Kepemilik

an Buku
Berat
Anak Tanggal Lahir Jenis No Kartu NIK (Nomor Induk KIA/KMS
No Nama anak Badan
Ke Kelamin Keluarga Kependudukan) (BB) Lahir
1=YA
2=Tidak
(1) (2) (3) (4) (5) (6) (7) (8) (9)

3174092006175000
1 3 6/20/2017 L 5 JAMALUDIN 3500 1

1
2 12/12/2015 L '3174091212150003 M. AZZAM 3500 1

3 8/18/2016 3174091170816000
3 L 3 M. YASSID 2800 1

3 12/1/2016 MUHAMMAD
4 L 3174090112160003 FATTAN 3500 1

2 10/9/2016 AHMAD
5 L 3174090910160003 GHIFARI 3600 1

1 4/4/2014
6 L 3174090403141005 FAKIH 2900 1

3 7/16/2015 MUHAMMAD
7 L 3174096071510004 MUKLIS 3500 1

1 4/30/2015 3174093040151000 MUHAMMAD

8 L 5 DALIL 3000 1

2 5/4/2016 3174090405114100 MUHAMMAD

9 L 01 FAHRIE 3100 1

2 12/6/2015
10 L 317409061216000 AZRIL RAZQA 2500 1

2 9/6/2013
11 L 3174095011611001 M. RAFFI S. 1800 1

1 5/10/2017 P KEESHA
12 3174095005170003 ARIANA 2650 1

3 8/29/2016 P
13 3174096908160002 GASBINNYU 3150 1

3 12/15/2013 P 3174095506131000
14 7 NADIFA 3600 1

2 9/7/2016 P
15 3174094709160004 ITA PISKA 3000 1

2 6/19/2013 P
16 317409590615100 THURFAH 3500 1

3 11/14/2014 P
17 317409541141001 HILDA 3200 1

3 6/10/2015 P
18 317409506151006 KHUMAIROH 3000 1

3 2/3/2016 P
19 3174094302160003 ADELIA 3000 1
 1 12/12/2014 P 3174091202111000
20 4 M. RIZAL 4000 1
21 3 10/22/2016 P 3174096210160001 SHAKILA 3200 1
22 1 3/24/2014 P 3327076403140003 FIRDA A. 2700 1
23 1 4/19/2016 P 3329145703170004 KAYLA A. 2800 1
24 2 3/20/2016 P 3174096003160005 AQIFA N. 3300 1
25 1 3/31/2014 L 3310043103140001 ZIDAN 2000 1
26 1 8/29/2014 P 3174096908141003 ARUNA 2800 1
27 2 7/31/2015 L 3174093107151004 SULTAN 2700 1
28 3 9/13/2017 L 3174091309170002 MAULANA 1400 1
29 1 12/23/2016 L 3174092312160001 HUSEIN 3300 1
MUHAMMAD
1 6/14/2015 L 3174091406151001
30 AZKA A. 2700 1
31 3 12/15/2017 P 3314015512170001 FATIMAH 2700 1
32 3 10/6/2015 L 3174090608151001 RESTU 3500 1
2 7/20/2017 P 3174096007170001 SHARIFA
33 3200 1
34 3 4/8/2014 L 3174090804140002 APRILIANO 3400 1
35 2 12/9/2016 L 3174090912160004 HASYIM M. 3500 1
36 1 4/19/2016 P 3174095904160001 KAYLA Z 3300 1
37 2 6/13/2015 P 3174095306151001 KINAN 3000 1
38 1 8/25/2015 P 3314016508150003 SYAFIRA 3000 1
39 2 1/25/2016 P 3174096501160005 ANJANI 2800 1
40 1 11/23/2015 P 3174046311150003 AYSHA AILANI 3100 1
41 3 1/9/2015 p 3174034907151001 AINI SAKIRAH 2900 1
42 3 9/12/2014 L 3174091204141009 A. YUSUF 2900 1
43 1 9/4/2013 P 3174094409131004 DIFIA AYU L. 2700 1
2 P
44 1/15/2017 3173035601160002 YASMIN NOURAH 3500 1
M. AGAM
1 P
45 6/4/2016 3174090440616004 PRATAMA 4700 1
46 1 7/19/2016 L 3174091407160005 FATIH M. SALMA 3200 1
47 3 7/27/2014 P 3174096706141006 R. FIRSHA S.A 3200 1
1 P
48 3/15/2016 3174095503160001 TRI KURNIAWATI 3000 1
IMD Tgl
No Tlp/
Nama Ayah NIK Ayah Alamat RT RW Pengukura BB (kg)
HP Ayah n
1=YA,
2=Tidak
(10) (11) (12) (13) (14) (15) (16) (17) (18)

004 001 8/14/2018 10.4

1 SUBHAN 3228090608750004 Jl. Raisan

004 001 8/14/2018 13.5

1 ABDUL AZIZ 317409150350005 Jl. Raisan

KHOIRUDIN 31740981270005 004 001 8/14/2018 9.5

1 Jl. Raisan
MUHAMMAD
3174090810750004 004 001 8/14/2018 9.9
1 ARIFIN Jl. Raisan

MUNIH 317409051800005 004 001 8/14/2018 10

1 Jl. Raisan

WAHYU 3174092006880001 004 001 8/14/2018 13.1

1 Jl. Raisan

AHMAD 3174090908710002 004 001 8/14/2018 13

1 Jl. Raisan

FAIS 3174092014970002 004 001 8/14/2018 12.6

1 Jl. Raisan
MUHAMMAD
3174091211840002 004 001 8/14/2018 9
1 SHOLEH Jl. Raisan

DENNY 3174090110870000 004 001 8/14/2018 11

1 Jl. Raisan

DAHLIA 3174096707860001 004 001 8/14/2018 15

1 Jl. Raisan

ARGA 317409110989000 004 001 8/14/2018 9

1 Jl. Raisan

SUNARTO 3174090204840006 004 001 8/14/2018 9

1 Jl. Raisan

ILYAS 3174090812790002 004 001 8/14/2018 13

1 Jl. Raisan

SARWANI 31740917109840006 004 001 8/14/2018 12

1 Jl. Raisan

ANJUN 3174090907830011 004 001 8/14/2018 14

1 Jl. Raisan

ABDUL TOLIB 3174091701780066 004 001 8/14/2018 18

1 Jl. Raisan

JAANIH 31740913088150002 004 001 8/14/2018 12.8

1 Jl. Raisan

HARIANSYAH 3174091502760002 004 001 8/14/2018 12

1 Jl. Raisan
 ABDUL ROSYID 3174091001830003 004 001 8/14/2018 19
1 Jl. Raisan
1 GUNAWAN 3174090203750007 Jl. Sawo 013 001 8/14/2018 8
1 FIRMAN 3327070211920041 Jl. Sawo 013 001 8/14/2018 19
1 GIYARNO 3174101007800014 Jl. Sawo 013 001 8/14/2018 8
1 SLAMET 3174091510750002 Jl. Sawo 013 001 8/14/2018 11.1
1 HARI 3310043011990002 Jl. Sawo 013 001 8/14/2018 15
1 TONO 3174092109960001 Jl. Sawo 013 001 8/14/2018 13
1 ADITYA 3174092008800006 Jl. Sawo 013 001 8/14/2018 15
1 MAEMIN 3174090510750012 Jl. Sawo 013 001 8/14/2018 8.5
1 IRFAN 3174090612800010 Jl. Sawo 013 001 8/14/2018 9.81

A. SAHRUNI 3174091608870007 Jl. Sawo 013 001 8/14/2018 19.5

1
1 SENEN 3314011005810009 Jl. Sawo 013 001 8/14/2018 8.6
1 SURONO 3174092112780004 Jl. Sawo 013 001 8/14/2018 13.6
MUHAMMAD
3174090111840003 Jl. Sawo 013 001 8/14/2018 8
1 NUR
1 HOLIK 3216111810770001 Jl. Sawo 013 001 8/14/2018 20
1 MUSLIM 3174090503800019 Jl. Sawo 013 001 8/14/2018 10.6
1 ASMAT 3174101203760008 Jl. Sawo 013 001 8/14/2018 10
1 AGUS W. 3174050508860014 Jl. Sawo 013 001 8/14/2018 10.7
1 SUGIYONO 3314012410900001 Jl. Sawo 013 001 8/14/2018 10.6
1 FERI 3316011002800005 Jl. Sawo 013 001 8/14/2018 11.8
1 NUN A. 3174040207890013 Jl. Sawo 013 001 8/14/2018 10.8
1 A. MANAP 317403 Jl. ASELIH 012 001 8/14/2018 13
2 AZIL 317409 JL.ASELIH 012 001 8/14/2018 18
1 SUDARTO 317409 JL.ASELIH 8/14/2018

SUPRAYOGI Jl. ASELIH 8/14/2018

1 317409 9
GUNAWAN 8/14/2018
2 317409 10
1 A. SALMAN 317409 8/14/2018 9
1 HAMZAH 317409 8/14/2018 15
8/14/2018
1 SAAMIH 317409
8/14/2018
Panjang Vitamin A Vitamin A
Cara Ukur ASI EksklusifF1=YA, 2=Tidak
Badan/ Februari Agustus
Tinggi
Badan
(cm) 1=Telentang umur 0 umur 1 umur 2 umur 3 umur 4 1=YA 1=YA
umur5 bln 2=Tidak
2=Berdiri bln bln bln bln bln 2=Tidak
(19) (20) (21) (22) (23) (24) (25) (26) (27) (28)

7.2
1 1

91
1 1

81

81

81

100

92

90

91

85

101

75

83

90

92

92

92

93

91
100

105
95
95
105
105
102
97
103

100

100
103

87

106
90
100
103
100
100
100
98 1 1 1
105

78

88
87
105
Provinsi : : Nama Posyandu
Kabupaten/Kota : JAKARTA SELATAN : Bulan
Puskesmas/Kecamatan : JAGAKARSA : Tahun
Desa/Kelurahan : CIPEDAK :

Kepemilik
an Buku
Berat
Anak Tanggal Lahir Jenis No Kartu NIK (Nomor Induk KIA/KMS
No Nama anak Badan
Ke Kelamin Keluarga Kependudukan) (BB) Lahir
1=YA
2=Tidak
(1) (2) (3) (4) (5) (6) (7) (8) (9)

RACHEL
`317409610517000 ARSYILLA
1 1 5/21/2017 P 317409 4 PUTRI 2800 1

2 `317409230417000
2 4/23/2017 L 317409 7 Aditya amizan 2600 1

1 `317409080815101 AZMI ROLAND

3 8/8/2015 L 317409 4 MARZUKI 3200 1

ANINDYA
2 RAESHA
4 4/12/2018 P 317409 3274095204180001 MAHARANI 3200 1

3 `317205220115100 ARKHAN EIL

5 1/25/2015 L 317409 6 SHAQIRI 2750 1

2 RAFANDYKA
`330117140814000 PUTRA
6 8/14/2014 L 317409 1 NOVAWAN 3100 1

1 FAREL BIMO
7 4/28/2017 L 317409 3174092804170004 PRASOGO 2850 1

2 `317409490418000 AIKO NESYA

8 4/9/2018 P 317409 7 CALLYSTA 2500 1

2 `327604190214000 IMAM
9 2/19/2014 L 317409 3 MUHAMMAD 2700 1
 1
SYABIL ALFATIH
`321401230217000 AQILA IMAN
10 2/23/2017 L 317409 4 SOEBRATA 2910 1

NASYITA
2 `317409530317000 SHAFWATUNNI
11 3/13/2017 P 317409 9 SA NADIN 3000 1

3 `332917150216000 RAFKA PRIYA

12 2/15/2016 L 317409 1 MAHESA 3300 1

2 `332917480318000 SHAFIRA PRILLY

13 3/8/2018 P 317409 2 RAGANIA 3140 1

1 `317409161113100 IBNU
14 11/16/2013 L 317409 9 PRASETYA 3200 1

2 `130107150715000 Muhammad
15 7/15/2015 L 317409 1 fadil mahendra 2800 1

1 `317409641116000 SAURA
16 11/24/2016 P 317409 8 SOLINSTA 3800 1

2
ALYA
`317409700415100 MUSYAFFA
17 4/30/2015 P 317409 4 FATHIRINA 4000 1

2 `317409080117000 MUHAMMAD
18 1/8/2017 L 317409 4 ZAFRAN 2700 1

1 SURYA
`317409311213100 KENCANA
19 12/31/2013 L 317409 8 NUSWANTORO 2700 1

1 `317409591215000 DESTYA
20 12/19/2015 P 317409 1 CANTIKA DEVI 3500 1

2 `317409421114100 NAYLA
21 11/2/2014 P 317409 1 SALSABILA 3200 1

3 `317409660515100 JIHAN YASMIN

22 5/26/2015 P 317409 1 AZZAHRA 3300 1
 2
23 6/26/2018 L 317409 3174092606180004 ALFA RIZKY 2700 1

NAIRA
1 `317409591113100 RABIATUL
24 11/19/2013 P 317409 1 ADAWIYAH 2700 1

2 `317409040517000 MUHAMMAD
25 5/4/2017 L 317409 5 RAFLIANSYAH 3100 1

MUHAMMAD
1 `317409211113100 GABRIEL
26 11/21/2013 L 317409 4 WAHID 2750 1

2 `317409521017000 BUNGA HASNA

27 10/12/2017 P 317409 2 SYAKIRA 3400 1

2 `317407050216000 BAYI NY SRI

29 5/8/2017 L 317409 0 AMBARWATI 2740 1

MEISYA
1 `317501520517000 AYUNDA
30 5/12/2017 P 317409 5 KHAZANAH 2800 1

SABRINA
1 `317409531017000 KHUMAIRA AL
31 10/13/2017 P 317409 2 DJUMAH 2840 1

AFLAH
2 `317409640914100 MUMINA
32 9/24/2014 P 317409 6 HARIRA 3800 1

2 `317409271216000 Adnan qois

33 12/27/2016 L 317409 1 purnama 3100 1

`317409280518000 Alfajri
34 3 5/28/2018 L 317409 4 ramadhan 3260 1
 FORMULIR PEMANTAUAN PERTUMBUHAN BALITA DI POSYANDU

Panjang
IMD Tgl Badan/
Nama No Tlp/
NIK Ayah Alamat RT RW Pengukura BB (kg) Tinggi
Ayah HP Ayah n Badan
1=YA, (cm)
2=Tidak
(10) (11) (12) (13) (14) (15) (16) (17) (18) (19)

Mirza `317409080617 8/16/2018 8,5 75

1 kartika 0011 Jl resmi `001 `002
Hasbunall `317409140317 8/16/2018 9.2 75
1 oh 0022 Jl jambu 2 `011 `002

`3174091
30415101 8/16/2018 12.5 96
1 0 ARI HERMAWAN Gg. Resmi `001 `002

`3174091
30415101 8/16/2018 6.2 67
1 0 ARI HERMAWAN Gg. Resmi `001 `002

`3172050 Jl.
80109313 Pembang 8/16/2018 17.8
1 8 KUSMANTO unan `002 `002

JL
`3275041 PEMBAN 8/16/2018 13.8
61214002 GUNAN
1 2 EKA NOVAWAN RT 02/02 `002 `002

`3174092
00718000 Jl. 8/16/2018 10
1 6 MUJIYONO Antariksa `004 `002

`3174090
91117002 RAWA 8/16/2018 5.6 67
1 3 PREDY BADAK `004 `002

`3276040
70316000 Jl. 8/16/2018 17
1 1 ANIH Antariksa `004 `002
 BILLAL 8/16/2018 13
`3214011 MOCHAMMAD
50317001 FEBRIAN IMAN
1 0 SOEBRATA JAMBU II `005 `002

`3174092
10109456 8/16/2018 11
1 5 SARIFUDIN JAMBU II `005 `002

`3329171
61115001 MUHAMAD 8/16/2018 16.5
1 2 NOFRIZAL JAMBU II `005 `002

`3329171
61115001 MUHAMAD 8/16/2018 6.7
1 2 NOFRIZAL JAMBU II `005 `002

`3174090
60114101 MUH.MUADZ 8/16/2018 15.5
1 7 ABDULLAH JAMBU II `011 `002

`3174091
80817003 8/16/2018 13
1 2 Hendra Jl family `008 `002

`3174092
40415100 8/16/2018 10.5
1 5 Mohamad soleh Jl family `008 `002

JL. Jambu 8/16/2018 17

`3174092 2 RT 07
10109461 RW 02
1 2 Mulyadi NO. 05 G `007 `002

`3174090
41111100 JL. 8/16/2018 12.9
1 2 NISAN Antariksa `009 `002

`3174092 8/16/2018 16
10211102 FAISAL JL.
1 4 NUSWANTORO Antariksa `009 `002

`3174092
00109724 RACHMAT JL. 8/16/2018 11
1 8 SUMBONO Antariksa `009 `002

`3174092 Rawa
00109688 Badak, 8/16/2018 15.8
1 7 Syamsuddin No.37A `005 `002

`3174092 GANG
00109829 JAMALUDIN PALEM 8/16/2018 14.3
1 2 EFENDI NO 064 `001 `002
 `3174092 GANG
00109829 JAMALUDIN PALEM 8/16/2018 4.8
1 2 EFENDI NO 064 `001 `002

`3174091
50713101 GANG 8/16/2018 22.7
1 3 ASEP PURNAMA RESMI `001 `002

`3174092
10417003 GANG 8/16/2018 9.1
1 0 ARDIANSYAH RESMI `001 `002

`3174091 JL
11213101 ANTARIKS 8/16/2018 17
1 3 ABDUL WAHID A `009 `002

`3174091 JL
11213101 ANTARIKS 8/16/2018 7.8
1 3 ABDUL WAHID A `009 `002
Nurmans `317407050216 Jl m. Kahfi 8/16/2018 9.4
1 yah 0003 5c `001 `002

`317501140317 Jl palem 8/16/2018 9

1 M. Isom 0017 29c `001 `002

`317409160311 JL. MOH 8/16/2018 8.1

1 Riyadi 1058 KAFI 1 `010 `002

Abdul `317409301215 Rawa 8/16/2018 18

1 haris 0026 badak `010 `002
Suparma `317409170412 JL.jambu 8/16/2018 10
1 n 1018 2 `011 `002

