVAC 9/25/2021
082313832600 YA SINOVAC 9/25/2021
085339391313 YA SINOVAC 9/25/2021
085740185918 YA SINOVAC 9/25/2021
082247489502 YA SINOVAC 9/25/2021
085226446323 YA SINOVAC 9/25/2021
085325324503 YA SINOVAC 9/25/2021
0895326369005 YA SINOVAC 9/25/2021
083836936962 YA SINOVAC 9/25/2021
081225070404 YA SINOVAC 9/25/2021
0823322347096 YA SINOVAC 9/25/2021
081225848703 YA SINOVAC 9/25/2021
087786960711 YA SINOVAC 9/25/2021
082324379321 YA SINOVAC 9/25/2021
085225134818 YA SINOVAC 9/25/2021
085257507209 YA SINOVAC 9/25/2021
081231921424 YA SINOVAC 9/25/2021
085878266587 YA SINOVAC 9/25/2021
0882003324383 YA SINOVAC 9/25/2021
085325324892 YA SINOVAC 9/25/2021
085225864512 YA SINOVAC 9/25/2021
0819032328614 YA SINOVAC 9/25/2021
083866189639 YA SINOVAC 9/25/2021
085325573069 YA SINOVAC 9/25/2021
081271314720 YA SINOVAC 9/25/2021
081325599332 YA SINOVAC 9/25/2021
085227856669 YA SINOVAC 9/25/2021
088225116511 YA SINOVAC 9/25/2021
081285933687 YA SINOVAC 9/25/2021
083186172972 YA SINOVAC 9/25/2021
088216577819 YA SINOVAC 9/25/2021
081227178708 YA SINOVAC 9/25/2021
08392145226 YA SINOVAC 9/25/2021
085325573069 YA SINOVAC 9/25/2021
2134482401 YA SINOVAC 9/25/2021
088902851837 YA SINOVAC 9/25/2021
0895414228052 YA SINOVAC 9/25/2021
0882005993044 YA SINOVAC 9/25/2021
088228964239 YA SINOVAC 9/25/2021
082335379788 YA SINOVAC 9/25/2021
081335759547 YA SINOVAC 9/25/2021
085881574913 YA SINOVAC 9/25/2021
081225464199 YA SINOVAC 9/25/2021
5325081112 YA SINOVAC 9/25/2021
085347661732 YA SINOVAC 9/25/2021
085641384080 YA SINOVAC 9/25/2021
085221692921 YA SINOVAC 9/25/2021
081331763397 YA SINOVAC 9/25/2021
081252700415 YA SINOVAC 9/25/2021
089696249815 YA SINOVAC 9/25/2021
088232881774 YA SINOVAC 9/25/2021
081327452647 YA SINOVAC 9/25/2021
089504458224 YA SINOVAC 9/25/2021
082314205552 YA SINOVAC 9/25/2021
089539458800 YA SINOVAC 9/25/2021
085290152192 YA SINOVAC 9/25/2021
089531755959 YA SINOVAC 9/25/2021
0895360013430 YA SINOVAC 9/25/2021
085329441050 YA SINOVAC 9/25/2021
088221291964 YA SINOVAC 9/25/2021
081259547722 YA SINOVAC 9/25/2021
085348055525 YA MODERNA 9/25/2021
085249698146 YA MODERNA 9/25/2021
085235718866 YA MODERNA 9/25/2021
085236443378 YA MODERNA 9/25/2021
085852565951 YA MODERNA 9/25/2021
087833183458 YA MODERNA 9/25/2021
081330196517 YA MODERNA 9/25/2021
- YA MODERNA 9/25/2021
085290152070 YA MODERNA 9/25/2021
082328621878 YA MODERNA 9/25/2021
085776091566 YA MODERNA 9/25/2021
085254577667 YA MODERNA 9/25/2021
081351362916 YA MODERNA 9/25/2021
08974311771 YA MODERNA 9/25/2021
08996177997 YA MODERNA 9/25/2021
08882551705 YA MODERNA 9/25/2021
083843281620 YA MODERNA 9/25/2021
0882006163894 YA MODERNA 9/25/2021
08895159841 YA MODERNA 9/25/2021
088215296590 YA MODERNA 9/25/2021
082322460411 YA MODERNA 9/25/2021
089647575369 YA MODERNA 9/25/2021
088802671609 YA MODERNA 9/25/2021
088229975182 YA MODERNA 9/25/2021
089627687311 YA MODERNA 9/25/2021
085523969152 YA MODERNA 9/25/2021
081575641941 YA MODERNA 9/25/2021
082135620303 YA MODERNA 9/25/2021
085225440846 YA MODERNA 9/25/2021
081248848400 YA MODERNA 9/25/2021
081248848400 YA MODERNA 9/25/2021
089601035677 YA MODERNA 9/25/2021
082133923516 YA MODERNA 9/25/2021
085726853519 YA MODERNA 9/25/2021
089671318568 YA MODERNA 9/25/2021
088216006982 YA MODERNA 9/25/2021
085234667800 YA MODERNA 9/25/2021
089647575390 YA MODERNA 9/25/2021
081398074975 YA MODERNA 9/25/2021
085239667800 YA MODERNA 9/25/2021
085218798023 YA MODERNA 9/25/2021
085226579899 YA MODERNA 9/25/2021
082243985067 YA MODERNA 9/25/2021
085328393958 YA MODERNA 9/25/2021
082322796456 YA MODERNA 9/25/2021
085290900754 YA MODERNA 9/25/2021
082281749772 YA MODERNA 9/25/2021
082136682190 YA MODERNA 9/25/2021
08995951511 YA MODERNA 9/25/2021
089668219297 YA MODERNA 9/25/2021
085878977694 YA MODERNA 9/25/2021
082281749772 YA MODERNA 9/25/2021
089530861775 YA MODERNA 9/25/2021
0813290090808 YA MODERNA 9/25/2021
0838843306868 YA MODERNA 9/25/2021
085327608242 YA MODERNA 9/25/2021
082324857014 YA MODERNA 9/25/2021
082337009265 YA MODERNA 9/25/2021
085236443378 YA MODERNA 9/25/2021
083874960568 YA MODERNA 9/25/2021
081326337866 YA MODERNA 9/25/2021
081227552882 YA MODERNA 9/25/2021
085156317458 YA MODERNA 9/25/2021
088232767260 YA MODERNA 9/25/2021
088239958946 YA MODERNA 9/25/2021
08995854033 YA MODERNA 9/25/2021
082264104747 YA MODERNA 9/25/2021
081350824251 YA MODERNA 9/25/2021
081228478787 YA MODERNA 9/25/2021
081334824792 YA MODERNA 9/25/2021
085736286211 YA MODERNA 9/25/2021
082323932074 YA MODERNA 9/25/2021
089647575369 YA MODERNA 9/25/2021
08532533029 YA MODERNA 9/25/2021
085225472489 YA MODERNA 9/25/2021
082397957180 YA MODERNA 9/25/2021
082171667274 YA MODERNA 9/25/2021
082244370008 YA MODERNA 9/25/2021
085234667800 YA MODERNA 9/25/2021
082281749772 YA MODERNA 9/25/2021
085226826900 YA MODERNA 9/25/2021
081230800040 YA MODERNA 9/25/2021
081228534471 YA MODERNA 9/25/2021
088238565912 YA MODERNA 9/25/2021
085157792167 YA MODERNA 9/25/2021
082137617519 YA MODERNA 9/25/2021
08952565445 YA MODERNA 9/25/2021
089503996174 YA MODERNA 9/25/2021
08112705338 YA SINOVAC 9/25/2021
0895395310494 YA SINOVAC 9/25/2021
- YA SINOVAC 9/25/2021
085325353663 YA SINOVAC 9/25/2021
085234142894 YA SINOVAC 9/25/2021
085861724644 YA SINOVAC 9/25/2021
kerjaan
0
0
0
0
0
149
(Ditunda/Tid
Tanggal ak Tanggal Lahir
Tanggal Pemberian Diberikan/La
