U

Umur Jenis No. Rekam

No Nama* Medis (jika No. Telepon
(th/bln)* Kelamin* ada)

1 RUSDIYANTI 28 P

2 SITI RUKAYAH 36 P
085225323782

3 SRI UTAMI 33 P 08562678801

4 DIAH SUDARYATI 20 P

5 MUNTI ASIH 26 P

6 RIMAWASIH 32 P

7 RAHAYU 34 P

8 ISTIQOMAH 31 P 085866884644

9 EKO NURYANI 26 P
085326839510

10 ROHMIATI 40 P
088221557202

11 EKA RAHAYU 31 P 08222367024

12 PRIHATININGSIH 28 P
08577332549

13 DEWI INDRAYANI 31 P

14 SITI ASPIYATUN 33 P
15 QOIC NUR 28 P 087828298514

16 RIBUT 30 P

17 RISMA KHOIRUNNISA 21 P
082134141737

18 ETIK AL QORIAH 33 P 085201413615

19 SOFIDAH 27 P 082325181387

20 DEWI RATNA 25 P
085802599916

21 36 P
SUJINAH

22 DWI SEPTIANI 20 P
081390575920

23 WIWIK LISTIANI 27 P
085831386694

24 JUMIYEM 43 P
082314712686

25 ROHAYATI 32 P 081332835142

26 EKO ERNAWATI 38 P

27 QUROTUN AINI 23 P

28 NURUL FADILAH 30 P

29 INDAH PURWANINGSIH 21 P 08561526319

30 ISTIYOWATI 30 P 085326277429

31 ULFAH NUR 23 P 085880116879

32 WINARTI 35 P 081332669973

33 MUTMAINAH 27 P 085713798063
34 SRI MULYANI 42 P

35 IKA FATIMAH 30 P
085727542394

36 MUNAZIROH 35 P 082136579999

37 KASENI 34 P

38 SUSILOWATI 30 P 085727229691

39 RAHMAWATI 22 P

40 HANUNG S 30 P 085641723237

41 MUNIROTUL FUADAH 26 P 0859160106571

42 PUJI ASTUTI 32 P 085640593693

43 SITI HASANAH 30 P 085647794669

44 SUTINI 23 P 085326376668

45 FATIN ZULAIKAH 26 P

46 RIFAH AULIA 21 P

47 NURIL FATIHAH 27 P 085950832240

48 JUWARIYAH 27 P

49 SITI AISYAH 20 P

50 SABAR HARIANTI 23 P 081482905966

51 MISIATI 38 P
 FORM PERMINTAAN VTM IBU HAMIL
UPTD PUSKESMAS BANCAK KEC. BANCAK
KAB. SEMARANG

Kasus (Kontak Erat/Rapid

NIK* Tanggal Lahir* Alamat* Reaktif,dll)

