Laporan Agustus 2020 PKM PJ

Lampiran 2
FORMULIR PEMANTAUAN IBU HAMIL
Provinsi : Lampung
Kabupaten/Kota : Tulang Bawang Bulan : JANUARI
Puskesmas/Kecamatan Tahun : 2020
Kampung : BRATASENA MANDIRI
TTD (Tablet Jika YA, Jika YA,

Hamil NIK (Nomor Induk Berat Badan BUKU KIA GOL KB sblm Tambah brp butir brp butir
No Ke- Tanggal Lahir No Kartu Keluarga Kependudukan) Nama Ibu Hamil awal hamil/ 1 Ya 2 Nama Suami NIK Suami Hb darah Hamil Alamat RT RW Tanggal ukur BB (kg) TB (cm) LiLA (Cm) darah) TTD TTD
Trimester I Tdk 1=YA, diterima diminum
2=Tidak
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20)
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1
10
Keterangan
- Kolom 9 : Jika suami tidak ada, isikan nama orang tua
- Kolom 10 : Jika suami tidak ada, isikan NIK orang tua
s
Lampiran 3
FORMULIR PEMANTAUAN PERTUMBUHAN BALITA DI POSYANDU
Provinsi : Lampung Nama Posyandu : MELATI I

Puskesmas/Kecamatan : PASIRAN JAYA Tahun : 2020
PB LAHIR Kepemilik Panjan Cara ASI EksklusifF1=YA, 2=Tidak Vitamin Vitamin

g Ukur
Anak NIK (Nomor Induk an Buku IMD 1=YA, BB Badan/ 1=Telen A A
No Tanggal Lahir L/P No Kartu Keluarga Nama Anak BB Lahir KIA/KMS 2=Tidak Nama Ayah NIK Ayah No Tlp/ HP Ayah Alamat RT RW Tgl Ukur Umur Februari Agustus
Ke Kependudukan) ANAK PB LAHIR 1=YA, (kg) Tinggi tang umur umur 2 umur 3 umur umur umur 1=YA 1=YA
(Bln) Badan 2=Berdi 1 bln bln bln 4 bln 5 bln 6 bln
2=Tidak (cm) ri 2=Tidak 2=Tidak
1 1 10/14/2019 1805252307190009 1805252410190001 Sea Adara Zahra 2900 1 1 Erwan S 8123456789 B. Mandiri
2 2 10/1/2019 180709270080012 Umi Wahyu 3000 1 1 Budi S 8123456789 B. Mandiri
3 2 4/9/2019 Kadek Lovata 3400 1 1 Wayan Andita 8123456789 B. Mandiri
4 1 9/16/2019 1802051601130003 Dzakia Rizatun 3000 1 1 Aan 8123456789 B. Mandiri
5 3 8/18/2019 Rasya Geza M 3500 1 1 Rohimin 8123456789 B. Mandiri
6 2 2/7/2019 Adittya Fahry 3600 1 1 Siswanto 8123456789 B. Mandiri
7 1 7/11/2019 Ahmad Ashar 3500 1 1 Nur Khalis 8123456789 B. Mandiri
8 2 11/30/2019 1805080303160002 Naufal Ardi P 3200 1 1 Dwi Prianto 8123456789 B. Mandiri
9 1 7/14/2019 1805251604150006 1805251407190002 Adara Niranthy 3000 1 1 Misbahul 8123456789 B. Mandiri
10 1 1/28/2018 M. Alfatih 2900 1 1 Ajid N 8123456789 B. Mandiri
11 1 12/18/2015 Adiba Shaqila 3000 1 1 Darmanto 8123456789 B. Mandiri
12 1 10/20/2017 I Gede Yoga P 2800 1 1 I Made Eka J 8123456789 B. Mandiri
13 2 12/17/2016 Siti Maryam 3000 1 1 M. Sultan 8123456789 B. Mandiri
14 1 5/3/2015 Arsy Imzaatul 3100 1 1 Kasimun 8123456789 B. Mandiri
15 1 31-06-17 Julian 3000 1 1 Yusuf E 8123456789 B. Mandiri
16 1 5/1/2017 Fahdil Akbar 2900 1 1 Triyanto 8123456789 B. Mandiri
17 1 5/4/2015 Revi Aldino 3000 1 1 Ratino 8123456789 B. Mandiri
18 1 3/8/2017 Muhammad Arfan 2800 1 1 Lukman Agus 8123456789 B. Mandiri
19 10/20/2016 1805302611140017 Sabit Haya 3000 1 1 Heri Juniarto 8123456789 B. Mandiri
20 5/10/2017 1802102707170004 Annindita Keysa 3100 1 1 Aris Mawanto 8123456789 B. Mandiri
21 10/25/2015 1807142606120003 1807142510150001 Muhammad Rizky. A 3000 1 1 Bambang S 8123456789 B. Mandiri
22 2 11/8/2017 1803160509120004 Dwi Ayu M 2700 1 1 Nasikin 8123456789 B. Mandiri
23 6/18/2016 M. Damai Al. R 3100 1 1 Heru Purwanto 8123456789 B. Mandiri
24 9/2/2016 180527041007028 Irgi Irfandi 3500 1 1 Katubi 8123456789 B. Mandiri
25 1 5/30/2015 Reynan Davin 3500 1 1 Zainal Arifin 8123456789 B. Mandiri
26 1 5/22/2016 Arsyla Kanza 3100 1 1 Slamet W 8123456789 B. Mandiri
Provinsi : Lampung Nama Posyandu : MELATI II

Puskesmas/Kecamatan : PASIRAN JAYA Tahun : 2020
PB LAHIR ASI EksklusifF1=YA, 2=Tidak

Panjan Cara
Kepemilik g Ukur Vitamin Vitamin
No Tanggal Lahir L/P No Kartu Keluarga Nama Anak BB Lahir KIA/KMS 2=Tidak Nama Ayah NIK Ayah No Tlp/ HP Ayah Alamat RT RW Tgl Ukur Umur Februari Agustus
Ke Kependudukan) ANAK PB LAHIR 1=YA, (kg) Tinggi tang umur umur 2 umur 3 umur umur umur 1=YA 1=YA
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) (22) (23) (24) (25) (26) (27) (28)
BRATASENA
1 2 9/3/2019 P 1802262412100024 1802260211820002 JIHANE LUTVIA. A 3000 47 1 1 A.SUROTO 1802264309190001 82176331609 MANDIRI 7 3 1/10/2020 4 6.4 58 1 1 1 1 1
2 1 3/20/2019 L 1805272503890001 M.AZMI ALHATSBI 3100 48 1 1 SIGIT P BRATASENA 7 3 1/10/2020 9 6.7 67 1 1 1 1 1 1 1 1
1805251303190007 1805252003190001 82176331609 MANDIRI
3 3 5/14/2017 P 1805273008770001 ALFIA KHOIRUNISA 3300 48 1 1 SIPIYAN BRATASENA 7 3 1/10/2020 31 12.9 88.5 2 1 1 1 1 1 1 1
1805271206090017 1805255405170002 82176331609 MANDIRI
BRATASENA
4 2 5/7/2019 L EROS DWI MAHENDRA 2900 47 1 1 RIKI 82176331609 MANDIRI 7 3 1/10/2020 7 8.3 73 1 1 1 1 1 1 1
BRATASENA
5 4 5/13/2019 L 1811042411090001 AHMAD NURRAHMADANI 3000 48 1 1 MASIS 1811042009690001 82176331609 MANDIRI
2 1 1/10/2020 7 9.2 70 1 1 1 1 1 1 1
6 3 8/30/2019 L A. IKWANUDIN 3400 49 1 1 BADORI BRATASENA 6 3 1/10/2020 3 5.8 61 1 1 1 1
82176331609 MANDIRI
BRATASENA
7 2 4/30/2018 L RISKI 3000 49 1 1 GUNADI 82176331609 MANDIRI 6 3 1/10/2020 20 11.5 76 2
8 1 9/14/2015 P ADIBA 3500 48 1 1 DEDI KURNIAWAN BRATASENA 6 3 1/10/2020 50 18.8 107 2
82176331609 MANDIRI
BRATASENA
9 1 5/8/2017 P BILQIS 3600 49 1 1 ADITYA RANGGA 82176331609 MANDIRI 6 3 1/10/2020 31 13.4 95.1 2
BRATASENA
10 3 1/22/2016 L PRANAJA ABID 3500 48 1 1 ISWANTO 82176331609 MANDIRI 2 3 1/10/2020 46 15.2 98 2
11 3 3/3/2019 P 1802102806110012 SYAKILA 3200 47 1 1 BOWO SANTOSO 1802102409800004 BRATASENA 2 3 1/10/2020 9 6.8 70 1
82176331609 MANDIRI
BRATASENA
12 3 9/12/2019 L ILHAM 3000 48 1 1 NGADIMUN 82176331609 MANDIRI 6 3 1/10/2020 3 5.9 58 1
13 2 8/27/2018 L IRZIQ MUHAMMAD FILDAN 2900 47 1 1 HERI KUSMIRAN BRATASENA 4 3 1/10/2020 16 8.2 79 2
1085271911090037 1805271088790010 82176331609 MANDIRI
14 1 7/19/2015 P 18070502022180006 SAQILA NUR ROFIAH 3000 48 1 1 ARBI ABADI 1872022106900001 BRATASENA 3 4 1/10/2020 41 11.8 92 2
82176331609 MANDIRI
BRATASENA
15 1 12/30/2016 P BELLA PUTRI CAHYA DINI 2800 47 1 1 JAINURI 82176331609 MANDIRI 4 3 1/10/2020 33 14.2 95.5 2
16 2 1/27/2018 L M. IQBAL 3000 48 1 1 KASIM BRATASENA 2 3 1/10/2020 23 10 81 2
82176331609 MANDIRI
17 2 10/6/2015 L PASHA HAIDAR YUSUF 3100 47 1 1 MULYADI BRATASENA 1 3 1/10/2020 50 12.5 97 2
1805250906140012 1805250610150001 1805250106820001 82176331609 MANDIRI
BRATASENA
18 1 5/7/2015 P 1805252010140004 SILFI 3000 48 1 1 ANDIANTO 1805250101860006 82176331609 MANDIRI 4 3 1/10/2020 56 15 103 2

Nama Posyandu : FLAMBOYAN
Tahun : 2020
Panjan Cara
Anak NIK (Nomor Induk an Buku IMD 1=YA, BB Badan/ 1=Telen ASI EksklusifF1=YA, 2=Tidak A A
No Tanggal Lahir L/P No Kartu Keluarga Nama Anak BB Lahir PB LAHIR KIA/KMS 2=Tidak Nama Ayah NIK Ayah No Tlp/ HP Ayah Alamat RT RW Tgl Ukur Umur (kg) Tinggi tang umur umur 2 umur 3 umur umur umur Februari Agustus
Ke Kependudukan) ANAK 1=YA, 1=YA 1=YA
1 8/20/2017 P ASKIA 3500 47 2=Tidak
1 1 BUDI 82176331609 BRATASENA 42 12.5 (cm) 2=Tidak 2=Tidak
MANDIRI ri
2 4/6/2017 L ARSHA 3100 48 1 1 PRASTIYO 82176331609 BRATASENA 41 12.6
MANDIRI
BRATASENA
3 8/7/2016 L BAGAS 3100 47 1 1 AGUS 82176331609 MANDIRI 32 11
4 5/7/2017 P NISA 2900 48 1 1 ARIPIN 82176331609 BRATASENA 22 10.5
MANDIRI
5 11/13/2018 P JUWITA 3000 49 1 1 INDRA 82176331609 BRATASENA
MANDIRI
BRATASENA
6 10/19/2018 L AZRIL 3100 48 1 1 82176331609 MANDIRI
7 5/27/2018 P ALEKSA 2900 48 1 1 ICHA 82176331609 BRATASENA 12 9
MANDIRI
BRATASENA
8 2/7/2019 P KAMELA 2900 47 1 1 LAMIRAN 82176331609 MANDIRI 11 8
9 2/15/2019 L KOMANG 3200 49 1 1 NENGAH 82176331609 BRATASENA 9 7.3
MANDIRI
10 4/27/2019 P SIFA 3000 47 1 1 SARIJO 82176331609 BRATASENA 7 8
MANDIRI
BRATASENA
11 6/7/2019 P NAFISA 3500 47 1 1 RIJAL 82176331609 MANDIRI
12 12/19/2019 L MAULANA 3900 48 1 1 ARI 82176331609 BRATASENA
MANDIRI
BRATASENA
13 9/8/2019 L DELVIN 4000 48 1 1 NARTO 82176331609
MANDIRI
4 7.7
BRATASENA
14 9/9/2019 P RISMA 3500 47 1 1 SUHERMAN 82176331609 MANDIRI
15 7/27/2018 L GIBRAN 3300 49 1 1 PERO 82176331609 BRATASENA 18 9.5
MANDIRI