No. Batch Pemberian No. Batch
Vaksinasi njut)
Vaksinasi
9/25/2021 20218153G LANJUT 2/1/2002
9/25/2021 20218153G LANJUT 11/4/2003
9/25/2021 20218153G LANJUT 1/25/2000
9/25/2021 20218153G LANJUT 8/8/1994
9/25/2021 20218153G LANJUT 8/30/2000
9/25/2021 20218153G LANJUT 8/4/1992
9/25/2021 20218153G LANJUT 8/5/1987
9/25/2021 20218153G LANJUT 6/9/1995
9/25/2021 20218153G LANJUT 5/1/2001
9/25/2021 20218153G LANJUT 5/12/1976
9/25/2021 20218153G LANJUT 2/12/1972
9/25/2021 20218153G LANJUT 6/5/1994
9/25/2021 20218153G LANJUT 8/27/1963
9/25/2021 20218153G LANJUT 3/12/1987
9/25/2021 20218153G LANJUT 6/27/2003
9/25/2021 20218153G LANJUT 1/7/1993
9/25/2021 20218153G LANJUT 1/28/1997
9/25/2021 20218153G LANJUT 3/3/2000
9/25/2021 20218153G LANJUT 5/18/1962
9/25/2021 20218153G LANJUT 3/5/1977
9/25/2021 20218153G LANJUT 6/11/1995
9/25/2021 20218153G LANJUT 3/29/1993
9/25/2021 20218153G LANJUT 4/2/1978
9/25/2021 20218153G LANJUT 1/31/1972
9/25/2021 20218153G LANJUT 2/11/1989
9/25/2021 20218153G LANJUT 8/15/2003
9/25/2021 20218153G LANJUT 3/11/2000
9/25/2021 20218153G LANJUT 12/20/2000
9/25/2021 20218153G LANJUT 6/22/2001
9/25/2021 20218153G LANJUT 6/15/1991
9/25/2021 20218153G LANJUT 10/10/2003
9/25/2021 20218153G LANJUT 9/16/1982
9/25/2021 20218153G LANJUT 12/26/1984
9/25/2021 20218153G LANJUT 1/26/1980
9/25/2021 20218153G LANJUT 1/1/1969
9/25/2021 20218153G LANJUT 11/30/1997
9/25/2021 20218153G LANJUT 6/16/1994
9/25/2021 20218153G LANJUT 12/25/1997
9/25/2021 20218153G LANJUT 11/10/1962
9/25/2021 20218153G LANJUT 11/25/2008
9/25/2021 20218153G LANJUT 10/28/2002
9/25/2021 20218153G LANJUT 4/3/1974
9/25/2021 20218153G LANJUT 9/22/1982
9/25/2021 20218153G LANJUT 4/8/2001
9/25/2021 20218153G LANJUT 6/4/1972
9/25/2021 20218153G LANJUT 7/31/2004
9/25/2021 20218153G LANJUT 10/3/1988
9/25/2021 20218153G LANJUT 8/5/1997
9/25/2021 20218153G LANJUT 9/10/1992
9/25/2021 20218153G LANJUT 12/10/1999
9/25/2021 20218153G LANJUT 4/1/1997
9/25/2021 20218153G LANJUT 7/4/1980
9/25/2021 20218153G LANJUT 5/5/1991
9/25/2021 20218153G LANJUT 9/4/1972
9/25/2021 20218153G LANJUT 4/12/1977
9/25/2021 20218153G LANJUT 6/12/1978
9/25/2021 20218153G LANJUT 4/17/1959
9/25/2021 20218153G LANJUT 4/21/1969
9/25/2021 20218153G LANJUT 7/6/1957
9/25/2021 20218153G LANJUT 5/11/1993
9/25/2021 20218153G LANJUT 7/15/2000
9/25/2021 20218153G LANJUT 7/12/1997
9/25/2021 20218153G LANJUT 7/19/1963
9/25/2021 20218153G LANJUT 11/1/2003
9/25/2021 20218153G LANJUT 7/6/1980
9/25/2021 20218153G LANJUT 4/2/2003
9/25/2021 20218153G LANJUT 11/28/1992
9/25/2021 20218153G LANJUT 12/3/1998
9/25/2021 20218153G LANJUT 10/16/2002
9/25/2021 20218153G LANJUT 4/12/1981
9/25/2021 20218153G LANJUT 6/6/2000
9/25/2021 20218153G LANJUT 7/12/1957
9/25/2021 20218153G LANJUT 7/11/1983
9/25/2021 20218153G LANJUT 6/5/2000
9/25/2021 20218153G LANJUT 2/27/2002
9/25/2021 20218153G LANJUT 7/6/2003
9/25/2021 20218153G LANJUT 4/21/1960
9/25/2021 20218153G LANJUT 5/5/1969
9/25/2021 20218153G LANJUT 8/19/2003
9/25/2021 20218153G LANJUT 3/9/1967
9/25/2021 20218153G LANJUT 9/14/2005
9/25/2021 20218153G LANJUT 7/12/1982
9/25/2021 20218153G LANJUT 6/29/1995
9/25/2021 20218153G LANJUT 10/24/1989
9/25/2021 20218153G LANJUT 4/1/1980
9/25/2021 20218153G LANJUT 9/6/1968
9/25/2021 20218153G LANJUT 4/6/1997
9/25/2021 20218153G LANJUT 12/26/1985
9/25/2021 20218153G LANJUT 7/21/1990
9/25/2021 20218153G LANJUT 4/24/1988
9/25/2021 20218153G LANJUT 3/27/1983
9/25/2021 20218153G LANJUT 1/16/2004
9/25/2021 20218153G LANJUT 9/14/1963
9/25/2021 20218153G LANJUT 9/7/1999
9/25/2021 20218153G LANJUT 11/14/1983
9/25/2021 20218153G LANJUT 7/25/1999
9/25/2021 20218153G LANJUT 5/28/1984
9/25/2021 20218153G LANJUT 1/9/1997
9/25/2021 20218153G LANJUT 1/1/1960
9/25/2021 20218153G LANJUT 12/28/1989
9/25/2021 20218153G LANJUT 2/3/1971
9/25/2021 20218153G LANJUT 9/13/2000
9/25/2021 20218153G LANJUT 1/19/1951
9/25/2021 20218153G LANJUT 5/27/2003
9/25/2021 20218153G LANJUT 3/18/1988
9/25/2021 20218153G LANJUT 4/11/1986
9/25/2021 20218153G LANJUT 9/15/1994
9/25/2021 20218153G LANJUT 8/18/1987
9/25/2021 20218153G LANJUT 1/10/1984
9/25/2021 20218153G LANJUT 6/1/1965
9/25/2021 20218153G LANJUT 6/14/2004
9/25/2021 20218153G LANJUT 6/5/1989
9/25/2021 20218153G LANJUT 1/3/1971
9/25/2021 20218153G LANJUT 9/8/1964
9/25/2021 20218153G LANJUT 11/17/1985
9/25/2021 20218153G LANJUT 4/11/1967
9/25/2021 20218153G LANJUT 7/7/1986
9/25/2021 20218153G LANJUT 2/3/1990
9/25/2021 20218153G LANJUT 1/14/1973
9/25/2021 20218153G LANJUT 8/18/1985
9/25/2021 20218153G LANJUT 11/4/1979
9/25/2021 20218153G LANJUT 6/1/1986
9/25/2021 20218153G LANJUT 6/14/1986
9/25/2021 20218153G LANJUT 4/1/2003
9/25/2021 20218153G LANJUT 11/15/2000
9/25/2021 20218153G LANJUT 8/18/1980
9/25/2021 20218153G LANJUT 5/2/1984
9/25/2021 20218153G LANJUT 12/8/1995
9/25/2021 20218153G LANJUT 3/17/2003
9/25/2021 20218153G LANJUT 10/5/1984
9/25/2021 20218153G LANJUT 9/14/1975
9/25/2021 20218153G LANJUT 9/4/1985
9/25/2021 20218153G LANJUT 8/10/1984
9/25/2021 20218153G LANJUT 12/17/1978
9/25/2021 20218153G LANJUT 7/2/2002
9/25/2021 20218153G LANJUT 11/22/2004
9/25/2021 20218153G LANJUT 8/27/1998
9/25/2021 20218153G LANJUT 10/22/1993
9/25/2021 20218153G LANJUT 5/25/1988
9/25/2021 20218153G LANJUT 6/26/1990
9/25/2021 20218153G LANJUT 6/8/2000
9/25/2021 20218153G LANJUT 8/19/1998
