PEMERINTAH KABUPATEN KUDUS

DINAS KESEHATAN
UPTD PUSKESMAS NGEMPLAK
Jalan Kudus - Purwodadi Km 6 Kode Pos : 59372
Telp. (0291) 4247790 E-mail : uptpuskesmasngemplak@gmail.com

ABSENSI VAKSINASI COVID-19

TANGGAL : .................................

NO Timestamp NIK NAMA DESA USIA

1 9/28/2021 9:02:21 3319045312620001 Ngasiri Undaan Lor 59
2 9/28/2021 9:02:29 3319045502720001 SUMARI Ngemplak 49
3 9/28/2021 9:03:02 3319045112820005 Sumarti Undaan Lor 39
4 9/28/2021 9:03:20 3319043001940001 SLAMET ARIFIN Karangrowo 27
5 9/28/2021 9:03:24 3319040704830008 Suroto Undaan Lor 38
6 9/28/2021 9:03:30 3319044904830002 Ambariyanti Ngemplak 38
7 9/28/2021 9:03:33 3319042709930002 Muhammad lathiful umam Undaan Lor 28
8 9/28/2021 9:03:35 3319041807940005 MUHAMMAD ABDUL BASYAR Undaan Lor 27
9 9/28/2021 9:03:38 3319046602960005 Arisca Listiyani Undaan Lor 25
10 9/28/2021 9:04:03 3319040302020002 SYAFIQ MACHALLI DINUNNAWA Ngemplak 19
11 9/28/2021 9:04:20 3319046912850002 Tutik ambarwati Karangrowo 36
12 9/28/2021 9:04:29 3319045312620001 NGASIRI Undaan Lor 59
13 9/28/2021 9:05:18 3319047112780060 Wahyu putra ardyansyah Karangrowo 15
14 9/28/2021 9:05:24 085736929588 ERVITA LAILATUL FAUZIAH Ngemplak 27
15 9/28/2021 9:05:28 3319044601740004 MURINI Larikrejo 47
16 9/28/2021 9:05:33 3319042512910001 muhammad dliyauddin Undaan Lor 30
17 9/28/2021 9:05:53 3319041404880004 MUHAMMAD ZAINUR ROHMAN Undaan Lor 33
18 9/28/2021 9:06:44 3319044502010004 SONIA SAFERO NIKA Karangrowo 20
19 9/28/2021 9:07:01 3319045702650002 Romdlonah Wates 56
20 9/28/2021 9:07:07 3319041708040001 Dimas Agil Kusuma Karangrowo 17
21 9/28/2021 9:07:15 3319041808970004 Agus Dwi Irfandi Ngemplak 24
22 9/28/2021 9:07:43 3319040102840001 Miftahul Hidayat Undaan Lor 38
23 9/28/2021 9:08:21 3319046812990003 Rosa Liana Undaan Lor 21
24 9/28/2021 9:08:28 3319042403630002 KAERUN Ngemplak 58
25 9/28/2021 9:08:52 3319042306810001 Sodikin Ngemplak 40
26 9/28/2021 9:09:39 3319043004950004 Manaf hidayat tulloh Karangrowo 26
27 9/28/2021 9:09:48 3319040506960001 MUHAMMAD ARIFIN Undaan Lor 25
28 9/28/2021 9:10:01 3319044912910003 FILLAILI ITSNAINI Ngemplak 29
29 9/28/2021 9:10:40 3319046203040001 Nadia Elmanida Pramudita Undaan Tengah 17
30 9/28/2021 9:11:20 3319046304930001 Siti Maesyaroh Karangrowo 28
31 9/28/2021 9:11:42 1706026905040001 Eka wahyuni Karangrowo 17
32 9/28/2021 9:11:51 3319045512400002 Ma'rufah Wates 81
NO Timestamp NIK NAMA DESA USIA
33 9/28/2021 9:12:34 3319046804890002 Sri haryanti Undaan Lor 32
34 9/28/2021 9:12:52 3319044912830005 Umi Latifah Ngemplak 38
35 9/28/2021 9:13:35 3319042412930005 Suhariyadi Ngemplak 27
36 9/28/2021 9:14:18 3319040706870003 Dekiirawan Karangrowo 34
37 9/28/2021 9:14:46 3318115208850002 siti khotijah Karangrowo 32
38 9/28/2021 9:14:53 3319045209880004 dewi istiqomah Undaan Tengah 34
39 9/28/2021 9:14:56 3319045804910004 NOOR INDAH SAFITRI Undaan Tengah 30
40 9/28/2021 9:14:59 3319044204060001 Saskia Audia Zamza Ngemplak 15
41 9/28/2021 9:15:10 3319040909940001 Ferry dwi septian Ngemplak 28
42 9/28/2021 9:15:11 3319041411010002 Hanafi Anang Ma'ruf Karangrowo 19
43 9/28/2021 9:15:21 3319042512910001 MUHAMMAD DLIYAUDDIN Undaan Lor 30
44 9/28/2021 9:15:32 3319040202710002 MUSLIH Karangrowo 50
45 9/28/2021 9:15:47 3319041711740001 Purwoko Karangrowo 46
