Tgl Pelayanan

(ketik sesuai
Nama Pos Pelayanan Imunisasi Desa/Kel No.
format tgl di
excel)

1 2 3 4
Semangka Mojopahit 5/19/2022 1
MURAI ONO HARJO 6/13/2022 2
 DATA PELAYANAN VAKSINASI DALAM RANGKA BIAN D

TANGGAL UMUR (Tahun)

LAHIR (Ketik Terisi otomatis
Nama Anak NIK ANAK
sesuai format tgl krn ada
di excel) rumusnya

5 6 7 8
XXXXX 2/7/2015 7.6 00000000000000
AGATA DWI IRAMA 3/30/2022 0.3 1812052306130003
INES HAURA 9/20/2021 0.8 1807014109090003
RAFIF ARYA 10/8/2016 5.9 1801102705130002
WIRA 1/26/2019 3.5 1802071507120006
MANAF IRFANUL 8/7/2018 4.0 1802111701110001
M HAFIDZ 11/7/2019 2.7 1802075205130002
DEWI AGUNG 1/29/2020 2.5 1802074705120003
AFIFAH NADA 9/23/2018 3.9 1802132308110003
ECHA ZIKRA 5/23/2019 3.2 1802071311130002
SIVA BEILA 9/23/2019 2.9
RAFA KHAFIDHZ 10/17/2018 3.8 1802070803150004
ABIZARD HAFIZ 9/24/2018 3.9 1802076508100003
ARSAL RADEYA 7/1/2020 2.1 1802110509120001
ASKYA ALLUNA 3/30/2019 3.4 1802071608120003
EMILIA JENNI 9/11/2021 0.9
ADITYA PUTRA 9/4/2017 4.9 1802072806120006
M ALVERO 6/3/2017 5.2 1802070807110002
UNNA MIKAYLA 7/11/2019 3.1 3275020410130002
M SYAUFIQ 3/29/2021 1.3 1802110711110003
QIANNO ASWINDRA 9/16/2018 3.9 1802075412090002
ALIFVIANO 1/13/2018 4.6 1802072504130003
ISNA AISYA 7/26/2021 1.0
ALISHA ZAHRA 2/5/2019 3.5 1802076708110003
RINDU AULIA 8/3/2020 2.0 1802075312140004
REYHAN ADITYA 3/24/2020 2.4 1802075701110002
ELLO PRADITYA 3/15/2019 3.4 1802072707110003
M HIWANUDIN 7/1/2019 3.1 1802076903130002
VENIA NUR 5/23/2018 4.2 1802071510090003
REYGA EZRA 4/5/2020 2.3 1802070109100002
TASYA SUCHIELLA 3/23/2021 1.3
LATIFATUL HUSNA 3/5/2018 4.4 1802071711140002
MUTIARA NAFISHA 2/27/2019 3.4 1802070702100001
JULIA NANDA 7/21/2017 5.1 1802077112100008
FAHRI SHAGUFTA 04-04-2019 #VALUE! 1802072309120001
MAFAZA AINA 3/5/2020 2.4 1802075205130004
HAFIZ FATAN 2/1/2020 2.5 1802074904140002
AZKIA MAULANA 1/19/2019 3.6 1802074208110001
KENZO ARNOVANO 11/6/2017 4.8 1802076612120003
NAMIRA MITHAYA 5/28/2019 3.2 1802072508130005
KHIYRA 8/14/2019 3.0 1802076711100002
OSIL ARDANA 7/1/2019 3.1 1802074406120004
AZAM MAARUF 7/30/2018 4.0 1802071905120002
APRILIA NIZA 4/20/2016 6.3 1802072004110002
STEVANUS ARNAKA 8/25/2021 0.9 9101012106110005
ZALFA 5/5/2021 1.2 1802074304150002
TITAN AMANDITA 4/6/2018 4.4 1802070701080001
HATIM HIBNI 11/15/2016 5.8 1804066904090001
AGNI 3/28/2022 0.3 1802075808130003
JOANA A 11/27/2021 0.7 1802070309150000
RAISHA Z 3/14/2018 4.4 16120141111150000
ADIRA N 3/21/2019 3.4 1802070705150000
ALDILA N 3/21/2019 3.4 1802072002150000
DHINI A 6/24/2019 3.1 1802071901150000
AHLAM F 7/21/2018 4.1 1802071904160000
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DALAM RANGKA BIAN DI PUSKESMAS … KABUPATEN LAMPUNG TENGAH

