No.

Klinik Nama Anak NIK Anak Tempat Lahir

1 KLINIK AMANA CALLISTA SHANUM 3404084212220001

2 KLINIK AMANA M FAISAL L 3371010911220001
3 KLINIK AMANA SAHILA AKSARA SENJA
4 KLINIK AMANA ELVANO ZHAFAR 3308102910220002
5 KLINIK AMANA ARSALAAN RAYYANKA 3308101510220003
6 KLINIK AMANA IRISH FERY A 3308104410220001
7 KLINIK AMANA GIOSE LEON 3308102712220001
8 KLINIK AMANA CHAYRA ZIANA
9 KLINIK AMANA ALINA KADERA
10 KLINIK AMANA AZIGHA OKTA REVANDRA 3308102710220002
11 KLINIK AMANA CEISYA ALMAHYRA
12 KLINIK AMANA RAJA SALMAN B 3308152502210001
13 KLINIK AMANA UWAIS
14 KLINIK AMANA FAHZEA ARETHA PUTRI
15 KLINIK AMANA QIANA ZARA ZALINA
16 KLINIK AMANA M NABIL NABAWI
17 KLINIK AMANA M ARIFIN ALMAVZA
18 KLINIK AMANA DEVAN RASKA KANAKA
19 KLINIK AMANA M ARKAN FAWAZ 3308100106220BOYOLALI
20 KLINIK AMANA M RAFKA RAFANDAN 3371010209220MAGELANG
21 KLINIK AMANA GASANI SHANUM
22 KLINIK AMANA AZZAHRA SHEVA ELMYRA 3308106607210MAGELANG
23 KLINIK AMANA RIFQI ATHADECINO QAISAR
24 KLINIK AMANA ZEA NADIRA ASSALWA 3308104504210001
25 KLINIK AMANA ADILA HANUM HUMAIRA
26 KLINIK AMANA KEZIA KANAYA 3308104202230MAGELANG
27 KLINIK AMANA DENISH ALSAD RASKSHAN
28 KLINIK AMANA DANANJAYA SHEAN MAHENDRA 3404012302230YOGYAKARTA
29 KLINIK AMANA AHZA RUMAISHA
30 KLINIK AMANA AISHWA AZQILA FAYOLA 3308105402230MAGELANG
31 KLINIK AMANA M HAMDAN MAULANA 3308201101123MAGELANG
32 KLINIK AMANA AHMAD LATIFAH
33 KLINIK AMANA ARRAYYAN DYLAN ALFARIZQI
34 KLINIK AMANA VIRDA SAFITRI 3308105209210MAGELANG
35 KLINIK AMANA DILAN RAKA MAHAAWIRA
36 KLINIK AMANA KENZI RAFANDA
37 KLINIK AMANA DAVIANDA ARKANANTA ALKAHFI
38 KLINIK AMANA NADHIFA HUMAIRA 3308141022100MAGELANG
39 KLINIK AMANA MUHAMMAD BAYAZID F
40 KLINIK AMANA NABILA NAVISHA P
41 KLINIK AMANA DYBALA RODJA
42 KLINIK AMANA CHAIAVARA GANESA
43 KLINIK AMANA M BANI SURYA
44 KLINIK AMANA M KHALIF PUTRA ZAKARIA 3371011201230001
45 KLINIK AMANA M ARTHANABRI EL FATIH
46 KLINIK AMANA JIHANE ALMAHYRA 3308104412220001
47 KLINIK AMANA HASAN NAJIB
48 KLINIK AMANA HUSAIN NAJIB
49 KLINIK AMANA ELVANO ERJAZ
50 KLINIK AMANA ERLANGGA AKBAR 3371022012220001
51 KLINIK AMANA ANOV EVANO 3308102312220001
52 KLINIK AMANA M RAIHAN ALFARIZKY 3308100412220002
53 KLINIK AMANA ARSHAKA NAGATA 3308101206210003
54 KLINIK AMANA NATHAN NARADIPTA 3371012610220002
55 KLINIK AMANA BARIQ KENZIE KEENAN 3308102111220001
