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SASARAN ORI CAMPAK UPT PUSKESMAS KALIANGET

TAHUN 2016
DESA : MARENGAN LAOK
DUSUN : MASJID / RT 001 RW 04

LAHIR UMUR STATUS IMUNISASI


NO NAMA ANAK NAMA ORANG TUA KETERANGAN
( Tgl, Bln, Thn ) (Thn, Bln) Sudah ( Tgl, Bln, Thn ) Belum
1 MOH. ALI MAKIK SUDARMO - SURAYA 19/06/2001 15
2 PUTRI AYU AZHARI SUDARMO - SURAYA 19/01/2004 12
3 MUH. FATI FARHAT SULIMAN - SUNARTI 16/07/2003 13
4 MUHAMMAD RISAL MAULANA SALAMET HARIYADI - KAHIRIYAH 26/10/2003 13
5 ACHMAD FATHIRURRAHMAN ABD. RAHMAN - SUZANA 25/11/2007 9
6 FAHRI KHAIRUL ANAM EDI SUMANTRI - SILVA YUNI ASTUTIK 30/06/2009 7
7 FAQIH AINUR RAHMAN EDI SUMANTRI - SILVA YUNI ASTUTIK 28/12/2005 10
8 FATIN AQILA NURHASANAH EDI SUMANTRI - SILVA YUNI ASTUTIK 12/11/2014 2
9 MOH. RIZKI ANDIKA ACHMAD - SUBAIDAH 08/12/2004 12
10 ABU RIZAL BAKRIE SYAMSURIYADI - ANITA PRATIWI PUTRI 22-10-14 2
11 AHMAD MUSYFIKUL KHOIR MOH. GAMAR - SAATIK 12/12/2014 2
12 NURFITRIA RAMADHANI SUTRISNO - RAHMANI 22/10/2005 11
13 SUHADIYAH SAHIRUDIN - MARDIYAH 28/07/2004 12
14 ACHMAD BUSRO SAHIRUDIN - MARDIYAH 14/09/2001 15
15 DWI AJENG AMATILLAH SUPANTONO - SRI DEWI FATHONIA 21/04/2010 6
16 MOH. ADIMAS SUPANTONO SUPANTONO - SRI DEWI FATHONIA 24/01/2004 12
17 AHMAD RAYIS 'ABDILLAH SUPANTONO - SRI DEWI FATHONIA 12/12/2014 2
18 ZASKIA TALITA SAKHI RAMADHANI AGUS JUNAIDI - NURUL LAILA HAFANA 21/07/2013 3
19 EKA PRATIWI HOSNI - BAHRATI 02/03/2010 6
20 VARELINO ARLONSI N NURYANI - ENDANG NORIYANI 28/03/2010 6
21 DHAFA FEBRIYAN WIRANATA MASDURI - ERMAWATI 12/02/2002 14
22 KHOIRUN NISA' SARIF EFENDI - MELISA 11/06/2004 12
23 NUSAIBA MUHARIKA NARYO - NUR RASIDA 26/09/2003 13
24 NOVIANA LAILI PUTRI RAMDIYANI SULAIMAN - DIANA FEBRI TRISNAWATI 10/11/2003 13
25 ADITYA DWI MAULANA RAHMAN SULAIMAN - DIANA FEBRI TRISNAWATI 01/04/2007 9
26 AULIA KINANTI FAJARINA JOHARIYANTO - MARINA SYA'BANI 26/11/2009 7
27 ARIA HASANUDIN JOHARIYANTO - MARINA SYA'BANI 25/05/2006 10
28 HARIYAWAN ARI SANTOSO EDI HARIYANTO - NUR HALIFAH 11/02/2007 9
