NO NAME PASPOR PN DOI DOE POI

1 ISMIRAH CIPTO DIHARJO C9017963 2022/04/12 2027/04/12 CILACAP

2 PURWANDARI MUHENI ACHMAD KHARIRI C7448636 2020/10/27 2025/10/27 CILACAP
3 MUHADI SUHAD NURSIDI C6963876 2020/03/16 2025/03/16 CILACAP
4 ROIDI TAWIJAYA TABESARI C9018065 2022/04/12 2027/04/12 CILACAP
5 TOHIRUN ACHMAD SANUMAR C9018655 2022/04/19 2027/04/19 CILACAP
6 SANGADAH MUCHAMAD SAERI C9018791 2022/04/21 2027/04/21 CILACAP
7 ARYO DEWANTO SOEBARI C9019208 2022/04/26 2027/04/26 CILACAP
8 SRI UTAMI KADIS C9018310 2022/04/14 2027/04/14 CILACAP
9 TITI INDRADIARTI BINTI MARTO HARSONO C9018970 2022/04/25 2027/04/25 CILACAP
10 ADI SUPRIYATNO SUDIYONO C9019134 2022/04/26 2027/04/26 CILACAP
11 PENI KURNIAWATI TRIMA C9018962 2022/04/25 2027/04/25 CILACAP
12 SUWAHYO WIRYO PREMONO C9018960 2022/04/25 2027/04/25 CILACAP
13 WIDIYARTI MARNO MADARJO C9018961 2022/04/25 2027/04/25 CILACAP
14 PRIYONO SUTARNO PRAWIRO C9018080 2022/04/12 2027/04/12 CILACAP
15 WARSIYAH MUSTAREDJA KARJAWIDJAJA C7303090 2020/09/03 2025/09/03 CILACAP
16 SAONAH DULMADI WIRJASEMITA C8494283 2022/01/31 2027/01/31 CILACAP
17 RISMANTO ARDJOSENTONO DIPASENTANA C8494280 2022/01/31 2027/01/31 CILACAP
18 SUNARTI JASMIN SAN MUKSIN C8494282 2022/01/31 2027/01/31 CILACAP
19 SABARIYAH DALIKOEN TOYIB C7448633 2020/10/27 2025/10/27 CILACAP
20 NUR YULIATI MISAR C7448634 2020/10/27 2025/10/27 CILACAP
21 MARSINI KASWADI ARSADI C8563688 2022/02/15 2027/02/15 CILACAP
22 P PUJOWINARNO KARSO WIYONO C8244776 2021/12/13 2026/12/13 CILACAP
23 YATINAH KARYOREJO MANGUN C8244775 2021/12/13 2026/12/13 CILACAP
24 SETYA ARIANI KUSUMAWATI C9019582 2022/05/09 2027/05/09 CILACAP
25 AULIA MUNTI RAHMAWANI C6092948 2019/12/20 2024/12/20 CILACAP
26 MASNGUDI HADIWISASTRO ARJAWIJAYA C9019590 2022/05/09 2027/05/09 CILACAP
27 SITI CHOZANAH DJARKASIH C9018955 2022/04/25 2027/04/25 CILACAP
28 ZULMAHDI MUHI SYARI C0229621 2018/04/23 2023/04/23 PALEMBANG
29 FITRIA AGUSTINA MUHAMMAD ZEN C9030966 2022/05/11 2027/05/11 PALEMBANG
30 SUTARYO SUTARJO SAMBES SARI C9019768 2022/05/10 2027/05/10 CILACAP
31 RASITI MAD KUSNI C9019769 2022/05/10 2027/05/10 CILACAP
32 NANA KARTINAH MADKUSNI C9019763 2022/05/10 2027/05/10 CILACAP
33 SAEFUDIN ACHMAD JAENI C9019764 2022/05/10 2027/05/10 CILACAP
34 EROS LANY TORINA C2908804 2019/03/22 2024/03/22 JAKARTA SELATAN
35 DEDE MAHENDRA RUSDI LUBIS C3528247 2019/04/01 2024/04/01 JAKARTA TIMUR
36 DWI INDAH SEPTIARI C3528400 2019/04/02 2024/04/02 JAKARTA TIMUR
37 ABDULLAH SALIM C3528377 2019/04/02 2024/04/02 JAKARTA TIMUR
38 KHADIJAH SALIMAH C3528252 2019/04/01 2024/04/01 JAKARTA TIMUR

