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SASARAN ORI CAMPAK UPT PUSKESMAS KALIANGET

TAHUN 2016
DESA : MARENGAN LAOK
DUSUN : KARANG KOMIS / RT 001 RW 03

LAHIR UMUR STATUS IMUNISASI


NO NAMA ANAK NAMA ORANG TUA KETERANGAN
( Tgl, Bln, Thn ) (Thn, Bln) Sudah ( Tgl, Bln, Thn ) Belum
1 NUVITA SAWALINDA ASMONI - HARIANI 11/17/2004 12
2 AHMAD SUFYAN KARNOTO - LILIK SUPIYANI 6/11/2002 14
3 SITI HOLIFATUL KHOMARIA KARNOTO - LILIK SUPIYANI 4/23/2005 11
4 NURUL JANNAH KARNOTO - LILIK SUPIYANI 1/8/2007 9
5 MOCH. JAINURI ALFI ISMAIL - SRI WAHYUNI 1/31/2002 14
6 ACH. FAJARISMAN ALFARISI ISMAIL - SRI WAHYUNI 1/6/2008 8
7 SITI ANNISATUL MAULIDA ISMAIL - SRI WAHYUNI 1/24/2015 1
8 SITI MAISAROH ABDUR RAHMAN - SINEMO 2/10/2005 11
9 MOH. IBRAHIM ABDUR RAHMAN - SINEMO 6/4/2011 5
10 RAHMATULLAH ABDUR RAHMAN - SINEMO 8/25/2014 2
11 DAFFA PUTRA RAMADHAN KHOIRIL ANAM - BUSAIYAH 6/10/2016 0.6
12 NURUL APRILIA ASMONI - HASIATI 4/20/2003 13
13 MARETA PUTRI AYU SARTIKA SUPENNO CIPTO - RUSMIYATI 3/16/2003 13
14 SUNDARI ABDULLAH - SURIYATI 11/3/2002 14
15 KADARISMAN MOH. SAHIMIN - NUR HASANAH 12/23/2004 11
16 NUR FADIL MOH. SUNAWI - SUMINA 2/18/2003 13
17 INTAN APRILIYANA PUTRI SASMITO - EMBENG FITRIANI 7/23/2006 10
18 NAFI INDRA PUTRA SASMITO - EMBENG FITRIANI 3/14/2013 3
19 KUSMIYATI MOH. KUSMAN - SUSIYATI 7/29/2004 12
20 DESWITA JIHAN SAFIRA MOH. KUSMAN - SUSIYATI 12/13/2009 7
21 MUHAMMAD KRISNA WICAKSONO HASANUDDIN - ENDANG SUSTRIYANI 5/30/2011 5
22 MAULANA ANDI FIRMANTO BUDIONO - FIRDAWATI 1/22/2013 3
23 MOH. TOLAK ASSYAMSI SAHIRUDIN - SAHWANI 4/21/2007 9
24 SANJAY RONI WIJAYA SAHIRUDIN - SAHWANI 1/2/2014 2
