FORMULIR AMPRAHAN RAPIDTEST

TAHUN 2021
UPT PUSKESMAS : SAMARANG

NO. NAMA IBU / SUAMI UMUR G P A AT

1 ADE/JAJANG 42 3 2 0 10
2 AI JAMILAH/YOGA 20 1 0 0
3 YULI/BURHAN 18 1 0 0
4 RAHMA/RIZAL 23 2 1 0
5 YUNI/DIANA 22 1 0 0
6 AYI/USMAN 22 1 0 0
7 ICA/SALIM 22 2 1 0
8 DIANA/ADE 28 5 4 0
9 DIANA/RIDWAN 24 2 1 0 4
10 WATI/ADE 37 4 3 0 2
11 SITI JUBAEDAH/CECE 39 4 3 0 2
12 ISTI/ROHMAT 19 1 0 0
13 SUPRIATIN/YUSWANTO 40 6 5 0 3
14 NURHASANAH/HERI 36 2 1 0
15 TINI/ALDI 32 1 0 0
16 RANI/IYON 41 4 3 0 5
17 SITI FADILAH/ALFIN 19 1 0 0
18 ENENG/ATEP 37 3 2 0 5
19 SILVI/NURDIN 23 1 0 0
20 HILMA/TAUFIK 21 1 0 0
21 SITI SOPIAN/AGUS 32 3 2 0 4
22 NENG ASRI/ 26 1 0 0
23 IRA/ABDUL 20 1 0 0
24 IKOH/ABDUL ROHMAN 43 11 10 0 10
25 EMPONG/ENJANG 37 5 4 0 3
26 FITRI/YUDIMAN 25 2 1 0 6
27 RENI/YUSUF 26 2 1 0 7
28 IKEU/ASEP 34 3 2 0 6
29 AI FARIDA/DEDE 34 1 0 0
30 IMAS/YUSUF 20 1 0 0 7
31 AI SUMI/KOSWARA 40 5 4 0 5
32 DAHLIA/ANDRI 25 1 0 0
33 AI/UUS 27 2 1 0 5
34 SARI/MUKLIS 31 7 6 0 3
35 AI RATNA/IJAN 44 6 5 0 4
36 LIA/IWAN 28 2 1 0 6
37 SITI AMINAH/ENCENG 38 7 6 0 5
38 SITI ROHMAH/FAISAL 40 6 5 0 3
39 TASYA/ACE 20 1 0 0
40 LAELI/DIAN 20 1 0 0 8
41 SIFA/SAEFULOH 25 2 1 0 5
42 DEDEH/SANI 29 2 1 0 4
43 SOFI/KAKAN 28 3 2 0 2
44 FITRI/USEP 33 4 3 0 4
45 ADE SITI/KAMAL 20 1 0 0
46 ISTI/ROHMAT 19 1 0 0
47 IIS/UJANG 34 4 3 0 7
48 AISYAH/ASEP 28 3 2 0 2
49 ARZIA/AGUS 19 1 0 0
50 ANITA/ACENG 35 6 4 1 6
51 WAHYUNI/RIZAL 22 2 1 0 3
52 SITI K/YULIUS 32 4 3 0 5
53 ALVI/ADE 30 2 1 0 8
54 SRI/AJI 20 2 1 0 4
55 ELIS/SAMSU 35 3 2 0 5
56 TITA/TISNA 32 1 0 0
57 DILA/GILANG 28 1 0 0
58 LENI/DEDE 23 1 0 0
59 ERNA/USMAN 20 1 0 0
60 FIFAH/GUGUN 21 1 0 0
61 NISA/RIKI 27 2 1 0 8
62 NANAN/IFAN 21 1 0 0
