Bulan Penimbangan Balita 2017

FORMULIR PENCATATAN
BULAN PENIMBANGAN BALITA (BPB)

DINAS KESEHATAN KABUPATEN BEKASI TAHUN 2017
PUSKESMAS : MEKAR MUKTI

POSYANDU/DESA : MELATI IX / SIMPANGAN
NAMA NAMA TANGGAL TGL LAHIR CARA BB

NO ALAMAT G / NG L/P
BALITA ORANG TUA TIMBANG (TGL/BLN/TH) B/T (KG)
1 2 3 4 5 6 7 8 9 10
1 RASYA ATHAYA PIAT / ECIH RT. 001 / 005 8/14/2017 7/1/2016 1 7 2016 B L 9.4
2 DINDA ASSYIFA ARIPIN / NURWENDAH RT. 001 / 005 8/14/2017 9/3/2015 B P 11.5
3 AZKA DWI P. NURROIS / SRI S. RT. 001 / 005 8/14/2017 2/5/2014 T L 12
4 ASEEQA S.N. KASMAN / NANI S. RT. 001 / 005 8/14/2017 10/8/2016 B P 7.5
5 ALISA N.Z. ILAN P. / MARYANAH RT. 001 / 005 8/14/2017 1/29/2013 T P 14
6 ADAM SARI M. SUPRIATNA / KARMIAN RT. 001 / 005 8/14/2017 3/6/2013 T L 13
7 M. ALDIANSYAH DIANTO / AAS S. RT. 001 / 005 8/14/2017 12/18/2012 T L 17
8 ADEEVA A.I. FERRY / NURLAILA RT. 001 / 005 8/14/2017 5/30/2010 B P 9.5
9 M. AUFAR M. M. FAJAR / CICIH P. RT. 001 / 005 8/14/2017 12/11/2013 T L 14
10 ABDILLAH AL-H RIKI / JUJU RT. 001 / 005 8/14/2017 12/28/2016 B L 7.8
11 NAFISA M. A. BASYIT / EKAWATI RT. 001 / 005 8/14/2017 5/21/2016 T P 8.3
12 DAMAR PRATAMA DAVID / MIMIN RT. 001 / 005 8/14/2017 12/14/2014 T L 13
13 JAFIRA A.A NATA / YANI RT. 001 / 005 8/14/2017 12/23/2012 B P 15
14 ABID R. ATO P. / ANIH R. RT. 001 / 005 8/14/2017 7/10/2014 B L 12
15 MARWAH S.P SUMARNA / ANEH RT. 001 / 005 8/14/2017 9/13/2012 B P 10
16 REDI ADITIYA M. ASEP DERIS / YULIANA RT. 001 / 005 8/14/2017 11/10/2013 B L 14
17 DEDEN PURNAMA FERRY / TUTI RT. 001 / 005 8/14/2017 5/16/2014 B L 10
18 HAFIZH R.M AGUS / MARLINA RT. 001 / 005 8/14/2017 8/23/2016 T L 8.1
19 MARTIN M. ASMAN / SITI K. RT. 001 / 005 8/14/2017 11/4/2013 B L 20
20 DZAKIYA AUFA SATAR / INDAR RT. 001 / 005 8/14/2017 6/22/2016 T P 8
21 SAFALUNA W.R.J SATAR / INDAR RT. 001 / 005 8/14/2017 4/13/2017 P
22 NUR DEEVA MASKIM / YATI M. RT. 001 / 005 8/14/2017 3/24/2013 P 12
23 ASTIAN SANUSI UCI S. / NURHAYATI RT. 001 / 005 8/14/2017 11/2/2013 L 14
24 M. ALFA RIZKY AMIR / MARLAH RT. 001 / 005 8/14/2017 7/8/2016 L 10.3
25 MIKHAYLA N.A KARNITA / RINI S. RT. 001 / 005 8/14/2017 10/29/2014 P 11
26 ADZKIA H.N M. IRFAN / ATIKAH RT. 001 / 005 8/14/2017 3/10/2015 P 10.5
27 DIAN P. YAYAN / TITA RT. 001 / 005 8/14/2017 5/21/2013 P 12
28 MICHELL PRASETYO / DEWI RT. 001 / 005 8/14/2017 12/2/2012 P 13
29 ARKAN PRASETYO / DEWI RT. 001 / 005 8/14/2017 4/21/2014 L 12
30 M. ZIDHAN A. RIFKI / LIA RT. 001 / 005 8/14/2017 8/29/2014 L 10
31 SYAIQ IRMAN / DIKA RT. 001 / 005 8/14/2017 2/13/2016 L 9
32 FITRI ROPAL / MERI RT. 001 / 005 8/14/2017 6/20/2016 P 8.3
33 RISA SEPTIANI MINTA / EVIH RT. 001 / 005 8/14/2017 9/3/2016 P 7.5
34 REYSA PUTRI MUJIONO / NANENG RT. 001 / 005 8/14/2017 6/27/2016 P 6.5
PETUGAS
(...................................)
FORMULIR PENCATATAN

POSYANDU/DESA : MELATI XI / SIMPANGAN

1 2 3 4 5 6 7 8 9 10
35 KARISA P. HERY / KAESIH RT. 001 / 005 8/14/2017 8/20/2012 B P 10
36 ADIRA HERY / KAESIH RT. 001 / 005 8/14/2017 6/7/2014 T P 6
37 BUNGA S.U SYAWAL / NURNI RT. 001 / 005 8/14/2017 12/30/2013 B P 15
38 ANINDARA ANWAR / NURFAJRIAH RT. 001 / 005 8/14/2017 5/31/2017 P 5.3
39 RAZQA A.S M. SIDIQ / NUR SETCI RT. 001 / 005 8/14/2017 11/17/2016 B L 8
40 RESKY PRATAMA KANAM / SALBIAH RT. 001 / 005 8/14/2017 7/20/2015 L 9
41 ZAHRA S.R ANDRI / SUHARTANTI RT. 001 / 005 8/14/2017 9/27/2014 B P 11.5
42 NANDA EDI / NURTYAS RT. 001 / 005 8/14/2017 1/13/2014 B P 12
43 FAKHRI Z. WIDYANTO / UMI RT. 001 / 005 8/14/2017 11/23/2014 B L 12.8
44 BERTA ALISA F. KARYAWAN / TRI W. RT. 001 / 005 8/14/2017 10/24/2014 B P 11
45 ABINAYA H.N ABD. RAHMAN / EKA RT. 001 / 005 8/14/2017 1/29/2016 B L 10
46 M. ALWI R.R ERIS / MARLINA RT. 001 / 005 8/14/2017 7/22/2013 B L 15
47 LUTFIA A. MAD YUSUF / YAYUK RT. 001 / 005 8/14/2017 10/29/2014 B P 15
48 ZAHROTUL N. SLAMET / MARWATI RT. 001 / 005 8/14/2017 8/17/2012 B P 15
49 NARENDRA ZIDAN ASEP / SIMAH RT. 001 / 005 8/14/2017 5/10/2016 T L 8
50 NURSYIFA ALIYA WIDADI / NIA RT. 001 / 005 8/14/2017 8/12/2014 B P 11
51 SITI NAFISAH T. LASIRIM / SITI INDAH RT. 001 / 005 8/14/2017 3/29/2014 B P 12.5
52 NAUFAL K. AZZAM ADI / SAMAH RT. 001 / 005 8/14/2017 5/28/2015 B L 9
53 WINA A.P CECEP / SRI WULAN RT. 001 / 005 8/14/2017 8/16/2014 B P 16
54 ZAHRA SUMIAJI IYUS / SUTARI RT. 001 / 005 8/14/2017 9/14/2014 B P 16
55 RIFFA S. SUDIRMAN / DESI RT. 001 / 005 8/14/2017 12/30/2013 B P 12
56 NUR UMAIRAH S. ADE/ MARFUAH RT. 001 / 005 8/14/2017 12/26/2016 B P 11
57 M. ALFAILAH RUDIANA / SITI N. RT. 001 / 005 8/14/2017 11/5/2013 B L 15
58 EUIS K. DEDI / UNAH RT. 001 / 005 8/14/2017 9/30/2014 B P 10
59 MURTIA MULKI / SRI H. RT. 001 / 005 8/14/2017 2/19/2014 B P 10
60 BILQIS UFAIRA SUHENDAR / NIA RT. 001 / 005 8/14/2017 1/29/2015 B P 11
61 RIANSYAH ADE / NURHAYATI RT. 001 / 005 8/14/2017 3/17/2014 B L 10.5
62 NAZILA OCTA F. MACHRONI / PIPIT F. RT. 001 / 005 8/14/2017 10/23/2012 B P 12.5
63 ANISA R.W WIRYA / MELAWATI RT. 001 / 005 8/14/2017 10/19/2014 B P 10
64 AKILA N.M MULYADI / ARYANI RT. 001 / 005 8/14/2017 1/17/2014 B P 14
65 AVKA F.N SOLIHIN / DEDEH RT. 001 / 005 8/14/2017 3/12/2014 B L 10.5
66 ZIDNI A.N JAJANG / TITIN RT. 001 / 005 8/14/2017 8/20/2015 B L 10
67 M. LEANO FASLAH RINO / LENI RT. 001 / 005 8/14/2017 12/23/2013 B L 10.5
68 M. HALIT A. SANA / ERNA RT. 001 / 005 8/14/2017 11/5/2015 B L 10
PETUGAS
(...................................)
FORMULIR PENCATATAN

POSYANDU/DESA : MELATI XI / SIMPANGAN

1 2 3 4 5 6 7 8 9 10
69 M. JAELANI UDIN / OMIH RT. 001 / 005 8/14/2017 8/8/2013 B L 11
70 ARSYAD BILAL A. ASEP / LINDA RT. 001 / 005 8/14/2017 10/27/2015 B L 10.5
71 AISYAH NUR A. KARMADI / SUSI RT. 001 / 005 8/14/2017 8/28/2015 B P 10.5
72 AZIIZAH HERU / HERNI RT. 001 / 005 8/14/2017 12/23/2013 B P 11.5
73 ZASKIA YADI / KARTINI RT. 001 / 005 8/14/2017 3/6/2013 B P 12.5
74 NABILA SANUSI / ROMLAH RT. 001 / 005 8/14/2017 2/10/2014 B P 13
75 DAVA PRAYOGA DERI / SITI RT. 001 / 005 8/14/2017 11/11/2016 T L 7.7
76 M. FAREL NURDIN / LIA RT. 001 / 005 8/14/2017 11/15/2012 B L 12.5
77 HAIKAL UMAR / NINA RT. 001 / 005 8/14/2017 2/17/2014 B L 10
78 RIZKY DASAN / NENGSIH RT. 001 / 005 8/14/2017 5/30/2014 B L 13
79 M. RIZKI SUWANDA / NURSINAH RT. 001 / 005 8/14/2017 3/22/2013 B L 12
80 LANA SAPUTRA UJANG / WULAN RT. 001 / 005 8/14/2017 11/10/2015 B L 10.5
81 REYHAN M.Y YUSUF / SRI DEWI RT. 001 / 005 8/14/2017 6/13/2015 B L 10
82 NIKEN CAHAYA M. AJIN / NANI S. RT. 001 / 005 8/14/2017 5/29/2016 T P 9
83 HAFIFAH F. ARFAN / MAEMUNAH RT. 001 / 005 8/14/2017 4/16/2015 B P 13
84 HAFIDZAH A.P DEDI / SITI RT. 001 / 005 8/14/2017 6/9/2013 P 12.5
85 ALIF NANDONO JOKO / DEWI RT. 001 / 005 8/14/2017 11/11/2012 L 13
86 FITIN ZAHRA A. ROBY / ANI RT. 001 / 005 8/14/2017 5/6/2013 P 13.5
87 NITA LESTARI S. IMAN / IRMAYANIH RT. 001 / 005 8/14/2017 9/16/2012 P 14
88 FARIS ASOTARI ABD. HAMID/ROKAYAH RT. 001 / 005 8/14/2017 11/10/2012 L 15.5
89 M. NURFADILAH KUSNANDAR/MUSTAKI RT. 001 / 005 8/14/2017 10/28/2012 L 15
90 AISYAH F.B IRPAN / IDAH RT. 001 / 005 8/14/2017 9/26/2012 P 14.5
91
92
93
94
95
96
97
98
99
100
101
102
PETUGAS
(...................................)
FORMULIR PENCATATAN

POSYANDU/DESA : MELATI 3 / SIMPANGAN (KAUM TENGAH)

1 2 3 4 5 6 7 8 9 10
1 ALESSYA S.S CECEP SUPRIYADI RT.002/001 8/16/2017 12/1/2014 B P 14.2
2 ROUDHOTUN N.W RUDI WINARTO RT.002/001 8/16/2017 3/5/2016 B P 10.9
3 MUHAMMAD DZIKRI RIKI SYARPANI RT.002/001 8/16/2017 5/27/2016 B L 8.5
4 AFIQAH PUTRI R. AFIF MARTINO RT.002/001 8/16/2017 5/31/2016 B P 10
5 SEKAR AYUKINASIH L. BAMBANG ARIS B. RT.002/001 8/16/2017 10/2/2014 B P 13.1
6 ALIFIA ABQORI N. DITA NUGRAHA RT.002/001 8/16/2017 5/31/2016 B P 6.7
7 KEIRA HASYA K. ADE KURNIAWAN RT.002/001 8/16/2017 9/8/2013 B P 15.8
8 NACHILLA AFSHEENA K. ADE KURNIAWAN RT.002/001 8/16/2017 4/5/2016 B P 9.4
9 SHAKILA PUTRI Z. TRI SUSANTIYO RT.002/001 8/16/2017 3/21/2015 B P 11
10 SARI ASIH EMAN SULAEMAN RT.002/001 8/16/2017 6/14/2016 B P 7.1
11 ZIHAN ALFIRA LESMANA INDRA LESMANA RT.002/001 8/16/2017 8/28/2013 B P 13.1
12 M. HAFIZD RIDWAN RIDWAN RT.002/001 8/16/2017 3/28/2015 B L 10.8
13 NAJMAH KAMILAH ABDULLAH ARFAN RT.002/001 8/16/2017 12/4/2015 B P 10.9
14 UMAM JAINAL ARIFIN RT.002/001 8/16/2017 2/24/2016 B L 11
15 REYSTAND VANBOYS N. TONGAM NABATAN RT.002/001 8/16/2017 6/15/2013 B L 19.9
16 SRI AYU NINGSIH JAENUDIN RT.002/001 8/16/2017 7/23/2015 B P 10
17 SALSA AULYA P. SAHIDIN RT.002/001 8/16/2017 6/25/2013 B P 15.7
18 M. RIZKY RAMADHAN JUHANA GUSDAN RT.002/001 8/16/2017 7/16/2014 B L 16.1
19 DAYIN KAYSHA SYAKIRA ABDUL BASIT RT.002/001 8/16/2017 2/27/2016 B P 7.5
20 AZKI YATUNNISA YOGA SUMANTRI RT.002/001 8/16/2017 9/8/2014 B P 11.5
21 ABDURAHHMAN A. SUPANDI RT.002/001 8/16/2017 3/31/2014 B L 12.1
22 HANIA PUTRI S. HARTOYO RT.002/001 8/16/2017 8/5/2014 B P 11.8
23 VINO WIJAYA TRIWIJAYANTO RT.002/001 8/16/2017 5/26/2013 L 17.6
24 REGINA A.R ROZALI RT.002/001 8/16/2017 5/18/2013 P 16.6
25 M. ALFIKRI M. SAEPUL YUSUF RT.002/001 8/16/2017 1/31/2013 L 15.3
26 CAHAYA P.A.R SUPARMAN RT.002/001 8/16/2017 8/11/2012 P 14.9
27 AZKA A.P TARSO RT.002/001 8/16/2017 7/10/2012 L 17.9
28 AFANDI FAIRUZ BAMBANG EFENDI RT.002/001 8/16/2017 1/19/2013 L 15.4
29 ANISA Z.J CECEP NUGRAHA RT.002/001 8/16/2017 7/4/2012 P 16.8
30 TRISTAN ALUARO USMAN EFENDI RT.002/001 8/16/2017 7/11/2012 L 15.3
31 HASSAM KHOLIL R. INARA SUDITA RT.002/001 8/16/2017 11/20/2014 L 13.3
32
33
34
PETUGAS
(...................................)
FORMULIR PENCATATAN

POSYANDU/DESA : MELATI 2 C / SIMPANGAN ( JL. CILIWUNG )
TB UMUR NAMA NAMA TANGGAL TGL LAHIR CARA BB

(CM) (BULAN) BALITA ORANG TUA TIMBANG (TGL/BLN/TH) B/T (KG)
11 12 1 2 3 4 5 6 7 8 9 10
74 BLN 1 NAFIZAR M.Y SUYADI JL.CLWG 1 8/9/2017 9/24/2013 B L 12
82 BLN 2 CHANDRA N. KARDIYONO JL.CLWG RY. 8/9/2017 4/4/2013 B L 31.2
94.5 BLN 3 VITO I. SLAMET W. JL.CLWG RY. 8/9/2017 11/23/2013 B L 17.9
67 BLN 4 FRIDA P.R ROMADHON JL.CLWG 1 8/9/2017 5/6/2015 B P 12
102 BLN 5 USTMAN PURWA A. JL.CLWG 1 8/9/2017 4/1/2015 B L 10
98.5 BLN 6 FRAFANDRA A. NUR SAHADI JL.CLWG RY. 8/9/2017 1/1/2014 B L 16.6
110 BLN 7 NADA F. LILI ASYHARI JL.CLWG RY. 8/9/2017 8/13/2013 B P 21.7
76 BLN 8 DAFI A.P RUDIYANTO JL.CLWG RY. 8/9/2017 2/9/2015 B L 14.1
95 BLN 9 HARIS ALFI BADRUN JL.CLWG RY. 8/9/2017 8/10/2012 B L 20.8
68 BLN 10 FAQIH A. BDRUN JL.CLWG RY. 8/9/2017 5/10/2015 B L 11.8
70 BLN 11 BRIAN D.S ACHIR PUJI JL.CLWG RY. 8/9/2017 2/2/2014 B L 15.8
88.5 BLN 12 NAURA A.S MUHASIN JL.CLWG 1 8/9/2017 6/2/2015 B P 11.3
110 BLN 13 ULDA K. BAMBANG P. JL.CLWG 1 8/9/2017 3/22/2004 B P 11.4
89 BLN 14 ALVI ALDIAN SURADI JL.CLWG 1 8/9/2017 6/14/2013 B P 17.8
91 BLN 15 HARUMI Z. DEDY JL.CLWG 1 8/9/2017 12/10/2014 B P 12.3
100 BLN 16 AULIA I. FATHUR R. JL.CLWG 1 8/9/2017 1/19/2013 B P 15.3
88 BLN 17 FATHIYA FATHUR R. JL.CLWG 1 8/9/2017 9/16/2015 B P 9.4
69 BLN 18 ANINDITHA K. BAMBANG JL.CLWG 1 8/9/2017 2/9/2015 B P 12.3
104 BLN 19 AFIKA H. HERI JL.CLWG 1 8/9/2017 1/15/2014 B P 15.8
74 BLN 20 CALISTA A. HERI JL.CLWG 1 8/9/2017 6/18/2016 T P 9.5
BLN 21 RAFI I.H PONIMIN JL.CLWG 4 8/9/2017 8/18/2013 B L 15.2
95 BLN 22 ISMAIL A. PURWA A. JL.CLWG 1 8/9/2017 8/13/2012 B L 16.8
99 BLN 23 GHINA Q. TONI A. JL.CLWG 2 8/9/2017 11/1/2013 B P 18.4
76 BLN 24 ASTAGINA S. SENO JL.CLWG 4 8/9/2017 10/29/2015 B P 16.3
88 BLN 25 M. ULIL A. HADI P. JL.CLWG 2 8/9/2017 9/27/2013 B L 11.7
83 BLN 26 RAIHANA M. JAJAY Z. JL.CLWG 2 8/9/2017 1/3/2015 B P 11.7
9 BLN 27 THALLITA M. JHONI L. JL.CLWG 2 8/9/2017 2/3/2016 T P 8
99 BLN 28 ALKHALIFI D. DEDE ANARI JL.CLWG 2 8/9/2017 8/6/2015 B L 17.3
94 BLN 29 NAYARA A. BACHTIAR JL.CLWG 2 8/9/2017 12/27/2014 B P 12.8
88 BLN 30 M. ARKAN EKO S. JL.CLWG 2 8/9/2017 2/5/2016 B L 10.8
87 BLN 31 DAFI F. HERMANSYAH JL.CLWG 2 8/9/2017 10/2/2012 B L 22.3
73 BLN 32 ABDILLAH KHOLIL JL.CLWG RY. 8/9/2017 7/20/2016 B L 7.5
66 BLN 33 ARFA A.F FAIZAN JL.CLWG 4 8/9/2017 11/25/2014 B L
67 BLN 34 ARKA REGA RODMAD JL.CLWG RY. 8/9/2017 7/9/2013 b L 15.9
PETUGAS
.....................) (...................................)
FORMULIR PENCATATAN


11 12 1 2 3 4 5 6 7 8 9 10
95 BLN 35 ZALFA P.H HERMAN JL.CLWG 6 8/9/2017 8/18/2016 T P 8.3
55 BLN 36 BUDHIMAN SUWOYO JL.CLWG 6 8/9/2017 7/28/2013 B L 15.1
95 BLN 37 FRASH MONO CAHYO JL.CLWG 6 8/9/2017 8/31/2013 B L 17.6
60 BLN 38 M. AZKA A. DEDY JL.CLWG 6 8/9/2017 10/16/2015 B L 12.1
68 BLN 39 DANIEL P. YI P. JL.CLWG 5 8/9/2017 6/17/2014 B L 13
75 BLN 40 FAREL HAFIZ BAGUS P. JL.CLWG 6 8/9/2017 1/8/2016 B L 1.7
83 BLN 41 IBRAHIM S. SUWANTO JL.CLWG 3 8/9/2017 8/29/2012 B L 16.4
90 BLN 42 MILATUL M. YAHYA JL.CLWG 5 8/9/2017 2/6/2016 B P 11
96 BLN 43 YEBRINA N. YUSAK JL.CLWG 3 8/9/2017 12/23/2012 B P 14.8
87 BLN 44 TAFANA R. RONI U. JL.CLWG RY. 8/9/2017 3/16/2015 B P 11.2
77 BLN 45 AKMAL A. ERWIN JL.CLWG 6 8/9/2017 2/7/2014 B L 12.2
98 BLN 46 ABID R. TEGUH JL.CLWG 5 8/9/2017 6/22/2013 B L 36.7
88 BLN 47 RAHMA M. CECEP JL.CLWG 6 8/9/2017 2/10/2014 B P 17.7
107 BLN 48 MUKIA R.K SYAMSUL JL.CLWG 6 8/9/2017 7/13/2016 T P 9.1
72 BLN 49 ABBAS NGATONO JL.CLWG RY. 8/9/2017 8/14/2013 B L 12.9
93 BLN 50 FAHMI A. ARIF USMAN JL.CLWG 3 8/9/2017 3/3/2014 B L 12.6
92 BLN 51 M. ATHFAL A. RISAWANDI JL.CLWG 7 8/9/2017 11/11/2015 B L 10.5
94 BLN 52 HILAL N. JUYANTO JL.CLWG 8 8/9/2017 7/27/2016 T L 7.7
94 BLN 53 EDGHAR H. YAYAT S. JL.CLWG 8 8/9/2017 1/30/2012 B L 17.9
93 BLN 54 UMAIRA A. MULYONO JL.CLWG 10 8/9/2017 5/12/2014 B P
92 BLN 55 FAEZA D. KAMILUDIN JL.CLWG 8 8/9/2017 11/9/2013 B L 25
91 BLN 56 ANAM T.B M. SYUKUR JL.CLWG 8 8/9/2017 2/26/2016 B L 1.5
95 BLN 57 NAYSA R. SUPRIYANTO JL.CLWG 10 8/9/2017 8/13/2015 B P 11.8
84 BLN 58 KHANZA N. ANGGA JL.CLWG 8 8/9/2017 1/25/2014 B P 13.7
97 BLN 59 M. RIFAN M. RIADI U. JL.CLWG 9 8/9/2017 12/25/2016 B L 9.3
88 BLN 60 KAINAN A. RUSNANTO JL.CLWG 9 8/9/2017 29/02/2016 B L 11
90 BLN 61 KEISHA A.J WIRO F. JL.CLWG 9 8/9/2017 12/9/2015 B P 8.1
102 BLN 62 M. FUAD A. PURWANTO JL.CLWG 9 8/9/2017 5/16/2014 B L 12.7
92 BLN 63 M. SYAFIQ EDY YANORA JL.CLWG 9 8/9/2017 5/21/2015 B L 12
96 BLN 64 JUAN A. JACKSON JL.CLWG 8 8/9/2017 3/19/2015 B L 11.2
90 BLN 65 SYAFA R.M ARIEF L. JL.CLWG 7 8/9/2017 11/1/2013 B P 14.1
84 BLN 66 M. ALTHAR R. ARIEF L. JL.CLWG 7 8/9/2017 8/13/2012 B L 12.1
98 BLN 67 RIZKY R. AL-IBRAHIM JL.CLWG 7 8/9/2017 6/6/2016 T L 7.5
82 BLN 68 RASYID N. HERMANSYAH JL.CLWG 2 8/9/2017 9/10/2016 T L 9.7
PETUGAS
.....................) (...................................)
FORMULIR PENCATATAN


11 12 1 2 3 4 5 6 7 8 9 10
100 BLN 69 KHAIRA UJANG W. JL.CLWG 4 8/9/2017 9/22/2016 B P 8.5
88 BLN 70 SARAH BAMBANG JL.CLWG RY. 8/9/2017 8/1/2016 B P 8.1
82 BLN 71 M. RIDWAN RAHMATULLAH JL.CLWG RY. 8/9/2017 9/13/2016 B L 10
104 BLN 72 ADITIYA R. CECEP JL.CLWG 6 8/9/2017 10/14/2016 T L 10
110 BLN 73 DANIER F.G ROMADHON JL.CLWG 1 8/9/2017 9/30/2016 T L 10.1
93 BLN 74 ASKADINA FAKHRUZI JL.CLWG 7 8/9/2017 9/10/2016 T P 8.7
68 BLN 75 MAHIRA H. DWI S. JL.CLWG RY. 8/9/2017 10/23/2016 T P 8.5
113 BLN 76 SHAHIA L. TRIYANTA JL.CLWG 9 8/9/2017 7/21/2016 T P 10
88 BLN 77 MAITIAS J. JIANG GUO JL.CLWG 7 8/9/2017 1/15/2013 B L 28.6
95 BLN 78 FELISHA Q. JIANG GUO JL.CLWG 7 8/9/2017 10/20/2014 B P 14
97 BLN 79 ZIKRI A. ROHMAT JL.CLWG 7 8/9/2017 8/15/2012 B L 17
98 BLN 80 SARAH H. EKO H. JL.CLWG 7 8/9/2017 4/3/2017 T P 6.4
84 BLN 81 AL AZIZAH WASNO JL.CLWG 3 8/9/2017 6/11/2017 T P 5
76 BLN 82 REYSA A. SHOLEHAN JL.CLWG 6 8/9/2017 4/14/2017 T P 6.6
87 BLN 83 IBRAHIM GILANG JL.CLWG 3 8/9/2017 3/30/2017 T L 7
100 BLN 84 BEINARA ENDRO JL.CLWG 6 8/9/2017 10/7/2017 T P 7.6
115 BLN 85 FATHAN ARI S. JL.CLWG 1 8/9/2017 5/25/2017 T L 6.6
120 BLN 86 AGHAM R. AMIRUIN JL.CLWG RY. 8/9/2017 7/5/2017 T L 4.6
125 BLN 87 ANNASYA BUDIHARTO JL.CLWG 1 8/9/2017 7/25/2012 T P 3.6
100 BLN 88 RAISHA A. AHMAD M. JL.CLWG 8 8/9/2017 11/11/2013 B L 13.4
115 BLN 89 RAFIF T. ERIKKO JL.CLWG 7 8/9/2017 10/20/2014 B L 13
110 BLN 90 M. IBRAHIM INDRA G. JL.CLWG 4 8/9/2017 10/17/2013 B L 13
BLN 91 WAHYU R. KASNO JL.CLWG 3 8/9/2017 4/9/2015 B L 12.8
BLN 92 WAHYU J. KASNO JL.CLWG 3 8/9/2017 11/23/2013 B L 12.6
BLN 93
BLN 94
BLN 95
BLN 96
BLN 97
BLN 98
BLN 99
BLN 100
BLN 101
BLN 102
PETUGAS
.....................) (...................................)
FORMULIR PENCATATAN
PUSKESMAS :
POSYANDU/DESA : MELATI 2 B / SIMPANGAN ( JL. CITARUM)

11 12 1 2 3 4 5 6 7 8 9 10
103 BLN 1 AQILA NUR IKHSAN / SUSI W. CITARUM 9 8/7/2017 5/24/2015 B P 10.5
87 BLN 2 SITI AULIA SLAMET D./ SUKARTINI CITARUM 2 8/7/2017 12/1/2015 B P 12
86 BLN 3 CORNELIA IRAWAN F. / UJU J. CITARUM 9 8/7/2017 2/11/2015 B P 12
86 BLN 4 RAISA HERY S. / YENIK P. CITARUM 9 8/7/2017 1/30/2013 B P 13
103 BLN 5 TUPA RAMOTAN / RAMA S. CITARUM 2 8/7/2017 10/15/2013 B P 19
77 BLN 6 FAIDA DIAN HARDIYANTO / NUMI CITARUM 8 8/7/2017 5/7/2015 B P 11.5
111 BLN 7 KHANZA NUR RAHMAD / ERNI CITARUM 8 8/7/2017 12/6/2015 B P 9
85 BLN 8 NADIA BAMBANG / SULISTIAWAT CITARUM 3 8/7/2017 12/30/2014 B P 11
83 BLN 9 AKIFA NAILA SARYANTO / NUR CITARUM 3 8/7/2017 1/18/2013 B P 13
81 BLN 10 KAEL NYOTO / SUMINAR CITARUM 5 8/7/2017 12/13/2014 B L 12
110 BLN 11 KEPAS DARSONO / LENTIKER CITARUM 9 8/7/2017 9/20/2012 B L 22
96 BLN 12 KEVIN SAMUEL SUTRISNO / KRISTINA CITARUM 2 8/7/2017 7/19/2016 T L 9.3
89 BLN 13 PUTRI IRANA TARMIDI / MUR CITARUM 9 8/7/2017 12/28/2015 B P 9
95 BLN 14 M. ARIF M. ASKUR / NANI CITARUM 4A 8/7/2017 4/12/2015 B L 12
117 BLN 15 M. ALIF ARIF / SISKA CITARUM 9B 8/7/2017 5/20/2015 B L 11.5
91 BLN 16 FAYYADH SUGIARTO / DARUKI CITARUM 2B 8/7/2017 7/16/2014 B L 12
113 BLN 17 ATHAR MISNO / KHUSNUL CITARUM 8 8/7/2017 2/17/2016 B L 10.5
105 BLN 18 INTAN ZAINUDIN / SITI CITARUM 5C 8/7/2017 9/3/2016 T P 7.1
81 BLN 19 BILQIS YAYAT / NENDEN CITARUM 8B 8/7/2017 8/18/2013 B P 16
97 BLN 20 TOMI JOKO / HERNA CITARUM 2 8/7/2017 10/23/2013 B L 14
98 BLN 21 ANDIKA RIAN / SUM CITARUM 9B 8/7/2017 12/28/2012 B L 14
97 BLN 22 KAMILA MAMAN / ETI CITARUM 4A 8/7/2017 1/11/2016 T P 10
117 BLN 23 ANDIN ASWIN / SA'IYAH CITARUM 8C 8/7/2017 2/28/2013 B P 13
114 BLN 24 ADELIA ASWIN / SA'IYAH CITARUM 8C 8/7/2017 4/28/2016 B P 8.3
119 BLN 25 NURUL SUTIYONO / KUNIJAH CITARUM 8B 8/7/2017 12/20/2014 B P 10
109 BLN 26 FAQIH TRIYONO / NANIK CITARUM 4A 8/7/2017 12/21/2015 B L 9
116 BLN 27 RAGIL SUGI / NUNIK CITARUM 3C 8/7/2017 12/6/2013 B P 11
109 BLN 28 GENDIS SUGI / NUNIK CITARUM 3C 8/7/2017 1/3/2016 T L 7.3
117 BLN 29 JASSON RAFAEL / ASMEDI CITARUM 9 8/7/2017 8/15/2012 B L 18
117 BLN 30 ARIQAH SUJARI / WILASTUTI CITARUM 4A 8/7/2017 5/30/2016 B P 8.7
100 BLN 31 GERRA RONI / LITA CITARUM 7B 8/7/2017 12/19/2013 B L 12
BLN 32 AYUNDA PURWANTO / ENDANG CITARUM 2C 8/7/2017 6/27/2014 B P 10
BLN 33 FARHAN ANANG / PIPIH CITARUM 2C 8/7/2017 5/5/2014 B L 12.5
BLN 34 AHMAD MUHAMMAD / SUSI CITARUM 2C 8/7/2017 5/28/2015 B L 11.5
PETUGAS
.....................) (...................................)
FORMULIR PENCATATAN
PUSKESMAS :
POSYANDU/DESA : MELATI 2 B / SIMPANGAN ( JL. CITARUM)

1 2 3 4 5 6 7 8 9 10
35 RAFFI TITO / IDA CISANGKUY 8/7/2017 5/25/2015 B L 12
36 AFIFAH CAHYO / ASMAUL CITARUM 5C 8/7/2017 11/30/2013 B P 15
37 CHEVY TARDI / RENI CITARUM 2C 8/7/2017 7/7/2015 B L 9
38 DZIKA HARI / NUR CITARUM 4 8/7/2017 10/22/2012 B L 20
39 AMIRA LILIK / EVA CISANGKUY 8/7/2017 7/30/2014 B P 9.7
40 ELKA DENI / WAHYU CITARUM 7 8/7/2017 1/1/2014 B L 17
41 JANEETA AGUS / SUISTIYANINGSIH CITARUM 2C 8/7/2017 11/11/2012 B L 18
42 HAFIZH SUWARNO / ERLINA CITARUM 2C 8/7/2017 4/3/2014 B L 17
43 TALITA FAWALA / RARA CITARUM 2 8/7/2017 5/15/2015 B P 9.1
44 NAUFAL HARYONO / UTAMI CITARUM 7 8/7/2017 2/24/2013 B L 17
45 FIRDA EKO / ASTUTI CITARUM 6 8/7/2017 3/4/2014 B P 9
46 ZIA AL ATHAR / NURIL CITARUM 9 8/7/2017 7/11/2013 B P 15
47 PARIKESIT AL ATHAR / NURIL CITARUM 9 8/7/2017 8/6/2015 B L 9.6
48 ROSIHAN KASWIN / NUR CITARUM 4C 8/7/2017 3/26/2013 B L 16
49 MARCHELL LEONARDO / RIDA CITARUM 4C 8/7/2017 3/21/2015 B L 13.5
50 AMANDA USMAN / WIWIN CITARUM 8 8/7/2017 2/17/2014 B P 14
51 RASYID SLAMET / NING CITARUM 5C 8/7/2017 1/21/2013 B L 13
52 HAFIZH ZULNAIDI / SITI 8/7/2017 10/14/2015 B L 12
53 AZMYA JUPRI / ENDAR CITARUM 2C 8/7/2017 7/2/2016 B P 9
54 M. IBNU SULAIMAN / SRI CITARUM 8 8/7/2017 5/30/2016 B L 10.5
55 HANUM GUNTORO / CITARUM 9 8/7/2017 8/5/2015 B P 9
56 KANAYA KANTA / NANI CITARUM 4 8/7/2017 3/12/2016 B P 10.1
57 JUAN JUNIAR / HOTNA CITARUM 8 8/7/2017 9/7/2012 B L 16
58 AL CAESAR NANA / SUSI CITARUM 8 8/7/2017 8/21/2013 B L 13
59 NAYLA SARYANTO / NUR CITARUM 3 8/7/2017 1/18/2013 B L 13
60 AMRI SRI HIDAYAT/ROHANA CISANGKUY 8/7/2017 10/10/2014 B L 10
61 ANINDIYA RAMLAN / IDA CITARUM 5 8/7/2017 11/7/2015 B P 10
62 ATAYA MISNO SUYADI / TRI CITARUM 5 8/7/2017 1/28/2017 T L 7.7
63 BINTANG BAGUS / UMROH CITARUM 9 8/7/2017 8/27/2014 B L 15
64 AJUAN IMRAN / PUNIA CITARUM 5 8/7/2017 7/14/2012 B L 22
65 ATIIZAR SULAIMAN/FATHANAN CITARUM 3 8/7/2017 6/1/2016 B L 8.4
66 MARQUEST PABER / BERLIANA CITARUM 5 8/7/2017 3/12/2014 B L 15
67 JUAN JAFAR / DEWI CITARUM 5 8/7/2017 6/28/2014 B L 12
68 ADELINA JAFAR / DEWI CITARUM 5 8/7/2017 4/7/2017 T P 5.5

69 ABDUL ARIS / SRI CITARUM 8 8/7/2017 10/14/2016 T L 8.8
PETUGAS
(...................................)
FORMULIR PENCATATAN
PUSKESMAS :
POSYANDU/DESA : LAVENDER / SIMPANGAN

11 12 1 2 3 4 5 6 7 8 9 10
101 BLN 1 NINDA EKO RT. 002/009 8/16/2017 2/12/2012 B P
109 BLN 2 ANNAS A. KARIM RT. 002/009 8/16/2017 0/02/2012 B L
96 BLN 3 FATHIR JULY RT. 002/009 8/16/2017 5/28/2012 B L
89 BLN 4 MARIZKA RAJALALI RT. 002/009 8/16/2017 5/25/2012 B P
78 BLN 5 ALZENA RAHMAT RT. 002/009 8/16/2017 6/18/2012 B P
99 BLN 6 RASYA AFRIJAL RT. 002/009 8/16/2017 6/13/2012 B L
103 BLN 7 NAGARUDA ERWAN RT. 002/009 8/16/2017 7/17/2012 B L
94 BLN 8 RANIA DEDE RT. 002/009 8/16/2017 8/15/2012 B P 16
105 BLN 9 S. GLEEN YOHANES RT. 002/009 8/16/2017 9/8/2012 B L 25.2
87 BLN 10 SUHAEB ABDULLAH RT. 002/009 8/16/2017 10/15/2012 B L
97 BLN 11 IRSYAD AUB RT. 002/009 8/16/2017 10/5/2012 B L
81 BLN 12 KARINA SUGIARTO RT. 002/009 8/16/2017 10/22/2012 B P
83 BLN 13 A. WILLY RO'YAT RT. 002/009 8/16/2017 11/1/2012 B L 15.8
4 BLN 14 JAMES M. IBRAHIM RT. 002/009 8/16/2017 11/1/2012 B L
89 BLN 15 M. LUTHFI LUTHFI RT. 002/009 8/16/2017 1/27/2013 B L 17
96 BLN 16 NAZILLA SUKRISYONO RT. 002/009 8/16/2017 3/26/2013 B P
79 BLN 17 YEPANYA DARIANTO RT. 002/009 8/16/2017 4/15/2013 B P
81 BLN 18 RAISA BAMBANG RT. 002/009 8/16/2017 9/27/2013 B P
90 BLN 19 AISYAH FATHURAHMAN RT. 002/009 8/16/2017 5/23/2013 B P
71 BLN 20 SCOLARTIKA YOHANES JJ/23 8/16/2017 7/2/2013 B P 20.2
97 BLN 21 BRADIKTUS YOHANES JJ/23 8/16/2017 7/2/2013 B L 21.2
101 BLN 22 NAUFAL WAHYU RT. 002/009 8/16/2017 7/26/2013 B L 17.8
105 BLN 23 GABRIEL JOKO RT. 002/009 8/16/2017 8/18/2013 B L 16
92 BLN 24 NIJHAMUL NOVAL RT. 002/009 8/16/2017 8/14/2013 B L
87 BLN 25 ARRISA SUCIPTO RT. 002/009 8/16/2017 9/7/2013 B P 13.8
85 BLN 26 ABYAN DARMAWAN RT. 002/009 8/16/2017 9/17/2013 B L 12.9
78 BLN 27 KANAYA AGUS QQ/16 8/16/2017 9/28/2013 B P 15.1
81 BLN 28 ABDULLOH SHOLIH SUMARNO RT. 002/009 8/16/2017 10/29/2013 B L
90 BLN 29 ANLIA TONI RT. 002/009 8/16/2017 11/14/2013 B P 12.4
81 BLN 30 ARINA ANDYANO RT. 002/009 8/16/2017 11/26/2013 B P
111 BLN 31 ADHYASTHA UTOMO RT. 002/009 8/16/2017 11/29/2013 B L
72 BLN 32 NAJINA M. SHOLEH RT. 002/009 8/16/2017 1/6/2014 B P 19
BLN 33 YASMIN NANANG RT. 002/009 8/16/2017 3/9/2014 B P
100 BLN 34 REZA NURDIN RT. 002/009 8/16/2017 4/14/2014 B L 13.4
PETUGAS
......................) (...................................)
FORMULIR PENCATATAN
PUSKESMAS :

11 12 1 2 3 4 5 6 7 8 9 10
70 BLN 35 KANAYA RUDI RT. 002/009 8/16/2017 9/7/2014 B P 15.9
98 BLN 36 ABDURROHMAN CHSAN ROUF RT. 002/009 8/16/2017 9/7/2014 B L
98 BLN 37 MUSA A. KARIM RT. 002/009 8/16/2017 9/9/2014 B L
80 BLN 38 BILQIS DECKY RT. 002/009 8/16/2017 5/28/2014 B P 13.2
89 BLN 39 GIZKA RIZAL RT. 002/009 8/16/2017 6/5/2014 B P 12.2
74 BLN 40 AFFAN FERRY RT. 002/009 8/16/2017 7/9/2014 B L 15.3
105 BLN 41 M. RAJA MUSTALA RT. 002/009 8/16/2017 9/2/2014 B L 15.6
76 BLN 42 FIO ENJA DERIK RT. 002/009 8/16/2017 10/22/2014 B P 13.3
99 BLN 43 RUMAISHO ABDULLAH RT. 002/009 8/16/2017 12/29/2014 B P
79 BLN 44 AL-QIN WIYONO RT. 002/009 8/16/2017 12/30/2014 B L 12.7
97 BLN 45 BRIONI AGUS RT. 002/009 8/16/2017 12/3/2014 B P
122 BLN 46 FADLAN FAIZAN RT. 002/009 8/16/2017 12/17/2014 B L 13.8
98 BLN 47 TIARA FATHONI RT. 002/009 8/16/2017 5/13/2015 B P 10.8
75 BLN 48 CHILYA RAJALALI RT. 002/009 8/16/2017 5/24/2015 B P 12.1
96 BLN 49 SYIFA SURYALAGA RT. 002/009 8/16/2017 6/26/2015 B P 10.8
87 BLN 50 SYARIF RAHMAT RT. 002/009 8/16/2017 6/10/2015 B L 11.2
72 BLN 51 RAJASA YUDHI RT. 002/009 8/16/2017 7/15/2015 B L 10.4
67 BLN 52 M. AZRIEL ENANG RT. 002/009 8/16/2017 9/9/2015 B L 9.6
101 BLN 53 SANIA DEDE RT. 002/009 8/16/2017 11/18/2015 B P 8.6
88 BLN 54 ARSHALAN EDI RT. 002/009 8/16/2017 12/9/2015 T L 11.2
101 BLN 55 IBRAHIM SUMARNO] RT. 002/009 8/16/2017 12/30/2015 L
78 BLN 56 M. AMIR A. KARIM RT. 002/009 8/16/2017 1/5/2016 T L
78 BLN 57 KHAIRA WAHYU RT. 002/009 8/16/2017 2/13/2016 T P 8.1
95 BLN 58 AJENG ADHA JJ/37 8/16/2017 2/18/2016 T P 8
75 BLN 59 PELANGI HERIANSYAH II/53 8/16/2017 6/22/2016 T P 8.3
53 BLN 60 SAUSAN DONY RT. 002/009 8/16/2017 6/29/2016 T P
74 BLN 61 NADIRA ANDY RT. 002/009 8/16/2017 9/15/2016 T P 8.1
89 BLN 62 LANGIT SUHERMAN RT. 002/009 8/16/2017 10/31/2016 T L 9.5
85 BLN 63 DANIEL FITRI RT. 002/009 8/16/2017 8/2/2016 T L
93 BLN 64 AL FATAH ACEP RT. 002/009 8/16/2017 8/17/2016 T L 8.7
91 BLN 65 FABRIZIO DERIK RT. 002/009 8/16/2017 8/30/2016 T L 8.7
93 BLN 66 YUMNA RAJALALI RT. 002/009 8/16/2017 12/1/2016 T P
73 BLN 67 SYAFIQ ANTON RT. 002/009 8/16/2017 7/2/2017 T L 5.9
75 BLN 68 KAESANG DZIKRUR RT. 002/009 8/16/2017 6/26/2016 T L 8.9
PETUGAS
......................) (...................................)
FORMULIR PENCATATAN
PUSKESMAS :

11 12 1 2 3 4 5 6 7 8 9 10
68 BLN 69 REBECCA JHON CITARIK 3/9 8/16/2017 1/25/2014 P 17.7
68 BLN 70 TYAGA ISMOYO EMILIA 3/9 8/16/2017 9/30/2016 L 11.7
73 BLN 71 KHARIZA SUHEMI CITARIK 7/9 8/16/2017 P
70 BLN 72 KAYLA ANANG EMILIA 3/9 8/16/2017 10/17/2013 P 13
73 BLN 73 M. ADIHATARA M. ADI CITARIK 1/9 8/16/2017 8/12/2015 B L 11
75 BLN 74 DODITA ANDI RT. 002/009 8/16/2017 12/8/2012 B P 20.4
66 BLN 75 SYIFA RAHMAT QQ/009 8/16/2017 6/13/2017 T P 3.8
85 BLN 76 ALYA NADA LUTHFI 55/004 8/16/2017 3/4/2014 T P 8
111 BLN 77 KAYLA ANANG RT. 002/009 8/16/2017 10/17/2013 B
95 BLN 78 REBECCA JHON RT. 002/009 8/16/2017 25/14/14 B
101 BLN 79 M. ALTHOF HARUN RT. 002/009 8/16/2017 8/13/2014 B
62 BLN 80 SABRINA LUKMAN RT. 002/009 8/16/2017 12/11/2014 B
55 BLN 81 HANIFA FAKHRUDIN RT. 002/009 8/16/2017 8/8/2015 B
62 BLN 82 LINDA DANILTA RT. 002/009 8/16/2017 10/10/2015 B
63 BLN 83 AHSAN ANDREAS RT. 002/009 8/16/2017 12/20/2015 B
60 BLN 84 ABID M. TAUFIK RT. 002/009 8/16/2017 12/30/2015 B
59 BLN 85 ADAM ARI RT. 002/009 8/16/2017 9/21/2016 B
55 BLN 86 HUMAM M. ANDI KUNCORO EMILIA II/33 8/16/2017 6/3/2013 B L 18.6
48 BLN 87 RANIA DIMAS SURYA EMILIA EE/14 8/16/2017 6/26/2016 B P 7.7
97 BLN 88 JOANA OLIVIA DANDI P. EMILIA CC/9 8/16/2017 1/14/2016 B P 12.6
90 BLN 89 M. FARIHAN CHAIRUL EMILIA GG/10 8/16/2017 8/28/2015 B L 12.5
92 BLN 90 FAHREZA 8/16/2017 5/9/2017 B 6.6
86 BLN 91 MEYSHA AGUS WAHYUDI EMILIA BB/3 8/16/2017 5/27/2016 B P 8.4
98 BLN 92 CLAIRINE BUDIMAN EMILIA GG/10 8/16/2017 9/22/2015 B P 10.5
BLN 93 M. ALTHAF YUDI SANJAYA EMILIA EE/3 8/16/2017 7/7/2013 B L 17.5
BLN 94 NANO IBNU SAMSU EMILIA CC/7 8/16/2017 10/13/2016 B L 8.2
BLN 95 MARYAM BHAKTI EMILIA DD/19 8/16/2017 1/16/2016 B P 7.7
BLN 96 M. HAILAL RIFA EMILIA 8/16/2017 9/23/2012 L
BLN 97 NAURAH AGUS WAHYUDI EMILIA 8/16/2017 2/11/2013
BLN 98 AISYAH ARIF EMILIA 8/16/2017 3/22/2013
BLN 99 DANNESH LUCKY EMILIA 8/16/2017 7/23/2013
BLN 100 M. FATTAN M. FITRA EMILIA 8/16/2017 8/10/2013
BLN 101 HAFIZ BAMBANG EMILIA 8/16/2017 8/17/2013
BLN 102 KAMIH DONY EMILIA 8/16/2017 10/15/2013
PETUGAS
......................) (...................................)
FORMULIR PENCATATAN
PUSKESMAS :

11 12 1 2 3 4 5 6 7 8 9 10
91 BLN 103 SYIFA W.R ROJAK / LILIS CITARIK 1/19 8/16/2017 2/23/2012 B P 14.4
81 BLN 104 DIANDRA K.H IMBANG / RATIH CITARIK 1/17 8/16/2017 9/4/2013 B P 9.6
93 BLN 105 AULIA CELINE BUDI / SRI HASTUTI CITARIK 1/26 8/16/2017 8/24/2013 B P 15.7
102 BLN 106 NAWAL FADLI / YANI CITARIK 1/15 8/16/2017 2/16/2014 B P 13.7
107 BLN 107 FEGIH SLAMET CITARIK 3/33 8/16/2017 B L 12
85 BLN 108 FADHIL SARWADI CITARIK 1/23 8/16/2017 B L 15.2
BLN 109 PUTRI F. SARWADI 8/16/2017 T P 7.1
89 BLN 110 ZHILAL ALI MUKMIN CITARIK 3/31 8/16/2017 B L 14
99 BLN 111 ADITYA H. HERMAN 8/16/2017 B L 12
90 BLN 112 ALVINO M. RIDWAN 8/16/2017 B L 15.6
14 BLN 113 ALETTA M. RIDWAN 8/16/2017 B P 11.3
BLN 114 ALDRIAZ M. RIDWAN 8/16/2017 B L 9.6
7.3 BLN 115 ROHANY AYAT 8/16/2017 B P 15.6
BLN 116 AKRO FIRMANSYAH' 8/16/2017 B L 16.2
85 BLN 117 M. RIDWAN M. ARIF Y. 8/16/2017 B L 12
BLN 118 TYAGA ISMOYO 8/16/2017 B L
80 BLN 119 FIRYAL M. FIRDA 8/16/2017 B L
75 BLN
98 BLN
96 BLN
BLN
80 BLN
102 BLN
BLN
83 BLN
75 BLN
BLN
BLN
112 BLN
BLN
94 BLN
85 BLN
95 BLN
BLN
PETUGAS
......................) (...................................)
TB UMUR
(CM) (BULAN)
11 12
85 BLN
97 BLN
83 BLN
BLN
90 BLN
100 BLN
101 BLN
98 BLN
80 BLN
108 BLN
BLN
99 BLN
BLN
107 BLN
BLN
97 BLN
100 BLN
87 BLN
80 BLN
BLN
81 BLN
82 BLN
105 BLN
97 BLN
99 BLN
89 BLN
BLN
67 BLN
96 BLN
108 BLN
BLN
95 BLN
96 BLN
BLN
78 BLN
......................)
FORMULIR PENCATATAN

POSYANDU/DESA : MELATI 15 / SIMPANGAN (SUMAPANJATI)

11 12 1 2 3 4 5 6 7 8 9 10
BLN 1 KHANZA A. NANA / NENG RT. 001/003 8/11/2017 2/24/2014 B P 15
BLN 2 SALWA A. ENDANG / TITIN RT. 001/003 8/11/2017 8/22/2014 B P 14
BLN 3 M. FAUZAN EDI / AYU RT. 001/003 8/11/2017 11/12/2014 B L 17
BLN 4 WIEKE W. SARMAT / DASIH RT. 001/003 8/11/2017 9/27/2012 B L 16
BLN 5 AMANDA EMAN / MIA RT. 001/003 8/11/2017 12/12/2014 B P 13
BLN 6 DAFFA DADAN / FATONAH RT. 001/003 8/11/2017 5/6/2012 B L 13
BLN 7 NAYLA NAWAN / RINI RT. 001/003 8/11/2017 4/11/2014 B P 11
104 BLN 8 ASYIFA TONI / YANI RT. 001/003 8/11/2017 11/20/2014 B P 15
112 BLN 9 M. AKSA F. ERIK / SINTA RT. 001/003 8/11/2017 4/8/2014 B L 23
BLN 10 M. AKSA P. SUBARNA / HERNA RT. 001/003 8/11/2017 9/10/2016 B L 7.9
BLN 11 ARSY A. SYARIF / DEDEH RT. 001/003 8/11/2017 9/18/2016 B P 6.9
BLN 12 SHARUL A. SARI / ATIH RT. 001/003 8/11/2017 10/12/2012 B L 17
106 BLN 13 M. MAHFUDIN MAMAN / TINI RT. 001/003 8/11/2017 9/20/2014 B L 11
BLN 14 S. MUTIARA A. UCI S. / UMI K. RT. 001/003 8/11/2017 11/23/2013 B P 16
110 BLN 15 FADIL UCI S. / LENA RT. 001/003 8/11/2017 7/26/2014 B L 21
BLN 16 SITIFAH WIRSA / YULI RT. 001/003 8/11/2017 8/22/2012 B P 16
BLN 17 RAFFI RASIM / YUYUN RT. 001/003 8/11/2017 9/26/2014 B L 18
BLN 18 SAROH N. ASEP / SANAH RT. 001/003 8/11/2017 4/28/2014 B P 15
BLN 19 SRI RAHAYU USUP / TARSIH RT. 001/003 8/11/2017 4/14/2015 B P 10
104 BLN 20 DEDE S. HARI / DEDEH RT. 001/003 8/11/2017 6/13/2015 B L 11
106 BLN 21 RODIAH EDI / MANAH RT. 001/003 8/11/2017 1/10/2015 B P 10
100 BLN 22 FAREL S. HENDRA / IIS RT. 001/003 8/11/2017 7/18/2016 B L 9.3
106 BLN 23 MUKTI FERI I. / NUR RT. 001/003 8/11/2017 10/7/2014 B L 14
BLN 24 BUNGA BONIN / ENI RT. 001/003 8/11/2017 8/14/2012 B P 15
97 BLN 25 S. ROHIMAH TARMEDI / NENENG RT. 001/003 8/11/2017 11/24/2015 B P 11
96 BLN 26 SYAFE'I ATAM / SAFITRI RT. 001/003 8/11/2017 5/8/2014 B L 13
98 BLN 27 HAFIZ M. ABUNG / NENENG RT. 001/003 8/11/2017 2/14/2016 B L 8.2
BLN 28 ADHUSA M. ASEP / DIAN RT. 001/003 8/11/2017 6/14/2013 B P 14
99 BLN 29 HARIS P. NANA / DITA RT. 001/003 8/11/2017 9/20/2015 B L 11
BLN 30 M. FIKRI M. ABDI / ELIA RT. 001/003 8/11/2017 10/11/2015 B L 15
BLN 31 M. WILDAN SARDI / AMINI RT. 001/003 8/11/2017 10/29/2015 B L 14
98 BLN 32 NAJRIL ILHAM BUANG / KOKOM RT. 001/003 8/11/2017 2/2/2017 T L 2.1
BLN 33 NINA NUR / AYU RT. 001/003 8/11/2017 9/9/2013 B P 14
94 BLN 34 ONES BASUSENO / RIATUN RT. 001/003 8/11/2017 6/30/2016 B P 8.5
PETUGAS
.....................) (...................................)
FORMULIR PENCATATAN


11 12 1 2 3 4 5 6 7 8 9 10
96 BLN 35 ANDIKA N. ANDRE / NENDAH RT. 001/003 8/11/2017 3/6/2014 B L 18
BLN 36 YUSUF AL AZHAR SAEFUL / TINTIN RT. 001/003 8/11/2017 7/20/2015 B L 15
BLN 37 HAFIZ M. WAWAN / SUSI RT. 001/003 8/11/2017 8/15/2015 B L 10
92 BLN 38 FARID S. HENDRIK / FATMA RT. 001/003 8/11/2017 12/9/2014 B L 16
97 BLN 39 RONI HANAFI / AZIZAH RT. 001/003 8/11/2017 7/16/2016 B L 8
97 BLN 40 DEA AZZAHRA DEDE / EHA RT. 001/003 8/11/2017 7/5/2016 B P 9.3
99 BLN 41 M. FAHRI DUDUNG / NINING RT. 001/003 8/11/2017 10/24/2013 B L 10
92 BLN 42 SATRIA F. ANRI / AHYANI RT. 001/003 8/11/2017 2/5/2013 B L 15
BLN 43 AZKAYRA B. SADIKIN / AULIA RT. 001/003 8/11/2017 9/17/2014 B P 10
91 BLN 44 M. AUFAR A. NUNUNG / ABSAH RT. 001/003 8/11/2017 10/21/2012 B L 15
BLN 45 M. ALBI MISBAH / DINA RT. 001/003 8/11/2017 8/3/2016 B L 9.3
92 BLN 46 AQILA ADUL / ATIK RT. 001/003 8/11/2017 2/15/2013 B P 11
86 BLN 47 ALIF M. BILAL / SULIYANI RT. 001/003 8/11/2017 9/29/2014 B L 15
87 BLN 48 SYEIKHA A. NOVIAN / NASEM RT. 001/003 8/11/2017 5/6/2015 B P 14
84 BLN 49 AKBAR T. SENAN / AYAN RT. 001/003 8/11/2017 8/17/2012 B L 15
87 BLN 50 ZAHRA N. SAIR / MILAH RT. 001/003 8/11/2017 11/26/2015 B P 9
84 BLN 51 DAFFA A. DIAN P. / JALIAH RT. 001/003 8/11/2017 5/11/2016 B L 15
89 BLN 52 A. LINTANG H. BASRI / KHODIJAH RT. 001/003 8/11/2017 5/11/2015 B L 9.8
77 BLN 53 NURIKHA R. AHMAD / RIKHAT RT. 001/003 8/11/2017 6/18/2015 B P 9
82 BLN 54 S. FATIMAH SURATNO / KESIH RT. 001/003 8/11/2017 12/11/2012 B P 17
BLN 55 FIRJA R. ROHADI / MARDI RT. 001/003 8/11/2017 9/28/2012 B L 25
BLN 56 S. NURJANAH DANA / YULI RT. 001/003 8/11/2017 1/17/2013 B P 15
77 BLN 57 TIYANATA SUNJANA / ANITA RT. 001/003 8/11/2017 7/20/2013 B L 14.7
76 BLN 58 KESYA MARWAN / EVA RT. 001/003 8/11/2017 2/9/2016 B P 9.1
74 BLN 59 NATANIN A. TEGUH / LILIS RT. 001/003 8/11/2017 11/9/2013 B L 14.1
BLN 60 KESYAH RUSDIANA / DANIAH RT. 001/003 8/11/2017 4/30/2016 B P 10
BLN 61 RARA RATU N. HENDRIK / NUR H. RT. 001/003 8/11/2017 7/5/2013 B P 14.2
71 BLN 62 ELA M. HENDRA / IIDA F. RT. 001/003 8/11/2017 7/15/2013 B P 14
BLN 63 ELIS M. HENDRA / IIDA F. RT. 001/003 8/11/2017 7/15/2013 B P 15
73 BLN 64 SUHA NEMIN / WIWIN RT. 001/003 8/11/2017 3/16/2013 B P 16
73 BLN 65 IBNU HAYYAN SARDI / NURLELA RT. 001/003 8/11/2017 8/20/2015 B L 12
BLN 66 SITI TASYA TARSAN / BEDAH RT. 001/003 8/11/2017 3/9/2014 B P 15
55 BLN 67 RAFKA DEDE / TIARA RT. 001/003 8/11/2017 11/30/2013 B L 14.5
79 BLN 68 DIMAS R. BONDAN / NELI A. RT. 001/003 8/11/2017 10/7/2016 B L 9
PETUGAS
.....................) (...................................)
FORMULIR PENCATATAN


11 12 1 2 3 4 5 6 7 8 9 10
102 BLN 69 RIAN HAFIZ ASMARI / HERNA RT. 001/003 8/11/2017 10/17/2016 B L 9
82 BLN 70 AZAM SOLEH / ALIH RT. 001/003 8/11/2017 6/3/2016 B L 8.5
BLN 71 MONALISA MANCIUNG / MANIH RT. 001/003 8/11/2017 5/5/2016 B P 10
97 BLN 72 KELVIN A. ENDANG / TITIN RT. 001/003 8/11/2017 9/18/2013 B L 15
88 BLN 73 SALSA A. ENDANG / TITIN RT. 001/003 8/11/2017 8/22/2014 B P 14
108 BLN 74 ADELIA HERMAN / ACEM RT. 001/003 8/11/2017 1/3/2015 B P 12
53 BLN 75 M. HAIKAL ANIN / YETI RT. 001/003 8/11/2017 11/19/2014 B L 13
67 BLN 76 M. RUBY A. MUS M. / SANTI RT. 001/003 8/11/2017 10/18/2013 B L 17
BLN 77
BLN 78
BLN 79
BLN 80
BLN 81
BLN 82
BLN 83
BLN 84
BLN 85
110 BLN 86
70 BLN 87
85 BLN 88
85 BLN 89
60 BLN 90
70 BLN 91
82 BLN 92
103 BLN 93
67 BLN 94
70 BLN 95
BLN 96
BLN 97
BLN 98
BLN 99
BLN 100
BLN 101
BLN 102
PETUGAS
.....................) (...................................)
TB UMUR
(CM) (BULAN)
11 12
106 BLN
80 BLN
102 BLN
100 BLN
96 BLN
94 BLN
65 BLN
95 BLN
95 BLN
105 BLN
84 BLN
7.4 BLN
106 BLN
998 BLN
89 BLN
BLN
BLN
BLN
BLN
BLN
BLN
BLN
BLN
BLN
BLN
BLN
BLN
BLN
BLN
BLN
BLN
BLN
BLN
BLN
.....................)
FORMULIR PENCATATAN

POSYANDU/DESA : MELATI IV / SIMPANGAN (KP. KAUM TENGAH)