25 NURAINI SUGIANTO - AHMANIYAH 2/4/2014 2
26 SITI NOR FATIMA MASTURI - JUMA'ATI 4/13/2001 15
27 DEBRI RAHMAN NURDIYANSYAH MASNIN RAHMAN - SITI NAWIYA 12/30/2009 6
28 NUR AINI AL HASANA SUPAMI - MINATUS 5/14/2005 11
29 SAIFUL BAHRI KARIM - MARYATI 2/16/2005 11
30 FITRIYANI NUR FADILAH ZAINUDDIN - SADDRIYA 11/5/2006 10
31 RUSPANDI JUMA'ASIM - SURIYA NINGSIH 10/23/2003 13
32 RAMADANI JUMA'ASIM - SURIYA NINGSIH 8/25/2011 5
33 NOR DEWI FITRI RAHAYU SUNARTO, S.Sn - RUHANIYAH 8/17/2012 4
34 MOHAMMAD RACHMAT DANI SUNARTO, S.Sn - RUHANIYAH 6/8/2008 8
35 MELDA MINHATUN NAJAH ABD. KADIR JAELANI, S.PD - SITTI AISIYAH, 9/19/2010 6
36 SITI JUHAIRIYA MASDURI - JUMA'ESA 8/28/2003 13
37 DWI NURUL INSAN KAMALIA HASAN BASRI - ISMAWATI 2/14/2004 12
38 ACHMAD RIZQI NURIL ABDILLAH ACH. RIFA'I - JUMA'ATI 1/5/2012 4
39 HENDRIYANTO SANIYANTO - MARWIYAH 5/29/2004 12
40 ACH. SAIFUL JAMIL BUKARNA - SURIYANI 8/8/2008 8
41 ASIRA DAMAYANTI BUKARNA - SURIYANI 2/11/2005 11
42 USWATUN HASANA JUNAIDI - ENDANG SUTRIA KARTINI 7/21/2012 4
43 LAILA MIRZA MUSVIRA JUNAIDI - ENDANG SUTRIA KARTINI 6/27/2016 0.6
44 PURNOMO ASSIDDIKI AHMAD ZINAL - MA'ATI 4/22/2008 8
45 MOH. IFDAL ARIFIN HAIRUL - SUSMIYATI 11/23/2008 8
46 MOH. RAFA RABBANI HAIRUL - SUSMIYATI 1/5/2013 3
47 MUHAMMAD IBNU RIZQY MUHAMMAD - MAHMUDATUL HALIYAH 11/6/2013 3
48 NUR HASANAH MAULIDINA AKHMAD HASAN - NURHOLIPAH 5/4/2004 12
49 ARIFATUS SA'DIYA ABD. RAHMAN - ALMANIA 3/15/2009 7
50 EKA MARHATUS SHOLEHA ABD. RAHMAN - ALMANIA 10/23/2002 14
51 MASSURI MASRAWI - NURHAYATI 5/2/2002 14
52 SARI DWI YANTI MUHAMMAD HARIYONO - SITI KHO'RATUN AINI 12/14/2013 3
53
54
55
56
57
58

