FORMAT

DAFTAR PENERIMA BANTUAN IURAN JAMINAN KESEHATAN MELALUI

ANGGARAN PENDAPATAN DAN BELANJA DAERAH KABUPATEN TOBA SAMOSIR

Kelamin
Status
Kawin

Kode Faskes Dokter Gigi

Jenis
NIK/KITAS PISAT Tgl Lahir

Nama Faskes Tk.I

Nama Kecamatan

Kode Faskes Tk.I

Kode Kecamatan

Nama Desa
Kode Desa
Alamat Tempat Kode
No No KK Nama Lengkap RTRW
1=K, Tinggal Pos
P/I/S
2=B,
/A1..3 Tempat L=1
KITAP dd/mm/yyyy
Lahir 'P=2
3=J,
/T1..n
4=D

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

1 24210390120005 121201020552000 Mangasa Napitupulu P Balige 05-02-1952 1 1 Balerong 0 0 22313 121201 Balige Napitupulu 0206030101 Puskesmas 0
5 Balige

2 1212012004100314121201100650002 Basmen Simanjuntak P Parsuratan 08-10-1965 1 1 Jl. Mulia Raja Ujung 0 0 22313 121201 Balige Napitupulu 0206030101 Puskesmas 0
Balige

3 12120105111200011212014203110001Navda N. Napitupulu A Balige 03-02-2011 2 2 Napitupulu D. Tolong 0 0 22313 121201 Balige Napitupulu 0206030101 Puskesmas 0
Balige

4 12120108020800451212010812650001Darwin Napitipulu P Balige 08-12-1965 1 1 Bukit Barisan 0 0 22313 121201 Balige Napitupulu 0206030101 Puskesmas 0
Balige

5 12120112060900021212015708560001Risma Uli Hutajulu I Laguboti 17-08-1956 2 1 Napitupulu 0 0 22313 121201 Balige Napitupulu 0206030101 Puskesmas 0
Balige

6 041103901206 1212014603510002Sondang L.Tobing I Medan 06-03-1951 2 1 Bukit Barisan 0 0 22313 121201 Balige Napitupulu 0206030101 Puskesmas 0
Balige

7 12120108121100091212015305840004Meiland Napitupulu I Balige 13-05-1984 2 1 Bukit Barisan 0 0 22313 121201 Balige Napitupulu 0206030101 Puskesmas 0
Balige

8 12120129041000051212011706470004Walon M. Aruan P Jakarta 17-08-1947 1 1 Napitupulu Bagasan 0 0 22313 121201 Balige Napitupulu 0206030101 Puskesmas 0
Balige
9 12120129041000051212015701560003Helperia S. Napitupulu I Balige 17-01-1956 2 1 Napitupulu Bagasan 0 0 22313 121201 Balige Napitupulu 0206030101 Puskesmas 0
Balige

10 12120129041000051212016502480001Tiurmara Sitompul I Balige 25-02-1946 2 1 Napitupulu Bagasan 0 0 22313 121201 Balige Napitupulu 0206030101 Puskesmas 0
Balige

11 12120120071100101212015104840003Sudarsi I Kisaran 11-04-1984 2 1 Napitupulu D. Tolong 0 0 22313 121201 Balige Napitupulu 0206030101 Puskesmas 0
Balige

12 12120115063700151212015608690003Mariani Nainggolan I P.Siantar 16-08-1969 2 1 Mulia Raja Ujung 0 0 22313 121201 Balige Napitupulu 0206030101 Puskesmas 0
Balige

13 12120115060700141212012711620001Resman Mangandar P Balige 27-11-1962 1 1 Jln. Mesjid 0 0 22313 121201 Balige Napitupulu 0206030101 Puskesmas 0
Balige

14 Rinto 1 1 Jl.Napitupulu bagasan 0 0 22313 121201 Balige Napitupulu 0206030101 Puskesmas 0

Balige

Riyani Simanjuntak

Juliver Napitupulu

17 12120127080900081212015512510001Rita Napitupulu P Balige 15-12-1951 2 3 Jln. Lbn Simangambit 0 0 22313 121201 Balige Napitupulu 0206030101 Puskesmas 0
Balige

18 12120101020507271212011406710000Josafat Purba P Barus 14-06-1971 1 1 Balige I 0 0 22313 121201 Balige Balige I 0206030101 Puskesmas 0
Balige

19 12120102050727 1212015411700001Tiur Sinaga I Barus 09-10-1970 2 1 Balige I 0 0 22313 121201 Balige Balige I 0206030101 Puskesmas 0
Balige

20 121201070910007 1212016710960002Putri Dewi M. Sinaga A Balige 27-10-1996 2 2 Balige I 0 0 22313 121201 Balige Balige I 0206030101 Puskesmas 0
Balige

21 121201070910007 1212012004990005Andri Panahatan Purba A Balige 20-04-1999 1 2 Balige I 0 0 22313 121201 Balige Balige I 0206030101 Puskesmas 0
Balige

22 12120101020507271212015905010009Vera Dita Purba A Balige 19-05-2001 2 2 Balige I 0 0 22313 121201 Balige Balige I 0206030101 Puskesmas 0
Balige

23 12120101020507271212010202040004Fernidan Purba A Balige 02-02-2004 1 2 Balige I 0 0 22313 121201 Balige Balige I 0206030101 Puskesmas 0
Balige

24 12120109111100051212014507530002Donny Logoan Siahaan I Balige 05-07-1953 1 1 Balige I 0 0 22313 121201 Balige Balige I 0206030101 Puskesmas 0
Balige
25 12120106011100131212010112550001Robert Siahaan P Balige 01-12-1955 1 1 Balige I 0 0 22313 121201 Balige Balige I 0206030101 Puskesmas 0
Balige

26 12120109111100051212016205830004Maria Silalahi I Balige 22-'05-1983 2 1 Balige I 0 0 22313 121201 Balige Balige I 0206030101 Puskesmas 0
Balige

27 12120109111100051212012003840005Mikael Silalahi P Balige 20-03-1984 1 1 Balige I 0 0 22313 121201 Balige Balige I 0206030101 Puskesmas 0
Balige

28 12120109111100051212011707860006Anos Silalahi A Balige 17-07-1986 1 2 Balige I 0 0 22313 121201 Balige Balige I 0206030101 Puskesmas 0
Balige

29 12120109111100051212011103910002Anggiat Silalahi A Balige 11-03-1991 1 2 Balige I 0 0 22312 121201 Balige Balige I 0206030101 Puskesmas 0
Balige

30 121201240609001312120612680001 Harry Hutagaol P Balige 12-06-1968 1 1 Balige I 0 0 22312 121201 Balige Balige I 0206030101 Puskesmas 0
Balige

31 Manosor Elikson Simangunsong Balige I 0 0 22312 121201 Balige Balige I 0206030101 Puskesmas 0
Balige

32 12120122091000131212014611560002Rusmi Manurung I Laguboti 06-11-1956 2 1 Balige I 0 0 22312 121201 Balige Balige I 0206030101 Puskesmas 0
Balige