29 TAFFY NURFISABILLA FITRIAHARI EDI HARIYANTO - NUR HALIFAH 30/08/2010 6
30 AHMAD SURYA KAMIL SURYADI - SURYANI 29/04/2012 4
31 PUTRA NABILA ASOBRI JUHARI - SURYANI 23/05/2005 11
32 NURUL QOLBI JUHARI - SURYANI 02/08/2009 7
33 VEMAS ALFINSYAH PRATAMA PUTRA MOHAMMAD HOSNI - NOFITA WAHYUNI 24/08/2013 3
34 MOH. NISAM MAULANA SUGIONO - FARADILLAH SANTI 23/02/2012 4
35 BIMA MAULANA SAKTI SUGIONO - FARADILLAH SANTI 11/01/2008 8
36 AIRA SUFI ROMADHANI SURYADI - RANI FITRIANA 03/08/2010 6
37 LUTFIAH YULIANA ALI YANTO - FAUSIYAH 28/06/2006 10
38 AHMAD HAMDANI PRADANA AGUS - IRFANI FAJRIANI 24/08/2008 8
39 FITRI NOVITA SARI SAMSUL ADI - IRFANI 06/08/2014 2
40 ROFIQ FUADI ISMAIL - HERLINA IRIYANI 10/11/2003 13
41 KAMAL SUBHI ISMAIL - HERLINA IRIYANI 26/05/2009 7
42 PUTRI VANANDA REGANATA SUGIONO - DEWI SUMRATI 20/06/2006 10
43 SYEILA ANGGRAINI PUTRI SUGIONO - DEWI SUMRATI 20/12/2006 9
44 AHMAD ZAINUR FAHRI SUHARTONO - TITIK NOVIATI 22/02/2010 6
45 SRI HARTATIK ULVATUL ULYA SUHARTONO - TITIK NOVIATI 06/05/2005 11
46 MARIYATUL QIBTIYAH CATUR RIYANTO - SRI SUHARYATI 07/06/2004 12
47 FIRMAN WAHYUDA UNANG FAUZI - SULASTRI 09/02/2006 10
48 HABIBUR RAHMAN MAT SIRI - HATIJAH 10/11/2008 8
49 DESWITA MILA KURNIA MAT SIRI - HATIJAH 26/12/2002 13
50 FAIRUS FIRDAUS MOH. TABRANI - HALIDAH 03/09/2005 11
51 MOH. FIRMANSYAH MOH. TABRANI - HALIDAH 05/03/2007 9
52 MOH. FARHAN MOH. TABRANI - HALIDAH 11/08/2002 14
53 HAIRUL ANWAR SABARUDIN - MARWIYAH 10/12/2007 9
54 LAILATUL HASANAH SABARUDIN - MARWIYAH 29/12/2005 10
55 RIDO MAULANA SUTRISNO HADY - INDRIYANI 30/11/2011 5
56 NUR ACHMAD ASHARI SUTRISNO HADY - INDRIYANI 22/08/2002 14
57 RIYAN SUBHAN AKBAR SUTRISNO HADY - INDRIYANI 07/03/2003 13
58 AS SYIFA NUR ZAHIRA MOH. NAWAWI - NUR AISYAH 08/11/2011 5
59 MOH. KAFI ZAKIAMANI MOH. NAWAWI - NUR AISYAH 12/08/2003 13
60 NABILA NUR LAILI MOH. NAWAWI - NUR AISYAH 19/04/2006 10
61 NAYLATUL KAMILAH AKH. IKSAN - MISNATI 02/01/2007 9
62
63
64
65
66
67
68
69
70
71

