DATA SASARAN IBU HAMIL 2018

Provinsi : Jawa Timur

Kabupaten/Kota : Situbondo
Puskesmas : Mangaran

BB (Kg)
NIK (Nomor Induk
BB
NAMA Kependudukan) ALAMAT TANGGAL Tanggal
No NO KK NAMA IBU Nama Suami NIK Suami Telp Suami sebelum RT RW
POSYANDU atau hamil Lengkap LAHIR pengukuran
NO. KTP sebelum
sekarang
hamil

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (4) (15) (16)

1 Kutilang 1 3512092405180004 3512094612980001 Eva Puspitasari A.Jaini 3512090107920147 085212553316 58 Trebungan Selatan 2 3 26/12/1998 31/05/2018 58 68

2 Kutilang 1 3512091606080044 3512094401930001 Siti Maryam Sopan Efendi 085335366614 44 Trebungan Selatan 3 2 04/01/1993 12/02/2018 44 55

3 Kutilang 2 3512091305120002 3512094401760001 Suniatin Sunoto 3512090106710002 082337013815 60 Trebungan Selatan 2 2 04/01/1976 4-8-2018 58 63

4 Kutilang 2 3512114303980003 Rini Widiastutik Edi 3512092503990001 085330230700 36 Trebungan Selatan 2 2 03/03/1998 04/08/2016 36 42

5 Karang Malang 3512091704120001 3512096202950004 Solehati Hafid 351209011800003 085339464645 65 Karang Malang 1 1 22/02/1995 07/04/2018 65 71

6 Karang Malang 3512091606080096 3512096105930001 Siti Naimah Ali Kasim 3512090105910002 72 Karang Malang 1 1 21/05/1993 21/06/2018 72 80

7 Karang Malang 3512091606080085 3512094407980001 Nadiyatul Afifah Salman Alfarisi 081553470703 50 Karang Malang 1 1 04/07/1998 09/08/2018 50 52

8 Karang Malang 3512090810100001 3512095604920002 Italiya Hariyanto 3512091209850001 085330777319 65 Karang Malang 1 1 16/04/1992 23/02/2018 65 75
9 Karang Malang 3512091606080128 3512095511870002 Mayulis Saiful 3512092511870002 082385584290 44 Karang Malang 1 1 15/11/1987 02/08/2018 44 55

10 Cendrawasih 1 3512092506120005 3512084409900003 Siti Masruroh Tolak Riyanto 3512092211870001 082323423249 60 Trebungan Barat 2 6 04/09/1990 26/12/2017 60 73

11 Cendrawasih 1 3512090611051225 3512095007950001 Yulianingsih Farid 351202007790003 085257022511 44 Trebungan Barat 2 6 10/07/1995 29/07/2018 44 48

12 Cendrawasih 2 3512091101180002 1960121219890320003 Riskiyah Kurnianto 3512099405910003 085336111913 53 Trebungan Barat 2 5 11/01/2018 12/04/2018 53 57

13 Cendrawasih 2 Vita Laraswati Anton B. 3512092010940003 082338860712 52 Trebungan Barat 1 5 03/05/2018 52 61

14 Cendrawasih 2 3512090611050740 3512094803950001 Siti Fatimah Putut Waskito 3512092002850002 085204867266 64 Trebungan Barat 1 5 18/03/1995 09/05/2018 64 70

15 Merpati 3512091101180003 3512095611970001 Siti Arifah Ismail Badri 3512070905970000 085236581847 41.5 Trebungan Krajan 3 4 16/11/1997 12/03/2018 41.5 51

16 Merpati 3512090711050097 3512096007870001 Isaniya Samiudin 3512091403780001 082334204449 63 Trebungan Krajan 2 4 20/07/1987 03/04/2018 63 75

17 Merpati 3512090711051027 3512094711770001 Novi Suwarda Samsul 3512091707750002 085330199068 57 Trebungan Krajan 2 3 07/11/1977 10/06/2018 57 65

18 Merpati 3512092812070027 3512094508930001 Ayu Wilastri Andika Eko 082301706339 50 Trebungan Krajan 1 4 05/08/1993 09/07/2018 50 52

19 Merpati 3507171106130008 3512074505870006 Ira Irmawanti Yofan Arin 3507171506860004 081334290118 63 Trebungan Krajan 1 4 05/05/1987 23/06/2018 63 72
 TTD
(Tablet
PMT
Jika YA, brp
TB LILA Tambah
(Cm) (cm)
Kehamilan ke
darah)
butir TTD KETERANGAN
didapat Pemberan Sumber tgl pemberian
1=YA,
2=Tidak Ke PMT