Nama Posyandu : MAWAR
Tahun : 2020
Panjan Cara
an Buku IMD 1=YA, ASI EksklusifF1=YA, 2=Tidak A A
No Anak Tanggal Lahir L/P No Kartu Keluarga NIK (Nomor Induk Nama Anak BB Lahir PB LAHIR KIA/KMS 2=Tidak Nama Ayah NIK Ayah No Tlp/ HP Ayah Alamat RT RW Tgl Ukur BB Badan/ 1=Telen
Ke Kependudukan) ANAK Umur (kg) Tinggi tang umur umur 2 umur 3 umur umur umur Februari Agustus
1=YA, (Bln) Badan 2=Berdi 1 bln bln bln 4 bln 5 bln 6 bln 1=YA 1=YA
2=Tidak BRATASENA 2=Tidak 2=Tidak
1 4/7/2018 p 1802110208120003 1802110704180001 GENDIS AYU 3100 50 1 1 I MADE 082176331609 MANDIRI 1/15/2020 21 (cm) ri
BRATASENA
2 2/27/2018 L AZRIL SUGIH RAHANDIKA 3100 49 1 1 WAWAN 082176331609 MANDIRI 1/15/2020 23
BRATASENA
3 7/20/2017 P 1805250711180002 1805252007170004 FIRZA KHOIRUMMAHMUDAH 2900 48 1 1 M KHOIRI 082176331609
MANDIRI
1/15/2020 30
4 2/28/2018 L M. DEFRAN ARAFIF 3000 48 1 1 ABDUL LATIF 082176331609 BRATASENA 1/15/2020 23
MANDIRI
BRATASENA
5 10/31/2018 P KHAFILATRITESIA 3100 49 1 1 EKO 082176331609 1/15/2020 15
MANDIRI
6 1/11/2018 L I KETUT NAREZ ADI BRATA 2900 49 1 1 KETUT ARDIKA 082176331609 BRATASENA 1 1 1/15/2020 25
MANDIRI
BRATASENA
7 7/1/2018 L 1807090109080002 1807090107180001 JUNA ELTIOFITRANDO 2900 47 1 1 JUMARDI 082176331609 MANDIRI 1/15/2020 28
BRATASENA
8 12/12/2018 L 1805270404080004 1805251212180002 M. GIBRAN 3200 48 1 1 SUPARJAN 082176331609 MANDIRI 1/15/2020 14
9 5/13/2018 P AZALEA ZAHIRA 3000 48 1 1 AGUS KUSTIAWAN 082176331609 BRATASENA 1/15/2020 20
MANDIRI
10 10/9/2018 P KOMANG ARUNI 3500 48 1 1 NYOMAN SUDANE 082176331609 BRATASENA 1/15/2020 5
MANDIRI
BRATASENA
11 1/18/2018 L I KOMANG ARYA PRATAMA 3700 47 1 1 I WAYAN 082176331609 MANDIRI 1/15/2020 24
12 2/23/2020 P FELYDIA ARNESTI 3300 49 1 1 TRI HARIYANTO
13 12/23/2018 L AZRIL HANIF RAMADANI 3500 50 1 1 RAMDANU

Nama Posyandu : DAHLIA
Tahun : 2020
Panjan Cara
Anak NIK (Nomor Induk an Buku IMD 1=YA, BB Badan/ 1=Telen ASI EksklusifF1=YA, 2=Tidak A A
No Tanggal Lahir L/P No Kartu Keluarga Nama Anak BB Lahir PB LAHIR KIA/KMS 2=Tidak Nama Ayah NIK Ayah No Tlp/ HP Ayah Alamat RT RW Tgl Ukur Umur Februari Agustus
Ke Kependudukan) ANAK 1=YA, (kg) Tinggi tang umur umur 2 umur 3 umur umur umur 1=YA 1=YA
2=Tidak BRATASENA 2=Tidak 2=Tidak
1 1 9/24/2019 L ZAMRUD HAYATUN 3100 1 1 RASDI 82176331609 MANDIRI
1/13/2020 4 61
(cm) ri1
BRATASENA
2 2 10/12/2019 L 1802102203190002 1802105210190001 KOMANG DHITA N 3200 1 1 KETUT SUBAWA 1805271503780001 82176331609 MANDIRI 5 3 1/13/2020 3 60 1
BRATASENA
3 1 6/13/2019 P 1802051706190003 1802055306190001 MIKAYLA AZZALEA ZALINDRA 3500 1 1 ABDUL ROHIM 1802052409000003 82176331609 25 13 1/13/2020 7 62 1
MANDIRI
4 6/27/2019 P NISA SAFIRA A 3800 1 1 MULO PARMUNO BRATASENA 1/13/2020 7 1
82176331609 MANDIRI
BRATASENA
5 2 3/14/2019 L 1802102208140001 1802100403190002 MADE MARVEL D 3500 1 1 MADE NURYADI 1802100109870007 82176331609 MANDIRI 12 5 1/13/2020 10 72 1
6 1 11/13/2018 L FAREL SANJAYA 2800 1 1 A SAIFUL BRATASENA 1/13/2020 14 74 1
82176331609 MANDIRI
BRATASENA
7 3 11/9/2018 P 1805271609080001 1805254211180001 SALSABILA NADIFATUZZAHRO 2900 1 1 AHMAD MUHAIMIN 1805270705760003 82176331609 MANDIRI 1 4 1/13/2020 14 70 1
BRATASENA
8 2 11/15/2018 P 1807010104110002 1807015511180002 NAZILA NUR AULIA 2800 1 1 MALIKI 1807012007820004 82176331609 MANDIRI 1 1 1/13/2020 14 74 1
9 2/4/2019 L MUHAMMAD RADITIYA 3000 1 1 HARTONO BRATASENA 1/13/2020 11 1
82176331609 MANDIRI
10 2 1/23/2016 P ADZKIYA THIRFA 3200 1 1 SUTARNO BRATASENA 3 4 1/13/2020 48 102 2
1805270112080007 1805256301160004 1805272012700003 82176331609 MANDIRI
BRATASENA
11 2 2/15/2017 P 1805271409090013 NUR AMALIA SAFIRA 3000 1 1 A SODIKIN 1805270204820003 82176331609 MANDIRI 7 4 1/13/2020 35 92 2
12 L ARFAN MUZAKI 1 1 MEDI BRATASENA 1/13/2020 36 91 2
82176331609 MANDIRI
13 AHMAD RIFKI ALBAHRI 1 1 WALYONO BRATASENA 1/13/2020 40 2
82176331609 MANDIRI
Kampung : PASIRAN JAYA

Nama Posyandu : ANGGREK
Tahun : 2020
ASI EksklusifF1=YA, 2=Tidak

Panjan Cara
an Buku IMD 1=YA, A A
No Anak Tanggal Lahir L/P No Kartu Keluarga NIK (Nomor Induk Nama Anak BB Lahir PB LAHIR KIA/KMS 2=Tidak Nama Ayah NIK Ayah No Tlp/ HP Ayah Alamat RT RW Tgl Ukur BB Badan/ 1=Telen Februari Agustus
Ke Kependudukan) ANAK Umur (kg) Tinggi tang umur umur 2 umur 3 umur umur umur 1=YA
1=YA, (Bln) Badan 2=Berdi 1 bln bln bln 4 bln 5 bln 6 bln 1=YA
1 2 9/26/2019 P 1805251010140010 ARSILA FARZANA P 3500 1 1 ILHAM PRIBADI P 1805250605900004 82176331609 PASIRAN JAYA 1/14/2020
2 2 9/23/2019 L 1805271906120070 ALFARO 3000 IRAWAN 1805272307840002 82176331609 PASIRAN JAYA 1/14/2020
3 2 5/10/2019 P 1805252605130015 AZAHRA 4000 KASIM 1805251505830002 82176331609 PASIRAN JAYA 1/14/2020
4 3 9/19/2020 L 1805253009130018 KANU AFNAN 3500 HERMANTO 1805250105750001 82176331609 PASIRAN JAYA 1/14/2020
5 2 7/8/2019 L 1805251011160008 M. HAFIS A 3200 SLAMET ROHADI 1805251101890002 82176331609 PASIRAN JAYA 1/14/2020
6 6 3/24/2019 P 1805255903190001 DINA NURAZIZAH 3600 SAIUN 1805271111750005 82176331609 PASIRAN JAYA 1/14/2020
7 1 10/24/2019 L M AKMAL Y 2400 TONI ARDIASYAH 1805272009840001 82176331609 PASIRAN JAYA 1/14/2020
8 2 6/30/2018 P 1805271906120095 FIRDA AYU 3000 AHMAD SUGIONO 1805270705860007 82176331609 PASIRAN JAYA 1/14/2020
9 2 4/24/2019 P 1805256404180001 PUPUT NABILA P 3000 SUGIARTO 1805250204810002 82176331609 PASIRAN JAYA 1/14/2020
10 3 3/11/2019 L NUR FURQON F 3500 MAKMUR H 1805272705850002 82176331609 PASIRAN JAYA 1/14/2020
11 2 5/15/2018 L BALKIS 3900 AHMAD YAHYA 1805250512930003 82176331609 PASIRAN JAYA 1/14/2020
12 2 2/17/2018 L 1872051702180001 NASRUL ABDUL K 3100 RUSTAM E 1805270510870003 82176331609 PASIRAN JAYA 1/14/2020
13 3 10/3/2017 L 1805250310170003 AZKA ADAM F 3300 AJANG 1805270610750004 82176331609 PASIRAN JAYA 1/14/2020
14 3 5/19/2018 P 1805255905180001 ATIFAH ALYA F 3500 SUYATNO 1805270603780001 82176331609 PASIRAN JAYA 1/14/2020
15 3 6/10/2018 1805255006180003 ANISA FITRI A 2900 KABUL 1805252411870003 82176331609 PASIRAN JAYA 1/14/2020
16 2 6/14/2018 L BILAL 3000 TURMUDI 1805271102770001 82176331609 PASIRAN JAYA 1/14/2020
17 1 2/26/2016 P SAFIRA K. N 4000 MUHRODIN 1805251206840003 82176331609 PASIRAN JAYA 1/14/2020
18 1 2/17/2017 L 1805251705170001 IKLAS ADTYA 3700 CHANDRA 1805251209900001 82176331609 PASIRAN JAYA 1/14/2020
19 2 7/5/2015 L 1805254507150001 GALIH 3500 A. SUARDI 1805271103830004 82176331609 PASIRAN JAYA 1/14/2020
20 3 6/29/2018 L 1805256906180001 LINTANG 3600 PARIJAN 1805271510720003 82176331609 PASIRAN JAYA 1/14/2020
21 1 9/19/2017 P 1805255909170001 ARSY SEPTIANA 3000 SAMSUL AZIZ 1805270505950004 82176331609 PASIRAN JAYA 1/14/2020
22 1 3/5/2018 L 1805250503180002 FADIL APDILAN 2600 PONIMAN 1805150107930003 82176331609 PASIRAN JAYA 1/14/2020
23 2 3/4/2019 P 18052544031190001 AULIA IZATUL N 3000 MISBAH 1807130404830006 82176331609 PASIRAN JAYA 1/14/2020
24 2 11/9/2016 L 1805250911160001 ALFAN GYHARTA 2600 SARJIONO 1805250101790005 82176331609 PASIRAN JAYA 1/14/2020
25 2 5/1/2018 L 1805250105180001 BAYU AJI 3700 SULAM TAUFIK 1805270102020003 82176331609 PASIRAN JAYA 1/14/2020
26 1 7/9/2016 L 1805250907160002 FADLAN AHMAD 2700 SUYANTO 180525130950003 82176331609 PASIRAN JAYA 1/14/2020
27 2 11/19/2016 L 1805251911160001 AHZA ZIKRI 3100 M. IHSAN 1805270101850025 82176331609 PASIRAN JAYA 1/14/2020
28 2 10/3/2018 L 1805250310180002 CHANDRA 3500 HAYAT 1805251208820003 82176331609 PASIRAN JAYA 1/14/2020
29 2 8/6/2018 L 1805250408180001 IDRUS 3500 MARTINI 1805250408850001 82176331609 PASIRAN JAYA 1/14/2020
30 2 11/10/2018 P 180525511180001 ANISA AZZAHRA 3100 SUSANTO 180525205780001 82176331609 PASIRAN JAYA 1/14/2020
31 3 7/16/2018 P 1805255607180001 NAFISA ADELIA M 3000 AGUS 1805271908870001 82176331609 PASIRAN JAYA 1/14/2020
32 2 8/21/2017 P 1805255307180001 LUTHFIA I 3000 PURWADI 180527040380001 82176331609 PASIRAN JAYA 1/14/2020
33 3 6/14/2017 P 1805255406170001 TANTRI 3100 JOKO 1805271903770001 82176331609 PASIRAN JAYA 1/14/2020
34 4 4/7/2018 L 1805250704180003 M. AZZAM M 3800 ALI MARSUDI 1805270912750005 82176331609 PASIRAN JAYA 1/14/2020
35 2 10/20/2019 L 1805252010190001 RIZKI AGAM S AHMAD S 1805252203870001 82176331609 PASIRAN JAYA 1/14/2020
36 1 9/11/2018 P 1805250205180009 KEISSA 3500 DEDI HARYANTO 1805251807900006 82176331609 PASIRAN JAYA 1/14/2020
37 3 6/16/2018 L 1805251106180005 M. ATTOILAH M 3800 MUNGAZIN 1807140207810002 82176331609 PASIRAN JAYA 1/14/2020
38 2 6/19/2018 L 1805251906180001 M. ARFAN SAPUTRA 3700 M. HARIS WANDI 1805250206880003 82176331609 PASIRAN JAYA 1/14/2020
39 2 9/5/2019 P 1805270208120015 NADIA 2600 SYAHRUDIN 1805270604710006 82176331609 PASIRAN JAYA 1/14/2020
40 1 3/15/2019 P 1805252105180004 WERTA INDAH SARI 2900 WASIMAN 180525504870003 82176331609 PASIRAN JAYA 1/14/2020
41 2 8/4/2019 P 1805271505120056 RAFIKA AGUSTIN 4000 MINAN 1805270709830007 82176331609 PASIRAN JAYA 1/14/2020
42 3 11/15/2018 P 1805255511180001 MELINDA NOVITA 2500 SUDIMAN 1805270806760009 82176331609 PASIRAN JAYA 1/14/2020
43 2 12/24/2018 L 1805252412180002 FATHAN RAFASYA H 3000 ROHMAN 1805251504870002 82176331609 PASIRAN JAYA 1/14/2020
44 1 6/11/2018 L 1805251106180003 ARDILAN 2800 SUPRIYADI 1805252702940003 82176331609 PASIRAN JAYA 1/14/2020
45 2 9/18/2017 L 1805251809170001 MIHROM MUARIFIN 4000 ABDUL LATIF 1805272808850003 82176331609 PASIRAN JAYA 1/14/2020
46 1 5/5/2018 L 1805252312130020 ALFIAN 2800 SURNADI 1805251005900004 82176331609 PASIRAN JAYA 1/14/2020
47 1 5/23/2019 L 1807080703110012 C. FANDRA 3000 DEDI IRAWAN 1807080109830003 82176331609 PASIRAN JAYA 1/14/2020
48 1 12/19/2018 L 1805251709180023 AZRIL 3400 ARI ANGGARA 1805272102930001 82176331609 PASIRAN JAYA 1/14/2020
49 2 8/26/2019 L 1805252312130015 M. RAYYAN AL 3000 SAMSUL MUIN 1805251006840002 82176331609 PASIRAN JAYA 1/14/2020

