FORMULIR ISIAN DAFTAR PENERIMA PEMBERIAN MAKANAN TAMBAHAN (PMT) BUMIL

DARI KABUPATEN BIMA WILAYAH UPT PUSKESMAS BOLO TAHUN 2017

BB LILA
NO NAMA TGL LAHIR (TAHUN) TB UMUR KEHAMILAN ALAMAT RT RW KET
I II III I II III
1 Nurrahmania Bahtiar 27 tahun 46 46.5 47 23 23 23.2 155 26 minggu Bontokape 1 1
2 Sukran Sukrin 25 tahun 60 60.5 61 23.5 23.6 23.7 158 16 Minggu Darussalam 2 1
3 lita Nurfatun 20 tahun 41 41 41.5 22 22.1 22.2 150 20 Bulan Tumpu 5 3
4 Sumiati Muhammad 28 tahun 44 45 46 23.5 23.5 23.6 150 34 minggu Darussalam 6 3
5 Nurlaini Arismunandar 27 tahun 42 43 43.5 23.5 23.7 23.8 152 14 minggu Darussalam 2 1
6 Samiati Suherman 33 Tahun 46 46.5 47 23 23.1 23.2 152 20 minggu Kananga 3 2
7 Rita Wani Basri 23 Tahun 41 41.5 42 21 21.1 21.2 155 11 minggu Darussalam 3 1
8 Salman Faris Imran 22 tahun 45 45.5 46 18 18.1 18.2 168 20 minggu Leu 7 2
9 Nuraeni Wildan 21 Tahun 45 46 46.5 20 20.1 20.2 155 35 minggu Tumpu 8 1
10 Nining Aditya 25 tahun 36 37 38 19 19.1 19.2 145 27 minggu Rato 12 6
11 itam Arajak 28 tahun 45 46 46.5 18 18.1 18.2 150 37 minggu Nggembe 4 1
12 Arrina Haryono 30 Tahun 40 40.5 41 21 21.1 21.2 157 6 minggu Tambe 7 2
13 Rahmi Ramadhan 17 tahun 50 51 52 20 20 20.1 148 26 minggu Sonco/ sanolo 4 1
14 Eni Arif 21 Tahun 51 52 53 22 22.1 22.2 149 14 minggu Bontokape 6 1
15 Nurjawa Ahmad 37 Tahun 49 50 51 22 22 22.1 155 16 minggu Nggembe 13 2
16 Ika Rusdiansyah 25 Tahun 45 45.5 46 22 22.1 22.2 151 22 minggu Bontokape 2 1
17 Ririn Subhan 18 Tahun 40 41 42 19 19.1 19.2 150 20 minggu Kananga 12 6
18 Jumiati Arrahma 28 Tahun 46 46.5 47 21 21.1 22 150 25 minggu Kananga 12 6
19 sirawati Salahudin 30 Tahun 47 47.5 48 23 23.1 23.2 148 5 minggu Rato 5 3
20 Surdiana Muhammadyah 20 tahun 38 39 40 22 22 23 145 20 minggu Kananga 8 3

Mengetahui Bolo, Januari 2017

Kepala UPT Puskesmas Bolo Koordinator Gizi UPT Puskesmas Bolo

Bisrun, SKM Rahmatun Nazillah, SKM

NIP : 19741231 200003 1 026 NIP: 19710820 199203 2 011
 FORMULIR ISIAN DAFTAR PENERIMA PEMBERIAN MAKANAN TAMBAHAN (PMT) BALITA
DARI KABUPATEN BIMA WILAYAH UPT PUSKESMAS BOLO TAHUN 2019

BERAT BADAN
NO NAMA NAMA ORANG TUA TANGGAL LAHIR JENIS KELAMIN ALAMAT RT RW KET
I II III
1 M. Afif Riski Juli Setiawan 7/22/2017 L 8.1 7.4 8 Leu 1 2
2 M. Syahril Heryanto 8/24/2017 L 7.5 4 1
3 M. Riski Ramadhan Suaidin 5/27/2017 L 7.5 8 10 5
4 Nazwa Dalila Adnan 12/22/2016 P 7 12
5 Dwi Juliyanti Khaerul Asri 7/28/2016 P NGGEMBE
6 Sahidatun Abd. Farid 12/11/2017 7.5 7.7 6 NGGEMBE
4 Akhsan Akhirul R Heriyanto 10/13/2016 10 10.5 6 NGGEMBE
5 Elfita Khaerani Ishaka 3/25/2016 10.5 10.7 12 NGGEMBE
6 M. Alferi Ridwan 15 bln 8 7 NGGEMBE
7 Miratil Supriadi 10/23/2016 P 7.8 8 5 NGGEMBE
8 Rizal M. Putra Nurmala 1/26/2017 L 8.2 4 NGGEMBE
9 M. Alif Asikin 11/18/2017 L 7.8 8 4 NGGEMBE
10 M. Rizki Jaidun 11/9/2016 L 9 5 NGGEMBE
11 Aisyah Gina putri Mustamin 6/3/2016 P 9.8 12 NGGEMBE
12 Nabil Agus Riyadi 5/17/2017 10.5 Rato 2 NGGEMBE
13 Ifra Mikaila Risman 4/6/2018 L 6 8 NGGEMBE
14 Izul Alfadeh Ahmad St Nur 2/14/2018 L 6.7 7.2 11 NGGEMBE
18 M. Putra Ardiansah A. Haris 12/12/2017 L 6.4 7 9 5
19 Muh. Ridho Artoyo Sukma 12/31/2018 L 6.5 4 5
1 M. Nabil Wawandar Eka M 6/28/2017 P 7.8 5 3
2 Alif Ramdhan M. Nasir 5/26/2018 L 6.8 17 4
3 M. Ramzan Zahiri Maliki Yahdi Maya Sari 12/30/2017 L 7.3 7.5 6 4
4 Mifzal Qajan Zhafiri Nurhariwati Edi kUrniawa 9/16/2016 L 9 9 5
24 Nurazizah Burhan Rosdiana 11/24/2017 P 7.4 7.4 9 5
25 M. Putra Ardiansah Abd. Haris Dewi 12/12/2017 L 6.4 9 5
26 Nurjumiatin Syaiful Hasan Nita 3/31/2018 P 9.5 2 3
27 Alfin Nurahma Sadakah Asmah 8/9/2016 L 12 2 1
28 Dafa Maulana 2/11/2018 L 7.6
10 Sri Sulastri Bambang 12/19/2017 P 6.8 Sanolo 14 6
11 Nurdaniah Jaidin 8/5/2016 P 8.7 15 6
12 nurijatun al fatin syahbudin 11/2/2016 p 8.5 8.7 8.9 tumpu 13 3
13 nuraliah putri aisyah ilyas 10/13/2015 p 10.8 10.9 11 5 3
14 afriansyah putra usman 12/5/2016 L 9.5 9.8 10 5 3
muthiah putri yusuf 8/7/2016 p 8.5 8.9 9.2 5 3
hasibah ifhiah mahfud 3/2/2018 p 6.7 7 7.2 6 3
nurfatir wahyudin 3/6/2018 L 7.5 7.7 7.9 6 3
ALYA TAUFIK 12/13/2015 P 11 11.5 11.8 6 3
sauki JUNAIDIN 10/1/2017 L 9 9.8 10 5 3
YUYUN SYAFITRI NOVITA WULANDARI 12/6/2017 P 6.5 6.7 7 TAMBE MEKAR 9 5
INTAN PERMATASARI Ahmad 1/11/2016 P 10 10 10.4 5 7
NASRUL PUTRA 6/21/2017 L 8 8 10 9 5
PUTRI ALIQA RIAN 4/21/2017 P 9 8 10 15 5
8 GIAN ADITIA ARDANI ABDURAHMAN 10/30/2016 L 10 9.8 10.2 15 5
9 AINUN ZARIYAH FERDIAN 10/24/2017 P 7 7.2 7.5 19 9
10 ADIRA RANO 12/18/2017 P 6 6.2 6.6 19 9
11 NABIL SYPUTRA M NOR 9/4/2017 L 6.9 7.2 7.5 SEDAP MALAM 5 3
12 OJIL KURNIAWAN AHMAD 11/29/2017 L 7.2 7.5 7.8 SEPAKAT 13 5
13 NURJAHIRAH SUAEDIN 5/13/2017 P 8 8.2 8.5 LARA 19 5
14 RAMDANI A. HARIS 7/12/2017 P 6.5 6.8 7 TAMBE 12 6
NURMALA SYARUDIN 9/3/2016 P 8.9 9 9.3 TAMBE 1 1
MUJAHIR MUHLIS 7/24/2017 L 8 8.2 8.4 TAMBE 2 1
1 MEISYAH RAMDANI M ABAS 5/26/2018 P 5 5.3 5.6 TAMBE 1 SANOLO
2 RAFA RAMADhAN SUAEDIN 6/11/2017 L 7.4 8.4 9.4 TIMU 2 SANOLO
3 SYAHIDIN FAJA SYAEFUL 12/12/2017 L 7 7.2 7.6 TIMU 5 SANOLO
4 M AWALUDIN AGUSTIAN 11/21/2017 L 7.4 7.2 8 TIMU 4 SANOLO
5 SILMI ALFATUNNISA SUKARDIN 3/24/2018 P 6.2 6.6 7.3 TIMU 6 2
6 M AJRIL IBRAHIM 4/4/2018 L 7 7.9 JUNAIDINTIMU 9 3
7 MARYAM INDRAINSYAH 10/9/2017 P 8.6 7.2 8 TIMU 6 2
8 PUTRA RISMIAWAN MULYADIN 4/4/2017 L 7.3 7.5 8.8 TIMU 10 4
9 M. ALBARAK IWAN KURNIAWAN 3/29/2018 L 6.4 6.5 6.8 NGGEMBE 19 5
10 FAKIH JUNAEDIN 7/27/2015 L 10.6 10.7 11 17 5
MUTIAH SAHRIR 1/3/2015 P 11 11 11.2 18 5
PUTRI NAILA M RUN 9/15/2014 P 12.2 12.2 12.5 18 5
AMELIA 10/4/2015 P 10.5 10.7 18 5
KALISA PUTRI ARIFUDIN 1/1/2015 P 11.4 11.7 5
WAHYU RAHMAN EFIYANTO 2/10/2017 P 8.4 8.4 2
ZAKIR IRFAN 12/2/2016 L 9 10.7 2
ATIKAH JUMRAH 7/31/2017 P 9.4 9.5 2
JAKIRA WAWAN 3/17/2016 P 10.7 10.3 2
FAHIRA FILJAN AMIRUDIN 2/20/2018 P 5.7 6 1
X TIMU 2/20/2018 7.1 8.2 4
1 5/14/2017 8.5 8.1 TIMU
2 9/21/2017 6.5 6.8 TIMU
3 3/28/2017 8.7 8.9 TIMU
4 4/8/2016 9.5 9.6 TIMU
5 3/16/2017 6.5 7.1 TIMU
6 3/28/2017 7.4 7.8 TIMU
7 6/23/2017 7.4 8.5 TIMU
8 RIDHO IRFAN 14/8/2016 L
KHAERUL AZAM EDI GUNAWAN 1/12/2014 L
SANTIKA WARDA EBAN 30/11/2017 P
MIRAATIL HAYATI MIRATIL HAYATI 23/10/2016 P TAMBE
M. RENDI M RENDI 25/7/2016 L
AKILA AKILA 24/9/2017 P
M ZIDAN ALGIFAR HASAN 26/6/2016 L
RAMADHAN USMAN 24/6/2016 L
FIRA RAMADHAN AHARIS 30/6/2016 P
HARUN A RASYID SUKIMAN 9/2/2017 L
NURBILKIS 4/1/2017
ALIFAH NURUL R 5/15/2018 5.4 6.2 BONTOKAPE 3 2
ALIFAH BILQIS 6/16/2018 7 7.3 3 2
M AKHTAR M 4/28/2018 6 6.6 3 2
M FITRA 7/6/2017 8 9 4 2
 M AKBAR 5/4/2018 7.2 7.4 1 1
AZKAR RISKI 4/24/2018 6.9 7.3 6 3
M. ARDAN SADIKIN 3/5/2017 10.2 10.4 SONDOSIA 8 4
ERKAN 5/9/2018 8.9 9.2 8 4
M RAHMAN 7/27/2016 9.2 9.9 4 2
19 FARADILLAH SUWARDIN 12/11/2016 P 8.2 8.4 8.8 4 2
20 IBRAHIM 1/23/2017 P 8.7 9 9.2 6 2
21 SINTA 3/4/2017 P 6.9 7.2 7.6 6 2
4/13/2017 7.4 8.6
2/23/2018 8.8 7.8
2/25/2015 9.9 10.2 RADA
3/5/2017 8 8.3
8/2/2018 7 7.2
6/22/2016 9 9.3 DARUSALLAM
6/16/2017 8.5 9.5
KURNIATI SYARIFUDIN 12/31/2016 P 8 8.2 8.5 6 3
SAKIRA JULKIFLI 6/14/2016 P 10 10.2 10.5 4 2
M RISKI AHARIS 6/4/2016 L 8.4 8.8 9 3 2
KHAERUNAS DEDIANSYAH 8/24/2017 L 7.9 8.2 8.5 4 2
IMATUL ZAHRA IRWAN 8/1/2016 P 8.5 8.7 9 4 2
SAKIRA SRI MULYATI 31/6/16 P 9 9.2 9.5 3 1
ST NURUL SYAFIRA ASRUN 1/2/2017 P 9.4 9.9 10.5 KARA 3 2
REFATUL ASMAH HUSNAENI 1/4/2016 P 10.5 10.9 11 5 1
M RISKI IMRAN 2/12/2018 L 8 8.9 9 3 2
M TAUFIK FIRDAUS 4/1/2017 L 9.7 10 10.5 4 2
BILAL 12/2/2016 L 9 9.5 10.2 1 1
HAMDAN JULFA SABRIN L 7 7.5 8 4 3
SYAMSUDIN ALFARUK FAISAL 1/17/2018 L 8 8.5 8.7 5 3
FANDI MAULANA ALDI 11/15/2015 L SANOLO
FITRATUL ADIBA TAMRIN 1/4/2017 P
NURANISA FATWA NURSIA 16/4/2016 P
ARIF KURAHMAN SUHERMAN 2/4/2016 L
ARTA NABIL ILHAM 17/4/2017 L
MUH ISLAM ALFARIJI JUNAIDIN 25/7/2017 L
AIRIN KHUMAIRAH MUHTAR 2/3/2016 P NGGEMBE
MUHAMMAD MUHAIMIN ARFAH 14/02/2017 L
AURA APRIANINGSIH SYAFRUDIN 17/04/2017 P
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 FORMULIR ISIAN DAFTAR PENERIMA PEMBERIAN MAKANAN TAMBAHAN (PMT) BALITA
UPT PUSKESMAS BOLO