PENANGGUNG JAWAB DESA

.......................................................................
SASARAN ORI CAMPAK UPT PUSKESMAS KALIANGET
TAHUN 2016
DESA : MARENGAN LAOK
DUSUN : MASJID / RT 002 RW 04

LAHIR UMUR STATUS IMUNISASI


NO NAMA ANAK NAMA ORANG TUA KETERANGAN
( Tgl, Bln, Thn ) (Thn, Bln) Sudah ( Tgl, Bln, Thn ) Belum
1 MOH. FAHRUL BASRI HASAN BASRI - NASAROH 01/05/2003 13
2 NAYSILA NUR HASANAH HASAN BASRI - NASAROH 09/08/2010 6
3 TAUFIKURRAHMAN MOH. TAHIR - TIYANI 31/07/2009 7
4 TUTI YULISTIYAWATI H. SAWAWI IMRON - TITIK APRIYANI 01/06/2003 13
5 FEBRI ARDIANSYAH JUNAIDI - SITI RAHMA 27/02/2003 13
6 MOH.WIRA MARTIN AWALUDDIN JUNAIDI - SITI RAHMA 21/03/2008 8
7 MEISYA CAHYA ROSALINA MUHAMMAD SALEH - DARMA YANTI 22/05/2002 14
8 MOH. RAFAEL INDRAJANA SUHARIYANTO - LILIK YULISTIYANI 23/06/2014 2
9 ANDIKA RAMADHANA SAIFUL ZAIFUL ANAM, S. PD.I - ATIKA, A.MD. KEB 16/08/2011 5
10 SELFIATUL MUKARROMA ATRISHA MOH. SALEH - SULASTRI 03/06/2012 4
11 SAHIRAH DZAKIRAH SALSABILA MOHAMMAD FURWANTO DANAFIAH 23/06/2013 3
12 WASHILATUL KAROMAH MALIKI - MAISURA, A.MA 25/09/2011 5
13 MOH. AISYUL KIROMI MALIKI - MAISURA, A.MA 15/11/2007 9
14 SHAFIYA NAFISHA LUQYANA SALIHAN - SURYATI 29/10/2014 2
15 NURUL RAUDA MOH. WAHYUDI - ROMLAH 16/11/2015 1
16 MOH. YUSRIYANTO SINUDIN - SU'IYA 12/11/2004 12
17 SELVIA WULAN SARI SUKRIYANTO - MUNIAMA 06/10/2009 7
18 TRIA SUKMA PRILIYANA SUKRIYANTO - MUNIAMA 23/04/2016 0.8
19 AYU SAFARA FAISAL SANOLLAH - SUHRIYANI 30/08/2005 11
20 ILHAM WAHYUDI MASRAWI - RUSNIYAH 04/12/2008 8
21 MOH. RAFI LUKMAN HAKIM MASRAWI - RUSNIYAH 20/06/2004 12
22 BELLA VALENTINA DEWI MASRAWI - RUSNIYAH 17/02/2014 2
23 RENO PUTRA WIRADANA MASRAWI - IRA ARIANTI 18/01/2005 11
24 LUNA AMELIA MASRAWI - IRA ARIANTI 17/06/2008 8
25 DAVI TEGUH RAMADHANA IMAM WISUDA - HALIMATUSSUHRA 26/10/2005 11
26 AHMAD ABIDZAR AL GHUFRAN IMAM WISUDA - HALIMATUSSUHRA 23/07/2015 1
27 DANU RAMADHAN KUSNO - ERINA LISAWATI 10/08/2011 5
28 CAHYA PUTRA KUSUMA KUSNO - ERINA LISAWATI 30/10/2004 12
29 DIMAS ARYA WIJAYA JUNAIDI - TITIK JANUARITA 16/04/2011 5
30 NOVAL AJIS FERDIANSYAH JUNAIDI - TITIK JANUARITA 22/01/2008 8
31
32
33
34
35
36
37
38
39
40

PENANGGUNG JAWAB DESA

.......................................................................
SASARAN ORI CAMPAK UPT PUSKESMAS KALIANGET
TAHUN 2016
DESA : MARENGAN LAOK
DUSUN : MASJID / RT 003 RW 04

