1.

Petugas Entri Data

REGISTER PELAYANAN KB R/I/KB/20
Lembar 1

1 2 V 4 5 6
6 1 1 2 0 4 5 Bulan : 2023
NAMA FASKES/ PUSKESMAS PAL SEMBILAN 7 8 9 10 11 12
:
JARINGAN/JEJARING Kode Provinsi Kode No. Register Faskes No. Jaringan/
Kabupaten/ Jejaring Faskes
Kota

PESERTA KB JENIS TINDAKAN Kasus PENGGUNAAN

SUMBER ALOKON

STATUS PESERTA KB (Kode)

(Kode) (Kode) ASURANSI

PELAYANAN BERGERAK
ISTRI

INFORMED CONSENT

PASCA KEGUGURAN
PASCA PERSALINAN

KOMPLIKASI BERAT
PENCABUTAN DAN

BPJS KESEHATAN
NO. TANGGAL ALAMAT NO. HANDPHONE

PEMASANGAN

PENCABUTAN
NAMA SUAMI

KEGAGALAN
PEMBERIAN/
OPERATIF/
TANGGAL
NIK (NOMOR INDUK KEPENDUDUKAN) NAMA

LAINNYA

MANDIRI
LAHIR

TIDAK

APBN

APBD
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

1 03-Mar-2023 AHMADI 6 1 1 2 0 9 4 1 0 7 8 9 0 4 0 2 SENIMAH 01-Jul-1989 KALIMAS HULU 123 2 1 0 0 3 1 0 0 1 0 0 0

2 03-Mar-2023 saruji 6 1 1 2 0 9 4 8 0 1 8 9 0 0 0 2 sitirokayah 03-Apr-1989 parit wagattak 123 1 1 0 0 3 0 0 1 1 0 0 0

3 04-Mar-2023 LUKONG DALIN 6 1 1 2 0 9 6 3 0 5 8 0 0 0 0 5 HENISA 23-Jun-1980 JL. PERDAMAIAN 123 1 1 0 0 3 1 0 0 1 0 0 0

4 04-Mar-2023 anggun 6 1 1 2 0 9 5 0 0 2 9 7 0 0 0 4 HOIRIYEH 10-Feb-1997 JL. KALIMAS HULU 1 1 0 0 3 0 0 1 1 0 0 0

5 04-Mar-2023 abdurosyid 6 1 1 2 0 9 4 6 0 6 8 6 0 0 0 9 MISNAWATI 06-Jun-1986 JL. UJUNG PANDANG 123 1 1 0 0 3 0 0 1 1 0 0 0

6 06-Mar-2023 mansur 6 1 1 2 0 9 4 7 0 8 8 9 0 0 0 2 ZULAIHA 07-Aug-1989 JL. KALIMAS HULU 1 1 0 0 3 0 0 1 1 0 0 0

7 06-Mar-2023 junaidi 6 1 1 2 0 9 5 2 0 7 0 0 0 0 1 4 ayu wulandari 15-Apr-2000 jl ikamra 1 1 0 0 3 1 0 0 1 0 0 0

8 07-Mar-2023 rusli laher 6 1 1 2 0 9 6 5 0 8 7 8 0 0 0 2 DARNAWATI YAKOB 15-Aug-1978 JL. KALIMAS HULU 1 0 0 1 4 1 0 0 1 0 0 0

9 07-Mar-2023 abdussalam 6 1 1 2 0 9 5 8 0 7 8 4 0 0 0 7 JULIANA 18-Jul-1984 PARIT WA'GATAK 1 1 0 0 3 0 0 1 1 0 0 0

10 08-Mar-2023 AHIYEH 6 1 1 2 0 9 5 0 1 1 9 0 0 0 0 6 ASTIGEN 10-Nov-1990 JL. SWADAYA 1 1 0 0 3 1 0 0 1 0 0 0

11 08-Mar-2023 3 1 7 0 9 4 7 0 8 8 8 0 0 0 2 9 RENI SITOHANG 30-Aug-1988 JL. ARI KARYA 1 1 0 0 3 0 0 1 1 0 0 0

12 08-Mar-2023 6 1 1 2 0 9 5 1 0 6 0 4 0 0 0 5 THEN FONG 11-Jun-2004 JL. TUNAS HARAPAN 1 0 0 0 4 1 0 0 1 0 0 0

13 09-Mar-2023 ABDUL RAHMAN 6 1 1 2 0 9 4 9 0 4 8 2 0 6 0 3 ANALIANA 03-Aug-1964 JL PERDAMAIAN 1 1 0 0 3 0 0 1 1 0 0 0

14 09-Mar-2023 SYARIF 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 SANTI 15-Dec-1994 SUNGAI BEMBAN 1 1 0 0 3 1 0 0 1 0 0 0

15 09-Mar-2023 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 ROSITA 16-Oct-1987 DALAM BUGIS 1 1 0 0 3 0 0 1 1 0 0 0

16 09-Mar-2023 3 5 7 9 0 2 6 5 0 9 9 2 0 0 0 5 EPI NAFITA 15-Sep-1992 JL. SWADAYA 1 1 0 0 3 0 0 1 1 0 0 0

17 10-Mar-2023 SELADIN 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 MUMINTEN 17-Feb-1982 PARIT WAGATTAK 1 1 0 0 3 0 0 1 1 0 0 0

18 10-Mar-2023 MISBAHUL MUNIR 6 1 1 2 0 9 5 2 0 7 9 8 0 0 0 4 ROKIAH 12-Oct-1998 JL. KALIMAS HULU 1 1 0 0 3 0 0 1 1 0 0 0

19 10-Mar-2023 M.SABRAN 6 1 1 2 0 1 4 4 0 1 8 8 0 0 0 9 KURNIAWATI 18-Apr-1989 JL. PARIT WAGATTAK 1 0 0 0 4 0 0 1 1 0 0 0

20 11-Mar-2023 SAHRI GUNAWAN 6 1 1 2 0 9 4 1 0 8 9 9 0 0 0 7 MITA LINDA SARI 01-Aug-1999 JL PARIT BANJAR 1 1 0 0 3 1 0 0 1 0 0 0

21 11-Mar-2023 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 JASIRATU LU'LU 05-Dec-1994 JL. KALIMAS HULU 1 1 0 0 3 0 0 1 1 0 0 0

22 13-Mar-2023 6 1 7 1 0 4 5 8 0 3 8 2 0 0 1 3 NURSANTIWATI 18-Mar-1982 JL. PERDAMAIAN 1 1 0 0 3 1 0 0 1 0 0 0

23 13-Mar-2023 MUZAKIR 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 SURIEH 08-Sep-1995 JL.PARIT WAGATTAK 1 0 0 0 4 1 0 0 1 0 0 0

24 14-Mar-2023 HARYONO 6 1 0 2 0 1 4 5 0 9 8 7 0 0 0 4 SUBAIDAH 10-Jul-1987 SUNGAI NANAS 1 1 0 0 3 0 0 1 1 0 0 0

25 14-Mar-2023 SUKARDI 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 MARSUNI 15-Apr-1995 JL. IKAMRA 1 0 0 0 4 0 0 1 1 0 0 0

26 14-Mar-2023 M YUNUS 6 1 1 2 0 9 5 6 0 5 8 1 0 0 0 4 NURMAINI 16-May-1981 PARIT WAGATTAK 1 0 0 0 4 1 0 0 1 0 0 0

27 15-Mar-2023 ABDUL MUKTI 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 RAHMA 13-Jun-2004 JL.IKAMRA 1 1 0 0 3 0 0 1 1 0 0 0

28 15-Mar-2023 M. ASWIN APRIYANTO 6 1 1 2 0 9 6 8 0 6 9 3 0 0 0 5 PUTIMA 05-Aug-1994 SUNGAI BEMBAN 1 1 0 0 3 1 0 0 1 0 0 0

29 16-Mar-2023 ABDUL AZIZ 6 1 1 2 0 9 6 0 0 2 8 8 0 0 0 9 SARTIKA MUTIARA 18-Nov-1988 JL. PARIT WAGATTAK 1 1 0 0 3 1 0 0 1 0 0 0

30 16-Mar-2023 marilan 6 1 1 2 0 9 5 6 1 0 8 7 0 0 0 5 HOLILAH 16-Oct-1987 JL. IKRAM 123 1 1 0 0 3 0 0 1 1 0 0 0

31 16-Mar-2023 BAHWI 6 1 1 2 0 9 7 1 0 7 9 5 0 0 0 1 LINDAWATI 31-Jul-1995 KALIMAS HULU 123 1 1 0 0 3 1 0 0 1 0 0 0

32 17-Mar-2023 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 ROSITA 07-May-1987 DALAM BUGIS 1 1 0 0 3 1 0 0 1 0 0 0

