Cangkring WUS

Format 1
HASIL KEGIATAN SKRINING DAN IMUNISASI TT WUS DI POSYANDU

POSYANDU : APEL 30 PUSKESMAS : JENGGAWAH
DESA / KELURAHAN : CANGKRING TAHUN : 2010
STATUS T AWAL (SAAT HASIL VAKSINASI TT
TGL TGL KUNJ PENDATAAN / DATANG
NO NAMA WUS NAMA ORTU / SUAMI PERTAMA KALI) WUS NON HAMIL WUS HAMIL
LAHIR WUS
NON HAMIL HAMIL T-1 T-2 T-3 T-4 T5 T-1 T-2 T-3 T-4 T5
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 Juahairiyah Madi 01/01/80 T4 06/06/11
2 Munawaroh Jon 16/03/82 T4
3 Hoseimah Ahmadi 03/07/75 T4 06/06/11
4 Aisah Salem 17/05/85 T4 06/06/11
5 Holifah M. Nasir 12/12/81 08/03/10 T4 08/03/10
6 Hosnul Khoirul 26/02/86 08/03/10 T4 08/03/10
7 Isdarlia Mu'i 11/07/85 T3 06/06/11
8 Sutik Rasek 25/03/80 08/03/10 T4 08/03/10
9 Hosniatun Sugianto 16/06/78 T4
10 Hotima Hanafi 25/05/75 T4
11 Sumriyah Mustofa 12/10/78 08/03/10 T4 08/03/10
12 Asiseh Ahmad Husin 25/02/81 T4
13 Mufliha Mustofa 01/06/80 T4
14 Holifah Rahem 01/04/78 T4
15 Sri Hidaiyah Rahem 12/01/80 T4
16 Siti Maisaroh Lutfi 11/05/81 08/03/10 T4 08/03/10
17 Wardatul H. M. Soleh 23/09/85 08/03/10 T4 08/03/10
18 Homsiyah Samsul H. 11/07/89 08/03/10 T4 08/03/10
19 Holifah Moyo 25/12/80 T4 06/06/11
20 Tatik Holek 16/04/81 T4
21 Lutsifiyah Saha 15/10/80 08/03/10 T4 08/03/10
22 Suryati Hanafi 28/07/85 T4
23 Tina Sucipto 22/11/80 T4
24 Nur Hayati Jaidi 14/07/82 08/03/10 T3 06/06/11 08/03/10
25 Ida Nawawi 15/04/78 08/03/10 T4 08/03/10
26 Maimunah Ahmad jalal 24/01/82 08/03/10 T4 08/03/10
27 Kutsiyah Bebun 10/05/81 T4 06/06/11
28 Ismaula Ulum 19/02/84 T4
29 Yuyun Abdul Holek 11/11/85 T4
30 Cici Faisal 19/02/80 T4
31 Zulaika Joko 17/01/75 T4
32 Yuliatin Mos 20/10/86 T4 06/06/11
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
33 Tumyati Hasan 11/02/88 08/03/10 T4 08/03/10
34 Maimunah Ahmad Arif 13/03/82 T4
35 Jum Slamet 14/10/80 08/03/10 T4 08/03/10
36 Suryati Mat 07/09/83 T4
37 Homsatun Warno 21/08/82 T4
38 Sunarmi Pai 22/01/82 08/03/10 T4 08/03/10
39 Yatinem Musni 11/06/86 T4
40 Kusyati Sutoyo 07/07/73 T4
41 Parmi Miski 19/01/78 T4
42 Ferawidiyati Abdullah 08/03/10 T4 08/03/10
43 Holis Martadi 10/05/85 08/03/10 T4 08/03/10
44 Tarmi Nurol 13/09/82 T4
45 Nurhafiyah Sunhaji 20/03/75 T4 06/06/11
46 Helmiyah Kholil 11/01/72 08/03/10 T4 08/03/10
47 Koimah Asmawi 10/09/80 T4
48 Filatul Aji 21/02/81 T4
49 Misyani Miski 10/10/83 T4
50 Siti Maisaroh Kayet 11/07/76 T4
51 Yanti Nahrawi 15/10/89 08/03/10 T4 08/03/10
52 Andriyani Supriadi 10/11/89 T3
53 Wahyuni Di 25/07/84 T4
54 Tima K. Agil 09/07/77 T4
55 Asiati Abdul HD 11/06/82 08/03/10 T4 08/03/10
56 Ponima Mundor 10/01/79 T4
57 Tumi Misyanto 23/04/76 T4
58 Faik Feri 11/12/85 T4
59 Ahyatun Toyyip 12/12/85 T4
60 Miswati Usi 10/03/77 T4
61 Irmawati Sulton 30/05/91 T3 06/06/11
62 Sulastri Sutrisno 11/06/92 08/03/10 T4 08/03/10
63 Nanik Senol 15/03/88 T3
64 Tipah Seniman 14/07/86 T4
65 Asiati Ahmad Hadi 25/05/80 T4
66 Rupik Dulhari 16/06/78 T4
67 Napsiyah Widodo 10/10/60 08/03/10 T4 08/03/10
68 Siti Komariyah Andi 15/02/83 08/03/10 T4 08/03/10
69 Lasmi Halem 11/10/79 T4
70 Siti Ersad 06/12/76 08/03/10 T4 08/03/10
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
71 Fatimah Sulaiman 30/09/80 T4
72 Tini Hariyanto 25/02/80 T4
73 Muslimah Sonhaji 11/06/91 08/03/10 T3 08/03/10
74 Fitria Samsuri 17/01/93 T3
75 Ike Jalal 12/12/93 T3
76 Istiqomah P. afandi 10/01/90 T4 06/06/11
77 Fitria P. Mudai 13/04/91 T3
78 Nasifah Tawi 17/09/89 T4
79 Wardatul H. P. Farok 11/12/93 T3
80 Lim Holip 10/10/91 08/03/10 T4 08/03/10
81 Heni Holil 20/04/82 08/03/10 T4 08/03/10
82 Sania Bungkus 17/08/75 08/03/10 T4 08/03/10
83 Sukenti Ahmad 10/04/65 08/03/10 T4 08/03/10
84 Minarti Sugiyono 11/11/90 08/03/10 T4 08/03/10 04/06/14
85 Dewi Ahmad 12/01/65 08/03/10 T4 08/03/10
86 Hafidah Liantoro 17 th 04/11/13 T3 04/02/14
87 Husnul Hotimah Yanto 21 th 06/01/14 T4 04/02/14
88 Sri Tutik Asmat 37 th 06/01/14 T4 04/02/14
89 Yuliana A.Husen 31 th 13/01/14 T4 04/02/14
90 Dila sofia A.Yani 24 th 06/03/14 T3 08/04/14
91 eka yuliatin A.Mustofa 23 th 05/05/14 T3 04/06/14
92 ST Aisah winarto 20 th 06/06/14 T4 08/09/14
93 sri wahyuni M. holik 25 th 14/07/14 T3
94 Devi nurhayati Samsul arifin 18 th 04/10/14 T3 06/10/14
95 suryati m0hal 28 th 15/11/14 T3
95 JUMLAH T0 0 0 0 0 0 2 9 0 0 0 0 0
T1 0 0
T2 0 0 PEMAKAIAN LOGISTIK ……………., ………………….20….
T3 8 8 VAKSIN Pelaksana Imunisasi/bidan,
T4 68 11 ADS 0,5 ML 11
Penjelasan : T5 0 0 SAFETY BOX
Kolom 5 : isilah tgl, bulan dan tahun saat kedatangan atau kunjungan WUS ke petugas kesehatan / sarana kesehatan
Kolom 6-7 : Isilah status TT WUS sesuai hasil pendataan (wawancara), misalnya : T0, T1, T2, T3, T4, T5 (………………………………….. )
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Kolom 8-12 : isilah tgl, bulan dan tahun vaksinasi TT saat ini, khusus untuk WUS yang sedang tidak
NIP :
hamil
Format 1
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 Sabiye Jalil/Sugiman 11/10/72 15/12/09 T1
2 Dewi Nurholila Sugiman/Alif 01/09/86 15/12/09 T3
3 Nati Misdi/Saber 01/07/67 17/03/10 T2 17/03/10
4 Suami Muhali/Kadir 01/07/67 15/12/09 T2
5 Maryati Kadir 09/03/91 15/12/09 T3
6 Sofiah Mahmudi/Kadir 11/12/81 17/03/10 T3 17/03/10
7 Minati Tohed/Samsul 01/01/60 15/12/09 T3
8 Fatimah Kasmuri/Dahlan 08/02/70 15/12/09 T1
9 Suibah Arjo/Ahmad Zaini 01/07/75 15/12/09 T3
10 Rizalatul M. Ahmad/Zaini 01/07/95 17/03/10 T2 17/03/10
11 Unsia Sahabudin/Imam M. 09/04/72 17/03/10 T2 17/03/10
12 Parti Holila Imam Mahrus 06/12/98 15/12/09 T3
13 Holifah Suadi/Abdullah 06/01/71 17/03/10 T1 17/03/10
14 Helmi Abdullah 03/05/93 15/12/09 T3
15 Uswatun Abdullah 01/06/98 15/12/09 T3
16 Siti Maimunah Mukimin/Sidiq 05/06/75 15/12/09 T3
17 Sri Indahyani Supardin/Edi H 10/10/76 15/12/09 T4
18 Rahmi Sale/Samsuri 02/06/65 15/12/09 T2
19 Farida Samsuri/Sugianto 03/01/84 15/12/09 T3
20 Busiya Dahlan/Supardi 10/04/70 15/12/09 T2
21 Sulha Muali/Bari 05/07/60 15/12/09 T2
22 Suti Jamal/Rifin 01/12/72 15/12/09 T2
23 Sumi Johar/Suyono 06/01/65 15/12/09 T2
24 Nur Asia Suyono/M. eko 01/12/91 15/12/09 T3
25 Purwati Moyo/Busiri 18/02/83 15/12/09 T3
26 Ni Hajar 01/07/62 15/12/09 T1
27 Hidayati Suparman/Saturi 01/09/87 17/03/10 T2 17/03/10 07/06/11
28 Holila Romla/Ahmad Fauzi 10/02/85 17/03/10 T1 17/03/10
29 Herlin F. Heriyanto/Ilman 13/05/88 15/12/09 T3
30 Eli Kurnia Samsul/Edi 30/06/80 17/03/10 T2 17/03/10 07/06/11
31 Muklipa Sanokdek/Narsari 01/07/67 15/12/09 T1
32 Mina Nursari 15/12/09 T1
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
33 Soleha Misran 03/01/86 15/12/09 T1
34 Niwati Jamhar/Sukarjo 03/03/65 15/12/09 T2
35 Kiptiyah Noto/H. Abdul Salim 06/04/63 15/12/09 T2
36 Subaida Usman/Takdir 03/11/79 15/12/09 T2
37 Heriyati Kadir/Abdul Aziz 03/05/71 15/12/09 T2
38 Asfiatus S. Abdul Halim/Rohim 20/07/88 17/03/10 T2 17/03/10
39 Siti Fitriana Ahmad/Abdul Bari 15/06/83 15/12/09 T2
40 Sumiati Sale/Suwondo 30/03/81 15/12/09 T3 07/06/11
41 Siama Ahmad/Suparman 02/12/65 15/12/09 T2
42 Betti Hasanah Suparman 20/05/91 15/12/09 T3
43 Andriyani Suparman 12/06/93 15/12/09 T3
44 Sunarti Seniman/Holek 01/07/72 15/12/09 T1
45 Tutik Hamsah Abdul Bari/Nurkolis 15/08/84 15/12/09 T2
46 Sri Wahyuni Irsad 12/07/93 17/03/10 T1 17/03/10
47 Tuni Suhardi 25/08/87 15/12/09 T1
48 Hotim Dulbari 07/06/67 15/12/09 T2
49 Siti Shofiatul Asan 29/12/88 15/12/09 T2
50 Saini Kacung/Purwadi 02/01/75 15/12/09 T3
51 Romlah Misnadi/Suryadi 06/10/76 15/12/09 T3
52 Manisa Adus/Kusnadi 01/05/71 15/12/09 T3
53 Ita Kusnadi 09/04/75 15/12/09 T3 07/06/11
54 Ponira Di/Adus 08/08/68 15/12/09 T4
55 Manisa Samsul/Edi 05/07/56 15/12/09 T4
56 Siani Anan 11/09/80 15/12/09 T4
57 Tumina Jeri/Sadriye 11/09/73 15/12/09 T4
58 Hanipa Samo/Suliman 10/07/59 15/12/09 T4
59 Halimatus Sakdiyah Suliman 18/04/92 15/12/09 T2
60 Suriya Rafiq/Hasan 11/04/68 15/12/09 T4
61 Hanipa Hasan/Sugiono 20/03/88 15/12/09 T3 07/06/11
62 Kusyati Endun/Buyani 17/01/69 15/12/09 T4
63 Hotija Buyani 01/01/90 15/12/09 T3
64 Holila Buyani 05/07/91 15/12/09 T3
65 Holia Buyani 05/04/94 15/12/09
66 Busia Dijen/Muhtar 25/01/67 15/12/09
67 Hanipa Muftar/Sale 11/07/76 15/12/09
68 Sri wilujeng Sudiono 15/12/09
69 Dewi Sudiono 15/12/09
70 Sari Sudiono 15/12/09
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
71 Mina Dijen/Mat Sale 20/04/65 17/03/10 T0 17/03/10
72 Sofiah Begiso/Hariyadi 02/04/94 15/12/09
73 Sitina Nasib/Surib 07/04/62 15/12/09
74 Poniati Surib/Fendi 20/02/80 15/12/09
75 Sri Wahyuni Fendi 21/05/94 15/12/09
76 Sumiati Sunarmi/Subur 01/04/70 17/03/10 T0 17/03/10
77 Sumiati Maya dewi Subur 12/02/82 15/12/09
78 Tima Jesek/Rusik 01/07/69 17/03/10 T0 17/03/10 07/06/11
79 Nisa Niro/Muhamad 23/03/68 15/12/09
80 Suliha Sardiman/Muri 17/06/63 15/12/09 T1
81 Sami Sardiman/Misto 01/07/73 15/12/09 T1
82 Rifatul hasanah Misto 15/01/96 15/12/09 T3 07/06/11
83 Maryam Busadin/Mahmud 03/11/75 15/12/09 T1
84 Maryam Saha/Eko 15/05/73 15/12/09 T2
85 Maimunah Toha/Ariman 14/06/86 15/12/09 T2
86 Maryam Saha 15/05/73 15/12/09 T2
87 Holila Maskur 01/07/92 15/12/09 T2
88 Nurhalima Sarip/Niser 20/05/68 15/12/09 T1
89 Yeni Niser 01/02/87 15/12/09 T2
90 Faida Niser 07/09/93 15/12/09 T4
91 Misrifa Absadin/Junaidi 01/03/79 15/12/09 T2
92 Arnisa Namo/Sin 07/03/64 15/12/09 T1
93 Nasia Sin/Absadin 17/02/73 15/12/09 T2
94 Holwati Absadin 06/03/87 15/12/09 T4
95 Sargima Sardiman/Mahat 18/09/71 15/12/09 T2
96 In Mahat 05/08/96 15/12/09 T2 07/06/11
97 Dianiluh Injan Imam Sujani/Faisal 13/08/78 15/12/09 T4 07/06/11
98 Fitria Samanhadi/Marsuki 05/07/84 17/03/10 T4 17/03/10
99 Amalia Samanhadi/Heri 10/11/75 15/12/09 T4 07/06/11
100 Misdi Saman 01/12/56 15/12/09 T4 07/06/11
101 Asia Ali/Ahmad Zaini 01/07/83 15/12/09 T3
102 Leha Suradi/Sali 08/07/72 15/12/09 T4
103 Asia Angwari/Saidi 01/07/84 15/12/09 T3
104 Sutri Angwari/Edi 01/07/89 15/12/09 T3
105 Leha Ali/Rianso 30/06/80 15/12/09 T3
106 Saoda Busia/Aziz 01/07/84 15/12/09 T3
107 Maryati Kadi/Sugito 07/07/82 15/12/09 T3
108 lamina Kadi/P. Edi 20/08/71 15/12/09 T4
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
109 Dwi Citra Yulia Purnomo/Yusuf W. 17/07/76 15/12/09 T4
110 Wiwik Mulyadi 08/06/69 15/12/09 T4 07/06/11
111 Imroatul Mulyadi/Baihaki 17/07/80 15/12/09 T4
112 Jati Suradi/Senadin 01/07/68 15/12/09 T4
113 Sadini Suradi 1968 15/12/09 T4
114 Misnaya Su/Amin 1968 15/12/09 T4
115 Yani Sale 1990 15/12/09 T3
116 Juwita Asmawi/M. Sobri 21/01/83 17/03/10 T4 17/03/10
117 Sukarsih Tuki 20/02/59 15/12/09 T4
118 Setiani Ilyas/Sujoko 22/09/76 15/12/09 T4 07/06/11
119 Dwi juwita Sari Sujoko 17/06/96 15/12/09 T3
120 Sulastri Ilyas/Sujoko/Muni 1978 15/12/09 T4 07/06/11
121 Sumarlia Abdullah/Ustufa 1966 15/12/09 T4
122 Rahmi Sulistyana Ustufa 1990 15/12/09 T3 07/06/11
123 Sri Astutik Munasar/Zaenal A. 1975 17/03/10 T4 17/03/10
124 Sumiyatun Munasar/Antono 11/06/70 17/03/10 T4 17/03/10
125 Eka Diana Agustin antono 02/08/91 17/03/10 T3 17/03/10
126 Sumiyatun Jayudi/Abdullah 03/09/69 17/03/10 T4 17/03/10
127 Siti jamalia Abdullah 20/05/96 17/03/10 T4 17/03/10
128 Kutsiyeh Miski/Abdullah Mu'in 03/07/89 15/12/09 T4
129 Ahyati Lamra/Miski 1967 15/12/09 T3
130 Misnati Arbaiya/Niman 1984 15/12/09 T3
131 Rukmiyati Asmo/M. Holek 1982 15/12/09 T3
132 Aliyatun Seniwi/tayib 08/05/87 15/12/09 T3 07/06/11
133 Maryami Lamra/Natun 1965 15/12/09 T4
134 Samsini H. Latif/Munir 17/03/73 15/12/09 T4
135 Siti Aisah Munir 28/03/98 15/12/09 T3
136 B. robi'ah Takrik/Ponirun 1964 15/12/09 T3
137 Farida P. Hanaki 1980 15/12/09 T4
138 Hj. Sunaini Miskati/H. Holik 1966 15/12/09 T4
139 Hosnaini H. Holik/Mukti 30/12/79 15/12/09 T4
140 Arifatul Mukti 13/05/95 15/12/09 T3
141 Yuliantika Haderi/Karim 01/08/86 15/12/09 T4
142 Sunariya Painem/haderi 15/07/69 15/12/09 T4
143 Sanaya Senamo/Suardi 04/02/71 15/12/09 T4
144 Endang Nirup/Samsudi 10/07/80 15/12/09 T3
145 Elok Sri Handayani KosHariyanto/Ahmad 05/05/82 15/12/09 T4
146 Sri Hartatik Edi Suyono/Kushariyanto 17/12/59 15/12/09 T4
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
147 Suparmi Sujei/Untung 01/06/79 15/12/09 T4
148 Samina Tapa/Nawi 07/01/66 15/12/09 T4
149 Turina Sukarman/Marsudi 1973 15/12/09 T4 07/06/11
150 Tima Nasiha/Dulla 10/12/84 17/03/10 T1 17/03/10
151 Nidi Bunawi 05/12/82 15/12/09 T3
152 Sadi /Rasek 1965 15/12/09 T4
153 Sumiyati P. Nami/Nirup 1966 17/03/10 T1 17/03/10
154 Wesil Tapa/Toya 1992 15/12/09 T3
155 Kiptiya Surami 1969 15/12/09 T4
156 Vivin Atma/Suyanto 17/01/89 15/12/09 T4
157 Sadi Juma'i 1955 15/12/09 T1
158 Supartin Juma'i/Wahed 06/03/85 15/12/09 T3
159 Win Juma'i 01/07/93 15/12/09 T3 07/06/11
160 Sunarti Tosan/Jalil 01/07/63 15/12/09 T1
161 Rahmatus S. Jalil 21/11/90 15/12/09 T3
162 Miswati Dewi Jalil/Didik M. 26/10/84 15/12/09 T3
163 Sujeni Sukur 07/08/45 15/12/09 T1
164 Siti Maisaroh Jalil/Nurkholis 11/11/80 15/12/09 T3
165 Rofiah Buhari/Abdul Baki 15/05/75 15/12/09 T3
166 Siti maryamah Abdul baki 05/01/95 15/12/09 T4
167 Siti aminah Sunardi/Tomo 07/12/82 15/12/09 T3
168 Sahbatul Mukaromah Abdul baki/Rahmad 10/08/88 15/12/09 T4
169 Rina Sunaria 06/12/58 15/12/09 T3
170 Sunaria Buhari/Dali 11/08/57 15/12/09 T3
171 Halimah Halil/Ningrum 27/12/73 17/03/10 T4 17/03/10
172 Siamul hasanah Holil 09/12/84 17/03/10 T4 17/03/10
173 Asia Samsuri/Tohari 08/12/75 15/12/09 T4
174 Ika Agustin Tahari/M. Niri 17/08/90 15/12/09 T4
175 Toria Mistari/samsul 09/08/55 15/12/09 T3
176 Lasmini Samsul/Ali Mullah 10/04/89 15/12/09 T4
177 Samsini Samsul 12/03/93 15/12/09 T4
178 Tutik Hamsah Tosan/Jalil 12/07/88 15/12/09 T4
179 Misna M. Sutomo/Misbun 10/08/75 15/12/09 T4
180 Sudarmi Buhari 10/12/52 15/12/09 T3
181 Siti Fatimah Wahyudi 10/03/80 15/12/09 T4 07/06/11
182 Husnul hotimah Samsuri 10/08/73 15/03/10 T2 15/03/10 07/06/11
183 Ridatul Jannah Supriyanto 24/02/94 15/12/09 T4
184 Juwati Ningrum 07/07/59 15/12/09 T3
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
185 Anis Jamal 04/07/67 15/12/09 T3
186 Wakiyem P.Ti 11/04/45 15/12/09 T3
187 Maisaro Ahmad 12/02/87 15/12/09 T3
188 Misnati Budianto 05/10/73 15/12/09 T3
189 Hanifah Budianto 09/03/92 17/03/10 T4 15/03/10
190 Sulasih Lasio 14/07/69 15/12/09 T4
191 Renny Ronny 07/12/91 15/12/09 T4
192 Sumiyati Lasio/Suraji 22/02/66 15/12/09 T4
193 Indras Woro W. Suraji 16/09/91 15/12/09 T4
194 Suryani Lasio 16/10/52 15/12/09 T3
195 Wiwit K. Surakno 16/12/84 15/12/09
196 Diana Surakno 27/12/86 15/12/09
197 Elvi Joko Agus 09/09/75 15/12/09 T4 07/06/11
198 Kamilah Mastur 29/10/80 15/12/09
199 Sutiah Sucipto 13/10/54 17/03/10 T4 17/03/10
200 Suyatmi Mulyadi 08/09/85 17/03/10 T4 17/03/10
201 Sulastri Samiran 08/08/83 15/12/09
202 Fitria Wagiman 12/06/86 15/12/09
203 Sitina Katijan 02/03/62 15/12/09
204 Surya Dewi Surbangi 20/05/89 15/12/09