9/25/2021 20218153G LANJUT 8/30/2002
9/25/2021 20218153G LANJUT 1/19/1990
9/25/2021 20218153G LANJUT 4/28/2001
9/25/2021 20218153G LANJUT 7/23/1996
9/25/2021 20218153G LANJUT 11/7/1999
9/25/2021 20218153G LANJUT 11/6/1988
9/25/2021 20218153G LANJUT 5/4/1982
9/25/2021 20218153G LANJUT 11/2/1980
9/25/2021 20218153G LANJUT 3/16/1998
9/25/2021 20218153G LANJUT 10/16/1995
9/25/2021 20218153G LANJUT 9/28/1985
9/25/2021 20218153G LANJUT 6/7/2000
9/25/2021 20218153G LANJUT 11/1/2000
9/25/2021 20218153G LANJUT 12/3/1999
9/25/2021 20218153G LANJUT 6/21/1990
9/25/2021 20218153G LANJUT 6/17/1995
9/25/2021 20218153G LANJUT 12/29/2005
9/25/2021 20218153G LANJUT 2/9/1980
9/25/2021 20218153G LANJUT 4/24/1996
9/25/2021 20218153G LANJUT 4/22/1973
9/25/2021 20218153G LANJUT 8/29/2003
9/25/2021 20218153G LANJUT 4/15/1998
9/25/2021 20218153G LANJUT 12/29/2002
9/25/2021 20218153G LANJUT 12/24/2003
9/25/2021 20218153G LANJUT 8/20/1986
9/25/2021 023021A LANJUT 6/9/1981
9/25/2021 023021A LANJUT 9/10/1990
9/25/2021 023021A LANJUT 12/25/1977
9/25/2021 023021A LANJUT 12/31/1955
9/25/2021 023021A LANJUT 12/13/1994
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9/25/2021 023021A LANJUT 6/15/1967
9/25/2021 023021A LANJUT 11/13/1983
9/25/2021 023021A LANJUT 8/2/1987
9/25/2021 023021A LANJUT 8/20/1965
9/25/2021 023021A LANJUT 5/17/1987
9/25/2021 023021A LANJUT 3/18/1982
9/25/2021 023021A LANJUT 9/7/1968
9/25/2021 023021A LANJUT 9/13/1979
9/25/2021 023021A LANJUT 8/18/1998
9/25/2021 023021A LANJUT 12/22/2002
9/25/2021 023021A LANJUT 3/5/1984
9/25/2021 023021A LANJUT 1/4/1984
9/25/2021 023021A LANJUT 8/23/1988
9/25/2021 023021A LANJUT 7/11/1994
9/25/2021 023021A LANJUT 4/12/1987
9/25/2021 023021A LANJUT 3/20/2003
9/25/2021 023021A LANJUT 6/12/1978
9/25/2021 023021A LANJUT 3/1/1981
9/25/2021 023021A LANJUT 8/3/1982
9/25/2021 023021A LANJUT 3/27/1968
9/25/2021 023021A LANJUT 4/18/2003
9/25/2021 023021A LANJUT 2/16/1979
9/25/2021 023021A LANJUT 10/25/1996
9/25/2021 023021A LANJUT 8/17/2000
9/25/2021 023021A LANJUT 9/12/2001
9/25/2021 023021A LANJUT 4/7/1986
9/25/2021 023021A LANJUT 12/18/1979
9/25/2021 023021A LANJUT 2/10/1991
9/25/2021 023021A LANJUT 9/22/1997
9/25/2021 023021A LANJUT 1/25/1997
9/25/2021 023021A LANJUT 4/8/1975
9/25/2021 023021A LANJUT 10/14/1985
9/25/2021 023D21A LANJUT 9/6/1989
9/25/2021 023D21A LANJUT 2/6/2000
9/25/2021 023D21A LANJUT 8/12/1961
9/25/2021 023D21A LANJUT 11/20/1993
9/25/2021 023D21A LANJUT 1/4/2000
9/25/2021 023D21A LANJUT 7/6/1998
9/25/2021 023D21A LANJUT 9/5/1979
9/25/2021 023D21A LANJUT 4/16/1978
9/25/2021 023D21A LANJUT 11/14/1977
9/25/2021 023D21A LANJUT 11/22/2001
9/25/2021 023D21A LANJUT 10/28/1980
9/25/2021 023D21A LANJUT 5/12/1988
9/25/2021 023D21A LANJUT 9/10/1965
9/25/2021 023D21A LANJUT 3/23/1994
9/25/2021 023D21A LANJUT 2/23/1983
9/25/2021 023D21A LANJUT 9/19/1991
9/25/2021 023D21A LANJUT 9/14/1989
9/25/2021 023D21A LANJUT 10/24/1986
9/25/2021 023D21A LANJUT 6/16/1980
9/25/2021 023D21A LANJUT 2/25/1997
9/25/2021 023D21A LANJUT 5/28/1980
9/25/2021 023D21A LANJUT 12/21/1989
9/25/2021 023D21A LANJUT 9/17/1999
9/25/2021 023D21A LANJUT 5/4/1999
9/25/2021 023D21A LANJUT 3/10/1994
9/25/2021 023D21A LANJUT 6/10/2003
9/25/2021 023D21A LANJUT 11/27/1984
9/25/2021 023D21A LANJUT 5/5/2003
9/25/2021 023D21A LANJUT 7/29/1979
9/25/2021 023D21A LANJUT 2/28/1950
9/25/2021 023D21A LANJUT 9/19/2002
9/25/2021 023D21A LANJUT 10/3/1976
9/25/2021 023D21A LANJUT 5/17/1993
9/25/2021 023D21A LANJUT 7/11/1998
9/25/2021 023D21A LANJUT 12/6/2001
9/25/2021 023D21A LANJUT 12/10/1986
9/25/2021 023D21A LANJUT 4/8/1992
9/25/2021 023D21A LANJUT 4/2/1991
9/25/2021 023D21A LANJUT 5/16/2001
9/25/2021 023D21A LANJUT 3/6/1976
9/25/2021 023D21A LANJUT 1/30/1980
9/25/2021 023D21A LANJUT 10/30/1986
9/25/2021 023D21A LANJUT 7/25/1988
9/25/2021 023D21A LANJUT 7/22/1989
9/25/2021 023D21A LANJUT 3/18/1997
9/25/2021 023D21A LANJUT 4/21/2001
9/25/2021 023D21A LANJUT 4/21/2001
9/25/2021 023D21A LANJUT 6/7/1997
9/25/2021 023D21A LANJUT 1/15/1998
9/25/2021 023D21A LANJUT 7/2/1993
9/25/2021 023D21A LANJUT 5/4/1986
9/25/2021 023D21A LANJUT 7/2/1987
9/25/2021 023D21A LANJUT 1/15/1991
9/25/2021 023D21A LANJUT 9/20/1988
9/25/2021 023D21A LANJUT 9/19/1969
9/25/2021 023D21A LANJUT 11/16/2000
9/25/2021 023D21A LANJUT 4/1/1973
9/25/2021 023D21A LANJUT 1/18/1984
9/25/2021 023D21A LANJUT 8/29/1986
9/25/2021 023D21A LANJUT 11/17/1996
9/25/2021 023D21A LANJUT 3/12/1979
9/25/2021 023D21A LANJUT 3/11/1991
9/25/2021 023D21A LANJUT 2/4/1958
9/25/2021 023D21A LANJUT 7/8/1990
9/25/2021 023D21A LANJUT 8/19/2002
9/25/2021 023D21A LANJUT 1/30/1998
9/25/2021 023D21A LANJUT 11/17/1996
9/25/2021 023D21A LANJUT 9/19/1992
9/25/2021 023D21A LANJUT 2/16/2003
9/25/2021 023D21A LANJUT 7/14/1966
9/25/2021 023D21A LANJUT 2/6/2000
9/25/2021 023D21A LANJUT 9/26/1998
9/25/2021 023D21A LANJUT 6/2/1997
9/25/2021 023D21A LANJUT 4/22/2001
9/25/2021 023D21A LANJUT 6/1/1996
9/25/2021 023D21A LANJUT 1/20/1995
9/25/2021 - LANJUT 1/8/1987
9/25/2021 - LANJUT 8/5/2000
9/25/2021 - LANJUT 9/7/1955
9/25/2021 - LANJUT 4/10/1991
9/25/2021 - LANJUT 6/16/1942
9/25/2021 - LANJUT 2/4/1979
9/25/2021 - LANJUT 4/3/1998
9/25/2021 - LANJUT 5/17/1971
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Jenis
Kelamin
1 P-WUC8PQMS 3317066209050001 NOFA ALISTYANA P
2 P-XJ70EULQ 3317061105040002 M.FARIS MUSTOFA L

