HASIL IMUNISASI RUMAH SAKIT / KLINIK / DOKTER SPESIALIS ANAK / BIDAN PRAK

RUMAH SAKIT :
BULAN :
TAHUN :
Wajib di Isi DI ISI TANGGAL PEMBERIAN VAKSIN / PENYUNTIK
ALAMAT

TANGGAL JENIS
NO NAMA NAMA / KELURAHAN** KECAMATAN
LAHIR KELAMIN NAMA BCG POLIO 1 POLIO 2 POLIO 3 POLIO 4
NOMOR NOMOR
JALAN RUMAH
GANG

1 2 3 4 5 6 7 8 9 10 11 12 13 14

1
2
3
4
5
6
7
8
9
10

*Untuk vaksin yang mandiri mohon untuk tetap di isi sesuai pemakaian
T / KLINIK / DOKTER SPESIALIS ANAK / BIDAN PRAKTEK
HASIL IMUNISASI
MANDIRI RUMAH SAKIT / KLINIK / DOKTER SPESIALIS
RUMAH SAKIT :
BULAN :
TAHUN :
DI ISI TANGGAL PEMBERIAN VAKSIN / PENYUNTIKAN (BUKAN DICENTANG)
BAYI
HEPATITIS B UNIJECT
TANGGAL
NO NAMA CAMPAK/ DPT HB DPT HB
LAHIR HB <24 HB 0-7 Hari HIB 1
MR HIB 2
JAM

1 2 3 15 16 17 18 19

1
2
3
4
5
6
7
8
9
10
 HASIL IMUNISASI RUMAH SAKIT / KLINIK / DOKTER SPESIALIS ANAK / BIDAN PRAKTE
RUMAH SAKIT :
BULAN :
TAHUN :
DI ISI TANGGAL PEMBERIAN VAKSIN / PENYUNTIKAN (BUKAN DICENTANG)
ANAK WUS VAKSIN BAYI (NON PEMERINTAH)

TANGGAL Infanrif
NO NAMA DPT HB DPT HB CAMPAK/ HIB Infanrif Tetract
LAHIR IPV HIB MR TT Engerix B Euvax B DTP HIB Pediacel Infanrix
HIB 3 BOOSTER BOOSTER (DPaT- HIB IPV HIB
HiB)

1 2 3 20 21 22 23 24 25 26 27 28 29 30 31 32 33

1
2
3
4
5
6
7
8
9
10

Mengetahui,
Kepala .........................

(NAMA)
 HASIL IMUNISASI RUMAH SAKIT / KLINIK / DOKTER SPESIA
RUMAH SAKIT :
BULAN :
TAHUN :

VAKSIN BAYI (NON PEMERINTAH)

TANGGAL
NO NAMA
LAHIR Trimovax MMR Tetagam HB Vax Act Hib

1 2 3 34 35 36 37 38

1
2
3
4
5
6
7
8
9
10
 HASIL IMUNISASI RUMAH SAKIT / KLINIK / DOKTER SPESIALIS ANAK / BIDAN PRAK
NAMA PRAKTEK :
BULAN :
TAHUN :
Wajib di Isi DI ISI TANGGAL PEMBERIAN VAKSIN / PENYUNTIK
ALAMAT

TANGGAL JENIS
NO NAMA NAMA / KELURAHAN** KECAMATAN
LAHIR KELAMIN NAMA BCG POLIO 1 POLIO 2 POLIO 3 POLIO 4
NOMOR NOMOR
JALAN RUMAH
GANG

1 2 3 4 5 6 7 8 9 10 11 12 13 14

1
2
3
4
5
6
7
8
9
10

*Untuk vaksin yang mandiri mohon untuk tetap di isi sesuai pemakaian
T / KLINIK / DOKTER SPESIALIS ANAK / BIDAN PRAKTEK
HASIL IMUNISASI
MANDIRI RUMAH SAKIT / KLINIK / DOKTER SPESIALIS
NAMA PRAKTEK :
BULAN :
TAHUN :
DI ISI TANGGAL PEMBERIAN VAKSIN / PENYUNTIKAN (BUKAN DICENTANG)
BAYI
HEPATITIS B UNIJECT
TANGGAL
NO NAMA CAMPAK/ DPT HB DPT HB
LAHIR HB <24 HB 0-7 Hari HIB 1
MR HIB 2
JAM

1 2 3 15 16 17 18 19

1
2
3
4
5
6
7
8
9
10
 HASIL IMUNISASI
HASIL IMUNISASI
RUMAHRUMAH
SAKIT /SAKIT
KLINIK
/ KLINIK
/ DOKTER
/ DOKTER
SPESIALIS
SPESIALIS
ANAK /ANAK
BIDAN/ PRAKTE
BIDAN
NAMA PRAKTEK :
BULAN :
TAHUN :
DI ISI TANGGAL PEMBERIAN VAKSIN / PENYUNTIKAN (BUKAN DICENTANG)
ANAK WUS VAKSIN BAYI (NON PEMERINTAH)

TANGGAL Infanrif
NO NAMA DPT HB DPT HB CAMPAK/ HIB Infanrif Tetract
LAHIR IPV HIB MR TT Engerix B Euvax B DTP HIB Pediacel Infanrix
HIB 3 BOOSTER BOOSTER (DPaT- HIB IPV HIB
HiB)

1 2 3 20 21 22 23 24 25 26 27 28 29 30 31 32 33

1
2
3
4
5
6
7
8
9
10

Mengetahui,
Kepala .........................

(NAMA)
H SAKIT / KLINIK / DOKTER SPESIALIS ANAK / BIDAN
HASIL
PRAKTEK
IMUNISASI
MANDIRI
RUMAH SAKIT / KLINIK / DOKTER SPESIA
NAMA PRAKTEK :
BULAN :
TAHUN :

VAKSIN BAYI (NON PEMERINTAH)

TANGGAL
NO NAMA
LAHIR Trimovax MMR Tetagam HB Vax Act Hib

1 2 3 34 35 36 37 38

1
2
3
4
5
6
7
8
9
10
 HASIL IMUNISASI RUMAH SAKIT / KLINIK / DOKTER SPESIALIS ANAK / BIDAN PRAK
NAMA PRAKTEK :
BULAN :
TAHUN :
Wajib di Isi DI ISI TANGGAL PEMBERIAN VAKSIN / PENYUNTIK
ALAMAT

TANGGAL JENIS
NO NAMA NAMA / KELURAHAN** KECAMATAN
LAHIR KELAMIN NAMA BCG POLIO 1 POLIO 2 POLIO 3 POLIO 4
NOMOR NOMOR
JALAN RUMAH
GANG

1 2 3 4 5 6 7 8 9 10 11 12 13 14

1
2
3
4
5
6
7
8
9
10

*Untuk vaksin yang mandiri mohon untuk tetap di isi sesuai pemakaian
T / KLINIK / DOKTER SPESIALIS ANAK / BIDAN PRAKTEK
HASIL IMUNISASI
MANDIRI RUMAH SAKIT / KLINIK / DOKTER SPESIALIS
NAMA PRAKTEK :
BULAN :
TAHUN :
DI ISI TANGGAL PEMBERIAN VAKSIN / PENYUNTIKAN (BUKAN DICENTANG)
BAYI
HEPATITIS B UNIJECT
TANGGAL
NO NAMA CAMPAK/ DPT HB DPT HB
LAHIR HB <24 HB 0-7 Hari HIB 1
MR HIB 2
JAM

1 2 3 15 16 17 18 19

1
2
3
4
5
6
7
8
9
10
 HASIL IMUNISASI
HASIL IMUNISASI
RUMAHRUMAH
SAKIT /SAKIT
KLINIK
/ KLINIK
/ DOKTER
/ DOKTER
SPESIALIS
SPESIALIS
ANAK /ANAK
BIDAN/ PRAKTE
BIDAN
NAMA PRAKTEK :
BULAN :
TAHUN :
DI ISI TANGGAL PEMBERIAN VAKSIN / PENYUNTIKAN (BUKAN DICENTANG)
ANAK WUS VAKSIN BAYI (NON PEMERINTAH)

TANGGAL Infanrif
NO NAMA DPT HB DPT HB CAMPAK/ HIB Infanrif Tetract
LAHIR IPV HIB MR TT Engerix B Euvax B DTP HIB Pediacel Infanrix
HIB 3 BOOSTER BOOSTER (DPaT- HIB IPV HIB
HiB)

1 2 3 20 21 22 23 24 25 26 27 28 29 30 31 32 33

1
2
3
4
5
6
7
8
9
10

Mengetahui,
Kepala .........................

(NAMA)
H SAKIT / KLINIK / DOKTER SPESIALIS ANAK / BIDAN
HASIL
PRAKTEK
IMUNISASI
MANDIRI
RUMAH SAKIT / KLINIK / DOKTER SPESIA
NAMA PRAKTEK :
BULAN :
TAHUN :

VAKSIN BAYI (NON PEMERINTAH)

TANGGAL
NO NAMA
LAHIR Trimovax MMR Tetagam HB Vax Act Hib

1 2 3 34 35 36 37 38

1
2
3
4
5
6
7
8
9
10
 HASIL IMUNISASI RUMAH SAKIT / KLINIK / DOKTER SPESIALIS ANAK / BIDAN PRAK
NAMA PRAKTEK :
BULAN :
TAHUN :
Wajib di Isi DI ISI TANGGAL PEMBERIAN VAKSIN / PENYUNTIK
ALAMAT

TANGGAL JENIS
NO NAMA NAMA / KELURAHAN** KECAMATAN
LAHIR KELAMIN NAMA BCG POLIO 1 POLIO 2 POLIO 3 POLIO 4
NOMOR NOMOR
JALAN RUMAH
GANG

1 2 3 4 5 6 7 8 9 10 11 12 13 14

1
2
3
4
5
6
7
8
9
10

*Untuk vaksin yang mandiri mohon untuk tetap di isi sesuai pemakaian
T / KLINIK / DOKTER SPESIALIS ANAK / BIDAN PRAKTEK
HASIL IMUNISASI
MANDIRI RUMAH SAKIT / KLINIK / DOKTER SPESIALIS
NAMA PRAKTEK :
BULAN :
TAHUN :
DI ISI TANGGAL PEMBERIAN VAKSIN / PENYUNTIKAN (BUKAN DICENTANG)
BAYI
HEPATITIS B UNIJECT
TANGGAL
NO NAMA CAMPAK/ DPT HB DPT HB
LAHIR HB <24 HB 0-7 Hari HIB 1
MR HIB 2
JAM

1 2 3 15 16 17 18 19

1
2
3
4
5
6
7
8
9
10
 HASIL IMUNISASI
HASIL IMUNISASI
RUMAHRUMAH
SAKIT /SAKIT
KLINIK
/ KLINIK
/ DOKTER
/ DOKTER
SPESIALIS
SPESIALIS
ANAK /ANAK
BIDAN/ PRAKTE
BIDAN
NAMA PRAKTEK :
BULAN :
TAHUN :
DI ISI TANGGAL PEMBERIAN VAKSIN / PENYUNTIKAN (BUKAN DICENTANG)
ANAK WUS VAKSIN BAYI (NON PEMERINTAH)

TANGGAL Infanrif
NO NAMA DPT HB DPT HB CAMPAK/ HIB Infanrif Tetract
LAHIR IPV HIB MR TT Engerix B Euvax B DTP HIB Pediacel Infanrix
HIB 3 BOOSTER BOOSTER (DPaT- HIB IPV HIB
HiB)

1 2 3 20 21 22 23 24 25 26 27 28 29 30 31 32 33

1
2
3
4
5
6
7
8
9
10

Mengetahui,
Kepala .........................

(NAMA)
H SAKIT / KLINIK / DOKTER SPESIALIS ANAK / BIDAN
HASIL
PRAKTEK
IMUNISASI
MANDIRI
RUMAH SAKIT / KLINIK / DOKTER SPESIA
NAMA PRAKTEK :
BULAN :
TAHUN :

VAKSIN BAYI (NON PEMERINTAH)

TANGGAL
NO NAMA
LAHIR Trimovax MMR Tetagam HB Vax Act Hib

1 2 3 34 35 36 37 38

1
2
3
4
5
6
7
8
9
10
 H
NAMA PRAKTEK : RSI DARUS SYIFA' BENOWO
BULAN : MEI
TAHUN : 2021

ALAMAT

NO NAMA TANGGAL LAHIR JENIS KELAMIN NAMA /

NAMA JALAN NOMOR NOMOR
RUMAH
GANG

1 2 3 4 5 6 7

1 BN NY FANY AYU NING TYAS 02 MEI 2021 LAKI LAKI

2 BY NY PUTRI LESTARI 02 MEI 2021 LAKI LAKI
3 BY NY REVITA DIYAH 03 MEI 2021 LAKI LAKI
4 BY NY SELLA TRIYA AMANDA 03 MEI 2021 PEREMPUAN
5 BY NY CINDY CLAUDERA 02 MEI 2021 LAKI LAKI
6 BY NY NUR FARIDAH 02 MEI 2021 PEREMPUAN
7 BY NY SALMAH RAMADANI 03 MEI 2021 PEREMPUAN
8 BY NY CHRISTINA MATILDA 03 MEI 2021 LAKI LAKI
9 BY NY ENY SYABANURIYAH 03 MEI 2021 LAKI LAKI
10 BY NY PUTRI SHOLEKHAH 04 MEI 2021 LAKI LAKI
11 BY NY LIDYA AVRILYA 04 MEI 2021 LAKI LAKI
12 BY NY ANNURUL HIDAHYANTI 04 MEI 2021 PEREMPUAN
13 BY NY LIDIYAWATI 04 MEI 2021 PEREMPUAN
14 BY NY SANYAR CADA PUTRI 04 MEI 2021 LAKI LAKI
15 BY NY DEWI SINTA 04 MEI 2021 PEREMPUAN
16 BY NY TITIN ARINDAH 04 MEI 2021 PEREMPUAN
17 BY NY MAYA PERMATA NSARI 04 MEI 2021 LAKI LAKI
18 BY NY RATNAWATI 04 MEI 2021 LAKI LAKI
19 BY NY INDAH 04 MEI 2021 LAKI LAKI
20 BY NY SITI NUR KHOTIMAH 04 MEI 2021 PEREMPUAN
21 BY NY SITI KHOLIPAH 05 MEI 2021 LAKI LAKI
22 BY NY NOER AINI SITI 05 MEI 2021 PEREMPUAN
23 BY NY LIA DWI AGUSTIN 05 MEI 2021 PEREMPUAN
24 BY NY ARI DEVI NOVI TRIYANTI 05 MEI 2021 PEREMPUAN
25 BY NY MULYANI 05 MEI 2021 LAKI LAKI
26 BY NY AINUN FARIDA 05 MEI 2021 LAKI LAKI
27 BY NY UMINAH 05 MEI 2021 LAKI LAKI
28 BY NY YULI FITA INDRIYANI 06 MEI 2021 PEREMPUAN
29 BY NY RATNA DWININGSIH 06 MEI 2021 PEREMPUAN
30 BY NY WAHYUNINGSIH 06 MEI 2021 PEREMPUAN
31 BY NY RINI WIDIASTUTI 06 MEI 2021 LAKI LAKI
32 BY NY IIN IRAWATI 06 MEI 2021 LAKI LAKI
33 BY NY ENDANG RAHMAWATI 06 MEI 2021 LAKI LAKI
34 BY NY RINDI SUANTIKA 06 MEI 2021 LAKI LAKI
35 BY NY NUR HALIMAH 07 MEI 2021 PEREMPUAN
36 BY NY YESI WULANSARI 06 MEI 2021 LAKI LAKI
37 BY NY EVIN NUR FADILAH 06 MEI 2021 PEREMPUAN
38 BY NY RODHIATUN KHASANAH 07 MEI 2021 PEREMPUAN
39 BY NY INTAN NUR OKTAFIYAH 08 MEI 2021 PEREMPUAN
40 BY NY ARBA ANIS SIYAMI 08 MEI 2021 LAKI LAKI
41 BY NY ELOK KHOIROTUL KHULUQ 10 MEI 2021 LAKI LAKI
42 BY NY DEVI ALFIANTI 09 MEI 2021 LAKI LAKI
43 BY NY ALIMAH 09 MEI 2021 PEREMPUAN
44 BY NY MIBTAKU ROIPAH 09 MEI 2021 LAKI LAKI
45 BY NY ANIFATUR ROHMAH 09 MEI 2021 PEREMPUAN
46 BY NY SUNARTI 10 MEI 2021 PEREMPUAN
47 BY NY CINTYA NURJANAH 10 MEI 2021 PEREMPUAN
48 BY NY FITRI ANGGRAENI 10 MEI 2021 PEREMPUAN
49 BY NY UMU KUROTIN 10 MEI 2021 LAKI LAKI
50 BY NY RATNA DWININGSIH 10 MEI 2021 LAKI LAKI
51 BY NY MEGA MUSTIKA 10 MEI 2021 LAKI LAKI
52 BY NY SITI NUR KHOMARIYAH 10 MEI 2021 LAKI LAKI
53 BY NY FITRIANA NINGSIH 11 MEI 2021 PEREMPUAN
54 BY NY RRIN ANDRIYANI 11 MEI 2021 LAKI LAKI
55 BY NY AMINAH 11 MEI 2021 PEREMPUAN
56 BY NY NOVIANTI 11 MEI 2021 PEREMPUAN
57 BY NY THERESIA ELLY 11 MEI 2021 PEREMPUAN
58 BY NY LLASMININGSIH 12 MEI 2021 PEREMPUAN
59 BY NY NUR ROHMAH 12 MEI 2021 LAKI LAKI
60 BY NY ANIS WIJAYANTI 12 MEI 2021 LAKI LAKI
61 BY NY RIKA INDRIANI 12 MEI 2021 LAKI LAKI
62 BY NY RAHMA DEWI 13 MEI 2021 PEREMPUAN
63 BY NY SELLY AYU NOVITA 13 MEI 2021 LAKI LAKI
64 BY NY KRISTIN NINGRUM 15 MEI 2021 PEREMPUAN
65 BY NY EVI SETYOWATI 14 MEI 2021 PEREMPUAN
66 BY NY IMUNG AMANAHFIYAH 14 MEI 2021 PEREMPUAN
67 BY NY RISNA ROSITA 15 MEI 2021 LAKI LAKI
68 BY NY RUNI RAHMA APRILIANI 15 MEI 2021 PEREMPUAN
69 BY NY DIAN SULISTYAWATI 15 MEI 2021 LAKI LAKI
70 BY NY SARFIN INA RAHAYU 15 MEI 2021 PEREMPUAN
71 BY NY SYABRINA DIA 15 MEI 2021 PEREMPUAN
72 BY NY ZAMHARI ROTUL 16 MEI 2021 LAKI LAKI
73 BY NY NUR HIDAYATI 17 MEI 2021 PEREMPUAN
74 BY NY INDRI SILVIA 17 MEI 2021 PEREMPUAN
75 BY NY LIA ANGGRAINI 17 MEI 2021 PEREMPUAN
76 BY NY NUNUNG PAWATI 17 MEI 2021 LAKI LAKI
77 BY NY ENDAH RUSTIANA 16 MEI 2021 PEREMPUAN
78 BY NY UMROTUL FIKRIYAH 17 MEI 2021 LAKI LAKI
79 BY NY ENDAH KARTIKAWATI 17 MEI 2021 PEREMPUAN
80 BY NY NALA 17 MEI 2021 PEREMPUAN
81 BY NY KURDIAN PUJI 17 MEI 2021 PEREMPUAN
82 BY NY NADLIFAH AL QONITA 17 MEI 2021 LAKI LAKI
83 BY NY DINDA AYU 17 MEI 2021 LAKI LAKI
84 BY NY LESSYE SANDRA KUSUMA 18 MEI 2021 LAKI LAKI
85 BY NY ARUM AMBAR 17 MEI 2021 LAKI LAKI
86 BY NY DEWI MASITA 17 MEI 2021 PEREMPUAN
87 BY NY NIHAYATIL KHUSNA 17 MEI 2021 LAKI LAKI
88 BY NY DEWI UMI 17 MEI 2021 LAKI LAKI
89 BY NY LILIS NUR INDAH 18 MEI 2021 LAKI LAKI
90 BY NY NOVITA SARI 18 MEI 2021 LAKI LAKI
91 BY NY IRENE IRSA HAWANG 19 MEI 2021 PEREMPUAN
92 BY NY FARIHATUL HOIROH 18 MEI 2021 PEREMPUAN
93 BY NY IKA YULI ISTANTI 19 MEI 2021 PEREMPUAN
94 BY NY IRENE LAURENTIA 19 MEI 2021 PEREMPUAN
95 BY NY EVA SARI BIARAWATI 19 MEI 2021 LAKI LAKI
96 BY NY AZILA ROHMATUL INAYAH 19 MEI 2021 PEREMPUAN
97 BY NY FATIMATUZZAHRO 19 MEI 2021 PEREMPUAN
98 BY NY ALIFIA FARA SALSABILA 19 MEI 2021 LAKI LAKI
99 BY NY AYU MEILANY 19 MEI 2021 LAKI LAKI
100 BY NY ULFATUL MURTASYIDAH 19 MEI 2021 LAKI LAKI
101 BY NY ASTERLITA SIBARANI 19 MEI 2021 PEREMPUAN
102 BY NY SHARAH NUR FADILLAH 20 MEI 2021 LAKI LAKI
103 BY NY EKA PURWATI 20 MEI 2021 PEREMPUAN
104 BY NY SITI MURSALINAH 20 MEI 2021 PEREMPUAN
105 BY NY AYUNDA NOVITA S 20 MEI 2021 PEREMPUAN
106 BY NY NIKEN PRATIWI 20 MEI 2021 LAKI LAKI
107 BY NY CHUSNUL KHOTIMAH 20 MEI 2021 LAKI LAKI
108 BY NY VIKA NAFIDATUL 20 MEI 2021 PEREMPUAN
109 BY NY RETNO AR IYANTI 21 MEI 2021 PEREMPUAN
110 BY NY USWATUN KHASANAH 22 MEI 2021 LAKI LAKI
111 BY NY SUMINAH 22 MEI 2021 PEREMPUAN
112 BY NY YULI FATMAWATI 22 MEI 2021 PEREMPUAN
113 BY NY NUR RAMDHANA 22 MEI 2021 PEREMPUAN
114 BY NY LAILIYAH 22 MEI 2021 LAKI LAKI
115 BY NY MAMIK SRI 22 MEI 2021 LAKI LAKI
116 BY NY MUVIDAH FIDAYANTI 22 MEI 2021 PEREMPUAN
117 BY NY HERLINDA 22 MEI 2021 LAKI LAKI
118 BY NY CORY KURNIANINGSIH 23 MEI 2021 PEREMPUAN
119 BY Meri Andani 5/24/2021 LAKI LAKI Pengalangan 2/32
120 BY Rani Enggarsari 5/23/2021 LAKI LAKI Kandangan II B
121 BYCitra Nur Arini 5/23/2021 LAKI LAKI Pradah Permai
122 BY Resti Rahayu 5/24/2021 LAKI LAKI Pakal Madya no 16
123 BY Nurila Mardziana 5/24/2021 PEREMPUAN Tambakdono
124 BY 'Syifa Nurhalimah 5/24/2021 LAKI LAKI Tanjung priok JKT
125 BY Mita Constantia 5/24/2021 LAKI LAKI Jelidro Indah 3/9
126 BY Ika manjasari 5/24/2021 PEREMPUAN uka 5/4
127 BY Astutik 5/24/2021 PEREMPUAN ngablak rejo menganti
128 BY Devita Ayu Agustin 5/24/2021 PEREMPUAN Sememi Baru 4/7
129 BY Satta Adyra 5/25/2021 PEREMPUAN Raya Phirus biru KBD
130 BY Dewi Isnawati 5/25/2021 PEREMPUAN Manukan Thohirin
131 BY Wiwik Susanti 5/25/2021 PEREMPUAN Manukan Luhur V blok 20
132 BY Lailatus Sholihah 5/25/2021 PEREMPUAN Kepatihan 3/1
133 BY Fitria Nanda Sari 5/25/2021 PEREMPUAN Putat Lor
134 BY Dwi Juniasari 5/25/2021 PEREMPUAN Sememi Jaya 5/b2
135 BY Marlik 5/26/2021 LAKI LAKI Perum UKA 18A/102
136 BY Siti Nur Hidayah 5/26/2021 LAKI LAKI Candi lontar
137 BY Dwi Putri Rahayu 5/26/2021 PEREMPUAN Kauman Asri
138 BY Galis Wahyu Maidawati 5/26/2021 PEREMPUAN PBI 1CC/24
139 BY Tri Septiya 5/26/2021 PEREMPUAN Putat Lor 1/1
140 BY Pudji Astuti 5/26/2021 PEREMPUAN Asem Madya
141 BY Rahayu 5/27/2021 LAKI LAKI Boboh 2/3
142 BY Iswahyuni 5/27/2021 LAKI LAKI Kapasan
143 BY Siti Hidayati 5/28/2021 PEREMPUAN Putat Lor 4/2
144 BY Asislah 5/28/2021 LAKI LAKI Munggu gebang
145 BY Novi Pahlawanti 5/28/2021 PEREMPUAN Puri Asta Kencana A/39
146 BY Ria Kurnia Sari 5/28/2021 LAKI LAKI Tulung Kedamean
147 BY Siti Mujiati 5/29/2021 PEREMPUAN Balongsari
148 BY Ismi Faridah 5/30/2021 PEREMPUAN Brongkos
149 BY Rusta Alan Nawa 5/29/2021 LAKI LAKI Rejosari Indah
150 BY Almira Tria Angela 5/30/2021 PEREMPUAN Manukan Lor