33 12120119021400011212010404790002Charles Siahaan A Balige 04-04-1979 1 2 Balige I 0 0 22312 121201 Balige Balige I 0206030101 Puskesmas 0
Balige

34 12120116081100041212012707900004Riduan Sirait A Baruara 27-07-1990 1 2 Baruara 0 0 22312 121201 Balige Baruara 0206030101 Puskesmas 0
Balige

Sitonggi
35 1212011510120039121201560844001 Farida Batubara I 16-08-1944 2 1 Baruara 0 0 22312 121201 Balige Baruara 0206030101 Puskesmas 0
tonggi Balige

36 12120111121100071212010710070001Andi P Butar-Butar A Tambunan 10-07-2007 1 2 Lumban Gaol 0 0 22313 121201 Balige Lumban Gaol 0206030101 Puskesmas 0
Balige

37 12120112020800961212012906020001Gabe B Tambunan A Tambunan 29-06-2002 1 2 Lumban Gaol 0 0 22313 121201 Balige Lumban Gaol 0206030101 Puskesmas 0
Balige

38 KK dlm Pengurusana1212015812440001Rosmani Silitonga P Sipahutar 18-12-1944 2 3 Lumban Gaol 0 0 22313 121201 Balige Lumban Gaol 0206030101 Puskesmas 0
Balige

39 1212013108120004121201170297003 Jaka Chandra P Jakarta 17-02-1987 1 1 Lumban Gaol 0 0 22313 121201 Balige Lumban Gaol 0206030101 Puskesmas 0
Balige

40 121201120208037612120149010001 Mega Teremia A Jakarta 09-07-2001 2 2 Lumban Gaol 0 0 22313 121201 Balige Lumban Gaol 0206030101 Puskesmas 0
Balige
41 12120112020803761212015703680001Berliana Hutasoit I Lbn. Gaol 11-05-1955 2 1 Lumban Gaol 0 0 22313 121201 Balige Lumban Gaol 0206030101 Puskesmas 0
Balige

42 Yusuf Tambunan Lumban Gaol 0 0 22313 121201 Balige Lumban Gaol 0206030101 Puskesmas 0
Balige

43 12120111111100011212012908810003Monang Tambunan P Tambunan 29-08-1981 1 4 Lumban Gaol 0 0 22313 121201 Balige Lumban Gaol 0206030101 Puskesmas 0
Balige

44 1212011202080060 Burhan Tambunan P Tambunan 18-04-1987 1 2 Lumban Gaol 0 0 22313 121201 Balige Lumban Gaol 0206030101 Puskesmas 0
Balige

45 12120115100800031212011905560001Elisman Hutagaol P Hutagaol 19-05-1956 1 1 Bonan dolok I 0 0 22313 121201 Balige Bonan Dolok I 0206030101 Puskesmas 0
Balige

46 12120115100800031212016506580001Lamria Siagian I Bonandolok 25-06-1959 2 1 Bonan dolok I 0 0 22313 121201 Balige Bonan Dolok I 0206030101 Puskesmas 0
Balige

47 12120104081000011212012505550004Kapman Siagian P Bonan Dolok I 25-05-1955 1 1 Bonan dolok I 0 0 22313 121201 Balige Bonan Dolok I 0206030101 Puskesmas 0
Balige

48 12120124021100381212012303500001Wilter Siagian P Bonan Dolok I 23-03-1950 1 1 Bonan dolok I 0 0 22313 121201 Balige Bonan Dolok I 0206030101 Puskesmas 0
Balige

49 12120124021100381212014112540004Langgatan Simanjuntak I L. Gala-gala 01-12-1954 2 1 Bonan dolok I 0 0 22313 121201 Balige Bonan Dolok I 0206030101 Puskesmas 0
Balige

50 12120107020801071212012307710002Donal Siagian P Bonan Dolok 23-07-1971 1 1 Bonan dolok I 0 0 22313 121201 Balige Bonan Dolok I 0206030101 Puskesmas 0
Balige

51 12120107020801071212016606750002Lidia Tambunan I Tanah Gambus 26-06-1975 2 1 Bonan dolok I 0 0 22313 121201 Balige Bonan Dolok I 0206030101 Puskesmas 0
Balige

52 Manogari Siagian Bonan dolok I 0 0 22313 121201 Balige Bonan Dolok I 0206030101 Puskesmas 0
Balige

53 12120106117700021212010611770002Porman Siagian P Simaranjan 06-11-1977 1 1 Bonan Dolok II 0 0 22313 121201 Balige Bonan Dolok II 0206030101 Puskesmas 0
Balige

54 12120165037300021212016503730002Rendi Tampubolon P Lbn. Atas 25-03-1973 1 1 Bonan dolok II 0 0 22313 121201 Balige Bonan Dolok II 0206030101 Puskesmas 0
Balige
55 12120118034300021212011803430001Saudin Batubara P Bonandolok 18-03-1943 1 1 Bonan dolok II 0 0 22313 121201 Balige Bonan Dolok II 0206030101 Puskesmas 0
Balige

56 12120149045300011212016006530001Tiomsi Simorangkir P Tarutung 20-06-1953 1 1 Bonan dolok II 0 0 22313 121201 Balige Bonan Dolok II 0206030101 Puskesmas 0
Balige

57 12120112110800021212011211080002Ruben Siagian A Bonandolok 12-11-2008 1 2 Bonan dolok II 0 0 22313 121201 Balige Bonan Dolok II 0206030101 Puskesmas 0
Balige

58 12120112110800021212011120112000Ferdinan Siagian A Bonandolok 12-01-2012 1 2 Bonan dolok II 0 0 22313 121201 Balige Bonan Dolok II 0206030101 Puskesmas 0
Balige

59 12120115105400151212015302920053Nurliana Siagian A Sihobuk 13-02-1992 2 2 Bonan dolok III 0 0 22313 121201 Balige Bonan dolok III 0206030101 Puskesmas 0
Balige

60 1212011510540015121201150540015 Harlen Siagian P Sihobuk 15-10-1954 1 1 Bonan dolok III 0 0 22313 121201 Balige Bonan dolok III 0206030101 Puskesmas 0
Balige

61 12120115105400151212015510530055Rosida Napitupulu I Bah. gunung 15-01-1953 2 1 Bonan dolok III 0 0 22313 121201 Balige Bonan dolok III 0206030101 Puskesmas 0
Balige

62 121204510540015 1212012008954002Robin Siagian A Sihobuk 20-08-1998 2 2 Bonan dolok III 0 0 22313 121201 Balige Bonan dolok III 0206030101 Puskesmas 0
Balige

63 12120115105400151212012712970027Jonatan Siagian A Sihobuk 27-12-1997 2 2 Bonan dolok III 0 0 22313 121201 Balige Bonan dolok III 0206030101 Puskesmas 0
Balige