PENANGGUNG JAWAB DESA


.......................................................................
SASARAN ORI CAMPAK UPT PUSKESMAS KALIANGET
TAHUN 2016
DESA : MARENGAN LAOK
DUSUN : KARANG KOMIS / RT 002 RW 03

LAHIR UMUR STATUS IMUNISASI


NO NAMA ANAK NAMA ORANG TUA KETERANGAN
( Tgl, Bln, Thn ) (Thn, Bln) Sudah ( Tgl, Bln, Thn ) Belum
1 SUSILAWATI SAMSUL ARIFIN - SUNDUSIYA 11/8/2003 13
2 SULTAN AGUS WIRANANDA SAMSUL ARIFIN - SUNDUSIYA 8/17/2009 7
3 DEWI NOFITA SARI ISKANDAR - MANISA 11/20/2007 9
4 PUTRI DEWI KARTIKA BENI SUHARTO - IDAYANI 9/17/2013 3
5 FATAH MAULANA DAVA MANDA SYAPUTRA MASDA HARTANTO - SUBAIDA 11/13/2011 5
6 SALMA SOFIYA MISRADIN - ATMAWIYA 3/31/2004 12
7 JIHADIL AKBAR AMIRUDDIN - HAMIDAH 4/5/2012 4
8 FARIDATUN AMIRUDDIN - HAMIDAH 12/29/2000 15
9 NURKA PUTRI HIJRIYANTI AHMAD - SAHWANI 1/16/2005 11
10 ANITA MARDIYANA MOH. IDRIS - FATTINNA 4/3/2001 15
11 MOH. TAUFIQURROHMAN MAULANA PUTRA AHMAD - FATTINNA 7/1/2011 5
12 ALDI FARDIANSYAH ISMAIL - SRI FAJARIYAH 7/30/2008 8
13 PUTRA BAYU LASMANA JOHAN WAHYUDI - KARNIA LINDA 6/9/2010 6
14 MELLI AULIA JOHAN WAHYUDI - KARNIA LINDA 7/1/2012 4
15 HOLIFATUL UMAMA MOH. TAHA - SUTINA 2/17/2013 3
16 SOFI LAILATUL JANNAH MOH. TAHA - SUTINA 2/11/2008 8
17 NUR ANISA SAFITRI AZIS - SITI ROHANA 9/24/2004 12
18 AHMAD SALIM PERDANA BUKADING - HAERATU 3/3/2005 11
19 MOH. ERLANGGA ADITIYASAPUTRA SAMSUL BAHRI - MARIYANI 2/13/2008 8
20 NIAMA SUPYI - RUSIDA 7/20/2009 7
21 SITTI RAHMANIA MOH. SALEH - RISKIYA 7/2/2003 13
22 PUTRI PRAMISWARI AHMAD SUHARTO - SULAEHA 7/3/2001 15
23 MARIYONO MOH. HASAN - MARIYANI 12/23/2001 14
24 RUMIYATI MA'EL - RUSNIYAH 2/26/2011 5
25 MOH. IKBAL RAMADAN MOH. JUFRIYANTO - RUHANIYAH 11/7/2003 13
26 RADITYA AFANDI MOH. JUFRIYANTO - RUHANIYAH 08/12/2013 3
27 DEVI PERMATASARI KADARISMAN - RUWAMI 6/23/2003 13
28 REGINA ALIFTUN NISA MAHMUDI - AMSATUN 10/27/2011 5
29 FITRI ROMADHANI MAHMUDI - AMSATUN 10/25/2004 12
30 MUHAMMAD ALFIN ZIDNA MULYA MUHAMMAD SHOLEH - HALIMATUS SUHRA 6/26/2014 2
31 REZA DENI MAULANA PUTRA MISNAYU - AMRATI 12/3/2011 5
32 AGUS SUTRISNO MISNAYU - AMRATI 2/5/2002 14
33 DENA WINATA ACHMAD MUNIR - SRI HANDAYANI 6/27/2013 3
34 MUHAMMAD AGUNG ACHMAD MUNIR - SRI HANDAYANI 12/10/2006 10
35 SALMA AL FARIZA RAMADANIA SUHAIRI - AMLANI 9/17/2008 8
36 MUHAMMAD RADHO SAMSUL EFENDI - SITI SUBAIDA 8/13/2007 9
37 IZZAH MAULIDA AURA PUTRI SAMSUL EFENDI - SITI SUBAIDA 1/31/2014 2
38 M. FAJRIN FAJARIYANTO AKH. FADIL - FATMAWATI 4/2/2012 4
