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  • 1 April Di Balai Dusun Balekambang

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    This document is a list of participants who received COVID-19 vaccinations at the Majenang I Public Health Center. It includes the names, identification numbers, gender, date of birth, address, phone number and signature of 51 individuals who received their first, second or third dose of the vaccine on an unspecified date. The vaccinations were administered by several health workers, identified by their initials.

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    daftar hadir

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    1 APRIL DI BALAI DUSUN BALEKAMBANG

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    This document is a list of participants who received COVID-19 vaccinations at the Majenang I Public Health Center. It includes the names, identification numbers, gender, date of birth, address, phone number and signature of 51 individuals who received their first, second or third dose of the vaccine on an unspecified date. The vaccinations were administered by several health workers, identified by their initials.

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    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
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    14 views34 pages

    1 April Di Balai Dusun Balekambang

    Uploaded by

    DesiPurwiyanti
    This document is a list of participants who received COVID-19 vaccinations at the Majenang I Public Health Center. It includes the names, identification numbers, gender, date of birth, address, phone number and signature of 51 individuals who received their first, second or third dose of the vaccine on an unspecified date. The vaccinations were administered by several health workers, identified by their initials.

    Copyright:

    © All Rights Reserved
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    of 34

    DAFTAR HADIR PESERTA VAKSINASI COVID 19 SASARAN MASYARAKAT UMUM

    UPTD PUSKESMAS MAJENANG I

    HARI, TANGGAL :
    LOKASI :
    JENIS VAKSIN :

