FORMAT PENCATATAN HASIL PELAYANAN

PROVINSI : MALUKU
KABUPATE : MALUKU TENGGARA
TAHUN : 2022

Imunisasi Kejar
(Ya = 1, Tidak=0)
Campak
Rubela
No. Nama Anak Tgl lahir Umur Jenis Kelamin (L/P) Nama orang tua Alamat No.Hp NIK (Ya=1,
Tidak=0)
OPV IPV DPT-HB-Hib

a b c d e f g h i j k l m
1 FADLAN A. YAMLEAN 3/18/2021 1 L TILAWATI NGANGUN SATHEAN 1
2 FAJRUL I. YAMLEAN 4/7/2018 4 L TILAWATI NGANGUN SATHEAN 1
3 M. FIKRI YAMSEHU 2/5/2019 3 L JENA J WARAYAAN SATHEAN 1
4 RADEN SELMAN 10/21/2020 1 L FAJAR RUMAJAAN SATHEAN 1
5 M. ANAKA ALHAMID 6/10/2021 1 L SARIFAH FATMA SATHEAN 1
6 ZEIN M. K SUAT 6/8/2021 1 L HILDAYANTI T. SATHEAN 1
7 AMER RIZAL YAMLEAN 3/14/2020 2 L SRI LATAR SATHEAN 1
8 M. ALFATIH RAFLI 8/18/2019 2 L SUPIATI SATHEAN 1
9 NAFISYA KAYLA 1/1/2020 2 P RANI BELEKUBUN SATHEAN 1
10 HUD ZAIF 4/1/2020 2 L NOVA INDRAYANI SATHEAN 1
11 KINANTI SUAT 8/25/2021 9 Bln P WARNIYANI SATHEAN 1
12 ZAHIRA NADIFA 1/1/2020 2 P JENA J WARAYAAN SATHEAN 1
13 WA ODE AZRINA 9/18/2020 1 P WA ODE HARUNA SATHEAN 1
14 ADELIA 6/5/2017 5 P RISKY RAHMANIA SATHEAN 1
15 SELAMAT HUSEIN YAMLEAN 5/1/2020 2 P SUHADA USMAN SATHEAN 1
16 EMANUEL IKANUBUN 5/17/2015 7 L ALBERTINA LEFUBUN SATHEAN 1
17 DAMARA ATMARIZA BUTON 10/30/2017 4 P IDRIS BUTON SATHEAN 1
18 ADBIDAH F YAMLEAN 7/13/2021 10 Bln P BOYKEKE SATHEAN 1
19 HERIS OHOIRENAN 1/27/2019 3 L AINIA YAMLEAN SATHEAN 1
20 ABDUL HARAWARIN 3/1/2020 2 L SYAMSIAH YAMLEAN SATHEAN 1
21 LESTI RUMAF 6/5/2020 8 P RUKBUS YAMLEAN SATHEAN 1
22 AFIFA YAMLEAN 3/5/2020 2 P NURAINI YAMLEAN SATHEAN 1
23 MADINA YAMLEAN 6/18/2017 4 P ELISABETH YAMLEAN SATHEAN 1
24 ATAKA 10/20/2016 5 P RAHMAWATI BASRI SATHEAN 1
25 ALIYA 10/12/2018 3 P RAHMAWATI BASRI SATHEAN 1
26 AIDIN SYAWAL SUAT 6/15/2018 4 L KANBIRU SUAT SATHEAN 1
27 RASID OHOIBOR 2/5/2020 2 L SUMIATI SATHEAN 1
28 KADAUID OHOIBOR 1/1/2019 3 L SUMIATI SATHEAN 1
29 ADILLA 6/15/2017 5 P RISKY RAHMANIA SATHEAN 1
30 Aprilia Koleka Jamlean 4/19/2020 2 P Sebastiana Telaubun Sathean 1
31 Dwi Gracia Jamlean 11/30/2020 1 P Viana Jamlean Sathean 1
32 Imanuel Jamlean 12/13/2015 6 L Gracia Tupan Sathean 1
33 Antonia Jamlean 7/24/2019 2 P Gracia Tupan Sathean 1
34 Maria Margarita Warayanan 11/9/2021 7 bulan P Ana Maria Ikanubun Sathean 1
35 B Yamin Fans Rahayaan 2/16/2011 11 L Irene Yamlean Sathean 1
36 Ana Yunia Warawarin 3/14/2012 10 P Christina Kainama Sathean 1
37 Allea Warayaan 7/1/2020 1 P Anastasia Warayaan Sathean 1
38 Arsenia Selestina Renwarin 6/28/2019 2 L Temotea Vanohoi Sathean 1
39 Maria Gracia Ikanubun 10/24/2020 1 P Albertina Lefubun Sathean 1
40 Rosa Anisia Rahayaan 1/24/2020 2 P Helena Warawarin Sathean 1
41 Maria Dewi Warawarin 5/15/2019 3 P Novita Warayaan Sathean 1
42 Maria Jean Warayaan 2/25/2020 2 P Wehelmina Kore Sathean 1