LAKI-LAKI
PEREMPUAN
JUMLAH
SEX POB DOB MAHRAM NO RELATION
F SRAGEN 1974/05/30 WOMEN GROUP
F PURBALINGGA 1961/12/13 WOMEN GROUP
M PURBALINGGA 1952/09/06
M PURBALINGGA 1965/08/08
M BANYUMAS 1950/03/02
F BANYUMAS 1952/10/12 6.TOHIRUN ACHMAD SANUMAR HUSBAND
M SEMARANG 1969/07/21
F SEMARANG 1970/10/05 7 HUSBAND
F BANYUMAS 1961/05/21 WOMEN GROUP
M BANYUMAS 1979/11/05
F TEGAL 1981/05/31 10 HUSBAND
M BANYUMAS 1963/07/11
F BANYUMAS 1964/11/11 12.SUWAHYO WIRYO PREMONO HUSBAND
M KLATEN 1953/11/10
F BANYUMAS 1953/11/07 WOMEN GROUP
F BANYUMAS 1963/01/18 WOMEN GROUP
M BANYUMAS 1961/04/03
F MEDAN 1967/12/31 17.RISMANTO ARDJOSENTONO DIPASENTANA HUSBAND
F BANYUMAS 1951/05/05 19. NUR YULIATI MISAR DOUGHTER
F BANYUMAS 1979/07/09 20. SABARIYAH DALIKOEN TOYIB MOTHER
F BANYUMAS 1965/07/27 WOMEN GROUP
M SUKOHARJO 1953/01/04
F SUKOHARJO 1954/02/08 22. P PUJOWINARNO KARSO WIYONO HUSBAND
F SEMARANG 1976/03/18 WOMEN GROUP
F BANYUMAS 1976/07/17 WOMEN GROUP
M CILACAP 1969/04/22
F PURBALINGGA 1960/01/11 WOMEN GROUP
M LAWANG AGUNG 1977/11/26
F SEKAYU 1979/08/23 28. ZULMAHDI MUHI HUSBAND
M BANYUMAS 1965/02/09
F BANYUMAS 1969/05/07 30. SUTARYO HUSBAND
F BANYUMAS 1978/07/04 31. RASITI MAD KUSNI SANMURSID SISTER
M PURBALINGGA 1975/09/28
F BANYUMAS 1978/06/08 34. SAEFUDIN HUSBAND
M TANJUNG BARULAK 1981/05/01
F PEKANBARU 1985/09/08 DEDE MAHENDRA RUSDI LUBIS HUSBAND
M JAKARTA 2011/12/17 DEDE MAHENDRA RUSDI LUBIS FATHER
F PEKANBARU 2014/08/28 DEDE MAHENDRA RUSDI LUBIS FATHER

