Blangko Penjaringan '22

PENJARINGAN KESEHATAN ANAK SEKOLAH
PUSKESMAS PURWANTORO I TAHUN 2022
NAMA SEKOLAH : MIM SANGGRONG

KELAS :I
JENIS KELAMIN KELUHAN

NAMA SISWA NIK SISWA TGL LAHIR SISWA NO HP BB TB ISPA ( Infeksi Saluran
NO L P Pernafasan
GIGI & MULUT PANCA INDRA
1 2 3 4 5 6 7 8 9 10 11 12
1 Aliya Naysila Putri 3312176609140001 26/09/2014 082133928359 P 20 110 - - -
2 Alma Nur Aulia 3312174904150001 9/4/2015 087822267306 P 16 115 - - -
3 Alula Shakila Prasayunindya 3312166610150001 26/10/2015 082134332520 P 28 122 - - -
4 Arjuna Putra Wiyono 3577030512140002 26/10/2015 082134332520 L 30 122 - - -
5 Arkananta Farras Pradipta 3312172201150001 22/01/2015 081393074271 L 30 120 - - -
6 Aufaa Yuan Early 3312176709140001 27/09/2014 082250340245 P 25 125 - - -
7 Bhilqis Rahma Ashilla 3312176301150001 23/01/2015 08816611639 L 22 120 - - -
8 Brayen Hexsel Ferdinansyah 3312171702150002 17/2/2015 085280862762 L 25 115 - - -
9 Bulan Syahputri 3312174101150002 1/1/2015 081227903032 P 22 118 - - -
10 Fadhil Yaqdan Nasrulloh 3312173112140002 31/12/2014 089523058905 L 40 134 - - -
11 Fadhlan Naufal Adytama 3312170301150001 3/1/2015 081905405890 L 25 120 - - -
12 Faris Azka Robbani 3372022403140001 24/03/2014 085799567844 L 19 123 - - -
13 Fikri Aditya Zidane 3312173107140001 31/07/2014 081336979327 L 41 130 - - -
14 Khaton Maulana Iansyah 3312172503150001 25/3/2015 081332081866 L 25 117 - - -
15 Lailatul Munawaroh 3312176204140001 22/04/2014 087812564936 P 27 120 - - -
16 Lintang Dwi Oktaviano 3312172610140001 26/10/2014 085225003432 L 45 125 - - -
17 Muhammad Rafi Nizam Wardana 3312170608140001 6/8/2014 089518180885 L 15 104 - - -
18 Novita Anggun Nurcahya 3312174811140002 8/11/2014 081227900126 P 27 120 - - -
19 Rafa Arifianto 3312171706150003 17/06/2014 088239791128 L 25 119 - - -
20 Raffa Faid Faeyza Fattah 3312170911140001 9/11/2014 081804564509 L 23 120 - - -
21 Raissa Dhea Pavita Putri 3312177108140001 31/8/2014 P 30 120 - - -
22 Wistara Naufal Rabbani 3312171505140002 15/5/014 081227900466 L 24 119 - - -
NB KOLOM
10 : ex , Sakit Batuk,Pilek,Panas
11 : ex, Karies ( gigis,gigi berlubang), Sariawan,amandel
12: ex, Pakai kaca mata ( -/+, silinder), gangguan pendengaran
KET
KULIT
13 14