43 Geojando Gregorio 8/9/2018 3 L Maria Sinta Jamlean Sathean 1
44 Ana Maria Warasalemon 1/1/2020 2 P Rohana Efwar Sathean 1
45 Lopez Warasalemon 4/18/2021 1 L Rohana Efwar Sathean 1
46 Eseloius Jamlean 6/8/2017 5 L Adrianus Jamlean Sathean 1
47 Christina Jamlean 10/5/2019 2 L Adrianus Jamlean Sathean 1
48 Gabriel J. Fautngil 8/6/2021 10 bulan L Johana Kamyanan Sathean 1
49 Cristin Jonathan Saleka 8/11/2021 10 bulan L Marieta Jamlean Sathean 1
50 Putri Fautngiljanan 8/3/2018 3 L Imakulata Warayaan Sathean 1
51 Joseph Simon 10/9/2016 5 L Yuliana Fatngil Sathean 1
52 Gerfasia B. Warawarin 12/7/2017 4 P Masita A. Badmas Sathean 1
53 Dionsius Rumlus 11/17/2019 2 L Yustina Y. T Sathean 1
54 Yohanis Tumaubun 10/17/2020 1 L Marina Renhungan Sathean 1
55 Juliana Warayaan 7/17/2020 1 P Maria Maturbongs Sathean 1
56 Ana Grisella Batlayeri 1/6/2019 3 P Margareta Warawarin Sathean 1
57 Jeremia Angamel 4/21/2018 4 L Susi Warawarin Sathean 1
58 Christina Jayfer Warayaan 04//12/2019 2 L Elsina Leisubun Sathean 1
59 Regina Prisil Tadubun 1/29/2019 3 P Perpela Renyaan Sathean 1
60 Ludia Warawarin 6/14/2019 3 P Veronika Renyaan Sathean 1
61 ADRIAN HUSEIN LEISUBUN 8/11/2011 10 L KASIM LEISUBUN IBRA 8102011108110001 1
62 AFRIL KARTINI RENGUR 4/21/2009 13 P ADI RANO RENGUR IBRA 8102016104090001 1
63 AGNIA RENUAT 11/30/2015 6 P AHMAD RENUAT IBRA 8102017011150003 1
64 AINUN RAHMADANI KAMIS 8/27/2010 11 P RASMIN KAMIS IBRA 8102016308100066 1
65 ALQANZA SAPUTRA WOWOTUBUN 1/6/2014 8 L GANI WOWOTUBUN IBRA 8172020601140002 1
66 AYNUN JAHRA SELAYAR 5/1/2010 11 P JUSMAN SELAYAR IBRA 8102017105100001 1
67 AYU FITRIANI RENUAT 5/15/2013 9 P MUHAMMAD ALI RENUAT IBRA 8102015505130002 1
68 ELVIRA RENUAT 3/26/2010 12 L AHMAD RENUAT IBRA 8102016603100004 1
69 FADLI AMBON 11/1/2010 11 L SAMAUN AMBON IBRA 8102010111100002 1
70 FAKAR RENUAT 5/12/2013 9 L MUHAMMAD AMIN RENUAT IBRA 8102011205130001 1
71 FAUZAN ULMERA RENUAT 2/2/2012 10 L TAHA RENUAT IBRA 8102010202120001 1
72 FEBRIANTY DERWOTUBUN 2/10/2014 8 P ABU SIGAT DERWUTUBUN IBRA 8102015002140001 1
73 HASAN RENUAT 5/11/2010 12 L UDIN DINO RENUAT IBRA 8102011105100003 1
74 HATIJA RENUAT 11/15/2011 10 P JAKARIA RENUAT IBRA 8102015511110001 1
75 HUMIRA AZUHRA KILMURIN 7/6/2010 11 P HAMIT KILMURIN IBRA 8102014607100002 1
76 IBRAHIM RENWARIN 2/14/2010 12 L MOHAMMAD RENWARIN IBRA 8102011402100002 1
77 IKSAN RENUAT 1/7/2012 10 L YAKUT RENUAT IBRA 8102010701120005 1
78 ISMAIL RUMAF 7/23/2014 7 L SAMSUDIN RUMAF IBRA 1
79 JOHAR RENUAT 2/26/2014 8 L JAKARIA RENUAT IBRA 8102012602140002 1
80 LA ODE ARDIANSYAH ALFATIH 5/28/2014 8 L LA ODE INYO IBRA 8102012805140001 1
81 MOZAD FAIRUZ DITUBUN 9/30/2014 7 L SAID DITUBUN IBRA 8102013009140002 1
