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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 Muh.Haykal Adam Yulie Astuti/Sudi Hartono L 16-8-2009 5/I 16-8-2009 2-9-2009 1-11-2009 6-12-2009 3-1-2010 2-9-2009 1-11-2009 6-12-2009 3-1-2010 20-6-2010

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 Muh.Mahdi Nurrafa Fauziah/Agus Nurokhman L 13-7-2010 3/I 13-7-2010 21-8-2010 22-9-2010 20-1-2010 20-11-2010 21-8-2010 22-9-2010 20-1-2010 20-11-2010 13-6-2011

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 M.Anang Hermansyah Muslichun/Indah L 10-1-2011 6/I
2 Maryam M.safik/Sakinah P 13-1-2011 9/I
3 Umi Nur Azizah Suwarso/Ati S P 28-1-2011 7/I
4 Ata Maulana Putra Agustina/Eko L 3-2-2011 5/I 17-6-2014*
5 Andika Guntur P Subiyakto/Herwati L 19-3-2011 5/I
6 Rizki Dwi Pratama Sumarni/Andi Hartanto L 7-4-2011 5/I 7-4-2011 12-5-2011 7-6-2011 7-7-2011 9-11-2011 7-6-2011 7-7-2011 26-10-2011 26-11-2011 8-10-2012
7 Naili Riski Ayu Dwi Mulya/Hadi.S P 4-6-2011 7/I
8 Ridho Yuniar Handoyo/Tuti L 11-6-2011 3/I
9 Nadila Endah/Mansur P 26-6-2011 5/I 17-6-2014*
10 Sauqi Rizki Maulana Kristianti/Haryanto L 2-7-2011 7/I 15-7-2014*
11 Zaida Humaria R Adi Wahyuni/Andri A P 13-8-2011 1/I 13-8-2011 10-9-2011 15-11-2011 13-12-2011 17-1-2012 10-9-2011 26-10-2011 13-12-2011 17-1-2012 14-5-2012
12 Nada Sasy Rachmadini Jaroah/Munadi Rosyid P 18-8-2011 7/I 19-8-2011 3-10-2011 8-11-2011 22-12-2011 17-2-2012 3-10-2011 8-11-2011 22-12-2011 17-2-2012 27-8-2012 15-7-2011*
13 Nida Sasy Rachmadina Jaroah/Munadi Rosyid P 18-8-2011 7/I 19-8-2011 3-10-2011 14-11-2011 19-12-2011 25-1-2012 3-10-2011 14-11-2011 19-12-2011 25-1-2012 12-6-2012
14 Aisya Ainurofinah Elsi P 23-8-2011 9/I 17-6-2014*
15 Tsabit Elbadar Arif/Arifah L 25-8-2011 6/I
16 M.Gilang Supriono/Ningrum L 30-8-2011 8/I
17 M. Alfi Sofian Agus/Sulasmi L 11-9-2011 5/I
18 Arsa Zalfa N Daryanto/St. Maisaroh P 16-9-2011 6/I
19 Dafin Abd. Cholid/Amalia L 5-10-2011 5/I
20 Padya Mumtazah Fery L 13-11-2011 4/I
21 Lacly Fadilah Putri Purwandoro/Lely P 22-11-2011 9/I
22 Moh. Jefri Agus/Maratun L 10-12-2011 8/I
23 Kirana Ratu Amelia Dewi/Heri P 17-12-2011 9/I 17-6-2014*
24 Silvi Tania Sutani/Asih P 20-12-2011 7/I
25 Mohamad Azam Aqila Erlinawati/Moh.Subhan L 28-12-2011 5/I 12-1-2012 20-2-2012 13-3-2012 28-4-2012 12-6-2012 20-2-2012 13-3-2012 28-4-2012 12-6-2012 8-10-2012 15-7-2014*
26 Mohamad Nizam Aqila Erlinawati/Moh.Subhan L 28-12-2011 5/I 12-1-2012 20-2-2012 13-3-2012 28-4-2012 12-6-2012 20-2-2012 13-3-2012 28-4-2012 12-6-2012 8-10-2012 15-7-2014*

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
Intan Nur Hikmah Putri P 10-1-2012 6/I 10-1-2012 25-1-2012 10-3-2012 17-4-2012 14-5-2012 25-1-2012 10-3-2012 17-4-2012 14-5-2012 PINDAH
M.Soleh Sakinah L 2-2-2012 9/I TIDAK ADA
1 Nazhiifa Zahrani Dian Anggraini/Arif R P 4-3-2012 3/I 4-3-2012 20-3-2013 5-5-2012 6-6-2012 6-7-2012 25-3-2012 5-5-2012 6-6-2012 6-7-2012 6-12-2012 17-6-2014* 13-10-2015#
2 Muflihah Azhari Unun Fitriyah/M.Zainul A P 22-3-2012 7/I 28-3-2012 14-5-2012 11-6-2012 17-7-2012 14-8-2012 14-5-2012 11-6-2012 17-7-2012 14-8-2012 7-1-2013 15-7-2014*
3 Putri Aulia Azzahra Farchatun/Suwito P 25-3-2012 1/I 21-6-2014*
4 Jihan Aufa Amalia Es Tati/Abdul Hasyim L 1-4-2012 7/I 1-4-2012 28-5-2012 24-6-2012 30-7-2012 27-8-2012 28-5-2012 24-6-2012 30-7-2012 27-8-2012 9-1-2013 17-6-2014* 13-10-2015#
5 Beby Cinta Apriliyani Nursiyati/Deddy Saparino P 11-4-2012 6/I 11-4-2012 16-4-2012 12-6-2012 17-7-2012 14-8-2012 16-4-2012 12-6-2012 17-7-2012 14-8-2012 11-2-2013 17-6-2014* 13-10-2015#
6 Raesya Kartika Sari Etti/Gunawan P 13-5-2012 6/I 17-5-2012 23-7-2012 23-8-2012 23-9-2012 23-10-2012 23-7-2012 23-8-2012 23-9-2012 23-10-2012 16-9-2013 13-5-2014* 7-7-2015#
7 Dinar Satria Wijaya K Susilowati/Imam Subechi L 15-5-2012 5/I 15-5-2012 20-5-2012 15-7-2012 14-8-2012 16-9-2012 25-5-2012 15-7-2012 14-8-2012 16-9-2012 4-3-2013 16-9-2014*
8 Regina Virginia Karim P 21-5-2012 3/I 21-5-2012 30-5-2012 9-7-2012 10-9-2012 8-1-2013 30-5-2012 9-7-2012 10-9-2012 8-1-2013 13-2-2013 17-6-2014*
9 Nazamah Putri N Leli/Nurohmah P 26-6-2012 8/I 26-6-2012 1-7-2012 8-9-2012 13-11-2012 4-12-2012 1-7-2012 8-9-2012 13-11-2012 4-12-2012 5-3-2013 15-7-2014*
Alif Juned Neli Juwaeti/Ronal L 29-6-2012 7/I 29-6-2012 11-7-2012 3-9-2012 3-10-2012 12-11-2012 11-7-2012 3-9-2012 3-10-2012 12-11-2012 JKT
10 Aldo Fernando Endang Linawati/Untung L 3-7-2012 3/I 3-7-2012 25-7-2012 8-10-2012 12-11-2012 15-12-2012 25-7-2012 8-10-2012 12-11-2012 15-12-2012 3-5-2013 17-6-2014* 13-10-2015#
11 Najma Armel Sahira M.Nazarudin P 3-7-2012 9/I 9-1-2013
12 Khafiz Fauzan K Fera Purwanti/Iwan S L 27-8-2012 7/I 27-8-2013 5-10-2012 27-11-2012 17-1-2013 25-2-2013 5-10-2012 27-11-2012 17-1-2013 25-2-2013 7-9-2013 12-8-2014* 7-7-2015#
13 M.Elthaff Vivi Handayani/Ismail L 8-9-2012 9/I 9-9-2012 17-10-2012 12-11-2012 11-12-2012 22-1-2013 17-10-2012 12-11-2012 11-12-2012 22-1-2013 29-7-2013 12-8-2014*
14 Thalita Ulfa O Dewi Haryani/Anton S P 14-10-2012 6/I 14-10-2012 17-11-2012 5-1-2013 6-2-2013 9-3-2013 17-11-2012 5-1-2013 6-2-2013 9-3-2013 28-8-2013
15 Andrean Rizky Dwi K Dian Novieta/Hadi K L 15-10-2012 6/I 15-10-2012 17-12-2012 22-1-2013 16-4-2013 14-5-2013 17-12-2012 22-1-2013 16-4-2013 14-5-2013 16-9-2013 13-5-2014* 7-7-2015#
16 Anisa Zahra Amelia Sukma/Luki P 18-10-2012 1/I 19-10-2012 19-11-2012 19-11-2012 20-2-2013 25-3-2013 19-10-2012 19-11-2012 20-2-2013 25-3-2013 20-8-2013
17 Saquele Risky Amanda I/Yanuar P 22-10-2012 7/I 27-10-2012 17-12-2012 5-2-2013 8-3-2013 8-4-2013 17-12-2012 5-2-2013 8-3-2013 8-4-2013 28-5-2013
18 Nur Althaafunnisa Nur Asih/Purwantoro P 26-10-2012 6/I 26-10-2013 7-11-2012 26-12-2012 26-1-2013 26-2-2013 7-11-2012 26-12-2012 26-1-2013 26-2-2013 21-8-2013 17-6-2014* 7-7-2015#
19 Aisyah Raihanah Ani Fitriyah/Yeni Ari P 24-11-2012 6/I 24-11-2012 2-1-2013 2-2-2013 4-3-2013 10-4-2013 2-1-2013 2-2-2013 4-3-2013 10-4-2013 16-9-2013 16-9-2014*
20 Alesha Diva Amalia/Ahmad Kholik P 2-12-2012 6/I 24-12-2012 23-1-2013 24-2-2013 14-5-2013 -9-2014 23-1-2013 24-2-2013 14-5-2013 -9-2013 11-8-2015#
Rafi Evanallah Wijaya Betty Yulistyowati/Agus L 10-12-2012 9/I 10-12-2012 21-1-2013 12-2-2013 13-3-2013 15-4-2013 21-1-2013 12-2-2013 13-3-2013 15-4-2013 25-9-2013* BANDUNG
21 Rico Fiki Pratama Susi/Heri L 23-12-2012 9/I MENOLAK
Belqis A. Fahidin P 24-12-2012 6/I 24-12-2012 23-1-2013 16-4-2013 14-5-2013 23-1-2013 16-4-2013 14-5-2013 11-6-2013 DAMPYAK

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
Isti Syakirah Fenty/Sujeki P 1-2-2013 7/I 1-2-2013 5-3-2013 5-4-2013 16-6-2013 16-7-2013 5-3-2013 5-4-2013 16-6-2013 16-7-2013 20-11-2013 16-9-2014* RSUK
Fawwaz Daimah/Abdullah L 4-2-2013 8/I 4-2-2013 5-3-2013 14-4-2013 16-5-2013 PINDAH 5-3-2013 14-4-2013 16-5-2013 KE SKR INDAH A RSI
1 Hilal Putra Sopan Zein Tria Sang Putri/Agus S L 21-2-2013 8/I 21-2-2013 11-3-2013 14-5-2013 11-6-2013 16-7-2013 11-3-2013 14-5-2013 11-6-2013 16-7-2013 6-1-2014* 16-9-2014*
2 Ikhfa Anisa Rela Asih/Ade S P 21-2-2013 2/I 21-2-2013 11-3-2013 14-5-2013 11-6-2013 20-8-2013 11-3-2013 14-5-2013 11-6-2013 20-8-2013 5-5-2014* 13-10-2015# 10-11-2015# Bd.M
Donna/Deddy L 23-2-2013 6/I 24-2-2013 TIDAK ADA RSI
Leli R/Puspayana L 26-2-2013 8/I 26-2-2013 JAKARTA RSUK
Aprilia Setianingsih Parikha/Kuspriaji P 2-4-2013 7/I 3-4-2013 PINDAH MAWAR B Bd.M
Beta Rezki/M.Aliyin P 10-4-2013 /I 10-4-2013 TIDAK ADA RBKhr
Halia Nurfika/Dedi P 12-4-2013 5/I 12-4-2013 TIDAK ADA RSUK
3 M.Aisar Zhapran Diana/Samto L 2-5-2013 8/I 2-5-2013 TIDAK 16-7-2013 22-8-2013 17-6-2014* 22-8-2013 16-7-2013 13-5-2014* 17-6-2014* 13-5-2014* 7-7-2015# 11-8-2015# RSUK(3,3)
4 Qoirun Nizama St.Maesaroh/Daryanto L 14-6-2013 6/I 18-6-2013 9-9-2013 22-8-2013 17-9-2013 22-10-2013 22-8-2013 17-9-2013 22-10-2013 17-12-2013 13-5-2014* 11-11-2014* Bd.M(3,5)
Muammar Aqila S Rina(Alm)/Rizal L 17-6-2013 8/I 17-6-2013 PINDAH BANDUNG RBRhm(2.9)
5 Haedar Kanan Rani Wulandari L 24-6-2013 3/I 24-6-2013 2-8-2013* 11-9-2013* 19-10-2013* 25-1-2014* 2-8-2013* 11-9-2013* 19-10-2013* 25-1-2014* 4-6-2014* Pndn Dbg
Bayu Zhafran Al Faresqi Herdhina/Zaenal L 7-7-2013 6/I 7-7-2013 2-9-2013 TIDAK ADA 2-9-2013 TIDAK ADA
6 Tania Rachmadani Y.P. Yuli Fitriyah/Sakur P 13-7-2013 2/I 21-7-2013 26-8-2013 6-11-2013 10-12-2013 8-1-2014* 26-8-2013 6-11-2013 10-12-2013 8-1-2014* 5-5-2014* 7-7-2015# 9-8-2016^ RSUK(3,7)sc
7 Fernando Sandi R Susanti/Adi Irawan L 19-7-2013 5/I 19-7-2013 4-11-2013 17-9-2013 22-10-2013 17-12-2013 17-9-2013 22-10-2013 17-12-2013 21-1-2014* 28-4-2014* 7-7-2015# RSUK(2,8)
Dafa Agusta Khusaeri Theni K/Nandi P L 16-8-2013 5/I 16-8-2013 16-9-2013 16-10-2013 PINDAH 16-9-2013 16-10-2013 BANDUNG RSUK(3,3)
8 Ainun Nur Azalia Ati Setyorini/Suwarso P 20-8-2013 7/I 20-8-2013 30-9-2013 22-10-2013 7-12-2013 9-1-2014* 30-9-2013 22-10-2013 7-12-2013 9-1-2014* 13-5-2014* 7-7-2015# 13-10-2015# RB.St.Hj(3,1)sc
9 Mikeyla Nunung/Dede P 24-9-2013 3/I 24-9-2013 16-10-2013 24-11-2013 2-1-2014* 4-2-2014* 16-10-2013 24-11-2013 2-1-2014* 4-2-2014* 16-9-2014* 7-7-2015# Bd.E(2,8)
M.Ghozali Saputra Rita Nur H/Heri Saputro L 1-10-2013 6/I 1-10-2013 28-10-2013 PINDAH 28-10-2013 DEBONG RB.Rhm(3,8)
10 Nailatur Rifdah Hermi Nur Fitriani/Agung P 21-10-2013 9/I 21-10-2013 20-11-2013 21-12-2013* 25-1-2014* 28-2-2014* 20-11-2013 21-12-2014* 25-1-2014* 28-2-2014* 24-7-2014* 30-4-2015# PNDH MEJSEM
11 Rafi Hanif Fairus/Hanip Basemu L 24-10-2013 5/I 24-10-2013 MENOLAK RSI(2,7)
12 Pratama Abei Zubahir Nawang Putri/Obaidik L 28-12-2013 8/I 28-12-2013* 24-2-2014* 3-3-2014P* 7-4-2014P* 13-5-2014P* 24-2-2014* 7-4-2014* 13-5-2014 17-6-2014 13-10-2014* 7-7-2015# 14-6-2016^ RSUK(2,8)sc
13 Alisha Khaira Wilda Tri Nawang W/Daryanto P 30-12-2013 7/I 30-12-2013* 17-2-2014* 11-3-2014P* 15-4-2014P* 13-5-2014P* 17-2-2014* 11-3-2014* 15-4-2014* 13-5-2014* 13-10-2014* 11-8-2015# 10-5-2016^ Bd.Pmlg(4)
Imunisasi yang diberikan 11-8-15
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
Nadia/M.Yusuf P 16-1-2014 4/I 16-1-2014 PINDAH CIREBON RSI(3,2)
1 Nur Aulia Zulfani Yulianti/Sarifudin P 30-1-2014 5/I 30-1-2014 24-2-2014 7-4-2014P 5-5-2014P 9-6-2014P 24-2-2014 7-4-2014 5-5-2014 9-6-2014 20-10-2014# 11-8-2015# 10-5-2016^ RSUK(3,2)
Alysia Riki(RSI) Riski Widyaningrum/Heri P 14-2-2014 3/I 14-2-2014 26-3-2014 TIDAK 26-3-2014 ADA RSI(2,9)
2 Alvaro Novitasari/Heri L 4-3-2014 3/I 4-3-2014 15-4-2014 13-5-2014P 3-7-2014P 12-8-2014P 15-4-2014 13-5-2014P 3-7-2014P 12-8-2014P 4-12-2014# PINDAH Pndhn KK
M.Fattan Navisyah/Saeful(DF/8) L 19-3-2014 1/I 20-3-2014 16-4-2014 4-7-2014P 9-9-2014P 14-10-2014P 16-4-2014 4-7-2014 9-9-2014 14-10-2014 V PINDAH Bd.E(2,9)
3 Qonata Teti/Suali P 3-4-2014 6/I 4-4-2014 16-4-2014 3-6-2014P 3-7-2014P 3-8-2014P 16-4-2014 3-6-2014 3-7-2014 3-8-2014 11-2-2015# 9-2-2016^ Bd.E(3,1)
4 Nadiyah Rizki Manik Sri Rejeki/Lasron Manik P 7-4-2014 7/I 7-4-2014 20-5-2014 17-6-2014P 15-7-2014P 25-8-2014 20-5-2014 17-6-2014 15-7-2014 25-8-2014 13-1-2015# 15-12-2015# 14-6-2016^ Bd.Mas(3,1)
5 Albi Syahril Rayi Ayu/Tahril Purwanto L 8-4-2014 2/I 8-4-2014 12-8-2014P 16-9-2014P 12-8-2014 16-9-2014 MENOLAK Bd.M(3)
Sakila Sabila Ananda Citra Y/Yanuar P 14-4-2014 7/I 15-4-2014 23-5-2014 13-8-2014P TIDAK ADA 23-5-2014 13-8-2014 TIDAK ADA
St.Khodijah/Jaenal M P 17-4-2014 6/I PINDAH SLEROK Bd.Mas(1,85)
St.Khodijah/Jaenal M P 17-4-2014 6/I PINDAH SLEROK Bd.Mas(2)
6 Intan Putri Aprilia Wiwin Kamelia/Siswaryanto P 18-4-2014 2/I 18-4-2014 28-5-2015# 18-6-2014# 23-7-2014P 22-8-2014 28-5-2015# 18-6-2014# 23-7-2014 22-8-2014 14-1-2015# 10-11-2015# 11-10-2016^ RSUK(3,6)sc
Lina/Syukur L 19-5-2014 6/I BAYI IUFD RSUK
Muhammad Abror Ratna Rahma/Ahmadin L 23-5-2014 9/I 23-5-2014 TIDAK 27-6-2014 ADA RSI(3,3)
7 Bayu Ahmad Dafa F Faria Agustina/Mulyadi L 30-6-2014 1/I 30-6-2014 28-7-2014 31-8-2014P 2-10-2014P 10-11-2014P 28-7-2014 31-8-2014 2-10-2014 10-11-2014 20-5-2015# 10-5-2016^
8 Riza Muhammad Nur Arofah/Suwarno L 10-7-2014 7/I 10-7-2014 28-7-2014 16-9-2014P 13-10-2014P 11-11-2014P 28-7-2014 16-9-2014 13-10-2014 11-11-2014 14-4-2015# 14-6-2016^ Bd.M(3,6)
9 Gabriela Meli Safitri Salimah/Ho se tjaw P 10-8-2014 9/I 10-8-2014 21-9-2014 13-10-2014P 11-11-2014P 11-12-2014P 21-9-2014 13-10-2014 11-11-2014 11-12-2014 30-5-2015# PINDAH TEGALSARI Pusk(3,4)
10 Fakhrie Buana Al Hafidzi Arum Wulandari/Kanda Buana L 8-8-2014 7/I 14-8-2014 20-9-2014 14-10-2014P 17-11-2014P 15-12-2014# 20-9-2014 17-11-2014 15-12-2014# 13-1-2015# 11-5-2015# 12-4-2016^ 13-9-2016^ Bd.Mas
11 Gendis Fatia Rahman Nok Fasicha/M.Rahman(DF/8/1) P 18-10-2014 3/I 18-10-2014 17-11-2014 29-12-2014# 10-3-2015# 14-4-2015# 17-11-2014 29-12-2014# 10-3-2015# 14-4-2015# 11-8-2015#DF 9-8-2016^ RSUK(3,1)sc
12 M. Syahmi Rokhimah/Asep Kusma L 24-11-2014 4/I 24-11-2014 21-1-2015# 25-2-2015# 25-3-2015# 25-4-2015# 21-1-2015# 25-2-2015# 25-3-2015# 25-4-2015# 29-8-2015# TIDAK ADA
13 Riski Ayunda Humaira Solicha/Moch.Nursidik(DF/8) P 13-12-2014 1/I 20-12-2014# 23-3-2015# 10-3-2015# 14-4-2015# 7-7-2015# 10-3-2015# 14-4-2015# 7-7-2015# 15-9-2015# 10-11-2015# 13-9-2016^ Bd.M

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 Moh.Risky Syarifudin Indri Anggraeni/Ramita L 4-1-2015 7/I 4-1-2015 20-1-2015 10-3-2015 14-4-2015 15-5-2015 20-1-2015 10-3-2015 14-4-2015 15-5-2015 10-11-2015 12-7-2016^ Pusk(2,9)
2 Asyifa Monica Nur F/Wisnu P 2-2-2015 8/I 2-2-2015 23-3-2015 14-4-2015 12-5-2015 16-6-2015 23-3-2015 14-4-2015 12-5-2015 16-6-2015 10-11-2015 13-9-2016^ RSUK(2,9)
3 Ilham Adi N Adi Wahyuni/Andri A(DF/8/2) L 16-2-2015 1/I 16-2-2015 7-3-2015 18-5-2015 7-7-2015 11-8-2015DF 7-3-2015 18-5-2015 7-7-2015 11-8-2015DF 23-11-2015 13-9-2016^
4 Haidar Haryani/Adi Setiadi(DF/8/3) L 11-3-2015 9/I 11-3-2015 27-4-2015# 12-5-2015 16-6-2015 11-8-2015DF 27-4-2015# 16-6-2015 11-8-2015DF 15-9-2015 15-12-2015 13-9-2016^ RSI(3,4)
5 M.Sidik Putri Karunia/Mulya W L 30-3-2015 5/I 30-3-2015 5-5-2015 20-7-2015 MENOLAK 5-5-2015 20-7-2015 MENOLAK
1^ Keanu Umar Yahya Dwi Sapta/M.Zakaria(DF/8/4) L 21-4-2015 6/I 21-4-2015 8-6-2015 7-7-2015 11-8-2015DF 15-9-2015 28-4-2015 7-7-2015 11-8-2015DF 15-9-2015 25-1-2016^ 8-11-2016^
2 Bening Ade Irma/M. Reza(DF/8) P 5-5-2015 6/I 6-5-2015 20-6-2015 6-7-2015 5-9-2015 14-11-2015 6-5-2015 6-7-2015 5-9-2015 14-11-2015 18-2-2016^
3 Risqiana A.S Lina/Syukur(DF/8/5) P 8-6-2015 6/I 8-6-2015 12-7-2015 11-8-2015DF 15-9-2015 13-10-2015 12-7-2015 11-8-2015DF 15-9-2015 13-10-2015 14-3-2016^
4 Zaki Nyai Kasmi/Widi W L 11-6-2015 3/I 17-6-2015 17-7-2015 21-8-2015 21-9-2015 21-10-2015 17-7-2015 21-8-2015 21-9-2015 21-10-2015 12-4-2016^ RSIAKI
5 Safira Yuli Astuti/Hartono P 25-6-2015 5/I 26-6-2015 5-8-2015 13-9-2015 26-10-2015 28-1-2016^ 5-8-2015 13-9-2015 26-10-2015 28-1-2016^ 31-3-2016^ 3.6
Reynanda Azka W Muanah/Iwan Wahyudi L 4-7-2015 3/I 5-7-2015 23-7-2015 PINDAH 23-7-2015 PINDAH Bd.M(3,6)
6 Afiqa Islamir Anjar Melati/Dedi I(DF/8) P 12-7-2015 2/I 12-7-2015 7-9-2015 15-9-2015 11-11-2015 15-12-2015 7-9-2015 11-11-2015 15-12-2015 9-2-2016^ 15-8-2016^ Bd.M(3,1)
Leli Fitriani/Anton M P 14-7-2015 Salak 106 15-7-2015 TIDAK ADA RSI
7 Mahira Nuri Septian Nur janah/Agus Setiawan P 21-9-2015 8/I 22-9-2015 20-10-2015 24-11-2015 24-12-2015^ 9-2-2016^ 20-10-2015 24-11-2015 24-12-2015^ 9-2-2016^ 13-9-2016^ RSI(3,5)
8 Mia Andrey Suci Anggraeni/Teguh I P 30-9-2015 I/I 1-10-2015 16-11-2015 15-12-2015 12-1-2016^ 9-2-2016^ 8-10-2015 15-12-2015 12-1-2016^ 9-2-2016^ 12-7-2016^ RSI(2,9)
9 M.Ibnu Andrean Astini/ Charis Jaenudin L 13-11-2015 8/I 13-11-2015 4-1-2016^ 13-1-2016^ 29-2-2016^ 29-3-2016^ 4-1-2016^ 9-2-2016^ 12-4-2016^ 14-6-2016^ 13-9-2016^ Bd.M(3)
Toipah/Aris L 13-11-2015 3/I 14-11-2015 PINDAH TALANG RSIA(3,1)
Oso Al Aunara Bilqis Kartini/Muhajir P 23-11-2015 7/I 24-11-2015 28-12-2015 PINDAH 28-12-2015 MEJASEM RS Plry(3,1)
10 Fatimah Azzahra Agustina/Eko saputra P 2-12-2015 5/I 3-12-2015 9-12-2015 4-2-2016^ 8-3-2016^ 12-4-2016^ 9-12-2015 4-2-2016^ 12-4-2016^ 14-6-2016^ 13-9-2016^ Bd.Ety(3,5)
Liyanti/Ari P 12-12-2015 4/I 12-12-2015 TIDAK ADA
11 Nabila Muazara Dian Anggraeni/Arief P 14-12-2015 3/I 14-12-2015 13-1-2016^ 22-2-2016^ 24-3-2016^ 28-4-2016^ 13-1-2016^ 22-2-2016^ 12-4-2016^ 10--5-2016 14-9-2016^ Bd.Ety(3)
12 M.Maulana Endriasih/M.Diding L 26-12-2015 1/I 27-12-2015^ 6-1-2016^ 28-2-2016^ 27-3-2016^ 10-5-2016^ 6-1-2016^ 28-2-2016^ 12-4-2016^ 10-5-2016 11-10-2016^ RSI(3,2)
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 Aliyah Aisyah/Faraz P 1-1-2016 4/I 2-1-2016 MENOLAK RB Khr(2,5)
2 M. Nizam Muazam Sulistyaningsih/M.Soleh L 18-1-2016 8/I 18-1-2016 22-2-2016 3-5-2016 14-6-2016 13-9-2016 28-1-2016 3-5-2016 14-6-2016 13-9-2016 RSI(2,5)
3 Syarif Abdullah Vera Mudalisa/Faozan L 29-1-2016 8/I 30-1-2016 20-2-2016 29-3-2016 28-4-2016 29-5-2016 20-2-2016 12-4-2016 28-4-2016 29-5-2016 Bd.M(3)
4 Fino Febrian Sumarni/M.Harin L 25-2-2016 5/I 25-2-2016 18-7-2016 10-5-2016 12-7-2016 11-10-2016 2-3-2016 10-5-2016 12-7-2016 11-10-2016 RSUK(2,5)SC
5 Kinan Nabila Tita Rohayati/Ari Hidayat P 8-3-2016 7/I 8-3-2016 11-4-2016 10-5-2016 14-6-2016 12-7-2016 11-4-2016 10-5-2016 14-6-2016 12-7-2016 Bd.(3,4)
6^ Zhi Zhi putri salsabila Rayi Ayu/Tahril P 21-3-2016 2/I 21-3-2016 20-4-2016 14-6-2016 9-8-2016 11-10-2016 20-4-2016 14-6-2016 9-8-2016 11-10-2016 Bd.M(3)
7 M.Raffa As Sidiq Lucky Handayani/M.Nurochman L 8-4-2016 6/I 9-4-2016 12-5-2016 13-6-2016 13-7-2016 15-4-2016 13-6-2016 13-7-2016 RSI(3,3)
8 Fardhan Pramudya Fatikhah/Ali Aryanto L 8-4-2016 6/I 8-4-2016 20-5-2016 23-6-2016 31-7-2016 11-9-2016 16-4-2016 20-5-2016 31-7-2016 11-9-2016 RSI(3,5)
10 Khodijah Az zahra Fatimah/Muksin P 18-4-2016 5/I 19-4-2016 23-5-2016 12-7-2016 9-8-2016 13-9-2016 27-4-2016 12-7-2016 9-8-2016 11-10-2016 RSI(2,6)
9 Safira Farkhana Putri Lina Yuliati/Kasirun P 22-4-2016 9/I 22-4-2016 20-5-2016 MENOLAK 20-5-2016 MENOLAK Bd.M(4)
11 Zayyan Hafizh Islam Yuni Irmasari/Tri Heri L 10-5-2016 9/I 10-5-2016 20-5-2016 20-7-2016 24-8-2016 24-9-2016 20-5-2016 20-7-2016 24-8-2016 24-9-2016 RSUK(3,4)
12 M. Alfarizhi Eka Reni/Syahrudin L 28-5-2016 8/I 28-5-2016 16-7-2016 9-8-2016 2-9-2016 7-10-2016 16-7-2016 1-8-2016 2-9-2016 7-10-2016 RSMK(3,95)
13 Keisha Zahra Bugri Imanisghina/ Fikrie P 19-6-2016 6/I MENOLAK 11-10-2016 8-11-2016 11-10-2016 8-11-2016 RSI(2,7)
14 Airlangga Saif Aslam Raticha/ Ratono L 18-7-2016 6/I 18-7-2016 14-9-2016 3-10-2016 8-11-2016 25-7-2016 14-9-2016 8-11-2016 RSIAKI(3,2)
15 Sherli Aura Putri Prihatin/ Fredi Permana L 6-10-2016 8/I 7-10-2016 Rsuk(2,9)

Imunisasi TT
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Sarah/Tio Riski K 8/I V
2 Kusmiyati/Wahidin K 6/I 16-10-2014
3 Sumarni/Moh.Khariri K 5/I 7-10-2014C
4 Desi Restina K 5/I 6-10-2014
5 Adi Wahyuni/Andri A K 1/I 27-10-2014
6 Monica K 8/I 11-11-2014 11-12-14
7 Haryani K9/I 28-10-2014
8 Indri Anggraeni K 7/I 4-12-14
Imunisasi TT
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Dwi Sapta/M.Zakaria K 6/I 10-2-2015
2 Kristin/Ripto R K 8/I 13-1-2015
3 Anjar Melati/Raswin K 2/I 17-3-2015 23-4-15
4 Yuli Astuti K 5/I 10-2-2015 10-3-15
5 Nurjanah/Agus S K 8/I 30-5-2015
6 Suci Anggraeni K1/I 9-7-2015
6 Nyai Kasmi/Widi W K6/I 23-1-2015
7 Astini/Kharis J K 8/I 8-8-2015
8 Dian A/Arif K3/I 8-8-2015
9* Ayu Salak 74 7-7-2015
10 Vera Muda Lisa/Fauzan K 8/I 3-9-2015
11 Sulistioningsih/M.soheh K8/I 4-10-2015
12 Agustina/Eko Saputra K5/I 1-11-2015
13 Sumarni/Moh.Khariri K5/I 6-11-2015
14 Lucky H/M. Nurokhman K3/I 10-12-2015
15 Tita Rohayati/Ari H K7/I 30-11-2015
16 Yuni Irmasari/Tri Heri K9/I 5-12-2015
Imunisasi TT
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Yuni Irmasari/Tri Heri K9/I 11-1-2016
2 Lina Yuliati/Kasirun K 9/I 29-1-2016
3 Fatikhah/Ali.A K 6/I 13-2-2016
4 Imasghina/Fikri Y K6/I 1-3-2016
5 Rayi Rahayu/Tahril P K2/I 27-2-2016
6 Hidayah/Fajar K 7/I 16-3-2016 2-5-2016
7 Imanis Gina/Fikri Y K 6/I 1-3-2016C 30-3-2016
8 Prihatin/Fredi Permana K8/I 20-5-2016 29-8-2016
9 Nia Ramadhani/M.Irfan K7/I 28-8-2016
10 Fenti/Rujeki K7/I 4-9-2016
RB.St.Hj(3,1)sc
Bd.Mas(1,85)

l
LAPORAN BULANAN IMUNISASI BAYI
POSYANDU MAWAR A

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 A. Nabil Adzakia Andi/ Nurdiana L 28-2-2011 2/II
2 Salman Alfaria Ditia/Umi Faizah L 20-3-2011 4/II
3 M.Rizky Maulana St.Maryam L 15-4-2011 2/II 14-5-2014*
4 Fahmi Ramzi Jejen L 16-4-2011 4/II
5 Lukman Hakim Kusnendar L 14-5-2011 4/II
6 Arfadia Zen Dwi Rinasari/Iman S L 11-6-2011 2/II 16-7-2014*
7 Bustanul Khafid Nur Hikmah/Mulyono L 1-7-2011 1/II 18-6-2014*
8 Ach. Zidan Abu Bakar L 8-9-2011 1/II
9 Sayidina Aii Faris L 15-10-2011 1/II
10 Jesika Sugiyarti/Lukas P 24-10-2011 4/II 13-8-2014*
11 Ivon Herati Gangan/ Ratna P 11-11-2011 2/II
12 Nicko Ardiansyah Marwati/Herry Noerdy L 20-11-2011 6/III 18-6-2014*
13 Fatan M.Zulhani/Mansur L 8-12-2011 1/II
14 Nadira Zalni P 12-12-2011 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 Atika Sari Samsi P 4-1-2012 2/II 4-1-2012 6-2-2012 11-4-2012 14-5-2012 18-10-2012 6-2-2012 11-4-2012 14-5-2012 18-10-2012 12-11-2012
2 Najwa Aulia Sahid Susi/Rudi P 19-4-2012 1/II 20-4-2012 7-5-2012 19-6-2012 16-7-2012 13-8-2012 7-5-2012 19-6-2012 16-7-2012 13-8-2012 21-1-2013
3 M.Rifki Bawazir Astufah/Ismail L 1-5-2012 1/II 1-5-2012 MENOLAK
4 Fikri Rohdiana L 20-6-2012 4/II 20-3-2013
5 Ahmad Fares Martini/Karyono L 26-6-2012 1/II 26-6-2012 30-7-2012 17-10-2012 12-11-2012 12-12-2012 30-7-2012 17-10-2012 12-11-2012 12-12-2012 17-6-2013 3-6-2015#
6 M.Yusuf Adil Jaetun L 10-7-2012 1/II 10-7-2012 19-9-2012 24-10-2012 28-11-2012 19-3-2013 19-9-2012 24-10-2012 28-11-2012 19-3-2013 20-7-2013
7 Zacky Pratama Putra Riski Amalia/Windi Dwi L 25-8-2012 4/II 26-8-2012 19-9-2012 12-12-2012 19-2-2013 19-3-2013 19-9-2012 12-12-2012 19-2-2013 19-3-2013 15-7-2013 3-6-2015#
8 Amanda Septiani Indriyani/Adi P P 8-9-2012 1/II 8-9-2012 22-10-2012 27-11-2012 7-1-2013 11-2-2013 22-10-2012 27-11-2012 7-1-2013 11-2-2013 10-6-2013
9 Arka Bima Pratama Ekasari/Taryani L 29-11-2012 1/II 1-12-2012 26-12-2012 12-2-2013 19-3-2013 19-5-2013 26-12-2012 12-2-2013 19-3-2013 19-5-2013 27-11-2013
10 Annisah Kaylatus S Jaridah M/Heriyanto P 9-12-2012 2/II 9-12-2012 19-1-2013 9-2-2013 9-3-2013 10-4-2013 9-1-2013 9-2-2013 9-3-2013 10-4-2013 9-10-2013 18-6-2014* 1-7-2015# Bd.Mas
11 Abdurrochman Zein Wellina/Yanuar L 31-12-2012 1/II 31-12-2012 4-2-2013 4-3-2013 13-4-2013 15-5-2013 4-2-2013 4-3-2013 13-4-2013 15-5-2013 4-11-2013 18-6-2014* 1-7-2015#

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 Nindi Maulidya Aisha Diah Mirna S/Apun G P 23-1-2013 1/II 23-1-2013 25-2-2013 25-3-2013 22-4-2013 27-5-2013 25-2-2013 25-3-2013 22-4-2013 27-5-2013 11-11-2013
2 Arga Putra Aulia Yanti/M.Yanuar L 12-3-2013 4/II 13-3-2013 10-4-2013 13-5-2013 1-7-2013 18-11-2013 10-4-2013 13-5-2013 1-7-2013 18-11-2013 3-2-2014* 5-12-2015# Bd.E
3 Anindya Syahda F.R Tri Agustina/Joko P 11-4-2013 2/II 11-4-2013 22-4-2013 16-10-2013 18-12-2013 16-7-2014* 22-4-2013 16-10-2013 18-12-2013 16-7-2014* 15-9-2014* 13-12-2014* 5-8-2015# Klaten(3,2)
4 Fathiah Bunga G Catur Yulia R/Ruslan A.G. P 5-5-2013 4/II 5-5-2013 5-6-2013 9-7-2013 13-8-2013 13-9-2013 5-6-2013 9-7-2013 13-8-2013 13-9-2013 20-2-2014* 4-5-2015# 9-9-2015# RSUK(2,8)s.c
5 Rafael Marshall P Nur Azizah/Michael Y L 12-5-2013 2/II 12-5-2013 17-6-2013 15-7-2013 26-8-2013 21-10-2013 17-6-2013 15-7-2013 26-8-2013 21-10-2013 25-3-2014* 2-4-2016^ Bd.Mas(2,9)
6 Nabil Aliy Darmawan Mahdalena/Junaedi L 14-5-2013 2/II 14-5-2013 17-6-2013 15-7-2013 26-8-2013 16-10-2013 17-6-2013 15-7-2013 26-8-2013 16-10-2013 24-3-2014* 5-3-2016^ RSUK(2,8)
Suweni/Gita Arham P 16-5-2013 4/II 16-5-2013 TIDAK ADA RSI(2,8)
Muh.Fairel Atharizz Meli Dwi/Adi S L 3-6-2013 2/II 4-6-2013 19-6-2013 PINDAH 19-6-2013 SEKAR INDAH B Bd.Eti(3,2)
9 Angga Yudistira Wahyudi L 8-6-2013 4/II 8-6-2013 17-7-2013* 17-8-2013* 17-9-2013* 17-10-2013* 17-7-2013* 17-8-2013* 17-9-2013* 17-10-2013* 17-3-2014* 3-10-2015# 1-7-2015#
10 Nayla Az Zahra Fani/Abdul Roni P 7-7-2013 1/II 7-7-2013 22-7-2013 18-9-2013 16-10-2013 18-12-2013 22-7-2013 18-9-2013 16-10-2013 18-12-2013 28-4-2014* 9-9-2015# 5-3-2016^ RSUK
11 Muh.Iqbal Romadhon Asiyah/Tarmudi L 24-7-2013 4/II 24-7-2013 16-9-2013 21-10-2013 2-12-2013 6-1-2014* 16-9-2013 21-10-2013 2-12-2013 6-1-2014* 28-4-2014* 9-9-2015# 5-8-2015# RSUK(3)
Mirza Reski Pratama Riska Atmaja/Dendi P L 19-8-2013 3/II 19-8-2013 23-9-2013 23-10-2013 27-11-2013 PINDAH 23-9-2013 23-10-2013 27-11-2013 JAKARTA Bd.Mas(2,7)
12 Almira Sania Fauziyah/Tasroh P 18-11-2013 1/VI PINDAHAN 7-4-2014# SEKAR INDAH A 13-10-2014* 5-8-2015#
Imunisasi yang diberikan 5-8-2015
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
Melisa/Didik M(2/)T P 21-1-2014 2/II 22-1-2014 TIDAK ADA RSIAKI(3,9)
Ahlan Hanum/Salim P 10-2-2014 1/II PLUS
Farida/Hasan L 18-3-2014 1/II 19-3-2014 TIDAK ADA RSI
1 Keisha Anindya Risky Neneng P/Komarudin P 24-3-2014 2/II 24-3-2014 5-5-2014 23-6-2014P 23-7-2014P 23-8-2014P 2-4-2014 23-6-2014 23-7-2014 23-8-2014 26-1-2015# 5-11-2016^ RSMK(3,15)sc
2 Quen Zafira Hanifah/Abu Bakar P 28-3-2014 1/II 29-3-2014 14-5-2014 4-6-2014P 13-8-2014P 14-5-2014 4-6-2014 13-8-2014 MENOLAK
3 Zahra Dwi Meicila Anisa/Yahya Sutrisno P 4-5-2014 1/II 4-5-2014 14-4-2015# 13-8-2014P 17-9-2014P 32-12-2014P 13-8-2014 17-9-2014 13-12-2014 14-4-2015# 23-3-2015# 5-3-2016^ RSU(2,7)
Lutfiah/Yahya Sutrisno P 4-5-2014 4/II 4-5-2014 RSUK(2,7)
5 Ahdan Muna/Jamal M.Nasir L 23-5-2014 5/II 23-5-2014 MENOLAK RSI(2,3)
6 Balqis Soppiyah/Salim P 25-5-2014 1/II 25-5-2014 17-9-2014P 17-9-2014 MENOLAK RSUK(2,4)sc
7 Moh. Alfian Tri Aryono Murni /Mohamad Daryono L 25-6-2014 1/II 25-6-2014 14-7-2014 11-9-2014 11-12-2014 5-3-2015 14-7-2014 11-9-2014 11-12-2014 5-3-2015# 1-7-2015# 5-12-2015# 3-9-2016^
Celsi Indah/Anggita(DF/8) P 27-6-2014 2/II 27-6-2014 12-8-2014# 23-9-2014P 30-10-2014P -12-2014 12-8-2014# 23-9-2014 30-10-2014 -12-2014 PINDAH KEMANDUNGAN
8 Alif Abdurrahman Ayu Komari/Purwanto(DF/8) L 8-8-2014 4/II 14-8-2014 8-9-2014 20-10-2014P 24-11-2014P 5-1-2015P# 8-9-2014 20-10-2014 24-11-2014 5-1-2015# 10-9-2015# Bd.Mas(2,5)
Lia Rosliana Cherry Indah Purnama/Arfaqi P 13-8-2014 4/II 13-8-2014 17-9-2014 16-10-2014P 14-11-2014P 22-12-2014P 17-9-2014 16-10-2014 14-11-2014 22-12-2014 PINDAH LAWATAN
Gavin Nuni H/Andri P(DF/8) L 15-9-2014 1/II 15-9-2014 19-10-2014 19-11-2014P PINDAH 19-10-2014 19-11-2014 BREBES RSI(3,3)
9 M.Jirjiz Nur Khikmah/Mulyono L 24-9-2014 1/II 24-9-2014 1-10-2014 1-12-2014P 7-1-2015# 4-2-2015# 1-10-2014 1-12-2014 7-1-2015# 4-2-2015# 13-7-2015# 2-4-2016^ RB.St.Hj(3,3)
10 Okan Hendarsah Ratna/Gangan(DF/8) L 6-10-2014 2/II 6-10-2014 19-1-2015# 13-12-2014P 4-2-2015# 6-5-2015# 13-12-2014 19-1-2015# 4-2-2015# 6-5-2015# 15-10-2015# 4-6-2016^ RSUK(4,1)
Dea Haniya S Rani/Adi P 20-11-2014 4/II 21-11-2014# 8-12-2014# PINDAH 8-12-2014# PURWOKERTO RSUK(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
Mikail Hayat Rizki N/Wildan(DF/8) L 3-2-2015 4/II 3-2-2015 26-3-2015 21-4-2015 21-5-2015 26-3-2015 21-4-2015 21-5-2015 PINDAH RSUK(3,6)
1^ Fadhil Abdurrahman Marni/Mulyawan L 24-2-2015 1/II 25-2-2015 23-3-2015 27-4-2015 25-5-2015 22-6-2015 23-3-2015 27-4-2015 25-5-2015 22-6-2015 15-12-2015^ 3-9-2016^ PTB
Hafsya Muhammad Nur Masitoh/Hery W(DF/8/1) L 7-4-2015 3/II 7-4-2015 5-6-2015 1-7-2015 5-8-2015DF 9-9-2015 5-6-2015 5-8-2015DF 9-9-2015 3-10-2015 9-1-2016^ PINDAH Bd.M(3)
Qurotul Aeni L 2-5-2015 4/II 3-5-2015 TIDAK ADA RB.St.Hj
2 Zafina Hanifah/Abu Bakar P 4-5-2015 1/II 4-5-2015 MENOLAK RB.Khr
3 Amira Aenun Sri Mulyani/Teguh S(DF/8) P 5-5-2015 4/II 6-5-2015 1-6-2015 10-8-2015 14-9-2015 26-10-2015 1-6-2015 10-8-2015 14-9-2015 26-10-2015 RSI(2,1)
4 Rayfan Zannurain A.S Wahyuni C/Adi Firmanto L 19-5-2015 1/II 19-5-2015 22-6-2015 27-7-2015 9-9-2015 23-11-2015 27-5-2015 27-7-2015 9-9-2015 23-11-2015 2-4-2016^ RSMK(2,4)
5 Rayhan Zannurain A.S Wahyuni C/Adi F(DF/8/2) L 19-5-2015 1/II 19-5-2015 22-6-2015 5-8-2015DF 9-9-2015 19-10-2015 27-5-2015 5-8-2015DF 9-9-2015 19-10-2015 5-3-2016^ RSMK(2,2)
6 M.Labib Muzaka Nurdiana/Andi K L 8-6-2015 2/II 8-6-2015 2-7-2015 10-8-2015 7-9-2015 26-10-2015# 2-7-2015 10-8-2015 7-9-2015 26-10-2015# 23-5-2016^ RSI(3,1)sc
Aisah Afif/Fahmi Afif L 21-9-2015 1/II 22-9-2015 TIDAK ADA RSI(3,2)
7 Daffa Arya Fifi Handayani/Agus S L 7-10-2015 2/II 8-10-2015 9-11-2015 7-12-2015 9-1-2016^ 6-2-2016^ 9-11-2015 7-12-2015 9-1-2016^ 6-2-2016^ 7-7-2016^ Bd.Mas(2,7)
8 Briliant Athar Aghani Catur Yulia/Ruslan A Gani L 10-10-2015 4/II 10-10-2015 9-11-2015 14-12-2015 18-1-2016^ 22-2-2016^ 9-11-2015 14-12-2015 18-1-2016^ 1-10-2016^ 24-10-2016^ RSUK(3,1)
9 A.Loisius eko Khotimah/Ari Kristiyanto L 5-12-2015 3/II 5-12-2015 9-12-2015 5-2-2016^ 5-3-2016^ 4-4-2016^ 9-12-2015 5-2-2016^ 5-3-2016^ 4-4-2016^ 14-9-2016^ Bd.ety
10 Aisyah Nuha Zahira Jaridah M/Heryanto P 12-12-2015 2/II 12-12-2015 23-1-2016^ 27-2-2016^ 2-4-2016^ 7-5-2016^ 23-1-2016^ 7-5-2016^ 4-6-2016^ 2-7-2016^ 1-10-2016^ Pusk(4,5)
11 Salma Maulida Umi Faizah/Aditia M P 27-12-2015 4/II 27-12-2015^ 1-2-2016^ 5-3-2016^ 2-4-2016^ 7-5-2016^ 1-2-2016^ 7-5-2016^ 2-7-2016^ 3-9-2016^ 1-10-2016^ RSUK(3,2)
12 Delfia Maulidia Jamilah/Agus Sawaludin P 28-12-2015 4/II 3-1-2016^ 22-2-2016^ 5-3-2016^ RSUK(2,1)
13^ Dalia Maulidia Jamilah/Agus Sawaludin P 28-12-2015 4/II 3-1-2016^ 7-3-2016^ 4-6-2016^ 4-6-2016^ RSUK(1,9)

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
Keisha Alula Pujiyani/Le P 31-3-2016 1/II 31-3-2016 2-5-2016 4-6-2016 2-7-2016 4-6-2016 2-7-2016 PINDAH SURADADI
1 M. Adhyasta Raymond Siti Maryam/Soleh L 19-4-2016 2/II 20-4-2016 16-5-2016 20-6-2016 18-7-2016 20-8-2016 16-5-2016 20-6-2016 18-7-2016 20-8-2016 Bd.Mas(3,4)
2 Gilang Mahdalena/Junaedi L 11-5-2016 2/II 11-6-2016 25-7-2016 1-10-2016 5-11-2016 11-6-2016 25-7-2016 1-10-2016 5-11-2016 RSI(2,2)
3 Nisrina Aulia K Hidayah/M.Agus S P 30-5-2016 2/II 30-5-2016 MENOLAK Bd.M(2,2)
4 Adeva Raisa Azara Wahyuningrum/Kusnul Y P 8-6-2016 1/II 8-6-2016 11-7-2016 3-9-2016 11-7-2016 3-9-2016 Bd.M(3,8)
5 Arkhan Ramadhan Dinayah/Wasikin L 5-7-2016 4/II 11-7-2016 20-7-2016 1-10-2016 5-11-2016 20-7-2016 3-9-2016 1-10-2016 5-11-2016
6 Barkah Anita/ Fauzan P 2-7-2016 I/II 2-7-2016 5-9-2016 3-9-2016 1-10-2016 5-11-2016 3-9-2016 1-10-2016 5-11-2016 Bd.Sykr(2,6)
7 Saqinandita Nafeeza Heni Utami/ Edi Susilo P 21-9-2016 3/II 21-9-2016 24-10-2016 29-9-2016 RSI(#)

Imunisasi TT
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Marni/Mulyawan K 1/II 9-12-2014
Imunisasi TT
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Nazalina/A.Salman K 1/II V
2 Sri Mulyani/Teguh K 4/II 8-4-2015
3 Catur Yulia/Ruslan K 4/II 8-6-2015
4 Ita Masitah/Heri K3/II 5-2-2015
5 Hanifah/Abu Bakar K1/II 13-2-2015
6 Hidayah/Rizky K3/II V 9-1-2015
7 Wahyuni C/Adi F K4/II 6-4-2015
8 Vivi H/Agus S K2/II 10-6-2015
9 Nurdiana/Andi K K2/II 5-1-2015
10 Shelia/Teguh M K3/II 8-7-2015
Imunisasi TT
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Hidayah/M.Agus K 4/II 6-2-2016 2-4-2016
2 Dinayah/Wasikin K4/II 18-2-2016
3 Mahdalena/Junaedi K2/II 5-3-2016 2-4-2016
4 Wahyuningrum/Kusnul K1/II 1-3-2016
5 Yuniar Adi/Budi S K2/II 28-3-2016
6 Siti Maryam/ Soleh K 2/2 4-1-2016 2-4-2016
7 Resti M/Dwi Heriyanto K4/2 3-10-2016
LAPORAN BULANAN IMUNISASI BAYI
POSYANDU MAWAR B

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 Maulana Fakhri Akbar Kholisah/Chamim L 28-2-2009 8/II 28-2-2009 6-4-2009 9-7-2009 14-10-2009 1-12-2009 6-4-2009 9-7-2009 14-10-2009 1-12-2009 7-4-2010