KELAS : II

NO NAMA SISWA NIK SISWA TGL LAHIR NO HP SISWA BB TB
L P ISPA ( Infeksi Saluran GIGI & MULUT
Pernafasan
1 2 3 4 5 6 7 8 9 10 11
1 Adil Jaya Atmanegara 3312172210130001 22/10/2013 082233560915 L 25 117 pilek -
2 Aditya Putra Pratama 3312161512130001 15/12/2013 088220049120 L 19 115 - -
3 Andreansyah Tegar Trihambodho 3312170808130001 8/8/2013 088806706642 L 32 135 batuk pilek -
4 Anggun Revina Puspita 3312175905130001 19/05/2013 082322911294 P 21 125 - -
5 Aqilah Amiedy Aljihani 3312174610130001 6/10/2013 082325694606 P 26 125 - -
6 Aqilah Assyifatu Haifa 3312175505140002 15/5/2014 0882006237162 P 25 118 - -
7 Aqilla Novita Putri 3312175311130001 13/11/2013 081228552608 P 20 114 - berlubang
8 Arif Maulana Prasetyo 3312171101140002 11/1/2014 081252670329 L 21 114 - -
9 Auliya Agustina 3312175208130002 12/8/2013 0882005565596 P 35 120 - -
10 Ayyana Ananda Azzahwa 3312174309130003 3/9/2013 085234923292 P 37 120 - berlubang
11 Desta Andika Prasetya 3312162912130001 29/12/2013 081215009592 L 20 120 - -
12 Fabian Kyenza Al Farro 3522042202140002 22/02/2014 08818678823 L 20 135 pilek gigis
13 Faezha Akdan Arziki 3312170905140001 9/5/2014 082133740182 L 23 114 pilek gigis
14 Geoverrel Khenzo Pratama 3312172604140001 26/04/2014 085232947880 L 32 128 pilek gigis
15 Isna Faiza Rahmadani 3312175007130001 10/7/2013 08812839721 P 42 127 - berlubang
16 Izzan Amsyar Hafiz Asrofi 3312162209130001 22/09/2013 082313251549 L 20 110 batuk pilek -
17 Kaka' Taulanie 3312172408133000 24/08/2013 0882006557477 L 23 125 - -
18 Khayyana Anindiya Azzahra 3312174309130002 3/9/2013 085234923292 P 38 120 batuk pilek gigis
19 Lathifa Qothrun Nada 3312166507130001 25/7/2013 082325687321 L - -
20 Marsya Maulida Azzahra 3312174901140002 9/1/2014 0881024306451 P 20 124 batuk pilek gigis
21 Muhammad Azka Nailul Asyrofi 3312161204140001 12/4/2014 081238652615 L - -
22 Muhammad Iqbal 3312171909130001 19/09/2013 081357763326 L 48 130 - -
23 Nurun Nabilaturrohmah 3312166411130002 24/11/2013 081325419213 P 26 124 batuk berlubang
24 Ridwan Bagus Saputra 3312172811130002 28/11/2013 08819383821 L 24 115 - -
25 Rifqi Nugraha 3312170906130002 9/6/2013 082235024339 L 40 131 batuk berlubang
26 Rizal Febrian Setyawan 3312171802140002 18/2/2014 085285111574 L 38 130 - -
27 Sabrina Citra Aulia 3312174402140001 4/2/2014 085326183970 P 25 130 - -
28 Teuku Reyhan Alfarizy 3312172907130001 29/07/2013 085229130513 L 20 115 pilek berlubang
29 Tirta Adelia Bunga Lestari 3312176407140001 24/7/2014 081226672012 L 25 115 - gigis
30 Vania Nur Khairinnisa 3312174311130002 3/11/2013 088226710893 P 25 120 pilek gigis
31 Zalfa Nadia Akhyar 3312175103140001 11/3/2014 081246139115 P 20 125 pilek berlubang
NB KOLOM
UHAN
KET
PANCA INDRA
12 13
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-

