1.

Petugas Entri
Data
REGISTER PELAYANAN KB R/I/KB/20
Lembar 1

V 2 3 4 5 6
1 6 1 3 0 0 8 Bulan : 2022
NAMA FASKES/ puskesmas muara kulam 7 8 9 10 11 12
:
JARINGAN/JEJARING Kode Provinsi Kode No. Register Faskes No. Jaringan/
Kabupaten/ Jejaring Faskes
Kota

PESERTA KB JENIS TINDAKAN Kasus PENGGUNAAN SUMBER ALOKON

(Kode) (Kode) ASURANSI

PELAYANAN BERGERAK
STATUS PESERTA KB

INFORMED CONSENT

PASCA KEGUGURAN
PASCA PERSALINAN
ISTRI

BPJS KESEHATAN
NO. TANGGAL ALAMAT NO. HANDPHONE

PEMASANGAN
PENCABUTAN

PENCABUTAN

KEGAGALAN
PEMBERIAN/

KOMPLIKASI
NAMA SUAMI

OPERATIF/

LAINNYA
TANGGAL

MANDIRI
NIK (NOMOR INDUK KEPENDUDUKAN) NAMA

BERAT
LAHIR

(Kode)

TIDAK

APBN

APBD
DAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

01-January-2022 19-August-1979
1 Alamsyah 1 6 0 5 0 6 5 6 0 8 7 9 0 0 0 1 Laili Suryani KELURAHAN MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

01-January-2022 10-September-
2 LUKMAN HAKIM 1 6 0 5 0 6 5 0 0 9 0 0 0 0 0 2 RODIAH MUARA KULAM 3 0 0 0 2 0 0 1 0 0 1 0
2000
01-January-2022 07-September-
3 M.YUSUP 1 6 0 5 0 6 4 7 0 9 6 5 0 0 0 1 MAIMUNAH MUARA KULAM 1 0 1 0 2 0 0 1 1 0 0 0
1965
05-January-2022
4 Aridan Habi 1 6 0 5 0 6 0 8 0 3 9 5 0 0 0 1 Meta Trisusanti 08-March-1998 KELURAHAN MUARA KULAM 3 0 0 0 2 0 0 1 0 0 1 0

05-January-2022
5 EDI GUNTUR 1 6 0 5 0 6 6 7 0 6 8 8 0 0 0 4 YOSNIDA 27-June-1988 MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

05-January-2022 HUZAIR PRIMA 12-August-1983

6 1 6 0 5 0 6 5 2 0 8 8 3 0 0 0 2 LINDA MAIYANA MUARA KULAM 3 0 0 0 2 0 0 1 0 0 1 0
PUTRA
05-January-2022
7 Jhoni Afrizal 1 6 1 3 0 6 4 5 0 9 9 7 0 0 0 1 Ayu Anis 05-July-1997 KELURAHAN MUARA KULAM 3 0 0 0 2 0 0 1 0 0 1 0

05-January-2022 19-August-1979
8 ZULKIPLI 1 6 0 5 0 6 5 9 0 8 7 9 0 0 0 1 MARNILA KELURAHAN MUARA KULAM 3 0 0 0 2 0 0 1 0 0 1 0

06-January-2022
9 AHMADI 1 6 1 3 0 7 4 2 0 5 9 3 0 0 0 1 SUKARIA 02-May-1993 MUARA KULAM 3 0 0 0 2 0 0 1 0 0 1 0

06-January-2022
10 Sofyan Hadi 1 6 0 5 0 6 4 3 0 1 9 2 0 0 0 2 Riska Ria Sari 27-March-1958 MUARA KULAM 3 0 0 0 2 0 0 1 0 0 1 0

08-January-2022 10-October-1997
11 DIDENDI SURYADI 1 6 0 5 0 6 5 3 0 2 1 3 0 0 0 1 EVISNA NAVAYANTI MUARA KULAM 3 0 0 0 2 0 0 1 0 0 1 0

08-January-2022
12 ISHAK 1 6 0 5 0 6 4 5 0 7 9 6 0 0 0 2 ERISKA YULANDA 05-July-1996 MUARA KULAM 3 0 0 0 2 0 0 1 0 0 1 0

10-January-2022 04-November-
13 MARZUKI 1 6 0 5 0 6 4 1 0 7 9 0 0 0 0 1 KARMISANTIKA KELURAHAN MUARA KULAM 3 0 0 0 2 0 0 1 0 0 1 0
1990
11-January-2022
14 ALAMSYAH 1 6 0 5 0 6 6 4 0 7 9 7 0 0 0 1 MAIMUNAH 24-July-1997 MUARA KULAM 3 0 0 0 2 0 0 1 0 0 1 0

11-January-2022
15 IDRIS ARONI 1 6 0 5 0 6 6 0 0 6 7 8 0 0 0 1 MARIANA 20-May-1978 MUARA KULAM 3 0 0 0 2 0 0 1 0 0 1 0

11-January-2022
16 YAKUB 1 6 0 5 0 6 6 5 0 7 8 5 0 0 0 1 RATNA WILA 25-July-1985 MUARA KULAM 3 0 0 0 2 0 0 1 0 0 1 0

12-January-2022
17 RIDUAN 1 6 0 5 0 6 1 1 8 1 1 8 6 0 0 3 HAMIDAH 03-July-1987 KELURAHAN MUARA KULAM 3 0 0 0 2 0 0 1 0 0 1 0

12-January-2022 07-January-1997
18 TARMIZI 1 6 1 3 0 7 0 1 0 7 9 1 0 0 1 2 ANIS KARTINA MUARA KULAM 3 0 0 0 2 0 0 1 0 0 1 0

14-January-2022
19 ARIPIN 1 6 1 3 0 7 4 2 0 4 8 0 0 0 0 1 DEWI 02-April-1980 MUARA KULAM 3 0 0 0 2 0 0 1 0 0 1 0