`3174091
80314100 8/16/2018
1 7 Samsuri Jl.jambu 2 `011 `002 5
 Vitamin A Vitamin A
Cara Ukur ASI EksklusifF1=YA, 2=Tidak Februari Agustus

1=Telentang umur 0 umur 1 umur 2 umur 3 umur 4 1=YA 1=YA

umur5 bln 2=Tidak
2=Berdiri bln bln bln bln bln 2=Tidak
(20) (21) (22) (23) (24) (25) (26) (27) (28)

1 1 1

1 1 1

2 1 1

1 1 1

2 1 1

2 1 1

1 1 1

1 1 1

2 1 1
1 1 1

1 1 1

2 1 1

1 1 1

2 1 1

2 1 1

2 1 1

2 1 1

1 1 1

2 1 1

2 1 1

2 1 1

2 1 1
1 1 1

2 1 1

1 1 1

2 1 1

1 1 1

1 1 1

1 1 1

1 1 1

2 1 1

2 1 1

1 1 1
Provinsi : : Nama Posyandu
Kabupaten/Kota : : Bulan
Puskesmas/Kecamatan : : Tahun
Desa/Kelurahan :

Kepemilik
an Buku
Berat
Anak Tanggal Lahir Jenis No Kartu NIK (Nomor Induk KIA/KMS
No Nama anak Badan
Ke Kelamin Keluarga Kependudukan) (BB) Lahir
1=YA
2=Tidak
(1) (2) (3) (4) (5) (6) (7) (8) (9)

317409 `317409170714100 Enzo Ammar

1 1 7/17/2014 P 5 Karim 2550 1

Humeira
2 317409
`317409640518000 akhsaninoor
2 5/24/2018 P 1 taqy 2850 1

HUMAIRA
1 317409
`317409630415100 YUMNA
3 4/23/2015 P 4 MAHENDRI 3200 1

MEREDITH
1 317409
`317409250914101 BINTANG
6 8/4/2016 P 0 SERENA 2670 1

2 317409
`317409410816000 AZKIA FAYYOLA
8 8/1/2016 P 8 NADHIFA 2700 1

2 317409 SYAHIRAH
`317409470314100 SEVENNY
10 3/7/2014 P 1 SYAFRIADIN 2550 1

3 317409 `317403420114100 Amira azka

11 1/2/2014 P 3 qonita 2860 1

2 317409 `317409590917000 HASYA ALULA

12 9/19/2017 P 2 RUMAS 2600 1

2 317409
`317409510216000 PUTRI ARSYILA
13 2/11/2016 P 2 AFNAN 3200 1

1 317409 `317409460417000
18 4/6/2017 P 5 Arifah fir rizqi 2750 1

1 317409 `317409440216000 TRIA AYUDYA

21 2/4/2016 P 3 SALAMAH 3000 1
 SHOFIYAH
1 317409
`317409560217000 PUTRI
22 2/16/2017 P 2 MAYANGSARI 2870 1

1 317409
`317409041116000 FAIZ ABDILLAH
28 11/4/2016 P 5 PRATAR 3200 1

2 317409
TALITHA
`317409711214100 AQILAH VELIA
33 12/31/2014 P 2 NURSHAFIYAH 2720 1

DANIA
317409
`330116561015000 AZZAHRA
35 1 10/16/2015 P 2 PRIBADI 3100 1

BILQIS
317409
`317409670914101 SHAFIYAH
37 2 9/27/2014 P 4 SUHANDI 2700 1
317409 `317409640516000 NAFI ATUR
38 1 5/24/2016 P 6 ROHMAH 2800 1
317409 `317106530415100 DANICA
39 2 4/13/2015 P 4 APRILLIA 2700 1
317409 `317409541115100 Isvara Calysta
40 1 11/14/2015 P 0 Almahyra 3100 1

SABRINA
317409 THAFANA
`317409490216000 QANITA
41 1 2/9/2016 P 3 SOFYAN 3600 1

NADHIFA
317409
`317409690813100 KHANSA
43 2 8/29/2013 P 2 AZZAHRA 2850 1

317409 SOFIA ATHALIA

`317409460314100 ANJALI
45 2 3/6/2014 P 7 PURNOMO 3100 1

NAFA
317409
`317409510614100 FAUZIYAH
46 1 6/11/2014 P 5 RAHMAN 2700 1

FARHANNAH
317409
`317409640317000 ZULFA
47 1 3/24/2017 P 4 RAHMAN 2750 1

AISYAH
317409
`317409570615100 FAZARNA
48 2 6/17/2015 P 5 MARYAM 2500 1
317409 `317409440913100 FAKHIRAH
49 1 9/4/2013 P 7 ZAHRA 2800 1
 ALESHA
317409
`317409670415100 ZHAFIRA
50 2 4/27/2015 P 5 WIJAYA 3100 1

317409
`317409420514100 MUTIARA
51 1 5/12/2014 P 3 NAJWA ARASY 3400 1

VANESYA
317409
`317505581113100 ARILIA
52 1 11/18/2013 P 4 SURIAWAN 3100 1
317409 `317409590914101 NAJWA ALDA
56 1 9/19/2014 P 1 WAILISSA 2650 1
317409 `317409431117000 TRI JAMILA
57 2 11/3/2017 P 8 WAILISSA 2800 1
317409 `320323650415000
59 1 4/25/2015 P 3 Sabrina nurizqi 2550 1
317409 `317409460518000 Azrina raisa
60 2 4/6/2018 P 1 salsabila 2700 1

317409
Raisya azkadina
62 2 8/2/2018 P `317409420810007 an nur 3200 1
317409 `317409610814100 ZIFARA ALYA
65 1 8/21/2014 P 7 AZIZA 3000 1
317409 `321104500916000 AQILA ZAHRA
68 2 9/10/2016 P 1 NURAINI 2900 1

317409 THARRA
`317409610215100 SYAURAH
69 2 2/21/2015 P 2 MIRWANSYAH 3140 1

317409 INARA
`317409620217000 SHABRINA
70 1 2/22/2017 P 1 MIRWANSYAH 3200 1
317409 `317409600913100 DAANISH
71 2 9/20/2013 P 5 IRAWAN 2800 1
317409 `317409490117000
72 1 1/9/2017 P 1 NATISYA DHIFA 3800 1
317409 QIANA
73 2 4/16/2016 P 317409 ZAFARANI 4000 1
317409 `317409510818000 KINARA
74 1 8/11/2018 P 1 QUINIDA 2700 1
 FORMULIR PEMANTAUAN PERTUMBUHAN BALITA DI POSYANDU

IMD Tgl
No Tlp/
Nama Ayah NIK Ayah Alamat RT RW Pengukura
HP Ayah n
1=YA,
2=Tidak
(10) (11) (12) (13) (14) (15) (16) (17)

`317409070414 22-18-2018
1 Handoyo 1008 Gg tondo 1 `004 `003

`317409070414 22-18-2018
1 Handoyo 1008 Gg tondo 1 `004 `003

`317409060515 22-18-2018
1 HENDRI 1035 Jl muamalah no 28 b `005 `003

JYMMY `317409250914 RM KAHFI II RT 007/03 22-18-2018

1 ROUSSOS P.P 1010 NO.21a `007 `003

DJAMALUDDI `317409060815 GG.SORO RT 007/03 22-18-2018

1 N 1025 NO.34 `007 `003

JL. M. KAHFI II NO. 005 22-18-2018

SYARIFAH `317409130117 CIPEDAK JAGAKARSA
1 FADLUN 0007 JAKARTA SELATAN `007 `003
`317403311213 22-18-2018
1 Ngatino 1004 JL. Nurul ihsan `005 `003
`317409200417 22-18-2018
1 Fenser rumas 0004 JL. Nurul ihsan `003 `003

`317409190110 22-18-2018
1 Yusdi alfan 0023 JL.M.KAHFI II `005 `003
`317409150416 22-18-2018
1 Riyanto 0024 Jl.m.kahfi 2 `007 `003
`317409210109 22-18-2018
1 TRIYANTO, SH 4874 Jl. Timbul `001 `003
 IDKUN TIMBUL RT. 01/03 NO. 22-18-2018
1 SANJAYA 317409 53 `001 `003

`317409230115 22-18-2018
1 HARYANTO 1031 JL M KAHFI II NO 059 C `007 `003

22-18-2018
NURHADI `317409060614 CIPEDAK RT 007/03
1 NURDIN 1004 NO. 69 `007 `003

RIZKI YUNUS `330116120615 22-18-2018

1 PRIBADI 0003 JL. R moch kahfi no 12 `007 `003

`317409190516 JL.R.MOCH KAHFI II 22-18-2018

1 SUHANDI 0005 NO.71 RT 07/03 `007 `003
IYUT BIN `317409101214 JL.R.MOCH KAHFI II 22-18-2018
1 GOPLE 1020 NO.71 RT 07/03 `007 `003
`317106160710 JL.R.MOCH KAHFI II 22-18-2018
1 WILDAN 0004 NO.71 RT 07/03 `007 `003
HELMI FAIZAL `317409541115 JL. MOCH KAHFI 2 RT 22-18-2018
1 HADI 1000 06 RW 03 NO. 108 `006 `003

22-18-2018
`317409220210 JL. CIPEDAK RT. 07/03
1 AGUS SOFYAN 0031 GG DULJAIM `006 `003

AGUS
NURDIANSYA `317409050913 JL. CIPEDAK RT. 07/03 8/22/2018
1 H 1019 GG DULJAIM `004 `003

22-18-2018
`317409250511 CIPEDAK RT 04/03
1 MAIMUNAH 0015 NO.64 `004 `003

JL. M KAHFI II GG
FATHUR `317409160317 MUAMALA RT 04/03 22-18-2018
1 RAHMAN 0014 NO.90 `004 `003

JL. M KAHFI II GG
FATHUR `317409160317 MUAMALA RT 04/03 22-18-2018
1 RAHMAN 0014 NO.90 `004 `003

ABDUL `317409080113 22-18-2018

1 RAHMAN 1012 Jl. Muamalah II `004 `003
IRFAN `317409240518 Jl MUAMALA IV NO 8/22/2018
1 HIDAYAT 0001 110A `002 `003
 `317409291014 22-18-2018
1 ARIF WIJAYA 1006 Jl timbul no 38A `001 `003

M.ZAZURI
HENDRIYANSY `317409140514 JL. RISIN RT 05 RW 03 22-18-2018
1 AH 1013 NO. 44 `005 `003

JL.M KAHFI 2 RT
`317505290416 007/03 NO.042 8/22/2018
1 EVA WARNI 0013 JAGAKARSA `007 `003
SALEH `317409230915 22-18-2018
1 WAILISSA 1009 JL. R moch kahfi no 72 `007 `003
SALEH `317409230915 22-18-2018
1 WAILISSA 1009 JL. R moch kahfi no 72 `007 `003
`320321090311 22-18-2018
1 Salsa 0069 JL.M KAFFI 2 NO 69 `003 `003
`320321090311 22-18-2018
1 Salsa 0069 JL.M KAFFI 2 NO 69 `003 `003

`317409210109 JL. Nurul iman RT. 22-18-2018

1 Abdul mumin 5508 002/003 n0 91 `002 `003
Zaelani `317409081112 JL. Jl muamala RT. 22-18-2018
1 amsari 1005 001/003 no 084 `001 `003
`321104090516 JL. MUAMALAH 3 NO 22-18-2018
1 RUSYADI 0006 026 A `004 `003

22-18-2018
WAWAN `317409190814 JL. MOCH KAHFI II RT
1 MIRWANSYAH 1004 01 RW 03 NO. 4 `001 `003

22-18-2018
WAWAN `317409190814 JL. MOCH KAHFI II RT
1 MIRWANSYAH 1004 01 RW 03 NO. 4 `001 `003
`317409210109 JL.MUAMALAH RT 8/22/2018
1 ERIK IRAWAN 7882 002/03 `002 `003
RISKI `317409041116 22-18-2018
1 NURDIANA 0018 JL.M KAHFI 2 `001 `003
AGUS `317409040111 JL. CIPEDAK RT 01/03 22-18-2018
1 SUTARNO 0061 no91 a `002 `003
AGUS `317409040111 JL. CIPEDAK RT 01/03 22-18-2018
1 SUTARNO 0061 no91 a `002 `003
 Panjang Vitamin A
Cara Ukur ASI EksklusifF1=YA, 2=Tidak
Badan/ Februari
BB (kg) Tinggi
Badan
(cm) 1=Telentang umur 0 umur 1 umur 2 umur 3 umur 4 1=YA
umur5 bln 2=Tidak
2=Berdiri bln bln bln bln bln
(18) (19) (20) (21) (22) (23) (24) (25) (26) (27)

20
2 1

7
1 1

14
2 1

15.4
2 1

14.3
2 1

22.5

2 1

23
2 1

8
1 1

16
2 1

9.2
1 1

15.8
2 1
8.5
1 1

13
2 1

17

2 1

15.3 2 1

17 2 1

14.5 2 1

17 2 1

16.8 2 1

16.5 2 1

22 2 1

19.2 2 1

16.4 2 1

10 1 1

15 2 1

21.6 2 1
 18.3 2 1

15.2 2 1

20.5 2 1

14.7 2 1

8 1 1

17.5 2 1

8.2 1 1

3.5 1 1

15.8 2 1

12.6 2 1

19.2 2 1

12 1 1

24 2 1

12.5 1 1

15 2 1

3.2 1 1
Vitamin A
Agustus

1=YA
2=Tidak
(28)

1
1

1
1

1
Provinsi : : Nama Posyandu
Kabupaten/Kota : : Bulan
Puskesmas/Kecamatan : : Tahun
Desa/Kelurahan :

Kepemilik
an Buku
Berat
Anak Tanggal Lahir Jenis No Kartu NIK (Nomor Induk KIA/KMS
No Nama anak Badan
Ke Kelamin Keluarga Kependudukan) (BB) Lahir
1=YA
2=Tidak
(1) (2) (3) (4) (5) (6) (7) (8) (9)

317409 MUHAMMAD
`317409190115100 ARKANA
1 1 1/19/2015 L 8 DEWANSYAH 3200 1

2 317409
`317409150416000
2 4/15/2016 L 1 Ade arfa sulaiman 2400 1

1 P 317409
`317409440514100 SHOFIYAH ADWA
3 5/4/2014 5 UFAIRAH 2700 1

1 P 317409
`317502660414100 AQILAH
4 4/26/2014 8 KHAIRATUNNISA 2800 1

1 L 317409
`317409071015100 MUHAMMAD
5 10/7/2015 2 ARSYIL AZHIIM 2700 1

1 L 317409
`317409300115100 MUHAMMAD
6 1/30/2015 4 WIRABUMI 3100 1

2 L 317409
`330708200714000 AFTA VICKY
7 7/20/2014 4 ARMADANI 3600 1

1 L 317409
8 1/2/2015 317409 M buston L firdaus 3450 1
 1 P 317409
`317409471016000 BUNGA SYAKILA
9 10/7/2016 4 MAHARANI 2850 1

1 L 317409 `167106200516000
10 5/20/2015 5 M Alby namora 3870 1

2 P 317409
`317409510714100 AQILA MUHRA
11 7/11/2014 3 KARAMAYA 3100 1

2 P 317409 `317409660118000
12 1/26/2018 2 Eliyah talita inayah 2500

1 L 317409
`317409270317000 Muhammad raffa
13 3/27/2017 5 azkaputra 4000 1

ABIDAH
1 L 317409
`317408501215000 BASSAMAH AL
14 12/10/2015 2 KHON 3000 1

1 317409
`317409070417000 King Zamzam
15 4/7/2017 L 5 Purbowo 2400 1

2 317409
`317409440718000 El Rryona
16 7/4/2018 L 2 Alexandra Pratam 2500 1

2 317409

`317408591217000 ALIR TEMATA

17 12/19/2017 P 7 SIMPUH 2600

1 317409

`317406421214100 PUTI HADYA

18 12/2/2014 P 4 ARUNDATI 2800 1

1 317409
ZHERINA
`317409610218000 QUEENSHA
19 2/21/2018 P 2 TIANTA 2800
 1 317409

`327609650614000 ZARA NAJLA

20 6/25/2014 P 2 QOSAMAH 2750 1

2 317409

`317409271014101 MUHAMMAD
21 10/27/2014 L 0 RIZKI ALFARIZI 2840 1

1 317409
MUHAMMAD
`317409061017001 FARHAN
22 10/6/2017 L 1 FIRMANSYAH 2600 1

2 317409

`317409510615100 BALQIS
23 6/11/2015 P 7 ALFATHONY 2500 1

1 317409
`317404621015100 FARISYA KHANSA
24 10/22/2015 P 2 HAFIZHAH 3100 1

2 317409

`317403071115000 RIZKY ABID AQILA

25 11/7/2015 L 3 PRANAJA 2800 1

1 317409
`317404210415100 MUHAMMAD
26 4/21/2015 L 1 AZZAM SULTHONI 2750 1

3 317409

`317409410915100
27 9/1/2015 P 3 JITA SARI HIDAYAH 2650 1

2 317409

`317409190318000 Muhamad padli

28 3/19/2018 L 5 hidayat 3600 1
 1 317409
`317403110713100 MUHAMMAD
29 11/7/2013 L 6 NATHAN AL FATIH 2700 1

1 317409
`317403701117000 NUMA SYAHIRA
30 11/30/2017 P 3 MAHARANI 2750

1 317409 MUHAMMAD
`317409190115100 ARKANA
31 1/19/2015 L 8 DEWANSYAH 2500 1

2 317409
`317409150416000
32 4/15/2016 L 1 Ade arfa sulaiman 2800 1

1 317409
`317409440514100 SHOFIYAH ADWA
33 5/4/2014 P 5 UFAIRAH 3100 1

317409
`317502660414100 AQILAH
34 2 4/26/2014 P 8 KHAIRATUNNISA 3400 1

317409
`317409071015100 MUHAMMAD
35 1 10/7/2015 L 2 ARSYIL AZHIIM 3100 1
317409 `317407680813100
36 1 8/28/2013 P 4 SYIFA AINUNNISA 2700 1

