Provinsi : Kepri Nama Posyandu

Kabupaten/Kota : Lingga Bulan

Puskesmas/Kecamatan : Lanjut Tahun
Desa/Kelurahan : Pelakak

NIK (Nomor Induk

No No Kartu Keluarga Anak Ke Nama anak Tanggal Lahir
Kependudukan)

(1) (2) (3) (4) (5) (6)

1 21040 11903120005 21040 64504150003 2 DHEA APROLIA 4/5/2015
2 21040 60212150001 21040 064805140001 2 FADILA 5/8/2014
3 21040 11202080006 21040 062001160001 2 M.NURDIN 1/20/2016
4 21041 1172070063 21040 64709160001 2 KLARA.RW 9/7/2016
5 21040 12310120007 21040 63108130001 1 M.RAIHAN.T 8/31/2013
6 21041 2310120007 21040 66008170001 2 ASSYFA.H 8/20/2017
7 21040 33005180001 21040 35612170001 1 MIA SAKILA 12/16/2017
8 21040 62402140001 21040 65508140001 1 GRACIA ANGEL.H 8/15/2014
9 21040 62008180001 21040 61211150001 1 M.NOVANDI 11/12/2015
10 21040 11612070094 21040 67011150001 2 JIHAN MULIANA 11/30/2015
11 21040 10304120002 21040 65008150001 3 AURA WULAN.S 8/10/2015
12 21040 11008110001 21040 66512130001 1 LUVIA AULIA 12/25/2013
13 21040 11008110001 21040 61701160001 2 M.ARSYA.J 1/17/2016
14 21040 60301180001 21040 066306170001 1 EKA SAKILA 6/28/2017
15 21040 11612110004 21040 65601170001 2 KEISHA.Q 1/16/2017
 FORMULIR PEMANTAUAN PERTUMBUHAN BALITA DI POSYANDU

: Jasmine
: Agustus
: 2018

Berat
Jenis Nama Ortu
Badan NIK Ayah No Tlp/ HP Ortu Alamat RT
Kelamin (Ayah)
(BB) Lahir

(7) (8) (9) (10) (11) (12) (13)

P 4.1 JUNAIDI 21040 51605860001 08127 5654477 PELAKAK 1
P 3.8 ANDIK.S 14720 22606810043 08126 6754406 PELAKAK 2
L 3.2 ISKANDAR 21040 1012800001 08228 8170139 PELAKAK 2
P 3.1 HAIDIWAN 21040 1141080001 08238 2697834 PELAKAK 2
L 3.2 AMIR 21041 2502870002 08238 9004565 PELAKAK 1
P 3.3 AMIR 21042 2502870002 8239 9004565 PELAKAK 1
P 3.5 TOPIK 21043 2103900001 08137 4199728 PELAKAK 2
P 3.1 HERMAN 21041 221920001 08126 7818236 PELAKAK 2
L 2.7 JOHARI 21040 10607940001 08228 8300992 PELAKAK 1
P 2.4 MUSLIM 21040 10807820001 08228 5399955 PELAKAK 1
P 3.8 MUHLIZAR 21040 13112850001 08137 8700848 PELAKAK 1
P 2 ALIE 21040 54710840003 08126 8230002 PELAKAK 1
L 3.8 ALIE 21041 54710840003 81276 8230002 PELAKAK 1
P 2.3 D.SURIANTO 21040 41605910002 08228 7587087 PELAKAK 1
P 1.7 MULYA 21040 117022870002 08127 1934309 PELAKAK 1
 Panjang Cara Ukur ASI Vitamin A Vitamin A Kepemilik
Badan/
Tgl 1=Telenta EksklusifF IMD Februari Agustus an Buku
RW BB (kg) Tinggi 1=YA,
Pengukuran ng 1=YA, 1=YA 1=YA
Badan 2=Berdiri 2=Tidak 2=Tidak KIA
2=Tidak 2=Tidak
(cm)
(14) (15) (16) (17) (18) (19) (20) (21) (22) (23)
2 8/16/2018 15.1 101.6 2 2 2 2 2 V
2 8/16/2018 19.6 105.4 2 2 2 2 2 V
2 8/16/2018 13.2 84.3 2 2 2 2 2 V
2 8/16/2018 10.1 80.5 2 2 2 2 2 V
2 8/16/2018 21 113.5 2 2 2 2 2 V
2 8/16/2018 9.5 75.5 2 2 2 2 2 V
2 8/16/2018 10.4 73 2 2 2 2 1 V
1 8/16/2018 13.7 99.1 2 2 2 2 2 V
2 8/16/2018 11.7 87 2 2 2 2 2 V
2 8/16/2018 11.9 88 2 2 2 2 2 V
2 8/16/2018 12.9 92 2 2 2 2 2 V
1 8/16/2018 13.6 105.2 2 2 2 2 2 V
1 8/16/2018 16 104 2 2 2 2 2 V
2 8/16/2018 9.5 75 2 2 2 2 2 V
2 8/16/2018 8.5 77 2 2 2 2 2 V
 FO

Provinsi : Kepri Nama Posyandu : Nusa Indah

Kabupaten/Kota : Lingga Bulan : Agustus
Puskesmas/Kecamatan : Lanjut Tahun : 2018
Desa/Kelurahan : Persing

NIK (Nomor Induk Nama Jenis

No No Kartu Keluarga Anak Ke Tanggal Lahir Kelamin
Kependudukan) anak

(1) (2) (3) (4) (5) (6) (7)