KET
15 BEDA TTL PASPOR DAN KTP
23
38
 VAKSIN 1 VAKSIN 2 VAKSIN 3 TGL VAKSIN 1 TGL VAKSIN 2 TGL VAKSIN 3
SINOVAC SINOVAC 9/18/2021 0:00 2021//11/03
SINOVAC SINOVAC ASTRAZENECA
ASTRAZENECA MODERNA 2/10/2022 0:00 4/7/2022 0:00
PFIZER PFIZER
SINOVAC SINOVAC
SINOVAC SINOVAC
SINOVAC SINOVAC MODERNA 2021/04/16 2021/05/19 2022/01/21
SINOVAC SINOVAC MODERNA
SINOVAC SINOVAC PFIZER
SINOVAC SINOVAC MODERNA 2021/01/25 2021/02/18 2021/08/21
SINOVAC SINOVAC MODERNA
ASTRAZENECA ASTRAZENECA
SINOVAC SINOVAC PFIZER
SINOVAC SINOVAC
ASTRAZENECA ASTRAZENECA
ASTRAZENECA ASTRAZENECA
ASTRAZENECA ASTRAZENECA
ASTRAZENECA ASTRAZENECA
SINOVAC SINOVAC
SINOVAC SINOVAC 2021/07/01 2021/07/29
SINOVAC SINOVAC 2021/10/13 2021/11/10
SINOVAC SINOVAC ASTRAZENECA
SINOVAC SINOVAC ASTRAZENECA
SINOVAC SINOVAC MODERNA
SINOVAC SINOVAC 2021/07/17 2021/10/25
PFIZER PFIZER 2021/12/31 2022/01/21
PFIZER PFIZER
SINOVAC SINOVAC PFIZER
SINOVAC SINOVAC PFIZER 2021/06/14 2021/07/16 2022/02/18
SINOVAC SINOVAC MODERNA
ASTRAZENECA ASTRAZENECA ASTRAZENECA
ASTRAZENECA ASTRAZENECA 2021/12/2021 2022/02/16
SINOVAC SINOVAC
SINOVAC SINOVAC MODERNA 2021/06/22 2021/07/24 2021/10/04
 NIK NAME AGE
3302207005740004 ISMIRAH 48
3303105312630001 PURWANDARI 61
3303070609520001 MUHADI SUHAD 70
3302200808650001 ROIDI 57
3302120203500003 TOHIRUN 72
3302125210520001 SANGADAH 70
3302272107690001 ARYO DEWANTO 53
3302274510700001 SRI UTAMI 52
3302226105610001 TITI INDRADIARTI 61
3302210511790001 ADI SUPRIYATNO 43
3302217105810002 PENI KURNIAWATI 41
3302061107630001 SUWAHYO 59
3302065111630001 WIDIYARTI 58
3302191011530003 PRIYONO 69
3302164711530003 WARSIYAH 69
3302245801630001 SAONAH 59
3302120304610002 RISMANTO 61
3302127112670011 SUNARTI 54
3302254505510001 SABARIYAH 71
3302254907790001 NUR YULIATI 43
3302216707650006 MARSINI 57
3302240401530002 P.PUJOWINARNO 69
3302244802540001 YATINAH 68
3273065803760005 SETYA ARIANI KUSUMAWATI 46
3302245707760002 AULIA MUNTI RAHMAWANI 46
3301052204690002 MASNGUDI 53
3303055101600001 SITI CHOZANAH 62.43
1606012611770001 ZULMAHDI MUHI 45
1606016308790002 FITRIA AGUSTINA 43
3302260902650002 SUTARYO 57
3302264705690004 RASITI 53
3302224407780001 NANA KARTINAH 44
3302202809750003 SAEFUDIN 47
3302204806780008 EROS LANY TORINA 44
DEDE MAHENDRA RUSDI LUBIS 41
DWI INDAH SEPTIARI 37
ABDULLAH SALIM 10
KHADIJAH SALIMAH 8
 ADDRESS
JL CAPUNG RT 006 RW 008 LEDUG KEMBARAN BANYUMAS
DUSUN ADIREJA RT 001 RW 006 TLAHAB LOR KARANGREJA PURBALINGGA
KARANGREJA RT 012 RW 006 KUTASARI PURBALINGGA
DESA PURWODADI RT 003 RW 001 KEMBARAN BANYUMAS
KEDUNGRANDU RT 03 RW 02 KEDUNGRANDU PATIKRAJA BANYUMAS
KEDUNGRANDU RT 03 RW 02 KEDUNGRANDU PATIKRAJA BANYUMAS
PURWANEGARA RT 002 RW 004 PURWOKERTO UTARA BANYUMAS
PURWANEGARA RT 002 RW 004 PURWOKERTO UTARA BANYUMAS
PAMIJEN RT 002 RW 001 BATURADEN BANYUMAS
GANG JERUK RT 005 RW 003 KARANGGINTUNG SUMBANG BANYUMAS
GANG JERUK RT 005 RW 003 KARANGGINTUNG SUMBANG BANYUMAS
KARANGGINTUNG RT 001 RW 002 KEMRANJEN BANYUMAS
KARANGGINTUNG RT 01 RW 02 KEMRANJEN BANYUMAS
LEMBERANG RT 004 RW 001 SOKARAJA BANYUMAS
DESA KRAJAN RT 002 RW 004 KRAJAN PEKUNCEN BANYUMAS
KARANGKLESEM RT 003 RW 008 PURWOKERTO SELATAN BANYUMAS
PEGALONGAN RT 02 RW 02 PEGALONGAN PATIKRAJA BANYUMAS
PEGALONGAN RT 02 RW 02 PEGALONGAN PATIKRAJA BANYUMAS
JL. JAMBU GG MENTENG NO 23 B RT 001 RW 005 KEDUNGWULUH PURWOKERTO BARAT
PERUM LEDUG LESTARI RT 007 RW 003 LEDUG KEMBARAN
SILADO RT 03 RW 03 SUMBANG BANYUMAS
JL. SUNAN KALIJAGA 18A RT 002 RW 002 BERKOH PURWOKERTO SELATAN
JL. SUNAN KALIJAGA 18A RT 002 RW 002 BERKOH PURWOKERTO SELATAN
JL. KARANG BENDA RT 006 RW 004 BERKOH PURWOKERTO SELATAN BANYUMAS
KARANGKLESEM RT 002 RW 010 PURWOKERTO SELATAN BANYUMAS
DUSUN NUSAORI RT 004 RW 002 NUSAWUNGU CILACAP
KEMBARAN KULON RT 005 RW 001 KEMBARAN KULON PURBALINGGA
JALAN KOLONEL WAHID UDIN RT 002 RW 001 SERASAN JAYA SEKAYU BANYUASIN
JALAN KOLONEL WAHID UDIN RT 002 RW 001 SERASAN JAYA MUSI BANYUMASIN
JL. BANOWATI NO 39 RT 08 RW 09 PURWOKERTO LOR PURWOKERTO TIMUR BANYUMAS
JL. BANOWATI NO 39 RT 08 RW 09 PURWOKERTO LOR PURWOKERTO TIMUR BANYUMAS
KARANGTENGAH RT 002 RW 02 KARANGTENGAH BATURADEN BANYUMAS
PERUM PERMATA HARMONI A.2 NO.9 RT 001 RW 012 LEDUG KEMBARAN BANYUMAS
PERUM PERMATA HARMONI A.2 NO.9 RT 001 RW 012 LEDUG KEMBARAN BANYUMAS
 FN PHONE NUMBER STATUS PASPOR
STATUS MENINGITIS
CIPTO DIHARJO +62 877-3067-0770 FINISH FINISH
MUHENI +62 822-2752-7979 FINISH FINISH
NURSIDI FINISH FINISH
TAWIJAYA +62 857-8631-1949 FINISH FINISH
ACHMAD SANUMAR +62 813-9026-7715 FINISH FINISH
MUCHAMAD SAERI +62 813-9026-7715 FINISH FINISH
SOEBARI +62 811-2647-476 FINISH FINISH
KADIS +62 882-2549-8316 FINISH FINISH
MARTO HARSONO +62 821-3604-6849 FINISH FINISH
SUDIYONO +62 856-4047-8465 FINISH ON PROSES
TRIMA MS +62 858-3823-7618 FINISH ON PROSES
WIRYO PREMONO S +62 823-2371-3968 FINISH FINISH
MARNO +62 812-5151-6363 FINISH FINISH
SUTARNO +62 813-3423-0904 FINISH FINISH
MUSTAREDJA FINISH FINISH
DULMADI +62 852-2754-5217 FINISH FINISH
ARJOSENTONO +62 858-9139-3664 FINISH FINISH
JASMIN +62 813-1171-3547 FINISH FINISH
DALIKOEN +62 812-2662-633 FINISH FINISH
MISAR +62 812-2662-633 FINISH FINISH
KASWADI +62 821-3768-5690 FINISH FINISH
KARSO WIYONO +62 896-6458-4063 FINISH ON PROSES
KARYOREJO +62 896-6458-4063 FINISH ON PROSES
R. HADI SETYO +62 813-1227-9993 FINISH FINISH
+62 811-2617-776 FINISH FINISH
HADIWISASTRO +62 895-3840-63031 FINISH FINISH
DJARKASIH FINISH FINISH
SYARI ON PROSES ON PROSES
MUHAMMAD ZEN ON PROSES ON PROSES
SUTARJO FINISH FINISH
MAD KUSNI FINISH FINISH
MADKUSNI FINISH FINISH
ACH. DJAENI +62 878-7948-2100 FINISH FINISH
EDY T +62 822-4338-0686 FINISH FINISH
JENIS IDENTITAS JENIS KELAMIN
KODE KETERANGAN KODE
KTP KTP M
F