14-January-2022
20 DANDI PATIANSYAH 1 6 0 5 0 6 6 5 0 5 0 0 0 0 0 1 MIRA SARTIKA 20-June-2000 MUARA KULAM 3 0 0 0 2 0 0 1 0 0 1 0

15-January-2022
21 GUNTUR 1 6 0 5 0 6 4 2 0 7 9 1 0 0 0 1 MASKINA 02-July-1991 KELURAHAN MUARA KULAM 3 0 0 0 2 0 0 1 0 0 1 0

15-January-2022 11-September-
22 MUNAWIR 1 6 0 5 0 6 5 1 0 9 8 6 0 0 0 1 SUMI NARNI MUARA KULAM 3 0 0 0 2 0 0 1 0 0 1 0
1986
15-January-2022
23 NASRULLAH 1 6 0 5 0 6 4 4 0 3 9 4 0 0 0 1 ROHIMATUL FITRAH 04-March-1994 MUARA KULAM 3 0 0 0 2 0 0 1 0 0 1 0
 15-January-2022 21-October-1995
24 TAUPIK 1 6 1 3 0 7 6 1 0 1 9 5 0 0 0 1 SANA KEL. MUARA KULAM 3 0 0 0 2 0 0 1 0 0 1 0

17-January-2022
25 AYUB 1 6 0 5 0 6 6 9 0 4 9 2 0 0 0 1 ROILA 29-April-1992 MUARA KULAM 3 0 0 0 2 0 0 1 0 0 1 0

17-January-2022
26 SAPII 1 6 0 5 0 6 4 2 0 3 8 8 0 0 0 1 NURHASIA 03-May-1988 MUARA KUIS 3 0 0 0 2 0 0 1 0 0 1 0

18-January-2022
27 HIDAYAT 1 6 0 5 0 6 5 6 1 0 9 8 0 0 0 1 RUMO TAPSIAH 25-May-1998 MUARA KULAM 3 0 0 0 2 0 0 1 0 0 1 0

18-January-2022 07-February-
28 M.DAUD 1 6 0 5 0 6 4 7 0 8 9 4 0 0 0 2 VERA WATI MUARA KULAM 3 0 0 0 2 0 0 1 0 0 1 0
1992
22-January-2022 30-August-1989
29 ARPAN SALIM 1 6 0 5 0 6 7 0 0 8 8 9 0 0 0 4 MARSANTI MUARA KULAM 3 0 0 0 2 0 0 1 0 0 1 0

24-January-2022 BAMBANG
30 1 6 0 5 0 6 6 9 0 6 8 8 0 0 0 2 ESVI DARKIAH 29-June-1988 MUARA KULAM 3 0 0 0 2 0 0 1 0 0 1 0
RUGIANTO
24-January-2022
31 BURNIAT 1 6 0 5 0 6 4 6 0 4 7 7 0 0 0 1 SULASTRI 18-April-1981 MUARA KULAM 3 0 0 0 2 0 0 1 0 0 1 0

24-January-2022 25-August-1980
32 HERI YANTO 1 6 0 5 0 6 6 5 8 8 8 0 0 0 0 2 SITI AISYAH MUARA KULAM 3 1 0 0 2 0 0 1 0 0 1 1

24-January-2022
33 M.ALI 1 6 0 5 0 6 6 6 0 3 9 7 0 0 0 1 PARDIAH 26-March-1997 MUARA KULAM 3 0 0 0 2 0 0 1 0 0 1 0

26-January-2022 10-October-1978
34 JUNAIDI AHMAD 1 6 0 5 0 6 5 0 1 0 7 8 0 0 0 1 MURAH HANA MUARA KULAM 3 0 0 0 2 0 0 1 0 0 1 0

26-January-2022
35 SADIL 1 6 0 5 0 6 6 9 0 5 7 5 0 0 0 1 SITI PATIMAH 20-May-1975 MUARA KULAM 1 0 0 0 2 0 0 1 0 0 1 0

27-January-2022 09-October-1994
36 ZULKIPLI 1 6 0 5 0 6 4 9 1 0 9 4 0 0 0 2 AYU RINA KELURAHAN MUARA KULAM 3 0 0 0 2 0 0 1 0 0 1 0

21-February-
37 ABDUL HADI 1 6 0 5 0 6 6 8 0 7 8 4 0 0 0 1 SUWAIBAH 18-July-1984 KELURAHAN MUARA KULAM 3 0 0 0 2 0 0 1 0 0 1 0
2022
21-February- 08-February-
38 ABDULLAH 1 6 0 5 0 6 4 8 0 2 7 6 0 0 0 1 PATIMAH SALEH KELURAHAN MUARA KULAM 3 0 0 0 0 0 1 1 0 0 0
2022 1976
21-February- DUSUN SENDAWAR KELURAHAN
39 ABDUL WAHID 1 6 0 5 0 6 4 3 0 5 8 9 0 0 0 1 NELI YANI 03-May-1989 3 0 0 0 0 0 1 0 0 1 0
2022 MUARA KULAM
21-February- 01-October-1986
40 AHMAD 1 6 0 5 0 6 4 1 0 7 8 6 0 0 0 8 SUMMAINI KELURAHAN MUARA KULAM 3 0 0 0 2 0 0 1 0 0 1 0
2022
21-February-
41 ALIAS 1 6 0 5 0 6 5 1 0 6 9 4 0 0 0 1 AZIZAH 11-June-1994 KELURAHAN MUARA KULAM 3 0 0 0 2 0 0 1 0 0 1 0
2022
21-February- 11-September-
42 ALIPIAH 1 6 0 5 0 6 5 1 0 9 8 5 0 0 0 1 YURNIMA KELURAHAN MUARA KULAM 3 0 0 0 0 0 1 0 0 1 0
2022 1985
21-February- 12-November-
43 ALI TANZIL 1 6 0 5 0 6 5 2 1 1 8 5 0 0 0 1 MISMITA MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0
2022 1985
21-February-
44 ARSAL 1 6 0 5 0 6 5 7 0 4 8 8 0 0 0 1 HASANAH 17-April-1988 KELURAHAN MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0
2022
21-February- 23-August-1979
45 HARDIANSYAH 1 6 0 5 0 6 6 3 0 8 7 9 0 0 0 2 HALIMAH MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0
2022
21-February-
46 IBNU HAJAR 1 6 0 5 0 6 4 6 0 7 9 4 0 0 0 2 LIKA HIZATUL IZMI 06-July-1994 KELURAHAN MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0
2022
21-February- 30-January-2001
47 MULYADI 1 6 1 3 0 7 7 6 4 0 1 0 0 0 0 1 MIRA KELURAHAN MUARA KULAM 3 0 0 0 2 0 0 1 0 0 1 0
2022
21-February-
48 M YUSUP 1 6 0 5 0 6 6 5 0 4 8 0 0 0 0 3 HAWATI 25-May-1980 KELURAHAN MUARA KULAM 3 0 0 0 2 0 0 1 0 0 1 0
2022
09-September-
49 01-March-2022 IWAN ZAHRI 1 6 0 5 0 6 4 0 9 0 9 9 4 0 0 1 TOIBA NIRMALA SARI MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0
1994
06-August-2003
50 01-March-2022 PAHRUL ROZI 1 6 0 5 0 6 4 4 0 8 0 3 0 0 0 3 LUVITA PAIANI MUARA KULAM 3 1 0 0 2 0 0 1 1 0 0 0