1 21040 61212130001 21040 66306150001 6/23/2015 P
2 21041 1112070110 21040 67112160001 12/31/2016 P
3 1/8/2015 P
4 21040 12302100002 21040 66412150001 12/24/2015 P
5 21040 11112070031 21040 66811150001 11/23/2015 P
6 21040 21805100001 21040 65810160001 10/13/2016 P
7 21040 12608080005 21040 61111150001 11/11/2015 L
8 21040 60207140002 21040 63026140001 6/30/2014 L
9 10/7/2013 P
10 10/13/2015 L
11 21040 12210100011 21040 64305140001 5/3/2014 P
12 5/22/2014 P
13 21040 61809140001 21040 64110140001 1 5/22/2014 P
14 21040 11112070085 21040 61209160001 2 12/24/2017 L
15 21040 62206150001 21040 64505140001 1 5/5/2014 L
16 21040 10109080001 21040 62804160001 4/24/2015 P
17 6/28/2017 L
18 21040 10703120001 21040 62607170001 7/24/2017 L
19 11/18/2013 L
20 11/18/2013 P
21 11/5/2016 L
22 1/30/2016 P
23 21040 6171014000 21040 64511140001 11/21/2016 P
24 11/21/2016 L
25 21040 62601150001 21040 62111150001 1/7/2014 L
26 10/29/2018 P
27 4/25/2014 P
28 21040 11112070106 21040 62504140002 10/17/2014 L
29 11/13/2015 P
30 11/15/2015 P
31 2/1/2014 L
32 2/1/2014 P
33 8/4/2013 L
34 11/20/2017 L
35 11/27/2017 L
36 10/30/2013 L
37 21040 11509110001 21040 61812170001 12/18/2017 L
38 21040 62912170001 21040 61206180001 6/13/2018 L
 FORMULIR PEMANTAUAN PERTUMBUHAN BALITA DI POSYANDU

: Nusa Indah

Berat No Tlp/
Badan Nama Ortu (Ayah) NIK Ayah Alamat RT RW
HP Ortu
(BB) Lahir

(8) (9) (10) (11) (12) (13) (14)

SUPARMAN 21040 12664830003 PERSING 3 1
CHAIRI 21040 11203670001 PERSING 2 2
SAPUTRA PERSING 2 1
ABD HAFI 21040 10107820054 PERSING 2 2
TARMIZI 21040 10601770001 PERSING 1 1
NIZAN 21040 20411800001 PERSING 1 2
HENDRA 21040 11004820001 PERSING 2 2
SURYADI 21040 63006140001 PERSING 1 2
HARYANTO PERSING
HERMAN PERSING 1 2
EDY PRAMANA 21040 11811910002 PERSING 2 2
NORMAN PERSING 3 1
RAMATONI 21040 10703120001 PERSING 2 1
MISRAN 21040 1070670001 PERSING 3 1
NASIR PERSING 1 1
FIRMAN 21040 12311870003 PERSING 2 2
M.JAURI PERSING 3 2
HENDRA 21040 12311890001 PERSING 2 1
LAI.K PERSING 3 1
GUSNANTO PERSING 3 1
SABRAH PERSING 2 1
ALFISANA PERSING 1 1
SUKRIMA PERSING 1 1
MUGTAR PERSING 2 1
TOMI 12711 21404860004 PERSING 3 1
STEVE 21040 10505940001 PERSING 2 2
SAMSUL PERSING 2 1
SUARDI PERSING 2 2
RAH PERSING 2 2
DAUD PERSING 1 1
PENDI PERSING 1 1
SUJADI PERSING 2 2
 SAMSURI 21040 10107800001 PERSING 2 1
SISWANTO PERSING 3 1
KHALIK PERSING 2 2
BUDIANTO PERSING 2 2
MAIZIR 21040 11803830001 PERSING 2 2
SUDIRMAN 21040 20107870040 PERSING 2 2
 Panjang Cara Ukur ASI Vitamin A Vitamin A Kepemilik
Badan/
Tgl 1=Telenta EksklusifF IMD Februari Agustus an Buku
BB (kg) Tinggi 1=YA,
Pengukuran ng 1=YA, 1=YA 1=YA
Badan 2=Berdiri 2=Tidak 2=Tidak KIA
2=Tidak 2=Tidak
(cm)
(15) (16) (17) (18) (19) (20) (21) (22) (23)
8/4/2018 15.6 100 2 1 1 1 1 V
8/4/2018 1 1 1 1 1 V
8/4/2018 12.5 98.3 2 2 1 1 1 V
8/4/2018 2 1 1 1 1 V
8/4/2018 13.9 96.5 2 2 1 1 1 V
8/4/2018 1 1 1 1 1 V
8/4/2018 11.4 91.5 2 1 1 1 1 V
8/4/2018 2 1 1 1 1 V
8/4/2018 2 1 1 1 1 V
8/4/2018 13.5 91.5 2 1 1 1 1 V
8/4/2018 2 1 1 1 1 V
8/4/2018 16.1 97 2 1 1 1 1 V
8/4/2018 2 1 1 1 1 V
8/4/2018 1 1 1 1 1 V
8/4/2018 13.4 184 1 2 1 1 1 V
8/4/2018 98 104 2 1 1 1 1 V
8/4/2018 2 1 1 1 1 V
8/4/2018 9 77 1 1 1 1 1 V
8/4/2018 1 1 1 1 1 V
8/4/2018 2 1 1 1 1 V
8/4/2018 3.5 72 2 1 1 1 1 V
8/4/2018 1 1 1 1 1 V
8/4/2018 1 1 1 1 1 V
8/4/2018 2 1 1 1 1 V
8/4/2018 14 98.2 2 1 1 1 1 V
8/4/2018 2 1 1 1 1 V
8/4/2018 2 2 1 1 1 V
8/4/2018 19.5 112.6 2 1 1 1 1 V
8/4/2018 1 1 1 1 1 V
8/4/2018 2 1 1 1 1 V
8/4/2018 2 1 1 1 1 V
8/4/2018 2 1 1 1 1 V
8/4/2018 2 1 1 1 1 V
8/4/2018 2 1 1 1 1 V
8/4/2018 106 106 1 2 1 1 1 V
8/4/2018 8 74 1 1 1 1 1 V
8/4/2018 5.4 59 2 1 1 1 1 V
8/4/2018 1 1 1 1 1 V
Provinsi : KEPRI Nama Posyandu
Kabupaten/Kota : LINGGA Bulan
Puskesmas/Kecamatan : LANJUT Tahun
Desa/Kelurahan : BERINDAT

