FORMAT PENCATATAN PELAKSANAAN VAKSINA

TINGKAT PUSKESMAS/FASYANKES/POS VA

Nama Puskesmas/Fasyankes/Pos : GILANG TUNGGAL MAKARTA

Kabupaten/Kota : TULANG BAWANG BARAT
Provinsi : LAMPUNG

Nama
Umur Kelompok
No No. Registrasi NIK Penerima Jenis Kelamin Pekerjaan* Alamat
(18-59 tahun) Umur
Vaksin

1 1963 18120755066300002 MARIJEM P MASYARAKAT UMUM 58 46-59 PAGAR JAYA

2 1993 1608081701930001 EKO FREDY YA L MASYARAKAT UMUM 28 12-19 PAGAR JAYA

3 1972 1812070412720003 MUHAIL L MASYARAKAT UMUM 49 46-59 PAGAR JAYA

4 1958 1812071112560002 NGADENAN L MASYARAKAT UMUM 63 0 PAGAR JAYA

5 1951 1812070809510002 WAJIMAN L MASYARAKAT UMUM 70 0 PAGAR JAYA

6 1982 1812071005820008 JAJANG L MASYARAKAT UMUM 39 31-45 PAGAR JAYA

7 1959 1812070803590002 IKHSAN MADI L MASYARAKAT UMUM 62 0 PAGAR JAYA

8 1961 1812071010610007 TIMBUL PRIBAD L MASYARAKAT UMUM 60 0 PAGAR JAYA

9 1945 1812071812550001 SARINO L MASYARAKAT UMUM 76 0 PAGAR JAYA

10 1965 1812075812650002 SITI AISYAH P MASYARAKAT UMUM 56 46-59 PAGAR JAYA

11 2009 1812074910090002 SHILVIA ARUM P REMAJA 12 12-19 PAGAR JAYA

12 1965 1812075004650002 HARIYATI P MASYARAKAT UMUM 56 46-59 PAGAR JAYA

13 1960 1812075110600003 PARIYA P MASYARAKAT UMUM 61 0 PAGAR JAYA

14 1991 1812070307910001 ANDI L MASYARAKAT UMUM 30 12-19 PAGAR JAYA

15 1996 1812070304960001 FARID AZIS L MASYARAKAT UMUM 25 12-19 PAGAR JAYA

16 2000 181207121200002 AGUNG WREDA L MASYARAKAT UMUM 21 12-19 PAGAR JAYA

17 1971 1812075704710001 SUMINAH L MASYARAKAT UMUM 50 46-59 PAGAR JAYA

18 1959 1812071611590001 NARUH L MASYARAKAT UMUM 62 0 PAGAR JAYA

19 1967 1812074806670001 MULYATI P MASYARAKAT UMUM 54 46-59 PAGAR JAYA

20 1963 1812071307640001 SAKIUN L MASYARAKAT UMUM 58 46-59 PAGAR JAYA

21 1955 1812071009550001 SUTIMAN L MASYARAKAT UMUM 66 0 PAGAR JAYA

22 1989 1812072905890003 ANDI SAPUTRA L MASYARAKAT UMUM 32 31-45 PAGAR JAYA

23 1958 1812071507580001 SUGIMAN L MASYARAKAT UMUM 63 0 PAGAR JAYA

24 2003 1812070401030002 JEKY SETIAWA L REMAJA 18 12-19 PAGAR JAYA

25 1993 1805207103930002 LILIS SULILAWA P MASYARAKAT UMUM 28 12-19 PAGAR JAYA

26 1979 3216065201790019 SITI AMINAH P MASYARAKAT UMUM 42 31-45 PAGAR JAYA

27 1963 1812076305630001 RUSTINI P MASYARAKAT UMUM 58 46-59 PAGAR JAYA

28 1973 181207520773003 NUR SAMSIYAH P MASYARAKAT UMUM 48 46-59 PAGAR JAYA

29 1971 1812071011710001 SARMAN L MASYARAKAT UMUM 50 46-59 PAGAR JAYA

30 1961 1812072507610001 JAMAL L MASYARAKAT UMUM 60 0 PAGAR JAYA

31 1959 1812074711560001 SAKEM P MASYARAKAT UMUM 62 0 PAGAR JAYA

32 1965 1812074809650001 HALIMAH P MASYARAKAT UMUM 56 46-59 PAGAR JAYA

33 1972 18120769079200002 ANA MUNAWAR P MASYARAKAT UMUM 49 46-59 PAGAR JAYA