Nama Posyandu : NUSA INDAH
Tahun : 2020

Panjan Cara
Ke Kependudukan) ANAK Umur (kg) Tinggi tang umur umur 2 umur 3 umur umur umur
1 5/10/2019 P 1805251106190007 NATUSA RIZKI 1805271205930002 82176331609 PASIRAN JAYA

2 1/7/2019 L 180527080811011 NUROHMAH SUTRIS 1805272708820002 82176331609 PASIRAN JAYA
3 10/8/2019 L 180527250112003 ARTA TARSIMAN 1805271017850004 82176331609 PASIRAN JAYA
4 4/29/2019 L 1805272607120029 NUROHIM AKSARI 1805272808890003 82176331609 PASIRAN JAYA
5 7/23/2019 L 18055221907120037 RASYID MUHLISIN 1805272604820005 82176331609 PASIRAN JAYA
6 6/16/2019 L 1805252006140022 RIDHO ERWAN 1805252510810001 82176331609 PASIRAN JAYA
7 9/30/2019 P INESYA BAGUS 82176331609 PASIRAN JAYA
8 11/10/2019 L KHOLID BADRI 82176331609 PASIRAN JAYA
9 12/14/2019 L 1805251511170005 FADIL MARSI 1805255440592002 82176331609 PASIRAN JAYA
10 6/28/2018 L GEO PURY 82176331609 PASIRAN JAYA
11 1/7/2017 P SOFINA PARJONI 82176331609 PASIRAN JAYA
12 1/14/2018 L 1805251607130038 1805251401180001 JINDAN MUARIF 180525050272001 82176331609 PASIRAN JAYA
13 11/26/2016 P JILAH MURDIANTO 82176331609 PASIRAN JAYA
14 5/27/2019 L 180527201212003 ARIF. M UJANG 1805272603880002 82176331609 PASIRAN JAYA
15 7/22/2015 P 1805250409180003 1805256207150001 ASIFA SUPRI 1805251412820001 82176331609 PASIRAN JAYA
16 5/22/2017 P 1805252006140022 1805256205170001 SAFITA ERWAN 1805252510810001 82176331609 PASIRAN JAYA
17 10/3/2017 L 1805253105130018 AL SODIQ HENGKI 1805251208770001 82176331609 PASIRAN JAYA
18 8/3/2017 L DEMICO IWAN 82176331609 PASIRAN JAYA
19 7/7/2018 P 18052550807130044 SYAKILA GUNTORO 1805271108840003 82176331609 PASIRAN JAYA
20 8/6/2017 L ASKA. W YUDA 82176331609 PASIRAN JAYA
21 8/5/2017 L 1805251309160030 1805250508180001 AHMAD. Y AGUS 1805250108980002 82176331609 PASIRAN JAYA
22 9/5/2016 P INDANA DANAR 82176331609 PASIRAN JAYA
23 11/7/2016 L 1805251208130009 RAFFA EDI 1805251208130009 82176331609 PASIRAN JAYA

Nama Posyandu : KENANGA
Tahun : 2020
Panjan Cara ASI EksklusifF1=YA, 2=Tidak

Kepemilik Vitamin Vitamin
an Buku IMD 1=YA, g Ukur A A
Anak NIK (Nomor Induk BB Badan/ 1=Telen
No Ke Tanggal Lahir L/P No Kartu Keluarga Kependudukan) ANAK Nama Anak BB Lahir PB LAHIR KIA/KMS 2=Tidak Nama Ayah NIK Ayah No Tlp/ HP Ayah Alamat RT RW Tgl Ukur Umur (kg) Tinggi tang umur umur 2 umur 3 umur umur umur Februari Agustus
2=Tidak 2=Tidak 2=Tidak
(cm) ri
1 2/23/2018 L GALANG 4000 VERY 82176331609 PASIRAN JAYA 2
2 9/22/2018 L ARFAN 3800 IHWAN 82176331609 PASIRAN JAYA 2
3 1/1/2018 L DANU 3400 SIIS HERMANTO 82176331609 PASIRAN JAYA 2
4 8/30/2018 L HAFIS 3000 ROIS 82176331609 PASIRAN JAYA 2
5 7/23/2018 P DINDA 3300 HERI 82176331609 PASIRAN JAYA 2
6 7/1/2018 P NINDI 2900 IKSAN 82176331609 PASIRAN JAYA 2
7 9/9/2018 P FARISA 2800 M. BASRI 82176331609 PASIRAN JAYA 2
8 1/27/2017 L ARKAN 1900 UDIN 82176331609 PASIRAN JAYA 2
9 4/22/2018 P ANISA 2700 TAMIM 1805271506630005 82176331609 PASIRAN JAYA 2
10 8/29/2018 P ZULAIKA 2700 ZUNAIDI 82176331609 PASIRAN JAYA 2
11 1/15/2018 P 1805115501170001 KHO;IF TULJANAH 3000 YUSUF 1805110808850001 82176331609 PASIRAN JAYA 2
12 6/11/2018 L AIDIR ALI 3500 AMIR 1602150808740006 82176331609 PASIRAN JAYA 2
13 1/24/2018 L IQBAL ALFALAH 2200 RIADIN 82176331609 PASIRAN JAYA 2
14 8/6/2018 P AISYAH AYUDIA 2800 NASRUL 82176331609 PASIRAN JAYA 2
15 12/2/2018 P 1805254212180001 ARLINTANG ANUM 4000 SLAMET 180570403830001 82176331609 PASIRAN JAYA 2
16 7/9/2018 L ZAKI MAULANA 3500 SOLEHAN 82176331609 PASIRAN JAYA 2
17 12/1/2017 L MAULANA DIRGA 2400 EDI 82176331609 PASIRAN JAYA 2
18 11/5/2018 P 1805254511170001 ANANDA 3500 SAMSUDIN 1805270804740005 82176331609 PASIRAN JAYA 2
19 9/26/2017 L ATHAR ATQHORI 3500 SUBANDI 82176331609 PASIRAN JAYA 2
20 7/17/2017 L ADITYA RAHMAD 2300 DENI 82176331609 PASIRAN JAYA 2
21 10/20/2017 L AFZAR HAZIK 3700 IIS SUGIANTO 1805201507890009 82176331609 PASIRAN JAYA 2
22 10/22/2017 L KAISAR ABHI 4400 RUDIANTO 1805256807960003 82176331609 PASIRAN JAYA 2
23 1/3/2017 L ILHAM ARIFIN 2800 NURHUDA 1807181004720001 82176331609 PASIRAN JAYA 2
24 9/21/2018 L SAHIN 2900 ADI 82176331609 PASIRAN JAYA 2
25 8/30/2018 L ABDUL ROHMAN 2700 ABDUL ROIS 82176331609 PASIRAN JAYA 2
26 5/6/2018 P RAISA AHMAD 2900 SAPRI 82176331609 PASIRAN JAYA 2
27 2/19/2018 P 1805255902180002 AYRA 3000 ANDI 1807020501880005 82176331609 PASIRAN JAYA 2
28 8/22/2018 P ALESHA AYU 3400 YOGA 18052508850003 82176331609 PASIRAN JAYA 2
29 1/7/2018 L HERNANDI 3000 HERWANTO 1806030711880003 82176331609 PASIRAN JAYA 2
30 4/25/2018 L M. HANIF 2700 DEDI. R 1802052812890003 82176331609 PASIRAN JAYA 2
31 8/14/2018 L LIONIL AZKA 3700 FIRDAUS 180525250580003 82176331609 PASIRAN JAYA 2
32 5/29/2019 P SALMA 3100 IMAM 82176331609 PASIRAN JAYA
33 9/19/2019 L M. FARIS MAULANA 2700 ROSIHUN 82176331609 PASIRAN JAYA
34 11/9/2019 P MAUDY H 2800 EKA S 82176331609 PASIRAN JAYA
35 7/5/2019 L IBRAHIM 3800 DEDEN 82176331609 PASIRAN JAYA
36 12/4/2019 L JEFRI 2600 HERI 82176331609 PASIRAN JAYA
37 1/21/2019 L ABYAN YOGA 3500 YOGA 1805272304920001 82176331609 PASIRAN JAYA
38 L 1805252101190001 WILDAN MURFUAD 2600 WARAS 82176331609 PASIRAN JAYA
39 10/16/2019 L AQMAR 3700 SUPRIADI 1805272109720001 82176331609 PASIRAN JAYA
40 12/3/2019 L FAHRI 2900 SUHERMAN 82176331609 PASIRAN JAYA
41 5/10/2019 L TEGES WICAKSONO 3300 RISWANTO 82176331609 PASIRAN JAYA
42 8/11/2019 L AFNAN ZULFIKAR 2700 HAYUN 82176331609 PASIRAN JAYA
43 9/14/2019 P ZULFA 2800 DODI 82176331609 PASIRAN JAYA
44 5/12/2019 P KAHIYANG 3200 GALIH 82176331609 PASIRAN JAYA
45 9/11/2019 P ZEA ALMARA 3100 YOYOK 82176331609 PASIRAN JAYA
46 10/25/2019 L 1805250502190001 MUHAMAD KHALIF 2700 ZAINUDIN 180527200960003 82176331609 PASIRAN JAYA
47 2/5/2019 L M. AKROMINIZAM 2600 MUJIB 1805272906750001 82176331609 PASIRAN JAYA
48 3/13/2019 L AQMAR NAUFAL HERMANTO 1805271912780001 82176331609 PASIRAN JAYA
49 9/11/2019 P DEBY ALIFAH 2800 NGADIMEN 82176331609 PASIRAN JAYA
50
50