No No Kartu Keluarga NIK (Nomor Induk Kependudukan) Anak Ke Nama anak

(1) (2) (3) (4) (5)

1 1 AULIAN KHALIF
2 3 REYHAN
3 1 NUDI ALFURQON
4 21040 60612160001 21040 64406170001 1 ZIZILIA
5 21040 60501100001 1 RIFQYAUNUR
6 21040 62706140001 3 ADITYA
7 1 ANDI PRATAMA
8 21040 60405160001 21040 62404140001 5 AL-FIKAR
9 21040 60405160001 21040 62404140002 5 AL-FIKAR
10 21040 12104090001 21040 64504150002 2 ANNISA AZFIRA
11 21040 11012070007 21040 64507150001 3 ANISYA
12 1 DHYZI RAFANDA
13 21040 10305120001 21040 66310130001 2 KEISYA
14 21040 65504140001 1 KHALISA
15 21040 64912140002 2 KHANSA SABILA
16 1 KHAIRA
17 2 LILA
18 1 LAURA
19 21040 64107140001 1 MUTIA
20 21040 65210130001 5 MELUR
21 21040 110120170116 5 M.FATIRHAN
22 21040 13001120002 21040 62811130001 2 M.DESTIAN
23 21040 61409170001 21040 60911150001 2 M.AZRIL
24 21040 61101150001 1 M.ALDRIC
25 21040 110127070116 21040 66402140001 4 NURSIFA
26 1 NURAISYAH
27 21040 11012070114 21040 46309130001 1 NAFISHA
28 21040 62010140001 2 ROHMAT
29 2 SERLIN
30 21040 65002140001 2 RAISA BELINA
31 4 RAFIF
32 1 ABID IRFANUL
33 1 TIKA
34 1 IZAATI
35 21040 11012070111 21040 61301150001 3 AL-VARO
36 3 ASHALINA
37 3 DERIA PUTRA
38 1 DAFA
39 21040 41106130009 21040 46808170001 5 JENI PUSPITA
40 21040 11012070136 21040 66406140001 ANASTASYA
41 1 KHAIRA
42 21040 60505170001 21040 60707170001 KENZIA
 FORMULIR PEMANTAUAN PERTUMBUHAN BALITA DI POSYANDU

Posyandu :
: AGUSTUS
: 2018

Berat
Jenis Nama Ortu No Tlp/
Tanggal Lahir Kelamin Badan NIK Ayah Alamat
(Ayah) HP Ortu
(BB) Lahir

(6) (7) (8) (9) (10) (11) (12)

4/14/2018 L 2.8 NENDA BERINDAT
9/27/2017 L 3.7 CILIN BERINDAT
10/7/2013 L 3.5 ABDULLAH BERINDAT
6/4/2017 P 3.5 ZULKIFLIN 21040 10406910001 BERINDAT
1/5/2016 L 3.3 REGI 21040 1250690001 BERINDAT
6/27/2014 L 3.2 RONI 21040 11911800001 BERINDAT
11/20/2013 L 2.7 DINARDI BERINDAT
4/4/2014 L 2.7 SUPIADI 21040 10912680001 BERINDAT
4/4/2014 L 1.9 SUPIADI 21040 10912680001 BERINDAT
4/5/2015 P 2.9 ZABIDI 21040 11003820001 BERINDAT
7/5/2015 P 2.7 AZUAR 21040 11109730001 BERINDAT
6/24/2014 P 2.4 YUDI BERINDAT
10/20/2013 P 2.7 OKTA 21710 20110840000 BERINDAT
4/25/2014 P 3.2 RIKI 21040 12104900001 BERINDAT
12/9/2014 P 3.2 RIAN 21040 11301810001 BERINDAT
1/28/2016 P 2.7 IRFAN BERINDAT
8/28/2016 P 3.3 RAHMAN BERINDAT
2/17/2017 P 4.2 MARHAFIN BERINDAT
7/1/2014 P 2.4 INDRA 21040 10612700003 BERINDAT
10/12/2013 P 3.2 RIDULAN 21040 60107760001 BERINDAT
12/7/2016 L 2.7 IDRIS 21040 10509750001 BERINDAT
12/29/2013 L 2.8 ZAKARIA 21041 10105500000 BERINDAT
11/9/2015 L 2.8 DARMANI 21040 11703730002 BERINDAT
1/11/2015 L 2.2 JUMADI BERINDAT
2/24/2014 P 3.5 IDRIS 21040 10509750001 BERINDAT
6/16/2014 P 2.7 YANTO BERINDAT
9/23/2013 P 2.5 JASMIN 21040 40711760001 BERINDAT
10/20/2014 L 3.8 ZULKIFLIN 21040 63110810001 BERINDAT
2/2/2015 P 2.7 JASMIN BERINDAT
2/10/2014 P 3.5 RACU 21710 60168300000 BERINDAT
8/1/2017 L HARDIANTO 21040 11007770001 BERINDAT
10/21/2015 L DEDI ARDI BERINDAT
6/19/2018 P SYAWET BERINDAT
1/9/2015 P JABAR BERINDAT
1/13/2015 L PADIL 21040 10112830001 BERINDAT
9/21/2017 P AGUS 21040 11708770001 BERINDAT
7/31/2017 L RUSLAN BERINDAT
10/11/2017 L FERIANTO BERINDAT
8/28/2017 P ZULKIFLIN 21040 51106644001 BERINDAT
4/26/2014 P SAPRI 21040 60107690002 BERINDAT
1/28/2016 P IRFAN BERINDAT
7/7/2017 L 21040 11209910003 BERINDAT
 Panjang Cara Ukur ASI Vitamin A Vitamin A
Badan/
Tgl 1=Telenta EksklusifF IMD Februari Agustus
RT RW BB (kg) Tinggi 1=YA,
Pengukuran ng 1=YA, 1=YA 1=YA
Badan 2=Berdiri 2=Tidak 2=Tidak 2=Tidak 2=Tidak
(cm)
(13) (14) (15) (16) (17) (18) (19) (20) (21) (22)
3 1 8/3/2018 4.6 58 1 1 1 2 2
2 1 8/3/2018 8.7 72 1 2 1 2 1
3 1 8/3/2018 22.5 111 2 1 1 1 1
5 2 8/3/2018 10.2 83 1 1 1 2 1
4 2 8/3/2018 11.6 88.8 2 1 1 1 1
5 2 8/3/2018 15.2 104 2 1 1 1 1
5 2 8/3/2018 24.1 121 2 1 1 1 1
5 2 8/3/2018 17 103 2 1 1 1 1
5 2 8/3/2018 17.5 99 2 1 1 1 1
5 2 8/3/2018 13.3 93.5 2 1 1 1 1
3 1 8/3/2018 12.3 91 2 1 1 1 1
3 1 8/3/2018 12.1 91 2 1 1 1 1
5 2 8/3/2018 14 100.3 2 1 1 1 1
4 1 8/3/2018 14.8 101 2 1 1 1 1
4 2 8/3/2018 11.3 93.2 2 1 1 1 1
4 2 8/3/2018 9.4 83.4 2 1 1 1 1
5 2 8/3/2018 13.1 101 2 1 1 1 1
4 2 8/3/2018 8.7 73 2 1 1 1 1
5 2 8/3/2018 12 98.4 2 1 1 1 1
5 2 8/3/2018 15.2 100 2 1 1 1 1
5 2 8/3/2018 9.4 83 2 1 1 1 1
5 2 8/3/2018 19.6 112 2 1 1 1 1
5 2 8/3/2018 12.5 89 2 1 1 1 1
5 2 8/3/2018 11.8 91 2 1 1 1 1
5 2 8/3/2018 13.5 102 2 1 1 1 1
5 2 8/3/2018 12.1 94 2 1 1 1 1
5 2 8/3/2018 20 109 2 1 1 1 1
5 2 8/3/2018 18 99 2 1 1 1 1
5 2 8/3/2018 12.5 96 2 1 1 1 1
5 2 8/3/2018 16.9 107.5 2 1 1 1 1
4 2 8/3/2018 10.5 75 1 1 1 1 1
4 2 8/3/2018 14.7 76 2 1 1 1 1
5 2 8/3/2018 53 705 1 1 1 1 1
5 2 8/3/2018 7.7 71 1 1 1 1 1
4 2 8/3/2018 2 1 1 1 1
3 1 8/3/2018 9.7 82 1 1 1 1 1
3 1 8/3/2018 8.2 74 1 1 1 1 1
3 1 8/3/2018 8 73.5 1 1 1 1 1
5 1 8/3/2018 9.1 1 1 1 1 1
5 1 8/3/2018 2 1 1 1 1
3 1 8/3/2018 9.3 8.4 2 1 1 1 1
5 1 8/3/2018 9.3 76 1 1 1 1 1
Kepemilik
an Buku
KIA