205 Wahyu Dwi N.F Surbangi 30/04/92 15/12/09
206 Khusnul Khotimah Surbangi 27/10/95 15/12/09
207 Jamilah Jehra/Junaidi 01/01/76 15/12/09
208 Eka Wardina Junaidi 18/09/93 15/12/09
209 Soleha Jahra/A. Bahri 13/04/74 15/12/09
210 Sama Busari 13/04/78 17/03/10 T2 17/03/10
211 Husnul Hotimah Hasan 11/03/84 17/03/10 T2 17/03/10
212 Susiyati Mahmud/Suyitno 10/05/69 17/03/10 T2 17/03/10
213 Suhaimi Suyitno/Agus S. 05/02/85 15/12/09 T3
214 Sri Sundari Adam/Sudi 09/12/86 17/03/10 T2 17/03/10 07/06/11
215 Bunaria Sanam/adam 09/10/63 15/12/09 T2
216 Mualimatul H. Adam 23/03/96 15/12/09 T3
217 Juma'ati Sarim/Suliman 10/11/78 15/12/09 T1
218 Sari Begiden/Buari 10/07/70 15/12/09 T1
219 Susiyam Sulasiyo/Solehan 27/05/89 15/12/09 T4
220 Hj. Siti Maisaroh Arsidin/ H. Suratman 11/01/63 15/12/09 T1
221 Hamidah H. Suratman 29/08/76 15/12/09 T2
222 Siti Hosniah W. H. Suratman 18/10/90 15/12/09 T4 07/06/11
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
223 Buni Suto/Mugiman 15/05/73 15/12/09 T2
224 Syamsiyah Mugiman 02/02/95 15/12/09 T3
225 Toni Samidin/Wagiman 10/03/63 15/12/09 T1
226 Tona Samidin/Zaenudin 21/10/65 15/12/09 T1
227 Siti Maimunah Zaenudin/Miskadi 14/12/81 17/03/10 T2 17/03/10 07/06/11
228 Juwariyah Darisman/Sariya 11/01/53 15/12/09 T1
229 Murtiya Kasman/Giman 14/02/67 15/12/09 T1
230 Ririn Giman 15/12/09 T2
231 Juma'ati Misron/Wahid 11/05/61 15/12/09 T1
232 Sudermim Darisman/Arip 02/12/62 15/12/09 T2
233 Jami Junaidi 12/04/79 15/12/09 T2
234 Supiyat Munali/Rasmito 11/05/80 15/12/09 T3
235 Sri Astami Jayusman 1960 15/12/09 T4
236 Somna Samsu/Haryono 05/11/83 15/12/09 T2
237 Maimuna To/Erfan 06/11/78 15/12/09 T2
238 Sutarti Darisman/Jusin 16/03/64 15/12/09 T3
239 Siti latifah Miswi/Hasan 20/05/67 15/12/09 T3
240 Yeni Astutik Hasan 17/01/84 15/12/09 T5
241 Wahyuni Sugianto/Turimin 11/09/65 15/12/09 T3
242 Siti hasanah Turimin 31/03/88 15/12/09 T5
243 Dewi Wulandari Turimin 10/05/95 17/03/10 T2 17/03/10
244 Supiya Enji/Ahmad Sodiq 03/12/72 17/03/10 T2 17/03/10
245 Holisa Ahmad Sodiq/Fathor 14/02/85 15/12/09 T3 07/06/11
246 Ami Aswar/Suparno 15/03/56 17/03/10 T1 17/03/10
247 Mar Suparno 15/12/09 T3 07/06/11
248 Misrati Saden/Jamani 01/07/64 15/12/09 T2
249 Nima Sadin 21/05/53 15/12/09 T2
250 Misdi Misnari/Sagi 14/02/74 15/12/09 T2
251 Misna Misren/Nipan 05/10/60 15/12/09 T2
252 Musliha Saher/Abdullah 17/08/85 15/12/09 T2
253 Juhairiyah H. Nurhasan/Miski 20/10/76 15/12/09 T3
254 Sumiati Miski/Ifan Susanto 14/02/88 17/03/10 T1 17/03/10
255 Busimi H. Nurhasan/Miski 13/02/68 15/12/09 T2
256 Jumani Asden/Sunarto 11/12/58 17/03/10 T1 17/03/10
257 Sumarmi Sunarto/Hendriawan 06/06/84 15/12/09 T2
258 Tukina Slami/Asnawi 15/03/64 15/12/09 T1
259 Sami Duyo/Sunari 12/05/67 15/12/09 T1
260 Nurholisa Sunari 05/03/93 17/03/10 T2 17/03/10
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
261 Nami Masromo/Sagiman 30/12/63 15/12/09 T1
262 Bunama Mislen/Mulhanim 15/08/62 15/12/09 T1
263 Astutik Handayani Tasrip/Mulyadi 26/04/81 17/03/10 T2 17/03/10
264 Hj. Lilik Maulidah H. Hadi Ruspani 16/11/67 17/03/10 T4 17/03/10
265 Erni Dianasari H.Hadi Ruspani 10/07/92 15/12/09 T5
266 Titin Indriasari Gesi Dodi Hariyanto 25/11/74 17/03/10 T4 17/03/10
267 Halimah Miskum 20/08/78 17/03/10 T2 17/03/10
268 Fitri Samsul 31/01/80 15/12/09 T4
269 Ani Jumari 14/07/87 17/03/10 T2 17/03/10
267 siti aisah hamdani 21 th 19/08/14 T5 12/02/14
268 sifa unikmah Abd rohman 20 th 06/08/14 T3 16/01/14
268 Mita Sutikno 17 th T4 06/02/14
269 Supartin Abd Wahit 27 th 09/09/14 T4 06/02/14
270 Siti Yana Misto 26 th 12/09/14 T4 13/01/14
271 Nurul Alfiah M.Bisri 26 th 16/09/14 T4 12/02/14
272 Nur aisiah M.Eko 22 th 07/10/14 T4 06/03/14
273 Yuni sofifah M.johan 19 th 06/03/14 T4 05/06/14
274 Diah fitriana Imam rijai 18 th 07/04/14 T4
275 Eka Diana Fathur R 23 th 08/04/14 T4 07/09/14
276 Yuliantika Kari mullah 28 th 10/05/14 T3 09/08/14
277 Imroatul A> Baihaki 28 th 14/06/14 T3 08/09/14
278 Iif Nur aini M subaidi 29 th 06/10/14 T4
279 ita purnama sari Holili 19 th 06/10/14 T4
280
284 JUMLAH T0 3 0 0 1 0 13 12 0 0 0 0 0
T1 36 0
T4 74 10 ADS 0,5 ML 26
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
NIP :
hamil
Format 1
TGL TGL KUNJ PENDATAAN / DATANG PERTAMA
NO NAMA WUS NAMA ORTU / SUAMI KALI) WUS NON HAMIL WUS HAMIL
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 Zaenap Untung 03/01/81 08/04/10 T4 08/04/10
2 Muzayana Jalel 10/05/83 08/04/10 T4 08/04/10
3 Muslimat nasir 07/09/71 08/04/10 T4 08/04/10
4 Miswati Siri 04/03/79 08/04/10 T4 08/04/10
5 Hopsatu Ahmadi 15/04/81 08/04/10 T4 08/04/10
6 Jumana Adam 20/08/62 08/04/10 T4 08/04/10
7 Subaiah Imam 17/07/79 08/04/10 T4 08/04/10
8 Mardiyah Mahfud 08/10/68 08/04/10 T4 08/04/10
9 Linda Sleman 28/01/84 08/04/10 T3 08/04/10 08/07/11
10 Salma Bungkos 17/10/74 08/04/10 T4 08/04/10
11 Fatima Solihin 10/07/81 08/04/10 T3 08/04/10 08/07/11
12 Muhawana Saini 08/06/84 08/04/10 T4 08/04/10
13 Yuliatin Solihin 18/07/86 08/04/10 T4 08/04/10
14 Liha Sakur 12/10/79 08/04/10 T4 08/04/10
15 Amina Junaidi 20/08/78 08/04/10 T4 08/04/10
16 Arifah Sidik 01/12/80 08/04/10 T4 08/04/10
17 Saripah Hotip 12/01/81 08/04/10 T4 08/04/10
18 Juma'ati Tuki 15/05/70 08/04/10 T4 08/04/10
19 Mini Sanar 11/12/63 08/04/10 T4 08/04/10
20 Soleha Beni 09/11/70 08/04/10 T4 08/04/10
21 Musrifah Andrik 02/06/71 08/04/10 T4 08/04/10
22 Hasana Fauzan 01/07/84 08/04/10 T4 08/04/10
23 Suhartik Dulal 10/11/72 08/04/10 T4 08/04/10
24 Mustainah Lailul 01/12/84 08/04/10 T4 08/04/10
25 Khowiyun Robet 16/11/86 08/04/10 T4 08/04/10
26 Nifah Heru 30/01/82 08/11/09 T4
27 Holip Ali 01/03/75 08/04/10 T4 08/04/10
28 Suyati Tohari 29/01/81 08/11/09 T4 08/07/11
29 Hosnol Kudsi 09/04/83 08/04/10 T4 08/04/10
30 Sumiati Mad Said 07/06/73 08/04/10 T4 08/04/10
31 Holifah Sukedi 04/03/79 08/04/10 T4 08/04/10
32 S. Latifah Musaki 10/10/73 08/04/10 T4 08/04/10
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
33 Jumalia Toadi 01/04/73 08/11/09 T4
34 Halima Holes 27/01/76 08/11/09 T4
35 Jum Bungkos 08/11/78 08/11/09 T4
36 Siti P. Pipi 15/12/62 08/11/09 T4
37 Marwati H. yusuf 30/10/62 08/11/09 T4
38 Farida Afed 05/11/76 08/11/09 T4
39 Tuna Somad 11/04/71 08/11/09 T4
40 Juria P. Sun 20/08/72 08/11/09 T4
41 Halima Saha 02/03/71 08/11/09 T4
42 Hotija Madhur 06/10/69 08/04/10 T4 08/04/10
43 Sadhi Aliman 19/01/69 08/11/09 T4 08/07/11
44 Sumiati P. Sepol 22/11/69 08/04/10 T4 08/04/10
45 Arbaiya Muhamad 15/06/70 08/11/09 T4
46 Eni Wagini Nemo 18/05/64 08/11/09 T4
47 Mardiye Kadir 24/11/62 08/11/09 T4
48 Toryati P. Hadiya 18/10/62 08/11/09 T4
49 Jesmani 18/06/63 08/11/09 T4
50 Sabiye Heri 02/07/69 08/11/09 T4
51 Samini P. Su 15/04/68 08/04/10 T4 08/04/10
52 Lima P. Luman 01/08/67 08/11/09 T4
53 Ya Buniman 19/02/71 08/11/09 T4
54 Yayuk Yasin 28/01/76 08/11/09 T4 08/07/11
55 Jamila Aliman 11/03/75 08/11/09 T4
56 Faik 06/10/96 08/11/09 T4
57 Suyami Edi Wahidi 06/01/94 08/04/10 T4 08/04/10
58 Sami Samsul 27/04/94 08/04/10 T4 08/04/10
59 Riska P. Tofik 15/02/94 08/11/09 T3
60 Ida Suruso 20/05/93 08/11/09 T3
61 Is P. Hadiya 17/04/94 08/11/09 T4
62 Ani Aliman 27/01/93 08/04/10 T3 08/04/10 08/07/11
63 Leha Samud 30/01/93 08/11/09 T3 08/07/11
64 Misnaya Adam 11/12/95 08/11/09 T3 08/07/11
65 Leha Sanur 15/01/85 08/04/10 T3 08/04/10
66 Arifah P. Pipi 20/06/96 08/11/09 T3 08/07/11
67 Misyeni P. Sunap 11/02/80 08/11/09 T4
68 Munawaroh Mad Said 30/06/96 08/11/09 T3
69 Miftahul Holid 18/06/96 08/11/09 T3 08/07/11
70 Holip Mad 17/09/86 08/11/09 T4
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
71 Tuni Di 11/10/85 08/11/09 T4
72 Mai Sista Junaidi 10/01/88 08/11/09 T4 08/06/11
73 Zaenap Mastuhi 06/01/82 08/04/10 T3 08/04/10 08/06/11
74 Iin Sabana Asmar Efendi 30/03/82 08/11/09 T4
75 Israni Ismail 22/08/90 08/11/09 T4
76 Soleha Hendro 06/12/96 08/11/09 T3
77 Laili Ali 08/10/98 08/11/09 T3
78 Wiwin Aliman 08/04/95 08/11/09 T3
79 Nartik Heri 17/12/98 08/11/09 T3
80 Mawedeh Kulhadi 08/06/11
81 St Fatimah Hoirudin 08/06/11
82 Sulastri Gafor 08/06/11
83 Rahmati Dulal 08/06/11
84 Jubiya Hanapi 08/06/11
85 Mita Sugiono 17 th 16/09/13 T4 06/02/14
86 Yuliatin Solihin 27 th 11/10/13 T4 06/02/14
87 Risadatul A.Yusuf 25 th 09/12/13 T4 06/02/14
88 Nur aini Ahmadi 22 th 10/03/14 T4 10/06/14
89 Siti N ur aini Rohim 17 th 10/06/14 T3 08/10/14
90 Vivin Rahayu Asis Dulh 20 th 09/06/14 T3 10/11/14
91 Arifah Sidik 34 th 17/06/14 T4 04/12/14
92
93
94
95
95 JUMLAH T0 0 0 0 0 0 7 10 0 0 0 0 0
T1 0 0
T4 61 7 ADS 0,5 ML 17
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
NIP :
hamil
Format 1
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 Siti Munawaroh Mahfud E. 03/03/84 15/03/10 T3 15/03/10 09/06/11
2 Sumiati Habuba 10/07/80 15/11/09 T4
3 Marwiyah Siddiq 07/02/82 15/03/10 T3 15/03/10 09/06/11
4 Halimatus Miswi 10/04/75 15/11/09 T4
5 Siti Fatimah Muked 02/06/77 15/03/10 T3 15/03/10
6 Sawini M. ali 14/07/60 15/11/09 T4
7 Fatmawati Livin 06/11/87 15/11/09 T4
8 Yuliana Misbeh 07/12/84 15/11/09 T5
9 Hutim Mastuki 11/04/79 15/11/09 T5
10 Yuliatin H. Sidiq 01/10/64 15/11/09 T4
11 Hafifah Rofik 31/12/83 15/11/09 T4
12 Naimah Tumadi 27/05/73 15/11/09 T4
13 Ani Jumari 03/08/80 15/11/09 T4
14 Fitri Samsul 01/09/79 15/11/09 T4
15 Halimah Hasim 05/01/71 15/11/09 T4
16 Halipa Abdul Rohman 11/02/66 15/03/10 T3 15/03/10
17 Khusnul H. Nanang K. 19/12/91 15/03/10 T4 15/03/10
18 Susyani Yasin 17/02/76 15/11/09 T3
19 Robiyati Karmin 01/07/57 15/11/09 T3
20 Nela Ali Wafa 24/05/83 15/11/09 T4
21 Jamsia Buramin 12/07/63 15/03/10 T3 15/03/10
22 Fadila Ngatemin 04/06/65 15/11/09 T3
23 Misna Ahmad 03/06/85 15/11/09 T3
24 Supiyati Umar 05/08/84 15/11/09 T3 09/06/11
25 Holip Saeni 20/12/78 15/11/09 T3
26 Sami Budianto 25/06/75 15/11/09 T3
27 Siti Khotijah Ali 31/03/88 15/03/10 T4 15/03/10
28 Hotijah Muzaki 30/06/60 15/11/09 T3
29 Laili Lutfi 12/08/93 15/11/09 T4
30 Sumiati Tohari 05/08/70 15/03/10 T3 15/03/10
31 Yuliatik Jueni 07/08/98 15/03/10 T4 15/03/10
32 Kiptiya Kayet 10/05/75 15/11/09 T4
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
33 Siti Halel 07/08/70 15/11/09 T4
34 Tutik Sotek 01/07/86 15/03/10 T4 15/03/10
35 Holip Toyyib 09/12/85 15/03/10 T4 15/03/10
36 Hosiseh Bunali 11/12/78 15/11/09 T3 09/06/11
37 Susyati Ahmad Munir 03/06/70 15/03/10 T3 15/03/10 09/06/11
38 Jannah Jalal 22/06/75 15/11/09 T3 09/06/11
39 Siti Kusnan 10/12/69 15/03/10 T3 15/03/10
40 Tona Limah 27/06/65 15/11/09 T3 09/06/11
41 Sumiati Zaeni 18/06/85 15/03/10 T3 15/03/10
42 Asmina Misyono 07/07/78 15/11/09 T3 09/06/11
43 Bibit Poniran 15/07/75 15/03/10 T3 15/03/10
44 Suliya Naweri 23/12/75 15/11/09 T4
45 Azizeh Mursid 30/05/74 15/03/10 T4 15/03/10
46 Junuriyah Sunhadi 22/08/78 15/11/09 T4
47 Sarini Toni 19/02/70 15/11/09 T4
48 Juma Bakri 06/11/80 15/11/09 T3 09/06/11
49 Rahmi Sudibyo 11/11/73 15/03/10 T3
50 Sofia Anto 01/07/82 15/11/09 T3 15/03/10 07/07/11
51 Asiya Sutuyo 24/12/79 15/11/09 T4
52 Salma Miski 06/09/75 15/11/09 T4
53 Maryani Sumardi 29/01/70 15/11/09 T4
54 Yuliani Solehan 07/02/77 15/11/09 T4 07/07/11
55 Elin Gofur 12/07/80 15/03/10 T4 15/03/10
56 Tumina M. Romli 19/01/75 15/11/09 T4 07/07/11
57 Kustina Jauhari 05/10/82 15/11/09 T3 09/06/11
58 Suryati Mastuki 26/07/73 15/03/10 T4 15/03/10
59 Insiyati Abas 01/12/77 15/11/09 T4 07/07/11
60 Mala Jatem 27/02/75 15/03/10 T4 15/03/10
61 Sara Yasid 14/06/60 15/11/09 T4
62 Rahma Mahfud 07/01/71 15/11/09 T4
63 Ulfatur R. 25/08/97 15/11/09 T4
64 Misdi Alwi 10/11/71 15/11/09 T3
65 Nami 27/02/92 15/11/09 T3 07/07/11
66 Sri Junaidi 30/03/89 15/03/10 T3 15/03/10
67 Miswe Lani 21/06/72 15/11/09 T4
68 Susyati Asan 06/05/74 15/11/09 T4
69 Endang 07/12/98 15/11/09 T3
70 Murtik Awi 20/02/75 15/11/09 T4
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
71 Busina Jamsia 11/01/60 15/11/09 T4
72 Nima 15/11/09 T3 07/07/11
73 Suryani Begiman 30/01/69 15/11/09 T4 07/07/11
74 Amina Sleman 02/01/70 15/11/09 T4 07/07/11
75 Habibah Totok 18/07/92 15/03/10 T4 15/03/10
76 Juma'ani Abdul 06/01/89 15/11/09 T4
77 Halima Zaenudin 10/02/68 15/11/09 T4
78 Juma'ati Mahmud 06/12/71 15/11/09 T4 07/07/11
79 Tuyani Pardi 25/06/84 15/11/09 T3 07/07/11
80 Tipa Basri 19/01/86 15/11/09 T3 07/07/11
81 Maryam Begiman 30/05/68 15/11/09 T4
82 Misna Sarmadi 01/07/73 15/11/09 T4
83 Solehati 20/02/84 15/11/09 T3
84 Sarmi Mahfud 13/01/85 15/11/09 T3
85 Juria Mistar 27/07/71 15/11/09 T4
86 Sitina Totok 08/12/89 15/03/10 T3 15/03/10 07/07/11
87 Sardiya Zainudin 26/03/71 15/11/09 T4
88 Eka Wahyudi 06/10/96
89 Fatima Suyut 01/05/61
90 Zahro 12/01/93 07/07/11
91 Faikoh 25/05/97
92 Hotija Munir 06/12/73
93 Fatima Herudin 01/10/73 07/07/11
94 Insiyati Abas 27/04/75 07/07/11
95 Nur Holida Basoni 07/07/91 07/07/11
96 Mala Jatim 22/11/79 07/07/11
97 Hosnul H Hendy 01/08/92 07/07/11
98 Tama Dulbaki 15/02/76
99 Tom Abdul Aziz 08/11/91 07/07/11
100 Mara Manaf 17/02/83 07/07/11
101 Indah wati Salam 06/10/83 07/07/11
102 Sumiati Naki 28/02/72 07/07/11
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
102 JUMLAH T0 0 0 0 0 0 5 27 0 0 0 0 0
T1 0 0
T4 47 2 ADS 0,5 ML 32
NIP :
hamil
Format 1
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
7 Dewi Imron 1996 05/05/10 T3 05/05/10 08/06/11 /06/11
8 Malina In 1990 04/04/10 T3 04/04/10 08/06/11 /06/11
13 Wiwit Sodek 1991 05/04/10 T3 05/04/10 08/06/11 /06/11
23 Iz Juma'i 1977 04/04/10 T3 04/04/10 08/06/11 /06/11
24 Muna Ri 1979 05/05/10 T3 05/05/10 08/06/11 /06/11
25 Ul P. Suyati 1987 05/05/10 T3 08/06/11 05/05/10 /06/11
57 Laili Nima 1990 05/05/10 T3 08/06/11 05/05/10 /06/11
Laili Abd.rohman 25 th 03/10/13 T4 06/02/14
Ayu M.Mukhlis 21 th 04/11/13 T3 06/02/14
Ika Zaenal 19 th 04/11/13 T3 06/02/14
Kiptiyah A.Fauzi 19 th 05/12/13 T4 06/02/14
St.Aisyah Saini 31 th 05/12/13 T4 06/02/14
266 JUMLAH T0 0 0 0 0 0 5 63 0 0 0 0 7
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
T1 0 0
T4 140 4 ADS 0,5 ML 75
NIP :
hamil
HASIL KEGIATAN SKRINING DAN IMUNISASI TT
POSYANDU : APEL 35
DESA / KELURAHAN : CANGKRING
STATUS T AWAL (SAAT
NO NAMA WUS NAMA ORTU / SUAMI PERTAMA KALI)
LAHIR WUS
NON HAMIL HAMIL
1 2 3 4 5 6 7
1 Fatimatus Zahro A.Azis 26 th 06/12/13 T4
1 JUMLAH T0 0 0
T1 0 0
T2 0 0
T3 0 0
T4 0 1
Penjelasan : T5 0 0
Kolom 6-7 : Isilah status TT WUS sesuai hasil pendataan (wawancara), misalnya : T0, T1, T2, T3, T4, T5
hamil
Kolom 13-17 : isilah tgl, bulan dan tahun vaksinasi TT saat ini, khusus untuk WUS yang sedang hamil
Format 1
DAN IMUNISASI TT WUS DI POSYANDU
PUSKESMAS : JENGGAWAH
TAHUN : 2010
HASIL VAKSINASI TT
WUS NON HAMIL WUS HAMIL

T-1 T-2 T-3 T-4 T5 T-1 T-2 T-3 T-4 T5
8 9 10 11 12 13 14 15 16 17
07/01/14
0 0 0 0 0 0 0 0 0 1
PEMAKAIAN LOGISTIK ……………., ………………….20….