39 RINDI HANIFA AKH. FADIL - FATMAWATI 2/6/2002 14
40 M. AGUS SUBRIYAN AKH. FADIL - FATMAWATI 8/14/2007 9
41 AGUS SUPRY YADI SAMIN - SITI SUMA'ADIYAH 8/1/2004 12
42 RAMBO JR MARSUTO - SARI WULANDARI 2/19/2016 0.1
43 AMINA SANDONO - AMSATI 12/23/2002 13
44 IMAM FIRDAUS HOSEN - FARIDA 10/10/2008 8
45 NINDI HOSRIAWATI HOSEN - FARIDA 12/18/2000 15
46 ACH. FAIQ AKBAR JUNAIDI - ERMANINGSIH 4/15/2009 7
47 BUDIMAN ACH. SULAIMAN - ISTRIYANI 2/13/2002 14
48 SABRI YANTO FENDI SUSANTO - SITI HALIMAH 2/16/2013 3
49 SARIYANTONO FENDI SUSANTO - SITI HALIMAH 8/8/2006 10
50 SALEH MASRAWI - MARWIYA 9/25/2004 12
51 MERY PUSPITA SARI AHMAD - SUHRIYA 5/8/2005 11
52 MOHAMMAD DANI ROHMAN SABUANG - RATNA UMIRI 10/31/2004 12
53 KHOIRULLAH SABUANG - RATNA UMIRI 3/5/2014 2
54 EKA SEPTIAN RAHMAN SAPUTRA ABD. RAHMAN - SRI YULIANA 9/21/2006 10
55 DWI SHINTA PUTRI YAMANDA SARI ABD. RAHMAN - SRI YULIANA 6/29/2012 4
56 MOH. MAULANA ILHAM SURIYANTO - SUMIYATI 12/4/2011 5
57 ZHAHIRA PRATIWY HARIYANTO - IDAWATI 12/23/2010 5
58 YULITA SUDAWI - SURIYA 7/22/2003 13
59 YASIN ILLAHI DURANI - SULASTRI 2/16/2003 13
60 NURISA HIDAYANTI DURANI - SULASTRI 11/6/2005 11
61 KAYFA NUR AZIZAH DANI BAGUS SETIAJI - FITRIYANI 8/28/2013 3
62 SEPTY AULIA PUTRI ATIKA MOH. KADIR - MARTINI 9/1/2012 4
63 HENI OKTAVIA NURDIANA AHMAD - AMINAH 10/11/2005 11
64 KUSI ROBBANI IBADALLAH AHMAD - AMINAH 8/25/2014 2
65 NANDA AYU AMELIA MULYADI - SUPIYANI 3/5/2010 6
66 AULIA APRILYANANDA SALEMAN - SRI ASTUTIK 4/10/2007 9
67 MOHAMMAT RAHMAT HERIYANTO - SITI FAJARIYAH 8/30/2013 3
68 MOH. SAHRUL LAIL ROMI PRATAMA JUHARI - HASIYATUN 5/4/2007 9
69 MOHAMMAD REYHAN EDI SUKARDI - KHOSNOL FATIMA 6/29/2007 9
70 PUTRI INDA PERMATA SARI MASKI - SUMIATI 1/2/2005 11
71 SYAMSUL ARIFIN UMAR - JAHRIYATI 10/10/2004 12
72 IRFAN HARIYANTO SUMAHDAR - SANTI NURAINI 1/30/2007 9
73 CITRA PUTRY BILQIS MANSUR - INDAH WATI 11/6/2010 6
74 TANAKA ADLY FIRDAUS MANSUR - INDAH WATI 4/17/2008 8
75 ASFIYANA JULIA RAMADONA MATLANI - ANIS TIYANA 6/25/2015 1
76 DIANA ALFADIYAH ZAINUDIN - SEPTI ANDRAYNI 3/15/2014 2
77 TAQIYYA NASYIFA SURYADI - ROSIDA 2/24/2014 2
78 VIRGA OZELA ADINATA FAJARISMAN - NEILY KAFILAWATI 6/27/2015 1
79 MOH. EFENDI ANWAR SUGIYONO MOH. ASKI - SARWIYAH 3/16/2004 12
80 AWALIA RAMADHANI MOH. ASKI - SARWIYAH 7/21/2012 4
81 DWI NUR SAFITRI RAHMAN FATHOR RAHMAN -SALASRI 9/13/2005 11
82 AHMAD FIRMANSAH RAHMAN FATHOR RAHMAN - SALASRI 12/6/2014 2
83
84
85
86
87
88
89
90
91
92

