DAFTAR NAMA PENDUDUK DAN DATA KESEHATAN KECAMATAN MABA

WILAYAH KERJA PUSKESMAS PERAWATAN BULI

TAHUN 2018

DESA : RT: ENUMERATOR :

JAMINAN

STATUS P/I/A/T

LINAKES (BAYI)

CUCITANGAN
AE (7-23 BLN)

SAYURBUAH
NO JK KESEHAT NO PIS-

AIRBERSIH
TANGGAL

AKTIFISIK
AN PK

TIMBANG
NAMA NOMOR BPJS / KIS NIK NOMOR AKTE KELAHIRAN

JAMBAN
LAHIR

ROKOK
JENTIK

BATRA
BPJS
RMH

RMH
LAIN

SPAL
JKD
L P
KK

KK
3M
1 2 3 4 5 6 7 8 9 10 11 12 13 RMH C D E F G H I J K L M N O
1 SHARLES RIDUA P
DENS MINA INTO PINOA I
DELFELA RIDUA A
APRILIA RIDUA A
1
RMH

NO

2
KK

3
NAMA

STATUS P/I/A/T
5
LAHIR
TANGGAL

L P

BPJS
JKD
AN
JAMINAN

6 7 8 9 10
JK KESEHAT

LAIN
11
NOMOR BPJS / KIS

12
NIK

13
AKTE KELAHIRAN

SPAL
JENTIK
3M
LINAKES (BAYI)
AE (7-23 BLN)
TIMBANG
AIRBERSIH
CUCITANGAN
RMH C D E F G H I

JAMBAN
SAYURBUAH
AKTIFISIK
ROKOK
J K L M

BATRA
RMH
N
PK

KK
NO PIS-
DESA : RT: ENUMERATOR :
JAMINAN

LINAKES (BAYI)
STATUS P/I/A/T

CUCITANGAN
AE (7-23 BLN)

SAYURBUAH
NO JK KESEHAT NO PIS-

AIRBERSIH
TANGGAL

AKTIFISIK
AN PK

TIMBANG
NAMA NOMOR BPJS / KIS NIK AKTE KELAHIRAN

JAMBAN
LAHIR

ROKOK
JENTIK

BATRA
BPJS
RMH

RMH
LAIN

SPAL
JKD
L P
KK

KK
3M
1 2 3 4 5 6 7 8 9 10 11 12 13 RMH C D E F G H I J K L M N O
J U M LAH ############ 0

 DAFTAR NAMA PENDUDUK KECAMATAN MABA
WILAYAH KERJA PUSKESMAS PERAWATAN BULI
TAHUN 2018

DESA : RT: 01 ENUMERATOR :

JAMINAN

STATUS P/I/A/T

LINAKES (BAYI)

CUCITANGAN
AE (7-23 BLN)

SAYURBUAH
NO JK KESEHAT NO PIS-

AIRBERSIH
TANGGAL

AKTIFISIK
AN PK

TIMBANG
NAMA NOMOR BPJS / KIS NIK AKTE KELAHIRAN

JAMBAN
LAHIR

ROKOK
JENTIK

BATRA
BPJS
RMH

RMH
LAIN

SPAL
JKD
L P
KK

KK
3M
1 2 4 5 6 7 8 9 10 11 12 13 14 A B C D E F G H I J K L M N O
1 ABUBAKAR MANUAI P 04-02-1980 1 0 1 0 0 `8206020408800001
SURIYATI HI UMAR I 04-02-1980 0 1 1 0 0 `8206024402800002
INSAN GTASAH VITRI MANUAI A 04-11-2005 0 1 1 0 0
2 ALWAN LANGKA P 25-08-1967/49 1 0 0 1 0 `8206022908670002
ROHANA ROTU I 20-05-1967/49 0 1 0 1 0 `8206026005630001
MARWAN LANGKA A 13-09-1995/21 1 0 0 1 0 `8206021309950001
3 ALI M SALEH P 19-10-1974/42 1 0 1 0 0 `8271031910740001
HARTATI PAKAYA I 07-03-1972/44 0 1 1 0 0
4 AMIRUDINTIDORE P 02-05-1985/31 1 0 1 0 0 00012777544562 `8206020205850001
NURLIA YASIN I 05-11-1984/32 0 1 1 0 0 0001277754682
ANUGRA PUTRA A TIDORE 25-07-2011/05 1 0 1 0 0 0001277755209 `8206022507110002
A
PUTRI YULIANINGSI. S DJANAD 26-02-2005/11 0 1 0 1 0 `8206026602050001
5 AKBAR P 17-11-1986/30 1 0 1 0 0 0002041064908 `8206021711860001
A .RAHMA I 20-11-1987/29 0 1 1 0 0 0002041066539 `8206026011871001
ALGI FAHRI A 12-09-2012/4 1 0 1 0 0 0002041067538 `8206021209120002
6 ABAS ADAM P 28-08-1972/45 1 0 0 1 0 `8206022808710002
ASNA UMAR I 17-05-1975/41 0 1 0 1 0 `8206025705750001
APRILIA ABAS A 20-04-1996/20 0 1 0 1 0
7 ADE FATAHA P 17-03-1962/54 1 0 0 1 0 `8206021703620001
UMI AZIS I 27-02-1964/27 0 1 0 1 0 `8206025003680001
NURJANI SERO-SERO A 27-02-2003/13 0 1 0 1 0 `8206026702030001
8 ABDURAH MAN KIYE P 26-06-1964/52 1 0 1 0 0 0000140113989 `8206022606640001
JAMALIA BAKSIR I 05-10-1980/36 0 1 1 0 0 0001897288964 `8206084307800001
 JAMINAN

STATUS P/I/A/T

LINAKES (BAYI)

CUCITANGAN
AE (7-23 BLN)

SAYURBUAH
NO JK KESEHAT NO PIS-

AIRBERSIH
TANGGAL

AKTIFISIK
AN PK

TIMBANG
NAMA NOMOR BPJS / KIS NIK AKTE KELAHIRAN

JAMBAN
LAHIR

ROKOK
JENTIK

BATRA
BPJS
RMH

RMH
LAIN

SPAL
JKD
L P
KK

KK
3M
1 2 4 5 6 7 8 9 10 11 12 13 14 A B C D E F G H I J K L M N O
9 AMIRUDDIN P 12-12-1985/31 1 0 0 1 0 `8206012127850002
HASNAH I 03-08-1980/36 0 1 0 1 0 `8206024308800001
FIKA JUUTA SARI 30-07-2006/10 0 1 0 1 0 `8206027007060001
A
MUSDALIFA 24-06-2013/3 0 1 0 1 0
10 ABDUL MUIS MARSAOLY P 05-06-1993/23 1 0 1 0 0 0002002915438 ``8206020506930002
ESTI MAHERA I 12-09-1996/20 0 1 1 0 0 0002002915451 `8206025209960003
PUTRI DELISA MARSAOLY 10-02-2015/1 0 1 1 0 0 0002002915462 `8206024102150001
A
SILVIA RAMADHANI MARSAOLY 14/06/2016 0 1 0 1 0
11 ADINA KASENGE P 25-11-1970 0 1 0 1 0
JUSMIN LAHABIR 05-07-1995 1 0 0 1 0
A
FAIKAL LAHABIR 30-09-2006 1 0 0 1 0
12 ANAS BIN UMAR P 01-10-1969/47 1 0 0 1 0 `8206020110690001
SUTINI I 10-12/1980/36 0 1 0 1 0 `8206024112810001
FIRMAN 14-02-1996/20 1 0 0 1 0 `8206021402960002
NIRWANA 10-06-1998/18 0 1 0 1 0 `8206024106980001
ANISA A 15-09-1999/17 0 1 0 1 0 `8206025509950002
AHMAD RIVHAY ANAS 10-07-2012/ 1 0 0 1 0 `8206020107120001
PUTRI APRILIA ANAS 05-04-2013/ 0 1 0 1 0 `8206024504130001
13 ABDUL SANIAL AMARIE P 17-11-1977/39 1 0 0 1 0 `8206021711770001
FARIDA USMAN I 20-03-1980/36 0 1 0 1 0 `8206026003800001
NINDIA A. NINGRUM AL. AMARIE 04-12-2005/11 0 1 0 1 0 `8206024412050001
A
ZIA ULMILAHAL,AMARIE 02-09-2008/8 0 1 0 1 0 `8206024209080001
14 BAHTIAR SADEK P 18/05/1976 1 0 1 0 0
15 BURHANUDDIN RUTUK P 09-03-1986/30 1 0 0 1 0 `8206020903860002`
TRIMUGI LESTARI I 05-07-1995/21 0 1 1 0 0 0000975070541 `8206084507950001
GINANJAR RADITYA A 15-05-2016/10 1 0 0 1 0
 JAMINAN

STATUS P/I/A/T

LINAKES (BAYI)

CUCITANGAN
AE (7-23 BLN)

SAYURBUAH
NO JK KESEHAT NO PIS-

AIRBERSIH
TANGGAL

AKTIFISIK
AN PK

TIMBANG
NAMA NOMOR BPJS / KIS NIK AKTE KELAHIRAN

JAMBAN
LAHIR

ROKOK
JENTIK

BATRA
BPJS
RMH

RMH
LAIN

SPAL
JKD
L P
KK

KK
3M
1 2 4 5 6 7 8 9 10 11 12 13 14 A B C D E F G H I J K L M N O
16 BAHARUDDIN . M P 25-01-1986/30 1 0 1 0 0 `8206022501860001
MASNA SAHAPATI I 23-05-1989/27 0 1 1 0 0 `8206020305890002
ARIFUDDIN . B 25-11-2009/7 1 0 1 0 0 `8206022509090001
KHIRIL NIZAM A 07-10-2012/4 1 0 1 0 0 `8206020710120001
BY. MASNA 21/11/2016 0 1 0 1 0
17 DALIFA ABDULLAH P 07-07-1953/63 0 1 0 1 0 `8206021509570001
ALYUSRI MARSAOLY A 26-06-1989/27 1 0 0 1 0 `8206022606890002
18 DEDI SANJAYA P 12/12/1986 1 0 1 0 0
ROSIKA Hi. MUHAMMAD I 25/05/1974 0 1 1 0 0
19 HEBRON NERO SUSU P 06-05-1973/43 1 0 1 0 0 `8206020605730001
CARMI EVA MATAHAYA I 19-03-1981/35 0 1 1 0 0 `8206025903810002
APRIANDO SUSU 15-04-2002/14 1 0 1 0 0 `8206021504020001
DAWNER SUSU A 02-06-2005/11 1 0 1 0 0 `820602020650002
BRIGTHA SILA SUSU 02-05-2010/6 0 1 1 0 0 `820602600510002
20 HERMAN HI JASMAN P 01-04-1978/38 1 0 0 1 0 `8206021505800001
AMELIA SULTAN I 28-05-1988/28 0 1 0 1 0 `8206024303850001
MUHAMAD ZHARAN 22-06-2006/10 1 0 0 1 0 `8206022206060001
A
ZULKHAIRI AFFAN 07-02-2010/6 1 0 0 1 0 `8206020702100002
21 HJ. DJALEHA MARSAOLY P 15-01-1938/78 0 1 0 1 0 `8206025004500001
FATMA KASTURI A 12-08-1978/38 0 1 1 0 0 0002002868976
FAHDI HASAN T 14-12-1999/17 1 0 1 0 0 0002002714839
22 IRFAN KAMAH P 13-07-1975 1 0 0 1 0 `8206021307750003
NURMINA SUTFI I 12- 10- 1979 0 1 0 1 0 `8206025210790001
YURNAWATI KAMAH 08-01-1988 0 1 0 1 0 `8206024801980002
MUTMAINA KAMAH A 02-02-2001 0 1 0 1 0 `8206024202010001
 A
MUHAMAD FAIJUL KAMAH 27-08-2011 1 0 0 1 0 `8206022708110001
23 ILHAM MANUAI P 12-05-1985/31 1 0 0 1 0 `8206021205850002
MASRIA B SAFI.SKM I 13-06-1988/28 0 1 0 1 0 `820711075306880001
RIZKULLATUL IBAD MANUAI A 23-05-2015/01 1 0 0 1 0 `8206022305150001

JAMINAN

STATUS P/I/A/T

LINAKES (BAYI)

CUCITANGAN
AE (7-23 BLN)

SAYURBUAH
NO JK KESEHAT NO PIS-

AIRBERSIH
TANGGAL

AKTIFISIK
AN PK

TIMBANG
NAMA NOMOR BPJS / KIS NIK AKTE KELAHIRAN

JAMBAN
LAHIR

ROKOK
JENTIK

BATRA
BPJS
RMH

RMH
LAIN

SPAL
JKD
L P
KK

KK
3M
1 2 4 5 6 7 8 9 10 11 12 13 14 A B C D E F G H I J K L M N O
24 IKBAL P 1 0 0 1 0
BADARIA MUMEN I 16-01-1982/34 0 1 0 1 0 `8206025601820001
MUSA MAUJUD 09-05-2003/13 1 0 0 1 0 `8206020905030001
JUNITA MAUJUD 04-07-2006/10 0 1 0 1 0 `8206024505050002
GALANG MAUJUD A 01-06-2007/9 1 0 0 1 0 `8206020106070001
FAUJAN MAUJUD 28-11-2009/7 1 0 0 1 0 `8206022811090002
BINCAFA MAUJUD 08-08-2012/4 0 1 0 1 0 `8206024808120001
25 ISBAT . MARSAOLY P 29-06-1976/40 1 0 0 1 0 `8206022906760001
HALIMA MARSAOLY I 01-12-1976/40 0 1 0 1 0 `8206024112760001
SYAVITRI .I. MARSAOLY 16-02-1996/20 0 1 0 1 0 `8206025602960001
ZUWAIRIA. I MARSAOLY A 24-03-1998/18 0 1 0 1 0 `8206026403980001
AYA SOPHIA 20-12-2005/11 0 1 0 1 0 `8206026012060001
26 IMRAN KAIDAT P 07-07-1968/48 0 1 1 0 0 0002002932009 `8206024707680002
27 IDHAM MARSAOLY P 18-10-1970/46 1 0 1 0 0 0000140155852 `8206021810700001
ACI KASTURI I 25-04-1974/42 0 1 1 0 0 0001078751406 `8206026504740001
RIMAYUNI . M MARSAOLY 11-11-1995/21 0 1 1 0 0 00001078151152 `8206025111950002
RIZKIVANI NI . M A 28-08-2002/14 0 1 1 0 0 00001078151163 `8206026808020001
ZULFATHAN . F MARSAOLY 28-01-2004/12 1 0 0 1 0 `8206022801040002
FARIDA . L T 04-10-1951/65 0 1 0 1 0 `8272044410510001
28 KAMARUDDIN NASER P 10-07-1965/51 1 0 1 0 0 `8206021007650001
NURSAFA LATAWAN I 10-11-1965/51 0 1 1 0 0 0002002933258 `8206025011650002
NURNINGSI K 28-04-1993/23 0 1 0 1 0 `8206026804930001
M RIJAL KAMARUDDIN 15-08-1995/21 1 0 1 0 0 0002002932887 `8206021508950001
M. RIFAI KAMARUDDIN A 19-01-1998/18 1 0 1 0 0 `8206020901990001
 A
SITI GAMARIA K 05-10-1999/17 0 1 1 0 0 0002002933304 `8206024510990001
M. FAREL KAMARUDDIN 30-10-2009/07 1 0 1 0 0 0002002932641 `82060230100990001
29 KADER SALASA P 27-07-1978/38 1 0 0 1 0
SURIYANTI DEN I 27-12-1982/34 0 1 0 1 0
NOFRIYANTI KADER A 05-11-2010/6 0 1 0 1 0