VAKSIN Pelaksana Imunisasi/bidan,
ADS 0,5 ML 1
SAFETY BOX
(………………………………….. )
NIP :
Format 1
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 Hony sutanto 1977 08/11/09 T4
2 Sumartin saiful 1981 15/04/10 T4 15/04/10
3 Wati ribut 1986 15/04/10 T3 15/04/10
4 Kustiyah Suhat 1978 08/11/09 T4
5 Mina Mol 1986 08/11/09 T3
6 Yana Misto 1988 15/04/10 T3 15/04/10
7 Sunaria Sakur 1986 08/11/09 T3 13/06/11
8 Mardiya Imam 1991 15/04/10 T2 15/04/10
9 Nima Kusnadi 1980 08/11/09 T4
10 Rohma yanto 1976 15/04/10 T4 15/04/10
11 Sa*ada Por 1988 15/04/10 T3 15/04/10
12 Sida Sipol 1982 08/11/09 T3
13 Um Gijan 1981 08/11/09 T4
14 Yuliana Agus 1985 15/04/10 T3 15/04/10
15 Rina Wahyu 1982 15/04/10 T3 15/04/10
16 Puji Dadang 1984 15/04/10 T3 15/04/10
17 Mulysni Hasim 1970 15/04/10 T3 15/04/10 13/06/11
18 Yati Harjeh 1985 15/04/10 T3 15/04/10
19 Rida totok 1987 15/04/10 T3 15/04/10 13/06/11
20 halima Nanang 1985 15/04/10 T3 15/04/10
21 Buyani Sujak 1976 08/11/09 T4
22 Ton suyitno 1984 08/11/09 T4
23 Yana Rofik 1983 08/11/09 T3 13/06/11
24 Mis Nur 1986 15/04/10 T3 15/04/10
25 Miswa Rahmat 1970 08/11/09 T4
26 apyati Aden 1970 15/04/10 T3 15/04/10
27 som Mat 1972 15/04/10 T3 15/04/10 13/06/11
28 iin Mis 1988 08/11/09 T3
29 Sipah Dodik 1988 08/11/09 T3 13/06/11
30 Ju Molla 1982 08/11/09 T4
31 Nova Maryono 1991 08/11/09 T3
32 sama riman 1980 08/11/09 T4
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
33 Hami Mat 1986 08/11/09 T3
34 cik Arso 1975 15/04/10 T4 15/04/10
35 sukaria hanapi 1974 08/11/09 T4
36 Yuyun Rojali 1984 08/11/09 T4
37 dewi dasuki 1982 08/11/09 T4
38 sup Lihen 1972 08/11/09 T4
39 Sukarse Yitno 1985 15/04/10 T4 15/04/10
40 Mina Arsen 1977 08/11/09 T4
41 ti demo 1971 08/11/09 T4
42 siami Miski 1992 08/11/09 T3 13/06/11
43 Asmi Sanom 1974 08/11/09 T4
44 Morti giton 1972 15/04/10 T4 15/04/10
45 slama Tres 1984 08/11/09 T4
46 tutik soni 1985 08/11/09
47 siti roni 1985 08/11/09 T4
48 Juma*a Eksan 1977 08/11/09 T4
49 Sulasmi Tukiman 1979 08/11/09 T4
50 Ropa 1983 08/11/09 T4
51 Ro Joni 1988 08/11/09
52 Heria Herman 1976 08/11/09 T4
53 Mona Hani 1975 08/11/09 T4
54 Samsini Nipan 1972 08/11/09 T4
55 Wa Sugik 1988 08/11/09 13/06/11
56 Lupna Nohan 1975 08/11/09 T4
57 Sophie abdullah 1985 15/04/10 T3 15/04/10 13/06/11
58 Fifin Arif 1984 15/04/10 T4 15/04/10
59 Sutiha Yono 1977 08/11/09 T4
60 Isa Baser 1975 08/11/09 T4
61 senap Nipan 1980 08/11/09 T4
62 kip Pan 1983 08/11/09 T4
63 Ponima Yahya 1985 08/11/09 T4
64 Waro Joni 1981 08/11/09 T4
65 Luluk Misra*i 1983 08/11/09 T4
66 Nima Mahad 1980 15/04/10 T4 15/04/10
67 sutik Fauzen 1980 15/04/10 T4 15/04/10
68 Nur Mad 1984 08/11/09 T4
69 Ti Kur 1977 08/11/09 T4
70 Hotija samsul 1984 08/11/09 T4
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
71 Kip Hamit 1983 08/11/09 T4
72 Lipah Tres 1988 15/04/10 T3 15/04/10
73 Ti Eksan 1981 08/11/09 T4
74 Hemi Pur 1974 08/11/09 T4
75 senap Suyono 1981 15/04/10 T4 15/04/10
76 sSlami Fauzi 1970 15/04/10 T4 15/04/10
77 farihah Rokib 1983 15/04/10 T4 15/04/10
78 Nikwati Sahrawi 1984 15/04/10 T4 15/04/10
79 Leha Dulla 1985 15/04/10 T4 15/04/10
80 Opiya Mansur 1965 08/11/09 T4 13/06/11
81 senap sunarto 1981 08/11/09 T4
82 saro Hofifi 1984 15/04/10 T4 15/04/10
83 Kus Marsuki 1977 15/04/10 T4 15/04/10
84 Mainah Ropa 1977 15/04/10 T4 15/04/10
85 Mosbi Oim 1974 08/11/09 T4
86 Julaeha Lutfi 1981 15/04/10 T4 15/04/10
87 sundari Misrun 1994 08/11/09 T3
88 ro sanom 1992 08/11/09 T3
89 Isa arso 1992 08/11/09 T3
90 Ju Misto 1980 08/11/09 T4
91 Ti Fendi 1980 15/04/10 T4 15/04/10
92 Sri Kabul 1972 08/11/09 T4 13/06/11
93 rati Amin 1970 08/11/09 T4
94 Nur Sipul 1981 08/11/09 T4
95 Rosyidah Syaiful 1982 15/04/10 T4 15/04/10
96 st. Rosiyati suharyono 1978 15/04/10 T4 15/04/10
97 Jumati supari 1975 15/04/10 T4 15/04/10
98 fitri 1983 15/04/10 T2 15/04/10
99 Liyana 1995 15/04/10 T2 15/04/10
100 Sunami sudi 1990 15/04/10 T2 15/04/10
101 rusmiati baharudin 1991 15/04/10 T2 15/04/10
102 Sitiyana Misto 1988 12/09/13 T4 13/01/14
103 Nurul alfiyah M.Bisri 1988 16/09/13 T4 12/02/14
104 Waqi'ah Tori 1995 2/11/2014 T3 2/11/2014
103 JUMLAH T0 0 0 0 0 0 5 6 0 0 0 0 0
T1 0 0
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
T4 65 3 ADS 0,5 ML 11
Kolom
Kolom 56-7 : Isilah
: isilah tgl,status
bulan TT
dan tahun saat kedatangan atau kunjungan WUS ke petugas kesehatan / sarana kesehatan
WUS sesuai hasil pendataan
(………………………………….. )
(wawancara), misalnya : T0,
Kolom
T1, T2,8-12 : isilah
T3, T4, T5 tgl, bulan
dan tahun vaksinasi TT saat
NIP :
ini, khusus untuk WUS yang
sedang tidak hamil
Format 1
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 Yul Enik / anwar 1991 13/04/10 T1 13/07/11 13/04/10
2 zaenab Slama / Sulton 1985 07/11/09 T4 13/07/11
3 Julaeha Selama / Kos 1987 07/11/09 T3 15/06/11
4 Hotima Slama 1980 07/11/09 T4 15/06/11
5 Karom Slama 1970 07/11/09 T4
6 Urifatin Rodiya / Slamat 1980 07/11/09 T4 15/06/11
7 Wahyun Maryam / Rosi 1991 13/04/10 T1 13/04/10 13/07/11
8 Ida satini 1990 07/11/09 T1
9 Norul Solehatin / Tain 1990 13/04/10 T1 13/04/10 13/07/11
10 Afia Murina / Mualim 1979 07/11/09 T4 15/06/11
11 Rovia Nawawi / den 1976 13/04/10 T1 13/04/10
12 Liya Jum / Senol 1989 13/04/10 T1 13/04/10
13 Kulsum sop /muklis 1985 13/04/10 T1 13/04/10 13/07/11
14 Juhairiyah Mudawana/ H. anam 1989 13/04/10 T1 13/04/10 13/07/11
15 Holip suama/ Kadi 1985 13/04/10 T1 13/04/10
16 Mutam Tima / samsuri 1978 07/11/09 T4 15/06/11
17 Hikmah Bisri / Ar 1981 07/11/09 T3 15/06/11
18 Hotik Piya / sawi 1980 07/11/09 T4 13/07/11
19 Musey Uro / Tija 1993 07/11/09 T2
20 Ida Uro / Tija 1990 07/11/09 T3 15/06/11
21 Farid Dul / Leha 1987 13/04/10 T3 13/04/10 13/07/11
22 Insiyah sadroya / alwi 1985 13/04/10 T3 13/04/10 13/07/11
23 Yus suhana / Sudi 1986 13/04/10 T3 13/04/10
24 Limah Limah / Siri 1981 13/04/10 T3 13/04/10 13/07/11
25 Hidayati Tasrip / Supiyatin 1990 13/04/10 T3 13/04/10 13/07/11
26 Ani Suasih 1989 07/11/09 T3 13/07/11
27 Da 1981 07/11/09 T4 13/07/11
28 ti Sawi / Tiwar 1976 07/11/09 T4 13/07/11
29 Maysaroh padle 1990 07/11/09 T3 13/07/11
30 Rude siri / Limah 1998 07/11/09 T4 13/07/11
31 Kiptiyah Nawawi / alifit 1969 07/11/09 T3
32 Nurhayati abd.muni / saiful 1978 07/11/09 T3
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
33 Urifatin Mahfud / sawir 1968 07/11/09 T3 13/07/11
34 Fatimus Zuhro Buhori / basuki 1983 13/04/10 T3 13/04/10
35 Rohilla samsul / Habari 1966 07/11/09 T4
36 Wakiah saiful / Hamid 1975 07/11/09 T4
37 Burdania Holek 1993 07/11/09 T3
38 Hamimah sawir 1991 07/11/09 T3 15/06/11
39 Halima Hajar / Abd. Rohman 1968 07/11/09 T4
40 Henik Ahyar / imron 1990 13/04/10 T3 13/04/10
41 Maisaroh seri / Rosi 1967 07/11/09 T4
42 Nadifa Abdullah / Maryono 1965 07/11/09 T4
43 Maimunah abdullah / Abd. Rohman 1970 07/11/09 T4
44 Muryani H. Rosid / Hesim 1968 07/11/09 T4
45 warda Hesim / Tori 1988 07/11/09 T4 15/06/11
46 Mulam rohmat 1981 07/11/09 T4 13/07/11
47 Hikmah Ahmad 1979 07/11/09 T4 13/07/11
48 Hotik Gofur 1980 07/11/09 T4 13/07/11
49 Musey tija 1972 07/11/09 T4
50 Ida Tija / Di 1980 07/11/09 T4 13/07/11
51 Farid Leha / Lis 1978 07/11/09 T4 13/07/11
52 Insiyah sadruya / Am 1973 07/11/09 T3 13/07/11
53 Yus sahana / wayan 1980 13/04/10 T3 13/04/10 13/07/11
54 Limah Lis / siri 1977 13/04/10 T3 13/04/10 13/07/11
55 Hidayati Supiyati ? Roni 1991 07/11/09 T3 13/07/11
56 Ani Suasih / Hor 1978 13/04/10 T3 13/04/10 13/07/11
57 Da Muk *is 1970 13/04/10 T3 13/04/10 13/07/11
58 Ti Sami / Naden 1971 13/04/10 T3 13/04/10 13/07/11
59 Maysaroh Muhyi 1983 07/11/09 T3 13/07/11
60 Rude Limah 1998 13/04/10 T3 13/04/10 13/07/11
61 Sulipa Saiman 1983 13/04/10 T3 13/04/10 13/07/11
62 Yuyun Jeli 1981 07/11/09 T3 15/06/11
63 tin Ser 1975 07/11/09 T4 13/07/11
64 Liya radiya saini 1977 07/11/09 T4 13/07/11
65 Suryani Karsi / p. sop 1981 07/11/09 T3 13/07/11
66 iin saro / Muhyi 1983 07/11/09 T3
67 Wasik soi 1984 07/11/09 T3
68 Helmi Tofek 1985 07/11/09 T3 13/07/11
69 Ul Pakar 1980 07/11/09 T3
70 Norul Solehatin / Tain 1979 07/11/09 T4 13/07/11
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
71 Jamila Busadi / Mahod 1981 07/11/09 T3
72 sainab Radiya / Ahmad 1977 07/11/09 T4
73 Ifa Herani 1972 07/11/09 T4
74 sainab Sak *ada 1979 07/11/09 T4 13/07/11
75 sop Iskandar 1980 07/11/09 T4
76 St.Aisyah Hamdani 1996 19/08/13 T4 12/02/14
76 JUMLAH T0 0 0 0 0 5 5 38 0 0 0 0 0
T1 8 1
T4 31 1 ADS 0,5 ML 48
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
NIP :
hamil
Format 1
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 Mulim Udin 1981 15/11/09 T2
2 Matus suhar 1990 15/11/09 T2 14/06/11
3 Farida Holil 1990 16/04/10 T2 16/04/10 14/06/11
4 Sopyaten Baidowi 1975 16/04/10 T2 16/04/10
5 Fatimah tirto 1970 15/11/09 T2
6 sa*ada Burhanudin 1980 16/04/10 T2 16/04/10
7 wati Mujib 1984 15/11/09 T2
8 Holipa irwanto 1982 16/04/10 T2 16/04/10 14/06/11
9 Ririn Bagiti 1988 16/04/10 T2 16/04/10 14/06/11
10 Anita ridwan 1989 16/04/10 T1 16/04/10
11 Yarina sugianto 1985 15/11/09 T2 14/06/11
12 Winarsih seniwi 1986 15/11/09 T3 14/06/11
13 Umi Kulsum sophan 1983 16/04/10 T3 16/04/10
14 Miswa Sahed 1975 15/11/09 T1
15 Asmina paing 1968 16/04/10 T1 16/04/10
16 Farida Temon 1969 15/11/09 T3
17 Darwati sahrul 1985 15/11/09 T3
18 Hosniati wawan 1979 16/04/10 T2 16/04/10
19 Inda abd. Hadi 1980 15/11/09 T3
20 Homisa Taufik 1976 16/04/10 T3 16/04/10
21 Buyati Iskandar 1971 16/04/10 T2 16/04/10
22 Jamila sakur 1971 15/11/09 T2
23 Suparmi Rohim 1980 15/11/09 T2
24 rofiah safiudin 1978 15/11/09 T3
25 Iswatun Netro 1974 16/04/10 T3 16/04/10
26 Farida Sulaiman 1976 16/04/10 T3 16/04/10
27 Asmani Marhaye 1970 16/04/10 T2 16/04/10
28 Nur Ani Sutirno 1973 16/04/10 T3 16/04/10
29 Maftuha maspur hadi 1974 16/04/10 T4 16/04/10
30 ropa Taufik 1978 16/04/10 T3 16/04/10
31 Soleha Maspor 1976 15/11/09 T2 14/06/11
32 Mahtum sole 1978 15/11/09 T3
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
33 Anis sonhaji 1986 16/04/10 T3 16/04/10
34 Usnawiyah Novi 1973 15/11/09 T2
35 suti*ah babun 1981 15/11/09 T3
36 diana Fauzi 1985 16/04/10 T3 16/04/10
37 aryani Hasan 1968 15/11/09 T2 14/06/11
38 hofifah Kadri 1977 15/11/09 T2
39 Musdalifah hasyim 1987 16/04/10 T2 16/04/10 14/06/11
40 st. Holiyah samsul 1984 16/04/10 T2 16/04/10
41 Hosia Gunawan 1988 16/04/10 T3 16/04/10
42 Indrawati Carin 1986 16/04/10 T3 16/04/10
43 Hartini sodek 1974 15/11/09 T2
44 Holip Mulyadi 1986 16/04/10 T3 16/04/10
45 sutina Azis 1970 16/04/10 T3 16/04/10
46 Sunarti Hafid 1980 15/11/09 T2
47 Holipa Musleh 1973 16/04/10 T2 16/04/10 14/06/11
48 Juhairiyah Uwi 1986 16/04/10 T3 16/04/10
49 Ismawati au star 1978 16/04/10 T2 16/04/10
50 Yana sucipto 1976 15/11/09 T2
51 sana Sunarto 1989 16/04/10 T2 16/04/10
52 sa8diya Abd. Rohim 1977 15/11/09 T2 14/06/11
53 endang Edi 1972 16/04/10 T3 16/04/10
54 Ummi solehan 16/04/10 T2 16/04/10
55 Jumaani warno 1969 15/11/09 T3
56 maryam sarmin 1970 15/11/09 T3
57 Yulyaten tohari 1979 16/04/10 T3 16/04/10 14/06/11
58 taheyatin sumaryadi 1989 15/11/09 T3
59 Hosia Moh arif 1969 16/04/10 T3 16/04/10
60 Ummi Kulsum Giman 1976 16/04/10 T4 16/04/10
61 Jalila ansori 1970 16/04/10 T4 16/04/10
62 Subaida ali 1969 15/11/09 T3 14/06/11
63 Salwati sukir 1971 16/04/10 T3 16/04/10 14/06/11
64 Lutfiah Joni 1971 16/04/10 T3 16/04/10 14/06/11
65 Rukmiati Suyono 1980 16/04/10 T4 16/04/10
66 suswati Ja*far 1973 16/04/10 T4 16/04/10
67 Muslimah Azizi 1989 16/04/10 T3 14/06/11 16/04/10
68 Masula Sahri 1980 16/04/10 T3 16/04/10
69 Nima Sutio 1968 15/11/09 T4
70 Hadiatun Nisa ansori 1996 16/04/10 T4 16/04/10
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
71 rumyati Mangsur 1970 15/11/09 T3 14/06/11
72 Maryani toha 1968 16/04/10 T3 16/04/10
73 Juma8ani safi*i 1975 16/04/10 T3 16/04/10
74 Kamila Lutfi 1990 15/11/09 T3
75 Musaiyada Sulaiman 1968 16/04/10 T3 16/04/10
76 Sifaunnikmah Abd.Rohman 1994 06/08/13 T3 06/01/14
76 JUMLAH T0 0 0 0 0 4 8 5 0 0 0 0 0
T1 3 0
T4 7 0 ADS 0,5 ML 17
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
NIP :
hamil
Format 1
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 Lutfiah supriyadi 09/04/10 T4 09/04/10
2 Artini Muhyi 09/04/10 T4 09/04/10
3 Hoiriyah taufik 09/04/10 T4 09/04/10
4 Kartini Nimo 09/04/10 T4 09/04/10
5 solehati Saiful 09/04/10 T4 09/04/10
6 Juhairiyah Wahyudi 09/04/10 T4 09/04/10
7 Suryati nasiji 09/04/10 T4 09/04/10
8 tini nasiji 09/04/10 T2 09/04/10 10/06/11 07/07/11