82 MUHAMAD RIFKI AZHAR RENWARIN 2/13/2010 12 L HARIS F RENWARIN IBRA 8172021312100001 1
83 MUZNIARAH DERWOTUBUN 11/25/2011 10 P ABU SIGAT IBRA 8102016511110001 1
84 NUR AFNI RAHAYAAN 2/6/2011 11 P DJAMAL RAHAYAAN IBRA 8102014602110003 1
85 NURUL AULIA RENUAT 9/30/2010 11 P ABDUL GANI RENUAT IBRA 8102017009100001 1
86 PARAMITHA BUGIS 12/8/2011 10 P AHMAD TAMHER IBRA 8102014812110006 1
87 PELANGI RENUAT 4/3/2010 12 P LATIF LAMINUBUN IBRA 8102014304100002 1
88 PUASA SAWIYAH RUMLUS 8/30/2011 10 P MUHAMAD RUMLUS IBRA 8102017008110003 1
89 PUTRI SIFA RUMAF 6/1/2010 12 P MALUKU RUMAF IBRA 8102134106100001 1
90 RAISA ALMIRA KILMURIN 10/8/2015 6 P HAMIT KILMURIN IBRA 8102014810150004 1
91 RAMADAN RENUAT 9/10/2009 12 L AHMAD RENUAT IBRA 8102011009090001 1
92 RESKIA RENUAT 3/30/2010 12 P HAMZA RENUAT IBRA 8102017003100001 1
93 RIFKI RAHAYAAN 6/10/2013 9 L ZAWAWI RAHAYAAN IBRA 8102011006130002 1
94 SABRINA AMIRA METANFANUAN 9/2/2012 9 P IKBAL METANFANUAN IBRA 8102014209120001 1
95 SAFARUDIN FAHRI SELAYAR 2/9/2010 12 L RIDWAN SELAYAR IBRA 8102010902100003 1
96 SALWA DERWOTUBUN 3/14/2009 13 P AMIRUDI BERUATUBUN IBRA 8102015403090001 1
97 SALWA RENWARIN 6/6/2010 12 P MOKSEN RENWARIN IBRA 8102014606100003 1
98 SASA SELAYAR 7/17/2010 11 P MOH ANWAR SELAYAR IBRA 8102015707100001 1
99 SATRIA NUSA SAMUDRA BUGIS 10/19/2013 8 L KAHAR BUGIS IBRA 8102011910130003 1
100 SRI WULAN SARI DITUBUN 1/14/2010 12 P MOH ZAIT DITUBUN IBRA 8102015701100001 1
101 SUMARNI RAHAYAAN 3/3/2012 10 P HAMIS RAHAYAAN IBRA 8102014303120003 1
102 SYAFRIL IBAS LEISUBUN 4/22/2014 8 L KASIM LEISUBUN IBRA 8102012204140002 1
103 SYAIFUL RAHMAN TAMHER 5/24/2010 12 L ALWAN TAMHER IBRA 8102012405100001 1
104 TAHER ABDULLAH LEISUBUN 6/20/2013 8 L IKBAL LEISUBUN IBRA 8102012006130002 1
105 ZAHWA ZEIN LEISUBUN 8/10/2010 11 P KASIM LEISUBUN IBRA 8102135008100002 1
106 ZULFIKAR RENUAT 7/31/2010 11 L MUHAMAD ALI RENUAT IBRA 8102013107100003 1
107 ZULKIPLI ABDIL GANI DERLAUT 7/5/2012 9 L LA RAMLI IBRA 8102010507120002 1
108 PUTRI ZALMIFAH LA MIDUN 3/1/2012 9 P LA MIDUN IBRA 1
109 CHRISTANO ADITYA RENYAAN 10/23/2015 6 L YONAS RENYAAN SATHEAN 1
110 ISRAFEL JOEL MOZARTH WARANYAAN 1/4/2015 7 L PETRUS WARAYAAN SATHEAN 1
111 EMANUEL HAWIGI RIANI 10/17/2014 7 P YOHANIS PAULUS RAHAYAAN SATHEAN 1
112 BALDAWINA PUTRI WARAYAAN 4/15/2014 8 L PRIMUS WARAYAAN SATHEAN 1
113 BENEDIKTUS FATIB RENYAAN 4/4/2014 8 L MIKAEL RENYAAN SATHEAN 1
114 ALFONS SUKMARA JAMLEAN 8/3/2013 9 L YOHANIS K. YAMLEAN SATHEAN 1
115 AGUSTINUS HOROKUBUN 8/21/2013 8 L ANDREAS HOROKUBUN SATHEAN 1
116 KLARISA VIANI RENYAAN 3/1/2012 9 P A. Renyaan SATHEAN 1
117 MASNA WATI YAURBULAN 9/9/2012 9 P ABDUL MUTALIB YAURBULAN SATHEAN 1
118 ALEXIUS RENYAAN 8/19/2013 8 L ELIAS RENYAAN SATHEAN 1
