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LAPORAN BULANAN IMUNISASI BAYI

POSYANDU MAWAR

Imunisasi yang diberikan


No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang
1 Kharisma Ramadhani Kunaenah/Saprudin P 5-9-2009 1/I 7-9-2009 16-9-2009 16-11-2009 8-12-2009 7-1-2010 6-11-2009 7-1-2010 9-2-2010 9-3-2010 5-7-2010

Imunisasi yang diberikan


No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang
1 Aurora Ruth Agustine Prahesti/Eko Raharjo P 12-8-2010 1/I 12-8-2010 20-9-2010 18-10-2010 17-1-2011 28-2-2011 20-9-2010 18-10-2010 17-1-2011 28-2-2011 9-5-2011

Imunisasi yang diberikan


No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang
1 Mesya Kusdayani Endang/Saefudin P 7-1-2011 3/I
2 Helmi Kusni/Tomi L 5-2-2011 3/I
3 Lutfatul Latifah Eka A/ Sahroni P 6-2-2011 3/I
4 Febriansyah Warsiyah/Tolit L 26-2-2011 3/I
5 Dzakaria N.Salfa Selfi/Nurcholis P 3-3-2011 1/I
6 Nizam Nur/Tarzan L 3-4-2011 3/I
7 Eren Ning/Rina L 31-4-2011 5/I
8 Naya Azahra Sunanto/Puryanah P 6-5-2011 3/I
9 M.Khaerul Anam Mayasuri/sainsuri L 2-6-2011 1/I
10 Naya Puryanah P 5-6-2011 3/I 8-7-2014*
11 Dodi Roilah/Karim L 10-6-2011 3/I
12 Galuh Pragita Sri S/Sopari L 16-6-2011 3/I
13 Sulfa Ayuningtyas Hartati/Hartoyo P 21-6-2011 3/I
14 Rafi Fadhil Musniati/Iwan L 1-7-2011 3/I
15 M.Rafa Rapikah/Joko L 7-7-2011 3/I
16 Nadia Jaetun/Taryono P 3-8-2011 3/I
17 Aulia Asih/Sunarso P 6-8-2011 3/I
18 Naila Kmariyah/Zaenudin P 22-9-2011 1/I
19 Kranda Devin A Laila/Dodi P 19-11-2011 1/I
20 Natasya Sarti P 21-11-2011 3/I 8-7-2014*
21 Anidya Sukirno/Diyah Ayu P 25-12-2011 3/I
22 Nazril Maulana Ali syafei/Darwati L 30-11-2011 3/I

Imunisasi yang diberikan


No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang
1 Faiz Deni S Darti/Darta L 8-1-2012 3/I 9-4-2012 14-5-2012 19-6-2012 9-8-2012 9-4-2012 14-5-2012 19-6-2012 9-8-2012 5-12-2012 8-7-2014*
2 Muh.Izam Maulana Turipah/Hasanudin L 16-1-2012 5/I 16-1-2012 20-1-2012 27-3-2012 27-4-2012 2-6-2012 20-1-2012 27-3-2012 27-4-2012 2-6-2012 29-10-2012 8-7-2014*
3 Lukman Tunaesih/Sukyat L 31-1-2012 3/I 1-2-2012 22-2-2012 5-4-2012 5-5-2012 V 22-2-2012 5-4-2012 5-5-2012 V 21-11-2012
4 Aisyah Safa A Lili N/Sodikin P 8-2-2012 3/I 9-2-2012 20-2-2012 3-4-2012 8-5-2013 5-7-2013 20-2-2012 3-4-2012 8-5-2013 5-7-2013 12-11-2012 8-7-2014*
5 M.Khizam Al Farizqi Sunengsih/Agus L 20-2-2012 3/I 23-2-2012 7-3-2012 V V V 7-3-2012 V V V V
6 Wilda Aulia Widyaningrum/Khaerudin P 3-4-2012 1/I 3-4-2012 10-4-2012 19-12-2012 21-1-2013 21-2-2013 10-4-2012 19-12-2012 21-1-2013 21-2-2013 6-3-2013
7 Anesa Arsya Nurkhaya Korisah/Ahmad Aridi P 11-5-2012 5/I 11-5-2012 16-5-2012 15-6-2012 17-7-2012 16-8-2012 16-5-2012 15-6-2012 17-7-2012 16-8-2012 4-3-2013 8-7-2014*
8 Cinta Sefiana A Evi Fitria/Adi Sucipto P 12-5-2012 1/I 12-5-2012 18-6-2012 18-7-2012 16-8-2012 19-9-2012 18-6-2012 18-7-2012 16-8-2012 19-9-2012 18-2-2013
9 Sela Purin H Ririn/Ipung P 13-6-2012 3/I 10-7-2012 7-8-2012 4-9-2012 18-10-2012 10-7-2012 7-8-2012 4-9-2012 18-10-2012 1-4-2013 8-7-2014*
10 Gisel Regina Kasmini/Imam P 20-7-2012 3/I 20-7-2012 10-8-2012 20-9-2012 20-10-2012 20-11-2012 10-8-2012 20-9-2012 20-10-2012 20-11-2012 10-4-2013 8-7-2014*
11 Moh.Rizky Roshar Saputra Sri Sugiarti/Rokhasid L 30-9-2012 3/I 30-9-2012 19-11-2012 4-12-2012 4-1-2013 4-2-2013 19-11-2012 4-12-2012 4-1-2013 4-2-2013 8-7-2013 8-7-2014* 25-8-2015#
12 Nasril Anam Witriyani/Teguh L 18-10-2012 3/I 18-10-2012 19-11-2012 14-1-2013 4-3-2013 6-4-2013 19-11-2012 14-1-2013 4-3-2013 6-4-2013 5-8-2013 8-7-2014* 25-8-2015#
13 Rahma Aliyah Nikmatul/Sentot L 30-10-2012 1/I 1-11-2012 20-11-2012 6-1-2013 5-2-2013 6-3-2013 20-11-2012 6-1-2013 5-2-2013 6-3-2013 5-8-2013 19-8-2015#
14 Windiana Wulandari Putri Apriliyani/Ramin P 29-12-2012 1 /I 29-12-2012 9-1-2013 4-3-2013 22-4-2013 23-5-2012 8-1-2013 4-3-2013 22-4-2013 23-5-2012 16-12-2013 8-7-2014*
Imunisasi yang diberikan
No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang
Aruma Sashi Eka S/Agus T P 15-1-2013 1/I 15-1-2013 6-4-2013 16-5-2013 16-6-2013 16-7-2013 6-4-2013 16-5-2013 16-6-2013 16-7-2013 15-11-2013 PINDAH
1 Ahmad Zaenunal Toipah/Muslihin L 18-1-2013 3/I 18-1-2013 24-4-2013 22-5-2013 20-6-2013 22-7-2013 24-4-2013 22-5-2013 20-6-2013 22-7-2013 11-12-2013 MENOLAK
2 Azyla Zahra Fitriani Fitri/Rohani P 29-1-2013 1/I 29-1-2013 1-4-2013 1-4-2013 27-5-2013 26-7-2013 6-2-2013 1-4-2013 27-5-2013 26-7-2013 Dr
Beni Marselemora Janah L 6-3-2013 3/I TAMU 11-12-2013
3 Casay Dewa Arta Trima Wati/Sanudin L 2-4-2013 1/I 2-4-2013 22-4-2013 10-6-2013 17-7-2013 19-8-2013 22-4-2013 10-6-2013 17-7-2013 18-9-2013 3-3-2014* 6-6-2015# 19-8-2015# RSUK(2,6)
4 Chaerul Anam Nurlela/Supriyadi L 10-4-2013 3/I 10-4-2013 10-4-2013 11-6-2013 12-7-2013 17-8-2013 10-4-2013 11-6-2013 12-7-2013 17-8-2013 MENOLAK Bd.F(3,0)
5 Aprilia Shafira Yasmin Endang Mulyati/Waudi P 19-4-2013 1/I 19-4-2013 10-5-2013 21-6-2013 23-7-2013 30-8-2013 10-5-2013 21-6-2013 23-7-2013 30-8-2013 3-3-2014* 6-6-2015# 19-8-2015# Bd.F(2,9)
6 Al Iqro Aditia Risky Rastini/Adimun L 15-4-2013 3/I 15-4-2013 20-5-2013 17-6-2013 22-7-2013 22-8-2013 20-5-2013 17-6-2013 22-7-2013 22-8-2013 20-4-2014* 25-8-2015# Bd.F(3,5)
7 Deandra Widia Uti/Zaenal P 26-4-2013 3/I 28-4-2013 8-5-2013 26-6-2013 29-7-2013 31-8-2013 8-5-2013 26-6-2013 29-7-2013 31-8-2013 3-2-2014* Bd.E(3,5)
8 Khaerul Anam Albus Rodiah/Dikron L 28-4-2013 1/I 28-4-2013 15-7-2013 10-9-2013 12-10-2013 27-9-2014* 15-7-2013 10-9-2013 27-9-2014* MENOLAK RSIAKI
9 Aldi Nazoroni Rita/Warsam L 17-5-2013 1/I 17-5-2013 29-5-2013 20-6-2013 20-7-2013 21-8-2013 29-5-2013 20-6-2013 20-7-2013 21-8-2013 11-12-2014* RB.Khr(3,5)
10 Ainun Niswatunnisa Wariyah/Abdul P 10-6-2013 1/I 10-6-2013 25-6-2013 25-8-2013 24-9-2013 14-10-2013 25-6-2013 25-8-2013 24-9-2013 14-10-2013 19-3-2014* 9-12-2014 1-7-2015# RB.Rhm(3,1)
11 Rafit Sriyati/Yudi L 1-7-2013 1/I 2-7-2013 10-7-2013 1-9-2013 3-10-2013 2-11-2013 10-7-2013 1-9-2013 3-10-2013 2-11-2013 16-6-2014* 19-8-2015# Bd.E(2,8)
12 Bilqis Istiqoh Nul A Masruchah/Herman P 12-7-2013 3/I 12-7-2013 21-8-2013 12-9-2013 16-10-2013 18-11-2013 21-8-2013 12-9-2013 16-10-2013 18-11-2013* 4-4-2014* 25-8-2015# Bd.E(2,7)
13 Amanda Putia Nurkalimah/Rizki P 16-8-2013 3/I 16-8-2013 10-9-2013 16-10-2013 16-11-2013 19-12-2013 10-9-2013 16-10-2013 16-11-2013 19-12-2013 20-12-2014* Bd.F2,9)
Bahtiar Riswinawa Dwi Saputri/Aris L 16-8-2013 3/I 19-8-2013 20-8-2013 20-10-2013 PINDAH 20-8-2013 20-10-2013 PESLOR Bd.F(3,3)
14 M.Devan Apri Trisnawati/Supriyasoh L 23-8-2013 2/I 23-8-2013 20-9-2013 20-10-2013 23-11-2013 27-12-2013* 20-9-2013 20-10-2013 23-11-2013 27-12-2013* 20-12-2014* 11-6-2015# Bd.F(3,1)
Chaerul Nur Ayati/Khaerul L 30-8-2013 3/I 30-8-2013 PLUS '16-3-2014 RB.Khr(2,1)sc
15 M.Fahri Efi Rokhanah/Darto L 9-9-2013 5/I 10-9-2013 4-10-2013 4-11-2013 4-12-2013 6-1-2014* 4-10-2013 4-11-2013 4-12-2013 6-1-2014* 5-4-2014* 5-1-2016^ RB.Khr(4,2)
16 Iqrom Mustofa Khamal Erni Nurgiarti/Casyudi L 11-10-2013 3/I 11-10-2013 10-11-2013 17-12-2013 19-1-2014* 3-6-2014* 10-11-2013 17-12-2013 19-1-2014* 3-6-2014* 27-9-2014* 11-8-2015# 15-10-2015# Bd.F(3,2)
17 Zidan Nur Diana/Abdul M L 12-10-2013 3/I 12-10-2013 11-12-2013 12-1-2014* 12-2-2014* 17-11-2014* 11-12-2013 12-1-2014* 12-2-2014* 17-11-2014* 10-12-2014* RB.Rhm(3,2)
18 Erisa Azahera St.Rohayah/Edi Santoso P 13-11-2013 3/I 13-11-2013 11-12-2013 21-1-2014* 21-2-2014* 21-3-2014* 11-12-2013 21-1-2014* 21-2-2014* 21-3-2014* 17-9-2014* 6-6-2015# Bd.E(2,9)
Linda Ayu/Risdianto L 29-11-2013 5/I 29-11-2013 PINDAH RB.Rhm(3,35)
Anik Rahmawati/Susanto L 22-11-2013 3/I 22-11-2013 PINDAH RSI(3,6)
19 Anindita Kesya Zahra Tuti/Kirno P 13-11-2013 3/I 13-11-2013 20-11-2014 20-2-2014P* 20-3-2014P* 20-5-2014P* 20-11-2014 20-2-2014* 20-3-2014* 20-5-2014* 20-10-2014* RB.Khr(sc)
20 Zyonino Al Baasith Wahyuningsih/Karyono L 20-11-2013 3/I POSY.MLT 13-1-2014 13-2-2014P* 7-4-2014P* 5-5-2014P* 13-1-2014 13-2-2014* 7-4-2014* 5-5-2014* 15-10-2015# Bd.Las
Ibras Elzaro Ela Y L 22-12-2013 3/I 5-2-2014* 25-2-2014* 25-4-2014* 5-2-2014* 25-2-2014* 25-4-2014* TIDAK ADA

Imunisasi yang diberikan 15-10-15


No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak 12-11-15
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang
1 Daffa Ibnu Windi Dwi/Kuswondo(1/) L 15-1-2014 1/I 16-1-2014 12-2-2014 15-3-2014P 15-4-2014P 14-5-2014P 12-2-2014 15-3-2014 15-4-2014 14-5-2014 5-1-2015# Bd.E(2,6)
2 Aina Talita Zahra Khodijah/Roni Paslah(4/) P 12-2-2014 5/I 12-2-2014 17-2-2014 14-4-2014P 12-6-2014P 13-7-2014P 17-2-2014 14-4-2014 12-6-2014 13-7-2014 15-4-2015# RB.Khr(3,5)
3 Arkan R St.Khotimah/Tejo(4/) L 24-4-2014 3/I 25-4-2014 14-5-2014 25-6-2014P 2-8-2014P 25-8-2014P 14-5-2014 25-6-2014 2-8-2014 25-8-2014 15-4-2015# Bd.E(3)
4 Syafira Aulia Susanti/Wantoro(6/) P 13-5-2014 5/I 13-5-2014 18-6-2014 18-7-2014P 19-8-2014P 21-9-2014P 18-6-2014 18-7-2014 19-8-2014 21-9-2014 15-4-2015# RB.Khr(3,4)
5 Sherin Tarwi/Suhar(5/) P 22-5-2014 3/I 22-5-2014 11-6-2014 22-7-2014P 20-8-2014P 29-10-2014P 11-6-2014 22-7-2014 20-8-2014 29-10-2014 11-3-2015# Bd.E(4)
6 Kalila Artisha Munthazah Yuni Sarah/Tri Mulyo Hadi W P 3-6-2014 3/I 4-6-2014 7-7-2014 29-10-2014P 31-11-2014# 11-2-2015# 7-7-2014 29-10-2014 3-11-2014# 11-2-2015# 11-3-2015# 3-5-2016^ 8-8-2016^ RB.Khr(2,5)
7 Laelatul Sumiyati/Roziun L 2-7-2014 2/III 2-7-2014 16-7-2014 1-9-2014P 10-10-2014P 15-11-2014P 16-7-2014 1-9-2014 10-10-2014 15-11-2014 15-4-2015# 9-8-2016^
8 Farzan Ria Mariyana/Dedy P L 24-7-2014 5/I 24-7-2014 13-8-2014 7-10-2014P 7-11-2014P 17-1-2015 13-8-2014 7-10-2014 7-11-2014 17-1-2015 15-4-2015# 5-4-2016^ RB.Khr(3,5)
9 Wilda Karmi/Tarmudi P 31-8-2014 3/I 1-9-2014 17-9-2014 31-10-2014P 3-12-2014# 5-1-2015# 17-9-2014 31-10-2014 3-12-2014# 5-1-2015# 6-6-2015# Bd.E(2,7)
11 Inshi Khaerunisa Tutiningsih/Trisno(DF/10/11) P 3-10-2014 1/I 4-10-2014 10-12-2014 22-12-2014P 22-1-2015# 22-3-2015# 10-12-2014 22-1-2015# 22-3-2015# 21-4-2015# 5-1-2016^ RSIAKI(4,1)
10 Rafi Akbar Darwati/Tubi L 6-10-2014 3/I 7-10-2014 15-10-2014 5-1-2015# 7-4-2015# 6-6-2015# 5-1-2015 7-4-2015# 5-5-2015# 6-6-2015# 25-8-2015# Bd.E(3)
12 Afrina Ghosiko Sintia Novitasari/Safrudin P 12-10-2014 3/I 12-10-2014 20-10-2014# 19-8-2015# 19-9-2015# 10-11-2015# 20-10-2014# 19-8-2015# 19-9-2015# 10-11-2015# 7-6-2016^ 19-7-2016^ Bd.F(3)
13 Putri Dwi Sulistyowati/Kusyono P 22-10-2014 3/I 22-10-2014 17-12-2014 22-1-2015# 22-2-2015# 22-3-2015# 17-12-2014 22-1-2015# 22-2-2015# 22-3-2015# 12-8-2015# Bd.E(3,1)
Atika Puspitasari/Rizky Tri N P 1-11-2014 1/I 1-11-2014 PINDAH GEBANG RSI(2,94)sc
14 Navya Ayuti Sumiyati/Ipung S(DF/10) P 19-12-2014 3/I 20-12-2014# 26-1-2015# 23-2-2015# 23-3-2015# 11-5-2015# 26-1-2015# 23-2-2015# 23-3-2015# 11-5-2015# 15-10-2015#DF 16-11-2016^ Pusk(3,3)
15 Naila Suci(DF/10) P 20-12-2014 3/I 19-12-2014# 14-1-2015# 21-2-2015# 20-3-2015# 16-4-2015# 14-1-2015# 21-2-2015# 20-3-2015# 16-4-2015# 15-10-2015#DF

Imunisasi yang diberikan


No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang
Raditia Algani Dewi L 3-1-2015 3/I 3-1-2015 11-1-2015 6-4-2015 20-5-2015 20-6-2015 11-1-2015 6-4-2015 20-5-2015 20-6-2015 PINDAH KONTRAK
1 Sultan Hatim Witati/Suprayitno L 16-1-2015 3/I 16-1-2015 11-3-2015 16-4-2015 16-5-2015 16-6-2015 11-3-2015 16-4-2015 16-5-2015 16-6-2015 14-10-2015 Bd.Las(3,1)
2 Rizal Suniti/Aris L 22-1-2015 3/I 23-1-2015 MENOLAK
3 Sakila Aurelia Tuti Ningsih/Sugianto(DF/11) P 12-2-2015 3/I 13-2-2015 15-4-2015 12-5-2015 11-6-2015 3-8-2015 15-4-2015 12-5-2015 11-6-2015 3-8-2015 9-12-2015 Bd.E(3,1)
4 Rania Humaira Sindi Istri Handayani/Imam Sapii P 3-3-2015 3/I 3-3-2015 4-5-2015 3-6-2015 6-7-2015 9-8-2015 4-5-2015 3-6-2015 6-7-2015 9-8-2015 3-11-2016 RSI(2,7)
1^ Qinara Asyfira Siti M/Moh.Bayu(DF/10/11) P 8-4-2015 1/I TIDAK 9-8-2015 9-9-2015 9-11-2015 9-8-2015 9-9-2015 9-11-2015 Bd.E(1,7)
2 Raza Daryanti/Saefudin L 10-4-2015 1/I 10-4-2015 15-4-2015 10-6-2015 10-7-2015 12-8-2015 15-4-2015 10-6-2015 10-7-2015 12-8-2015 3-11-2016^ Bd.E(3,4)
3 Adam Zidni Al Amri Susilowati(DF/11) L 17-4-2015 3/I 17-4-2015 27-4-2015 25-8-2015 6-10-2015 27-4-2015 25-8-2015 6-10-2015
4 Mirza Albaniago Siti Fatimah/Adi M(DF/10/1) L 15-5-2015 3/I 15-5-2015 20-5-2015 18-8-2015 18-9-2015 15-10-2015DF 20-5-2015 18-8-2015 18-9-2015 15-10-2015DF 14-4-2016^ Bd.Fat
5 Iftina Assyabiya Rafifa Yesi Umarsanah/Ali A(DF/10/11) P 19-5-2015 3/1 20-5-2015 9-7-2015 5-8-2015 28-10-2015 19-12-2015^ 26-5-2015 5-8-2015 28-10-2015 15-12-2015^ 24-2-2016^ RSI(3,6)sc
6 Barbara St.Waslikha/Edwin S(DF/10/11) L 26-5-2015 1/I 26-5-2015 8-7-2015 27-8-2015 27-10-2015^ 8-7-2015 27-8-2015 27-10-2015^ RB.Khr(3,1)
Nurhayati/Karyono P 12-6-2015 3/I 12-6-2015 20-6-2015 PINDAH SLAWI RSI
7 Faizal Diah Ayu/Sumanto(DF/11) L 17-6-2015 3/I 17-6-2015 12-8-2015 3-10-2015 12-8-2015 3-10-2015 Bd.E(2,5)
8 Ramadhani Warkonah/ Daryo L 5-7-2015 3/I 6-7-2015 8-7-2015 MENOLAK 8-7-2015
9 Asyila Zahra Rafifa Rofiko/ Nuridin(DF/10/11) P 11-7-2015 3/I 12-7-2015 8-7-2015 20-12-2015^ 8-7-2015 20-12-2015^ Bd.E(3,3)
M. Mahdi Siti Nuryani L 15-7-2015 3/I 12-8-2015 12-8-2015 28-9-2015 2-11-2015 1-12-2015 12-8-2015 28-9-2015 2-11-2015 1-12-2015 PINDAH JAKARTA Rs DKT
10 Ubaidillah Muniroh/Suryadi(DF/11) L 20-7-2015 5/I 20-7-2015 19-8-2015 2-10-2015 10-12-2015^ 5-4-2016^ 19-8-2015 2-10-2015 10-12-2015^
11 Assyafa Amalia Eka Apriliana/M.Farid P 24-7-2015 3/I 25-7-2015 7-9-2015 7-10-2015 9-11-2015 7-12-2015 7-9-2015 7-10-2015 9-11-2015 7-12-2015 PTB(3,6)
12 Asifa Safitri/Anjar(DF/11) P 31-7-2015 3/I 1-8-2015 16-9-2015 3-10-2015 3-11-2015 8-12-2015 17-9-2015 3-10-2015 3-11-2015 8-12-2015 3-11-2016^ Bd.E(3,7)
13 Azka Ardile Wiratma Kotim/Siman L 28-8-2015 3/I 28-8-2015 6-9-2015 10-11-2015 3-2-2015^ 3-4-2016^ 6-9-2015 10-11-2015^ 3-2-2015^ 3-4-2016^ Bd.F(3,4)
14 Maheza Alfauzi Nurlaela/Supriadi(DF/11) L 8-10-2015 3/I 9-10-2015 9-12-2015 9-1-2016^ 9-2-2016^ 9-3-2016^ 9-12-2015 9-1-2016^ 9-2-2016^ 9-3-2016^ 14-9-2016^ Bd.E(3,5)
15 Varisha Rifani Azahra Ria/ Eko sandro L 15-10-2015 5/I 17-10-2015^ 18-11-2015^ 9-1-2016^ 26-4-2016^ 18-11-2015^ 9-1-2016^ 26-4-2016^ RB.SC(3,2)
16 Hafiz Alfarizi Dian N/ Dulloh L 22-10-2015 3/I 23-10-2015^ 22-11-2015^ 24-1-2016^ 2-4-2016^ 22-11-2015 24-1-2016^ RB.Rhm(4)
Turoh Selviana/Ocfiyan Alif P 23-11-2015 3/I 23-11-2015 PINDAH MEJASEM Bd E(3,3)
17 Naura Hasnah Devi Nurkhikmah/Aprianto P 5-12-2015 3/I 5-12-2015^ 13-1-2016^ 23-2-2016^ 23-3-2016^ 24-4-2016^ 13-1-2016^ 23-2-2016^ 23-3-2016^ 24-4-2016^ 3-11-2016^ RB KHR SC(2,4)