11 12 1 2 3 4 5 6 7 8 9 10
96 BLN 1 DARLISH R.A MAYA / IRFAN RT. 003/002 8/15/2017 6/9/2015 B L 12
99 BLN 2 MAYRA IWAN / NIA RT. 003/002 8/15/2017 4/27/2015 B P 11
101 BLN 3 NAZIFAH KUAT RT. 003/002 8/15/2017 5/8/2015 B P 12
103 BLN 4 GIBRAN LUKMAN / LIA RT. 003/002 8/15/2017 2/20/2015 B L 14
86 BLN 5 HANI ADISTI MULYANI / HANAFI RT. 003/002 8/15/2017 12/30/2013 B P 17
84 BLN 6 YUMNA FRISTI / GALUH RT. 003/002 8/15/2017 8/17/2014 B P 11
89 BLN 7 AZKA GHANI INDAN / WAHYU RT. 003/002 8/15/2017 4/23/2015 B L 10
98 BLN 8 RAFATAR YULI / LILI RT. 003/002 8/15/2017 10/22/2015 B L 9
101 BLN 9 RAYFAN AFNI / MUKHTAR RT. 003/002 8/15/2017 12/11/2013 B L 12
68 BLN 10 AZZAHRA J. SERAH / MUJAMI RT. 003/002 8/15/2017 11/12/2014 P
64 BLN 11 AYU NAFISHA RISKA / ROBI RT. 003/002 8/15/2017 1/6/2015 P
106 BLN 12 ASILA M.P ASTI / ARIS RT. 003/002 8/15/2017 1/15/2013 B P 19
88 BLN 13 AL MAULA EMAH / ASEP RT. 003/002 8/15/2017 11/16/2014 B P 10
98 BLN 14 REGINA FITRI / ROJALI RT. 002/001 8/15/2017 188/11/13 P
100 BLN 15 VINO FIRDA RT. 002/001 8/15/2017 5/26/2013 L
100 BLN 16 WILDAN IYOS / SUEB RT. 003/002 8/15/2017 5/13/2013 B L 14
107 BLN 17 RYOUKO METI / DENI RT. 002/001 8/15/2017 5/22/2013 B L 16
100 BLN 18 SHAKIRA A. MIRA / MEDI RT. 003/002 8/15/2017 10/17/2012 B P 15
82 BLN 19 ANASYA MIRA / MEDI RT. 003/002 8/15/2017 9/18/2016 T P 7.5
82 BLN 20 MUTIARA K. NURHASANAH / SUN RT. 003/002 8/15/2017 8/1/2015 P
76 BLN 21 A. FURQON N. WINDA / EGAR RT. 003/002 8/15/2017 6/3/2016 B L 10
71 BLN 22 A. RAHMAN R. WINDA / EGAR RT. 003/002 8/15/2017 12/23/2014 B L 11
93 BLN 23 RAFFA MIMIN / JAMAL RT. 003/002 8/15/2017 5/18/2014 B L 14
99 BLN 24 FAHREZA AAS RT. 003/002 8/15/2017 B L 14
80 BLN 25 ARSAKA NURSIAH / OKKY RT. 003/002 8/15/2017 7/24/2016 L
92 BLN 26 ARSEN M. FRIDA / ANGGARA RT. 003/002 8/15/2017 4/29/2016 B L 11
65 BLN 27 RAFADAN DWI / YOGI RT. 003/002 8/15/2017 4/12/2016 B L 9
100 BLN 28 KELVIN NINING / RIBUT RT. 003/002 8/15/2017 5/16/2013 B L 13
79 BLN 29 AISYAH INARA RESI / RIJAL RT. 003/002 8/15/2017 12/4/2016 B P 12
91 BLN 30 JAHIRA FRISTI / GALUH RT. 003/002 8/15/2017 11/15/2015 B P 7
89 BLN 31 ALBI IYUS / DONI RT. 003/002 8/15/2017 8/30/2016 L
60 BLN 32 NAJWA MURYATI / SUPRI RT. 003/002 8/15/2017 3/3/2016 B P 9
100 BLN 33 MAULANA I. ANDINI / HILMAN RT. 003/002 8/15/2017 6/9/2016 B L 9
63 BLN 34 MUTIARA ARTIKA TINI / WIJIONO RT. 003/002 8/15/2017 12/28/2016 P
PETUGAS
......................) (...................................)
FORMULIR PENCATATAN

POSYANDU/DESA : MELATI IV / SIMPANGAN (KP. KAUM TENGAH)

11 12 1 2 3 4 5 6 7 8 9 10
101 BLN 35 RASYA NENG / TARJO RT. 003/002 8/15/2017 6/6/2014 B L 14
86 BLN 36 RAISA A.P REZA / RAMDAN RT. 003/002 8/15/2017 11/3/2016 T P 8.5
84 BLN 37 DIRGAHAYU RISKY / ERNA RT. 003/002 8/15/2017 11/12/2016 L
93 BLN 38 EVELYNE LIN / RUDI RT. 003/002 8/15/2017 3/26/2015 B P 9
65 BLN 39 M. ARKA NISA / SUHERMAN RT. 003/002 8/15/2017 4/5/2017 T L 6
69 BLN 40 NAILA YANTI / LILI J. RT. 003/002 8/15/2017 10/21/2012 B P 14
10 BLN 41 DEA RINI / LUTHFI RT. 003/002 8/15/2017 3/15/2014 B P 10
101 BLN 42 SARI LUTHFIANI MAYA / ARIFIN RT. 003/002 8/15/2017 11/8/2015 B P 8.5
90 BLN 43 GHANIA P. AYU SAODAH / A. NUJUR RT. 003/002 8/15/2017 12/12/2014 B P 13
6 BLN 44 AZAHRA A.P NURUL / DIDIK RT. 003/002 8/15/2017 7/9/2017 P
75 BLN 45 AULIA AGUS / SUMIATI RT. 003/002 8/15/2017 P
90 BLN 46 M. KRISTIAN EGI / BAMBANG RT. 003/002 8/15/2017 9/2/2016 L
100 BLN 47 SAFANA HARUN / ACIH RT. 003/002 8/15/2017 7/14/2016 B P 9
96 BLN 48 ALDIAN NURUL / ADI RT. 003/002 8/15/2017 5/30/2014 B L 12
107 BLN 49 SHAKILA F.Y YUSUF / ELNI RT. 003/002 8/15/2017 2/3/2014 B P 13
86 BLN 50 BINTANG PRATIKA AMINARTI RT. 003/002 8/15/2017 4/8/2014 L
107 BLN 51 M. ALDRIC E. GILANG/ / IRMA RT. 003/002 8/15/2017 7/9/2016 T L 8
79 BLN 52 TISHA MURI S. / VINKA RT. 003/002 8/15/2017 11/16/2012 B P 15
83 BLN 53 NABEEL K.E LUKMAN / LIA RT. 003/002 8/15/2017 5/21/2016 B L 8
109 BLN 54 YESIKA R. KOKOM / YOSEP RT. 003/002 8/15/2017 7/3/2016 B P 8.5
109 BLN 55 ARPHAN IRMA / WALIDI RT. 003/002 8/15/2017 2/4/2016 B L 7
101 BLN 56 NABILA HERA / GIGIN RT. 003/002 8/15/2017 4/14/2014 B P 12.4
99 BLN 57 JESNA A. IKA / JEPRIYADI RT. 003/002 8/15/2017 5/19/2017 T P 5
65 BLN 58 FAIRUZ YUNITA / SARIFUIDN RT. 003/002 8/15/2017 10/30/2012 B L 14
89 BLN 59 RAFA FUJI / S. ROHAYAH RT. 003/002 8/15/2017 B L 12
68 BLN 60 NADA AMARA LILIS / NURSAMSU RT. 003/002 8/15/2017 B P 11
101 BLN 61
105 BLN 62
100 BLN 63
98 BLN 64
95 BLN 65
100 BLN 66
99 BLN 67
68 BLN 68
PETUGAS
......................) (...................................)
FORMULIR PENCATATAN
PUSKESMAS :
POSYANDU/DESA : SIMPANGAN (GRAHA KMK)

11 12 1 2 3 4 5 6 7 8 9 10
86 BLN 1 AFIQA N. ANA BUDIYANTO P1.14 8/14/2017 11/11/2016 T P 8.9
87 BLN 2 GILANG A. M. ANWAR P.10 8/14/2017 8/29/2016 B L 8.7
78 BLN 3 MARULI JOSEP JOE VV.04 8/14/2017 10/10/2016 B L 9.5
107 BLN 4 RAFIF NUR HIDAYAT P1.5 8/14/2017 1/15/2017 B L 9.4
97 BLN 5 ADAM A. ERWIN P.17 8/14/2017 7/31/2016 B L 7.2
98 BLN 6 AIRA PUTIE AGUS P. P5.16 8/14/2017 11/28/2015 B P 9
101 BLN 7 ATHAYA S. HAMINDYO P5.10 8/14/2017 8/21/2012 B P 14
107 BLN 8 AZKA A. PRIAN P5.32 8/14/2017 10/24/2013 B L 16.5
BLN 9 ACHMAD W. HARTONO P1.17 8/14/2017 4/18/2013 B L 19.5
BLN 10 ARSYA NENDRA AJI PRABOWO VV.2 8/14/2017 6/1/2016 B L 9.4
BLN 11 ALKAISAR A. AANG P5.28 8/14/2017 6/16/2013 B L 15.9
BLN 12 ARKAN DODDY VV.3 8/14/2017 10/24/2015 B L 14.6
BLN 13 ARJUNA SIDIQ UU.5 8/14/2017 9/30/2014 L
BLN 14 ATHAYA SIDIQ UU.5 8/14/2017 10/27/2012 P
BLN 15 ALVINE RAZIQ SUPARDI C.21 8/14/2017 10/20/2013 L
BLN 16 ALMERSYAH AHMAD S. W.18 8/14/2017 12/31/2014 B L 14
BLN 17 ALEENA AJI PRABOWO VV.2 8/14/2017 3/6/2013 P 10.4
BLN 18 ARKHA F. DIAN P.36 8/14/2017 2/19/2015 B L
BLN 19 AZFAR UJANG P2.14 8/14/2017 8/2/2013 B L 12,,5,
BLN 20 ASHILLA IRWAN P.48 8/14/2017 7/15/2013 B P 17.7
BLN 21 AUFA H. ANA BUDIYANTO P1.14 8/14/2017 9/29/2012 B P ,9,,9
BLN 22 DAFFA I. DADAN P4.4 8/14/2017 1/31/2015 B L 14
BLN 23 DANIELLA CANTIKA JOE VV.4 8/14/2017 10/27/2014 B P 8
BLN 24 DZIKRINA T. ABDUR RASYID P5.22 8/14/2017 5/25/2016 B P 14
BLN 25 FAEZA N.A SUMARDI P2.5 8/14/2017 1/10/2014 B L 15.5
BLN 26 FAUZAN NURROCHIM P5.18 8/14/2017 8/7/2013 B L 14.5
BLN 27 HAMZAH ZAYN SUMARNO 8/14/2017 2/24/2013 B L 15.7
BLN 28 HISYAM ARIF USMAN P5.12 8/14/2017 6/16/2015 B L 11.1
BLN 29 ISNA ENDANG P3.9 8/14/2017 7/4/2013 B P 13.8
BLN 30 ILHAM AKBAR PRIHASTADI P5.26 8/14/2017 7/9/2015 B L 10.8
BLN 31 JOSHUA HARDIMAN P.45 8/14/2017 10/15/2012 B L 13
BLN 32 KENZIE HIRO SUPRIYANTO P.39 8/14/2017 4/26/2015 L
BLN 33 KENZIE ARSENIO APRIYANTO P1.47 8/14/2017 8/11/2016 B L 8.5
BLN 34 KALINDA GEDE OKA P.7 8/14/2017 8/8/2015 B P 19
PETUGAS
......................) (...................................)
FORMULIR PENCATATAN
PUSKESMAS :

1 2 3 4 5 6 7 8 9 10
35 KIRAM NURHIDAYAT P.28 8/14/2017 7/8/2015 B L 10.1
36 KANAYA BINTANG REKA 8/14/2017 3/20/2013 P
37 M. YUSUF M. THOLIB 8/14/2017 10/12/2013 L
38 MIRZA U. SIGIT VV.3 8/14/2017 11/9/2013 B L 16.3
39 M. KAFFA PRIAN P5.32 8/14/2017 5/19/2015 B L 9.9
40 M. SYAKIR SULAEMAN P2.1 8/14/2017 4/30/2016 T L 8.3
41 MIKAIL ARJUNA ERIK ARIYANTO VV.7 8/14/2017 6/17/2016 L
42 MALIKA HARTANTO P.27 8/14/2017 5/14/2014 P
43 M. ASHAR BAMBANG P.37 8/14/2017 7/19/2013 L
44 M. HAIDAR UJANG P.14 8/14/2017 7/13/2015 L
45 NAJWAH EKI P2.12 8/14/2017 3/16/2016 B P 9.4
46 ORIYZA ERIK 8/14/2017 9/8/2013 P
47 RAZIQ L. MUSLIM P4.10 8/14/2017 10/29/2014 B L 12.2
48 RALIN F.Y YUSUF 8/14/2017 6/1/2015 P
49 SHOFFYAH IQBAL P4.9 8/14/2017 10/21/2014 B P 12.7
50 SATIVA ERIK 8/14/2017 9/8/2013 P
51 SERGIO H. HARDIMAN P.45 8/14/2017 9/16/2015 B P 10.6
52 SYAMS HAZWAN C. AMRO P.44 8/14/2017 10/28/2015 L 9
53 SYAFIRA BAMBANG P.38 8/14/2017 10/18/2014 B P 12
54 SAPTA N. PRASETYO P4.12 8/14/2017 7/29/2015 B P 12.2
55 SELBY R. RAMADHAN U.3 8/14/2017 7/12/2013 B P 10.1
56 SAMUEL GUGUN 8/14/2017 4/24/2013 L
57 TIARA SUANR P1.31 8/14/2017 3/20/2015 B P 10.9
58 VANIA NUR P2.9 8/14/2017 5/28/2016 B P 9.4
59 VITA NURYAMIN P4.3 8/14/2017 6/9/2014 B P 11.8
60 WIDYA N. GADONG P2.2 8/14/2017 8/27/2015 B P 9.7
61 YODHA IWAN P.32 8/14/2017 7/5/2013 B L 14.9
62 ZAHRA AINA TRIBUDI P5.30 8/14/2017 5/24/2013 B P 29
63 ADAMAR AHMAD W.18 8/14/2017 7/16/2016 B L 10
64 IVANA VORSECA PALTI MANULANG TT.5 8/14/2017 10/14/2016 B L 8.8
65
66
67
68
PETUGAS
(...................................)
FORMULIR PENCATATAN

POSYANDU/DESA : MELATI 14 / SIMPANGAN (KP. POPONCOL)

11 12 1 2 3 4 5 6 7 8 9 10
88 BLN 1 ANAGGUN AUNI H. DHISTIAN / NURLELA RT. 002/003 8/18/2017 12/13/2012 B P 14.5
91 BLN 2 ALYZANA PUTRI SYAHRIL / RUKMINI RT. 002/003 8/18/2017 9/19/2013 B P 25
93 BLN 3 YOGI AL MAHARI WMIN / WULAN RT. 002/003 8/18/2017 10/9/2012 B L 16
98 BLN 4 ZIDANE RIDHO A. RAHMAT / LULU RT. 002/003 8/18/2017 12/4/2001 B L 11.5
114 BLN 5 M. FAUZAN ACU / MARSIH RT. 002/003 8/18/2017 3/10/2013 B L 13
99 BLN 6 ZUAN RADIHIYA EKO / IRMA RT. 002/003 8/18/2017 11/28/2015 B L 9
93 BLN 7 NUGI FEBRIAN NABIN / RAHAYU RT. 002/003 8/18/2017 2/24/2014 B L 14
88 BLN 8 AZWA NUR A. KARMA / DIAN RT. 002/003 8/18/2017 5/9/2011 B P 7.5
100 BLN 9 GITA NUR KAMILA JABAR / DALIS RT. 002/003 8/18/2017 7/27/2016 B P 9
BLN 10 AJI AHMAD K. AHMAD / AMIH RT. 002/003 8/18/2017 7/19/2012 B L 13
BLN 11 KARDIFA RASYA P. CUCU / MARDIAH RT. 002/003 8/18/2017 9/6/2015 B L 12.1
115 BLN 12 IRWAN FIRMANSYAH ATO / AYATIH RT. 002/003 8/18/2017 3/31/2014 B L 13
95 BLN 13 NADIRA PUTRI NASIR / MIA RATNA RT. 002/003 8/18/2017 11/10/2015 B P 9.6
BLN 14 SATRIA R. ADI / ESIH RT. 002/003 8/18/2017 8/26/2012 B L 15.2
BLN 15 ENDI NOVIANSYAH RUDI / ENI RT. 002/003 8/18/2017 11/26/2015 B L 10.9
105 BLN 16 ARKA SURO B. SYAMSUDIN / ENI RT. 002/003 8/18/2017 10/1/2016 B L 9.5
110 BLN 17 AQILA MEIDINA IYUS / DEVI RT. 002/003 8/18/2017 5/10/2014 B P 11.3
112 BLN 18 SANDI YANA P. SACIM / SISKA RT. 002/003 8/18/2017 8/9/2016 B L 9.3
77 BLN 19 DEWA SUKANTI HASANUDIN / NETI RT. 002/003 8/18/2017 12/7/2012 B L 28
BLN 20 DEWI NURHASANAH HASANUDIN / NETI RT. 002/003 8/18/2017 12/7/2012 B P 27
84 BLN 21 MARINAH ENJAN / KIKI RT. 002/003 8/18/2017 1/20/2017 B P 7.1
99 BLN 22 MASARAH ENJAN / KIKI RT. 002/003 8/18/2017 4/17/2015 B P 9.9
110 BLN 23 YASINTA PUTRI KAMALUDIN/ISTIYANI RT. 002/003 8/18/2017 1/17/2017 B P 6.5
110 BLN 24 SALSABILA CECEP / NIA RT. 002/003 8/18/2017 4/9/2016 B P 8.3
BLN 25 ADILA HERMAWAN / ITOH RT. 002/003 8/18/2017 7/7/2016 B P 9.1
93 BLN 26 M. HAIKAL UMAR / YANTI RT. 002/003 8/18/2017 11/25/2016 B L 8.3
86 BLN 27 ALYKA MAULIDA UMAR / YANTI RT. 002/003 8/18/2017 12/20/2015 B P 10.3
112 BLN 28 CAHYO DIKA P. MADIH / KOMARIAH RT. 002/003 8/18/2017 11/29/2016 B L 9.5
94 BLN 29 M. EZA WAHYUDI WAHYUDI / RISAH RT. 002/003 8/18/2017 7/23/2016 B L 9.2
84 BLN 30 TIARA NATALIA SUPRAYOGI / ROSITA RT. 002/003 8/18/2017 8/4/2016 B P 8
BLN 31 AZKA IWAY / KASWIYAH RT. 002/003 8/18/2017 8/18/2016 B L 9.5
86 BLN 32 ABSYAR FATHIRIA JAKARIA / SARYATI RT. 002/003 8/18/2017 3/20/2015 B L 11.3
85 BLN 33 DEDE RAHMAN ENGKIM / DAMAH RT. 002/003 8/18/2017 2/14/2015 B L 9.5
BLN 34 JIBRAN RAKA YAWAN / IRA RT. 002/003 8/18/2017 7/26/2015 B L 18
PETUGAS
.....................) (...................................)
FORMULIR PENCATATAN


11 12 1 2 3 4 5 6 7 8 9 10
104 BLN 35 M. DAFA A. ADE / NINING RT. 002/003 8/18/2017 8/19/2015 B L 10.1
64 BLN 36 A. ZAKI M. MUDI / NARTI RT. 002/003 8/18/2017 5/8/2015 B L 10.5
BLN 37 FARASATIO IWAN / IRA RT. 002/003 8/18/2017 11/24/2015 B L 18
91 BLN 38 NURDIAN SUANRDI / EVI RT. 002/003 8/18/2017 11/3/2015 B L 12
60 BLN 39 NAJWA SYARIFAH MUZZAYIN / NURAINI RT. 002/003 8/18/2017 10/2/2015 B P 9.2
110 BLN 40 ASSYIFA NENOH / NENDI RT. 002/003 8/18/2017 6/17/2016 B P 9
95 BLN 41 NAJWA SYARIFAH MADIH / LUPI RT. 002/003 8/18/2017 5/8/2015 B P 13
90 BLN 42 FAIZ ANADI JUMADI / SAMINAH RT. 002/003 8/18/2017 3/2/2014 B L 9.9
88 BLN 43 KANZA KIRANA NACIN / MARLINA RT. 002/003 8/18/2017 2/16/2015 B P 16
BLN 44 SOVIA AMAN / NURMALA RT. 002/003 8/18/2017 4/14/2014 B P 10
BLN 45 AI PUTRI AYU ADI / ESIH RT. 002/003 8/18/2017 6/3/2014 B P 12.6
BLN 46 DIANDRA H. ENDANG / EVI RT. 002/003 8/18/2017 5/21/2014 P 14
81 BLN 47 AKILA INDRIANI ABDUL MUHI / YANI RT. 002/003 8/18/2017 5/24/2014 P 12.1
90 BLN 48 MEISHA FERY / ADELIA RT. 002/003 8/18/2017 5/5/2014 P 12
115 BLN 49 ALIF ATARA SARYANA / ASIH RT. 002/003 8/18/2017 6/29/2014 L 11.2
BLN 50 M. OVAL DESTIAN OCIN / SUMIATI RT. 002/003 8/18/2017 12/22/2014 L 14.1
60 BLN 51 CHIKA ADINATA ADI / HAMIDAH RT. 002/003 8/18/2017 10/8/2014 P 11.7
118 BLN 52 EVAN UVAN / ULAN RT. 002/003 8/18/2017 8/14/2014 L 12.4
92 BLN 53 CITRA KIRANA ACUM / ITA RT. 002/003 8/18/2017 8/22/2014 P 11.5
92 BLN 54 AMELIA PENDI / UAS RT. 002/003 8/18/2017 4/29/2014 P 12.2
84 BLN 55 RISKY AMAD / NISA RT. 002/003 8/18/2017 5/31/2014 L 11.6
105 BLN 56 ASYIFA ASUR / FENI RT. 002/003 8/18/2017 4/6/2016 P 8.2
56 BLN 57 PAJRI DEP ASUR / FENI RT. 002/003 8/18/2017 3/31/2014 L 12
112 BLN 58 M. REINDRA DWI / LIA RT. 002/003 8/18/2017 2/3/2013 L 15
105 BLN 59 AZAM S. AMAN / IPAH RT. 002/003 8/18/2017 4/5/2013 L 14.1
110 BLN 60 BASTIAN UJANG JUMADI/IBAH RT. 002/003 8/18/2017 3/23/2013 L 14.2
BLN 61 DAVINA DUHA / NURLELA RT. 002/003 8/18/2017 5/19/2013 P 15.2
BLN 62 RESTU ACEP / NARSIAH RT. 002/003 8/18/2017 1/9/2013 L 16.1
BLN 63 SIFA ZAHRA ALEX / IDA RT. 002/003 8/18/2017 3/22/2013 P 14.5
BLN 64 M. FIKIH RUDI / ICIH RT. 002/003 8/18/2017 4/25/2013 L 12
BLN 65 KARLINA KARTA / RENA RT. 002/003 8/18/2017 7/9/2013 P
BLN 66 FIRLY RUDI / FITRI RT. 002/003 8/18/2017 2/17/2013 L 15.6
BLN 67 NANDA NAJI / LINDA RT. 002/003 8/18/2017 9/4/2013 P
BLN 68 CITRA R. HENBRI / SANTI RT. 002/003 8/18/2017 7/23/2012 P
PETUGAS
.....................) (...................................)
FORMULIR PENCATATAN


11 12 1 2 3 4 5 6 7 8 9 10
65 BLN 69 P. NUR ANGGRAINI ANAN / /HERNI RT. 002/003 8/18/2017 12/23/2012 P 12.5
65 BLN 70 REZA SLAMAET / ALYA RT. 002/003 8/18/2017 9/25/2012 L 17.5
76 BLN 71 XEINA PUTRI AEN / JUJU RT. 002/003 8/18/2017 3/11/2017 P
64 BLN 72 ALIFA M. ACEP / YAYAH RT. 002/003 8/18/2017 5/22/2017 P 7.2
69 BLN 73 NURI AULIA M. HANDI / FITRIA RT. 002/003 8/18/2017 1/8/2014 P 10.7
81 BLN 74 VINA H. ARIS / NENGSIH RT. 002/003 8/18/2017 6/15/2012 P 20
103 BLN 75 AZKA ZAENA ROHILI / SITI RT. 002/003 8/18/2017 4/10/2016 P 10.1
108 BLN 76 ALIKA NAILA P. PERIYANA / YESI RT. 002/003 8/18/2017 8/9/2016 L 7.5
111 BLN 77 SITI AIDA ASMAWI / PUR RT. 002/003 8/18/2017 10/1/2012 L 15.7
79 BLN 78
102 BLN 79
85 BLN 80
BLN 81
BLN 82
BLN 83
96 BLN 84
BLN 85
88 BLN 86
BLN 87
93.5 BLN 88
101 BLN 89
83 BLN 90
95 BLN 91
71.5 BLN 92
97 BLN 93
101 BLN 94
101 BLN 95
86.5 BLN 96
97.5 BLN 97
84 BLN 98
121 BLN 99
BLN 100
76 BLN 101
89 BLN 102
PETUGAS
.....................) (...................................)
TB UMUR
(CM) (BULAN)
11 12
86 BLN
BLN
BLN
100 BLN
91 BLN
69 BLN
BLN
BLN
BLN
BLN
78 BLN
BLN
90 BLN
BLN
98.5 BLN
BLN
81 BLN
80 BLN
93 BLN
84 BLN
85.5 BLN
BLN
85 BLN
75 BLN
87 BLN
82 BLN
100 BLN
113 BLN
77 BLN
72 BLN
BLN
BLN
BLN
BLN
.....................)
FORMULIR PENCATATAN

POSYANDU/DESA : MELATI 6 / SIMPANGAN (CIBEBER)

11 12 1 2 3 4 5 6 7 8 9 10
105 BLN 1 FAYZA I.S KUSNO / LILIS RT. 001/004 8/10/2017 1/24/2014 B P 14
108 BLN 2 MUFIS A. DUNDRI / WARSIH RT. 001/004 8/10/2017 11/13/2016 T L 10
108 BLN 3 REYVAN IWAN / SITI RT. 001/004 8/10/2017 10/18/2016 T L 10.2
96 BLN 4 ADIBA BAHRI / AISAH RT. 001/004 8/10/2017 8/26/2016 B P 8
94 BLN 5 IHSAN DARMAN / INI RT. 001/004 8/10/2017 11/27/2014 B P 12.9
69 BLN 6 SALIM BUDI / NINING RT. 001/004 8/10/2017 10/26/2015 B P 11
96 BLN 7 REZA MUMUN / YUYUN RT. 001/004 8/10/2017 2/3/2015 B L 13.5
90 BLN 8 ARYA B. ADE R. / WULAN RT. 001/004 8/10/2017 10/30/2013 B L 16.6
68 BLN 9 BINTANG ADE R. / WULAN RT. 001/004 8/10/2017 12/20/2015 B P 10.3
102 BLN 10 M. JAFAR TAUFIK / KAMIS CIBEUREUM 8/10/2017 5/19/2016 B L 10.1
98 BLN 11 ANDRIAN M. IWAN / TIARA RT. 001/004 8/10/2017 3/6/2015 B L 13
96 BLN 12 RIFKY SUTOPO / BAH RT. 001/004 8/10/2017 12/12/2012 B L 16.5
69 BLN 13 AZMA MASRURI / IDUNG CIBEUREUM 8/10/2017 7/30/2016 B P 9.9
101 BLN 14 MAWAR AFANDI / ASMIRAH RT. 001/004 8/10/2017 7/30/2016 B P 8.9
86 BLN 15 HAURI UDIN / UUM RT. 001/004 8/10/2017 6/22/2014 B P 13
77 BLN 16 FAHRI SUYATNO / KARMI RT. 001/004 8/10/2017 6/1/2015 B L 10
81 BLN 17 HAIKAL IRFAN / YENI RT. 001/004 8/10/2017 11/14/2015 B L 14
76 BLN 18 GHIYAT I.I IRSAN / MARYATI RT. 001/004 8/10/2017 11/25/2014 B L 14.8
110 BLN 19 FATHAN ERIK / JAMAH RT. 001/004 8/10/2017 6/26/2016 B L 9
105 BLN 20 AVISA UKAR / HABIBAH RT. 001/004 8/10/2017 9/9/2013 B P 11.2
61 BLN 21 QEYMORA BOY / WIDYA RT. 001/004 8/10/2017 11/14/2015 B P 9
73 BLN 22 HASYA JUMAN / ISNA RT. 001/004 8/10/2017 9/9/2016 B P 7
55 BLN 23 DAFA KOHAR / TATI RT. 001/004 8/10/2017 4/10/2013 B L 13.6
63 BLN 24 ARDIAN ISKANDAR / OKY RT. 001/004 8/10/2017 7/25/2015 B L 12.1
3 BLN 25 IZZY ARMI / DESI CIBEUREUM 8/10/2017 10/10/2015 B L 14.2
70 BLN 26 DELISHA SAEFUL / SRI RT. 001/004 8/10/2017 11/28/2016 T P 7.9
75 BLN 27 SHAKILA HASAN / YENI RT. 001/004 8/10/2017 8/31/2015 B P 8.9
73 BLN 28 AGMA AGUNG / META RT. 001/004 8/10/2017 12/26/2015 B P 9.9
68 BLN 29 RISDO SAMIN / TINI RT. 001/004 8/10/2017 11/24/2012 B L 16.8
65 BLN 30 FARUK SAMIN / TINI RT. 001/004 8/10/2017 3/8/2017 B L 8.1
71 BLN 31 DERREN DENI / FITRI RT. 001/004 8/10/2017 5/21/2016 B P 8.5
89 BLN 32 NABILA SAURAHMAN / MKA RT. 001/004 8/10/2017 8/6/2014 B L 12.9
72 BLN 33 DILA R. JALAI / TUTI RT. 001/004 8/10/2017 7/14/2015 B P 9.6
101 BLN 34 ZAHRA MAKIN / WINDA RT. 001/004 8/10/2017 10/13/2014 B P 16.5
PETUGAS
.....................) (...................................)
FORMULIR PENCATATAN


11 12 1 2 3 4 5 6 7 8 9 10
72 BLN 35 HAIRA EHSA RIO / HERLINA RT. 001/004 8/10/2017 4/3/2017 T P 8
75 BLN 36 M. ABDIEL F. RIKI / DEWI RT. 001/004 8/10/2017 9/26/2016 T L 9
92 BLN 37 MAULANA Y. MINAN / ELI CIBEUREUM 8/10/2017 12/2/2015 B L 10
80 BLN 38 KARIN EDI / NUNUNG RT. 001/004 8/10/2017 3/13/2013 B P 14
74 BLN 39 DEFA ADI / ROSITA RT. 001/004 8/10/2017 11/21/2012 B L 15
73 BLN 40 AIDAN ANAS / HATI RT. 001/004 8/10/2017 5/6/2017 T L 6.8
88 BLN 41 INTAN P. IWAN / SITI CIBEUREUM 8/10/2017 4/17/2017 B P 8
84 BLN 42 HANA IWAN / SITI RT. 001/004 8/10/2017 5/5/2013 B P 13.6
100 BLN 43 YOGI HARYONO / DENA RT. 001/004 8/10/2017 8/3/2015 B L 10
75 BLN 44 SAPUTRA HENIM / MAR CIBEUREUM 8/10/2017 10/26/2016 B L 10
74 BLN 45 ABELINA FANDRI / IKA RT. 001/004 8/10/2017 5/14/2015 B P 12
94 BLN 46 XAVERA ARI / ANI RT. 001/004 8/10/2017 1/26/2017 B P 8.9
91 BLN 47 AMORA SAEFUL / SRI RT. 001/004 8/10/2017 3/6/2013 B P 11.5
93 BLN 48 NAILA ANWAR / SUCI RT. 001/004 8/10/2017 4/20/2017 T P 8
95 BLN 49 NOVA DANI / LENI RT. 001/004 8/10/2017 11/18/2016 B P 9.2
92 BLN 50 RULLY RUDI / ENAH CIBEUREUM 8/10/2017 12/7/2015 B L 11
94 BLN 51 ASMATUR R. ANWAR / AISYAH RT. 001/004 8/10/2017 8/27/2015 B P 10.5
8 BLN 52 RAFA ENDAN / EMAS CIBEUREUM 8/10/2017 7/8/2015 B L 14
88 BLN 53 CLARA RAHMAT / KOMALA RT. 001/004 8/10/2017 12/10/2016 T P 8
90 BLN 54 M. IILHAM PARMAN / DEDEH RT. 001/004 8/10/2017 3/8/2015 B L 11
78 BLN 55 RINDIANI SUPANDI / TINA CIBEUREUM 8/10/2017 5/12/2016 B P 8.3
71 BLN 56 RAYKANA ANDI / YATI RT. 001/004 8/10/2017 9/25/2016 B L 9.9
95 BLN 57 FERLIYANDRA MANDRA / IPAH RT. 001/004 8/10/2017 3/5/2017 B L 8.5
101 BLN 58 RIZKY SONI / MINTARSIH CIBEUREUM 8/10/2017 10/1/2016 B L 8.1
101 BLN 59 APRILIO P. IWBAL / ROSITA RT. 001/004 8/10/2017 4/29/2016 B L 8.5
103 BLN 60 NADIA OMI / SONI CIBEUREUM 8/10/2017 7/1/2016 B P 9
105 BLN 61 YAYAN IWAN / EWI RT. 001/004 8/10/2017 1/21/2013 B P 13
104 BLN 62 FARDHAN RUDI / LIA RT. 001/004 8/10/2017 6/4/2016 B L 10
105 BLN 63 ANDARA PARDI / AMI RT. 001/004 8/10/2017 11/11/2017 B P 12
BLN 64 ANNISA PARYANTO / CINDE RT. 001/004 8/10/2017 5/26/2016 B P 8
BLN 65 RANIAH SAHIB / NANI RT. 001/004 8/10/2017 6/5/2016 B P 9.9
BLN 66 ARDA M. WAHYU / RIA RT. 001/004 8/10/2017 8/1/2016 B L 9.9
BLN 67 RAISA WAHYU / DINA RT. 001/004 8/10/2017 8/9/2015 B P 9.6
BLN 68 SABRINA SUHERMAN / EKA RT. 001/004 8/10/2017 1/31/2014 P 18.8
PETUGAS
.....................) (...................................)
FORMULIR PENCATATAN


11 12 1 2 3 4 5 6 7 8 9 10
105 BLN 69 IHSAN P. ROHMAT / AYU RT. 001/004 8/10/2017 7/24/2016 B L 9.4
107 BLN 70 IBNU .H. MISRIN / TUTI RT. 001/004 8/10/2017 2/14/2016 B L 9.5
BLN 71 MUSLIM RENI / MELA RT. 001/004 8/10/2017 9/16/2016 B L 9.8
BLN 72 SHERLINE DASWA / IIS RT. 001/004 8/10/2017 3/18/2014 B P 24.9
84 BLN 73 ANNISA DWI / IIN RT. 001/004 8/10/2017 11/1/2016 T P 9
104 BLN 74 DONI SUWARDA / ARNI RT. 001/004 8/10/2017 10/13/2012 B L 13.7
BLN 75 RAYSA EDI / IDA RT. 001/004 8/10/2017 6/19/2012 B P 13.8
61 BLN 76 REZA BONEL / IRMA RT. 001/004 8/10/2017 6/24/2017 B L 18.2
104 BLN 77 HAURA YANTO / ELLA RT. 001/004 8/10/2017 11/18/2015 B P 11.6
BLN 78 BILQIS H. FERI / SELVI RT. 001/004 8/10/2017 12/14/2014 B P 9.3
BLN 79 M. SAKTI AJI GIANT / AI RT. 001/004 8/10/2017 10/1/2016 T L 9.9
BLN 80 ALIFAH AGUS / IMAS RT. 001/004 8/10/2017 4/14/2013 B P 12.4
BLN 81 AQILA FERI / SELVI RT. 001/004 8/10/2017 6/5/2017 B P 17
BLN 82 IBAM YUSUF / NURUL RT. 001/004 8/10/2017 4/22/2015 B L 11
BLN 83 CINDY ARI / DEVI RT. 001/004 8/10/2017 10/16/2014 B P 12
BLN 84 RAYHAN YAYAN / NOVI RT. 001/004 8/10/2017 6/27/2014 B L 12
BLN 85 RASYID SOHIB / NANI RT. 001/004 8/10/2017 6/30/2017 T L 4.5
BLN 86 KIAN HAIRTA WAHYUDI / LASTRI RT. 001/004 8/10/2017 7/29/2017 T L 5
BLN 87 ZALFA SABILA UGAN / DEWI RT. 001/004 8/10/2017 7/2/2017 T P 3.9
BLN 88 MERU UDAY / ANI RT. 001/004 8/10/2017 3/17/2014 B P 12.8
BLN 89 MELOVA AHYA / FIKEN RT. 001/004 8/10/2017 7/9/2014 B P 12.6
BLN 90 SAMMY EGIT / ENUNG RT. 001/004 8/10/2017 7/13/2015 B L 11.5
BLN 91 BUNGA CITRA A. AJIG / BONA RT. 001/004 8/10/2017 4/6/2015 B P 10.2
BLN 92 IQBAL UDI / SRI RT. 001/004 8/10/2017 7/15/2013 B L 15.2
BLN 93 WAFI HASAN NASUTION / AISYAH RT. 001/004 8/10/2017 4/30/2013 B L 18
BLN 94 FAIZI FIRMAN / DEVI RT. 001/004 8/10/2017 9/30/2015 B L 12.5
BLN 95 AHSAN LUTFAN AGUS / RANI RT. 001/004 8/10/2017 4/12/2015 B L 12.9
BLN 96 DAFA D. DION / CUYANTI RT. 001/004 8/10/2017 8/10/2001 B L 13
BLN 97 MAHESA F. GIANT / AISIH H. RT. 001/004 8/10/2017 12/26/2012 B L 13.2
BLN 98 BILQIS AJI / JUWITA RT. 001/004 8/10/2017 10/7/2014 B P 13.8
BLN 99
BLN 100
BLN 101
BLN 102
PETUGAS
.....................) (...................................)
FORMULIR PENCATATAN

POSYANDU/DESA : GRAHA DAELIM / SIMPANGAN (JL. CIHERANG)

11 12 1 2 3 4 5 6 7 8 9 10
98 BLN 1 AZZAHRA BILQIS F.N SAMSUL BAHRI 7A.31 8/2/2017 8/31/2012 B P 15.9
7.3 BLN 2 AFIQA ANGGRAENI SAMIJO 4 8/2/2017 9/7/2012 P
77 BLN 3 NAZWA KHOIRUNISA S. TUGIONO 3 8/2/2017 10/12/2012 B P 17.1
72 BLN 4 NADIRA PUTRI T.S AGUNG HADI S. 6 8/2/2017 10/27/2012 B P 14.5
95 BLN 5 JUNDAN UBAYDILLAH SIDIK WIYANTO 7 8/2/2017 12/14/2012 B L 13.8
87 BLN 6 M. SHALIH FAUZAN SUSYANTO 3 8/2/2017 12/22/2012 L
5 BLN 7 M. SYAFIQ NAGRENDA BAMBANG 4 8/2/2017 1/16/2013 L
103 BLN 8 GABRIEL LIONEL S. JEFRY N. SUNDAKH 2 8/2/2017 1/24/2013 B L 20.7
88 BLN 9 SYAMIL UKASYAH MASRIYAI 1 8/2/2017 1/24/2013 B L 15
78 BLN 10 M. ZIDANE A. MUJRYANTO JL.CITARIK RY. 8/2/2017 3/15/2013 L
95 BLN 11 ZAIN AR RAYYAN PANUT RIYADI 7 8/2/2017 3/2/2013 B L 20
110 BLN 12 APRILIA MUSTIKA H. SUGENG TRIONO 4 8/2/2017 4/3/2013 B P 11.7
75 BLN 13 RANGGA R. JOHN FREEZER JL.CISANGKUY 8/2/2017 31/04/2013 L
75 BLN 14 ABDULLAH AL FAUZAN DIDI PRASETYA 8/2/2017 5/15/2013 L
103 BLN 15 FELICIA WIJAYA DAVID WIJAYA CIHERANG RY. 8/2/2017 5/17/2013 P
99 BLN 16 JABAR ADIS SAFA'AT ADE SAFA'AT 1C.7 8/2/2017 6/15/2013 B L 15.1
95 BLN 17 HAWA DAMIA B. JAJANG 6 8/2/2017 6/18/2013 B P 19.7
99 BLN 18 TUPAMA DAVID ARNOLD PURBA 8/2/2017 9/9/2013 B L 16
77 BLN 19 AIRA KHAERANA J. KUDUS WALUYO 1A.12 8/2/2017 9/29/2013 B P 12.9
106 BLN 20 RIFAI GALUH MARYOTO 6 8/2/2017 10/22/2013 B P 12.5
84 BLN 21 UBAYDILLAH SAFTANI 7A.29 8/2/2017 8/26/2013 B L 10.9
72 BLN 22 SAFKA AL FARIZ TARONO 1C.9 8/2/2017 1/28/2013 B L 12.7
110 BLN 23 M. HANIF AZHAR PARLINI 4 8/2/2017 1/20/2014 B L 13
96 BLN 24 HANIF MAULANA R. MISRAN 6 8/2/2017 1/20/2014 B L 14.3
107 BLN 25 RAISYA AJLA KAMILA M. RIDWAN A.34 8/2/2017 1/20/2014 B P 13.9
71 BLN 26 FAQIH KHAIRY F.P JOKO PRASETYO 3 8/2/2017 2/2/2014 B L 13.9
91 BLN 27 SARAH INAYAH HENDRY IRAWAN 1C.01 8/2/2017 2/7/2014 P
85 BLN 28 M. FAJRI M. TANTAN 3 8/2/2017 3/7/2014 B L 14.6
104 BLN 29 AHMAD SUDIBYO DIDIT RIYANTO 4 8/2/2017 4/30/2014 B L 12.3
68 BLN 30 ADITIYA FAHRIZAL WENDRIZAL JL.CITARIK RY. 8/2/2017 4/30/2014 B L 12
85 BLN 31 NAJWA KHAIRUNISA TEGUH HARYANTO 1C.15 8/2/2017 5/14/2014 B P 11
99 BLN 32 FADHILAH AZZAHRA AGUS 3 8/2/2017 6/3/2014 B P 12.5
91 BLN 33 RIFKY IBNU KHOIRI ROHIDIN 2A 8/2/2017 6/21/2014 B L 13.4
97 BLN 34 NAURA NADIFA ADI WINATA 2A 8/2/2017 8/8/2014 B P 12.5
PETUGAS
.....................) (...................................)
FORMULIR PENCATATAN

POSYANDU/DESA : GRAHA DAELIM / SIMPANGAN (JL. CIHERANG)

11 12 1 2 3 4 5 6 7 8 9 10
67 BLN 35 DZAKIRA TALITA U. SUDIYONO 3 8/2/2017 8/22/2014 B P 11.8
79 BLN 36 FELICITY DIDERA IKE CHUKWU 3 8/2/2017 9/10/2014 P
88 BLN 37 FAISAL SHIDDIQ TRI HANDOKO 6C.16 8/2/2017 10/10/2014 B L 9.7
108 BLN 38 FATIR AKBAR P. ALI NURDIN 2A 8/2/2017 12/24/2014 L
108 BLN 39 YOGASENA UMAR MARYOTO 3 8/2/2017 12/28/2014 B L 15.8
25 BLN 40 AULIANI HAFIZAH SODRI 6 8/2/2017 3/20/2015 B P 9.7
64 BLN 41 JOSEPHING CLEO KRISTANTO 6 8/2/2017 4/5/2015 P
105 BLN 42 ASHILLA ATMARINI YUSUF T. 5 8/2/2017 7/30/2015 B P 10.5
89 BLN 43 M. AKBAR P. BAMBANG 4 8/2/2017 9/12/2015 B L 12
68 BLN 44 M. ADRIANSYAH S. RIDWAN KHOLIQ 8/2/2017 11/11/2015 B L 8.3
94 BLN 45 M. DANI MUSTOFA SAMINGAN 1A.16 8/2/2017 12/18/2015 B L 10.6
61 BLN 46 HANIF ABDULLAH RIDWAN 6 8/2/2017 11/9/2015 B L 11.3
106 BLN 47 RISKI ADITIYA DEDE RAHMAN JL.CISANGKUY 8/2/2017 11/24/2012 L
65 BLN 48 ARKA PRDITA A. TRIYUNO JL.CISANGKUY 8/2/2017 11/29/2012 L
63 BLN 49 JANUAR R. DARSONO 2A 8/2/2017 1/21/2016 L
91 BLN 50 ABID FADIL P. RAHMAN 5 8/2/2017 2/2/2016 B L 9.3
81 BLN 51 DRIRA SUMBAGA ISMAIL 2 8/2/2017 8/8/2014 B L 11.7
96 BLN 52 ALESHA ARIF 6 8/2/2017 4/19/2016 B P 8.9
71 BLN 53 GEOFANI DAVID WIJAYA CIHERANG RY. 8/2/2017 4/25/2016 P
92 BLN 54 THEO TRIMEN D. SAWOTO DAWOLO 3 8/2/2017 5/11/2016 T L 7.5
82 BLN 55 M. ABIZHAR R.R WITONO 4 8/2/2017 6/26/2016 T L 9
73 BLN 56 ANNISA DIAN U. SUTARNO 3 8/2/2017 8/2/2016 T P 10.5
71 BLN 57 ALIKHA NAYLA HERY SETIAWAN 8/2/2017 10/19/2015 B P 13
80 BLN 58 FATIMAH AZZAHRA LUKMAN 4 8/2/2017 9/28/2016 T P 7.9
85 BLN 59 RIZA PUTRA N. SUPRIYONO 4 8/2/2017 10/3/2016 L
64 BLN 60 AHMA MAULANA SODRI 6 8/2/2017 11/8/2016 T L 6.7
108 BLN 61 NESYA ELFIRA K. ROHIDIN 2 8/2/2017 10/22/2016 T P 9
82 BLN 62 MUTIARA SYIFA PUJI SETIAWAN 1A.24 8/2/2017 1/8/2017 T P 6.9
100 BLN 63 ASYA ADAH FATUROHMAN 1A.20 8/2/2017 1/14/2017 T P 7.2
80 BLN 64 ALTAN ARTANA W. ADI WINATA 2A 8/2/2017 1/17/2017 T L 7.5
80 BLN 65 HIKMAH ANINDYA SUGENG TRIONO 4 8/2/2017 1/21/2017 T P 7.1
86 BLN 66 FAIZAN GAISAN ANDRI HENDRIANA 4 8/2/2017 3/7/2017 T L 7.4
90 BLN 67 SHAREEFA YASMIN WAGIMAN 5 8/2/2017 4/6/2017 T P 6.5
116 BLN 68 ISYANA ISMAIL 2A 8/2/2017 4/19/2017 T P 4.4

69 ALYA PUTRI KAMILA MUGIYANTO 4 8/2/2017 7/6/2017 T P 3.3
PETUGAS
.....................) (...................................)
FORMULIR PENCATATAN

POSYANDU/DESA : MELATI 1 / SIMPANGAN

11 12 1 2 3 4 5 6 7 8 9 10
81 BLN 1 ASKA ASEP PULO KECIL 8/3/2017 7/18/2016 B L 9
78 BLN 2 MUTIA SITI PULO KECIL 8/3/2017 12/4/2016 T P 7.3
82 BLN 3 ATALAH UJANG PULO KECIL 8/3/2017 9/9/2015 B L 10.8
108 BLN 4 RAMDANI HUSEN PULO KECIL 8/3/2017 6/26/2015 B L 11.6
64 BLN 5 GHANI SARYO PULO KECIL 8/3/2017 9/18/2013 B L 14.1
108 BLN 6 ANIK ARMAN PULO KECIL 8/3/2017 4/14/2016 B P 8.6
106 BLN 7 FIRMAN TOMO PULO KECIL 8/3/2017 6/3/2014 B L 11.1
106 BLN 8 KINAN YOEL PULO KECIL 8/3/2017 7/2/2016 B P 8.1
88 BLN 9 BUNGA IRMANSYAH PULO KECIL 8/3/2017 8/4/2014 B P 10.4
85 BLN 10 ADIT APUK PULO KECIL 8/3/2017 9/30/2015 B L 9.9
86 BLN 11 ZAHRA ODIK PULO KECIL 8/3/2017 9/18/2013 B P 16.9
100 BLN 12 AGHAM ODIK PULO KECIL 8/3/2017 2/28/2016 B L 11
107 BLN 13 AISYAH NANO PULO KECIL 8/3/2017 5/27/2015 B P 10
86 BLN 14 SALSA APIN PULO KECIL 8/3/2017 6/26/2013 B P 13.1
89 BLN 15 FATHIR YAYA PULO KECIL 8/3/2017 5/15/2013 B L 12.5
90 BLN 16 ELBAS ROZIKIH PULO KECIL 8/3/2017 7/2/2017 T L 4.9
52 BLN 17 ADEL AGUS PULO KECIL 8/3/2017 6/26/2013 B P 20.9
56 BLN 18 INAYAH EDI PULO KECIL 8/3/2017 5/19/2017 T P 6.5
50 BLN 19 ZASKIA TAROM PULO KECIL 8/3/2017 4/26/2016 B P 6.4
86 BLN 20 GISEL TEJA PULO KECIL 8/3/2017 4/14/2013 B P 14.6
82 BLN 21 BASTIAN ANTO PULO KECIL 8/3/2017 12/31/2015 B L 9
79 BLN 22 EUIS ROSANI PULO KECIL 8/3/2017 1/10/2015 B P 14
84 BLN 23 ANZANI ANGGA PULO KECIL 8/3/2017 11/12/2015 B P 8.8
115 BLN 24 ATHAR HERI PULO KECIL 8/3/2017 2/8/2012 B L 13.9
1174 BLN 25 AZIS BAMBANG PULO KECIL 8/3/2017 2/2/2016 B L 10
95 BLN 26 GEA TEJA PULO KECIL 8/3/2017 3/19/2016 T P 7.6
95 BLN 27 SALSA B. AMRI PULO KECIL 8/3/2017 5/11/2015 B P 9.3
94 BLN 28 ARTIAN ARI PULO KECIL 8/3/2017 9/20/2015 B L 10.5
105 BLN 29 SYIFA ABDUL H. PULO KECIL 8/3/2017 2/13/2016 B P 9.8
96 BLN 30 RAKA SUHERMAN PULO KECIL 8/3/2017 7/17/2015 B L 11
BLN 31 NADIVA HADI PULO KECIL 8/3/2017 6/7/2015 B P 10.2
BLN 32 FATIH IRFAN PULO KECIL 8/3/2017 3/29/2016 B L 8.4
BLN 33 MELINDA DEWI PULO KECIL 8/3/2017 5/30/2015 B P 11.9
BLN 34 NIZAM ALI PULO KECIL 8/3/2017 4/14/2016 B L 9.7
PETUGAS
.....................) (...................................)
FORMULIR PENCATATAN


1 2 3 4 5 6 7 8 9 10
35 AHMAD DEDI PULO KECIL 8/3/2017 5/7/2013 B L 14.7
36 SAFINA AMRI PULO KECIL 8/3/2017 8/15/2014 B P 18.1
37 ABDUL F. APNI PULO KECIL 8/3/2017 6/2/2015 B L 11.1
38 GERI DEDI PULO KECIL 8/3/2017 5/24/2016 B L 7.5
39 SERLI SUPARNO PULO KECIL 8/3/2017 4/16/2013 B P 17.2
40 DILEN BEDI PULO KECIL 8/3/2017 7/2/2013 B L 14.2
41 DAFFI ROZIKIN PULO KECIL 8/3/2017 12/17/2012 B L 13.8
42 AINUN ABAS PULO KECIL 8/3/2017 3/10/2013 B P 11.2
43 PUTRI ANDI PULO KECIL 8/3/2017 4/21/2014 P 10.8
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
PETUGAS
(...................................)
FORMULIR PENCATATAN
PUSKESMAS :
POSYANDU/DESA : GRAHA ASTRA / SIMPANGAN

11 12 1 2 3 4 5 6 7 8 9 10
107 BLN 1 SULTAN TIRTO RT.003 8/11/2017 8/25/2012 B L
BLN 2 M. ZULFAN H. RISDIANA RT.003 8/11/2017 9/12/2012 B L
108 BLN 3 AMARA N. BRUSELI RT.003 8/11/2017 9/26/2012 B P 19
105 BLN 4 ALDIANA P. ALFIANTO RT.001 8/11/2017 9/20/2012 B P
101 BLN 5 DARUS B. DARSO RT.001 8/11/2017 12/31/2012 B L 23
BLN 6 AISYAKIRA Z. TABRANI RT.004 8/11/2017 2/4/2013 B P
BLN 7 FARISYA MIFTAH RT.001 8/11/2017 2/11/2013 B P
108 BLN 8 M. FAHDIL S. KHOIRUDIN RT.004 8/11/2017 3/31/2013 B L
99 BLN 9 NABILA A. SUHANDI RT.003 8/11/2017 4/3/2013 B P
BLN 10 M. ADNIN KUSNOYO RT.003 8/11/2017 5/22/2013 B L
103 BLN 11 H. MUNFARID SUMIARTO RT.003 8/11/2017 5/25/2013 B L 15.4
94 BLN 12 FATHIN N. BONG RT.003 8/11/2017 7/10/2013 B P
BLN 13 M. HAIKAL R. YAMIN RT.002 8/11/2017 7/11/2013 B L 15.6
BLN 14 M. SYAFIQ ISHAK RT.003 8/11/2017 4/15/2014 B L 15
BLN 15 SAIDAN M. IMAM RT.002 8/11/2017 8/4/2013 B L 18.2
100 BLN 16 UNAISAN SANTO RT.003 8/11/2017 8/21/2013 B P 14.1
105 BLN 17 FATIMAH Z. NIMAS RT.004 8/11/2017 12/10/2013 B P
104 BLN 18 ATIKAH YOPI RT.003 8/11/2017 12/24/2013 B P 19.9
98 BLN 19 HABIBIE SAKTI RT.003 8/11/2017 10/28/2013 B L 16.5
93 BLN 20 SOFWAN S. SAIFUL RT.003 8/11/2017 11/6/2013 B L 14.1
90 BLN 21 NAIRA HALIM RT.003 8/11/2017 7/31/2013 B P 23.4
98 BLN 22 AAFIYAH A. SUJANA RT.003 8/11/2017 1/5/2014 B L 12.4
97 BLN 23 SYAKILLA N. M. ISKAK RT.003 8/11/2017 3/15/2014 B P 14.2
97 BLN 24 I. KHALIFATUS HANANTO RT.003 8/11/2017 8/25/2013 B L 10
93 BLN 25 AYESA H. WISMO RT.003 8/11/2017 6/1/2014 B P 17.7
94 BLN 26 YAZID ARIS P. RT.003 8/11/2017 5/28/2014 B L 12
BLN 27 ANISA C. ANTO RT.003 8/11/2017 6/22/2014 B P 12.9
91 BLN 28 NARENDRA A. JOKO RT.003 8/11/2017 6/22/2014 L
98 BLN 29 NAYLA M. TUSINO RT.003 8/11/2017 7/24/2014 P
90 BLN 30 HAFSAH MURWAT RT.003 8/11/2017 9/12/2014 B P 16
90 BLN 31 ALISA SUJANTO RT.003 8/11/2017 5/15/2015 P
92 BLN 32 HASBI HERI RT.003 8/11/2017 4/20/2015 B L 10.5
105 BLN 33 ZIYAD ARIS P. RT.003 8/11/2017 5/12/2015 B L 10
94 BLN 34 FATIH H. SARWOKO RT.003 8/11/2017 5/20/2015 L
PETUGAS
.....................) (...................................)
FORMULIR PENCATATAN
PUSKESMAS :

11 12 1 2 3 4 5 6 7 8 9 10
90 BLN 35 IQBAL R. BUDIYONO RT.002 8/11/2017 7/3/2015 B L 12
BLN 36 M. ILHAM M. JAKA RT.004 8/11/2017 8/19/2015 B L 10.2
85 BLN 37 AVELIA N. TUGIO RT.003 8/11/2017 8/29/2015 B P 11.1
BLN 38 M. LATIEF ISHAK RT.003 8/11/2017 9/3/2015 B L 11.4
95 BLN 39 MARYAM SARDIYO RT.004 8/11/2017 10/11/2015 P
92 BLN 40 SAKINA R. MUMU RT.002 8/11/2017 9/17/2015 B P 8.8
BLN 41 HAFIZH MULYADI RT.004 8/11/2017 1/19/2016 B L 8.5
84 BLN 42 AURA NABILA MUHAIMIN RT.004 8/11/2017 1/11/2016 B P 8.8
86 BLN 43 ARKAN WALIMIN RT.001 8/11/2017 B 15.1
78 BLN 44 AMIRA Z. SUNARTO RT.003 8/11/2017 4/1/2013 B P 13.1
82 BLN 45 M. DAFFA DANI RT.001 8/11/2017 2/6/2016 L
81 BLN 46 M. LUTHFI T. AGUNG RT.003 8/11/2017 2/18/2016 B L 8.6
BLN 47 RAFARDAN A. RUDI RT.001 8/11/2017 2/12/2016 B L 9.6
BLN 48 KHALISAH SANTO RT.003 8/11/2017 2/28/2016 B P 8
BLN 49 JANNATU S. MURWAT RT.003 8/11/2017 3/5/2016 B P 14.5
79 BLN 50 ARKASYA K. SAEFUL RT.004 8/11/2017 4/1/2016 B L 10.1
90 BLN 51 CANTIKA H. ARIS RT.002 8/11/2017 6/9/2016 B P 11
78 BLN 52 ADHA S. SARWOKO RT.003 8/11/2017 9/7/2016 T P 7.3
BLN 53 ISSA ALBARA WISMO RT.003 8/11/2017 9/23/2016 T L 9.2
7274 BLN 54 AQILLA A. HANANTO RT.003 8/11/2017 10/1/2016 T P 6.2
BLN 55 DEVANDRA MEI RT.003 8/11/2017 10/10/2016 T L 8.5
37 BLN 56 NATHAN A. SUTAMI RT.003 8/11/2017 12/5/2016 T L 8.1
70 BLN 57 HUSNA SURYADI RT.003 8/11/2017 10/7/2016 T P 8.1
70 BLN 58 ATTAR N. M. DUBET RT.003 8/11/2017 5/2/2016 B 9.2
BLN 59 SAKHI Z. SUKITO RT.003 8/11/2017 3/12/2017 T L 7.6
69 BLN 60 ATHAFARIZ WAYAN RT.003 8/11/2017 10/9/2016 B L 9.6
70 BLN 61 WILDAN SEPRI RT.003 8/11/2017 5/25/2014 B L 12
61 BLN 62 NAYARA SUGIHARTO RT.003 8/11/2017 10/8/2013 B P 15.7
70 BLN 63 AISYAH GINA KAMALUDIN RT.003 8/11/2017 3/10/2015 B P 12
64 BLN 64 NUGROHO H. TEGUH RT.003 8/11/2017 11/26/2013 B L 14.3
62 BLN 65 M. BERRY N. DEDE S. RT.003 8/11/2017 10/28/2014 B L 13.8
62 BLN 66 DIRGANTARA HALIM RT.003 8/11/2017 B 8.5
58 BLN 67 FATIH FARHAN SAEFUDDIN RT.003 8/11/2017 10/11/2014 B 14.8
57 BLN 68 GINA H. WILUN RT.003 8/11/2017 7/23/2015 B 12.7

53 BLN
PETUGAS
.....................) (...................................)
FORMULIR PENCATATAN
PUSKESMAS :

11 12 1 2 3 4 5 6 7 8 9 10
73 BLN 69 RESTU YAMIRON RT.003 8/11/2017 12/12/2012 B L 15.4
62 BLN 70 SEFTY C. NURSYAFIAN RT.001 8/11/2017 3/12/2016 B P 9.4
79 BLN 71 ATTAR N. M. DOBET RT.004 8/11/2017 5/2/2016 T
BLN 72
105 BLN 73
72 BLN 74
87 BLN 75
70 BLN 76
84 BLN 77
79 BLN 78
106 BLN 79
77 BLN 80
96 BLN 81
96 BLN 82
97 BLN 83
52 BLN 84
113 BLN 85
62 BLN 86
70 BLN 87
114 BLN 88
81 BLN 89
81 BLN 90
79 BLN 91
100 BLN 92
68 BLN 93
78 BLN 94
82 BLN 95
84 BLN 96
77 BLN 97
81 BLN 98
88 BLN 99
74 BLN 100
89 BLN 101
86 BLN 102
PETUGAS
.....................) (...................................)
TB UMUR
(CM) (BULAN)
11 12
95 BLN
95 BLN
85 BLN
85 BLN
100 BLN
98 BLN
110 BLN
88 BLN
98 BLN
BLN
BLN
BLN
BLN
BLN
BLN
BLN
BLN
BLN
BLN
BLN
BLN
BLN
BLN
BLN
BLN
BLN
BLN
BLN
BLN
BLN
BLN
BLN
BLN
.....................)
FORMULIR PENCATATAN

POSYANDU/DESA : MELATI 2 D / SIMPANGAN (CHEMCO)