3 P-XHZWRCBQ 3317062201050001 ADI SETIAWAN L
4 P-XETWYUVU 3317062101050001 HENDRI EKA PAMBUDI L
5 P-XFXZ6A9S 3317064204040004 NILNA MIN HATILLAH P
6 P-XGQUO5JA 3317060504040001 MUHAMAD BURHAN NUR.A L
7 P-XAL7KV2Y 3317062409050003 MUHAMMAD KELVIN L
8 P-XBA6RANN 3317062011050002 BAHAK UDIN L
9 P-WUXA4LTW 3317066605050004 DWI MISNA WATI P
10 P-XHFVPCYW 3317060808040002 CHOIRUL ANWAR L
11 P-XUZJUVXD 3318081212050001 HARIYANTO L
12 P-X4MAHJBI 3317066905060001 SIFATUN NI'MAH P
13 P-XIKYAMSJ 3317061612030002 M.SUBHAN L
14 P-X6MQO7QG 3317060607020001 MOH.ALI INSAN L
15 P-XFE4MSE6 3317115911040001 NUR AFIFAH P
16 P-XGHB6TQR 3317061305040001 DONY WIBISONO L
17 P-XHFOCGPA 3317061907040001 WAHYUDI L
18 P-XE2YET6I 3317061309050002 ACHMAD ALVIN NAJAH L
19 P-XCHDHEAP 3317065505050001 KISMATUL QOIRIYAH P
20 P-X9E26RF9 3317062612050001 MUHAMAD RIFQI TSALASA L
21 P-V269E6OP 3317111201090002 KHOIRUL ANWAR L
22 P-RX34050V 3317065508080001 ARINA RUSIDAH P
23 P-W3LQ58T2 3317060511080001 MOHAMMAD ROGHIB L
24 P-TBFFU8YU 3317061604090001 ANANDA RIYAN PRATAMA L
25 P-O076WEX7 3317064307080002 NABILATUL MU'MINAH P
26 P-MGAANWZE 3317066301090001 YUSROH FARIHA P
27 P-PZCVUOF7 3317064406090001 ANIQOTUL JAZILAH P
28 P-OLPMAVIF 3317066801080001 HIMMATUL ALIYAH P
29 P-WSTQT9DV 3317062311060001 NUR MAHMUDI L
30 P-WJOLQRJE 3317061604060001 SYAHRUL AFANDI L
31 P-UFK9VY1T 3317112406080001 WAHYU EKA SAPUTRA L
32 P-VCUTNEI9 3317065302080003 ALIYYATUL HIMMAH P
33 P-W3INMRNR 3317061303090001 AHMAD TAMSIR YUSUF L
34 P-VCX9DFV9 3317065504080001 SYAFINATUN NAJAH P
35 P-LJWR5IID 3317065012080001 ALFITA PUTRI CAHYANI P
36 P-JV9P9LWY 3317060306080002 MUH. MUNIFUL AMIN L
37 P-P8NXAINH 3317063110080001 MUH.HAFIDZ ALFANSYAH L
38 P-LLUEKF2K 3317061406090002 MIFTAHUL ASROR L
39 P-REWVJMUG 3317066707090001 TIA FANI SAFITRI P
40 P-TMMM1DUX 3317065911080001 HADZIQOTUL MA'RIFAH P
41 P-U7513LTV8 3317064203090001 NABILATUL FIKRIYAH P
42 P-VOQKOH56 3317061603090001 DZUL FAHMIRROJIH L
43 P-UMGEYIG2 3317065803080001 NISWATUL MUHIMMAH P
44 P-W4QAM13E 3317064708080002 CHOIRUN NIKMAH P
45 P-I1ZCII6J 3317066305090002 SAFAATUL UMMAH NUR.M P
46 P-QR7RUOJO 3578135810080001 DARIYA NAFISA.R.M P
47 P-O5107FGH 3317111612080001 MOH.FAIF FADLI L
48 P-S19BLUGI 3317110307090001 AHMAD JEFRI MAULANA L
49 P-MV4LTUIX 3317061106080001 HAKIMUL FATAH L
50 P-HDR2F3JV 3317066611080001 NAILATUL BAROKAH P
51 P-WCASZ7XS 3317112710080001 MUH.ULIL MABRUR L
52 P-WDI57SKM 3317061204070001 MUH.ULIN NUHA L
53 P-WECH6POS 3317062204070001 RAKA ARYA ADHIKUSUMA L
54 P-WF3ZYIQ4 3317061101080002 MUH.IRFAN MAULANA L
55 P-WFUTIR2J 3317065612080003 SAFA'ATUN NI'MAH P
56 P-W69REOU9 3317067009080002 SITI NUR LAILATUL .F. P
57 P-W7VV6U2K 3317065406070001 SHINDY DZATUL FAIDHOH
58 P-W9VRUPLU 3317061004080002 MUH.NAILATUL KHUSNA L
59 P-W9HMYGDS 3317061201070001 MUH.ILHAM MAULANA L
60 P-WAPOS61V 3317064401080001 KHAMILATUS SYARI'AH P
61 P-WECEXCKQ 3317065507080001 SITI HALIMAHTUS.S. P
62 P-WC78NRXB 3317061201080001 WIWIT ANDIKA L
63 P-WFLDTF6N 3317062309080002 SATRIO WAHYU.R. L
64 P-WG5QKRZB 3317066207080004 SOFWATUN NI'AM L
65 P-W68E2WO5 3317060103080004 BAGAS ARDIYANTO L
66 P-W7DOSLLA 3317090603080001 DIMAS TAUFIK ROKHIM L
67 P-W8WS3KIS 3317111204060001 NUR ROHMAT L
68 P-WAFH09HS 3317064904080002 DINA ARYANI P
69 P-WACO8LIM 3317066007070002 SITI MUFATKHIROH P
70 P-WAX8Y367 3317112507080004 BUDI SETIAWAN L
71 P-WDIHNRHQ 3317062010070001 MUH.RIDHO FITRAYANA L
72 P-WEVK9SFL 3317063112070001 M.ARDIANSYAH L
73 P-WF34BSNB 3317067005070001 DAHLIA INDANA P
74 P-WFTYGG6F 3317065211080001 SOSIATUL ILMIAH P
75 P-WGILCSLC 3317066612070001 INTAN NUR AINI P
76 P-W6XYYTLS 3317065209080003 BADI'ATUS SYAMSIYAH P
77 P-W8MMLYTP 3317061902080002 MUH.FARCHAN FUADY L
78 P-W9PJEFSF 3317062001080002 SYAIFULM WAFI L
79 P-W8BPWEEN 3317064511070001 ATIKATUL MAULANA P
80 P-WAVIFIPM 3317062110060001 MUHAMMAD SAIFUL L
81 P-WM8M8DUO 3317064910060001 NISFATUL RAMADANI P
82 P-WMSTCODH 3317065202070003 ATIYATUL MAULA P
83 P-WLDXEOO1 3317115502060001 SOFI PUTRI NOVITA SARI P
84 P-WNCRBQGU 3317065910060001 ROHMA FITRI'ANI P
85 3317122707060001 KHOIRUR ROZIKIN L
86 P-WH8UJ63G 3317065012070001 ANISATUL ZAHRA P
87 P-WHS7RIHO 3317116003080001 SITI HERLINA DWIWATI P
88 P-WHRSPAAG 3317065505080001 WADHIHATUN NI'MAH P
89 P-WKHYIBHL 3317062807060003 M.SYAMSU DLUHA L
90 P-WKCRCYII 3317060108070001 SALMA FITRIANI P
91 P-WJWYLSG9 3317066707060001 BADIATUL MALIKHA P
92 P-WIGINQ4E 3317064502070002 SITI MARDHIYAH P
93 P-WOKTO4Y3 3317061208060010 SAIFUL ANWAR L
94 P-WH4SJIS2 3317110304070002 AHMAD MUSHOFIHIN L
95 P-WHUOKF8Z 3317064911060001 ALIYATIN ILMIYAH P
96 P-WILE8JOD 3317065211070001 SALSA BILA KHOIRUN.N. P
97 P-WJDYO1WZ 3317115901080003 LILIS SUSANTI P
98 P-WJYMLEJR 3317064203080003 HESTI INDAH MULYANI P
99 P-WKLXSTVL 3523024407070002 REVINA NURUL.G. P
100 P-WCS6CPKS 3317062212070001 AHMAD SUWONDHO L
101 P-WBC2OODI 3317064412070001 NAELA IMROATUS.S. P
102 P-W6QXVRCI 3317064208090001 SHOLIKHATUN NIKMAH P
103 P-WLJDBIWU 3317064609060004 ROHMATUL HASANAH P
104 P-WBF7XYGM 3317066810070001 HABIBATUL KHOIROH P
105 P-WNIZ4SHS 3317066006060001 FITROTUL MAULIDIYA P
106 P-WM6XAFVC 3317061404060001 MUHAMAD KHOIZUNNIAM L
107 P-WXCJ2B37 3317060301070001 MUHAMMAD NOOR IRFAN L
108 P-WLZGIMSV 3317065807060001 NI'MATUN NAFIAH P
109 P-WMZRK9K2 3317065905070001 SHOFIATUS SA'ADAH P
110 P-WNVDNVZW 3317062604060001 SYARIFUDIN HADI.M. L
111 P-WO62FI2C 3317061210060002 REZANI L
112 P-WH8L4SVK 3317110805070001 MOH.FARID MABRUR L
113 P-YIVDUZOZ 3317064906800001 SUPIYATI P
114 P-YHGUG1IV 3317061001710001 M.ANSORI L