Imunisasi yang diberikan


No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang
1 Gita Restiana Dewi Kartika/Karto P 3-1-2016 3/I 6-1-2016 29-2-2016 1-5-2016 5-6-2016 3-11-2016 29-2-2016 1-5-2016 5-6-2016 3-11-2016 Bd F(2,9)
2 Yasir Maulana Megawati/Wasto L 4-2-2016 3/I 4-2-2016 12-5-2016 25-7-2016 17-10-2016 25-7-2016 17-10-2016 RSUK SC(3,2)
3 Alita Rika Natasya Rita Sugiharti/Nur Ali P 10-2-2016 3/I 10-2-2016 29-2-2016 10-5-2016 10-9-2016 10-10-2016 29-2-2016 10-5-2016 10-9-2016 10-10-2016 15-11-2016 Bd.T(3,3)
4 Moh. Arif Atarahman Siti Faizah/M.Sobirin L 22-2-2016 1/I 23-2-2016 20-5-2016 3-5-2016 31-5-2016 28-6-2016 3-5-2016 31-5-2016 28-6-2016 6-8-2016 PTB
5 Afrin Anisa Deci Putri Sri Atun/Waidin P 24-2-2016 5/I 23-2-2016 7-3-2016 7-6-2016 8-8-2016 10-9-2016 7-6-2016 8-8-2016 4-10-2016 Bd.F(3,4)
6 Arshaka Virendra S Casri/Daruni L 29-2-2016 3/I 29-2-2016 30-3-2016 30-4-2016 30-5-2016 30-3-2016 30-4-2016 30-5-2016 RB.Rhm(3,8)
7 Selahul Azman Al Ghifari Yeyen/Satrio L 1-3-2016 5/I 2-3-2016 13-4-2016 14-5-2016 23-6-2016 28-7-2016 13-4-2016 14-5-2016 23-6-2016 28-7-2016 Dr(3,3)
8 M.Arsya Zein Al-Fatih Novi/Daryono L 25-3-2016 5/I 26-3-2016 4-5-2016 9-6-2016 4-5-2016 9-6-2016 RB Rhm SC(4)
9 Rafatar Ardiansyah Sri Rejeki/Karimun L 25-3-2016 1/I 25-3-2016 1-5-2016 7-6-2016 19-7-2016 5-9-2016 1-5-2016 7-6-2016 19-7-2016 5-9-2016 RB Khr(3,1)
10^ Ibrahim Siti Daruni/Riyanto L 29-3-2016 3/I 29-3-2016 18-4-2016 2-6-2016 11-7-2016 15-8-2016 18-4-2016 2-6-2016 11-7-2016 15-8-2016 Bd.F(2,9)
11 Delisa Putri Erni Nugiarti/Casyudi P 6-4-2016 3/I 6-4-2016 22-5-2016 3-11-2016 22-5-2016 3-11-2016 RB Khr(2,8)
12 Kayla reva Nungki Amalia/Doni P 6-4-2016 3/I 6-4-2016 11-5-2016 6-6-2016 6-7-2016 11-8-2016 13-5-2016 6-6-2016 6-7-2016 11-8-2016 RSI(3,1)
13 Kafaa Bilkafi Marpuah/Sustomo L 23-4-2016 5/I 25-4-2016 1-6-206 8-8-2016 1-11-2016 4-5-2016 8-8-2016 1-11-2016 RB Khr(3,1)
14 Aira Zakia Eka Pipit/Arbiansyah P 4-6-2016 5/I 4-6-2016 20-7-2016 17-10-2016 13-6-2016 17-10-2016 RB.Khr(3)
15 Danishwara Nadif Sariti/Febri L 15-7-2016 1/I 15-7-2016 24-8-2016 27-9-2016 24-8-2016 27-9-2016 Rhm(2,5)
16 Danendra Naufal Sariti/Febri L 15-7-2016 1/I 15-7-2016 24-8-2016 27-9-2016 24-8-2016 27-9-2016 Rhm(2,7)
17 Assayidati Delisa Afriansyah Bugar/Romi P 17-8-2016 5/I 17-8-2016 19-9-2016 21-10-2016 19-9-2016 21-10-2016 Bd.E(3,4)

Imunisasi TT
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Sila 1-7-2014
2 Tuti 28-7-2014
3 Susiyanti/Yuda K M 1/I 21-7-2014C
4 Ria M M 5/I 27-5-2014
5 Suniti/Aris M 3/I 17-8-2014
6 Surtia/Saprudin M 3/I 3-7-2014
7 Sumiati M 3/I 18-8-2014
8 Tuti/Sugianto M 3/I 5-9-2014 5-10-2014
9 Nur Aini Brawijaya 95 26-8-2014
10 Istri/Imam Syafii M 3/I 22-10-2014 17-11-2014
11 Nurhayati/Haryono M 3/I 12-11-2014
Imunisasi TT
No Nama Ibu Alamat (RT/RW)
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Susilowati/Sutrisno M 3/I V
2 Istri/Imam Syafei M 3/I V
3 Siti Muniroh/Trisuroyo M 5/I 10-2-2015
4 St.Munawaroh/M.Bayu M 1/I 21-2-2015
5 Warningsih/Abdullah 24-2-2015
6 Tarwen/Suyanto 27-2-2015
7 Kalimah/Usnanda M 3/I 23-3-2015C
8 Warkonah/Daryono M 3/I 13-3-15
9 Kotim/S.Imam M 3/I 16-3-2015 8-6-2015
10 Dian Novianti/Duloh M 3/1 24-5-2015
11 Devi/Apri M 3/I 30-5-2015
12 Santi Widiowati/Wahyudi M 1/I 24-7-2015 1-9-2015
13 Nurlaela/ Supriadi M3/I 8-7-2015
14 Casri M3/I 4-11-2015
Imunisasi TT
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Rini Widyastuti/Gunawan M 3/I 21-1-2016C 30-4-2016
2 Emi Nugiarti/Casudin M 3/I 6-1-2016
3 Siti Faizah/M.Sobirin M 1/I 3-2-2016
4 Suningsih/Waridi M 2/I 27-2-2016
5 Maria Solicha/Sahrul M1/I 16-2-2016
6 Ita/Dede Hendra M 3/I 1-3-2016
7 Rohana/Imam Wahyudin M 1/I 1-4-2016C
8 Sariti/Febri M 1/I 10-7-2016
9 Ririn/Khaerudin M3/I 1-8-2016
10 Kusniasih/Tomi M5/I 9-8-2016 28-9-2016
LAPORAN BULANAN IMUNISASI BAYI
POSYANDU DAHLIA

Imunisasi yang diberikan


No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang
1 Gishela Mumpuni A Novi Indah Liana/Rozax P 28-1-2010 2/I 29-1-2010 28-2-2010 25-4-2010 5-6-2010 6-7-2010 28-2-2010 25-4-2010 5-6-2010 6-7-2010 20-1-2011
2 Riza Tachsya Ilfina Sulistiowati/Hery Setia Irawan P 29-9-2010 2/I 29-9-2010 9-10-2010 9-11-2010 9-12-2010 9-1-2011 9-10-2010 9-11-2010 9-12-2010 9-1-2011 2-6-2011

Imunisasi yang diberikan


No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang
1 Saeful Utik/Zaenal L 17-2-2011 3/I
2 Syaekhu Amar M Warsini L 6-4-2011 2/I
3 Azam Evan Apriliyana Dewi Priyanti/Untung L 22-4-2011 2/I 22-4-2011 11-5-2011 19-7-2011 19-8-2011 19-9-2011 11-5-2011 19-7-2011 19-8-2011 19-9-2011 25-4-2012
4 Kelvin Ramadhan Waita/Drisanto L 16-8-2011 2/I 16-8-2011 20-8-2011 17-10-2011 30-11-2011 2-1-2012 20-8-2011 31-10-2011 30-11-2011 2-1-2012 9-7-2012
5 Irza Maulana Kasih L 28-9-2011 2/I
6 Mutia Salma Farkhatun Rochatun/Kanapi P 14-11-2011 2/I 15-11-2011 9-4-2012 22-5-2012 21-6-2012 23-7-2012 9-4-2012 22-5-2012 21-6-2012 23-7-2012 10-9-2012
7 Mutia Salfa Rokhtaun/Knafi P 14-11-2011 2/I
8 Sava Dinda Wastiah/Warno P 15-11-2011 2/I
9 Witno Rafael Erplika/Darmanto L 10-12-2011 2/I

Imunisasi yang diberikan


No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang
1 Naela P 12-2-2012 2/I 10-7-2014*
2 Arsal L 22-3-2012 2/I 10-7-2014*
Haryanti/Zaki L 14-9-2012 2/I 14-9-2012 PINDAH PANGGUNG
3 Afifah P 18-9-2012 2/I 10-7-2014*
4 Umy Masito P 4-11-2012 2/I 10-7-2014* 11-8-2015#
5 A'isyah Putri Rahmadani Warningsih/Tarmudi P 12-12-2012 2/I 12-12-2012 20-1-2013 2-3-2013 11-4-2013 16-5-2013 20-1-2013 2-3-2013 11-4-2013 16-5-2013 7-7-2014 11-6-2015# 11-8-2015#
6 Ardiansyah Rum/Suryana 15-10-2015#

Imunisasi yang diberikan


No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang
Eka Nur Afifa Tuti A/Maman P 18-1-2013 2/I 10-2-2013 11-3-2013 12-4-2013 10-7-2013 12-9-2013 7-3-2013 12-4-2013 10-7-2013 12-9-2013 10-12-2013 PINDAH RB.Rhm
1 Muh.Fahri Abdul R Bayinah/Sunadi L 27-1-2013 2/I 27-1-2013 20-2-2013 28-3-2013 23-5-2013 23-6-2013 20-2-2013 28-3-2013 23-5-2013 10-11-2013 10-11-2013 7-5-2015# 11-8-2015#
2 Suwanda Kamila/Wasno L 31-1-2013 2/I 1-2-2013 6-3-2013 19-5-2013 20-6-2013 21-7-2013 6-3-2013 19-5-2013 20-6-2013 21-7-2013 20-11-2013 Dr
B.Gerdian Bara Gerda/Saiful(Tamu) L 12-2-2013 2/I 12-2-2013 11-4-2013 PINDAH 12-2-2013 11-4-2013 PINDAH RB.Khr(2,6)
3 Morza Citra Marselina Suningsih/Sumarto P 18-2-2013 2/I 19-2-2013 6-3-2013 18-4-2013 18-5-2013 21-7-2013 6-3-2013 18-4-2013 18-5-2013 21-7-2013 11-12-2013
Emely Calista Savila/warso P 25-4-2013 2/I 25-4-2013 8-5-2013 PLUS 8-5-2013 26-1-2014 RSUK(2,6)
Yunda Sudiroh/Rudiyono L 24-5-2013 2/I 24-5-2013 PINDAH JAKARTA RB.Khr(3,5)
4 Kay' Lezzer Rayen V Nur Maulidia Sari/Agus S L 18-6-2013 2/I 18-6-2013 10-7-2013 18-8-2013 20-9-2013 20-10-2013 10-7-2013 18-8-2013 20-9-2013 20-10-2013 20-3-2014* 7-5-2015# RSIAKI
5 Eko Setiawan Ramini/Agus L 20-7-2013 2/I 20-7-2013 20-8-2013 10-10-2013 12-11-2013 14-12-2013 20-8-2013 20-10-2013 12-11-2013 14-12-2013 MENOLAK RB.Khr(3,75)
6 Almira Shiena Kanaya Desi Lutfiana/Agung T P 26-8-2013 2/I 26-8-2013 2-9-2013 28-10-2013 28-11-2013 9-2-2014* 2-9-2013 28-10-2013 28-11-2013 9-2-2014* 16-7-2014* Bd.F2,9)
7 Fariza Faiq S Sugiarti/Samsuri L 12-10-2013 2/I 12-10-2013 10-11-2013 14-12-2013 3-2-2014* 6-3-2014* 10-11-2013 14-12-2013 3-2-2014* 6-3-2014* 20-9-2014* 11-8-2015# 3-3-2016^ RB.Khr(4,2)
8 Azizah Nur Aviska Darningsih/Widianto P 15-10-2013 2/I 15-10-2013 10-11-2013 15-12-2013 15-1-2014* 1-4-2014* 10-11-2013 15-12-2013 15-1-2014* 1-4-2014* 20-7-2014* 8-6-2015# Bd.F(3)
9 Afgan Aji Saputra Darningsih/Widianto L 15-10-2013 2/I 15-10-2013 10-11-2013 15-12-2013 15-1-2014* 7-4-2014* 10-11-2013 15-12-2013 15-1-2014* 7-4-2014* 20-7-2014* 8-6-2015# 7-1-2016^ RB.Rhm(3,2)
10 Geo Anvenda Rizki Nur Azizah/Tarsono L 26-11-2013 2/I 26-11-2013 20-12-2013 11-3-2014P* 17-4-2014P* 21-6-2014P* 20-12-2013 11-3-2014* 17-4-2014* 21-6-2014* 20-1-2015 7-1-2016^ 12-4-2016^ RB.Rhm(2,3)
11 Alisa Dian Ayu S P 9-12-2013 2/I 9-12-2013 5-1-2014* 1-3-2014* 2-4-2014* 7-7-2014* 5-1-2014* 1-3-2014* 2-4-2014* 7-7-2014* 7-10-2014* Bd.F
12 Nadia Syafa Almira Wahyuningsih P 17-12-2013 2/I 17-12-2013* 10-1-2014* 17-2-2014P* 18-3-2014P* 11-5-2014P* 10-1-2014* 17-2-2014* 18-3-2014* 11-5-2014* 20-9-2014* 11-8-2015# 3-3-2016^ RB.Khr(sc)

Imunisasi yang diberikan 15-10-15


No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak 12-11-15
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang
1 Salsabilla Aufa Rahma Yunita Silvi M/Rudi Haryanto(1/) P 17-1-2014 2/I 17-1-2014 12-2-2014# 17-3-2014P 18-4-2014P 18-5-2014P 12-2-2014# 17-3-2014 18-4-2014 18-5-2014 15-10-2014# 10-9-2015# 12-4-2016^ Bd.E(2,3)
2 Ceelsy Bintang Asahra St.Rohayah/Sugiyanto(Heri)(1/) P 21-1-2014 2/I 23-1-2014 26-2-2014 26-3-2014 29-4-2014 31-5-2014P 26-2-2014 26-3-2014 29-4-2014 31-5-2014 29-10-2014 RB.Rhm(4)
3 Anisa Bunga Lestari Dewi Rani/Cahyono(1/) P 24-1-2014 2/I 24-1-2014 26-5-2014 2-4-2014P 9-5-2014P 12-6-2014P 2-4-2014 9-5-2014 12-6-2014 10-12-2014# 10-12-2014 7-1-2016^ RB.Rhm(3,5)sc
4 Muh.Wisnu Aji Khotimah/Sairin(3/) L 25-3-2014 2/I 27-3-2014 30-6-2014 10-7-2014 24-9-2014P 25-10-2014P 30-6-2014 10-7-2014 24-9-2014 25-10-2014 20-1-2015# 11-8-2015# RSIAKI(2,45)sc
5 Hisnul Muslim K Haryanti/Zaki(4/) P 29-3-2014 2/I 29-3-2014 MENOLAK Bd.Tar(3,1)
Arfis Berli Canyanku Feriani/Samsudin(4/) L 21-4-2014 2/I 20-4-2014 4-5-2014 23-6-2014P 27-9-2014P 7-5-2015# 4-5-2014 23-6-2014 27-9-2014 7-5-2015# PINDAH Bd.F(3,3)
6 Konan P Tarningsih/Komarudin(5/) L 7-5-2014 2/I 8-5-2014 20-5-2014 10-7-2014P 12-8-2014P 17-9-2014P 20-5-2014 10-7-2014 12-8-2014 17-9-2014 10-4-2015# 7-1-2016^ Bd.E(2,7)
Tarnisih/Rokis(6/) P 15-5-2014 2/I IUFD RSUK(1,1)
7 Elis Bintang Rizki Nur Indah/Santoni(6/) P 8-6-2014 2/I 8-6-2014 16-6-2014 10-8-2014P 10-9-2014P 10-10-2014P 16-6-2014 10-8-2014 10-9-2014 10-10-2014 20-4-2015# 4-2-2016^ Bd.F
8 Geby Keysa Rohningsih P 18-6-2014 2/I 18-6-2014 10-9-2014 25-9-2014P 20-11-2014P 17-4-2015 10-9-2014 20-11-2014 17-4-2015# 10-6-2015# 10-6-2015# RB.Rhm(2,5)
9 Alfina Zhuni Rahma Dwi Sugiarti/Candra(6/) P 26-6-2014 2/I 26-6-2014 7-7-2014 24-8-2014P 25-9-2014P 24-10-2014P 7-7-2014 24-8-2014P 25-9-2014P 24-10-2014P 30-3-2015# 4-2-2016^ 3-11-2016^ Bd.F(2,3)
Fathan Ubaid Al Aziz Evi Puji L 27-6-2014 2/I 28-6-2014 6-8-2014 PINDAH 6-8-2014 BREBES RB.Rhm
10 Alfin Ramadani Lina L 25-7-2014 2/I 26-7-2014 24-9-2014 20-10-2014P 22-11-2014P 23-12-2014 24-9-2014 20-10-2014 22-11-2014 23-12-2014 22-4-2015# RB.Rhm
Anistiya Cariyah/Wirjaya P 25-8-2014 2/I 26-8-2014 15-10-2014 PINDAH 15-10-2014 BREBES Bd.E(3)
11 Firgia Riana/Carto(DF/10/11) P 31-8-2014 2/I 31-8-2014 15-9-2014 16-4-2015# 11-8-2015# 7-1-2016^ 15-9-2014 16-4-2015# 11-8-2015# 7-1-2016^ 4-2-2016^ RB.Rhm(3,4)
12 Aldo Sela Kusmiati/Surip(DF/10/11/1) L 25-10-2014 2/I 26-10-2014 10-11-2014# 8-1-2015# 12-3-2015# 7-5-2015# 10-11-2014# 8-1-2015# 12-3-2015# 7-5-2015# 12-11-2015DF Bd.F(3,4)
13 Aqila Yauma Heni P 29-10-2014 2/I 30-10-2014 10-12-2014 6-1-2015# 9-2-2015# 21-6-2015# 10-12-2014 6-1-2015# 9-2-2015# 21-6-2015# 11-8-2015#
Atika Puspitasari/Rizky Tri N P 1-11-2014 1/I 1-11-2014 PINDAH GEBANG RSI(2,94)sc
14 Karena Runisa/Komar(DF/10/11/2) P 10-12-2014 2/I 11-12-2014# 14-1-2015# 18-3-2015# 11-6-2015# 11-8-2015# 14-1-2015# 18-3-2015# 11-6-2015# 11-8-2015# 12-11-2015DF 14-7-2016^ Bd.E(2,4)
Syafiyatun Zahra Umi P 26-12-2014 2/I 20-1-2015# 28-2-2015# 27-3-2015# 25-5-2015# 20-1-2015# 28-2-2015# 27-3-2015# 25-5-2015# PINDAH SUMUR PANGGANG
Elisa Nur Azahra Rosilah/Tohir(DF/10) P 30-12-2014 2/I 30-12-2014# 19-1-2015# 2-3-2015# 27-4-2015# 25-5-2015# 19-1-2015# 2-3-2015# 27-4-2015# 25-5-2015# 15-10-2015#DF PINDAH NUSA INDAH RSIAKI(3,2)sc

Imunisasi yang diberikan


No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang
1 Silvia Kayla Athaya Neliyah/Fredi(DF/10/11) P 7-1-2015 2/I 8-1-2015 25-2-2015 27-3-2015 22-6-2015 28-7-2015 25-2-2015 27-3-2015 22-6-2015 28-7-2015
2 Sa'adah Marlina/Maskuri P 8-2-2015 2/I 8-2-2015 16-2-2015 16-2-2015 MENOLAK
3 Muh.Prasetyo Riyanti/Slamet L 10-3-2015 2/I 11-3-2015 20-4-2015 20-5-2015 20-6-2015 21-7-2015 20-4-2015 20-5-2015 20-6-2015 21-7-2015 9-6-2016^ RSIAKI(3,1)sc
1^ Savia Nurahma Misturoh P 18-4-2015 2/I 18-4-2015 27-4-2015 18-6-2015 11-8-2015 10-9-2015 27-4-2015 18-6-2015 11-8-2015 10-9-2015 4-2-2016^ 3-11-2016^ RSUK
2 Naila Kanza R Sri Mulyanti/ Sutarto P 14-7-2015 2/I 15-7-2015 19-8-2015 21-10-2015 3-11-2016^ 19-8-2015 21-10-2015 3-11-2016^ Dr parjito(3,2)
3 M Ghani Ramadhani Nani Syarifah/Ahmad Riyanto L 26-6-2015 2/I 26-6-2015 8-7-2015 27-8-2015 27-9-2015 4-11-2015 8-7-2015 27-8-2015 27-9-2015 4-11-2015 12-4-2016^
4 Tsalasa Dhuha Susyatun/Priyono L 15-10-2015 2/I 15-10-2015 13-11-2015 15-12-2015^ 15-1-2016^ 18-2-2016^ 13-11-2015 15-12-2015^ 15-1-2016^ 18-2-2016^ 14-7-2016^ Bd.Fat(3,2)
5 Seril Ainun Yahya Yeni Puspitasari/M.Sholeh P 16-10-2015 2/I 16-10-15 19-10-2015 18-1-2016^ 21-3-2016^ 3-11-2016^ 19-10-2015 18-1-2016^ 3-11-2016^ PTB, (2,9)
Tri Yanti/Rodi L 23-10-2015 2/I PINDAH DEBONG Bidan debong(3,5)
6 Natasya Adinda Shakila Fatimah/Slamet Riyadi P 14-11-2015 2/I 14-11-2015 10-12-2015 14-1-2016^ 15-2-2016^ 14-3-2016^ 10-12-2015 14-1-2016^ 15-2-2016^ 28-4-2016^ 20-9-2016^ Bd.D(2,8)
7 Azka Putra Asidiq Nurhayati/Soni A sidik L 31-12-2015 2/I 31-12-2015^ 14-3-2016^ 12-4-2016^ 4-8-2016^ 6-9-2016^ 14-3-2016^ 4-8-2016^ 6-9-2016^ RB KHR (3,1)
Tarnisa/Rokis P 2/I PLUS TANGGAL 5-1-2016
8 Kirana Ayu A Fresti / Satrio P 6-8-2015 2/I 7-1-2016^ 12-4-2016^ 12-5-2016^ 7-1-2016^ 12-5-2016^

Imunisasi yang diberikan


No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang
1 Aden Firzi Purtika Mustika/Purwanto L 6-2-2016 2/I RB.Khr(2,7)
2 Arzendra Ammar Zoni Rochati/Dauri L 19-2-2016 2/I 27-2-2016 10-3-2016 12-5-2016 14-7-2016 6-9-2016 12-5-2016 14-7-2016 6-9-2016 6-10-2016 Bd.Z (2,8)
3 Saka Ainu Zafi Daryati/Sapii L 2-3-2016 2/I 2-3-2016 7-3-2016 12-5-2016 14-7-2016 6-10-2016 12-5-2016 14-7-2016 6-10-2016 3-11-2016 Bd.F(4,1)
4 Rachelia Novita Stefani Novi/Rusdi P 11-3-2016 2/I Bd.F(2)
5^ Zakira Niken Suningsih/Waridi P 25-3-2016 2/I 25-3-2016 5-5-2016 9-6-2016 4-8-2016 6-9-2016 5-5-2016 9-6-2016 4-8-2016 6-9-2016 Bd.F(2,8)
6 Rejendra Arsenio Aydin Tri Mulyasih/Rizal L 10-4-2016 2/I 10-4-2016 2-5-2016 13-6-2016 11-7-2016 10-8-2016 2-5-2016 13-6-2016 11-7-2016 10-8-2016 RSI(3,1)
7 Al Thaf Leon Hamizan Leli Puji/Mulyono P 9-5-2016 2/I 9-5-2016 16-5-2016 11-7-2016 9-8-2016 20-9-2016 16-5-2016 11-7-2016 9-8-2016 20-9-2016 PTB (3,9)
8 Nafadilah Surinah/M.Ali Faridin P 11-5-2016 2/I 11-5-2016 13-7-2016 2-8-2016 3-11-2016 13-7-2016 2-8-2016 3-11-2016 Bd.E(3)
9 Nasya Aulia Putri Warinah/Sirin P 5-7-2016 2/I 5-7-2016 21-7-2016 6-9-2016 6-10-2016 3-11-2016 21-7-2016 6-9-2016 6-10-2016 3-11-2016 Bd.F(3)
10 Jelita Ayu Damayanti Sri Devi / Warnali P 15-7-2016 2/I 20-7-2016 3-11-2016 11-11-2016 6-9-2016 11-11-2016 PTB(2,7)
11 Zilva Rahmalia Lilis Wahyuni/Rusdianto P 12-8-2016 2/I 13-8-2016 10-10-2016 3-11-2016 10-10-2016 Bd.E(2,8)
12 Rere Amora Felicia Ade Kiswanti/Winoto P 22-8-2016 2/I 21-8-2016 5-10-2016 5-10-2016 RB.RHM(3,1)
Puput Parenti/Kurniadi L 13-9-2016 2/I BAYI PLUS 13-9-2016 RSUK
13 Siti Nurjanah/Husni L 9-10-2016 2/I 9-10-2016 Bd.F(3)

Imunisasi TT
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Rosita M 2/I 21-7-2014
2 Sila 1-7-2014
3 Tuti 28-7-2014
4 Runisa/Kumar M 2/I 17-8-2014 13 -9-2014
5 Umi/Triyono M 2/I 8-9-2014
6 Neliyah M 2/I 7-8-2014 5-9-2014
7 Nur Aini Brawijaya 95 26-8-2014
8 Marlina/Maskuri M 2/I 17-10-2014
Imunisasi TT
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Eli Ermawati/Juli H M 2/I VC
2 Warningsih/Abdullah 24-2-2015
3 Tarwen/Suyanto 27-2-2015
4 Nani Syarifah M 2/I 14-2-15
5 Fresty/Satrio M 2/I 31-3-15
6 Sri Noryanti/Suhul M 2/I 14-5-2015
7 Susyatun/Priyo A M 2/I 4-6-2015
8 Fatimah/Slamet Riyadi M 2/I 20-7-2015 6-9-2015
9 Nurhayati/Soni A M 2/I 24-8-2015
10 Novi/Rusdi M2/I 7-10-2015
11 Tarnisa/Rokis M2/I 27-9-2015
12 Mustika/Purwanto M2/I 12-11-2015
Imunisasi TT
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Novi/Rusdi M2/I 6-11-2015
2 Trimulyasih/Rizal M 2/I 19-12-2015 4-4-2016
3 Suningsih/Waridi M2/I 11-12-2015
4 Surinah/M ali Faridin M 2/I 21-1-2016 18-2-2016
5 Lilis Wahyuni M 2/I 11-3-2016 25-4-2016
6 Leli Puji A M 2/I 3-3-2016
7 Siti Nurjanah M 2/I 21-5-2016 12-7-2016
8 Sinta Ratna/Subur M 2/I 1-9-2016
LAPORAN BULANAN IMUNISASI BAYI
POSYANDU ANGGREK