56 KLINIK AMANA M RAYA AL ZAFRAN 3308150212220MAGELANG
57 KLINIK AMANA ALBIANSYAH ALFARIZKY N 3371012412220MAGELANG
58 KLINIK AMANA GALEN RAY SURENDRA
59 KLINIK AMANA EMIR AL TAQY 3175042401230MAGELANG
60 KLINIK AMANA QIANA ZEA AMARA SUCI
61 KLINIK AMANA CHAERUNNISA DENIA ATHALLA
62 KLINIK AMANA BYAKTA KURNIA NAGAN 3312200201230MAGELANG
63 KLINIK AMANA GRANADA PUTRI SATRIA
64 KLINIK AMANA M ARYA DZAKY PRADANA
65 KLINIK AMANA ARSYLA ANDYA AZZAHRA
66 KLINIK AMANA NADIF HANAN SAPUTRA
67 KLINIK AMANA BACHTIAR SANGKARA ABIMANYU
68 KLINIK AMANA FAHRUL AZAM RAMADAN 3371012104220MAGELANG
69 KLINIK AMANA REVANDRA ARSAKA GEMALA 3313041605220KAANGANYAR
70 KLINIK AMANA MISHARY IBRAHIM EL YUSUF
71 KLINIK AMANA AZKIYA SHAKIRA AZAHRA 3308105707210MAGELANG
72 KLINIK AMANA M IBRAHIM ALDEVARO
73 KLINIK AMANA ARCILLA AFSHEEN MALIQ 3308195606220MAGELANG
74 KLINIK AMANA ALSAKI BERYL ARL REKSA 3308100506220MAGELANG
75 KLINIK AMANA DENISH ABDILLAH ALFATIH 3371030511220004
76 KLINIK AMANA ALEA SYNANTIA CHEISYA
77 KLINIK AMANA ANINDIRA NAFIA PRASETYO
78 KLINIK AMANA DHEFFIN EL FATIH 3308102311210MAGELANG
79 KLINIK AMANA M DZAKI ZAYAN 3210216082100MAJALENGKA
80 KLINIK AMANA NAHLA ZUNAIRA 3308106610220MAGELANG
81 KLINIK AMANA EZRA REYNAND ALFAREZI 3308140207210MAGELANG
82 KLINIK AMANA ELVANO YODA 3310020503220MAGELANG
83 KLINIK AMANA QUEENGY EGA EDREA S
84 KLINIK AMANA FIRDAUS SADAM
85 KLINIK AMANA GEMMA ARUNA 3371037008210KOTA MAGELANG
86 KLINIK AMANA AHMAD HAMIZAN AKHTAR 3308100510210MAGELANG
87 KLINIK AMANA ALMEER IZHAR MAUZA
88 KLINIK AMANA ALEESHA MALAIKA ORLYN
89 KLINIK AMANA RAFASHA ZYAN MALIQ
90 KLINIK AMANA BY NY YUNIDA RESTIYANI MAGELANG
91 KLINIK AMANA BY NY ARINA KHOIRUNNISA MAGELANG
92 KLINIK AMANA BY NY NUR ANA LALATUL MAGELANG
93 KLINIK AMANA BY NY INTAN RETNO W MAGELANG
94 KLINIK AMANA BY NY USNUL COTIMAH MAGELANG
95 KLINIK AMANA BY NY FEBRI INDRAWATI MAGELANG
96 KLINIK AMANA BY NY ENI KUSRIANI MAGELANG
97 KLINIK AMANA BY BY YUNITA RAHAYU MAGELANG
98 KLINIK AMANA BY NY KHAIRUNISA HAQUE MAGELANG
 99 KLINIK AMANA BY NY YULI RETNO MAGELANG
100 KLINIK AMANA BY NY DIFA FITRIYANI MAGELANG
101 KLINIK AMANA BY NY ZANA YULIANA MAGELANG
102 KLINIK AMANA BY NY SITI KOMARIYAH MAGELANG
103 KLINIK AMANA BY NY STEFANY TURSIA MAGELANG
104 KLINIK AMANA BY NY CINDY ANISTA D MAGELANG
