LAPORAN PENDATAAN SASARAN BIAS 2023

di KABUPATEN LOMBOK TIMUR

PUSKESMAS : SURALAGA (isi kolom yang berwarna kuning)

JUMLAH SASARAN
No NAMA SEKOLAH DESA I II III IV V VI TOTAL I+II+V
L P TOT L P TOT L P TOT L P TOT L P TOT L P TOT L P
1 SDN 1 Anjani Anjani 30 17 47 23 18 41 32 19 51 21 27 48 31 24 55 19 21 40 84 59
2 SDN 2 Anjani Anjani 15 16 31 24 26 50 14 20 34 11 24 35 23 21 44 12 21 33 62 63
3 SDN 3 Anjani Anjani 19 11 30 12 12 24 14 6 20 8 15 23 19 23 42 9 5 14 50 46
4 SDN 4 Anjani Anjani 11 10 21 15 20 35 11 19 30 13 8 21 13 15 28 11 25 36 39 45
5 SDN 5 Anjani Anjani 16 11 27 7 11 18 12 10 22 11 11 22 9 9 18 13 10 23 32 31
6 SDN Gapuk Anjani 9 14 23 10 17 27 10 11 21 20 17 37 16 17 33 17 11 28 35 48
7 MI NW SZ Anjani Anjani 28 14 42 16 11 27 23 11 34 10 5 15 22 8 30 9 8 17 66 33
8 MI NW Anjani Anjani 13 15 28 15 15 30 16 6 22 11 10 21 13 3 16 15 4 19 41 33
9 Home Schooling Inspirasi Anjani 2 1 3 3 2 5 6 3 9 5 1 6 4 5 9 4 4 8 9 8
10 MI NW Majuwet Bintang Rinjani 7 11 18 9 13 22 8 14 22 13 8 21 9 11 20 14 15 29 25 35
11 SDI AL-Birruni Bintang Rinjani 6 11 17 6 7 13 10 13 23 6 5 11 6 7 13 6 10 16 18 25
12 SDN 1 Suralaga Suralaga 16 10 26 9 5 14 3 12 15 22 12 34 13 14 27 12 8 20 38 29
13 SDN 2 Suralaga Suralaga 6 2 8 8 4 12 13 9 22 5 3 8 14 8 22 7 12 19 28 14
14 SDN 3 Suralaga Suralaga 4 4 8 8 15 23 11 10 21 2 5 7 7 3 10 6 3 9 19 22
15 SDN 4 Suralaga Suralaga 4 5 9 4 3 7 1 3 4 10 3 13 8 7 15 4 5 9 16 15
16 SDIT Assunnah Assalafiyah Suralaga 46 32 78 39 34 73 25 34 59 33 23 56 32 29 61 40 34 74 117 95
17 SDIT An-nur Suralaga Suralaga 12 14 26 12 11 23 15 18 33 12 15 27 15 13 28 11 12 23 39 38
18 MI AL-Istiqomah Suralaga 14 17 31 12 10 22 13 16 29 15 15 30 13 20 33 9 12 21 39 47
19 MI TGH MUH. Shadruddin NW Suralaga Suralaga 7 10 17 16 12 28 17 13 30 15 15 30 10 6 16 7 11 18 33 28
20 SDN 1 Tumbuh Mulia Tumbuh Mulia 1 8 9 1 5 6 8 10 18 5 3 8 8 6 14 10 5 15 10 19
21 MI Nurul Huda NW Gegurun Tumbuh Mulia 7 9 16 10 10 20 9 7 16 7 9 16 11 8 19 12 6 18 28 27
22 MI NW 1 Boro' tumbuh Tumbuh Mulia 16 15 31 12 15 27 16 14 30 9 6 15 11 12 23 15 10 25 39 42
23 SDN 1 Bagik Payung Bagik Payung 8 2 10 14 9 23 19 12 31 11 10 21 9 11 20 16 15 31 31 22
24 SDN 2 Bagik Payung Bagik Payung 20 8 28 20 13 33 11 10 21 7 6 13 16 9 25 9 14 23 56 30
25 SDN 2 Waringin Bagik Payung 3 10 13 11 15 26 11 16 27 13 16 29 15 18 33 17 18 35 29 43
26 SDIT IBNU ABBAS Bagik Payung 13 8 21 5 11 16 6 6 12 0 18 19
27 MI NW 2 Bagik Payung Bagik Payung 4 11 15 11 8 19 6 8 14 10 8 18 12 8 20 7 7 14 27 27
JUMLAH - 337 296 633 332 332 664 340 330 670 305 280 585 359 315 674 311 306 617 1,028 943