151 BY Dewi Rizta 5/30/2021 LAKI LAKI Donowati

152 BY Ayu Ambarwati 5/30/2021 PEREMPUAN Laban Kulon gg 3
153 BY Erni Triana 5/30/2021 PEREMPUAN Perum Batara
154 BY Rahayu Tuhulele 5/30/2021 PEREMPUAN PBI Y/8
155 BY Shinta 5/31/2021 PEREMPUAN Manukan Peni
156 BY Widya Putri 5/30/2021 LAKI LAKI Sambiarum Lor 2
157 BY Herwana 5/31/2021 LAKI LAKI DK. Kuwukan no 15
158 BY Puji Rahayu 6/1/2021 LAKI LAKI Bandarejo 3
159 BY Fitri Erliyana 6/1/2021 PEREMPUAN Klakahrejo
160 BY Yuliaten 5/31/2021 PEREMPUAN Kendung Jaya 4/28
161 BY Lamiati 5/31/2021 PEREMPUAN Kandangan 3 e/94
162 BY Eka Cahyaning Putri 6/1/2021 PEREMPUAN Raci 2/30
163 BY Diah Retno Sayekti 6/1/2021 PEREMPUAN Kendung 1H/20
*Untuk vaksin yang mandiri mohon untuk tetap di isi sesuai pemakaian
 HASIL IMUNISASI RUMAH SAKIT / KLINIK / DOKTER
HASIL
NAMA PRAKTEK : RSI DARUS SYIFA' BENOWO
BULAN : MEI
TAHUN : 2021
Wajib di Isi DI ISI TANGGAL PEMBERIAN VA

NO NAMA TANGGAL LAHIR KELURAHAN** KECAMATAN

BCG

1 2 3 8 9 10

1 BN NY FANY AYU NING TYAS 02 MEI 2021 KENDUNG JAYA GG 12 KNDUNG JAYA GG 12
2 BY NY PUTRI LESTARI 02 MEI 2021 DK. JERAWAT DK. JERAWAT
3 BY NY REVITA DIYAH 03 MEI 2021 ALUN ALUN RANGKAH ALUN ALUN RANGKAH
4 BY NY SELLA TRIYA AMANDA 03 MEI 2021 REJOSARI REJOSARI
5 BY NY CINDY CLAUDERA 02 MEI 2021 VETERAN KURVI VETERAN KUVRI
6 BY NY NUR FARIDAH 02 MEI 2021 PAKAL BARAT PAKAL BARAT
7 BY NY SALMAH RAMADANI 03 MEI 2021 RANDUPADANGAN RANDUPADANGAN
8 BY NY CHRISTINA MATILDA 03 MEI 2021 KANDANG GUNUNG KANDANG GUNUNG
9 BY NY ENY SYABANURIYAH 03 MEI 2021 BENOWO BENOWO
10 BY NY PUTRI SHOLEKHAH 04 MEI 2021 SEMEMI JAYA SEMEMI JAYA
11 BY NY LIDYA AVRILYA 04 MEI 2021 PACUH PACUH
12 BY NY ANNURUL HIDAHYANTI 04 MEI 2021 PETEMON SIDOMULYO PETEMON SIDOMULYO
13 BY NY LIDIYAWATI 04 MEI 2021 DALEAN DALEAN
14 BY NY SANYAR CADA PUTRI 04 MEI 2021 SWAN MENGANTI MAS SWAN MENGANTI MAS
15 BY NY DEWI SINTA 04 MEI 2021 PERUM PALEM PERTIWI PERUM PALEM PERTIWI
16 BY NY TITIN ARINDAH 04 MEI 2021 MANUKAN LOR MANUKAN LOR
17 BY NY MAYA PERMATA NSARI 04 MEI 2021 GLINTUNG GLINTUNG
18 BY NY RATNAWATI 04 MEI 2021 SEMEMI JAYA SELATAN SEMEMI JAYA
19 BY NY INDAH 04 MEI 2021 TAMBAK DALAN BARU TAMBAK DALAM BARU
20 BY NY SITI NUR KHOTIMAH 04 MEI 2021 SEMEMI JAYA SELATAN SEMEMI JAYA SELATAN
21 BY NY SITI KHOLIPAH 05 MEI 2021 LEKEREJO LEKEREJO03/03
22 BY NY NOER AINI SITI 05 MEI 2021 KUTIL 7/1 KUTIL 7/1
23 BY NY LIA DWI AGUSTIN 05 MEI 2021 SEMEMI JAYA 7A SEMEMI JAYA 7 A
24 BY NY ARI DEVI NOVI TRIYANTI 05 MEI 2021 DRANCANG DRANCANG
25 BY NY MULYANI 05 MEI 2021 TUBANAN BARU TUBANAN BARU
26 BY NY AINUN FARIDA 05 MEI 2021 BENDUL MERISI JAYA BENDUL MERISI JAYA
27 BY NY UMINAH 05 MEI 2021 RANDUPADANGAN RANDUPADANGAN
28 BY NY YULI FITA INDRIYANI 06 MEI 2021 KANDANGAN GUNUNG KANDANGAN GUNUNG
29 BY NY RATNA DWININGSIH 06 MEI 2021 PEGADEN MANYAR PEGANDEN MANYAR
30 BY NY WAHYUNINGSIH 06 MEI 2021 BALONG KEPUH BALONG KEPUH
31 BY NY RINI WIDIASTUTI 06 MEI 2021 RAYA PAKAL RAYA PAKAL
32 BY NY IIN IRAWATI 06 MEI 2021 HENDROSARI HENDROSARI
33 BY NY ENDANG RAHMAWATI 06 MEI 2021 PUNDUT TRATE PUNDUT TRATE
34 BY NY RINDI SUANTIKA 06 MEI 2021 MASEK BOTENG MASEK BOTENG
35 BY NY NUR HALIMAH 07 MEI 2021 RANDUPADANGAN RANDUPADANGAN
36 BY NY YESI WULANSARI 06 MEI 2021 MANUKAN MUKTI MANUKAN MUKTI
37 BY NY EVIN NUR FADILAH 06 MEI 2021 TAMBAK MAYOR TAMBAK MAYOR
38 BY NY RODHIATUN KHASANAH 07 MEI 2021 GADING WATU GADING WATU
39 BY NY INTAN NUR OKTAFIYAH 08 MEI 2021 PELEMWATU PELEMWATU
40 BY NY ARBA ANIS SIYAMI 08 MEI 2021 BENOWO BENOWO
41 BY NY ELOK KHOIROTUL KHULUQ 10 MEI 2021 BEJI BEJI
42 BY NY DEVI ALFIANTI 09 MEI 2021 PAKAL BARAT PAKAL BARAT
43 BY NY ALIMAH 09 MEI 2021 BENOWO BENOWO
44 BY NY MIBTAKU ROIPAH 09 MEI 2021 LEKEREJO LEKEREJO03/03
45 BY NY ANIFATUR ROHMAH 09 MEI 2021 GREGES RAYA GREGES RAYA
46 BY NY SUNARTI 10 MEI 2021 NYANYAT NYANYAt
47 BY NY CINTYA NURJANAH 10 MEI 2021 KLAKAH REJO KLAKAH REJO
48 BY NY FITRI ANGGRAENI 10 MEI 2021 BENOWO BENOWO
49 BY NY UMU KUROTIN 10 MEI 2021 HENDROSARI HENDROSARI
50 BY NY RATNA DWININGSIH 10 MEI 2021 JELIDRO JELIDRO
51 BY NY MEGA MUSTIKA 10 MEI 2021 KARANG POH KARANG POH
52 BY NY SITI NUR KHOMARIYAH 10 MEI 2021 KEPATIHAN KEPATIHAN
53 BY NY FITRIANA NINGSIH 11 MEI 2021 TAMBAK DONO TAMBAK DONO
54 BY NY RRIN ANDRIYANI 11 MEI 2021 PAKAL BARAT PAKAL BARAT
55 BY NY AMINAH 11 MEI 2021 HENDROSARI HENDROSARI
56 BY NY NOVIANTI 11 MEI 2021 KENDUNG KENDUNG
57 BY NY THERESIA ELLY 11 MEI 2021 TENGGER RAYA TENGGER RAYA
58 BY NY LLASMININGSIH 12 MEI 2021 BANDAREJO BANDAREJO
59 BY NY NUR ROHMAH 12 MEI 2021 SUMBERSARI SUMBERSARI
60 BY NY ANIS WIJAYANTI 12 MEI 2021 KAPAS MADYA KAPAS MADYA
61 BY NY RIKA INDRIANI 12 MEI 2021 MANUKAN THOHIRIN MANUKAN THOHIRIN
62 BY NY RAHMA DEWI 13 MEI 2021 KEDIRI KEDIRI
63 BY NY SELLY AYU NOVITA 13 MEI 2021 KUTIL 7/1 KUTIL 7/1
64 BY NY KRISTIN NINGRUM 15 MEI 2021 BANYUURIP LOR BANYUURIP LOR
65 BY NY EVI SETYOWATI 14 MEI 2021 BENDIL BENDIL
66 BY NY IMUNG AMANAHFIYAH 14 MEI 2021 KAUMAN ASRI KAUMAN ASRI
67 BY NY RISNA ROSITA 15 MEI 2021 MANUKAN LOR 8 B MANUKAN LOR 8B
68 BY NY RUNI RAHMA APRILIANI 15 MEI 2021 CANDI LONTAR CANDI LONTAR
69 BY NY DIAN SULISTYAWATI 15 MEI 2021 BENOWO BENOWO
70 BY NY SARFIN INA RAHAYU 15 MEI 2021 BENJENG BENJENG
71 BY NY SYABRINA DIA 15 MEI 2021 KANDANGAN GUNUNG KANDANGAN GUNUNG
72 BY NY ZAMHARI ROTUL 16 MEI 2021 NGASINAN NGASINAN
73 BY NY NUR HIDAYATI 17 MEI 2021 BANJARSUGIHAN BANJARSUGIAN
74 BY NY INDRI SILVIA 17 MEI 2021 KLAMPOK KLAMPOK
75 BY NY LIA ANGGRAINI 17 MEI 2021 DK MULYOMUKTI DK MULYOMUKTI
76 BY NY NUNUNG PAWATI 17 MEI 2021 HENDROSARI HENDROSARI
77 BY NY ENDAH RUSTIANA 16 MEI 2021 BULAK BULAK
78 BY NY UMROTUL FIKRIYAH 17 MEI 2021 NGEMPLAK NGEMPLAK
79 BY NY ENDAH KARTIKAWATI 17 MEI 2021 BENOWO TEGAL BENOWO TEGAL
80 BY NY NALA 17 MEI 2021 SEMEMI JAYA SEMEMI JAYA
81 BY NY KURDIAN PUJI 17 MEI 2021 PAKAL RESIDEN PAKAL RESIDEN
82 BY NY NADLIFAH AL QONITA 17 MEI 2021 AKIM KAYAT AKIM KAYAT
83 BY NY DINDA AYU 17 MEI 2021 GADING WATU GADING WATU
84 BY NY LESSYE SANDRA KUSUMA 18 MEI 2021 BALONG SARI BALONGSARI
85 BY NY ARUM AMBAR 17 MEI 2021 LABAN KULON LABAN KULON
86 BY NY DEWI MASITA 17 MEI 2021 PENGALANGAN PENGALANGAN
87 BY NY NIHAYATIL KHUSNA 17 MEI 2021 SWAN MENGANTI PARK SWAN MENGANTI PARK
88 BY NY DEWI UMI 17 MEI 2021 REJOSARI REJOSARI
89 BY NY LILIS NUR INDAH 18 MEI 2021 WRINGIN KURUNG WRINGIN KURUNG
90 BY NY NOVITA SARI 18 MEI 2021 KANDANGAN JAYA KANDANGAN JAYA
91 BY NY IRENE IRSA HAWANG 19 MEI 2021 DOMAS DOMAS
92 BY NY FARIHATUL HOIROH 18 MEI 2021 JOGO DALU JOGO DALU
93 BY NY IKA YULI ISTANTI 19 MEI 2021 GLINTUNG GLINTUNG
94 BY NY IRENE LAURENTIA 19 MEI 2021 SEMEMI JAYA SEMEMI JAYA
95 BY NY EVA SARI BIARAWATI 19 MEI 2021 BENDIL BENDIL
96 BY NY AZILA ROHMATUL INAYAH 19 MEI 2021 JURIT 01/02 CERME JURIT 01/02 CERME
97 BY NY FATIMATUZZAHRO 19 MEI 2021 BENOWO GG 5 BENOWO GG 5
98 BY NY ALIFIA FARA SALSABILA 19 MEI 2021 SAWO BRINGIN SAWO BRINGIN
99 BY NY AYU MEILANY 19 MEI 2021 TAMBAK MAYOR TAMBAK MAYOR
100 BY NY ULFATUL MURTASYIDAH 19 MEI 2021 SAMBIARUM SAMBIARUM
101 BY NY ASTERLITA SIBARANI 19 MEI 2021 PERUM UKA PERUM UKA
102 BY NY SHARAH NUR FADILLAH 20 MEI 2021 SEMEMI JAYA SEMEMI JAYA
103 BY NY EKA PURWATI 20 MEI 2021 SIMORUKUN SIMORUKUN
104 BY NY SITI MURSALINAH 20 MEI 2021 BABAT JERAWAT BABAT JERAWAT
105 BY NY AYUNDA NOVITA S 20 MEI 2021 HULAAN HULAAN
106 BY NY NIKEN PRATIWI 20 MEI 2021 WISMA TENGGER WISMA TENGGER
107 BY NY CHUSNUL KHOTIMAH 20 MEI 2021 LAKARSANTRI LAKARSANTRI
108 BY NY VIKA NAFIDATUL 20 MEI 2021 PUTAT GEDE PUTAT GEDE
109 BY NY RETNO AR IYANTI 21 MEI 2021 RAYA TANDES LOR RAYA TANDES LOR
110 BY NY USWATUN KHASANAH 22 MEI 2021 SEMEMI JAYA SEMEMI JAYA
111 BY NY SUMINAH 22 MEI 2021 PRAMBON BOBOH PRAMBON BOBOH
112 BY NY YULI FATMAWATI 22 MEI 2021 BEJI BEJI
113 BY NY NUR RAMDHANA 22 MEI 2021 TANJUNGSARI JAYA TANJUNGSARI JAYA
114 BY NY LAILIYAH 22 MEI 2021 RANDUPADANGAN RANDUPADANGAN
115 BY NY MAMIK SRI 22 MEI 2021 KLAKAH REJO KLAKAH REJO
116 BY NY MUVIDAH FIDAYANTI 22 MEI 2021 SIDOREJO SIDOREJO
117 BY NY HERLINDA 22 MEI 2021 DK. JAWU KIDUL DK. JAWU KIDUL
118 BY NY CORY KURNIANINGSIH 23 MEI 2021 TENGGER KANDANGAN TENGGER KANDANGAN
119 BY Meri Andani 5/24/2021
120 BY Rani Enggarsari 5/23/2021
121 BYCitra Nur Arini 5/23/2021
122 BY Resti Rahayu 5/24/2021
123 BY Nurila Mardziana 5/24/2021
124 BY 'Syifa Nurhalimah 5/24/2021
125 BY Mita Constantia 5/24/2021
126 BY Ika manjasari 5/24/2021
127 BY Astutik 5/24/2021
128 BY Devita Ayu Agustin 5/24/2021
129 BY Satta Adyra 5/25/2021
130 BY Dewi Isnawati 5/25/2021
131 BY Wiwik Susanti 5/25/2021
132 BY Lailatus Sholihah 5/25/2021
133 BY Fitria Nanda Sari 5/25/2021
134 BY Dwi Juniasari 5/25/2021
135 BY Marlik 5/26/2021
136 BY Siti Nur Hidayah 5/26/2021
137 BY Dwi Putri Rahayu 5/26/2021
138 BY Galis Wahyu Maidawati 5/26/2021
139 BY Tri Septiya 5/26/2021
140 BY Pudji Astuti 5/26/2021
141 BY Rahayu 5/27/2021
142 BY Iswahyuni 5/27/2021
143 BY Siti Hidayati 5/28/2021
144 BY Asislah 5/28/2021
145 BY Novi Pahlawanti 5/28/2021
146 BY Ria Kurnia Sari 5/28/2021
147 BY Siti Mujiati 5/29/2021
148 BY Ismi Faridah 5/30/2021
149 BY Rusta Alan Nawa 5/29/2021
150 BY Almira Tria Angela 5/30/2021
151 BY Dewi Rizta 5/30/2021
152 BY Ayu Ambarwati 5/30/2021
153 BY Erni Triana 5/30/2021
154 BY Rahayu Tuhulele 5/30/2021
155 BY Shinta 5/31/2021
156 BY Widya Putri 5/30/2021
157 BY Herwana 5/31/2021
158 BY Puji Rahayu 6/1/2021
159 BY Fitri Erliyana 6/1/2021
160 BY Yuliaten 5/31/2021
161 BY Lamiati 5/31/2021
162 BY Eka Cahyaning Putri 6/1/2021
163 BY Diah Retno Sayekti 6/1/2021
*Untuk vaksin yang mandiri mohon untuk tetap di isi sesuai pemakaian
HASIL IMUNISASI RUMAH SAKIT / KLINIK / DOKTER SPESIALIS ANAK / BIDAN PRAKTEK MANDIRI HASIL
NAMA PRAKTEK : RSI DARUS SYIFA' BENOWO
BULAN : MEI
TAHUN : 2021
DI ISI TANGGAL PEMBERIAN VAKSIN / PENYUNTIKAN (BUKAN DICENTANG)

NO NAMA TANGGAL LAHIR

POLIO 1 POLIO 2 POLIO 3

1 2 3 11 12 13

1 BN NY FANY AYU NING TYAS 02 MEI 2021

2 BY NY PUTRI LESTARI 02 MEI 2021
3 BY NY REVITA DIYAH 03 MEI 2021
4 BY NY SELLA TRIYA AMANDA 03 MEI 2021
5 BY NY CINDY CLAUDERA 02 MEI 2021
6 BY NY NUR FARIDAH 02 MEI 2021
7 BY NY SALMAH RAMADANI 03 MEI 2021
8 BY NY CHRISTINA MATILDA 03 MEI 2021
9 BY NY ENY SYABANURIYAH 03 MEI 2021
10 BY NY PUTRI SHOLEKHAH 04 MEI 2021
11 BY NY LIDYA AVRILYA 04 MEI 2021
12 BY NY ANNURUL HIDAHYANTI 04 MEI 2021
13 BY NY LIDIYAWATI 04 MEI 2021
14 BY NY SANYAR CADA PUTRI 04 MEI 2021
15 BY NY DEWI SINTA 04 MEI 2021
16 BY NY TITIN ARINDAH 04 MEI 2021
17 BY NY MAYA PERMATA NSARI 04 MEI 2021
18 BY NY RATNAWATI 04 MEI 2021
19 BY NY INDAH 04 MEI 2021
20 BY NY SITI NUR KHOTIMAH 04 MEI 2021
21 BY NY SITI KHOLIPAH 05 MEI 2021
22 BY NY NOER AINI SITI 05 MEI 2021
23 BY NY LIA DWI AGUSTIN 05 MEI 2021
24 BY NY ARI DEVI NOVI TRIYANTI 05 MEI 2021
25 BY NY MULYANI 05 MEI 2021
26 BY NY AINUN FARIDA 05 MEI 2021
27 BY NY UMINAH 05 MEI 2021
28 BY NY YULI FITA INDRIYANI 06 MEI 2021
29 BY NY RATNA DWININGSIH 06 MEI 2021
30 BY NY WAHYUNINGSIH 06 MEI 2021
31 BY NY RINI WIDIASTUTI 06 MEI 2021
32 BY NY IIN IRAWATI 06 MEI 2021
33 BY NY ENDANG RAHMAWATI 06 MEI 2021
34 BY NY RINDI SUANTIKA 06 MEI 2021
35 BY NY NUR HALIMAH 07 MEI 2021
36 BY NY YESI WULANSARI 06 MEI 2021
37 BY NY EVIN NUR FADILAH 06 MEI 2021
38 BY NY RODHIATUN KHASANAH 07 MEI 2021
39 BY NY INTAN NUR OKTAFIYAH 08 MEI 2021
40 BY NY ARBA ANIS SIYAMI 08 MEI 2021
41 BY NY ELOK KHOIROTUL KHULUQ 10 MEI 2021
42 BY NY DEVI ALFIANTI 09 MEI 2021
43 BY NY ALIMAH 09 MEI 2021
44 BY NY MIBTAKU ROIPAH 09 MEI 2021
45 BY NY ANIFATUR ROHMAH 09 MEI 2021
46 BY NY SUNARTI 10 MEI 2021
47 BY NY CINTYA NURJANAH 10 MEI 2021
48 BY NY FITRI ANGGRAENI 10 MEI 2021
49 BY NY UMU KUROTIN 10 MEI 2021
50 BY NY RATNA DWININGSIH 10 MEI 2021
51 BY NY MEGA MUSTIKA 10 MEI 2021
52 BY NY SITI NUR KHOMARIYAH 10 MEI 2021
53 BY NY FITRIANA NINGSIH 11 MEI 2021
54 BY NY RRIN ANDRIYANI 11 MEI 2021
55 BY NY AMINAH 11 MEI 2021
56 BY NY NOVIANTI 11 MEI 2021
57 BY NY THERESIA ELLY 11 MEI 2021
58 BY NY LLASMININGSIH 12 MEI 2021
59 BY NY NUR ROHMAH 12 MEI 2021
60 BY NY ANIS WIJAYANTI 12 MEI 2021
61 BY NY RIKA INDRIANI 12 MEI 2021
62 BY NY RAHMA DEWI 13 MEI 2021
63 BY NY SELLY AYU NOVITA 13 MEI 2021
64 BY NY KRISTIN NINGRUM 15 MEI 2021
65 BY NY EVI SETYOWATI 14 MEI 2021
66 BY NY IMUNG AMANAHFIYAH 14 MEI 2021
67 BY NY RISNA ROSITA 15 MEI 2021
68 BY NY RUNI RAHMA APRILIANI 15 MEI 2021
69 BY NY DIAN SULISTYAWATI 15 MEI 2021
70 BY NY SARFIN INA RAHAYU 15 MEI 2021
71 BY NY SYABRINA DIA 15 MEI 2021
72 BY NY ZAMHARI ROTUL 16 MEI 2021
73 BY NY NUR HIDAYATI 17 MEI 2021
74 BY NY INDRI SILVIA 17 MEI 2021
75 BY NY LIA ANGGRAINI 17 MEI 2021
76 BY NY NUNUNG PAWATI 17 MEI 2021
77 BY NY ENDAH RUSTIANA 16 MEI 2021
78 BY NY UMROTUL FIKRIYAH 17 MEI 2021
79 BY NY ENDAH KARTIKAWATI 17 MEI 2021
80 BY NY NALA 17 MEI 2021
81 BY NY KURDIAN PUJI 17 MEI 2021
82 BY NY NADLIFAH AL QONITA 17 MEI 2021
83 BY NY DINDA AYU 17 MEI 2021
84 BY NY LESSYE SANDRA KUSUMA 18 MEI 2021
85 BY NY ARUM AMBAR 17 MEI 2021
86 BY NY DEWI MASITA 17 MEI 2021
87 BY NY NIHAYATIL KHUSNA 17 MEI 2021
88 BY NY DEWI UMI 17 MEI 2021
89 BY NY LILIS NUR INDAH 18 MEI 2021
90 BY NY NOVITA SARI 18 MEI 2021
91 BY NY IRENE IRSA HAWANG 19 MEI 2021
92 BY NY FARIHATUL HOIROH 18 MEI 2021
93 BY NY IKA YULI ISTANTI 19 MEI 2021
94 BY NY IRENE LAURENTIA 19 MEI 2021
95 BY NY EVA SARI BIARAWATI 19 MEI 2021
96 BY NY AZILA ROHMATUL INAYAH 19 MEI 2021
97 BY NY FATIMATUZZAHRO 19 MEI 2021
98 BY NY ALIFIA FARA SALSABILA 19 MEI 2021
99 BY NY AYU MEILANY 19 MEI 2021
100 BY NY ULFATUL MURTASYIDAH 19 MEI 2021
101 BY NY ASTERLITA SIBARANI 19 MEI 2021
102 BY NY SHARAH NUR FADILLAH 20 MEI 2021
103 BY NY EKA PURWATI 20 MEI 2021
104 BY NY SITI MURSALINAH 20 MEI 2021
105 BY NY AYUNDA NOVITA S 20 MEI 2021
106 BY NY NIKEN PRATIWI 20 MEI 2021
107 BY NY CHUSNUL KHOTIMAH 20 MEI 2021
108 BY NY VIKA NAFIDATUL 20 MEI 2021
109 BY NY RETNO AR IYANTI 21 MEI 2021
110 BY NY USWATUN KHASANAH 22 MEI 2021
111 BY NY SUMINAH 22 MEI 2021
112 BY NY YULI FATMAWATI 22 MEI 2021
113 BY NY NUR RAMDHANA 22 MEI 2021
114 BY NY LAILIYAH 22 MEI 2021
115 BY NY MAMIK SRI 22 MEI 2021
116 BY NY MUVIDAH FIDAYANTI 22 MEI 2021
117 BY NY HERLINDA 22 MEI 2021
118 BY NY CORY KURNIANINGSIH 23 MEI 2021
119 BY Meri Andani 5/24/2021
120 BY Rani Enggarsari 5/23/2021
121 BYCitra Nur Arini 5/23/2021
122 BY Resti Rahayu 5/24/2021
123 BY Nurila Mardziana 5/24/2021
124 BY 'Syifa Nurhalimah 5/24/2021
125 BY Mita Constantia 5/24/2021
126 BY Ika manjasari 5/24/2021
127 BY Astutik 5/24/2021
128 BY Devita Ayu Agustin 5/24/2021
129 BY Satta Adyra 5/25/2021
130 BY Dewi Isnawati 5/25/2021
131 BY Wiwik Susanti 5/25/2021
132 BY Lailatus Sholihah 5/25/2021
133 BY Fitria Nanda Sari 5/25/2021
134 BY Dwi Juniasari 5/25/2021
135 BY Marlik 5/26/2021
136 BY Siti Nur Hidayah 5/26/2021
137 BY Dwi Putri Rahayu 5/26/2021
138 BY Galis Wahyu Maidawati 5/26/2021
139 BY Tri Septiya 5/26/2021
140 BY Pudji Astuti 5/26/2021
141 BY Rahayu 5/27/2021
142 BY Iswahyuni 5/27/2021
143 BY Siti Hidayati 5/28/2021
144 BY Asislah 5/28/2021
145 BY Novi Pahlawanti 5/28/2021
146 BY Ria Kurnia Sari 5/28/2021
147 BY Siti Mujiati 5/29/2021
148 BY Ismi Faridah 5/30/2021
149 BY Rusta Alan Nawa 5/29/2021
150 BY Almira Tria Angela 5/30/2021
151 BY Dewi Rizta 5/30/2021
152 BY Ayu Ambarwati 5/30/2021
153 BY Erni Triana 5/30/2021
154 BY Rahayu Tuhulele 5/30/2021
155 BY Shinta 5/31/2021
156 BY Widya Putri 5/30/2021
157 BY Herwana 5/31/2021
158 BY Puji Rahayu 6/1/2021
159 BY Fitri Erliyana 6/1/2021
160 BY Yuliaten 5/31/2021
161 BY Lamiati 5/31/2021
162 BY Eka Cahyaning Putri 6/1/2021
163 BY Diah Retno Sayekti 6/1/2021
TER SPESIALIS ANAK / BIDAN PRAKTEK MANDIRI HASIL
NAMA PRAKTEK : RSI DARUS SYIFA' BENOWO
BULAN : MEI
TAHUN : 2021