105 KLINIK AMANA BY NY DITA PRAMITA MAGELANG
106 KLINIK AMANA BY NY NURHASANAH MAGELANG
107 KLINIK AMANA BY NY PUTRI YUNIANTI MAGELANG
108 KLINIK AMANA BY NY RARASWATI MAGELANG
109 KLINIK AMANA BY NY ANITA INDAH S MAGELANG
110 KLINIK AMANA BY NY IKA YULIATI MAGELANG
111 KLINIK AMANA BY NY YUNI ISNAWATI MAGELANG
112 KLINIK AMANA BY NY METY MEITAVENI MAGELANG
113 KLINIK AMANA BY NY TUTIK LATIFAH MAGELANG
114 KLINIK AMANA BY NY DITTA FEBRIANTY MAGELANG
115 KLINIK AMANA BY NY ARI SEYANINGSIH MAGELANG
 Jenis
Tanggal Lahir Nama Ibu
Kelamin
12/2/2023 PEREMPUA HENI
11/9/2022 LAKI-LAKI SUPRIYANTI
11/6/2022 LAKI-LAKI LIA
10/29/2022 LAKI-LAKI ERVIN
10/15/2022 LAKI-LAKI YULISTIA
10/4/2022 LAKI-LAKI ALDILA
12/27/2022 LAKI-LAKI FANI
10/27/2022 PEREMPUA ERINA
11/24/2022 PEREMPUA SAFITRI
10/27/2022 LAKI-LAKI ENI RAHAYU
12/23/2022 PEREMPUA AFNI NUR
2/15/2021 LAKI-LAKI RATNA E
12/9/2022 LAKI-LAKI KHUSNUL
2/10/2023 PEREMPUA SITI MARKOMAH
4/9/2021 PEREMPUA DEWI
5/15/2022 LAKI-LAKI TRI MIRANTI
1/19/2023 LAKI-LAKI ISTIKOMAH
2/2/2023 LAKI-LAKI FUJI UTAMI
6/1/2022 LAKI-LAKI KHUSNUL
9/2/2022 LAKI-LAKI YUNITA
2/6/2023 PEREMPUA LIN KHOIRUNA
7/26/2021 PEREMPUA APRILLASARI
11/25/2022 LAKI-LAKI RAHATI
4/5/2021 PEREMPUA NOVI
2/21/2023 PEREMPUA PARYANI
2/2/2023 PEREMPUA YASHINTA
2/27/2023 LAKI-LAKI RISKAWATI
2/23/2023 LAKI-LAKI TRI SEPTIYANI
1/11/2023 PEREMPUA DIFFA
2/14/2023 PEREMPUA RIKA
1/11/2023 LAKI-LAKI ARITA DEWANTI 33081060050000BAGONGAN 7/2 MTY
8/2/2022 LAKI-LAKI FAJAMTUL
11/28/2022 LAKI-LAKI ATHIFA
9/12/2021 PEREMPUA FITI
2/3/2023 LAKI-LAKI DWI SETYOWATI
9/18/2023 LAKI-LAKI NUR ARININGSIH
2/21/2023 LAKI-LAKI NOVITA
2/1/2021 PEREMPUA MUSLICHAH
2/9/2023 LAKI-LAKI NURANIFAH
11/15/2022 PEREMPUA ELIYATUL
4/5/2022 LAKI-LAKI INDY MEGAYANTI
3/18/2022 PEREMPUA FATAYA
12/29/2022 LAKI-LAKI SITI KHOIRUNISA 33080229122201KEMBANGAN 2/5 SALAMAN
1/12/2023 LAKI-LAKI MILA KIKI
10/28/2023 LAKI-LAKI RANI SOFIYANI 33081969040100BALEH BAWANG
NIK Ibu Alamat Lengkap (Dusun, RT RW)
34040870077900KRANGGAN 2/7
33710156038500TRUNAN 3/8 MGL SELATAN
JURANG 5/3 BANDONGAN
PERUM BUMI GEMILANG
GLAGAH 3/3 MTY
PASAR ANYAR 8/7
DOGATEN 6/1
MANTENAN 2/2 MTY
PONDOKREJO ASRI 10/12
BANYAKAN 3/01
MANGGORAN 4/7 MTY
CANDIMULYO
JLN SUNAN BONANG 1/4
BANYAKAN 3/1 MTY
TIDAR BARU 2/12
BINTARO 1/6 SUKOREJO MTY
KRANGGAN BANYUROJO