Mengetahui
Kepala UPT BLUD Puskesmas Suralaga Yang Melapor
Pengelola Program Imunisasi

HAYADIN, S. Kep Nurhasanah, A.Md.,Kep

NIP. 19681231 198903 1 087 NIP. 19790823 200604 2 011
TOTAL I+II+V TOT (I-VI) KET
TOT L P TOT
143 156 126 282
125 99 128 227
96 81 72 153
84 74 97 171
63 68 62 130
83 82 87 169
99 108 57 165
74 83 53 136
17 24 16 40
60 60 72 132
43 40 53 93
67 75 61 136
42 53 38 91
41 38 40 78
31 31 26 57
212 215 186 401
77 77 83 160
86 76 90 166
61 72 67 139
29 33 37 70
55 56 49 105
81 79 72 151
53 77 59 136
86 83 60 143
72 70 93 163
37 24 25 49
54 50 50 100
1,971 1,984 1,859 3,843
AMPRAHAN KEBUTUHAN VAKSIN DAN LOGISTIK IMUNISASI ANAK SEKOLAH ( BIAS ) TAHUN 2023
di KABUPATEN LOMBOK TIMUR PUSK :

JUMLAH SASARAN KEBUTUHAN

No NAMA SEKOLAH I II V TOTAL II + V VAKSIN LOGISTIK SAFETY BOX
L P TOT L P TOT L P TOT L P TOT MR DT Td HPV 0.5 5 2.5 L 5L
1 SDN 1 Anjani 30 17 47 23 18 41 31 24 55 54 42 96 5 5 11 24 214 5 4 2
2 SDN 2 Anjani 15 16 31 24 26 50 23 21 44 47 47 94 3 3 10 21 177 3 4 2
3 SDN 3 Anjani 19 11 30 12 12 24 19 23 42 31 35 66 3 3 7 23 149 3 3 2
4 SDN 4 Anjani 11 10 21 15 20 35 13 15 28 28 35 63 2 2 7 15 120 2 2 1
5 SDN 5 Anjani 16 11 27 7 11 18 9 9 18 16 20 36 3 3 4 9 99 3 2 1
6 SDN Gapuk 9 14 23 10 17 27 16 17 33 26 34 60 3 3 7 17 123 3 3 1
7 MI NW SZ Anjani 28 14 42 16 11 27 22 8 30 38 19 57 5 5 6 8 149 5 3 2
8 MI NW Anjani 13 15 28 15 15 30 13 3 16 28 18 46 3 3 5 3 105 3 2 1
9 Home Schooling Inspir 2 1 3 3 2 5 4 5 9 7 7 14 0 0 2 5 25 0 1 0
10 MI NW Majuwet 7 11 18 9 13 22 9 11 20 18 24 42 2 2 5 11 89 2 2 1
11 SDI AL-Birruni 6 11 17 6 7 13 6 7 13 12 14 26 2 2 3 7 67 2 1 1
12 SDN 1 Suralaga 16 10 26 9 5 14 13 14 27 22 19 41 3 3 5 14 107 3 2 1
13 SDN 2 Suralaga 6 2 8 8 4 12 14 8 22 22 12 34 1 1 4 8 58 1 1 1
14 SDN 3 Suralaga 4 4 8 8 15 23 7 3 10 15 18 33 1 1 4 3 52 1 1 1
15 SDN 4 Suralaga 4 5 9 4 3 7 8 7 15 12 10 22 1 1 2 7 47 1 1 0
16 SDIT Assunnah Assalaf 46 32 78 39 34 73 32 29 61 71 63 134 9 9 15 29 319 9 7 3
17 SDIT An-nur Suralaga 12 14 26 12 11 23 15 13 28 27 24 51 3 3 6 13 116 3 2 1
18 MI AL-Istiqomah 14 17 31 12 10 22 13 20 33 25 30 55 3 3 6 20 137 3 3 1
19 MI TGH MUH. Shadrud 7 10 17 16 12 28 10 6 16 26 18 44 2 2 5 6 84 2 2 1
20 SDN 1 Tumbuh Mulia 1 8 9 1 5 6 8 6 14 9 11 20 1 1 2 6 44 1 1 0
21 MI Nurul Huda NW Ge 7 9 16 10 10 20 11 8 19 21 18 39 2 2 4 8 79 2 2 1
22 MI NW 1 Boro' tumbu 16 15 31 12 15 27 11 12 23 23 27 50 3 3 6 12 124 3 3 1
23 SDN 1 Bagik Payung 8 2 10 14 9 23 9 11 20 23 20 43 1 1 5 11 74 1 2 1
24 SDN 2 Bagik Payung 20 8 28 20 13 33 16 9 25 36 22 58 3 3 6 9 123 3 3 1
25 SDN 2 Waringin 3 10 13 11 15 26 15 18 33 26 33 59 1 1 7 18 103 1 2 1
26 SDIT IBNU ABBAS 13 8 21 5 11 16 0 0 0 5 11 16 2 2 2 0 58 2 1 1
27 MI NW 2 Bagik Payung 4 11 15 11 8 19 12 8 20 23 16 39 2 2 4 8 77 2 2 1
JUMLAH 337 296 633 332 332 664 359 315 674 691 647 1,338 70 70 149 2,919 70 60 30