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 Putri Rola Rahmadani Fitriah Nurlaila/A.Rhofiq P 2-9-2010 3/II 2-9-2010 20-10-2010 20-11-2010 20-12-2010 20-1-2011 20-10-2010 20-11-2010 20-12-2010 20-1-2011 16-6-2011
2 Sagita Rohmatul Ummah Diana Sustiani/Sunardi P 26-9-2010 3/II 27-9-2010 3-11-2010 21-12-2010 22-2-2011 21-6-2011 3-11-2010 21-12-2010 22-2-2011 21-6-2011 20-7-2011
7 Izza Fadilah Slamet/Khotidah P 13-5-2011 7/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 M. Faris Hafis Jono/Juli L 14-1-2011 7/II
2 Agnia Jenes Shafira Satria/Intan P 10-5-2011 6/II
3 M. Kurniawan Himza/Wiwi L 24-5-2011 6/II
4 Sinar Aulia Rohmah Nurochman/Sugiarti P 7-6-2011 3/II
5 Rafa Filla Sugiarto Trisno/ Rina L 4-7-2011 7/II
6 Firas Aan L 19-7-2011 6/II 11-6-2014*
7 Ananda Rekhan A. Ghofur/Niken L 25-9-2011 3/II
8 Muh.Fatih Maulana Agustinah F/Moh.Fadjar L 18-10-2011 3/II 23-10-2011 12-12-2011 19-12-2011 18-1-2012 21-2-2012 27-10-2011 19-12-2011 18-1-2012 21-2-2012 23-1-2012 11-6-2014*
9 Syafa Afi Anifah L 23-10-2011 8/II 11-6-2014*
10 M. Syauqi Sucipto L 27-10-2011 8/II
11 M.Ridho Aji Sofiatik L 14-11-2011 6/II 11-6-2014*
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
M.Rifai Darsono L 25-1-2012 7/II 25-1-2012 28-3-2012 9-5-2012 25-6-2012 PINDAH 28-3-2012 9-5-2012 25-6-2012 JKT
1 Adinda Nabila Firli Sri Mulyani/Moh.Sugeng P 17-2-2012 8/II 17-2-2012 20-2-2012 17-4-2012 16-7-2012 14-9-2012 20-2-2012 17-4-2012 16-7-2012 14-9-2012 26-11-2012
2 Ananda Nur Fadillah Eka Setiawati/Eko P P 21-2-2012 6/II 21-2-2012 17-4-2012 18-5-2012 21-6-2012 24-7-2012 17-4-2012 18-5-2012 21-6-2012 24-7-2012 23-11-2012 10-9-2014* 22-7-2015#
3 Ananda Firly Febriani Eka Setiawati/Eko P P 21-2-2012 6/II 21-2-2012 17-4-2012 18-5-2012 21-6-2012 24-7-2012 17-4-2012 18-5-2012 21-6-2012 24-7-2012 23-11-2012 11-6-2014* 22-7-2015#
5 Yasmin Lifa Azahra Septi/Cakim P 12-4-2012 1/II 12-4-2012 20-4-2012 23-6-2012 28-7-2012 5-9-2012 20-4-2012 23-6-2012 28-7-2012 5-9-2012 20-2-2013
4 Rizky Apriyani Sri Murahayu/Hengki P 23-4-2012 7/II 23-4-2012 7-5-2012 25-6-2012 25-7-2012 27-8-2012 7-5-2012 25-6-2012 25-7-2012 27-8-2012 5-2-2013 11-6-2014* 22-7-2015#
5 Mukh.Raeza Alfarizi Rodiyah/Sapuri L 27-4-2012 7/II 27-4-2012 20-5-2012 27-6-2012 30-7-2012 5-9-2012 20-5-2012 27-6-2012 30-7-2012 5-9-2012 20-2-2013 8-7-2014* 28-10-2015#
6 Quin Talitha Endang Priyatin/Dony P 24-5-2012 8/II 24-5-2012 4-6-2012 8-8-2012 26-9-2012 7-11-2012 4-6-2012 8-8-2012 26-9-2012 7-11-2012 6-2-2013 10-9-2014* 22-7-2015#
7 Aliyah Yuliafika Yuliasih/Alimudin P 11-6-2012 9/II 11-6-2012 20-6-2012 30-8-2012 9-10-2012 12-11-2012 20-6-2012 30-8-2012 9-10-2012 12-11-2012 25-3-2013
8 Arkaan Harith P Meilani/Danil Prasetya L 25-6-2012 3/II 25-6-2012 16-7-2012 3-9-2012 8-10-2012 19-11-2012 16-7-2012 3-9-2012 8-10-2012 19-11-2012 8-4-2013
9 Putri Chaeri Sarenga P 25-6-2012 6/II 5-7-2012 25-7-2012 1-9-2012 1-10-2012 1-11-2012 5-7-2012 1-9-2012 1-10-2012 1-11-2012 V
10 Al Raffi Prawira N Sri Wuryaningsih/Adi N L 29-6-2012 3/II 29-6-2012 4-7-2012 11-9-2012 22-10-2012 19-11-2012 4-7-2012 11-9-2012 22-10-2012 19-11-2012 22-4-2013
11 Rendi Abdi Kusuma Suparti S/Riswanto L 18-7-2012 3/II 25-7-2012 1-8-2012 18-9-2012 19-10-2012 18-11-2012 1-8-2012 18-9-2012 19-10-2012 18-11-2012 22-4-2013 11-6-2014*
12 Mutia Rahmadani Sofiatun/Yudi P 21-7-2012 9/II 21-7-2012 15-10-2012 7-11-2012 6-3-2013 12-4-2013 15-10-2012 7-11-2012 6-3-2013 12-4-2013 15-7-2013
13 Putri Nurul Andini Hermanto P 24-7-2012 9/II 24-7-2012 2-8-2012 24-10-2012 30-11-2012 16-1-2013 2-8-2012 24-10-2012 30-11-2012 16-1-2013 -5-2013 22-7-2015#
14 Riska Dwi Ramadani St.Indun/Prawiro H P 6-8-2012 7/II 6-8-2012 5-9-2012 6-10-2012 7-11-2012 5-12-2012 5-9-2012 6-10-2012 7-11-2012 5-12-2012 8-7-2013 8-7-2014* 20-8-2015#
15 Nadyne Erisa R M.Fauzan P 6-8-2012 8/II 7-8-2012 5-10-2012 7-11-2012 5-12-2012 9-1-2013 5-10-2012 7-11-2012 5-12-2012 9-1-2013 5-6-2013
16 Muh.Faiq Ibrahim Uswatun C/Fauzan L 26-8-2012 7/II 26-8-2012 24-9-2012 29-10-2012 18-12-2012 11-2-2013 24-9-2012 29-10-2012 18-12-2012 11-2-2013 1-7-2013 6-5-2015# 28-10-2015#
17 Mohamad Shaeful Alif Intan Y/M.Joenaedi L 5-9-2012 7/II 5-9-2012 20-9-2012 11-11-2012 11-12-2012 18-1-2013 20-9-2012 11-11-2012 11-12-2012 18-1-2013 20-6-2013 10-12-2014
18 Rizki Nur Fadhilah Sri Mulyati/Wurdiyanto L 9-10-2012 6/II 9-10-2012 31-10-2012 11-12-2012 14-1-2013 15-2-2013 31-10-2012 11-12-2012 14-1-2013 15-2-2013 22-7-2013 19-8-2014* 22-7-2015#
19 Aji Saputra Marlina L 5-11-2012 6/II 11-5-2012 12-6-2013 11-1-2013 8-2-2013 8-3-2013 12-6-2012 11-1-2013 8-2-2013 8-3-2013 18-9-2013
20 Nomesa Ayu Suroso Eli Ikawati/Ujang Taufik P 15-11-2012 7/II 15-11-2012 10-12-2012 15-1-2013 19-3-2013 8-5-2013 10-12-2012 15-1-2013 19-3-2013 8-5-2013 11-12-2013 11-6-2014* 17-11-2015#
21 Nomesi Ayu Surosi Eli Ikawati/Ujang Taufik P 15-11-2012 7/II 15-11-2012 10-12-2012 15-1-2013 19-3-2013 8-5-2013 10-12-2012 15-1-2013 19-3-2013 8-5-2013 11-12-2013 8-7-2014* 28-10-2015#
22 Aviqa Al Haura Cholidah/Wirofyan P 31-12-2012 7/II 31-12-2012 16-1-2013 12-2-2013 16-3-2013 8-5-2013 16-1-2013 12-2-2013 16-3-2013 8-5-2013 5-10-2013

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 Jihan Nur Laila Santi P/Tindra Ardi P 6-1-2013 7/II 6-1-2013 6-2-2013 6-3-2013 12-4-2013 13-5-2013 6-2-2013 6-3-2013 12-4-2013 13-5-2013 11-12-2013 10-12-2014* PINDAH Bd.M
2 M.Arka Ibanes Tri Agustinah/M.Slamet L 21-1-2013 7/II 21-1-2013 30-1-2013 21-3-2013 21-5-2013 21-6-2013 21-1-2013 21-3-2013 21-5-2013 21-6-2013 11-12-2013 3-6-2015^ 19-1-2016^
Rofid Maulana Ela Eli/Tarjoli L 17-3-2013 8/II 24-3-2013 15-4-2013 5-6-2013 PINDAH 15-4-2013 JAKARTA Bd.M
3 Inez Miranti Zaman Rissa S/Nur Yasin P 18-3-2013 7/II 18-3-2013 22-4-2013 20-5-2013 2-7-2013 2-9-2013 22-4-2013 20-5-2013 2-7-2013 2-9-2013 23-12-2013 RSUK
Syahla Yuma Faiha Eva M/Guruh Eko P 18-3-2013 7/II 18-3-2013 PINDAH SEKAR INDAH A RSUK
4 Aprilia Setianingsih Parikha/Kuspriaji P 2-4-2013 8/II 2-4-2013 13-5-2013 5-6-2013 15-7-2013 24-8-2013 13-5-2013 15-7-2013 24-8-2013 11-12-2013 17-3-2014* 22-9-2015# 16-2-2016^ RSUK
By. Plus '8-4-2013 Dwi Indira K/M.Taufik L 6-4-2013 8/II 7-4-2013 PLUS Bd.M
Firdaus Bani Ali Yunik/Muzaeri L 19-4-2013 7/II 20-4-2014 20-5-2013 15-7-2013 24-8-2013 6-11-2013 20-5-2013 15-7-2013 24-8-2013 6-11-2013 28-4-2014* PINDAH JAKARTA
Kasanah/Tito Arsani P 6-5-2013 8/II 6-5-2013 PINDAH KARTINI A RSI(2,5)
Satya Budi Listiyono Lylyiana L 6-5-2013 7/II 13-5-2013 28-5-2013 20-9-2013 28-5-2013 20-9-2013 26-2-2014 TIDAK ADA
Moh.Alby Ria L 10-5-2013 3/II PINDAH 24-8-2013 24-8-2013 MAYANGSARI RB.Rhm(2,9)
Maslicha/Ahmad Fauzi L 18-5-2013 8/II 18-5-2013 PINDAH RSI(2,5)
5 Fitri Arofah Fitrawati/Aji P 5-6-2013 /II 5-6-2013 17-6-2013 19-8-2013 23-9-2013 18-10-2013 17-6-2013 19-8-2013 23-9-2013 18-10-2013 -3-2014* -10-2014# RB.Rhm(3,4)
Syecha P 16-7-2013 3/II 19-7-2013 PINDAH POSY. BU CICI RB.Rhm
6 Risma Nur Yulia Safitri Imamah/Yuliono P 12-8-2013 6/II 21-8-2013 7-10-2013 6-11-2013 11-12-2013 22-2-2014* 7-10-2013 6-11-2013 11-12-2013 22-2-2014* 10-9-2014* 22-7-2015# 17-11-2015# RSUK(1,95)sc
Mirza Reski Pratama Riska Atmaja/Dendi P L 19-8-2013 3/II 19-8-2013 23-9-2013 23-10-2013 27-11-2013 PINDAH 23-9-2013 23-10-2013 27-11-2013 MAWAR A Bd.Mas(2,7)
7 Firyaal Salmaam N Endang Sinarsih/Ismail L 31-8-2013 8/II 31-8-2013 20-9-2013 6-11-2013 11-12-2013 12-1-2014* 20-9-2013 6-11-2013 11-12-2013 12-1-2014* 5-7-2014* 22-7-2015# 20-8-2015# Bd.M(3,5)
8 Vina Septiyani Budi Widiyanti/M.Solichin P 15-9-2013 7/II 15-9-2013 5-10-2013 15-11-2013 16-12-2013* 16-1-2014* 5-10-2013 15-11-2013 16-12-2013* 16-1-2014* 10-9-2014* 20-8-2015# 28-10-2015# RB.Khr(3)
9 Fathan Abiyan Aziz Agustinah F/Moh.Fadjar L 16-11-2013 3/II 16-11-2013 5-12-2013 21-1-2014* 22-2-2014* 8-4-2014* 5-12-2013 21-1-2014* 22-2-2014* 8-4-2014* 8-9-2014* 13-6-2015# 17-11-2015# Bd.M(2,7)
9 Arsyad Bellanmyl Agus Budi Laksono L 25-11-2013 3/II 25-11-2013 31-12-2013* 24-1-2014* 29-3-2014* 21-5-2014* 25-11-2013* 24-1-2014* 29-3-2014* 21-5-2014* -8-2014*
11 Noval Nazirul Asrofi Rodiyah/Sapuri L 29-11-2013 7/II 29-11-2013 20-12-2013 11-2-2014P* 15-3-2014* 15-4-2014* 20-12-2013 11-2-2014* 15-3-2014* 15-4-2014* 5-9-2014* 17-11-2015# 22-12-2015# RSUK(3,45)
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.Nab'han Al Kahfi Cholidah/Slamet W L 19-1-2014 7/II 21-1-2013 19-2-2014 MENOLAK 19-2-2014 MENOLAK RSI(2,4)
2 Dinda Fajra Nadifa Kholisah/Chamim P 31-1-2014 8/II 31-1-2014 24-2-2014 8-4-2014P 7-5-2014P 11-6-2014P 24-2-2014 8-4-2014 7-5-2014 11-6-2014 24-11-2014 17-11-2015# 15-3-2016^ RSUK(3,75)sc
Nike Nurhayati/Sutikno P 18-2-2014 6/II 18-2-2014 TIDAK ADA RSUK(2,8)sc
Kinara Tsabita Aslam Ria Nuraeni/Edi Junaedi P 24-2-2014 7/II 25-2-2014 5-4-2014 5-5-2014P 5-6-2014P 5-7-2014P 5-4-2014 5-5-2014 5-6-2014 5-7-2014 PINDAH JAKARTA RSIAKI(2,6)
3 Nazmadya Irtifa Ima Tania/Grestianto P 8-3-2014 7/II 8-3-2014 5-4-2014 7-5-2014P 11-6-2014P 8-7-2014P 5-4-2014 7-5-2014 11-6-2014 8-7-2014 15-12-2014 28-10-2015# 17-5-2016^ RB.Rhm(3,5)
4 Niken Syahputri Kristianti/Amirudin P 8-3-2014 6/II 8-3-2014 8-4-2014 28-5-2014 19-7-2014 18-10-2014 8-4-2014 28-5-2014 19-7-2014 18-10-2014 17-11-2014 17-5-2016^ 19-7-2016^
5 Almira Dwi Solichati Istiharoh P 13-3-2014 6/II 24-4-2014 16-6-2014 8-7-2014 10-9-2014P MENOLAK 16-6-2014 8-7-2014 10-9-2014 MENOLAK 17-12-2014 MENOLAK RSUK(1,85)
6 Akhmad Azzam Ayu Wirawati/Teguh(DF/8) L 23-4-2014 6/II 23-4-2014 11-6-2014 5-7-2014P 10-9-2014P 12-11-2014P 11-6-2014 5-7-2014 10-9-2014 12-11-2014 28-10-2015^ 17-5-2016^ 19-7-2016^ RSMK(2,7)
7 Dara puspita Darwati/Daryo(6/)T P 9-5-2014 8/II 9-5-2014 MENOLAK RB.Khr(2,8)
8 Rafka Valian Dwi Santoso Ani Handayani/Untung S(6/)T L 13-5-2014 6/II 13-5-2014 16-6-2014 8-7-2014 19-8-2014P 18-9-2014P 17-5-2014 16-6-2014 19-8-2014 18-9-2014 16-2-2015# 17-11-2015# 19-7-2016^ RSUK(3,7)
9 Meynanda Aysha Syareefa Nurul Fitria/Syarif H P 17-5-2014 8/II 17-5-2014 21-5-2014 14-8-2014P 14-9-2014P 14-10-2014P 21-5-2014 14-8-2014 14-9-2014 14-10-2014 20-2-2015# 20-12-2015# 20-5-2016^ RB.St.Hj(3,2)
10 Galih Saad Rifai Nok Ika/Muzaki(6/) L 30-5-2014 8/II 30-5-2014 10-8-2014 20-9-2014P 20-10-2014P 20-11-2014P 10-8-2014 20-9-2014 20-10-2014 20-11-2014 15-3-2016^ 17-5-2016^ 18-10-2016^
11 Sitana Nur Anggraeni Wastiah/Darsono L 16-6-2014 7/II 16-6-2014 4-8-2014 27-11-2014 23-12-2014 4-2-2015 4-8-2014 27-11-2014 23-12-2015 4-2-2015 27-6-2015 19-1-2016^ 19-7-2016^ Pusk(2,7)
12 Amayka Indi Rodiah/Nuriman P 8-7-2014 8/II 8-7-2014 8-9-2014 20-9-2014 3-11-2014 9-12-2014 8-9-2014 2-9-2014 3-11-2014 9-12-2014 11-4-2015# 19-4-2016^ 19-7-2016^
M.Firlan Rizkiyah/Dede Arif L 6-8-2014 3/II 7-8-2014 1-10-2014 PINDAH 1-10-2014 JALAN MERPATI RSI(2,8)sc
13 Putra Herdi Pratama Herawati/Sukardi(DF/8) L 3-10-2014 7/II 3-10-2014 5-11-2014 7-12-2014P 10-1-2015# 17-2-2015# 5-11-2014 10-1-2015# 17-2-2015# 17-3-2015# V MENOLAK Bd.M(2,7)
14 Hani Akur N Siti Fauziyah/Hermanto L 9-10-2014 9/II 9-10-2014 5-11-2014 10-12-2014P 17-2-2015# 21-4-2015# 5-11-2014 10-12-2014 17-2-2015# 21-4-2015# 22-7-2015# 19-4-2016^ 18-10-2016^ RB.St.Hj(2,8)
M.Argya Abhirama Yeni/Ridianto L 11-10-2014 6/II 11-10-2014 21-10-2014 10-12-2014P 20-2-2015# 10-12-2014 20-2-2015# PINDAH JL.POSO RSIAKI
15 M.Aden Al Jibran Cicah Trisnawati/Meki L 4-12-2014 8/II 4-12-2014# 29-12-2014# 2-2-2015# 12-3-2015# 21-4-2015# 29-12-2014# 2-2-2015# 12-3-2015# 21-4-2015# 14-12-2015^ 16-8-2016^ RSUK
16 Mutia Rahma Teguh/Sofi(DF/8/1) P 6-12-2014 8/II 21-4-2015# 13-6-2015# 22-7-2015# 21-4-2015# 13-6-2015# 13-7-2015# 20-8-2015#DF 22-9-2015# 16-8-2016^
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 Almira Maulida Safiani Indriani/Imron Safii P 3-1-2015 7/II 3-1-2015 4-2-2015 20-3-2015 20-4-2015 20-5-2015 4-2-2015 20-3-2015 20-4-2015 20-5-2015 17-11-2015 PINDAH KRANDON
2 Dihyah Al Kalby Arifah/Abu Khoiri L 18-1-2015 7/II 19-1-2015 26-1-2015 18-3-2015 20-4-2015 18-5-2015 26-1-2015 18-3-2015 20-4-2015 18-5-2015 19-10-2015 9-8-2016^ PTB-RUSUNAWA
Kamil Abiyu Ahmad Ernawati/A.Zaeni L 8-3-2015 7/II 8-3-2015 6-4-2015 11-5-2015 13-6-2015 16-3-2015 11-5-2015 13-6-2015 PINDAH CIREBON RSUK(sc)
3 Salman Alfarizi Waskuroh/Rudi Setio H L 16-3-2015 6/II 17-3-2015 27-4-2015 19-5-2015 22-6-2015 28-7-2015 27-4-2015 19-5-2015 22-6-2015 28-7-2015 22-12-2015 PINDAH BREBES Bd.M(3)
4^ Arsyad Badali Sonita/Amak Toni L 10-4-2015 6/II 11-4-2015 7-5-2015 6-6-2015 13-7-2015 11-8-2015 7-5-2015 6-6-2015 13-7-2015 11-8-2015 25-1-2016 PINDA PUR'IN RSUK(3)SC
5 M.Fatchan Dwi Indira/Tofikudin(DF/8/2) L 20-4-2015 8/II 21-4-2015 4-5-2015 22-7-2015 20-8-2015DF 28-10-2015 4-5-2015 22-7-2015 20-8-2015DF 28-10-2015 19-1-2016^ RSI(3,1)
6 Qintara Kanza Sabila Imastania/Grestianto P 27-4-2015 7/II 27-4-2015 5-6-2015 22-7-2015 21-8-2015 22-9-2015 5-6-2015 22-7-2015 21-8-2015 22-9-2015 16-2-2016^ 15-11-2016^ PTB
7 Husni Mubarok Ika Rosiana/Wanto L 30-4-2015 7/II 1-5-2015 25-5-2015 4-7-2015 4-8-2015 5-9-2015 25-5-2015 4-7-2015 4-8-2015 5-9-2015 16-2-2016^ 15-11-2016^ RSUK
8 Revan Alfarizki Rizki Yuliani/Heffan P 4-5-2015 7/II 5-5-2015 5-6-2015 8-7-2015 14-8-2015 25-9-2015^ 5-6-2015 8-7-2015 14-8-2015 25-9-2015^ 15-2-2016^ 15-11-2016^
Clarinta Nindya Retno W/Fahturozi P 5-5-2015 6/II 5-5-2015 17-6-2015^ 30-7-2015 3-9-2015^ 6-10-2015^ 17-6-2015^ 30-7-2015 3-9-2015^ 6-10-2015^ PLUS 18-4-2016 RB.Rhm(2,8)
9 Meydita Aulia Khanza Nur Fitriyani/Subhan P 27-5-2015 6/II 27-5-2015 15-6-2015 27-7-2015 31-8-2015 28-10-2015 4-6-2015 27-7-2015 31-8-2015 28-10-2015 29-2-2016^ RSI(3,5)
Daryuni/Eko Wahyono Hadi P 27-5-2015 6/II 28-5-2015 PINDAH JAKARTA RSI
10 Hardianto Saputra Sri Murahayu/Hengki Biyanto L 30-5-2015 7/II 30-5-2015 5-6-2015 4-8-2015 5-9-2015 4-10-2015 5-6-2015 4-8-2015 5-9-2015 4-10-2015 5-3-2016^ Bd.M(3,5)
11 Ayunindya Hania S Tri Wijayanti/Wahyudi P 8-8-2015 8/II 8-8-2015 20-8-2015 28-10-2015 24-11-2015 22-12-2015 20-8-2015 28-10-2015 24-11-2015 22-12-2015 17-5-2016^
12 Hilda Nur Syifani Dhanie Fitria/Nanang S P 10-9-2015 8/II 10-9-2015 5-10-2015 12-11-2015 16-12-2015 19-1-2016^ 5-10-2015 12-11-2015 16-12-2015 19-1-2016^ 5-8-2016^ Bd.M(2,4)
Marlina/Hari L 28-9-2015 6/II 29-9-2015 Bd.E(3,8)
13 Aqilla Khairusyifa Wiarti/Tarsono P 29-9-2015 9/II 30-9-2015 26-10-2015 22-12-2015^ 19-1-2016^ 23-3-2016^ 26-10-2015 22-12-2015^ 19-1-2016^ 19-4-2016^ 16-8-2016^ Bd.Mas(2,4)
14 Marshall Setiawan Melinda/Doni L 22-10-2015 6/II 22-10-2015^ 15-11-2015^ 19-1-2016^ 21-6-2016^ 16-8-2016^ 15-11-2015^ 19-1-2016^ 21-6-2016^ 16-8-2016^ 11-10-2016^
Sri Widiarsih/M.Tofik P 11-11-2015 7/II 11-11-2015 PINDAH DEBONG LOR
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 Krisbandaru Siti Fauziah/Herman L 23-1-2016 9/II 23-1-2016 16-3-2016 19-4-2016 17-5-2016 19-7-2016 19-3-2016 19-4-2016 17-5-2016 19-7-2016 St.HJr(2,4)SC
2 Fauziah Juwita Lestan Agustina/M.Fajar P 27-1-2016 3/II 28-1-2016 21-3-2016 19-4-2016 17-5-2016 19-7-2016 19-4-2016 17-5-2016 19-7-2016 16-8-2016 15-11-2016 Bd.M(2,6)
3 Nadia Kamila Yasmine Dita Wulandari/Dimas P 12-2-2016 7/II 13-2-2016 22-2-2016 13-4-2016 18-5-5016 21-6-2016 13-4-2016 18-5-5016 21-6-2016 19-7-2016 15-11-2016 Bd.Mas(3)
4 Reynand Abrisam Cholidah/Slamet L 7-4-2016 7/II 7-4-2016 MENOLAK RSI(2,6)
5 Muhamad ananda tegar Fitria Ida/Khariri L 19-4-2016 7/II 19-4-2016 20-5-2016 20-6-2016 21-7-2016 25-8-2016 20-5-2016 20-6-2016 21-7-2016 25-8-2016 Bd.M(3)
6 Moh.Daffa Kurniawan Filia/Andri L 29-4-2016 6/II 29-4-2016 25-7-2016 18-8-2016 7-5-2016 25-7-2016 RSI(2,9)
Fitrawati/Waryono P 6-6-2016 9/II 6-6-2016 PINDAH PURBOLINGGO Bd.M(3,5)
7 Banu Abimana Siti Azizah/A.Muzaki L 22-8-2016 8/II 29-9-2016 24-10-2016 15-11-2016 24-10-2016 RSI(2)
8 Pramudion A Wati/Supriyadi L 3-9-2016 7/II 3-9-2016 17-10-2016 14-9-2016 17-10-2016 RB KHr(2,45)
9 Al Amaira K Dwi Rizki Handayani P 28-9-2016 3/II 29-9-2016 Bd.M(
10 Suneti/ Ahimsa L 13-11-2016 8/II 13-11-2016

Imunisasi TT
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 v
2 Dwi Indira/Tofikudin K 8/II 27-11-2014
3 Nur Fitriani/A.Subhan K 6/II 13-12-2014
4 Ika Rosiana/Watno K 7/II 19-12-2014
5 Nur Masitah K 3/II 13-12-2014
6 Sonita/Amak Toni K 6/II 15-12-2014
Imunisasi TT
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Nur Fitriani/Ah.Subhan K 6/II 14-1-15
2 Hidayah/Rizky K 3/II V
3 Dwi Indira/Tofikudin K 8/II V
4 Ika Rosiana/Watno K 7/II 16-1-15
5 Ernawati/Achqad Zaeni K 8/II V V
6 Retno W/Fahruroji K 6/II 5-1-2015
7 Rizki Yuliani/Heftan K 7/II 4-3-15
8 Tri Wijayanti/Wahyudi K 7/II 6-3-2015
9 Novia Rizqiana K 7/II 15-4-2015
10 Marlina/Hari K 6/II 26-5-2015
11 Wiarti/Tarsono K9/II 21-4-2015
12 Dhani Fitria/Nanang S K 8/II 30-7-2015
13 Filia/Andri K 6/II 12-10-2015 1-12-2015
Imunisasi TT
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Siti Azizah/A.Muzaki K8/II 14-4-2016 23-5-2016
2 Fitrawati/Aji Bakar K9/II 7-4-2016 2-5-2016
3 Dwi Rizki H/Taufik K K3/II 8-5-2016 14-7-2016
4 Wati/Supriyadi K7/II 19-7-2016 16-8-2016
5 Suneti/ Ahimsa K 8/II 16-8-2016 20-9-2016
6 Sri Yuli E/Kapidin K7/II 28-9-2016 15-11-2016
7 Elvi Sukaesih/Waskito K 8/II 13-7-2016 15-8-2016
LAPORAN BULANAN IMUNISASI BAYI
POSYANDU KENANGA A

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.Aulia Azka H Nelly K/Aji Hermawan L 13-2-2009 3/III 26-2-2009 6-3-2009 25-4-2009 23-5-2009 2-7-2009 6-3-2009 25-4-2009 23-5-2009 2-7-2009 20-11-2009

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
Khaerunisa Wahyu/ S . Warningsih P 13-2-2011 3/III
Efelin Yelmo Ester P 14-3-2011 3/III
1 Adiba Nuril Afifah Riyadi/Handayani P 13-4-2011 3/III
2 Fernanda Firli A Kusnoto/Noni L 28-4-2011 1/III
Keyra A P Toni/Yesilia P 5-7-2011 3/III
Nadia P 9-7-2011 1/III
3 M Rehan Afitria Abdullah/Fitri L 30-8-2011 3/III
4 Fitria Dwi Adinda Nani Rosiani/Tredianto P 1-9-2011 2/III 12-7-2014* 12-8-2014*
5 Fajar Maulana Sugiarti/Abdul Azis L 21-11-2011 2/III 12-8-2014* 11-9-2014*

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
5 Qaleesya Zaahirah Nelly/Aji H P 17-1-2012 3/III 17-1-2013 3-2-2013 22-3-2013 22-5-2012 3-12-2012 3-2-2012 22-3-2012 22-5-2012 3-12-2012 24-5-2013
1 Khalisa Naura Aliya Karniti/Widodo P 29-1-2012 1/III 29-1-2012 20-2-2012 29-3-2012 30-4-2012 30-5-2012 20-2-2012 29-3-2012 30-4-2012 30-5-2012 5-11-2012
2 Anastasya Lasmi/Eko Susanto P 12-3-2012 1/III 14-3-2012 9-4-2012 10-5-2012 12-7-2012 11-10-2012 9-4-2012 10-5-2012 12-7-2012 11-10-2012 28-1-2013 11-9-2014* 6-11-2014*
3 Rafan Ayash Arkana Nina Veronika/Arief L 24-4-2012 1/III 24-4-2012 1-5-2012 12-7-2012 9-8-2012 6-9-2012 1-5-2012 12-7-2012 9-8-2012 6-9-2012 28-1-2013 12-7-2014* 12-8-2014* RUSUNAWA
6 Ahmad Rifai Hati Nuraeni/Muh.Soleh L 17-7-2012 3/III TIDAK 5-10-2012 6-11-2012 6-12-2012 9-1-2013 5-10-2012 6-11-2012 6-12-2012 9-1-2013 20-4-2013 9-10-2014* 2-7-2015#
7 Alya Ramadani Kamilah/Darto P 9-8-2012 1/III 10-8-2012 MENOLAK
Rafie Alauddin Budiarti/Erwin L 17-8-2012 2/III PINDAH
4 Zafira Najwa Khaerunisa Rahmawati/Edi Suroko P 9-12-2012 8/III 10-12-2012 16-1-2013 21-2-2013 21-3-2013 23-4-2013 13-12-2012 16-1-2013 21-2-2013 21-3-2013 2-10-2013 12-7-2014* 2-7-2015#
Rizal Aldi Raditya Sudiroh/Eko Purwanto L 15-12-2012 8/III 18-12-2012 7-1-2013 PINDAH 7-1-2013 TEGALSARI

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 Rafanda Aqlan L Siti Fatimah/Pudjo L 3-1-2013 1/III 3-1-2013 14-1-2013 7-3-2013 11-4-2013 7-5-2013 14-1-2013 7-3-2013 11-4-2013 7-5-2013 2-12-2013 4-6-2015# 6-8-2015# Bd.Mas
Ayu Widosari/Diki A P 3-1-2013 8/III 3-1-2013 PINDAH MAWAR MERAH RB.Rhm(2,2)
Naura Hasna Anida Dwi E/Bagus K P 22-2-2013 8/III 22-2-2013 4-3-2013 8-5-2013 -6-2013 19-7-2013 4-3-2013 8-5-2013 -6-2013 19-7-2013 PINDAH PEKALONGAN RSI
2 Naura Azka Azzahra Dewi E/Kuswantoro P 12-4-2013 3/III 13-4-2013 1-5-2013 18-6-2013 22-7-2013 23-8-2013 20-4-2013 18-6-2013 22-7-2013 23-8-2013 6-3-2014* MENOLAK RSI(2,4)
3 Koichi Dominique A Desi/Ari L 14-4-2013 8/III 4-5-2013 5-6-2013 23-7-2013 23-8-2013 23-9-2013 5-6-2013 23-7-2013 23-8-2013 23-9-2013 MENOLAK RB.Rhm(1,8)
4 Latifah Nur Azizah Tri Yulianti/Tarmudi P 24-4-2013 2/III 25-4-2013 13-5-2013 4-6-2013 1-8-2013 12-9-2013 13-5-2013 4-6-2013 1-8-2013 12-9-2013 6-2-2014* 2-7-2015# 6-8-2015# Bd.M
Bentang Artansyah Nuryati/Banu L 4-5-2013 2/III 5-5-2013 10-6-2013 5-7-2013 19-8-2013 21-9-2013 10-6-2013 5-7-2013 19-8-2013 21-9-2013 10-2-2014* PINDAH PANGGUNG Bd.Mas
Qonita Yuyun Retno/Deski Z P 23-5-2013 2 /III 24-5-2013 1-7-2013 1-8-2013 12-9-2013 10-10-2013 3-6-2013 1-8-2013 12-9-2013 10-10-2013 2-6-2014* 2-7-2015# PINDAH RSI(3.28)
5 Kenzie Arka Alviansyah Yessi Y/Moh.Samsul A L 13-6-2013 3/III 14-6-2013 10-7-2013 24-8-2013 24-9-2013 24-10-2013 10-7-2013 24-8-2013 24-9-2013 24-10-2013 20-3-2014* 4-6-2015# 2-7-2015# RB.Rhm(3,9)
6 Afikah Kiara Salsabila Darolah/Imam Solichin P 23-6-2013 3/III 23-6-2013 31-7-2013 30-8-2013 30-9-2013 29-10-2013 31-7-2013 30-8-2013 30-9-2013 29-10-2013 26-3-2014* 23-11-2014# 1-7-2015# RB.Rhm(2,0)sc
Fakhira Nafisya H Bety Komala P 23-6-2013 8/III 23-6-2013* 29-8-2013* 27-6-2013* 13-11-2013 11-1-2014* 29-8-2013* 27-6-2013* 13-11-2013 11-1-2014* 22-3-2014* PINDAH RSMK(3,4)
7 Sabrina Zafira Ibnu Syafiq/Farkhatunisa P 30-6-2013 3/III 2-11-2013# 2-11-2013# 5-4-2014# 14-3-2015# 2-7-2015# Bd.Rgyh
8 Putra Akbar Maulana Ratih Utami/Sukeri I L 1-7-2013 3/III 2-7-2013 10-7-2013 1-9-2013 30-9-2013 28-10-2013 10-7-2013 1-9-2013 30-9-2013 28-10-2013 11-9-2014* 2-7-2015# Bd.D(3,2)
9 Ilham Maulana Sugiarti/Abdul Ajis L 4-7-2013 2/III 4-7-2013 22-7-2013 12-9-2013 10-10-2013 7-11-2013 22-7-2013 12-9-2013 10-10-2013 7-11-2013 14-4-2014* 5-2-2015# 6-8-2015# RB.St.Hj(3,3)
Jaden Henny L 17-7-2013 KI 121 17-7-2013 31-7-2013 23-9-2013 TEGALSARI 23-9-2013 RB.Rhm
10 Alif Naufal Hanif Ratna Diah/Arifulloh L 18-7-2013 2/III 19-7-2013 19-8-2013 26-9-2013 29-11-2013 29-1-2014 19-8-2013 26-9-2013 29-11-2013 29-1-2014 13-6-2014* RSI(2,8)
Azka Faiz Nur Faizah/Dion Haris L 3-8-2013 8/III 3-8-2013 21-8-2013 15-11-2013* 4-1-2014* 13-5-2014* 21-8-2013* 15-11-2013* 4-1-2014* 13-5-2014* PINDAH SEMARANG RB.Khr(2,8)sc
Nauval Akhtar Syawal Esti Diah/Benny Arya R L 20-8-2013 1/III 20-8-2013 16-9-2013 PINDAH 16-9-2013 TEGALSARI Bd.Rgyh
11 Muh.Aji Pangestu Fitri Rahayu/Abdulloh L 2-10-2013 3/III 2-10-2013 5-11-2013 12-12-2013 6-3-2014* 11-12-2104* 5-11-2013 12-12-2013 6-3-2014* 11-9-2014* 11-9-2014* 2-7-2015# Bd.M(3,6)
Chayra Alysha Fahrani Erni Herawati/Risqi A P 11-11-2013 2/III 11-11-2013 18-12-2013* 15-1-2014* 15-2-2014* 5-4-2014* 16-11-2013 18-12-2013* 15-1-2014* 5-4-2014* 16-8-2014* MEJASEM RSUK(3,1)
12 Saabiqah Hanifah R Yesi Tri Susanti/M.Iqbal P 25-12-2013 3/III 25-12-2013 27-1-2014* 24-2-2014P* 24-3-2014P* 8-5-2014P* 2-1-2014* 24-2-2014* 24-3-2014* 8-5-2014* 9-10-2014* MENOLAK RSI(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 Naira Ayla Askana Nina Veronika/Arief S P 13-2-2014 1/III 13-2-2014 10-3-2014 9-5-2014P 12-6-2014P 12-7-2014P 10-3-2014 9-5-2014 12-6-2014 12-7-2014 17-11-2014 24-8-2015^ 20-7-2016^ Bd.D(3,3)RUSUN
Nadifa Aisywa(std) Dhini Puji U/M.Bahtiar P 23-2-2014 2/III 23-2-2014 22-4-2014 5-5-2014P PINDAH 22-4-2014 5-5-2014 KABUPATEN RSI(3)
2 Syailendra Parama H Dessy Ria I/Febru Rian H L 29-3-2014 2/III 29-3-2014 12-5-2014 12-6-2014P 12-7-2014P 12-8-2014P 5-4-2014 12-6-2014 12-7-2014 12-8-2014 7-1-2015# 8-10-2015# 7-4-2016^ RSI(3)
Isti Kurniasih/Faizal P 14-4-2014 3/III 14-4-2014 TIDAK ADA RSI(3,15)
3 Maryatul Qibthiyyah Hati Nuraeni/Muh.Soleh P 28-4-2014 3/III 28-4-2014 26-5-2014 30-6-2014P 12-8-2014P 11-9-2014P 26-5-2014 30-6-2014 12-8-2014 11-9-2014 2-2-2015# 7-4-2016^ 1-10-2016^ RSUK(2,6)sc
Gista Deanda Quinara Revi Erlania/Bambang P 16-5-2014 3/III 16-5-2014 20-6-2014 22-7-2014P 8-9-2014P 7-10-2014 20-6-2014 22-7-2014 8-9-2014 7-10-2014 20-2-2015# PINDAH TGS RB.Rhm(3,7)sc
Husein Farah/Toriq L 18-6-2014 1/III 18-6-2014 16-7-2014 DOMISILI 16-7-2014 BUMIAYU Bd.E
Zhafran Maulana Dwi Oktaviani/Nahrawi L 21-6-2014 2/III 21-6-2014 4-8-2014 DOMISILI 4-8-2014 GETASKEREP RB.Rhm(2,8)
Ihya Mafaza Indah Trisna/Nurhadi P 7-7-2014 2/III 7-7-2014 16-7-2014 DOMISILI DEBONG RB.Khr(3,8)
4 Dyfa Widyasari Ritasari/M.Nuridin P 19-7-2014 2/III 17-9-2014 5-10-2014 18-11-2014P 17-12-2014P 17-1-2015# 5-10-2014 18-11-2014 17-12-2014 17-1-2015# 20-6-2015# 21-3-2016^ 20-10-2016 RSI(3,4)
Necy Ignasia/Nicolas A L 20-7-2014 /III 21-7-2014 TIDAK ADA RSI(3,5)
5 Naufal Risqi Raditya Hendriyana R/Diantoro L 8-8-2014 3/III 9-8-2014 10-9-2014 10-10-2014P 10-11-2014P 7-12-2014P 10-9-2014 10-10-2014 10-11-2014 7-12-2014 10-5-2015# 7-4-2016^ 3-9-2016^ RB.Rhm(3,5)sc
6 Raffi Quthbie Nelly Kurniawati/Aji H L 29-9-2014 3/III 29-9-2014 4-12-2014 18-12-2014# 7-2-2015# 26-4-2015# 9-10-2014 18-12-2014# 7-2-2015# 26-4-2015# 16-7-2015# RSMK(3,9)sc
Akhyatmi/Beni P 29-10-2014 1/III 29-10-2014 DOMISILI SLAWI RB.Rhm(3,7)
7 Zahira Qonita Anjani Dewi Ningsih/Novlan Dwi P 24-12-2014 2/III 25-12-2014 14-1-2015 24-2-2015 24-3-2015 24-4-2015 14-1-2015 24-2-2015 24-3-2015 24-4-2015 24-10-2015

Imunisasi yang diberikan 5-11-15


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 Adzkia Parastya Golis L/Irwan(DF/11/1) P 17-1-2015 1/III 17-1-2015 26-1-2015 20-3-2015 25-4-2015 2-7-2015 26-1-2015 20-3-2015 25-4-2015 6-8-2015 5-11-2015DF RSUK(4,15)
2 Anindya Amalia H Andika W/Yusuf A(DF/11) P 3-2-2015 2/III 4-2-2015 13-4-2015 28-4-2015 28-5-2015 29-6-2015 11-2-2015 28-4-2015 28-5-2015 13-7-2015 16-11-2015 6-8-2016^ RSMK(2,9)
Rizki Ade Prasetyo Intan Muharni/Waryono L 9-2-2015 2/III 9-2-2015 10-3-2015 10-4-2015 10-5-2015 11-6-2015 10-3-2015 10-4-2015 10-5-2015 11-6-2015 PINDAH MUARAREJA RSI(2,7)
3 Hafshah Rizqiya Sri Indahwati/Mulyono P 12-2-2015 2/III 13-2-2015 20-4-2015 4-5-2015 4-6-2015 2-7-2015 20-4-2015 4-5-2015 4-6-2015 6-8-2015 3-12-2015 1-10-2016^ RSI(3,1)sc
Adiguna Aprilio Eli/Yohanes Edi L 29-4-2015 3/III 29-4-2015 8-6-2015 2-7-2015 5-5-2015 PINDAH CIREBON RSI(3)
Nadira Qiana Ramadhani Risqa Nursa/Maulana A P 3-7-2015 3/III 3-7-2015 PINDAH KARTINI B RSMK(3,5)
4^ Afiqa Khanza Aquilla(DOFU) Noni O/Kusnoto(DF/11/2) P 18-7-2015 1/III 18-7-2015 31-8-2015 8-10-2015 5-11-2015DF 3-12-2015 31-8-2015 8-10-2015 5-11-2015DF 3-12-2015 2-5-2016^ Bd.Mas(3,0)
5 Aysha Ayudia Inara Lily Eka Priyantini/Jenio R P 10-9-2015 1/III 10-9-2015 14-10-2015 10-11-2015 11-12-2015^ 16-1-2016^ 17-9-2015 14-10-2015 10-11-2015 16-1-2016^ 6-8-2016^ RSI(3,2)
6 Jihan Puspa Cantigi Rian Arindi/Edi Suparto P 8-10-2015 1/III 8-10-2015 23-11-2015 28-12-2015 8-2-2016^ 14-3-2016^ 16-10-2015 23-11-2015 28-12-2015^ 8-2-2016^ 6-8-2016^ RSI(3,4)SC
7 Alisha Khaira Wilda Ika Yuniarti P/Slamet P 6-11-2015 3/III 7-11-2015 10-12-2015 11-1-2016^ 11-2-2016^ 15-3-2016^ 14-11-2015 11-1-2016^ 11-2-2016^ 7-5-2016^ 6-8-2016^ RSI(2,8)sc
8 Muhamad Rafa Azka Giaputra Rokhayati/Sugiono L 11-11-2015 3/III 12-11-2015 10-12-2015 20-1-2016^ 22-2-2016^ 7-4-2016^ 10-12-2015 20-1-2016^ 7-5-2016^ 7-7-2016^ 1-10-2016^ Bd.D(2,7)

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^ Yanuar Riski Mulyana Sari Nofiana/Herfyan R L 30-1-2016 2/III 30-1-2016 15-2-2016 7-5-2016 2-7-2016 6-8-2016 15-2-2016 7-5-2016 2-7-2016 6-8-2016 RSUK
2 Afrizal Afi Marta (T) Dede L/Mudzakir L 8-2-2016 8-2-2016 27-2-2016 11-4-2016 11-4-2016
3 Moh.Daffa Abdul Hafidz Nuryati/M.Nurul Iman L 1-4-2016 3/III 2-4-2016 9-5-2016 7-6-2016 11-7-2016 26-9-2016 9-4-2016 9-5-2016 7-6-2016 11-7-2016 RSI(3,7)SC
4 Racelia Azzahra Suginah/Takim P 5-4-2016 1/III 5-4-2016 20-4-2016 6-6-2016 11-7-2016 9-8-2016 20-4-2016 6-6-2016 11-7-2016 9-8-2016 dr.Cholid
5 Anindita Keisha Zahra Dewi Ekayani/Kuswantoro P 13-4-2016 3/III 14-4-2016 9-5-2016 20-6-2016 25-7-2016 22-8-2016 9-5-2016 20-6-2016 25-7-2016 22-8-2016 Bd.D(2,8)
6 Anindita Keyza Zahra Nila Safitri/Zazuli P 14-5-2016 1/III 14-5-2016 10-6-2016 14-7-2016 10-6-2016 14-7-2016 Bd.L(2,9)
7 Muhammad Miqdad Syamil Farkhatunnisa/Ibnu S L 16-5-2016 3/III 16-5-2016 10-6-2016 6-8-2016 3-9-2016 1-10-2016 10-6-2016 6-8-2016 3-9-2016 1-10-2016 Bd.Mas(3,1)
8 Alishba Halwa Setiawan Kusrini/Adi Prakoso P 24-9-2016 2/III 25-9-2016 21-11-2016 21-11-2016 RSI(3,5)sc
9 Jihan Adelia Nafia Yesi Tri S/ M.Iqbal P 13-11-2016 3/III 13-11-2016 21-11-2016 21-11-2016 RSUK(3,1)

Imunisasi TT
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Pipit K 2/III 31-5-2014
2 Andika/Yusuf K 2/III 5-9-2014 5-10-2014
3 Sri Indahwati K 2/III -9-2014 16-10-2014
4 Akhyatmi K 1/III 11-10-14
5 Intan Muharini/Waryono K 2/III 9-11-2014
Imunisasi TT
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Risqa Nursa/Maulana K 3/III 7-2-2015 11-4-15
2 Noni Oktarian/Kusnoto K 1/III 5-3-2015
3 Eli/Yohanes Edi K 3/III 5-4-2015
4 Nani Cahyani/Tofiq H K 2/III 5-5-2015C
5 Rokhayati/Sugiono K 3/III 8-6-2015
6 Rian Arindi K1/III 1-6-2015 2-7-2015
7 Ika Yuniarti Putri/SlametR K3/III 5-8-2015 5-9-2015
8 Sari Nofiana/Herfyan R K2/III 7-10-2015
9 Nuryati/ Muh. Nurul Iman K 3/III 4-11-2015
10 Dewi Eka Yani/Kuswantoro K3/III 5-11-2015
Imunisasi TT
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Nuryati/ Muh. Nurul Iman K 3/III 14-12-2015
2 Dewi Eka Yani/Kuswantoro K3/III 7-1-2016
3 Farkhatunnisa/ Ibnu Syafiq K 3/III 14-12-2015 23-1-2016
4 Eti Solikha/M.Baiquni K 8/III 4-2-2016 3-3-2016
5 Nila Safitri/Zazuli K 1/III 4-2-2016 3-3-2016
6 Suginah/Takim K 1/III 16-1-2016
7 Kusrini/Adi Prakoso K2/III 20-4-2016 23-5-2016
8 Yesi Tri S/Moh.Iqbal K3/III 7-5-2016 6-8-2016
9 Nila febrilianti P/Handi H K8/III 27-7-2016 15-10-2016
LAPORAN BULANAN IMUNISASI BAYI
POSYANDU KENANGA B

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 Sendy Farel Saputra Susanti/Adi Cahyo L 28-6-2009 4/III 28-6-2009 13-7-2009 24-8-2009 28-9-2009 24-11-2009 13-7-2009 24-8-2009 28-9-2009 7-6-2010 7-6-2010
2 Zahra Khairunisa Sulasmi/Rochman P 5-9-2009 4/III 10-9-2009 10-10-2009 24-11-2009 22-12-2009 23-2-2010 10-10-2009 24-11-2009 22-12-2009 23-2-2010 14-6-2010
3 Rani Puspitasari Siti Solicha/Satimin P 31-8-2009 5/III 1-9-2009 28-9-2009 24-11-2009 22-12-2009 25-1-2010 28-9-2009 24-11-2009 22-12-2009 25-1-2010 24-5-2010

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 Asty Tiara Yusniar Yusnita P/Oman Rahman P 13-12-2010 4/III 14-12-2010 10-1-2011 16-2-2011 16-3-2011 13-4-2011 10-1-2011 16-2-2011 16-3-2011 13-4-2011 15-9-2011

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 Izaas Aqilasyah Jafar/Herlina P 5-3-2011 5/III
Nabil Daffa M Yogi/Maya P 21-3-2011 5/III PINDAH JALAN POSO
Abdul Rivan Alamsyah Yusron/Nurbaeti L 25-4-2011 5/III PINDAH BUMIJAWA
2 M Ardan Azkia Tarjono/Sarmila L 16-6-2011 5/III RUSUNAWA
3 M Irfan Hanafi Marjuli/Nur aida L 19-6-2011 6/III
4 M gian Darmono/Kurnia L 20-10-2011 5/III
5 Aura Yulianyta Supartin/Kusnendar P 4-12-2011 5/III 4-12-2011 2-1-2012 21-2-2012 26-3-2012 28-5-2012 2-1-2012 21-2-2012 26-3-2012 28-5-2012 3-9-2012 21-6-2014*
6 Winda Hamidah Mubarokah/Untung P 15-12-2011 5/III 21-6-2014*
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 Irfan Febrian Sibuai Ramdon/Triyana P 24-2-2012 6/III
2 Naufal Azka A Ratna/Eko L 25-3-2012 6/III 26-3-2012 15-4-2012 28-5-2012 24-7-2012 18-9-2012 15-4-2012 28-5-2012 24-7-2012 18-9-2012 21-1-2013 21-6-2014* RUSUNAWA
3 M.Fais Tumiyem/Kuspriyadi L 26-3-2012 4/III 26-3-2012 15-4-2012 15-7-2013 RIWAYAT 15-4-2013 15-7-2013 KEJANG
4 Hafiz Rizki Isti/Santoso L 5-4-2012 5/III 15-4-2012 15-4-2012 MENOLAK 15-4-2012 MENOLAK
5 Asyiatul Fauziah Suci Ningsih P 6-4-2012 4/III
6 Nasywa Indriani Nur Baeti/Nur Yanto P 13-5-2012 5/III 13-5-2012 24-5-2012 28-7-2012 25-8-2012 1-10-2012 24-5-2012 28-7-2012 25-8-2012 1-10-2012 18-2-2013 15-4-2015#
7 Faisal Septi/Mahir L 17-5-2012 6/III 17-5-2012 MENOLAK
8 Rizky Ageng Saputera Ira W/Iman Agung W L 20-6-2012 5/III 27-6-2012 11-8-2012 18-9-2012 28-10-2012 28-11-2012 11-8-2012 18-9-2012 28-10-2012 28-11-2012 25-3-2013 19-7-2014*
9 Muchamad Lutfi Nur Nurtikhat/Moh.Nur H L 17-7-2012 5/III 18-7-2012 27-7-2012 30-9-2012 25-11-2012 30-12-2012 27-7-2012 30-9-2012 25-11-2012 30-12-2012 20-5-2013 19-7-2014* 20-9-2014*
Audrey Fira Itaria/Taufik P 24-7-2012 5/III 24-7-2012 21-8-2012 24-9-2012 21-10-2012 27-11-2012 21-8-2012 24-9-2012 21-10-2012 27-11-2012 PINDAH
Ahmad Muadib Sunarsih/Waridi L 23-8-2012 5/III 30-8-2012 25-9-2012 23-10-2012 27-11-2012 14-1-2013 25-9-2012 23-10-2012 27-11-2012 14-1-2013 1-7-2013 16-6-2014* PESAYANGAN
Talita Neyma Dyah/Nuskan P 24-9-2012 4/III 25-9-2013 2-10-2013 26-12-2012 25-1-2013 25-2-2013 2-10-2013 26-12-2012 25-1-2013 25-2-2013 24-6-2013 BREBES
10 Naura Eka Oktaviany Titi Arbani/Bambang P 16-10-2012 4/III 16-10-2012 20-11-2012 12-12-2012 4-4-2013 15-6-2013 20-11-2012 12-12-2012 4-4-2013 15-6-2013 21-9-2013 17-5-2014* 13-6-2015#
11 Ainaya Zalicha Azzahra Kartika/Rismarno P 20-10-2012 5/III 22-10-2012 16-1-2013 30-1-2013 4-4-2013 5-6-2013 16-1-2013 30-1-2013 4-4-2013 5-6-2013 5-7-2013 17-5-2014* 18-10-2014*