BAYI
HEPATITIS B UNIJECT
NO NAMA TANGGAL LAHIR
POLIO 4 CAMPAK/MR
HB <24 JAM

1 2 3 14 15 16

1 BN NY FANY AYU NING TYAS 02 MEI 2021 02 MEI 2021

2 BY NY PUTRI LESTARI 02 MEI 2021 02 MEI 2021
3 BY NY REVITA DIYAH 03 MEI 2021 03 MEI 2021
4 BY NY SELLA TRIYA AMANDA 03 MEI 2021 03 MEI 2021
5 BY NY CINDY CLAUDERA 02 MEI 2021 02 MEI 2021
6 BY NY NUR FARIDAH 02 MEI 2021 02 MEI 2021
7 BY NY SALMAH RAMADANI 03 MEI 2021 03 MEI 2021
8 BY NY CHRISTINA MATILDA 03 MEI 2021 03 MEI 2021
9 BY NY ENY SYABANURIYAH 03 MEI 2021 03 MEI 2021
10 BY NY PUTRI SHOLEKHAH 04 MEI 2021 04 MEI 2021
11 BY NY LIDYA AVRILYA 04 MEI 2021 04 MEI 2021
12 BY NY ANNURUL HIDAHYANTI 04 MEI 2021 04 MEI 2021
13 BY NY LIDIYAWATI 04 MEI 2021 04 MEI 2021
14 BY NY SANYAR CADA PUTRI 04 MEI 2021 04 MEI 2021
15 BY NY DEWI SINTA 04 MEI 2021 04 MEI 2021
16 BY NY TITIN ARINDAH 04 MEI 2021 04 MEI 2021
17 BY NY MAYA PERMATA NSARI 04 MEI 2021 04 MEI 2021
18 BY NY RATNAWATI 04 MEI 2021 04 MEI 2021
19 BY NY INDAH 04 MEI 2021 04 MEI 2021
20 BY NY SITI NUR KHOTIMAH 04 MEI 2021 05 MEI 2021
21 BY NY SITI KHOLIPAH 05 MEI 2021 05 MEI 2021
22 BY NY NOER AINI SITI 05 MEI 2021 05 MEI 2021
23 BY NY LIA DWI AGUSTIN 05 MEI 2021 05 MEI 2021
24 BY NY ARI DEVI NOVI TRIYANTI 05 MEI 2021 05 MEI 2021
25 BY NY MULYANI 05 MEI 2021 05 MEI 2021
26 BY NY AINUN FARIDA 05 MEI 2021 05 MEI 2021
27 BY NY UMINAH 05 MEI 2021 05 MEI 2021
28 BY NY YULI FITA INDRIYANI 06 MEI 2021 06 MEI 2021
29 BY NY RATNA DWININGSIH 06 MEI 2021 06 MEI 2021
30 BY NY WAHYUNINGSIH 06 MEI 2021 06 MEI 2021
31 BY NY RINI WIDIASTUTI 06 MEI 2021 06 MEI 2021
32 BY NY IIN IRAWATI 06 MEI 2021 06 MEI 2021
33 BY NY ENDANG RAHMAWATI 06 MEI 2021 06 MEI 2021
34 BY NY RINDI SUANTIKA 06 MEI 2021 06 MEI 2021
35 BY NY NUR HALIMAH 07 MEI 2021 07 MEI 2021
36 BY NY YESI WULANSARI 06 MEI 2021 06 MEI 2021
37 BY NY EVIN NUR FADILAH 06 MEI 2021 06 MEI 2021
38 BY NY RODHIATUN KHASANAH 07 MEI 2021 07 MEI 2021
39 BY NY INTAN NUR OKTAFIYAH 08 MEI 2021 08 MEI 2021
40 BY NY ARBA ANIS SIYAMI 08 MEI 2021 08 MEI 2021
41 BY NY ELOK KHOIROTUL KHULUQ 10 MEI 2021 10 MEI 2021
42 BY NY DEVI ALFIANTI 09 MEI 2021 09 MEI 2021
43 BY NY ALIMAH 09 MEI 2021 09 MEI 2021
44 BY NY MIBTAKU ROIPAH 09 MEI 2021 09 MEI 2021
45 BY NY ANIFATUR ROHMAH 09 MEI 2021 09 MEI 2021
46 BY NY SUNARTI 10 MEI 2021 10 MEI 2021
47 BY NY CINTYA NURJANAH 10 MEI 2021 10 MEI 2021
48 BY NY FITRI ANGGRAENI 10 MEI 2021 10 MEI 2021
49 BY NY UMU KUROTIN 10 MEI 2021 10 MEI 2021
50 BY NY RATNA DWININGSIH 10 MEI 2021 10 MEI 2021
51 BY NY MEGA MUSTIKA 10 MEI 2021 10 MEI 2021
52 BY NY SITI NUR KHOMARIYAH 10 MEI 2021 10 MEI 2021
53 BY NY FITRIANA NINGSIH 11 MEI 2021 11 MEI 2021
54 BY NY RRIN ANDRIYANI 11 MEI 2021 11 MEI 2021
55 BY NY AMINAH 11 MEI 2021 11 MEI 2021
56 BY NY NOVIANTI 11 MEI 2021 11 MEI 2021
57 BY NY THERESIA ELLY 11 MEI 2021 11 MEI 2021
58 BY NY LLASMININGSIH 12 MEI 2021 12 MEI 2021
59 BY NY NUR ROHMAH 12 MEI 2021 12 MEI 2021
60 BY NY ANIS WIJAYANTI 12 MEI 2021 12 MEI 2021
61 BY NY RIKA INDRIANI 12 MEI 2021 12 MEI 2021
62 BY NY RAHMA DEWI 13 MEI 2021 13 MEI 2021
63 BY NY SELLY AYU NOVITA 13 MEI 2021 13 MEI 2021
64 BY NY KRISTIN NINGRUM 15 MEI 2021 15 MEI 2021
65 BY NY EVI SETYOWATI 14 MEI 2021 14 MEI 2021
66 BY NY IMUNG AMANAHFIYAH 14 MEI 2021 14 MEI 2021
67 BY NY RISNA ROSITA 15 MEI 2021 15 MEI 2021
68 BY NY RUNI RAHMA APRILIANI 15 MEI 2021 15 MEI 2021
69 BY NY DIAN SULISTYAWATI 15 MEI 2021 15 MEI 2021
70 BY NY SARFIN INA RAHAYU 15 MEI 2021 15 MEI 2021
71 BY NY SYABRINA DIA 15 MEI 2021 15 MEI 2021
72 BY NY ZAMHARI ROTUL 16 MEI 2021 16 MEI 2021
73 BY NY NUR HIDAYATI 17 MEI 2021 17 MEI 2021
74 BY NY INDRI SILVIA 17 MEI 2021 17 MEI 2021
75 BY NY LIA ANGGRAINI 17 MEI 2021 17 MEI 2021
76 BY NY NUNUNG PAWATI 17 MEI 2021 17 MEI 2021
77 BY NY ENDAH RUSTIANA 16 MEI 2021 16 MEI 2021
78 BY NY UMROTUL FIKRIYAH 17 MEI 2021 17 MEI 2021
79 BY NY ENDAH KARTIKAWATI 17 MEI 2021 17 MEI 2021
80 BY NY NALA 17 MEI 2021 17 MEI 2021
81 BY NY KURDIAN PUJI 17 MEI 2021 17 MEI 2021
82 BY NY NADLIFAH AL QONITA 17 MEI 2021 17 MEI 2021
83 BY NY DINDA AYU 17 MEI 2021 17 MEI 2021
84 BY NY LESSYE SANDRA KUSUMA 18 MEI 2021 18 MEI 2021
85 BY NY ARUM AMBAR 17 MEI 2021 17 MEI 2021
86 BY NY DEWI MASITA 17 MEI 2021 17 MEI 2021
87 BY NY NIHAYATIL KHUSNA 17 MEI 2021 17 MEI 2021
88 BY NY DEWI UMI 17 MEI 2021 17 MEI 2021
89 BY NY LILIS NUR INDAH 18 MEI 2021 18 MEI 2021
90 BY NY NOVITA SARI 18 MEI 2021 18 MEI 2021
91 BY NY IRENE IRSA HAWANG 19 MEI 2021 19 MEI 2021
92 BY NY FARIHATUL HOIROH 18 MEI 2021 18 MEI 2021
93 BY NY IKA YULI ISTANTI 19 MEI 2021 19 MEI 2021
94 BY NY IRENE LAURENTIA 19 MEI 2021 19 MEI 2021
95 BY NY EVA SARI BIARAWATI 19 MEI 2021 19 MEI 2021
96 BY NY AZILA ROHMATUL INAYAH 19 MEI 2021 19 MEI 2021
97 BY NY FATIMATUZZAHRO 19 MEI 2021 19 MEI 2021
98 BY NY ALIFIA FARA SALSABILA 19 MEI 2021 19 MEI 2021
99 BY NY AYU MEILANY 19 MEI 2021 19 MEI 2021
100 BY NY ULFATUL MURTASYIDAH 19 MEI 2021 19 MEI 2021
101 BY NY ASTERLITA SIBARANI 19 MEI 2021 19 MEI 2021
102 BY NY SHARAH NUR FADILLAH 20 MEI 2021 20 MEI 2021
103 BY NY EKA PURWATI 20 MEI 2021 20 MEI 2021
104 BY NY SITI MURSALINAH 20 MEI 2021 20 MEI 2021
105 BY NY AYUNDA NOVITA S 20 MEI 2021 20 MEI 2021
106 BY NY NIKEN PRATIWI 20 MEI 2021 20 MEI 2021
107 BY NY CHUSNUL KHOTIMAH 20 MEI 2021 20 MEI 2021
108 BY NY VIKA NAFIDATUL 20 MEI 2021 20 MEI 2021
109 BY NY RETNO AR IYANTI 21 MEI 2021 21 MEI 2021
110 BY NY USWATUN KHASANAH 22 MEI 2021 22 MEI 2021
111 BY NY SUMINAH 22 MEI 2021 22 MEI 2021
112 BY NY YULI FATMAWATI 22 MEI 2021 22 MEI 2021
113 BY NY NUR RAMDHANA 22 MEI 2021 22 MEI 2021
114 BY NY LAILIYAH 22 MEI 2021 22 MEI 2021
115 BY NY MAMIK SRI 22 MEI 2021 22 MEI 2021
116 BY NY MUVIDAH FIDAYANTI 22 MEI 2021 22 MEI 2021
117 BY NY HERLINDA 22 MEI 2021 22 MEI 2021
118 BY NY CORY KURNIANINGSIH 23 MEI 2021 23 MEI 2021
119 BY Meri Andani 5/24/2021 5/24/2021
120 BY Rani Enggarsari 5/23/2021 5/23/2021
121 BYCitra Nur Arini 5/23/2021 5/23/2021
122 BY Resti Rahayu 5/24/2021 5/24/2021
123 BY Nurila Mardziana 5/24/2021 5/24/2021
124 BY 'Syifa Nurhalimah 5/24/2021 5/24/2021
125 BY Mita Constantia 5/24/2021 5/24/2021
126 BY Ika manjasari 5/24/2021 5/24/2021
127 BY Astutik 5/24/2021 5/24/2021
128 BY Devita Ayu Agustin 5/24/2021 5/24/2021
129 BY Satta Adyra 5/25/2021 5/25/2021
130 BY Dewi Isnawati 5/25/2021 5/25/2021
131 BY Wiwik Susanti 5/25/2021 5/25/2021
132 BY Lailatus Sholihah 5/25/2021 5/25/2021
133 BY Fitria Nanda Sari 5/25/2021 5/25/2021
134 BY Dwi Juniasari 5/25/2021 5/25/2021
135 BY Marlik 5/26/2021 5/26/2021
136 BY Siti Nur Hidayah 5/26/2021 5/26/2021
137 BY Dwi Putri Rahayu 5/26/2021 5/26/2021
138 BY Galis Wahyu Maidawati 5/26/2021 5/26/2021
139 BY Tri Septiya 5/26/2021 5/26/2021
140 BY Pudji Astuti 5/26/2021 5/26/2021
141 BY Rahayu 5/27/2021 5/27/2021
142 BY Iswahyuni 5/27/2021 5/27/2021
143 BY Siti Hidayati 5/28/2021 5/28/2021
144 BY Asislah 5/28/2021 5/28/2021
145 BY Novi Pahlawanti 5/28/2021 5/28/2021
146 BY Ria Kurnia Sari 5/28/2021 5/28/2021
147 BY Siti Mujiati 5/29/2021 5/29/2021
148 BY Ismi Faridah 5/30/2021 5/30/2021
149 BY Rusta Alan Nawa 5/29/2021 5/29/2021
150 BY Almira Tria Angela 5/30/2021 5/30/2021
151 BY Dewi Rizta 5/30/2021 5/30/2021
152 BY Ayu Ambarwati 5/30/2021 5/30/2021
153 BY Erni Triana 5/30/2021 5/30/2021
154 BY Rahayu Tuhulele 5/30/2021 5/30/2021
155 BY Shinta 5/31/2021 5/31/2021
156 BY Widya Putri 5/30/2021 5/30/2021
157 BY Herwana 5/31/2021 5/31/2021
158 BY Puji Rahayu 6/1/2021 6/1/2021
159 BY Fitri Erliyana 6/1/2021 6/1/2021
160 BY Yuliaten 5/31/2021 5/31/2021
161 BY Lamiati 5/31/2021 5/31/2021
162 BY Eka Cahyaning Putri 6/1/2021 6/1/2021
163 BY Diah Retno Sayekti 6/1/2021 6/1/2021
 H
NAMA PRAKTEK : RSI DARUS SYIFA' BENOWO
BULAN : MEI
TAHUN : 2021

BAYI
HEPATITIS B UNIJECT
NO NAMA TANGGAL LAHIR
DPT HB HIB 1 DPT HB HIB 2
HB 0-7 Hari

1 2 3 17 18 19

1 BN NY FANY AYU NING TYAS 02 MEI 2021

2 BY NY PUTRI LESTARI 02 MEI 2021
3 BY NY REVITA DIYAH 03 MEI 2021
4 BY NY SELLA TRIYA AMANDA 03 MEI 2021
5 BY NY CINDY CLAUDERA 02 MEI 2021
6 BY NY NUR FARIDAH 02 MEI 2021
7 BY NY SALMAH RAMADANI 03 MEI 2021
8 BY NY CHRISTINA MATILDA 03 MEI 2021
9 BY NY ENY SYABANURIYAH 03 MEI 2021
10 BY NY PUTRI SHOLEKHAH 04 MEI 2021
11 BY NY LIDYA AVRILYA 04 MEI 2021
12 BY NY ANNURUL HIDAHYANTI 04 MEI 2021
13 BY NY LIDIYAWATI 04 MEI 2021
14 BY NY SANYAR CADA PUTRI 04 MEI 2021
15 BY NY DEWI SINTA 04 MEI 2021
16 BY NY TITIN ARINDAH 04 MEI 2021
17 BY NY MAYA PERMATA NSARI 04 MEI 2021
18 BY NY RATNAWATI 04 MEI 2021
19 BY NY INDAH 04 MEI 2021
20 BY NY SITI NUR KHOTIMAH 04 MEI 2021
21 BY NY SITI KHOLIPAH 05 MEI 2021
22 BY NY NOER AINI SITI 05 MEI 2021
23 BY NY LIA DWI AGUSTIN 05 MEI 2021
24 BY NY ARI DEVI NOVI TRIYANTI 05 MEI 2021
25 BY NY MULYANI 05 MEI 2021
26 BY NY AINUN FARIDA 05 MEI 2021
27 BY NY UMINAH 05 MEI 2021
28 BY NY YULI FITA INDRIYANI 06 MEI 2021
29 BY NY RATNA DWININGSIH 06 MEI 2021
30 BY NY WAHYUNINGSIH 06 MEI 2021
31 BY NY RINI WIDIASTUTI 06 MEI 2021
32 BY NY IIN IRAWATI 06 MEI 2021
33 BY NY ENDANG RAHMAWATI 06 MEI 2021
34 BY NY RINDI SUANTIKA 06 MEI 2021
35 BY NY NUR HALIMAH 07 MEI 2021
36 BY NY YESI WULANSARI 06 MEI 2021
37 BY NY EVIN NUR FADILAH 06 MEI 2021
38 BY NY RODHIATUN KHASANAH 07 MEI 2021
39 BY NY INTAN NUR OKTAFIYAH 08 MEI 2021
40 BY NY ARBA ANIS SIYAMI 08 MEI 2021
41 BY NY ELOK KHOIROTUL KHULUQ 10 MEI 2021
42 BY NY DEVI ALFIANTI 09 MEI 2021
43 BY NY ALIMAH 09 MEI 2021
44 BY NY MIBTAKU ROIPAH 09 MEI 2021
45 BY NY ANIFATUR ROHMAH 09 MEI 2021
46 BY NY SUNARTI 10 MEI 2021
47 BY NY CINTYA NURJANAH 10 MEI 2021
48 BY NY FITRI ANGGRAENI 10 MEI 2021
49 BY NY UMU KUROTIN 10 MEI 2021
50 BY NY RATNA DWININGSIH 10 MEI 2021
51 BY NY MEGA MUSTIKA 10 MEI 2021
52 BY NY SITI NUR KHOMARIYAH 10 MEI 2021
53 BY NY FITRIANA NINGSIH 11 MEI 2021
54 BY NY RRIN ANDRIYANI 11 MEI 2021
55 BY NY AMINAH 11 MEI 2021
56 BY NY NOVIANTI 11 MEI 2021
57 BY NY THERESIA ELLY 11 MEI 2021
58 BY NY LLASMININGSIH 12 MEI 2021
59 BY NY NUR ROHMAH 12 MEI 2021
60 BY NY ANIS WIJAYANTI 12 MEI 2021
61 BY NY RIKA INDRIANI 12 MEI 2021
62 BY NY RAHMA DEWI 13 MEI 2021
63 BY NY SELLY AYU NOVITA 13 MEI 2021
64 BY NY KRISTIN NINGRUM 15 MEI 2021
65 BY NY EVI SETYOWATI 14 MEI 2021
66 BY NY IMUNG AMANAHFIYAH 14 MEI 2021
67 BY NY RISNA ROSITA 15 MEI 2021
68 BY NY RUNI RAHMA APRILIANI 15 MEI 2021
69 BY NY DIAN SULISTYAWATI 15 MEI 2021
70 BY NY SARFIN INA RAHAYU 15 MEI 2021
71 BY NY SYABRINA DIA 15 MEI 2021
72 BY NY ZAMHARI ROTUL 16 MEI 2021
73 BY NY NUR HIDAYATI 17 MEI 2021
74 BY NY INDRI SILVIA 17 MEI 2021
75 BY NY LIA ANGGRAINI 17 MEI 2021
76 BY NY NUNUNG PAWATI 17 MEI 2021
77 BY NY ENDAH RUSTIANA 16 MEI 2021
78 BY NY UMROTUL FIKRIYAH 17 MEI 2021
79 BY NY ENDAH KARTIKAWATI 17 MEI 2021
80 BY NY NALA 17 MEI 2021
81 BY NY KURDIAN PUJI 17 MEI 2021
82 BY NY NADLIFAH AL QONITA 17 MEI 2021
83 BY NY DINDA AYU 17 MEI 2021
84 BY NY LESSYE SANDRA KUSUMA 18 MEI 2021
85 BY NY ARUM AMBAR 17 MEI 2021
86 BY NY DEWI MASITA 17 MEI 2021
87 BY NY NIHAYATIL KHUSNA 17 MEI 2021
88 BY NY DEWI UMI 17 MEI 2021
89 BY NY LILIS NUR INDAH 18 MEI 2021
90 BY NY NOVITA SARI 18 MEI 2021
91 BY NY IRENE IRSA HAWANG 19 MEI 2021
92 BY NY FARIHATUL HOIROH 18 MEI 2021
93 BY NY IKA YULI ISTANTI 19 MEI 2021
94 BY NY IRENE LAURENTIA 19 MEI 2021
95 BY NY EVA SARI BIARAWATI 19 MEI 2021
96 BY NY AZILA ROHMATUL INAYAH 19 MEI 2021
97 BY NY FATIMATUZZAHRO 19 MEI 2021
98 BY NY ALIFIA FARA SALSABILA 19 MEI 2021
99 BY NY AYU MEILANY 19 MEI 2021
100 BY NY ULFATUL MURTASYIDAH 19 MEI 2021
101 BY NY ASTERLITA SIBARANI 19 MEI 2021
102 BY NY SHARAH NUR FADILLAH 20 MEI 2021
103 BY NY EKA PURWATI 20 MEI 2021
104 BY NY SITI MURSALINAH 20 MEI 2021
105 BY NY AYUNDA NOVITA S 20 MEI 2021
106 BY NY NIKEN PRATIWI 20 MEI 2021
107 BY NY CHUSNUL KHOTIMAH 20 MEI 2021
108 BY NY VIKA NAFIDATUL 20 MEI 2021
109 BY NY RETNO AR IYANTI 21 MEI 2021
110 BY NY USWATUN KHASANAH 22 MEI 2021
111 BY NY SUMINAH 22 MEI 2021
112 BY NY YULI FATMAWATI 22 MEI 2021
113 BY NY NUR RAMDHANA 22 MEI 2021
114 BY NY LAILIYAH 22 MEI 2021
115 BY NY MAMIK SRI 22 MEI 2021
116 BY NY MUVIDAH FIDAYANTI 22 MEI 2021
117 BY NY HERLINDA 22 MEI 2021
118 BY NY CORY KURNIANINGSIH 23 MEI 2021
119 BY Meri Andani 5/24/2021
120 BY Rani Enggarsari 5/23/2021
121 BYCitra Nur Arini 5/23/2021
122 BY Resti Rahayu 5/24/2021
123 BY Nurila Mardziana 5/24/2021
124 BY 'Syifa Nurhalimah 5/24/2021
125 BY Mita Constantia 5/24/2021
126 BY Ika manjasari 5/24/2021
127 BY Astutik 5/24/2021
128 BY Devita Ayu Agustin 5/24/2021
129 BY Satta Adyra 5/25/2021
130 BY Dewi Isnawati 5/25/2021
131 BY Wiwik Susanti 5/25/2021
132 BY Lailatus Sholihah 5/25/2021
133 BY Fitria Nanda Sari 5/25/2021
134 BY Dwi Juniasari 5/25/2021
135 BY Marlik 5/26/2021
136 BY Siti Nur Hidayah 5/26/2021
137 BY Dwi Putri Rahayu 5/26/2021
138 BY Galis Wahyu Maidawati 5/26/2021
139 BY Tri Septiya 5/26/2021
140 BY Pudji Astuti 5/26/2021
141 BY Rahayu 5/27/2021
142 BY Iswahyuni 5/27/2021
143 BY Siti Hidayati 5/28/2021
144 BY Asislah 5/28/2021
145 BY Novi Pahlawanti 5/28/2021
146 BY Ria Kurnia Sari 5/28/2021
147 BY Siti Mujiati 5/29/2021
148 BY Ismi Faridah 5/30/2021
149 BY Rusta Alan Nawa 5/29/2021
150 BY Almira Tria Angela 5/30/2021
151 BY Dewi Rizta 5/30/2021
152 BY Ayu Ambarwati 5/30/2021
153 BY Erni Triana 5/30/2021
154 BY Rahayu Tuhulele 5/30/2021
155 BY Shinta 5/31/2021
156 BY Widya Putri 5/30/2021
157 BY Herwana 5/31/2021
158 BY Puji Rahayu 6/1/2021
159 BY Fitri Erliyana 6/1/2021
160 BY Yuliaten 5/31/2021
161 BY Lamiati 5/31/2021
162 BY Eka Cahyaning Putri 6/1/2021
163 BY Diah Retno Sayekti 6/1/2021
 HASIL IMUNISASI RUMAH SAKIT / KLINIK
HASIL IMU
/D
NAMA PRAKTEK : RSI DARUS SYIFA' BENOWO
BULAN : MEI
TAHUN : 2021
DI ISI TANGGAL PEMBERIAN VAKSIN / PENYUNTIKAN (BUKA
ANAK WUS

