FORMAT PENCATATAN HASIL PELAYANAN SUBPIN POLIO

Nama Posyandu/Sekolah/Pos layanan : Nama petugas :

Nama Desa/kelurahan : Puskesmas :
Tanggal : Kabupaten :

* Tuliskan alasan jika anak tidak bisa diimunisasi dan rencana jadwal pemberian imunisasi susulan pada kolom keterangan
Dosis 1 Dosis 2
Jenis
No. Nama Anak Tgl lahir Umur Kelami NIK Nama orang tua NIK Orang Tua Alamat No.Hp Tanggal Tanggal
Keterangan
n (L/P) Diimunisasi
No Batch Diimunisasi
No Batch
nOPV2 Vaksin nOPV2 Vaksin
a b c d e f g h i j k l m n o

1 SHAIDAH FATIMAH AZAHRA 2023-01-17  P 3214505701237578  Suryana CIJANTUNG SEKAR ARUM 1 4/6/2023 2226522 5/17/2023 2228622

2 SHANUM ALMAHERA 2022-12-24  P 3214506412224820  Cecep royadi CIJANTUNG SEKAR ARUM 1 4/6/2023 2226522 5/17/2023 2228622

3 AZAM HAQI ASSAURI 2022-12-22  L 3214052212220001  Asep Muhaemin CIJANTUNG SEKAR ARUM 1 4/6/2023 2226522 5/17/2023 2228622

4 SYIFA APRILIA 2022-11-27  P 3214056711220001  Oman Abdurohman CIJANTUNG SEKAR ARUM 1 4/6/2023 2226522 5/17/2023 2228622

5 ZAIRA YUNA DAYANTI 2022-09-24  P 3214056409220003  Hadi Samsul hamsah CIJANTUNG SEKAR ARUM 1 4/6/2023 2226522 5/17/2023 2228622

6 RANDI PUTRA MAULANA 2022-09-05  L 3214050509220005  Salim Mulyana CIJANTUNG SEKAR ARUM 1 4/6/2023 2226522 5/17/2023 2228622

7 MUHAMMAD RIDHO 2022-08-31  L 3214503108225310  Ilham agustian Kusumah Jaelani CIJANTUNG SEKAR ARUM 1 4/6/2023 2226522 5/17/2023 2228622

8 MUHAMAD KEVIN MAULANA 2022-08-30  L 3214053008220001  Warman CIJANTUNG SEKAR ARUM 1 4/6/2023 2226522 5/17/2023 2228622

9 MUHAMMAD DAFFI ADZIKRI 2022-06-28  L 3214052806220001  ILHAM MUHAMMAD SAFA\'AT CIJANTUNG SEKAR ARUM 1 4/6/2023 2226522 5/17/2023 2228622

10 ARSAKA 2022-06-28  L 3214502806222123  Rian nawawi CIJANTUNG 4/6/2023 2226522 5/17/2023 2228622

11 ALRIFAI ARIANSYAH PUTRA 2022-06-21  L 3214052106220002  Aridulloh CIJANTUNG SEKAR ARUM 1 4/6/2023 2226522 5/17/2023 2228622

12 SHAQIL 2022-06-01  L 3214500106222489  Suganda CIJANTUNG SEKAR ARUM 1 4/6/2023 2226522 5/17/2023 2228622

13 ARSYAD FAUZA D 2022-04-28  L 3214502804222627  Ridwan priana CIJANTUNG SEKAR ARUM 1 4/6/2023 2226522 5/17/2023 2228622

14 PAHREZA 2022-03-29  L 3214502903222122  Ahmad patoni CIJANTUNG SEKAR ARUM 1 4/6/2023 2226522 5/17/2023 2228622

15 AHMAD YAHYA 2022-03-20  L 3214502003229463  Ahmad Yusuf CIJANTUNG SEKAR ARUM 1 4/6/2023 2226522 5/17/2023 2228622
16 MUHAMMAD RAIHAN 2022-03-17  L 3214051703220001  Nendi CIJANTUNG SEKAR ARUM 1 4/6/2023 2226522 5/17/2023 2228622