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
2 Rifqi Adnan Subekhi Dhesi Ike/M.Subekhi L 28-1-2013 4/III 28-1-2013 4-3-2013 1-4-2013 1-5-2013 31-5-2013 4-3-2013 1-4-2013 1-5-2013 31-5-2013 4-11-2013 30-3-2015# 13-6-2015# RSUK
1 Bryan Pramana Putra Atick/Tri Apriyanto L 16-2-2013 6/III 16-2-2013 5-3-2013 17-4-2013 18-5-2013 15-6-2013 5-3-2013 17-4-2013 18-5-2013 15-6-2013 21-12-2013 14-3-2015# 13-6-2015# Bd.D
3 Mufidah Zahiroh Siti Asiyah/Wardi P 17-4-2013 6/III 17-4-2013 12-5-2013 15-6-2013 20-7-2013 24-8-2013 12-5-2013 15-6-2013 20-7-2013 24-8-2013 18-1-2014* 11-4-2015# 13-6-2015# RSUK(2,6)
11 Muh.Kutub Robana Hendry Mulyani/Imron L 5-6-2013 6/III 6-6-2013 3-7-2013* 14-8-2013* 25-9-2013* 30-10-2013* 3-7-2013* 14-8-2013* 25-9-2013* 30-10-2013* 12-3-2014* 9-5-2015# MENOLAK
12 Muh.Kutub Robani Hendry Mulyani/Imron L 5-6-2013 6/III 6-6-2013 3-7-2013* 14-8-2013* 25-9-2013* 30-10-2013* 3-7-2013* 14-8-2013* 25-9-2013* 30-10-2013* 12-3-2014* 14-3-2015# MENOLAK
10 Maisa Neneng/Toha P 25-5-2013 4/III 12-5-2014* 21-12-2013 18-1-2014* 15-2-2014* 21-12-2013 18-1-2014* 15-2-2014* 17-5-2014* 17-5-2014* 20-12-2014# 13-6-2015# Jedah
Nasya Kalila Raisya P Dian Pujiati/Idul F P 27-5-2013 6/III 27-5-2013 3-6-2013 28-7-2013 PINDAH 3-6-2013 28-7-2013 KALIMANTAN RSUK(3,0)
6 Muh Fahri Ramadani Triningsih/Supriyanto L 22-7-2013 6/III 29-7-2013 19-8-2013 21-9-2013 19-10-2013 16-11-2013 19-8-2013 21-9-2013 19-10-2013 16-11-2013 17-5-2014* 9-5-2015# RSUD Bbs(3,85)
4 Maulana Al Qurtubi Siti Nurmasnah/Abdus S L 12-8-2013 6/III 12-8-2013 20-9-2013 19-10-2013 16-11-2013 21-12-2013 20-9-2013 19-10-2013 16-11-2013 21-12-2013 17-5-2014* 9-5-2015# 14-11-2015# Bd.D(3,9)
5 Aerix Mas Kaisar Tri Murti/Agus Riyatno L 7-9-2013 4/III 8-9-2013 22-9-2013 7-11-2013* 7-12-2013* 7-1-2014* 22-9-2013 7-11-2013* 7-12-2013* 7-1-2014* 10-6-2014* 13-6-2015# RSI(3,1)
7 Kiki Khaerul Umam Susi/Muh.Sopan L 6-10-2013 5/III 7-10-2013 5-11-2013 21-12-2013 15-2-2014* 15-3-2014* 5-11-2013 21-12-2013 15-2-2014* 15-3-2014* 27-9-2014* Bd.D(2,95)RUSUNAWA
8 Giftia Mahda Nisrina Nurjanah/Waryo P 22-10-2013 5/III 22-10-2013 3-11-2013* 19-1-2014* 21-2-2014* 16-6-2014* 3-11-2013* 19-1-2014* 21-2-2014* 16-6-2014* 27-9-2014* RB.Rhm(2,9)
Stefani/M.Aris R L 25-10-2013 5/III PINDAH RSUK(1,8)
Okta Aryani/Umar A L 8-11-2013 5/III 8-11-2013 TIDAK ADA RSI(2,9)
9 Aan Ahmad Kurniawan Tini Frida S/Syaeful Amin L 9-11-2013 4/III 9-11-2013 23-12-2013 18-1-2014* 15-2-2014* 15-3-2014* 23-12-2013 15-2-2014* 15-3-2014* 20-9-2014* 20-9-2014* 13-6-2015# 12-12-2015# RSUK(3,15)

Imunisasi yang diberikan 9-9-15


No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak 10-10-15
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang
1 M.Azka Al Hafidz Vera Ashari Yuliandi L 23-1-2014 6/III 29-1-2014 14-4-2014 12-5-2014P 16-6-2014P 19-7-2014 14-4-2014 12-5-2014 16-6-2014 19-7-2014 15-11-2014 15-8-2015# 6-2-2016^ RSI(1,5)
2 Damar Ariq Aulian Dyah Mitriana S/Imam W L 3-2-2014 5/III 4-2-2014 17-3-2014 19-4-2014P 17-5-2014P 19-7-2014 11-2-2014 17-3-2014 19-4-2014 17-5-2014 15-11-2014 15-8-2015# 6-2-2016^ RSI(3,3)sc
3 Nur Syifa Salsabila Isro Dwi T/Abu Bakar P 10-2-2014 6/III 10-2-2014 24-3-2014 28-4-2014P 26-5-2014P 30-6-2014P 24-3-2014 28-4-2014 26-5-2014 30-6-2014 15-11-2014 15-8-2015# 9-4-2016^ RB.Rhm((3,2)sc
Nayla Adela Syakira Sri Chanipah/Susanto P 22-3-2014 6/III 23-3-2014 PINDAH 5-4-2014 JAKARTA RSI(2,7)
4 Amesty Nur'ainin Anin Solechah/Zaenudin P 28-3-2014 4/III 29-3-2014 4-5-2014 10-6-2014P 20-7-2014P 16-8-2014P 9-4-2014 10-6-2014 20-7-2014 16-8-2014 3-1-2015# 12-12-2015# RSI(2,8)
Aisyah Maya Mahfiah/Yogi P 4-4-2014 6/III 5-4-2014 21-5-2014 28-6-2014P DOMISILI 14-4-2014 28-6-2014 SLEROK RSI(3,9)sc
5 Nada Fajria Salsabila Ismiyati/Sutrisno P 18-4-2014 4/III 18-4-2014 12-5-2014 21-6-2014P 19-7-2014P 16-8-2014P 12-5-2014 21-6-2014 19-7-2014 16-8-2014 17-1-2015# 14-11-2015# 11-6-2016^ RSUK(3)
6 Avril Laura A Neneng Imas R/Toha P 19-4-2014 4/III 20-4-2014 18-5-2014 21-6-2014P 15-11-2014P 20-12-2014P 18-5-2014 21-6-2014 15-11-2014 20-12-2014 9-5-2015# 12-12-2015# 12-11-2016^ Bd.D(2,8)
7 Arkan Arziqi Dina Agus/Fajar J L 7-5-2014 6/III 7-5-2014 7-7-2014 16-8-2014P 20-9-2014P 15-11-2014P 7-7-2014 16-8-2014 20-9-2014 15-11-2014 14-2-2015# 14-11-2015# RSUK(1,8)
8 Ardan Arziqi Dina Agus/Fajar J L 7-5-2014 6/III 7-5-2014 7-7-2014 16-8-2014P 20-9-2014P 15-11-2014P 7-7-2014 16-8-2014 20-9-2014 15-11-2014 14-2-2015# 14-11-2015# RSUK(1,7)
Salman Alfarizi Nur Kholifah/Subandi L 14-5-2014 5/III 14-5-2014 19-5-2014 19-7-2014P 16-8-2014P 18-9-2014P 19-5-2014 19-7-2014 16-8-2014 18-9-2014 PINDAH RB.Rhm(3)
Khoirunisa Ramadhani Devi Fitriana/Aef Saefudin P 25-7-2014 5/III 25-7-2014 15-9-2014 20-10-2014P 24-11-2014P 22-12-2014# 15-9-2014 20-10-2014 24-11-2014 22-12-2014# PINDAH Tasik
9 Yuko Asyifa Aulia Putri Yuyun Yuningsih/Koko Aji P 24-8-2014 6/III 25-8-2014 15-9-2014 24-10-2014# 26-11-2014# 26-12-2014# 27-8-2014 24-10-2014# 26-11-2014# 26-12-2014# 13-6-2015# 9-4-2016^ RSI(2,8)ve
10 Moh.Aziz Nurfaatun/Afifi(DF/9/10/1) L 30-10-2014 4/III 30-10-2014 30-12-2014# 30-1-2015# 2-3-2015# 4-6-2015# 30-12-2014# 30-1-2015# 2-3-2015# 4-6-2015# 10-10-2015#DF PINDAH KARANGANYAR RSI(2,9)
11 Moh.Husen Neneng D/Wahyudi(DF/9/1) L 6-11-2014 4/III 6-11-2014 19-1-2015# 17-1-2015# 14-2-2015# 14-3-2015# 17-1-2015# 14-2-2015# 14-3-2015# 13-6-2015# 9-9-2015#DF PINDAH TEGALSARI RSUK(2,3)sc
12 Moh.Hasan Neneng D/Wahyudi(DF/9/2) L 6-11-2014 4/III 6-11-2014 19-1-2015# 17-1-2015# 14-2-2015# 14-3-2015# 17-1-2015# 14-2-2015# 14-3-2015# 13-6-2015# 9-9-2015#DF PINDAH TEGALSARI RSUK(2,6)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 Nur Faizah Teti S/Nur Abdulah(DF/9) P 5-3-2015 4/III 5-3-2015 5-5-2015 5-6-2015 5-7-2015 5-8-2015 12-3-2015 5-6-2015 5-7-2015 5-8-2015 14-9-2016^ RSI(3,5)
2 Moh Aldrian Al Kahfi Yuyun L/Edi S(DF/9/3/10) L 27-4-2015 5/III 27-4-2015 20-6-2015 9-8-2015 9-9-2015DF 20-10-2015 20-6-2015 9-8-2015 9-9-2015DF 20-10-2015 6-2-2016^ RSUK(2,8)
3 Nadhir Falah M Maslikha/Sujatno(DF/10/2) L 13-7-2015 6/III 13-7-2015 3-8-2015 15-9-2015 10-10-2015DF 14-11-2015 3-8-2015 15-9-2015 10-10-2015DF 14-11-2015 6-6-2016^ RSUK(2,8)sc
4 Zidan Hasan Nurohman(T) Devi Ristiana/Lukman L 10-12-2015 5/III 11-12-2015 14-11-2016^ 14-5-2016^ 14-11-2016^ 10-9-2016^ RSI

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 Alby Tsaqih Al Ghozali Estri Komariyah/Dede W L 20-1-2016 4/III 20-1-2016 10-2-2016 31-3-2016 2-5-2016 6-6-2016 10-2-2016 2-5-2016 6-6-2016 8-8-2016 21-11-2016 Bd.D (3,3)
2 Ibrahim Haji Rizqi Dewantara Ridiyanah/Hartono L 16-2-2016 6/III 17-2-2016 5-4-2016 8-5-2016 8-6-2016 16-7-2016 5-4-2016 8-5-2016 8-6-2016 16-7-2016 Bd.M(3,4)
3 Omar Bachtiyar Ismiati/Sutrisno L 21-3-2016 4/III 5-4-2016 18-4-2016 23-5-2016 27-6-2016 13-8-2016 5-4-2016 23-5-2016 27-6-2016 13-8-2016 RSUK(3,2)
4^ Rafasya Saquille Alfa Riski Kartika/Rismarno L 26-3-2016 5/III 26-3-2016 18-4-2016 11-6-2016 16-7-2016 8-10-2016 18-4-2016 11-6-2016 16-7-2016 8-10-2016 PTB(3,4)
5 Lintang Queenayra A Dyah Mitriana/Imam W P 1-4-2016 5/III 2-4-2016 23-5-2016 20-6-2016 25-7-2016 5-9-2016 16-4-2016 23-5-2016 20-6-2016 25-7-2016 RSI(3,8)SC
6 Kayla Almira Susanti/Adi Cahyo P 23-4-2016 4/III 23-4-2016 16-5-2016 27-6-2016 25-7-2016 22-8-2016 16-5-2016 27-6-2016 25-7-2016 22-8-2016 RSUK(3,6)
7 Nurva Reva Ramadhani Nurjanah/Waryo P 5-6-2016 6/III 5-6-2016 10-9-2016 19-9-2016 19-9-2016
8 Rosa Nur Ramadhani Nuraeni/ Rosidi P 23-6-2016 5/III 25-6-2016 22-8-2016 10-9-2016 22-8-2016 RSI(2,7)
9 Arifah Lutfiah Zahra Hana Febrina/Syahroni P 7-7-2016 5/III 6-7-2016 25-7-2016 10-9-2016 10-10-2016 12-7-2016 10-10-2016 RSUK
10 Khayla Almira Maritza Yuni anjani/Andriyanto P 26-7-2016 6/III 26-7-2016 20-9-2016 8-10-2016 28-7-2016 8-10-2016 RSCRBN(2,1)SC
Nia Kurniasari/ Mayo P 5-9-2016 5/III 6-9-2016 PTB(2,9)RUSUN

Imunisasi TT
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Yuyun Y//Koko Aji K 6/III 21-4-2014
2 Teti/Nur Abdullah K 4/III 20-9-2014
3 Darti/Wardi K 5/III 11-10-2014C
4 Yuyun L/Edi Samsudin K 5/III 18-10-2014 15-11-2014
Imunisasi TT
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Christian Fajarwati K 4/III 9-2-2015 1-6-2015
2 Maslikha/Sujatno K 6/III 18-2-2015 13-6-2015
3 Chuswatun/Iwan S K 5/III 6-6-2015
4 Ridianah/Hartono K 6/III 21-11-2015 18-12-2015
5 Dyah Mitriana S/Imam K5/III 14-12-2015
6 Kartika/Rismarno 5/III 21-12-2015
Imunisasi TT
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Ismiyati/sutrisno K 4/III 9-1-2016
2 Susanti/Adi Cahyo K 4/III 9-1-2016
3 Hana Febrina/Syahroni K 5/III 9-1-2016 6-2-2016
4 Estri Nur/Dede W K 4/III 26-8-2015 19-1-2016
5 Dyah M/Imam Waluyo K5/III 3-2-2016
6 Kartika/Rismarno K5/III 4-2-2016
7 Nuraeni/Rosidi K5/III 14-5-2016 18-2-2016
8 Nia Kurniasari/Maryo K5/III 2-5-2016
9 Dini Febriani/Suleman K4/III 2-5-2016 11-6-2016
10 Khusnul K/ Rasikun K5/III 13-8-2016
11 Sulis Setyaningsih/Joko P K5/III 13-7-2016 13-8-2016
12 Kapsah/Rasdi K5/III 18-10-2016
LAPORAN BULANAN IMUNISASI BAYI
POSYANDU ASTIKA A

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 Fairuz Rasendra M Kastumi/Dwi Handoko L 2-7-2009 3/IV 2-7-2009 16-7-2009 2-9-2009 2-10-2009 2-11-2009 16-7-2009 2-9-2009 2-10-2009 2-11-2009 9-4-2010

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 Almira Gerilda Ilda Silviana/Angger Susilo P 8-5-2010 2/IV 8-5-2010 21-6-2010 15-7-2010 23-9-2010 13-1-2011 21-6-2010 15-7-2010 23-9-2010 13-1-2011 17-3-2011
2 Moh.Ali Ashbari Siti Atikah/Widodo L 17-8-2010 2/IV
3 Olivia Zevanya Rubiyanti/Jefri P 10-10-2010 2/IV
4 Syafira Anis S Ilfa Mei Sigesti/Subakti P 18-10-2010 2/IV 19-10-2010 26-10-2010 16-12-2010 13-1-2011 17-3-2011 26-10-2010 16-12-2010 13-1-2011 17-3-2011 27-10-2011
5 Raditya Azmi Nurul/Hendro L 23-10-2010 2/IV
6 Sherina Novelia Anasya P Yuni Setiyowati/M.Nasudi P 4-11-2010 3/IV 5-11-2010 16-12-2010 13-1-2011 17-2-2011 17-3-2011 16-12-2010 13-1-2011 17-2-2011 17-3-2011 17-11-2011

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 Marsya Nabila Tukhariyah P 25-1-2011 2/IV
2 Ikhsan Baihaqi Ari/Heri L 17-5-2011 9/IV
3 Yusril Tri Jaya Yos/Eti L 18-9-2011 1/IV
4 Jian Malik Juweriyah/Kardiman L 16-10-2011 3/IV 9-6-2014* 13-10-2014*
5 Novita Arayan T M Suneci/Indra P 12-11-2011 1/IV
6 Deshinta Eka Putri S Sutriyowati/Deden Supriyanto P 7-12-2011 1/IV 9-12-2011 21-12-2011 7-2-2012 15-3-2012 19-4-2012 21-12-2011 7-2-2012 15-3-2012 19-4-2012 24-9-2012 18-8-2014* 13-10-2014*

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 Anggit Pratama Nur Asiyah L 9-1-2012 2/IV 9-1-2012 MENOLAK
Athar Ayashi Okti Dewi L 14-1-2012 9/IV 14-1-2012 25-2-2012 14-3-2012 15-5-2012 24-7-2012 24-1-2012 14-3-2012 15-5-2012 24-7-2012 18-11-2012 PINDAH
2 Fauzan Dwi N Vita/Sanuri L 22-1-2012 3/IV 26-1-2012 7-2-2012 19-4-2012 21-5-2012 27-8-2012 7-2-2012 19-4-2012 21-5-2012 27-8-2012 29-10-2012
Adinda Gendis K Riesdiana/Riadi P 14-3-2012 1/IV 18-11-2012 11-12-2012 14-1-2013 9-2-2013 14-3-2013 11-12-2012 14-1-2013 9-2-2013 14-3-2013 10-10-2013 PINDAH
3 Ahmad Faturrohman Taslimah/Agus Santoso L 4-4-2012 2/IV 4-4-2012 1-5-2012 11-6-2012 16-7-2012 13-8-2012 1-5-2012 11-6-2012 16-7-2012 13-8-2012 13-1-2013 14-7-2014* 15-9-2014*
4 Naura Hasana Anida Faturoh/Sarifudin P 7-4-2012 2/IV MENOLAK
5 Moh.Refan Arya S Erna Hidayah/Wahyudi L 25-5-2012 3/IV PINDAHAN TUNAS BAHARI 13-10-2014*
6 Safina Ramadan Rina Herawati/Ady I P 12-7-2012 3/IV 13-7-2012 14-8-2012 10-9-2012 15-10-2012 15-11-2012 14-8-2012 10-9-2012 15-10-2012 15-11-2012 15-4-2013 19-5-2014* 15-9-2014*
7 Raihan Ramadhan Nur Asiyah/Suharso L 30-7-2012 1/IV 30-7-2012 10-8-2012 15-10-2012 10-12-2012 13-1-2013 10-8-2012 15-10-2012 10-12-2012 13-1-2013 10-6-2013 9-6-2014* 13-10-2014*
8 Nizam Dwi Ramadhani Wimarlina/Agus L 1-8-2012 2/IV 1-8-2012 28-8-2012 15-10-2012 19-11-2012 13-1-2013 28-8-2012 15-10-2012 19-11-2012 13-1-2013 20-5-2013 9-6-2014* 9-3-2015#
9 Ramadhani Bagus H St.Nurjanah/Tommy H L 17-8-2012 2/IV 18-8-2012 18-9-2012 18-10-2012 19-11-2012 17-1-2013 18-9-2012 18-10-2012 19-11-2012 17-1-2013 17-6-2013 9-6-2014* 13-10-2014*
10 Azkia Nilna Alanza Winy M/Agus S P 23-8-2012 1/IV 23-8-2012 3-9-2012 10-12-2012 13-1-2013 11-3-2013 3-9-2012 10-12-2012 13-1-2013 11-3-2013 25-6-2013 19-5-2014* 15-9-2014*
11 Refi Setyaji Suharti/Tasirun L 15-10-2012 3/IV 16-10-2012 7-11-2012 15-12-2012 15-1-2013 15-2-2013 7-11-2012 15-12-2012 15-1-2013 15-2-2013 5-8-2013 15-9-2014* 10-8-2015#
Uwaiz Sriyatni/Erizal(TAMU) L 20-10-2012 2/IV 20-10-2012 20-11-2012 3-1-2013 4-2-2013 20-6-2013 20-11-2012 3-1-2013 4-2-2013 20-6-2013 PINDAH
12 Ali Fauzi Pratama Farkhatun/Suchaerun L 12-11-2012 3/IV 12-11-2012 7-1-2013 14-1-2013 14-2-2013 14-3-2013 7-1-2013 14-2-2013 14-3-2013 14-4-2013 16-9-2013 9-6-2014* 15-6-2015#
13 Bagas Adyah Farezky Tobiah/Yusuf Adi Susanto L 15-11-2012 2/IV 15-11-2012 21-11-2012 20-1-2013 20-2-2013 26-3-2013 21-11-2012 20-1-2013 20-2-2013 26-3-2013 6-9-2013 9-6-2014*
Dava Putra Areski Listiani/Ari(TAMU) L 15-11-2012 1/IV 22-11-2012 9-1-2013 4-2-2013 14-3-2013 13-5-2013 9-1-2013 4-2-2013 14-3-2013 13-5-2013 PINDAH
Radinka Hamam A Milastri/Suhendar L 24-12-2012 9/IV 24-12-2012 2-1-2013 26-2-2013 26-3-2012 23-4-2013 2-1-2013 26-2-2013 26-3-2012 23-4-2013 PINDAH
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 Juwita Sri Nawang S Tuslicha/Wawang P 11-1-2013 2/IV 12-1-2013 20-2-2013 20-3-2013 22-4-2013 20-5-2013 20-2-2013 20-3-2013 22-4-2013 20-5-2013 21-10-2013 22-9-2014* 9-3-2015# RSI
Raya Alfari Nur Teri Septiana/Nur F L 12-2-2013 3/IV 12-2-2013 26-2-2013 14-4-2013 13-5-2013 10-6-2013 26-2-2013 14-4-2013 12-5-2013 10-6-2013 PINDAH BATAM Bd.D
2 Naufal Mirza Widya Aryani/Noto S L 22-2-2013 6/V 22-2-2013 6-3-2013 22-4-2013 10-6-2013 8-7-2013 6-3-2013 22-4-2013 10-6-2013 8-7-2013 2-12-2013 15-9-2014 11-1-2016^ Bd.E
Sunarti/Rifai P 24-2-2013 2/IV 24-2-2013 PINDAH TEGALSARI RB.Rhm
3 Muh.Hariz Ar Rasyid Leli Handayani/Sumardi L 13-3-2013 2/IV 13-3-2013 6-4-2013 13-5-2013 10-6-2013 8-7-2013 6-4-2013 13-5-2013 10-6-2013 8-7-2013 20-5-2014* Bd.D
4 Nur Isam Tayatul A Munirah/Arvi Septianto L 13-3-2013 3/IV 14-3-2013 26-3-2013 13-5-2013 24-6-2013 19-8-2013 26-3-2013 13-5-2013 24-6-2013 7-10-2013 16-12-2013 15-9-2014 9-3-2015# RSI
5 Vanio Tristan Ardhani Karti/Santoro L 1-5-2013 3/IV 1-5-2013 12-5-2013 1-7-2013 30-9-2013 13-1-2014* 12-5-2013 1-7-2013 30-9-2013 13-1-2014* 14-4-2014* 13-1-2015# 11-5-2015# Bd.D(3,8)
6 M.Kevin Dwi Putra N Nurul Hidayah/Hendro L 4-5-2013 2/IV 4-5-2013 12-5-2013 8-7-2013 18-8-2013 19-9-2013 12-5-2013 8-7-2013 18-8-2013 19-9-2013 3-3-2014* 17-11-2014* 15-6-2015# Bd.D(2,7)
7 Jennifer Nadine S Endang Purwoningsih P 6-5-2013 1/IV 6-5-2013 17-6-2013 25-7-2013 24-9-2013 14-11-2013 17-6-2013 25-7-2013 24-9-2013 14-11-2013 3-3-2014* 5-1-2015# 29-5-2015# RSMK
Azima Khanza Nur D Usnul/Azis P 6-5-2013 1/IV 6-5-2013 11-6-2013 21-7-2013 19-8-2013 17-10-2013 11-6-2013 21-7-2013 19-8-2013 17-10-2013 KARTINI A Bd.Mas
8 Maidina Kanaya R Dewi Suciati/Dwi Hardi P 10-5-2013 1/IV 11-5-2013 24-6-2013 25-7-2013 24-8-2013 24-9-2013 24-6-2013 25-7-2013 24-8-2013 24-9-2013 12-2-2014* RSMK
9 Zaki Puji Mustofa Titin/Untung Pujiono L 20-5-2013 1/IV 20-5-2013 10-6-2013 29-7-2013 11-11-2013 16-12-2013 10-6-2013 29-7-2013 11-11-2013 16-12-2013 14-4-2014* 13-4-2015# 15-6-2015# Bd.D(3,2)
Maryam/Murahwi P 20-5-2013 1/IV 20-5-2013 PINDAH Bd.D(3,2)
Muh.Zaidin Zidan Komariyah/Widayatno L 5-6-2013 1/IV 5-6-2013 11-6-2013 5-8-2013 23-9-2013 21-10-2013 11-6-2013 5-8-2013 23-9-2013 21-10-2013 10-3-2014* 15-12-2014* PINDAH RSI
10 Mohamad Panut Ely Sofianti/Wardi L 20-6-2013 3/IV MYGSRI 1-8-2013 23-9-2013 28-10-2013 19-12-2013 1-8-2013 23-9-2013 28-10-2013 19-12-2013 MENOLAK RSUK
11 Aisyah Az-zahra Dina Maryana/Rudi J P 21-6-2013 1/IV 24-6-2013 29-7-2013 27-9-2013 11-11-2013 16-12-2013 29-7-2013 27-9-2013 11-11-2013 16-12-2013 20-4-2014* 13-7-2015# Bd.D(2,4)
Erna Suciati/Dedi P P 2-7-2013 9/IV 3-7-2013 PINDAH RSI(3)
12 Alma Riska Nur Aikah Waripah/Asik Martino P 15-7-2013 3/IV 15-7-2013 21-8-2013 16-9-2013 18-10-2013 24-11-2013 21-8-2013 16-9-2013 18-10-2013 24-11-2013 11-6-2014* 30-1-2015# 11-5-2016^ Bd.E(3,5)
13 Najwa Khaera Wilda Irma/Rizki P 6-8-2013 1/IV 14-8-2013 5-9-2013 10-10-2013 18-12-2013 10-2-2014* 5-9-2013 10-10-2013 18-12-2013 10-2-2014* 9-6-2014* 10-8-2015# Bd.L(2,9)
Miftahudin Khusnul K Dwi Lis S/Komarudin L 1-9-2013 2/IV 1-9-2013 7-10-2013 PINDAH 7-10-2013 DEBONG RSUK(3,15)sc
Finegan Yessy Yulianti/Yusuf S P 9-9-2013 9/IV 9-9-2013 16-10-2013 24-10-2013 PINDAH 16-10--2013 PINDAH RSI(2,5)sc
Naura Hasna Anida Irma/M.Makmuri P 10-9-2013 1/IV 10-9-2013 24-10-2013 -11-2013* PINDAH 20-9-2013 24-10-2013 -11-2013* JAKARTA RSI(2,9)
14 Nabilah Kholya M Evi Oktaviani/Abdul Kholiq P 9-10-2013 3/IV 9-10-2013 19-10-2013 10-12-2013 10-1-2014* 13-2-2014* 19-10-2013 10-12-2013 10-1-2014* 13-2-2014* 20-7-2014* 9-4-2015# 9-2-2016^ RSUK(3,1)
Rafasha Suci L 20-10-2013 3/IV 13-8-2014* 11-7-2015#
Rosidi Dwi Siti Umayah/Untung L 21-10-2013 3/IV 22-10-2013 20-11-2013 21-12-2013 21-1-2014* 7-3-2014* 20-11-2013 21-12-2013 21-1-2014* 7-3-2014* PINDAH TEGALSARI Bd.E(3)
15 Khalif Zikri Hamizan Diah Triana/Eka K(Tamu) L 16-11-2013 2/IV 16-11-2013 10-12-2013 10-3-2014P MENOLAK 10-12-2013 10-3-2014 MENOLAK RSUK(2,8)
Faith Haqqi Affandi Tri Ari Wijayanti/Buntoro L 25-11-2013 2/IV 25-11-2013 11-12-2013 25-1-2014* 25-2-2014* 25-3-2014* 11-12-2013 25-1-2014* 25-2-2014* 25-3-2014* 17-9-2014* PINDAH DEBONG Bd.E(3,6)

Imunisasi yang diberikan 14-9-15


No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak 9-11-15
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang
1 Asyam Najwan S Nur Kholifah/Sanggit Azamal K L 2-3-2014 2/IV 2-3-2014 20-5-2014 20-6-2014P 20-7-2014P 20-8-2014P 14-3-2014 20-5-2014 20-6-2014 20-7-2014 20-12-2014 14-9-2015# 11-4-2016^ RSI(3,3)
Ade W/Irfan Agus S(Tamu) P 17-3-2014 2/IVno49 17-3-2014 PINDAH DEBONG RSI(2,7)
Apriliani Rositi/Junaedi P 9-4-2014 3/IV 9-4-2014 PINDAH KONTRAKAN DI MAYANGSARI Debong
2 M.Ageil Al Bagdhawi Ayu Kresna Widi/Suyono L 22-4-2014 3/IV 22-4-2014 14-5-2014 22-6-2014P 22-7-2014P 22-8-2014 14-5-2014 22-6-2014 22-7-2014 22-8-2014 9-2-2015# 21-3-2016^ Bd.E(2,8)
3 Rofi Albaihaqi Sugiyarti/Tarsono L 28-4-2014 3/IV 28-4-2014 20-5-2014 28-6-2014P 26-7-2014P 24-8-2014P 20-5-2014 28-6-2014 26-7-2014 24-8-2014 10-2-2015# 11-1-2016^ 13-9-2016^ Bd.D(3,7)
4 Khairul Imam Haqiqi Kusrini/Suswoyo L 30-4-2014 1/IV 30-4-2014 9-6-2014 15-9-2014P 13-10-2014P 17-11-2014P 6-5-2014 9-6-2014 15-9-2014 13-10-2014 10-2-2015# RSUK(3)
Ida Eliza/Rohim(Tamu) L 5-5-2014 2/IV 5-5-2014 PINDAH BREBES RSUK(2,95)
5 Meisya Widia Lestari Eka Zulfarkhani/Sandi L P 6-5-2014 3/IV 11-5-2014 10-6-2014 10-7-2014P 11-8-2014P 12-9-2014P 10-6-2014 10-7-2014 11-8-2014 12-9-2014 10-2-2015# 11-4-2016^ 1-6-2016^ Rmh(3)
6 Aninda Putri Ilda/Angger P 16-5-2014 2/IV 16-5-2014 20-7-2014 18-8-2014P 13-10-2014P 17-11-2014P 20-7-2014 18-8-2014 13-10-2014 17-11-2014 9-3-2015# RB.Rhm(3,6)
7 Mutia Reva Gunawan Heni Handayani/Indra G P 5-6-2014 2/IV 5-6-2014 20-6-2014 4-9-2014P 6-10-2014P 10-11-2014P 20-6-2014 4-9-2014 6-10-2014 10-11-2014 9-3-2015# 13-9-2016^ 14-11-2016^ RSI(3)
8 Mutia Revi Gunawan Heni Handayani/Indra G P 5-6-2014 2/IV 5-6-2014 20-7-2014 15-9-2014P 13-10-2014P 17-11-2014P 20-7-2014 15-9-2014 13-10-2014 17-11-2014 9-3-2015# 11-4-2016^ RSI(2,55)
Fathia Izatunnisa Susi Haryati/Wahyu S(Tamu) P 9-6-2014 1/IV 9-6-2014 20-6-2014 PINDAH 20-6-2014 JAKARTA Bd.D(3,3)
Moh.Alnadif Javier Ligar Lastiyani/Wahyu A(6/)T L 1/IV 12-6-2014 20-6-2014 5-8-2014P DOMISILI 20-6-2014 5-8-2014 TEGALSARI RSMK(2,4)sc
Nizam Kafah H(Tamu) Putri/Tito(DF/11/1) L 22-6-2014 2/IV 24-6-2014 6-8-2014 8-9-2014 13-10-2014 10-11-2014 6-8-2014 8-9-2014 13-19-2014 10-11-2014 9-11-2015#DF PINDAH Bd.Titi H(3)
Desi Risdiawati/Juman Watoni P 5-7-2014 2/IV 6-7-2014 DOMISILI SLAWI RSI(2,5)sc
9 Naura Ain Sheza Nur Afiati/Tanuji P 25-7-2014 2/IV 28-7-2014 5-9-2014 13-10-2014P 17-11-2014P 15-12-2014P 5-9-2014 13-10-2014 17-11-2014 15-12-2014 11-5-2015# 9-2-2016^ Bd.Las(3)
Azzahra Fitri Agustin Karniti/Surono P 18-8-2014 2/IV DEBONG 22-9-2014 22-10-2014P 18-11-2014P 20-12-2014P 22-9-2014 22-10-2014 18-11-2014 20-12-2014 30-5-2015# PINDAH Bd.Nrl
10 Aisyah Nabila Susi Ningsih/Budi Suharto P 27-8-2014 3/IV 27-8-2014 20-9-2014 25-10-2014P 2-12-2014P 8-1-2015# 20-9-2014 25-10-2014 2-12-2014 8-1-2015# 10-6-2015# Bd.Srph(2,5)
11 Anisa Putri Oktaviani Wiwin Lisnawati/Romi Fajar P 19-10-2014 1/IV 19-10-2014 17-11-2014 13-1-2015# 10-2-2015# 9-3-2015# 17-11-2014 13-1-2015# 10-2-2015# 9-3-2015# 10-8-2015# PTB(2,8)
12 Habibi Mochtar Dina Maryana/Rudi J(DF/9/1) L 31-10-2014 1/IV 31-10-2014 10-12-2014 13-1-2015# 10-2-2015# 9-3-2015# 10-12-2014 13-1-2015# 10-2-2015# 9-3-2015# 14-9-2015#DF RSI(2,6)
13 Fatimah Azzahra Siti Atikah/Widodo P 7-11-2014 2/IV 8-11-2014 20-12-2014# 13-1-2015# 10-2-2015# 9-3-2015# 20-12-2014# 10-2-2015# 9-3-2015# 13-4-2015# 10-8-2015# PTB(2,7)
14 Muhammad Zeroun Tri Nawang P/Zahrul A(DF/9) L 15-11-2014 9/IV 15-11-2014 24-11-2014# 24-1-2014# 24-2-2015# 8-4-2015# 24-11-2014# 24-1-2015# 24-2-2015# 8-4-2015# 1-10-2015# RSI(3,1)sc
Mufrikha/Wirto L 16-11-2014 1/IV 17-11-2014 PINDAH PESLOR Bd.D(2,85)
15 Syahnaz Adelia S(Tamu) Trima Astuti/Sofyan P 17-11-2014 3/IV 17-11-2014 17-12-2014 17-2-2015 31-3-2015 21-5-2015# 26-11-2014 17-1-2015 31-3-2015 21-5-2015# 26-8-2015#
16 Nafisa Salsabila Nur Faizah/Indra Sis(DF/9) P 8-12-2014 3/IV MRJ 4/I 22-12-2014# 7-2-2015# 9-3-2015# 23-5-2015# 22-12-2014# 7-2-2015# 9-3-2015# 23-5-2015# 16-11-2015# 13-9-2016^ Pusk(2,3)

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 Mikaila Ayu Anjani Ane P/Kristiantoro(DF/9/11) P 12-2-2015 1/IV 12-2-2015 20-3-2015 5-7-2015 20-3-2015 5-7-2015 MENOLAK RB.Rhm(2)
2^ Dzaki Ardhani Sutriyowati/Deden(DF/9/2/11/2) L 15-4-2015 1/IV 15-4-2015 9-11-2015 15-6-2015 14-9-2015DF 9-11-2015DF 15-6-2015 14-9-2015DF 9-11-2015DF 9-2-2016^ 9-2-2016^ Bd.D(3,1)
3 Faizul Anwar Khumayah/Handoyo(DF/9) L 18-4-2015 1/IV 22-4-2015 15-6-2015 10-8-2015 15-10-2015 9-2-2016 15-6-2015 10-8-2015 15-10-2015 9-2-2016 1-6-2016^ Dukun Bojong
4 Bilqis Khanza Z Arie Desiyanti/Heri susanto P 20-4-2015 9/IV 21-4-2015 4-5-2015 23-6-2015 27-7-2015 31-8-2015 4-5-2015 23-6-2015 27-7-2015 31-8-2015 9-2-2016^ RSI(2,65)
5 Nurlaela Azzahra(DOFU) Tri Wijayanti/Agus(DF/9) P 20-4-2015 2/IV 20-4-2015 20-5-2015 3-7-2015 10-8-2015 14-9-2015DF 25-4-2015 10-8-2015 14-9-2015DF 15-10-2015 9-2-2016^ 14-11-2016^ RSUK(2,8 SC)
Ghoffar Faeyza A(DOFU) Eka Susanti/Abdul Wahid(DF/11/4) L 30-4-2015 2/IV 30-4-2015 25-5-2015 30-6-2015 3-8-2015 7-9-2015 25-5-2015 3-8-2015 7-9-2015 9-11-2015DF 1-2-2016^ PINDAH JAKARTA PTB (3,0)
6 Rangga Albara Dyah Prihati/Slamet(DF/9/3) L 11-5-2015 2/IV 18-5-2015 18-5-2015 13-7-2015 10-8-2015 14-9-2015DF 18-5-2015 13-7-2015 10-8-2015 14-9-2015DF 15-2-2016^ 14-11-2016^ RSI(2,8)
7 M.Fatih Alfa Riski(DOFU) Muslichatun/Anton Z(DF/9/4) L 4-6-2015 2/IV 5-6-2015 6-7-2015 10-8-2015 14-9-2015DF 15-10-2015 6-7-2015 10-8-2015 14-9-2015DF 15-10-2015 9-5-2016^ RSI(2,4)
8 Harumi Cherry Susiana/Tulus Mugiono P 5-6-2015 2/IV 5-6-2015 10-7-2015 31-8-2015 30-9-2015 4-11-2015 10-7-2015 31-8-2015 30-9-2015 4-11-2015 12-4-2016^ RB.Rhm(2,15)
9 Harumi Sakura Susiana/Tulus Mugiono P 5-6-2015 2/IV 5-6-2015 10-7-2015 24-8-2015 28-9-2015 29-10-2015 10-7-2015 24-8-2015 28-9-2015 29-10-2015 12-4-2016^ RB.Rhm(2,15)
10 M. Nabil Almusyafa (T) Yuliani/Mudzakir L 13-6-2015 3/IV 17-6-2015 8-7-2015 13-8-2015 10-9-2015 9-10-2016 8-7-2015 13-8-2015 10-9-2015 9-10-2016 21-3-2016^
11 Hafidzi Siti Faturoh/Saripudin L 19-7-2015 2/IV MENOLAK Bd.D(2,7)
12 Felix Imanuel F Cristian F/Timortius(DF/11/3) L 25-7-2015 3/IV 25-7-2015 1-8-2015 9-10-2015 9-11-2015DF 23-12-2015 1-8-2015 9-10-2015 9-11-2015DF 23-12-2015 18-7-2016^ RSUK(3)SC
13 Nesa Arshanti P Tri Susanti/Arif Rosman(DF/11/5) P 22-8-2015 1/IV 22-8-2015 10-10-2015 9-11-2015DF 11-1-2016^ 24-3-2016^ 10-10-2015 9-11-2015DF 11-1-2016^ 11-4-2016^ 1-6-2016^ Bd.D(3,0)
14 Nafis Abdul Kodir Siti Fauzah/Sultoni(DF/11/6) L 16-8-2015 3/IV 17-8-2015 10-10-2015 9-11-2015DF 14-12-2015 11-1-2016^ 10-10-2015 9-11-2015DF 14-12-2015 11-1-2016^ 13-6-2016^ Bd.D(3,05)
15 Ahmad Salafudin Nur Sofiatun/Rasito L 13-9-2015 2/IV 13-9-2015 20-10-2015 24-11-2015 24-12-2015 9-2-2016^ 20-10-2015 24-11-2015 24-12-2015 9-2-2016^ 8-8-2016^ Bd.D(2,9)
16 Wirda Al Khumairoh Evi Suswanti/A.Muzani P 22-9-2015 2/IV MENOLAK RB.Rhm(3)
17 Muhammad Fachri Azzamy Diah Triana/Eka Krisetyari L 28-9-2015 2/IV 28-9-2015 MENOLAK RB.Rhm(2,8)sc
18 Embun Anindya Maria Dyah E/Taufik P 7-10-2015 9/IV 7-10-2015 16-11-2015 8-12-2015 7-1-2016^ 10-2-2016^ 16-11-2015 8-12-2015 7-1-2016^ 10-2-2016^ 25-7-2016^ RB Rhm(2,6)SC
19 Khansa Adelia Naifah Rina Herawati/Adi Ismanto P 16-10-2015 3/IV 16-10-2015 10-11-2015 14-12-2015 9-2-2016^ 21-5-2016^ 24-10-2015 10-11-2015 14-12-2015 9-2-2016^ 8-8-2016^ RUSK(3,5)
20 Fadlan Tri Hamdani Andriyati/Amirudin L 11-10-2015 3/IV 11-10-2015 10-11-2015 14-12-2015 11-1-2016^ 11-4-2016^ 10-11-2015 14-12-2015 11-1-2016^ 11-4-2016^ 18-7-2016^ RSI(3,5)SC
21 M. Alfa Reski Wibowo Wiwi Murdiawati/Rasikem L 20-11-2015 2/IV 20-11-2015 10-12-2015 22-1-2016 22-2-2016 18-7-2016^ 10-12-2015 22-1-2016 18-7-2016^ 10-10-2016^ 10-10-2016^
22 Tristan Farel Trisnaningsih/kusnendar L 19-12-2015 3/IV 19-12-2015 20-2-2016^ 4-4-2016^ 9-5-2016^ 18-7-2016^ 28-12-2015^ 11-4-2016^ 9-5-2016^ 18-7-2016^ 10-10-2016^ RSMK(4,3)

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 Jesslyn Emmanuella Natalia Lestari/Andi Susanto P 1-1-2016 2/IV 1-1-2016 10-3-2016 4-6-2016 1-7-2016 6-8-2016 8-1-2016 4-6-2016 1-7-2016 6-8-2016 8-10-2016
Prillyo yusuf Al Fatah Tobiah/Yusuf adi L 4-4-2016 2/IV 4-4-2016 9-5-2016 8-6-2016 16-7-2016 PINDAH 8-6-2016 16-7-2016 MEJASEM RSUD(3,3)
2 Ambar Rukma Qatrumanda Sutriyowati/Deden P 11-4-2016 1/IV 11-4-2016 9-5-2016 18-7-2016 10-10-2016 14-11-2016 9-5-2016 18-7-2016 10-10-2016 14-11-2016 Rmh(3,2)
Shafa Aulia Salsabila Umayah/Nurofik P 20-4-2016 3/IV 20-4-2016 30-5-2016 30-5-2016 RSUK(2,7)sc
3 Richika Astri Ramadanti Tri Novia A/Asep Ridwan P 13-6-2016 3/IV 14-6-2016 15-8-2016 13-9-2016 13-10-2016 14-11-2016 15-8-2016 13-10-2016 14-11-2016 Bd.Dnk(3,3)
4 Aliya Mecca Ramadhanisa Dewi Suciati/Adi Hardi P 22-6-2016 1/IV 23-6-2016 15-8-2016 13-9-2016 15-8-2016 Bidan Banyumas (3,1)
5 Kanaya Salsabila Oktaviani/Dedi Riski P 25-6-2016 2/IV 25-6-2016 13-8-2016 16-9-2016 11-11-2016 4-7-2016 16-9-2016 11-11-2016 RSMK(2,8)SC
6 Addnan Khiar Al Badhawi Ayu Kresna Widi/Suyono L 14-7-2016 3/IV 14-7-2016 14-7-2016 15-9-2016 17-10-2016 14-11-2016 14-7-2016 15-9-2016 17-10-2016 14-11-2016 Bd.Dnk(3)
7 Dwinda Aliyya Rahma Nur Kholifah/Sanggit Azamal P 3-8-2016 2/IV 4-8-2016 20-9-2016 10-10-2016 10-11-2016 10-10-2016 10-11-2016 RSUK(3,4)
Jihan Farzana Al Farizi Heni Ariestanti/ Komar riyadi P 7-9-2016 2/IV 7-9-2016 PINDAH BOGOR RSI(2,8)
Imunisasi TT
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Khumayah/Handoyo K 1/IV 21-12-2014 21-1-2015
2 Muslichatun/Anton K 2/IV 7-1-2015 7-2-2015
3 Susiana/Tulus M K 2/IV 7-2-2015 22-3-2015
4 Eka Susanti K 2/IV ?-11-2014 ?-12-2014
5 Oktaviana K 2/IV 31-3-15C
6 Tri Ari W/Buntoro K 2/IV 7-4-2015
7 Siti Fauzah/Sultoni K 3/IV 13-4-2015 8-6-2015
8 Nur Sofiatun/Rasito K 3/IV 6-5-2015 11-8-2015
9 Maria Diah Erawati K 9/IV 21-4-2015
10 Andri/Amirudin K 3/IV 10-5-2015
11 Tri Susanti/Arif R K 1/IV ?-4-2015 ?-5-2015
12 Rina Herawati K 3/IV 8-6-2015 10-7-2015
13 Tobiah/yusuf adi K2/IV 15-12-2015
14 Nur Hikmah/Mulyanto K 3/IV 23-12-15C
Imunisasi TT
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Tri Novia A/Asep Ridwan K 3/IV 11-1-2016 9-2-2016
2 Tobiah/yusuf adi K 2/IV 15-1-2016
3 Ayu Kresna Widi/Suyono K 3/IV 9-2-2016 24-3-2016
4 Sutriyowati/Deden K 1/IV 14-10-2016
5 Oktaviani/Dedy Riski K2/IV 16-2-2016 19-3-2016
6 Nurkholifah/Sanggit K 2/IV 9-5-2016
7 Siti Umayah/Nurofik K3/IV 16-11-2015 29-2-2016
8 Heni Arisetanti/Komar Riyadi K2/IV 28-6-2016 27-7-2016
10 Nur Azizah/Nevri Nur Hidayat K2/IV 20-9-2016
nyumas (3,1)
LAPORAN BULANAN IMUNISASI BAYI
POSYANDU ASTIKA B

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 Satrio Andi Wibowo Yuli Setiawati/Andi Dwi F L 11-2-2009 6/IV 13-2-2009 20-2-2009 8-4-2009 7-5-2009 11-6-2009 20-2-2009 8-4-2009 7-5-2009 11-6-2009 12-11-2009

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 Nahla Nurul Hanifa Arinta Uzlifatil L/M.Kurniawan P 28-10-2010 6/IV 28-10-2010 29-11-2010 30-12-2010 30-1-2011 4-3-2011 29-11-2010 30-12-2010 30-1-2011 4-3-2011 8-8-2011

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 Izzat Dhuha Budi M/Suci R P 11-4-2011 6/IV
2 M.abi syafa Rasmudin/Nina A L 13-4-2011 8/IV
3 Dewi maryam Rudini P 12-5-2011 4/IV
4 Andan Muafa Sri Heriwati/Kusnanto L 23-6-2011 8/IV 7-7-2014*
5 Arlo Rajendra Endra/Gebi L 5-7-2011 7/IV
6 M. Agustian Husnul L 7-8-2011 8/IV
7 Akham Gibran R Yuli K/Fahrun Nisa L 10-8-2011 7/IV
8 Faiq Abqori Lutfiah/Koko L 2-9-2011 4/IV 6-10-2014*
9 Fitri Septiana Awing/Y. Ratnasari P 7-9-2011 4/IV
10 Ari Sandi Saputra Rita Sahara/Susanto L 1-10-2011 7/IV 7-7-2014*
11 A.Reza Ghazali Noro/Susi L 4-10-2011 8/IV
12 Najwa Ainus Syifa Purwani R/A.Sazali P 27-11-2011 6/IV 2-12-2011 16-1-2012 12-4-2012 11-5-2012 7-6-2012 16-1-2012 12-4-2012 11-5-2012 7-6-2012 18-11-2012 15-9-2014*
13 Maulida Nur Aisyah Tristanto/Susiwati P 17-12-2011 4/IV
14 Dede Sulaiman Endang/Slamet L 23-12-2011 6/IV 15-9-2014*
15 Duta Aulia Udin/Sri Rejeki P 24-12-2011 7/IV

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 Arief Maulana Dinawati/Adi Siswanto L 17-1-2012 4/IV 23-1-2012 16-2-2012 16-4-2012 16-5-2012 14-6-2012 16-2-2012 16-4-2012 16-5-2012 14-6-2012 17-10-2012 7-7-2014*
2 Bagas Adi Putra Nur Laela/A.Tauhidin Nur I L 10-3-2012 6/IV 10-3-2012 12-5-2012 12-7-2012 11-10-2012 6-5-2013 12-5-2012 12-7-2012 11-10-2012 6-5-2013 10-6-2013
3 Ririn Metiana Ningsih/Prasetyo P 15-5-2012 6/IV MENOLAK
4 Aurelia Jeconia Ratna/Danil P 8-6-2012 6/IV 8-6-2012 10-7-2012 -8-2012 -9-2012 10-7-2012 -8-2012 -9-2012 10-3-2013
5 Ilham Mandala Novi Riwayati/Alvi W L 15-6-2012 6/IV SERING KEJANG
6 Delani Nur Hidayah Nursidik P 21-6-2012 3/IV 23-6-2012 24-7-2012 27-8-2012 27-9-2012 16-11-2012 24-7-2012 27-8-2012 27-9-2012 16-11-2012 13-4-2013
7 Qurrota A'yun Azizah/Slamet M.N. P 25-6-2012 7/IV 25-6-2012 11-7-2012 25-8-2012 27-9-2012 28-10-2012 11-7-2012 25-8-2012 27-9-2012 28-10-2012 15-4-2013 12-5-2014* 11-8-2014*
8 Regi Junior Sya'ban Sinta/Arif L 28-6-2012 MENOLAK
9 Nursyifa Melani S Meilya Dwi S/Lani Andri W P 1-7-2012 7/IV 2-7-2012 24-7-2012 6-9-2012 23-10-2012 6-12-2012 24-7-2012 6-9-2012 23-10-2012 6-12-2012 15-4-2013 12-5-2014* 7-7-2014*
10 Alzam Ibad Santoso Kusmiatun/Imam Santoso L 30-7-2012 6/IV 30-7-2012 5-9-2012 4-10-2012 19-11-2012 10-1-2013 5-9-2012 4-10-2012 19-11-2012 10-1-2013 15-6-2013
11 Revan Fahri R Lifa/Mudofir L 6-8-2012 4/IV 6-8-2012 17-9-2012 16-10-2012 16-11-2012 16-12-2012 17-9-2012 16-10-2012 16-11-2012 16-12-2012 3-6-2013
12 Aisyah Samiyah/Abdullah P 17-8-2012 4/IV MENOLAK
13 Zaqhela Anastasya Ninik/Mirza P 17-9-2012 7/IV 18-9-2012 10-10-2012 17-11-2012 3-1-2013 4-2-2013 10-10-2012 17-11-2012 3-1-2013 4-2-2013 21-8-2013
14 Hasna Azatia Eliyah Ervina/Sugianto P 6-10-2012 6/IV 6-10-2012 10-1-2013 MENOLAK 10-1-2013 MENOLAK
15 Dicky Tri Pamungkas Ani Haryati/Slamet Waluyo L 11-11-2012 6/IV 11-11-2012 17-12-2012 10-1-2013 9-2-2013 7-3-2013 17-12-2012 10-1-2013 9-2-2013 7-3-2013 9-12-2013 9-6-2014* 5-10-2015#
16 Raihan Sahid Parkhatun/Karno L 22-11-2012 8/IV 7-1-2013 9-2-2013 13-3-2013 11-4-2013 7-1-2013 9-2-2013 13-3-2013 11-4-2013 9-12-2013 9-6-2014*
Dwi Anggraeni Supriyani/Eko P 3-12-2012 4/IV PINDAH