11 12 1 2 3 4 5 6 7 8 9 10
BLN 1 AHMAD REZA KAMDI RT.001 8/12/2017 9/18/2016 B L 8
BLN 2 ALVIAN RIZQI JONI GUNTORO RT.001 8/12/2017 3/10/2016 B L 10.1
BLN 3 SYAUQI A. EKI SENTOSA RT.001 8/12/2017 4/27/2016 B L 8.7
BLN 4 FARREL G. SUPRAPTO RT.001 8/12/2017 1/18/2017 T L 9.1
BLN 5 HAYFA P. ARIFIN RT.001 8/12/2017 6/13/2017 T P 11.5
BLN 6 SHEILAVANIA GUNAWAN RT.001 8/12/2017 10/17/2015 B P 8.4
BLN 7 DENIS ROLAN EDI PRAYITNO RT.001 8/12/2017 7/23/2014 B L 14.1
BLN 8 DAVITA IZA M. BAHRUDIN RT.001 8/12/2017 10/13/2014 B P 11.4
BLN 9 RAFA ADITYA AGUNG M. RT.001 8/12/2017 10/14/2014 L
BLN 10 M. IQBAL F. KAMDI RT.001 8/12/2017 1/10/2014 B L 13.1
BLN 11 RAMADANISH FIVANONO RT.001 8/12/2017 7/10/2013 B L 15.2
BLN 12 B. DIMAS A. YOHANES TEGUH RT.001 8/12/2017 4/22/2013 B L 17
BLN 13 KAHIYANG JUMADI RT.002 8/12/2017 4/5/2016 P
BLN 14 M. FIKRI A. ARIANTO RT.002 8/12/2017 6/30/2016 T L 10.7
BLN 15 ASMA N. BUDIYONO RT.002 8/12/2017 7/26/2015 B P 11.7
BLN 16 ALIFAH N. BAMBANG RT.002 8/12/2017 11/23/2014 B P 12.5
BLN 17 BHANU CETA AGUS KUSWANTO RT.002 8/12/2017 1/2/2015 B L 12.6
BLN 18 EARLYTA A. SUGIYANTO RT.002 8/12/2017 12/8/2014 B P 11.2
BLN 19 FAHREZA R. ARIS RT.002 8/12/2017 9/4/2015 B L 10.8
BLN 20 AZIFA TRI WAHOYO RT.002 8/12/2017 8/7/2014 B P 11
BLN 21 ADITYA HERMANSYAH RT.002 8/12/2017 5/15/2014 B L 11.7
BLN 22 AZKIA Z. GINANJAR RT.002 8/12/2017 5/26/2014 B P 10.8
BLN 23 KEANU SIGIT RT.002 8/12/2017 12/11/2012 L
BLN 24 DZAKIRA T. DIDIK SRI P. RT.002 8/12/2017 12/3/2012 B P 19.5
BLN 25 FAIZ ALIHSAN AHMAD AFANDI RT.002 8/12/2017 12/21/2012 B L 18.4
BLN 26 NUR AZIZAH AHMAD SOGIRI RT.002 8/12/2017 11/19/2012 B P 16.3
BLN 27 ROBERTINO G. ARDY C. RT.002 8/12/2017 10/9/2016 B L 7
BLN 28 M. MAUZA A. WITRI SASONGKO RT.003 8/12/2017 8/26/2016 L
BLN 29 M. RIOA RDHAN ADE CAHYA RT.003 8/12/2017 1/22/2016 L
BLN 30 ANDIBOY TOBIRIN RT.003 8/12/2017 5/18/2016 L 7.6
BLN 31 MIRZA R. SUWARJA RT.003 8/12/2017 6/28/2015 T L 9.6
BLN 32 AYLA PUTRI ARI SUPRIYANTO RT.003 8/12/2017 4/30/2014 B P 16.7
BLN 33 MAHIRA HENDI B. RT.003 8/12/2017 10/18/2014 B P 14.7
BLN 34 GILANG S SUKARNO RT.003 8/12/2017 7/5/2014 B L 13.8
PETUGAS
......................) (...................................)
FORMULIR PENCATATAN

POSYANDU/DESA : MELATI 2 D / SIMPANGAN (CHEMCO)

11 12 1 2 3 4 5 6 7 8 9 10
BLN 35 M. ALFIN Z. HADI PRAYITNO RT.002 8/12/2017 9/27/2013 B L 15.7
BLN 36 ADIBA SHAKILA AHAMD SYAMSUL RT.003 8/12/2017 8/21/2013 B P 14.9
BLN 37 ATHIFANY N. WITRI SASONGKO RT.003 8/12/2017 1/20/2013 P
BLN 38 LARISA ANDRI K. RT.003 8/12/2017 2/22/2013 B P 13.3
BLN 39 GENDIS HADI PURNOMO RT.003 8/12/2017 11/10/2012 B P 16.5
BLN 40 M. NABIL A. ADE CAHYA RT.003 8/12/2017 1/9/2014
BLN 41 ZAHRANA T. AGUS RT.004 8/12/2017 10/25/2016 B P 8
BLN 42 NASYA FAIHA FIKA CAHYONO RT.004 8/12/2017 6/24/2016 B P 10
BLN 43 PUTRI HAFIDZAH LISTIA MARYANA RT.004 8/12/2017 3/24/2016 B P 7.7
BLN 44 GENDIS PRATIKNO RT.004 8/12/2017 3/13/2016 B P 9.9
BLN 45 ZEFTA ANDREASTA TOTOK WANTORO RT.004 8/12/2017 9/15/2015 B L 11
BLN 46 STERA ARIMATEA AGUS T. RT.004 8/12/2017 10/20/2015 B L 10.1
BLN 47 DEVAN ABDUL BASIR RT.004 8/12/2017 6/15/2015 B L 12.6
BLN 48 MAURA H. SUTOMO EDY RT.004 8/12/2017 12/10/2014 T P 10.5
BLN 49 M. TRISTAN SUYADI RT.004 8/12/2017 9/24/2014 B L 13
BLN 50 M. AZRI BAMBANG RT.004 8/12/2017 3/7/2014 B L 17.9
BLN 51 ANAYA RAGIL SAPUTRO RT.004 8/12/2017 4/15/2014 P
BLN 52 M. ZIDANE MURJIANTO RT.004 8/12/2017 3/15/2014 B L 15.7
BLN 53 NABILAH H. BAMBANG RT.004 8/12/2017 8/10/2012 B P 18.5
BLN 54 CHALILA DARTONO RT.004 8/12/2017 8/1/2012 B P 18
BLN 55 SAHIRA SIGIT P. RT.004 8/12/2017 9/30/2014 B P 12.1
BLN 56 AULIA IZZATU YULIANTO RT.004 8/12/2017 7/26/2014 B P 10
BLN 57 NAFIZAH N, WAKIT NURHUDA RT.004 8/12/2017 9/19/2015 P
BLN 58 YUSUF WAKIT NURHUDA RT.004 8/12/2017 4/4/2013 L
BLN 59 INAYA JOKO SUSANTO RT.004 8/12/2017 11/24/2014 B P 11.2
BLN 60 RAFKA JOKO SUSANTO RT.004 8/12/2017 12/10/2012 B L 16.2
BLN 61
BLN 62
BLN 63
BLN 64
BLN 65
BLN 66
BLN 67
BLN 68
PETUGAS
......................) (...................................)
FORMULIR PENCATATAN
PUSKESMAS :

11 12 1 2 3 4 5 6 7 8 9 10
BLN 1 ALANI HAFIZ HADI MUSTOFA / AI E15/02 8/3/2017 9/2/2013 B P 9
BLN 2 HAFIZ HADI MUSTOFA / AI E15/02 8/3/2017 10/20/2016 T L 8.1
BLN 3 CHIKA LUPITA EDY W. / LESTARI P. E15/17 8/3/2017 11/14/2014 B P 9.9
BLN 4 HAMDA DIDIN / EEN SAENAL E15/25 8/3/2017 5/2/2013 B P 16
BLN 5 SULTAN ZAMIR RIDWAN / SRI W. E15/26 8/3/2017 10/8/2016 B L 8.8
BLN 6 MAHIRA JUHRI / WIWIK C17/03 8/3/2017 3/17/2015 B P 10.9
BLN 7 ALYA GUGUN / MUTIA C17/04 8/3/2017 3/7/2014 B P 10.2
BLN 8 FADLY GUGUN / MUTIA C17/04 8/3/2017 4/13/2016 B L 9.5
BLN 9 JINGGA NANANG/TRI WAHYU C17/03 8/3/2017 6/1/2016 B P 12
BLN 10 ALESHA DANISWERA / HENI C17/08 8/3/2017 12/27/2013 B P 10
BLN 11 NANDA TARSONI / UMI H. C17/09 8/3/2017 12/23/2013 B P 12
BLN 12 DARA JUNAIDI / ITA ROSITA C17/10 8/3/2017 10/21/2015 B P 11
BLN 13 KEYSA P. JAROT / NANA E14/01 8/3/2017 12/25/2014 B P 9.9
BLN 14 RAFA YOYO / UNTARYANI C17/18 8/3/2017 12/13/2013 B L 14
BLN 15 KEN KEANO SUSANTO / JUANAH C18/04 8/3/2017 2/6/2016 B L 13.7
BLN 16 ERLANGGA DIDIN / BARNA N. E13/06 8/3/2017 9/6/2016 T L 10
BLN 17 NAVYA SURIPTO / SUPARMI E13/07 8/3/2017 11/5/2015 B P 9.5
BLN 18 AISYAH SUTORO / DYAH K. E14/04 8/3/2017 12/2/2015 B P 7.7
BLN 19 ARKAN SAID JOKO WASKITO/DEWI C18/06 8/3/2017 7/14/2015 B L 13.3
BLN 20 YUSMINA JOKO WASKITO/DEWI C18/06 8/3/2017 5/25/2016 B P 10.8
BLN 21 KHAIRINA WAHYUDI / NENI C19/ 8/3/2017 5/11/2014 B P 13
BLN 22 AHMAD WAHYUDI / NENI C19/ 8/3/2017 2/18/2017 T L 8.2
BLN 23 FERNANDO BUYUNG C19/ 8/3/2017 10/15/2013 B L 13.5
BLN 24 NAYSHITA PADMA / RINA E14/05 8/3/2017 6/6/2015 B P 11
BLN 25 NUR HAMDI TARSONO / PARTINAH C17/04 8/3/2017 7/5/2014 B L 13
BLN 26 GENDIS HERU / ST NURJANAH C18/15 8/3/2017 8/9/2013 B P 12
BLN 27 TIARA ARIIFN / SUSI W. C19/02 8/3/2017 9/6/2014 B P 10
BLN 28 KHYAR DENI / NIA E14/02 8/3/2017 7/20/2016 B L 9
BLN 29 BINTANG ISMAWAN / LITA M. C18/08 8/3/2017 11/11/2013 B P 15
BLN 30
BLN 31
BLN 32
BLN 33
BLN 34
PETUGAS
......................) (...................................)
FORMULIR PENCATATAN
PUSKESMAS :
POSYANDU/DESA :

1 2 3 4 5 6 7 8 9 10
1 LIM CHEW YOU NIKEN / HERYANTI C8/09 3/10/2014 P
2 M. FABIAN S. FERRY S. / FITRI W. C8/23 1/31/2014 L
3 BIMO AZAM D. DIDI M. / WULAN R.S C8/26A 5/28/2014 L
4 FADHLAN A.F KUSNANDI / NOPI Y. C8/26B 4/30/2015 L
5 KENZO PRATAMA AFIF CH. / JETTI T. C9/04 1/8/2013 L
6 KHAZA AQILA AFIF CH. / JETTI T. C9/04 11/20/2015 P
7 ARZI CAHAYA N. BONDAN/RIZKIAWATI C9/09 11/20/2014 L
8 AHMAD ERZI M. ROHIM / EKA I. C9/15 10/3/2014 L
9 ANDHIKA R. ROCHIM / ROHMINI C9/07 7/14/2012 L
10 FANY RISKIA S. JONI S.S / SRI M. C11/14 1/8/2015 P
11 NIZAM ALTAMIS M. BADRUD T. / DEWI C10/16 2/8/2015 L
12 KEISHA ULAYYA SUBHAN / IIS R. C11/13 P
13 NAURA FERRY S. / FITRI W. C8/23 P
14 ARUMI BAREP A. / UTIK P. C10/09 P
15 FERNANDO HERMAN/CHANSUNG 2/26/2015
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
PETUGAS
(...................................)
FORMULIR PENCATATAN

POSYANDU/DESA : MELATI 2 A / SIMPANGAN

11 12 1 2 3 4 5 6 7 8 9 10
72 BLN 1 ZAHRA ALMAYZA RAHMAN / NOVI RT. 002/007 8/4/2017 6/2/2014 B P 13.5
80 BLN 2 ALILA SYAFIYYA BUDI / YULIANA RT. 002/007 8/4/2017 5/29/2016 P 9.5
73 BLN 3 RAFAEL KRISMAN / ANGGUN RT. 002/007 8/4/2017 6/7/2016 L 9
76 BLN 4 M. ABI.F. DWI / WIWIN RT. 002/007 8/4/2017 2/15/2015 B L 15.2
50 BLN 5 FARZAN ALFARIZI BAROKAH / TRI RT. 002/007 8/4/2017 1/17/2016 B L 11.7
85 BLN 6 AZZA LITA SUWARDI / SUHARTI RT. 002/007 8/4/2017 2/24/2017 P 6.5
100 BLN 7 WILDAN HASBY JAROT / RATNA RT. 002/007 8/4/2017 3/16/2017 L 10.9
91.5 BLN 8 ARKANA ZAFRAN YANUAR / NOVI RT. 002/007 8/4/2017 3/27/2014 B L 15.6
BLN 9 KHALISA SUMA / YANI RT. 002/007 8/4/2017 9/3/2016 P 8
98 BLN 10 PUTRA NAWAF AAN / TUSLIKHATUN RT. 002/007 8/4/2017 6/12/2016 B L 9.3
108 BLN 11 SHOFIYAH TRIO / SUPRIYATI RT. 002/007 8/4/2017 12/25/2014 P 12.3
104 BLN 12 FELICIA L.SIHOYANG / IMELDA RT. 002/007 8/4/2017 8/8/2016 P 8.8
BLN 13 NABILA SAHRONI / VITA RT. 002/007 8/4/2017 9/27/2016 B P 8.6
0 BLN 14 YOSAFAT ALEXANDER / FELIDA RT. 002/007 8/4/2017 4/13/2016 L 8
87 BLN 15 KHANZA NURSALIM / LINA RT. 002/007 8/4/2017 4/1/2013 B P 17.7
93 BLN 16 M. HISYAM ENDANG / NILA RT. 002/007 8/4/2017 12/4/2016 T L 7
91 BLN 17 AZNI KIASA INARA SARYONO / ERNI RT. 002/007 8/4/2017 2/15/2017 P 6.7
92 BLN 18 ALMAIDA P. YAKUB / IMAS RT. 001/006 8/4/2017 4/7/2017 L 6.4
85 BLN 19 NAYLA SAMSUDIN / IRA RT. 001/006 8/4/2017 1/12/2014 B L 13.4
94 BLN 20 SAKI ANTON / BINA RT. 001/006 8/4/2017 5/23/2015 B P 8.9
97 BLN 21 YESLYN L. YANI / DEWI RT. 001/006 8/4/2017 9/15/2012 B L 26.1
89 BLN 22 NARENDRA NURKAMID / NURUL RT. 001/006 8/4/2017 10/8/2015 B L 10.5
BLN 23 ALIFA BASRIAH BASRIAL / WIDIA RT. 001/006 8/4/2017 11/24/2016 T P 7
111 BLN 24 LUIVINA S. HELMI / MARLITA RT. 001/006 8/4/2017 1/20/2015 B P 10.6
111 BLN 25 CALYSTA AZIZ / EVA RT. 001/006 8/4/2017 7/3/2015 B P 12.5
105 BLN 26 SYIFA EPIN / KHODIJAH RT. 001/006 8/4/2017 9/25/2013 B P 11.7
7.7 BLN 27 ASYIFA SUKANA / WIWIK RT. 001/006 8/4/2017 1/12/2013 B P 12.2
BLN 28 KAYLILA INARA EKO / TRI H. RT. 001/006 8/4/2017 12/20/2014 B P 10.1
BLN 29 ARIF A. SUPARDI / ARIS RT. 001/006 8/4/2017 9/29/2016 T L 7.8
77 BLN 30 SYAHRIZA DEDE / LIA RT. 001/006 8/4/2017 12/27/2016 T L 7.8
88 BLN 31 PUTY ARI M. / ATIK RT. 001/006 8/4/2017 3/2/2014 B P 12.9
101 BLN 32 SILMY ARI M. / ATIK RT. 001/006 8/4/2017 10/20/2016 T P 6.8
96 BLN 33 FU'NUN SUNGKONO / WAGIMAN RT. 001/006 8/4/2017 9/17/2012 B P 14.7
100 BLN 34 AMIRA JOKO / SUYATUN RT. 001/006 8/4/2017 3/23/2014 B P 15.2
PETUGAS
.....................) (...................................)
FORMULIR PENCATATAN


11 12 1 2 3 4 5 6 7 8 9 10
107 BLN 35 ALFI ALAN / ARAMA RT. 002 8/4/2017 1/5/2016 L 7.3
104 BLN 36 FELICIA L.SIHOYANG / IMELDA RT. 002 8/4/2017 8/8/2016 P 8.8
BLN 37 IMANUEL ALEXANDER / FELIDA RT. 002 8/4/2017 6/1/2013 B L 14.2
103 BLN 38 FATIR AGUS / MARYATI RT. 002 8/4/2017 2/17/2013 B L 12.3
112 BLN 39 ZAHRA YUSRAN / RIKA RT. 001 8/4/2017 5/2/2016 B P 8.4
BLN 40 AQILA PURWOKO / NINIK RT. 001 8/4/2017 9/26/2012 B P 17
72 BLN 41 ALIFAR PURWOKO / NINIK RT. 001 8/4/2017 6/4/2017 T L 5.4
79 BLN 42 ARJUNA ARIF / YULIA RT. 001 8/4/2017 7/15/2016 L 8.4
79 BLN 43 IBRAHIM SUHAEMI / YULI RT. 002 8/4/2017 11/7/2015 L 9.8
83 BLN 44 AQILA PUTRI PURNOMO / SITI RT. 002 8/4/2017 10/30/2015 P 9.5
86 BLN 45 M. HAFDHUDIN SUKAMYANTO RT. 002 8/4/2017 7/19/2014 L 11.7
88 BLN 46 M. AZZAM ARIYONO / SRI RT. 002 8/4/2017 4/21/2014 L 21.2
91 BLN 47 AFNAN ARIYONO / SRI RT. 002 8/4/2017 10/3/2015 10.3
94 BLN 48 BELVIANA LILI / DEDI RT. 004 8/4/2017 7/10/2015 11.4
97 BLN 49 BASIRA PRASETYO / EMMA RT. 004 8/4/2017 11/4/2016 8.9
105 BLN 50 NUR ASYIFA AMUNG / MARLINA RT. 001 8/4/2017 1/2/2015 B 12.1
BLN 51 ADITYA SULISTYO / ISTY RT. 001 8/4/2017 3/12/2016 B 13.2
106 BLN 52 FAIZ ARSYA FERY A. / FITRIANI RT. 003 8/4/2017 5/24/2014 B L 17.1
110 BLN 53 AL FATIH SLAMET / IKE RT. 003 8/4/2017 11/18/2014 B L 10.5
114 BLN 54 RADIT AMIR / YUNI RT. 003 8/4/2017 7/1/2013 B L 14.9
92 BLN 55 SAKHA AIMAR INA / UJANG RT. 003 8/4/2017 5/3/2016 L 10.7
92 BLN 56 AULIA UNTUNG / SITI M. RT. 003 8/4/2017 10/13/2015 B P 8.9
BLN 57 SAKILA ARIFIN / AINI RT. 003 8/4/2017 12/29/2015 B P 10.9
BLN 58 AISYAH S. KHAIRUL / MALASARI RT. 003 8/4/2017 5/22/2013 B P 15.1
92.5 BLN 59 ARJUNA OSI / RENA RT. 003 8/4/2017 1/28/2016 B L 10.3
105.2 BLN 60 ANDARA WIDODO / SARI RT. 003 8/4/2017 11/9/2013 B P 1.7
BLN 61 ZALFA ABIDAH DIDIK / JULIATIN RT. 003 8/4/2017 12/13/2012 B P 12.8
BLN 62 AJENG P. AGUS / SUMIATI RT. 003 8/4/2017 7/26/2013 B P 20.6
BLN 63 RISA KAMILA ACHMAD / SUMARTI RT. 003 8/4/2017 11/2/2012 B P 19.8
BLN 64 FARAH NUR AMIR / SULIYAM RT. 003 8/4/2017 2/6/2014 B P 16.2
BLN 65 B. INDRA FATA SALAMAN / ASTUTI RT. 003 8/4/2017 6/30/2015 B L 13.2
BLN 66 ILHAM BINTANG HERU / MARTINI RT. 003 8/4/2017 4/11/2017 L 6.4
BLN 67 GHAZI AL F. DANI / SRI RT. 003 8/4/2017 10/7/2017 B L 8.7
BLN 68 RAYWA AGUS /SITI RT. 003 8/4/2017 2/25/2014 B L 14.8
PETUGAS
.....................) (...................................)
FORMULIR PENCATATAN


11 12 1 2 3 4 5 6 7 8 9 10
82 BLN 69 ARSHYLA ARWANI / PUSPITA RT. 004/007 8/4/2017 3/12/2016 B P 9.3
70 BLN 70 M. FATHAN ARWANI / PUSPITA RT. 004/007 8/4/2017 12/8/2012 B L 18.1
85 BLN 71 SALMIRA ANTAR / MIFTA RT. 004/007 8/4/2017 10/8/2014 B P 10
102 BLN 72 KHOFIFAH KHOIRI / DEVI RT. 004/007 8/4/2017 9/13/2013 B P 13.3
73 BLN 73 ZASKIA BUDI / MARTINI RT. 004/007 8/4/2017 1/21/2015 B P 10.7
85 BLN 74 RAIFAN ASEP / AIMIA RT. 004/007 8/4/2017 9/9/2013 B L 21.2
92 BLN 75 NAJWA SITI / AHMAD RT. 004/007 8/4/2017 3/31/2014 B P 11.8
75 BLN 76 CELO JAMES / EVA RT. 004/007 8/4/2017 5/19/2013 B L 15.9
87 BLN 77 OSWAL JAMES / EVA RT. 004/007 8/4/2017 10/8/2014 P 17
89 BLN 78 KIRANA AHAMD / YAYU RT. 004/007 8/4/2017 9/27/2016 T P 7.8
89 BLN 79 ABIYYU HERI / M. TRI RT. 004/007 8/4/2017 9/19/2015 L 11.6
90 BLN 80 DARWIS A. HADY / NIA RT. 004/007 8/4/2017 6/1/2013 B L 11.7
90 BLN 81 LEAN H. YARENTA / LASMAIDA RT. 004/007 8/4/2017 5/11/2015 B L 10.9
101 BLN 82 ANGGUN YULI / IMAN RT. 004/007 8/4/2017 4/16/2015 B P 10
86 BLN 83 BANI H. PUTRA / HERAWATI RT. 004/007 8/4/2017 11/1/2015 B L 10.1
78 BLN 84 AMRIZAL WAHYU / ARIYANI RT. 004/007 8/4/2017 12/18/2015 B L 19
85 BLN 85 MU'AMAR FEBY / LESTIA RT. 004/007 8/4/2017 10/10/2015 L 10.2
76 BLN 86 HAFIDZ MUTADIN / PUJI RT. 003/007 8/4/2017 8/17/2016 B L 10
85 BLN 87 AISYAH SARJAKA / DESI RT. 003/007 8/4/2017 7/2/2015 B P 10.9
76 BLN 88 NUR SUKMA ADE / IIN RT. 003/007 8/4/2017 9/7/2013 B L 11.1
99 BLN 89 REZA BUDI S. / NILA RT. 003/007 8/4/2017 6/30/2015 B L 13.6
73 BLN 90 FAJRI HARUN AGUS / YULIANTI RT. 003/007 8/4/2017 10/31/2015 B L 10
102 BLN 91 FIKRI ISKANDAR AGUS / YULIANTI RT. 003/007 8/4/2017 12/2/2013 B L 16.8
87 BLN 92 ADELA SAHRONI / FITRIA RT. 003/007 8/4/2017 5/20/2014 B P 15.1
90 BLN 93 ADELIA SAHRONI / FITRIA RT. 003/007 8/4/2017 9/20/2014 B P 16
88 BLN 94 KIRANA MULYADI / SITI RT. 003/007 8/4/2017 10/13/2015 B P 10.5
85 BLN 95 AIMAR BAMBANG / DESI RT. 003/007 8/4/2017 3/15/2013 B L 19.4
78 BLN 96 KENZA BAMBANG / DESI RT. 003/007 8/4/2017 3/29/2013 T L 10.7
100 BLN 97 NAZIHAH EDI / NUR RT. 003/007 8/4/2017 2/11/2017 T P 6.8
BLN 98 KINAR DEDEH / RINI RT. 003/007 8/4/2017 8/26/2012 B P 14.7
BLN 99 ARSILA SUMARI / ASIH RT. 002/007 8/4/2017 8/17/2014 B P 12.6
BLN 100 SAFIRA A. JOKO / KHUSNUL RT. 002/007 8/4/2017 10/27/2013 B P 12.6
BLN 101 RAISYA ALAN / RAMA RT. 002/007 8/4/2017 12/6/2013 B P 17.5
BLN 102 AZZAM Z. TEJO / SITI RT. 002/007 8/4/2017 B L 16.6
PETUGAS
.....................) (...................................)
FORMULIR PENCATATAN


11 12 1 2 3 4 5 6 7 8 9 10
BLN 103 NAJWA ANDRIANSYAH/R.WATI RT. 001 8/4/2017 10/4/2012 B P 16.8
BLN 104 AZALEA SANTO / INARI RT. 001 8/4/2017 8/12/2012 B P 21.1
BLN 105 DYMAS E.L SANTO / INARI RT. 001 8/4/2017 9/1/2013 B L 18.4
BLN 106 M. ATHALLA M. SAFRUDIN / YENTI RT. 003 8/4/2017 8/24/2015 B L 12.2
BLN 107 HUMAIRAH BAYU / SUPANTI RT. 003 8/4/2017 8/7/2014 B P 11.8
BLN 108 ERMA SAMSON / MARTA RT. 003 8/4/2017 8/7/2013 B P 15.5
BLN 109 NAJMUDIN NASUHA / JUARIAH RT. 003 8/4/2017 7/7/2014 B L 12.9
BLN 110 RIEL HERI / SOFI RT. 003 8/4/2017 1/28/2016 B L 10
BLN 111 ARYA ARIFIN / PIPIK RT. 002 8/4/2017 9/16/2013 B L 13.5
BLN 112 RACHEL RAFLI / DIKA RT. 001 8/4/2017 11/19/2007 T L 7.5
BLN 113 SELVIA P. EDI M. / TITIN RT. 001 8/4/2017 5/4/1946 B P 13.4
BLN 114 ZIYAN SUYONO / NAZELA RT. 001 8/4/2017 8/7/2014 B L 12.4
BLN 115 JELITA EVELYN DIKSON / SARI RT. 001 8/4/2017 7/12/2016 B P 8
BLN 116 SYHILA P. IMAL MURNIA / ANI RT. 003 8/4/2017 3/6/2013 P 15
BLN 117 ZARIMA IMAL MURNIA / ANI RT. 003 8/4/2017 9/19/2015 P 12
BLN 118 ALIF M. KHUABERI / MUJI RT. 003 8/4/2017 4/10/2013 B L 2.9
BLN 119 KEISHA DANANG / DARIAH RT. 003 8/4/2017 6/20/2016 P 10.8
BLN 120 M. KAHOIRUL AZZAM SUDRIYO / ASNATI RT. 002/007 8/4/2017 12/13/2012 B L 16
BLN 121 HUSN NABILA SUDRIYO / ASNATI RT. 002/007 8/4/2017 11/6/2015 P 9.2
BLN 122 YOEL TOGU / SERTIANA RT. 002/007 8/4/2017 4/27/2016 B L 10
BLN 123 YOELL AGATA BENI / DEWI RT. 001/007 8/4/2017 7/3/2015 B L 13
BLN 124 M. ZULFADHIL AMIN / MUHNI RT. 001/007 8/4/2017 1/27/2015 B L 10.6
BLN 125 YUMNA CHERLAN / SUCI RT. 001/007 8/4/2017 8/26/2014 B P 22.3
BLN 126 MARGARET POSMAR / NAOMI RT. 001/007 8/4/2017 7/1/2016 P 9.9
BLN 127 KAYLA DEWI HENDRI / MARLINA RT. 001/007 8/4/2017 3/30/2014 B P 13.9
BLN 128 DAFFA DZAKY RISTIAWAN / NUR RT. 001/007 8/4/2017 6/3/2016 B L 10.8
BLN 129 AIMAN RAKIM / FEBRI RT. 001/007 8/4/2017 9/25/2014 L 10
BLN 130 VIOLA WAGIANTO / RINI RT. 001/007 8/4/2017 7/15/2013 B P 14.4
BLN 131 ARIYAN IKHAN IWAN / WINANSIH RT. 001/007 8/4/2017 3/16/2015 B L 10.9
BLN 132 ARLINDA SETIOKO / YUHAENI RT. 001/007 8/4/2017 5/28/2013 B P 12.7
BLN 133 DZAKYYA NGATENO/WINARSIH RT. 001/007 8/4/2017 11/2/2014 B P 14.4
BLN 134 M. ELFARIZ ANHAR / WARSITI RT. 001/007 8/4/2017 2/4/2014 B L 12.9
BLN 135 NAJMA AHMAD / SUPARNI RT. 001/007 8/4/2017 7/26/2014 B P 14.1
BLN 136 ALIKA DARIMAN / WARIDA 8/4/2017 8/2/2015 P
PETUGAS
.....................) (...................................)
(...................................)
FORMULIR PENCATATAN
PUSKESMAS :
POSYANDU/DESA : MELATI 13 / GRAHA CIKARANG RT. 001/016

11 12 1 2 3 4 5 6 7 8 9 7.8
96.8 BLN 1 HAIFA MARYANTO / RIRIN E9/18 8/3/2017 2/3/2016 B P 7.8
BLN 2 DZAHIR A. HARLEY / HENI C23/11 8/3/2017 5/18/2014 B L 13.3
BLN 3 ARRAUF KENZO KRISTIANTO / IKA C21/6 8/3/2017 7/17/2014 B L 11.3
92.4 BLN 4 A. KENZI HENGKI / PATMIYATI E10/6 8/3/2017 8/19/2016 B L 8
91 BLN 5 NADA F. TEGUH / DIAN C21/6 8/3/2017 3/30/2013 B P 12.7
BLN 6 A. SAUFA SAIFUL / PIPIH E10/2 8/3/2017 2/11/2016 B P 9.7
BLN 7 A. NADIA A. SANGID / ROYANI C23/20 8/3/2017 5/1/2014 B P 12
93 BLN 8 PUSPA ROSIDIN / HERAWATI E9/9 8/3/2017 11/10/2014 B P 11.2
BLN 9 RAHMA WAWAN / ALFIYAH C23/23 8/3/2017 10/28/2012 B P 19
79.5 BLN 10 AERILYN B. DANIEL / TAMISRI E9/4 8/3/2017 4/21/2014 B P 13
BLN 11 M. IRHAZ JUNAEDI / TRI H. E9/25 8/3/2017 10/22/2016 T L 8.7
BLN 12 DANISH T. SUGIYONO / PONI Y. E10/9 8/3/2017 10/27/2014 T L 12.3
72.5 BLN 13 NABILA E. DARSIM / JANUARI E10/7 8/3/2017 5/14/2013 T P 21.2
BLN 14 DIMAS O. MATHIUS / NENILZA E9/13 8/3/2017 10/10/2013 T L 11
107.5 BLN 15 AYUNDA C. TRI JOKO / WIWIN C21/7 8/3/2017 2/22/2014 T P 13.2
64 BLN 16 DAFFA ARYA M. IMRON / DEWI F. C20/23 8/3/2017 11/15/2013 T P 14.3
BLN 17 NAUFAL MANSIR/KUSNIAWATI E9/15 8/3/2017 12/31/2015 T L 9.3
BLN 18 ATHAR HENDARTO / DYAH R. C21/11 8/3/2017 T L 10
93.2 BLN 19 SHEYNA MAFIQHRUL / AZIZAH C20/2 8/3/2017 4/1/2016 T P 9.5
81 BLN 20 AJI CANDRA RAWANTO / MULYANI E8/96 8/3/2017 T L 13
113 BLN 21 M. UBAYDDILLAH ROZIKIN / ERNI I. E9/29 8/3/2017 6/25/2013 T L 14.4
81 BLN 22 M. ATHAR Z. M. ISA / MAFTUKHAH E11/2 8/3/2017 9/12/2012 T L 14
BLN 23 AFIKA RESTU T. /EVI YUNITA E10/5B2 8/3/2017 12/16/2015 T P 9.6
89 BLN 24 GAMAL A. BUDI SUSANTO / TRI C23/10 8/3/2017 11/9/2014 T L 12.7
85.4 BLN 25 SHEZA M. ASEP S. / TRIANA C20/22 8/3/2017 10/25/2013 T P 12.7
95.6 BLN 26 ISKINA FEBRI T. C20/24 8/3/2017 12/16/2015 T P 9.8
94.1 BLN 27 YUDHIA A. ROSO / SUTRISNI E10/5 8/3/2017 12/3/2013 B L 13.5
89 BLN 28 CHALISA F. AMBANG E9/6 8/3/2017 B P 14.9
BLN 29 EVAN EKA E9/6 8/3/2017 B L 9.8
BLN 30 M. ZALFAN HARIYANTO / ARI A. C20/1 8/3/2017 11/21/2017 T L 7.2
97.8 BLN 31 ANUGERAH ADI CANRA / MARSINI E9/32 8/3/2017 8/4/2013 T L 15
65.5 BLN 32 AGISNA ALEXANDER E11/4 8/3/2017 3/30/2013 T P 13
103 BLN 33 SOLIFAH SRI W. E11/4 8/3/2017 8/21/2015 T P 9.2
99.8 BLN 34
PETUGAS
......................) (...................................)
FORMULIR PENCATATAN
PUSKESMAS :
POSYANDU/DESA : MELATI 13 / GRAHA CIKARANG RT. 002

11 12 1 2 3 4 5 6 7 8 9 10
BLN 1 AISYAH PUTRI AGUS KUSNAEDI E8/86 7/2/2016 B P 7
BLN 2 ASKIYA S. DWI RAHARJO E8/94 8/8/2015 B P 7.9
104.7 BLN KENU KESYA SAFRUDIN C22/94 12/5/2014 B L 8
94.3 BLN 3 AI FAIJAL MANSYUR C22/08 8/16/2016 T L 6
71.5 BLN 4 MAHIRA D. ANGGA KRESNO C12/10 9/19/2015 B P 7.1
113 BLN 5 WAHAB AHMAD EDINA C15/02 9/16/2016 T L 10
58.3 BLN 6 MUBAROK LUKMANUL H. C15/18 1/14/2013 B L 29
BLN 7 M. YUSUF ASEP SUBHI C12/15 3/26/2013 B L 20.7
BLN 8 MEGAN AULIA DUAN JIWO E8/87 10/14/2014 B P 16.5
BLN 9 HAFIZ ILHAM PRANOTO C14/05 7/11/2013 B L 20.2
BLN 10 BACHTIAR INDIRA E8/84 9/5/2013 B L 14
BLN 11 NAZEETA INDIRA E8/84 11/23/2016 T P 6
BLN 12 NAURA INDIRA E8/84 11/23/2016 T P 6
BLN 13 SAFWAN DEDEN E8/72 10/1/2015 B L 14
BLN 14 FARHAN ABDUL WAHID E8/70 12/25/2012 B L 20
95.5 BLN 15 KEIYAN JHOSEP C22/02 8/19/2013 B L 14.5
83.5 BLN 16 RENDI SAHADI C13/10 4/9/2016 B L 10.5
BLN 17 ASSYILLA AHMAD BASYATI C22/02 11/18/2016 T P 14.5
85 BLN 18 M. ALFAR BUNTAR TAUFIK C12/25 11/29/2012 B L 16.7
102.5 BLN 19 NEZA ASEP SUBHI C12/15 T P 8
BLN 20 KENU TESYA SAFRUDIN C22/19 12/5/2014 T L 8
81.5 BLN 21
71.5 BLN 22
101.3 BLN 23
81.5 BLN 24
97 BLN 25
98 BLN 26
108 BLN 27
105 BLN 28
99.9 BLN 29
108 BLN 30
BLN 31
75 BLN 32
103 BLN 33
PETUGAS
......................) (...................................)
FORMULIR PENCATATAN
PUSKESMAS :

11 12 1 2 3 4 5 6 7 8 9 10
75.5 BLN 1 M. ALIF A.K WAHYU SETIAWAN E4/06 8/3/2017 11/6/2013 T L 13
107.8 BLN 2 M. WAFIQHOTUL A. SUYATNO E4/88 8/3/2017 6/10/2013
84.5 BLN 3 M. AFIQ N. SLAMET W. E4/19 8/3/2017 11/6/2012 B L 13
101 BLN 4 ANINDITA N SURAJAN E4/21 8/3/2017 9/26/2013 B P 12.6
87.2 BLN 5 FARHAN TRI R. KUNARTO E6/17 8/3/2017 7/27/2013 B L 13.6
108 BLN 6 BALQIS YUKO A. TAUFIK H. E6/22 8/3/2017 B P 13.6
97.5 BLN 7 ALFARIZA AZZAHRA DWI HARYANTO E6/06 8/3/2017 11/16/2016 T P 8.5
105 BLN 8 M. FAREL SETIAWAN FEBRI S. E6/03 8/3/2017 B L 13.7
BLN 9 M. HIROSHI ARI BAGUS E7/09 8/3/2017 5/1/2014 L
69 BLN 10 NAJWA T. JAMAL JAMALUDIN E7/10 8/3/2017 B P 10
BLN 11 AHMAD Z. ARZAQ B.M MULYADI E7/11 8/3/2017 3/15/2014 B L 13.5
88 BLN 12 M. ARKAN ZEIN ZAINUDIN E7/12 8/3/2017 B L 10
86.4 BLN 13 M. LAIS ATAM NGIMRON E7/13 8/3/2017 10/4/2014 B L 12
82 BLN 14 ATHOILAH ZAIN KARSAN E7/17 8/3/2017 11/9/2013 B L 14
80 BLN 15 ADELIA T. ANDI W. E7/18 8/3/2017 6/15/2015 B P 12
83 BLN 16 AL KHODAFI B. BASRI E7/22 8/3/2017 3/26/2014 B L 12
72 BLN 17 KANIS MAHIRAH RUDI K. E7/25 8/3/2017 11/8/2015 B P 10.2
77 BLN 18 M. AL ARKHAN M. SUPRIYADI E8/31 8/3/2017 B L 10
83.5 BLN 19 M. KENZIE H. RAHMAT Y. E8/37 8/3/2017 10/9/2015 B L 12
9.3 BLN 20 DAMARA A.H.U SUPRAYITNO E8/53 8/3/2017 10/19/2013 B L 13.3
92 BLN 21 BETANY KRISTY D. TRIYONO E8/58 8/3/2017 2/25/2013 B P 17
BLN 22 DIMAS A.A.A EDI SUBIYANTO E8/59 8/3/2017 10/8/2012 B L 14
104 BLN 23 INNAYAH N.A HASAN ISKANDAR E8/61 8/3/2017 5/30/2014 B P 13.5
95 BLN 24 AGAPE FEODORE S. BAMBANG S. E8/62 8/3/2017 1/2/2013 L
99 BLN 25 NAURA TITI MANGUNAH E7/06 8/3/2017 P
84.5 BLN 26 BRIGITA MANDHARA S.P OBED SANDA P. E7/05 8/3/2017 2/27/2016 P
107.4 BLN 27 RADHIKA A. ASER ABU E8/30 8/3/2017 2/2/2017 T L 8.5
76.2 BLN 28 AMELIA C. ASER ABU E8/30 8/3/2017 11/28/2012 B P 14
67.2 BLN 29 CANDRA W. KOMARI E8/35 8/3/2017 9/13/2012 B L 16.5
103.5 BLN 30 WAFIQ A.T SYAMSUL H. E8/64 8/3/2017 10/6/2012 B P 15.3
98.2 BLN 31 IQLIMA N.S SYAMSUL H. E8/64 8/3/2017 1/15/2017 T P 8.1
95.2 BLN 32 EBEN MONAS E7/ 8/3/2017 P
BLN 33 RADITYA A. SATRIA E8/42 8/3/2017 L 9.7
98 BLN 34 DAFFA R. ACU HERMAWAN E4/09 8/3/2017 L 13.7

35 BERAYA MIKHA E8/38 8/3/2017 L 17.4
PETUGAS
......................) (...................................)
FORMULIR PENCATATAN
PUSKESMAS :

11 12 1 2 3 4 5 6 7 8 9 10
99.7 BLN 1 AZKA A.R IMAN N. / MILAWATI C1/01 8/3/2017 9/8/2014 B L 15
112 BLN 2 ANANDA K.L ANDI / SITI RIYANI C1/13 8/3/2017 5/6/2013 B P 21
102 BLN 3 BALQIS N. AGUS Y. / ANAH E1/02 8/3/2017 3/8/2013 B P 14
87.8 BLN 4 SHAFFA A. ASEP / ATIK E1/05 8/3/2017 9/5/2012 B P 20
93.4 BLN 5 ADITIYA F.A PUJI W. / FALLA E1/10A 8/3/2017 7/24/2013 B L 15.8
97.2 BLN 6 WAHYU A. SUYANTO / RUSTYANI E1/15 8/3/2017 11/4/2014 B L 14
94.9 BLN 7 GILANG TRI HARTONO / ARYA E1/23 8/3/2017 4/6/2013 B L 16
77 BLN 8 NIZA ZARA DARRANI/SUNENGSIH E2/02 8/3/2017 11/26/2014 B P 10
98.5 BLN 9 BAGAS SULISTIONO / TUTI A. E2/09 8/3/2017 4/13/2014 B L 15.8
61.8 BLN 10 RAZKA AL SRIYONO / DEWI E2/10 8/3/2017 2/27/2014 B L 12.7
98 BLN 11 RAYYAN HADI W. / NURYANTI E2/16 8/3/2017 2/23/2015 B L 13.1
90 BLN 12 ZAIDAN SUBEKI / NINA E3/14 8/3/2017 3/31/2013 B L 13.9
76 BLN 13 FARAH M. PRATAMA/SUCI W. E2/23 8/3/2017 10/2/2015 B L 14.5
BLN 14 AUDI KRISTIONO / KANTI E3/20 8/3/2017 2/17/2013 B P 9
BLN 15 ADITIYA P. AHMAD DANI / LIA E8/04 8/3/2017 1/12/2015 B L 13
11.2 BLN 16 KENJI EKO / DEWI E8/06 8/3/2017 4/11/2016 B L 7.2
BLN 17 ALISYA A. BUDI S. / MUMUN E8/ 8/3/2017 5/5/2014 B P 10.6
108 BLN 18 SULTAN YANTO / RINI E8/28 8/3/2017 8/6/2013 B L 12
BLN 19 BE;FANIA AMIRUDIN E1/01 8/3/2017 8/11/2013 B P 13.9
74 BLN 20 SYAFIRA DELLA S. DEDI SETIADI / ROSITA E2/07 8/3/2017 12/12/2012 B P 13.5
86.9 BLN 21 KANOYO R. BUCHORI / NUR K. E3/02 8/3/2017 4/8/2017 T P 5.5
85.6 BLN 22 AZRINA LUKMAN H. /SRI S. E8/20 8/3/2017 11/19/2016 T P 6.4
BLN 23 AIRLANGGA AGUSTIAN P.S/DIANA E8/12A 8/3/2017 1/14/2016 B L 7.6
BLN 24 CHINTIYA KOSNESI / WIDIYA E3/22 8/3/2017 6/26/2016 P 7.9
94.8 BLN 25 FATHIR AL F. HERI / NURAENI 8/3/2017
73.9 BLN 26 ASKANA S. SIGIT / IKA SUNYI 8/3/2017
BLN 27 ARKANA R. AGUSTIAN / DIANA 8/3/2017
100 BLN 28 ADIRA I.S TEGUH / STEPHIA 8/3/2017
85.3 BLN 29 DAFIA MAHRUR / NURUL 8/3/2017
96 BLN 30 DZAKIRA MAHRUR / NURUL 8/3/2017
97 BLN 31 ADIVA N.R ALI / YANI 8/3/2017
96.7 BLN 32 SUPRIYANTI EDWARD / RIMBA S. 8/3/2017
95.2 BLN 33 8/3/2017
BLN 34 8/3/2017
PETUGAS
......................) (...................................)
......................)
FORMULIR PENCATATAN
PUSKESMAS :
POSYANDU/DESA : MELATI 8 / SIMPANGAN (GRAHA MATTEL RW. 012)

11 12 1 2 3 4 5 6 7 8 9 10
76 BLN 1 AZKA M. TEGUH RISWONO RT. 001 8/1/2017 11/22/2012 B P 22.6
97 BLN 2 GHAZIYA H. LUKMAN P. RT. 004 8/1/2017 10/16/2014 B P 14.3
92 BLN 3 KINANTI S. WALUYO RT. 004 8/1/2017 7/8/2014 B P 14.3
67 BLN 4 MUHAMMAD DAFFA ADIONO RT. 002 8/1/2017 10/22/2013 B L 14.1
96 BLN 5 CARINNA R. WINARTO RT. 002 8/1/2017 10/23/2014 B P 13.6
75 BLN 6 CARISSA N. TAR;IM SUPRIYANTO RT. 004 8/1/2017 12/20/2015 B P 10.2
89 BLN 7 KAYYISAH A. WAHID ROZALI RT. 002 8/1/2017 7/16/2015 B P 13.9
90 BLN 8 NAYLA SHAKIRA IWAN SOLIHIN RT. 001 8/1/2017 7/14/2014 B P 13.2
102 BLN 9 JOYCELINE C. KRIS BIYANTORO RT. 001 8/1/2017 7/13/2013 B P 14.5
98 BLN 10 KHANSA AQILA PUTRA MAHARDANI RT. 001 8/1/2017 5/28/2013 B P 12.3
68 BLN 11 GIAN ADITIYA A. MUHTANZI RT. 001 8/1/2017 9/14/2013 B L 13.9
93 BLN 12 MUHAMMAD R. SULARNA RT. 004 8/1/2017 12/12/2015 T L 9.9
107 BLN 13 M. AIRUL ADLI CAHYADI RT. 001 8/1/2017 11/28/2013 B L 13.6
96 BLN 14 BAGUS ARYA P. FAJAR AGUNG P. RT. 002 8/1/2017 8/20/2014 B L 12.6
95 BLN 15 AYUDIA INARA FAJAR AGUNG P. RT. 002 8/1/2017 6/5/2016 T P 9
100 BLN 16 RAKA RAYYAN FARIYANTO RT. 001 8/1/2017 1/11/2014 B L 12.3
77 BLN 17 DAVID IBRAHIM FAHRUL ROZI RT. 002 8/1/2017 3/20/2014 B L 14
76 BLN 18 ANINDRA A. SURIANTO RT. 004 8/1/2017 8/22/2016 T P 8.3
77 BLN 19 KAYLA PUTRI H. HARIS WIBOWO RT. 004 8/1/2017 5/31/2015 B P 14.4
102 BLN 20 CALYSTA A. SUGIONO RT. 002 8/1/2017 1/23/2014 B P 15.4
107 BLN 21 ALIFA SALSABILA M. MIFTAHUL HUDA RT. 001 8/1/2017 8/26/2014 B P 12.3
105 BLN 22 AZMYA ZAIRA A. ABDUL KOHAR RT. 004 8/1/2017 7/24/2016 T P 11
82 BLN 23 KHAIRA NUR SYIFA RAHMAT DARMAWAN RT. 002 8/1/2017 2/10/2014 B P 17.2
88 BLN 24 KHOLID ABDULLAH RAHMAT DARMAWAN RT. 002 8/1/2017 3/26/2017 T L 8.5
97 BLN 25 ALIKA NURUL M. MOH. JUNAEDI RT. 001 8/1/2017 7/6/2016 T P 9
77 BLN 26 ARSYA DWI A. PARWADI RT. 004 8/1/2017 6/1/2016 T L 8.7
98 BLN 27 ELMIRA K.A MARJOKO RT. 004 8/1/2017 5/25/2013 B P 18.6
97 BLN 28 NABILA SAKINA EKO MULYADI RT. 004 8/1/2017 8/30/2013 T P 14.6
77 BLN 29 RAISHA PUTRI A. BENNY AGUS P. RT. 004 8/1/2017 3/26/2015 B P 11.8
73 BLN 30 GLADIOLA K. GANJAR PERMANA RT. 003 8/1/2017 5/25/2013 B P 13.6
109 BLN 31 RADEA KHAIRIRA GANJAR PERMANA RT. 003 8/1/2017 B P 9.5
107 BLN 32 MUHAMMAD SAIDAN HERU SANTOSO RT. 001 8/1/2017 7/30/2014 B L 12.7
78 BLN 33 SHIZA RAIHANAN AGUS SUDARYONO RT. 002 8/1/2017 T P 2.8
BLN 34 RAIHAN HAFIZ A. ARI WIBOWO RT. 002 8/1/2017 B L 7.9
PETUGAS
......................) (...................................)
FORMULIR PENCATATAN
PUSKESMAS :

11 12 1 2 3 4 5 6 7 8 9 10
72 BLN 35 UKASYAH AN NUR ROMLI SEPTIAN RT. 001 8/1/2017 10/20/2016 T L 7.6
80 BLN 36 ZAFRAN A. ANDRI EFENDI RT. 002 8/1/2017 9/4/2015 B L 9.8
80 BLN 37 AGUSTINUS K.S STEVANUS RIKIYANTO RT. 005 8/1/2017 8/12/2013 B L 14.4
70 BLN 38 MUHAMMAD RASYIED ROHMADIYONO RT. 003 8/1/2017 8/27/2014 B L 9.9
75 BLN 39 M. FAITH AYYASHI SUTRISNO RT. 002 8/1/2017 1/3/2014 B L 12.2
79 BLN 40 NAYLA OLYVIA SUGENG WIDODO RT. 004 8/1/2017 11/21/2012 B P 22.3
108 BLN 41 SAKTI HARISA S. GARDAN S. RT. 002 8/1/2017 5/14/2015 B L 12
108 BLN 42 LUTHFIA ALIZA A. M. TRIYONO S. RT. 001 8/1/2017 9/22/2014 B P 13.2
107 BLN 43 NISA LATHIFA SURATMAN RT. 001 8/1/2017 12/31/2015 B P 8.2
107 BLN 44 DZAKIR KHOFADI R. EDI SUMARNO RT. 001 8/1/2017 6/22/2015 B L 11.5
100 BLN 45 KAYLA NAZWA P. AHLAN RT. 001 8/1/2017 2/13/2014 B P 13.3
68 BLN 46 SYAKIRA HAIFA TOTOH M. RT. 003 8/1/2017 B P 14.7
70 BLN 47 NINDITA F. AGUS P. RT. 003 8/1/2017 7/4/2015 B P 9
100 BLN 48 ADRIAN P. NOVIANTO RT. 002 8/1/2017 8/7/2016 T L 8.6
105 BLN 49 EL RIZQY K AGUNG SETIYO W. RT. 002 8/1/2017 3/7/2016 B L 8.7
103 BLN 50 ALVARO SERTANKIAN AWAN HERNANTO RT. 003 8/1/2017 10/24/2014 B L 14.1
83 BLN 51 LINTANG AZMYA MOH. SUPARTO RT. 004 8/1/2017 10/15/2016 P 9
103 BLN 52 KHANZA SABRINA WINDARTO RT. 005 8/1/2017 6/8/2014 B P 12.5
90 BLN 53 AZKA GHAZI A. WINDARTO RT. 005 8/1/2017 2/28/2016 L 10.7
70 BLN 54 KAMILAH N. SUMARYANTO RT. 001 8/1/2017 3/9/2014 B P 14.5
80 BLN 55 ANTONIUS ANDIKA SENYUMAN DAELI RT. 001 8/1/2017 5/24/2013 B L 13.5
BLN 56 HAFIZ GILANG A. ZAMRONI RT. 001 8/1/2017 5/7/2014 B L 13
BLN 57 M. GAGAH PRAKOSO HARTONO RT. 001 8/1/2017 3/25/2015 B L 11.8
BLN 58 RADIAN TATI L. SLAMET NURYANTO RT. 001 8/1/2017 8/8/2013 B P 20.5
BLN 59 IMA ASRIA R. SUGINO HARTONO RT. 001 8/1/2017 12/2/2013 B P 11.8
BLN 60 ABID ATHAYASA INDRA MARFINAS RT. 002 8/1/2017 5/31/2017 T 5.7
BLN 61 FARZAN AHZA A. IDI YATMAKO RT. 003 8/1/2017 11/26/2013 B L 15.9
BLN 62 FAIZ ALYA A. ROHMAT DANI RT. 001 8/1/2017 1/15/2015 B P 9.2
BLN 63 M. ERLANGGA MAHMUD SOBARI RT. 001 8/1/2017 5/23/2017 T L 6
BLN 64 SHOTIYYAH F. HARI SUPARDI RT. 003 8/1/2017 7/20/2014 P 11.2
BLN 65 M. HAFIDZ AL FATIH M. HUSNAN RT. 004 8/1/2017 10/8/2013 B L 14.4
BLN 66 ARSYIFA RIZQI A. AKHMAD SANTOSO RT. 001 8/1/2017 5/2/2017 T P 7
BLN 67 AFIFAH NUR R. KASIM KARYANA RT. 001 8/1/2017 6/6/2014 B P 13.5
BLN 68 AMEENA FITIYA S. TEGUH WIDODO RT. 001 8/1/2017 8/19/2014 B P 15
PETUGAS
......................) (...................................)
FORMULIR PENCATATAN
PUSKESMAS :

11 12 1 2 3 4 5 6 7 8 9 10
99 BLN 69 RIO IVANDER SUHERMAN RT. 005 8/1/2017 5/25/2013 B L
BLN 70 HAFSHA KAMILA TARIMAN RT. 005 8/1/2017 6/18/2016 P 8.4
100 BLN 71 ZULKARNAEN ARYA P. JAJA SUPRIATNA RT. 002 8/1/2017 3/15/2015 B L
99 BLN 72 MUHAMMAD RASYIED HERU WINARNO RT. 003 8/1/2017 1/17/2015 B L
99 BLN 73 SHAFIYAH NAFISA HERU WINARNO RT. 003 8/1/2017 8/30/2014 B P
95 BLN 74 AISYAH R.Z ARIF SISWANDI RT. 003 8/1/2017 6/29/2015 B P 12.5
72 BLN 75 M. FADHIL F. ERNI ANGGRAENI RT. 003 8/1/2017 4/4/2017 L 6.2
87 BLN 76 M. FADLAN F. ERNI ANGGRAENI RT. 003 8/1/2017 4/4/2017 B L 6
BLN 77 JIBRIL AS SHAKA ASEP SUGIARTO RT. 003 8/1/2017 12/9/2014 L 14.7
86 BLN 78 M. YAFI N. URIP PRIYADI RT. 002 8/1/2017 5/11/2015 B L 9.3
96 BLN 79 ATHAYA ALKHOLIFI AGUS RUIN RT. 002 8/1/2017 9/1/2014 B L 14
77 BLN 80 M. FATIH R. ASNANTO RT. 001 8/1/2017 4/17/2016 L 9.3
85 BLN 81 NADIEN BILQIS N. WANTO RT. 004 8/1/2017 6/25/2014 B P 15.7
96 BLN 82 DENAZRA NOER S. WANTO RT. 004 8/1/2017 9/27/2016 T P 8.1
86 BLN 83 MAULA MAYA SUGIONO RT. 001 8/1/2017 1/14/2016 P 9.7
96 BLN 84 OSARIEL KAHFI A. SIGIT H.W RT. 001 8/1/2017 10/26/2015 B L 11.4
82 BLN 85 IGNASIUS AVELINO NORMAN SUBRATA RT. 001 8/1/2017 11/10/2014 B L 12.5
80 BLN 86 RALINTHA Z. CANDRA NAYA RT. 001 8/1/2017 11/12/2014 B P 17
89 BLN 87 MIKI ARSA D.R YAYAN ANDRIS RT. 003 8/1/2017 1/30/2017 T L 7.5
92 BLN 88 KOSISOKI GODWIN LATAN DAELI RT. 001 8/1/2017 7/25/2015 B L 12.3
103 BLN 89 EMMANUEL BAGUS DWI SETYANTO RT. 002 8/1/2017 12/22/2016 T L 8.2
100 BLN 90 ERLANGGA A. MARDIYANTO RT. 002 8/1/2017 4/18/2013 B L 20.6
92 BLN 91 NAILAH KHUZAMI BUDIYONO RT. 002 8/1/2017 10/17/2012 B P 17.3
BLN 92 AISYAH NADIF A. DANI ARIE KUS RT. 002 8/1/2017 12/12/2013 B P
BLN 93 FAIHA AGUS SUYATNO RT. 002 8/1/2017 10/10/2012 B P 17.9
BLN 94 AGUINA OKTA L. ANDRI DENI L. RT. 002 8/1/2017 10/7/2016 T P
66 BLN 95 LUTHFI ILHAM P. RINDI A. RT. 003 8/1/2017 10/21/2014 B P 12.5
100 BLN 96 RAYYA RABTANI ARI WIYADI RT. 002 8/1/2017 5/5/2014 B L
102 BLN 97 RINDIANI R. HERMAWAN RT. 002 8/1/2017 8/7/2012 B P 12.8
102 BLN 98 THALHAH ABD. JOKO RT. 001 8/1/2017 10/22/2016 T L 5.6
67 BLN 99 THOFAIL ABD. JOKO RT. 001 8/1/2017 10/22/2016 T L 6.4
BLN 100 LULU ZAHIRA SODIKIN RT. 001 8/1/2017 9/29/2016 T P 7.7
80 BLN 101 M. RAFATAR A.F ASEP SANDRIS RT. 001 8/1/2017 8/11/2015 B L 11.8
86 BLN 102 M. RAKHA M.Z.P ASEP SANDRIS RT. 001 8/1/2017 9/10/2012 B L 17.2
103 BLN
PETUGAS
......................) (...................................)
FORMULIR PENCATATAN
PUSKESMAS :

11 12 1 2 3 4 5 6 7 8 9 10
97 BLN 103 ASFAR IHSAN ARIF SISWANDI RT. 003 8/1/2017 11/3/2012 B L 16.3
100 BLN 104 LULU ZAHIRA SODIKIN RT. 001 8/1/2017 9/29/2016 T P 7.7
97 BLN 105 AHMAD ASHYASTHA AKHMAD SENTOSA RT. 001 8/1/2017 3/4/2015 B L 11
11 BLN 106 DIANA JOHAIRINISWA BAMBANG P. RT. 001 8/1/2017 5/15/2013 B P 15.2
102 BLN 107 NUSAIBAH KUKUH RT. 001 8/1/2017 9/15/2016 T P 9.2
8 BLN 108 RUMAYSHA KUKUH RT. 001 8/1/2017 6/5/2013 B P 17.3
99 BLN 109 KARIMAH A. SUSIANTO RT. 001 8/1/2017 1/20/2014 B P 11.5
85 BLN 110 GHAZIYA H. LUKMAN P. RT. 004 8/1/2017 10/16/2014 B P 14.3
100 BLN 111 ARSINID LUKMAN P. RT. 004 8/1/2017 8/1/2016 T L 9.5
95 BLN 112 BIGEL JOKO RT. 004 8/1/2017 7/9/2014 B 25.1
96 BLN 113 ANNISA FELICIA M. SYAIFUDIN RT. 004 8/1/2017 2/8/2014 B 17.1
90 BLN 114 EMIR DANIS TEGUH P. RT. 004 8/1/2017 9/12/2014 B 13.4
96 BLN 115 ALMAIR R. ASEP RT. 004 8/1/2017 11/21/2013 B 14.5
80 BLN 116 JENNIFER EKA SRI WIDODO RT. 004 8/1/2017 1/19/2013 B 17.5
97 BLN 117
70 BLN 118
88 BLN 119
98 BLN 120
100 BLN 121
99 BLN 122
57 BLN 123
65 BLN 124
93 BLN 125
72 BLN 126
BLN 127
BLN 128
BLN 129
BLN 130
BLN 131
BLN 132
BLN 133
BLN 134
BLN 135
BLN 136
PETUGAS
......................) (...................................)
FORMULIR PENCATATAN
PUSKESMAS :
POSYANDU/DESA : ANGGREK / SIMPANGAN (GRAHA CIKARANG)

11 12 1 2 3 4 5 6 7 8 9 10
112 BLN 1 YUSUF SOLEKAN GRAHA CKRG 8/19/2017 10/3/2012 L 14.7
87 BLN 2 HAFEEZA BUI NOVIADI GRAHA CKRG 8/19/2017 10/3/2012 P 14.9
94 BLN 3 KHAIRANA KHOIRI GRAHA CKRG 8/19/2017 5/14/2014 P 17.7
98 BLN 4 FATHINAH DIASKORO GRAHA CKRG 8/19/2017 1/1/2014 P 98
95 BLN 5 M. ALIF AMAR AGUS GRAHA CKRG 8/19/2017 5/14/2013 L 12.9
82 BLN 6 DIMAS JISTIN JUMANTO GRAHA CKRG 8/19/2017 10/15/2015 L
89 BLN 7 FARIS HASBI IRFAN GRAHA CKRG 8/19/2017 6/6/2013 L 14.4
95 BLN 8 NUR HAFIZ BUDIYANTO GRAHA CKRG 8/19/2017 1/10/2013 L 15.9
100 BLN 9 DIMAS B. SUGENG GRAHA CKRG 8/19/2017 7/22/2015 L
95 BLN 10 ARJUNA SUGENG GRAHA CKRG 8/19/2017 10/10/2012 L 14.2
97 BLN 11 RADITYA DIDI / SUPRIYADI GRAHA CKRG 8/19/2017 11/29/2016 L 7
77 BLN 12 ZULFA Z. LILI YULIANA GRAHA CKRG 8/19/2017 5/11/2015 P 12.3
99 BLN 13 SHILVIA Z. API HANAFI GRAHA CKRG 8/19/2017 11/4/2014 P 13.5
94 BLN 14 DZIKRI HAFIZ HELDI GRAHA CKRG 8/19/2017 12/31/2014 L 11.8
76 BLN 15 MAHESWARA NUR AJI GRAHA CKRG 8/19/2017 1/10/2016 L 1.7
95 BLN 16 AQILAH AMAT KARIM GRAHA CKRG 8/19/2017 1/9/2015 P 13.7
97 BLN 17 HAGIYA HARUN GRAHA CKRG 8/19/2017 10/11/2013 P 17.1
73 BLN 18 ADELIA K. IMAM SUKOCO GRAHA CKRG 8/19/2017 3/8/2015 P 11.5
86 BLN 19 ATTAKA H. SAFARI GRAHA CKRG 8/19/2017 4/20/2015 L 15.5
99 BLN 20 MARCELLINO KASMIR GRAHA CKRG 8/19/2017 2/6/2016 L 1.2
90 BLN 21 ANINDITA C. YUDI GRAHA CKRG 8/19/2017 9/29/2016 P 11.4
77 BLN 22 HANA YASMIN YAYAN S. GRAHA CKRG 8/19/2017 4/8/2015 P 11
101 BLN 23 ALMISA Q. M. ALWI GRAHA CKRG 8/19/2017 6/15/2015 P 10.8
68 BLN 24 RADITYA ARIF GRAHA CKRG 8/19/2017 11/10/2012 L 18.1
71 BLN 25 CALISTA SILVAN GRAHA CKRG 8/19/2017 11/17/2013 P 15.4
73 BLN 26 AISYAH A. SAMSUL GRAHA CKRG 8/19/2017 6/30/2013 P 15.4
103 BLN 27 FIRMAN S. RASWAN GRAHA CKRG 8/19/2017 11/21/2015 L 8.7
105 BLN 28 NAIRA S. SUMARYONO GRAHA CKRG 8/19/2017 4/1/2013 P 12.7
8 BLN 29 REYHAN ENDI P. GRAHA CKRG 8/19/2017 5/26/2017 L 6.5
96 BLN 30 FATHIR GIBRAN FAJAR F. GRAHA CKRG 8/19/2017 2/7/2014 L 12.9
79 BLN 31 M. BAIHAQI FAJAR F. GRAHA CKRG 8/19/2017 1/31/2017 L 8.4
93 BLN 32 NAURA NGADIYONO GRAHA CKRG 8/19/2017 10/10/2012 P 15.2
60 BLN 33 M. OZIL ISMAIL GRAHA CKRG 8/19/2017 11/21/2016 L 8
76 BLN 34 M. ROYYAN BENY GRAHA CKRG 8/19/2017 3/7/2016 L 8.9
PETUGAS
......................) (...................................)
FORMULIR PENCATATAN
PUSKESMAS :