NO NAMA TANGGAL LAHIR DPT HB CAMPAK/

DPT HB HIB 3 IPV HIB MR TT Engerix B Euvax B DTP HIB
BOOSTER BOOSTER

1 2 3 20 21 22 23 24 25 26 27 28

1 BN NY FANY AYU NING TYAS 02 MEI 2021

2 BY NY PUTRI LESTARI 02 MEI 2021
3 BY NY REVITA DIYAH 03 MEI 2021
4 BY NY SELLA TRIYA AMANDA 03 MEI 2021
5 BY NY CINDY CLAUDERA 02 MEI 2021
6 BY NY NUR FARIDAH 02 MEI 2021
7 BY NY SALMAH RAMADANI 03 MEI 2021
8 BY NY CHRISTINA MATILDA 03 MEI 2021
9 BY NY ENY SYABANURIYAH 03 MEI 2021
10 BY NY PUTRI SHOLEKHAH 04 MEI 2021
11 BY NY LIDYA AVRILYA 04 MEI 2021
12 BY NY ANNURUL HIDAHYANTI 04 MEI 2021
13 BY NY LIDIYAWATI 04 MEI 2021
14 BY NY SANYAR CADA PUTRI 04 MEI 2021
15 BY NY DEWI SINTA 04 MEI 2021
16 BY NY TITIN ARINDAH 04 MEI 2021
17 BY NY MAYA PERMATA NSARI 04 MEI 2021
18 BY NY RATNAWATI 04 MEI 2021
19 BY NY INDAH 04 MEI 2021
20 BY NY SITI NUR KHOTIMAH 04 MEI 2021
21 BY NY SITI KHOLIPAH 05 MEI 2021
22 BY NY NOER AINI SITI 05 MEI 2021
23 BY NY LIA DWI AGUSTIN 05 MEI 2021
24 BY NY ARI DEVI NOVI TRIYANTI 05 MEI 2021
25 BY NY MULYANI 05 MEI 2021
26 BY NY AINUN FARIDA 05 MEI 2021
27 BY NY UMINAH 05 MEI 2021
28 BY NY YULI FITA INDRIYANI 06 MEI 2021
29 BY NY RATNA DWININGSIH 06 MEI 2021
30 BY NY WAHYUNINGSIH 06 MEI 2021
31 BY NY RINI WIDIASTUTI 06 MEI 2021
32 BY NY IIN IRAWATI 06 MEI 2021
33 BY NY ENDANG RAHMAWATI 06 MEI 2021
34 BY NY RINDI SUANTIKA 06 MEI 2021
35 BY NY NUR HALIMAH 07 MEI 2021
36 BY NY YESI WULANSARI 06 MEI 2021
37 BY NY EVIN NUR FADILAH 06 MEI 2021
38 BY NY RODHIATUN KHASANAH 07 MEI 2021
39 BY NY INTAN NUR OKTAFIYAH 08 MEI 2021
40 BY NY ARBA ANIS SIYAMI 08 MEI 2021
41 BY NY ELOK KHOIROTUL KHULUQ 10 MEI 2021
42 BY NY DEVI ALFIANTI 09 MEI 2021
43 BY NY ALIMAH 09 MEI 2021
44 BY NY MIBTAKU ROIPAH 09 MEI 2021
45 BY NY ANIFATUR ROHMAH 09 MEI 2021
46 BY NY SUNARTI 10 MEI 2021
47 BY NY CINTYA NURJANAH 10 MEI 2021
48 BY NY FITRI ANGGRAENI 10 MEI 2021
49 BY NY UMU KUROTIN 10 MEI 2021
50 BY NY RATNA DWININGSIH 10 MEI 2021
51 BY NY MEGA MUSTIKA 10 MEI 2021
52 BY NY SITI NUR KHOMARIYAH 10 MEI 2021
53 BY NY FITRIANA NINGSIH 11 MEI 2021
54 BY NY RRIN ANDRIYANI 11 MEI 2021
55 BY NY AMINAH 11 MEI 2021
56 BY NY NOVIANTI 11 MEI 2021
57 BY NY THERESIA ELLY 11 MEI 2021
58 BY NY LLASMININGSIH 12 MEI 2021
59 BY NY NUR ROHMAH 12 MEI 2021
60 BY NY ANIS WIJAYANTI 12 MEI 2021
61 BY NY RIKA INDRIANI 12 MEI 2021
62 BY NY RAHMA DEWI 13 MEI 2021
63 BY NY SELLY AYU NOVITA 13 MEI 2021
64 BY NY KRISTIN NINGRUM 15 MEI 2021
65 BY NY EVI SETYOWATI 14 MEI 2021
66 BY NY IMUNG AMANAHFIYAH 14 MEI 2021
67 BY NY RISNA ROSITA 15 MEI 2021
68 BY NY RUNI RAHMA APRILIANI 15 MEI 2021
69 BY NY DIAN SULISTYAWATI 15 MEI 2021
70 BY NY SARFIN INA RAHAYU 15 MEI 2021
71 BY NY SYABRINA DIA 15 MEI 2021
72 BY NY ZAMHARI ROTUL 16 MEI 2021
73 BY NY NUR HIDAYATI 17 MEI 2021
74 BY NY INDRI SILVIA 17 MEI 2021
75 BY NY LIA ANGGRAINI 17 MEI 2021
76 BY NY NUNUNG PAWATI 17 MEI 2021
77 BY NY ENDAH RUSTIANA 16 MEI 2021
78 BY NY UMROTUL FIKRIYAH 17 MEI 2021
79 BY NY ENDAH KARTIKAWATI 17 MEI 2021
80 BY NY NALA 17 MEI 2021
81 BY NY KURDIAN PUJI 17 MEI 2021
82 BY NY NADLIFAH AL QONITA 17 MEI 2021
83 BY NY DINDA AYU 17 MEI 2021
84 BY NY LESSYE SANDRA KUSUMA 18 MEI 2021
85 BY NY ARUM AMBAR 17 MEI 2021
86 BY NY DEWI MASITA 17 MEI 2021
87 BY NY NIHAYATIL KHUSNA 17 MEI 2021
88 BY NY DEWI UMI 17 MEI 2021
89 BY NY LILIS NUR INDAH 18 MEI 2021
90 BY NY NOVITA SARI 18 MEI 2021
91 BY NY IRENE IRSA HAWANG 19 MEI 2021
92 BY NY FARIHATUL HOIROH 18 MEI 2021
93 BY NY IKA YULI ISTANTI 19 MEI 2021
94 BY NY IRENE LAURENTIA 19 MEI 2021
95 BY NY EVA SARI BIARAWATI 19 MEI 2021
96 BY NY AZILA ROHMATUL INAYAH 19 MEI 2021
97 BY NY FATIMATUZZAHRO 19 MEI 2021
98 BY NY ALIFIA FARA SALSABILA 19 MEI 2021
99 BY NY AYU MEILANY 19 MEI 2021
100 BY NY ULFATUL MURTASYIDAH 19 MEI 2021
101 BY NY ASTERLITA SIBARANI 19 MEI 2021
102 BY NY SHARAH NUR FADILLAH 20 MEI 2021
103 BY NY EKA PURWATI 20 MEI 2021
104 BY NY SITI MURSALINAH 20 MEI 2021
105 BY NY AYUNDA NOVITA S 20 MEI 2021
106 BY NY NIKEN PRATIWI 20 MEI 2021
107 BY NY CHUSNUL KHOTIMAH 20 MEI 2021
108 BY NY VIKA NAFIDATUL 20 MEI 2021
109 BY NY RETNO AR IYANTI 21 MEI 2021
110 BY NY USWATUN KHASANAH 22 MEI 2021
111 BY NY SUMINAH 22 MEI 2021
112 BY NY YULI FATMAWATI 22 MEI 2021
113 BY NY NUR RAMDHANA 22 MEI 2021
114 BY NY LAILIYAH 22 MEI 2021
115 BY NY MAMIK SRI 22 MEI 2021
116 BY NY MUVIDAH FIDAYANTI 22 MEI 2021
117 BY NY HERLINDA 22 MEI 2021
118 BY NY CORY KURNIANINGSIH 23 MEI 2021
119 BY Meri Andani 5/24/2021
120 BY Rani Enggarsari 5/23/2021
121 BYCitra Nur Arini 5/23/2021
122 BY Resti Rahayu 5/24/2021
123 BY Nurila Mardziana 5/24/2021
124 BY 'Syifa Nurhalimah 5/24/2021
125 BY Mita Constantia 5/24/2021
126 BY Ika manjasari 5/24/2021
127 BY Astutik 5/24/2021
128 BY Devita Ayu Agustin 5/24/2021
129 BY Satta Adyra 5/25/2021
130 BY Dewi Isnawati 5/25/2021
131 BY Wiwik Susanti 5/25/2021
132 BY Lailatus Sholihah 5/25/2021
133 BY Fitria Nanda Sari 5/25/2021
134 BY Dwi Juniasari 5/25/2021
135 BY Marlik 5/26/2021
136 BY Siti Nur Hidayah 5/26/2021
137 BY Dwi Putri Rahayu 5/26/2021
138 BY Galis Wahyu Maidawati 5/26/2021
139 BY Tri Septiya 5/26/2021
140 BY Pudji Astuti 5/26/2021
141 BY Rahayu 5/27/2021
142 BY Iswahyuni 5/27/2021
143 BY Siti Hidayati 5/28/2021
144 BY Asislah 5/28/2021
145 BY Novi Pahlawanti 5/28/2021
146 BY Ria Kurnia Sari 5/28/2021
147 BY Siti Mujiati 5/29/2021
148 BY Ismi Faridah 5/30/2021
149 BY Rusta Alan Nawa 5/29/2021
150 BY Almira Tria Angela 5/30/2021
151 BY Dewi Rizta 5/30/2021
152 BY Ayu Ambarwati 5/30/2021
153 BY Erni Triana 5/30/2021
154 BY Rahayu Tuhulele 5/30/2021
155 BY Shinta 5/31/2021
156 BY Widya Putri 5/30/2021
157 BY Herwana 5/31/2021
158 BY Puji Rahayu 6/1/2021
159 BY Fitri Erliyana 6/1/2021
160 BY Yuliaten 5/31/2021
161 BY Lamiati 5/31/2021
162 BY Eka Cahyaning Putri 6/1/2021
163 BY Diah Retno Sayekti 6/1/2021
HASIL IMUNISASI RUMAH SAKIT / KLINIK / DOKTER SPESIALIS ANAK / BIDAN PRAKTEK MANDIRI HASIL I
NAMA PRAKTEK : RSI DARUS SYIFA' BENOWO
BULAN : MEI
TAHUN : 2021
DI ISI TANGGAL PEMBERIAN VAKSIN / PENYUNTIKAN (BUKAN DICENTANG)
VAKSIN BAYI (NON PEMERINTAH)

Infanrif
NO NAMA TANGGAL LAHIR HIB Infanrif Tetract
Pediacel Infanrix Trimovax MMR Tetagam HB Vax
(DPaT- HIB IPV HIB
HiB)

1 2 3 29 30 31 32 33 34 35 36 37

1 BN NY FANY AYU NING TYAS 02 MEI 2021

2 BY NY PUTRI LESTARI 02 MEI 2021
3 BY NY REVITA DIYAH 03 MEI 2021
4 BY NY SELLA TRIYA AMANDA 03 MEI 2021
5 BY NY CINDY CLAUDERA 02 MEI 2021
6 BY NY NUR FARIDAH 02 MEI 2021
7 BY NY SALMAH RAMADANI 03 MEI 2021
8 BY NY CHRISTINA MATILDA 03 MEI 2021
9 BY NY ENY SYABANURIYAH 03 MEI 2021
10 BY NY PUTRI SHOLEKHAH 04 MEI 2021
11 BY NY LIDYA AVRILYA 04 MEI 2021
12 BY NY ANNURUL HIDAHYANTI 04 MEI 2021
13 BY NY LIDIYAWATI 04 MEI 2021
14 BY NY SANYAR CADA PUTRI 04 MEI 2021
15 BY NY DEWI SINTA 04 MEI 2021
16 BY NY TITIN ARINDAH 04 MEI 2021
17 BY NY MAYA PERMATA NSARI 04 MEI 2021
18 BY NY RATNAWATI 04 MEI 2021
19 BY NY INDAH 04 MEI 2021
20 BY NY SITI NUR KHOTIMAH 04 MEI 2021
21 BY NY SITI KHOLIPAH 05 MEI 2021
22 BY NY NOER AINI SITI 05 MEI 2021
23 BY NY LIA DWI AGUSTIN 05 MEI 2021
24 BY NY ARI DEVI NOVI TRIYANTI 05 MEI 2021
25 BY NY MULYANI 05 MEI 2021
26 BY NY AINUN FARIDA 05 MEI 2021
27 BY NY UMINAH 05 MEI 2021
28 BY NY YULI FITA INDRIYANI 06 MEI 2021
29 BY NY RATNA DWININGSIH 06 MEI 2021
30 BY NY WAHYUNINGSIH 06 MEI 2021
31 BY NY RINI WIDIASTUTI 06 MEI 2021
32 BY NY IIN IRAWATI 06 MEI 2021
33 BY NY ENDANG RAHMAWATI 06 MEI 2021
34 BY NY RINDI SUANTIKA 06 MEI 2021
35 BY NY NUR HALIMAH 07 MEI 2021
36 BY NY YESI WULANSARI 06 MEI 2021
37 BY NY EVIN NUR FADILAH 06 MEI 2021
38 BY NY RODHIATUN KHASANAH 07 MEI 2021
39 BY NY INTAN NUR OKTAFIYAH 08 MEI 2021
40 BY NY ARBA ANIS SIYAMI 08 MEI 2021
41 BY NY ELOK KHOIROTUL KHULUQ 10 MEI 2021
42 BY NY DEVI ALFIANTI 09 MEI 2021
43 BY NY ALIMAH 09 MEI 2021
44 BY NY MIBTAKU ROIPAH 09 MEI 2021
45 BY NY ANIFATUR ROHMAH 09 MEI 2021
46 BY NY SUNARTI 10 MEI 2021
47 BY NY CINTYA NURJANAH 10 MEI 2021
48 BY NY FITRI ANGGRAENI 10 MEI 2021
49 BY NY UMU KUROTIN 10 MEI 2021
50 BY NY RATNA DWININGSIH 10 MEI 2021
51 BY NY MEGA MUSTIKA 10 MEI 2021
52 BY NY SITI NUR KHOMARIYAH 10 MEI 2021
53 BY NY FITRIANA NINGSIH 11 MEI 2021
54 BY NY RRIN ANDRIYANI 11 MEI 2021
55 BY NY AMINAH 11 MEI 2021
56 BY NY NOVIANTI 11 MEI 2021
57 BY NY THERESIA ELLY 11 MEI 2021
58 BY NY LLASMININGSIH 12 MEI 2021
59 BY NY NUR ROHMAH 12 MEI 2021
60 BY NY ANIS WIJAYANTI 12 MEI 2021
61 BY NY RIKA INDRIANI 12 MEI 2021
62 BY NY RAHMA DEWI 13 MEI 2021
63 BY NY SELLY AYU NOVITA 13 MEI 2021
64 BY NY KRISTIN NINGRUM 15 MEI 2021
65 BY NY EVI SETYOWATI 14 MEI 2021
66 BY NY IMUNG AMANAHFIYAH 14 MEI 2021
67 BY NY RISNA ROSITA 15 MEI 2021
68 BY NY RUNI RAHMA APRILIANI 15 MEI 2021
69 BY NY DIAN SULISTYAWATI 15 MEI 2021
70 BY NY SARFIN INA RAHAYU 15 MEI 2021
71 BY NY SYABRINA DIA 15 MEI 2021
72 BY NY ZAMHARI ROTUL 16 MEI 2021
73 BY NY NUR HIDAYATI 17 MEI 2021
74 BY NY INDRI SILVIA 17 MEI 2021
75 BY NY LIA ANGGRAINI 17 MEI 2021
76 BY NY NUNUNG PAWATI 17 MEI 2021
77 BY NY ENDAH RUSTIANA 16 MEI 2021
78 BY NY UMROTUL FIKRIYAH 17 MEI 2021
79 BY NY ENDAH KARTIKAWATI 17 MEI 2021
80 BY NY NALA 17 MEI 2021
81 BY NY KURDIAN PUJI 17 MEI 2021
82 BY NY NADLIFAH AL QONITA 17 MEI 2021
83 BY NY DINDA AYU 17 MEI 2021
84 BY NY LESSYE SANDRA KUSUMA 18 MEI 2021
85 BY NY ARUM AMBAR 17 MEI 2021
86 BY NY DEWI MASITA 17 MEI 2021
87 BY NY NIHAYATIL KHUSNA 17 MEI 2021
88 BY NY DEWI UMI 17 MEI 2021
89 BY NY LILIS NUR INDAH 18 MEI 2021
90 BY NY NOVITA SARI 18 MEI 2021
91 BY NY IRENE IRSA HAWANG 19 MEI 2021
92 BY NY FARIHATUL HOIROH 18 MEI 2021
93 BY NY IKA YULI ISTANTI 19 MEI 2021
94 BY NY IRENE LAURENTIA 19 MEI 2021
95 BY NY EVA SARI BIARAWATI 19 MEI 2021
96 BY NY AZILA ROHMATUL INAYAH 19 MEI 2021
97 BY NY FATIMATUZZAHRO 19 MEI 2021
98 BY NY ALIFIA FARA SALSABILA 19 MEI 2021
99 BY NY AYU MEILANY 19 MEI 2021
100 BY NY ULFATUL MURTASYIDAH 19 MEI 2021
101 BY NY ASTERLITA SIBARANI 19 MEI 2021
102 BY NY SHARAH NUR FADILLAH 20 MEI 2021
103 BY NY EKA PURWATI 20 MEI 2021
104 BY NY SITI MURSALINAH 20 MEI 2021
105 BY NY AYUNDA NOVITA S 20 MEI 2021
106 BY NY NIKEN PRATIWI 20 MEI 2021
107 BY NY CHUSNUL KHOTIMAH 20 MEI 2021
108 BY NY VIKA NAFIDATUL 20 MEI 2021
109 BY NY RETNO AR IYANTI 21 MEI 2021
110 BY NY USWATUN KHASANAH 22 MEI 2021
111 BY NY SUMINAH 22 MEI 2021
112 BY NY YULI FATMAWATI 22 MEI 2021
113 BY NY NUR RAMDHANA 22 MEI 2021
114 BY NY LAILIYAH 22 MEI 2021
115 BY NY MAMIK SRI 22 MEI 2021
116 BY NY MUVIDAH FIDAYANTI 22 MEI 2021
117 BY NY HERLINDA 22 MEI 2021
118 BY NY CORY KURNIANINGSIH 23 MEI 2021
119 BY Meri Andani 5/24/2021
120 BY Rani Enggarsari 5/23/2021
121 BYCitra Nur Arini 5/23/2021
122 BY Resti Rahayu 5/24/2021
123 BY Nurila Mardziana 5/24/2021
124 BY 'Syifa Nurhalimah 5/24/2021
125 BY Mita Constantia 5/24/2021
126 BY Ika manjasari 5/24/2021
127 BY Astutik 5/24/2021
128 BY Devita Ayu Agustin 5/24/2021
129 BY Satta Adyra 5/25/2021
130 BY Dewi Isnawati 5/25/2021
131 BY Wiwik Susanti 5/25/2021
132 BY Lailatus Sholihah 5/25/2021
133 BY Fitria Nanda Sari 5/25/2021
134 BY Dwi Juniasari 5/25/2021
135 BY Marlik 5/26/2021
136 BY Siti Nur Hidayah 5/26/2021
137 BY Dwi Putri Rahayu 5/26/2021
138 BY Galis Wahyu Maidawati 5/26/2021
139 BY Tri Septiya 5/26/2021
140 BY Pudji Astuti 5/26/2021
141 BY Rahayu 5/27/2021
142 BY Iswahyuni 5/27/2021
143 BY Siti Hidayati 5/28/2021
144 BY Asislah 5/28/2021
145 BY Novi Pahlawanti 5/28/2021
146 BY Ria Kurnia Sari 5/28/2021
147 BY Siti Mujiati 5/29/2021
148 BY Ismi Faridah 5/30/2021
149 BY Rusta Alan Nawa 5/29/2021
150 BY Almira Tria Angela 5/30/2021
151 BY Dewi Rizta 5/30/2021
152 BY Ayu Ambarwati 5/30/2021
153 BY Erni Triana 5/30/2021
154 BY Rahayu Tuhulele 5/30/2021
155 BY Shinta 5/31/2021
156 BY Widya Putri 5/30/2021
157 BY Herwana 5/31/2021
158 BY Puji Rahayu 6/1/2021
159 BY Fitri Erliyana 6/1/2021
160 BY Yuliaten 5/31/2021
161 BY Lamiati 5/31/2021
162 BY Eka Cahyaning Putri 6/1/2021
163 BY Diah Retno Sayekti 6/1/2021
 Mengetahui,
Kepala .........................