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 Afidkah Artadilla Kurniasih/M.Subur P 9-1-2013 6/IV 9-1-2013 23-1-2013 9-3-2013 6-5-2013 10-6-2013 23-1-2013 9-3-2013 6-5-2013 10-6-2013
Naila Syakira Sari Santika/Wahyudi P 11-1-2013 8/IV 12-1-2013 26-2-2013 11-4-2013 PINDAH 26-2-2013 11-4-2013 PANGGUNG Bd.D
2 Tsabit Daffa Paricha/Indra L 23-1-2013 4/IV MENOLAK
Winarni/Aryanto L 14-2-2013 8/IV 14-2-2013 PINDAH RSI
Ismatul/Iman L 21-2-2013 8/IV 21-2-2013 PINDAH
3 Zufar Adi Nayottama Ita Djumanti/Wisnu Adi M L 7-3-2013 4/IV 7-3-2013 14-4-2013 14-6-2013 23-8-2013 15-11-2013 14-3-2013 14-4-2013 14-6-2013 23-8-2013 17-1-2014* RSI(3,3)
4 Moh.Azza Robbani Wiwin Yustiati/Prabani A P 8-3-2013 6/IV 8-3-2013 6-5-2013 10-6-2013 11-11-2013 6-1-2014* 6-5-2013 10-6-2013 11-11-2013 6-1-2014* 6-6-2014* 8-9-2014* RSUK
5 Nur Hisya Alfiani Darwati/Rusmanto P 8-3-2013 7/IV MEKARSARI 9-12-2013 MENOLAK 9-12-2013 MENOLAK 7-7-2014* Bd.D
6 Muhammad Hafid Ilham Fuji Astuti/Tatang Aryanto L 11-4-2013 7/IV 11-4-2013 19-5-2013 27-6-2013 11-9-2013 16-10-2013 19-5-2013 27-6-2013 11-9-2013 16-10-2013 17-3-2014* 2-3-2015#
7 Nur Sifa Siti Khodijah/Sulaiman P 22-4-2013 8/IV 22-4-2013 22-5-2013 31-7-2013 2-9-2013 4-10-2013 22-5-2013 31-7-2013 2-9-2013 4-10-2013 20-2-2014* Bd.E
8 Kesya Qonifah Lia Andriani/Subur S P 22-4-2013 6/IV 22-4-2013 MENOLAK RSUK(2,0)
Banyu Rajendra Gaby Prajuki/Endra L 2-5-2013 7/IV 2-5-2013 5-6-2013 20-7-2013 29-8-2013 30-9-2013 5-6-2013 20-7-2013 29-8-2013 30-9-2013 PINDAH KAB RSI
M.Zaki Mubarok P Ratna Dewi/Eko P L 16-5-2013 4/IV 16-5-2013 15-7-2013 PINDAH 15-7-2013 JAKARTA RB.Khrna(2,7)s.c
9 Ashwina Arsylia Anami Patmi/Ardiansyah P 18-5-2013 7/IV 18-5-2013 12-6-2013 24-7-2013 26-8-2013 26-9-2013* 12-6-2013 24-7-2013 26-8-2013 26-9-2013* 5-3-2014* 20-2-2016^ RSI(2,8)RUSUN
10 Haryaka Hitaru Nurul Azizah/Bayu N L 23-5-2013 4/IV DR ASTIKA C 13-6-2013 1-8-2013 2-10-2013 19-12-2013* 29-5-2013 1-8-2013 2-10-2013 19-12-2013* 28-2-2014* RSMK(3,2)
11 Fikri Arkan Maulana Agus Priyati/M.Fahrizal L 30-5-2013 4/IV 30-5-2013 6-7-2013 5-8-2013 5-9-2013 5-10-2013 6-7-2013 5-8-2013 5-9-2013 5-10-2013 26-5-2014* 12-1-12015# 7-9-2015# Bd.Las
12 Moh.Ridho R Siswi Siswanti/M.Wahyudin L 11-6-2013 6/IV 11-6-2013 10-7-2013 21-8-2013 21-9-2013 21-10-2013 10-7-2013 21-8-2013 21-9-2013 21-10-2013 11-3-2014* 2-11-2015# RSUK(3,1)
13 Nabil Fayyadh Muhammad Arinta Uzlifatil L/M.Kurniawan L 19-6-2013 6/IV 19-6-2013 20-7-2013* 31-8-2013 5-10-2013 19-11-2013 19-11-2013* 31-8-2013 5-10-2013 19-11-2013 7-7-2014* 2-3-2015# 7-9-2015#
14 Dini Yuniarti Dwi Windi Putri/Slamet S P 21-6-2013 4/IV 21-6-2013 10-7-2013 26-8-2013 30-9-2013 11-11-2013 10-7-2013 26-8-2013 30-9-2013 11-11-2013 10-4-2014* 12-1-2015# Bd.D(2,5)
15 Mustofa Sidik Dewi Astuti/Supradi L 12-8-2013 4/IV 12-8-2013 21-8-2013 22-10-2013 17-12-2013* 17-2-2013* 21-8-2013 22-10-2013 17-12-3013* 17-2-2014* 7-5-2014* 7-9-2015# 4-4-2016^ RSI
16 Ibnu Rifqi Muttaqin Indahyani/Mugiono L 11-8-2013 8/IV 11-8-2013 10-9-2013 10-10-2013 9-6-2014P* 10-9-2013 10-10-2013 9-6-2014* Bd.D(3,25)
Azar Siti Maemudah/Wasikin L 14-8-2013 6/IV 15-8-2013 21-8-2013 TIDAK 21-8-2013 ADA Bd.E(3,5)
17 Hafsa Izzatunnisa Yunita P/Mohamad Tohir P 31-8-2013 7/IV 1-9-2013 5-12-2013* 16-11-2013* 18-1-2014* 13-3-2014* 10-9-2013* 16-11-2013* 18-1-2014* 13-3-2014* 14-6-2014* 13-8-2015#
18 Almira Nur Alifah Nur Aeni/Hery Setiono P 2-9-2013 7/VI PINDAHAN SEKAR INDAH B 13-8-2015# 7-12-2015# RSUK(3,35)
19 Muh.Abdul Faqih Umi Hani/Karno L 25-9-2013 8/IV 25-9-2013 20-11-2013 6-1-2014* 10-2-2014* 9-6-2014P* 20-11-2013 6-1-2014* 10-2-2014* 9-6-2014* 8-12-2014 Bd.M(3)
Farhan Ar Rasyid Karwinda Mei/Andri D L 24-10-2013 SB no 46 25-10-2013 21-1-2014* 25-2-2014* 25-3-2014* 21-1-2014* 25-2-2014* 25-3-2014* 13-8-2014* RSI(2,9)
20 Perlita Rohani/Waryono P 27-10-2013 4/IV 3-8-2015#
21 Chaerul Putra Pratama St.Rahayu/Nur Tofik L 6-11-2013 8/IV 13-12-2013 13-1-2014* 13-2-2014* 14-3-2014* 17-4-2014* 9-11-2013* 13-12-2013* 13-2-2014* 14-3-2014* 12-12-2014
22 Nafisa Arisanti Rini Handayani/Fery I P 19-11-2013 7/IV 25-11-2013 10-2-2014* 10-3-2014P* 12-5-2014P* 9-6-2014P* 10-2-2014* 10-3-2014* 12-5-2014* 9-6-2014* 11-10-2014 8-6-2015# 7-11-2016^ Bd.D(2,3)
23 Galuh Sasikirana S Retno Panggih P/Cuk S P 29-11-2013 6/IV 29-11-2013 15-1-2014* 11-2-2014P* 10-4-2014P* 16-6-2014P* 7-12-2013* 11-2-2014* 10-4-2014* 16-6-2014* 10-9-2014* 6-7-2015# RSIAKI(2,9)
24 Andhika Wahyu Pramoedya Nurnaeni/Sumito L 6-12-2013 6/IV 6-12-2013 30-12-2013 10-2-2014P* 10-3-2014P* 14-4-2014P* 30-12-2013 10-2-2014* 10-3-2014* 14-4-2014* 15-9-2014* 8-6-2015# 4-1-2016^ RSUK(3,3)sc
Nurul Wahidatuzzahro Nurchasanah/Aji Setiawan P 14-12-2013 8/IV 15-12-2013 29-12-2013 22-2-2014P* 7-8-2014P* 6-9-2014P* 29-12-2013 22-2-2014* 7-8-2014* 6-9-2014* 22-9-2014* 8-8-2016^ Bd.D(2,7)

Imunisasi yang diberikan


No Nama Bayi Nama Ortu L/P Tanggal Alamat
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 Alya Tsabita Uswatun Chasanah/Rosidin P 1-1-2014 4/IV 1-1-2014 10-2-2014 8-3-2014P 7-4-2014P 9-6-2014P 10-2-2014 8-3-2014 7-4-2014 9-6-2014 10-11-2014# 6-7-2015# 9-5-2016^ Bd.Mas(2,7)
2 Moh.Naim Al Muizzu Nina Arisinta/A.Najmudin L 11-2-2014 8/IV 11-2-2014 10-4-2014 7-7-2014P 11-8-2014P 11-10-2014# 10-4-2014 7-7-2014 11-8-2014 11-10-2014# 8-12-2014# 8-8-2016^ 7-11-2016^ RSUK(4,2)sc
3 Zahroh Siswanti Dinawati/Adi Siswanto P 15-2-2014 4/IV 15-2-2014 5-5-2014 9-6-2014P 7-7-2014P 8-9-2014P 15-5-2014 9-6-2014 7-7-2014 8-9-2014 8-12-2014# 11-7-2016^ 3-10-2016^ Bd.D(3,5)
4 Windanur Sabrina Munjiati/Feri Cahyo R(2/) P 22-2-2014 8/IV 22-2-2014 12-5-2014 9-6-2014P 7-7-2014P 8-9-2014P 12-5-2014 9-6-2014 7-7-2014 8-9-2014 12-1-2015# PINDAH Bd.D(3,1)
5 Aditya P Tias Dwi Septiani/Edi S L 21-4-2014 6/IV 22-4-2014 9-6-2014 11-8-2014P 8-9-2014P 6-10-2014P 9-6-2014 11-8-2014 8-9-2014 6-10-2014 18-2-2015^ 7-12-2015# 7-11-2016^ Bd.D(3)
6 Gafriel Aloysius Giovani Kristina/Agung L 28-4-2014 6/IV 28-4-2014 11-5-2014 8-6-2014P 13-7-2014P 11-8-2014P 11-5-2014 8-6-2014 13-7-2014 11-8-2014 26-2-2015# PINDAH PURWOKERTO Pdhn Pmlg
Syafierra Meuthia/Anggun P 6-5-2014 7/IV 7-5-2014 TIDAK ADA RSI(2,5)
7 Praditya Tirta P Windriasih/Solikhin L 12-5-2014 4/IV 12-5-2014 18-5-2014 MENOLAK 18-5-2014 MENOLAK Bd.D(2,8)
8 Rohman Fera Istianti/Budi Santoso L 26-5-2014 6/IV 26-5-2014 30-6-2014 11-8-2014P 8-9-2014P 6-10-2014P 30-6-2014 11-8-2014 8-9-2014 6-10-2014 9-2-2015# 7-12-2015# 1-6-2016^ Pusk(2,9)
Neli/Syaros P 25-6-2014 6/IV 25-6-2014 TIDAK ADA RSMK(2,8)
Nabila Khairul Dian Novita/Rudi H P 4-7-2014 7/IV 13-8-2014 4-9-2014P 4-10-2014P 13-8-2014 4-9-2014 4-10-2014 TIDAK ADA
Fadil Ramandani Dewi Anggraeni/Triyono P L 22-7-2014 6/IV 23-7-2014 17-9-2014 17-9-2014 TIDAK ADA RSI(3,1)sc
9 Fatin Sidqiyah Turiyah/Nursidik P 22-7-2014 4/IV 28-7-2014 10-9-2014 22-10-2014 23-11-2014 31-12-2014 10-9-2014 22-10-2014 23-11-2014 31-12-2014 7-12-2015^ 11-7-2016^ RSI(3,3)
Chaerul azam (T) Khotimah/ Supardi L 5-8-2014 8/IV 5-8-2014 15-8-2014 15-10-2014 15-11-2014 15-12-2014 15-8-2014 15-10-2014 15-11-2014 15-12-2014 15-8-2015#
10 Sheilla Maureen Silviana/Yuli S P 9-8-2014 6/IV 9-8-2014 11-10-2014 27-10-2014# 13-12-2014# 2-3-2015# 16-8-2014 27-10-2014# 13-12-2014# 2-3-2015# 18-5-2015 RSMK(3,3)sc
Ayu Andita Maya Nur Aulia P 15-8-2014 7/IV 15-8-2014 17-9-2014 11-12-2014 17-9-2014 11-12-2014 TIDAK ADA RSUK(3,1)
Farkhanah/Fauzi Maulana L 23-8-2014 6/IV 23-8-2014 TIDAK ADA RB.St.Hj(2,9)
12 Rifki Arya Pratama Marlinah/Dinroso L 27-10-2014 4/IV 27-10-2014 10-12-2014 7-1-2015# 4-2-2015# 9-3-2015# 10-12-2014 7-1-2015# 4-2-2015# 9-3-2015# 10-8-2015# 1-6-2016^ 7-11-2016^ Bd.D(3,7)
11 Clarreta Indah Dwi N/Sigit Arieaji P 31-10-2014 6/IV 31-10-2014 17-11-2014# 12-1-2015# 9-2-2015# 4-3-2015# 17-11-2014# 12-1-2015# 9-2-2015# 4-3-2015# 24-12-2015^ 7-11-2016^ RSI(2,8)

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 Adiba Zahra Septi Nurul P 15-1-2015 8/IV 15-1-2015 21-1-2015 6-4-2015 4-5-2015 8-6-2015 21-1-2015 6-4-2015 4-5-2015 8-6-2015 6-1-2016^ 3-10-2016^ RB.St.Hjr
2 Hanifa Rasyida Dewi Katresnaningsih/Suratno P 10-2-2015 6/IV 10-2-2015 2-3-2015 23-6-2015 29-7-2015 5-9-2015 2-3-2015 23-6-2015 29-7-2015 5-9-2015 7-12-2015 PTB(2,5)
Juwita Diana Alista Desi Rosanti/Agus Subehi P 10-2-2015 6/IV 10-2-2015 2-3-2015 11-5-2015 8-6-2015 PINDAH 2-3-2015 11-5-2015 8-6-2015 BREBES PTB
3 Talita Hasna Humairoh Bety Madiyanti/Uki Rianto P 13-2-2015 8/IV 20-2-2015 20-3-2015 22-4-2015 20-5-2015 20-6-2015 20-3-2015 22-4-2015 20-5-2015 20-6-2015 7-12-2015 Bd.M(2,4)
4 Qonita Isman Neka Lestari/Hari Wiharso P 3-3-2015 7/IV 3-3-2015 20-3-2015 4-5-2015 8-6-2015 3-8-2015 20-3-2015 4-5-2015 8-6-2015 3-8-2015 7-12-2015 Bd.D(3)
5 Safira Oktafiani Siti Nurjanah/Riswanto P 12-4-2015 6/IV TIDAK 6-7-2015 3-8-2015 7-9-2015 5-10-2015 6-7-2015 3-8-2015 7-9-2015 5-10-2015 1-2-2016^ 7-11-2016^ RSUK(1,8)
6 Wildan Mona/Tri Aji L 19-4-2015 4/IV 19-4-2015 20-6-2015 22-7-2015 22-9-2015 23-11-2015 22-5-2015 22-7-2015 22-9-2015 23-11-2015 7-3-2016^ RB.Adeli(3,3)
Darkem/Madraslim L 21-4-2015 8/IV 21-4-2015 PINDAH BANJARNEGARA Bd.D(3,2)
7 Nayla Amalia Paricha/Adi Indra P P 6-5-2015 4/IV 6-5-2015 MENOLAK PTB(3,5)
8 M Ardhani Kris Rahayu/Saefudin L 9-5-2015 6/IV 9-5-2015 8-6-2015 6-7-2015 3-8-2015 7-9-2015 8-6-2015 6-7-2015 3-8-2015 7-9-2015 9-2-2016^ PTB(2,8)
Fitria Suci Maharani Yaniati/Agus Cahtono P 19-7-2015 8/IV 19-7-2015 10-8-2015 PINDAH 10-8-2015 PINDAH WIJAYAKUSUMA A RB.Khr(3,2)
Winarni/Ariyanto P 30-7-2015 8/IV 30-7-2015 PINDAH RANDUGUNTING RSI(3,2)
9 M.Ashif barkhoiya Uswatun Chasanah/Rosadi L 23-8-2015 4/IV 24-8-2015 10-10-2015 10-11-2015 10-12-2015 10-2-2016^ 10-10-2015 10-11-2015 10-12-2015 10-2-2016^ PINDAH INDRAMAYU Bd.D(3,3)
10 Irsyad Muzaki Ina Krisnawati/Eko Prayitno L 9-9-2015 4/IV 19-1-2016^ 16-2-2016^ 3-10-2016^ 29-11-2015^ 19-1-2016^ 16-2-2016^ 3-10-2016^ 7-11-2016^ RSUK(1,5)
Kiki (T) Ristiana/ Ari L 10-10-2015 6/IV 28-11-2015 20-1-2016^ 7-3-2016^ 4-4-2016^ 28-11-2015 9-5-2016^ 11-7-2016^ PINDAH LAMPUNG
11 Fahri Argo Zalmi Ratna Yuliani/Sarwo Edi L 23-10-2015 6/IV 24-10-2015 23-11-2015 23-12-2015 28-1-2016^ 7-3-2016^ 23-11-2015 23-12-2015 28-1-2016^ 3-10-2016^ 3-10-2016^ RSUK(3,2)
12 Pangeran Krisna Ning K. Omefrida/Lingga L 28-10-2015 4/IV MENOLAK
13 Cindy Maulidia Surati/Toto Agus P 9-11-2015 4/IV 9-11-2015 10-12-2015 10-1-2016^ 10-2-2016^ 10-3-2016^ 17-11-2015 10-12-2015^ 10-1-2016^ 10-2-2016^ 22-8-2016^ PINDAH SLAWI RSI(2,7)
14 Ramadhani Chosilah/Darsono P 9-11-2015 4/IV 9-11-2015 18-4-2016^ 4-4-2016^ 9-5-2016^ 9-4-2016^ 9-5-2016^ RSUK(3,1)SC
15 Nayla Dwi N Endang Marchatun/Sakti Utomo P 16-11-2015 6/IV 16-11-2015 14-12-2015 18-1-2016^ 18-2-2016^ 18-3-2016^ 24-11-2015 18-1-2016^ 18-2-2016^ 9-5-2016^ 22-8-2016^ RSI(3,1)
16 Nayla Uthia Salsabila Nurwachidah/Rizal Pamungkas P 26-11-2015 6/IV 27-11-2015 28-12-2015 1-2-2016^ 4-3-2016^ 4-4-2016^ 5-12-2015 1-2-2016^ 5-9-2016^ 7-11-2016^ 5-9-2016^ RSI(3,6)
17 Ataleta Kanza R Kholifah/Sudiarto P 6-12-2015 6/IV 7-12-2015 21-12-2015 10-2-2016^ 16-3-2016^ 27-4-2016^ 21-12-2015 10-2-2016^ 16-3-2016^ 11-7-2016^ 5-9-2016^ RB siti hjr(3,8)
Maulana (T) Tika Saputra/ Supriyani L 16-12-2015 4/IV 16-12-2015 4-4-2016^ TIDAK ADA

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
Yayah Siti F/Fahruroji P 3-1-2016 6/IV 3-1-2016 PINDAH RS.Pl Ry(2,9)
1 M.Atha Rasyid Sri Mulyati / Heru L 21-1-2016 8/IV 21-1-2016 9-3-2016 4-4-2016 9-5-2016 9-6-2016 29-1-2016 9-5-2016 9-6-2016 11-7-2016
2 Kayla Raffa Rini Anggraeni/ A.Saefudin P 18-2-2016 6/IV 19-2-2016 7-3-2016 19-4-2016 19-5-2016 20-6-2016 19-4-2016 19-5-2016 20-6-2016 11-7-2016 RSI
3 Agam Husni A Yuli Setyawati/Andi Dwi L 29-2-2016 6/IV 29-2-2016 21-3-2016 9-5-2016 9-6-2016 8-8-2016 9-5-2016 9-6-2016 8-8-2016 5-9-2016 PTB(2,9)
4 Al Hafis Atmajaya Devi Oktaviana/Dwi Yosi L 31-3-2016 4/IV 1-4-2016 10-5-2016 10-6-2016 22-7-2016 22-8-2016 10-5-2016 10-6-2016 22-7-2016 22-8-2016 IBI
5 Laluna Nur aprianaa Nuraeni/Heri S P 11-4-2016 6/IV 11-4-2016 9-5-2016 16-6-2016 16-7-2016 23-8-2016 9-5-2016 16-6-2016 16-7-2016 23-8-2016 RSUK(3,1)
6 Fatkhiya Yumna Turiyah/Nursidik P 30-4-2016 4/IV 4-5-2016 11-5-2016 11-7-2016 8-8-2016 5-9-2016 11-5-2016 11-7-2016 8-8-2016 5-9-2016 Bd.E
7 Uwais Al Ghifani Rosyidah/Henu Reskyana L 12-5-2016 4/IV 12-5-2016 MENOLAK RB.KH(3,1)
8 M.Alfin Andra A Karnita/Tarjono L 18-5-2016 6/IV 18-5-2016 1-7-2016 8-8-2016 5-9-2016 3-10-2016 1-7-2016 8-8-2016 5-9-2016 3-10-2016 RSI(3)
9 M. Azzam Khalif Bani Qonatu/Koko Aryanto L 31-5-2016 4/IV 31-5-2016 20-6-2016 1-8-2016 1-9-2016 3-10-2016 20-6-2016 1-8-2016 1-9-2016 3-10-2016 Bd.D (3,1)
10 Qomara Khaira Anami Patmi/Ardiansyah P 19-6-2016 7/IV 19-6-2016 20-7-2016 23-8-2016 20-9-2016 23-8-2016 20-9-2016
11 Rayhan Ramadhan Erni Wijayanti/ M.Sofyan L 27-6-2016 7/IV 27-6-2016 13-7-2016 27-8-2016 30-9-2016 27-10-2016 13-7-2016 27-8-2016 30-9-2016 27-10-2016
12 Ayu Tri Fadhilah Kris Rahayu/ Syaefudin P 29-9-2016 6/IV 30-9-2016 10-10-2016 10-10-2016 PTB(2,5)
13 Aqilla Nafisha Efendi Sari Santika/ Wahyudi P 29-9-2016 8/IV 29-9-2016 7-11-2016 7-11-2016 Bd.D(3,1)
14 Okalina Neisya Azalia Eti Susati/Faizal P 5-10-2016 8/IV 5-10-2016 20-10-2016 20-10-2016 Bd.D(3,6)

Imunisasi TT
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Nelly Fauziyah K 6/IV V
2 Marlina/Dinroso K 4/IV 10-7-2014
3 Desi Rosanti K 6/IV 12-9-2014
4 Sefti K 8/IV 26-8-2014
5 Darti/Madraslim K 8/IV 6-10-2014
6 Yunita Putri K 8/IV 6-10-2014 11-11-2014
7 Beti Madiyanti K 8/IV 6-10-2014
8 Indah D K 6/IV 10-9-2014
9 Dewi Katresnaningsih K 6/IV 6-10-2014 10-11-14
10 Syifa Afiyati/Nurhadi K 6/IV 28-11-14C
Imunisasi TT
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Siti Nurjanah/Tiswanto K 6/IV 4-2-2015
2 Indah Eka K 8/IV 23-4-15
3 Ratna Yuliani/Sarwo Edi K 6/IV 15-6-2015 3-9-2015
4 Endang M/Sakti Utomo K 6/IV 9-6-2015
5 Uswatun C/Rosadi K 4/IV 6-6-15
6 Intan Sari/Nur Wahid K 6/IV 27-6-2015
7 Ina Krisnawati K6/IV 6-7-2015 10-8-2015
8 Chosilah K4/IV 22-7-2015
9 Surati K 8/IV 13-7-2015
10 Tri Mulyaningsih/Winarno K 7/IV 3-8-2015C
11 Yayah Siti Vani/Fatkhul R K 6/IV 19-8-2015 1-10-2015
12 Rini Anggraeni/A. Saefudin K6/IV 3-12-2015
Imunisasi TT
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Nuraeni/Heri Setiono K6/IV 22-1-2016
2 Bani Qonaatu/Koko A K 4/IV 6-1-2016 6-2-2016
3 Mei dwi/Febby K 6/IV 8-2-2016
4 Patmi/Ardiansyah K7/IV 20-2-2016
5 Karnita/Tarjono K 6/IV 2-3-2016
6 Retno Winarti/Achmad F K4/IV 4-5-2016C
7 Indah Dwi/Sigit Arie K 6/IV 4-8-2016
8 Daroyani/ Suro K 8/IV 6-8-2016
9 Endang Indarni/Hadi K 6/IV 6-9-2016
LAPORAN BULANAN IMUNISASI BAYI
POSYANDU ASTIKA C

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 Regina Tri M Sunori/Desi P 14-2-2011 5/IV
2 Ajeng Afitatul Abdul/rina P 25-2-2011 5/IV
3 Angga Nur Riski Satori/Kustyah L 17-3-2011 5/IV
4 Abilza Kirana Erwin/Dini P 25-4-2011 5/IV
5 Zulfa Nurlaila Dimas/Dian P 12-5-2011 5/IV
6 Alika Meisyani Sadi/Undari P 31-5-2011 5/IV
7 Naela Zulfa M Kambali/ Anisa P 15-7-2011 5/IV
8 Ridho Dwi Satria Hendro/Sri L 19-9-2011 5/IV
9 Irgi Triansyah Trisno/Ria L 18-11-2011 5/IV
10 Ananda Balqis Nurhidayah/Iyan P 11-12-2011 5/IV 10-6-2014*
11 Hastari Wahyu Santika Lia Eka Liviati/Wahyudi P 20-12-2011 5/IV 20-12-2011 10-1-2012 23-3-2012 10-9-2014 6-11-2014 10-1-2012 23-3-2012 10-9-2014 6-11-2014 13-10-2012
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 Oneil Pramudya Soninda/Ade L 11-1-2012 5/IV 11-1-2012 V 20-3-2012 3-6-2012 27-11-2012 20-3-2012 3-6-2012 27-11-2012 -1-2013 -1-2013 11-11-2014* RUSUNAWA
2 Farez Zuhdi Al Asyrof Ely Widiyanti/Tejo S L 14-1-2012 5/IV 14-1-2012 28-2-2012 14-4-2012 10-12-2012 30-1-2013 28-2-2012 14-4-2012 10-12-2012 30-1-2013 13-4-2013
Devi Komalasari Sunarti/Kusnanto P 15-1-2012 5/IV 15-1-2012 22-2-2012 15-3-2012 12-5-2012 9-6-2012 22-2-2012 15-3-2012 12-5-2012 9-6-2012 13-10-2012 PINDAH TEGALSARI
3 Arsya Ahlan Fakhira Erma Fatmawati/Agung L 16-3-2012 5/IV 16-3-2012 16-4-2012 9-6-2012 14-7-2012 11-8-2012 16-4-2012 9-6-2012 14-7-2012 11-8-2012 13-4-2013
4 Mariana Latifah B Irianti/Budi Novianto P 27-3-2012 5/IV 30-3-2012 1-5-2012 29-5-2012 27-6-2012 26-7-2012 1-5-2012 29-5-2012 27-6-2012 26-7-2012 16-1-2013 10-6-2014*
5 Askiah Naura Ratih/Rangga P 26-6-2012 5/IV 26-6-2013 4-7-2012 3-9-2012 6-1-2013 23-1-2013 4-7-2012 3-9-2012 6-1-2013 23-1-2013 17-4-2013
6 Silvina Cika Yulia Z Sri Kanti/Kariman P 14-7-2012 5/IV 14-7-2012 14-8-2012 13-10-2012 7-11-2012 8-12-2012 14-8-2012 13-10-2012 7-11-2012 8-12-2012 13-4-2013 10-6-2014* 7-7-2015#
7 Fafian Jaka Ramadan Dian/Dimas L 29-7-2012 5/IV 29-7-2012 13-10-2012 7-11-2012 8-12-2012 13-10-2012 7-11-2012 8-12-2012 14-9-2013 14-9-2013 10-6-2014* 7-7-2015#
8 Dilan Hadani Robbi Yuni Setiawati/Daryono L 26-8-2012 5/IV 26-8-2012 5-9-2012 30-10-2012 10-12-2012 11-1-2013 5-9-2012 30-10-2012 10-12-2012 11-1-2012 10-6-2013 10-6-2014* 24-8-2015#
9 M.Thiago Silva Yeni Maryana/Agus Z L 5-11-2012 5/IV 5-11-2012 13-12-2012 16-1-2013 25-2-2013 13-4-2013 13-12-2012 16-1-2013 25-2-2013 13-4-2013 14-9-2013 10-6-2014* 7-7-2015#
10 Kenar Artika Putri Nur Yuni Astika/Widi H P 25-11-2012 5/IV 25-11-2012 9-12-2012 9-2-2013 9-3-2013 21-5-2013 9-12-2012 9-2-2013 9-3-2013 21-5-2013 14-9-2013 8-7-2014* 7-7-2015#
11 Arka Pranata Wijaya Dwi Nurbaeti/Tri W L 30-12-2012 5/IV 30-12-2012 16-1-2013 25-2-2013 13-4-2013 9-11-2013 16-1-2013 25-2-2013 13-4-2013 9-11-2013 V RUSUNAWA
12 Faiz Arya Sumitro Tri Hendrayani/M.Sutoyo L 6-12-2012 5/IV 7-12-2012 7-1-2013 9-2-2013 9-3-2013 6-7-2013 7-1-2013 9-2-2013 9-3-2013 6-7-2013 14-9-2013 8-7-2014* 9-6-2015#

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 Maulidia Tri Mulya S Chofifah/Suhadi P 31-1-2013 5/IV 1-2-2013 5-2-2013 3-4-2013 4-5-2013 4-6-2013 5-2-2013 3-4-2013 4-5-2013 4-6-2013 MENOLAK
2 Wahyu Febri Pratama Sisri Upitami/Hendrik L 16-2-2013 5/IV 16-2-2013 19-3-2013 8-6-2013 6-7-2013 8-2-2014* 19-3-2013 8 -6-2013 6-7-2013 8-2-2014* 8-5-2014*
Linda/Tedi Kurniawan P 24-4-2013 5/IV PINDAH
Nurul Azizah/Bayu N L 23-5-2013 5/IV 23-5-2013 PINDAH ASTIKA B
3 Tifa Dwi Utary Tri Utami/Warsono P 19-6-2013 5/IV 19-6-2013 10-7-2013 9-11-2013 14-12-2013 10-7-2013 9-11-2013 14-12-2013 MENOLAK
4 Sri Mulyani/Rudi Joyo P 26-6-2013 5/IV 26-6-2013 MENOLAK
Rini S/Fajar Kherul P 17-9-2013 5/IV 17-9-2013 PINDAH
5 M.Nur Ajiansah Evi Jaetun/M.Agus Purwanto L 8-10-2013 5/IV 9-10-2013 5-11-2013 10-12-2013 11-1-2014* 9-2-2014* 5-11-2013 10-12-2013 11-1-2014* 9-2-2014* 4-8-2014* 9-6-2015# 26-10-2015#
6 Jehan Natasya Putri Sri Rejeki/Suharto P 29-11-2013 5/IV 29-11-2013 10-12-2013 8-2-2014* 8-3-2014* 10-6-2014P* 10-12-2013 8-2-2014* 8-3-2014* 10-6-2014* 7-10-2014* 9-6-2015# 2-2-2016^
Laeli/Rahmadi P 6-11-2013 5/IV 6-11-2013 PINDAH

Imunisasi yang diberikan 8-9-15


No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak 3-11-15
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang
Widiya Astuti Dewi Sri N.S/Kartono P 17-1-2014 5/IV 18-1-2014 20-2-2014 PINDAH 20-2-2014 KAB. Bd.D(3)
1 Salma Nur Faizah Asiah R/ Bambang Sulaksana P 10-2-2014 5/IV 10-2-2014 20-3-2014 20-4-2014P 8-7-2014P 9-9-2014P 20-3-2014 20-4-2014 8-7-2014 9-9-2014 11-11-2014 6-10-2015# 12-7-2016^ Bd.D(3,6)
2 Ayunda Estika Yuriz Nani Wahyuni/Moh.Abu Rizal P 8-4-2014 5/IV 8-4-2014 12-5-2014 10-6-2014P 8-7-2014 7-10-2014 12-5-2014 10-6-2014 8-7-2014 7-10-2014 3-2-2015# 2-2-2016^ 4-10-2016^ RSUK(2,8)sc
Alula Farzana(dr.std) Citra Mulyana/Riski M(5/)T P 11-4-2014 5/IV 11-4-2014 23-4-2014 PINDAH 23-4-2014 TEGALSARI RB.Khr(3,1)ve
3 Nabil Syahla Nurriswar Ririn Setiorini/Wartono L 17-4-2014 5/IV 3-5-2014 28-5-2014 28-6-2014P 6-8-2014P 17-9-2014P 28-5-2014 28-6-2014 6-8-2014 17-9-2014 4-2-2015# 3-5-2016^ 12-7-2016^ RB.Rhm(3,5)sc
4 Riski Nur Iman Sri Kanti/Kariman L 4-6-2014 10/IV 5-6-2014 23-6-2014 23-12-2014P 3-2-2015# 3-3-2015# 23-6-2014 23-12-2014 3-2-2015# 3-3-2015# 9-6-2015# Bd.D(3,1)
5 Afra Naila Arkarna Wastini/Eko Yuni Ardianto P 16-6-2014 5/IV 25-6-2014 20-7-2014 13-9-2014P 11-11-2014P 31-12-2014P 25-6-2014 13-9-2014 11-11-2014 31-12-2014 30-3-2015# 5-1-2016^ RSUK(2,2)sc
6 Evan Aurellio R Heni Sulistiowati/Hendro S L 24-7-2014 10/IV 24-7-2014 10-8-2014 24-9-2014P 25-10-2014P 23-11-2014P 10-8-2014 24-9-2014 25-10-2014 23-11-2014 20-5-2015# 27-1-2016^ 10-8-2016^ Bd.D(2,8)
7 Naura Elok Nannang/Rochmani P 16-9-2014 10/IV 16-9-2014 13-10-2014 11-11-2014P 9-12-2014P 7-1-2015# 13-10-2014 11-11-2014 9-12-2014 7-1-2015# 9-6-2015# 5-4-2016^ 4-10-2016^ RSUK(3,3)
8 Sabrina Amanda Badriyah/Amirudin P 4-11-2014 10/IV 4-11-2014 26-1-2015# 6-1-2015# 3-2-2015# 3-3-2015# 6-1-2015# 3-2-2015# 3-3-2015# 5-5-2015# 4-8-2015# RSUK(2,9)
Lintang Bayu Seno Siti Rahayu/Iwan(DF/9/1) L 15-11-2014 5/IV PINDAHAN MAYANGSARI 8-9-2015#DF PINDAH PEKALONGAN 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 Nagita Dwi Zabibah Dwi Jayanti/Imam Mulyono P 17-2-2015 10/IV 18-2-2015 30-3-2015 9-6-2015 7-7-2015 4-8-2015 30-3-2015 9-6-2015 7-7-2015 4-8-2015 8-12-2015 Bd.D(3)
2 Ahmad Abizar Alfatih Undari/Sadi L 26-3-2015 5/IV 27-3-2015 11-5-2015 9-6-2015 7-7-2015 24-8-2015 11-5-2015 9-6-2015 7-7-2015 24-8-2015 5-4-2016^ RSUK(3,7)
3^ Tahlita Yustia A Tuslia Laela/M.Yusuf(DF/9/2) P 30-4-2015 10/IV 30-4-2015 20-5-2015 7-7-2015 8-9-2015DF 6-10-2015 20-5-2015 7-7-2015 8-9-2015DF 6-10-2015 2-2-2016^ RB.St.Hj(3,2)
4 Aisyah Dwi Maylane Ramini/Sodikin(DF/9/3) P 3-5-2015 10/IV 3-5-2015 10-6-2015 3-7-2015 4-8-2015 8-9-2015DF 10-6-2015 7-7-2015 4-8-2015 8-9-2015DF 2-2-2016^ Bd.D(3,7)
Panji Riski Wijaya Nur Trisna/Ramani(DF/9/4/11/1) L 11-5-2015 10/IV 11-5-2015 30-7-2015 4-8-2015 8-9-2015DF 3-11-2015DF 4-8-2015 8-9-2015DF 3-11-2015DF 8-12-2015 PINDAH RSUK(3,85)
5 Quinzha Fayyola N Vina Septhiana/Riza Tria(DF/9/11) P 25-5-2015 5/IV 25-5-2015 10-7-2015 7-8-2015 28-11-2015 3-6-2015 7-8-2015 28-11-2015 RB.Khr(2,5)
Kevin Junanto P Weni Lestari/Darmanto L 6-6-2015 10/IV PINDAH ASTIKA B Bd.E(2,3)
Kenisha Fathiyya R Rosi Ariyah/Lutfi Arouf P 28-6-2015 5/IV 28-6-2015 29-7-2015 2-9-2015 5-10-2015 PINDAH 29-7-2015 2-9-2015 5-10-2015 MAYANGSARI RB.Rhm(2,8)
Keisha Fathina R Rosi Ariyah/Lutfi Arouf P 28-6-2015 5/IV 28-6-2015 29-7-2015 2-9-2015 5-10-2015 PINDAH 29-7-2015 2-9-2015 5-10-2015 MAYANGSARI RB.Rhm(2,3)
6 Al Fazio Ziggy Afandi Ayu Nabela/Ragil Afandi(DF/11) L 26-8-2015 10/IV 26-8-2015 30-9-2015 PINDAH 10-9-2015 TEGALSARI RB.Khr(3,45)
Robiatul Adawiyah Sandrayani/ Isnaeni P 2-10-2015 5/ IV TunasBahari 10-11-2015 10-12-2015 11-1-2016^ 10-2-2016^ 8-10-2015 10-11-2015 10-12-2015 11-1-2016^ PINDAH RSUK(3,5)sc
7 Arsyifa Naila Zahra Wuningsih/A.Hakim P 16-10-2015 5/IV 19-10-2015 23-11-2015 23-12-2015 23-1-2016^ 20-2-2016^ 23-11-2015 23-12-2015 23-1-2016^ 20-2-2016^ 10-8-2016^ Bd.Dnk(2,8)
8 Nouvel Abid Pratama Silvana/Imam Subechi L 16-11-2015 5/IV 16-11-2015 14-12-2015 2-2-2016^ 3-5-2016^ 12-7-2016^ 14-12-2015 2-2-2016^ 3-5-2016^ 12-7-2016^ 4-10-2016^ RSUK(3,2)
9 Sukma Amrina Rosyada Suyati/Mustofa P 26-11-2015 10/IV 26-11-2015 11-1-2016^ 11-2-2016^ 5-12-2015 11-1-2016^ 11-2-2016^ RSI(2,5)sc
Fanza Destia Rafanza Kristin Azizah P 17-12-2015 10/IV 17-12-2015 POSYANDU MEKARSARI RSI(3,15)

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^ Aiman Ibrahim Atalla Katimi/Mahmud L 1-2-2016 10/IV 2-2-2016 10-2-2016 5-4-2016 3-5-2016 12-7-2016 10-2-2016 3-5-2016 12-7-2016 6-9-2016 1-11-2016 RSI(4050)
2 Arfa Kusuma Rizki Malikhatun/Sulistio L 2-4-2016 10/IV 3-4-2016 2-5-2016 6-6-2016 18-7-2016 26-8-2016 2-5-2016 6-6-2016 18-7-2016 26-8-2016 PTB(3,4)RUSUN
3 Anggun Widya A Desi Arisandi/Sunori P 9-4-2016 10/IV 9-4-2016 9-5-2016 12-7-2016 4-10-2016 9-5-2016 12-7-2016 PTB(4,0)
4 Azzam Akmal Mafeet Rike Sista/Casmudianto L 7-8-2016 10/IV 8-8-2016 22-8-2016 22-8-2016 RSI(3,3)SC
5 Abyal El Shirazi Suherni/Sapei L 10-8-2016 5/IV 10-8-2016 22-8-2016 24-10-2016 22-8-2016 24-10-2016 RSUK(3.3)
6 Riski Budi Winata Kustiah/Tasori L 8-9-2016 10/IV 8-9-2016 12-10-2016 12-10-2016 Rb.Rhm(4,2)
7 Juwika Sakti Pratama Sri Rejeki/Juyanto L 13-9-2016 5/IV TIDAK 20-10-2016 20-10-2016 RSUK(2,8)sc
8 Firza Adhama Sotha Upik Pitriyami/Agus Nurhendi L 17-9-2016 5/IV 27-9-2016 14-11-2016 27-9-2016 14-11-2016 RSUK(1,7)SC
9 Nasya Septiyani Sri Kanti/Kariman P 20-9-2016 10/IV 20-9-2016 26-9-2016 26-9-2016 PTB(3,0)

No Imunisasi TT
Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Mudrikah K 5/IV 10-7-2014
2 Sri Rejeki/Juyanto K 5/IV 13-10-14C
3 Weni/Darmanto K 5/IV 20-12-2014
4 Dwi Jayanti/Imam K 5/IV 7-12-14
No Imunisasi TT
Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Weni/Darmanto K 5/IV 20-1-15
2 Ramini/Sodikin K 5/IV 4-2-2015
3 Tuslia laela/M.Yusuf K 5/IV 4-2-2015
4 Nur Trisnawati/Ramani K 5/IV 26-10-2015
5 Undari/Sadi K 5/IV 10-1-2015
6 Vina Septhiana/Riza K 5/IV 9-3-2015
7 Wuningsih/A.Hakim K 5/IV 23-5-2015
8 Rosi Ariyah/Lutfi K 5/IV 11-5-2015
9 Silvana/Imam S K 5/IV 6-7-2015 6-8-2015
10 Suyati/Mustofa K10/IV 29-6-2015
11 Katimi/Mahmud K 10/IV 14-8-2015 4-11-2015
12 Desi Arisandi/Sunori K10/IV 16-12-2015
Imunisasi TT
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Desi Arisandi/Sunori K10/IV 19-2-2016
2 Rike Sista/Casmudianto K 10/IV 15-2-2016 22-3-2016
3 Kustiah/Tasori K 10/IV 5-4-2016
4 Sri Kanti/Kariman K 10/IV 5-4-2016
5 Upik Pitriyami/Agus N K 5/IV 3-5-2016 17-6-2016
6 Suhernih/Sapei K 10/IV 19-4-2016 20-5-2016
7 Murniasih/Mukharomsyah K10/IV 11-4-2016C 7-9-2016
8 Mujianti/Prayitno K10/IV 2-6-2016 20-7-2016
9 Rudini T/Teguh K10/IV 30-6-2016C
10 Suryani/Dedy K10/IV 1-9-2016 2-10-2016
11 Dian Utami/M nurofi K 5/IV 2-9-2016C
LAPORAN BULANAN IMUNISASI BAYI
POSYANDU KARTINI A

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 Yuliati Umi Hani P 31-12-2010 3/V 13-11-2014#

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.Irfan P Slamet/Diah L 18-2-2011 9/V
2 Farhan Abdullah Solehudin/Sopiah L 18-2-2011 9/V
3 Wahyu Maulana Imron/Wiharyati L 19-3-2011 9/V
4 A.Noval Aprianto Siswanto/Kusrini L 13-4-2011 3/V
5 Nayla Dian Sylvia Nasikhun/Sri P 3-5-2011 10/V
6 Deni Faris Al Rasyid Handoko/Khaerunisa L 25-5-2011 10/V
7 Anna Afatul Nisa Sri Haryunah P 18-6-2011 3/V 19-6-2014*
8 Adnansyah Musripah L 21-6-2011 3/V 19-6-2014*
9 Adnan Syauqi Ibrahim/Musripah L 21-6-2011 3/V
10 Kristian Jadi/Rena P 20-9-2011 9/V
11 M.Lanang Saefullah Wasri/Rahmatullah L 6-10-2011 3/V 19-6-2014*
12 Santi Oktaviani Rastono/Wasriah P 11-10-2011 3/V
13 M.Noval Prastyo Aji/Dian Ningrum L 2-11-2011 3/V
14 Kafka Endang L 13-11-2011 3/V 19-6-2014*
15 Afifah Yunita P 23-11-2011 9/V 10-7-2014*
16 Desmalia Nur Hanifah/Roni P 30-11-2011 3/V 16-5-2014*

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 Kayla Alifiah Eka/Tekad P 29-1-2012 9/V 29-1-2012 8-2-2012 29-3-2012 30-4-2012 30-5-2013 8-2-2012 29-3-2012 30-4-2012 30-5-2013 -11-2012 10-7-2014*
2 Fernando Carlos A Evi Widyawati/Parjono L 18-2-2012 9/V 23-2-2012 30-4-2012 19-5-2012 18-6-2012 19-7-2012 30-4-2012 19-5-2012 18-6-2012 19-7-2012 19-11-2012 19-6-2014*
3 M.Haidan Dahendra Yanti/Danu L 21-2-2012 3/V 21-2-2012 13-4-2012 12-5-2012 12-6-2012 12-7-2012 13-4-2012 12-5-2012 12-6-2012 12-7-2012 9-1-2013
4 Kiara Avika Tifanny Titi Fauziah/M.Azhar P 15-3-2012 3/V 16-3-2012 16-4-2013 18-5-2013 16-6-2013 16-7-2013 16-4-2013 18-5-2013 16-6-2013 16-7-2013 7-1-2013 16-5-2014*
5 Agista Putri Nuryanti Nur Salamah/Wilyanto P 7-4-2012 3/V 8-4-2012 7-5-2012 14-6-2012 19-7-2012 17-8-2012 7-5-2012 14-6-2012 19-7-2012 17-8-2012 25-2-2013 16-5-2014* 13-8-2015#
6 Fahri Arif Setiawan Sri Candrayani/Sugeng S L 24-5-2012 3/V 25-5-2012 6-6-2012 14-9-2012 20-10-2012 23-11-2013 6-6-2012 14-9-2012 20-10-2012 23-11-2013 6-3-2013
7 M.Zakaria Zulfikar Wiwik/Ali Rozikin L 5-6-2012 3/V 5-6-2012 25-6-2012 30-7-2012 27-8-2012 1-10-2012 25-6-2012 30-7-2012 27-8-2012 1-10-2012 28-1-2013
8 Syaiful Hizam Raban/Baeni L 24-7-2012 3/V 24-7-2012 3-9-2012 24-9-2012 29-10-2012 3-12-2012 3-9-2012 24-9-2012 29-10-2012 3-12-2012 19-5-2013 19-6-2014* 11-6-2015#
9 Nurleli Kartika Sari/Carum P 23-7-2012 3/V 23-7-2012 17-9-2013 18-10-2012 31-1-2013 14-3-2013 17-9-2013 18-10-2012 31-1-2013 14-3-2013 16-1-2014
Rafi Rahman Susi/Aenur Rohman L 3-9-2012 3/V 3-9-2012 5-9-2012 5-10-2012 16-11-2012 16-12-2012 5-9-2012 5-10-2012 16-11-2012 16-12-2012 -5-2013 PINDAH PANGGUNG
M.Faisal Hafis Agus Wawan L 30-11-2012 10/V 30-11-2012 21-1-2013 PINDAH 21-1-2013 KALKUL
10 Djayanti Moworuci Utarina/Catur P 2-12-2012 10/V 3-12-2012 12-12-2012 5-3-2013 5-9-2013 4-7-2013 12-12-2012 5-3-2013 5-9-2013 4-7-2013 16-10-2013
11 Kanaya Putri Azahra Cici Rahayu/M.Gozali P 28-12-2012 9/V 2-1-2013 11-2-2013 13-3-2013 15-4-2013 4-5-2013 11-2-2013 13-3-2013 15-4-2013 4-5-2013 2-10-2013
Imunisasi yang diberikan
No Nama Bayi Nama Ortu L/P Tanggal Alamat
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 Mahdarima Aisyah/Yasir Makhmud P 6-1-2013 3/V 6-1-2013 18-2-2013 18-3-2013 29-4-2013 5-6-2013 18-2-2013 18-3-2013 29-4-2013 13-6-2013 21-10-2013 11-6-2015# 9-7-2015#
2 Ainun Rosidatun N Fitriyah/Joko P 1-3-2013 Kurma 9 16-3-2013 9-4-2013 10-5-2013 17-6-2013 17-7-2013 9-4-2013 10-5-2013 17-6-2013 17-7-2013 15-1-2014* 13-8-2015# 17-12-2015# RB.Rhm
3 Natan Cahya Putra St.Romyati/Cahyana L 15-3-2013 3/V 15-3-2013 10-4-2013 15-5-2013 17-6-2013 15-7-2013 10-4-2013 15-5-2013 17-6-2013 15-7-2013 19-5-2014* PINDAH PEKAUMAN Bd.E(3,0)
Rahandika Sri Wijayanti/Restu L 15-4-2013 10/V 15-4-2013 25-4-2013 5-6-2013 11-7-2013 15-8-2013 25-4-2013 5-6-2013 11-7-2013 15-8-2013 15-1-2014* PINDAH SLAWI RSI(3,3)
Bagas Safa Ardhani Noviyanti Si/Mustofa L 23-4-2013 3/V 24-4-2013 12-6-2013 3-7-2013 14-9-2013 PINDAH 12-6-2013 3-7-2013 14-9-2013 PINDAH PEKAUMAN RSIAKI
4 Selvi Nur Meylin Mei Fitriana/Edi P 2-5-2013 3/V 2-5-2013 20-5-2013 15-8-2013 24-9-2013 14-11-2013 20-5-2013 15-8-2013 24-9-2013 14-11-2013 17-3-2014* 13-11-2014* 11-6-2015# RSUK(2,8)s.c
5 Angelika Purnamasari Kasanah/Tito Arsani P 6-5-2013 3/V DR MWR B 22-7-2013 18-7-2013 24-9-2013 14-11-2013 18-7-2013 24-9-2013 14-11-2013 13-3-2014* 7-3-2014* 18-12-2014# 9-7-2015# RSI
6 M.Salman Dyhya Nur Hindun L 13-5-2013 3/V 21-6-2013* 19-7-2013* 23-8-2013* 20-9-2013* 21-6-2013* 19-7-2013* 23-8-2013* 20-9-2013* 13-2-2014* PINDAH PEKAUMAN Bd.Pwkt
7 Azima Khanza Nur D Usnul/Azis P 5-6-2013 1/IV PINDAHAN ASTIKA A 10-4-2014* 9-7-2015# 14-4-2016^ Bd.Mas
8 Sakinah Millati H Yuliana/Teguh H P 14-6-2013 9/V 22-6-2013 5-7-2013 15-8-2013 24-9-2013 14-11-2013 5-7-2013 15-8-2013 24-9-2013 14-11-2013 17-4-2014* 18-12-2014# 18-5-2016^ Bd.L(2,9)RUSUN
9 Nafisatul Hayya Khikmah/Heri Budiyanto P 23-6-2013 3/V 23-6-2013 22-7-2013 23-8-2013 23-9-2013 22-10-2013 22-7-2013 23-8-2013 23-9-2013 22-10-2013 12-5-2014* 15-1-2015# 13-8-2015# RSUK(2,7)
10 Dinar Putri Aulia S Winarti/Muhadi P 29-6-2013 9/V 30-6-2013 31-7-2013 12-10-2013 16-11-2013* 14-12-2013 31-7-2013 12-10-2013 16-11-2013* 14-12-2013 28-5-2014* RB.Rhm(3,0)
11 Temmy Rahardiyanto Sukaryati/Dede S L 18-7-2013 9/V 18-7-2013 2-9-2013 24-9-2013 21-10-2013 18-11-2013 2-9-2013 24-9-2013 21-10-2013 18-11-2013 17-4-2014* 12-2-2015# 13-8-2015# RSUK(2,9)
Akhdan Rina Mey/Mulyono L 3-8-2013 3/V 3-8-2013 21-8-2013 TIDAK ADA 21-8-2013 TDK ADA Bd.E(2,7)
12 Aldi Ristian Slamet/Maya L 2-9-2013 9/V IMUNISASI DIKALIMANTAN 9-7-2015# 17-9-2015#
13 Khayla Hafizhah A Nurjanah/Rizki Eka S P 3-11-2013 3/V 3-11-2013 10-12-2013 16-1-2014* 13-2-2014* 13-3-2014* 10-12-2013 16-1-2014* 13-2-2014* 13-3-2014* 14-8-2014* 23-5-2015# 17-12-2015# Bd.D(2,5)
14 Fasha Akila Tifanny Titi Fauziah/Moh.Azhar A P 22-12-2013 3/V 23-12-2013* 20-1-2014* 13-3-2014P* 17-4-2014P* 16-5-2014P* 20-1-2014* 13-3-2014* 17-4-2014* 16-5-2014* 27-9-2014* 9-7-2015# 11-2-2016^ Bd.Mas