PENANGGUNG JAWAB DESA


.......................................................................
SASARAN ORI CAMPAK UPT PUSKESMAS KALIANGET
TAHUN 2016
DESA : MARENGAN LAOK
DUSUN : KARANG KOMIS / RT 003 RW 03

LAHIR UMUR STATUS IMUNISASI


NO NAMA ANAK NAMA ORANG TUA KETERANGAN
( Tgl, Bln, Thn ) (Thn, Bln) Sudah ( Tgl, Bln, Thn ) Belum
1 RIKA RAMADHANI SUNARTO - MANISA 7/10/2013 3
2 RITA PERMATA SARI SUNARTO - MANISA 1/29/2004 12
3 MOH. RIZAL DWI FIRMANSYAH SUNARTO - MANISA 4/21/2007 9
4 LUKAMNUL HAKIM JONI FIRMAN FIRDAUS 11/19/2005 11
5 MOH. HAYRIL ALAMIN JEFRI MAULIDAH - BARRATIN FIRDAUS 2/27/2011 5
6 MOH. MAULANA DODY PRATAMA JEFRI MAULIDAH - BARRATIN FIRDAUS 6/2/2002 14
7 AURA TRI MAULIDIYAH FIRZAHADAT JEFRI MAULIDAH - BARRATIN FIRDAUS 1/13/2014 2
8 SITI FATIMAH AZZAHRO RASULI - JUMRATI 2/14/2005 11
9 LAILATUL FAJRINA RAMADANI RASULI - JUMRATI 8/27/2009 7
10 LAILATUL FITRIA RAMADANI RASULI - JUMRATI 8/27/2009 7
11 MOH. RIKI MAULANA SUKANDAR - MARWIYAH 6/13/2004 12
12 BUSAIRI SUHUD - NA'ISA 5/23/2001 15
13 ACHMAD KHAIRI MASDARI - SRI NURHAYATI 12/30/2004 11
14 KARUNIA NIKATUL KUSWARI MASSURI - KUSMAWATI 3/8/2012 4
15 FIRDA AYU AGUSTIN URIP RAHARJO - RASIDA 8/20/2003 13
16 SAFITRI WULANDARI SURAWI - NURHASANAH 11/6/2002 14
17 TRI FANI AISYAH EDI SUTIKNO - MARWIYANI 12/28/2003 12
18 SUHARTATI ROYNI HAMSYI SYAIFUR RAHMAN - AMRATI 7/23/2010 6
19 AYATUL HUSNA SUPANDI - AMRATI 4/16/2015 1
20 AGUS NUR PRASETYO BAINUR RAHMAN - RAHAYU NINGSIH 8/17/2015 1
21 ASYRAF HEVIAN WAHYUDI HERI WAHYUDI - NOVITA YULIATI 1/10/2016 0.11
22 SHOFI DIANA LARA FEBRIYANTI ADI SUPRAPTO 11/25/2011 5
23 INSYIRA JANNETA MAULIDAH JONI PRASETIO - ANITA CRISTINA 1/25/2013 3
24 RINANTA NUR ZIDKI MOHAMMAD NURSIDIK - YUNITA NURINA 9/11/2009 7
25 YUANITA KHAIRINDA HAIRULLAH - YUNITA 6/4/2013 3
26 VIOLA AYU FARDIANA TURSIADI - NURHALIFA 6/29/2012 4
27 BAYU FATUR FARDIANSYAH TURSIADI - NURHALIFA 4/15/2008 8
28 MOHAMMAD SHOFRIL ANWAR HUMAIDULLAH - KASTRIYAH 2/10/2010 6
29 PANJI SURYA PUTRA ADI SUPRAPTO - RA. KARTINI 1/26/2008 8
30 DINDA ARLETTA PUTRI HAIRUL KUTSI NUR ALAM - LUH SUKERNI 10/30/2011 5
31 RISKI MAHENDRA PUTRA HAIRUL KUTSI NUR ALAM - LUH SUKERNI 9/23/2015 1
32 AULIA TRI SETYA RAHAJENG BUDI SETYA SANTOSO -MARTUHANI 12/13/2011 5
33 GANDI SETYO RAHARJO BUDI SETYA SANTOSO -MARTUHANI 3/23/2001 15
34 ANINDYA DWI SETYA RAHAYU BUDI SETYA SANTOSO -MARTUHANI 6/6/2005 11
35 RAIHAN ASYAM AKRAMI SAHIRUDDIN - DESI RATIH NURHASANI 12/27/2010 5
36 LUKMAN IRWANSYAH LUKMAN HAKIM - NOERYATIK 4/21/2003 13
37 AKH. FAJARIANSYAH RAMADHANA RAHMAN SURAHMAN - SITI FATHONAH 9/5/2010 6
38 ENAYATUL HASANIYAH MASGIYANTO - SULIS TRIAWATI 5/30/2014 2
39
40
41
42
43
44
45
46
47
48
49
50