(NAMA)
 NAMA PRAKTEK : RSI DARUS SYIFA' BENOWO
BULAN : MEI
TAHUN : 2021

NO NAMA TANGGAL LAHIR

Act Hib

1 2 3 38

1 BN NY FANY AYU NING TYAS 02 MEI 2021

2 BY NY PUTRI LESTARI 02 MEI 2021
3 BY NY REVITA DIYAH 03 MEI 2021
4 BY NY SELLA TRIYA AMANDA 03 MEI 2021
5 BY NY CINDY CLAUDERA 02 MEI 2021
6 BY NY NUR FARIDAH 02 MEI 2021
7 BY NY SALMAH RAMADANI 03 MEI 2021
8 BY NY CHRISTINA MATILDA 03 MEI 2021
9 BY NY ENY SYABANURIYAH 03 MEI 2021
10 BY NY PUTRI SHOLEKHAH 04 MEI 2021
11 BY NY LIDYA AVRILYA 04 MEI 2021
12 BY NY ANNURUL HIDAHYANTI 04 MEI 2021
13 BY NY LIDIYAWATI 04 MEI 2021
14 BY NY SANYAR CADA PUTRI 04 MEI 2021
15 BY NY DEWI SINTA 04 MEI 2021
16 BY NY TITIN ARINDAH 04 MEI 2021
17 BY NY MAYA PERMATA NSARI 04 MEI 2021
18 BY NY RATNAWATI 04 MEI 2021
19 BY NY INDAH 04 MEI 2021
20 BY NY SITI NUR KHOTIMAH 04 MEI 2021
21 BY NY SITI KHOLIPAH 05 MEI 2021
22 BY NY NOER AINI SITI 05 MEI 2021
23 BY NY LIA DWI AGUSTIN 05 MEI 2021
24 BY NY ARI DEVI NOVI TRIYANTI 05 MEI 2021
25 BY NY MULYANI 05 MEI 2021
26 BY NY AINUN FARIDA 05 MEI 2021
27 BY NY UMINAH 05 MEI 2021
28 BY NY YULI FITA INDRIYANI 06 MEI 2021
29 BY NY RATNA DWININGSIH 06 MEI 2021
30 BY NY WAHYUNINGSIH 06 MEI 2021
31 BY NY RINI WIDIASTUTI 06 MEI 2021
32 BY NY IIN IRAWATI 06 MEI 2021
33 BY NY ENDANG RAHMAWATI 06 MEI 2021
34 BY NY RINDI SUANTIKA 06 MEI 2021
35 BY NY NUR HALIMAH 07 MEI 2021
36 BY NY YESI WULANSARI 06 MEI 2021
37 BY NY EVIN NUR FADILAH 06 MEI 2021
38 BY NY RODHIATUN KHASANAH 07 MEI 2021
39 BY NY INTAN NUR OKTAFIYAH 08 MEI 2021
40 BY NY ARBA ANIS SIYAMI 08 MEI 2021
41 BY NY ELOK KHOIROTUL KHULUQ 10 MEI 2021
42 BY NY DEVI ALFIANTI 09 MEI 2021
43 BY NY ALIMAH 09 MEI 2021
44 BY NY MIBTAKU ROIPAH 09 MEI 2021
45 BY NY ANIFATUR ROHMAH 09 MEI 2021
46 BY NY SUNARTI 10 MEI 2021
47 BY NY CINTYA NURJANAH 10 MEI 2021
48 BY NY FITRI ANGGRAENI 10 MEI 2021
49 BY NY UMU KUROTIN 10 MEI 2021
50 BY NY RATNA DWININGSIH 10 MEI 2021
51 BY NY MEGA MUSTIKA 10 MEI 2021
52 BY NY SITI NUR KHOMARIYAH 10 MEI 2021
53 BY NY FITRIANA NINGSIH 11 MEI 2021
54 BY NY RRIN ANDRIYANI 11 MEI 2021
55 BY NY AMINAH 11 MEI 2021
56 BY NY NOVIANTI 11 MEI 2021
57 BY NY THERESIA ELLY 11 MEI 2021
58 BY NY LLASMININGSIH 12 MEI 2021
59 BY NY NUR ROHMAH 12 MEI 2021
60 BY NY ANIS WIJAYANTI 12 MEI 2021
61 BY NY RIKA INDRIANI 12 MEI 2021
62 BY NY RAHMA DEWI 13 MEI 2021
63 BY NY SELLY AYU NOVITA 13 MEI 2021
64 BY NY KRISTIN NINGRUM 15 MEI 2021
65 BY NY EVI SETYOWATI 14 MEI 2021
66 BY NY IMUNG AMANAHFIYAH 14 MEI 2021
67 BY NY RISNA ROSITA 15 MEI 2021
68 BY NY RUNI RAHMA APRILIANI 15 MEI 2021
69 BY NY DIAN SULISTYAWATI 15 MEI 2021
70 BY NY SARFIN INA RAHAYU 15 MEI 2021
71 BY NY SYABRINA DIA 15 MEI 2021
72 BY NY ZAMHARI ROTUL 16 MEI 2021
73 BY NY NUR HIDAYATI 17 MEI 2021
74 BY NY INDRI SILVIA 17 MEI 2021
75 BY NY LIA ANGGRAINI 17 MEI 2021
76 BY NY NUNUNG PAWATI 17 MEI 2021
77 BY NY ENDAH RUSTIANA 16 MEI 2021
78 BY NY UMROTUL FIKRIYAH 17 MEI 2021
79 BY NY ENDAH KARTIKAWATI 17 MEI 2021
80 BY NY NALA 17 MEI 2021
81 BY NY KURDIAN PUJI 17 MEI 2021
82 BY NY NADLIFAH AL QONITA 17 MEI 2021
83 BY NY DINDA AYU 17 MEI 2021
84 BY NY LESSYE SANDRA KUSUMA 18 MEI 2021
85 BY NY ARUM AMBAR 17 MEI 2021
86 BY NY DEWI MASITA 17 MEI 2021
87 BY NY NIHAYATIL KHUSNA 17 MEI 2021
88 BY NY DEWI UMI 17 MEI 2021
89 BY NY LILIS NUR INDAH 18 MEI 2021
90 BY NY NOVITA SARI 18 MEI 2021
91 BY NY IRENE IRSA HAWANG 19 MEI 2021
92 BY NY FARIHATUL HOIROH 18 MEI 2021
93 BY NY IKA YULI ISTANTI 19 MEI 2021
94 BY NY IRENE LAURENTIA 19 MEI 2021
95 BY NY EVA SARI BIARAWATI 19 MEI 2021
96 BY NY AZILA ROHMATUL INAYAH 19 MEI 2021
97 BY NY FATIMATUZZAHRO 19 MEI 2021
98 BY NY ALIFIA FARA SALSABILA 19 MEI 2021
99 BY NY AYU MEILANY 19 MEI 2021
100 BY NY ULFATUL MURTASYIDAH 19 MEI 2021
101 BY NY ASTERLITA SIBARANI 19 MEI 2021
102 BY NY SHARAH NUR FADILLAH 20 MEI 2021
103 BY NY EKA PURWATI 20 MEI 2021
104 BY NY SITI MURSALINAH 20 MEI 2021
105 BY NY AYUNDA NOVITA S 20 MEI 2021
106 BY NY NIKEN PRATIWI 20 MEI 2021
107 BY NY CHUSNUL KHOTIMAH 20 MEI 2021
108 BY NY VIKA NAFIDATUL 20 MEI 2021
109 BY NY RETNO AR IYANTI 21 MEI 2021
110 BY NY USWATUN KHASANAH 22 MEI 2021
111 BY NY SUMINAH 22 MEI 2021
112 BY NY YULI FATMAWATI 22 MEI 2021
113 BY NY NUR RAMDHANA 22 MEI 2021
114 BY NY LAILIYAH 22 MEI 2021
115 BY NY MAMIK SRI 22 MEI 2021
116 BY NY MUVIDAH FIDAYANTI 22 MEI 2021
117 BY NY HERLINDA 22 MEI 2021
118 BY NY CORY KURNIANINGSIH 23 MEI 2021
119 BY Meri Andani 5/24/2021
120 BY Rani Enggarsari 5/23/2021
121 BYCitra Nur Arini 5/23/2021
122 BY Resti Rahayu 5/24/2021
123 BY Nurila Mardziana 5/24/2021
124 BY 'Syifa Nurhalimah 5/24/2021
125 BY Mita Constantia 5/24/2021
126 BY Ika manjasari 5/24/2021
127 BY Astutik 5/24/2021
128 BY Devita Ayu Agustin 5/24/2021
129 BY Satta Adyra 5/25/2021
130 BY Dewi Isnawati 5/25/2021
131 BY Wiwik Susanti 5/25/2021
132 BY Lailatus Sholihah 5/25/2021
133 BY Fitria Nanda Sari 5/25/2021
134 BY Dwi Juniasari 5/25/2021
135 BY Marlik 5/26/2021
136 BY Siti Nur Hidayah 5/26/2021
137 BY Dwi Putri Rahayu 5/26/2021
138 BY Galis Wahyu Maidawati 5/26/2021
139 BY Tri Septiya 5/26/2021
140 BY Pudji Astuti 5/26/2021
141 BY Rahayu 5/27/2021
142 BY Iswahyuni 5/27/2021
143 BY Siti Hidayati 5/28/2021
144 BY Asislah 5/28/2021
145 BY Novi Pahlawanti 5/28/2021
146 BY Ria Kurnia Sari 5/28/2021
147 BY Siti Mujiati 5/29/2021
148 BY Ismi Faridah 5/30/2021
149 BY Rusta Alan Nawa 5/29/2021
150 BY Almira Tria Angela 5/30/2021
151 BY Dewi Rizta 5/30/2021
152 BY Ayu Ambarwati 5/30/2021
153 BY Erni Triana 5/30/2021
154 BY Rahayu Tuhulele 5/30/2021
155 BY Shinta 5/31/2021
156 BY Widya Putri 5/30/2021
157 BY Herwana 5/31/2021
158 BY Puji Rahayu 6/1/2021
159 BY Fitri Erliyana 6/1/2021
160 BY Yuliaten 5/31/2021
161 BY Lamiati 5/31/2021
162 BY Eka Cahyaning Putri 6/1/2021
163 BY Diah Retno Sayekti 6/1/2021
 H
NAMA PRAKTEK : RSI DARUS SYIFA' BENOWO
BULAN : JUNI
TAHUN : 2021

ALAMAT

NO NAMA TANGGAL LAHIR JENIS KELAMIN NAMA /

NAMA JALAN NOMOR NOMOR
RUMAH
GANG

1 2 3 4 5 6 7

1 by.ny. Vivit Arini 6/1/2021 Beji 35

2 by.ny.Siti Rochaniah 6/1/2021 1 Made Barat
3 by.ny.Romelah 6/2/2021 1 Genting Tambak Dalam
4 by.ny.Oktaviani Iman Sari 6/2/2021 1 Manukan Thohir 38
5 by.ny.Rakhmawati Eka Syaputri 6/3/2021 Manukan Lor
6 by.ny.Sumi Rahayu 6/2/2021 1 Tengger Raya 3/3
7 by.ny.Pitri Endrawati 6/3/2021 Manukan Lor 5c/27
8 by.ny.Efiatur Rochmah 6/3/2021 Sememi Kidul 02/04
9 by.ny.Julia Kristianti 6/3/2021 1 Sememi Jaya Selatan
10 by.ny.Agustin 6/3/2021 1 Kendung XC/7
11 by.ny.Anik Indarti 6/3/2021 Dsn. Sumber jambe 3/4
12 by.nyIndah Puspitasari 6/3/2021 1 Sememi Jaya 10
13 by.ny.Masruroh 6/3/2021 1 Balongsari
14 by.ny.Lina Harianti 6/3/2021 Tlogo bedah
15 by.ny.Weni Puspitasari 6/3/2021 1 Sipat Lidah Kulon
16 by.ny.Ika Wahyuning 6/3/2021 1 Manukan Luhur
17 by.ny.Siti Istiqomah 6/3/2021 1 Kuwukan
18 by.ny.Isnurifatul Amelia 6/4/2021 1 Kupang Krajan
19 by.ny.Septiana Dwi Cahya 6/4/2021 Manukan Tengah
20 by.ny.Nur Rodhiya 6/4/2021 Jugruk Rejosari
21 by.nyIndah Mulyani 6/4/2021 1 Simorejo gg II/70
22 by.nyPurwati 6/4/2021 Putat Lor
23 by.nyLuluk Putri Setiyowati 6/5/2021 Sememi Jaya Selatan
24 by.nyLutfiatun 6/5/2021 Raya Bibis no 12
25 by.ny.Vivi Dwi Astuti 6/5/2021 1 Sememi Jaya 5 no 9
26 by.nySiti Maisaroh 6/5/2021 1 Pakal AMD
27 by.ny.Dwi Indah Yanti 6/5/2021 1 Ngasinan 1/2
28 by.nyResita Atiswaduni 6/5/2021 1 Petemon timur no 100
29 by.nyIndar Safitri 6/6/2021 1 Raya Benowo no 5
30 by.nyTrie Mawarti 6/6/2021 1 TSI C/2
31 by.nyAnanda Putri 6/6/2021 DK. Jelidro 3/1
32 by.nyErlita Mala Ayu Dwi 6/7/2021 1 Ngasinan 2/4
33 by.ny'Yugo Amalia Romadhoni 6/7/2021 Glintung 4/4
34 by.nyVika Kurniawati 6/8/2021 Kutisari Utara 1/6
35 by.ny.Andi Marsa Putri Hayyu 6/8/2021 1 Perum Kehakiman
36 by.nySiti Ilmawati 6/8/2021 Dsn. Padangan RT 04/02
37 by.nyHosma 6/9/2021 Sememi Jaya 8/29
38 by.ny'Oktavia Nur Aini 6/9/2021 1 Sememi Baru
39 by.nyKrydha Permatasari 6/8/2021 1 PBI
40 by.nySiti Amalah 6/9/2021 Ds. Dooro, Cerme
41 by.nyYuni Wulandari 6/9/2021 Rejosari no 68
42 by.ny.Dwita Putri Megasari 6/10/2021 Raya Ngemplak no 81
43 by.nyKhalimatus Sa'diah 6/10/2021 Sidorejo no 16
44 by.ny'Agustin Puji Rahayu 6/10/2021 Kedung doro
45 by.nySiti Nur Afifah 6/10/2021 1 Kendung 3 2/3
46 by.nyInayatul Uliyah 6/10/2021 1 Beji Pakal
47 by.nyRhosita Ira Endrawati 6/10/2021 Bandarejo 4 gg Asri 3/21
48 by.nyRatna Yuniarti 6/10/2021 Mojotengah
49 by.nyTitik Purwanti 6/10/2021 Domas
50 by.nyRina Natalia 6/10/2021 Pakal
51 by.nySri Wahyuni 6/11/2021 Kepatihan RT 07/RW 02
52 by.ny.Mutmainah 6/11/2021 1 Hendrosari
53 by.nyYuniarti 6/12/2021 Ds. Sekarputih
54 by.nyPipit Fitriyah 6/12/2021 1 Perum Sawo Bukit Lestari
55 by.nyUmu Khoiroh 6/12/2021 Randupadangan
56 by.nyNur Fadilah Romadani 6/12/2021 Benowo 3/16
57 by.nySampurni Ningsih 6/12/2021 1 Raya Ngemplak 1/5
58 by.nyStya Tito Yuniar 6/13/2021 1 Perum BPH K 4/F4
59 by.nyTiara 6/14/2021 Kendung RT 08 RW 03
60 by.ny.Suhaya 6/14/2021 Tangu bangi Cerme
61 by.ny.Yuli Nurwindasari 6/14/2021 1 Kendung Jaya 5/1
62 by.ny'Marida Isnaini 6/14/2021 Manukan Kasman no 57
63 by.nyRetno Dwi Wulansari 6/14/2021 Bandarejo 3 RT 5 no 15
64 by.ny.Vina Dwi Susanti 6/14/2021 Pelemwatu
65 by.nySuliyati 6/15/2021 1 Dk. Sambikerep RT 06/04
66 by.ny.Vika Maulidiana Hasni 6/16/2021 Sawobringin gg 1 A 5/2
67 by.ny.Vitriyana Kusuma Dewi 6/16/2021 Manukan Bakti 20D/13
68 by.ny.Ika Anggraeni 6/17/2021 PBI DZ/05
69 by.ny.Siti Fatimah 6/17/2021 1 Made 2/1 Sambikerep
70 by.ny.Isnawati 6/17/2021 1 GCA
71 by.nySiti Muhayati 6/17/2021 Pelem dodol
72 by.nyNabila Ismi Alfiyana 6/17/2021 Raya Kendung Selatan
73 by.nyAyu Setiowati 6/17/2021 Dk. Bungkal
74 by.nyPipit Nuritasari 6/17/2021 Bringin RT 01 RW 02
75 by.nyRosmini 6/18/2021 Balongsari
76 by.nyFitria Dwi Rizantin 6/18/2021 1 Cerme Kidul 4/1
77 by.nyMutmainah 6/18/2021 Raya Lontar no 123
78 by.nyRositasari 6/18/2021 1 Sumberejo Makmur 3
79 by.ny.Muhsinatul Khali 6/19/2021 1 Ngepung Sari
80 by.ny.Putri Dwi K 6/19/2021 Palem Pertiwi
81 by.ny.Susilawati 6/19/2021 1 Kandangan Gunung
82 by.ny.Nur Afifah 6/19/2021 1 Banyuurip 3/5
83 by.ny.Rifana 6/19/2021 Pakal Sumberan
84 by.ny.Arumsari 6/20/2021 1 Sambikerep 4/4
85 by.nySusan Widiyawati 6/20/2021 Kendung 9 no 44
86 by.ny.Rifatin Fadilah 6/20/2021 1 Benowo 2/1
87 by.nyFaridah 6/21/2021 Bendil Jaya 02/06
88 by.nyLeli Putri 6/21/2021 1 Bongsowetan
89 by.nyInawati Aprinus 6/21/2021 Tulung Kedamean
90 by.ny.Amalia Putri Cahayani 6/21/2021 1 Sawo bringin I A/2
91 by.ny.Arimbi Desita 6/23/2021 Sidowungu
92 by.ny.Fibrianita Sukmawati 6/23/2021 DK. Jelidro
93 by.ny.Rohadatul Aisyi 6/23/2021 Bandarejo
94 by.ny.Nova Mardiyanah 6/23/2021 Ngering 2/2 cerme
95 by.ny.Debby Permata Sari 6/23/2021 1 Pakal Residence
96 by.ny.Novitasari 6/24/2021 Hendrosari 8/1
97 by.ny.Kristina Yulianti 6/24/2021 1 Perum Permata Regency
98 by.ny.Sri Wulandari 6/25/2021 1 Perum WSI blok J/14 A
99 by.nyDyah Ayu Fatmawati 6/26/2021 Swan Park AA/76
100 by.nyEva Dwi Lestari 6/27/2021 1 Sidowungu
101 by.nyKhoiriyatul Ulum 6/28/2021 1 Sememi Baru 6/5
102 by.nySania Dwi Kartika 6/27/2021 1 Dk. Ngemplak
103 by.nyFitri Liliani 6/27/2021 1 Sikatan 14/18
104 by.nyWidyawati 6/27/2021 1 Sumberejo 2
105 by.ny.Eka Nopiyanti 6/27/2021 1 Dsn. Dono 2/6 kedamean
106 by.nyNurul Ainiyah 6/28/2021 Sumberejo Makmur IV
107 by.ny.Rani Sumita 6/27/2021 Balongsari Krajan 1/33
108 by.nyHilmiyatus Saidah 6/28/2021 1 Kedamean
109 by.nyUswatun Khasanah 6/28/2021 1 Sambikerep
110 by.ny.Ni Wayan Putri 6/28/2021 1 GSN blok l2
111 by.ny.Indrawati 6/28/2021 1 Setro 12/6
112 by.ny.Kurniawati 6/28/2021 1 Benowo tegal
113 by.ny.'Suroiyah Habibah 6/29/2021 Beji 33
114 by.ny.Endang Prapti 6/29/2021 1 Putat Jaya 5
115 by.nyYeni Tamara 6/29/2021 Sememi Jaya
116 by.ny.Sovi Dewi Ravika 6/29/2021 Pranti
117 by.nyNadila Dwi Puji 6/29/2021 Ngemplak 3/5
118 by.ny.Vellawati Linda 6/29/2021 1 Sukomanunggal
119 by.ny.Linda Wulandari 6/29/2021 Kendung IX 07/03
120 by.ny.Siti Zainab 6/29/2021 Dono kerto
121 by.ny.Mega Kartika Sari 6/29/2021 1 Sememi Jaya 5/17
122 by.ny.Putri Suryanti 6/30/2021 1 Lidah Kulon 4/5
123 by.nyNovita Kumala 30/06/2021 Bengkelo Kidul
124 by.ny.Asmaul Khusnah 6/30/2021 1 Boteng Masek 31/1
125 by.ny.Nur Sholiha 6/30/2021 Pengalangan 07/04
126 by.nyIke Wulandari 6/30/2021 Bringin
127 by.ny.Jarmiati 6/30/2021 1 Swan Menganti Park K
128 by.ny.Rochmawati 6/30/2021 1 Kendung 3 2/3
129 by.ny.Lisa Budiarti 7/1/2021 Ngasinan 3/07
130 by.ny.Siti Chomariah 7/1/2021 1 Babat Jerawat 1/5
131 by.ny.Nailatun Nikmah 7/1/2021 1 Jeruk 3/16

*Untuk vaksin yang mandiri mohon untuk tetap di isi sesuai pemakaian
 HASIL IMUNISASI RUMAH SAKIT / KLINIK / DOKTER
HASIL
NAMA PRAKTEK : RSI DARUS SYIFA' BENOWO
BULAN : JUNI
TAHUN : 2021
Wajib di Isi DI ISI TANGGAL PEMBERIAN VA