17 FATIMAH AZZAHRA 2022-01-22  P 3214056201225427  FUJI A CIJANTUNG SEKAR ARUM 1 4/6/2023 2226522 5/17/2023 2228622

18 M.DAFA 2022-01-04  L 3214050401227321  MUI CIJANTUNG SEKAR ARUM 1 4/6/2023 2226522 5/17/2023 2228622

19 RAPISQI 2021-12-20  L 3214052012215341  YADI CIJANTUNG SEKAR ARUM 1 4/6/2023 2226522 5/17/2023 2228622

20 FURQON 2021-12-16  L 1612218731  CECEP CIJANTUNG SEKAR ARUM 1 4/6/2023 2226522 5/17/2023 2228622

21 ARLOVA 2021-09-21  P 3214056110210001  WILLY CIJANTUNG SEKAR ARUM 1 4/6/2023 2226522 5/17/2023 2228622

22 RIFAT S.A 2021-09-21  L 3214052109215268  IQBAL CIJANTUNG SEKAR ARUM 1 4/6/2023 2226522 5/17/2023 2228622

23 ADINDA A.P 2021-09-09  P 3214054909210002  SAEPUDIN CIJANTUNG SEKAR ARUM 1 4/6/2023 2226522 5/17/2023 2228622

24 ABIYAN 2021-07-29  L 2907216742  YAN.T CIJANTUNG SEKAR ARUM 1 4/6/2023 2226522 5/17/2023 2228622

25 ARSYA 2021-06-13  L 3214501306213992  Cecep Mahfudz CIJANTUNG SEKAR ARUM 1 4/6/2023 2226522 5/17/2023 2228622

26 SALWA N.A 2021-05-16  P 3214055605217241  RIKI Y CIJANTUNG SEKAR ARUM 1 4/6/2023 2226522 5/17/2023 2228622

27 GEMMA 2021-05-10  L 3214051005217345  ADITIA CIJANTUNG SEKAR ARUM 1 4/6/2023 2226522 5/17/2023 2228622

28 MUHAMAD KAFFI RAMADAN 2021-05-07  L 3214050705210005  Muhamad ramdon CIJANTUNG SEKAR ARUM 1 4/6/2023 2226522 5/17/2023 2228622

29 SALSA 2021-05-04  P 3214054405210003  UEP CIJANTUNG SEKAR ARUM 1 4/6/2023 2226522 5/17/2023 2228622

30 RIZQI N.R 2021-04-19  L 3214051404210001  PIPING CIJANTUNG SEKAR ARUM 1 4/6/2023 2226522 5/17/2023 2228622

31 M. Miftah 2020-10-18  L 3214051810202343  Bapaknya Miftah CIJANTUNG SEKAR ARUM 1 4/6/2023 2226522 5/17/2023 2228622

32 M. Devano 2020-08-24  L 3214052408205646  Bapaknya Devano CIJANTUNG SEKAR ARUM 1 4/6/2023 2226522 5/17/2023 2228622

33 Abizar M.A 2020-07-20  L 321405290720002  Bapaknya Abizar CIJANTUNG SEKAR ARUM 1 4/6/2023 2226522 5/17/2023 2228622

34 M.Hamdan 2020-05-06  L 3214051312190005  Bapaknya Hamdan CIJANTUNG SEKAR ARUM 1 4/6/2023 2226522 5/17/2023 2228622

35 PUTRI A 2020-03-28  P 3214056803200004  ADE YOYO CIJANTUNG SEKAR ARUM 1 4/6/2023 2226522 5/17/2023 2228622

36 A. Rizal P 2020-01-17  L 3214051701202343  Bapaknya Pizal CIJANTUNG SEKAR ARUM 1 4/6/2023 2226522 5/17/2023 2228622
37 Dea. P 2019-12-06  P 3214054612197456  Riki CIJANTUNG SEKAR ARUM 1 4/6/2023 2226522 5/17/2023 2228622