119 FADELIA JAMLEAN 5/12/2012 10 P PASKAL M. YAMLEAN SATHEAN 1
120 JULIO WARAYAAN 7/6/2012 9 L AGUSTINUS WARAYAAN SATHEAN 1
121 ANANIAS FATOR RENYAAN 3/5/2011 11 L ANANIAS RENYAAN SATHEAN 1
122 PANGRATSIA HOROKUBUN 1/1/2011 11 P YULIUS HOROKUBUN SATHEAN 1
123 ANSELMA RENJAAN 4/21/2010 12 P SELESTINUS RENJAAN SATHEAN 1
124 CRISTIAN ABEL IKANUBUN 4/27/2010 12 L BONEFASIUS IKANUBUN SATHEAN 1
125 DANIEL MESSY RENYAAN 7/23/2010 11 L YOHANIS RENYAAN SATHEAN 1
126 DANILO ROSARIYANTO RENYAAN 10/10/2009 12 L YOHANIS RENYAAN SATHEAN 1
127 DHIMETRIO YHOSEP SOTER INUHAN 4/9/2010 12 L MARTINUS P. J. INUHAN SATHEAN 1
128 FERDINANDUS MARJO AFLAUBUN 5/4/2010 12 L AGATHA AVLOUBUN SATHEAN 1
129 FRANSISKUS FANGOHOI 4/5/2010 12 L MARIUS FANGOHOI SATHEAN 1
130 FRANSISKUS WARAWARIN 3/30/2010 12 L ANSELMUS WARAWARIN SATHEAN 1
131 JULIA MASEN RETTOB 7/2/2010 11 P LODIVIKUS RETTOB SATHEAN 1
132 JULIUS KEISANTO JUANG 4/12/2010 12 L ARNOLDUS K. JUANG SATHEAN 1
133 KASPAR RENRUSUN 7/8/2009 12 L GREGORIUS RENRUSUN SATHEAN 1
134 KRISTINA DELFIA TADUBUN 12/18/2010 11 P EMELIANUS TADUBUN SATHEAN 1
135 MARIO EMERICUS WARAWARIN 12/4/2009 12 L PIUS WARAWARIN SATHEAN 1
136 PASKALINA IKANUBUN 1/8/2009 13 P ANTONIUS IKANUBUN SATHEAN 1
137 PRISILIA RENJAAN 8/14/2010 11 P PAULUS RENJAAN SATHEAN 1
138 RENATA BALDAWINA YAMLEAN 10/27/2010 11 P JOHANIS BOSKO YAMLEAN SATHEAN 1
139 THOBIAS ARKHELIS WARAYAAN 5/12/2010 12 L NIKO THOMAS WARAYAAN SATHEAN 1
140 VINSEN FAUTNGILYAAN 6/16/2010 11 L HERMAN JOSSEPH FAUTNGILYAAN SATHEAN 1
141 Syadzali Huzaifa Reniwurwarin 9/19/2014 8 Tahun L Rano Reniwurwarin Sathean 082239645422 8172011909140001 1
142 Hairula Azam Suat 12/2/2014 8 Tahun L Asri Suat Sathean 082198113427 8102010212140002 1
143 Moh. Zidan Yamlean 5/27/2014 8 Tahun L Udin Yamlean Sathean 081294890529 8102012705140001 1
144 Moh. Rabbil Yamlean 2/14/2015 7 Tahun L Sabarudin Yamlean Sathean 082329752927 8102011402150001 1
145 Maria Dominika Fangohoi 3/20/2015 7 Tahun P Wilem Fangohoi Sathean 081390979621 8102016003150001 1
146 Rezkia Adelia Rusli 10/12/2014 8 Tahun P La Rusli Enu Sathean 081343005059 8102015210140001 1
147 Zahdan Hasan Ikanubun 3/1/2015 7 Tahun L Samsul Bahri Ikanubun Sathean 082239302213 8102010103150003 1
148 Yusron Nasril Suat 1/12/2015 7 Tahun L Musa Suat Sathean 081247180562 8102011201150001 1
149 Onci Wanci Jamlean 11/16/2014 8 Tahun L Berlenda Jamlean Sathean 1
150 Jefri Juneidi Yamlean 6/16/2013 9 Tahun L Ladatimu Yamlean Sathean 1
151 Reza Dwi Erlangga Yamlean 6/22/2013 9 Tahun L Ahmad Jamlean Sathean 1
152 Halima Tamnge 6/23/2012 9 Tahun P Moksen Tamnge Sathean 1
153 Juhuria Sabila Rusian 6/5/2013 9 Tahun P Ruslan Buton Sathean 1