115 P-YGFCY9RX 3317064501840001 HIDAYATUN NIKMAH P
116 P-YGHCRALF 3317064504690005 WARISIH P
117 P-YFJXWPO4 3317065205810001 SUTINI P
118 P-YFESYHUK 3317061203630001 MUNAJAT L
119 P-YFSYJQ9Q 3317064710800001 SUMARNI P
120 P-YEVGOUTF 3317062304000003 TAUFIQURROMAN L
121 P-YEM452ZF 3317065603010002 KHOIROTUN NISA' P
122 P-YE3EJNLL 3317065704840002 DARWATI P
123 P-YSQGU2MY 3317065304840003 DARILAH NAFISATUL P
124 P-Y5M6KNJF 3317067108840003 SURINI P
125 P-Y60AVBDI 3317066404030003 DURROTUN NA'IM P
126 P-Y723SB2Z 3317065107030001 SOFIYAH P
127 P-Y7HLV787 3317066604650001 DASIKAH P
128 P-Y9EDVZRV 3317065007020002 DAIMATUR ROHMAH P
129 P-Y9ZSTS3B 3317066503020002 UMMU QOYYIMAH P
130 P-YCVKBOGT 3317064808820001 WARTINI P
131 P-YDFWJTQK 3317060510760002 KUNADI L
132 P-YDKIMRZO 3317065209790002 PATMIATI P
133 P-XVDOCUJA 3317065910980005 ARINA HIMMATUL AULIA P
134 P-XWAE39FI 3317064205840002 FATIMAH P
135 P-XXFL6PAC 3317062605010001 AHMAD HASANUDDIN L
136 P-XXYZVIQF 3317062308030001 MUH.SYAFIUL MUKHTAR L
137 P-XZ4DTDGZ 3317065203830003 RINI SUPAIDAH P
138 P-XZLIWHNU 3317065501930003 NUR HASANAH P
139 P-YIUUS436 2171114705809009 KARTINI P
140 P-Y1UK2MLD 3317065312810002 SUNARTI P
141 P-Y2QHD8PA 3317064802790001 SUNDARI P
142 P-Y4L73GOC 3317062309780004 M.MUNZER L
143 P-XMT4HGQ9 3317061702790001 ASHARI L
144 P-XSBLVWUN 3317066607680001 SAMINI P
145 P-XSHH6SOF 3317065211670001 SAODAH P
146 P-XQJIMILZ 3317065011760001 AMI P
147 P-XSRYW7E4 3317064512720005 JASMI P
148 P-XTRI75LP 3317060102890004 MUSTAQIM P
149 P-YKR6ORK5 3317064102730002 SARTINI P
150 P-YM1WWYYG 3317060502830001 HASRUN L
151 P-YMNONFKY 3317061110710001 SUPRI L
152 P-Y4WDKR8T 3317064701930002 ASIMATUR ROHMAH P
153 P-XLGVCWFB 3317066001910001 AFIFAH P
154 P-XNCUT6FE 3317065012780003 MUNARTI P
155 P-XNFUBJSH 3317065003840005 SRIYATUN P
156 P-XPNHVPC7 3317060611790002 WAHIB L
157 P-XRS6L36K 3317061203650005 SUWONO L
158 P-XR6VQHSW 3317064107700018 KANIFAH P
159 P-XR759GDG 3317064204760003 NGASRINI P
160 P-XT1LCE4N 3317115704930001 SITI NAFIAH P
161 P-XVCJYAJJ 3317065107800007 RASTINI P
162 P-XUPWWNJQ 3317066506920001 KAROMAH P
163 P-XVTW8LSO 3317067107790004 DARMINAH P
164 P-XWYMU4AK 3317065103030003 SITI P
165 P-XXXCNXG6 3317050402890001 A.AFIFFUDIN L
166 P-XYJ7GNHW 3317064802900004 SRI WENI P
167 P-XZKOAQ1I 3317065112900002 ASIYAH P
168 P-Y02QMCFD 3317065510750003 SRI HANDINI P
169 P-YOE657JY 2171116612989003 DEVI YANTI P
170 P-Y2IGI1SC 3317064705880002 DUR SETYOWATI P
171 P-Y3CCI7WL 3317064712950003 MUDRIKAH P
172 P-Y54LAHIR 3317065304970002 THOIFATUL MAHMUDAH P
173 P-Y6BPTNNX 3317064411830002 DARMI P
174 P-Y6RM6S53 3317060602660001 DASMO L
175 P-Y8T3DSDG 3317115003030001 DEVA NUR HIDAYAH P
176 P-YDNNXJCS 3317062301800001 SUKIRNO P
177 P-YDT45HJM 3317064705960003 FAIZATUL MUNA P
178 P-YEEQY1A9 3317064903740002 KASTINI P
179 P-YFTC4A45 3317065409880002 WAONAH P
180 P-YEZSE8DM 3317065907690002 FATHONAH P
181 P-YCM2GWD2 3317064306790003 WASINGAH P
182 P-YCXXK225 3317116801020001 SRI HANDAYANI P
183 P-YG642V6F 3317066604980001 DURROTUN NI'MAH P
184 P-XOIRRBHY 3317060703910008 FAIZIN L
185 P-YH10HEBR 3317060107650019 JAMIN L
186 P-YHVVDYK2 3317061010630002 MUSRI L
187 P-YILEI8VC 3317065601730001 MISRI P
188 P-YISXOS7J 3317060710780002 ZUBAIDI L
189 P-YJ2ZZBYG 3317065207770002 SAFI'AH P
190 P-YL31UFDA 3317064804740001 APSIYAH P
191 S-6231F8D7 3317060307790008 ACHMAT DANDI L
192 P-YLSEXLKY 3317061411980001 DASIRIN L
193 P-YMXFAKSJ 3317145810980001 SITI MUNAWAROH P
194 S-83B0F4DI 3317061705750001 SARMADI L
195 P-YMZ6FSVN 3317065102750004 PARSI P
196 P-YLP9XNRG 3317060901640001 SALIM L
197 S-4A6D34AF 3317065608950001 SITI LAYINATUL AFIDAH P
198 P-YJ8DDJS8 3317064606780006 DARNISIH P
199 P-YIMUBOKZ 3317066107830001 KASMIJAH P
200 P-YI6YGR71 3317065405650002 DASRIPAH P
201 P-YD7P4SJY 3317061004810001 SHOLIHIN L
202 P-YEODE7PG 3317061209830001 JUMALIN L
203 P-YE2Z1BBB 3317060503710002 ABDUL HAFIDH L
204 P-YEDOSQDO 3317064909930002 SITI AFU'AH P
205 P-YD8ZZVCP 3317065703900004 DAIMATUL KHASANAH P
206 P-YCQ38JC8 3317064610800001 JIYATI P
207 P-Y8BKYWMO 3317060808970002 AGUS ALI GHUFRON L
208 P-Y6SYNVIR 3317066004720003 TASRIPAH P
209 P-YSEIDS3G 3317064910960003 KOTIJAH P
210 P-Y4FL87M4 3317110107730022 SUKAHAR L
211 P-Y198MNOO 3317056902920002 MAR'ATUS SOLIKAH P
212 P-YIFCJN2X 3317066707920001 USWATUN HASANAH P
213 P-XZSBJXER 3317060102740006 WASIR L
214 P-XXJS7TJ6 3317062904960002 M.SYAIROZI L
215 P-XXKJDQUD 3317062605880002 TASRIKIN L
216 P-XVR4PGFD 3317066703980001 ZULFINA IDA.M. P
217 P-XUU8GFZ7 3317065203950006 SA'ADATUL UMMAH P
218 P-XTRQQW8 3317114602930002 NUR HASANAH P
219 P-XQJ47NCD 3317065906920003 DURROTUS SYAFA'AH P
220 P-XPR470N4 3317065208880001 FAIZATUN P
221 P-XTRBBZFU 3317064111990006 QOMARIYAH P
222 P-XO5VQTU8 3317064705760001 WAONAH P
223 P-XMNOXFID 3317064307910007 DEWI YULI ROHMAWATI P
224 P-YQUKFHYV 3317065408640002 MARMI P
225 P-XREFXRDW 3317060307740002 ABDULLAH L
226 P-YK15D1HH 3317061303980001 AHMAD MANSYUR L
227 P-YKIEPQWZ 3317112804810002 YUSUF L
228 3317064411920002 PURDANINGSIH P
229 P-YKN61L4O 3317060207670001 NASIR L
230 P-YKDLKNO2 3317066604760002 SRI NINGSIH P
231 P-YJO2BUF4 3317062111010003 AHMAD MA'RUF L
232 P-YJSLUMVR 3317062006800003 KOMARUDDIN L
299
300
A = Petugas Medis dan Non Medis di Fasilitas Pelayana B = Lainnya (Mohon disebutkan jenis vaksin yang diterima Puskesmas
D = Lainnya
E = Tidak Bekerja
Kelompok Umur:
12-17 111
18-30 42
31-45 50
46-59 29
60>
Total
Pekerjaan:
A 0
B 0
C 0
D 0
E 0
Total 150
FORMAT PENCATATAN PELAKSANAAN VAKSINA
TINGKAT PUSKESMAS/FASYANKES/POS VAKSINA