NO JENIS KELUARGA PROVINSI KABUPATEN KECAMATAN PEMBERIAN KE BERAPA SUMBER PMT TGL. PEMBERIAN PMT JUMLAH PEMBERIAN BB AWAL TB AWAL BB I BB II BB III BB AKHIR TB AKHIR

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20

Mengetahui Tanggal:
Kepala UPT Puskesmas Bolo Koordinator Gizi UPT Puskesmas Bolo

Bisrun, SKM Rahmatun Nazillah, SKM

NIP : 19741231 200003 1 026 NIP: 19710820 199203 2 011
 FORMULIR ISIAN DAFTAR PENERIMA PEMBERIAN MAKANAN TAMBAHAN (PMT) BUMIL
UPT PUSKESMAS BOLO

NO JENIS KELUARGA PROVINSI KABUPATEN KECAMATAN PEMBERIAN KE BERAPA SUMBER PMT TGL. PEMBERIAN PMT JUMLAH PEMBERIAN BB AWAL TB AWAL BB I LILA BB II LILA BB III LILA BB AKHIR TB AKHIR

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20

Mengetahui Tanggal: Januari 2016

Kepala UPT Puskesmas Bolo Koordinator Gizi UPT Puskesmas Bolo

Bisrun, SKM Rahmatun Nazillah, SKM

NIP : 19741231 200003 1 026 NIP: 19710820 199203 2 011
 FORMULIR ISIAN DAFTAR PENERIMA PEMBERIAN MAKANAN TAMBAHAN (PMT) BUMIL
UPT PUSKESMAS BOLOTAHUN 2020
PROVINSI: NUSA TENGGARA BARAT
BULAN : MARET
KABUPATEN: BIMA
PUSKESMAS: BOLO

TTD (TABLET
BB BB (KG) TB LILA TAMBAH JIKA YA BERAPA
TANGGAL LAHIR/ UMUR KEHAMILAN KEHAMILAN BUTIR TABLET
NO NO. NIK KTP/SIM NAMA IBU SEBELUM ALAMAT RT RW UMUR (TAHUN) (MINGGU) KE DARAH) TAMBAH
HAMIL 1. YA DARAH
I II III I II III I II III 2. TIDAK