11 12 1 2 3 4 5 6 7 8 9 10
72 BLN 35 HALWA R. NUR GRAHA CKRG 8/19/2017 12/21/2015 P 8.7
83 BLN 36 RABBANI K. SUTAN TAUFIK GRAHA CKRG 8/19/2017 3/27/2015 L 10.9
97 BLN 37 NESYANA A. RUDI GRAHA CKRG 8/19/2017 11/4/2016 P 7.7
85 BLN 38 AHMAD AQIB FATHUL ARIF GRAHA CKRG 8/19/2017 2/14/2012 L
92 BLN 39 IBNU AQIL FATHUL ARIF GRAHA CKRG 8/19/2017 4/19/2017 L
110 BLN 40 YUSUF AKBAR TOPIK GRAHA CKRG 8/19/2017 10/17/2013 L 15.5
88 BLN 41 KHAFID KASAN A. GRAHA CKRG 8/19/2017 6/7/2014 L 133.1
95 BLN 42 RAYSYA P. KHOIRIL GRAHA CKRG 8/19/2017 3/2/2016 P 8.6
74 BLN 43 M. HARIYO SASONGKO GRAHA CKRG 8/19/2017 9/15/2014 L 14.6
90 BLN 44 GENDHIS A. YOYOK GRAHA CKRG 8/19/2017 11/20/2016 P 8
96 BLN 45 CHIKA NAJWA TRI AGUNG GRAHA CKRG 8/19/2017 9/7/2012 P 17
5 BLN 46 AHMAD ROYYAN ALEX P. GRAHA CKRG 8/19/2017 7/31/2016 L 8.2
82 BLN 47 AMRAN TARANG MA GRAHA CKRG 8/19/2017 8/8/2014 L 14.6
72 BLN 48 TESALONIKA TARANG MA GRAHA CKRG 8/19/2017 9/23/2016 P 9.5
79 BLN 49 FATIMAH A. DARMAN GRAHA CKRG 8/19/2017 3/23/2013 P 14
98 BLN 50 NAJWA N. DARMAN GRAHA CKRG 8/19/2017 12/2/2015 P 10.7
71 BLN 51 AZKA DINA CATUR E. GRAHA CKRG 8/19/2017 7/7/2016 P 9.3
91 BLN 52 ANINDIA F. TRI HARYADI GRAHA CKRG 8/19/2017 6/22/2015 P 10.8
83 BLN 53 KEISHA N. TRI HARYADI GRAHA CKRG 8/19/2017 11/1/2016 P 7.1
100 BLN 54 GALIH RIVANO TUGIMO GRAHA CKRG 8/19/2017 3/31/2013 L 14.6
99 BLN 55 NAYFA Z. RAHMAD GRAHA CKRG 8/19/2017 9/15/2012 P 21.8
96 BLN 56 FATHAN SYAHRIN GRAHA CKRG 8/19/2017 12/8/2014 L 12.5
88 BLN 57 HASNA SYA HERI PURWANTO GRAHA CKRG 8/19/2017 7/17/2014 P 12.5
103 BLN 58 INAYAH S. AGUS T. GRAHA CKRG 8/19/2017 9/16/2013 P 12.7
90 BLN 59 KHOLID A. AGUS T. GRAHA CKRG 8/19/2017 9/26/2016 L 7.7
57 BLN 60 ATTAYA SINOM P. GRAHA CKRG 8/19/2017 6/7/2014 P 10.9
103 BLN 61 MAHESTRI SINOM P. GRAHA CKRG 8/19/2017 11/16/2016 P 7.4
84 BLN 62 ARISKO B. SUDARNO GRAHA CKRG 8/19/2017 10/16/2016 L 8
63 BLN 63 ABRISAN TIRTIAWAN GRAHA CKRG 8/19/2017 5/3/2014 L 17.5
8 BLN 64 JENIFER SUGENG GRAHA CKRG 8/19/2017 P 12
100 BLN 65 RAFI M.I DADANG R. GRAHA CKRG 8/19/2017 11/25/2013 L 13.7
58 BLN 66 ALESHA SYAIFUL GRAHA CKRG 8/19/2017 11/2/2016 P 8.8
94 BLN 67 HAIFA N. HANA M. GRAHA CKRG 8/19/2017 8/27/2016 P 6.6
98 BLN 68 MAULANA MAHMUD GRAHA CKRG 8/19/2017 12/31/2015 L 10.5
PETUGAS
......................) (...................................)
FORMULIR PENCATATAN
PUSKESMAS :

11 12 1 2 3 4 5 6 7 8 9 10
BLN 69 FARHAN M. MARSONO GRAHA CKRG 8/19/2017 10/3/2015 L 10.8
73 BLN 70 AISYAH P. WAHYU R. GRAHA CKRG 8/19/2017 2/18/2015 P 11.6
BLN 71 SHAQUEENA DEDI GRAHA CKRG 8/19/2017 7/2/2016 P 9.5
BLN 72 M. HAIKAL BAMBANG GRAHA CKRG 8/19/2017 10/12/2016 L 7.8
BLN 73 M. HAIDAR BAMBANG GRAHA CKRG 8/19/2017 10/12/2016 L
92 BLN 74 AQILA Z. YULI H. GRAHA CKRG 8/19/2017 9/28/2016 P 13.9
59 BLN 75 M. ASHIF W. EKO P. GRAHA CKRG 8/19/2017 4/30/2016 L 11.1
59 BLN 76 TAZKIYATUN RIONO GRAHA CKRG 8/19/2017 12/7/2015 P 11
96 BLN 77 SYAFIQ ADI GRAHA CKRG 8/19/2017 6/6/2014 L 10.8
85 BLN 78 KHAIRA P. CIK GRAHA CKRG 8/19/2017 L 13.1
96 BLN 79 THEO GUNAWAN GRAHA CKRG 8/19/2017 1/27/2016 L 10.6
77 BLN 80 ATTALLA S. KARYADI GRAHA CKRG 8/19/2017 11/22/2014 L 13.4
99 BLN 81 AZZAHRA S. RUMI HARTONO GRAHA CKRG 8/19/2017 3/13/2013 P 14.4
73 BLN 82 ARSEN S. SUGIYO GRAHA CKRG 8/19/2017 10/16/2016 L 8.2
80 BLN 83 M. ADITIYA DERI GRAHA CKRG 8/19/2017 1/23/2015 L 10.7
80 BLN 84 FITRIA A. ANA SURYANA GRAHA CKRG 8/19/2017 8/18/2012 P 21.5
96 BLN 85 ANGELITA WAHYUDI GRAHA CKRG 8/19/2017 9/19/2014 P 12.3
93 BLN 86 KINAYA S. KHRISNA GRAHA CKRG 8/19/2017 9/25/2016 P 8.2
64 BLN 87 AZKA N. BONDAN P.S GRAHA CKRG 8/19/2017 4/7/2013 L 15.3
84 BLN 88 ARSHAKA N.. BONDAN P.S GRAHA CKRG 8/19/2017 5/4/2015 L 11
68 BLN 89 ARVINZA R. BONDAN P.S GRAHA CKRG 8/19/2017 6/14/2017 L 5.2
109 BLN 90 ANNISA K. MAS'U GRAHA CKRG 8/19/2017 6/22/2015 P 9.9
113 BLN 91 LIBINA H. HUSEIN GRAHA CKRG 8/19/2017 4/26/2013 P 9.3
BLN 92 AQILA A. ANDRIANA GRAHA CKRG 8/19/2017 1/20/2014 P 14.1
111 BLN 93 FAQIH H. FIRMAN GRAHA CKRG 8/19/2017 11/29/2015 L 10
BLN 94 SAKHA P. TOTO GRAHA CKRG 8/19/2017 11/27/2015 L 12.4
91 BLN 95 M. HAFIZ A. PURWANTO GRAHA CKRG 8/19/2017 11/7/2013 L 13.5
BLN 96 GIBRAN K. HARIYANTO GRAHA CKRG 8/19/2017 7/28/2015 L 13.3
99 BLN 97 NATHANAEL BONI R. GRAHA CKRG 8/19/2017 12/14/2016 L 7.6
64 BLN 98 ALISHA . AHMAD H. GRAHA CKRG 8/19/2017 12/30/2013 L 13.1
63 BLN 99 NATSA KISMANTO GRAHA CKRG 8/19/2017 11/12/2016 P 3.9
67 BLN 100 ANGELIN N. SUNOTO GRAHA CKRG 8/19/2017 5/26/2014 P 12.2
85 BLN 101 ARZAN IKHSAN KARMANTO GRAHA CKRG 8/19/2017 3/11/2013 L 16.5
109 BLN 102 ALETA . NANANG GRAHA CKRG 8/19/2017 6/8/2015 P 10.2
PETUGAS
......................) (...................................)
FORMULIR PENCATATAN
PUSKESMAS :

11 12 1 2 3 4 5 6 7 8 9 10
108 BLN 103 M. ALIF A. AGUS GRAHA CKRG 8/19/2017 5/14/2013 L 14
67 BLN 104 ASSYIFA N. MAMAN GRAHA CKRG 8/19/2017 7/24/2014 P 14
86 BLN 105 ARIF AN. MAMAN GRAHA CKRG 8/19/2017 5/23/2017 P 6.7
100 BLN 106 SHABRINA INRA G. GRAHA CKRG 8/19/2017 8/13/2017 P 12.5
73 BLN 107 BETRIK FREDI GRAHA CKRG 8/19/2017 9/15/2014 P 13
103 BLN 108 M. FAHMI M. MAKMUM GRAHA CKRG 8/19/2017 2/7/2017 L 7.6
93 BLN 109 HUMAIRA YUDIANTO GRAHA CKRG 8/19/2017 3/23/2017 P 6.9
87 BLN 110 HILAL FIKRI IMAM S. GRAHA CKRG 8/19/2017 3/3/2016 L 12.5
75 BLN 111 KARA ARIMBI MEIYTATAG GRAHA CKRG 8/19/2017 P 9.7
106 BLN 112 YUMNA S. PUJI GRAHA CKRG 8/19/2017 8/5/2010 P 1.5
101 BLN 113 NADIN BAMBANG GRAHA CKRG 8/19/2017 11/4/2013 P 12.6
93 BLN 114 M. HADYAN SEPRIYANTO GRAHA CKRG 8/19/2017 2/15/2015 L 12
100 BLN 115 AZRILLAH ALI OMRON GRAHA CKRG 8/19/2017 9/23/2015 L 10.3
105 BLN 116
BLN 117
BLN 118
BLN 119
BLN 120
BLN 121
BLN 122
BLN 123
BLN 124
BLN 125
BLN 126
BLN 127
BLN 128
BLN 129
BLN 130
BLN 131
BLN 132
BLN 133
BLN 134
BLN 135
BLN 136
PETUGAS
......................) (...................................)
FORMULIR PENCATATAN
PUSKESMAS :
POSYANDU/DESA : MELATI 7 / SIMPANGAN (RW. 004)

11 12 1 2 3 4 5 6 7 8 9 10
101 BLN 1 MOCH. DAIFULLAH DARJA RT. 003 8/12/2017 1/14/2017 B L 6.8
95 BLN 2 MAULIDA ZAENAL ABIDIN RT. 003 8/12/2017 12/24/2015 B P 12
98 BLN 3 M. SYAKIB M. ISMAIL MARZUKI RT. 003 8/12/2017 4/1/2016 B L 9.8
BLN 4 SABRINA H. LATIF J. RT. 003 8/12/2017 1/21/2013 B P 13
96 BLN 5 MUKLIS MUHTAR RT. 003 8/12/2017 7/1/2015 B L 10.6
BLN 6 ZAHRA THOAMIN 8/12/2017 7/8/2015 B P 9
BLN 7 NIKEN NIKSON RT. 002 8/12/2017 3/3/2014 B P 12
98 BLN 8 ABKARI SUHERMAN RT. 003 8/12/2017 30/15/16 B L 10.9
BLN 9 MUTHIA KOMARUDIN RT. 002 8/12/2017 11/1/2015 B P 10
103 BLN 10 M. AZZAM SUGENG RT. 003 8/12/2017 7/3/2015 B L 9
68 BLN 11 TERRY MISTAKIM 8/12/2017 1/7/2015 B L 13
84 BLN 12 KAYASA ABUN RT. 002 8/12/2017 4/14/2014 B P 10
90 BLN 13 SYEHAN MULYANA RT. 002 8/12/2017 7/20/2015 B L 11.6
91 BLN 14 FARES OCID RT. 002 8/12/2017 9/7/2013 B L 12
82 BLN 15 M. FAHRI AHYAD RT. 003 8/12/2017 5/17/2012 B L 14
90 BLN 16 AZZAMI SONI 8/12/2017 2/4/2014 B L 10
105 BLN 17 RIFKA SAID RT. 002 8/12/2017 10/21/2013 B P 13
86 BLN 18 RYANTI HERA HERMAN S. RT. 002 8/12/2017 7/7/2013 B P 8.8
99 BLN 19 RESTU S. HENDI RT. 002 8/12/2017 3/23/2013 B L 12
78 BLN 20 JULIA PUTRI TAMAN R. RT. 002 8/12/2017 12/7/2012 B P 8
84 BLN 21 KHAIFA NURDIANSYAH RT. 003 8/12/2017 8/23/2012 B P 7.5
84 BLN 22 M. KENZIE HARJO K. RT. 002 8/12/2017 5/9/2012 B L 13
81 BLN 23 MIKO R. ERIK RT. 003 8/12/2017 1/24/2012 B L 8.1
111 BLN 24 AQILA AHMAD SANUSI RT. 002 8/12/2017 10/10/2011 B P 12
97 BLN 25 ZAHRA FAJAR RT. 002 8/12/2017 6/26/2011 B P 13
97 BLN 26 ADSILA FAJAR 8/12/2017 3/12/2011 B P 9
75 BLN 27 ALIF ARYA RT. 003 8/12/2017 11/26/2010 B L 10.3
96 BLN 28 KHAYLA T. HENDRA G. RT. 003 8/12/2017 8/12/2010 B P 10
52 BLN 29 KHAOIRUNNISA AEP RT. 002 8/12/2017 4/28/2010 B P 12
94 BLN 30 KEISHA SOFYAN RT. 002 8/12/2017 1/12/2010 B P 11
66 BLN 31 M. ABDI R. ADE IRAWAN RT. 002 8/12/2017 9/28/2009 B L 9.5
105 BLN 32 M. ALBYAN SAEPUDIN RT. 002 8/12/2017 6/14/2009 B L 9
68 BLN 33 M. FATIH ANDI 8/12/2017 2/28/2009 B L 10.9
75 BLN 34 M. RIZKY M. ANDI 8/12/2017 11/14/2008 B L 8
PETUGAS
......................) (...................................)
FORMULIR PENCATATAN
PUSKESMAS :

11 12 1 2 3 4 5 6 7 8 9 10
77 BLN 35 ALI MUZAKI RAHMAT RT. 002 8/12/2017 2/19/2013 B L 14
87 BLN 36 KUMAIRAH ASEP RT. 003 8/12/2017 12/3/2016 T P 65
71 BLN 37 ASYILA P. SAEPUDIN RT. 001 8/12/2017 12/6/2014 B P 10
BLN 38 NAYLA RAPIDI RT. 003 8/12/2017 7/16/2015 B P 12.5
BLN 39 NADIA MIFTAHUDIN RT. 003 8/12/2017 4/12/2014 B P 12
100 BLN 40 RAFFA SADAM H. RT. 002 8/12/2017 2/11/2013 B L 16
92 BLN 41 DZASKYYA DUDI RT. 003 8/12/2017 4/10/2014 B P 9.5
73 BLN 42 KAKA ASEP RT. 002 8/12/2017 9/7/2013 B L 13
96 BLN 43 HAIDAR SEHABUDIN RT. 002 8/12/2017 10/13/2014 B L 11
69 BLN 44 DEVI DODO RT. 003 8/12/2017 11/13/2013 B P 13
99 BLN 45 SATRIA IJAM RT. 003 8/12/2017 2/22/2016 B L 9
71 BLN 46 ADILLA SUHENDRIK RT. 002 8/12/2017 1/4/2016 B P 9
95 BLN 47 INARA ANDRI RT. 003 8/12/2017 B 7.1
69 BLN 48 FITRI ADAN RT. 002 8/12/2017 2/14/2014 B P 15
BLN 49 SALIM RAHMAT RT. 002 8/12/2017 9/12/2016 B L 8
79 BLN 50 RAYSHA ZAINI RT. 003 8/12/2017 9/2/2014 B L 11
81 BLN 51 NABILA SAFRIN RT. 002 8/12/2017 4/29/2016 B P 8.5
83 BLN 52 PUAD AMAS RT. 002 8/12/2017 9/10/2015 L 9
66 BLN 53 ESHAL RIZKI RT. 002 8/12/2017 3/14/2015 B P 11.5
101 BLN 54 NIZAM JOKO RT. 002 8/12/2017 15
116 BLN 55 BINTANG KRIS RT. 002 8/12/2017 12
88 BLN 56 MEYLANI HENDRA RT. 002 8/12/2017 5/7/2015 B P 9
88 BLN 57 YESHIKA H, ZAENAL ABIDIN RT. 003 8/12/2017 10/9/2014 B P 13
94 BLN 58 FIKRI MARHAYANI RT. 002 8/12/2017 2/24/2012 B L 15
65 BLN 59 FAREL AGUS RT. 003 8/12/2017 12/19/2012 B L 14
85 BLN 60 SARIF RAHMAT RT. 003 8/12/2017 12/5/2013 B L 15
67 BLN 61 KISELLA KARTONO RT. 003 8/12/2017 2/4/2013 B P 16
7 BLN 62 M. ARKAN SOPIANDI RT. 003 8/12/2017 12/22/2016 B L 8.2
100 BLN 63 NADIA RUSNADI RT. 003 8/12/2017 5/1/2012 B P 25
80 BLN 64 ABDUL MUHYI SOFYAN RT. 003 8/12/2017 8/30/2013 B L 13
94 BLN 65 ACELIN KOKO 8/12/2017 3/11/2016 B P 10
71 BLN 66 M. RAFFA RONI RT. 002 8/12/2017 9/20/2013 B L 14
68 BLN 67 M. RAFFA RYAN R. RT. 003 8/12/2017 8/8/2015 B L 10.9
BLN 68 AZZAMI SONI RT. 003 8/12/2017 2/4/2014 B L 15
PETUGAS
......................) (...................................)
FORMULIR PENCATATAN
PUSKESMAS :

11 12 1 2 3 4 5 6 7 8 9 10
89 BLN 69 SITI NUR AISYAH AMIN RT. 003 8/12/2017 10/6/2013 B P 11
85 BLN 70 ALHAM AHMAD B. RT. 003 8/12/2017 10/13/2012 B L 18
72 BLN 71 NECHRI M. MARYADI RT. 003 8/12/2017 2/7/2017 B L 8.2
67 BLN 72 ZAHARA INDRIYENI RT. 003 8/12/2017 11/3/2013 B P 13
BLN 73 NABIHAN RIBUT RT. 003 8/12/2017 10/3/2013 B L 12
96.6 BLN 74 Y. RICO JAFARDI RT. 003 8/12/2017 1/3/2013 B L 14
76 BLN 75 ARSHAKA OKKY RT. 003 8/12/2017 7/24/2016 B P 9.2
81 BLN 76 AFFAN TAUFIK RT. 003 8/12/2017 2/2/2013 B L 14
84.5 BLN 77 SAHLA RIDWAN RT. 003 8/12/2017 4/6/2014 B P 11
98 BLN 78 RAISYA SARKOSIH RT. 003 8/12/2017 6/4/2013 B P 12
77 BLN 79 FAEZA IMAN SETIYO RT. 003 8/12/2017 3/2/2014 B L 14
90 BLN 80 ALKHOLIFI EDI RT. 003 8/12/2017 6/1/2014 B L 12.8
100 BLN 81 NOLAN EKO RT. 003 8/12/2017 1/1/2015 B L 11
69 BLN 82 M. AKBAR M. MUKHLIS RT. 003 8/12/2017 10/16/2014 B L 12
89 BLN 83 ALIKA HARDEA RT. 003 8/12/2017 9/27/2015 B P 10
110 BLN 84 BILQIS WAWAN RT. 003 8/12/2017 6/25/2016 B P 7.7
90 BLN 85 NUILMA SUPRIYADI RT. 003 8/12/2017 3/21/2017 B L 12
BLN 86 HISYAM EKA / AMEL RT. 003 8/12/2017 5/19/2016 B L 10
103 BLN 87 AUFAR EKA / AMEL RT. 003 8/12/2017 2/24/2013 B L 15
80 BLN 88 UWAIS AJI / MAYA RT. 003 8/12/2017 1/1/2016 T L 7
54 BLN 89 MARSYA AAN / R. SILVIA RT. 003 8/12/2017 3/4/2014 B P 15
53.5 BLN 90 AZMI TAFSIR ALI RT. 003 8/12/2017 7/15/2016 B P 8.5
BLN 91 INGGID DEDI RT. 003 8/12/2017 2/12/2015 B P 13
9 BLN 92 M. KHOLID R. ARIF / MIDAH RT. 003 8/12/2017 7/2/2014 B L 11
80 BLN 93 FAQIH JONI / ANI RT. 003 8/12/2017 5/18/2014 B L 11.5
89 BLN 94 MAHIRA HANIN RT. 003 8/12/2017 7/13/2012 B P 12
99 BLN 95 SISKA FENDI RT. 003 8/12/2017 9/9/2012 B P 18
98 BLN 96 M. WINARA MASKARA RT. 003 8/12/2017 11/12/2016 B L 9.5
BLN 97 ALIF FIRDA RT. 003 8/12/2017 B 11
92 BLN 98 M. HAKIKI SURYANI RT. 003 8/12/2017 2/6/2015 B L 10.3
65 BLN 99 RENDI AMIRUDIN RT. 003 8/12/2017 11/5/2016 B L 8.5
91 BLN 100 KHAESYA SUHERMAN RT. 003 8/12/2017 12/30/2012 B P 15
102 BLN 101 MIRZA SUPARMAN RT. 003 8/12/2017 12/29/2012 B L 16
105 BLN 102 NAYLA SAPRUDIN RT. 003 8/12/2017 7/25/2012 B P 13
PETUGAS
......................) (...................................)
FORMULIR PENCATATAN
PUSKESMAS :

11 12 1 2 3 4 5 6 7 8 9 10
BLN 103 RIFKA SAID 8/12/2017 10/21/2013 B P 11
92 BLN 104 BUNGA HENDRA 8/12/2017 10/13/12 B P 15
56 BLN 105 REVA WAWAM 8/12/2017 11/8/2016 B P 68
94 BLN 106 ASYILA PUTRI SAEPUDIN 8/12/2017 12/6/2014 B 10
92 BLN 107 MEMEY MAHMUD 8/12/2017 4/8/2013 B P 17
69 BLN 108 MISEI HERI 8/12/2017 11/12/2014 B P 15
62 BLN 109 ALDA ANWAR 8/12/2017 10/15/2013 B 15
80 BLN 110 RIA YAYAN 8/12/2017 B 17
77 BLN 111 AURA DIKI 8/12/2017 10/26/2013 B 13
74 BLN 112 SITI F. M. SYAMSUDIN 8/12/2017 4/20/2014 B 15
92 BLN 113 ADIBA NANA 8/12/2017 12/14/2016 B 7
81 BLN 114 VIVIAN H. ADE 8/12/2017 2/26/2014 B 11
82 BLN 115 ALESHA CECEP 8/12/2017 11/6/2015 B 11
BLN 116 PAIS LEMBON 8/12/2017 2/3/2013 B 15
BLN 117 YUSUF ADE 8/12/2017 7/15/2015 B 12
BLN 118 AKSILA HENDRIK 8/12/2017 9/2/2016 B 8
BLN 119 NANTA BUSHAERI 8/12/2017 7/9/2014 B
BLN 120 HAFIDZUL M. RIFAL / ANITA RT. 002 8/12/2017 10/18/2014 B 11.5
BLN 121 KAMAL RUDI / NUR RT. 002 8/12/2017 B 16
BLN 122 AMARA ACENG / NIRI RT. 002 8/12/2017 1/26/2015 B 15
BLN 123 M.H. DEDEN HERI RT. 002 8/12/2017 12/2/2013 B 15
BLN 124 M. REFI H. HAERUL S. 8/12/2017 8/15/2014 B 12
BLN 125 GUNTHER LUKMAN RT. 003 8/12/2017 1/25/2016 11
BLN 126 GHAITSUL LUKMAN 8/12/2017 2/25/2014 11
BLN 127 RAISA ENDANG 8/12/2017 7/6/2016 8.4
BLN 128 RAFAEL ENDANG 8/12/2017 8/13/2014 14
BLN 129 ABIDZAR SUTARMAN 8/12/2017 4/14/2015 11
BLN 130 MUTIARA JAMAL 8/12/2017 6/15/2016 7.4
BLN 131 FAIREL FAHRUL 8/12/2017 6/10/2015 11
BLN 132 GINA HENDRAWAN 8/12/2017 1/6/2016 12.5
BLN 133 PUTRI ISNIN 8/12/2017 9/16/2015 9.3
BLN 134 RAHMAH FADLI 8/12/2017 9/29/2018 8.1
BLN 135 INTAN AYUB 8/12/2017 7/5/2015 8
BLN 136 SALSABILA AJAT 8/12/2017 9/18/2014 11.4
PETUGAS
......................) (...................................)
FORMULIR PENCATATAN
PUSKESMAS :

1 2 3 4 5 6 7 8 9 10
137 GINA QURTUAINI HENDRAWAN RT. 002 8/12/2017 1/6/2015 B P 14
138 NAYLA SAPRUDIN RT. 002 8/12/2017 7/25/2012 B P 16
139 NAFASHA AGUS RT. 003 8/12/2017 6/26/2012 B P 16
140 ARSHAKA OKKY RT. 003 8/12/2017 7/24/2016 B P 10
141 SAHLA RIDWAN RT. 003 8/12/2017 4/6/2014 B P 14
142 SAFIRA FIRMAN RT. 003 8/12/2017 4/21/2013 B P 11
143 ALIZA KAMAL RT. 002 8/12/2017 3/6/2016 B P 9
144 IRMA ANO RT. 002 8/12/2017 3/10/2016 B P 7.5
145 BINTANG EDI RT. 002 8/12/2017 7/1/2012 B L 12
146 BIMA EDI RT. 002 8/12/2017 4/4/2014 B L 10
147 KAILA OCID RT. 002 8/12/2017 2/8/2016 B P 8
148 FARES OCID RT. 002 8/12/2017 9/7/2013 B L 11
149 BISMA BAYU RT. 002 8/12/2017 9/8/2013 B L 20
150 M. ANJAR SAID RT. 002 8/12/2017 4/9/2016 B L 9.2
151 LEVI FIRDAUS RT. 002 8/12/2017 1/13/2014 B P 15.5
152 KARLINA ACING RT. 002 8/12/2017 1/17/2014 B P 13
153 KAILA M. NASRUDIN RT. 003 8/12/2017 1/17/2016 B P 8.5
154 DAFA M. NASRUDIN RT. 003 8/12/2017 3/28/2014 B L 9.5
155 RAFLI ACEP 8/12/2017 2/6/2017 B L 8.6
156 RESKI K. WAWAN 8/12/2017 6/22/2016 B L 7.6
157 IBRAHIM ENGKOS RT. 003 8/12/2017 B L 13
158 JIBRAN HERI RT. 003 8/12/2017 B L 12
159 MICHELLE ADE RT. 002 8/12/2017 1/6/2016 B P 9.5
160 DIAMS ANGGA 8/12/2017 12/2/2015 B L 12
161 MEMEN MAHMUD RT. 002 8/12/2017 4/8/2013 B P 17
162 AFIKA SAMSUDARI 8/12/2017 5/20/2017 B P 5.5
163 8/12/2017
164 8/12/2017
165 8/12/2017
166 8/12/2017
167 8/12/2017
168 8/12/2017
169 8/12/2017
170 8/12/2017
PETUGAS
(...................................)
FORMULIR PENCATATAN

POSYANDU/DESA : MELATI 5

11 12 1 2 3 4 5 6 7 8 9 10
65 BLN 1 DILL A. WAHYU A. RT. 001/002 8/8/2017 4/12/2014 B P 9
94 BLN 2 NATASYA P. FERI RT. 001/004 8/8/2017 9/27/2016 T P 7.5
75 BLN 3 BAGAS N.P SUMARJO RT. 001/002 8/8/2017 7/2/2014 B LL 10
108 BLN 4 SETIAWAN SISWANDARA RT. 001/002 8/8/2017 5/5/2016 B L 8
81 BLN 5 M. GHAZY F. ASEP KUMBARA 8/8/2017 9/14/2014 B L 16
79 BLN 6 KHANZIA N. ARI SUGIAR 8/8/2017 10/22/2016 T P 6.5
102 BLN 7 MIRZA A. SUNTONI 8/8/2017 3/2/2014 B L 13
77 BLN 8 AZIZAH A. AHMAD S. 8/8/2017 12/6/2014 B P 12
77 BLN 9 DIVYANSA D. SAHID D. 8/8/2017 12/9/2013 B P 11
86 BLN 10 AHMAD F. AKBAR 8/8/2017 4/10/2013 B L 15
91 BLN 11 FADILLAH A. RONI BUSTAMIL A. RT. 004/002 8/8/2017 6/3/2013 B L 13
96 BLN 12 ISABITAH M. ARIF RAHMAN 8/8/2017 12/14/2012 B P 17
85 BLN 13 MUHAMMA W. NENDA BIN N. 8/8/2017 6/8/2014 B L 15
108 BLN 14 SOLIHATUN H. MAT. SIRI 8/8/2017 1/18/2013 B P 13
109 BLN 15 REYHAN R.A TOAT 8/8/2017 1/17/2012 B L 16
97 BLN 16 HAFIZAH A. SUGENG H. 8/8/2017 8/28/2016 B P 8.2
109 BLN 17 AHMAD A. RUMANTO 8/8/2017 3/15/2013 B L 17
78 BLN 18 NAURA A. BAMBANG P. RT. 004/002 8/8/2017 6/26/2016 T P 7
100 BLN 19 M. FATAN M. YUSUF P. RT. 001/002 8/8/2017 2/5/2015 B L 10
75 BLN 20 AKMAL C.N FAIZAL F. RT. 004/002 8/8/2017 9/1/2014 B L 10
70 BLN 21 HANIF EL C. TUGIYNATO RT. 004/002 8/8/2017 4/22/2014 B L 12
100 BLN 22 RIZKY F.M ADI SUHENDIN RT. 004/002 8/8/2017 12/3/2012 B L 15
73 BLN 23 AHMAD D. AHMAD S. RT. 004/002 8/8/2017 12/26/2015 B L 10
100 BLN 24 SOIATUL M. SAHRUDIN RT. 004/002 8/8/2017 1/16/2015 B P 10
110 BLN 25 M. MALKA B. ROSADA RT. 001/002 8/8/2017 2/17/2016 B P 12
85 BLN 26 KAILA P.R SLAMET R. RT. 001/002 8/8/2017 8/9/2012 B P 15
80 BLN 27 AL FATIH AHMAD YAZID RT. 004/002 8/8/2017 4/6/2016 B L 9
88 BLN 28 M. SYABIL A.H DIDI / YATI RT. 004/002 8/8/2017 2/28/2014 B L 20
85 BLN 29 M. ARZEN CARMIN RT. 004/002 8/8/2017 6/24/2015 B L 13
107 BLN 30 IJAH CARMIN /ARIDA RT. 004/002 8/8/2017 8/8/2014 B P 9
71 BLN 31 ALIFAH R.A ARIE SETIAWAN RT. 001/002 8/8/2017 8/21/2013 B P 14
80 BLN 32 ZIDNY R. ARIF RAHMAN RT. 004/002 8/8/2017 3/16/2016 B L 8.1
85 BLN 33 MIKDAJAD H. RIDJAL H. RT. 004/002 8/8/2017 1/9/2014 B L 15
75 BLN 34 KEYLA H. HERI HERYANA RT. 004/002 8/8/2017 3/13/2013 B P 14
PETUGAS
......................) (...................................)
FORMULIR PENCATATAN


11 12 1 2 3 4 5 6 7 8 9 10
104 BLN 35 ALFINA AZRA R. ISMAIL M. RT. 004/002 8/8/2017 8/7/2012 B P 32
62 BLN 36 YASIRLY P.R AHMAD FATONI RT. 004/002 8/8/2017 11/29/2012 B P 16
88 BLN 37 AHMAD AL H. SAIFUL BACHTIAR RT. 001/002 8/8/2017 8/5/2012 L
86 BLN 38 FATHIA M.R AHMAD S. RT. 004/002 8/8/2017 10/23/2016 T P 8.6
81 BLN 39 ALIFYA Q.M HADI HAFIZ H. RT. 001/002 8/8/2017 2/22/2013 B P 15
106 BLN 40 AZKA ALFIAN ZAENAL A. RT. 001/002 8/8/2017 6/23/2013 B L 14
92 BLN 41 NADA F.S NASEP SURYANA RT. 001/002 8/8/2017 11/29/2013 B P 13
97 BLN 42 DENIS S. DANI H. RT. 001/002 8/8/2017 8/26/2015 B L 10
89 BLN 43 ILYASA A.R SALMAN RT. 001/002 8/8/2017 10/9/2012 B L 17
96 BLN 44 NAJWA A.R SALMAN RT. 001/002 8/8/2017 10/3/2014 B P 10
72 BLN 45 GILANG R. DWI SETIA B. RT. 001/002 8/8/2017 7/9/2014 B L 10
73 BLN 46 GHAZIYA C.S DICKY S. RT. 001/002 8/8/2017 12/15/2015 B P 11
68 BLN 47 ARINA S. HERI SUDRAJAT RT. 001/002 8/8/2017 9/13/2014 B P 10
104 BLN 48 ALDIANSYAH A. MUZH M. RT. 001/002 8/8/2017 1/28/2016 B L 8.5
71 BLN 49 ALFIYAH H.K IKIN M.S RT. 001/002 8/8/2017 10/15/2015 B P 8
89 BLN 50 ADINDA P. VOVONG R. RT. 001/002 8/8/2017 12/5/2015 B P 8
76 BLN 51 CAESAR R.D ADJAT S. RT. 001/002 8/8/2017 5/2/2013 B L 16
81 BLN 52 ALFIA T. SAFE'I RT. 001/002 8/8/2017 5/22/2015 B P 12
91 BLN 53 ADEEVA J.S JOHAN R. 8/8/2017 12/30/2015 B P 14
100 BLN 54 KHAIRONISSA RIZKY F.H 8/8/2017 6/29/2016 B P 11
91 BLN 55 LASHIRA A.W INAR R.B 8/8/2017 10/21/2013 B P 13
77 BLN 56 AINAYA K.Z M. FAHRUL R. 8/8/2017 1/6/2016 B P 10
96 BLN 57 M. IZLAL A. TOMI WAHYUDI 8/8/2017 7/15/2015 B L 10
105 BLN 58 NASRULLOH M.R SYARIF H. 8/8/2017 6/13/2014 B L 15
102 BLN 59 REVA A.R RIZWAN RT. 004/002 8/8/2017 6/27/2014 B P 12
96 BLN 60 ALIKA N.A SUHARJO RT. 001/002 8/8/2017 4/4/2013 B P 19
107 BLN 61 AILANI A. SAMSUL A. RT. 001/002 8/8/2017 12/20/2015 B P 9
69 BLN 62 M. GIBRAN I. DANA RUSDIANA 8/8/2017 10/20/2013 B L 17
114 BLN 63 NAUFAL Z.R DANA RUSDIANA 8/8/2017 4/27/2015 B L 10
90 BLN 64 NICO K. HENDRA GUNAWAN RT. 004/002 8/8/2017 10/28/2014 B L 10
77 BLN 65 RIFQI H.S A. SULISTION RT. 004/002 8/8/2017 4/3/2015 B L 10
106 BLN 66 FANSYAH A. BONIN 8/8/2017 10/3/2011 B L 15
84 BLN 67 DZULFIKAR A.K AZIZ MUSLIM 8/8/2017 9/28/2014 B L 12
100 BLN 68 MIKAIL Z.A DION RIZKY A. 8/8/2017 8/21/2015 B L 14
PETUGAS
......................) (...................................)
FORMULIR PENCATATAN


11 12 1 2 3 4 5 6 7 8 9 10
91 BLN 69 SAFA ALIFAH HERI P. RT. 004/002 8/8/2017 11/2/2015 P 9
104 BLN 70 M. CAKRA S.M WAHYUDIN RT. 004/002 8/8/2017 12/15/2015 L 10
65 BLN 71 QUEENA K.S BAMBANG R. RT. 004/002 8/8/2017 5/10/2013 P 18
97 BLN 72 ZIHAN A.Z BUDI BUDIMAN RT. 004/002 8/8/2017 12/14/2013 P 12
97 BLN 73 M. RAFIQ A.F BARKI A. RT. 004/002 8/8/2017 7/28/2016 L 9
98 BLN 74 M. AIDANSYAH YOGA SUDONO RT. 004/002 8/8/2017 8/1/2014 L 12
75 BLN 75 PRADITA B.K HERYANTO RT. 004/002 8/8/2017 2/6/2015 L 9
104 BLN 76 NATASYA T.W SURYA WIJAYA RT. 004/002 8/8/2017 2/16/2013 P 17
94 BLN 77 ALIKA NUR A. KENAN RT. 001/002 8/8/2017 11/4/2001 P 10
96 BLN 78 RIVANA S.A VIIVI SOFIAH RT. 001/002 8/8/2017 5/25/2013 P 15
101 BLN 79 FABIAN MUH. FADILAH A. RT. 001/002 8/8/2017 5/11/2015 L 11
79 BLN 80 DIMAS R. KUSNADI RT. 004/002 8/8/2017 10/30/2015 L 12.5
85 BLN 81 HAIKAL A.M FUJIATI W.I.S RT. 004/002 8/8/2017 9/23/2013 L 13
72 BLN 82 SARI MUH P. ABU BAKAR S. RT. 004/002 8/8/2017 1/18/2015 L 13
83 BLN 83 ARKA KARIN A.R HARTONO / NONI RT. 004/002 8/8/2017 10/7/2015 L 10
82 BLN 84 ALISA W.S DAHLIA S. RT. 004/002 8/8/2017 10/19/2013 P 13
65 BLN 85 NIZAR R. DADANG S. RT. 001/002 8/8/2017 11/8/2016 L 10.5
BLN 86 MUKTIA M. ALI NURDIN 8/8/2017 4/24/2016 P 11
BLN 87 BERIE ZIDNY I. AGUNG MAULANA 8/8/2017 6/12/2015 L 10
70 BLN 88 DINAR A.H NUR FADILAH 8/8/2017 11/1/2015 P 10
115 BLN 89 ALESHA K.A MOH. AKBAR RT. 001/002 8/8/2017 6/23/2012 P 25
73 BLN 90 UFAIRA A.S ASEP SAEPUDIN RT. 004/002 8/8/2017 10/10/2014 P 9.1
88 BLN 91 RASKA M. DOI ZULKARNAIN RT. 004/002 8/8/2017 7/26/2014 L 20
90 BLN 92 ADNA HEBI M. TASINI SANJAYA RT. 001/002 8/8/2017 11/26/2016 P 8.5
95 BLN 93 MEI GITA A.S IYAN SOFYAN RT. 001/002 8/8/2017 5/25/2015 P 11
104 BLN 94 ABIZAR ARIS RT. 004/002 8/8/2017 L 2
112 BLN 95 SILFA AS. ADI PRIYATNA RT. 001/002 8/8/2017 6/18/2016 P 6.8
71 BLN 96 JIBRIL A.S GANJAR SAPUTRA RT. 004/002 8/8/2017 3/6/2014 L 14
98 BLN 97 CALISTA L.Z MULYADI RT. 004/002 8/8/2017 1/24/2014 P 14
80 BLN 98 TAKI DAHLIA 8/8/2017 8/12/2015 L 10
72 BLN 99 NESYA SARI ASEP SAEPUDIN RT. 001/002 8/8/2017 5/2/2016 P 10
105 BLN 100 DEWA P. UCI SANUSI RT. 004/002 8/8/2017 11/2/2012 L 15
106 BLN 101 ABIDIN K.S.S YOGA SUDONO RT. 004/002 8/8/2017 11/1/2016 P 7.6
103 BLN 102 ARKAN F.J ARIE SETIAWAN RT. 001/002 8/8/2017 4/19/2017 L 6.3
PETUGAS
......................) (...................................)
FORMULIR PENCATATAN


11 12 1 2 3 4 5 6 7 8 9 10
85 BLN 103 RAFAEL FAUZY HENDRA P. RT. 001/002 8/8/2017 5/20/2017 T L 5.6
100 BLN 104 AHMAD RIFAI ASRIP ASKIN RT. 001/002 8/8/2017 2/2/2017 T L 8.3
66 BLN 105 INDAH DWI P. DWI SETIABUDI RT. 001/002 8/8/2017 3/18/2017 T P 5.9
88 BLN 106 YARA SAYUDIN RT. 004/002 8/8/2017 4/9/2017 T P 6.3
107 BLN 107 FADLAN TASBIH ABD. GHAFAR M. 8/8/2017 4/18/2017 T L 7.1
90 BLN 108 WATA K.A.S ABU BAKAR S. 8/8/2017 2/2/2017 T P 9.1
97 BLN 109 RINI AZKA D.R ASEP SAEPUDIN 8/8/2017 3/31/2017 T P 6.7
102 BLN 110 SHAHBAZ M.A MARKOS RT. 001/002 8/8/2017 6/27/2017 T L 5.2
97 BLN 111 ARSYILA M.A AKBAR RT. 004/002 8/8/2017 3/4/2017 T P 6.1
90 BLN 112 M. RIO F. M. FAUZI RT. 001/002 8/8/2017 2/20/2017 T L 6.5
67 BLN 113 M. AZMI UMI RT. 001/002 8/8/2017 T L 8
90 BLN 114 ALESHA C. YUSTRIANTO 8/8/2017 2/8/2017 T P 7
84 BLN 115 ADELLA N. ABDUL FATAH RT. 004/002 8/8/2017 4/2/2017 T P 5.8
102 BLN 116 ARSILA P. PUSPA AYU I. RT. 004/002 8/8/2017 6/14/2017 P 4
92 BLN 117 ZHIVANA A. YOGIAS Y. RT. 001/002 8/8/2017 1/19/2014 P
70 BLN 118
BLN 119
91 BLN 120
107 BLN 121
95 BLN 122
105 BLN 123
93 BLN 124
BLN 125
BLN 126
71 BLN 127
91 BLN 128
86 BLN 129
72 BLN 130
85 BLN 131
81 BLN 132
79 BLN 133
70 BLN 134
87 BLN 135
87 BLN 136
PETUGAS
......................) (...................................)
TB UMUR
(CM) (BULAN)
11 12
110 BLN
115 BLN
110 BLN
91 BLN
95 BLN
95 BLN
70 BLN
72 BLN
115 BLN
95 BLN
53 BLN
73 BLN
102 BLN
73 BLN
110 BLN
94 BLN
78 BLN
92 BLN
68 BLN
76 BLN
100 BLN
100 BLN
77 BLN
89 BLN
107 BLN
56 BLN
BLN
BLN
BLN
BLN
BLN
BLN
BLN
BLN
......................)
FORMULIR PENCATATAN

POSYANDU/DESA : MELATI X / SIMPANGAN (KP. CIBEBER)

11 12 1 2 3 4 5 6 7 8 9 10
91 BLN 1 AHLAN Z. SOHIRLIN RT. 002/005 8/9/2017 4/30/2012 B P 15.5
70 BLN 2 HANA NIA RISKI K. RT. 002/005 8/9/2017 10/16/2015 B P 9.1
92 BLN 3 HASBI A. ALAMSYAH RT. 002/005 8/9/2017 7/12/2012 B L 11.1
77 BLN 4 FIKA H. WAHYUNI I. RT. 002/005 8/9/2017 1/4/2016 B P 8.6
101 BLN 5 AQILA N. RAHMAT H. RT. 002/005 8/9/2017 9/25/2014 B P 9.1
57 BLN 6 NEYLA A. TALA RT. 002/005 8/9/2017 5/19/2014 B P 8.8
98 BLN 7 DEVAN JR. PANJI W. RT. 002/005 8/9/2017 7/24/2014 B L 13.2
93 BLN 8 RONIA SUKITO RT. 002/005 8/9/2017 12/5/2015 B P 11.9
98 BLN 9 NAURA TRISNO RT. 002/005 8/9/2017 7/17/2012 B P 15.5
111 BLN 10 SAHRUL ALI (ALM) RT. 002/005 8/9/2017 4/27/2013 B L 14.4
99 BLN 11 SAHRUL ALI (ALM) RT. 002/005 8/9/2017 4/27/2013 B L 14.4
108 BLN 12 ARIA M. AMIN / EUIS RT. 002/005 8/9/2017 1/29/2017 B L 11.3
99 BLN 13 GUSTIANI YANDI RT. 002/005 8/9/2017 8/5/2014 B P 13.3
99 BLN 14 NAFFA U.T PURWANTO RT. 002/005 8/9/2017 1/6/2015 B P 10.5
16 BLN 15 KABIL ASEP SUNANDANG RT. 002/005 8/9/2017 3/9/2015 B P 12.5
65 BLN 16 BAHRUL SALWAN DEDI JUNARDI RT. 002/005 8/9/2017 6/14/2014 B L 16.1
117 BLN 17 FIRMANSYAH LUKMAN RT. 002/005 8/9/2017 8/27/2015 B L 11.7
74 BLN 18 SYAQILLA I.T SAEPUL RT. 002/005 8/9/2017 1/12/2016 B P 8
91 BLN 19 FAJAR FADILAH JAMALUDIN RT. 002/005 8/9/2017 9/8/2014 B L 12.2
88 BLN 20 FARHAN M. ANTONIUS C. RT. 002/005 8/9/2017 12/18/2016 B L 9.5
96 BLN 21 EGIS KOHARUDIN ROSIDIN RT. 002/005 8/9/2017 12/29/2013 B L 16.2
101 BLN 22 AGIS RAYA S. ANWAR S. RT. 002/005 8/9/2017 7/6/2016 B P 8.4
83 BLN 23 M. FARAS R. JARWO RT. 002/005 8/9/2017 10/25/2014 B L 12.3
92 BLN 24 FATHAN AL WAISAN HERLAN RT. 002/005 8/9/2017 2/14/2014 B L 16.2
83 BLN 25 SOPIAN MULYOKU SAKUM RT. 002/005 8/9/2017 9/19/2014 B L 11.4
111 BLN 26 OKTALIFA N.W SAMSUL HADI RT. 002/005 8/9/2017 10/14/2015 B P 12.9
78 BLN 27 VIONA ALFIONI KOMARUDIN RT. 002/005 8/9/2017 7/4/2016 B P 7.7
103 BLN 28 NAZWA YAYA RT. 002/005 8/9/2017 4/6/2017 B P 5.6
51 BLN 29 SYAQIFA F. FIRMAN RT. 002/005 8/9/2017 6/16/2013 B P 13.1
98 BLN 30 M. AZHAR F. SUKEDIR RT. 002/005 8/9/2017 3/7/2014 B L 13.1
103 BLN 31 HUSNAH FADJARIN RT. 002/005 8/9/2017 11/26/2014 B P 9.3
76 BLN 32 FADLAN PADILAH PARDI RT. 002/005 8/9/2017 1/15/2017 L 7.4
100 BLN 33 ALFIN M. RIKI M. RT. 002/005 8/9/2017 1/4/2017 B L 8.3
95 BLN 34 ALIF M. RIKI M. RT. 002/005 8/9/2017 7/17/2015 L 12.1
PETUGAS
......................) (...................................)
FORMULIR PENCATATAN


11 12 1 2 3 4 5 6 7 8 9 10
116 BLN 35 M. ARAFI JOKORI JEHAN RT. 002/005 8/9/2017 10/11/2012 L 12.5
108 BLN 36 RAIHAN FARIS P. SUGITO RT. 002/005 8/9/2017 4/7/2014 L 15
BLN 37 NOVA ADRIAN S. ASNAWI RT. 002/005 8/9/2017 11/6/2016 L 8.8
68 BLN 38 BIANKHA A. DIAN FARASTIO RT. 002/005 8/9/2017 1/14/2014 P 11
100 BLN 39 RAFA M.A JAMSARI RT. 002/005 8/9/2017 4/26/2016 L 0.3
101 BLN 40 TIA BONI TELANI RT. 002/005 8/9/2017 7/20/2016 P 9.2
102 BLN 41 UBOX AL FAUZAN ABUL GOFUR RT. 002/005 8/9/2017 4/23/2016 L 9.6
9 BLN 42 M. IQBAL A. EENG M. RT. 002/005 8/9/2017 2/14/2015 L 14.7
110 BLN 43 NATASYA A.LIM HAKIM RT. 002/005 8/9/2017 6/16/2014 P 16.5
88 BLN 44 CALISTA ASEP JAMURI RT. 002/005 8/9/2017 3/18/2015 P 17.1
94 BLN 45 RAESHA ASEP JAMURI RT. 002/005 8/9/2017 5/9/2017 P 5.5
74 BLN 46 ARSYILLA INTAN P. RAHMAT PANJI RT. 002/005 8/9/2017 8/19/2016 P 7.2
61 BLN 47 PANJI MULYANA RT. 002/005 8/9/2017 12/13/2016 L 7.8
BLN 48 LUTHFI RAFA A.. ADRIYAN RT. 002/005 8/9/2017 3/15/2014 L 12.6
78 BLN 49 ADRIANSYAH YAYAN H. RT. 002/005 8/9/2017 3/25/2017 L 15.2
75 BLN 50 KINARA M. DAYAT RT. 002/005 8/9/2017 3/24/2016 P 8.8
110 BLN 51 NAUVAL NABINA ROHENDI RT. 002/005 8/9/2017 6/1/2015 L 9.3
85 BLN 52 AISYAH PUTRI FEBRI ISMOYO RT. 002/005 8/9/2017 11/16/2015 P 11.7
86 BLN 53 RAISYA PUTRI RHMAN RT. 002/005 8/9/2017 11/23/2015 P 8.2
BLN 54 PUTRI ANJANI DAYAT RT. 002/005 8/9/2017 1/14/2013 P 15.4
98 BLN 55 FATIYA SALSABILA EKO SETIAWAN RT. 002/005 8/9/2017 10/3/2015 P 10.1
82 BLN 56 TANIA NABILA SAEFUL RT. 002/005 8/9/2017 7/9/2014 P 13.8
82 BLN 57 ULFAH RIFA SUKORAD RT. 002/005 8/9/2017 9/17/2013 P 13.6
98 BLN 58 AL GHOZALI WARSONO RT. 002/005 8/9/2017 12/26/2015 L 10.7
87 BLN 59 ENO AKBAR EKO SUSANTO RT. 002/005 8/9/2017 10/25/2012 L 18
108 BLN 60 MOURA M.S TOTO SUMARNO RT. 002/005 8/9/2017 1/9/2015 P 11.7
76 BLN 61 NISSA A.Z AZWAR RT. 002/005 8/9/2017 3/14/2014 P 10.1
109 BLN 62 JIHAN TALITA ERLAN RT. 002/005 8/9/2017 2/24/2014 P 11.9
81 BLN 63 KENPUNG DIYANTO SLAMET RIYADI RT. 002/005 8/9/2017 1/22/2016 L 9.4
91 BLN 64 FATHAN AL RATIKY ALI RT. 002/005 8/9/2017 5/6/2015 L 12.4
98 BLN 65 CINTA NAZQILA MAWAR RT. 002/005 8/9/2017 8/9/2014 P 12.5
107 BLN 66 JESSICA SIKOMBANG EDISON RT. 002/005 8/9/2017 4/4/2015 P 11.5
93 BLN 67 KALRAN IPAN RT. 002/005 8/9/2017 8/2/2014 P 12.9
90 BLN 68 BRIAN FAHLI S. TAUFIK MAULANA RT. 002/005 8/9/2017 7/16/2017 L 3.4
PETUGAS
......................) (...................................)
FORMULIR PENCATATAN


11 12 1 2 3 4 5 6 7 8 9 10
82 BLN 69 KHALISA NUR SAFITRI ARI RT. 002/005 8/9/2017 9/14/2014 B P 15.2
80 BLN 70 YUMNA FAUZIAH WARDI RT. 002/005 8/9/2017 10/19/2013 B P 14.5
108 BLN 71 ABDUL RISKY SAEPUL KAMIL RT. 002/005 8/9/2017 10/18/2014 B L 14.5
98 BLN 72 RIKA ROMADONI KARMAN RT. 002/005 8/9/2017 6/25/2016 B P 12.2
75 BLN 73 AZIZAH IYAS RT. 002/005 8/9/2017 8/24/2015 B P 16.7
99 BLN 74 AINASUHA SUKENDI RT. 002/005 8/9/2017 1/26/2017 P 7
BLN 75 BRIAN PRABOSWORO YAMAN RT. 002/005 8/9/2017 2/8/2016 L 10
112 BLN 76 LUTFILLAH LEONAL A. NAKIM SOBENDI RT. 002/005 8/9/2017 8/3/2016 L 7.8
79 BLN 77 ABDUL ROJAK AGUS ANDI ANANG RT. 002/005 8/9/2017 5/17/2017 L 4.5
105 BLN 78 RIFKI ADITIA EKA SURAHMAN RT. 002/005 8/9/2017 2/1/2017 L 5.3
90 BLN 79 NAEMA M. KIMASU AJAT SUTRISNA RT. 002/005 8/9/2017 5/28/2013 P 13.5
85 BLN 80 FARIS ASOSERI ABDUL HAMID RT. 002/005 8/9/2017 4/10/2012 L 20
100 BLN 81 CUT ZHE-ZHE AGAM RT. 002/005 8/9/2017 8/27/2012 P 29
87 BLN 82 MIEPRAN A. YULIANTO RT. 002/005 8/9/2017 4/4/2012 L 15.7
86 BLN 83 M. ARIF SOLEH DIRMAN RT. 002/005 8/9/2017 5/5/2017 L 5.5
101 BLN 84 SABRINA ALYA R. BUDI SANTOSO RT. 002/005 8/9/2017 11/1/2016 P 6.7
63 BLN 85 BARA NAGISA DEWI CARMANG RT. 002/005 8/9/2017 4/3/2013 P 13.4
BLN 86 BUNGA DARI ARYANA BUDIYONO RT. 002/005 8/9/2017 11/13/2014 B P 11
70 BLN 87 ARZHANKA MUFTAUFUN RT. 002/005 8/9/2017 11/27/2015 B L 12
89 BLN 88 AZKA HAIKAL SYAQIEL ARIF HIDAYAT RT. 002/005 8/9/2017 6/2/2017 T L 4.5
118 BLN 89 HAFIZAH AYUDIA AGUNG PRIYANTO RT. 002/005 8/9/2017 11/28/2015 B P 8.6
85 BLN 90 ASIYAH PARKAWAN IRFAN RT. 002/005 8/9/2017 9/26/2012 B P 16
9 BLN 91 KHUSNA AQILA S. AJAT SANJAYA RT. 002/005 8/9/2017 4/13/2013 B P 20.4
60 BLN 92 SEPTI IMAN RT. 002/005 8/9/2017 9/16/2012 B P 15.7
87 BLN 93 KOLILA RIPDA IMAN RT. 002/005 8/9/2017 9/24/2016 T P 7.4
104 BLN 94 ARHALITHA A. IMAN SETIAWAN RT. 002/005 8/9/2017 1/3/2016 B P 13.6
61 BLN 95 VIONA ROSELINA Y. SAEFUL ANWAR RT. 002/005 8/9/2017 1/21/2012 B P 17
98 BLN 96 MALFA M. M. ZAMSUDI RT. 002/005 8/9/2017 5/30/2012 B P 10.5
98 BLN 97 HUSNA NUR FATTHAH SEMBIDI KAMAL RT. 002/005 8/9/2017 9/20/2011 B P 26.5
86 BLN 98 AKBAR AL GOZALI IWAN RT. 002/005 8/9/2017 5/19/2014 B L 11.5
87 BLN 99 KENDRA ZIO AIMANYU EMED SAEFUDIN RT. 002/005 8/9/2017 4/8/2017 T L 6.3
103 BLN 100 NAUVAL AKROR SUKARDONO RT. 002/005 8/9/2017 11/29/2014 B L 21.3
63 BLN 101 RASYID SUKARDONO RT. 002/005 8/9/2017 2/2/2017 B L 7.3
68 BLN 102 HAFIZ HABIBI KUNORO RT. 002/005 8/9/2017 4/20/2016 B L 8.1
PETUGAS
......................) (...................................)
FORMULIR PENCATATAN


11 12 1 2 3 4 5 6 7 8 9 10
56 BLN 103 AMIR SANJAYA SUTARNA RT. 002/005 8/9/2017 9/22/2016 T L 9.2
60 BLN 104 AMAR SANJAYA SUTARNA RT. 002/005 8/9/2017 9/22/2016 T L 8.9
57 BLN 105 AZRA PUTRI M. DEDI MULYADI RT. 002/005 8/9/2017 9/9/2012 B P 22
56 BLN 106 GHENTAR P.A ASEP SWARMAN RT. 002/005 8/9/2017 4/23/2012 B L 15,,5
58 BLN 107 ASSYARAH YADIH RT. 002/005 8/9/2017 8/1/2011 B P 15.5
65 BLN 108 AFRIANSYA IBRAHIM WAWAN RT. 002/005 8/9/2017 9/29/2012 B L 16.2
61 BLN 109 AQILA NAZWA FAHIRA ASEP RT. 002/005 8/9/2017 10/22/2015 B P 10.8
49 BLN 110 AZKA FEBRIAN ASEP RT. 002/005 8/9/2017 2/1/2012 B L 17.5
58 BLN 111 ALIF NANDONO JOKO SETIWAN RT. 002/005 8/9/2017 11/11/2012 B L 20.1
52 BLN 112 DELIZA PURWANTO RT. 002/005 8/9/2017 1/23/2012 B P 17.2
60 BLN 113 BUNGA ALISA AZALEA HALIMI RT. 002/005 8/9/2017 1/5/2014 B P 14.2
63 BLN 114 M.A. RAIHAN A. YONO RT. 002/005 8/9/2017 1/9/2012 B L 20
59 BLN 115 MON. MAULANA EDY RT. 002/005 8/9/2017 3/6/2014 B L 8.3
49 BLN 116 FATHIR AFAN ARDI SAPUTRA RT. 002/005 8/9/2017 3/10/2013 B L 16.2
BLN 117 APRILIAN SULTON P. ARI IRAWAN RT. 002/005 8/9/2017 4/25/2013 B L 14.3
BLN 118 AINA THALITA BENI RT. 002/005 8/9/2017 12/15/2013 B P 15.5
BLN 119 SRI RAHAYU MUSLIH RT. 002/005 8/9/2017 4/16/2016 B P 8.6
BLN 120 M. ABIZAR AL GHOFARI IRFAN RT. 002/005 8/9/2017 5/22/2017 B 5.4
BLN 121 KHOLIL JIBBRAN A.B BENI BIN YUSUF RT. 002/005 8/9/2017 L 10
BLN 122 SILVIA AZZAHRA IRFAN ISMAIL RT. 002/005 8/9/2017 P 8
BLN 123
BLN 124
BLN 125
BLN 126
BLN 127
BLN 128
BLN 129
BLN 130
BLN 131
BLN 132
BLN 133
BLN 134
BLN 135
BLN 136
PETUGAS
......................) (...................................)
TB UMUR
(CM) (BULAN)
11 12
105 BLN
81 BLN
91 BLN
78 BLN
87 BLN
87 BLN
97 BLN
87 BLN
102 BLN
102 BLN
103 BLN
92 BLN
93 BLN
86 BLN
87 BLN
96.5 BLN
87 BLN
73 BLN
94 BLN
80 BLN
101 BLN
72 BLN
88 BLN
104 BLN
89 BLN
90 BLN
73 BLN
64 BLN
97 BLN
95 BLN
86 BLN
72 BLN
72 BLN
90 BLN
......................)
TB UMUR
(CM) (BULAN)
11 12
99 BLN
98 BLN
73 BLN
91 BLN
78 BLN
80 BLN
82 BLN
98 BLN
96 BLN
98 BLN
64 BLN
73 BLN
69 BLN
99 BLN
105 BLN
78 BLN
85 BLN
87 BLN
75 BLN
108 BLN
84 BLN
82 BLN
100 BLN
81 BLN
110 BLN
88 BLN
88 BLN
91 BLN
79 BLN
92 BLN
92 BLN
85 BLN
84 BLN
52 BLN
......................)
TB UMUR
(CM) (BULAN)
11 12
99 BLN
99 BLN
88 BLN
76 BLN
86 BLN
61 BLN
82 BLN
65 BLN
54 BLN
65 BLN
100 BLN
19 BLN
100 BLN
102 BLN
61 BLN
68 BLN
97 BLN
87 BLN
85 BLN
57 BLN
78 BLN
103 BLN
114 BLN
110 BLN
68 BLN
84 BLN
108 BLN
103 BLN
120 BLN
93 BLN
54 BLN
91 BLN
79 BLN
7.5 BLN
......................)
TB UMUR
(CM) (BULAN)
11 12
78 BLN
75 BLN
110 BLN
110 BLN
110 BLN
110 BLN
84 BLN
105 BLN
113 BLN
108 BLN
93 BLN
113 BLN
88 BLN
103 BLN
100 BLN
100 BLN
53 BLN
53 BLN
87 BLN
87 BLN
BLN
BLN
BLN
BLN
BLN
BLN
BLN
BLN
BLN
BLN
BLN
BLN
BLN
BLN
......................)
FORMULIR PENCATATAN
PUSKESMAS :
POSYANDU/DESA : ANGGREK 2 / PASIR GOMBONG
NAMA NAMA TANGGAL TGL LAHIR CARA BB TB UMUR

