FORMAT PENDATAAN KELUARGA SEHAT (KS)

PUSKESMAS KAMPALA
DESA : KAMPALA 1 = Ya
DUSUN : KAMPALA RT 1 2 = Tidak

Indikator keluarga Sehat

Nama KK/Anggota Akses Hasil

No Urut Keluarga
No Urut Rumah

Hub. Keluarga
Akses SAB Gangguan Jiwa TB Paru Hipertensi

Pendidikan

Pekerjaan
JK Tgl. Lahir NIK NO JKN Jamban Keluarga peng. Ibu Imunisa
Anggota Wanita
keluarga 10 - 54 Melahirka si Dasar Bayi ASI Balita
n di Lengka EKS 7-23 Timbang
Meroko Thn Ikut Fasyangke p 12-23 bln < 5 thn
Tekanan k KB
AK Obat Di s < 12 bln bln
Terse Terlind Terse Jamban BAB di Di Obat Di Obat
Keluarga dia saniter Jamban Diagnosa Teratur dipasun Teratu Diagnos Teratur
dia ung Diagnosa
g r a
Darah

1 1 Usman L 1 12/10/1982 7307031210820002 0001069996994 6 1 1 1 1 1 2 2 2 120/70 1 2

Rohana p 2 12/10/1983 7307035210830005 0001069996994 1 1 1 1 1 1 2 2 2 120/80 2 2

Abd. Rahman L 3 12/1/2012 7307031201120001 0001069996994 1 1 1 1 1 1 2 2 2 2

M KHadir L 3 9/11/2017 7307030911170001 0001069996994 1 1 1 1 1 1 2 2 2 2 1 1 1 1

2 2 Usman L 1 29/12/1974 7307032912740002 0001069997804 6 1 1 1 1 1 2 2 2 120/80 1 1

Sufiana p 2 12/8/1983 7307035208930002 0001069997815 1 1 1 1 1 1 2 2 2 120/80 2 1

Putri Salsabila L 3 18/03/2006 7307035803160001 2 1 1 1 1 1 2 2 2 2

3 3 Abd Kahar Djule L 1 31-12-1956 7307033112560018 0000128652287 3 1 1 1 1 1 2 2 2 1 N

Hj. Siarni Hs P 2 30-03-1962 7307037009620000 0000128642321 3 1 1 1 1 1 2 2 1 1 2 N

Yasin Arafah L 3 30-5-1993 7307033105930001 00001069996994 3 1 1 1 1 1 2 2 2 1

Sudirman HS L 7 31-12-1960 7307037112640082 2201108365 3 1 1 1 1 1 2 2 22 1

4 4 Syai P 1 31-12-1958 7307037112580048 0000928688692 6 1 1 1 1 1 2 2 2 130/90 2 N

5 5 Ramlah P 1 31-12-1974 7307037112740057 0001069996994 6 1 1 1 2 1 2 2 2 2 120/80 2 N

 Amran L 3 7/7/1997 7307030707970004 0001069997005 2 1 1 1 2 1 2 2 2 2 1

M. Alif Amrullah L 3 25-7-1998 7307037112640082 0001069997016 2 1 1 1 2 1 2 2 2 2 2

Rahmat L 3 24-3-2006 7307032403060001 0001069997027 2 1 1 1 2 1 2 2 2 2 2

6 6 Rahman L 1 5/7/1973 7307030507730000 0000928852907 5 1 1 1 1 1 2 2 2 1 1

Hajra P 2 10/2/1971 7307035002710002 0000928853076 1 1 1 1 1 1 2 2 2 120/80 2 1

Kasman L 3 21-11-1998 7307032011980001 0000928853166 1 1 1 1 1 1 2 2 2 90/70 1 N

Risal L 3 10/11/2000 7307031011000003 0000928853256 2 1 1 1 1 1 2 2 2 2 N

M. Aris Rahman L 3 20-10-2010 7307032010100001 0000928853796 2 1 1 1 1 1 2 2 2 2 N

7 7 Yusuf L 1 1/5/1965 7307030209620001 0001069996959 6 1 1 1 1 1 2 2 2 120/80 1 2

Harlina P 2 27-12-1974 7307036712740002 0001069996961 1 1 1 1 1 1 2 2 2 120/90 2 2

Muh. Yusran L 3 4/12/1991 7307030412910001 0001069996972 2 1 1 1 1 1 2 2 2 120/70 2 N

Harmawat P 3 27-8-1995 7307036708950004 0001069996983 2 1 1 1 1 1 2 2 2 120/60 2 N

8 8 Junaid L 1 31/12/1980 7307033112800045 0001563796898 9 1 1 1 2 2 2 2 120/80 2 N

Saoda P 6 31/12/1940 7307037112400054 0001563795909 1 1 1 1 2 2 1 1 140/90 2 N

9 Kamria P 1 31/12/1978 7307037112640082 0001069996994 1 1 1 1 1 2 2 2 2 90/70 2 N

Riskayant P 3 9/10/1998 7307030910980059 0002131064201 2 1 1 1 1 1 2 2 2 2 120/80 2

Rifdayant P 3 15/11/2000 7307035511000001 0001932987104 2 1 1 1 1 1 2 2 2 2 120/70 2

Rahmat Hidayat L 3 22/11/2012 7307032611130001 0001939987115 2 1 1 1 1 1 2 2 2 2

M. Alfaiz L 3 26/9/2016 7307037112640082 0001069996994 2 1 1 1 1 1 2 2 2 2

9 10 Arifin L 1 31/12/1971 7307033112710062 0001563807284 1 1 1 1 1 2 2 2 120/90 1 N

 Diana P 2 31/12/1969 7307037112690066 0001563807295 1 1 1 1 1 2 2 2 120/80 2 N

11 Ardiansya L 1 10/11/1988 7371061011880006 0001563807284 1 1 1 1 1 2 2 2 110/70 2 N

Arfina P 2 13/8/1991 7307035308910001 0001563807306 1 1 1 1 1 2 2 2 110/70 2 N

10 12 Nasir L 1 31/12/1961 7307033112610016 0000929312177 1 1 1 1 1 1 1 1 1 140/90 1 N

Sarifa P 2 31/12/1958 7307037112580046 0000929313189 1 1 1 1 1 2 2 110/80 2 N

Baco L 7 31/12/1956 7307033112560076 0000929313909 1 1 1 1 1 1 1 2 2 2 1 N

11 13 Amrullah L 1 31/12/1985 7307033112850028 0001069998647

Mariani P 2 1/7/1985 7307034107850008 0001069998658

Isal L 3 7307031202100001 0001069998669

12 14 Jafar L 1 65 thn/31-12-1951 7307033112510015 9 1 1 1 1 1 2 2 2 120/70 2 1

Kanang P 2 44Thn/31-12-1972 7307037112720052 1 1 1 1 1 1 2 2 2 140/90 2 1

Agus L 3 19 thn/17--10-1997 7307031710970004 8 1 1 1 1 1 2 2 2 120/70 2

Ismail L 3 18 thn/07-07-1998 7307030707980003 8 1 1 1 1 1 2 2 2 120/70 1

Maelani P 3 9 thn/26-05-2007 7307037112640082 0000929650195 2 1 1 1 1 1 2 2 2 2

13 15 Hamiman P 1 31-12-1965 7307034112640003 0000929307429 6 1 1 1 1 1 2 2 2 100/70 2 N

Ansar L 3 23-03-1992 7307037112640082 0001069996994 9 1 1 1 1 1 2 2 2 110/70 2

FAJAR L 3 31-12-1994 7307037112640082 0001069996994 9 1 1 1 1 1 2 2 2 100/60 2

14 16 Amir L 1 46 Thn/31-12-1972 7307033112720084 0000929812206 9 1 0 1 1 1 2 2 2 120/70 1 N

Bukra P 2 45 thn/31-12-1973 7307037112730094 0000929812612 9 1 0 1 1 1 2 2 2 120/80 2 N

Ikramulla L 3 27 thn/20-12-1991 7307032012910003 0000929813139 9 1 0 1 1 1 2 2 2 120/80 2

 Israwat P 3 25 thn/20-01-1993 7307038001030001 0000929813409 9 1 0 1 1 1 2 2 2 120/70 2

rahmawat P 3 14 thn/24-10-2004 7307036410040002 0000929814197 9 1 0 1 1 1 2 2 2 120/60 2

15 17 Kamaruddin L 1 52 Thn/31-12-1966 7307033112660036 0001069996994 9 1 1 1 1 1 2 2 2 120/70 1 1

Humra P 2 43 thn/20-05-1975 7307036005750002 0001069996994 1 1 1 1 1 1 2 2 2 100/60 2 1

Nugrahwat P 3 21 thn/01-10-1997 7307034110970002 0001069996994 9 1 1 1 1 1 2 2 2 110/70 2

Kurniawan L 3 17 thn/21-08-2001 7307032106010001 0001069996994 2 1 1 1 1 1 2 2 2 100/60 2

Syam alamsyah L 3 10 thn/20-09-2008 7307032009080003 0001069996994 2 1 1 1 1 1 2 2 2 2

16 18 Abd kadir L 1 55 thn/04-05-1963 730703405630001 0001069996994 9 1 1 1 1 1 2 2 2 120/80 2 N

Risya P 2 53 thn/31-12.1965 7307037112650112 0001069996994 9 1 1 1 1 1 2 2 2 110/70 2 N

17 19 Enre L 1 48 thn/31-12-1970 7307033112700120 0000929655156 9 1 1 1 1 1 2 2 2 120/90 1 1

Marlina P 2 35 thn/19-08-1981 7307037112710057 0000929655358 1 1 1 1 1 1 2 2 2 100/70 2 1

Apriyanto L 3 16 thn/06-04-2000 7307033112000001 0000929656124 2 1 1 1 1 1 2 2 2 100/70 2

Nurbaet P 3 15 thn/09-05-2001 7307033112010016 0000929656337 2 1 1 1 1 1 2 2 2 100/80 2

Ramadan L 3 14 thn/08-11-2002 7307037112640082 0000929656124 2 1 1 1 1 1 2 2 2 2

Ernawat P 3 12 thn/19-01-2004 7307037112030007 00000929657823 2 1 1 1 1 1 2 2 2 2

Apriyansyah L 3 21 bln/14-04-2015 7307031404150002 0001563806441 1 1 1 1 1 1 2 2 2 2 1

18 20 Pandang L 1 41 thn/01-07-1977 7307030107770031 000929269225 6 1 1 1 1 1 2 2 2 110/80 1 1

Murniat P 2 43 thn/01-07-1975 7307034107750025 000929269304 1 1 1 1 1 1 2 2 2 90/60 2 1

Ulfayant P 3 15 thn/01-07-2003 7307034107030023 0000929269776 2 1 1 1 1 1 2 2 2 90/60 2

Jelita P 3 11 thn/17-07-2007 7307035707070002 0000929269888 2 1 1 1 1 1 2 2 2 2

Syahrul L 3 9 thn/09-06-2009 7307030906090001 0000929270441 2 1 1 1 1 1 2 2 2 2

19 21 Antong L 1 69 thn/31-12-1947 7307033112490033 0001069996994 6 1 1 1 1 1 2 2 1 1 140/90 1 N n

Parto L 3 36 thn/31-12-1982 7307033112820001 0001568806406 9 1 1 1 1 1 2 2 2 120/80 2 N n

20 22 M. Arja L 1 47 thn/16-02-1971 7307031502710002 0001563806474 5 1 1 1 1 1 2 2 2 110/70 2 1

Halima P 2 44 thn/01-09-1974 730703410170003 0001563806485 1 1 1 1 1 1 2 2 2 100/60 2 1

Sri wahyuni P 3 23 thn/29-09-1995 7307036000050002 2 1 1 1 1 1 2 2 2 100/70 2 N

Dita cahyat P 3 20 thn/06.10-1998 7307034510880002 0001563806496 2 1 1 1 1 1 2 2 2 100/60 2 N

Alif ramadani L 3 18 thn/02-02-2000 7307030202000001 2 1 1 1 1 1 2 2 2 100/70 2 N

23 Hani P 1 83 thn/01-07-1935 7307034107350010 0001069999457 1 1 1 1 1 1 2 2 1 2 160/100 2 N

Rudini P 5 31 thn/18-09-1987 7307031809870001 0000929277044 9 1 1 1 1 1 2 2 2 120/70 1

21 24 Sawiah P 1 47 thn/01-09-1971 7307035209710001 0001563795922 9 1 1 1 1 1 2 2 1 1 140/70 2 N

Saleha P 6 80 thn/31-12-1938 7307037112380051 1 1 1 1 1 1 2 2 1 2 160/80 2 N

22 25 Armi P 1 44 Thn/31-12-1974 7307037112600206 3 1 1 1 1 1 2 2 2 130/90 2 N

A. Asni Badong P 7 44 Thn31-12-1974 7307037112600124 0001069996994 9 1 1 1 1 1 2 2 2 110/70 2 N

23 26 A. Akbar Badong L 1 `01-03-1972 `7307030103720001 `0000128526748 3 1 1 1 1 1 2 2 2 110/80 2 1

drg. A. Susant Bactar P 2 `31-12-1974 `7307036612740001 `0000128567889 3 1 1 1 1 1 2 2 2 110/80 2 1

A. Ali Akbar Badong L 3 `03-04-2006 `7307030304060002 `0000128567891 2 1 1 1 1 1 2 2 2 2

A. Ghoniyyah Akbar P 3 `19-03-2008 `7307035903080001 `0000128567902 2 1 1 1 1 1 2 2 2 2

A. Rania Akbar P 3 `11-07-2009 `7307035107030001 `0001274686571 2 1 1 1 1 1 2 2 2 2

A. Muammmar Badong L 3 `26-04-2011 `7307032604110001 `0001274697461 2 1 1 1 1 1 2 2 2 2

 A. Indo Kartka Adawiah P 3 `07-05-2013 `7307034705130002 `0000127470615 2 1 1 1 1 1 2 2 2 2

24 27 A. Halilintar L 1 `31-12-1963 `7307031608630001 ASKES 3 1 1 1 1 1 2 2 1 1 150/80 2 1

Erna A. Hamza P 2 `28-121986 `7307036812860004 TIDAK ADA 9 1 1 1 1 1 2 2 2 110/80 2 1

25 28 Nurdin L 1 `31-12-1938 `7307037112640082 6 1 1 1 1 1 2 2 2 110/70 1 N

29 Ahmad Kaddafi L 1 `05-05-1987 `7307050505870001 9 1 1 1 1 1 2 2 2 110/80 1 N

Isnawat P 2 `01-07-1980 `7307037112820079 5 1 1 1 1 1 2 2 2 110/70 2 N

26 30 Hj. Asia Djule P 1 `30-03-1947 `7307037003470001 ASKES 3 1 1 1 1 1 2 2 2 110/70 2 N

Hj.Nuraeni Djule P 7 `31-12-1949 `730703741240043 ASKES 3 1 1 1 1 1 2 2 2 140/80 2 N

A. Usman Balo L 7 `31-12-1955 `7307037112640082 MANDURI 6 1 1 1 1 1 2 2 2 130/80 2 N

Riska Yusuf P 7 `17-03-1998 `7307037112640082 2 1 1 1 1 1 2 2 2 120/80 2 N

27 31 Jamaluddin L 1 `14-04-1973 7307031404730003 `0001069999582 6 1 1 1 1 1 2 2 2 100/80 1 1

Wahidah P 2 `30-12-1983 7307037012830008 `0001069999593 1 1 1 1 1 1 2 2 2 90/60 2 1

Zulfikar Usman L 3 `17-08-2004 7307031708040002 `0001069999604 2 1 1 1 1 1 2 2 2

Zulfadli Usman L 3 `01-01-2007 7307030101070002 `0001069999615 2 1 1 1 1 1 2 2 2

Zulkifli Usman L 3 `03-02-2010 7307030302100001 `0001069999626 2 1 1 1 1 1 2 2 2

Zuljalali L 3 `03-06-2012 7307030306120002 `0001563806834 1 1 1 1 1 2 2 2

Zulfikram L 3 `03--08--2014 7307030308140002 `0001563806845 1 1 1 1 1 2 2 2

28 32 Erni P 1 `31-12-1979 `7307037112780039 6 1 1 1 1 1 2 2 2 120/60 2 N

Annisa P 3 `22-09-1997 `7307037112960004 1 1 1 1 1 1 2 2 2 120/80 2

 Bob Jonath L 3 `19-08-2000 `7307030207000002 1 1 1 1 1 1 2 2 2 120/60 2

29 33 Rusli L 1 `31-12-1976 `7307033112760050 `0000928640902 6 1 1 1 1 1 2 2 2 120/80 1 1

Nani P 2 `31-12-1978 `7307037112780022 `0000928641003 1 1 1 1 1 1 2 2 2 130/90 2 1