I DESA RADA
1 5204225303940001 NURAIDA 39 RADA 1 1 23 16 39 40 41 150 150 151 20 21 22 1 1 30
2 5206024209880001 MEGA MUSTIKA 40 RADA 3 2 27 20 40 41 42 154 154 155 22 23 24 2 1 30
3 5206025210911003 DESI RATNASARI 44 RADA 3 3 27 23 44 45 46 151 151 152 23 23.5 24 1 1 20
4 5206024107911142 ERNI 45 RADA 5 3 29 16 45 46 47 145 145 146 20 21 22 2 1 20
5 5206025708950001 SRI AGUSTINA 40 RADA 4 3 22 10 40 41 42 148 148 149 22 23 24 1 1 30
6 5206025012911005 SRI RAMADHAN 42 RADA 9 5 30 24 42 43 44 155 155 156 20 21 22 3 1 30
7 6206026012871004 KALTUM 41 RADA 3 3 29 24 41 42 43 150 150 151 22 23 24 2 1 30
8 5206025103860005 YESI KURNIATI 43 RADA 8 5 30 28 43 44 45 152 152 153 23 23.5 24 2 1 20
9 5206024507010009 ANIS MARDIATI 44 RADA 9 5 24 10 44 45 46 149 149 150 22 23 24 1 1 20
10 5206024401860001 WARDAN 45 RADA 9 5 31 20 45 46 47 149 149 150 22 23 24 3 1 30
11 5060251060001065 NURFADILA 40 RADA 8 5 22 9 40 41 42 158 158 159 22 23 24 1 1 20
12 5206024101811004 JUMRAH 41 RADA 3 3 32 27 41 42 43 150 150 151 23.5 24 24 4 1 20
2 DESA TAMBE
13 5206025204791008 SUHARTI 40 TAMBE 2 1 32 21 40 41 42 148 148 149 22 23 24 3 1 30
14 5206025010011003 NURATIFA 51 TAMBE 2 1 19 31 51 51 52 150 150 151 23 23.5 24 1 1 30
15 5206024204821003 NURLAELA 54 TAMBE 2 1 32 22 54 54 55 153 153 154 23 23.5 24 3 1 30
16 5206025107901094 NIA KURNIAWATI 43 TAMBE 2 1 28 32 43 44 45 145 145 146 23 23.5 24 2 1 30
17 5206025208910001 DINI AINUN 49 TAMBE 3 2 28 28 49 50 51 160 160 161 23.5 24 24 3 1 30
18 1810094206890004 HELYANA 49 TAMBE 4 2 30 32 49 50 51 150 150 151 23 23.3 24 2 1 30
19 5206025012751003 RINI MEGAWATI 47 TAMBE 6 3 23 27 47 48 49 150 151 152 23.5 24 24 2 1 30
20 5206024810880003 ROSDIANA 51 TAMBE 7 3 30 20 51 52 53 153 154 155 23 23.1 23.4 2 1 30
21 5206026110000002 ST ARINA 39 TAMBE 15 3 19 30 39 40 41 155 155 156 20 20.1 21 1 1 30
22 5206021506021003 WAHYUNI 41 TAMBE 15 3 17 32 41 42 43 150 151 152 22 22.5 23 1 1 30
23 5206136701900001 RAHMA 33 TAMBE 10 4 23 33 33 34 35 152 152 153 23 23.5 23,7 1 1 30
24 5206024107891245 SRI ERNAWATI 45 TAMBE 12 5 33 19 45 45 46 154 154 155 23 23.3 23.5 4 1 30
25 5200001057894121 SINTA ADRIANI 32 TAMBE 12 5 16 13 32 33 34 146 147 148 22 22.3 23 1 1 30
26 520602451101002 YENI 36 TAMBE 10 5 18 21 36 37 38 149 149 150 23 23.2 23.5 1 1 30
27 5206026012021006 FEBRIANA 38 TAMBE 12 5 18 28 38 39 40 150 151 151 20 20.5 21 1 1 30
28 5206024704941002 APRIANI 41 TAMBE 11 5 19 32 41 42 43 150 150 151 19 20 21 1 1 30
29 5206026811961003 FATUNURNISA 40 TAMBE 13 7 23 28 40 41 42 153 154 154 20 21 22 1 1 30
30 5206137006011005 IKA PUSPITA YANTI 39 TAMBE 14 7 19 16 39 40 41 155 155 156 21 21.5 22 1 1 30
31 5206024101000006 FITRI 40 TAMBE 13 7 19 28 40 41 42 154 154 155 21 21.5 22 2 1 30
32 5206024107001218 ERNI 40 TAMBE 19 8 20 28 40 41 42 149 149 150 23.5 23.5 24 1 1 30
33 5206026303850001 ROSDIANA 43 TAMBE 15 4 27 14 43 44 45 148 149 149 23.5 23.5 24 4 1 30
34 5206024808020001 FENIRAHAYA 45 TAMBE 6 3 19 32 45 46 47 150 150 151 23 23.2 24 1 1 30
35 5206026008901005 JUHANA 45 TAMBE 10 4 29 28 45 46 47 148 148 149 23.5 23.6 24 2 1 30
36 5206025707900002 NURFITRIYANTI 52 TAMBE 16 3 28 16 52 53 54 148 148 149 23 23.3 24 2 1 30
37 5206022304110040 SUHARTI 50 TAMBE 2 1 41 32 50 51 52 148 148 149 22 22.3 24 3 1 30
3 DESA RASABOU
38 5206025004951005 ASTUTI ABD MALIK 46 RASABOU 2 29 30 46 47 48 156 156 157 23 23.5 24 2 1 30
39 520602450893002 ERI MURNIATI 52 RASABOU 7 26 28 52 53 54 154 154 155 23 23.6 24 1 1 30
40 520602410700197 NURJANAH ARDIANSYAH 51 RASABOU 11 19 26 51 52 53 149 149 150 22.5 23 24 1 1 30
41 5206026107931003 NURMI ISWAN 49 RASABOU 11 26 31 49 50 51 148 148 149 23 23.1 24 1 1 30
42 5206024107801279 RUKMINI RIDWAN 50 RASABOU 2 38 31 50 51 52 151 151 152 23 23.4 24 6 1 30
43 5206026304990003 NURAENI ARIF 48 RASABOU 10 25 27 48 49 50 150 150 151 23 23.2 24 1 1 30
44 5206026002830002 NURGAMALIA NURDIN 51 RASABOU 10 36 32 51 52 53 152 152 153 23 23.4 24 2 1 30
45 52006025708920001 ASTUTI ARIFIN 52 RASABOU 14 26 32 52 53 54 154 154 155 22.5 23 23.3 3 1 30
46 5206024508840001 ISDESI IKSAN 50 RASABOU 13 36 32 50 51 52 155 155 156 21 22 23 3 1 30
47 31720365005920010 ARDINI MUSLIM 50 RASABOU 9 27 26 50 51 52 153 153 154 22.3 23 23.6 4 1 30
48 5206025509941003 NELLY M ALFAJRIN 40 RASABOU 1 25 24 40 41 42 152 152 153 20 21 22 1 1 30
49 5206025102001002 SITI HAJAR MARWAN 42 RASABOU 8 20 20 42 43 44 150 150 151 21 22 23 1 1 30
50 5206027108920001 NURUL RIJAL 50 RASABOU 6 27 32 50 51 52 151 151 152 23 23.5 24 2 1 30
51 5206027112921009 YULYAN IKRAMAN 42 RASABOU 1 27 30 42 43 44 152 152 153 23 23.4 24 2 1 30
52 5206027108920001 NURULFAHMI 47 RASABOU 3 27 30 47 48 49 159 159 159 23 23.6 24 2 1 30
53 5206025301990001 ADE JAITUN ISTQ 55 RASABOU 13 4 21 32 55 56 58 160 160.2 160.3 23 23.4 23.8 1 1 30
54 5206024507851006 IRNAWATI 55 RASABOU 5 4 35 20 55 56 57 150 150.3 150 23 23 23.1 3 1 30
55 5201124107900265 ELPANI 55 RASABOU 5 4 28 12 55 56 57 150 150.2 150.3 23 23.4 23.7 3 1 30
56 5206026004850003 MIRA 60 RASABOU 5 4 34 8 60 61 62 150 151 152 23 23.5 23.9 2 1 30
4 DESA RATO
57 5206025705930003 NURHIDAYATI 40 RATO 4 2 24 28 40 41 42 158.9 160 161 23 23.5 24 1 1 30
58 520514507840004 NUNUNG SURYANI 52 RATO 4 2 36 20 52 53 54 156 156 157 23 23.5 24 3 1 30
59 5206134507861003 NURHIDAYAH 45 RATO 4 2 36 24 45 45 46 157 157 158 23 23.4 24 2 1 30
60 5206025201050002 DINI FITRIAH 46 RATO 13 3 20 16 46 46 47 158 158 159 22 23 24 1 1 30
61 9171014508900010 AINUN JARIAH 47 RATO 13 3 28 30 47 47 48 150 150 151 23 23.3 24 2 1 30
62 5206024709851003 NURLAILA 49 RATO 13 3 37 30 49 49 50 152 152 153 22 23 23.6 3 1 30
63 5206020209190004 NURHAYATI 50 RATO 13 3 28 32 50 50 51 153 153 154 23 23.3 23.8 1 1 30
64 5206026708931002 SUKRENI 50 RATO 12 6 27 30 50 51 52 155 155 156 22 23 23.2 2 1 30
65 5206024107901266 ROSANI 48 RATO 10 5 25 32 48 49 50 154 154 155 23 23.5 23.7 1 1 30
66 5206024410891003 HUMAIRAH 49 RATO 1 1 30 28 49 50 51 160 160 161 23 23.5 24 2 1 30
67 5206024508951006 VIVI 50 RATO 8 4 26 24 50 51 52 160 160 161 23 23.5 24 3 1 30
68 5206025565850001 NURINTAN 50 RATO 6 4 34 32 50 51 52 150 151 151 23 23.4 23.6 3 1 30
69 5206026505820002 ROSNAINI 37 RATO 18 4 37 28 57 58 59 157 157 158 22 22.3 23 1 1 30
70 5206024505940002 RATNAH 49 RATO 12 6 27 20 49 50 51 153 154 154.3 23 23.4 23.8 1 1 30
71 5206026508910006 NURHAYATI 56 RATO 12 6 30 24 56 57 58 150 151 151.2 22 23 23.4 2 1 30
72 5206024107871169 KARTINI 55 RATO 8 4 35 16 55 56 57 160 160 160.3 22 23 23.2 5 1 30
73 5206134507861003 NURHIDAYAH 49 RATO 4 2 30 30 49 50 51 153 153.2 153.1 23 23.4 23.7 2 1 30
74 5206024707971010 PUTRI MEGA 50 RATO 11 6 29 30 50 50.5 52 151 151.2 151.3 22 23 23.5 1 1 30
75 5206024708890001 SRI MULYATI 51 RATO 7 4 30 32 51 52.3 53 152 152.1 153 23 23.3 23.7 2 1 30
76 5272034304880002 VERAKARTIKA 55 RATO 8 4 32 30 55 55.5 56 153 153 154 22 23 23.6 3 1 30
5 DESA KANANGA
77 5206134805900001 FITRI FARID 46 KANANGA 1 1 24 25 46 46 47 146 146 147.2 22 22.1 23.6 2 1 30
78 5206029405930002 SUKMAWATI 47 KANANGA 6 3 24 20 47 47 48 148 148 148.4 23 23.2 23.6 2 1 30
79 5206024303921009 DWI NURAM 49 KANANGA 1 1 25 24 49 49.3 49.9 150 150 150.2 23 23.4 23.8 1 1 30
80 5205035210010002 MARLINDA 50 KANANGA 6 3 25 24 50 50 52 152 152 152.4 22 22.6 23.1 1 1 30
81 5206024501941004 KHUSNUL 50 KANANGA 7 3 24 30 50 50 52 153 153 153.2 23 23.6 23.7 2 1 30
82 5206024505940006 NURUL FITRIANI 48 KANANGA 6 3 25 30 48 48 49 149 149 149.2 22 22.8 23 3 1 30
83 5206025103860008 EKA SUSILAWATI 49 KANANGA 6 3 24 24 49 49 50.5 149 149 149.1 23 23.6 23.9 3 1 30
84 5206024310901003 MARYATI SUGENG 52 KANANGA 6 3 29 32 52 52 53.2 150 150 150.2 22 22.6 23 1 1 30
85 5206024408921002 AYUDIA M. BUDIMAN 65 KANANGA 11 6 28 32 65 65 65.3 151 151 151.3 23 23.9 24 1 1 30
86 5206024806890002 AMALINA SAHIDAH 49 KANANGA 7 3 31 30 49 49 50 138 138 138.1 22 23 23.6 1 1 30
87 5206027112861017 AGUSTINAH AHMAD 47 KANANGA 1 1 34 32 47 47 48 150 150 151 23 23.1 23.4 4 1 30
88 5206025707240003 suharti 60 KANANGA 6 3 26 28 60 61 62 153 153 154 23 23.1 24 2 1 30
89 5206136407940002 nurunnisa 51 KANANGA 6 3 25 22 51 51 53 153 153 153 23 23.2 24 2 1 30
90 5206134805900001 fitri farid 42 KANANGA 12 6 26 32 42 42 43 154 154 155 21 22 23 2 1 30
91 5206024405930002 sukmawati 45 KANANGA 6 3 26 24 45 45 46 149 149 150 22 23.2 23.8 1 1 30
92 5206025604830001 MARYATI DEDY 47 KANANGA 9 3 37 24 47 48 49 148 148.2 148.3 23 23.4 23.6 3 1 30
93 5206024405790002 FATIMAH 48 KANANGA 6 3 41 30 48 49 50 149 149.3 149.8 23 23.4 23.8 5 1 30
94 6206036802881002 NURAFNI 47 KANANGA 6 3 32 32 47 48 49 149 150 150 23 23.4 23.9 2 1 30
95 5206025604830001 MARHAYATI 48 KANANGA 9 3 37 24 48 49 50 150 151 151 23 23.6 23.7 4 1 30
96 5206024809920001 QURATUAINI 55 KANANGA 2 1 28 12 55 56 57 160 160.2 160.4 23.1 23.3 23.61 1 1 30
97 520602203860001 FADLUN INDRIANI 60 KANANGA 3 1 32 24 60 61 62 150 151 151.2 23 23.2 23.8 2 1 30
6 DESA LEU
98 5206026803920001 DEWI SINTA ARIF 44 LEU 4 27 24 44 45 45 147 147 148 20 21 22 1 1 30
99 5206026709920001 ROSIDAH HUSNI 40 LEU 4 27 20 40 41 41.5 148 148 149 22 23 24 1 1 30
100 5206025003930003 FITRI SUDIRMAN 44 LEU 4 26 26 44 45 45.5 149 149 149.5 21 22 23 2 1 30
101 5205044711880001 FITRIA SUMARDIN 52 LEU 4 31 28 52 52 53 150 150 151 22 23 24 1 1 30
102 520603221009008 HAERINI Arsyad 40 LEU 6 24 9 40 41 42 150 150 151 23.2 24 24 1 1 30
103 5206025002910003 SITI HAJAR 50 LEU 8 3 39 12 50 50 51 151 151 152 23 24 24 1 1 30
104 520602150310019 ASNI 64 LEU 6 3 38 7 64 64 64.5 152 152 152.5 23.4 24 24 3 1 30
105 5206020310110042 ASMAH 80 LEU 6 3 46 7 80 80 80.5 151 151 151.3 22 23.6 23.6 3 1 30
106 5206024606900093 NURHASNAH 57 LEU 8 3 39 24 57 57 58 152 152 153 23 23.7 23.7 1 1 30
107 5271065109890006 MIRAWATI 57 LEU 5 2 30 30 57 58 58 153 153 154 22 23.6 23.6 1 1 30
108 5206024611870002 SRI SUNARWATI 60 LEU 7 3 33 7 60 60 61 150 150 151 23 23.9 24 2 1 30
109 5206025703941002 SALMAH 75 LEU 11 4 25 24 75 75 76 151 151 152 23 23.7 23.7 1 1 30
110 520602611920001 NURHAYATI 53 LEU 6 3 27 7 53 53 54 149 149 150 22 23 23.6 2 1 30
111 5206025208991003 FITRATUL SAHIDAH 50 LEU 1 5 20 24 50 51 52.5 150 151 151.3 23 233 23.6 2 1 30
7 DESA TIMU
112 5206022510180014 nia daniati masrin 49 TIMU 1 23 17 49 50 51 151 151 152 22 23 23.6 1 1 30
113 5206020603130093 RUKMINI SUDIRMAN 39 TIMU 2 31 29 39 40 41 153 153 154 19 21 222 3 1 30
114 5206020608190007 SRI ENDANG JUNAIDIN 43 TIMU 3 21 9 43 44 45 154 154 155 23 23 24 2 1 30
115 5206024804980002 INDAHWINARTI IMAN 34 TIMU 3 21 18 34 35 46 150 150 151 23 23 14 1 1 30
116 520605502946001 NURYATI JAYASURATMA 43 TIMU 7 25 5 43 44 45 150 150 151 23 23 13.8 1 1 30
117 520602021219005 AGUSTIANINGSIH IRHAM 48 TIMU 3 18 24 48 49 50 151 151 152 19 20 21 1 1 30
118 5205035106010005 INDAH SARI MARHABAN 47 TIMU 3 18 20 47 48 49 152 152 53 22 23 23.8 1 1 30
119 5206024508930005 SRI RAHAYU JAIDIN 48 TIMU 3 27 17 48 49 50 151 151 152 21.5 22 23.7 2 1 30
120 5206024306991006 IKE FEBRIANTI PARIS 50 TIMU 4 20 4 50 51 51 152 152 153 21 22 23 1 1 30
121 5206026107811008 SILATURAHMI ISNAINI 65 TIMU 2 39 24 65 65 66 154 154 155 23.4 24 24 3 1 30
122 5206025207921004 NURMA ILHAM 48 TIMU 4 2 28 20 48 49 50 148 148.3 148.9 23 23.3 23.8 1 1 30
123 5206027112781015 FATMAH 47 TIMU 9 3 24 24 47 48 49 150 151.1 151.3 23 23.3 23.4 3 1 30
124 5206025212830005 SRI RAHMAWATI 52 TIMU 9 3 12 12 52 53 54 150 150.1 151 23 23.3 23.6 4 1 30
125 5206026011001003 RAHMANTIA 62 TIMU 10 4 20 20 62 63 64 155 155.2 156 22 22.3 23 1 1 30
126 5206035010001003 SUHADA 60 TIMU 9 3 16 16 60 61 62 155 155 155.2 23 23.1 23.6 1 1 30
8 DESABONTOKAPE
127 5206136806980002 EFIELYINDA FERIYADIN 24 BONTOKAPE 4 2 21 24 42 45 46 48 148 149 19 20 22 1 1 30
128 5206024201870002 JUNARI MUH AZHAR 25 BONTOKAPE 3 2 32 25 45 46 47 149 149 150 22.3 23 23.8 1 1 30
129 5206025401851003 RINI SRYANI FURKAN 23 BONTOKAPE 6 3 34 23 36 37 38 150 150 151 21 22 23.6 2 1 30
130 5206022501920002 DARMINI RAHMAT 24 BONTOKAPE 4 2 27 24 50 55 56 150 150 151 22.5 23 23.7 1 1 30
131 5206024107781277 AZHAR NURDIN 29 BONTOKAPE 3 2 40 29 37 48 49 150 150 151 21.5 22 23.6 4 1 30
132 5203044107980051 HIKMAH 28 BONTOKAPE 2 1 19 28 35 49 50 151 151 152 20 21 22 2 1 30
133 5272025601000003 LASMI 28 BONTOKAPE 2 1 16 28 45 50 51 152 152 153 21 22 23 1 1 30
134 5205076009970002 suriyani 19 BONTOKAPE 2 1 23 19 41 47 48 154 154 155 21 22 23.7 1 1 30
135 5206024307860001 YULIAN MARGIANTI 55 BONTOKAPE 1 1 34 10 55 56 57 147 148 149 22 23 23.7 3 1 30
136 5206024808821005 ASMAH AINUN NAJIB 46 BONTOKAPE 1 1 38 9 46 47 48 156 149 150 22.3 23 23.8 3 1 30
137 52060265007841003 RAHMAHUSMAN 50 BONTOKAPE 2 1 36 20 50 51 52 152 150 151 21 22 23.6 4 1 30
9 DESA SONDOSIA
138 5206034107871211 DAMRAH JAIDUN 29 SONDOSIA 1 1 29 21 49 49.5 50 147 147.2 148 21 22 23.6 1 1 30
139 5206034107011168 SARAFIAH MUHLIS 21 SONDOSIA 1 1 21 16 50 51 52 149 149.4 149.6 22 22.5 23 1 1 30
140 5206026103811005 DAHLI SAFRUDIN 38 SONDOSIA 1 1 28 18 49 49.5 51 150 150.1 150.3 21 22.5 23.7 4 1 30
141 5206046505880002 LENI MARLINA ADHAR 28 SONDOSIA 6 3 28 12 48 48.3 49 150 150 150.2 21 22.2 23.8 1 1 30
142 5206025111970001 NAFIRAH MUHAMMAD 22 SONDOSIA 6 3 22 9 45 45.8 46.5 148 148 148.5 21 22 23.6 1 1 30
143 5206020301200001 DESI RABIATUN ADI 26 SONDOSIA 1 1 26 7 42 43 44.3 149 149 149.2 22 22.4 23.8 1 1 30
144 5206024112830002 MAANI AHMAD 36 SONDOSIA 1 1 36 11 40 41.3 42.6 151 151.2 152 23 23.5 23.8 4 1 30
145 5206025003010002 JUMIATI NAJAMUDIN 23 SONDOSIA 6 3 23 11 49 49 50 152 152.2 153 23 23.4 23.7 2 1 30
146 527201201090005 ST RUBIAH ADHAR 22 SONDOSIA 6 3 22 34 45 45.5 46.3 155 155 156 22 23 23.6 2 1 30
147 5206024107921232 NURNANINGSIHINDRA 26 SONDOSIA 6 3 26 24 47 48 49 149 149.2 150 23 23.2 23.7 1 1 30
148 5206026403890001 NURUL KHATIMAH 30 SONDOSIA 6 3 30 28 48 48.6 49 148 148.3 149 23 23.2 23.6 2 1 30
149 5206184712050003 SRI WAHYUNINGSIH 55 SONDOSIA 5 6 35 21 49 49.5 50 147 147.2 148 21 22 23.6 2 1 30
150 5206025705820001 RITA ASRARIANI 50 SONDOSIA 8 4 24 16 50 51 52 149 149.4 149.6 22 22.5 23 4 1 30
151 5206029208840002 SALMIATI 49 SONDOSIA 3 2 29 18 49 49.5 51 150 150.1 150.3 21 22.5 23.7 3 1 30
152 5206026208240002 SURYATI 48 SONDOSIA 3 2 16 12 48 48.3 49 150 150 150.2 21 22.2 23.8 3 1 30
10 DESA SANOLO