154 Imanuel G. ikanubun 10/18/2010 11 Tahun L Fabianus Ikanubun Sathean 8102011810100002 1
155 Oktovianus Warayaan 10/12/2010 11 Tahun L Rimus Warayaan Sathean 8102011210100001 1
156 Yusril Ilham Yamlean 5/6/2011 11 Tahun L Fadli Batmas Sathean 8172010605110001 1
157 Agustina Warawarin 12/19/2010 11 Tahun P Yakobus Warawarin Sathean 8102015912100001 1
158 Asnidar Bugis 5/11/2011 11 Tahun P Jusman I. Bugis Sathean 8102015105110003 1
159 Aulia Kabakoran 6/16/2010 12 Tahun P Muhid Kabakoran Sathean 8172015607100001 1
160 Basilika Warawarin 1/27/2010 12 Tahun P Benjamin Warawarin Sathean 8102016701100005 1
161 Diva Saputri Awal 6/16/2010 12 Tahun P Jayadi Awal Sathean 8101095606100003 1
162 Gresiana P. Metubun 3/21/2010 12 Tahun P Abner E. Metubun Sathean 8102016103100001 1
163 Izza Faradiba Yamlean 11/23/2010 11 Tahun P Moh. Hasan Yamlean Sathean 8102016311100002 1
164 Maria Rosa Yamlean 5/10/2010 12 Tahun P Berlenda Jamlean Sathean 8102015005100003 1
165 Maria Angela Warawarin 5/11/2010 12 Tahun P Remundus H. Warawarin Sathean 8102015105100004 1
166 meilani Ohoirenan 5/13/2010 12 Tahun P Baco Ohoirenan Sathean 8102015305100001 1
167 Tarsisia Ikanubun 3/31/2010 12 Tahun P Yakobus Ikanubun Sathean 8102017103100003 1
168 Yohana G. Pontoh 5/16/2010 12 Tahun P Alberth Pontoh Sathean 8102015605100006 1
169 Yonstia Kempirmase 12/4/2010 11 Tahun P Andi Kempirmase Sathean 8102014412110002 1
170 Selda S. Yamlean 3/15/2010 12 Tahun P Udin Yamlean Sathean 8102015503100003 1
171 Sulayla Jamlean 8/29/2010 11 Tahun P Akbarudin Jamlean Sathean 8102016290810001 1
172 ADAWIATUL RAHMA 1/15/2017 5 P RUSIAN BUTON SATHEAN 8102015501170001 1
173 ADRIANSYAH OHOIBOR 8/1/2019 2 L USMAN OHOIBOR SATHEAN 8102010108190001 1
174 ADILLAH FARAH RAMADANI ABIDIN 6/5/2017 5 P SUADI ABIDIN SATHEAN 8102014506170002 1
175 ADELIA PUTRI RAMADANI ABIDIN 6/5/2017 5 P SUADI ABIDIN SATHEAN 8102014506170001 1
176 ALAWIA BELLA ARZHU WADLAU 10/12/2017 4 P SAHRIL WADLAU SATHEAN 8102015210170001 1
177 ARKARUNA RIZKI UBAIDILLAH 11/8/2016 5 L LA DEMO SATHEAN 8102010611160001 1
178 AHMAD RIFAY JAMLEAN 6/5/2016 6 L AKBARUDIN JAMLEAN SATHEAN 8102010508160004 1
179 FRIDA GLORIA JAMLEAN 6/8/2018 4 P NUBERTUS JAMLEAN SATHEAN 8102014806180001 1
180 FADLY ROHMAN FALI RETOB 8/18/2017 5 L ABURANI RETOB SATHEAN 8102011808170001 1
181 GAYATRI DIFINUBUN 5/27/2018 4 P HALIK DAHLAN DIFINUBUN SATHEAN 8102016705180001 1
182 JIBRAN RHABANI JAMLEAN 5/18/2016 6 L AZIZ JAMLEAN SATHEAN 8102011805160001 1
183 QHAYLA QHOZAIMA MADUBUN 9/29/2015 6 P VITA IRIANI JAMLEAN SATHEAN 8102016909150003 1
184 SAHIRA NHASHYFA YAMSEHU 2/12/2016 6 P MUHAMAD RUSIAN YAMSEHU SATHEAN 8102015202160001 1
185 SHABIR DJAI USMAN YAMLEAN 10/5/2016 6 L LAIMU OHOIBOR SATHEAN 8102010510160002 1