KELAS : III

NAMA SISWA NIK SISWA TGL LAHIR SISWA NO HP SISWA BB TB
NO Pernafasan
1 2 3 4 5 6 7 8 9 10 11
1 Ahmad Fadil Ardiansyah 3312172106130001 21/6/2013 081910869282 L 38 127 - -
2 Ahhmad Irham Hakim Asrofi 3312162903120001 29/03/2012 082313251549 L 20 110 - -
3 Alinka Febby Prasetyanti 3310226302130001 23/02/2013 082210081211 P 25 125 - -
4 Aqhmal Viccky Pradana 3312171305130001 13/05/2013 082227226445 L 30 128 - -
5 Athif Dhiya Aldin Asyafi 1802233101130001 31/1/2013 085230881020 L 27 126 - -
6 Aulia Diva Septiana 3312176509130001 25/09/2013 085293805100 P 19 124 - -
7 Callista Ivana Niti Prita 3312175407130001 14/7/2013 081225858286 P 26 153 - -
8 Delima 3312175603120001 16/03/2012 081390145521 P 20 120 - -
9 Farel Eka Pratama 3312161002130002 10/2/2013 085932948660 L 19 120 - -
10 Kenzo Amuzha 3172042406121002 24/06/2012 082111278617 L 34 130 - -
11 Khayla Salfa Hamzah 3275045305130002 13/5/2013 081239380926 P 24 124 - -
12 Kindi Hanifa 3312174604140003 6/4/2014 08813729304 P 20 120 - gigis
13 Kiyan Adi Perwira 3312161007120003 10/7/2012 08882588459 L 38 127 - -
14 Muhammad Aziz Abimayu 3312170607120001 6/72012 088239049409 L 40 125 gejala asma -
15 Muhammad Fajar Rizki 3312163101130002 31/01/2013 083147013076 L 37 133 - -
16 Muhammad Reza Ainurrofiq 3312162907120001 29/07/2012 085200225234 L 35 150 - -
17 Nabila Fa'iza Arifin 3312166311120001 23/11/2012 085692325131 P 26 116 - -
18 Nafiza Muazara Destiani 3312174212130001 2/12/2013 082322476900 P 25 152 - -
19 Nimas Aurora 3312176412120001 24/12/2012 088224270922 P 33 130 asma -
20 Nungki Larasati 3312175305120001 13/05/2012 081225691875 P 22 125 - -
21 Pinasti Maharani 3312175809120001 18/09/2012 081336256861 P 19 120 sesak nafas -
22 Raffa Nur Wahid 3312172706130001 27/06/2013 085230598236 L 28 133 - -
23 Rasya Arbiansyah 3312172105130000 21/05/2013 088238993549 L 29 126 - -
24 Ridho Ramadhan Saputra 3312221308120001 13/08/2012 081249223648 L 23 127 - -
25 Riya Puspita 3312174205120002 2/5/2012 082138097460 P 30 130 - -
26 Satria Irgo Dirgantara 3312172905120003 29/05/2012 088806824858 L 29 140 - -
27 Zahra Amira Rahmani 3312176506130002 25/06/2013 082322638846 P 43 133 - -
28 Zenyta Dwi Oktavia 3312176810120001 28/10/2012 087802498718 P 30 121 - -
NB KOLOM
UHAN
KET
PANCA INDRA
12 13
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-

KELAS : IV

NO NAMA SISWA NIK SISWA TGL LAHIR NO HP BB TB
Pernafasan
1 2 3 4 5 6 7 8 9 10 11
1 Alrizqy Nouval Darma Rodzakhi '3312172708110002 27/08/2011 081225344527 L 57 150 - berlubang
2 Arlen Ardinata Defo Harmono '3312161801120001 18/01/2012 082322104717 L 41 135 - -
3 Dafit Adiwitia Saputra '3312172804110001 28/4/11 081339426463 L 28 120 - -
4 Elin Septhaaindhita '3312176009110002 11/9/2012 088233991334 P 38 95 - -
5 Fania Nofellin '3506245311110002 13/11/2011 085271061043 P 25 120 - -
6 Ghesta Putra Marfianda '3312172007110002 21/07/2011 085326992658 L 38 100 - berlubang
7 Ilham Muhammad Fadli '3312172702120001 27/2/2012 081228996246 L 22 126 - -
8 Insani Ciziana Nur Fauzy '3312174803120001 8/3/2012 082337881604 P 30 140 Asma -
9 Jaa Jia Eeis '3312171010110001 10/10/2011 088238348706 L 25 131 - berlubang
10 Khoirun Nisa Wahyu Azahra '3312175406110002 14/6/2011 081297025077 P 28 128 - berlubang
11 Luqman Khoirul An'am '3312171206110001 12/6/2011 085234968936 L 30 130 - berlubang
12 Muhamad Ilham Maulana '3312161602120002 16/02/2012 085234073499 L 37 110 - berlubang
13 Muhammad Alif Muzzaqhi '3312160105120001 1/5/2012 085291975902 L 36 130 - berlubang
14 Muhammad Fatkhur Rozzy '3312161203120003 12/3/2012 081231957118 L 55 135 - -
15 Nuryl Khoiriyah '3312174704120003 7/4/2012 081779810538 P 27 130 - berlubang
16 Rama Raditya Pratama '3312170903120001 9/3/2012 081227535725 L 24 131 - berlubang
17 Rita Sabrina '3312174603120003 6/3/2012 081390230804 P 20 123 - -
18 Rizky Rahmanda Saputra '3312170910110001 9/10/2011 088215782925 L 29 132 - -
19 Roihana Rihadatul Aisya '3312177103120003 31/03/2012 085647837517 P 30 130 - -
20 Zahrotus Syifa Apriliantika '3312176904120001 29/04/2011 081226183476 P 21 125 - berlubang
NB KOLOM
UHAN
KET
PANCA INDRA
12 13
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-