27-February-
51 03-March-2022 AFRIZAN 1 6 0 5 0 6 6 0 0 7 9 2 0 0 0 1 SAMSIAH MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0
1992

52 03-March-2022 ILYAS 1 6 0 5 0 6 5 0 0 7 7 2 0 0 0 2 ASMI 10-July-1972 MUARA KULAM 3 1 0 0 2 0 0 1 1 0 0 0

53 04-March-2022 M.ALI 1 6 0 5 0 6 6 6 0 3 9 7 0 0 0 1 PARDIAH 26-March-1997 MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

27-November-
54 05-March-2022 ABDURRAHMAN 1 6 0 5 0 6 8 0 0 2 9 8 0 0 0 1 MINA LESTARI MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0
1994

55 05-March-2022 MUSTOPA 1 6 0 5 0 6 4 2 0 5 8 5 0 0 0 3 SITI KHODIJAH 02-May-1985 MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

09-September-
56 13-March-2022 ABU SIAM 1 6 0 5 0 6 4 9 0 9 9 7 0 0 0 1 SESSA SARINAPI KELURAHAN MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0
1997
09-September-
57 13-March-2022 TANTOWI 1 6 0 5 0 6 4 9 0 9 8 1 0 0 0 1 EKA NOVITASARI MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0
1981
10-September-
58 13-March-2022 USMAN 1 6 0 5 0 6 5 0 0 9 7 3 0 0 0 2 MASYUDAN MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0
1973
 06-August-1985 DUSUN SENDAWAR KELURAHAN
59 13-March-2022 ZAHERI 1 6 0 5 0 6 4 8 0 8 5 0 0 0 0 2 MAISITOH 3 0 0 0 2 0 1 0 1 0 0 0
MUARA KULAM
08-February-
60 16-March-2022 DUNGCIK 1 6 0 5 0 6 4 8 0 2 8 1 0 0 0 1 ROILA WATI MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0
1981

61 16-March-2022 M.YAMIN 1 6 0 5 0 6 4 4 0 5 8 2 0 0 0 2 NURSIAH 04-May-1982 MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

62 16-March-2022 SURATMO 1 6 1 3 0 7 5 8 0 5 7 6 0 0 0 1 MARYAM NURDIN 18-May-1976 MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

63 22-March-2022 ALAMSYA 1 6 0 5 0 6 4 1 0 6 7 9 0 0 0 1 PATMA WATI 01-June-1979 MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

64 22-March-2022 ALIAS 1 6 0 5 0 6 5 1 0 6 9 4 0 0 0 1 AZIZAH 11-June-1994 KELURAHAN MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

65 22-March-2022 KAMALUDIN 1 6 0 5 0 6 4 1 0 7 8 0 0 0 1 8 MARNI 27-July-1980 KELURAHAN MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

16-August-1978 DUSUN SENDAWAR KELURAHAN

66 22-March-2022 M NUH 1 6 0 5 0 6 5 6 0 8 7 8 0 0 0 1 JUAIRIAH 3 0 0 0 2 0 0 1 1 0 0 0
MUARA KULAM
08-August-1992
67 22-March-2022 MUSLIM 1 6 0 5 0 6 5 9 8 8 9 2 0 0 0 2 NURBAITI KELURAHAN MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

10-October-2001 DUSUN SENDAWAR KELURAHAN

68 26-March-2022 ABDUL AZIZ 1 6 0 5 0 6 4 1 0 7 5 5 0 0 1 5 KOMARIAH 3 0 0 0 2 0 0 1 1 0 0 0
MUARA KULAM

69 01-April-2022 MUHAMMAD SOLEH 1 6 0 5 0 6 5 2 0 6 8 7 0 0 0 1 MUSAMMAH 12-June-1992 MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

20-November-
70 02-April-2022 YUSUP AMIN 1 6 1 3 0 7 6 0 1 1 9 7 0 0 0 1 MARYANA MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0
1997
08-November-
71 04-April-2022 BASRI 1 6 0 5 0 6 4 5 1 1 8 4 0 0 0 2 ROHANA MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0
1984
03-January-1992
72 04-April-2022 SOPIAN HADI 1 6 0 5 0 6 4 3 0 1 9 2 2 0 0 2 RISKA RIA SARI MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