CEPIT 1/4 BONDOWOSO MTY
33090964099490SARAGAN 2/9 BANYUROJO MTY
33710152069600TIAR SARI 2/12 MGL SELTAN
MANGGORAN BONDOWOSO
33081640495000SABRANGAN 3/7
PERUM MARISHON TEMPURAN
33141560129100JL BONOKELING PA 1
BLETUKAN 2/17 MTY
33710244018500KRANGGAN 4/6 MTY
GITUNGAN 2/12 DEYANGAN
33081059099940CEPIT BONDOWOSO MTY
SECANG
33081566019900BAYANAN KULON 1/3 PASURUHAN MTY
TIDAR SARI
BOGEMAN 5/3 PANJANG
33081070068400BANYAKAN 5/1
GATEN 2/3 BONDOWOSO MTY
TRAYAN 1 2/1 TOPNOBOYO BANDUNGAN
BOJONG 2/11 MENDUT MUNGKID
33081064049300KALIPETUNG 8/2
PRAJENAN 10/1 MTY
BOJONG 2/7
BANYUURIP TEGALREJO
CACABAN BARAT 7/9
33081441293000ASPOL GANTEN 2/3 JURANGOMBO
 12/4/2022 PEREMPUA NURULIA SETIATI 33081468119000DAMPIT 3/1
11/3/2022 LAKI-LAKI HESTI PAWIT 33081250090000JAPUNAN 1/3
11/3/2022 LAKI-LAKI REGITA FANSA JAPUNAN 1/3
12/30/2022 LAKI-LAKI REGITA FANSA 33711052139200MALANGAN 1/5
12/20/2022 LAKI-LAKI INDAH W 33710145118800NGEMBIK LOR 1/1
12/23/2022 LAKI-LAKI SRI HENY 33241042048900SARATAN 1 3/12
12/4/2022 LAKI-LAKI ANIS WIDIASTUTI JL SUDIRO 7 PRAJENAN
6/2/2021 LAKI-LAKI NURUL YUNITA 33702449069600DAMPIT 1/1
10/27/2022 LAKI-LAKI SULIARA TIDAR WARUNG 3/5
11/21/2022 LAKI-LAKI DEWI 32041154019100BAYANAN 2/11
12/2/2022 LAKI-LAKI DARIYATI 33081546069400TEMPAK CANDIMULYO
12/24/2022 LAKI-LAKI DARYANTI 33710153098700JL SUNAN G JATI NO 65
1/11/2023 LAKI-LAKI GEMA SIYANGAN 22/9 KEBONAGUNG TEGALREJO
1/24/2023 LAKI-LAKI NAZHIERAH 33081049098900LEMBAH ASRI AG 1/7
12/17/2022 PEREMPUA RIA DESY KIRINGAN 2/4 RINGINANOM
3/11/2023 PEREMPUA SITI GLAGAH 2 BANJARNEGORO MTY
1/2/2023 PEREMPUA EMI SRI 33080945039600RANDU GUNTING 5/2 MUNGKID
12/23/2022 PEREMPUA DIAN PATEN JURANG 2/15
12/21/2022 LAKI-LAKI ANNIDA 33061360497000BUTUH 8/16 TAMANAGUNG KALIANGKRIK
12/28/2022 LAKI-LAKI SUPARTI SUTAN 3/11 MTY SUMBEREJO
6/11/2022 LAKI-LAKI FIA KEDUNGDOWO
3/6/2022 LAKI-LAKI ENY BOTO 4/4 SUMBERARUM TEMPURAN
4/21/2022 LAKI-LAKI MELUR 33710163119400PATEN GUNUNG 245 2/9 RJW
5/16/2022 LAKI-LAKI RIKA 33130457079500BANYAKAN 5/1
3/8/2023 LAKI-LAKI YULISTIA BRENGOSAN 3/3 DONOROJO
7/17/2021 LAKI-LAKI SHINWANI 33081071018300MUNGKIDAN DANUREJO MTY
12/18/2022 LAKI-LAKI MARATUL BANYAKAN 4/1 MTY
6/16/2022 PEREMPUA DWI SURYANI 33081971030200BANYUURP TEGALREJO
12/30/2022 LAKI-LAKI YENI SUSANTI 33081448019500BANYAKAN 2/1 MTY