63 EULIS/MAHMUD 27 3 2 2 6
64 ANISA/AAP 20 1 0 0
65 YAYAH/ARMAN 28 2 0 1
66 PENTI/UJANG 31 3 2 1 6
67 RATNA/HIKMAN 19 1 0 0
68 MARWAH/DENI 20 1 0 0
69 YANTI/DEDEH 38 2 1 0 4
70 IKOM/UUN 35 2 1 0 5
71 SUMIATI/SUGANDA 36 3 2 0 5
72 SUSI/JAJANG 21 1 0 0
73 SUSILAWATI/IRPAN 23 1 0 0
74 ASKANAH/YUSUP 42 4 3 0 8
75 RISMAWATI/ISAN 20 2 1 0 3
76 ULFAH/DENDA 23 2 1 0 6
77 CICI/YANDI 18 1 0 0
78 ALO R/ASEP N 39 4 3 0 7
79 SATIAH/SARIF 30 3 2 0 5
80 LIA/IRWAN 25 1 0 0
81 ITA/SYARIFUDIN 20 1 0 0
82 IIM/ACENG 27 2 1 0 4
83 SITI NURLAELA/ACENG 20 1 0 0
84 AI SARIFAH/OBUR 31 4 3 0 4
85 IDA/YAYANG 36 3 1 1 3
86 IRMA/ACENG 25 2 1 0 4
87 YATI/SEHABUDIN 39 3 2 0 6
88 AJENG/ASEP 19 1 0 0
89 YULIANTI/ADE 24 2 1 0 5
90 NURCAHYATI/IKIM 16 1 0 0
 91 KOKOM/MULYANA 36 3 2 0 5
92 SRI/DADAN 21 2 1 0 4
93 ANI/JUJU 33 3 2 0 6
94 NENG/IMAM 30 2 1 0 5
95 RAHMI/ADE 27 2 1 0 2
96 LUSIA/DIDIK 27 1 0 0
97 SYIFA/SAEFUDIN 25 2 1 0 4
98 WULAN/ENTANG 21 1 0 0
99 HILDA/MAMAD 20 1 0 0
100 TUTI/KIKIN 26 2 1 0 9
101 HILMA/TAUFIK 21 1 0 0
102 WINI/DANI 31 2 1 0 6
103 PIPIN/DENIS 25 2 1 0 5
104 IMA/HENDI 23 2 0 5
105 SANTI/ALIYUDIN 31 2 1 0 4
106 IKA/HENDRIK 22 2 1 0 6
107 NONOP/ROYADIN 29 2 1 0 7
108 VHYA/ABDUL 22 1 0 0
109 RISNA/DEDEN 26 2 1 0 5
110 ANI/JEJEN 25 1 0 0
111 IIS/ITEP 21 1 0 0
112 NOLIS/KAMAL 30 4 3 0 12
113 KOYAH/DEDE 22 2 1 0 7
114 ANISA/RIKI 19 1 0 0
115 ELIS/SARIF 22 3 1 1 6
116 LINA/TARYANA 22 2 1 0 4
117 AI RATNA/IJAN 44 6 5 0 5
118 SITI/ENDE 27 2 1 0 5
119 RISA/PANTI 25 1 0 0
120 MARWAH/DENI 21 1 0 0
121 CUCU/SOLAH 32 3 2 0 6
122 NY.ANIS/RAHMAT 25 2 1 0 5
123 NY.IRMA/IWAN 20 1 0 0
124 SRI/IDAN 27 3 1 1 4
125 SITI H/ENI 35 3 1 1 6
126 RANI/IYON 42 4 3 0 5,5
127 ADE/APIP 28 2 1 0 6
128 CUCU/ENDANG 41 4 3 0 8