73 05-April-2022 ANHAR 1 6 0 5 0 6 4 3 0 4 9 0 0 0 0 4 YUSMAR 25-May-1988 MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

74 06-April-2022 MULKAN 1 6 0 5 0 6 6 9 0 7 7 7 0 0 0 1 AMINAH 29-July-1977 KELURAHAN MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

HUZAIR PRIMA 12-August-1983

75 07-April-2022 1 6 0 5 0 6 5 2 0 8 8 3 0 0 0 2 LINDA MAIYANA MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0
PUTRA

76 11-April-2022 1 6 0 5 0 6 0 8 0 3 9 5 0 0 0 1 Meta Trisusanti 08-March-1998 KELURAHAN MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

77 14-April-2022 ALAMSYAH 1 6 0 5 0 6 6 4 0 7 9 7 0 0 0 1 MAIMUNAH 24-July-1997 MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

01-August-1986
78 14-April-2022 AL PAJAR LAKONI 1 6 0 5 0 6 0 4 1 0 8 6 0 0 0 1 NURHAYATI YUSUP MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

79 14-April-2022 ARIPIN 1 6 1 3 0 7 4 2 0 4 8 0 0 0 0 1 DEWI 02-April-1980 MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

80 14-April-2022 AYUB 1 6 0 5 0 6 6 9 0 4 9 2 0 0 0 1 ROILA 29-April-1992 MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

81 14-April-2022 HIDAYAT 1 6 0 5 0 6 5 6 1 0 9 8 0 0 0 1 RUMO TAPSIAH 25-May-1998 MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

82 14-April-2022 Jhon Aprizal 1 6 1 3 0 5 4 5 0 9 9 7 0 0 0 1 ayu anis 05-July-1997 KELURAHAN MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

28-August-1997
83 14-April-2022 M. Ardiansyah 1 6 0 5 0 6 6 8 0 9 9 7 0 0 0 2 Sifa Fauziah KELURAHAN MUARA KULAM 1 0 0 0 2 0 0 1 1 0 0 0

07-February-
84 14-April-2022 M.DAUD 1 6 0 5 0 6 4 7 0 8 9 4 0 0 0 2 VERA WATI MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0
1992

85 14-April-2022 NASRULLAH 1 6 0 5 0 6 4 4 0 3 9 4 0 0 0 1 ROHIMATUL FITRAH 04-March-1994 MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

86 14-April-2022 SADIL 1 6 0 5 0 6 6 9 0 5 7 5 0 0 0 1 SITI PATIMAH 20-May-1975 MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

07-January-1997
87 14-April-2022 TARMIZI 1 6 1 3 0 7 0 1 0 7 9 1 0 0 1 2 ANIS KARTINA MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

88 14-April-2022 ZAINI 1 6 0 5 0 6 6 1 0 7 8 7 0 0 0 1 EVI SALNITA 21-July-1987 MUARA KULAM 1 0 1 0 2 0 0 1 1 0 0 0

19-August-1979
89 14-April-2022 ZULKIPLI 1 6 0 5 0 6 5 9 0 8 7 9 0 0 0 1 MARNILA KELURAHAN MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

11-November-
90 16-April-2022 ALI IMRAN 1 6 0 5 0 6 6 1 1 1 8 3 0 0 0 1 SUMAR TIANA MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0
1983

91 16-April-2022 SAYUTI ABDULLAH 1 6 0 5 0 6 5 5 0 5 8 9 0 0 0 3 HOPSAH 15-May-1989 KELURAHAN MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

28-August-1993
92 19-April-2022 KARNO SUSANTO 1 6 0 5 0 6 6 6 0 6 9 3 0 0 0 1 HARNI JASMALA NITA MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

93 21-April-2022 AHMADI 1 6 1 3 0 7 4 2 0 5 9 3 0 0 0 1 SUKARIA 02-May-1993 KELURAHAN MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

94 21-April-2022 BURNIAT 1 6 0 5 0 6 4 6 0 4 7 7 0 0 0 1 SULASTRI 18-April-1981 KELURAHAN MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

09-October-1994
95 22-April-2022 ZULKIPLI 1 6 0 5 0 6 4 9 1 0 9 4 0 0 0 2 AYU RINA KELURAHAN MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

96 05-May-2022 AHMADI 1 6 1 3 0 7 4 2 0 5 9 3 0 0 0 1 SUKARIA 02-May-1993 MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

97 05-May-2022 ANHAR 1 6 0 5 0 6 4 3 0 4 9 0 0 0 0 4 YUSMAR 25-May-1988 MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

98 05-May-2022 HASAN MURNI 1 6 0 5 0 6 6 7 0 4 8 8 0 0 0 1 PARDIAN 27-April-1988 MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

99 05-May-2022 HIDAYAT 1 6 0 5 0 6 5 7 0 5 9 8 0 0 0 2 KURRATUL AYUNI 05-July-1998 KELURAHAN MUARA KULAM 1 0 0 0 2 0 0 1 1 0 0 0

20-February-
100 05-May-2022 M.SOLEH 1 6 0 5 0 6 6 0 0 2 9 2 0 0 0 1 MIFTAHUL JANNAH MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0
1992

101 08-May-2022 1 6 0 5 0 6 5 0 0 5 5 6 0 0 0 1 HALIMAH 04-May-1956 MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

102 08-May-2022 A. KARIM 1 6 0 5 0 6 6 5 5 0 4 9 3 0 0 0 NELI ASMARA 15-April-1993 KELURAHAN MUARA KULAM 1 0 0 0 0 0 1 1 0 0 0

09-December-
103 08-May-2022 BELLY KALANA P 1 6 0 5 0 6 4 9 1 2 8 8 0 0 0 2 SIMURNI KELURAHAN MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 1
1988
19-August-1979
104 08-May-2022 ZULKIPLI 1 6 0 5 0 6 5 9 0 8 7 9 0 0 0 1 MARNILA KELURAHAN MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