9 Musula sidin 09/04/10 T4 09/04/10
10 hartatik zanuri 18/10/09 T4 10/06/11
11 Muslimah Rosidi 09/04/10 T4 09/04/10
12 Yuliati Rudi 09/04/10 T4 09/04/10
13 Makrifah Anwar 09/04/10 T4 09/04/10
14 tutik Samheri 09/04/10 T3 09/04/10 10/06/11
15 sumiati edi s 09/04/10 T4 09/04/10
16 Isnaini Yusuf 09/04/10 T4 09/04/10
17 Rukmini Marsa*i 09/04/10 T4 09/04/10
18 Hasima Hasyim 10/05/10 T4 10/05/10
19 Hosna sanur 18/10/09 T5 10/06/11
20 Nadifah abd. Rosit 09/04/10 T4 09/04/10
21 wiwikJ asari 10/05/10 T4 10/05/10
22 Mahtufah holili 10/05/10 T4 10/05/10
23 eni Mustopa 09/04/10 T3 09/04/10 10/06/11
24 Neneng sunarto 09/04/10 T3 09/04/10 10/06/11
25 sholeha sahrawi 09/04/10 T4 09/04/10
26 Hamimah Mustofa 10/05/10 T4 10/05/10
27 Fatimah Junaidi 10/05/10 T4 10/05/10
28 Hartatik Haderi 10/05/10 T4 10/05/10
29 sri sugiarti asis 09/04/10 T4 09/04/10
30 widiya suib 10/05/10 T3 10/05/10 10/06/11
31 Azizah Junaedi 10/05/10 T4 10/05/10
32 Isnaini senol 10/05/10 T4 10/05/10
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
33 Umamah Mulyadi 10/05/10 T4 10/05/10
34 Eliya Buhari 09/04/10 T4 09/04/10
35 Rahmani sari 09/04/10 T4 09/04/10
36 Mahmuda samari 10/05/10 T4 10/05/10
37 Hosiati sugito 10/05/10 T4 10/05/10
38 Suarni Omar 09/04/10 T4 09/04/10
39 nadila slamet 09/04/10 T3 09/04/10 10/06/11
40 Lilik Fendi 09/04/10 T3 09/04/10 10/06/11
41 lilis Amat 09/04/10 T2 09/04/10 10/05/11 /07/11
42 Farida Jusi 09/04/10 T4 09/04/10
43 Hoswati Matadam 10/05/10 T4 10/05/10
44 Komariyah Yanto 10/05/10 T4 10/05/10
45 alfia Handoyo 09/04/10 T3 10/06/11 09/04/10
46 dewi S Fauzi 10/05/10 T4 10/05/10
47 ella Jauhari 10/05/10 T4 10/05/10
48 Fina Jauhari 10/05/10 T4 10/05/10
49 Arini Jauhari 09/04/10 T2 09/04/10 10/06/11 07/07/11
50 sofia faruk 10/05/10 T4 10/05/10
51 santi Latif 10/05/10 T3 10/05/10 10/06/11
52 Sri sugiarti abd. Rohim 10/05/10 T4 10/05/10
53 Amina turi 09/04/10 T4 09/04/10
54 Misyani mansur 09/04/10 T4 09/04/10
55 Sholeha Mursit 09/04/10 T4 09/04/10
56 Hofidah Hasan 10/05/10 T4 10/05/10
57 Kristina Munir 09/04/10 T4 09/04/10
58 nanik Muhtar 09/04/10 T4 09/04/10
59 st. Hardiyanti hasim 09/04/10 T3 09/04/10 10/06/11
60 St. Hotijah rahem 10/05/10 T4 10/05/10
61 sulis Muket 09/04/10 T4 09/04/10
62 Nur Fitri yupi 09/04/10 T3 09/04/10 10/06/11
63 Hotijah Mahmudi 10/05/10 T3 10/05/10 10/06/11
64 sumiati Rahmat 10/05/10 T4 10/05/10
65 Ponimah Rahem 10/05/10 T4 10/05/10
66 Robi*ah wahyudi 10/05/10 T3 10/05/10 10/06/11
67 Lilis Wahyudi 09/04/10 T2 09/04/10 10/06/11 07/07/11
68 Hoiriyah Yasin 09/04/10 T4 09/04/10
69 Aminah Sulaiman 10/05/10 T3 10/05/10 10/06/11
70 Junaida suparman 09/04/10 T4 09/04/10
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
71 Hani sutikno 09/04/10 T4 09/04/10
72 Nurhalimah amsuri 10/05/10 T4 10/05/10
73 Poniran sinal 10/05/10 T4 10/05/10
74 Junarsih suarso 09/04/10 T4 09/04/10
75 suarti samsuri 10/05/10 T4 10/05/10
76 Yayuk tohari 09/04/10 T3 09/04/10 10/06/11
77 sholehati Juki 09/04/10 T4 09/04/10
78 Riska Mahfut 10/05/10 T3 10/05/10 10/06/11
79 Laili Muklis 09/04/10 T4 09/04/10
80 arsi Adi 09/04/10 T4 09/04/10
81 Nurhayati Muhamad 09/04/10 T3 10/06/11 09/04/10
82 Maryati Manan 09/04/10 T4 09/04/10
83 rika Arik 10/05/10 T2 10/05/10 10/06/11 07/07/11
84 Muslima Muhlis 10/05/10 T4 10/05/10
85 Widiya suib 10/05/10 T3 10/05/10 10/06/11
86 Susi Ahmad 09/04/10 T3 10/06/11 09/04/10
87 Hotijah suhaidi 09/04/10 T4 09/04/10
88 wasiah Ali Suparman 09/04/10 T3 10/06/11 09/04/10
89 suswati Kaprawai 10/05/10 T4 10/05/10
90 Asiati sofyan 18/10/09 T4 10/05/10
91 Asih Imam Junaidi 10/06/11 T4 10/06/11
92 Muslihan Sian 10/06/11 T5 10/06/11
93 Aminah Samsul 10/06/11 T4 10/06/11
94 sofia Bakri 10/06/11 T5 10/06/11
95 wiwikJ Asari 10/06/11 T5 10/06/11
96 Nuraini Sutikno 10/06/11 T5 10/06/11
97 Afifah Ulung 10/06/11 T5 10/06/11
98 Hoiriyah Yasin 10/06/11 T5 10/06/11
99 Mahmuda Sumari 10/06/11 T5 10/06/11 07/07/11
100 Nanik Zaenuri 07/07/11 T5
101 Alfiyah Supriyadi 1980 9/9/2013 T4 1/8/2014
102 Adilah Adi 1992 11/1/2013 T4 2/10/2014
103 Sisilatul Haritono 1995 12/18/2013 T3 2/10/2014
104 Vianingsih Fani Puji 1993 12/7/2013 T4 2/10/2014
105 Ely Nurul A.Mukip 1995 1/17/2013 T3 2/10/2014
106 St.Qomariyah M.Ishaq 1995 1/8/2014 T4 1/8/2014
107
100 JUMLAH T0 0 0 0 0 0 5 32 0 0 0 2 2
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
T1 0 0
T4 63 4 ADS 0,5 ML 41
Kolom 6-7 : Isilah status TT
WUS sesuai hasil pendataan
(………………………………….. )
(wawancara), misalnya : T0,
T1, T2, T3, T4, T5
Kolom 8-12 : isilah tgl, bulan
dan tahun vaksinasi TT saat
NIP :
ini, khusus untuk WUS yang
sedang tidak hamil
Format 1
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 Wakik 12/01/68 12/04/10 T4 12/04/10
2 Farida M. Ayun A. 10/10/74 12/04/10 T4 12/04/10
3 Aminah Mursid 12/04/10 T4 12/04/10
4 Cholifatul Laili Andriyono 24/09/81 12/04/10 T4 12/04/10
5 Alfiah Yasin 02/03/72 12/11/09 T5
6 Yessey Alfiana 09/02/89 12/04/10 T3 12/04/10 13/06/11
7 Sumyati Hendi 12/08/77 12/04/10 T4 12/04/10
8 Khusnul Hotimah 09/02/68 12/11/09 T5
9 Hartini Mat Rais 02/03/60 12/11/09 T5
10 Ngatiyem Salim 12/11/09 T5
11 Rohemah Jupri 12/04/10 T3 12/04/10 13/06/11
12 Hotim Rahmadi 12/04/10 T3 12/04/10 13/06/11
13 B. Lilik Mad. Diyani 12/11/09 T5
14 Solehati 12/04/10 T3 12/04/10 13/06/11
15 B. Sol Supar 12/11/09 T5
16 Mas'adah Ahm. Safi'i 13/05/64 12/11/09 T5
17 Faiqotul 06/02/94 12/04/10 T3 12/04/10 13/06/11
18 Rusmiati Di 12/04/10 T4 12/04/10
19 Lastri Asip 12/04/10 T4 12/04/10
20 Alfia 12/04/10 T3 12/04/10 13/06/11
21 Sumarni Samad 12/11/09 T5
22 Yayuk 12/04/10 T3 12/04/10 13/06/11
23 B. Is Dolla 12/11/09 T5
24 Nining Rohim 12/04/10 T4 12/04/10
25 Siti Fatimah Muksin 12/04/10 T4 12/04/10
26 Su 12/04/10 T4 12/04/10
27 Maina Nursilam 12/11/09 T5
28 Rofi Sulhan 12/04/10 T3 12/04/10 13/06/11
29 Rohana 12/04/10 T3 12/04/10 13/06/11
30 B. Rosid 12/11/09 T5
31 Pon 12/11/09 T5
32 Lut 12/04/10 T3 12/04/10 13/06/11
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
33 Ati 12/04/10 T4 12/04/10
34 Wiwik Toni 12/04/10 T3 12/04/10 13/06/11
35 Ros Azis 12/04/10 T3 12/04/10 13/06/11
36 Mai P. Nurin 12/04/10 T4 12/04/10
37 Sum Mulyadi 12/04/10 T4 12/04/10
38 Sus Holis 12/04/10 T4 12/04/10
39 B. Samsul Sawi 12/11/09 T5
40 Sami Mawardi 12/11/09 T5
41 Mu'awah 12/11/09 T5
42 Yani Qiman 12/11/09 T5
43 Endang Sidik 12/04/10 T4 12/04/10
44 Herlin Yusuf 12/11/09 T5
45 Riska 12/04/10 T3 12/04/10 13/06/11
46 Winarsih Mat Hori 12/02/74 12/11/09 T5
47 Mursia Kamidi 12/04/10 T4 12/04/10
48 Tumiran Satori 12/11/09 T5
49 Yasemi Sakrim 12/11/09 T5
50 Manisa Saleh 12/04/10 T4 12/04/10
51 Rosideh Mastur 12/04/10 T4 12/04/10
52 Asmawi H. Suandi 12/11/09 T5
53 Titin Suandi 12/04/10 T3 12/04/10 13/06/11
54 Fatima Wakik 16/12/70 12/11/09 T5
55 Kamil Wakik 12/11/09 13/06/11
56 Tiana 12/04/10 T3 12/04/10 13/06/11
57 B. Mor Diran 20/04/64 12/11/09 T5
58 Naini Ahmad 24/09/83 12/04/10 T4 12/04/10
59 Manisa 12/04/10 T4 12/04/10
60 Iman 12/04/10 T3 12/04/10 13/06/11
61 B. Juari P. Juari 12/11/09 T5
62 Suswati Susiman 12/05/10 T4 12/05/10
63 Maisaroh 12/05/10 T4 12/05/10
64 Naima P. Pur 12/11/09 T5
65 B. Mai 12/11/09 T5
66 Mai 12/05/10 T4 12/05/10
67 Buama Misto 24/05/70 12/05/10 T4 12/05/10
68 Vin 21/02/76 12/11/09 T5
69 Fit 12/05/10 T4 12/05/10
70 Helus Pon 28/10/75 12/11/09 T5
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
71 Musrifah Samsuri 12/06/72 12/11/09 T5
72 Ideh 12/05/10 T4 12/05/10
73 Kiptiah Narto 05/04/71 12/11/09 T5
74 Firoh Mahsum 16/02/91 12/05/10 T3 12/05/10 13/06/11
75 Sulis Solikin 24/05/81 12/11/09
76 Sideh H. Akbar 14/02/75 12/11/09 T5
77 Wartik 06/03/69 12/11/09 T5
78 Marfuah Bar 05/03/78 12/11/09 T5
79 Herati Kartono 08/08/69 12/11/09 T5
80 Ita Holik 05/10/80 12/05/10 T3 12/05/10 13/06/11
81 Romlah Bawon 22/12/70 12/11/09 T5
82 Rahma Pak Mo 12/11/09 T5
83 Hotija Dul Halim 30/06/77 12/11/09 T5
84 Pauzah Mansyur 02/03/79 12/11/09 T5
85 Soleha Muji 12/11/09 T5
86 Syanti Sanusi 12/11/09 T5
87 Bibin 12/11/09 T3 13/06/11 12/07/11
88 Sayati 11/02/83 12/11/09 T4 13/06/11
89 Umi Leman 07/06/85 12/04/10 T3 12/04/10 13/06/11
90 Rofati Satori 24/07/82 12/04/10 T3 12/04/10 13/06/11
91 Marwiyah 29/07/70 12/11/09 T5
92 Sukarsih 12/11/09 T5
93 Warna 12/11/09 T3 13/06/11 12/07/11
94 Wanti 12/04/10 T3 12/04/10 13/06/11
95 Wakik 12/05/10 T4 12/05/10
96 Suryati Misto 05/07/75 12/11/09 T5
97 B. Ho 12/11/09 T5
98 Santi 12/11/09 T3 13/06/11 12/07/11
99 Harmi 12/11/09 T5
100 Lika 12/04/10 T3 12/04/10 13/06/11
101 Ulfa 12/05/10 T3 12/05/10 13/06/11
102 Misna Paikan 12/11/09 T5
103 Holipah Dordiri 02/08/77 12/11/09 T5
104 Fitrah 11/07/98 12/04/10 T4 12/04/10
105 Halimah Suyip 01/05/80 12/05/10 T4 12/05/10
106 Ririn Ansori 12/11/09 T3 13/06/11 12/07/11
107 Siti Hadi 26/05/73 12/11/09 T5
108 Sitiha Purwo 12/04/10 T3 12/04/10 13/06/11
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
109 Jumi Qiram 25/11/57 12/11/09 T5
110 Fitriah Dullah 04/02/81 12/05/10 T4 12/05/10
111 Wakik Sutrisna 07/11/89 12/05/10 T4 12/05/10
112 Nawaro Susanto 07/09/82 12/04/10 T3 12/04/10 13/06/11
113 Hopiah Abdul Rohma 19/06/69 12/11/09 T5
114 Sinta 12/05/10 T3 12/05/10 13/06/11
115 Holipah Bunisam 11/07/62 12/11/09 T5
116 Ika Rohbini 09/05/82 12/11/09 T4 13/06/11
117 Aris Bukhori 04/10/87 12/11/09 T5
118 Sutima Supangal 19/04/96 12/05/10 T4 12/05/10
119 Winda 25/09/96 12/11/09 T4 13/06/11
120 Sulastri Habib 12/11/09 T5
121 B. Dina 12/11/09 T5
122 Dina 12/11/09 T4 13/06/11
123 Fatimah Naam 12/11/09 T5
124 Hotimah Umar 07/05/83 12/05/10 T4 12/05/10
125 B. Um Salikon 12/11/09 T5
126 Suna 12/11/09 T4 13/06/11
127 sudiyeh 12/11/09 T4 13/06/11
128 Farida Hadi 12/11/09 T3 13/06/11 12/07/11
129 Laili Samsul 05/07/88 12/05/10 T3 12/05/10 13/06/11
130 Yani Narjo 26/05/82 12/11/09 T3 13/06/11 12/07/11
131 Rohma Nisato 24/02/74 12/11/09 T5
132 Yuni 24/11/95 12/05/10 T3 12/05/10 13/06/11
133 Rohemah 12/11/09 T4 12/07/11
134 Amina Habit 12/11/09 T4 12/07/11
135 Aryati Habit 12/11/09 T4 13/06/11
136 Hosni Wa 07/09/80 12/11/09 T4 13/06/11
137 Nofi 05/11/97 12/11/09 T5
138 Fitriah Paiman 14/02/90 12/11/09 T5
139 B. Indah Miskari 12/11/09 T5
140 Siti 25/10/94 12/11/09 T4 12/07/11
141 Ariyati Asmat/P. Ulum 17/09/70 12/11/09 T5
142 Afif Farhan 28/11/87 12/11/09 T3 13/06/11 12/07/11
143 Sumiyati P. Erfan 13/05/73 12/11/09 T5
144 Khotima Asir 24/11/64 12/11/09 T5
145 Sumarni Pat/P. Sanah 02/11/73 12/11/09 T5
146 Sanah 16/10/90 12/11/09 T5
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
147 Hanik 04/07/99 12/11/09 T5
148 Senap 12/10/79 12/11/09 T5
149 Siti Atun 15/07/80 12/11/09 T5
150 Sutima Supangat 12/11/09 T5
151 Hotima Niman 12/11/09 T4 13/06/11
152 Halima 12/11/09 T5
153 Rodia Sukandar 09/11/62 12/11/09 T5
154 Rabek Dul Basir 12/04/68 12/11/09 T5
155 Rahmati Adul Rosit 25/05/71 12/11/09 T5
156 Afif 02/07/91 12/11/09 T5
157 Heni Robi'i 24/05/71 12/11/09 T5
158 Qurrotul Aini 12/11/09
159 Khoriyah Musayyim 05/10/75 12/11/09 T5
160 Wulan 16/05/99 12/11/09 T5
161 Hadiyah Rakib 23/05/80 12/11/09 T5
162 Siama P. Jon 07/08/70 12/11/09 T5
163 Siti 13/12/73 12/11/09 T5
164 Vivi 06/10/82 12/11/09 T5
165 Kosiati Busir 02/10/70 12/11/09 T5
166 Ita 11/05/87 12/11/09 T5
167 Ulfa Helmi 12/07/87 12/11/09 T5
168 Maliya Sucipto 10/05/72 12/11/09 T5
169 Ayu 13/02/98 12/11/09 T5
170 Wahyuni 14/02/87 12/11/09 T5
171 Heni 06/07/94 12/11/09 T5
172 Kholifah 27/07/95 12/11/09 T4 13/06/11
173 Anita Iqolbi Muhlisin 12/11/09 T5
174 Munim 12/11/09 T5
175 Fifi Andriani 12/11/09 T5
176 Supakmi Subali 12/11/09 T5
177 Fatimah 14/02/92 12/11/09 T4 13/06/11
178 Titin 12/05/10 T2 12/05/10 13/06/11 12/07/11
179 Hosniati 12/11/09 T5
180 S. Nafiah Ansori 03/04/83 12/11/09 T4
181 Siti Aminah Suroto 12/11/09 T5
182 Siti Maimunah Abdul baki 15/12/70 12/11/09 T5
183 Siti Soleha Taufik 20/06/75 12/11/09 T5
184 Maratul Hasanah 12/11/09 T4
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
185 Warsih Murahmat 12/11/09 T5
186 Nuryati Temon 12/11/09 T5
187 Sri Widadi 12/11/09 T5
188 Sopiyati Ulum 01/01/81 12/11/09 T5
189 Hosniyeh Imam Baidowi 12/11/09 T5
190 Hamiyeh Mustafa 12/11/09 T5
191 Uul Mahmud 05/05/84 12/11/09 T5
192 Hosiah Ahmad 12/04/64 12/11/09 T5
193 Siti Maryam 08/07/93 12/11/09 T5
194 Siti Jamiatus S. 08/06/94 12/11/09 T5
195 Purwati Hanik 12/11/09 T3 13/06/11 12/07/11
196 Hanik Mulyono 15/05/79 12/11/09 T5