Imunisasi yang diberikan


No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang
1

Imunisasi yang diberikan


No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang
1

Imunisasi yang diberikan


No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang
1 Rena Yanto/Suci p 6-1-2011 4/I
2 Aula Ayu Nazwa Somali/Karmini P 2-3-2011 4/I
3 Zian Rifki Akbar Slamet/Fatimah L 12-4-2011 1/II
4 Anjani Ariza Karto/Kartika P 26-4-2011 4/I
5 Asifatun Nisa Ratno/Kustiati P 19-5-2011 1/II
6 Sendi Rohyanti Yanto/Rochimah P 26-6-2011 4/I
7 Steven Aldi Wiwit Utari/Darmojo L 1-7-2011 5/II 1-7-2011 5-8-2011 5-9-2011 6-10-2011 7-11-2011 5-8-2011 5-9-2011 6-10-2011 7-11-2011 23-4-2012
8 Erza Maulana Witno/Siti Fatimah L 13-7-011
9 M.Ainun Nurohim Durochim/Runi L 20-7-2011 3-7-2014*
10 Arya Maulana Erlanda Maryati/Supriyanto L 21-7-2011 1/II 21-7-2011 10-8-2011 31-10-2011 1-2-2012 21-4-2012 10-8-2011 21-9-2011 31-10-2011 1-2-2012 8-10-2012 6-8-2014*
11 Kelvin Drisanto/Waita L 16-8-2011 6-8-2014*
12 Tiara Wijayanti P 31-8-2011 3-7-2014*
13 Naufal Hafidz Irwan/Rita L 18-9-2011 1/II
14 Bayu Irwansyah Sohman/Murni L 18-9-2011 4/I
15 Sri Narawati Tarmidi/Hikmah P 23-10-2011 4/I
16 Aisyah Ma Rifati Saiyas/Turinah P 27-11-2011 4/I
17 Gefira Asafa Karyono/Endang P 7-12-2011 1/I
18 Gevira Asyafa Endang Nursanah/Karyono P 7-12-2011 1/II 7-12-2011 20-12-2011 1-2-2012 6-6-2012 9-7-2012 20-12-2011 1-2-2012 6-6-2012 9-7-2012 10-9-2012
19 Rehan Lep/Lili L 11-12-2011 4/I
20 Alika Maura A Waryono/Yanti P 29-12-2011 1/II

Imunisasi yang diberikan


No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang
1 Valensia Azzahra Atika/Rochamin P 24-1-2012 4/I 26-1-2012 10-2-2012 24-3-2012 24-4-2012 24-6-2012 10-2-2012 24-3-2012 24-4-2012 24-6-2012 20-11-2012 3-7-2014*
2 Geysa Deli/Bagus P 11-2-2012 2/I 11-2-2012 22-2-2012 11-4-2012 11-5-2012 11-7-2012 22-2-2012 11-4-2012 11-5-2012 11-7-2012 21-11-2012
3 Nizam L 16-2-2012 6-8-2014*
4 Wafi Roid Khoiri(A) Siti Rahayu/Kastoni L 18-2-2012 1/II 18-2-2012 10-3-2012 19-4-2012 18-5-2012 22-6-2012 10-3-2012 19-4-2012 18-5-2012 22-6-2012 5-12-2012
5 Wafi Roid Khoiry Siti Rahayu/Kastoni L 18-2-2012 1/II 18-2-2012 10-3-2012 19-4-2012 18-5-2012 22-6-2012 10-3-2012 19-4-2012 18-5-2012 22-6-2012 5-12-2012 3-7-2014*
6 Anam Maulana L 24-2-2012 6-8-2014*
7 Noval L 25-2-2012 6-8-2014*
8 Mandala Wali Warsita/Sofandi L 9-3-2012 4/I 9-3-2012 25-4-2012 7-5-2012 11-6-2012 19-7-2012 7-5-2012 11-6-2012 19-7-2012 5-12-2012 5-12-2012
9 Syaif Maulana Akbar Titin/Wardi L 13-3-2012 4/I 13-3-2012 21-3-2012 26-5-2012 18-7-2012 5-9-2012 21-3-2012 26-5-2012 18-7-2012 5-9-2012 10-2-2013
10 Rafka Feri/Samsudin L 13-3-2012 2/I 13-3-2012 4-4-2012 21-5-2012 7-8-2012 4-10-2012 4-4-2012 21-5-2012 7-8-2012 4-10-2012 6-3-2013
11 Arsal Sri Kanti/Nuridin L 22-3-2012 2/I 22-3-2012 4-10-2012 7-3-2012 GIZI 4-10-2012 7-3-2012 BURUK
12 M.Syarif S Noviyana/Riswanto L 11-4-2012 4/I 11-4-2012 10-5-2012 13-6-2012 11-7-2012 5-9-2012 10-5-2012 13-6-2012 11-7-2012 5-9-2012 20-3-2013
13 Nur Afni Sukmawati Daemah/Suroso P 25-4-2012 1/II 25-4-2013 18-5-2012 25-6-2012 25-7-2012 25-8-2012 18-5-2012 25-6-2012 25-7-2012 25-8-2012 20-2-2013
14 Moh.Zidan Ruswi/Wardi L 5-5-2012 2/I 5-5-2012 9-7-2012 9-8-2012 8-9-2012 8-10-2012 9-7-2012 9-8-2012 8-9-2012 8-10-2012 4-3-2013
15 Karendra Erniati L 8-5-2012 3-7-2014* 8-6-2015#
16 Ayu Ningtyas Muasih/Bambang P 16-5-2012 4/I V 20-5-2012 1-8-2012 3-10-2012 2-1-2013 20-5-2012 1-8-2012 5-9-2012 3-10-2012 6-3-2013
17 Fadil Ernawati/Wandoko L 18-5-2012 2/I 18-5-2012 V 20-7-2012 24-8-2012 V 20-7-2012 24-8-2012 16-12-2013
18 Sakinah Zaki N Daryati/Sapi'i P 3-6-2012 2/I 3-6-2012 10-7-2012 12-8-2012 13-9-2012 15-10-2012 10-7-2012 12-8-2012 13-9-2012 15-10-2012 10-9-2013
19 Sunil Bramansyah Prihartati/Wastari L 18-6-2012 4/I 18-6-2012 27-8-2012 5-9-2012 3-10-2012 7-11-2012 31-7-2012 5-9-2012 3-10-2012 7-11-2012 15-4-2013
20 Zakariya Agusti Pancaningrum L 27-6-2012 3-7-2014* 8-6-2015#
21 Aulia Ramadhani Rengganis/Domulyo P 31-7-2012 2/I 31-7-2012 10-9-2012 9-11-2012 9-12-2012 14-1-2013 10-9-2012 9-11-2012 9-12-2012 14-1-2013 21-4-2013 8-6-2015#
22 Nafisa Naya S (A) Muslikha/Taryono P 24-8-2012 5/II 24-8-2012 10-9-2013 10-11-2012 12-12-2012 13-1-2013 10-9-2012 10-11-2012 12-12-2012 13-1-2013 10-6-2013
23 Majida Alfiana Winda R/Cipto P 30-8-2012 2/I 30-8-2012 20-9-2012 7-11-2012 12-12-2012 12-1-2013 20-9-2012 7-11-2012 12-12-2012 12-1-2013 10-9-2013
Akh.Khairil Anam Rosyana/Abdul R L 25-9-2012 3/I V 15-10-2012 26-11-2012 26-12-2012 28-1-2013 26-11-2012 26-12-2012 28-1-2013 TEGALSARI
24 Ahlul Nizar Argya Kristianingsih/Nuryatin L 28-9-2012 1/II 28-9-2012 24-10-2012 28-11-2012 28-12-2012 28-1-2013 24-10-2012 28-11-2012 28-1-2013 20-6-2013 20-6-2013 3-7-2014* 5-8-2015#
25 Rayhan Zamzami Tuti Purniati/Anggit Setiawan L 1-10-2012 5/II 1-10-2012 20-10-2012 5-12-2012 2-1-2013 6-2-2013 20-10-2012 5-12-2012 2-1-2013 6-2-2013 8-7-2013 3-7-2014*
26 Sheza Azkiya Dency/Aris P 18-10-2012 2/I 18-10-2012 24-10-2012 17-12-2012 22-1-2013 1-3-2013 24-10-2012 17-12-2012 22-1-2013 1-3-2013 20-9-2013
27 Cinta Aulia Putri Sri Hartuti/Suherman P 19-10-2012 4/I 21-10-2012 20-12-2012 2-1-2013 15-2-2013 15-5-2013 20-12-2012 2-1-2013 15-2-2013 15-5-2013 26-8-2013 16-6-2014
28 Umi Masitoh Karsini/Edi P 4-11-2012 2/I 4-11-2012 10-11-2012 10-12-2012 10-1-2013 11-2-2013 10-11-2012 10-12-2012 10-1-2013 11-2-2013 20-8-2013
29 Aleya Sugianah/Mulya P 5-11-2012 2/I 5-11-2012 21-11-2012 7-3-2013 22-4-2013 27-5-2013 21-11-2012 7-3-2013 22-4-2013 27-5-2013 20-11-2013
Tito Rico B Sugini L 20-11-2012 2/I v 20-2-2013 PINDAH 20-2-2013 TEGALSARI
30 Aisyah Putri R Warningsih/Tarmudi P 12-12-2012 2/I 12-12-2012 20-1-2013 2-3-2013 11-4-2013 16-5-2013 20-1-2013 2-3-2013 11-4-2013 16-5-2013 20-11-2013
31 Rohna Syakur Pratama Dona Dwi S/Nurochim L 25-12-2012 1/II 25-12-2012 10-1-2013 4-3-2013 3-4-2013 6-5-2013 10-1-2013 4-3-2013 3-4-2013 6-5-2013 18-11-2013 6-8-2014*

Imunisasi yang diberikan


No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang
Syahkeren Widianingsih/Jamani L 29-1-2013 4/I 20-1-2013 10-4-2013 29-4-2013 29-5-2013 29-6-2013 10-4-2013 29-4-2013 29-5-2013 29-6-2013 12-11-2013 RANDUGUNTING Bd.E
1 Mohamad Alvino Waisah/Sucipto L 11-2-2013 5/II 11-2-2013 10-4-2013 6-5-2013 5-6-2013 3-7-2013 10-4-2013 6-5-2013 5-6-2013 3-7-2013 23-12-2013 6-8-2014 2-9-2015# RSIAKI
2 Muh.Dani Kherudin Defi Septiani/Amirudin L 17-2-2013 5/II 24-2-2013 8-4-2013 1-5-2013 12-6-2013 24-7-2013 8-4-2013 1-5-2013 12-6-2013 24-7-2013 11-11-2013* 5-8-2015# Bd.L(2,9)
3 Zidan Arkana Evi Fitri Yani/Eli Rosikin L 24-2-2013 1/II 24-2-2013 10-3-2013 26-4-2013 27-5-2013 28-6-2013 10-3-2013 26-4-2013 27-5-2013 28-6-2013 10-12-2013* 24-2-2015# 5-8-2015# RB.Rhm
4 Luthfiya Afni Royanti/Heni Wantoro P 10-3-2013 4/I 10-3-2013 10-4-2013 10-5-2013 11-6-2013 10-7-2013 10-4-2013 10-5-2013 11-6-2013 10-7-2013 10-1-2014* 7-1-2015# 3-6-2015#
5 Alfin Alfarizi April/Revi L 18-3-2013 4/I 8-3-2013 27-3-2013 19-5-2013 20-6-2013 21-7-2013 27-3-2013 19-5-2013 20-6-2013 21-7-2013 15-1-2014* 6-8-2014 RB.Khr(3,1)
6 Kenzi Billa Najwa Nur Aeni/Sasi Kapur P 31-3-2013 4/I 31-3-2013 10-4-2013 2-6-2013 3-7-2013 10-11-2013 10-4-2013 2-6-2013 3-7-2013 10-11-2013 10-1-2014* 6-5-2015# 5-8-2015#
7 Meylita Dwi Aryani Kurniasih/Suparno P 2-5-2013 4/I 2-5-2013 20-5-2013 2-7-2013 17-8-2013 17-9-2013 20-5-2013 2-7-2013 17-8-2013 17-9-2013 20-2-2014* 25-8-2015# 15-10-2015# Bd.F(2,7)
8 Kinanti Amelia Putri Reni Maryanah/Wanto P 26-5-2013 4/I 26-5-2013 15-7-2013 20-8-2013 20-9-2013 20-10-2013 15-7-2013 20-8-2013 20-9-2013 20-10-2013 10-8-2014* 5-8-2015# 15-10-2015# RB.Khr(2,5)
9 Daffa Al Ghozali Sasunih/Mustoro L 15-6-2013 1/II 15-6-2013 8-7-2013 17-8-2013 17-9-2013 17-10-2013 8-7-2013 17-8-2013 17-9-2013 17-10-2013 20-3-2014* 5-8-2015# 7-10-2015# RB.Khr(2,5)sc
M.Putra Alfandi Widiarti/Sutoyo L 22-6-2013 4/I 22-6-2013 20-7-2013 11-9-2013 10-10-2013 20-12-2013 20-7-2013 11-9-2013 10-10-2013 20-12-2013 16-10-2014* TIDAK ADA RB.Khr(3,3)
10 Fiqih Nur Ramadhani Sumiati/Nurochman P 5-7-2013 5/II 11-7-2013 5-9-2013 7-10-2013 5-11-2013 5-12-2013 5-9-2013 7-10-2013 5-11-2013 5-12-2013 5-6-2014* Bd.L(3,5)
11 Felisya Adhiba K Veri Dia/Toni Kuswoyo P 2-8-2013 1/II 2-8-2013 10-9-2013 17-10-2013 17-11-2013 23-12-2013 10-9-2013 17-10-2013 17-11-2013 23-12-2013 19-5-2014* 2-9-2015# 7-10-2015# Bd.F(3,0)
12 Melani Setia Putri Maryati/Rajikin P 4-8-2013 1/II 4-9-2013 20-9-2013 4-11-2013 4-12-2013 4-1-2014* 20-9-2013 4-11-2013 4-12-2013 4-1-2014* 20-6-2014* Bd.F(3)
13 M.Syafawi Ajwa Wanilah/Karmad L 21-9-2013 4/I 21-9-2013 26-10-2013 20-11-2013 20-12-2013 22-1-2014 16-10-2013 20-11-2013 20-12-2013 22-1-2014 18-6-2014 3-2-2016^ RSUK
14 Mutiara Arofah Nuraeni/Yatin P 9-10-2013 4/I 9-10-2013 10-11-2013 10-1-2014* 10-2-2014* 20-3-2014* 10-11-2013 10-1-2014* 10-2-2014* 20-3-2014* 20-7-2014* 6-5-2015# 15-10-2015# RB.Khr(3,4)
15 Fatan Kafa Billah Wasripah/Suharjo L 21-12-2013 5/II 21-12-2013* 6-1-2014* 26-2-2014P* 7-4-2014P* 12-5-2014P* 6-1-2014* 26-2-2014* 7-4-2014* 12-5-2014* 20-10-2014* 5-8-2015# 21-12-2015# Bd.F(2,7)

Imunisasi yang diberikan 20-10-15


No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak 4-11-15
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang
1 Naya Azmi Afifah Ika Purwaningsih/Agus P 20-1-2014 1/II 20-1-2014 27-1-2014 25-3-2014P 25-4-2014P 30-5-2014P 27-1-2014 25-3-2014 25-4-2014 30-5-2014 20-11-2014 12-8-2015# Bd.F(2,9)
2 Ezy Miftah Nur Falih Yahya Wiwin M/Nursoleh L 23-1-2014 1/II 24-1-2014 10-2-2014 26-3-2014P 26-4-2014P 4-6-2014P 10-2-2014 26-3-2014 26-4-2014 4-6-2014 10-12-2014 5-8-2015# 19-2-2016^ RSIAKI(3,4)
3 Najwa Al arifah Rita Kurniasih/Irwan P 25-1-2014 1/II 15-1-2014 20-1-2014 1-4-2014P 2-5-2014P 11-6-2014P 20-1-2014 1-4-2014 2-5-2014 11-6-2014 20-11-2014 5-8-2015# 3-2-2016^ Bd.F(2,5)
4 Sekar Dwi Putri Tri Maryani/Ratno P 10-2-2014 1/II 10-2-2014 10-2-2014 11-4-2014P 13-5-2014P 11-6-2014P 10-2-2014 11-4-2014 13-5-2014 11-6-2014 10-12-2014 10-8-2015# 12-2-2016^ Bd.F(3,5)
5 Safina Rasiti/Sugandi P 22-2-2014 4/I 22-2-2014 12-3-2014 21-4-2014P 23-5-2014P 23-6-2014P 12-3-2014 21-4-2014 23-5-2014 23-6-2014 17-12-2014 25-8-2015# 2-3-2016^ Bd.E(3)
6 Marcelo Evan Dimas K Sulasmi/Muamar K L 28-2-2014 1/II 28-2-2014 14-4-2014 7-5-2014P 9-6-2014P 7-7-2014P 7-5-2014 9-6-2014 7-7-2014 22-12-2014 22-12-2014 2-9-2015# Bd.F(2,0)
7 Alfis Putra Albaehaqi Sier/Iswanto P 18-3-2014 5/III 18-3-2014 MENOLAK RB.Khr(3,5)
8 Ayundha Shiffa A Susanah/Kasmin P 24-4-2014 4/I 24-4-2014 6-5-2014 24-6-2014P 24-7-2014P 24-8-2014P 6-5-2014 24-6-2014 24-7-2014 24-8-2014 20-1-2015 4-11-2015 Bd.F(2,9)
9 Vino Ardiansyah Epi Cahya/Warsono L 30-4-2014 5/II 30-4-2014 4-5-2014 2-7-2014P 6-8-2014P 7-9-2014P 4-5-2014 2-7-2014 6-8-2014 7-9-2014 2-3-2015# 4-11-2015# 2-11-2016^ Bd.F(2,9)
10 Azarifah Chaerunisa K Neneng P/Arif P 4-5-2014 1/II 4-5-2014 12-5-2014 2-7-2014P 5-8-2014P 8-9-2014P 12-5-2014 2-7-2014 5-8-2014 8-9-2014 9-2-2015# 4-11-2015 9-5-2016^ Bd.F(2,9)
11 Daniel Maulana Fatmawati/Waridin L 9-5-2014 4/I 9-5-2014 12-5-2014 7-7-2014P 17-8-2014P 17-9-2014P 12-5-2014 7-7-2014 17-8-2014 17-9-2014 10-2-2015# 9-11-2015# 11-5-2016^ Bd.F(3,3)
12 Nada Syafira Sekarwati/Wahroni P 13-5-2014 4/II 14-5-2014 11-6-2014 15-7-2014P 15-8-2014P 15-9-2014P 11-6-2014 15-7-2014 15-8-2014 15-9-2014 11-3-2015# 12-11-2015# 2-11-2016^ Bd.E(3,5)
13 Sabrina Tarkini/Nuryaman P 18-5-2014 4/I 19-5-2014 11-6-2014 20-7-2014P 20-8-2014P 20-9-2014P 11-6-2014 20-7-2014 20-8-2014 20-9-2014 11-3-2015# 9-12-2015^ 8-6-2016^ Bd.E(3,1)
14 Rasya Andika Eka L 26-6-2014 4/I 26-6-2014 20-7-2014 25-8-2014P 25-9-2014P 5-11-2014P 20-7-2014 25-8-2014 25-9-2014 5-11-2014 10-5-2015# 3-2-2016^ 2-11-2016^ RB.Khr(3,8)
Farel Alfaro Erina Desi Asti/Nursipin L 3-7-2014 4/I 3-7-2014 16-7-2014 PINDAH JABAR RB.Khr
15 Stevani A Wiwit Utari/Darmojo L 8-7-2014 5/II 5-7-2014 5-8-2014 8-9-2014P 10-10-2014P 10-11-2014P 5-8-2014 8-9-2014 10-10-2014 10-11-2014 1-6-2015# Bd.Las
16 Dzakira Talita Sukarti P 2-8-2014 4/I 2-8-2014 11-8-2014 3-10-2014P 10-11-2014P 10-12-2014 11-8-2014 3-10-2014 10-11-2014 10-12-2014 10-5-2015# 28-2-2016^
17 Alfi Damar Panullah Pingki/Ali L 27-8-2014 4/I 27-8-2014 17-9-2014# 3-12-2014P 5-1-2015# 15-6-2015# 17-9-2014 3-12-2014# 5-1-2015# 15-6-2015# 5-8-2015# Bd.E(4,2)
18 Mualip Prasetyo Endang H/Sobirin L 1-9-2014 5/II 1-9-2014 1-9-2014 24-11-2014P 4-3-2015# 1-9-2014 24-11-2014 4-3-2015# MENOLAK Bd.F(3,2)
19 Hana Okiyana/Yoyo Iskandar P 5-9-2014 1/II 6-9-2014 13-10-2014 15-11-2014# 3-12-2014P 7-1-2015# 13-10-2014 5-11-2014# 3-12-2014 7-1-2015# 3-6-2015# 6-4-2016^ 5-10-2016^ RB.Khr(3,2)
20 Nuraeninun Anisa F Lili Widyawati/Asep S(DF/10/11) P 12-9-2014 4/I 12-9-2014 8-10-2014# 7-12-2014# 10-2-2015# 2-7-2015# 8-10-2014# 7-12-2014# 10-2-2015# 2-7-2015# 27-7-2015# RB.Khr(3,7)
21 Tafana Nur Aeni P 8-10-2014 1/II 9-10-2014 19-11-2014# 13-1-2015# 31-3-2015# 18-6-2015# 19-11-2014# 13-1-2015# 31-3-2015# 18-6-2015# 5-8-2015#
22 Rangga David M Ambarwati/Sunarto L 29-10-2014 1/II 29-10-2014 10-11-2014 7-1-2015# 1-4-2015# 3-6-2015# 10-11-2014 7-1-2015# 1-4-2015# 3-6-2015# 25-8-2015# Bd.F
Karsih/Irmanto L 14-11-2014 4/I IUFD RSUK(2,5)
23 Nadifa Ita Ernawati/Andri P 18-11-2014 4/I 18-11-2014# 17-12-2014 20-2-2015# 20-3-2015# 24-4-2015# 17-12-2014 20-2-2015# 20-3-2015# 24-4-2015# 16-9-2015# 26-5-2016^ RSIAKI(3,8)sc
24 Aulia Darsiti/Tanto(DF/10/11) P 4-12-2014 4/I 5-12-2014# 17-12-2014 4-2-2015# 4-3-2015# 4-4-2015# 17-12-2014 4-2-2015# 4-3-2015# 4-4-2015# 17-10-2015# 17-8-2016^ Bd.E(2,7)
Nur Faizah/Indra Siswantoro P 8-12-2014 4/I 8-12-2014# PINDAH KRATON ASTIKA A Pusk(2,3)
25 Ade Prasetya Susi H/Agus L 20-12-2014 5/II 23-2-2015# 9-3-2015# 13-4-2015# 18-5-2015# 23-2-2015# 9-3-2015# 13-4-2015# 18-5-2015# 28-9-2015# Bd.F(2,4)
26 Anjani Mila Safitri Astuti/Karto P 22-12-2014 4/I 23-12-2014 16-3-2015# 9-3-2015# 8-4-2015# 11-5-2015# 9-3-2015# 8-4-2015# 11-5-2015# 15-6-2015# 15-10-2015# 2-11-2016^ RB.Khr

