PENCATATAN OUT BREAK IMUNIZATION ( ORI ) DIFENTRI

PROVINSI JAWA BARAT TAHUN 2017

FORM F3b. Pos Pelayanan (Sekolah)

KAB / KOTA : KAB. CIREBON
PUSKESMAS : KEC. GEGESIK
DESA / KELURAHAN : BAYALANGU LOR
NAMA SEKOLAH / LOKASI IMUNISASI : PAUD NURUL HIKMAH

NO NAMA ANAK TGL LAHIR KELAS TANGGAL KETERANGAN

1 2 3 4 5 6

1 ABDUL FALA AFANI 28/09/2013 A

2 ADINDA VERA 8/5/2012 A
3 ALESHA NAURA PRATAMA 8/31/2013 A
4 ANDRA NORMAL REALDI PUTRA 12/17/2012 A
5 ARKA SHABRI AMANATULLOH 12/26/2011 A
6 ASIFA AULIA 20/10/2012 A
7 AZRILIA APRILIAN 4/21/2013 A
8 BASTIAN 9/17/2012 A
9 BRIAN AFFANDI 11/23/2012 A
10 CHALLISTA 03/12/2011 A
11 DIMAS APRUDIN 03/05/2012 A
12 DIMAS MAULANA 9/28/2011 A
13 ELINAWATI 6/22/2012 A
14 EVANDER UBAIDILLAH AS'HAR 22/05/2013 A
15 FADEL FETRA 8/9/2013 A
16 FADIL 25/05/2012 A
17 FIQIH BAIHAQI 09/04/2013 A
18 FITRI JULIYANTI 02/07/2013 A
19 GITA ANGELINA 16/12/2012 A
20 HAFIZH PERMANA PUTRA 01/12/2012 A
21 HANA PERTIWI 4/5/2013 A
22 HELMI SAEFUDIN ZUHRI 5/28/2012 A
23 IBNU AQIL 1/11/2013 A
24 IKHSAN RAMADHANI 11/07/2013 A
25 INDAH MAULIDIYANI 24/01/2013 A
26 KEYSHA ADHA PRATIWI 10/28/2012 A
27 KHOTRUN NADA 11/8/2012 A
28 LIGI PAMILI 9/28/2012 A
29 MAYSA 30/04/2012 A
30 MOH RAIHAN YUDIS PRAYOGA 1/9/2013 A
31 MOHAMMAD CHOLIL AZHAR 9/25/2011 A
32 MUHAMMAD AGA AGIANSYAH 10/7/2012 A
33 MUHAMMAD FIRDIYANSYAH AL ALAWIYA 6/23/2013 A
34 NAERA SAFIRA 2/7/2012 A
35 NAURA SHABIRA AZZAHRA 22/12/2011 A
36 NAYALIFATUN 2/15/2012 A
37 NUR ARIEF PRATAMA 07/02/2012 A
38 NUR INDRIYANI 10/18/2012 A
39 NURASIVA SURIZKY MAULIDAH 01/02/2012 A
40 NAJWA FABILAH 21/12/2012 A
41 PUTRA HENDRIYANTO 03/02/2013 A
42 RAFA HIDATAT 06/05/2013 A
43 REVANIE NURAFIFAH SAFARIYAH 04/01/2012 A
44 RITA MAULANA SARI 9/3/2012 A
45 RIYAN ADI PRATAMA 6/25/2012 A
46 SALMAN AL FARIZI 24/04/2012 A
47 SILVIA YATI 5/21/2013 A
48 SINDI SAFITRI 22/07/2013 A
49 SITI FATMA SARI 5/25/2013 A
50 STEVEN MADE SAPUTRA 10/17/2012 A
51 SITI SUMAENAH 1/20/2013 A
52 TASYA 29/08/2012 A
53 TEGAR ABDE NEGARA 10/4/2012 A
54 TIARA 12/27/2011 A
55 TRI HESA LATIFA 3/3/2013 A
56 VENI RISTIYANI 12/23/2013 A
57 YOGI SAPUTRA 3/14/2014 A
58 ZAHRAH PUTRI AULIA 15/05/2013 A
59 ZAHWA AQILA 15/06/2012 A
60 ZAHIRA AGUSTIN 9/9/2011 A
61 SITI SUMAENAH 1/20/2013 A
62 ASIFAH 02/12/2012 B
63 KEYVIN RAMADANI 13/082013 B
64 LYRA VIRNA 9/29/2012 B
65 M. ADHIKA ARGA R. 1/17/2012 B
66 PUTRI SYAFIRA 1/1/2012 B
67 REVA IRENA 2/15/2013 B
68 SAHRUDIN 7/24/2012 B
69 SISKA AJENG P. 5/17/2012 B
70 SAFIRA PUTRI H. 1/8/2012 B
71 ADE RIANTI 8/7/2011 B
72 EVILIA PERMATAHATI 12/17/2011 B
73 KHASYIFA NUR N. 7/11/2012 B
74 MOH ABDUL RAJAB 6/20/2011 B
75 MUH. RAMA DANI 8/7/2012 B
76 PUTRI ANGGUN SARI 10/10/2012 B
77 REVI DINDA RAMADHANI 7/30/2012 B
78 RINDI WINCI 6/11/2012 B
79 RINDU WINCU 6/11/2012 B