197 Kamsia 12/11/09 T5
198 Hartatik Suparman 12/11/09 T5
199 Asia haqi 12/11/09 T2 13/06/11 12/07/11
200 Istik 12/11/09 T2
201 Siti Zaenab Suip 15/02/78 12/11/09 T5
202 Muawanah 12/11/09 T3 13/06/11 12/07/11
203 Jamila Senindal 21/06/71 12/11/09 T5
204 Suriyah 12/11/09 T4 13/06/11
205 Pupus 15/02/92 12/11/09 T4 12/07/11
206 Tumina P. Nico 12/11/09 T5
207 Tisadi P. Abdul 12/11/09 T5
208 Suharni Arsuto 12/11/09 T5
209 Deni 05/08/92 12/11/09 T4 13/06/11
210 B. Sibol Trimo 12/11/09 T5
211 Nurisnaini H. Imam Haderi 07/12/59 12/11/09 T5
212 Rohana A. Wahit 10/05/54 12/11/09 T5
213 Toyiba Slamet 12/11/09 T4 13/06/11
214 Umi Sutrisno 05/12/80 12/11/09 T5
215 Rosida Simon 16/02/69 12/11/09 T5
216 Dwi Aryani Harik 22/04/84 12/11/09 T5
217 Sutiha P. Rosid/Ahmad 16/09/68 12/11/09 T5
218 Hotimah Mubarik 02/11/85 12/11/09 T5
219 Supiyah P. Her 11/05/63 12/11/09 T5
220 Hosiah Saden 02/12/76 12/11/09 T5
221 evi 24/04/91 12/11/09 T5
222 Uswatun 06/06/94 12/11/09 T5
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
223 Siti Masitoh Saiful 16/02/79 12/11/09 T5
224 Soleha 12/07/57 12/11/09 T5
225 Ganesa 09/11/90 12/11/09 T5
226 Yenny Hosin 20/04/80 12/11/09 T5
227 B. Inul P. Inul 12/11/09 T5
228 Saadah Mulyadi 28/07/76 12/11/09 T5
229 Marhama Mahak 11/07/69 12/11/09 T5
230 Maryatun P. Gufron/Misnari 06/10/72 12/11/09 T5
231 Paidah Suyut 02/09/72 12/11/09 T5
232 Sumiati 12/11/09 T5
233 Yuli 12/11/09 T4 13/06/11
234 Sumarni Herman 16/10/83 12/11/09 T4 13/06/11
235 Wahyuni 12/11/09 T5
236 Rigiah Wahyudi 35 th 16/10/13 T4 11/02/14
236 JUMLAH T0 0 0 0 0 0 10 59 0 0 0 0 0
T1 0 0
T4 55 1 ADS 0,5 ML 69
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
NIP :
hamil
Format 1
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 Nadiroh M. Qurdi 1979 02/12/09 T5
2 Nawaroh Nurul 1977 02/12/09 T5
3 Utari Kadi 1985 12/05/10 T4 12/05/10
4 Fadiya Amal 1978 12/05/10 T4 12/05/10
5 Arsida Hasim 1972 02/12/09 T5
6 Hitija Riman 1974 02/12/09 T4 Jul-11
7 Siti Halima Zinal 1978 02/12/09 T5
8 Yati Suyit 1984 02/12/09 T3 Jul-11
9 Maryani Hadi 1980 02/12/09 T4
10 Halifa Naryo 1968 12/05/10 T4 12/05/10
11 Novi P. Yudi 1987 12/05/10 T4 12/05/10
12 Hayati Slamet 1969 12/05/10 T4 12/05/10
13 Fitriya P. Rosid 1992 02/12/09 T4 Jul-11
14 Namimah Rasid 1982 02/12/09 T3 Jul-11
15 Sayenah Saman 1977 12/05/10 T4 12/05/10
16 Susiana P. Rio 1985 02/12/09 T4 Jul-11
17 Sofiya Heri 1979 02/12/09 T4 Jul-11
18 Asih Halil 1975 12/05/10 T4 12/05/10
19 Titin Hafid 1986 02/12/09 T3 Jul-11
20 Wiwik Mustofa 1989 02/12/09 T2 Jul-11
21 Titik Masudi 1988 12/05/10 T4 12/05/10
22 Kartini Sukadi 1971 02/12/09 T3 Jul-11
23 Solehati Yanto 1979 02/12/09 T4 Jul-11
24 Farid P. Yudi 1986 02/12/09 T4 Jul-11
25 Sumianten P. Yudi 1969 02/12/09 T2 Jul-11
26 Holideh P. Nafik 1977 02/12/09 T3 Jul-11
27 Heni Anton 1985 02/12/09 T3 Jul-11
28 Sarifa Samiah 1974 02/12/09 T5
29 Ika Juber 1971 02/12/09 T4
30 Hotija 1984 02/12/09 T3 Jul-11
31 Isnani Imam 1974 04/12/09 T4
32 Insiyatul P. Adit 1975 04/12/09 T4
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
33 Tamimah P. Mahfud 1979 04/12/09 T4
34 Safiyah Suryati 1970 04/12/09 T5
35 Harifah Sugianto 1972 12/05/10 T4 12/05/10
36 Balfin Suhar 1979 04/12/09 T5
37 Siti Aminah Heri 1974 04/12/09 T4 Jul-11
38 Hosning Sa'at 1972 04/12/09 T5
39 Muriya Dulberi 1970 04/12/09 T3 Jul-11
40 Nurhayati Kari 1971 04/12/09 T3 Jul-11
41 Yuli Rudi 1990 04/12/09 T4
42 Misnawati Mustofa 1977 04/12/09 T3 Jul-11
43 Sumarni Dul 1984 12/05/10 T4 12/05/10
44 Hosniyah Asari 1975 04/12/09 T5
45 Fatimah Hosen 1970 04/12/09 T3 Jul-11
46 B. H Gufron P.H Gufron 1968 05/11/09 T4 Jul-11
47 Nurmasitoh Iwan 1984 05/11/09 T4 Jul-11
48 Senima P. eko 1969 05/11/09 T4 Jul-11
49 Holif Muksin 1985 12/05/10 T3 12/05/10 Jul-11
50 Lailis P. H Gufron 1992 05/11/09 T3 Jul-11
51 Ida P. Di 1974 12/05/10 T3 12/05/10 Jul-11
52 Sumi P. Miatun 1974 05/11/09 T3 Jul-11
53 Wasi'a Junaidi 1992 12/05/10 T4 12/05/10
54 Hofifa 1984 12/05/10 T3 12/05/10 Jul-11
55 Lestari Durahman 1977 05/11/09 T4 Jul-11
56 Sutika H. Sidi 1972 05/11/09 T3 Jul-11
57 Nur Marhaki 1974 05/11/09 T4 Jul-11
58 Umyati Yan 1973 12/05/10 T3 12/05/10 Jul-11
59 Mina Busri 1988 12/05/10 T3 12/05/10 Jul-11
60 Lia Mistrali 1969 05/11/09 T3 Jul-11
61 Muniroh Manan 1969 05/11/09 T3 Jul-11
62 Sifaf Ani 1979 15/05/10 T4 15/05/10
63 Nikmah Dulwali 1979 05/11/09 T4 Jul-11
64 Ana P. Reva 1984 05/11/09 T4 Jul-11
65 Ana Holis 1989 12/05/10 T4 12/05/10
66 Naimah Sahri 1968 05/11/09 T4 Jul-11
67 Susi P. Bambamg 1984 05/11/09 T4 Jul-11
68 B. Bambang P. Bambang 1967 05/11/09 T3 Jul-11
69 Roki A. P. Sofi 1974 05/11/09 T3 Jul-11
70 Holif P. Rokia 1991 05/11/09 T3 Jul-11
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
71 Kipti P. Tika 1977 12/05/10 T4 12/05/10
72 Isbat P. Tapa 1983 05/11/09 T4 Jul-11
73 Miati Suri 1979 12/05/10 T4 12/05/10
74 Asnap 1974 12/05/10 T4 12/05/10
75 Kulsum P. Kevin 1987 12/05/10 T4 12/05/10
76 Maksufah Sulhan 18/08/81 12/05/10 T4 12/05/10
77 Islamiati B. Sudi 06/01/82 12/05/10 T4 12/05/10
78 Ruhati Saniwi 04/03/68 05/11/09 T4 Jul-11
79 Narti Muzekqi 19/09/64 05/11/09 T4 Jul-11
80 Efat Budi 27/06/82 05/11/09 T4 Jul-11
81 Komaria Sori 19/04/76 12/05/10 T4 12/05/10
82 Holila Mufet 20/06/71 05/11/09 T5
83 Lilik Jainuri 06/10/81 12/05/10 T4 12/05/10
84 Wesik Iwan 18/08/81 12/05/10 T4 12/05/10
85 Ham Hj. Mudi 13/09/84 05/11/09 T4 Jul-11
86 Sulfa Hj. Mudi 13/10/88 05/11/09 T4 Jul-11
87 Nafis Hj. Mudi 15/05/98 05/11/09 T4 Jul-11
88 Efik Bahrod 14/07/87 12/05/10 T4 12/05/10
89 Dimah Amin 07/04/66 05/11/09 T5
90 Ningsih Turfadi 21/03/73 05/11/09 T5
91 Siti Warna 12/05/10 T4 12/05/10
92 Rid Sarnu 05/11/09 T5
93 Siti Salem 05/11/09 T5
94 Suliha Asnawi 12/05/10 T4 12/05/10
95 Lilik Misnu 05/11/09 T5
96 Satria Misnu 05/11/09 T4 Jul-11
97 Misyati Ramsugi 12/05/10 T1 12/05/10 Jul-11
98 B. Ferdi Tohari 05/11/09 T5
99 Nur Sinal 05/11/09 T4 Jul-11
100 Is P. Jir 19/09/91 05/11/09 T5
101 Elita Allem 08/01/91 05/11/09 T4 Jul-11
102 Holideh Rianto 12/07/75 05/11/09 T2 Jul-11
103 Marbiyeh Muair 05/11/09 T5
104 Siti Maisaroh Mat 13/10/89 05/11/09 T5
105 Wiwin Sinal 14/10/88 05/11/09 T5
106 Su Selami 05/11/09 T5
107 Isnaini Marsai 05/11/09 T4 Jul-11
108 Rahmati Baihaki 05/11/09 T5
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
109 Anik Lisan 05/11/09 T5
110 Fatimah P. Aldi 05/11/09 T5
111 Jumaiya P. Hot 05/11/09 T1 Jul-11
112 Novi Jun 05/11/09 T5
113 Ponima Sumade 05/11/09 T3 Jul-11
114 Halima P. Sumiarto 05/11/09 T1 Jul-11
115 Supriyati Sapik 05/11/09 T1 Jul-11
116 Mani P. Linda 05/11/09 T3 Jul-11
117 Sus Pausi 05/11/09 T5
118 Dimah Muki 12/05/10 T4 12/05/10
119 Hotija Rusdi 05/11/09 T4 Jul-11
120 Hakim P. Imron 12/05/10 T4 12/05/10
121 Nasiha P. Gapor 05/11/09 T5
122 Halima H. bali 05/11/09 T5
123 Utari P. yet 05/11/09 T3 Jul-11
124 ganimah Mad 12/05/10 T4 12/05/10
125 Werdeh Muki 05/11/09 T3 Jul-11
126 Buyami H. Hamit 05/11/09 T5
127 Nuraini Musi 05/11/09 T5
128 Roini P. Lila 05/11/09 T5
129 Lila P. Lila 05/11/09 T5
130 Sadey Dolamin 05/11/09 T5
131 Dewi Asari 12/05/10 T4 12/05/10
132 Nurhasanah Tolo 05/11/09 T5
133 Saideh P. Kamuri 05/11/09 T5
134 Maryani Miysen 12/05/10 T4 12/05/10
135 Kamil Rusdi 05/11/09 T4 Jul-11
136 Yuyun Eviana P. Rahmat 04/08/83 12/05/10 T4 12/10/10
137 Saiful M. P. Rahmat 12/08/95 05/11/09 T4 Jul-11
138 Mani Rahmat 06/04/68 05/11/09 T3 Jul-11
139 Faridatus S. Taufik 24/11/99 05/11/09 T4 Jul-11
140 Jayanti Sumadi 09/06/91 05/11/09 T3 Jul-11
141 Ernawati P. Busri 10/03/70 05/11/09 T5
142 Miftahul Jannah Naryo 15/05/93 12/05/10 T4 12/05/10
143 Ririn Saman 20/10/87 12/05/10 T4 12/05/10
144 Tutik P. Subir 16/07/73 05/11/09 T4 Jul-11
145 Suwining Mat Bardi 28/07/74 05/11/09 T4 Jul-11
146 Mutmaina Fandi 24/07/88 05/11/09 T4 Jul-11
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
147 Su/B. Frisa Nimam 15/05/79 05/11/09 T4 Jul-11
148 Hamideh Munir 04/08/80 12/05/10 T4 12/05/10
149 B. Noval Sugianto 12/03/74 05/11/09 T4 Jul-11
150 Bawon Hartono 18/04/78 12/05/10 T4 12/05/10
151 Sumiati H. samsul 17/01/64 03/12/09 T5
152 Fatimah Hosen 03/12/09 T5
153 Haripah Sugianto 07/09/69 03/12/09 T5
154 B. Alpin Sunar 05/08/82 03/12/09 T4 Jul-11
155 Tomyati Munir 12/05/10 T4 12/05/10
156 Halima Munir 06/08/94 12/05/10 T4 12/05/10
157 Isnaini Imam 03/12/09 T5
158 Tamimah Mahfut 03/12/09 T5
159 Sapiya Suryadi 15/02/67 03/12/09 T5
160 B. Ria Siyo 03/12/09 T5
161 Bikaya Sunaryo 03/12/09 T5
162 Dani Ari 03/12/09 T3 Jul-11
163 Asih Halil 10/08/73 03/12/09 T5
164 Rina Halil 03/12/09 T3 Jul-11
165 Titin Hafit 12/05/10 T4 12/05/10
166 Husaimah Asnandi 12/11/93 03/12/09 T5
167 Safrida Asnandi 10/07/94 03/12/09 T5
168 Misyani Mastuki 30/06/90 03/12/09 T5
169 Lilis S. Abdul Hamid 08/05/91 15/05/10 T4 15/05/10
170 Hosning Saat 06/08/72 03/12/09 T5
171 Siti Amina Heri 10/06/78 03/12/09 T5
172 Nuriya Dulberi 03/12/09 T5
173 Maryati P. Sirih 03/12/09 T5
174 Nurhayati Kari 04/08/70 03/12/09 T5
175 Yuli Rudi 15/05/10 T4 15/05/10
176 Misnawati Mustofa 17/05/75 03/12/09 T5
177 Biarni Slamet 03/12/09 T5
178 Sumarni Abdul Hamid 03/12/09 T4 Jul-11
179 Hosniyah Asari 03/12/09 T5
180 Sumiana Napi 04/03/65 05/12/10 T5
181 Holila Toha 15/05/10 T4 15/05/10
182 Businti P. Adit 15/05/10 T4 15/05/10
183 Niwa P. heni 15/05/10 T4 15/05/10
184 Heni Anton 15/05/10 T4 15/05/10
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
185 Kamila Ali Wafa 16/08/89 15/05/10 T3 15/05/10 Jul-11
186 Wasiroh Umar 02/05/92 05/12/10 T5
187 Yayuk Sugianto 14/10/91 15/05/10 T4 15/05/10
188 Anis Napi 19/12/92 05/12/10 T4 Jul-11
189 Ikoh H. Samsul 23/02/92 05/12/10 T4 Jul-11
190 Fani Imam B. 05/12/10 T3 Jul-11
191 Tatik Hamidin 05/12/10 T3 Jul-11
192 Heni Hamidin 05/12/10 T4
193 B. sukaron Hamidin 05/12/10 T5
194 Hofifah Sidik 05/12/10 T4 Jul-11
195 Misnawati P. Aldi 05/12/10 T4 Jul-11
196 Mus/B. Jun P. Juli 05/12/10 T5
197 Wiwik Mustofa 15/05/10 T4 15/05/10
198 Maridi Sugi 05/12/10 T5
199 Titik Masudi 05/12/10 T4 Jul-11
200 Sumanten P. yudi 05/12/10 T5
201 Rodiyeh Hadi 05/12/10 T4 Jul-11
202 Sriyanti P. ali 05/12/10 T5
203 Ani Asan 05/12/10 T4 Jul-11
204 Holideh P. Nafik 15/05/10 T4 15/05/10
205 Hamdelah Mistari 05/12/10 T4 Jul-11
206 Kartini Sukardi 05/12/10 T5
207 Sutila Asari 05/12/10 T3 Jul-11
208 Us Kastam 05/12/10 T5
209 Sofiyeh Ahmad 05/12/10 T5
210 Saripa Samian 05/12/10 T5
211 Rusmiati P. aldi 01/12/76 02/12/09 T5
212 Kikah Wit P. Rindi 02/12/09 T5
213 Rum 02/12/09 T5
214 B. Hengki P. Hengki 02/12/09 T5
215 Sofiyem P. Ratna 02/12/09 T4 Jul-11
216 B. Win P. Win 02/12/09 T5
217 Rosideh Mahfut 02/12/09 T3 Jul-11
218 Sumiati Juari 02/12/09 T5
219 B. Rid Ribut 02/12/09 T5
220 Ribut P. Aditia 02/12/09 T5
221 Mardiana Dwi Fawaik 21 th 26/01/14 T4 14/02/14
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
221 JUMLAH T0 0 0 0 3 4 31 53 0 0 0 0 0
T1 4 0
T4 99 3 ADS 0,5 ML 91
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
NIP :
hamil
Format 1
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 Endang isnaini Anwari 12/04/10 T4 12/04/10
2 Anis W Anwari 16/11/09 T5
3 maisaroh sudahnan 20/04/10 T4 20/04/10
4 Riskiwati Nurul Mustopa 20/04/10 T4 20/04/10
5 Lisa Muhammad 20/04/10 T4 20/04/10
6 Misnaya Adi Muhtar 20/04/10 T4 20/04/10
7 Misnati Mujiono 12/05/10 T4 12/05/10
8 Nadiroh Arsat 12/05/10 T4 12/05/10
9 rifatul Halim 12/05/10 T4 12/05/10
10 Jatimah Hakim 20/04/10 T4 20/04/10
11 Bugi 20/04/10 T4 20/04/10
12 Sunarti Supiyono 12/05/10 T4 12/05/10
13 Fitriyah Taufik 12/05/10 T4 12/05/10
14 Subaidah Azis 20/04/10 T4 20/04/10
15 suhan 20/04/10 T4 20/04/10
16 Wakiah M. Rifa*i 12/05/10 T4 12/05/10
17 Tellen salim 12/05/10 T4 12/05/10
18 sri Ahmad 16/11/09 T5
19 Lutfiah ahmad Z 20/04/10 T4 20/04/10
20 Buama Jalal 12/06/10 T4 12/06/10
21 Nijo 12/06/10 T4 12/06/10
22 Nadiroh Nijo 12/06/10 T4 12/06/10
23 Aryati siri 16/11/09 T5
24 Hosni Riyanto 12/05/10 T4 12/05/10
25 Luluk Riyanto 12/05/10 T2 12/05/10 16/06/11 20/07/11
26 Fitriyah Misno 20/04/10 T4 20/04/10
27 Satumi Suwardi 20/04/10 T4 20/04/10
28 Widia Suwardi 16/11/09 T4 16/06/11
29 Widiya Suwardi 20/04/10 T4 20/04/10
30 Tariye Holil 20/04/10 T4 20/04/10
31 tumyati Sadru 20/04/10 T4 20/04/10
32 Zaenab Bahratun 12/05/10 T4 12/05/10
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
33 Komariyah Tarom 12/05/10 T4 12/05/10
34 Misnati 20/04/10 T4 20/04/10