34 1986 1812070506860001 DARMAWAN L MASYARAKAT UMUM 35 31-45 PAGAR JAYA

35 1963 1812071308630003 SAMINO L MASYARAKAT UMUM 58 46-59 PAGAR JAYA

36 1971 1812075612710002 SETYANI P MASYARAKAT UMUM 50 46-59 PAGAR JAYA

37 1989 1812072904890002 EKO LELONO L MASYARAKAT UMUM 32 31-45 PAGAR JAYA

38 1986 1812070411850002 MARJUNI L MASYARAKAT UMUM 35 31-45 PAGAR JAYA

39 1969 1812071409690001 TUMIJO L MASYARAKAT UMUM 52 46-59 PAGAR JAYA

40 2008 1812071703080001 RENDI MARIO L MASYARAKAT UMUM 13 12-19 PAGAR JAYA

41 1961 1812076910610002 SUMINEM P MASYARAKAT UMUM 60 0 PAGAR JAYA

42 1988 1807126467880003 IMA PUJI ASTUT P IBU HAMIL 33 31-45 PAGAR JAYA

43 1950 181207520650001 SARMI P MASYARAKAT UMUM 71 0 PAGAR JAYA

44 1973 1812076010740003 SULARNI P MASYARAKAT UMUM 48 46-59 PAGAR JAYA

45 2009 1812071505090000 ILHAM SAPUTR L REMAJA 12 12-19 PAGAR JAYA

46 2009 18120706070900000 CALVIN SAPUT L REMAJA 12 12-19 PAGAR JAYA

47 1993 1803046811930002 WAHYUNI P MASYARAKAT UMUM 28 12-19 PAGAR JAYA

48 1992 18070417101920002 INDRA SETIAW L MASYARAKAT UMUM 29 12-19 PAGAR JAYA

49 2003 1812071905030001 RENDI GALANG L REMAJA 18 12-19 PAGAR JAYA

50 2009 1812074811090001 AMIRA ANDINA L REMAJA 12 12-19 PAGAR JAYA

51 1982 1812071206820008 SUSILO L MASYARAKAT UMUM 39 31-45 PAGAR JAYA

52 1945 1812076909560001 KUNING P MASYARAKAT UMUM 76 0 PAGAR JAYA

53 1970 181207451070001 ETIK FATMAWA P MASYARAKAT UMUM 51 46-59 PAGAR JAYA

54 1983 1607130701830001 ARIF SISWANT L MASYARAKAT UMUM 38 31-45 PAGAR JAYA

55 1978 1812071403780002 MUHAMMAD RO L MASYARAKAT UMUM 43 31-45 PAGAR JAYA

56 1951 1812074709520001 SUYATNI P MASYARAKAT UMUM 70 0 PAGAR JAYA

57 1971 1812078110710002 SARNI P MASYARAKAT UMUM 50 46-59 PAGAR JAYA

58 1948 1812070909480001 SUWADI L MASYARAKAT UMUM 73 0 PAGAR JAYA

59 1961 18120750026100001 SUDARMI P MASYARAKAT UMUM 60 0 PAGAR JAYA

60 1977 1808070708770010 SUTANTO L MASYARAKAT UMUM 44 31-45 PAGAR JAYA

61 1975 1808074907750001 JUMIATI P MASYARAKAT UMUM 46 46-59 PAGAR JAYA

62 1981 1812075006810002 SULIS SETIYOW P MASYARAKAT UMUM 40 31-45 PAGAR JAYA

63 2009 1812070901090001 ANDIKA PRASE L MASYARAKAT UMUM 12 12-19 PAGAR JAYA

64 2004 1812072409040006 RIZKY SETIAW L REMAJA 17 12-19 PAGAR JAYA

65 1990 1807066707900007 MUSLIKAH P MASYARAKAT UMUM 31 31-45 PAGAR JAYA

66 1994 1812071008940001 EKO BUDIARTO L MASYARAKAT UMUM 27 12-19 PAGAR JAYA

67 1943 1812070208430001 SAMIRAN L MASYARAKAT UMUM 78 0 PAGAR JAYA

68 1978 1812070912780002 SUPADI L MASYARAKAT UMUM 43 31-45 PAGAR JAYA

69 1961 1812071204610002 MARSONO L MASYARAKAT UMUM 60 0 PAGAR JAYA