Ferdi L 3 `31-03-2007 `7307033103070001 `0000928641295 2 1 1 1 1 1 2 2 2

Fitra P 3 `23-05-2013 `7307036305130001 `0001563806799 1 1 1 1 1 1 2 2 2

Fitri P 3 23-05-2013 `7307036305130002 `0001933471866 1 1 1 1 1 1 2 2 2

34 Salama L 1 `31-12-1931 `7307033112310018 `0001069996994 6 1 1 1 1 1 2 2 2 120/70 2 N

Enre P 2 `31-12-1938 `7307037112380050 1 1 1 1 1 1 2 2 2 120/80 2

Isya Enre P 7 `31-12-1926 `7307037112260009 1 1 1 1 1 1 2 2 2 120/70 2

Budi L 7 `31-12-1996 `7307033112060008 9 1 1 1 1 1 2 2 2 120/80 2

30 35 Syamsiah Salamah P 1 `19-05-1966 `7307035505660003 `0001563806924

Zakiah Nur Khalidah P 3 `17-06-1995 `7307034905950004 `0001563806935

Zulham Massenge L 3 `24-06-2002 `7307033001020004 `0001563806946

31` 36 BUCCUNG L 1 `31-12-1949 `7307032708460001 `0000928637954 6 1 1 1 1 2 2 1 2 140/80 2 N

NIAR P 3 `31-12-1972 `7307034107750049 `0000928638088 1 1 1 1 1 2 2 2 120/80 2 N

BURHANUDDIN L 3 `01-01-1981 `7307030107810030 `0000928639405 9 1 1 1 1 2 2 2 1

BAKRI L 3 `31-12-1981 `7307033112800072 `0000928639574 9 1 1 1 1 2 2 2 0

DEA P 5 `11-12-2002 `7307035112020003 `0000928640496 9 1 1 1 1 2 2 2 100/70 0

ADE SAPUTRA L 5 `12-12-2006 `7307031212060001 `0000928640529 2 1 1 1 1 2 2 2 0

FADEL ANANTA L 5 `21-02-2009 `7307032102090001 `0000928640608 2 1 1 1 1 2 2 2 0

IMRAN L 5 `14-03-1996 `7307037112640082 `0000928640529 9 1 1 1 1 2 2 0 0

32 37 LANGKE L 1 `05-01-1975 `7307030501750006 `0001069996994 4 1 1 2 2 2 2 2 2 120/80 2

RAHMANIAR P 2 `03-10-1982 `7307034310820001 1 1 2 2 2 2 2 2 100/70 2

FADIL L 3 `25-07-2010 `7307032507100002 1 1 2 2 2 2 2 2 120/60 2

IAN RAMADAN L 3 `23-06-2015 `7307032306150001 1 1 2 2 2 2 2 2 120/60 2

ILHAM L 7 `27-03-2001 `7307037112640082 1 1 2 2 2 2 2 2 120/80 2

33 38 RUSMIN L 1 29.-12-1980 7307032912800002 00001069997501 6 1 1 1 1 1 2 2 2 120/80 2 N

M.RAYATUSSAADA L 3 5 THN/07-03-2011 7307030730110002 00001069997523 1 1 1 1 1 1 2 2 2

QIBLAT L 3 54 BLN/26/07-2012 7307032607120002 00001563808529 1 1 1 1 1 1 2 2 2

39 SYEKONG P 1 `31-12-1952 `7307037112640082 `00001069997488 1 1 1 1 1 1 2 2 2 120/80 2 N

FATIMAH P 7 `31-12-1980 1 1 1 1 1 1 2 2 2 100/70 2 N

34 40 JIDI L 1 `02-05-1970 `7307030205700001 `0001069997681 6 1 1 1 1 1 2 2 2 120/80 1 N

DARMA P 2 `31-12-1972 `7307037112720022 `0001069997692 1 1 1 1 1 1 2 2 2 110/70 2 N

ATMASARI P 3 `15-01-1993 `7307035501030001 9 1 1 1 1 1 2 2 2 110/70 2

HAWARIA P 3 `17-03-1994 `7307035703940003 9 1 1 1 1 1 2 2 2 100/70 2

ISMAWATI P 3 27-08-1995 `7307036808950002 9 1 1 1 1 1 2 2 2 110/70 2

ASMAWATI P 3 `27-08-1995 `7307036708950002 `0001069997736 2 1 1 1 1 1 2 2 2 100/70 2

M.ASKUM L 3 `15-10-1998 `7307031510980001 `0001069997747 2 1 1 1 1 1 2 2 2 100/80 1

NUR RAMADHANI P 3 `15-10-2005 `7307035510050002 `0001069997758 2 1 1 1 1 1 2 2 2 100/70 2

35 41 A.TENRI AJENG P 1 `25-03-1998 `7307086503880001 `0001069996994 9 1 1 1 1 1 2 2 2 120/80 2 N

A. SATIA RAJA BAGEND L 3 `24-02-1916 `7307032402160002 1 1 1 1 1 1 2 2 2

 A.SAKTI MAPUJI L 3 `06-05-2017 `730703605170001 1 1 1 1 1 1 2 2 2 1 1 1

36 42 SADLI NAJAMUDDIN L 1 `05-01-1982 `737107501820014 9 1 1 1 1 1 2 2 2 120/70 2 1

LEDI HERDIANTI P 2 `14-10-1989 `7307035410890001 9 1 1 1 1 1 2 2 2 110/70 S 1

ANDI AMIDAH SRIAND P 3 `15-02-2017 `7307035502170001 1 1 1 1 1 1 2 2 2 2 1 1 1

37 43 ITTE P 1 `31-12-1932 `7307037112640082 `0001069996994 1 1 1 1 1 1 2 2 2 120/80 2 N

Ket : 57 L

63 P
 FORMAT PENDATAAN KELUARGA SEHAT (KS)
PUSKESMAS KAMPALA

DESA : KAMPALA

DUSUN : KAMPALA RT 02

Indikator keluarga Sehat

Nama KK/Anggota Akses

No Urut Keluarga
No Urut Rumah

Akses SAB Gangguan Jiwa TB Paru Hipertensi

Pendidikan
Jamban Keluarga

Pekerjaan
Anggo Ibu
JK Tgl. Lahir NIK NO JKN Hasil ta Wanita Melahirk Imunisas Bayi Balita
i Dasar
peng.Teka keluar 10 - 54 an di Lengkap ASI Timba
Hub. Keluarga nan ga Thn Fasyangk 12-23 EKS 7- ng < 5
Terse Terlind Terse Jamba BAB di Di Obat AK Di Obat Di Obat Darah Merok Ikut KB es < 12 23 bln thn
Keluarga n Jamba Diagno Teratu dipasu Diagno Teratu Diagno Teratu bln
dia ung dia ok bln
saniter n sa r ng sa r sa r

38 44 A. BAHARUDDIN/ Merantau L 5 1 1 1 1 1 2 2 1 1 1 N
1 03/07/1970 730703703700002 0000928651465
SADERIA P 1 1 1 1 1 1 2 2 1 1 170/80 2 N
2 05/05/1968 7307034505680001 0000928651588
A. NURFADA P 4 100/70
3 17/03/1996 7307035703960000
A.HASAN L 1
3 15/05/1998 7307031505980004 0000928652005
A.BARAKA L 1 90/60
3 01/01/2001

39 45 ANDI SAIFULLAH L 3 1 1 1 1 1 2 2 2 137/60 2 1 N

DAHLIA NUR
ANDI MUSLIHALI SAIFULLAH
ANDI MAHYUDDIN SAIFULLAH
ANDI MAMMINASA SAIFULLAH
1 31/12/1967 7307033112570113 0000128642218
p 3 1 1 1 1 1 2 2 2 100/60 2 1
2 31/12/1966 7307037112660017 '0000128642201
L 2 2 2 90/50 2 N
3 15/04/2003 7307035504030004
L 2 2 2 2 N
3 29/08/2004 7307032808040001 0000128642231
p 2 2 2 2 N
3 25/05/2007 7307036505070002

40 46 L 22/05/1981 3 1 1 1 1 1 2 2 2 1 1
AKMAL 1 7307032205810001 ASKES
P 15/10/1982 3 1 1 1 1 1 2 2 2 2 1
NAJMAWATI 2 7307035510820003 ASKES
L 16/10/2010 2 1 1 1 1 1 2 2 2 2 1
A.OTHMANLDO MARUMPA 3 7307031510100001 ASKES
P 14/07/2015 1 1 1 1 1 1 2 2 2 2 1
A.MUMUKAI IMAZAYA 3 7307035407150001 ASKES
 L 1
A.RI 3
P 31/12/1956 1 1 1 1 1 1 2 2 2 2 N
DAHLIAH SANUSI 6 7307037112560047 ASKES

41 47 HJ. BADDARE p 5 1 1 1 1 1 2 2 2 130/80 2 N

1 31/121957 7307037112570122 0002033563702

42 48 MUSTAMIN L 4 1 1 1 1 1 2 2 1 1 140/100 2 N N N N N
1 07/01/1957 7307030107570041 0001069998232
NURLIA p 6 1 1 1 1 1 2 2 2 100/70 2 N N N N N
2 07/01/1960 7307034107600048 0002365936007
MUZAKKIR L 4 1 1 1 1 1 2 2 2 120/80 2 N N N N N
3 31/01/1985 7307033101850001 0001069998254
HARDIANSYAH L 1 1 1 1 1 2
3 30/09/1997
LIKMAR L 2 1 1 1 1 1 2
3 29/09/2005

43 49 BACO HASAN L 6 1 1 1 1 1 2 2 2 120/70 1 N

1 31/12/1952 7307033112570095 TDK ADA
SARIBUANG P 5 1 1 1 1 1 2 2 2 120/80 2 N
2 31/12/1950 7307037112500060 TDK ADA

44 50 AMIR SALAM L 6 1 1 1 1 1 2 2 2 130/90 1 1

1 29/12/1978 7307032912780000
DINA YANTI P 6 1 1 1 1 1 2 2 2 100/70 2 1
2 25/12/1984 7307036512840003 0000929824931
ILVIANI P 2 1 1 1 1 1 2 2 2 2
3 15/11/2004 7307035511040001 0000929825662
SYAMSIAH P 2 1 1 1 1 1 2 2 2 2
3 14/11/2006 7307035411060001
SRI ULANG P 1 1 1 1 1 1 2 2 2 2
3 11/11/2008 7307035111080003 0002365937706
MUH.FIKRAM L
3 07/04/2013

45 51 KAHAR/ MERANTAU L 1 04/07/1987 7307030704870002 TDK ADA JKN

MURNIATI P 5 1 1 1 1 1 2 2 2 90/60 2 2
2 30/03/1986 7307037003860001
NUR AFIFAH P 2 1 1 1 1 1 2 2 2 2
3 10/02/2011
NURHAFISAH KAHAR P 2 1 1 1 1 1 2 2 2 2
3 14/09/2014

46 52 HUME P 5 1 1 1 1 1 2 2 1 2 150/90 2 N
1 13.-10-1958 7307035310580000 0001563807384
 NIKMAH P 5 1 1 1 1 1 2 2 2 2 110/80 2 N
3 17.-12-1976 7307035712760002 0001563807385
SYAMSIAH P 5 1 1 1 1 1 2 2 2 110/60 2 N
3 11.-12-1977 7307035112770002 0001563807396

47 53 JUMAIN L 5 1 1 1 1 1 2 2 2 120/80 2 N
1 31/12/1965 7307053112650134 0001563807238
MULIATI P 9 1 1 1 1 1 2 2 2 110/70 2 N
2 06/10/1968 7307035006680001 0001069997995
Muh. Ardi P 9 1 1 1 1 1 2 2 2 1
3 21/11/1995 7307052111950003 0001563833496

54 SUYUTI L 2 1 1 1 1 1 2 2 2 2
1 05/12/1993
TENNANG P 1 1 1 1 1 1 2 2 2 140/80 2
7 09/02/1945 7307034209450001 0001069997984
MONRO P 1 1 1 1 1 1 2 2 2 100/70 2
6 31/12/1928 7307037112280019 0001069997973

48 55 MUH .UMAR TOMBONG L

1 31/12/1956 7307033112560049 0000114768898
HADIAH P
2 18/05/1955 7307035805550001 0002365933397
NURHIKMA JUMAR P
3 23/07/1990 7307036307990003 0000114768909

49 56 SITTI SUFIATI P 3 1 1 1 1 1 2 2 2 120/80 2 N

1 31/12/1961 7307037112610045 0000128639204
MALFI TUNRUANG MALEELO L 2 1 1 1 1 1 2 2 2
3 04/041991 7307030404910002 0000128639237
ATIMIA INDO LETTE P 4 1 1 1 1 1 2 2 2
3 18/11/1992 7307035811920001 0000128639248

57 A.ARDIANSYAL L 3 1 1 1 1 1 2 2 2 120/80 1 N
1 27/01/1981 7307022701810003 0001887960363
SUKMA JAMALIA PUTI P 9 1 1 1 1 1 2 2 2 100/70 2 N
2 12/12/1988 7307035212880003 0000128639226
A.MUSLIKA MUHA ACMAD P 1 1 1 1 1 1 2 2 2 1 1 1
3 16/05/2017 7307031605170003 0002256573172

50 58 HJ.DAHLIAH ABBAS P 3 1 1 1 1 1 2 2 2 120/80 2 N

1 31/12/1954 7307037112540077

59 ANDI. ABRAHMAN L 5 1 1 1 1 1 2 2 2 130/80 1 1

1 09/12/1977 7307031209770003 0002032774029
WAHIDA P 1 1 1 1 1 1 2 2 2 120/80 2 1
2 12/10/1974 7307035012740003 0002032774706
 ANDI NURSAIDA BADONG P 2 1 1 1 1 1 2 2 2 100/70 2 N
3 22/05/2002 7307036205020007 '0002032775471
ANDI NUR AISYAH BADONG P 2 1 1 1 1 1 2 2 2 100/70 2 N
3 25/12/2003 7307036512030002 0002032776944
ANDI RAISYAH BADONG P 2 1 1 1 1 1 2 2 2 2 N
3 30/06/2010 7307037006100001 0002032778114
ANDI HASMADIA BADONG P 1 1 1 1 1 1 2 2 2 2 N
3 19/01/2017 7307035901170001 0002208397443

60 A. FERI ASDAR L 1 1 1 1 1 1 2 2 2 130/70 1 1

1 12-31-1969 730703002690097 ASKES
A. MARLIANINGSI P 5 1 1 1 1 1 2 2 2 100/80 2 1
2 11-10-1985 7307035011850004 ASKES
A. AZHIMA TANRI BADONG P 2 1 1 1 1 1 2 2 2 2
3 25-1-2008 7307036501080001 ASKES
A. MUH.ADIB MAPPAGESSA L 2 1 1 1 1 1 2 2 2 2
3 4-6-2009 7307030604090001 ASKES

61 MUH ARFAH L 5 1 1 1 1 1 2 2 2 110/66 1 N

1 15/09/1985 7307061509850001

51 62 BASRI L 8
1 01/01/1975
INDIANI 1 1 1 1 1 1 2 2 2 130/8 2 1
2 05/05/1984 7307034505840006 0001933471528
DAWIL BASRI 2 1 1 1 1 1 2 2 2 2
3 10/02/2005 7307030210050002 0002365932475
DJALIL BASRI 2 1 1 1 1 1 2 2 2 2
3 13/06/2009 7307031306090001 0001933471541
KARMILA 1 1 1 1 1 1 2 2 2 2
3 10/04/2012 7307054410120001 0001933471552

52 63 NANI P 1 1 1 1 1 1 2 2 1 1 150/90 2 N
1 31/12/1961 7307037112610068 PBI

53 64 5 1 1 1 1 1 2 2 2 1
MUH ALWI 1 31/12/1956 7307033112560061
1 1 1 1 1 1 2 2 1 1 150/90 2 1
MAEMUNAH 2 31/12/1969 7307037112690003
9 1 1 1 1 1 2 2 2 100/60 2 N
SRI WAHYUNI 3 10./06/1990 7307035006900001
9 1 1 1 1 1 2 2 2 2 N
NUR REZKI 3 02/01/1993 7307034102930001

65 AGUSSALIM 5 1 1 1 1 1 2 2 2 110/80 1 1
1 28/06/1986 7307032806860001 TIDAK ADA JKN
JUMRAH 1 1 1 1 1 1 2 2 2 90/60 2 1
2 14/12/1990 7307035412900001
 ANGGUNG HAIRUNISA 1 1 1 1 1 1 2 2 2 2
3 31/03/2011 7307037103110001
MUH. ADIT 1 1 1 1 1 1 2 2 2 2
3 22/01/2014 7307032201140001

54 66 SALMAH LASUBBU 6 1 1 1 1 1 2 2 1 1 140/90 2 1

1 31/12/1952 7307037112520054
RUKIAH L 5 1 1 1 1 1 2 2
2 31/12/1959 7307037112540151
NURBAYA L 3 1 1 1 1 1 2 2
3 31/12/1959 7307037112590084
MASKUL 4 1 1 1 1 1 2 2
3 06/04/1995 7307030406950001

55 67 SABIR 3 1 1 1 1 1 2 2 2 130/80 1 1
1 22/10/1959 7307032210590001
SYAMSIAH LASUBU 3 1 1 1 1 1 2 2 2 130/90 2 1
2 31/12/1961 7307037112610048
NURFAISA 4 1 1 1 1 1 2
3 26/02/1988 7307032502880001
RIFKA 4 1 1 1 1 1 2 2 2 2 1
3 11/01/1990 7307034111800003
RIKSA 9 1 1 1 1 1 2 2 2 110/80 2 1
3 11/01/1990 7307034111900002
NURFAHIRAH 4
3 16/01/201 7307034212940001
NURWAHIDA 2 1 1 1 1 1 2 2 2 100/70 2
3 12/02/1994 7307034212940001
NUR HASANA 2 1 1 1 1 1 2 2 2 100/70 2
3 28/12/2002 7307036812020002
NURHILYATUL AULIA 2 1 1 1 1 1 2 2 2
3 19/09/2004 7307035909040001

56 68 HARDIN 5 1 1 1 1 1 2 2 2 140/100 1 2
1 20/12/1973 7307032012750003
SITTI MARWAH 5 1 1 1 1 1 2 2 2 100/70 2 2
2 05/10/1975 7307035001750001
MIFTAHUL KAIRAH 2 1 1 1 1 1 2 2 2 2
3 04/04/1997 7307034404970001
MAWADDAH WARAHMAH 2 1 1 1 1 1 2 2 2 90/60 2
3 10/08/2001 7307034910010002
MUFLIHUL AFIA 2 1 1 1 1 1 2 2 2
3 24/09/2009 7307032409090001
HERO 1 1 1 1 1 1 2 2 2 110/80 2 1
3 31/12/1936 7307037112380022

57 69 MUH ANNUAR RAPPE 5 1 1 1 1 1 2 2 2 110/70 1 1

1 03/12/1974 7307031403740001
SUARNI JULAI 5 1 1 1 1 1 2 2 2 100/70 2 1
2 09/09/1979 7307034809790002
 ASSIRAF 2 1 1 1 1 1 2 2 2 2
3 06/08/2009 7307030906090002

58 70 SAMSUL L 5 1 1 1 1 1 2 2 130/90 2 N
1 06/01/1951 7307030106510002
RAHMATIA P 5 1 1 1 1 1 100/70 2
2 31/12/1958 7307037112560040

59 71 ZANUDDING 6 1 1 1 1 1 2 2 2 1 N
1 03/05/1954 7307030503540000
SIANG 1 1 1 1 1 1 2 2 2 120/80 2
2 05/02/1962 7307034205620001