(23)
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
Provinsi : KEPRI
Kabupaten/Kota : LINGGA
Puskesmas/Kecamatan : LANJUT
Desa/Kelurahan : KOTE
No No Kartu Keluarga
(1) (2)
1 21040 62606130001
2 21040 11607090005
3 21040 11312070140
4 21040 11212070074
5 21040 631101130001
6 21040 10307090001
7 21040 11212070008
8 21040 11303080004
9 21040 11212070030
10 21040 11203120004
11 21040 62504400001
12 21040 11212070028
13 21040 11312070028
14 21040 11312070163
15 21040 11212070018
16 21040 11312070155
17 21040 61602170001
18 21040 61108150003
19 21040 41006130005
20 21040 11212070008
21 21040 11312070154
22 21040 61803160002
23 21040 11412070067
24 21040 60809150002
25 21040 61910150001
26 21040 11612070109
27 21040 11409120002
28 21040 14120700409
29 21040 62504140002
30 21040 61503170002
31 21040 61403160001
32 21040 11212070077
Nama Posyandu
Bulan
Tahun
NIK (Nomor Induk
Anak Ke Nama anak Tanggal Lahir
Kependudukan)
(3) (4) (5) (6)
21040 60610130001 1 ABID AQILA 10/6/2013
21040 62511130001 2 M.AADY 11/26/2013
21040 60712130001 2 M.FATHIR 12/7/2013
21040 61801140001 3 RAJA.TRI.M 12/18/2013
21040 62504140001 1 DEGO 4/25/2014
21040 61405140001 2 AFWAN 5/14/2015
21040 61706140001 4 M.FAZILA 6/17/2014
21040 66307140001 2 RAMADANI 7/23/2014
21040 61111140001 3 SAMIURALAH 11/21/2014
21040 61801150001 2 VARIANI 1/18/2015
21040 65801150001 1 AZKIA 1/18/2015
21040 64504150001 2 YUMNA 4/15/2015
21040 66650415001 3 TASLITIA 4/25/2015
21040 60506150001 2 M.ABQARI 6/5/2015
21040 61006150001 1 FERM 6/14/2015
21040 62507150001 1 FREDI PRATAMA 5/10/2015
21040 65108150001 1 M.ALFATIH 7/5/2015
21040 61309150001 1 QURRATA 8/11/2015
21040 64611150001 1 M.ZAIN 9/13/2015
21040 65500316001 5 NUR ASYIFA 11/6/2015
21040 61803160001 3 NISA PUTRI 3/6/2016
21040 66303160001 1 PHADIL.A 3/19/2016
21040 61005160001 3 KHAIRUL IZATY 3/23/2016
21040 62908160001 1 AL-FATIH 5/10/2016
21040 66508160001 1 RAJA 8/28/2016
21040 64512160001 3 KANZIA 8/15/2016
21040 66403170001 1 RASIDATUL 12/5/2016
21040 60606170001 3 SITI SAIDATUL 3/24/2017
21040 62108170001 2 M.AYMAN 6/6/2017
21040 66409170001 1 ZEA ULHAK 8/21/2017
21040 6640917001 2 ELISA 9/24/2017
21040 61110170001 2 ABIB 10/11/2017
33 21040 11212070079 21040 66612170001 3 AUREL 10/26/2018
34 21040 1121121207005 21040 661180001 2 LAODE 1/6/2018
35 21040 62606130001 21040 64502180002 2 DELLISA 1/26/2018
36 21040 11312070153 21040 67003180002 3 PURNAMA 2/5/2018
37 21040 61010170002 21040 65504180001 1 EMBUN 3/31/2018
38 21040 62709170001 21040 65904180001 1 KAMARILA 4/15/2018
39 21040 62103170001 21041 65904180001 2 NAUREN 4/19/2018
 FORMULIR PEMANTAUAN PERTUMBUHAN BALITA DI POSYANDU

