Nama Puskesmas/Fasyankes/Pos

Kabupaten/Kota
Provinsi
Hari, Tanggal

No No. Tiket

1 P-6IEE9SCB

2 P-GFY8BFI5

3 P-7AVOTV2N

4 P-7G9ZUDB2

5 L-00000FER

6 P-7TS5PNON

7 P-8QJZW3SJ

8 P-9IWTYDR
9 P-9XMWHK0Z

10 P-AEI2YCTJ

11 P-APPR8J79

12 P-B0UMA13T

13 P-BOCQ2DOI

14 P-BZII3DOM

15 P-COR81HUK

16 P-CGKYBEBJ

17 P-CMD7OHPW

18 P-DGBUOTE1

19 P-DRDX6365

20 P-E4NUUD1R

21 P-ER6O1E6H

22 P-F3VQ4V6S

23 P-FDEXMGTJ

24 P-FMNM7QI3

25 L-00001VJB

26 P-FPHRULV8
27 P-GH1HNUT0

28 P-GRJOA953

29 P-H5DH3HZH

30 L-00001VRW

31 P-HKJHHW1B

32 P-HM7WSJLB

33 P-NHU73K5V

34 Y-0134BVNO

35 P-IJQCZVC5

36 P-ICI84SFM

37 P-J04CIJM6

38 P-J1FI64EU

39 P-KFZAJ5WN

40 Y-0134J2ZS

41 P-L7S5WMZG

42 P-L8RKMEJ5

43 P-LDIZI2LF

44 P-LTWSP99J
45 P-M18J7B0S

46 P-M6V1RK02

47 P-MREPZ12Q

48 P-MRX8QF5V

49 P-NDPBOOES

50 P-NK8QLKKJ

51 P-MQ1WZISQ

52 P-O6829ZIJ

53 J-0000NEAM

54 P-OAK0HGRS

55 P-OASZZNCZ

56 P-OAEF9NQK

57 S-D814A605

58 P-OBDCQQ4C

59 P-OBF4DR6U

60 P-OBIWF7FF

61 P-OBSLMCXB

62 P-OBWLVWVS
63 J-0000MD57

64 P-OCGFJ7ZI

65 P-OCMGRIVB

66

67 P-OCSJ5ERZ

68 P-OCY2GLIJ

69 P-OD3QVBIK

70 P-ODGWLIG9

71 P-ODNC5420

72 P-ODU0K0ET

73 J-0000BKUX

74 J-0000MTB

75 J-0000M006

76 P-OEAYFA9F

77 P-OERGMCHK

78 P-OEVDQBXL

79 P-OF5TJPXZ

80 P-OFNFKMP0
81 P-OF819LOD

82 S-8414BE29

83 P-OFQJSA2W

84 P-OFYJFG6N

85 P-915G4PLJ

86 P-0K3M19FT

87 P-176PKXHZ

88 P-1BOQVLE5

89 P-0WA0DJF8

90 P-1DY93UWQ

91 P-1D9RBNCS

92 P-09J1VGM8

93 P-13QA3OS3

94 P-0IT8FJJE

95 P-16GSHIUV

96 P-0L91KFYD

97 P-0EZRB2HD

98 P-0OPNF9QM
99 P-1ORL8T5C

100 P-0P2Y2RR7

101 S-0238288A

102 P-1WGKNHAJ

103 S-0694ADOF

104 P-11IH6U30

105 Y-01369GQI

106 P-X7LQGO6F

107 P-0ZRGR04D

108 P-1AKAAOOT

109 P-X7LQG0GF

110 P-0XNCEHGN

111 P-0BB7EPCA

112 P-16EJI28V

113 P-0YFS56IC

114 J-0000MR83

115 P-1U5OY7FE

116 P-1T7HPASZ
117 J-0000MVP1

118 P-1GNKGYSL

119 P-22IVLSYH

120 P-0WCNLZHM

121 P-08PU5FXY

122 P-1LOYCR2L

123 P-0JYEJHGF

124 P-1D16ARIJ

125 P-24HN1AU9

126 P-0HT64SNM

127 P-27KMFCJY

128 P-022SI6E5

129 P-04KZNBWL

130 P-1HJX26EW

131 P-26RWWL60

132 P-0EQPJFQW

133 P-031S7J7H

134 P-229CZZWM
135 S-2C940CCB

136 P-21Y50TWV

137 P-0LIWFTPO

138 P-0X1Q85FZ

139 P-0IUGO1QS

140 P-1GAVSTST

141 P-05DDCJHV

142 P-1ILBF0BO

143 P-0G0KHKVS

144 P-1BYKSQJY

145 P-0B1ZPNJE

146 P-02P1WPG6

147 P-0CI5WPAP

148 P-0BC6TGCV

149 P-07OKTHUC

150 P-05KUCGEO

151 P-0025KPIH

152 P-0ZK5ZJNR
153 P-0MX4OOGZ

154 P-120H2HFX

155 P-0ZBP8RKN

156 P-1CFMLY4F

157 J-0000MV5T

158 P-1FA7R2PI

159 P-1NBGIF7W

160 P-1LLMLBAU

161 P-1MV7JPQ7

162 J-0000MV09

163 P-1QHMI2WB

164 P-1QRVFUOL

165 P-1SLGRNZK

166 P-1UVO72HA

167 P-1UOKCKNY

168 P-1USZ0DAX

169 J-0000MYDQ

170 P-1YFXFW1B
171 P-IYRB5B50

172 J-0000MV70

173 P-2265MKLY

174 P-26XC637E

175 P-26JSIPL6

176 P-2BEUU90OX

177 P-29RXEYPL

178 P-2CLCCMDE

179 P-2D5NMV5W

180 P-2ECYD7UR

181 P-2CZAY7DD

182 P-2DWPQ7A9

183 P-2EPB5UEE

184 J-0000N11V

185 J-0000MWM8

186 P-2FOKAAQ8

187 P-2GK7E0HF

188 J-0000MOTX
189 P-2IDX7ZLD

190 P-2JI5KLNF

191 P-2HLOO7DE

192 S-DA090F01

193 P-2LBEO0HW

194 P-2JR48C7Y

195 P-2MH14755

196 P-2M5JBC05

197 P-2NPN9AXR

198 J-0000M03N

199 P-2P0CKK2H

200

201 P-2QV9WXMD

202 J-0000MQ6F

203 P-2RAU4IOB

204 J-0000MNLS

205 J-0000MO88

206 P-2UVP7CIN
 207 J-0000M09F

208 P-2W743NNV

Keterangan
* Pekerjaan dikelompokkan menjadi:
A = Petugas Medis dan Non Medis di Fasilitas Pelayanan Kesehatan
B = Petugas pelayanan publik yang berhadapan langsung dengan masyarakat
C = Administrator Pemerintahan
D = Lainnya
E = Tidak Bekerja
 NIK

3213160704990008

3213162402030007

3213162206030003

3213160904820007

3213161704820006

3215140702820006

3213161806000008

3213161406030001
3213162102930001

3213166810970010