60 72 YUSRAN SAINUDDIN L 6 1 1 1 1 1 2 2 2 100/70 1 1

1 17/02/1987 7307031702870001
SUKMAWATI P 6 1 1 1 1 1 2 2 2 110/80 2 1
2 02/03/1986 7307044203860002
MUH. FATIR P 1 1 1 1 1 1 2 2 2 2
3 25/04/2013 7307032504130001
FURQAN APRUADI P 1 1 1 1 1 1 2 2 2 2
3 03/09/2017 7307030903170002

60 73 AMRI 12/07/1985
1 7307031207850001
ERNAWATI 11/11/1986
2 7307035111860001
RILVALDI MAULANA 15/03/2008
3 7307031503080001
ALVIN 11/02/2010
3 7307031102100001
ALIF AMRI 14/01/2016
3 7307031401160001

61 74 BAHARUDDIN L 20/02/1979 3 1 1 1 1 1 2 2 2 120/70 2 1

1 7307032002790001 ASKES
ARNITA P 31/12/1981 3 1 1 1 1 2 2 2 2 1
2 7307037112810013 ASKES
ACHMAD AN NIZAR MAULANA
ARDIN
L 01/06/2009 2 1 1 1 1 2 2 2
3 7307032408090001 ASKES
NABILAH AZ ZAHRA DWI PUTRI
ARDIN P 22/12/2015 1 1
3 7307036212130001 ASKES

62 75 SARAMUDDIN L 3 1 1 1 1 1 2 2 2 110/70 1
1 19/03/1955 7307031903550001 0000009717388
NUR CAYA P 3 1 1 1 1 1 2 2 2 2
2 31/12/1950 7307037112580070
SAHIRA ANISA P 1 1 1 1 1 1 2 2 2 2
3 04/12/1995 7307035204950005
 ROSIDA ANISA P 1 1 1 1 1 1 2 2 2 2
3 17/02/1998 7307035702960002
ALYA P 1 1 1 1 1 1 2 2 2 2
3 07/01/1937 7307034107370030

63 76 SYUAIB RAUP P 31/12/1951 1 1 1 1 1 1 2 2 1 1 160/100 2 N

1 7307033112510014 ASKES

77 NURLAILA SUAIB P 09/04/1977 1 1 1 1 1 1 2 2 2 120/80 2 1

3 7307034409770001 ASKES
ALFILA KADIJAH IDRIS P 16/04/2017 3 1 1 1 1 1 2 2 2 2 1 1 1 1
1 7307035604170001 ASKES

64 78 HATTA L 3 1 1 1 1 1 2 2 2 120/90 2
1 31/12/1967 7307033112670118
KARTINA P 1 1 1 1 1 1 2 2 2 90/60 2
2 31/12/1982 7307037112820005
KURNIA P 2 1 1 1 1 1 2 2 2 2
3 20/08/2006 7307036008050002
RAHMA P 2 1 1 1 1 1 2 2 2 2
3 29/08/2006 7307036905100002
WAHYU L 1 1 1 1 1 1 2 2 2 2
3 04/05/2013 7307030584130001

65 79 ALIMIN L 05/07/1980 1 1 1 1 1 2 2 2 1 1
1 7307030507800004
P 13/01/1983 9 1 1 1 1 1 2 2 2 2 1
HERNIDA 2 7307035301830001
P 04/12/2015 2
ALIFA FARZANA ALIMIN 3 7307034412150001
L 27/10/2017 2 1 1
ARKHAN MATTALIU 3 7307032710170001
P 31/12/1973 1 1 1 1 1 1 2 2 2 2 N
SANAWATI 7 7571037112730074

66 80 ABD RAHIM L 3 1 1 1 1 1 2 2 2 2 N
1 31/12/1967 7307033112670039
HASNA P 3 1 1 1 1 1 2 2 1 1 150/90 2 N
2 31/12/1965 7307037112650118
ALHAM SETIA REFALDI P 2 1 1 1 1 1 2 2 2 2
3 22/09/1996 7307032209960001
DARHAM SUKARDI P 2 1 1 1 1 1 2 2 2 2
3 11/04/19999 7307031104830001
AYUDIA RIANTI IBRAHIM P 2 1 1 1 1 1 2 2 2 2
3 27/07/2004 7307036707040001
MUH.DEWAN APRIANTO P 2 1 1 1 1 1 2 2 2 2
3 04/09/2009 7307030904090001
RAHMALIA RAMADHANI P 2 1 1 1 1 1 2 2 2 2
3 14/08/2010 7307035408100000
 SAILATUL AFIFA P 2 1 1 1 1 1 2 2 2 2
3 07/02/1996 7307034207960003
MUH.ZAQI MAULANA L 2 1 1 1 1 1 2 2 2 2
3 27/07/1999 3321122707990005

67 81 AHMAD P L 3 1 1 1 1 1 2 2 2 110/80 2 1
1 31/12/1966 7307033112660020 0000128687725
SYAMSIDAR P 3 1 1 1 1 1 2 2 2 100/70 2 1
2 23/11/1981 7307036311810001 0000128677735
TINA WARDANI AHMAD P 06/02/2008 2 1 1 1 1 1 2 2 2 2
3 7307034206080001 0000128687736
PANDANG P 1 1 1 1 1 1 2 2 2 110/70 2 N
6 31/12/1974 7307037112470074 0001823730206

68 82 M.YAKUB L 9 1 1 1 1 1 2 2 2 130/80 2 N
1 03/05/1958 7307030503580001 0000128683359
ROSLINA P 3 1 1 1 1 1 2 2 2 120/70 2 N
2 10/03/1964 7307034310640001 0000128683348
NURAINUN FITRIANI P 2 1 1 1 1 1 2 2 2 N
2 17/3/1994 7307035703940001
BUNSYSH P 1 1 1 1 1 1 1 2 2 120/70 2 N
3 31/12/1929 '7307033112290028 TIDAK ADA

69 83 JUSMADI L 3 1 1 1 1 1 2 2 1 1 180/110 2 2
1 20/07/1965 7307032007650001
SAHRIA P 9 1 1 1 1 1 2 2 1 1 150/100 2 2
2 12/07/1969 7307034712690002
FAIQAH AULIA P 2 1 1 1 1 1 2 2 2 90/60 2
3 05/05/2002 7307034505020001
DEWI FAHIRA P 2 1 1 1 1 1 2 2 2 2
3 10/08/2003 7307034810030004

70 84 ASHARI

41 L 72 P

85 NURJANNA P 5 1 1 1 1 1 2 2 2 90/60 2 N
1 25/12/1963 7307036512630002
KARTINI P 9 1 1 1 1 1 2 2 2
3 11/12/1963 7307035211910003
KARTIKA DEWI P 2 1 1 1 1 1 2 2 2 90/60 2
3 14/12/1998 7307035412980003
71 86 ABDULLAH BURUNG L 3 1 1 1 1 1 2 2 1 1 150/100 1 N
1 17/07/1947 7307031707490001 0000128611304
JUMRIAH P 5 1 1 1 1 1 2 2 2 N
2 31/051951 7307037105510001
MUH.YUSUF YOGA 8 1 1 1 1 1 2 2 2 100/60 1
5 14/07/2001 7307031407010002

72 87 JAMALUDDIN BURUNG L 3 1 1 1 1 1 2 2 2 2 N
1 12/31/1965 7307033112650100
HASNIAR JAMALUDDIN P 3 1 1 1 1 2 2 2 2 N
2 1/8/1967 7307034801670001
ANUGRAH ASHARA JAMAL P 9
3 12/10/1993 '7307035012930002
HIKMAH SAHRIANI JAMALUDDIN P 3
3 08/12/1996 7307034812980007
KHAIRUL NIKMAH JAMAL P 2 1 1 1 1 1 2 2 2 2
3 20/8/1998 7307036008980008
MUKHLISAI JAMAL P 2 1 1 1 1 1 2 2 2 2
3 1/7/2009 7307032408030002
AHMAD BASIR L
3 20/5/1944 7307032806860001

73 88 IHSAN L 12/31/1957 3 1 1 1 1 1 2 2 2 2 N
1 7307033112570032
NUR QOLI IKSAN L 5/15/2003
3 7307031505030001

74 89 BURHAN BURUNG L 5 1 1 1 1 1 2 2 2 100/70 1 N

1 29/10/1969 7307032910690001 0000128642275
MULIATI P 3 1 1 1 1 1 2 2 2 110/70 2 N
2 09/10/1972 7307035609720002
NILA FEBRIANI P 2
3
ISHAK IRMADANI P 2
3
NUR KHADIJAH P 1
3
AL KURNIAWAN P 1 1 1 1 1 1 2 2 2 110/70 2
3 3./3/2003 7307030303030002 0002023985799
SALSABILA MUTMAINNAH P 1 1 1 1 1 1 2 2 2 2
3 09/07/2006 7307034709060001
MAGFIRATUL JANNAH P 1 1 1 1 1 1 2 2 2 2
3 19/12/2007 7307035912070001
P

75 90 IWAN SETIAWAN L 5 1 1 1 1 1 2 2 2 90/70 1 1

1 18/.07/1980 3206321807800001
NURAISAH P 5 1 1 1 1 1 2 2 110/70 2 1
2 17/09/1983 3206325709830003
 IKRIMAAULIA AZZAHRA P 2 2
3 26/02/2007 3206326602070002

76 91 AMBOTANG L 6 1 1 1 1 1 2 2 2 2 210/140 1 N
1 31/12/1965 7307033112650074 0000928860344
NIRMA P 5
2 31/12/1969 7307037112698114 0002365932519
LUKING L 2
3 09/09/2002 7307030909020001 0002365932521

77 92 ARSYAD COMPA 3 3 1 1 1 1 1 2 2 2 2 N
1 31/12/1963 7307033112630058 ASKES
SITTI 3 3 1 1 1 1 1 2 2 2 120/80 2 N
2 31/12/1965 7307037112650072 ASKES
JUMIATI ARSAD 2 2
3 29/3/1991 7307036903910001
MUH YUSUF ARSAD 2 2
3 17/61993 7307031706930002
MUH FAISAL ARSAD 2 2
3 23/3/1996 7307032303960001
NURUL MUTMAINNAH ARSAD 2 2
3 05/10/1998 7307035005980002
MUH.FIRDAUS ARSYAD 2 2 1 1 1 1 1 2 2 2 100/80 2 N
3 22/11/2003 7307032211030001
SUSILAWATI ARSAD 2 2
3 17/4/2006 7307035709060002
RAMLA 9 9 1 1 1 1 1 2 2 2 110/90 2 N
9 19/7/1977 7307035907770002 TDK ADA

78 93 SADDAM SYARIFUDDIN L 5 1 1 1 1 1 2 2 2 112/60 1 1

1 27/12/1984 7308032703840003 0001559499063
NURSIA P 3 1 1 1 1 1 2 2 1 1 176/111 2 1
2 10/10/1977 7307035010770003 0000165757757
BAU P 1 1 1 1 1 1 2 2 2 136/61 2 N
6 31/12/1951 7307037112510058 0000165758387

79 94 DARMAN L 6 1 1 1 1 1 2 2 2 125/74 1 2
1 30/07/1972 7307033007720001 0000929291681
ROSMAWATI P 1 1 1 1 1 1 2 2 1 1 152/97 2 2
2 31/12/1969 7307037112690017 0000929292344
NURSAADA DARMAN P 2 1 1 1 1 1 2 2 2 98/60 2
3 20/11/1999 7307036011990001 0000929292658
NURHIDAYAH DARMAN P 2 1 1 1 1 1 2 2 2 123/62 2
3 20/06/200 7307036006010001 0000929293154

80 95 SALENG L 6 1 1 1 1 1 2 2 2 1 2
1 31.-12-1965 7307033112650001 ADA
HADIRAH P 6 1 1 1 1 1 2 2 2 2 2
2 31.-12-1964 7307037112640009 0000928674718
 SYAMSUL ALAM L 1
3 03.-2-1998
NURWANA P 1
3 19.-12-1997 7307035912970001 0002365231981
JAMALUDDIN L 1
3
NUR AENI P 1
3 19.-3-2003 7307035903030001 0000928675045
JUMAEDI L 1
3 16.12-2008 7307031612080001 928675326

96 BADI RASIDO L 8 1 1 1 1 1 2 2 2 110/80 1 1

1 17/11/1981 730703171181005
NISMAWATI p 1 1 1 1 1 1 2 2 2 2 2
2 17/12/1991 7307035712910002
MUH. ALIF L 1 1 1 1 1 1 2 2 2 2
3 24/06/2014 7307032406140002
MUH. ASLIE L 1 1 1 1 1 1 2 2 2 2
3 28/08/2015 7307032808150001

81 97 AHMAD L 6 1 1 1 1 1 2 2 2 120/70 2 N
1 31.-12-1972 7307033112720017 0002327019794
HANIJU P 9 1 1 1 1 1 2 2 2 120/80 2 N
2 19.-06-1966 7307035906660001 0002327020795
MUSADDIK L
3 03.-02-1998 7307030302980001
AZIZAH P
3 31.-05-1999 7307037105990001
MUKRIMIN L
3 21.-12-2000 7307032112000001
MURSIDIN UMAR L
3 23.-07-2009 7307032307090001
FORMAT PENDATAAN KELUARGA SEHAT (KS)
PUSKESMAS KAMPALA
DESA : KAMPALA 1 = Ya
DUSUN : KAMPALA RT 3
2 = Tidak
Indikator keluarga Sehat
Akses
Nama KK/Anggota
No Urut Keluarga

Akses SAB Gangguan Jiwa TB Paru Hipertensi

No Urut Rumah

Hub. Keluarga
Jamban Keluarga Angg Wanit Ibu Imunis

Pendidikan

Pekerjaan
Hasil ota a 10 - Melahi asi Bayi
JK Tgl. Lahir NIK NO JKN Balita
peng.Teka keluar 54 rkan di Dasar ASI
nan ga Thn Fasyan Lengka EKS 7- Timbang
Jamb Di Obat Di Obat Darah Mero Ikut gkes < p 12-23 23 bln < 5 thn
Tersed Terlin Ters an BAB di Di Obat AK
Keluarga kok KB 12 bln bln
ia dung edia sanit Jamba Diagn Terat dipasu Diagn Teratu Diagn Terat
n osa ur ng osa r osa ur
er

82 98 HAMIDAH P 1 31-12-1958 7307037112560069 00023656356 9 1 1 1 1 1 2 2 2 130/80 2N N N N N

83 99 BEJO UTOMO L 1 10/2/1976 '7405011002760002 0002041725064 1 1 1 1 1 2 2 2 100/70 1N N N N N

PAINAH L 2 16/05/1970 7405015605700001 0002041726331 1 1 1 1 1 2 2 2 1 1 1 1 1
DAVID SULISTIAWAN L 3 10/8/1996 7307031008960002 0002041727027 1 1 1 1 1 2 2 2 N N N N N
FEBY TASA NINGRUM P 3 4/12/2005 7307034412050001 0002071727747 1 1 1 1 1 2 2 2 N N N N N
BRIAN SAPUTRA L 3 6/9/2016 7307030609160001 0002093965043 1 1 1 1 1 2 2 2 N N N N N

84 100 AHMAD ARASE L 1 31/02/1970 7307033112700091 0002365936773 5 1 1 1 1 1 2 2 2 110/80 2N N N N N

ROSMIATI P 2 3/2/1973 7307034302730001 0002365936795 5 1 1 1 1 1 2 2 2 100/70 2 1N N N N
BAHRI xxxx di mks L 3 28/11/1993 7307032011930003 TDK ADA

SAFIRA FEBRIANI P 3 21/02/2010 7307036102100001 000236936704 2 1 1 1 1 1 2 2 2 2N N N N N

85 101 HAFSAH BASIR P 1 17/07/1946 7307035707480001 0000196473082 1 1 1 1 1 1 2 2 1 1 2N N N N N

86 102 COLLI L 1 31/12/1961 7307031612610001 0000128696422

NURAENI P 2 31/12/1960 7307037112600121 0000128696411

INE HERLINA P 3 2/4/1996 TDK ADA

IRANA INDRASARI P 3 19/11/1994 730703591194001 TDAK ADA

 ITA PUSPITA P 3 19/01/1997 7307035901070001 TDK ADA

RICKY RAHMAT L 3 6/5/2003 7307030405030002 0001889493006

103 AGUS GOZAL L 1 31/12/1990

INDRI DIAN LESTARI P 2 19/09/1992
BRYAN GOZAL L 3 20/05/2015

87 104 AMRIN L 1 8/5/1973 7371130803730003 2 5 1 1 1 1 1 2 2 1 1 180/100 1N N N N N

JASWATI. NS P 2 27/12/1982 7371106712810010 2 5 1 1 1 1 1 2 2 2 100/80 2 2N N N 2
M.KENZIE A.RAYHAN L 3 26/08/2013 7371132608130002 2 1 1 1 1 1 1 2 2 2 2N N N N N

105 NURLINDA P 1 7/7/1977

88 106 M.IDRIS L 1 6/1/1968 7307030106680002 3 1 1 1 1 1 2 2 2 140/90 2 2N N N N

LILIS SARIANTI P 2 5/8/1971 7307034508710002 9 1 1 1 1 1 2 2 2 110/60 2 2N N N N
ANISA MAGFIRA RIANI P 3 29/04/2004 7307036904040002 2 1 1 1 1 1 2 2 2 2 2N N N N

89 107 BADE L 1 31/12/1949 7307033112190008 2 5 1 1 1 1 1 2 2 2 110/80 2N N N N N

90 108 HAMZAH L 1 17/09/1982 7209051709820004 3 1 1 1 1 1 2 2 2 2

SANAWATI T MOTADA P 2 16/08/1986 7209055608860004 0001285290415 9 1 1 1 1 1 2 2 2 110/80 2N 1 1 1 2
ALIFQA RAHMATU AQILA P 3 2/8/2008 7209054208080003 2 1 1 1 1 1 2 2 2
SITI HUMAIRAH AHNAF P 3 30/08/2016 7307037008160001 1 1 1 1 1 1 2 2 2
ANI SAFHIRA FL 3 2/11/2006 7209054211060001 2