LAHIR UMUR STATUS IMUNISASI


NO NAMA ANAK NAMA ORANG TUA KETERANGAN
( Tgl, Bln, Thn ) (Thn, Bln) Sudah ( Tgl, Bln, Thn ) Belum
1 NORIL RAHMAN ABD. RAHMAN - HAIRATUN 7/16/2005 11
2 IMAM RASULI ABD. GANI - SANITIK 1/30/2001 15
3 DHITA APRIYATI PUSPITA SARI ANWAR - SURIYATI 4/10/2006 10
4 FIRMAN ROBBY DESTA ANGGARA MOH. SU'UT - ENDANG ARIFAH 12/15/2004 12
5 JENI KARTIKA DEWI MOH. SU'UT - ENDANG ARIFAH 6/21/2010 6
6 DINI FAHIRA SUMARNO - HARIDAH 7/2/2002 14
7 FARAH TSABITA FIRDAUS KARMAN - ISTI HOLIFAH 8/26/2012 4
8 AFIF ALI ZAKARIYYA KARMAN - ISTI HOLIFAH 6/9/2006 10
9 LIANA MISRAWI - SANIMA 7/6/2002 14
10 DAFFA IRFANUL RAHMAN ZAINUR RAHMAN - SUSANTI 2/13/2015 1
11 MOH. ARFIN SIDQI SUMARNA - NURHAMSA 4/17/2007 9
12 HANDAYANI SUYONO - ARMANIYAH 3/24/2008 8
13 HAIRUL HIDAYAT SUYONO - ARMANIYAH 8/9/2001 15
14 MOHAMMAD FARUQ AKBAR HARUN SUBARI - ASSITTINA 11/27/2009 7
15 HARIS RAMADANI HARUN SUBARI - ASSITTINA 11/29/2001 15
16 HOSNOL HOTIMAH SYAFIUDIN - KUSMIYATUN 6/8/2008 8
17 CHOZI RISKI AKBAR ASMONI - ROKAYA 9/13/2003 13
18 MOH. HIDAR RITANSYA BASIRUN - BARIDAH 10/28/2001 15
19 LIA KURNIA SARI ACH. TOHA - HAIRIYAH 1/29/2012 4
20 ULIL ABSHAR ABDILLAH RUDY SUTIKNO - RA. NOURMA YULITA 9/18/2011 5
21 RUNI RAMADHANI KURNIAWAN SONY KURNIAWAN - ENDANG SUSILOWATI 7/19/2013 3
22 NABILA DIAN ABABIL MASTURAN - FATRIYAH 1/11/2005 11
23 DESTI KARTIKA PUTRI SALAMET RIYADI - IKE HESTI WULANDARI 12/26/2012 3
24 INAYATUL FADILA MASTIYO - ANNISAH 3/10/2006 10
25 RISTY ROMADHONIAH MASTIYO - ANNISAH 8/14/2011 5
26 DEVIYANTI FARHANNA MASTIYO - ANNISAH 9/11/2001 15
27 MERY DWI JAYANTI H. ABD. RAHMAN - HJ. HAIRATU 5/26/2003 13
28 ACH. JUNAIDI H. ABD. RAHMAN - HJ. HAIRATU 4/15/2008 8
29 FEBTI SOFIA LOREN ACH. SUNARTO - SUPIYATI 2/15/2005 11
30 RINA PUTRI AYU OKTAVIAH MOH. SYAMSUL ARIFIN - MIRNAWATI 10/19/2013 3
31 NASILATUL LATIFAH ZAINUDDIN - SUMIYATUN 11/1/2008 8
32 TANZILUL MUBARAK RAMADANY ZAINUDDIN - SUMIYATUN 6/19/2016 0.6
33 FARAH ANNISA SUFIYANTO - ERNAWATI. 5/8/2008 8
34 AFIFATUS SHOLEHA SUFIYANTO - ERNAWATI. 10/6/2014 2
35 AHMAD KHAIRUL ZAINURI ZAINUR RAHMAN - FARIDATUN 7/7/2003 13
36 AHMAD FAHRI ZAINURI ZAINUR RAHMAN - FARIDATUN 2/27/2009 7
37 ZABRINA OKTA ZAINURIYA ZAINUR RAHMAN - FARIDATUN 10/4/2013 3
38 SINTA DWI MIRIYANTI MUDAKKIR - HORRIYAH 3/16/2002 14
39 BILQIS SARMAEKA AZZAHRA ANDIK SEPTIAWAN - ERMANIYA 1/30/2015 1
40 SASKIA MAULIDA KADAR JATIM - SHOLEHATI 11/21/2010 6
41 NABILA SYA'BANI KADAR JATIM - SHOLEHATI 10/14/2003 13
42 ABD. RAHMAN BURAWI - MARIYANI 7/26/2011 5
43 NURUL AINI BURAWI - MARIYANI 11/13/2001 15
44 NAYLA ANISAH ALZENA SYAIFUL BARI - DIANATUS SHALEHA 2/26/2012 4
45 INDRA PRATAMA PUTRA EKO ANTORN SUMARLIN -HERLINDA VERAWATI 5/31/2012 4
46 DEWI PUTRI ABDUL RAHMAN - SULASTRI 6/30/2008 8
47 RENDI CAHYA SAPUTRA ABDUL RAHMAN - SULASTRI 11/24/2013 3
48
49
50
51
52
53
54
55
56
57