3213162901030004

3213165909890003

3213165909030001

3213095506970002

3213162003940003

3213161910900003

3213160908730001

3213166711030001

3213161408010007

3213160908990002

3213160101040002

3213161103980005

3213162002030011

3213167007820002

3213166306990004

3213166808000009
3213165105030001

3213164212040002

3213160711020007

3213162003000003

3213164510200001

3213160805970003

3213160206950004

31740701120510004

3213162310020001

3213163009020010

3213160211030001

3213161201010003

3213164809950002

3173024906820006

3213166307900003

3213165511010001

3213166702970009

3213166001750004
3213161806070002

3213165910920004

3213160608020008

3213160207010001

3213282606910003

3213161304920002

3213166607990001

3213165805990001

3213160101880024

3213164812630002

3213164904990004

3213166307090004

3213160512660002

3213160104760007

3213163007020011

3213164509010002

3213160102990002

3213165105830001
3213161212010008

3213161603020008

3213095707900009

3213166409000007

3213165408970004

3213166707010003

3213162507030004

3213161702620003

3213160106680009

3213161210820001

3213163101010002

3213166807940001

3213160507650013

3213160107750029

3213160708940006

3213166209920001

3213162810020006

3213160205670003
3213166403010003

3213165211830001

3213164906950002

3213165711000009

3213165002030007

3213161012790009

3213165105980002

3206360702610002

3213164604870002

3213160711930008

3213160110690002

3213167004010001

3213166008880001

3206366505950002

3213161208010001

3213160602730006

32131641127000006

3215045502910003
3213162111930002

3213165005950001

3213166310890003

3213164909940003

3172030908950001

3213166311830002

3213161802950001

3671102508820004

3213162301890004

7313065301780004

3213164504940003

3213161405060004

3213091509870001

3213162103010004

3213095409760001

3172035202910003

3213160102910001

3213164806870007
3213165012970003

3215146104790003

3213160107770283

3213091201990001

3215146211940003

3213161606960001

3215146702990004

3213096509910003

3215255110930003

3213164201940004

3213095204880003

3213093005920004

3215146005800003

3215295107850003

3213164107880435

3215145505010001

3213091009910001

3213162305000111
3213161403600007

3213166507000001

3215137105930004

3213096810800002

3213164212900006

3213166611800003

3213164505930005

3213094604950001

3215144505940002

3213164705000002

3213056805910001

3215147008890002

3213164509990014

3213164802010001

3215145409890002

3213166408850007

321309640890006

3209154306940007
3213161010030010

3213161606920002

3213164702930006

3213160411860001

3213065308960001

3213161512860001

3213164809030003

3213164602820004

3213162002630001

3213040105000003

3213094309870009

3213164508780003

3275050211840008

3213162909950002

3215141307880001

3213012407950001

3213161505890004

3213160207950002
3213163110960009

3213094903010005

3213161005710004

3213164906920001

3213161807960001

3213162205770002

3213162103990005

3213092805850004

3213162804820003

3213091510910005

3213160410960004

3213162102970004

3213165101940002

3213096111970001

3173032707980001

3213161203980001

3213166402970003

3213164604010003
3213162903020001

3213164101930003

3213164307020004

3213161604600003

32131622126500001

3213164505030001

3273090905800005

3213060210930001

3213161012030004

3213165801050001

3213164408910012

3275050211840008

3213165712030003

321316420290008

3213161410880003

3213166710010001

3213166010930003

3213161008700390
 3213165606720009

3213165204910010

litas Pelayanan Kesehatan

dapan langsung dengan masyarakat
 Kelompok Umur:
12-17
18-30
31-45
46-59
≥ 60 tahun
Total
Pekerjaan:
A
B
C
D
E
Total
:
:
:
:

Jenis
Nama Penerima Vaksin Pekerjaan*
Kelamin

TORIQ ALFAZIAN L SWASTA

ASEP RUKHIYAT L PELAJAR

ARIPIN ANDREANO L PELAJAR

H. DEDE NURYANO L WIRSWASTA

SURAHMAN L WIRSWASTA

OTING SURATMAN L WIRSWASTA

AHMAD MUSA D L PELAJAR

MAHER L PELAJAR
ADENG SUPRIATNA L SWASTA

VIVI OCKTIANI SUNENDANG P PELAJAR

TOMY FATHURAHMAN L PELAJAR

SITI PATIMAH P MRT

RIZKI AMELIA SIFA P PELAJAR

AJENG SYIFA SA'ADAH P PELAJAR

AMAN SULAEMAN L SWASTA

ASEPUDIN L SWASTA

MAMAN ABDUROHMAN L WIRSWASTA

NOVI FITRIANI SUNENDANG P PELAJAR

FAJAR FATRIYA HIDAYAT L PELAJAR

HAMDUN HILAL L PELAJAR

AHMAD NURJAYA L PELAJAR

M. ROJIKIN L PELAJAR

SYAHRIL VIANA IRAWAN L PELAJAR

SRI WAHYU NENGSIH P MRT

HEPI KARINA P PELAJAR

ANNISA KEMALA DEWI P PELAJAR

YESI WIDIA MELANICA P PELAJAR

ELAWATI P PELAJAR

BAHRUL HIDAYAT L PELAJAR

DANIL RAKA SIWI L PELAJAR

TRIYANI P PELAJAR

TEGUH SAMSUL MUARIF L PELAJAR

ABU RAHMANDA L PELAJAR

RAFI RASHA L PELAJAR

ESA ALDANIO L PELAJAR

SYAHRIAN L PELAJAR

MOH HIKMAL MAULANA L PELAJAR

ANGGIT BUDIMAN L PELAJAR

NANDA ABILLAK P WIRSWASTA

SINTA DWI KLARA P MRT

TITIK NUR P MRT

SRI WULANDARI P PELAJAR

AYU NITA PEBRIANI P MRT

ANAH P MRT
MUHAMMAD RAFHLI SOHIRIN L PELAJAR

ASIH KURNIASIH P MRT

DIKA WAHYUDI L PELAJAR

FARHAN ALDI WIJAYA L PELAJAR

ILHAM SYAKIR L SWASTA

ADI MUHTAR L SWASTA

LAILATUL FAJRIYAH P PELAJAR

DESI AMELIA P SWASTA

TATANG HAERUDIN L WIRSWASTA

ANYI P MRT

INDI APRIANI P MRT

MAHARANI ZHROTUSSYIFA P PELAJAR

ASEP ZARKASIH L WIRSWASTA

SUHENDI L BURUH TANI

DERI IRAWAN L PELAJAR

ANGGITA AMARIZKA P PELAJAR

SETIAJI WIRASUHADA L SWASTA

KARSENI P MRT
YUSUP GUNAWAN L PELAJAR

EKO WIJAYANTO L PELAJAR

SUHARTINI P MRT

HERLINA P PELAJAR

NURHAYATI P MRT

SITI RODIAH P PELAJAR

DUDUNG L PELAJAR

NAMIN L BURUH TANI

SATA L BURUH TANI

NASA BIN RAWIS L BURUH

TIRTA WIJAYA L PELAJAR

YULI ANDYANI P MRT

PRAMONO BIN PURWODIHARJO L WIRSWASTA

ARIF AMIN L WIRSWASTA

ANTO KUSWANTO L PELAJAR

ICEU KURNIAWATI P MRT

M. GILANG DARMAWAN L PELAJAR

OTONG SUHARJA L PETANI

WINENGSIH P PELAJAR

PENIH NURAENI BT BANA P MRT

DIAN PERTIWI P MRT

NURYANAH P PELAJAR

ADE ROHENI P PELAJAR

LEMIN L WIRSWASTA

ARNESIH P MRT

JAKA L WIRSWASTA

KESMI P MRT

DEDI SAPUTRA L WIRSWASTA

SALA BIN SAMIL L WIRSWASTA

RINA MARSELA P PELAJAR

EEN SUKARSIH P MRT

RATIH MEIRANI P MRT

AGUS MAULANA L PELAJAR

MUKRI L BURUH

AMIH P MRT

OMAH MATYAMAH P MRT

NEMIN L PELAJAR

MINTARSIH P WIRSWASTA

MERI OKTAVIANA P GURU

NURYANI P MRT

DANY HERDIAN L SWASTA

SATI P WIRSWASTA

AKBAR PRIATNA L SWASTA

ENDANG SUKARYA L SWASTA

YUSUF RAMDANI L PELAJAR

SITI JURIAH P MRT

NINING KARTIKA P MRT

MUHSIN HISBULLAH L PELAJAR

TONI HARDI L BURUH

AGHMAD RIVAN JAKARIA L PELAJAR

MASRIPAH P MRT

NURHAYATI P MRT

PERI SANDRIA L WIRSWASTA

WIWI P MRT
MIFTAHUL JANAH P SWASTA

HERAWATI P SWASTA

HEMAN L WIRSWASTA

MUHAMAD RAMDAN SOLEH L PELAJAR

CAHYATI P SWASTA

SUNARYO L SWASTA

PEBRIYANAH P SWASTA

NENI SUSANTI P MRT

SRI SUHARNI P SWASTA

LILIS NURASIAH P MRT

IIS SADIYAH P MRT

YAYAN HENDRI YANA L WIRSWASTA

SITI NURYETI P MRT

VIRDA DEVIANI P SWASTA

SITI MARIAM P MRT

RASTINAH P PELAJAR

BILLI NURDIANSYAH L SWASTA

DEDE HERMAWAN L SWASTA

NUNUNG ASMUNI L BURUH

SELLY SOLIHAT P PELAJAR

RANI PRATIWI P MRT

DEDE SUKAESIH P SWASTA

NENDEN ROSIDAH P SWASTA

IMAS P MRT

KARLINA P SWASTA

FATIMAH P MRT

SITI AISAH P MRT

PRIHARTINI P SWASTA

SUSI SANTIKA P SWASTA

EFIYAWATI P SWASTA

MIMI SURYANI P PELAJAR

AYU KARLISNA P PELAJAR

MIA HERMINA P MRT

RINI NURAENI P MRT

SITI KONA'AH P MRT

SITI NAPSIAH P SWASTA

AHMAD FAUZI L PELAJAR

WAHYU L SWASTA

SYIFA FAUZIAH P MRT

DEDY PURWANDI L SWASTA

SITI MAEMUNAH P SWASTA

NURHAYADI BIN YAHYA L SWASTA

RINTAN SEPTIANI P PELAJAR

OSIH P MRT

AKUM BIN NATA L PETANI

MUHAMAD FAHRUL L PELAJAR

FIKA SEPTI MAFIKASARI P MRT

ROHAYATI P MRT

ANDIKA SETYO PAMUNGKAS L SWASTA

ABDUL PAQIH L SWASTA

BUANG RIDWAN L SWASTA

ADE KOSWARA L PELAJAR

PANANI L WIRSWASTA

JAJANG KUNIADI L SWASTA

UWAN L SWASTA

DEBY HABIBAH P PELAJAR

WASMAR L SWASTA

SITI ALIYAH P MRT

IZMAL MULQI L SWASTA

MISKAR KHARISMA L WIRSWASTA

HALDI FIRDAUS L SWASTA

CHARLIE TOPANI L WIRSWASTA

SUMARNA L WIRSWASTA

FACHRUDIN L SWASTA

MEGA LOSARI P SWASTA

ROPIK NUROHMAN L SWASTA

RINI YULIA NINGSIH P MRT

KAMILIA NUR AINI P PELAJAR

M. IMAM MAULANA L PELAJAR

INU FIDI NUGRAHA L SWASTA

LILIS SOLIHAT P SWASTA

SITI QORIANAMIYAH L PELAJAR

MUHAMAD BRILLIANT L PELAJAR

TATI MULYANI P SWASTA

DEDE YULIA DIAH P PELAJAR

KARMO L PETANI

ASEP KS BIN ACIP L WIRSWASTA

LULU ULJANAH P PELAJAR

HADI PRAYITNO HARTOYO L SWASTA

AAM AMRULLOH L SWASTA

TRIHADI AHDIYAT L PELAJAR

WINDA AMALIA P PELAJAR

NURLAELY P MRT

ANDIKA SETYO PAMUNGKAS L SWASTA

ESTI KOMALA P PELAJAR

MUHAYYAH P SWASTA

TARIP L SWASTA

MILA NUR MILLATI P PELAJAR

NANI NURAFIFAH P MRT

LEGIYO PRIYO AMBODO L WIRSWASTA

MUNIROH BT H MANAF P MRT

IRA AMINAH P MRT

***Merek Vaksin
A = Sinovac
B = Lainnya (Mohon disebutkan jenis vaksin yang diterima Puskesmas/Faskes)
elompok Umur: Kepesertaan BPJS
6 BPJS PBI
123 BPJS Non PBI
59 Non Anggota
16
4 Total
208 Pemberian Dosis
Pekerjaan: Dosis 1
0 Dosis 2
0 Total
0
0
0
0
 FORMAT PENCATA
TINGKAT PUS

Umur
Tanggal Lahir Kelompok Umur
(18 sd ≥ 60 tahun)