129 SITI NUR/ANDI 22 1 0 0
130 LIA/UJANG 30 3 2 0 3
131 PENTI/UJANG 25 2 1 0 2
132 IDA/VIRLY 25 2 1 0 7
133 MIRA/EDI 27 3 2 0 2
134 FATMAWATI/BUDI 23 2 1 0 2
135 SOPIAH/AA 35 2 1 0 5
136 SRI/GINA 34 3 0 0 3
137 RAHMA/RIZAL 23 2 1 1 5
138 ROSITA/HERMAN 30 3 2 0 3
139 TUTI/NURSAHID 28 3 1 1 4
140 SITI/ALFIN 19 1 0 0
141 ADE SITI/KAMAL 23 1 0 0
142 ZENI/ROGI 16 1 0 0
143 ATIN/IKRA 22 1 0 0
144 ZENI/FEBI 16 1 0 0
145 DEWI/ASEP 33 3 2 0 3
146 IIN/ADE 30 4 2 1 3
147 MAE/DEDE 31 4 2 1 4
148 SITI/DASEP 35 3 2 0 7
149 NIDA/IRMAN 19 1 0 0
150 NINING/SOMAR 30 2 1 0 8
151 ENUNG/DODI 25 2 1 0 5
152 SANTI/HILMAN 23 3 1 1 4.5
153 NIA/SAEP 25 1 0 0
154 CUCU/ M RIDWAN 21 1 0 0
155 SUSI/BAGJA 27 2 1 0
156 WOTI/SILMI 29 2 1 0
157 ENYONG/ENJANG 37 5 4 0 5,5
158 SINTA/HERMAN 20 1 0 0
159 MILA/HERI 22 1 0 0
160 MILAH/AGUS 33 2 1 0 7
161 NETI/HENDRA 19 1 0 0
162 RANI/KIPDI 24 1 0 0
163 LINDA/YADI 20 1 0 0
164 NENI/ACEP 35 3 2 0 4
165 DEWI/TONI 24 2 1 0 3
166 ALFI/ADE 27 2 1 0 4
167 DEWI/IRWAN 23 2 1 0 5
168 SUMIATI/DANI 18 1 0 0
169 WIDI/ADE 26 1 0 0
170 ASRI/AGUNG 20 2 1 0 3
171 RISNAWATI/ADE 20 1 0 0
172 MIRA/DODO 21 1 0 0
173 NENAH/SAEFULOH 21 1 0 0
174 IIS/HENDRI 21 1 0 0
175 SUCI/UJANG 23 1 0 0
176 ANISA/FARMAN 24 1 0 0
177 EMIL/ARDEN 21 1 0 0
178 IDA/AGUS 26 1 0 0
179 IMAS/JAMALUDIN 32 2 1 0 3
180 RATNA/IDAN 44 3 2 0 5
181 MIRDA/LUKMAN 18 1 0 0
182 DEFA/YUSEF 20 1 0 0
183 EUSI/AYI 38 6 5 0 2
184 PIPIH/YOGA 31 5 4 0 3
185 AJRI/YASA 31 3 2 0 5
186 IMAS/YUSUF 20 1 0 0
187 ELIS/YUSUF 28 4 3 0 4
188 ALMI/AH,AD 25 2 1 0 2.5
189 SITA/DIAN 30 4 3 0 3
190 TUTI/UUS 31 3 2 0 5
191 ERLIN/IKIN 34 3 2 0 4
192 NURHAYATI/SURYANA 26 2 1 0 4
193 EUTIK/AYAT 32 4 3 0 3
194 NADIA/CUCU 19 1 0 0