: CEMPAKA PUTIH
: AGUSTUS
: 2018

Berat
Jenis No Tlp/
Badan Nama Ortu (Ayah) NIK Ayah Alamat RT RW
Kelamin HP Ortu
(BB) Lahir

(7) (8) (9) (10) (11) (12) (13) (14)

L SOPYAN 21040 11710800001 KOTE 1 5
L MUSDIAR 21040 11609910001 KOTE 2 2
L ILHAM 21040 10201800001 KOTE 1 4
L SYAMIR 21040 12511790001 KOTE 2 1
L AMRZA 21040 60212760001 KOTE 2 1
L RIDUAN 21040 10710030001 KOTE 2 1
L GAMALIZUR 21040 12905680005 KOTE 1 1
P DAMAR 21040 10212670001 KOTE 1 4
L S GUNAWAN 21040 1160380001 KOTE 1 1
P KRISDIANSAH 21040 111708830001 KOTE 1 5
P KITAMRUZAN 21040 12912820001 KOTE 1 5
P TAUFIK 21040 13108790000 KOTE 1 1
P RAHMAT 21040 12311660001 KOTE 1 3
L JOHAN 21040 10504820001 KOTE 1 4
L ABDARI 21040 1100700001 KOTE 1 1
L ANDRESON 21040 6100615001 KOTE 1 2
L ISKANDAR 21710 3300179902 KOTE 1 4
L SAHRUL.SOS 21020 4070383007 KOTE 1 3
L M.RAFIK 21710 2230386005 KOTE 1 2
P GAMALIUS 21040 1290568005 KOTE 2 4
P SURYADI 21040 1080166001 KOTE 2 2
L ISWANTO 21040 1150591001 KOTE 2 1
L SULAIMAN 21040 1120979001 KOTE 1 5
L ARIAN.S 21040 1280487001 KOTE 1 2
L RAHMAN 21040 1280487001 KOTE 2 1
L JULIAR 21040 1120781001 KOTE 1 2
L RASIDAN 21040 1120066002 KOTE 1 4
P MHD.MUSAFAR 21040 1040571001 KOTE 2 1
L KAMARUZAMAN 21040 1290128201 KOTE 1 3
L JAKPAR 21040 1300468001 KOTE 1 5
P IIQ ABDUL 21711 0020583904 KOTE 2 5
L RIONALDO 21040 1080282001 KOTE 1 5
P ALIM 21040 1130982001 KOTE 2 1
L ROSLAN 21040 1140519001 KOTE 1 1
P SOPYAN 21040 117108001 KOTE 2 1
P ARIPIN 21040 102037001 KOTE 1 5
P RIKO 21040 111870001 KOTE 1 4
P M.ZUHAILY 21040 1260391001 KOTE 1 2
P RIKO 21011 5080483001 KOTE 2 1
 Panjang Cara Ukur ASI Vitamin A Vitamin A Kepemilik
Badan/ 1=Telenta EksklusifF IMD Februari Agustus an Buku
Tgl Pengukuran BB (kg) Tinggi 1=YA,
ng 1=YA, 1=YA 1=YA
Badan 2=Berdiri 2=Tidak 2=Tidak KIA
2=Tidak 2=Tidak
(cm)
(15) (16) (17) (18) (19) (20) (21) (22) (23)
8/5/2018 15.9 106 2 1 1 v
8/5/2018 16.1 107 2 2 1 1 v
8/5/2018 15.9 108 1 1 1 1 v
8/5/2018 15.8 106 1 1 1 v
8/5/2018 14 99 1 1 1 1 v
8/5/2018 14.5 102 2 1 1 v
8/5/2018 13.1 93 1 2 1 1 v
8/5/2018 12.3 100 1 2 1 1 v
8/5/2018 16.3 100 1 2 1 1 v
8/5/2018 15.1 100 2 1 1 v
8/5/2018 14.7 99 2 1 1 v
8/5/2018 16 99 2 1 1 1 v
8/5/2018 13.1 93 1 1 1 1 v
8/5/2018 12.3 100 1 1 1 v
8/5/2018 15 97 1 1 1 1 v
8/5/2018 15.1 95 2 1 1 v
8/5/2018 pindah 1 1 1 1 v
8/5/2018 15 100 1 1 1 1 v
8/5/2018 12 91 2 1 1 v
8/5/2018 12.3 94 2 1 1 v
8/5/2018 14 104 2 2 1 v
8/5/2018 12.5 95 2 1 1 v
8/5/2018 10.7 86 2 1 1 v
8/5/2018 pindah 1 1 1 v
8/5/2018 12 88 1 1 1 v
8/5/2018 10 84 1 2 1 1 v
8/5/2018 7.4 76 2 1 1 v
8/5/2018 9.1 78 2 1 1 1 v
8/5/2018 11.5 79 2 1 1 v
8/5/2018 10 75 1 2 1 1 v
8/5/2018 7.2 73 1 1 1 1 v
8/5/2018 9.2 75 2 2 1 1 v
8/5/2018 9.9 71 1 2 1 1 v
8/5/2018 7.6 73 1 1 1 1 v
8/5/2018 7.9 72 2 1 1 v
8/5/2018 7.1 63 2 2 1 1 v
8/5/2018 6.9 64 1 1 1 v
8/5/2018 8.6 69 1 1 1 1 v
8/5/2018 5.6 62 1 1 1 1 v
Provinsi
Kabupaten/Kota : LINGGA
Puskesmas/Kecamatan : LANJUT
Desa/Kelurahan : SEDAMAI
No No Kartu Keluarga
(1) (2)
1 21040 61810130003
2 21040 6300916001
3 21040 11912070114
4 21040 13003100002
5 21040 12603031001
6 21040 11912070071
7 21040 61006130003
8 21040 11912070009
9 21040 61110130001
10 21040 11003100002
11 21040 10207130004
12 21040 12112070104
13 21040 12812110001
14 21040 11812070072
15 21040 12301080034
16 21040 61810130004
17 21040 61411140001
18 21040 62205180000
19 21040 60709170002
20 21040 11501100004
21 21040 61811140001
22 21040 11511100002
23 21040 11511100002
24 21040 62904150001
25 21040 11812070018
26 21040 60202160001
27 21040 62204130001
28 21040 11310100006
29 21040 63009160001
30 21040 61511160001
: KEPRI Nama Posyandu
Bulan
Tahun
NIK (Nomor Induk
Anak Ke Nama anak Tanggal Lahir
Kependudukan)
(3) (4) (5) (6)
21040 60912130001 1 REHAN 12/9/2013
21020 51211130002 1 M. IQBAL 11/12/2013
21040 62012130001 3 ALFIANSAH 12/20/2013
21040 65511140001 2 RESTU.Z 1/15/2014
21040 65407140001 2 RIANA.R 7/14/2014
21040 63007140001 3 M.SYALIS 7/30/2014
21040 64608140001 1 CHELSIA.K.K.A 8/6/2014
21040 66808140001 2 ARMELITA 8/29/2014
21040 66109140001 1 RAIHANAH.S 9/21/2014
21040 61107100001 2 HAFIZ.D.P 10/15/2014
21040 14702140002 1 KARLINA 12/7/2014
21040 64012140001 1 NADIA.A 12/9/2014
21040 16602020001 2 DESSY.S 12/20/2014
21040 15801060001 1 FAIREL.A 1/19/2015
21040 61503150001 1 E.HASYIM 4/15/2015
21040 60405150012 2 FARIZ.A.C 5/4/2015
21040 60405150001 1 ZAKIR.K 5/4/2015
21040 67006150001 2 PUTRI. R 6/30/2015
21711 15108150000 1 YOFI.A.H 8/11/2015
21040 66809150001 1 SAFFAMINA 9/18/2015
21040 61210150001 2 ZIKRI ARYA 10/12/2015
21040 60711150001 2 AJJU.R 11/7/2015
21040 64711150001 1 AZZITA.P 11/7/2015
21040 66012160001 2 SYFA.Q.A 12/20/2016
21040 65301160001 1 AYUDIA 1/15/2016
21040 66404160001 1 REPA SAPITRI 4/24/2016
21040 67105160001 2 NATASYA M 5/31/2016
21040 65006180001 2 SYAEREZA.R.P 6/10/2016
21040 61311160001 1 ABDUL PATAH 11/13/2016
21040 65712160000 1 AQILA 12/17/2016
 FORMULIR PEMANTAUAN PERTUMBUHAN BALITA DI POSYANDU