33 17-Mar-2023 3 5 7 9 0 2 6 5 0 9 9 2 0 0 0 5 EPI NAFITA 15-Sep-1992 JL. SWADAYA 1 1 0 0 3 0 0 1 1 0 0 0

34 17-Mar-2023 ANDRE KURNIADI 6 1 7 1 0 3 4 9 0 9 9 5 0 0 0 6 RINI 18-May-1995 JL. PANGLIMA AIM 1 0 0 0 4 1 0 0 1 0 0 0

35 18-Mar-2023 AGUS 6 1 1 2 0 9 6 0 0 9 8 4 0 0 0 3 RUSMA 08-Sep-1985 JL. KALIMAS HULU 1 1 0 0 3 1 0 0 1 0 0 0

36 18-Mar-2023 MOH KADIR 6 1 7 1 0 1 4 9 0 7 0 0 0 0 0 8 SOLEHA 09-Jul-2000 PARIT WA'GATAK 1 1 0 0 3 1 0 0 1 0 0 0

37 18-Mar-2023 6 1 1 2 0 9 4 8 0 9 9 3 0 0 0 6 NUR'AINI 08-Sep-1993 JL. PARIT SERONG 1 1 0 0 3 1 0 0 1 0 0 0

38 20-Mar-2023 BUDIANSYAH 6 1 1 2 0 9 6 3 1 1 9 5 0 0 0 3 EKA NURJANAH 09-Nov-1995 JALAN HASANUDDIN 1 1 0 0 3 1 0 0 1 0 0 0

39 20-Mar-2023 SULAIMANA 6 1 1 2 0 9 6 2 0 1 8 5 0 0 0 4 LELI JUNIARTI 22-Jan-1985 PARIT BANJAR DUSUN MELATI 1 0 0 0 4 1 0 0 1 0 0 0

40 20-Mar-2023 6 1 0 1 1 0 4 8 0 6 9 0 0 0 0 1 SITI ROISAH 02-Mar-1990 RASAU JAYA 1 0 0 0 4 1 0 0 1 0 0 0

41 20-Mar-2023 BAHWI 6 1 1 2 0 9 7 1 0 7 9 5 0 0 0 1 LINDAWATI 31-Jul-1995 KALIMAS HULU 123 1 1 0 0 3 1 0 0 1 0 0 0

42 21-Mar-2023 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 DAHLIANA 16-Sep-1986 KALIMAS 1 0 0 0 4 1 0 0 1 0 0 0

43 21-Mar-2023 SYARIF 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 SANTI 13-Apr-1994 SUNGAI BEMBAN 1 1 0 0 3 1 0 0 1 0 0 0

44 24-Mar-2023 UMAR 6 1 1 2 0 9 5 1 0 7 8 6 0 0 0 3 RODIANA 19-Aug-1987 JL. KALIMAS HULU 1 1 0 0 3 0 0 1 1 0 0 0

45 24-Mar-2023 AHMAD TINGWAR 6 1 1 2 0 9 4 5 0 5 9 3 0 0 0 9 MARTATILA 05-May-1993 SUNGAI BEMBAN DUSUN MELATI RT 25 1 1 0 0 9 1 0 0 1 0 0 0

46 24-Mar-2023 ASMADI 6 1 7 1 0 5 4 3 0 3 8 8 0 0 1 0 MARNAI 12-Jul-1988 PARIT BANJAR 1 1 0 0 3 0 0 1 1 0 0 0

47 25-Mar-2023 USMAN 6 1 0 4 1 3 4 5 0 8 7 1 0 0 0 5 SANINAH 23-Sep-1981 JL. TANGGUL LAUT 1 1 0 0 3 0 0 1 1 0 0 0

48 01-Apr-2023 safidin 6 1 1 2 0 9 4 7 0 8 9 3 0 0 0 4 mayura 21-Feb-1994 sungai nenas 2 1 0 0 3 1 0 0 1 0 0 0

49 01-Apr-2023 MUHRI 6 1 1 2 0 9 4 7 0 1 7 8 0 0 0 4 SATIYEH 07-Jan-1978 SUNGAI NENAS RT 35 3 0 0 0 3 1 0 0 1 0 0 0

50 02-Apr-2023 6 1 1 2 0 1 4 4 0 1 8 8 0 0 0 9 KURNIAWATI 18-Apr-1989 JL. PARIT WAGATTAK 3 1 0 0 3 1 0 0 1 0 0 0

51 03-Apr-2023 MUJIB 6 1 1 2 0 9 4 6 0 8 7 9 0 0 0 3 ZUBAIDAH 06-Mar-1979 JL. KALIMAS HULU 3 0 0 0 4 1 0 0 1 0 0 0

52 03-Apr-2023 6 1 1 2 0 9 4 8 0 1 8 9 0 0 0 2 SITIROKAYAH 08-Jan-1989 PARIT WA'GATAK 3 1 0 0 3 1 0 0 1 0 0 0

53 04-Apr-2023 DANIEL 6 1 1 2 0 9 6 1 0 9 9 9 0 0 0 7 SEPTIANA 03-Mar-2021 JL.PERDAMAIAN 1 1 1 0 9 1 0 0 1 0 0 0

54 05-Apr-2023 HERMAN 6 1 1 2 0 9 4 7 0 2 2 3 0 0 0 1 PUTRI 23-May-2002 SUNGAI KUPAH 1 0 1 0 4 1 0 0 1 0 0 0

55 05-Apr-2023 SUNARWI 6 1 1 2 0 9 5 0 0 6 9 5 0 0 0 8 SUMNATI 10-Jun-1995 JL. KALIMAS HULU 3 1 0 0 3 1 0 0 1 0 0 1

56 06-Apr-2023 SURIJI 6 1 1 2 0 9 5 8 0 2 9 2 0 0 0 2 AYUNI 12-Jul-1993 JL. PERINTIS 1 0 0 0 4 1 0 0 1 0 0 0

57 06-Apr-2023 M. MAHALI 6 1 7 1 0 4 6 0 0 9 9 9 0 0 1 1 DIANA 20-May-1991 JL. KAMRA 1 0 0 0 4 1 0 0 1 0 0 0

58 07-Apr-2023 A LATIF 6 1 0 1 0 3 4 6 1 1 9 1 0 0 0 1 ANITA 23-Jul-1991 P. TIMUR 1 1 0 0 3 1 0 0 1 0 0 0

59 07-Apr-2023 RUDIHARNO 6 1 1 2 0 1 6 6 0 6 8 5 0 0 0 9 AYU RAHADI ANITA 06-Jul-1985 AKCAYA 1 1 0 0 3 1 0 0 1 0 0 0

60 09-Apr-2023 6 1 7 1 0 3 5 0 0 6 0 2 0 0 0 8 DEWI SARTIKA 08-Aug-2003 JL. SWADAYA 1 1 0 0 3 1 0 0 1 0 0 0

61 10-Apr-2023 IWAN 6 1 1 2 0 9 4 6 0 3 8 5 0 0 0 3 MARWE 06-Mar-1985 JALAN PERDAMAIAN GG OSKAR 3 0 0 0 4 1 0 0 1 0 0 0

62 10-Apr-2023 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 ANITA 04-Mar-1981 PARIT WAGATTAK 1 0 0 0 4 1 0 0 1 0 0 0

63 10-Apr-2023 SUMARDI 6 1 1 2 0 9 4 6 0 8 9 1 0 0 0 5 EKA SAPUTRI 06-Aug-1991 JLN. PARIT BANJAR 3 0 0 0 4 1 0 0 1 0 0 0

64 11-Apr-2023 6 1 1 2 0 9 6 4 0 9 8 7 0 0 0 3 SANIRAH 01-Jul-1987 JL. SWADAYA 3 0 0 0 4 1 0 0 1 0 0 0

65 11-Apr-2023 BAHWI 6 1 1 2 0 9 7 1 0 7 9 5 0 0 0 1 LINDAWATI 31-Jul-1995 KALIMAS HULU 3 1 0 0 3 1 0 0 1 0 0 0

66 12-Apr-2023 ANDRI PURNOMO 6 1 0 3 0 6 4 3 0 1 9 3 0 0 0 1 EZA NURIZAWATI 25-Sep-1993 JL URAY BAWARI 1 1 0 0 3 0 0 1 1 0 0 0

67 13-Apr-2023 AHMAD MASDUKI 6 1 1 2 0 9 6 8 0 7 8 8 0 0 0 8 JUHAIRIYAH 07-Mar-1980 SUNGAI NENAS 1 1 0 0 3 1 0 0 1 0 0 0

68 14-Apr-2023 RUSLI LAHER 6 1 1 2 0 9 6 5 0 8 7 8 0 0 0 2 DARNAWATI 25-Aug-1978 JL. KALIMAS HULU 3 1 0 0 3 1 0 0 1 0 0 0

69 15-Apr-2023 MUHTAR AGUS 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 FITRIANI 05-Apr-1981 KALIMAS HULU 2 1 0 0 9 1 0 0 1 0 0 0