Imunisasi yang diberikan


No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang
1 Kirana Ayu Najuba Sayati/Riyanto(DF/11/1) P 25-1-2015 4/I 26-1-2015 5-2-2015 6-4-2015 3-6-2015 6-7-2015 5-2-2015 6-4-2015 3-6-2015 6-7-2015 4-11-2015DF 2-11-2016 Bd.
2 Asraf Endang Sumiati/Rasmun(DF/11) L 26-1-2015 1/II 26-1-2015 26-1-2015 1-4-2015 4-5-2015 3-6-2015 26-1-2015 1-4-2015 4-5-2015 3-6-2015 30-11-2015 7-9-2016^ Pusk
3 Vino Bastian Eka Silvi(DF/11) L 29-1-2015 1/II 29-1-2015 11-2-2015 4-3-2015 6-4-2015 6-5-2015# 11-2-2015 4-3-2015 6-4-2015 6-5-2015# 2-11-2016^
4 Gozi Irhamdani Nafis Wichati/Sultoni L 20-3-2015 4/I 20-3-2015 20-3-2015 8-6-2015 3-8-2015 2-9-2015 20-3-2015 8-6-2015 3-8-2015 2-9-2015 2-3-2016^
5 Alfian Choiril Zidan Widia Yanti L 21-3-2015 4/I 21-3-2015 27-4-2015 27-7-2015 1-11-2015 6-1-2016^ 27-3-2015 27-7-2015 1-11-2015 6-1-2016^ 1-3-2016^ 2-11-2016^ RSI(3,4)
1^ Sri Warningsih L 22-4-2015 5/II 23-4-2015 MENOLAK RSIAKI
2 Lanang Dwi Sesa Saerah L 10-5-2015 1/II 10-5-2015 15-6-2015 5-8-2015 7-10-2015 17-12-2015 15-6-2015 5-8-2015 7-10-2015 17-12-2015 12-2-2016^ Bd.F
3 Hafis Almajidah Rini Apriyanti/Sudarso(DF/10) L 24-5-2015 4/I 24-5-2015 25-5-2015 29-7-2015 9-9-2015 9-11-2015 25-5-2015 29-7-2015 9-9-2015 9-11-2015
4 Karisma Darsini/Karman(DF/11/2) P 24-5-2015 1/II 25-5-2015 26-6-2015 26-8-2015 30-9-2015 4-11-2015DF 26-6-2015 26-8-2015 30-9-2015 4-11-2015DF 26-2-2016^ RSIAKI(3,9)sc
5 Fatir El Faqih Indah Marlina/Andri L 25-5-2015 1/II 3-6-2015 8-6-2015 27-7-2015 28-8-2015 25-9-2015 8-6-2015 27-7-2015 28-8-2015 25-9-2015 7-3-2016^ PINDAH MINAB RSUK(2,5)
6 Marsel Alfareza Riski Amalia/Tanto L 10-6-2015 1/II 10-6-2015 20-6-2015 10-8-2015 16-9-2015 19-10-2015^ 20-6-2015 10-8-2015 16-9-2015 19-10-2015^ RB.Khr(2,8)
7 Riska R Khana/Toni Wahyudi(DF/10/1) P 11-6-2015 4/I 12-6-2015 15-7-2015 11-8-2015 14-9-2015 20-10-2015DF 15-7-2015 11-8-2015 14-9-2015 20-10-2015DF 18-3-2016^ Bd.E(3,2)
8 Anissa Ramadhani Anita/Waryo(Zakiyatul)(DF/11) P 11-7-2015 1/II 11-7-2015 10-8-2015 26-9-2015 26-11-2015 26-12-2015^ 10-8-2015 26-9-2015 26-11-2015 26-12-2015^ 20-4-2016^ RSIAKIsc
Tri Handayani/ Suhendra L 14-7-2015 5/II 15-7-2015 PINDAH Bd.E(2,9)
9 M. Gibran Al-Aksa Lucyati/Usman L 29-7-2015 4/I 29-7-2015 31-8-2015 29-9-2015 2-11-2015 2-12-2015 31-8-2015 29-9-2015 2-11-2015 2-12-2015 9-5-2016^
10 Syafira Ana Amaliyani/Darkiman P 20-9-2015 1/II 20-9-2015 12-10-2015 21-11-2015^ 20-12-2015^ 21-3-2016^ 12-10-2015 21-11-2015^ 20-12-2015^ 21-2-2016^ RB.Khr(3)
11 Renia Rodiah/Surono(DF/11) P 13-9-2015 3/II 13-9-2015 21-9-2015 13-11-2015^ 13-12-2015^ 13-1-2016^ 21-9-2015 13-11-2015^ 13-12-2015^ 13-1-2016^ 13-6-2016^ RB rahma((3,(3)sc
12 Hafika Naila Putri Santi Widiawati/Wahyudi P 13-10-2015 4/I 13-10-2015 17-10-2015 30-12-2015^ 19-2-2016^ 1-9-2016^ 17-10-2015 30-12-2015^ 19-2-2016^ 1-9-2016^ RB.Khr(3)
13 Adya Elif Gendhis M Karlina/ Adi P 24-10-2015 5/II 25-10-2015^ 22-12-2015 PINDAH 19-1-2016 JAKARTA RSIAKI(3,5)sc
14 Ismah Aliyah H Deti/Tresna P 28-10-2015 4/I 29-10-2015^ 2-12-2015^ 6-1-2016^ 24-5-2016^ 29-10-2016^ 10-11-2015 6-1-2016^ 24-5-2016^ 29-10-2016^ 28-9-2016^ RB. Khr(3,3)
15 Ryan Habibi Al via Diana/Suridin P 3-11-2015 4/I 2-11-2015^ 23-11-2015^ 5-1-2016^ 23-11-2015 5-1-2016^ RB khr(3,2)
16 Haikal Fanda Pramata Aida/M. Irfan L 19-11-2015 4/I 19-11-2015^ 23-11-2015^ 19-1-2016^ 7-3-2016^ 23-11-2015^ 19-1-2016^ PINDAH JAKARTA Bd. F(3)
17 Anom Romsiah/Waud L 3-12-2015 1/II 3-12-2015^ 7-12-2015^ 14-2-2016^ 6-4-2016^ 3-8-2016^ 7-12-2015^ 14-2-2016^ 2-7-2016^ 3-8-2016^ 2-11-2016^ Bd. F(3,1)
18 Reva Merisca Muniroh/Riski P 19-12-2015 5/II 19-12-2015^ 21-12-2015^ 29-2-2016^ 21-12-2015^ Bd.F(3,1)
Defita Aura Afandi Riski/Irfan L 17-12-2015 4/I 17-12-2015 14-11-2016^ 20-2-2016^ 26-3-2016^ 25-4-2016^ 14-1-2016^ 20-2-2016^ 26-3-2016^ 25-4-2016^ 24-9-2016^ RB rahma((3,2)
19 Yhegis Rafansya Turini/Ratmo L 26-12-2015 1/II 26-12-2015^ 15-2-2016^ 6-4-2016^ 9-5-2016^ 2-7-2016^ 9-5-2016^ 9-5-2016^ 2-7-2016^ 7-9-2016^ 2-11-2016 Bd.F(3,1)

Imunisasi yang diberikan


No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang
1 Viona Tasya Taryuni /Cipto P 1-1-2016 4/I 1-1-2016 13-1-2016 5-3-2016 5-4-2016 6-5-2016 13-1-2016 5-3-2016 5-4-2016 6-5-2016 12-10-2016 Bd Ety(4)
2 Alesha Zahra Deliah/Dedi P 27-1-2016 4/I 27-1-2016 29-2-2016 6-4-2016 8-5-2016 2-7-2016 8-5-2016 8-6-2016 2-7-2016 7-9-2016 RB.Rhm(2,9)
3 Noval Abbiyu Anita Carolina/Waryo L 16-2-2016 1/II 16-2-2016 21-3-2016 21-5-2016 20-6-2016 4-8-2016 21-5-2016 20-6-2016 4-8-2016 7-9-2016 RSUK(2,7) SC
4 Abi Naufal Rumarni/Carkidin L 1-3-2016 1/II 1-3-2016 7-4-2016 9-5-2016 2-7-2016 5-10-2016 10-3-2016 9-5-2016 2-7-2016 5-10-2016 RSI(3,5)
5 Al-Khalif Zhikri A Intan Fitriyaningsih/Satrianto L 8-3-2016 4/I 9-3-2016 8-5-2016 8-6-2016 14-7-2016 15-8-2016 8-5-2016 8-6-2016 14-7-2016 15-8-2016 RB.KI93,6)
6^ Raisha Callista Desi Nurhalimah/Ainur L 14-3-2016 1/II 14-3-2016 28-4-2016 5-6-2016 3-8-2016 5-10-2016 28-4-2016 5-6-2016 3-8-2016 5-10-2016 RSI (3,2)
7 Asyifa Nurhamidah/Romi P 4-4-2016 4/I 4-4-2016 25-4-2016 19-6-2016 24-7-2016 3-9-2016 25-4-2016 19-6-2016 24-7-2016 3-9-2016 Bd.F(2,6)
8 Muh. Faizal Suci/Nano L 9-4-2016 4/I 10-4-2016 11-5-2016 9-6-2016 9-7-2016 9-8-2016 11-5-2016 9-6-2016 9-7-2016 9-8-2016 Bd.E(3,9)
9 Satria Rizki Alfatih Desi/Sandi L 15-4-2016 4/I 15-4-2016 20-5-2016 21-6-2016 21-7-2016 23-8-2016 20-5-2016 21-6-2016 21-7-2016 23-8-2016 RB.Rhm(3,2)
10 Kenzi Saputra Maryati/Rakijan L 18-4-2016 5/II 19-4-2016 19-5-2016 19-6-2016 2-11-2016 19-5-2016 19-6-2016 2-11-2016 Bd.T(3,7)
11 Revalina Putri Eli Rahayu/Nurokhman P 19-4-2016 1/II 19-4-2016 27-4-2016 19-6-2016 25-7-2016 7-9-2016 27-4-2016 19-6-2016 25-7-2016 7-9-2016 RB.Rhm(3,2)sc
12 Argani Hasyif Gunaedi/Dewi K L 14-5-2016 4/I 16-5-2016 8-6-2016 14-7-2016 14-8-2016 14-9-2016 8-6-2016 14-7-2016 14-8-2016 14-9-2016 Bd.E(3)
13 Syahdan Daril A Sri Ruhimi/Daryanto L 12-6-2016 4/I 12-6-2016 27-7-2016 24-8-2016 29-9-2016 31-10-2016 20-6-2016 24-8-2016 29-9-2016 31-10-2016 Rb.Rhm(2,8)
13 Anasya Adrena S. Widiawati/Warto P 17-6-2016 1/II 17-6-2016 18-7-2016 18-8-2016 18-10-2016 18-7-2016 18-8-2016 18-10-2016 Bd.T(3,4)
14 Ramadhan Alfarizki Bella/Waryono L 21-6-2016 4/I 22-6-2016 13-7-2016 17-8-2016 17-9-2016 17-10-2016 13-7-2016 17-8-2016 17-9-2016 17-10-2016 Bd.E(3,2)
15 Hafiz Farizki Asih Widyarti/Nurokhman L 27-6-2016 1/II RSUK(2,1)SC
16 Riyadi Nuriyah/Heri L 13-7-2016 5/II 13-7-2016 25-7-2016 2-11-2016 25-7-2016 2-11-2016
17 Azahra Taskiyatun N Puput Elfandari/Raga P 3-8-2016 4/I 3-8-2016 RSI(3.2)
18 Lovy Ranesya Z Lasputri/Sudirman P 7-8-2016 1/II 7-8-2016 7-9-2016 2-11-2016 13-8-2016 5-10-2016 2-11-2016 Bd.T(3,2)
Teti Anugrahsari/Yudi L 23-8-2016 4/I BAYI PLUS TGL 28-8-2016 Bd.A(2,9)
19 Fasya Shakeel Ibrahim Indah/Syahroni L 25-8-2016 5/II 25-8-2016 3-10-2016 2-11-2016 1-9-2016 3-10-2016 2-11-2016 RSUK(3,4)SC
20 Alvin Faiz Maezun/A.Nahrawi L 5-9-2016 5/II 5-9-2016 2-11-2016 Bd.T(3)
21 Adinda Septiani Murni/Sutiman P 19-9-2016 4/I 19-9-2016 3-10-2016 RSI(3,1)SC
22 Kiki Septiana/Hengki P 30-9-2016 5/II 30-9-2016 Bd.T(3)
23 Najmi Hafizah Usman Trisna Itia/Aji Yulia P 1-10-2016 4/I 1-10-2016 RSI(2,2)SC
24 Najma Hamidah Usman Trisna Itia/Aji Yulia P 1-10-2016 4/I 1-10-2016 RSI(2,1)SC

Imunisasi TT
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Nur Faizah/Indra M 4/I 11-8-2014
2 Darsiti/Toto M 4/I 18-8-14
3 Selvi/Rosidin M 1/II 20-8-2014
4 Astuti/Karto M 4/I 20-9-2014
5 Uswatun/Supri M 1/II -9-2014
6 Endang S/Rasmun M 1/II 11-10-2014 8-11-14
7 Eka Silviana/Rasidin M 1/II 24-10-14
8 Wartinah/Sandi M 1/II 8-11-14
9 Sayati/Riyanto M 4/I 8-11-2014
10 Wiehati/Sultoni M 4/I 8-11-2014
11 Saerah/Syaefudin M 1/II 8-11-2014
12 Rizky/Tanto M1/II 23-12-2014
13 Rini/Darso M 4/I 26-11-2014
Imunisasi TT
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Khana Rosidah/Toni M 4/I 14-1-2015
2 Rini/Darso M 4/I V
3 Indah/Andri M 1/II 27-1-2015 6-5-15
4 Turatih/Carmadin M 1/II 21-2-2015
5 Darsinih/Karman M 1/II 16-3-2015
6 Rizky/Tanto M 1/II 26-1-15
7 Tri Hendrayani M 5/II 6-4-2015
8 Lusiati/Usman M 4/I 7-4-2015
9 Asih Widiarti M 1/II 6-4-2015C
10 Widyawati/Warto M 1/II 14-4-2015C
11 Meli/Darkiman M 1/II 4-4-2015 4-5-15
12 Rodiah/Surono M 1/II 4-4-2015
13 Romsiyah/Waud M 1/II 12-6-2015
14 Zakiyah/Ahmad M 1/II 9-6-15
15 Siti Darojah/Kasrini M 2/II 28-6-2015
16 Deliah/Dedi M 4/I 24-7-2015
17 Karlina/Adi M 5/II 13-8-2015 14-9-2015
18 Noviatul/Rohmadi M 1/II 15-8-2015
19 Kartika/Dedi Rudianto M 4/I 31-8-2015C
20 Taryuni/Cipto M4/1 3-9-2015
21 Nurfaizah/Rahmat M1/II 1-10-2015
22 Desi Nur.H/Aenur M1/II 19-10-2015
23 Saniti/Warsono M5/II 12-11-2015C
24 Rizky M4/1 11-8-2015
25 Eli Rahayu/Nurochman M 1/II 7-12-2015
Imunisasi TT
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Intan F/Satrianto M 4/1 15-1-2016 19-2-2016
2 Wuningsih/Hendrik M4/II 4-2-2016
3 Eli/Nurohman M 1/2 18-1-2016
4 Widiawati/warto M1/2 31-1-2016 3-3-2016
5 Eli Rahayu/Nurochman M 1/II 18-1-2016
6 Bella Oktavia M 4/I 29-2-2016
7 Teti Anugrah/Yudi S M 4/I 14-3-2016C
8 Sri Ruhimi/Daryanto M 4/I 23-4-2016
9 Murni/ Sutiman M 4/ I 27-5-2016 14-7-2016
10 Dewi Ruhmana/Adi B M 1/2 4-8-2016
11 Sasunih/Mustofa M 1/2 3-8-2016
12 Apriyani/Hendra M5/2 12-7-2016
13 Sinta/Debi M1/2 28-7-2016
14 Dewi/Tomi M 4/I 5-8-2016
LAPORAN BULANAN IMUNISASI BAYI
POSYANDU NUSA INDAH

Imunisasi yang diberikan


No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang
1

Imunisasi yang diberikan


No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang
1

Imunisasi yang diberikan


No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang
1 Mia Maharani R Casuni/ P 21-2-2011 2/II
2 Vanesa Wahyudi/Revi P 15-3-2011 1/II
3 A.Galam Fairus Hendro/Ana Takarina L 15-3-2011 2/II
4 Aliya Apriliani Tarisno/Dulloh P 30-4-2011 2/II
5 Khaerul R Sunarti L 1-5-2011 3/II
6 Lisna Apriliani Karman/Darsini P 5-5-2011 1/II
7 Syifa Nur Husna Sukemi/Sohimin P 22-5-2011 3/II 18-7-2011 18-8-2011 12-10-2011 24-11-2011 18-7-2011 18-8-2011 20-12-2011 11-4-2012 14-5-2012
8 Glasdy FA Janu/Kurnia P 26-5-2011 2/II
9 Steven Aldi Darmojo/Wiwit L 1-7-2011 3/II
10 Adiksa M Alamul/Ruri L 25-7-2011 2/II
11 Ghiusofilla Azka Sinta/Rois P 26-7-2011 3/II
12 Nurul Nizam M Saprudin/Muniroh L 21-8-2011 2/II
13 Arya Yuli L 23-10-2011 2/II 14-8-2014*
14 Arya Pangestu Rusdi/Yuliana L 23-10-2011 2/II
15 Arya Pangestu Rusdi/Yuliana L 23-10-201 1/II
16 Adinda Asya N Surdini/Warsito P 1-11-2011 2/II 2-11-2011 10-11-2011 1-1-2012 1-2-2012 2-3-2012 1-1-2012 1-2-2012 2-3-2012 11-4-2012 10-8-2012 14-8-2014*
17 Yogi Rifaldi Darmidi/ L 30-11-2011 3/II
18 Rizka P 18-12-2011 14-8-2014*
19 Riska Ananda N Suniti/ P 18-12-2011 2/II

Imunisasi yang diberikan


No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang
1 Faeza Attarrayhan Kiano Sri Tunasih/Iyan Heryana L 3-1-2012 5/II 4-1-2012 8-2-2012 14-3-2012 14-4-2012 23-5-2012 8-2-2012 14-3-2012 14-4-2012 23-5-2012 7-10-2012
2 M.Nurozak Dewi/Joni L 17-1-2012 2/II 21-1-2012 10-2-2012 17-3-2012 10-10-2012 10-11-2012 10-2-2012 17-3-2012 10-10-2012 10-11-2012 17-12-2012
3 Febrina Evi Riyani/Wawan P 3-2-2012 2/II 3-2-2012 10-2-2012 11-4-2012 17-5-2013 15-6-2013 10-2-2012 11-4-2012 17-5-2013 15-6-2013 10-2-2013
4 Nizam Khoirul Anam Uun Kurniasih/Yuli Eko L 18-2-2012 5/II 18-2-2012 20-2-2012 24-4-2012 29-5-2012 29-6-2012 20-2-2012 24-4-2012 29-5-2012 29-6-2012 5-12-2012
5 Egison Giovino Carti/Tarno L 20-2-2012 2/II 20-2-2012 MENOLAK 11-4-2012 11-7-2012 MENOLAK
6 M.Anam Maulana Widiyanti/M.Wahyudi L 24-2-2012 1/II 24-2-2012 10-3-2012 24-4-2012 24-5-2012 24-6-2012 10-3-2012 24-4-2012 24-5-2012 24-6-2012 26-11-2012
7 M.Kama Revano Taripah/Suwarno L 26-2-2012 1/II 26-2-2012 26-5-2012 2-5-2012 26-7-2012 29-8-2012 26-5-2012 26-7-2012 29-8-2012 10-10-2012 17-12-2012
8 Noval Arli Muzaki Yuliani/Taryono L 25-2-2012 5/II 25-2-2012 16-4-2012 16-5-2012 16-6-2012 23-7-2012 16-4-2012 16-5-2012 16-6-2012 23-7-2012 5-12-2012
9 Asyifa Rohana/Daryono P 6-3-2012 5/II 6-3-2012 10-4-2012 7-5-2012 11-7-2012 14-8-2012 10-4-2012 7-5-2012 11-7-2012 14-8-2012 17-12-2012
10 Zidan Asyar Aki Juningsih/Solihin L 16-3-2012 1/II V 20-4-2012 20-5-2012 20-6-2012 20-7-2012 20-4-2012 20-5-2012 20-6-2012 20-7-2012 20-12-2012
11 Vayissa Naila Salsabila Nur Chasanah/Kariman P 20-3-2012 2/II 20-3-2012 30-4-2012 9-5-2012 16-6-2012 16-7-2012 11-4-2012 9-5-2012 16-6-2012 16-7-2012 20-12-2012
12 Adinda Puspita Sari Kusniati/Ruslani P 4-4-2012 3/II 4-4-2012 4-5-2012 16-6-2012 1-8-2012 11-9-2012 4-5-2012 16-6-2012 1-8-2012 11-9-2012 7-1-2013
Dede Indra Maemunah/Dede H L 6-4-2012 5/II 6-4-2012 20-4-2012 PINDAH 20-4-2012 JAKARTA
13 M.Syarif Noviana/Riswanto L 11-4-2012 1/II 11-4-2012 10-5-2012 10-6-2012 11-7-2012 15-8-2012 10-5-2012 10-6-2012 11-7-2012 15-8-2012 20-2-2013
14 Abyan Gaza Diah Santi/Hadiansyah L 16-4-2012 2/II v 25-4-2013 19-6-2012 16-8-2012 18-10-2012 25-4-2013 19-6-2012 16-8-2012 18-10-2012 28-3-2013
15 M.Egi Atalah Sumirah/Ratno L 18-4-2012 1/II 18-4-2012 10-5-2012 21-6-2012 21-7-2012 31-8-2012 10-5-2012 21-6-2012 21-7-2012 31-8-2012 10-2-2013
16 M.Fariz Salam Tarwinah/Wanto L 19-4-2012 2/II 19-4-2012 28-5-2012 4-7-2012 8-8-2012 10-10-2012 28-5-2012 4-7-2012 8-8-2012 10-10-2012 22-4-2013
17 Karendra Erman A Erniyati/Imam Faroji L 8-5-2012 1/II 8-5-2012 9-7-2012 9-8-2012 8-9-2012 5-12-2012 9-7-2012 9-8-2012 8-9-2012 5-12-2012 8-4-2013
Dafid Carini/Amin L 11-5-2012 3/II 11-5-2012 23-5-2012 11-7-2012 TIDAK 23-5-2012 11-7-2012 8-8-2012 ADA
18 Ahmad Hilal Tuti H/Rardiyan L 14-5-2012 2/II 14-5-2012 10-6-2012 17-7-2012 21-8-2012 1-10-2012 10-6-2012 17-7-2012 21-8-2012 1-10-2012 1-4-2013
19 M.Fadli Reni P/Andri Nugroho L 30-5-2012 3/II v 10-6-2012 12-8-2012 23-9-2012 23-10-2012 10-6-2012 12-8-2012 23-9-2012 23-10-2012 22-4-2013
20 Muh.Khoirul Azam Kunaeni/Kamilin L 7-6-2012 3/II 7-6-2012 10-7-2012 8-8-2012 10-9-2012 10-10-2012 10-7-2012 8-8-2012 10-9-2012 10-10-2012 1-7-2013 14-8-2014*
21 Mohamad Rekhan Rani Setevilia/Kandar L 25-6-2012 2/II 25-6-2012 20-7-2012 28-8-2012 5-10-2012 8-12-2012 20-7-2012 28-8-2012 5-10-2012 8-12-2012 10-4-2013
22 Zulva Harum Zakaria Agusti/Tarhadi P 27-6-2012 1/II 27-6-2012 10-7-2012 5-9-2012 5-12-2012 2-1-2013 10-7-2012 5-9-2012 5-12-2012 2-1-2013 8-4-2013
Nadin Dea Devita P 7-7-2012 5/II 7-7-2012 10-7-2012 TIDAK 10-7-2012 ADA
23 M.Zigit Prayogi Dimas Suroyo L 13-7-2012 4/II 13-7-2012 24-9-2012 15-10-2012 23-2-2013 23-3-2013 24-9-2012 13-3-2013 GIZI BURUK
24 Prastio A Yuyun/Ansori L 3-8-2012 3/II 3-8-2012 10-9-2012 19-10-2012 20-11-2012 22-12-2012 10-9-2012 19-10-2012 20-11-2012 22-12-2012 20-5-2013
25 Zulfikar Kamal Thorio Julipah/Carmuad L 13-8-2012 2/II 13-8-2012 10-9-2012 15-10-2012 16-11-2012 17-12-2012 10-9-2012 15-10-2012 16-11-2012 17-12-2012 20-5-2013 14-8-2014*
26 Syaif Ramadani Wasnah/Rastoni L 16-8-2012 1/II 16-8-2012 15-10-2012 12-11-2012 17-12-2012 18-1-2013 15-10-2012 12-11-2012 17-12-2012 18-1-2013 17-7-2013
27 Nafisya Naya Safitri Muslicha/Taryono P 23-8-2012 5/II 24-8-2012 10-9-2012 10-11-2012 12-12-2012 21-1-2013 10-9-2012 10-11-2012 12-12-2012 21-1-2013 10-6-2013
28 Zahwa Juanita Rosdiyana Wati/Sukyat P 24-8-2012 2/II 24-8-2012 9-10-2012 24-10-2012 26-11-2012 26-12-2012 24-10-2012 26-11-2012 26-12-2012 28-5-2013 28-5-2013
29 M.Reza Erlangga Warsiyah/Rasmani L 29-8-2012 3/II 29-8-2012 10-10-2012 29-11-2012 28-1-2013 28-2-2013 10-10-2012 29-11-2012 28-1-2013 28-2-2013 25-7-2013
30 Esa Bima Sumiati/Suharjo L 24-9-2012 2/II 24-9-2013 20-2-2013 26-6-2013
31 Ahlul Nizar Argya Kristiyaningsih/Nur Yatin L 28-9-2012 1/II 28-9-2012 10-12-2012 28-11-2012 28-12-2012 28-1-2013 28-11-2012 28-12-2012 28-1-2013 3-7-2013 20-7-2013
32 Kafahairun Kusendang/Kartono L 1-11-2012 3/II 1-11-2012 5-12-2012 7-1-2013 27-3-2013 27-5-2013 5-12-2012 7-1-2013 27-3-2013 27-5-2013 30-9-2013 15-10-2015#
33 Dani Alvin St.Komisah/Ipul L 20-11-2012 3/II 20-11-2012 10-12-2012 12-1-2013 16-2-2013 22-3-2013 10-12-2012 12-1-2013 16-2-2013 22-3-2013 20-8-2013
34 Dava Rizqi Pratama Supriyatin/Tri Yuwono L 21-11-2012 5/II 21-11-2012 5-1-2013 5-2-2013 5-3-2013 6-4-2013 5-1-2013 5-2-2013 5-3-2013 6-4-2013 5-9-2013
35 Yogi L 30-11-2012 14-8-2014*
36 Levina Amelia Siti Nur Alfianita/Edi P P 30-12-2012 1/II 30-12-2012 4-2-2013 4-3-2013 5-4-2013 6-5-2013 4-2-2013 4-3-2013 5-4-2013 6-5-2013 20-11-2013
37 Abbasy Brillan Restu A Kusriyanti/Darmanto L 31-12-2012 2/II 31-12-2012 11-2-2013 9-3-2013 13-4-2013 28-8-2013 11-2-2013 9-3-2013 13-4-2013 28-8-2013 30-9-2013 12-8-2015# 15-10-2015#