25-October-1988
105 11-May-2022 ABU BAKAR 1 6 0 5 0 6 5 0 0 4 8 8 0 0 0 2 ELLIZA MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

16-November-
106 11-May-2022 JAUHARI EPENDI 1 6 0 5 0 6 4 2 0 7 9 2 0 0 0 1 YURAINI MUARA KULAM 1 0 0 0 2 0 0 1 1 0 0 0
1988

107 11-May-2022 ZAINAL 1 6 0 5 0 6 5 8 0 6 7 5 0 0 0 3 MINARNI 18-June-1972 MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

01-October-2002
108 14-May-2022 ARIYANTO 1 6 1 3 0 7 0 1 0 1 0 2 0 0 0 2 EKA ARDILA KELURAHAN MUARA KULAM 1 0 0 0 2 0 0 1 1 0 0 0

07-August-1987
109 14-May-2022 IBNU HAJAR 1 6 0 5 0 6 4 7 0 8 8 4 0 0 0 3 RITA MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

110 14-May-2022 RIDUAN 1 6 0 5 0 6 1 1 8 1 1 8 6 0 0 3 HAMIDAH 03-July-1987 KELURAHAN MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

12-December-
111 15-May-2022 SOPIYAN 1 6 0 5 0 6 5 2 1 2 9 7 0 0 0 1 DESMI HARTATI MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0
1997
05-October-1984
112 20-May-2022 ADI SISWANTO 1 6 0 5 0 6 4 5 1 0 8 4 0 0 0 1 LENI ASNIAR MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

01-October-1986
113 20-May-2022 AHMAD 1 6 0 5 0 6 4 1 0 7 8 6 0 0 0 8 SUMMAINI KELURAHAN MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

22-August-1982
114 20-May-2022 ARIPIN 1 6 0 5 0 6 0 2 0 8 8 2 0 0 0 2 NURHAYATI MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

115 20-May-2022 ASRIMAN JAYA 1 6 0 5 0 6 5 6 0 4 8 8 0 0 0 1 RATNA WATI 16-April-1988 MUARA KULAM 3 0 0 0 0 0 1 1 0 0 0

116 20-May-2022 BANI AMIN 1 6 0 5 0 6 4 1 0 7 7 7 0 0 2 6 RUMO TAPSIAH 01-July-1977 MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

117 20-May-2022 BURNIAT 1 6 0 5 0 6 4 6 0 4 7 7 0 0 0 1 SULASTRI 18-April-1981 MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

118 20-May-2022 DARU QUTNI 1 6 0 5 0 6 1 3 0 5 9 2 0 0 0 1 MIZBAHATUZZOLAM 13-May-1992 MUARA KULAM 1 0 0 0 2 0 0 1 1 0 0 0

25-February-
119 20-May-2022 DODI CANDRA 1 6 0 5 0 6 6 5 0 2 8 7 0 0 0 3 MIRANTI MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0
1987

120 20-May-2022 FIRDAUS 1 3 1 0 0 2 6 4 0 3 9 7 0 0 0 2 PUTRI 24-March-1997 MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

28-August-1995
121 20-May-2022 GUNAWAN 1 6 1 3 0 7 6 8 0 8 9 5 0 0 0 1 SITI ROBIAH DESA MUARA KUIS 3 0 0 0 2 0 0 1 1 0 0 0

122 20-May-2022 HAJAR BUSTOMI 1 6 0 5 0 6 5 6 0 7 8 2 0 0 0 1 YUR PIKA 16-July-1982 MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

09-September-
123 20-May-2022 HARIZON 1 6 1 3 0 7 0 9 0 9 9 5 0 0 0 1 SITI PARTIMAH MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0
1995
DESA MUARA KUIS KECAMATAN
124 20-May-2022 HELMI 1 6 0 5 0 6 5 2 0 9 7 8 0 0 0 2 NILA WATI 12-April-1978 3 0 0 0 2 0 0 1 1 0 0 0
ULU RAWAS
30-October-1991
125 20-May-2022 HENDRI YANTO 1 6 0 5 0 6 7 0 1 0 9 1 0 0 0 3 LAILI KELURAHAN MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

20-October-1980
126 20-May-2022 H. SYUKUR 1 6 0 5 0 6 6 0 0 0 1 8 0 0 0 1 HJ NURBAITI KELURAHAN MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

127 20-May-2022 JUPRI 1 6 0 5 0 6 5 2 0 4 8 1 0 0 0 1 SRI MARDIAH 12-April-1981 MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

03-September-
128 20-May-2022 MAIDIN 1 6 1 3 0 7 4 3 0 9 9 3 0 0 0 1 KURNIA NINGSIH DESA MUARA KUIS 3 0 0 0 2 0 0 1 1 0 0 0
1993
129 20-May-2022 M.ALI H.ISMAIL 1 6 0 5 0 6 1 0 0 5 6 5 0 0 0 1 SUPARIDA 10-May-1965 MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

20-January-1977
130 20-May-2022 M.DAUD 1 6 0 5 0 6 6 0 0 1 7 7 0 0 0 1 SITI HODIJAH MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

24-December-
131 20-May-2022 M.KASAH 1 6 0 5 0 6 6 4 1 2 8 4 0 0 0 1 NURSIAM MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0
1984

132 20-May-2022 M.SULTAN 1 6 0 5 0 6 5 4 0 7 9 6 0 0 0 1 LALA UZILAWATI 14-July-1996 MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

133 20-May-2022 MUHAMMAD SUKRI 1 6 0 5 0 6 4 5 0 6 8 7 0 0 0 6 NURHAYATI 05-June-1987 KELURAHAN MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