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 Maisie Aurelia Elisya Nuzulul Qur'ani/Thomas P 7-1-2014 11/V 7-1-2014 27-1-2014 19-3-2014 21-4-2014 5-6-2014P 27-1-2014 19-3-2014 21-4-2014 5-6-2014 20-10-2014 12-5-2016^ 11-8-2016^ Bd.Pklgn(3,2)
3 M.Haikal Firdaus Khusnul Chotimah/Azam L 26-1-2014 3/V 1-2-2014 5-3-2014 21-4-2014P 9-6-2014P 10-7-2014P 5-3-2014 21-4-2014 9-6-2014 10-7-2014 30-7-2015# 20-1-2016^ 18-5-2016^ Bd.L(3)RUSUN
4 Azzahra G Suci Cahyani/Aenur P 16-2-2014 3/V 21-2-2014 5-3-2014 24-12-2014 14-1-2016^ 14-4-2016^ 5-3-2014 24-12-2014 14-1-2016^ 14-4-2016^ 21-1-2015# 14-1-2016^ 11-8-2016^ Bd.Las(3)
Fairel Attaris Dwi K Mei Rohmani/Kaprawi L 10-3-2014 3/V 10-3-2014 PINDAH KARTINI B Bd.E(2,9)
Keisha Nur Azizah/Nugroho P 19-3-2014 10/V 20-3-2014 16-4-2014 19-5-2014P 16-4-2014 19-5-2014 PINDAH GG.SAWO 9/II RSIAKI(2,8)
5 Afrizal Rizki Pratama Darsiti/Kholik L 24-3-2014 3/V MENOLAK RSI(2,3)sc
Isti Kurniasih/Faizal P 14-4-2014 3/V 14-4-2014 TIDAK ADA RSI(3,15)
Devi Wulandari/Supriadi L 15-4-2014 3/V 15-4-2014 TIDAK ADA Bd.Mas(2,6)
Irlan Riandra Kasyanti/Danu P L 6-6-2014 3/V 19-8-2014P TIDAK ADA 19-8-2014 TIDAK ADA Pdhn Smrg
6 Hafidz Alfath H.S. Nur Hanifah/Roni H L 2-7-2014 3/V 2-7-2014 4-8-2014 18-9-2014P 16-10-2014P 17-11-2014P 4-8-2014 18-9-2014 16-10-2014 17-11-2014 11-6-2015# 14-1-2016^ 14-7-2016^ Pusk(3,6)
7 Risqi Ramadhani Kustiah/Rudiyanto L 7-7-2014 9/V 7-7-2014 10-8-2014 18-9-2014P 16-10-2014P 10-12-2014P 10-8-2014 18-9-2014 16-10-2014 10-12-2014 15-6-2015# 11-2-2016^ 13-10-2016^ Bd.D(2,8)
8 Tri Dinda Darmilah/Sutarjo P 20-7-2014 3/V 20-7-2014 6-10-2014 18-12-2014# 15-1-2015# 12-3-2015# 6-10-2014 18-12-2014# 15-1-2015# 12-3-2015# 11-6-2015# Bd.L(3)
Nicky Destya/Arief R P 22-7-2014 9/V 23-7-2014 TIDAK ADA RSI(3,2)sc
Nanik/Nasrul L 25-10-2014 10/V 25-10-2014 TIDAK ADA RSI(3,4)
9 Asyifa Nur Alfiah/Januri P 26-10-2014 9/V 27-10-2014 12-11-2014 26-12-2014# 18-2-2015# 12-3-2015# 12-11-2014 26-12-2014# 18-2-2015# 12-3-2015# 13-8-2015# 9-6-2016^ 10-11-2016^ Bd.E(3,6)
10 Inayah Azmi Athifa Taryati/Ali Sodikin P 29-11-2014 3/V 30-11-2014# 5-1-2015# 2-2-2015# 2-3-2015# 20-4-2015# 5-1-2015# 2-2-2015# 2-3-2015# 20-4-2015# 19-10-2015# RSI(2,6)
Yani/Diding L 19-11-2014 3/V 19-11-2014 TIDAK ADA Rb.Rhm(2,9)

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 Nesya Putri Indriyani/Suradin P 23-2-2015 3/V 23-2-2015 16-3-2015 27-4-2015 25-5-2015 29-6-2015 16-3-2015 27-4-2015 25-5-2015 9-7-2015 17-12-2015 8-9-2016^ RSI(2,7)
2 Zalima Ayunindya Peni Asih/Samsudin P 6-3-2015 3/V 10-3-2015 23-3-2015 5-5-2015 4-6-2015 4-7-2015 23-3-2015 5-5-2015 4-6-2015 4-7-2015 28-12-2015 26-9-2016^
Nabil Fayadh Rifai Indah Istiqomah/Rokhim L 22-3-2015 9/V 23-3-2015 30-4-2015 30-5-2015 PINDAH KARTINI B 30-4-2015 30-5-2015 PINDAH KARTINI B RB.Rhm(3,2)
3 Moh Rafaz Endang/Moh.Sandi L 23-4-2015 3/V 23-4-2015 TIDAK 24-6-2015 24-7-2015 25-8-2015 TIDAK 24-6-2015 24-7-2015 25-8-2015 PINDAH BATAM Bd.E(3,5)
4 Jihan Kanaya Dian/Kurniasih P 4-5-2015 10/V 4-5-2015 11-6-2015 1-8-2015 12-9-2015 24-10-2015 11-6-2015 1-8-2015 12-9-2015 24-10-2015 21-3-2016^ 10-11-2016^ PTB(3,4)
5 Rendi Rafii Pratama Nurhayati/Imam Syafii L 11-5-2015 9/V 11-5-2015 18-5-2016 11-7-2015 13-8-2015 19-9-2015 18-5-2015 11-7-2015 13-8-2015 19-9-2015 11-2-2016^ PTB
Fransiskus Jefta (T) Yosianne/ Wendi L 7-7-2015 10/V 8-7-2015 8-8-2015 18-9-2015 25-10-2015 27-11-2015 8-7-2015 8-8-2015 18-9-2015 25-10-2015 14-4-2016^ RB KHR(3,5)
6 Raffasya Alfariski Yuni Firdayanti/Royan L 23-8-2015 3/V 24-8-2015 31-8-2015 23-10-2015 23-11-2015 23-12-2015 31-8-2015 23-10-2015 23-11-2015 23-12-2015 23-5-2016^
Syafia L Nurbaeti/Dakri P 16-9-2015 9/V 17-9-2015 14-10-2015 TIDAK ADA 14-10-2015 TIDAK ADA RSIHA(3050)
7 Salsabila Apifa Yuli Kurniasih/Yanuar P 17-9-2015 9/V 17-9-2015^ 5-11-2015^ 28-11-2015^ 14-1-2016^ 15-2-2016^ 5-11-2015^ 28-11-2015^ 14-1-2016^ 15-2-2016^ 20-6-2016^ Bd.E(3,8)
8 Nayla Susi Cahyani/Doni P 21-9-2015 3/V 21-9-2015 14-10-2015 21-11-2015 14-1-2016^ 11-2-2016^ 14-10-2015 21-11-2015 14-1-2016^ 11-2-2016^ 14-7-2016^ PTB(2,7)
9 Alia Azzahra Gita Nurhayati/Mifa M P 24-9-2015 9/V 24-9-2015 14-10-2015 23-11-2015 10-1-2016^ 13-2-2016^ 14-10-2015 23-11-2015 10-1-2016^ 13-2-2016^ 18-7-2016^
10 Adinda Salwa Oktaviani Rahmawati/Saldi P 1-10-2015 9/V 1-10-2015 20-10-2015 1-12-2015 3-1-2016^ 3-2-2016^ 20-10-2015 1-12-2015 3-1-2016^ 3-2-2016^ 20-7-2016^ RSI(3)sc
Nadine Oktavian Endang S/Kodri Fajar P 4-10-2015 3/V 4-10-2015 20-10-2015 17-12-2015 14-1-2016^ PINDAH 20-10-2015 17-12-2015 14-1-2016^ BATAM Bd.D(3,4)
Naila Putri Rizqi Anisah/Angga Yoga P 7-10-2015 3/V 7-10-2015 12-10-2015 21-12-2015 25-1-2016^ 12-10-2015 21-12-2015 25-1-2016^ PINDAH PANGGUNG Bd.D(3,1)
11 M. Nafi Dwi Aska Siti Maemunah/Slamet L 22-10-2015 9/V 23-10-2015 26-10-2015 22-12-2015 23-1-2016^ 21-3-2016^ 26-10-2015 22-12-2015 23-1-2016^ 14-4-2016^ 11-8-2016^ Bd.E(3,5)
12 Aura Latisa Umu Aminah/Warta P 1-11-2015 9/V 1-11-2015 9-12-2015 5-1-2016^ 11-2-2016^ 14-4-2016^ 9-12-2015 5-1-2016^ 11-2-2016^ 14-4-2016^ 11-8-2016^ PTB(2,7)
13 Salman Arfa Maulana Fahmi Ulil K/Putra Arie W L 2-11-2015 11/V 2-11-2015 9-11-2015 3-1-2016^ 5-2-2016^ 4-3-2016^ 9-11-2015 3-1-2016^ 5-2-2016^ 14-4-2016^ 11-8-2016^ Bd.L(3,3)
Faridah/Subekhi L 27-11-2015 10/V 27-11-2015 PINDAH PANGGUNG RSUK
Harzan Irfan Sutari/ Saeni L 6-12-2015 9/V 9-12-2015 18-1-2016^ 16-4-2016^ 2-8-2016^ 16-4-2016^ 2-8-2016^
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 Rafka Hafid Maulana Ike Nofiani/Abd.Kodir L 19-1-2016 9/V 20-1-2016^ 22-2-2016 19-3-2016 24-5-2016 24-6-2016 20-4-2016 19-3-2016 24-5-2016 24-6-2016 10-11-2016 Rmh(3)Rusunawa
Khumayroh/M.Subekhi L 26-3-2016 3/V 26-3-2016 PINDAH MELATISARI A RSI(3,4)
2 Adelia Faranisa Devilia P 11-5-2016 9/V 11-5-2016 30-5-2016 11-7-2016 11-8-2016 11-9-2016 30-5-2016 11-7-2016 11-8-2016 11-9-2016 RSI(2,6)
3 Anggi Puji Lestari Sri Pujiati/Adi Subekhi P 13-5-2016 3/V 13-5-2016 14-7-2016 PINDAH 14-7-2016 SLEROK PTB (3,1)
4 Aqila Salsabila Ayu W/Moh.Riski P 13-5-2016 10/V 13-5-2016 8-6-2016 PINDAH 8-6-2016 SIDAPURNA RSI(2,3)
Wulan Suci/M. Fatoni L 6-6-2016 3/V 6-6-2016 13-6-2016 PINDAH 13-6-2016 PAGONGAN PTB(3,5)
5 Moh. Sam'un K Julianti/Puji Subekhi L 8-6-2016 3/V 8-6-2016 17-10-2016 11-8-2016 8-9-2016 13-10-2016 11-8-2016 8-9-2016 13-10-2016 10-11-2016 RSUD(3,3)
6 Ayra Shirly Alnaira Nur Khodijah/ Ade P 24-6-2016 11/V 24-6-2016 25-7-2016 8-9-2016 13-10-2016 10-11-2016 25-7-2016 8-9-2016 13-10-2016 10-11-2016 RSI(2,5)
7 Ananda Perwira Kuswoyo Riski Khairunnisa/Edi K L 27-7-2016 3/V 1-8-2016 15-8-2016 28-9-2016 28-10-2016 15-8-2016 28-9-2016 28-10-2016 DKT(3)SC
8 Evi Sugiarti/Risky Wandis L 18-8-2016 9/V 18-8-2016 PINDAH PETARUKAN RSI(3,5)
9 Muhammad Raffi Tuningsih/Tasrin L 24-9-2016 9/V 25-9-2016 10-10-2016 10-10-2016 PTB(3,8)
10 Cantika Nuha Artanti Wijayanti/ Imam Safii P 16-9-2016 3/V 17-9-2016 19-10-2016 19-10-2016 RSIAKI(2,7)
11 Sri Kustiningsih/ Tohari P 14-10-2016 3/V 14-10-2016 RSI(3)

Imunisasi TT
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Pariyah/Usman K 3/V 13-8-2014C
2 Taryati/Ali Sodikin K3/V 22-9-2014
3 Indah I/Nurokhim K 9/V 24-10-2014
4 Indriyani/Suratin K 3/V 29-10-2014
Imunisasi TT
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Nurhayati/Imam K 9/V V 9-2-2015
2 Suci Cayani/Danny M K 3/V 4-3-2015C
3 Kustiah/Rudiyanto K 9/V 28-3-2015C
4 Gita Nur H/Mifa K 9/V 27-4-2015
5 Rahmawati/Saldi K 9/V 28-4-2015
6 Yuni Firdayanti K 3/V 11-4-2015
7 Endang S/Kodri Fajar K 3/V 19-6-2015
8 Anisah/Angga Yoga P K3/V -4-2015
9 Faridah/Subekhi K3/V 1-7-2015
10 Tarsijah/Mismo K3/V 29-7-2015C
11 Siti muniroh/M. Rojikun K10/V 27-7-2015C
12 Yuli Kurniasih/Yanuar K9/V 4-8-2015
13 Khumayroh/Mustofa A K3/V 18-12-2015
Imunisasi TT
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Sri Pujiati/Adi S K 3/V 12-1-2016 19-2-2016
2 Wulan Suci/M. Fatoni K3/V 3-2-2016 30-3-2016
3 Julianti/Puji Subekhi K3/V 11-2-2016
4 Rizky Khairun/Edy K K3/V 10-3-2016 14-4-2016
5 Nurchodijah/Ade P K3/V 18-1-2016 17-3-2016
6 Ayu/ Moh.Riski K 10/V 23-2-2016 21-3-2016
7 Puji Astuti/ Taufik K 3/V 28-9-2016
8 Nurjanah/ Rizky Eka K 3/V 13-10-2016
LAPORAN BULANAN IMUNISASI BAYI
POSYANDU KARTINI B

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 Febrylianty Shafira Maryatun/Gatot Prasetyono P 21-2-2009 2/V 21-2-2009 23-3-2009 23-4-2009 2-6-2009 14-7-2009 2-3-2009 23-4-2009 2-6-2009 14-7-2009 7-12-2009

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 Hanifatun A Rifatun P 21-3-2010 2/V
2 Evan Fatihul Rumiyati L 4-4-2010 1/V
3 Nanda Rizqiana Putri Fury Setiane/Edi Junaedi P 14-4-2010 4/V 15-4-2010 5-5-2010 15-6-2010 21-8-2010 16-10-2010 5-5-2010 15-6-2010 21-8-2010 16-10-2010 15-1-2011
4 Sahita Passa Taruni P 29-5-2010 1/V
5 Lintang Tenny P 5-6-2010 8/V
6 Damar Prabowo Istiqomah L 30-6-2010 2/V
7 M.Alva Yulianto Nur Khasanah L 14-7-2010 2/V
8 Lintang Nur Afifa Tenny Maulia/Dinar M P 5-8-2010 1/IV 5-6-2010 16-6-2010 6-8-2010 9-10-2010 23-12-2010 10-6-2010 6-8-2010 9-10-2010 23-12-2010 13-4-2011
9 Sabrina Az Z Nazalia P 17-8-2010 1/V
10 Rafka Ardiansyah Dewi Lisnawati L 22-8-2010 8/V
11 Dede Yusuf R Yeni L 7-9-2010 2/V
12 Nabila Ananda Nur Sekha P 21-9-2010 1/V
13 Putri Mawar J Rosawati P 18-10-2010 5/V
14 Intan Siti Fatimah P 5-11-2010 8/V
15 Dimas Ari M Tunisah L 5-11-2010 5/V
16 Risma Novi Maftukhan Ristiawati/Muh.Maftufudin P 14-11-2010 2/V 15-11-2010 20-12-2010 21-1-2011 25-2-2011 3-4-2011 20-12-2010 21-1-2011 25-2-2011 3-4-2011 7-9-2011
17 Nessa Natania Stefani P 18-11-2010 2/V
18 Alsabila Fuan Azzahra Hermi Kristianti/M.Sofuan P 3-12-2010 4/V 3-12-2010 29-12-2010 17-3-2011 14-4-2011 15-5-2011 29-12-2010 17-3-2011 14-4-2011 8-12-2011 8-12-2011
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
Irsyad Putra P Titi L 6-1-2011 5/V
1 Aisya Nabilah# Fatima P 6-1-2011 8/V
2 Zaskia Fariski Siti Fatonah P 6-1-2011 8/V
3 Zaliya Maharani# Casini P 18-1-2011 7/V
Fidia Larasati Rini A P 10-2-2011 2/V
4 Lutfi Febrian# Eli L 26-2-2011 8/V
5 Ahmad Maulana# Tarminah L 1-3-2011 8/V
M Iqbal Taufana Taufana/Sulistini L 18-3-2011 8/V
6 Naira Inayah# Sri Wahyuningsih P 13-4-2011 1/V
Cheelsie Elviram Putri/Devi P 5-5-2011 2/V
7 Anugrah Nurwani Jepri/Yuli L 24-5-2011 2/V RUSUNAWA
8 Almira# Devi N P 29-6-2011 8/V
9 Rolan Denis# Deni L 31-6-2011 8/V
10 Satria# Novi L 1-7-2011 8/V
11 Ahmad Nurdianto# Nurjanah L 12-7-2011 8/V
12 Karina Avriani# Kowiyah/Edi P 7-8-2011 8/V 10-7-2014*
13 Gilang Ramadan# Shelia L 14-8-2011 7/V
Nuraeni S# Dewi P 9-10-2011 8/V
14 Vanka Achsanu Arsy# Puji Astuti/Rastono L 15-10-2011 5/V 19-6-2014*
15 Moh.Fadilah# Kurti L 21-10-2011 8/V
16 Fariza Fatah Risqy Tasripah/Roni L 3-11-2011 1/V 18-9-2014*
17 Janur P Shanaya# Suratmi P 11-11-2011 7/V
18 Rizkydila Raja Azka# Wiwit Sakuntala/Retmond L 13-11-2011 4/V 13-9-2011 28-9-2011 1-12-2011 4-2-2012 4-4-2012 28-9-2011 1-12-2011 4-2-2012 4-4-2012 27-6-2012
Nanda Fadilah Widodo Sri Mulyati/Albert L 16-11-2011 9/V
19 Tiur Aisyah# Reany T P 20-11-2011 8/V
20 Sena Aji Maria/Melinda L 24-11-2011 5/V
21 Nayra Dwi Permata Diono/Rima P 4-12-2011 5/V RUSUNAWA
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 Irsyad Putra Pratama# Titi Sugiarti/Hery Sugiarto L 6-1-2012 4/V 6-1-2012 19-1-2012 15-3-2012 19-4-2012 26-5-2012 19-1-2012 15-3-2012 19-4-2012 26-5-2012 18-10-2012 18-9-2014*
2 Intan Nur Khalifah# Putri Mariana/Galank V.R P 10-1-2012 7/V 10-1-2012 25-1-2012 10-3-2012 17-4-2012 19-5-2012 25-1-2012 10-3-2012 17-4-2012 19-5-2012 18-10-2012 10-7-2014* 18-9-2014*
3 Moh. Aldan Kasynti/Danu L 21-2-2012 11/V
4 Satya Agam Aruna# Nur Sekha/Sukarno Herdi L 15-3-2012 1/V 15-3-2012 15-4-2012 26-5-2012 2-7-2012 16-8-2012 15-4-2012 26-5-2012 2-7-2012 16-8-2012 8-3-2013 14-8-2014*
5 Naufal Azkal Azkia Ratna Dewi/Eko Pujiono L 25-3-2012 8/V 26-3-2012 15-4-2012 28-5-2012 24-7-2012 18-9-2012 15-4-2012 28-5-2012 24-7-2012 18-9-2012 21-1-2013
6 Muhammad Farkhan# Sri Hartati/Safrudin L 27-3-2012 2/V 27-3-2012 10-4-2012 28-5-2012 29-6-2012 28-7-2012 10-4-2012 28-5-2012 29-6-2012 28-7-2012 5-1-2013 13-5-2014* 12-10-2015#
7 Krisna Abyan Setiawan# Yusti Maretina/Iwan Setiawan L 29-3-2012 1/V 4-4-2012 2-5-2012 2-6-2012 4-7-2012 4-9-2012 2-5-2012 2-6-2012 4-7-2012 4-9-2012 1-12-2012
Rifki Fadhil F# Indah/Atik Fahmi L 14-4-2012 1/V 14-4-2012 25-4-2012 20-6-2012 16-8-2012 15-9-2012 25-4-2012 20-6-2012 16-8-2012 15-9-2012 PINDAH SLEROK
8 M.Harfi Muhtadin# Lillah Awaliyah/Wargino L 19-4-2012 7/V 21-4-2012 5-5-2012 5-6-2012 19-7-2012 13-9-2012 5-5-2012 5-6-2012 19-7-2012 13-9-2012 4-2-2013 14-8-2014* 18-9-2014*
9 Chelsie Elvira# Devy P 5-5-2012 2/V
Keanu Pinarello Kristanti L 19-5-2012 2/V 19-5-2012 V 19-7-2012 21-8-2012 21-9-2012 V 19-7-2012 21-8-2012 21-9-2012 6-3-2013 PINDAH
10 Yasmin Yumna N# Suciati/Bambang S P 22-5-2012 2/V 22-5-2012 5-6-2012 27-7-2012 8-9-2012 6-10-2012 5-6-2012 27-7-2012 8-9-2012 6-10-2012 5-4-2013 10-7-2014* 12-8-2014*
11 Yuniar Reva Amelia# Yulia Nur Atika/Imam P P 16-6-2012 2/V 16-6-2012 10-7-2012 17-8-2012 16-9-2012 25-11-2012 10-7-2012 17-8-2012 16-9-2012 25-11-2012 21-4-2013 10-7-2014* 14-8-2014*
12 Afrizal Dwi Wibisana# Ely Kadaryanti/Riski L 21-6-2012 4/V 21-6-2012 23-7-2012 6-10-2012 6-11-2012 8-12-2012 23-7-2012 6-10-2012 6-11-2012 8-12-2012 14-8-2014* 18-9-2014*
13 Raphael# Lea/Berkah L 24-6-2012 7/V 25-6-2012 4-7-2012 23-8-2012 24-9-2012 24-10-2012 4-7-2012 23-8-2012 24-9-2012 24-10-2013 9-4-2013
14 Aira Rasya Nastia Huda Tutik/Nasikin P 26-6-2012 2/V 26-6-2012 11-7-2012 26-8-2012 26-9-2012 7-11-2012 11-7-2012 26-8-2012 26-9-2012 7-11-2012 20-5-2013 19-6-2014* 14-8-2014*
15 Tedi Bayu Sutisna# Umi Fitria/Hasim S L 2-7-2012 4/V 2-7-2012 31-7-2012 17-9-2012 18-10-2012 17-11-2012 31-7-2012 17-9-2012 18-10-2012 19-11-2012 21-4-2013 19-6-2014* 10-7-2014*
16 Junio Pilar Raya# Sutati/Tjahjo Tri A L 31-7-2012 1/V 1-7-2012 29-8-2012 3-10-2012 7-11-2012 12-12-2012 1-7-2013 3-10-2012 7-11-2012 12-12-2012 10-4-2013 19-6-2014* 14-8-2014*
17 M.Riziq Romadhoni# Arifatun C/Haryono L 2-8-2012 2/V 2-8-2012 3-9-2012 5-11-2012 10-12-2012 17-1-2013 3-9-2012 5-11-2012 10-12-2012 17-1-2013 13-5-2013 18-9-2014* 16-10-2014*
Arya Ramadhan Listianti/Purwoko L 4-8-2012 1/V 5-8-2012 12-9-2012 10-10-2012 8-11-2012 6-12-2012 12-9-2012 10-10-2012 8-11-2012 6-12-2012 5-8-2013 PINDAH
18 Narisha Aurelli Septiana# Dea Yuliandari P 6-9-2012 4/V TIDAK 8-11-2012 8-12-2012 8-1-2013 17-2-2013 8-11-2012 8-12-2012 8-1-2013 17-2-2013 23-8-2013 6-3-2014 9-7-2015#
Zahra Rahma A Nani Handayani/Kusno P 10-9-2012 1/V 25-9-2012 13-11-2012 13-12-2012 16-5-2013 25-9-2012 13-11-2012 13-12-2012 16-5-2013 13-6-2013 PINDAH
19 M.Wahyu Wicaksono# Priyatin/Masmin L 21-9-2012 2/V 21-9-2012 5-10-2012 21-11-2012 21-12-2012 21-1-2013 5-10-2012 21-11-2012 21-12-2012 21-1-2013 21-6-2013 23-5-2015# 9-7-2015#
20 Indah Azzahra Novi Kurniawati/Diyoko P 22-9-2012 7/V 30-9-2012 10-10-2012 22-11-2012 22-12-2012 22-1-2013 10-10-2012 22-11-2012 22-12-2012 22-1-2013 15-7-2013 17-9-2015#
21 Muh.Affan Almuli# Sri Mulyati/Chalimi L 1-10-2012 2/V 1-10-2012 15-10-2012 13-12-2012 17-1-2013 14-2-2013 15-10-2012 13-12-2012 17-1-2013 14-2-2013 1-7-2013 19-6-2014* 16-10-2014*
22 Kiraya Syafana# Anggit Septilina/Heri S P 3-10-2012 4/V 3-10-2012 22-10-2012 13-12-2012 28-1-2013 4-3-2013 22-10-2012 13-12-2012 28-1-2013 4-3-2013 18-7-2013 13-5-2014* 16-10-2014*
23 Fareza Fatah# Tasripah L 3-10-2012 1/V
24 Aditya Oktavian P# Murdiyanti/Tri Budi P L 5-10-2012 9/V 6-10-2012 15-10-2012 17-12-2012 19-1-2013 19-2-2013 15-10-2012 17-12-2012 19-1-2013 19-2-2013 18-7-2013 19-6-2014* 16-10-2014*
25 Naila Az Zahra Dian/Bagus P 13-10-2012 4/V 18-10-2012 5-11-2012 15-12-2012 15-1-2013 15-2-2013 5-11-2012 15-12-2012 15-1-2013 15-2-2013 5-8-2013 15-7-2014 9-7-2015#
26 Shesya Adelaide Ririn Isnaeni/Sapto B P 17-10-2012 2/V 17-10-2012 24-10-2012 17-12-2012 17-1-2013 14-2-2013 24-10-2012 17-12-2012 17-1-2013 14-2-2013 18-7-2013 5-5-2014* 16-10-2014* RUSUNAWA
27 Naufal Aditya Putra# Nur Afiana/Wahyu S L 17-11-2012 8/V 17-11-2012 29-11-2012 17-1-2013 14-2-2013 25-3-2013 29-11-2012 17-1-2013 14-2-2013 25-3-2013 19-9-2013 14-8-2014* 15-1-2015#
28 Raffa Alif Syaputra# Kusniyati/Arif Nuryanto L 12-12-2012 7/V 12-12-2012 7-1-2013 14-2-2013 14-3-2013 14-4-2013 7-1-2013 14-2-2013 14-3-2013 14-4-2013 16-9-2013 19-6-2014* 25-8-2015#
29 Nuraeni Putri# Mujiana/Ade Setiawan P 12-12-2012 7/V 13-12-2012 13-1-2013 13-2-2013 14-3-2013 14-4-2013 13-1-2013 13-2-2013 14-3-2013 14-4-2013 15-11-2014*
30 Moh Risky Galang S# Rosyanti/Erwin L 18-12-2012 5/V 19-12-2012 21-1-2013 17-2-2013 19-4-2013 16-5-2013 21-1-2013 17-2-2013 19-4-2013 16-5-2013 14-11-2013 14-8-2014* 15-1-2015#
31 Destiana Shafarini# Tati Pujiati/Soebadi P 24-12-2012 4/V 17-1-2013 4-2-2013 18-4-2013 13-6-2013 18-7-2013 17-1-2013 14-3-2013 18-4-2013 13-6-2013 14-11-2013 11-6-2015#
32 Shidqi Tsafig Reyna# Imania Solawati/Relly L 27-12-2012 2/V 27-12-2012 4-2-2013 8-3-2013 8-4-2013 8-5-2013 4-2-2013 8-3-2013 8-4-2013 8-5-2013 27-11-2013 18-9-2014* 23-5-2015#
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
Muh.Ainul Haqqi Nurkhasanah/Rifai L 15-2-2013 5/V 21-2-2013 26-3-2013 26-4-2013 26-5-2013 26-6-2013 26-3-2013 26-4-2013 26-5-2013 26-6-2013 21-11-2013 PINDAH Bd.Mas(2,9)
Elsa Salsabila# Farida/Subekhi P 16-2-2013 3/V 16-2-2013 16-3-2013 16-4-2013 16-5-2013 16-6-2013 16-3-2013 16-4-2013 16-5-2013 16-6-2013 5-2-2014* PINDAH RSUK(3,2)s.c
1 Almas Zafran Ramadya Ratih Ratnasari/Madya B L 4-3-2013 5/V 5-3-2013 13-3-2013 10-5-2013 22-6-2013 30-8-2013 13-3-2013 10-5-2013 22-6-2013 30-8-2013 19-2-2014* RSI(4,1)
2 Fikrotul Aulia Afifi# Lisnawati/Asip Awaludin P 13-3-2013 7/V 13-3-2013 20-3-2013 13-5-2013 13-6-2013 13-7-2013 20-3-2013 13-5-2013 13-6-2013 13-7-2013 18-1-2014* 9-7-2015# 17-9-2015# Bd.E(3,2)
3 Alfa Rezky Janatin N# Ani Maulida/Eko L 13-3-2013 7/V 14-3-2013 20-5-2013 13-6-2013 24-9-2013 28-10-2013 20-5-2013 13-6-2013 24-9-2013 28-10-2013 16-1-2014* 25-8-2015# 14-1-2016^ Bd.E(2,4)
Ade Nisa Fitriani/Yasir P 16-3-2013 4/V 16-3-2013 TIDAK ADA RS
Ghina Aulia Solekha Nurchasanah/Solikhin P 23-3-2013 5/V 24-3-2013 28-4-2013 27-5-2013 23-6-2013 31-7-2013 28-4-2013 27-5-2014 23-6-2014 31-7-2013* 26-12-2013* PINDAH CIREBON Bd.Mas(2,9)
4 Zazkia Putri Apriliani# Ika Nurhayati/Budi Riyadi P 7-4-2013 2/V 7-4-2013 12-5-2013 13-6-2013 18-7-2013 15-8-2013 12-5-2013 13-6-2013 18-7-2013 15-8-2013 14-1-2014* 16-10-2014* 23-5-2015# RSUK(2,6)
5 Avril Amanda Ayrul A Dian Ayu/Nurul P 11-4-2013 1/V 11-4-2013 20-5-2013 17-6-2013 15-7-2013 15-8-2013 20-5-2013 17-6-2013 15-7-2013 15-8-2013 14-1-2014* RSUK(3,3)
Alnaira Naswa# Soraya Tri P 14-4-2013 8/V PINDAH
6 Naura Putri Rahma D# Eka Lestari/Tarman P 26-4-2013 5/V 26-4-2013 27-5-2013 26-6-2013 26-7-2013 26-8-2013 27-5-2013 26-6-2013 26-7-2013 26-8-2013 27-1-2014* RB.Rhm(2,6)
7 Sofyan Ali# Nur Soimah/Bambang Y L 27-4-2013 2/V 28-4-2013 12-5-2013 1-7-2013 15-8-2013 24-9-2013 12-5-2013 1-7-2013 15-8-2013 24-9-2013 13-2-2013* 16-10-2014* 11-6-2015 RSI(3,0)
8 Yosias Kristian Setiadi# Tri Mulya/Dedi W L 10-5-2013 7/V 14-5-2013 5-6-2013 15-7-2013 18-9-2013 20-10-2013 5-6-2013 15-7-2013 18-9-2013 20-10-2013 3-3-2014* 15-1-2015# 23-5-2015# RSI(2,7)
Cindai Sukma Jelita Ercha Gita/Misbahul P 28-5-2013 2/V 29-5-2013 5-6-2013 8-7-2013 21-8-2013 23-9-2013 5-6-2013 8-7-2013 21-8-2013 23-9-2013 PINDAH SEMARANG RSI(3,1)s.c
9 Yuniar Levian Rahman# Laeli Hidayah/Savian R L 1-6-2013 1/V 1-6-2013 15-7-2013 15-8-2013 24-9-2013 4-11-2013 15-7-2013 15-8-2013 24-9-2013 4-11-2013 13-2-2014* RSUK(3,0) sc
Bagas Juni A St.Rochayatun/Rajani L 4-6-2013 7/V 4-6-2013 5-7-2013 PINDAH 5-10-2013 PINDAH 5-7-2013 PINDAH 5-10-2013 SERUNI Bd.L(3,5)
10 Hylmi Nandana S# Yusti Maretina/Iwan S L 7-6-2013 1/V 10-6-2013 3-7-2013 4-9-2013 3-10-2013 7-11-2013 3-7-2013 4-9-2013 3-10-2013 7-11-2013 11-3-2014* RS.PlRy(3,3) s.c
11 Hafizh Rizqi Mutha K# Fifit Nofiati/A.Khafid L 11-6-2013 2/V 12-6-2013 19-6-2013 11-8-2013 11-9-2013 12-10-2013 19-6-2013 11-8-2013 11-9-2013 12-10-2013 14-5-2014* 11-12-2014* 9-7-2015# Bd.E(3,5)
12 Dafa Ibnu Santoso# Desi Purwasih/santoso L 23-6-2013 9/V 24-6-2013 22-7-2013 29-8-2013 3-10-2013 5-11-2013 22-7-2013 29-8-2013 3-10-2013 5-11-2013 12-3-2014* RSMK(3,5)sc
13 Izzatunisa Ramadhani# Fera Yuliat D.W./Tomi S P 11-7-2013 4/V 12-7-2013 18-9-2013 14-11-201319-12-2013 14-6-2014* 20-7-2013 18-9-2013 14-11-2013 19-12-2013 19-6-2014* 9-7-2015# 25-8-2015# RSI(3)
Imran Talib Rosidah/Syarif L 19-7-2013 1/V 20-7-2013 19-8-2013 PINDAH 29-7-2013 19-8-2013 PINDAH RSIAKI(3,1)
Reynata Suci Ramadani Seli Agustina/Agus P 26-7-2013 2/V 31-7-2013 5-9-2013 6-11-2013 19-12-2013* 14-1-2014* 5-9-2013 6-11-2013 19-12-2013* 14-1-2014* 7-4-2014* PINDAH SUMPANG Bd.L(2,7)
Haikal Fatin Ramadhan Pudji Astuti/Edi G L 29-7-2013 2/V 29-7-2013 9-9-2013 16-10-2013 PINDAH 9-9-2013 16-10-2013 PINDAH RSUK(3,5)s.c
Gendis Nareswari Ajeng Qurani/Zulfan(T) P 11-8-2013 4/V 11-8-2013 PINDAH 12-12-2013* PINDAH 12-12-2013* BULAKAMBA RB.Khr
Zakia Sabrina Azakiya Putri/Ertono P 24-8-2013 2/V 29-8-2013 9-12-2013 PEKAUMAN 29-5-2013 9-12-2013 PEKAUMAN Bd.Mas(2,8)
Adelia Putri Eva Haryati/Riyanto P 29-9-2013 2/V 29-9-2013 4-11-2013 3-12-2013 PINDAH 4-11-2013 3-12-2013 PINDAH
14 Hania Farzana Syakira# Evi Ayu Optaviani/Firdaus P 6-10-2013 4/V 7-10-2013 21-10-2013 19-12-2013 20-1-2014* 17-2-2014* 21-10-2013 19-12-2013 20-1-2014* 17-2-2014* 25-8-2014* 16-4-2015# 14-1-2016^ Bd.Mas(3)
15 Sidiq Wibowo# Ana Yuliastuti/Trisno R L 23-10-2013 7/V 24-10-2013 20-11-2013 23-12-2013 20-1-2014* 17-2-2014* 20-11-2013 23-12-2013 20-1-2014* 17-2-2014* 10-7-2014* 11-6-2015# 14-4-2016^ Bd.E(2,5)
16 Elmira Salsa Arrifa# Nur Eliya/Subandi P 24-11-2013 8/V 24-11-2013 23-12-2013 27-1-2014* 24-2-2014* 24-3-2014* 23-12-2013 13-2-2014* 13-3-2014* 17-4-2014* 18-9-2014* 17-9-2015# 11-8-2016^ RSUK(3,4)sc
17 Citra Mutiara Sari Hesty Kristiningrum/Joni P 1-12-2013 2/V 1-12-2013 11-12-2013 13-2-2014P* 13-3-2014P* 17-4-2014P* 11-12-2013 13-2-2014* 13-3-2014* 17-4-2014* 18-9-2014* 9-7-2015# 11-8-2016^ RSUK(3,5)
Santi/Slamet L 6-12-2013 8/V 6-12-2013 PINDAH PESKID RSUK(3,1)
18 Salman Abdul Fatah# Ernawati/Sugiyanto L 19-12-2013 8/V 19-12-2013 28-12-2013* 23-2-2014* 24-3-2014* 4-5-2014* 28-12-2013* 23-2-2014* 24-3-2014* 4-5-2014* 13-11-2014* 25-8-2015# 14-4-2016^ RSUK(3,4)
19 Alesha Zafarani# Dwi Ayuningtias/Eyus T P 23-12-2013 8/V 24-12-2013 15-1-2014* 6-3-2014P* 6-5-2014P* 17-7-2014* 15-1-2014* 6-3-2014* 6-5-2014* 17-7-2014 27-9-2014* RSI
20 Dany Fayyadhi Zhafar# Gemilang/Martoyo L 24-12-2013 8/V 24-12-2013 12-3-2014* 24-3-2014P* 24-4-2014P* 4-6-2014P* 12-3-2014* 24-3-2014* 24-4-2014* 4-6-2014* 19-11-2014* 11-6-2015# 14-4-2016^
21 Moh.Syahrul Yunus# Supriyatin/Yunus L 27-12-2013 8/V 27-12-2013* 20-1-2014* 27-2-2014P* 28-3-2014P* 28-4-2014P* 20-1-2014* 27-2-2014* 28-3-2014* 28-4-2014* 29-9-2014* 25-8-2015# 11-2-2016^ Bd.E
Kanaya# Cici/Ahmad Ghozali P 28-12-2013 8/V PINDAH

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 Sabrina Aulia Nadia Rustini/Eri Indrawan P 8-1-2014 1/V 8-1-2014 20-1-2014 11-3-2014 14-4-2014 13-5-2014 20-1-2014 11-3-2014 14-4-2014 13-5-2014 13-10-2014 25-8-2015# 14-1-2016^
Nuraeni/Hadi Wibowo(T) P 15-1-2014 8/V 15-1-2014 PINDAH RSI(2,76)ve
Martati Lumei/Dolly(T) P 15-1-2014 Blim48 15-1-2014 PEKAUMAN RSMK(3)sc
2 Akifa Naila Rabbani# Ani Yuliati/Tris Mulyono P 16-1-2014 2/V TIDAK 17-3-2014 17-4-2014P 10-7-2014P 27-8-2014P 17-3-2014 17-4-2014 10-7-2014 27-8-2014 13-11-2014 25-8-2015# 10-3-2016^ RB.Rhm(1,6)
3 Moh.Akhsan Pratama# Sunidem/Satori L 18-1-2014 1/V 19-1-2014 17-2-2014 17-4-2014P 19-5-2014P 19-6-2014P 17-2-2014 17-4-2014 19-5-2014 19-6-2014 16-10-2014 9-7-2015# 11-2-2016^ RSUK(2,4)
4 Moh.Ikhsan Pradana# Sunidem/Satori L 18-1-2014 1/V 19-1-2014 17-2-2014 17-4-2014P 19-5-2014P 19-6-2014P 17-2-2014 17-4-2014 19-5-2014 19-6-2014 16-10-2014 9-7-2015# 11-2-2016^ RSUK(2,34)
Hani Larasati/Firman M P 18-1-2014 1/V 18-1-2014 TIDAK ADA RSIAKI(3,25)
5 Aqila Mahmudah# Kayanah/Muchlis P 1-2-2014 8/V 15-2-2014 16-4-2014 24-4-2014P 5-6-2014P 14-8-2014P 15-2-2014 24-4-2014 5-6-2014 14-8-2014 12-11-2014 25-8-2015# 14-4-2016^ RSI(2,2)
Sakura Bilqis Ifia Mysha Sofiah/Sugito P 7-2-2014 5/V 7-2-2014 17-3-2014 18-5-2014P PINDAH 17-3-2014 18-5-2014 BREBES Bd.Mas(3,2)
6 Zulfikar Bani Al Hafidz# Usnul Khotimah/Aman S L 10-3-2014 8/V 10-3-2014 26-3-2014 13-5-2014P 10-7-2014P 9-10-2014P 23-3-2014 13-5-2014 10-7-2014 9-10-2014 17-12-2014 14-4-2016^ RB.Khr(3)sc
7 Fairel Atthariz Dwi K# Mei Rochmani/Kaprawi L 10-3-2014 9/V KARTINI A 26-5-2014 13-5-2014P 19-6-2014P 21-7-2014P 13-5-2014 19-6-2014 21-7-2014 16-10-2014 15-1-2015# 14-4-2016^
8 Revani Khoirunnisa# Rini Sumartini/Meispan P 21-3-2014 2/V 26-3-2014 5-4-2014 4-6-2014P 4-7-2014P 4-8-2014 5-4-2014 4-6-2014 4-7-2014 4-8-2014 12-2-2015# Bd.Las(3,4)
9 Fallah Widiaz Arrazaqu# Wiwit Sakuntala/Retmono J L 29-3-2014 4/V 29-3-2014 16-4-2014 29-5-2014P 26-6-2014P 26-7-2014P 16-4-2014 29-5-2014 26-6-2014 26-7-2014 15-1-2015# 12-10-2015# 14-4-2016^ Bd.E(3,4)
10 Arka Pandu Pranata# Windi Pisanti/Rhohman L 21-4-2014 7/V 21-4-2014 14-5-2014 21-6-2014P 21-7-2014P 21-8-2014P 14-5-2014 21-6-2014 21-7-2014 21-8-2014 20-1-2015# 14-4-2016^ RSIAKI
11 Javier Aktam Maulana Tri Eka Saputri/Beni L 29-4-2014 2/V 29-4-2014 2-6-2014 7-7-2014P 2-6-2014 7-7-2014 Bd.Mas(3)RUSUN
12 Risqi Afif Wicaksono Teni Mulia/Dinar L 9-5-2014 8/V 10-5-2014 18-6-2014 10-7-2014P 15-9-2014# 22-11-2014# 31-5-2014 10-7-2014 15-9-2014# 22-11-2014# 11-3-2015# RSI(2,5) sc
13 M.Roffi Widiya Nugroho# Neli/Novri L 22-6-2014 1/V 22-6-2014 16-7-2014 22-8-2014P 22-9-2014P 23-10-2014P 16-7-2014 22-8-2014 22-9-2014 23-10-2014 11-3-2015# Bd.E(3,9)
Suci Rohati/Achmad Yani P 15-7-2014 7/V 16-7-2014 13-8-2014 DOMISILI 13-8-2014 DEBONG Bd.E(2,7)
14 Rezki Ramadani Tri Nuryanti/Fandi K L 18-7-2014 8/V 18-7-2014 30-8-2014 4-10-2014P 4-11-2014P 17-12-2014P 30-8-2014 4-10-2014 4-11-2014 17-12-2014 22-10-2016^ RB.Rhm(2,9)RUSUN
Chayra Litahayu# Nicky Destya S/Arief R P 22-7-2014 9/V KARTINI A RSI(2,9)
Vinaya Sumini/Supardi P 6-8-2014 8/V 6-8-2014 17-9-2014 7-10-2014P 6-11-2014P 6-12-2014P 17-9-2014 7-10-2014 6-11-2014 6-12-2014 13-5-2015# PINDAH Bd.E(3)
15 Hafizh Syadi Ismallah# Koisah/Yani Saputra Ardianto L 7-8-2014 2/V 7-8-2014 3-9-2014 22-10-2014P 24-11-2014P 24-12-2014# 3-9-2014 22-10-2014 24-11-2014 24-12-2014# 3-6-2015# 8-9-2016^ 13-10-2016^ RB.St.Hj(3)
16 Moh.Ibnu Sopyan# Andriyani/Joko Wasisto L 19-8-2014 2/V 20-8-2014 20-10-2014 20-11-2014P 20-12-2014P 20-1-2015# 28-8-2014 20-10-2014 20-11-2014 20-12-2014 25-8-2015# 14-7-2016^ RSIAKI(3,1)sc
17 El Farabi Muslim# Yuliani/Mokhamad Muslim L 27-8-2014 8/V 27-8-2014 15-9-2014 15-11-2014P 15-12-2014P 15-1-2015# 15-9-2014 15-11-2014 15-12-2014 15-1-2015# 9-7-2015# 10-3-2016^ 8-9-2016^ Bd.E(2,9)
Rizki Ana L/Sigit Pradipto L 2-10-2014 4/V 2-10-2014 PINDAH MINTARAGEN RSUK(3,1)sc
18 Khansa Adelia Naifa# Efie Sri Mulyati/Wiryo P 9-10-2014 2/V 10-10-2014 12-11-2014 9-12-2014P 9-1-2015# 9-2-2015# 12-11-2014 9-12-2014 9-1-2015# 9-2-2015# 9-7-2015# 12-5-2016^ 10-11-2016^ Bd.E(2,9)
Nila Anjani/Toto Sugiarto L 9-10-2014 4/V 9-10-2014 PINDAH MARTOLOYO Bd.Mas(3)
Marselio Endang Susilowati/Salim L 17-10-2014 7/V TIDAK 12-11-2014 PINDAH 12-11-2014 MINASARI RB.Rhm(3,8)
19 Kahiyang Ayu Maria Melinda P 18-10-2014 5/V 18-11-2014 21-4-2015 18-5-2015 18-11-2014 21-4-2015 18-5-2015
Maria Relinda/Wahlan P 18-10-2014 5/V 18-10-2014 PINDAH ADIWERNA RSUK(3,4)
M.Tegar Saputra# Bayuk Sumarni/Andri Yasin L 23-11-2014 4/V 23-11-2014 22-12-2014 24-2-2015# PINDAH 22-12-2014 24-2-2015# PURWOREJO Bd.Mas(2,4)
Lutvi Agustina/Moh.Riyadi P 30-11-2014 2/V 30-11-2014 DOMISILI KEMANDUNGAN Bd.L(3,4)
20 Nayla Muazzara Ulfa Juneri/Heri P 1-12-2014 8/V 1-12-2014 24-12-2014 3-2-2015 9-3-2015 9-4-2015 24-12-2014 3-2-2015 9-3-2015 9-4-2015 19-10-2015 8-9-2016^
Bulgis S/Moch.Mujiarto L 15-12-2014 7/V 16-12-2014 PINDAH FLORES Bd.D(3.15)
Imunisasi yang diberikan 12-10-15
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 Ziqri Fifit Nofiati/A.Khafid L 19-1-2015 2/V 19-1-2015 11-2-2015 19-3-2015 16-4-2015 9-7-2015 11-2-2015 19-3-2015 16-4-2015 9-7-2015 12-11-2015 10-11-2016^ RB.Rhm(3,25)
Suripah/M.Subkhan L 21-1-2015 7/V 21-1-2015 PINDAH KABUPATEN RSUK(3,8)
2 Ardiona Hamka Gauzan Frisca Ayu/Saeful Arif L 27-1-2015 8/V POSYANDU MELATISARI A 2-11-2015 8-9-2016^ Bd.E
3 Khaerul Azzam Kris Yan M/Imam S(DF/10) L 2-3-2015 8/V 2-3-2015 6-5-2015 30-6-2015 15-10-2015 6-5-2015 30-6-2015 15-10-2015 11-2-2016^ RB.Khr(3,8)
4 Nabil Fayadh Rifai Indah Istiqomah/Nurokhim L 22-3-2015 9/V POSYANDU KARTINI A 30-6-2015 10-8-2015 KARTINI A 9-7-2015 10-8-2015 25-1-2016^ RB.Rhm
5 Thalita Khaerunisa Werdanis/Sudin H(DF/10) P 24-3-2015 5/V 15-6-2015 9-7-2015 17-9-2015 12-11-2015 15-6-2015 17-9-2015 12-11-2015 17-12-2015 11-2-2016^ RSUK(1,6)
6 Yemima Rasya Milka/Budi P 16-4-2015 7/V 16-4-2015 26-5-2015 26-6-2015 22-7-2015 25-8-2015 26-5-2015 26-6-2015 22-7-2015 25-8-2015 11-2-2016^ 10-11-2016^
7^ Nazza Dzikriya Suheni/Mustofa(DF/10) L 16-4-2015 7/V 16-4-2015 13-5-2015 19-6-2015 27-7-2015 25-8-2015 13-5-2015 19-6-2015 27-7-2015 25-8-2015 11-2-2016^ 10-11-2016^ Bd.E(3,4)
8 Haidar Almairi Tsafiq Suciati/M.Fathurochim(DF/10/1) L 23-4-2015 7/V 23-4-2015 27-5-2015 9-7-2015 25-8-2015 12-10-2015DF 27-5-2015 9-7-2015 25-8-2015 12-10-2015DF 11-2-2016^ 10-11-2016^ Bd.Mas(3,1)
9 Syafina Dian Ayu Rofikoh Nurdiana/M.Arif K P 24-4-2015 2/V 25-4-2015 10-5-2015 24-6-2015 24-7-2015 25-8-2015 10-5-2015 24-7-2015 25-8-2015 25-9-2015 20-2-2016^ PTB(2,8)
10 Debi Sulistiowati Hesty Kristiningrum/Joni(DF/10/2) P 6-5-2015 2/V 6-5-2015 8-6-2015 9-7-2015 25-8-2015 12-10-2015DF 8-6-2015 9-7-2015 25-8-2015 12-10-2015DF 11-2-2016^ PTB(3,2)
11 Ayudisa Ristiawati/M.Maftufudin P 26-5-2015 2/V 26-5-2015 20-6-2015 26-7-2015 25-8-2015 26-9-2015 20-6-2015 26-7-2015 25-8-2015 26-9-2015 10-3-2016^ Bd.D(3)
12 May Rose Ayunda Desi Lusiana/Eri Fajar(DF/10/3) P 31-5-2015 2/V 1-6-2015 10-7-2015 25-8-2015 12-10-2015DF 12-11-2015 10-7-2015 25-8-2015 12-10-2015DF 12-11-2015 10-3-2016^ Bd.Mas(3,1)
13 Qiana Hasna Mufida Ratih Ratnasari/Madya(DF/10) L 20-6-2015 5/V 20-6-2015 29-7-2015 2-9-2015 8-10-2015 20-11-2015 29-7-2015 2-9-2015 8-10-2015 20-11-2015 RB.Rhm(3,1)sc
14 Syafiq Azzura Damar Suci Taruni/Maryono(DF/10) L 4-7-2015 1/V 7-7-2015 12-7-2015 17-9-2015 12-11-2015 17-12-2015 12-7-2015 17-9-2015 12-11-2015 17-12-2015 14-4-2016^ RSUK (2,7)
15 Muhammad Raihan Syawal Tri Lestari/Rohman L 18-7-2015 7/V 18-7-2015 10-8-2015 17-9-2015 19-10-2015 23-11-2015 10-8-2015 17-9-2015 19-10-2015 23-11-2015 20-5-2016^ RSUK(2,5)
16 Syifa Nur Achyani Leni Sopiyati/Andi P 21-7-2015 7/V TIDAK 10-9-2015 10-10-2015 10-11-2015 11-2-2016^ 10-9-2015 10-10-2015 10-11-2015 11-2-2016^ 9-6-2016^ Bd.D(2)
17 Moh.Ilham Agus Setiawan Rosyanti/Erwin L 17-8-2015 5/V 17-8-2015 21-9-2015 12-11-2015 17-12-2015 10-3-2016^ 21-9-2015 12-11-2015 17-12-2015 14-4-2016^ 12-5-2016^ Bd.Mas(3,5)
18 Aisyah Aqila Desi Natalia/M.NurZaman P 4-9-2015 8/V 4-9-2015 PINDAH 9-11-2015 7-12-2015 14-1-2016^ MINABAHARI 9-11-2015 7-12-2015 14-1-2016^ 1-10-2016^ RSUD(2,6)SC
19 Kinanti Okalina Putri Deniati/Robi Kusnandar(DF/10) P 8-9-2015 8/V 8-9-2015 20-10-2015 12-11-2015 17-12-2015 14-1-2016^ 20-10-2015 17-12-2015 14-1-2016 11-2-2016^ 20-6-2016^ Bd.D(3,4)
20 Benazir Hasnah Indah Rohyati/Indra P P 30-9-2015 2/V 1-10-2015 2-11-2015 17-12-2015 14-1-2016^ 11-2-2016^ 7-10-2015 17-12-2015 14-1-2016^ 11-2-2016^ 14-7-2016^ RSUK(3,6)
21 Affan Erga Aldira Erni Suszanah/Agus B L 2-10-2015 2/V 3-10-2015 16-11-2015 17-12-2015 14-1-2016^ 11-2-2016^ 16-11-2015 17-12-2015 14-1-2016^ 11-2-2016^ 14-7-2016^ RSI(3,9)
22 Khansa Saniyyah Suryanti/Riyanto P 5-10-2015 2/V 5-10-2015 23-11-2015 28-12-2015 13-2-2016^ 23-3-2016^ 23-11-2015 28-12-2015 13-2-2016^ 18-4-2016^ 10-8-2016^ RSI-RUSUNAWA
23 Syakila Utari Kartika Agustina/Tarmo P 21-10-2015 8/V 21-10-2015 10-12-2015 13-1-2016^ 13-2-2016^ 12-3-2016^ 10-12-2015 13-1-2016^ 13-2-2016^ 12-3-2016^ 11-8-2016^ RSI(2,8)sc
Sugiarti/Sahrudin L 30-10-2015 7/V PINDAH KRANDON RSUK(2,9)SC
24 Fathan Rasyiqul Ilmi Twin Wulan/Fathul Aziz L 31-10-2015 1/V 5-11-2015 2-12-2015^ 13-1-2016^ 20-2-2016^ 30-3-2016^ 2-12-2015^ 13-1-2016^ 20-2-2016^ 30-3-2016^ RSIAKI(3,1)
Nova Dwi Aryani Yulia Nur Atika/Imam P P 1-11-2015 2/V 2-11-2015 10-12-2015 PINDAH 10-12-2015 DEBONG RSI(3,16)
Humaira Khomsatun/Fahrudin P 3-11-2015 5/V 3-11-2015 23-11-2015 PINDAH 23-11-2015 DEBONG RSUK(2,8)
25 Aditya Rifki Hamizan Kartini/Mei Pambudi L 10-11-2015 2/IX 9-11-2015 28-12-2015 7-1-2016^ 17-2-2016^ 16-3-2016^ 14-11-2015 22-12-2015^ 7-1-2016^ 20-4-2016^ 20-8-2016^ RSUK(3,3)RUSUNAWA
Wulandari/Ahmad L 4-12-2015 7/V 4-12-2015 PINDAH PAGONGAN RSI(3,3)
26 Devina Safara Shelia/Teguh P 5-12-2015 7/V 6-12-2015 7-3-2016^ 11-4-2016^ 9-5-2016^ 9-6-2016^ 11-4-2016^ 9-5-2016^ 9-6-2016^ 11-7-2016^ 8-9-2016^ PTB(3,5)
27 M.Arsyad Al Faribi Neni Mandera/Heri P L 8-12-2015 8/V 8-12-2015 21-12-2015 11-2-2016^ 10-3-2016^ 14-4-2016^ 21-12-2015 11-2-2016^ 14-4-2016^ 12-5-2016^ 8-9-2016^ RSI(3,5)
28 Rasheed Abiyyu Allan Eka Wulan/Allan Agus L 20-12-2015 4/V 20-12-2015^ 18-1-2016^ 20-2-2016^ 19-3-2016^ 20-4-2016^ 27-12-2015^ 18-1-2016^ 20-2-2016^ 20-4-2016^ 20-9-2016^ RSI(4,2)