70 16-Apr-2023 6 1 1 2 0 9 5 1 0 6 0 4 0 0 0 5 THEN AFONG 11-Jun-2004 JL. TUNAS HARAPAN 3 0 0 0 4 1 0 0 1 0 0 0

71 17-Apr-2023 ABDUL RASID 6 1 1 2 0 8 5 2 0 7 9 6 0 0 0 6 MANI 23-Sep-1997 PUNGGUR KECIL 1 1 0 0 3 1 0 0 1 0 0 0

72 18-Apr-2023 LIYAS 6 1 1 2 0 9 5 5 0 3 7 8 0 0 0 3 ARBATIK 15-Mar-1978 DUSUN NUSA INDAH RT 33 3 1 0 0 3 1 0 0 1 0 0 0

73 20-Apr-2023 APRIANSYAH 6 1 1 2 0 9 5 0 0 5 8 8 0 0 0 4 LITA 06-Mar-1981 KOMPLEK ALAM DAMAI INDAH 1 1 0 0 3 1 0 0 1 0 0 0

74 01-May-2023 SAMSUDIN 6 1 1 2 0 9 4 9 0 1 9 8 0 0 0 2 MARYANI 09-Jan-1998 JLN. PARIT BANJAR 3 1 0 0 3 1 0 0 1 0 0 0

75 02-May-2023 M ALQO 6 1 1 2 0 9 4 5 0 6 9 8 0 0 1 4 QUKSUM 04-Jun-1998 paret serong 3 1 0 0 3 1 0 0 1 0 0 0

76 02-May-2023 AHMADI 6 1 1 2 0 9 4 4 1 1 0 1 0 0 0 7 NURHALIMAH 09-Apr-2002 jl parit banjar 1 1 0 0 3 1 0 0 1 0 0 0

77 02-May-2023 BASIR 6 1 1 2 0 9 4 1 0 7 9 9 0 4 9 3 SULIFAH 06-Jul-1997 jl. ikamra 3 1 0 0 3 1 0 0 1 0 0 0

78 04-May-2023 6 1 1 2 0 3 4 5 0 5 8 9 0 0 0 2 MANIYAH 11-Apr-1987 sungai ambawang 1 1 0 0 3 1 0 0 1 0 0 0

79 05-May-2023 IDRIS MASKUR 6 1 1 2 0 9 4 1 0 7 9 0 0 4 6 2 SITI MARYAM 01-Jul-1990 PARIT SERONG 3 1 0 0 3 1 0 0 1 0 0 0

80 08-May-2023 SYAFI'I 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 MARSI 06-Jul-1985 jl. kalimas hulu 3 1 0 0 3 1 0 0 1 0 0 0

81 08-May-2023 SYAFI'I 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 MARSI 06-Jul-1985 jl. kalimas hulu 3 1 0 0 3 1 0 0 1 0 0 0

82 11-May-2023 6 1 1 2 0 9 6 8 0 6 9 3 0 0 0 5 putima 23-Jul-1993 sungai bemban 1 1 0 0 3 1 0 0 1 0 0 0

83 11-May-2023 usman 6 1 0 4 1 3 4 5 0 8 7 1 0 0 0 5 SANINAH 23-Sep-1981 JL. TANGGUL LAUT 3 1 0 0 3 1 0 0 1 0 0 0

84 15-May-2023 ZAINAL 3 2 0 1 3 4 4 8 0 8 9 8 0 0 0 6 NADIATUL HASANAH 21-Mar-1999 JL. PERDAMAIAN 33/16 3 1 0 0 3 1 0 0 1 0 0 0

85 15-May-2023 SUKUR 6 1 1 2 0 9 6 2 0 4 7 2 0 0 0 1 ENNOR SIPA 22-Apr-1972 jl. ikamra 3 1 0 0 3 1 0 0 1 0 0 0

86 17-May-2023 6 1 1 2 0 9 5 1 0 6 0 4 0 0 0 5 THEN FONG 11-Jun-2004 JL. TUNAS HARAPAN 3 1 0 0 3 1 0 0 1 0 0 0

87 17-May-2023 SUCIPTO 6 1 1 2 0 9 4 8 0 6 8 9 0 0 0 6 MARWATI 06-Aug-1989 parit banjar 3 1 0 0 3 1 0 0 1 0 0 0

88 22-May-2023 SAHRI GUNAWAN 6 1 1 2 0 9 4 1 0 8 9 9 0 0 0 7 MITA LINDA SARI 01-Aug-1999 JL PARIT BANJAR 3 0 0 0 4 1 0 0 1 0 0 0

89 22-May-2023 TOMI AZIZ 6 1 1 2 0 1 4 5 0 7 9 3 0 0 1 5 SYF YANTI 11-May-1993 jl.petani 3 0 0 0 4 1 0 0 1 0 0 0

90 22-May-2023 BUSRI 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 YUMNA 24-Aug-1990 jl.kalimas 3 1 0 0 3 1 0 0 1 0 0 0

91 22-May-2023 TOMI AZIZ 6 1 1 2 0 1 4 5 0 7 9 3 0 0 1 5 SYF YANTI 11-May-1993 jl.petani 3 0 0 0 4 1 0 0 1 0 0 0

92 22-May-2023 SAMSUDIN 6 1 1 2 0 9 4 9 0 1 9 8 0 0 0 2 MARYANI 09-Jan-1998 JLN. PARIT BANJAR 3 1 0 0 3 1 0 0 1 0 0 0

93 23-May-2023 JEMAH/SUHARDI 6 1 1 2 0 9 4 9 0 1 0 2 0 0 0 1 ASNAWATIK 02-Mar-2002 parit wagatak 1 1 1 0 3 1 0 0 1 0 0 0

94 27-May-2023 BUSNI 6 1 1 2 0 0 4 6 0 6 8 1 0 0 0 3 HARTATI 12-Sep-1982 jl.kalimas hulu 3 0 0 0 4 1 0 0 1 0 0 0

95 30-May-2023 MUNALI 6 1 1 2 0 9 4 7 0 8 8 9 0 0 1 1 MAYA 07-Aug-1989 JL. PERINTIS 2 1 0 0 8 1 0 0 1 0 0 1

96 30-May-2023 AFRIANDANY 3 3 1 1 0 6 6 1 0 2 9 6 0 0 0 2 RISZKY FITRI LIANTO 21-Feb-1996 JL. HUSIN HAMZAH 1 1 1 0 9 1 0 0 1 0 0 1

97 30-May-2023 M. SYAM AGIL 6 1 1 2 0 9 4 7 0 7 2 9 0 0 0 4 SRI MARYANI 07-Jul-1989 PAL 9 1 1 1 0 9 1 0 0 1 0 0 1

98 30-May-2023 HENDRI 6 1 7 1 0 5 4 5 0 6 9 7 0 0 0 5 SERUNI VITALOKA 05-Jun-1997 UJUNG PANDANG 2 1 0 0 9 1 0 0 1 0 0 1

99 30-May-2023 MULYADI KURNIAWAN 6 1 7 1 0 5 5 3 1 7 9 4 0 0 0 9 YULIANTI 13-Jul-1994 UJUNG PANDANG 2 1 0 0 9 1 0 0 1 0 0 1

100 30-May-2023 A.HADI 6 1 7 1 0 5 6 2 0 2 9 8 0 0 0 5 FITRI YANI 22-Jan-1998 JL. H. RAIS A RAHMAN 1 1 0 0 9 1 0 0 1 0 0 1

SRI INDARTO WIRO

101 30-May-2023 6 1 0 9 0 7 6 9 0 7 9 0 0 0 0 6 NUR HAYATI 29-Jul-1990 DESA BELITANG SATU 2 1 0 0 8 1 0 0 1 0 0 1
TOMO

102 30-May-2023 ARDIANSYAH 6 1 1 2 0 2 5 1 2 0 7 9 8 0 0 1 MALIAH 12-Jul-1998 JL. PERDAMAIAN 1 1 0 0 9 1 0 0 1 0 0 1

103 30-May-2023 UMAR SAID 6 1 1 2 0 9 5 4 0 6 0 0 0 0 0 3 INTAN NUR AINI 14-Jun-2000 JL. PERDAMAIAN 1 1 0 0 8 1 0 0 1 0 0 1
104 01-Jun-2023 HABIBI 6 1 1 2 0 9 5 8 0 6 8 3 0 0 0 3 NURHAYATI 18-Jun-1983 JALAN PERINTIS GG JAWA 3 1 0 0 3 0 0 1 1 0 0 0

105 01-Jun-2023 M. TOHIR 6 1 1 2 0 9 5 0 0 6 8 5 0 0 1 7 CHOIRIYAH 06-Oct-1985 JL. IKAMRA 3 0 0 0 4 1 0 0 1 0 0 0

106 01-Jun-2023 6 1 1 2 0 0 4 6 0 6 8 1 0 0 0 3 HARTATI 12-Sep-1982 jl.kalimas hulu 3 0 0 0 4 0 0 1 1 0 0 0