186 WENSISLAUS RISKI JAMLEAN 7/17/2019 2 L NATALIUS JAMLEAN SATHEAN 8102011707190002 1
187 ARUM HUMAIRA JAMLEAN 11/25/2016 5 P SALIM SATHEAN 8102016511160001 1
188 ARSYILA RAYANDA JAMLEAN 12/24/2016 5 P MUHAMAD KIFLI JAMLEAN SATHEAN 8102016412160001 1
189 AIDIN JAHWAL SUAT 6/15/2018 4 L ASRI SUAT SATHEAN 8102011506180001 1
190 ALIEF JAMLEAN 6/16/2017 5 L RUSLAN JAMLEAN SATHEAN 8102011606170003 1
191 ISARA AZIZAH PATOTNEM 11/9/2018 3 P JAFAR PATOTNEM SATHEAN 8102014911180002 1
192 KHALIFAH FAZIAH DIFINUBUN 4/23/2018 4 P RAMLI DIFINUBUN SATHEAN 8102016304180002 1
193 LUKMAH HAKIM SETIAWAN 8/17/2015 6 L IWAN SETIAWAN SATHEAN 8102011708150001 1
194 MILBURGA JAMLEAN 4/17/2017 5 P YOHANIS JAMLEAN SATHEAN 8102015704170001 1
195 MUHAMAD CHOIR SAFI'I 9/19/2017 4 L SELAMET SUPRIADI SATHEAN 8102011909170003 1
196 NAZWAH B. JAMLEAN 2/2/2016 6 P BASRI JAMLEAN SATHEAN 8102014202100001 1
197 NURLINA SUAT 2/21/2018 4 P HAMSIR SUAT SATHEAN 8102016101180002 1
198 NIZAR ARBANI BETWAHI 11/11/2017 4 L YUSUF BELWAHI SATHEAN 8102011111170001 1
199 PUPUT WANDI INGRATUBUN 4/25/2017 5 P JAMALUDIN INGRATUBUN SATHEAN 8102014601190002 1
200 SALMA YAMLEAN 1/6/2019 3 P MUHAMAD AMIN YAMLEAN SATHEAN 8102015806170002 1
201 SYAFITRI A. JAMLEAN 8/18/2017 4 P SABARUDIN JAMLEAN SATHEAN 8102014110170001 1
202 SUHARIA Z. MADUBUN 10/1/2017 5 P VITA IRIANI JAMLEAN SATHEAN 8102014307170001 1
203 TALITA M. JAMLEAN 7/3/2017 4 P MUSTAFA YAMLEAN SATHEAN 8102014908180001 1
204 YASNI NISA SUAT 10/21/2018 4 P MUSA SUAT SATHEAN 8102016305170001 1
205 YASMIN MAYRA JAMLEAN 5/23/2017 5 P YAHYA JAMLEAN SATHEAN 8102012409600002 1
206 FALISYA ANOWI 5/6/2018 4 P DIMAS AJI P.P. WIJASONO SATHEAN 8102012010160001 1
207 ATAKA DARDA MURTAZA 10/20/2016 5 L MUHAMAD N. JAMLEAN SATHEAN 1
208 REVITA SALSIKA RUSLI 1/31/2017 5 P LARUSLI ENO SATHEAN 1
209 AIRINI SAFITRI TEMERMAS P SATHEAN 1
210 REHAN JAMLEAN L SENEN JAMLEAN SATHEAN 1
211 WATERUS NOEL JAMLEAN 9/29/2018 3 L MARIA OKTAVIRA SATHEAN 1
212 FAUSTINA JAMLEAN 2/28/2020 2 P MARIA OKTAVIRA SATHEAN 1
213 IMANUEL JAMLEAN 5/15/2020 2 L BATSEBA MELISASAI SATHEAN 1
214 MARIA ANFIRA 5/2/2018 4 P IDA RENYAAN SATHEAN 1
215 CARLO O. BALUBUN 1/13/2021 1 L ROSIMALINDAR SATHEAN 1
216 VITALIS C. RENRUSUN 2/2/2020 2 L FARHAZAKIA SATHEAN 1
217 VALENTINA RAHAYAAN 9/13/2019 2 P MAKARIA WARAWARIN SATHEAN 1
218 JEEKSON 4/25/2018 4 L NIA RENYAAN SATHEAN 1
219 ROSA DELIMA RAHAYAAN 6/18/2020 1 P ADRIANA RAHAYAAN SATHEAN 1
220 BEATRIK YOLANDA MARJON 6/30/2019 2 P GODELITA B. SATHEAN 1
221 DENHASAN RETTOB 3/28/2020 2 L MARGANETA WARYAAN SATHEAN 1
222 OKTAVIANUS XAVIER 6/7/2021 1 L YOSEPHA R. RENJAAN SATHEAN 1
223 MARIORI CHRISTIN JAMLEAN 4/15/2019 3 P OKTOVINA RENYAAN SATHEAN 1