Mengetahui
Kepala UPT BLUD Puskesmas Suralaga Yang Melapor
PENGELOLA COLDCHAIN/FARMASI

HAYADIN, S. Kep Nurhasanah, A.Md.,Kep

NIP. 19681231 198903 1 087 NIP. 19790823 200604 2 011
LAPORAN HASIL PELAKSANAAN BIAS
di KABUPATEN LOMBOK TIMUR TAHUN 2023
PUSKESMAS : SURALAGA

SASARAN

NO. NAMA SEKOLAH KELAS 1 KELAS 2 KELAS 5 KELAS 2+5 TOTAL 1+2+5

L P TOT L P TOT L P TOT L P TOT L P TOT

1 SDN 1 Anjani 30 17 47 23 18 41 31 24 55 54 42 96 84 59 143
2 SDN 2 Anjani 15 16 31 24 26 50 23 21 44 47 47 94 62 63 125
3 SDN 3 Anjani 19 11 30 12 12 24 19 23 42 31 35 66 50 46 96
4 SDN 4 Anjani 11 10 21 15 20 35 13 15 28 28 35 63 39 45 84
5 SDN 5 Anjani 16 11 27 7 11 18 9 9 18 16 20 36 32 31 63
6 SDN Gapuk 9 14 23 10 17 27 16 17 33 26 34 60 35 48 83
7 MI NW SZ Anjani 28 14 42 16 11 27 22 8 30 38 19 57 66 33 99
8 MI NW Anjani 13 15 28 15 15 30 13 3 16 28 18 46 41 33 74
9 Home Schooling Inspiras 2 1 3 3 2 5 4 5 9 7 7 14 9 8 17
10 MI NW Majuwet 7 11 18 9 13 22 9 11 20 18 24 42 25 35 60
11 SDI AL-Birruni 6 11 17 6 7 13 6 7 13 12 14 26 18 25 43
12 SDN 1 Suralaga 16 10 26 9 5 14 13 14 27 22 19 41 38 29 67
13 SDN 2 Suralaga 6 2 8 8 4 12 14 8 22 22 12 34 28 14 42
14 SDN 3 Suralaga 4 4 8 8 15 23 7 3 10 15 18 33 19 22 41
15 SDN 4 Suralaga 4 5 9 4 3 7 8 7 15 12 10 22 16 15 31
16 SDIT Assunnah Assalafiy 46 32 78 39 34 73 32 29 61 71 63 134 117 95 212
17 SDIT An-nur Suralaga 12 14 26 12 11 23 15 13 28 27 24 51 39 38 77
18 MI AL-Istiqomah 14 17 31 12 10 22 13 20 33 25 30 55 39 47 86
19 MI TGH MUH. Shadruddi 7 10 17 16 12 28 10 6 16 26 18 44 33 28 61
20 SDN 1 Tumbuh Mulia 1 8 9 1 5 6 8 6 14 9 11 20 10 19 29
21 MI Nurul Huda NW Gegu 7 9 16 10 10 20 11 8 19 21 18 39 28 27 55
22 MI NW 1 Boro' tumbuh 16 15 31 12 15 27 11 12 23 23 27 50 39 42 81
23 SDN 1 Bagik Payung 8 2 10 14 9 23 9 11 20 23 20 43 31 22 53
24 SDN 2 Bagik Payung 20 8 28 20 13 33 16 9 25 36 22 58 56 30 86
25 SDN 2 Waringin 3 10 13 11 15 26 15 18 33 26 33 59 29 43 72
26 SDIT IBNU ABBAS 13 8 21 5 11 16 0 0 0 5 11 16 18 19 37
27 MI NW 2 Bagik Payung 4 11 15 11 8 19 12 8 20 23 16 39 27 27 54