07/04/1999 23 18-30

24/02/2003 19 18-30

22/06/2003 19 18-30

09/04/1982 40 31-45

17/04/1982 40 31-45

07/02/1982 40 31-45

18/07/2000 22 18-30

14/06/2003 19 18-30
21/02/1993 29 18-30

27/10/1997 25 18-30

29/01/2003 19 18-30

19/09/1989 33 31-45

19/09/2003 19 18-30

15/06/1997 25 18-30

20/03/1993 29 18-30

12/04/1989 33 31-45

09/08/1973 49 46-59

29/09/2004 18 18-30

14/06/2001 21 18-30

09/08/1999 23 18-30

01/01/2004 18 18-30

11/03/1998 24 18-30

20/02/2003 19 18-30

30/07/1982 40 31-45

23/06/1999 23 18-30

28/08/2000 22 18-30
11/05/2002 20 18-30

02/12/2004 17 12-17

05/11/2000 22 18-30

01/03/1999 23 18-30

11/09/2002 20 18-30

08/05/1997 25 18-30

02/06/1995 27 18-30

01/12/2005 16 12-17

23/10/2002 20 18-30

30/09/2002 20 18-30

02/11/2003 19 18-30

12/01/2001 21 18-30

08/09/1995 27 18-30

09/06/1982 40 31-45

23/07/1990 32 31-45

15/11/2001 21 18-30

27/02/1997 25 18-30

20/01/1975 47 46-59
18/06/2007 15 12-17

19/10/1992 30 18-30

06/08/2002 20 18-30

02/07/2001 21 18-30

26/06/1991 31 31-45

13/04/1992 30 18-30

26/07/1999 23 18-30

18/05/1999 23 18-30

01/01/1988 34 31-45

08/12/1963 58 46-59

09/04/1999 23 18-30

23/07/2009 13 12-17

05/12/1966 55 46-59

18/08/1979 43 31-45

28/09/2002 20 18-30

05/09/2001 21 18-30

01/02/1999 23 18-30

11/05/1983 39 31-45
12/12/2001 20 18-30

16/03/2002 20 18-30

17/07/1990 32 31-45

24/09/2000 22 18-30

14/08/1997 25 18-30

27/07/2001 21 18-30

25/07/2003 19 18-30

17/02/1962 60 ≥60

01/06/1968 54 46-59

12/10/1982 40 31-45

31/01/2001 21 18-30

28/07/1994 28 18-30

05/07/1965 57 46-59

01/08/1975 47 46-59

07/08/1994 28 18-30

22/09/1992 30 18-30

28/10/2002 20 18-30

02/05/1967 55 46-59
24/03/2001 21 18-30

12/11/1983 39 31-45

09/06/1995 27 18-30

17/11/2000 22 18-30

10/02/2003 19 18-30

10/12/1979 42 31-45

11/05/1998 24 18-30

07/02/1961 61 ≥60

06/04/1987 35 31-45

07/11/1993 29 18-30

01/10/1969 53 46-59

30/04/2001 21 18-30

20/08/1988 34 31-45

25/05/1995 27 18-30

12/08/2001 21 18-30

06/02/1973 49 46-59

01/12/1970 51 46-59

15/02/1991 31 31-45
21/11/1993 29 18-30

10/05/1995 27 18-30

23/10/1989 33 31-45

09/09/1995 27 18-30

09/08/1995 27 18-30

23/11/1983 39 31-45

18/02/1995 27 18-30

25/08/1982 40 31-45

23/01/1998 24 18-30

13/01/1978 44 31-45

05/04/1994 28 18-30

14/05/2006 16 12-17

15/09/1987 35 31-45

21/03/2001 21 18-30

10/10/1980 42 31-45

12/02/1991 31 31-45

01/02/1991 31 31-45

08/06/1987 35 31-45
10/12/1997 24 18-30

21/04/1979 43 31-45

07/10/1978 44 31-45

12/01/1999 23 18-30

22/11/1994 28 18-30

16/06/1996 26 18-30

27/02/1999 23 18-30

25/02/1991 31 31-45

11/10/1993 29 18-30

02/01/1994 28 18-30

12/04/1988 34 31-45

30/05/1992 30 18-30

20/08/1980 42 31-45

01/07/1985 37 31-45

29/08/1988 34 31-45

15/05/2001 21 18-30

10/09/1995 27 18-30

23/05/2000 22 18-30
14/03/1960 62 ≥60

25/07/2000 22 18-30

31/05/1993 29 18-30

28/10/1980 42 31-45

27/12/1990 31 31-45

26/11/1980 42 31-45

05/05/1993 29 18-30

06/04/1995 27 18-30

05/05/1994 28 18-30

07/05/2000 22 18-30

28/05/1991 31 31-45

30/08/1989 33 31-45

05/09/1999 23 18-30

08/02/2001 21 18-30

14/09/1989 33 31-45

24/08/1985 37 31-45

24/08/1998 24 18-30

03/06/1994 28 18-30
10/10/2003 19 18-30

16/06/1992 30 18-30

07/02/1993 29 18-30

04/11/1989 33 31-45

13/08/1996 26 18-30

15/12/1986 35 31-45

12/09/2003 19 18-30

06/02/1982 40 31-45

20/02/1963 59 46-59

01/05/2000 22 18-30

03/09/1987 35 31-45

05/08/1978 44 31-45

02/11/1984 38 31-45

29/09/1995 27 18-30

13/06/1987 35 31-45

24/07/1995 27 18-30

15/05/1989 33 31-45

02/07/1995 27 18-30