Imunisasi yang diberikan


No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang
1 Nurul H Novi W/Kusni P 2-2-2013 3/II 2-2-2013 10-2-2013 13-3-2013 13-4-2013 10-6-2013 10-2-2013 13-3-2013 13-4-2013 10-6-2013 10-12-2013 Bd.F(3,1)
2 Azri Hafis Nur Firdaus Nur Faidah/Rahmat L 6-3-2013 1/II 6-3-2013 10-3-2013 10-5-2013 12-6-2013 13-7-2013 10-3-2013 10-5-2013 12-6-2013 13-7-2013 13-12-2014* 3-6-2015# RSMK(3,5)
3 Muh.Fajri Waskinah/Sukro L 12-3-2013 1/II 12-3-2013 22-4-2013 MENOLAK 22-4-2013 MENOLAK
4 Naifa Prasetyani Rismah F/Suprayitno P 13-3-2013 2/II 13-3-2013 10-5-2013 10-6-2013 20-7-2013 20-8-2013 10-5-2013 10-6-2013 20-7-2013 20-8-2013 20-3-2014* 12-8-2015# 13-1-2016^ Bd.F(2,9)
5 Moh.Hanif Riyanto Witriyaningsih/Riyanto L 3-5-2013 2/II 3-5-2013 10-5-2013 11-7-2013 12-8-2013 29-9-2013 10-5-2013 11-7-2013 12-8-2013 29-9-2013 20-2-2014* Bd.F(2,5)
6 Faeyza Agashar Cuci Lawati/Eko Hardi W L 8-5-2013 1/II 9-5-2013 5-6-2013 8-7-2013 8-8-2013 8-9-2013 5-6-2013 8-7-2013 80-8-2013 8-9-2013 10-2-2014* 15-10-2015# Bd.E(2,7)
Moh.Bayu St.Kholifah/Wasno L 8-5-2013 3/II 8-5-2013 22-5-2013 8-7-2013 14-8-2013 15-9-2013 22-5-2013 8-7-2013 14-8-2013 15-9-2013 12-2-2014* PINDAH JAWA TIMUR Bd.E
7 Dian Kayla Arisna Rina/Aris Sunandar P 10-5-2013 3/II 10-5-2013 26-5-2013 16-7-2013 28-8-2013 29-9-2013 26-5-2013 16-7-2013 28-8-2013 29-9-2013 27-9-2014* RB.Khr(3,0)
Indah/Ronito P 26-6-2013 5/II 26-6-2013 PINDAH RSUK(2,7)
8 Hafiza Suheti/M.Teguh P 26-6-2013 2/II 26-6-2013 19-7-2013 4-9-2013 4-10-2013 5-11-2013 4-9-2013 4-10-2013 5-11-2013 7-12-2013* 14-5-2014* 15-10-2015# RB.Rhm(3,4)
9 Nurul Syafaatul Chairi Muslikha/Hariyanto P 9-7-2013 4/II PINDAHAN POSY. CEMPAKA 5-6-2014* Bd.L(3,5)
10 Muhafizd Alwi R Dewi R/A.Khamidun L 16-7-2013 2/II 16-7-2013 26-8-2013 23-9-2013 23-10-2013 23-11-2013 23-7-2013 23-9-2013 23-10-2013 23-11-2013 5-5-2014* 15-10-2015# RSI(3,6)
Risya Fadila Rahmadani Sri Tanti/Aris Efendi P 25-7-2013 5/II 25-7-2013 20-8-2013 3-10-2013 8-11-2013 8-12-2013 20-8-2013 3-10-2013 8-11-2013 8-12-2013 PINDAH LAMPUNG Bd.F(2,75)
11 Fitriana Rahmadhani Tanti Purwanti/Rosito P 25-7-2013 2/II 26-7-2013 10-9-2013 27-9-2013 27-10-2013 28-11-2013 27-9-2013 27-10-2013 28-11-2013 15-10-2015#
12 Vera Sri Mulyani Tursinah/Waryono P 19-9-2013 2/II 22-9-2013 10-11-2013 11-12-2013 10-1-2014* 10-2-2014* 10-11-2013 11-12-2013 10-1-2014* 10-2-2014* 11-6-2014* 12-8-2015# 15-10-2015# RSIAKI(3)sc
Maya Azmi Oktaviani Windriyani/Tedi Irawan P 4-10-2013 3/II 4-10-2013 21-10-2013 5-12-2013 PINDAH 21-10-2013 5-12-2013 PESLOR RSUK(3,2)
Taryuni L 7-10-2013 2/II 10-10-2013 BREBES 10-10-2013 BREBES Tamu
13 Muchammad Dzulfikar Yunizar Firdaus/Alfin M L 10-10-2013 2/II 10-10-2013 25-11-2013 13-1-2014* 17-2-2014* 17-3-2014* 25-11-2013 13-1-2014* 17-2-2014* 17-3-2014* 21-7-2014* 10-8-2015# 15-10-2015# RSUK(3,5)
14 Arfa Talitha Az-Zahra Nofa Tuti Haryati/Tarjuman P 14-10-2013 2/II 14-10-2013* 5-12-2013* 7-1-2014* 7-2-2014* 7-3-2014* 5-12-2013* 7-1-2014* 7-2-2014* 7-3-2014* 10-8-2014* Bd.Tkmh(3,1)
15 Diva Aulia Putri Sulasmi/Karsudin P 1-11-2013 3/II 1-11-2013 20-11-2013 8-1-2014* 17-3-2014* 28-4-2014* 20-11-2013 8-1-2014* 17-3-2014 28-4-2014* 15-9-2014* 15-10-2015# Bd.F(3,1)
16 Delia Luri Suniti/Kalimun P 6-12-2013 3/II 6-12-2013 16-1-2014* 6-2-2014* 6-3-2014* 6-4-2014* 16-1-2014* 6-2-2014* 6-3-2014* 6-4-2014* 17-12-2014* Bd.E(3,4)
17 Citra Nadia Azzahra Toinah/Warja P 8-12-2013 2/II 8-12-2013 20-12-2013 9-2-2014* 8-3-2014* 8-4-2014* 20-12-2013 9-2-2014* 8-3-2014* 8-4-2014* 17-12-2014* Bd.F(3,5)
18 Putri Ayu Veronica Nok Indriyani/Kasnawi P 28-12-2013 3/II 28-12-2013 6-1-2014* MENOLAK 6-1-2014* MENOLAK 27-9-2014* Bd.F(2,9)
Imunisasi yang diberikan 28-8-15
No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak 14-10-15
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang
1 Zidni Ilman N Nur Aeni/Ipik L 22-1-2014 2/II 22-1-2014 10-2-2014 20-3-2014P 20-4-2014P 23-6-2014P 10-2-2014 20-3-2014 20-4-2014 23-6-2014 20-10-2014 25-8-2015# RB.Rhm(3,1)sc
2 Muhammad Fajar Sidik Sumiah/Sabi'is L 20-2-2014 2/II 20-2-2014 20-4-2014 5-5-2014P 6-6-2014P 2-7-2014P 20-4-2014 5-5-2014 6-6-2014 2-7-2014 24-11-2014 10-8-2015# RSIAKI(2,8)
3 M.Haikal Suci Juniroh/Said Aqil(DF/8) L 20-2-2014 1/II Posy Mlti 15-3-2014 25-5-2014P 27-6-2014P 6-8-2014P 15-3-2014 25-5-2014P 27-6-2014P 6-8-2014P 11-2-2015# RB.Khr(3,35)
Rafelio Tenswa M St.Maesaroh/Samsudin(DF/8) L 7-3-2014 2/II 7-3-2014 19-3-2014 7-6-2014P 9-7-2014P V 19-3-2014 7-6-2014 9-7-2014 PINDAH TEGALSARI RW 2 RB.Khr(3,8)
4 Aurel Dwi Apriliani Machani/Nurali Sahuri P 21-4-2014 2/II 21-4-2014 4-5-2014 23-6-2014P 6-8-2014P 8-9-2014P 4-5-2014 23-6-2014 6-8-2014 8-9-2014 16-2-2015 23-11-2015# Bd.F(3,1)
5 Bilqis Rasiyah/Tafrudin L 8-5-2014 1/II 9-5-2014 13-8-2014 13-8-2014# 17-10-2014# 17-12-2015# 13-8-2014 13-8-2014# 17-10-2014# 17-12-2015# 13-4-2015# RSIAKI(2,7)sc
6 Jibril Alkaisar Agus Sri Handayani/Nursaid L 29-7-2014 3/II 30-7-2014 10-9-2014 30-9-2014 29-10-2014# 7-12-2014# 10-9-2014 30-9-2014 29-10-2014# 7-12-2014# 7-5-2015# RSI(2,6)
7 Zen Abdillah Ropiah/Juned L 7-8-2014 2/II 7-8-2014 11-8-2014 27-10-2014P 1-12-2014P 12-2-2015# 11-8-2014 27-10-2014 1-12-2014 12-2-2015# 22-6-2015#
8 Azkia Saufa Sabna Shinta Amalia/Rois P 9-9-2014 3/II 10-9-2014 15-10-2014 5-1-2015# 9-2-2015# 29-4-2015# 15-10-2014 5-1-2015# 9-2-2015# 29-4-2015# 10-8-2015# 11-4-2016^ 26-9-2016^ RB.Khr(3)
9 Sawika Wati/Rakimang(DF/8) L 29-9-2014 3/II 29-9-2014 12-11-2014 29-12-2014# 18-5-2015# 12-11-2014 29-12-2014# 18-5-2015# Bd.E(3,9)
10 Rafi Pangestu Riyanti L 12-10-2014 2/II 13-10-2014 12-11-2014# 16-12-2014# 19-1-2015# 3-3-2015# 12-11-2014# 16-12-2014# 19-1-2015# 3-3-2015# 29-7-2015# RSIAKI(3,4)sc
Aqsa Bramasta Setyaningsih/Khaerudin L 28-10-2014 2/II 28-10-2014 1-12-2014 29-12-2014# 2-2-2015# 11-3-2015# 1-12-2014 29-12-2014# 2-2-2015# 11-3-2015# 10-8-2015# PINDAH MOGA RSUK(3,2)
11 Hafidz Putra Windi Astuti/Nurcholis L 6-11-2014 3/II 7-11-2014 17-12-2014 8-1-2015# 14-2-2015# 17-3-2015# 17-12-2014 8-1-2015# 14-2-2015# 17-3-2015# 12-8-2015# 17-5-2016^ Bd.E(3)
12 Ulfa Danisa Marwati/Deni P 28-11-2014 2/II 28-11-2014# 1-12-2014 1-12-2014# 16-3-2015# 20-4-2015# 1-12-2014 1-12-2014# 16-3-2015# 20-4-2015# 28-9-2015# 8-6-2016^ Bd.F(2,8)
13 Alfiyah Putri S Khalimatus S/Hermanto P 7-12-2014 2/II 8-12-2014# 29-12-2014 8-2-2015# 16-3-2015# 20-4-2015# 29-12-2014 8-2-2015# 16-3-2015# 20-4-2015# 14-9-2015# 8-6-2016^ Pusk(2,7)
14 Earlita asifa Salsabila Iin Tarlina/Tandriono P 8-12-2014 2/II 8-12-2015# 14-1-2015# 27-2-2015# 27-3-2015# 4-5-2015# 14-1-2015# 27-2-2015# 27-3-2015# 4-5-2015# 16-9-2015# RB.Khr
15 Bilzan Kiki Asmaya W/Rasun(DF/10) L 14-12-2014 2/II 15-12-2014# 14-1-2015# 14-2-2015# 14-3-2015# 25-5-2015# 14-1-2015# 14-2-2015# 14-3-2015# 25-5-2015# 15-10-2015# Bd.E(3,7)
16 Adhelia Faraswati Kiki(DF/10/1) P 24-12-2014 2/II 24-12-2014 17-1-2015# 30-3-2015# 3-4-2015# 8-6-2015# 17-1-2015# 30-3-2015# 3-4-2015# 8-6-2015# 14-10-2015#DF RB.Khr
17 Elisa Nur Azahra Rosilah/Tohir(DF/10) P 30-12-2014 2/I 30-12-2014# 19-1-2015# 2-3-2015# 27-4-2015# 25-5-2015# 19-1-2015# 2-3-2015# 27-4-2015# 25-5-2015# 15-10-2015#DF RSIAKI(3,2)sc
Imunisasi yang diberikan
No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang
Rafa Alfarizi Rindih Atika/Fendra L 3-1-2015 1/II 3-1-2015 5-2-2015 5-3-2015 5-4-2015 10-5-2015 5-2-2015 5-3-2015 5-4-2015 10-5-2015 PINDAH Bd.Las
1 Susi Sugiarti Rodiah/Tobari(DF/10) P 27-1-2015 2/II 27-1-2015 5-2-2015 12-8-2015 15-10-2015 5-2-2015 12-8-2015 15-10-2015 MENOLAK Bd.F
2 Aditia Dwi Prasetya Junani/Tarsudin(DF/8) L 1-3-2015 2/II 1-3-2015 4-3-2015 22-6-2015 28-9-2015 26-10-2015 4-3-2015 22-6-2015 28-9-2015 26-10-2015 15-11-2016^ Bd.F
3 Meviana Marisa/Iscandra P 22-3-2015 2/II 22-3-2015 15-4-2015 22-5-2015 22-6-2015 22-7-2015 15-4-2015 22-5-2015 22-6-2015 22-7-2015 13-1-2016 Bd.E(3,2)
1^ Rafel Nihamzi Nilah Agustin/Suhandi(DF/8/10) L 16-4-2015 3/II 16-4-2015 13-5-2015 16-6-2015 13-5-2015 16-6-2015 Bd.E(2,6)
2 Muhammad Faris K Fahriatun A/Riswanto L 16-4-2015 3/II 16-4-2015 13-5-2015 9-7-2015 19-9-2015 19-10-2015 23-4-2015 9-7-2015 19-9-2015 19-10-2015 25-1-2016^
3 M.Hafis Ais(DF/8) L 16-4-2015 2/II 16-4-2015 13-5-2015 26-6-2015 19-9-2015 19-10-2015 13-5-2015 26-6-2015 19-9-2015 19-10-2015 RB.Khr
4 M.Rizki Dermawan Tareda/Rosidi L 28-4-2015 3/II 29-4-2015 28-5-2015 10-7-2015 9-8-2015 20-9-2015 28-5-2015 10-7-2015 9-8-2015 20-9-2015 10-2-2016^ 29-10-2016^
Dwi Astuti Sugiyarti/Novel(DF/10) P 29-5-2015 3/II 30-5-2015 6-7-2015 12-8-2015 15-10-2015 15-12-2015 6-7-2015 12-8-2015 15-10-2015 15-12-2015 PINDAH MELATISARI 2 RSIAKI(2,9)sc
5 Fatir Al Fatih Z Indah/Andri Setiawan(DF/8/1) L 25-5-2015 1/II 25-5-2015 8-6-2015 27-7-2015 28-8-2015DF 25-9-2015 8-6-2015 27-7-2015 28-8-2015DF 25-9-2015 7-3-2016^
Subhaj Sutarti/Suheli L 19-8-2015 2/II 20-8-2015 16-9-2015 19-10-2015 19-11-2015 19-1-2016^ 16-9-2015 19-10-2015 19-11-2015 19-1-2016^ 10-8-2016^ Bd.E(2,7)
M. Al-Fatih Toat/ Novi L 29-8-2015 2/II 23-9-2015 12-10-2015 11-1-2016^ 18-8-2016^ 12-10-2015 11-1-2016^ 18-8-2016^
6 Arsa Rizki Kapsari/Sutrisna(DF/10/2) L 4-9-2015 2/II 4-9-2015 14-10-2015DF 4-11-2015 4-12-2015 4-1-2016^ 14-10-2015DF 4-11-2015^ 4-12-2015 4-1-2016^ RB.Rhm(3,2)
7 Tania Raniti/Warmo P 7-10-2015 2/II 8-10-2015^ 17-10-2015 3-1-2016^ 9-2-2016^ 17-10-2015 3-1-2016^ 9-2-2016^ Bd E(3,2)
8 Adrian Azka P Siti Darojah/Kasimin L 21-10-2015 2/II 21-10-2015^ 2-11-2015^ 21-12-2015^ 18-1-2016^ 22-2-2016^ 2-11-2015 21-12-2016^ 18-1-2016^ 18-4-2016^ 8-8-2016 RSUD(3,2)
9 Celsi Angeline Desi Lindrasi/Dedi P 21-10-2015 2/II 21-10-2015^ 21-11-2015^ 27-1-2016^ 20-5-2016^ 21-11-2015 21-12-2015^ 20-5-2016^ RB(3,1)
Bunga Mayang/Sanudin P 25-10-2015 2/II 25-10-2015 15-11-2015 15-11-2015 PINDAH JAKARTA Kli Adi P(3,1)
Alifah firmanza Yulia Mansasri/Tamam L 25-10-2015 5/IV 15-11-2015 15-11-2015 TIDAK ADA RSIA(3,1)
10 Jesika Komalasari Ayu Ningrum/Sarifin P 31-10-2015 3/II 2-11-2015^ 30-11-2015^ 1-1-2016^ 19-2-2016^ 19-3-2016^ 30-11-2015^ 1-1-2016^ 19-2-2016^ 19-3-2016^
11 Nizam rofi pratama Noviatul/Rohmadi L 15-11-2015 1/II 20-11-2015^ 10-1-2016^ 9-2-2016^ 15-3-2016^ 15-4-2016^ 10-1-2016^ 9-2-2016^ 15-3-2016^ 15-4-2016^ 19-6-2016^
12 Neyshia Nurzahwa Sunengsih/Ramidi P 18-11-2015 3/II 18-11-2015^ 12-12-2015^ 25-1-2016^ 29-2-2016^ 12-12-2015^ 25-1-2016^ MENOLAK Bd E(3,9)
13 Naura Ayu Syifa Warningsh /Sastro P 8-12-2015 2/II 8-12-2015^ 11-1-2016^ 3-3-2016^ 14-4-2016^ 20-5-2016^ 11-1-2016^ 14-4-2016^ 20-5-2016^ 21-6-2016^ RSI (4)
14 Raifiqoh Tarningsih/Tarrohan P 27-12-2015 2/II 31-12-2015 28-1-2016^ 29-2-2016^ 29-3-2016^ 29-4-2016^ 28-1-2016^ 29-2-2016^ 29-3-2016^ 29-4-2016^ 9-10-2016^
Imunisasi yang diberikan
No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang
1 Anindita Keska Santi/Agus P 3-1-2016 2/II 3-1-2016 21-3-2016 11-3-2016 18-4-2016 17-5-2016 11-3-2016 18-4-2016 17-5-2016 16-7-2016 19-9-2016 Bd F(2,9)
Abi Naufal Rumarni/Carkidin L 1-3-2016 1/II 1-3-2016 PINDAH POSY. ANGGREK RSI(3,5)
2 Raja Erlan Mega Daru/Warsito L 24-4-2016 2/II 24-4-2016 25-5-2016 28-6-2016 30-7-2016 31-8-2016 25-5-2016 28-6-2016 30-7-2016 31-8-2016 Bd.E(2,8)
3 Neysa Renita/M. Ishaludin P 7-5-2016 3/II 11-5-2016 30-5-2016 30-5-2016 16-7-2016 15-8-2016 30-5-2016 16-7-2016 15-8-2016 15-11-2016 PTB(3)
4 Dimas Aji P Daerah/Heri P L 16-5-2016 2/II 16-5-2016 8-6-2016 19-7-2016 20-9-2016 8-6-2016 19-7-2016 20-9-2016 Bd.E(2,9)
5 Kenzi Pratama Rani/Tri Mulyo L 29-5-2016 2/II 29-5-2016 13-7-2016 7-8-2016 7-9-2016 15-11-2016 13-7-2016 7-8-2016 7-9-2016 15-11-2016 Rhm.SC(2,8)
6 Anasya Adrena S. Widiawati/Warto P 17-6-2016 1/II 17-6-2016 18-7-2016 18-8-2016 PINDAH 18-7-2016 18-8-2016 ANGGREK Bd.T(3,4)
7 M.Zain Al-Qory Korotunisa/Warno L 21-6-2016 3/II 21-6-2016 1-8-2016 2-9-2016 3-10-2016 3-11-2016 1-8-2016 2-9-2016 3-10-2016 3-11-2016 Bd.E(2,7)
8 Juan Ramdika N Triyanah/Kholik L 26-6-2016 3/II 26-6-2016 14-8-2016 14-9-2016 14-8-2016 14-9-2016 Bd.T(3,2)
9 Altafandra Kenveran Wiwit/Safari L 15-7-2016 2/II 16-7-2016 19-9-2016 6-11-2016 19-9-2016 6-11-2016 RSUK(3)
10 Lovy Ranesya Z Lasputri/Sudirman P 7-8-2016 1/II 7-8-2016 PINDAH POSY. ANGGREK Bd.T(3,2)
11 Arjun Agustin Erika/Agus L 7-9-2016 2/II 7-9-2016 8-10-2016 9-11-2016 8-10-2016 9-11-2016 Bd.T(3,1)
12 M.Refan Alfarizi Dewi Maryam/Darkasih L 26-9-2016 3/II 26-9-2016 26-10-2016 26-10-2016 Bd.T(3,7)
13 Rizki Aulia P Anita/Dirman P 29-9-2016 2/II 29-9-2016 15-11-2016 15-11-2016 Bd.T(4)

Imunisasi TT
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Kiki Fatmala/Adi M 2/II 17-7-2014 10-9-2014
2 Sri Warningsih/Ghofar M 5/II 5-12-14 13-8-2014C
3 Marwati M 2/II 15-8-2014
4 Kiki/Rasin M 2/II 11-8-2014
5 Windi/Nurkholis M 3/II 29-8-2014
6 Marisa/Iscandra M 2/II 14-9-2014
7 Nilah/Subur M 3/II 29-9-2014
8 Iin Tarlina/Tardiono M 2/II 13-10-2014
9 Junani/Tarsudin M 2/II 12-11-2014
10 Daryuni/Khamrin M 2/II 11-11-14C
Imunisasi TT
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Nuryanti/Rosikin M 3/II 27-4-2015C
2 Sari M 2/II 30-5-2015
3 Ayuningrum/Saripin M 3/II 24-8-2015
4 Noviatul Janah M1/II 15-8-2015
5 Efa Lesti/Rasimun M 2/II 29-7-2015C
6 Tarini/Ratmo M 1/II 28-8-2015
7 Tarningsih/Tarnohan M 2/II 13-9-2015 10-10-2015
8* Muniroh/ Toni Dwi M 5/ II 3-10-2015 7-11-2015
9 Anita/Waryo M1/II 7-11-2015
10 Rani Stevalia/Tri M M2/II 16-12-2015
11 Ekawati/Slamet H M 3/II 18-12-2015C
Imunisasi TT
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Renita/Islal Hudin M 3/II 5-12-2015 18-1-2016
2 Rani Stevalia/Tri M M2/II 16-12-2015 18-1-2016
3 Suniti/Kalimun M 3/II 15-1-2016
4 Daerah/Heri Purwanto M 2/II 18-1-2016
5 Triyanah/ Kholik M 3/ 2 27-2-2016 28-3-2016
6 Kurotun Nisa/Warno M 3/II
7 wiwit winarsih/safari M2/II 12-4-2016
8 Erika Putriasih/Agus s M2/II 10-5-2016
9 Dewi Maryam/Darkasih M2/II 6-6-2016
10 Heti Kuresih/Roimah M2/II 5-6-2016
11 Ekawati/Slamet H M3/II 16-8-2016
12 Ratna/Irwan M2/II 12-8-16
13 Lela N/Kasim M 3/II 22-9-2016
14 Royani/Karno M1/II 4-10-2016
LAPORAN BULANAN IMUNISASI BAYI
POSYANDU CEMPAKA

Imunisasi yang diberikan


No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang
1

Imunisasi yang diberikan


No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang
1

Imunisasi yang diberikan


No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang
1 Yanuzar Ade Fuza Karnoto/Kunayah L 1-1-2011 4/II
2 Calysa Delya Hendrik/Wuri P 1-3-2011 4/II
3 Hapsah Anisa S Purwanto/Sartinah P 10-3-2015 4/II
4 Hasup Ahmad/Puput L 5-5-2011 4/II
5 Velinda Dakroni P 4-6-2011 4/II
6 Rima Septiana P 12-9-2011 4/II 16-7-2014*
7 Rima Septiana Khodijah/Sapari P 12-9-2011 4/II
8 Galuh Abdul Teguh/Susi L 28-9-2011 4/II
9 Reza Ferginansyah Rohayati/Tegin L 10-10-2011 4/II 10-10-2011 25-10-2011 21-12-2011 18-1-2012 21-3-2012 25-10-2011 21-12-2011 18-1-2012 21-3-2012 15-8-2012
10 Oriza Dinda Nurhasim/Rohana P 9-11-2011 4/II
11 Syahril Ica/Karim L 14-11-2011 4/II
12 Refan Sukram/Masitoh L 9-12-2011 4/II 16-7-2014*

