FORMAT PENDATAAN P

KABUPATEN : SIDOARJO
PUSKESMAS : GEDANGAN
DESA : PUNGGUL
POSYANDU :
ALAMAT (Dusun/RT/RW) : PUNGGUL/01/02

No. NIK KK/No. KK NIK ISTRI Nama* Tgl Lahir* NIK SUAMI

1 I3511890001 ARTYANI PUTRI B 15/11/1989

2 I3511780003 RIRIN SULISTYA 11/26/1978 S3512720002

3 I3504750009 UMI SALAMA 4/4/1975

4 I3509740008 SUGIARTI 9/19/1974 S3507670001

5 I3506840004 INDAH S 6/3/1984 S3507690002

6 I3508710004 LILIK FARIDA 8/7/1971 S3507630003

7 I3505690003 SRI KATENI 5/20/1969 S3501660017

8 I3508880001 AIDA FARISKHI 8/30/1988 S3509840006

9 I3511780003 SITI ROISAH 11/22/1978 S3503700003

 10 I3502720001 AMILIN ROFIATI 2/8/1972 S3508630003

11 I3502700002 SRI MUJIATI 2/17/1970 S3506650002

12 I3510780003 LISTIFAROH A 10/20/1978 S3512780005

13 I3508850001 RITA S 8/31/1985 S3502830006

14 I3507690004 TITIN YULIANI 7/4/1969 S3508600001

15 I3501680001 NUR MACHMA S 1/7/1968 S3504620001

16 I3511690003 SAROMA 11/22/1969 S3510670002

TOTAL KB
Suntik : 5
Pil 2
Kondom : 0
IUD 0
MOP : 0
MOW : 3
Kalender : 0
ASI Eksklusif (Laktasi) : 0