91 109 SYAMSURIADI L 1 20/09/1985 7307032009850001 3 1 1 1 1 1 2 2 2 120/80 2 2

JUMARNI B P 2 1/3/1985 7307034103850002 3 1 1 1 1 1 2 2 2 100/60 2 2 1 1 1 1
AFIFAH A.S P 3 3/6/2013 7307034306130001 1 1 1 1 1 1 2 2 2 2
KHAIRUL IKHWAN L 3 1 1 1 1 1 1 2 2 2
NAUFAL Z.A.S. L 3 25/01/2017 7307032501170002 1 1 1 1 1 1 2 2 2

92 110 RAODAH AFRIYANI P 1 7/5/1994 7307044705940003 2 9 1 1 1 1 1 2 2 2 100/70 2N N N N N

93 111 ABDUL RAHIM L 1 2/3/1969 7307030203690002 1 1 1 1 1 1 1 2 2 2 120/80 2 2N N N N
MASYITA P 2 7/2/1970 7307034702700002 1 1 1 1 1 1 1 2 2 2 120/70 2 N N N N
FAUZIAH A.R P 3 18/09/2004 73070335809040001 1 1 1 1 1 1 1 2 2 2 2 N N N N

94 112 ANDY 94 L 1 6/9/1977 7307050609700003 2 5 1 1 1 1 1 2 2 2 100/70 2N N N N N

DWI PUSPITASARI P 2 10/2/1998 7307055002880004 2 5 1 1 1 1 1 2 2 2 90/70 2 N N N N
ANDITA RIZKI P 3 15/02/2008 7307055502080003 2 1 1 1 1 1 1 2 2 2 2N N N N N
MOH.SOGENG IBRAHIM L 3 26/01/2011 7307052601110002 2 1 1 1 1 1 1 2 2 2 2N N N N N

95 113 A. BASRI MAKKARAKKA L 1 31/12/1964 7307033112640095 5 1 1 1 1 1 2 2 2 160/100 2 2N N N N

SYAMSIAH P 2 31/12/1972 7307037112720065 5 1 1 1 1 1 2 2 2 120/80 2 1N N N N
NURLAELA P 3 17/10/1990 7307035710900001 1 1 1 1 1 1 2 2 2 110/70 2 N N N N
NURHIKMAH P 3 31/12/1991 7307037112910020 1 1 1 1 1 1 2 2 2 2 N N N N
NURFADILLAH P 3 27/11/1992 7307036711920003
NUR MUTAAAL R. L 3 24/07/2012 7307032407120001 1 1 1 1 1 1

96 114 ADRIAN L 1 12/4/1977 7307030412770001 2 5 1 1 1 1 1 2 2 2 100/60 2

NURBAYA P 2 7/5/1977 7307034507770001 2 9 1 1 1 1 1 2 2 2 100/60 2 1N N N N
KUSNADI ANGGARA L 3 9/6/2001 7307030609010001 2 9 1 1 1 1 1 2 2 2 2
NURUL AINI P 3 27/06/2009 7307036706100001 2 1 1 1 1 1 1 2 2 2 2
ATIKA AZZAHRA P 3 27/12/2013 7307036712130002 2 1 1 1 1 1 1 2
RASUL DG SITABA L 7 31/12/1950 7307033112500131

97 115 RUSDI SYUAIB L 1 30/05/1977 7307033005770001 5 1 1 1 1 1 2 2 2 100/80

SANMAR DAYAH P 2 21/03/1982 7307036103820001 2 1 1 1 1 1 2 2 2
ADAM RUSDI L 3 18/09/2009 7307031809090001 1 1 1 1 1 1 2 2 2
AISAH GHASANI P 3 25/03/2016 7307036503160001 1 1 1 1 1 1 2 2 2

98 116 BASRI L 1 31/12/1969 7307033112690068

SRIANINGSIH P 2 5/8/1977 7307034508770003
FIQIH YAMANI L 3 3/1/2003 7307030301030006
 NABILA A.IBAS P 20/10/2011 7307036010110002

99 117 BASRI KULAHU L 1 29/09/1964 7307032909640001 6 1 1 1 1 1 2 2 2 120/80 1N N N N N

MURNI MAJID P 2 27/07/1967 7307036707670001 9 1 1 1 1 1 2 2 1 2 1N N N N
MUTHARAH BASRI P 3 14/10/1995 7307035410950001 2 1 1 1 1 1
NURUL AULIA BASRI P 3 14/08/1997 7307035408970002 2 1 1 1 1 1
HUSNUL KHATIMAH BASRI P 3 5/1/2001 7307034501010005 2 1 1 1 1 1 2 2 2 120/70 2N N N N N
MIFTAHUL KHAERATI BASRI P 3 4/5/2004 7307034405040004 2 1 1 1 1 1 2 2 2 110/70 2N N N N N
DEA NURFADILAH BASRI P 3 13/12/2011 73070353121100001 1 1 1 1 1 1
KULAHU L 6 21/12/1933 7307033112330007 1 1 1 1 1 1 2 2 2 130/90 2N N N N N

100 118 M.SABRI AMSY L 1 29/05/1977 7307032905770001 000204755935 9 1 1 1 1 1 2 2 2 110/90 2

RAHMIATI P 2 15/09/1981 7307035509810001 000204675003 1 1 1 1 1 1 2 2 2 110/90 2N 2 2
M.ARAF GAZALI L 3 21/08/2002 7307032108020003 0002046761177 2 1 1 1 1 1 2 2 2 2
AULIA RAMADANI P 3 3/11/2004 7307034311040001 0002046761673 2 1 1 1 1 1
M.RIFQI L 3 14/04/2007 7307031404070004 0002046761792 2 1 1 1 1 1
ALIQA NURFATIMAH P 3 29/05/2016 7307036905160001 000204486749 1 1 1 1 1 1

101 119 UKKASE L 1 31/12/1927 7307033112270006 TDK ADA 6 1 1 1 1 1 2 2 2 110/70 2N N N N N

DALLE L 3 31/12/1954 7307037112540048 TDK ADA 5 1 1 1 1 1 2 2 2 130/70 2N N N N N
MARIAM P 3 31/12/1958 7307037112620007 TDK ADA 5 1 1 1 1 1 2 2 2 120/80 2N N N N N
SUBAEDAH P 3 31/12/1962 7307037112620007 TDK ADA 3 1 1 1 1 1 2 2 2 100/80 2N N N N N

102 120 SALMAH P 1 31/12/1945 7307037112450096 9 1 1 1 1 1 2 2 1 1 160/90 2

MURNI. M P 2 31/12/1964 7307037112640174 9 1 1 1 1 1 2 2 1 1 180/110 2 2N N N N
HIKMALADEWI P 5 14/05/1994 7307035405940001 9 1 1 1 1 1 2 2 2 120/70 2
ILHAM IRHAM L 5 16/12/1996 7307031002960002 9 1 1 1 1 1 2 2 2 120/80 2

103 121 JALIL L 1 31/12/1952 7307033112520038 2 6 1 1 1 1 1 2 2 1 1 150/80 2N N N N N

MURNI P 2 31/12/1954 7307037112540059 2 1 1 1 1 1 1 2 2 2 130/70 2N N N N N
TAUFIK L 3 31/12/1977 7307033112770019 2 4 1 1 1 1 1 2 2 2
MUHLIS L 3 8/1/1984 7307030801840001 2 4 1 1 1 1 1 2 2 2 110/70 2N N N N N
 HARMIANTI P 3 18/10/1987 7307035810870001 2 1 1 1 1 1 1 2 2 2 2 1N N N N
MURSALIM L 3 5/10/1994 7307030510940004 2 1 1 1 1 1 1 2 2 2 1N N N N N
SYAMSUL ALAM L 3 28/01/1996 7307032801960001 2 1 1 1 1 1 1 2 2 2 2N N N N N

122 NAJEMAWATI P 1 16/08/1990 7307035608900001 2 1 1 1 1 1 1 2 2 2 100/70 2 2N N N N

NURFADILLAH P 2 18/09/2006 2 1 1 1 1 1 1 2 2 2 N

104 123 A. MURNIATI AMRA P 1 8/7/1974 7307054807740001 ASKES 1 1 1 1 1 1 2 2 2 2N

A. ARYA ANUGRAH L 3 14/01/2003 7307051401030004 1 1 1 1 1 1 2 2 2
A.AULIA MAGFIRAH P 3 23/09/2004 7307056309040003 1 1 1 1 1 1 2 2 2

105 124 MIDU L 1 31/12/1951 7307033112510011 2 1 1 1 1 1 1 2 2 2 110/70 2N N N N N

HAFE P 2 31/12/1952 7307037112520019 2 1 1 1 1 1 1 2 2 2 120/80 2N N N N N
BAHRA P 3 1/7/1963 7307034107630014 2 1 1 1 1 1 1 2 2 2 100/70 2N N N N N

106 125 ABD LATIF L 1 31/12/1966 7307033112660055 2 1 1 1 1 1 1 2 2 1 2 180/80 2N N N N N

HAFSAH P 2 31/12/1963 7307037112630112 2 1 1 1 1 1 1 2 2 2 100/80 2N N N N N
RESTU A.A P 3 10/11/1998 7307031011980002 2 1 1 1 1 1 1 2 2 2
HASNIAH P 3 31/12/1955 7307037112550115

107 126 SITTI P 1 31/12/1957 7307037112570073 1 1 1 1 1 2 2 2 130/90 N N N N N N

DALENG L 6 31/12/1923
AISYAH P 7 8/7/1962 7307034807620001 0001069998838 5 1 1 1 2 2 2 110/70 N N N N N N

108 127 M.JUFRI L 1 31/12/1960 7307033112600107

ONTE P 2 31/12/1962 7307037112620102 1 1 1 1 1 1 2 2 2 130/80 2N N N N N
IWAN L 3 31/12/1985 7307033112850054 9 1 1 1 1 1 2 2 2 110/70 1
IMRAN L 3 31/12/1987 7307033112970026
SATRIANI P 3 7/11/1989 7307034711890002
SURIANI P 3 31/12/1991 7307037112910004
ALAMSYAH L 3 7/1/1997 7307030701970002 9 1 1 1 1 1 2 2 2 100/80 1
109 128 M.AMIN SYAM L 1 15/06/1960 7307031506600001 3 1 1 1 1 1 2 2 2 120/80 2
ST.MAEMUNAH P 2 31/03/1968 7307037103680001 9 1 1 1 1 1 2 2 2 2 2 2 2 2 2
FAHRIANI P 3 21/12/1991 7307036111291.00 9 1 1 1 1 1 2 2 2 120/70 2 1 1 1 1 1
NURFAIDAH P 3 1/10/1997 7307034110970001 2 1 1 1 1 1 2 2 2 120/80 2 2 1 1 1 1
HAIRIL MA'RUF L 3 3/2/1999 7307030302990002 2 1 1 1 1 1 2 2 2 110/70 2
AHMAD RIFAI L 3 14/08/2002 2 1 1 1 1 1 2 2 2 120/70 2

110 129 M.NASIR L 1 31/12/1955 7307033112550016 6 1 1 1 1 1 2 2 2 110/70 2N N N N N

HALIMAH P 2 31/12/1963 7307037112630111 1 1 1 1 1 1 2 2 2 90/70 2N N N N N
AMIRUDDIN L 3 1/12/1992 7307030112920002 4 1 1 1 1 1 2 2 2 2
IRMAWATI P 3 10/2/1997 7307035002970002 5 1 1 1 1 1 2 2 2 2

111 130 SAKKA L 1 31/12/1952 7307037112520074 1 1 1 1 1 1 2 2 1 1 180/70 2N N N N N

TASBI L 3 10/9/1989 7307031009890003 000193347160 9 1 1 1 1 1 2 2 2 110/70 1N N N N N

113 131 ASDAR L 1 31/12/1983 7307033112830026 1 1 2 2 2 2 2 1 1 100/70 1N N N N N

HIJRAH P 2 25/11/1984 7307036511840001 1 1 2 2 2 2 2 1 1 100/80 2 2N N N N
SRI AYU ASTUTI P 3 1/1/2002 7307034101020002 1 1 1 2 2 2 2 2 2 100/70 2N N N N N
ASHAR L 3 3/7/2004 7307030307040002 1 1 1 2 2 2 2 2 2 2N N N N N
MUH. AIDIL L 3 6/3/2010 7307030603100001 1 1 1 2 2 2 2 2 2 2N N N N N

114 132 SYANROA L 1 6/10/1951 7307030610510001 0000929834436 6 2 1 1 1 2 2 2 120/70 1N N N N N

SAPIAH P 2 10/7/1956 7307035007560001 0000929835101 9 2 1 1 1 2 2 1 1 190/80 2N N N N N
RAHMI P 3 13/03/2004 7307035303040001 0000929836113 1 2 1 1 1 2 2 2 N N N N N

133 IKBAL L 1 3/9/1986 7307030309860002 0000929835145 6 2 1 1 1 2 2 2 130/70 1N N N N N

ASMA P 2 11/9/1993 7307035109930002 0001936965824 9 2 1 1 1 2 2 2 130/80 2 1N 2 2 2
NUR HIDAYAH P 3 3-Aug 7307034803130001 0001936965835 1 2 1 1 1 2 2 2 N N N N N N
NUR FAJRIAH P 3 21/08/2014 7307036108140001 0001936965846 1 2 1 1 1 2 2 2 N N N N N N
SRI WAHYUNI P 3 2/6/2016 7307034602160001 0001936985857 1 2 1 1 1 2 2 2 N N N N N N
52 L
58 P
0.75
 FORMAT PENDATAAN KELUARGA SEHAT (KS)
PUSKESMAS KAMPALA

DESA : KAMPALA 1 = Ya
DUSUN : KAMPALA RT 03 2 = Tidak

Indikator keluarga Sehat

Akses
Nama KK/Anggota
No Urut Keluarga

Akses SAB Gangguan Jiwa TB Paru Hipertensi

No Urut Rumah

Anggot Ibu Imunis

Pendidikan
Jamban Keluarga

Pekerjaan
a Wanita Melahi asi Balita
Hasil Dasar Bayi
JK Tgl. Lahir NIK NO JKN ASI Timban
peng.Teka keluarg 10 - 54 rkan di EKS 7-
a Thn Fasyan Lengka 23 bln g < 5
nan Darah Merok Ikut KB gkes < p 12- thn
Hub. Keluarga
Jamba BAB di Di Obat AK Di Obat Di
Terse Terlin Tersed Obat ok 12 bln 23 bln
Keluarga n Jamba Diagn Teratu dipas Diag Teratu Diagnos Teratur
dia dung ia saniter n osa r ung nosa r a

115 134 BAHAR L 1 `08-10-1964 7307030810640001 0000928780209 5 1 1 1 2 2 2 2 2 130/100 1 2

YASMI P 2 `03-05-1975 `7310064305750004 000093143552 1 1 1 1 2 2 2 2 2 120/70 2 2
HERO P 6 `31-12-1937 `7307037112370065 0000928778488 1 1 1 1 2 2 2 2 2 120/60 2

116 135 MANSIR L 1 `05-07-1977 `7307030507750002 TDK ADA 4 1 1 1 1 1 2 2 2 2 2 130/70 1 2

HAMRAH P 2 31-3/973 `7307034303730001 4 1 1 1 1 1 2 2 2 2 2 90/70 2 2

117 136 GENO P 1` `7307037112380037 4 1 1 1 2 2 2 2 2 160/100 2

JUMAIN L 2 `73070301010983001 1 1 1 1 2 2 2 2 2 2

118 137 SUDIRMAN L 1 29/07/1984 7307032907840004 PBI

NURAENI P 9/9/1990 7307034909900004 PBI

AINUN FAJRIANSYAH P 1/6/2010 7307030106100001 PBI

NURUL FARHANATUL KAMILA P 26/10/2013 7307036610130001 PBI

119 138 Hume P 1 31/12/1947 7307037112470067 0000929653997 1 1 1 1 1 1 2 2 1 1 1150/90 2 N

Safiah P 7 31/12/1969 7307037112690028 0000929653097 6 1 1 1 1 1 2 2 2 2 130/80 2 N

139 Akmal L 1 23-01-1994 7303012301940002 0000929654313 9 1 1 1 2 2 2 2 2 120/70 2 1

RIska Amalia P 2 28-02-1997 7307036802970002 1 1 1 1 2 2 2 2 2 120/70 2 1
Rafa Muzzam P 3 1 1 1 1 2 2 2 2 2 2 1
120 140 SABONTA L 1 31/12/1956 7307033112560043 00001286606446 6 1 1 1 1 1 2 2 1 1 150/80 2 N
NILAWATI 31/12/1968 7307037112680086 0000009698174 1 1 1 1 1 1 2 2 2 120/80 2 N

121 141 SUARDI L 1 `31-12-1962 `7307033112620084 TIDAK ADA 6 1 1 1 2 2 2 2 2 120/60 2 2

RAMLAH P 2 `31-12-1974 `7307037112740060 TIDAK ADA 1 1 1 1 2 2 2 2 2 120/60 2 2
RUSNI P 3 `09-02-1993 `7307034902930001 TIDAK ADA 1 1 1 1 2 2 2 2 2 110/60 2
RUKMAWATI P 3 `23-11-1996 `7307036311960001 TIDAK ADA 2 1 1 1 2 2 2 2 2 2
NURFATIMAH P 3 `04-03-2009 `7307030403090001 TIDAK ADA 2 1 1 1 2 2 2 2 2 2

142 RUSDI L 1 `28-01-1988 `7307032801880001 TIDAK ADA 6 1 1 1 2 2 2 2 2 110/60 2 2

HERAWATI P 2 `22-06-1988 `7307036206880002 TIDAK ADA 1 1 1 1 2 2 2 2 2 2 2
ZAIRATUL L 3 `29-08-2015 `7307036908150001 TIDAK ADA 2 1 1 1 2 2 2 2 2 2 1