MENGETAHUI GARUT, 19 JANUARI 2021

KEPALA UPT PUSKESMAS SAMARANG PJ KIA

H.Elan Suherlan, Amd. Kep.,SKM.,M.Kes Hj.Tikah Rosyati, S.ST

NIP. 19641212 198501 1 001 NIP. 19720211 199203 2 002
 ALAMAT TP
KP.BONGKOR 6/19/2021
KP.SAMBOK 5/25/2020
KP.SAMPIREUN 6/17/2021
KP.BARU 1/3/2021
KP.BARU 7/5/2021
kp. Cimencek 6/29/2021
KP.CIKAMIRI 4/22/2021
KP.BARUJATI 5/16/2021
KP.CIMANGGAH 7/22/2021
KP.MALAYU 6/7/2021
KP.SITUGIRANG 6/2/2021
KP.SITUGIRANG 4/19/2021
KP.PAMULIHAN 6/17/2021
KP.CIKAMIRI 5/20/2021
KP.BAROS 5/16/2021
PALNUNJUK 5/25/2021
KP.CILEMAH 4/9/2021
KP. PASIR 11/4/2020
KP.SARADAN 1/29/2021
KP.SITUGIRANG 3/22/2021
KP.SITUGIRANG 3/22/2021
KP.BABAKAN KIARA 2/25/2021
KP.BAROS 7/10/2021
KP.SAMBOK 3/10/2021
KP.CILEMAH 1/26/2021
KP.CIGUNA 2/17/2021
KP.CIKAMIRI 4/20/2021
KP.CIKAMIRI 4/24/2021
KP.CILEMAH /03/2021
KP.CILEMAH 6/15/2021
KP.CIMANGGAH 4/4/2021
KP.CILEMAH 9/13/2021
KP.SAMBOK 8/13/2021
KP.SAMBOK 4/29/2021
KP.BONGKOR 4/20/2021
KP.SITUGIRANG 3/2/2021
KP.LENGKONG 3/6/2021
KP.LENGKONG KALER 3/1/2020
KP.SIRNASARI 7/10/2021
KP.LEUWI GUGUR 3/20/2021
KP.CIMENCEK 4/3/2021
KP.BARUJATI 3/21/2021
KP.CIMANGGAH 4/20/2021
KP.BONGKOR 3/2/2021
KP.BONGKOR 3/6/2021
KP.SANGKAN 3/1/2020
KP.SAWAH SARI 7/10/2021
KP. PASIR UCING 3/20/2021
KP.CIKAMIRI 4/3/2021
KP.PANGSOR 3/21/2021
KP.NANGKELAN 3/23/2021
KP.NANGKELAN 2/22/2021
KP.CIMANGGAH 8/1/2021
KP.SOMONG 5/15/2021
KP.PANGSOR 7/2/2021
KP.SITUGIRANG 7/9/2021
KP.SALAMANJAH 3/21/2021
LEGOK 4/12/2021
KP. PASIR UCING 30/2/2021
KP.BABAKAN KIARA 2/6/2021
KP.SAMPIREUN 7/15/2021
KP.SARADAN 7/10/2021
KP.SAMARANG 4/19/2021
KP.BAROS 2/15/2021
KP.SARADAN 6/8/2021
KP.LENGKONG 2/6/2021
KP.BONGKOR 3/26/2021
KP.BAROS 2/3/2021
KP.BABAKAN KIARA 2/23/2021
KP.BARUJATI 2/12/2021
KP.SAWAH SARI 5/17/2021
KP. PASIR UCING 4/23/2021
KP.CIKAMIRI 7/17/2021
KP.PANGSOR 5/27/2021
KP.NANGKELAN 2/4/2021
KP.NANGKELAN 5/16/2021
KP.CIMANGGAH 3/22/2021
KP.SOMONG 2/28/2021
KP.PANGSOR 6/30/2021
KP.SITUGIRANG 2/25/2021
KP.MUNJUL 3/13/2021
KP.SINDANGSARI 2/19/2021
KP.CILEMAH 5/23/2021
KP.SITUGIRANG 8/7/2021
KP.CIGUNA 2/17/2021
KP.BAROS LEBAK 3/10/2021
KP.BAROS LEBAK 3/8/2021
KP.CISUMUR 3/5/2021
KP.PASIR 2/7/2021
KP.LEGOK 3/21/2021
KP.BONGKOR 6/15/2021
KP.SARADAN 8/17/2021