'Ya' pada kolom yang
Umur sesuai)
Kelompok
Pekerjaan* (18-59 Alamat No. Hp
Umur
tahun) BPJS
PBI
REMAJA 16 12-17 KUMBO 010/05 082329362536

REMAJA 17 12-17 LEMAH PUTIH 01/01 081326923520
REMAJA 16 12-17 TRENGGULUNAN 02/01 082128083373
REMAJA 16 12-17 LEMAH PUTIH 04/02 081391064286 YA
REMAJA 17 12-17 KUMBO 08/04 088215703872
REMAJA 17 12-17 KUMBO 07/04 083827780232 YA
REMAJA 15 12-17 KUMBO 03/02 082324734583
REMAJA 16 12-17 KUMBO 010/05 081393574895
REMAJA 17 12-17 KUMBO 010/05 087733984650
REMAJA 15 12-17 KUMBO 09/01 08238358741
REMAJA 17 12-17 KUMBO 01/01 083853941107
REMAJA 16 12-17 TRENGGULUNAN 02/01 087814423130 YA
REMAJA 17 12-17 KUMBO 02/01 083195002252 YA
REMAJA 17 12-17 KUMBO 05/03 085290152225 YA
REMAJA 16 12-17 KUMBO 010/05 083845464421 YA
REMAJA 13 12-17 KUMBO 03/02 082226148682
REMAJA 12 12-17 KUMBO 07/04 082226148682
REMAJA 13 12-17 KUMBO 07/04 082326225928
REMAJA 12 12-17 KUMBO 04/02 082326225928
REMAJA 12 12-17 KUMBO 04/02 082326225928
REMAJA 13 12-17 KUMBO 010/05 082326225928
REMAJA 14 12-17 KUMBO 05/03 082220115631
REMAJA 15 12-17 KUMBO 09/05 085641648174
REMAJA 13 12-17 NGULANGAN 01/01 082226148682
REMAJA 13 12-17 KUMBO 08/04 082226148682
REMAJA 12 12-17 KUMBO 07/04 082226148682
REMAJA 13 12-17 KUMBO 07/04 082226148682
REMAJA 13 12-17 KUMBO 08/04 082326225928
REMAJA 12 12-17 KUMBO 08/04 082326225928
REMAJA 12 12-17 DADAPAN 05/04 - YA
REMAJA 12 12-17 KUMBO 07/04 082226148682
REMAJA 12 12-17 KUMBO 02/01 082226148682 YA
REMAJA 12 12-17 KUMBO 04/02 082226148682 YA
REMAJA 13 12-17 KUMBO 010/05 082226148682 YA
REMAJA 13 12-17 KUMBO 010/05 08222614882 YA
REMAJA 12 12-17 KUMBO 08/04 082326225928
REMAJA 12 12-17 GUNDIH 011/06 SBY 082326225928
REMAJA 12 12-17 NGROTO 06/03 082326225928 YA
REMAJA 13 12-17 KUMBO 08/04 -
REMAJA 12 12-17 KUMBO 09/05 -
REMAJA 12 12-17 NGROTO 01/01 085225098178
REMAJA 14 12-17 KUMBO 010/05 085225098178
REMAJA 14 12-17 LEMAH OUTIH 05/02 085225098178 YA
REMAJA 13 12-17 DADAPAN 01/03 085225098178
REMAJA 13 12-17 SAMBONG 04/03 085290736809
REMAJA 14 12-17 KUMBO 010/05 085290736809
REMAJA 13 12-17 KUMBO 05/03 085290736809
REMAJA 13 12-17 KUMBO 04/02 085225098178
REMAJA 13 12-17 KUMBO 03/02 085225098178
REMAJA 13 12-17 KUMBO 06/03 085290736809
REMAJA 13 12-17 RUMBUTMALANG 02/05 085290730809
REMAJA 13 12-17 KUMBO 03/02 085290736809
REMAJA 14 12-17 KUMBO 07/04 085290736809
REMAJA 13 12-17 NGROTO 03/02 085290736809
REMAJA 13 12-17 KUMBO 01/01 085225098178 YA
REMAJA 14 12-17 KUMBO 07/04 085225098178 YA
REMAJA 13 12-17 KUMBO 07/04 085290736809 YA
REMAJA 13 12-17 KUMBO 010/05 085290736809 YA
REMAJA 14 12-17 KUMBO 01/01 085290736809 YA
REMAJA 15 12-17 KARAS 03/01 082220115631
REMAJA 14 12-17 KUMBO 04/02 082220115631
REMAJA 15 12-17 BENGKONG 01/012 082220115631
REMAJA 15 12-17 TANJUNGAN 05/02 082220115631
REMAJA 13 12-17 KUMBO 04/02 085641648174
REMAJA 15 12-17 KUMBO 010/05 085641648174
REMAJA 15 12-17 KUMBO 02/01 085641648174
REMAJA 15 12-17 KUMBO 01/01 085641648174 YA
REMAJA 14 12-17 KUMBO 04/02 085641648174 YA
REMAJA 15 12-17 KUMBO 05/03 082220115631
REMAJA 14 12-17 NGROTO 02/01 085641648174
REMAJA 12 12-17 KUMBO 09/05 085641648174
REMAJA 13 12-17 KUMBO 010/05 085641648174 YA
REMAJA 13 12-17 KUMBO 05/03 085641648174
REMAJA 14 12-17 BESOWO 05/04 085641648174
REMAJA 13 12-17 KUMBO 08/04 085290736809
REMAJA 12 12-17 KUMBO 08/04 085290736809 YA
REMAJA 15 12-17 KUMBO 08/04 082220115631 YA
REMAJA 13 12-17 KUMBO 07/04 082220115631 YA
REMAJA 15 12-17 KUMBO 02/01 082220115631 YA
REMAJA 15 12-17 KUMBO 09/05 082220115631
REMAJA 15 12-17 KUMBO 05/03 082220115631 YA
REMAJA 14 12-17 DADAPAN 02/04 082220115631
REMAJA 15 12-17 KUMBO 07/04 082220115631
REMAJA 15 12-17 KUMBO 07/04 082220115631
REMAJA 14 12-17 NGROTO 04/02 085641648174
UMUM 41 31-45 KUMBO 05/03 085290713389 YA
UMUM 50 46-59 KUMBO 05/03 085225515749 YA
UMUM 37 31-45 KUMBO 010/05 085290713389 YA
RENTAN 52 46-59 KUMBO 010/05 085225615217 YA
UMUM 40 31-45 KUMBO 010/05 083840342898 YA
RENTAN 58 46-59 LEMAH PUTIH 03/02 087718635673 YA
UMUM 41 31-45 KUMBO 04/02 083865942512 YA
UMUM 21 18-30 KUMBO 08/04 085329467060
UMUM 20 18-30 KUMBO 04/02 083866923819 YA
UMUM 37 31-45 KUMBO 05/03 081340407876 YA
UMUM 37 31-45 KUMBO 04/02 085291264216 YA
UMUM 37 31-45 KUMBO 07/04 085290558257 YA
UMUM 18 18-30 KUMBO 04/02 083105938169 YA
UMUM 18 18-30 KUMBO 08/04 088802681419 YA
RENTAN 56 46-59 KUMBO 03/02 0882006277984 YA
UMUM 19 18-30 DADAPAN 05/04 087814423130
UMUM 19 18-30 KUMBO 07/04 087814423130 YA
UMUM 39 31-45 KUMBO 07/04 085257371499 YA
UMUM 45 31-45 KUMBO 03/02 081325577614
UMUM 42 31-45 LEMAH PUTIH 04/02 082314090290 YA
UMUM 37 31-45 KUMBO 04/02 083843216394 YA
UMUM 20 18-30 KUMBO 010/05 082137999502 YA
UMUM 18 18-30 KUMBO 010/05 082195966826
UMUM 38 31-45 KUMBO 03/02 081225287435 YA
UMUM 28 18-30 KUMBO 03/02 0882006277984 YA
UMUM 41 31-45 KUMBO 04/02 082335856464 YA
UMUM 39 31-45 KUMBO 05/03 081322484234 YA
UMUM 42 31-45 KUMBO 02/01 082324670510 YA
UMUM 43 31-45 KUMBO 06/03 081225314426
UMUM 42 31-45 KUMBO 010/05 085226529024
UMUM 44 31-45 KUMBO 010/05 085865551666 YA
UMUM 32 31-45 KUMBO 05/03 085326002580 YA
UMUM 48 46-59 DADAPAN 03/01 081392122841 YA
UMUM 38 31-45 KUMBO 04/02 082324794338
UMUM 50 46-59 KUMBO 05/03 083843215841 YA
UMUM 28 18-30 KUMBO 08/03 085225515749 YA
UMUM 30 18-30 KUMBO 05/03 085335061218 YA
UMUM 43 31-45 KUMBO 010/05 085226529024 YA
UMUM 37 31-45 KUMBO 010/05 081325328420 YA
UMUM 41 31-45 KUMBO 08/04 082138087892
RENTAN 56 46-59 LEMAH PUTIH 03/02 081718635673
RENTAN 51 46-59 LEMAH PUTIH 01/01 083843362111
UMUM 45 31-45 LEMAH PUTIH 03/02 087718635673
UMUM 41 31-45 LEMAH PUTIH 05/02 082135617275
UMUM 42 31-45 KUMBO 08/03 081393476224 YA
UMUM 18 18-30 KUMBO 06/03 083171169485 YA
UMUM 32 31-45 KUMBO 010/05 082195966826 YA
UMUM 31 31-45 KUMBO 02/01 085327222905 YA
UMUM 30 18-30 KUMBO 03/02 0882006277984 YA
UMUM 45 31-45 KUMBO 03/02 0882006277984
UMUM 22 18-30 KUMBO 04/02 082335856464
UMUM 33 31-45 KUMBO 03/02 085796676254 YA
UMUM 25 18-30 KUMBO 02/01 085245022147 YA
UMUM 24 18-30 KUMBO 08/04 0882005527915 YA
UMUM 37 31-45 KUMBO 04/02 083105938169 YA
RENTAN 55 46-59 KUMBO 03/02 0882006277984 YA
UMUM 18 18-30 TRENGGULUNAN 02/01 087814423130 YA
UMUM 41 31-45 KUMBO 09/05 081277739588 YA
UMUM 25 18-30 KUMBO 04/02 082226217455 YA
UMUM 47 46-59 KUMBO 07/04 085385903603
RENTAN 52 46-59 KUMBO 010/05 088233815180
UMUM 42 31-45 KUMBO 08/04 088802681419 YA
UMUM 20 18-30 TRENGGULUNAN 02/01 087814423130 YA
UMUM 23 18-30 KUMBO 010/05 085225615217 YA
UMUM 30 18-30 MENORO 02/01 088806294701 YA
UMUM 48 46-59 KUMBO 05/03 083865942512 YA
UMUM 44 31-45 KUMBO 05/03 083866923819 YA
UMUM 47 46-59 KUMBO 05/03 083843215841 YA
UMUM 42 31-45 KUMBO 02/01 085290031342 YA
UMUM 22 18-30 KUMBO 06/04 083843215841 YA
UMUM 22 18-30 KUMBO 02/01 085602328354 YA
UMUM 46 46-59 KUMBO 05/03 088232164756 YA
UMUM 46 46-59 KUMBO 02/01 085602328354
RENTAN 57 46-59 DADAPAN 03/01 081392122841
UMUM 26 18-30 DADAPAN 04/01 081392122841
UMUM 43 31-45 KUMBO 05/03 088232164756
UMUM 38 31-45 KUMBO 05/03 081340407876
RENTAN 56 46-59 KUMBO 03/02 083865942512
UMUM 40 31-45 KUMBO 08/04 085292189767
UMUM 38 31-45 KUMBO 010/05 082138783663
UMUM 50 46-59 LEMAH PUTIH 03/02 082325537239
UMUM 28 18-30 KUMBO 02/01 085290031342
UMUM 31 31-45 KUMBO 02/01 085326524252
UMUM 41 31-45 KUMBO 05/03 081330181530
UMUM 24 18-30 KUMBO 01/01 082359213094
UMUM 49 46-59 KUMBO 07/04 081226068329 YA
UMUM 25 31-45 KUMBO 04/02 085225101392
UMUM 48 46-59 NGROTO 04/02 083863424145
UMUM 29 18-30 KUMBO 03/02 082371994681 YA
UMUM 29 18-30 KUMBO 03/02 082371994681
UMUM 47 46-59 KUMBO 03/02 081225025837
UMUM 25 18-30 KUMBO 010/05 082195966826
UMUM 33 31-45 KUMBO 05/03 081225025837
UMUM 23 18-30 LEMAH PUTIH 04/02 082314090290
UMUM 26 18-30 KUMBO 04/02 082135817952
UMUM 28 18-30 KUMBO 05/03 085326002580
UMUM 29 18-30 KUMBO 07/04 085257371499
UMUM 33 31-45 KUMBO 08/04 082138087892
UMUM 21 18-30 LEMAH PUTIH 04/02 083846568300
UMUM 45 31-45 KUMBO 010/05 082314866260 YA
UMUM 30 18-30 KUMBO 04/02 083122613282
RENTAN 57 46-59 KUMBO 04/02 083840342898 YA
UMUM 47 46-59 KUMBO 010/05 083840342898 YA
UMUM 23 18-30 KUMBO 05/03 082136549486 YA
UMUM 40 31-45 KUMBO 05/03 088232164756 YA
UMUM 28 18-30 KUMBO 05/03 088232164756 YA
RENTAN 54 46-59 KUMBO 05/03 082210528469 YA
UMUM 45 31-45 KUMBO 05/03 085253191017 YA
UMUM 19 18-30 KUMBO 05/03 085328229488 YA
UMUM 41 31-45 KUMBO 07/04 082323782536 YA
is vaksin yang diterima Puskesmas/Faskes)