JAMINAN

STATUS P/I/A/T

LINAKES (BAYI)

CUCITANGAN
AE (7-23 BLN)

SAYURBUAH
NO JK KESEHAT NO PIS-

AIRBERSIH
TANGGAL

AKTIFISIK
AN PK

TIMBANG
NAMA NOMOR BPJS / KIS NIK AKTE KELAHIRAN

JAMBAN
LAHIR

ROKOK
JENTIK

BATRA
BPJS
RMH

RMH
LAIN

SPAL
JKD
L P
KK

KK
3M
1 2 4 5 6 7 8 9 10 11 12 13 14 A B C D E F G H I J K L M N O
30 M. SAID HADI P 18-06-1993/23 1 0 0 1 0 `8206021806930003
NURSIN HI KADIR I 06-08-1994/22 0 1 0 1 0 `8206024608940001
AYU ANDIRA HADI A 24-05-2014/2 0 1 0 1 0 `8206026405140002
31 MUHLIS- BUKA P 14-05-1968/48 1 0 1 0 0 0000975617627 `8206021405680002
SUFIA SABAN I 04-04-1975/41 0 1 1 0 0 0000975617921 `8206024404740001
NURSAEFA MUHLIS 03-12-1993/23 0 1 1 0 0 0000975617976 `8206024312930002
MAGFIRA IZZANI.M A 19-09-1999/17 0 1 0 1 0 `8206025004980001
ALIF PRNAZA 24-12-2015/1 1 0 0 1 0
32 MUSLIM SAHAPATI P 23-09-1965/51 1 0 1 0 0 `8206022309650001
SUMARNI KABURUANG I 10-03-1968/48 0 1 1 0 0 `8206025003680003
MASNI SAHAPATI 10-04-1999/17 0 1 0 1 0 `8206025004990001
ADAM SAHAPATI A 17-01-2002/14 0 1 0 1 0
MURNIATI SAHAPATI 04-07-2003/13 0 1 1 0 0 `8206024407030001
HERIMINA LAKADA T 28-08-1940/76 0 1 0 1 0
33 MARUF TALIB P 11-09-1952/64 1 0 0 1 0 `8206021109520001
HAMDI MARUF A 07/07/1992/24 1 0 0 1 0
34 MUJAFARUDIN P 20/06/1983 1 0 1 0 0
35 NYAMIN P 19-01-1977/39 1 0 0 1 0 `8205021901770001
RASIMAN T 16/06/1977 1 0 0 1 0
36 RIBA TANAK P 10-01-1956/60 0 1 1 0 0 0000975638193 `8206024107560008
SAMIN KASENGE 31-05-1987/29 1 0 0 1 0 `8206023105870001
RUSLIADI KASENGE 21-11-1992/24 1 0 0 1 0 `8206022111920001
A
 RUSLIN KASENGE
HAMALIN KASENGE
SARTIWI KASENGE
37 RAHMAN HI . DJAMAL
ARWIA MUMEN
M .JIFRAN HI DJAMAL
38 RUSLI IDRIS
RAUDA A . RAHIM
GHIFARI IMAN DAFA A 25-02-2003
A 21-03-1997/19 1 0 0 1 0 `8206022103970001
15-06-2002/14 0 1 0 1 0 `82106021506020001
14-05-2003/13 0 1 0 1 0 `8206025405030002
P 10-06-1992/24 1 0 1 0 0 000289130196 `8206020107930003
I 25-12-1994/22 0 1 0 1 0 `8206026512940002
A 30-04-2011/05 1 0 0 1 0 `8206023004110001
P 10-02-1972 1 0 0 1 0 `8206020107720008
I 10-10-1972 0 1 0 1 0 `8206024107730004
1 0 0 1 0
JAMINAN

STATUS P/I/A/T

LINAKES (BAYI)

CUCITANGAN
AE (7-23 BLN)

SAYURBUAH
NO JK KESEHAT NO PIS-

AIRBERSIH
TANGGAL

AKTIFISIK
AN PK

TIMBANG
NAMA NOMOR BPJS / KIS NIK AKTE KELAHIRAN

JAMBAN
LAHIR

ROKOK
JENTIK

BATRA
BPJS
RMH

RMH
LAIN

SPAL
JKD
L P
KK

1 2 4 5
INALA YASMIN
GIRANA
39 RIDWAN MALURANG
JAENA M TALIB
KING SYAFIQ JINGLI
40 SALAM MAHMUD
TRISNO LAODE SURFAN
WAOFDE TRISNAWATI SURFAN
WAODE LISMANIAR SURFAN
WAODE IRMANIAR SURFAN
LAODE KAHRUDIN SURFAN
BAHRAN
41 SAFRUDDIN MUMEN
RASMILA KADIR
BAYU FIRANSA
RISNA
42 SUKRAN MAJID
ANITA SOPE
JAHRA K. S MAJID
KK
3M
6 7 8 9 10 11 12 13 14 A B C D E F G H I J K L M N O
06-02-2006 0 1 0 1 0
01-02-2008 0 1 0 1 0
P 20-02-1985/31 1 0 1 0 0 `8206032002850001
I 27-03-1987/29 0 1 0 1 0 `82060267038700001
A 03-03-2016/2 1 0 0 1 0
P 08-08-1952/64 0 1 1 0 0 0001888332816 `8206024808520001
12-07-1991/25 1 0 1 0 0 `8206021207910001
09-10-1993/23 0 1 1 0 0 0001557745233 `8206024910930002
A 09-03-1995/21 0 1 1 0 0 00011901142898 `8206024903950001
09-03-1995/21 0 1 1 0 0 `8206024903960001
12-04-1997/19 1 0 1 0 0 `8206021204970001
T 03-06-1993/23 1 0 0 1 0 `8206020306930001
P 09-03-1988/28 1 0 0 1 0
I 20-02-1989/27 0 1 0 1 0
26-08-2007/9 1 0 0 1 0
A
12-20-2011/5 0 1 0 1 0
P 24-07-1993/33 1 0 1 0 0 0001640301208 `8206102407930001
I 07-07-1990/15 0 1 1 0 0 0001640301221 `8203104707900001
A 06-2015/1 0 1 0 1 0
 43 SALMAN P 08-05-1980/36 1 0 0 1 0 `8206020805800001
SITI SALMA INDRIYANI I 04-02-1979/37 0 1 0 1 0 `8206024402790001
SAYAHRUL RAMA DHAN 20-10-2006/10 1 0 0 1 0 `82060220110050003
A
MUHAMMAD SYAHRIL 01-14-2008/8 1 0 0 1 0 `8206021401080001
44 SAHARUDIN MUMEN P 17-03-1961/55 1 0 0 1 0 `8206021703610001
RADIA MONIMNYAKE I 11-02-1963/53 0 1 0 1 0 `82060251022630002
SADAKA MUMEN A 27-06-2000/16 1 0 0 1 0 `8206022706000001
45 SALAM BURAIM P 05-03-1942/74 0 1 0 1 0 `8206024503460001
SINGKOI A 0 1 0 1 0
IKBAL JABIR T 08-08-1998/18 1 0 0 1 0

JAMINAN
STATUS P/I/A/T

LINAKES (BAYI)

CUCITANGAN
AE (7-23 BLN)

SAYURBUAH
NO JK KESEHAT NO PIS-

AIRBERSIH
TANGGAL

AKTIFISIK
AN PK

TIMBANG
NAMA NOMOR BPJS / KIS NIK AKTE KELAHIRAN

JAMBAN
LAHIR

ROKOK
JENTIK

BATRA
BPJS
RMH

RMH
LAIN

SPAL
JKD
L P
KK

KK
3M
1 2 4 5 6 7 8 9 10 11 12 13 14 A B C D E F G H I J K L M N O
46 SALEH MARSAOLY P 26-03-1962 1 0 1 0 0 `8206022603620001
JAENA SARAMBAE I 16-03-1965 0 1 0 1 0 `8206026903650001
RAMADANI MARSAOLY T 20-08-2010 0 1 0 1 0 `8206026008100001
RUSMIYATI MARSAOLY A 03-12-1989 0 1 0 1 0 `8206024312890001
SAFITRI DAUD T 25-06-2013 0 1 0 1 0 `8206026506130001
47 SINEN RUTUK P 03-08-1951 1 0 0 1 0 `8206020308510001
SAEHAN. ABDULLAH I 06-06-1952 0 1 0 1 0 `8206024606520001
TASLIM R. 14-09-1993 1 0 0 1 0 `8206021409930001
NURHAYA R A 28-12-1995 0 1 0 1 0 `8206026812950001
SITI RUTUK 19-07-2000 0 1 0 1 0 `8206025707000001
48 SAID ABDUL LATIF P 15/051976 1 0 1 0 0
SRIMINA I 01/06/1980 0 1 1 0 0 0000140908498
RESMA AULIA ABDUL LATIF A 22/09/2006 0 1 0 1 0 0001274208693
SAEBA T 23/07/1942 0 1 0 1 0
49 SUDUANTO M. THALIB P 17/07/1979 1 0 0 1 0
HILDA AL KATIRI I 22/09/1984 0 1 0 1 0
NAJLA FARADILLA 23/01/2008 0 1 0 1 0
A
 A
SAKIRA 23/01/2011 0 1 0 1 0
50 USMAN HI. ISMAL P 10-11-1958/58 1 0 1 0 0
51 WAHYUDI M TALIB P 18-11-1984/32 1 0 0 1 0 `8206021811840001
RAHAYU DJABIDI I 18/03/1992 0 1 0 1 0

DESA : RT: 02 ENUMERATOR :

JAMINAN
STATUS P/I/A/T

LINAKES (BAYI)

CUCITANGAN
AE (7-23 BLN)

SAYURBUAH
NO JK KESEHAT NO PIS-

AIRBERSIH
TANGGAL

AKTIFISIK
AN PK

TIMBANG
NAMA NOMOR BPJS / KIS NIK AKTE KELAHIRAN

JAMBAN
LAHIR

ROKOK
JENTIK

BATRA
BPJS
RMH

RMH
LAIN

SPAL
JKD
L P
KK

KK
3M
1 2 4 5 6 7 8 9 10 11 12 13 14 A B C D E F G H I J K L M N O
52 ASRI MAHMUD P 4/5/1975 1 0 1 0 0 0002002933394 `8206020504750001
NURMINA MARSAOLY I 1/4/1975 0 1 1 0 0 0002002912323 `8206024401750001
SUPRIADI ASRI 7/21/2000 1 0 1 0 0 0002002933552 `8206022107000001
MULYADI ASRI A 8/10/2002 1 0 1 0 0 0002002933451
SITI ZAHRA ASRI 5/2/2008 0 1 1 0 0 0002002934428 `8206024205080002
53 ABDUL KADIR MARSAOLY P 1/16/1988 1 0 1 0 0 0001636832305
WAHYUNI JAFAR I 10/10/1985 0 1 1 0 0 0001636832316 `8206025010850001
ALFAJRI MARSAOLY 10/1/2010 1 0 1 0 0
A
MURI FITRAH M 8/8/2012 1 0 1 0 0
54 ASIS DJAMA P 8/18/1963 1 0 0 1 0 `8206021808530001
FARIDA H. ADAM I 11/28/1968 0 1 0 1 0
M.FAISAL H. SAMIUN A 4/14/1991 1 0 0 1 0 `8206021404910001
55 ABD TUA LEPE P 8/27/1986 1 0 1 0 0 0001095156819
SYAMSIA TUALEKE I 3/13/1985 0 1 0 1 0 0001287471892 8171025303850010
 SYAHNAS RAHMADANI TUALEPE A 7/15/2015 0 1 0 1 0
56 ARDI MAULANA P 5/20/1965 1 0 0 1 0
NURSYAFA MAULANA I 1/11/1969 0 1 0 1 0 `8208025106690001
INKA AYU LESTARI MAULANA 11/26/1990 0 1 0 1 0 `8206026611900001
DWI ULANSARI MAULANA A 1/13/1992 0 1 0 1 0 `8206025301920001
EKAL MAULANA 8/27/1993 1 0 0 1 0 `8206022708930001
57 AMIRUDDIN KARIM P 8/29/1967 1 0 1 0 0 `8206022908670001
HADIJA BAHMID I 5/26/1972 0 1 1 0 0 `8206026605720001
NAMIRA AMIRUDDIN 3/8/2000 0 1 0 1 0 `8206024803000001
A
FADILA AMIRUDDIN 12/27/2004 0 1 0 1 0 `8206026712040002
58 AGUNG NUGROHO P 5/24/1972 1 0 0 1 0 `3521112405720000
ANIK PURYANINGSIH I 4/2/1973 0 1 0 1 0 `3521114204730006
M. HAFIZHAL HASBI NUGROHO A 6/14/2003 1 0 0 1 0 `3521114060360005

JAMINAN
STATUS P/I/A/T

LINAKES (BAYI)

CUCITANGAN
AE (7-23 BLN)

