DATA SASARAN BAL

Provinsi :
Kabupaten/Kota :
Puskesmas :

NIK
(Nomor Berat
NAMA TANGGAL JENIS Nama NIK Orang No Tlp/HP
No Induk ANAK KE ANAK LAHIR Badan
KELAMIN Lahir Ayah Tua Orang Tua
Kependud (Kg)
ukan)

Ucok ###
1 ### 5 L 3.9 Khairuddin ### -
Bambang ###
2 ### 3 L 4 Susilo ### -
Syahdan
3 ### 2 8/23/2013 L 3.2 Bidiono ### -
Kelvin ###
4 ### 3 L 3.5 Lokot Batub ### -
Mirani 2-Jun-2012
5 ### 2 P 3 Niran ### -
Rian 4-032013
6 ### 2 L 3.1 Suwito Sireg ### -
Hidayat ###
7 ### 4 L 3.6 Ramdani ### -
Rizki 8-Jul-2013 L
8 ### 2 3.1 Gandi Hasib ### -
Sifa 5-Jan-2015
9 ### 2 P 3.7 Syaiful Anw ### -
Raihan
10 ### 1 4/2/2013 L 3.8 Syaful Anwa ### -
Gea 18-022014
11 ### 1 P 3.2 Gunawan ### -
Hani ###
12 ### 2 L 3.9 Medi ### -
Siti 4-Jun-2012
13 ### 5 P 2.5 Asmar ### -

14 ### 1 Ane ### P 3.8 Leman ### -

15 ### 2 Butet ### P 3.7 Leman ### -

16 ### 2 Amira ### P 3.7 Trisudario ### -

17 ### 1 Diki ### L 3.2 Budi Hand ### -

18 ### 2 Dandi ### L 3.1 Andika ### -

19 ### 5 Pasada Sir ### L 3.8 Amri ### -

20 ### 3 Rizki ### L 3.9 Panyahata ### -

21 ### 4 Ayu 4/9/2014 P 3.5 Sulpani ### -

SyahrulGu ###
22 ### 1 nawan L 2.5 Herman R ### -
Aprida ###
23 ### 1 Rambe P 3.1 MHD. Syafi ### -
Utcok
24 2 Rambe 4/17/2017 L 3.5 MHD. Syafi ### -
Solika 5-Jul-2015
25 2 Azzahra P 2.4 M.Soleh ### -
Adam
Lubis 6-Oct-2014
26 2 L 3.2 Haris Lubis ### -
Ayu Lubis 5-Jan-2017
27 3 P 3.4 Haris Lubis ### -
Syahrial ###
28 7 Hidayah L 4.1 Sampurna ### -
Farinsal ###
29 2 L 3.5 Salaman D ### -
Azzam Riton ###
30 3 L 3.1 Ridwan Rit ### -
Assifa
31 4 Azzahra ### P 3.7 senti Ramb ### -
Ariel
Siregar 3-Oct-2012
32 ### 3 L 3.1 Jarkasih Si ### -
Mutiara
Siregar ###
33 4 P 2.8 Jarkasih Si ### -
Jihad ###
34 1 Rambe L 3.2 Ahmad Ra - -

35 ### 5 Silwa Rito 9/7/2013 P 3.7 Syafuddin ### -

36 6 Kaila Riton ### P 3.4 Syafuddin ### -

37 4 Utcok God ### L 3 Pindum Do ### -

38 6 Anggriani ### P 3.3 Tenang Ra ### -

39 1 Alza Prata ### L 2.7 Marhom R - -

40 1 Humairoh S ### P 3 Asima Rito - -

41 3 Hafiz ### L 3.1 sandan Ra ### -

42 1 Raudha ### P 2.8 Wahab Don - -

43 1 Lima Sasmi ### P 3.3 Jakar Ram - -

44 -
45 -
46 -
47 -
48 -
49 -
50 -
51 -
52 -
53 -
54 -
55 -
56 -
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78 -
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83 -
84 -
85 -
86 -
87 -
88 -
89 -
90 -
91 -
92 -
93 -
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96 -
97 -
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100 -
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103 -
104 -
105 -
106 -
107 -
108 -
109 -
110 -
111 -
112 -
113 -
DATA SASARAN BALITA