122 143 MUH. JAFAR L 1 `31-12-1963 `7307033112630082 6 1 1 1 2 2 2 2 2 110/80 2 2

MARYAM P 2 `31-12-1967 `7307037112670115 5 1 1 1 2 2 2 2 2 110/70 2 2
BACOA L 3` 2 1 1 1 2 2 2 2 2 1

123 144 SAENUDDIN L 1 `10-07-1975 `7307032107750001 0001563806856 6 1 1 1 2 2 2 2 2 120/70 2 2

HARTANI P 2 `04-02-1984 `7307035402840001 0000194637879 2 1 1 1 2 2 2 2 2 110/60 2 2
NURUL HIKMAH P 3 27/01/2006 `7307036701060001 0001563806867 2 1 1 1 2 2 2 2 2 2
ISMAIL HASAN L 3 30/01/2008 `7307033001080001 0001563806878 2 1 1 1 2 2 2 2 2 2
TENE P 6 31/12/1946 `7307037112460044 000156380689 2 1 1 1 2 2 2 2 2 140/90 2

124 145 NORMA P 1 31/12/1960 7307037112600082 TDK ADA 5 1 1 1 2 2 2 2 2ADA SAMA K EBNG2 N
HIJRA P 3 05/10/2008 7307036006030002 0000928671761 2 1 1 1 2 2 2 2 2 100/70 2 N

125 146 MUH. JAMIL L 1 `16-05-1974 `7307031605740001 6 1 1 1 2 2 2 2 2 2 2

NURJANAH P 2 `15-04-1972 `7307035504720001 1 1 1 1 2 2 2 2 2 2 2
ARI ARDIANSYAH L 3 `27-06-2002 `7307033005040003 2 1 1 1 2 2 2 2 2 2
NURAZIZAH JAMIL P 3 `30-05-2004 `7307036706020001 2 1 1 1 2 2 2 2 2 2
MUH. AL-AZHAR A L 3 `21-05-2006 `7307032105080003 2 1 1 1 2 2 2 2 2 2
RUDI ALAMSYAH L 3 `12-08-2008 `7307031206080001 2 1 1 1 2 2 2 2 2 2
ZULFIKAR JAMIL L 3 `04-10-2010 `7307030411100001 2 1 1 1 2 2 2 2 2 2
NURFAIKAH JAMIL P 3 `12-10-2012 `7307035210120001 2 1 1 1 2 2 2 2 2 2
 RESKI RAMADHANI L 3 `11-07-2015 `7307035107150001 2 1 1 1 2 2 2 2 2 2

126 147 HASYIM L 1 7307033112620075 0001563807058 6 1 1 1 2 2 2 2 2 130/90 1

SIBA 7307037112680025 0001563807069 1 1 1 1 2 2 2 2 2 140/100
' FAJAR MENYINSIR 1998 7307032003980001 0001563807071 1 1 1 1 2 2 2 2 2 1

127 148 ARNI P 1 `15-05-1982 `7307035150820001 1 1 1 2 2 2 2 2 100/90 2

ANRI SETIAWAN L 3 `02-06-2001 `7307030206010003 1 1 1 2 2 2 2 2 90/70 2
ASTIANI ADRIANI P 3 `23-03-2003 `7300703230303005 1 1 1 2 2 2 2 2 2
FADIL L 3 `02-03-2006 `7307030203060001 1 1 1 2 2 2 2 2 2
SALWAH NADIA P 3 `24-01-2009 `7307036401090002 1 1 1 2 2 2 2 2 2

128 149 SAKKA L 1 `01-07-1959 `7307030107590024 PBI 6 1 1 1 2 2 2 2 2 2 2

HALIJA P 2 `01-07-1972 `7307034107720038 PBI 1 1 1 1 2 2 2 2 2 2 2
WAHIDA P 3 `12-12-1993 `730703521930006 PBI 1 1 1 1 2 2 2 2 2 2
FAHMI L 3 `07-04-1997 `7307030704970005 PBI 1 1 1 1 2 2 2 2 2 2
NARTI P 3 `06-01-2000 `7307034601000001 PBI 2 1 1 1 2 2 2 2 2 2
IRWAN L 6 `12-12-1988 PBI 5 1 1 1 2 2 2 2 2 2
ATIBA UFAIRAH P 5 `29-05-2016 PBI 2 1 1 1 2 2 2 2 2 2

129 150 BAHRI L 1 2/7/1950 7307030702500001 3 1 1 1 2 2 2 1 1 150/100 1 N

HUDAYA P 2 5/15/1957 7307035505570001 1 1 1 1 2 2 2 1 1 170/110 2

130 151 ZULKIFLI L 1 23/09/1981 7307032309810001 askes 3 1 1 1 2 2 2 2 2 1 1

SURIATI P 2 20/10/1981 7307036010810001 askes 3 1 1 1 2 2 2 2 2 2
PUTRI SALSABILA P 3 01/04/2010 7307031041000001 askes 2 1 1 1 2 2 2 2 2 2
NUR ABDILA P 3 15/04/2017 7307031504170001 askes 1 1 1 2 2 2 2 2 2 1 1 1 1

131 152 TAJUDDIN L 1 `31-12-1966 7307033112660062 5 1 1 1 2 2 2 2 2 120/70 1 2

NURASIA P 2 `31-12-1965 7307037112650004 9 1 1 1 2 2 2 2 2 `130/80 2 2
RISKA SATRI P 3 `12-02-1998 7307035202980005 2 1 1 1 2 2 2 2 2 90/70 2
SAKIA BAIDURI P 3 `10-10-2002 7307035010020002 2 1 1 1 2 2 2 2 2 90/70 2

132 153 GENO P 2 `31-12-1958 `7307037112580076 TIDAK ADA 1 1 1 1 2 2 2 2 2 140/80 2 2

134 154 MUH. TAHIR L 1 `05-01-1975 7307030501750003 3 1 1 1 2 2 2 2 2 133/82 2 2
MILDAYANTI P 2 `31-12-1980 7307037112800002 1 1 1 1 2 2 2 2 2 110/69 2 2
AMAL TAHIR L 3 `26-03-2004 7307032603040002 2 1 1 1 2 2 2 2 2 2
AGUN ANUGRAH L 3 `27-03-2005 7307032703050001 2 1 1 1 2 2 2 2 2 2
FATAHILLAH L 3 `05-01-2008 7307030504060001 2 1 1 1 2 2 2 2 2 106/79 2
AL MUZAQIR L 3 `07-04-2012 7307030704120001 2 1 1 1 2 2 2 2 2 88/65 2

135 155 PT DOLO L 31-12-1934 7307033112350017 PBI

HANIA P 31-12-1942 7307037112420039 PBI

136 156 IMRAN L 1 `07-08-1979 `7307030788790003 TIDAK ADA 5 1 1 1 2 2 2 2 2 160/80 1 2

MISBAH P 2 `03-12-1981 `7301014312810001 TIDAK ADA 5 1 1 1 2 2 2 2 2 110/80 2 2
SANDI SAPUTRA L 3 `08-12-2006 2 1 1 1 2 2 2 2 2 2
ALYA FAZILA P 3 `22-09-2012 2 1 1 1 2 2 2 2 2 2

137 157 MUHANI P 1 `31-12-1942 `7307037112420113 1 1 1 1 2 2 2 2 2 130/90 2

RUDDING L 3 `10-071972 `7307031007720004 8 1 1 1 2 2 2 2 2 120/80 2

138 158 AGUS L 1 `15-08-1995 `7307031508950002 TIDAK ADA 6 1 1 1 2 2 2 2 2 1 2

ARDA P 2 `23-12-1996 `7307036312980001 TIDAK ADA 9 1 1 1 2 2 2 2 2 130/10 2 2
ST. HAJAR P 3 `01-07-2016 ` 2 1 1 1 2 2 2 2 2 2

139 159 DEWA L 1 `31-12-1978 7307030107830042 PBI 6 1 1 1 2 2 2 2 2 1 2

SUNARTI P 2 `31-12-1984 7307037112840073 PBI 6 1 1 1 2 2 2 2 2 120/90 2 1
AL MAUMMAR L 3 `03-06-2005 7307030306050002 PBI 2 1 1 1 2 2 2 2 2 2
HAERUL M L 3 `15-10-2006 7307031510060001 PBI 2 1 1 1 2 2 2 2 2 2
SAHWAL L 3 `29-10-2007 7307032910070001 PBI 2 1 1 1 2 2 2 2 2 2
WAHYU AL QADRI L 3 `18-02-2015 7307031802150001 PBI 2 1 1 1 2 2 2 2 2 2
ENRE L 6 `31-12-1947 7307033112470064 PBI 1 1 1 1 2 2 2 2 2 2

140 160 SYAMSUL ALAM L 1 `30-10-1969 7307030109690002 PBI 6 1 1 1 2 2 2 2 2 130/90 1 2

ST. RIANG P 2 `24-10-1974 7307036410740002 PBI 1 1 1 1 2 2 2 2 2 140/90 2 1
ASRUL L 3 `26-05-2001 7307032605010001 PBI 2 1 1 1 2 2 2 2 2 130/80 2
ST AISYAH P 3 `23-06-2009 7307036306090002 PBI 2 1 1 1 2 2 2 2 2 2
AL VIKA P 3 `06-04-2013 7307036604130002 PBI 2 1 1 1 2 2 2 2 2 2
141 161 SUARDI L 1 `10-08-1995 `7307034412990002 TIDAK ADA 6 1 1 1 2 2 2 2 2 120/80 2
IRMAWATI P 2 `04-12-1999 `7307031008950002 TIDAK ADA 1 1 1 1 2 2 2 2 2 110/70 2
RAHMAT HIDAYAT L 3 `19-09-2015 TIDAK ADA 2 1 1 1 2 2 2 2 2 2

162 NURBAYA P 1 `31-12-1971 `7307037112710058 TIDAK ADA 1 1 1 1 2 2 2 2 2 130/80 2

INRAWATI P 3 `31-12-1988 `7307031205010002 TIDAK ADA 2 1 1 1 2 2 2 2 2 130/70 2
SYAHRUL L 3 `12-05-2001 `7307031205010002 TIDAK ADA 2 1 1 1 2 2 2 2 2 110/70 2
SYAHRIL L 3 `05-06-2007 TIDAK ADA 2 1 1 1 2 2 2 2 2 2

142 163 TIDAK MAU BUKA PINTU 31 L 38 P

 FORMAT PENDATAAN KELUARGA SEHAT (KS)
PUSKESMAS KAMPALA
DESA : KAMPALA 1 = Ya
DUSUN : KAMPALA 2 = Tidak
RT/RW : 005/00

Indikator keluarga Sehat

Nama KK/Anggota Akses

No Urut Keluarga

Akses SAB Gangguan Jiwa TB Paru Hipertensi

No Urut Rumah

Pendidikan
Jamban Keluarga Anggot Ibu

Pekerjaan
JK Tgl. Lahir NIK NO JKN Hasil a Wanita Melahirka Imunisasi Bayi Balita
peng.Te keluarg 10 - 54 n di Dasar ASI EKS Timba
kanan a Thn Fasyangk Lengkap 7-23 ng < 5
Hub. Keluarga

Terse Terlind Terse Jamba BAB di Di AK Di Di Obat Darah Meroko Ikut KB es < 12 12-23 bln bln thn
Obat dipasu Obat Diagn
Keluarga n Jamba Diagno Teratur Diagnos Teratur Teratu k bln
dia ung dia saniter n sa ng a osa r