SAYURBUAH
NO JK KESEHAT NO PIS-

AIRBERSIH
TANGGAL

AKTIFISIK
AN PK

TIMBANG
NAMA NOMOR BPJS / KIS NIK AKTE KELAHIRAN

JAMBAN
LAHIR

ROKOK
JENTIK

BATRA
BPJS
RMH

RMH
LAIN

SPAL
JKD
L P
KK

KK
3M
1 2 4 5 6 7 8 9 10 11 12 13 14 A B C D E F G H I J K L M N O
59 ABU BAKAR RABO P 5/21/1973 1 0 1 0 0 `8208022105730001
JENA BENU I 2/5/1974 0 1 1 0 0 `8206022450740001
TETI ABUBAKAR 11/1/1994 1 0 1 0 0 `8206024111940002
NANANG ABUBAKAR 8/5/1997 1 0 1 0 0 `8206020791870001
SISDA ABUBAKAR A 6/1/2003 0 1 1 0 0 `8206024107030011
ANI ABUBAKAR 9/21/2005 0 1 1 0 0 `8206026109040001
ABDULLAH ABUBAKAR 9/17/2013 1 0 1 0 0 `8206021709130001
HANAFI YUSUF T 30 THN 1 0 0 1 0
60 ABDUL MUTALIB MUMEN P 30/06/1991 1 0 0 1 0
NURBAYA. M GUNTUR I 2/9/1991 0 1 0 1 0
FARANISA INAYA MUMEN A 16/09/2014 0 1 0 1 0
61 BASRI HI KARIM P 23/13/1973 1 0 0 1 0
ARMA KEIWAYALELE I 12/22/1981 0 1 0 1 0
 PUTRI ARISKA HI KARIM 5/30/2002 0 1 0 1 0
AMRI IRAWAN HI KARIM A 12/9/2004 1 0 0 1 0
AL GHIFARI BASRI HI KARIM 6/4/2013 1 0 0 1 0
62 DONLY JACONIAS SAUHOKA P 9/10/1979 1 0 0 1 0 `8206021009790001
LASMIATI I 3/27/1976 0 1 0 1 0 `8206026703760001
ADITYA SAUHOKA A 8/22/2003 1 0 0 1 0 `8206022208030001
63 DELY MULYADI P 12/10/1983 1 0 0 1 0
WIDYASTUTI I 7/17/1986 0 1 0 1 0
AHMAD SALMAN ALFATANK A 1/18/2013 1 0 0 1 0
64 Hi. NURDIN HABY P 5/28/1950 1 0 0 1 0 `8206022805500001
HI. JAHRATAN RIDWAN I 12/31/1967 0 1 0 1 0 `8206027112720002
DARLIS NURDIN 1/7/1990 1 0 0 1 0 `8206020201900002
NURLINDA NURDIN 1/7/1995 0 1 0 1 0 `82060241069500001
A
ASWIN NURDIN 1/16/1997 1 0 0 1 0 `8206022004970001
TAJJUDIN NURDIN 12/28/2002 0 1 0 1 0
65 Hi.MUSA KIYE P 9/20/1944 1 0 0 1 0 `8206022005440001

JAMINAN
STATUS P/I/A/T

LINAKES (BAYI)

CUCITANGAN
AE (7-23 BLN)

SAYURBUAH
NO JK KESEHAT NO PIS-

AIRBERSIH
TANGGAL

AKTIFISIK
AN PK

TIMBANG
NAMA NOMOR BPJS / KIS NIK AKTE KELAHIRAN

JAMBAN
LAHIR

ROKOK
JENTIK

BATRA
BPJS
RMH

RMH
LAIN

SPAL
JKD

L P
KK

KK
3M
1 2 4 5 6 7 8 9 10 11 12 13 14 A B C D E F G H I J K L M N O
66 Hi. KARIM SAPTU P 1/3/1939 1 0 0 1 0 `8206020301390001
SARIFA DARAM I 4/20/1959 0 1 0 1 0
67 Hi. SYAMSI MUMEN P 10/15/1952 1 0 1 0 0 0000140901895 `8206021510520001
SITTI HAWA LATAWAN I 5/20/1961 0 1 1 0 0 0000140901906
HALID MUMEN A 4/3/2000 1 0 0 1 0 0000140901917 `8206020304000002
68 HADIJA MUMEN P 8/6/1965 0 1 1 0 0 0000140886786 `8206024608650002
HAMID KIYE 2/19/1991 1 0 0 1 0 `8206021402910001
A
FAHIMA KIYE 1/17/1997 0 1 0 1 0 `8206025701970001
69 Hi. MAURAJI MARSAOLY P 2/4/1943 1 0 0 1 0 `8206020402430001
HJ HARIDJA MUMEN I 6/15/1946 0 1 0 1 0 `8206025506460001
NURMUNA MARSAOLY A 9/24/1978 0 1 1 0 0 `8206026409780001
 70 HUSEN ILHAM P 15/06/1989 1 0 0 1 0
KARTINI SABTU I 10/10/1992 0 1 0 1 0
MUHAMAD ALFARUQ ILHAM A 15/06/2013 1 0 0 1 0
MUHAMAD GAMAL T 28/08/2008 1 0 0 1 0
71 IMAN MUMEN P 6/21/1973 1 0 0 1 0 `8206022106730001
MISNA ABDUL I 4/7/1985 0 1 0 1 0 `8206022106730001
MASNI MUMEN 7/18/2002 0 1 0 1 0 `8206022106730001
FAISAL MUMEN A 8/18/2004 1 0 0 1 0 `8206022106730001
IFKAL MUMEN 12/31/2009 1 0 0 1 0 `8206022106730001
72 ISHAK HI ADAM P 4/4/1975 1 0 1 0 0 `8206020404750001
SARIFA MANAF I 5/4/1980 0 1 1 0 0 `8206024306800001
IRWAN RAMADHAN A 12/6/2000 1 0 1 0 0
73 IKRAM KABALMAY P 12/18/1985 1 0 1 0 0
ROHANA I 2/5/1984 0 1 0 1 0 `8206024505840003
74 ISMUNANDAR MARSAOLY P 11/2/1984 1 0 1 0 0 `8206020211840001
MIRNAWATI UMA CINA I 5/5/1992 0 1 1 0 0 `8206024505920001
M FATIR MARSAOLY A 10/9/2015 1 0 0 1 0

JAMINAN
STATUS P/I/A/T

LINAKES (BAYI)

CUCITANGAN
AE (7-23 BLN)

SAYURBUAH
NO JK KESEHAT NO PIS-

AIRBERSIH
TANGGAL

AKTIFISIK
AN PK

TIMBANG
NAMA NOMOR BPJS / KIS NIK AKTE KELAHIRAN

JAMBAN
LAHIR

ROKOK
JENTIK

BATRA
BPJS
RMH

RMH
LAIN

SPAL
JKD

L P
KK

KK
3M
1 2 4 5 6 7 8 9 10 11 12 13 14 A B C D E F G H I J K L M N O
75 JAMADIL AHMAD P 3/4/1974 1 0 0 1 0
RAKIDA HARUNA I 6/2/1973 0 1 0 1 0
RABIARILL ADAWA 3/24/2001 0 1 0 1 0
FITRI PUTRI RAMA-DANI A 11/2/2006 0 1 0 1 0
SITTI RISALAN 5/5/2011 0 1 0 1 0
76 JAFAR MUMEN P 10/12/1961 1 0 0 1 0
KHAMEL MUMEN A 10/26/1997 1 0 0 1 0
77 KALAM GURU LATUPONO P 10/6/1984 1 0 0 1 0 `8206020610840004
MAHYUNI SALAMPESSY I 4/4/1988 0 1 0 1 0 `8206024404880002
 78 LAODE NAZIM P 12/31/1950 1 0 0 1 0
WANIHA I 2/15/1955 0 1 0 1 0 `8206026502650001
79 LUTFI SALEH P 8/9/1952 1 0 0 1 0 `8206080908520001
FATMA MARSAOLY I 5/14/1965 0 1 0 1 0 `8206081405660001
MUSITA LUTFI 10/14/1985 0 1 0 1 0 `8206085408850001
RUSLI LUTFI A 6/7/1994 1 0 0 1 0 `8206080706940001
NURNI LUTFI 1/14/1997 0 1 0 1 0 `8206085401970001
80 MOENAWAR H ADAM P 8/23/1962 1 0 0 1 0 `8206022308620001
LATIFA MUHAMMAD I 3/6/1968 0 1 0 1 0
MULTI MUNAWAR 12/9/1994 1 0 0 1 0
A
M. GILANG MUNAWA 12/20/2002 1 0 0 1 0
RAHDIMAN MUNAWAR T 11/16/1999 1 0 0 1 0
81 MARDAN P 4/16/1974 1 0 0 1 0 `8206021604740002
UMI AHMAD I 4/5/1975 0 1 0 1 0
M. ISMIT 11/3/1997 1 0 0 1 0 `8206020311970001
M. NURMIN MARDAN A 4/1/2001 1 0 0 1 0 `8206020104010002
M. FAUZI 9/3/2005 1 0 0 1 0 `8206020309050003
82 MOH LISIN P 10/4/1982 1 0 0 1 0 `3324150410820001
HASNIWATI HI.DJAIM I 4/17/1983 0 1 0 1 0 `3324155704830004
MAULANA MUHAMMAD FIRDAUS 11/27/2011 1 0 0 1 0 `3324152711110004
A
HIYATUL AULIA 3/24/2014 0 1 0 1 0 `8206026403140001
JAMINAN
STATUS P/I/A/T

LINAKES (BAYI)

CUCITANGAN
AE (7-23 BLN)

SAYURBUAH
NO JK KESEHAT NO PIS-

AIRBERSIH
TANGGAL

AKTIFISIK
AN PK

TIMBANG
NAMA NOMOR BPJS / KIS NIK AKTE KELAHIRAN

JAMBAN
LAHIR

ROKOK
JENTIK

BATRA
BPJS
RMH

RMH
LAIN

SPAL
JKD

L P
KK

KK
3M
1 2 4 5 6 7 8 9 10 11 12 13 14 A B C D E F G H I J K L M N O
83 MAELUDIN P 6/25/1986 1 0 0 1 0 `8206022506860001
RADA I 7/6/1990 0 1 0 1 0 `8206024607900001
ALYA SIZASTYA 10/10/2013 0 1 0 1 0 `8206025208140001
A
NAILA AZHALYA 8/12/2014 0 1 0 1 0 `7407010901950001
84 MUHDAR LUTFI P 2/24/1978 1 0 0 1 0 `8206022402780002
FAUJIA IDRIS I 5/29/1979 0 1 0 1 0 `8206026905790001
M. NAJRIL A 2/23/2010 1 0 0 1 0
 85 M. SAENONG P 8/20/1966 1 0 0 1 0
SITI RAHMA I 05//06/1986 0 1 0 1 0
NURUL ALFINA 3/13/2004 0 1 0 1 0
M IRWANSYA A 6/16/2009

1 0 0 1 0
ILHAMSYAH 3 THN 1 0 0 1 0
HASNA T 70 THN 0 1 0 1 0
86 MUH. RISKI ABBAS P 7/13/1997 1 0 0 1 0
SITI MARHAMA HI ADAM I 11/30/1997 0 1 0 1 0
LABIB FAUJAN A 3/25/2016 1 0 0 1 0
87 RUSLAN HI. ADAM P 4/2/1973 1 0 0 1 0 `8206020204730001
SUSANTI I 11/18/1976 0 1 0 1 0 `8206025811760001
NADIA PRATIWI R 9/30/2003 0 1 0 1 0 `8206027009030001
A
RIYANA FATIKA SARI R 6/5/2008 0 1 0 1 0 `8206024506080001
88 RUSLIA MARSAOLY P 4/24/1971 0 1 1 0 0
MOH. RAFLI ABDULLAH 8/10/1995 1 0 1 0 0 `8206021008950001
SIRAJUDDIN ABDULLAH 9/16/1997 1 0 0 1 0 `8206021609970001
ASRUL ABDULLAH A 7/20/1999 1 0 1 0 0 `8206022007990001
SITI DAWANI 8/4/2007 0 1 0 1 0 `8206024608070001
MUH.YASDI 4/23/2011 1 0 0 1 0 `8206022304110001

JAMINAN
STATUS P/I/A/T

LINAKES (BAYI)

CUCITANGAN
AE (7-23 BLN)

SAYURBUAH
NO JK KESEHAT NO PIS-

AIRBERSIH
TANGGAL

AKTIFISIK
AN PK

TIMBANG
NAMA NOMOR BPJS / KIS NIK AKTE KELAHIRAN

JAMBAN
LAHIR

ROKOK
JENTIK

BATRA
BPJS
RMH

RMH
LAIN

SPAL
JKD

L P
KK

KK
3M
1 2 4 5 6 7 8 9 10 11 12 13 14 A B C D E F G H I J K L M N O
89 RAIDI J HASAN P 9/8/1977 1 0 0 1 0 `8206020809770001
WARNIDA MARSAOLY I 10/19/1980 0 1 0 1 0
LILI RUSMIATI RAIDI 11/26/2003 0 1 0 1 0 `8206026611030001
IKA MIRANTI RAIDI 7/20/2006 0 1 0 1 0 `8206026007060001
MUH BAKIR RAIDI A 1/4/2009 1 0 0 1 0 `8206020401090001
 A
NURFAHRANI RAIDI 10/1/2012 0 1 0 1 0 `8206024110120001
NURLELA RAIDI 7/26/2014 0 1 0 1 0 `8206026607140001
90 RIKI ERWANTO P 1/17/1970 1 0 0 1 0
NURFADILA I 4/6/1974 0 1 0 1 0 `8206022801150002
NURANISA A 2/24/2004 0 1 0 1 0 `8206026402040001
91 RAHMAN MARZABESY P 12/6/1972 1 0 0 1 0
NURIMA MANSUR I 0 1 0 1 0
AKIFANAILA A 0 1 0 1 0
92 SAHID DULALI P 3/4/1974 1 0 0 1 0 `8206020403740002
DEWI GUSTI RAHAYU I 8/22/1978 0 1 0 1 0 `8206026208180001
ANNISA SAYYIDA 1/24/2000 0 1 0 1 0
A
MUAMMAR TSANI ALFARIZI 7/4/2006 1 0 0 1 0 `8206020407060001
93 SITIMAWA KIYE P 7/14/1965 0 1 0 1 0 `8206025407650001
RIFANDI H.ADAM A 8/31/1995 1 0 0 1 0 `8206023108950001
94 SLAMET KUABANG P. KIYE P 12/12/1983 1 0 0 1 0 `820602231122840002
SERLY MS I 5/5/1984 0 1 0 1 0
SEBASTIAN AYATILLA WIGUNA A 2/13/2012 1 0 0 1 0 `8206021302110001
95 SABRANI TOISUTA P 9/28/1968 1 0 0 1 0 `8206022809680001
FITRIA ABD. AZIS I 7/22/1978 0 1 0 1 0 `8206026107780001
NADIRA TOISUTA 11/5/2003 0 1 0 1 0 `8206024510030001
A
ALRISAL TOISUTA 3/24/2010 1 0 0 1 0 `8206022403100001
96 SUFRO HI KARIM P 5/1/1980 1 0 1 0 0 `8206020105800001
FAHRIA TOTONA I 3/9/1980 0 1 1 0 0 `8206024903800001
AUM CHANTIKA ROMELANI 9/24/2008 0 1 1 0 0 `8206026409080001
A
WAIS ALQURANI 3/23/2011 1 0 1 0 0
JAMINAN
STATUS P/I/A/T