L/P Alamat No.Hp NIK IBU

9 10 11 12
P G buntu 0000000000 0000000000
L/P ONO HARJO 0 0
P ONO HARJO 0 0
L/P ONO HARJO 0 0
P ONO HARJO 0 0
L/P ONO HARJO 0 0
P ONO HARJO 0 0
L/P ONO HARJO 0 0
P ONO HARJO 0 0
L/P ONO HARJO 0 0
P ONO HARJO 0 0
L/P ONO HARJO 0 0
P ONO HARJO 0 0
L/P ONO HARJO 0 0
L/P ONO HARJO 0 0
L/P ONO HARJO 0 0
L/P ONO HARJO 0 0
L/P ONO HARJO 0 0
P ONO HARJO 0 0
P ONO HARJO 0 0
L/P ONO HARJO 0 0
L/P ONO HARJO 0 0
P ONO HARJO 0 0
P ONO HARJO 0 0
P ONO HARJO 0 0
L/P ONO HARJO 0 0
L/P ONO HARJO 0 0
L/P ONO HARJO 0 0
P ONO HARJO 0 0
L/P ONO HARJO 0 0
P ONO HARJO 0 0
P ONO HARJO 0 0
P ONO HARJO 0 0
L/P ONO HARJO 0 0
L/P ONO HARJO 0 0
L/P ONO HARJO 0 0
L/P ONO HARJO 0 0
L/P ONO HARJO 0 0
L/P ONO HARJO 0 0
P ONO HARJO 0 0
L/P ONO HARJO 0 0
L/P ONO HARJO 0 0
L/P ONO HARJO 0 0
P ONO HARJO 0 0
L/P ONO HARJO 0 0
L/P ONO HARJO 0 0
P ONO HARJO 0 0
L/P ONO HARJO 0 0
L/P ONO HARJO 0 0
L/P ONO HARJO 0 0
L/P ONO HARJO 0 0
L/P ONO HARJO 0 0
P ONO HARJO 0 0
P ONO HARJO 0 0
L/P ONO HARJO 0 0
G TENGAH

Imunisasi Kejar (Ya = 1, Tidak=0)

Campak Rubela
Nama Ibu (Ya=1, Tidak=0)

OPV IPV DPT-HB-Hib

13 14 15 16 17
ANU 1 1 1 1
YOHANA W 1
ATIKA L 1
ATIKA L 1
KARTIKA 1
NURLAILA 1
SITI MAYSAROH 1
SARTINI 1
SUTILAH 1
DEWI L 1
DAMAYANTI 1
RAHAYU 1
SURATMI 1
NOVITA 1
SUTRINI 1
FRANSISKA 1
ETI 1
MUJIATI 1
NITA 1
ANISA 1
FARIDA 1
SUMIATI 1
LAILATUL 1
TUMINAH 1
KURNIAWATI 1
SRI WAHYUNI 1
IRMA 1
NISA 1
NURYANI 1
WIYARSIH 1
SUSI S 1
SITI WAHYUNI 1
AYU NOVITA 1
AYU NOVITA 1
ENI HARYATI 1
PENETRASI 1
HERLINA 1
RANIS 1
AYU SEPTI 1
SEIVILA 1
SITI ZUHRU 1
RENI A 1
PEPTI R 1
PEPTI R 1
FRANSISKA 1
KHUSNUL 1
TRIA ANGGRAENI 1
EVA R 1
SINTA 1
FRANSISKA 1
TRI TITIK 1
SUFIANA 1
SUFIANA 1
MURNI 1
NURHAYATI 1
 Ket** (bila anak mendapatkan dosis
kedua/keetiga/keempat OPV/Penta saat BIAN,
maka tetap dicatat namun tidak dimasukkan
sebagai cakupan BIAN)

18
DI baris ini contoh ya cara penulisannya sehingga datanya bisa diolah
anya bisa diolah
 DATA PEMAKAIAN LOGISTIK BIAN D
OPV IPV
Tanggal
Nama Pos Pelayanan Imunisasi Desa/Kel
Pelayanan Jumlah Vial Jumlah Vial
digunakan digunakan
1 2 3 6 8
Aster Candirejo 5/19/2022 1
LOGISTIK BIAN DI PUSKESMAS ….
DPT-HB-Hib Campak Rubela Jumlah Logistik yang digunakan

Jumlah Vial Jumlah Vial

Pelarut Dropper ADS 0,5 ML ADS 5 ML Safety Box Pen Marker
digunakan digunakan
10 12 13 14 15 16 17 18
1 2 2 1 16 2 1 1
DI baris ini contoh ya cara penulisannya sehingga datanya bisa diolah
 REKAPITULASI HASIL VAKSINASI BIAN DI PUSKESMAS …. KABUPATEN LAMPUNG TENGAH