NO NAMA TANGGAL LAHIR KELURAHAN** KECAMATAN

BCG

1 2 3 8 9 10

1 by.ny. Vivit Arini 6/1/2021 Beji 35

2 by.ny.Siti Rochaniah 6/1/2021 Made Barat
3 by.ny.Romelah 6/2/2021 Genting Tambak Dalam
4 by.ny.Oktaviani Iman Sari 6/2/2021 Manukan Thohir 38
5 by.ny.Rakhmawati Eka Syaputri 6/3/2021 Manukan Lor
6 by.ny.Sumi Rahayu 6/2/2021 Tengger Raya 3/3
7 by.ny.Pitri Endrawati 6/3/2021 Manukan Lor 5c/27
8 by.ny.Efiatur Rochmah 6/3/2021 Sememi Kidul 02/04
9 by.ny.Julia Kristianti 6/3/2021 Sememi Jaya Selatan
10 by.ny.Agustin 6/3/2021 Kendung XC/7
11 by.ny.Anik Indarti 6/3/2021 Dsn. Sumber jambe 3/4
12 by.nyIndah Puspitasari 6/3/2021 Sememi Jaya 10
13 by.ny.Masruroh 6/3/2021 Balongsari
14 by.ny.Lina Harianti 6/3/2021 Tlogo bedah
15 by.ny.Weni Puspitasari 6/3/2021 Sipat Lidah Kulon
16 by.ny.Ika Wahyuning 6/3/2021 Manukan Luhur
17 by.ny.Siti Istiqomah 6/3/2021 Kuwukan
18 by.ny.Isnurifatul Amelia 6/4/2021 Kupang Krajan
19 by.ny.Septiana Dwi Cahya 6/4/2021 Manukan Tengah
20 by.ny.Nur Rodhiya 6/4/2021 Jugruk Rejosari
21 by.nyIndah Mulyani 6/4/2021 Simorejo gg II/70
22 by.nyPurwati 6/4/2021 Putat Lor
23 by.nyLuluk Putri Setiyowati 6/5/2021 Sememi Jaya Selatan
24 by.nyLutfiatun 6/5/2021 Raya Bibis no 12
25 by.ny.Vivi Dwi Astuti 6/5/2021 Sememi Jaya 5 no 9
26 by.nySiti Maisaroh 6/5/2021 Pakal AMD
27 by.ny.Dwi Indah Yanti 6/5/2021 Ngasinan 1/2
28 by.nyResita Atiswaduni 6/5/2021 Petemon timur no 100
29 by.nyIndar Safitri 6/6/2021 Raya Benowo no 5
30 by.nyTrie Mawarti 6/6/2021 TSI C/2
31 by.nyAnanda Putri 6/6/2021 DK. Jelidro 3/1
32 by.nyErlita Mala Ayu Dwi 6/7/2021 Ngasinan 2/4
33 by.ny'Yugo Amalia Romadhoni 6/7/2021 Glintung 4/4
34 by.nyVika Kurniawati 6/8/2021 Kutisari Utara 1/6
35 by.ny.Andi Marsa Putri Hayyu 6/8/2021 Perum Kehakiman
36 by.nySiti Ilmawati 6/8/2021 Dsn. Padangan RT 04/02
37 by.nyHosma 6/9/2021 Sememi Jaya 8/29
38 by.ny'Oktavia Nur Aini 6/9/2021 Sememi Baru
39 by.nyKrydha Permatasari 6/8/2021 PBI
40 by.nySiti Amalah 6/9/2021 Ds. Dooro, Cerme
41 by.nyYuni Wulandari 6/9/2021 Rejosari no 68
42 by.ny.Dwita Putri Megasari 6/10/2021 Raya Ngemplak no 81
43 by.nyKhalimatus Sa'diah 6/10/2021 Sidorejo no 16
44 by.ny'Agustin Puji Rahayu 6/10/2021 Kedung doro
45 by.nySiti Nur Afifah 6/10/2021 Kendung 3 2/3
46 by.nyInayatul Uliyah 6/10/2021 Beji Pakal
47 by.nyRhosita Ira Endrawati 6/10/2021 Bandarejo 4 gg Asri 3/21
48 by.nyRatna Yuniarti 6/10/2021 Mojotengah
49 by.nyTitik Purwanti 6/10/2021 Domas
50 by.nyRina Natalia 6/10/2021 Pakal
51 by.nySri Wahyuni 6/11/2021 Kepatihan RT 07/RW 02
52 by.ny.Mutmainah 6/11/2021 Hendrosari
53 by.nyYuniarti 6/12/2021 Ds. Sekarputih
54 by.nyPipit Fitriyah 6/12/2021 Perum Sawo Bukit Lestari
55 by.nyUmu Khoiroh 6/12/2021 Randupadangan
56 by.nyNur Fadilah Romadani 6/12/2021 Benowo 3/16
57 by.nySampurni Ningsih 6/12/2021 Raya Ngemplak 1/5
58 by.nyStya Tito Yuniar 6/13/2021 Perum BPH K 4/F4
59 by.nyTiara 6/14/2021 Kendung RT 08 RW 03
60 by.ny.Suhaya 6/14/2021 Tangu bangi Cerme
61 by.ny.Yuli Nurwindasari 6/14/2021 Kendung Jaya 5/1
62 by.ny'Marida Isnaini 6/14/2021 Manukan Kasman no 57
63 by.nyRetno Dwi Wulansari 6/14/2021 Bandarejo 3 RT 5 no 15
64 by.ny.Vina Dwi Susanti 6/14/2021 Pelemwatu
65 by.nySuliyati 6/15/2021 Dk. Sambikerep RT 06/04
66 by.ny.Vika Maulidiana Hasni 6/16/2021 Sawobringin gg 1 A 5/2
67 by.ny.Vitriyana Kusuma Dewi 6/16/2021 Manukan Bakti 20D/13
68 by.ny.Ika Anggraeni 6/17/2021 PBI DZ/05
69 by.ny.Siti Fatimah 6/17/2021 Made 2/1 Sambikerep
70 by.ny.Isnawati 6/17/2021 GCA
71 by.nySiti Muhayati 6/17/2021 Pelem dodol
72 by.nyNabila Ismi Alfiyana 6/17/2021 Raya Kendung Selatan
73 by.nyAyu Setiowati 6/17/2021 Dk. Bungkal
74 by.nyPipit Nuritasari 6/17/2021 Bringin RT 01 RW 02
75 by.nyRosmini 6/18/2021 Balongsari
76 by.nyFitria Dwi Rizantin 6/18/2021 Cerme Kidul 4/1
77 by.nyMutmainah 6/18/2021 Raya Lontar no 123
78 by.nyRositasari 6/18/2021 Sumberejo Makmur 3
79 by.ny.Muhsinatul Khali 6/19/2021 Ngepung Sari
80 by.ny.Putri Dwi K 6/19/2021 Palem Pertiwi
81 by.ny.Susilawati 6/19/2021 Kandangan Gunung
82 by.ny.Nur Afifah 6/19/2021 Banyuurip 3/5
83 by.ny.Rifana 6/19/2021 Pakal Sumberan
84 by.ny.Arumsari 6/20/2021 Sambikerep 4/4
85 by.nySusan Widiyawati 6/20/2021 Kendung 9 no 44
86 by.ny.Rifatin Fadilah 6/20/2021 Benowo 2/1
87 by.nyFaridah 6/21/2021 Bendil Jaya 02/06
88 by.nyLeli Putri 6/21/2021 Bongsowetan
89 by.nyInawati Aprinus 6/21/2021 Tulung Kedamean
90 by.ny.Amalia Putri Cahayani 6/21/2021 Sawo bringin I A/2
91 by.ny.Arimbi Desita 6/23/2021 Sidowungu
92 by.ny.Fibrianita Sukmawati 6/23/2021 DK. Jelidro
93 by.ny.Rohadatul Aisyi 6/23/2021 Bandarejo
94 by.ny.Nova Mardiyanah 6/23/2021 Ngering 2/2 cerme
95 by.ny.Debby Permata Sari 6/23/2021 Pakal Residence
96 by.ny.Novitasari 6/24/2021 Hendrosari 8/1
97 by.ny.Kristina Yulianti 6/24/2021 Perum Permata Regency
98 by.ny.Sri Wulandari 6/25/2021 Perum WSI blok J/14 A
99 by.nyDyah Ayu Fatmawati 6/26/2021 Swan Park AA/76
100 by.nyEva Dwi Lestari 6/27/2021 Sidowungu
101 by.nyKhoiriyatul Ulum 6/28/2021 Sememi Baru 6/5
102 by.nySania Dwi Kartika 6/27/2021 Dk. Ngemplak
103 by.nyFitri Liliani 6/27/2021 Sikatan 14/18
104 by.nyWidyawati 6/27/2021 Sumberejo 2
105 by.ny.Eka Nopiyanti 6/27/2021 Dsn. Dono 2/6 kedamean
106 by.nyNurul Ainiyah 6/28/2021 Sumberejo Makmur IV
107 by.ny.Rani Sumita 6/27/2021 Balongsari Krajan 1/33
108 by.nyHilmiyatus Saidah 6/28/2021 Kedamean
109 by.nyUswatun Khasanah 6/28/2021 Sambikerep
110 by.ny.Ni Wayan Putri 6/28/2021 GSN blok l2
111 by.ny.Indrawati 6/28/2021 Setro 12/6
112 by.ny.Kurniawati 6/28/2021 Benowo tegal
113 by.ny.'Suroiyah Habibah 6/29/2021 Beji 33
114 by.ny.Endang Prapti 6/29/2021 Putat Jaya 5
115 by.nyYeni Tamara 6/29/2021 Sememi Jaya
116 by.ny.Sovi Dewi Ravika 6/29/2021 Pranti
117 by.nyNadila Dwi Puji 6/29/2021 Ngemplak 3/5
118 by.ny.Vellawati Linda 6/29/2021 Sukomanunggal
119 by.ny.Linda Wulandari 6/29/2021 Kendung IX 07/03
 120 by.ny.Siti Zainab 6/29/2021 Dono kerto
121 by.ny.Mega Kartika Sari 6/29/2021 Sememi Jaya 5/17
122 by.ny.Putri Suryanti 6/30/2021 Lidah Kulon 4/5
123 by.nyNovita Kumala 30/06/2021 Bengkelo Kidul
124 by.ny.Asmaul Khusnah 6/30/2021 Boteng Masek 31/1
125 by.ny.Nur Sholiha 6/30/2021 Pengalangan 07/04
126 by.nyIke Wulandari 6/30/2021 Bringin
127 by.ny.Jarmiati 6/30/2021 Swan Menganti Park K
128 by.ny.Rochmawati 6/30/2021 Kendung 3 2/3
129 by.ny.Lisa Budiarti 7/1/2021 Ngasinan 3/07
130 by.ny.Siti Chomariah 7/1/2021 Babat Jerawat 1/5
131 by.ny.Nailatun Nikmah 7/1/2021 Jeruk 3/16

*Untuk vaksin yang mandiri mohon untuk tetap di isi sesuai pemakaian
HASIL IMUNISASI RUMAH SAKIT / KLINIK / DOKTER SPESIALIS ANAK / BIDAN PRAKTEK MANDIRI HASIL
NAMA PRAKTEK : RSI DARUS SYIFA' BENOWO
BULAN : JUNI
TAHUN : 2021
DI ISI TANGGAL PEMBERIAN VAKSIN / PENYUNTIKAN (BUKAN DICENTANG)

NO NAMA TANGGAL LAHIR

POLIO 1 POLIO 2 POLIO 3

1 2 3 11 12 13

1 by.ny. Vivit Arini 6/1/2021

2 by.ny.Siti Rochaniah 6/1/2021
3 by.ny.Romelah 6/2/2021
4 by.ny.Oktaviani Iman Sari 6/2/2021
5 by.ny.Rakhmawati Eka Syaputri 6/3/2021
6 by.ny.Sumi Rahayu 6/2/2021
7 by.ny.Pitri Endrawati 6/3/2021
8 by.ny.Efiatur Rochmah 6/3/2021
9 by.ny.Julia Kristianti 6/3/2021
10 by.ny.Agustin 6/3/2021
11 by.ny.Anik Indarti 6/3/2021
12 by.nyIndah Puspitasari 6/3/2021
13 by.ny.Masruroh 6/3/2021
14 by.ny.Lina Harianti 6/3/2021
15 by.ny.Weni Puspitasari 6/3/2021
16 by.ny.Ika Wahyuning 6/3/2021
17 by.ny.Siti Istiqomah 6/3/2021
18 by.ny.Isnurifatul Amelia 6/4/2021
19 by.ny.Septiana Dwi Cahya 6/4/2021
20 by.ny.Nur Rodhiya 6/4/2021
21 by.nyIndah Mulyani 6/4/2021
22 by.nyPurwati 6/4/2021
23 by.nyLuluk Putri Setiyowati 6/5/2021
24 by.nyLutfiatun 6/5/2021
25 by.ny.Vivi Dwi Astuti 6/5/2021
26 by.nySiti Maisaroh 6/5/2021
27 by.ny.Dwi Indah Yanti 6/5/2021
28 by.nyResita Atiswaduni 6/5/2021
29 by.nyIndar Safitri 6/6/2021
30 by.nyTrie Mawarti 6/6/2021
31 by.nyAnanda Putri 6/6/2021
32 by.nyErlita Mala Ayu Dwi 6/7/2021
33 by.ny'Yugo Amalia Romadhoni 6/7/2021
34 by.nyVika Kurniawati 6/8/2021
35 by.ny.Andi Marsa Putri Hayyu 6/8/2021
36 by.nySiti Ilmawati 6/8/2021
37 by.nyHosma 6/9/2021
38 by.ny'Oktavia Nur Aini 6/9/2021
39 by.nyKrydha Permatasari 6/8/2021
40 by.nySiti Amalah 6/9/2021
41 by.nyYuni Wulandari 6/9/2021
42 by.ny.Dwita Putri Megasari 6/10/2021
43 by.nyKhalimatus Sa'diah 6/10/2021
44 by.ny'Agustin Puji Rahayu 6/10/2021
45 by.nySiti Nur Afifah 6/10/2021
46 by.nyInayatul Uliyah 6/10/2021
47 by.nyRhosita Ira Endrawati 6/10/2021
48 by.nyRatna Yuniarti 6/10/2021
49 by.nyTitik Purwanti 6/10/2021
50 by.nyRina Natalia 6/10/2021
51 by.nySri Wahyuni 6/11/2021
52 by.ny.Mutmainah 6/11/2021
53 by.nyYuniarti 6/12/2021
54 by.nyPipit Fitriyah 6/12/2021
55 by.nyUmu Khoiroh 6/12/2021
56 by.nyNur Fadilah Romadani 6/12/2021
57 by.nySampurni Ningsih 6/12/2021
58 by.nyStya Tito Yuniar 6/13/2021
59 by.nyTiara 6/14/2021
60 by.ny.Suhaya 6/14/2021
61 by.ny.Yuli Nurwindasari 6/14/2021
62 by.ny'Marida Isnaini 6/14/2021
63 by.nyRetno Dwi Wulansari 6/14/2021
64 by.ny.Vina Dwi Susanti 6/14/2021
65 by.nySuliyati 6/15/2021
66 by.ny.Vika Maulidiana Hasni 6/16/2021
67 by.ny.Vitriyana Kusuma Dewi 6/16/2021
68 by.ny.Ika Anggraeni 6/17/2021
69 by.ny.Siti Fatimah 6/17/2021
70 by.ny.Isnawati 6/17/2021
71 by.nySiti Muhayati 6/17/2021
72 by.nyNabila Ismi Alfiyana 6/17/2021
73 by.nyAyu Setiowati 6/17/2021
74 by.nyPipit Nuritasari 6/17/2021
75 by.nyRosmini 6/18/2021
76 by.nyFitria Dwi Rizantin 6/18/2021
77 by.nyMutmainah 6/18/2021
78 by.nyRositasari 6/18/2021
79 by.ny.Muhsinatul Khali 6/19/2021
80 by.ny.Putri Dwi K 6/19/2021
81 by.ny.Susilawati 6/19/2021
82 by.ny.Nur Afifah 6/19/2021
83 by.ny.Rifana 6/19/2021
84 by.ny.Arumsari 6/20/2021
85 by.nySusan Widiyawati 6/20/2021
86 by.ny.Rifatin Fadilah 6/20/2021
87 by.nyFaridah 6/21/2021
88 by.nyLeli Putri 6/21/2021
89 by.nyInawati Aprinus 6/21/2021
90 by.ny.Amalia Putri Cahayani 6/21/2021
91 by.ny.Arimbi Desita 6/23/2021
92 by.ny.Fibrianita Sukmawati 6/23/2021
93 by.ny.Rohadatul Aisyi 6/23/2021
94 by.ny.Nova Mardiyanah 6/23/2021
95 by.ny.Debby Permata Sari 6/23/2021
96 by.ny.Novitasari 6/24/2021
97 by.ny.Kristina Yulianti 6/24/2021
98 by.ny.Sri Wulandari 6/25/2021
99 by.nyDyah Ayu Fatmawati 6/26/2021
100 by.nyEva Dwi Lestari 6/27/2021
101 by.nyKhoiriyatul Ulum 6/28/2021
102 by.nySania Dwi Kartika 6/27/2021
103 by.nyFitri Liliani 6/27/2021
104 by.nyWidyawati 6/27/2021
105 by.ny.Eka Nopiyanti 6/27/2021
106 by.nyNurul Ainiyah 6/28/2021
107 by.ny.Rani Sumita 6/27/2021
108 by.nyHilmiyatus Saidah 6/28/2021
109 by.nyUswatun Khasanah 6/28/2021
110 by.ny.Ni Wayan Putri 6/28/2021
111 by.ny.Indrawati 6/28/2021
112 by.ny.Kurniawati 6/28/2021
113 by.ny.'Suroiyah Habibah 6/29/2021
114 by.ny.Endang Prapti 6/29/2021
115 by.nyYeni Tamara 6/29/2021
116 by.ny.Sovi Dewi Ravika 6/29/2021
117 by.nyNadila Dwi Puji 6/29/2021
118 by.ny.Vellawati Linda 6/29/2021
119 by.ny.Linda Wulandari 6/29/2021
120 by.ny.Siti Zainab 6/29/2021
121 by.ny.Mega Kartika Sari 6/29/2021
122 by.ny.Putri Suryanti 6/30/2021
123 by.nyNovita Kumala 30/06/2021
124 by.ny.Asmaul Khusnah 6/30/2021
125 by.ny.Nur Sholiha 6/30/2021
126 by.nyIke Wulandari 6/30/2021
127 by.ny.Jarmiati 6/30/2021
128 by.ny.Rochmawati 6/30/2021
129 by.ny.Lisa Budiarti 7/1/2021
130 by.ny.Siti Chomariah 7/1/2021
131 by.ny.Nailatun Nikmah 7/1/2021
TER SPESIALIS ANAK / BIDAN PRAKTEK MANDIRI HASIL
NAMA PRAKTEK : RSI DARUS SYIFA' BENOWO
BULAN : JUNI
TAHUN : 2021

BAYI
HEPATITIS B UNIJECT
NO NAMA TANGGAL LAHIR
POLIO 4 CAMPAK/MR
HB <24 JAM

1 2 3 14 15 16

1 by.ny. Vivit Arini 6/1/2021 6/1/2021

2 by.ny.Siti Rochaniah 6/1/2021 6/1/2021
3 by.ny.Romelah 6/2/2021 6/2/2021
4 by.ny.Oktaviani Iman Sari 6/2/2021 6/2/2021
5 by.ny.Rakhmawati Eka Syaputri 6/3/2021 6/3/2021
6 by.ny.Sumi Rahayu 6/2/2021 6/2/2021
7 by.ny.Pitri Endrawati 6/3/2021 6/3/2021
8 by.ny.Efiatur Rochmah 6/3/2021 6/3/2021
9 by.ny.Julia Kristianti 6/3/2021 6/3/2021
10 by.ny.Agustin 6/3/2021 6/3/2021
11 by.ny.Anik Indarti 6/3/2021 6/3/2021
12 by.nyIndah Puspitasari 6/3/2021 6/3/2021
13 by.ny.Masruroh 6/3/2021 6/3/2021
14 by.ny.Lina Harianti 6/3/2021 6/3/2021
15 by.ny.Weni Puspitasari 6/3/2021 6/3/2021
16 by.ny.Ika Wahyuning 6/3/2021 6/3/2021
17 by.ny.Siti Istiqomah 6/3/2021 6/3/2021
18 by.ny.Isnurifatul Amelia 6/4/2021 6/4/2021
19 by.ny.Septiana Dwi Cahya 6/4/2021 6/4/2021
20 by.ny.Nur Rodhiya 6/4/2021 6/4/2021
21 by.nyIndah Mulyani 6/4/2021 6/4/2021
22 by.nyPurwati 6/4/2021 6/4/2021
23 by.nyLuluk Putri Setiyowati 6/5/2021 6/5/2021
24 by.nyLutfiatun 6/5/2021 6/5/2021
25 by.ny.Vivi Dwi Astuti 6/5/2021 6/5/2021
26 by.nySiti Maisaroh 6/5/2021 6/5/2021
27 by.ny.Dwi Indah Yanti 6/5/2021 6/5/2021
28 by.nyResita Atiswaduni 6/5/2021 6/5/2021
29 by.nyIndar Safitri 6/6/2021 6/6/2021
30 by.nyTrie Mawarti 6/6/2021 6/6/2021
31 by.nyAnanda Putri 6/6/2021 6/6/2021
32 by.nyErlita Mala Ayu Dwi 6/7/2021 6/7/2021
33 by.ny'Yugo Amalia Romadhoni 6/7/2021 6/7/2021
34 by.nyVika Kurniawati 6/8/2021 6/8/2021
35 by.ny.Andi Marsa Putri Hayyu 6/8/2021 6/8/2021
36 by.nySiti Ilmawati 6/8/2021 6/8/2021
37 by.nyHosma 6/9/2021 6/9/2021
38 by.ny'Oktavia Nur Aini 6/9/2021 6/9/2021
39 by.nyKrydha Permatasari 6/8/2021 6/8/2021
40 by.nySiti Amalah 6/9/2021 6/9/2021
41 by.nyYuni Wulandari 6/9/2021 6/9/2021
42 by.ny.Dwita Putri Megasari 6/10/2021 6/10/2021
43 by.nyKhalimatus Sa'diah 6/10/2021 6/10/2021
44 by.ny'Agustin Puji Rahayu 6/10/2021 6/10/2021
45 by.nySiti Nur Afifah 6/10/2021 6/10/2021
46 by.nyInayatul Uliyah 6/10/2021 6/10/2021
47 by.nyRhosita Ira Endrawati 6/10/2021 6/10/2021
48 by.nyRatna Yuniarti 6/10/2021 6/10/2021
49 by.nyTitik Purwanti 6/10/2021 6/10/2021
50 by.nyRina Natalia 6/10/2021 6/10/2021
51 by.nySri Wahyuni 6/11/2021 6/11/2021
52 by.ny.Mutmainah 6/11/2021 6/11/2021
53 by.nyYuniarti 6/12/2021 6/12/2021
54 by.nyPipit Fitriyah 6/12/2021 6/12/2021
55 by.nyUmu Khoiroh 6/12/2021 6/12/2021
56 by.nyNur Fadilah Romadani 6/12/2021 6/12/2021
57 by.nySampurni Ningsih 6/12/2021 6/12/2021
58 by.nyStya Tito Yuniar 6/13/2021 6/13/2021
59 by.nyTiara 6/14/2021 6/14/2021
60 by.ny.Suhaya 6/14/2021 6/14/2021
61 by.ny.Yuli Nurwindasari 6/14/2021 6/14/2021
62 by.ny'Marida Isnaini 6/14/2021 6/14/2021
63 by.nyRetno Dwi Wulansari 6/14/2021 6/14/2021
64 by.ny.Vina Dwi Susanti 6/14/2021 6/14/2021
65 by.nySuliyati 6/15/2021 6/15/2021
66 by.ny.Vika Maulidiana Hasni 6/16/2021 6/16/2021
67 by.ny.Vitriyana Kusuma Dewi 6/16/2021 6/16/2021
68 by.ny.Ika Anggraeni 6/17/2021 6/17/2021
69 by.ny.Siti Fatimah 6/17/2021 6/17/2021
70 by.ny.Isnawati 6/17/2021 6/17/2021
71 by.nySiti Muhayati 6/17/2021 6/17/2021
72 by.nyNabila Ismi Alfiyana 6/17/2021 6/17/2021
73 by.nyAyu Setiowati 6/17/2021 6/17/2021
74 by.nyPipit Nuritasari 6/17/2021 6/17/2021
75 by.nyRosmini 6/18/2021 6/18/2021
76 by.nyFitria Dwi Rizantin 6/18/2021 6/18/2021
77 by.nyMutmainah 6/18/2021 6/18/2021
78 by.nyRositasari 6/18/2021 6/18/2021
79 by.ny.Muhsinatul Khali 6/19/2021 6/19/2021
80 by.ny.Putri Dwi K 6/19/2021 6/19/2021
81 by.ny.Susilawati 6/19/2021 6/19/2021
82 by.ny.Nur Afifah 6/19/2021 6/19/2021
83 by.ny.Rifana 6/19/2021 6/19/2021
84 by.ny.Arumsari 6/20/2021 6/20/2021
85 by.nySusan Widiyawati 6/20/2021 6/20/2021
86 by.ny.Rifatin Fadilah 6/20/2021 6/20/2021
87 by.nyFaridah 6/21/2021 6/21/2021
88 by.nyLeli Putri 6/21/2021 6/21/2021
89 by.nyInawati Aprinus 6/21/2021 6/21/2021
90 by.ny.Amalia Putri Cahayani 6/21/2021 6/21/2021
91 by.ny.Arimbi Desita 6/23/2021 6/23/2021
92 by.ny.Fibrianita Sukmawati 6/23/2021 6/23/2021
93 by.ny.Rohadatul Aisyi 6/23/2021 6/23/2021
94 by.ny.Nova Mardiyanah 6/23/2021 6/23/2021
95 by.ny.Debby Permata Sari 6/23/2021 6/23/2021
96 by.ny.Novitasari 6/24/2021 6/24/2021
97 by.ny.Kristina Yulianti 6/24/2021 6/24/2021
98 by.ny.Sri Wulandari 6/25/2021 6/25/2021
99 by.nyDyah Ayu Fatmawati 6/26/2021 6/26/2021
100 by.nyEva Dwi Lestari 6/27/2021 6/27/2021
101 by.nyKhoiriyatul Ulum 6/28/2021 6/28/2021
102 by.nySania Dwi Kartika 6/27/2021 6/27/2021
103 by.nyFitri Liliani 6/27/2021 6/27/2021
104 by.nyWidyawati 6/27/2021 6/27/2021
105 by.ny.Eka Nopiyanti 6/27/2021 6/27/2021
106 by.nyNurul Ainiyah 6/28/2021 6/28/2021
107 by.ny.Rani Sumita 6/27/2021 6/27/2021
108 by.nyHilmiyatus Saidah 6/28/2021 6/28/2021
109 by.nyUswatun Khasanah 6/28/2021 6/28/2021
110 by.ny.Ni Wayan Putri 6/28/2021 6/28/2021
111 by.ny.Indrawati 6/28/2021 6/28/2021
112 by.ny.Kurniawati 6/28/2021 6/28/2021
113 by.ny.'Suroiyah Habibah 6/29/2021 6/29/2021
114 by.ny.Endang Prapti 6/29/2021 6/29/2021
115 by.nyYeni Tamara 6/29/2021 6/29/2021
116 by.ny.Sovi Dewi Ravika 6/29/2021 6/29/2021
117 by.nyNadila Dwi Puji 6/29/2021 6/29/2021
118 by.ny.Vellawati Linda 6/29/2021 6/29/2021
119 by.ny.Linda Wulandari 6/29/2021 6/29/2021
120 by.ny.Siti Zainab 6/29/2021 6/29/2021
121 by.ny.Mega Kartika Sari 6/29/2021 6/29/2021
122 by.ny.Putri Suryanti 6/30/2021 6/30/2021
123 by.nyNovita Kumala 30/06/2021 30/06/2021
124 by.ny.Asmaul Khusnah 6/30/2021 6/30/2021
125 by.ny.Nur Sholiha 6/30/2021 6/30/2021
126 by.nyIke Wulandari 6/30/2021 6/30/2021
127 by.ny.Jarmiati 6/30/2021 6/30/2021
128 by.ny.Rochmawati 6/30/2021 6/30/2021
129 by.ny.Lisa Budiarti 7/1/2021 7/1/2021
130 by.ny.Siti Chomariah 7/1/2021 7/1/2021
131 by.ny.Nailatun Nikmah 7/1/2021 7/1/2021
 H
NAMA PRAKTEK : RSI DARUS SYIFA' BENOWO
BULAN : JUNI
TAHUN : 2021