LINAKES (BAYI)

CUCITANGAN
AE (7-23 BLN)

SAYURBUAH
NO JK KESEHAT NO PIS-

AIRBERSIH
TANGGAL

AKTIFISIK
AN PK

TIMBANG
NAMA NOMOR BPJS / KIS NIK AKTE KELAHIRAN

JAMBAN
LAHIR

ROKOK
JENTIK

BATRA
BPJS
RMH

RMH
LAIN

SPAL
JKD

L P
KK

KK
3M
1 2 4 5 6 7 8 9 10 11 12 13 14 A B C D E F G H I J K L M N O
97 TAHER SANAKY P 8/15/1985 1 0 0 1 0
KUMALA SANAKY I 5/22/1987 0 1 0 1 0
HADIJA REGINA PUTRI SANAKY 3/19/2010 0 1 0 1 0
A
 HALIFA HUMARA SANAKY A 2/20/2012 0 1 0 1 0
RADITIAM PRATAMA SANAKY 2/15/2014 1 0 0 1 0
98 TAKBIR KARIM P 5/5/1967 1 0 0 1 0
HARMA SAYANGA I 4/15/1973 0 1 0 1 0
IRWANDI TAKBIR 3/30/1994 1 0 0 1 0 `8206023003940001
ABD.HAIR TAKBIR 7/13/1997 1 0 0 1 0 `8206021307970001
A
ASRIA TAKBIR 11/27/2000 0 1 0 1 0 `8206026710000001
BUKHARI TAKBIR 4/10/2003 1 0 0 1 0 `8206021014030001
99 YUDI WAHYUDI BUDIARTO P 6/1/1983 1 0 1 0 0
FABILA DEWANTI A 3/30/2005 0 1 0 1 0 `8206027003080001

DESA : RT: 03 ENUMERATOR :

JAMINAN
STATUS P/I/A/T

LINAKES (BAYI)

CUCITANGAN
AE (7-23 BLN)

SAYURBUAH
NO JK KESEHAT NO PIS-

AIRBERSIH
TANGGAL

AKTIFISIK
AN PK

TIMBANG
NAMA NOMOR BPJS / KIS NIK AKTE KELAHIRAN

JAMBAN
LAHIR

ROKOK
JENTIK

BATRA
BPJS
RMH

RMH
LAIN

SPAL
JKD

L P
KK

KK
3M
1 2 4 5 6 7 8 9 10 11 12 13 14 A B C D E F G H I J K L M N O
 100 ALFIAN NURHAMIDIN P 1/11/1976 1 0 0 1 0 `8206021101760001
NANI RIANTI KHARIE I 2/3/1982 0 1 0 1 0 `8206024302820001
M RIZKI NURHAMIDI A 5/23/2003 1 0 0 1 0 `8206022305030001
101 AMIR MAHMUD P 2/25/1979 1 0 1 0 0 820602250279000 1
NURLINA JAFAR I 12/25/1983 0 1 1 0 0 820602651279000 1
NURUL FARIRA 9/11/2006 0 1 1 0 0 820602109060000 1
DWI. R RAMADANIYAH A 9/10/2009 0 1 1 0 0 820602510909000 1
TRI ADZKIYATUNNISA 11/28/2015 0 1 0 1 0
102 ALI HAMZA P 8/19/1975 1 0 1 0 0 0001483241095 820602090873000 2
RUSNA SYARIF I 11/27/1978 0 1 1 0 0 0001483241117 820602671178000 1
RISKI M ALI 6/25/2000 1 0 1 0 0 0001483241128 820602250600000 1
A
NAILA SHALSAFIRA 5/10/2005 0 1 1 0 0 0001483241139 820602500505000 1
103 AHMAD ADAM P 5/21/1972 1 0 0 1 0 820602210672000 1
FATIMA AYUB I 3/28/1978 0 1 0 1 0 820602420678000 1
SAWIA AHMAD 8/12/1997 0 1 0 1 0 820602680397000 1
VAHRIZA AHMAD 1/10/2004 0 1 0 1 0 820602500104000 1
RINALDY AHMAD 12/3/2005 1 0 0 1 0 820602650105000 1
A
ABDDUL RETAN AHMAD 2/6/2009 1 0 0 1 0 820602410103000 2
ABDULWAFDAN AHMAD 7/3/2011 1 0 0 1 0 820602030711000 1
BY. FATMA 1 BLN 0 1 0 1 0
104 ARFIA IBRAHIM P 2/10/1959 0 1 0 1 0 820602600259000 1
MUHAMAD IKRAM A 6/30/1995 1 0 0 1 0 820602160493000 1
105 BAKRI SALAMA P 10/7/1988 1 0 1 0 0 860602071088000 2
DEWI SRTIANI NINGSIH I 7/18/1988 0 1 1 0 0 820602580288000 1
RISKI SAPUTRA BAKRI A 9/19/2012 1 0 1 0 0 820602190912000 1

JAMINAN
STATUS P/I/A/T

LINAKES (BAYI)

CUCITANGAN
AE (7-23 BLN)

SAYURBUAH
NO JK KESEHAT NO PIS-

AIRBERSIH
TANGGAL

AKTIFISIK
AN PK

TIMBANG
NAMA NOMOR BPJS / KIS NIK AKTE KELAHIRAN

JAMBAN
LAHIR

ROKOK
JENTIK

BATRA
BPJS
RMH

RMH
LAIN

SPAL
JKD

L P
KK

KK
3M
1 2 4 5 6 7 8 9 10 11 12 13 14 A B C D E F G H I J K L M N O
106 BUDI HAMID P 5/29/1976 1 0 1 0 0 0001370851931 820602290576000 1
HALIFA SALIM I 5/11/1978 0 1 0 1 0 820602510578000 1
FITRIA APRIANI 4/30/1999 0 1 1 0 0 0001370851953 820602700499000 1
FITRA BANI A 11/17/2000 0 1 1 0 0 0001370851975 820602571100000 2
ALFADJRI BUDI 11/22/2006 1 0 0 1 0 820602221106000 1
107 BAHDAR HAYA P 16/08/1969 1 0 0 1 0 `8206021608190003
AISYA MUMEN I 8/9/1967 0 1 0 1 0 `8206024709670001
BAHTIAR MUMEN 6/9/1988 1 0 0 1 0 `82060209068880001
MAJIDA HAYA A 12/6/1997 0 1 0 1 0 `8206024612970002
FAHRIAN HAYA 9/8/2003 1 0 0 1 0 `8206020809030001
108 BUSRA HI IDRIS P 10/19/1981 1 0 0 1 0
ARFIA MANUAI I 6/15/1985 0 1 0 1 0
ERISTINA BUSRA A 31/03/2003 0 1 0 1 0
109 BUSDIAMIN JAMALUDIN P 3/9/1984 1 0 0 1 0
NASRIANI I 11/12/2980 0 1 0 1 0
KARISMAN 22/07/2008 1 0 0 1 0
A
RISKY 22/04/2015 1 0 0 1 0
110 DULSARI ROSIM P 2/14/1973 1 0 0 1 0 820602140272000 1
WAODE SARTINA I 10/10/1976 0 1 0 1 0 820602501076000 1
GUNARDI URAMA ROSIM 7/3/2001 1 0 0 1 0 820602030701000 2
A
RIVALDI ROSIM 4/16/2004 1 0 0 1 0
111 FAKHRI KURNIAWAN P 24/12/1975 1 0 1 0 0
TUTI FARIYANTI I 13/09/1973 0 1 1 0 0
RHEASITA YUDINDA PUTRI 2/6/1994 0 1 1 0 0
A
NADIA DWI RAMADHANI 6/12/2000 0 1 1 0 0
M. HAFIZH KURNIAWAN T 21/06/2015 1 0 1 0 0
112 RIFAI P 9/24/1989 1 0 1 0 0 820602240989000 1
YULIUN WAKIM I 12/31/1989 0 1 1 0 0 820602711289000 1

JAMINAN
STATUS P/I/A/T

LINAKES (BAYI)

CUCITANGAN
AE (7-23 BLN)

SAYURBUAH
NO JK KESEHAT NO PIS-

AIRBERSIH
TANGGAL

AKTIFISIK
AN PK

TIMBANG
NAMA NOMOR BPJS / KIS NIK AKTE KELAHIRAN

JAMBAN
LAHIR

ROKOK
JENTIK

BATRA
SPAL

3M
 TANGGAL

STATUS P

AE (7-23 B
LINAKES (

SAYURBU
AKTIFISIK
AIRBERSI
TIMBANG
NAMA NOMOR BPJS / KIS NIK AKTE KELAHIRAN

CUCITAN
JAMBAN
LAHIR

ROKOK
JENTIK

BATRA
BPJS
RMH

RMH
LAIN

SPAL
JKD
L P
KK

KK
3M
1 2 4 5 6 7 8 9 10 11 12 13 14 A B C D E F G H I J K L M N O
113 HENDRA PURBA P 12/16/1986 1 0 1 0 0 060602161286000 1
ULFA I 9/20/1988 0 1 1 0 0 820602600988000 1
SITI JENAHARA AQILA PURBA A 23/08/2012 0 1 0 1 0 820602630812000 1
ABDUL KADER T 6/5/1992 1 0 0 1 0 827101050692000 2
ANGGA KADER T 5/14/1997 1 0 0 1 0 827101170895000 2
EMA SRIWINANDA T 11/3/1998 0 1 0 1 0
114 HAMUDIN SOAMOLE P 11/7/1985 1 0 1 0 0
VITA NAVIYANY I 12/19/1990 0 1 1 0 0
115 IBRAHIM MUMEN P 5/13/1980 1 0 0 1 0 820602130580000 1
ANISA MAHMUD I 7/5/1983 0 1 0 1 0 820602450684000 1
NURLAILY. S MUMEN 8/7/2002 0 1 0 1 0
A
SULISTIAWATI. S MUMEN 8/17/2009 0 1 0 1 0
116 IBRAHIM. S ROTAN P 3/10/1963 1 0 0 1 0 820602100363000 1
MARINCE. A RAHMAN I 5/12/1965 0 1 0 1 0 820602620665000 1
YUYUN KARTIKA IBRAHIM 7/13/1998 0 1 0 1 0 820602630799000 1
SULASTRI IBRAHIM 11/23/2003 0 1 0 1 0 820602631102000 2
A
ARTI ARDILA 10/10/2010 0 1 0 1 0
ZULFIKAR SYAPUTRA 4/7/2015 1 0 0 1 0
117 ISKANDAR ARIF P 9/16/1979 1 0 1 0 0 0000211668772 820602160979000 1
NOVA AHMAD I 2/16/1982 0 1 1 0 0 0000211668625 820602560285000 1
YUSRIL ISKANDAR 10/2/2003 1 0 1 0 0 0000211668838 820602221003000 1
A
FANISA ISKANDAR 8/23/2011 0 1 1 0 0 0000211668849
118 ILHAM SAMAT P 2/2/1976 1 0 1 0 0 0001640301085
SELVI NASER I 9/7/1981 0 1 0 1 0 0001640301107
REZA ILHAM 2/8/1999 1 0 0 1 0 0001640301186
BAMBANG ILHAM 12.02.2004 1 0 0 1 0
A
LANANG ILHAM 1/5/2008 1 0 0 1 0 0001640301164
M. NASER ILHAM 10/11/2014 1 0 0 1 0
 JAMINAN

STATUS P/I/A/T

LINAKES (BAYI)

CUCITANGAN
AE (7-23 BLN)

SAYURBUAH
NO JK KESEHAT NO PIS-

AIRBERSIH
TANGGAL

AKTIFISIK
AN PK

TIMBANG
NAMA NOMOR BPJS / KIS NIK AKTE KELAHIRAN

JAMBAN
LAHIR

ROKOK
JENTIK

BATRA
BPJS
RMH

RMH
LAIN

SPAL
JKD
L P
KK

KK
3M
1 2 4 5 6 7 8 9 10 11 12 13 14 A B C D E F G H I J K L M N O
119 JUARIA IDRIS P 7/6/1968 0 1 0 1 0
FITRA TUHAREA A 1 0 0 1 0
120 JOHARENG P 12/31/1990 0 1 0 1 0 820602711270000 1
SRI WAHYUNI 4/6/1988 0 1 0 1 0 820602460488000 1
SITI RAHMA A 5/3/1994 0 1 0 1 0 820602430594000 1
FITRI RAMADANI 10/19/2004 0 1 0 1 0 820602591004000 1
121 KASMAN UMAR P 5/5/1968 1 0 0 1 0 820602050568000 1
MITIA AYUB I 4/11/1974 0 1 0 1 0 820602510474000 1
SULFANA KASMAN 9/4/1995 0 1 0 1 0 820602440995000 2
ARFAN KASMAN 7/24/1998 1 0 0 1 0 820602240798000 1
JULIANTI MAGFINE KASMAN 6/24/2003 0 1 0 1 0 820602640603000 2
A
NURIUL HAFIJA KASMAN 3/3/2008 0 1 0 1 0 820602430308000 1
DEWI CAHYANI KASMA 11/17/2013 0 1 0 1 0 820602571113000 2
NURAMIRA KASMAN 9/4/2015 0 1 0 1 0 820602440915000 1
122 KADIM MUMEN P 6/15/1971 1 0 1 0 0 0001967189861 820602150871000 1
RUSDA MANSUR I 5/25/1975 0 1 1 0 0 0001967191749 820602650575000 1
RATNAWATI MUMEN 9/25/1994 0 1 1 0 0 820602650994000 1
RASWIN MUMEN 9/12/1996 1 0 1 0 0 820602520701000 2
A
NURJANI MUMEN 7/12/2001 0 1 1 0 0 0001967200367 820602520701000 1
FAHRULA MUMEN 7/12/2007 1 0 1 0 0 0001967201379 820602120207000 1
123 LUKMAN HANAFI P 5/4/1976 1 0 1 0 0 820602040576000 1
SITI RAFIA I 8/16/1979 0 1 1 0 0 820602560879000 2
ADHY GEGANAN PUTRA HANAFI 4/19/2003 1 0 1 0 0 820602190404000 1
A
FADHILA AYU LESTARI HANIFI 4/23/2006 0 1 1 0 0 820602040486000 3
 JAMINAN