153 5206034301010001 NUURAISYAH KURNIAW 46 SANOLO 20 12 46 47 47.5 154 154 155 22 22.3 23.6 1 1 30
154 5206023409960001 DEWI ROSTINA NASRULA 47 SANOLO 3 6 25 24 47 48 48.5 156 156 156.3 19 20 21.5 2 1 30
155 520605015103000003 ANDARI AKSAN 51 SANOLO 3 6 26 20 51 51 52 152 152 153 20 21.5 22 2 1 30
156 5026024808881003 SRI YULI WAHYUDIN 48 SANOLO 14 9 27 28 48 49 49.5 185 185.2 185.4 22 23 23.8 2 1 30
157 5206027003980001 SUHARNI FIRMANSAH 48 SANOLO 13 9 20 22 48 48 48.5 158 158.3 159 22 23.6 23.9 1 1 30
158 5206026203970002 JIHAN ILHAM 50 SANOLO 15 6 23 24 50 51 51 150 151.2 152 21 22 23.6 1 1 30
159 5206026012930005 NURFAJRIATISARIFUDIN 49 SANOLO 15 6 25 24 49 49 49.8 143 144 145 20 21 22 1 1 30
160 5206025508901004 NURI FERAWATIIRAWAN 48 SANOLO 15 6 30 22 48 49 49.7 149 150 151 22 23 237 2 1 30
161 5206024605990001 LILIS ARDIANSYAH 47 SANOLO 18 7 22 32 47 48 48.4 152 153 154 20.5 21 22 1 1 30
162 5206024404941007 KARTINIIDULADHAR 51 SANOLO 19 7 24 32 51 52 52.4 150 151 152 22 23 23.9 1 1 30
163 5206024711930002 RENIANGGIENI NASARD 52 SANOLO 19 7 27 32 52 52.5 53 147 148 148.4 21.5 22 23.6 1 1 30
164 5206024507841002 MAANI JUNAIDIN 48 SANOLO 19 7 30 32 48 49.5 50 154 155 156 19 20 21 2 1 30
165 5206024307991003 SRI WAHYUNI NASRUDIN 46 SANOLO 19 7 28 28 46 46.5 47 152 153 154.2 21 22 23.7 1 1 30
166 5206024504890003 RAHMH SALHUDIN 51 SANOLO 19 7 28 30 51 51 51.9 147 147.2 147.5 20 21 22 2 1 30
167 5206084108970004 YANTI SUMARNI 51 SANOLO 12 4 29 32 51 52 54 147 148 148.8 20 22 23.4 2 1 30
168 5206027003980001 SUHARNI 51 SANOLO 1 2 30 30 51 51 51.9 147 147.2 147.5 20 21 22 1 1 30
169 5206025207891004 KURNIAWATI 51 SANOLO 13 5 31 28 51 51.5 53 147 147.2 148 20 22 222.3 1 1 30
11 DESA TUMPU