BAYI
HEPATITIS B UNIJECT
NO NAMA TANGGAL LAHIR
DPT HB HIB 1 DPT HB HIB 2
HB 0-7 Hari

1 2 3 17 18 19

1 by.ny. Vivit Arini 6/1/2021

2 by.ny.Siti Rochaniah 6/1/2021
3 by.ny.Romelah 6/2/2021
4 by.ny.Oktaviani Iman Sari 6/2/2021
5 by.ny.Rakhmawati Eka Syaputri 6/3/2021
6 by.ny.Sumi Rahayu 6/2/2021
7 by.ny.Pitri Endrawati 6/3/2021
8 by.ny.Efiatur Rochmah 6/3/2021
9 by.ny.Julia Kristianti 6/3/2021
10 by.ny.Agustin 6/3/2021
11 by.ny.Anik Indarti 6/3/2021
12 by.nyIndah Puspitasari 6/3/2021
13 by.ny.Masruroh 6/3/2021
14 by.ny.Lina Harianti 6/3/2021
15 by.ny.Weni Puspitasari 6/3/2021
16 by.ny.Ika Wahyuning 6/3/2021
17 by.ny.Siti Istiqomah 6/3/2021
18 by.ny.Isnurifatul Amelia 6/4/2021
19 by.ny.Septiana Dwi Cahya 6/4/2021
20 by.ny.Nur Rodhiya 6/4/2021
21 by.nyIndah Mulyani 6/4/2021
22 by.nyPurwati 6/4/2021
23 by.nyLuluk Putri Setiyowati 6/5/2021
24 by.nyLutfiatun 6/5/2021
25 by.ny.Vivi Dwi Astuti 6/5/2021
26 by.nySiti Maisaroh 6/5/2021
27 by.ny.Dwi Indah Yanti 6/5/2021
28 by.nyResita Atiswaduni 6/5/2021
29 by.nyIndar Safitri 6/6/2021
30 by.nyTrie Mawarti 6/6/2021
31 by.nyAnanda Putri 6/6/2021
32 by.nyErlita Mala Ayu Dwi 6/7/2021
33 by.ny'Yugo Amalia Romadhoni 6/7/2021
34 by.nyVika Kurniawati 6/8/2021
35 by.ny.Andi Marsa Putri Hayyu 6/8/2021
36 by.nySiti Ilmawati 6/8/2021
37 by.nyHosma 6/9/2021
38 by.ny'Oktavia Nur Aini 6/9/2021
39 by.nyKrydha Permatasari 6/8/2021
40 by.nySiti Amalah 6/9/2021
41 by.nyYuni Wulandari 6/9/2021
42 by.ny.Dwita Putri Megasari 6/10/2021
43 by.nyKhalimatus Sa'diah 6/10/2021
44 by.ny'Agustin Puji Rahayu 6/10/2021
45 by.nySiti Nur Afifah 6/10/2021
46 by.nyInayatul Uliyah 6/10/2021
47 by.nyRhosita Ira Endrawati 6/10/2021
48 by.nyRatna Yuniarti 6/10/2021
49 by.nyTitik Purwanti 6/10/2021
50 by.nyRina Natalia 6/10/2021
51 by.nySri Wahyuni 6/11/2021
52 by.ny.Mutmainah 6/11/2021
53 by.nyYuniarti 6/12/2021
54 by.nyPipit Fitriyah 6/12/2021
55 by.nyUmu Khoiroh 6/12/2021
56 by.nyNur Fadilah Romadani 6/12/2021
57 by.nySampurni Ningsih 6/12/2021
58 by.nyStya Tito Yuniar 6/13/2021
59 by.nyTiara 6/14/2021
60 by.ny.Suhaya 6/14/2021
61 by.ny.Yuli Nurwindasari 6/14/2021
62 by.ny'Marida Isnaini 6/14/2021
63 by.nyRetno Dwi Wulansari 6/14/2021
64 by.ny.Vina Dwi Susanti 6/14/2021
65 by.nySuliyati 6/15/2021
66 by.ny.Vika Maulidiana Hasni 6/16/2021
67 by.ny.Vitriyana Kusuma Dewi 6/16/2021
68 by.ny.Ika Anggraeni 6/17/2021
69 by.ny.Siti Fatimah 6/17/2021
70 by.ny.Isnawati 6/17/2021
71 by.nySiti Muhayati 6/17/2021
72 by.nyNabila Ismi Alfiyana 6/17/2021
73 by.nyAyu Setiowati 6/17/2021
74 by.nyPipit Nuritasari 6/17/2021
75 by.nyRosmini 6/18/2021
76 by.nyFitria Dwi Rizantin 6/18/2021
77 by.nyMutmainah 6/18/2021
78 by.nyRositasari 6/18/2021
79 by.ny.Muhsinatul Khali 6/19/2021
80 by.ny.Putri Dwi K 6/19/2021
81 by.ny.Susilawati 6/19/2021
82 by.ny.Nur Afifah 6/19/2021
83 by.ny.Rifana 6/19/2021
84 by.ny.Arumsari 6/20/2021
85 by.nySusan Widiyawati 6/20/2021
86 by.ny.Rifatin Fadilah 6/20/2021
87 by.nyFaridah 6/21/2021
88 by.nyLeli Putri 6/21/2021
89 by.nyInawati Aprinus 6/21/2021
90 by.ny.Amalia Putri Cahayani 6/21/2021
91 by.ny.Arimbi Desita 6/23/2021
92 by.ny.Fibrianita Sukmawati 6/23/2021
93 by.ny.Rohadatul Aisyi 6/23/2021
94 by.ny.Nova Mardiyanah 6/23/2021
95 by.ny.Debby Permata Sari 6/23/2021
96 by.ny.Novitasari 6/24/2021
97 by.ny.Kristina Yulianti 6/24/2021
98 by.ny.Sri Wulandari 6/25/2021
99 by.nyDyah Ayu Fatmawati 6/26/2021
100 by.nyEva Dwi Lestari 6/27/2021
101 by.nyKhoiriyatul Ulum 6/28/2021
102 by.nySania Dwi Kartika 6/27/2021
103 by.nyFitri Liliani 6/27/2021
104 by.nyWidyawati 6/27/2021
105 by.ny.Eka Nopiyanti 6/27/2021
106 by.nyNurul Ainiyah 6/28/2021
107 by.ny.Rani Sumita 6/27/2021
108 by.nyHilmiyatus Saidah 6/28/2021
109 by.nyUswatun Khasanah 6/28/2021
110 by.ny.Ni Wayan Putri 6/28/2021
111 by.ny.Indrawati 6/28/2021
112 by.ny.Kurniawati 6/28/2021
113 by.ny.'Suroiyah Habibah 6/29/2021
114 by.ny.Endang Prapti 6/29/2021
115 by.nyYeni Tamara 6/29/2021
116 by.ny.Sovi Dewi Ravika 6/29/2021
117 by.nyNadila Dwi Puji 6/29/2021
118 by.ny.Vellawati Linda 6/29/2021
119 by.ny.Linda Wulandari 6/29/2021
120 by.ny.Siti Zainab 6/29/2021
121 by.ny.Mega Kartika Sari 6/29/2021
122 by.ny.Putri Suryanti 6/30/2021
123 by.nyNovita Kumala 30/06/2021
124 by.ny.Asmaul Khusnah 6/30/2021
125 by.ny.Nur Sholiha 6/30/2021
126 by.nyIke Wulandari 6/30/2021
127 by.ny.Jarmiati 6/30/2021
128 by.ny.Rochmawati 6/30/2021
129 by.ny.Lisa Budiarti 7/1/2021
130 by.ny.Siti Chomariah 7/1/2021
131 by.ny.Nailatun Nikmah 7/1/2021
 HASIL IMUNISASI RUMAH SAKIT / KLINIK
HASIL IMU
/D
NAMA PRAKTEK : RSI DARUS SYIFA' BENOWO
BULAN : JUNI
TAHUN : 2021
DI ISI TANGGAL PEMBERIAN VAKSIN / PENYUNTIKAN (BUKA
ANAK WUS

NO NAMA TANGGAL LAHIR DPT HB CAMPAK/

DPT HB HIB 3 IPV HIB MR TT Engerix B Euvax B DTP HIB
BOOSTER BOOSTER

1 2 3 20 21 22 23 24 25 26 27 28

1 by.ny. Vivit Arini 6/1/2021

2 by.ny.Siti Rochaniah 6/1/2021
3 by.ny.Romelah 6/2/2021
4 by.ny.Oktaviani Iman Sari 6/2/2021
5 by.ny.Rakhmawati Eka Syaputri 6/3/2021
6 by.ny.Sumi Rahayu 6/2/2021
7 by.ny.Pitri Endrawati 6/3/2021
8 by.ny.Efiatur Rochmah 6/3/2021
9 by.ny.Julia Kristianti 6/3/2021
10 by.ny.Agustin 6/3/2021
11 by.ny.Anik Indarti 6/3/2021
12 by.nyIndah Puspitasari 6/3/2021
13 by.ny.Masruroh 6/3/2021
14 by.ny.Lina Harianti 6/3/2021
15 by.ny.Weni Puspitasari 6/3/2021
16 by.ny.Ika Wahyuning 6/3/2021
17 by.ny.Siti Istiqomah 6/3/2021
18 by.ny.Isnurifatul Amelia 6/4/2021
19 by.ny.Septiana Dwi Cahya 6/4/2021
20 by.ny.Nur Rodhiya 6/4/2021
21 by.nyIndah Mulyani 6/4/2021
22 by.nyPurwati 6/4/2021
23 by.nyLuluk Putri Setiyowati 6/5/2021
24 by.nyLutfiatun 6/5/2021
25 by.ny.Vivi Dwi Astuti 6/5/2021
26 by.nySiti Maisaroh 6/5/2021
27 by.ny.Dwi Indah Yanti 6/5/2021
28 by.nyResita Atiswaduni 6/5/2021
29 by.nyIndar Safitri 6/6/2021
30 by.nyTrie Mawarti 6/6/2021
31 by.nyAnanda Putri 6/6/2021
32 by.nyErlita Mala Ayu Dwi 6/7/2021
33 by.ny'Yugo Amalia Romadhoni 6/7/2021
34 by.nyVika Kurniawati 6/8/2021
35 by.ny.Andi Marsa Putri Hayyu 6/8/2021
36 by.nySiti Ilmawati 6/8/2021
37 by.nyHosma 6/9/2021
38 by.ny'Oktavia Nur Aini 6/9/2021
39 by.nyKrydha Permatasari 6/8/2021
40 by.nySiti Amalah 6/9/2021
41 by.nyYuni Wulandari 6/9/2021
42 by.ny.Dwita Putri Megasari 6/10/2021
43 by.nyKhalimatus Sa'diah 6/10/2021
44 by.ny'Agustin Puji Rahayu 6/10/2021
45 by.nySiti Nur Afifah 6/10/2021
46 by.nyInayatul Uliyah 6/10/2021
47 by.nyRhosita Ira Endrawati 6/10/2021
48 by.nyRatna Yuniarti 6/10/2021
49 by.nyTitik Purwanti 6/10/2021
50 by.nyRina Natalia 6/10/2021
51 by.nySri Wahyuni 6/11/2021
52 by.ny.Mutmainah 6/11/2021
53 by.nyYuniarti 6/12/2021
54 by.nyPipit Fitriyah 6/12/2021
55 by.nyUmu Khoiroh 6/12/2021
56 by.nyNur Fadilah Romadani 6/12/2021
57 by.nySampurni Ningsih 6/12/2021
58 by.nyStya Tito Yuniar 6/13/2021
59 by.nyTiara 6/14/2021
60 by.ny.Suhaya 6/14/2021
61 by.ny.Yuli Nurwindasari 6/14/2021
62 by.ny'Marida Isnaini 6/14/2021
63 by.nyRetno Dwi Wulansari 6/14/2021
64 by.ny.Vina Dwi Susanti 6/14/2021
65 by.nySuliyati 6/15/2021
66 by.ny.Vika Maulidiana Hasni 6/16/2021
67 by.ny.Vitriyana Kusuma Dewi 6/16/2021
68 by.ny.Ika Anggraeni 6/17/2021
69 by.ny.Siti Fatimah 6/17/2021
70 by.ny.Isnawati 6/17/2021
71 by.nySiti Muhayati 6/17/2021
72 by.nyNabila Ismi Alfiyana 6/17/2021
73 by.nyAyu Setiowati 6/17/2021
74 by.nyPipit Nuritasari 6/17/2021
75 by.nyRosmini 6/18/2021
76 by.nyFitria Dwi Rizantin 6/18/2021
77 by.nyMutmainah 6/18/2021
78 by.nyRositasari 6/18/2021
79 by.ny.Muhsinatul Khali 6/19/2021
80 by.ny.Putri Dwi K 6/19/2021
81 by.ny.Susilawati 6/19/2021
82 by.ny.Nur Afifah 6/19/2021
83 by.ny.Rifana 6/19/2021
84 by.ny.Arumsari 6/20/2021
85 by.nySusan Widiyawati 6/20/2021
86 by.ny.Rifatin Fadilah 6/20/2021
87 by.nyFaridah 6/21/2021
88 by.nyLeli Putri 6/21/2021
89 by.nyInawati Aprinus 6/21/2021
90 by.ny.Amalia Putri Cahayani 6/21/2021
91 by.ny.Arimbi Desita 6/23/2021
92 by.ny.Fibrianita Sukmawati 6/23/2021
93 by.ny.Rohadatul Aisyi 6/23/2021
94 by.ny.Nova Mardiyanah 6/23/2021
95 by.ny.Debby Permata Sari 6/23/2021
96 by.ny.Novitasari 6/24/2021
97 by.ny.Kristina Yulianti 6/24/2021
98 by.ny.Sri Wulandari 6/25/2021
99 by.nyDyah Ayu Fatmawati 6/26/2021
100 by.nyEva Dwi Lestari 6/27/2021
101 by.nyKhoiriyatul Ulum 6/28/2021
102 by.nySania Dwi Kartika 6/27/2021
103 by.nyFitri Liliani 6/27/2021
104 by.nyWidyawati 6/27/2021
105 by.ny.Eka Nopiyanti 6/27/2021
106 by.nyNurul Ainiyah 6/28/2021
107 by.ny.Rani Sumita 6/27/2021
108 by.nyHilmiyatus Saidah 6/28/2021
109 by.nyUswatun Khasanah 6/28/2021
110 by.ny.Ni Wayan Putri 6/28/2021
111 by.ny.Indrawati 6/28/2021
112 by.ny.Kurniawati 6/28/2021
113 by.ny.'Suroiyah Habibah 6/29/2021
114 by.ny.Endang Prapti 6/29/2021
115 by.nyYeni Tamara 6/29/2021
116 by.ny.Sovi Dewi Ravika 6/29/2021
117 by.nyNadila Dwi Puji 6/29/2021
118 by.ny.Vellawati Linda 6/29/2021
119 by.ny.Linda Wulandari 6/29/2021
120 by.ny.Siti Zainab 6/29/2021
121 by.ny.Mega Kartika Sari 6/29/2021
122 by.ny.Putri Suryanti 6/30/2021
123 by.nyNovita Kumala 30/06/2021
124 by.ny.Asmaul Khusnah 6/30/2021
125 by.ny.Nur Sholiha 6/30/2021
126 by.nyIke Wulandari 6/30/2021
127 by.ny.Jarmiati 6/30/2021
128 by.ny.Rochmawati 6/30/2021
129 by.ny.Lisa Budiarti 7/1/2021
130 by.ny.Siti Chomariah 7/1/2021
131 by.ny.Nailatun Nikmah 7/1/2021
HASIL IMUNISASI RUMAH SAKIT / KLINIK / DOKTER SPESIALIS ANAK / BIDAN PRAKTEK MANDIRI HASIL I
NAMA PRAKTEK : RSI DARUS SYIFA' BENOWO
BULAN : JUNI
TAHUN : 2021
DI ISI TANGGAL PEMBERIAN VAKSIN / PENYUNTIKAN (BUKAN DICENTANG)
VAKSIN BAYI (NON PEMERINTAH)

Infanrif
NO NAMA TANGGAL LAHIR HIB Infanrif Tetract
Pediacel Infanrix Trimovax MMR Tetagam HB Vax
(DPaT- HIB IPV HIB
HiB)

1 2 3 29 30 31 32 33 34 35 36 37

1 by.ny. Vivit Arini 6/1/2021

2 by.ny.Siti Rochaniah 6/1/2021
3 by.ny.Romelah 6/2/2021
4 by.ny.Oktaviani Iman Sari 6/2/2021
5 by.ny.Rakhmawati Eka Syaputri 6/3/2021
6 by.ny.Sumi Rahayu 6/2/2021
7 by.ny.Pitri Endrawati 6/3/2021
8 by.ny.Efiatur Rochmah 6/3/2021
9 by.ny.Julia Kristianti 6/3/2021
10 by.ny.Agustin 6/3/2021
11 by.ny.Anik Indarti 6/3/2021
12 by.nyIndah Puspitasari 6/3/2021
13 by.ny.Masruroh 6/3/2021
14 by.ny.Lina Harianti 6/3/2021
15 by.ny.Weni Puspitasari 6/3/2021
16 by.ny.Ika Wahyuning 6/3/2021
17 by.ny.Siti Istiqomah 6/3/2021
18 by.ny.Isnurifatul Amelia 6/4/2021
19 by.ny.Septiana Dwi Cahya 6/4/2021
20 by.ny.Nur Rodhiya 6/4/2021
21 by.nyIndah Mulyani 6/4/2021
22 by.nyPurwati 6/4/2021
23 by.nyLuluk Putri Setiyowati 6/5/2021
24 by.nyLutfiatun 6/5/2021
25 by.ny.Vivi Dwi Astuti 6/5/2021
26 by.nySiti Maisaroh 6/5/2021
27 by.ny.Dwi Indah Yanti 6/5/2021
28 by.nyResita Atiswaduni 6/5/2021
29 by.nyIndar Safitri 6/6/2021
30 by.nyTrie Mawarti 6/6/2021
31 by.nyAnanda Putri 6/6/2021
32 by.nyErlita Mala Ayu Dwi 6/7/2021
33 by.ny'Yugo Amalia Romadhoni 6/7/2021
34 by.nyVika Kurniawati 6/8/2021
35 by.ny.Andi Marsa Putri Hayyu 6/8/2021
36 by.nySiti Ilmawati 6/8/2021
37 by.nyHosma 6/9/2021
38 by.ny'Oktavia Nur Aini 6/9/2021
39 by.nyKrydha Permatasari 6/8/2021
40 by.nySiti Amalah 6/9/2021
41 by.nyYuni Wulandari 6/9/2021
42 by.ny.Dwita Putri Megasari 6/10/2021
43 by.nyKhalimatus Sa'diah 6/10/2021
44 by.ny'Agustin Puji Rahayu 6/10/2021
45 by.nySiti Nur Afifah 6/10/2021
46 by.nyInayatul Uliyah 6/10/2021
47 by.nyRhosita Ira Endrawati 6/10/2021
48 by.nyRatna Yuniarti 6/10/2021
49 by.nyTitik Purwanti 6/10/2021
50 by.nyRina Natalia 6/10/2021
51 by.nySri Wahyuni 6/11/2021
52 by.ny.Mutmainah 6/11/2021
53 by.nyYuniarti 6/12/2021
54 by.nyPipit Fitriyah 6/12/2021
55 by.nyUmu Khoiroh 6/12/2021
56 by.nyNur Fadilah Romadani 6/12/2021
57 by.nySampurni Ningsih 6/12/2021
58 by.nyStya Tito Yuniar 6/13/2021
59 by.nyTiara 6/14/2021
60 by.ny.Suhaya 6/14/2021
61 by.ny.Yuli Nurwindasari 6/14/2021
62 by.ny'Marida Isnaini 6/14/2021
63 by.nyRetno Dwi Wulansari 6/14/2021
64 by.ny.Vina Dwi Susanti 6/14/2021
65 by.nySuliyati 6/15/2021
66 by.ny.Vika Maulidiana Hasni 6/16/2021
67 by.ny.Vitriyana Kusuma Dewi 6/16/2021
68 by.ny.Ika Anggraeni 6/17/2021
69 by.ny.Siti Fatimah 6/17/2021
70 by.ny.Isnawati 6/17/2021
71 by.nySiti Muhayati 6/17/2021
72 by.nyNabila Ismi Alfiyana 6/17/2021
73 by.nyAyu Setiowati 6/17/2021
74 by.nyPipit Nuritasari 6/17/2021
75 by.nyRosmini 6/18/2021
76 by.nyFitria Dwi Rizantin 6/18/2021
77 by.nyMutmainah 6/18/2021
78 by.nyRositasari 6/18/2021
79 by.ny.Muhsinatul Khali 6/19/2021
80 by.ny.Putri Dwi K 6/19/2021
81 by.ny.Susilawati 6/19/2021
82 by.ny.Nur Afifah 6/19/2021
83 by.ny.Rifana 6/19/2021
84 by.ny.Arumsari 6/20/2021
85 by.nySusan Widiyawati 6/20/2021
86 by.ny.Rifatin Fadilah 6/20/2021
87 by.nyFaridah 6/21/2021
88 by.nyLeli Putri 6/21/2021
89 by.nyInawati Aprinus 6/21/2021
90 by.ny.Amalia Putri Cahayani 6/21/2021
91 by.ny.Arimbi Desita 6/23/2021
92 by.ny.Fibrianita Sukmawati 6/23/2021
93 by.ny.Rohadatul Aisyi 6/23/2021
94 by.ny.Nova Mardiyanah 6/23/2021
95 by.ny.Debby Permata Sari 6/23/2021
96 by.ny.Novitasari 6/24/2021
97 by.ny.Kristina Yulianti 6/24/2021
98 by.ny.Sri Wulandari 6/25/2021
99 by.nyDyah Ayu Fatmawati 6/26/2021
100 by.nyEva Dwi Lestari 6/27/2021
101 by.nyKhoiriyatul Ulum 6/28/2021
102 by.nySania Dwi Kartika 6/27/2021
103 by.nyFitri Liliani 6/27/2021
104 by.nyWidyawati 6/27/2021
105 by.ny.Eka Nopiyanti 6/27/2021
106 by.nyNurul Ainiyah 6/28/2021
107 by.ny.Rani Sumita 6/27/2021
108 by.nyHilmiyatus Saidah 6/28/2021
109 by.nyUswatun Khasanah 6/28/2021
110 by.ny.Ni Wayan Putri 6/28/2021
111 by.ny.Indrawati 6/28/2021
112 by.ny.Kurniawati 6/28/2021
113 by.ny.'Suroiyah Habibah 6/29/2021
114 by.ny.Endang Prapti 6/29/2021
115 by.nyYeni Tamara 6/29/2021
116 by.ny.Sovi Dewi Ravika 6/29/2021
117 by.nyNadila Dwi Puji 6/29/2021
118 by.ny.Vellawati Linda 6/29/2021
119 by.ny.Linda Wulandari 6/29/2021
120 by.ny.Siti Zainab 6/29/2021
121 by.ny.Mega Kartika Sari 6/29/2021
122 by.ny.Putri Suryanti 6/30/2021
123 by.nyNovita Kumala 30/06/2021
124 by.ny.Asmaul Khusnah 6/30/2021
125 by.ny.Nur Sholiha 6/30/2021
126 by.nyIke Wulandari 6/30/2021
127 by.ny.Jarmiati 6/30/2021
128 by.ny.Rochmawati 6/30/2021
129 by.ny.Lisa Budiarti 7/1/2021
130 by.ny.Siti Chomariah 7/1/2021
131 by.ny.Nailatun Nikmah 7/1/2021