10-September- DESA MUARA KUIS KECAMATAN

134 20-May-2022 MUNAMAD FADLI 1 5 0 3 0 3 5 0 0 9 9 0 0 0 0 5 SANTI MANDALA 3 0 0 0 2 0 0 1 1 0 0 0
1990 ULU RAWAS

135 20-May-2022 MUSA SOLEH 1 6 0 5 0 6 5 1 0 4 8 4 0 0 0 1 FATIMAH HARUN 11-April-1984 MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

10-February-
136 20-May-2022 MUZAL ANWAR 1 6 0 5 0 6 5 0 0 2 9 1 0 0 0 2 RANITA MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0
1991
07-August-1982
137 20-May-2022 RIDUAN ISMAIL 1 6 0 5 0 6 2 1 0 7 9 7 0 0 0 1 SITI KHODIJAH MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 1

21-January-1983
138 20-May-2022 SAIPUL ANWAR 1 6 0 5 0 6 5 8 0 3 8 5 0 0 0 2 MASLINDA MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

139 20-May-2022 SAMSU BAHRI 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 CINTAMI 02-May-1985 MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

30-October-1988 KELURAHAN MUARA KULAM

140 20-May-2022 SISWANDI 1 6 0 5 0 6 3 0 1 0 8 8 0 0 0 1 DWI ASTUTI 3 0 0 0 2 0 0 1 1 0 0 0

12-December- DESA MUARA KUIS KECAMATAN

141 20-May-2022 SUARDI 1 6 0 5 0 6 5 2 1 2 8 4 0 0 0 3 KASMA WATI 3 0 0 0 2 0 0 1 1 0 0 0
1985 ULU RAWAS
02-August-1994
142 20-May-2022 SYAFII 1 6 0 5 0 6 4 2 0 8 9 4 0 0 0 1 MURDIANA MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

143 20-May-2022 Umar 1 6 0 5 0 6 4 9 0 7 8 1 0 0 0 1 NURBAITI 08-July-1981 MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

144 20-May-2022 ZAHRI 1 6 0 5 0 6 5 4 0 5 7 5 0 0 0 1 JUBAIDAH 12-May-1980 MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

08-August-1991
145 06-June-2022 IBRAHIM 1 6 0 5 0 6 1 8 0 8 9 3 0 0 0 1 NURROTUL AHYA MUARA KULAM 2 0 0 0 2 0 0 1 1 0 0 0

146 06-June-2022 M.DAUD 1 6 0 5 0 6 4 6 0 6 9 2 0 0 0 1 IIN BILLAH 05-May-1994 MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

07-October-1984
147 15-June-2022 ABDUL HOLID 1 6 0 5 0 6 4 7 1 0 8 4 0 0 0 1 NUR AZIZA MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 1

01-February-
148 15-June-2022 ARIPIN 1 6 0 5 0 6 6 4 1 0 2 9 2 0 0 7 DEWI SARTIKA MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 1
1982

149 15-June-2022 AWALUDIN 1 6 0 5 0 6 6 1 0 5 8 1 0 0 0 1 HAYANI 21-May-1981 MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 1

06-February-
150 15-June-2022 BASTARI 1 6 0 5 0 6 4 8 0 9 9 3 0 0 0 1 LISKA DEWI KELURAHAN MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 1
1993

151 15-June-2022 EDI GUNTUR 1 6 0 5 0 6 6 7 0 6 8 8 0 0 0 4 YOSNIDA 27-June-1988 MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 1

25-February-
152 15-June-2022 KARTA WIJAYA 1 6 0 5 0 6 6 5 0 2 9 3 0 0 0 1 MARIA SOFINA MUARA KULAM 2 0 0 0 2 0 0 1 1 0 0 1
1993

153 15-June-2022 MARDANI 1 6 0 5 0 6 1 1 0 6 0 0 0 0 0 1 EKA NURLELA 11-June-1996 MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 1

154 15-June-2022 M.NUH ARMAIN 1 6 0 5 0 6 4 2 0 6 8 0 0 0 0 1 ETI ERNINGSIH 02-June-1980 MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 1

155 15-June-2022 SUKIMAN 1 6 0 5 0 6 6 7 0 4 8 6 0 0 0 1 ROSITA 27-April-1986 MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 1

156 15-June-2022 USMAN ABU BAKAR 1 6 0 5 0 6 4 1 0 7 8 6 0 0 1 0 RIA HARMONIS 01-July-1986 MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 1

11-October-1989
157 15-June-2022 YOHANAN 1 6 0 5 0 6 5 1 1 0 8 9 0 0 0 1 IRMA DAMAIYANTI MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 1

14-August-1995
158 17-June-2022 ISHAK 1 6 0 5 0 6 5 4 0 8 9 5 0 0 0 2 MEGA WATI KELURAHAN MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

05-October-1984
159 07-July-2022 ADI SISWANTO 1 6 0 5 0 6 4 5 1 0 8 4 0 0 0 1 LENI ASNIAR MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

160 07-July-2022 FIRDAUS 1 3 1 0 0 2 6 4 0 3 9 7 0 0 0 2 PUTRI 24-March-1997 MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

04-December-
161 07-July-2022 SRI MARDIAH 1 6 0 5 0 6 6 6 0 5 8 2 0 0 0 1 SRI MARDIAH KELURAHAN MUARA KULAM 3 0 0 0 2 1 0 0 1 0 0 0
1981

162 13-July-2022 RAPZAN 1 6 0 5 0 3 4 5 0 5 0 0 0 0 0 5 DINA HERMATIANA 05-May-2000 MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

12-February-
163 15-July-2022 ABUBAKAR 1 6 0 5 0 6 5 2 0 2 8 9 0 0 0 1 SOPIYANTI KELURAHAN MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0
1989
 11-September-
164 15-July-2022 MUNAWIR 1 6 0 5 0 6 5 1 0 9 8 6 0 0 0 1 SUMI NARNI MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0
1986
11-November-
165 20-July-2022 ALI IMRAN 1 6 0 5 0 6 6 1 1 1 8 3 0 0 0 1 SUMAR TIANA MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0
1983