PENANGGUNG JAWAB DESA

.......................................................................
SASARAN ORI CAMPAK UPT PUSKESMAS KALIANGET
TAHUN 2016
DESA : MARENGAN LAOK
DUSUN : KARANG KOMIS / RT 004 RW 03

LAHIR UMUR STATUS IMUNISASI


NO NAMA ANAK NAMA ORANG TUA KETERANGAN
( Tgl, Bln, Thn ) (Thn, Bln) Sudah ( Tgl, Bln, Thn ) Belum
1 KANZA KAFFA RAMADHAN FERI FADLI - PUTRI SARI AGUSTIN 6/8/2016 0.6
2 ALIEF PRATAMA INDRAWAN MOHAMMAD ARIF - WIWIN PUJAYANTI 5/5/2011 5
3 AHMAD RIZAL ARISANDI MA'ON - MASRIYANI 10/8/2002 14
4 ANGGA ZENO MOH. ANWAR - ASMAWATI 3/2/2005 11
5 ARJUNA MANDALA PUTRA MOH. ANWAR - ASMAWATI 5/11/2009 7
6 NAZRIL ARIYA PUTRA AGUS SUBIYANTO - SAHWANI 1/1/2013 3
7 ABU SOFYAN AGUS SUBIYANTO - SAHWANI 3/9/2005 11
8 AQILA NAZWA ZAFIRAH HERMAN DIYANTO - SITI AISYAH 3/29/2013 3
9 NURUS SYAMSIA HERMAN DIYANTO - SITI AISYAH 12/24/2006 9
10 MOH. BENI HENDRA WIJAYA EDI SUSANTO - NURHAYATI 5/13/2007 9
11 AHMAD RAFI NURAHMAN - ERNAWATI 9/15/2008 8
12 TAUFIK HIDAYAT NURAHMAN - ERNAWATI 11/21/2001 15
13 MOH. SURYA FAJAR ABSARI ABU YASIT - SURIYANI 11/12/2010 6
14 MOH. ENDARDY YANI ABSARI ABU YASIT - SURIYANI 6/14/2004 12
15 QURROTUL FAIZAH HASANAH KALONG - MASIDAH 3/30/2008 8
16 NUR AIDA ROHMAWATI ABDUR RAHMAN - SUMAWIYAH 2/16/2011 5
17 MERY NURWIDIYAWATI ABDUR RAHMAN - SUMAWIYAH 1/3/2006 10
18 MOH. ABDUL QODIR JAILANI MOH SAHARI - SITTI FATIMAH 4/10/2001 15
19 NOVITA NUR AISYAH MOH SAHARI - SITTI FATIMAH 11/29/2004 12
20 MOH. KHOIRUS SHOLIHIN ABDUR RAHMAN - ERNAWATI 7/19/2007 9
21 REVA FIDYA RAMADHANI EDI YANTO - FIFIN 6/20/2016 0.6
22 DEWI AYU MARCHELA PUTRI SARKIYAH - MISRADIN 3/31/2004 12
23 ISMA ANGGA JAYADI MASNITO - MARDIYANI 2/12/2004 12
24 TRI UTARI NINGSIH ARIFIN - ZUMRATUL AQIDAH 10/15/2007 9
25 SITTI ALIYAH MOH. HASAN - MUDALIFA 1/4/2009 7
26 AHSAN RAIHAN ZAHIRUL BAQ MOH. HASAN - MUDALIFA 4/21/2014 2
27 IHSAN FADIL SYIHABUDDIN MOH. HASAN - MUDALIFA 4/21/2014 2
28 SYAMSUL ARIEF MOH. SUDARSONO - SANIMA 9/11/2007 9
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43