70 1974 1812074910740002 RUSMIYATI WA P MASYARAKAT UMUM 47 46-59 PAGAR JAYA

71 2001 1812071606010002 AHMAD ZAENAL L MASYARAKAT UMUM 20 12-19 PAGAR JAYA

72 1978 1812070407780003 SUYONO L MASYARAKAT UMUM 43 31-45 PAGAR JAYA

73 2006 1812072107060003 MAHRUF ARDIA L REMAJA 15 12-19 PAGAR JAYA

74 2009 1812076807090003 LUPITA SARI P REMAJA 12 12-19 PAGAR JAYA

75 1994 1812076711940001 FITIN MISNAWA P MASYARAKAT UMUM 27 12-19 PAGAR JAYA

76 1961 1812075602610001 YARNI P MASYARAKAT UMUM 60 0 PAGAR JAYA

77 1990 1812070504900005 HENDRI L MASYARAKAT UMUM 31 31-45 PAGAR JAYA

78 1989 1812074108890002 RELA DWI FADI L MASYARAKAT UMUM 32 31-45 PAGAR JAYA

79 2009 1812072404090001 HENDRA SAPU L REMAJA 12 12-19 PAGAR JAYA

80 1977 1812070208770001 SEHONO L MASYARAKAT UMUM 44 31-45 PAGAR JAYA

81 1980 1812075512800002 SITI MUJAYANT P MASYARAKAT UMUM 41 31-45 PAGAR JAYA

82 1976 1812075703760002 SITI KOMARIYA P MASYARAKAT UMUM 45 31-45 PAGAR JAYA

83 1994 1812070308940003 EKO ALFIADIN L MASYARAKAT UMUM 27 12-19 PAGAR JAYA

84 1992 1812075807920000 SUYATMI P MASYARAKAT UMUM 29 12-19 PAGAR JAYA

85 2009 1812070804090001 BINTANG ANDI L REMAJA 12 12-19 PAGAR JAYA

86 1968 1812071405880002 IRFANTO L MASYARAKAT UMUM 53 46-59 PAGAR JAYA

87 1985 1812071712850001 AHMAD MUCHLI L MASYARAKAT UMUM 36 31-45 PAGAR JAYA

88 2003 1812072007030002 AJI PURNOMO L REMAJA 18 12-19 PAGAR JAYA

89 1996 1812066910960001 SITI KHOLIFATU P MASYARAKAT UMUM 25 12-19 PAGAR JAYA

90 1960 1812075102600002 AWEN P MASYARAKAT UMUM 61 0 PAGAR JAYA

91 2009 1812070105090002 DEDI ANDIKA L REMAJA 12 12-19 PAGAR JAYA

92 2009 1812076606090001 AULIVIA ZAHRA P REMAJA 12 12-19 PAGAR JAYA

93 2009 1812070112090001 SUDIRMAN L REMAJA 12 12-19 PAGAR JAYA

94 2008 1812070312080001 LUKI ARDIANS L REMAJA 13 12-19 PAGAR JAYA

95 1967 1812075308670001 INDIAH P MASYARAKAT UMUM 54 46-59 PAGAR JAYA

96 1977 1812071012770001 ZAT MIKO L MASYARAKAT UMUM 44 31-45 PAGAR JAYA

97 1979 1812075210790001 TARWIJI RAHA P MASYARAKAT UMUM 42 31-45 PAGAR JAYA

98 1935 1812076509350001 SUMI P MASYARAKAT UMUM 86 0 PAGAR JAYA

99 2004 1812072911040003 RENDI EKA SA L REMAJA 17 12-19 PAGAR JAYA

100 1957 1812074508570001 TURMINI P MASYARAKAT UMUM 64 0 PAGAR JAYA

101 1970 1812070404700002 SOFII L MASYARAKAT UMUM 51 46-59 PAGAR JAYA

102 1992 1812074501920001 MUNDHALIKAH P MASYARAKAT UMUM 29 12-19 PAGAR JAYA

103 1954 1812071211540002 ARIS L MASYARAKAT UMUM 67 0 PAGAR JAYA

104 1987 1812071205870001 ROHMADI L MASYARAKAT UMUM 34 31-45 PAGAR JAYA

105 2006 1812074604060003 SYIFA APRILIA P REMAJA 15 12-19 PAGAR JAYA

106 1977 1812076202770002 SUMIRAH P MASYARAKAT UMUM 44 31-45 PAGAR JAYA