38 DIVA R 2019-11-03  P 3214050311190001  MIMIN CIJANTUNG SEKAR ARUM 1 4/6/2023 2226522 5/17/2023 2228622

39 Kastara 2019-09-15  L 3214051509190002  Sidik CIJANTUNG SEKAR ARUM 1 4/6/2023 2226522 5/17/2023 2228622

40 SITI M 2019-09-07  P 3214054709170003  KOMARUDIN CIJANTUNG SEKAR ARUM 1 4/6/2023 2226522 5/17/2023 2228622

41 BILQIS 2019-07-16  P 3214055607199273  KUSNADI CIJANTUNG SEKAR ARUM 1 4/6/2023 2226522 5/17/2023 2228622

42 Arsila 2019-06-22  P 3214056206195676  Bapaknya Arsila CIJANTUNG SEKAR ARUM 1 4/6/2023 2226522 5/17/2023 2228622

43 Amora 2019-03-09  P 3214054903190002  Holiq CIJANTUNG SEKAR ARUM 1 4/6/2023 2226522 5/17/2023 2228622

44 AIZZA 2019-02-17  P 3214055702190001  resta CIJANTUNG 4/6/2023 2226522 5/17/2023 2228622

45 GALIH 2018-11-21  L 3214052111185438  OJA CIJANTUNG SEKAR ARUM 1 4/6/2023 2226522 5/17/2023 2228622

46 Fiona 2018-11-15  P 3214055511180004  Wawan CIJANTUNG SEKAR ARUM 1 4/6/2023 2226522 5/17/2023 2228622

47 RANIA 2018-09-12  P 3214055809185427  DEWI CIJANTUNG SEKAR ARUM 1 4/6/2023 2226522 5/17/2023 2228622

48 HAFIZ 2018-08-11  L 3214051108188979  SUBANA CIJANTUNG SEKAR ARUM 1 4/6/2023 2226522 5/17/2023 2228622

49 LIANDRA MAUZA 2018-07-24  L 3214162407180001  Ridwan priana CIJANTUNG SEKAR ARUM 1 4/6/2023 2226522 5/17/2023 2228622

50 Salsabila 2018-07-22  P 3214056207185624  Ilham CIJANTUNG SEKAR ARUM 1 4/6/2023 2226522 5/17/2023 2228622

51 ARSYILA 2018-06-07  P 3214054706180000  RONI CIJANTUNG SEKAR ARUM 1 4/6/2023 2226522 5/17/2023 2228622

52 CARRISA HANA AULIA 2022-10-10  P 3214055010220001  Aep saepul Anwar CIJANTUNG SEKAR ARUM 2 4/6/2023 2226522 5/17/2023 2228622

53 TANISHA AZ-ZAHRA KHALISAH 2022-08-15  P 3214055508220002  DEDEN AHMAD RYAN CIJANTUNG SEKAR ARUM 2 4/6/2023 2226522 5/17/2023 2228622

54 SYIFA CANTIKA AGNISTI 2022-08-01  P 3214054108200001  PARID ATAULA CIJANTUNG SEKAR ARUM 2 4/6/2023 2226522 5/17/2023 2228622

55 JIHAN SALSABILA 2022-07-22  P 3214056207200001  Alpian CIJANTUNG SEKAR ARUM 2 4/6/2023 2226522 5/17/2023 2228622

56 FARISA NUR FATHIA 2022-07-06  P 3214504607226676  Kuswanto CIJANTUNG SEKAR ARUM 2 4/6/2023 2226522 5/17/2023 2228622

57 AQILLA ZAHRA FADILLAH 2022-04-25  P 3214506504221227  ADE mawi CIJANTUNG SEKAR ARUM 2 4/6/2023 2226522 5/17/2023 2228622
58 MUHAMAD RAAFA 2022-01-05  L 3214050501220002  Husna CIJANTUNG SEKAR ARUM 2 4/6/2023 2226522 5/17/2023 2228622

59 MUHAMAD YUSUF FADILAH 2022-01-03  L 3214050301220003  Ujang kosasih CIJANTUNG SEKAR ARUM 2 4/6/2023 2226522 5/17/2023 2228622

60 ALESHA TITANIA RIZWAN 2022-01-02  P 3214054201220001  Dadan rijwan CIJANTUNG SEKAR ARUM 2 4/6/2023 2226522 5/17/2023 2228622

61 MUHAMAD ARYA IBRAHIM 2021-11-01  L 3214500111213150  Pebri CIJANTUNG SEKAR ARUM 2 4/6/2023 2226522 5/17/2023 2228622

62 MUHAMAD RAFKA FAUZAI 2021-10-30  L 3214053010210002  Sukirman CIJANTUNG SEKAR ARUM 2 4/6/2023 2226522 5/17/2023 2228622

63 MUHAMAD RAFA ALFARIZI 2021-10-04  L 3214050410210002  Paris ataula CIJANTUNG SEKAR ARUM 2 4/6/2023 2226522 5/17/2023 2228622

64 MUHAMAD RAFA ALFARIZI 2021-10-04  L 3214500410219819  PARId ataula CIJANTUNG SEKAR ARUM 2 4/6/2023 2226522 5/17/2023 2228622

65 ARSHAKA ZAYDAN EL RUMI 2021-08-17  L 3214501708214429  Komarudin CIJANTUNG SEKAR ARUM 2 4/6/2023 2226522 5/17/2023 2228622

66 MUHAMAD RAFFA SULAIMAN 2021-04-01  L 3214050104210003  Dani tantawi CIJANTUNG SEKAR ARUM 2 4/6/2023 2226522 5/17/2023 2228622

67 Earlyna 2020-12-23  P 3214056312201245  cecep CIJANTUNG SEKAR ARUM 2 4/6/2023 2226522 5/17/2023 2228622

68 Syakila 2020-11-24  P 3214056411200003  gustira CIJANTUNG SEKAR ARUM 2 4/6/2023 2226522 5/17/2023 2228622

69 MUHAMAD AZAM AL-MAJID 2020-08-06  L 3214050608200001  Abdul majid CIJANTUNG SEKAR ARUM 2 4/6/2023 2226522 5/17/2023 2228622