JUMLAH 337 296 633 332 332 664 359 315 674 691 647 1,338 1,028 943 1,971

Mengetahui Yang Melapor

Kepala UPT BLUD Puskesmas Suralaga PENGELOLA PROGRAM IMUNISASI

HAYADIN, S. Kep Nurhasanah, A.Md,.Kep

NIP. 19681231 198903 1 087 NIP. 19790823 200604 2 011
LAPORAN HASIL PELAKSANAAN BIAS
di KABUPATEN LOMBOK TIMUR TAHUN 2023
PUSKESMAS (isi kolom yang berwarna kuning) (isi kolom yang berwarna kuning)

CAKUPAN PEMAKAIAN VAKSIN

ADS
NO. NAMA SEKOLAH
MR DT Td HPV JUMLAH VIAL TERPAKAI IP SAFETY
KELAS 1 KELAS 1 KELAS 2 KELAS 5 KELAS 2+5 KELAS 5 BOX
MR DT Td HPV MR DT Td HPV 0.5 5
L P TOT % L P TOT % L P TOT % L P TOT % L P TOT % P %
1 SDN 1 Anjani 0 0 0 0 0 0 0 0 0 0 0 0 0 #DIV/0! #DIV/0! #DIV/0! #DIV/0! 0 0 0
2 SDN 2 Anjani 0 0 0 0 0 0 0 0 0 0 0 0 0 #DIV/0! #DIV/0! #DIV/0! #DIV/0! 0 0 0
3 SDN 3 Anjani 0 0 0 0 0 0 0 0 0 0 0 0 0 #DIV/0! #DIV/0! #DIV/0! #DIV/0! 0 0 0
4 SDN 4 Anjani 0 0 0 0 0 0 0 0 0 0 0 0 0 #DIV/0! #DIV/0! #DIV/0! #DIV/0! 0 0 0
5 SDN 5 Anjani 0 0 0 0 0 0 0 0 0 0 0 0 0 #DIV/0! #DIV/0! #DIV/0! #DIV/0! 0 0 0
6 SDN Gapuk 0 0 0 0 0 0 0 0 0 0 0 0 0 #DIV/0! #DIV/0! #DIV/0! #DIV/0! 0 0 0
7 MI NW SZ Anjani 0 0 0 0 0 0 0 0 0 0 0 0 0 #DIV/0! #DIV/0! #DIV/0! #DIV/0! 0 0 0
8 MI NW Anjani 0 0 0 0 0 0 0 0 0 0 0 0 0 #DIV/0! #DIV/0! #DIV/0! #DIV/0! 0 0 0
9 Home Schooling Inspiras 0 0 0 0 0 0 0 0 0 0 0 0 0 #DIV/0! #DIV/0! #DIV/0! #DIV/0! 0 0 0
10 MI NW Majuwet 0 0 0 0 0 0 0 0 0 0 0 0 0 #DIV/0! #DIV/0! #DIV/0! #DIV/0! 0 0 0
11 SDI AL-Birruni 0 0 0 0 0 0 0 0 0 0 0 0 0 #DIV/0! #DIV/0! #DIV/0! #DIV/0! 0 0 0
12 SDN 1 Suralaga 0 0 0 0 0 0 0 0 0 0 0 0 0 #DIV/0! #DIV/0! #DIV/0! #DIV/0! 0 0 0
13 SDN 2 Suralaga 0 0 0 0 0 0 0 0 0 0 0 0 0 #DIV/0! #DIV/0! #DIV/0! #DIV/0! 0 0 0
14 SDN 3 Suralaga 0 0 0 0 0 0 0 0 0 0 0 0 0 #DIV/0! #DIV/0! #DIV/0! #DIV/0! 0 0 0