PENDIDIKAN TERAKHIR PEKERJAAN

KODE KETERANGAN KODE
Tidak Sekolah Tidak Sekolah PNS
SD/MI SD/MI / Sederajat Peg. Swasta
SMP/MTs SMP/MTs / Sederajat Wirausaha
SMA/MA SMA/MA / Sederajat TNI / POLRI
D1 D1 / Sederajat Petani
D2 D2 / Sederajat Nelayan
D3 D3 / Sederajat Lainnya
D4/S1 D4/S1 / Sederajat TIDAK BEKERJA
S2 S2/Sp1 / Sederajat
S3 S3/Sp2 / Sederajat

VAKSIN MENINGITIS
KODE
PILIHAN KAMAR 1
KODE KETERANGAN 2
4 QUAD - Rp 21.500.000 3
4
5
 STATUS MENIKAH
KETERANGAN KODE KETERANGAN
LAKI-LAKI 1 MENIKAH
PEREMPUAN 2 BELUM MENIKAH
3 JANDA/DUDA

KATEGORI USIA
KETERANGAN KODE KETERANGAN
PNS 1 DEWASA (12 TAHUN KEATAS)
Peg. Swasta 2 ANAK (2 - 12 TAHUN)
Wirausaha 3 BAYI (DIBAWAH 2 TAHUN)
TNI / POLRI
Petani VAKSIN
Nelayan KODE KETERANGAN
Lainnya 1 SINOVAC
TIDAK BEKERJA 2 MODERNA
3 PFIZER
4 ASTRAZENECA
5 SINOPHARM

N MENINGITIS
KETERANGAN
P
O