70 Raya 2020-07-22  P 3214056207204578  Ruslan CIJANTUNG SEKAR ARUM 2 4/6/2023 2226522 5/17/2023 2228622

71 Zahira 2020-06-29  P 3214056906200001  jaenudin CIJANTUNG SEKAR ARUM 2 4/6/2023 2226522 5/17/2023 2228622

72 Zhafira 2020-06-23  P 321405271290002  Fauzan CIJANTUNG SEKAR ARUM 2 4/6/2023 2226522 5/17/2023 2228622

73 Zhafira 2020-06-20  P 3214056306200002  Ahmad P CIJANTUNG SEKAR ARUM 2 4/6/2023 2226522 5/17/2023 2228622

74 Arfan 2020-06-11  L 3214051166200003  irpan CIJANTUNG SEKAR ARUM 2 4/6/2023 2226522 5/17/2023 2228622

75 Aluna 2020-03-07  P 3214054793200002  dadan CIJANTUNG SEKAR ARUM 2 4/6/2023 2226522 5/17/2023 2228622

76 M. Dhafa 2020-02-29  L 3214052902200001  jana CIJANTUNG SEKAR ARUM 2 4/6/2023 2226522 5/17/2023 2228622

77 Meisha 2020-02-25  P 3214056502201235  Dedi CIJANTUNG SEKAR ARUM 2 4/6/2023 2226522 5/17/2023 2228622

78 ALIFA PUTRI 2020-01-17  P 3214055701200003  Deni suhaya CIJANTUNG SEKAR ARUM 2 4/6/2023 2226522 5/17/2023 2228622
79 HAFIZ 2019-12-22  L 3214052212190003  NANANG CIJANTUNG SEKAR ARUM 2 4/6/2023 2226522 5/17/2023 2228622

80 NIHA 2019-11-12  P 3214055211190003  DENI CIJANTUNG SEKAR ARUM 2 4/6/2023 2226522 5/17/2023 2228622

81 Keysya 2019-11-10  P 3214045011190002  Wawan CIJANTUNG SEKAR ARUM 2 4/6/2023 2226522 5/17/2023 2228622

82 Kelvin 2019-11-03  L 3214050311190007  aan CIJANTUNG SEKAR ARUM 2 4/6/2023 2226522 5/17/2023 2228622

83 Sakira Asapa 2019-07-19  P 3214055907190002  hahmad CIJANTUNG SEKAR ARUM 2 4/6/2023 2226522 5/17/2023 2228622

84 Angga 2019-06-05  L 3214050506192356  Suhaya CIJANTUNG SEKAR ARUM 2 4/6/2023 2226522 5/17/2023 2228622

85 ADEN 2019-02-13  L 3214051202190003  BABAS CIJANTUNG SEKAR ARUM 2 4/6/2023 2226522 5/17/2023 2228622

86 AIRA 2018-12-28  P 3214056812180001  AYI CIJANTUNG SEKAR ARUM 2 4/6/2023 2226522 5/17/2023 2228622

87 WINDA RIZKIA KHUSNA 2018-11-07  P 3214054711180001  Suseno CIJANTUNG SEKAR ARUM 2 4/6/2023 2226522 5/17/2023 2228622

88 AKSAN 2018-10-23  L 3214052310180002  YOPI CIJANTUNG SEKAR ARUM 2 4/6/2023 2226522 5/17/2023 2228622

89 Naila 2018-08-28  P 3214058606160002  almunaemin CIJANTUNG SEKAR ARUM 2 4/6/2023 2226522 5/17/2023 2228622

90 KIARA 2018-08-08  P 3214054808180003  TOHIDIN CIJANTUNG SEKAR ARUM 2 4/6/2023 2226522 5/17/2023 2228622

91 Dhisa 2018-07-31  P 3214057107180001  irpan CIJANTUNG SEKAR ARUM 2 4/6/2023 2226522 5/17/2023 2228622

92 ABILAL 2018-07-26  L 3214052607180012  ASEP CIJANTUNG SEKAR ARUM 2 4/6/2023 2226522 5/17/2023 2228622

93 AMANDA 2018-06-23  P 3214056306180003  ADE CIJANTUNG SEKAR ARUM 2 4/6/2023 2226522 5/17/2023 2228622

94 RAMDAN 2018-05-22  L 3214052208150002  DEDI CIJANTUNG SEKAR ARUM 2 4/6/2023 2226522 5/17/2023 2228622

95 ASRIP 2018-04-20  L 3214052904118000  SARIP CIJANTUNG SEKAR ARUM 2 4/6/2023 2226522 5/17/2023 2228622

96 SITI MARWAH 2022-09-23  P 3214056309220001  Diki / tina CIJANTUNG SEKAR ARUM 3 4/6/2023 2226522 5/17/2023 2228622

97 M.KHALID 2022-09-11  L 3214051109220003  ENDANG / AI CIJANTUNG SEKAR ARUM 3 4/6/2023 2226522 5/17/2023 2228622

98 ADEVA SANARI 2022-06-15  P 3214505506227767  Agung / devi CIJANTUNG SEKAR ARUM 3 4/6/2023 2226522 5/17/2023 2228622

99 M.IRFANSYAH 2022-05-20  L 3214052005220002  CECEP / LENI CIJANTUNG SEKAR ARUM 3 4/6/2023 2226522 5/17/2023 2228622
100 M.RAFISQY ABIZAR 2022-04-03  L 3214050304220002  Anang / lusy CIJANTUNG SEKAR ARUM 3 4/6/2023 2226522 5/17/2023 2228622