317409
`317409300115100 MUHAMMAD
37 1 1/30/2015 L 4 WIRABUMI 4000 1

317409
`330708200714000 AFTA VICKY
38 1 7/20/2014 L 4 ARMADANI 2800 1
317409 `999999999999999
39 2 1/2/2015 L 9 M buston L firdaus 2710 1
317409 `167106200516000
41 1 5/20/2015 L 5 M Alby namora 2550 1
317409 `317409301113100 NAUFAL KHALIIL
42 1 11/30/2013 L 2 AFKAR 2600 1

317409
`317409460215100
43 1 2/6/2015 P 02 Kayla paradisha 3100 1
 317409 `317409701113100 FAGHIRAH GHAZI
44 2 11/30/2013 P 6 HANIFAH 2650 1

317409

`317409540514100 FANIA AYUDIA

45 1 5/14/2014 P 9 INARA 2800 1

317409
`317409491016000 RIANI ANINDYA
46 2 10/9/2016 L 5 OKTAKINA 3000 1
317409 `317406500115100 PUTRI AQILLA
47 1 1/10/2015 P 4 AZZAHRA 2550 1
317409 `317409670915101 RIEZCHA SHALSHA
48 2 9/27/2015 P 0 BIELA 2700 1
317409 `317409181017000
49 1 10/18/2017 L 7 fikriansyah 2800 1

317409
ARKHAIRAN
`317409061015100 ATHALLAH
50 2 10/6/2015 P 7 KUSUMA DINATA 3200 1

317409

`317407300913100 ALWI HAUZAN

51 1 9/30/2013 P 1 SAKHI 2800 1

317409

`317409500614100 Adinda Fayola

52 1 6/10/2014 P 1 Dyah Maheswari 3550 1

317409

`317409471216000 DYEVA AYUDIA

53 1 12/7/2016 P 3 GAYATRI 3000 1

317409
`317409560614100 SYAFFIYYA RAHMA
54 2 6/16/2014 P 2 NUR RABBANI 3800 1

317409
`327504190916002 KENAR GIATRI
55 2 8/18/2017 P 8 QUKARASENJA 2800
 317409 `317409410615100 KAANA BIE
56 2 6/1/2015 P 1 HAFIYYA 3150 1
317409 `317409250417000 Muhammad isyqi
57 1 4/25/2017 L 1 alie 3200 1

317409
`317409650917001 KANZIA AZMYA
58 1 9/25/2017 P 0 RAISA 3100

AUBREE
317409
`317403491017000 RAMADHANI
59 1 10/9/2017 P 4 IRAWAN 3200

317409
`317409030515100 MUHAMMAD
60 2 5/3/2015 L 3 AHSAN 3800 1

317409
`317409220816001 ZAKARIA AHMAD
61 1 8/22/2016 L 1 ARYA 2870 1

317409 MUHAMAD
`317409110716000 AKMALUDIN
62 2 7/11/2016 L 2 SAHID 2900 1
317409 `317409670115100
63 1 1/27/2015 P 1 Aisyah aulia 2700 1

317409
`317409510916000 MALIKHA AZARINE
64 2 9/11/2016 P 4 NAFISA 3200 1

317409
`317409070117000 MAHESA NARAIN
65 1 1/7/2017 L 2 ANDRIANTO 3100 1
317409 `317409101216000 ZANDAM HAKAM
66 1 12/10/2016 L 7 ARSYAD 2900 1

anggun
317409
`317202620715100 khairunnisa
67 1 7/22/2015 P 7 priatna 2850 1

KINANTI
317409
`317202560817000 MAHAJENG
68 2 8/16/2017 P 4 PRIATNA 2800
317409 `317409171214100
69 2 12/17/2014 L 1 abdira dirga 3500 1
317409 `317409111016000 REZA AHMAD
70 1 10/11/2016 L 6 ZAHID 2800 1

MUHAMAD
317409
`327606260515000 AZZAM
71 1 5/26/2015 L 6 NURFATTAH 2760 1
 317409
`317409620914100 SHEINNA BERLIAN
72 1 9/22/2014 P 7 AZ ZAHWA 2600 1
317409 `317409490117000
73 2 1/9/2017 P 3 Khalisa ruby 2750

317409

`317409191016000 MUHAMMAD
74 1 10/19/2016 L 1 AZKA HAZIQ 2900 1

317409

`332807200216000 MUHAMAD RASYA

75 1 2/20/2016 L 2 WASANAH PUTRA 3200 1

317409
`317409470813100 NADIFA NAURA
76 1 8/7/2013 P 5 RAMADHANI 3200 1

317409
`317409651116000 Naura indriyani
77 2 11/25/2016 L 7 muchtar 3800 1

317409

`317406640615100 QAIREEN NAYSA

78 1 6/24/2015 P 6 KHADIJAH 3200 1

317409

`999999999999999
79 1 9/1/2016 L 9 Zerlina najima a 2850 1
317409 `317409250816000 NUR AFIF
80 2 8/25/2016 L 5 PRATAMA 2450 1

317409
`317409140715100 FARIEL ARGANTA
81 2 7/14/2015 L 5 DARMAWAN 2720 1

317409
`317409080417000 KAIO ARYASATYA
82 1 4/8/2017 L 1 DARMAWAN 2900 1
317409 `317409010116000 JEVIN ADEL
83 1 1/1/2016 L 7 ABQARI 3100 1
317409 `317401080217000 Mahathir amimar
84 1 2/8/2017 L 2 huzein 2800 1
 317409 `317409290916000 Farhan abdul
85 2 12/18/2016 L 3 kholid 3700 1

RANDY
317409
`317409070616000 ZURAMDHAN
86 1 6/7/2016 L 5 WAHYUDI 3000 1
317409 `317505510215101
87 2 2/11/2015 P 1 NAURA AZQIARA 2650 1
317409 `317409570216001 CHINTYA
88 1 2/17/2016 P 3 FEBRIYANI 3500 1

317409
`327602170314000 FAKHRI ZHAFRAN
89 2 3/17/2014 L 6 KHAIRY 2800 1

317409
`317409590515100 KHUMAYRO
90 1 5/19/2015 P 6 HUJJATUL AULIYA 2800 1

317409
`317409590418000 MEDINA
91 1 4/19/2018 P 4 IZZATUNNISA ARFI 3100 1
317409 `317403050814100 MUHAMMAD
92 2 8/5/2014 L 1 AFFAN ALFARIZI 2860 1
317409 `317409271213100 Muhammad
93 1 12/27/2013 L 5 Raihan Arganta 3500 1
317409 `317404680614100
94 2 6/28/2014 P 1 relina defi arum 2750 1
317409 `317409200514101 FAHRIE ZHAFRAN
95 1 5/20/2014 L 0 ZABIDI 3620 1
317409 `320406190514000 MUHAMMAD
96 2 5/19/2014 L 1 HABIBI AL FARIZI 2800 1

Zufar
317409
`317409070813100 fadlurrahman
97 1 8/7/2013 L 1 fitrah 2700 1

317409
`317409190913100
98 2 9/19/2013 L 9 ABDUL KHOIR 2650 1

317409
`317409431013100 AFIFAH NUR
99 2 10/3/2013 P 4 HIDAYAT 3250 1
317409 `317409290118000 ARSYA MARTA
100 1 1/29/2018 L 2 PRATAMA 3000 1

317409
`317107590615100 LEXA MARISA
101 1 6/19/2015 P 2 PUTRI CAHAYA 3400 1

317409
`317409630614100
102 1 6/23/2014 P 3 NUR AISYAH 2800 1
 317409
`317409700716000
103 2 7/30/2016 P 1 NUR FAUZIAH 2930 1
317409 `317409700318000 AYRA GENDIS
104 1 3/30/2018 P 3 KAHIYANG 2650

317409
`317407140216000 MUAZZAM FAIQA
105 2 2/14/2016 L 2 ALKHALIFI IZLAMI 2780 1

PRADIFTA
317409
`317409200814101 GUSTIAN
106 1 8/20/2014 L 0 PRATAMA 2900 1

317409
`331401550516000 NAOMI AYUNDA
107 2 5/15/2016 L 1 PUTTY 3140 1
317409 `317409010814100 ABIZAR AL GHIFARI
108 1 8/1/2014 L 1 SYAWAL 3200 1
317409 `317409140815100 ATHAR RIZKY
109 1 8/14/2015 P 3 YUDHISTIRA 2800 1

317409
`317409200916000
110 2 9/20/2016 L 4 PANJI ALVIANSYAH 3800 1

317409
`317409030617001 MUHAMMAD
111 1 6/3/2017 L 2 SULTAN HARIRI 4000 1

317409

`317409601113100
112 1 11/20/2013 P 1 KAYLA ANINDITA 2700 1

317409

`317409470116000 HANIFA INARA

113 1 1/7/2016 P 7 ANJANY 2700 1

317409

`317409020517000 ATHALLAH
114 2 5/2/2017 L 9 ALKHALIFI 3500 1

317409
`999999999999999 ATHAR MAUZA
115 1 7/17/2018 L 9 SATRIA 4000 1
317409 `317404470317000 Shofie annaila
116 1 3/7/2017 P 3 zahirah 2800
 317409
`317405530116000 ALESHA KHAYRA
117 2 1/13/2016 P 6 SYAIFA 2840 1

317409
`317409151213100 Alhafiz Shaquille
118 1 12/15/2013 L 3 Nizam 3800 1

317409
`317409450714100 AISYAH SYAKIRA
119 2 7/5/2014 P 3 RAMADHANI 3100 1

317409
`317409280115100 AHMAD IBNI
120 1 1/28/2015 L 2 RIANSAH 3260 1

317409
`317409300514100 MUHAMAD
121 2 5/30/2014 L 1 SYAHBANI RIZKI 2800 1

317409
`317409111115100 RAFFA FAUZAN
122 1 11/11/2015 L 9 SYAHPUTRA 2600 1

317409
`317409431114100
123 1 11/3/2014 P 2 NAFLA SYAKIRA 3200 1

317409
`330912060115000 MUHAMMAD
124 2 1/6/2015 L 4 IQBAL MAULANA 3200 1

317409
`317409251216000 ARTANABIL AZKA
125 1 12/25/2016 L 4 ALGHIFARI 2750 1

317409

`332703470815000 KHAFIZA NUR

126 2 8/7/2015 L 3 SHAFANA 2470 1

317409
`317409160414100
127 2 4/16/2014 L 9 AHMAD FAKRI 3000 1
 317409 `317409570417000
128 1 4/17/2017 P 5 DIANA SYAUQIAH 3100

317409

`317409640714100 INDAH NUR

129 2 7/24/2014 P 7 RAHMADANI 2750 1

317409

`327604610714000 ADELA SYAIDA

130 1 7/21/2014 P 2 RAMADHANI 2380 1

317409

`317409710115100 GHAZEA SAKA

131 1 1/31/2015 L 4 SAFALUNA 2800 1

317409
`999999999999999 HENSA TAMA
132 2 2/18/2018 L 9 SAJARI TANJUNG 3000 1

317409

`317405250116000
133 1 1/25/2016 L 4 RIZKY MAULANA 2870 1

317409

`320233700617000 TIARA LARASATI

134 1 6/30/2017 P 2 AZMI 3200

317409
`111608550416000
135 2 4/15/2016 P 2 khairin nazila arsyil 2500 1

317409

136 1 9/18/2017 P KHALISA AZWA 3200

317409 MUHAMMAD
`317409070416000 ARKA RAJENDRA
137 2 4/7/2016 L 4 ARRAFA 2600 1
 317409

`317409460718000 MIKHAYLA ADARA

138 1 7/6/2018 P 2 KAMILA 2800
317409 `317409421117000 Syafiqa azmya
139 2 11/2/2017 P 7 ashalina 2700
317409 `317409630317000
140 1 3/23/2017 P 7 Alifah Azahra 2750
317409 `317409140714100
141 2 7/14/2014 L 2 HAIDAR ALFAQIH 2780 1
317409 `317409500716000
142 1 7/10/2016 P 8 Alesha Azra Syafitri 2750 1

317409 ABYAN
`317409070217000 ARYAPUTRA
143 1 2/7/2017 L 3 AMINUDDIN 2680 1
317409 `317409020715100 umar abrisam al
144 1 7/2/2015 L 5 fajr 3000 1
317409
145 1 4/2/2018 P 3174094204180001 AISYAH 2600 1

317409
`317409530314100 ZAHRA ALMAIRA
146 1 3/13/2014 P 2 NAFISA 2700 1

317409

`317409220517000 Syaban halimun

147 1 5/22/2017 L 9 hanif 3700 1

317409

`317409540117000
148 1 1/14/2017 P 2 Gea auliana badri 2900

317409

`317409020215000 muhammad ar
149 2 2/2/2016 L 3 rafid ardhania 3250 1
 317409

`317404180914100
150 1 9/18/2014 L 4 Athar rizky haikal 2600 1
317409 `317401541113100 ALISHA SAHIRA
151 1 11/14/2013 P 3 FARACH 2550 1
317409 `317102310715100
152 1 7/31/2015 L 2 GHANI JHONG 2740 1
317409 `352212271217000 calon bayi ny
153 1 2/12/2018 L 4 robiatul 2800 1

317409
`317409700116000 NAYYARA AQUILA
154 1 1/30/2016 P 8 AZZAHRA 2800 1

SALMA
317409
`317409640616000 RAHMADANI
155 1 6/24/2016 P 4 ALGHANJURY 2950 1
317409 `321617610515000 Meisya vania
156 1 5/21/2015 P 1 azzahra 3150 1
317409 `332803700315000
157 2 3/30/2015 P 1 Kiviyatus sakila 2800 1
317409 `317404440415100
158 1 4/4/2015 P 3 SHAKIRA AZZALEA 2750 1
317409 `317409040718000 ABIARSHA
159 2 7/4/2018 L 3 PRADIPHA 3100 1
317409 `317409660414100 talitha
160 1 4/26/2014 P 6 candraningtyas 2800 1

317409
`317409440914100 AISHA TALITA
161 2 9/4/2014 P 4 SAKHI 3420 1

317409
`317409520114100 AQEELA FATHIA
162 1 1/12/2014 P 7 SJAHRAN 3800 1

317409
`317406250914100 MUHAMMAD
163 2 9/25/2014 L 2 AZZAMI 3400 1

317409
`317409060615100 TEUKU AHMAD AL
164 1 6/6/2015 L 2 AZZAM 2700 1

317409
`317409210916000 REVINZA FATHUL
165 2 9/21/2016 L 5 MURDIYANTO 3100 1
 317409
`317409210515100 ALBY DAMA
166 1 5/21/2015 L 1 PUTRA 2700 1

317409
`317409260417000 ARKHA MULYA
167 1 4/26/2017 L 8 PUTRA 3209 1

317409
`317409540414100 Aldila ghania
168 1 4/14/2014 P 1 khanza 3650 1

317409
`317409701215000 KAISA DZAHIN
169 2 12/30/2015 P 4 SASMITA 3100 1

317409
`317409250717000 AL FATH KAAMIL
170 1 7/25/2017 L 3 SASMITA 2540 1
317409 `317104601216000 MIKHAYLA ZAHSY
171 2 12/20/2016 P 4 ARIFIN 3400 1

317409
`317410120616000 MUHAMMAD RIKO
172 1 6/12/2016 L 2 HANAFI 2700 1

317409
`317410480817000 HANANIA NUR
173 3 8/8/2017 P 3 AZIZAH 3100

317409
`317409240914100 MUHAMMAD
174 2 9/24/2014 L 5 VIRZA ALGIBRAN 3200 1
317409 `317409570614100
175 3 6/17/2014 P 6 ALICIA KHADIJAH 2850 1
317409 `317409100317000
176 1 3/10/2017 L 3 SEAN ALI 3500 1

317409

MUHAMMAD
177 1 7/13/2017 L 3174091307170001 FIKRI AL BUKHORI 3400 1
317409 `317409521015100 SHOFIA
178 2 10/12/2015 P 8 NURLATIFAH 2500 1

317409

`317409050917000 EMIER KHALIF

179 3 9/5/2017 L 3 SETIAWAN 2780 1
 317409
`317409230614100 MUHAMMAD
180 1 6/23/2014 L 6 NAZRIL FADHILLAH 2900 1

317409

`317409080417000 CHENOA DWIBUDI

181 2 4/8/2017 L 5 RABBANI 3450 1

317409
`317409641017000
182 3 10/24/2017 P 9 Keyla ailia az-zahra 2500

317409
`317409481114100
183 1 11/8/2014 P 4 ZABINA SALSABILA 3200 1

317409

`317404070614100 RAKHA ADITYA

184 2 6/7/2014 P 8 PUTRA 3850 1

317409

`317401570515100 REYNA KHALIQA

185 2 5/17/2015 P 4 ZAHIN 2650 1

317409

`317401080717000 Muhammad
186 1 7/8/2017 L 5 zaidan rahsya 2600 1
317409 `317409550214100 ALISIA CATUR
187 2 2/15/2014 P 9 MULIA 3600 1

GILANG
317409
`317403130614100 RAMADHAN
188 1 6/13/2014 L 3 KIBERLY 2750 1
317409 `317409020816000
189 1 8/2/2016 L 8 ananda dwi irawan 2600 1
317409 `317409641116000 Shanum adzra
190 3 11/24/2016 P 1 dafiya 3100 1
317409 `317409030717000 Nur Ali
191 2 7/3/2017 L 3 Rahmansyah 3100 1
 317409
`317409211014100
192 1 10/21/2014 L 4 JOKO WIDODO 2800 1

317409
`317409060914100 TUBAGUS ALDRICH
193 2 9/6/2014 L 7 ALFARIZI 2750 1

MUHAMMAD
317409
`317409110216000 SUHAIL
194 1 2/11/2016 L 7 ALFACHRIZZI 3200 1

317409
`317409200118000 Muhammad Danar
195 2 1/20/2018 L 9 shidqi 2870 1

317409
`317409290814100 Azzamy Sauqy
196 1 8/29/2014 L 4 Akbar 3200 1
317409 `317409011013101 FABRIAN ALEXY
197 1 10/1/2013 P 2 OCTOVIANSYAH 2600 1
317409 `317409470114100 zahra almaira
198 1 1/7/2014 P 9 rahmawati 2750 1
317409 `110805271213000 Muhammad anza
199 2 12/27/2013 L 1 pratama 2840 1
317409 Anzanabiya
200 2 7/1/2018 L 3174090107180001 syakeena 2700 1
317409 `317409111017001
201 2 10/11/2017 L 0 Muhammad al fath 2800 1
317409 `317409601215000 ALIFAH SYATI
202 1 12/20/2015 P 1 MAULIDA 3200 1