STATUS P/I/A/T

LINAKES (BAYI)

CUCITANGAN
AE (7-23 BLN)

SAYURBUAH
NO JK KESEHAT NO PIS-

AIRBERSIH
TANGGAL

AKTIFISIK
AN PK

TIMBANG
NAMA NOMOR BPJS / KIS NIK AKTE KELAHIRAN

JAMBAN
LAHIR

ROKOK
JENTIK

BATRA
BPJS
RMH

RMH
LAIN

SPAL
JKD
L P
KK

KK
3M
1 2 4 5 6 7 8 9 10 11 12 13 14 A B C D E F G H I J K L M N O
124 M. DARWIS P 10/1/1972 1 0 1 0 0
MARDIA I 31/03/1981 0 1 1 0 0
SABILA. M UTAMI 17/06/2001 0 1 1 0 0
SAKILA MD 31/03/2003 0 1 1 0 0
A
SATRIA 10/1/2008 1 0 1 0 0
SAHRIL DARMAWAN 10/1/2008 1 0 0 1 0
125 MUHAMAD HASDI TAMIMA P 12/1/1961 1 0 0 1 0 820602011261000 1
HAIRIL M HASBI TAMIMA 11/11/1988 1 0 0 1 0 820602111188000 1
A
ASRIYADI 11/21/1992 1 0 0 1 0 820602211192000 1
126 MAWAR MARSAOLY P 4/25/1980 0 1 1 0 0 820602650480000 1
NAFSIATUL NURMAINA A 4/2/2007 0 1 1 0 0 820602420407000 1
127 M. ASRI SYAMSI P 2/27/1973 1 0 0 1 0
SURYATI SOAMOLER I 7/11/1978 0 1 0 1 0
RAFIDINAL. M ASRI 3/23/1999 1 0 0 1 0
A
HALIMA SRIWINDI 5/5/2005 0 1 0 1 0
128 MAKMUR P 6/15/1969 1 0 0 1 0 820602150669000 1
ASNAH I 12/6/1966 0 1 0 1 0 820602461266000 1
DESAL BAYU LESTARI. P HAMESYA T 12/15/2009 1 0 0 1 0
JOHA T 6/1/1940 0 1 0 1 0
129 MULYANA P 5/22/1966 1 0 1 0 0 0001767532858 820602220566000 1
130 MURSID SYAMSUDIN P 4/20/1978 1 0 1 0 0 820602200478000 1
RAJIBA SAJANGU I 5/5/1981 0 1 0 1 0 820602450581000 2
RURIHZA 12/14/2003 0 1 0 1 0 820602541203000 1
M. MAULANA HAFIZ M 8/6/2007 1 0 0 1 0 820602060807000 1
A
MUHAMAD IBRAHIM 12/6/2010 1 0 0 1 0 820602061210000 1
SOFIA KHIRUTUNISA 16/10/2016 0 1 0 1 0
 JAMINAN

STATUS P/I/A/T

LINAKES (BAYI)

CUCITANGAN
AE (7-23 BLN)

SAYURBUAH
NO JK KESEHAT NO PIS-

AIRBERSIH
TANGGAL

AKTIFISIK
AN PK

TIMBANG
NAMA NOMOR BPJS / KIS NIK AKTE KELAHIRAN

JAMBAN
LAHIR

ROKOK
JENTIK

BATRA
BPJS
RMH

RMH
LAIN

SPAL
JKD
L P
KK

KK
3M
1 2 4 5 6 7 8 9 10 11 12 13 14 A B C D E F G H I J K L M N O
131 MUSA HI MEDO P 11/26/1978 1 0 0 1 0 820602261178000 1
JAMILA MARSAOLI I 12/7/1977 0 1 0 1 0 820602471277000 1
ARJUNMUSA 7/24/2004 1 0 0 1 0 820602240724000 1
AKRAM MUSA A 1/30/2006 1 0 0 1 0 820602300106000 1
FENRIANTI MUSA 2/13/2013 0 1 0 1 0 820602530213000 2
132 MUBIN SALASA P 7/25/1979 1 0 1 0 0 820602250779000 1
UMI ALI I 9/10/1979 0 1 1 0 0 0001370853707 820602500479000 1
GUNTUR A 5/7/2004 1 0 0 1 0 820602070504000 1
133 MUTALIB HI. HARUN P 12/22/1973 1 0 0 1 0 820602221073000 1
BIJANUN HI. IBRAHIM I 4/22/1975 0 1 0 1 0 820602620472000 1
FARYUMI MUTALIB 2/25/2001 0 1 0 1 0 820602650201000 1
FAHYU NISA MUTALIB A 3/19/2004 0 1 0 1 0 820602590304000 1
ADITIYO MUTALIB 2/7/2007 1 0 0 1 0 820602070207000 1
ISRA HAYUN T 6/16/1992 1 0 0 1 0 820602560692000 1
KIARA SINTA HARIS T 6/6/1997 0 1 0 1 0 820602460697000 1
134 RASIDIN LAPENAON P 10/3/1992 1 0 0 1 0 827202031092000 1
NUNUNG JUMAINI IBRAHIM I 7/12/1993 0 1 0 1 0 820602620793000 1
M. TAUFIK A 10/18/2013 1 0 0 1 0
135 RASID TITIAHI P 7/5/1977 1 0 1 0 0 0002090622069 820602050777000 1
FAHILA ABDULJAJIL I 1/9/1983 0 1 1 0 0 0002090624332 820602490183000 1
VIRGIAWAN SANDIKA 11/9/2000 1 0 1 0 0 0002090625456 820602091100000 1
SALFA KIRANI A 12/31/2008 0 1 0 1 0 820602711210000 2
NURFITRI 8/15/2014 0 1 0 1 0
HAFSA HALIK T 0 1 0 1 0
SURFI TITIAHI T 28/09/1986 1 0 0 1 0
 JAMINAN

STATUS P/I/A/T

LINAKES (BAYI)

CUCITANGAN
AE (7-23 BLN)

SAYURBUAH
NO JK KESEHAT NO PIS-

AIRBERSIH
TANGGAL

AKTIFISIK
AN PK

TIMBANG
NAMA NOMOR BPJS / KIS NIK AKTE KELAHIRAN

JAMBAN
LAHIR

ROKOK
JENTIK

BATRA
BPJS
RMH

RMH
LAIN

SPAL
JKD
L P
KK

KK
3M
1 2 4 5 6 7 8 9 10 11 12 13 14 A B C D E F G H I J K L M N O
136 SAMAD HI. MEDO P 7/27/1971 1 0 1 0 0 0001655088658 820602270771000 1
NURNAWI AHMAD I 6/16/1977 0 1 1 0 0 0001655088669 820602560677000 1
RUSMAN SAMAD 7/3/1993 1 0 0 1 0 820602050793000 1
MIZWAR SAMAD 10/15/1998 0 1 1 0 0 0001655088682 820602151098000 2
A
RUSMALINDA SAMAD 2/21/2005 1 0 1 0 0 0001655088671 820602810205000 1
ROFIKA SAMAD 7/14/2014 0 1 0 1 0 820602540713000 1
NURLELA HASAN T 3/12/1954 0 1 0 1 0 820206520354000 1
137 SLAMET HI ALIM P 8/5/1983 1 0 1 0 0 `8206020508830003
ASRIA MASUKU I 25/05/1991 0 1 1 0 0 0001370852627 `8206056505910001
NAJWA ASYILIA MUMEN 22/10/2014 0 1 0 1 0
A
FATIMA AZARA MUMEN 12/6/2015 0 1 0 1 0
138 SIDIK HAMID P 11/6/1969 1 0 0 1 0 820602061169000 2
ARBIA RAHUM I 2/2/1969 0 1 0 1 0 820602420269000 2
RIKSAN SIDIK 25/06/1991 1 0 0 1 0 820602260591000 1
HAMMA SIDIK 12/10/1992 0 1 0 1 0 820602601292000 1
ARDILA SIDIK A 3/5/1998 0 1 0 1 0 820602450396000 1
NURDAYANTI SIDIK 4/7/2001 0 1 0 1 0 820602470401000 2
NIRWAWAN SIDIK 5/19/2005 1 0 0 1 0 820602190506000 1
139 SAHRANI MANSUR P 3/3/1970 1 0 0 1 0
HASNA HASAN I 7/21/1973 0 1 0 1 0
ASMIATI MANSUR 12/21/1999 0 1 0 1 0
MIRNAWATI MASUR 11/23/2002 0 1 0 1 0
A
RIFDA MANSUR 7/21/2005 0 1 0 1 0
ISMAN MANSUR 6/3/2012 1 0 0 1 0
140 SAHRUDDIN DJAFAR P 3/11/1979 1 0 0 1 0 820602110379000 1
 HJ. ANA FITRIANI I 1/10/1982 0 1 0 1 0 820602500182000 3
MUH. RAJAB 8/2/2008 1 0 0 1 0 820602020808000 1
A
FARDIANSAH 1/12/2014 1 0 0 1 0 820602120114000 2
NORMI T 9/29/1950 1 0 0 1 0 820602690450000 1
JAMINAN

STATUS P/I/A/T

LINAKES (BAYI)

CUCITANGAN
AE (7-23 BLN)

SAYURBUAH
NO JK KESEHAT NO PIS-

AIRBERSIH
TANGGAL

AKTIFISIK
AN PK

TIMBANG
NAMA NOMOR BPJS / KIS NIK AKTE KELAHIRAN

JAMBAN
LAHIR

ROKOK
JENTIK

BATRA
BPJS
RMH

RMH
LAIN

SPAL
JKD
L P
KK

KK
3M
1 2 4 5 6 7 8 9 10 11 12 13 14 A B C D E F G H I J K L M N O
141 SALIM. S HI. HAFIL P 9/4/1979 1 0 1 0 0 820610090479000 1
ASNIA HI. LADA I 14/09/1981 0 1 1 0 0 820610540981000 1
RINTA HI.HAFIL 7/11/1999 0 1 1 0 0 820610471199000 1
SANDA HI. HAFIL A 17/03/2006 0 1 1 0 0 820610570306000 1
SRIFAYA HI. HAFIL 17/05/2016 0 1 0 1 0
YULIANA TAIB T 5/2/2002 0 1 0 1 0
142 SYAMSURA P 11/29/1979 1 0 0 1 0 820602291179000 1
LIZYA SANTI I 8/1/1989 0 1 0 1 0 820602410889000 1
ZALSA SALSABILLA 10/9/2010 0 1 0 1 0 820602491010000 1
A
ZYAFIQA ZYABIRA 3/4/2014 0 1 0 1 0 820602440314000 1
143 SAINUDDIN PALALOI P 4/3/1968 1 0 0 1 0 820602030468000 3
MASEANI I 1/10/1970 0 1 0 1 0 820602500170000 1
FITRIA DEWI H SAINUDDIN 11/8/1989 0 1 0 1 0 820602481189000 1
FADLI RISALDI SAINUDDIN 6/18/1996 1 0 0 1 0 820602180695000 2
A
RAFHI GUNAWAN H SAINUDDIN 1/16/2000 1 0 0 1 0 820602160100000 1
PUTRI ANGGUN N H SAINUDDIN 1/11/2010 0 1 0 1 0 820602510110000 1
144 UDIYANTO I BASRI P 4/20/1967 1 0 1 0 0 0001385812045 820602200467000 1
NURSANI DJAMALUDIN I 2/21/1964 0 1 1 0 0 0001385813013 820602610264000 1
ANNISA UDIYANTO A 5/29/2006 0 1 1 0 0 0001385813968 820602690506000 1
145 ZAINAL SAHABIDIN P 10/21/1986 1 0 0 1 0 820602211086000 1
146 YAMIN HI. KASIM P 2/8/1972 1 0 0 1 0 820602802720000 1
NURHANI ILYAS I 2/20/1970 0 1 0 1 0 820602600270000 1
SISKO RIJAN 5/29/1997 1 0 0 1 0 820602290527000 1
A
ANGGUN RIJAN 8/10/2005 0 1 0 1 0 820602500805000 1
 147 YAMIN BUAMONA P 4/3/1979 1 0 1 0 0 0001829575607 820602030479000 1
FITRIA H. MOHTAR I 6/19/1979 0 1 1 0 0 0001829574123 820602390679000 1
RAFFY ALKIYA BUAMONA 12/14/2006 1 0 1 0 0 0001829585215 820602141206000 2
AZQA ALMIFTA BUAMONA A 5/3/2010 1 0 1 0 0 00018292587948 820602030510000 1
ZULAIKHA KHANSA AMIRA B 12/22/2014 0 1 1 0 0 0002044947745 820602621214000 1
JAMINAN

STATUS P/I/A/T

LINAKES (BAYI)

CUCITANGAN
AE (7-23 BLN)

SAYURBUAH
NO JK KESEHAT NO PIS-

AIRBERSIH
TANGGAL

AKTIFISIK
AN PK

TIMBANG
NAMA NOMOR BPJS / KIS NIK AKTE KELAHIRAN

JAMBAN
LAHIR

ROKOK
JENTIK

BATRA
BPJS
RMH

RMH
LAIN

SPAL
JKD
L P
KK

KK
3M
1 2 4 5 6 7 8 9 10 11 12 13 14 A B C D E F G H I J K L M N O
DJAMILA DAWANGI T 6/12/1958 0 1 0 1 0 820602620658000 2
DESA : RT: 04 ENUMERATOR :
JAMINAN

STATUS P/I/A/T

LINAKES (BAYI)

CUCITANGAN
AE (7-23 BLN)