6/5/2022 LAKI-LAKI BURHAN DIPONEGORO GEDUNG SUTI 2/1 GELANGAN
11/2/2023 PEREMPUA LYDIA CINTIA 33081969029600PERUM PONDOK REJO ASRI DANUREJO
3/3/2023 PEREMPUA NUR ANA TEGALARUM 3/3 BOROBUDUR
11/23/2021 LAKI-LAKI RENI DIWANTI 33081049089300DUKUNAN 1 1/1 DONOROJO
8/16/2021 LAKI-LAKI INTAN RATINI 32101249129400JAPUNAN ARMADA VILLAGE
10/26/2022 PEREMPUA NANDA 33081063119300JL FLORES SOKA MTY
7/2/2021 LAKI-LAKI MUTIA HANUM 33081546129200NGIMPIK TEGALSARI CANDIMULYO
3/5/2022 LAKI-LAKI BENEDICTA PENI 33081053059600JL MAWAR MTY
10/31/2022 PEREMPUA GATI JETIS KALINEGORO
11/21/2022 LAKI-LAKI SALMA AURA KARET 4/3
8/20/2021 PEREMPUA TEODORA 33710243048900GELANGAN
10/5/2021 LAKI-LAKI CITRA MUULITA 33081949099200BANAR 1/6 DEYANGAN MTY
12/2/2022 LAKI-LAKI YULIATUN KIRINGAN 2/4 RINGINANOM
9/12/2022 PEREMPUA MIRAWATI PERUM TIDAR ASRI MTY
12/30/2022 RETNO DEWI JLN RAYA BLABAK 4/10 MUNGKID 1
3/3/2023 PEREMPUA YUNIDA RESTIYANI JLJ JATILUHUR 4 6/21
3/3/2023 LAKI-LAKI ARINA KHOIRUNNISA PRAJENAN 3/1 MTY
3/3/2023 PEREMPUA NUR ANA LALATUL TEGAL WANGI 3/3 TEGALARUM BOROBUDUR
3/4/2023 PEREMPUA INTAN RETNO W GEJAGAN 1/1 SIDOARJO TEGALREJO
3/4/2023 LAKI-LAKI USNUL COTIMAH TEGALSARI 1/10 MAGERSARI
3/6/2023 LAKI-LAKI FEBRI INDRAWATI KEMBANGAN 4/7
3/6/2023 LAKI-LAKI ENI KUSRIANI BOTO 4/4 TEMPURAN
3/7/2023 PEREMPUA YUNITA RAHAYU NUREN 6/2 TEGALREJO
3/8/2023 LAKI-LAKI KHAIRUNISA HAQUE PONGANGAN DEYANGAN
 3/9/2023 LAKI-LAKI YULI RETNO BRENGOSAN 3/3 DONOROJO
3/11/2023 LAKI-LAKI DIFA FITRIYANI TEMPUREJO 2/2 TEMPURAN
3/11/2023 PEREMPUA ZANA YULIANA BAGONGAN 2/2 SUKOREJO
3/15/2023 PEREMPUA SITI KOMARIYAH GLAGAH 2 4/4
3/16/2012 PEREMPUA STEFANY TURSIA SENENG 2 3/3 MTY
3/16/2023 LAKI-LAKI CINDY ANISTA D SANGGRAHAN MUNGKID
3/17/2023 PEREMPUA DITA PRAMITA KALITAN 3/13 BLONDO
3/17/2023 LAKI-LAKI NURHASANAH KRANGGAN 1/6
3/17/2023 PEREMPUA PUTRI YUNIANTI BAYANAN KULON 2/1
3/22/2023 PEREMPUA RARASWATI BRINGASAN 2/1 TTEMPURAN
3/22/2023 PEREMPUA ANITA INDAH S NEPAK BULUREJO 7/1
3/22/2023 LAKI-LAKI IKA YULIATI SRATEN DONOROJO
3/24/2023 LAKI-LAKI YUNI ISNAWATI BANDUNG 1/5 MERTOYUDAN
3/24/2023 LAKI-LAKI METY MEITAVENI KEMASAN 1/7 SAMAN
3/23/2023 LAKI-LAKI TUTIK LATIFAH NGARAN 2 BOROBUDUR
3/26/2023 LAKI-LAKI DITTA FEBRIANTY BANYAKAN 4/1 MTY
3/28/2023 LAKI-LAKI ARI SEYANINGSIH JLN ANGGREK MTY
 Wilayah
Desa HB0 Batch HB0 BCG Batch BCG
Puskesmas