WILONA
317409
`317409491115100 CHARLOTTE
203 2 11/9/2015 P 3 SIANTURI 2800 1
317409 `317507420414101
204 1 4/2/2014 P 3 Anthea 3200 1
317409 `317406561213100
205 2 12/16/2013 L 4 Adila azzahra 3300 1

317409
`317409160714100
206 1 7/16/2014 L 4 rifki naufal saputra 2750 1
317409 `317403670614100
207 1 6/27/2014 P 6 HANINDA AULIA 2750 1

317409
`317505650614100 NESYA NAFIZAH
208 1 8/25/2014 P 6 AFDI 3550 1
 317409
`317409100318000 Muhammad al
209 2 3/10/2018 L 8 fatih 3240 1

317409
`331019530517000 Adibah alisha
210 2 5/13/2017 P 1 zahra 2650
317409 `317403490214100 Aufa makaila
211 2 2/9/2014 L 1 Kamania 2500 1

317409
`317108161014100 SILO SEIN SHALOM
212 1 10/16/2014 L 4 PURBA 2550 1
317409 `317409410914100 RAFIFA AISHA
213 1 9/1/2014 P 3 MAHERA 2850 1

317409

`317409150414100 MUHAMMAD
214 2 4/15/2014 L 1 YAZID HUSSEIN 3200 1
317409 `330217220114000 MUHAMAD ALWI
215 1 1/22/2014 L 2 AHNAF 3100 1

317409
`317403260714100 MUHAMMAD
216 2 7/26/2014 L 2 ALAWI 3420 1

317409
MALIQ
217 1 8/28/2017 L 3174092808170001 ALBIRRUHADIT 2670 1

317409
`317409020816000 ZAFRAN MALIK AL
218 1 8/2/2016 L 3 FATIH 2900 1

317409
`330708630814000 ASHILLA NAURA
219 1 8/23/2014 P 1 ARSY 2700 1

317409
`317409040415100 GHATAN
220 2 4/4/2015 L 2 AMRULLAH SYAFIQ 2800 1

317409
`317409420414100 RAISYA PUTRI
221 1 4/2/2014 P 4 APRILIA 2550 1

317409
`317409091115100 MUHAMMAD
222 1 11/9/2015 L 3 AGHA RAFAEL 2400 1
 317409
`317409480716000 ANINDYA DIVA
223 1 7/8/2016 P 3 KAMILA 2800 1
317409 `317409110416000 muhammad sakhi
224 2 4/11/2016 P 2 anam 2950 1
317409 `327606620317000 AZZAHRA QAILLA
225 1 3/22/2017 P 1 AISYAHRI 2700 1

317409
`320509160615000 FAJAR RAMADHAN
226 1 6/16/2015 L 5 PUTRA 2450 1

317409
`317408210617000 MUHAMMAD
227 2 6/21/2017 L 7 FATIH RAMADHAN 3000 1
317409 `317409170217000
228 1 9/8/2017 P 7 Danu ali aditama 3200
317409 `317409701214100 TSANIAH NUR
229 2 12/30/2014 P 4 ASHERA 3200 1
317409 `317406661014100 DZALIKA AUFA
230 1 10/26/2014 P 6 NABELLA 3600 1

317409
`317409490615100 AISYAH PUTRI
231 1 6/9/2015 P 2 SALSABILA 2650 1
317409 `320515070514000
232 1 5/7/2014 L 2 M RECHAN 2800 1
317409 `320515681115000
233 2 11/28/2015 P 1 SABITA SYFA 3200 1
317409 `317409270916000
234 2 9/27/2016 P 4 hildan gunawan 2500 1
317409
235 1 8/31/2013 P 3174097108130001 CINDY AINI NOOR 2500 1

317409
`317509150615100 GANESHA GILANG
236 1 6/15/2015 L 2 HABIBIE 2670 1
317409 `351515520494000 Muhammad Uwais
237 1 9/12/2017 L 6 Al Fatih 2800 1

317409
`317409540714100 Zahrana Alika
238 2 7/14/2014 P 2 Syabani 2800 1

317409
`317409290516000 ERGA RADITYA
239 1 5/29/2016 L 8 PUTRA 2650 1

317409
`317409180614100 Aditya
240 2 6/18/2014 L 4 Ainnurachman 2600 1
 317409
241 1 1/1/2018 P 3174094101180001 Gafrilla 2550 1

317409
Rizky Herdian
`317409051017000 Syahputra
242 2 10/5/2017 L 4 wicaksono 3200 1

317409
`317409650216000 GENDHIS HANUM
243 1 2/25/2016 P 4 RAFIFA 3300 1

317409
`317409640518000
244 2 5/24/2018 P 3 GEA ANDINI 2700
317409 `317409500215100 KHANZA AZURA
245 2 2/10/2015 P 5 NASYWA 2700 1
317409 `317409190115100 MUHAMMAD
246 1 1/19/2015 L 4 INAMUL FATIH 3100 1
317409 ABIDAH DANIAH
247 1 5/25/2018 P 3174096505180001 RAMADHANI 2750

317409

`317409480416000 ALFINA
248 1 4/8/2016 P 5 DhAMAYANTI 3400 1

317409
`330110470813000 BUNGA FITRIA
249 1 8/7/2013 P 2 AZZAHRA 3200 1

317409

250 2 5/26/2018 L 3174092605180001 JUNA NARENDRA 2700 1

317409

`317409041013100
251 1 10/4/2013 L 2 ABRIZAM IRZA 3350 1

317409

`317404690715100 AISYAH QANITA EL

252 2 7/29/2015 P 6 HAQ 2860 1
 317409

`317409601116000
253 1 11/20/2016 P 3 DALIYAH PUTRI 2600 1

317409
QUEENSHA
`317409560618000 SYAREEFA
254 2 6/16/2018 L 1 AFSHEEN 3000 1

317409

`317409091116000 affan
255 2 11/9/2016 P 1 dhiaurrahman 3100 1

317409

`317409430813100
256 1 8/3/2013 P 4 ZAYTA AL JANNA 2600 1

317409
`317409661013101 ALEYZA MADANIA
257 1 10/26/2013 P 2 AZKAYLA 2750 1

317409
`317409040216000
258 1 2/4/2016 L 5 DAFFA ILYASA 2780 1

317409
`317404471115000
259 2 11/7/2015 P 1 NAYSILA AZHARI 2750 1
317409 `317409270215100 ALKHALIFI ZIKRI
260 1 2/27/2015 L 5 HAMIZAN 2600 1

317409
`317409651113100 HAJAH RACHEL
261 1 11/25/2013 P 5 QONITA 3100 1
 FORMULIR PEMANTAUAN PERTUMBUHAN BALITA DI POSYANDU

IMD Tgl
No Tlp/
Nama Ayah NIK Ayah Alamat RT RW Pengukura BB (kg)
HP Ayah n
1=YA,
2=Tidak
(10) (11) (12) (13) (14) (15) (16) (17) (18)

JL. 8/18/2018 15
ANDRI `317409200109 PERSAHA
1 HERMAYADI 8464 BATAN 3 `011 `004

JL WR
SILAH NO 11.4
`317409090215 88 RT
1 ADE SULAEMAN 1009 11/04 `011 `004

JL.
`317409021110 PERSAHA 8/18/2018 13.5
1 WALUYO BASUKI 1007 BATAN `001 `004

JL.
MUHAMAD JUNS `317502070710 PERSAHA 8/18/2018 14
1 JUNISPU 0088 BATAN `001 `004

JL. 8/18/2018 13.4

`317409100310 PERSAHA
1 MUSA 0011 BATAN 3 `001 `004

MUHAMMAD JL. 8/18/2018 15.8

ISNAENI `317409130111 PERSAHA
1 SAIKHURAHMAN 0072 BATAN 7 `013 `004

JL
DANANG `330708050515 persahab 16.8
1 MUSTOFA 0004 atan `013 `004
`317409020518 Jl.warung 8/18/2018 16
1 SYUKRON 0019 sila 1 `002 `004
 JL.
AMSAR 8/18/2018 9
AGUS `317409100316 RT 12 RW
1 SUPRIYANTO 0003 04 `002 `004
DESVIANTY `999999999999 8/18/2018 13.1
1 AMELIA 9999 JL H Nuh `002 `004

JL
`317409230113 PERSAHA 8/18/2018 15.2
1 Yaya sugiana 0002 BATAN `011 `004
`317409260511 JL. Batu 8/18/2018 8
Wahyudi 1036 belah 1 `013 `004

JL.
`317409200109 PERSAHA 8/18/2018 9
1 Imam radji 9894 BATAN `001 `004

`317409280717 JL. Bhakti 8/18/2018 14.5

1 Neneng mulya 0015 89 `001 `004

VISKAYA JL. DAMAI 8/18/2018 10

PURBOWO `317409200109 74 RT
1 HENTYADI 7263 009/04 `009 `004

RIZA WAHYU `317409220518 8/18/2018 3.2

1 PRATAMA 0015 No. 120 `012 `004

JL.
PERSAHA 8/18/2018 8.5
BATAN
WAHONO WAHYU `317408211112 No.4 B
DEWANTO 1009 RT. 11/04 `011 `004

JL.
PERSAHA 8/18/2018 13.2
BATAN
RAYA No.
`317406070910 117 RT.
1 JOKO WIDODO 1009 11/04 `011 `004

RT. 01/04 8/18/2018 6.8

No. 027 B
`317409200813 jl. Buni
AGUSTIAN 1020 Buntu `001 `004
 RT. 01/04 8/18/2018 14.8
No. 027 B
`317409200813 jl. Buni
1 AGUSTIAN 1020 Buntu `001 `004

RT. 01/04 17
No. 058
HILWAN `317409100914 jl. Bhakti
1 SETIAWAN 1021 89 `001 `004

RT. 01/04 8/18/2018 9.2

No. 058
HILWAN `317409100914 jl. Bhakti
1 SETIAWAN 1021 89 `001 `004

Jl.
WARUNG 8/18/2018 13.2
SILA
`317409220615 RT.02/04
1 SUDIR 1012 No. 140 `002 `004

`317404171115 8/18/2018 12.3

1 AHMAD FAUJI 1008 No. 64A `005 `004

8/18/2018 10
JL WR
`317489130218 SILAH GG
1 Muchlis 0028 SAAMAN `003 `004

Jl.
ZAID AKHMAD `317404260215 Rindang 8/18/2018 15.3
1 SYULTONIE 1010 No. 36 `005 `004

JL.
PERSAHA 8/18/2018 13
BATAN RT
`317409301211 11 RW 4
1 MARTUA 1053 NO. 12 `011 `004

JL.
PERSAHA 8/18/2018 7
BATAN RT
`317409301211 11 RW 4
1 MARTUA 1053 NO. 12 `011 `004
 JL WR
SILAH NO 8/18/2018 14
SANDI `317403200313 88 RT
1 KURNIAWAN 1014 11/04 `011 `004

JL WR
SILAH NO 8/18/2018 7.5
SANDI `317403200313 88 RT
KURNIAWAN 1014 11/04 `011 `004

JL. 8/18/2018 14.7

ANDRI `317409200109 PERSAHA
1 HERMAYADI 8464 BATAN 3 `011 `004

JL WR
SILAH NO 13.2
`317409090215 88 RT
1 ADE SULAEMAN 1009 11/04 `011 `004

JL.
`317409021110 PERSAHA 8/18/2018 15.6
1 WALUYO BASUKI 1007 BATAN `001 `004

JL.
MUHAMAD JUNS `317502070710 PERSAHA 8/18/2018
1 JUNISPU 0088 BATAN `001 `004 17.5

JL. 8/18/2018
`317409100310 PERSAHA
1 MUSA 0011 BATAN 3 `001 `004 16
SYAFRI BIN `317407120109 JL. BAKTI
1 HAMDANI 5712 89 `001 `004 ### 15.2

MUHAMMAD JL. 8/18/2018

ISNAENI `317409130111 PERSAHA
1 SAIKHURAHMAN 0072 BATAN 7 `013 `004 15.3

JL
DANANG `330708050515 persahab
1 MUSTOFA 0004 atan `013 `004 20
`317409020518 Jl.warung 8/18/2018
1 SYUKRON 0019 sila 1 `002 `004 16.2
DESVIANTY `999999999999 8/18/2018
1 AMELIA 9999 JL H Nuh `002 `004 14.5
JUNAEDI `317409140611 WARUNG 8/18/2018
1 ABDILLAH 1060 SILAH `002 `004 14.7

JL
MOHAMMAD `317409211114 persahab 8/18/2018
1 ADITYO K 1018 atan `001 `004 18.3
 `317409150212 JL bakti
1 ABDUL AZIS 1025 89 `001 `004 ### 14

JL
PERSAHA 8/18/2018
BATAN III
`317409151010 NO 59 C
1 Ismail 0066 RT 11/04 `011 `004 15.5

`317409230916 Jl. Damai

1 RIKI CAHYADI 0015 74 `009 `004 14
`999999999999 8/18/2018
1 Ubaydillah 9999 JL.H.Nur `002 `004 17.8
`317409240912 8/18/2018
1 Marullah 1009 Jl.H.Nuh `002 `004 15.2
`317409240912 8/18/2018
1 Marullah 1009 Jl.H.Nuh `002 `004 9.7

JL 8/18/2018
PERSAHA
INDRA KUSUMA `317409300713 BATAN I
1 DINATA 1013 NO 005 B `011 `004 14.5

JL
PERSAHA
`317409080318 BATAN II
1 ATIKA DAMAYANTI 0005 NO 122 C `011 `004 ### 16.1

JL 8/18/2018
PERSAHA
SUBEKTI `317409020813 BATAN II
1 NUGROHO 1024 NO 091 B `011 `004 16.5

JL 8/18/2018
PERSAHA
SUBEKTI `317409020813 BATAN II
1 NUGROHO 1024 NO 091 B `011 `004 10

CIPEDAK
RT 8/18/2018
`317409050109 001/004
1 MUNAJI 8732 NO 002 `001 `004 17.3

CIPEDAK
YOHANA N.A `327504190916 RT 8/18/2018
KHARISMA 0028 001/004 `001 `004 10
 `317409130313 Jl.damai 8/18/2018
1 Mahidin 1017 74 `009 `004 15.8
`317409130313 Jl.damai 8/18/2018
1 Mahidin 1017 74 `009 `004 9.3

CIPEDAK
`317409160217 RT 8/18/2018
HERU SETIAWAN 0012 001/004 `001 `004 9.2

CIPEDAK
`317403110615 RT 8/18/2018
RIKI IRAWAN 1002 001/004 `001 `004 8.5

JL H NUH
RT 8/18/2018
WAHYUDIN `317409010211 002/004
1 SUPRIYADI 0028 NO 035 `002 `004 15.7

JL H NUH
`317409010312 RT 8/18/2018
1 A. RAHMAT 1030 002/004 `002 `004 11.5

JL
PERSAHA
MUHAMAD REZA `317409040516 BATAN no
1 FAHREVI 0014 26 `011 `004 11.8
MOHAMMAD `317409210109 Jl.damai 8/18/2018
1 SOLEH 2662 74 `009 `004 18.1

JL. Betu
SONI `317409060513 belah no 8/18/2018
1 MURDIAWAN, SE 1031 113 a `013 `004 12.5

MAERA KACA `317409010313 Jl. H. 8/18/2018

1 PANJI ANDRIANTO 1010 Amsar II `012 `004 10.2
`317409141116 Jl. H.
1 ADE SURATMAN 0017 Amsar II `012 `004 13

`317202270215 Jl. H. 8/18/2018

1 VERI PRIATNA 1011 Amsar II `005 `004 13.2

`317202270215 Jl. H. 8/18/2018

VERI PRIATNA 1011 Amsar II `005 `004 9.2
`317409151210 Jl. H.
1 TEGUH 1081 Amsar II `005 `004 18.2
SYAMSUL HADI `317409270214 Jl. H.
1 SISWANTO 1007 Amsar II `004 `004 14

MUHAMMAD `327606120515 Jl. H. 8/18/2018

1 AMIRULLOH 0020 Amsar II `004 `004 12.8
 `317409210109 JL.warung 8/18/2018
1 Husin 0992 silah `011 `004 18.2
`317409190109 8/18/2018
Amin hulaifie 7121 JL.H saidi `013 `004 12.1

JL.PERSA
HABATAN
`317409021215 RT 01/04
1 Opik taufik 0008 NO.6 `001 `004 11.2

JL.PERSA
HABATAN
`332902140716 RT 01/04
1 Topik 0012 NO.71 `001 `004 13.4

JL.WARU
NG SILA
`317409010213 NO.1 RT
1 Madinah 1027 012/004 `012 `004 ### 20.5

GG H
AMSAR
`317409071016 RT 12/04
1 Indra andriana 0034 NO.02 `012 `004 11.7

JL. 8/18/2018
AMSAR
`317406280116 RT. 12/04
1 Didi suciati 0027 NO. 041 `005 `004 13

JL.
AMSAR
`317406280116 RT. 12/04
1 Didi suciati 0027 NO. 041 `005 `004 14
Wisnu amir `317409090713 JL H.
1 pratama 1010 AMSAR `012 `004 11.8

Marco wedy `317409240815 JL. HAJI 8/18/2018

1 muchtar 1001 AMSAR `012 `004 13.2

Marco wedy `317409240815 JL. HAJI 8/18/2018

1 muchtar 1001 AMSAR `012 `004 10
`317409090816 JL. HAJI
1 Alfriadi 0004 AMSAR `005 `004 13.4
`317401041111 JL. HAJI 8/18/2018
1 Mohammad zein 1001 AMSAR `005 `004 9.8
 `317409110144
1 Idam kholid 0042 JL AMSAR `005 `004 14

`317409010914 Jl.H.Amsa
1 Rangga wahyudi 1028 r `004 `004 12.9
`317505010715 8/18/2018
1 MEIKE WIJAYA 1004 JL. H nuh `002 `004 16.3
`317409260615 8/18/2018
1 RETNO ISKANDAR 1024 JL. H nuh `002 `004 17