Imunisasi yang diberikan


No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang
1 M.Syafrizal Taryuni/Imam B L 6-1-2012 4/II V 10-2-2012 10-3-2012 11-4-2012 11-5-2012 10-2-2012 10-3-2012 11-4-2012 11-5-2012 20-10-2012
2 Jeslyn Triningsh/Faturahman P 17-1-2012 4/II V V 16-5-2012 26-6-2012 20-9-2012 V 16-5-2012 26-6-2012 20-9-2012 26-11-2012
3 A.Wildan Pratama Rustini/A.Sarip L 21-1-2012 4/II MENOLAK
4 Rizki Adisa Maslikha/Wiyono L 5-2-2012 4/II V 8-2-2012 5-4-2012 7-5-2012 6-6-2012 8-2-2012 5-4-2012 7-5-2012 6-6-2012 26-11-2012
5 Elang Aquila K Somi Yessi/Edi Kartono L 11-2-2012 4/II 15-2-2012 15-2-2012 24-4-2012 16-7-2012 24-11-2012 15-2-2012 24-4-2012 16-7-2012 24-11-2012 10-12-2012
6 Reni Febriani Sri Herningsih/Rudi H P 11-2-2012 4/II 13-2-2012 5-4-2012 5-5-2012 5-6-2012 5-7-2012 5-4-2012 5-5-2012 5-6-2012 5-7-2012 19-12-2012
7 Rena Febriana Sri Herningsih/Rudi H P 11-2-2012 4/II 13-2-2012 5-4-2012 5-5-2012 5-6-2012 5-7-2012 5-4-2012 5-5-2012 5-6-2012 5-7-2012 19-12-2012
8 Hasan L 9-4-2012 4/II 16-7-2014*
9 M.Hasan Z Zulfa/M.Ali L 16-4-2012 4/II 16-4-2012 20-4-2012 25-6-2012 25-7-2012 25-8-2012 20-4-2012 25-6-2012 25-7-2012 25-8-2012 11-2-2013
10 Moh.Yusuf Fadillah Kartini/Sumarno L 21-4-2012 4/II 21-4-2012 10-5-2012 21-6-2012 2-8-2012 3-9-2012 10-5-2012 21-6-2012 2-8-2012 5-9-2012 10-2-2013
M.Rafi Aquila Ratna/Miftahudin L 7-5-2012 4/II v v v v v v v v v PINDAH
11 Tri Sandi Atma Aditiya Tarisah/Sutrisno L 10-5-2012 4/II V 20-6-2012 20-7-2012 3-9-2012 28-10-2012 20-6-2012 20-7-2012 3-9-2012 28-10-2012
12 Amanda Lisnawati/Casripan P 9-6-2012 4/II 9-6-2012 13-7-2012 3-10-2012 25-11-2012 13-7-2012 3-10-2012 25-11-2012
12 M.Reihan Ni'matul F/Haris L 13-6-2012 4/II 13-6-2012 18-7-2012 16-8-2012 16-9-2012 14-10-2012 18-7-2012 16-8-2012 16-9-2012 14-10-2012 13-7-2013 16-7-2014*
12 M.Yusuf Lusi T/Jirun L 28-6-2012 4/II 28-6-2012 8-8-2012 30-7-2012 30-8-2012 30-9-2012 8-8-2012 2-10-2012 30-8-2012 30-9-2012 28-3-2013 16-7-2014*
15 Dyaz Satriani Wiji/Samsudin P 28-6-2012 4/II 28-6-2012 15-8-2012 20-9-2012 22-10-2012 19-12-2012 15-8-2012 20-9-2012 22-10-2012 19-12-2012 7-5-2013
Fransiska Alya Trisna D.Amelia/Wat A P 2-7-2012 4/II 3-7-2012 13-8-2012 PINDAH 13-8-2012 PINDAH
16 Nizam Riko Chumaroh/Edi S L 11-7-2012 4/II 11-7-2012 10-8-2012 20-9-2012 18-6-2014 V 10-8-2012 20-9-2012 18-6-2014 V 26-1-2015 16-6-2015#
17 Nizam Alhabsy Sugiarti/Waskin L 20-7-2012 4/II 20-7-2012 20-7-2012 20-9-2012 22-10-2012 21-11-2012 20-7-2012 20-9-2012 22-10-2012 21-11-2012 20-6-2013 15-6-2015#
18 Friska Regina P Nurhikmah/Iwan P 31-7-2012 4/II 31-7-2012 8-8-2012 2-10-2012 22-12-2012 18-1-2013 8-8-2012 2-10-2012 22-12-2012 18-1-2013 V
19 Iska Aksan V Kardina Novi/Sunanda L 10-8-2012 4/II 10-8-2012 10-8-2012 10-10-2012 21-11-2012 23-1-2013 10-8-2012 10-10-2012 21-11-2012 23-1-2013 20-5-2013
20 Khoerul Ardiyanto Wikhaliyana L 26-8-2012 4/II 26-8-2012 10-10-2012 10-11-2012 10-12-2012 20-3-2013 10-10-2012 10-11-2012 10-12-2012 20-3-2013 20-7-2013
21 Sela Septiana Diari Santi/Wisnu P 13-9-2012 4/II 13-9-2012 24-9-2012 21-11-2012 20-12-2012 20-1-2013 24-9-2012 21-11-2012 20-12-2012 20-1-2013 12-5-2013
22 M.Nur Ikhsan Khomisah/Sujanah L 16-9-2012 4/II 16-9-2012 10-11-2012 24-11-2012 11-4-2013 15-5-2013 10-11-2012 11-4-2013 15-5-2013 26-7-2013 26-7-2013
23 Asraf Khairul A Ratnasari/Dedi L 23-9-2012 4/II 23-9-2012 12-11-2012 8-11-2012 12-12-2012 23-1-2013 8-11-2012 12-12-2012 23-1-2013 23-6-2013 23-6-2013 16-6-2015#
24 Naufal H Kikih/Fendi L 22-11-2012 4/II 22-11-2012 20-12-2012 22-1-2013 22-2-2013 23-3-2013 20-12-2012 22-1-2013 22-2-2013 23-3-2013 11-11-2013

Imunisasi yang diberikan


No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang
1 Denis Khoerul Nizar/Agus Zulmi L 31-1-2013 4/II 31-1-2013 20-2-2013 1-4-2013 6-5-2013 10-6-2013 20-2-2013 1-4-2013 6-5-2013 10-6-2013 11-11-2013 15-6-2015# 25-8-2015#
2 Muh.Afdal Fahrezi Sugiarti/Sukro L 18-2-2013 4/II 17-3-2013 25-3-2013 25-4-2013 27-5-2013 29-6-2013 25-3-2013 25-4-2013 27-5-2013 29-6-2013 25-1-2014* RB.Khr(3,1)
Galang Yoes E Yeti/Waridin L 24-2-2013 4/II 5-4-2013 5-5-2013 5-7-2013 23-8-2013 5-4-2013 5-5-2013 5-7-2013 23-8-2013 5-1-2014* TIDAK ADA
3 Silvana Anggraeni Eni Sasunih/Edi S P 15-4-2013 4/II 15-4-2013 20-4-2013 16-6-2013 15-7-2013 16-8-2013 20-4-2013 16-6-2013 15-7-2013 16-8-2013 27-4-2014* PINDAH JEPARA Bd.F(2,8)
4 Kanza Putri Adibha Rukayah/Eko Nurhadi P 27-4-2013 4/II 27-4-2013 20-5-2013 27-6-2013 27-7-2013 27-8-2013 20-5-2013 27-6-2013 27-7-2013 27-8-2013 10-2-2014* 25-5-2015# Bd.F(3,2)
5 M.Ridwan Atarik Luki/Sugino L 25-4-2013 4/II 26-4-2013 15-5-2013 17-6-2013 20-7-2013 21-8-2013 15-5-2013 17-6-2013 20-7-2013 21-8-2013 5-5-2014* RB.Khr(3,49)
6 Abdul Izya Ul Mudin Solikha/Sunardi L 14-6-2013 4/II 14-6-2013 20-7-2013 25-8-2013 25-9-2013 25-10-2013 20-7-2013 25-8-2013 25-9-2013 25-10-2013 25-5-2014* 16-6-2015# 21-10-2015# Bd.F(2,75)
7 Muhammad Sa'id St.Sulicha/Moh.Haryanto L 18-6-2013 4/II 18-6-2013 10-7-2013 20-8-2013 20-9-2013 20-10-2013 10-7-2013 20-8-2013 20-9-2013 20-10-2013 10-5-2014* 18-5-2015# 25-8-2015# Bd.F(3,6)
Nurul Syafaatul Chairi Muslikha/Hariyanto P 9-7-2013 4/II 14-7-2013 5-8-2013 25-9-2013 5-4-2014 8-1-2014* 5-8-2013 25-9-2013 5-4-2013 8-1-2014* PINDAH POSYANDU NUSA INDAH Bd.L(3,5)
8 Abdulah Nur Sultan Carini/Casidin L 19-7-2013 4/II 19-7-2013 7-10-2013* 25-9-2013 28-10-2013 27-11-2013 7-10-2013 25-9-2013 28-10-2013 27-11-2013* 19-5-2014* 21-10-2015# RSUK(3,1)sc
9 Gilang Rahmadani P Koriyah/Purnata L 6-8-2013 4/II 6-8-2013 20-8-2013 6-10-2013 4-11-2013 9-1-2014 20-8-2013 6-10-2013 4-11-2013 9-1-2014 20-7-2014* 25-5-2015# 17-9-2015# RSUK(32,7)
10 Pardo Iroh L 21-8-2013 4/II V 19-9-2013 17-10-2013 23-12-2013 2-4-2014 19-9-2013 17-10-2013 23-12-2013 2-4-2014 21-7-2014* 16-6-2015# 21-10-2015#
11 M.Ilham Maulana Suyanti/Sukro L 15-9-2013 4/II 15-9-2013 20-9-2013 23-11-2013 5-4-2014* 7-7-2014* 20-9-2013 23-11-2013 5-4-2014* 7-7-2014* 20-9-2014* 25-5-2015# 21-10-2015# Bd.F(3)
12 Adiba Toripah/Heri Setyono P 31-10-2013 4 /II 31-10-2013 20-11-2013 6-1-2014* 10-3-2014* 14-4-2014* 20-11-2013 6-1-2014* 10-3-2014* 14-4-2014* 5-9-2014* Bd.E
13 A.Noval Arif Salimah/Zaenal L 9-11-2013 4/II 11-11-2013 5-12-2013 9-1-2014* 8-2-2014* 8-3-2014* 5-12-2013 9-1-2014* 8-2-2014* 8-3-2014* 5-9-2014* 16-6-2015# 15-6-2016^ Bd.Las(3,5)

Imunisasi yang diberikan 8-8-15


No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak 21-10-15
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang
1 Haikal Hairul Susanti/Dulbari L 25-1-2014 4/II 25-1-2014 10-6-2014 12-5-2014 24-6-2014P 24-7-2014P 12-5-2014 10-6-2014 24-7-2014 20-11-2014 20-11-2014 21-10-2015# Brebes
2 Muh.Ikhsanudin Ice T/Takwan P 6-2-2014 4/II 6-2-2014 10-2-2014 18-6-2014P 21-7-2014P 27-10-2014P 10-2-2014 18-6-2014 21-7-2014 27-10-2014 22-12-2014# 17-9-2015# 19-10-2016^ Bd.F(3)
3 Fadhillah Wulandari Rusmiati/Wawan Herwanto(DF/8) P 10-2-2014 4/II 10-2-2014 12-3-2014 10-4-2014P 10-5-2014P 17-6-2014P 12-3-2014 10-4-2014 10-5-2014 17-6-2014 12-11-2015# 21-10-2015# 17-2-2016^ Bd.E(3.3)
4 Moh.Rizki Ainurohmah/Adi Triono L 28-2-2014 4/II 28-2-2014 16-4-2014 28-5-2014P MENOLAK 16-4-2014 28-5-2014 MENOLAK Bd.E(3,1)
5 Muh.Rifki Aditia Kastini/Imam Santoso L 16-4-2014 4/II 16-4-2014 4-5-2014 17-6-2014P 31-7-2014P 20-11-2014P 4-5-2014 17-6-2014 31-7-2014 20-11-2014 10-4-2015# 21-10-2015# Bd.F(3,3)
6 M.Bagas Safitri/Sugiman L 12-5-2014 4/II 12-5-2014 12-6-2014 12-7-2014P 12-8-2014P 13-9-2014P 12-6-2014 12-7-2014 12-8-2014 13-9-2014 28-5-2015# RB.Khr(3)
Arya Pratama Sri Rahayu/Suswono P 19-5-2014 4/II 19-5-2014 PLUS 16 JUNI 2014 Bd.E(2,6)
7 Arya Mangku Praja St.Mutmainah/Karmi L 24-5-2014 4/II 24-5-2014 16-6-2014 18-8-2014P 21-1-2015# 18-2-2015# 16-6-2014 18-8-2014 21-1-2015# 18-2-2015# 25-5-2015# 16-12-2015# 16-8-2016^ Bd.F(3,5)
8 Ananda Restu Nafi Rohayah/Amat L 25-5-2014 4/II 25-5-2014 16-6-2014 18-8-2014P 3-11-2014P 18-2-2015 16-6-2014 18-8-2014 3-11-2014 18-2-2015 1-6-2015# 21-10-2015# 19-10-2016^ Bd.F(3,1)
9 Serina Khaerrulisa Sukirah/Surono P 9-6-2014 4/II 10-6-2014 7-7-2014 9-8-2014P 8-9-2014P 8-10-2014P 7-7-2014 9-8-2014 8-9-2014 8-10-2014 20-4-2015# 16-12-2015# 22-8-2016^ Pusk(3,2)
10 M.Nurul Fahmi Tuti Wigati L 15-7-2014 4/II 15-7-2014 21-7-2014 25-9-2014P 29-10-2014P 30-11-2014P 21-7-2014 25-9-2014 29-10-2014 30-11-2014 10-5-2015# Bd.F(2,8)
Widya Ning/Imam Abdul L 22-8-2014 4/II 23-8-2014 TIDAK ADA RSI
Risa Rismawati/Moh.Erwin A L 22-8-2014 4/II 22-8-2014 TIDAK ADA RSI(3,35)
11 Mozza Sri Kuni P 26-8-2014 4/II 26-8-2014 17-9-2014 26-10-2014P 26-12-2014 26-1-2015 17-9-2014 26-10-2014 26-12-2014 26-1-2015 9-3-2016^ RSI
12 Affana Munandar Ika Damayanti/Deni I(DF/8) L 16-9-2014 4/II 16-9-2014 5-11-2014# 5-1-2015# 5-2-2015# 18-6-2015# 5-11-2014# 5-1-2015# 5-2-2015# 18-6-2015# 8-7-2015# Bd.L(2,8)
13 Asraf Nuraeni/Antoro(DF/8/10/1) L 6-10-2014 4/II 7-10-2014 15-10-2014 6-12-2014P 8-1-2015# 18-2-2015# 15-10-2014 6-12-2014 8-1-2015# 18-2-2015# 21-10-2015#DF Bd.E(3)
Syafira Sumiati/Sarifudin(DF/8) P 20-11-2014 4/II 21-11-2014 17-12-2014P 14-1-2015# 18-2-2015# 17-12-2014 14-1-2015# 18-2-2015# 16-9-2015# PINDAH MARGADANA Bd.E(2,5)
14 Day Robi St.Julekha(DF/8/10/3) L 19-12-2014 4/II 19-12-2014 20-3-2015# 18-5-2015# 25-8-2015# 21-10-2015#DF 20-3-2015# 18-5-2015# 25-8-2015# 21-10-2015#DF 21-12-2015
15 Indrawan Dwi Saputra Waidah/Carmun(DF/10/2) L 23-12-2014 4/II 23-12-2014# 2-3-2015# 16-3-2015# 27-4-2015# 27-5-2015# 2-3-2015# 2-4-2015# 27-4-2015# 27-5-2015# 21-10-2015#DF
Imunisasi yang diberikan
No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang
1 Anindya Nurhikmah/Turino(DF/10) L 16-1-2015 4/II 17-1-2015 5-3-2015 28-3-2015 30-5-2015 1-8-2015 5-3-2015 28-3-2015 30-5-2015 1-8-2015 24-10-2015
2 Teguh Febianto Tri Haryanti/Rowidin(DF/8) L 3-2-2015 4/II 4-2-2015 11-2-2015 23-4-2015 23-5-2015 24-8-2015 11-2-2015 23-4-2015 23-5-2015 24-8-2015 18-11-2015 Bd.E(3,2)
Zareen Sri Ningsih P 3-2-2015 4/II 11-2-2015 TIDAK ADA 11-2-2015 TIDAK ADA
3 M.Alibiyan Endang/Susilo(DF/8/1) L 23-3-2015 4/II 23-3-2015 9-5-2015 9-6-2015 9-7-2015 8-8-2015DF 9-5-2015 9-6-2015 9-7-2015 8-8-2015DF 16-8-2016^ Bd.E(3,2)
1^ Fahmi April Riansyah Narti/Rosikin(DF/8/10/4) L 3-4-2015 4/II 4-4-2015 11-5-2015 11-6-2015 21-10-2015DF 11-5-2015 11-6-2015 21-10-2015DF
2 Micaela Maryam Z Rofikoh/Fadli P 10-5-2015 4/II 10-5-2015 6-8-2015 25-7-2015 28-9-2015 2-12-2015^ 19-7-2015 25-7-2015 28-9-2015 2-12-2015^ 20-2-2016^ RS.mitra((2,9)
3 Rakha Sebastian Winda/Dodi L 11-5-2015 4/II 11-5-2015 5-6-2015 11-7-2015 11-8-2015 11-9-2015 5-6-2015 11-7-2015 11-8-2-15 11-9-2015 5-4-2016^ 16-11-2016^
4 Gibran Arafif Winarti/Nurafik L 13-6-2015 4/II 14-6-2015 12-7-2015 9-9-2015 9-10-2015 9-11-2015 12-7-2015 9-9-2015 9-10-2015 9-11-2015 9-8-2016^ Bd.Tik(2,7)
5 Rizal Maulana Indah/ Riswanto(DF/8/2) L 19-6-2015 4/II 19-6-2015 8-8-2015DF 9-9-2015 9-10-2015 9-11-2015 8-8-2015DF 9-9-2015 9-10-2015 9-11'2015 20-3-2016^ RSUK(2,7)
6 Sri Adnan(DOFU) Fitri suciani/Sanen(DF/8/3/10/6) L 23-6-2015 4/II 24-6-2015 8-8-2015DF 17-9-2015 21-10-2015DF 16-12-2015 8-8-2015DF 17-9-2015 21-10-2015DF 16-12-2015 RSUK(3,1)
7 Syafira Aulia Suyanti/ Sukro(DF/10/5) P 3-7-2015 4/II 3-7-2015 6-7-2015 21-9-2015 21-10-2015DF 23-11-2015 6-7-2015 21-9-2015 21-10-2015DF 23-11-2015 25-7-2016^ Bd.Fat
Endang/Wandi P 16-7-2015 4/II 16-7-2015 PINDAH RB.Rhm(3,7)
8 Aena Nursyifa Dewi Krisnawati/ Carito P 11-9-2015 4/II 19-9-2015 14-10-2015 14-11-2015^ 14-12-2015^ 31-1-2016^ 14-10-2015 14-11-2015^ 14-12-2015^ 31-1-2016^ 24-7-2016^ Bd.T(3)
9 Tri Keiza Oktaviani Tati Harningsih/Slamet P 9-10-2015 4/II 9-10-2015^ 30-11-2015^ 16-12-2015^ 1-2-2016^ 18-4-2016^ 15-10-2015 30-11-2015^ 1-2-2016^ 18-4-2016^ 21-7-2016^ RSI(3,6)
10 Arafi Dwi Salam Ice Trisnawati/Takwan L 10-10-2015 4/II 11-10-2015 2-11-2015 7-12-2015^ 11-1-2016^ 17-2-2016^ 2-11-2015 7-12-2015^ 11-1-2016^ 17-2-2016^ 16-8-2016^ Bd.F(2,8)
11 Akselia Asifah Warnita/Agus Santoso P 3-11-2015 4/II 3-11-2015^ 5-12-2015^ 22-1-2016^ 25-2-2016^ 5-12-2015^ 22-1-2016^ Bd Las(3,1)
12 M. Haikal Kurniasih/Agus L 25-12-2015 4/II 26-12-15 RSI(3)

Imunisasi yang diberikan


No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang
1 Naura Hasna A Siti Maesaroh/Darwanto P 16-1-2016 4/II 16-1-2016 14-2-2016 5-5-2016 5-6-2016 11-7-2016 14-2-2016 5-5-2016 5-6-2016 11-7-2016 24-10-2016 Bd.T(3,1)
2 Rayhan Habib Puri Arinta / Ahmad Solikhin L 27-2-2016 4/II 28-2-2016 7-3-2016 27-4-2016 13-6-2016 15-3-2016 27-4-2016 13-6-2016 PTB(3,7)
3 Katrina Salsabila A Karsiti/Trio Sufaldi P 22-3-2016 4/II 23-4-2016 22-5-2016 23-4-2016 22-5-2016 RB.Khr(3,1)
4^ Ina Amrina Rosyada Nur Azizah/Ahmad Jaeni P 23-3-2016 4/II 23-3-2016 27-4-2016 1-6-2016 1-7-2016 3-8-2016 27-4-2016 1-6-2016 1-7-2016 3-8-2016 RSUK SC(3,5)
5 Asyifa Putri Ningsih/Sunarto P 15-4-2016 4/II 15-4-2016 15-5-2016 15-6-2016 29-8-2016 15-5-2016 15-6-2016 29-8-2016 Bd.T(3,5)
6 Ahlan Sufaldi Firdaus Karsih/Irmanto L 3-5-2016 4/II 3-5-2016 3-6-2016 10-7-2016 10-8-2016 14-9-2016 3-6-2016 10-7-2016 10-8-2016 14-9-2016 RSUK SC(3,3)
7 Kenzi Evan P Ade Selfi Tia/Hendra L 7-5-2016 4/II 8-5-2016 7-6-2016 7-7-2016 9-8-2016 17-9-2016 7-6-2016 7-7-2016 9-8-2016 17-9-2016 Bd.T(2,6)
8 Khairun Lulu Kurniasih/Rustam P 22-5-2016 4/II 22-5-2016 22-6-2016 5-8-2016 8-9-2016 8-10-2016 22-6-2016 5-8-2016 8-9-2016 8-10-2016 Bd.E(3)
9 M.Syaroful Anam Siti Sulicha/Moh.Haryanto L 8-6-2016 4/II 8-6-2016 RSI
10 Asyila Naysa R Nuraeni Amaliyah/Antoro P 30-6-2016 4/II 30-6-2016 25-7-2016 21-9-2016 16-11-2016 25-7-2016 21-9-2016 16-11-2016 RSUK(3,2)
11 Aqila Adiba Siti Badaroh/Tarjuki P 30-7-2016 4/II 30-7-2016 22-8-2016 19-10-2016 22-8-2016 19-10-2016 RSUK(2,9)
12 Prima Atmar Kunayah/Rindiyanto L 15-9-2016 4/II 15-9-2016 15-10-2016 15-11-2016 15-10-2016 15-11-2016 Bd.T(2,8)

Imunisasi TT
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Ika Damayanti/Deni M 4/II 28-6-2014
2 Nur Aeni/Antoro M 4/II 12-7-2014
3 Waidah/Carmun M 4/II 4-9-2014
4 Yanti/Romidin M 4/II 15-10-2014
5 Endang/Susilo M 4/II 1-11-2014
Imunisasi TT
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Siti Fatonah/Aris M 4/II V 8-2-2015
2 Indah/Riswanto M 4/II 26-1-2015
3 Winarti/Nurofik M 4/II 25-1-2015
4 Dewi Krisnawati M 4/II 13-7-2015 2-8-2015
5 Endang/Wandi M 4/II 10-7-2015
6 Siti Maesaroh/ Darwanto M 4/II 21-10-2015 21-11-2015
Imunisasi TT
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Karsih/Irmanto M 4/II 26-1-2016
2 Putri Ningsih/Sunarto M 4/II 26-1-2016
3 Wuningsih/Hendrik M 4/II 2-2-2016 4-2-2016
4 Putriningsih/Sunarto M 4/II 29-2-2016
5 Azah Munazah/Budi M 4/II 15-3-2016
6 Kurniasih/Rustam M 4/II 22-12-2016 1-3-2016
7 Inayah Nur/Waryo M4/II 15-5-2016
8 Sumiyati/Nur Hasan M4/II 28-6-2016 8-9-2016
9 Daeni/Supratikno M4/II 17-8-16
LAPORAN BULANAN IMUNISASI BAYI
POSYANDU MELATI

Imunisasi yang diberikan


No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang
1

Imunisasi yang diberikan


No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang
1

Imunisasi yang diberikan


No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang
1 M. Alfatir Sukandar/Eka L 12-2-2011 4/III
2 Jaya Satria Raniti L 26-2-2011 1/III
3 M.Haekal Nabil Solikhun/Prisniati L 3-3-2011 1/III
4 Kirani Nuraeni Darmuji /Idah P 4-3-2011 3/III
5 Fadil Putra P Darsono/Leli L 1-4-2011 2/III
6 Aurel Yasmin A Takwan/Rumiyati P 13-5-2011 1/III
7 Brian Mei P Nurokhim/Wifi Mulida L 21-5-2011 4/III
8 Rizky Nur Fahmi Sri Rahayu/Sakim L 26-5-2011 3/III 1-6-2011 5-7-2011 6-8-2011 12-9-2011 12-10-2011 5-7-2011 6-8-2011 12-9-2011 12-10-2011 10-3-2012
9 Alkarina Saskia Dimin/Rame P 3-6-2011 1/III
10 Carel Lefina Sutirsno/Indah P 15-6-2011 4/III
11 Levina P 15-6-2011 17-7-2014*
12 Neva Arnalisa Waiman/ Suci P 11-7-2011 3/III
13 Bima Fajar Abas/Suci Rahayu L 22-7-2011 2/III
14 Elisa Enjelika Sunarto/Warningsih P 27-7-2015 4/III
15 Elsa Enjjel Lita Warningsih/Sunarto P 27-7-2011 4/III 27-7-2011 27-8-2011 28-9-2011 28-12-2011 25-4-2012 27-8-2011 28-9-2011 25-4-2012 22-1-2012 22-10-2012
16 Wisnu Aryadi Ranot/Saripah L 13-8-2011 3/III
17 Dika Fadil P Naslam/Suayati L 2-9-2011 1/III
18 Wahyu Irfan Woro/Tarinah L 10-9-2011 2/III
19 Wahyu L 10-9-2011 17-7-2014*
20 Safik Izan M Warso/Tareni L 12-9-2011 3/III
21 Sri Handayani Wargo/Erna Irlas P 15-9-2011 4/III
22 Ulfi Inayah Nasirin/Siti Aliyah P 20-9-2011 1/III
23 Armi Pratama Darmin/Neneng L 26-9-2011 3/III
24 Fidal Irsad Zalim Rujan/Astuti L 3-10-2011 3/III
25 M.Tegar Jian S Puji Efendi/Riyana L 2-11-2011
26 Aisyah Karmono/Suci P 15-11-2011 3/III
27 Aeni Maslikhatun Rastoni/Jaenatun P 2-12-2011 3/III
28 Moh.Raffael Daryono/Kusni L 19-12-2011 3/III
29 Rena P 17-7-2014*