31/10/1996 26 18-30

09/03/2001 21 18-30

10/05/1971 51 46-59

09/06/1992 30 18-30

18/07/1996 26 18-30

22/05/1977 45 31-45

14/11/1999 23 18-30

28/05/1985 37 31-45

28/04/1982 40 31-45

05/10/1991 31 31-45

10/11/1996 26 18-30

21/02/1997 25 18-30

11/01/1994 28 18-30

21/11/1997 25 18-30

27/07/1998 24 18-30

12/03/1998 24 18-30

24/02/1997 25 18-30

06/04/2001 21 18-30
29/03/2002 20 18-30

01/01/1993 29 18-30

03/07/2002 20 18-30

16/04/1960 62 ≥60

22/12/1965 56 46-59

05/05/2003 19 18-30

09/05/1980 42 31-45

02/10/1993 29 18-30

10/12/2003 18 18-30

18/01/2005 17 12-17

04/08/1993 29 18-30

02/11/1984 38 31-45

17/12/2003 18 18-30

02/02/1990 32 31-45

14/10/1988 34 31-45

27/10/2001 21 18-30

20/10/1993 29 18-30

10/08/1970 52 46-59
16/06/1972 50 46-59

12/04/1991 31 31-45
0
0
0

0
0
FORMAT PENCATATAN PELAKSANAAN VAKSINASI COV
TINGKAT PUSKESMAS/FASYANKES/POS VAKSINAS

Alamat

GARDU

BUWER

BUWER

BAKAN KIARA

BUWER

RANCABANGO

RANCABANGO

GARDU
RANCABANGO

PANGKALAN

GARDU

RANCABANGO

GARDU

SUKAMANDI

MAYASARI

MAYASARI

PASIR HURUP

PANGKALAN

MULYASARI

RANCABANGO

MALAKA

RANCABANGO

BUWER

BUWER

BUWER

BUWER
BUWER

BUWER

BUWER

BUWER

MULYASARI

BUWER

BUWER

BUWER

MULYASARI

MULYASARI

BUWER

BUWER

RANCAJAYA

BUWER

RANCABANGO

MAYASUTA

BUWER

PANGKALAN
PUNDONG

PENGKOLAN

PENGKOLAN

PATOKBEUSI

PATOKBEUSI

CIRANGGON

PUNGANGAN

CIRANGGON

NAMBO

CIRANGGON

CIRANGGON

PUNGANGAN

PUNGANGAN

TANJUNGAN

TANJUNGAN

NAMBO

MAYASARI

RANCABANGO
WATES

NAMBO

NAMBO

WATES

NAMBO

MALAKA

WATES

PENGKOLAN

PAGELARAN

CIDAMPA

NAMBO

NAMBO

MULYASARI

RANCABANGO

SENGON

SIMPANG

PATOKBEUSI

JUNGKLANG
MAYASUTA

MAYASUTA

WATES

TANJUNGAN

PAGELARAN

PENGKOLAN

JUNGKLANG

PATOKBEUSI

JUNGKLANG

CIRANGGON

CIRANGGON

JUNGKLANG

PATOKBEUSI

PATOKBEUSI

JUNGKLANG

MAYASARI

CIRANGGON

NAMBO
PENGKOLAN

RANJENG

MULYASARI

NAMBO

JAKARTA UTARA

NAMBO

RANCAASIH

TANGERANG

BAKAN KIARA

RANCABANGO

BABAKAN PESAWAHAN

MAYASUTA

GARDU

RANCAASIH

CIASEM

RANCABANGO

RANCABANGO

TANJUNGSARI
MAYASARI

GRAND SUBANG

GARDU

DUKUH

KARAWANG

PUNDONG

KARAWANG

CIASEM GIRANG

CIKALONG

KARAWANG

SUKAMANDI

PUSAKAJAYA

KARAWANG

KARAWANG

CIBERES

JATIRAGAS

MARGALUYU BARAT

GEMPOLSARI
PUNGANGAN

CIBERES

KARAWANG

MARGALUYU TIMUR

CIBERES

CIBERES

TAMBAKJATI

CIASEM

KARAWANG

CIBERES

PABUARAN

KARAWANG

CIBERES

CIBERES

JATISARI

CIBERES

PINANGSARI

KARAWANG
GARDU

CIBERES

PANGKALAN

CIBERES

BLENDUNG

RANCABANGO

GARDU

CIBERES

BABAKAN PESAWAHAN

KALIJATI

CIASEM

MANGANTI

SUKAMANDI

GARDU

KARAWANG

SAGALAHERANG

PUNGANGAN

CIBERES
GARDU

SUKAMANDI

RANCABANGO

PANGKALAN

RANCABANGO

TEGAL KONENG

RANCABANGO

TEGAL KONENG

MAYASARI

CIASEM BARU

GARDU

MAYASARI

GARDU

SUKAMANDI

MAYASARI

RANCABANGO

SUKAJAYA

PUNGANGAN
PANGKALAN

PANGKALAN

GARDU

PANGKALAN

PUNGANGAN

MAYASUTA

BANDUNG

RANCABANGO

MAYASARI

PUNGANGAN

RANCABANGO

SUKAMNDI

RANCABANGO

PUNGANGAN

RANCABANGO

PUNGANGAN

PUNGANGAN

PENGKOLAN
PUNGANGAN

GARDU
 Pekerjaan
A
B
C

D
E
Total
LAKSANAAN VAKSINASI COVID-19
/FASYANKES/POS VAKSINASI

Kepesertaan BPJS (tulis 'Ya' pada kolom yang sesuai)

No. Hp

BPJS PBI BPJS Non PBI

083816346783

081224147059

082118786059

083180324699

082218713181

085696384250

083816233171

083117781037
083816745007

081219315613

083823967104

083148397392

083139363639

081386197735

087822450555

087760690010

083102666018

082110052639

083816197274

083116380475

083811470627

085697426423

081223982548

081931410306

081220757155

08120502505
081318590373

083162267851

083101955702