143 164 AMIRUDDIN 1 09/12/1979 7307030912790001 1 2 2 2 2 2 1 2 2

SUSANTI 2 25/12/1984 7307036512840002

ANDY INDRA BUDI AMIR 3 22/04/2004 7307032204040001

NURFADILLAH ADRIANI AMIR 3 09/07/2005 7307034907050001

SARIFAH 6 31/12/1958 7307037112580028

144 165 TAMARIN L 1 `04-07-1965 `7307035407650001 TIDAK ADA 6 1 1 2 2 2 2 2 120/70 2 2

YAMIATI P 2 `14-08-1967 `7307035408670001 TIDAK ADA 1 1 1 2 2 2 2 2 140/80 2 2

MUH. YUNUS L 3 `17-05-1999 `7307031705990002 TIDAK ADA 1 1 1 2 2 2 2 2 110/70 2

SALEHA P 6 `31-12-1942 `7307037112420053 1 1 1 2 2 2 2 2 130/70 2

145 166 MUH.ANWAR L 1 `31-12-1958 `7307033112580053 `0000128686061 3 1 1 2 2 2 2 2 120/80 2

HASNAH P 2 `31-12-1958 `7307037112580092 `0000128686072 1 1 1 2 2 2 2 2 2

AMIR MAHMUD L 3 `31-10-1984 2 1 1 2 2 2 2 2 2

AMRULLAH L 3 `4-1-1989 2 1 1 2 2 2 2 2 2

AHMAD A L 3 `28-3-2000 `7307032804020004 `0001276032453 2 1 1 2 2 2 2 2 1

146 167 NURAENI.T P 1 7307037112560052 0000128625715 1 1 1 1 1 2 2 1 1 150/90 2 N

147 168 HASAN BASRI L KK `02-01-1947 `7307030201470001 `0000155507163 9 1 1 2 2 2 2 2 120/90 2 2

NURSIAH TOBBO P ISTRI `05-02-1955 `7307034502550001 `0000155471927 1 1 1 2 2 2 2 2 130/80 2 2

MAHARANI P CUCU `16-08-2001 `7307035608010001 2 1 1 2 2 2 2 2 2

AMINAH P F.L `01-07-1935 TIDAK ADA 1 1 1 2 2 2 2 2 130/80 2

148 169 MARSUKI L `7-2-1972 `7307030702720002 6 1 1 2 2 2 2 2 130/80 2 2

MUSLIMA P `15-11-1977 `7307035511770002 1 1 2 2 2 2 2 120/80 2 1

FIRMAN L `27-8-2002 `7307032708020002 1 1 2 2 2 2 2 2

KAHARUDDIN L `5-5-2004 1 1 2 2 2 2 2 2

RAHMAT SOFIAN L `12-5-2007 `7307031205070003 TIDAK ADA 1 1 2 2 2 2 2 120/80 2

MUH. ARIEL RESKI L `1-6-2014 `7307030106140002 1 1 2 2 2 2 2 2

MULI P `34-12-1947 `7307037112470108 TIDAK ADA 1 1 2 2 2 2 2 160/80 1

149 170 ALIMUDDIN L KK 1 2 2 2 2 2 1 2 2

NURHAYATI P ISTRI `31-12-1957 `7307037112570043 `0000128648575 1 2 2 1 1 2 2 90/60 2 2

A. NURFAIDAH ALI P ANAK `4.-9-1993 `7307034409930001 1 1 2 2 2 2 2 90/60 2

UBAID L CUCU `20-3-2014 `7307032003140001 TIDAK ADA 1 1 2 2 2 2 2 2

A. KHAFIFA ALI P ANAK 17-11-1999 `7307035711990001 1 1 2 2 2 2 2 90/60 2

A. ASTRID P ANAK `18-10-2003 `7307035800300002 TIDAK ADA 1 1 2 2 2 2 2 90/60 2

KR. MARE L ORTU `31-12-1942 `7307037112420097 TIDAK ADA 1 1 2 2 2 1 2 160/90 2

150 171 BASO IMRAN L KK `10-08-1979 `7307021008790004 3 1 1 2 2 2 1 1 130/90 2 2

SUGIRAWATI P ISTRI `24-11-1983 `7307026411830001 9 1 1 2 2 2 2 2 100/80 2 1

A. BESSE BONE P ANAK `13-12-2003 `7307035311030001 2 1 1 2 2 2 2 2 90/70 2

A. MANGGARAI L ANAK `27-06-2007 `7307022706070004 2 1 1 2 2 2 2 2 2

A. KHUMAIROH BL P ANAK `15-05-2012 `7307035505120001 2 1 1 2 2 2 2 2 2

A. MARYAM P ANAK `18-01-2016 `7307035801160001 2 1 1 2 2 2 2 2 2

151 172 AMBO ARSYAD L KK `06-07-1971 `7307030607710001 5 1 1 2 2 2 2 2 2 2

NURCAYA UMAR P ISTRI `31-12-1966 `7307037112660055 3 1 1 2 2 2 2 2 100/90 2 2

ASMINI A P ANAK `27-04-1998 `7307036704980002 1 1 2 2 2 2 2 2

CHAERUL ASWAR L ANAK `21-12-1999 `7307032112990001 1 1 2 2 2 2 2 120/80 2

 A. ANNISA A P ANAK `25-02-2062 `7307036502020001 1 1 2 2 2 2 2 2

A. MUH. HAERIL L ANAK `29-03-2010 `7307032903100001 1 1 2 2 2 2 2 2

UMAR L MERTUA`31-12-1939 `7307033112390030 1 1 2 2 2 1 1 190/100 2

SAFIAH P MERTUA31-12-1951 `7307037112510049 1 1 2 2 2 2 2 120/50 2

A MAPPISEWANG L F.L `31-12-1950 `7307033112500058 1 1 2 2 2 2 2 2

152 173 ABD. KADIR L KK `31-12-1966 `7307033112660069 1 1 2 2 2 2 2 2 2

JULMIATI P ISTRI `05-04-1969 `7307034504690003 1 1 2 2 2 2 2 100/70 2 2

FIRMANSYAH L ANAK `05-04-1998 `7307030204950002 1 1 2 2 2 2 2 2

ARIANTO L ANAK `31-12-1998 `7307033112080023 1 1 2 2 2 2 2 110/80 2

NURUL FATIMAH P ANAK `02-04-2002 `7307034204020005 1 1 2 2 2 2 2 90/60 2

NURUL FADILLAH P ANAK `22-03-2005 `7307036203050002 1 1 2 2 2 2 2 90/60 2

FIRDA SAFITRI P ANAK `18-03-2008 `7307035803080002 1 1 2 2 2 2 2 2

MINDA P ORTU `31-12-1940 `7307037112490089 1 1 2 2 2 2 2 130/80 2

153 174 TAMARIN L KK `31-12-1981 `7307033112810062 1 1 2 2 2 2 2 2 2

HUSNI P ISTRI `06-11-1987 `7307034611870003 1 1 2 2 2 2 2 120/80 2 2

NURFAIZA P ANAK `18-05-2006 `7307035805060003 1 1 2 2 2 2 2 2

SULFIKAR L ANAK `15-07-2008 `7307035507060001 1 1 2 2 2 2 2 2

FAZILA RAMADANI P ANAK `10-06-2013 `7307035006150001 1 1 2 2 2 2 2 2

154 175 ANDI YUDA DARMAN KK `14-01-1986 `7307031401860002 3 1 1 2 2 2 1 1 110/80 1 2

NURAENI ISTRI `18-12-1985 `7307035812850001 3 1 1 2 2 2 2 2 `100/70 2 2

A. ZAQIATUL MARWAH M ANAK `08-01-2010 `7307034801100001 `0000199826133 2 1 1 2 2 2 2 2 2

155 176 HAMSIAH P KK `25-05-1976 `7307036710990002 TIDAK ADA 1 1 1 2 2 2 2 2 100/60 2

MIFTAHUL JANNAH P ANAK `27-10-1999 `7307036805750002 TIDAK ADA 2 1 1 2 2 2 2 2 100/70 2

AHLUL USMAN L ANAK `05-09-2003 `7307030509030001 TIDAK ADA 2 1 1 2 2 2 2 2 2

177 HALIJAH P KK `31-12-1944 `7307037112440058 1 1 1 2 2 2 2 2 120/80 2

MUNIRAH P CUCU `11-06-1982 `7307035106820002 1 1 1 2 2 2 2 2 90/70 2

`156 178 HENDRA L KK `31-12-1969 `7307033112690072 9 1 1 2 2 2 2 2 110/80 1 2

MULIATI P ISTRI `31-12-1969 `7307037112690065 1 1 1 2 2 2 2 2 100/80 2 2

IRMAWATI P ANAK `29-09-1990 `7307036909900002 1 1 1 2 2 2 2 2 110/70 2

MUH. IRWAN L ANAK 20-05-1995 `7307038005850003 2 1 1 2 2 2 2 2 2

157 179 ISMAIL L KK 31.-12-1984 7307033112840020 0000928849364 6 1 1 2 2 2 2 2 120/70 1 N

158 180 HUDA P KK `31-12-1940 `7307037112400101 9 1 1 2 2 2 2 2 130/80 2

159 181 ANWAR L KK `10-01-1961 `7307031001610001 6 1 1 2 2 2 2 2 2 2

NORMALIA P ISTRI `31-12-1969 `7307037112690067 1 1 1 2 2 2 2 2 100/80 2 2

REKI UTAMI P ANAK `24-07-1996 `7307036407960001 2 1 1 2 2 2 2 2 2

SULISTIANI P ANAK `17-11-2001 `7307035711010004 2 1 1 2 2 2 2 2 90/60 2

160 182 ASDAR L KK `13-06-1989 `7307024107790016 1 1 2 2 2 2 2 2 2

ISRAWATI P ISTRI `25-02-1990 `7307036502900002 9 1 1 2 2 2 2 2 2 2

RESKI DARMAWAN ASDAR L ANAK `08-12-2016 `7307030812160001 1 1 2 2 2 2 2 2

161 183 HASDAR L KK `31-12-1979 `7307030102790001 6 1 1 2 2 2 2 2 110/80 2 2

TASRIYANI P ISTRI `14-08-1980 `7307035408800002 `0000128638787 3 1 1 2 2 2 2 A 120/80 2 2

GAITYA SYAHIRAH NADLA A P ANAK `23-07-2005 `7307036307050002 2 1 1 2 2 2 2 2 2

162 184 MUHAMMAD L 31.-02-1945 7307033112450069 6 1 1 2 2 2 2 2 110/80 1 N

BOSYANG 31.-12-1954 7307037112540069 140/90 2

WAHYUNINGSI P 17.05-1992 730703708420001

LAELY REZKY P 25.-12-2000 730703651200004

MALIF L 20.-02-2008 9171022903080003

163 185 AMIRUDDIN L `06-04-1974 `7307030604740001 1 1 2 2 2 2 2 120/80 1

NURFAKIDAH P `31-12-1978 `7307037112780079 1 1 2 2 2 2 2 120/80 2

IRFAN SAUHA L `14-07-1998 `7307031407960002 1 1 2 2 2 2 2 100/60 2

MUH.GAZALI L `03-06-2007 `7307030306070002 1 1 2 2 2 2 2 1

164 186 AISYAH P KK `27-12-1969 ` 9 1 1 2 2 2 2 2 120/80 2

165 187 SYAMSUDDIN L KK `20-03-1975 `7307032003760002 `0001933471607 6 1 1 2 2 2 2 2 120/80 1

RAMLAH P ANAK `23-04-1976 `7307036304760002 `0001933471615 2 1 1 2 2 2 2 2 120/80 2

SYAMSIDAR P ANAK `11-08-1994 `7307036108940001 `0001563806698 2 1 1 2 2 2 2 2 2

HASFIRANTA P ANAK `30-08-1995 `7307037008950002 `0001563806709 2 1 1 2 2 2 2 2 2

RISKA FAUZIAH P ANAK 13-03-2003 `7307036303020001 `0001563806711 2 1 1 2 2 2 2 2 2

32 L 46 P

SATTU L KK `31-12-1965 `7307035003480001 `00019329871 6 1 1 2 2 2 2 2 120/80 2 2

NORMA P ISTRI `10-3-1948 `7307033112650048 ` 9 1 1 2 2 2 2 2 2 2

ARBA ANAK `15-11-1987 `7307031511870001 `0001932987227 6 1 1 2 2 2 2 2 1

NURDAYA P ANAK `10-12-1995 `7307035812950003 TIDAK ADA 2 1 1 2 2 2 2 2 90/60 2

1 1 2 2 2 2 2 2
 FORMAT PENDATAAN KELUARGA SEHAT (KS)
PUSKESMAS KAMPALA
DESA : KAMPALA 1 = Ya
DUSUN : KAMPALA 2 = Tidak
RT/RW : 006/003

Indikator keluarga Sehat

Nama KK/Anggota Akses

No Urut Keluarga

Akses SAB Gangguan Jiwa TB Paru Hipertensi

No Urut Rumah

S PERKAWINAN
Pendidikan

Pekerjaan
Jamban Keluarga Anggo Ibu
JK Tgl. Lahir NIK NO JKN ta Wanit Melahi Imunisas Bayi Balita
Hasil i Dasar
peng.Teka keluar a 10 - rkan di Lengkap ASI Timba
ga 54 Thn Fasyan 12-23 EKS 7- ng < 5
nan Darah Merok
Jamb Ikut KB gkes < 23 bln thn
bln
Tersed Terlind Ters an BAB di Di Obat AK Di Obat Di Obat
Hub. Keluarga

ok 12 bln
Keluarga ung edia sanite Jamba Diagno Teratu dipasu Diagn Teratu Diagn Teratu
ia n sa r ng osa r osa r
r

166 188 ABD. HARIS L KK 31-12-1962 7307033112620074 7 1 3 1 1 1 1 1 2 2 2 2 2 1 1 160/80 2 2

NORMAH P ISTRI 14-08-1966 7307035408660001 5 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2

HERAWATI P AK 11-04-1987 7307035104870001 5 2 2 1 1 1 1 1 2 2 2 2 2 2 110/70 2

MUH.ALIF L AK 23-01-2002 7307032301020002 5 2 2 1 1 1 1 1 2 2 2 2 2 2 2

ST.NUR AFIFAH PUTRI P AK `24-01-2004 `7307036401040001 3 2 2 1 1 1 1 1 2 2 2 2 2 2 2

167 189 MUSTAFA L KK `10-05-1979 `7307031005790002 Tidak Ada 5 1 5 1 1 2 2 2 2 120/80 2 2

ANDRIANA P ISTRI `19-04-1988 `7307035904880005 Tidak Ada 5 1 1 1 1 2 2 2 2 120/80 2 2

SARIFA P FL `31-12-1935 `7307037112350079 Tidak Ada 2 4 1 1 1 2 2 2 2 180/80 2

DARWATIAH P FL `01-07-1959 `7359005807034107 Tidak Ada 2 1 1

SUNDARIA P FL `31-07-1959 `7307037112590148 Tidak Ada 2 1 1 1 2 2 2 2 2

168 190 EKO SUPRIADI L KK `7307031010810002 Tidak Ada 5 1 5 1 1 2 2 2 2 120/80 1 1

ROSDIANI P ISTRI `10-051979 `7307035005780003 Tidak Ada 7 1 9 1 1 2 2 2 2 110/85 2 2

FITRAH RAMADHANI P AK `09-10-2007 `7307034910070001 Tidak Ada 3 2 2 1 1 2 2 2 2 2

ADE ALIF L AK `03-07-2011 `7307030307110002 Tidak Ada 2 2 2 1 1 2 2 2 2 2

ADE AL - GHAZALI L AK `08-09-2014 `7307030809140001 Tidak Ada 2 2 2 1 1 2 2 2 2 2

169 191 M. JUFRI L KK `31-12-1965 `7307033112660022 3 1 5 1 1 2 2 2 2 140/80 1 2

 JULIANAH P ISTRI `31/12/1967 `7307037112670007 3 1 1 1 1 2 2 2 2 120/80 2 2

FIRDAUS L AK `16-08-1995 `7307031608950001 5 2 2 1 1 2 2 2 2 1

MAULIANAH P AK `06-07-1998 `7307034607980001 5 2 2 1 1 2 2 2 2 1

RAMLAN L AK `25-11-2000 `7307032511000002 5 2 2 1 1 2 2 2 2 2

ISMAWATI P AK `01-10-2003 `7307034110030001 5 2 2 1 1 2 2 2 2 2

ROSMAH P FL `31-12-1968 `7307037112680011 1 4 1 1 1 2 2 2 2 2

170 192 RAMLI L KK `12-10-1974 `7307031210740003 Tidak Ada 4 1 6 1 1 2 2 2 2 1 1

MULIATI P ISTRI `18-08-1976 `7307035808760005 Tidak Ada 5 1 1 1 1 2 2 2 2 113/84 2 1

YUSRAN JAYA L AK `18-10-1997 `7307031810970002 Tidak Ada 5 2 2 1 1 2 2 2 2 2

AWALUDDIN L AK `08-10-1998 `7307031810980002 Tidak Ada 5 2 2 1 1 2 2 2 2 2

SRI RAMADANI P AK `17-11-2001 `7307035711010005 Tidak Ada 5 2 2

FEBRIANI P AK `16-02-2004 `7307035602040000 Tidak Ada 3 2 2 1 1 2 2 2 2 2

CINTA ASTRI P AK `18-06-2007 `730703806070004 Tidak Ada 3 2 2 1 1 2 2 2 2 2

171 193 M. SALEH L KK `31-12-1953 `730703112530054 Tidak Ada 5 1 6 1 1 2 2 2 2 117/79 2 2

MURNI P ISTRI `31-12-1956 `7307037112560056 Tidak Ada 5 1 1 1 1 1 2 2 1 149/90 2 2

172 194 BAHARUDDIN S L KK `31-12-1966 `7307033112550056 7 1 3 1 1 2 2 2 2 130/80 1 2

NURHAYATI ISTRI `31-12-1964 `7307037112640127 5 1 1 1 1 2 2 2 2 110/70 2 2

ADIL ILAHI L ANAK `27-03-1998 `7307032103980002 5 2 3 1 1 2 2 2 2 2

FITRIANA P FL `28-01-2000 `730703681100004 5 2 1 1 1 2 2 2 2 2

173 195 ASRUL L KK `05-04-1976 `7307010504760001 7 1 3 1 1 2 2 2 2 90/50 2 2

NAJMIATI P ISTRI `02-03-1984 `7307014203840003 7 1 3 1 1 2 2 2 2 100/60 2 2

ASNI NURSYAMSIH P AK `16-01-2008 `7307015601080001 2 2 1 1 2 2 2 2 2

174 196 SAMIR L KK `31-12-1965 `7307033112650088

JUMRIAH P ISTRI `31-12-1958 `7307037112580105

KASMAWATI P ANAK `17-6-1980 `7307035707890001

RISNAWATI P ANAK `8-9-1994 `7307034000640002

SAPARMAN.S L ANAK `17-9-1999 `7307031700000002

JAMIATI.S P ANAK `31-12-2002 `7307037112020005

 ALDI YANTI LESTARI L CUCU `30-12-2008 `7307037012080001

175 197 HASYIM L KK `31-12-1952 `7307033112520046 6 1 1 2 2 2 2 100/70 2 2

HAMDANA P ISTRI `31-12-1957 `7307037112570029 1 1 1 2 2 2 2 170/90 2 2

NINGSIH P AK `25-10-1990 `7307036510900001 2 1 1 2 2 2 2 2

KARABU L AK 31-121995 `7307033112950042 2 1 1 2 2 2 2 2

176 198 ASTANG L KK `06--10-1087 `7307030510870001 6 1 1 2 2 2 2 100/70 1 2

MULIANI P ISTRI `18-11-1993 `7307035811890001 1 1 1 2 2 2 2 120/70 2 2

RESA ALFANDI L AK `04-04-2009 `7307030404090002 2 1 1 2 2 2 2 2

MUH. JALIL L AK `18-07-2012 `7307031807120001 2 1 1 2 2 2 2 2

NUR ADIRA P AK

177 199 BAHARUDDIN L KK `31-12-1985 `7307033112850002 6

SURIANI P ISTRI `06-05-1985 `7307033112850001 1

ANISA BAHAR P AK `12-12-2007 `7307035212070001 2

ADITYA SAPUTRA L AK `12-06-2013 `7307031205130001 2

178 200 FATIMAH P ISTRI `20-05-1971 `7307035005710001 1 1 1 2 2 2 2 2 110/80 2 1

FAISAL ARHAM L AK `26-02-2000 `7307032602000001 2 1 1 2 2 2 2 110/80 2

IKBAL FAHRUL L AK `25-12-2003 `7307032512030003 2 1 1 2 2 2 2 2

IRFAN FAUZAN L AK `24-02-2004 `7307032402040001 2 1 1 2 2 2 2 2

BACCOA L FL `31-12-1930 `730703312300006 1 1 1 2 2 2 1 2 160/100 2

179 201 SATTU L KK `31-12-1965 `7307033112650048 6

NORMAH P ISTRI `10-03-1948 `7307035003480001 1

ANSAR L AK `31-12-1986 `7307033112880043 1

ARBA L AK `15-11-1987 `7307031511870001 1

ABD. RAHMAN L AK `31-12-1988 `7307033112880040 2

NURDAYA P AK `10-12-1995 `7307035012950003 2

180 202 RAJMA P KK `31-12-1962 `7307037112620137 1

181 203 ABD. KAHAR L KK `31-12-1968 `730703312680014 6 1 1 2 2 2 2 120/90 1 2

NAIDA P ISTRI `31-12-1969 `7307037112690044 1 1 1 2 2 2 2 110/80 2 2

ARMAN L AK `06-11-1990 `7307030611900001 1

HARIS L AK `31-05-1992 `7307033105920001 1

MUSFIRAH P AK `31-12-1999 `7307037112990021 2 1 1 2 2 2 2 90/80 2

182 204 SUFIANA P KK `31-12-1966 `7307037112660097 3 1 1 2 2 2 2 120/70 2 2

SITI IZZA FAUZYYAH P AK `20-04-2002 `7307036004020003 2 1 1 2 2 2 2 100/90 2

MUH. KAYSAN ALFAROQ L AK `26-11-2011 `7307032611110001 2 1 1 2 2 2 2 2

183 205 TURUN L KK `31-12-1942 `7307033112420075 5 1 1 2 2 2 2 2 130/90 1 2

NOTTA P ISTRI `12-12-1957 `7307035212570002 1 1 1 2 2 2 2 2 130/80 2 2

TAMA L KK `31-12-1985 `7307033112350031 `0001932987128 6 1 1 2 2 2 2 120/80 2 2

SEBBE P ISTRI `31-12-1986 `7307037112360005 `00019342466632 1 1 1 2 2 2 2 120/90 2 2

184 206 SUMAPPA L KK `31-12-1950 `7307033112500053 6 1 1 2 2 2 2 2 140/80 1 2

APPE P ISTRI `31-12-1956 `7307037112560022 1 1 1 2 2 2 2 2 140/80 2 2

ERNAWATI P AK `02-04-1990 `7307034204900001 2 1 1 2 2 2 2 2 110/70 1

JUMIATI P AK `10-121991 `730703501200003 2 1 1 2 2 2 2 2 120/70 2

FATUR RAHMAN L AK `17-11-2002 `7307031711020003 2 1 1 2 2 2 2 2 100/70 2

NURSAADA P AK `24-11-2004 `7307036411040001 2 1 1 2 2 2 2 2 100/70 2

185 207 SUDIRMAN L KK `21-091980 `7307042109800001 6 1 1 2 2 2 2 100/70 1 2

SRI UTAMI T P ISTRI `09-05-1979 `7307034905700001 `0001563807328 1 1 1 2 2 2 2 120/70 2 2

RISWAN L AK `14-11-2006 `7307031411060001 2 1 1 2 2 2 2 2

AFINA NUR ZAHIDAH P AK `13-10-2014 `7307036310140003 2 1 1 2 2 2 2 2

186 208 AMIRUDDIN L KK `21-01-1969 `7307032101690002 3 1 1 2 2 2 2 2 120/80 1 2

NURAENI MARJUNI P ISTRI `06-06-1980 `7307034506800004 3 1 1 2 2 2 2 2 100/70 2 1

SANDI YUDHA P AK `21-08-1997 `7307032108970002 2 1 1 2 2 2 2 2 100/70 2

ALFIAH NURUL AMINI P AK `18-12-2007 `7307035812070002 2 1 1 2 2 2 2 2 2

MUH. RIFQHI AMINI L AK `25-02-2000 `7307032502080003 2 1 1 2 2 2 2 2 2

AULIAH RAMADHANI A P AK `11-08-2010 `7307035106100002 2 1 1 2 2 2 2 2 2

ZAKIRA HIDAYANTI A P AK `25-04-2012 `7307036504120001 2 1 1 2 2 2 2 2 2

187 209 PATTA MANG L KK `06-11-1961 `7307030611610001 3 1 1 2 2 2 1 1 180/110 1 2

HASNAH P AK `01-07-1960 `7307034107500062 3 1 1 2 2 2 1 1 200/120 2 2

188 210 ASHARIANI P KK `01-04-1989 `7307034104890006 1

A. KHALIFA NURIA P AK `16-11-2009 `7307035611090005 2

RAIDA MUHARIKA P FL `07-05-1999 `7307034705990002 2

190 211 SAHARUDDIN L KK `03-06-1988 `7371060308800006 6 1 1 2 2 2 2 2 110/80 1 2

SUARNI P ISTRI `21-05-1979 `7371066105790004 1 1 1 2 2 2 2 2 100/70 2 1

INRA ARDIANSYAH L AK `04-08-2001 `7307030408010001 2 1 1 2 2 2 2 2 2

IHWAN PEBRIANSYAH L AK `19-04-2005 `73071061904050002 2 1 1 2 2 2 2 2 2

191 212 ABD. RAHMAN L KK `20-12-1970 `7307032012700002 Tidak Ada 4 1 1 2 2 2 2 2 90/80 2 2