170 5206025404920002 MENTARI M ANHAR 46 TUMPU 13 3 28 12 46 46.5 47 154 154 155 22.5 23.6 23.9 1 1 30
171 5206025007810001 DAHLIA 48 TUMPU 5 3 39 28 48 48.3 49 156 156 157 23 23.6 23.8 3 1 30
172 5206024104941009 NURFARIDAH 46 TUMPU 13 3 26 28 46 46.3 47 152 152 153 22 23.3 23.7 2 1 30
173 5206026912950003 JUMRATUL SYARIF 48 TUMPU 13 3 25 20 48 48.5 49 185 185.2 185.4 23 23.6 24 2 1 30
174 5206024764820002 HALIMAH 50 TUMPU 12 3 27 10 50 51 52 158 158.3 159 23 23.8 24 1 1 30
175 5206025401990001 SUKRENI JIA 43 TUMPU 12 3 21 13 43 44 44.6 150 151.2 152 21.5 22 23 1 1 30
176 52060544100000014 SRI YANI HASANUDIN 48 TUMPU 8 2 20 25 48 49 49.5 143 144 145 22.4 22.7 23 2 1 30
177 52060253039600002 NIA ANGGREANI 37 TUMPU 9 2 22 28 37 38 39.6 149 150 151 23.1 24 24 1 1 30
178 5206020606880004 FITRI RAMLI 40 TUMPU 10 2 32 25 40 41 41.7 152 153 154 23.4 24 24.1 1 1 30
179 5206021601980001 IKAWULANDARI JAHART 45 TUMPU 3 2 22 30 45 45.6 46 150 151 152 22 23.1 23.6 2 1 30
180 5206024104941008 NURWAHIDAH 44 TUMPU 13 8 24 24 44 45.1 46 147 148 149 22 23.3 23.4 1 1 30
181 5206025601930001 NURINTAN 49 TUMPU 8 1 27 32 49 50 51 154 155 156 23 23.6 24 3 1 30
182 5206026608910004 NURHAYATI 48 TUMPU 13 3 28 20 48 49 50 152 153 154 23 23.7 24 2 1 30
12 DESA NGGEMBE
183 5206024707901009 HADIJAHUSMAN 40 NGGEMBE 16 29 26 40 41 41.8 148 148 149 22.3 23 23.6 2 1 30
184 5206022302040001 IMA PUTRI KAHARUDIN 46 NGGEMBE 1 19 26 46 46.5 47 151 151 151 22.6 23 23.3 1 1 30
185 5206025504870005 SRI RAHMAWATI 39 NGGEMBE 8 31 7 39 39.4 40 152 152 152 23 23.5 23.9 2 1 30
186 5206155507951002 NURSIDA ABAS 43 NGGEMBE 8 23 10 43 44 44.8 153 153 153 23.2 23.6 24 1 1 30
187 5205044506890004 LENI MARLINA 45 NGGEMBE 1 8 31 12 45 46 46.6 154 154 155 23.1 23.4 24 1 1 30
188 5206024301841004 NURLENI 40 NGGEMBE 19 4 36 20 40 41 42 151 151 152 22 23 23.2 1 1 20
189 5206025004870002 SITI NUR 55 NGGEMBE 18 5 33 24 55 55.4 56 152 152 153 23.2 23.5 24 1 1 30
190 5206020509860001 MASDAR 54 NGGEMBE 18 5 34 30 54 54.4 55 155 155 156 23 23.2 24 1 1 20
191 5206027107970002 YENI MARYANI 40 NGGEMBE 3 1 29 20 40 41 41.8 148 148 149 22.3 23 23.6 2 1 20
192 5206024106890002 EKA RAHMAWATI 46 NGGEMBE 2 1 19 32 46 46.5 47 151 151 151 22.6 23 23.3 2 1 20
193 5206186210920001 FAUJIAH 39 NGGEMBE 1 1 31 28 39 39.4 40 152 152 152 23 23.5 23.9 2 1 20
194 5206025312930001 RENIKUSMIYANTI 43 NGGEMBE 1 1 23 12 43 44 44.8 153 153 153 23.2 23.6 24 2 1 20
195 3601264203920001 INTAN PUSPITA 45 NGGEMBE 2 1 31 10 45 46 46.6 154 154 155 23.1 23.4 24 2 1 20
196 5206024107721273 NURHAYATI 40 NGGEMBE 3 1 36 12 40 41 42 151 151 152 22 23 23.2 4 1 20
197 5206024107851245 DEWIYANTI 55 NGGEMBE 12 2 33 20 55 55.4 56 152 152 153 23.2 23.5 24 4 1 20
198 5206026401800001 SIFATURAHMAN 54 NGGEMBE 11 2 30 24 54 54.4 55 155 155 156 23 23.2 24 1 1 20
199 5206157112831027 ENDANG KUSMIATI 48 NGGEMBE 7 2 36 30 48 49 51 150 150.2 150.4 22 23.1 23.7 1 1 20
13 DESA DARUSALAM 20
200 5206024903820004 SRI SUSILAWATI 50 DARUSALAM 5 4 38 20 50 51 51.4 153 153 153.2 23.4 23.6 23.9 5 1 30
201 ;5206024702921005 HARNI 47 DARUSALAM 1 1 27 20 47 48 48.8 150 150 150.3 23.5 24 24 2 1 30
202 5206024107801286 ASMAH ARIF 39 DARUSALAM 2 1 39 19 39 40 41 150 150 150.2 23.5 24 24 1 1 30
203 5371027004910003 WASIATUL HARISMAN 50 DARUSALAM 6 3 28 13 50 51 52 155 155 155.4 23 23.5 23.5 1 1 30
204 5206025605920001 KARTINI 40 DARUSALAM 6 3 28 17 40 41 42.2 155 155 155.6 22 22.5 23 2 1 30
205 5206024708820001 NURWAHIDAH 43 DARUSALAM 6 3 25 17 43 43.5 44 155 155.3 156 22 22.5 23 3 1 30
206 5206025810950001 NOVI INRASARI 45 DARUSALAM 2 1 25 32 45 45 45.7 147 147.5 148 23 23.3 23.5 2 1 30
207 5206077009970003 SURYANTI IKBAL 48 DARUSALAM 6 3 22 30 48 48.4 49 153 153.4 154 23 23 23.5 1 1 30
14 DESA KARA
208 5206137112951012 NURJANNAH 35 KARA 2 1 24 6 35 36 37 145 145 146 21.5 21.5 22 1 1 30
209 5206026907950002 ASTIAWATIK 34 KARA 1 1 24 10 34 35 36 145 145 146 18 18 19 1 1 30
210 5206026707931003 TURAYA 45 KARA 4 2 25 10 45 47 48 152 152 153 23.4 23.4 24 2 1 30
211 5272024510880005 RIRIN INRAYANI 48 KARA 1 1 32 10 48 49 50 150 150 151 23.4 23.4 24 4 1 30
212 5206137112951012 NURHASANAH 46 KARA 2 1 25 10 46 48 49 156 156 156 23.2 23.2 23.8 2 1 30
213 5206024203820002 SYAMSIAH 47 KARA 2 1 38 6 47 48 49 162 162 163 23.4 23.4 24 4 1 30
214 5206134511970002 FITRIANI 38 KARA 2 1 22 4 38 39 40 155 155 156 19 20 22 2 1 30
5206024107021194 NOFITA 47 KARA 5 2 29 12 47 53 54 157 157 157.5 22.8 23 23.8 6 1 30
 FORMULIR ISIAN DAFTAR PENERIMA PEMBERIAN MAKANAN TAMBAHAN (PMT) BALITA
DARI PROVINSI WILAYAH UPT PUSKESMAS BOLO TAHUN 2019
PROVINSI: NUSATENGGARA BARAT
BULAN : MARET
KABUPATEN: BIMA
PUSKESMAS: BOLO
BERAT BADAN (KG) TINGGI BADAN (CM)
BERAT
ANAK TANGGAL LAHIR JENIS NO TLP/HP ORANG TANGGAL
NO NO. NIK KTP/SIM NAMA ANAK KE KELAMIN BADAN NAMA AYAH NIK ORANG TUA TUA ALAMAT RT RW PENGUKURAN KET
LAHIR (KG) I II II I II II