(17) (18) (19) (20) (21) (22) (23) (24) (25)

143 28 1 1 60

141 24 2 1 90

150 27 3 1 40

156 21.5 1 1 90 1 8/4/2016

152 25 2 1 60

154 32 2 1 70

145.5 27.3 1 1 30

156 28 2 1 90
147 26.5 2 1 90

148 28 2 1 90

147 24 1 1 30

159 25 1 1 60

148.6 25.5 1 1 60

156.5 27.3 1 1 60

137.5 24.5 1 1 70

149 30 1 1 80

154.5 26.5 3 1 90

156 24.5 1 1 20

162 25 5 1 50
 DATA SASARAN IBU HAMIL 2018

Provinsi : Jawa Timur

Kabupaten/Kota : Situbondo
Puskesmas : Mangaran

BB (Kg)
NIK (Nomor Induk
BB
NAMA Kependudukan) ALAMAT TANGGAL Tanggal
No NO KK NAMA IBU Nama Suami NIK Suami Telp Suami sebelum RT RW
POSYANDU atau hamil Lengkap LAHIR pengukuran
NO. KTP sebelum
sekarang
hamil

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (4) (15) (16)

1 Kutilang 1 3512092405180004 3512094612980001 Eva Puspitasari A.Jaini 3512090107920147 085212553316 58 Trebungan Selatan 2 3 26/12/1998 31/05/2018 58 68

2 Kutilang 2 3512091305120002 3512094401760001 Suniatin Sunoto 3512090106710002 082337013815 60 Trebungan Selatan 2 2 04/01/1976 4-8-2018 58 63

3 Kutilang 2 3512090611050268 3512094911980001 Novita Sari Mawardi 3512100107960099 081358108019 71 Trebungan Selatan 2 2 09/11/1998 25/09/2018 71 69

4 Karang Malang 3512091704120001 3512096202950004 Solehati Hafid 351209011800003 085339464645 65 Karang Malang 1 1 22/02/1995 07/04/2018 65

5 Karang Malang 3512091606080096 3512096105930001 Siti Naimah Ali Kasim 3512090105910002 72 Karang Malang 1 1 21/05/1993 21/06/2018 72

6 Karang Malang 3512091606080085 3512094407980001 Nadiyatul Afifah Salman Alfarisi 081553470703 50 Karang Malang 1 1 04/07/1998 09/08/2018 50

7 Cendrawasih 1 3512090611051225 3512095007950001 Yulianingsih Farid 351202007790003 085257022511 44 Trebungan Barat 2 6 10/07/1995 29/07/2018 44

8 Cendrawasih 2 3512091101180002 1960121219890320003 Riskiyah Kurnianto 3512099405910003 085336111913 53 Trebungan Barat 2 5 11/01/2018 12/04/2018 53 57
9 Cendrawasih 2 Vita Laraswati Anton B. 3512092010940003 082338860712 52 Trebungan Barat 1 5 03/05/2018 52

10 Cendrawasih 2 3512090611050740 3512094803950001 Siti Fatimah Putut Waskito 3512092002850002 085204867266 64 Trebungan Barat 1 5 18/03/1995 09/05/2018 64

11 Cendrawasih 2 3512090611050864 3512096110000001 Rusmini Siswono Aji 3512090308960001 082232819662 65 Trebungan Barat 2 5 21/10/2000 06/09/2018 65

12 Merpati 3512091101180003 3512095611970001 Siti Arifah Ismail Badri 3512070905970000 085236581847 41.5 Trebungan Krajan 3 4 16/11/1997 12/03/2018 41.5

13 Merpati 3512090711050097 3512096007870001 Isaniya Samiudin 3512091403780001 082334204449 63 Trebungan Krajan 2 4 20/07/1987 03/04/2018 63

14 Merpati 3512090711051027 3512094711770001 Novi Suwarda Samsul 3512091707750002 085330199068 57 Trebungan Krajan 2 3 07/11/1977 10/06/2018 57

15 Merpati 3512092812070027 3512094508930001 Ayu Wilastri Andika Eko 082301706339 50 Trebungan Krajan 1 4 05/08/1993 09/07/2018 50

16 Merpati 3507171106130008 3512074505870006 Ira Irmawanti Yofan Arin 3507171506860004 081334290118 63 Trebungan Krajan 1 4 05/05/1987 23/06/2018 63 72