RENDRA `327602141207 JL. H nuh 8/18/2018

1 KARNINDA 1267 no 25 `002 `004 17.1

`317409210109 Jl. 8/18/2018

1 HAFQI RAFQI 3801 Panjang `006 `004 14.2

`317409180717 JL. H nuh 8/18/2018

1 ARDIANSYAH 0015 no 48 a `002 `004 6.7
MUHAMAD AFIF `317403130214 JL. H nuh 8/18/2018
1 ZUHAILI 1008 no 48 b `002 `004 16.8
`317409210109 Gg.panja 8/18/2018
1 Sri rahayu 7323 ng `006 `004 20
`317404190109 8/18/2018
1 LULUK YULIAWAN 9593 Jl cipedak `001 `004 16.5
`317409070211 JL.
1 SUBHAN 0040 Cipedak `001 `004 20
`320406220217
1 AGUS HERLIANA 0009 Jl. Timbul `007 `004 22

`317409250213 Jalan 8/18/2018

1 Muhamad 1014 damai `009 `004 18

CIGANJU
CARMUDI HARDI `317409270211 R RT 8/18/2018
1 YANTO 0012 009/004 `009 `004 22

`317409210101 GG
1 RUSLI HIDAYAT 92710 PALAGAN `009 `004 ### 15.5
MUHAMMAD `317409091017 JL H 8/18/2018
1 TAMZIZ 0033 AMSAR `012 `004 7.2

JL H
`317107140109 AMSAR 8/18/2018
1 ERWIN 0557 NO 025 F `012 `004 13.8

JL H
`317409181213 AMSAR 8/18/2018
1 SUHENDRA 1011 NO 025 F `012 `004 15.8
 JL H
`317409181213 AMSAR 8/18/2018
1 SUHENDRA 1011 NO 025 F `012 `004 14.5
`317409090109 JL H 8/18/2018
SUPRIYONO 0264 AMSAR `012 `004 6.8

MOHAMAD `317409310518 JL H
1 FAISAL 0009 AMSAR `005 `004 13.4

`317409111210 JL H
1 SUPARMIN 1018 AMSAR `005 `004 22.3

JL H
`331401281216 AMSAR
1 ANDY SAPUTRO 0006 NO 068 B `005 `004 14
`317409081215 JL
1 WIWIN ABIDIN 0017 TIMBUL `007 `004 20
`317409200109 JL 8/18/2018
1 DANI MULYADI 886 TIMBUL `007 `004 14.5

`317409091011 Jl. Timbul

1 ROHIMIN 1002 III `010 `004 13.2

`317409300614 Jl. Timbul 8/18/2018

1 ROKI SAPUTRA 1002 III `008 `004 9

JL.
TIMBUL 3
`317409221013 RT 08 RW
1 HAERUDIN 1025 04 NO. 16 `008 `004 ### 15

JL. 8/18/2018
TIMBUL 3
`317409221013 RT 08 RW
1 HAERUDIN 1025 04 NO. 16 `008 `004 16.2

JL. 8/18/2018
TIMBUL 3
`317409221013 RT 08 RW
1 HAERUDIN 1025 04 NO. 16 `008 `004 10.7

JL.
UMRON `317409110215 TIMBUL 8/18/2018
1 SYARIFUDIN 1039 III `008 `004 5.1
`317404150716 8/18/2018
IWAN SUMANTRI 0017 JL. Timbul `001 `004 9.1
 JL. H NUH 8/18/2018
DODI `317405220216 RT. 02/04
1 DEWANTARA 0003 NO. 80A `002 `004 16.5

JL. H NUH 8/18/2018

`317409200109 RT. 02/04
1 ABDULLAH 1578 NO. 20 `002 `004 19

JL
PERSAHA 8/18/2018
`317409210109 BATAN
1 ABDUL SYUKUR 4465 NO 16 `001 `004 18.2

JL H
AMSAR 8/18/2018
`317409210109 RT 01/04
1 HAFRIANSAH 5914 NO 39B `004 `004

JL H
AMSAR
MUHAMAD `999999999999 RT 01/04
1 ANDRI ROSADI 9999 NO 39C `004 `004

JL H
AMSAR 8/18/2018
`317409281015 RT 04/04
1 DERI ARIADI 1026 NO 90 `004 `004

JL H
KAISIN RT 8/18/2018
`317409200109 04/04 NO
1 MURSALI 7798 13 `004 `004 17.5

JL H
KAISIN RT 8/18/2018
`317409010217 04/04 NO
1 NUR KHOJIN 0033 60 `004 `004

JL H
KAISIN RT
`317409010217 04/04 NO
1 NUR KHOJIN 0033 60 `004 `004

JL
PERSAHA 8/18/2018
BATAN RT
MOHAMAD `332703030118 13/04 NO
1 ABDUL AJIS 0003 7 `013 `004

JL BATU
BELAH I
`317409201011 RT 13/04
1 FARDIANSYAH 1052 NO 106G `013 `004
 `317409080911 JL 8/18/2018
SAIFUL BAHRI 1014 TIMBUL `010 `004 9.2

JL H
AMSAR 8/18/2018
NO 25B
ARIYANTI `317409090616 RT 12/04
1 NURHASANAH 0001 CIPEDAK `012 `004 15.5

JL H
AMSAR 8/18/2018
NO 20 RT
ROMMY `327604091014 12/04
1 HARYONO 0003 CIPEDAK `012 `004 17.5

JL H
AMSAR 8/18/2018
NO 25 RT
`317409220114 09/04
1 RIYAN FITRIYANTO 1015 CIPEDAK `009 `004

JL.DAMAI
12A RT 8/18/2018
NUR TANJUNG `317409141215 009/04
1 SAPUTRA 0025 NO.31 `009 `004

Jl
H.AMSAR
RT/RW
`317405030216 05/04 NO
1 MOCH FARID 0016 25 `005 `004

Jl
H.AMSAR 8/18/2018
RT/RW
`320233120912 05/04 NO
SARWADI 0018 32B `005 `004 8.8

JL.
PANJANG 8/18/2018
`111608100215 06/04
1 KHAIRUDDIN 0002 NO. 51B `006 `004 15

JL.
PANJANG 8/18/2018
`111608100215 06/04
KHAIRUDDIN 0002 NO. 51B `006 `004 8.7

JL.
PANJANG
`317709210109 06/04
1 HERMAN 2946 NO. 51C `006 `004
 JL. M.
KAHFI 1
GANG 8/18/2018
HAJI
AMSAR
`317409911041 RT 12 RW
HADI SUPRIYADI 60023 4 `012 `004
MANSUR `317409211114 8/18/2018
SETIAWAN 1028 Cipedak `013 `004 9.5
`317409180216 JL. BATU 8/18/2018
Ating 0001 BELAH `013 `004 11
`317409210109
1 MASTURO 4675 JL damai `009 `004
`317409200109 8/18/2018
1 SAIPULOH 4138 JL damai `009 `004 8.5

JL. 8/18/2018
`317409010513 PERSAHA
1 Ariadin 1021 BATAN II `011 `004
`317409280715 Jl. H. 8/18/2018
1 HARTANTO 1004 Saaman `003 `004
`317409280715 Jl. H. 8/18/2018
1 HARTANTO 1004 Saaman `003 `004

`317409040111 JL. Damai 8/18/2018

1 MARMO 0029 74 no 86 `009 `004 18.1

JL. HAJI 8/18/2018

KAISIN RT
Ade fajar `317409270117 04 RW 04
1 norpriyansah 0014 NO. 036 `004 `004

JL. DAMAI 8/18/2018

74 RT
`317409050311 009/04
Samsul badri 1012 NO.74 `009 `004 12.6

JL. DAMAI
74 RT
Muhamad `317409100715 009/04
1 ramadhani 1004 NO.999 `009 `004
 JL. DAMAI
74 RT
`317409170117 009/04
1 Nahrawi 0018 NO.094 `009 `004
`317401080282 Jl hj nuh
1 Achmad fahrizal 0002 no 102 `002 `004 ### 16.3
`317102050109 Jl bahti 8/18/2018
1 Tshin sugito 0328 no 41 `002 `004
Weni syamsu `352212271217 Jl bahti 8/18/2018
1 dhukha 0006 no 41 `002 `004

`317409191110 8/18/2018
1 Nasir rudin 0003 JL. Timbul `007 `004 15

JL
`317409141113 TIMBUL 8/18/2018
1 Abdu rohman 1008 III `007 `004 11
`321617160813 Jl.timbul 8/18/2018
1 Robiansyah 0002 3A `008 `004 15.2
Muhammad `332803310315 Jl.timbul 8/18/2018
1 mutaalim 0002 3 `008 `004 18.1
`317404230810 8/18/2018
1 Tajuddin 0056 Jl.saaman `003 `004 17
`317409271216 Jl timbul 8/18/2018
1 ARIES WIDIYANTO 0015 no 97A `006 `004
MUHAMMAD `317409090311 8/18/2018
1 NURDIN 1052 Jl.h.amsar `003 `004 15.5

`317409210109 Jl warung 8/18/2018

1 SEPTEO PRAYITNO 6486 sila `011 `004 16

Jl 8/18/2018
R.CHAIRUL AMAR `317409130812 persahab
1 NOTOADITJOKRO 1003 atan `011 `004 21

JL h
`317406260514 amsar RT
1 Idham 1003 4/4 `004 `004

JL
persahab 8/18/2018
Teuku amir `317409150415 atan no k
1 hamzah 1013 14 `013 `004

`317409070612 Jl h amsar
1 ADI MURDIYANTO 1019 no 50 `005 `004
 `317409200109 Jl h amsar 8/18/2018
1 HERLAN SAPUTRA 7941 no 53 `005 `004

`317409200109 Jl h amsar 8/18/2018

1 HERLAN SAPUTRA 7941 no 53 `005 `004

JL.
`317409100210 WARUNG 8/18/2018
1 Suheri 0039 SILAH `011 `004 18.2

JL.
`317409091115 PERSAHA 8/18/2018
1 Didi sasmita 1003 BATAN `011 `004 11.2

JL.
`317409091115 PERSAHA 8/18/2018
1 Didi sasmita 1003 BATAN `011 `004
`317104290216 JL. 8/18/2018
1 SYAMSUL ARIPIN 0010 BHAKTI `001 `004 9.3

JAWADI `317410301210 JL.

1 WURDIHANDOKO 1035 BHAKTI `001 `004

JAWADI `317410301210 JL. 8/18/2018

WURDIHANDOKO 1035 BHAKTI `001 `004 9.2

`317409090817 JL.BHAKTI
1 Romansyah 0020 NO.001A `001 `004
`317409250614 JL.BHAKTI 8/18/2018
1 Suhendra 1002 89 `001 `004 16.5
`317409250614 JL.BHAKTI 8/18/2018
1 Suhendra 1002 89 `001 `004

JL. 8/18/2018
TIMBUL 3
`317409310516 RT. 08/04
1 ERNA WATI 0030 NO. 44 `008 `004
`317409290212 Jl asem 8/18/2018
1 KHOIRUDDIN 0001 no 38 `010 `004 13

JL. KAHFI
1 GG. 8/18/2018
ASEM RT
`317409160211 010/04
1 HERDI SETIAWAN 0069 NO. 36 `010 `004
 JL
Persahab
`317409050214 atan 3 no
1 Nurdin 1008 40 e `001 `004

JL.
TIMBUL 8/18/2018
III RT
`317409080812 08/04
1 DEWI PATMASARI 1018 NO. 11 `008 `004

JL H
`317409260111 AMSAR 8/18/2018
Hendra 1003 NO 030 `005 `004 8.8

JL H
`317409090109 AMSAR 8/18/2018
1 SAMANIH 4653 NO 030a `005 `004 15.5

JL.
PANJANG 8/18/2018
RT 04 RW
DIMAS BAYU `317409010616 04 NO.
1 ADITYA 0015 B004 `004 `004 16.2

JL.
PANJANG 8/18/2018
RT 04 RW
MUHAMMAD `317401170315 04 NO.
1 SUBEKHAN 1006 B005 `004 `004 14.6

JL.
PANJANG 8/18/2018
RT 04 RW
MUHAMMAD `317401170315 04 NO.
1 SUBEKHAN 1006 B005 `004 `004
`317409071111 8/18/2018
1 BUDIONO 1024 GG bakti `001 `004 17.4

`317403170411 Jl batu
1 ARFANI 0006 belah `001 `004
`317409110314
1 ANDY SARKUM 1001 Jl bakti 3 `001 `004
`317409210109 8/18/2018
1 Tomi 4873 Jl bakti 3 `001 `004 12
`317409210109 8/18/2018
1 Iwansyah 6211 Jl bakti 4 `001 `004
 `317409200109 Jl warung 8/18/2018
1 AHMAD EFENDI 3692 silah `002 `004

TB IVAN `317409040613 8/18/2018

1 KURNIAWAN 1001 Jl saaman `002 `004

KASANUDIN BIN `317409230217 Jl warung 8/18/2018

1 WARKIYAH 0030 silah `002 `004

KASANUDIN BIN `317409230217 Jl warung 8/18/2018

1 WARKIYAH 0030 silah `002 `004

`317409260318 Jl warung 8/18/2018

1 RONI ERWAN 0039 silah `002 `004
`317409211113 Jl.damai
1 SUHERNA 1018 74 `012 `004 ### 17
`317409110411 JL. 8/18/2018
1 AGUS BUDIANTO 1032 Panjang `006 `004 23
`317409080212 8/18/2018
1 Mas anton 0013 JL. Timbul `006 `004
`317409080212 8/18/2018
1 Mas anton 0013 JL. Timbul `006 `004
`317409270218 8/18/2018
1 MUHAMAD IRPAN 0016 JL. Timbul `006 `004
`317409041110 Jl.damai 8/18/2018
1 SAIPUL ROMDON 1048 74 `012 `004 11

NICHOLAS `317409290715 Jl.damai 8/18/2018

1 NATALINO 1022 74 `012 `004 12.2
MARADEN SYAH `317507100114 CIPEDAK 8/18/2018
1 PUTRA 1027 RT 04/04 `006 `004 17.4
`317406170109 CIPEDAK 8/18/2018
1 Wasito 7277 RT 04/04 `006 `004

JL.TIMBU
L RT
MOCH AANG `317409101211 007/04
1 GUNANDANA 1008 NO.31 D `007 `004
`317403060109 CIPEDAK 8/18/2018
1 SUKADI 4476 RT 04/04 `004 `004 16.5

KP
`317505210817 CIPEDAK 8/18/2018
1 RHENOLD AFDI 0025 no 35 f `004 `004 17.8
 JL
persahab 8/18/2018
`317409080109 atan no k
1 Ivan siswanto 6801 18 `013 `004

JL
persahab 8/18/2018
`331019100912 atan no
Sri widodo 0005 102 f `013 `004 6.7
Galeh anggoro `317403230114
1 putro 1006 JL bhakti `001 `004

BIONDY
MARSADO `317108150415 Jl bhakti
1 GERIANTOO 1004 III `001 `004
`317409051111 Jl bhakti 8/18/2018
1 Apin haryanto 0011 III `001 `004 17.5

JL.
WARUNG 8/18/2018
SILA 1 RT
`317409021213 02/04
1 Ahmad tahrir 1009 NO.105 b `002 `004
`317409270116 Jl asem
1 NASIWAN 0003 no 999 `010 `004

Gg
BELTA CANDRA `317403130514 panjang
1 CATUR N 1013 n0 40 `006 `004

`330211270317 JL. Timbul 8/18/2018

1 SIDIK PRASETIYO 0005 1 no 43 `007 `004

`317409020216 JL. Bhakti

1 Nugroho susilo 0003 89 `001 `004

ARMAN `330708200413 JL. Bhakti 8/18/2018

1 NUGRAHA 0001 89 `001 `004 21.2

Totok budi `317409090109 JL. Bhakti 8/18/2018

1 cahyono 7081 89 `001 `004

`317409280414 JL. Bhakti 8/18/2018

1 Dedi kurniadi 1020 89 `001 `004 22

`317409280414 JL. Bhakti 8/18/2018

1 Dedi kurniadi 1020 89 `001 `004
 Arif rahman `317409310715 JL. Bhakti 8/18/2018
1 hakim 1043 89 `001 `004 13.2
M. Muawin `317409150115 JL. Batu 8/18/2018
1 hakam. U 1003 Belah `013 `004 13.5
`327606310310 8/18/2018
1 Yudi 0054 JL. Bakti `002 `004 10.3

`320509060312 8/18/2018
1 Eko prayitno 0004 JL. Bakti `002 `004

Maulana irwan `317408271217 8/18/2018

1 nuryadi 0015 JL. Bakti `012 `004
`317409071111 CIPEDAK 8/18/2018
NURHASAN 1027 RT 04/04 `004 `004 10.2
`317409230710 Jl.damai 8/18/2018
1 MAHBUB H 0022 74 `005 `004 14.3
BAYU `317409080514 Jl.damai 8/18/2018
1 WHELLYNDRA 1011 74 `005 `004 16.2

`317409170718 JL. Timbul 8/18/2018

1 SARIPAH 0023 iii no 34 `008 `004 14.5
`320515031211 8/18/2018
1 BUDI 50006 JL AMSAR `003 `004
`320515031211 8/18/2018
1 BUDI 50006 JL AMSAR `003 `004 11
`317409150109 JL.H.AMS 8/18/2018
1 SUKIRNO 3763 AR `003 `004 10.8
`317409130217 JL.H.AMS
1 ECIN 0021 AR `003 `004 ### 22

POERNOMO HADI `317509300115 GG. 8/18/2018

1 WIBOWO 1022 PANJANG `004 `004
MUHAMMAD `317409091216 JL. Batu 8/18/2018
1 ISLAM FADILLAH 0029 Belah `001 `004

JL. Bakti
`317409210109 89 No. 8/18/2018
1 SIBANDI B KARPO 1226 109 `001 `004 18.2

JL.AMSAR
`317409210109 NO RT
1 M.suhali 6788 005/04 `005 `004 12.4

`317409210109 JL. Bakti

1 Masturoh 1421 89 No. 81 `001 `004 17.3
 MUHAMMAD `317409111113 JL. H. Nuh 8/18/2018
1 GIYANTO 1015 No. 38 `002 `004 7.6

Jl. 8/18/2018
Persahab
HERRY DWI `317409280815 atan II
1 UTOMO 1048 No. 104A `011 `004 10.8