FORMAT PENDATAAN P

KABUPATEN : SIDOARJO
PUSKESMAS : GEDANGAN
DESA : PUNGGUL
POSYANDU :
ALAMAT (Dusun/RT/RW) : PUNGGUL/02/02

No. NIK KK/No. KK NIK ISTRI Nama* Tgl Lahir* NIK SUAMI

1 I3505850004 NINUK NOVITA 5/18/1985 S3511840004

2 I3512690001 LIKAYATIN 12/29/1969 S3503600001

3 I3509880001 KHALIMATUS SADIYAH 9/21/1988 S3507870001

4 I3505770003 KHALIMATUS SADIYAH 5/17/1977 S3512680008

5 I3506740006 LAILI DURRO NABILA 6/13/1974 S3505690013

6 I3502690003 NURONIYAH Hj 9/27/1969 S3505610001

7 I3501740006 SUTATIK 1/5/1974 S3508720013

8 I3509770006 NUR AIDAH 9/23/1977 S3506740002

9 I3503770001 DEWI MURTOSIYAH 3/19/1977 S35112670006

10 I3501820009 SITI CHOMAIRO 1/1/1982 S3506760005

11 I3512720003 KARYATIN 12/28/1972 S3509720002

12 I3512800002 PANTI ASIH 12/24/1980 S3512700002

13 LULUK SUNDARI 1/5/1980

14 I3504880004 FIFIN ANDRIATI 4/18/1988 S3507840002

15 I3611940006 UMMI KULSUM CHOIR 11/7/1994 S3512860001

16 I3507720002 KHUSNIYAH 7/3/1972 S3506650001

17 I3506730002 NUR FATONAH Hj 6/20/1973 S3503650001

18 I3507730003 MAISUNA Hj 7/26/1973 S3509630002

19 I3506780001 AINIYAH Hj 6/19/1978 S3505720002

20 I3512790005 NURHAYATI 12/19/1979 S3503760004

21 I3507940002 SITI KALIMAH 7/2/1994 S3507850004

22 I3504940007 SERLI AFRILIA 4/11/1994 S3506850002

23 I3505730012 SRI WAHYUNI 5/2/1973 S3508720001

24 I3511920002 NOVITA AMBAR 11/7/1992 S3503850003

25 SITI HANDAMARI 12/25/1980 S3507820003

26 I3508850001 DUWI RAHMAWATI 8/14/1985 S3505830010

27 I3507810011 YULI MARIYANI 7/3/1981 S35012800003

28 I3501820001 PURWATI 1/18/1982 S3504790001

29 I3511830003 EVI SUSILOWATI 11/12/1983 S3512770001

30 I3508870006 MIMIN YULIATI 8/2/1987 S3505830001

31 I3508910001 MALIYAH NUR 8/24/1991 S3506890002

32 SITI TOWILAH 9/21/1990 S3505890003

33 I3508800006 NINING MUAROFAH 8/22/1980 S3503800002

34 I3512780004 MUFIROH 12/29/1978 S3505710003

35 I3302710001 SUHARLIK 2/7/1971 S3311670001

36 I3501690009 JAMINI 1/1/1969 S3506680003

37 I3504870005 ELI KRISTIANA 4/30/1987 S3505820014

38 I3504800006 SITI JULAIKA 4/6/1980 S3512780002

39 I3508730002 SOEPRAPTI 8/27/1973 S3510710001

40 I3512740003 YATI 12/24/1974 S3501650017

41 I3508790003 SARMINI 8/12/1979 S3512740002

42 I3508870002 HENI HARI AGUSTIN 8/3/1987 S3509780003

43 I3501680002 SAMINI 1/7/1968 S3507620002

44 I3504910002 ELOK APRILIA A 4/27/1991 S3503870002

45 I3508750000 NIKMATUS SOLIKAH 8/22/1975 S3505710005

46 I3508790002 TRI MARGININGSIH 8/17/1979 S3501760001

47 I3502810004 WIRDA ELHAMRO 2/21/1981 S3507810003

48 I3506820003 RINAWATI 6/9/1982 S3503830002

49 I3507910006 YULIANAH 7/16/1991 S3506870004

50 I3509730003 SITI MASPIAH 9/12/1973 S3510710002

51 I3503820004 TITINNIKMATIN 3/10/1982 S3501720002

52 SUMARMI 2/6/1973

53 I3508690001 ERNIWATI 8/9/1969 S3511630002

54 I3508730002 NADIRO 8/7/1973 S3509650001

TOTAL KB
Suntik : 25
Pil 7
Kondom : 0
IUD 2
MOP : 0
MOW : 1
Kalender : 0
ASI Eksklusif (Laktasi) : 0
FORMAT PENDATAAN PUS 2017

Nama* Tgl Lahir* NIK Anak Nama* JK* Tgl Lahir*

CANDRA DWITA KUSUMA 1/10/1986

PITONO 12/7/1972 A3506980003 YOLA PITDIANA K P 6/1/1998

A3504010004 VANIA SALSABILA P P 4/28/2001

SENEN A3511980003 SISKA CHOIRIS SHOLATI P 11/23/1998

A3507060001 NANDA TRESYA SALWA Z P 7/14/2006
A3509090002 RAHMAT BAYU ADITIAR L 9/6/2009

MOCH. TOYIB 7/24/1967 A3509980001 RIZKY FANDI SEPTIANTO L 9/27/1998

A3509030002 ODIE SAPUTRA L 9/8/2003

IMAM SUHADI 7/12/1969

KHOIRUL ANAM DASUKI 7/1/1963 A3504920003 MOHAMMAD YUSUF RIZAL L 4/26/1992

A3507950001 MOHAMMAD FAJAR IQBAL L 7/9/1995
A3502000004 MAULANA AHMAD RIFQI L 2/16/2000
A3502100003 ZAHRA MAULIDIA PUTRI P 2/21/2010
NUR CHOLIK 1/1/1966 A3501980004 NURANTIKA RAHMAWATI P 1/22/1998

MUH. JUNAEDI 9/3/1984

MARIN 3/13/1970 A3512080003 KHOIRINA DEVIYANTI A P 12/25/2008

 MOCH. FAUJAN 8/21/1963 A3506940004 YUNITA RAHMA P 6/19/1994

MOH. SOLEH 6/4/1965 A3504960001 DEWI NUR ALIFAH P 4/4/1996

MUHAMMAD FATIKH 12/14/1978 A3511110004 SYAFA AQILAH PUTRI P 11/11/2011

SYAMSUL ANAS 2/24/1983 A3511080001 MOCH. RAYHAN ADITYA P L 11/24/2008

ABD. ROCHIM 8/17/1960 A3509980002 TRI BAGUS SEPTIAN L 9/9/1998

A3511050002 RAGIL PUTRA DARMAWAN L 11/7/2005

ABDUL CHAFIDZ 4/25/1962 A3506910001 ACHMAD MUCHAMMAD F L 6/3/1991

A3502930002 NURUL KHOFIFAH P 2/23/1993
A3504960006 NUR CHASANAH P 4/14/1996
A3502990003 NUR AINIYAH P 2/8/1999
ARIEF HARIJONO 10/9/1967