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 Zafarani Khanza A Desti Ristianingrum/Ami P P 10-2-2016 1/V 11-2-2016 23-3-2016 1-6-2016^ 13-10-2016 18-2-2016 1-6-2016^ 13-10-2016 RSI(3,0)
2 Azara Asyila Taliyah/ Joko Giyono P 18-2-2016 4/V 18-2-2016 9-3-2016 18-4-2016 18-5-2016 19-6-2016 9-3-2016 18-4-2016 18-5-2016 19-6-2016 Bd.E
3 Aditya Lukmanul Azam Pujianah/Riswanto L 27-3-2016 8/V 28-3-2016 4-4-2016 30-5-2016 27-6-2016 25-7-2016 30-5-2016 27-6-2016 25-7-2016 8-9-2016 PTB(4)
4^ Azka Ais Arrafit Ani Maulida/Eko Janatina L 28-3-2016 7/V 28-3-2016 4-4-2016 30-5-2016 27-6-2016 25-7-2016 30-5-2016 27-6-2016 25-7-2016 13-10-2016 PTB(2,8)
5 Shakina Ayu Ayu Widya/Budi P 1-4-2016 2/V 2-4-2016 11-4-2016 6-6-2016 20-7-2016 20-8-2016 9-4-2016 6-6-2016 20-7-2016 20-8-2016 RSUK(3)RUSUN
Fera Yuliat D/Tomi Septono L 24-4-2016 4/V 25-4-2016 PINDAH 4-5-2016 MARTOLOYO RSI(2,5)SC
Syafa Nafeeza Tri Eka/Beni P 29-4-2016 4-5-2016 16-5-2016 29-6-2016 27-7-2016 27-8-2016 16-5-2016 29-6-2016 27-7-2016 27-8-2016 Bd.Ety(3,2)RUSUN
6 Anisa Riski Rabbani Ani Yuliati/Tris Mulyono P 5-5-2016 2/V 5-5-2016 20-6-2016 11-8-2016 8-9-2016 10-11-2016 20-6-2016 11-8-2016 8-9-2016 10-11-2016 RSI(2,1)sc
7 Ikfi Nur Avini Yulistia/Firmansyah P 14-5-2016 7/V 14-5-2016 13-6-2016 14-7-2016 11-8-2016 19-9-2016 13-6-2016 14-7-2016 11-8-2016 19-9-2016 PKMBJ(3,2)
8 Muhammad Abizar Alfandi Sriningsih/Imam Budi S L 16-5-2016 2/V 9-6-2016 4-7-2016 5-8-2016 9-6-2016 5-8-2016 RSUK(4,1)
9 Alika Naila Putri Nur Aeni/Mulyanto P 24-5-2016 4/V 25-5-2016 29-6-2016 30-7-2016 31-8-2016 4-10-2016 29-5-2016 30-7-2016 31-8-2016 4-10-2016 RB.Rhm(2,9)
12 Moh.Rafa Mukvi Tati Noviati/Muksin L 2-6-2016 8/V 2-6-2016 20-6-2016 3-8-2016 2-9-2016 20-6-2016 3-8-2016 2-9-2016 RSI(2,8)
11 Aisyah Syakilla Azara Suciani/Kasidin P 3-6-2016 2/V 3-6-2016 20-6-2016 3-8-2016 3-9-2016 4-10-2016 20-6-2016 3-8-2016 3-9-2016 4-10-2016 RSI(3,1)
10 Aulia Putri Ramadhan Febriyani/Dede Sumantri P 7-6-2016 1/V 7-6-2016 20-6-2016 11-8-2016 8-9-2016 13-10-2016 20-6-2016 11-8-2016 8-9-2016 13-10-2016 Bd.Dnk(3,0)
13 Hasbi Riski Ramadya Madya Bamanisa/ Ratih R. L 1-7-2016 5/V 1-7-2016 3-8-2016 3-8-2016 RSUK(3,7)
14 Athaya Akaela Keinarra Chaulia Nur R/Slamet P 15-8-2016 6/V 16-8-2016 20-9-2016 20-9-2016 Bd.D(3,2)
15 Sakila Naura Tika Wiranti/Willy K P 29-8-2016 2/V 31-8-2016 26-9-2016 7-11-2016 26-9-2016 7-11-2016 RSI(2,6)
16 Meysha Anastasya AP Astrid Pradipta/Diki Andreas P 13-9-2016 8/V 13-9-2016 17-10-2016 14-11-2016 17-10-2016 14-11-2016 RSUK(2,6)SC
17 Tri Nuryanti/ Fandy K P 18-9-2016 4/IX 18-9-2016 24-10-2016 24-10-2016 PTB(3,1)RUSUN
18 Fiona Najya Wasesa Afriska Agustin/Sukma P 6-10-2016 7/V 6-10-2016 7-11-2016 7-11-2016 RSUK(2,2)
19 Aqita Cahaya Nadhifa Agnes Tanjung/Cahyanto P 17-10-2016 7/V 17-10-2016 7-11-2016 7-11-2016

Imunisasi TT
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Fifit/A.Khafid K 2/V 14-7-2014 10-8-2014
2 Dian Rahmayani/Ahmad K 8/V 3-7-2014C
3 Andriyani/Joko W K 2/V 14-8-2014
4 Lutvi Agustina/M.Riyadi K 2/V 10-8-2014
5 Fadlina Azmi K 7/V 10-7-2014
6 Suripah/M.Subhan K 7/V 4-9-2014
7 Merlin/Imam K 8/V 11-9-2014
8 Desti/Amipriyono K 1/V 9-10-2014C
9 Suheni/Mustofa K 7/V 23-12-14
Imunisasi TT
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Suciati/M.Fathurochim K 7/V 28-12-2014 5-2-2015
2 Rofiko Nurdiana/M.Arif K 2/V 27-12-2014
3 Ristiawati/Maftufudin K 2/V 18-1-2015
4 Taruni/Mariono K 1/V 4-2-2015
5 Hesty K/Joni K 2/V 9-2-2015
6 Desi Lusiana/Eri K 2/V 2-3-2015
7 Tri Lestari/Rohman K 7/V 5-3-2015 2-4-2015
8 Desi Natalia/M.Nur Zaman K 8/V 14-4-2015 14-5-2015
9 Leni Sopiyati/Andi Purwanto K 7/V 6-5-2015 15-6-2015
10 Indah Rohyati/Indra K 2/V 23-5-2015 11-6-2015
11 Yulia Nur Atika/Imam P K 2/V 11-6-2015
12 Suciatiningsih/Danu S K 2/V 9-6-15C
13 Suciani/Kasidin K 2/V 22-6-2015C
14 Ratih Ratnasari/Madya K 5/V 5-5-2015
15 Eka Wulan/Alan K4/V 4-7-2015 13-8-2015
16 Shelia/Teguh Mulyono K 7/V 8-7-2015
17 Neni Mandera/Heru P K 8/V 13-8-2015
18 Erni Suszanah/Agus B K 2/V 18-8-2015
19 Wulandari/Ahmad K 7/V 8-7-2015 19-7-2015
20 Twin Wulan/Fathul Azis K 1/V 8-6-2015 31-7-2015
21 Taliyah/Joko Giyono K 8/V 17-9-2015
22 Sugiarti/Sahrudin K7/V 3-6-2015 5-8-2015
23 Ani Maulida/Eko Janantina K7/V 11-12-2015
24 Pujianah/Riswanto K8/V 11-12-2015
25 Yulistia/Firmansyah K7/V 30-11-2015
Imunisasi TT
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Ani Maulida/Eko Janantina K7/V 11-1-2016
2 Yulistia/Firmansyah K7/V 8-1-2016
3 Tatik Noviati/Muksin K 8/V 18-1-2016
4 Ayu Widya/Budi L K 2/V 6-1-2016
5 Suciani/Kasidin K2/V 11-2-2016
6 Sriningsih/Imam Budi K2/V 11-2-2016
7 Sri Haryati/Denang P K 5/V 14-3-2016C
8 Afriska Agustina/Sukma dwi K7/5 4-4-2016 4-5-2016
9 Chaulia Nur/Slamet K6/V 25-2-2016
10 Ayu Widya/Budi L K 2/V 6-1-2016
11 Tika Wiranti/Wily Kristianto K2/V 4-4-2016
12 Astrid Pradipta/Diki A K8/V 4-4-2016 2-5-2016
13 Febriyani L/Dede S K 1/V 6-2-2016 5-3-2016
14 Septi/Hendra K4/5 12-7-2016C
15 Agnes Tanjung/ Cahyanto K7/V 28-5-2016 29-6-2016
16 Ratih Ratnasari/Madya K5/V 18-6-2016
LAPORAN BULANAN IMUNISASI BAYI
POSYANDU SEKAR INDAH A

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 Nurdista Puspita P 26-1-2011 4/VI
2 Azzalea Rodatul Janah P 5-3-2011 1/VI
3 Moh.Syarif Hidayattuloh Handayani S/Taruno L 6-3-2011 4/VI 6-3-2011 25-5-2011 10-6-2011 22-7-2011 23-8-2011 25-5-2011 10-6-2011 22-7-2011 23-8-2011 7-12-2011 23-7-2014*
4 Syaif Salim Koman Syafuroh L 18-3-2011 3/VI
5 Moh.Rizki Maulana Sofiati L 7-4-2011 3/VI
6 Moh. Yopi R Salmah L 7-4-2011 3/VI
7 Moh. Arif Rahman Nurhidayah L 25-4-2011 4/VI
8 Faiz maulana Amalia L 20-5-2011 4/VI
9 Andin Naura Rizki P 13-6-2011 4/VI
10 Anindya Heronisa Indah P 21-7-2011 2/VI
11 Najwa Ramadania Naini A P 20-8-2011 1/VI
12 Shauma Nur Tanti/Sudibyo P 23-8-2011 4/VI RUSUNAWA
13 Inez Halea Aeni/Iwan P 1-9-2011 1/VI 23-7-2014*
14 Moza Isma Wardani Warkonah/Warmo P 26-10-2011 3/VI 26-10-2011 31-10-2011 21-12-2011 21-1-2012 27-2-2012 31-10-2011 21-12-2011 21-1-2012 27-2-2012 30-7-2012
15 Riansyah Yuli P 6-11-2011 4/VI
16 Rendiansyah Lisnur L 8-11-2011 2/VI
17 Wiwit Cahyani Nurbaeti P 25-11-2011 /VI 22-10-2014*
18 Mohammad Yunia L 27-11-2011 4/VI
15 Moh. Rafi A Anifah L 18-12-2011 2/VI
19 M. Arkadika Eka Susyanti L 19-12-2011 1/VI
20 Zabier Paulus L -2011 7/VII 26-11-2014*

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 Akhira Naufal Yusuf Kartika/Yusuf P 6-1-2012 4/VI 7-1-2012 25-1-2012 7-2-2012 7-3-2012 5-4-2012 25-1-2012 7-2-2012 7-3-2012 5-4-2012 6-10-2012
2 Syarif Afkhah Ekawati/Avin A L 14-1-2012 4/VI 14-1-2012 5-3-2012 6-4-2012 5-5-2012 18-6-2012 5-3-2012 6-4-2012 5-5-2012 18-6-2012 7-1-2013
3 Sya'ick Avka Avriana Windaningsih/Ridwan L 14-1-2012 4/VI 14-1-2012 5-3-2012 2-4-2012 5-5-2012 18-6-2012 5-3-2012 2-4-2012 5-5-2012 18-6-2012 7-1-2013*
4 M.Syafik Saputra Uci A/Rosadi L 11-5-2012 4/VI 11-5-2012 11-6-2012 9-7-2012 3-9-2012 24-10-2012 11-6-2012 9-7-2012 3-9-2012 24-10-2012 25-2-2013 22-10-2014* 21-1-2015#
5 M.Fadil Rosita/Edison L 26-5-2012 4/VI 26-5-2012 21-10-2012 21-11-2012 19-12-2012 18-2-2013 21-10-2012 21-11-2012 19-12-2012 18-2-2013 19-6-2013
6 M.Riky Saputra Puput/Maulana Tri W L 11-6-2012 5/VI 11-6-2012 30-7-2012 19-9-2012 24-10-2012 21-11-2012 30-7-2012 19-9-2012 24-10-2012 21-11-2012 15-4-2013
7 Syafira Fitriani Novi Dwi/Haris P 11-6-2012 4/VI 26-8-2012 26-11-2012 20-2-2013 20-3-2013 23-7-2013 26-11-2012 20-2-2013 20-3-2013 23-7-2013 V
8 Sami Amelia/A.Ali L 19-6-2012 3/VI 19-6-2012 9-7-2012 19-9-2012 23-1-2013 20-11-2013 9-7-2012 19-9-2012 23-1-2013 20-11-2013 V
9 Fikri Arsy Rabani Rohdiana/Haryono L 20-6-2012 4/VI 20-6-2012 11-7-2012 20-8-2012 22-10-2012 18-10-2012 11-7-2012 20-8-2012 22-10-2012 18-11-2013 20-3-2013 23-7-2014* 17-6-2015#
Afrizal Dwi Wibisono Eti U/Riski L 21-6-2012 4/VI 21-6-2012 TIDAK ADA 6-12-2012 6-12-2012
10 Benaya Septia Yunita/Kristian L 4-9-2012 7/VII 4-9-2012 3-10-2012 10-11-2012 21-12-2012 4-2-2012 3-10-2012 10-11-2012 21-12-2012 4-2-2013 10-6-2013 26-11-2014*
Nadine A P 16-9-2012 2/VI TIDAK ADA 17-4-2013 17-4-2013
M.Faqih Mardika Proborini/Yuda L 10-10-2012 4/VI TIDAK ADA 11-3-2013 11-3-2013
11 Naila Azzahra Bagus P 13-10-2012 4/VI 14-10-2012 12-11-2012 10-12-2012 18-12-2012 14-1-2013 12-11-2012 10-12-2012 18-12-2012 14-1-2013 5-8-2013
12 M.Akhtar Rayyan A St.Khotimah/Hasbi A L 12-12-2012 2/VI 13-12-2012 20-12-2012 12-2-2012 12-3-2012 12-4-2012 20-12-2012 12-2-2012 12-3-2012 12-4-2012 20-9-2013 19-8-2015#

Imunisasi yang diberikan


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 Fawaz Daimah/Abdullah S L 4-2-2013 4/VI PINDAHAN 26-6-2013 DR NUSA INDAH 26-6-2013 18-11-2013 RSI
2 M.Sani Fabryan Lusia W/Sugeng N L 24-2-2013 4/VI 24-2-2013 6-3-2013 24-4-2013 22-5-2013 26-8-2013 6-3-2013 24-4-2013 22-5-2013 26-8-2013 11-3-2014* RB.StHj
Humaira Ira P 3-3-2013 3/VI 15-7-2013 PINDAH 15-7-2013 TASIK
Syahla Yuma Faiha Eva M/Guruh Eko P 18-3-2013 7/II MWR B 23-5-2013 19-6-2013 23-7-2013 9-12-2013 19-6-2013 23-7-2013 9-12-2013 18-8-2014 RSUK-RUSUN
Raditya Bagas Wijaya Eka Suyanti/Daryono L 7-4-2013 1/VI 7-4-2013 20-4-2013 8-6-2013 8-7-2013 6-8-2013 20-4-2013 8-6-2013 8-7-2013 6-8-2013 20-1-2014* PINDAH SLAWI Bd.M
Salsa Dendra Dewi Handayani/Indra P 9-4-2013 /6 10-4-2013 20-5-2013 10-6-2013 15-7-2013 19-8-2013 20-5-2013 10-6-2013 15-7-2013 19-8-2013 PINDAH SMP 8 RSI
3 Hayan Fatan Lis Dianawati/Slamet L 24-4-2013 2/VI 25-4-2013 5-5-2013 1-7-2013 5-8-2013 24-9-2013 5-5-2013 1-7-2013 5-8-2013 24-9-2013 27-1-2014* 26-11-2014 13-4-2016^ Bd.M
4 Zielfika Rifiani Rodatul Janah/Aenul K P 28-4-2013 1/VI 28-4-2013 6-5-2013 8-7-2013 19-8-2013 18-9-2013 6-5-2013 8-7-2013 19-8-2013 18-9-2013 24-2-2014* RSUK(2,7)
Sudiana/Rahmat H P 14-6-2013 4/VI 14-6-2013 TIDAK ADA RSUK(3,1)
Retno/Andri P 27-8-2013 3/VI 27-8-2013 TIDAK ADA RSUK(4)
Sri Kandita Tanti/Sudibyo P 20-9-2013 4/VI 21-9-2013 19-3-2014P* 23-4-2014P* 19-3-2014* 23-4-2014* Bd.Mas(2,6)RUSUN
Siti Nafisah/Nurcholik L 5-10-2013 3/VI 10-10-2013 TIDAK ADA Bd.Las(3)
5 Silvi Inayah Ani Widayati/Widodo P 30-10-2013 1/VI 31-10-2013 16-12-2013 20-1-2014* 3-3-2014* 2-6-2014* 16-12-2013 20-1-2014* 3-3-2014* 2-6-2014* RSUK(2,3)
Nathanael Fidelis Kuswati/Yopi L 2-11-2013 4/VI 2-11-2013 3-12-2013* 19-2-2014* PINDAH 3-12-2013* 19-2-2014* BANDUNG Bndg(3,1)
Almira Sania Fauziyah/Tasroh P 18-11-2013 1/VI 19-11-2013 15-1-2014* 19-2-2014P* 7-4-2014P* PINDAH 25-11-2013* 15-1-2014* 19-2-2014* 7-4-2014* MAWAR A
6 Regian Beni Sugiarti Wiwi Sugiarti/Beni P 19-11-2013 1/VI 19-11-2013 23-12-2014* 21-1-2014* 21-2-2014* 26-3-2014* 23-12-2014* 21-1-2014* 21-2-2014* 26-3-2014* 10-11-2014* 10-2-2016^ 12-3-2016^ RSI(3,1)
7 M.Ali Fatih Fitria T/M.Ibnu L 17-12-2013 5/VI 17-12-2013 30-12-2013 25-2-2014P* 29-4-2014P* 20-8-2014* 30-12-2013 25-2-2014* 29-4-2014* 20-8-2014 -12-2014* RSI
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.Aisy Haffi Nur Dahlia/Aldi Firyan. L 15-2-2014 5/VI 16-2-2014 12-3-2014 15-4-2014P 15-6-2014P 15-8-2014P 12-3-2014 15-4-2014 15-6-2014 15-8-2014 17-12-2014 24-8-2015# 11-5-2016^ Bd.E(2,8)
2 Rahayu Febriana Haryani/Bambang P 19-2-2014 5/VI 19-2-2014 5-5-2014 23-4-2014P 21-5-2014P 23-7-2014P 23-4-2014 21-5-2014 23-7-2014 20-8-2014 24-12-2014 13-4-2016^ 11-5-2016^ RSUK(3,1)sc
Asmaul Nabilah(RSI) Noviana P 25-2-2014 1/VI 23-4-2014 23-4-2014
3 Gendis Rizky Putri Rias Astuti/Afif A P 2-3-2014 1/VI 2-3-2014 7-4-2014 5-5-2014P 5-6-2014P 14-7-2014 11-3-2014 7-4-2014 5-5-2014 5-6-2014 15-12-2014 12-3-2016^ 10-8-2016^ RSI(3,2)sc
Hana Sulastri/Umar L 14-3-2014 2/VI 14-3-2014 PINDAH SLAWI RSUD Slw(sc)
(St.Hj) Ivo Fauziyah/Mulyansyah P 17-3-2014 4/VI 18-3-2014 7-5-2014 7-5-2014 RS.Pl.Ry(2,8)
4 M.Firmansyah Faricha/M.Juwahir L 24-3-2014 5/VI 24-3-2014 28-4-2014 2-6-2014P 30-6-2014P 11-8-2014P 2-4-2014 28-4-2014 2-6-2014 30-6-2014 24-12-2014 25-11-2015# 10-8-2016^ RSI(3,9)sc
5 Danis Athar Vitria Erfitriana/Agus I L 27-3-2014 4/VI 31-3-2014 19-4-2014 26-5-2014P 25-6-2014P 23-7-2014P 19-4-2014 26-5-2014 26-5-2014 23-7-2014 24-12-2014 23-12-2015# 8-6-2016^ Bd.Mas(3,8)
Apriliani Rudi Hartono P 29-4-2014 4/VI 29-4-2014 12-6-2014 10-7-2014P 19-8-2014P 22-10-2014P 12-6-2014 10-7-2014 19-8-2014 22-10-2014 PINDAH CIANJUR
6 Abigail Eirene Aprilia Berlian Yosiana/T.Pramono P 21-4-2014 4/VI 23-4-2014 25-4-2014 25-6-2014P 23-7-2014P 20-8-2014P 25-4-2014 25-6-2014 23-7-2014 20-8-2014 21-1-2015# 21-10-2015# 8-6-2016^ Dr.Jay(2,7)
7 Khanza Nadia Kamila Prita Ayu W/Fuad Hasan P 6-5-2014 4/VI 6-5-2014 19-6-2014 17-7-2014P 14-8-2014P 18-12-2014P 17-7-2014 14-8-2014 22-10-2014 22-10-2014 16-4-2015# 10-8-2016^ RSUK(3,4)
8 Carina Anisa Sumiyarti/Hendra P 12-6-2014 4/VI 12-6-2014 11-8-2014 20-8-2014 24-9-2014P 22-10-2014P 11-8-2014 24-9-2014 22-10-2014 24-12-2014# 18-5-2015# 9-11-2016^ RSUK(2,8)
Satria R Anggun Ciptasari/Oky R L 22-7-2014 5/VI 22-7-2014 10-9-2014 TIDAK ADA 10-9-2014 TIDAK ADA RSI(3,5)
Abdul Rosyid Novita Ayu/Danang N.C. L 29-8-2014 salak 3/6 29-8-2014 22-10-2014 TIDAK ADA 22-10-2014 TIDAK ADA RB.Khr(3,82)sc
Farah Firdos/Saleh Abu Bakar P 31-8-2014 salak 47 31-8-2014 24-9-2014 TIDAK ADA 24-9-2014 TIDAK ADA RB.Khr(3,45)
Dian Hayati/Wawan L 5-10-2014 5-10-2014 TIDAK ADA RSI
9 Rizky Jihan Oktaviani Puput Pujianto/Maulana P 16-10-2014 5/VI 16-10-2014 24-11-2014 24-12-2014P 21-1-2015# 18-3-2015# 24-11-2014 24-12-2014 21-1-2015# 18-3-2015# 7-9-2015# 8-6-2016^ 9-11-2016^ RSI(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
1 Nur Maulida Rieke Damayanti/Ismail P 13-1-2015 4/VI 14-1-2015 18-2-2015 15-5-2015 17-6-2015 29-7-2015 18-2-2015 15-5-2015 17-6-2015 29-7-2015 17-10-2015 16-7-2016^
2 Sarefa Jihan Amira Alfiah/Arif Riyanto P 18-1-2015 4/VI 18-1-2015 5-3-2015 5-4-2015 MENOLAK 5-3-2015 5-4-2015 MENOLAK
M.Fahri Syarifah Naela/Haikal L 27-1-2015 1/VI 27-1-2015 18-2-2015 TIDAK ADA 18-2-2015 TIDAK ADA RB.St.Hj
3 M.Radhika Aditia Ria Astuti/Moh.Jaim L 28-2-2015 2/VI 28-2-2015 23-3-2015 29-4-2015 30-5-2015 27-6-2015 23-3-2015 29-4-2015 30-5-2015 8-7-2015 30-11-2015 12-10-2016^ RSUK(3,4)
4 Azhar Yustizar Santi Herawati/M.Ayub L 7-3-2015 1/VI 7-3-2015 6-4-2015 11-5-2015 15-6-2015 13-7-2015 6-4-2015 11-5-2015 15-6-2015 13-7-2015 23-12-2015 12-10-2016^ RB.St.Hj
5 Rizki Hadi Kusmiyati/Wahidun L 10-3-2015 1/VI 11-3-2015 27-4-2015 17-6-2015 29-7-2015 21-10-2015 27-4-2015 17-6-2015 29-7-2015 21-10-2015 23-12-2015 12-10-2016^ PTB
6 Kenzo Alfaro Restu Zalita/Feri F L 26-3-2015 1/VI 26-3-2015 4-5-2015 6-6-2015 6-7-2015 10-8-2015 4-5-2015 6-6-2015 6-7-2015 10-8-2015 1-2-2016^ 9-11-2016^
7 Nijananda Asyraf J Vina Liana/Tarjuni L 10-5-2015 4/VI 10-5-2015 29-6-2015 3-8-2015 31-8-2015 5-10-2015 18-6-2015 3-8-2015 31-8-2015 5-10-2015 9-5-2016^ RSUK(2,6)ve
Rodhiyah Ayu/Hanafi P 13-5-2015 2/VI 13-5-2015 TIDAK ADA RSI(3,1)
M. Nizar Silvana/Chasan L 20-5-2015 5/VI 21-5-2015 22-6-2015 3-8-2015 28-9-2015 PINDAH 22-6-2015 3-8-2015 28-9-2015 PINDAH RANDUGUNTING
8 Winda Nurokhayatun Warsiti/Sukarno P 30-5-2015 5/VI 31-5-2015 4-6-2015 29-7-2015 31-8-2015 1-10-2015 4-6-2015 29-7-2015 31-8-2015 1-10-2015 13-4-2016^
9 Fadlan Mela Armala/Rosin L 25-8-2015 5/VI 26-8-2015 MENOLAK
10 Muh.Farhan E Intan Sari/Syarif E L 9-9-2015 4/VI 9-9-2015 28-9-2015 25-11-2015 21-1-2016^ 13-4-2016^ 28-9-2015 25-11-2015 21-1-2016^ 13-4-2016^ 14-9-2016^
Fauziah Nur Chasanah/Muqotip P 23-9-2015 3/VI 23-9-2015 30-11-2015 25-11-2015 23-12-2015 P[PINDAHAH 2-10-2015 25-11-2015 23-12-2015 SURABAYA RSI(3,6)sc
11 Putri Priska S.A Emalia/Rohmat P 26-9-2015 4/VI 27-9-2015 5-10-2015 26-11-2015 26-12-2015 10-2-2016^ 5-10-2015 26-11-2015 26-12-2015 10-2-2016^ 16-7-2016^
12 Bilqis Okta Talenta Siti Solicha/Edi Irwanto P 4-10-2015 4/VI 4-10-2015 20-10-2015 23-12-2015 14-3-2016^ 8-6-2016^ 20-10-2015 23-12-2015^ 8-6-2016^ 16-7-2016^ 16-7-2016^ RSI(2,6)
13 Shofiyyah Lely Maulidah/Kartino P 28-11-2015 1/VI 29-11-2015 28-12-2015 10-2-2016^ 12-3-2016^ 13-4-2016^ 28-12-2015 10-2-2016^ 13-4-2016^ 11-5-2016^ 14-9-2016^ Bd.M(2,9)
14 Naryama Cahya Heni Maryani/Agung R P 31-12-2015 4/VI 31-12-2015^ 7-3-2016^ 12-3-2016^ 13-4-2016^ 11-5-2016^ 12-1-2016^ 13-4-2016^ 11-5-2016^ 8-6-2016^ 9-11-2016^ RB.St.Hj (3,2)

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 Ainayya Azyan Linda Melina/Saeful L 3-1-2016 8/VI 3-1-2016 15-2-2016 12-3-2016 18-4-2016 16-5-2016 15-2-2016 18-4-2016 16-5-2016 12-6-2016 3-10-2016 RS Plry((2,9)
2 Dewi Ilyana Eti Watiningsih/Suprapto P 4-3-2016 4/VI 4-3-2016 4-4-2016 11-5-2016 8-6-2016 16-7-2016 13-4-2016^ 11-5-2016 8-6-2016 16-7-2016 Bd.Srp (3,4)
3^ Naufal Rasydan Rintis/ Helmi M L 4-3-2016 2/VI 4-3-2016 20-3-2016 4-5-2016 4-6-2016 19-7-2016 4-5-2016 4-6-2016 19-7-2016 28-8-2016 Bd.M(3,8)
4 Dini Apriliani Shopaeni/M.Hasan P 13-4-2016 4/VI 13-4-2016 9-5-2016 20-6-2016 10-8-2016 14-9-2016 9-5-2016 20-6-2016 10-8-2016 24-10-2016 Bd.M(3,2)
5 Safira Ananda Rizki Apriyana/Andi Yuniar P 14-4-2016 1/VI 15-4-2016 2-5-2016 PINDAH 2-5-2016 MEJASEM PTB(2,8)
6 Fateen Farkhanah/ Saleh P 13-5-2016 4/IV 6-6-2016 20-7-2016 20-8-2016 19-9-2016 17-10-2016 20-7-2016 20-8-2016 19-9-2016 17-10-2016
7 Syahir Zafran Astika N/Suroso L 2-6-2016 1/VI 2-6-2016 13-6-2016 10-8-2016 13-6-2016 10-8-2016 PTB
8 Naura Ve Aliea Ferna sri utami/Sucipto P 14-6-2016 5/VI 14-6-2016 20-7-2016 26-8-2016 PINDAH 20-7-2016 26-8-2016 DAMPYAK RSI 2,8
9 Nailatus Safa'ati Uci Andani/Rosadi P 7-8-2016 4/VI 8-8-2016 26-9-2016 12-10-2016 9-11-2016 26-9-2016 9-11-2016 RS.CRBON(2,1)
10 Kayla Almira Yuni Anjani/ Andrianto P 26-7-2016 5/VI PINDAH KENANGA B KRATON
11 Alisha Kairani Hidayah/Fajar Suryawan P 23-8-2016 3/VI 24-8-2016 26-9-2016 9-11-2016 26-9-2016 9-11-2016 St.Hjr(2,6)
12 Ahmad Bagir Indriyati/Syeh H P 28-8-2016 5/VI 2-9-2016 17-10-2016 9-11-2016 17-10-2016 RSI(2,48)SC

Imunisasi TT
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Ayu/Toto K 3/VI V
2 Fina K 4/VI 8-10-2014
3 Kusmiyati/Wahidin K1/VI 3-12-2014
4 Restu Zalita K 1/VI 3-11-2014 3-12-2014
Imunisasi TT
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Nely/Dodi K 1/VI -12-2014
2 Warsiti/Soekarno K 5/VI V
3 Nyai Kasmi/Widi K 4/VI V
4 Udu Mahfudah/Bagus K 5/VI V
5 Sudiana/Rahman K 4/VI V 17-6-2015 12-8-2015
6 Fina K 4/VI 8-1-2015 9-3-2015
7 Fitri Meilana Surya K 3/VI 30-5-2015 14-8-2015
8 Nur Chasanah/Mokotip K3/VI 19-8-2015 19-9-2015
9 Lely Maulidah/Kartino K1/VI 9-9-2015 10-11-2015
10 Eti W/Suprapto K4/VI 3-11-2015
Imunisasi TT
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Farkhanah/Saleh K4/VI 13-1-2016
2 Shopaeni/Kasan K4/VI 13-1-2016
3 Apriyana/Sugiarto K 1/VI 8-12-2015 10-2-2016
4 Astika Nurjanah/Suroso K 1/VI 2-11-2015 30-1-2016
5 Indriyati/Seh husen A K 5/VI 30-5-2016 28-6-2016
LAPORAN BULANAN IMUNISASI BAYI
POSYANDU SEKAR INDAH B

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 Andika Pulza Ika L 5-3-2011 8/VI
2 Tri wulandari Samsudin P 8-3-2011 6/VI
3 Zakaria Khadafi Jujun/Hani L 25-4-2011 7/VI
4 Rasya Maulana Arif/Anifah L 21-8-2011 7/VI
5 Vianita Azahra Muslih/Anita P 2-9-2011 7/VI
6 Celine Oktavia Hendri/Natalia P 5-10-2011 7/VI
7 Hettiana Sasaria Wachidin/Susilowati P 12-11-2011 6/VI
8 M. Azam Sigit/Airana L 14-11-2011 7/VI
9 Eva Arlo A Maestro/Wiki P 17-12-2011 7/VI

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 Kanza Kirana Arifin P 11-1-2012 7/VI 12-1-2012 2-7-2012 18-6-2012 23-7-2012 27-8-2012 18-6-2012 23-7-2012 27-8-2012 21-1-2013 21-1-2013
Nurul Fahri Pujiningrum L 28-2-2012 6/VI TIDAK ADA
Alicia Lilis/Ibnu P 15-3-2012 8/VI DEBONG
2 Andre Putra Pratama Ika Noviyanti/Nuryadi L 15-3-2012 7/VI 28-6-2012 30-7-2012 1-8-2012 1-9-2012 5-10-2012 30-7-2012 1-8-2012 1-9-2012 5-10-2012 20-4-2013
3 Irfan Maulana Suroyo L 12-5-2012 7/VI 12-5-2012 20-5-2012 23-7-2012 25-8-2012 25-9-2012 20-5-2012 23-7-2012 25-8-2012 25-9-2012 15-4-2013
4 Naura Sahira Rahmah Inayah/Arif P 16-5-2012 8/VI 16-5-2012 11-6-2012 23-7-2012 27-8-2012 1-10-2012 11-6-2012 23-7-2012 27-8-2012 1-10-2012 18-2-2013
5 Wisnu Awaludin Darti/Imam Santoso L 19-5-2012 8/VI 26-5-2012 16-7-2012 30-7-2012 21-8-2012 12-11-2012 16-7-2012 20-9-2012 27-8-2012 12-11-2012 1-4-2013
6 Rekhan Aditya Anisah/Untung L 8-6-2012 6/VI 8-6-2012 17-12-2012 21-1-2013 23-12-2013 17-12-2012 21-1-2013 23-12-2013 MENOLAK
7 Lintang Fredella Diana M/Joko Purnomo P 20-6-2012 6/VI 20-6-2012 11-7-2012 20-8-2012 22-9-2012 23-10-2012 11-7-2012 20-8-2012 22-9-2012 23-10-2012 20-3-2013 22-6-2015# 27-7-2015#
8 Andini Alica Putri Mety Trinya/Nurpendi P 2-7-2012 6/VI 2-7-2012 5-8-2012 5-9-2012 5-10-2012 5-11-2012 5-8-2012 5-9-2012 5-10-2012 5-11-2012 5-4-2013 24-12-2014* 27-7-2015#
9 A.Hadi Zakiyah/Kholid L 28-7-2012 2/VI 28-7-2012 13-8-2012 24-10-2012 10-12-2012 21-1-2013 13-8-2012 24-10-2012 10-12-2012 21-1-2013 27-5-2013 22-6-2015 27-7-2015#
10 Huwaida Kusrini/Maliki P 19-10-2012 8/VI 21-11-2012 19-12-2012 23-1-2013 20-2-2013 21-11-2012 19-12-2012 23-1-2013 20-2-2013 20-7-2013
11 Moh.Anaf Husain A L 20-10-2012 6/VI MENOLAK 21-1-2013 MENOLAK 21-1-2013 MENOLAK
12 Naura Salsabila Sriningsih/M.Bahrudin P 10-11-2012 6/VI 10-11-2012 20-11-2012 10-1-2013 10-2-2013 10-3-2013 20-11-2012 10-1-2013 10-2-2013 10-3-2013 20-9-2013 27-7-2015#
Syifa Aulia Zahra Rokhimah/Jaelani P 19-11-2012 8/VI 20-11-2012 28-11-2012 20-1-2013 26-2-2013 26-3-2013 28-11-2012 20-1-2013 26-2-2013 26-3-2013 SURADADI
13 Yasmin Kaysha Hikmah/Edi P 24-11-2012 7/VI 24-11-2012 20-12-2012 24-1-2013 24-2-2013 17-4-2013 20-12-2012 24-1-2013 24-2-2013 17-4-2013 20-9-2013
14 Nurul Hidaayah Murniati/Abdul Rochim P 6-12-2012 8/VI 6-12-2012 7-1-2013 18-2-2013 18-3-2013 22-4-2013 7-1-2013 18-2-2013 18-3-2013 22-4-2013 21-10-1013 19-10-2015#
15 Radithya Arja Hasyim Sariyanti/Wahid Hasyim L 28-12-2012 8/VI 28-12-2012 28-1-2013 1-3-2013 22-4-2013 20-5-2013 28-1-2013 1-3-2013 22-4-2013 20-5-2013 8-11-2013 19-1-2015^ 27-7-2015#
16 Fatimah Azzahra Sri Murti P 25-12-2012 6/VI 25-12-2015 MENOLAK 21-7-2014*

Imunisasi yang diberikan


No Nama Bayi Nama Ortu L/P Tanggal Alamat
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 Aenur Sidiq Nuraeni/Heri L 7-1-2013 7/VI 7-1-2013 20-1-2013 22-4-2013 17-6-2013 18-11-2013 20-1-2013 22-4-2013 17-6-2013 18-11-2013 19-1-2015 18-1-2016^ Bd.M
Fatimah Az Zahra L 20-3-2013 6/VI 21-3-2013 TIDAK ADA RB.StHj
Nur Maulana/Andre L 24-3-2013 7/VI 25-3-2013 TIDAK ADA Bd.M
Alin Zahra Gunawan Aminah A/Edi Gunawan P 12-5-2013 7/VI 12-5-2013 17-6-2013 PINDAH 17-6-2013 KUNCUP MEKAR RSMK(2,8)
2 Henedictus Greffy J Heni Dwi I/Edi Sarjono L 15-5-2013 7/VI 23-5-2013 8-7-2013 23-7-2013 23-9-2013 18-11-2013 23-5-2013 8-7-2013 23-9-2013 18-11-2013 21-7-2014* RSIAKI(2,5)
Sri Indayani/Samsul S P 29-5-2013 6/VI 29-5-2013 PINDAH RSI(3,34)
3 Muh.Fairel Atharizz Melly Dwi/Adi Setiawan L 3-6-2013 2/II PINDAHAN 23-9-2013 21-10-2013 23-11-2013 MWR A 23-9-2013 23-10-2013 23-11-2013 7-4-2014* PINDAH MEJASEM Bd.Eti(3,2)
4 Kenzie Vanes Nadhirrizky Ira Tri Evaningsih/Johan S L 12-6-2013 8/VI 12-6-2013 7-8-2013 22-8-2013 31-10-2013 23-12-2013 7-8-2013 22-8-2013 31-10-2013 23-12-2013 21-7-2014* 31-10-2015^ 16-2-2016^ RSI
5 Fairel Atharizz R St.Maryam/Triyanto L 10-7-2013 8/VI 10-7-2013 5-8-2013 10-9-2013 21-10-2013 18-11-2013 5-8-2013 10-9-2013 21-10-2013 18-11-2013 19-5-2014* 22-6-2015# 21-9-2015# Bd.M(3,0)
Naaila Sakira Wijaya Wiwin N/Indra Wijaya P 17-7-2013 7/VI 17-7-2013 20-8-2013 23-9-2013 23-10-2013 20-8-2013 23-9-2013 23-10-2013 PINDAH KAB Bd.M(3,2)
6 Anggita Syifa Agustina Ismi Hanifah/Ade R P 17-8-2013 6/VI 17-8-2013 2-10-2013 23-10-2013 22-1-2014* 8-4-2014* 23-8-2013 23-10-2013 22-1-2014* 8-4-2014* 21-7-2014* 22-6-2015# 19-10-2015# RSI(3,3)
Almira Nur Alifah Nur Aeni/Hery Setiono P 2-9-2013 7/VI 2-9-2013 23-9-2013 6-11-2013 7-12-2013 7-1-2014* 23-9-2013 6-11-2013 7-12-2013 7-1-2014* 30-6-2014* PINDAH ASTIKA B RSUK(3,35)
7 M.Maher Zein Zakiyah L 17-9-2013 6/VI 17-9-2013 23-10-2013 18-11-2013 24-12-2013* 21-1-2014* 23-10-2013 18-11-2013 24-12-2013* 21-1-2014* 25-6-2014* 22-6-2015# 18-4-2016^ RSI(3,1)
Tanti Y/Sudibyo P 20-9-2013 6/VI 21-9-2013 PINDAH SEKAR INDAH A Bd.Mas(2,6)
Nafla Syakira Fitria/Lutfi Mator P 10-10-2013 6/VI 11-10-2013 18-11-2013 18-12-2013 21-1-2014* 25-2-2014* 18-11-2013 18-12-2013 21-1-2014* 25-2-2014* PINDAH RSI(3,4)
Arfa Rina Siana/Aang K L 10-10-2013 7/VI 10-10-2013 PINDAH 16-12-2013* PINDAH 16-12-2013* DUKUH TURI RSUK(2,9)
Sukaeni/Catur L 17-11-2013 7/VI IUFD--->PLUS RB.Rhm(1,7)

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
Nadhira Saffira Al Meira Wiky Permata/Irfanudin P 27-3-2014 7/VI(std) 27-3-2014 16-4-2014 30-5-2014P 26-6-2014P 1-8-2014P 16-4-2014 30-5-2014 26-6-2014 1-8-2014 6-1-2015# 29-2-2016^ PINDAH RSI(3)
1 Aprilia Restami Eti Kurniasih/Urip Sugianto P 6-4-2014 8/VI 12-4-2014 12-4-2014 23-6-2014P 21-7-2014P 18-8-2014P 12-4-2014 23-6-2014 21-7-2014 18-8-2014 17-1-2015# 16-11-2015# 18-7-2016^ RSUK(2,1)
M.Fadli Priharyanto Halimah/Priyanto L 18-5-2014 8/VI 18-5-2014 29-7-2014 19-8-2014 IKUT 29-7-2014 MERTUA RSUK(2,8)
2 Asraf Khaerul Anam Sri Wahyuni/Sumarno L 31-5-2014 6/VI 2-6-2014 1-7-2014 1-8-2014 1-9-2014 1-10-2014# 1-7-2014 1-8-2014 1-9-2014# 1-10-2014# 15-3-2015# 21-12-2015# 13-7-2016^ Solo
3 Putri Nadia Nurris Nurul/M.Idris P 20-9-2014 8/VI 27-9-2014 27-10-2014 19-1-2015 24-3-2015# 21-9-2015# 27-9-2014 27-10-2014# 19-1-2015# 24-3-2015# 16-11-2015# 18-4-2016^
Sri Bulan/Moh.Jamaludin L 26-9-2014 6/VI 26-9-2014 PINDAH RSUK(3,8)sc
Dian Hijayanti/Wawan L 5-10-2014 5-10-2014 TIDAK ADA RSI(3,4)
4 Syakira Ainunnisa Anisah/Tarmono P 8-10-2014 7/VI 8-10-2014 20-11-2014 26-12-2014# 26-1-2015# 21-2-2015# 20-11-2014 26-12-2014# 26-1-2014# 21-2-2015# 27-7-2015# 15-8-2016^ 17-10-2016^ RSI(2,3)sc
Zahir Zanera A.R Laelatul B/Eko Mutaqin P 24-10-2014 6/VI 24-10-2014 24-11-2014 24-12-2014P TIDAK 24-11-2014 24-12-2014 ADA RSUK(3,3)sc
5 Syakila Rindy/Maidanu P 26-10-2014 8/VI 26-10-2014 12-11-2014 26-12-2014# 26-1-2015# 26-2-2015# 12-11-2014 26-12-2014# 26-1-2015# 26-2-2015# 27-7-2015# 7-5-2016^ 21-11-2016^ Bd.E(3,1)
Aisyah Dawimah/Sumarno P 27-10-2014 6/VI 28-10-2014 12-11-2014 26-12-2014# 27-1-2015# 27-2-2015# 12-11-2014 26-12-2014# 27-1-2015# 27-2-2015# 16-9-2015# PINDAH PEK Bd.E(3,1)
Silvana/M.Syahmirli P 4-11-2014 7/VI 4-11-2014 TIDAK ADA RSI(2,5)sc
6 Alifa Assyabiya R Mega/Herman P 17-11-2014 6/VI Tidak 24-12-2014 28-1-2015# 17-3-2015# 21-4-2015# 24-12-2014 28-1-2015# 17-3-2015# 21-4-2015# 17-2-2015# 19-5-2015# 21-11-2016^ (1,9)
7 Fakhri Zahfran Nastiti/Sigit L 22-11-2014 9/VI 22-11-2014# 24-12-2014# 27-1-2015# 28-2-2015# 26-3-2015# 24-12-2014# 27-1-2015# 28-2-2015# 26-3-2015# 27-8-2015# 9-11-2016^ RB.Rhm(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 Bintang Andriyani/Hartadi L 18-1-2015 8/VI 18-1-2015 27-4-2015 24-3-2015 18-5-2015 22-6-2015 27-1-2015 24-3-2015 18-5-2015 18-6-2015 19-10-2015# 17-10-2016^ RSI(3,2)
2 Abiyyu Raziq Assakur Ade Kustati/Abdul A L 21-2-2015 TGS 10/II 22-2-2015 8-4-2015 9-5-2015 9-6-2015 9-7-2015 8-4-2015 9-5-2015 9-6-2015 9-7-2015 16-11-2015 RB.Rhm(2,65)
3 Anindita Khairinisa Diana/Joko P 3-5-2015 6/VI 3-5-2015 13-5-2015 4-7-2015 3-8-2015 4-9-2015 13-5-2015 4-7-2015 3-8-2015 4-9-2015 10-2-2016^ RSUK(3,1)
4 Much. Syafiq Ramadhan Sri Fatmawati/Robi L 19-6-2015 6/VI 23-6-2015 16-11-2015 18-8-2015 21-9-2015 19-10-2015 18-8-2015 21-9-2015 19-10-2015 16-11-2015 18-4-2016^
Grace Nolla Dero Cecilia Laili/Daud P 23-6-2015 6/VI 24-6-2015 PINDAH 30-6-2015 SURADADI

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 Khusnul Khotimah Sri Murti/Moh.Taefur P 27-3-2016 8/VI 28-3-2016 MENOLAK St.Hjr (3,2)
2 Moh.Uwais Laelatul B/Eko Muttaqin L 11-4-2016 6/VI 11-4-2016 16-5-2016 20-6-2016 19-9-2016 16-5-2016 20-6-2016 19-9-2016 RSUK(3,5) SC
3 Chalisa Jihan Nadhifa Eti Kurniasih/Urip S P 3-5-2016 8/VI 3-5-2016 20-6-2016 15-8-2016 19-9-2016 17-10-2016 20-6-2016 15-8-2016 19-9-2016 17-10-2016 RSI(3,1)
4 Hafiza Khaira L Nur Inayah/ Eko P P 14-5-2016 6/VI 14-5-2016 23-5-2016 PINDAH 23-5-2016 TALANG PTB (3)
5 Ananda Aska Winni/ Sukamdani L 16-7-2016 8/VI 16-7-2016 15-8-2016 19-9-2016 17-10-2016 15-8-2016 19-9-2016 17-10-2016 RSUK(3,1)
6 Cakra Nuryasa Nurhayati/Topo L 11-11-2016 8/VI 12-11-2016 St.Hjr(2,5)

Imunisasi TT
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Laelatul/Eko Muttaqin K 6/VI 26-7-2014 29-8-2014
2 Dawimah/Sumarno K 6/VI 26-8-2014
3 Nastiti/Sigit K 9/VI 26-8-2014
4 Andriyani/Hartadi K 8/VI 1-11-2014
Imunisasi TT
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Ika Noviyanti/Nur Yadi K 7/VI VC
2 Cecilia/Daud K 8/VI V
3 Chamidah/Subandi K 7/VI 27-4-2015
4 Yeni Indah A/M.Soleh K 8/VI 3-9-2015
Imunisasi TT
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Sri Murti/Moh.Taefur K 8/VI 18-1-2016
2 Eti Kurniasih/Urip S K8/VI 18-1-2016
3 Nur Inayah/Eko P K6/VI 18-1-2016 18-3-2016
4 Laelatul B/Eko Muttaqin K 6/VI 23-12-2015
5 Winni C/Sukamdani K 8/VI 22-12-2015
6 Nurhayati/Topo K8/VI 15-7-2016
LAPORAN BULANAN IMUNISASI BAYI
POSYANDU MAYANG SARI

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 Aryo Prakoso Kurniasih/Sugeng Santoso L 21-2-2009 8/VII 22-2-2009 6-3-2009 6-5-2009 11-6-2009 13-7-2009 6-3-2009 6-5-2009 11-6-2009 13-7-2009 8-1-2010
2 Queena Erythrina Adara Erlin Catarina/Kasir P 14-4-2009 1/VII 20-4-2009 29-5-2009 28-6-2009 28-7-2009 31-8-2009 29-5-2009 28-6-2009 28-7-2009 31-8-2009 20-1-2010
3 Shelfi Permata Chotimah/Bambang K P 28-12-2009 8/VII 28-12-2009 15-3-2010 25-2-2010 27-3-2010 22-4-2010 25-2-2010 15-3-2010 24-6-2010 23-9-2010 23-9-2010

DPT-HB Polio Penta Campak


HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang
1 Arief Maulana Khaedar Sekar Jatiningsih/Arifin L 29-1-2010 7/VII 30-1-2010 1-3-2010 27-3-2010 5-5-2010 24-6-2010 1-3-2010 24-6-2010 21-7-2010 1-11-2010 1-11-2010
2 Rifal Maulana Zain Cartisari/Junita L 28-7-2010 8/VII 28-7-2010 7-9-2010 22-12-2010 18-1-2011 19-4-2011 7-9-2010 22-12-2010 18-1-2011 19-4-2011 23-6-2011
3 Jasmine Aulia Radhwa R Indra Kusumanti/Donna W P 4-9-2010 7/VII 4-9-2010 6-10-2010 8-12-2010 26-1-2011 30-3-2011 6-10-2010 8-12-2010 26-1-2011 30-3-2011 19-7-2011
4 Rhama Rizal Khairudin Shinta Fitriyana/Wasiludin L 31-10-2010 8/VII 31-10-2010 6-12-2010 20-1-2011 24-2-2011 25-5-2011 6-12-2010 20-1-2011 24-2-2011 25-5-2011 20-8-2011
5 Keysha Regina Putri A Alpiyah/Diyartana P 30-11-2010 3/VII 5-12-2010 5-1-2011 29-1-2011 5-4-2011 7-5-2011 5-1-2011 29-1-2011 5-4-2011 7-5-2011 29-10-2011
6 Muh.Ibram Rizky M Ari Purwadaningsih/Kristanto L 20-12-2010 8/VII 21-12-2010 28-12-2010 21-2-2011 24-3-2011 2-5-2011 28-12-2010 21-2-2011 24-3-2011 2-5-2011 10-11-2011
7 Latifatul Diana Isya'i Danisah/Dulatip P 21-12-2010 8/VII 21-12-2010 28-12-2010 21-2-2011 24-3-2011 2-5-2011 28-12-2010 21-2-2011 24-3-2011 2-5-2011 10-11-2011