107 1975 1812060104770002 SUGIARTO L MASYARAKAT UMUM 46 46-59 PAGAR JAYA

108 1951 1812077005510002 MAFSIAH P MASYARAKAT UMUM 70 0 PAGAR JAYA

109 1948 18120710074800002 PAIMAN L MASYARAKAT UMUM 73 0 PAGAR JAYA

110 1991 1812075010900005 YENI NALURITA P MASYARAKAT UMUM 30 12-19 PAGAR JAYA

111 1980 1812072708800002 MAD YUDI L MASYARAKAT UMUM 41 31-45 PAGAR JAYA

112 1970 1812070708700007 SUCIPTO L MASYARAKAT UMUM 51 46-59 PAGAR JAYA

113 1986 1812074710860002 SITI MASLAHAH P MASYARAKAT UMUM 35 31-45 PAGAR JAYA

114 1986 1812071508860001 SUWANTO L MASYARAKAT UMUM 35 31-45 PAGAR JAYA

115 1968 1812074907680001 PONIYEM P MASYARAKAT UMUM 53 46-59 PAGAR JAYA

116 1979 1812011804790001 SUYONO L MASYARAKAT UMUM 42 31-45 PAGAR JAYA

117 1982 1812074407820001 SUSIATI P MASYARAKAT UMUM 39 31-45 PAGAR JAYA

118 1987 1805086412870001 SIT INDAH WATI P MASYARAKAT UMUM 34 31-45 PAGAR JAYA

119 1988 1812071805880002 ARI BUDI UTOM L MASYARAKAT UMUM 33 31-45 PAGAR JAYA

120 1942 1812071407420001 MISNO L MASYARAKAT UMUM 79 0 PAGAR JAYA

121 1960 1812070811480001 SUPARMAN L MASYARAKAT UMUM 61 0 PAGAR JAYA

122 1989 1812074701890006 FITRIYANA SAR P IBU HAMIL 32 31-45 PAGAR JAYA

123 1994 1812075202940002 SRI RAHAYU P IBU HAMIL 27 12-19 PAGAR JAYA

124 1939 1812074206120003 MISIYEM P MASYARAKAT UMUM 82 0 PAGAR JAYA

 125 1938 1812071107380001 NISKAN L MASYARAKAT UMUM 83 0 PAGAR JAYA

126 1957 1812074308570001 TUMINI P MASYARAKAT UMUM 64 0 PAGAR JAYA

127 1870 1812075109700002 LAMITUN P MASYARAKAT UMUM 151 0 PAGAR JAYA

128 1956 1812074311560001 TUSRI L MASYARAKAT UMUM 65 0 PAGAR JAYA

129 1989 1812070507890011 AGUS HENDRA L MASYARAKAT UMUM 32 31-45 PAGAR JAYA

130 1966 1608080806660002 KASIMIN L MASYARAKAT UMUM 55 46-59 PAGAR JAYA

131 1993 181207500493007 SUGIARTI P IBU HAMIL 28 12-19 PAGAR JAYA

132 1964 1811043003840001 HARI PRASETY L MASYARAKAT UMUM 57 46-59 PAGAR JAYA

B = Petugas pelayanan publik yang berhadapan langsung dengan masyarakat

C = Administrator Pemerintahan

D = Lainnya

E = Tidak Bekerja
 KETERANGAN

JUMLAH VAKSIN 80

TERPAKAI 66

SISA 14

Total 80

Pemberian Dosis

Dosis 1 82

Dosis 2 50

Total 132

Pekerjaan Dosis 1 Dosis 2

REMAJA 19 14 5

LANSIA 33 25 8

IBU HAMIL 4 4 0

MASYARAKAT RENTAN 0 0 0
MASYARAKAT UMUM 76 39 37

PELAYAN PUBLIK

SDM KESEHATAN

Total 132 82 50
KSANAAN VAKSINASI COVID-19
ASYANKES/POS VAKSINASI

Kepesertaan BPJS (tulis

'Ya' pada kolom yang Dosis I Dosis 2
sesuai)
Merek Tanggal Keterangan
No. Hp
Vaksin*** Screening (Ditunda/Tidak Diberikan/Lanjut)
BPJS Tanggal Tanggal
BPJS Non
Non Pemberian No. Batch Pemberian No. Batch
PBI Anggota
PBI Vaksinasi Vaksinasi

