FORMULIR REGISTER DATA KEGIATAN REKRUTMEN DAN SELEKSI CALON PENDONOR DARAH DI PUSKESMAS

PUSKESMAS KOTARAJA KODE 1090542

IDENTITAS IBU HAMIL REKRUTMEN SELEKSI

KESIMPULAN
GOL. DARAH PN L/P PEMERIKSAAN FISIK GOL. DARAH MEMENUHI SYARAT
NO NAMA IBU UMUR NAMA SUAMI DESA/KEL AP NO NAMA CALON PENDONOR UMUR DESA/KEL TGL HB HASIL PENGISIAN DONOR PETUGAS/
NON KUESIONER PEMERIKSA
ABO RHESUS L P TD BB N S ABO RHESUS YA TIDAK
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26

1 OSPAIDA AWULLE 26 VIM L O

2 ALFARIDA
1 EDA IREUW 24 OSPAIDA AWULLE VIM O AP
3 ERNAULI
4

1 DANIEL ASMURUF 23 VIM L

2 ALFARIDA
2 SARAH AWINERO 23 DANIEL ASMURUF VIM O AP
3 ERNAULI
4

1
2 ALFARIDA
3 CARLA ARONGGEAR 19 ALVARO LANIA VIM B AP
3 ERNAULI
4

1
2 ALFARIDA
4 ANDERA WAKUR 23 WAIMOROCK AB AP
3 ERNAULI
4

1
2 ALFARIDA
5 ARMINA YIKWA 36 EDI TABUMI WAHNO O AP
3 ERNAULI
4

1
2 ALFARIDA
6 ARLINCE DOGA 27 ABDUL RAHMAN ARMI ASANO A AP ERNAULI
3
4

1 KRISTOFEL RUMBIAK 22 WAHNO L O

2 ALFARIDA
7 ALENA WENA AIBOY 21 KRISTOFEL VIM O AP
3 ERNAULI
4

1 GLADI KAUDE 24 VIM P O

2 RAYMAN KUDE 23 VIM L O ALFARIDA
8 AGNES KAUDE 22 HERMAN RUMBEWAS VIN O AP
3 ERNAULI
4

1 YESKEL ADII 20 WAHNO L O

2 ALFARIDA
9 YOHANCE BOMA 20 YESKEL ADII WAHNO O AP
3 ERNAULI
4

1
2 ALFARIDA
10 YUNITA PADANG 21 ROBIN AREBO VIM A AP
3 ERNAULI
4

1
2 ALFARIDA
11 TINA BOBII 23 ABNER DON WAHNO A AP
3 ERNAULI
4

1
2 ALFARIDA
12 SELFI DASERONA 22 NIKSON RONSUMBRE WAHNO O AP
3 ERNAULI
4

1
2 ALFARIDA
13 PASKALINA MARONDOF 23 DAVID SIMON RUMBIWAN VIM O AP
3 ERNAULI
4

1
2 ALFARIDA
14 NELI LAKOBAL 14 SIMON TIBUL ENTROP AP
3 ERNAULI
4

1
2 ALFARIDA
15 NEMINCE MAGAYANG 22 ESUI BUSUP WAHNO 0 AP ERNAULI
3
4

1 MESAK MARABON 35 WAIMOROCK

2 ALFARIDA
16 MERE METAVIA AINAGO 26 MESAK MARABON WAIMOROCK O AP
3 ERNAULI
4

ALFARIDA
17 MALINCE KOGAYA 37 MENIAS WENDA WAIMOROCK AP ERNAULI

1
2 ALFARIDA
18 MINCE WANIMBO 21 FREDIK WENDA WAIMOROCK AP
3 ERNAULI
4

1 YERMIEN TABO O
2 ALFARIDA
19 MARICE GIAY 19 YERMIEN TABO WAHNO O AP
3 ERNAULI
4

1 YUTUS DAPLA 30 L O
2 ALFARIDA
20 LINA SONOP 19 YUTUS DAPLA WAHNO O AP
3 ERNAULI
4

1 SANDRA MANUFANDU 24 WAHNO O

2 ALFARIDA
21 GEBI YULINA DULAN LEDIT 24 SADRAK MANUFANDU WAHNO O AP
3 ERNAULI
4

1 PETRA WENDA 22 WAHNO L

2
22 PERLI KOGOYA 24 PETRA WENDA WAHNO A AP YUDITH YUNIKE
3
4

1
2
23 NOLI TABUNI 18 YOTIAS WANDIKBO VIM AP YUDITH YUNIKE
3
4

1
2
24 NIKE AGIMBAU 22 ODED ZANAMBANI WAHNO O AP YUDITH YUNIKE
3
4

1
2
25 NOVELA RUMBAIRUSI 24 JACHSON BUKORPIOPER VIM O AP YUDITH YUNIKE
3
4

1
2
26 NOVITA MAKATITA 21 FERNANDO YEUN VIM A AP YUDITH YUNIKE
3
4

1
2
27 NORLINCE SUHUNIAP 17 ALPINUS KABAK VIM A AP YUDITH YUNIKE
3
4

1
2
28 LIDIA ERARI 22 ROMARIO SABAMI WAHNO O AP YUDITH YUNIKE
3
4

1
2
29 PRISKILA AYU NUNAKI 18 KORNELES WARIMON WAIMHIOROK AP YUDITH YUNIKE
3
4

1 JEKSON SALOSA 28 VIM L

2
30 SONDERS C. WANGGAY 28 JEKSON SALOSA VIM AP YUDITH YUNIKE
3
4

1
2
31 FIANDRA MAMBRASAR 34 BRAM SUEBU VIM AB AP YUDITH YUNIKE
3
4

1
2
32 EVELIN YANSIP 22 YANSEN IRAP WAHNO O AP YUDITH YUNIKE
3
4

1
2
33 HELENAT TJO'E 27 BOBY RAJAWANE VIM A PN VERONIKA RIRIN
3
4

1 ANDRI TANATI 35 WAIMHOROCK L O

2
34 BILHA HAMADI 37 ANDRI TANATI WAIMHOROCK O PN VERONIKA RIRIN
3
4

1
2
35 NATALIA MERAUDJE 32 ESTEPANUS RUMBEWAS VIM B PN VERONIKA RIRIN
3
4

1 HERIK WAIMBO L A

36 MARLEIN MERAUDJE 23 HERIK WAIMBO VIM A PN VERONIKA RIRIN

37 YOHANA BETAY 25 KORNELIS MAMARI WAHNO O AP VERONIKA RIRIN

38 YOHANA RAWAR 29 ADAM DAUNDI VIM O AP VERONIKA RIRIN

39 PENI TABUNI 30 JEK TOBAY VIM AB AP VERONIKA RIRIN

40 MELANI JENNISMAS 26 RONI INEKEB VIM O AP VERONIKA RIRIN

41 MELINDA TABUNI 30 JHON BEMBOK WAIMHOROCK AP VERONIKA RIRIN