224 WENSIS LAUS RISKI 7/17/2019 2 L LODIA LEWIR SATHEAN 1
225 ALEXIUS L. RENYAAN 5/25/2020 2 L EGENIS RENYAAN SATHEAN 1
226 MARIA H RUMANGUN 1/28/2021 1 P FENTI RENYAAN SATHEAN 1
227 LEONEL L. JAMLEAN 2/1/2021 1 L BAGJA T. SUPRATIN SATHEAN 1
228 KHARISMA RETTOB 9/10/2021 9 bln L AURELIA HERMATA SATHEAN 1
229 JUSE S. RENRUSUN 11/30/2017 4 L AMIRITA SATHEAN 1
230 REVUNI ZULKIFLIN 9/11/2020 1 P ADOVIRA YAMLEAN SATHEAN 1
231 SAMUELA S. FANOHOI 8/8/2020 1 P BEATRIX IKANUBUN SATHEAN 1
232 THERESIA JAMLEAN 11/1/2019 2 P ANGELINA JAMLEAN SATHEAN 1
233 APRILIA RENRUSUN 4/20/2020 2 P FREDERIKA N. SATHEAN 1
234 FELECIA SERMAF 9/10/2020 1 P ODETA RAHAYAAN SATHEAN 1
235 NONA AGNIA RENYAAN 8/22/2021 9 bln P LUCIA RENYAAN SATHEAN 1
 236 MARCIA OHOIRAT 2/22/2020 2 P BRIGITA J. RENYAAN SATHEAN 1
237 YOSEFINA IKANUBUN 10/18/2020 1 P TEKIA IKANUBUN SATHEAN 1
238 GABRIEL ARJAD MATRUTTY 6/5/2015 7 L BRAMPI KORNELES MATRUTTY KOMPI-IBRA 8102010506150001 1
239 QUINDRI YANTI MATRUTTY 5/14/2016 6 P BRAMPI KORNELES MATRUTTY KOMPI-IBRA 8102015405160001 1
240 SETION MATRUTTY 1/1/2020 2 L BRAMPI KORNELES MATRUTTY KOMPI-IBRA 1
241 MA'RUF ALMIZAN LA MIDUN 6/22/2019 2 L LA MIDUN KOMPI-IBRA 8103012206190001 1
242 AGNESYA AVIA PASKALIN DJONLER 4/11/2010 12 P YOPPY YOSEP DJONLER KOMPI-IBRA 1
243 RASYAEKA TAHANILAN ODE RIDWAN 3/10/2020 2 P RIDWAN KOMPI-IBRA 8102015003200001 1
244 SOLVLANUS ELWARIN 1/11/2020 2 L YUNUS ELWARIN KOMPI-IBRA 1
245 GERALD HANORSIAN 7/4/2019 2 L JOHAN RATUBULYANAN KOMPI-IBRA 8103010407190001 1
246 ALNUR REFANDA JUNIANTARA 6/14/2018 4 L YONI P PRAYOGI KOMPI-IBRA 8102011406180004 1
247 MUHAMMAD HADI ARRASYID 8/2/2021 10 Bln L SOPAN SOPIAN KOMPI-IBRA 8102010208210001 1
248 JAVIER JAUHARI LABOBAR 12/22/2019 2 L SISTIMUS LABOBAR KOMPI-IBRA 1
249 MUHAMAD SYAID EFRUAN 9/11/2017 4 L SAMSUDIN EFRUAN KOMPI-IBRA 8102011109170002 1
250 ASYIFA FEBRIANTI RETTOB 2/18/2020 2 P ARSITO RETTOB KOMPI-IBRA 8172045802210001 1
251 KSATRIA WIRADIKA BOIRATAN 4/11/2020 2 L NIRWAN BOIRATAN KOMPI-IBRA 1
252 ANZAHRA ANGGRAINI 9/9/2018 3 P ADRIAWAN KOMPI-IBRA 8102011490918001 1
253 ANZAHIRA ANDRIANI 2/27/2021 1 P ADRIAWAN KOMPI-IBRA 8102016702210001 1
254 FAREL KRISTIAN ADHITAMA SITOMORANG 11/12/2020 1 L IYAN SARI SITOMORANG KOMPI-IBRA 8102011211200001 1
255 APRILIO EMANUEL DACRUS 4/20/2021 1 L LEO SAPUTRA DACRUS KOMPI-IBRA 1
256 ZAHRATU PUTRI SALSABILA EFRUAN 3/14/2020 2 P SAMSUDIN EFRUAN KOMPI-IBRA 1
257 AIRLANGGA SATYA DIRGA MAULANA 7/3/2021 11 Bln L IMAM MAULANA KOMPI-IBRA 3511140307210001 1
258 ATHALIE BELFANIA WEMAY 6/21/2017 4 P ELYSON F. WEMAY KOMPI-IBRA 1
259 AYUMNA AZKADINA BABA 11/22/2021 6 Bln P MUHAMAD NUR BABA KOMPI-IBRA 1
260 TRIMATRA JUPITER WEMAY 9/5/2021 9 Bln L ELYSON F. WEMAY KOMPI-IBRA 1