BALITA ORANG TUA TIMBANG (TGL/BLN/TH) B/T (KG) (CM) (BULAN)
1 2 3 4 5 6 7 8 9 10 11 12
1 AZZAHRA ENDAR P.GOMBONG 8/15/2017 10/16/2015 9.3 BLN
2 OKA IRFAN P.GOMBONG 8/15/2017 11/21/2014 11.3 BLN
3 ADKIA KHOIRUDIN P.GOMBONG 8/15/2017 5/6/2014 19.5 BLN
4 PIDA HERMIANTO P.GOMBONG 8/15/2017 2/10/2015 10.2 BLN
5 ESAL KHOIRUDIN P.GOMBONG 8/15/2017 1/3/2016 12.3 BLN
6 SAHRUL MULYONO P.GOMBONG 8/15/2017 7/30/2014 14 BLN
7 DEWI JAJANG P.GOMBONG 8/15/2017 7/28/2016 9 BLN
8 ARKAN HERLAN P.GOMBONG 8/15/2017 1/7/2016 8.2 BLN
9 HAFIZAH MUSHOLIH P.GOMBONG 8/15/2017 4/24/2016 99 BLN
10 FIKRI HERI P.GOMBONG 8/15/2017 9/14/2016 19 BLN
11 HAIKAL HENDRA P.GOMBONG 8/15/2017 8/22/2016 10 BLN
12 AYASA AGUNG P.GOMBONG 8/15/2017 5/17/2016 8.5 BLN
13 ALMERA PRABOWO P.GOMBONG 8/15/2017 6/6/2016 9.3 BLN
14 FAQIH SURYANDI P.GOMBONG 8/15/2017 3/5/2016 11 BLN
15 SALWA SAMSUL P.GOMBONG 8/15/2017 11/22/2013 15 BLN
16 VANESSA AHMAD P.GOMBONG 8/15/2017 7/11/2014 17 BLN
17 PADILAH EDI P.GOMBONG 8/15/2017 5/6/2012 14.5 BLN
18 ALVINO ASMONO P.GOMBONG 8/15/2017 5/24/2016 9 BLN
19 AL MAIR EKO ARISTAN P.GOMBONG 8/15/2017 5/3/2016 13.2 BLN
20 FAWAZ RAHMAT P.GOMBONG 8/15/2017 6/18/2015 15 BLN
21 AL HAFIZ MUNAN P.GOMBONG 8/15/2017 4/25/2016 8.7 BLN
22 KESYA RIKI P.GOMBONG 8/15/2017 11/19/2016 7.9 BLN
23 AL KAHFI ARI WIJAYA P.GOMBONG 8/15/2017 7/17/2016 11 BLN
24 ADIBAH DAMAN P.GOMBONG 8/15/2017 2/14/2016 9.2 BLN
25 SAKIN USMAN P.GOMBONG 8/15/2017 6/8/2016 10 BLN
26 SAHEL YANTO P.GOMBONG 8/15/2017 6/8/2012 20 BLN
27 HASBY KASIM P.GOMBONG 8/15/2017 4/20/2016 11.2 BLN
28 AZRIL IQBAL P.GOMBONG 8/15/2017 3/31/2016 9.2 BLN
29 RAISA ASEP P.GOMBONG 8/15/2017 9/14/2013 20 BLN
30 KHANZA WAWAN P.GOMBONG 8/15/2017 5/7/2013 13 BLN
31 LATIF SURYANDI P.GOMBONG 8/15/2017 1/16/2015 10 BLN
32 INDAH DULHAIR P.GOMBONG 8/15/2017 4/22/2014 13.5 BLN
33 FEBI RUSTAM P.GOMBONG 8/15/2017 8/8/2014 13 BLN
34 GINA DEDE P.GOMBONG 8/15/2017 4/3/2016 2.4 BLN
PETUGAS
(...................................)
FORMULIR PENCATATAN
PUSKESMAS :

1 2 3 4 5 6 7 8 9 10 11 12
35 TASYA AKO P.GOMBONG 8/15/2017 7/17/2016 8.2 BLN
36 NOPALIN ZAENAL P.GOMBONG 8/15/2017 2/22/2016 8 BLN
37 BIBAH AJUM P.GOMBONG 8/15/2017 9/13/2014 12 BLN
38 ADELIA MIRTO P.GOMBONG 8/15/2017 11/12/2014 14 BLN
39 HABIBI SAEPUDIN P.GOMBONG 8/15/2017 11/19/2015 11 BLN
40 PUTRI RIKI P.GOMBONG 8/15/2017 10/23/2016 14 BLN
41 NAILA SAEPUDIN P.GOMBONG 8/15/2017 1/19/2012 18.5 BLN
42 QUEENA IMAN P.GOMBONG 8/15/2017 7/4/2014 13 BLN
43 GLADIS IWAN P.GOMBONG 8/15/2017 1/17/2013 12 BLN
44 WILDAN DIAN SOPANGI P.GOMBONG 8/15/2017 12/7/2014 12 BLN
45 FAUZIAH HASTONO P.GOMBONG 8/15/2017 12/8/2012 16 BLN
46 FADIL MAMAN P.GOMBONG 8/15/2017 12/20/2015 9.4 BLN
47 SERLI JAJAT P.GOMBONG 8/15/2017 4/29/2015 16 BLN
48 SERLA DEDE P.GOMBONG 8/15/2017 4/16/2013 16 BLN
49 ATIKAH ADI P.GOMBONG 8/15/2017 9/25/2014 12 BLN
50 INES DARMAN P.GOMBONG 8/15/2017 10/6/2012 13.5 BLN
51 SITI UMAYAH RUSTAM P.GOMBONG 8/15/2017 1/31/2015 10 BLN
52 GILANG ARKA / SAFEI P.GOMBONG 8/15/2017 2/16/2016 9.5 BLN
53 MAULANA SUWARSO P.GOMBONG 8/15/2017 12/13/2015 11 BLN
54 RAFA MAIL P.GOMBONG 8/15/2017 11/20/2012 15.4 BLN
55 ALIFAH SIDIK P.GOMBONG 8/15/2017 12/26/2012 17.2 BLN
56 KARIN WONGKI P.GOMBONG 8/15/2017 7/12/2016 9.5 BLN
57 SAKILAH ACEP P.GOMBONG 8/15/2017 8/13/2015 10 BLN
58 TALITA DONA P.GOMBONG 8/15/2017 4 TAHUN 15 BLN
59 AKILAH PIRJAN P.GOMBONG 8/15/2017 7/13/2014 13.5 BLN
60 ARFA IMAN P.GOMBONG 8/15/2017 10/5/2014 10.5 BLN
61 MESYA NURAINI DADE P.GOMBONG 8/15/2017 5/17/2016 9.4 BLN
62 ALICIA MULYADI P.GOMBONG 8/15/2017 8/18/2015 10.5 BLN
63 PALEN MUHIDIN P.GOMBONG 8/15/2017 6/3/2014 14 BLN
64 KESHA MULYADI P.GOMBONG 8/15/2017 1/12/2013 16 BLN
65 ZIO MADIN P.GOMBONG 8/15/2017 1/15/2013 25 BLN
66 ALKALIFI CECEP P.GOMBONG 8/15/2017 12/23/2015 11 BLN
67 AZKA DODO P.GOMBONG 8/15/2017 1/15/2017 8.2 BLN
68 AIDAN SUPRIYADI P.GOMBONG 8/15/2017 12/22/2016 8.4 BLN
PETUGAS
(...................................)
FORMULIR PENCATATAN
PUSKESMAS :

1 2 3 4 5 6 7 8 9 10 11 12
69 ATAYA AKLI P.GOMBONG 8/15/2017 2/23/2015 10 BLN
70 NADILA ANDRIAN P.GOMBONG 8/15/2017 5/8/2016 8.5 BLN
71 NAILA DEDI / PUJI P.GOMBONG 8/15/2017 1/31/2017 8 BLN
72 ALKAHFI ARI P.GOMBONG 8/15/2017 7/17/2016 13 BLN
73 UZMATUL ILHUM P.GOMBONG 8/15/2017 5/2/2014 14 BLN
74 M. FARHAN RAHMAT HIDAYAT P.GOMBONG 8/15/2017 8/3/2016 10 BLN
75 SERGIO SUHADA P.GOMBONG 8/15/2017 7/14/2015 10.4 BLN
76 DANES ZAENAL P.GOMBONG 8/15/2017 4/20/2014 10.2 BLN
77 ABIYAN HENDAR P.GOMBONG 8/15/2017 14 BLN
78 ANISAH SUBUR P.GOMBONG 8/15/2017 1/28/2013 18 BLN
79 NAZLA AYUB P.GOMBONG 8/15/2017 7/7/2016 8.5 BLN
80 FAUZAN RIDWAN P.GOMBONG 8/15/2017 6/4/2012 14.2 BLN
81 M. RAKA SUPRI P.GOMBONG 8/15/2017 5/18/2017 7 BLN
82 KURNIA HABIBI BOBBY P.GOMBONG 8/15/2017 4/19/2017 7.1 BLN
83 SYAKIR USMAN P.GOMBONG 8/15/2017 6/8/2016 10.2 BLN
84 DAPA YUSUF P.GOMBONG 8/15/2017 9/15/2013 19 BLN
85 M. ALI SURYA P.GOMBONG 8/15/2017 5/20/2015 10.2 BLN
86 AZHARUL NURDIN P.GOMBONG 8/15/2017 5/9/2017 6.7 BLN
87 KASIAR SOPIAN P.GOMBONG 8/15/2017 10/18/2012 14.5 BLN
88 DITA YANI P.GOMBONG 8/15/2017 7/11/2013 11.1 BLN
89 SYIFA SUKRON P.GOMBONG 8/15/2017 11/12/2012 15.2 BLN
90 SATRIA TIAS P.GOMBONG 8/15/2017 3/24/2016 10 BLN
91 MISYA ALWI P.GOMBONG 8/15/2017 8/12/2016 9 BLN
92 SELIYANA SLAMET P.GOMBONG 8/15/2017 4/15/2014 15 BLN
93 VINA IYAN P.GOMBONG 8/15/2017 10/4/2014 11 BLN
94 NABILAH MULYADI P.GOMBONG 8/15/2017 12/17/2016 8 BLN
95 SITA SUHERDI P.GOMBONG 8/15/2017 1/2/2014 15.2 BLN
96 PUTRI ADRIYANTO P.GOMBONG 8/15/2017 5/2/2016 7 BLN
97 NADIA RUNDI P.GOMBONG 8/15/2017 5/14/2014 11 BLN
98 AMIRA RAMBAT P.GOMBONG 8/15/2017 2/27/2017 6.8 BLN
99 ABIYAN RAMLI P.GOMBONG 8/15/2017 8/14/2014 16.5 BLN
100 M. HUNZA HENDRA P.GOMBONG 8/15/2017 7/2/2017 3 BLN
101 AMIRA SAEFUL P.GOMBONG 8/15/2017 6/14/2013 13.5 BLN
102 AINA AGIL P.GOMBONG 8/15/2017 2/3/2014 15 BLN
PETUGAS
(...................................)
FORMULIR PENCATATAN
PUSKESMAS :

1 2 3 4 5 6 7 8 9 10 11 12
103 DANI SUDI P.GOMBONG 8/15/2017 7/29/2017 2.9 BLN
104 ARUMI ARIFIN P.GOMBONG 8/15/2017 10/19/2015 8.9 BLN
105 AQILA AGUNG P.GOMBONG 8/15/2017 1/1/2017 6.2 BLN
106 SUCI A. ALIF WIDODO P.GOMBONG 8/15/2017 8/13/2016 7.2 BLN
107 AFIS ACEP P.GOMBONG 8/15/2017 8/14/2016 8.3 BLN
108 RIZKY WADI P.GOMBONG 8/15/2017 5/22/2013 13.5 BLN
109 SALSA ABDULLAH P.GOMBONG 8/15/2017 1/26/2014 17 BLN
110 MIKO SAEFUL P.GOMBONG 8/15/2017 5 TAHUN 17 BLN
111 APA USIN P.GOMBONG 8/15/2017 4 TAHUN 17 BLN
112 RIZKY ADI P.GOMBONG 8/15/2017 6/17/2013 11 BLN
113 M. ILHAM USIN P.GOMBONG 8/15/2017 8/12/2013 13.5 BLN
114 SALSABILA SAHRUL P.GOMBONG 8/15/2017 2/14/2013 16 BLN
115 GUSTI AGUS P.GOMBONG 8/15/2017 /08/2013 20 BLN
116 NAILA DANI P.GOMBONG 8/15/2017 8/16/2013 14 BLN
117 KEVIN NASUM P.GOMBONG 8/15/2017 10/31/2013 15 BLN
118 ALDAN TONI P.GOMBONG 8/15/2017 4 TAHUN 16 BLN
119 NAYSILA NANANG P.GOMBONG 8/15/2017 1/2/1900 14.3 BLN
120 GEA IAN P.GOMBONG 8/15/2017 2 TAHUN 16 BLN
121 HENDRI SOLEH P.GOMBONG 8/15/2017 9/7/2014 12 BLN
122 YASMIN MULYADI P.GOMBONG 8/15/2017 8/23/2014 23 BLN
123 TEJA SABAN P.GOMBONG 8/15/2017 9/9/2015 9.8 BLN
124 A. HAMID DELA P.GOMBONG 8/15/2017 8/8/2014 11 BLN
125 M. ROHIM AJAT P.GOMBONG 8/15/2017 12/1/2013 13 BLN
126 M. ILHAM AJAT P.GOMBONG 8/15/2017 11/22/2014 23 BLN
127 M. IHSAN NERMAN P.GOMBONG 8/15/2017 10/14/2014 12 BLN
128 M. IBRAHIM UMAR P.GOMBONG 8/15/2017 10/25/2013 12.5 BLN
129 HAMDALAH DEDI P.GOMBONG 8/15/2017 6/8/2014 18.4 BLN
130 BILQIS DON P.GOMBONG 8/15/2017 3/22/2013 6.7 BLN
131 KHOFIPAH JAKA P.GOMBONG 8/15/2017 5/9/2017 12 BLN
132 M. HASBY ABDUL P.GOMBONG 8/15/2017 4/1/2013 5.5 BLN
133 GILANG SURYA P.GOMBONG 8/15/2017 4/18/2013 16.4 BLN
134 MAHDI ASEP P.GOMBONG 8/15/2017 12/19/2017 6.8 BLN
135 ARSILA AGUS P.GOMBONG 8/15/2017 16 BULAN 12 BLN
136 RIZKY HERI P.GOMBONG 8/15/2017 10/9/2013 14 BLN
PETUGAS
(...................................)
FORMULIR PENCATATAN
PUSKESMAS :

1 2 3 4 5 6 7 8 9 10 11 12
137 HAFIZ SAMSURI P.GOMBONG 8/15/2017 10/7/2015 8 BLN
138 BUNGA SUCI ASMAWI P.GOMBONG 8/15/2017 5/12/2012 15 BLN
139 M. IHFA WAWAN P.GOMBONG 8/15/2017 5 TAHUN 13.4 BLN
140 AZRIL MAMAN P.GOMBONG 8/15/2017 6/18/2012 28 BLN
141 SAHILA SALEH P.GOMBONG 8/15/2017 8/17/2012 12.5 BLN
142 NIKI ADE P.GOMBONG 8/15/2017 2/3/2014 15 BLN
143 HALIM MUHAGAR P.GOMBONG 8/15/2017 4 TAHUN 13 BLN
144 BLN
145 BLN
146 BLN
147 BLN
148 BLN
149 BLN
150 BLN
151 BLN
152 BLN
153 BLN
154 BLN
155 BLN
156 BLN
157 BLN
158 BLN
159 BLN
160 BLN
161 BLN
162 BLN
163 BLN
164 BLN
165 BLN
166 BLN
167 BLN
168 BLN
169 BLN
170 BLN
PETUGAS
(...................................)
FORMULIR PENCATATAN
PUSKESMAS :
POSYANDU/DESA : MAWAR 1 / PASIR GOMBONG (KP. SEMPU)

1 2 3 4 5 6 7 8 9 10 11 12
1 LINA WARIN RT. 005/004 8/14/2017 9/15/2015 10 97 BLN
2 MARCHELL NIIN RT. 005/004 8/14/2017 10/27/2014 11 107 BLN
3 SHAQILA TOHA RT. 005/004 8/14/2017 10/26/2014 15 106 BLN
4 ZAHIRA UMAR RT. 005/004 8/14/2017 6/8/2014 12 9.7 BLN
5 ARI NURI RIONO RT. 005/004 8/14/2017 5/19/2014 10 96 BLN
6 AYAS BONAN RT. 005/004 8/14/2017 3/2/2014 13 101 BLN
7 AISYAH SALAMM RT. 005/004 8/14/2017 5/31/2014 12 98 BLN
8 FIRA BONAN RT. 005/004 8/14/2017 11/23/2016 6 62 BLN
9 SHELVIA KARWAN RT. 005/004 8/14/2017 12/8/2014 14 102 BLN
10 NAGIA SYARIFAH RT. 005/004 8/14/2017 11/11/2015 9.3 97 BLN
11 AIDA DALIH RT. 005/004 8/14/2017 6/26/2013 14 103 BLN
12 PIPIT DODI RT. 005/004 8/14/2017 6/26/2015 14 102 BLN
13 FAJAR DADANG RT. 005/004 8/14/2017 1/14/2016 10 96 BLN
14 MELISSA JO RT. 005/004 8/14/2017 5/12/2013 11 100 BLN
15 NANDITA MARWATI RT. 005/004 8/14/2017 11/30/2013 14 103 BLN
16 HILAL TRIO RT. 005/004 8/14/2017 5/29/2014 14 99 BLN
17 AZKA ENDING RT. 005/004 8/14/2017 5/21/2016 11 73 BLN
18 FAJAR SAMAT RT. 005/004 8/14/2017 1/14/2014 12 98 BLN
19 GISEL JOKO RT. 005/004 8/14/2017 9/15/2016 10 81 BLN
20 NATHAN MUID RT. 005/004 8/14/2017 1/30/2017 9 98 BLN
21 WILDAN M. KHOIRUDIN RT. 005/004 8/14/2017 3/16/2017 7 60 BLN
22 ASYIFA DANI RT. 005/004 8/14/2017 3/18/2017 6 61 BLN
23 RAFKA DANI RT. 005/004 8/14/2017 2/12/2016 11 79 BLN
24 FALAH MARTIN RT. 005/004 8/14/2017 13 99 BLN
25 ALIYA EMAN RT. 005/004 8/14/2017 15 101 BLN
26 BAMBANG ADIT RT. 005/004 8/14/2017 16 102 BLN
27 RASYA DEDI RT. 005/004 8/14/2017 3/19/2016 9 77 BLN
28 SALSABILA JONI RT. 005/004 8/14/2017 2/9/2015 12 83 BLN
29 SHAHILA PIPIN RT. 005/004 8/14/2017 5/15/2013 14 102 BLN
30 YASHA RIKI RT. 005/004 8/14/2017 11/16/2015 15 110 BLN
31 ALISHA ANDI RT. 005/004 8/14/2017 4/29/2015 15 109 BLN
32 ZAM-ZAM DAMAN RT. 005/004 8/14/2017 11/13/2015 10 78 BLN
33 PUTRI AJI RT. 005/004 8/14/2017 7/27/2014 10 84 BLN
34 NURAINI FERDIANSYAH RT. 005/004 8/15/2017 16 114 BLN
PETUGAS
(...................................)
FORMULIR PENCATATAN
PUSKESMAS :
POSYANDU/DESA : MAWAR 1 / PASIR GOMBONG (KP. SEMPU)

1 2 3 4 5 6 7 8 9 10 11 12
35 NURJANAH NAJA RT. 005/004 8/14/2017 14 110 BLN
36 ARSIL TATANG RT. 005/004 8/14/2017 4/16/2016 10.6 97 BLN
37 DESKA DANI RT. 005/004 8/14/2017 10/7/2016 7.7 88 BLN
38 ADRIL MISLIM RT. 005/004 8/14/2017 11/18/2014 16 99 BLN
39 IRHAM SANUDIN RT. 005/004 8/14/2017 4/12/2016 9.7 87 BLN
40 RIFDA SIRBINI RT. 005/004 8/14/2017 4/9/2017 12 93 BLN
41 APRIL SLAMET RT. 005/004 8/14/2017 4/19/2017 6 65 BLN
42 DESWITA YADI RT. 005/004 8/14/2017 12/21/2012 14 100 BLN
43 RAFADHAN ARIF RT. 005/004 8/14/2017 10/7/2016 13 97 BLN
44 FEOZ ALI RT. 005/004 8/14/2017 4/6/2013 17 117 BLN
45 DAFA JOKO RT. 005/004 8/14/2017 5/29/2014 15 112 BLN
46 WISNU ARIF RT. 005/004 8/14/2017 9/14/2015 14 93 BLN
47 HUSNA SANUDIN RT. 005/004 8/14/2017 9/11/2014 12 71 BLN
48 FADLI ANDRI RT. 005/004 8/14/2017 15 111 BLN
49 DESMIAN SUHENDAR RT. 005/004 8/14/2017 12/27/2015 11 83 BLN
50 NAZMA SUHERMAN RT. 005/004 8/14/2017 9/1/2016 7.5 69 BLN
51 ALI A. JOMAR RT. 005/004 8/14/2017 11/13/2005 12 88 BLN
52 BLN
53 BLN
54 BLN
55 BLN
56 BLN
57 BLN
58 BLN
59 BLN
60 BLN
61 BLN
62 BLN
63 BLN
64 BLN
65 BLN
66 BLN
67 BLN
68 BLN
PETUGAS
(...................................)
FORMULIR PENCATATAN
PUSKESMAS :
POSYANDU/DESA : ASTER 1 / PASIRGOMBONG

1 2 3 4 5 6 7 8 9 10 11 12
1 ANINDITA SADELI P.GOMBONG 8/3/2017 9/5/2016 8.7 72
2 PUTRI MARYADI P.GOMBONG 8/3/2017 12/15/2014 17 110
3 DEVIKA DARWANTO P.GOMBONG 8/3/2017 5/27/2016 9 72
4 RIZKY JAJANG P.GOMBONG 8/3/2017 10/2/2011 19 109
5 AZRIYA ROHIM P.GOMBONG 8/3/2017 8/10/2016 8.7 72
6 ANGGUN WINDA P.GOMBONG 8/3/2017 1/19/2012 14 99
7 RAFFI ANYIM P.GOMBONG 8/3/2017 1/8/2013 15 99
8 AVIKA PRIO P.GOMBONG 8/3/2017 8/24/2015 11 85
9 KENZHA TRISNA P.GOMBONG 8/3/2017 12/31/2012 13 102
10 INTAN IWAN P.GOMBONG 8/3/2017 6/19/2014 17 110
11 SYAHRIL SUKMADANI P.GOMBONG 8/3/2017 8/31/2014 12 87
12 GIO FAJAR EFRADO JON P.GOMBONG 8/3/2017 10/14/2014 16 96
13 KANAYA NANANG P.GOMBONG 8/3/2017 9/11/2016 6 66
14 KINARA A.R YADI P.GOMBONG 8/3/2017 2/23/2017 6.2 60
15 RANIA DEDI P.GOMBONG 8/3/2017 8/22/2015 10 83
16 EVAN MASIN P.GOMBONG 8/3/2017 2/18/2014 16 97
17 AZKIA ENCEP P.GOMBONG 8/3/2017 5/23/2013 12
18 KENZIE AGUS P.GOMBONG 8/3/2017 5/21/2014 20 99
19 RAISYA BOBBY P.GOMBONG 8/3/2017 1/9/2013 17 104
20 KAIRA ANGGA P.GOMBONG 8/3/2017 10/15/2012 13 101
21 SYAKILA ANTON P.GOMBONG 8/3/2017 1/24/2016 11 75
22 ONANDO HENDRIK P.GOMBONG 8/3/2017 7/25/2014 13 89
23 AQILA AGUS YULIANTO P.GOMBONG 8/3/2017 5/21/2014 14 42
24 AZALEA AMIN P.GOMBONG 8/3/2017 7/31/2014 12 89
25 AZALIA AMIN P.GOMBONG 8/3/2017 7/31/2014 12 90
26 ZAFIRA SUBHAN P.GOMBONG 8/3/2017 8/26/2014 15 98
27 AZKA SUJANA P.GOMBONG 8/3/2017 6/22/2015 14 84
28 ABUJU SOPYAN P.GOMBONG 8/3/2017 5/2/2015 12 80
29 ARIAS OGI P.GOMBONG 8/3/2017 5/8/2015 9 83
30 ALBY RAHMAT P.GOMBONG 8/3/2017 12/28/2015 11
31 M. ARSYA PUTRA ANDI P.GOMBONG 8/3/2017 3/22/2017 6.4 65
32 RAFHA ADITIYA EMAN S. P.GOMBONG 8/3/2017 9/18/2016 10 77
33 GENZI DENIH P.GOMBONG 8/3/2017 5/7/2015 10 84
34 ARCHELL DEDE R. P.GOMBONG 8/3/2017 6/30/2016 8.3 69
PETUGAS
(...................................)
FORMULIR PENCATATAN
PUSKESMAS :

1 2 3 4 5 6 7 8 9 10 11 12
35 SYAKILA IRWANSYAH P.GOMBONG 8/3/2017 2/26/2013 13 99
36 ARSYA ENDA P.GOMBONG 8/3/2017 6/27/2017 4.9
37 AZHAR ADEN P.GOMBONG 8/3/2017 2/9/2014 10 88
38 NAYLA JUMANTA P.GOMBONG 8/3/2017 10/12/2013 21 100
39 NAURA DIMAS P.GOMBONG 8/3/2017 5/8/2014 13 93
40 AIMARA HERLAMBANG P.GOMBONG 8/3/2017 10/16/2016 6.8 67
41 ADEFA RAMLI P.GOMBONG 8/3/2017 7/13/2016 8.3 73
42 AUREN NOVIANDRI P.GOMBONG 8/3/2017 5/15/2015 11
43 KHUSNUL JOJON P.GOMBONG 8/3/2017 1/30/2014 10 87
44 AHZA ANDI P.GOMBONG 8/3/2017 4/10/2014 10 30
45 ADHNIA A. YANTO P.GOMBONG 8/3/2017 3/23/2014 13 95
46 FATTA SUNGKOMO P.GOMBONG 8/3/2017 9/20/2014 16 90
47 ADIL HANAFI P.GOMBONG 8/3/2017 8/11/2013 13 98
48 ALYA MUHAIMIN P.GOMBONG 8/3/2017 4/7/2014 12 90
49 KESYA AGUS P.GOMBONG 8/3/2017 6/9/2015 13 93
50 ANDIN MUJE P.GOMBONG 8/3/2017 11/19/2015 10 77
51 M. SYAHLAN YAYAN P.GOMBONG 8/3/2017 10/10/2016 9.5 69
52 AQILA BUNAG P.GOMBONG 8/3/2017 11/21/2013 10 89
53 AGUNG SAHUDI P.GOMBONG 8/3/2017 8/29/2015 9 79
54 RATU H. ASEP P.GOMBONG 8/3/2017 /10/2016 7 72
55 AINA AHMAD P.GOMBONG 8/3/2017 7/9/2016 7.4 76
56 NUDA BAHIRA MAMAN P.GOMBONG 8/3/2017 7/8/2015 12 78
57 MARWAH HUSNI P.GOMBONG 8/3/2017 6/13/2015 10 79
58 KHOFIFAH MANSYUR P.GOMBONG 8/3/2017 6/10/2017 4.6
59 ZALFA BAWON P.GOMBONG 8/3/2017 10/27/2012 16 100
60 UFAIRA M. MUIS P.GOMBONG 8/3/2017 2/23/2017 11 79
61 M. SYAMSUL HUDA ADI P.GOMBONG 8/3/2017 3/5/2017 7.2 63
62 M. RAFFI W. RONI P.GOMBONG 8/3/2017 2/14/2017 7.3 63
63 HABIBAH USMAN P.GOMBONG 8/3/2017 3/2/2017 7.6 63
64 SASKIA PUTRI B. SAMSUL P.GOMBONG 8/3/2017 5/16/2015 13
65 MEMEY FADLI P.GOMBONG 8/3/2017 5/12/2013 16 96
66 ABIYAN NORMA P.GOMBONG 8/3/2017 9/14/2015 11 79
67 BANYU NORMA P.GOMBONG 8/3/2017 4/9/2013 18 100
68 FERTY HASBY PUGUH P.GOMBONG 8/3/2017 5/12/2017 6.6
PETUGAS
(...................................)
FORMULIR PENCATATAN
PUSKESMAS :

1 2 3 4 5 6 7 8 9 10 11 12
69 ASYIFA AKBAR P.GOMBONG 8/3/2017 5/25/2011 16 109
70 AVIKA YONO P.GOMBONG 8/3/2017 6/27/2016 8 69
71 AQILA ANDRI P.GOMBONG 8/3/2017 7/20/2014 15 90
72 M. RASYID A. SAFARI P.GOMBONG 8/3/2017 10/10/2015 8.5 78
73 INGGRID BADAN P.GOMBONG 8/3/2017 11/20/2015 10 80
74 KAYLA PUTRI MIMIN P.GOMBONG 8/3/2017 9/23/2014 15 89
75 AQILA HASANUDIN P.GOMBONG 8/3/2017 12/10/2015 10 76
76 AYLA SUCI A. SAIM P.GOMBONG 8/3/2017 6/3/2017 2.5
77 M. RAFFI AGUS P.GOMBONG 8/3/2017 5/2/2016 10 75
78 FIKRI ACEP P.GOMBONG 8/3/2017 10/12/2016 8.1 75
79 YUMNA KANSAR P.GOMBONG 8/3/2017 4/10/2015 13 82
80 NAURA ANGGA S. P.GOMBONG 8/3/2017 7/26/2016 9.3 71
81 ADIBA ISMAIL P.GOMBONG 8/3/2017 9/9/2016 8.1 69
82 FAHRI FEBRIAN HALIM P.GOMBONG 8/3/2017 2/11/2016 12 77
83 M. IAN MUSTOFA IWAN P.GOMBONG 8/3/2017 2/1/2013 17 104
84 ELZA RIZKA AULIA ADE P.GOMBONG 8/3/2017 1/23/2017 6.5 58
85 AIRA MUFI P.GOMBONG 8/3/2017 9/3/2015 9 80
86 ADINDA AMIN P.GOMBONG 8/3/2017 7/13/2015 9 82
87 FAIZ YADI P.GOMBONG 8/3/2017 2 TAHUN 13 98
88 FINA YADI P.GOMBONG 8/3/2017 12 93
89 RAFA AHMAD P.GOMBONG 8/3/2017 12 99
90 SYARIF TANYA P.GOMBONG 8/3/2017 11 91
91 ZIDAN MUSLIM P.GOMBONG 8/3/2017 12/10/2014 15 91
92 ABIMANYU YADI P.GOMBONG 8/3/2017 1/28/2014 12 99
93 ABDUL MAULANA NURHOLIK P.GOMBONG 8/3/2017 3/28/2013 15 101
94 M. FAIQ ADE RAHMAT P.GOMBONG 8/3/2017 5/24/2014 13 94
95 AISYAH NASIP P.GOMBONG 8/3/2017 5/4/2016 7.8 73
96 KANAYA NANA P.GOMBONG 8/3/2017 6/10/2013 13 93
97 DEZA HERI S. P.GOMBONG 8/3/2017 7/1/2015 11 82
98 AZKIYA HERU P.GOMBONG 8/3/2017 1/27/2017 8 66
99 MUTIARA RAHMAT P.GOMBONG 8/3/2017 3/28/2015 10 80
100 NURUL INAYAH NURUL LINDA P.GOMBONG 8/3/2017 10/3/2014 14 99
101 M. RAIZ RENDI P.GOMBONG 8/3/2017 1/28/2013 12 93
102 BILQIS N. JAYAMEN P.GOMBONG 8/3/2017 11/3/2014 14 93
PETUGAS
(...................................)
FORMULIR PENCATATAN
PUSKESMAS :

1 2 3 4 5 6 7 8 9 10 11 12
103 FIRA AULIA DENIS P.GOMBONG 8/3/2017 2/24/2016 8.1
104 DINDA ERIK P.GOMBONG 8/3/2017 1/10/2013 18 102
105 DWI ALVIONA ADI P.GOMBONG 8/3/2017 8/15/2016 9.7 72
106 JANETA TOPAN P.GOMBONG 8/3/2017 3/3/2014 13 93
107 PRADITYA FUJI P.GOMBONG 8/3/2017 6/23/2016 7.6 95
108 MEGA HAMDAN P.GOMBONG 8/3/2017 8/7/2016 6.8 67
109 SHELLA SUMBER MULYO P.GOMBONG 8/3/2017 12/15/2015 9.5 79
110 APDAN DIMAN P.GOMBONG 8/3/2017
111 KESYA ANO SUNARTO P.GOMBONG 8/3/2017
112 ANDA SALI P.GOMBONG 8/3/2017
113 SYAILA SUPRI P.GOMBONG 8/3/2017 13 93
114 ABIZAR DEDEN P.GOMBONG 8/3/2017 13 88
115 FALI BAMBANG P.GOMBONG 8/3/2017 12 95
116 DELIA MULYANA P.GOMBONG 8/3/2017 10 79
117 HAIFA ANDRI P.GOMBONG 8/3/2017 10 76
118 AKIRA SUNARYO P.GOMBONG 8/3/2017 13 89
119 M. BANYU SUSANTO P.GOMBONG 8/3/2017 16 98
120 AUFA YAYAN P.GOMBONG 8/3/2017 8/12/2014 13 92
121 ANADA DWI R. OCIN P.GOMBONG 8/3/2017 5.9
122 ANGGI KASSUM P.GOMBONG 8/3/2017 14 95
123 BWUTSEP LIKA ARTHA P.GOMBONG 8/3/2017 12/5/2015 11 80
124 KAYLA ADI P.GOMBONG 8/3/2017 12/11/2014 12 88
125 GIBRAN FIKI P.GOMBONG 8/3/2017 8/10/2015 10 85
126 QOIS WAWAN P.GOMBONG 8/3/2017 8.2 70
127 FADIL CASMITA P.GOMBONG 8/3/2017 1/18/2001 15 93
128 QILA CASMITA P.GOMBONG 8/3/2017 9/3/2016 9.3 73
129
130
131
132
133
134
135
136
PETUGAS
(...................................)
FORMULIR PENCATATAN
PUSKESMAS : PUSKESMAS
POSYANDU/DESA : ASTER III / PASIR GOMBONG POSYANDU/DE

NO ALAMAT G / NG L/P NO
1 2 3 4 5 6 7 8 9 10 11 12 1
1 NOVAL NADIH P.GOMBONG 8/16/2017 10/26/2011 L 19 116 1
2 ARKAN RORO P.GOMBONG 8/16/2017 11/15/2013 L 22 97 2
3 M. AFIAN SURA P.GOMBONG 8/16/2017 L 13 3
4 MIKAILA WAWAN P.GOMBONG 8/16/2017 12/14/2013 P 12 106 4
5 SUHA NADI P.GOMBONG 8/16/2017 5/8/2014 L 22 107 5
6 ALIFAH NANANG P.GOMBONG 8/16/2017 13 99 6
7 VIRA RIADI P.GOMBONG 8/16/2017 8/13/2013 P 15 106 7
8 BRI DARTO P.GOMBONG 8/16/2017 L 11 88 8
9 YUDA NENDI P.GOMBONG 8/16/2017 6/25/2016 L 10 9
10 GALANG ENDANG P.GOMBONG 8/16/2017 8/21/2016 10
11 DONA AGUS P.GOMBONG 8/16/2017 4/19/2014 P 10 90 11
12 SURU ELI P.GOMBONG 8/16/2017 1/4/2016 L 11 77 12
13 ICAN P.GOMBONG 8/16/2017 12 96 13
14 AISYAH SATEH P.GOMBONG 8/16/2017 10 14
15 RONA INDRA P.GOMBONG 8/16/2017 10 87 15
16 RIZKI MUHAMMAD P.GOMBONG 8/16/2017 5/3/2016 L 10 16
17 KIKI MISKAN P.GOMBONG 8/16/2017 11/30/2013 P 11 101 17
18 DINA YUSUF P.GOMBONG 8/16/2017 7/6/2017 4.5 18
19 M. HIDAYAT MAMAN P.GOMBONG 8/16/2017 10/16/2015 9.5 19
20 ARKAN AMAR P.GOMBONG 8/16/2017 12/9/2016 10.3 20
21 AL RAHMAN ENAP P.GOMBONG 8/16/2017 9/10/2012 15 112 21
22 AL KANIS ASMAWI P.GOMBONG 8/16/2017 10/19/2016 L 9 22
23 RIZKI ENDIN P.GOMBONG 8/16/2017 12/13/2013 10 94 23
24 ARIYA JAKA P.GOMBONG 8/16/2017 10/19/2014 L 9 96 24
25 SAHIR ILHAM P.GOMBONG 8/16/2017 6/9/2016 L 8 73 25
26 LUTFIAH UMAR P.GOMBONG 8/16/2017 3/30/2017 7.2 26
27 ISNAWATI ISYANDI P.GOMBONG 8/16/2017 7/9/2016 L 10 75 27
28 AQILA EDI P.GOMBONG 8/16/2017 8/20/2016 P 8.1 77 28
29 JIRAN DEDI P.GOMBONG 8/16/2017 5/17/2017 L 11 85 29
30 RAIS RIKO P.GOMBONG 8/16/2017 4/30/2016 P 9 75 30
31 JIHAD YANTO P.GOMBONG 8/16/2017 14 80 31
32 NAILA UBAY P.GOMBONG 8/16/2017 3/14/2014 P 14 99 32
33 DILAH ATENG P.GOMBONG 8/16/2017 1/11/2015 P 10.5 84 33
34 RISNA AGUS P.GOMBONG 8/16/2017 12/27/2014 P 15 34
PETUGAS
(...................................)
FORMULIR PENCATATAN
POSYANDU/DESA : ASTER III / PASIR GOMBONG POSYANDU/DE

NO ALAMAT G / NG L/P NO
1 2 3 4 5 6 7 8 9 10 11 12 1
35 AULIA SALMAN P.GOMBONG 8/16/2017 12/26/2011 P 21 114 35
36 AUFAR ASEP P.GOMBONG 8/16/2017 4/8/2015 L 14 99 36
37 MAGITA HERMAN P.GOMBONG 8/16/2017 5/7/2014 P 14 91 37
38 DAMAR PARWADI P.GOMBONG 8/16/2017 3/6/2016 L 10 72 38
39 AL FATH P.GOMBONG 8/16/2017 11 39
40 ALVARO DEDEN P.GOMBONG 8/16/2017 25 40
41 RAHMA RANA P.GOMBONG 8/16/2017 13 94 41
42 SALMA RANA P.GOMBONG 8/16/2017 7 42
43 WULAN UMAR P.GOMBONG 8/16/2017 17 108 43
44 MIKAILA DANU P.GOMBONG 8/16/2017 8 44
45 DEVI MULJASIN P.GOMBONG 8/16/2017 20
46 DEWI ANJANI MINAN P.GOMBONG 8/16/2017 2/26/2017 6
47 TIARA PARTA P.GOMBONG 8/16/2017 3/17/2012 15 111
48 M. FATHIR AMIN P.GOMBONG 8/16/2017 5/14/2015 12 89
49 ASRIL HARIS P.GOMBONG 8/16/2017 3/28/2015 10 86
50 FAJRI LENA P.GOMBONG 8/16/2017 4 TAHUN 12
PETUGAS
(...................................)
FORMULIR PENCATATAN
PUSKESMAS :
POSYANDU/DESA : ASTER VI / PASIR GOMBONG

1 2 3 4 5 6 7 8 9 10 11 12
1 AINI YASIN GOMBONG 8/21/2017 3/13/2012 B P 17 105
2 ANINUNNISA IYAN GOMBONG 8/21/2017 9/8/2012 B P 14 108
3 AJENG RIFIN GOMBONG 8/21/2017 1/15/2013 B P 13.6 101
4 ANDIKA S. ADE SUGARA GOMBONG 8/21/2017 9/7/2014 B L 13 90
5 M. RIZKY AL NERIS GOMBONG 8/21/2017 6/12/2013 B L 12 99
6 SOFIA S. KRIS GOMBONG 8/21/2017 9/11/2015 B P 9 85
7 KESYA NABILA IKIM GOMBONG 8/21/2017 6/16/2014 B P 11 98
8 ANGELY DESTA NURDIN GOMBONG 8/21/2017 7/21/2014 B P 11.9 93
9 ALBI WAWAN GOMBONG 8/21/2017 10/10/2016 B L 9.1 79
10 FEBY NUR C. BENI GOMBONG 8/21/2017 2/18/2014 B P 10 96
11 AZIZAH K.S SUTARTO GOMBONG 8/21/2017 12/12/2015 B P 8.8 65
12 RAISA R. SUDIN GOMBONG 8/21/2017 8/3/2015 B P 15 108
13 ARKAN NUR S. M. NUR GOMBONG 8/21/2017 7/26/2016 B L 8 78
14 PUTRI AULIA SANDI GOMBONG 8/21/2017 3/14/2016 B P 9 86
15 GISELA SAMSURI GOMBONG 8/21/2017 1/18/2016 B P 8.5 76
16 KEYSA SAMSURI GOMBONG 8/21/2017 1/13/2014 B P 11.5 90
17 INTAN TUIN GOMBONG 8/21/2017 3/30/2013 B 13 99
18 AI SITI MARISA ITANG GOMBONG 8/21/2017 5/26/2015 B P 9 83
19 M. ARKA JAMJUDI GOMBONG 8/21/2017 9/16/2016 B L 7 69
20 KHUSNA LUKMAN GOMBONG 8/21/2017 9/21/2014 P 12.8 93
21 SYAKILLA ASEP GOMBONG 8/21/2017 2/3/2017 B P 6.4
22 NAURA NANANG GOMBONG 8/21/2017 12/22/2014 B P 13 92
23 HILAL RONI GOMBONG 8/21/2017 6/10/2014 B L 13 102
24 APRILIA DADANG GOMBONG 8/21/2017 4/18/2016 B P 10 78
25 RAFARI ERMAN GOMBONG 8/21/2017 5/9/2013 B L 18 105
26 BUNGA IRWAN GOMBONG 8/21/2017 2/17/2014 B P 12 98
27 ARGA MAULANA ASEP GOMBONG 8/21/2017 2/2/2015 B L 10 91
28 RISKA M. YANTO GOMBONG 8/21/2017 5/15/2014 B P 11 96
29 ALFIAN ANA GOMBONG 8/21/2017 7/19/2013 B L 15 99
30 M. RAFA FAUZI GOMBONG 8/21/2017 10/21/2015 L 9.5
31 REZA JIMAN GOMBONG 8/21/2017 4/18/2014 B L 13 97
32 AKILA PUTRI A. ASEP GOMBONG 8/21/2017 4/15/2015 B P 10 88
33 DAKA S. YANTO GOMBONG 8/21/2017 4/21/2015 B L 10.5 95
34 AZKA A. YAN HARYONO GOMBONG 8/21/2017 6/16/2013 B L 18 111
PETUGAS
(...................................)
FORMULIR PENCATATAN
PUSKESMAS :

1 2 3 4 5 6 7 8 9 10 11 12
35 BILQIS A.H DODI GOMBONG 8/21/2017 8/16/2014 B P 10 90
36 PUTRI RIKI GOMBONG 8/21/2017 10/19/2015 B P 9.1 76
37 PANCA A. SENO GOMBONG 8/21/2017 5/15/2011 B L 20 115
38 SALMAH PEPEN GOMBONG 8/21/2017 6/6/2014 B P 10 89
39 NAURA NANANG GOMBONG 8/21/2017 12/22/2014 B P 12 81
40 RIZKI A. NONO GOMBONG 8/21/2017 6/8/2015 B L 10 76
41 AKMAL CICIH GOMBONG 8/21/2017 4 TAHUN B L 16 118
PETUGAS
(...................................)
FORMULIR PENCATATAN
POSYANDU/DESA : ASTER VII / PASIR GOMBONG POSYANDU/DESA

ALAMAT G / NG L/P NO
2 3 4 5 6 7 8 9 10 11 12 1
NUROHMAN SURYANIALDI P.GOMBONG 8/22/2017 11/3/2015 10 85 1
FITRAL ANI P.GOMBONG 8/22/2017 7/7/2016 7.4 73 2
FIAN PAKMIN P.GOMBONG 8/22/2017 8/9/2015 8.6 76 3
REFIANTO DODI P.GOMBONG 8/22/2017 2/14/2013 13 93 4
ZAHIRA DODI P.GOMBONG 8/22/2017 11/24/2014 10 87 5
IIS ZULFA MAHRUZ P.GOMBONG 8/22/2017 4/30/2017 5.5 6
AHMAD M. M. SETIAWAN P.GOMBONG 8/22/2017 11/7/2012 21 708 7
NASYLA ROSHID P.GOMBONG 8/22/2017 10/24/2014 12 98 8
ALICIA EKO P.GOMBONG 8/22/2017 6/5/2015 10 88 9
FAHRI RENGKE P.GOMBONG 8/22/2017 7/29/2015 13 92 10
SANSAN YANTO P.GOMBONG 8/22/2017 6/20/2016 9.8 73 11
RIAN YANTO P.GOMBONG 8/22/2017 10/22/2015 10 85 12
TIANA AGUS P.GOMBONG 8/22/2017 3/26/2014 15 103 13
NADIN DANI P.GOMBONG 8/22/2017 8/26/2016 9.4 76 14
INAYAH ALI P.GOMBONG 8/22/2017 5/12/2015 11.6 86 15
NADIE ROSIDIN P.GOMBONG 8/22/2017 11/3/2012 15 10 16
GALIH ROSIDIN P.GOMBONG 8/22/2017 10/19/2015 9 82 17
ROSIDAH WATI WAGINO P.GOMBONG 8/22/2017 8/13/2013 15 96 18
HANA WAGINO P.GOMBONG 8/22/2017 3/19/2013 5 102 19
HANI EKO P.GOMBONG 8/22/2017 3/19/2012 18 101 20
DIKA JOSE P.GOMBONG 8/22/2017 2/17/2014 12 94 21
HUMAIRAH NUNU P.GOMBONG 8/22/2017 12/5/2013 10 76 22
IBRA AGUS P.GOMBONG 8/22/2017 11/11/2012 15 105 23
M. HAIRI MAY P.GOMBONG 8/22/2017 9/18/2013 14 99 24
ALISA AGUS P.GOMBONG 8/22/2017 9/28/2013 13 100 25
SATRIA PUHARI P.GOMBONG 8/22/2017 12/11/2015 13 97 26
RAISA TUMAN P.GOMBONG 8/22/2017 4/5/2015 27
MAHESA ENJANG P.GOMBONG 8/22/2017 28
DAFA ENJANG P.GOMBONG 8/22/2017 4/12/2014 11 79 29
ZURIYAH FIAN P.GOMBONG 8/22/2017 2/18/2016 15 112 30
M. AKUL AHMAD P.GOMBONG 8/22/2017 4/12/2012 31
KAMAL FURQON P.GOMBONG 8/22/2017 5/17/2015 32
ALWI YANTO P.GOMBONG 8/22/2017 12/30/2011 19 113 33
FADIL ANDA P.GOMBONG 8/22/2017 5/8/2013 16 107 34
PETUGAS
(...................................)
FORMULIR PENCATATAN
POSYANDU/DESA : ASTER VII / PASIR GOMBONG POSYANDU/DESA

2 3 4 5 6 7 8 9 10 11 12 1
FADIL YANTO P.GOMBONG 8/22/2017 6/19/2012 18 113 35
SAEPUDIN ANDA P.GOMBONG 8/22/2017 10/20/2012 14 102 36
ARSA OZI P.GOMBONG 8/22/2017 3/28/2017 37
SAFINA PURWANTO P.GOMBONG 8/22/2017 12/25/2013 13 97 38
SALSABILA AGUS P.GOMBONG 8/22/2017 6/15/2016 8.7 71 39
SARAH NURAMANSYAH P.GOMBONG 8/22/2017 5/28/2011 16 109 40
HUMAIRA ZAHRA DEDE P.GOMBONG 8/22/2017 8/16/2015 10.6 86 41
RANEGI BANDA P.GOMBONG 8/22/2017 8/8/2011 17 115 42
AMAR ADAM P.GOMBONG 8/22/2017 1/2/2016 10 81 43
FAIRUZ SARIJAM P.GOMBONG 8/22/2017 8/17/2012 18 109 44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
PETUGAS
(...................................)
PUSKESMAS
POSYANDU/DESA
NO
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
FORMULIR PENCATATAN
POSYANDU/DESA : MAWAR 2 / PASIR GOMBONG POSYANDU/DESA

2 3 4 5 6 7 8 9 10 11 12 1
NURAINI NAWIN KP.SEMPU 8/14/2017 6/4/2015 P 11 78 1
AULIA SOLIHIN KP.SEMPU 8/14/2017 5/26/2017 P 5.2 60 2
DEA ASEP KP.SEMPU 8/14/2017 10/8/2015 P 10 82 3
KHALISA ARIF KP.SEMPU 8/14/2017 2/10/2016 P 10 74 4
AYLA SALAM KP.SEMPU 8/14/2017 5/15/2017 P 5.7 61 5
INDRA DARTAM KP.SEMPU 8/14/2017 6/29/2013 L 17 103 6
ZALFA LILI KP.SEMPU 8/14/2017 1/19/2016 P 6.5 63 7
DANI JANIN KP.SEMPU 8/14/2017 3/15/2015 L 15 102 8
ADINDA JUNANI KP.SEMPU 8/14/2017 5/12/2017 P 7.5 68 9
SHAKIRA IDANG KP.SEMPU 8/14/2017 3/10/2014 P 12 82 10
AZKA N. TOMI KP.SEMPU 8/14/2017 10/2/2014 L 15 100 11
LULU M. NASRUDIN KP.SEMPU 8/14/2017 2/14/2015 P 12 91 12
DANIS TRIYANTO KP.SEMPU 8/14/2017 2/7/2015 L 14 96 13
GENDIS ADE KP.SEMPU 8/14/2017 7/8/2015 P 15 82 14
M. RUSLI UCUP KP.SEMPU 8/14/2017 3/18/2014 L 11 78 15
CINTA ENJUM KP.SEMPU 8/14/2017 6/20/2013 P 15 104 16
AMAN SABAR KP.SEMPU 8/14/2017 3/29/2013 L 16 104 17
KHANZA DODI KP.SEMPU 8/14/2017 1/3/2013 P 20 120 18
AISYAH A. HERI KP.SEMPU 8/14/2017 10/3/2015 P 12 87 19
ARSILA MULYADI KP.SEMPU 8/14/2017 1/15/2017 P 8 74 20
ALBI AGUNG KP.SEMPU 8/14/2017 6/10/2016 L 10 78 21
ROBI JUMINO KP.SEMPU 8/14/2017 4/11/2014 L 14 92 22
HANA NANDAR KP.SEMPU 8/14/2017 2/4/2017 P 8.5 71 23
ARSILA RUBIYANTO KP.SEMPU 8/14/2017 2/3/2017 P 7.5 67 24
AULIA ANGGA KP.SEMPU 8/14/2017 4/1/2013 P 13 95 25
FAJRI FIRMAN KP.SEMPU 8/14/2017 5/20/2013 L 16 102 26
BILQIS SAKIRUDIN KP.SEMPU 8/14/2017 7/17/2014 P 15 99 27
ALBI AYAT KP.SEMPU 8/14/2017 4/11/2014 L 20 107 28
AINI AHMAD KP.SEMPU 8/14/2017 1/5/2017 P 9 77 29
ARDAN M. NASRUNI KP.SEMPU 8/14/2017 4/1/2014 L 14 96 30
JASMIN ASEP KP.SEMPU 8/14/2017 6/20/2017 P 6.9 70 31
HUSNA KARIM KP.SEMPU 8/14/2017 8/7/2014 P 22 96 32
ANSYA ANDI KP.SEMPU 8/14/2017 5/28/2017 P 8 70 33
YASMIN KARTA KP.SEMPU 8/14/2017 2/10/2017 P 10 78 34
PETUGAS
(...................................)
FORMULIR PENCATATAN

2 3 4 5 6 7 8 9 10 11 12 1
ABRISAM GUGUN KP.SEMPU 8/14/2017 5/12/2013 L 16 101 35
DEANDRA ROSADI KP.SEMPU 8/14/2017 5/1/2016 L 9.1 74 36
ADLI ALI KP.SEMPU 8/14/2017 2/3/2015 L 11 79 37
RANIA MADI KP.SEMPU 8/14/2017 6/14/2015 P 13 90 38
ZIDAN BAYU KP.SEMPU 8/14/2017 5/9/2017 L 8.5 65 39
NABILA KABAR KP.SEMPU 8/14/2017 4/24/2016 P 8 79 40
ABAY SAMAD KP.SEMPU 8/14/2017 10/24/2014 L 14 96 41
IKBAR TOP KP.SEMPU 8/14/2017 8/21/2015 L 10 86 42
AULIA DASIN KP.SEMPU 8/14/2017 2/6/2013 P 14 110 43
AKSYA PENDI KP.SEMPU 8/14/2017 4/23/2017 L 9 80 44
NAYLA WARYONO KP.SEMPU 8/14/2017 3/9/2014 P 16 100 45
ADINDA AGUS KP.SEMPU 8/14/2017 1/26/2014 P 10 81 46
ASKA YANTO KP.SEMPU 8/14/2017 6/3/2014 L 12 79 47
REYHAN KARMAN KP.SEMPU 8/14/2017 12/8/2013 L 17 110 48
M. ADAM HAIDIR KP.SEMPU 8/14/2017 12/7/2016 L 14 98 49
KIAN ADUL KP.SEMPU 8/14/2017 3/30/2014 L 16 105 50
FAJAR KASAM KP.SEMPU 8/14/2017 2/22/2014 L 15 104 51
ABIDAH JANI KP.SEMPU 8/14/2017 9/26/2013 P 14 106 52
AULIA HANIF KP.SEMPU 8/14/2017 5/1/2014 P 15 110 53
YANI YASIN KP.SEMPU 8/14/2017 2/3/2013 P 20 112 54
NAYLA GUNAWAN KP.SEMPU 8/14/2017 6/26/2015 P 10 85 55
ANGGITA GITO KP.SEMPU 8/14/2017 4/3/2014 P 12 94 56
NISA OJI KP.SEMPU 8/14/2017 12/3/2013 15 107 57
DIRGA LAJU KP.SEMPU 8/14/2017 10 93 58
SALMA AAN KP.SEMPU 8/14/2017 15 59
LULU NASRUDIN KP.SEMPU 8/14/2017 60
KHANZA DODI KP.SEMPU 8/14/2017 61
FAJRI FIRMAN KP.SEMPU 8/14/2017 62
M. SAEFUDIN BANDI KP.SEMPU 8/14/2017 8.3 73 63
NAYAH ANTO KP.SEMPU 8/14/2017 64
AINUN ASEP KP.SEMPU 8/14/2017 7.1 65 65
SELLA DAMIN KP.SEMPU 8/14/2017 66
NOVA AHMAD KP.SEMPU 8/14/2017 20 100 67
AZKA KP.SEMPU 8/14/2017 68
PETUGAS
(...................................)
FORMULIR PENCATATAN

2 3 4 5 6 7 8 9 10 11 12 1
AQNA KP.SEMPU 8/14/2017 4/23/2015 10 79 69
ZULFA KP.SEMPU 8/14/2017 15 100 70
NAJMI KP.SEMPU 8/14/2017 9.6 115 71
ADAM KP.SEMPU 8/14/2017 15 100 72
ABIYAN KP.SEMPU 8/14/2017 10 87 73
ZAHRA KP.SEMPU 8/14/2017 8.9 71 74
GILANG KP.SEMPU 8/14/2017 14 89 75
AULIA KP.SEMPU 8/14/2017 11 90 76
NAJRI KP.SEMPU 8/14/2017 9.6 103 77
YASMIN KP.SEMPU 8/14/2017 10 84 78
RIFANO KP.SEMPU 8/14/2017 1/5/2017 7 79 79
INDAH KP.SEMPU 8/14/2017 3/25/2013 15 113 80
FITRI KP.SEMPU 8/14/2017 6.7 81
KAYLA KP.SEMPU 8/14/2017 82
NADIRA KP.SEMPU 8/14/2017 11 80 83
ALBY. F.H KP.SEMPU 8/14/2017 8/2/2015 84
85
PETUGAS
(...................................)
FORMULIR PENCATATAN
PUSKESMAS : MEKAR MUKTI PUSKESMAS


2 3 4 5 6 7 8 9 10 11 12 1
DEWINA AMAR SEMPU 003 8/7/2017 7/30/2016 B P 10 80 1
ABDUL MAJID SEMPU 003 8/7/2017 T L 7.1 73 2
EVAN ARTA SEMPU 003 8/7/2017 5/23/2015 B P 15 83 3
BINTANG ASEP SUHAERTA SEMPU 003 8/7/2017 2/29/2016 B L 10 86 4
CESIH DAIN SEMPU 003 8/7/2017 6/26/2016 T 7.2 72 5
NIDA RAMIN SEMPU 003 8/7/2017 12/27/2016 T 7 67 6
NAJWA PANDI SEMPU 003 8/7/2017 2/18/2016 B 8.5 86 7
ZAHRA DANI SEMPU 003 8/7/2017 4/16/2013 B 9.2 84 8
ZASKIA DENI SEMPU 003 8/7/2017 3/28/2014 B 15 99 9
VIONA FREDI SEMPU 003 8/7/2017 12/7/2011 B 19 117 10
REVAN JAYA SEMPU 003 8/7/2017 4/25/2016 B 12 79 11
ASHARI R. ANDRI SEMPU 003 8/7/2017 7/10/2015 B 13 83 12
HAPIT EKO SEMPU 003 8/7/2017 2/11/2015 B 11 86 13
AMELIA TONI SEMPU 003 8/7/2017 8/20/2016 T 6.5 65 14
BAGAS BUDI SEMPU 003 8/7/2017 3/20/2016 T 8.6 77 15
M. YUSUF DAYUT SEMPU 003 8/7/2017 10/6/2011 B 16 107 16
ANDRIAN PARTA SEMPU 003 8/7/2017 10/31/2015 B 8.5 83 17
AKIVAH N. HADI SEMPU 003 8/7/2017 6/14/2014 P 8 81 18
MUNIPA MURSID SEMPU 003 8/7/2017 10/17/2016 B P 17 106 19
SALSA B. HENDAR SEMPU 003 8/7/2017 6/25/2016 B P 8.2 73 20
LILI JAINUL SEMPU 003 8/7/2017 B P 17 95 21
ARVAN Y. HENDAR SEMPU 003 8/7/2017 9/16/2016 B L 8.9 72 22
LALA JAINUL SEMPU 003 8/7/2017 B P 12 95 23
HAKAM DEDE SEMPU 003 8/7/2017 6/9/2013 B L 22 110 24
DENAHAUNA ISWAHYUDI SEMPU 003 8/7/2017 4/22/2011 B P 19 119 25
ANISA SAMAT SEMPU 003 8/7/2017 8/11/2014 B P 13 99 26
ASYIFA ISWAHYUDI SEMPU 003 8/7/2017 10/25/2015 B P 9 87 27
ARSAH SAMAT SEMPU 003 8/7/2017 11/26/2014 B P 11.5 97 28
AFRIJAL MULYONO SEMPU 003 8/7/2017 4/3/2012 B L 21 119 29
ROSITA DALIM SEMPU 003 8/7/2017 11/11/2014 B P 11.5 92 30
RIFAI SELAMET SEMPU 003 8/7/2017 6/27/2012 B L 18 117 31
IMAN NAMIN SEMPU 003 8/7/2017 10/15/2013 L 15 101 32
SILFI KUSNAN SEMPU 003 8/7/2017 4/22/2012 P 20 111 33
ATHIRA GURUH SEMPU 003 8/7/2017 5/26/2016 P 18 82 34
PETUGAS
(...................................)
FORMULIR PENCATATAN


2 3 4 5 6 7 8 9 10 11 12 1
DENISA DENA SEMPU 003 8/7/2017 2/24/2013 B P 14 130 35
NOLITA NATAM SEMPU 003 8/7/2017 B P 15 110 36
ERVAN ASEP SEMPU 003 8/7/2017 4/26/2015 B L 12 82 37
ERIK P. EMIN SEMPU 003 8/7/2017 10/19/2017 B L 18 114 38
AKILA KANDA SEMPU 003 8/7/2017 3/30/2015 B P 10 88 39
EPANDER SAEPULOH SEMPU 003 8/7/2017 12/3/2012 B L 18 117 40
NAUREN YANI SEMPU 003 8/7/2017 10/24/2015 B P 9.5 85 41
ABIYUNA ASEP BUDIYONO SEMPU 003 8/7/2017 2/17/2012 B L 42
KEYSA ENDI SEMPU 003 8/7/2017 8/26/2014 B P 15 100 43
DINDA KHAIRUDIN SEMPU 003 8/7/2017 6/22/2012 P 15 106 44
REVANLE SAOLEH SEMPU 003 8/7/2017 8/20/2012 L 23 111 45
SANDI ENDI SEMPU 003 8/7/2017 11/21/2011 L 22 122 46
DZIKRA RIFKI SEMPU 003 8/7/2017 9/27/2015 P 9 83 47
DAMAR SURANTU SEMPU 003 8/7/2017 T L 6.2 62 48
RAMA YUDA SEMPU 003 8/7/2017 6/2/2016 T L 7.5 62 49
LUTHFI WADA SEMPU 003 8/7/2017 L 20 106 50
GHAISAL TEGUH SEMPU 003 8/7/2017 4/4/2016 T L 12 83 51
ZAKIN AGUS SETIYONO SEMPU 003 8/7/2017 10/14/2016 T L 8.3 73 52
ZAKI ATHAYA AANG H.S SEMPU 003 8/7/2017 8/15/2012 B L 20 110 53
RAIHAN DANANG SEMPU 003 8/7/2017 10/18/2013 B L 15.5 105 54
AISYAH MUHAMMAD ATHAR SEMPU 003 8/7/2017 3/24/2014 T P 7.1 68 55
AYU TARDIANA SEMPU 003 8/7/2017 8/28/2013 B P 13 98 56
ASEP AMIN NOULIN SEMPU 003 8/7/2017 3/24/2016 B P 20 114 57
ALEA DODI SEMPU 003 8/7/2017 5/9/2015 B P 10 86 58
RISMA SURADI SEMPU 003 8/7/2017 T P 59
FAJRIL DOFIR SEMPU 003 8/7/2017 2/25/2014 B L 13 99 60
SALSA KASIM SEMPU 003 8/7/2017 8/3/2011 B P 61
AMANDA HADIYUDIN SEMPU 003 8/7/2017 12/7/2014 T P 10 89 62
AZA BUDI BUDIMAN SEMPU 003 8/7/2017 T L 15 105 63
PUTRI AHMAD YANI SEMPU 003 8/7/2017 5/22/2013 B P 26 102 64
LATIF ANIN SEMPU 003 8/7/2017 B L 15 110 65
KAYLA TAJUIN SEMPU 003 8/7/2017 12/11/2014 B P 13 95 66
RAY KANA TAMIKA SEMPU 003 8/7/2017 B L 17 105 67
RAYA R. IYAN S. SEMPU 003 8/7/2017 6/26/2016 T P 9.3 82 68
PETUGAS
(...................................)
FORMULIR PENCATATAN