Imunisasi yang diberikan


No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang
1 Putri Nur Aeni Rini A/Nur Dianto P 11-1-2012 4/III 11-1-2012 20-1-2012 11-3-2012 11-4-2012 11-5-2012 20-1-2012 11-3-2012 11-4-2012 11-5-2012 20-10-2012
2 Dwi Nanik A Suharningsih/Hartoyo P 12-1-2012 3/III 12-1-2012 5-3-2012 16-3-2012 16-4-2012 14-5-2012 5-3-2012 16-4-2012 14-5-2012 24-5-2012 12-1-2013
3 Khalipah Dwi Aryani Karesih/Darto P 22-1-2012 3/III 24-1-2012 11-3-2012 3-4-2012 14-5-2012 27-7-2012 11-3-2012 3-4-2012 14-5-2012 27-7-2012 5-11-2012
4 Muhammad Ikhsan Nurhidayah/Riwanto L 27-1-2012 3/III 27-1-2012 10-2-2012 4-4-2012 3-5-2012 5-6-2012 10-2-2012 4-4-2012 3-5-2012 5-6-2012 10-11-2012
5 Syifa Widya F Darningsih/Rodis P 12-2-2012 2/III 20-3-2012 23-4-2012 25-5-2012 27-6-2012 20-3-2012 23-4-2012 25-5-2012 27-6-2012 26-11-2012 17-7-2014*
6 Jihan Castiyah/Nur Saefudin P 22-2-2012 3/III V 10-4-2012 10-6-2012 5-11-2012 5-12-2012 10-4-2012 10-6-2012 5-11-2012 5-12-2012 27-12-2012
7 Khalifah Alivia Zahro Novi Sukmawati/Tolikhin P 28-3-2012 3/III 28-3-2012 10-5-2012 30-5-2012 3-7-2013 7-8-2013 10-5-2012 30-5-2012 3-7-2013 7-8-2013 10-2-2013
8 Fitria Nurhayati Nurhayati/M.Hayat P 20-4-2012 4/III 20-4-2013 2-7-2012 18-7-2012 26-9-2012 28-2-2013 2-7-2012 18-7-2012 26-9-2012 28-2-2013 15-4-2013
9 Latifah Nurjanah Saripah/Wasja P 25-4-2012 3/III 25-4-2013 10-6-2012 5-9-2012 3-10-2012 28-11-2012 10-6-2012 5-9-2012 3-10-2012 28-11-2012 22-3-2013
Zulfa Tutik/Sutrisno P 30-4-2012 1/III 30-4-2012 PINDAH MINTARAGEN
10 Tania Maydinna Salsabila Isna Andriyani/Sandi Yuliawan P 2-5-2012 4/III 3-5-2012 24-5-2012 20-7-2012 4-9-2012 25-11-2012 24-5-2012 20-7-2012 4-9-2012 25-11-2012 4-3-2013
11 Irfan Maulana Ibrahim Ika Agustin S/Suroyo L 12-5-2012 4/III 20-5-2012 20-5-2012 23-6-2012 25-7-2012 25-8-2012 20-5-2012 23-6-2012 25-7-2012 25-8-2012 15-4-2013
12 M.Arlan Purnama Dewi Setiyawati/M.Rozaku L 5-6-2012 2/III 20-7-2012 12-8-2012 12-9-2012 18-11-2012 4 12-8-2012 12-9-2012 18-11-2012 10-4-2013
Ardiansyah Darwati/Tarjuki L 15-6-2012 3/III 15-6-2012 13-8-2012 4-10-2012 11-12-2012 PINDAH 13-8-2012 4-10-2012 11-12-2012 TEGALSARI
13 Aiman Adhi Muhti Suheni/Tarsono L 15-6-2012 1/III 15-6-2012 10-7-2012 26-8-2012 27-9-2012 25-10-2012 10-7-2012 26-8-2012 27-9-2012 25-10-2012 V
14 Selfiyani Khairun N St.Rohani/Carto P 21-6-2012 3/III 20-7-2013 6-9-2012 9-10-2012 10-11-2012 20-7-2013 6-9-2012 9-10-2012 10-11-2012 20-7-2013
15 Nadia E St.Mulyanah/Waridin P 23-6-2012 4/III 23-6-2012 20-7-2012 10-9-2012 10-10-2012 10-11-2012 20-7-2012 10-9-2012 10-10-2012 10-11-2012 10-4-2013
16 Rafi Rizki Pratama Lindayani/Riyanto L 27-6-2013 2/III 13-7-2012 25-7-2012 30-8-2012 29-11-2012 29-3-2013 25-7-2013 30-8-2012 29-11-2012 29-3-2013 10-6-2013
17 Hilmi Maulana Ani Djumeli/Rokani L 5-7-2012 4/III 5-7-2012 16-7-2012 1-11-2012 6-12-2012 30-1-2013 16-7-2012 1-11-2012 6-12-2012 30-1-2012 10-6-2013
M.Ainal Mulya Wiwi A/Januar L 16-8-2012 3/III 16-8-2012 10-9-2012 V 14-11-2012 PINDAH 10-9-2012 V 14-11-2012 JAKARTA
18 Roby Saputra Rohani/Samsudin L 19-8-2012 2/III 19-8-2012 20-9-2012 22-10-2012 25-11-2012 27-12-2012 20-9-2012 22-10-2012 25-11-2012 27-12-2012 20-6-2013 17-7-2014*
19 Aji Putra Sundari/Jahuri L 1-9-2012 3/III 1-9-2012 10-9-2012 15-11-2012 5-12-2012 7-1-2013 10-9-2012 15-11-2012 5-12-2012 7-1-2013 3-6-2013
Silfa Adelia Rini/Didi P 3-9-2012 3/III 3-9-2012 15-10-2012 PINDAH 15-10-2012 JAKARTA
20 Agil Priyanto Endang/Dodi L 17-9-2012 2/III 17-9-2012 15-10-2013 20-11-2012 27-2-2013 13-5-2013 15-10-2013 20-11-2012 27-2-2013 13-5-2013 30-10-2013
21 Muh.Shafa Rizky P Ely F/Rismawan L 4-10-2012 4/III 9-10-2012 24-10-2012 11-12-2012 10-1-2013 18-2-2013 24-10-2012 11-12-2012 10-1-2013 18-2-2013 8-7-2013 17-7-2014*
Farzan Aryan A Jayanti/Aryono L 31-10-2012 1/III 31-10-2012 7-11-2012 30-1-2013 PINDAH 7-11-2012 30-1-2013 BREBES
22 Tiara Putri Wasrah/Sarosa P 31-10-2012 1/III 31-10-2012 7-1-2-13 31-1-2013 27-2-2013 29-3-2013 31-1-2013 27-2-2013 29-3-2013 30-9-2013 30-9-2013
Amanda Afika Afini/Prasetyo P 17-11-2012 4/III 17-11-2012 20-12-2012 30-1-2013 27-2-2013 27-3-2013 20-12-2012 30-1-2013 27-2-2013 27-3-2013 PINDAH
23 Rizky Adelia Darkini/Warsono P 19-11-2012 1/III 19-11-2012 20-12-2012 20-1-2013 23-2-2013 27-3-2013 20-12-2012 20-1-2013 23-2-2013 27-3-2013 10-11-2013
Rosy Wihayati P 29-11-2012 3/III 1-4-2013 1-4-2013 PINDAH
24 Fabian Santi/Nizar L 2-12-2012 2/III 2-12-2012 4-2-2013 28-2-2013 28-3-2013 22-4-2013 4-2-2013 28-2-2013 28-3-2013 22-4-2013 10-12-2013 17-7-2014*
25 Nikita Maharani Nita Rahayu/Suparman P 24-12-2012 1/III 24-12-2012 20-1-2013 28-2-2013 28-3-2013 28-5-2013 20-1-2013 28-2-2013 28-3-2013 28-5-2013 20-10-2013
26 M.Alif Setya Tri Susanti L 26-12-2012 3/III 26-12-2012 20-1-2013 6-3-2013 12-4-2013 16-5-2013 20-1-2-13 6-3-2013 12-4-2013 16-5-2013 10-12-2013

Imunisasi yang diberikan


No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang
1 Dea Karina Rosinta/Karnoto P 4-1-2013 4/III 4-1-2013 4-2-2013 27-2-2013 1-4-2013 1-5-2013 4-2-2013 27-2-2013 1-4-2013 1-5-2013 28-10-2013
2 Chika Nafina Darwati/Sutarno P 15-1-2013 3/III 15-1-2013 20-1-2013 6-4-2013 8-5-2013 17-7-2013 20-1-2013 6-4-2013 8-5-2013 17-7-2013 20-9-2014 21-10-2015#
3 Faiza Sulistyana Sofiyani/Zaenudin P 17-1-2013 3/III 17-1-2013 20-1-2013 19-3-2013 19-4-2013 19-5-2013 20-1-2013 20-3-2013 19-4-2013 19-5-2013 10-10-2013 14-7-2015# 11-8-2015#
4 Fiqih Aryaguna Rosilah/Sutari L 24-1-2013 3/III 24-1-2013 10-2-2013 23-3-2013 24-4-2013 23-10-2013 10-2-2013 23-3-2013 24-4-2013 23-10-2013 13-1-2014*
5 Muh.Abdul Rasid T Waridah/Tarsudin L 29-1-2013 2/III 29-1-2013 10-2-2013 29-3-2013 10-5-2013 11-6-2013 10-2-2013 10-5-2013 11-6-2013 20-11-2013 20-11-2013
6 Naura Kadhisha Asifa Darningsih/Kasan P 30-1-2013 4/III 30-1-2013 4-3-2013 1-4-2013 30-4-2013 30-5-2013 27-3-2013 1-4-2013 30-4-2013 30-5-2013 28-10-2013 17-7-2014*
7 Tri Daffa Saifulloh Marinah/Sunaryo L 22-2-2013 3/III 22-2-2013 10-3-2013 22-4-2013 24-5-2013 26-6-2013 10-3-2013 22-4-2013 24-5-2013 26-6-2013 10-1-2014* 21-10-2015#
8 Renita Eka Febiani Sulastri/Jumadun P 22-2-2013 3/III 22-2-2013 10-3-2013 23-4-2013 23-5-2013 23-6-2013 10-3-2013 23-4-2013 23-5-2013 23-6-2013 10-12-2013 14-7-2015# 11-8-2015#
9 Wilda Salsabila N Kusningsih/A.Rochmani P 9-3-2013 1/III 9-3-2013 20-5-2013 13-6-2013 13-7-2013 30-8-2013 20-5-2013 13-6-2013 13-7-2013 30-8-2013
10 Muh.Azis Mubarok Doriti/Sodikin L 28-3-2013 3/III 28-3-2013 10-4-2013 29-5-2013 29-7-2013 25-9-2013 10-4-2013 29-5-2013 29-7-2013 25-9-2013 20-3-2014*
11 Rafi Anwar Wastri/Nurohim L 28-3-2013 3/III 28-3-2013 10-4-2013 28-5-2013 27-9-2014* 10-4-2013 28-5-2013 27-9-2014* 21-12-2014*
12 Dahlia Darningsih/Jumali P 26-4-2013 1/III 26-4-2013 20-6-2013 23-7-2013 28-8-2013 10-10-2013 20-6-2013 23-7-2013 28-8-2013 10-10-2013 20-3-2014* Bd.F(2,50
13 Abizar Al Fahri Sri Sulistiowati/Sujarwo L 16-5-2013 1/III 17-5-2013 20-6-2013 21-7-2013 22-8-2013 23-9-2013 20-6-2013 21-7-2013 22-8-2013 23-9-2013 20-2-2014* RSUK(3,2)
14 Sandi Caesar Trianto Casrinah/Sarkup L 23-5-2013 4/III 23-5-2013 15-7-2013 9-9-2013 23-10-2013 27-11-2013 15-7-2013 9-9-2013 23-10-2013 27-11-2013 26-5-2014* 15-9-2015# 21-10-2015# Bd.F(2,6)
15 Rafli Kristianingsih/Ali S L 19-5-2013 1/III 19-5-2013 5-6-2013 19-8-2013 19-9-2013 17-11-2014P# 5-6-2013 19-8-2013 19-9-2013 17-11-2014# 12-3-2014 Bd.E
16 Azizah Mei Syafira Sri Wulan/Krisyanto P 28-5-2013 2/III 28-5-2013 20-6-2013 25-9-2013 28-10-2013 MENOLAK 20-6-2013 25-9-2013 28-10-2013 MENOLAK Bd.F(2,8)
17 Diaz Susyanti/Rofiko P 6-6-2013 2/III 6-6-2013 20-6-2013 MENOLAK 20-6-2013 MENOLAK Bd.F(3,3)
18 Yusuf Azka Aldrix Darningsih/Ribut L 29-8-2013 3/III 29-8-2013 10-9-2013 31-10-2013 1-12-2013 3-1-2014* 10-9-2013 31-10-2013 1-12-2013 3-1-2014* 10-6-2014* Bd.F(2,8)
M.Rafi Khoirul Huda Sifa A/Agus K L 1/III 4-6-2013 17-6-2013 6-8-2013 TAMU 17-6-2013 6-8-2013 TAMU
19 Zilfi Septia Syafani Darsinah/M.Sarobet P 9-9-2013 4/III 9-9-2013 28-10-2013 11-11-2013 13-1-2014* 7-7-2014* 28-10-2013 11-11-2013 13-1-2014* 7-7-2014* 21-7-2014* 15-9-2015# 14-4-2016^
Mujiyah/Tresnanto L 18-9-2013 1/III 2-10-2013 PINDAH PESLOR Bd.D(2,7)
20 Alvaro Risky Pandeva Eva Erviana/Pandu Setianto L 9-10-2013 4/III 9-10-2013 5-11-2013 10-12-2013 13-1-2014* 26-2-2014* 5-11-2013 10-12-2013 13-1-2014* 26-2-2014* 21-7-2014* 11-6-2015# Bd.Las(3,5)
21 Naufal Aji Sulthoni Serli Andisi/Eko Priwiyono L 19-10-2013 4/III 20-10-2013 2-12-2013 6-1-2014* 26-2-2014* 28-4-2014* 2-12-2013 6-1-2014* 26-2-2014* 28-4-2014* 11-8-2014* 14-7-2015# Bd.Mas(2,5)
Lutfi P 22-10-2013 4/III DUKUHTURI RSIAKI(3,1)
Aisyah Winda Ayu/Sunarto P 23-10-2013 1/III 23-10-2013 PINDAH RSI(3,1)
22 Monica Ratu Novalia Fariyatun/Kusen P 2-11-2013 3/III 3-11-2013 23-12-2013 10-2-2014* 17-3-2014* 28-4-2014* 23-12-2013 10-2-2014* 17-3-2014* 28-4-2014* 13-10-2014* RSUK(3,35)
23 Iqbalil Wahyu Saputra Qori Noviani/Daryanto L 23-11-2013 3/III 23-11-2013 6-1-2014* 5-5-2014P* 25-6-2014P* 24-9-2014P* 6-1-2014* 5-5-2014* 25-6-2014* 24-9-2014* 15-11-2014* RSI(3)
Wahyuningsih/Waryono L 20-11-2013 1/III 25-11-2013 POSYANDU MAWAR Bd.Las(2,9)
24 Am Qonitahwa Al G Waitin/A.Gusaeni P 24-11-2013 1/III 24-11-2013 10-12-2013 21-2-2014P* 20-4-2014P* 2-9-2014* 10-12-2013 21-2-2014* 20-4-2014* 2-9-2014* 17-12-2014* 11-8-2015# 17-11-2016^ Bd.F(3)
Zulkarnain Hafiz(Tamu) Heni A/Agus L 22-11-2013 3/III TAMU 10-12-2013 11-3-2014P* 12-4-2014P* TAMU 10-12-2013 11-3-2014* 12-4-2014* TAMU RSI
25 Kholifah Nur Sabrina Dariyah/Usman P 15-12-2013 4/III 15-12-2013 20-12-2013 26-2-2014P* 27-9-2014P* MENOLAK 20-12-2013 26-2-2014* 27-9-2014* MENOLAK Bd.F
26 Sulton Hilmi M Windi R/Arif L 16-12-2013 1/III 2-12-2013 20-12-2013 10-2-2014* 22-3-2014* 23-4-2014* 20-12-2013 10-2-2014* 22-3-2014* 23-4-2014* 10-9-2014* 11-8-2015# 14-5-2016^ Bd.F
Priyansi Tarmini/Hendrik P 16-12-2013 1/III 16-12-2013 20-12-2013 14-3-2014P* 21-4-2014P* PINDAH 20-12-2013 14-3-2014* 21-4-2014* JAKARTA Bd.F

Imunisasi yang diberikan 13-10-15


No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak 10-11-15
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang
1 Adnan Ghozali Waetati/Raidi L 15-1-2014 3/III 16-1-2014 20-1-2014 16-3-2014P 10-8-2014P 14-10-2014P 20-1-2014 16-3-2014 10-8-2014 14-10-2014 20-11-2014 11-8-2015# Bd.F(3,1)
2 Sonia Putri Turidah/Sipon(1/) P 23-1-2014 1/III 23-1-2014 6-2-2014 23-3-2014P 23-5-2014P 25-6-2014P 6-2-2014 23-3-2014 23-5-2014 25-6-2014 19-1-2015# 14-1-2016^
17-11-2016^ Bd.F(2,7)
3 Steevent Shelo Qalby A Selly Fatmawati/W.Susilo(1/) L 16-1-2014 1/III 16-1-2014 25-2-2014 19-3-2014P 19-4-2014P 19-5-2014P 25-2-2014 19-3-2014 19-4-2014 19-5-2014 20-10-2014 26-7-2015#
17-11-2016^ RB.Khr(3,1)
Afikah Rohati/Heri(2/) P 9-2-2014 1/III 9-2-2014 17-2-2014 PINDAH 17-2-2014 JAKARTA Bd.F(3,1)
Suci Juniroh/Said Aqil(4/) L 20-2-2014 1/III 20-2-2014 PINDAH POSYANDU NUSA INDAH RB.Khr(3,35)
4 Nova Febrianti Erna/Gunung(2/) P 21-2-2014 1/III 21-2-2014 24-2-2014 21-4-2014P 22-5-2014P 23-6-2014P 24-2-2014 21-4-2014 22-5-2014 23-6-2014 20-11-2014 MENOLAK Bd.F(2,5)
5 Adrian M.Daifulloh Waridah/Sutrisno(3/) L 9-3-2014 2/III 9-3-2014 20-3-2014 9-5-2014P 9-6-2014P 10-7-2014P 20-3-2014 9-5-2014 9-6-2014 10-7-2014 20-1-2015# 13-10-2015# 8-9-2016^ RB.Khr(3,5)
Wilqis Salsabila Putri Sri Puji/Tulus R(4/) P 5-4-2014 2/III 5-4-2014 14-4-2014 10-6-2014P 10-7-2014P PINDAH 14-4-2014 10-6-2014 10-7-2014 JAKARTA Bd.F(3,1)
6 Iqhhar Ibrahim Muslicha/Heri Susanto(4/) L 28-4-2014 3/III 28-4-2014 4-5-2014 10-7-2014P 28-8-2014P 29-9-2014# 4-5-2014 10-7-2014 28-8-2014 29-9-2014# 28-2-2015# Bd.F(2,5)
Rizal Efendi Kusyanti/Darwoto(5/) L 5-5-2014 1/III 5-5-2014 12-5-2014 7-7-2014P 26-9-2014P 4-11-2014P 12-5-2014 7-7-2014 26-9-2014 4-11-2014 PINDAH JAKARTA Bd.F(2,6)
7 Tajri Ruziqna Ernawati/Dahuri(6/) L 10-6-2014 4/III 10-6-2014 20-6-2014 15-9-2014P 5-12-2014# 28-1-2015# 20-6-2014 15-9-2014 5-12-2014# 28-1-2015# 13-5-2015# 15-3-2016^ Bd.D(3,4)
8 Syahril Nur P Rosita/Subekhi L 5-6-2014 2/III 5-6-2014 16-7-2014 5-8-2014P 9-9-2014P 16-10-2014P 16-7-2014 5-8-2014 9-9-2014 16-10-2014 11-8-2015# Bd.E(2,9)
9 Moh.Zidan Juriyah L 7-7-2014 2/III 8-7-2014 16-7-2014 7-9-2014P 7-10-2014P 19-11-2014P 16-7-2014 7-9-2014 7-10-2014 19-11-2014 13-4-2015#
10 Dinda Karnita/Cariwan P 17-7-2014 3/III 18-7-2014 13-8-2014 18-9-2014P 18-10-2014P 18-11-2014P 13-8-2014 18-9-2014 18-10-2014 18-11-2014 13-5-2015# 16-4-2016^ RSI(4,8)
11 Wahyu Iis Winarti L 19-7-2014 3/III 19-7-2014 4-8-2014 20-9-2014P 10-11-2014P 24-12-2014P 4-8-2014 20-9-2014 10-11-2014 24-12-2014 20-4-2015# 10-2-2016^ Bd.F
Naila Kurniasih/Darmojo P 19-7-2014 3/III 19-7-2014 4-8-2014 20-9-2014P 30-11-2014P 5-1-2015 4-8-2014 20-9-2014 30-11-2014 5-1-2015 PINDAH JAKARTA Bd.F
12 Kevin Sumini L 20-7-2014 2/III 20-7-2014 13-8-2014 20-10-2014P 19-11-2014P 20-12-2014P 13-8-2014 20-10-2014 19-11-2014 20-12-2014 15-4-2015# 19-2-2016^ 21-7-2016^
13 Aqifah Ely/Nuridin P 28-8-2014 4/III 28-8-2014 15-9-2014 MENOLAK 15-9-2014 MENOLAK Bd.F(2,8)
Aqila Dola Rustiyana/Taryono P 7-9-2014 3/III 7-9-2014 17-9-2014 7-11-2014P 13-12-2014P 13-1-2015# 17-9-2014 7-11-2014 13-12-2014 13-1-2015# PINDAH JAKARTA Bd.E(2,4)
Dwi Nesa Kurniasih/Darminto P 3-10-2014 1/III 3-10-2014 20-11-2014 5-1-2015# PINDAH 20-11-2014 5-1-2015# KALADAWA RB.Rhm(3)sc
14 Micaela Rukayah/Wihendy P 4-10-2014 3/III 4-10-2014 13-10-2014 20-12-2014P 21-1-2015# 24-2-2015# 13-10-2014 20-12-2014 21-1-2015# 24-2-2015# 6-7-2015# 24-4-2016^ 17-11-2016^ Bd.F(2,8)
Devina Nurbayanah P 6-10-2014 3/III 6-10-2014# 15-11'2014# 20-12-2014# 30-1-2015# 1-8-2015# 15-11'2014# 20-12-2014# 30-1-2015# 1-8-2015# PINDAH
15 Maya Susi Waniroh/Hasan P 28-11-2014 3/III 29-11-2014# 8-12-2014 12-2-2015# 11-3-2015# 13-5-2015# 8-12-2014 12-2-2015# 11-3-2015# 13-5-2015# 5-10-2015# Bd.F(3,1)
16 Zahra Amira Winda Nofitasari/Lukman P 11-12-2014 4/III 11-12-2014# 22-12-2014 12-2-2015# 11-3-2015# 14-4-2015# 22-12-2014 12-2-2015# 11-3-2015# 14-4-2015# 15-9-2015# 11-8-2016^ 17-11-2016^ Pusk(2,7)
17 Sadela Putri Susilowati/Rudi(DF/10/11) P 30-12-2014 3/III 31-12-2014# 11-2-2015# 11-8-2015# 21-10-2015# 14-4-2016^ 11-2-2015# 11-8-2015# 21-10-2015# 14-4-2016^ 15-9-2015# 17-11-2016^ RSI
18 Cahaya Agro A Rohyani/Wandi(DF/10/1) P 30-12-2014 1/III 5-1-2015# 16-3-2015# 13-5-2015# 11-8-2015# 5-1-2015# 16-3-2015# 13-5-2015# 11-8-2015# 13-10-2015#D11-8-2016^ 17-11-2016^ RSUK