085381366708 SINOVAC 12/20/2021 12/20/2021 202109200K

082377813101 SINOVAC 12/20/2021 12/20/2021 202109200K

085268287063 SINOVAC 12/20/2021 12/20/2021 202109200K

082121178435 SINOVAC 12/20/2021 12/20/2021 202109200K

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085692141866 SINOVAC 12/20/2021 12/20/2021 202109200K

082372179353 SINOVAC 12/20/2021 12/20/2021 202109200K

085266951491 SINOVAC 12/20/2021 12/20/2021 202109200K

081369472534 SINOVAC 12/20/2021 12/20/2021 202109200K

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082179948972 SINOVAC 12/20/2021 12/20/2021 202109200K

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083896907033 SINOVAC 12/20/2021 12/20/2021 202109200K

085273774796 SINOVAC 12/20/2021 1/20/2021 202109200K

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085789629426 SINOVAC 12/20/2021 20--12-2021 202109200K 12/20/2021 202109200K

082377037858 SINOVAC 12/20/2021 12/20/2021 202109200K

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081373953716 SINOVAC 12/20/2021 20-12-201 202109200K

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085269941986 SINOVAC 12/20/2021 12/20/2021 202109200K

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082307292226 SINOVAC 12/20/2021 12/20/2021 202109200K

087721060967 SINOVAC 12/20/2021 20--12-2021 202109200K

082376131226 SINOVAC 12/20/2021 12/20/2021 202109200K

085848917914 SINOVAC 12/20/2021 12/20/2021 202109200K

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087867035498 SINOVAC 12/20/2021 12/20/2021 202109200K

085366060344 SINOVAC 12/20/2021 12/20/2021 202109200K

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082183092494 SINOVAC 12/20/2021 12/20/2021 202109200K

085768046723 SINOVAC 12/20/2021 12/20/2021 202109200K

085768046723 SINOVAC 12/20/2021 12/20/2021 202109200K

085384514256 SINOVAC 12/20/2021 12/20/2021 202109200K

085379973061 SINOVAC 12/20/2021 12/20/2021 202109200K

081993306654 SINOVAC 12/20/2021 12/20/2021 202109200K

085379973061 SINOVAC 12/20/2021 12/20/2021 202109200K

082188303904 SINOVAC 12/20/2021 12/20/2021 202109200K

082262260261 SINOVAC 12/20/2021 20--12-2021 202109200K

085669407396 SINOVAC 12/20/2021 12/20/2021 202109200K

082378841950 SINOVAC 12/20/2021 12/20/2021 202109200K

082282443074 SINOVAC 12/20/2021 12/20/2021 202109200K

082282443073 SINOVAC 12/20/2021 12/20/2021 202109200K

085381111868 SINOVAC 12/20/2021 12/20/2021 202109200K

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082278272851 SINOVAC 12/20/2021 12/20/2021 202109200K

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085382063081 SINOVAC 12/20/2021 12/20/2021 202109200K

082373886818 SINOVAC 12/20/2021 12/20/2021 202109200K

085378905025 SINOVAC 12/20/2021 12/20/2021 202109200K

085236146236 SINOVAC 12/20/2021 12/20/2021 202109200K

081278835912 SINOVAC 12/20/2021 12/20/2021 202109200K

081278835912 SINOVAC 12/20/2021 12/20/2021 202109200K

082377672732 SINOVAC 12/20/2021 12/20/2021 202109200K

082269259556 SINOVAC 12/20/2021 12/20/2021 202109200K

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081272152491 SINOVAC 12/20/2021 12/20/2021 202109200K

082179847030 SINOVAC 12/20/2021 12/20/2021 202109200K

087895502634 SINOVAC 12/20/2021 12/20/2021 202109200K

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0821865508002 SINOVAC 12/20/2021 12/20/2021 202109200K

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087707071244 SINOVAC 12/20/2021 12/20/2021 202109200K

081274060315 SINOVAC 12/20/2021 12/20/2021 201209200K

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082210290635 SINOVAC 12/20/2021 12/20/2021 202109200K

082210290635 SINOVAC 12/20/2021 12/20/2021 202109200K

082375661580 SINOVAC 12/20/2021 12/20/2021 202109200K

082210290635 SINOVAC 12/20/2021 12/20/2021 202109200K

081379289165 SINOVAC 12/20/2021 12/20/2021 202109200K

082210290635 SINOVAC 12/20/2021 12/20/2021 202109200K

082210290635 SINOVAC 12/20/2021 12/20/2021 202109200K

082210290635 SINOVAC 12/20/2021 12/20/2021 202109200K

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