I DESA NGGEMBE
1 5206022903180001 M. ALBARAK 2 3/29/2018 L 2,4 IWAN KURNIAWAN 5206020410950003 08533717250 NGGEMBE 5 3 3/24/2019 8 8.1 8.5 72 72 72.1
2 5206022707150001 FAKIH 2 7/27/2015 L 2,6 JUNAEDIN 5206020901800004 08533717250 NGGEMBE 14 3 3/25/2019 10 10.2 10.4 90 90 91
3 5206027110150001 MUTIAH 1 1/3/2015 P 4,1 SAHRIR 5206022403900002 08533717250 NGGEMBE 15 3 3/26/2019 11 11.2 11.4 89 89 90
4 5206255091400002 PUTRI NAILA 2 9/15/2014 P M RUN 5206021028600003 08533717250 NGGEMBE 3/27/2019 12.2 12.2 12.5 93
5 AMELIA 2 10/4/2015 P 08533717250 NGGEMBE 3/28/2019 10.5 10.7 10.9 93
6 5206024101150001 KALISA PUTRI 3 1/1/2015 P 2.7 ARIFUDIN 5206024101150001 08533717250 NGGEMBE 6 6 3/29/2019 11.4 11.7 11.9 93
7 WAHYU RAHMAN 4 2/10/2017 L 2.5 EFIYANTO 5206120302811008 08533717250 NGGEMBE 6 6 3/30/2019 8.3 8.4 8.5 87 87 88
8 52060200212160001 ZAKIR 2 12/2/2016 L 2.5 IRFAN 5206020107841250 08533717250 NGGEMBE 6 6 3/31/2019 9 10.2 10.4 82 82 82
9 5206027107170002 ATIKAH 3 7/31/2017 P 2.8 JUMRAH 5206021205870004 08533717250 NGGEMBE 1 1 4/1/2019 9.4 9.5 9.7 79
10 5206023703160001 JAKIRA 2 3/17/2016 P 2.6 WAWAN 5206021001851009 08533717250 NGGEMBE 2 1 4/2/2019 10.7 10.3 11 77 77 78
11 FAHIRA FILJAN 1 2/20/2018 P 2.7 AMIRUDIN 08533717250 NGGEMBE 6 3 4/3/2019 5.7 6 6.1 68 68 69
12 AIRIN KHUMAIRAH 2 2/3/2016 P 2.7 MUHTAR 08533717250 NGGEMBE 4 5 4/4/2019 8 9 9.5 86 86 86
13 MUHAMMAD MUHAIMIN 2 14/02/2017 L 2.6 ARFAH 08533717250 NGGEMBE 3 2 4/5/2019 7.4 8 8.7 80.6 80.6 80.6
14 AURA APRIANINGSIH 1 17/04/2017 P 3.2 SYAFRUDIN 08533717250 NGGEMBE 2 1 4/6/2019 8.7 9 9.4 80 80 80