107 03-Jun-2023 M. SAIDY 6 1 1 2 0 2 5 3 0 5 8 0 0 0 0 2 FITRIA 05-Apr-1988 PARIT WA'GATTAK 1 1 1 0 3 0 0 1 1 0 0 0

108 03-Jun-2023 SAYAN 6 1 1 2 0 9 5 8 0 3 8 8 0 0 0 8 NITA 18-Mar-1988 JL PARIT BANJAR 3 1 0 0 3 1 0 0 1 0 0 0

109 07-Jun-2023 MUHLIS 6 1 1 2 0 9 4 2 0 3 9 2 0 0 0 6 MANIAH 07-Apr-71992 PARIT WAGATTAK 3 1 0 0 3 0 0 1 1 0 0 0

110 07-Jun-2023 BUDIANSYAH 6 1 1 2 0 9 6 3 1 1 9 5 0 0 0 3 EKA NURJANAH 09-Nov-1995 JALAN HASANUDDIN 2 1 0 0 3 0 0 1 1 0 0 0

111 08-Jun-2023 SURA'I 6 1 1 2 0 6 5 4 1 0 9 5 0 0 0 9 ANISEH 10-Apr-1995 MEGA TIMUR 3 1 0 0 3 1 0 0 1 0 0 0

112 08-Jun-2023 6 1 1 2 0 9 5 1 0 7 8 6 0 0 0 3 RODIANA 19-Aug-1987 JL. KALIMAS HULU 3 1 0 0 3 0 0 1 1 0 0 0

113 09-Jun-2023 AGUS 6 1 1 2 0 9 6 0 0 9 8 4 0 0 0 3 RUSMA 08-Sep-1985 JL. KALIMAS HULU 3 1 0 0 3 1 0 0 1 0 0 0

114 12-Jun-2023 KHAIRUL MUKMININ 6 1 1 2 0 9 6 0 0 5 9 7 0 0 0 5 FITRIATUS SA'DIYAH 05-Feb-1997 JL. KALIMAS HULU 3 1 0 0 3 1 0 0 1 0 0 0

115 12-Jun-2023 EFFENDI ILYAS 6 1 1 2 0 9 4 8 1 0 8 1 0 0 0 4 NURYATI 08-Oct-1981 JLN. PARIT BANJAR 3 0 0 0 4 0 0 1 1 0 0 0

116 14-Jun-2023 FEBRI 6 1 7 1 0 1 5 9 0 7 8 4 0 0 0 6 YUSRIANA 07-Dec-1984 KALIMAS HULU 3 1 0 0 3 1 0 0 1 0 0 0

117 14-Jun-2023 YUSUP 6 1 1 2 0 9 4 6 0 2 8 2 0 0 0 4 JUARTI 26-Feb-1982 JL PERDAMAIAN 3 1 0 0 3 1 0 0 1 0 0 0

118 16-Jun-2023 YAHDI 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 HALIMAH 07-Jul-1986 JL.PERDAMAIAN 3 1 0 0 3 1 0 0 1 0 0 0

119 20-Jun-2023 SAHAR 6 1 7 1 0 2 6 0 0 6 9 8 0 0 0 7 NURHALIMAH 03-Feb-1998 KALIMAS HULU 3 1 0 0 3 1 0 0 1 0 0 0

120 26-Jun-2023 ALATIF 6 1 0 1 0 3 4 6 1 1 9 1 0 0 0 1 ANITA 23-Jul-1991 P. TIMUR 3 1 0 0 3 1 0 0 1 0 0 0

121 26-Jun-2023 AHMADI 6 1 1 2 0 3 4 5 1 1 8 8 0 0 0 4 FENTRI SUNDARI 11-May-1988 JL.PERINTIS 3 1 0 0 3 1 0 0 1 0 0 0

122 03-Jul-2023 SAHLI 6 1 1 2 0 2 4 1 0 7 9 6 0 3 0 3 SARIDEH 01-Jan-1996 JL.IKAMRA 3 1 0 0 3 1 0 0 1 0 0 0

123 03-Jul-2023 MARKAN 6 1 1 2 0 9 4 7 0 1 9 4 0 0 0 9 RIHAMA 07-Jan-1994 SUNGAI NENAS RT 35 3 1 0 0 3 1 0 0 1 0 0 0

124 03-Jul-2023 6 1 7 1 0 3 5 0 0 6 0 2 0 0 0 8 DEWI SARTIKA 08-Aug-2003 JL. SWADAYA 3 1 0 0 3 1 0 0 1 0 0 0

125 04-Jul-2023 MUAMAR LIHADAFI 6 1 1 2 0 9 4 4 0 8 8 9 0 0 0 6 MUHARANI 08-Apr-1989 JL. RAYA SUI KAKAP 2 1 0 0 8 0 0 1 1 0 0 1

126 04-Jul-2023 RAHMAT HARIYANTO 6 1 1 2 0 5 5 0 1 2 9 6 0 0 0 2 WAHDANIA 12-Oct-1996 CEYEMLA 5 2 1 0 0 8 0 0 1 1 0 0 1

127 04-Jul-2023 ACHMAD NAZARUDIN 6 1 1 2 0 9 4 1 0 7 8 5 0 5 4 4 SALMAH 01-Jul-1985 PARIT ALANG UMAR 2 1 0 0 9 0 0 1 1 0 0 1

128 04-Jul-2023 ANTON 6 1 7 1 0 1 5 4 0 8 8 4 0 0 1 4 LINDANIA 05-Feb-81984 SBR 4 2 1 0 0 8 1 0 0 1 0 0 1

129 04-Jul-2023 EDI PRAYITNO 6 1 1 2 0 9 4 5 0 4 8 7 0 0 0 6 NUR'AINI 04-May-1987 PARIT ALANG UMAR 2 1 0 0 9 1 0 0 1 0 0 1

130 05-Jul-2023 M.HASAN 6 1 7 1 0 4 5 7 0 2 9 5 0 0 1 1 FITRIANI 17-Feb-1995 PARIT SERONG 3 0 0 0 4 1 0 0 1 0 0 0

131 08-Jul-2023 6 1 1 2 0 9 6 8 0 7 8 8 0 0 0 8 JUHAIRIYAH 07-Mar-1980 SUNGAI NENAS 3 1 0 0 3 1 0 0 1 0 0 0

132 10-Jul-2023 MOH KADIR 6 1 7 1 0 1 4 9 0 7 0 0 0 0 0 8 SOLEHA 09-Jul-2000 PARIT WA'GATAK 3 1 0 0 3 1 0 0 1 0 0 0

133 11-Jul-2023 SYARIF 6 1 1 2 0 9 5 0 1 0 8 9 0 0 1 2 SANTI 04-Jul-1989 SUI BEMBAN 3 1 0 0 3 0 0 1 1 0 0 0

134 12-Jul-2023 6 1 7 1 0 3 5 0 0 6 0 2 0 0 0 8 DEWI SARTIKA 08-Aug-2003 JL. SWADAYA 3 0 0 0 4 1 0 0 1 0 0 0

135 12-Jul-2023 RUSLI LAHER 6 1 1 2 0 9 6 5 0 8 7 8 0 0 0 2 DARNAWATI YAKOB 25-Aug-1978 JL. KALIMAS HULU 3 1 0 0 3 1 0 0 1 0 0 0

136 14-Jul-2023 LUKMAN HAKIM 6 1 1 2 0 9 4 9 0 7 8 9 0 0 0 2 SUHADA 09-Jul-1989 JALAN HASANUDDIN 3 0 0 0 4 1 0 0 1 0 0 0

137 15-Jul-2023 ABU HANIFAH 6 1 7 1 0 5 4 1 1 0 0 1 0 0 0 9 LENA 01-Oct-2000 Jln Kalimas hulu 3 1 0 0 3 1 0 0 1 0 0 0

138 15-Jul-2023 6 1 1 2 0 9 5 0 1 1 7 7 0 0 0 2 SANIMA 10-Nov-1977 JL. PERDAMAIAN 2 1 0 0 8 1 0 0 1 0 0 0

139 15-Jul-2023 SUMHARI 6 1 1 2 0 9 5 1 0 8 8 5 0 0 1 3 SUMIATI 08-Jun-1985 PARIT WA'GATTAK 3 1 0 0 3 0 0 1 1 0 0 0

140 15-Jul-2023 6 1 7 1 0 1 6 7 1 0 8 8 0 0 0 4 SRI ASIH LETARI 27-Oct-1988 PARIT WA'GATTAK 1 1 1 0 9 1 0 0 1 0 0 0

141 17-Jul-2023 SAIMAN 6 1 1 2 0 9 4 2 0 8 8 0 0 0 0 5 HABIBEH 02-Aug-1980 PARIT SERONG 3 1 0 0 3 1 0 0 1 0 0 0

142 18-Jul-2023 MURDIONO RISKI 6 1 1 2 0 9 4 8 1 0 9 5 0 0 0 8 SHEILA ARISTA 08-Oct-1995 KOMP.ARI KARYA 4 3 0 0 0 4 1 0 0 1 0 0 0