12/3/23 0371MA042

12/3/23 0371MA042
12/3/23 0371MA042

12/3/23 0371MA042

12/3/23 0371MA042
12/3/23 0371MA042
12/3/23 0371MA042
12/3/23 0371MA042

SURUHAN MTY 12/3/23 0371MA042

12/3/23 0371MA042
YO BANDUNGAN
12/3/23 0371MA042

12/3/23 0371MA042
GUNG TEGALREJO

26/3/23 0371MA042

NG KALIANGKRIK

TEMPURAN 26/3/23 0371MA042

26/3/23 0371MA042

SUTI 2/1 GELANGAN

SRI DANUREJO
26/3/23 0371MA042
26/3/23 0371MA042

3/3/2023 3656521
3/3/2023 3656521
ARUM BOROBUDUR 3/3/2023 3656521
TEGALREJO 3/4/2023 3656521
3/4/2023 3656521
3/6/2023 3656521
3/6/2023 3656521
3/7/2023 3656521
3/8/2023 3656521
 3/9/2023 3656521
3/11/2023 3656521
3/11/2023 3656521
3/15/2023 3656521
3/16/2012 3656521
3/16/2023 3656521
3/17/2023 3656521
3/17/2023 3656521
3/17/2023 3656521
3/22/2023 3656521
3/22/2023 3656521
3/22/2023 3656521
3/24/2023 3656521
3/24/2023 3656521
3/23/2023 3656521
3/26/2023 3656521
3/28/2023 3656521
 Polio 1 Batch Polio 1 DPT-HB-Hib 1Batch DPT-HB-Hib 1 Polio 2 Batch Polio 2

05/3/23 5042821 05/3/23 2052722

05/3/23 5042821 05/3/23 2052722

12/3/23 2052722

12/3/23 2052722
12/3/23 2052722

12/3/23 2052722

12/3/23 2052722
12/3/23 2052722
12/3/23 2052722
12/3/23 2052722
12/3/23 5042821 12/3/23 2052722
12/3/23 2052722
12/3/23 5042821 12/3/23 2052722