SAYURBUAH
NO JK KESEHAT NO PIS-

AIRBERSIH
TANGGAL

AKTIFISIK
AN PK

TIMBANG
NAMA NOMOR BPJS / KIS NIK AKTE KELAHIRAN

JAMBAN
LAHIR

ROKOK
JENTIK

BATRA
BPJS
RMH

RMH
LAIN

SPAL
JKD
L P
KK

KK
3M
1 2 4 5 6 7 8 9 10 11 12 13 14 A B C D E F G H I J K L M N O
148 AMIR P 12/12/1968 1 0 1 0 0 8206020212680001
ROSNAINI I 1/7/1970 0 1 1 0 0 0000934301766 8206024107700001
HASNIDAR 13/6/1995 0 1 0 1 0 8206025306950001
A
SARDINAL 17/12/1998 1 0 0 1 0 8206021712980002
ARDIANSYAH T 1 0 0 1 0 -
149 AKBAR HARIMAN P 10/3/1985 1 0 1 0 0 8206021003850002
ISTIANA ISMAIL I 1/11/1987 0 1 1 0 0 8206024111870003
ADITYA. D HARIMAN 5/11/2006 1 0 1 0 0 8206020511060001
A
MUHAMMAD .T HARIMAN 16/1/2009 1 0 1 0 0 8206021601090001
150 ARIF HADI P 25/5/1986 1 0 1 0 0
151 AUDY ALISA RONSUL P 22/08/1982 1 0 0 1 0 0001838423002
152 ANHAR MARSAOLY P 3/2/1969 1 0 1 0 0 0000140894201
SURIAM LATIF I 25/01/1970 0 1 1 0 0
FADRIN MARSAOLY 29/03/1993 1 0 1 0 0
NURSANTI MARSAOLY 14/08/1997 0 1 1 0 0
NURSAFA MARSAOLY A 5/10/2000 0 1 1 0 0
ABDULWAHAB MARSAOLY 23/03/2008 1 0 1 0 0
RAHMAT MARSAOLY 9/11/2005 1 0 1 0 0
FITRIA LATIF T 6/11/1989 0 1 0 1 0
ASMIATY T 8/3/2009 0 1 0 1 0
153 BODA P 29/12/1974 1 0 0 1 0 8206022912740001
 HI. SURIANA I 15/8/1977 0 1 0 1 0 82060255087770003
FANDI ADINATA 4/10/1997 1 0 0 1 0 8206020410990001
FAHRIL ADIGUNA A 29/12/2005 1 0 0 1 0 8206022912050002
FAHRUL ADIATAMA 29/12/2005 1 0 0 1 0 8206022912050001

JAMINAN

STATUS P/I/A/T

LINAKES (BAYI)

CUCITANGAN
AE (7-23 BLN)

SAYURBUAH
NO JK KESEHAT NO PIS-

AIRBERSIH
TANGGAL

AKTIFISIK
AN PK

TIMBANG
NAMA NOMOR BPJS / KIS NIK AKTE KELAHIRAN

JAMBAN
LAHIR

ROKOK
JENTIK

BATRA
BPJS
RMH

RMH
LAIN

SPAL
JKD
L P
KK

KK
3M
1 2 4 5 6 7 8 9 10 11 12 13 14 A B C D E F G H I J K L M N O
154 BUDI YULIANTO P 23/7/1987 1 0 0 1 0 8206022307800001
JAKIAT MARSAOLY I 12/7/1983 0 1 0 1 0 8206025207830001
SITI FATIMA ZAHRA YULIANTO 16/4/2004 0 1 0 1 0 8206025604040001
MUHAMMAD FADRA YULIANTOP 3/3/2006 1 0 0 1 0 8206020303060001
A
SYAUQI KHAHATUN B. YULIANTO 8/1/2012 0 1 0 1 0 8206024801120001
MUHAMMAD RAI SYAHARI Y 15/9/2009 1 0 0 1 0 8206021509090002
155 BAHTIAR WAHID P 12/2/1970 1 0 1 0 0 0000206651169 82060101202700001
RUADIA SYAMSI I 23/9/1978 0 1 1 0 0 0000140904731 82060106309780001
TESA ARDIAWAN WAHID 26/11/2000 0 1 1 0 0 0000206651362 82060102611000001
A
ADINDA DWI MARSYA 11/4/2006 0 1 1 0 0 0000206651531 82060105104060001
156 FREDI WALANDA P 21/3/1968 1 0 0 1 0 8206102103680001
YEANY. V LAMBEY I 28/6/1968 0 1 0 1 0 8206026806680002
157 GAUS MUMEN P 29/8/1969 1 0 1 0 0 8206022908690001
JAEDE LASILOM I 15/11/1973 0 1 1 0 0 8206025511730002
M. HARWAN G. MUMEN 10/11/1996 1 0 1 0 0 8206021011961001
RAHMAT RIYADI 25/11/1999 0 1 1 0 0 8206022511950001
A
FARADILA CT. MUMEN 25/8/2004 0 1 0 1 0 8206026508040001
M. BAGIR G. MUMEN 12/7/2007 1 0 0 1 0 8206021207070002
158 Hi. ABDUL FATAH P 24/12/1972 1 0 1 0 0 8206022412720001
HJ. NURHAYATI I 9/4/1976 0 1 1 0 0 8206024904760002
AINUN FAHRIA FAHAY 18/1/1999 0 1 1 0 0 8206025801990001
A
 AINUN RIDA FAHAY A 28/12/2002 1 0 1 0 0 8206022812020001
AFIF ALMIKSITH FAHAY 24/9/2009 1 0 1 0 0 8206022409090001
159 HARTONO SOEKOENAY P 8/10/1972 1 0 0 1 0 82060101810720001
FONI KURNIATAI I 8/6/1976 0 1 0 1 0 8206024806780001
HANNY RIZKY SOEKOENAY 10/11/1997 1 0 0 1 0
FAJRIATI DWI RAHMA A 6/12/2009 0 1 0 1 0 8206024612010001
TAUFAN PUTRA SOEKOENAY 26/7/2007 1 0 0 1 0 8206022607070009

JAMINAN

STATUS P/I/A/T

LINAKES (BAYI)

CUCITANGAN
AE (7-23 BLN)

SAYURBUAH
NO JK KESEHAT NO PIS-

AIRBERSIH
TANGGAL

AKTIFISIK
AN PK

TIMBANG
NAMA NOMOR BPJS / KIS NIK AKTE KELAHIRAN

JAMBAN
LAHIR

ROKOK
JENTIK

BATRA
BPJS
RMH

RMH
LAIN

SPAL
JKD
L P
KK

KK
3M
1 2 4 5 6 7 8 9 10 11 12 13 14 A B C D E F G H I J K L M N O
160 Hj. DARWATI P 12/3/1970 0 1 0 1 0 8206024906700001
SAMSUL RIJAL HASRI 7/8/1993 1 0 0 1 0 8206020906960001
A
NURUL DILLA 14/8/2002 0 1 0 1 0 8206024707020001
161 HARUN HASAN P 6/11/1973 1 0 1 0 0 0000198957868 8206020611730001
RAHIDA KAMAH I 29/9/1982 0 1 0 1 0 0000198957554 8206026909820001
NURHALIZA HARUN 25/1/2003 0 1 0 1 0 0000198958037 8206026501030001
MUAMAR HARUN 30/6/2005 1 0 0 1 0 8206023006050001
A
NURASYIFFA HARUN 30/11/2012 0 1 0 1 0 8206027011120001
MUALIF AHRUN 22/3/2015 1 0 0 1 0 8206023011120001
162 HERI POET P 8/8/1989 1 0 1 0 0 8206020808890001
LUSTINA SARDIN I 31/7/1975 0 1 0 1 0 8206024107890004
SEAN POET A 10/9/2010 0 1 0 1 0
163 HI. MAHDI ACIL ASIS P 31/12/1945 1 0 1 0 0 0001895565576 8206023112450001
HAJIJA MARSAOLY I 8/3/1982 0 1 1 0 0 0001895562549 8206024803820002
EMIR TAQIYUDIN AZIZ 6/3/2006 1 0 1 0 0 0001895568671
A
UMMU HAFZA AZIZ 28/8/2012 0 1 1 0 0 0001895570561
164 HERMANUS BATAWI P 9/7/1977 1 0 0 1 0 8206020907770002
NETI SISENA PINGE I 12/2/1980 0 1 0 1 0 8206025805810001
JEKSON BATAWI 7/6/1994 1 0 0 1 0 8206024704010001
JELRIN YULISTRI BATAWI 7/4/2001 0 1 0 1 0 8206020710030001
A
 A
JERAL VERIL BATAWI 7/10/2003 1 0 0 1 0 8206020710030001
JULISTIN BATAWI 28/08/2016 0 1 0 1 0
165 HARDI ABIDIN P 30/07/1987 1 0 1 0 0 0001370853336
NURNA RAMLIL I 30/12/1988 0 1 1 0 0 0001370853368
ATTAHIRA HARDIA 27/08/2009 0 1 0 1 0
A
EKA SEPTIANA 29/09/2014 0 1 0 1 0

JAMINAN

STATUS P/I/A/T

LINAKES (BAYI)

CUCITANGAN
AE (7-23 BLN)

SAYURBUAH
NO JK KESEHAT NO PIS-

AIRBERSIH
TANGGAL

AKTIFISIK
AN PK

TIMBANG
NAMA NOMOR BPJS / KIS NIK AKTE KELAHIRAN

JAMBAN
LAHIR

ROKOK
JENTIK

BATRA
BPJS
RMH

RMH
LAIN

SPAL
JKD
L P
KK

KK
3M
1 2 4 5 6 7 8 9 10 11 12 13 14 A B C D E F G H I J K L M N O
166 ILHAM P 7/3/1977 1 0 0 1 0 8206020703770001
HASBIAH I 24/4/1978 0 1 1 0 0 8206026404780001
M. ANUGERAH ILHAM 16/2/2003 1 0 0 1 0 8206021602030001
A
M. ADIRGA ILHAM 10/3/2007 1 0 0 1 0
167 JUHANSAR P 9/7/1974 1 0 1 0 0 8206020907740001
SRININGSI HASAN I 21/9/1977 0 1 1 0 0 8206026109770001
FAIRUS YUNI PRATIWI 6/6/2008 0 1 1 0 0 8206021709140001
A
FADGAM AL KAFADI 17/9/2014 1 0 1 0 0
168 JACKSON E KUHU P 30/7/1986 1 0 0 1 0 8271023007680002
LUSHAYATI BOLENG I 24/10/1982 0 1 0 1 0 8271026410820001
ALICIA HERA.M KUHU A 2/9/2009 0 1 0 1 0 8271024209090001
169 JAFAR MARSAOLY P 13/10/1979 1 0 0 1 0 8206021210790001
SRI HANDAYANI I 12/8/1979 0 1 0 1 0 8206025208790001
NURUL OKTAFIANA 10/10/1999 0 1 0 1 0 8206025010990001
A
M. NABIL MARSAOLY 18/4/2005 1 0 0 1 0 8206021804050001
170 JUMARIS P 13/04/1986 1 0 0 1 0
ROS INDAH I 11/1/1990 0 1 0 1 0
CHAERUL ARFAR 16/01/2010 1 0 0 1 0
A
NAJWA KHAIRA W 01/016/2014 0 1 0 1 0
 171 KAMARIA WONGE P 28/7/1962 0 1 0 1 0 8206086607620001
ALWIA SUDIRMAN 8/11/1986 0 1 0 1 0 8206086710860001
SUSAN SUDIRMAN 15/12/1993 0 1 0 1 0 8206085512930001
A
SUSWANTO SUDIRMAN 26/6/1995 1 0 0 1 0 8206082606950001
SUINGLI SUDIRMAN 4/10/1997 1 0 0 1 0 -
172 KOMARUDIN DAENG RATE P 28/08/1974 1 0 0 1 0
SATRIANI SINA I 23/12/1975 0 1 0 1 0
173 LA ALIF UNTUNG P 26/2/1953 1 0 0 1 0
DINA I 12/3/1955 0 1 0 1 0

STATUS P/I/A/T JAMINAN

LINAKES (BAYI)

CUCITANGAN
AE (7-23 BLN)

SAYURBUAH
NO JK KESEHAT NO PIS-

AIRBERSIH
TANGGAL

AKTIFISIK
AN PK

TIMBANG
NAMA NOMOR BPJS / KIS NIK AKTE KELAHIRAN

JAMBAN
LAHIR

ROKOK
JENTIK

BATRA
BPJS
RMH

RMH
LAIN

SPAL
JKD
L P
KK

KK
3M
1 2 4 5 6 7 8 9 10 11 12 13 14 A B C D E F G H I J K L M N O
174 LEDA PINGE P 20/12/1976 0 1 0 1 0 82060260009760003
FICKO RICHARD PINGE 4/5/2001 1 0 0 1 0 82060220405010003
A
FICKY ADITYA PINGE 28/11/2007 1 0 0 1 0 82060222811070002
175 M. IKSAN ANWAR P 12/11/1986 1 0 1 0 0 0001095392237 8206021211860002
FIRDA LASILOM I 6/4/1990 0 1 0 1 0 0002033787644 8206024604900001
RISQY FISRHAN ANWAR A 25/11/2010 1 0 0 1 0 00020337789883 8206022511100001
176 MUH. ILYAS P 19/5/1986 1 0 0 1 0 8206021905860001
ASNI ANGKA I 29/8/1986 0 1 0 1 0 8206026908860002
177 MURSID PAWANE P 25/4/1980 1 0 1 0 0 000164300938
SULASTRIKAMARUDIN I 9/1/1986 0 1 1 0 0 8207014901860001
GHIBRAN ASSATYA PAWANE A 30/09/2016 1 0 0 1 0
178 MUHTAR HI. HANNA P 18/7/1970 1 0 1 0 0 0002056740028 8206021807700001
MUSMETI HI. HUSTAFA I 21/10/1977 0 1 1 0 0 0002056740849 8206026110720001
UMI ANISAH ZALFA ZAHIRAH 30/11/1997 0 1 1 0 0 0002056741402 8206027011970002
A
AHLAN FAUZAN IJAL 15/4/2003 1 0 1 0 0 0002056741558 8206021504030001
179 M. SAID MARSAOLY P 5/8/1983 1 0 0 1 0
RAHIMA MEREK I 6/11/1987 0 1 0 1 0
180 MURFIL PAWANE P 9/10/1977 1 0 0 1 0 8206090910770001
 APRIYANTI TORAR I 6/4/1973 0 1 0 1 0 8206094604730001
GIO ARIENDO PAWANE A 29/12/2009 1 0 0 1 0 8206092912090001
181 MANSUT. T P 1 0 1 0 0
WA. RICI I 2/1/1990 0 1 1 0 0
182 MUHAMMAD KASTURI P 18/09/1970 1 0 0 1 0 `8206021809700004
NAMIRA YUSUF I 20/05/1977 0 1 0 1 0 `8205086005770003
183 RUSTAM IBRAHIM P 11/11/1983 1 0 0 1 0 8206021111830002
UMI MARSAOLI I 23/10/1985 0 1 0 1 0 8206026310850001
HALIMA TUHSIADIA 8/10/2006 0 1 0 1 0 8206024810060002
MIRANI HASTUTI A 20/7/2009 0 1 0 1 0 8206026007090001
TRI PUTRI UTAMI 10/3/2015 0 1 0 1 0
JAMINAN
STATUS P/I/A/T