Nama Posyandu : MELATI
Tahun : 2020

Kepemilik Panjan Cara Vitamin Vitamin
g Ukur
No Tanggal Lahir L/P No Kartu Keluarga Nama Anak BB Lahir PB LAHIR KIA/KMS 2=Tidak Nama Ayah NIK Ayah No Tlp/ HP Ayah Alamat RT RW Tgl Ukur Umur umur umur 2 umur 3 umur umur umur Februari Agustus
Ke Kependudukan) ANAK 1=YA, (kg) Tinggi tang 1=YA 1=YA
1 1 4/11/2018 L 1805250409180004 1805251104180001 ATHA FARIS KIANO 2900 MUGIONO 82176331609 PASIRAN JAYA 1/18/2020
2 2 8/29/2015 L ANGGA 3800 SUSILO 82176331609 PASIRAN JAYA 1/18/2020
3 1 5/5/2016 L 1805253108180001 1805250505160002 A. KHOIRUL ANAM 3000 KADIR 82176331609 PASIRAN JAYA 1/18/2020
4 3 6/3/2018 P 1805270904080123 MUFIDAH ALAIMAN 3200 SAMINO 82176331609 PASIRAN JAYA 1/18/2020
5 1 4/18/2016 L 1805252310180008 1805251804160005 M. DAVID AKBAR NIZAR 82176331609 PASIRAN JAYA 1/18/2020
6 4 3/30/2019 L 1805272811080019 AZAM AULIYAM 4300 SAMSUL M 82176331609 PASIRAN JAYA 1/18/2020
7 1 2/12/2019 P AISYAH AYUDIA 2900 SURONO 82176331609 PASIRAN JAYA 1/18/2020
8 1 4/2/2019 P AISYAH AYLA 2700 YUSUF 82176331609 PASIRAN JAYA 1/18/2020
9 3 4/20/2019 L 1805251111140032 1805252004190002 FAJRI AL HAFIS 3500 BUDIONO 82176331609 PASIRAN JAYA 1/18/2020
10 1 3/25/2019 L 1802262608190001 1802262503190001 ALBIYAN PRATAMA 2500 JUMIARTO 82176331609 PASIRAN JAYA 1/18/2020
11 1 5/5/2019 P AULIA IZZATUNNISA 3700 M ZAENAL 82176331609 PASIRAN JAYA 1/18/2020
12 1 8/2/2019 P AZIZAH 4000 M ZUHRI 82176331609 PASIRAN JAYA 1/18/2020

13 2 4/18/2019 L 1805271202130001 1805251804190001 KENZI BANAR 4400 SUKIMIN 82176331609 PASIRAN JAYA 1/18/2020
14 1 7/23/2019 P ULYA 3900 NAJIB 82176331609 PASIRAN JAYA 1/18/2020
15 5 8/27/2016 L A. BINTANG 2700 TEGUH 82176331609 PASIRAN JAYA 1/18/2020
16 2 8/20/2019 L M. KEMIL MAULANA 2800 JATMIKO 82176331609 PASIRAN JAYA 1/18/2020
17 1 7/29/2019 L BAGUS ADRIAN 3200 AGUS 82176331609 PASIRAN JAYA 1/18/2020
18 2 9/28/2019 L 1805250712160007 YUNUS DENI S 3000 ADE S 82176331609 PASIRAN JAYA 1/18/2020
19 1 9/10/2019 L 1807041201110003 ADNAN 4200 WALUYO 82176331609 PASIRAN JAYA 1/18/2020
20 2 9/25/2019 L KHOIRUL ROJIKIN 3500 TAUFIQ 82176331609 PASIRAN JAYA 1/18/2020
21 1 10/14/2019 P RACIKA M BUSTOMI 82176331609 PASIRAN JAYA 1/18/2020
22 1 10/18/2019 P ALMAIRA TUH FATUL 2500 A SOLIKIN 82176331609 PASIRAN JAYA 1/18/2020
23 1 11/8/2019 L KENZO EKO 82176331609 PASIRAN JAYA 1/18/2020
24 2 9/26/2019 L A. RAYHAN BABANG 82176331609 PASIRAN JAYA 1/18/2020
25 1 11/19/2019 L M. DAFFA NOVAL YANTO 82176331609 PASIRAN JAYA 1/18/2020
26 1 9/12/2019 P FARIDA 3700 LUKMAN 82176331609 PASIRAN JAYA 1/18/2020
27 1 12/10/2019 L AFTAR MAHER SATORI 82176331609 PASIRAN JAYA 1/18/2020
28 1 11/4/2017 P 1801102410160005 NELNA AMERA 4100 M FAUZI 82176331609 PASIRAN JAYA 1/18/2020
29 1 12/21/2019 P ASIFA NIKEN 3000 RAFA 82176331609 PASIRAN JAYA 1/18/2020
30 1 9/8/2018 P ARETA AYU 3000 YUDI 82176331609 PASIRAN JAYA 1/18/2020
31 1 12/1/2019 L A. FADIL ARIQ 2700 EDI 82176331609 PASIRAN JAYA 1/18/2020
32 2 3/7/2018 L 1805251706160006 DAVID MAULANA 2700 SURATNO 82176331609 PASIRAN JAYA 1/18/2020
33 2 4/30/2014 P 1805272707120027 1805257004150001 JIHAN APRIYANI 3800 JOKO 82176331609 PASIRAN JAYA 1/18/2020
34 1 10/14/2018 P 1805253108140016 ALZENA AYRA FITRI 3300 SLAMET 82176331609 PASIRAN JAYA 1/18/2020
35 4 1/23/2018 L 1805253001170012 DEDI WIJAYANTO 4200 ALI HASAN 82176331609 PASIRAN JAYA 1/18/2020
36 3 9/19/2018 L 1812062710170003 1812061909170001 ROZI ABDILAH 3100 ABDUL GHOFUR 82176331609 PASIRAN JAYA 1/18/2020
37 3 9/16/2018 P 1805272901130023 SABRINA AISYA 3000 SARBINI 82176331609 PASIRAN JAYA 1/18/2020
38 3 4/11/2017 P 180527030310015 1805255104170002 AINUN AQILA 2700 INDRA 82176331609 PASIRAN JAYA 1/18/2020
39 1 10/4/2018 P 1805270907080016 SHELIN 3500 SUSILO 82176331609 PASIRAN JAYA 1/18/2020
40 2 4/1/2017 P 1805251709180009 1805254104170002 JAUZA 2800 RUDIANTO 82176331609 PASIRAN JAYA 1/18/2020
41 2 11/13/2018 L 1805251008180004 A. KHOIRUL ANAM 3900 ROHMAT 82176331609 PASIRAN JAYA 1/18/2020
42 2 4/6/2017 L 1805251211140026 REHAN ARSHY 3700 ISNADI 82176331609 PASIRAN JAYA 1/18/2020
43 2 10/20/2018 L 1805252801190002 1805022010180003 ATHA FARIS NIZAM 3100 SUNYOTO 82176331609 PASIRAN JAYA 1/18/2020
44 2 1/7/2018 P 1805270401110011 RACHEL 3600 SUYANTO 82176331609 PASIRAN JAYA 1/18/2020
45 1 4/26/2017 P 1807051610120020 ZAHRA SILVA 2700 SULTONI 82176331609 PASIRAN JAYA 1/18/2020
46 2 10/2/2018 L 1805272311100027 M FAHRI 4400 DWI SUKOLIS 82176331609 PASIRAN JAYA 1/18/2020
47 3 5/28/2018 P 1805252507160004 1805256805180001 AQILA 2900 SUKARDI 82176331609 PASIRAN JAYA 1/18/2020
48 2 5/16/2017 P 1805270703110008 1805255605170004 FATIHA LATIFA 3300 DARMANTO 82176331609 PASIRAN JAYA 1/18/2020
49 2 7/22/2018 L 1805252207180001 1805252207180001 AZRIL 2800 SUGENG 82176331609 PASIRAN JAYA 1/18/2020
50 3 7/22/2019 L 1805252207180001 1805252207180002 AZRUL 2200 SUGENG 82176331609 PASIRAN JAYA 1/18/2020
51 3 4/16/2019 L 1805270710080031 1805251604180001 AFFAN 4000 ABU SOFYAN 82176331609 PASIRAN JAYA 1/18/2020
52 1 11/12/2017 P 1805251804180002 1805255211170001 ARSILA FANESA 3300 WAHYU 82176331609 PASIRAN JAYA 1/18/2020
53 3 8/13/2018 L 1805271301120046 CAHYO WIQID 2800 SARIYATUN 82176331609 PASIRAN JAYA 1/18/2020
54 2 5/22/2018 P 180527254110001 1805256205180002 ANDIEN AYLA 2900 MUSANDI 82176331609 PASIRAN JAYA 1/18/2020
55 1 11/4/2015 P 1805251906170007 180525441150001 YASMIN ASHILA 2500 A. HOLIDIN 82176331609 PASIRAN JAYA 1/18/2020
56 5 4/28/2016 L 1805272711080043 1805252804160001 SUTIKNO 4200 TUMIRAN 82176331609 PASIRAN JAYA 1/18/2020
57 2 6/1/2017 L 1805272901130023 ABIZARD RAMADHAN 3400 SARBINI 82176331609 PASIRAN JAYA 1/18/2020
58 2 9/21/2017 P 1805252409180007 1805256109170002 ASHIFA AMELIA 2800 ISWANTO 82176331609 PASIRAN JAYA 1/18/2020
59 3 11/24/2018 P ARSYILA ALNAIRA 2400 MARYONO 82176331609 PASIRAN JAYA 1/18/2020
60 1 8/9/2016 P 1805251802190008 1805254908160001 KEYSA 4000 A. MUNTAHIR 82176331609 PASIRAN JAYA 1/18/2020
61 2 7/6/2018 P 1807021210120050 1807024607180001 AFFIFAH 2800 A. MUDZAKIR 82176331609 PASIRAN JAYA 1/18/2020
62 2 12/22/2017 P 1805251206130017 ROFFIFAH ALESA 3200 ABDUL GHOLIB 82176331609 PASIRAN JAYA 1/18/2020
63 2 9/2/2017 P 1805272001090038 AINUHA NAYYARA 3800 DODI TRIAMAN 82176331609 PASIRAN JAYA 1/18/2020
64 2 7/27/2018 P 1805271904110001 PRATISTA INARA 2800 BAMBANG 82176331609 PASIRAN JAYA 1/18/2020
65 4 8/27/2016 P 1805270911090026 1805256708160001 ADEEVA AGIS 3500 SUNARTO 82176331609 PASIRAN JAYA 1/18/2020
66 1 11/9/2016 L 1805270511090007 1805250911160002 SHAFIQ 4300 SULFI RIONO 82176331609 PASIRAN JAYA 1/18/2020
67 1 8/14/2017 P OLIVIA PUTRI 3000 DADAN 82176331609 PASIRAN JAYA 1/18/2020
68 2 11/1/2017 P 1805250806150007 AMRINA ZAINA 3400 DICKY 82176331609 PASIRAN JAYA 1/18/2020
69 2 6/27/2017 L 1805271010080010 1805252706170003 NAUFAL 2800 UMAR 82176331609 PASIRAN JAYA 1/18/2020
70 1 10/14/2017 P 1805252610160010 SAPIRA 2800 SUBIRMAN 82176331609 PASIRAN JAYA 1/18/2020