101 M.DZAKIR 2022-03-24  L 3214502403225737  Epul / imas CIJANTUNG SEKAR ARUM 3 4/6/2023 2226522 5/17/2023 2228622

102 GIBRAN 2022-01-28  L 3214502801228318  Budi / siska CIJANTUNG SEKAR ARUM 3 4/6/2023 2226522 5/17/2023 2228622

103 YARDAN 2022-01-14  L 3214501401225840  Heri / ilah CIJANTUNG SEKAR ARUM 3 4/6/2023 2226522 5/17/2023 2228622

104 SYAHIRA 2021-12-15  P 3214055512210002  JANA / LINA CIJANTUNG SEKAR ARUM 3 4/6/2023 2226522 5/17/2023 2228622

105 ELFATHAN 2021-12-14  L 3214501412218468  Gilang / lia CIJANTUNG SEKAR ARUM 3 4/6/2023 2226522 5/17/2023 2228622

106 KHAIRIN 2021-12-09  P 3214504912219362  rahmat yeni CIJANTUNG SEKAR ARUM 3 4/6/2023 2226522 5/17/2023 2228622

107 NAIFA RAFANIA 2021-09-24  P 3214056409210001  Ahmad rohidin / kusmawati CIJANTUNG SEKAR ARUM 3 4/6/2023 2226522 5/17/2023 2228622

108 NAURA SIDQIA 2021-09-20  P 3214056009210001  WEWEN / LENI CIJANTUNG SEKAR ARUM 3 4/6/2023 2226522 5/17/2023 2228622

109 ARRIZKY AGUSTIAN FIRDAUS 2021-08-24  L 3214052408210001  Suherman / wulan CIJANTUNG SEKAR ARUM 3 4/6/2023 2226522 5/17/2023 2228622

110 KHALISA HUMAIRA 2021-07-19  P 3214055907210001  DENI / DWI CIJANTUNG SEKAR ARUM 3 4/6/2023 2226522 5/17/2023 2228622

111 ABHIMATA 2021-04-23  L 3214052304210001  Abdul sulaeman / winni CIJANTUNG SEKAR ARUM 3 4/6/2023 2226522 5/17/2023 2228622

112 ASHEEQA BASAGITA 2021-04-23  P 3214056304210001  Abdul sulaeman / winni CIJANTUNG SEKAR ARUM 3 4/6/2023 2226522 5/17/2023 2228622

113 M. Nizam 2021-01-01  L 3214050101215678  Dede CIJANTUNG SEKAR ARUM 3 4/6/2023 2226522 5/17/2023 2228622

114 M.RAFKA ABDULLAH 2020-12-24  L 3214052412200001  Irpan/siti hasnah CIJANTUNG SEKAR ARUM 3 4/6/2023 2226522 5/17/2023 2228622

115 ARSYAD ALFARIZKI 2020-12-19  L 3214501912203970  Agus / wiwi CIJANTUNG SEKAR ARUM 3 4/6/2023 2226522 5/17/2023 2228622

116 M. HIKAM J 2020-10-09  L 3214051009205676  YAYAN / NINA CIJANTUNG SEKAR ARUM 3 4/6/2023 2226522 5/17/2023 2228622

117 ASHEEQA NAZRA EILIYA 2020-09-19  P 3214055909200002  Anggi herdiana / eli CIJANTUNG SEKAR ARUM 3 4/6/2023 2226522 5/17/2023 2228622

118 RAFASYA 2020-06-12  L 3214051106203456  UJUNG/ALIS CIJANTUNG SEKAR ARUM 3 4/6/2023 2226522 5/17/2023 2228622

119 Khanza Nafisa 2020-05-18  P 3214055805203456  Sandi Epedi CIJANTUNG SEKAR ARUM 3 4/6/2023 2226522 5/17/2023 2228622

120 Maira 2020-05-05  P 3214054505203344  Jajang N CIJANTUNG SEKAR ARUM 3 4/6/2023 2226522 5/17/2023 2228622
121 Al Fatih Aqsa 2020-03-22  L 321405220320001  Agus J CIJANTUNG SEKAR ARUM 3 4/6/2023 2226522 5/17/2023 2228622