17 Merpati 3512144906980001 Novia Zainul Arifin 3512092506910001 082232123986 51 Trebungan Krajan 1 4 09/06/1998 05/09/2018 51

18 Merpati 3512093001180007 3512086709850001 Devi Nilam Buyamin 082331010314 51 Trebungan Krajan 2 3 27/09/1985 17/08/2018 51 48
 TTD
(Tablet
PMT
Jika YA, brp
TB LILA Tambah
(Cm) (cm)
Kehamilan ke
darah)
butir TTD KETERANGAN
didapat Pemberan Sumber tgl pemberian
1=YA,
2=Tidak Ke PMT

(17) (18) (19) (20) (21) (22) (23) (24) (25)

143 28 1 1 40

150 27 3 1 30

151 29 1 1 10

152 25 2 1 40

154 32 2 1 40

145.5 27.3 1 1 30

147 24 1 1 30

159 25 1 1 60
148.6 25.5 1 1 60

156.5 27.3 1 1 60

158.5 29 1 1 10

137.5 24.5 1 1 70

149 30 1 1 80

154.5 26.5 3 1 90

156 24.5 1 1 20

162 25 5 1 50

151 26 1 1 20

150 29 3 1 20
 TTD
BB (Kg)
(Tablet
PMT
Jika YA, brp
TANGGAL Tanggal Kehamilan Tambah
TB (Cm) LILA (cm) butir TTD
LAHIR pengukuran ke darah)
didapat Pemberan Sumber tgl
sebelum hamil sekarang 1=YA,
2=Tidak Ke PMT pemberian

(13) (4) (15) (16) (17) (18) (19) (20) (21) (22) (23) (24)
7/1/1997 61 67 158 31 I 1 100
1/7/1984 2-Aug-2018 74 74 158 32.5 III 1 20
3/6/1994 19-Mar-2018 42 48 152 27 II 1 70
30-Mar-2018 80.5 86 152 34 I 1 120
15/10/1997 4-Jun-2018 48 54 140 27 I 1 40
27/04/1997 16-Jun-2018 56 60 158 26 I 1 50
1/7/1985 7-Apr-2018 73 84 150.5 33 II 1 90
28-11-1990 20-06-2018 67 71 155 31 III 1 30
3/10/1993 21-08-2018 70 78 160 31.5 II 1 30
5/7/1995 7/2/2018 70 75 160 32.2 II 1 90
3/18/1987 7/17/2018 46 50 150 24 III 1 90
6/15/2000 3/16/2018 49 58 159 26 II 1 100
10/12/1992 4/24/2018 49 57 152 28 II 1 90
 TTD
BB (Kg)
(Tablet
PMT
Jika YA, brp
TANGGAL Tanggal Kehamilan Tambah
TB (Cm) LILA (cm) butir TTD
LAHIR pengukuran ke darah)
didapat Pemberan Sumber tgl
sebelum hamil sekarang 1=YA,
2=Tidak Ke PMT pemberian

(13) (4) (15) (16) (17) (18) (19) (20) (21) (22) (23) (24)
158 31 I 1 100
7/1/84 2-Aug-2018 14-Mar-1900 74 158 32.5 III 1 20
16-05-1997 18-Sep-2018 21-Feb-1900 53 157 28 I 1 20
4-Sep-2018 5-Feb-1900 37 146.8 20.5 I 1 10
3/6/94 19-Mar-2018 10-Feb-1900 152 27 II 1 70
30-Mar-2018 20-Mar-1900 152 34 I 1 120
15/10/1997 4-Jun-2018 16-Feb-1900 140 27 I 1 40
27/04/1997 16-Jun-2018 24-Feb-1900 158 26 I 1 50
1/7/1985 7-Apr-2018 13-Mar-1900 84 150.5 33 II 1 90
28-11-1990 20-06-2018 3/7/1900 155 31 III 1 30
3/10/1993 21-08-2018 70 78 160 31.5 II 1 30
8/3/1998 25-6-2018 47 155 24.5 I 1 40
16-4-2018 79 90 152 34 I 1 70
5/7/1995 7/2/2018 70 75 160 32.2 II 1 90
3/18/1987 7/17/2018 46 50 150 24 III 1 90
2/5/1996 9/24/2018 63 66 160 29 II 1 30
7/14/1996 9/29/2018 50 52.5 153 26 II 1 30
6/15/2000 3/16/2018 49 58 159 26 II 1 100
10/12/1992 4/24/2018 49 57 152 28 II 1 90