71 2 12/3/2018 P 1805272505100002 ADIBA 2600 A. MUBAROK 82176331609 PASIRAN JAYA 1/18/2020
72 2 6/27/2016 L 1801173006110003 180117676170002 MICHEL 4400 YONO 82176331609 PASIRAN JAYA 1/18/2020
73 1 1/31/2018 L 1805250905160010 ABIZARD 2800 JEFRI 82176331609 PASIRAN JAYA 1/18/2020
74 12/21/2019 P FELISA KRISTIANI AGUS WITONO 82176331609 PASIRAN JAYA 1/18/2020
75 5/5/2019 L M. GILANG RAMADHAN AHMAD 82176331609 PASIRAN JAYA 1/18/2020
76 12/3/2018 P HABIBAH A MUBAROK 82176331609 PASIRAN JAYA 1/18/2020
Nama Posyandu : CISADANE
Tahun : 2020
Panjan Cara ASI EksklusifF1=YA, 2=Tidak

Ke Kependudukan) ANAK 1=YA, (kg) Tinggi tang 1=YA 1=YA
Badan 2=Berdi
Kepemilik Panjan Cara Vitamin Vitamin
an Buku IMD 1=YA, g Ukur A A
Anak NIK (Nomor Induk BB Badan/ 1=Telen
No Ke Tanggal Lahir L/P No Kartu Keluarga Kependudukan) ANAK Nama Anak BB Lahir PB LAHIR KIA/KMS 2=Tidak Nama Ayah NIK Ayah No Tlp/ HP Ayah Alamat RT RW Tgl Ukur (kg) Tinggi tang umur umur 2 umur 3 umur umur umur Februari Agustus
1=YA, Umur 1=YA 1=YA
2=Tidak (Bln) Badan 2=Berdi 1 bln bln bln 4 bln 5 bln 6 bln 2=Tidak 2=Tidak
(cm) ri
1 2 11/30/2018 P AKILA VANESYA MUFIA 2900 AGUS 82176331609 PASIRAN JAYA 1/24/2020
2 P KHALISA BILQIS NANDANG 82176331609 PASIRAN JAYA 1/24/2020

3 1 9/24/2019 L GAVIN MADAFA PRASETYO 3600 WANTO 82176331609 PASIRAN JAYA 1/24/2020
4 1 3/16/2018 P ANGELA ALEYSYA T 2900 REZA 82176331609 PASIRAN JAYA 1/24/2020
5 2 10/27/2018 P SEPTIANI 3500 SUTARTO 82176331609 PASIRAN JAYA 1/24/2020
6 3 1/1/2019 P ASY SHIFA 3100 AGUS H 82176331609 PASIRAN JAYA 1/24/2020
7 1 2/26/2018 P AKILA 4000 IMAM N 82176331609 PASIRAN JAYA 1/24/2020
8 2 3/29/2017 L M. RAFIV 3100 UDIN 82176331609 PASIRAN JAYA 1/24/2020
9 2 4/23/2019 P SHAKIRA DWI ASTUTI 3100 SARYANTO 82176331609 PASIRAN JAYA 1/24/2020
10 3 12/17/2017 P HAFSHOH 2800 MIXDAR 82176331609 PASIRAN JAYA 1/24/2020
11 2 11/17/2017 P GEA NOVITA SARI 2500 MAMAT 82176331609 PASIRAN JAYA 1/24/2020
12 2 10/22/2018 L M. IBNU JAMIL 3200 IHWANUDIN 82176331609 PASIRAN JAYA 1/24/2020

13 2 9/4/2016 P AULIA PUTRI 3500 DAMAS 82176331609 PASIRAN JAYA 1/24/2020
14 3 2/6/2019 P ALIFAH SALSABILA 3500 DAMAS 82176331609 PASIRAN JAYA 1/24/2020
15 1 4/9/2017 P SAJIDAH 3500 IMANTO 82176331609 PASIRAN JAYA 1/24/2020
16 1 10/25/2018 P ZAKIA RAINA SAPUTRI 2500 DWI SANTOSO 82176331609 PASIRAN JAYA 1/24/2020
17 2 5/11/2018 P DIANA HUSNIA 3100 AMBO UPEK 82176331609 PASIRAN JAYA 1/24/2020
18 1 8/2/2016 P LESTI AGUSTINE 3200 SARFUDIN 82176331609 PASIRAN JAYA 1/24/2020
19 2 10/26/2016 L HERI IRAWAN SAPUTRA 3500 PARIMUN 82176331609 PASIRAN JAYA 1/24/2020
20 2 12/8/2016 P ADARA ANASTASIA 3000 KAMIRUDIN 82176331609 PASIRAN JAYA 1/24/2020
21 3 9/11/2017 P RIZKA ARETA ADNANI 2500 SUWARNO 82176331609 PASIRAN JAYA 1/24/2020
22 3 5/30/2018 L IQBAL RAMADHAN 3500 A SAFEI 82176331609 PASIRAN JAYA 1/24/2020

23 2 2/20/2019 P FANI IZZATUL LAILATUS 3500 SOFYAN 82176331609 PASIRAN JAYA 1/24/2020
24 1 9/17/2018 P WIDYA PRAVITA 3400 WIDODO 82176331609 PASIRAN JAYA 1/24/2020
25 2 6/4/2019 P CLARISSA FITRI RAHMADANI 3500 AMBO ACO 82176331609 PASIRAN JAYA 1/24/2020
26 3 3/29/2019 P SASKIA AYU NINDIA 3500 AHMAD SAID 82176331609 PASIRAN JAYA 1/24/2020
27 1 8/4/2018 P SASIKA KARUNIA 3000 SUSWANTO 82176331609 PASIRAN JAYA 1/24/2020
28 1 7/10/2018 L VITO ERMANSYAH 3200 MARYONO 82176331609 PASIRAN JAYA 1/24/2020
29 2 12/22/2019 L M. AL AZKA 3000 ANTON WIJAYA 82176331609 PASIRAN JAYA 1/24/2020
30 2 9/20/2016 L WAGIMAN 3800 JADI 82176331609 PASIRAN JAYA 1/24/2020
31 2 6/23/2015 P NARITA RAMADANI 3200 SLAMET RIYADI 82176331609 PASIRAN JAYA 1/24/2020
32 2 11/18/2019 L AD ILHAM 3000 TURAHMAN 82176331609 PASIRAN JAYA 1/24/2020
33 2 11/15/2019 L IQBAL AULIA DARYANTO 3500 DARYANTO 82176331609 PASIRAN JAYA 1/24/2020
34 2 1/2/2020 P ALYA NURHASANAH 3000 SUGIYANTO 82176331609 PASIRAN JAYA 1/24/2020
35 3 8/6/2018 P ALMARA ZEINALKEISA 3900 MUHSIN 82176331609 PASIRAN JAYA 1/24/2020

36 3 4/29/2019 L RESTU MAULANA AKBAR
37 2 7/5/2018 L ALIF ROHMATIN
38 3 3/22/2019 L ARYA GHOSAN
39 4 9/15/2016 L IMAM KHOIRUR ROJIKIN
40 5 4/28/2018 P MIKAYANI
41 1 6/24/2018 L ALWI PRATAMA
42 1 9/14/2017 L DAFA AL HAFIS
43 3 11/1/2018 L ZAQI HADIAN BASYA
44 4 12/4/2015 L FADILLAH ALFAUZI
45 2 P RESTI KARTIKA PUTRI
46 2 L SARIMAN ADITYA
47 1 L FAHRI ANANDA SAPUTRA
48 3 L KHOIRUL ANAM
49 2 L DEHAN PRASETYA
50 1 L DEVAN ADINATA
51 1 L FAISAL ZAHARYADIKA
52 1 L RIZKY ARIF KHOIRUDIN
53 2 P NABILA AMANDA ALMAHERA
54 2 P TALITA PRADITA SALSABILA
55 3 L MUHAMMAD FALIH AQMAR
56 2 P SHASFA AZZAHRA NURHAIFA
57 5 P CITRA AULIA
58 5 P HANUM SALSABELLA
59 1 L ARI PRASSETYO
60 5 L QISI FEBRIAN
61 5 P LIORA ZAHIRA LESTARI
62 2 L MUHAMMAD SULTAN
63 4 P NUR AYU NABILA
64
Lampiran 4
Provinsi : LAMPUNG
Kabupaten : TULANG BAWANG Bulan : Januari
Puskesmas/Kecamatan : Tahun : 2020
Jumlah Jumlah Balita Status Gizi Indeks BB/U Status Gizi Indeks TB/U Status Gizi Indeks BB/TB
No Nama Desa/Kelurahan sasaran diukur Sangat
Balita Antropometri Gizi Buruk Gizi Kurang Gizi Baik Gizi Lebih Sangat Pendek Pendek Normal Kurus Normal Gemuk
Kurus
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15)
1 Pasiran Jaya 443 405 0 2 400 3 2 1 402 0 3 399 3
2 Pendowo Asri 467 458 0 2 454 2 2 1 455 0 4 450 4
3 Bratasena Adiwarna 182 173 0 2 168 3 1 2 170 0 2 169 2
4 Bratasena Mandiri 140 135 0 2 129 4 2 2 131 0 2 132 1
5 Sungai Burung 142 137 0 2 131 4 1 2 134 0 2 134 1
Pasiran Jaya 1374 1308 0 10 1282 16 8 8 1292 0 13 1284 11
Provinsi : LAMPUNG
Kabupaten : TULANG BAWANG Bulan : Februari
Kurus
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15)
1 Pasiran Jaya 443 405 0 2 400 3 6 14 398 0 4 395 6
2 Pendowo Asri 467 458 0 2 454 2 8 55 405 0 6 444 8
5 Sungai Burung 142 137 0 2 131 4 9 12 119 0 2 133 2
Pasiran Jaya 1374 1308 0 10 1282 16 26 93 1189 0 17 1270 21
Provinsi : LAMPUNG
Kabupaten : TULANG BAWANG Bulan : Maret
Kurus
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15)
1 Pasiran Jaya 443 305 0 3 299 3 7 16 282 0 2 296 7
2 Pendowo Asri 467 387 0 3 379 5 5 30 352 0 3 376 8
5 Sungai Burung 142 90 0 2 84 4 5 9 76 0 2 86 2
Pasiran Jaya 1374 972 0 12 942 18 20 64 888 0 10 940 22
Provinsi : LAMPUNG
Kabupaten : TULANG BAWANG Bulan : April
Kurus
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15)
1 Pasiran Jaya 443 305 0 3 299 3 7 16 282 0 2 296 7
2 Pendowo Asri 467 387 0 3 379 5 5 30 352 0 3 376 8
5 Sungai Burung 142 90 0 2 84 4 5 9 76 0 2 86 2
Pasiran Jaya 1374 972 0 12 942 18 20 64 888 0 10 940 22
Provinsi : LAMPUNG
Kabupaten : TULANG BAWANG Bulan : Mei
Balita Antropometri Gizi Buruk Gizi Kurang Gizi Baik Gizi Lebih Sangat Pendek Pendek Normal Kurus Kurus Normal Gemuk
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15)
1 Pasiran Jaya 443 185 0 4 173 8 0 3 182 0 4 173 8
2 Pendowo Asri 467 163 0 3 153 7 0 4 159 0 3 153 7
5 Sungai Burung 142 76 0 3 70 3 0 2 74 0 3 70 3
Pasiran Jaya 1374 561 0 13 523 25 0 13 548 0 13 510 25
Provinsi : LAMPUNG
Kabupaten : TULANG BAWANG Bulan : Juni
Kurus
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15)
1 Pasiran Jaya 443 245 0 5 232 8 0 2 243 0 4 237 4
2 Pendowo Asri 467 285 0 3 275 7 0 4 281 0 3 277 5
5 Sungai Burung 142 102 0 2 97 3 0 1 101 0 3 96 3
Pasiran Jaya 1374 804 0 12 767 25 0 10 794 0 13 772 19
Provinsi : LAMPUNG
Kabupaten : TULANG BAWANG Bulan : Juli
Kurus
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15)
1 Pasiran Jaya 443 301 0 7 284 10 3 5 293 2 1 288 10
2 Pendowo Asri 467 315 0 6 297 12 2 4 309 1 1 301 12
5 Sungai Burung 142 85 0 5 77 3 1 1 83 1 1 79 5
Pasiran Jaya 1374 914 0 25 851 38 9 15 890 4 5 866 40
Provinsi : LAMPUNG
Kabupaten : TULANG BAWANG Bulan : Agustus
Balita Antropometri Gizi Buruk Gizi Kurang Gizi Baik Gizi Lebih Sangat Pendek Pendek Normal Kurus Kurus Normal Gemuk
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15)
1 Pasiran Jaya 443 432 0 10 410 12 11 38 383 4 10 393 25
2 Pendowo Asri 467 396 0 12 369 15 17 41 338 2 12 372 10
5 Sungai Burung 142 105 0 3 99 3 5 15 85 1 3 98 3
Pasiran Jaya 1374 1251 0 36 1174 41 42 119 1090 9 36 1155 51
Lampiran 6
FORMULIR REKAPITULASI IBU HAMIL ANEMIA, IBU HAMIL KEK MENDAPAT MT, DAN IBU HAMIL MENDAPAT TTD
Provinsi : Lampung
Kabupaten/Kota : Tulang bawang
Tahun : 2020
JANUARI
Jumlah
Kode Desa/Kel Sasaran Ibu Jumlah Ibu
Hamil Jumlah Ibu Jumlah Ibu Jumlah Ibu Ibu hamil % ibu hamil
% Ibu Hamil Jumlah Ibu Hamil KEK % Ibu Hamil KEK Ibu hamil
(proyeksi) Hamil Periksa Hamil
Anemia
Hamil
Hamil KEK Mendapat Mendapat MT akhir TW 3
mendapat TTD mendapat TTD
Hb Anemia Periksa LiLA min 90 tablet min 90 tablet
MT
(1) (2) (3) (4) (5) (6=5/4*100) (7) (8) (9) (10=9/8*100) (11) (12) (13=12/11*100)
Lampiran 7
FORMULIR REKAPITULASI BAYI MENDAPAT IMD DAN BAYI BBLR
Provinsi : Lampung
Kabupaten/Kota : Tulang Bawang
Tahun : 2020
JANUARI
Kode Kampung Jumlah Sasaran Bayi