081210232685

083149861556

081382885314

087726927069

081298237857

085798807615

085721805538

081282776812

081223238812

08819879461

083865983690

083877769227

081322946983

087828332422

081222292509
083803727662

083899190108

083841182262

0859115604656

087779672999

085215912694

083820942026

081297662253

081287888233

083895749

083895749066

083820942026

085317547227

081213977944

081213864923

083191977089

083879334969

082262338344
082134634957

083872929711

083816496530

081220136500

083879334064

081214331791

081223054517

083842092201

087883409662

085911492296

0821229081170

082352343117

08128134681

083820280005

083121140636

081214693553

081280794014

085352901878
083130604657

083815328660

083127742935

081353419659

081211560307

083199614887

083816777905

081221883005

083821071987

081931813838

081912634759

083822803097

082127423057

081369284797

083148158252

082218471622

082130014716

083138839040
082130120565

083137267363

083130407965

082319511260

085217203438

083195857097

087726575246

082122365959

082118604581

081313196224

083130508168

082139337197

085797968198

083148280303

083821666691

083842091536

083878605949

083891054294
083116373294

085889702977

08882099436

081902649465

083195275205

083824148635

085694190419

083195556974

087779186815

085695237416

083837721928

083816255239

085695241189

085719899828

083148715300

087721633502

083148722342

085846034126
082122903041

083826728234

085711941360

087726659294

081906690568

083892607184

083822001559

083865338930

083104297111

089629834106

087752389855

085693325138

085774483165

083841233145

085813339351

087760632702

0816727650

085759706695
083866618645

083842996151

083120800920

085947659106

081220564672

0859138646474

083116067296

083195275192

0877268550675

081313845915

085795233096

083879334168

082216487377

083148459251

089636781723

081324958647

0887433183766

083816364578
083816743050

089678399762

083148476738

087828368022

081910087773

083877502889

087760673795

081386555228

081312031404

085320351767

083866618310

083195755037

083819253881

081514121664

082122401217

083117422600

087708764199

083866061500
082116460669

081324244087

083120731877

087821183990

083869393752

081223315362

085221720508

083841907058

083841333503

083825377789

083823153491

082216487377

0859138647064

0818164228

083174877891

083837300621

087886571228

081223267791
083825377789

083816493313
aan
0
0
0

0
0
0
a' pada kolom yang sesuai)

Tanggal Screening Nama/Jenis/Merek Vaksin***

Non Anggota
 Dosis I

Tanggal Pemberian
No. Batch No. Serial
Vaksinasi
 Dosis 2

Tanggal Pemberian
No. Batch No. Serial
Vaksinasi
 Keterangan
(Ditunda/Tidak Diberikan/Lanjut)
 FORMA
TI
Nama Puskesmas/Fasyankes/Pos :
Kabupaten/Kota :
Provinsi :

Sasaran
Tahap 1 Tahap 2 Tahap 3
Tanggal/ Bulan
Pelaksanaan
Masyarakat
SDM Kesehatan Lansia Pelayan Publik
Rentan

TOTAL 0 0 0 0
FORMAT REKAPITULASI PELAKSANAAN VAKSINASI COVI
TINGKAT PUSKESMAS/FASYANKES/POS VAKSINASI
:
:
:

Tahap 3 Total Dosis I Tahap 1

(Semua Tahapan)
Total Sasaran SDM Kesehatan
Masyarakat
Remaja
Umum
# % # %

0 0 #DIV/0! #DIV/0!
0 0 #DIV/0! #DIV/0!
0 0 #DIV/0! #DIV/0!
0 0 #DIV/0! #DIV/0!
0 0 #DIV/0! #DIV/0!
0 0 #DIV/0! #DIV/0!
0 0 #DIV/0! #DIV/0!
0 0 #DIV/0! #DIV/0!
0 0 #DIV/0! #DIV/0!
0 0 #DIV/0! #DIV/0!
0 0 0 0 #DIV/0! 0 #DIV/0!
SINASI COVID-19
VAKSINASI

Penerima Vaksin Dosis 1

Tahap 2 Tahap 3

Lansia Pelayan Publik Masyarakat Rentan Masyarakat Umum

# % # % # % #

#DIV/0! #DIV/0! #DIV/0!

#DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0!
0 #DIV/0! 0 #DIV/0! 0 #DIV/0! 0
 Tahap 3 Total Tunda Dosis I Tahap 1 Tah
(Semua Tahapan)
syarakat Umum Remaja SDM Kesehatan Lansia

% # % # % # % #

#DIV/0! #DIV/0! 0 #DIV/0! #DIV/0!

#DIV/0! #DIV/0! 0 #DIV/0! #DIV/0!
#DIV/0! #DIV/0! 0 #DIV/0! #DIV/0!
#DIV/0! #DIV/0! 0 #DIV/0! #DIV/0!
#DIV/0! #DIV/0! 0 #DIV/0! #DIV/0!
#DIV/0! #DIV/0! 0 #DIV/0! #DIV/0!
#DIV/0! #DIV/0! 0 #DIV/0! #DIV/0!
#DIV/0! #DIV/0! 0 #DIV/0! #DIV/0!
#DIV/0! #DIV/0! 0 #DIV/0! #DIV/0!
#DIV/0! #DIV/0! 0 #DIV/0! #DIV/0!
#DIV/0! 0 #DIV/0! 0 #DIV/0! 0 #DIV/0! 0
 Tunda Vaksin Dosis 1
Tahap 2 Tahap 3

Lansia Pelayan Publik Masyarakat Rentan Masyarakat Umum Remaja

% # % # % # % #

#DIV/0! #DIV/0! #DIV/0! #DIV/0!

#DIV/0! #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0! #DIV/0!
#DIV/0! 0 #DIV/0! 0 #DIV/0! 0 #DIV/0! 0
 Batal Vaksin Dosis
Total Batal Dosis I Tahap 1 Tahap 2
(Semua Tahapan)
Remaja SDM Kesehatan Lansia Pelayan Publik

% # % # % # % #

#DIV/0! 0 #DIV/0! #DIV/0! #DIV/0!

#DIV/0! 0 #DIV/0! #DIV/0! #DIV/0!
#DIV/0! 0 #DIV/0! #DIV/0! #DIV/0!
#DIV/0! 0 #DIV/0! #DIV/0! #DIV/0!
#DIV/0! 0 #DIV/0! #DIV/0! #DIV/0!
#DIV/0! 0 #DIV/0! #DIV/0! #DIV/0!
#DIV/0! 0 #DIV/0! #DIV/0! #DIV/0!
#DIV/0! 0 #DIV/0! #DIV/0! #DIV/0!
#DIV/0! 0 #DIV/0! #DIV/0! #DIV/0!
#DIV/0! 0 #DIV/0! #DIV/0! #DIV/0!
#DIV/0! 0 #DIV/0! 0 #DIV/0! 0 #DIV/0! 0
 Batal Vaksin Dosis 1
ap 2 Tahap 3 Total Dosis 2
(Semua Tahapan)
Pelayan Publik Masyarakat Rentan Masyarakat Umum Remaja

% # % # % # % #

#DIV/0! #DIV/0! #DIV/0! #DIV/0! 0

#DIV/0! #DIV/0! #DIV/0! #DIV/0! 0
#DIV/0! #DIV/0! #DIV/0! #DIV/0! 0
#DIV/0! #DIV/0! #DIV/0! #DIV/0! 0
#DIV/0! #DIV/0! #DIV/0! #DIV/0! 0
#DIV/0! #DIV/0! #DIV/0! #DIV/0! 0
#DIV/0! #DIV/0! #DIV/0! #DIV/0! 0
#DIV/0! #DIV/0! #DIV/0! #DIV/0! 0
#DIV/0! #DIV/0! #DIV/0! #DIV/0! 0
#DIV/0! #DIV/0! #DIV/0! #DIV/0! 0
#DIV/0! 0 #DIV/0! 0 #DIV/0! 0 #DIV/0! 0
 Penerima Vaksin Dosis 2
Total Dosis 2 Tahap 1 Tahap 2 Tahap
(Semua Tahapan)
Masyarakat
SDM Kesehatan Lansia Pelayan Publik
Rentan

% # % # % # % # %

#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!

#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
#DIV/0! 0 #DIV/0! 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
2
Tahap 3 Total Tunda Dosis 2 Tahap 1 Tahap 2
(Semua Tahapan)
Masyarakat Umum Remaja SDM Kesehatan Lansia

# % # % # % # % # %

#DIV/0! #DIV/0! 0 #DIV/0! #DIV/0! #DIV/0!

#DIV/0! #DIV/0! 0 #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! 0 #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! 0 #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! 0 #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! 0 #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! 0 #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! 0 #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! 0 #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! 0 #DIV/0! #DIV/0! #DIV/0!
0 #DIV/0! 0 #DIV/0! 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
 Tunda Vaksin Dosis 2
Tahap 2 Tahap 3 Total Batal Dosis 2
(Semua Tahapan)
Masyarakat
Pelayan Publik Masyarakat Umum Remaja
Rentan

# % # % # % # % #

#DIV/0! #DIV/0! #DIV/0! #DIV/0! 0

#DIV/0! #DIV/0! #DIV/0! #DIV/0! 0
#DIV/0! #DIV/0! #DIV/0! #DIV/0! 0
#DIV/0! #DIV/0! #DIV/0! #DIV/0! 0
#DIV/0! #DIV/0! #DIV/0! #DIV/0! 0
#DIV/0! #DIV/0! #DIV/0! #DIV/0! 0
#DIV/0! #DIV/0! #DIV/0! #DIV/0! 0
#DIV/0! #DIV/0! #DIV/0! #DIV/0! 0
#DIV/0! #DIV/0! #DIV/0! #DIV/0! 0
#DIV/0! #DIV/0! #DIV/0! #DIV/0! 0
0 #DIV/0! 0 #DIV/0! 0 #DIV/0! 0 #DIV/0! 0
 Batal Vaksin Dosis 2
Total Batal Dosis 2 Tahap 1 Tahap 2
(Semua Tahapan)
SDM Kesehatan Lansia Pelayan Publik Masyarakat Rentan

% # % # % # % #

#DIV/0! #DIV/0! #DIV/0! #DIV/0!