166 21-July-2022 ALMUKMIN 1 6 0 5 0 6 5 1 0 3 9 5 0 0 0 1 MARKINA 11-March-1995 MUARA KULAM 2 0 0 0 2 0 0 1 1 0 0 0

02-August-1993
167 21-July-2022 ASWAN IBROHIM 1 6 0 5 0 6 4 2 0 8 9 3 0 0 0 2 LAILI YUSUP MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

04-November-
168 21-July-2022 MARZUKI 1 6 0 5 0 6 4 1 0 7 9 0 0 0 0 1 KARMISANTIKA KELURAHAN MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0
1990

169 26-July-2022 SAYUTI ABDULLAH 1 6 0 5 0 6 5 5 0 5 8 9 0 0 0 3 HOPSAH 15-May-1989 MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

23-August-1989
170 29-July-2022 HATMI FAHLEVI 1 6 0 5 0 6 6 3 0 6 8 9 0 0 0 1 ISARMI JUNEVA DESA NAPALLICIN 3 0 0 0 2 0 0 1 1 0 0 0

04-September-
171 30-July-2022 AHMAD RIPAI 1 6 0 5 0 6 4 4 0 9 7 5 0 0 0 1 ROAINI DESA NAPALLICIN 3 0 0 0 2 0 0 1 1 0 0 0
1975
22-December-
172 30-July-2022 ALBAH DADI 1 6 0 5 0 6 2 2 1 2 8 5 0 0 0 2 ETI MARYANI DESA NAPALLICIN 3 0 0 0 2 0 0 1 1 0 0 0
1985
15-August-1992
173 30-July-2022 BRAHIM MUTAZAR 1 6 0 5 0 6 5 5 0 8 9 2 0 0 0 1 UMI PARTIWI DESA NAPALLICIN 3 0 0 0 2 0 0 1 1 0 0 0

28-October-1999
174 30-July-2022 HAZIKA PUTRAMA 1 6 0 5 0 6 6 8 1 0 9 9 0 0 0 2 JAMIATUL KHOIRIAH DESA NAPALLICIN 3 0 0 0 2 0 0 1 1 0 0 0

08-August-2022
175 1 6 0 5 0 6 6 5 5 0 4 9 3 0 0 0 NELI ASMARA 15-April-1993 KELURAHAN MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

08-August-2022
176 AHMADI 1 6 1 3 0 7 4 2 0 5 9 3 0 0 0 1 SUKARIA 02-May-1993 MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

08-August-2022
177 ANHAR 1 6 0 5 0 6 4 3 0 4 9 0 0 0 0 4 YUSMAR 25-May-1988 MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

08-August-2022
178 EFENDI 1 6 0 5 0 6 4 5 0 3 8 6 0 0 0 1 MINARNI 06-March-1985 KELURAHAN MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

08-August-2022
179 HASAN MURNI 1 6 0 5 0 6 6 7 0 4 8 8 0 0 0 1 PARDIAN 27-April-1988 MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

08-August-2022 04-November-
180 MARZUKI 1 6 0 5 0 6 4 1 0 7 9 0 0 0 0 1 KARMISANTIKA KELURAHAN MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0
1990
08-August-2022 19-August-1979
181 ZULKIPLI 1 6 0 5 0 6 5 9 0 8 7 9 0 0 0 1 MARNILA KELURAHAN MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

11-August-2022 25-October-1988
182 ABU BAKAR 1 6 0 5 0 6 5 0 0 4 8 8 0 0 0 2 ELLIZA MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

14-August-2022
183 1 6 0 5 0 6 5 7 0 4 8 8 0 0 0 1 HASANAH 17-April-1988 KELURAHAN MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

14-August-2022 01-October-1986
184 AHMAD 1 6 0 5 0 6 4 1 0 7 8 6 0 0 0 8 SUMMAINI KELURAHAN MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

14-August-2022 11-September-
185 ALIPIAH 1 6 0 5 0 6 5 1 0 9 8 5 0 0 0 1 YURNIMA KELURAHAN MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0
1985
14-August-2022 01-October-2002
186 ARIANTO 1 6 1 3 0 7 0 1 0 1 0 2 0 0 0 2 EKA ARDILA KELURAHAN MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

14-August-2022
187 HALIM 1 6 0 5 0 6 2 5 0 7 2 0 0 0 1 SERI DEPI 25-July-2000 KELURAHAN MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

14-August-2022 06-November-
188 HERMAN 1 6 0 5 0 6 4 6 1 1 8 0 0 0 0 1 HALIMAH MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0
1980
14-August-2022
189 IBNU HAJAR 1 6 0 5 0 6 4 6 0 7 9 4 0 0 0 2 LIKA HIZATUL IZMI 06-July-1994 KELURAHAN MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

14-August-2022 20-January-1977
190 M.DAUD 1 6 0 5 0 6 6 0 0 1 7 7 0 0 0 1 HODIJAH MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

14-August-2022 30-January-2001
191 MULYADI 1 6 1 3 0 7 7 6 0 1 0 1 0 0 0 1 MIRA HANTATI KELURAHAN MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

14-August-2022
192 RIDUAN 1 6 0 5 0 6 1 1 8 1 1 8 6 0 0 3 HAMIDAH 03-July-1987 KELURAHAN MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

14-August-2022 12-December-
193 SOPIYAN 1 6 0 5 0 6 5 2 1 2 9 7 0 0 0 1 DESMI HARTATI MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0
1997
27-August-2022
194 BURNIAT 1 6 0 5 0 6 4 6 0 4 7 7 0 0 0 1 SULASTRI 18-April-1981 MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

29-August-2022
195 ARDAD IBROHIM 1 6 0 5 0 6 5 0 9 7 8 0 0 0 0 1 NURAINI IBDULLAH 10-July-1980 MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