NURKAYA L ISTRI `04-05-1974 `7307034405740002 Tidak Ada 1 1 1 2 2 2 2 2 140/80 2 2

MUH. RAMADHAN P AK `26-10-2004 `7307032610040002 Tidak Ada 2 1 1 2 2 2 2 2 2

ALMIRA FAQHA R P AK `01-02-2012 `7307030102120002 Tidak Ada 2 1 1 2 2 2 2 2 2

192 213 MAMARA P KK `31-12-1940 `7307037112400168 Tidak Ada 1 1 1 2 2 2 2 2 100/70 2 2

HERLINA P AK `17-10-1966 `7307035710660001 Tidak Ada 5 1 1 2 2 2 2 2 110/80 2

194 214 MUH. ASDAR L KK `23-06-1970 `7307032305700001 3 1 1 2 2 2 2 2 120/70 2 2

FANNI FADILLAH P ISTRI `29-03-1978 `7307036903780001 1 1 1 2 2 2 2 2 120/80 2 2

RADIA RAMADHAN A P AK `18-10-2006 `7307035810060001 2 1 1 2 2 2 2 2 2

195 215 SINRING SYAM L KK `31-121940 `7307033112400065 5 1 1 2 2 2 1 2 166/104 2 2

SUBAEDAH A PAKKI P ISTRI `31-12-1952 `7307037112520034 1 1 1 2 2 2 2 2 136/82 2 2

SUARNI P FL `31-12-1968 `7307037112680125 1 1 1 2 2 2 2 2 159/100 2

196 216 SYINNONG P KK `31-12-1942 `7307037112420088 1 1 1 2 2 2 1 1 190/100 2

SALMAH P AK `31-12-1963 `7307037112630057 1 1 1 2 2 2 2 2 130/90 2

YASFAR L CUCU `29-09-1994 `7307032909940001 2 1 1 2 2 2 2 2 2

197 217 NURSINAR P

198 218 DAHLIA P KK `25-05-1988 7.30703650588E+016 5 2 2 2 2 2 2 2 100/70 2 2

PAHOSI

200 219 ASDAR L KK `12-03-1972 `7307031203720001 3

SITTI HAERANI P ISTRI `06-06-1967 `7307034606670001 3

MUH. HAYKAL P L AK `11-06-2009 `7307033112390006 2

201 220 ABD. RAUF L KK `31-12-1939 `7307033112390006 1 1 1 2 2 2 2 2 110/70 2 2

BAURAHMA L AK `14-11-1972 `7307035411720001 5 1 1 2 2 2 2 2 120/80 2 2

202 221 BASRI

203 222 HASYIM L KK `31-12-1962 `7307033112620090 6 1 1 2 2 2 2 120/80 1 2

NURLIAH N P ISTRI `31-12-1962 `7307037112620092 1 1 1 2 2 2 2 2 120/80 2 2

JUSMANIAR H L AK `02-12-1994 `7307034212940002 2 1 1 2 2 2 2 2 90/60 2

JAEJUNUN P AK `16-12-1998 `7307035612980001 2 1 1 2 2 2 2 2

204 223 AMIRUDDIN L KK `05-07-1978 `7307030507780006 Tidak Ada 6 1 1 2 2 2 2 120/80 1 2

NURHAYATI P ISTRI `07-08-1984 `7307034708840002 Tidak Ada 1 1 1 2 2 2 2 120/80 2 1

PUTRI ANNA P AK `08-01-2003 `7307034601030002 Tidak Ada 2 1 1 2 2 2 2 2

205 224 SOMMENG L KK `31-12-1952 `7307033112520067 `0000928774383 6 1 1 2 2 2 1 2 160/90 1 2

PATI P AK `31-12-1964 `7307037112640055 `0000928774438 1 1 1 2 2 2 2 2 130/80 2 2

AMIRUDDIN L AK `01-07-1990 `7307030107900003 1 1 1 2 2 2 2 2 2

SARINAWATI P AK `12-12-1992 `7307035212920003 `0000928775891 2 1 1 2 2 2 2 2 100/70 2

ABD. HARIS L AK `16-12-1994 `7307031812940002 `0000928778095 2 1 1 2 2 2 2 120/80 2

206 225 SIRAJUDDIN L KK `01-07-1960 `7307030107600009 Tidak Ada 6 1 1 2 2 2 2 2 130/70 2 2

HARTINI P ISTRI `07-04-1969 `7307034704690001 Tidak Ada 1 1 1 2 2 2 2 2 120/70 2 2

HERAWATI P AK `16-08-1991 `7307035608910004 Tidak Ada 2 1 1 2 2 2 2 2 2

NURHIAYAT P AK `28-12-1994 `7307032812940001 Tidak Ada 2 1 1 2 2 2 2 2 2

207 226 AHMAD L KK `31-12-1946 `7307033112460026 6
INDO MASING P ISTRI `31-12-1946 `7307037112460028 1
ROSMIATI P ANAK `8-8-1981 `7307034008810001 1
FATMAWATI AHMAD P ANAK 20-12-1984 `730703830840002 1

56 L

87 P

46 5 JUSNIH P AK `31-12-2002 `7307037112020002 PELAJAR 1 1 2 2 2 2 2 80/60 2

6 JUSMAN L AK `31-12-2002 `7307031703090006 PELAJAR 1 1 2 2 2 2 2

7 MARNI P AK `31-12-2004 `7307037112040010 PELAJAR 1 1 2 2 2 2 2

3 YUSUF L AK `31-12-1977 `7307033112770013 PETANI 1 1 1 2 2 2 2

1 RAIMAN L KK `16-10-1976 `7307031810760002 PETANI 1 1 2 2 2 2 120/80 1

2 INAH P ISTRI `01-08-1980 `7307034109800001 IRT 1 1 2 2 2 2 110/70 2

3 MUH. TAUFIK HIDAYAT L AK `20-06-2001 `7307031702000000 PELAJAR 1 1 2 2 2 2 2

22 4 MUH. RUSLI L AK `01-10-2002 `7307032405020001 PELAJAR 1 1 2 2 2 2 2

5 NURMAYANTI P AK `05-04-2004 `7307034504060002 PELAJAR 1 1 2 2 2 2 2

6 MUH. FERDI L AK `20-08-2007 `7307031902080002 PELAJAR 1 1 2 2 2 2 2

1 BAHARUDDIN L KK `31-12-1965 `7307033112650087 Tidak Ada PETANI 1 1 2 2 2 2 2 110/80 1 2

2 SYAMSIAh P AK `25-12-1969 `7307036512690003 Tidak Ada IRT 1 1 2 2 2 2 2 120/80 2 1

3 SUDIRMAN L AK `24-04-1989 `7307032404890003 Tidak Ada TIDAK KERJA1 1 2 2 2 2 1

4 SULASTRI P AK `11-05-1994 `7307035105940003 Tidak Ada TIDAK KERJA1 1 2 2 2 2 2 100/70 2

23 5 SUPARMAN L AK `13-02-1999 `7307031302990002 Tidak Ada PELAJAR 1 1 2 2 2 2 2 120/70 1

6 SATRIANI P AK `26-12-2004 `7307035409020003 Tidak Ada PELAJAR 1 1 2 2 2 2 90/60 2

7 SUKAMAWATI P AK `26-12-2004 `7307036612040002 Tidak Ada PELAJAR 1 1 2 2 2 2 2 2

25 1 HJ HASNA

3
30 1 HASAN L KK

31 3

1 HUMRAH P KK `31-12-1976 `7307037112760044 IRT

2 UMAR L FL `31-12-1990 `7307033112900022 TIDAK KERJA

39 1 HJ. NUR

40 2

44 1 NURAENI

4 1 ASIAH P KK `31-12-1970 `7307037112700146 Tidak Ada 1 1 1 2 2 2 2 2

2 KASUMAN L FL `31-12-1940 `7307037112400186 Tidak Ada 1 1 1 2 2 2 2 2

1 ASYANG L KK `31-121950 `7307033112500054 6

2 INTANG P AK `31-12-1953 `7307037112530024 1

12 1 BUNGAWALI P KK `31-12-1959 `7307037112590111 IRT

2 ADE ISLAMIAH P AK `02-05-1988 `7306074205880002 HONORER

1 SUARDI L KK `31-12-1983 PETANI 2

JUMRIAH P ISTRI `31-12-1988 `7307037112880048 IRT 2 1 1

MUH. ALIF AZHAR L AK `14-10-2014 PELAJAR 2

2

2
 2 2 2 1 1 1

110/80 2 2 2 2 1 1

2 2 2 2 1 1
 FORMAT PENDATAAN KELUARGA SEHAT (KS)
PUSKESMAS KAMPALA
DESA : KAMPALA 1 = Ya
DUSUN : KAMPALA 2 = Tidak
RT/RW : 00 7/00

Indikator keluarga Sehat

Nama KK/Anggota Akses

No Urut Keluarga
No Urut Rumah

Akses SAB Gangguan Jiwa TB Paru Hipertensi

Pendidikan

Pekerjaan
Jamban Keluarga Anggot Ibu Imunisa Bayi
JK Tgl. Lahir NIK NO JKN a Wanita Melahir
Hasil keluarg si Dasar
10 - 54 kan di Lengkap ASI EKS
peng.Teka a Thn Fasyang 7-23

Hub. Keluarga
Jamb nan Darah 12-23
BAB di Di Obat AK Di Obat Di Obat Merok Ikut KB kes < 12 bln
Tersedi Terlind Terse an bln
Keluarga Jamba Diagn Terat dipas Diagn Terat Diagn Teratu ok bln
a ung dia sanit n osa ur ung osa ur osa r
er

208 227 SODDING 1 1 2 2 2 2 1 N

3 1 1 1
1 1 2 2 2 2 2 120/80 1 2
209 228 BAHARUDDIN 1 L KK `31-12-1963 `7307033112630053 6
1 1 2 2 2 2 2 120/70 2 2
NURAENI P ISTRI `31-12-1980 `7307037112800041 1
1 1 2 2 2 2 2 2
SALAM L ANAK `20-02-2010 `7307032002100001 2
1 1 2 2 2 2 2 2
ALAMSYAH L ANAK `2-05-2014 `7307030205140001 2
1 1 2 2 2 2 2 120/80 1 2
210 229 SYARIFUDDIN 2 L KK `31-12-1960 `7307033112600105 6
1 1 2 2 2 2 2 100/80 2 2
RABANIA P ISTRI `14-01-1978 `7307035401780001 1
1 1 2 2 2 2 2 110/70 2
FADLI L ANAK `25-11-1999 `7307032511990004 2
1 1 2 2 2 2 2 2
FAUZIAH RAMADHANI P ANAK `9-12-2001 `7307034912010001 2
1 1 2 2 2 2 2 100/70 2
FARADIBA P ANAK `14-01-2009 `7307035401090001 2
1 1 2 2 2 2 2 2 2
211 230 HUSEN 3 L KK `1-06-1969 `7307030107690014 5
1 1 2 2 2 2 2 2 2
NURJANNAH P ISTRI `6-06-1983 `7307034807830002 9
1 1 2 2 2 2 2 2
RIFALDI L ANAK `25-10-2006 `7307032510060004 2
1 1 2 2 2 2 2 2
ASMAN HUSNI P ANAK `4-07-2008 `7307031107086002 2
212 231 SATUNA L KK `31-12-1945 `7307037112450077 1 1 2 2 2 2 2 2
1
1 1 2 2 2 2 2 120/80 2
NINING P ANAK `18-12-2001 `7307035808010003 2
1 1 2 2 2 2 2 140/20 2 2
213 232 BASRI 4 L KK `11-12-1978 `7307033112760010 6
1 1 2 2 2 2 2 90/80 2 2
RATNA P ISTRI `31-12-1980 `7307037112800091 9
1 1 2 2 2 2 2 120/70 2
214 233 NANE P KK `1-06-1950 `7307034107500044 9
 1 1 2 2 2 2 2 110/89 2
JUMARNI P ANAK `27-01-1992 `7307032701920001 1
1 1 2 2 2 2 2 110/70 2
RISNAWATI P ANAK `13-02-1997 `7307035302970001 1
1 1 2 2 2 2 2 120/70 2 2
215 234 ZAINUDDIN L KK `09-10-1984 `7307030910840002 5
TIDAK ADA 1 1 2 2 2 2 2 100/70 2 2
ARNI ARFIANTI 5 P ISTRI `17-05-1993 `7307035703930001 1
TIDAK ADA 1 1 2 2 2 2 2 90/80 2
NAURA RAMADHANI P ANAK `01-08-2012 `7307034108120001 2
TIDAK ADA 1 1 2 2 2 2 2 90/70 2
FADHIL RAMADHAN L ANAK `10-06-2013 `7307031007130002 2
216 235 MUH.ALI L KK `31-12-1949 `7307033112490010 TIDAK ADA 1 1 2 2 2 2 2 120/80 1 2
6
BARLIAN 6 P ISTRI `01-06-1950 `7307034107500058 TIDAK ADA 1 1 2 2 2 1 1 130/70 2 2
9
SYARIFUDDIN L ANAK `07-08-1992 `7307030708920007 TIDAK ADA 1 1 2 2 2 2 2 120/80 1
2
KAHARUDDIN L ANAK `11-08-1994 `7307031108940004 TIDAK ADA 1 1 2 2 2 2 2 110/80 2
2
1 1 2 2 2 2 2 120/80 1 2
217 236 TAJUDDIN 7 L KK `22-08-1982 `7307032208820002 5
1 1 2 2 2 2 2 110/70 2 1
KARTINI P ISTRI `31-12-1987 `7307037112870061 9
1 1 2 2 2 2 2 2
ANDINI WIDAYA ASTUTI P ANAK `21-06-2007 `7307036107070001 2
1 1 2 2 2 2 2 2
ADITIYA L ANAK `19-11-2015 `7307031911150001 2
218 237 BAKRI 8 L KK `31-12-1972 `7307033112720048 1 1 2 2 2 2 2 2 2
6
SUNARTI P ISTRI `31-12-1975 `7307037112750056 1 1 2 2 2 2 2 2 2
1
FIRKAWATI P ANAK `10-07-1994 `7307035006950002 1 1 2 2 2 2 2 120/80 2
1
MIRDA P ANAK `17-09-1998 `7307035711980004 1 1 2 2 2 2 2 2
1
MIRNA P ANAK `17-09-1998 `7307035711980005 1 1 2 2 2 2 2 2
1
NOFITASARI P ANAK `12-09-2004 `7307035209040001 1 1 2 2 2 2 2 2
2
1 1 2 2 2 2 2 120/80 1
219 238 ATO 9 L KK `10-07-1972 `7307031007720005 6
1 1 2 2 2 2 2 100/70 2
NURALAM P ISTRI `31-12-1979 `7307037112790058 1
1 1 2 2 2 2 2 110/70 2
NURFADILLAH P ANAK `05-05-1999 `7307034503990003 2
1 1 2 2 2 2 2 100/70 2
FAISAL L ANAK `10-05-2003 `7307031003030007 2
1 1 2 2 2 2 2 90/80 2
SYAHRUL GUNAWAN L ANAK `5-11-2005 `7307030511060002 2
1 1 2 2 2 2 2 100/60 2
220 239 RATU P KK `31-12-1941 `7307037112410028 1
1 1 2 2 2 2 2 110/80 1
AMIRULLAH L ANAK `12-05-1990 `7307031205900002 5
1 1 2 2 2 2 2 1 2
221 240 ARIFE L KK `1-06-1956 `7307030107560020 6
1 1 2 2 2 2 2 2 2
RAHMA 10 P ISTRI `1-06-1957 `7307034107570034 9
 1 1 2 2 2 2 2 110/70 2
ARHAM 11 L KK `26-12-1980 `7307032612880001 5
1 1 2 2 2 2 2 110/70 2
HASMIDAR P ISTRI `12-06-1997 `7307085207970001 9
1 1 2 2 2 2 2 2
AGUSTIAN DIRGA L ANAK `17-08-2017 `7307031708170002 2
1 1 2 2 2 2 2 2 2
SATTAR 12 L KK `15-09-1990 `7307081509900001 5
1 1 2 2 2 2 2 2 2
RAHMI P ISTRI `20-05-1990 `7307036005910001 5
1 1 2 2 2 2 2 2 2
222 241 ABD. ASIS 13 L KK `5-06-1982 `7307030507820001 6
1 1 2 2 2 2 2 120/70 2 2
KURNIA P ISTRI `1-06-1984 `7307034107840042 1
1 1 2 2 2 2 2 2
AKBAR L ANAK `17-02-2010 `7307031702100001 2
223 242 HAERUDDING 14 L KK `11-08-1967 `7307031108670002 1 1 2 2 2 2 2 2 2
3
SAFIAH P ISTRI `10-12-1970 `7307035012700004 1 1 2 2 2 2 2 2 2
9
HAMZAH HAS L ANAK `31-05-1996 `7307033105960001 1 1 2 2 2 2 2 100/70 2
9
HAERANI HAS P ANAK `2-1-2001 `7307034201010002 1 1 2 2 2 2 2 2
2
PUTRI APRILIA HAS P ANAK `19-05-2004 `7307035904040002 1 1 2 2 2 2 2 2
2
NURAZIZAH HAS P ANAK `19-01-2006 `7307035421080002 1 1 2 2 2 2 2 2
2
224 243 RAHMATULLAH 15 L KK `22-03-1996 `7307032207980001 1 1 2 2 2 2 2 2 2
5
ASTRIANI P ISTRI `05-03-2000 `7307034503000001 1 1 2 2 2 2 2 2 2
9
MUH. ALIF RAHMAT L ANAK `17-12-2017 `730703712170001 1 1 2 2 2 2 2 2
2
BASIR 16 L KK `31-12-1966 `73070332660063 1 1 2 2 2 2 2 2 2
5
DARMIATI P ISTRI `28-10-1963 `7307036810630001 1 1 2 2 2 2 2 130/90 2 2
9
225 244 SYANGGI L KK `31-12-1939 `7307037112390018 1 1 2 2 2 2 2 2
9
RESKY L CUCU `05-05-1999 `7307030505990005 1 1 2 2 2 2 2 100/70 2
2
226 245 KATU P KK `1-07-1955 `7307034107550024 1 1 2 2 2 2 2 160/80 2
5
228 246 IHWAN 17 L KK `22-12-1990 `7307032212900004 1 1 2 2 2 2 2 100/60 2 2
6
ALFINASATI P ISTRI `15-02-1995 `7307035502950002 1 1 2 2 2 2 2 120/80 2 2
9
ASHARI SAPUTRO L ANAK `26-07-2012 `7307032605120002 1 1 2 2 2 2 2 2
2
NURSYAIFAILAH P ANAK 31-12-2013 `7307033442130001 1 1 2 2 2 2 2 2
2
229 247 FIRMAN 18 L KK `1-5-1982 `7307030103820001 1 1 2 2 2 2 2 100/80 2 2
6
ROSMINI.A P ISTRI `6-6-1988 `7307034607880001 1 1 2 2 2 2 2 100/80 2 2
9
DIINDRIANI P ANAK `8-05-2007 `7307034803070002 1 1 2 2 2 2 2 2
2
230 248 SALAMA 19 L KK `5-10-1955 `7307030510550001 TIDAK ADA 1 1 2 2 2 2 2 120/80 1 2
6
HUFRAH P ISTRI `10-05-1969 `7307035005690001 TIDAK ADA 1 1 2 2 2 1 1 190/100 2 1
9
231 249 KAMARUDDIN 20 L KK `2-12-1970 `7307030212700001 1 1 2 2 2 2 2 120/80 1 2
6
DARMAWATI P ISTRI `2-02-1976 `7307034201760002 1 1 2 2 2 2 2 110/80 2 2
9
SAUDI DARMAWAN L ANAK `25-10-1998 `7307032510980002 1 1 2 2 2 2 2 120/70 1
5
LIN DWI FANI DARMA P ANAK `19-9-2000 `7307035909000001 1 1 2 2 2 2 2 100/70 2
5
232 250 FIHE 21 L KK `7-01-1972 `7307030710720001 1 1 2 2 2 2 2 120/70 1 2
6
MIRNAWATI P ISTRI `1-04-1986 `7307035004860002 1 1 2 2 2 2 2 120/80 2 1
1
ADTIYA HAFIN L ANAK `12-12-2008 `7307031202080001 1 1 2 2 2 2 2 2
2
FIHRIANSYA P ANAK `19-05-2009 `7307019005090001 1 1 2 2 2 2 2 2
2
HAFINE HARINI L ANAK `06-02-2013 `7307034502130001 1 1 2 2 2 2 2 2
2
NURHIDAYAT APRIL P ANAK `16-04-2015 `7307031604150001 1 1 2 2 2 2 2 2
2
234 251 AKIS L KK `31-12-1949 `7307033112490022 1 1 2 2 2 2 2 130/80 1
6
235 252 BAHTIAR 22 L KK `08-08-1978 `7307030808780002 1 1 2 2 2 2 2 120/90 1 2
6
JUMALIA P ISTRI `02-11-1982 `7307034211820001 1 1 2 2 2 2 2 110/80 2 2
1
IRFANDI L ANAK `07-11-1998 `73070330711980001 1 2 2 2 2 2 2 100/80 2
2
NIA HIRFANI P ANAK `13-07-2001 `7307035306010002 1 1 2 2 2 2 2 100/70 2
2
NURAEDAINA P ANAK `29-02-2004 `7307036902040001 1 1 2 2 2 2 2 2
2
NURMAULIANA TILKA P ANAK `10-05-2018 `7307035003080001 1 1 2 2 2 2 2 2
2
MUH. RAFA REZKI. B L ANAK `09-10-2017 `7307030910170001 1 1 2 2 2 2 2 2
2
236 253 RATNO 23 L KK `23-08-1978 `7307032308780003 1 1 2 2 2 2 2 110/80 2 2
5
YAYA RULIATI P ISTRI `7-05-1982 `7307034705820004 1 1 2 2 2 2 2 120/70 2 1
9
ACI RAHAYU 24 P ANAK `12-05-2012 `7307035205120001 1 1 2 2 2 2 2 2
2
237 254 SULAEMAN 25 L KK `31-12-1954 `7307033112540084 1 1 2 2 2 2 2 120/80 1 2
5
BONDENG P ISTRI `31-12-1959 `7307037112590076 1 1 2 2 2 2 2 130/80 2 2
1
KASMAWATI P ANAK `24-04-1989 `7307036404890002 1 1 2 2 2 2 2 100/70 2
9
238 255 M. YUSUF ARWAN 26 L KK `22-06-1980 `7307032207800002 1 1 2 2 2 2 2 100/80 1 2
5
NURDIATI P ISTRI `13-09-1993 `7307035309930001 1 1 2 2 2 2 2 2 2
1
NURNOVITA YANI SAFITRI P ANAK `7-11-2011 `7307034711110001 1 1 2 2 2 2 2 2
2
 MUH. RAHMAT MAKKALAU L ANAK `7-02-2014 `730703471110601 1 1 2 2 2 2 2 2
2
239 256 NURAENI P KK `31-12-1955 `7307037112550074 1 1 2 2 2 2 2 130/70 2
3
A. HERMAN L ANAK `12-12--1973 `7307031212730004 1 1 2 2 2 2 2 110/80 2
6
A.BASO AKMAL L ANAK `25-10-1979 `7307032510790001 TIDAK ADA 1 1 2 2 2 2 2 110/60 1
5
A. DEWI INDRIANI P ANAK `1-11-1981 `7307034111810002 1 1 2 2 2 2 2 100/70 2
9
257 A. ZULKIFLI LUBIS 27 L KK `1-10-1977 `7307030110770001 1 1 2 2 2 2 2 110/80 2
5
RABITA P ISTRI `18-06-1980 `7307035887800004 1 1 2 2 2 2 2 2
6
A. SURYA ABDILLAH L ANAK `7307031204070002 1 1 2 2 2 2 2 2
`12-04-2007 2
240 258 NURFAISAL 28 L KK `25-05-1986 `7307032503880002 1 1 2 2 2 2 2 110/80 2 2
6
MARIANA P ISTRI `26-12-1986 `7307036612860002 1 1 2 2 2 2 2 100/60 2 2
1
MUH. RIFAL L ANAK `01-06-2009 `7307030107090008 1 1 2 2 2 2 2 2
2
241 259 ADRIAWAN L KK `31-12-1953 `7307033112530043 1 1 2 2 2 2 2 150/80 1
6
260 KITANG L KK `31-12-1932 `7307037112320073 1 1 2 2 2 2 2 140/80 2
1
242 261 TAKDIR 29 L KK `10-12-1984 `7307031012840002 1 1 2 2 2 2 2 110/80 2 2
7
NURMIATI P ISTRI `15-06--1983 `7307035506830002 1 1 2 2 2 2 2 120/70 2 2
9
NURHASANAH P ANAK 16-07-2006 `7307035606060002 1 1 2 2 2 2 2 2
2
243 262 HARDIN L KK `7307033112500021 2 2 2 2 2