Sasaran dan Cakupan Imunisasi Kejar Sasaran dan cakupan imunisasi campak rubela
Usia 12 - 59 bulan Usia 9-59 bulan Usia 5 - <7 thn Usia 7-<12 thn
NO TANGGAL OPV IPV DPT-HB-Hib Campak Rubella Campak Rubella Campak Rubella
Jumlah Jumlah Jumlah
Jumlah diimunisasi Jumlah diimunisasi Jumlah diimunisasi
diimunisasi diimunisasi diimunisasi
1 2 3 4 5 6 7 8
1 5/19/2022 1 1 1 - - 1
2 5/20/2022 - - - - - -
3 5/21/2022 - - - - - -
4 5/22/2022 - - - - - -
5 5/23/2022 - - - - - -
6 5/24/2022 - - - - - -
7 5/25/2022 - - - - - -
8 5/26/2022 - - - - - -
9 5/27/2022 - - - - - -
10 5/28/2022 - - - - - -
11 5/29/2022 - - - - - -
12 5/30/2022 - - - - - -
13 5/31/2022 - - - - - -
14 6/1/2022 - - - - - -
15 6/2/2022 - - - - - -
16 6/3/2022 - - - - - -
17 6/4/2022 - - - - - -
18 6/5/2022 - - - - - -
19 6/6/2022 - - - - - -
20 6/7/2022 - - - - - -
21 6/8/2022 - - - - - -
22 6/9/2022 - - - - - -
23 6/10/2022 - - - - - -
24 6/11/2022 - - - - - -
25 6/12/2022 - - - - - -
26 6/13/2022 - - - 1 - -
27 6/14/2022 - - - - - -
28 6/15/2022 - - - - - -
29 6/16/2022 - - - - - -
30 6/17/2022 - - - - - -
31 6/18/2022 - - - - - -
32 6/19/2022 - - - - - -
33 6/20/2022 - - - - - -
34 6/21/2022 - - - - - -
35 6/22/2022 - - - - - -
36 6/23/2022 - - - - - -
37 6/24/2022 - - - - - -
38 6/25/2022 - - - - - -
39 6/26/2022 - - - - - -
40 6/27/2022 - - - - - -
41 6/28/2022 - - - - - -
42 6/29/2022 - - - - - -
43 6/30/2022 - - - - - -
JUMLAH 1 1 1 1 - 1
BIAN DI PUSKESMAS …. KABUPATEN LAMPUNG TENGAH

Sasaran dan cakupan imunisasi campak rubela

Total diimunisasi
Campak Rubella

9
1
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
1
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
2
 REKAPITULASI PENGGUNAAN LOGISTIK

OPV IPV

NO TANGGAL
Jumlah Jumlah Vial Jumlah Jumlah Vial
IP IP
diimunisasi digunakan diimunisasi digunakan

1 2 3 4 5 6 7 8
1 5/19/2022 1 1 1.0 1 - -
2 5/20/2022 - - - 0 - -
3 5/21/2022 - - - 0 - -
4 5/22/2022 - - - 0 - -
5 5/23/2022 - - - 0 - -
6 5/24/2022 - - - 0 - -
7 5/25/2022 - - - 0 - -
8 5/26/2022 - - - 0 - -
9 5/27/2022 - - - 0 - -
10 5/28/2022 - - - 0 - -
11 5/29/2022 - - - 0 - -
12 5/30/2022 - - - 0 - -
13 5/31/2022 - - - 0 - -
14 6/1/2022 - - - 0 - -
15 6/2/2022 - - - 0 - -
16 6/3/2022 - - - 0 - -
17 6/4/2022 - - - 0 - -
18 6/5/2022 - - - 0 - -
19 6/6/2022 - - - 0 - -
20 6/7/2022 - - - 0 - -
21 6/8/2022 - - - 0 - -
22 6/9/2022 - - - 0 - -
23 6/10/2022 - - - 0 - -
24 6/11/2022 - - - 0 - -
25 6/12/2022 - - - 0 - -
26 6/13/2022 - - - 0 - -
27 6/14/2022 - - - 0 - -
28 6/15/2022 - - - 0 - -
29 6/16/2022 - - - 0 - -
30 6/17/2022 - - - 0 - -
31 6/18/2022 - - - 0 - -
32 6/19/2022 - - - 0 - -
33 6/20/2022 - - - 0 - -
34 6/21/2022 - - - 0 - -
35 6/22/2022 - - - 0 - -
36 6/23/2022 - - - 0 - -
37 6/24/2022 - - - 0 - -
38 6/25/2022 - - - 0 - -
39 6/26/2022 - - - 0 - -
40 6/27/2022 - - - 0 - -
41 6/28/2022 - - - 0 - -
42 6/29/2022 - - - 0 - -
43 6/30/2022 - - - 0 - -
JUMLAH 1 1 1 1 - -
ASI PENGGUNAAN LOGISTIK BIAN DI PUSKESMAS …. KABUPATEN LAMPUNG TENGAH

DPT-HB-Hib Campak Rubela Jumlah Logistik yang diguna

Jumlah Jumlah Vial Jumlah Jumlah Vial

IP IP Pelarut Dropper
diimunisasi digunakan diimunisasi digunakan

9 10 11 12 13 14 15 16
1 1 1.0 1 2 0.5 2 1
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1 1 1 2 2 1 2 1
GAH

Jumlah Logistik yang digunakan

ADS 0,5
ADS 5 ML Safety Box Pen Marker
ML

17 18 19 20
16 2 1 1
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16 2 1 1