PENANGGUNG JAWAB DESA


.......................................................................
SASARAN ORI CAMPAK UPT PUSKESMAS KALIANGET
TAHUN 2016
DESA : MARENGAN LAOK
DUSUN : MASJID / RT 004 RW 04

LAHIR UMUR STATUS IMUNISASI


NO NAMA ANAK NAMA ORANG TUA KETERANGAN
( Tgl, Bln, Thn ) (Thn, Bln) Sudah ( Tgl, Bln, Thn ) Belum
1 FADHILATUS ZAHROH MUSAIRI - ARMANIA 12/4/2011 5
2 MAILATUR ROHMA MUSAIRI - ARMANIA 7/12/2006 10
3 SYIFA FAUZIAH MARDATILLAH AHMAD FADIL - SALAMA 11/4/2011 5
4 ASRI NUR FADILAH AHMAD FADIL - SALAMA 3/7/2004 12
5 AHMAD DANI MASTURA - SA'DIYAH 10/30/2011 5
6 SITI AFIYAH MASTURA - SA'DIYAH 1/1/2005 11
7 DEWI ANJANI BUSAHRA - SUSILAWATI 1/15/2004 12
8 SRI WAHYUNI BUSAHRA - SUSILAWATI 3/15/2011 5
9 ROSIDA SUMANTORO - SRI BUWANA 5/10/2009 7
10 SELVIANA DEWI JUHARIYANTO - YUSMIYATI 3/1/2006 10
11 NOFI NUR ARISKA JURIYANTO - YUSMIYATI 1/14/2011 5
12 AFRAH NAUFALYN NATHANIA SUNAWI - RATNA HIDAYATI SARI 4/26/2016 0.8
13 SINDI SAPUTRI SAIFUL BAHRI - HALIMA 4/26/2012 4
14 SAMIK WAHYUDI SAIFUL BAHRI - HALIMA 5/20/2005 11
15 HERLIYATI SAIFUL BAHRI - HALIMA 1/30/2007 9
16 SITTI AMILIA JAMALI - JUMAATIYA 12/4/2004 12
17 MOHAMMAD ALIF NURULLAH JAMALI - JUMAATIYA 4/2/2016 0.8
18 M. RISQI FEBRIYANTO MASRAWI - SAHIMAH 5/3/2007 9
19 NIKITA ANJANI PUTRI MASRAWI - SAHIMAH 1/9/2015 1
20 FATMIYATUN SABUWANG - SARIPA 1/27/2003 13
21 ALIFATUL JANNAH ABU YASID - SITI AMRATI 5/28/2009 7
22 ACH. FAWAID AL FARISI SARIYANTO - YULI INDRAWATI 4/25/2009 7
23 ACH. MIFTAHUR ROZIQI SARIYANTO - YULI INDRAWATI 12/17/2014 1
24 SURIYADI MOH. HATIP - SURIYANI 5/23/2013 3
25 ROHANNI MOH. HATIP - SURIYANI 4/30/2006 10
26 MAULIDATUL ROSIDAH NURRAHMAN - SITI HAJAR 8/3/2009 7
27 SUFAIDA NURRAHMAN - SITI HAJAR 11/21/2003 13
28 MEISARI AMELIA RAHMAN NURRAHMAN - SITI HAJAR 5/7/2015 1
29 AHMAD SUMANNA - ERMANIYAH 1/3/2002 14
30 ERMA SULISTIYANA SUMANNA - ERMANIYAH 4/11/2012 4
31 ASIS MISNADIN - SATUNA 3/17/2004 12
32 SULFA NURIYANI RODIONO - DALIFA 2/28/2009 7
33 ISRIYANI FATIMAH ABU BAKAR - LATIFA 10/5/2002 14
34 AHMAD NUR FAUSY HAIRULLAH - HAWASIYAH 5/4/2003 13
35 AFDAL FAUSI MOH. WIRDAN RAMDANI - HAIRATI 6/20/2012 4