35 Herlina 20/04/10 T2 20/04/10 16/06/11 20/07/11
36 saima Napi 20/04/10 T4 20/04/10
37 Misnati Misli 16/11/09 T5
38 Hartini Mulyadi 20/04/10 T4 20/04/10
39 Juhairiyah Mulyadi 12/05/10 T4 12/05/10
40 Hosey Mulyadi 16/11/09 T5
41 Almaratus Saenal A 20/04/10 T4 20/04/10
42 sumiati Wagiono 20/04/10 T4 20/04/10
43 Begini supono 20/04/10 T4 20/04/10
44 Sakdia Anwari 20/04/10 T4 20/04/10
45 Senaini Deka 16/11/09 T5
46 Hani Sumarno 12/05/10 T4 12/05/10
47 Soleha Tukiman 12/05/10 T4 12/05/10
48 asmani Bunamin 16/11/09 T5
49 Istiqomah Bunamin 16/11/09 T5
50 toyani Misdin 12/05/10 T4 12/05/10
51 Maimunah Bura*i 12/05/10 T4 12/05/10
52 Urida Bura*i 16/11/09 T5
53 Jumani Misnadin 12/05/10 T4 12/05/10
54 Erna adi 20/04/10 T4 20/04/10
55 Tisnawati Yesin 20/04/10 T4 20/04/10
56 Poni Denan 12/05/10 T4 12/05/10
57 Jumaiya Awiyanto 12/05/10 T4 12/05/10
58 St Aminah Gunawan 20/04/10 T4 20/04/10
59 Sifak Turi 20/04/10 T4 20/04/10
60 Hena Hena 12/05/10 T4 12/05/10
61 Buadi Sahridi 20/05/10 T4 20/05/10
62 Fatima Jalil 20/05/10 T4 20/05/10
63 Saideh Miskon 20/05/10 T4 20/05/10
64 Laili Irwan 20/04/10 T3 20/04/10 16/06/11
65 Nais Mar 20/05/10 T4 20/05/10
66 Rohati Madin 20/04/10 T4 20/04/10
67 Jumalia Mulyadi 16/11/09 T5
68 Nuraini Mulyadi 20/05/10 T4 20/05/10
69 Endrayana didik 20/05/10 T4 20/05/10
70 Halima Sukar 20/05/10 T4 20/05/10
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
71 Wildasari sukaryanto 20/04/10 T4 20/04/10
72 Hanifa Rudi 20/05/10 T4 20/05/10
73 Buse Tosan 20/05/10 T4 20/05/10
74 Giman Yeni 20/05/10 T4 20/05/10
75 Suryati Saham 16/11/09 T5
76 Rahmawati Wahyudi 20/05/10 T4 20/05/10
77 siati rijo 20/05/10 T4 20/05/10
78 Eva Saehu 16/11/09 T5
79 maisaroh Juma*i 20/04/10 T4 20/04/10
80 Aminah Abd. Karim 20/05/10 T4 20/05/10
81 Yayuk Teguh 16/11/09 T5
82 Junaida Tukiman 20/04/10 T4 20/04/10
83 Tariye Arif 20/05/10 T4 20/05/10
84 siseh samsul 20/05/10 T4 20/05/10
85 Mus 16/11/09 T5
86 Mery 16/11/09 T3 16/06/11 20/07/11
87 Yosi 16/11/09 T3 16/06/11 20/07/11
88 Paena sugianto 20/05/10 T4 20/05/10
89 Tima saman 20/04/10 T4 20/04/10
90 Mariye sumarsono 20/04/10 T4 20/04/10
91 Juhriya Buniman 20/05/10 T4 20/05/10
92 Manise Buamin 20/04/10 T4 20/04/10
93 Buani Basir 16/11/09 T5
94 Sutina Nurhadi 16/11/09 T5
95 Mutik Sumandri 20/05/10 T4 20/05/10
96 Ngatemi Gimo 20/05/10 T4 20/05/10
97 Halil Supiyani 16/11/09 T5
98 Sriatun Rahman 16/11/09 T5
99 Yuliatin 16/11/09 T5
100 Nuris naini Satimin 16/11/09 T5
101 Tiami Hamit 20/05/10 T4 20/05/10
102 Fitriah Hartono 20/04/10 T4 20/04/10
103 Trimo Ita 20/05/10 T4 20/05/10
104 St. Fatimah Fian 20/05/10 T4 20/05/10
105 tuyani Tohimin 20/05/10 T4 20/05/10
106 Yuliana Imam Mustopa 20/04/10 T4 20/04/10
107 Elik Abd.latif 20/05/10 T4 20/05/10
108 Sumiati Ahmad Fauzi 20/05/10 T4 20/05/10
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
109 Suyati Asmuni 20/05/10 T4 20/05/10
110 samsiyeh M. sukri 20/05/10 T4 20/05/10
111 Solehah Mahsun 16/11/09 T4 16/06/11
112 Hasanah 16/11/09 T4 16/06/11
113 Kusyati Matrawi 16/11/09 T4 16/06/11
114 Paenem Denan 20/05/10 T4 20/05/10
115 tima 20/05/10 T4 20/05/10
116 Sri wahyuni Samsul 20/04/10 T4 20/04/10
117 Misna Mursit 20/05/10 T4 20/05/10
118 Sutrini Arif 20/05/10 T4 20/05/10
119 sarini Heri 20/05/10 T4 20/05/10
120 Sumina Samhadi 16/11/09 T4 16/06/11
121 Sutila Hartono 20/05/10 T4 20/05/10
122 katini Asnawi 20/05/10 T4 20/05/10
123 Desi Deni 16/11/09 T5
124 Juma*a Sawil 16/11/09 T5
125 Safaatun samhari 20/04/10 T4 20/04/10
126 Kusmi Ponidi 20/04/10 T4 20/04/10
127 Suliyayah Buamin 20/05/10 T4 20/05/10
128 Fitriyah sugiono 20/04/10 T4 20/04/10
129 suarti Yesin 20/05/10 T4 20/05/10
130 Hartatik sugiono 20/05/10 T4 20/05/10
131 Latifah sarkam 20/05/10 T4 20/05/10
132 Mutmainah rosidi 16/11/09 T5
133 Holifah Faisol 16/11/09 T5
134 B. wedik Tajib 20/05/10 T4 20/05/10
135 solehati 16/11/09 16/06/11 20/07/11
136 Ahyani Saenol 16/11/09 16/06/11 20/07/11
137 Wakiah Waro 20/04/10 T4 20/04/10
138 fitriyah Yahya 20/04/10 T4 20/04/10
139 rosida Ahmad 20/04/10 T4 20/04/10
140 supini Jaelani 16/11/09 T5
141 Ponirah Sumar 16/11/09 T5
142 tumyati Nito 20/04/10 T4 20/04/10
143 Insiyah Hasim 20/04/10 T4 20/04/10
144 Sulasmi Agus 20/04/10 T4 20/04/10
145 Nuning Jaelani 20/04/10 T4 20/04/10
146 Tutik 20/04/10 T4 20/04/10
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
147 Rohana 20/04/10 T4 20/04/10
148 Ririn T Suhar 20/04/10 T4 20/04/10
149 Surep Mundur 20/04/10 T4 20/04/10
150 Paini Mus 20/04/10 T4 20/04/10
151 tija So 16/11/09 T5
152 Nur iman Agus 20/04/10 T4 20/04/10
153 tutik Budi 20/05/10 T4 20/05/10
154 Miskali Lilik 20/05/10 T4 20/05/10
155 Lilik Mulyadi 20/05/10 T4 20/05/10
156 tona Asnadi 16/11/09 16/06/11 20/07/11
157 Yani Marsum 20/05/10 T4 20/05/10
158 Jumani Sayuti 20/05/10 T4 20/05/10
159 Mimah Yusran 20/05/10 T4 20/05/10
160 Hotina Seniwi 20/05/10 T4 20/05/10
161 Monidi Nanang 16/11/09 T5
162 Suwini habibi 16/11/09 T5
163 Sumiyati Sudi 20/05/10 T4 20/05/10
164 Wita sudi 20/04/10 T4 20/04/10
165 Tima Mursit 16/11/09 T5
166 Siti Aminah Munir 16/06/11 T5 16/06/11 20/07/11
167 Nadiroh Rudi 16/06/11 T5 20/07/11
168 Anisa Asari 16/06/11 T5
169 Nur aini Budiantono 16/06/11 T5
170 Ayu Arif 16/06/11 T5
171 Siati Nijo 16/06/11 T5
172 Siti Alfiah Muklis 16/06/11 T5
173 Aryati Hari 16/06/11 T5
174 Sulina Tukiman 16/06/11 T5
175 Isnaini Asmuri 16/06/11 T5
176 Lilik Mulyadi 16/06/11 T5
177 Halimatus Dani 16/06/11 T5 16/06/11
178 Rodiah Saleh 16/06/11 T5 16/06/11
179 Tria Eka Samsul 16/06/11 T5 16/06/11
180 Nur Imami Agus 16/06/11 T5 16/06/11
181 Ningsih Santoso 16/06/11 T5 16/06/11
182 Buami Abdul Jalal 16/06/11 T5 16/06/11
183 Umamah Mulyadi 16/06/11 T5 16/06/11
184 Widiawati A. Sueb 16/06/11 T5 16/06/11
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
185 Siti Hoiriyah A. Yasin 16/06/11 T5 16/06/11
Format 1
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 Eli M Imam 20/10/09 T5
2 Yayuk S Sukur 17/03/10 T4 17/03/10
3 Falihah Muzayin 20/10/09 T5
4 Sofiah Mustaji 20/10/09 T5
5 Willa Nurul Huda 20/10/09 T5
6 Susi Hadi 20/10/09 T5
7 Afiyah Umar 20/10/09 T5
8 Yuni Mahin 20/10/09 T4 20/06/11
9 istikomah Taufik 20/10/09 T4 20/06/11
10 Neneng Superno 20/10/09 T5
11 Soleha Sutaher 20/10/09 T5
12 Mujai Mas*ot 20/10/09 T5
13 Yuliatin Slamet 17/03/10 T4 17/03/10
14 Jumaiya 20/10/09 T4 20/06/11
15 Indah Parmin 20/10/09 T5
16 Sri Tasrip 17/03/10 T3 17/03/10 20/06/11
17 Sudartik Tasrip 20/12/09 T5
18 Heni Makmun 20/12/09 T5
19 Nawaroh Yasin 20/12/09 T5
20 Riapin Nasar 20/12/09 T5
21 Maria Heri 20/12/09 T4 20/06/11
22 Emi Nasar 20/12/09 T2 14/07/11
23 Saraton Satrawi 20/12/09 T5
24 Saniyem Romawi 20/12/09 T5
25 Krista Romawi 17/03/10 T2 17/03/10 20/06/11 14/07/11
26 Susanti Romawi 20/12/09 T2 14/07/11
27 Fitriya Satrawi 20/12/09 T2 14/07/11
28 sutilah Hambali 20/12/09 T5
29 Holifah Misrai 20/12/09 T3 20/06/11 14/07/11
30 Mutik atem 20/12/09 T4 20/06/11
31 Kus Amal 17/03/10 T4 17/03/10
32 Jaemo Hotip 17/03/10 T4 17/03/10
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
33 raudeh H. Anam 17/03/10 T4 17/03/10
34 Mariyam Abduh 20/12/09 T5
35 Romlah Jumari 17/03/10 T4 17/03/10
36 ama Azis 20/12/09 T5
37 Eni Azis 20/12/09 T2 14/07/11
38 Meluk 20/12/09 T1 14/07/11
39 Trihardini M.Hatibin 20/12/09 T2 14/07/11
40 Winarti Mariyadi 17/03/10 T4 17/03/10
41 Mutmainah Mustopa 17/03/10 T4 17/03/10
42 Jum Cemat 20/12/09 T5
43 Misnaya Parto 20/12/09 T5
44 Ayu Agus 20/12/09 T3 20/06/11 14/07/11
45 sri Umiyati 20/12/09 T5
46 Triani Cemat 20/12/09 T2 14/07/11
47 Yuliatin taufik 17/03/10 T4 17/03/10
48 Yani suleman 20/12/09 T5
49 Jaenap Bayu 17/03/10 T4 17/03/10
50 Parmi makrup 17/03/10 T4 17/03/10
51 Hakinah Suavi 20/12/09 T5
52 Husnul Supriyadi 20/12/09 T5
53 Irma Supriyadi 20/12/09 T2 14/07/11
54 ti*ah Misdi 20/12/09 T5
55 Royan Amam 17/03/10 T4 17/03/10
56 Lia misdi 20/12/09 T2 14/07/11
57 tum Gimin 20/12/09 T4 20/06/11
58 Fatimah 20/12/09 T4 20/06/11
59 Rohmah Marsuki 20/12/09 T4 20/06/11
60 Muayanah Nur 17/03/10 T4 17/03/10
61 Ni Ilham 20/12/09 T4 20/06/11
62 Halima surojo 20/12/09 T4 20/06/11
63 Suyati Nijo 20/12/09 T2 14/07/11
64 Mistina Bunaim 20/12/09 T5
65 titin eko 20/12/09 T5
66 suprihatin solehudin 20/12/09 T5
67 Laili Mahfud 20/12/09 T2 14/07/11
68 Iis/Fitriyah solehudin 20/12/09 T2 14/07/11
69 Yatim sugiono 20/12/09 T5
70 Wulan sugiono 20/12/09 T2 14/07/11
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
71 Katin Suyitno 20/12/09 T5
72 Eka mahmud 17/03/10 T4 17/03/10
73 sunarni Misnanto 20/12/09 T5
74 Wulan Misnanto 20/12/09 T2 14/07/11
75 Kholila Supriyadi 17/03/10 T4 17/03/10
76 Mar Saiful 20/12/09 T5
77 rofiqoh Maelan 20/12/09 T4 20/06/11
78 Yatimah toha 20/12/09 T4 20/06/11
79 Firda toha 20/12/09 T2 14/07/11
80 Riami kasmidi 20/12/09 T5
81 Anif Giman 20/12/09 T4 20/06/11
82 Muf Budi 20/12/09 T5
83 Atik Huda 20/12/09 T5
84 hotim Bunali 20/12/09 T2 14/07/11
85 Aminah tolip 17/03/10 T4 17/03/10
86 dewi tolip 20/12/09 T1 14/07/11
87 Indah tolip 20/12/09 T1 14/07/11
88 Gini Dureh 20/12/09 T5
89 Fatimah Dureh 20/12/09 T2 14/07/11
90 Kholifah Dureh 20/12/09 T2 14/07/11
91 Mutiqoh Murtali 20/12/09 T5
92 sani narto 20/12/09 T5
93 Indah narto 20/12/09 T2 14/07/11
94 Kitul sucip 20/12/09 T4 20/06/11
95 Kusyati rohman 20/12/09 T5
96 sifak Fauzi 20/12/09 T4 20/06/11
97 tumi Azan 20/12/09 T5
98 Nunuk agus 20/12/09 T5
99 Siswati Karjo 17/03/10 T4 17/03/10
100 Utami Karjo 20/12/09 T2 14/07/11
101 Rosida Muklis 20/12/09 T5
102 riska Muklis 20/12/09 T2 14/07/11
103 Mur Awi 20/12/09 T5
104 Bunasri Nijo 20/12/09 T5
105 Musrifa Farhan 20/12/09 T5
106 Jumani Jalal 20/12/09 T5
107 Um Awi 20/12/09 T5
108 Halima Awi 21/04/10 T2 20/06/11 14/07/11 21/04/10
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
109 Ida M. Anwari 17/03/10 T4 17/03/10
110 Hotria Jaedi 17/03/10 T4 17/03/10
111 rosida Mulyono 20/12/09 T5
112 S. rohana Joko 20/12/09 T5
113 Umi Dulla 20/12/09 T5
114 Khot wahid 17/03/10 T4 17/03/10
115 Kana Hoiri 20/12/09 T5
116 Muslihatin Hoiri 20/12/09 T3 20/06/11 14/07/11
117 Siti Rokaya thori 20/12/09 T5
118 Nur Sodik 20/12/09 T5
119 zaenab Tris 20/12/09 T5
120 Lis Safaat 20/12/09 T5
121 Kasiyati Jamsari 20/12/09 T5
122 Siti Rokaya 20/12/09 T4 20/06/11
123 Mariyam wagiman 20/12/09 T5
124 Laili wagiman 20/12/09 T2 14/07/11
125 Bibit sardi 17/03/10 T4 17/03/10
126 Nunuk 20/12/09 T3 14/07/11
127 Misnari Tajab 20/12/09 T5
128 Um Hasim 20/12/09 T5
129 zaema Misbah 17/03/10 T4 17/03/10
130 ariyati Hojen 20/12/09 T5
131 Ponira Busro 20/12/09 T5
132 Pon arifin 20/12/09 T5
133 Peni arifin 20/12/09 T2 14/07/11
134 Emi Di 20/12/09 T5
135 Romiati Mawi 20/12/09 T5
136 Mus Lipong 20/12/09 T5
137 Agustini Mijan 20/12/09 T5
138 Holip samsul 20/12/09 T5
139 zaenab taji 20/12/09 T5
140 Lumayatun sulaeman 20/12/09 T5
141 Juma rusdi 20/12/09 T4 20/06/11
142 Tima Kamasari 20/12/09 T3 14/07/11
143 Suraiya Sukur 20/12/09 T5
144 Mini Misri 20/12/09 T5
145 Sarina Untung 20/12/09 T1 14/07/11
146 santi Sipul 20/12/09 T3 14/07/11
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
147 Temu Budin 20/12/09 T4 20/06/11
148 Silla Napi 20/12/09 T5
149 Vera Dulla 20/12/09 T3 14/07/11
150 Iid Lipong 20/12/09 T2 14/07/11
151 Atik Maidi 20/12/09 T5
152 Atik sutrisno 17/03/10 T4 17/03/10
153 Lia Kamsun 17/03/10 T4 17/03/10
154 Badriyah Mardi 20/12/09 T5
155 Mega Mijan 20/12/09 T2 14/07/11
156 Minik 20/12/09 T5
157 Asiyatul Hariyono 20/12/09 T5
158 Yem Mat 20/12/09 T5
159 Luluk Joni 20/12/09 T4 20/06/11
160 Hosniyah Karyono 20/12/09 T5
161 siti Karyono 20/12/09 T4 20/06/11
162 Titik Bendi 20/12/09 T4 20/06/11
163 Yayuk S totok 17/03/10 T4 17/03/10
164 erin totok 20/12/09 T2 14/07/11
165 Erni samad 20/12/09 T5
166 Saomi Mursid 20/03/09 T5
167 Sumarni Sugiono 17/03/10 T4 17/03/10
168 Muntamah Dikon 20/03/09 T5
169 Fatimah sugiono 20/03/09 T5
170 tatik suaji 17/03/10 T4 17/03/10
171 Uswatun saiful 20/03/09 T5
172 toyiba Miskadi 17/03/10 T4 17/03/10
173 tik Mistaha 20/03/09 T4 20/06/11
174 Mariyam Abdullah 20/03/09 T5
175 Holisah Biyut 20/03/09 T5
176 surakmi Baidowi 20/03/09 T5
177 Makrifah Aliyamo 20/03/09 T5
178 Rika Aliyamo 20/03/09 T5
179 istikomah Dedi 17/03/10 T4 17/03/10
180 Hil Yamo 20/03/09 T2 14/07/11
181 Luluk Yamo 20/03/09 T2 14/07/11
182 Yahmi Buyamin 20/03/09 T2 14/07/11
183 Mia Buyamin 20/03/09 T2 14/07/11
184 Sumaia Kadir 20/03/09 T5