2 DESA RATO
1 5206021705170002 Nabil 2 5/17/2017 L 2.5 Agus Riyadi 5206021408810001 RATO 12 6 3/27/2019 8.4 8.5 8.8 77 77 77
2 5206024604180001 Ifra Mikaila 2 4/6/2018 L Risman RATO 10 5 3/28/2019 7 7.5 8 71 71 71
3 Izul Alfadeh 2 2/14/2018 L 2.9 Ahmad St Nur RATO 4 2 3/29/2019 7 7.5 8 72 72 72
4 5206021611100011 M. Putra Ardiansah 3 12/12/2017 L 3.1 A. Haris 520602103800002 RATO 7 4 3/30/2019 8.2 8.6 9 74 74 74
5 5206031301180002 Muh. Ridho 4 12/31/2018 L 3 Artoyo Sukma 5206030709993104 RATO 7 4 3/31/2019 8.2 8.6 9.7 84 84 84
6 5206022806170001 M. Nabil 2 6/28/2017 L 3.3 Wawandar Eka M 52060217001850001 RATO 7 4 4/1/2019 7.7 8 8.4 68 68 68
7 Alif Ramdhan 1 5/26/2018 L 2.7 M. Nasir 5206020101830003 RATO 2 2 4/2/2019 8.2 8.4 8.8 77 82.6 82.6
8 5206023012170001 M. Ramzan Zahiri Maliki 1 12/30/2017 L 2 Yahdi Maya Sari 5206022106801002 RATO 5 4 4/3/2019 8.5 8.2 8.7 82.6 82.6 82.6
9 5206021809160001 Mifzal Qajan Zhafiri 1 9/16/2016 L 3.4 Nurhariwati Edi kUr 5206020808820001 RATO 9 6 4/4/2019 8.1 8.4 8.9 78.4 78.4 78.4
10 5206026411170001 Nurazizah 3 11/24/2017 P 2.5 Burhan Rosdiana 5206023112841017 RATO 9 5 4/5/2019 7.4 7.6 7.8 89 89 90
11 5206021212170001 M. Putra Ardiansah 3 12/12/2017 L 3 Abd. Haris Dewi 5206021003800002 RATO 9 5 4/6/2019 6.4 6.6 6.8 72 72 73
12 52006027103170001 nurjumiatin 2 3/31/2018 P 2.5 Syaiful Hasan Nita 5206020606900006 RATO 11 5 4/7/2019 8.7 9 9.3 75 75 75
13 Alfin Nurahma 3 8/9/2016 L 2.4 Sadakah Asmah 5206020107771234 RATO 4 2 4/8/2019 10.2 10.8 11 96 96 96
14 Dafa Maulana 4 2/11/2018 L 2.3 RATO 11 5 4/9/2019 9 9.4 9.8 83 83 83
15 5206026807160003 Dwi Juliyanti 1 7/28/2016 p 2.7 Khaerul Asri 1603120107860092 RATO 4 5 4/10/2019 9.2 9.4 9.5 89 89 90
3 DESA LEU
1 M. Afif Riski 1 7/22/2017 L 2.6 Juli Setiawan 5206021007930001 85338082269 LEU 12 5 3/28/2019 8.5 8.7 9 80 80 80
2 M. Syahril
5206020211120003 1 8/24/2017 L 2.5 Heryanto 5206022001790002 0 LEU 5 2 3/29/2019 8 8.5 9.2 89 89 89
3 5206022705170002 M. Riski Ramadhan 2 5/27/2017 L 2.1 Suaidin 5206023112751036 0 LEU 5 2 3/30/2019 8 8.8 9.1 81 81 81
4 5206026212100001 Nazwa Dalila 4 12/22/2016 P 2.3 Adnan 5206022207770001 0 LEU 5 2 3/31/2019 6 6.5 7.1 76 76 76
5 5206026807160003 Dwi Juliyanti 1 7/28/2016 P 3 Khaerul Asri 1603120107860092 0 LEU 5 2 4/1/2019 6 6.4 7 78 78 78
6 5206020560540025 Sahidatun 4 12/11/2017 P 2.5 Abd. Farid 5206020502891004 0 LEU 9 4 4/2/2019 8.6 9 9.4 91 91 91
7 5206021111100024 Akhsan Akhirul R 1 10/13/2016 P 3.2 Heriyanto 6408161112780001 0 LEU 12 5 4/3/2019 9.9 10.2 10.7 79 79 79
8 5206022403100001 Elfita Khaerani 1 3/25/2016 P 3 Ishaka 5206021707861002 LEU 12 5 4/4/2019 10.5 10.7 10.8 80 80 80
9 520505107800496 M. Alferi 1 15 bln L 3 Ridwan LEU 7 3 4/5/2019 8.0 8.2 8.4 80 80 80
10 5206026310160001 Miratil 2 10/23/2016 P 3 Supriadi 5206021901840003 0 LEU 1 1 4/6/2019 8.2 8.2 8.6 64 64 64
11 5206022601170001 Rizal M. Putra 1 1/26/2017 L 2.7 Nurmala 5206025203791002 0 LEU 4 2 4/7/2019 9 10.6 11 86 86 86
12 5206021811170001 M. Alif 1 11/18/2017 L 2.4 Asikin 5206020706800001 0 LEU 3 2 4/8/2019 8 9.2 9.7 77 77 77
13 5206020911160001 M. Rizki 2 11/9/2016 P 2.4 Jaidun 5206021010871002 0 LEU 3 2 4/9/2019 8.2 8.5 9 77 77 77
14 5206022404110049 Aisyah Gina putri 1 6/3/2016 P 2.4 Mustamin 5206020107811218 82341512273 LEU 4 4 4/10/2019 8.5 9.9 10 76 76 76
 2 1 6.5 7 7.2 72 72 72
4 SANOLO
1 SANDI MAULANA 1 11/15/2015 L 2.6 ALDI 0 SANOLO 5 2 5/3/2019 8.6 8.8 9 68 68 68
2 FITRATUL ADIBA 3 1/4/2017 P 2.8 TAMRIN 0 SANOLO 5 2 5/4/2019 7.1 7.3 7.5 70 70 70
3 NURANISA FATWA 16/4/2016 P NURSIA SANOLO 5/5/2019
4 ARIF KURAHMAN 2/4/2016 L SUHERMAN SANOLO 5/6/2019
5 ARTA NABIL 3 17/4/2017 L 3 ILHAM 0 SANOLO 5 2 5/7/2019 9 9.6 9.7 81 81 81
6 MUH ISLAM ALFARIJI 3 25/7/2017 L 1.1 JUNAIDIN 0 SANOLO 4 1 5/8/2019 6.4 7 7.2 64 64 64
7 5206025912170001 Sri Sulastri 1 12/19/2017 P 2.6 Bambang 520602609840009 0 SANOLO 7 3 5/9/2019 8.2 9.2 10 78.3 78.3 78.3
8 5206024508160002 Nurdaniah 2 8/5/2016 P 2.5 Jaidin 520602060851009 0 SANOLO 3 2 5/10/2019 7.9 8.5 8.7 78 78 78

5 DESA RASABOU
1 520602600210002 ZILFANAZIAH 3 2/20/2018 P 3 FAHRUDIN 5206020503850000 RASABOU 14 3 2/4/2019 7.1 8.2 8.3 69 69 70
2 5206020112100015 AWALUL RAF'AH 3 5/14/2017 L 2.6 AMIRUDIN 52060202830001 RASABOU 9 1 2/5/2019 8.5 8.6 8.8 81.2 81.2 81.2
3 5206026109170002 IFRAH MIKAILA 2 9/21/2017 L 2.4 M YAMIN 5206020107871290 RASABOU 9 1 2/6/2019 6.5 6.8 7 65 65 66
4 ALIKA 3 3/28/2017 P 2.8 ALFUKORIMA 5206021406790000 RASABOU 10 3 2/7/2019 8.7 8.8 9.0 84 84 84
5 5206020084160001 M RAFLI 2 4/8/2016 L 2.5 ILIYAS 5206020107861240 RASABOU 10 3 2/8/2019 9.5 9.6 9.8 79 79 80
6 5206025603170002 NURUL ISTIQOMAH 3 3/16/2017 P 2.7 AHARIS 5206020107791300 RASABOU 10 3 2/9/2019 6.5 7.1 7.2 70 70 71
7 5206002603170001 M AL YUFRAN 1 3/28/2017 L 2.6 RASABOU 2 1 2/10/2019 7.4 7.5 7.8 76 76 76
6 TIMU
1 520602304180009 RAFA RAMADhAN 1 6/11/2017 L 2.3 SUAEDIN 5020602091090001 TIMU 12 8 2/6/2019 7.4 8.4 9.6 80 80 80
2 5206022281008005 SYAHIDIN FAJA 3 12/12/2017 L 2.5 SYAEFUL 5206020107731139 TIMU 8 6 2/7/2019 7 7.2 7.4 70 70 71
3 5206022104170002 M AWALUDIN 1 11/21/2017 L 3 AGUSTIAN 5206020107941175 TIMU 9 1 2/8/2019 7.4 8 8.5 68 68 68
4 0002443359249 SILMI ALFATUNNISA 1 3/24/2018 P 2.7 SUKARDIN 5206025301800001 TIMU 11 5 2/9/2019 7 7.2 7.6 76.2 76.2 76.2
5 5206020104110016 M AJRIL 2 4/4/2018 L 3 IBRAHIM 50206021103801003 TIMU 5 3 2/10/2019 9 9.4 9.6 81 81 81
6 5206025710170001 MARYAM 1 10/9/2017 P 3.6 INDRAINSYAH 5206025204870002 TIMU 14 1 2/11/2019 8.2 7.9 8.2 70 70 70
7 5206020404170003 PUTRA RISMIAWAN 3 4/4/2017 L 2.7 MULYADIN 5206020505830005 TIMU 6 3 2/12/2019 8.4 8.8 9.1 80 80 80

7 DESA TAMBE
1 MIRAATIL HAYATI 1 23/10/2016 P 2.4 MIRATIL HAYATI 85337742420 TAMBE 5 2 3/14/2019 6.6 6.9 7.2 63.5 63.5 63.5
2 M. RENDI 1 25/7/2016 L 3 M RENDI 82236842440 TAMBE 7 15 3/15/2019 7.5 7.8 8 70.6 70.6 70.6
3 AKILA 1 24/9/2017 P 2.6 AKILA 0 TAMBE 1 1 3/16/2019 8 8.4 8.9 78 78 78
4 M ZIDAN ALGIFAR 2 26/6/2016 L 2.8 HASAN 0 TAMBE 9 5 3/17/2019 8 8.7 7.5 73 73 73 MENCRET
5 RAMADHAN 5 24/6/2016 L 2.7 USMAN 0 TAMBE 13 7 3/18/2019 8 9 8.5 75.6 75.6 75.6 MENCRET
6 FIRA RAMADHAN 1 30/6/2016 P 2.5 AHARIS 0 TAMBE 16 7 3/19/2019 8 8.8 8.9 76 76 76
7 HARUN A RASYID 3 9/2/2017 L 2.5 SUKIMAN 0 TAMBE 15 7 3/20/2019 7 7.9 8.3 74 74 74
8 NURBILKIS 3 4/1/2017 P 2.6 85253863182 TAMBE 15 7 3/21/2019 7 7.5 7.8 72 72 72
9 5206024612170002 YUYUN SYAFITRI 1 12/6/2017 P 2.5 NOVITA WULANDAR5206024107001246 0 TAMBE MEKAR 3 2 3/22/2019 8 8.2 8.4 66 66 66
10 5206025101160002 INTAN PERMATASARI 2 1/11/2016 P 2.4 Ahmad 5206022001870001 0 3 2 3/23/2019 8.6 9.1 9.5 82 82 82
11 NASRUL 1 6/21/2017 L 1.5 PUTRA 5206022003781002 0 14 6 3/24/2019 10.2 10.7 11.2 82.4 82.4 82.4
12 PUTRI ALIQA 1 4/21/2017 P 2.6 RIAN 5206020610900002 0 11 6 3/25/2019 10.7 10.7 9.7 84.3 84.3 84.3 PANAS
13 GIAN ADITIA ARDANI 3 10/30/2016 L 3 ABDURAHMAN 5206020207821025 0 13 4 3/26/2019 8 8.7 9.7 75.2 75.2 75.2
14 AINUN ZARIYAH 1 10/24/2017 P 2.7 FERDIAN 5206020107951224 0 17 5 3/27/2019 7.3 7.5 7.8 68.5 68.5 68.5
15 ADIRA 1 12/18/2017 P 2.7 RANO 0 19 8 3/28/2019 7.2 7.6 7.9 70.1 70.1 70.1
16 5206021909180025 NABIL SYPUTRA 2 9/4/2017 L 2.5 M NOR 520613003980001 0 SEDAP MALAM 2 1 3/29/2019 8.3 9.7 9.7 80 80 80
17 OJIL KURNIAWAN 4 11/29/2017 L 2.5 AHMAD 5206020107871236 82145140082 SEPAKAT 1 1 3/30/2019 8.2 8.7 8.9 76 76 76
18 5206021804110192 RAMDANI 2 7/12/2017 P 2.8 A. HARIS 520602017841264 0 TAMBE 9 2 3/31/2019 6 6.4 6.9 67.6 67.6 67.6
19 NURMALA 9/3/2016 P SYARUDIN 5206020107860002 TAMBE 4/1/2019
20 MUJAHIR 7/24/2017 L MUHLIS 5272012402810001 TAMBE 4/2/2019
21 5206026605180001 MEISYAH RAMDANI 2 5/26/2018 P 3 M ABAS 5206020407740001 0 TAMBE 5 3 4/3/2019 11 11.9 12.4 97 97 97