143 18-Jul-2023 MUHAMMAD 6 1 1 2 0 9 6 4 0 9 0 1 0 0 0 3 ANA LAILA 14-Sep-2001 JL PARIT BANJAR 3 1 0 0 3 0 0 1 1 0 0 0

144 21-Jul-2023 SUNARWI 6 1 1 2 0 9 4 6 0 9 9 0 0 0 0 1 SUMIYEH 06-Sep-1990 JL. KALIMAS HULU 3 1 0 0 3 1 0 0 1 0 0 0

145 24-Jul-2023 BASIR 6 1 1 2 0 9 4 1 0 7 9 9 0 4 9 3 SULIFAH 07-May-1997 JL.IKAMRA 3 1 0 0 3 0 0 1 1 0 0 0

146 25-Jul-2023 BUDI IRAWAN 1 8 0 5 2 7 5 3 1 2 9 5 0 0 0 1 MARIA ULFA 13-Dec-1995 JL.SWADAYA 3 0 0 0 4 1 0 0 1 0 0 0

147 01-Aug-2023 AHMADI 6 1 1 2 0 9 4 4 1 3 0 1 0 0 0 7 NURHALIMAH 07-Mar-2001 PARIT BANJAR 3 0 0 0 4 0 0 1 1 0 0 0

148 01-Aug-2023 MILKI ERIKSON 8 1 7 1 0 1 5 3 0 1 8 2 0 0 0 5 HERLIN LESB ASSA 21-Nov-0982 JL. KALIMAS HULU 3 1 0 0 3 1 0 0 1 0 0 0

149 01-Aug-2023 NAWARDI 6 1 1 2 0 9 4 2 0 5 9 3 0 0 0 6 MUSYAROFAH 02-May-1993 JL. KALIMAS HULU 3 1 0 0 3 0 0 1 1 0 0 0

150 01-Aug-2023 MALQO 6 1 1 2 0 9 4 5 0 6 9 8 0 0 1 4 QUKSUM 04-Jun-1998 paret serong 3 1 0 0 3 0 0 1 1 0 0 0

151 02-Aug-2023 SLADIN 6 1 1 2 0 9 4 4 1 1 8 3 0 0 0 2 MURNINTEN 08-Aug-1983 JL.PARIT WAKGATTAK 3 1 0 0 3 0 0 1 1 0 0 0

152 02-Aug-2023 SUCIPNO 6 1 1 2 0 9 4 8 0 6 8 9 0 0 0 6 Marwati 08-Jun-1989 DESA KALIMAS 3 1 0 0 3 1 0 0 1 0 0 0

153 03-Aug-2023 MUSTOFA 6 1 1 2 0 9 5 7 0 8 9 3 0 0 1 1 HOSIAH 17-Aug-1993 JL.IKAMRA 3 1 0 0 3 1 0 0 1 0 0 0

154 03-Aug-2023 THALIB 6 1 1 2 0 9 5 5 0 6 8 1 0 0 1 0 RUSMIYAH 15-Jun-1981 JLN. PARIT BANJAR 3 0 0 0 4 1 0 0 1 0 0 0

155 04-Aug-2023 SUBEIDI 6 1 1 2 0 9 7 0 0 9 9 4 0 0 0 1 HANIPAH 24-Nov-1995 PARIT WA'GATTAK 2 1 0 0 3 1 0 0 1 0 0 0

156 04-Aug-2023 6 1 1 2 0 9 5 8 0 7 8 4 0 0 0 7 JULIANA 18-Jul-1984 PARIT WA'GATAK 3 1 0 0 3 0 0 1 1 0 0 0

157 06-Aug-2023 TOHIR 6 1 1 2 0 9 5 3 0 9 9 2 0 0 0 3 HAMIYEH 06-May-1992 PARIT WAKGATTAK 3 1 0 0 3 0 0 1 1 0 0 0

158 07-Aug-2023 6 1 1 2 0 9 4 8 0 9 9 3 0 0 0 6 NUR'AINI 08-Sep-1993 JL. PARIT SERONG 3 1 0 0 3 1 0 0 1 0 0 0

159 07-Aug-2023 ZAINAL 3 2 0 1 3 4 4 8 0 8 9 8 0 0 0 6 NADIATUL HASANAH 21-Mar-1999 JL. PERDAMAIAN 33/16 3 1 0 0 3 0 0 1 1 0 0 0

160 08-Aug-2023 ABDUL MU'THI 6 1 1 2 0 9 4 1 0 1 8 5 0 0 2 5 RAHMA 01-Jan-1985 JL. IKAMRA 3 1 0 0 3 1 0 0 1 0 0 0

161 09-Aug-2023 BUDI IRAWAN 1 8 0 5 2 7 5 3 1 2 9 5 0 0 0 1 MARIA ULFA 13-Dec-1995 JL. SWADAYA 3 1 0 0 3 1 0 0 1 0 0 0

162 09-Aug-2023 ROIL 3 5 2 6 0 9 4 4 0 9 7 6 0 0 0 2 LILAH 04-Sep-1976 JL. SWADAYA 3 1 0 0 3 1 0 0 1 0 0 0

163 09-Aug-2023 6 1 1 2 0 9 5 1 0 6 0 4 0 0 0 5 THEN FONG 11-Jun-2004 JL. TUNAS HARAPAN 3 0 0 0 4 1 0 0 1 0 0 0

164 10-Aug-2023 HASMAN 6 1 1 2 0 9 5 2 0 4 8 4 0 0 0 5 MISRIYEH 06-Mar-1984 PERDAMAIAN 3 1 0 0 3 0 0 1 1 0 0 0

165 12-Aug-2023 ABDUL RAHMAN 6 1 1 2 0 9 4 9 0 4 8 2 0 0 0 3 ANA LIANA 07-Aug-1982 JL.PERDAMAIAN 3 1 0 0 3 0 0 1 1 0 0 0

166 15-Aug-2023 SUHARDI 6 1 1 2 0 9 4 9 0 1 0 2 0 0 0 1 ASNAWATIK 09-Jan-2002 PARIT WA'GATTAK 1 0 1 0 4 0 0 1 1 0 0 0

167 15-Aug-2023 SAMSUDIN 6 1 1 2 0 9 4 9 0 1 9 8 0 0 0 2 MARYANI 09-Jan-1998 JLN. PARIT BANJAR 3 1 0 0 3 1 0 0 1 0 0 0

168 16-Aug-2023 TORIMAN 6 1 1 2 0 9 4 1 0 7 7 0 0 4 9 7 ROKIAH 01-Jul-1970 SUNGAI NENAS RT 35 3 1 0 0 3 1 0 0 1 0 0 0

169 18-Aug-2023 ASMAWI SAMID 6 1 1 2 0 9 6 3 0 2 5 7 0 0 0 1 MAIMUNA 23-Feb-1957 KALIMAS HULU 3 1 0 0 3 1 0 0 1 0 0 0

170 18-Aug-2023 6 1 7 1 0 5 5 3 0 9 9 3 0 0 0 1 RIZKI MAULIANA 13-Sep-1993 JL NATAKUSUMA 3 0 0 0 4 1 0 0 1 0 0 0

171 19-Aug-2023 AHMADI 6 1 1 2 0 9 4 4 1 1 0 1 0 0 0 7 NURHALIMAH 04-Nov-2001 jl parit banjar 2 1 0 0 8 1 0 0 1 0 0 1

172 19-Aug-2023 FAIDAL 6 1 7 1 0 5 6 5 0 6 9 7 0 0 0 1 NILAM SANTIARA 25-Jun-1997 JL.PERDAMAIAN 2 1 0 0 9 1 0 0 1 0 0 1

173 19-Aug-2023 SUHARDI 6 1 1 2 0 9 4 9 0 1 0 2 0 0 0 1 ASNAWATIK 02-Mar-2002 parit wagatak 2 1 0 0 8 1 0 0 1 0 0 1

174 19-Aug-2023 TOLIB 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 RUSMIYAH 15-Jun-1981 JL.PARIT BANJAR 2 1 0 0 8 1 0 0 1 0 0 1

175 21-Aug-2023 6 1 7 1 0 5 5 9 1 2 8 9 0 0 1 1 ROSITA 06-Jul-1989 KOMPLEK KRATON 2 1 0 0 3 1 0 0 1 0 0 0

176 22-Aug-2023 HABIBI 6 1 1 2 0 9 5 8 0 6 8 3 0 0 0 3 NURHAYATI 18-Jun-1983 JALAN PERINTIS GG JAWA 3 1 0 0 3 1 0 0 1 0 0 0

177 23-Aug-2023 TAMSIH 6 1 1 2 0 1 4 6 0 3 7 7 0 0 0 2 SRI SUSANTI 06-Mar-1977 JL. HARAPAN SETIA 3 0 0 0 4 1 0 0 1 0 0 0

178 26-Aug-2023 SAIJO WIJOYO 6 1 1 2 0 9 4 7 0 8 0 4 0 0 0 5 PITRIANI 07-Aug-2004 KALIMAS HULU 3 1 0 0 3 1 0 0 1 0 0 0

179 26-Aug-2023 ABDUL MUKTI 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 SUMIA ASTUTI 08-Aug-1995 KALIMAS HULU 3 1 0 0 3 1 0 0 1 0 0 0