: ASTER
: AGUSTUS
: 2018

Berat
Jenis No Tlp/
Badan Nama Ortu (Ayah) NIK Ayah Alamat RT RW
Kelamin HP Ortu
(BB) Lahir

(7) (8) (9) (10) (11) (12) (13) (14)

L MUHARDI 210400 61606860001 SEDAMAI 2 1
L ABOHARI 21040 13006740001 SEDAMAI 1 4
L EFENDI 21040 10707710001 SEDAMAI 1 2
L RIZAL 21040 16181287001 SEDAMAI 1 1
P OMPITER 21720 22402810001 SEDAMAI 3 1
L MUKSHININ 21040 11506810003 SEDAMAI 1 2
P M.YUSUF 21040 12605900001 SEDAMAI 3 1
P BUDI 21040 11212790001 SEDAMAI 1 2
L GIOVANA 21040 10812900001 SEDAMAI 3 1
L HERU ANDRIAN 21040 12211030003 SEDAMAI 1 2
P KARMINTO 21040 11803880002 SEDAMAI 2 1
P JUNAIDI 21040 11606790001 SEDAMAI 2 2
P PITRIO.S 21040 61010830001 SEDAMAI 2 3
L KHAIRIL.A 21040 10506770002 SEDAMAI 2 1
L HAIDIR 21040 11507790001 SEDAMAI 1 4
L EDI.M 21711 11904790001 SEDAMAI 2 1
L JONI.S 21720 2140670001 SEDAMAI 1 2
P LUKMAN 21040 14104850003 SEDAMAI 2 4
P SUKRA 21040 11603860001 SEDAMAI 1 2
P YUSHARDI 21040 12409790001 SEDAMAI 2 4
L TOMMY 21040 10805840001 SEDAMAI 1 3
L JUNAIDI 21040 10805820001 SEDAMAI 2 2
L JUNAIDI 21041 10805820001 SEDAMAI 1 4
P 2.7 MUSFIZAR 21040 123033870001 SEDAMAI 1 2
P PAUZI 21040 10802660001 SEDAMAI 2 4
P ELHAM 21040 10107900007 SEDAMAI 1 1
P YANTO 21040 11807870002 SEDAMAI 1 4
L ALAMSYAH 21040 11504820003 SEDAMAI 2 1
L 2.8 ABOHARI 21040 13006740001 SEDAMAI 1 4
P 2.8 MUZAMAN 21040 10107890004 SEDAMAI 2 2
 Panjang Cara Ukur ASI Vitamin A Vitamin A Kepemilik
Badan/
Tgl 1=Telenta EksklusifF IMD Februari Agustus an Buku
BB (kg) Tinggi 1=YA,
Pengukuran ng 1=YA, 1=YA 1=YA
Badan 2=Berdiri 2=Tidak 2=Tidak KIA
2=Tidak 2=Tidak
(cm)
(15) (16) (17) (18) (19) (20) (21) (22) (23)
8/6/2018 18.7 98.5 2 2 2 1 1 V
8/6/2018 12.2 94 2 2 2 1 1 V
8/6/2018 24 116 2 2 2 1 1 V
8/6/2018 15 99.5 2 2 2 1 1 V
8/6/2018 13.6 96 2 2 2 1 1 V
8/6/2018 14 97 2 2 2 1 1 V
8/6/2018 12.5 92 2 2 2 1 1 V
8/6/2018 13.5 98 2 2 2 1 1 V
8/6/2018 16.2 107 2 2 2 1 1 V
8/6/2018 12 95 2 2 2 1 1 V
8/6/2018 12.7 99 2 2 2 1 1 V
8/6/2018 17.5 99 2 2 2 1 1 V
8/6/2018 14.5 97 2 2 2 1 1 V
8/6/2018 19.5 96 2 2 2 1 1 V
8/6/2018 20.2 97 2 2 2 1 1 V
8/6/2018 17.7 105 2 2 2 1 1 V
8/6/2018 13.8 97 2 2 2 1 1 V
8/6/2018 13.8 90 2 2 2 1 1 V
8/6/2018 14.2 95 2 2 2 1 1 V
8/6/2018 11 83 2 2 2 1 1 V
8/6/2018 12.5 90 2 2 2 1 1 V
8/6/2018 11.5 88 2 2 2 1 1 V
8/6/2018 11.8 89 2 2 2 1 1 V
8/6/2018 10.9 86 2 2 2 1 1 V
8/6/2018 11.1 82 2 2 2 1 1 V
8/6/2018 9.3 81 2 2 2 1 1 V
8/6/2018 10.5 85 2 2 2 1 1 V
8/6/2018 10.6 81 2 2 2 1 1 V
8/6/2018 11.2 81.6 2 2 2 1 1 V
8/6/2018 7.9 76 2 2 2 1 1 V
 F