64 12120114021100131212010805700001Bisker Simanjuntak P Lbn. Gala-gala 08-05-1970 1 1 Bonan dolok III 0 0 22313 121201 Balige Bonan dolok III 0206030101 Puskesmas 0
Balige

65 12120114021100131212015203760002Rosmida Sihotang I Lbk. Pakam 12-03-1976 2 1 Bonan dolok III 0 0 22313 121201 Balige Bonan dolok III 0206030101 Puskesmas 0
Balige

66 121201022050325 121201022050325 Manahan Simanjuntak P Hutadame 03-04-1940 1 1 Huta dame 0 0 22313 121201 Balige Huta dame 0206030101 Puskesmas 0
Balige

67 121201301100003 1212010502286000Binsar Simanjuntak P Huta dame 05-02-1986 1 1 Huta dame 0 0 22313 121201 Balige Huta dame 0206030101 Puskesmas 0
Balige

68 12120130113000031212015005940002Apriani Ambarita I P. Siantar 10-05-1994 2 1 Huta Dame 0 0 22313 121201 Balige Huta Dame 0206030101 Puskesmas 0
Balige
69 12120126101000051212015612470003Landus Hutahaean I Hutahaean 16-12-1947 2 1 Huta dame 0 0 22313 121201 Balige Huta dame 0206030101 Puskesmas 0
Balige

70 12120103120700541212016111710001Ronti Tambunan I Huta dame 21-11-1971 2 Huta dame 0 0 22313 121201 Balige Huta dame 0206030101 Puskesmas 0
Balige

71 12120107061000111212010612400001Janneas Sinaga P Tarutung 26-12-1940 1 1 Huta Namora 0 0 22313 121201 Balige Huta Namora 0206030101 Puskesmas 0
Balige

72 12120107061000111212016806590001Ramlia Simangunsong I Nasonak 26-06-1956 2 1 Huta Namora 0 0 22313 121201 Balige Huta Namora 0206030101 Puskesmas 0
Balige

73 12120106020800851212014403900005Nurlela Sitompul I Hutanamora 04-03-1990 2 1 Huta Namora 0 0 22313 121201 Balige Huta Namora 0206030101 Puskesmas 0
Balige

74 12120107020803411212012603470001Harlen Simangunsong P Hutagalung 26-03-1947 1 1 Huta Namora 0 0 22313 121201 Balige Huta Namora 0206030101 Puskesmas 0
Balige

75 1212012605090001121201651046031 Mathile Simangunsong I Lbn. Julu 25-10-1946 2 1 Lbn. Julu 0 0 22313 121201 Balige Huta Namora 0206030101 Puskesmas 0
Balige

76 12120195885400051212015602570056Renta Hutagaol I Hutagaol 16-02-1957 2 1 Hutagaol 0 0 22313 121201 Balige Hutagaol 0206030101 Puskesmas 0
Balige

77 12120101074700041212014603510002Bilman Hutagaol P Hutagaol 01-07-1947 1 1 Hutagaol 0 0 22313 121201 Balige Hutagaol 0206030101 Puskesmas 0
Balige

78 12120101074700041212010909490002Elferia Tambunan A Tambunan 09-09-1949 1 2 Hutagaol 0 0 22313 121201 Balige Hutagaol 0206030101 Puskesmas 0
Balige

79 12120125115800251212016309590063Loiner Simanjuntak I Sihatandohan 23-09-1959 2 1 Hutagaol 0 0 22313 121201 Balige Hutagaol 0206030101 Puskesmas 0
Balige

80 1212012202080161121201102530001 Patar Hutagaol P Simarmar 11-02-1953 1 1 Hutagaol Simarmar 0 0 22313 121201 Balige Hutagaol 0206030101 Puskesmas 0
Balige

81 12120122020801611212016006540001Siti Hutahaean I Hutahean 20-06-1954 2 1 Hutagaol Simarmar 0 0 22313 121201 Balige Hutagaol 0206030101 Puskesmas 0
Balige

82 12120130081200021212011002290004Daniel Hutagaol P Simarmar 11-02-1953 1 1 Hutagaol Simarmar 0 0 22313 121201 Balige Hutagaol 0206030101 Puskesmas 0
Balige

83 12120114091000011212016407770002Erika Mesraida Tampubolon I Sibolahotang 24-07-1977 2 1 Sosor Dolok 0 0 22313 121201 Balige Hutagaol 0206030101 Puskesmas 0
Balige

84 12120149103800011212015512710001Bertua Hutagaol P Sosor Dolok 15-12-1971 1 1 Sosor Dolok 0 0 22313 121201 Balige Hutagaol 0206030101 Puskesmas 0
Balige
85 12120126091200021212016502560065Sanur Simatupang I Sosor Dolok 25-02-1956 2 1 Sosor Dolok 0 0 22313 121201 Balige Hutagaol 0206030101 Puskesmas 0
Balige

86 12120165025600651212011207930012Hendra Hutagaol A Sosor Dolok 12-07-1993 1 2 Sosor Dolok 0 0 22313 121201 Balige Hutagaol 0206030101 Puskesmas 0
Balige

87 12120115037500041212011503750004Rudi Hutagaol P Medan 15-03-1975 1 1 Sosor Dolok 0 0 22313 121201 Balige Hutagaol 0206030101 Puskesmas 0
Balige

88 12120115037500041212014109770008Erisda Marbun P Sosor Dolok 01-09-1977 1 1 Sosor Dolok 0 0 22313 121201 Balige Hutagaol 0206030101 Puskesmas 0
Balige

89 12120115037500041212012201011000Roy Dandi Hutagaol A Jakarta 22-01-2001 1 2 Sosor Dolok 0 0 22313 121201 Balige Hutagaol 0206030101 Puskesmas 0
Balige

90 12120114110008 1212014507750002Elida Marisi Hutagaol I Sosor Dolok 05-07-1957 2 1 Sosor Dolok 0 0 22313 121201 Balige Hutagaol 0206030101 Puskesmas 0
Balige

91 12120128101400021212016704700002Nursalam Hutagaol A Sosor Dolok 27-04-1970 2 2 Sosor Dolok 0 0 22313 121201 Balige Hutagaol 0206030101 Puskesmas 0
Balige

92 12120121100900041212011510680001Renson H. Nababan P Balige 15-10-1968 1 1 Jln. Gereja 0 0 22313 121201 Balige Balige III 0206030101 Puskesmas 0
Balige

93 12120121100900041212016307650003Gokmauli Siahaan I P. Siantar 23-07-1965 2 1 Jln. Gereja 0 0 22313 121201 Balige Balige III 0206030101 Puskesmas 0
Balige

94 12120117111100041212010204850003Miduk Simanjuntak P HT. Ginjang 02-04-1985 1 1 Jln. Jambu 0 0 22313 121201 Balige Balige III 0206030101 Puskesmas 0
Balige

95 12120117111100041212014910740003Lenny Siregar I Balige 09-10-1974 2 1 Jln. Jambu 0 0 22313 121201 Balige Balige III 0206030101 Puskesmas 0
Balige