8 DESA SONDOSIA
1 5206021912110006 M ADRAN SADIKIN 2 3/5/2017 L 2.8 syafrudin 5206022708820001 0 SONDOSIA 8 4 4/4/2019 6.5 6.6 7.5 70 70.5 70.5
2 5206022012100027 ERKAN 3 5/4/2018 l 3 JAERIN 5206022405790001 0 SONDOSIA 8 4 8.1 8.5 8.9 76 76 76
3 5206022707160001 M RAHIMAN 1 7/27/2016 p 2.6 SUFRIN 5206020107891349 0 SONDOSIA 4 2 8 8.6 8.9 74 74 74
4 5206025112160001 FARADILLAH 2 12/11/2016 p 3.4 SUWARDIN 5206020205840005 0 SONDOSIA 4 2 9 9.9 10 81 82 83.5
5 NURAFIJAH 3 1/23/2017 P 3.2 IBRAHIM 5206020107701178 82341992037 SONDOSIA 6 3 9 9.4 9.7 75.3 75.3 75.3
6 HIDAYAH 2 3/4/2017 P 2.6 SINTA 5206024101931007 0 SONDOSIA 6 3 6 6.3 6.9 69 69 69
7 MIKA CANTIKA 1 4/13/2017 P 2.5 ST. RUBIAH 5206026805970002 85338973305 SONDOSIA 6 3 8.2 8.6 8.9 76 76 76
8 AKILA FEBRIANTI 1 2/23/2018 P 3 RIDWAN 5206022103941003 SONDOSIA 6 3 8.8 9 9.2 74

9 DESA RADA
1 52060216002110017 PUTRI SAFRAN 3 2/25/2015 P YAMIN 85205745857 RADA 5 2 5/4/2019 9.1 9.2 9.5 89 89 90
2 KHAIRA 2 3/5/2017 P HERMAN 85337720466 3 1 8 8.2 8.5 78 78 79
3 AMZAR 3 7/2/2018 L EDI YANTO 0 2 1 7.8 8 8.2 80 80 81

10 DESA BONTOKAPE
1 ALIFANURUL R 2 5/25/2018 P 2.6 HERIYANTO 5206020204791005 85338292580 BONTOKAPE 3 2 6/5/2019 8 7.9 8.5 74 74 74
2 5206025406180001 ASIFA BILQIS 3 6/16/2018 P 2.8 IBRAHIM 527103140780003 0 BONTOKAPE 3 2 9.5 9.5 10 79 79 79
3 5206022804180002 M AHTAR 2 8/28/2018 L 4 HUSNI MUBARAK 5206021103861002 85237264889 BONTOKAPE 3 2 10.1 10.5 11 82 82 82
4 5206020607170002 M. FITRAH 4 7/6/2017 L 2.7 MUHTAR 5206023112641057 0 BONTOKAPE 4 2 8.7 8.9 9.2 82 82 82
5 00025518573995 M AKBAR 2 5/4/2018 L 2.6 HERMAN 5206020511901002 0 BONTOKAPE 1 1 8.9 9.2 9.7 82.4 82.4 82.4
6 5206022404180001 AJKAR RISKI 4 4/24/2018 L 2.4 ABDUL HARIS 5206022606870002 0 BONTOKAPE 6 3 11.9 12.1 13 98.7 98.7 98.7

11 DESA TUMPU
1 52060224211160002 nurijatun al fatin 4 11/2/2016 p 2.8 syahbudin 5206021505840001 0 TUMPU 13 3 7/5/2019 8.5 8.7 8.9 90 90 90
2 5206025310150001 nuraliah putri aisyah 3 10/13/2015 p 2.5 ilyas 5206020305830003 0 TUMPU 5 3 10.8 10.9 11 73 73 73
3 5206020512160004 afriansyah putra 2 12/5/2016 L 2.7 usman 5206022402840001 0 TUMPU 5 3 9.5 9.8 10 74 74 74
4 5206024708160002 muthiah putri 3 8/7/2016 p 2.4 yusuf 5206021204750002 85333942488 TUMPU 5 3 8.5 8.9 9.2 84 84 84
5 5206024203180001 hasibah ifhiah 2 3/2/2018 p 3.1 mahfud 5206130107911134 0 TUMPU 6 3 6.7 7 7.2 91 91 91
6 5206024603180002 nurfatir 2 3/6/2018 L 2.8 wahyudin 52060217077710004 0 TUMPU 6 3 7.5 7.7 7.9 70 70 70
7 5206025312150004 ALYA 2 12/13/2015 P 2.6 TAUFIK 5206112409897004 0 TUMPU 6 3 11 11.5 11.8 87.2 87.2 87.2
8 5206025312150004 sauki 2 10/1/2017 L 2.8 JUNAIDIN 5206021106891005 0 TUMPU 5 3 9 9.8 10 76 76 76

12 KARA
1 5206024201170001 ST NURUL SAFIRA 1 1/2/2017 P 2.8 ASRUL SANI 5206020408840002 82341478509 KARA 3 2 20/4/19 9.4 9.9 10.5 72
2 5206024401160001 RAFATUL ASUMA 1 1/4/2016 P 3.1 HUSNAINI 5206022102870001 KADER KARA 5 1 10.5 10.9 11 85
3 5206021202180001 M.RISKI 1 2/12/2018 L 3 IMRAN 5206022407921001 KARA 3 2 8.0 8.9 9.0 65
4 5206020104170001 M. TAUFIK 1 4/1/2017 L 2.9 FIRDAUSS 5206021807961003 KARA 4 2 9.7 10 10.5 75
5 BILAL 1 12/2/2016 L 3.0 KARA 1 1 9.0 9.5 10.2 65

13 DARUSALLAM
1 5206022206160002 BAHTIAR 2 6/22/2016 L 3 JUKARNAIN 5206021208880008 DARUSALLAM 6 3 2/3/2019 9 9.2 9.5 84
2 5206151606170002 HABIB RAHMAN 1 6/16/2017 L 3 SYUKRIN 5206150102901004 2 1 8.5 8.8 9 73
3 5206024507811002 KURNIATI 4 P 3.3 SYARIFUDIN 5206020107781300 6 3 8.0 8.2 8.4 76
4 520602280116003 SYAKIRAH R 1 6/14/2016 P 2.9 JULKIFLI 5206025406160001 4 2 10 10.2 10.4 86
5 5206020509166005 M.ARIZKI 1 6/4/2016 L 2.7 A.HARIS 5206021208831006 3 2 8.4 8.6 9 78
6 520602602260618005 KHAERUNNISA 1 8/24/2017 P 3 DEDIANSYAH 5206021505970004 14 2 7.9 8 8.2 77
7 5206021804110058 IMATUL ZAHRA 3 8/1/2016 P 3.5 IRWAN 5206021808800003 4 2 8.5 8.7 9 88

14 DESA KANANGA
1 5206022306170001 M.KHAERUL RAMADHA 1 6/23/2017 L 3.2 ARDIANSYAH 5206020808891007 TIMUKARA 11 5 23/7/19 7.4 8.5 8.7 77.5
JUMLAH DARI PKM : 11
JUMLAH DARI POSYANDU : 130
 PENCATATAN STOK PMT BALITA KURUS UPT PUSKESMAS BOLO TAHUN 2019
JUMLAH PMT DITERIMA JUMLAH PMT KELUAR SISA STOK PMT
NO TANGGAL
DUS KG DUS KG DUS KG
1 6/22/2018 424 4.076.48 424 4.076.48 0 0
2
3
4
5
6
7
8

catatan:
Pendistribusian PMT setiap tanggal 15 april 2017

PENCATATAN STOK PMT BUMIL KEK UPT PUSKESMAS BOLO TAHUN 2019
JUMLAH PMT DITERIMA JUMLAH PMT KELUAR SISA STOK PMT
NO TANGGAL
DUS KG DUS KG DUS KG
1 6/22/2018 17 17 17 17 0 0
2
3
4
5
6
7
8

Catatan:
Pendistribusian PMT setiap tanggal 15 sampai bulan berikutnya selama 3 bulan