Jl.
Persahab 8/18/2018
`317409250815 atan II
1 PANDJI NUGROHO 1014 No. 103 `011 `004 16.5

Jl.
Persahab 8/18/2018
`317409250815 atan II
PANDJI NUGROHO 1014 No. 103 `011 `004 5.5
`317409210109 Jl timbul 8/18/2018
1 DWI ARIYANTO 7605 2 4A `007 `004 14.8
`317409241214 Jl timbul 8/18/2018
1 ABDUL MUIZ 1023 3 no 73 `007 `004 14.3
`317409241214 Jl timbul 8/18/2018
ABDUL MUIZ 1023 3 no 73 `007 `004 6.2

JL. 8/18/2018
TIMBUL 3
`317401080311 RT 07 RW
1 UWON SURADI 0071 04 NO. 29 `007 `004 14

JL.TIMBU
L RAYA
`330110130716 NO. 36A
1 SUPRIYONO 0006 RT 07/04 `007 `004 ### 19.5

JL.TIMBU
L RAYA 8/18/2018
`330110130716 NO. 36A
1 SUPRIYONO 0006 RT 07/04 `007 `004 5.3

JL.
WARUNG 8/18/2018
SILA RT
`317409211210 03/04
1 DIAN CHOIRUDIN 0105 NO.99 `003 `004 15

JL. 8/18/2018
WARUNG
`317404260109 SILA RT
1 ABDUL RACHMAN 0920 02/04 90 `002 `004 15.3
 JL.WARU
NG SILA
GG.NUH 8/18/2018
RT
FIKTOR TRI `317409260814 002/04
1 MUTAKIN 1021 NO.46 `002 `004 10.2

JL
PERSAHA 8/18/2018
BATAN
ADITYA DENNY `317409161116 NO 59B
1 PRATAMA 0027 RT 11/04 `011 `004 4.5

Jl DAMAI 8/18/2018
74 RT
`317409210109 009/04
1 DODY IRAWAN 5573 NO.33 C `009 `004 9.8

JL
PERSAHA
BATAN
IMAM `317409130511 NO 55 RT
1 KURNIAWAN 0044 11/04 `011 `004 ### 16.2

Jl. Batu
`317409031213 Belah I
1 INDIKA TAUFIQ 1005 No. 100 D `007 `004 ### 14

Jl.
`317409090512 Persahab
1 YUSUP 1012 atan 7 `007 `004 11.8

JL
PANJANG 8/18/2018
`317404291014 RT 06 RW
1 AZHARI 1023 04 `013 `004 13.4
`317409110713 Jl.musya 8/18/2018
1 Siswoyo 1020 warah `008 `004 15

JL.
`317409200109 BHAKTI
1 Untung slamet 3582 89 `001 `004 ### 15.5
Panjang Vitamin A Vitamin A
Cara Ukur ASI EksklusifF1=YA, 2=Tidak
Badan/ Februari Agustus
Tinggi
Badan
(cm) 1=Telentang umur 0 umur 1 umur 2 umur 3 umur 4 1=YA 1=YA
umur5 bln 2=Tidak
2=Berdiri bln bln bln bln bln 2=Tidak
(19) (20) (21) (22) (23) (24) (25) (26) (27) (28)

2 1 1

2 1 1

2 1 1

2 1 1

2 1 1

2 1 1

2 1 1

2 1 1
2 1 1

2 1 1

2 1 1

1 1 1

1 1 1

2 1 1

1 1 1

1 1 1

1 1 1

2 1 1

1 1 1
2 1 1

2 1 1

1 1 1

2 1 1

2 1 1

2 1 1

2 1 1

2 1 1

1 1 1
2 1 1

1 1 1

2 1 1

2 1 1

2 1 1

2 1 1

2 1 1

2 1 1

2 1 1

2 1 1

2 1 1

2 1 1

2 1 1

2 1 1
2 1 1

2 1 1

2 1 1

2 1 1

2 1 1

1 1 1

2 1 1

2 1 1

2 1 1

2 1 1

2 1 1

1 1 1
2 1 1

1 1 1

1 1 1

1 1 1

2 1 1

2 1 1

2 1 1

2 1 1

2 1 1

1 1 1

2 1 1

2 1 1

1 1 1

2 1 1

2 1 1

2 1 1
2 1 1

1 1 1

2 1 1

2 1 1

2 1 1

2 1 1

2 1 1

2 1 1

2 1 1

2 1 1

1 1 1

2 1 1

1 1 1
2 1 1

2 1 1

2 1 1

2 1 1

2 1 1

2 1 1

1 1 1 1 1 1 1 1 1

2 1 1

2 1 1

2 1 1

2 1 1

2 1 1

2 1 1

2 1 1

2 1 1

1 1 1

2 1 1

2 1 1
2 1 1

1 1 1 1 1 1 1 1 1

2 1 1

2 1 1

2 1 1

2 1 1

2 1 1

2 1 1

1 1 1

2 1 1

2 1 1

1 1 1

1 1 1

1 1 1
2 1 1

2 1 1

2 1 1

2 1 1

2 1 1

2 1 1

2 1 1

2 1 1

2 1 1

2 1 1

2 1 1
1 1 1

2 1 1

2 1 1

2 1 1

1 1 1

2 1 1

1 1 1

2 1 1

1 1 1

2 1 1
1 1 1 1 1 1 1 1 1

1 1 1

1 1 1

2 1 1

2 1 1

1 1 1

2 1 1

1 1 1 1 1 1 1 1 1

2 1 1

1 1 1

1 1 1

2 1 1
2 1 1

2 1 1

2 1 1

1 1 1

2 1 1

2 1 1

2 1 1

2 1 1

2 1 1

1 1 1

2 1 1

2 1 1

2 1 1

2 1 1

2 1 1

2 1 1
2 1 1

1 1 1

2 1 1

2 1 1

1 1 1

2 1 1

2 1 1

1 1 1

2 1 1

2 1 1

1 1 1

1 1 1

2 1 1

1 1 1
2 1 1

1 1 1

1 1 1

2 1 1

2 1 1

2 1 1

1 1 1

2 1 1

2 1 1

2 1 1

2 1 1

1 1 1
2 1 1

2 1 1

2 1 1

1 1 1

2 1 1

2 1 1

2 1 1

2 1 1

1 1 1

1 1 1

2 1 1

2 1 1

2 1 1

2 1 1

2 1 1

2 1 1

2 1 1
1 1 1

1 1 1

2 1 1

2 1 1

2 1 1

2 1 1

2 1 1

2 1 1

1 1 1

2 1 1

2 1 1

2 1 1

2 1 1

2 1 1
2 1 1

2 1 1

1 1 1

2 1 1

1 1 1

1 1 1

2 1 1

2 1 1

2 1 1

2 1 1

2 1 1

2 1 1

2 1 1

2 1 1

1 1 1

2 1 1

2 1 1

2 1 1
1 1 1 1 1 1 1 1 1

1 1 1

2 1 1

1 1 1 1 1 1 1 1 1

2 1 1

2 1 1

1 1 1 1 1 1 1 1 1

2 1 1

2 1 1

1 1 1

2 1 1

2 1 1
2 1 1

1 1 1

2 1 1

2 1 1

2 1 1

2 1 1

2 1 1

2 1 1

2 1 1
Provinsi : : Nama Posyandu
Kabupaten/Kota : : Bulan
Puskesmas/Kecamatan : : Tahun
Desa/Kelurahan :

Kepemilik
an Buku
Berat
Anak Tanggal Lahir Jenis No Kartu NIK (Nomor Induk KIA/KMS
No Nama anak Badan
Ke Kelamin Keluarga Kependudukan) (BB) Lahir
1=YA
2=Tidak
(1) (2) (3) (4) (5) (6) (7) (8) (9)

`317409470817000 NAYRA
1 1 07/08/2017 P 317409 1
2 MAHARANI
2550
`317409660716000 Jihan hasna
2 2 26/07/2016 P 317409 1
3 humaira 2850

`317204010716000 fillio farzana

3 2 01/07/2016 L 317409 1
7 sahabi
3200

`317409420616000 NYAYU
4 3 02/06/2016 P 317409 MARYAM 1
6 SYAMILAH
3100

`332908510514000 NAYLA NATASYA

5 1 11/05/2014 P 317409 1
7 PUTRI
3420

`317409090417000 ARSEN DISKI

6 2 09/04/2017 L 317409 1
3 APRILIO
2670

`317409051114101 MUHAMMAD
7 1 05/11/2014 L 317409 FADHIL IRZA 1
0 TASLIM 2900

`317409200716000 MUHAMAD
8 2 20/07/2016 L 317409 IRFANUL 1
2 HAKIM 2700

`317409120216001 Gibran Khiri

9 1 12/02/2016 L 317409 1
0 Pandiangan
2800
 `320114250714000 MUHAMMAD
10 2 25/07/2014 L 317409 GILANG 1
3 RAMADHAN 2550

`317409560716000 QUEENNAVISH
11 2 16/07/2016 P 317409 A ZAINA AL 1
3 FATH

2860

`317409081214100 PUTRA
12 3 08/12/2014 L 317409 1
4 REFANDA
2600

`317307660414100 NAJMA
13 2 26/04/2014 P 317409 QUROTU 1
3 AYUNINA 3000
14 11/06/2015 P 317409
`317406510615100 NUR AURYN 1
1 2 NAFIS 3100
`317505460215100 Maryam abdul
15 1 06/02/2015 P 317409 1
5 2600

`317101210315100 GAELEN
16 1 21/03/2015 L 317409 ABHISEVA 1
2 PRASETYO 2750

`317409230418000 OZIELGIBRAN
17 1 23/04/2018 L 317409 1
1 FAEYA
2780
`332902150415000 DEYAN TOTTI
18 3 15/04/2015 L 317409 1
4 APRILLIO 2750

`317409070515100 ABYAN MALIK

19 2 07/05/2015 L 317409 1
5
2600

`317409270115100 ALFIDO KURNIA

20 4 27/01/2015 L 317409 1
9 TANTO
3100

`317409630115100 KENZIA
21 2 23/01/2015 P 317409 SAFFAKIRANA 1
8 OCTAMAR
3100

`317409270916000 HAIDAR
22 2 27/09/2016 L 317409 ADELARD 1
7 OCTAMAR
2700
 `317409541014100 AFIQAH
23 2 14/10/2014 P 317409 HUMAYRAH 1
5 KHANZA 3209

`317409040714100 MUHAMMAD
24 2 04/07/2014 L 317409 1
4 NAJIBUL AZHAR
3650
`317409120517000 arsal zikri
25 1 12/05/2017 L 317409 1
2 hamizan 3100

`317409230517000 Adnan ibni wafi

26 1 23/05/2017 L 317409 1
3
2540

`317409660717000 ARSYILA
27 3 26/07/2017 P 317409 1
7 SYAFANI
3400

`330419300414000 Tomo adi

28 1 30/04/2014 L 317409 1
1 santoso
2700

`317409510617000 AZIZAH
29 1 11/06/2017 P 317409 ANINDYA 1
2 RAMADHANI
3100

`317404580314100 KHANSA AFIFA

30 1 18/03/2014 P 317409 1
1 NABILAH

3200

`320117431214000 CATRINE
31 2 03/12/2014 P 317409 NAULISA DWI 1
2 AMANDA 2780
`317409531214100 HANA JELITA
32 1 13/12/2014 P 317409 1
5 LESTARI 2900

`317409300415100 ARKAAN
33 1 30/04/2015 L 317409 ABIWARA 1
1 PUTRA 3140

`317409220417000 BAYU YUDHA

34 3 22/04/2017 L 317409 1
5 PRATAMA
3200

`317409100414100 MUHAMMAD
35 2 10/04/2014 L 317409 ROMADANI N 1
4 W
2800
 `317409031115101 MUHAMMAD
36 1 03/11/2015 L 317409 1
2 ELHADY WIJAYA
3800
`317409280914100 FIQRI AL
37 1 28/09/2014 L 317409 1
3 ZAHRAN 4000

`317409261017000 Muhammad
38 2 26/10/2017 L 317409 1
3 azka hidayanto
2700

`317409011215000 ADSKHAN
39 1 01/12/2015 L 317409 SEVILEN KEMAL 1
1 DAFFANDI
2700
`317409410416000 AYU AISYAH
40 2 01/04/2016 P 317409 1
6 3500
41 2 24/12/2016 P 317409
`317409641216000 Uswatunhasana 1
1 h 3200

`317409130515100 Samudra akbar

42 1 13/05/2015 L 317409 1
1 pramudya
3300

`317409270415101 RASHYAFA
43 2 27/04/2015 P 317409 GHAISAN 1
3 ARIZKY 2700

`317403580114100 HAZNAH
44 1 18/01/2014 P 317409 NURAINI 1
2 MARSYA 2700
`317409280714100 NAUFAL SAKHA
45 1 28/07/2014 L 317409 1
1 RIZIQ 3100
`317409121217000 maulana al
46 2 12/12/2017 L 317409 1
5 farisi 2750

`317409560515100 ANINDITA
47 1 16/05/2015 P 317409 1
2 NOURA ZALFA
3400

`317306580115100 BRANTANDARI
48 1 18/01/2015 P 317409 ARUNA 1
4 TRYANTORO 3200
`317409571115100 Nafisah Azzahra
49 1 17/11/2015 P 317409 1
4 2700

`317409691115000 ASYLA NAZWA

50 2 29/11/2015 L 317409 NUR 1
9 ANGGRAINI 3350

`317409250514100 MUHAMMAD
51 2 25/05/2014 L 317409 RAYHAN SYAH 1
4 PUTRA 2950
 `317409241217000 Muhammad
52 3 24/12/2017 L 317409 1
7 fariz al-fatih 3150
`317409170514100 AZKA HARDANY
53 2 17/05/2014 L 317409 1
8 2800
KHALILUNA
`317409570915100 SHANUM
54 2 17/09/2015 P 317409 1
6 DESHERMAWA
N
2750
`317409600114100 ALYQA ZALFA
55 1 20/01/2014 P 317409 1
6 RINJANI 3100
`317409300817000 Arya Pratama
56 1 30/08/2017 L 317409 1
8 Setyawan 2800
`317409250914100 BAYI NY RIZKY
57 1 06/09/2017 L 317409 1
8 AMALIA 3420

`317406070214100 ALI IBRAHIM

58 1 07/02/2014 L 317409 1
2 SIRAT

3800

`317409671017000 Arsyila nur

59 1 27/10/2017 L 317409 1
1 oktavia

3400

`317409470414101 Ivania rochele

60 1 07/04/2014 L 317409 1
0 zerlinda adja

2700

`317409190515100 AL- KHALIFI

61 2 19/05/2015 L 317409 1
4 FAEZA

2600

`317409600915100 AINUN NUR

62 1 20/09/2015 P 317409 1
4 AZIZAH

2700

`317409150817000 FATTAN AL
63 2 15/08/2017 L 317409 1
7 FAEYZA

3700
 `317409250515100 FADLI TRISTAN
64 2 25/05/2015 L 317409 1
4
2900

`317409580714100 KAYLA
66 2 18/07/2014 P 317409 MUTIARA 1
6 AZAHRA 2600
`332910550816000 Anisa Putri a
67 1 15/08/2016 P 317409 1
2 2550

`317409090915101 AKHDAN LATIEF

68 1 09/09/2015 L 317409 1
0 TRI SEPTIYANTO
2740

Alvoita
69 2 16/12/2014 P 317409 3174095612140002 1
rahmaajeng
2800

Raya Fitri
70 1 22/06/2017 P 317409 3174094206170002 1
Ramadani
2800

`317409070616000 BAGAS KURNIA

71 1 07/06/2016 P 317409 1
1 RAMADAN
2800
`317409070917000 Ahmad Lutfi
72 2 07/09/2017 L 317409 1
8 mubaarok 3200

`317409020314100 AL GIBRAN
73 2 02/03/2014 L 317409 PUTRA 1
6 LIANDRA 2500

`317409690815100 RAHIL RAZITA

74 1 29/08/2015 P 317409 1
1 PUTRI

2500

`317409231014100 Muhammad
75 1 23/10/2014 P 317409
1 Alfiansyah 1

2670

MUHAMMAD
76 2 18/05/2016 L 317409 3174091805160001 1
SABANI
2800
 `317409501114100 NAMIA AZWA
77 2 10/11/2014 P 317409 1
3 AFIFAH

2800

`317409130514100 ZULFADHLI AL
78 1 13/05/2014 L 317409 1
1 FATIH
2650

`332803090415000 RAYA
79 1 09/04/2015 L 317409 PRAMUASHARI 1
1
WIBOWO 2600

`317409160318000 Muhammad
80 2 16/03/2018 L 317409 1
5 hafidz
2550

`317402530415100 nizma alisyah

81 1 13/04/2015 P 317409 1
1 haq
2500

`317409230817000 AHMAD
82 2 23/08/2017 L 317409 DZAKIANDRA 1
3 SUTAJI 3200

`317409220115100 ADITYA
83 1 22/01/2015 P 317409 1
2 ALFIANDRA
2600
`317409610914100 FILZHA NUR
84 2 21/09/2014 P 317409 1
4 ASYHURA 2800