96 12120125071100081212011204680002Toni H.Marpaung P Balige 06-04-1968 1 1 Jln. S. Debata 0 0 22313 121201 Balige Balige III 0206030101 Puskesmas 0
Balige

97 12120225071100081212015803040004Devina Marpaung A Balige 18-08-2004 2 2 Jln. S. Debata 0 0 22313 121201 Balige Balige III 0206030101 Puskesmas 0
Balige

98 12120125071100081212016304010004Winny Marpaung A Balige 23-04-2001 2 2 Jln. S. Debata 0 0 22313 121201 Balige Balige III 0206030101 Puskesmas 0
Balige
99 12120125071100081212011520772000Tiurna Manullang I Pakkat 15-10-1970 2 1 Jln.S.Debata 0 0 22313 121201 Balige Balige III 0206030101 Puskesmas 0
Balige

100 12120117111100041212012707020002Samuel Mangaratua A Balige 27-03-2003 1 2 Jln. Jambu 0 0 22313 121201 Balige Balige III 0206030101 Puskesmas 0
Balige

101 12120105011000061212010106680001Ronald Saragih P Balige 01-06-1968 1 1 Lbn. Saragi 0 0 22313 121201 Balige Balige III 0206030101 Puskesmas 0
Balige

102 12120105011000061212016212700004Roni Manullang I Balige 12-12-1970 2 1 Lbn. Saragi 0 0 22313 121201 Balige Balige III 0206030101 Puskesmas 0
Balige

103 12120105011000061212012105960001Togam Saragi A Balige 21-05-1996 1 2 Lbn. Saragih 0 0 22313 121201 Balige Balige III 0206030101 Puskesmas 0
Balige

104 12120126081100011212010411750001Horas Tambunan P Balige 04-11-1975 1 1 Jl. Jambu 0 0 22313 121201 Balige Balige III 0206030101 Puskesmas 0
Balige

105 12120126081100011212015606750001Christiana Sitompul I P. Sidempuan 16-06-1975 2 1 Jl. Jambu 0 0 22313 121201 Balige Balige III 0206030101 Puskesmas 0
Balige

106 12120163073600631212016307360063Timoria Tambunan I Tambunan 23-07-1936 2 1 Lbn. Pea 0 0 22313 121201 Balige Lbn. Pea 0206030101 Puskesmas 0
Balige

107 1271092712060003121201060750010 Kasianus Tambunan P Tambunan 08-07-1950 1 1 Lbn. Pea 0 0 22313 121201 Balige Lbn. Pea 0206030101 Puskesmas 0
Balige

108 12120104081000101212014901750001Mastiur Aritonang I Balige 09-05-1975 2 1 Lbn. Pea 0 0 22313 121201 Balige Lbn. Pea 0206030101 Puskesmas 0
Balige

109 12120120100800021212015611670003Sonti Manullang I Pakkat 16-11-1967 2 1 Lbn. Pea 0 0 22313 121201 Balige Lbn. Pea 0206030101 Puskesmas 0
Balige

110 12120117130003 1212011562800002Indra N. Tambunan P Tambunan 15-02-1980 1 1 Lbn. Pea 0 0 22313 121201 Balige Lbn. Pea 0206030101 Puskesmas 0
Balige

111 12120122120900021212016011560001Magdalena Sitohang I Lampinan 10-11-1956 2 1 Lbn. Pea 0 0 22313 121201 Balige Lbn. Pea 0206030101 Puskesmas 0
Balige

112 212011211120003 1212015703760003Rugun Panjaitan I Tambunan 17-03-1976 2 2 Lbn. Pea 0 0 22313 121201 Balige Lbn. Pea 0206030101 Puskesmas 0
Balige

113 12120125051000011212016705570005Magdalena Hutagaol I Medan 27-05-1957 2 1 Lbn. Pea 0 0 22313 121201 Balige Lbn. Pea 0206030101 Puskesmas 0
Balige
114 Sondang Nababan 0 0 22313 121201 Balige Lbn. Pea 0206030101 Puskesmas 0
Balige

115 12120124051000101212016506610062Sorta Tambunan I Medan 25-06-1961 2 1 Lbn. Pea Timur 0 0 22313 121201 Balige Lbn. Pea Timur 0206030101 Puskesmas 0
Balige

116 12120114025700141212010804990008Oloan Tambunan A Tambunan 08-04-1999 1 2 Lbn. Pea Timur 0 0 22313 121201 Balige Lbn. Pea Timur 0206030101 Puskesmas 0
Balige

117 12120114025700141212017112640001Rosmani Manurung I Lbn. Julu 31-12-1964 2 1 Lbn. Pea Timur 0 0 22313 121201 Balige Lbn. Pea Timur 0206030101 Puskesmas 0
Balige

118 12120108051000061212014608020002Lisdayanti Emelia Manullang A Tambunan 06-08-2002 2 2 Lbn. Pea Timur 0 0 22313 121201 Balige Lbn. Pea Timur 0206030101 Puskesmas 0
Balige

119 12120110100800031212016510560001Rumintang Sitorus P Tiga dolok 25-10-1958 2 3 Lbn. Pea Timur 0 0 22313 121201 Balige Lbn. Pea Timur 0206030101 Puskesmas 0
Balige

120 12120119020900051212012003440001Hisar Tambunan P Tambunan 20-03-1944 1 1 Lbn. Pea Timur 0 0 22313 121201 Balige Lbn. Pea Timur 0206030101 Puskesmas 0
Balige

121 12121126020800451212010805630003Bakti Tampubolon P Janjimaria 01-05-1963 1 1 Saribu Raja 0 0 22313 121201 Balige Janjimaria 0206030101 Puskesmas 0
Balige

122 12120107091000081212016801680002Lisbet R Tampubolon I Balige 28-01-1968 2 1 Saribu Raja 0 0 22313 121201 Balige Janjimaria 0206030101 Puskesmas 0
Balige

123 121201602080004 1212015111540051Resianna Tampubolon I Balige 14-04-1981 2 1 Sariburaja 0 0 22313 121201 Balige Janjimaria 0206030101 Puskesmas 0
Balige

124 12120113071000011212014701850006Justan Simanjuntak S Balige 18-08-1945 1 1 Saribu Raja 0 0 22313 121201 Balige Janjimaria 0206030101 Puskesmas 0
Balige

125 12120119020801311212016001640080Ria Sihombing I L. Nihuta 20-01-1964 2 1 Saribu Raja 0 0 22313 121201 Balige Janjimaria 0206030101 Puskesmas 0
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126 12120108121100061212016611830004Lisnawaty Tambunan I Balige 26-11-1983 2 1 Saribu Raja 0 0 22313 121201 Balige Janjimaria 0206030101 Puskesmas 0
Balige

127 12120122050900011212012412550001Dumangar Tampubolon P Lbn. Atas 24-12-1955 1 1 Saribu Raja 0 0 22313 121201 Balige Janjimaria 0206030101 Puskesmas 0
Balige