Provinsi : kepri Nama Posyandu

Kabupaten/Kota : lingga Bulan
Puskesmas/Kecamatan : lanjut Tahun
Desa/Kelurahan : lanjut

NIK (Nomor Induk

No No Kartu Keluarga Anak Ke Nama anak Tanggal Lahir
Kependudukan)

(1) (2) (3) (4) (5) (6)

1 21040 61308140001 21040 64810140001 2 AISYA FARADILA 10/8/2014
2 21040 60809150001 21040 64609150001 1 ADIA NASYA DELONA 8/6/2015
3 21040 11912070101 21040 66903170000 3 ASSYIFA PUTRI AULIA 3/29/2017
4 21040 11112070141 21040 60708170001 2 ANDRA WIJAYA 8/7/2017
5 21040 60802180001 21040 65001180001 1 ASYIFA SYAHPUTRI 1/10/2018
6 21040 11912070116 21040 61908150001 2 CHIKO YAZUKO 8/19/2015
7 21040 11412090005 21040 61405178001 3 DAFFA MUHAMMAD.R 5/14/2017
8 21040 11412090005 21040 61405178002 3 DAFFI MUHAMMAD.R 5/14/2017
9 21040 13105120001 21040 12709120001 2 DIFKY AL HABSY 7/28/2017
10 21040 61109150005 21040 61512150001 3 E.REZA SYAHPUTRA 12/15/2015
11 21040 11912070109 21040 65804160001 2 ELVIRA APRILIA 4/18/2016
12 21040 12112070109 21040 65512150001 3 FATMA WULANDARI 12/15/2015
13 21040 61306140001 21040 64511170001 3 FISKA NADIA PUTRI 11/15/2017
14 21040 62511160001 21040 62712160001 1 FATIH YUANDI.S 12/27/2016
15 21040 11812070095 21040 66602170001 2 HUSNAH FITRINTY 2/26/2017
16 21040 21402140001 21040 26102150001 1 JIHAN THALITA ULVA 2/21/2015
17 21040 60404180003 21040 66106180001 1 KAYLA KUMAIRA .A 6/21/2018
18 21040 62001170001 21040 62905170001 1 LAGINDA 5/29/2017
19 21040 12112070053 21040 61412130001 2 MUHAMMAD ADIBAN 12/14/2013
20 21040 12112070023 21040 61207140001 3 M.SAPUTRA.R 7/12/2014
21 21040 61006130002 21040 61910140001 1 M.RAFLI ABQARI 10/19/2014
22 21040 60108160001 21040 60104160001 1 MUHAMMAD FADLI 4/1/2016
23 21040 11912070072 21040 61506160001 3 M.FITRIA RAMADAN 6/15/2016
24 21040 61010170001 21040 61611170001 1 M.SAFAWI R 11/16/2017
25 21040 12112070064 21040 61503170001 2 M.ILHAM.RADJA.P 3/15/2017
26 21040 11805090002 21040 64112170001 2 MAULIDA AZAHRA 11/16/2017
27 21040 12112070056 21040 60405140001 3 M.ZIKRI FIRMANSYAH 5/4/2014
28 21040 61603160001 21040 64907160001 1 NAKILA LESTI.S.A 7/9/2016
29 21040 10808080002 21040 64511140001 2 NADA ALYSSA.A 11/5/2014
30 21040 60312140001 21040 64308170001 1 NADHUFA AGUSTIN 8/4/2017
31 21040 61603160001 2 NASIFA FITA ISABELA 6/29/2018
32 21040 60408150001 21040 61808160001 2 PRADIFTA ZIJRI HADY 8/18/2016
33 21040 60910170001 21040 63105170001 1 RAHMAN.R 5/31/2017
34 21040 60810130001 21040 60909170001 1 REHAN SAPITRA 9/9/2017
35 21040 12112070064 21040 64711140001 1 SITI MULYANA 11/7/2014
36 21040 61211140001 21040 65309150001 1 SEFTIA NURFAMILA 9/13/2015
37 21040 60412150001 21040 65709160001 1 SHOFI SALSABILA 9/17/2016
38 21040 10105090002 21040 60105170001 2 TRISTAN ABIAQSA.S 5/1/2017
39 21040 12212070008 21040 54110170001 3 ULFA AULIA PUTRI 10/1/2017
40 21040 11912070052 21040 6405140001 3 ZURI MELINDA 5/4/2014
 FORMULIR PEMANTAUAN PERTUMBUHAN BALITA DI POSYANDU