180 26-Aug-2023 M SAIDI 6 1 1 2 0 2 5 3 0 5 8 0 0 0 0 2 FITRIANI 06-Jun-1988 PARIT WA'GATTAK 3 1 0 0 3 1 0 0 1 0 0 0

181 02-Sep-2023 MUHLIS 6 1 1 2 0 9 4 2 0 3 9 2 0 0 0 6 MANIAH 05-Sep-1992 JL. PARIT WAGATTAK 1 1 0 0 8 0 0 1 1 0 0 0

182 02-Sep-2023 UMAR 6 1 1 2 0 9 5 1 0 7 8 6 0 0 0 3 RODIANA 19-Aug-1987 JL. KALIMAS HULU 3 1 0 0 3 0 0 1 1 0 0 0

183 02-Sep-2023 ANTO 6 1 1 2 0 9 4 5 0 2 8 0 0 0 0 2 ATI 05-Feb-1980 PRT WAGGATAK 2 1 0 0 8 0 0 1 1 0 0 0

184 02-Sep-2023 MISTAR 6 1 1 2 0 9 4 4 0 5 8 0 0 0 0 6 MODEH 04-May-1980 JLN. PARIT BANJAR 2 1 0 0 8 1 0 0 1 0 0 0

185 02-Sep-2023 SAYAN 6 1 1 2 0 9 5 8 0 3 8 8 0 0 0 8 NITA 18-Mar-1988 JL PARIT BANJAR 3 1 0 0 3 1 0 0 1 0 0 0

186 04-Sep-2023 abdul holim 6 1 1 2 0 9 5 2 0 3 0 2 0 0 0 9 agustia ningsih 12-Jun-2002 PARIT WAGATTAK 1 1 0 0 3 0 0 1 1 0 0 0

187 04-Sep-2023 AGUS 6 1 1 2 0 9 6 0 0 9 8 4 0 0 0 3 RUSMA 08-Sep-1985 JL. KALIMAS HULU 2 1 0 0 8 1 0 0 1 0 0 0

188 04-Sep-2023 M. TOHIR 6 1 1 2 0 9 5 0 0 6 8 5 0 0 1 7 CHOIRIYAH 06-Oct-1985 JL. IKAMRA 3 0 0 0 4 1 0 0 1 0 0 0

189 05-Sep-2023 KHAIRUL MUKMININ 6 1 1 2 0 9 6 0 0 5 9 7 0 0 0 5 FITRIATUS SA'DIYAH 05-Feb-1997 JL. KALIMAS HULU 3 1 0 0 3 1 0 0 1 0 0 0

190 05-Sep-2023 KHAIRUDIN 6 1 1 2 0 9 4 4 0 9 0 0 0 0 0 2 ANISYATUN INSYANIA 04-Sep-2000 PARIT WAGATTAK 3 1 0 0 3 1 0 0 1 0 0 0

191 06-Sep-2023 - 3 2 0 4 1 4 6 4 0 5 8 4 0 0 0 3 YUBI YAMASARI 24-May-1984 DUSUN ANGSANA 3 1 0 0 3 1 0 0 1 0 0 0

192 06-Sep-2023 FEBRI 6 1 7 1 0 1 5 9 0 7 8 4 0 0 0 6 YUSRIANA 07-Dec-1984 KALIMAS HULU 3 1 0 0 3 1 0 0 1 0 0 0

193 06-Sep-2023 RICKY 6 1 1 2 0 9 5 1 0 6 0 4 0 0 0 5 THEN FONG 11-Jun-2004 JL. TUNAS HARAPAN 3 0 0 0 4 1 0 0 1 0 0 0

194 07-Sep-2023 ACHMUD RUFI'I 6 1 1 2 0 9 4 4 1 0 9 5 0 0 0 4 MAISARO 04-Dec-1995 JL.IKAMRA 3 1 0 0 3 1 0 0 1 0 0 0

195 09-Sep-2023 HAIRUDIN 6 1 1 2 0 9 6 2 1 0 8 5 0 0 0 7 JULIANA 22-Oct-1991 JL. RAYA KALIMAS TENGAH 3 1 0 0 3 1 0 0 1 0 0 0

196 13-Sep-2023 ANDRE KURNIADI 6 1 7 1 0 3 4 9 0 9 9 5 0 0 0 6 RINI 09-Sep-1995 JL. PANGLIMA AIM 1 1 0 0 3 1 0 0 1 0 0 0

197 13-Sep-2023 SUNARWIN 6 1 1 2 0 9 7 0 1 2 9 1 0 0 0 2 KHUSNUL KHOTIMAH 30-Dec-1991 SUI BEMBAN 3 1 0 0 3 1 0 0 1 0 0 0

198 14-Sep-2023 IRFAN SAPUTRA 6 1 1 2 0 9 6 7 0 9 0 4 0 0 0 5 NOVIA 24-Sep-2004 JL. RAYA KAKAP 3 1 0 0 3 1 0 0 1 0 0 0

199 14-Sep-2023 M. MAHALANI 6 1 7 1 0 4 6 0 0 9 9 9 0 0 1 1 DIANA 20-May-1991 JL. KAMRA 3 1 0 0 3 1 0 0 1 0 0 0

200 15-Sep-2023 NUR MISBEHA 6 1 7 1 0 1 4 6 0 6 9 8 0 0 0 8 MAHLI 06-Jun-1998 JL.IKAMRA 3 1 0 0 8 1 0 0 1 0 0 0

201 15-Sep-2023 SUNARWI 6 1 1 2 0 9 5 0 0 6 9 5 0 0 0 8 SUMNATI 10-Jun-1995 JL. KALIMAS HULU 3 1 0 0 3 0 0 1 1 0 0 0

202 15-Sep-2023 MUBASIR 6 1 1 2 0 9 6 0 1 1 8 7 0 0 0 3 SANIDAH 27-Apr-2004 KALIMAS HULU 3 0 0 0 4 1 0 0 1 0 0 0

203 18-Sep-2023 ALATIF 6 1 0 1 0 3 4 6 1 1 9 1 0 0 0 1 ANITA 23-Jul-1991 P. TIMUR 2 0 0 0 6 1 0 0 1 0 0 0

204 19-Sep-2023 AHMADI 6 1 1 2 0 3 4 5 1 1 8 8 0 0 0 4 FENTRI SUNDARI 11-May-1988 JL.PERINTIS 3 0 0 0 4 1 0 0 1 0 0 0

205 20-Sep-2023 KUSNADI 6 1 1 2 0 1 0 1 6 3 0 9 8 6 0 0 RUSNIAH 02-Nov-1993 TELUK KAPUAS 3 1 0 0 3 1 0 0 1 0 0 0

206 20-Sep-2023 ABDURROSYID 6 1 1 2 0 9 4 6 0 6 8 6 0 0 0 9 MISNAWATI 06-Jun-1986 JL. UJUNG PANDANG 3 1 0 0 3 1 0 0 1 0 0 0

207 20-Sep-2023 YANTO 6 1 1 2 0 9 4 2 1 1 9 3 0 0 0 3 MARYANI 02-Nov-1993 PARIT SERONG 3 1 0 0 3 1 0 0 1 0 0 0

208 21-Sep-2023 SAPARUDIN 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 SUHAINI 03-Oct-1981 KALIMAS HULU 3 1 0 0 3 1 0 0 1 0 0 0

209 02-Oct-2023 MOH KADIR 6 1 7 1 0 1 4 9 0 7 0 0 0 0 0 8 SOLEHA 09-Jul-2000 PARIT WA'GATAK 3 1 0 0 3 1 0 0 1 0 0 0

210 02-Oct-2023 AGUS MUNIF 6 1 1 2 0 9 4 7 0 4 9 8 0 0 0 4 SUMIYATI 07-Apr-1998 JALAN HASANUDDIN 1 1 1 0 8 1 0 0 1 0 0 0

211 02-Oct-2023 MADEH 6 1 1 2 0 9 5 0 0 9 8 0 0 0 0 6 RAHIM 23-Oct-1990 JL. IKAMRA 1 1 1 0 3 0 1 0 1 0 0 0

212 09-Oct-2023 ISHAK 6 1 7 1 0 3 6 1 0 6 9 3 0 0 0 7 NURJANNAH 21-Jun-1993 JALAN KELOLA 3 0 0 0 4 1 0 0 1 0 0 0

213 10-Oct-2023 JUNAIDI 6 1 1 2 0 9 4 1 0 7 9 4 0 4 6 1 JUMIANTI 05-Sep-1994 JL. KELOLA 3 1 0 0 3 1 0 0 1 0 0 0

214 11-Oct-2023 MUHAMMAD EFENDI 6 1 1 2 0 9 5 7 0 7 9 4 0 0 1 1 RITA HERMALIA 17-Jul-1994 PARIT BANJAR DUSUN MELATI 3 1 0 0 3 0 0 1 1 0 0 0