Baru Lahir (proyeksi) Bayi Jumlah bayi
Bayi baru Mendapat % Bayi baru lahir Jumlah bayi % bayi BBLR
lahir IMD mendapat IMD ditimbang BBLR
(1) (2) (3) (4) (5) (6=5/4*100) (7) (8) (9=8/7*100)

Lampiran 8
FORMULIR REKAPITULASI BAYI KURANG DARI 6 BULAN MENDAPAT ASI
Provinsi : Lampung
Tahun : 2020
FEBRUARI
0 bulan 1 bulan 2 bulan 3 bulan 4 bulan 5 bulan 0 - 5 bulan
Jumlah
sasaran Bayi Jumlah Jumlah Jumlah Jumlah Jumlah Jumlah Jumlah
Kode Kampung umur <6 Jumlah Jumlah Jumlah Jumlah Jumlah Jumlah Jumlah
bayi bayi masih % bayi bayi masih % bayi bayi masih % bayi bayi masih % bayi bayi masih % bayi bayi masih % bayi bayi masih %
bulan ASI ASI ASI ASI ASI ASI ASI
direcall direcall direcall direcall direcall direcall direcall
Eksklusif Eksklusif Eksklusif Eksklusif Eksklusif Eksklusif Eksklusif
(1) (2) (3) (4) (5) (6=5/4*100 (7) (8) (9=8/7*100 (10) (11) (12=11/10* (13) (14) (15=14/13* (16) (17) (18=17/16* (19) (20) (21=20/19* (22) (23) (24=23/22*
) ) 100) 100) 100) 100) 100)
Lampiran 9
FORMULIR REKAPITULASI BAYI SAMPAI USIA 6 BULAN MENDAPAT ASI EKSKLUSIF
Provinsi : Lampung
Tahun : 2020
JANUARI FEBRUARI MARET APRIL

Jumlah
Kode Kampung sasaran Jumlah bayi Jumlah bayi Jumlah bayi Jumlah Jumlah Jumlah Jumlah
Bayi % bayi ASI % bayi umur bayi ASI % bayi umur
umur 6 bulan ASI Eksklusif umur 6 bulan
Eksklusif 6 bulan Eksklusif 6 bulan
(1) (2) (3) (4) (5) (6=5/4*100) (7) (8) (9=8/7*100 (10) (11) (12=11/10* (13)
) 100)
Lampiran 13
FORMULIR REKAPITULASI SKDN
Provinsi : Lampung
Tahun : 2020
JANUARI
Jumlah
Sasaran
Kode Kampung Balita
(proyeksi) Jumlah bayi baru lahir ditimbang Jumlah bayi BBLR % BBLR
L P L+P L P L+P
Lampiran 10
FORMULIR REKAPITULASI BALITA KURUS MENDAPAT MAKANAN TAMBAHAN
Provinsi : Lampung
Tahun : 2020
JANUARI FEBRUARI MARET
Jumlah Sasaran Jumlah

Kode Kampung Balita Kurus Jumlah
Jumlah Balita Jumlah Balita kurus % Jumlah Balita % Balita
(proyeksi) Kurus dapat PMT Balita Kurus kurus Kurus
dapat PMT
(1) (2) (3) (4) (5) (6=5/4*100) (7) (8) (9=8/7*100 (10)
)
Lampiran 11
FORMULIR REKAPITULASI BALITA 6 - 59 BULAN MENDAPAT VITAMIN A
Provinsi : Lampung
Tahun : 2020
FEBRUARI
Jumlah sasaran Jumlah bayi Jumlah Jumlah

Kode Kampung balita umur 6 - Jumlah Bayi 6- 6-11 bulan Jumlah balita 12-59 Jumlah Balita balita 6-59
59 bulan 11 bulan dapat % Balita 12-59 bulan dapat % 6-59 bulan bulan dapat %
bulan
Vitamin A Vitamin A Vitamin A
(1) (2) (3) (4) (5) (6=5/4*100) (7) (8) (9=8/7*100) (10) (11) (12=11/10*10
0)
MARET
Jumlah Jumlah Jumlah Jumlah Jumlah

Jumlah Jumlah Jumlah Balita tidak balita balita naik balita tidak balita tidak
Jumlah Balita % D/S Balita % K/S Balita Baru ditimbang ditimbang berat % N/D' naik berat % T1/D' naik berat % 2T/D'
Balita
Ditimbang punya KMS (B) bulan lalu terkoreksi badannya badannya badannya 2
(O) (D') (N) (T1) kali (2T)
(28) (29) (30=29/28* (31) (32=31/28* (33) (34) (35) (36) (37=36/35* (38) (39=38/35*
100) 100) 100) 100)
443 305 69 304 69 15 14 276 268 97 5 2 3 1
467 387 83 387 83 17 15 355 349 98 3 1 2 1
182 105 58 105 58 7 12 86 84 98 2 2 1 1
140 85 61 82 59 8 9 68 66 97 2 3 1 1
142 90 63 90 63 4 9 77 75 97 2 3 1 1
1374 972 71 968 70 51 59 862 842 98 14 2 8 1
Lampiran 13
FORMULIR REKAPITULASI SKDN
Provinsi : Lampung
Tahun : 2020
JANUARI
Jumlah
Sasaran
Kode Kampung Balita
(proyeksi) Jumlah Balita Jumlah Balita Ditimbang % D/S
L P L+P L P L+P
Lampiran 14
FORMULIR REKAPITULASI IBU NIFAS MENDAPAT VITAMIN A
Provinsi : Lampung
Tahun : 2020
JANUARI FEBRUARI MARET APRIL

Jumlah
sasaran Ibu Jumlah ibu
Kode Kampung Nifas Jumlah Ibu % Jumlah Ibu Jumlah ibu % Jumlah Ibu Jumlah ibu % Jumlah Ibu
Nifas nifas dapat Nifas nifas dapat Nifas nifas dapat Nifas
(proyeksi) Vitamin A Vitamin A Vitamin A
(1) (2) (3) (4) (5) (6=5/4*100) (7) (8) (9=8/7*100 (10) (11) (12=11/10* (13)
) 100)
Lampiran 15
FORMULIR REKAPITULASI RUMAH TANGGA MENGONSUMSI GARAM BERIODIUM
Provinsi : Lampung
Bulan/Tahun : 2020
FEBRUARI AGUSTUS TAHUNAN
RT RT RT
Kode Kampung Sasaran Jumlah RT mengonsum Jumlah RT mengonsu Jumlah RT mengonsu
% % %
diperiksa si Garam diperiksa msi Garam diperiksa msi Garam
Beriodium Beriodium Beriodium
(1) (2) (3) (4) (5) (6=5/4*100) (7) (8) (9=8/7*100 (10) (11) (12=11/10*
) 100)
Lampiran 12
FORMULIR PENCATATAN BALITA GIZI BURUK MENDAPAT PERAWATAN
Provinsi : Lampung
Tahun : 2020
Jumlah Jumlah
Jumlah Jumlah Kasus Total Kasus Jumlah Kasus Gizi Total Kasus Jumlah Kasus Gizi Total Kasus
Kasus Total kasus Gizi Buruk, Gizi Buruk, Jumlah Kasus Total kasus Buruk, Gizi Buruk, Jumlah Jumlah Kasus Total kasus Buruk, Gizi Buruk, Jumlah
Kode Kampung Balita Gizi (kumulatif mendapat mendapat persentase Jumlah kasus kasus Balita Gizi (kumulatif mendapat mendapat persentase kasus kasus Balita Gizi (kumulatif mendapat mendapat persentase kasus
buruk sampai perawatan perawatan mendapat membaik di meninggal buruk sampai perawatan perawatan mendapat membaik meninggal buruk sampai perawatan perawatan mendapat membaik
ditemukan bulan ini) pertama kali (kumulatif perawatan bulan ini dibulan ini ditemukan bulan ini) pertama (kumulatif perawatan di bulan ini dibulan ini ditemukan bulan ini) pertama (kumulatif perawatan di bulan ini
sampai bulan sampai sampai
bulan ini di bulan ini ini) bulan ini kali di bulan ini) bulan ini kali di bulan ini)
bulan ini bulan ini
(1) (2) (3) (4=3) (5) (6=5) (7=6/4*100) (8) (9) (10) (11=4+10) (12) (13=6+12) 14=13/11*1 (15) (16) (17) (18=11+17) (19) (20=13+19) (21=20/18* (22)
00) 100)
Lampiran 16
FORMULIR PEMANTAUAN PROGRAM PEMBERIAN TTD REMAJA PUTRI DI SEKOLAH
yati
Nama Puskesmas Pembina : PASIRAN JAYA