Imunisasi yang diberikan


No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang
1 Rasya Faqih Ina Marselina/Syaeful(DF/11) L 30-1-2015 3/III 5-2-2015 9-3-2015 12-4-2015 12-5-2015 12-6-2015 9-3-2015 12-4-2015 12-5-2015 12-6-2015 23-11-2015 Bd.F(2)
2 Rizki Ade Prasetyo Intan Muharni/Waryono L 9-2-2015 2/III PINDAHAN KENANGA A KRATON 12-11-2015 11-8-2016^ RSI(2,7)
3 Wasis Misbahuddin Rositah/Ipung L 21-2-2015 3/III 23-2-2015 9-3-2015 9-7-2015 10-8-2015 14-9-2015 9-3-2015 9-7-2015 10-8-2015 14-9-2015 14-1-2016^ 17-11-2016^ Bd.F(2,3)
4 Zacky Fehly A Rosinta(DF/1011) L 26-2-2015 4/III 27-2-2015 9-3-2015 4-5-2015 11-8-2015 9-3-2015 4-5-2015 11-8-2015
5 Anisah Rahma N Kurnita/Raqi P 25-3-2015 4/III 25-3-2015 9-5-2015 9-6-2015 9-7-2015 10-10-2015 9-5-2015 9-6-2015 9-7-2015 10-10-2015 15-1-2016^ Bd.Tik
1^ Tiara Nur Apriliani Wasrini/Rasto(DF/10/3) P 15-4-2015 4/III 15-4-2015 15-6-2015 14-7-2015 24-8-2015 13-10-2015DF 15-6-2015 14-7-2015 24-8-2015 13-10-2015DF10-2-2016^
2 M.Abdul Bais Trisyanto/Trirohayatun L 26-4-2015 3/III 26-4-2015 22-7-2015 14-7-2015 19-8-2015 21-9-2015 14-7-2015 19-8-2015 21-9-2015 21-10-2015 15-3-2016^ Bd.Kramat(3,3)
3 Rafa Aska Nugraha Dini Vivi/Taryono(DF/10) L 18-5-2015 3/III 18-5-2015 8-6-2015 25-8-2015 21-10-2015 19-3-2016^ 8-6-2015 25-8-2015 21-10-2015 14-4-2016^ 14-4-2016^ bd.St.Fatimah
4 Riski Anhayat Nurhayati/Hayat(DF/10/2) L 27-5-2015 4/III 28-5-2015 28-7-2015 9-9-2015 13-10-2015DF 12-11-2015 28-7-2015 9-9-2015 13-10-2015DF 12-11-2015 21-7-2016^
5 Saefullah Warningsih/Abdullah(DF/11) L 25-5-2015 3/III 26-5-2015 21-9-2015 10-10-2015 9-12-2015 10-1-2016^ 21-9-2015 10-10-2015 9-12-2015^ 10-1-2016^ 10-3-2016^
6 Jeni Alona Cita Caridah/Casmita P 16-6-2015 4/III 16-6-2015 9-7-2015 9-9-2015 12-10-2015 12-11-2015 9-7-2015 9-9-2015 12-10-2015 12-11-2015 3-4-2016^ Bd.T(3,3)
7 Firma Damayanti Sumarti/ Tardi(DF/11) P 20-6-2015 1/III 26-6-2015 28-7-2015 9-9-2015 9-10-2015 9-11-2015 28-7-2015 9-9-2015 9-10-2015 9-11-2015 11-4-2016^ Bd.T(2,7)
8 Riski Safira Tri Rahayu/ Joni Toipin P 6-7-2015 4/III 8-7-2015 4-8-2015 15-9-2015 21-10-2015 22-11-2015 4-8-2015 15-9-2015 21-10-2015 16-6-2016^ 14-4-2016^ Bd.T(3,3)
9 Risyanur Asiha Siti Soliha/Budiharjo(DF/11/1) P 6-7-2015 1/III 13-7-2015 15-8-2015 9-9-2015 10-10-2015 10-11-2015DF 15-8-2015 9-9-2015 10-10-2015 10-11-2015DF19-4-2016^
10 Arya Ramadani Ike Listiani/ Luki K(DF/10/5) L 8-7-2015 3/III 10-7-2015 18-8-2015 10-9-2015 13-10-2015DF 21-11-2015 18-8-2015 10-9-2015 13-10-2015DF 21-11-2015 8-5-2016^ Bd.T(3,4)
11 Naila Ramadani Fitri Dewi Pitaloka/Ujang(DF/10/4) P 15-7-2015 4/III 15-7-2015' 27-7-2015 15-9-2015 13-10-2015DF 12-11-2015 27-7-2015 15-9-2015 13-10-2015DF 12-11-2015 14-4-2016^ PTB (3,1)
12 Chelsy Azahrifa F Kristianti/ M. Farihi P 21-7-2015 2/III 21-7-2015 22-7-2015 MENOLAK 22-7-2015 MENOLAK BD.Siti F(2,9)
13 Chayra Hana Warningsih/ Carbikin(DF/11) P 4-8-2015 3/III 5-8-2015 12-8-2015 4-10-2015 4-11-2015 10-12-2015 12-8-2015 4-10-2015 4-11-2015 10-12-2015 11-5-2016^ Bd.E(3,4)
14 Achmad Azam Alfadila Witati/Iskandar(DF/11) L 7-8-2015 3/III 14-8-2015 15-9-2015 9-10-2015 9-11-2015 9-12-2015 15-9-2015 21-10-2015 9-11-2015 9-12-2015 Bd.T(3,4)
15 Tiar Rosilah/Surip(DF/10) L 12-8-2015 3/III 12-8-2015 24-8-2015 18-10-2015 19-11-2015 25-12-2015^ 24-8-2015 18-10-2015 19-11-2015^ 25-12-2015^ 10-8-2016^ BD.Siti fat(3,4)
Dian Noviany/Riski Kurniadi P 16-8-2015 4/III 16-8-2015 PINDAH TEGAL TIMUR RSI(2,8)
16 Mirza Syafan Ardani Suci Rahayu/Abdul Abas L 27-8-2015 1/III 29-8-2015 29-9-2015 9-11-2015 10-12-2015^ 9-2-2016^ 29-9-2015 9-11-2015 10-12-2015^ 9-2-2016^ 17-11-2016^ Bd.T(2,6)
17 Muh.Alfatin Novi S/ Toat L 29-8-2015 2/III 3-9-2015 12-10-2015 11-1-2016^ MENOLAK 12-10-2015 11-1-2016^ MENOLAK Bd.T(2,9)
18 Gani Arsenio Suci Amalia/Waiman L 3-9-2015 3/III 10-9-2015 19-10-2015 19-11-2015 21-1-2016^ 19-10-2015 19-11-2015^ 21-1-2016^ Bd.T(3,2)
Ahmad Iqbal Muzaki Rumini/Taryudi(DF/11) L 22-9-2015 1/III 22-9-2015 9-10-2015 9-12-2015 PINDAH V 9-10-2015 9-12-2015 RANDUSANGA Bd.T(3,2)
19 Thalita Aida F Endang/Kholilullah(DF/11) P 17-7-2015 1/III 17-7-2015 18-8-2015 17-9-2015 7-10-2015 17-11-2-015 18-8-2015 17-9-2015 7-10-2015 17-11-2015 20-4-2016^ RB.Khr
20 Sultan Fathan Dita Lisa A/Karyudi L 13-10-2015 3/III 13-10-2015^ 18-11-2015^ 28-12-2015^ 29-12-2015^ 27-2-2016^ 21-10-2015^ 28-12-2015^ 29-12-2015^ 27-2-2016^ Rb Khr(3,5)
21 Khilyatul Mumazah Eka Yuliani/Sukendar L 24-10-2015 4/III 25-10-2015^ 23-11-2015^ 28-12-2015^ 10-2-2016^ 15-3-2016^ 23-11-2015 28-12-2015^ 10-2-2016^ 14-4-2016^ 11-8-2016^ RSUK(3,2)sc
22 Fatimatul Zahra Nurani/Darwanto P 5-11-2015 3/III 10-11-2015^ 5-12-2015^ 29-2-2016^ 5-12-2015^ Bd T(2,4)
23 Citra Amalia Nurhayati/Kartono P 9-11-2015 1/III 14-11-2015^ 9-12-2015^ 11-2-2016^ 11-3-2016^ 11-4-2016^ 9-12-2015^ 11-2-2016^ 11-3-2016^ 11-4-2016^ 11-8-2016^ Bd T(3,2)
24 Wiwit Novitalia Husna Casriyah/Warmo P 28-11-2015 3/III 28-10-2015^ 7-12-2015^ 28-1-2016^ 28-2-2016^ 28-3-2016^ 7-12-2015^ 28-1-2016^ 28-2-2016^ 28-3-2016^ 10-9-2016^ Bd. F(3)

Imunisasi yang diberikan


No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang
1 Karina Sriyanti/Solihin P 11-1-2016 3/III 11-1-2016 10-2-2016 10-3-2016 11-11-2016 10-2-2016 11-11-2016 Bd Ety(3,3)
2 Azka Rizki Yudistira Warsiti/Andi P L 9-1-2016 4/III 19-1-2016 RSI
3 Daffa Firdaus Karmini/Sugiri L 14-1-2016 1/III 15-1-2016 23-2-2016 26-3-2016 Bd.T(3,6)
4 Tasya Riski Sinta Amelia/Puji P 17-2-2016 1/III 17-2-2016 17-3-2016 17-4-2016 17-5-2016 17-6-2016 17-3-2016 17-4-2016 17-5-2016 17-6-2016 17-11-2016 Bd.T(2,7)
5 Cindy Tika/Tarsono P 21-3-2016 3/III 21-3-2016 9-4-2016 22-5-2016 28-7-2016 28-8-2016 11-4-2016 22-5-2016 28-7-2016 28-8-2016 Bd.F(2,6)
6 Alika Laela P Siswanti/Julias P 23-3-2016 3/III 23-3-2016 23-4-2016 23-5-2016 23-6-2016 23-8-2016 23-4-2016 23-5-2016 23-6-2016 23-8-2016 Bd.T(2,6)
7^ Rasya Almahera Rini/Lukman P 16-3-2016 4/III 16-3-2016 16-4-2016 17-5-2016 17-6-2016 21-7-2016 16-4-2016 17-5-2016 17-6-2016 21-7-2016 Bd.T
8 Aditya Nur Intan Sari/Tamrin L 14-4-2016 3/III 14-4-2016 14-5-2016 14-6-2016 15-7-2016 15-8-2016 14-5-2016 14-6-2016 15-7-2016 15-8-2016 Bd.T(3,4)
9 Marfa Nur F Leli Indah/Darsono P 9-4-2016 1/III 9-4-2016 11-4-2016 11-6-2016 8-9-2016 13-10-2016 11-4-2016 11-6-2016 13-10-2016 17-11-2016 Bd.F(3,5)
10 Syafira Aprilia Rini/Nurdianto P 13-4-2016 4/III 14-5-2016 20-5-2016 20-6-2016 20-7-2016 28-8-2016 20-5-2016 20-6-2016 20-7-2016 28-8-2016 Bd.A(2,9)
11 Tasya Solicha/Aris P 21-5-2016 3/III 21-5-2016 21-8-2016 25-9-2016 21-8-2016 25-9-2016 Bd.T(2,4)
12 Farael R Dina Mariana/Wirja L 20-6-2016 3/III 20-6-2016 31-7-2016 30-8-2016 30-9-2016 30-10-2016 31-7-2016 30-8-2016 30-9-2016 30-10-2016 RB.Rhm(2,7)
M. Zain Al-Qori Korotunnisa/Warno L 21-6-2016 2/III 21-6-2016 1-8-2016 PINDAH 1-8-2016 NUSA INDAH Bd.E(2,7)
13 Naura Sakila Suci/Ahmad P 18-7-2016 1/III 18-7-2016 18-8-2016 20-9-2016 21-10-2016 18-8-2016 20-9-2016 21-10-2016 Bd.T(3,2)
14 Andini Arsy Dwi Jayanti Rini Nopianti/Jayadi P 30-7-2016 1/III 30-7-2016 7-9-2016 10-10-2016 15-11-2016 7-9-2016 10-10-2016 15-11-2016 Bd.T(3)
15 Satria Arka al-Faruz Warningsih/Sunarto L 23-8-2016 4/III 24-8-2016 29-8-2016 13-10-2016 17-11-2016 29-8-2016 13-10-2016 17-11-2016 PTB(2.9)
16 Almaura Farzana D Tunirah/Durki P 24-9-2016 2/III 24-9-2016 7-11-2016 4-10-2016 17-11-2016 RSI SC(2,7)
17 Alby Farzana D Tunirah/Durki L 24-9-2016 2/III 24-9-2016 7-11-2016 4-10-2016 17-11-2016 RSI SC(2,6)
18 Diah Okta/Sugito P 28-9-2016 2/III 28-9-2016 Bd.T(3,3)

Imunisasi TT
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Cipningsih/A.Khaerul M 4/III 7-8-14C
2 Rosita/Ipung M 3/III 12-9-2014 24-12-14
3 Midah/Tarman M 4/III 2-10-2014C
4 Kurnita/Rakil M 4/III 20-10-2014 20-11-14
5 Ina Marselina/Syaeful M 1/III 13-11-14
6 Susi/Hasan M 3/III 15-11-14
7 Wasti/Rasto M 4/III 8-11-2014
8 Susilowati/Rudi M 3/III 26-11-2014
9 Salika/Sanuri M 3/III 16-11-14
10 Sumarti/Nardi M 1/III 22-12-2014
Imunisasi TT
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Dini Vivi S/Tarjono M 1/III V
2 Wasrini/Rasto M 4/III V
3 Iis Susilowati/Subagja M 3/III 2-2-2015C 3-3-15C
4 Tarwen/Suyanto M 3/III 10-3-2015
5 St.Solikha/Edi M 1/III 17-3-2015 15-4-15
6 Endang Yuniarti M 4/III 28-2-2015
7 Dita/Wardi M 1/III 1-4-2015
8 Warningsih/Cardikin M 3/III 14-4-15
9 Warningsih/Abdulloh M 3/III 16-2-2015
10 Suci Amaliyah/Waiman M 3/III 16-3-2015
11 Ike Listiani/Luki K M3/III 13-4-15
12 Witati/Iskandar M 3/III 15-5-2015
13 Novi/Taat M 2/III 4-5-15
14 Sutarti/Suheli M 2/III 2-5-15
15 Suci Rahayu/Abdul Abas M2/III 3-6-2015
16 Eka Yuliani/Sukendar M4/III 30-7-2015
17 Nurhayati/Edi K M1/III 10-9-2015
18 Mahfirotul/A.Solikhin M 3/III 19-10-2015
19 Leli/Darsono M3/III 13-10-2015
20 Siti Daruni/Riyanto M1/III 1-10-2015
21 Warningsih/ Sasto M 2/ III 17-10-2015
Imunisasi TT
No Nama Ibu Alamat (RT/RW)
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Tika/Santika M 3/III 15-12-2015
2 Siswanti/Jully S M 3/III 4-1-2016
3 Tria Herlina
4 Afini Deslani M4/III 25-2-2016
5 Rini Nopianti M 1/III 2-3-2016 6-4-2016
6 Ade Shelfi Tia M 4/III 1-3-2016
7 Salicha T/Aris Susanto M 3/III 3-3-2016
8 Nurkhasanah/Solikhin M 3/III 5-3-2016
9 Opi/Teguh M 3/III 9-3-2016
10 Dina Mariana/Wirja M 3/III 16-3-2016
11 Ratna S/Nurohman M4/III
12 Warningsih/Sunarto M4/III 17-6-2016
LAPORAN BULANAN IMUNISASI BAYI
POSYANDU KEMUNING

Imunisasi yang diberikan


No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang
1

Imunisasi yang diberikan


No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang
1

Imunisasi yang diberikan


No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang
1 Dini Nurfadilah Kholipah/Karpangi P 14-1-2011 5/III 20-1-2011 5-2-2011 26-3-2011 11-6-2011 21-11-2011 5-2-2011 26-3-2011 11-6-2011 21-11-2011 19-12-2011
2 M.Zidan Ratono/Titin L 8-3-2011 5/III
3 Adelia Anjani Durjan/Rokhanah P 23-4-2011 5/III
4 Rizky Nur F Sakim/Sri Rahayu P 26-5-2011 3/III
5 Nikeisha Dzakiyah Sakhi Mutiati/Rosikin P 2-6-2011 5/III 2-6-2011 27-7-2011 26-8-2011 21-9-2011 30-11-2011 27-7-2011 26-8-2011 21-9-2011 30-11-2011 12-3-2011
6 Hafidz Ibnu Al Mundziri Wiri Ningsih/Abdul Ta'at L 2-11-2011 5/III 3-11-2011 20-11-2011 7-1-2012 11-2-2012 12-3-2012 20-11-2011 7-1-2012 11-2-2012 12-3-2012 6-8-2012

Imunisasi yang diberikan


No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang
1 Muh.Ikhsan Nurhidayah/Riwanto L 27-1-2012 3/III 27-1-2012 10-2-2012 4-4-2012 3-5-2012 5-6-2012 10-2-2012 4-4-2012 3-5-2012 5-6-2012 10-11-2012
2 Tasya Afrina Salsabilah Andi Ningsih/Waridin P 18-4-2012 5/III 18-4-2012 16-5-2012 15-6-2012 16-7-2012 16-8-2012 16-5-2012 15-6-2012 16-7-2012 16-8-2012 21-1-2013
3 Wahyu Rafa S Raminah/Warid L 26-5-2012 3/III 26-5-2012 10-6-2012 26-7-2012 2-9-2012 3-10-2012 10-6-2012 26-7-2012 2-9-2012 3-10-2012 10-4-2013
4 Mayla Azahra Triati/Taryono P 27-5-2012 3/III 27-5-2012 5-7-2012 4-8-2012 8-9-2012 12-10-2012 5-7-2012 4-8-2012 8-9-2012 12-10-2012 5-4-2013
5 Eka Nur Fitriani Umi Yati/Kusno Afandi P 12-6-2012 3/III 12-6-2012 10-9-2012 30-10-2012 4-3-2013 15-4-2013 10-9-2012 30-10-2012 4-3-2013 15-4-2013 10-3-2013
6 Syifa Ayatul Husna Kristiana/Sopyanto P 20-6-2012 3/III 20-6-2012 10-7-2012 23-8-2012 23-9-2012 24-10-2012 10-7-2012 23-8-2012 23-9-2012 24-10-2012 10-4-2013
7 M.Wafik Yuli/Sugiyanto L 15-7-2012 5/III 19-7-2012 8-8-2012 25-9-2012 25-10-2012 26-11-2012 8-8-2012 25-9-2012 25-10-2012 26-11-2012 13-5-2013
8 Gunawan Putra A Warningsih/Nurjaya L 22-9-2012 3/III 22-9-2012 10-10-2012 22-11-2012 20-12-2012 22-1-2013 10-10-2012 22-11-2012 20-12-2012 22-1-2013 26-7-2013
9 Dika K.N Ernawati/Nazarudin L 17-11-2012 5/III 17-11-2012 26-12-2012 23-1-2013 25-2-2013 27-3-2013 26-12-2012 23-1-2013 25-2-2013 27-3-2013 5-10-2013 13-6-2015# 9-7-2015#

Imunisasi yang diberikan


No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang
1 Mesti Listiyani Tati/Mulyadi P 5-1-2013 5/III 5-1-2013 5-1-2013 18-2-2013 26-3-2013 15-5-2013 18-2-2013 26-3-2013 15-5-2013 20-10-2013 20-10-2013 13-6-2015# 13-8-2015#
Ahmad Rifai Nurjanah/Supardi L 7-1-2013 3/III 7-1-2013 16-1-2013 10-3-2013 10-4-2013 10-5-2013 16-1-2013 10-3-2013 10-4-2013 10-5-2013 20-10-2013 JAKARTA Bd.F(2,4)
2 Fajar Maulana Sidik Lut Piatun K/Khaliri L 23-3-2013 3/III 23-3-2013 10-4-2013 22-5-2013 6-7-2013 9-8-2013 10-4-2013 22-5-2013 6-7-2013 9-8-2013 20-1-2014* 13-6-2015# 13-8-2015# Bd.F(3,7)
3 Naili Aqliyatunnisa Putri Sarpi/Sumarno P 1-4-2013 5/III 1-4-2013 20-4-2013 5-6-2013 6-7-2013 28-8-2013 20-4-2013 6-7-2013 28-8-2013 28-9-2013* 6-1-2014* 13-6-2015# 13-8-2015# Bd.F(2,9)
Apriyani/Siswoyo L 6-4-2013 5/III 6-4-2013 PINDAH RSUK
Maysa(tamu) Puji Lestari/Supriyanto P 21-5-2013 5/III 21-5-2013 v TAMU v TAMU Bd.Mas(3,4)
Muh.Dani Khaeri Yuli Kartika/Sugiarto L 22-8-2013 5/III 4-9-2013 6-11-2013 9-1-2014* 4-9-2013 6-11-2013 9-1-2014* PINDAH JAKARTA
Alisa Qonita Onsi Fasikha/Akhmad Zarkhoni P 9-10-2013 5/III 9-10-2013 14-11-2013 10-12-2013 9-1-2014* 9-2-2014* 9-11-2013 10-12-2013 9-1-2014* 9-2-2014* 10-7-2014* 13-6-2015# PEMALANG Bd.Moga
Musari Afnan Al'Afasi Defi L 19-10-2013 5/III 19-10-2013 1-11-2013 16-12-2013 10-2-2014* 12-4-2014* 1-11-2013 16-12-2013 10-2-2014* 12-4-2014* 16-8-2014* TIDAK ADA
4 Moh.Rafizar Dzulkarnaen Jumi'ati/Santori L 13-12-2013 5/III 13-12-2013 20-2-2014* 20-3-2014P* 20-5-2014P* 20-6-2014P* 20-2-2014* 20-3-2014* 20-5-2014* 20-6-2014* 20-9-2014* 13-6-2015# 6-2-2016^ RB.Rhm(sc)

Imunisasi yang diberikan


No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang
Maura Nur Nafisah Jaronah/Suhairi(2/) P 2-2-2014 3/III 3-2-2014 10-2-2014 2-4-2014P 2-5-2014P 2-6-2014P 10-2-2014 2-4-2014 2-5-2014 2-6-2014 5-11-2014 PINDAH TEGALSARI Bd.M(2,9)
1 Navisya Nur Fadhilah Susanti/Wiwin Wiharto(2/) P 22-2-2014 5/III 22-2-2014 12-3-2014 24-4-2014P 24-5-2014P 24-6-2014P 12-3-2014 24-4-2014 24-5-2014 24-6-2014 17-12-2014 20-8-2015# 12-3-2016^ Bd.E(2,7)
2 Arkan Ataya Rokhanah/Tejo L 14-3-2014 5/III 14-3-2014 MENOLAK 21-10-2014P MENOLAK 21-10-2014 MENOLAK Bd.Mas
Rahma St.Muhayati/Sumarto(5/) P 1-4-2014 3/III 1-4-2014 PINDAH SLAWI RSUK(3)
Kaeyla Salsabila Warningsih P 28-6-2014 5/III 29-6-2014 4-8-2014 21-10-2014P PINDAH 4-8-2014 21-10-2014 PINDAH
3 Fikri Ramadan Nur Hidayah L 29-6-2014 3/III 29-6-2014 10-8-2014 10-9-2014P 10-10-2014P 10-11-2014P 10-8-2014 10-9-2014 10-10-2014 10-11-2014 10-4-2015# 6-2-2016^ RB.Rhm(2,4)
4 Masha Ramadhani Sri Naidah/Tofik P 11-7-2014 5/III 12-7-2014 16-8-2014 11-9-2014P 11-10-2014P 11-11-2014 16-8-2014 11-9-2014 11-10-2014 11-11-2014 15-4-2015# 23-1-2016^ 18-8-2016^
5 M.Syafiq Romadhon Kartini/Abu Dirman L 14-7-2014 5/III 15-8-2014 25-8-2014 1-10-2014P 9-11-2014P 15-12-2014P 25-8-2014 1-10-2014 9-11-2014 15-12-2014 13-5-2015# 6-2-2016^ 6-8-2016^ Pusk(2,2)
6 Ataris Reza Toipah L 27-7-2014 3/III 27-7-2014 10-9-2014 10-10-2014P 10-11-2014P 10-12-2014P 10-9-2014 10-10-2014 10-11-2014 10-12-2014 20-4-2015# 6-2-2016^ 6-8-2016^ Bd.F
7 Alvino(Warningsih) Siti Maesaroh/Safrudin L 10-9-2014 3/III 10-9-2014 10-9-2014 10-11-2014 10-12-2014# 10-1-2015# 10-9-2014 10-11-2014 10-12-2014# 10-1-2015# 13-6-2015# Bd.F(2,8)
8 Afif Aji P St.Khamidah/Nurkosirin L 29-9-2014 3/III 29-9-2014 5-10-2014 10-12-2014P 10-1-2015# 10-2-2015# 5-10-2014 10-12-2014 10-1-2015# 10-2-2015# 29-6-2015# Bd.F(3,2)
9 Esti Nabilla Susi Susanti/Nantoro(DF/8/1) P 21-10-2014 5/III 22-10-2014 10-12-2014 6-1-2015# 17-2-2015# 17-3-2015# 10-12-2014 6-1-2015# 17-2-2015# 17-3-2015# 10-8-2015#DF 24-4-2016^ RSIAKI(3,8)sc
10 Moh.Akmal Al Awi Dewi S/Romadhon L 3-12-2014 5/III 3-12-2014# 11-1-2015# 7-2-2015# 9-3-2015# 12-4-2015# 11-1-2015# 7-2-2015# 9-3-2015# 12-4-2015# 10-9-2015# 4-6-2016^

Imunisasi yang diberikan


No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang
1 A.Hasan Nuraeni/Slamet(DF/10/1) L 1-1-2015 5/III 1-1-2015 6-2-2015 7-3-2015 11-4-2015 23-5-2015 6-2-2015 7-3-2015 11-4-2015 23-5-2015 5-10-2015DF RSI
2 M.Faqih Hani/Urif L 19-1-2015 5/III 10-1-2015 9-2-2015 10-4-2015 9-5-2015 9-6-2015 9-2-2015 10-4-2015 9-5-2015 9-6-2015 9-11-2015
3 Muh.Septiyan Solecha/Sanuri L 10-2-2015 5/III 10-2-2015 23-2-2015 12-4-2015 20-5-2015 13-6-2015 23-2-2015 12-4-2015 20-5-2015 13-6-2015 10-11-2015 17-8-2016^
1^ Aisyah Putri Kinanti Sani/Sigit(DF/8/10) P 30-4-2015 5/III 1-5-2015 10-6-2015 30-7-2015 30-9-2015^ 12-11-2015^ 10-5-2015 30-7-2015 30-9-2015^ 12-11-2015^ 17-2-2016^
2 Hafiz Bintang Tobi'in/Ika S L 23-5-2015 3/III 23-5-2015 5-7-2015 10-8-2015 16-9-2015 19-10-2015 5-7-2015 10-8-2015 16-9-2015 14-5-2016^ 14-5-2016^
3 Nadia Safitri Tarwen/ Suyanto L 4-8-2015 3/III 5-8-2015 28-9-2015 12-12-2015^ 6-2-2016^ 12-3-2016^ 28-9-2015 12-12-2015^ 6-2-2016^ 16-4-2016^ 14-5-2016^ RSUK(3,1)sc
4 Azka Sisma Hendra Linda Fitriyani/Dede R L 5-8-2015 3/III 23-9-2015 26-10-2015 23-11-2015 26-12-2015^ 26-1-2016^ 26-10-2015 23-11-2015^ 26-12-2015^ 26-1-2016^ 30-5-2016^ RSI(1,6)
Tika Rahayu/Nurkholis P 3/III PINDAH JKT Bd Las(3)
5^ Windy Tutut S/Maskhuri P 26-12-2015 5/III 26-12-2015^ 28-2-2016^ Bd F(2,5)

Imunisasi yang diberikan


No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang

Imunisasi TT
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Hani/Urif M 5/III 22-7-2014 26-8-2014
2 Susi M 5/III 25-6-2014 25-7-2014
3 Siti maesaroh M 3/III 22-6-2014
4 Dewi Sriani/Romadhon M 5/III 13-9-2014
5 Solicha/Sanuri M 5/III 15-10-2014
6 Seli/Sanuri M 5/III 16-11-2014
Imunisasi TT
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Linda/Dedi M 5/III 17-3-2015 29-4-15
2 Sari M 5/III -3-15
3 Tutut S/Maskuri M 5/III 10-9-2015
4 Tika/Idin M3/III 9-11-2015 15-12-2015
Imunisasi TT
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Maghfirotul M 3/III 15-2-2016

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