PENCATATAN BULAN IMUNISASI ANAK SE

DI UNIT PELAYANAN

KABUPATEN KOTA : KOTAWARINGIN TIMUR

PUSKESMAS : KETAPANG 2
SEKOLAH : SDN 6 KETAPANG
TAHUN : 2023

TANGGAL
NO NAMA NIK
LAHIR/UMUR

1 Ahmad Norhalis 6202082301170001 1/23/2017

2 Alya Syahira Khumaira 6202064211160003 11/2/2016
3 Aqiela Syifa Ardiani 3/18/2017
4 Chayra Fitri Mayumi 6202074607160001 7/6/2016
5 Dhafita Nizza Nurazzizah 3308135303170001 3/13/2017
6 Febri Ananda Aditya 6202050103160002 3/1/2016
7 Haydar Gibran Faletekhan 10/23/2016
8 Indira Ananda Budi 6372046811150001 11/23/2015
9 Khairus Sa'adah 6202066905160001 5/29/2016
10 Langgeng Triatmono 6202063009160001 9/30/2016
11 Melda Nur Intan 6202065108160004 8/11/2016
12 Muhamad Gibran Khalfani 6202082105160002 5/21/2016
13 Muhammad Adri Azka Alfaro 6202060807150001 7/8/2015
14 Muhammad Mundzir 6202062312160001 12/23/2016
15 Muhammad Naufal 6202060205160003 5/2/2016
16 Muhammad Rafly Aditya 6204061005160001 5/10/2016
17 Muhammad Rifaldi 4/26/2016
18 Muhammad Rifqi 6202051901160001 1/19/2016
19 Mutia Azzahra Almahyra 6202062604170001 4/26/2017
20 Nafa Elino 6202035902170002 2/19/2017
21 Najwa Agsa Ramadhani 6202065006160001 6/10/2016
22 Najwa Khaira Wilda 6202064301170001 1/3/2017
23 Nur Safitri Ramadhani 6/17/2015
24 Olif Fila Bestari 6202065710160001 10/17/2016
25 Prabu Dimas Wardana 6202052205170001 5/22/2017
26 Pua Amaraline 6/17/2016
27 Raisya Naila Putri 6202085309160002 9/13/2016
28 Ridha Citra Adiva 6202066101170006 1/21/2017
29 Rizki Muhammad Fauzan 3206180507150001 7/5/2015
30 Rohmatul Hasanah 6202066206170002 6/22/2017
31 Abdiel Setianagara 6202060208160003 8/2/2016
32 Abida Irana Rinaldi 2171026905150001 5/29/2015
33 Abiyyu Rafano 6202132901160001 1/29/2016
34 Adella Aqila Elvaretta 3321105301170002 1/13/2017
35 Ahmad Ardana Saputra 6202062411160001 11/24/2016
36 Ahmad Taufiq Ramadhani
37 Alia Nur Fitrah
38 Alika Naila Putri
39 Deshiva Ayunindia Maharani 6202066612160001 12/26/2016
40 Esma Nur Hafizah 6202064412150001 12/4/2015
41 Julia Safitri 6202066007150002 7/20/2015
42 Lourenon Priendah 6202061406160003 6/14/2016
43 Lughina Auryn 6202065105160001 5/11/2016
44 Muhammad Munzir 6202061206160003 6/12/2016
45 Muhammad Rafan Alfarizqi 6202060310160003 10/3/2016
46 Muhammad Ramadhan Noor 6202062306160002 6/23/2016
47 Muhammad Safarudin 6202060110150002 10/1/2015
48 Nabila Nahtadia 3320044405160002 5/4/2016
49 Okta Lena Sari 6202066010160002 10/20/2016
50 Rhara Karunia Musyarofah 6202066111150002 11/21/2015
51 Rizky Aditya Rachman 6202062602160002 2/26/2016
52 Siti Fatimah Tuszahrah 6202066610160001 10/26/2016
53 Tuhfa Fachira 6202065111160001 11/11/2016
54 Zahirah Putri Agustina 6202065108150004 8/11/2015

Mengetahui
Kepala Sekolah

( )
N BULAN IMUNISASI ANAK SEKOLAH (BIAS)
DI UNIT PELAYANAN

TANGGAL IMUNISASI
NAMA ORANG TUA CAMPAK DT Td Td HPV1
RUBELLA (KELAS 1) (KELAS 2) (KELAS 5) (KELAS 5)
(KELAS 1)
Saihuna/Juhairiah
Ari Kusnadi/Linda Oktavia
Yediansyah/Lisdawati
Tri Ajie Satriya/Liu Widi Astuti
Iwan Ariyanto/Triyati
Govarurokhim/Sriyani
Sulaeman Abd. Jabbar/Lili Solicha
Budi Suhartanto/Noor Hidayanti
Mardiono/Mardiana
Mulyono/Sutri Wahyuningsih
Saptono/Eva Norjanah
Ahmad Fauzi/Maya Sari
Wakidun/Maisyarah
Marjoko/Rusmina 8/3/2023
Hendra Fitriadi/Normiati
Supriadi/Yetnawati
Mirhan/Rusita Deli Purnamasari
Robby Al Amin/Rina
Abdul Muin/Tina Elviyana
Eliandi/Dama Arwani
Agus Prawono/Aisa Nur Siswandi
Ariandi/Yulia Mayasari
Muhammad Arsyad/Nurul Fadillah
Sumidi/Tuas Tutik
Irwan/Ivan Susanti
Hartono/Rahel Devita Chandra
Al Kahfi/Rinawati
Rudi Rumantyo/Ida Rusanti
Nursamsi/Santi
Supardi/Jumiati
Anekaria Safari/Saripah
Dedi Septian Rinaldi/Susilawati
Mugiono/Rofiatul Munifah
Misbah/Lilik Indrawati
Juwita Prayani
Hendriansyah/Mayasari
Ery Cahyadi/Risva Octaviany
Andiy/Midah
Suprianto/Endang
Tri Sutrisno/Novia Herdita
Edy Suryanto/Rusmala Dewi
Khadminah
M. Kursani/Zainab
Fahrul Anwar Sada/Badariyah Safitri
Agus Siswanto/Ika Kesumaningrum
Ikhwan Ariyadi/Sundari
Djoko Suryanto/Makiyah
Joko Purdianto/Sarniah
Samsiar/Siti Rahmah
Suwandi/Erni Kurniati
Abu Salim/Muntoharoh

Sampit,

Petugas Pelaksana

( )
I
HPV2
(KELAS 6)
ruangan
IA
IA
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IA
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IA
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IA
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IA
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IA
IA
IA
IA
IA
IA
IB
IB
IB
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IB
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IB
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