12/3/23 5042821 12/3/23 2052722

12/3/23 2052722

12/3/23 2052722

12/3/23 2052722

19/03/23 5042821 19/03/23 2052722

19/03/23 5042821 19/03/23 2052722
 19/03/23 5042821 19/03/23 2052722

26/3/23 5042821 26/3/23 2052722

26/3/23 5042821 26/3/23 2052722

26/3/23 2052722
26/3/23 5042821 26/3/23 2052722

26/3/23 5042821 26/3/23 2052722

26/3/23 5042821 26/3/23 2052722

26/3/23 2052722

26/3/23 2052722

26/3/23 5042821 26/3/23 2052722

26/3/23 2052722
26/3/23 2052722

26/3/23 5042821 26/3/23 2052722

 IMUNISASI BAYI (Isikan tanggal di kolom antigen sesuai dengan imunisasi yang d
PCV 1 Batch PCV 1 Rotavirus 1Batch Rotavirus 1
DPT-HB-HibBatch
2 DPT-HB-Hib 2

Tidak perlu mengisi kolom PCV, Rotavirus, JE 05/3/23 5042821

05/3/23 5042821

05/3/23 5042821

05/3/23 5042821

12/3/23 5042821

12/3/23 5042821

12/3/23 5042821
19/03/23 5042821

19/03/23 5042821

19/03/23 5042821

26/3/23 5042821
26/3/23 5042821
26/3/23 5042821

26/3/23 5042821

26/3/23 5042821

26/3/23 5042821

26/3/23 5042821

26/3/23 5042821
gen sesuai dengan imunisasi yang diberikan)
Polio 3 Batch Polio 3 PCV 2 Batch PCV 2 DPT-HB-HibBatch
3 DPT-HB-Hib 3 Polio 4

05/3/23 2052722 tidak perlu diisi

05/3/23 5042821 05/3/23
05/3/23 5042821 05/3/23
05/3/23 2052722
05/3/23 5042821 05/3/23
05/3/23 5042821

05/3/23 5042821 05/3/23

05/3/23 2052722
05/3/23 5042821 05/3/23

05/3/23 2052722

12/3/23 2052722

12/3/23 2052722

12/3/23 5042821 12/3/23

12/3/23 5042821 12/3/23

12/3/23 2052722

12/3/23 5042821 12/3/23

19/03/23 5042821 19/03/23

19/03/23 2052722
19/03/23 5042821 19/03/23
19/03/23 5042821 19/03/23
19/03/23 2052722
19/03/23 5042821 19/03/23

19/03/23 2052722

19/03/23 5042821 19/03/23

26/3/23 2052722
26/3/23 2052722
26/3/23 2052722

26/3/23 2052722

26/3/23 2052722

26/3/23 2052722

26/3/23 2052722

26/3/23 5042821 26/3/23

26/3/23 5042821 26/3/23

26/3/23 2052722
Batch Polio 4 IPV Batch IPV Rotavirus 2Batch Rotavirus 2 MR 1 Batch MR 1

tidak perlu diisi

2052722
2052722

2052722

2052722

2052722

12/3/23 012W202

12/3/23 012W202

2052722

2052722

12/3/23 012W202
2052722

2052722
2052722
2052722

2052722

2052722

26/3/23 012W202

26/3/23 012W202
26/3/23 012W202

26/3/23 012W202

26/3/23 012W202

26/3/23 012W202

2052722

26/3/23 012W202
2052722

26/3/23 012W202
 IMUNISASI BADUTA
JE Batch JE PCV 3 Batch PCV 3 DPT-HB-Hib 4 Batch DPT-HB-Hib 4

Tidak perlu mengisi kolom PCV, Rotavirus, JE

05/3/23 5042821

12/3/23 5042821

12/3/23 5042821
19/03/23 5042821

26/3/23 5042821

26/3/23 5042821

26/3/23 5042821

26/3/23 5042821
 MR 2 Batch MR 2 Keterangan

12/3/23 012W202

12/3/23 012W202

12/3/23 012W202
26/3/23 012W202
 Jumlah Pemakaian (Dosis)
Antigen Jumlah Vaksin Dipakai (Vial) *sesuai dengan jumlah
sasaran
HB0 0 0
BCG 0 0
Polio 1,2,3,4 0 0
Penta 1,2,3,4 0 0
MR 1,2 0 0
IPV 0 0
Td (WUS) 0 0
Jumlah 0 0