128 12120108121100061212014209110001Diansyah Fitri A Balige 21-06-2006 2 2 Saribu Raja 0 0 22313 121201 Balige Janjimaria 0206030101 Puskesmas 0
Balige
129 12120119020800871212011206380001Eleteria Tampubolon P Balige 12-06-1938 2 3 Saribu Raja 0 0 22313 121201 Balige Janjimaria 0206030101 Puskesmas 0
Balige

130 12120114111100031212011509800000Linggom Pardede P Balige 15-09-1980 1 1 P. Onan 0 0 22313 121201 Balige P. Onan 0206030101 Puskesmas 0
Balige

131 12120122031000031212010612970004Rio Siahaan A Balige 06-12-1997 1 2 Jln. Sianipar 0 0 22313 121201 Balige P. Onan 0206030101 Puskesmas 0
Balige

132 12120102021100101212016808500001Togi br. Tamba I Tamba 23-08-1950 2 2 Lbn. Ginabean 0 0 22313 121201 Balige P. Onan 0206030101 Puskesmas 0
Balige

133 3901036KK2006 1212016810370002Herlina Aritonang I Balige 28-10-1937 2 1 Lbn. Sianipar 0 0 22313 121201 Balige P. Onan 0206030101 Puskesmas 0
Balige

134 12120114111100031212014107080001Gracie Pardede A Balige 07-01-2008 2 2 P. Onan 0 0 22313 121201 Balige P. Onan 0206030101 Puskesmas 0
Balige

135 121201210610000412120131240002 T. Saulus Simanjuntak P Sigumpar Julu 31-12-1940 1 1 P.Onan 0 0 22313 121201 Balige P.Onan 0206030101 Puskesmas 0
Balige

136 12120113101000061212012804810002Ingot Sitohang P Sumbul Tengah 28-04-1981 1 1 P.Onan 0 0 22313 121201 Balige P.Onan 0206030101 Puskesmas 0
Balige

137 12120114111100031212010159088200Mariani Aritonang I Belawan 19-08-1982 2 1 P.Onan 0 0 22313 121201 Balige P.Onan 0206030101 Puskesmas 0
Balige

138 12120102121000071212011801850004Jeprin Gultom A Balige 18-01-1985 1 2 P.Onan 0 0 22313 121201 Balige P.Onan 0206030101 Puskesmas 0
Balige

139 12120113101000061212010303110001Daniel Sitohang A Balige 03-03-2011 1 2 P.Onan 0 0 22313 121201 Balige P.Onan 0206030101 Puskesmas 0
Balige

140 12120116041200011212015404940001Mariani Pardede A Balige 14-04-1994 2 2 P.Onan 0 0 22313 121201 Balige P.Onan 0206030101 Puskesmas 0
Balige

141 12120116041200011212015810010001Arta Pardede A Balige 18-10-2001 2 2 P.Onan 0 0 22313 121201 Balige P.Onan 0206030101 Puskesmas 0
Balige

142 12120120041000141212014203510002Repina Siahaan I P. Bandar 02-03-1951 2 1 Nagatimbul 0 0 22313 121201 Balige P. Onan 0206030101 Puskesmas 0
Balige
143 121204304710013 1212115707744001Siaida Silaen I Lumban Gaol 17-09-1974 2 2 R.T Buhit 0 0 22313 121201 Balige P. Onan 0206030101 Puskesmas 0
Balige

144 12120111066200011212015012530003Magdalena Sianipar I Kisaran 10-121953 2 2 Siliwangi 0 0 22313 121201 Balige P. Onan 0206030101 Puskesmas 0
Balige

145 12120119081000071212015210620003Anita Pardede P Balige 12-10-1962 2 3 P. Onan 0 0 22313 121201 Balige P.Onan 0206030101 Puskesmas 0
Balige

146 12120108020802851212015911690001Sonty Nasrina Pasaribu I Medan 19-11-1969 2 1 Sosor Gurgur 0 0 22313 121201 Balige P. Onan 0206030101 Puskesmas 0
Balige

147 12120108020802851212015911010001Elsa Nova Sitinjak A Medan 19-11-2001 2 2 Sosor Gurgur 0 0 22313 121201 Balige P. Onan 0206030101 Puskesmas 0
Balige

148 Lambok Barimbing 0 0 22313 121201 Balige P. Onan 0206030101 Puskesmas 0

Balige

149 12120122120900021212011503720003Prancis Siahaan P Sidamanik 15-03-1972 1 1 Lbn. Bulbul 0 0 22313 121201 Balige Lbn. Bulbul 0206030101 Puskesmas 0
Balige

150 12120122129900021212014506720000Juni Rina Pardede I Parsikkaman 05-06-1972 2 1 Lbn. Bulbul 0 0 22313 121201 Balige Lbn. Bulbul 0206030101 Puskesmas 0
Balige

151 12120117120800051212011206030004Vander Siahaan A Lbn. Bulbul 11-06-2003 1 2 Lbn. Bulbul 0 0 22313 121201 Balige Lbn. Bulbul 0206030101 Puskesmas 0
Balige

152 12120122120900021212012512060003Natal Siahaan A Lbn. Bulbul 25-12-2006 1 2 Lbn. Bulbul 0 0 22313 121201 Balige Lbn. Bulbul 0206030101 Puskesmas 0
Balige

153 12120125120600031212091901660001Hotman Simangunsong S Balige 19-01-1966 1 1 Lbn. Bulbul 0 0 22313 121201 Balige Lbn. Bulbul 0206030101 Puskesmas 0
Balige

154 12710927120600031212094506780001Rut Yana Hutagaol I Bekasi 05-06-1978 2 1 Lbn. Bulbul 0 0 22313 121201 Balige Lbn. Bulbul 0206030101 Puskesmas 0
Balige

155 12120113021400021212010406520001Oloan rumintang P Lbn. Gorat 04-06-1952 1 1 Lbn. Gorat 0 0 22313 121201 Balige Lbn. Gorat 0206030101 Puskesmas 0
Balige

156 12120114070900101212015908470002Tiurlan Simanjuntak I Parsuratan 19-08-1947 2 1 Lbn. Gorat 0 0 22313 121201 Balige Lbn. Gorat 0206030101 Puskesmas 0
Balige

157 12120113061100031212012706740003Lamhot Siahaan P Lbn. Gorat 27-06-1974 1 1 Lbn. Gorat 0 0 22313 121201 Balige Lbn. Gorat 0206030101 Puskesmas 0
Balige

158 12120113061100031212014303490002Senti Aritonang I P. Siantar 07-03-1996 2 1 Lbn. Gorat 0 0 22313 121201 Balige Lbn. Gorat 0206030101 Puskesmas 0
Balige
159 1212013101080023121201410160003 Yannur Siahaan I Lbn. Gorat 01-01-1960 2 1 Lbn. Gorat 0 0 22313 121201 Balige Lbn. Gorat 0206030101 Puskesmas 0
Balige

