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FORMAT PENCATATAN PELAKSANAAN VAKSINASI COVID-19

TINGKAT PUSKESMAS/FASYANKES/POS VAKSINASI

Nama Puskesmas/Fasyankes/Pos : LIWUTO


Kabupaten/Kota : Baubau
Provinsi : Sulawesi Tenggara
Tanggal Pelaksanaan : 7 April 2021

Dosis I Dosis 2

Jenis Umur Keterangan


Kelompo Tanggal Nama/Jenis/Mer
No No. Tiket NIK Nama Penerima Vaksin Kela Pekerjaan* (18-59 No. Hp (Ditunda/Tidak
k Umur Screening ek Vaksin***
min tahun) Tanggal Tanggal Diberikan/Lanjut)
Pemberian No. Batch Pemberian No. Batch
Vaksinasi Vaksinasi

1 2 3 4 5 6 7 8 #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF!

1 L B 46-59 CORONAVAC LANJUT


P-QO54L5ZM 730608******0008 AZIS 49 081340508899 07/04/2021 07/04/2021 24001321

2 P B 31-45 CORONAVAC LANJUT


P-QOM4UMIH 747204******0001 WA ODE SITI RAHMAWATI 33 082343989800 07/04/2021 07/04/2021 24001321

3 P B 18-30 CORONAVAC LANJUT


P-QOU22LLF 747202******0001 SARINAH 29 085395801760 07/04/2021 07/04/2021 24001321

4 P B 31-45 CORONAVAC LANJUT


P-QP516BTG 747107******0002 NIMALI FIDELIS BUKE 36 085342682909 07/04/2021 07/04/2021 24001321

5 L B 18-30 CORONAVAC LANJUT


P-QPKIVISK 747205******0002 BIMA SAKTI HERFINTA 28 085241076839 07/04/2021 07/04/2021 24001321

6 L B 31-45 CORONAVAC LANJUT


P-QPS0QA97 747201******0001 HASIRUN 39 082275629403 07/04/2021 07/04/2021 24001321

7 L B 31-45 CORONAVAC LANJUT


P-QQ0KVYEZ 747202******0003 ROLAND CALVIN MANANGIN 33 082191086499 07/04/2021 07/04/2021 24001321

8 L B 31-45 CORONAVAC LANJUT


P-QRXXT5M5 747205******0001 HUSFIN 38 085299177587 07/04/2021 07/04/2021 24001321

9 L B 31-45 CORONAVAC LANJUT


P-QSC2CWFU 747201******0001 TAMRIN 45 081262255758 07/04/2021 07/04/2021 24001321

10 P B 18-30 CORONAVAC LANJUT


P-QSNEB2I8 747202******0001 CATUR ASTAGINA OKTAVIA 23 082290549645 07/04/2021 07/04/2021 24001321

11 L B 31-45 CORONAVAC LANJUT


P-QWCSE8KD 747206******0002 LA ODE FERDI ZILU 43 081242692009 07/04/2021 07/04/2021 24001321

12 L B 31-45 CORONAVAC LANJUT


P-QWTWOP1J 747204******0002 MURFIN 34 082278233275 07/04/2021 07/04/2021 24001321

13 L B 31-45 CORONAVAC LANJUT


P-QX99E2PU 747206******0003 MUHAMMAD ZULKARNAIN BAIDULLAH 36 085255225926 07/04/2021 07/04/2021 24001321

14 P B 18-30 CORONAVAC LANJUT


P-QXNL0ZBD 747206******0002 SRI NUR PRATIWI 29 081145571780 07/04/2021 07/04/2021 24001321
1 2 3 4 5 6 7 8 #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF!

15 L B 31-45 CORONAVAC LANJUT


P-QXZLEL1M 747206******0003 LA ODE MUHAMAD SAHBUDDIN ALIMU 43 082296666178 07/04/2021 07/04/2021 24001321

16 P B 31-45 CORONAVAC LANJUT


P-QYDXJ0DQ 747206******0001 NELA WIDYASTUTI 33 082271175878 07/04/2021 07/04/2021 24001321

17 L B 18-30 CORONAVAC LANJUT


P-QYVNA85S 747205******0001 HAIROL ANUAR 23 082360611938 07/04/2021 07/04/2021 24001321

18 L B 31-45 CORONAVAC LANJUT


P-QZC723J1 747202******0003 LA ODE DANY HASBUDIN 34 085242155546 07/04/2021 07/04/2021 24001321

19 L B 31-45 CORONAVAC LANJUT


P-R8H01QIP 747205******0001 RONAL MEYFRI SANI MANGORI 42 082268788480 07/04/2021 07/04/2021 24001321

20 L B 31-45 CORONAVAC LANJUT


P-R8WPH9V1 747206******0001 IDRIS WABULA 33 082290000424 07/04/2021 07/04/2021 24001321

21 L B 46-59 CORONAVAC LANJUT


P-R96VR60A 737113******0008 ANDI JUNAEDIN, SE 52 081141502102 07/04/2021 07/04/2021 24001321

22 L B 31-45 CORONAVAC LANJUT


P-R9GDUF8J 740410******0001 HERMAN 37 085341505186 07/04/2021 07/04/2021 24001321

23 P B 31-45 CORONAVAC LANJUT


P-R9N1YYRZ 747202******0001 WA ODE AGUSTINA MADY 33 081242041741 07/04/2021 07/04/2021 24001321

24 P B 18-30 CORONAVAC LANJUT


P-R9RREGKD 747206******0002 WA ODE LEADY FITRIYANI JALIL SILEA 26 082291648591 07/04/2021 07/04/2021 24001321

25 P B 31-45 CORONAVAC LANJUT


P-RA53LAVX 217104******0006 LA WATI 38 081372538561 07/04/2021 07/04/2021 24001321

26 L B 18-30 CORONAVAC LANJUT


P-RBJFZSH7 740411******0001 L.M. SADRUN MIZAT 25 082292408225 07/04/2021 07/04/2021 24001321

27 P B 31-45 CORONAVAC LANJUT


S-41BDABD4 747206******0001 KRIS SETIAWAN ODE 31 08114002401 07/04/2021 07/04/2021 24001321

28 L B 18-30 CORONAVAC LANJUT


S-70F04779 747202******0001 RUSLIN 26 085394642012 07/04/2021 07/04/2021 24001321

29 L B 31-45 CORONAVAC LANJUT


S-8D562B1D 747205******0001 FANDHY RAMADHAN 37 081341777943 07/04/2021 07/04/2021 24001321

30 P B 31-45 CORONAVAC LANJUT


S-978487A5 747108******0003 RIBKA JULIATI PALEBANGAN 31 082345985190 07/04/2021 07/04/2021 24001321

31 L B 18-30 CORONAVAC LANJUT


S-ECF27EB6 747206******0002 SAIFUL 27 085343553204 07/04/2021 07/04/2021 24001321

17 17 17 17

Keterangan ***Merek Vaksin


* Pekerjaan dikelompokkan menjadi: A = Sinovac Mengetahui,
A = Petugas Medis dan Non Medis di Fasilitas Pelayanan KB = Lainnya (Mohon disebutkan jenis vaksin yang diterima Puskesmas/Faskes) Kepala Puskesmas Liwuto
B = Petugas pelayanan publik yang berhadapan langsung dengan masyarakat
C = Administrator Pemerintahan
D = Lainnya
E = Tidak Bekerja
ALFIAH, AMK
NIP. 19670711 198903 2 016

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