2 3 4 5 6 7 8 9 10 11 12 1
WINDA HUMAIDAH SEMPU 003 8/7/2017 10/13/2016 T P 7 68 69
PRATAMA RUSMONO SEMPU 003 8/7/2017 B L 15 107 70
AFIKA DEDE SEMPU 003 8/7/2017 7/14/2016 B P 7.3 78 71
AIRA APRIJAL SEMPU 003 8/7/2017 B P 17 105 72
AZKA HANAFI SEMPU 003 8/7/2017 9/2/2015 B L 10 84 73
MUHAMMAD ARSA SEMPU 003 8/7/2017 T L 7 68 74
INTAN ANTO SEMPU 003 8/7/2017 B P 15 107 75
FAKIH SEMPU 003 8/7/2017 B L 15 107 76
NADIA ZULFI IZUL SEMPU 003 8/7/2017 11/5/2012 B P 26 114 77
BILAL SEMPU 003 8/7/2017 B L 13 86 78
ELNATHAN JOSEP SEMPU 003 8/7/2017 11/15/2015 B L 12 78 79
EVA SEMPU 003 8/7/2017 B P 12 87 80
MASRSHALL EKA SEMPU 003 8/7/2017 6/4/2016 B L 7.7 78 81
AULIAN F. HERI SUBAGIO SEMPU 003 8/7/2017 10/20/2012 B P 16 102 82
AIDA NOVAN SEMPU 003 8/7/2017 1/29/2017 T P 6.3 66 83
KHAIRUNNISA SEMPU 003 8/7/2017 T P 11 47 84
ERDANA ERIK SEMPU 003 8/7/2017 11/25/2014 B L 12 94 85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
PETUGAS
(...................................)
PUSKESMAS
POSYANDU/DESA
NO
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
FORMULIR PENCATATAN

POSYANDU/DESA : ASTER V POSYANDU/DESA

2 3 4 5 6 7 8 9 10 11 12 1
BAMBANG F.R MAHFUDZ P. GOMBONG 8/7/2017 10/16/2012 B L 15 116 1
MIKAILA F.R ADI HIDAYAT P. GOMBONG 8/7/2017 3/13/2016 B P 11 90 2
OKTA TONI P. GOMBONG 8/7/2017 10/5/2011 B P 23 124 3
RAMDANI SANIN P. GOMBONG 8/7/2017 7/27/2014 B P 11 102 4
TATA SODIK P. GOMBONG 8/7/2017 10/24/2011 B P 20 131 5
DAFFA SIX SELIYANTO P. GOMBONG 8/7/2017 10/2/2015 B L 11 96 6
ADITIYA YEPRI P. GOMBONG 8/7/2017 2/14/2015 B L 10 66 7
ASYIFA IKSAN P. GOMBONG 8/7/2017 10/21/2014 B P 11 111 8
HABIBAH DARMIN P. GOMBONG 8/7/2017 5/24/2016 B P 7 82 9
ABIAN ALI P. GOMBONG 8/7/2017 5/22/2015 B L 14 98 10
NOVAL PARMAN P. GOMBONG 8/7/2017 6/10/2016 B L 11 91 11
FAJAR DERI P. GOMBONG 8/7/2017 12/27/2012 B L 15 119 12
DANDI TARNU P. GOMBONG 8/7/2017 12/18/2012 B L 10.4 114 13
ALIKA WIDNONO P. GOMBONG 8/7/2017 3/22/2016 B L 8.5 80 14
NAYLLA HENDRA P. GOMBONG 8/7/2017 1/24/2017 T P 6.5 68 15
ADIBA DADAN P. GOMBONG 8/7/2017 9/23/2015 B P 9 92 16
NADILA MASAN P. GOMBONG 8/7/2017 1/13/2013 B P 18 113 17
ADELIA IMAN P. GOMBONG 8/7/2017 6/30/2013 B P 18 118 18
ZAKI MASRURI P. GOMBONG 8/7/2017 3/8/2013 B L 17 118 19
HANA SAEPUL P. GOMBONG 8/7/2017 9/15/2014 B P 18 110 20
ALKALIFI AGUS P. GOMBONG 8/7/2017 6/5/2017 T L 5.5 49 21
AZAHRA JUMHARI P. GOMBONG 8/7/2017 12/3/2014 B P 10 101 22
YUMNA SUGIANTO P. GOMBONG 8/7/2017 8/4/2016 B P 10 82 23
EARGTA ALI P. GOMBONG 8/7/2017 10/27/2014 B P 11 101 24
HAIDAR ENDANG P. GOMBONG 8/7/2017 3/18/2016 B L 7 84 25
RADITA FAJAR P. GOMBONG 8/7/2017 6/10/2014 B L 10 104 26
ABAS ADUNG P. GOMBONG 8/7/2017 7/13/2015 B L 9 105 27
MARIAM NURHAKIM P. GOMBONG 8/7/2017 5/9/2013 B P 11 110 28
GILANG PANCA P. GOMBONG 8/7/2017 11/9/2013 B L 13 114 29
INDAH PANCO P. GOMBONG 8/7/2017 3/25/2017 T P 6 63 30
DUTA A. KUAT P. GOMBONG 8/7/2017 11/19/2012 B L 15 122 31
BILQIS MULYADIN P. GOMBONG 8/7/2017 4/25/2014 B P 17 118 32
PRAMUDIA BAHRUDIN P. GOMBONG 8/7/2017 2/5/2014 B L 19 113 33
ANNISA RIYANTO P. GOMBONG 8/7/2017 8/31/2013 B P 13 116 34
PETUGAS
(...................................)
FORMULIR PENCATATAN


2 3 4 5 6 7 8 9 10 11 12 1
ANINDYA ROHMAT P. GOMBONG 8/7/2017 7/17/2016 T P 7.7 77 35
DANIEL MANUFAK P. GOMBONG 8/7/2017 5/9/2017 T L 7.6 56 36
DANIS MAHMUDIN P. GOMBONG 8/7/2017 9/15/2015 B L 10 97 37
ANINDITA HADI P. GOMBONG 8/7/2017 2/28/2015 B P 10 102 38
AZKA IMAN P. GOMBONG 8/7/2017 10/16/2014 B L 14 106 39
RASYA DANI P. GOMBONG 8/7/2017 9/2/2015 B L 9.5 94 40
SITI NAURA ASEP P. GOMBONG 8/7/2017 10/4/2015 B P 9.5 92 41
SITI SURAYA YONO P. GOMBONG 8/7/2017 8/7/2013 B P 15 113 42
SILA TARNO P. GOMBONG 8/7/2017 4/30/2013 B P 13 114 43
ELDA DANI P. GOMBONG 8/7/2017 7/25/2013 B P 15 115 44
KEISHA ERWIN P. GOMBONG 8/7/2017 8/23/2016 B P 8.7 87 45
ARON DELMAR P. GOMBONG 8/7/2017 10/26/2015 B L 10 96 46
TALITA KUAT P. GOMBONG 8/7/2017 10/22/2013 B P 18 118 47
FAISAL ACENG P. GOMBONG 8/7/2017 12/25/2013 B L 15 118 48
AZAM CEPI P. GOMBONG 8/7/2017 2/17/2013 B L 15 118 49
DEFAN SUNARTO P. GOMBONG 8/7/2017 12/6/2016 B L 7.5 67 50
SITI FATIMA ASEP P. GOMBONG 8/7/2017 5/2/2017 T P 6 59 51
SUKMAWATI SARJA P. GOMBONG 8/7/2017 7/18/2013 B P 17 107 52
GANTI SOBRIN P. GOMBONG 8/7/2017 11/1/2016 B L 8.5 83 53
TRISNA KISWANTO P. GOMBONG 8/7/2017 12/29/2015 B L 10 80 54
AZIZAH INUR P. GOMBONG 8/7/2017 1/19/2016 B P 9.5 84 55
RIZKI WAHYU P. GOMBONG 8/7/2017 1/8/10/13 B L 11 106 56
M. SALMAN PURNAMA P. GOMBONG 8/7/2017 7/7/2017 T L 4.5 55 57
MAHIRA PANDRI P. GOMBONG 8/7/2017 8/10/2015 B P 12 95 58
NAZRIEL KOMARUDIN P. GOMBONG 8/7/2017 6/16/2015 B P 13 48 59
ALINDA SUKAMTO P. GOMBONG 8/7/2017 7/13/2013 B L 15 112 60
HASBI NEIN P. GOMBONG 8/7/2017 2/11/2016 B L 11 94 61
LUTHFIANI ILHAM P. GOMBONG 8/7/2017 11/10/2015 B P 10 91 62
KAILA NEMAN P. GOMBONG 8/7/2017 12/31/2015 B P 10 92 63
DEFAN TOTO P. GOMBONG 8/7/2017 12/4/2015 B L 15 114 64
ROBI NIZAR P. GOMBONG 8/7/2017 4/4/2015 B L 16 103 65
IKSAN DENI P. GOMBONG 8/7/2017 6/19/2015 B L 15 106 66
INAYAH NURSALIM P. GOMBONG 8/7/2017 12/9/2014 B P 15 106 67
ASILLA IKIN P. GOMBONG 8/7/2017 11/9/2015 B P 15 100 68
PETUGAS
(...................................)
FORMULIR PENCATATAN


2 3 4 5 6 7 8 9 10 11 12 1
AHMAD MINTA P. GOMBONG 8/7/2017 3/6/2014 B L 13 111 39
SUCI JUMIN P. GOMBONG 8/7/2017 7/19/2015 B P 11 93 70
DANIS WAWAN P. GOMBONG 8/7/2017 4/14/2015 B L 19 108 71
IBRAHIM ARIF P. GOMBONG 8/7/2017 12/21/2016 B L 7 63 72
RANGGA H. HERMAN P. GOMBONG 8/7/2017 2/4/2016 B L 10 88 73
GIBRAN FIKI P. GOMBONG 8/7/2017 8/10/2015 B L 12 102 74
ELISA ENDANG P. GOMBONG 8/7/2017 2/15/2015 B P 13 102 75
HAIRIN AMIN P. GOMBONG 8/7/2017 9/7/2015 B L 12 100 76
ICAL ACUM P. GOMBONG 8/7/2017 6/25/2014 B L 12 88 77
DINAR FARULIN P. GOMBONG 8/7/2017 31/11/12 B P 20 120 78
FAZRIL YOGA P. GOMBONG 8/7/2017 8/31/2014 B L 12 104 79
ARSILA ATANG P. GOMBONG 8/7/2017 5/29/2017 B P 5.5 56 80
AIFA AHAD P. GOMBONG 8/7/2017 7/21/2013 B P 11 96 81
ADITYA AHAD P. GOMBONG 8/7/2017 9/25/2015 B L 8 92 82
SHAFA OKI P. GOMBONG 8/7/2017 5/31/2014 B P 15 109 83
KHANZA ASEP P. GOMBONG 8/7/2017 12/13/2014 B P 15 111 84
MUKTI NARMAN P. GOMBONG 8/7/2017 7/6/2016 B L 8.5 83 85
DIANA MASAN P. GOMBONG 8/7/2017 1/13/2013 B P 18 113 86
AZKA AGUS P. GOMBONG 8/7/2017 8/2/2015 B L 13 100 87
AZKA ALIM P. GOMBONG 8/7/2017 11/2/2016 B L 10 78 88
STEVAN DOGAN P. GOMBONG 8/7/2017 11/2/2013 B L 15 116 89
DUTA ASFAR UNTUNG P. GOMBONG 8/7/2017 12/6/2015 B L 11 99 90
RIZKI HENDAR P. GOMBONG 8/7/2017 4/22/2016 B L 9 90 91
BAIM SUTIRMAN P. GOMBONG 8/7/2017 4/5/2017 T L 7.5 62 92
M. SAIFUL WAWAN P. GOMBONG 8/7/2017 5/28/2016 B L 9 99 93
FARIS HERI P. GOMBONG 8/7/2017 1/16/2017 T L 7 69 94
M. MALIK JOHAN P. GOMBONG 8/7/2017 1/15/2006 B L 10 92 95
MARTIN SAAD P. GOMBONG 8/7/2017 3/15/2014 B L 14 107 96
RAFA RUDI P. GOMBONG 8/7/2017 5/11/2015 B L 12 111 97
FERDI YANTO P. GOMBONG 8/7/2017 2/17/2014 B L 10 100 98
ATIKA SETIAWAN P. GOMBONG 8/7/2017 1/10/2014 B P 21 112 99
GIBRAN JOKO P. GOMBONG 8/7/2017 7/19/2013 B L 12 102 100
NIKITA YAYAT P. GOMBONG 8/7/2017 5/21/2013 B P 15 108 101
SYIFA SAKUM P. GOMBONG 8/7/2017 5/28/2016 t P 7 64 102
PETUGAS
(...................................)
FORMULIR PENCATATAN


2 3 4 5 6 7 8 9 10 11 12 1
BRIYANA PUGUH P. GOMBONG 8/7/2017 10/29/2016 B P 8 74 103
ARYADITA MULKI P. GOMBONG 8/7/2017 12/2/2013 B L 15 116 104
SAMSUL ASEP P. GOMBONG 8/7/2017 1/23/2012 B L 15 107 105
FIZI JUMIN P. GOMBONG 8/7/2017 6/24/2014 B L 15 106 106
M. RIZKI JUMIN P. GOMBONG 8/7/2017 5/3/2017 T L 5.5 59 107
AL FARIBI LUKI P. GOMBONG 8/7/2017 3/24/2017 T L 7 63 108
MIRNAWATI AMIRUDIN P. GOMBONG 8/7/2017 10/4/2015 B P 8 98
MIFTA FAUZAN P. GOMBONG 8/7/2017 11/25/2014 B P 10 99
SATRIA AZIS P. GOMBONG 8/7/2017 3/23/2012 B L 15 107
AIRA ASEP P. GOMBONG 8/7/2017 9/6/2013 B P 16 120
HAIKAL EKO P. GOMBONG 8/7/2017 11/27/2015 B L 9 98
NENDRA ARIS P. GOMBONG 8/7/2017 7/7/2012 B L 20 120
FEBRIAN DENI P. GOMBONG 8/7/2017 1/23/2016 B L 9 68
FADELA JAYADI P. GOMBONG 8/7/2017 2/23/2017 T P 6.2 58
AYU AGUS P. GOMBONG 8/7/2017 T P 12 112
DELA DEDE P. GOMBONG 8/7/2017 12/17/2011 B P 17 113
ADINDA P. GOMBONG 8/7/2017 B P 29 128
ADIL HANAFI P. GOMBONG 8/7/2017 8/11/2013 L 13 113
NAURAH NURYADI P. GOMBONG 8/7/2017 1/15/2012 P 18 122
ADINDA SUPRAPTO P. GOMBONG 8/7/2017 1/20/2012 P 20 127
CHIKO ADING P. GOMBONG 8/7/2017 3/1/2011 L 15 122
AZAM JULI P. GOMBONG 8/7/2017 11/13/2016 L 8.2 66
PETUGAS
(...................................)
FORMULIR PENCATATAN
POSYANDU/DESA : PASIR GOMBONG POSYANDU/DESA

2 3 4 5 6 7 8 9 10 11 12 1
ARPAN AGUS RT. 007/001 8/10/2017 10/5/2015 1
ARYA DIAS MAKMUR RT. 007/001 8/10/2017 7/19/2014 2
AZZAHRA BAMBANG RT. 007/001 8/10/2017 5/12/2016 3
ASNA RUDI RT. 007/001 8/10/2017 8/1/2012 4
ARKA DINATA YAYAH RT. 007/001 8/10/2017 2/2/2017 5
BILQIS RAHMAT RT. 007/001 8/10/2017 11/16/2014 6
BAYU HAMDANI RT. 007/001 8/10/2017 2/13/2014 7
BRIAN AIDIL ADI .S RT. 007/001 8/10/2017 5/24/2015 8
CHELSEA IMAM RT. 007/001 8/10/2017 11/22/2012 9
DAFA SLAMET RT. 007/001 8/10/2017 9/7/2013 10
DEVITA ASEP RT. 007/001 8/10/2017 11
GILANG WAHID RT. 007/001 8/10/2017 7/20/2015 12
HUNA DARTO RT. 007/001 8/10/2017 7/9/2014 13
HAFIZ NAUFAL ALMUTAQIN RT. 007/001 8/10/2017 10/15/2015 14
HAIKAL RAHAYU RT. 007/001 8/10/2017 1/25/2016 15
HAMDAN NURHENDRA RT. 007/001 8/10/2017 11/14/2014 16
HUMAIRA IRMA RT. 007/001 8/10/2017 17
HAIFAL SANTI RT. 007/001 8/10/2017 18
ISAM SAMAN RT. 007/001 8/10/2017 5/10/2016 19
JOSHUA SULIANTO RT. 007/001 8/10/2017 7/13/2014 20
ZIKRI DEDE RT. 007/001 8/10/2017 21
KAHOIRUL DEDE RT. 007/001 8/10/2017 22
KAIRA SAIMAH RT. 007/001 8/10/2017 3/29/2017 23
KENZI SOLEHAN RT. 007/001 8/10/2017 8/16/2015 24
M. FAZRI DEDE RT. 007/001 8/10/2017 25
MALIKA MAMAN RT. 007/001 8/10/2017 11/29/2014 26
MIDA EKA RT. 007/001 8/10/2017 5/23/2014 27
M. RANGGA ANI RT. 007/001 8/10/2017 2/11/2016 28
NAFISA ASEP RT. 007/001 8/10/2017 8/11/2016 29
NADIA IHSAN RT. 007/001 8/10/2017 8/16/2015 30
NADIRA NUR RT. 007/001 8/10/2017 8/25/2015 31
NAYLA LIARI RT. 007/001 8/10/2017 9/25/2014 32
NAUFAL PUTRI RT. 007/001 8/10/2017 2/20/2014 33
RAINA DEVI RT. 007/001 8/10/2017 6/23/2015 34
PETUGAS
(...................................)
FORMULIR PENCATATAN
POSYANDU/DESA : PASIR GOMBONG POSYANDU/DESA

2 3 4 5 6 7 8 9 10 11 12 1
RUBY ASEP RT. 007/001 8/10/2017 6/23/2015 35
RIQKI RISMA RT. 007/001 8/10/2017 8/22/2016 36
RIFKI RISMA RT. 007/001 8/10/2017 8/22/2016 37
RAFA RIAN RT. 007/001 8/10/2017 12/30/2015 38
REFA RIAN RT. 007/001 8/10/2017 12/30/2015 39
KAKA JONI RT. 007/001 8/10/2017 12/4/2013 40
RAFA MIRJAT RT. 007/001 8/10/2017 12/2/2012 41
SRI NOVIANTI NAMIN RT. 007/001 8/10/2017 11/17/2012 42
RAISA INTI RT. 007/001 8/10/2017 12/1/2014 43
SRI RAHMAWATI RURI RT. 007/001 8/10/2017 44
SULTAN SYARIF RURI RT. 007/001 8/10/2017 4/1/2017 45
ULAN SARI FERRY RT. 007/001 8/10/2017 46
AQILA IIS RT. 007/001 8/10/2017 8/1/2016 47
AKIL ITA RT. 007/001 8/10/2017 10/14/2013 48
ANGGITA WAHYUDIN RT. 007/001 8/10/2017 49
ADEL HARYANTO RT. 007/001 8/10/2017 50
M. KHALID SITI RT. 007/001 8/10/2017 6/20/2017 51
VALERI AMPRIONALDI RT. 007/001 8/10/2017 52
PUTRI NURSEHA RT. 007/001 8/10/2017 53
WINNER ROLITA RT. 007/001 8/10/2017 12/27/2014 54
HANA ISHANI RT. 007/001 8/10/2017 10/3/2013 55
RAFA DIAN RT. 007/001 8/10/2017 56
YASMIN MINAH RT. 007/001 8/10/2017 10/13/2015 57
THALITA NURIDA RT. 007/001 8/10/2017 3/6/2016 58
DINDA NAMIH RT. 007/001 8/10/2017 8/5/2013 59
SAIFARA CECEP RT. 007/001 8/10/2017 7/23/2014 60
FADLI PENDI RT. 007/001 8/10/2017 8/26/2013 61
FAQIH SURASKINI RT. 007/001 8/10/2017 3/29/2012 62
NAJWA SITI RT. 007/001 8/10/2017 12/14/2013 63
PUTRI NABILA IKA RT. 007/001 8/10/2017 2/9/2013 64
M. FALIH IKOH RT. 007/001 8/10/2017 12/4/2016 65
BAGUS AMI RT. 007/001 8/10/2017 10/16/2016 66
DINDA SUCI RT. 007/001 8/10/2017 3/28/2016 67
MARSYA FITRI RT. 007/001 8/10/2017 3/28/2015 68
PETUGAS
(...................................)
FORMULIR PENCATATAN
POSYANDU/DESA : GRAHA ASTRA / SIMPANGAN POSYANDU/DESA

2 3 4 5 6 7 8 9 10 11 12 1
ABDUL MAJID JULENI RT. 007/001 8/10/2017 7/21/2015 69
MOSE RT. 007/001 8/10/2017 5/20/2015 70
CHALES WATI RT. 007/001 8/10/2017 7/12/2016 71
ALDE JANAN RT. 007/001 8/10/2017 3/3/2014 72
SALSABILA ASTUTI RT. 007/001 8/10/2017 3/15/2013 73
FEBRI RIANTI RT. 007/001 8/10/2017 2/6/2014 74
M. ALWI KARLINA RT. 007/001 8/10/2017 11/9/2013 75
ZAKIA ANYAR RT. 007/001 8/10/2017 2/25/2016 76
ARSYILA YUSTINI RT. 007/001 8/10/2017 3/25/2016 77
AFIS TRISNAWATI RT. 007/001 8/10/2017 78
ALIFENDRI MARIA MELIA RT. 007/001 8/10/2017 5/5/2016 79
SASWA ROSANTI RT. 007/001 8/10/2017 3/26/2017 80
WILDAN SRI RT. 007/001 8/10/2017 5/3/2014 81
NADIA YAYU RT. 007/001 8/10/2017 2/21/2014 82
ZAHRAH IIN RT. 007/001 8/10/2017 2/6/2017 83
LINTANG ROHAYA RT. 007/001 8/10/2017 11/20/2015 84
RAHMA INTI RT. 007/001 8/10/2017 2/7/2013 85
ANGGIA IDA RT. 007/001 8/10/2017 11/20/2015 86
ADELIA TINA RT. 007/001 8/10/2017 5/20/2014 87
M. ISKO SITI RT. 007/001 8/10/2017 4/20/2017 88
M. ASKA ELI RT. 007/001 8/10/2017 10/20/2015 89
DIVA RT. 007/001 8/10/2017 5/19/2016 90
FAHIRA ARUM RT. 007/001 8/10/2017 4/19/2014 91
KHARISA MIA RT. 007/001 8/10/2017 11/13/2014 92
AISYAH ZULKIFLI RT. 007/001 8/10/2017 5/30/2012 93
DAIFULLAH BILAT RT. 007/001 8/10/2017 6/12/2014 94
M. AKHIL ZULKIFLI RT. 007/001 8/10/2017 3/23/2014 95
EZA IMRON RT. 007/001 8/10/2017 9/5/2013 96
AQILAH AZAM RT. 007/001 8/10/2017 6/17/2012 97
BAGAS HERNI RT. 007/001 8/10/2017 98
AFNAN FAIZAH RUDIYANTO RT. 007/001 8/10/2017 9/13/2016 99
NABILA MULYADI RT. 007/001 8/10/2017 4 TAHUN 100
M. DAFA AJUM RT. 007/001 8/10/2017 11/11/2013 101
KAISAR ALI SOPIAN RT. 007/001 8/10/2017 10/18/2012 102
PETUGAS
(...................................)
FORMULIR PENCATATAN
POSYANDU/DESA : GRAHA ASTRA / SIMPANGAN POSYANDU/DESA

2 3 4 5 6 7 8 9 10 11 12 1
BAYU HAMDANI RT. 007/001 8/10/2017 2/13/2014 103
FADIL ELA RT. 007/001 8/10/2017 5 TAHUN 104
MUTIARA DHUHA SALIH RT. 007/001 8/10/2017 3 TAHUN 105
RAMDAN / BUDI BUDI RT. 007/001 8/10/2017 8/14/2012 106
NANA ISHANI RT. 007/001 8/10/2017 10/3/2013 107
NAYLA FIRMAN RT. 007/001 8/10/2017 9/25/2014 108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
PETUGAS
(...................................)
FORMULIR PENCATATAN

POSYANDU/DESA : ASTER IV / PASIR GOMBING POSYANDU/DESA

2 3 4 5 6 7 8 9 10 11 12 1
AHMAD ZAFRAN FAJAR KP.GOMBONG 8/3/2017 10/19/2015 B L 15 92 1
AFRIZAL ADE KP.GOMBONG 8/3/2017 5/4/2014 B L 15 98 2
ELPIRA ENAN KP.GOMBONG 8/3/2017 2/27/2015 B P 11 87 3
REYUANDRA HARISUYANTO KP.GOMBONG 8/3/2017 9/14/2015 B L 13 92 4
ANDINI CARWAN KP.GOMBONG 8/3/2017 1/30/2013 B P 16 115 5
FATHAN A. RUDI KP.GOMBONG 8/3/2017 12/30/2014 B L 12 99 6
FADHIL KASIN KP.GOMBONG 8/3/2017 11/9/2012 B L 15 110 7
CANTIKA KASIN KP.GOMBONG 8/3/2017 11/4/2016 T P 7.3 64 8
JAFAR WANTO KP.GOMBONG 8/3/2017 7/18/2016 B L 8.1 67 9
SHAKILA PEPEN KP.GOMBONG 8/3/2017 2/2/2016 B P 10 87 10
DINAR MUSTOFA KP.GOMBONG 8/3/2017 12/15/2013 B P 15 109 11
RAHMAN ADE KP.GOMBONG 8/3/2017 2/4/2015 B L 14 103 12
MELODI RAHMAT KP.GOMBONG 8/3/2017 11/20/2014 B P 28 110 13
ALDES ANGKUNG KP.GOMBONG 8/3/2017 11/19/2014 B L 26 103 14
ZEIN KAFI PUAD KP.GOMBONG 8/3/2017 1/18/2015 B L 16 103 15
NAZWA ENGKUS KP.GOMBONG 8/3/2017 9/7/2012 B P 17 108 16
BILQIS M. SODIKIN KP.GOMBONG 8/3/2017 6/27/2015 B P 9.5 88 17
YANTI YADI KP.GOMBONG 8/3/2017 4/2/2014 B P 11 102 18
AMARA JAMALUDIN KP.GOMBONG 8/3/2017 9/12/2012 B P 16 111 19
SAFIK NASAN KP.GOMBONG 8/3/2017 5/13/2015 B L 16 101 20
ALFIAN TATA KP.GOMBONG 8/3/2017 5/1/2014 B L 11 98 21
ABKORI HAI KP.GOMBONG 8/3/2017 3/12/2013 B L 11 104 22
ANSORI ABU BAKAR KP.GOMBONG 8/3/2017 10/10/2013 B L 12 106 23
ANDIKA ENJA 8/3/2017 5/29/2015 B L 13 87 24
AHAMD PANDANU DAUDIN PANDANU KP.GOMBONG 8/3/2017 12/12/2015 B L 10 86 25
DWI MULYA SUNARSO KP.GOMBONG 8/3/2017 4/23/2013 B P 21 114 26
INAYA WIDODO KP.GOMBONG 8/3/2017 2/27/2014 B P 12 104 27
HANINDIYA CASWITO KP.GOMBONG 8/3/2017 10/29/2014 B P 10 96 28
RAKA FADHILAH TARYO KP.GOMBONG 8/3/2017 9/11/2012 B L 15 115 29
ADELIA ROSIDI KP.GOMBONG 8/3/2017 10/5/2016 T P 9.7 90 30
RAFA EWIT KP.GOMBONG 8/3/2017 2/1/2014 B L 15 100 31
RAKA INDRAJID SANDI I. KP.GOMBONG 8/3/2017 1/8/2016 B L 10 75 32
ICA FAUZI KP.GOMBONG 8/3/2017 10/21/2015 B P 9 77 33
M. KENZO ANSORI KP.GOMBONG 8/3/2017 9/1/2014 B L 11 98 34
PETUGAS
10 (...................................)
FORMULIR PENCATATAN


2 3 4 5 6 7 8 9 10 11 12 1
LEONARDO ANDRI KP.GOMBONG 8/3/2017 9/11/2014 B L 16 103 35
ZAHWA SUPRI KP.GOMBONG 8/3/2017 10/24/2014 B P 22 109 36
ALBY ROTAMA KP.GOMBONG 8/3/2017 11/22/2016 B L 7.9 70 37
ARFAH SAHRANI KP.GOMBONG 8/3/2017 7/30/2016 B P 9 84 38
DERISKA HILMAN KP.GOMBONG 8/3/2017 /06/2015 B P 9 87 39
KAIRA ISKARNO KP.GOMBONG 8/3/2017 11/5/2015 B P 8 75 40
RAFFA MAHMUD KP.GOMBONG 8/3/2017 7/1/2016 B L 8.4 72 41
LIDYA YUDI KP.GOMBONG 8/3/2017 12/28/2012 B P 16 114 42
NABIL ASEP KP.GOMBONG 8/3/2017 3/14/2015 B L 10 100 43
RINA P. SATAM KP.GOMBONG 8/3/2017 4/2/2015 B P 11 91 44
EVI ENAN KP.GOMBONG 8/3/2017 B P 10 98 45
HAIDAR TEDI KP.GOMBONG 8/3/2017 8/6/2015 B L 11 90 46
RIDO SABAR KP.GOMBONG 8/3/2017 8/21/2016 B L 10 87 47
RANGGA SABAR KP.GOMBONG 8/3/2017 11/6/2015 B L 21 89 48
MUTIA RAHMA LAMET KP.GOMBONG 8/3/2017 6/19/2015 B P 11.5 84 49
TASYA WILONA NANANG P. KP.GOMBONG 8/3/2017 7/8/2015 B P 10 83 50
HAIKAL ACEP SANJAYA KP.GOMBONG 8/3/2017 2/11/2016 B L 10 75 51
AULIA JUMANTO KP.GOMBONG 8/3/2017 7/10/2015 B P 10 82 52
M. FADLI WIRTA KP.GOMBONG 8/3/2017 6/11/2014 T L 12 98 53
ADLY ADE KP.GOMBONG 8/3/2017 1/9/2017 B L 9.2 71 54
SATRIA AMAD KP.GOMBONG 8/3/2017 9/13/2015 B L 13 94 55
ALIFA M. TAOFIK KP.GOMBONG 8/3/2017 7/30/2014 B P 11 95 56
HABIBY H.M. RIDWAN KP.GOMBONG 8/3/2017 6/12/2016 B L 10 84 57
BINTANG HUSNI KP.GOMBONG 8/3/2017 9/26/2014 B L 19 110 58
JIHAN CANAP KP.GOMBONG 8/3/2017 7/21/2012 B P 19 118 59
ATILAH UKAR A. KP.GOMBONG 8/3/2017 7/25/2013 B P 13 107 60
ZULFA SUYANTO KP.GOMBONG 8/3/2017 12/4/2015 B P 11 102 61
RAFANDRA ANDRI Y. KP.GOMBONG 8/3/2017 2/5/2016 B L 10.5 88 62
QUEENSHA ARYO KP.GOMBONG 8/3/2017 8/1/2013 B P 13 105 63
ZIDNI ARYO KP.GOMBONG 8/3/2017 4/6/2016 B P 8 84 64
SAKTIA SUDARMAJI KP.GOMBONG 8/3/2017 10/26/2013 B L 13 99 65
ZALSABILA DEDE KP.GOMBONG 8/3/2017 12/12/2014 B P 10 95 66
AYSHA YOSI KP.GOMBONG 8/3/2017 5/26/2015 B P 10.5 92 67
RAISA RULI KP.GOMBONG 8/3/2017 3/2/2015 B P 11 96 68
PETUGAS
(...................................)
FORMULIR PENCATATAN


2 3 4 5 6 7 8 9 10 11 12 1
DEANDRA KHAERUL KP.GOMBONG 8/3/2017 4/22/2016 B P 9 81 69
FAHIRA MINAL KP.GOMBONG 8/3/2017 B P 11 96 70
AMAR NUR CAHYO AGUS KP.GOMBONG 8/3/2017 4/6/2015 B L 16 93 71
SABRINA WAHYU KP.GOMBONG 8/3/2017 6/6/2016 B P 8.6 85 72
RAFAN S. SUGIARTO KP.GOMBONG 8/3/2017 5/11/2015 B L 9.3 85 73
ADZKIA ADE KP.GOMBONG 8/3/2017 8/24/2015 B P 13 90 74
KHUMAIRAH HASAN KP.GOMBONG 8/3/2017 2/24/2017 T P 6.6 60 75
AIRA DWI SUSANTO KP.GOMBONG 8/3/2017 12/30/2014 B P 12 98 76
HASAN FAJAR KP.GOMBONG 8/3/2017 2/25/2015 B L 12 97 77
ALPIAN DWI HARTANTO KP.GOMBONG 8/3/2017 10/4/2013 B L 13 102 78
KENZI YANTO KP.GOMBONG 8/3/2017 5/11/2015 B L 11 97 79
AKMAL AKROM KP.GOMBONG 8/3/2017 5/24/2015 B L 12 100 80
ADAM Z. RIFKI ITENG KP.GOMBONG 8/3/2017 10/19/2014 B L 12 102 81
AZKA JUMARNA KP.GOMBONG 8/3/2017 7/24/2016 B L 9 68 82
KEVIN RIFAL KP.GOMBONG 8/3/2017 11/3/2015 B L 10 92 83
DAFA DIDI KP.GOMBONG 8/3/2017 4/10/2013 B L 21 118 84
AZKA SALIP KP.GOMBONG 8/3/2017 6/24/2013 B L 16 110 85
RIANA EDI KP.GOMBONG 8/3/2017 12/29/2013 B P 14 96 86
SHAKILA M. TOHIR KP.GOMBONG 8/3/2017 11/6/2012 B P 15 110 87
NAYLA YUDI KP.GOMBONG 8/3/2017 6/4/2016 B P 10 84 88
ZIDAN KHAFIDIN KP.GOMBONG 8/3/2017 6/29/2016 B L 9.2 87 89
HAFIZ MARYONO KP.GOMBONG 8/3/2017 4/23/2014 B L 13 105 90
RIAN ANJANI ATANG KP.GOMBONG 8/3/2017 7/27/2016 B P 7.6 78 91
CHELSEA SURYADI KP.GOMBONG 8/3/2017 10/12/2016 T P 9 67 92
ARDI ANDRE KP.GOMBONG 8/3/2017 10/23/2013 B L 13 103 93
DENIS GERY KP.GOMBONG 8/3/2017 3/22/2015 B L 17 98 94
ALIKA AMAD KP.GOMBONG 8/3/2017 2/13/2013 B P 12 107 95
ZAHIR DINU KP.GOMBONG 8/3/2017 8/11/2015 B L 11 92 96
ASKA AGUS KP.GOMBONG 8/3/2017 10/22/2015 B L 10 93 97
NURHAN ANDRI KP.GOMBONG 8/3/2017 9/1/2014 B L 11 9 98
LOVELY ANDRI KP.GOMBONG 8/3/2017 2/6/2017 T P 5.9 57 99
ARYA AWAN KP.GOMBONG 8/3/2017 1/19/2015 B L 10 87 100
PUTRI BUDI KP.GOMBONG 8/3/2017 12/16/2016 T P 7.1 88 101
FARHAN BUDI KP.GOMBONG 8/3/2017 /01/2014 B L 13 96 102
PETUGAS
(...................................)
FORMULIR PENCATATAN


2 3 4 5 6 7 8 9 10 11 12 1
ADIBA AAN KP.GOMBONG 8/3/2017 8/18/2015 B P 14 96 103
ADARA SUARLAN KP.GOMBONG 8/3/2017 10/10/2016 T P 7.8 61 104
YUMNA MAMAT KP.GOMBONG 8/3/2017 12/10/2013 B P 14 104 105
AKILA MAMAT KP.GOMBONG 8/3/2017 8/5/2012 B P 18 114 106
ANASYA SOPIAN H. KP.GOMBONG 8/3/2017 2/22/2017 T P 6 62 107
AIRA ASEP KP.GOMBONG 8/3/2017 9/6/2013 B P 12 100 108
TIFANY ANDRIANTO KP.GOMBONG 8/3/2017 4/17/2016 B P 10 77 109
NUGI HANAPI KP.GOMBONG 8/3/2017 3/21/2014 B L 15 100 110
SYIFA ALPIAH PARLAUNGAN KP.GOMBONG 8/3/2017 4/15/2016 B P 11 68 111
HAJIQ IWAN KP.GOMBONG 8/3/2017 12/22/2014 B L 10 98 112
DAFA MANSYUR KP.GOMBONG 8/3/2017 12/23/2016 B L 8 50 113
FAIZAL ANDEN KP.GOMBONG 8/3/2017 2/22/2014 B L 11 86 114
HAIKAL EKO KP.GOMBONG 8/3/2017 11/27/2015 B L 10 85 115
ASILA IKIN KP.GOMBONG 8/3/2017 11/9/2015 B P 9.5 83 116
RAFA RUDI KP.GOMBONG 8/3/2017 5/11/2015 B L 10.5 88 117
REYGA SEPRIYANTO KP.GOMBONG 8/3/2017 5/17/2016 B L 11 76 118
RAHMAN SANANG KP.GOMBONG 8/3/2017 4/22/2016 B L 7 70 119
NUR RIZKY SURYO KP.GOMBONG 8/3/2017 12/20/2015 B L 12 85 120
NAYA SALIM KP.GOMBONG 8/3/2017 12/9/2014 B P 11 90 121
ALVARO ADE LUTHFI KP.GOMBONG 8/3/2017 5/1/2015 B L 10 86 122
123
124
125
126
127
PETUGAS
(...................................)
FORMULIR PENCATATAN

POSYANDU/DESA : ASTER 2 / PASIR GOMBONG POSYANDU/DESA

2 3 4 5 6 7 8 9 10 11 12 1
ALIF ADANG RT. 005/006 8/7/2017 5/20/2014 B L 16 114 1
GIZR AJA / YOKO RT. 004/006 8/7/2017 1/13/2015 B L 11 107 2
BAGUS NATALA RT. 004/006 8/7/2017 8/17/2014 B L 10 107 3
MIKAILA ADE RT. 004/006 8/7/2017 5/21/2017 T P 6 53 4
QUEEN SADIM RT. 004/006 8/7/2017 11/11/2016 T P 9.5 89 5
ZAIM ABDUL RT. 004/006 8/7/2017 3/25/2015 T L 11 103 6
TANIA P. TOPIK RT. 004/006 8/7/2017 6/12/2015 B P 17 100 7
ARKAN BUDI RT. 004/006 8/7/2017 12/28/2015 B L 10 93 8
KAYLA SATIM RT. 004/006 8/7/2017 12/26/2012 B P 14 113 9
AQILA SUPRI RT. 004/006 8/7/2017 11/19/2014 B P 13 107 10
GIBRAN SUPRI RT. 004/006 8/7/2017 6/2/2016 T L 15 92 11
RAMDANI SAKRIM RT. 004/006 8/7/2017 12/2/2015 B L 9 98 12
INZAGHI YANDI RT. 004/006 8/7/2017 1/7/2015 B L 11 107 13
HERLINA SUBIANTO RT. 004/006 8/7/2017 6/25/2017 T P 9 90 14
RIZKY YAHYA RT. 004/006 8/7/2017 8/28/2015 B L 9 99 15
IYAN YAHYA RT. 004/006 8/7/2017 4/11/2012 B L 11 115 16
PUTRI ABDUL RT. 004/006 8/7/2017 6/3/2016 B P 10 96 17
ARYA SARWONO RT. 004/006 8/7/2017 10/28/2016 B L 9.6 92 18
ZEGI TISNAWARDANI RT. 005/006 8/7/2017 9/12/2015 B L 10 104 19
FAHIRA IMAM RT. 005/006 8/7/2017 11/6/2015 B P 9.5 95 20
FITRI YULI RT. 005/006 8/7/2017 8/8/2013 B P 15 114 21
ALBARA ANO RT. 004/006 8/7/2017 8/24/2015 B L 12 98 22
SAFKA UJANG RT. 004/006 8/7/2017 3/23/2016 B L 9 95 23
MELANI AGUS RT. 004/006 8/7/2017 5/18/2013 B P 10.2 113 24
BIMA HARUN RT. 004/006 8/7/2017 7/4/2013 B L 15 122 25
NAIRA AMAD RT. 004/006 8/7/2017 7/25/2013 B P 13 108 26
FATAH LUKMAN RT. 004/006 8/7/2017 7/21/2016 B L 11 90 27
NURSYIFA BAHRUDIN RT. 004/006 8/7/2017 1/13/2015 B P 15 102 28
ZULFIKAR BAHRUDIN RT. 004/006 8/7/2017 10/22/2013 L 29
AISYAH UMAR RT. 004/006 8/7/2017 11/21/2016 T P 8 84 30
NAJMA MISBAH RT. 004/006 8/7/2017 10/15/2015 B P 8.5 97 31
ZAKIRA ENGKOS RT. 004/006 8/7/2017 10/20/2016 B P 12.5 112 32
DAFA KRISTIAWAN RT. 004/006 8/7/2017 10/20/2013 B L 15 120 33
RIZQO H. ROHIM RT. 004/006 8/7/2017 7/29/2015 T L 10 100 34
PETUGAS
(...................................)
FORMULIR PENCATATAN


2 3 4 5 6 7 8 9 10 11 12 1
RAFASYA RIAN RT. 005/006 8/7/2017 1/14/2017 B L 7.5 88 35
NURMA PAIDI RT. 005/006 8/7/2017 6/15/2014 B P 11 102 36
ERLANGGA DIDI RT. 004/006 8/7/2017 12/9/2016 T L 9.5 98 37
BAGAS DENI RT. 004/006 8/7/2017 9/27/2014 B L 10 107 38
ELIF JUIMANO RT. 004/006 8/7/2017 7/9/2012 B P 15 155 39
RIZKY FARONI RT. 004/006 8/7/2017 4/11/2013 B L 10 106 40
NASYA SUARNO RT. 004/006 8/7/2017 8/5/2015 B P 11 96 41
ALIF DWI RT. 005/006 8/7/2017 6/17/2014 B L 12 109 42
AULIA BIMBIM RT. 004/006 8/7/2017 2/17/2015 B P 11 102 43
RAMDAN RONAL RT. 004/006 8/7/2017 6/15/2016 B L 0.2 90 44
SAHRIL INDRA RT. 004/006 8/7/2017 2/6/2015 B L 10 104 45
ILAL FERI RT. 004/006 8/7/2017 10/10/2016 T L 8.2 86 46
MAHARDIKA WANDI RT. 004/006 8/7/2017 9/22/2013 T L 12 130 47
NAFIS JAINURI RT. 004/006 8/7/2017 4/30/2013 T L 19 123 48
ALIYUDIN ARIF PUDIN RT. 005/006 8/7/2017 11/27/2016 B L 7.5 80 49
SALSABILA TEGUH RT. 005/006 8/7/2017 9/15/2016 T P 9 88 50
LOVIANA HERI RT. 005/006 8/7/2017 12/14/2016 T P 8 85 51
NOVAL ANWAR RT. 005/006 8/7/2017 7/21/2016 B L 10 9 52
RANUM SATIM RT. 005/006 8/7/2017 9/9/2016 T P 10 96 53
LALA HARTONO RT. 005/006 8/7/2017 2/18/2015 B P 16 105 54
LAISA PUTRA RT. 005/006 8/7/2017 T P 12 110 55
AQILA PAIJIN RT. 004/006 8/7/2017 2/18/2017 T P 87 64 56
ARFAN TRINO RT. 004/006 8/7/2017 2/10/2017 T L 9 61 57
DEVA NOTO RT. 004/006 8/7/2017 9/12/2014 T P 12 107 58
SANDRINA KAMAL RT. 004/006 8/7/2017 9/25/2013 T P 13 112 59
BILQIS SUDRAJAT RT. 004/006 8/7/2017 7/4/2013 T P 15 117 60
FATAR YOYO RT. 004/006 8/7/2017 10/13/2015 T L 11 95 61
FIRA SAEPUL RT. 004/006 8/7/2017 12/20/2013 T P 13 100 62
YOS OYON RT. 004/006 8/7/2017 9/1/2014 T L 15 110 63
ULFA SAMAN RT. 005/006 8/7/2017 8/28/2013 T P 20 190 64
ALIF SLAMET RT. 004/006 8/7/2017 5/21/2014 T L 16 112 65
GOFUR JAUZI RT. 004/006 8/7/2017 2/1/2013 T L 17 120 66
DIKRI DANDI RT. 004/006 8/7/2017 10/25/2013 T L 17 117 67
GABRIEL PUTRA RT. 005/006 8/7/2017 11/10/2016 T L 8.5 66 68
PETUGAS
(...................................)
FORMULIR PENCATATAN


2 3 4 5 6 7 8 9 10 11 12 1
NAYLA NIMIN RT. 004/006 8/7/2017 2/8/2014 B P 16 119 69
BINTANG NIMIN RT. 004/006 8/7/2017 6/1/2017 T L 6 53 70
FAIRUZ EDI RT. 004/006 8/7/2017 10/23/2015 B L 11 104 71
RAYHAN WIDI / RINI RT. 004/006 8/7/2017 1/29/2015 B L 11 101 72
AQILA TEGUH / RISWADI RT. 004/006 8/7/2017 1/31/2015 B P 11 101 73
ADNAN FARID / WINDA RT. 004/006 8/7/2017 2/9/2013 B L 12 111 74
AZIS UPAY / CASWI RT. 004/006 8/7/2017 11/25/2013 B L 18 117 75
AZZAHRA INGGIT / MAYA RT. 005/006 8/7/2017 1/5/2017 T P 8.5 65 76
TORAZ ERWIN / AISYAH RT. 005/006 8/7/2017 5/11/2015 B L 15 110 77
RAJU BONAR / SUDARI RT. 005/006 8/7/2017 3/14/2017 T L 8 61 78
ALFARIZQI ANTO / ROSIDAH RT. 005/006 8/7/2017 4/11/2017 T L 8 59
ALIKA WAHYU / ZAHYANAH RT. 005/006 8/7/2017 11/15/2016 T P 7 65
AIRA AGUNG / LUSI RT. 005/006 8/7/2017 5/10/2017 T P 6 57
ALBI DIDIN / MAYA RT. 005/006 8/7/2017 5/24/2017 T L 5.5 57
MANGGALA SETIONO / SITI Z. RT. 005/006 8/7/2017 11/1/2016 T L 8.2 64
M. FATIH SETIONO / SITI Z. RT. 005/006 8/7/2017 6/2/2014 B L 14 114
HINATA ADE / ITA RT. 004/006 8/7/2017 1/8/2017 T P 8 62
MUGHNI TARYANTO / MULYANI 8/7/2017 9/26/2016 L 8 66
RAFA TARYANTO / MULYANI 8/7/2017 4/7/2001 L 13 119
YUSRA WAHYUDIN 8/7/2017 11/2/2012 L 17 118
NAJWA TOYIB RT. 005/006 8/7/2017 10/15/2013 P 13 111
JULI JUNAIDI RT. 005/006 8/7/2017 7/5/2013 P 12 107
JENI JUNAIDI RT. 005/006 8/7/2017 1/3/2015 P 11 92
AYUNDA SAEPUL RT. 005/006 8/7/2017 1/4/2015 P 14 102
M. ZIYAD GANDI RT. 004/006 8/7/2017 10/16/2016 L 7.5 62
SYIFA SALIM 8/7/2017 3/14/2013 P 12 100
NAVIA ACIM 8/7/2017 11/24/2016 P 7.5 63
KHAIRA SUGENG 8/7/2017 7/17/2013 P 15 112
ANASTASYA RETNO RT. 004/006 8/7/2017 10/13/2012 P 15 118
DANI YUNIATO RT. 005/006 8/7/2017 6/19/2015 L 1 103
AMEL SAMIN RT. 005/006 8/7/2017 6/15/2012 P 17 127
JIAN ENDANG RT. 004/006 8/7/2017 5/7/2015 P
SALSABILA 8/7/2017
FAJAR 8/7/2017
35
PETUGAS
(...................................)
FORMULIR PENCATATAN

POSYANDU/DESA : ASTER 2 / PASIR GOMBONG

ALAMAT G / NG L/P
2 3 4 5 6 7 8 9 10 11 12
KENZI ARIS RT. 004/006 8/7/2017 6/10/2011 L
RAFLI PARIADI RT. 004/006 8/7/2017 3/9/2013 L 16 118
ZIO RT. 004/006 8/7/2017 22 126
AGA HERI 8/7/2017 12/22/2013 12 113
TIKA AL 8/7/2017 7/15/2015 10 92
ALIKA YUSUF 8/7/2017 5/22/2016 12 98
ALISA YUSUF 8/7/2017 10/5/2012 18 117
DAFA HAKIM 8/7/2017 10/21/2015 6.5 104
KHADAFI ATEN 8/7/2017 10/19/2016 9
SALMAN 8/7/2017
AYSILA UMANG 8/7/2017 9/26/2015 10 100
IMEL 8/7/2017
PANJI 8/7/2017
ELMA 8/7/2017
8/7/2017
8/7/2017
8/7/2017
8/7/2017
8/7/2017
8/7/2017
8/7/2017
8/7/2017
8/7/2017
8/7/2017
8/7/2017
PETUGAS
(...................................)
(...................................)
FORMULIR PENCATATAN

POSYANDU/DESA : MELATI 1 / PASIR GOMBONG ( KP. SEMPU ) POSYANDU/DESA

2 3 4 5 6 7 8 9 7.8 11 12 1
ZAINAL MELIH / NAMIH RT. 003/003 8/9/2017 4/5/2016 B L 8 84 1
CHILA MAN / DEVI RT. 003/003 8/9/2017 9/18/2014 B P 16.2 90.4 2
DEFA DEDE / IDA RT. 003/003 8/9/2017 7/29/2014 B P 12 94.4 3
CANTIKA NURGENI / JUJU RT. 003/003 8/9/2017 9/10/2014 B P 11 91 4
AINAYA SUROSO / NUNIK RT. 003/003 8/9/2017 1/22/2015 B P 11 90 5
AZIZAH BANI / ASIH RT. 003/003 8/9/2017 5/12/2016 T P 8.1 72.2 6
SITI FARHANAH IMAN / ROMLAH RT. 003/003 8/9/2017 7/10/2015 B P 10.5 84.5 7
SITA SURAHMAN / SARI RT. 003/003 8/9/2017 5/20/2013 B P 16 10.5 8
TEGAR JAYA / ELI RT. 003/003 8/9/2017 6/6/2013 B L 16 101.5 9
BRIYAN FERI / MIMIN RT. 003/003 8/9/2017 1/12/2015 B L 12 91 10
NAYA DAKUN / DAISAH RT. 003/003 8/9/2017 3/28/2013 B P 15 98 11
ABIYU RAHMAN / SRI RT. 003/003 8/9/2017 9/11/2016 B L 9 78.5 12
ARINI ARI / ARIS RT. 003/003 8/9/2017 4/2/2017 T P 5.4 63 13
NAFIS SAIP / FITRI RT. 003/003 8/9/2017 4/29/2014 B P 11.5 91 14
BILQIS TEDI / RINI RT. 003/003 8/9/2017 11/14/2014 B P 19.3 93.6 15
JINDAN SLAMET / DIANA RT. 003/003 8/9/2017 6/19/2016 T L 8.5 74 16
RADITYA SARIPUDIN / IIN RT. 003/003 8/9/2017 2/20/2016 T L 11.5 80 17
RAISYA BUDI / ROS RT. 003/003 8/9/2017 6/6/2013 T P 14.8 100.6 18
QISYA DANI / DESI RT. 003/003 8/9/2017 7/24/2016 B P 8.9 73.8 19
M. AZIS DOIM / WACIH RT. 003/003 8/9/2017 10/26/2016 T L 8.5 72 20
SALSABILA SAMSUL / ATUN RT. 003/003 8/9/2017 7/12/2015 T P 10.1 84.5 21
M. RAFA MUR / DIAN RT. 003/003 8/9/2017 1/13/2015 B L 13.4 91.2 22
KANAYA MUHTAR / EVI RT. 003/003 8/9/2017 10/28/2013 T P 15.8 104 23
EL NINO NABRIH / NURUL RT. 003/003 8/9/2017 5/30/2015 B L 14.1 96 24
KAILA KARNA / WASIMAH RT. 003/003 8/9/2017 4/25/2016 T P 8 75.1 25
DIANA P. NURDI / WATI RT. 003/003 8/9/2017 11/12/2012 B P 21 11.7 26
ADIBA SAIPUL / MUTIA RT. 003/003 8/9/2017 12/20/2015 B P 10.5 82.8 27
AGAM SUHNDI / WATI RT. 003/003 8/9/2017 10/31/2014 T L 12.4 93.6 28
DAFA DEDE / RISKA RT. 003/003 8/9/2017 7/4/2013 B L 15 99.4 29
AZKA WAHYU / FERA RT. 003/003 8/9/2017 2/4/2013 B P 14 98.1 30
AFIKA GINANJAR / LILI RT. 003/003 8/9/2017 6/24/2013 B P 13 98.1 31
IMAS SUTIJO / JAEMAH RT. 003/003 8/9/2017 2/28/2015 T L 11 88.6 32
PUPUT KARSAN / TINI RT. 003/003 8/9/2017 9/20/2014 T P 13.5 95 33
PUAN HAGI / MIKE RT. 003/003 8/9/2017 2/6/2013 T P 16 102 34
PETUGAS
(...................................)
FORMULIR PENCATATAN


2 3 4 5 6 7 8 9 10 11 12 1
NAILA SOANR / NUR RT. 003/003 8/9/2017 9/19/2013 B P 13.2 93.7 35
HILDA JISRUN / AINUR RT. 003/003 8/9/2017 8/6/2015 B P 9 81.5 36
INTAN ASMUNI / IJAH RT. 003/003 8/9/2017 4/19/2014 B P 10.7 87.6 37
NIZAM AMIN / DIAH RT. 003/003 8/9/2017 11/28/2014 B L 12 92.5 38
GINA ROHMAN / LINA RT. 003/003 8/9/2017 4/2/2016 B P 8.5 74.5 39
RACHEL BANGGA / WULAN RT. 003/003 8/9/2017 4/2/2013 B P 11 100.8 40
AYYARA SUGIH / DEWI RT. 003/003 8/9/2017 9/10/2015 B P 9.7 81 41
M. HAIKAL SUGIARTO / SRI RT. 003/003 8/9/2017 6/17/2017 T L 5.2 55 42
DAYAT SYARIFUDIN / TINA RT. 003/003 8/9/2017 10/31/2014 B L 14.6 91 43
RAFI MANSUR / APRI RT. 003/003 8/9/2017 7/31/2013 B L 19 107.5 44
NAZWA UCU / YUNI RT. 003/003 8/9/2017 7/21/2012 B P 14 103.3 45
ARKAN UCU / YUNI RT. 003/003 8/9/2017 2/19/2016 T L 8.1 71 46
M. RIFKI ADIM / WAHYUNI RT. 003/003 8/9/2017 11/25/2016 T L 9 71 47
DESI RATNA RAIN / SITI RT. 003/003 8/9/2017 8/14/2013 B P 11.4 87.5 48
HILMA S. ALIL / SAMIN RT. 003/003 8/9/2017 4/15/2016 T P 7.5 72 49
RAFFI MISTA / ANA RT. 003/003 8/9/2017 5/10/2015 B L 9.5 85.5 50
SOFI HERI / IPAH RT. 003/003 8/9/2017 8/20/2013 B P 11 92.6 51
NAILA P. KASIM / OMAH RT. 003/003 8/9/2017 4/9/2016 T P 7.5 72 52
ARSYAM EMIN / WIJI RT. 003/003 8/9/2017 6/26/2015 B L 12 90 53
RAFA ENDI / RINA RT. 003/003 8/9/2017 2/8/2017 T L 8 69.8 54
NABILA UDIN / DEWI RT. 003/003 8/9/2017 2/16/2013 T P 15 16.4 55
RIANA M. ZAINUDIN / ASIH RT. 003/003 8/9/2017 7/15/2015 T P 12 90 56
UMAY UDI / SARNI RT. 003/003 8/9/2017 2/6/2017 T L 7.7 69 57
DILA FERI /ANI RT. 003/003 8/9/2017 1/31/2016 T P 8.2 78 58
BINTANG AGUN / DEWANTI RT. 003/003 8/9/2017 7/25/2015 B P 9.4 85.9 59
YOGA ADI / SAROH RT. 003/003 8/9/2017 9/14/2012 T L 14.9 103.5 60
AYU IRHAM / ERNI RT. 003/003 8/9/2017 1/12/2015 T P 14.5 95 61
ZIDAN BENI / IIS RT. 003/003 8/9/2017 10/19/2015 T L 10 83.2 62
ALIFAH DEDI / KESIH RT. 003/003 8/9/2017 11/3/2013 T P 13 98.2 63
NAIRA ZAFRI / DIAH RT. 003/003 8/9/2017 8/15/2016 T P 8 69 64
ANINDIYA DANANG / IPAH RT. 003/003 8/9/2017 4/9/2016 T P 8.7 80 65
SYIFA DANANG / IPAH RT. 003/003 8/9/2017 4/8/2013 T P 14.5 104 66
FADHILAH SA'AM / INTAN RT. 003/003 8/9/2017 11/13/2012 B L 20 97 67
ARKAN SUYADI / LILIS RT. 003/003 8/9/2017 9/2/2013 T L 16 99 68
PETUGAS
(...................................)
FORMULIR PENCATATAN


2 3 4 5 6 7 8 9 10 11 12 1
NISA SATIKEN / AZIZAH RT. 003/003 8/9/2017 7/29/2012 B P 13.3 102 69
IVANA RIAN / SINTA RT. 003/003 8/9/2017 8/16/2012 B P 20 100 70
FAY RIAN / SINTA RT. 003/003 8/9/2017 5/28/2014 B P 15 87 71
DAFA ITA / AYAT RT. 003/003 8/9/2017 7/26/2013 B L 15 90 72
SYIFA AZKIANI RINA / ACENG RT. 003/003 8/9/2017 8/16/2013 B P 16 92 73
NATANIA AISYAH / YUDI RT. 003/003 8/9/2017 6/17/2013 B P 16 103 74
SITI KHADIJAH UDIN / MINAH RT. 003/003 8/9/2017 4/14/2016 B P 8.9 78 75
ZULFA SARDI / MINTI RT. 003/003 8/9/2017 6/13/2014 B P 12 89 76
ANGGA IMAM / ROHMAH RT. 003/003 8/9/2017 1/27/2013 B L 15 96 77
RAISA BONAN / MINAH RT. 003/003 8/9/2017 9/24/2013 B P 16 93 78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
BERAYA MIKHA E8/38 8/3/2017 L 17.4 103 BLN
PETUGAS
(...................................)
PUSKESMAS
POSYANDU/DESA
NO
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
PUSKESMAS
POSYANDU/DESA
NO
137
138
139
FORMULIR PENCATATAN

POSYANDU/DESA : ANGGREK 1 / PASIR GOMBONG ( KP. JATI ) POSYANDU/DESA

2 3 4 5 6 7 8 9 10 11 12 1
RIZKY M. MUHIDIN RT. 001/001 8/15/2017 3/27/2017 T L 6.3 70 1
MARTIN TASIM RT. 001/001 8/15/2017 10/11/2012 B L 13 117 2
ADZIBA A.E EFENDI RT. 001/001 8/15/2017 3/27/2015 B P 13 90 3
ADNAN HANIF DADANG RT. 001/001 8/15/2017 T L 6.3 61 4
WIRA GADING RT. 001/001 8/15/2017 B L 15 122 5
FADHAN M.K AFIR HIDAYAT RT. 001/001 8/15/2017 B L 9 87 6
ABDUL DARYANTO RT. 001/001 8/15/2017 3/8/2014 B L 13 101 7
DAFFA DODI RT. 001/001 8/15/2017 12/18/2014 B L 11 99 8
NILA A. ALI WIJAYA RT. 001/001 8/15/2017 10/2/2015 B P 11 103 9
ADI PUTRA ACIN RT. 001/001 8/15/2017 3/31/2016 B L 9 85 10
ALYA AZIZAH BUDI PRAYOGO RT. 001/001 8/15/2017 6/17/2016 T P 8.8 84 11
HALIMAH OMA ROHMA RT. 001/001 8/15/2017 8/22/2014 B P 11 103 12
M. RAIZ LUKMAN RT. 001/001 8/15/2017 10/17/2015 B L 9 90 13
LUTFI NURJAYA RT. 001/001 8/15/2017 1/15/2014 B P 10 94 14
WAFA LATIFAH NURJAYA RT. 001/001 8/15/2017 11/26/2016 T P 7.5 64 15
ALFIAN PRIA RT. 001/001 8/15/2017 4/22/2016 B L 9.9 86 16
HAFSOH ZAELANI RT. 001/001 8/15/2017 11/19/2014 B P 11 98 17
ZULFATUL ULFAH MINA RT. 001/001 8/15/2017 10/27/2016 T P 8.8 69 18
ANGEL UJANG ZAILANI RT. 001/001 8/15/2017 7/26/2014 B P 10 103 19
SAFIRA RAMA RT. 001/001 8/15/2017 2/14/2014 B P 12 103 20
FARIS R. HASANUDIN RT. 001/001 8/15/2017 4/23/2015 B L 11 99 21
KALISAH Q. AJAT RT. 001/001 8/15/2017 T P 4.2 46 22
HILMI PADLI RT. 001/001 8/15/2017 7/7/2015 B P 11 93 23
SILA TARONI RT. 001/001 8/15/2017 11/20/2016 B P 10 92 24
RIZKY RONI RT. 001/001 8/15/2017 12/6/2016 B L 10 97 25
LOFIYANA SOLATUN RT. 001/001 8/15/2017 T P 8.2 9 26
FAREL FERI RT. 001/001 8/15/2017 11/9/2014 B L 13 102 27
AZKA IQBAL RT. 001/001 8/15/2017 B P 15 107 28
LIA SAIFUL RT. 001/001 8/15/2017 B P 12 95 29
AL-GHAZALI MARIYANA RT. 001/001 8/15/2017 9/19/2015 B L 16 101 30
NAURA MUKSIH RT. 001/001 8/15/2017 9/21/2015 B P 1 100 31
SAFUL ANWAR NUR ALI RT. 001/001 8/15/2017 10/24/2016 T L 10 85 32
SYAHRUL R. DANI RT. 001/001 8/15/2017 4/20/2017 T L 7.3 65 33
ABDUL FARID RT. 001/001 8/15/2017 B L 12 102 34
PETUGAS
(...................................)
FORMULIR PENCATATAN