160 1212011302080326121201611070003 Melati Marpaung A Balige 27-11-2007 2 2 Matio 0 0 22313 121201 Balige Matio 0206030101 Puskesmas 0
Balige

161 121201054080002 1212010166105700Rusmi Siagian I Sihobuk 26-10-1957 2 1 Matio 0 0 22313 121201 Balige Matio 0206030101 Puskesmas 0
Balige

162 12120109010900081212015801840000Andina Panjaitan I Matio 18-01-1994 2 1 Matio 0 0 22313 121201 Balige Matio 0206030101 Puskesmas 0
Balige

163 1212012609130003121201150249002 Jausmin Panjaitan P Matio 27-02-1949 1 1 Matio 0 0 22313 121201 Balige Matio 0206030101 Puskesmas 0
Balige

164 12120117125500241212015508560001Rita Tambunan I Baruara 15-08-1956 2 1 Matio 0 0 22313 121201 Balige Matio 0206030101 Puskesmas 0
Balige

165 1212011511110004121201230875002 Hendri P. Hutagaol P Balige 23-08-1975 1 1 Mejan 0 0 22313 121201 Balige Hutabulu Mejan 0206030101 Puskesmas 0
Balige

166 12120115028000151212015008520002Roida Hutagaol I Hutagaol 10-08-1952 2 1 Mejan 0 0 22313 121201 Balige Hutabulu Mejan 0206030101 Puskesmas 0
Balige

167 12120115063700151212011506370015Dompak Tambunan P Mejan 15-06-1937 1 1 Mejan 0 0 22313 121201 Balige Hutabulu Mejan 0206030101 Puskesmas 0
Balige

168 12120120020801981212010406070001Bastanta Siagian A Mejan 04-06-2007 ? 2 Mejan 0 0 22313 121201 Balige Hutabulu Mejan 0206030101 Puskesmas 0
Balige

169 12120120046200201212012004620020Bona Parte Hutagaol P Mejan 20-04-1962 1 1 Mejan 0 0 22313 121201 Balige Hutabulu Mejan 0206030101 Puskesmas 0
Balige

170 12120120020801141212012002080114Norma Sinambela I Narumonda 11-03-1942 2 1 Mejan 0 0 22313 121201 Balige Hutabulu Mejan 0206030101 Puskesmas 0
Balige

171 12120130091000021212015408580002Rukini Tampubolon P Pardagangan 14-08-1958 2 3 Paindoan 0 0 22313 121201 Balige Paindoan 0206030101 Puskesmas 0
Balige

172 12120108095000081212016802320002Tamaria Hutahean I Pardagangan 28-02-1938 2 1 Paindoan 0 0 22313 121201 Balige Paindoan 0206030101 Puskesmas 0
Balige
173 12120128061000101212010608500001Sunggul Siahaan P Paindoan 08-06-1950 1 1 Paindoan 0 0 22313 121201 Balige Paindoan 0206030101 Puskesmas 0
Balige

174 121201120800005 1212016410660001Suryani Guci I Balige 24-10-1966 2 1 Paindoan 0 0 22313 121201 Balige Paindoan 0206030101 Puskesmas 0
Balige

175 12120125081000031212015010550001Erminia Napitupulu I Doloksanggul 10-10-1955 2 1 Paindoan 0 0 22313 121201 Balige Paindoan 0206030101 Puskesmas 0
Balige

176 12120113070900041212010412550003Volmer Siahaan P Paindoan 04-12-1955 1 1 Paindoan 0 0 22313 121201 Balige Paindoan 0206030101 Puskesmas 0
Balige

177 12120128070900131212010505600001Jaiman Tampubolon P Pandumayu 05-05-1960 1 1 Paindoan 0 0 22313 121201 Balige Paindoan 0206030101 Puskesmas 0
Balige

178 12120128070900131212015506620001Pariama Simanjuntak I Onan Sampang 15-06-1962 2 1 Paindoan 0 0 22313 121201 Balige Paindoan 0206030101 Puskesmas 0
Balige

179 12120115060900011212015202590001Rolli Pasaribu I Parsoburan 12-02-1959 2 1 Paindoan 0 0 22313 121201 Balige Paindoan 0206030101 Puskesmas 0
Balige

180 12120127010900051212012208110013Semma Wati I Balige 25-11-1964 2 1 Parsuratan 0 0 22313 121201 Balige Parsuratan 0206030101 Puskesmas 0
Balige

181 12120122008110011212013101990001Marihot Simanjuntak A Parsuratan 31-01-1999 1 2 Parsuratan 0 0 22313 121201 Balige Parsuratan 0206030101 Puskesmas 0
Balige

182 12120128070900181212011607630000Togar Simanjuntak I Negeri Lama 16-07-1963 2 1 Parsuratan 0 0 22313 121201 Balige Parsuratan 0206030101 Puskesmas 0
Balige

183 12120128070900281212016907030001Julik Simanjuntak A Hutagaol 31-01-2000 2 2 Parsuratan 0 0 22313 121201 Balige Parsuratan 0206030101 Puskesmas 0
Balige

184 12120128070900181212011606110011Porman Simanjuntak I Laguboti 11-03-1979 2 1 Parsuratan 0 0 22313 121201 Balige Parsuratan 0206030101 Puskesmas 0
Balige

185 121204602110011 1212011304710013Tiolida Sihombing I Kota cane 26-08-1974 2 1 Parsuratan 0 0 22313 121201 Balige Parsuratan 0206030101 Puskesmas 0
Balige

186 12120104031100081212015712430003Rena Sinaga P Bah Jambi 17-12-1943 2 3 Parsuratan 0 0 22313 121201 Balige Parsuratan 0206030101 Puskesmas 0
Balige
187 12120106120700541212013112470002Joyakin Simanjuntak P Parsuratan 31-12-1947 1 4 Parsuratan 0 0 22313 121201 Balige Parsuratan 0206030101 Puskesmas 0
Balige

188 12120102111000021212014607820002Dorta Sihite I Hutaginjang 06-07-1982 2 1 Parsuratan 0 0 22313 121201 Balige Parsuratan 0206030101 Puskesmas 0
Balige

189 12120129111300021212013009510003Harungguan Siahaan P Balige 30-09-1951 1 1 Sibolahotang SAS 0 0 22313 121201 Balige Sibolahotang SAS 0206030101 Puskesmas 0
Balige

190 12120122120900161212010511690001Pahotan Tanpubolon P Balige 05-11-1969 1 1 Sibolahotang SAS 0 0 22313 121201 Balige Sibolahotang SAS 0206030101 Puskesmas 0
Balige

191 12120111212070061212012501750003Tangkas P. Tampubolon P Sibulele 25-01-1975 1 1 Sibolahotang SAS 0 0 22313 121201 Balige Sibolahotang SAS 0206030101 Puskesmas 0
Balige