3322164605920002 6/5/1992 PENGGUNG 02/05, BOTO HAMIL TM 3

3322164611840001 30/11/1984 MUNGKRUK 1/3 REJOSARI

HAMIL TM 3

3322164302870001 3/2/1987 Boto 1/7 Boto HAMIL TM 3

3322165805000002 18/5/2000 BANYURIPAN 1/5 REJOSARI

HAMIL TM 3

3322164207940002 7/2/1994 Banjarsari, RT.04/RW.09, Bancak HAMIL TM 3

3305084507880001 5/7/1988 Bamban 1/4 Lembu

HAMIL TM 3

3322165704860002 17/04/1986 krajan 4/2, Plumutan

HAMIL TM 3

3322166802890001 28/02/1989 Krajan II 2/2 , Pucung HAMIL TM 3

3322166110940002 21/10/1994 KREMPEL 1/5LEMBU

HAMIL TM 3

3322165503800002 3/15/1980 Ngebleng rt 01/06,lembu

HAMIL TM 3

3322045112880003 11/12/1988 Krajan III 1/3 ,Pucung HAMIL TM 3

3321144707920004 7/7/1992 Krajan rt 02/02, Lembu

HAMIL TM 3

3322124711890001 7/11/1989 GUNUNG 01/02, BOTO HAMIL TM 3

3322166704870001 27/04/1987 Jumbelng 4/5,Wonokerto HAMIL TM 3

 3322064602920002 6/2/1992 Karangjati 2/7 , Pucung
HAMIL TM 3

3322164906900002 9/6/1990 randusari 9/2, Plumutan

HAMIL TM 3

3322164609990001 6/9/1999 KALISAT 1/7 REJOSARI

HAMIL TM 3

3322164502870002 5/2/1987 Gayam 2/8 Bantal

HAMIL TM 3

3322164505930002 5/5/1993 Krajan III 1/3, Pucung

HAMIL TM 3

3322036606950002 26/06/1995 Jetis, Wonokerto HAMIL TM 3

kalisari 2/1, Plumutan

3322164208840001 2/8/1984 HAMIL TM 3

3322164609000001 6/9/2000 MUNGKRUK 1/3 REJOSARI

HAMIL TM 3

3322166806930001 28/06/1993 Santren 2/2, Wonokerto HAMIL TM 3

3309175606770002 6/16/1977 Boto 1/7 Boto HAMIL TM 3

3322165505880005 7/5/1988 Krempel , Lembu HAMIL TM 3

3322015006820005 10/6/1982 PENGGUNG 02/05, BOTO HAMIL TM 3

3322166610000001 28/4/97 BANJARSARI 01/08, BANCAK

HAMIL TM 3

3322166501900001 25/1/1990 BANJARSARI 02/08, BANCAK

HAMIL TM 3

3322165002990001 10/2/199 Beran 1/8 Rejosari HAMIL TM 3

3322165604900001 16/04/1990 Karangwuni 1/1 Plumutan HAMIL TM 3

3674055401880004 14/1/1988 Dawung 2/4 Plumutan HAMIL TM 3

3322164307850003 73/1985 Ngebleng 1/6 Lembu HAMIL TM 3

3322165201930002 12/1/1993 Kendel 3/3 Lembu HAMIL TM 3

 3322166706780001 27/6/1978 Kalisat 2/7 , Rejosari
HAMIL TM 3

3322164710900001 7/10/1990 Wonokerto 1/1 HAMIL TM 3

3322165810850002 18/10/1985 Kalisari 2/1 , Plumutan

HAMIL TM 3

3309186012860001 10/12/1986 Legok1/2 Bantal HAMIL TM 3

3322164610900003 6/10/1990 Krajan 1/1/ Bancak HAMIL TM 3

3322165111980001 11/11/1998 Ngentak HAMIL TM 3

3322166403900001 24/03/1990 Kalisari 2/1 , Plumutan HAMIL TM 3

3322164203940003 2/3/1994 Ngentak I 3/11 Bancak HAMIL TM 3

3322164404880001 4/4/1988 Gunung Jayan 12/3 Bancak

HAMIL TM 3

3315175803900003 22/10/1980 Jatisari 7/2 Plumutan HAMIL TM 3

3314148109700003 8/10/1997 Karet 1/4 Plumutan HAMIL TM 3

3315015005930003 10/5/1983 Krasak 1/1 Boto HAMIL TM 3

3322164101990001 11/2/1999 Krasak 3/1 Boto

HAMIL TM 3

3322165309930002 3/9/1993 Gunung 4/1 , Bantal HAMIL TM 3

3322164501930001 5/1/1993 Banjarsari 4/9 Bancak HAMIL TM 3

3322165512990001 5/12/1999 Jlumpang 2/1 Jlumpang HAMIL TM 3

3322167008970002 30/08/1987 Krajan 2/2Lembu HAMIL TM 3

3322165504820001 11/10/1982 Wonokerto 3/1 HAMIL TM 3

Instansi Pengirim
Swab I Swab II
(Puskesmas / JUMLAH VTM HPL UMUR KEHAMILAN
RS)* Tgl Tgl

PUSKESMAS
14/11/2020 39 MGG
BANCAK

PUSKESMAS
15/11/2020 39 MGG
BANCAK

PUSKESMAS
18/11/2020 38MGG
BANCAK

PUSKESMAS
17/11/2020 38 MGG
BANCAK

PUSKESMAS
BANCAK 22/11/2020 38 MGG

PUSKESMAS
BANCAK 16/11/2020 38 MGG

PUSKESMAS
21/11/2020 37 MGG
BANCAK

PUSKESMAS
27/11/2020 37 MGG
BANCAK

PUSKESMAS
27/11/2020 37 MGG
BANCAK

PUSKESMAS
BANCAK 30/11/2020 37 MGG
PUSKESMAS
21/11/2020 37 MGG
BANCAK

PUSKESMAS
BANCAK 04/12/2020 36 MGG
PUSKESMAS
4/12/2020 36 MGG
BANCAK

PUSKESMAS
7/12/2020 36 MGG
BANCAK
PUSKESMAS
BANCAK 27/11/2020 36 MGG
PUSKESMAS
BANCAK 27/11/2020 36 MGG

PUSKESMAS
12/12/2020 35 MGG
BANCAK

PUSKESMAS
BANCAK 4/12/2020 35 MGG

PUSKESMAS
BANCAK
5/12/2020 35 MGG
PUSKESMAS
16/12/2020 34 MGG
BANCAK

PUSKESMAS
22/12/2020 34 MGG
BANCAK

PUSKESMAS
21/12/2020 34 MGG
BANCAK

PUSKESMAS 20/12/2020 34 MGG

BANCAK

PUSKESMAS
21/12/2020 34 MGG
BANCAK

PUSKESMAS
17/1/2021 34 MGG
BANCAK

PUSKESMAS
27/12/2020 33 MGG
BANCAK

PUSKESMAS 26/12/2020 33 MGG

BANCAK

PUSKESMAS
29/12/2020 33 MGG
BANCAK

PUSKESMAS
29/12/2020 33 MGG
BANCAK

PUSKESMAS
30/12/2020 32 MGG
BANCAK

PUSKESMAS 31/12/2020 32 MGG

BANCAK

PUSKESMAS
31/12/2020 32 MGG
BANCAK

PUSKESMAS
31/12/2020 32 MGG
BANCAK
PUSKESMAS
10/1/2021 31 MGG
BANCAK

PUSKESMAS
8/1/2021 31 MGG
BANCAK

PUSKESMAS
9/1/2021 31 MGG
BANCAK

PUSKESMAS
BANCAK 31/12/2020 31 MGG

PUSKESMAS
1/2/2021 30 MGG
BANCAK

PUSKESMAS
17/01/2021 30 MGG
BANCAK

PUSKESMAS
14/01/2021 30 MGG
BANCAK

PUSKESMAS
19/01/2021 29 MGG
BANCAK

PUSKESMAS 21/01/2021 29 MGG

BANCAK

PUSKESMAS
23/01/2021 29 MGG
BANCAK

PUSKESMAS
20/01/2021 29 MGG
BANCAK

PUSKESMAS
18/01/2021 29 MGG
BANCAK

PUSKESMAS 23/01/2021 29 MGG

BANCAK

PUSKESMAS
18/12/2020 29 MGG
BANCAK

PUSKESMAS
24/01/2021 28 MGG
BANCAK

PUSKESMAS
BANCAK 12/1/2021 28 MGG

PUSKESMAS
BANCAK 17/01/2021 25 MGG

PUSKESMAS
22/01/2021 24 MGG
BANCAK