KP.BARUJATI 7/9/2021
KP.PASIR 1/10/2021
KP.BABAKAN PALAH 6/9/2021
KP.MALAYU 3/19/2021
KP.CIMENCEK 5/10/2021
KP.SIRNAHURIF 2/19/2021
KP.PANGSOR 5/15/2021
KP.SAMBOK 4/11/2021
KP.SAMPIREUN 7/20/2021
KP.BARU 6/27/2021
KP.BARU 5/24/2021
kp. Cimencek 8/2/2021
KP.CIKAMIRI 4/19/2021
KP.BARUJATI 2/11/2021
KP.CIMANGGAH 8/7/2021
KP.MALAYU 7/25/2021
KP.SITUGIRANG 6/2/2021
KP.SITUGIRANG 5/12/2021
KP.PAMULIHAN 4/9/2021
KP.CIKAMIRI 8/8/2021
KP.BAROS 5/7/2021
PALNUNJUK 7/26/2021
KP.CILEMAH 3/20/2021
KP. PASIR 4/6/2021
KP.BONGKOR 4/2/2021
KP.CIKAMIRI 2/14/2021
KP.CILEMAH 02/5/2021
KP.BAROS TONGGOH 8/12/2021
KP.CIKAMIRI 5/17/2021
KP.POJOK 08/7/2021
KP.POJOK 8/27/2021
KP.POGOR 2/14/2021
KP.MALAYU TENGAH 2/12/2021
KP.PALNUNJUK 1/30/2021
KP.TUNGGEREUNG 3/25/2021
KP.PANGSOR 5/12/2021
KP.CILEMAH 8/20/2021
KP.PANYAWUNGAN 5/21/2021
LENGKONG 5/12/2021
KP.PALNUNJUK 01/7/2021
KP.SITUGIRANG 04/4/42021
KP.BONGKOR 2/15/2021
KP.SANGKAN 1/30/2021
KP.NANJUNGSARI 2/24/2021
KP.CINTAASIH 04/3/2021
KP.SIRNASARI 2/23/2021
KP.CILEMAH RANGON 2/18/2021
KP.CINTAASIH 30/4/2021
KP.BONGKOR 5/25/2021
KP.SITUGIRANG 15/4/2021
KP.CILEMAH 30/2/2021
KP.SITUGIRANG 08/7/2021
LKP.PAMULIHAN 09/9/2021
KP.CIJUGUL 7/25/2021
KP.BONGKOR 3/11/2021
KP.CILEMAH 5/22/2021
KP.SARADAN 6/12/2021
KP.SARADAN 6/30/2021
KP.LEGOK 11-Apr-21
KP.PANGSOR 5/26/2021
SAMBIL 3/11/2021
KP.PANGSOR 3/21/2021
KP.PASIR 7/9/2021
KP.CIROYOM 6/15/2021
KP.CILEMAH 3/25/2021
PALNUNJUK 3/26/2021
PAMULIHAN 1/25/2021
KP.KAUM 3/23/2021
KP.BONGKOR 5/22/2021
KP.BAROS TONGGOH 3/13/2021
KP.LENGKONG 2/19/2021
KP.LENGKONG 5/23/2021
KP.TUNGGEREUNG 8/7/2021
KP.CISANCA 2/17/2021
KP.PASAR 3/10/2021
KP.SAMBOK 3/8/2021
KP.LENGKOING KIDUL 3/5/2021
KP.LENGKONG HILIR 2/7/2021
KP.PINTU 3/21/2021
KP.POGOR 6/15/2021
KP.SANGKAN 8/17/2021
KP.PAJAGAN 7/9/2021
KP. NAROS LEBAK 1/10/2021
KP.PASAR 6/9/2021
KP. CIGUNA 3/19/2021
KP.CIGUNA 5/10/2021
KP.CIMANGGAH 2/19/2021
KP.BONGKOR 5/15/2021
KP.PASIR 4/11/2021
KP.CIGUNA 7/20/2021
KP.LENGKONG 15/4/2021
KP.PASAR KIDUL 30/2/2021
KP.SAWAH SARI 08/7/2021
KP.SUKAHAJI 09/9/2021
KP.CILEMAH 7/25/2021
KP.BONGKOR 3/11/2021
KP.CIMANGGAH 5/22/2021
KP.SANGKAN 6/12/2021
KP.SALAMANJAH 6/30/2021
KP.CILEMAH 11-Apr-21
KP.SINDANG SARI 5/26/2021
KP.SITUGIRANG 3/11/2021