BPJS PBI A 0
BPJS Non PBI B 0
Non Anggota C 0
Total D 0
Pemberian Dosis E 0
Dosis 1 0 Total 149
Dosis 2 0
Total 149
NAAN VAKSINASI COVID-19
S/POS VAKSINASI

'Ya' pada kolom yang Dosis I Dosis 2
sesuai)
Merek Tanggal
Vaksin*** Screening Tanggal Tanggal
BPJS Non
Pemberian No. Batch Pemberian
Non PBI Anggota
Vaksinasi Vaksinasi
YA SINOVAC 10/14/2021 10/14/2021 20210979F

YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
SINOVAC 10/14/2021 10/14/2021 20210979F
SINOVAC 10/14/2021 10/14/2021 20210979F
SINOVAC 10/14/2021 10/14/2021 20210979F
SINOVAC 10/14/2021 10/14/2021 20210979F
SINOVAC 10/14/2021 10/14/2021 20210979F
SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
SINOVAC 10/14/2021 10/14/2021 20210979F
SINOVAC 10/14/2021 10/14/2021 20210979F
SINOVAC 10/14/2021 10/14/2021 20210979F
SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
SINOVAC 10/14/2021 10/14/2021 20210979F
SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
SINOVAC 10/14/2021 10/14/2021 20210979F
SINOVAC 10/14/2021 10/14/2021 20210979F
SINOVAC 10/14/2021 10/14/2021 20210979F
SINOVAC 10/14/2021 10/14/2021 20210979F
SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
SINOVAC 10/14/2021 10/14/2021 20210979F
SINOVAC 10/14/2021 10/14/2021 20210979F
SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
SINOVAC 10/14/2021 10/14/2021 20210979F
SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
SINOVAC 10/14/2021 10/14/2021 20210979F
SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
SINOVAC 10/14/2021 10/14/2021 20210979F
SINOVAC 10/14/2021 10/14/2021 20210979F
SINOVAC 10/14/2021 10/14/2021 20210979F
SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
YA SINOVAC 10/14/2021 10/14/2021 20210979F
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
YA ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
YA ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
YA ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
YA ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
YA ASTRA 10/14/2021 10/14/2021 AB0016
YA ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
YA ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
YA ASTRA 10/14/2021 10/14/2021 AB0016
YA ASTRA 10/14/2021 10/14/2021 AB0016
YA ASTRA 10/14/2021 10/14/2021 AB0016
YA ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
YA ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
YA ASTRA 10/14/2021 10/14/2021 AB0016
YA ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
YA ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
YA ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
YA ASTRA 10/14/2021 10/14/2021 AB0016
YA ASTRA 10/14/2021 10/14/2021 AB0016
YA ASTRA 10/14/2021 10/14/2021 AB0016
YA ASTRA 10/14/2021 10/14/2021 AB0016
YA ASTRA 10/14/2021 10/14/2021 AB0016
YA ASTRA 10/14/2021 10/14/2021 AB0016
YA ASTRA 10/14/2021 10/14/2021 AB0016
YA ASTRA 10/14/2021 10/14/2021 AB0016
YA ASTRA 10/14/2021 10/14/2021 AB0016
YA ASTRA 10/14/2021 10/14/2021 AB0016
YA ASTRA 10/14/2021 10/14/2021 AB0016
YA ASTRA 10/14/2021 10/14/2021 AB0016
YA ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
YA ASTRA 10/14/2021 10/14/2021 AB0016
YA ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
YA ASTRA 10/14/2021 10/14/2021 AB0016
YA ASTRA 10/14/2021 10/14/2021 AB0016
YA ASTRA 10/14/2021 10/14/2021 AB0016
YA ASTRA 10/14/2021 10/14/2021 AB0016
YA ASTRA 10/14/2021 10/14/2021 AB0016
YA ASTRA 10/14/2021 10/14/2021 AB0016
YA ASTRA 10/14/2021 10/14/2021 AB0016
YA ASTRA 10/14/2021 10/14/2021 AB0016
YA ASTRA 10/14/2021 10/14/2021 AB0016
YA ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
YA ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
ASTRA 10/14/2021 10/14/2021 AB0016
Dosis 2 Keterangan
(Ditunda/Tid
ak Tanggal Lahir Tanggal Input
Diberikan/La
No. Batch njut)
LANJUT 9/22/2005 10/14/2021