FORMAT PENDATAAN PUS 2017

 Nama* Tgl Lahir* NIK Anak Nama* JK* Tgl Lahir*

NOVIAN R 11/2/1984 A3512130003 VIOLETTA EL NINO R. P 12/4/2013

HADI SUKOCO 3/28/1960 A3506940001 AKBAR HADIYANTO L 6/3/1994

A3510970001 FAJAR HARDIYANTO L 10/12/1997

MOHAMMAD SUKRON 7/11/1987 A3501120001 M SALMAN AL FARUQI L 1/27/2012

SYAIKHUR ROHMAN 12/1/1968 A3506970005 M ALI JAFAR ROHMAN L 6/1/1997

A3508020001 SYERLI RAHMAWATI P 8/3/2002

MOCH. SOFYAN 5/10/1969 A3504980005 NUR HAMALATUN NISA P 4/18/1998

A3510010004 HASAN ABDULLOH L 10/17/2001
A3510060003 ABDUR ROSYID L 10/26/2006
A3510110010 HILMIYATUL MUFIDAH P 10/5/2011
AINUL YAKIN H 5/15/1961 A3512900002 M CHOIRUMAN L 12/14/1990
A3509960002 M IMAMMUDDIN L 9/15/1996
A3507030005 ZULIA AINUR ROHMAH P 7/12/2003