215 13-Oct-2023 CANDRA 6 1 1 2 0 9 5 6 0 8 9 4 0 0 0 6 EKA ULANSARI 16-Aug-1994 KALIMAS HULU 1 1 1 0 8 1 0 0 1 0 0 0

216 14-Oct-2023 APRIANSYAH 6 1 1 2 0 9 5 0 0 5 8 8 0 0 0 4 LITA 05-Oct-1988 KOMPLEK ALAM PERMAI 3 1 0 0 3 0 1 0 1 0 0 0

217 15-Oct-2023 winda wulandari 6 1 1 2 0 2 6 8 0 3 9 4 0 0 0 3 ZORY 28-Mar-1999 KAYONG UTARA 1 1 1 0 3 0 1 0 1 0 0 0

218 15-Oct-2023 M YUNUS 6 1 1 2 0 9 5 6 0 5 8 1 0 0 0 4 NURMAINI 16-May-1981 PARIT WAGATTAK 2 0 0 0 4 1 0 0 1 0 0 0

219 16-Oct-2023 M. ALQO 6 1 1 2 0 9 4 5 0 6 9 8 0 0 1 4 QUKSUM 04-Jun-1998 paret serong 1 1 1 0 3 1 0 0 1 0 0 0

220 19-Oct-2023 SURAJI 6 1 0 1 0 7 5 4 0 6 8 9 0 0 0 9 TITIN 07-Jun-1989 JL. PERDAMAIAN 2 1 0 0 3 0 1 0 1 0 0 0

221 20-Oct-2023 RUDIANTO 6 1 7 1 0 1 4 3 1 1 9 6 0 0 1 6 RATMI 04-Aug-1996 DALAM BUGIS 3 1 0 0 3 0 1 0 1 0 0 0

222 20-Oct-2023 - 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 ANA 08-Jul-1987 P.SELATAN 2 1 0 0 3 0 1 0 1 0 0 0

223 23-Oct-2023 NAWARDI 6 1 1 2 0 9 4 2 0 5 9 3 0 0 0 6 MUSYAROFAH 02-May-1993 JL. KALIMAS HULU 2 1 0 0 3 1 0 0 1 0 0 0

224 23-Oct-2023 EDI SUPRATO 6 1 1 2 0 7 5 6 0 7 9 4 0 0 0 2 TRI UTAMI 16-Jul-1994 DUSUN HILIR TENGAH 1 1 1 0 3 1 0 0 1 0 0 0

225 23-Oct-2023 SUHERMAN 6 1 0 3 1 2 6 0 1 1 0 0 0 0 0 4 PELISIA MARNI 20-Nov-2000 PUNGGUR 1 0 1 0 4 1 0 0 1 0 0 0

226 24-Oct-2023 SLADIN 6 1 1 2 0 9 4 4 1 1 8 3 0 0 0 2 MURNINTEN 08-Aug-1983 JL.PARIT WAKGATTAK 3 1 0 0 3 1 0 0 1 0 0 0

227 25-Oct-2023 IRWANSA 6 1 7 1 0 5 5 8 0 6 0 4 0 0 0 8 PUTRI 18-Jun-2004 KALIMAS HULU 3 1 0 0 3 1 0 0 1 0 0 0

228 25-Oct-2023 POLINDI 6 1 0 1 1 0 4 1 0 8 9 8 0 0 0 5 KHIKMOTUN 01-Aug-1998 KOMPLEK ARI KARYA 4 1 1 1 0 3 1 0 0 1 0 0 0

229 25-Oct-2023 M. ASWIN 6 1 1 2 0 9 6 8 0 6 9 3 0 0 0 5 PUTIMA 05-Aug-1994 sungai bemban 3 1 0 0 3 1 0 0 1 0 0 0

230 26-Oct-2023 BUDI IRAWAN 1 8 0 5 2 7 5 3 1 2 9 5 0 0 0 1 MARIA ULFA 13-Dec-1995 JL. SWADAYA 3 1 0 0 3 1 0 0 1 0 0 0

231 27-Oct-2023 USMAN 6 1 0 4 1 3 4 5 0 8 7 1 0 0 0 5 SANINAH 23-Sep-1981 JL. TANGGUL LAUT 3 1 0 0 3 1 0 0 1 0 0 0

232 27-Oct-2023 HAIRANI 6 1 1 2 0 9 6 4 0 7 8 3 0 0 0 3 HAWIYAH 24-Jul-1983 JL. RAYA KAKAP 3 1 0 0 3 1 0 0 1 0 0 0

233 28-Oct-2023 JUNIOR PUTRA 6 1 1 2 0 8 6 9 1 0 9 5 0 0 0 1 miawati dewi 29-Oct-1995 SUNGAI RENGAS 3 1 0 0 3 1 0 0 1 0 0 0

234 28-Oct-2023 ABDUSSALAM 6 1 1 2 0 9 5 8 0 7 8 4 0 0 0 7 JULIANA 18-Jul-1984 PARIT WA'GATAK 3 1 0 0 3 1 0 0 1 0 0 0

235 01-Nov-2023 HOLIK 6 1 1 2 0 9 4 1 0 7 8 0 0 4 6 2 SUMAIRAH 13-May-1980 JL. PARIT WAGATAK 2 1 0 0 8 0 1 0 1 0 0 0

236 02-Nov-2023 SAPARUDIN 6 1 1 2 0 9 5 5 1 2 7 7 0 0 0 2 JULIANA 15-Dec-1977 PARIT TUADIK 2 1 0 0 8 1 0 0 1 0 0 0

237 03-Nov-2023 ABDUL 6 1 1 2 0 9 4 9 0 4 8 2 0 0 0 3 ANA LIANA 07-Aug-1982 JL.PERDAMAIAN 3 1 0 0 3 1 0 0 1 0 0 0

238 03-Nov-2023 HOSMAN 6 1 1 2 0 9 5 2 0 4 8 4 0 0 0 5 MISRIYEH 06-Mar-1984 PERDAMAIAN 3 1 0 0 3 1 0 0 1 0 0 0

239 03-Nov-2023 - 6 1 1 2 0 9 4 7 0 5 8 6 0 0 1 2 RIMA 07-May-1986 JL. SWADAYA 2 1 0 0 8 1 0 0 1 0 0 0

240 04-Nov-2023 ABDUL HAMID 6 1 1 2 0 3 5 6 0 9 8 8 0 0 0 2 SRI WAHYUNINGSIH 16-Sep-1988 DUSUN GARUDA 2 1 0 0 8 1 0 0 1 0 0 0

241 04-Nov-2023 TOHIR 6 1 1 2 0 9 5 3 0 9 9 2 0 0 0 3 HAMIYEH 06-May-1992 PARIT WAKGATTAK 3 1 0 0 3 1 0 0 1 0 0 0

242 04-Nov-2023 - 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 JUNAINAH 14-Feb-1991 PARIT TUADIK 3 1 0 0 8 0 1 0 1 0 0 0

243 04-Nov-2023 TAHARI 6 1 1 2 0 9 6 1 0 3 8 9 0 0 0 1 HAMIMAH 13-Oct-1992 PARIT WAGATTAK 3 1 0 0 3 1 0 0 1 0 0 0

244 04-Nov-2023 ROIL 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 INDAH 05-Jul-1976 JL. SWADAYA 3 1 0 0 3 0 1 0 1 0 0 0

245 06-Nov-2023 LUKONG 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 HENISA 07-Apr-1980 JL. PERDAMAIAN 3 1 0 0 3 0 1 0 1 0 0 0

246 06-Nov-2023 MUSTOFA 6 1 1 2 0 9 5 7 0 8 9 3 0 0 1 1 HOSIAH 17-Aug-1993 JL.IKAMRA 3 1 0 0 3 1 0 0 1 0 0 0

247 07-Nov-2023 SAMSUDIN 6 1 1 2 0 9 4 9 0 1 9 8 0 0 0 2 MARYANI 09-Jan-1998 JLN. PARIT BANJAR 3 1 0 0 3 1 0 0 1 0 0 0

248 09-Nov-2023 ABDUL BASYIR 6 1 1 2 0 9 5 0 0 2 8 7 0 0 0 5 ASNAWATI 02-Oct-1987 JL. KALIMAS HULU 2 1 0 0 8 0 1 0 1 0 0 0

249 13-Nov-2023 SUHARMAN 6 1 1 2 0 9 4 4 0 9 0 3 0 0 0 3 SUMMA 04-Sep-2003 JL. PARIT WAGATTAK 3 1 0 0 3 1 0 0 1 0 0 0

250 16-Nov-2023 JAIDIN 6 1 1 2 0 9 4 2 0 9 0 0 0 0 0 4 MULIATI 02-Sep-2000 JL. PARIT WAGATTAK 3 1 0 0 3 1 0 0 1 0 0 0

251 17-Nov-2023 ROFIK 6 1 7 1 0 2 6 5 1 1 9 3 0 0 0 3 NOVIANA LESTARI 03-Nov-1993 KOMPLEK PANGERAN 5 3 1 0 0 3 1 0 0 1 0 0 0