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
185 Watik edy 17/03/10 T4 17/03/10
186 Junaeda Udin 17/03/10 T4 17/03/10
187 Inson suyitno 20/03/09 T5
188 Patmi Ishak 17/03/10 T4 17/03/10
189 Nur Abs. Muhisun 17/03/10 T4 17/03/10
190 Hosyati Nasikan 20/03/09 T5
191 In Asan 20/03/09 T5
192 Nofi pik 20/03/09 T2 14/07/11
193 Lilik siswanto 20/03/09 T5
194 Luluk Joko 20/03/09 T5
195 Wida Joko 20/03/09 T2 14/07/11
196 Parti nasikin 20/03/09 T5
197 sum satimin 20/03/09 T5
198 Sup sumari 20/03/09 T5
199 Dewi sumari 20/03/09 T2 14/07/11
200 Ninig Satiman 20/03/09 T2 14/07/11
201 Suryati tugirin 17/03/10 T4 17/03/10
202 fitriya tugirin 20/03/09 T2 14/07/11
203 toyimah Imam 17/03/10 T4 17/03/10
204 Sumiati pardal 20/03/09 T5
205 Tumiya Toyib 20/03/09 T5
206 ayu Pardal 20/03/09 T2 14/07/11
207 atik sunawi 20/03/09 T5
208 etik agus 20/03/09 T5
209 susyati miswan 20/03/09 T5
210 Heni rojik 20/03/09 T4 20/06/11
211 Sulastri Heru 20/12/09 T4 20/06/11
212 Junairiya sugiono 20/12/09 T4 20/06/11
213 Ni Nijo 20/12/09 T5
214 samiyah Putu 20/12/09 T5
215 atik Holil 20/12/09 T5
216 Us 20/12/09 T2 14/07/11
217 Halima Ach. Hadi 20/12/09 T5
218 Retno supriadi 20/12/09 T3 14/07/11
219 Rohma Ahmad 20/12/09 T5
220 Faikoh Ahmad 20/12/09 T2 14/07/11
221 sugiarnik Nuralim 17/03/10 T4 17/03/10
222 Mina Seful 20/12/09 T5
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
223 Ana Nuralim 17/03/10 T4 17/03/10
224 toya salam 20/12/09 T5
225 Fatmawati salam 20/12/09 T3 14/07/11
226 Marmi Sadiran 20/12/09 T5
227 Maimunah Agus 20/12/09 T5
228 Saima saiful 20/12/09 T5
229 Fitriawati 20/12/09 T2 14/07/11
230 Devi halim 20/12/09 T5
231 Ani halim 20/12/09 T2 14/07/11
232 A. Lavenda Karim 17/03/10 T4 17/03/10
233 Gebi 20/12/09 T2 14/07/11
234 Sri wahyuni Mulyadi 20/12/09 T5
235 Olivia basid 17/03/10 T4 17/03/10
236 Ningrum Mulyadi 20/12/09 T2 14/07/11
237 Kiki Mulyadi 20/12/09 T2 14/07/11
238 rusmiati Hasan 17/03/10 T4 17/03/10
239 Sofiana deni 20/12/09 T3 14/07/11
240 retno ridwan 17/03/10 T4 17/03/10
241 Juhar Insiyah Irwan 17/03/10 T3 17/03/10 20/06/11
242 maryati Imam 20/03/10 T5
243 Mulyatin R. Fauzi 20/03/10 T5
244 anis R. Fauzi 20/03/10 T2 14/07/11
245 Asiati Robani 20/03/10 T5
246 Arik Fiqoh Robani 20/03/10 T2 14/07/11
247 Riska s Mukti ali 17/03/10 T3 17/03/10 20/06/11
248 Misnari sunarto 20/03/10 T5
249 rina sunarto 17/03/10 T3 17/03/10 20/06/11
250 zaenab Mursid 20/03/10 T5
251 Solehah Agus efendi 17/03/10 T3 17/03/10 20/06/11
252 Marfuah Dofir 20/03/10 T5
253 Aminatus s Dofir 20/03/10 T2 14/07/11
254 Darmi sudi 20/03/10 T5
255 Lutfiah Mursid 20/03/10 T5
256 Nurhayati suris 20/12/10 T5
257 Ulfa suris 20/12/10 T2 14/07/11
258 Mufti suris 20/12/10 T2 14/07/11
259 Naimah Murodi 20/12/10 T5
260 Juairiyah Mansur 17/03/10 T4 17/03/10
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
261 Khotijah 20/12/10 T5
262 yuyun 20/12/10 T4 20/06/11
263 Madda Mulyadi 17/03/10 T4 17/03/10
264 Ernawati Jono 20/12/10 T4
265 Meli Jono 20/12/10 T2 14/07/11
266 daeni Nakho*i 20/12/10 T2 14/07/11
267 Ifah E. Mulyono 20/12/10 T4 20/06/11
268 Alfiyah sugiono 20/12/10 T3
269 Sri Milik Samsul 20/12/10 T4
270 Khotijah Mulyono 20/12/10 T2 14/07/11
271 Insiyah Mulyono 20/03/10 T5
272 Kiki tom 20/03/10 T2 14/07/11
273 Komariyah 20/03/10 T4 20/06/11
274 Laili Burham 17/03/10 T2 17/03/10
275 Kumala Erliyanto 20/03/10 T5
276 Herlina H. wafi 20/03/10 T4 20/06/11
277 Faizeh I. Kholis 20/03/10 T5
278 Ida I. Kholis 17/03/10 T1 14/07/11 17/03/10
279 Dani Wono 20/03/10 T2 14/07/11
280 Iin Nurhayati Wono 20/03/10 T4 20/06/11
281 Tatik 20/03/10 T5
282 sumarmi 20/03/10 T5
283 Elti Basiuki 20/03/10 T5
284 Lilik amin 20/03/10 T5
285 Suliha Surat 20/03/10 T5
286 Lia Wit 21/04/10 T3 21/04/10 20/06/11
287 Rumiati Paijo 20/12/09 T5
288 sumiati sulyono 20/12/09 T4 20/06/11
289 Farida ansori 20/12/09 T4 20/06/11
290 Umiyati naijo 21/04/10 T4 21/04/10
291 Misnati 20/12/09 T5
292 Mis 20/12/09 T2 14/07/11
293 Bebun samsul 20/12/09 T2 14/07/11
294 Ita Samsul 20/12/09 T2 14/07/11
295 Nail taufik 20/12/09 T2 14/07/11
296 Ika Slamet 21/04/10 T3 21/04/10 20/06/11
297 ayik makmun 20/12/09 T3 20/06/11
298 Heni 21/04/10 T4 21/04/10
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
299 Iis Ton 20/12/09 T4 20/06/11
300 uul Tori 20/12/09 T4 20/06/11
301 Rina Samsul 20/06/11 T5 20/06/11
302 Misnati 20/06/11 T5 20/06/11
303 Husnul H Muhitur 20/06/11 T5 20/06/11
304 Halimatus Mujiono 20/06/11 T5 20/06/11
305 Novi Ayu TAufik 20/06/11 T5 20/06/11
306 Dani Fandi 20/06/11 T5 20/06/11
307 Tumiyah Toyib 20/06/11 T5 20/06/11
308 Rofi Deni 20/06/11 T5 20/06/11
309 Ulfa Saiful 20/06/11 T5 20/06/11
310 Kumiati Rohman 20/06/11 T5 20/06/11
311 Sifak Fauzi 20/06/11 T5 20/06/11
312 Misnati Imam 20/06/11 T5 20/06/11
313 Tukimah Agus 20/06/11 T5 20/06/11
314 Nurhayati M. Zaenal 20/06/11 T5 20/06/11
315 Ana Suryadi 20/06/11 T5 20/06/11
316 Yuni Mahin 20/06/11 T5 20/06/11
317 Feni 20/06/11 T5 20/06/11
317 JUMLAH T0 0 0 0 4 57 12 64 0 0 0 0 0
T1 4 1
T4 81 0 ADS 0,5 ML 137
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
NIP :
hamil
Format 1
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 Misnaya Muri 1955 19/05/10 T4 19/05/10
2 Ririn wahyuni Muri 1987 19/05/10 T4 19/05/10
3 Nurul Holifah Muri 1989 03/11/09 T4 21/06/11
4 Kristiyana H. Abd. Azis 1976 19/05/10 T4 19/05/10
5 Supina 1964 03/11/09 T5
6 ani sulistyowati Dadang 1976 19/05/10 T4 19/05/10
7 Muti*ah Ynato 1990 19/05/10 T4 19/05/10
8 siti Aminah sucipto 1974 03/11/09 T5
9 Lilik Fitriyah sucipto 1996 03/11/09 T4 21/06/11
10 Wiwit Ika W sucipto 1990 03/11/09 T4 21/06/11
11 Indah P hadi 1993 03/11/09 T3 21/06/11
12 Miswati Misnari 1974 03/11/09 T5
13 Junaidah Mispan 1988 03/11/09 T5
14 Yanti Miski 1975 03/11/09 T5
15 Holifah Miski 1994 03/11/09 T4 21/06/11
16 Toni Slamet 1965 04/11/09 T5
17 Endang Slamet 1994 04/11/09 T4 21/06/11
18 Nuriatul Jannah Hendro 1990 04/11/09 T4 21/06/11
19 Sumiati Sukerto 1967 04/11/09 T5
20 Indi Novitasari Sukerto 1995 04/11/09 T4 21/06/11
21 Ayu agustin Sukerto 1995 04/11/09 T3 21/06/11 18/07/11
22 Siti alfiyah Dedi Irawan 1988 04/11/09 T5
23 Sugiariningsih Mahsus 1970 04/11/09 T5
24 Irvani Auliadewi Mahsus 1992 04/11/09 T5
25 Ristia Mahsus 1990 04/11/09 T5
26 samsiah Marjuki 1980 04/11/09 T5
27 Maryam suber 1964 04/11/09 T5
28 asiyah Imam Bukhori 1976 04/11/09 T5
29 Marsiya Mistar 1961 04/11/09 T5
30 Nunaini maki 1971 19/05/10 T4 19/05/10
31 Rofiah Nuryadi 1988 19/05/10 T3 19/05/10 21/06/11
32 nurul Hidayah salamun 1982 19/05/10 T4 19/05/10
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
33 Nafiah bambang 1991 19/05/10 T4 19/05/10
34 soleha Rohman 1987 19/05/10 T3 21/06/11 19/05/10
35 Rodatul Hasanah Hojin 1973 T4 21/06/11
36 maria Ulfa Farid 1976 T4 21/06/11
37 Masruroh Iksan 1982 T4 21/06/11
38 Nanik Asrofah Saeri 1979 T4 21/06/11
39 St. Romlah Saeri 1995 T4 21/06/11
40 St. Fatimah Saeri 1997 T4 21/06/11
41 Yuliatin sanusi 1993 T4 21/06/11
42 Misnaya sanusi 1965 T4 21/06/11
43 Zulfatul Umami Hojin 1995 T4 21/06/11
44 Yanti Jumar 1985 T4 21/06/11
45 siti Markonah Wagiman 1978 T4 21/06/11
46 Mufidah supriyanto 1975 19/05/10 T4 19/05/10
47 Piipit mansur 1974 T5
48 Maulida Imron 1975 T5
49 Nurhalima Mat Mukson 1973 T5
50 supiyah Havit 1975 T5
51 Muzayana Fathur 19/05/10 T4 19/05/10
52 Enwaningsih ahmadi 1978 T4 21/06/11
53 Atem ahmadi 1971 T4 21/06/11
54 Lastri suryono 1978 T4 21/06/11
55 sutri Soim 1973 T4 21/06/11
56 Yuni Ahmad sayudi 1992 19/05/10 T4 19/05/10
57 Rusiati sawir 1972 T4 18/07/11
58 sutantin sawir 1975 T4 18/07/11
59 Hartatik imam Mudakir 1975 T4 18/07/11
60 Dewi tanjungsari ali sodikin 1976 19/05/10 T4 19/05/10
61 Kasiatun Imam 1978 19/05/10 T4 19/05/10
62 susminah slamet 1962 T2 18/07/11
63 Rofiah sigit 1984 T3 18/07/11
64 Meinanik Sabar Imam 1969 T4 21/06/11
65 Hartatik sandi 1978 T4 21/06/11
66 Saida tono 1983 19/05/10 T4 19/05/10
67 Kasyati Ervan 1978 T4 18/07/11
68 Murtini Halil 1970 T4 18/07/11
69 Jamilatul Istiqomah Halil 1990 T4 18/07/11
70 Iin Nurhasanah 1979 T4 21/06/11
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
71 Semiati Ismail Marzuki 1973 T2 18/07/11
72 Lusiana Ismail Marzuki 1993 T4 21/06/11
73 Julaeha Mukmin 1970 T3 21/06/11 18/07/11
74 siti maqfiroh Mukmin 1989 T4 21/06/11
75 Musyarofah Dimyati 1977 T4 21/06/11
76 siti Hotisa Amir 1966 12/10/09 T5
77 wiwik susanti Amir 1988 12/10/09 T5
78 Indah Hartatik Faruq 1983 19/05/10 T4 19/05/10
79 tumyati Matyadi 1972 12/10/09 T5
80 seswati Bukhari 12/10/09 T5
81 Eka sriwahyuni Imam Bukhori 1995 12/10/09 T5
82 Siti masruroh M. Suim 1995 12/10/09 T5
83 Icha maya S Idris 1993 12/10/09 T5
84 Intan Maya S Idris 1996 12/10/09 T5
85 Umi Marfuah Idris 1970 12/10/09 T4 18/07/11
86 Uswatun Nafiah Mahfud 1985 12/10/09 T4 18/07/11
87 hartatik Budi 1964 12/10/09 T4 21/06/11
88 slama Abd. Azis 1974 19/05/10 T4 19/05/10
89 Wahyu W Abd. Azis 1994 19/05/10 T4 19/05/10
90 Siti rokaya Sulhani 1975 12/10/09 T4 18/07/11
91 Mamik S Sardi 1993 T4 18/07/11
92 Supriyani Sardi 1991 T4 18/07/11
93 Nining Muthaharoh Ahmad 1989 T4 18/07/11
94 Nurhayati andik s 1978 T4 18/07/11
95 Arifatul Izah Imam safi*i 1983 T4 18/07/11
96 st. Rohema Holifin 1982 T4 18/07/11
97 Holip Mohet 1988 19/05/10 T4 19/05/10
98 Yani Asmawi 1970 18/07/11
99 badriyah abd. Rohman 1985 19/05/10 T3 18/07/11 19/05/10
100 wasila Muhamad 1987 19/05/10 T4 19/05/10
101 Watik Sarip 1970 T4 21/06/11
102 Muniroh Khodir 1975 T4 21/06/11
103 Elok Muawanah Joni 1981 T4 21/06/11
104 Ulfatul H Kholik 1985 T4 18/07/11
105 saripah Kholik 1965 T4 18/07/11
106 Sri wahyuningsih Sutrisno 1985 19/05/10 T4 19/05/10
107 Kartini Jumari 1973 T4 21/06/11
108 Siti masfufah Jumari 1990 19/05/10 T4 19/05/10
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
109 Nurhayati Saha 1992 19/05/10 T4 19/05/10
110 Lilik Fatimah Z janda 1987 T4 21/06/11
111 Fitriyah abd. Azis 1991 T4 18/07/11
112 soleha Misto 1973 T4 18/07/11
113 Ririn H Herman 1982 T4 21/06/11
114 Murtini Buyono 1987 T2 18/07/11
115 rufiah Musa 1965 T3 18/07/11
116 Siti Aminatul Q samsul Huda 1987 T3 18/07/11
117 slama Lasmari 1977 T4 18/07/11
118 Sri Wahyuni Karyo 1979 T4 18/07/11
119 Yatik Kandar 1970 T3 18/07/11
120 Nisa Bungkus 1964 T4 18/07/11
121 Erlin Susanti Bungkos 1992 18/07/11
122 Jumaiyah Sunar 1967 18/07/11
123 Ismiati suyono 1982 19/05/10 T4 19/05/10
124 sunarti Asid 1961 18/07/11
125 Sifaul Asid 1991 18/07/11
126 Nining Maniseh Imron 1970 18/07/11
127 sadiah Rahmad 1969 19/05/10 T4 19/05/10
128 Siti Nurhalimah Suyono 1981 18/07/11
129 Nafiah Rahmad 1989 18/07/11
130 Suryati Holil 1975 18/07/11
131 Siti Soleha Holil 1997 18/07/11
132 Yulaikah Samsul Arifin 1985 18/07/11
133 Jumilah Afandi 1969 18/07/11
134 Yeni rahmawati Ahmad Solehan 1985 19/05/10 T4 19/05/10
135 Eva Ahmad Zaeni 1988 19/05/10 T4 19/05/10
136 Nurasih Saiful bahri 1980 T4 21/06/11
137 Nurhamidah H. salam 1995 T4 18/07/11
138 Supaenah Bahari 1971 T4 18/07/11
139 Musfiqoh Hidayati Abd. Wahid 1990 T4 18/07/11
140 Siti Nuraeni Holek 1985 T4 18/07/11
141 suhaeba Junaedi 1978 T4 18/07/11
142 Misiya Ismun 1965 T5
143 suswati sarpin 1971 T4 18/07/11
144 Muya saroh sarpin 1993 T4 18/07/11
145 Jumani Dimyati 1968 T5
146 Sulis 1985 T4 18/07/11
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
147 Murtini Imam 1976 T4 18/07/11
148 sofiah Munasir 1964 T5
149 tumiati Jalil 1973 T4 18/07/11
150 sugianti Mohet efendi 1988 T4 18/07/11
151 Siti raudatul Jannah Imam 1995 T4 18/07/11
152 Sofiah topo 1969 T4 18/07/11
153 Karni Hasan 1967 T4 18/07/11
154 ririn Dika 1992 T4 18/07/11
155 maryati Bumin 1968 T3 18/07/11
156 dada abd. Halim 1990 T4 18/07/11
157 Hotiah Haryono 1970 T4 18/07/11
158 sumardi 1972 T4 18/07/11
159 Linda 1993 T4 18/07/11
160 Riyan 1989 T4 18/07/11
161 St.Aisyah Wahyudi 20 th 12/12/13 T3 15/01/14
162 Sofiah Agus 23 th 15/01/14 T4 15/01/14
162 JUMLAH T0 0 0 0 0 4 14 88 0 0 0 0 0
T1 0 0
T4 100 5 ADS 0,5 ML 106
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
NIP :
hamil
Format 1
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 St. Khosiah bay Rohman 20/05/10 T4 20/05/10
2 isnaini Mulyadi 01/11/09 T3 15/06/11 13/07/11
3 Mahmuda Saedi 01/11/09 T5 13/07/11
4 st. Khotija Moh Kholik 01/11/09 T5 13/07/11
5 Nurisha F Moh Kholik 20/05/10 T2 20/05/10 15/06/11 13/07/11
6 Mega Agustina bay Rohman 01/11/09 T2 13/07/11