192 12120111109120001212012211660002Joni Aritonang P Aritonang 22-12-1966 1 1 Sibolahotang SAS 0 0 22313 121201 Balige Sibolahotang SAS 0206030101 Puskesmas 0
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193 Timbul E Larosa 0 0 22313 121201 Balige Sibolahotang SAS 0206030101 Puskesmas 0
Balige

194 12120117101100161212015504930003Nurcahaya Butar-Butar I Tampubolon 15-04-1993 2 1 Sibolahotang SAS 0 0 22313 121201 Balige Sibolahotang SAS 0206030101 Puskesmas 0
Balige

195 1212010705090002121201120242001 Kasima Siahaan P Siboruon 12-02-1942 1 1 Siboruan 0 0 22313 121201 Balige Siboruan 0206030101 Puskesmas 0
Balige

196 - 1212012509470025Tohap Simanjuntak P Sihatandokan 25-09-1947 1 4 Siboruon 0 0 22313 121201 Balige Siboruan 0206030101 Puskesmas 0
Balige

197 263110145/TU79 1212015111540051Eleria Simanjuntak I Parapat 23-06-1950 2 1 Siboruon 0 0 22313 121201 Balige Siboruan 0206030101 Puskesmas 0
Balige

198 12120113105100131212014701850006Trina Siahaan I Siboruon 07-01-1985 2 1 Siboruon 0 0 22313 121201 Balige Siboruan 0206030101 Puskesmas 0
Balige

199 12120127031300011212015205310001Rimmy T Hutagalung I Sibaruan 12-05-2013 2 1 Siboruan 0 0 22313 121201 Balige Siboruan 0206030101 Puskesmas 0
Balige

200 12120127031300011212010703820003Risman Hutagalung A Sibuntuon 07-03-1982 1 2 Siboruan 0 0 22313 121201 Balige Siboruan 0206030101 Puskesmas 0
Balige

201 12120119101200011271183006820009Batara Sianturi P Simatupang 30-06-1982 1 1 Siboruon 0 0 22313 121201 Balige Siboruon 0206030101 Puskesmas 0
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202 12120119101200011212010306100004Marcel Sianturi A Medan 06-03-2010 1 2 Siboruon 0 0 22313 121201 Balige Siboruon 0206030101 Puskesmas 0
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203 12120119101200011212012805130001Rafael Sianturi A Balige 28-05-2013 1 2 Siboruon 0 0 22313 121201 Balige Siboruon 0206030101 Puskesmas 0
Balige

204 12120127030001 1212011912730002Larly Damanik I Siantar 27-02-1983 2 1 Sibuntuon 0 0 22313 121201 Balige Sibuntuon 0206030101 Puskesmas 0
Balige

Siborong -
205 12120110065300011212015507420002Tiurlan Silaban I 06-10-1942 2 1 Sibuntuon 0 0 22313 121201 Balige pp 0206030101 Puskesmas 0
borong Balige

206 12120155074200021212011006530003Julifer Siahaan I Sibuntuon 22-04-1942 2 1 Sibuntuon 0 0 22313 121201 Balige Sibuntuon 0206030101 Puskesmas 0
Balige

207 12120110065300031212016408400002Timoria Sirait I Tp. Bolon 24-08-1940 2 1 Sibuntuon 0 0 22313 121201 Balige Sibuntuon 0206030101 Puskesmas 0
Balige

208 12120164084000021212011106620001Gunawan Siahaan P Sibuntuon 11-06-1962 1 1 Sibuntuon 0 0 22313 121201 Balige Sibuntuon 0206030101 Puskesmas 0
Balige

209 12120428011400041202040404860004Marlan Siregar P Hutaraja 04-04-1986 1 1 Tambunan Sunge 0 0 22313 121201 Balige Tambunan Sunge 0206030101 Puskesmas 0
Balige

210 12120113020800121212014906690001Delima Parhusip I Samosir 09-06-1959 2 1 Tambunan Sunge 0 0 22313 121201 Balige Tambunan Sunge 0206030101 Puskesmas 0
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211 12120112111300021202014802900001Eni Nurcahaya Tobing A Tarutung 08-02-1990 2 2 Sianipar 0 0 22313 121201 Balige Balige II 0206030101 Puskesmas 0
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212 12020118070812191212011307060003Rehan Sianipar A Bange 13-07-2006 1 2 Sianipar Tangga 0 0 22313 121201 Balige Balige II 0206030101 Puskesmas 0
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213 12120127121100031212010910130001Parningotan Sinaga A Balige 27-12-2011 1 2 Sosor Tangga 0 0 22313 121201 Balige Balige II 0206030101 Puskesmas 0
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Siborong -
214 12120125051100011212011101480001Rumina Napitupulu I 11-11-1948 2 1 Umarihit 0 0 22313 121201 Balige Balige II 0206030101 Puskesmas 0
borong Balige

215 121201060309005 1212010810550001Belman Sinaga P Balige 08-10-1955 1 4 Balige II 0 0 22313 121201 Balige Balige II 0206030101 Puskesmas 0
Balige

216 12120107041100041212012708820002Royen Caprin Sianipar P Balige 27-08-1982 1 1 Balige II 0 0 22313 121201 Balige Balige II 0206030101 Puskesmas 0
Balige
217 12120107041100041212015807770002Sewantika Simanjuntak I Balige 18-07-1977 2 1 Balige II 0 0 22313 121201 Balige Balige II 0206030101 Puskesmas 0
Balige

218 12120115101200271212012711700003Pamindo Tambunan P Balige 27-11-1970 1 1 Balige II 0 0 22313 121201 Balige Balige II 0206030101 Puskesmas 0
Balige

219 12120115101200271212016609130001Tio Cristabel Tambunan A Balige II 26-09-2013 2 2 Balige II 0 0 22313 121201 Balige Balige II 0206030101 Puskesmas 0
Balige

220 12120122031000031212014709610001Sumiati P Tulang Agung 07-09-1961 2 3 L. Dolok H.Bange 0 0 22313 121201 Balige L. Dolok H.Bange 0206030101 Puskesmas 0
Balige

221 12120121070900071212012109520005Tamba Pardede P Balige 21-09-1952 1 1 L. Dolok H.Bange 0 0 22313 121201 Balige L. Dolok H.Bange 0206030101 Puskesmas 0
Balige

222 12120117121000081212015809870001Ipah Seperina I Jakarta 18-05-1975 2 1 L. Dolok H.Bange 0 0 22313 121201 Balige L. Dolok H.Bange 0206030101 Puskesmas 0
Balige

223 12120117021100091212015406890002Junita Siagian I Medan 14-06-1989 2 1 L. Dolok H.Bange 0 0 22313 121201 Balige L. Dolok H.Bange 0206030101 Puskesmas 0
Balige

224 12120117021100091212016604090001Naomi Pardede A Tangerang 26-04-2009 2 2 L. Dolok H.Bange 0 0 22313 121201 Balige L. Dolok H.Bange 0206030101 Puskesmas 0
Balige