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 Ilham Reni/Kartubi L 1-1-2011 1/VII
2 Desy Aryani Yuni/Subkhi P 7-1-2011 3/VII
3 Rifki Febrian Sarini/Sarjani L 1-2-2011 8/VII
4 Dinda A Sulis/Agus P 4-2-2011 3/VII
5 Nafisa Gaisani Elok P "14-2-2011 4/VII
6 Anindya Tungga Dewi Beni/Febi P 15-3-2011 7/VII
7 Khaira Aditya Adi/Fikriya P 21-3-2011 6/VII
8 Rafi Agung Hidayat Warlina/Wiryono L 14-4-2011 1/VII
9 Salfa Anggun Kodriyah/Pujianto P 14-4-2011 3/VII
10 Syafira Aulia Shany Susiani/Sarkato P 20-4-2011 2/VII 21-4-2011 24-4-2011 23-6-2011 21-7-2011 20-8-2011 23-6-2011 21-7-2011 20-8-2011 31-1-2012 31-1-2012
11 Nadya Azka Syaqila Raodah/Achmad Fachrurrozi P 13-5-2011 2/VII 13-5-2011 5-6-2011 21-7-2011 20-8-2011 22-9-2011 5-6-2011 21-7-2011 20-8-2011 22-9-2011 13-2-2012
12 Falah Shyfa M Fatah P 17-5-2011 3/VII
13 Almira Leli/Topik P 25-5-2011 7/VII
14 Aisya Almaira Ika/Ganes P 27-5-2011 4/VII
15 M Ikbar Al Nunik/Punggung L 30-5-2011 3/VII
16 Fadilatur Najwa Nur Azizah/Kurnia P 19-6-2011 1/VII
17 Devan Izatil Hakim Lela S/Joko L 23-6-2011 1/VII 22-5-2014* 24-6-2014*
18 Atikah Intansari Kapsah/M.Mujahidin P 6-7-2011 3/VII 10-7-2011 17-7-2011 22-12-2011 28-5-2012 25-6-2012 17-7-2011 22-12-2011 28-5-2012 25-6-2012 13-8-2012 26-6-2014*
19 Ega Bisma Sanjaya Cianti/Rokhim L 8-7-2011 1/VII
20 Fardan Reza/Reksi L 12-7-2011 4/VII
21 Umar Abdul Basyir Nurlaelatul A/Surgianto L 19-7-2011 2/VII 22-5-2014*
22 Nurul Imtiyaaz Taripi/Tauchidin P 13-8-2011 2/VII 13-8-2011 26-9-2011 21-11-2011 22-12-2011 23-2-2012 12-9-2011 29-10-2011 22-12-2011 23-2-2012 2-7-2012
23 Eka Saraswati N.R. Tri Ken Narti/Triko Sugiatno P 17-8-2011 4/VIII 17-8-2011 29-8-2011 25-10-2011 24-11-2011 22-12-2011 29-8-2011 25-10-2011 24-11-2011 22-12-2011 24-5-2012 24-4-2014* 21-7-2014*
24 Dwi Arimbi N.R. Tri Ken Narti/Triko Sugiatno P 17-8-2011 4/VIII 17-8-2011 29-8-2011 25-10-2011 24-11-2011 22-12-2011 29-8-2011 25-10-2011 24-11-2011 22-12-2011 24-5-2012 24-4-2014* 21-7-2014*
25 Ashzarofatul Zam Zami Ika Setia H/Imam W P 22-8-2011 1/VII 26-6-2014* 21-7-2014*
26 Keisha Nur Afriyani Yeni/Teguh P 15-9-2011 3/VII 22-5-2014* 26-6-2014*
27 Fadil Nurul/Willi L 26-9-2011 3/VII
28 M Lukman Nur H Rucitra/Dina L 30-9-2011 5/VII
29 Abizaki Mubhi Sri Handayani L 10-10-2011 2/VII
30 Ikhsan Karniti/Roni L 4-11-2011 3/VII 21-8-2014*
31 Nur Azizah Nana/Andri P 18-11-2011 1/VII
32 Faiz Ahnaf Cariyah/Suryanto L 16-12-2011 1/VII
33 M.Delshadi Wibisono Leli S/Tommy L 19-12-2011 1/VII 22-5-2014* 26-6-2014*
34 Devina Syafira Khumairoh Tarningsih/Kaspu'i P 19-12-2011 8/VII 19-12-2011 26-1-2012 23-2-2012 26-4-2012 24-5-2012 26-1-2012 23-2-2012 26-4-2012 24-5-2012 1-10-2012
35 Farisa Nur Aqila Hanny Fadilah/Moh.Murtadho P 21-12-2011 1/VII 23-12-2011 10-1-2012 20-3-2012 20-4-2011 30-7-2011 10-1-2012 20-3-2012 20-4-2011 30-7-2011 23-9-2012 7-6-2014* 25-9-2014*
36 Nabila Suswanti/Mudofir P 24-12-2011 7/VII
37 Ibad Onan Nabiha Angga Pratomo L 29-12-2011 4/VII
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 Tegar Anastian Sujarwo Masturoh/Anto Sujarwo L 4-1-2012 3/VII 4-1-2012 7-2-2012 26-3-2012 26-4-2012 24-5-2012 7-2-2012 26-3-2012 26-4-2012 24-5-2012 9-10-2012 26-6-2014*
2 Faris A.F. Latifah/Syaifudin L 19-1-2012 7/VII 20-1-2012 25-1-2012 20-3-2012 22-5-2012 19-7-2012 25-1-2012 20-3-2012 22-5-2012 19-7-2012 V
Fardan St.Fatikha L 19-1-2012 7/VII TIDAK ADA
3 Khoirul Mazidan S Dewi Oktavia/Sefrudin L 24-1-2012 3/VII 24-1-2012 22-2-2012 24-3-2012 24-4-2012 24-5-2012 22-2-2012 24-3-2012 24-4-2012 24-5-2012 24-10-2012
4 Moh. Azar Adriyan Kerlina Elawati/Rinoso L 5-2-2012 2/VII 5-2-2012 7-3-2012 9-4-2012 7-5-2012 11-6-2012 7-3-2012 9-4-2012 7-5-2012 11-6-2012 25-2-2013
5 Aulia Fadillah Eka Puspa Dewi/M.Ratno P 17-3-2012 2/VII 18-3-2012 11-4-2012 10-10-2012 20-12-2012 23-1-2013 11-4-2012 10-10-2012 20-12-2012 23-1-2013 4-3-2013 22-5-2014*
6 Davino Althaaf H.P. Marliana Arini/Fauzan H L 17-3-2012 5/VII 17-3-2012 17-4-2012 20-5-2012 24-6-2012 20-9-2012 17-4-2012 20-5-2012 24-6-2012 20-9-2012 21-1-2013 21-7-2014* 21-8-2014*
7 Raykhan Azka Amaliah/Restu L 1-4-2012 3/VII 4-4-2012 22-4-2012 1-6-2012 2-7-2012 23-8-2012 22-4-2012 1-6-2012 2-7-2012 23-8-2012 5-1-2013 26-6-2014* 21-7-2014*
8 Widya Avrillianti A Sucianti Bunti/Widi Hartono P 7-4-2012 1/VII 7-4-2012 7-5-2012 21-6-2012 26-7-2012 30-8-2012 7-5-2012 21-6-2012 26-7-2012 30-8-2012 28-1-2013
Madabilly Ilyah/Boy Gunawan L 22-4-2012 1/VII 23-4-2012 22-5-2012 26-6-2012 30-7-2012 29-8-2012 22-5-2012 26-6-2012 30-7-2012 29-8-2012 18-3-2013 22-5-2014* 10-4-2015#
9 Divarima Ainara Safaat Delima Lili D/M.Safaat Rohim P 27-4-2012 3/VII 28-4-2012 29-5-2012 28-6-2012 28-7-2012 30-10-2012 29-5-2012 28-6-2012 28-7-2012 30-10-2012 30-1-2013 22-5-2014*
10 M. Fauzan A Yeti/Waridi L 2-5-2012 1/VII 2-5-2012 27-5-2012 17-7-2012 16-8-2012 18-9-2012 27-5-2012 17-7-2012 16-8-2012 18-9-2012 2-7-2013
11 Maria Felicia Hemi/Imam P 15-5-2012 7/VII 15-5-2012 18-7-2012 26-7-2012 30-8-2012 22-11-2012 26-5-2012 26-7-2012 30-8-2012 22-11-2012 21-3-2013
12 Rindu Arsya H Noviana/M.Nur P 9-6-2012 4/VII 9-6-2012 5-7-2012 5-9-2012 5-11-2012 11-12-2012 5-7-2012 5-9-2012 5-11-2012 11-12-2012 25-4-2013
13 Lisna Nur Afsari Kulsum/Moh.Zazuli P 11-6-2012 3/VII 11-6-2012 25-6-2012 30-8-2012 8-10-2012 13-11-2012 25-6-2012 30-8-2012 8-10-2012 13-11-2012 21-3-2013 24-4-2014* 25-9-2014*
14 Rizqi Hanimatul N.A. St. Aminah/Fachrudin P 12-6-2012 8/VII 12-6-2012 24-7-2012 6-3-2013 8-4-2013 24-6-2013 24-7-2012 6-3-2013 8-4-2013 24-6-2013 25-7-2012
15 Muh. Chaerul Firdaus Dita Siyani/Dedi Soleman L 15-6-2012 2/VII 16-6-2012 17-7-2012 17-8-2012 14-9-2012 14-10-2012 17-7-2012 17-8-2012 14-9-2012 14-10-2012 29-4-2013 22-5-2014*
16 Gisela Eka Prabowo Winda P 26-6-2012 5/VII 1-7-2012 8-8-2012 12-9-2012 10-10-2012 8-11-2012 8-8-2012 12-9-2012 10-10-2012 12-12-2012 1-4-2013 22-1-2015# 27-5-2015#
17 Rhaka Maulana Hasyim Eva Lilisetiawati/Fuad Hasim L 29-6-2012 2/VII 29-6-2012 25-7-2012 20-9-2012 8-12-2012 8-1-2013 25-7-2012 20-9-2012 8-12-2012 8-1-2013 25-4-2013 27-5-2015#
18 Ike Yuliani Ari Setyorini/Tumari P 20-7-2012 7/VII 20-7-2012 8-8-2012 20-9-2012 20-10-2012 20-11-2012 8-8-2012 20-9-2012 20-10-2012 20-11-2012 24-4-2013 22-5-2014*
19 Ervin Shula Julianto Widiarini/Maryanto L 20-7-2012 1/VII 21-7-2012 14-8-2012 20-9-2012 9-11-2012 14-12-2012 14-8-2012 20-9-2012 9-11-2012 14-12-2012 25-4-2013 22-5-2014* 26-6-2014*
20 Habibie Abdillah R Ika W/Indra Widiarto L 22-7-2012 4/VII 22-7-2012 25-7-2012 24-9-2012 22-10-2012 21-11-2012 25-7-2012 24-9-2012 22-10-2012 21-11-2012 25-4-2013 21-8-2014* 21-5-2015#
21 M.Bagas Arkansyahreza Susy Veronica/Tarono L 8-8-2012 2/VII 8-8-2012 11-9-2012 11-10-2012 11-11-2012 7-12-2012 11-9-2012 11-10-2012 11-11-2012 7-12-2012 23-5-2013 26-6-2014* 23-7-2015#
22 Gani Genza A Dwi Yanti/Wimarso L 13-8-2012 6/VII 14-8-2012 5-9-2012 19-10-2012 19-11-2012 25-2-2013 5-9-2012 19-10-2012 19-11-2012 25-2-2013 15-5-2013
Bintang Faiz Risti M Siti Jamilah/Rishendra L 20-8-2012 3/VII 21-8-2012 2-10-2012 5-11-2012 5-12-2012 7-1-2013 2-10-2012 5-11-2012 5-12-2012 7-1-2013 23-5-2013 PINDAH KAB
23 Aditya Pratama Riyati/Moh.Wahyu Junaedi L 23-8-2012 8/VII 23-8-2012 24-9-2012 22-10-2012 22-11-2012 21-1-2013 24-9-2012 22-10-2012 22-11-2012 21-1-2013 23-5-2013 22-5-2014*
Danang Alfian Fahrina L 10-9-2012 /VII TIDAK ADA 12-6-2013
M. Fatah Febi L 18-9-2012 2/VII PINDAH
24 Tifany Luisa Qistina Rohmawati/Budiyanto P 18-9-2012 1/VII 19-9-2012 16-10-2012 26-11-2012 26-12-2012 26-1-2013 16-10-2012 26-11-2012 26-12-2012 26-1-2013 8-7-2013 22-5-2014* 19-3-2015#
25 Syarif Ahmad Sulis R/Darmoyo L 20-9-2012 1/VII 25-9-2012 5-11-2012 3-12-2012 4-1-2013 6-3-2012 5-11-2012 3-12-2012 4-1-2013 6-3-2012 5-7-2013
26 Arya Wirabumi Febriana/Beni L 27-9-2012 7/VII 27-9-2012 4-9-2012 15-11-2012 4-9-2012 15-11-2012 V
27 Afika Nayla Althafunisa R Karyati/Riyanto P 29-9-2012 8/VII 30-9-2012 19-11-2012 10-12-2012 28-1-2013 4-3-2013 19-11-2012 10-12-2012 28-1-2013 4-3-2013 15-7-2013 22-5-2014* 23-4-2015#
28 Daffa Nur Maulana Ratna/Subhanur L 14-10-2012 8/VII 14-10-2012 5-12-2012 3-1-2013 6-2-2013 22-8-2013 5-12-2012 3-1-2013 6-2-2013 22-8-2013 24-10-2013 22-5-2014* 21-5-2015# RUSUNAWA
Lisbeth Firdreis Poti Setiyadi L 27-10-2012 /VII TIDAK ADA 11-6-2013 11-6-2013 21-8-2013
Okshelia Yhuna Darwati P 29-10-2012 1/VII PINDAH
29 Rendi Pratama Tushartini/Winoto L 1-11-2012 1/VII 1-11-2012 7-11-2012 9-1-2013 6-3-2013 9-4-2013 7-11-2012 9-1-2013 6-3-2013 9-4-2013 27-5-2015#
30 Hamizan Uqa'il Iman Nurchaiti W/Diarto L 6-11-2012 3/VII 6-11-2012 9-12-2012 26-1-2013 25-2-2013 25-3-2013 9-12-2012 26-1-2013 25-2-2013 25-3-2013 22-8-2013 22-5-2014* 20-11-2014*
31 Ali Fauzi Pratama Farkhatun/Suchaerun L 12-11-2012 3/IV 12-11-2012 7-1-2013 14-1-2013 14-2-2013 14-3-2013 7-1-2013 14-2-2013 14-3-2013 14-4-2013 16-9-2013 9-6-2014* 15-6-2015#
32 Humairo Azzahra Mela Yuliati/Iwan Fadilah P 19-11-2012 3/VII 19-11-2012 9-12-2012 23-1-2013 25-2-2013 25-3-2013 9-12-2012 23-1-2013 25-2-2013 25-3-2013 22-8-2013 22-5-2014* 20-11-2014*
33 Adinda Syafira Febrianti Desiyanti/Adikin Slamet P 12-12-2012 8/VII 20-12-2012 7-1-2013 4-3-2013 1-4-2013 6-5-2013 7-1-2013 4-3-2013 1-4-2013 6-5-2013 16-9-2013 26-6-2014* 19-3-2015#
34 M.Afif Endang W/Suswanto L 15-12-2012 8/VII 9-1-2013 15-2-2013 21-3-2013 25-4-2013 9-1-2013 15-2-2013 21-3-2013 25-4-2013 21-11-2013 26-6-2014* 22-12-2014*
Raja Pradipta Sinta/Duhay D L 23-12-2012 4/VII 23-12-2012 v 4-3-2013 PINDAH 4-3-2013 SUMUR PANGGANG
Imunisasi yang diberikan RSUK(2,2)
No Nama Bayi Nama Ortu L/P Alamat DPT-HB Polio Penta Campak Bd.D(2,6)
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang RSUK(3,7)s.c
Puji Elisa P 3-1-2013 1/VII PEKAUMAN Bd.D(3,0)
Dani Kurniawan Dairoh/Trisno L 22-2-2013 2/VII 22-2-2013 26-3-2013 PINDAH 26-3-2013 PANGGUNG RSUK(2,9)s.c
1 Fairel Athariz Calief Candra Dewi/Sunoto L 8-3-2013 1/VII 8-3-2013 5-4-2013 23-5-2013 20-6-2013 25-7-2013 5-4-2013 23-5-2013 20-6-2013 25-7-2013 31-12-2013 25-9-2014* 19-3-2015# Bd.E(2,9)
2 Insira Taqiya Ade Nisa/Yaser Arafat P 16-3-2013 6/VII MENOLAK
Hana Ruby Shahmina Risetin/Zulfikar P 19-3-2013 4/VII 20-3-2013 6-4-2013 23-5-2013 25-7-2013 26-9-2013 6-4-2013 23-5-2013 25-7-2013 26-9-2013 23-1-2014* PINDAH MGDN RSI(3070)
Sakinah/Haidar P 21-3-2013 6/VII 21-3-2013 PINDAH JAWA BARAT Bd.D(2,9)
3 Muh. Dzulqarnain Aniestia Nurmalita/Haruno L 26-3-2013 3/VII 26-3-2013 6-4-2013 26-6-2013 30-7-2013 21-8-2013 6-4-2013 26-6-2013 30-7-2013 21-8-2013 3-1-2014* 23-10-2014* RSUK(2,9)
4 Naufal Azmi Dafa Lili Indriani/Tofik R L 4-5-2013 8/VII 4-5-2013 10-6-2013 15-7-2013 19-8-2013 ` 11-6-2013 15-7-2013 19-8-2013 23-9-2013 3-3-2014* 20-11-2014* 21-5-2015# RSUK(4,5)s.c
5 Moh.Alby Farzan Ria D/Sakti L 10-5-2013 5/VII 10-5-2013 24-6-2013* 24-7-2013* 24-8-2013* 24-9-2013* 13-5-2013* 24-7-2013* 24-8-2013* 24-9-2013* 10-3-2014* 19-11-2015# 30-12-2015#
Rut Imanuella Elisabet Ervina/Andre P 25-5-2013 2/VII 25-5-2013 3-6-2013 1-8-2013 3-9-2013 3-10-2013 3-6-2013 1-8-2013 3-9-2013 3-10-2013 3-3-2014* PINDAH RSI(3,9)s.c
Nurul Aulia Sri Subekti/Casmidi P 1-6-2013 1/VII 1-6-2013 24-6-2013 5-8-2013 PINDAH 8-6-2013 5-8-2013 BUMIJAWA Bd.D(3,2)
6 M.Aqmar Leni/Totok L 2-6-2013 3/VII 2-6-2013 12-6-2013 3-8-2013 14-10-2013 26-12-2013* 12-6-2013 3-8-2013 14-10-2013 26-12-2013* RSMK(2,7)
7 Muh.Zaidin Zidan Komariyah/Widayatno L 5-6-2013 1/IV PINDAHAN ASTIKA A 25-6-2015#
Jaselin Christin Setiawati/Yulius H P 10-6-2013 5/VII 10-6-2013 17-7-2013 PINDAH 19-6-2013 17-7-2013 RANDUGUNTING RSI
8 Azzahrotul Sya'baniyah Nur Ihya Sofiyah/Feri M P 13-6-2013 7/VII 14-6-2013 19-6-2013 22-8-2013 21-10-2013 21-11-2013 19-6-2013 22-8-2013 21-10-2013 21-11-2013 20-3-2014* 22-1-2015# 30-7-2015# RSI(3,74)RUSUN
Velensia Alfita Winarti/Santoso P 14-6-2013 8/VII 14- 6-2013 1-7-2013* 1-9-2013* 1-10-2013* 1-11-2013* 1-7-2013* 1-9-2013* 1-10-2013* 1-11-2013* 12-4-2014* 22-12-2014* 25-6-2015# Bd.D(3)
Moh.Panut Eli Sofiyanti/Wardi L 20-6-2013 3/VII 20-6-2013 PINDAH ASTIKA A RSI(2860)
9 Nur Mu'adhom Qomar S Kasdiah/Kuwatno L 20-6-2013 8/VII 20-6-2013 1-7-2013 22-8-2013 26-9-2013 24-10-2013 1-7-2013 22-8-2013 26-9-2013 24-10-2013 20-3-2014* 22-12-2014* 22-1-2015# Bd.Mas(2,6)
Muh.Arkan Al Fatih Karina Anjar S/M.Abdul R L 21-6-2013 8/VII 21-6-2013 26-6-2013 22-8-2013 28-9-2013 26-10-2013 26-6-2013 22-8-2013 28-9-2013 26-10-2013 10-4-2014* PINDAH KAB
Pratama Aldo Saputra Indrawati/Wahyono L 23-6-2013 2/VII 27-6-2013 10-7-2013 19-9-2013 31-12-2013* 20-2-2014* 10-7-2013 19-9-2013 31-12-2013* 20-2-2014* 24-4-2014* PINDAH Bd.D(3,1)
10 Alya Farzana Ayunindya Tia Ruriani/Sartono P 23-6-2013 3/VII 24-6-2013 10-7-2013 23-8-2013 23-9-2013 23-10-2013 10-7-2013 23-8-2013 23-9-2013 23-10-2013 20-4-2014* 22-12-2014* 23-7-2015# RSI(2770)
11 Rania Qalisha Rizki A Ratna Fitriani/Widi A L 30-6-2013 5/VII 1-7-2013 29-7-2013 2-9-2013 7-10-2013 11-11-2013 8-7-2013 2-9-2013 7-10-2013 11-11-2013 7-4-2014* Bd.D(3,3)
12 Arzachel Zikriazha Tanti Irmawati/Suwitno L 12-7-2013 1/VII 12-7-2013 1-8-2013 12-9-2013 16-10-2013 16-11-2013 1-8-2013 12-9-2013 16-10-2013 16-11-2013 10-6-2014* 19-3-2015# 19-11-2015# Bd.E(3,2)
Sri Anisah/Riyanto L 15-7-2013 1/VII 16-7-2013 PINDAH Bd.Mas(2,6)
Betty Indriastuti/Widi P 23-7-2013 4/VII 25-7-2013 PINDAH RB.Rhm(3,4)sc
Aiko Tita Komalasari/Isnu S(T) P 13-5-2013 4/VIII 13-6-2013 12-7-2013 24-7-2013 6-9-2013 7-11-2013 12-7-2013 6-9-2013 7-11-2013 PINDAH YOGYA RSUK(4,1)
Afiifah Fitriani Winarsih/Arja Hadi M P 10-8-2013 1/VII 11-8-2013 10-9-2013 17-10-2013 PINDAH 10-9-2013 17-10-2013 PEGIRIKAN RSUK(3,15)
13 Ashila Khayla Salsabila Nur Anisah/Tomi Saputro P 13-8-2013 1/VII 14-8-2013 10-9-2013 13-10-2013 14-11-2013 15-12-2013 10-9-2013 13-10-2013 14-11-2013 15-12-2013 22-5-2014* 19-3-2015# 20-8-2015# RSUK(3,1)
14 Putra Latif Adzizan Cartisari/Junita L 15-8-2013 8/VII 22-8-2013 23-9-2013 24-10-2013 21-11-2013 31-12-2013 23-9-2013 24-10-2013 21-11-2013 31-12-2013 22-5-2014* 26-2-2015# 20-8-2015# Bd.D(3,4)
15 Bagus Pratama Rochani/Sudoro L 15-8-2013 2/VII 16-8-2013 20-9-2013 25-10-2013 20-12-2013 18-3-2014* 20-9-2013 25-10-2013 20-12-2013 18-3-2014* 10-6-2014* MENOLAK Bd.L(3,1)
Giyati Panca/Budi K P 26-8-2013 3/VII 26-8-2013 PINDAH Bd.D(3,2)
16 Cello Aqila Pranaja Eli Hartati/Johani L 3-9-2013 8/VII 3-9-2013 20-9-2013 21-11-2013 31-12-2013 24-4-2014* 20-9-2013 21-11-2013 31-12-2013 24-4-2014* 26-6-2014* 23-4-2015# 22-9-2015# RB.Rhm(3,2)
17 Agung Setiawan Nurfitriyah/Nopan Riyanto L 16-9-2013 8/VII 16-9-2013 28-10-2013 2-12-2013 31-12-2013 20-2-2014* 28-10-2013 2-12-2013 31-12-2013 20-2-2014* 26-6-2014* 19-3-2015# 22-9-2015#
Diana/Akhmad L 23-9-2013 Rmbt14 23-9-2013 RW VIII
Syifa Ahmad Fauzan Tika/Mukhatab L 24-9-2013 5/VII 24-9-2013 30-10-2013 16-11-2013 17-12-2013 24-1-2014 30-10-2013 16-11-2013 17-12-2013 24-1-2014 PINDAH
18 Aqila Silmi Nafisah Eka Kuntari/Samsudin P 7-10-2013 1/VII 8-10-2013 5-11-2013 20-12-2013 21-1-2014* 7-3-2014* 5-11-2013 20-12-2013 21-1-2014* 7-3-2014* 10-8-2014* MENOLAK RS.Adela(3,6)
19 Mohammad Ali Murtadho Hanny Fadilah/M.Murtadho L 12-10-2013 1/VII 13-10-2013 5-11-2013 31-12-2013 5-3-2014* 22-5-2014* 5-11-2013 31-12-2013 5-3-2014* 22-5-2014* 21-8-2014* 23-4-2015# 22-10-2015# RB.Rhm(2,9)
Farkhan Fauzian Sri Wulandari/Damir L 12-10-2013 1/VII 13-10-2013 5-11-2013 PINDAH 5-11-2013 TEGALSARI RSI
Indriyani Salsabila Sonah/Wahyudin P 12-10-2013 1/VII 17-10-2013 25-11-2013 31-12-2013 20-2-2014* 16-4-2014* 25-11-2013 31-12-2013 20-2-2014* 16-4-2014* 21-5-2015 PINDAH RB.Rhm
Gibran Kashafa Alfaresqi Defi/Imanul Maula L 24-10-2013 2/VII 20-11-2013 25-12-2013 9-2-2014* 29-3-2014* 20-11-2013 25-12-2013 9-2-2014* 29-3-2014* 20-8-2014* 3-7-2015# PINDAH
20 Mandala Berlianto Suhamah/Darmanto L 28-10-2013 1/VII 28-10-2013 20-11-2013 31-12-2013 1-2-2014* 3-3-2014* 20-11-2013 31-12-2013 1-2-2014* 3-3-2014* 11-8-2014* 21-4-2016^ 18-8-2016^
21 Mohamad Ziyadurrisqi Rusyanti/Duladjis L 28-10-2013 8/VII 28-10-2013 10-12-2013 23-1-2014* 20-2-2014* 24-4-2014* 10-12-2013 23-1-2014* 20-2-2014* 24-4-2014* 21-8-2014* 23-4-2015# 22-10-2015#
Gibran Atalan Raja Tawang/Gan gan(TAMU) L 3-11-2013 4/VIII 16-1-2014* 17-2-2014* 16-1-2014* 17-2-2014*
Adiasta Fabian Isti/Pwan Setiati(TAMU) L 9-11-2013 7/VII 9-11-2013 11-1-2014* 10-2-2014* 11-1-2014* 10-2-2014*
22 Dzafran Dhar Al Ghifa Rizki M.Sidik/Heri Tri W L 17-12-2013 3/VII 17-12-2013 5-1-2014* 4-3-2014P* 4-4-2014P* 4-5-2014P* 5-1-2014* 4-3-2014* 4-4-2014* 4-5-2014* 17-9-2014* 30-7-2015# 21-1-2016^
23 Fahira Rumaisha Putri Ani Hidayati/Angga Pratomo P 17-12-2013 4/VII 17-12-2013* 17-2-2014* 20-3-2014P* 13-5-2014P* 26-6-2014P* 26-12-2013* 17-2-2014* 20-3-2014* 13-5-2014* 29-9-2014* 20-8-2015# 30-12-2015#
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 Feby Azhar Mauliddina Rita Wijayanti P 15-1-2014 8/VII 17-1-2014 10-3-2014 24-3-2014P 24-4-2014P 22-5-2014P 10-3-2014 24-4-2014 22-5-2014 21-8-2014 23-10-2014 23-7-2015# 21-4-2016^ RSIAKI(2,8)sc
2 Muh.Fauzan Zakaria Marini/ Muh.Athory L 13-3-2014 2/VII 14-3-2014 20-5-2014 3-7-2014P 6-8-2014P 18-9-2014P 20-5-2014 3-7-2014 6-8-2014 18-9-2014 20-12-2014 20-8-2016^ 20-10-2016^ Bd.D(3,6)
3 Keandra Ghaziya A.J. Tusy Mispasari P 14-3-2014 6/VII 14-3-2014 17-5-2014 31-5-2014P 2-8-2014P 30-10-2014# 21-3-2014 31-5-2014 2-8-2014 30-10-2014# 20-12-2014# RSMK
4 Abdul Antasari Riyanti/Darsono L 17-3-2014 1/VII 17-3-2014 20-4-2014 22-5-2014P 26-6-2014P 21-8-2014P 20-4-2014 22-5-2014 26-6-2014 21-8-2014 26-2-2015# 21-4-2016^ 16-6-2016^ RSUK(2,7)sc
Neli Yuliana/Yunianto P 18-3-2014 2/VII 18-3-2014 TIDAK ADA RB.Rhm(3)
5 Rosi Ariyah/Lutfi L 9-4-2014 1/VII 9-4-2014 MENOLAK RB.Rhm(3,5)
Al Ghifary (Tamu) Suharni/Joni L 19-4-2014 3/VII 19-4-2014 14-5-2014 15-7-2014 14-9-2014 19-10-2014 14-5-2014 15-7-2014 14-9-2014 19-10-2014 9-3-2015# PINDAH
Daffa Ibra Al Habsyi S Wiyuniyati/Adji Suprapto L 22-4-2014 1/VII 22-4-2014 26-5-2014 26-6-2014P 26-7-2014P 27-8-2014P 30-4-2014 26-5-2014 26-6-2014 26-7-2014 20-2-2015# PINDAH JAKARTA RSI(2,8)
6 Alesha Raihana A Ika Setiawati/Ganes P 26-4-2014 4/VII 26-4-2014 18-6-2014 19-7-2014 13-9-2014P 14-11-2014P 3-5-2014 19-7-2014 13-9-2014 14-11-2014 11-3-2015# RSI(2,8)
Brigita Maria/Pong Senghan P 28-4-2014 1/VII 28-4-2014 TIDAK ADA RB.Rhm(3,6)
Kenan Paska Natanael Dhita/Yoel Hari S(Tamu) L 30-4-2014 5/VII 30-4-2014 V PINDAH V JAKARTA RSMK(3,5)sc
7 Airin Salsabila Elo Navila/Dedi(Tamu) P 5-5-2014 3/VII 5-5-2014 20-6-2014 20-7-2014P 20-8-2014P 20-9-2014P 20-6-2014 20-7-2014 20-8-2014 20-9-2014 20-2-2015# 18-2-2016^ 18-8-2016^ RSUK(3,25)
8 Moh.Fikri Hanif Dwi Handayani/Madi S L 7-5-2014 3/VII 7-5-2014 18-5-2014 21-7-2014P 21-8-2014P 25-9-2014P 18-5-2014 21-7-2014 21-8-2014 25-9-2014 26-2-2015# 30-12-2015# Bd.D(3,5)
9 Mohamad Fatdil Rizki Nurhasanah/Riswandi L 14-5-2014 2/VII 14-5-2014 20-6-2014 20-7-2014P 18-8-2014P 15-9-2014P 20-6-2014 20-7-2014 18-8-2014 15-9-2014 20-2-2015# 30-12-2015# 21-7-2016^ RSUK(3)sc
Anisa Ainil Husna Casyati/M.Nurfatoni(Tamu) P 13-5-2014 1/VII 13-5-2014 16-6-2014 14-7-2014P 13-8-2014P 13-9-2014P 22-5-2014 14-7-2014 13-8-2014 13-9-2014 23-2-2015# PINDAH RSI(3,3)sc
Fitri Ayu W/Moch.Farid N P 18-5-2014 Rmbt VI/8 18-5-2014 TIDAK ADA RSI(2,8)
10 Almira Salsabila Siti Laeli/Taufik Irfan P 25-5-2014 7/VII 25-5-2014 30-6-2014 7-8-2014P 4-9-2014P 3-10-2014P 30-6-2014 7-8-2014 4-9-2014 3-10-2014 25-2-2015# 30-12-2015# Pusk(3,4)
11 Rasya Nasidik Sufatmi/Moh.Sodik(6/) P 27-5-2014 5/IIIa PINDAHAN 22-9-2014P 23-10-2014P MEKARSARI 22-9-2014 23-10-2014 26-2-2015# 30-12-2015# 16-6-2016^ RSI(3,3)
12 Jihan Talita Ulfa Meli Andrijati/Wari Priyadi P 2-6-2014 3/VII 2-6-2014 20-6-2014 2-8-2014P 31-8-2014P 27-9-2014P 20-6-2014 2-8-2014 31-8-2014 27-9-2014 25-2-2015# 30-12-2015# 21-7-2016^ RB.St.Hj(2,9)
13 Nadifa Siti Aminah/Fahrudin P 9-6-2014 8/VII 9-6-2014 1-9-2014 21-8-2014P 25-9-2014P 27-10-2014P 21-8-2014 25-9-2014 27-10-2014 23-4-2015# 20-6-2015# 21-1-2016^ Pusk(3,5)
Fanezha Syaraqy Tetes Yulifitri/Zarwan P 11-6-2014 6/VII 11-6-2014 1-7-2014 12-8-2014P 16-12-2014# 26-1-2015# 1-7-2014 12-8-2014 16-12-2014# 26-1-2015# PINDAH RSUK(3,3)
14 Hanifah Nur Surti/Kuswoyo P 5-7-2014 8/VII 6-7-2014 25-8-2014 25-9-2014P 23-10-2014P 20-11-2014P 25-8-2014 25-9-2014 23-10-2014 20-11-2014 23-4-2015# 21-1-2016^ 21-7-2016^ RSUK(2,3)
Novi Setyani/Denny L 7-7-2014 7/VII 8-7-2014 DOMISILI MEJASEM RSI(3)sc
15 Assyafa Dila Ramadani Nopi/Hendri P 9-7-2014 8/VII 9-7-2014 5-8-2014 24-9-2014P 23-10-2014P 20-11-2014P 5-8-2014 24-9-2014 23-10-2014 20-11-2014 23-4-2015# 21-1-2016^ 21-7-2016^ Bd.Las(2,8)RUSUNAWA
16 Kasyeff Malik Nia Kurniawati/Hendrata L 27-7-2014 7/VII TIDAK 1-12-2014 19-1-2015# 23-2-2015# 13-4-2015# 8-10-2014 1-12-2014 19-1-2015# 23-2-2015# 15-6-2015# 16-6-2016^ RSI(1,1)sc
17 Naura Aisha Salma Shinta Fitriyana/Wasiludin P 10-8-2014 8/VII TIDAK 29-9-2014 23-10-2014P 24-11-2014P 22-12-2014P 29-9-2014 23-10-2014 24-11-2014 22-12-2014 21-5-2015# 18-8-2016^ Bd.D(2,1)
Siska Wulandari Karmila/Siswoyo P 17-8-2014 3/VII 17-8-2014 18-8-2014 23-10-2014P 20-11-2014P 22-12-2014P 18-8-2014 23-10-2014 20-11-2014 22-12-2014 21-5-2015# PINDAH DEBONG PTB(2,9)
Michael Heru Widodo Kristanti W/Marcel P 26-8-2014 7/VII 27-8-2014 PINDAH RSMK(2,67) sc
19 Rafif Aimar Pratama A.Yuli W/Partono L 1-9-2014 3/VII 1-9-2014 6-10-2014 10-11-2014P 8-12-2014P 19-1-2015# 6-10-2014 10-11-2014 8-12-2014 19-1-2015# 8-6-2015# 21-7-2016^ RSUK(3,8)
Nur Azizah/Kurnia Hatma P 4-9-2014 1/VII 4-9-2014 PINDAH RSI
20 Isa Abdurrahman Aniestia N/Haruno Nur S L 4-9-2014 3/VII 4-9-2014 5-10-2014 5-11-2014P 5-12-2014P 7-1-2015# 5-10-2014 5-11-2014 5-12-2014 7-1-2015# 20-6-2015# 23-4-2016^ Bd.D(3,6)
21 Nur Syifa Azzahra Nur Fitriana/Firman H P 6-9-2014 3/VII 6-9-2014 5-10-2014 6-11-2014P 6-12-2014P 6-1-2015# 5-10-2014 6-11-2014 6-12-2014 6-1-2015# 10-6-2015# 10-3-2016^ 10-9-2016^ Bd.D(2.5)
22 Jena Talita Shidqi Noviana Maulida/M.Nur K P 16-9-2014 4/VII 16-9-2014 5-11-2014 5-12-2014P 22-1-2015# 26-2-2015# 5-11-2014 5-12-2014 22-1-2015# 26-2-2015# 23-7-2015# 18-8-2016^ Bd.L(3,8)
Yohana Durita P 25-9-2014 4/VII 25-9-2014 PINDAH RSMK(3)
23 Hanin Aulia Syifa R.A.Komalasari/Ade Prasetyo P 1-10-2014 4/VII 1-10-2014 3-11-2014 22-12-2014P 22-1-2015# 26-2-2015# 9-10-2014 22-12-2014 22-1-2015# 26-2-2015# 23-7-2015# 21-4-2016^ 20-10-2016^ RSUK(2,9)sc
24 Gigih Okta Fahira Kurniasih/Sugeng P 2-10-2014 8/VII 3-10-2014 26-11-2014# 6-12-2014P 6-1-2015# 6-2-2015# 8-10-2014# 6-12-2014 6-1-2015# 6-2-2015# 7-9-2015# 21-4-2016^ RSI(2,54)sc
25 Silva Oktaviani St.Sri Wulandari/Nuri Faozi P 5-10-2014 8/VII 5-10-2014 10-10-2014 22-12-2014P 22-1-2015# 19-3-2015# 10-10-2014 22-12-2014 22-1-2015# 19-3-2015# 23-7-2015# 16-6-2016^ PTB(3)
Gilang RS Ika Rahayu/Heri Suwarno L 8-10-2014 4/VII 8-10-2014 15-10-2014 26-12-2014# 26-1-2015# PINDAH 15-10-2014 26-12-2014# 26-1-2015# PINDAH RB.St.Hj(2,7)
26 Ardelisa Syarifah Nur Retno Selfia/Panji Setiaji P 9-10-2014 2/VII 9-10-2014 10-11-2014 10-12-2014P 10-1-2015# 10-2-2015# 10-11-2014 10-12-2014 10-1-2015# 10-2-2015# 10-7-2015# 20-8-2016 RSI(3)sc
27 Rekhan Kustoro Kotimah/Bambang K L 17-10-2014 8/VII 20-10-2014 24-11-2014 29-12-2014# 26-2-2015# 23-4-2015# 24-11-2014 29-12-2014# 26-2-2015# 23-4-2015# 23-7-2015# 16-6-2016^ RSI(3,48)
28 Azfar Hamizan Maulana Titin Sumiyati/Hari Wiharso L 18-10-2014 4/VII 18-10-2014 19-11-2014 19-12-2014P 19-1-2015# 23-2-2015# 19-11-2014 19-1-2015# 23-2-2015# 30-3-2015# 23-7-2015# 21-4-2016^ 20-10-2016^ RSI(3,2)
29 Raihan Asraf Ika Widya/Indra Widiarto L 25-10-2014 4/VII 25-10-2014 1-12-2014 29-12-2014P 2-2-2015# 2-3-2015# 1-12-2014 29-12-2014 2-2-2015# 2-3-2015# 3-8-2015# RSI(3,9)
30 Sabrina Kaureen Irdiana Dini/Wahyu T P 31-10-2014 7/VII 28-10-2014 3-12-2014# 19-1-2015 2-3-2015# 2-4-2015# 3-12-2014# 19-1-2015# 2-3-2015# 2-4-2015# 12-8-2015# RB.Rhm(3)
31 Bilfaqih M.Nazirul Asrafi Erlina Purwanti/M.Fadil L 1-11-2014 1/VII 1-11-2014 20-12-2014 11-1-2015# 15-2-2015# 14-3-2015# 20-12-2014 11-1-2015# 15-2-2015# 14-3-2015# 10-8-2015# RB.Rhm(3,2)
32 Adelia Faranisa Azni Windiati/Khasan Bisri P 5-11-2014 1/VII 5-11-2014 10-12-2014# 10-1-2015# 10-2-2015# 19-3-2015# 10-12-2014# 10-1-2015# 10-2-2015# 19-3-2015# 20-8-2015# Bd.D(3,3)
33 Naysila Noviani Cariyah/Suryanto P 6-11-2014 1/VII 6-11-2014 5-12-2014# 8-1-2015# 8-2-2015# 19-3-2015# 5-12-2014# 8-1-2015# 8-2-2015# 19-3-2015# 10-8-2015# 19-5-2016^ Bd.Las(2,9)
Fatimah Rodhiyah/Alex Wibowo P 11-11-2014 1/VII 12-11-2014 PINDAH RSI(3,2)
Lintang Bayu Seno Siti Rahayu/Iwan L 15-11-2014 1/VII 15-11-2014 22-12-2014 16-1-2015# 26-2-2015# 23-4-2015# 22-12-2014 22-1-2015# 26-2-2015# 23-4-2015# PINDAH ASTIKA C RSUK(3,4)ve
34 Damar Elke Raditya Mike/Bondan L 3-12-2014 4/VII 3-12-2014# 21-1-2015# 9-2-2015# 9-3-2015# 21-4-2015# 13-12-2014# 9-2-2015# 9-3-2015# 21-4-2015# 22-9-2015# 18-8-2016^ RSI(2,9)
35 Kevin Dias Saputra Ani Supriyati/Wahidin L 17-12-2014 8/VII 17-12-2014# 10-1-2015# 18-2-2015# 23-4-2015# 6-6-2015# 10-1-2015# 18-2-2015# 23-4-2015# 25-6-2015# 22-9-2015# 18-8-2016^ RSI(2,8)

Imunisasi yang diberikan 22-10-15


No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak
HBU BCG Campak
Lahir (Rt / Rw) 1 2 1 2 3 4 Ulang Ulang
1 Ade Nisa F/Yaser Arafat P 25-1-2015 6/VII MENOLAK RSI(3,1)sc
2 Fathan Al Maisan Zhafar Wiwi Widiarti L 31-1-2015 3/VII 1-2-2015 23-2-2015 6-4-2015 18-5-2015 27-6-2015 23-2-2015 6-4-2015 18-5-2015 27-6-2015 16-11-2015 RSI(3,15)
3 Muh.Alby Luthfy Fachry Deniati/Diarto L 4-2-2015 8/VII 4-2-2015 18-2-2015 23-4-2015 21-5-2015 23-7-2015 18-2-2015 23-4-2015 21-5-2015 23-7-2015 19-11-2015 RB.St.Hj(3)
4 Muh.Rifa'i (Tamu) Indria Sulistiowati/Asep S L 13-2-2015 2/VII 12-3-2015 16-3-2015 21-5-2015 25-6-2015 23-7-2015 16-3-2015 21-5-2015 25-6-2015 23-7-2015 19-11-2015 Bd.D(3)
5 M.Dzaki Adiwiansyah Winda Widyawati/Adi W L 20-2-2015 5/VII 20-2-2015 1-4-2015 23-4-2015 21-5-2015 25-6-2015 1-4-2015 21-5-2015 25-6-2015 23-7-2015 19-11-2015 PTS(2,9)
6 Alesha Naura(T) Halimah/Teguh P 21-2-2015 6/VII 21-2-2015 20-4-2015 9-5-2015 6-6-2015 7-7-2015 21-2-2015 20-4-2015 6-6-2015 7-7-2015 2-12-2015 15-9-2016^ Bd.Jkrt
7 Athoila Nuril Fajri Nunik Nur F/Punggung S L 23-2-2015 3/VII 23-2-2015 23-3-2015 27-4-2015 15-6-2015 24-8-2015 23-3-2015 27-4-2015 15-6-2015 24-8-2015 30-12-2015 15-9-2016^ RSI(3)
8 Syakira Yuka Humaira Eka Nur Hidayah/M.Yunus P 2-3-2015 3/VII 2-3-2015 15-4-2015 2-5-2015 2-6-2015 3-7-2015 15-4-2015 2-5-2015 2-6-2015 3-7-2015 RSI(3,6)
9 Aisha Syauqina Fickria Hasan/Sudi P(DF/10) P 13-3-2015 7/VII 13-3-2015 30-4-2015 19-5-2015 7-7-2015 20-10-2015 27-3-2015 19-5-2015 7-7-2015 20-10-2015 17-12-2015^ Bd.Mas(3,4)
10 Reinan Saputra Diah Nur Vianti/ Agus S. L 11-4-2015 4/VII Panggung 10-7-2015 31-7-2015 31-8-2015 29-9-2015 20-4-2015 31-7-2015 31-8-2015 29-9-2015 20-1-2016^ Rb.Rhm(3,1)
11 Raffaza Devaputra P Tri Feriana/Yunandra(DF/10) L 15-4-2015 4/VII 16-4-2015 4-6-2015 17-7-2015 15-8-2015 11-11-2015 24-4-2015 17-7-2015 15-8-2015 11-11-2015 28-1-2016^ RSI(3,5)
12 Amira Maritza Arini Marini/Muhammad Athory P 24-4-2015 2/VII 25-4-2015 20-5-2015 10-7-2015 10-8-2015 20-9-2015 20-5-2015 10-7-2015 10-8-2015 20-9-2015 21-3-2016^ PTT
13 Chayra Fayyora Nadhira Intan Permata S/Nur Aulia F P 14-5-2015 1/VII 15-5-2015 10-6-2015 20-7-2015 24-8-2015 26-9-2015 10-6-2015 20-7-2015 24-8-2015 26-9-2015 10-5-2016^ RSUK(3,5)
14 Arsyla Nur Azka Prasetyo Nur Baety/ Arifin Budi P P 31-5-2015 7/VII 31-5-2015 29-6-2015 30-7-2015 25-9--2015 26-10-2015 29-6-2015 30-7-2015 25-9-2015 26-10-2015 18-4-2016^
15 Rafa Dwi Adhiyasta Wirabuana Donna W/Indra Kesuma L 9-6-2015 7/VII 9-6-2015 29-6-2015 10-8-2015 14-9-2015 19-10-2015 23-7-2015 20-8-2015 22-9-2015 19-10-2015 17-3-2016^ Bd.Rug(3,5)
16 Kenisha Fathiyya R Rosi Ariyah/Lutfi Arouf P 28-6-2015 5/IV 28-6-2015 29-7-2015 2-9-2015 5-10-2015 7-11-2015 29-7-2015 2-9-2015 5-10-2015 7-11-2015 16-6-2016^
17 Keisha Fathina R Rosi Ariyah/Lutfi Arouf P 28-6-2015 5/IV 28-6-2015 29-7-2015 2-9-2015 5-10-2015 7-11-2015 29-7-2015 2-9-2015 5-10-2015 7-11-2015 16-6-2016^ RSI(3,1)
18 Sekar Ayu Putri K Desi I/Topik H P 14-7-2015 3/VII 15-7-2015 19-8-2015 19-9-2015 20-10-2015 21-11-2015 19-8-2015 19-9-2015 20-10-2015 21-11-2015 27-4-2016^ RSI(3,2)
19 Kenzo Putra Franaya Yanti A/Marcus(DF/10/1) L 19-7-2015 3/VII 20-7-2015 27-7-2015 22-9-2015 22-10-2015DF 19-11-2015 27-7-2015 22-9-2015 22-10-2015DF 19-11-2015 21-4-2016^ Rb.Rhm(2,6)
20 Amalia Fachrunisa Yuli P/Herman(DF/10/2) P 22-7-2015 2/VII 23-7-2015 10-8-2015 22-9-2015 22-10-2015DF 23-11-2015 10-8-2015 22-9-2015 22-10-2015DF 23-11-2015 16-6-2016^ Bd.D(3,0)
Nazalia k/Abdu Salam L 30-7-2015 1/VII 31-7-2015 PINDAH SEJAHTERA A RSUKsc
Lintang Mukhbita Tiberli/Riski P 24-8-2015 6/VII 25-8-2015 16-10-2015 PINDAH 2-9-2015 JAKARTA RSI(3)sc
21 Keisya Adhara Adia Suryani/Andi Mulyono P 26-8-2015 1/VII 26-8-2015 28-9-2015 2-11-2015 7-12-2015 21-1-2016^ 3-9-2015 2-11-2015 7-12-2015 21-1-2016^ 20-8-2016^ RSUK(3,4)RUSUN
22 Gigieh Rafif Alfarezki Dwi Tunjung K/Mukti W L 28-8-2015 4/VII 31-8-2015 30-9-2015 24-11-2015 5-3-2016 11-5-2016^ 30-9-2015 24-11-2015 5-3-2016^ 11-5-2016^ 8-6-2016^ Bd. A (3,1)
23 Shavira Putri Fadillah Dewi S/Rohmatulloh P 3-9-2015 1/VII 3-9-2015 10-10-2015 19-11-2015 30-12-2015 25-1-2016^ 11-9-2015 10-10-2015 19-11-2015 30-12-2015 15-6-2016^ RS.PlRy(2,8)sc
24 Mahira Cordellia Sulastri/Wahyu S P 7-9-2015 7/VII 7-9-2015 16-9-2015 24-11-2015 23-12-2015 31-1-2016 16-9-2015 24-11-2015 23-12-2015 31-1-2016 16-6-2016^
25 Maryam Putri Hayyin Harry W/Layyina P 11-9-2015 5/VII 11-9-2015 13-10-2015 26-11-2015 13-1-2016 23-3-2016 13-10-2015 26-11-2015 13-1-2016 23-3-2016 21-7-2016^
Infadilah Nurul/Faiq P 27-9-2015 4/VII 27-9-2015 5-11-2015 PINDAH 5-10-2015 PINDAH PTB(3,5)
26 Hasna Nabila NurBaeti/Wahyu P 6-10-2015 8/VII 6-10-2015 10-11-2015 10-12-2015 15-1-2016^ 19-2-2016^ 13-10-2015 10-11-2015 10-12-2015 15-1-2016^ 21-7-2016^ PTB(2,9)
27 Agam Fatul Halim Cuswatun C / Iwan Sugito L 20-10-2015 2/VII 21-10-2015 16-11-2015 14-1-206 11-2-2016 12-7-2016^ 16-11-2015 14-1-2016 11-2-2016 12-7-2016^
28 Muhammad Rizki Nur Nafisah/Fariyantoro L 28-10-2015 1/VII 29-10-2015 30-11-2015 30-12-2015^ 19-2-2016^ 17-3-2016^ 30-11-2015 30-12-2015^ 19-2-2016^ 21-4-2016^ RB.Rhm(3,2)
29 Abinaya Arkan Budiarto Veni Fitri/Doni Budiarto L 28-10-2015 4/VII 29-10-2015 3-12-2015^ 3-1-2016^ 6-2-2016^ 9-3-2016^ 3-12-2015^ 3-1-2016^ 6-2-2016^ 21-4-2016^ 24-8-2016^ RSUK(2,6)SC
30 Abrisam Adam Abisat Septriyani/Teguh P L 15-11-2015 8/VII 15-11-2015 21-1-2016^ 18-2-2016^ 21-4-2016^ 19-5-2016^ 21-1-2016^ 18-2-2016^ 21-4-2016^ 19-5-2016^ 15-9-2016^ RSI(3,1)
31 Kezhia Safa Almira Heni Kristiana/Mahardika P 15-12-2015 2/VII 15-12-2015 20-1-2016^ 17-2-2016^ 15-3-2016^ 13-4-2016^ 20-1-2016^ 17-2-2016^ 15-3-2016^ 13-4-2016^ 28-9-2016^ RSI(2,5)
32 Fauziah Nurhikmah Yeti Nurazizah/Waridi P 15-12-2015 1/VII 16-12-2015^ 22-12-2015^ 18-2-2016^ 17-3-2016^ 19-5-2016^ 22-12-2015^ 18-2-2016^ 19-5-2016^ 16-6-2016^
33 Adinda Zahra Zahira Rusniyati/Teguh P 16-12-2015 1/VII 17-12-2015 11-1-2016^ 18-2-2016^ 11-4-2016^ 16-5-2016^ 11-1-2016^ 18-2-2016^ 11-4-2016^ 16-5-2016^ Rb.Rhm(3,0)
Arya Dzaki Pradana Desi Oktavia/Tabana L 19-12-2015 2/VII 19-12-2015 21-1-2016^ 20-2-2016^ 21-3-2016^ PINDAH 29-12-2015^ 20-2-2016^ JAKARTA
34 Defa Khaira Maulidya Desyarti/Windu P 29-12-2015 8/VII 29-12-2015^ 11-1-2016^ 18-2-2016^ 21-4-2016^ 16-6-2016^ 11-1-2016^ 18-2-2016^ 21-4-2016^ 16-6-2016^ 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 Ghalibia Quinna Hafiza Nuni Faturohmah/Slamet P 2-3-2016 3/VII 2-3-2016 20-4-2016 19-5-2016 21-6-2016 26-7-2016 20-4-2016 19-5-2016 21-6-2016 26-7-2016 RSI(3,25)
2^ M.Azmi Huda K Kasiyani/Royani L 21-3-2016 8/VII 22-3-2016 18-4-2016 6-6-2016 21-7-2016 18-8-2016 18-4-2016 6-6-2016 21-7-2016 18-8-2016 RSUD(2,7)
3 Moh. Alaric A. Akbar Yunike Riska/Abdul Azas A L 17-4-2016 4/VII 17-4-2016 26-5-2016 18-6-2016 30-7-2016 3-9-2016 23-4-2016 18-6-2016 30-7-2016 3-9-2016 RSI(3)
Yuni Listiana L 26-4-2016 8/VII 26-4-2016 PINDAH KABUPATEN RB.Khr(3,3)
Dina Daniyati/Rucitra 16-4-2016 5/VII BAYI PLUS
4 M. Khairul Azam Bestri Tri F/ Affan Fathar L 27-4-2016 4/VII 27-4-2016 1-6-2016 1-7-2016 2-8-2016 2-9-2016 1-6-2016 1-7-2016 2-8-2016 2-9-2016
5 Haidar Ali Maemunah/M.Zein L 2-5-2016 2/VII MENOLAK IMUNISASI RSMK(3,4)
6 Ghania Ardani Elok/Eka Dani L 25-5-2016 4/VII 25-5-2016 25-6-2016 25-6-2016
7 Lintang Saputri Indah/Kasanudin P 28-6-2016 8/VII 27-6-2016 11-7-2016 15-9-2016 20-10-2016 11-7-2016 20-10-2016 RSI
8 Meysha Khaliqa Dzahin Fenny Purwati/Abdul Gofar P 3-7-2016 1/VII 3-7-2016 20-7-2016 15-9-2016 20-10-2016 20-7-2016 20-10-2016 RSUK(3,4)sc
9 Arsyila Keysha Anastasya Kerlina /Rinoso P 13-7-2016 2/VII 14-7-2016 10-9-2016 10-10-2016 10-9-2016 10-10-2016 Bd.Dnk(3,6)
10 Moh. Irfan Dwi Aryana Wiwik/Wastar L 26-8-2016 2/VII 26-8-2016 29-8-2016 14-11-2016 29-8-2016 14-11-2016 PTB(3,5)
11 Ivandra Vanara Murdiono Elva Novitasari/Eko M L 26-8-2016 1/VII 26-8-2016 -10-2016 -10-2016 RSUK(4,2)
12 Suswanti/Kasmudi P 30-9-2016 4/VII Rb.Khr(3750)
winda apriyatin/ M nababuri L 4-11-2016 1/VII 5-11-2016