36 FEBI ANANDIA PUTRI SANDONO RAHMAN - MISNATUN 2/12/2013 3
37 JAINURRAHMAN SANDONO RAHMAN - MISNATUN 4/21/2006 10
38 AHMAD BUSRO ALI MOH. ALI - BURATI 5/9/2003 13
39 NOVA AGGRAINI BUSAMIN - SUBAIDAH 7/6/2011 5
40 ASRI LINDA YANI ASRAWI - SITI PATIMA 8/13/2005 11
41 HARIYADI MOH. HALIL - ATIYA 4/25/2003 13
42 ERDAN RISKI RACHMATULLAH MADANI - ERNAWATI 5/30/2011 5
43 ERIZKA ALVEENA DANIE MADANI - ERNAWATI 3/1/2014 2
44 MAULIDIN ISMAIL MOHAMMAD BUSLAN - HAIRATUN 2/20/2011 5
45 SUDI MAHAT - JUMA'ATIYA 10/15/2002 14
46 NAUFAL FADILAH SUMAT - YULI 10/31/2011 5
47 BADRIYYAH NURSYIFA SUMAT - YULI 5/24/2015 1
48 TEGUH SAPUTRA MASTURANI - SUMIYATI 3/16/2011 5
49 AMIRUL MUKMININ AMIN - SUPIYATI, A.MA 10/21/2007 9
50 AISYAH NUR MAULIDYA AMIN - SUPIYATI, A.MA 2/2/2014 2
51 ARI ANGGARA EDI SISWANTO - SANITI 5/16/2008 8
52 FITRI MEYLINA SARI EDI SISWANTO - SANITI 9/13/2001 15
53 ARI NUGROHO EDI SISWANTO - SANITI 5/16/2008 8
54 RISKI SUYANTO - MISNARI 3/6/2010 6
55 RENDI SUYANTO - MISNARI 12/17/2005 10
56 RINA AMILIA RUDIYANTO - SUTRAIYA 4/27/2002 14
57 RATNA RENEYATUL JANNA RUDIYANTO - SUTRAIYA 6/1/2012 4
58 YULIATUL KARTINI KARTIKA SARI MOH. TOFA SAMSUL ARIFIN - DARMAWATI 4/21/2011 5
59 WIWIK YULIA EVATUL JANNAH MOH. TOFA SAMSUL ARIFIN - DARMAWATI 7/4/2007 9
60 MEIJI MITA MEILINDA PUTRI MOH. TOFA SAMSUL ARIFIN - DARMAWATI 5/2/2015 1
61 TRISNO KUSUMA SUDARSONO - KARTINI 2/19/2001 15
62 NUR AISYA MUHIDA JUMA'ADIN - MISNATI 5/17/2002 14
63 RIO AGUS RAMADANNI MULYADI - LISTERIYANI 8/6/2013 3
64 SURTIN SUPENNO CIPTO - SULASTRI 11/29/2007 9
65 ILA AGUSTIN FIRDAUS MOH. HASAN BASRI - YANI MAINNA 8/17/2004 12
66 SAIFUL RAHMAN MOH. SALEH - RASMAWATI 4/22/2003 13
67 AHMAD ROFIKI MOH. SALEH - RASMAWATI 12/2/2013 3
68 LAILATUL JANNAH SUPENNO CIPTO - JUMA'ATI 3/7/2005 11
69 NUR CAHYA SIRATUL FITRI SUPENNO CIPTO - JUMA'ATI 4/13/2001 15
70 AUSOFIL MAHMUDA MINASU - SURIYA 12/2/2007 9
71 FITRI SULISTIYAWATI SUKO - SUNDARI 3/3/2012 4
72 RUSDI HARIYANTO SAHIRUDIN - BUNASRI 4/12/2004 12
73 NUR AZIZAH SUHARTO PUTRI SUHARTO - NUR HASANAH 9/15/2014 2
74 HERGIAN KEVIN FIRMANSYAH BUDIYONO - NOVITA 2/17/2015 1
75
76
77
78
79
80