`317409670515100 KEISHA
85 2 27/05/2015 L 317409 ANINDITA 1
5 ZAHRA 2700

`317409590316000 Latisha Armilia

86 1 19/03/2016 P 317409 1
2 Putri

2750

`317409621014100 OKNA SAHIRA

87 2 20/10/2014 L 317409 1
7
2780
 `317409051016000 ALI RUHI
88 3 08/08/2016 L 317409 1
3
2750

`317409671117000 Falisha azska

89 2 27/11/2017 L 317409 1
7 dhina
2680

`317409690514100 ALYSHA
90 1 29/05/2014 P 317409 KHAZANA 1
5 APRIADI
3000

`367113170214000 Teofanus toby

91 1 17/02/2014 L 317409 1
1 lant ara
2400

`317409420917000 Edel weiss gita

92 1 02/09/2017 L 317409 1
8 alamsyah
2800

93 317409 1
`317409710815100 ADZKIA ATSILA
2 31/08/2015 P 3 RAHMA 2950

94 317409 1
`317409250118000 FATHIAN AL
2 25/01/2018 L 3 AYYUBI 2700

95 317409 1

AQILA
2 08/06/2018 P 3174094806180002 ANNASYA 2450

96 317409 1
KHOLID
`317409211215000 FOURLINO
1 21/12/2015 L 4 SUWITNO 3000

97 317409 1

`327101590214000 NABILA ASYILA

2 19/02/2014 P 1 RAHMA 3200
98 317409 1
OKTAV
`317409271014100 ADRIANSYAH
2 27/10/2014 L 6 SOPIAN 3200

99 317409 1
AHMAD
`317409280417000 BAIHAQI
1 28/04/2017 L 3 ISKANDAR 3600

100 317409 1

`317409560114100 RIFDA
2 16/01/2014 P 2 RUMAISHA 2650

101 317409 1

`317409560114100
2 16/01/2014 P 1 GHINA IMARAH 2750

ADZRIEL
102 317409
`317409190418000 FAKHRI 1
1 19/04/2018 L 3 IBRAHIM 2470

103 317409 1
`317404110415100 ABDAN KHAIRI
1 11/04/2015 L 4 TSABIT SYAH 3000

104 317409 1
`317404110415100 ABDAN RAJA
1 11/04/2015 L 3 SYADID SYAH 3100

105 317409 1
`317409510418000
1 11/04/2018 L 8 Ayra rumaisha 2750
106 317409 `317409600114100 ALYQA ZALFA 1
2 20/01/2014 P 6 RINJANI 2380
107 317409 `317409300817000 Arya Pratama 1
2 30/08/2017 L 8 Setyawan 2800
108 317409 `317409250914100 BAYI NY RIZKY 1
2 06/09/2017 L 8 AMALIA 3000
109 317409 1
`317406070214100 ALI IBRAHIM
1 07/02/2014 L 2 SIRAT 2870

110 317409 1
`317409671017000 Arsyila nur
2 27/10/2017 L 1 oktavia 3200

111 317409 1
`317409470414101 Ivania rochele
2 07/04/2014 L 0 zerlinda adja 3200

112 317409 1
`317409190515100 AL- KHALIFI
1 19/05/2015 L 4 FAEZA 2800

113 317409 1
`317409600915100 AINUN NUR
2 20/09/2015 P 4 AZIZAH 3200

114 317409 1
`317409150817000 FATTAN AL
1 15/08/2017 L 7 FAEYZA 3300

115 317409
`317409250515100 1
1 25/05/2015 L 4 FADLI TRISTAN 2750
116 317409 `317409230218001 bayi ny PUTRI 1
1 08/05/2018 L 2 PUJIAWATI 2750

KAYLA
117 317409
`317409580714100 MUTIARA 1
2 18/07/2014 P 6 AZAHRA 3550
118 317409 `332910600843000 1
1 20/08/2013 P 3 Aulia agustinah 3240
119 317409 `332910550816000 1
1 15/08/2016 P 2 Anisa Putri a 2650

120 317409
`317409090915101 AKHDAN LATIEF 1
1 09/09/2015 L 0 TRI SEPTIYANTO 2500
121 317409
Alvoita 1
1 16/12/2014 P 3174095612140002 rahmaajeng 4000

122 317409
Raya Fitri 1
2 22/06/2017 P 3174096206170002 Ramadani 2800

123 317409
`317409070616000 BAGAS KURNIA 1
1 07/06/2016 P 1 RAMADAN 2840
124 317409 `317409070917000 Ahmad Lutfi 1
2 07/09/2017 L 8 mubaarok 3800

AL GIBRAN
125 317409
`317409020314100 PUTRA 1
1 02/03/2014 L 6 LIANDRA 3100

126 317409 1
`317409690815100 RAHIL RAZITA
1 29/08/2015 P 1 PUTRI 3260

129 317409 1

`317409501114100 NAMIA AZWA

2 10/11/2014 P 3 AFIFAH 3200

130 317409 1
`317409130514100 ZULFADHLI AL
1 13/05/2014 L 1 FATIH 3200

131 317409 1
`317409160913100 ABDUL HAKIM
3 16/09/2013 L 3 MUSYAFFA 2800
132 317409 `317407300913100 1
2 30/09/2013 L 3 Kenzi al khalifi 2750

RAYA
133 317409
`332803090415000 PRAMUASHARI 1
1 09/04/2015 L 1 WIBOWO 3200

134 317409
`317409160318000 Muhammad 1
2 16/03/2018 L 5 hafidz 2870
135 317409
`317402530415100 nizma alisyah 1
1 13/04/2015 P 1 haq 3200

136 317409 SOFIA 1

`317409610914100 KHAIRIRA
2 21/09/2014 P 3 MAINATRI 2600

137 317409 1
`317409220115100 ADITYA
1 22/01/2015 P 2 ALFIANDRA 2750
138 317409 `317409610914100 FILZHA NUR 1
1 21/09/2014 P 4 ASYHURA 2840

KEISHA
139 317409
`317409670515100 ANINDITA 1
2 27/05/2015 L 5 ZAHRA 2700

140 317409 1

`317409590316000 Latisha Armilia

1 19/03/2016 P 2 Putri 2800

141 317409
`317409621014100 1
1 20/10/2014 L 7 OKNA SAHIRA 2600

142 317409
`317409051016000 1
1 08/08/2016 L 3 ALI RUHI 3100

143 317409
`317409671117000 Falisha azska 1
2 27/11/2017 L 7 dhina 3100

144 317409 ALYSHA 1

`317409690514100 KHAZANA
1 29/05/2014 P 5 APRIADI 2850

145 317409
`367113170214000 Teofanus toby 1
2 17/02/2014 L 1 lant ara 3500

146 317409
`317409420917000 Edel weiss gita 1
3 02/09/2017 L 8 alamsyah 3400

QAISAR
147 317409 MUHAMMAD 1
`317409180816000 NAUFAL
2 18/08/2016 L 6 ROSYADI 2500
148 317409 ADEEVA 1
`317409690515100 AFSHEEN
1 29/05/2015 P 7 MYESHA 2780

149 317409 KHAIRAH 1

`317409501216001 LOISSALSABILLA
2 10/12/2016 P 2 H MAULIDINA 2900
150 317409 `317409410915100 RAIDA AQILA 1
3 01/09/2015 P 9 GUNAWAN 3450

151 317409
`317409650116000 AISYAH NUR 1
2 25/01/2016 P 2 AFIFAH 2500

152 317409 1

`317409020282001 HABIBI IBNU

1 06/11/2016 L 1 AHMAD 3200

153 317409 1

`317404090913100 RAIHAN AKBAR

3 09/09/2013 L 1 SUHENDRA 3850

154 317409
`317409190214100 RASYID 1
2 19/02/2014 L 2 ARDIANSYAH 2650
155 317409 `317409650118000 Hanin karima 1
1 25/01/2018 P 3 afandi 2600

rafa
156 317409
`317409110415100 apriliansyah 1
2 11/04/2015 L 2 ajisman 3600

NAUFAL
157 317409
`317409041215000 SYAMADITYA 1
1 04/12/2015 L 3 DARMAWAN 2750
 FORMULIR PEMANTAUAN PERTUMBUHAN BALITA DI POSYANDU

IMD Tgl
No Tlp/
Nama Ayah NIK Ayah Alamat RT RW Pengukura
HP Ayah n
1=YA,
2=Tidak POSYANDU

(10) (11) (12) (13) (14) (15) (16) (17)

JL
MARDIYANT `317409241016 Hidayah `007
1 2 `005 8/21/2018
O 0027 RT 07/05
no 36

`317409130513 Jl.persaha `006

1 Sahidin 2 `005 8/21/2018
1001 batan

JL
Muhammad `317204050216
1 4 RINDANG `007 `005 8/21/2018
hamzah 0019 RT 07/05

JL
Dwi satya `317409270616
1 4 RINDANG `007 `005 8/21/2018
putra 0014 RT 07/05

`317409130917 JL m.kahfi `005

1 Failul 2 `005 8/21/2018
0032 gg.ikhlas

Jl al
Hadista beta `317409210317
1 2 hidayah `007 `005 8/21/2018
yunastika 0009 no 14

Jalan
`317409180412
1 Irwan 6 warung `008 `005 8/21/2018
1002 silah

MUHAMAD `317409200109
1 2 Jl. Timbul `005 `005 8/21/2018
TAUFIK 7628

DYAH `317409050216
1 INDRAPATI 1 JL RADIO `004 `005 8/21/2018
0004
MARO
 `317409010217 JL H
Rohani 6 MANENG `008
1 `005 8/21/2018
0037

JL
BELIMBIN
G GG
Deddy `317409280812
1 2 IKHLAS `005 `005 8/21/2018
soekarno 1016 RT 05 RW
05 NO
44.1

JL
BUDIAWAN `317409110211 persahab `004
1 2 `005 8/21/2018
1060 atan no
39

JOKO `317307060109 Jl ikhlas

1 2 `005 `005 8/21/2018
HARYANTO 4329 no 10

1 Sutejo `317409230217 1 Jl Sukarna `001 `005

0013 8/21/2018

Agus abdul `317505120109 Jl Nurul

1 1 `004 `005 8/21/2018
5969 iman

`317409290916 JL.NURUL `007

1 Antonius 6 `005 8/21/2018
0025 IMAN

JL.
`317409270911
1 Ismat 2 PERSAHA `006 `005 8/21/2018
1032 BATAN
`317409150616
1 Dieryanto 1 JL. RADIO `004 `005 8/21/2018
0006
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6446 A

1 Ferry tanto `317409130109 1 JL. RADIO `003 `005 8/21/2018

2370

Achmad CIPEDAK
`317409231214
1 bayu 1 RT. 03/05 `003 `005 8/21/2018
1005
octamar NO. 47

Achmad CIPEDAK
`317409231214
1 bayu 1 RT. 03/05 `003 `005 8/21/2018
1005
octamar NO. 47
1 ASROIDA.S `317409010914 1 Jl. RADIO `003 `005 8/21/2018
1021

`317409300513 jl radio rt `008

1 Subairi 6 `005 8/21/2018
1018 08/05

AGASTI `317409011116
1 8 Cipedak `005 `005 8/21/2018
SUKANTA 0018
JL KAHFI
`317409210109
1 Syaifudin 1 II GG `003 `005 8/21/2018
4921 RADIO

ARSYILA `317409111116 JL.GUDAN `002

1 1 `005 8/21/2018
SYAFANI 0005 G BARU

`330419170111 JL.
1 Marsono 1 Warung `001 `005 8/21/2018
0145 sila

Jl.warung
Aguz `317409280911 sila Gang `008
1 syamsul 6 `005 8/21/2018
056 H.Manen
arifin g

Jl.warung
Afif maulana `317404210314 sila Gang `008
1 6 `005 8/21/2018
1018 H.Manen
g

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1 ALI JUNAEDI `320117300108 1 kahfi 2 no `003 `005 8/21/2018
0012 2
Hasdiyan `317409210109
1 1 JL. Radio `004 `005 8/21/2018
hartawan 0985

Anggi `317409230315 JL. Al

1 2 `007 `005 8/21/2018
saputro 1034 hidayah

JL MASJID
DUWIK `317409220512
1 1 NURUL `005 `005 8/21/2018
HARTOYO 1018 IMAN

JL
`317409100210 WARUNG `004
1 WAHID 1 `005 8/21/2018
0040 SILA NO
006 D
 AHMAD `317409180313 JL AL
6 HIDAYAH `007
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FAUZI 1011

`317409090610
1 SUPRIYADI 4 Jl.radio `004 `005 8/21/2018
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1 SUPRIYANTO `317409040510 1 Jl. Turin `002 `005 8/21/2018

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Dadang `317409030114 Jl.Persaha `006

1 1 `005 8/21/2018
apandi 1006 batan

`317409210109 Jl.Al-
1 Suryanto 6 `007 `005 8/21/2018
3655 Hidayah

1 Rahmani `317409220916 1 Jl.Al- `004 `005

0029 Hidayah 8/21/2018

Pandowo `317409090410 Jl.H.Syakir `005

1 2 `005 8/21/2018
widodo 0025 in

`317409090109
1 Jusnaidi 1 Gg.Ikhlas `005 `005 8/21/2018
9151

Agung `317409101114 Jl.Gudang `001

1 maulana 1 `005 8/21/2018
1026 Baru
saputra
`317409130810 Jl.Gudang `008
1 Tarki 6 `005 8/21/2018
0002 Baru
`317409231110 Jl.H.Mane `008
1 Surono 6 `005 8/21/2018
1010 ng

JL. RADIO
Mohamad `317409080414
1 1 RT 03/05 `003 `005 8/21/2018
yusup 1020 NO.45

Sandy `317306181013
1 1 JL.Radio `003 `005 8/21/2018
tryantoro 1034

Arif `317409160312
1 1 JL.Radio `003 `005 8/21/2018
gunawan 10

Muhammad `317409131016
1 1 Jl.Radio `003 `005 8/21/2018
hambali 0033

Rahmat `317409311215 Jl.H.Mane `008

1 6 `005 8/21/2018
saleh 0031 ng
 Rahmat `317409311215 Jl.H.Mane `008
1 6 `005 8/21/2018
saleh 0031 ng
`317409010414 Jl.M.Kahfi `002
1 Ardony 1 `005 8/21/2018
1011 II

Aditia Jl.H.Turin,
1 deshermaw `317409201015 1 Gudang `002 `005 8/21/2018
1009
an Baru

REIKA `317409150816 JL. H.

1 1 `002 `005 8/21/2018
NOVIA 0028 Turin
IRWAN `317409220716 JL. H.
1 1 `002 `005 8/21/2018
SETYAWAN 0005 Turin
`317409260713 Jl Al-
1 Burhan 1 `001 `005 8/21/2018
1019 Hidayah

JL.
NURUL
`317406121093
1 Maryadi 6 IMAN RT `008 `005 8/21/2018
991 008/05
NO.999

JL.
NURUL
`317409210109
1 Marjaya 6 IMAN RT `008 `005 8/21/2018
2086 008/05
NO.007

JL.
NURUL
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1 6 IMAN RT `007 `005 8/21/2018
adja 1002 007/05
NO.009

JL.
NURUL
`317403079093
1 Nurdjanah 8 IMAN RT `003 `005 8/21/2018
097 003/05
NO.052

JL.
Zuhdi NURUL
`317409251010
1 ngainul 1 IMAN RT `003 `005 8/21/2018
0001
yasin 003/05
NO.096

JL.
NURUL
Andrian ulfa `317409190914
1 1 IMAN RT `003 `005 8/21/2018
rukmana 1021 003/05
NO.096
 GG Al
1 KRISTIANTO `317409130214 2 Ikhlas RT `005 `005 8/21/2018
1001 5 RW 5

`317409120109
1 Maman 1 Jl m khafi `002 `005 8/21/2018
7831

`332910211113 Jl M khafi `002

1 Triyono 1 `005 8/21/2018
0010 II

SLAMET `317409210109 Jl Warung `001

1 1 `005 8/21/2018
PURWANTO 3299 Sila

RAMADHAN `317409061217 Jl Warung `001

1 I TOHIR 1 `005 8/21/2018
GUNAWAN 0030 sila

RAMADHAN `317409061217 Jl Warung `001

1 I TOHIR 1 `005 8/21/2018
GUNAWAN 0030 sila

UJANG `317409160513 JL. rm

1 1 `003 `005 8/21/2018
TATANG 0003 khafi 1

`317409020617
1 Nurlaila 1 GG radio `003 `005 8/21/2018
0026

CHANDRA `317409210109 JL M
1 1 `002 `005 8/21/2018
MADRUSDI 7341 KHAFI 2

JL. AL
`317409091213 HIDAYAH `007
1 SOLIHIN S 6 `005 8/21/2018
1021 RT 7 RW
5 NO. 10

JL MASJID
NURUL
`317409130482
1 ERWIN 0010 1 IMAN RT `004 `005 8/21/2018
4 RW 5
NO 51

GUDANG
SOLEH AL `317409151116 BARU RT `008
1 1 `005 8/21/2018
AFGANI 0031 08/05 NO
38A
 JL. RADIO
GG
MOSHOL
NOPIH `317409110511 A
1 ASAKINA `003
1 `005 8/21/2018
ARDIANTO 0041
H RT
03/05 NO
49

JL. MOH
INDRAYANT `317409210109 KAHFI 2 `002
1 1 `005 8/21/2018
O SAIPUL R 6774 RT 02/05
NO 20

UNTUNG `332803200515 GG H
1 1 `002 `005 8/21/2018
WIBOWO 0004 TURIN

`317409151113 JL.AL
M. Irpan 6 HIDAYAH `007
1 `005 8/21/2018
1029

MUCHLIS `317402090109 JL.AL

6 HIDAYAH `007
1 `005 8/21/2018
S,PD.I 5528

AGUS `317409080912 Warung

1 6 `008 `005 8/21/2018
SUTAJI 1002 sila

JL. RADIO
Nurhikmawa `317409131117
1 1 RT 3 RW `003 `005 8/21/2018
ti 0022 5 NO. 20

Yogi `317409101114
1 1 Jl hj turin `002 `005 8/21/2018
maulana 1042
Jl
`317409210109
1 Saroni 1 sukaman `001 `005 8/21/2018
0082 no 14

JL.
RINDANG
1 Eko winarno `317409180912 6 RT 07 RT `007 `005 8/21/2018
1020 RW 05
NO. 35

JL.gudang
1 Khamalludin `317409190914 6 baru no `008 `005 8/21/2018
1024 34
 JL.gudang
1 Khamalludin `317409190914 6 baru no `008 `005 8/21/2018
1024 34

JL.gudang
Endang fidia `317409231017
1 1 baru no `004 `005 8/21/2018
ningsih 0022 999

JL.RADIO
`317409191112 RT
Apriadi 1 004/05 `004
1 `005 8/21/2018
1020
NO.4

Thomas `367113020412 JL.radio

1 1 `003 `005 8/21/2018
damas setyo 0019 no 9E

Iis alamsyah `317409280217 JL.gudang `002

1 1 `005 8/21/2018
0015 baru 215

1 2 JL. `005 8/21/2018

TIMBUL
WAHYU DWI `317409120815 NO. 55A
SANTOSO 1019 RT. 05/05 `005

1 2 JL. `005 8/21/2018

TIMBUL
WAHYU DWI `317409120815 NO. 55A
SANTOSO 1019 RT. 05/05 `005

1 1 `005 8/21/2018
Jl. NURUL
IMAN RT.
LISMAN `317409130218 04/05
ROHIM 0038 No.51 `004

Gg.
1 1 SUKARM `005 8/21/2018
A RT
EDI `317409210109 01/05
SUWITNO 3737 No.23 `001

1 6 JL.GUDAN `005
G BARU 8/21/2018
CIPEDAK
`327101240512 RT.08/05
AFRI ANTO 0016 No. 37B `008
1 1 JL. RADIO `005 8/21/2018
CIPEDAK
`317409270612 RT.03/05
SOPIAN ARIF 1007 No. 54 A `003