WIJANARKO 8/15/1972 A3511970001 RIZKA PUJA NOVIANTI P 11/4/1997

A3504100003 RAYHANSAH DONY S L 4/15/2010

SHODIQIN 6/1/1974 A3505970002 SHOFIATUR RODIYA P 5/27/1997

A3512000002 NADIROTUN NISAK P 12/18/2000
A3507090004 M AINUR RIZIQIN L 7/16/2009

SLAMET 12/1/1967 A3509100002 ABI AUFA A A. L 9/19/2010

A3506120001 M. NIZAM L 6/3/2012

M. YUFAN ISWANTO 6/24/1976 A3510020003 MFAJAR AL CHUSYAIRI L 10/24/2002

 A3509080001 NUR ROHMATUL ALIFIYAH P 9/3/2008
A3510100001 UMI LATIFATUL JANNAH L 10/7/2010

AGUSTONO 9/18/1972 A3511000006 DIKA WAHYUNENG ILLAHI P 11/8/2000

A3505040008 DIKI WAHYU PUTRA F L 5/8/2004

HERI SISWANTO 12/25/1970 A3502050003 MUHAMMAD RIZAL H D. L 2/17/2005

A3505140001 NABILA AZZA SYAKIRA P 5/8/2014

IRWANTO 10/21/1976 FERDI ARIDHO IRAWAN L 6/22/2004

RIZKY MAULANA IRAWAN L 6/29/2012

DAFIT HARIANTO 7/3/1984 A3512090005 MOCH. FARAND L 12/21/2009

MOCH. ANSORI 12/30/1986 A3504120001 M LABIB L 4/21/2012

ACH. KHASIR 6/5/1965

MOCH. ISMAIL H 3/11/1965 A3505940001 MOCH. KHABIB L 5/1/1994

A3508950001 HIMMAH TUMARDIYAH P 8/4/1995
A3501110001 ZAHIRA MAYANK FAUNA P 1/30/2011

MOCH. IRFAN H 9/13/1963 A3508930001 MOCH. BASHIT AL JABBAR L 8/9/1993

A3504960001 MOCH. PUJA ILLAHI L 4/15/1996
A3505090003 IRMA IMELDA HAMIDA P 5/19/2009

SUTRISNADI H 5/24/1972 A3505990002 NUR AJIZATUL MUFIDAH P 5/17/1999

A3509090005 AKBAR SATRIA ILAAHI L 9/15/2009

KUSNADI 3/12/1976 A3506970003 M. MIFTAKHUS SURURI L 6/26/1997

A3511020001 MOCH. NUURIL ANWARI L 11/17/2002

M. NASIHIH 7/14/1985
ARIEF AFFANDI 6/23/1985

ABDUL MUSLIK 8/20/1972 A3509990003 ROBIAH NADAWIYAH P 9/17/1999

A3503120006 M ALI RAHMATULLAH L 3/25/2012

AZIJUN MUTTAKIN 3/28/1985 A3509140001 ANDINATASYA N P 9/28/2014

MOCH. AINUL YAKIN 7/10/1982

SUPRIANTONO 5/11/1983 A3506120001 M. YAHYA AL IKWAN L 6/8/2012

A3506120001 SABRINA T P 6/8/2012

ABDUL MUKHID 12/10/1980 A3508040002 FIDELA MARSHA P 8/26/2004

A3507090005 CINDY CALLISTA P 7/13/2009
A3501130003 ZION FELIX A L 1/22/2013

DIDIK SETIAWAN 4/11/1979 A3511090001 ZAHROTUSHITA P 11/28/2009

A3504110006 M EL GILANG R. L 4/9/2011

KUSDI WIBOWO 12/22/1977 A3509030001 M RICKY ARDIANSYAH L 9/2/2003

A3509090002 HAFIDZ RAFIE L 9/18/2009

IMAM MOCHAMAD T 5/15/1983 A3505120002 MEITHA ALIYA P 5/7/2012

HIKMATUL DAWUD N 6/8/1989 A3511140006 ABIZHAR ADITYA N L 11/27/2014

NUR HIDAYAT 5/17/1989 UMI LATIFATUL JANNAH P 12/10/2011

ARIEF NUSWANTORO 3/24/1980 A3509040001 ARDANA GALANG S L 9/7/2004
A3508100003 NADIFA DWICANDRA P 8/2/2010

MOH. SAIKHU 5/27/1971 A3504040004 M. RIDHO DUTA MUSTIKA L 4/22/2004

JOKO TRIYANTO 11/17/1967 A3308000004 RAHMATULLOH G P 8/27/2000

A3303040001 DWI AYU RAHMAWATI P 3/14/2004

CHOMARI 6/28/1968 A3511900002 HENI MARIA P 11/25/1990

A3507920003 MUHAMMAD JULIANTA L 7/10/1992

HERI SANTOSO 5/5/1982 A3504090005 DENIYA E P 4/18/2009

HERIYANTO 12/23/1978 A3505000004 RIZQI L 5/19/2000

A3509100002 SAMUDRA ALIF L 9/22/2010

AZIZ MUSTOFA 10/27/1971 A3503070003 YASINTA AHWA P 3/25/2007

A3506130003 ALVI WAHWAH ADIPURA P 6/27/2013

M. NURIL TRI S. 1/1/1965 A3505010001 WAHYU KURNIAWAN N. L 5/23/2001

A3504080002 VERAWATI DWI A P 4/4/2008

DIDID 12/1/1974 A3506010006 PUTRI SULUNG DITASARI P 6/30/2001

A3504100003 M. FIRMANSYAH EFENDI L 4/6/2010
A3511130001 M KELVIN ADITYA S. L 11/26/2013

ARIF SUPRIYADI 9/28/1978 A3502070007 M REIHAN HARIADI L 2/2/2007

A3506120005 SALSABILLA PUTRI P 6/2/2012

GATOT SUBIANTORO 7/14/1962 A3509950001 ARIFIAN FARID SANDY L 9/4/1995

A3505040003 NAUFAL DAFFA F L 5/21/2004
A3511080001 SALSA SAKINANDIA P 11/8/2006
IQWAN CHANDRA W 3/3/1987 A3508110004 VALERIN RAMADHANIA L 8/29/2011

WITOYO 5/6/1971 A3508940002 RIKA CALLERIA RIZKY P 8/10/1994

A3508960002 HANIK AMINATUL P 8/24/1996

JUMALI 1/2/1976 A3508050001 ANJANI NUR KHOTIMAH P 8/21/2005

A3512090001 JASMINE NUR KHASANAH P 12/16/2009

SUGENG PURNOMO 7/3/1981 A3512060005 GHINA P 12/10/2006

A3505080008 RIZQI A L 5/25/2008

MOHAMMAD ERFAN 3/17/1983 A3507100001 JAVIER REFANO PRATAMA L 7/4/2010

AMIN JAKFAR 6/6/1987 AMIRA ASKANA SANNI P 5/1/2014

NUR HIDAYAT WAHYUDI 10/2/1971

MOH. JAZULI 1/21/1972 A3508060008 M. NUUR SHOKHIBUL L 8/7/2006

A3511140002 UMI KHOFIFAH P 11/4/2014

AHMAD SAIFUL 9/24/1969 M. PURWANSYAH L 2/20/1993

LINDAH DWI OKTAVIA P 10/16/2003

KHOZIN 11/30/1963

ACHMAD NURUL QOLBI 9/8/1965

Metode Ket. (Kronis,
KB* Gakin)

pil

MOW

pil

MOW

suntik
suntik

suntik

suntik

suntik

MOW
Metode Ket. (Kronis,
KB* Gakin)

suntik

pil

suntik

suntik

pil

suntik

suntik

suntik
suntik

suntik

suntik

suntik

pil

IUD

suntik

suntik

suntik
suntik

suntik

suntik

pil

pil

suntik
suntik

pil

suntik

suntik

implan

implan

IUD

MOW
 pil

suntik

suntik

suntik

suntik

suntik