2 3 4 5 6 7 8 9 10 11 12 1
M. RAMDAN MANSYUR RT. 001/001 8/15/2017 5/10/2014 B L 12 95 35
SURYADI F. DEDI RT. 001/001 8/15/2017 7/9/2016 T L 9.5 70 36
IRWAN MARTA RT. 001/001 8/15/2017 5/25/2015 B L 10.5 92 37
AULIA NASRUDIN RT. 001/001 8/15/2017 9/23/2017 T P 7.5 38
BELLA NASRUDIN RT. 001/001 8/15/2017 B P 13 39
DELISA SULAEMAN RT. 001/001 8/15/2017 1/1/2016 B P 10 78 40
NAYA ICAM RT. 001/001 8/15/2017 1/10/2016 B P 9 80 41
NURHASANAH RAHMAN RT. 001/001 8/15/2017 5/2/2013 B P 15 112 42
LUTFI RAHMAT RT. 001/001 8/15/2017 7/2/2013 B P 12 105 43
AZMI MAKFIROH RT. 001/001 8/15/2017 B P 13 109 44
RIAN AJI RT. 001/001 8/15/2017 B L 13 108 45
ADNAN S. KARNA RT. 001/001 8/15/2017 12/6/2013 B P 11 109 46
PANDA ENDANG RT. 001/001 8/15/2017 12/29/2016 B L 10 91 47
PANDU SOLEH RT. 001/001 8/15/2017 10/18/2012 B L 20 115 48
FAZRI ADUL RT. 001/001 8/15/2017 9/6/2015 B L 10 85 49
FAJAR ADUL RT. 001/001 8/15/2017 9/6/2015 B L 12 87 50
REZA ARJUN RT. 001/001 8/15/2017 9/28/2014 B L 10 94 51
SALSABILA AMUI RT. 001/001 8/15/2017 11/1/2016 T P 8.4 67 52
BAGAS ANDI M. RT. 001/001 8/15/2017 B L 17 124 53
BAGUS ANDI M. RT. 001/001 8/15/2017 B L 16 119 54
SALSA ANTO RT. 001/001 8/15/2017 10/21/2014 B P 12 99 55
ANGEL BAGUS RT. 001/001 8/15/2017 B P 18 93 56
ASILA MUNTOPIK RT. 001/001 8/15/2017 10/14/2014 B P 16 95 57
ARA SUTAY RT. 001/001 8/15/2017 8/4/2015 B P 8 68 58
RIZKY SELAMET RT. 001/001 8/15/2017 11/6/2016 T L 9.4 94 59
NURHASANAH RAHMAT RT. 001/001 8/15/2017 10/12/2015 B P 10 89 60
NUGIE CANDRA RT. 001/001 8/15/2017 10/10/2013 B L 10 93 61
AL-BUKHORI PRASETIO RT. 001/001 8/15/2017 7/27/2016 B L 12 102 62
KHOSIYAH SURAHMAN RT. 001/001 8/15/2017 8/1/2014 B P 13 103 63
AULIA ANTO RT. 001/001 8/15/2017 5/26/2017 T P 5.5 54 64
AZRIL NURMAN RT. 001/001 8/15/2017 T L 6.1 54 65
FANELLA ANTON RT. 001/001 8/15/2017 T P 6.6 62 66
ALIF NAJIB RT. 001/001 8/15/2017 B L 14 110 67
RIZKIA NAJIB RT. 001/001 8/15/2017 4/7/2016 B P 10 95 68
PETUGAS
(...................................)
FORMULIR PENCATATAN


2 3 4 5 6 7 8 9 10 11 12 1
AQILA SAMINTA RT. 001/001 8/15/2017 4/6/2014 B P 13 107 69
AHMAD IZWAR R. RIZKY RT. 001/001 8/15/2017 B L 11 96 70
KARISA ENDRI RT. 001/001 8/15/2017 7/29/2014 B P 12 120 71
ABDIL ABAR RT. 001/001 8/15/2017 12/17/2016 B L 12 71 72
HAFI AMING RT. 001/001 8/15/2017 8/16/2013 B L 11 97 73
ANDRA KARNAIN RT. 001/001 8/15/2017 5/22/2015 B L 11 101 74
SALSA YOGI RT. 001/001 8/15/2017 2/8/2016 B P 10 85 75
SILVI G.A SUPRIYANTO RT. 001/001 8/15/2017 9/9/2015 B P 9.4 79 76
HAFIS TOYIB RT. 001/001 8/15/2017 1/29/2014 B L 14 111 77
SAKIRA SOPIAN RT. 001/001 8/15/2017 12/23/2014 B P 11 101 78
ERIN SUBEKTI RT. 001/001 8/15/2017 10/10/2014 B P 11 110 79
SALSABILA REZA RT. 001/001 8/15/2017 11/24/2015 B P 10 93 80
RIZKY UJANG RT. 001/001 8/15/2017 11/19/2015 B L 10 87 81
KENZI DEBI RT. 001/001 8/15/2017 4/15/2016 B L 12 89 82
AISYAH S. TARSO RT. 001/001 8/15/2017 12/12/2015 B P 14 110 83
M. NURIL A. HASAN RT. 001/001 8/15/2017 8/27/2014 B L 35 127 84
AZMI LUSNU RT. 001/001 8/15/2017 12/1/2015 T P 5 57 85
HANIA MAYUDIN RT. 001/001 8/15/2017 3/12/2014 B P 11 94 86
DEDE RAHMAT RT. 001/001 8/15/2017 8/27/2014 B P 11 98 87
AINIDTA EKO RT. 001/001 8/15/2017 12/1/2015 T P 9.7 91 88
BANU USNU RT. 001/001 8/15/2017 3/12/2014 B L 13 112 89
KAREL NARTOYO RT. 001/001 8/15/2017 T L 9 80 90
FAISA DADANG RT. 001/001 8/15/2017 T P 9 85 91
ZIBKIRON SUKRON RT. 001/001 8/15/2017 11/8/2016 B L 10 78 92
CANDRA BUDI RT. 001/001 8/15/2017 6/24/2014 B L 11 98 93
RANI WARDI RT. 001/001 8/15/2017 12/9/2014 B P 9 79
NISRIN DEDEN RT. 001/001 8/15/2017 7/20/2014 B P 15 111
ADRIAN ARI WIBOWO RT. 001/001 8/15/2017 11/23/2013 B L 11 101
ANGGA MUMU RT. 001/001 8/15/2017 L
RAFIQ DADANG RT. 001/001 8/15/2017 9/5/2015 B L 10 79
NAZRIL YUDI RT. 001/001 8/15/2017 11/14/2016 B L 9.1 76
ARSYILA ARI WIBOWO RT. 001/001 8/15/2017 8/2/2016 T P 8.4 68
FATHAN RICO RT. 001/001 8/15/2017 1/7/2014 B L 12 68
FATHIAN RICO RT. 001/001 8/15/2017 5/14/2017 T L 5.4 50
PETUGAS
(...................................)
FORMULIR PENCATATAN

POSYANDU/DESA : ANGGREK 1 / PASIR GOMBONG ( KP. JATI )

ALAMAT G / NG L/P
2 3 4 5 6 7 8 9 10 11 12
SYAMIL ISMAIL RT. 001/001 8/15/2017 8/20/2016 T L 8.2 68
RIZKY DWI RT. 001/001 8/15/2017 10/24/2014 B L 13 105
AZ-ZAHRA SUTIKNO RT. 001/001 8/15/2017 12/11/2014 B P 10 99
M. AL GHAFARI MADIH RT. 001/001 8/15/2017 1/17/2017 T L 8.9 65
ANINDIKA JONI RT. 001/001 8/15/2017 4/10/2016 B P 9.8 75
FAHRI WAHONO RT. 001/001 8/15/2017 1/12/2015 B L 16 106
ZAHRA YAHYA RT. 001/001 8/15/2017 1/5/2015 B P 11 59
M. FIQIH FIKRIYANA RT. 001/001 8/15/2017 8/28/2013 B L 14 112
KEYLA ZAFIRA ANGGI KUSUMA RT. 001/001 8/15/2017 9/24/2016 T P 7.6 69
AY-NAYA ASEP RT. 001/001 8/15/2017 8/20/2015 B P 11 97
ADJAST HERI RT. 001/001 8/15/2017 4/14/2016 B L 9.4 83
A. BIMA Q. BENI RT. 001/001 8/15/2017 7/19/2015 B L 12 103
HAFIFAH N. HERU RT. 001/001 8/15/2017 1/15/2013 B P 19 103
KAIRA HENDRA RT. 001/001 8/15/2017 8/31/2013 B P 19 102
KAHFI SAIFUL ANWAR RT. 001/001 8/15/2017 7/18/2013 B L 16 113
HADIT H. AGUS RT. 001/001 8/15/2017 B L 18 114
ZAFRAN ADE SAPUTRA RT. 001/001 8/15/2017 7/5/2015 B L 11 98
FABIAN IHSAN RT. 001/001 8/15/2017 8/5/2013 B L 13 108
GUGUN SARMAN RT. 001/001 8/15/2017 1/23/2012 B L 16 113
LINTANG AGUNG RT. 001/001 8/15/2017 B L 12 111
ARSAKA ZAINUDIN RT. 001/001 8/15/2017 B L 10 93
ASHAR AGUNG RT. 001/001 8/15/2017 3/14/2016 B L 9.6 89
FARID H. KARMAN RT. 001/001 8/15/2017 B L 13 111
IBRAHIM ERWIN RT. 001/001 8/15/2017 2/22/2015 B L 12 98
AIDAN ERWIN RT. 001/001 8/15/2017 B L 18 114
ASKA AHMAD KHOLILI RT. 001/001 8/15/2017 B L 11 100
SARAH TARNOYO RT. 001/001 8/15/2017 B P 11 108
M. DALIH NANA RT. 001/001 8/15/2017 10/22/2013 B L 12 104
ATNAN SAMSUL RT. 001/001 8/15/2017 B L 11 85
RAISA SATARI RT. 001/001 8/15/2017 12/25/2015 B P 8 85
HERI HENDRA RT. 001/001 8/15/2017 6/2/2015 B L 10 89
SAHRUL TUMANGIN RT. 001/001 8/15/2017 B L 9.5 80
RIKO A. RINTO RT. 001/001 8/15/2017 2/4/2015 B L 10 86
RIDHO WANDI RT. 001/001 8/15/2017 6/2/2016 L
PETUGAS
(...................................)
FORMULIR PENCATATAN

POSYANDU/DESA : ANGGREK 1 / PASIR GOMBONG ( KP. JATI )

ALAMAT G / NG L/P
2 3 4 5 6 7 8 9 10 11 12
RAFA ROBI RT. 001/001 8/15/2017 6/15/2016 L
NAURA H. HASAN RT. 001/001 8/15/2017 1/29/2016 P
NAIRA H. HASAN RT. 001/001 8/15/2017 1/29/2016 P
PETUGAS
(...................................)
FORMULIR PENCATATAN

POSYANDU/DESA : CEMPAKA 2 / PASIR GOMBONG

ALAMAT G / NG L/P
2 3 4 5 6 7 8 9 10 11 12
SYAFIRA ACE RT. 004/002 8/2/2017 9/5/2015 B P 15 89
RAFFA DIKI RT. 004/002 8/2/2017 5/7/2016 T L 8.9 73
PUTERI MIKA DERI RT. 004/002 8/2/2017 7/1/2017 T P 4.5 84
WIDIA EDI RT. 004/002 8/2/2017 5/10/2014 B 13 90
ISNA ALI RT. 004/002 8/2/2017 5/30/2015 L 10 82
ALYA KAMSI RT. 004/002 8/2/2017 6/28/2016 8.5 725
DAFFA SAMSURI RT. 004/002 8/2/2017 12/22/2015 L 10 82
RAIHAL SYARIF RT. 004/002 8/2/2017 3/22/2017 6.6 59
RUBY KOHAR RT. 004/002 8/2/2017 11/7/2015 11 81
FADLAN RIZKY RT. 004/002 8/2/2017 9/2/2014 15 93
FADHIL JUMADI RT. 004/002 8/2/2017 2/20/2016 8.7 75
ARIJAL UYUN RT. 004/002 8/2/2017 10/26/2016 10 70
ABIDZAR IWAN RT. 004/002 8/2/2017 7/29/2013 15 93
BISMA SAKRIB RT. 004/002 8/2/2017 10/3/2014 13 92
M. FAHREZI NEMIN RT. 004/002 8/2/2017 12/6/2016 15 92
BALQIS BENI RT. 004/002 8/2/2017 7/6/2013 15 101
LITFIAH YADI RT. 004/002 8/2/2017 5/19/2013 15 100
JASMIN IMAN RT. 004/002 8/2/2017 1/3/2015 11 90
SYIFA EDI RT. 004/002 8/2/2017 6/17/2013 13 93
RAFI WIDIATMOKO RT. 004/002 8/2/2017 7/26/2013 14 94
YUDISTIRA ANING RT. 004/002 8/2/2017 1/23/2015 12 83
WISNU DIMAN RT. 004/002 8/2/2017 9/20/2014 13 90
RINDU SUNANDAR RT. 004/002 8/2/2017 2/26/2015 10 83
FIKA CUCU RT. 004/002 8/2/2017 3/4/2013 15 104
GEA / MARWAH SUHARYANTO RT. 004/002 8/2/2017 10/10/2015 9 80
VIRGIAWAN WANTO RT. 004/002 8/2/2017 10/28/2014 10 88
SULTAN DEDE RT. 004/002 8/2/2017 11/21/2014 14 90
TIA ASWATUN SUHERMAN RT. 004/002 8/2/2017 11/23/2016 9.5 62
AFNAN ABD. R. M. ASEP RT. 004/002 8/2/2017 3/17/2017 8 61
HINDU ZAHIRA TARWAN RT. 004/002 8/2/2017 8/5/2013 1 102
ARDIANSYAH HENDAR RT. 004/002 8/2/2017 4/12/2013 13 96
RIZKY RINDI RT. 004/002 8/2/2017 6/11/2013 15 100
RAFFA FIKRI RT. 004/002 8/2/2017 2/13/2016 8 74
AJI SUPANOH RT. 004/002 8/2/2017 1/1/2016 10 84
PETUGAS
(...................................)
FORMULIR PENCATATAN


ALAMAT G / NG L/P
2 3 4 5 6 7 8 9 10 11 12
ADINDA M. HARIS RT. 004/002 8/2/2017 6/1/2017 P 4.8 50
ADRIYAN ASEP RT. 004/002 8/2/2017 3/3/2017 7 58
ADIS MUDR RT. 004/002 8/2/2017 2/28/2015 10 85
SITI KHOLIFAH UWAN SUWANDA RT. 004/002 8/2/2017 7/23/2013 12 96
ADHYSTA SAFARI RT. 004/002 8/2/2017 11/28/2016 6.9 62
KAMILA DAANG RT. 004/002 8/2/2017 5/9/2014 1 52
NAURA ACEP RT. 004/002 8/2/2017 3/3/2016 8.5 73
SHAZFA MUKRIANA RT. 004/002 8/2/2017 7/5/2016 7.5 70
NABILA IPIN RT. 004/002 8/2/2017 6/17/2003 14 98
RAIHAN CARMIN RT. 004/002 8/2/2017 6/10/2013 16 100
RAISYA IRMANSYAH RT. 004/002 8/2/2017 1/10/2014 12 93
MARSYA IRMANSYAH RT. 004/002 8/2/2017 3/3/2015 10 83
AINUN AMIN RT. 004/002 8/2/2017 5/20/2014 11 79
KIRANA IRMANSYAH RT. 004/002 8/2/2017 10/6/2016 6.5 51
KENZIE PANDU YAYAN RT. 004/002 8/2/2017 8/29/2016 8.2 64
ANIS SUKESA RT. 004/002 8/2/2017 5/8/2015 11 85
AZKA HARUN RT. 004/002 8/2/2017 7/11/2014 13 97
RAFA WASKITO RT. 004/002 8/2/2017 10/9/2015 10 87
ALBI LUTFI ABD. LATIF RT. 004/002 8/2/2017 10/27/2016 8 60
ATIFA AHMAD BURHAN RT. 004/002 8/2/2017 7/25/2015 8.2 82
NAJWA RENO RT. 004/002 8/2/2017 6/21/2015 10.5 82
MEGANIA DADAN RT. 004/002 8/2/2017 6/10/2014 11 85
ALYA ARIF RT. 004/002 8/2/2017 31/4/15 10 78
AQILA YUSUF RT. 004/002 8/2/2017 8/23/2015 12.2 15
ZAHRA Z. RUSHIYANSYAH RT. 004/002 8/2/2017 4/7/2017 6.8 63
ANNISA TAKHURI RT. 004/002 8/2/2017 2/18/2014 13 90
CLAUDIA SOBARI RT. 004/002 8/2/2017 7/17/2014 15 96
FAREL BAGUS RT. 004/002 8/2/2017 6/8/2016 9.2 67
MALIK RADIKA EMAN RT. 004/002 8/2/2017 4/29/2016 9 74
ALYA RASMADI RT. 004/002 8/2/2017 1/27/2015 11 86
ANDIKA DARYANTO RT. 004/002 8/2/2017 8/11/2012 20 110
M. RIZA SHAHLI RT. 004/002 8/2/2017 8/28/2014 11 88
INARA ATIP RT. 004/002 8/2/2017 4/24/2016 7.9 73
ATIQAH KAHFI RT. 004/002 8/2/2017 1/13/2016 10 80
PETUGAS
(...................................)
FORMULIR PENCATATAN


ALAMAT G / NG L/P
2 3 4 5 6 7 8 9 10 11 12
ERNA RIZAL RT. 004/002 8/2/2017 6/6/2014 15 94
SYASA AMINUDIN RT. 004/002 8/2/2017 7/6/2016 11 73
AZRIEL YURIDILLAH RT. 004/002 8/2/2017 9/1/2014 14 98
KHANZA SUBUR RT. 004/002 8/2/2017 3/11/2017 6 66
BINTANG RAHMAT RT. 004/002 8/2/2017 9/28/2014 12 90
ABD. ROZAK RIDWAN RT. 004/002 8/2/2017 11/24/2015 13 83
FARIS SIGIT RT. 004/002 8/2/2017 3/28/2016 12 83
ASLAN RIZKY SULERISTANTO RT. 004/002 8/2/2017 7/3/2016 10 76
ZAVINKA MAMAN RT. 004/002 8/2/2017 3/5/2013 13 101
KHALIF NURMAN RT. 004/002 8/2/2017 2/16/2017 7 65
DIVA MAULANA SUKENDAR RT. 004/002 8/2/2017 6/12/2014 14 96
NABILA RUYAT RT. 004/002 8/2/2017 1/18/2014 16 100
FADIL AGUS RT. 004/002 8/2/2017 2/23/2014 15 94
AZKIA HANUN ANGGIT RT. 004/002 8/2/2017 3/5/2015 12 83
NOVAL MAULANA RT. 004/002 8/2/2017 1/10/2015 16 90
M. ALFATIH DAMIN RT. 004/002 8/2/2017 5/27/2016 9.5 77
ANINDI DIKI RT. 004/002 8/2/2017 8/20/2016 7.5 68
M. FIKIH UNAP RT. 004/002 8/2/2017 6/22/2017 5.2 62
ANNISA DWIYANTO RT. 004/002 8/2/2017 4/29/2017 5 58
AHMED AL FATIH CEVI KURNIAWAN RT. 004/002 8/2/2017 10/3/2016 9 75
AHMED AL FATKIH CEVI KURNIAWAN RT. 004/002 8/2/2017 10/3/2016 9 76
NICHOLAS ADI SUTINA RT. 004/002 8/2/2017 11/17/2013 12 92
QUTHBIE SAKHA D. RENDI RT. 004/002 8/2/2017 3/2/2017 8.5 67
AYSHA AILANI BURHANUDIN RT. 004/002 8/2/2017 4/3/2017 6.7 67
AULIA SAMSUDIN RT. 004/002 8/2/2017 5/10/2015 11 85
PETUGAS
(...................................)
FORMULIR PENCATATAN
BULAN PEMBERIAN VITAMIN A
PUSKESMAS :
POSYANDU/DESA : MAWAR 1 / PASIR GOMBONG
NAMA NAMA UMUR BB TB VIT

NO
BALITA ORANG TUA (BULAN) (KG) (CM) BIRU MERAH
1 LINA WARIN 25 BLN 10 97 ü
2 MARCHELL NIIN 28 BLN 11 107 ü
3 SHAQILA TOHA 34 BLN 15 106 ü
4 ZAHIRA UMAR 30 BLN 12 9.7 ü
5 ARI NURI RIONO 18 BLN 10 96 ü
6 AYAS BONAN 36 BLN 13 101 ü
7 AISYAH SALAMM 24 BLN 12 98 ü
8 FIRA BONAN 9 BLN 6 62 ü
9 SHELVIA KARWAN 40 BLN 14 102 ü
10 NAGIA SYARIFAH 27 BLN 9.3 97 ü
11 AIDA DALIH 46 BLN 14 103 ü
12 PIPIT DODI 35 BLN 14 102 ü
13 FAJAR DADANG 19 BLN 10 96 ü
14 MELISSA JO 16 BLN 11 100 ü
15 NANDITA MARWATI 39 BLN 14 103 ü
16 HILAL TRIO 34 BLN 14 99 ü
17 AZKA ENDING 16 BLN 11 73 ü
18 FAJAR SAMAT 28 BLN 12 98 ü
19 GISEL JOKO 26 BLN 10 81 ü
20 NATHAN MUID 16 BLN 9 98 ü
21 WILDAN M. KHOIRUDIN 9 BLN 7 60 ü
22 ASYIFA DANI 9 BLN 6 61 ü
23 RAFKA DANI 18 BLN 11 79 ü
24 FALAH MARTIN 29 BLN 13 99 ü
25 ALIYA EMAN 55 BLN 15 101 ü
26 BAMBANG ADIT 53 BLN 16 102 ü
27 RASYA DEDI 10 BLN 9 77 ü
28 SALSABILA JONI 29 BLN 12 83 ü
29 SHAHILA PIPIN 48 BLN 14 102 ü
30 YASHA RIKI 24 BLN 15 110 ü
31 ALISHA ANDI 28 BLN 15 109 ü
32 ZAM-ZAM DAMAN 21 BLN 10 78 ü
33 PUTRI AJI 36 BLN 10 84 ü
34 NURAINI FERDIANSYAH 51 BLN 16 114 ü
PETUGAS
(...................................)
FORMULIR PENCATATAN
PUSKESMAS :

NO
35 NURJANAH NAJA 52 BLN 14 110 ü
36 ARSIL TATANG 16 BLN 10.6 97 ü
37 DESKA DANI 14 BLN 7.7 88 ü
38 ADRIL MISLIM 29 BLN 16 99 ü
39 IRHAM SANUDIN 16 BLN 9.7 87 ü
40 RIFDA SIRBINI 36 BLN 12 93 ü
41 APRIL SLAMET 9 BLN 6 65 ü
42 DESWITA YADI 48 BLN 14 100 ü
43 RAFADHAN ARIF 19 BLN 13 97 ü
44 FEOZ ALI 52 BLN 17 117 ü
45 DAFA JOKO 3 BLN 15 112 ü
46 WISNU ARIF 24 BLN 14 93 ü
47 HUSNA SANUDIN 36 BLN 12 71 ü
48 FADLI ANDRI 39 BLN 15 111 ü
49 DESMIAN SUHENDAR 29 BLN 11 83 ü
50 NAZMA SUHERMAN 12 BLN 7.5 69 ü
51 ALI A. JOMAR 32 BLN 12 88 ü
52 SISIL UU 48 BLN 15 97 ü
53 DION HARYONO 52 BLN 18 103 ü
54 M. ZIDAN HANAFI 27 BLN 11 97 ü
55 AMORA ERNA 32 BLN 12 110 ü
56 ABIDZAR AGIL 32 BLN 14 109 ü
57 ADLAN AGUNG 6 BLN 6 55 ü
58 GALANG NANANG 52 BLN 14 115 ü
59 ARA AGUS 58 BLN 16 117 ü
60 RAMADHAN SARWAN 14 BLN 10 93 ü
61 KAKA ERI 59 BLN 16 110 ü
62 MISYA KOKO 15 BLN 8 92 ü
63 NANDIVA JOHAR 29 BLN 9 99 ü
64 SALMA HERU 53 BLN 13 98 ü
65 ICHA HERU 30 BLN 9 925 ü
66 PUTRI DOTING 35 BLN 10 60 ü
67 RIZAL 40 BLN 15 103 ü
68 SHIDIQ LUTFI 35 BLN 14 99 ü
PETUGAS
(...................................)
FORMULIR PENCATATAN
PUSKESMAS :

NO
69 AQILAH ANDI 48 BLN 24 119 ü
70 NAZWA ABDUL 24 BLN 13 102 ü
71 AZKA DENI 38 BLN 14 105 ü
72 IBRAHIM WAWAN 28 BLN 10 98 ü
73 KAYLA MATALI 15 BLN 10 93 ü
74 GILANG DARTO 35 BLN 10 99 ü
75 FIKRI SUKIRMAN 31 BLN 15 86 ü
76 HAFIDZI YANTO 36 BLN 14 109 ü
77 ASKIA HERI 35 BLN 11 98 ü
78 UMAR WILLY 28 BLN 9 87 ü
79 SITI KHADIJAH SAMAN 25 BLN 9 80 ü
80 AMIRA NANDANG 16 BLN 10 86 ü
81 AZKA AZIS 42 BLN 14 100 ü
82 HASYA ASEP 8 BLN 17 117 ü
83 DAFFA UDI 12 BLN 6 62 ü
84 IBBAS EGA 31 BLN 14 102 ü
85 NAURA IQBAL 12 BLN 9 92 ü
86 ABDUL RIA 48 BLN 14 110 ü
87 ANINDITA AGUS NANTO 8 BLN 7 67 ü
88 NAZWA NENDI 46 BLN 13 99 ü
89 SAFIK BASRI 13 BLN 8 68 ü
90 ERIK EMIN 60 BLN 13 110 ü
91 FAREL TAJUDIN 18 BLN 10 96 ü
92 JESSY JEJEN 36 BLN 10 99 ü
93 SARAH SUWANDI 15 BLN 7.5 80 ü
94 KANAYA MADAM 22 BLN 12 72 ü
95 ALVINA 33 BLN 13 97 ü
96 HAFIZ RAYA 36 BLN 14 89 ü
97 AL GHOZALI NURJAMAL 28 BLN 13 91 ü
98 ZULFA ZAENUDIN 48 BLN 12 94 ü
99 FAHKRUL MARTI 28 BLN 10 72 ü
100 FAIZAL SANTA 14 BLN 9 91 ü
101 NAFISA SANTA 13 BLN 9 92 ü
102 BLN ü
PETUGAS
(...................................)
PETUGAS
(...................................)
`
`
`
FORMULIR PENCATATAN
PUSKESMAS :
POSYANDU/DESA : NURI 1

1 2 3 4 5 6 7 8 9 10 11 12
1 LUTFI EVA / WAJAN 8/16/2017 2/15/2017 L 8.2 BLN
2 ISIKARIMAH AMELIA / HABIBULLAH 8/16/2017 12/4/2016 P 6.8 BLN
3 AHDAN SALAM / OTONG 8/16/2017 8/1/2015 L 8.8 BLN
4 ANGGA MARSIH / RASIM 8/16/2017 11/14/2014 L 12 BLN
5 ALFIANSYAH NUR / RAMLAN 8/16/2017 4/24/2016 L 12 BLN
6 TULIANSYAH INDAH / NURJAN 8/16/2017 7/13/2017 L 4.9 BLN
7 AZZWA MELANI / DULMALIK 8/16/2017 11/9/2013 P 11.5 BLN
8 ADZAMI MELANI / DULMALIK 8/16/2017 1/13/2015 L 11.5 BLN
9 FAJRIAN KIKI / DENI 8/16/2017 11/28/2014 L 13 BLN
10 AMEL ENAH / WARI 8/16/2017 1/15/2013 P 15 BLN
11 LANGIT WIWIN / SUYANTO 8/16/2017 9/14/2014 L 18 BLN
12 DARA EKA / NASWANTO 8/16/2017 4/19/2014 P 15 BLN
13 ILHAM SEPNAH / AHMAD 8/16/2017 8/6/2015 L 9 BLN
14 HALIMAH YONARAH / ADE 8/16/2017 7/12/2016 P 9.4 BLN
15 KAREL RODIAH / SARMADI 8/16/2017 7/14/2012 L 15 BLN
16 FARAH NURI / DEWI 8/16/2017 3/31/2016 P 8.4 BLN
17 FAREL YUYUN / HERU 8/16/2017 4/14/2014 L 14 BLN
18 RAKA ELA / AGUS 8/16/2017 12/20/2015 L 14 BLN
19 M. FAHRI KANAH / HASAN 8/16/2017 10/30/2014 L 7.6 BLN
20 ABIAN NANI / FARMAN 8/16/2017 4/22/2016 L 8.5 BLN
21 KENZO TIKA / DIDIN 8/16/2017 5/2/2015 L 14 BLN
22 HAIKAL RIA / IMRON 8/16/2017 10/2/2013 L 14 BLN
23 AL FAKINAN IKA / ASTONO 8/16/2017 1/10/2016 L 11 BLN
24 AZKA FITRI / WINDI 8/16/2017 7/16/2017 P 3.7 BLN
25 REYHAN DARINI / LUKMAN 8/16/2017 12/10/2013 L 14 BLN
26 ABSAHKA MELI / TOPIK 8/16/2017 5/28/2017 L 5.7 BLN
27 WILDAN ISAH / RESTONO 8/16/2017 7/10/2015 L 14 BLN
28 GHEA ANE / AGUNG 8/16/2017 10/18/2012 P 15 BLN
29 PUTRI HEMA / FERI 8/16/2017 11/10/2015 P 12 BLN
30 ALBIANO INDAH / EKO 8/16/2017 11/22/2016 L 8.6 BLN
31 AYU HANIFAH LUKFI / RUSLAN 8/16/2017 7/22/2017 P 4 BLN
32 TESA ANA / NAPITUPULO 8/16/2017 1/28/2016 P 10 BLN
33 ANASYA SOLIATI / TARJU 8/16/2017 1/13/2017 P 7.9 BLN
34 SARTIKA ARUMSIAH / ARI 8/16/2017 7/17/2015 P 10 BLN
PETUGAS
(...................................)
FORMULIR PENCATATAN
PUSKESMAS :
POSYANDU/DESA : NURI 1

1 2 3 4 5 6 7 8 9 10 11 12
35 AZAN EKA / TUSINO 8/16/2017 6/13/2016 L 8.6 BLN
36 ZAFIRA NIDIA / ANDI 8/16/2017 10/22/2015 P 11 BLN
37 MANA IPAH / MULYADI 8/16/2017 11/22/2016 P 8 BLN
38 ADIRA NEMAH / PURODI 8/16/2017 10/28/2016 P 8.2 BLN
39 FAQIH BADEH / AHROD 8/16/2017 1/4/2014 L 13 BLN
40 KEYLA BADEH / AHROD 8/16/2017 3/15/2012 P 15 BLN
41 HAKEU MEGA / NURYADI 8/16/2017 8/29/2014 L 14 BLN
42 RANGGA SALMA / ERIK 8/16/2017 10/5/2015 L 11 BLN
43 VINO PENI / KABAH 8/16/2017 3/16/2016 L 10 BLN
44 BLN
45 BLN
46 BLN
47 BLN
48 BLN
49 BLN
50 BLN
51 BLN
52 BLN
53 BLN
54 BLN
55 BLN
56 BLN
57 BLN
58 BLN
59 BLN
60 BLN
61 BLN
62 BLN
63 BLN
64 BLN
65 BLN
66 BLN
67 BLN
68 BLN
PETUGAS
(...................................)
FORMULIR PENCATATAN
PUSKESMAS :
POSYANDU/DESA : RAJAWALI 3 / MEKAR MUKTI

1 2 3 4 5 6 7 8 9 10 11 12
1 AZMI RIPAN / MINING R. LINTAH 8/15/2017 7/19/2016 72 BLN
2 HASBI RIPAN / MINING R. LINTAH 8/15/2017 7/19/2016 69 BLN
3 PUSPA GURULI / NATI R. LINTAH 8/15/2017 8/30/2015 74 BLN
4 NOVAL YUDI / ICAP R. LINTAH 8/15/2017 10/23/2012 109 BLN
5 AISYAH SOLIHIN / EMPAT R. LINTAH 8/15/2017 7/4/2014 93 BLN
6 FADL SURYADI / NENGSIH R. LINTAH 8/15/2017 90 BLN
7 NOVITA GURUH / NATI R. LINTAH 8/15/2017 11/24/2012 94 BLN
8 REGA HERI / ACIH R. LINTAH 8/15/2017 10/4/2013 96 BLN
9 MEGA ANDI / NUNUNG R. LINTAH 8/15/2017 10/10/2014 82 BLN
10 YULI JAKA / ASIH R. LINTAH 8/15/2017 2/5/2013 99 BLN
11 ICHA AMIN / CIAH R. LINTAH 8/15/2017 89 BLN
12 NOVI GANDI / ROMISTINI R. LINTAH 8/15/2017 101 BLN
13 DILA ENJANG / IMIH R. LINTAH 8/15/2017 106 BLN
14 KEYLA WAWAN / INUNG R. LINTAH 8/15/2017 107 BLN
15 AZKIA MISTA / EEN R. LINTAH 8/15/2017 12/12/2012 107 BLN
16 REZA FERI / RATNA R. LINTAH 8/15/2017 75 BLN
17 FARILI RIDWAN / BELA R. LINTAH 8/15/2017 5/10/2015 86 BLN
18 ROZI ASAN / ELI R. LINTAH 8/15/2017 2/9/5/15 86 BLN
19 DATA MUNJILIN / SUSI R. LINTAH 8/15/2017 7/1/2015 90 BLN
20 ZZAN IKOK / RODIAH R. LINTAH 8/15/2017 3/17/2014 93 BLN
21 MUGNI ENCAR / NENENG R. LINTAH 8/15/2017 3/22/2013 111 BLN
22 NAHDAN ANDA / MUNIH R. LINTAH 8/15/2017 25/07/ 117 BLN
23 ANDITA ACE / NENGSIA R. LINTAH 8/15/2017 10/13/2016 71 BLN
24 KANSA DWILAN / IJAH R. LINTAH 8/15/2017 102 BLN
25 ALFIAN TOPAN / YANI R. LINTAH 8/15/2017 2/20/2013 113 BLN
26 RAYAA WARSONO / ANI R. LINTAH 8/15/2017 4/22/2012 80 BLN
27 ALFIN TEDI / SUSI R. LINTAH 8/15/2017 3/8/2017 BLN
28 IFA R. LINTAH 8/15/2017 90 BLN
29 PUTRA DADANG / SURYANI R. LINTAH 8/15/2017 4/5/2015 90 BLN
30 DIVA MAMAN / IKA R. LINTAH 8/15/2017 9/27/2016 77 BLN
31 ARA NENENG R. LINTAH 8/15/2017 1/4/2014 97 BLN
32 RIJKI SUTA / IBAH R. LINTAH 8/15/2017 7/9/2014 95 BLN
33 ROHAUDIN DEDI / MULYANI R. LINTAH 8/15/2017 7/26/2015 94 BLN
34 RADIT YAMAN / OPI R. LINTAH 8/15/2017 2/9/2016 92 BLN
PETUGAS
(...................................)
FORMULIR PENCATATAN
PUSKESMAS :

1 2 3 4 5 6 7 8 9 10 11 12
35 ELAN UNIN / ANI R. LINTAH 8/15/2017 4/6/2013 115 BLN
36 AMANDA ABDUL / RANI R. LINTAH 8/15/2017 6/6/2015 92 BLN
37 DIMAS MAJIKUN / NENTI R. LINTAH 8/15/2017 7/16/2015 90 BLN
38 TALA ANDI / OPI R. LINTAH 8/15/2017 7/26/2014 113 BLN
39 ALFIN MARNA / RATNA R. LINTAH 8/15/2017 3/30/2013 111 BLN
40 ELSA MARNA / RATNA R. LINTAH 8/15/2017 10/10/2015 74 BLN
41 ZAKI ADI / DEWI R. LINTAH 8/15/2017 3/21/2013 100 BLN
42 RAFFA NESIN / OLIS R. LINTAH 8/15/2017 7/8/2012 105 BLN
43 AFRIZAL RADIAN / NENENG R. LINTAH 8/15/2017 4/27/2016 84 BLN
44 LULU MARIANA / ROHAYA R. LINTAH 8/15/2017 3/24/2013 107 BLN
45 NINA WAWAN / KINAH R. LINTAH 8/15/2017 7/31/2014 88 BLN
46 FAJAR JONO / MUNIH R. LINTAH 8/15/2017 10/30/2016 83 BLN
47 AINI DENI / ANITA R. LINTAH 8/15/2017 12/2/2012 111 BLN
48 WILDAN NIPAN / MINAH R. LINTAH 8/15/2017 6/10/2016 74 BLN
49 INTAN JUNAEDI / NUR R. LINTAH 8/15/2017 7/16/2013 96 BLN
50 ITA ASEP / BADRIAH R. LINTAH 8/15/2017 7/17/2012 104 BLN
51 ZIKRI JENA / KOKOM R. LINTAH 8/15/2017 1/11/2017 115 BLN
52 TIA MAMAN / IKA R. LINTAH 8/15/2017 2/21/2012 110 BLN
53 IKRAN EKA / EVI R. LINTAH 8/15/2017 12/8/2012 110 BLN
54 ALFAN DIMAN / NUR R. LINTAH 8/15/2017 9/13/2013 102 BLN
55 BLN
56 BLN
57 BLN
58 BLN
59 BLN
60 BLN
61 BLN
62 BLN
63 BLN
64 BLN
65 BLN
66 BLN
67 BLN
68 BLN
PETUGAS
(...................................)
FORMULIR PENCATATAN
PUSKESMAS :
POSYANDU/DESA : PIPIT / MEKAR MUKTI

1 2 3 4 5 6 7 8 9 10 11 12
1 SAKILA L.N SWANDA / NOVI 8/8/2017 5/23/2015 P 14 95 BLN
2 DIAS ANAH 8/8/2017 4/21/2014 L 15 96 BLN
3 JASMINE RAHMA 8/8/2017 10/22/2016 P 7 68 BLN
4 ARDI NURDIN / JAMILAH 8/8/2017 9/20/2015 L 15 77 BLN
5 LUTFI MANTO / ANIS 8/8/2017 7/29/2015 L 11.8 91 BLN
6 RASTY RATNA / JAYA 8/8/2017 4/30/2014 P 11 82 BLN
7 OKTARIAN RINDANG / YANI 8/8/2017 10/31/2016 L 8 72 BLN
8 RAFAEL RONALD / APRIANTI 8/8/2017 7/21/2016 L 11.4 75 BLN
9 MAHES SUROTO / WINA 8/8/2017 9/16/2012 L 6 102 BLN
10 ZAHRA SUPARDI / TITIN 8/8/2017 1/8/2014 P 13 85 BLN
11 HAFIZ AGUS / MEI 8/8/2017 9/30/2016 L 8.5 72 BLN
12 IFA DEDE / IIS 8/8/2017 9/16/2015 P 11 83 BLN
13 DENDI EEN / SUCI 8/8/2017 1/9/2014 L 7.8 66 BLN
14 RAFAEL RIAN / EGA 8/8/2017 8/30/2016 L 8 74 BLN
15 RIPAI NANANG / ISNAINI 8/8/2017 6/20/2016 L 13.3 78 BLN
16 ARSYA MADI / MARNI 8/8/2017 2/28/2017 L 10.8 67 BLN
17 NAURA ARMI / EUIS 8/8/2017 8/3/2015 P 10 84 BLN
18 BAQIR H. JAFAR / YAYAH 8/8/2017 5/3/2016 8.2 74 BLN
19 NAZWA UUS / SUPRIJAL 8/8/2017 10/5/2014 11 84 BLN
20 NAFISA NUR / BIMO 8/8/2017 10/20/2014 16 90 BLN
21 ELENOR KRIS / AISYAH 8/8/2017 11/9/2014 12.5 96 BLN
22 RISKI RAFA KARDI / RIKA 8/8/2017 4/29/2016 9.7 80 BLN
23 NIDA L. KARDI / RIKA 8/8/2017 1/23/2013 11 97 BLN
24 ANASTASYA SABAR / YUNIA 8/8/2017 10/15/2016 7.9 73 BLN
25 DAFA MAMAN / ATIN 8/8/2017 5/20/2016 10.2 82 BLN
26 DENAYA SETIAWAN / YAYUK 8/8/2017 8/10/2014 13 86 BLN
27 ADIVA AGUNG / MELI 8/8/2017 12/7/2016 7.5 62 BLN
28 AZKIA LUNA YAYAN / NENI 8/8/2017 9/4/2015 11.2 87 BLN
29 OQILA RETNO / TAMI 8/8/2017 11/15/2014 13 88 BLN
30 ADIBA ACEP / MIDAH 8/8/2017 11/7/2014 7.9 67 BLN
31 DIMAS DEDY / CITRA 8/8/2017 3/6/2015 13 86 BLN
32 BILAL BUDIMAN ANTON / ETI 8/8/2017 3/22/2016 9.2 77 BLN
33 RESYA JUMA / YUYU 8/8/2017 7/27/2015 10 67 BLN
34 ZIO ALVARO OKRI / ETI 8/8/2017 3/19/2015 10.4 79 BLN
PETUGAS
(...................................)
FORMULIR PENCATATAN
PUSKESMAS :
POSYANDU/DESA : PIPIT / MEKAR MUKTI

1 2 3 4 5 6 7 8 9 10 11 12
35 AYSHA WAHYU / MILA 8/8/2017 10/2/2015 10 81 BLN
36 NURUL DUDI / NUR 8/8/2017 11/18/2015 11 77 BLN
37 HASNA ENDAH / ECON 8/8/2017 2/8/2013 14 94 BLN
38 DAFHA DEDEN / ENIH 8/8/2017 5/9/2014 13 95 BLN
39 FATHAN CUCU / TATANG 8/8/2017 9/26/2013 15 95 BLN
40 RAHMA HAIRUDN / MARYATI 8/8/2017 10/31/2015 10 71 BLN
41 TANIA R. BUHA / ROMANTI 8/8/2017 5/15/2017 5.4 59 BLN
42 ELPRIDA BUHA / ROMANTI 8/8/2017 4/30/2014 15 92 BLN
43 AZKIA GUGUN / PARIDA 8/8/2017 2/5/2015 9 86 BLN
44 M. KENZIE GUGUN / PARIDA 8/8/2017 1/6/2017 7.5 71 BLN
45 M. YUSUF DHENIE / RIFKA 8/8/2017 2/18/2017 8.5 68 BLN
46 NAYLA AGUNG / HENI 8/8/2017 4/19/2015 12.7 81 BLN
47 ALYA S.M MUHANA / TRI 8/8/2017 7/17/2015 10 72 BLN
48 RICO J. AHMAD / WAGRO 8/8/2017 3/29/2015 9.5 85 BLN
49 AKBAR YEYEN / ASEP 8/8/2017 11/8/2012 15 99 BLN
50 RADEN ERNA / ADIN 8/8/2017 8/6/2012 15 94 BLN
51 S. NUR ALIM SULAEMAN / URTIN 8/8/2017 1/11/2012 17 93 BLN
52 ALSYAINA NURYANA 8/8/2017 9/14/2013 15 94 BLN
53 ARIF AFFANDI ROGANDA / NERSI 8/8/2017 18/11/111 18 101 BLN
54 CHABELITTA TOFATI / SUMARNI 8/8/2017 6/27/2011 14 96 BLN
55 ABNAN AGUS / ANITA 8/8/2017 12/22/2014 BLN
56 ADEVA DEDE / ANYAN 8/8/2017 11/28/2015 BLN
57 RACHEL RUSBAD / TARSUMO 8/8/2017 10/4/2014 10 80 BLN
58 SYAHLA ROHMAN / MUMUT 8/8/2017 10/31/2014 9 78 BLN
59 AGABI ENDANG / AYU 8/8/2017 4/6/2016 9 75 BLN
60 TIKA AL / LELI 8/8/2017 7/15/2015 9 79 BLN
61 SULTAN ADE YANA / ANIH 8/8/2017 3/8/2015 12 BLN
62 ABDIL ADE YANA / ANIH 8/8/2017 4/9/2017 6 64 BLN
63 WILDAN MINTO / OKMA 8/8/2017 6/18/2014 11 86 BLN
64 FAUZAN MINTO / OKMA 8/8/2017 11/17/2016 7.5 73 BLN
65 AZZAM AAN / AZIZ 8/8/2017 11/24/2016 8.8 64 BLN
66 RIXKY M. SUGIARTI / WANDI 8/8/2017 2/7/2014 12 85 BLN
67 ROHIM NILAN / NOLDI 8/8/2017 4/14/2014 10 85 BLN
68 PIRLI ENUNG / SAMSUDIN 8/8/2017 12/16/2014 14 85 BLN
PETUGAS
(...................................)
FORMULIR PENCATATAN
PUSKESMAS :

1 2 3 4 5 6 7 8 9 10 11 12
1 FITRI AMAN / RUM 8/16/2017 6/30/2016 P 8 69 BLN
2 UPI ICAN / WANIH 8/16/2017 10/31/2013 P 21 91 BLN
3 FAJAN TUGIMAN / DEWI 8/16/2017 10/5/2016 L 9.4 85 BLN
4 WULAN RINA / WAWAN 8/16/2017 4/10/2012 P 13,,5 88 BLN
5 HAMI EUIS / URIL 8/16/2017 12/21/2012 L 16.4 105 BLN
6 AIDIL YANI / ADE 8/16/2017 8/22/2012 L 16 98 BLN
7 ZAHRA AYUM / AYA 8/16/2017 5/1/2015 P 10 82 BLN
8 LUTFIA IRFAN / MIRA 8/16/2017 P 8.5 70 BLN
9 ANDRE UMAY 8/16/2017 4/27/2012 L 17 102 BLN
10 FARID 8/16/2017 7/21/2014 L 12.3 88 BLN
11 FADIL ANAH 8/16/2017 L 12.3 78 BLN
12 NAFI UDIN / RATI 8/16/2017 12/5/2011 L 16.3 106 BLN
13 BAYU DWI / GUNAWAN 8/16/2017 5/5/2014 L 19.3 98 BLN
14 ARDAN RANIH / BONAR 8/16/2017 3/20/2016 L 10.1 75 BLN
15 MUH FEBRI MARDIANA / KUSNIA 8/16/2017 2/17/2017 L 8.8 71 BLN
16 KINARA DESI / RIZKY 8/16/2017 3/19/2015 P 11.9 77 BLN
17 ARJUN NENENG 8/16/2017 L 14.5 78 BLN
18 FAHIRA EMAT / TATA 8/16/2017 P 14.5 95 BLN
19 BAIHAQI NUR YUSUF / NUR 8/16/2017 10/28/2016 L 9.7 72 BLN
20 BILQIS DEVI / SAHRUL 8/16/2017 5/27/2014 P 10.6 86 BLN
21 DELISA FITRI / NAYO 8/16/2017 7/5/2013 P 15 94 BLN
22 AZKA MULYANI / NISAN 8/16/2017 12/10/2016 L 10 66 BLN
23 SELLA TATI / TATANG 8/16/2017 4/9/2014 P 14.3 91 BLN
24 M. SHABIQ NUR / RAMDANI 8/16/2017 8/5/2015 L 11.4 80 BLN
25 KALISTA DIAN /ASEP 8/16/2017 10/13/2015 P 9.8 80 BLN
26 IQBAL YESI / UDIN 8/16/2017 4/17/2013 L 17 99 BLN
27 DAFA BONAH / BONIN 8/16/2017 5/15/2014 L 10.4 99 BLN
28 ALBERT MAYA / ROBIN 8/16/2017 12/10/2015 L 13 89 BLN
29 FANI ASIYAH 8/16/2017 5/5/2013 P 15.1 99 BLN
30 MITA ANISA / RIAN 8/16/2017 5/3/2016 P 9.3 78 BLN
31 M. FARIZ NUR / EDI 8/16/2017 /07/2016 L 10 76 BLN
32 AZAM JAMAL / NUR 8/16/2017 11/26/2015 L 12 78 BLN
33 SANDI CHERRY / AGUS 8/16/2017 4/23/2015 L 14 79 BLN
34 M. IFALDO KOKOM / KOSIM 8/16/2017 3/14/2017 L 7.2 71 BLN
PETUGAS
(...................................)
FORMULIR PENCATATAN
PUSKESMAS :

1 2 3 4 5 6 7 8 9 10 11 12
35 RAKA NIA / SOFIAN 8/16/2017 10/6/2013 L 16.6 98 BLN
36 SYAHIRA SARAH / YAMAN 8/16/2017 12/9/2012 P 16.3 99 BLN
37 NABILA IDAH / RASA 8/16/2017 5/13/2016 P 9.4 85 BLN
38 HILMA SITI / WALIN 8/16/2017 8/13/2013 P 14.5 94 BLN
39 RADIT ERIK / WIRDA 8/16/2017 8/29/2015 L 14.5 90 BLN
40 ALDIANSYAH AAN / DEDI 8/16/2017 8/19/2014 L 12.4 84 BLN
41 KHAIRAN UUN / JENI 8/16/2017 5/28/2014 L 15.5 98 BLN
42 KHAIRI UUN / JENI 8/16/2017 5/29/2016 P 7.9 88 BLN
43 SYAKILA WARSIH / NAIN 8/16/2017 6/10/2015 P 11.6 83 BLN
44 LELI DENDI / MARSIH 8/16/2017 7/21/2012 P 15 96 BLN
45 IJAJ HENGKI / NUR 8/16/2017 1/22/2013 15 98 BLN
46 ILYAS HENGKI / NUR 8/16/2017 10/7/2014 13 82 BLN
47 NISA 8/16/2017 6/5/2014 P 13.8 95 BLN
48 RAISYA FAIZAL / ATIKAH 8/16/2017 10/26/2016 P 9.5 83 BLN
49 RASYA FAIZAL / ATIKAH 8/16/2017 9/16/2012 L 20 103 BLN
50 YUSUF KAMAN / MINAH 8/16/2017 9/16/2012 L 20 102 BLN
51 YUNUS KAMAN / MINAH 8/16/2017 7/12/2013 L 13 94 BLN
52 IYAN ADE / YETI 8/16/2017 L 13 94 BLN
53 ALFIN HERMAN / FITRI 8/16/2017 4/8/2016 L 10 89 BLN
54 RINA MAHARANI JUMI / AJUK 8/16/2017 11/16/2012 P 18 102 BLN
55 IBNU RINA / ADEL 8/16/2017 L 18 102 BLN
56 SLAMET ROSIH / SOLEH 8/16/2017 L BLN
57 SALSABILA HALIMAH / AGUNG 8/16/2017 P BLN
58 RASYA HALIMAH / PARDI 8/16/2017 4/9/2016 L BLN
59 BLN
60 BLN
61 BLN
62 BLN
63 BLN
64 BLN
65 BLN
66 BLN
67 BLN
68 BLN
PETUGAS
(...................................)
FORMULIR PENCATATAN
PUSKESMAS :
POSYANDU/DESA : GELATIK 1 / MEKAR MUKTI

1 2 3 4 5 6 7 8 9 10 11 12
1 RADIANSYAH SISKA / IWAN 8/21/2017 1/1/2017 L 9.5 BLN
2 NAUDI MIRA / RIMOK 8/21/2017 10/17/2013 P 10 BLN
3 FIGAR FANI / MIRANTO 8/21/2017 8/7/2015 P 10 79 BLN
4 YUSUF YAYAH / FARMAN 8/21/2017 5/15/2016 L 10.5 77 BLN
5 NUR ALI FATULA KARTI / AHMAD 8/21/2017 12/4/2012 P 16 102 BLN
6 ZAHRA BIMA / AFIANTO 8/21/2017 8/6/2014 P 13 93 BLN
7 NOVAL IDA 8/21/2017 10/26/2015 L 13 82 BLN
8 ZENA ANING / AGUS 8/21/2017 3/21/2014 P 13 98 BLN
9 AZRIL NOVI / SUHUD 8/21/2017 4/19/2016 L 13 77 BLN
10 GHISA ADE / NADZIK 8/21/2017 7/3/2013 P 18 102 BLN
11 THALITA YUYUN / WAGA 8/21/2017 11/14/2014 P 15 94 BLN
12 M. NOVAL ANITA / ARDI 8/21/2017 10/24/2013 L 19 104 BLN
13 NADIRA LINA / RUDI 8/21/2017 9/26/2014 P 10 85.6 BLN
14 SELLA AWI / WANDI 8/21/2017 7/14/2014 P 16 87 BLN
15 DARA SUMI 8/21/2017 P 7.8 BLN
16 SYIFA MAMAN / SUHETI 8/21/2017 5/28/2017 P 10.3 83 BLN
17 HARA H. IYAM / NANANG 8/21/2017 4/24/2015 P 10 85 BLN
18 HAFIDZ AAT / DEDE 8/21/2017 3/23/2013 L 16.8 98.3 BLN
19 CAHAYA ESIN / DAHLIA 8/21/2017 P 9.4 BLN
20 AZIAN 8/21/2017 10/31/2016 L BLN
21 A. NABIL SUBARIAH / EMBAD 8/21/2017 10/6/2013 L 19 99 BLN
22 KAIYLA MARNI /DEO 8/21/2017 2/11/2017 P 7.2 BLN
23 NOVAL OSIH / SURANTO 8/21/2017 8/11/2017 L 8.5 74 BLN
24 KANSA IRA / JOKO 8/21/2017 4/13/2014 P 14 97 BLN
25 ARKA IRA / JOKO 8/21/2017 1/2/2016 L 11 83 BLN
26 ALDE IRA / JOKO 8/21/2017 9/6/2012 L 24 10.5 BLN
27 ORLIM BASIROH / DADANG 8/21/2017 2/2/2016 P 8.5 BLN
28 RASYA 8/21/2017 1/8/2017 L 6.4 67 BLN
29 SAFIRA NELI / SAEPUDIN 8/21/2017 2/10/2017 P 8.5 67 BLN
30 HILMA ELIS / HAMZAH 8/21/2017 10/2/2016 P 10 8 BLN
31 DAFA ENENG / DENI 8/21/2017 4/27/2016 L 10 8 BLN
32 ANDRIANA NOVI / DWI 8/21/2017 11/8/2013 L 18 101 BLN
33 RIZKI YUYUN / DEDI 8/21/2017 6/29/2014 L 15 101 BLN
34 RADIANSYAH SISKA / IRWAN 8/21/2017 1/1/2016 L 9.5 BLN
PETUGAS
(...................................)
FORMULIR PENCATATAN
PUSKESMAS :

1 2 3 4 5 6 7 8 9 10 11 12
35 ALDI UMI / INAN 8/21/2017 12/4/2014 L 13 90 BLN
36 AINI TRI / PISA 8/21/2017 4/21/2016 P 13 77 BLN
37 TAUFIK ANA / MUSTIKA 8/21/2017 5/29/2016 L 10 80 BLN
38 CIMIA EKA / AGUS 8/21/2017 6/2/2015 P 12 89 BLN
39 AKILA AYU / JONO 8/21/2017 6/21/2015 P 10 80 BLN
40 ARPIAN TINAH / KARNO 8/21/2017 3/25/2014 L 12 94 BLN
41 FARIS ELA / ISMAT 8/21/2017 1/18/2014 L 15.7 BLN
42 SINTA ASIH / SANTA 8/21/2017 5/5/2013 P 10.4 98 BLN
43 BUNGA SITI / EMIL 8/21/2017 5/12/2013 P 15 130 BLN
44 ASILA YUNI / IMAN 8/21/2017 8/24/2014 P 12 93 BLN
45 ALMAIRA TIEN / JUNAEDI 8/21/2017 10/13/2016 P 8.1 BLN
46 KANAYA ULFA / IWAN 8/21/2017 6/5/2015 P 11 83 BLN
47 ARKAN OLIF / OPI 8/21/2017 7/4/2014 L 15 99 BLN
48 DAVID CUCUN / SUPRI 8/21/2017 12/29/2014 L 15 BLN
49 AKILA LINA / EKO 8/21/2017 12/14/2013 P 12 92 BLN
50 ABIDZAR DIAN / ARIF 8/21/2017 11/1/2016 L 8 BLN
51 ADITYA AI / USMAN 8/21/2017 6/17/2016 L 10 BLN
52 YUANITA ADIN / LILIS 8/21/2017 P 10 98 BLN
53 M. ARFA ABIAN / AGUSTIN 8/21/2017 2/23/2015 L 10 80 BLN
54 ABDUL TITIN / MAHMUDIN 8/21/2017 6/11/2003 L 16 115 BLN
55 ABIZAR SEPTI 8/21/2017 6/18/2016 L 10 75 BLN
56 ALISA MAE / WAWAN 8/21/2017 10/30/2016 P 1 75 BLN
57 SIDIQ LINA / SAMSUL 8/21/2017 5/13/2016 L 9.1 74 BLN
58 SIDQI LINA / SAMSUL 8/21/2017 5/13/2016 P 8.3 72 BLN
59 RAVIQI TATI / RAHMAT 8/21/2017 8/14/2017 L 78 BLN
60 NANDITA TUTI / HENDRA 8/21/2017 1/3/2016 P 10 79 BLN
61 AFIKA KURNIA / WAWAN 8/21/2017 2/8/2014 P 13.2 92 BLN
62 NABIEL NURUL / NANA 8/21/2017 11/6/2016 L 8.5 69 BLN
63 AUNI SANTI / TAMBRIN 8/21/2017 6/13/2014 P 12.5 81 BLN
64 ARSYIL ROS / JUANDI 8/21/2017 5/11/2015 L 13 100 BLN
65 NAILA NURHAYATI / INA 8/21/2017 10/9/2014 P 15 93 BLN
66 ARI MARLINA / ADE 8/21/2017 12/30/2014 L BLN
67 FARHAN SAKINAH / ALI 8/21/2017 2/6/2016 L 14.4 77 BLN
68 AMEL TITIK / SARDI 8/21/2017 10/30/2013 P 19 110 BLN
PETUGAS
(...................................)
FORMULIR PENCATATAN
PUSKESMAS :

1 2 3 4 5 6 7 8 9 10 11 12
69 KELVIN TIKA / KARYA 8/21/2017 4/7/2015 L 8 75 BLN
70 KEYRA SRI / ANDI 8/21/2017 5/27/2013 P 9.5 85 BLN
71 ABIYAH RISTI / DEDE 8/21/2017 2/25/2015 P 11 BLN
72 SAKILA TITI / KARIM 8/21/2017 5/20/2016 P 8 69 BLN
73 FIKO PURI / RISKI 8/21/2017 1/1/2013 L 15 100 BLN
74 KEVIN HOTMAH / NURHADI 8/21/2017 11/8/2016 L 14 97 BLN
75 JUNAEDI TIMAH / RINAN 8/21/2017 L 15 105 BLN
76 BARA SRI / DONI 8/21/2017 10/11/2012 L 20 111 BLN
77 ADELIA MAYA 8/21/2017 7/4/2015 P 9.5 81 BLN
78 AZAM ANI / HADI 8/21/2017 10/8/2015 L 10 81 BLN
79 AKILAH IRNA H. / WAHYU 8/21/2017 7/23/2015 P 10.1 83 BLN
80 RIKO DESI / ABDILLAH 8/21/2017 3/12/2015 L 10 88 BLN
81 FADLAN PUAH / WARSUN 8/21/2017 4/21/2015 L 9.3 81 BLN
82 ALIANA ITOH / NUH 8/21/2017 3/15/2015 P 13 BLN
83 M. ASAT PERI / NANANG 8/21/2017 8/13/2015 L 12.5 85 BLN
84 ABDUL M. TITIN / MAHPUD 8/21/2017 6/11/2015 L 16 115 BLN
85 AZKA LINA / SAMSUL 8/21/2017 4/22/2013 L 14 102 BLN
86 WINDI MARNI / RATIM 8/21/2017 12/11/2016 P 7.6 69 BLN
87 EZA WIBOWO TRI / SUMARI 8/21/2017 1/3/2016 L 12 81 BLN
88 ELKANA MEVI / ANDRE 8/21/2017 7/15/2017 L 5.8 57 BLN
89 INTAN FATIMAH / NURDA 8/21/2017 12/11/2016 P 7.5 99 BLN
90 SAHLA AI / TOMI 8/21/2017 5/16/2016 P 7.6 72 BLN
91 SAKA IDEH / DADANG 8/21/2017 4/12/2015 L 12 83 BLN
92 NADIN PUJI / LILI 8/21/2017 2/11/2016 P 10 73 BLN
93 FATHIR PUJI / LILI 8/21/2017 2/5/2014 L 18 91 BLN
94 KIA H. IYEH / DADANG 8/21/2017 6/6/2013 P 17 95 BLN
95 BLN
96 BLN
97 BLN
98 BLN
99 BLN
100 BLN
101 BLN
102 BLN
PETUGAS
(...................................)
FORMULIR PENCATATAN
PUSKESMAS :
POSYANDU/DESA : POK BANG PIPIT / MEKAR MUKTI