JL.
1 1 WARUNG `005 8/21/2018
SILA
ENDANG `317409051216 RT.02/05
ISKANDAR 0035 No. 42 `002

1 2 JL. `005
PERSAHA 8/21/2018
BATAN
`317409030212 No.18 A
SAEPUDIN 1028 RT. 06/05 `006

1 2 JL. `005
PERSAHA 8/21/2018
BATAN
`317409030212 No.18 A
SAEPUDIN 1028 RT. 06/05 `006

CIPEDAK
1
EKO ARI `317409030418 6 RT 08/05 `005 8/21/2018
WIBOWO 0030 NO. 15 C `008

RM.KAHFI
1 RAMADHAN 6 RTT `005 8/21/2018
YUNIANSYA `317409180418 003/05
H 0012 NO.17 `007

RM.KAHFI
1 RAMADHAN 6 RTT `005 8/21/2018
YUNIANSYA `317409180418 003/05
H 0012 NO.17 `007

RM.KAHFI
1 RAMADHAN 6 RTT `005 8/21/2018
YUNIANSYA `317409180418 003/05
H 0012 NO.17 `007
1 REIKA `317409150816 1 JL. H. `005 8/21/2018
NOVIA 0028 Turin `002
1 IRWAN `317409220716 1 JL. H. `005 8/21/2018
SETYAWAN 0005 Turin `002
1 `317409260713 1 Jl Al- `005 8/21/2018
Burhan 1019 Hidayah `001
 JL.
1 8 NURUL `005 8/21/2018
IMAN RT
`317406121093 008/05
Maryadi 991 NO.999 `008

JL.
1 8 NURUL `005 8/21/2018
IMAN RT
`317409210109 008/05
Marjaya 2086 NO.007 `008

JL.
1 8 NURUL `005 8/21/2018
IMAN RT
Hironimus `317409310512 007/05
adja 1002 NO.009 `007

JL.
1 1 NURUL `005 8/21/2018
IMAN RT
`317403079093 003/05
Nurdjanah 097 NO.052 `003

JL.
1 1 NURUL `005 8/21/2018
Zuhdi IMAN RT
ngainul `317409251010 003/05
yasin 0001 NO.096 `003

JL.
1 1 NURUL `005 8/21/2018
IMAN RT
Andrian ulfa `317409190914 003/05
rukmana 1021 NO.096 `003

GG Al
1
`317409130214 1 Ikhlas RT `005 8/21/2018
KRISTIANTO 1001 5 RW 5 `005
1 FAJAR `317409170616 1 `005 8/21/2018
RAHMAN 0001 Jl m khafi `002

1
`317409120109 1 `005 8/21/2018
Maman 7831 Jl m khafi `002
1 `332910211113 1 Jl M khafi `005 8/21/2018
Triyono 0010 II `002
1 `332910211113 1 Jl M khafi `005 8/21/2018
Triyono 0010 II `002

1
SLAMET `317409210109 1 Jl Warung `005 8/21/2018
PURWANTO 3299 Sila `001
 RAMADHAN
1
I TOHIR `317409061217 1 Jl Warung `005 8/21/2018
GUNAWAN 0030 sila `001

RAMADHAN
1
I TOHIR `317409061217 1 Jl Warung `005 8/21/2018
GUNAWAN 0030 sila `001

1
UJANG `317409160513 1 JL. rm `005 8/21/2018
TATANG 0003 khafi 1 `003
1 `317409020617 1 `005 8/21/2018
Nurlaila 0026 GG radio `003

1
CHANDRA `317409210109 1 JL M `005 8/21/2018
MADRUSDI 7341 KHAFI 2 `002

1 6 JL. AL `005 8/21/2018

HIDAYAH
`317409091213 RT 7 RW
SOLIHIN S 1021 5 NO. 10 `007

JL. RADIO
1 1 GG `005 8/21/2018
MOSHOL
A
ASAKINA
H RT
NOPIH `317409110511 03/05 NO
ARDIANTO 0041 49 `003

JL. MOH
1 1 KAHFI 2 `005 8/21/2018
INDRAYANT `317409210109 RT 02/05
O SAIPUL R 6774 NO 20 `002

1 1 JL. AL `005 8/21/2018

HIDAYAH
ARID `317409050413 RT 07/05
RIZALDI 1001 NO 2 `002
1 `317407131011 6 Jl. Al `005 8/21/2018
Novrizal 0028 hidayah `007

1
UNTUNG `332803200515 1 GG H `005 8/21/2018
WIBOWO 0004 TURIN `002

1
`317409151113 6 JL.AL `005 8/21/2018
M. Irpan 1029 HIDAYAH `007
1
MUCHLIS `317402090109 6 JL.AL `005 8/21/2018
S,PD.I 5528 HIDAYAH `007

JL.
1 6 Warung `005 8/21/2018
HENCE `317409040711 Silah
MAIVINAS 1046 no.21 `008

1 1 JL. RADIO `005 8/21/2018

Nurhikmawa `317409131117 RT 3 RW
ti 0022 5 NO. 20 `003
1 Yogi `317409101114 1 `005 8/21/2018
maulana 1042 Jl hj turin `002

Jl
1
`317409210109 1 sukaman `005 8/21/2018
Saroni 0082 no 14 `001

JL.
1 6 `005 8/21/2018
RINDANG
RT 07 RT
`317409180912 RW 05
Eko winarno 1020 NO. 35 `007

JL.gudang
1
`317409190914 6 baru no `005 8/21/2018
Khamalludin 1024 34 `008

JL.gudang
1
`317409190914 6 baru no `005 8/21/2018
Khamalludin 1024 34 `008

JL.gudang
1
Endang fidia `317409231017 1 baru no `005 8/21/2018
ningsih 0022 999 `004

JL.RADIO
1 1 RT `005 8/21/2018
`317409191112 004/05
Apriadi 1020 NO.4 `004

1
Thomas `367113020412 1 JL.radio `005 8/21/2018
damas setyo 0019 no 9E `003

1
`317409280217 1 JL.gudang `005 8/21/2018
Iis alamsyah 0015 baru 215 `002

1 1 JL MOCH `005 8/21/2018

Imron `317409230413 KAFHI II
rosyadi 1021 RT 03/05 `003
1 6 `005 8/21/2018
`317409251114 JALAN AL
Sudarso 1025 HIDAYAH `007

1 H. 1 `005 8/21/2018
LOVERYANT `317409260116 JALAN
O,SE,M.Si 0022 TURIN `002
1 `317409260211 2 Gang `005 8/21/2018
Gunawan 0007 ikhlas `005

Jl
1
`317409090311 2 persahab `005 8/21/2018
Maman 1035 atan `006

1 1 JL. R `005
MOH 8/21/2018
KAFI 2 RT.
AHMAD `317409210109 02/05
WAHIDIN 5068 NO. 43A `002

1 1 JL. R `005
MOH 8/21/2018
KAFI 2 RT.
MUKHLIS `317404100109 02/05
SUHENDRA 4285 NO. 41 `002

JL.
1
AINUR `317409111110 2 PERSAHA `005 8/21/2018
ROFIEQ 1037 BATAN `006
1 `317409020916 6 CIPEDAK `005 8/21/2018
Irfan 0030 RT 08/05 `008

1
AJISMAN `317409041111 6 CIPEDAK `005 8/21/2018
S.PD 0012 RT 08/05 `008

KP
1
AGUS `317409210515 1 CIPEDAK `005 8/21/2018
DARMAWAN 1037 no 45 b `003

19
 Panjang Vitamin A
Cara Ukur ASI EksklusifF1=YA, 2=Tidak
Badan/ Februari
BB (kg) Tinggi
Badan
(cm) 1=Telentang umur 0 umur 1 umur 2 umur 3 umur 4 1=YA
umur5 bln 2=Tidak
2=Berdiri bln bln bln bln bln
(18) (19) (20) (21) (22) (23) (24) (25) (26) (27)

9 76 1 1

13.2 87 2
1

13.7 87 1

14.7 88 2

16.3 103 2
1

11 77 1

13 98 1

13.5 87 1

16.8 89 1
17 104 1

13 89 2

12.8 98 1

16 103 2
1

18 97 2
1

18.7 98 2
1

17 98 1

7 87 1

16.5 98 1

15 98 1

18.7 100 1

19 101 2

12 90 1
 14 100 2
1

18 103 1

12.4 78 1

13 79 1

13 88 1 1

20 102 1

12 80 1 1

17 103 2

12 104 2
1

12.4 103 2
1

16.8 98 1

12.6 80 1

18 103 1
12 100 1

15 105 1

10 75 1

11.5 99 1

16 103 2
1
8.5 105 2
1

15.2 96 1

14.7 98 2
1

22.5 107 2
1
16 103 1

7.4 74 1

15 98 2

19 98 2
1
11 96 2
1

13 95 1

17 103 1
7.5 75 1

18.2 103 1

16 98 2

1
22 104 2
1
10.4 78 1

8 76 1

21 103 1

9.6 74 1

21 103 1

15.8 96 1

13.5 100 2

9.5 75 1
15.7 98 1

18 103 2
1
12 88 2
1

16 96 1

12.3 105 2
1

12 76 1 1

15 88 2
1
8.4 74 1

22 103 1

16.2 96 2

14 102 2

17 89 1
13.5 106 2

19 104 1

16 97 1

8.2 65 1

14 97 2
1

8 75 1

18.7 100 2

1
17 103 2
1

15 98 1

16 88 2

18 100 1
10 87 1

7.6 74 1

16 103 2

22.4 104 1

8 74 1

17 96 1

8 71

1 1

6.8 52

12 98

21 105 1
18.3 102

12 78

23 103 1

22.7 103 1

1
7.3 79

14.5 97

16 98

7 55
2
22.5 104 1

10 75

9.8 74
21 103

8.6 74

20 103

17 97

13 100 1

9.8 75

16 97
1
9 53

2
18.5 100 1
2
24 110 1
2
12.5 102 1

15 98
 2
12.6 101 1

1 1
13 76

2
11 87 1

10 76

18 98

15 96 1

13 103 1

17 104

23 109

20 109

18 97

1
7.5 60
 2
14 97 1

18 102 1

19.8 97 1
2
18.2 110 1

15 98

16.4 87 1

17 99

11 87

8 73

17 104 1

21 103

9 74

11.4 103
 2

13 98 1

8.6 101 1
2
14 98 1

2
16 90 1

9.8 86

21 108

20 100
1 1
10.3 73

16 97

11.3 96
Vitamin A
Agustus

1=YA
2=Tidak POSYANDU
(28)

APEL 2

1 APEL 2

DUKU

1 DUKU

1 APEL 2

1
APEL 2

1
SIRSAK

1
APEL 2 nik sdh ada

1
APEL 1
1
SIRSAK

1 APEL 2

APEL 2

1 APEL 2

1 APEL 1

1 APEL 1

1
SIRSAK

1
APEL 2
1
APEL 1

1
APEL 1

1
APEL 1

1 APEL 1

APEL 1
1 APEL 1

1
SIRSAK
1
RAMBUTAN

1
APEL 1

1
APEL 1

1
APEL 1

SIRSAK

1 SIRSAK

1 APEL 1

1 APEL 1

1
APEL 2

APEL 1

APEL 1
1
SIRSAK
1
DUKU

1
APEL

APEL 1

1 SIRSAK

1 APEL 1

1
APEL 2

1 APEL 1

1 APEL 1
1
SIRSAK
1
SIRSAK

1 APEL 1

1 APEL 1

1 APEL 1

1
APEL 1

1
SIRSAK
1
SIRSAK
1
APEL 1

1 APEL 1

1 APEL 1
1
APEL 1
1
APEL 1

SIRSAK

SIRSAK

SIRSAK

RAMBUTAN

1 APEL 1

APEL 1
1
APEL 2

1 APEL 1

1 APEL 1

1
APEL 1

1 APEL 1

1
APEL 1

1 APEL 1
1
APEL 1

1
APEL 1

1 SIRSAK

1 APEL 1

APEL 1
1 APEL 1

APEL 1

1
APEL 1

1
SIRSAK

1 SIRSAK

1
SIRSAK

1 APEL 1

1 APEL 1

1
APEL 1

1 SIRSAK

1
SIRSAK
1
SIRSAK

1
APEL 1

1 APEL 1

1
APEL 1

1
APEL 1

1 APEL 2

APEL 2

APEL 1

APEL 1

1 SIRSAK
 APEL 1

APEL 1

1 APEL 2

1 APEL 2

1
SIRSAK

SIRSAK

SIRSAK

SIRSAK

1 APEL 1

APEL 1

APEL 1
 RAMBUTAN

RAMBUTAN

RAMBUTAN

APEL 1

1 APEL 1

APEL 1

1
APEL 1

1 APEL 1

1 APEL 1

1 APEL 1

APEL 1
1 APEL 1

1
APEL 1

1 APEL 1

APEL 1

APEL 1

1 SIRSAK

1 APEL 1

APEL 1

APEL 1

SIRSAK

APEL 1

1
SIRSAK
1 SIRSAK

1 SIRSAK

1 APEL 1

1 APEL 1

APEL 1

1 SIRSAK

SIRSAK

SIRSAK

APEL 1

1 APEL 1

APEL 1

APEL 1

APEL 1
1 SIRSAK

1 APEL 1

1 APEL 2

1 APEL 2

APEL 1

APEL 1

APEL 2
1
SIRSAK

SIRSAK

APEL 1
 FORMULIR PEMANTAUA

Provinsi : : Nama Posyandu

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

Kepemilik
an Buku IMD
Berat
Anak Jenis No Kartu NIK (Nomor Induk KIA/KMS
No Tanggal Lahir Nama anak Badan Nama Ayah NIK Ayah
Ke Kelamin Keluarga Kependudukan) (BB) Lahir
1=YA 1=YA,
2=Tidak 2=Tidak
(1) (2) -3 (4) (5) (6) (7) (8) (9) (10) (11) (12)

P BINAR JIWA ANDRITANY `317409260215

1 1 30/05/2015 317409 3174097005151002 ARDHIYASA 2700 1 1 ARDHIYASA 1013

2 L ATHARRINDRA SATRIO `317409020713

2 27/02/2013 317409 3174092702131004 BANI KSATRIAN 3209 1 1 WICAKSONO 1026

AR RAHMAN
1 L `317308120914100 MUHAMMAD `317308220513
3 12/09/2014 317409 1 AULIA 3650 1 1 Aulia a rivai 1017

GENDIS
3 P `317409440916000 ADISTYA Muhammad `317409071116
4 04/09/2016 317409 5 MAHESWARI 3100 1 1 anggakara 0040

1 L
ATTHARAJEND
`317409060117000 RA ZENEDINE `317409110214
5 06/01/2017 317409 1 ABHIMANTRA 2540 1 1 Moh iqbal 1008

Ainunnisa
2 P `337403650917000 namira Zulfikar `337403131017
6 25/09/2017 317409 4 muriadinata 3400 1 1 muriadiputra 0001
 2 P `317409450217000 Shalvi afsheena Shandy `317409140916
7 05/02/2017 317409 4 nuryadi 2700 1 1 nuryadi 0022

1 L `317409021217000 muhamad muhamad `317409222041

8 02/12/2017 317409 3 arsya abinaya 3100 1 1 tedi 600044

1 L `317409191113100 Azlen Yusuf `317409020710

9 19/11/2013 317409 1 Rahman 3200 1 1 rahman aziz 0002

ATHIRA
3 P `317409710315100 CANTIKA `317409020710
10 31/03/2015 317409 4 RAHMAN 2780 1 1 rahman aziz 0002
FORMULIR PEMANTAUAN PERTUMBUHAN BALITA DI POSYANDU

Panjang Cara Ukur ASI EksklusifF1=YA, 2=Tidak

Tgl Badan/
No Tlp/ Alamat RT RW Pengukura BB (kg) Tinggi
POSYANDU HP Ayah n Badan
(cm) 1=Telentang umur 0 bln umur 1 bln umur 2 bln
2=Berdiri
(13) (14) (15) (16) (17) (18) (19) (20) (21) (22) (23)

1 PERUM DKI BLOK Q 005 8/27/2018 16 97

NO 37 `006 2

1 PERUM DKI JL HAJI 003 8/27/2018 18 108

LISAN `006 2

2 8/27/2018 14.7 98
Jl purwa utama `008 `006 2

1 8/27/2018 12.5 85
Jl Kav dki `005 `006 2

1 8/27/2018 11 76
JL. KP CIPEDAK RT
05 RW 06 NO. 29 `005 `006 1

1 JL. KP CIPEDAK RT 8/27/2018 9 75

05 RW 06 NO. 29 `002 `006 1
 KOMP.DKI RT
1 001/006 BLOK R1 8/27/2018 12 78
NO.009 `001 `006 1

1 8/27/2018 7.2 74
komplek dki no 11.1 `001 `006 1

KAV. DKI JL. PURWA

1 RAYA I BLOK Z 12 RT 8/27/2018 17.8 108
3/6 `003 `006 2

KAV. DKI JL. PURWA

1 RAYA I BLOK Z 12 RT 8/27/2018 18 97
3/6 `003 `006 2
 Vitamin A Vitamin A
SI EksklusifF1=YA, 2=Tidak Februari Agustus

1=YA 1=YA
umur 3 bln umur 4 bln umur5 bln 2=Tidak 2=Tidak
(24) (25) (26) (27) (28)

1 1

1 1

1 1

1 1

1 1

1 1
1 1

1 1

1 1

1 1
Keterangan
- Kolom 11 : Jika ayah tidak ada, maka diisikan nama ibu
- Kolom 12 : Jika ayah tidak ada, maka diisikan NIK ibu
- Kolom 13 : Jika ayah tidak ada, maka diisikan No Telp/Hp ibu