46 9/28/2021 9:16:12 3318016507950002 YuLiati Undaan Tengah 26
47 9/28/2021 9:16:46 3319045102900003 Maria Ulfa Undaan Tengah 31
48 9/28/2021 9:17:23 3319045301870002 Nailil muna Undaan Tengah 33
49 9/28/2021 9:17:35 3319081708880004 Singgih wirawan Undaan Tengah 33
50 9/28/2021 9:18:43 3319040403070002 Miftahul Ulum Ngemplak 14
51 9/28/2021 9:18:43 3319041402570001 BASIRAN Karangrowo 64
52 9/28/2021 9:18:44 3319046810040001 ARINA FAZATUN NAFALA Ngemplak 16
53 9/28/2021 9:18:46 33190464029900001 Nurus sa'adah Undaan Lor 22
54 9/28/2021 9:19:33 3319042205910003 MAULANA NOOR AFIFUDDIN Undaan Lor 30
55 9/28/2021 9:20:57 3319047005090002 Naila mafaza Ngemplak 12
56 9/28/2021 9:21:01 3319040306010002 Muhamad zainuri Larikrejo 20
57 9/28/2021 9:22:28 3319041710900004 Muhammad suliyanto Wates 31
58 9/28/2021 9:26:33 331904590470002 ROFI'ATUS SA'ADAH Undaan Lor 51
59 9/28/2021 9:27:46 3319040108870003 Budi wahyono Karangrowo 34
60 9/28/2021 9:28:00 3319044607670002 Kasminah Ngemplak 54
61 9/28/2021 9:29:13 3319046803940001 Naili fitriani Karangrowo 27
62 9/28/2021 9:30:02 3319040702710002 NURIYANTO Ngemplak 50
63 9/28/2021 9:32:37 3319045906040002 Yunita Dwi Kusuma Wardani Undaan Lor 17
64 9/28/2021 9:33:00 3319040303030002 Ardi Hariyanto Wates 18
65 9/28/2021 9:34:24 3319042501950001 NOR AMPRIH Karangrowo 25
66 9/28/2021 9:35:37 3319045102900003 Maria ulfa Undaan Tengah 31
67 9/28/2021 9:38:12 3319041406820003 Sugiarto Undaan Lor 39
68 9/28/2021 9:39:53 3315036104950001 Senja Widianingrum Karangrowo 26
69 9/28/2021 9:43:00 3319040405920006 wiwin dyanto Undaan Lor 29
70 9/28/2021 9:45:48 3319041504810002 Saputro Karangrowo 40
71 9/28/2021 9:49:08 3319040504790001 Sutomo Ngemplak 58
72 9/28/2021 9:49:22 3319044912830005 Umi Latifah Ngemplak 38
73 9/28/2021 9:56:52 3319041007940003 Abdi Satrya Putra Undaan Lor 27
74 9/28/2021 9:59:14 33190411027550001 SUNARTO Karangrowo 46
75 9/28/2021 10:04:07 3319046805920002 EKA WATI Karangrowo 30
NO Timestamp NIK NAMA DESA USIA
76 9/28/2021 10:11:52 3319041709890005 SLAMET SUKARNO Karangrowo 31
77 9/28/2021 10:15:18 3319041904840001 Muslikin Karangrowo 37
78 9/28/2021 10:20:39 3319041801850004 Zaenal arifin Karangrowo 36
79 9/28/2021 10:21:38 3319046403960001 Heni setiyowati Karangrowo 25
80 9/28/2021 10:26:42 3319041204750005 Purwanto Karangrowo 46
81 9/28/2021 10:31:59 3319041409760002 SUGENG SRIYANTO Wates 45
82 9/28/2021 10:32:26 3319045309890003 Mayar Syafaah Undaan Lor 32
83 9/28/2021 10:37:31 3319040609890001 SAIFUL MU'ARIF Karangrowo 32
84 9/28/2021 10:38:01 3319045812010002 Putri retno sari Karangrowo 19
85 9/28/2021 10:42:09 3319045704040009 Dinda Ainun Ni'mah Ngemplak 17
86 9/28/2021 10:46:06 3319044305650004 MASRIAH Ngemplak 55
87 9/28/2021 10:47:26 3319041601040001 Priyo Utomo Karangrowo 17
88 9/28/2021 10:48:46 3319045104730001 Muslikah Karangrowo 48
89 9/28/2021 10:52:53 3319041504040003 Yonathan Firmanda Karangrowo 17
90 9/28/2021 10:53:29 3319041603000003 Akris vandim Wates 21
91 9/28/2021 11:05:11 3319045412920003 Rita mayasari Karangrowo 29
92 9/28/2021 11:11:22 3319042404840004 Adhitya himawan Undaan Tengah 37
93 9/28/2021 11:13:02 3319046904830002 Yuyun dwi prihati Undaan Lor 37
94 9/28/2021 11:17:42 3319045502710001 SRI EKOWATI Karangrowo 50
95 9/28/2021 11:19:58 3515080808760010 Denny Syahbana Wates 45