Imunisasi TT
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
2 Eka Nurhidayah/M.Yunus K 3/VII -8-2014 18-9-2014
3 Siti Rahayu/Iwan K 1/VII 11-7-2014
4 Cariyah/Suryanto K 1/VII 9-7-2014
5 Komalasari/Ade Prasetyo K 4/VII 28-6-2014
6 Widiyati/Hasan Bisri K 1/VII 21-7-2014
7 Shinta Fitriyana/Wasiludin K 8/VII 26-6-2014
8 Kristanti/Michael Heru K 7/VII -6-2014 -7-2014
9 Yanti/Marcus K 3/VII 25-8-2014C
10 A.Yuli W/Partono K 3/VII 20-6-2014
11 Irdiana Dini/Wahyu T K 7/VII 11-7-2014
12 Erlina P K 1/VII 1-8-2014
13 Siti Sri W/Nuri Fauzi K 8/VII 2-9-2014
14 Rodhiyah/Alex Wibowo K 1/VII 5-5-2014 5-6-2014
Imunisasi TT
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Wiwi Widiarti/Imron R K 3/VII 3-12-2014
2 Dhina Try/Shandi K 5/VII VC
3 Desi/Topik K 3/VII 22-2-2015 23-3-2015
4 Nazalia K/Abdul Salam K 1/VII 17-1-2015
5 Yanti/Marcus K 3/VII 23-2-2015
6 Tri Feriana/Yonandra B K 4/VII ?-11-2014 ?-12-14
7 Intan P.S/Nur Aulia Fikri K 1/VII 14-3-2015
8 Yuli Puspitasari/Herman K 2/VII 2-3-2015
9 Winarsih/Arja Hadi K 1/VII 2-4-2015
10 Yunike Rizka/Abdul Aziz K 4/VII 20-4-15C
11 Suryani/Andi Mulyono K 1/VII 19-5-2015 28-7-2015
12 Nur Baeti/Wahyu K 8/VII 14-5-2015
13 Nur Nafisah/Fariyantoro K 1/VII 18-5-2015 17-6-2015
14 Dewi Septiyaningsih K 1/VII 16-5-2015 23-6-2015
15 Desi Oktavia/Tabana K 2/VII 15-8-2015 15-9-2015
16 Desyarti/Windu K 8/VII 31-7-2015 11-10-2015
17 Veni Fitri /Doni B K 4/VII 1-8-2015 15-9-2015
18 Tiberly/Riski K 4/VII 15-6-2015
19 Romania F/Firma Edi K 3/VII 14-8-2015C
20 Sulastri/Wahyu K 7/VII 25-6-2015
21 Heni Kristiana/Mahardika K 2/VII 4-8-2015
22 Yeti/Waridi K 1/VII 4-8-2015
23 Rusniyati/Teguh Esar K 1/VII 1-10-2015
24 Nur Ulfah M/Nanang R K7/VII 11-11-15C
25 Kasiyani/Royani K 8/VII 23-11-2015
26 Nuni Faturohman/Slamet K3/VII 28-11-2015
27 Sri Hidayati/Slamet K 3/VII 8-12-15C
Imunisasi TT
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Yuni Listiana/Carto K 8/VII ?-12-2015
2 Indah/Khasanudin K8/VII 1-2-2016 21-4-2016
3 Dina Daniati/Rucitra Mulya K 2/VII 1-2-2016
4 Kerlina/Rinoso K 2/VII 24-1-2016
5 Yunike Riska/Abdul Aziz K4/VII ?-4-2015 ?-12-2015
6 Rina Maria/Wasroni K 1/VII 23-3-2016C 4-6-2016
7 Fitri Nursecha/Yuli Adni K 2/VII 8-3-2016C
8 Feni Purwanti/Abdul Gofar K 1/VII 22-3-2016
9 Wiwik/Wastar K 2/VII 21-5-2016 15-7-2016
10 Suswanti/Kasmudi K4/VII 3-6-2016
11 Winda A/M Nababuri K1/VII 15-7-2016 20-9-2016
12 Fifi Tri L/ Rikom Alan K8/VII 14-8-2016 3-10-2016
13 Delima Lili/ Moh. Safaat K3/VII 25-8-2016
14 Eka Kuntari/Samsudin K1/VII 6-8-2016
15 Deniati/Diarto K8/VII 19-8-2016
LAPORAN BULANAN IMUNISASI BAYI
POSYANDU SERUNI

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 Cheryl Indrasari/Yulianto P 11-1-2011 4/VIII
2 Kenzo Yunita/Sunan W L 31-1-2011 1/VIII
3 Dhea Aisha Tien H/Asepudin P 24-3-2011 2/VIII
4 Brayen Novi/Eko L 30-3-2011 3/VIII
5 Putri Devi Irvina Rina Y/Wiryono P 31-7-2011 3/VIII
6 Ega Candra Murti Lusi/Pamuji P 15-8-2011 3/VIII
7 Khaerunisa Arwin/Sapto P 22-8-2011 4/VIII 16-7-2014*
8 Mery Boru Silalahi Evi Setyawati P 11-11-2011 3/VIII 11-11-2011 28-11-2011 16-1-2012 16-2-2012 16-3-2012 28-11-2011 16-1-2012 16-2-2012 16-3-2012 12-9-2012
9 Vianny Gavrilla C Surjanti/Soetiono P 2-12-2011 2/VIII 3-12-2011 23-12-2011 14-2-2012 13-3-2012 17-4-2012 23-12-2011 14-2-2012 13-3-2012 17-4-2012 11-9-2012 18-6-2014*
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 Devan Revandra Ike/Andi L 15-5-2012 1/VIII 16-5-2012 18-6-2012 17-7-2012 21-8-2012 16-4-2013 18-6-2012 17-7-2012 21-8-2012 16-4-2013 6-5-2013 16-7-2014*
Naufal Ahza Shidqi Retno/Bima L 14-6-2012 2/VIII 14-6-2012 26-7-2012 15-8-2012 25-10-2012 26-11-2012 26-7-2012 15-8-2012 25-10-2012 26-11-2012 25-3-2013 PINDAH DEBONG
2 Hayuri Shevano Hari/Desi P 1-8-2012 3/VIII 2-8-2012 8-8-2012 3-10-2012 3-11-2012 1-12-2012 8-8-2012 3-10-2012 3-11-2012
1-12-2012 28-5-2013
3 Checyl Indrasari/Yulianto P 6-9-2012 4/VIII 6-9-2012 15-9-2012 8-12-2012 5-1-2013 22-2-2013 15-9-2012 8-12-2012 5-1-2013 22-2-2013 17-6-2013
Arash Omar Alvaro Ariyanti/Singgih L 25-9-2012 1/VIII 9-2-2013 9-2-2013 26-6-2013 PINDAH
Chanda Kirana H Chyntia/Beni P 7-10-2012 3/VIII 19-10-2012 8-11-2012 8-12-2012 8-1-2013 25-2-20138-11-2012 19-10-2012 8-12-2012 8-1-2012 7-8-2013 PINDAH
Nathasya Michelle Lee Tesalonika/Nicholas A.W. P 26-12-2012 2/VIII 26-12-2012 27-1-2013 19-3-2013 17-4-2013 12-6-201312-1-2013 19-3-2013 17-4-2013 12-6-2013 1-10-2013 16-7-2014* PINDAH
Imunisasi yang diberikan RSIAKI(3,4)
No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak Bd.E(2,6)
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang Bd.L(2,9)
Raehan Darmawan Dahlia/Wimen L 13-4-2013 3/VIII 14-4-2013 22-4-2013 1-6-2013 1-7-2013 4-8-2013 22-4-2013 1-6-2013 1-7-2013 4-8-2013 28-1-2014* PINDAH RSIAKI(3)sc
Zahra Atika Farida/Sunaryo P 3-5-2013 4/VIII 3-5-2013 10-6-2013* 10-8-2013* 11-9-2013* 12-10-2013* 10-6-2013* 10-8-2013* 11-9-2013* 12-10-2013* 10-2-2014* PINDAH RB.St.Hj(3,2)
1 Bagas Juni A St.Rochayatun/Rajani L 4-6-2013 7/V 4-6-2013 5-7-2013 5-9-2013* 5-10-2013 5-11-2013* 5-7-2013 5-9-2013* 5-10-2013 5-11-2013* 5-3-2014*
Anisa Jesi Berlian/Rangga P 10-6-2013 3/VIII 10-6-2013 19-6-2013 PINDAH 19-6-2013 PINDAH RSMK(3,2)
Leni Marlina/Agus S P 30-7-2013 4/VIII 31-7-2013 PINDAH
Adila Prabasiwi/Aliq L 21-8-2013 2/VIII 26-8-2013 PINDAH RSI(3,5)
2 Stefanus Juan Alfaro Yuli/Andi Wibowo L 10-10-2013 3/VIII 11-10-2013 5-12-2013 21-12-2013 21-2-2014 5-4-2014 17-10-2013 21-12-2013 21-2-2014 5-4-2014 30-8-2014#
Nur Suci Eti/Aris S L 30-10-2013 3/VIII 31-10-2013 PINDAH RANDUGUNTING
Arrasyi Mulya(St.Hj) Rasminingsih/Mulyono L 7-12-2013 3/VIII 8-12-2013* 22-1-2014* 28-2-2014* 6-5-2014* 27-6-2014P* 22-1-2014* 28-2-2013* 6-5-2014* 27-6-2014* PINDAH
Josephine Priscila/Yosafa P 17-12-2013 3/VIII 22-9-2014*

Imunisasi yang diberikan RSUK(3,7)


No Nama Bayi Nama Ortu L/P Tanggal Alamat
No Nama Bayi Nama Ortu L/P Tanggal Alamat DPT-HB Polio Penta Campak Bd.F(2,5)
HBU BCG Campak
Lahir (Rt / Rw) 1 2 3 1 2 3 4 Ulang Ulang RB.Rhm(3,1)
1 M.Abdulah Baqir Sri Kurniati/Solichin L 15-1-2014 3/VIII 15-1-2014 2-3-2014 MENOLAK 9-3-2014 MENOLAK Bd.D(2,3)
Kendra Iman Kirana (Titin Nuraeni/Sugiharto) L 4-2-2014 3/V PINDAHAN MAWAR MERAH 8-11-2014 PINDAH
2 Gabriel Darren Imanuel Christin/Akiong L 12-2-2014 3/VIII 12-2-2014 15-2-2014 13-5-2014P 3-7-2014P 3-9-2014P 15-2-2014 13-5-2014 3-7-2014 3-9-2014 18-11-2014#
3 Hasna Nur Fisqi Aulia Hilda Lestari/Kusnadi P 8-3-2014 3/VIII 8-3-2014 17-3-2014 12-5-2014P 18-6-2014P 16-7-2014P 17-3-2014 12-5-2014 18-6-2014 16-7-2014 17-12-2014 15-9-2015# 18-4-2016^ RSI(3,2)
Satrio Widjaya Triyana/Windono L 19-4-2014 3/VIII 19-4-2014 21-5-2014 21-6-2014P 13-9-2014P 15-10-2014P 21-5-2014 21-6-2014 13-9-2014 15-10-2014 8-11-2014# PINDAH
Marsello Dave H Marta/Handoyo L 30-4-2014 2/VIII 30-4-2014 PINDAH RB.Rhm(3,1)
4 Akifa Naila Hanan Nurul Azizah/A.Sabah P 19-5-2014 2/VIII 19-5-2014 23-6-2014 21-7-2014P 21-8-2014P 25-9-2014P 23-6-2014 21-7-2014 21-8-2014 25-9-2014 18-2-2015# 25-7-2016^ 10-8-2016^ RSMK
5 Hanung Putra W Wiwit/Darudin L 5-6-2014 1/VIII 5-6-2014 20-6-2014 13-8-2014P 17-9-2014P 20-10-2014P 20-6-2014 13-8-2014 17-9-2014 20-10-2014 13-5-2015# 3-2-2016^ 10-8-2016^ RB.Rhm(2,9))
Vino Moreno Fani/Johan L 7-6-2014 2/VIII 11-6-2014 16-6-2014 11-8-2014P 17-9-2014P 12-11-2014P 16-6-2014 11-8-2014 17-9-2014 12-11-2014 PINDAH Pusk(1,7)
6 Nur Rahma Suci Rina Yunita/Wiryono P 15-7-2014 3/VIII 15-7-2014 13-8-2014 30-9-2014P 1-11-2014P 2-12-2014P 13-8-2014 30-9-2014 1-11-2014 2-12-2014 22-4-2015# RB.Rhm
Siti Azizah/Gaus L 13-9-2014 3/VIII TIDAK BAYI PLUS PTB
7 Al Qaqa Diah Dwi M/Rully Putra S L 28-10-2014 1/VIII MENOLAK RSMK(3,5)

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
1 Berelsa Berly Bernessa Elya Findawati/Baernadus P 27-3-2015 1/VIII 27-3-2015 4-6-2015 27-6-2015 24-8-2015 22-10-2015 6-4-2015 27-6-2015 24-8-2015 22-10-2015 7-1-2016^ RSMK(2,8)
2 Walidi Faizah/Sutarno L 18-7-2015 1/VIII MENOLAK IMUNISASI
3 Elizabeth Naferuni Haniek Setiawati/Doddy H P 21-10-2015 1/VIII 24-10-2015 16-11-2015 21-12-2015 25-1-2016^ 29-2-2015^ 24-10-2015 21-12-2015 25-1-2016^ 13-4-2016^ 29-8-2016^ RS KARYADI

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 Fawwaz Adi Susleni/A.Sabah L 9-2-2015 2/VIII 9-2-2016 MENOLAK Bd.L(3)
2 Khanza Ziya Hafla Arsyila Nurul Azizah/A.Sabah P 7-4-2016 2/VIII 7-4-2016 27-4-2016 28-5-2016 18-8-2016 - 10-2016 27-4-2016 28-5-2016 18-8-2016 - 10 -2016 RSUK(3,7)
3 Xavier Lemuel Sky Marsella C./Toni L 30-7-2016 2/VIII 30-7-2016 20-9-2016 12-10-2016 10-11-2016 12-10-2016 10-112016 Rb.Rhm(3,3)sc
4 Diyah Dwi M/Ruli L 1-9-2016 1/VIII MENOLAK RSMK(3,1)
5 Gibran Wirasenta Mega Renawati/jamal L 1-10-2016 3/VIII 2-10-2016 5-10-2016 5-11-2016 5-10-2016 5-11-2016 Bd.L(3,5)
6 Elfa Anisa/Hari Putra L 25-9-2016 3/VIII 26-9-2016 PINDAH PEKALONGAN RSI(3,2)
7 M. Nabil Rahanditya christyana / Mugi R L 19-10-2016 3/VIII 19-10-2016
8

Imunisasi TT
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Elya Findawati/Bernadus K 1/VIII 11-11-2014 12-12-14
2 Marsella C/Toni K 2/VIII 13-5-2015C
3 Aqthiana Y/Andriyas M K 2/VIII 22-6-2015C
4 Cristiana/Mugi R K 3/VIII 8-12-15C
Imunisasi TT
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Cristiana/Mugi R K 3/VIII 11-5-2016
2 Marsella C/Toni K2/VIII 11-5-2016
3 Mega Renawati/Jamaludin K3/VIII 7-5-2016 19-6-2016
4 Diyah Dwi M/ Ruli K1/VIII 4-3-2016
5 Friska Yulita/Aditya K1/VIII 24-6-2016
6 Rena Rizki/M Reza P K 3/VIII 8-8-2016C
LAPORAN BULANAN IMUNISASI BAYI
POSYANDU DEWI SARTIKA

Imunisasi yang diberikan


No Nama Bayi Nama Ortu L/P Tanggal Alamat Alamat Asal DPT-HB Polio Penta Campak
HBU BCG Campak
Lahir (Rt / Rw) (Rt/Rw) 1 2 3 1 2 3 4 Ulang Ulang
1 Aldi Dwi Putra Siti Jaenah/Widodo L 10-6-2010 4/IX
2 Ayu Dista Syafira Solicha/Nurul S P 21-7-2010 1/IX
3 Umayah Yuli/Teguh P 27-7-2010 2/IX
4 Bagus Anisa Bela L 28-8-2010 2/IX
5 M. Ardiansyah Rahmatullah L -8-2010 2/IX
6 Nabila Eka P Nova/Saeful P 12-10-2010 1/IX
7 Ahmad Zidni Rosanti/Syarifudin L 23-11-2010 1/IX Kamboja 26-11-2010 6-12-2010 24-1-2011 22-2-2011 19-4-2011 6-12-2010 24-1-2011 22-2-2011 19-4-2011 -8-2011

Imunisasi yang diberikan


No Nama Bayi Nama Ortu L/P Tanggal Alamat Alamat Asal DPT-HB Polio Penta Campak
HBU BCG Campak
Lahir (Rt / Rw) (Rt/Rw) 1 2 3 1 2 3 4 Ulang Ulang
1 Deandra B.P Herni/Agung L 8-1-2011 3/IX
2 Salwa Rahadatul Erma Putriasa/Ade Setiawan P 24-1-2011 4/IX Kejambon 24-1-2011 23-2-2011 27-4-2011 15-6-2011 27-7-2011 30-3-2011 25-5-2011 11-6-2011 27-7-2011 7-12-2011
3 Nurazza I.P Suratmi/Ridho B P 24-3-2011 2/IX Pekauman
4 Aza Fatir Surya Susherwanti/Mursalim L 10-4-2011 1/IX Smpg
5 Anugrah Nurwani Karsiwen/Jefri L 24-5-2011 3/IX Kartini B 5-6-2011 5-6-2011 23-7-2011 26-9-2011 15-12-2011 5-6-2011 23-7-2011 26-9-2011 15-12-2011 10-12-2012
6 M. Ardan Samilah/Tarjono L 16-6-2011 2/IX Kenanga B
7 Hisyam Riyadi P Sofuroh/M. Juriyadi L 3-7-2011 4/IX Brebes 3-7-2011 2-1-2011 14-9-2011 12-10-2011 16-11-2011 13-7-2011 14-9-2011 22-10-2011 14-12-2011 20-4-2012
8 Shauma Nur Tanti/Sudibyo P 23-8-2011 4/IX Sekar Indah A
9 Alfiyah Yuli/Teguh P 23-8-2011 2/IX
10 M. Raihan Eka/Ardi L 8-9-2011 4/IX
11 Nata Kusuma Nana/Zaenal L 22-9-2011 4/IX
12 Nayra D.P Rima/Diono P 4-12--2011 1/IX Kartini B
13 Amara Anggraini Lili/Maryono P 9-12-2011 2/IX Mintaragen

Imunisasi yang diberikan


NO Nama Bayi Nama Ortu L/P Tanggal Alamat Alamat Asal DPT-HB Polio Penta Campak
HBU BCG Campak
Lahir (Rt / Rw) (Rt/Rw) 1 2 3 1 2 3 4 Ulang Ulang
1 Syiffa Ayuda Putri D Yuni/Puji P 11-1-2012 3/IX Panggung
2 Oniel Pramudya Ninda/Ade L 11-1-2012 3/IX Astika C 11-1-2012 V 20-3-2012 3-6-2012 27-11-2012 20-3-2012 3-6-2012 27-11-2012 -1-2013 -1-2013 11-11-2014*
3 Talita Azalia Ayu R/Wandito P 7-2-2012 4/IX
4 Ayu Mutiarahma Dwi Lestari P 27-2-2012 1/IX 27-12-2012 21-1-2013 2-3-2013 6-4-2013 4-5-2013 21-1-2013 2-3-2013 6-4-2013 4-5-2013 30-9-2013
5 Bagas Adi Saputra Nurlaela L 10-3-2012 4/IX
6 Dinda Sindi Dwi P Yuli/Amin P 22-3-2012 1/IX
7 Namira Novi P 4-4-2012 3/IX Kuncup Mekar 4-4-2012 4-5-2012 6-2-2013
8 Kirana Syafa A Aji Seti Indahyani/Eko S P 20-4-2012 4/IX Sejahtera I 20-4-2012 25-4-2012 12-7-2012 6-9-2012 11-10-2012 25-4-2012 12-7-2012 6-9-2012 11-10-2012 11-3-2013 27-4-2015
9 Rafah Ayash A Nina V/Arief S L 24-4-2012 3/IX Kenanga A 24-4-2012 24-4-2012 2-5-2012 12-7-2012 9-8-2012 6-9-2012 2-5-2012 12-7-2012 9-8-2012 28-1-2013 12-7-2014 12-8-2014
10 Indana Zulfa Davi/M. Hadil P 19-6-2012 1/IX
11 Hasna Azalia A Ervina P 10-10-2012 2/IX Pekauman
12 Daffa Nurmaulana Ratna/Subkhan L 14-10-2012 1/IX Mayangsari 14-10-2012 5-12-2012 3-1-2013 6-2-2013 22-8-2013 5-12-2012 3-1-2013 6-2-2013 22-8-2013 24-10-2013 22-5-2013 21-5-2015#
13 Shesya Ririn/Sapto P 17-10-2012 3/IX Kartini B 17-10-2012 24-10-2012 17-12-2012 17-1-2013 14-2-2013 24-10-2012 17-12-2012 17-1-2013 14-2-2013 18-7-2013 5-5-2014* 16-10-2014*
14 Subechi Mubarok Risnati Arni/A. Kholil L 13-11-2012 2/IX Mekarsari 13-11-2012 5-12-2012 17-1-2013 18-2-2013 21-3-2013 5-12-2012 17-1-2013 18-2-2013 21-3-2013 26-8-2013
15 Arka Pranata W Dwi Nurbaeti/Triwijaya L 30-11-2012 2/IX Astika C 30-12-2012 16-1-2013 25-2-2013 13-4-2013 9-11-2013 16-1-2013 25-2-2013 13-4-2013 9-11-2013 V

Imunisasi yang diberikan


No Nama Bayi Nama Ortu L/P Tanggal Alamat Alamat Asal DPT-HB Polio Penta Campak
HBU BCG Campak
Lahir (Rt / Rw) (Rt/Rw) 1 2 3 1 2 3 4 Ulang Ulang
1 Ratu Ajeng Khotijah/Zaenal P 14-2-2013 3/IX Pengabean
2 Syahla Yuma Faiha Eva M/Guruh Eko P 18-3-2013 2/IX Sekar Indah A 18-3-2013 23-5-2013 19-6-2013 23-7-2013 9-12-2013 19-6-2013 23-7-2013 9-12-2013 18-8-2014
3 Aswhina Arsylia A Patmi/Ardiansyah P 18-5-2013 4/IX Astika B 18-5-2013 12-6-2013 24-7-2013 26-8-2013 26-9-2013* 12-6-2013 24-7-2013 26-8-2013 26-9-2013* 5-3-2014* 20-2-2016^
4 Azzahrotul Sya'baniyah Nur Ihya Sofiyah/Feri M P 13-6-2013 4/IX Mayangsari 14-6-2013 19-6-2013 22-8-2013 21-10-2013 21-11-2013 19-6-2013 22-8-2013 21-10-2013 21-11-2013 20-3-2014* 22-1-2015# 30-7-2015#
5 Sakinah Millati H Yuliana/Teguh H P 14-6-2013 1/IX Kartini A 22-6-2013 5-7-2013 15-8-2013 24-9-2013 14-11-2013 5-7-2013 15-8-2013 24-9-2013 14-11-2013 17-4-2014* 18-12-2014# 18-5-2016^
6 Ahmad Nizam Sabani St.Elianawati/Yuyu W L 24-6-2013 1/IX Kamboja 24-6-2013 8-7-2013 24-8-2013 24-9-2013 24-10-2013* 8-7-2013 24-8-2013 24-9-2013 24-10-2013* 5-5-2014* 24-8-2015#
7 Julia Putri Ramadani Erna P 12-7-2013 3/IX Margadana
8 Abyan Zahran R Titin Safitri/Rusman L 2-8-2013 4/IX 28-8-2013 19-10-2013 19-11-2013 20-12-2013 28-8-2013 19-10-2013 19-10-2013 20-12-2013 20-6-2014*
9 Ibnu Zydane Pra Rodotul J/Dwi N L 24-8-2013 1/IX Randu Gunting 24-8-2013 1-9-2013 6-11-2013 7-12-2013 8-1-2014 1-9-2013 6-11-2013 7-12-2013 8-1-2014 11-6-2014* PINDAH PANGGUNG
10 Nur Amira Fitria Isnaeni/Nurwanto P 24-8-2013 4/IX Sejahtera I 24-8-2013 10-9-2013 6-11-2013 12-12-2013 22-1-2014* 10-9-2013 6-11-2013 12-12-2013 22-1-2014* 26-5-2014*
11 Sri Kandita Tanti/Sudibyo P 20-9-2013 4/IX Sekar Indah A 21-9-2013 19-3-2014P* 23-4-2014P* 19-3-2014* 23-4-2014* MENOLAK
12 Moh Bagas Sadewo Ambarwati/M. Wiji L 22-9-2013 4/IX MKK 22-9-2013 9-10-2013 11-12-2013 8-1-2014 12-2-1014 9-10-2013 11-12-2013 8-1-2014* 12-2-2014* 27-8-2014* 18-5-2016^
13 Kiki Khairul Susi/Sopan L 6-10-2013 4/IX Kenanga B 7-10-2013 5-11-2013 21-12-2013 15-2-2014* 15-3-2014* 5-11-2013 21-12-2013 15-2-2014* 15-3-2014* 27-9-2014*
14 Naela Risriani Deni Sinta/Arisman P 25-12-2013 4/IX Kemandungan 25-12-2013 6-1-2014 10-9-2014 6-1-2014 10-9-2014

Imunisasi yang diberikan


No Nama Bayi Nama Ortu L/P Tanggal Alamat Alamat Asal DPT-HB Polio Penta Campak
HBU BCG Campak
Lahir (Rt / Rw) (Rt/Rw) 1 2 3 1 2 3 4 Ulang Ulang
1 M. Haikal F Kusnul/Azam L 26-1-2014 2/IX Kartini A 1-2-2014 5-3-2014 21-4-2014P 9-6-2014P 10-7-2014P 5-3-2014 21-4-2014 9-6-2014 10-7-2014 30-7-2015# 20-1-2016^ 18-5-2016^
2 Naira Ayla Askana Nina V/Arief S P 12-2-2014 3/IX Kenanga A 13-2-2014 10-3-2014 9-5-2014P 12-6-2014P 12-7-2014P 10-3-2014 9-5-2014 12-6-2014 12-7-2014 17-11-2014 24-8-2015^ 20-7-2016^
3 M. Fahri Alfatir Ersa/Apip L 19-2-2014 2/IX Debong 19-2-2014 28-4-2014 30-6-2014 29-9-2014 30-11-2014 28-4-2014 30-6-2014 29-9-2014 30-11-2014 27-4-2015# 23-11-2015# 16-3-2016^
4 Mohammad Shoobirin Risnati Arni/Abd.Kholil M L 9-2-2014 2/IX Mekarsari 9-2-2014 5-3-2014 10-4-2014P 11-5-2014P 10-6-2014P 5-3-2014 10-4-2014 11-5-2014 10-6-2014 1-12-2014# 26-10-2015^ 17-2-2016^
5 Aulia Izzatunnisa Komariyah/Pani Gunawan P 9-5-2014 3/IX Keturen 9-5-2014 9-6-2014 14-7-2014 18-8-2014 22-19-2014 9-6-2014 14-7-2014 18-8-2014 22-9-2014 9-2-2015 9-11-2015 16-5-2016^
6 Airin Isnaeni Dewi ika/ Ari P 20-6-2014 3/IX Slerok 20-6-2014 11-8-2014 13-10-2014 10-11-2014 22-1-2015 11-8-2014 13-10-2014 10-11-2014 22-1-2015 30-6-2015 28-12-2015^ 21-9-2016^
7 Moh. Rasyid Setiawan Erma Putriana/Ade Setiawan L 10-7-2014 4/IX Kejambon 10-7-2014 18-8-2014 17-9-2014 28-10-2014 27-11-2014 17-9-2014 28-10-2014 27-11-2014 26-1-2015 27-4-2015 17-2-2016^ 5-9-2016^
8 Resky Ramadhan Tri Nuryanti/Fandi L 18-7-2014 4/IX Kartini B 18-7-2014 30-8-2014 4-10-2014P 4-11-2014P 17-12-2014P 30-8-2014 4-10-2014 4-11-2014 17-12-2014 22-10-2016^
9 Najwa K Yuni/Indarno P 20-8-2014 2/IX Panggung 20-8-2014 22-10-2014 26-11-2014 24-12-2014 4-2-2015 22-10-2014 26-11-2014 24-12-2014 4-2-2015 10-6-2015 PINDAH
10 M. Restu Asyira Nova Puspita/Saepul P 9-9-2014 1/IX Kuncup Mekar 9-9-2014 20-10-2014 20-11-2014P 20-12-2014P 20-1-2015# 20-10-2014 20-11-2014 20-12-2014 20-1-2015# 29-6-2015# 4-4-2016^ 5-10-2016^
11 M. Nurul Fajar Rosanti/Syarifudin L 29-9-2014 1/IX Kamboja 29-9-2014 20-10-2014 8-12-2014 12-1-2015# 23-2-2015 20-10-2014 8-12-2014 12-1-2015# 23-2-2015 30-7-2015# 20-4-2016^
12 Ratu Putri Khotijah/Zaenal P 17-11-2014 3/IX Pengabean
13 Ratu Ayu Khotijah/Zaenal P 17-11-2014 3/IX Pengabean
14 Azuhra Zidni Aulia Erlin/Rosikin P 31-12-2014 2/IX Pekauman 31-12-2014 5-1-2015 3-3-2015 11-4-2015 11-5-2015 5-1-2015 3-3-2015 11-4-2015 11-5-2015 5-10-2015 12-7-2016^

Imunisasi yang diberikan


No Nama Bayi Nama Ortu L/P Tanggal Alamat Alamat Asal DPT-HB Polio Penta Campak
HBU BCG Campak
Lahir (Rt / Rw) (Rt/Rw) 1 2 3 1 2 3 4 Ulang Ulang
1 Dihyah Al Kalby Arifah/Abu Khoiri L 18-1-2015 3/IX Mawar B 19-1-2015 26-1-2015 18-3-2015 20-4-2015 18-5-2015 26-1-2015 18-3-2015 20-4-2015 18-5-2015 19-10-2015 9-8-2016^ PTB
2 Nandit Kusuma Pradita Maria/Zaenal A L 18-2-2015 4/IX Mintaragen 18-2-2015 18-3-2015 27-4-2015 25-5-2015 30-6-2015 26-2-2015 27-4-2015 25-5-2015 30-7-2015 23-11-2015 21-9-2016^
Dzakira Aulia Wiharyati/Zakaria P 6-3-2015 1/IX Panggung 7-3-2015 9-3-2015 25-5-2015 PLUS 9-3-2015 25-5-2015 25-12-2015 PTB
3 Najwa Aulia Murniati/Yanuar P 19-3-2015 2/IX Randugunting19-3-2015 MENOLAK
4 Ziya Ulhaq Lulu/Burhanudin L 10-4-2015 4/IX Smpg 11-4-2015 6-7-2015 30-6-2015 30-7-2015 23-11-2015 6-7-2015 23-11-2015 20-1-2016^ 17-2-2016^ 17-2-2016^ 22-10-2016^
5 Intan Akmil Indriyani/ Imam P 7-6-2015 3/IX 7-6-2015 8-7-2015 8-8-2015 9-9-2015 12-10-2015 8-8-2015 9-9-2015 12-10-2015 27-5-2016^ 27-5-2016^
6 Moh. Qori Ika Puspita Sari/M.Soleh L 8-6-2015 4/IX Kuncup Mekar 8-6-2015 16-9-2015 6-10-2015 4-11-2015 7-12-2015^ 16-9-2015 6-10-2015 4-11-2015 7-12-2015^ 11-5-2016^ RSI(3)sc
7 Marisa Nuramadhani Nur Isnaeni/Nurwanto P 10-7-2015 4/IX Sejahtera I 15-7-2015 3-8-2015 28-9-2015 26-10-2015 20-1-2016^ 3-8-2015 28-9-2015 26-10-2015 20-1-2016^ 20-7-2016^ PTB
Rimadona/M.Faqih P 27-7-2015 4/IX Sejahtera I 28-7-2015 PINDAH KEJAMBON RSUK(3,4)
8 Achmad Hawwin Rozack Dewi Wulan Sari/Salafudin L 10-8-2015 1/IX Panggung 10-8-2015 14-9-2015 15-10-2015 16-11-2015 16-12-2015 14-9-2015 15-10-2015 16-11-2015 16-12-2015 16-5-2016^ PTB(3,4)
9 Anindya Putri Andari Lili Ismiyati/Maryono P 22-8-2015 2/IX Panggung 23-8-2015 7-9-2015 22-10-2015 23-11-2015 21-1-2016^ 7-9-2015 22-10-2015 23-11-2015 21-1-2016^ 20-8-2016^ PTB(3,1)
Thoani/Cholil L 11-9-2015 1/IX Panggung 11-9-2015 PINDAH Bd.M(3)
Khansa Saniyyah Suryanti/Riyanto P 5-10-2015 3/IX Kartini B 5-10-2015 23-11-2015 28-12-2015 13-2-2016^ 23-3-2016^ 23-11-2015 28-12-2015 13-2-2016^ 18-4-2016^ PINDAH KARTINI B RSUK(3,3)
10 Aditya Rifki Hamizan Kartini/Mei Pambudi L 10-11-2015 2/IX Kartini B 9-11-2015 28-12-2015 7-1-2016^ 17-2-2016^ 16-3-2016^ 14-11-2015 22-12-2015^ 7-1-2016^ 20-4-2016^ 20-8-2016^ RSUK(3,3)
11 Anindita Keisha Z Sri Wahyuningsih/Agustinus P 7-12-2015 4/IX Panggung 7-12-2015 4-1-2016^ 9-2-2016^ 23-3-2016^ 20-4-2016^ 15-12-2015 4-1-2016^ 9-2-2016^ 20-4-2016^ RSI(2,8)
12 Siti Nur Amaliyah Siti Chodijah/Samsudin P 24-12-2015 2/IX Panggung 25-12-2015 28-12-2015^ 20-4-2016^ 1-8-2016^ 1-9-2016^ 28-12-2015^ 20-4-2016^ 1-8-2016^ 1-9-2016^ 26-9-2016^ PTB
Imunisasi yang diberikan
No Nama Bayi Nama Ortu L/P Tanggal Alamat Alamat Asal DPT-HB Polio Penta Campak
HBO BCG Campak
Lahir (Rt / Rw) (Rt/Rw) 1 2 3 1 2 3 4 Ulang Ulang
Shareefa Jaehan Nunung N/M.Wahyudi P 13-1-2016 2/IX Mintaragen 14-1-2016 PINDAH 19-1-2016 PINDAH RSUK(2,7)
1 Rafka Hafid Maulana Ike Nofiani/Abd.Kodir L 19-1-2016 3/IX Kartini A 20-1-2016^ 22-2-2016 19-3-2016 24-5-2016 24-6-2016 20-4-2016 19-3-2016 24-5-2016 24-6-2016 10-11-2016 RMH(3)
2 Hafidz Salman Arifin Eka Rizki A/Sutaji L 30-1-2016 2/IX Kenanga A 31-1-2016 15-2-2016 1-5-2016 1-6-2016 20-8-2016 15-2-2016 1-5-2016 1-6-2016 20-8-2016 Rhm(2,3)
3 Diandra Aluna Putri Rosy Noktaliani/Adi Bagus P 24-3-2016 1/IX Pekauman 24-3-2016 25-4-2016 25-5-2016 29-6-2016 29-7-2016 25-4-2016 25-5-2016 29-6-2016 29-7-2016 RSI(3)
4 M Aditya Mikail Mariah Ulfa/M.Subekhi L 27-3-2016 4/IX Randugunting 28-3-2016 4-4-2016 30-5-2016 11-7-2016 15-8-2016 20-4-2016 30-5-2016 11-7-2016 15-8-2016 PTB(3,2)
5 Naura Jihan Nelasari/Irwan P 30-3-2016 2/IX Mawar Merah 30-3-2016 2-5-2016 2-6-2016 11-7-2016 11-8-2016 6-4-2016 2-6-2016 11-7-2016 11-8-2016 RSUK(3,3)
6 Shakina Ayu Ayu Widya/Budi P 1-4-2016 2/IX Kartini B 2-4-2016 11-4-2016 6-6-2016 20-7-2016 20-8-2016 9-4-2016 6-6-2016 20-7-2016 20-8-2016 RSUK(3)
7 Arfa Kusuma Rizki Malikhatun/Sulistio L 2-4-2016 3/IX Astika C 3-4-2016 2-5-2016 6-6-2016 18-7-2016 26-8-2016 2-5-2016 6-6-2016 18-7-2016 26-8-2016 PTB(3,4)
8 Anindya Tri Azmi Ratna Mariska/Eko Susanto P 28-4-2016 2/IX Randuguntng 28-4-2016 20-6-2016 20-7-2016 20-8-2016 19-11-2016 20-6-2016 20-7-2016 20-8-2016 19-11-2016 RSUK(3)
9 Moh.Rayga Caesyana Castirah/ Minggu Priana L 29-4-2016 2/IX MKK 30-4-2016 23-5-2016 30-6-2016 30-7-2016 30-7-2016 23-5-2016 30-6-2016 30-7-2016 30-7-2016 RSUK(2,2)SC
10 Syafa Nafeeza Tri Eka/Beni P 29-4-2016 2/IX Kartini B 4-5-2016 16-5-2016 29-6-2016 27-7-2016 27-8-2016 16-5-2016 29-6-2016 27-7-2016 27-8-2016 Bd.Ety(3,2)
11 Akhmad Ikhsan Indah /Yusuf L 9-5-2016 /IX 10-5-2016 13-6-2016 13-7-2016 13-8-2016 14-9-2016 13-6-2016 13-7-2016 13-8-2016 14-9-2016
12 Arif Bilah Arsyad Anipah/Arip E L 20-5-2016 3/IX Mintaragen 20-5-2016 27-6-2016 27-7-2016 27-8-2016 27-9-2016 27-6-2016 27-7-2016 27-8-2016 27-9-2016 Bd.Sy(2,7)
13 Qomara Chaira Anami Patmi/ Ardiansyah P 19-6-2016 2/IX Astika B 19-6-2016 20-7-2016 23-8-2016 20-9-2016 23-8-2016 20-9-2016 RSI(3,1)
14 Naura Faradila Ulfiah/ Slamet P 3-9-2016 / IX Pekauman 3-9-2016 14-9-2016 3-11-2016 3-11-2016
15 Iyaz Muzakki al Fathin Murniati/M.yanuar L 7-9-2016 2/IX Debong tengah 8-9-2016 MENOLAK PTB(3,1)
16 Racher Tri ananda Nia Kurniasari/ Mayo P 5-9-2016 /IX Kenanga B 6-9-2016 31-10-2016 31-10-2016 PTB(2,9)
17 Shafa Marwah Putri Tri Nuryanti/ Fandy K P 18-9-2016 4/IX Kartini B 18-9-2016 24-10-2016 24-10-2016 PTB(3,1)
18 Dimas Aditya Yeni Kristanti/Muh.Amin P 27-10-2016 /IX Pekauman 27-10-2016 31-10-2016 31-10-2016 PTB(3)

Imunisasi TT
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Rimadhona/M.Faqih K 4/IX(Sejahtera I) 10-6-2015
2 Dewi W/M. Salafudin K 1/IX 22-5-2015
3 Sri Wahyuningsih/Agustinus K4/IX 30-6-2015 20-7-2015
4 St. Chodidjah/Samsudin K2/IX 30-6-2015 23-11-2015
5 Kartini/Mei Pambudi K2/IX(Kartini B) 30-6-2015 22-7-2015
6 Ika Puspitasari/M.Soleh K4/IX(Kuncup Mekar) 25-6-2015 24-7-2015
7 Suryanti/Riyanto K3/IX(Kartini B) 22-7-2015
8 Malikhatun/Sulistio K 3/IX(Astika C) 21-10-2015 23-11-2015
9 Ike Nofiani/Abd.Rojak K3/IX(Kartini A) 29-10-2015 31-12-2015
10 Nelasari/Irwan K2/IX 3-12-2015
11 Eka Rizki Amalia/Sutaji K 2/IX 25-10-2015 23-11-2015
Imunisasi TT
No Nama Ibu Alamat (RT/RW)
1 2 3 4 5
1 Ayu Widya/Budi L K 4/IX(Kartini B) 6-1-2016
2 Castirah/Minggu Priana K 2/IX 25-1-2016
3 Nelasari/Irwan K2/IX(Mawar Merah) 1-2-2016
4 Mariah Ulfa/M. Subekhi K 4/IX 4-2-2016
5 Marlina/Rustanto K 4/IX 9-3-2016
6 Rohemi/Agus K /IX 21-9-2016
7 Sofuroh/ M.Jupriadi K 4/IX 21-9-2016
8 Anisa Bella/Eka Yulianto K 2/IX 18-10-2016
9 Rustini/ Eri Indrawan K /IX 18-11-2016
NAMA BAYI/BALITA POSYANDU DEWI SARTIKA
Tanggal Alamat
Nama Bayi Nama Ortu L/P
Lahir (Rt / Rw) (Rt/Rw)
No
Hisyam Riyadi P Sofuroh/M. Juriyadi L 3-7-2011 4/IX Brebes
1 Nurazza I.P Suratmi/Ridho B P 24-3-2011 2/IX Pekauman
2 Anugrah Nurwani Karsiwen/Jefri L 24-5-2011 3/IX Kartini B
3 Salwa Rahadatul Erma Putriasa/Ade Setiawan P 24-1-2011 4/IX Kejambon
4 Nayra D.P Rima/Diono P 4-12--2011 1/IX Kartini B
5 Aza Fatir Surya Susherwanti/Mursalim L 10-4-2011 1/IX Smpg
6 Shauma Nur Tanti/Sudibyo P 23-8-2011 4/IX Sekar Indah A
7 Alfiyah Yuli/Teguh P 23-8-2011 2/IX
8 Deandra B.P Herni/Agung L 8-1-2011 3/IX
9 M. Raihan Eka/Ardi L 8-9-2011 4/IX
10 Amara Anggraini Lili/Maryono P 9-12-2011 2/IX Mintaragen
11 M. Ardan Samilah/Tarjono L 16-6-2011 2/IX
12 Nata Kusuma Nana/Zaenal L 22-9-2011 4/IX
13 Tanggal Alamat
Nama Bayi Nama Ortu L/P
Lahir (Rt / Rw) (Rt/Rw)
No
Subechi Mubarok Risnati Arni/A. Kholil L 13-11-2012 2/IX Mekarsari
1 Kirana Syafa A Aji Seti Indahyani/Eko S P 20-4-2012 4/IX Sejahtera I
2 Hasna Azalia A Ervina P 10-10-2012 2/IX Pekauman
3 Rafah Ayash A Nina V/Arief S L 24-4-2012 3/IX Kenanga A
4 Oniel Pramudya Ninda/Ade L 11-1-2012 3/IX Astika C
5 Dinda Sindi Dwi P Yuli/Amin P 22-3-2012 1/IX
6 Talita Azalia Ayu R/Wandito P 7-2-2012 4/IX
7 Shesya Ririn/Sapto P 17-10-2012 3/IX Kartini B
8 Indana Zulfa Davi/M. Hadil P 19-6-2012 1/IX
9 Arka Pranata W Dwi Nurbaeti/Triwijaya L 30-11-2012 2/IX Astika C
10 Ayu Mutiarahma Dwi Lestari P 27-2-2012 1/IX
11 Bagas Adi Saputra Nurlaela L 10-3-2012 4/IX
12 Syiffa Ayuda Putri D Yuni/Puji P 11-1-2012 3/IX Panggung
13 Daffa Nurmaulana Ratna/Subkhan L 14-10-2012 1/IX Mayangsari
14 Namira Novi P 4-4-2012 3/VI Kuncup Mekar
15 Tanggal Alamat
Nama Bayi Nama Ortu L/P
Lahir (Rt / Rw) (Rt/Rw)
No
Azzahrotul Sya'baniyah Nur Ihya Sofiyah/Feri M P 13-6-2013 4/IX Mayangsari
1 Ibnu Zydane Pra Rodotul J/Dwi N L 24-8-2013 1/IX Randu Gunting
2 Abyan Zahran R Titin Safitri/Rusman L 2-8-2013 4/IX
3 Ahmad Nizam Sabani St.Elianawati/Yuyu W L 24-6-2013 1/IX Kamboja
4 Sakinah Millati H Yuliana/Teguh H P 14-6-2013 1/IX Kartini A
5 Moh Bagas Sadewo Ambarwati/M. Wiji L 22-9-2013 4/IX MKK
6 Naela Risriani Deni Sinta/Arisman P 25-12-2013 4/IX Kemandungan
7 Nur Amira Fitria Isnaeni/Nurwanto P 24-8-2013 4/IX Sejahtera I
8 Julia Putri Ramadani Erna P 12-7-2013 3/IX Margadana
9 Sri Kandita Tanti/Sudibyo P 20-9-2013 4/IX Sekar Indah A
10 Syahla Yuma Faiha Eva M/Guruh Eko P 18-3-2013 2/IX Sekar Indah A
11 Ratu Ajeng Khotijah/Zaenal P 14-2-2013 3/IX Pengabean
12 Aswhina Arsylia A Patmi/Ardiansyah P 18-5-2013 4/IX Astika B
13 Kiki Khairul Susi/Sopan L 6-10-2013 4/IX Kenanga B
14

Tanggal Alamat
Nama Bayi Nama Ortu L/P
Lahir (Rt / Rw) (Rt/Rw)
No
Azuhra Zidni Aulia Erlin/Rosikin P 31-12-2014 2/IX Pekauman
1 M. Restu Asyira Nova P 9-9-2014 1/IX Kuncup Mekar
2 M. Nurul Fajar Rosanti/Syarifudin L 29-9-2014 1/IX Kamboja
3 Moh. Shoobirin Risnati Arni/A. Kholil L 10-4-2014 2/IX Mekarsari
4 Aulia Izatunisa Komariyah/Fani P 9-5-2014 3/IX Keturen
5 Resky Ramadhan Tri Nuryanti/Fandi L 18-7-2014 4/IX Kartini B
6 M. Fahri Alfatir Ersa/Apip L 19-2-2014 2/IX Debong
7 Najwa K Yuni/Indarno P 20-8-2014 2/IX Panggung
8 Naira Ayla Askana Nina V/Arief S P 12-2-2014 3/IX Kenanga A
9 Moh. Rasyid Erma Putria/Ade Setiawan L 10-7-2014 4/IX Kejambon
10 M. Haikal F Kusnul/Azam L 26-1-2014 2/IX Kartini A
11 Ratu Putri Khotijah/Zaenal P 17-11-2014 3/IX Pengabean
12 Ratu Ayu Khotijah/Zaenal P 17-11-2014 3/IX Pengabean
13 Airin Isnaeni Dewi P 20-6-2014 3/IX Slerok
14 Tanggal Alamat
Nama Bayi Nama Ortu L/P
Lahir (Rt / Rw) (Rt/Rw)
No
Dihyah Al Kalby Arifah/Abu Khoiri L 18-1-2015 3/IX Mawar B
1 Dzakira Aulia Wiharyati/Zakaria P 6-3-2015 1/IX Panggung
2 Nandit Kusuma Pradita Maria/Zaenal A L 18-2-2015 4/IX Mintaragen
3 Najwa Aulia Murniati/Yanuar P 19-3-2015 2/IX Randugunting
4 Ziya Ulhaq Lulu/Burhanudin L 10-4-2015 4/IX Smpg
5 Marisa Nuramadhani Nur Isnaeni/Nurwanto P 10-7-2015 4/IX Sejahtera I
6 Achmad Hawwin Rozack Dewi Wulan Sari/Salafudin L 10-8-2015 1/IX Panggung
7 Anindya Putri Andari Lili Ismiyati/Maryono P 22-8-2015 2/IX Panggung
8 Rimadona/M.Faqih P 27-7-2015 4/IX Sejahtera I
9 Moh. Qori Ika Puspita Sari/M.Soleh L 8-6-2015 4/IX Kuncup Mekar
10 Thoani/Cholil L 11-9-2015 1/IX Panggung
11 Aditya Rifki Hamizan Kartini/Mei Pambudi L 10-11-2015 2/IX Kartini B
12 Anindita Keisha Z Sri Wahyuningsih/Agustinus P 7-12-2015 4/IX Panggung
13 Siti Nur Amaliyah Siti Chodijah/Samsudin P 24-12-2015 2/IX Panggung
14 Khansa Saniyyah Suryanti/Riyanto P 5-10-2015 3/IX Kartini B
15 Tanggal Alamat
Nama Bayi Nama Ortu L/P
Lahir (Rt / Rw) (Rt/Rw)
No
Nunung N/M.Wahyudi P 13-1-2016 2/IX
1 Rafka Hafid Maulana Ike Nofiani/Abd.Kodir L 19-1-2016 3/IX Kartini A
2 Hafidz Salman Arifin Eka Rizki A/Sutaji L 30-1-2016 2/IX
3
LAPORAN HARIAN PEMAKAIAN VAKSIN & LOGISTIK DI PUSKESMAS TEGAL BARAT
BULAN :
PEMAKAIAN VAKSIN/LOGISTIK TOTAL
NO VAKSIN/LOGISTIK
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 PEMAKAIAN
A VAKSIN
1 BCG
2 POLIO
3 PENTAVALEN
4 HB UNIJEC
5 CAMPAK
6 TT
B ADS/SPUIT
1 0,5 ml
a. Bayi
b.Bumil & WUS
c.BIAS
2 0,05 ml
3 5 ml
a.Bayi
b.BIAS
C SAFETY BOX
0,25L
5L
LAPORAN STOK HARIAN VAKSIN DI PUSKESMAS TEGAL BARAT
BULAN :
STOK VAKSIN
NO VAKSIN 1 2 3 4 5 6 7 8 9 10
Aw K Ak Aw K Ak Aw K Ak Aw K Ak Aw K Ak Aw K Ak Aw K Ak Aw K Ak Aw K Ak Aw K Ak
A VAKSIN
1 BCG
2 POLIO
3 PENTAVALEN
4 HB UNIJEC
5 CAMPAK
6 TT
STOK VAKSIN
NO VAKSIN 11 12 13 14 15 16 17 18 19 20
Aw K Ak Aw K Ak Aw K Ak Aw K Ak Aw K Ak Aw K Ak Aw K Ak Aw K Ak Aw K Ak Aw K Ak
A VAKSIN
1 BCG
2 POLIO
3 PENTAVALEN
4 HB UNIJEC
5 CAMPAK
6 TT
STOK VAKSIN
NO VAKSIN 21 22 23 24 25 26 27 28 29 30 31
Aw K Ak Aw K Ak Aw K Ak Aw K Ak Aw K Ak Aw K Ak Aw K Ak Aw K Ak Aw K Ak Aw K Ak Aw K Ak
A VAKSIN
1 BCG
2 POLIO
3 PENTAVALEN
4 HB UNIJEC
5 CAMPAK
6 TT
LAPORAN STOK LOGISTIK DI PUSKESMAS TEGAL BARAT
BULAN :
STOK STOK
NO LOGISTIK PENERIMAAN PEMAKAIAN
AWAL BULAN AKHIR BULAN
B ADS/SPUIT
1 0,5 ml
a.Bayi
b.Bumil & Wus
c.BIAS
2 0,05 ml
3 5 ml
a.Bayi
b.BIAS
C SAFETY BOX
0,25L
5L
LAPORAN PEMAKAIAN OBAT
PEMAKAIAN OBAT
NO NAMA OBAT 1 2 3 4 5 6 7 8 9 10 NO
Aw P K Ak Aw P K Ak Aw P K Ak Aw P K Ak Aw P K Ak Aw P K Ak Aw P K Ak Aw P K Ak Aw P K Ak Aw P K Ak
LAPORAN PEMAKAIAN OBAT
PEMAKAIAN OBAT
NO NAMA OBAT 11 12 13 14 15 16 17 18 19 20
Aw P K Ak Aw P K Ak Aw P K Ak Aw P K Ak Aw P K Ak Aw P K Ak Aw P K Ak Aw P K Ak Aw P K Ak Aw P K Ak
LAPORAN PEMAKAIAN OBAT
PEMAKAIAN OBAT
NAMA OBAT 21 22 23 24 25 26 27 28 29 30 31
Aw P K Ak Aw P K Ak Aw P K Ak Aw P K Ak Aw P K Ak Aw P K Ak Aw P K Ak Aw P K Ak Aw P K Ak Aw P K Ak Aw P K Ak

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