    TGL LAHIR/ VAKSINASI COVID 19


    NO NIK NAMA JK ALAMAT NOMOR HP TTD KET
    UMUR DOSIS 1 DOSIS 2 DOSIS 3

    1 3301142701000001 NAUFAL TRYAS HUTAMA 1/27/2000 L CILOPADANG 2/4 085694392196 MB ANITA

    2 3301140909980001 EGA SETYA PERMADI 9/9/1998 L MULYADADI 3/2 085747949170 MB ANITA

    3 3315084402850002 ENNIN LUTFIA 2/4/1985 P SINDANGSARI 2/5 BU DEDEH

    4 3301145010600002 ELI ROLIYAH 10/10/1960 P MULYASARI 1/1 BU DEDEH

    5 3301143108880004 ANTONY ADI PUTRA 8/31/1988 L SINDANGSARI 7/4 BU DEDEH

    6 3301146503820001 DWI MARLINA 3/25/1982 JENANG 2/10 BU DEDEH

    7 3273112605880004 VANDY KUNAEFI 5/26/1988 SINDANGSARI 2/4 BU YUNI

    8 3273065503920004 REVANYA SITTA VERARY 3/15/1992 SINDANGSARI 2/4 BU YUNI

    9 3301140109560003 FERRY IRAWAN 9/1/1956 SINDANGSARI 2/4 BU YUNI

    10 3301144212550001 SAGITA 12/2/1955 SINDANGSARI 2/4 BU YUNI

    11 3301132204620001 MUHYI 4/22/1962 PANIMBANG 1/8 CIMANGGU BU YUNI

    12 3301146409730001 ERLINA KUSMARYANTI 9/24/1973 JENANG 2/12 BU YUNI

    13 3301131909900004 SOFIYUDIN ALI ZUBAIR 9/19/1990 SINDANGSARI 4/2 BU YUNI

    14 3301145804040003 NAELI ALFI SABILA 4/18/2004 SINDANGSARI 4/2 BU YUNI

    15 3301146511830004 NOVIA MUJIYANTI 11/25/1983 JENANG 2/12 BU YUNI

    16 3301147108970002 DWIYANA GUSTIYA LADDY 8/31/1997 JENANG 2/12 087784567933 BU YUNI

    17 3301140404751001 IKHSAN RIYANTO 4/4/1975 JENANG 3/5 BU YUNI

    18 3301146202850001 FATIMAH NUR FAUZIAH 2/22/1985 JENANG 3/5 BU YUNI


    TGL LAHIR/ VAKSINASI COVID 19
    NO NIK NAMA JK ALAMAT NOMOR HP TTD KET
    UMUR DOSIS 1 DOSIS 2 DOSIS 3

    19 3301141411740004 SOHIBI 11/14/1974 SINDANGSARI 6/5 081903628324 MB MEI

    20 3301144105780004 SITI ALFIYAH 5/1/1978 SINDANGSARI 6/5 MB MEI

    21 TITIN SUYATI BOJA 4/1 MB MEI

    22 3301140408590001 KASIRUN 8/4/1959 CILOPADANG 081806598812 MB SRI

    23 3301142911960002 YUSIF SAEFUL RAHMAN 11/29/1996 CILOPADANG 2/11 083804417101 MB SRI

    24 3301147012680015 TATI CAHYATI 12/30/1968 SINDANGSARI 6/2 081229360732 MB SRI

    25 3174060801920007 YUSUP HADIWIBOWO 1/8/1992 SINDANGSARI 6/2 087735333636 MB SRI

    26 3301154611660002 HERLINA 11/6/1966 ADIMULYA 1 /4 WANAREJA MB DWI

    27 3301156907590001 NUNUNG SUHARTINI 7/29/1959 ADIMULYA 1 /4 WANAREJA MB DWI

    28 3301130703580003 H SYAEFUL MAJID DARKINO 3/7/1958 PESAHANGAN 3/1 CIMANGGU BU TRI

    29 3301134112620003 HJ. KHUSNUL KHOTIMAH 12/1/1962 PESAHANGAN 3/1 CIMANGGU BU TRI

    30 3301136107720002 TARTEM 7/21/1972 CIJATI 1/2 CIMANGGU BU TRI

    31 3301135411910004 SHANTI NOVITA 11/14/1991 CIJATI 1/2 CIMANGGU BU TRI

    32 3301146206920001 YUNI SOLIKHAH HIDAYAH 6/22/1992 PAHONJEAN 5/5 BU TRI

    33 3301186605780003 RAHAYUMI 5/26/1978 KUTASARI 1/5 BU WINDI

    34 SUNARTO 4/20/1969 PADANGJAYA 2/11 BU WINDI

    35 3301146209690001 DARYATUN 9/22/1969 PADANGJAYA 2/11 BU WINDI

    36 3301147103000004 INDAH HASNA 3/31/2000 BU WINDI

    37 3301145702910002 FERIYA EKA LILIS TRISNOWATI 2/17/1991 BU WINDI

    38 3301145311710002 HELY HIDAYATI 11/13/1971 SINDANGSARI 2/3 BU WINDI

    39 3301147112610033 RUSWATI 12/31/1961 BENER 4/1 BU WINDI


    TGL LAHIR/ VAKSINASI COVID 19
    NO NIK NAMA JK ALAMAT NOMOR HP TTD KET
    UMUR DOSIS 1 DOSIS 2 DOSIS 3

    40 3301145010700009 WARYATI BENER BU WINDI

    41 3329092705770008 UPIEK SULISTYO SUMARNO 5/27/1977 BREBES 1/20 BU WINDI

    42 3329094708820009 WIWIN TRI ASTUTI 6/7/1982 BREBES 1/20 BU WINDI

    43 3301141007940004 ACHMAD ELKI FIRDAUS 7/10/1994 PADANGJAYA 4/11 PAK BUDI

    44 3301144311930002 TINA NOVIANA 11/3/1993 PADANGJAYA 4/11 PAK BUDI

    45 3301142516087002 EDO PRIYANTO 10/25/1987 PADANGJAYA 3/11 PAK BUDI

    46 3301156609830001 SUMIYATI 9/26/1983 WANAREJA 3/4 PAK BUDI

    47 3301142207760001 MUHTARUDIN 7/22/1976 CIBEUNYING 3/1 PAK AJUN

    48 3301151005530001 IING MAHFUDIN 5/10/1953 LIMBANGAN 2/5 PAK AJUN

    49 3301150812840003 JUMHANA 12/8/1983 LIMBANGAN 1/6 PAK AJUN

    50 3301140612930002 RIFKI FIRMANSYAH 12/6/1993 JENANG 1/11 KHAYUN

    51 3301144303990003 FADHILATUL MAFA'AN NUR 3/3/1999 KEMUTUG LOR 1/5 BATURADEN B NONENG
    TGL LAHIR/ VAKSINASI COVID 19
    NO NIK NAMA JK ALAMAT NOMOR HP TTD KET
    UMUR DOSIS 1 DOSIS 2 DOSIS 3
    TGL LAHIR/ VAKSINASI COVID 19
    NO NIK NAMA JK ALAMAT NOMOR HP TTD KET
    UMUR DOSIS 1 DOSIS 2 DOSIS 3
    TGL LAHIR/ VAKSINASI COVID 19
    NO NIK NAMA JK ALAMAT NOMOR HP TTD KET
    UMUR DOSIS 1 DOSIS 2 DOSIS 3

    Majenang, 1 April 2022


    Kepala UPTD Puskesmas Majenang I

    SRI WAHYUNI, SKM


    NIP. 19671209 199103 2 005
    DAFTAR H

    HARI, TANGGAL : 1 APRIL 2022


    LOKASI : BALAI DUSUN BALEKAMBANG
    JENIS VAKSIN :

    NO NIK NAMA
    DAFTAR HADIR PESERTA VAKSINASI COVID 19 SASARAN MASYARAKAT UMUM
    UPTD PUSKESMAS I

    TGL LAHIR/
    JK ALAMAT NOMOR HP
    UMUR
    M

    VAKSINASI COVID 19
    TENSI SUHU JAM VAKSIN
    DOSIS 1 DOSIS 2 DOSIS 3
    Majenang, 1 April 2022
    Kepala UPTD Puskesmas Majenang I

    SRI WAHYUNI, SKM


    NIP. 19671209 199103 2 005
    KET

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