225 12120110081100091212016103750001Sri Ajeng Rukmawati I Jakarta 21-03-1975 2 1 L. Dolok H.Bange 0 0 22313 121201 Balige L. Dolok H.Bange 0206030101 Puskesmas 0
Balige

226 12120107091000091212011610950002Juanda Pardede A Medan 10-10-1995 1 2 L. Dolok H.Bange 0 0 22313 121201 Balige L. Dolok H.Bange 0206030101 Puskesmas 0
Balige

227 12120110081100091212011905650019Johansen Pardede P Balige 16-05-1965 1 1 L. Dolok H.Bange 0 0 22313 121201 Balige L. Dolok H.Bange 0206030101 Puskesmas 0
Balige

228 12120119056500191212010704870001Adi Syah Putra A Balige 07-04-1967 1 2 L. Dolok H.Bange 0 0 22313 121201 Balige L. Dolok H.Bange 0206030101 Puskesmas 0
Balige

229 12120119050900411212011709560001Biyadi P P. Siantar 17-09-1956 1 1 L. Dolok H.Bange 0 0 22313 121201 Balige L. Dolok H.Bange 0206030101 Puskesmas 0
Balige

230 12120121121000011212015608690004Rita Tambunan I T. Jawa 16-08-1969 2 1 L. Dolok H.Bange 0 0 22313 121201 Balige L. Dolok H.Bange 0206030101 Puskesmas 0
Balige

231 Herikson Napitupulu 0 0 22313 121201 Balige L. Dolok H.Bange 0206030101 Puskesmas 0
Balige

232 Christian 0 0 22313 121201 Balige L. Dolok H.Bange 0206030101 Puskesmas 0

Balige
233 12120129111100071212015405890004Isabella Malau A Medan 14-05-1989 2 2 L. Dolok H.Bange 0 0 22313 121201 Balige L. Dolok H.Bange 0206030101 Puskesmas 0
Balige

234 12120117031000081212014606470002Tianna Hutahaean P Laguboti 06-06-1947 2 3 L. Dolok H.Bange 0 0 22313 121201 Balige L. Dolok H.Bange 0206030101 Puskesmas 0
Balige

235 12120116121000021212011808100002Thobias H Pardede A Balige 18-08-2010 1 2 L. Dolok H.Bange 0 0 22313 121201 Balige L. Dolok H.Bange 0206030101 Puskesmas 0
Balige

236 12120116121000021212017011830001Rita Dewi Sitanggang I Siantar 30-11-1983 2 1 L. Dolok H.Bange 0 0 22313 121201 Balige L. Dolok H.Bange 0206030101 Puskesmas 0
Balige

237 121201911110002 1212010510790004Maneak Tua T Siahaan P Balige 05-10-1979 1 1 Lbn. Silintong 0 0 22313 121201 Balige Lbn. Silintong 0206030101 Puskesmas 0
Balige

238 121201911110002 1212014411570001Saurlina Siallagan I Kamp. Jagung 04-11-1957 2 1 Lbn. Silintong 0 0 22313 121201 Balige Lbn. Silintong 0206030101 Puskesmas 0
Balige

239 12120126091100111212012803700003Bulungan Pandiangan P Lbn. Bulbul 28-03-1970 1 1 Lbn. Bulbul 0 0 22313 121201 Balige Lbn. Bulbul 0206030101 Puskesmas 0
Balige

240 12120126091100111212016601690001Tiurlan Hutajulu I Lbn. Bulbul 26-01-1969 2 1 Lbn. Bulbul 0 0 22313 121201 Balige Lbn. Bulbul 0206030101 Puskesmas 0
Balige

241 12120126091100111212010804000004Dimas Doni Pandiangan A Lbn. Bulbul 08-04-2000 1 2 Lbn. Bulbul 0 0 22313 121201 Balige Lbn. Bulbul 0206030101 Puskesmas 0
Balige

242 12120126091100111212014301070006Ratu Celsia Pandiangan A Lbn. Bulbul 03-01-2007 2 2 Lbn. Bulbul 0 0 22313 121201 Balige Lbn. Bulbul 0206030101 Puskesmas 0
Balige

243 12120113101000011212011608520003Sahat Panjaitan P Matio 16-08-1952 1 1 Matio 0 0 22313 121201 Balige Matio 0206030101 Puskesmas 0
Balige

244 12120119111100041212010703720004Riduan Panjaitan P Matio 03-07-1972 1 1 Matio 0 0 22313 121201 Balige Matio 0206030101 Puskesmas 0
Balige

245 12120119111100041212014611830003Ellen Ridawati Doloksaribu I Sibuntuon 11-06-1983 2 1 Matio 0 0 22313 121201 Balige Matio 0206030101 Puskesmas 0
Balige

Puskesmas
246 12120109051200031272011208680002Parluhutan Simanjuntak P Hutadame 08-12-1968 1 1 Hutadame 0 0 22313 121201 Balige Hutadame 0206030101 Balige 0
247 12120109051200031272015201810004Riris Maita Elidaniar Sianturi I Kisaran 01-12-1981 2 1 Hutadame 0 0 22313 121201 Balige Hutadame 0206030101 Puskesmas 0
Balige

248 12120109051200031272012712100001Dion Wahyu Simanjuntak A P. Siantar 27-12-2010 1 2 Hutadame 0 0 22313 121201 Balige Hutadame 0206030101 Puskesmas 0
Balige

249 12120119101000051212010112630002Ronald Siahaan P Paindoan 12-01-1963 1 1 Paindoan 0 0 22313 121201 Balige Paindoan 0206030101 Puskesmas 0
Balige

250 12120119101000051212014211680002Rosinta Simanjuntak I Peatalun 11-02-1968 2 1 Paindoan 0 0 22313 121201 Balige Paindoan 0206030101 Puskesmas 0
Balige

Dumaria Siahaan
Dapot Sianipar
Morita Hutagaol
Mangantar Tambunan
Marince Tampubolon
Merdeka Tambunan
 Lampiran Keputusan Bupati/Walikota
Nomor :
Tanggal:

Negaraan
Kewarga
Nama Faskes Dokter Gigi

Asuran
Kelas si

Gapok / Pensiunan
Status
Rawat
Nomor Telepon

Lainny

Keterangan
No Passport
No. NPWP
TMT Kerja
a
Jabatan
Email
NPP

1=Kelas
1=Tetap,

Nama Asuransi
I,
1=WNI,
2=WNA
2=Kontra

No. Polis
2=Kelas
k,
II,
3=Paruh
3=Kelas
waktu
III
21 22232425 26 27 28 29 30 31 32 33 34 35

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu
blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu
blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu
Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu
Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu
Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu
Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu
Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu
Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu
Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu
Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu
Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu
Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu
Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu
 Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu
Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu
Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu
Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu
 Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu
Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu
Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu
Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu
Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu
Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu
Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu
Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu
 Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu
Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu
Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu
Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu
 Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu
Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu
Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu
Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0

Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu
Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu
Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu
Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu
Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu
Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu
Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu
Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu
 Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu
Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu
Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu
Blm
Poli Gigi 0 0 0 0 1 3 0 0 1 0 0 0 0 punya
kartu