252 17-Nov-2023 M. TOHIR 6 1 1 2 0 9 5 0 0 6 8 5 0 0 1 7 CHOIRIYAH 06-Oct-1985 JL. IKAMRA 3 1 0 0 3 1 0 0 1 0 0 0

253 18-Nov-2023 DAHLI 6 1 1 2 0 2 4 9 0 3 8 8 0 0 0 1 MANI 03-Sep-1988 JL. PARIT WAGTTAK 3 1 0 0 3 0 1 0 1 0 0 0

254 20-Nov-2023 - 3 2 0 4 1 4 6 4 0 5 8 4 0 0 0 3 YUBI YAMASARI 24-May-1984 DUSUN ANGSANA 3 1 0 0 3 1 0 0 1 0 0 0

255 20-Nov-2023 ABDUL HAKI 6 1 1 2 0 9 4 4 0 8 8 4 0 0 0 2 MISRIYAH 04-Aug-1984 JL PERDAMAIAN 3 0 0 0 4 1 0 0 1 0 0 0

 256 21-Nov-2023 PASAYEN 6 1 1 2 0 9 5 8 0 3 8 8 0 0 0 8 NITA 18-Mar-1988 PARIT BANJAR 3 1 0 0 3 0 0 1 1 0 0 0

257 22-Nov-2023 - 6 1 1 2 0 9 4 7 0 8 0 4 0 0 0 5 PITRIANI 07-Aug-2004 KALIMAS HULU 3 1 0 0 3 1 0 0 1 0 0 0

258 24-Nov-2023 SYAHID 6 1 1 2 0 9 4 1 0 7 9 9 0 4 7 9 TORIYEH 01-Jul-1999 JL.. SWADAYA 3 1 0 0 3 1 0 0 1 0 0 0

259 24-Nov-2023 PURI 6 1 1 2 0 1 4 6 0 8 8 2 0 0 0 7 NURHAYATI 06-Aug-1982 PARIT SERONG 2 1 0 0 8 1 0 0 1 0 0 0

260 27-Nov-2023 JUMADI 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 MARNI 15-Aug-1990 PARIT BERKAT 3 1 0 0 3 0 1 0 1 0 0 0

261 28-Nov-2023 KHAIRUL 6 1 1 2 0 9 6 0 0 5 9 7 0 0 0 5 FITRIATUS SA'DIYAH 05-Feb-1997 JL. KALIMAS HULU 3 1 0 0 3 1 0 0 1 0 0 0

262 28-Nov-2023 - 6 1 0 8 0 5 4 6 0 2 9 8 0 0 0 1 SUMIATI 02-Mar-1998 PARIT ALANG UMAR 3 0 0 0 3 1 0 0 1 0 0 0

263 01-Dec-2023 ABDUL KARIM 3 5 2 9 2 3 0 4 2 0 7 8 2 0 0 0 ZAHRA 06-May-1982 SUNGAI NENAS 2 1 0 0 8 0 0 1 1 0 0 0

264 01-Dec-2023 - 6 1 1 2 0 9 5 0 0 7 9 1 0 0 0 3 UMMAN 09-Aug-1995 PARIT MAKSUM 1 1 1 0 8 0 0 1 1 0 0 0

265 02-Dec-2023 EFFENDI ILYAS 6 1 1 2 0 9 4 8 1 0 8 1 0 0 0 4 NURYATI 08-Oct-1981 JLN. PARIT BANJAR 3 1 0 0 3 0 0 1 1 0 0 0

266 04-Dec-2023 - 6 1 7 1 0 5 5 2 0 3 8 4 0 0 0 6 PITRIYANTI 03-Dec-1984 JL. NIRBAYA 3 1 0 0 3 1 0 0 1 0 0 0

267 05-Dec-2023 SUNARWI 6 1 1 2 0 9 7 0 1 2 9 1 0 0 0 2 KHUSNUL KHOTIMAH 05-Sep-1990 SUI BEMBAN 3 1 0 0 3 1 0 0 1 0 0 0

268 05-Dec-2023 SURI 6 1 1 2 0 9 5 5 0 4 7 0 0 0 0 8 MARIAMAH 15-Apr-1970 JL BERKAT USAHA 3 1 0 0 3 1 0 0 1 0 0 0

269 08-Dec-2023 SUNARWI 6 1 1 2 0 9 5 0 0 6 9 5 0 0 0 8 SUMNATI 10-Jun-1995 JL. KALIMAS HULU 3 1 0 0 3 0 0 1 1 0 0 0

270 08-Dec-2023 MULYADI 6 1 1 2 0 2 5 7 0 2 9 7 0 0 0 1 NURKHOIBAH 17-Feb-1997 KUALA MANDOR 1 1 1 0 8 0 0 1 1 0 0 0

271 12-Dec-2023 ABDUR RASYID 6 1 1 2 0 9 4 6 0 6 8 6 0 0 0 9 MISNAWATI 06-Jun-1986 JL. UJUNG PANDANG 3 1 0 0 3 0 0 1 1 0 0 0

272 13-Dec-2023 OKTAVIANUS ARTI 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 RIKA 12-May-1992 LANDAK 1 1 1 0 3 0 0 1 1 0 0 0

273 13-Dec-2023 MEJURI 6 1 1 2 0 9 5 1 1 0 8 0 0 0 0 6 SATIMA 11-Oct-1980 JL.PERDAMAIAN 2 1 0 0 8 1 0 0 1 0 0 0

274 13-Dec-2023 SULAD 6 1 1 2 0 9 5 0 0 2 8 8 0 0 0 1 MARDIANDA 10-Feb-1988 SUNGAI BEMBAN DUSUN MELATI RT 17 3 1 0 0 3 1 0 0 1 0 0 0

275 16-Dec-2023 JUMAIDI 6 1 1 2 0 9 4 2 0 8 1 8 0 0 0 2 ROKIYAH 07-Jun-1983 JL. PERDAMAIAN 3 1 0 0 3 0 0 1 1 0 0 0

276 19-Dec-2023 MUNIWAR 6 1 1 2 0 9 4 4 0 6 7 7 0 0 1 3 SYARIFAH 04-Jun-1977 SUNGAI BEMBAN DUSUN MELATI RT 22 3 1 0 0 3 1 0 0 1 0 0 0

277 19-Dec-2023 - 6 1 1 2 0 9 5 1 0 5 8 5 0 0 0 9 AZMANIYAH 05-Nov-1985 SUNGAI BEMBAN 3 1 0 0 3 1 0 0 1 0 0 0

1) Keterangan Kode
STATUS PESERTA KB KODE JENIS ALOKON (Diisi Pada Jenis Tindakan dan Kasus)
1 : Peserta KB Baru 3 : Peserta KB Ulangan 1 : Suntikan 1 Bulanan 3 : Suntikan 3 Bulanan 5 : Pil Progestin 7 : Implan 1 Batang 9 : IUD 11 : Tubektomi
2 : Peserta KB Ganti 4 : Komplikasi 2 : Suntikan 3 Bulanan 4 : Pil Kombinasi 6 : Kondom 8 : Implan 2 Batang 10 : Vasektomi
2) SELAIN STATUS PESERTA KB, JENIS TINDAKAN DAN KASUS DIISI TANDA CENTANG (V)
1. Petugas Entri Data Lamp.R/I/KB/20
LAMPIRAN R/I/KB/20 Lembar 9

1 2 3 4 5 6
6 1 1 2 0 4 5 Bulan : 2023
NAMA FASKES/ PUSKESMAS PAL SEMBILAN 7 8 9 10 11 V
:
JARINGAN/JEJARING Kode Provinsi Kode No. Register Faskes No. Jaringan/
Kabupaten/ Jejaring Faskes
Kota

RINGKASAN HASIL PELAYANAN KB

PESERTA KB BARU (PB) PESERTA KB ULANGAN PELAYANAN KASUS

PEMBERIAN INFORMED PB DAN KESERTAAN JKN PEMBERIAN INFORMED

NO. METODE KONTRASEPSI CONSENT CONSENT (Untuk
(Untuk PB) PB PASCA PB PASCA Peserta KB Ulangan)
GANTI CARA PELAYANAN ULANG PENCABUTAN KOMPLIKASI BERAT KEGAGALAN
PERSALINAN KEGUGURAN
PB JKN PB NON JKN TOTAL PB

1 2 3 4 5 6 7 8 9 10 11 12 13 14

1 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
2 PIL 0 0 0 0 0 0 0 0 1 0 0
3 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
4 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
5 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
6 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
7 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
8 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
9 IUD 1 1 0 1 1 0 0 0 0 0 0
10 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
11 IMPLAN 0 0 0 0 0 0 1 1 0 0 0
12 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
13 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
14 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
15 SUNTIKAN 1 1 0 1 0 0 0 0 0 0 0
16 KONDOM 0 0 0 0 0 0 0 1 0 0 0
17 SUNTIKAN 0 0 0 0 0 0 1 1 0 0 0
18 SUNTIKAN 1 1 0 1 1 0 0 0 0 0 0
19 PIL 0 1 0 1 0 0 0 0 0 0 0
20 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
21 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
22 PIL 0 1 0 1 1 0 0 0 0 0 0

JUMLAH 68 53 2 55 19 0 161 36 157 0 0 0

,
Pimpinan Faskes KB/Jaringan/Jejaring*

197703172007012000
NIP/NRP
* Coret yang tidak perlu