122 M. Azka 2020-03-04  L 3214050403204567  Ujang R CIJANTUNG SEKAR ARUM 3 4/6/2023 2226522 5/17/2023 2228622

123 ARSYILA FATHIMA 2019-12-05  P 3214054512190001  Udeng / siti CIJANTUNG SEKAR ARUM 3 4/6/2023 2226522 5/17/2023 2228622

124 KINANTI 2019-12-01  P 3214055012192345  M. HASIM / RINA CIJANTUNG SEKAR ARUM 3 4/6/2023 2226522 5/17/2023 2228622

125 MUHAMMAD SILAN 2019-12-01  L 3214500112192677  Imam topiq / dini CIJANTUNG SEKAR ARUM 3 4/6/2023 2226522 5/17/2023 2228622

126 AULIAN ABDAD QIYAS 2019-11-14  L 3214051411190001  Agus susanto / rita CIJANTUNG SEKAR ARUM 3 4/6/2023 2226522 5/17/2023 2228622

127 MUHAMMAD HAMZI SYAHMI 2019-10-13  L 3214501310197378  Hasanudin / ati CIJANTUNG SEKAR ARUM 3 4/6/2023 2226522 5/17/2023 2228622

128 Syafik 2019-09-27  L 3214052709195676  Aang p CIJANTUNG SEKAR ARUM 3 4/6/2023 2226522 5/17/2023 2228622

129 AHMAD MALIK 2019-08-19  L 3214051908190001  Lili / yeni CIJANTUNG SEKAR ARUM 3 4/6/2023 2226522 5/17/2023 2228622

130 M. Wildan M 2019-07-15  L 3214051507190001  Abdul H CIJANTUNG SEKAR ARUM 3 4/6/2023 2226522 5/17/2023 2228622

131 AHMAD FAIZ 2019-06-19  L 3214051906203456  HENDRI / TIA CIJANTUNG SEKAR ARUM 3 4/6/2023 2226522 5/17/2023 2228622

132 TANISA PUTRI 2019-05-14  P 3214055405190005  Anang / lusy CIJANTUNG SEKAR ARUM 3 4/6/2023 2226522 5/17/2023 2228622

133 Faldiaz N 2018-11-30  L 3214053011180001  Handi CIJANTUNG SEKAR ARUM 3 4/6/2023 2226522 5/17/2023 2228622

134 Naira N M 2018-11-30  P 3214057011180002  Suminta CIJANTUNG SEKAR ARUM 3 4/6/2023 2226522 5/17/2023 2228622

135 Hana H 2018-10-16  P 3214055510180001  Anton R CIJANTUNG SEKAR ARUM 3 4/6/2023 2226522 5/17/2023 2228622

136 QUEENSA 2018-08-31  P 3214057108182345  RIANO/ ALIS CIJANTUNG SEKAR ARUM 3 4/6/2023 2226522 5/17/2023 2228622

137 SYAHRA 2018-05-27  P 3214056705180003  Mumuh / anis CIJANTUNG SEKAR ARUM 3 4/6/2023 2226522 5/17/2023 2228622

138 ALMEERA PEBRIANI 2023-02-14  P 3214505402235739  Ece rusnadi CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622

139 NADHIRA ALFATHUN NISA 2023-02-04  P 3214504403239755  SOLEH CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622

140 ADEELA NUR KAMILA 2023-01-22  P 3214506201237385  Hilmansyah CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622

141 MUHAMNAD ITACHI NOER IRFAN 2023-01-12  L 3214501203232997  Ridwan hadi irfan CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622
142 MUHAMMAD DIMAS NURMULKI 2022-11-28  L 3214052811220001  Daskim CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622

143 HILYA RIZKIA ARFA 2022-08-29  P 3214506908226608  Arip budiman CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622

144 HUMAIRA ALFATHUNNISA 2022-08-27  P 3214056708220002  Hadromi CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622

145 DEILA AZZAHRA PUTRI 2022-08-08  P 3214054808220002  Acing sutisna CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622

146 DELIMA PERMATA PUTRI 2022-08-08  P 3214054808220003  Acing sutisna CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622

147 AMELIA AZZAHRA 2022-08-05  P 3214054508220001  APIT JOHARI CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622

148 AMELIA FUJIYANTI 2022-07-09  P 3214054907220001  Ahmad zen CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622

149 RAPI MAULANA 2022-07-06  L 3214050607220001  Hendi hendriyawan CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622

150 SHABIRA ALMAHYRA 2022-04-17  P 3214055704220003  Miftahul munir CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622

151 SHANAYA RIZQIA ELSHANUM 2022-03-26  P 3214056603220001  Anang suryana CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622

152 HIMAWARI ARSYILA NOER IRFAN 2022-03-04  P 3214504403227203  Ridwan hadi irfan CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622