PENANGGUNG JAWAB DESA

.......................................................................
SASARAN ORI CAMPAK UPT PUSKESMAS KALIANGET
TAHUN 2016
DESA : MARENGAN LAOK
DUSUN : KARANG KOMIS / RT 005 RW 03

LAHIR UMUR STATUS IMUNISASI


NO NAMA ANAK NAMA ORANG TUA KETERANGAN
( Tgl, Bln, Thn ) (Thn, Bln) Sudah ( Tgl, Bln, Thn ) Belum
1 SALMAN ALFARIZI SUCIPTO - SUMRATUL AQIDAH 10/24/2003 13
2 NURROHMI AMELIA SUCIPTO - SUMRATUL AQIDAH 10/30/2010 6
3 MAULIDA ANISYABELA RIANTO - DEWI AYU RATNASARI 1/10/2014 2
4 PUTRA NOR ALIM MISWARI - MARWIYATUN 8/28/2005 11
5 SUPRIYANTO SASMITO - MASRIYA 3/21/2001 15
6 FATHIR RAHMAN EKO EDI RAHMAN - SITI HASANIYAH 6/29/2009 7
7 ACH SUHAIRI MARSUKNI - SITI FATIMAH 3/11/2005 11
8 AHMAD SUBAREDY MARSUKNI - SITI FATIMAH 4/18/2009 7
9 VINZA KHOMAIROH AGUSTIN ASRAWIADI, SH - TRISNI WIDAYATI 7/31/2008 8
10 MOH. REZA ADI SAPUTRA SURAWI - MASRIYATUL HASANAH 1/23/2011 5
11 PUTRI ANDITA ANDIKA LEO SANDI - DEVIN SUPIYANI 10/11/2013 3
12 KARUNIA LOVA MARTIA SETIAWAN KUKOH SETIAWAN - MARTIANI 1/3/2011 5
13 M. FADILAH RAHMAN KUKOH SETIAWAN - 8/19/2008 8
14 AZAHRA ILLAHI NUR SETIAWAN KUKOH SETIAWAN - MARTIANI 3/20/2004 12
15 IDRIS FEBRIANSYAH MARSUKI - ELLY SUSANTI 2/13/2003 13
16 MARCELLYNA DEWI MULYASARI MARSUKI - ELLY SUSANTI 3/14/2006 10
17 TRI DEVI AGUSTINA MOH. MANSUR - RUMINA 8/24/2004 12
18 WINDA DWI MAULIDA HASAN BASRI - MARWIYAH 4/15/2007 9
19 AZRIL MAULANA NAFI' FATHONAH SALAMET - SRI CHOTIJAH, S.PD.SD 4/13/2012 4
20 MEIDIVA RIFQOTUL MUFARROHAH SALAMET - SRI CHOTIJAH, S.PD.SD 5/13/2006 10
21 QOMARIYATUL NADATUS SILVIA DJUSUF - SUMINAH 10/30/2003 13
22 AHMAD HABIBILLAH DJUSUF - SUMINAH 10/27/2006 10
23 AHMAD SAYNUR ROHIM DJUSUF - SUMINAH 5/21/2014 2
24 RIKA PUTRI RAMADHANI MOH REYADI - SUSMIYATI 8/26/2009 7
25 ANDHIKA SAPUTRA MOH REYADI - SUSMIYATI 7/24/2015 1
26 MOH. SATRIO HIDAYATULLAH SYAMSURI - LISKA DEWI 5/11/2011 5
27 RETNO AYU WULANDARI SAIFUL RAZAK - YANTI 10/12/2011 5
28 NELLY AGUSTINA MASWAR - NUR HASANAH 8/4/2008 8
29 LAILATUL FARINA AURILLA FATHOR RAHMAN - ARINDA FITRIYANI 12/6/2008 8
30 RAFI AKBAR FATHOR RAHMAN - ARINDA FITRIYANI 4/1/2015 1
31 AFIKA NURAYA ZANETA SUYONO, S.PD - SITI KASWATI 3/27/2012 4
32
33
34
35
36
37
38
39
40
41
42
43
44
45