Nama Kabupaten TULANG BAWANG : TULANG BAWANG

1 2 3 4 5 1 2 3 4 5 1 2 3 4
SEKOLAH KELAS NO Nama Remaja Putri NIK
T M T M T M T M T M T M T M T M T M T M T M T M T M T
1 AMELIA SALSABILA 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
SMP N 01 DT
2 DELA SELVIA NINGSIH 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
3 DINA MELYANA SAPUTRI 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
4 FITRI WULANSARI 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
5 ISTIQOMAH 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
6 LARADIAH KURNIAWAN 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
7 MARSA EKA PERTIWI 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
8 MEI LISA PUJI RAHAYU 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
9 MEISY ANDINI 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
10 NURUL PADILA UTAMI 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
11 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
PUTRI NURUL HASANAH
12 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
RIFDA AULIA KHOIRUNNISA
13 SUCI SEPTRIAWATI 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
14 VIA CAHYA CANTIKA 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
15 CALISTA SALSA 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
16 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
ALIFA ANGELINA SALSABILA 1802246811040002
17 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
ANISA 1805274404050004
18 CLARA MEILANI PUTRI 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
19 DELPI SARI 1805254106050002 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
20 DINA LOVIANA 1805257105050001 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
21 INTAN RHAMANDA PUTRI 1805275210040001 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
22 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
LIDIA NUR ISNAINI
23 MELANI PRITAMA PUTRI 1805272705050005 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
24 NIKEN DYIAH AYU KUSUMA P 180525660904001 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
25 RESTU AMINAH WATI 1805254203050002 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
26 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
SAHARA KORY ALFANI 1805275209050002
27 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
SALSABILA AINUN MAHYA 1805275010060006
28 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
SEVIA KURNIA PUTRI 1805275809050001
29 SITI MASITOH 1805276012040003 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
30 TASYA FANY AYUNDA 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
31 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
ANNORA ELFREDA FAUZIYAH 1805255212040001
32 AYU VIRA MARGITHA 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
33 DIMA LUFI ANINGRUM 1807055507050001 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
34 ENI SETIANINGSIH 18052744505050001 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
35 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
INDIRA FATMASARI 1805274409050002
36 MELY OKTAVIA 1805276610040002 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
37 NI NYOMAN AYU SUCI RAHAYU '1805276012040001 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
38 NI NYOMAN SEPTI DIANTINA 1805271309050001 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
39 NI PUTU ANDHARA KEISYA BELLA 1802086009050001 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
40 SERLI NURHAYATI 1805275001050001 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
41 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
SITI MUNAWAROH 1808527480504007
42 SUSI SUSIOWATI 180527530804004 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
43 WAYAN RINA RAHAYU 180525540704002 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
44 WAYAN SINTA PUTNAAMA SARI 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
45 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
ADINDA PUJA KAIRA SARI 1810025605060004
46 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
ADILLA RAHMAWATI LESTARI 1805276707050001
47 ADINDA AMELIA SINTA 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
48 ALYA NADA ISTIQOMAH 1805276403050001 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
49 AMARA 1807112411160001 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
50 ANI ANJELA 1805254809050001 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
51 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
ARINDA SHERLINA PRATIWI 1805276506060002
52 AZRA SHOFIANA 1805184306050002 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
53 AZRI ATUL ULUL HIDAYAH 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
54 DEVA SILFIANI 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
55 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
FITRIANA HARJOKI PUTRI 1805276908050004
56 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
PUTRI EVA MUBRUROH 1805254702050001
57 RIA ANITA 1805274912010000 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
58 RISKA DWI ANDRIANI 180527710305001 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
59 ZHAKIA ARNASTASHA 1805175011050001 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
60 FAJAR RAHMANIA 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
61 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
AFIA NUR FIDYASTUTI
62 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
AMMALIA TRIA MANDA SARI
63 CHEILA ANANTA DEWI 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
64 CHINTIA NUR RIZKI 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
65 CINDY AMELIA 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
66 DARA ANGELINE SIHOMBING 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
67 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
DENOX WINDU ANDHINI
68 DIAN KARTIKA PUTRI 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
69 ELIZABETH FIODORA ELFRIDA 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
70 ELMI MELLINA 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
71 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
INDAH ADELA WATI
72 REFI JUNIA LESTARI 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
73 RIRIN PUTRI WAHYUNI 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
74 SEFIA DWI ANGRAINI 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
75 USWATUN HASANAH 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
76 ANGGUN AISTRY RAGA JOTI 180527690904001 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
77 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
ANGGUN FITRIA RAHMAWATI 1805275811040001
78 ANISATUS SOLIKHAH 1805256901050001 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
79 AZZAHRA ADELYA PUTRI 1805275512050003 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
80 DEVI SEFIA 1805276509040001 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
81 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
EKKY FILDA SAMITA 18052742020250001
82 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
EVA NURTIANA SARI 1805277105050002
83 IKA SETIAWATI 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
84 RISKA RAHMA DANI 1805255010050000 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
85 SALAMAH 1805254708050001 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
86 SANDA ERIKA SANTI 18052754050500001 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
87 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
FEBRIYANI JUNAIDI 1805274102050003
88 FITRIA WAHYU PUTRI MAYLANI 1805184506050004 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
89 DEWI WULAN SARI 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
90 DYAH DADMAYANTI 1805276406060001 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
91 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
INTAN ANGELA 180527500405002
92 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
JESSY RAHMA SARI 1812076405050004
93 KADEK ALYA ARYANI 1805255808080005 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
94 KOMANG ARDANI 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
95 NAFISHA ISMAWATI 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
96 NI KOMANG NOVA IRENA PUTRI 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
97 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
NI SAYU MADE DIAH A
98 PUTU RESI IRASAWATI 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
99 SANDITA AYUNUNG KUMALA DEWI 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
100 SAYU MADE GITA VALUVI 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
101 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
SEPTI ARYA NANDA PARAS AYU
102 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
SHINTA FEBRIANI HERLINA
103 SRI LESTARI 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
104 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
SUCI ADELLA
105 TIKA PUTRI WIDIA SARI 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
106 WAYAN DERA PASTIKA RANI 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
107 WAYAN IMELIA 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
X 1 ELLY KARTIKAN 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
SMK ALMUTTAQIN
X 2 LISMIRA ANGGAR YANI 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
X 3 NADIA SEPTIANA 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
X 4 YULIANA SAPUTRI 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
X 5 NADIA HANDAYANI 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
X 6 DEA PUTRI FADILLAH

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
X 7 ELLA AGUSTINA 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
X 8 ROSALINDA 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
X 9 SABRINA ANANTA 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
X 10 FINA MAWARNI
1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
X 11 ERNA NOVIANI
1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XI 12 BELLA DWI AMANDA 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XI 13 DEVI KURNIA WATI 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XI 14 ANGGI LESTARI 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XI 15 HALIMAH TUSYA'DIYAH 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XI 16 INTAN NOVANDA
1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XI 17 SINTIA NUR AINI 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XI 18 SUKMA ISTIKHOMAH 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XI 19 WAHYU NURAINI 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XII 20 DESY DWI FRITIANA

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XII 21 UMI ISTIQOMAH

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XII 22 TESSA AJENG 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XII 23 NISA PRAMESTY DEWI 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XII 24 FRANSISKA MARIANA 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XII 25 IKA FAJAR AGUSTIN 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XII 26 PUPUT LEFTIANA

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XII 27 TASYA EKA WAHYUNI 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XII 28 CINDY JUNISTIA WATI 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XII 29 DIYANTI 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XII 30 EKA FAUZIA WULANDARI

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XII 31 EMA LUSIANA

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XII 32 LENI SEPTIA NINGRUM 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
1 FADILAH 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
SMP IT INSAN CENDEKIA
2 SEHLIA 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
3 DELA SUSANTI 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
4 ANGGUN
1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
5 MALZA 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
6 NURFADILAH 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
SMP SATAP BRATASENA 1 ANISYARIVA APRILIA 1805274804050002 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

MANDIRI 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
ARDITA DWI PRATIWI 1805274802060001
3 CITRA SENA 18052114710050001 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
4 DELLA ANA MUTIARA R 1805274811040002

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
5 DEWA AYU PUTU RANTHI ANATASYA 1805275709050002 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
6 GITA ATIFA ASNABILLA 1805185903050003 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
7 MUTIA ISRA DINI 1805277008050003 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
8 NAURA ERFIA BERLIANA 1805276606050003

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
9 NAZARA RAHMA OKTAVIA 18120465410050001

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
10 NI PUTU ANGGI OCTAVIANI SARI 1805275610040001

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
11 OLIVIA DWI SHINTA 180527680705001 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
12 RENI ADELIA SAPUTRI 1805276504060001 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
13 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
SUCI AULIA HANUM 1805275910050001
14 RAHAZARIT SOFIA 1805277012040003 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
15 ADE DEFRILYA CAHYASA 1811064604060001 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
16 MEI LINDA DEWI ANGGREINI 1807024205070001

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
17 NURHANIF 1805277012060006 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
18 LISA NURDIANA 1105276210870005 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
VIII 1 ALFIAH SAFITRI 1805274109050004 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0

SMP ISLAM AL MUTTAQIN
VIII 2 DINA ALIFATUL MAULA 1805274805070001 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VIII 3 ANDIKA MARTINA TINANTI 1805272703060004 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VIII 4 DEVI RAHMAWATI 1805256910060004 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VIII 5 FANISA AMELIA 1807094808060002 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VIII 6 INDAH LESTARI 1805276303060003 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VIII 7 LINA PUSPITA SARI 1805274612060003 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VIII 8 LISNAWATI 1805266603050002 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0

VIII 9 MUTOHAROH 1805277004060004 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VIII 10 NOVA NAWALIYA 1805256406060001 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VIII 11 NURUT TAUFIQIR ROHMAH 1805275304050003 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VIII 12 PUTRI RATNA SARI 1807118406050007 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VIII 13 REVI MAHARANI 1805275409050003 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VIII 14 RIRIN KARINAH 1805274801070002 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VIII 15 SRI SUMARNI 1805264711940004 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VIII 16 TRI WAHYUNI 1805254909040001 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VIII 17 WULAN 1805275004040006 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VIII 18 YESI YULIANTI 1808017008060001 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VIII 19 ZULVA NUR AZYZA 1805275205060003 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VIII 20 CHINTIA DEWI SETYAWATI 1805255307060001 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VIII 21 DESTINA ANAS TASYA 1805276512050003 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VIII 22 IHFA YATUL FADILAH 1805277007050001 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VIII 23 ISTIQOMAH 1805275206060005 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VIII 24 LINA SETIOWATI 1805255712040001 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VIII 25 MURTISARI DEWI 1807206510050002 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VIII 26 NABILA SAFITRI 1805252908130013 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VIII 27 NOVEN INTAN MELANI 1805275811060006 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VIII 28 PUJA ANDES FRANSISKA 1805275110060005 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VIII 29 RATNA YUNITA 1805226706080005 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VIII 30 RINA PRIHATIN 1805253807050001 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VIII 31 SINTA NURYATI 1805275105060002 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VIII 32 TITI HARTATI 1805274410050003 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VIII 33 WIDIA AMI ANGGRAENI 1805274606060001 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VIII 34 YANI PRATIWI 1805275106050002 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VIII 35 YULI FITRIYANI 1805275511060005 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
IX 36 Aprilia Saputri 1805254604040004 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
IX 37 Denti Triantika A 1805274202050005 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
IX 38 Erni Ningsih 1805275210060002 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
IX 39 Fitriyah 1805275210050005 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
IX 40 Lia Safitri 1805275810040002 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
IX 41 Lina Wulan Sari 1805274307050002 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
IX 42 Noviarani Hardian P 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
IX 43 Nurhalimah 1805275309030004 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
IX 44 Siti Nurhaliza 1805254106050004 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
IX 45 Suci Nuraini 1805255111030001 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0

IX 46 Wahidatul Kholifah 1805255210050001 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
IX 47 May Saroh 1805254609920003 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
IX 48 Mira Yanti 1805275311020002 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
IX 49 Wiwik Tri Rahyu 1802226909070003 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
IX 50 Eka Wahyu Ningsih 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
IX 51 Indah Permata Sari 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
IX 52 Lutfi Azizatur R 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
IX 53 Milda Septiana 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
IX 54 Orinsa Myla Nur A 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
IX 55 Tia Anjani 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
IX 56 Tria Sena Ningsih 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
IX 57 Wiwik Widya Ningsih 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
IX 58 Yanti Susilowati 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
IX 59 Defita Dwi Anggraini 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VII 60 ami yanti 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VII 61 annisa alya 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VII 62 rizki salsabila 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VII 63 desti febriana sari 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VII 64 dewi hoirunisa 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VII 65 intan nur hasanah 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VII 66 kartika dwi lestari 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VII 67 ela fernani 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VII 68 nengsih 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VII 69 putu ayu ariyanti 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VII 70 sarah qintan maharani 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VII 71 sari surya dewi 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VII 72 sintia fitriyani 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VII 73 siti nurjanah 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VII 74 sri wahyuni asih 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VII 75 tendri oji 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VII 76 ana kurnia wati 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VII 77 aryanti mila sari 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VII 78 aulia haniffatun hasanah 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VII 79 ika agustiana sabila 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VII 80 lani nurrohmah 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VII 81 melinda anggun setiawati 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VII 82 nia amelia 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0