LINAKES (BAYI)

CUCITANGAN
AE (7-23 BLN)

SAYURBUAH
NO JK KESEHAT NO PIS-

AIRBERSIH
TANGGAL

AKTIFISIK
AN PK

TIMBANG
NAMA NOMOR BPJS / KIS NIK AKTE KELAHIRAN

JAMBAN
LAHIR

ROKOK
JENTIK

BATRA
BPJS
RMH

RMH
LAIN

SPAL
JKD
L P
KK

KK
3M
1 2 4 5 6 7 8 9 10 11 12 13 14 A B C D E F G H I J K L M N O
184 RAMLI LANGKA P 1/6/1969 1 0 0 1 0 8206020106690001
RUSHAN TAUFIK I 1/5/1978 0 1 0 1 0 82060244005680001
RASID. R LANGKA 2/11/1985 1 0 0 1 0 8206021503860001
NURHARISNAWATI. R LANGKA 10/5/1994 0 1 0 1 0 8206025505940001
NURJADRIA.R LANGKA A 14/2/2002 0 1 0 1 0 8206021109030001
FAHREJA. R LANGKA 1/9/2003 1 0 0 1 0 8206025402020002
ADELAN. R LANGKA 1/1/2011 1 0 0 1 0 8206020101110001
185 SAMIA KISMAN P 5/10/1964 0 1 0 1 0 8206084510640001
INDRIANI KHARIE 3/7/1984 0 1 0 1 0 8206024206840001
WAHYU KHARIE 29/1/1988 1 0 0 1 0
SOFYAN KHAIE 29/1/1994 1 0 0 1 0
A
NADIA KHAIE 31/8/2001 0 1 0 1 0
IRFANDI KHARIE 15/11/2006 1 0 0 1 0
MUHAMMAD RIZKI NURHAMIDIN 23/5/2003 1 0 0 1 0
186 SINEN MUKSIN P 15/8/1975 1 0 0 1 0 8206021508750001
RUSMINI YUSUP I 18/8/1977 0 1 0 1 0 8206025808770002
FREALSHA NASERA MUKSIN A 27/4/2010 0 1 0 1 0
 187 SAMIKUN P 20/8/1979 1 0 0 1 0 8206012008790001
SATIYA I 20/4/1979 0 1 0 1 0 8206016004790002
RINA ASTUTI 20/8/2002 0 1 0 1 0 8206014808020001
CIKA DWI LESTARI 29/9/2005 0 1 0 1 0 8206016909050001
A
DIAN MAHARANI 29/9/2006 0 1 0 1 0
HERO RAHMAWATI 4/6/2014 0 1 0 1 0 8206014406140001
188 SULTONI P 7/4/1989 1 0 0 1 0
INDA WAHYU TRI UTAMI I 21/5/1990 0 1 0 1 0

JAMINAN
STATUS P/I/A/T

LINAKES (BAYI)

CUCITANGAN
AE (7-23 BLN)

SAYURBUAH
NO JK KESEHAT NO PIS-

AIRBERSIH
TANGGAL

AKTIFISIK
AN PK

TIMBANG
NAMA NOMOR BPJS / KIS NIK AKTE KELAHIRAN

JAMBAN
LAHIR

ROKOK
JENTIK

BATRA
BPJS
RMH

RMH
LAIN

SPAL
JKD
L P
KK

KK
3M
1 2 4 5 6 7 8 9 10 11 12 13 14 A B C D E F G H I J K L M N O
189 TASEN. B TAMAENE P 21/11/1972 1 0 0 1 0 8206022111720001
ELIZABETH PINGE I 21/12/1972 0 1 0 1 0
RICHO TAMAENE 7/6/1997 1 0 0 1 0
RISYA DEBBY BEE TAMAENE 7/5/2001 0 1 0 1 0
A
RIKARDO BEE TAMAENE 1/10/2009 1 0 0 1 0
CRISTIAN 20/1/2012 1 0 0 1 0
190 TAUFIK LUANGE P 19/6/1973 1 0 0 1 0 8206021903730001
ABDULWAHAB MARSAOLY I 2/9/1973 0 1 0 1 0
SAFITRI LUANGE 18/2/1996 0 1 0 1 0
A
NAUFAL LUANGAE 4/4/2005 1 0 0 1 0
191 YUDI HARIYANTO P 16/6/1985 1 0 1 0 0
SITNA. R DJANNAH I 24/11/1974 0 1 1 0 0 8206026411400001
MOH. HAFIDJA YANTO 8/6/2007 1 0 1 0 0
SURYANI ISHAK A 3/6/1999 0 1 1 0 0
REINALDI 2/6/2001 1 0 1 0 0
192 YOSEFITO KIY P 14/6/1986 1 0 1 0 0 82060214068600001
 AGNESIA ITA PURNAMASARI I 14/8/1982 0 1 1 0 0 8206025404920001
DELFIN KIY A 9/5/2014 1 0 1 0 0 8206020905140001
193 YUSRIZAL HASRI P 15/6/1982 1 0 0 1 0 8206021807870001
INDO UPE I 2/7/1997 0 1 0 1 0 7313024308960001
194 YOSA LASE P 17/10/1989 1 0 1 0 0 8206021710891001
FITRI AYU LESTARI I 26/4/1990 0 1 1 0 0 8206026604901001
AIJUN LASE A 26/2/2013 1 0 1 0 0 8206022602130001
195 WAODE ROSPIATI P 31/12/1983 0 1 1 0 0
WAJABANI 4/4/1990 0 1 0 1 0
DAISC HI. BOB 30/3/2006 1 0 0 1 0
A
MALI MUJUR 3/5/2012 0 1 0 1 0
BISMILL 15/10/2004 1 0 0 1 0
196 WIDI SUGIATMONO P 7/4/1967 1 0 1 0 0 0001545109514

J U M LAH ############ 0
 CARA PENGISIAN FORMAT DATA KESEHATAN
PUSKESMAS BULI TAHUN 2018

Nomor 1-13
1. : Nomor Rumah :Diisi dengan nomor urut rumah yang didatangi
2. : Nomor KK : Diisi dengan nomor urut Kepala Keluarga yang diwawancarai
3 : Nama : Diisi dengan nama seluruh anggota keluarga termasuk KK
4. : Status : P = KK I = Istri A= Anak T= Tanggungan/Anggota Keluarga lain
5. : Tanggal Lahir : Jelas
6-7 : JK = Jenis Kelamin : Diisi dengan angka 1 pada kolom yang sesuai
8-10 : Jaminan Kesehatan
Diberi angka 1 pada kolom jenis jaminan kesehatan yang dimiliki
11 : Diisi dengan nomor BPJS bagi yang memiliki
Jika memiliki kartu BPJS tetapi sudah tidak aktif, nomornya dicatat dan dilingkari
12 : NIK : Lihat KK atau KTP
13 : berlaku untuk anggota keluarga pra sekolah (yang belum SD)
Diisi dengan nomor kutipan akte kelairan
Jika anggota keluarga memiliki akte kalahiran tapi tidak ditemukan
(nomor kutipannya tidak diketaui), diberi tanda rumput/contreng
Huruf A & B : Berlaku untuk Rumah/kos-kosan
A : Apakah terdapat SPAL sehat? 1. Ya 2. Tidak
B : Apakah terdapat jentik di sekitar rumah? 1. Ya 2. Tidak
Huruf C-M : Berlaku untuk KK
C : Apakah keluarga melakukan kegiatan pemberantasan jentik nyamuk minimal seminggu sekali?
(3M)
1. Ya 2. Tidak
D : Barlaku untuk keluarga yang memiliki bayi (anak usia 0-11 bulan 29 hari)
Apakah saat ibu melahirkan bayi……….. Ditolong di fasilitas pelayanan kesehatan?
1. Ya 2. Tidak
E : Berlaku untuk keluarga yang memiliki anak usia 7-23 bulan
Apakah bayi ini pada usia 0-6 bulan hanya diberi ASI saja tanpa makanan dan/atau minuman
lain?
1. Ya 2. Tidak
F : Berlaku untuk anggota keluarga berumur 2-59 bulan
Apakah dalam 1 bulan terakhir semua anak ibu (2-59 bulan) dibawa ke posyandu?
1. Ya 2. Tidak
G : Apakah anggota keluarga biasa menggunakan air bersih untuk keperluan sehari-hari?
1. Ya 2. Tidak
H :
Apakah seluruh anggota keluarga biasa cuci tangan pakai sabun (pada waktu mau makan dan
sehabis makan, setelah buang air, menceboki anak, memberi makan anak, menyusui, dll).

1. Ya 2. Tidak
I : Apakah seluruh anggota keluarga biasa buang air besar di jamban sehat?
1. Ya 2. Tidak
J : Apakah seluruh anggota keluarga (usia di atas 1 tahun) makan sayur/buah setiap hari?
1. Ya 2. Tidak
K : Apakh seluruh anggota keluarga (usia 15 tahun ke atas) melakukan aktifitas fisik / olah raga
secara teratur (minimal 30 menit setiap hari dan minimal 5 hari dalam seminggu/150 menit
setiap minggu)
1. Ya 2. Tidak
L : Apakah ada anggota keluarga yang merokok?
1. Ya 2. Tidak
M : Apakah ada anggota keluarga yang melakukan pengobatan tradisional (ramuan, pijit, dll)
1. Ya 2. Tidak
N&O : Nomor urut PIS-PK
N : Diisi dengan nomor urut rumah yang didata (sesuai dengan yang tertera pada kuisioner PIS-
PK)
O : Diisi dengan nomor urut KK yang diwawancarai (sesuai dengan yang tertera pada kuisioner
PIS-PK)
 DAFTAR NAMA PENDUDUK DAN DATA KESEHATAN KECAMATAN MABA
WILAYAH KERJA PUSKESMAS PERAWATAN BULI
TAHUN 2018

DESA : RT: 001

JAMINAN

STATUS P/I/A/T

LINAKES (BAYI)

CUCITANGAN
AE (7-23 BLN)

SAYURBUAH
NO JK KESEHAT NO PIS-

AIRBERSIH
TANGGAL

AKTIFISIK
AN PK

TIMBANG
NAMA NOMOR BPJS / KIS NIK NOMOR AKTE KELAHIRAN

JAMBAN
LAHIR

ROKOK
JENTIK

BATRA
BPJS
JIWA
RMH

RMH
LAIN

SPAL
JKD
L P
KK

KK
3M
1 2 3 4 5 6 7 8 9 10 11 12 13 14 RMH C D E F G H I J K L M N O
1
RMH

NO

2
KK

3
NAMA

STATUS P/I/A/T
5
LAHIR
TANGGAL

L P

BPJS
AN

JKD
JAMINAN

6 7 8 9 10
JK KESEHAT

LAIN
11
NOMOR BPJS / KIS

12
NIK

13
AKTE KELAHIRAN

SPAL
JENTIK
3M
LINAKES (BAYI)
AE (7-23 BLN)
TIMBANG
AIRBERSIH
CUCITANGAN
RMH C D E F G H I

JAMBAN
SAYURBUAH
AKTIFISIK
ROKOK
J K L M

BATRA
RMH
N
PK

KK
NO PIS-
 DAFTAR NAMA PENDUDUK DAN DATA KESEHATAN KECAMATAN MABA
WILAYAH KERJA PUSKESMAS PERAWATAN BULI
TAHUN 2018

DESA : RT: 02
JAMINAN

LINAKES (BAYI)
STATUS P/I/A/T

CUCITANGAN
AE (7-23 BLN)

SAYURBUAH
NO JK KESEHAT NO PIS-

AIRBERSIH
TANGGAL

AKTIFISIK
AN PK

TIMBANG
NAMA NOMOR BPJS / KIS NIK AKTE KELAHIRAN

JAMBAN
LAHIR

ROKOK
JENTIK

BATRA
BPJS
RMH

RMH
LAIN

SPAL
JKD
L P
KK

KK
3M
1 2 3 4 5 6 7 8 9 10 11 12 13 RMH C D E F G H I J K L M N O
1
RMH

NO

2
KK

3
NAMA

STATUS P/I/A/T
5
LAHIR
TANGGAL

L P

BPJS
AN

JKD
JAMINAN

6 7 8 9 10
JK KESEHAT

LAIN
11
NOMOR BPJS / KIS

12
NIK

13
AKTE KELAHIRAN

SPAL
JENTIK
3M
LINAKES (BAYI)
AE (7-23 BLN)
TIMBANG
AIRBERSIH
CUCITANGAN
RMH C D E F G H I

JAMBAN
SAYURBUAH
AKTIFISIK
ROKOK
J K L M

BATRA
RMH
N
PK

KK
NO PIS-
 
J U M LAH ############ 0
 DAFTAR NAMA PENDUDUK DAN DATA KESEHATAN KECAMATAN MABA
WILAYAH KERJA PUSKESMAS PERAWATAN BULI
TAHUN 2018

DESA : BULI RT: 01 ENUMERATOR :

JAMINAN

STATUS P/I/A/T

LINAKES (BAYI)

CUCITANGAN
AE (7-23 BLN)