PENANGGUNG JAWAB DESA

.......................................................................
SASARAN ORI CAMPAK UPT PUSKESMAS KALIANGET
TAHUN 2016
DESA : MARENGAN LAOK
DUSUN : KARANG KOMIS / RT 006 RW 03

LAHIR UMUR STATUS IMUNISASI


NO NAMA ANAK NAMA ORANG TUA KETERANGAN
( Tgl, Bln, Thn ) (Thn, Bln) Sudah ( Tgl, Bln, Thn ) Belum
1 SITI FATIMAH RASUL - MASDIYANI 3/10/2006 10
2 YULIYANI NURZUL KAIDAH ACHMAD - SUHAWIYAH 1/16/2003 13
3 SALSABILA PUTRI RAMADHANI MUHAMMAD - SUSILAWATI 9/28/2007 9
4 DZAKY RAIZAN ARRAFIF SUROTO - RINI YULIANI 4/12/2016 0.8
5 KAMILATUN ADIBAH ADI MARSUWANTO,S.Pd - SITI LIKA,S.Pd.SD 3/22/2011 5
6 MUHAMMAD ZIDAN AL FATIH ADI MARSUWANTO,S.Pd - SITI LIKA,S.Pd.SD 3/22/2011 5
7 ROFIIF AQBIL HIDAYATULLAH BUNARTO - NURRISKI 3/4/2012 4
8 IQBAL HABIBURRAHMAN ABU HASAN - ERMAWATI 5/16/2013 3
9 HERDI PUTRA ARJUNAWAN ANDI - HERLIN 6/29/2008 8
10 MUSLIMAH NUR KHOLIFA ANDI - HERLIN 2/25/2015 1
11 MOH. MIFTAHOL NUR ARDIANSA ASNI, SH - BUNIATUN 5/6/2010 6
12 MOH. NUZUL RAMADANI ASNI, SH - BUNIATUN 12/3/2004 12
13 DESY WULANDARI SARIFUDIN - MARWIYA 12/24/2001 14
14 NAILAH ZAHRATUS SYIFA SARIFUDIN - MARWIYA 12/22/2010 5
15 ANNI FARIKA MAHFUD - SAHRIYA 5/18/2004 12
16 NANDA EKA PRATIWI MOH. AYURI - MASRIYANI 10/17/2007 9
17 MUZAYYINATUS SHOLIHAH MOH. AYURI - MASRIYANI 9/12/2012 4
18 AMIRA LATHIFYAH AZZAHRA MOH. AMIR HAMZAH - SRI HANDAYANI 6/22/2013 3
19 SITI JAMILIYA ABD. WAHAB - SUSTRIYANI 3/12/2010 6
20 MOH. 'AZZAM ASYROFUL MU'MININ SURIYANTO, S.PD.I - ATIK SUSNOFITASARI 12/2/2012 4
21 MOH. FAKHRI FARHAN FAHREZI SURIYANTO, S.PD.I - ATIK SUSNOFITASARI 10/30/2008 8
22 AHMAD ZAINURI MASTURI - ATIYE 7/7/2003 13
23 MOHAMMAD RAFA MAULANA NOOR MOH. ANWAR - ASRIYANI 5/20/2013 3
24 MAULANA AGUS SALIM MOH. ANWAR - ASRIYANI 8/17/2006 10
25 ALIYA NABILA ZAHRA NURUL HIDAYAT - HILDA EMI SISWANTI 24/03/2015 1
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PENANGGUNG JAWAB DESA

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