96 9/28/2021 11:20:20 3319044701950002 vina yuni sintyani Undaan Lor 26
97 9/28/2021 11:28:36 3319041809860006 SUTIONO Wates 35
98 9/28/2021 11:35:55 3319040203930002 BAMBANG SUBOWO Undaan Lor 28
99 9/28/2021 11:38:39 331904404000008 Indun munawaroh Larikrejo 21
100 9/28/2021 11:39:19 3319041507680003 Sutiyo Karangrowo 53
101 9/28/2021 11:39:25 3319043112650082 SUKILAN Undaan Lor 56
102 9/28/2021 12:15:49 331904021003005 MUHAMMAD A'LA MUHIBBIN Ngemplak 17
103 9/28/2021 12:45:34 3319032911890003 AAN SOFYAN Wates 32
104 9/28/2021 12:45:50 3319045102930002 Fittriya Undaan Lor 28
105 9/28/2021 12:46:21 3319044601010002 Fitrianingrum Undaan Tengah 20
106 9/28/2021 13:00:54 331904300740004 Edi ikhomat Larikrejo 28
107 9/28/2021 13:11:10 3319042811790003 Noor fatah Wates 42
108 9/28/2021 13:12:36 3319046305860003 ROFIATUN Undaan Lor 36
109 9/28/2021 13:30:18 3319041111990003 MUHAMMAD HANDOYO Undaan Lor 21
110 9/28/2021 13:33:25 3319044403740005 Sumilah Karangrowo 47
111 9/28/2021 13:38:21 3319044710790005 SRI KUSTINI Undaan Lor 41
112 9/28/2021 14:01:51 3319044105920004 Siti Maryam syafaat Karangrowo 29
113 9/28/2021 14:10:57 3318111306690002 Sukiswanto Karangrowo 52
114 9/28/2021 14:39:34 3319046507040002 PINGKI SETIANINGRUM Ngemplak 17
115 9/28/2021 14:54:44 3319045402980001 Chindy Fitriya Undaan Lor 23
116 9/28/2021 14:58:39 3319045206000005 Fatma Noor Hidayanti Karangrowo 21
117 9/28/2021 15:39:20 3319042909950004 Muhammad Jumal Ngemplak 26
118 9/28/2021 15:46:58 3319044106040001 Noor Aeni Zunia Syafitri Wates 17
NO Timestamp NIK NAMA DESA USIA
119 9/28/2021 15:50:05 3319045110030001 ANA UMITASARI Ngemplak 18
120 9/28/2021 15:50:43 3319046304950002 Pipit rahayu Karangrowo 26
121 9/28/2021 16:14:30 3319044901040003 Faizzatul Ananda putri Wates 17
122 9/28/2021 16:21:00 3319041007860005 MUHAMMAD SUBAENI RIYANTO Ngemplak 35
123 9/28/2021 16:27:53 3319041805030004 WAHYU RIZKI HERMAWAN Karangrowo 18
124 9/28/2021 16:31:26 3319040704930001 Heri setiyono Ngemplak 28
125 9/28/2021 17:02:00 3319043112490038 Sukipan Karangrowo 72
126 9/28/2021 17:09:47 3319042006670005 SUGIONO Karangrowo 53
127 9/28/2021 17:41:17 3319040912060007 Nina bek anggayuh gumintang Karangrowo 15
128 9/28/2021 17:46:38 3319041006950004 RUDI SELAMET Karangrowo 26
129 9/28/2021 18:40:36 3319040706870003 Deki irawan Karangrowo 34
TEN KUDUS
ATAN
NGEMPLAK
Kode Pos : 59372
masngemplak@gmail.com

COVID-19

TEMPAT : .....................................

Keterangan TTD
1
2
3
4
5
6
7
8
9
10
11
Double dengan Nomor 1 12
13
14
15
16
17
18
19
20
21
22
23
24
KTP Luar Wilayah (Berugenjang) 25
26
27
28
29
30
31
32
 Keterangan TTD
33
34
35
36
37
38
39
40
41
42
Double dengan Nomor 16 43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
Double dengan Nomor 47 66
67
68
69
70
KTP Luar Wilayah (Kalirejo) 71
Double dengan Nomor 34 72
73
74
75
 Keterangan TTD
76
77
78
79
80
81
82
83
84
85
86
87
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90
91
92
93
94
95
96
97
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100
101
102
103
104
105
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107
108
Foto KTP/KK Tidak Sesuai 109
110
111
112
113
114
115
116
KTP Luar WIlayah (Kutuk) 117
118
 Keterangan TTD
KTP Luar Wilayah (Kalirejo) 119
120
121
122
123
124
125
126
Foto KTP/KK Tidak Sesuai 127
128
129