Tanggal Cara Ukur ASI IMD Vitamin A

1=Telenta Eksklusif Februari
ALAMAT RT RW pengukura BB (Kg) TB (Cm) ng 1=YA, 1=YA, 1=YA,
n 2=Tidak
2=Berdiri 2=Tidak 2=Tidak

Nabundon - -
g 4/22/2017 16 97 2 1 1 1
Nabundon
g - -
4/22/2017 17 95 2 1 1 1
Nabundon
g - -
4/22/2017 15 80 2 1 1 1
Nabundon - -
g 4/22/2017 16 86 2 1 1 1
Nabundon - -
g 4/22/2017 15 85 2 1 1 1
Nabundon - -
g 4/22/2017 16 87 2 1 1 1
Nabundon - -
g 4/22/2017 12 70 2 1 1 1
Nabundon
g - -
4/22/2017 15 75 2 1 1 1
Nabundon
g - -
4/22/2017 14.8 76 2 1 1 1
Nabundon - -
g 4/22/2017 19 95 2 1 1 1
Nabundon
g - -
4/22/2017 16 80 2 1 1 1
Nabundon - -
g 4/22/2017 18 87 2 1 1 1
Nabundon - -
g 4/22/2017 18.2 85 2 1 1 1
Nabundon
g - -
4/22/2017 17.8 80 2 1 1 1
Nabundon
g - -
4/22/2017 14 75 2 1 1 1
Nabundon - -
g 4/22/2017 19 77 2 1 1 1
Nabundon
g - -
4/22/2017 18 75 2 1 1 1
Nabundon - -
g 4/22/2017 17.5 77 2 1 1 1
Nabundon - -
g 4/22/2017 18.2 78 2 1 1 1
Nabundon
g - -
4/22/2017 16 77 2 1 1 1
Nabundon
g - -
4/22/2017 19.5 90 2 1 1 1
Nahula Jae - -
4/21/2017 11.5 103 2 2 2 1
Nahula Jae - -
4/22/2017 13.6 105 2 1 1 1
Nahula Jae - -
4/23/2017 3.7 50 1 1 1 1
Nahula Jae - -
4/24/2017 10 87 2 2 2 1
Nahula Jae - -
4/25/2017 9.5 88 2 1 1 1
Nahula Jae - -
4/26/2017 5.5 57 1 1 1 1
Nahula Jae - -
4/27/2017 12.8 78 2 1 1 2
Nahula Jae - -
4/28/2017 11 83 2 1 1 1
Nahula Jae - -
4/29/2017 12.1 85 2 1 1 1
Nahula Jae - -
4/30/2017 11.9 77 2 1 1 1
Nahula Jae - -
5/1/2017 14.3 109 2 1 1 1
Nahula Jae - -
5/2/2017 6.9 99 2 1 1 1
Nahula Jae - -
5/3/2017 8.8 73 2 2 2 1
Nahula Jae - -
5/4/2017 12.7 78.5 2 1 1 1
Nahula Jae - -
5/5/2017 7.3 66 1 1 1 1
Nahula Jae - -
5/6/2017 9.1 76 2 1 1 1
Nahula Jae - -
5/7/2017 14.5 104.5 2 1 1 1
Nahula Jae - -
5/8/2017 12.1 89 2 1 1 1
Nahula Jae - -
5/9/2017 13 103 2 1 1 1
Nahula Jae - -
5/10/2017 9.6 83 2 - - -
Nahula Jae - -
5/11/2017 9.3 87 2 - - -
Nahula Jae - -
5/12/2017 7.2 70 2 - - -
- -
Vitamin A Ada Buku
Agustus KIA
1=YA, 1=ya
2=Tidak 2=tidak

1 1

1 1

1 1

1 1

1 1

1 1

1 1

1 1

1 1

1 1

1 1

1 1

1 1

1 1

1 1

1 1

1 1

1 1

1 1
1 1

1 1

1 1

1 1

2 1

1 1

1 1

2 1

1 1

1 1

1 1

1 1

1 1

1 1

1 1

1 1

2 1

1 1

1 1

1 1

1 1

- -

- -

- -