Jumlah vaksin (vial) dan logistik yang digunakan

Jenis logistik OPV IPV DPT-HB-HIB CAMPAK RUBELA Pelarut Dropper ADS 0,5 ML ADS 3 ML Safety Box Pen Marker
Campak Rubela
Jumlah 31 31 260 62 3
Catatan
* Tuliskan alasan jika anak tidak bisa diimunisasi dan rencana jadwal pemberian imunisasi susulan pada kolom keterangan
FORMAT PENCATATAN HASIL PELAYANAN

Ket** (bila anak

mendapatkan dosis
kedua/keetiga/keempat
OPV/Penta saat BIAN,
maka tetap dicatat namun
tidak dimasukkan sebagai
cakupan BIAN)

n
Jumlah vaksin (vial) dan logistik yang digunakan
 FORMAT REKAPITULASI HASIL PELAYANAN BULAN IMUNISASI ANAK NASIONAL
Desa/kelurahan Sathean Periode 6/16/2022
Puskesmas Sathean Nama petugas Laylatul F Tamher
Isilah pada kolom yang berwarna

Sasaran dan Cakupan Imunisasi Kejar Sasaran dan cakupan imunisasi campak rubela
Usia 12 -<15 thn
Usia 12 - 59 bulan Usia 9-59 bulan Usia 5 - <7 thn Usia 7-<12 thn (bagi 5 Prov.)
Posyandu/Pos
NO layanan BIAN Total Sasaran Total dimunisasi Total
lainnya OPV IPV DPT-HB-Hib Campak Rubella Campak Rubela Campak Rubela Campak Rubela
Campak Rubella Campak Rubella Cakupan
Jumlah Jumlah Jumlah Jumlah Jumlah Jumlah Jumlah Jumlah Jumlah Jumlah Jumlah Jumlah Jumlah Jumlah
sasaran diimunisas % sasaran diimunisasi % sasaran diimunisa % sasaran diimunisas % sasaran diimunis % sasaran diimunisasi % sasaran diimunisasi %
i si i asi
a b c d e f g h i j k l m n o p q r s t u v w x = l+o+r / l+o+r+u y = m+p+s / m+p+s+v
1 Sweeping 0.0% 0.0% 0.0% 135 135 100.0% 14 14 100.0% 111 111 100.0% 0 0.0% 260 260 100.0%
0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0 0 0.0%
0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0 0 0.0%
0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0 0 0.0%
0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0 0 0.0%
0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0 0 0.0%
0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0 0 0.0%
0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0 0 0.0%
0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0 0 0.0%
0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0 0 0.0%
0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0 0 0.0%
0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0 0 0.0%
0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0 0 0.0%
0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0 0 0.0%
0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0 0 0.0%
0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0 0 0.0%
0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0 0 0.0%
Total 0 0 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0
Nama Provinsi :
Maluku
Nama Kabupaten : Maluku Tenggara
Nama Puskesmas : Ibra
Isilah Kolom yang berwarna!
OPV IPV
Posyandu/Pos Imunisasi
No. lainnya
Jumlah diimunisasi Jumlah Vial Indeks Pemakaian Jumlah diimunisasi
digunakan Vaksin

a b c d e f
#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!
TOTAL 0 0 #DIV/0! 0

Catatan :
IP = Jumlah yang diimunisasi/jumlah vial vaksin yang digunakan
 FORMAT REKAPITULASI LOGISTIK PUSKESMAS

h Kolom yang berwarna!

IPV DPT-HB-Hib Campak Rubela

Jumlah Vial Indeks Jumlah Jumlah Vial

Pemakaian IP Jumlah diimunisasi Jumlah Vial IP
digunakan Vaksin diimunisasi digunakan

g h i j k l m n
#DIV/0! #DIV/0! 260 31 8.3870967742
#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 0 #DIV/0! #DIV/0!
 Jumlah Logistik yang digunakan

Pelarut Dropper ADS 0,5 ML ADS 3 ML Safety Box Pen Marker

o p q r s t
31 260 62 3

0 260 0 0 0