#DIV/0! #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0! #DIV/0!
#DIV/0! 0 #DIV/0! 0 #DIV/0! 0 #DIV/0! 0
sis 2 Indeks Pemakaian V
Tahap 3
Coronavac Vaksin Covid-19 BF
asyarakat Rentan Masyarakat Umum Remaja (Single Dose Vial) (Multi Dose Vial)

Jmlh
Jmlh Vial Jmlh Vial
% # % # % Diimunis IP
Terpakai Terpakai
asi
#DIV/0! #DIV/0! #DIV/0! 0 #DIV/0!
#DIV/0! #DIV/0! #DIV/0! 0 #DIV/0!
#DIV/0! #DIV/0! #DIV/0! 0 #DIV/0!
#DIV/0! #DIV/0! #DIV/0! 0 #DIV/0!
#DIV/0! #DIV/0! #DIV/0! 0 #DIV/0!
#DIV/0! #DIV/0! #DIV/0! 0 #DIV/0!
#DIV/0! #DIV/0! #DIV/0! 0 #DIV/0!
#DIV/0! #DIV/0! #DIV/0! 0 #DIV/0!
#DIV/0! #DIV/0! #DIV/0! 0 #DIV/0!
#DIV/0! #DIV/0! #DIV/0! 0 #DIV/0!
#DIV/0! 0 #DIV/0! 0 #DIV/0! 0 0 #DIV/0! 0
 Indeks Pemakaian Vaksin Berdasarkan Merek

Vaksin Covid-19 BF
Astra Zeneca Lainnya
(Multi Dose Vial)

Jmlh Jmlh Jmlh

Jmlh Vial Jmlh Vial
Diimunis IP Diimunis IP Diimunis IP
Terpakai Terpakai
asi asi asi
0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
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 FORMAT REKAPITULASI HARIAN
TINGKAT K
Kabupaten/Kota :
Provinsi :
Hari, Tanggal :

Sasaran
Tahap 1 Tahap 2
Puskesmas/Fasyankes/
NO
Pos Vaksinasi
SDM Kesehatan Lansia

TOTAL 0 0
APITULASI HARIAN PELAKSANAAN VAKSINASI COVID-19
TINGKAT KABUPATEN/KOTA

Sasaran
Tahap 2 Tahap 3

Pelayan Publik Masyarakat Rentan Masyarakat Umum Remaja

0 0 0 0
ASI COVID-19

Penerim
Total Dosis I Tahap 1 Tahap 2
(Semua Tahapan)
Total Sasaran SDM Kesehatan Lansia

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 Penerima Vaksin Dosis 1
Tahap 2 Tahap 3
Masyarakat
Pelayan Publik Masyarakat Rentan Remaja
Umum

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 Tunda Vaksin Dosis 1
Total Tunda Dosis
I Tahap 1 Tahap 2 Tahap
(Semua Tahapan) Masyarakat
SDM Kesehatan Lansia Pelayan Publik
Rentan

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s1
Tahap 3 Total Batal Dosis I Tahap 1 Tahap 2
(Semua Tahapan)
Masyarakat Umum Remaja SDM Kesehatan Lansia

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 Batal Vaksin Dosis 1
Tahap 2 Tahap 3
Masyarakat
Lansia Pelayan Publik Masyarakat Umum Remaja
Rentan

% # % # % # % # %

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 Penerima Vaksin Dosis 2
Total Dosis 2 Tahap 1 Tahap 2 Taha
(Semua Tahapan)
Masyarakat
SDM Kesehatan Lansia Pelayan Publik
Rentan

# % # % # % # % #

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ksin Dosis 2
Total Tunda
Tahap 3 Dosis 2 Tahap 1 Tahap 2
(Semua
Masyarakat Tahapan)
Masyarakat Umum Remaja SDM Kesehatan Lansia
Rentan

% # % # % # % # % #

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 Tunda Vaksin Dosis 2
Tahap 2 Tahap 3
Masyarakat
Lansia Pelayan Publik Masyarakat Umum Remaja
Rentan

% # % # % # % # %

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#DIV/0! 0 #DIV/0! 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
 Batal Vaksin Dosis 2
Total Batal Dosis 2 Tahap 1 Tahap 2
(Semua Tahapan)
SDM Kesehatan Lansia Pelayan Publik

# % # % # % # %

0 #DIV/0! #DIV/0! #DIV/0! #DIV/0!

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atal Vaksin Dosis 2 Indeks
Tahap 3
Coronavac
Masyarakat Rentan Masyarakat Umum Remaja (Single Dose Vial)

Jmlh
Jmlh Vial
# % # % # % Diimunis IP
Terpakai
asi
#DIV/0! #DIV/0! #DIV/0! 0 #DIV/0!
#DIV/0! #DIV/0! #DIV/0! 0 #DIV/0!
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0 #DIV/0! 0 #DIV/0! 0 #DIV/0! 0 0 #DIV/0!
 Indeks Pemakaian Vaksin Berdasarkan Merek

Vaksin Covid-19 BF
Astra Zeneca Lainnya
(Multi Dose Vial)

Jmlh Jmlh Jmlh

Jmlh Vial Jmlh Vial Jmlh Vial
Diimunis IP Diimunis IP Diimunis IP
Terpakai Terpakai Terpakai
asi asi asi
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