153 ZIHAN ASQIARA 2022-01-05  P 3214054501220001  Agustiana CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622

154 SRI WULAN KHOERUNISA 2021-12-25  P 3214056512210002  Ahmad khoeruloh CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622

155 SALMA ARSILA 2021-12-22  P 3214056212210001  Agus rianto CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622

156 DIMAS AHMAD ALHAFIZ 2021-10-25  L 3214052510210002  Amad CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622

157 SABIRA AGNIA 2021-09-21  P 3214056109210002  Muhamad Ikbal maulana CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622

158 MUHAMAD RIZAL FIRMANSAH 2021-09-19  L 3214051909210001  Mulyadi CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622

159 MUHAMAD RAFA FATUROHMAN 2021-08-05  L 3214050508210001  Aas abdulah CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622

160 MUHAMMAD IMAM HUSAERI 2021-05-03  L 3214050305210002  Andri husaeri CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622

161 ZALFA INDAH RIZQIA 2020-11-19  P 3214055911200001  Tatang suryana CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622

162 MUHAMAD AZKA ALFARIZI 2020-07-02  L 3214050207200001  Rahman saepuloh CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622
163 ARKA MUBAROK 2020-05-14  L 3214051405200002  Muhamad kosim CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622

164 QIANA NAFIZA SALAMA 2020-04-07  P 3214014704200002  Agus selaeman CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622

165 HAFIZA KHAIRA LUBNA 2020-01-11  P 3214055101200002  Adi rusadi CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622

166 Ulul 2019-12-03  L 3214050312191234  Asep A CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622

167 Rafisky 2019-09-02  L 3214050209194567  wildan CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622

168 Revalina A 2019-07-24  P 3214056407191234  Lukman CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622

169 Keila A 2019-04-15  P 3214061504190001  Imamudin CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622

170 Alisya N 2019-02-03  P 3214054302190001  Predy CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622

171 M Lutfi 2019-01-26  L 3214052601190003  Ape S CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622

172 Rahayu D 2019-01-10  P 3211105001180002  Holil A CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622

173 Rayana 2019-01-07  P 317074701190001  Reindy CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622

174 Rayana 2019-01-07  P 3170741701190001  Reindy CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622

175 Aulia I 2018-12-15  P 3214055512180001  Dedi CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622

176 ANDIN FADILAH 2018-11-25  P 3214056511160002  Usman CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622

177 Ririn A 2018-11-01  P 321405411180002  M Kosim CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622

178 Ririn 2018-11-01  P 3214054111180002  M Kosim CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622

179 Syifa O 2018-10-06  P 3214054610184567  Endang CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622

180 M Alwi 2018-09-15  L 3214051509160004  M Kosim CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622

181 MD Atharil 2018-08-31  L 3203053108180001  Dadan CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622

182 Risma M 2018-08-28  P 3214056808181234  Aripin CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622

183 Saski Ayu 2018-08-15  P 3214055508180001  Soleh J CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622
184 M Regi 2018-08-13  L 3214051308180001  Jajang CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622

185 Kia Mecca 2018-08-07  P 3214034706160001  Anggi CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622

186 Rohim 2018-08-05  P 3214054508180003  Rohim CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622

187 nanda 2018-08-04  L 3214054408180001  andri CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622

188 azka 2018-07-31  L 3205122308870001  cep adi CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622

189 tiara 2018-07-25  P 3214506507180000  rosidi CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622

190 Awsal S 2018-07-05  L 3212190507160001  Wandi CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622

191 ADELIA 2018-06-29  P 3214052912070002  BUNYAMIN CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622

192 Adelia 2018-06-29  P 3214056906181234  Bunyamin CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622

193 radika 2018-06-28  L 3214502806180000  hendar CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622

194 Mutiara N 2018-06-20  P 3214055000618000  Acep CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622

195 Mutiara N 2018-06-20  P 3214056006180001  Acep CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622

196 arsyla 2018-06-01  P 3214504106180000  lulu CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622

197 azriel 2018-05-25  L 3214502505180000  m. dendi CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622

198 M Alghifari 2018-05-13  L 3214011305180001  Nandang CIJANTUNG SEKAR ARUM 4 4/6/2023 2226522 5/17/2023 2228622

199 MAULANA 2023-01-31  L 321401301230001  arif CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

200 CAMELIA 2022-07-22  P 321403607220001  hendra CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

201 AULIA 2022-03-16  P 3214055603220002  tanjung CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

202 GRESKA 2022-03-08  P 321405483220001  MANDU CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

203 JIO 2022-02-19  L 3214051902220001  SRIYONO CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

204 ALDEVARO 2022-01-28  L 3214122801220001  firda CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622
205 RAFKA 2021-11-29  L 3214052911217631  UCAN CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