29-August-2022 02-August-2002
196 ZULYA HABIBI 1 6 0 5 0 6 6 4 2 0 8 0 2 0 0 1 JUS AMMA MUARA KULAM 3 0 0 0 2 0 0 1 1 0 0 0

08-August-2022 20-February-
197 M.SOLEH 1 6 0 5 0 6 6 0 0 2 9 2 0 0 0 1 MIFTAHUL JANNAH MUARA KULAM 3 0 0 0 0 0 1 1 0 0 0
1992
08-January-2022
198 SURYANTO 1 6 0 5 0 6 4 1 0 7 8 9 0 0 1 4 MIRNA WATI 01-July-1989 MUARA KULAM 3 0 0 0 4 1 0 0 1 0 0 0
 11-January-2022 27-October-2000
199 INDRA ADI KUSUMA 1 6 0 5 0 6 4 1 0 7 0 1 0 0 0 1 MURSIDA KELURAHAN MUARA KULAM 3 0 0 0 4 0 0 1 1 0 0 0

27-February-
200 13-March-2022 ABDUL MUTHOLIB 1 6 0 5 0 6 6 7 0 2 8 4 0 0 0 1 KALMI MUARA KULAM 3 0 0 0 4 0 0 1 1 0 0 0
1984
12-February-
201 17-March-2022 AHMAD BUJIL 1 6 0 5 0 6 5 2 0 2 6 9 0 0 0 2 MARDIAH MUARA KULAM 3 0 0 0 4 0 0 1 1 0 0 0
1969
04-November-
202 07-April-2022 MARZUKI 1 6 0 5 0 6 4 1 0 7 9 0 0 0 0 1 KARMISANTIKA KELURAHAN MUARA KULAM 3 0 0 0 0 0 1 1 0 0 0
1990
18-November-
203 14-April-2022 ridwan 1 6 0 5 0 6 1 1 8 1 8 6 0 0 0 3 Hamidah KELURAHAN MUARA KULAM 3 0 0 0 4 0 0 1 1 0 0 0
19986
27-February-
204 17-April-2022 ABDUL MUTHOLIB 1 6 0 5 0 6 6 7 0 2 8 4 0 0 0 1 KALMI MUARA KULAM 3 0 0 0 4 0 0 1 1 0 0 0
1984
12-February-
205 17-April-2022 AHMAD BUJIL 1 6 0 5 0 6 5 2 0 2 6 9 0 0 0 2 MARDIAH MUARA KULAM 3 0 0 0 4 0 0 1 1 0 0 0
1969
17-October-1977
206 21-April-2022 ELVIS CHANDRA 1 6 0 5 0 6 5 7 1 0 7 7 0 0 0 3 TOYYIBA OKTORIA KELURAHAN MUARA KULAM 3 0 0 0 6 0 0 1 1 0 0 0

207 15-June-2022 HAJAR BUSTOMI 1 6 0 5 0 6 5 6 0 7 8 2 0 0 0 1 YUR PIKA 16-July-1982 MUARA KULAM 2 1 0 0 8 0 0 1 1 0 0 1

1. Petugas Entri Lamp.R/I/KB/20
Data LAMPIRAN R/I/KB/20 Lembar 8

1 2 3 4 5 V
1 6 1 3 0 0 8 Bulan : 2022
NAMA FASKES/ puskesmas muara kulam 7 8 9 10 11 12
:
JARINGAN/JEJARING Kode Provinsi Kode No. Register Faskes No. Jaringan/
Kabupaten/ Jejaring Faskes
Kota

RINGKASAN HASIL PELAYANAN KB

PESERTA KB BARU (PB) PESERTA KB ULANGAN PELAYANAN KASUS

PEMBERIAN
PEMBERIAN INFORMED PB DAN KESERTAAN JKN INFORMED CONSENT
METODE
NO. CONSENT (Untuk Peserta KB
KONTRASEPSI
(Untuk PB) PB PASCA PB PASCA Ulangan) PELAYANAN ULANG KOMPLIKASI BERAT
GANTI CARA PENCABUTAN KEGAGALAN
PERSALINAN KEGUGURAN
PB JKN PB NON JKN TOTAL PB

1 2 3 4 5 6 7 8 9 10 11 12 13 14

1 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0 0
2 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0 0
3 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0 0
4 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0 0
5 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0 0
6 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0 0
7 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0 0
8 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0 0
9 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0 0
10 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0 0
11 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0 0
12 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0 0
13 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0 0
14 PIL 0 0 0 0 0 0 0 0 1 0 0 0
15 SUNTIKAN 0 0 0 0 0 0 0 0 0 0 0 0
16 SUNTIKAN 0 0 0 0 0 0 0 1 0 0 0 0
17 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0 0
18 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0 0
19 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0 0
20 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0 0
21 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0 0
22 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0 0

JUMLAH 0 0 0 0 2 0 4 4 194 0 0 0

1) Keterangan Kode

STATUS PESERTA KB KODE JENIS ALOKON (Diisi Pada Jenis Tindakan dan Kasus)
1 : Peserta KB Baru 3 : Peserta KB Ulangan 1 : Suntikan 1 Bulanan 3 : Suntikan 3 Bulanan 5 : Pil Progestin 7 : Implan 1 Batang 9 : IUD 11 : Tubektomi
2 : Peserta KB Ganti 4 : Komplikasi 2 : Suntikan 3 Bulanan 4 : Pil Kombinasi 6 : Kondom 8 : Implan 2 Batang 10 : Vasektomi

2) SELAIN STATUS PESERTA KB, JENIS TINDAKAN DAN KASUS DIISI TANDA CENTANG (V)

Musi Rawas Utara, 09-July-2022

Pimpinan Faskes KB/Jaringan/Jejaring*

Umi rahmah, Am.Keb

( .................................................................................................)

NIP/NRP
* Coret yang tidak perlu