LANJUT 5/11/2004 10/14/2021
LANJUT 1/22/2005 10/14/2021
LANJUT 1/21/2005 10/14/2021
LANJUT 4/2/2004 10/14/2021
LANJUT 4/4/2004 10/14/2021
LANJUT 9/24/2005 10/14/2021
LANJUT 11/20/2005 10/14/2021
LANJUT 5/26/2005 10/14/2021
LANJUT 8/8/2004 10/14/2021
LANJUT 12/12/2005 10/14/2021
LANJUT 5/29/2006 10/14/2021
LANJUT 12/16/2003 10/14/2021
LANJUT 7/6/2002 10/14/2021
LANJUT 11/19/2004 10/14/2021
LANJUT 5/13/2004 10/14/2021
LANJUT 7/19/2004 10/14/2021
LANJUT 9/13/2005 10/14/2021
LANJUT 5/15/2005 10/14/2021
LANJUT 12/26/2005 10/14/2021
LANJUT 1/12/2009 10/14/2021
LANJUT 6/15/2008 10/14/2021
LANJUT 11/5/2008 10/14/2021
LANJUT 4/15/2009 10/14/2021
LANJUT 7/3/2008 10/14/2021
LANJUT 1/23/2009 10/14/2021
LANJUT 6/4/2009 10/14/2021
LANJUT 1/28/2008 10/14/2021
LANJUT 11/23/2006 10/14/2021
LANJUT 4/16/2006 10/14/2021
LANJUT 6/24/2008 10/14/2021
LANJUT 2/13/2008 10/14/2021
LANJUT 3/13/2009 10/14/2021
LANJUT 4/15/2008 10/14/2021
LANJUT 12/10/2008 10/14/2021
LANJUT 6/3/2008 10/14/2021
LANJUT 10/31/2008 10/14/2021
LANJUT 6/14/2009 10/14/2021
LANJUT 7/27/2009 10/14/2021
LANJUT 11/19/2008 10/14/2021
LANJUT 3/2/2009 10/14/2021
LANJUT 3/16/2009 10/14/2021
LANJUT 3/18/2008 10/14/2021
LANJUT 8/7/2008 10/14/2021
LANJUT 5/23/2009 10/14/2021
LANJUT 10/18/2008 10/14/2021
LANJUT 12/16/2008 10/14/2021
LANJUT 7/3/2009 10/14/2021
LANJUT 6/11/2008 10/14/2021
LANJUT 11/26/2008 10/14/2021
LANJUT 10/27/2008 10/14/2021
LANJUT 4/12/2007 10/14/2021
LANJUT 4/22/2007 10/14/2021
LANJUT 1/11/2008 10/14/2021
LANJUT 12/16/2008 10/14/2021
LANJUT 9/30/2008 10/14/2021
LANJUT 6/14/2007 10/14/2021
LANJUT 4/10/2008 10/14/2021
LANJUT 1/12/2007 10/14/2021
LANJUT 1/4/2008 10/14/2021
LANJUT 7/15/2008 10/14/2021
LANJUT 1/12/2008 10/14/2021
LANJUT 9/23/2008 10/14/2021
LANJUT 7/22/2008 10/14/2021
LANJUT 3/1/2008 10/14/2021
LANJUT 3/6/2008 10/14/2021
LANJUT 4/12/2006 10/14/2021
LANJUT 4/9/2008 10/14/2021
LANJUT 7/20/2007 10/14/2021
LANJUT 7/25/2008 10/14/2021
LANJUT 10/20/2007 10/14/2021
LANJUT 12/3/2007 10/14/2021
LANJUT 5/30/2007 10/14/2021
LANJUT 11/12/2008 10/14/2021
LANJUT 12/26/2007 10/14/2021
LANJUT 9/12/2008 10/14/2021
LANJUT 2/19/2008 10/14/2021
LANJUT 1/20/2008 10/14/2021
LANJUT 11/5/2007 10/14/2021
LANJUT 10/21/2006 10/14/2021
LANJUT 10/9/2006 10/14/2021
LANJUT 2/12/2007 10/14/2021
LANJUT 1/31/2006 10/14/2021
LANJUT 10/19/2006 10/14/2021
LANJUT 7/27/2006 10/14/2021
LANJUT 12/10/2007 10/14/2021
LANJUT 3/20/2008 10/14/2021
LANJUT 5/15/2006 10/14/2021
LANJUT 7/28/2006 10/14/2021
LANJUT 8/1/2007 10/14/2021
LANJUT 7/27/2006 10/14/2021
LANJUT 2/5/2007 10/14/2021
LANJUT 8/12/2006 10/14/2021
LANJUT 4/3/2007 10/14/2021
LANJUT 11/9/2008 10/14/2021
LANJUT 11/12/2007 10/14/2021
LANJUT 1/19/2008 10/14/2021
LANJUT 3/2/2008 10/14/2021
LANJUT 7/4/2007 10/14/2021
LANJUT 12/22/2007 10/14/2021
LANJUT 12/4/2007 10/14/2021
LANJUT 8/2/2009 10/14/2021
LANJUT 9/6/2006 10/14/2021
LANJUT 10/28/2007 10/14/2021
LANJUT 6/20/2006 10/14/2021
LANJUT 4/14/2006 10/14/2021
LANJUT 1/3/2007 10/14/2021
LANJUT 7/18/2006 10/14/2021
LANJUT 5/19/2007 10/14/2021
LANJUT 4/26/2006 10/14/2021
LANJUT 10/12/2006 10/14/2021
LANJUT 5/8/2007 10/14/2021
LANJUT 6/9/1980 10/14/2021
LANJUT 1/10/1971 10/14/2021
LANJUT 1/5/1984 10/14/2021
LANJUT 4/5/1969 10/14/2021
LANJUT 5/12/1981 10/14/2021
LANJUT 3/12/1963 10/14/2021
LANJUT 10/7/1980 10/14/2021
LANJUT 4/23/2000 10/14/2021
LANJUT 3/16/2001 10/14/2021
LANJUT 4/17/1984 10/14/2021
LANJUT 6/13/1984 10/14/2021
LANJUT 8/31/1984 10/14/2021
LANJUT 4/24/2003 10/14/2021
LANJUT 7/11/2003 10/14/2021
LANJUT 4/26/1965 10/14/2021
LANJUT 7/10/2002 10/14/2021
LANJUT 3/25/2002 10/14/2021
LANJUT 8/10/1982 10/14/2021
LANJUT 10/5/1976 10/14/2021
LANJUT 9/12/1979 10/14/2021
LANJUT 10/19/1998 10/14/2021
LANJUT 5/2/1984 10/14/2021
LANJUT 5/26/2001 10/14/2021
LANJUT 8/23/2003 10/14/2021
LANJUT 3/12/1983 10/14/2021
LANJUT 1/15/1993 10/14/2021
LANJUT 5/7/1980 10/14/2021
LANJUT 12/13/1981 10/14/2021
LANJUT 2/8/1979 10/14/2021
LANJUT 9/23/1978 10/14/2021
LANJUT 2/17/1979 10/14/2021
LANJUT 7/26/1968 10/14/2021
LANJUT 11/12/1967 10/14/2021
LANJUT 11/10/1976 10/14/2021
LANJUT 12/5/1972 10/14/2021
LANJUT 2/1/1989 10/14/2021
LANJUT 2/1/1973 10/14/2021
LANJUT 2/5/1983 10/14/2021
LANJUT 10/11/1971 10/14/2021
LANJUT 1/7/1993 10/14/2021
LANJUT 1/20/1991 10/14/2021
LANJUT 12/10/1977 10/14/2021
LANJUT 3/10/1984 10/14/2021
LANJUT 11/6/1979 10/14/2021
LANJUT 3/12/1965 10/14/2021
LANJUT 7/1/1970 10/14/2021
LANJUT 4/2/1976 10/14/2021
LANJUT 4/17/1993 10/14/2021
LANJUT 7/11/1980 10/14/2021
LANJUT 6/25/1992 10/14/2021
LANJUT 7/31/1979 10/14/2021
LANJUT 3/11/2003 10/14/2021
LANJUT 2/4/1989 10/14/2021
LANJUT 2/8/1990 10/14/2021
LANJUT 12/11/1990 10/14/2021
LANJUT 10/15/1975 10/14/2021
LANJUT 12/26/1998 10/14/2021
LANJUT 5/7/1988 10/14/2021
LANJUT 12/4/1995 10/14/2021
LANJUT 4/13/1997 10/14/2021
LANJUT 11/4/1983 10/14/2021
LANJUT 2/6/1966 10/14/2021
LANJUT 3/10/2003 10/14/2021
LANJUT 1/1/1980 10/14/2021
LANJUT 5/7/1996 10/14/2021
LANJUT 3/9/1974 10/14/2021
LANJUT 9/14/1988 10/14/2021
LANJUT 7/19/1969 10/14/2021
LANJUT 6/3/1979 10/14/2021
LANJUT 1/28/2001 10/14/2021
LANJUT 4/26/1998 10/14/2021
LANJUT 3/7/1991 10/14/2021
LANJUT 3/1/1965 10/14/2021
LANJUT 10/10/1963 10/14/2021
LANJUT 1/16/1973 10/14/2021
LANJUT 10/7/1978 10/14/2021
LANJUT 7/12/1977 10/14/2021
LANJUT 4/8/1974 10/14/2021
LANJUT 7/3/1979 10/14/2021
LANJUT 11/14/1998 10/14/2021
LANJUT 10/18/1998 10/14/2021
LANJUT 5/17/1975 10/14/2021
LANJUT 2/11/1975 10/14/2021
LANJUT 1/9/1964 10/14/2021
LANJUT 8/16/1995 10/14/2021
LANJUT 6/6/1978 10/14/2021
LANJUT 7/21/1983 10/14/2021
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Nama Puskesmas/Fasyankes/Pos Kabupaten/Kota Provinsi

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Nama Puskesmas/Fasyankes/Pos Kabupaten/Kota Provinsi

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Nama Puskesmas/Fasyankes/Pos : UPT Puskesmas Sedan

1 P-2QBH3T3N 331706309960004 MUHAMMAD ULIN N. L

* Pekerjaan dikelompokkan menjadi: A = Sinovac

UMUM 24 18-30 SEDAN 01/04

aksin yang diterima Puskesmas/Faskes)

Kepesertaan BPJS Pekerjaan

Kepesertaan BPJS (tulis

089618564222 YA ASTRAZENICA 8/23/2021

* Pekerjaan dikelompokkan menjadi: A = Sinovac

RENTAN 55 46-59 BOGOREJO 01/02

ksin yang diterima Puskesmas/Faskes)

Kepesertaan BPJS Pekerjaan

Kepesertaan BPJS (tulis 'Ya' pada

082337395803 YA SINOVAC 8/9/2021

1 P-SUJ3E4TV 3317056807000002 JAMILATUN NISA' P

UMUM 21 18-30 LODAN KULON 04/01

Kepesertaan BPJS Pekerjaan

083134721285 YA SINOVAC 9/16/2021 9/16/2021

2021081536 LANJUT 7/28/2000 9/16/2021

1 P-WKOGIVGN 3317064102020007 WIDIYA AMELIYA P

* Pekerjaan dikelompokkan menjadi: A = Sinovac

UMUM 19 18-30 MENORO 04/04

ksin yang diterima Puskesmas/Faskes)

Kepesertaan BPJS Pekerjaan

Kepesertaan BPJS (tulis 'Ya' pada

081225923290 YA SINOVAC 9/25/2021

1 P-WUC8PQMS 3317066209050001 NOFA ALISTYANA P

2 P-XJ70EULQ 3317061105040002 M.FARIS MUSTOFA L

Kepesertaan BPJS (tulis

REMAJA 16 12-17 KUMBO 010/05 082329362536

is vaksin yang diterima Puskesmas/Faskes)

Kepesertaan BPJS Pekerjaan

Kepesertaan BPJS (tulis

YA SINOVAC 10/14/2021 10/14/2021 20210979F

LANJUT 9/22/2005 10/14/2021

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