: seroja
: agustus
: 2018

Berat
Jenis No Tlp/
Kelamin (BB) Lahir Nama Ortu (Ayah)
Badan NIK Ayah Alamat RT RW
HP Ortu

(7) (8) (9) (10) (11) (12) (13) (14)

P ALI AKHMAD 21010 12801850001 LANJUT 2 1
P NANDA PUTRA 21040 62107940001 LANJUT 1 4
P SAPRIANTO 21040 11502720001 LANJUT 1 2
L RONI 21040 12306770018 LANJUT 1 4
P IRWANSYAH 21040 10712910001 LANJUT 1 5
L ADI ATEK 21040 10203860001 LANJUT 2 1
L NORMAN.S 21040 10203860001 LANJUT 1 3
L NORMAN.S 21041 10203860001 LANJUT 1 3
L JUNAIDI 21040 10403880001 LANJUT 2 2
L ROSLI 21040 12006770002 LANJUT 1 1
P ILYAS SAIRI 21040 12009700001 LANJUT 1 1
P ARMAN 21040 10107710008 LANJUT 1 3
P ATENI 21040 50310720001 LANJUT 2 2
L NOVRIANDI.H.S 21040 22611960001 LANJUT 1 2
P ASSALAM LANJUT 1 1
P NURIMAN.J 21040 10705870001 LANJUT 1 4
P JUNAIDI 21040 62010960002 LANJUT 1 4
L MARJONO 21040 101078780033 LANJUT 2 5
L DIDI KUSNADI 21040 12008820001 LANJUT 2 1
L AFRIZAL 21040 101078780033 LANJUT 2 5
L REKY SUHENDRA 21040 10908820001 LANJUT 1 3
L FAJAR 21040 31706950001 LANJUT 1 1
L ZAKIRAN 21040 12708790001 LANJUT 1 2
L DINO.R 21040 22504940001 LANJUT 2 5
L AHMAD 21040 10602770001 LANJUT 2 2
P LIN SUKISMANTO 21040 10703830002 LANJUT 2 4
L M.ZULKARNAEN 21040 12504790002 LANJUT 2 1
P JOHARI 21040 10603870002 LANJUT 2 1
P ABDUL WAHID 21040 12004760001 LANJUT 1 2
P AMSUDIN 21040 10506910001 LANJUT 2 1
P JOHARI 21040 10603870003 LANJUT 2 1
L SAMSUL 21020 52704860002 LANJUT 2 1
L SAFARUDIN 21040 10107950010 LANJUT 1 1
L ARMANSYAH 21040 11608860001 LANJUT 1 2
P AHMAD 21040 10602770001 LANJUT 2 2
P M.SHALEH 21040 51801930001 LANJUT 1 4
P SAPRIZAL 21040 41808800001 LANJUT 1 4
L BUDI HARDI 21040 112038400002 LANJUT 2 1
P MAHPUT 21040 11604710001 LANJUT 2 4
P JUMALI 21040 10101770001 LANJUT 1 1
 Panjang Cara Ukur ASI Vitamin A Vitamin A Kepemilik
Badan/
Tgl 1=Telenta EksklusifF IMD Februari Agustus an Buku
BB (kg) Tinggi 1=YA,
Pengukuran ng 1=YA, 1=YA 1=YA
Badan 2=Berdiri 2=Tidak 2=Tidak KIA
2=Tidak 2=Tidak
(cm)
(15) (16) (17) (18) (19) (20) (21) (22) (23)
8/18/2018 16 100.7 2 1 1 v
8/18/2018 11.1 89 2 2 1 1 v
8/18/2018 9 73 1 1 1 1 v
8/18/2018 7.8 72 1 1 1 v
8/18/2018 7 66 1 1 1 1 v
8/18/2018 17 98 2 1 1 v
8/18/2018 7.2 72 1 2 1 1 v
8/18/2018 8.5 76 1 2 1 1 v
8/18/2018 9 71 1 2 1 1 v
8/18/2018 12.4 94 2 1 1 v
8/18/2018 10 84 2 1 1 v
8/18/2018 13 96 2 1 1 1 v
8/18/2018 7.8 69 1 1 1 1 v
8/18/2018 11.8 87 1 1 1 v
8/18/2018 10.5 84 1 1 1 1 v
8/18/2018 16.3 99 2 1 1 v
8/18/2018 5.1 56 1 1 1 1 v
8/18/2018 9.4 79 1 1 1 1 v
8/18/2018 13 107 2 1 1 v
8/18/2018 13.2 93 2 1 1 v
8/18/2018 17.6 99 2 2 1 v
8/18/2018 9.5 83 2 1 1 v
8/18/2018 9.5 82 2 1 1 v
8/18/2018 8.5 68 1 1 1 v
8/18/2018 10.5 76 1 1 1 v
8/18/2018 7.5 70 1 2 1 1 v
8/18/2018 18 104 2 1 1 v
8/18/2018 10.9 82 2 1 1 1 v
8/18/2018 14.2 102 2 1 1 v
8/18/2018 8.5 71 1 2 1 1 v
8/18/2018 4 53 1 1 1 1 v
8/18/2018 13 84 2 2 1 1 v
8/18/2018 12 77 1 2 1 1 v
8/18/2018 11.3 72 1 1 1 1 v
8/18/2018 11.5 93 2 1 1 v
8/18/2018 22.5 100 2 2 1 1 v
8/18/2018 10 83 1 1 1 v
8/18/2018 9.4 77 1 1 1 1 v
8/18/2018 7 66 1 1 1 1 v
8/18/2018 13.2 97 2 1 1 1 v