Mengetahui,
Kepala UNIT RAJAL

dr. Yonansa Abiyoga

 NAMA PRAKTEK : RSI DARUS SYIFA' BENOWO
BULAN : JUNI
TAHUN : 2021

NO NAMA TANGGAL LAHIR

Act Hib

1 2 3 38

1 by.ny. Vivit Arini 6/1/2021

2 by.ny.Siti Rochaniah 6/1/2021
3 by.ny.Romelah 6/2/2021
4 by.ny.Oktaviani Iman Sari 6/2/2021
5 by.ny.Rakhmawati Eka Syaputri 6/3/2021
6 by.ny.Sumi Rahayu 6/2/2021
7 by.ny.Pitri Endrawati 6/3/2021
8 by.ny.Efiatur Rochmah 6/3/2021
9 by.ny.Julia Kristianti 6/3/2021
10 by.ny.Agustin 6/3/2021
11 by.ny.Anik Indarti 6/3/2021
12 by.nyIndah Puspitasari 6/3/2021
13 by.ny.Masruroh 6/3/2021
14 by.ny.Lina Harianti 6/3/2021
15 by.ny.Weni Puspitasari 6/3/2021
16 by.ny.Ika Wahyuning 6/3/2021
17 by.ny.Siti Istiqomah 6/3/2021
18 by.ny.Isnurifatul Amelia 6/4/2021
19 by.ny.Septiana Dwi Cahya 6/4/2021
20 by.ny.Nur Rodhiya 6/4/2021
21 by.nyIndah Mulyani 6/4/2021
22 by.nyPurwati 6/4/2021
23 by.nyLuluk Putri Setiyowati 6/5/2021
24 by.nyLutfiatun 6/5/2021
25 by.ny.Vivi Dwi Astuti 6/5/2021
26 by.nySiti Maisaroh 6/5/2021
27 by.ny.Dwi Indah Yanti 6/5/2021
28 by.nyResita Atiswaduni 6/5/2021
29 by.nyIndar Safitri 6/6/2021
30 by.nyTrie Mawarti 6/6/2021
31 by.nyAnanda Putri 6/6/2021
32 by.nyErlita Mala Ayu Dwi 6/7/2021
33 by.ny'Yugo Amalia Romadhoni 6/7/2021
34 by.nyVika Kurniawati 6/8/2021
35 by.ny.Andi Marsa Putri Hayyu 6/8/2021
36 by.nySiti Ilmawati 6/8/2021
37 by.nyHosma 6/9/2021
38 by.ny'Oktavia Nur Aini 6/9/2021
39 by.nyKrydha Permatasari 6/8/2021
40 by.nySiti Amalah 6/9/2021
41 by.nyYuni Wulandari 6/9/2021
42 by.ny.Dwita Putri Megasari 6/10/2021
43 by.nyKhalimatus Sa'diah 6/10/2021
44 by.ny'Agustin Puji Rahayu 6/10/2021
45 by.nySiti Nur Afifah 6/10/2021
46 by.nyInayatul Uliyah 6/10/2021
47 by.nyRhosita Ira Endrawati 6/10/2021
48 by.nyRatna Yuniarti 6/10/2021
49 by.nyTitik Purwanti 6/10/2021
50 by.nyRina Natalia 6/10/2021
51 by.nySri Wahyuni 6/11/2021
52 by.ny.Mutmainah 6/11/2021
53 by.nyYuniarti 6/12/2021
54 by.nyPipit Fitriyah 6/12/2021
55 by.nyUmu Khoiroh 6/12/2021
56 by.nyNur Fadilah Romadani 6/12/2021
57 by.nySampurni Ningsih 6/12/2021
58 by.nyStya Tito Yuniar 6/13/2021
59 by.nyTiara 6/14/2021
60 by.ny.Suhaya 6/14/2021
61 by.ny.Yuli Nurwindasari 6/14/2021
62 by.ny'Marida Isnaini 6/14/2021
63 by.nyRetno Dwi Wulansari 6/14/2021
64 by.ny.Vina Dwi Susanti 6/14/2021
65 by.nySuliyati 6/15/2021
66 by.ny.Vika Maulidiana Hasni 6/16/2021
67 by.ny.Vitriyana Kusuma Dewi 6/16/2021
68 by.ny.Ika Anggraeni 6/17/2021
69 by.ny.Siti Fatimah 6/17/2021
70 by.ny.Isnawati 6/17/2021
71 by.nySiti Muhayati 6/17/2021
72 by.nyNabila Ismi Alfiyana 6/17/2021
73 by.nyAyu Setiowati 6/17/2021
74 by.nyPipit Nuritasari 6/17/2021
75 by.nyRosmini 6/18/2021
76 by.nyFitria Dwi Rizantin 6/18/2021
77 by.nyMutmainah 6/18/2021
78 by.nyRositasari 6/18/2021
79 by.ny.Muhsinatul Khali 6/19/2021
80 by.ny.Putri Dwi K 6/19/2021
81 by.ny.Susilawati 6/19/2021
82 by.ny.Nur Afifah 6/19/2021
83 by.ny.Rifana 6/19/2021
84 by.ny.Arumsari 6/20/2021
85 by.nySusan Widiyawati 6/20/2021
86 by.ny.Rifatin Fadilah 6/20/2021
87 by.nyFaridah 6/21/2021
88 by.nyLeli Putri 6/21/2021
89 by.nyInawati Aprinus 6/21/2021
90 by.ny.Amalia Putri Cahayani 6/21/2021
91 by.ny.Arimbi Desita 6/23/2021
92 by.ny.Fibrianita Sukmawati 6/23/2021
93 by.ny.Rohadatul Aisyi 6/23/2021
94 by.ny.Nova Mardiyanah 6/23/2021
95 by.ny.Debby Permata Sari 6/23/2021
96 by.ny.Novitasari 6/24/2021
97 by.ny.Kristina Yulianti 6/24/2021
98 by.ny.Sri Wulandari 6/25/2021
99 by.nyDyah Ayu Fatmawati 6/26/2021
100 by.nyEva Dwi Lestari 6/27/2021
101 by.nyKhoiriyatul Ulum 6/28/2021
102 by.nySania Dwi Kartika 6/27/2021
103 by.nyFitri Liliani 6/27/2021
104 by.nyWidyawati 6/27/2021
105 by.ny.Eka Nopiyanti 6/27/2021
106 by.nyNurul Ainiyah 6/28/2021
107 by.ny.Rani Sumita 6/27/2021
108 by.nyHilmiyatus Saidah 6/28/2021
109 by.nyUswatun Khasanah 6/28/2021
110 by.ny.Ni Wayan Putri 6/28/2021
111 by.ny.Indrawati 6/28/2021
112 by.ny.Kurniawati 6/28/2021
113 by.ny.'Suroiyah Habibah 6/29/2021
114 by.ny.Endang Prapti 6/29/2021
115 by.nyYeni Tamara 6/29/2021
116 by.ny.Sovi Dewi Ravika 6/29/2021
117 by.nyNadila Dwi Puji 6/29/2021
118 by.ny.Vellawati Linda 6/29/2021
119 by.ny.Linda Wulandari 6/29/2021
120 by.ny.Siti Zainab 6/29/2021
121 by.ny.Mega Kartika Sari 6/29/2021
122 by.ny.Putri Suryanti 6/30/2021
123 by.nyNovita Kumala 30/06/2021
124 by.ny.Asmaul Khusnah 6/30/2021
125 by.ny.Nur Sholiha 6/30/2021
126 by.nyIke Wulandari 6/30/2021
127 by.ny.Jarmiati 6/30/2021
128 by.ny.Rochmawati 6/30/2021
129 by.ny.Lisa Budiarti 7/1/2021
130 by.ny.Siti Chomariah 7/1/2021
131 by.ny.Nailatun Nikmah 7/1/2021
 HASIL IMUNISASI RUMAH SAKIT / KLINIK / DOKTER SPESIALIS ANAK / BIDAN PRAK
NAMA PRAKTEK :
BULAN :
TAHUN :
Wajib di Isi DI ISI TANGGAL PEMBERIAN VAKSIN / PENYUNTIK
ALAMAT

TANGGAL JENIS
NO NAMA NAMA / KELURAHAN** KECAMATAN
LAHIR KELAMIN NAMA BCG POLIO 1 POLIO 2 POLIO 3 POLIO 4
NOMOR NOMOR
JALAN RUMAH
GANG

1 2 3 4 5 6 7 8 9 10 11 12 13 14

1
2
3
4
5
6
7
8
9
10

*Untuk vaksin yang mandiri mohon untuk tetap di isi sesuai pemakaian
T / KLINIK / DOKTER SPESIALIS ANAK / BIDAN PRAKTEK
HASIL IMUNISASI
MANDIRI RUMAH SAKIT / KLINIK / DOKTER SPESIALIS
NAMA PRAKTEK :
BULAN :
TAHUN :
DI ISI TANGGAL PEMBERIAN VAKSIN / PENYUNTIKAN (BUKAN DICENTANG)
BAYI
HEPATITIS B UNIJECT
TANGGAL
NO NAMA CAMPAK/ DPT HB DPT HB
LAHIR HB <24 HB 0-7 Hari HIB 1
MR HIB 2
JAM

1 2 3 15 16 17 18 19

1
2
3
4
5
6
7
8
9
10
 HASIL IMUNISASI
HASIL IMUNISASI
RUMAHRUMAH
SAKIT /SAKIT
KLINIK
/ KLINIK
/ DOKTER
/ DOKTER
SPESIALIS
SPESIALIS
ANAK /ANAK
BIDAN/ PRAKTE
BIDAN
NAMA PRAKTEK :
BULAN :
TAHUN :
DI ISI TANGGAL PEMBERIAN VAKSIN / PENYUNTIKAN (BUKAN DICENTANG)
ANAK WUS VAKSIN BAYI (NON PEMERINTAH)

TANGGAL Infanrif
NO NAMA DPT HB DPT HB CAMPAK/ HIB Infanrif Tetract
LAHIR IPV HIB MR TT Engerix B Euvax B DTP HIB Pediacel Infanrix
HIB 3 BOOSTER BOOSTER (DPaT- HIB IPV HIB
HiB)

1 2 3 20 21 22 23 24 25 26 27 28 29 30 31 32 33

1
2
3
4
5
6
7
8
9
10

Mengetahui,
Kepala .........................

(NAMA)
H SAKIT / KLINIK / DOKTER SPESIALIS ANAK / BIDAN
HASIL
PRAKTEK
IMUNISASI
MANDIRI
RUMAH SAKIT / KLINIK / DOKTER SPESIA
NAMA PRAKTEK :
BULAN :
TAHUN :

VAKSIN BAYI (NON PEMERINTAH)

TANGGAL
NO NAMA
LAHIR Trimovax MMR Tetagam HB Vax Act Hib

1 2 3 34 35 36 37 38

1
2
3
4
5
6
7
8
9
10
 HASIL IMUNISASI RUMAH SAKIT / KLINIK / DOKTER SPESIALIS ANAK / BIDAN PRAK
NAMA PRAKTEK :
BULAN :
TAHUN :
Wajib di Isi DI ISI TANGGAL PEMBERIAN VAKSIN / PENYUNTIK
ALAMAT

TANGGAL JENIS
NO NAMA NAMA / KELURAHAN** KECAMATAN
LAHIR KELAMIN NAMA BCG POLIO 1 POLIO 2 POLIO 3 POLIO 4
NOMOR NOMOR
JALAN RUMAH
GANG

1 2 3 4 5 6 7 8 9 10 11 12 13 14

1
2
3
4
5
6
7
8
9
10

*Untuk vaksin yang mandiri mohon untuk tetap di isi sesuai pemakaian
T / KLINIK / DOKTER SPESIALIS ANAK / BIDAN PRAKTEK
HASIL IMUNISASI
MANDIRI RUMAH SAKIT / KLINIK / DOKTER SPESIALIS
NAMA PRAKTEK :
BULAN :
TAHUN :
DI ISI TANGGAL PEMBERIAN VAKSIN / PENYUNTIKAN (BUKAN DICENTANG)
BAYI
HEPATITIS B UNIJECT
TANGGAL
NO NAMA CAMPAK/ DPT HB DPT HB
LAHIR HB <24 HB 0-7 Hari HIB 1
MR HIB 2
JAM

1 2 3 15 16 17 18 19

1
2
3
4
5
6
7
8
9
10
 HASIL IMUNISASI
HASIL IMUNISASI
RUMAHRUMAH
SAKIT /SAKIT
KLINIK
/ KLINIK
/ DOKTER
/ DOKTER
SPESIALIS
SPESIALIS
ANAK /ANAK
BIDAN/ PRAKTE
BIDAN
NAMA PRAKTEK :
BULAN :
TAHUN :
DI ISI TANGGAL PEMBERIAN VAKSIN / PENYUNTIKAN (BUKAN DICENTANG)
ANAK WUS VAKSIN BAYI (NON PEMERINTAH)

TANGGAL Infanrif
NO NAMA DPT HB DPT HB CAMPAK/ HIB Infanrif Tetract
LAHIR IPV HIB MR TT Engerix B Euvax B DTP HIB Pediacel Infanrix
HIB 3 BOOSTER BOOSTER (DPaT- HIB IPV HIB
HiB)

1 2 3 20 21 22 23 24 25 26 27 28 29 30 31 32 33

1
2
3
4
5
6
7
8
9
10

Mengetahui,
Kepala .........................

(NAMA)
H SAKIT / KLINIK / DOKTER SPESIALIS ANAK / BIDAN
HASIL
PRAKTEK
IMUNISASI
MANDIRI
RUMAH SAKIT / KLINIK / DOKTER SPESIA
NAMA PRAKTEK :
BULAN :
TAHUN :

VAKSIN BAYI (NON PEMERINTAH)

TANGGAL
NO NAMA
LAHIR Trimovax MMR Tetagam HB Vax Act Hib

1 2 3 34 35 36 37 38

1
2
3
4
5
6
7
8
9
10
 HASIL IMUNISASI RUMAH SAKIT / KLINIK / DOKTER SPESIALIS ANAK / BIDAN PRAK
NAMA PRAKTEK :
BULAN :
TAHUN :
Wajib di Isi DI ISI TANGGAL PEMBERIAN VAKSIN / PENYUNTIK
ALAMAT

TANGGAL JENIS
NO NAMA NAMA / KELURAHAN** KECAMATAN
LAHIR KELAMIN NAMA BCG POLIO 1 POLIO 2 POLIO 3 POLIO 4
NOMOR NOMOR
JALAN RUMAH
GANG

1 2 3 4 5 6 7 8 9 10 11 12 13 14

1
2
3
4
5
6
7
8
9
10

*Untuk vaksin yang mandiri mohon untuk tetap di isi sesuai pemakaian
T / KLINIK / DOKTER SPESIALIS ANAK / BIDAN PRAKTEK
HASIL IMUNISASI
MANDIRI RUMAH SAKIT / KLINIK / DOKTER SPESIALIS
NAMA PRAKTEK :
BULAN :
TAHUN :
DI ISI TANGGAL PEMBERIAN VAKSIN / PENYUNTIKAN (BUKAN DICENTANG)
BAYI
HEPATITIS B UNIJECT
TANGGAL
NO NAMA CAMPAK/ DPT HB DPT HB
LAHIR HB <24 HB 0-7 Hari HIB 1
MR HIB 2
JAM

1 2 3 15 16 17 18 19

1
2
3
4
5
6
7
8
9
10
 HASIL IMUNISASI
HASIL IMUNISASI
RUMAHRUMAH
SAKIT /SAKIT
KLINIK
/ KLINIK
/ DOKTER
/ DOKTER
SPESIALIS
SPESIALIS
ANAK /ANAK
BIDAN/ PRAKTE
BIDAN
NAMA PRAKTEK :
BULAN :
TAHUN :
DI ISI TANGGAL PEMBERIAN VAKSIN / PENYUNTIKAN (BUKAN DICENTANG)
ANAK WUS VAKSIN BAYI (NON PEMERINTAH)

TANGGAL Infanrif
NO NAMA DPT HB DPT HB CAMPAK/ HIB Infanrif Tetract
LAHIR IPV HIB MR TT Engerix B Euvax B DTP HIB Pediacel Infanrix
HIB 3 BOOSTER BOOSTER (DPaT- HIB IPV HIB
HiB)

1 2 3 20 21 22 23 24 25 26 27 28 29 30 31 32 33

1
2
3
4
5
6
7
8
9
10

Mengetahui,
Kepala .........................

(NAMA)
H SAKIT / KLINIK / DOKTER SPESIALIS ANAK / BIDAN
HASIL
PRAKTEK
IMUNISASI
MANDIRI
RUMAH SAKIT / KLINIK / DOKTER SPESIA
NAMA PRAKTEK :
BULAN :
TAHUN :

VAKSIN BAYI (NON PEMERINTAH)

TANGGAL
NO NAMA
LAHIR Trimovax MMR Tetagam HB Vax Act Hib

1 2 3 34 35 36 37 38

1
2
3
4
5
6
7
8
9
10
 HASIL IMUNISASI RUMAH SAKIT / KLINIK / DOKTER SPESIALIS ANAK / BIDAN PRAK
NAMA PRAKTEK :
BULAN :
TAHUN :
Wajib di Isi DI ISI TANGGAL PEMBERIAN VAKSIN / PENYUNTIK
ALAMAT

TANGGAL JENIS
NO NAMA NAMA / KELURAHAN** KECAMATAN
LAHIR KELAMIN NAMA BCG POLIO 1 POLIO 2 POLIO 3 POLIO 4
NOMOR NOMOR
JALAN RUMAH
GANG

1 2 3 4 5 6 7 8 9 10 11 12 13 14

1
2
3
4
5
6
7
8
9
10

*Untuk vaksin yang mandiri mohon untuk tetap di isi sesuai pemakaian
T / KLINIK / DOKTER SPESIALIS ANAK / BIDAN PRAKTEK
HASIL IMUNISASI
MANDIRI RUMAH SAKIT / KLINIK / DOKTER SPESIALIS
NAMA PRAKTEK :
BULAN :
TAHUN :
DI ISI TANGGAL PEMBERIAN VAKSIN / PENYUNTIKAN (BUKAN DICENTANG)
BAYI
HEPATITIS B UNIJECT
TANGGAL
NO NAMA CAMPAK/ DPT HB DPT HB
LAHIR HB <24 HB 0-7 Hari HIB 1
MR HIB 2
JAM

1 2 3 15 16 17 18 19

1
2
3
4
5
6
7
8
9
10
 HASIL IMUNISASI
HASIL IMUNISASI
RUMAHRUMAH
SAKIT /SAKIT
KLINIK
/ KLINIK
/ DOKTER
/ DOKTER
SPESIALIS
SPESIALIS
ANAK /ANAK
BIDAN/ PRAKTE
BIDAN
NAMA PRAKTEK :
BULAN :
TAHUN :
DI ISI TANGGAL PEMBERIAN VAKSIN / PENYUNTIKAN (BUKAN DICENTANG)
ANAK WUS VAKSIN BAYI (NON PEMERINTAH)

TANGGAL Infanrif
NO NAMA DPT HB DPT HB CAMPAK/ HIB Infanrif Tetract
LAHIR IPV HIB MR TT Engerix B Euvax B DTP HIB Pediacel Infanrix
HIB 3 BOOSTER BOOSTER (DPaT- HIB IPV HIB
HiB)

1 2 3 20 21 22 23 24 25 26 27 28 29 30 31 32 33

1
2
3
4
5
6
7
8
9
10

Mengetahui,
Kepala .........................

(NAMA)
H SAKIT / KLINIK / DOKTER SPESIALIS ANAK / BIDAN
HASIL
PRAKTEK
IMUNISASI
MANDIRI
RUMAH SAKIT / KLINIK / DOKTER SPESIA
NAMA PRAKTEK :
BULAN :
TAHUN :

VAKSIN BAYI (NON PEMERINTAH)

TANGGAL
NO NAMA
LAHIR Trimovax MMR Tetagam HB Vax Act Hib

1 2 3 34 35 36 37 38

1
2
3
4
5
6
7
8
9
10
 HASIL IMUNISASI RUMAH SAKIT / KLINIK / DOKTER SPESIALIS ANAK / BIDAN PRAK
NAMA PRAKTEK :
BULAN :
TAHUN :
Wajib di Isi DI ISI TANGGAL PEMBERIAN VAKSIN / PENYUNTIK
ALAMAT

TANGGAL JENIS
NO NAMA NAMA / KELURAHAN** KECAMATAN
LAHIR KELAMIN NAMA BCG POLIO 1 POLIO 2 POLIO 3 POLIO 4
NOMOR NOMOR
JALAN RUMAH
GANG

1 2 3 4 5 6 7 8 9 10 11 12 13 14

1
2
3
4
5
6
7
8
9
10

*Untuk vaksin yang mandiri mohon untuk tetap di isi sesuai pemakaian
T / KLINIK / DOKTER SPESIALIS ANAK / BIDAN PRAKTEK
HASIL IMUNISASI
MANDIRI RUMAH SAKIT / KLINIK / DOKTER SPESIALIS
NAMA PRAKTEK :
BULAN :
TAHUN :
DI ISI TANGGAL PEMBERIAN VAKSIN / PENYUNTIKAN (BUKAN DICENTANG)
BAYI
HEPATITIS B UNIJECT
TANGGAL
NO NAMA CAMPAK/ DPT HB DPT HB
LAHIR HB <24 HB 0-7 Hari HIB 1
MR HIB 2
JAM

1 2 3 15 16 17 18 19

1
2
3
4
5
6
7
8
9
10
 HASIL IMUNISASI
HASIL IMUNISASI
RUMAHRUMAH
SAKIT /SAKIT
KLINIK
/ KLINIK
/ DOKTER
/ DOKTER
SPESIALIS
SPESIALIS
ANAK /ANAK
BIDAN/ PRAKTE
BIDAN
NAMA PRAKTEK :
BULAN :
TAHUN :
DI ISI TANGGAL PEMBERIAN VAKSIN / PENYUNTIKAN (BUKAN DICENTANG)
ANAK WUS VAKSIN BAYI (NON PEMERINTAH)

TANGGAL Infanrif
NO NAMA DPT HB DPT HB CAMPAK/ HIB Infanrif Tetract
LAHIR IPV HIB MR TT Engerix B Euvax B DTP HIB Pediacel Infanrix
HIB 3 BOOSTER BOOSTER (DPaT- HIB IPV HIB
HiB)

1 2 3 20 21 22 23 24 25 26 27 28 29 30 31 32 33

1
2
3
4
5
6
7
8
9
10

Mengetahui,
Kepala .........................

(NAMA)
H SAKIT / KLINIK / DOKTER SPESIALIS ANAK / BIDAN
HASIL
PRAKTEK
IMUNISASI
MANDIRI
RUMAH SAKIT / KLINIK / DOKTER SPESIA
NAMA PRAKTEK :
BULAN :
TAHUN :

VAKSIN BAYI (NON PEMERINTAH)

TANGGAL
NO NAMA
LAHIR Trimovax MMR Tetagam HB Vax Act Hib

1 2 3 34 35 36 37 38

1
2
3
4
5
6
7
8
9
10
 HASIL IMUNISASI RUMAH SAKIT / KLINIK / DOKTER SPESIALIS ANAK / BIDAN PRAK
NAMA PRAKTEK :
BULAN :
TAHUN :
Wajib di Isi DI ISI TANGGAL PEMBERIAN VAKSIN / PENYUNTIK
ALAMAT

TANGGAL JENIS
NO NAMA NAMA / KELURAHAN** KECAMATAN
LAHIR KELAMIN NAMA BCG POLIO 1 POLIO 2 POLIO 3 POLIO 4
NOMOR NOMOR
JALAN RUMAH
GANG

1 2 3 4 5 6 7 8 9 10 11 12 13 14

1
2
3
4
5
6
7
8
9
10

*Untuk vaksin yang mandiri mohon untuk tetap di isi sesuai pemakaian
T / KLINIK / DOKTER SPESIALIS ANAK / BIDAN PRAKTEK
HASIL IMUNISASI
MANDIRI RUMAH SAKIT / KLINIK / DOKTER SPESIALIS
NAMA PRAKTEK :
BULAN :
TAHUN :
DI ISI TANGGAL PEMBERIAN VAKSIN / PENYUNTIKAN (BUKAN DICENTANG)
BAYI
HEPATITIS B UNIJECT
TANGGAL
NO NAMA CAMPAK/ DPT HB DPT HB
LAHIR HB <24 HB 0-7 Hari HIB 1
MR HIB 2
JAM

1 2 3 15 16 17 18 19

1
2
3
4
5
6
7
8
9
10
 HASIL IMUNISASI
HASIL IMUNISASI
RUMAHRUMAH
SAKIT /SAKIT
KLINIK
/ KLINIK
/ DOKTER
/ DOKTER
SPESIALIS
SPESIALIS
ANAK /ANAK
BIDAN/ PRAKTE
BIDAN
NAMA PRAKTEK :
BULAN :
TAHUN :
DI ISI TANGGAL PEMBERIAN VAKSIN / PENYUNTIKAN (BUKAN DICENTANG)
ANAK WUS VAKSIN BAYI (NON PEMERINTAH)

TANGGAL Infanrif
NO NAMA DPT HB DPT HB CAMPAK/ HIB Infanrif Tetract
LAHIR IPV HIB MR TT Engerix B Euvax B DTP HIB Pediacel Infanrix
HIB 3 BOOSTER BOOSTER (DPaT- HIB IPV HIB
HiB)

1 2 3 20 21 22 23 24 25 26 27 28 29 30 31 32 33

1
2
3
4
5
6
7
8
9
10

Mengetahui,
Kepala .........................

(NAMA)
H SAKIT / KLINIK / DOKTER SPESIALIS ANAK / BIDAN
HASIL
PRAKTEK
IMUNISASI
MANDIRI
RUMAH SAKIT / KLINIK / DOKTER SPESIA
NAMA PRAKTEK :
BULAN :
TAHUN :

VAKSIN BAYI (NON PEMERINTAH)

TANGGAL
NO NAMA
LAHIR Trimovax MMR Tetagam HB Vax Act Hib

1 2 3 34 35 36 37 38

1
2
3
4
5
6
7
8
9
10