15 SDN 4 Suralaga 0 0 0 0 0 0 0 0 0 0 0 0 0 #DIV/0! #DIV/0! #DIV/0! #DIV/0! 0 0 0
16 SDIT Assunnah Assalafiy 0 0 0 0 0 0 0 0 0 0 0 0 0 #DIV/0! #DIV/0! #DIV/0! #DIV/0! 0 0 0
17 SDIT An-nur Suralaga 0 0 0 0 0 0 0 0 0 0 0 0 0 #DIV/0! #DIV/0! #DIV/0! #DIV/0! 0 0 0
18 MI AL-Istiqomah 0 0 0 0 0 0 0 0 0 0 0 0 0 #DIV/0! #DIV/0! #DIV/0! #DIV/0! 0 0 0
19 MI TGH MUH. Shadruddi 0 0 0 0 0 0 0 0 0 0 0 0 0 #DIV/0! #DIV/0! #DIV/0! #DIV/0! 0 0 0
20 SDN 1 Tumbuh Mulia 0 0 0 0 0 0 0 0 0 0 0 0 0 #DIV/0! #DIV/0! #DIV/0! #DIV/0! 0 0 0
21 MI Nurul Huda NW Gegu 0 0 0 0 0 0 0 0 0 0 0 0 0 #DIV/0! #DIV/0! #DIV/0! #DIV/0! 0 0 0
22 MI NW 1 Boro' tumbuh 0 0 0 0 0 0 0 0 0 0 0 0 0 #DIV/0! #DIV/0! #DIV/0! #DIV/0! 0 0 0
23 SDN 1 Bagik Payung 0 0 0 0 0 0 0 0 0 0 0 0 0 #DIV/0! #DIV/0! #DIV/0! #DIV/0! 0 0 0
24 SDN 2 Bagik Payung 0 0 0 0 0 0 0 0 0 0 0 0 0 #DIV/0! #DIV/0! #DIV/0! #DIV/0! 0 0 0
25 SDN 2 Waringin 0 0 0 0.0 0 0 0 0 0 0 0 0 0 #DIV/0! #DIV/0! #DIV/0! #DIV/0! 0 0 0
26 SDIT IBNU ABBAS 0 0 0 0 0 0 0 #DIV/0! 0 0 0 0 #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! 0 0 0
27 MI NW 2 Bagik Payung 0 0 0 0 0 0 0 0 0 0 0 0 0 #DIV/0! #DIV/0! #DIV/0! #DIV/0! 0 0 0
JUMLAH - - - 0 - - - 0 - - - 0 - - - 0 - - - 0 - 0 - - - - #DIV/0! #DIV/0! #DIV/0! #DIV/0! - - -
 FORMAT PENCATATAN HASIL BIAS (BULAN IMUNISASI ANAK SEKOLAH)
DI UNIT PELAYANAN
KABUPATEN :
PUSKESMAS :
NAMA SD/MI : TANGGAL PELAKSANAAN :

TANGGAL IMUNISASI
UMUR
NO NAMA MURID (THN) NAMA ORANG TUA
KELAS I KELAS II KELAS V
CAMPAK DT Td Td HPV
1 2 4 5 6 7 8 9
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
Mengetahui
Kepala SD/MI___________________ PETUGAS

_______________________________ _______________________________
NIP. NIP.
)

KET
KELAS VI
HPV
10

GAS

_______________
890,511