PENANGGUNG JAWAB DESA

.......................................................................
SASARAN ORI CAMPAK UPT PUSKESMAS KALIANGET
TAHUN 2016
DESA : MARENGAN LAOK
DUSUN : MASJID / RT 005 RW 04

LAHIR UMUR STATUS IMUNISASI


NO NAMA ANAK NAMA ORANG TUA KETERANGAN
( Tgl, Bln, Thn ) (Thn, Bln) Sudah ( Tgl, Bln, Thn ) Belum
1 KEVIN AGUS TRIHADI SYARKAWI - ENDANG SULASTRI 27/08/2008 8
2 MOH. RIFKI DARMAWAN BOWANG DARMAWAN 03/06/2003 13
3 DEWA PUTRA KUSUMA EDY KUSUMA, S.PT - DEWI HARYANI, SE 01/08/2006 10
4 ARAFAH KUSUMA PUTRI EDY KUSUMA, S.PT - DEWI HARYANI, SE 18/04/2014 2
5 APRILIA NURMA AVITASARI HOMAIDI - NURHASANAH 12/04/2013 3
6 HAIRUL ANWARI HOMAIDI - NURHASANAH 25/03/2007 9
7 MITA FEBRIYANTI BUDIANTO - SRI RATNAWATI 16/02/2002 14
8 APRILIA SRI INDAH SARI SUNARTO - SARKIYA 17/04/2004 12
9 MAULANA ASLAM MUSTADI AHMAD MUSTADI, S.SOS - UFAIDAH 01/07/2004 12
10 MAULANA AHMAD MUSTADI AHMAD MUSTADI, S.SOS - UFAIDAH 15/06/2005 11
11 ROSALINA INDAH SYABANA M. SUTRISNO - HERLIN 26/07/2010 6
12 BABYLINA VINDAROSITA M. SUTRISNO - HERLIN 13/01/2003 13
13 NAILUL AUTSAR MOH. SIS - MAS JUNAIDAH 10/05/2002 14
14 WARDATUL HASANAH MOH. SIS - MAS JUNAIDAH 16/01/2006 10
15 KHUMAIRAH ALSYATTA MOH. SIS - MAS JUNAIDAH 20/03/2016 0.9
16 RISKIAN DWI INAYAH ABDUS SA'ID - SITI ANA 25/01/2002 14
17 FARELLA RAMADHANY MOHAMMAD ZAINI - RISWARTINI 18/10/2004 12
18 PUAN HERLIYAH NABILA MOH. RASUL - DIAH 11/06/2006 10
19 AIDIL HABIB AKBAR IMSANI - RIZE SEPTRIA DEWI 27/07/2014 2
20 SHAKILA HABIBAH AL IMZANI IMSANI -RIZE SEPTRIA DEWI 5/27/2016 0.7
21 KHANSA TAQIYYA HIDAYAT MOH. HIDAYAT, S.PD - WAHYUNINGSIH, S.PD 08/06/2013 3
22 KENZIE ATHARIZ RAFA HIDAYAT MOH. HIDAYAT, S.PD - WAHYUNINGSIH, S.PD 12/06/2014 2
23 ZAKI AL-MUBAROK MUFID HARSONO - HOIRIYANI 30/11/2015 1
24 SEPTIYAN ARIF RAHMATULLAH AHMAD SANTOSO S.V - ERTIN MARTININGSIH 9/27/2014 2
25 ANINDITA KEISHA OKTAVIANA ZAHRA SAYUNI - NISWATI 10/18/2015 1
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40

PENANGGUNG JAWAB DESA

.......................................................................
SASARAN ORI CAMPAK UPT PUSKESMAS KALIANGET
TAHUN 2016
DESA : MARENGAN LAOK
DUSUN : MASJID / RT 006 RW 04