VII 83 novalia 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VII 84 rizki triponingsih 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VII 85 siti nurhasanah 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VII 86 sri asih 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VII 87 syifat ul kamila 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VII 88 tri susanti 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VII 89 winda sapitri 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VII 90 marsya novalia 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
XI 1 Adelia arfadillah 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
SMA N 02 DT
XI 2 anisa fitriana 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XI 3 clara bintang pratiwi 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XI 4 devi risna wati 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XI 5 dwi indah kurniawati 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XI 6 evi lina azizah dian wardani 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XI 7 fadilah maissynta 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XI 8 farel calista khairunissa 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XI 9 kadek tirta wahyuni 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XI 10 lisa mai rifatu fadyallah 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XI 11 lisa nur maulira 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XI 12 mela rohman yulia 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XI 13 ni nengah dwi rahayu 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XI 14 putu tarisa 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XI 15 rauci prastika 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XI 16 ria apriliani 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XI 17 siti khotimah 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XI 18 wayan beni indrayani 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XI 19 winda 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XI 20 wulan dari 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XI 21 yuni khalistasari 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XI 22 ayulia risma wati 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XI 23 lusi erlinda 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XI 24 lusiana septiana 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XI 25 qolbiatul khasanah 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XI 26 rika mariska 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XI 27 ruth wulandari 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XI 28 savira putri 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XI 29 sintha anjani 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XI 30 erna krisdianti 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XI 31 desi anggi pinata 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XI 32 lina elviana 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XI 33 mega putri aulia 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XI 34 ni made rismawati 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XI 35 selvia deva yanti 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XI 36 siti suhaidah 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XI 37 wahyuni 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XI 38 anggita kusumajati 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XII 39 almaidah nur fianti 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XII 40 diah wulan dari 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XII 41 dwi indah permatasari 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XII 42 galuh indah pratiwi 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XII 43 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
indri mailani sonia
XII 44 khomsatun khasanah 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XII 45 lilik lindiani 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XII 46 mila afiah 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XII 47 novi nur hayati 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XII 48 nur anida 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XII 49 nur mala cahyati 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XII 50 trisna budi asih 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XII 51 nimas utari 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XII 52 adelia maysafitri 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XII 53 anafita asmara 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XII 54 annisa lutfi fadillah 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XII 55 arina septiani 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XII 56 arini habibah 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XII 57 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
chilvi oktavia
XII 58 jho vanka mardofa 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XII 59 komang ayu sri ningsih 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XII 60 komang ratri andriani 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XII 61 lya sari 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XII 62 niia widia astuti 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XII 63 okky dwi selfiana 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

XII 64 oktavia dwi anggraini 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XII 65 sarah wijayanti 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XII 66 septiana putri 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XII 67 riska agustin 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XII 68 zulia safitri 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XII 69 cikal bunga win girl 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XII 70 devitriani 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XII 71 trisna budi arti 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XII 72 gita mustika 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XII 73 tutur setiawati 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XII 74 yuyun kurnia 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XII 75 wahyu bil khusna 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XII 76 sri wahyuni 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XII 77 ketut narti 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XII 78 kadek lastri 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XII 79 fatiah khawari 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
XII 80 melisa jenita 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
x 81 gita cahyani 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
x 82 alfira kusuma dewi 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
x 83 amara dewi savitri 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
x 84 eka rahmawati 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
x 85 fitria 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
x 86 irma yulia sari 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
x 87 linda febriani 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
x 88 nabela agustin 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
x 89 regita zahrani mediasari 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
x 90 rena lestari 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
x 91 rima melati 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
x 92 sabrina filosophia haryanto 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
x 93 sela tri indah sari 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
x 94 yeni savira 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
x 95 zahra fadilah 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
x 96 zarafika saputri 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
x 97 ananda widia lorenza 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
x 98 aryani 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
x 99 auliana putri 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
x 100 ayu firniawati 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

x 101 cindi pratiwi 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
x 102 cindi nur fatiha 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
x 103 dala rahma 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
x 104 icha choirin nisa 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
x 105 ilmadin nur alfita 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
x 106 ita lusiana 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
x 107 kadek sarleni 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
x 108 resa safitri 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
x 109 salma zaa'idah 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
x 110 sella maria 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
x 111 ulfa dwi yanti 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
x 112 yuningsih 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
x 113 amelia fitriani 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
x 114 anggun sari setia dawi putri 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
x 115 asih suparti 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
x 116 ayu melawati 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
x 117 azahra shinta nuriah 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
x 118 eka lisa mariana 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
x 119 ira suara 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
x 120 komang tri wahyu lestari 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
x 121 nabila sabiel 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
x 122 oka ristu putra 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
x 123 sri yanti 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
x 124 uswatun hasanah 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
x 125 venti vera setianingrum 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
1 Selli Anggraeni
1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
MTS MUNADA
2 Maulita Cahyati 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
3 Sabila Yuliana 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
4 Purwati 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
5 Rosa Linda Junita 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
6 Icha Choirunisa
1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
7 Kurnia Ningsih 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
8 Dian Nurhayati 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
9 Dewi Masitoh 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
10 Weni Artika
1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
11 Nurjanah
1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
12 Indah Wulandari 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
13 Ayun Husaini
1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
14 Ani Melisa Wati 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
15 Anisa Nurul Sakinah 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
16 Dewi purwita sari 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
17 Devi Andre Yani 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
18 Erna Wati 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
19 Iis Winarti 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
20 Nia Siti Kholisa 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VII 1 Diyah Ayu Wulansari 1805274509040002 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0

MTS MA' ARIF
VII 2 Azizah Amelia Febriyanti 1802067007040001
1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VII 3 Chesya Putri 1805254902040001 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VII 4 Iis Yeti Purnamah 1805274807050001 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VII 5 Ina Amelia M 1805254607040002 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VII 6 Puspita Ristisna 1805274909030005

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VII 7 Selfi Noverista 1805275303020003

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VII 8 Yuyun Leoni N 1805254404060003 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VII 9 Yuyun Rismala Dewi 1805256604060001 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VII 10 Ubaidila 1805274302010003 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VII 11 Nur Habibah 1805276204050002 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
VII 12 Maya Sari 1805255806020003

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0
MARET Jumlah
4 5 minggu yang
Jumlah TTD di Jumlah TTD
dilalui dari
Terima (T) diminum (M)
Januari -
M T M Maret
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 100
15 15
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 100
15 15
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 100
15 15
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 100
15 15
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
1 1 1 15 15 100
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
0 0 0 15 10 67
Lampiran 18
FORMULIR 2 PEMANTAUAN PROGRAM TTD REMAJA PUTRI DI PUSKEMAS
Puskesmas Pembina : PASIRAN JAYA

Kabupaten : TULANG BAWANG
TW 1 TW 1 - TW 2 TW 1 - TW 3
Jumlah Jumlah mendapat TTD Jumlah Minum TTD Jumlah mendapat TTD Jumlah Minum TTD Jumlah mendapat TTD
No. Nama Sekolah
Siswi
≤ 50 % 51- 80 % 81 - 99% ≥ 100% ≤ 50 % 51 - 80 % 81 - 99% ≥ 100% ≤ 50 % 51 - 80 % 81 - 99% ≥ 100% ≤ 50 % 51 - 80 % 81 - 99% ≥ 100% ≤ 50 % 51 - 80 % 81 - 99% ≥ 100%
1 SMP N 01 DT 280
2 SMK ALMUTTAQIN 46
3 SMP IT INSAN CENDEKIA 23
4 SMP SATAP BRATASENA MANDIRI 19
5 SMP ISLAM ALMUTTAQIN 96
6 MTS MUNADA 25
7 SMA N 02 DT 130
8 MTS MA' ARIF 22
9 MA MA' ARIF 20
10 SMP SATAP SUNGAI PALEMBANG 6
11 SMP N 03 SATAP SUNGAI BURUNG 20
11
Keterangan:
Kolom kategori persentase (≤50%, 51-80%, 81-99%, ≥100%) diisi dengan jumlah rematri umur 12-18 tahun
yang masuk kategori tersebut berdasarkan form 1 Puskesmas
Catatan stok:
1. Jumlah TTD Sisa bulan lalu : tablet Tgl.
2. Jumlah TTD yang diterima : tablet Tgl.
3. Jumlah total stok : tablet Tgl.
4. Jumlah TTD yang dipakai : tablet Tgl.
5. Jumlah TTD Sisa : tablet Tgl.
TW 1 - TW 3 TW 1 - TW 4
Jumlah Minum TTD Jumlah mendapat TTD Jumlah Minum TTD
≤ 50 % 51 - 80 % 81 - 99% ≥ 100% ≤ 50 % 51 - 80 % 81 - 99% ≥ 100% ≤ 50 % 51 - 80 % 81 - 99% ≥ 100%

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Lampiran 2

FORMULIR PEMANTAUAN IBU HAMIL

TTD (Tablet Jika YA, Jika YA,

Provinsi : Lampung Nama Posyandu : MELATI I

PB LAHIR Kepemilik Panjan Cara ASI EksklusifF1=YA, 2=Tidak Vitamin Vitamin

Provinsi : Lampung Nama Posyandu : MELATI II

PB LAHIR ASI EksklusifF1=YA, 2=Tidak

Kampung : BRATASENA MANDIRI

Kampung : BRATASENA MANDIRI

Kampung : BRATASENA MANDIRI

Kampung : PASIRAN JAYA

ASI EksklusifF1=YA, 2=Tidak

Kampung : PASIRAN JAYA

ASI EksklusifF1=YA, 2=Tidak

1 5/10/2019 P 1805251106190007 NATUSA RIZKI 1805271205930002 82176331609 PASIRAN JAYA

Kampung : PASIRAN JAYA

Panjan Cara ASI EksklusifF1=YA, 2=Tidak

Kampung : PASIRAN JAYA

ASI EksklusifF1=YA, 2=Tidak

12 1 8/2/2019 P AZIZAH 4000 M ZUHRI 82176331609 PASIRAN JAYA 1/18/2020

70 1 10/14/2017 P 1805252610160010 SAPIRA 2800 SUBIRMAN 82176331609 PASIRAN JAYA 1/18/2020

Kampung : PASIRAN JAYA

Nama Posyandu : CISADANE

Panjan Cara ASI EksklusifF1=YA, 2=Tidak

2 P KHALISA BILQIS NANDANG 82176331609 PASIRAN JAYA 1/24/2020

12 2 10/22/2018 L M. IBNU JAMIL 3200 IHWANUDIN 82176331609 PASIRAN JAYA 1/24/2020

22 3 5/30/2018 L IQBAL RAMADHAN 3500 A SAFEI 82176331609 PASIRAN JAYA 1/24/2020

35 3 8/6/2018 P ALMARA ZEINALKEISA 3900 MUHSIN 82176331609 PASIRAN JAYA 1/24/2020

Kode Kampung Jumlah Sasaran Bayi

(1) (2) (3) (4) (5) (6=5/4*100) (7) (8) (9=8/7*100)

JANUARI FEBRUARI MARET APRIL

JANUARI FEBRUARI MARET

Jumlah Sasaran Jumlah

Jumlah sasaran Jumlah bayi Jumlah Jumlah

Jumlah Jumlah Jumlah Jumlah Jumlah

JANUARI FEBRUARI MARET APRIL

FEBRUARI AGUSTUS TAHUNAN

Nama Puskesmas Pembina : PASIRAN JAYA

JANUARI FEBRUARI MARET

3 DINA MELYANA SAPUTRI 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

7 MARSA EKA PERTIWI 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

8 MEI LISA PUJI RAHAYU 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

10 NURUL PADILA UTAMI 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

14 VIA CAHYA CANTIKA 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

19 DELPI SARI 1805254106050002 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

20 DINA LOVIANA 1805257105050001 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

21 INTAN RHAMANDA PUTRI 1805275210040001 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

24 NIKEN DYIAH AYU KUSUMA P 180525660904001 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

25 RESTU AMINAH WATI 1805254203050002 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

33 DIMA LUFI ANINGRUM 1807055507050001 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

34 ENI SETIANINGSIH 18052744505050001 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

37 NI NYOMAN AYU SUCI RAHAYU '1805276012040001 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

38 NI NYOMAN SEPTI DIANTINA 1805271309050001 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

39 NI PUTU ANDHARA KEISYA BELLA 1802086009050001 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

40 SERLI NURHAYATI 1805275001050001 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

43 WAYAN RINA RAHAYU 180525540704002 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

44 WAYAN SINTA PUTNAAMA SARI 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

48 ALYA NADA ISTIQOMAH 1805276403050001 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

50 ANI ANJELA 1805254809050001 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

53 AZRI ATUL ULUL HIDAYAH 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

58 RISKA DWI ANDRIANI 180527710305001 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

59 ZHAKIA ARNASTASHA 1805175011050001 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

64 CHINTIA NUR RIZKI 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

(1) (2) (3) (4) (5) (6=5/4100) (7) (8) (9=8/7100)