1 2 3 4 5 6 7 8 9 10 11 12
1 MARIYAN SAAN SANUSI TEGAL GEDE 8/23/2017 8/1/2012 B P 12 104 BLN
2 KHAIRA SUGENG TEGAL GEDE 8/23/2017 B P 12 99 BLN
3 AISYAH SA'LA / SANIAH TEGAL GEDE 8/23/2017 2/2/2012 B P 12 108 BLN
4 RIZKI KARNOTO / SITI TEGAL GEDE 8/23/2017 2/9/2013 B L 14 108 BLN
5 RENDI TEGAL GEDE 8/23/2017 8/24/2012 L 15 BLN
6 DALI JAMAL / MILA TEGAL GEDE 8/23/2017 3/19/2013 B L 10 10 BLN
7 NAILA TEGAL GEDE 8/23/2017 12/26/2013 P 16 BLN
8 FADEL TEGAL GEDE 8/23/2017 2/25/2012 B L 14 103 BLN
9 DILA JAMAL / MILA TEGAL GEDE 8/23/2017 8/11/2016 P 14 BLN
10 ALIKA DEDE / MARYONO TEGAL GEDE 8/23/2017 17 BLN
11 AISYAH DODO / FAFAMAH TEGAL GEDE 8/23/2017 8/10/2015 T P 8.8 82 BLN
12 NENO LILIH / AME TEGAL GEDE 8/23/2017 1/8/2015 T P 9 BLN
13 YASMIN MIRNA TEGAL GEDE 8/23/2017 9/7/2013 P 11 BLN
14 TAUFAN YANTI TEGAL GEDE 8/23/2017 10/29/2014 B L 9.9 BLN
15 RAFA HUSNUL TEGAL GEDE 8/23/2017 B L 10 BLN
16 DEVA HARYATI TEGAL GEDE 8/23/2017 11/5/2014 B L 10 BLN
17 SAKIRA NURUL TEGAL GEDE 8/23/2017 6/23/2015 B P 14 BLN
18 ADIBA AHMAD / SUSI TEGAL GEDE 8/23/2017 4/29/2016 P BLN
19 DIMAS EPUL TEGAL GEDE 8/23/2017 1/11/2014 B L 12 99 BLN
20 ZKI ISKANDAR ARA / DEDE TEGAL GEDE 8/23/2017 3/18/2016 B L 9.1 80 BLN
21 SAKILA TEGAL GEDE 8/23/2017 B 8.7 BLN
22 ARKANA DEDE / WENI TEGAL GEDE 8/23/2017 11/28/2016 T L 7.4 70 BLN
23 SYAHILA ELVENI TEGAL GEDE 8/23/2017 12/28/2014 B P 12 89 BLN
24 ALNILA FITRI / SYARIF TEGAL GEDE 8/23/2017 5/23/2015 B P 11.9 87 BLN
25 SALWA SOFYAN / EVA TEGAL GEDE 8/23/2017 1/5/2016 B P 10.4 80 BLN
26 PUTRI ACUM / RAFENAH TEGAL GEDE 8/23/2017 5/9/2017 P 6.5 BLN
27 FAHLAN LALA / SOPALA TEGAL GEDE 8/23/2017 6/26/2012 B L 15 95 BLN
28 ALESHA WIDODO / WINDI TEGAL GEDE 8/23/2017 4/5/2014 B L 13 100 BLN
29 ELINDA TEGAL GEDE 8/23/2017 12/11/2013 P BLN
30 KENZI TRI TEGAL GEDE 8/23/2017 5/16/2015 B L 11.5 89 BLN
31 M. ALIF A. CICIH TEGAL GEDE 8/23/2017 5/11/2015 B L 10 84 BLN
32 GISHA IKA TEGAL GEDE 8/23/2017 1/6/2016 B P 9.3 82 BLN
33 FIKRI LINA TEGAL GEDE 8/23/2017 L BLN
34 AZKA DESI TEGAL GEDE 8/23/2017 4/29/2013 B L 17 110 BLN
PETUGAS
(...................................)
FORMULIR PENCATATAN
PUSKESMAS :
POSYANDU/DESA : POK BANG PIPIT / MEKAR MUKTI

1 2 3 4 5 6 7 8 9 10 11 12
35 ZAHIRA MIDAH TEGAL GEDE 8/23/2017 9/3/2011 B P 14 BLN
36 ANGGIA FITRI TEGAL GEDE 8/23/2017 8/20/2016 T P 8.9 BLN
37 PITA IPAH TEGAL GEDE 8/23/2017 7/7/2014 B P 11 BLN
38 LULU Q.A VIKA TEGAL GEDE 8/23/2017 12/8/2014 B P 10.6 86 BLN
39 DELISA DINIA TEGAL GEDE 8/23/2017 11/2/2014 B P 14 90 BLN
40 KIRANA DIAN TEGAL GEDE 8/23/2017 5/22/2016 B P 9.1 74 BLN
41 PELANGI PUJI TEGAL GEDE 8/23/2017 1/28/2015 B P 10 98 BLN
42 AJENG ASIH TEGAL GEDE 8/23/2017 7/27/2016 B P 8 78 BLN
43 AGUS SARAH TEGAL GEDE 8/23/2017 5/23/2016 B L 8.9 78 BLN
44 IKMAL IKAH TEGAL GEDE 8/23/2017 8/24/2016 B L 9.7 78 BLN
45 ADAM EUIS TEGAL GEDE 8/23/2017 6/10/2016 B L 9.2 72 BLN
46 ROBI TUTI TEGAL GEDE 8/23/2017 4/23/2013 B L 10 98 BLN
47 RAZKA ODIH TEGAL GEDE 8/23/2017 4/4/2013 B L 14 110 BLN
48 AZKA AAK TEGAL GEDE 8/23/2017 7/2/2011 B L 13 95 BLN
49 ASYIFA SUMARNI / SUBEKTI TEGAL GEDE 8/23/2017 8/19/2015 B P 9 86 BLN
50 ANISA ABDUL MAZID TEGAL GEDE 8/23/2017 12/24/2015 B P 10.4 89 BLN
51 ALI DADAN / YAYAH TEGAL GEDE 8/23/2017 9/11/2015 T L 10.6 90 BLN
52 ILHAM BUDI / SANIAH TEGAL GEDE 8/23/2017 7/16/2014 B L 11 99 BLN
53 SARAH KARSAN TEGAL GEDE 8/23/2017 11/13/2012 B P 17 106 BLN
54 LEHA LINA / DANI TEGAL GEDE 8/23/2017 12/29/2012 B P 25 115 BLN
55 RAFFA ROMLAH / NASEP TEGAL GEDE 8/23/2017 10/18/2013 B L 13 100 BLN
56 FAYZA IDEH / ADI TEGAL GEDE 8/23/2017 9/18/2013 B P 12 97 BLN
57 NAYLA NARTI / UDIN TEGAL GEDE 8/23/2017 4/29/2012 B P 15 125 BLN
58 TESYA TOTO / RESNA TEGAL GEDE 8/23/2017 6/5/2013 B P 13 96 BLN
59 FARRAS TEGAL GEDE 8/23/2017 12 80 BLN
60 DELISA YENI / DODI TEGAL GEDE 8/23/2017 4/8/2013 B P 13 103 BLN
61 NAYRA SANARA / RIFA TEGAL GEDE 8/23/2017 3/17/2013 B P 20 108 BLN
62 FELIX IDA / ASEP TEGAL GEDE 8/23/2017 1/7/2013 B P 20 102 BLN
63 SHAQILA AJUD / SUCI TEGAL GEDE 8/23/2017 1/10/2014 B P 12 95 BLN
64 AQILA ALIF / TRI TEGAL GEDE 8/23/2017 10/25/2013 B P 17 105 BLN
65 ADIFA ALIF / TRI TEGAL GEDE 8/23/2017 1/24/2017 P 9.3 BLN
66 M. RIZKI TEGAL GEDE 8/23/2017 B L 8 7.4 BLN
67 BLN
68 BLN
PETUGAS
(...................................)
FORMULIR PENCATATAN
PUSKESMAS :

1 2 3 4 5 6 7 8 9 10 11 12
1 M. ARKA RIZAL / MEGA KP.CIBEREUM 8/8/2017 11/8/2012 B L 25 108 BLN
2 AGASTYA WARSAN / NAR KP.CIBEREUM 8/8/2017 L 2 THN
3 AURA AGUS / MIMIN KP.CIBEREUM 8/8/2017 P 8 2 THN
4 RANIA AHMAD / NINING KP.CIBEREUM 8/8/2017 P 8 1,1 THN
5 ANISA ANDI / ATIK KP.CIBEREUM 8/8/2017 P 12.6 2 THN
6 DIDI RONI / SITI KP.CIBEREUM 8/8/2017 L 3 THN
7 ARSYAKA FAEZA SURYADI / SUMARNI KP.CIBEREUM 8/8/2017 L 7 6 BLN
8 NURUL LATIFAH SLAMET R. / MIMIN KP.CIBEREUM 8/8/2017 B P 15 102 4,5 THN
9 IBRAHIM MISLAM / NAMIH KP.CIBEREUM 8/8/2017 L 10 82 1,5 THN
10 M. YASIR SAIRIN / WINI KP.CIBEREUM 8/8/2017 L 8.5 7 BLN
11 LUTFI ARI / FITRIANI KP.CIBEREUM 8/8/2017 L 10 1,8 THN
12 AZZAHRA SUPRI / AYA KP.CIBEREUM 8/8/2017 P 7.4 6 BLN
13 DIKA RUSMARA / TATI KP.CIBEREUM 8/8/2017 9.3 10 BLN
14 AHMAD DADANG / SUA KP.CIBEREUM 8/8/2017 19 4 THN
15 TIA ABDUL JAMIL / SRI KP.CIBEREUM 8/8/2017 10 1,3 THN
16 KHANZA DEDE / RIMA KP.CIBEREUM 8/8/2017 10 11 BLN
17 MEISA KP.CIBEREUM 8/8/2017 10 14 BLN
18 CHIKA ACENG / YAYAT KP.CIBEREUM 8/8/2017 P 11 4,5 THN
19 ZAHIRA KP.CIBEREUM 8/8/2017 P 10 3 THN
20 ASKIA KP.CIBEREUM 8/8/2017 P 3 THN
21 ALFIN SARININ / PIPIT KP.CIBEREUM 8/8/2017 L 15 3 THN
22 RIZA KP.CIBEREUM 8/8/2017 P 13 2,5 THN
23 HUSNA DAMRUN / FAJAR KP.CIBEREUM 8/8/2017 P 17 5 THN
24 ADIBA GIONO / DEWI KP.CIBEREUM 8/8/2017 P 8 11 BLN
25 MAHIRA MUDIH / NUR KP.CIBEREUM 8/8/2017 P 12 2,5 THN
26 DAHLIA RUDI / JUHARIAH KP.CIBEREUM 8/8/2017 P 12 3,2 THN
27 DILA HERU / RIKA KP.CIBEREUM 8/8/2017 2 3,5 THN
28 YUMNA KP.CIBEREUM 8/8/2017 9 8 BLN
29 FAHRI LADYO / NGATMI KP.CIBEREUM 8/8/2017 L 9 BLN
30 M. YUDA KP.CIBEREUM 8/8/2017 10.2 BLN
31 JULIA JUMANTA / ARMI KP.CIBEREUM 8/8/2017 6.7 10 BLN
32 DIANA BAMBANG / BEDAH KP.CIBEREUM 8/8/2017 9 11 BLN
33 MAULANA OMAN / ISIH KP.CIBEREUM 8/8/2017 10 4 THN
34 EDO DEDI / RIKA KP.CIBEREUM 8/8/2017 15 2,5 THN
PETUGAS
(...................................)
FORMULIR PENCATATAN
PUSKESMAS :

1 2 3 4 5 6 7 8 9 10 11 12
35 DINDA JIMMY / EUIS KP.CIBEREUM 8/8/2017 P 7.5 1,1 THN
36 OLIVIA KP.CIBEREUM 8/8/2017 P 13 2 THN
37 AZKA ROSADI / FITRI KP.CIBEREUM 8/8/2017 L 10 1,10 THN
38 HAIKAL HENDRIK / SARWI KP.CIBEREUM 8/8/2017 L 12 2,4 THN
39 RAIHAN RUDI / YANAH KP.CIBEREUM 8/8/2017 L 13 3,8 THN
40 ADITIYA KP.CIBEREUM 8/8/2017 15 96 4,5 THN
41 ZAIBRAN IRUL / DEWI KP.CIBEREUM 8/8/2017 L 15 104 3 THN
42 AKMAL EKO / JUNAH KP.CIBEREUM 8/8/2017 L 13 3,5 THN
43 ANIDI WARTO / VINI KP.CIBEREUM 8/8/2017 P 14 8 BLN
44 ARSEN HENDRIK / NIA KP.CIBEREUM 8/8/2017 8.6 1 THN
45 KANAYA AYOK / ROS KP.CIBEREUM 8/8/2017 8.5 1 THN
46 ADITYA JONI / YUNI KP.CIBEREUM 8/8/2017 10 BLN
47 BENING SAIFUL / ALYA KP.CIBEREUM 8/8/2017 7 4 THN
48 DIKA JOKO / UUT KP.CIBEREUM 8/8/2017 15 4 THN
49 DAFA WARDOYO / ATI KP.CIBEREUM 8/8/2017 3.5 5 THN
50 RAFA HARDI / DEWI KP.CIBEREUM 8/8/2017 1,3 THN
51 RIDWAN MINGGIH / YAYAH KP.CIBEREUM 8/8/2017 8.7 BLN
52 FITRI KP.CIBEREUM 8/8/2017 P 4 THN
53 NAOMI UDIN / IMAH KP.CIBEREUM 8/8/2017 P 12.6 89 2,9 THN
54 AZZAM KP.CIBEREUM 8/8/2017 L 8.3 1 THN
55 NIZAM AGUS / ANITA KP.CIBEREUM 8/8/2017 L 8.5 2 THN
56 AYUNDA KP.CIBEREUM 8/8/2017 P 16 5 THN
57 HAIKAL KP.CIBEREUM 8/8/2017 L 1 3,3 THN
58 RIDHO KP.CIBEREUM 8/8/2017 L 11 3 THN
59 AIDIL KP.CIBEREUM 8/8/2017 L 12 3 THN
60 AUDREY KP.CIBEREUM 8/8/2017 P 10.2 2 THN
61 ZIKRI KP.CIBEREUM 8/8/2017 L 9.5 11 BLN
62 HAIKAL KP.CIBEREUM 8/8/2017 L 9 8 BLN
63 AFAN SURYANTO / ANDRI KP.CIBEREUM 8/8/2017 L 21 3,5 THN
64 GIBRAN ASEP / DEWI KP.CIBEREUM 8/8/2017 L 8 8 BLN
65 FADLI ASEP / DEWI KP.CIBEREUM 8/8/2017 L 5 THN
66 ZAFRAN RAHMAN / SYIFA KP.CIBEREUM 8/8/2017 L 21 BLN
67 SALSA ABDUL K. / LIA KP.CIBEREUM 8/8/2017 P 10 BLN
68 AURA BUSTAN / DEWI KP.CIBEREUM 8/8/2017 P 1,2 THN
PETUGAS
(...................................)
FORMULIR PENCATATAN
PUSKESMAS :

1 2 3 4 5 6 7 8 9 10 11 12
69 KIRANA REDI / VINA KP.CIBEREUM 8/8/2017 P 15 4 THN
70 GATAN ARI / DITA KP.CIBEREUM 8/8/2017 L 11 2 THN
71 SAKILA HARI / UNI KP.CIBEREUM 8/8/2017 P 11 2 THN
72 FAHRIS ALI / MARWANI KP.CIBEREUM 8/8/2017 L 14 5 THN
73 FIOLA ROMI / DIANA KP.CIBEREUM 8/8/2017 P 16 2 THN
74 ALFIAN TRIHADI / ALYA KP.CIBEREUM 8/8/2017 L 15 3,8 THN
75 RIFKA TRISNO / AINI KP.CIBEREUM 8/8/2017 P 15 3,10 THN
76 AILA WIRA / NURUL KP.CIBEREUM 8/8/2017 P 3 THN
77 HANA JOHAR / SUSI KP.CIBEREUM 8/8/2017 P 9 1,5 THN
78 KESYA KP.CIBEREUM 8/8/2017 6 THN
79 ATIKA KP.CIBEREUM 8/8/2017 5,3 THN
80 BLN
81 BLN
82 BLN
83 BLN
84 BLN
85 BLN
86 BLN
87 BLN
88 BLN
89 BLN
90 BLN
91 BLN
92 BLN
93 BLN
94 BLN
95 BLN
96 BLN
97 BLN
98 BLN
99 BLN
100 BLN
101 BLN
102 BLN
PETUGAS
(...................................)
FORMULIR PENCATATAN
PUSKESMAS :

1 2 3 4 5 6 7 8 9 10 11 12
1 DAVA IIS / ASEP 8/8/2017 12/6/2015 9 79 BLN
2 ALIFIANDRA NENDEN / TEGUH 8/8/2017 12/27/2015 9.5 79 BLN
3 ZAIHAN FITRI / CUCU 8/8/2017 7/27/2013 15.5 96.5 BLN
4 ELZAPRON NELA / SAHRIL 8/8/2017 7/23/2016 10 81 BLN
5 DESTE ROSITA / ANTAN 8/8/2017 12/29/2015 10 77 BLN
6 ALFI ROSITA / ANTAN 8/8/2017 11/25/2014 10 81 BLN
7 NURSHELIN MAHFUDIN 8/8/2017 12/23/2012 16 95 BLN
8 SALSA DEWI / WINARSO 8/8/2017 4/24/2014 12 88 BLN
9 NAVISA DEWI / RIKI 8/8/2017 8/11/2016 7.2 67 BLN
10 AKILA DEWI / WAWAN 8/8/2017 1/1/2014 15 95 BLN
11 SAFA ECIH / WAWAN 8/8/2017 1/12/2012 16 106 BLN
12 ADNAN IKA / KASNO 8/8/2017 4/2/2016 8 72 BLN
13 NAYAKA NUR / DAPOT 8/8/2017 1/23/2016 10 75 BLN
14 NAJWA IKA / BILAL 8/8/2017 5/11/2017 7.2 BLN
15 HANIFAH UMROH / DEDE 8/8/2017 4/5/2016 10 BLN
16 KAPIA SULIS / EDI 8/8/2017 8/5/2014 12 86 BLN
17 M. AFIF NENENG / SIGIT 8/8/2017 7/25/2014 16 110 BLN
18 PARIDZI ASIH / EKO 8/8/2017 12/3/2016 9.9 65 BLN
19 DAVIVA RAHMAN / IJAH 8/8/2017 3/11/2012 14 98 BLN
20 ARIN ARUL / AMINAH 8/8/2017 5/26/2015 10 84 BLN
21 NAFISA APIP / NINA 8/8/2017 2/21/2015 12 83 BLN
22 AISYAH EKA / PALAH 8/8/2017 9/23/2015 14 87 BLN
23 FIONA HOLIS / MEMUNAH 8/8/2017 7/18/2015 12 BLN
24 JAHRAH RESI / ILIN 8/8/2017 2/9/2015 12 84 BLN
25 RISKY DARYONO / ARNI 8/8/2017 5/2/2016 10.5 77 BLN
26 DINA H. ARIF / NINGSIH 8/8/2017 4/14/2016 9.5 74 BLN
27 WILDAN HARSIN / RINI 8/8/2017 1/17/2015 12 84 BLN
28 ALFARO ARFAN / TIA 8/8/2017 11/2/2014 16 95 BLN
29 KALILA SANDI / NIA 8/8/2017 8/10/2015 14 83.5 BLN
30 NAILA NURI / NURMAN 8/8/2017 5/24/2015 9 75 BLN
31 ASHFA MUMUN / ROFLI 8/8/2017 12/1/2012 15 95 BLN
32 SASKIA FITRI / WAHYU 8/8/2017 10/31/2012 14 96 BLN
33 AFIKA NANAI / SUPRIYADI 8/8/2017 4/27/2012 15 98 BLN
34 AIRA NUR / ISEP 8/8/2017 7/23/2016 9 70 BLN
PETUGAS
(...................................)
FORMULIR PENCATATAN
PUSKESMAS :

1 2 3 4 5 6 7 8 9 10 11 12
35 ABIZAR ROMLAH / ALIKMAN 8/8/2017 1/25/2016 10 75 BLN
36 DILA DEDE / ATI 8/8/2017 1/1/2014 11 28 BLN
37 FAHIRA IKA / UDIN 8/8/2017 9/26/2014 12 84 BLN
38 HARLAN NURDIN / RISKI 8/8/2017 3/3/2017 9 BLN
39 HANIF 8/8/2017 BLN
40 RIFKI NURDIN / RISKI 8/8/2017 14 BLN
41 FAKIH BONIH / PRAM 8/8/2017 4/7/2014 14 39 BLN
42 RIZAL JUJU / ENJEN 8/8/2017 11/2/2015 14 79 BLN
43 BRIYAN DIAN / DANIL 8/8/2017 4/23/2015 13 85 BLN
44 RAFA RAHMAT / SRI 8/8/2017 9/20/2015 10 76 BLN
45 PUTRI SITI / MUKSIN 8/8/2017 6/30/2014 11 89 BLN
46 NIZAM LARAS / ASEP 8/8/2017 6/4/2014 13 95 BLN
47 TALITA IIN / LILIS 8/8/2017 11/3/2014 15 89 BLN
48 AMANDA ENIH / ENDANG 8/8/2017 9/14/2013 12 91 BLN
49 ELIS ENIH / RANEN 8/8/2017 10/24/2014 12 80 BLN
50 RIZA DEVI / YAHYA 8/8/2017 5/10/2014 20 95 BLN
51 SISKA YAMA / DALIH 8/8/2017 7/23/2016 10.6 72 BLN
52 HAMDI SARI / ACAM 8/8/2017 4/7/2014 18 92 BLN
53 ARYA EMI 8/8/2017 1/17/2016 10 65 BLN
54 FANO SITI / RIKO 8/8/2017 3/4/2014 14 97 BLN
55 NAJWA WITRI / RISKY 8/8/2017 10/16/2013 15 94 BLN
56 DWI SRI / UDIN 8/8/2017 8/11/2015 10 79 BLN
57 RIFA RATNA 8/8/2017 3/24/2015 12 83 BLN
58 AGA TANTI / TOPIK 8/8/2017 8/11/2014 13 86 BLN
59 RISKY IDA 8/8/2017 3/18/2015 13 82 BLN
60 SHIREN SISKA / RENAL 8/8/2017 9/2/2013 19 102 BLN
61 KANIA DEWI / PURKON 8/8/2017 9/18/2015 10 80 BLN
62 DINDA NAMI / YUDI 8/8/2017 10/3/2013 2.7 110 BLN
63 RISKY TIMAH / DANU 8/8/2017 9/28/2012 15 105 BLN
64 BUNGA HUFAH / HUSEIN 8/8/2017 8/29/2016 8.3 BLN
65 EZA YUNI / JANUDIM 8/8/2017 5/23/2013 16 101 BLN
66 CAHAYA AYAT / SOLIKIN 8/8/2017 3/6/2016 11 75 BLN
67 LINTANG LINKAN /ANTO 8/8/2017 6/2/2015 11 80 BLN
68 AMELIA NANYIH / ANTO 8/8/2017 2/3/2015 12 85 BLN
PETUGAS
(...................................)
FORMULIR PENCATATAN
PUSKESMAS :

1 2 3 4 5 6 7 8 9 10 11 12
69 ALIKA MAMAT / TINI 8/8/2017 4/14/2014 23 92 BLN
70 HANIA TUKMA / MAWADAH 8/8/2017 2/4/2014 21 103 BLN
71 DEWI NENAH / ACE 8/8/2017 11/14/2013 32 BLN
72 ABIL NANIH 8/8/2017 12/19/2015 12 BLN
73 ALESYA UUM / PENDI 8/8/2017 8/15/2016 9 BLN
74 FIRLI A. 8/8/2017 2.2 BLN
75 ARKAN INAH 8/8/2017 11/6/2017 2 BLN
76 CHELSEA SUMARSIH 8/8/2017 3/3/2014 13 93 BLN
77 SAORA DARU 8/8/2017 5/19/2016 13 72 BLN
78 SALSA AYAH / BENI 8/8/2017 5/4/2016 10 72 BLN
79 M. HAIKAL ALIT / BILAH 8/8/2017 8/25/2014 13 87 BLN
80 ROLIN ANIH / RIFKI 8/8/2017 9/5/2015 11 87 BLN
81 RAHMA PUDIN / LIA 8/8/2017 5/18/2014 13 90 BLN
82 RAKA ANDI / ITA 8/8/2017 11/27/2012 25 111 BLN
83 NIKEN SPARNI / KATWATI 8/8/2017 11/5/2012 15.1 99 BLN
84 DIVA KARTI / UDI 8/8/2017 2/14/2015 14 88 BLN
85 HAVAS SARI / ACAM 8/8/2017 4/7/2014 17 94 BLN
86 ROZAK ULFA / NAFSIAH 8/8/2017 1/7/2014 13 89 BLN
87 ZIHAN RISA / YAYAN 8/8/2017 12/14/2016 7.5 BLN
88 INAYAH IMAS / EDI 8/8/2017 7/24/2013 19 BLN
89 DIAS IMAS / EDI 8/8/2017 2/12/2015 13 BLN
90 SYAKILA IDAH / SUROTO 8/8/2017 11/8/2012 15 BLN
91 AULA NELI / TOAT 8/8/2017 10/18/2012 16 BLN
92 RAYHAN ODEH / ANIH 8/8/2017 5/13/2013 16 BLN
93 HAIKAL AAS / MARTIN 8/8/2017 5/18/2015 12 82 BLN
94 ASKA SANDRA / RINO 8/8/2017 12/18/2015 10 79 BLN
95 IRMA AAS / MARTIN 8/8/2017 4/17/2013 17 101 BLN
96 AIDA SAFA / MAWAN 8/8/2017 11/18/2011 19 104 BLN
97 AKILLA SAMAH / TARJO 8/8/2017 5/19/2017 6.5 BLN
98 AZRIL DEVI / SOLAH 8/8/2017 12/18/2017 7.5 BLN
99 ANJAR ATMINI / SUPARNO 8/8/2017 2/6/2012 18 106 BLN
100 M. ERLAN MURTIANA / SURYA 8/8/2017 12/24/2013 14 94 BLN
101 DZAKIR PURWATI / ASEP 8/8/2017 11/19/2016 10 80 BLN
102 BLN
PETUGAS
(...................................)
FORMULIR PENCATATAN
PUSKESMAS :
POSYANDU/DESA : NURI 2 / MEKAR MUKTI

1 2 3 4 5 6 7 8 9 10 11 12
1 KANTA TIKA RT. 002/005 8/2/2017 6/2/2014 P 17 BLN
2 QUINTA TIKA RT. 002/005 8/2/2017 11/2/2016 P 9.1 BLN
3 RATU ARNI RT. 002/005 8/2/2017 4/13/2016 P 8.3 BLN
4 WAWA TINA RT. 002/005 8/2/2017 2 TAHUN P 11.5 BLN
5 DAVID SRI RT. 002/005 8/2/2017 11/22/2015 L 11 76 BLN
6 FAHRI AYU RT. 002/005 8/2/2017 1/20/2015 L 15.7 BLN
7 HAFNA SULIS RT. 002/005 8/2/2017 10/22/2014 P 12 BLN
8 DAFA NUR RT. 002/005 8/2/2017 7/13/2013 L 12.8 98 BLN
9 KEYSA NUR RT. 002/005 8/2/2017 7/19/2016 P 8.8 71 BLN
10 ALMAHERA OY RT. 002/005 8/2/2017 11/30/2015 P 13 85 BLN
11 KESYA VIKA RT. 002/005 8/2/2017 3/10/2012 8.4 72 BLN
12 SALSABILA SAMRIH RT. 002/005 8/2/2017 1/15/2016 P 10.2 76 BLN
13 ANTIKA IMAS RT. 002/005 8/2/2017 9/17/2016 P 8.5 64 BLN
14 FIAN NUR RT. 002/005 8/2/2017 10/13/2015 P 7.5 67 BLN
15 ABYA AI RT. 002/005 8/2/2017 10/17/2017 P 4 48 BLN
16 HASAN RINI RT. 002/005 8/2/2017 4/24/2015 11.8 87 BLN
17 RIZKA YUNI RT. 002/005 8/2/2017 7/7/2015 12.7 BLN
18 LEANDRA ADE IMAN RT. 002/005 8/2/2017 10/10/2016 L 9.5 BLN
19 ZAHRA LIA RT. 002/005 8/2/2017 8/1/2016 P 7.5 BLN
20 MIRZA IIS RT. 002/005 8/2/2017 11/19/2016 L 7.8 BLN
21 HAIKAL SITI FATIMAH RT. 002/005 8/2/2017 7/6/2016 L 7.8 BLN
22 ABIAN SITI FATIMAH RT. 002/005 8/2/2017 2/20/2016 L 11.4 BLN
23 PUTRI KARNITA ROHAN RT. 002/005 8/2/2017 5/19/2012 P 12.4 BLN
24 DINDA LENI RT. 002/005 8/2/2017 P 19.2 BLN
25 ARFAN KUSMIYATI RT. 002/005 8/2/2017 8/6/2016 L 7.8 BLN
26 BAIM SARI RT. 002/005 8/2/2017 5/28/2015 L 12.7 BLN
27 ADIB KIKI RT. 002/005 8/2/2017 1/2/2015 L 15 BLN
28 ZAHRA ALMAHERA NARTI RT. 002/005 8/2/2017 5/1/2013 P 14.7 BLN
29 SYIFA RATNA RT. 002/005 8/2/2017 7/22/2015 P 10 BLN
30 GAHI NURJANAH RT. 002/005 8/2/2017 9/8/2015 L 12.3 BLN
31 ASZA DANI RT. 002/005 8/2/2017 2/21/2006 L 9.9 BLN
32 M. ALIF WAHAH RT. 002/005 8/2/2017 7/28/2016 L 8.3 BLN
33 ZAKI NITA RT. 002/005 8/2/2017 4/26/2013 L 13.3 BLN
34 SATRIA TIKA RT. 002/005 8/2/2017 5/22/2014 L 15 BLN
PETUGAS
(...................................)
FORMULIR PENCATATAN
PUSKESMAS :
POSYANDU/DESA : NURI 2 / MEKAR MUKTI

1 2 3 4 5 6 7 8 9 10 11 12
35 ZAM-ZAM DEWI CIBEREUM 8/2/2017 2/17/2013 L 14 103 BLN
36 DIFA ICAH PULO KAPUK 8/2/2017 P 18 104 3 THN
37 ARIF RAFI PULO KAPUK 8/2/2017 L 27 107 4 THN
38 FAHRI ANDRIYANI PULO KAPUK 8/2/2017 8/2/2012 L 16 105 BLN
39 FATIH ANITA PULO KAPUK 8/2/2017 L 15 106 3 THN
40 GIO GOMBONG 8/2/2017 8/17/2012 L 16 104 BLN
41 AZKA AAM PULO KAPUK 8/2/2017 L 16 104 2 THN
42 AFFAN WIWI PULO KAPUK 8/2/2017 12/23/2012 L 17 107 BLN
43 DZAKI ANANG MKR MUKTI 8/2/2017 3/26/2013 L 12 93 BLN
44 NAYLA NURHAYATI GOMBONG 8/2/2017 9/9/2012 P 12 90 BLN
45 KHALISTA ERNA MKR MUKTI 8/2/2017 11/25/2011 P 17 108 BLN
46 FAKIH 8/2/2017 L 17 90 3 THN
47 MORENO 8/2/2017 L 16 91 BLN
48 DZAKI 8/2/2017 L 16 92 BLN
49 RAFKA GOMBONG 8/2/2017 L 17 89 2 THN
50 SIKAM PULO KAPUK 8/2/2017 L 16 87 2 THN
51 ADINDA MKR MUKTI 8/2/2017 P 17 85 BLN
52 WINDA MKR MUKTI 8/2/2017 P 15 89 3 THN
53 MAURA MKR MUKTI 8/2/2017 P 16 80 4 THN
54 CACA MKR MUKTI 8/2/2017 P 17 87 5 THN
55 RISMA PULO KAPUK 8/2/2017 P 15 85 3 THN
56 APRIL GOMBONG 8/2/2017 P 14 87 2 THN
57 SYIFA GOMBONG 8/2/2017 P 13 86 2 THN
58 DEWI PULO KAPUK 8/2/2017 P 12 78 1 THN
59 RAMZAH PULO KAPUK 8/2/2017 L 16 89 2 THN
60 LUTHFI GOMBONG 8/2/2017 L 17 86 2 THN
61 LALA PULO KAPUK 8/2/2017 P 16 85 3 THN
62 AIS PULO KAPUK 8/2/2017 P 17 88 2 THN
63 SHERENA PULO KAPUK 8/2/2017 P 18 87 5 THN
64 ALIF ARI PULO KAPUK 8/2/2017 10/30/2014 L 16 9 BLN
65 NAHLA WICANG PULO KAPUK 8/2/2017 4/24/2014 P 18 82 BLN
66 ANJANI ADAM PULO KAPUK 8/2/2017 P 14 84 3 THN
67 AZAM ISMAIL PULO KAPUK 8/2/2017 L 13 83 2 THN
68 AL KAISAR DEDI PULO KAPUK 8/2/2017 L 12 83 5 THN

69 HERDIANSYAH HERI PULO KAPUK 8/2/2017 5/13/2013 L 16 87 BLN
70 AZKA HARI PULO KAPUK 8/2/2017 9/11/2015 L 17 89 BLN
PETUGAS
(...................................)
FORMULIR PENCATATAN
PUSKESMAS :
POSYANDU/DESA : CAMAR 1 / MEKAR MUKTI

1 2 3 4 5 6 7 8 9 10 11 12
1 SHALSA SANTI RT. 001/005 8/7/2017 6/7/2015 P 13 85.8 BLN
2 ALFIAN DEWI RT. 001/005 8/7/2017 P 11 80 BLN
3 ABIFATIH IDA RT. 001/005 8/7/2017 9/4/2015 L 15 102 BLN
4 FATUNA AAN RT. 001/005 8/7/2017 P 10 71 14 BLN
5 ANDRA SUSI RT. 001/005 8/7/2017 9/4/2015 P 11.5 80 BLN
6 AIRA IRMA RT. 001/005 8/7/2017 4/7/2016 P 9.8 72 BLN
7 SYIFA NUR RT. 001/005 8/7/2017 P 15 91 3 THN
8 AIRA SAWIH RT. 001/005 8/7/2017 P 15 120 5 THN
9 ASEP SAWIH RT. 001/005 8/7/2017 L 15 76 3 THN
10 ARSY MASILI RT. 001/005 8/7/2017 P 6.6 67 3 BLN
11 KEYLA NONOM RT. 001/005 8/7/2017 P 27 112 4 THN
12 NAURA NOVI RT. 001/005 8/7/2017 10/6/2015 P 8.6 65 BLN
13 IKHSAN WIWIN RT. 001/005 8/7/2017 12/6/2014 L 11 70 BLN
14 RAIHAN LITA RT. 001/005 8/7/2017 9/22/2016 P 8.3 65 BLN
15 RAJA LIA RT. 001/005 8/7/2017 8/26/2015 P 11.2 76 BLN
16 FITRI MILA RT. 001/005 8/7/2017 11/1/2016 L 8.6 65 BLN
17 FIRA JUNI RT. 001/005 8/7/2017 L 16 93 4 THN
18 MEISYA YANI RT. 001/005 8/7/2017 5/3/2015 P 5.3 50 BLN
19 AKMAL WINAH RT. 001/005 8/7/2017 6/17/2014 24 98 BLN
20 FALI DINAH RT. 001/005 8/7/2017 3/7/2016 L 10.1 67 BLN
21 NABILA RIKI RT. 001/005 8/7/2017 6/27/2014 12 85.5 BLN
22 SAFIQ TIARA RT. 001/005 8/7/2017 7/4/2014 20 96 BLN
23 AMALIA ROB RT. 001/005 8/7/2017 7/27/2016 9.4 BLN
24 ABIFATIH IIT RT. 001/005 8/7/2017 2/3/2015 14 84 BLN
25 KEYSA BEDEH RT. 001/005 8/7/2017 4/2/2013 17 110 BLN
26 ZIHAN CONGKUR RT. 001/005 8/7/2017 8/13/2014 P 13 70 BLN
27 SABIL TIRAH RT. 001/005 8/7/2017 11/25/2016 8 60 BLN
28 HABIBAH ELI RT. 001/005 8/7/2017 10 62 2 THN
29 TAURA SANTI RT. 001/005 8/7/2017 13 78 17 BLN
30 SASKIS ENGKOS RT. 001/005 8/7/2017 11/16/2013 19 98 BLN
31 SALSA ANITA RT. 001/005 8/7/2017 9/8/2012 15 100 BLN
32 DAFA FITRI RT. 001/005 8/7/2017 2/15/2015 14 86 BLN
33 OVAL LILIS RT. 001/005 8/7/2017 11/20/2016 11 74.1 BLN
34 SYALAB YANTI RT. 001/005 8/7/2017 5/19/2014 20 97 BLN
PETUGAS
(...................................)
FORMULIR PENCATATAN
PUSKESMAS :
POSYANDU/DESA : CAMAR 1 / MEKAR MUKTI

1 2 3 4 5 6 7 8 9 10 11 12
35 LYDIA SARIN RT. 001/005 8/7/2017 5/6/2013 13 92 BLN
36 LAILA WIRA RT. 001/005 8/7/2017 11/18/2014 11 85 BLN
37 FADHIL SITI KHODIJAH RT. 001/005 8/7/2017 12/19/2014 11 90 BLN
38 ZAKIR AI RT. 001/005 8/7/2017 8/1/2014 11 85 BLN
39 AGUSTINA RANI RT. 001/005 8/7/2017 13 76 4,5 THN
40 AURYN IPOL RT. 001/005 8/7/2017 14 70 4,5 THN
41 CHIKAL KIKI RT. 001/005 8/7/2017 15 80 5 THN
42 KAYLA FIKI RT. 001/005 8/7/2017 16 82 5 THN
43 ANA SUIKANA RT. 001/005 8/7/2017 17 84 1,10 THN
44 KEYSHA ARI RT. 001/005 8/7/2017 16 85 5 THN
45 KENZO RIANA RT. 001/005 8/7/2017 17 86 3 THN
46 RESKY RABIH RT. 001/005 8/7/2017 16 80 4,3 THN
47 RAJA FEBI RT. 001/005 8/7/2017 17 89 4,6 THN
48 SERENA UMI RT. 001/005 8/7/2017 12 76 4,3 THN
49 VIANDRA RITA RT. 001/005 8/7/2017 13 76 4,8 THN
50 VIO SYAFIAN RT. 001/005 8/7/2017 12 70 4,9 THN
51 FADLI LURAH RT. 001/005 8/7/2017 13 2 THN
52 RAFA MANROH RT. 001/005 8/7/2017 3 THN
53 PUTRI AURA ANI RT. 001/005 8/7/2017 17 76 4,1 THN
54 SALWA IMAS RT. 001/005 8/7/2017 16 70 3,6 THN
55 FRANSISCA RIRIN RT. 001/005 8/7/2017 17 76 3,5 THN
56 ZAHWA SATRI RT. 001/005 8/7/2017 16 70 3,9 THN
57 KAIRA TUTI RT. 001/005 8/7/2017 15 80 4 THN
58 ALBINKA IIN RT. 001/005 8/7/2017 14 82 4,3 THN
59 BLN
60 BLN
61 BLN
62 BLN
63 BLN
64 BLN
65 BLN
66 BLN
67 BLN
68 BLN
PETUGAS
(...................................)
FORMULIR PENCATATAN
PUSKESMAS :
POSYANDU/DESA : MERKURIUS / MEKAR MUKTI

1 2 3 4 5 6 7 8 9 10 11 12
1 RAHMAT HERMAN CIBEREUM 8/1/2017 B L 9.5 75 17 BLN
2 ELSA TAUFIQ M3 8/1/2017 B P 11.1 85 26 BLN
3 AZZAM MAHYUNIS M4 8/1/2017 B L 8.9 74 11 BLN
4 NADIRA PEBRI CIBEREUM 8/1/2017 B P 8.8 74 23 BLN
5 NATHAN TEDI M3 8/1/2017 B L 11.7 89 3 THN
6 AZIZAH UMAR CIBEREUM 8/1/2017 B P 10.7 88 3,3 THN
7 DIMAS ANDI M4 8/1/2017 B L 11.4 83 2 THN
8 M. ADE UNTUNG S. BM 8/1/2017 T L 8.4 65 6 BLN
9 SLANI SETO BM 8/1/2017 T P 8.2 62 6 BLN
10 ADNAN AGUS R. M2 8/1/2017 B L 12 80 2 THN
11 GEBI SANDI M5 8/1/2017 B P 16.6 707 4,10 THN
12 RADIT WARDI M5 8/1/2017 B L 22.1 703 3,6 THN
13 PIAN EKO M2 8/1/2017 B L 19.6 93 3,1 THN
14 AZELIA TRISARI B5 8/1/2017 T P 5.1 56 2 THN
15 AIANA IRMA CIBEREUM 8/1/2017 B P 9.4 72 21 BLN
16 FIKRI NONA CIBEREUM 8/1/2017 B P 11.2 83 21 BLN
17 NISSA RAHMAT CIBEREUM 8/1/2017 B P 9.5 98 5 THN
18 NATA NITA CIBEREUM 8/1/2017 B L 9.1 70 10 BLN
19 FARAH ZUL M5 8/1/2017 B P 10.8 80 1,10 THN
20 DANI S. RATNA M4 8/1/2017 B L 11.8 84 2 THN
21 ALMA CIBEREUM 8/1/2017 T P 5.5 87 6 BLN
22 ASKA INDASARI M2 8/1/2017 B L 16.8 92 2,10 THN
23 NUGI HIDAYAH CIBEREUM 8/1/2017 B L 18.3 87 3,3 THN
24 ALDO UPIT CIBEREUM 8/1/2017 B L 13 87 3,2 THN
25 ASILA UPIT CIBEREUM 8/1/2017 T P 8.2 57 5 BLN
26 ELEA WEW CIBEREUM 8/1/2017 B P 8 65 11 BLN
27 FAQIH FIKRI / RISKI M5 8/1/2017 B L 14.2 98 4 THN
28 MAHER TRI AGUS M5 8/1/2017 B L 15.5 95 3,5 THN
29 AGAM SIRIN M5 8/1/2017 B L 8.3 70 14 THN
30 ABI GUNAWAN M4 8/1/2017 B L 14.8 90 4 THN
31 PRADITA NUR PRATIWI CIBEREUM 8/1/2017 B L 10 76 1,6 THN
32 ALIF CIBEREUM 8/1/2017 T L 7.5 66 7 BLN
33 PA'I JAYADI M2 8/1/2017 L 4,3 THN
34 BUHORI CIBEREUM 8/1/2017 B L 11.9 87 4 THN
PETUGAS
(...................................)
FORMULIR PENCATATAN
PUSKESMAS :
POSYANDU/DESA : MERKURIUS / MEKAR MUKTI

1 2 3 4 5 6 7 8 9 10 11 12
35 AZELIA SARI M4 8/1/2017 B P 9.5 74 1,5 THN
36 OBI OKMASARI M5 8/1/2017 B L 11.2 88 3 THN
37 FAREL LASTRI M4 8/1/2017 B L 19.7 105 4 THN
38 AQILA SAMLI M4 8/1/2017 B P 12.3 89 3,3 THN
39 AEILA AIN M3 8/1/2017 B P 9.7 92 2 THN
40 KETTY M3 8/1/2017 B P 9.2 97 2,5 THN
41 ANDRA YUNI B5 8/1/2017 B L 12 85 3,6 THN
42 BAGAS M1 8/1/2017 L 18 THN
43 RIO M1 8/1/2017 L 3 THN
44 RAIHANA ANANG M2 8/1/2017 P 3 THN
45 BLN
46 BLN
47 BLN
48 BLN
49 BLN
50 BLN
51 BLN
52 BLN
53 BLN
54 BLN
55 BLN
56 BLN
57 BLN
58 BLN
59 BLN
60 BLN
61 BLN
62 BLN
63 BLN
64 BLN
65 BLN
66 BLN
67 BLN
68 BLN
PETUGAS
(...................................)
FORMULIR PENCATATAN
PUSKESMAS :
POSYANDU/DESA : CAMAR 3 / MEKAR MUKTI (RAWA LINTAH)

1
1 ASYFA R. IKA / ANDRI RT. 003/004 8/4/2017 11/22/2012 P 19 107 BLN
2 REGA R. MASIH / TASIAN RT. 003/004 8/4/2017 7/12/2012 L 19 108 BLN
3 WAHYU ANAH / MIHUN RT. 003/004 8/4/2017 6/2/2012 L 16 105 BLN
4 FAHRI LIDA / UPIK RT. 003/004 8/4/2017 7/13/2014 L 14 91.5 BLN
5 SEKAR WULAN / ICAN RT. 003/004 8/4/2017 6/27/2015 P 9 79.3 BLN
6 ZIDAN RT. 003/004 8/4/2017 10 BLN
7 HAFIDZ ACIH / BEHOK RT. 003/004 8/4/2017 L 16 103 4 THN
8 HAFIDZAH ACIH / BEHOK RT. 003/004 8/4/2017 P 15 105 4 THN
9 EVA ROHATI RT. 003/004 8/4/2017 10/22/2014 P 8.5 105.5 BLN
10 ALFAR MISIH / AGUNG RT. 003/004 8/4/2017 1/18/2013 L 14 104.7 BLN
11 SISKA NICKRY / SUHENDAR RT. 003/004 8/4/2017 10/27/2016 P 7.5 BLN
12 SALWA MANIH / USMAN RT. 003/004 8/4/2017 3/22/2016 P 9.2 79 BLN
13 CECEP ACIH / AGUS RT. 003/004 8/4/2017 L 24 112.5 4 THN
14 FAISAL AAN / SAMEN RT. 003/004 8/4/2017 12/31/2014 L 18 96 BLN
15 MUTIARA AAS / ACIM RT. 003/004 8/4/2017 4/18/2015 P 10 81.5 BLN
16 FEBI RT. 003/004 8/4/2017 2/6/2015 P 9 77.5 BLN
17 LUCKY LINA RT. 003/004 8/4/2017 7/14/2016 L 9.5 BLN
18 RISWAN RINI / ARIS RT. 003/004 8/4/2017 L 3,5 THN
19 LAILA ANI / UMAR RT. 003/004 8/4/2017 P 1,5 THN
20 PIPIK SARI RT. 003/004 8/4/2017 P 3 THN
21 BILLY LIA RT. 003/004 8/4/2017 L 16 100 4 THN
22 SELFY JAMI / MISIN RT. 003/004 8/4/2017 P 16 99.5 3,5 THN
23 CHA-CHA KANAH RT. 003/004 8/4/2017 P 12 98.5 3 THN
24 CLARA NOVI RT. 003/004 8/4/2017 P 2,5 THN
25 MARWAH YANI RT. 003/004 8/4/2017 4/20/2016 P 10.5 75 BLN
26 NOVAL AYU RT. 003/004 8/4/2017 L 17 106 3,5 THN
27 KAYLA SHELA RT. 003/004 8/4/2017 P 8 BLN
28 EVAN UPUH RT. 003/004 8/4/2017 8/14/2014 L BLN
29 AGAM UMI / TRI RT. 003/004 8/4/2017 3/7/2016 L 11 79 BLN
30 ARFAN DAYANTI / ARDIAN RT. 003/004 8/4/2017 5/2/2017 L 6 BLN
31 SALWA AAN / AMAD RT. 003/004 8/4/2017 3 THN
32 LUTFI FITRI / ANDRE RT. 003/004 8/4/2017 1 THN
33 TAMA WIWIN / AEP RT. 003/004 8/4/2017 3 THN
34 PRICILA RANI / DAHLAN RT. 003/004 8/4/2017 4 THN
PETUGAS
(...................................)
FORMULIR PENCATATAN
PUSKESMAS :
POSYANDU/DESA : PASIR GOMBONG
NAMA NAMA TANGGAL TGL LAHIR CARA

BALITA ORANG TUA TIMBANG (TGL/BLN/TH) B / T
1 2 3 4 5 6 7 8 9
1 ARPAN AGUS RT. 007/001 8/10/2017 10/5/2015

2 ARYA DIASMAKMURRT. 007/001 8/10/2017 7/19/2014
3 AZZAHRA BAMBANG RT. 007/001 8/10/2017 5/12/2016
4 ASNA RUDI RT. 007/001 8/10/2017 8/1/2012
5 ARKA DIN YAYAH RT. 007/001 8/10/2017 2/2/2017
6 BILQIS RAHMATRT. 007/001 8/10/2017 11/16/2014
7 BAYU HAMDANIRT. 007/001 8/10/2017 2/13/2014
8 BRIAN AIDADI .S RT. 007/001 8/10/2017 5/24/2015
9 CHELSEA IMAM RT. 007/001 8/10/2017 11/22/2012
10 DAFA SLAMET RT. 007/001 8/10/2017 9/7/2013
11 DEVITA ASEP RT. 007/001 8/10/2017
12 GILANG WAHID RT. 007/001 8/10/2017 7/20/2015
13 HUNA DARTO RT. 007/001 8/10/2017 7/9/2014
14 HAFIZ NA ALMUTAQRT. 007/001 8/10/2017 10/15/2015
15 HAIKAL RAHAYU RT. 007/001 8/10/2017 1/25/2016
16 HAMDAN NURHEND RT. 007/001 8/10/2017 11/14/2014
17 HUMAIRAIRMA RT. 007/001 8/10/2017
18 HAIFAL SANTI RT. 007/001 8/10/2017
19 ISAM SAMAN RT. 007/001 8/10/2017 5/10/2016
20 JOSHUA SULIANTORT. 007/001 8/10/2017 7/13/2014
21 ZIKRI DEDE RT. 007/001 8/10/2017
22 KAHOIRULDEDE RT. 007/001 8/10/2017
23 KAIRA SAIMAH RT. 007/001 8/10/2017 3/29/2017
24 KENZI SOLEHANRT. 007/001 8/10/2017 8/16/2015
25 M. FAZRI DEDE RT. 007/001 8/10/2017
26 MALIKA MAMAN RT. 007/001 8/10/2017 11/29/2014
27 MIDA EKA RT. 007/001 8/10/2017 5/23/2014
28 M. RANG ANI RT. 007/001 8/10/2017 2/11/2016
29 NAFISA ASEP RT. 007/001 8/10/2017 8/11/2016
30 NADIA IHSAN RT. 007/001 8/10/2017 8/16/2015
31 NADIRA NUR RT. 007/001 8/10/2017 8/25/2015
32 NAYLA LIARI RT. 007/001 8/10/2017 9/25/2014
33 NAUFAL PUTRI RT. 007/001 8/10/2017 2/20/2014
34 RAINA DEVI RT. 007/001 8/10/2017 6/23/2015
(...................................)
FORMULIR PENCATATAN
PUSKESMAS :
POSYANDU/DESA : PASIR GOMBONG

1 2 3 4 5 6 7 8 9
35 RUBY ASEP RT. 007/001 8/10/2017 6/23/2015

36 RIQKI RISMA RT. 007/001 8/10/2017 8/22/2016
37 RIFKI RISMA RT. 007/001 8/10/2017 8/22/2016
38 RAFA RIAN RT. 007/001 8/10/2017 12/30/2015
39 REFA RIAN RT. 007/001 8/10/2017 12/30/2015
40 KAKA JONI RT. 007/001 8/10/2017 12/4/2013
41 RAFA MIRJAT RT. 007/001 8/10/2017 12/2/2012
42 SRI NOVIANAMIN RT. 007/001 8/10/2017 11/17/2012
43 RAISA INTI RT. 007/001 8/10/2017 12/1/2014
44 SRI RAHMRURI RT. 007/001 8/10/2017
45 SULTAN SYRURI RT. 007/001 8/10/2017 4/1/2017
46 ULAN SARFERRY RT. 007/001 8/10/2017
47 AQILA IIS RT. 007/001 8/10/2017 8/1/2016
48 AKIL ITA RT. 007/001 8/10/2017 10/14/2013
49 ANGGITA WAHYUDIRT. 007/001 8/10/2017
50 ADEL HARYANTRT. 007/001 8/10/2017
51 M. KHALI SITI RT. 007/001 8/10/2017 6/20/2017
52 VALERI AMPRIONA RT. 007/001 8/10/2017
53 PUTRI NURSEHART. 007/001 8/10/2017
54 WINNER ROLITA RT. 007/001 8/10/2017 12/27/2014
55 HANA ISHANI RT. 007/001 8/10/2017 10/3/2013
56 RAFA DIAN RT. 007/001 8/10/2017
57 YASMIN MINAH RT. 007/001 8/10/2017 10/13/2015
58 THALITA NURIDA RT. 007/001 8/10/2017 3/6/2016
59 DINDA NAMIH RT. 007/001 8/10/2017 8/5/2013
60 SAIFARA CECEP RT. 007/001 8/10/2017 7/23/2014
61 FADLI PENDI RT. 007/001 8/10/2017 8/26/2013
62 FAQIH SURASKINRT. 007/001 8/10/2017 3/29/2012
63 NAJWA SITI RT. 007/001 8/10/2017 12/14/2013
64 PUTRI NABIKA RT. 007/001 8/10/2017 2/9/2013
65 M. FALIH IKOH RT. 007/001 8/10/2017 12/4/2016
66 BAGUS AMI RT. 007/001 8/10/2017 10/16/2016
67 DINDA SUCI RT. 007/001 8/10/2017 3/28/2016
68 MARSYA FITRI RT. 007/001 8/10/2017 3/28/2015
(...................................)
FORMULIR PENCATATAN
PUSKESMAS :
1 2 3 4 5 6 7 8 9
69 ABDUL MAJULENI RT. 007/001 8/10/2017 7/21/2015

70 MOSE RT. 007/001 8/10/2017 5/20/2015
71 CHALES WATI RT. 007/001 8/10/2017 7/12/2016
72 ALDE JANAN RT. 007/001 8/10/2017 3/3/2014
73 SALSABILAASTUTI RT. 007/001 8/10/2017 3/15/2013
74 FEBRI RIANTI RT. 007/001 8/10/2017 2/6/2014
75 M. ALWI KARLINA RT. 007/001 8/10/2017 11/9/2013
76 ZAKIA ANYAR RT. 007/001 8/10/2017 2/25/2016
77 ARSYILA YUSTINI RT. 007/001 8/10/2017 3/25/2016
78 AFIS TRISNAWA RT. 007/001 8/10/2017
79 ALIFENDRIMARIA ME RT. 007/001 8/10/2017 5/5/2016
80 SASWA ROSANTIRT. 007/001 8/10/2017 3/26/2017
81 WILDAN SRI RT. 007/001 8/10/2017 5/3/2014
82 NADIA YAYU RT. 007/001 8/10/2017 2/21/2014
83 ZAHRAH IIN RT. 007/001 8/10/2017 2/6/2017
84 LINTANG ROHAYA RT. 007/001 8/10/2017 11/20/2015
85 RAHMA INTI RT. 007/001 8/10/2017 2/7/2013
86 ANGGIA IDA RT. 007/001 8/10/2017 11/20/2015
87 ADELIA TINA RT. 007/001 8/10/2017 5/20/2014
88 M. ISKO SITI RT. 007/001 8/10/2017 4/20/2017
89 M. ASKA ELI RT. 007/001 8/10/2017 10/20/2015
90 DIVA RT. 007/001 8/10/2017 5/19/2016
91 FAHIRA ARUM RT. 007/001 8/10/2017 4/19/2014
92 KHARISA MIA RT. 007/001 8/10/2017 11/13/2014
93 AISYAH ZULKIFLI RT. 007/001 8/10/2017 5/30/2012
94 DAIFULLA BILAT RT. 007/001 8/10/2017 6/12/2014
95 M. AKHIL ZULKIFLI RT. 007/001 8/10/2017 3/23/2014
96 EZA IMRON RT. 007/001 8/10/2017 9/5/2013
97 AQILAH AZAM RT. 007/001 8/10/2017 6/17/2012
98 BAGAS HERNI RT. 007/001 8/10/2017
99 AFNAN FARUDIYANT RT. 007/001 8/10/2017 9/13/2016
100 NABILA MULYADIRT. 007/001 8/10/2017 4 TAHUN
101 M. DAFA AJUM RT. 007/001 8/10/2017 11/11/2013
102 KAISAR ALSOPIAN RT. 007/001 8/10/2017 10/18/2012
(...................................)
FORMULIR PENCATATAN
PUSKESMAS :

1 2 3 4 5 6 7 8 9
103 BAYU HAMDANIRT. 007/001 8/10/2017 2/13/2014

104 FADIL ELA RT. 007/001 8/10/2017 5 TAHUN
105 MUTIARA SALIH RT. 007/001 8/10/2017 3 TAHUN
106 RAMDAN /BUDI RT. 007/001 8/10/2017 8/14/2012
107 NANA ISHANI RT. 007/001 8/10/2017 10/3/2013
108 NAYLA FIRMAN RT. 007/001 8/10/2017 9/25/2014
PB)
HUN 2017
BB TB UMUR
(KG) (CM) (BULAN)
10 11 12
PETUGAS
(...................................)
PB)
HUN 2017
BB TB UMUR
(KG) (CM) (BULAN)
10 11 12
PETUGAS
(...................................)
PB)
HUN 2017
BB TB UMUR
(KG) (CM) (BULAN)
10 11 12
PETUGAS
(...................................)
PB)
HUN 2017
BB TB UMUR
(KG) (CM) (BULAN)
10 11 12

Bulan Penimbangan Balita 2017

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FORMULIR PENCATATAN

BULAN PENIMBANGAN BALITA (BPB)

PUSKESMAS : MEKAR MUKTI

NAMA NAMA TANGGAL TGL LAHIR CARA BB

3 AZKA DWI P. NURROIS / SRI S. RT. 001 / 005 8/14/2017 2/5/2014 T L 12

5 ALISA N.Z. ILAN P. / MARYANAH RT. 001 / 005 8/14/2017 1/29/2013 T P 14

6 ADAM SARI M. SUPRIATNA / KARMIAN RT. 001 / 005 8/14/2017 3/6/2013 T L 13

7 M. ALDIANSYAH DIANTO / AAS S. RT. 001 / 005 8/14/2017 12/18/2012 T L 17

9 M. AUFAR M. M. FAJAR / CICIH P. RT. 001 / 005 8/14/2017 12/11/2013 T L 14

11 NAFISA M. A. BASYIT / EKAWATI RT. 001 / 005 8/14/2017 5/21/2016 T P 8.3

12 DAMAR PRATAMA DAVID / MIMIN RT. 001 / 005 8/14/2017 12/14/2014 T L 13

13 JAFIRA A.A NATA / YANI RT. 001 / 005 8/14/2017 12/23/2012 B P 15

14 ABID R. ATO P. / ANIH R. RT. 001 / 005 8/14/2017 7/10/2014 B L 12

15 MARWAH S.P SUMARNA / ANEH RT. 001 / 005 8/14/2017 9/13/2012 B P 10

17 DEDEN PURNAMA FERRY / TUTI RT. 001 / 005 8/14/2017 5/16/2014 B L 10

19 MARTIN M. ASMAN / SITI K. RT. 001 / 005 8/14/2017 11/4/2013 B L 20

20 DZAKIYA AUFA SATAR / INDAR RT. 001 / 005 8/14/2017 6/22/2016 T P 8

21 SAFALUNA W.R.J SATAR / INDAR RT. 001 / 005 8/14/2017 4/13/2017 P

22 NUR DEEVA MASKIM / YATI M. RT. 001 / 005 8/14/2017 3/24/2013 P 12

23 ASTIAN SANUSI UCI S. / NURHAYATI RT. 001 / 005 8/14/2017 11/2/2013 L 14

25 MIKHAYLA N.A KARNITA / RINI S. RT. 001 / 005 8/14/2017 10/29/2014 P 11

27 DIAN P. YAYAN / TITA RT. 001 / 005 8/14/2017 5/21/2013 P 12

28 MICHELL PRASETYO / DEWI RT. 001 / 005 8/14/2017 12/2/2012 P 13

29 ARKAN PRASETYO / DEWI RT. 001 / 005 8/14/2017 4/21/2014 L 12

30 M. ZIDHAN A. RIFKI / LIA RT. 001 / 005 8/14/2017 8/29/2014 L 10

31 SYAIQ IRMAN / DIKA RT. 001 / 005 8/14/2017 2/13/2016 L 9

32 FITRI ROPAL / MERI RT. 001 / 005 8/14/2017 6/20/2016 P 8.3

PUSKESMAS : MEKAR MUKTI

NAMA NAMA TANGGAL TGL LAHIR CARA BB

35 KARISA P. HERY / KAESIH RT. 001 / 005 8/14/2017 8/20/2012 B P 10

36 ADIRA HERY / KAESIH RT. 001 / 005 8/14/2017 6/7/2014 T P 6

37 BUNGA S.U SYAWAL / NURNI RT. 001 / 005 8/14/2017 12/30/2013 B P 15

38 ANINDARA ANWAR / NURFAJRIAH RT. 001 / 005 8/14/2017 5/31/2017 P 5.3

40 RESKY PRATAMA KANAM / SALBIAH RT. 001 / 005 8/14/2017 7/20/2015 L 9

42 NANDA EDI / NURTYAS RT. 001 / 005 8/14/2017 1/13/2014 B P 12

43 FAKHRI Z. WIDYANTO / UMI RT. 001 / 005 8/14/2017 11/23/2014 B L 12.8

44 BERTA ALISA F. KARYAWAN / TRI W. RT. 001 / 005 8/14/2017 10/24/2014 B P 11

46 M. ALWI R.R ERIS / MARLINA RT. 001 / 005 8/14/2017 7/22/2013 B L 15

47 LUTFIA A. MAD YUSUF / YAYUK RT. 001 / 005 8/14/2017 10/29/2014 B P 15

48 ZAHROTUL N. SLAMET / MARWATI RT. 001 / 005 8/14/2017 8/17/2012 B P 15

49 NARENDRA ZIDAN ASEP / SIMAH RT. 001 / 005 8/14/2017 5/10/2016 T L 8

50 NURSYIFA ALIYA WIDADI / NIA RT. 001 / 005 8/14/2017 8/12/2014 B P 11

52 NAUFAL K. AZZAM ADI / SAMAH RT. 001 / 005 8/14/2017 5/28/2015 B L 9

54 ZAHRA SUMIAJI IYUS / SUTARI RT. 001 / 005 8/14/2017 9/14/2014 B P 16

55 RIFFA S. SUDIRMAN / DESI RT. 001 / 005 8/14/2017 12/30/2013 B P 12

56 NUR UMAIRAH S. ADE/ MARFUAH RT. 001 / 005 8/14/2017 12/26/2016 B P 11

57 M. ALFAILAH RUDIANA / SITI N. RT. 001 / 005 8/14/2017 11/5/2013 B L 15

58 EUIS K. DEDI / UNAH RT. 001 / 005 8/14/2017 9/30/2014 B P 10

59 MURTIA MULKI / SRI H. RT. 001 / 005 8/14/2017 2/19/2014 B P 10

60 BILQIS UFAIRA SUHENDAR / NIA RT. 001 / 005 8/14/2017 1/29/2015 B P 11

61 RIANSYAH ADE / NURHAYATI RT. 001 / 005 8/14/2017 3/17/2014 B L 10.5

63 ANISA R.W WIRYA / MELAWATI RT. 001 / 005 8/14/2017 10/19/2014 B P 10

64 AKILA N.M MULYADI / ARYANI RT. 001 / 005 8/14/2017 1/17/2014 B P 14

66 ZIDNI A.N JAJANG / TITIN RT. 001 / 005 8/14/2017 8/20/2015 B L 10

68 M. HALIT A. SANA / ERNA RT. 001 / 005 8/14/2017 11/5/2015 B L 10

PUSKESMAS : MEKAR MUKTI

NAMA NAMA TANGGAL TGL LAHIR CARA BB

69 M. JAELANI UDIN / OMIH RT. 001 / 005 8/14/2017 8/8/2013 B L 11

72 AZIIZAH HERU / HERNI RT. 001 / 005 8/14/2017 12/23/2013 B P 11.5

73 ZASKIA YADI / KARTINI RT. 001 / 005 8/14/2017 3/6/2013 B P 12.5

74 NABILA SANUSI / ROMLAH RT. 001 / 005 8/14/2017 2/10/2014 B P 13

76 M. FAREL NURDIN / LIA RT. 001 / 005 8/14/2017 11/15/2012 B L 12.5

77 HAIKAL UMAR / NINA RT. 001 / 005 8/14/2017 2/17/2014 B L 10