LAHIR UMUR STATUS IMUNISASI


NO NAMA ANAK NAMA ORANG TUA KETERANGAN
( Tgl, Bln, Thn ) (Thn, Bln) Sudah ( Tgl, Bln, Thn ) Belum
1 NUR AINI MASWI - BUDIAH 8/7/2004 12
2 AZZAM RESTU RIADI SLAMET RIADY - 4/10/2016 0.8
3 RISQIA OKTALINA CHAIRULLAH - SRI INDAYANI 10/20/2010 6
4 FITRIA RAMADANI CHAIRULLAH - SRI INDAYANI 6/24/2015 1
5 RASIDA NUR AINIA SARI MOH. RASIDI - HENI YULIANA 7/31/2007 9
6 HENDRA NUR HADI MOH. RASIDI - HENI YULIANA 5/16/2004 12
7 ADITIA NUR RAMADHANI MOH. RASIDI - HENI YULIANA 7/14/2014 2
8 MOH. LUTHFI INDRA MAULANA ISHAQ ZAINUDDIN - RUSMIYATI 1/29/2010 6
9 MOH. DIMAS AL FARISI ZAINUDDIN - RUSMIYATI 4/9/2015 1
10 RENO ARYA WIGUNA HARTONO - SAHWANI 9/4/2002 14
11 RAYHAN ARYA SAPUTRA HARTONO - SAHWANI 11/11/2008 8
12 SELVINA APRIYANTI AKHMAD MUHNI - SITI NURYATIM 4/26/2004 12
13 MOH. AZKA AL FARIZI AKHMAD MUHNI - SITI NURYATIM 1/31/2016 0.11
14 PANDUWINATA SUBANDRIYO - SITI ROMLAH 9/2/2011 5
15 NATASYA AULYA RAHMAN ATIKURRAHMAN - LIYA PUTRI FATANI 10/28/2008 8
16 MUHAMMAD ARLAN FATANI ACHMAD RAMLAN - PUTRI FATANI 10/30/2012 4
17 ARLIYANA AULYA PUTRI ACHMAD RAMLAN - PUTRI FATANI 12/10/2014 2
18 AVELLIA FITRIANA PUTRI MOH. JUNAEDI - DINI YULIYANTI 9/7/2011 5
19 AISYAH AMILIA PUTRI MOH. JUNAEDI - DINI YULIYANTI 5/2/2014 2
20 IZMY ALIEF FIRNANDHEA IBNU FAJAR - NURUL AINI 1/16/2007 9
21 DEBY ANISSA MUKARROMAH IBNU FAJAR - NURUL AINI 3/14/2010 6
22 GABY ANISSA MUSYARROFAH IBNU FAJAR - NURUL AINI 3/14/2010 6
23 YOGA KRISNA MURTI H. HAMZA - HJ. MURNIYATI 6/3/2003 13
24 DENI APRIYAH ZAHNI SUHAWAN - SURASMI 4/21/2008 8
25 DEDI FUJIYANTO SUHAWAN - SURASMI 6/25/2005 11
26 FAJRIYAH TUS HIJRIYAH SUMINAH 8/22/2010 6
27 AMINATUS SALEHA BUSATI - BUWAMI 3/28/2011 5
28 EKA PUTRI AMELYA ASBUDIYANTO - ERNAWATI 2/13/2002 14
29 AYU NURGITA AGUSTIN ASBUDIYANTO - ERNAWATI 8/24/2015 1
30 SITI QOMAYRO RUSDIYANTO - SITI MARIYAM 7/14/2011 5
31 SITI ROHANA RUSDIYANTO - SITI MARIYAM 1/5/2001 15
32 SRI WULAN DARI HANNAN - SITI AMINAH 9/20/2011 5
33 FADLILLA HANNAN - SITI AMINAH 11/30/2003 13
34 DESWITA VARADIKA ERMANDA ABDURRACHMAN RACHWINI - ERNAWATI 12/26/2007 8
35 ARNI HIKMATUL AMELLYA MOH. SALEH - SITTI 5/10/2001 15
36 JONI TRI CAHYONO A. ZAINUDIN - TARWIYATUN 1/17/2005 11
37 ANGGREYANI RAHMATULLAH SUCIPTO - MARDIYANI 2/27/2013 3
38 SARI LINDA SUCIPTO - MARDIYANI 1/9/2003 13
39 AZZEGAF CONDRO ADI LUKITO ABDUL HAMID - SITI KHOTIMAH 10/23/2001 15
40 BAYU UPIK SANTIKA DEWI AKH. SUPARTO - MASBIYA. 1/13/2002 14
41 SITI SOLEHA AKH. SUPARTO - MASBIYA. 1/31/2008 8
42 KAMILATUL MAULIDI ILA JUMAHWI - SRI HANDAYANI 2/3/2013 3
43 PUKA TAYSA'ADANIYA SAMSUL - BUWANI 5/13/2015 1
44
45
46
47
48
49
50
51
52
53

PENANGGUNG JAWAB DESA

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