206 DIARA 2021-10-28  L 3214012810210002  widy CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

207 RAFAEL 2021-10-26  L 321405280921001  hasto CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

208 LUBNA 2021-10-25  P 3171046510210001  DANI CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

209 METHIASA 2021-10-19  P 330610591020001  haryadi CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

210 AGHNIA 2021-08-29  P 3273156908210001  INDRA CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

211 DAFFA 2021-08-07  L 3214050708210001  yusuf CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

212 MELODY 2021-06-24  P 32140460620001  FAJAR CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

213 BRIAN 2021-06-06  L 3214050606210002  DERI CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

214 SUTAN 2021-06-03  L 3214050306210001  RONALDO CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

215 ADIKARA 2021-06-02  L 3214030206210002  AKBAR CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

216 DEVANKA 2021-04-05  L 3214050504210002  feby CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

217 AREZUMI 2021-03-25  P 3214056503210002  REZA CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

218 ARUMI 2021-01-06  P 3214054801210001  AGUS CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

219 DZAKIR 2020-12-28  L 3214052812200001  YOGA CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

220 ALFAREL 2020-12-16  L 3214041612200001  firdaus CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

221 M.FAREL 2020-12-16  L 321404162200001  firdaus CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

222 ARFAN 2020-11-12  L 3214051211200001  RESTA CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

223 ARSHAKA 2020-09-15  L 3273261509200003  ALAN CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

224 EL FATIH 2020-08-11  L 3214051108200001  angga CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

225 ALESHA 2020-05-13  P 3214055305200002  ASEP CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622
226 MEYRISA 2020-05-06  P 3214034605200004  SUPADI CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

227 KARISSA 2020-05-03  P 3213234305200001  RATNASARI CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

228 APRILI 2020-04-28  P 3214056804200003  WAWAN CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

229 K. KANZA 2020-04-25  P 3214056504200001  SUTRISNO CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

230 HAFIZ 2020-03-29  L 3214012903200002  SUPRIYADI CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

231 NAUFAL 2020-03-12  L 3311011203200001  lilik + faridah CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

232 VERENDRA 2020-01-30  L 3201133001200002  RIKI CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

233 M. ALWI 2020-01-29  L 3214052901200001  OYOK CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

234 ROWIMONA 2020-01-20  P 3214056001200004  H. RAHMAT CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

235 JUNA 2020-01-11  L 3214031101200001  NANA CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

236 SULTHAN 2019-12-28  L 3214052812190001  ALWAN CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

237 LADZ 2019-12-03  L 3210110312190001  ASEP CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

238 GHAZEA 2019-11-20  P 3214056011190001  YAN CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

239 DEIVA 2019-11-18  P 3214055811190003  YUSNI CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

240 SYABNA 2019-11-14  P 3203135417190004  TAUFIK CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

241 MAYLAFAISHA 2019-11-14  P 3214055411190003  angga CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

242 ALEA 2019-10-29  P 3204296910190001  MARTIN CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

243 ALVINO 2019-09-10  L 3214051009190002  yusuf CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

244 RAFISQI 2019-09-03  L 3214050309190002  WILDAN CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

245 DELISA 2019-08-06  P 3214084608190001  yusup CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

246 AFKAR 2019-07-24  L 3214052407190001  HANDAN CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622
247 RAZQIYA 2019-07-22  P 3214056207190002  SHOLEH CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

248 GILANG 2019-07-08  L 3214051607180004  YUDI CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

249 ALVINO 2019-07-05  L 3214120507190003  firda CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

250 HAFIZ 2019-05-25  L 3214133005190002  isma CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

251 AKHTAR 2019-05-10  L 3214041005190003  HENDRI CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

252 NAURA 2019-05-04  P 3214034405190004  EKI CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

253 AKMAR 2019-04-15  L 321406150190001  imam CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

254 ALFIEN 2019-02-17  L 3214031702190003  YUSUF CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

255 ARGENZI 2019-02-02  L 3214010202190003  NOVAN CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

256 ALUNA 2019-01-08  P 3214054801190002  ari CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

257 NADA 2018-12-13  P 3214055501210002  RONI CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

258 BRYAN 2018-11-23  L 3214052311160001  IIM CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

259 M. ATHARIZ 2018-11-20  L 3217042011180004  ALAN CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

260 M.KENAN 2018-11-05  L 3214050511180001  m ikhsan CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

261 AIRA 2018-10-15  P 3214055510180003  AFRIZAL CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

262 SELLA 2018-10-10  P 3214015010180002  TAUFIK CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

263 REVALDI 2018-05-29  L 3214052905180003  rani CIJANTUNG SEKAR ARUM 5 4/6/2023 2226522 5/17/2023 2228622

TOTAL

Jumlah Jumlah
Jumlah vial Jumlah Vial Sisa
dibawa vial vial
Jumlah Vial nOPV dipakai rusak