GARUT, 19 JANUARI 2021

PJ KIA

Hj.Tikah Rosyati, S.ST

NIP. 19720211 199203 2 002
 HASIL RAPIDTEST BULAN LALU
TAHUN 2020

UPT PUSKESMAS : SAMARANG

HASIL
NO. NAMA UMUR ALAMAT
REAKTIF

1 ATIKAH/M.AMIN 48 KP. SAMPIREUN DS.SIRNASARI

2 HJ.ENDEH/H.UDIN 35 Kp.PASIR MUNCANG DS.CINTARAKYAT
3 ENTIN/ASEP 27 KP.SALAMANJAH DS.CINTARASA
4 ASFI/IDANG 23 KP.SUKAHAJI DS.SAMARANG
5 TINA/CUCU 27 KP.CICAU DS.SAMARANG
6 TITA/TISNA 32 KP.SITUGIRANG DS.CINTARAKYAT
7 ENTIN/ASEP 27 KP.SALMANJAH DS.CINTARASA
8 DEDE/AGUS 41 KP. PASIR DS.CINTAKARYA
9 FUJI/AEF 31 KP.SITUGIRANG DS.CINTARAKYAT
10 DINA/M.RIDWAN 26 KP.CIPARAY DS.SUKARASA
11 FATIMAH/ADITIYA 27 KP.SAMARANG AWI DS.SAMARANG
12 ERNI/ASEP 28 KP. DATAR
13 RINI/DEDE 26 KP.CISUMUR DS.SAMARANG
14 AI SUMIATI/DADAN 32 KP.TAMAN SARI
15 UYAH/AJAT 35 KP.POGOR
16 DEWI/RIKI 19 KP.LENGKONG DS.SAMARANG
17 WIWIN/IHIN 38 KP.CILEMAH DS.CINTAASIH
18 FUJI/AEF 31 KP.SITUGIRANG DS.CINTARAKYAT
19 NURESA/DADAN 21 KP.PAJAGAN DS.SAMARANG
20 EULIS/GUNGUN 30 KP.PASIR DS.CINTAKARYA
21 WINI/AGUS 24 KP.SAMBIL DS.SAMARANG
22 ATIN/AHMAD 21 KP.BONGKOR DS.CINTARAKYAT
23 AI MASITOH/EPUL 31 KP.PANYINGKIRAN DS.SAMARANG
24 FITRI/RAHMAN 21 KP.PASIR DS.CINTAKARYA
25 FITRIANI 31 KP.NURUL HUDA DS.CINTADAMAI
26 SITI NURAISAH 26 KP.CIKAMIRI DS.SIRNASARI
27 IAR 36 KP.CIKENDI DS.SUKAWANGI
28 SUSILAWATI 35 KP.CITAMAN KIDUL DS.PANJIWANGI
29 SINTAWATI 30 KP. MALAYU DS.CINTARAKYAT
30 YUSI 26 KP.CIKAMIRI DS.SIRNASARI
31 RENI 26 KP.CIKAMIRI DS.SIRNASARI
32 NITA 23 KP.BARILUK DS.CINTAKARYA
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56

MENGETAHUI
KEPALA UPT PUSKESMAS SAMARANG

H.Elan Suherlan, Amd. Kep.,SKM.,M.Kes

NIP. 19641212 198501 1 001
HASIL KET.
NON REAKTIF ( YG REAKTIF, TGL PERIKSA, GPA,UMR KEHAMILAN, ) TINDAKLANJUT DG
SWABTEST?. HASIL?
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
 GARUT, 19 JANUARI 2021
PJ KIA

Hj.Tikah Rosyati, S.ST

NIP. 19720211 199203 2 002