HALIFAH 30 P ISTRI `7307034104890004 2 2 2 2 2

MARTATI HARIYANTI P ANAK `7307034912990004 2 2 2 2 2

ARDA SAHRIADI L ANAK `7307033311010001 2 2 2 2 2

HANAFIAH P ANAK `7307034708040005 2 2 2 2 2

ALGAZALI L ANAK `05-05--2016 `7307030503160001 1 1 2 2 2 2 2 2

2
244 263 DINI 31 L KK ` `7307032512670001 2 2 2 2 2
2
HALIMAH P ISTRI `7307037112670030 2 2 2 2 2
2
HARDI L ANAK `730703102970003 2 2 2 2 2
2
AZHAR L ANAK `7307032912050002 2 2 2 2 2
2
245 264 MUH.SALDI 32 L KK `01-06-1974 `7307050107740069 1 1 2 2 2 2 2 120/70 1 2
5
JUHAEMA P ISTRI `15-12-1982 `7307055512820005 1 1 2 2 2 2 2 110/80 2 1
9
TIFAHNA ZHAIZA ZABITA P ANAK 15-04-2009 `7307055504090001 1 1 2 2 2 2 2 2
2
 MUH. FAIZ AL ARKHAM L ANAK `11-02-2017 `7307031102170001 1 1 2 2 2 2 2 2
2
MANNENG L ANAK `03-12-1955 `7307030315500002 1 1 2 2 2 2 2 1
6
246 265 GENDA 33 L KK `03-03-1973 `7307030303703002 1 1 2 2 2 2 2 120/80 1 2
6
SYAMSIAH P ISTRI `04-04-1973 `7307034405730001 1 1 2 2 2 2 2 110/90 2 2
9
HIDAYANTI P ANAK `08-07--1998 `7307034807980001 1 1 2 2 2 2 2 90/80 2
5
MAWAR DANING SYAH P ANAK 16-01-2000 `7307035601000002 1 1 2 2 2 2 2 90/70 2
5
M. TAKBIR L ANAK `11-02-2003 `7307031102030001 1 1 2 2 2 2 2 100/70 2
2
SITTI QANITA MARDIAH P ANAK `15-04-2005 `7307035505050001 1 1 2 2 2 2 2 2
2
247 266 JUMALI 34 L KK `31-12-1960 `7307033112600097 1 1 2 2 2 2 2 150/100 1 2
6
DEWI P ISTRI `31-12-1961 `7307057126100029 1 1 2 2 2 2 2 190/90 2 2
9
248 267 MUH. YUSUF L KK `02-09-1962 `7307030209620001 1 1 2 2 2 2 2 120/70 1 2
6
HASMI 35 P ISTRI `05-11-1964 `7307034511640001 1 1 2 2 2 2 2 100/60 2 2
9
MUH. NURFIADI Y L ANAK `07-05-1987 `7307030705870002 1 1 2 2 2 2 2 100/70 2
5
BAHTIAR 36 L KK `06-09-1985 `7204070810830004 1 1 2 2 2 2 2 120/70 2 2
6
LIL HIDAYANTI P ISTRI `19-12-1989 `7271035912890002 1 1 2 2 2 2 2 100/70 2 1
9
MAGFIRAH BAHTIAR P ANAK `13-05-2010 `730703505100002 1 1 1 2 2 2 2 2
1
RATU AISYAH BAHTIAR P ANAK `10-06-2014 `7307035006140001 1 1 2 2 2 2 2 2
2
249 268 USMAN 37 L KK `07-10-1974 `7307030710740001 1 1 2 2 2 2 2 100/60 1 2
6
MARNI P ISTRI `31-12--1977 `7307037112770056 1 1 2 2 2 2 2 110/80 2 2
9
ADE GUNAWAN P ANAK `18-11-2002 `7307031811020003 1 1 2 2 2 2 2 90/60 2
2
ASMAR L ANAK `10-06-2003 `7307031006030001 1 1 2 2 2 2 2 90/60 2
2
250 269 HATIJA P KK `31-12-1959 `7307037112570084 1 1 2 2 2 2 2 110/70 2
1
251 270 RUSDIANTO 38 L KK `07-10-1989 `7307030710880003 TIDAK ADA 1 1 2 2 2 2 2 120/70 2 2
6
MARTINA P ISTRI `18-12-1965 `7307035812850002 1 1 2 2 2 2 2 110/80 2 2
5
RESKY ALVIAN L ANAK `13-03-2010 `7307031303100006 1 1 2 2 2 2 2 2
2
252 271 ASFAR L KK `31-12-1980 `7307033112830086 1 1 2 2 2 2 2 120/80 1 2
6
NURHAYATI 39 P ISTRI `14-04-1984 `7307035405840003 1 1 2 2 2 2 2 2 2
9
ASTIKA P ANAK `14-01-2005 `7307035401050003 1 1 2 2 2 2 2 2
2
L ANAK `23-01-2009 `7307032301090001 1 1 2 2 2 2 2 2
2
 272 AIRIL ALFARIZI P ANAK `23-0-2009 `7307032301090001 1 1 2 2 2 2 2 2
2
273 HAFID.JUNAEDI 40 L KK `17-10-1989 `7307031710830003 1 1 2 2 2 2 2 1 2
6
HARTATI P ISTRI `31-12-1989 `7307037112890076 1 1 2 2 2 2 2 2 2
5
AMAR MAHRUF L ANAK `28-10-2009 `7307032610090001 1 1 2 2 2 2 2 2
2
LELING KAMARIAH ANAK `18-02-2013 `7307035802130001 1 1 2 2 2 2 2 2
2
253 274 ABD. RAHMAN 41 L KK `07-03-1982 `7307030703820001 TIDAK ADA 1 1 2 2 2 2 2 100/70 2 2
6
JUSMAWATI P ISTRI `31-06-1992 `7307037107920000 TIDAK ADA 1 1 2 2 2 2 2 100/70 2 2
9
WAHYU SAPUTRA L ANAK `21-08-2012 `7307032108120002 TIDAK ADA 1 1 2 2 2 2 2 2
2
254 275 ABDULLAH 42 L KK `12-04-1969 `7307031204690002 1 1 2 2 2 2 2 2 2
6
SAHRIAH P ISTRI `19-07-1972 `7307035907720003 1 1 2 2 2 2 2 130/80 2 2
9
ARMANSYAH L ANAK `09-09-1990 `7307030209940002 1 1 2 2 2 2 2 2
6
MUH. ASRUL L ANAK `12-12--1997 `7307030212970002 1 1 2 2 2 2 2 2
2
ZULFIKAR L ANAK `24-11-2005 `7307032411050003 1 1 2 2 2 2 2 2
2
MUH.AKBAR L ANAK `27-10-2008 `7307032710080001 1 1 2 2 2 2 2 2
2
255 276 DARWIS UMAR 43 L KK `01-06-1957 `7307030107570030 1 1 2 2 2 2 2 130/90 1 2
8
ASNI LATIF P ISTRI `10-09-1962 `7307035009620001 1 1 2 2 2 2 2 120/90 2 2
3
DELLA JUNIARTI P ANAK `01-11-1997 `3578144111970006 1 1 2 2 2 2 2 100/70 2
2
M.IRFAN ARDIANSYAH L ANAK `02-04-2003 `7307030204030002 1 1 2 2 2 2 2 2
2
NURAENI P F.L `01-10-1974 `7307034110740001 0001833188196 1 1 2 2 2 2 2 2
5
HARTATI P F.L `12-07-1989 `7307035206890004 1 1 2 2 2 2 2 110/80 2
1
256 277 INDAH P KK `21-12-1948 `7307037112480007 929826088 1 1 2 2 2 1 1 160/100 2 2
1
257 278 AYATULLAH. S L KK `22-11-1982 `730703221800001 1 1 2 2 2 2 2 1 2
5
SULASTRI AMI 44 P ISTRI `17-09-1982 `7307035709820003 1 1 2 2 2 2 2 110/80 2 2
9
M.ARYA Y ROZIDANE L ANAK 18-05-2004 `7307031805040001 1 1 2 2 2 2 2 2
2
SATRIA YUDHIKA DEWA P ANAK `29-01-2010 `7307032901100001 1 1 2 2 2 2 2 2
2
258 279 HAFID L KK `09-09-1972 `7307030909720001 TIDAK ADA 1 1 2 2 2 2 2 120/79 2 2
6
SAWIAH 45 P ISTRI `29-03-1973 `7307036903730001 TIDAK ADA 1 1 2 2 2 2 2 120/80 2 2
1
259 280 BAHTIAR L KK `07-06-1986 `7307030707960003 1 1 2 2 2 2 2 120/70 2 2
6
MIRNAWATI 46 P ISTRI `12-10-1991 `7307035210910005 1 1 2 2 2 2 2 2 2
9
 AHMAD DAHLAN L ANAK` `07-09-2011 `730703709110003 TIDAK ADA 1 1 2 2 2 2 2 110/180 2
2
260 281 MARYAM L KK `31-12-1962 `7307037112620090 TIDAK ADA 1 1 2 2 2 2 2 120/80 2
9

69 L 70 P

DARMAWATI DARWIS P ISTRI `11-11-1983 `7307031111830001 1 1 1 2 2 2 2 2 2 2

M.IRAN ARDIANSYAH L ANAK `02-04-2003 `7307033112050000 2 1 1 2 2 2 2 2 2

10 10 Ady Irawan L KK 24-10-1985 7302410850002 6

Devi Novitasari Darwis P Istri 1/11/1997 3578144111970000 TIDAK ADA
Aisyatul Islamia P Anak 4/10/2017 7307034410170000 TIDAK ADA

10 10 NISWAN DININGSIH L KK `23-04-1964 `7307036304640001 9 1 1 2 2 2 2 2 130/90 2

29 32 MUHAMMAD L KK `31-12-1952 `7307033112520079

33 36 AMIRUDDIN L KK `31-12-1976 `7307033112760034 5 1 1 2 2 2 2 2 120/80 1 2

MARDIA P ISTRI `21-11-1978 `7307036111780002 1 1 1 2 2 2 2 2 100/80 2 2
FIRA RAHMADANI P ANAK `7-12-2000 `7307034712000001 2 1 1 2 2 2 2 2 100/70 2
IRSANDI PUTRA L ANAK `7-12-2002 `7307030712020002 2 1 1 2 2 2 2 2 110/70 2
MUH. RIZAT L ANAK `2-12-2007 `7307030212070001 2 1 1 2 2 2 2 2 100/70 2

42 45 SUDDING L KK `1-07-1945 `7307030107450034 6 1 1 2 2 2 2 2 180/20 2

53 58 ABD.ASIS L KK `09-08-1984 `7307030908840001 7 1 1 2 2 2 2 2 120/80 1 2

DARLINA P ISTRI `28-08-1928 `7307036808880002 1 1 1 2 2 2 2 2 100/80 2 2
FAUZAN ABHAULN ASIS L ANAK `20-09-2011 `7307033009110001 2 1 1 2 2 2 2 2 2
Balita
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