7 Musrifah Mistari 01/11/09 T3 15/06/11 13/07/11
8 Sulfatul M Muhid 20/05/10 T2 20/05/10 15/06/11 13/07/11
9 Rahmawati Marsuki 01/11/09 T4 15/06/11
10 Srifah rajak 01/11/09 T5 15/06/11
11 Kamsiyah ahmad 01/11/09 T3 15/06/11 13/07/11
12 Insaniyah wahyudi 01/11/09 T4 15/06/11
13 sulistyoawati hendrik 01/11/09 T4 15/06/11
14 wiji Astutik erik 20/05/10 T4 20/05/10
15 Al Qomariyah Usman 01/11/09 T5 15/06/11
16 Munawaroh Agus 20/05/10 T3 20/05/10 15/06/11
17 Lulyati Abd. Azis 01/11/09 T3 13/07/11
18 sumiyati Yoyok 01/11/09 T5 15/06/11
19 Lastri Amir 01/11/09 T5 15/06/11
20 Qomariyah Slamet 01/11/09 T5 15/06/11
21 Uun/ Anis Slamet 01/11/09 T2 13/07/11
22 Hafiyah solihin 01/11/09 T5 15/06/11
23 Mutmainah Budi H 20/05/10 T4 20/05/10
24 Warda Imam 20/05/10 T4 20/05/10
25 Rohami sabudin 01/11/09 T5 15/06/11
26 iin Suraji 01/11/09 T2 13/07/11
27 Titin ajib 01/11/09 T4 15/06/11
28 Nurhalima Isdariyanto 01/11/09 T4 15/06/11
29 Lutfiyah Anwar 20/05/10 T4 20/05/10
30 Yuli Firman 01/11/09 T4 15/06/11
31 Sofiatin sabudin 05/11/09 T2 13/07/11
32 Linda Dwi safitri amir 05/11/09 T2 13/07/11
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
33 Rina safitri Rawi 05/11/09 T2 13/07/11
34 Aisyatus s Slamet 05/11/09 T2 13/07/11
35 Ningsih sutaji 05/11/09 T2 13/07/11
36 Fitriatul L Sukri 20/05/10 T2 20/05/10 15/06/11
37 hamimah Asbar 05/11/09 T2 13/07/11
38 sriwati Rawi 05/11/09 T2 13/07/11
39 Arsika Rawi 05/11/09 T5 15/06/11
40 Juwariyah Subandi 20/05/10 T2 20/05/10 15/06/11
41 Nadiroh subaidi 05/11/09 T4 15/06/11
42 Nurul Idayan Akip 05/11/09 T4 15/06/11
43 Martini Dodik 05/11/09 T4 15/06/11
44 sutiha Suryono 05/11/09 T5
45 suma salim 05/11/09 T4 15/06/11
46 Hosiah Abd. Halim 20/05/10 T4 20/05/10
47 Nurani Rudin 06/11/09 T5 15/06/11
48 suparmi Munadi 06/11/09 T5 15/06/11
49 Mudalipah Husen 06/11/09 T5 15/06/11
50 St. Soleha Manan 20/05/10 T4 20/05/10
51 Musdalifah Salim 06/11/09 T2 13/07/11
52 Maimunah Hariyanto 06/11/09 T5 15/06/11
53 Novi Harianto 06/11/09 T2 13/07/11
54 Atmi Hamid 06/11/09 T5 15/06/11
55 Nimah Tarum 06/11/09 T4 15/06/11
56 Sholeha Suri 06/11/09 T5 15/06/11
57 Susanti Heriyanto 20/05/10 T3 20/05/10 15/06/11
58 Hofifah Masjidin 06/11/09 T4 15/06/11
59 Mualifah Saedi 20/05/10 T4 20/05/10
60 Rifatul H Saeri 20/05/10 T4 20/05/10
61 Ira Saeri 07/11/09 T2 13/07/11
62 Diana Fauzi 20/05/10 T4 20/05/10
63 Arifah Saiful 07/11/09 T4 15/06/11
64 Sholeha Hober 07/11/09 T5 15/06/11
65 Asfhin Naila H. ansori 07/11/09 T2 13/07/11
66 Nur hasanah Haryanto 20/05/10 T4 20/05/10
67 ela Babun 07/11/09 T2 13/07/11
68 Firda Suhar 07/11/09 T5 13/07/11
69 titin sumarni Marsahi 07/11/09 T5 13/07/11
70 Mayasari arus 20/05/10 T4 20/05/10
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
71 Maryati sawer 20/05/10 T4 20/05/10
72 Siti Aryana Dul Ghani 07/11/09 T5 13/07/11
73 vita Jupri 07/11/09 T2 13/07/11
74 Suliha Jupri 07/11/09 T5
75 Na*is Dul Ghani 07/11/09 T2 13/07/11
76 Diana M.O.D Joni 20/05/10 T4 20/05/10
77 Eris Haryanto 08/11/09 T5
78 alfiyah Ahmadi 08/11/09 T3 13/07/11
79 Eva Helman 08/11/09 T3 13/07/11
80 toyibah Faik 08/11/09 T3 13/07/11
81 Soleha Shodik 20/05/10 T4 20/05/10
82 musfiroh Saiho 08/11/09 T5
83 Nur Ila Y Rifa*i 20/05/10 T2 20/05/10 13/07/11
84 Nurul Imamah Rifa*i 08/11/09 T5
85 Firoh Muksin 08/11/09 T4
86 sa*adah Poniran 08/11/09 T5
87 Siti Muawanah Poniran 08/11/09 T2 13/07/11
88 Heriyah Misen 08/11/09 T3
89 Vira Nuraini Yanto 08/11/09 T2 13/07/11
90 tinil qoyimah Sukirman 20/05/10 T4 20/05/10
91 Saroh Junaidi 20/05/10 T4 20/05/10
92 Tutik sedek 10/11/09 T5
93 Yuli Fahroji 10/11/09 T5
94 Luluk Muasin 10/11/09 T4 13/07/11
95 Lailatul Abdullah 10/11/09 T4 13/07/11
96 Marhamah Abdul azis 10/11/09 T5
97 suparmi Juari 10/11/09 T5
98 Hayati Samsul 20/05/10 T4 20/05/10
99 Fatimah Juhari 10/11/09 T2 13/07/11
100 Lailatul M Juhari 10/11/09 T2 13/07/11
101 widiatul H supami 10/11/09 T2 13/07/11
102 Siti Asia salam 10/11/09 T5
103 Putri Sedek 20/05/10 T2 20/05/10 13/07/11
104 siti maryam Saiful 10/11/09 T5
105 Nur Indayani Abu Anas 10/11/09 T4 13/07/11
106 Miswati bakar 11/11/09 T4 13/07/11
107 Yanti Komari 20/05/10 T4 20/05/10
108 Eni suparno 11/11/09 T2 13/07/11
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
109 Indriani Rosi 11/11/09 T4 13/07/11
110 Yuli fahrozi 11/11/09 T5
111 Intan S suparno 20/05/10 T4 20/05/10
112 Diana M.O.D Joni 20/05/10 T4 20/05/10
113 Laila Dolla 11/11/09 T2 13/07/11
114 Nikmah Sujak 11/11/09 T2 13/07/11
115 Hasanah Mustakim 11/11/09 T2 13/07/11
116 aisah sujak 20/05/10 T2 20/05/10
117 Nuraini salam 11/11/09 T2 13/07/11
118 Aisah Pornomo 11/11/09 T2 13/07/11
119 Nilam santika Lukman 11/11/09 T2 13/07/11
120 Rom ansori 11/11/09 T2 13/07/11
121 Laili Dolla 11/11/09 T2 13/07/11
122 Enik suri 12/11/09 T5
123 Aryani suliman 12/11/09 T5
124 Ratnawati Suhandi 20/05/10 T4 20/05/10
125 Homsatin Asnadi 12/11/09 T5
126 siti Muhtar 12/11/09 T5
127 Munawaroh Nawawi 12/11/09 T5
128 Nuriha Misnawar 12/11/09 T5
129 rina sulton 20/05/10 T4 20/05/10
130 veliana samsul 20/05/10 T4 20/05/10
131 Musrifah H. Fauzen 20/05/10 T4 20/05/10
132 Nurhasanah tomin 20/05/10 T4 20/05/10
133 Indah Khorudin 12/11/09 T5
134 Nurwati ghofur 12/11/09 T5
135 aminah wahab 20/05/10 T4 20/05/10
136 Maniti Jamal 12/11/09 T5
137 Eni suparno 20/05/10 T4 20/05/10
138 rifatun suparno 20/05/10 T4 20/05/10
139 Sayani tuki 12/11/09 T5
140 rustin wito 12/11/09 T5
141 Annisa Mursid 12/11/09 T5
142 Ulfa Sohib 20/05/10 T4 20/05/10
143 Ifa H. Fauzen 12/11/09 T3 13/07/11
144 Alfia adnan 12/11/09 T3 13/07/11
145 Aminah adnan 12/11/09 T4 13/07/11
146 Lisa tuki 12/11/09 T3 13/07/11
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
147 Winda Nawawi 12/11/09 T3 13/07/11
148 Soleha rahman 12/11/09 T3 13/07/11
149 maryam rahman 12/11/09 T5
150 Nurhasanah Ghofur 12/11/09 T3 13/07/11
151 Nur Laila Sanidin 12/11/09 T4 13/07/11
152 fitri Mat 12/11/09 T4 13/07/11
153 Maimunah Mat 12/11/09 T5
154 marwiyah Sukarno 12/11/09 T5
155 vita Sukarno 12/11/09 T3 13/07/11
156 Sumiati Muklis 12/11/09 T4
157 Suhriyah Suhri 12/11/09 T3 13/07/11
158 Saroh Buari 12/11/09 T3 13/07/11
159 Riva busaden 12/11/09 T3 13/07/11
160 Ningsih busaden 12/11/09 T3 13/07/11
161 Nurhasanah Mustaqim 12/11/09 T4 13/07/11
162 Hotim Ridwan 12/11/09 T5
163 Miswati 12/11/09 T5
164 Miyah 12/11/09 T3 13/07/11
165 Lip Ipin 12/11/09 T3 13/07/11
166 Rina Solton 26 th 17/10/13 T4 16/01/14
167 ainurrohman Wakiq 28 th 14/11/13 T4 16/01/14
168 Ely Agus 30 th 18/12/13 T4 24/02/14
169 Arina Hermanto 18 th 13/12/13 T4 24/02/14
169 JUMLAH T0 0 0 0 0 31 26 49 0 0 0 0 0
T1 0 0
LAHIR WUS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
T4 49 9 ADS 0,5 ML 106
NIP :
hamil
POSYANDU :
DESA / KELURAHAN :
STATUS T AWAL (SAAT
LAHIR WUS
NON HAMIL HAMIL
1 2 3 4 5 6 7
0 JUMLAH T0 0 0
T1 0 0
T2 0 0
T3 0 0
T4 0 0
Penjelasan : T5 0 0
hamil
Format 1
PUSKESMAS :
TAHUN : 2010
HASIL VAKSINASI TT
T-1 T-2 T-3 T-4 T5 T-1 T-2 T-3 T-4 T5
8 9 10 11 12 13 14 15 16 17
0 0 0 0 0 0 0 0 0 0
ADS 0,5 ML 0
SAFETY BOX
(………………………………….. )
NIP :
POSYANDU :
DESA / KELURAHAN :
STATUS T AWAL (SAAT
LAHIR WUS
NON HAMIL HAMIL
1 2 3 4 5 6 7
0 JUMLAH T0 0 0
T1 0 0
T2 0 0
T3 0 0
T4 0 0
Penjelasan : T5 0 0
hamil
Format 1
PUSKESMAS :
TAHUN : 2010
HASIL VAKSINASI TT
T-1 T-2 T-3 T-4 T5 T-1 T-2 T-3 T-4 T5
8 9 10 11 12 13 14 15 16 17
0 0 0 0 0 0 0 0 0 0
ADS 0,5 ML 0
SAFETY BOX
(………………………………….. )
NIP :
POSYANDU :
DESA / KELURAHAN :
STATUS T AWAL (SAAT
LAHIR WUS
NON HAMIL HAMIL
1 2 3 4 5 6 7
0 JUMLAH T0 0 0
T1 0 0
T2 0 0
T3 0 0
T4 0 0
Penjelasan : T5 0 0
hamil
Format 1
PUSKESMAS :
TAHUN : 2010
HASIL VAKSINASI TT
T-1 T-2 T-3 T-4 T5 T-1 T-2 T-3 T-4 T5
8 9 10 11 12 13 14 15 16 17
0 0 0 0 0 0 0 0 0 0
ADS 0,5 ML 0
SAFETY BOX
(………………………………….. )
NIP :
POSYANDU :
DESA / KELURAHAN :
STATUS T AWAL (SAAT
LAHIR WUS
NON HAMIL HAMIL
1 2 3 4 5 6 7
0 JUMLAH T0 0 0
T1 0 0
T2 0 0
T3 0 0
T4 0 0
Penjelasan : T5 0 0
hamil
Format 1
PUSKESMAS :
TAHUN : 2010
HASIL VAKSINASI TT
T-1 T-2 T-3 T-4 T5 T-1 T-2 T-3 T-4 T5
8 9 10 11 12 13 14 15 16 17
0 0 0 0 0 0 0 0 0 0
ADS 0,5 ML 0
SAFETY BOX
(………………………………….. )
NIP :
HASIL KEGIATAN SKRINING DAN IMUNISASI TT WUS PER POSYAN
DESA/KELURAHAN :
PUSKESMAS :
STATUS T AWAL (SAAT PENDATAAN atau SAAT PERTAMA KALI DATANG) HASIL KEGIATAN
JML JML
NO POSYANDU NON HAMIL HAMIL
WUS BUMIL T5 NON HAMIL
T2 plus Bumil
T-0 T-1 T-2 T-3 T-4 T5 T-0 T-1 T-2 T-3 T-4 T5
ABS % ABS
% T-1 T-2 T-3 T-4
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
20 21 22 23 24
1 Apel 30 95 19 0 0 0 8 68 0 0 0 0 8 11 0 19 100.0 00.0 0 0 0 2
2 Apel 31 284 18 3 36 58 67 74 3 0 0 0 7 10 1 18 100.0 41.4 0 1 0 13
3 Apel 32 95 9 0 0 0 16 61 0 0 0 0 2 7 0 9 100.0 0 0.0 0 0 0 7
4 Apel 33 102 3 0 0 0 35 47 2 0 0 0 1 2 0 3 100.0 2 2.0 0 0 0 5
5 Apel 34 266 10 0 0 5 51 140 65 0 0 0 6 4 0 10 100.0 65 24.4 0 0 0 5
6 Apel 35 1 1 0 0 0 0 0 0 0 0 0 0 1 0 1 100.0 0 0.0 0 0 0 0
7 Apel 36 103 7 0 0 1 27 65 0 0 0 4 0 3 0 7 100.0 0 0.0 0 0 0 5
8 Apel 37 76 2 0 8 1 34 31 0 0 1 0 0 1 0 1 50.0 0 0.0 0 0 5 5
9 Apel 38 76 3 0 3 28 35 7 0 0 0 1 2 0 0 3 100.0 0 0.0 0 0 4 8
10 Apel 39 100 9 0 0 5 15 63 8 0 0 0 4 4 1 9 100.0 9 9.0 0 0 0 5
11 Apel 40 236 1 0 0 3 37 99 137 0 0 0 0 1 0 1 100.0 137 58.1 0 0 0 10
12 Apel 41 221 4 0 4 3 37 99 74 0 0 0 0 3 1 4 100.0 75 33.9 0 3 4 31
13 Apel 42 177 0 0 0 0 0 0 0 0 0 0 0 0 0 0 #DIV/0! 0 0.0 0 0 0 8
14 Apel 43 317 2 0 4 58 19 81 153 0 1 1 0 0 0 1 50.0 153 48.3 0 4 57 12
15 Apel 44 162 10 0 0 2 8 100 30 0 0 1 4 5 0 10 100.0 30 18.5 0 0 4 14
16 Apel 45 169 10 0 0 38 23 49 49 0 0 0 0 9 1 10 100.0 50 29.6 0 0 31 26
17 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 0 0 0
18 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 0 0 0
19 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 0 0 0
20 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 0 0 0
DESA 2480 108 3 55 202 412 984 521 0 2 7 34 61 4 106 98.1 525 21.2 0 8 105 156
Penjelasan :
Kolom 5-10 : isilah hasil penjumlahan dari format 1(kolom 6) Kolom 21-25 : isilah hasil penjumlahan format 1, yaitu hsl kegiatan imun TT khusus WUS tdk hamil
Kolom 11-16 : isilah hasil penjumlahan dari format 1(kolom 7) Kolom 26-30 : isilah hasil penjumlahan format 1, yaitu hsl kegiatan imun TT khusus WUS yang hamil
Kolom 17 : jumlahkan status T2, T3, T4, T5 khusus WUS hamil Kolom 31 : jumlahkan kolom 27 s/d 30 ditambah kolom 17
Kolom 18 : kolom 17 dibagi kolom 4 dikalikan 100 Kolom 32 : kolom 31 dibagi kolom 4 dikalikan 100
Kolom 19 : jumlahkan kolom 5 + kolom 16 Kolom 33 : jumlahkan kolom 19 + kolom 25 + kolom 30
Kolom 20 : kolom 19 dibagi kolom 3 kali 100 Kolom 34 : kolom 33 dibagi kolom 3 dikalikan 100
kolom 38 : Jumlahkan kolom 21s/d 30 dibagi 35
Format 2
DAN IMUNISASI TT WUS PER POSYANDU
KABUPATEN/KOTA : JEMBER
BULAN / TAHUN : 2010
JUMLAH LOGISTIK
HASIL KEGIATAN IMUNISASI TT STATUS T WUS SAMPAI JML DIGUNAKAN
DENGAN BULAN INI SUNTI IP
KAN BL VAKS SAFE VAKSIN
NON HAMIL HAMIL
T2 plus Bumil T5 INI ADS TY
IN
T5 T-1 T-2 T-3 T-4 T5 KUM % KUM % BOX
25 26 27 28 29 30 31 32 33 34 35 36 37 38 39
9 0 0 0 0 0 19 100.0 9 9.5 11 0 11 0 #DIV/0!
12 0 0 0 0 0 18 100.0 16 5.6 26 0 26 0 #DIV/0!
10 0 0 0 0 0 9 100.0 10 10.5 17 0 17 0 #DIV/0!
27 0 0 0 0 0 3 100.0 29 28.4 32 0 32 0 #DIV/0!
63 0 0 0 0 7 10 100.0 135 50.8 75 0 75 0 #DIV/0!
0 0 0 0 0 1 1 100.0 1 100.0 1 0 1 0 #DIV/0!
6 0 0 0 0 0 7 100.0 6 5.8 11 0 11 0 #DIV/0!
38 0 0 0 0 0 1 50.0 38 50.0 48 0 48 0 #DIV/0!
5 0 0 0 0 0 3 100.0 5 6.6 17 0 17 0 #DIV/0!
32 0 0 0 2 2 9 100.0 43 43.0 41 0 41 0 #DIV/0!
59 0 0 0 0 0 1 100.0 196 83.1 69 0 69 0 #DIV/0!
53 0 0 0 0 0 4 100.0 128 57.9 91 0 91 0 #DIV/0!
33 0 0 0 0 0 0 #DIV/0! 33 18.6 41 0 0 0 #DIV/0!
64 0 0 0 0 0 1 50.0 217 68.5 137 0 137 0 #DIV/0!
88 0 0 0 0 0 10 100.0 118 72.8 106 0 106 0 #DIV/0!
49 0 0 0 0 0 10 100.0 99 58.6 106 0 106 0 #DIV/0!
0 0 0 0 0 0 0 #DIV/0! 0 #DIV/0! - 0 0 0 #DIV/0!
0 0 0 0 0 0 0 #DIV/0! 0 #DIV/0! - 0 0 0 #DIV/0!
0 0 0 0 0 0 0 #DIV/0! 0 #DIV/0! - 0 0 0 #DIV/0!
0 0 0 0 0 0 0 #DIV/0! 0 #DIV/0! - 0 0 0 #DIV/0!
548 0 0 0 2 10 106 98.1 1083 43.7 829 0 788 0 #DIV/0!
……………., ………………….20…
Pelaksana Imunisasi/bidan,
(………………………………….. )
NIP :

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HASIL KEGIATAN SKRINING DAN IMUNISASI TT WUS DI POSYANDU

WUS NON HAMIL WUS HAMIL

PEMAKAIAN LOGISTIK ……………., ………………….20….

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