SAYURBUAH
NO JK KESEHAT NO PIS-

AIRBERSIH
TANGGAL

AKTIFISIK
AN PK

TIMBANG
NAMA NOMOR BPJS / KIS NIK NOMOR AKTE KELAHIRAN

JAMBAN
LAHIR

ROKOK
JENTIK

BATRA
BPJS
RMH

RMH
LAIN

SPAL
JKD
L P
KK

KK
3M
1 2 3 4 5 6 7 8 9 10 11 12 13 RMH C D E F G H I J K L M N O
1 SHARLES RIDUA P 19-09-1968 1 0
DENS MINA INTO PINOA I 19-12-1997 0 1
DELFELA RIDUA A 23-03-2005 1 0
APRILIA RIDUA A 12/4/2007 0 1
2 AGUSTA BOWAY 12/8/1949 0 1
3 KRISTOVEL SARDIN P 18-04-1994 P 0
RICO WUISAN I 13-11-1987 1 0
MARIAMCE SARDIN A 25-05-1988 0 1
PRAYSEL WUISAN A 20-10-2010 0 1
4 ABRAHAM OGI P 25-03-1975 1 0
NELSON OGI A 24-08-1998 1 0
ULIANTI OGI A 13-09-2008 0 1
5 BERNAT PEKAULANG P 10/10/1958 1 0
MELSINA RADJA I 2/5/1964 0 1
JOHAIN PEKAULANG A 20-10-1993 1 0
BERTI PEKAULANG A 2/9/1996 1 0
6 BERI PEKAULANG P 4/2/1999 1 0
MELAN KAPUGU I 8/18/1996 0 1
FLAREN H PEKAULANG A 23-02-2012 1` 0
7 ISAK MATAHAYA P 7/4/1952 1 0
MARTINA BADAULU I 11/5/1970 0 1
REINEL MATAHAYA A 1/9/2000 1 0
8 YORDAN MATAHAYA P 24-08-1995 1 0
FINCE DEPORON I 3/11/1997 0 1
KADELA MATAHAYA A 17-07-2015 0 1
 JAMINAN

STATUS P/I/A/T

LINAKES (BAYI)

CUCITANGAN
AE (7-23 BLN)

SAYURBUAH
NO JK KESEHAT NO PIS-

AIRBERSIH
TANGGAL

AKTIFISIK
AN PK

TIMBANG
NAMA NOMOR BPJS / KIS NIK AKTE KELAHIRAN

JAMBAN
LAHIR

ROKOK
JENTIK

BATRA
BPJS
RMH

RMH
LAIN

SPAL
JKD
L P
KK

KK
3M
1 2 3 4 5 6 7 8 9 10 11 12 13 RMH C D E F G H I J K L M N O
9 SELSON MATAHAYA P 18-08-1980 1 0
TECI MATAHAYA I 26-09-1973 0 1
WELCEN MATAHAYA A 16-04-2011 1 0
10 YUNI IDJA P 12/12/1992 1 0
ONA MATAHAYA I 24-04-1994 0 1
RENDI MATAHAYA A 21-03-2010 1 0
KRIS GEFIN IJA A 10/9/2012 1 0
11 OTNIEL BOLI P 10/10/1947 1 0
RATULINA MATAHAYA I 6/6/1950 0 1
12 AGUSTINUS BOLI P 15-08-1984 1 0
DELY DAOLY I 6/6/1988 0 1
NONA BOLI A 7/7/2008 0 1
JERECI BOLI A 25-01-2014 0 1
13 SELFIS HURUGAMO P 4/9/1996 1 0
MIMI ANTAHAR I 2/3/1997 1 0
14 YUSTUS MASSA P 7/8/1984 1 0
TECI BOLI I 6/8/1992 0 1
ELFAN MASSA A 8/4/2008 1 0
15 YETTY BOLI I 27-07-1981 0 1
RIDOLIN ANTAHARI A 2/8/2000 0 1
ANASYA ANTAHARI A 2/8/2008 0 1
SEREN ANTAHARI A 6/9/2009 0 1
YENI ANTAHARI A 15-07-2015 0 1
16 MUSTAMIN P 4/4/1984 1 0
 SYARIANI I 19-12-1992 0 1
M.AIRLANGGA RAMADAN A 25-08-2009 1 0
NADIA A 1/2/2011 0 1
17 GARADUS LAWARI P 9/7/1944 1 0
KALARA BOLO-BOLO I 1/8/1951 0 1
YUSTUS LAWARI A 7/8/1996 1 0
 JAMINAN

LINAKES (BAYI)
STATUS P/I/A/T

CUCITANGAN
AE (7-23 BLN)

SAYURBUAH
NO JK KESEHAT NO PIS-

AIRBERSIH
TANGGAL PK

AKTIFISIK
AN

TIMBANG
NAMA NOMOR BPJS / KIS NIK AKTE KELAHIRAN

JAMBAN
LAHIR

ROKOK
JENTIK

BATRA
BPJS
RMH

RMH
LAIN

SPAL
JKD
L P
KK

KK
3M
1 2 3 4 5 6 7 8 9 10 11 12 13 RMH C D E F G H I J K L M N O
18 YODI IDJA P 5/1/1983 1 0
FIDNA PUREN I 26-11-1986 0 1
TEGU WALES IJA A 25-07-2015 1 0
JULIO IDJA PUREN A 10/7/2016 1 0
19 BERTALIUS PEKAULANG P 23-08-1960 1 0
DEBORA HULUM I 28-01-1964 0 1
20 FIKO PUNI P 1/11/1989 1 0
MARIA PEKAULANG I 21-08-1991 0 1
ASYERA.F.PUNI A 29-05-2015 0 1
21 BENJIE AUTO 17-05-1978 1 0
FRANS LANTEMONA 5/7/1980 1 0
22 MOHEN MATAHAYA P 9/12/1984 1 0
LISTA HULUM I 24-08-1987 0 1
REMUS MATAHAYA A 7/7/2007 1 0
MARLEN MATAHAYA A 23-03-2010 0 1
DORLINCE MATAHAYA A 4/4/2014 0 1
23 REGINALD HANTJA P 18-09-1978 1 0
ERNA MATAHAYA I 25-05-1984 0 1
KRISTIANTI HANTJA A 21-09-2002 1 0
VANDI HANTJA A 14-09-2004 1 0
GREIS HANJTA A 1/8/2008 0 1
RENI MATAHAYA 26-04-1996 0 1
24 MARKUS LIHARD TUNANG P 3/8/1970 1 0
SELFINA SARIN I 1/9/1970 0 1
 BOBI TUNANG A 17-05-1997 1 0
OKTOVIANUS TUNANG A 16-10-2004 1 0
25 URBANUS BANAKONO 14-10-1981 1 0
RIANSI TRESIA TUNANG 7/29/1989 0 1
 JAMINAN

STATUS P/I/A/T

LINAKES (BAYI)

CUCITANGAN
AE (7-23 BLN)
NO JK KESEHAT

SAYURBUAH
NO PIS-

AIRBERSIH
TANGGAL AN

AKTIFISIK
NAMA NOMOR BPJS / KIS NIK AKTE KELAHIRAN PK

TIMBANG

JAMBAN
LAHIR

ROKOK
JENTIK

BATRA
BPJS
RMH

RMH
LAIN

SPAL
JKD
L P
KK

KK
3M
1 2 3 4 5 6 7 8 9 10 11 12 13 RMH C D E F G H I J K L M N O
26 KRIS YANTO BOLI P 5/5/1977 1 0
LOINA MANINGO I 17-11-1979 0 1
EVIANTI BOLI A 20-03-1996 1 0
DEVIN BOLI A 28-9-2002 1 0
GERAT BOLI A 7/11/2012 1 0
27 ARWAN PEKAULANG P 16-05-1989 1 0
HEIDI NIARADARAH I 7/4/1991 0 1
28 RISKO PEKAULANG P 6/6/1982 1 0
AGUSTINA BANOHI I 20-07-1988 0 1
FEBI PEKAULANG A 16-06-2007 0 1
SELWANUS PEKAULANG A 21-05-2013 1 0
KRISTIN PEKAULANG A 13-03-2015 0 1
29 ORMIANUS MATAHAYA P 10/10/1979 1 0
HERMIYANTI HAYON I 23-08-1985 0 1
KARLINA MATAHAYA A 2/9/2004 0 1
KARTISA MATAHAYA A 16-01-2008 0 1
30 PARTO MATAHAYA P 15-02-1982 1 0
VELMINA PEKAULANG I 19-05-1984 0 1
WIRNA MATAHAYA A 22-03-2002 0 1
DERWI MATAHAYA A 18-01-2004 0 1
31 SEFNAT DODOPO P 14-09-1988 1 0
ODANIA MATAHAYA I 24-08-1994 0 1
ANGLES DODOPO A 15-08-2011 0 1
 LEVI DODOPO A 30-10-2013 1 0
32 DOMIS BOLI P 6/6/1988 1 0
WERDINA Y TOKAN I 5/5/1993 0 1
33 DARWIS ABADRUM P 7/10/1986 1 0
WANI KATE-KATE I 10/1/1987 0 1
RIDHO AB A 8/28/2009 1 0
PUTRI KHAI BADRUM A 28-8-2016 0 1
 JAMINAN

LINAKES (BAYI)
STATUS P/I/A/T

CUCITANGAN
AE (7-23 BLN)

SAYURBUAH
NO JK KESEHAT NO PIS-

AIRBERSIH
TANGGAL

AKTIFISIK
AN PK

TIMBANG
NAMA NOMOR BPJS / KIS NIK AKTE KELAHIRAN

JAMBAN
LAHIR

ROKOK
JENTIK

BATRA
BPJS
RMH

RMH
LAIN

SPAL
JKD
L P
KK

KK
3M
1 2 3 4 5 6 7 8 9 10 11 12 13 RMH C D E F G H I J K L M N O
34 YOSAFAT KOMAI I 8/3/1961 1 0
MARIANCE MAWEKES I 5/11/1975 0 1
FESTUS KUMAI A 9/30/1996 1 0
MOVENDI KUMAI A 11/11/2001 1 0
MAYA RATNA KUMAI A 6/16/2013 0 1
35 PILET BAWEKES P 1/8/1951 1 0
36 YOSIS TJINTA P 7/22/1961 1 0
MONIKA SAURE I 3/3/1966 0 1
AKNES TJINTA A 4/26/1989 0 1
AKTER TJINTA A 26-04-19898 1 0
MARTO TJINTA A 3/24/2000 1 0
37 PERMENAS SAHARIA P 3/23/1959 1 0
ABETSINA PANGALILA I 7/27/1957 0 1
YULCE SAHARIA A 2/10/2014 0 1
KARMI RANTI SAHARIA A 6/13/2014 1 0
38 OZIS SADANG P 10/14/1985 1 0
SUSANA SAHARIA I 5/1/1984 0 1
CHELSIA SADANG A 1/8/2008 0 1
ADITIA SADANG A 1/17/2010 1 0
39 ARTO M BARBAKEM P 3/23/1976 1 0
MARTA WONGE I 6/5/1978 0 1
DENI RIVALDI BARBAKEM A 6/21/1998 1 0
MARLYA R BARBAKEM A ,1-01-2005 0 1
KRISTIAN BARBAKEM A 10/10/2012 1 0
40 OKTOSEA BARBAKEM P 10/1/1948 1 0
FENA BARBAKEM A ,4-04-1992 0 1
DENAN BARBAKEM A 9/10/1988 1 0
MARFEL BARBAKEM A 11/17/2008 1 0
ALINDA BARBAKEM A 4/29/2016 0 1
 JAMINAN

LINAKES (BAYI)
STATUS P/I/A/T
NO JK KESEHAT

CUCITANGAN
AE (7-23 BLN)
NO PIS-

SAYURBUAH
TANGGAL

AIRBERSIH
NAMA AN NOMOR BPJS / KIS NIK AKTE KELAHIRAN PK

AKTIFISIK
TIMBANG
LAHIR

JAMBAN

ROKOK
JENTIK

BATRA
BPJS
RMH

RMH
LAIN
JKD

SPAL
L P
KK

KK
3M
1 2 3 4 5 6 7 8 9 10 11 12 13 RMH C D E F G H I J K L M N O
41 YOSEPUS TADJIRI P 9/28/1993 1 0
FERTIANA BARBAKEM I 1/28/1980 0 1
NOFE TADJIRI A ,8-11-2013 1 0
42 BILDAT BARBAKEM P 2/16/1985 1 0
ELISABET A 0 1
43 ANWAR SAHITUA 5/28/1970 1 0
ITSAN TIDORE 1 0
44 ABDUL ASIS BUGIS P 10/12/1978 1 0
SARNA UMAR I 6/1/1980 0 1
NAIRA.A.BUGIS A 10/20/2010 0 1
AMIRA.A.BUGIS A 3/21/2013 0 1
45 IDRIS P 5/4/1968 1 0
ROSNAWATI I 12/6/1973 0 1
MUHAMAD RUSDI A 7/5/1993 1 0
MEGA LESTARI A 7/5/1996 0 1
RISKI EVENDI A 4/4/2000 1 0
BUDI SANTO A 5/15/2003 1 0
RISNA IDIYANTI A 4/15/2007 0 1
46 LEDY BOLI 3/2/2003 0 1
JEKSEN BOLI 1-06--2007 1 0
47 SUPRIYANTO P 8/18/1976 1 0
NAMIK SUPARDI I 4/19/1976 0 1
NAUFA.E.MERARDI A 6/26/2009 1 0
48 YETMI BANOHI 7/24/1996 0 1
DANDI KABAREIS 1 0
49 HERI YANTO P 8/28/1967 1 0
ENDA RATNAWATI I 10/9/1995 0 1
ANALIA DESI SAPUTRI A 1/14/1995 0 1
ARIF.M.DESI SAPUTRA A 8/25/2002 1 0


 
JAMINAN

LINAKES (BAYI)
STATUS P/I/A/T

CUCITANGAN
AE (7-23 BLN)
NO JK KESEHAT

SAYURBUAH
TANGGAL NO PIS-

AIRBERSIH
NAMA AN NOMOR BPJS / KIS NIK AKTE KELAHIRAN PK

AKTIFISIK
TIMBANG
LAHIR

JAMBAN

ROKOK
JENTIK

BATRA
BPJS
RMH

RMH
LAIN

SPAL
JKD
L P
KK

KK
3M
1 2 3 4 5 6 7 8 9 10 11 12 13 RMH C D E F G H I J K L M N O
50 SAEBASTIANG M SALEH P 1/14/1975 1 0
SITI HAJAR I 11-10--1981 0 1
ANANDI PRATIWI A 5/25/2005 1 0
FADHIL A 4/10/2009 1 0
MUHAMAD DAFA A 11/11/2013 1 0
51 HI DJAHADIN P 12/12/1954 1 0
HJ SITI I ,01-07-1963 0 1
ANJANI A 3/1/1999 0 1
52 MUHAMAD P 5/29/1977 1 0
MASNA ABDULLAH I 8/5/1980 0 1
ALAN DUTIA MUHAMAD A 10/22/2008 1 0
NURUL JAHIANI A 1/20/2011 0 1
53 MUSTAFA MUHAMAD P 3/20/1970 1 0
NADIRA SIRI I 6/15/1973 0 1
RISKI MUSTAFA A 10/8/1998 1 0
RISDA MUSTAFA A 7/31/2002 0 1
KAMARIA MUSTAFA A 20-30-2005 0 1
J U M LAH ############ 0