KELAS : : VA
JENIS KELAMIN
L P
1 2 3 4 5 6 7 8 9
1 Angelina Firdaus '3312174709100001 7/9/2010 082329515088 P 25 136
2 Anissa Nur Fadillah '3312176202110001 22/02/2011 081225843252 P 47 147
3 Aryan Ahmad Ubaidillah '3312172010100003 20/10/2010 082298740036 L 35 130
4 Azizah Wahidaturrohmah '3312175111110001 11/11/2011 081259177690 P 24 130
5 Bagas Hadi Prasetyo '3502051405110001 14/05/2011 081252161227 L 52 150
6 Danish Ahza Robbani '3372022510100001 25/10/2010 085643819530 L 31 150
7 Ferdian Wahyu Pratama '3312170602110001 6/2/2011 082242278284 L 35 141
8 Isnandar Putra Prasetya '3312170803110001 8/3/2011 087804958177 L 57 152
9 Lorinsta Syaraphova '3312175701110001 17/01/2011 081227841446 P 31 135
10 Marcheila Fauziah Rahma Ristaliana '3322175501110002 15/01/2011 085669566660 P 30 139
11 Muhammad Akbar '3312170708100001 7/8/2010 08818551773 L
12 Muhammad Hafizh Abdullah Ahmad '3175011712101004 17/12/2010 088232901006 L 53 153
13 Naufal Dharma Pratama '3312170709110001 7/9/2011 081392070437 L 49 140
14 Rafka Ardiansyah '3312171303110003 13/3/2011 087718084125 L
15 Revano Putra Pratama '3312171209100002 12/9/2010 081327451909 L
16 Sifa Rahidhatul Ais '3312174212100001 2/12/2010 08814180932 P 28 132
17 Yesika Maharani '3312175605110002 16/05/2011 082329453559 P 50 135
18 Zahra Adzkiatunnisa '3312174101110001 1/1/2011 088216689126 P 30 136
19
20
NB KOLOM
KELUHAN
ISPA ( Infeksi Saluran KET
Pernafasan GIGI & MULUT PANCA INDRA
10 11 12 13

KELAS : VB

Pernafasan
1 2 3 4 5 6 7 8 9 10 11
1 Aditya Nurdiansyah '3312172101110001 21/01/2011 081353613624 L 27 128
2 Aliffia Bela Maharani '3312175409110002 14/09/2011 085281698623 P 28 133
3 Andika Setyawan '3312170312100001 3/12/2010 082337921620 L 30 139
4 Aninda Zahra Alifahrani '3312176310100001 23/10/2010 081906856595 P 35 143
5 Arista Nazahla Putri '3312176503110001 25/03/2011 081227254034 P 45 134
6 Ghina Sayyidah D '3312176011100003 20/11/2010 081227947528 P 25 136
7 Karisma Rahmadany '3312176208100001 22/08/2010 082228074890 P 39 145
8 Lukman Priambudi '3312171106100002 11/6/2010 085234968936 L
9 Merlia Nadira Putri '3374165507110001 15/07/2011 0877 7997 7491 P 34 138
10 Muhammad Yusuf R '3312170509100001 5/9/2010 082135592544 L 50 145
11 Nicolas Dwi Saputra '3305080904110001 9/4/2011 081226868857 L 38 54
12 Rendy Saputra '3312171006100002 10/6/2010 0882 1487 4858 L 30 147
13 Riski Ramaputra M '3312172312100001 23/12/2010 085225004486 L
14 Wahdatul Nur Pratiwi '3312176910110001 22/10/2011 085291133646 P 45 135
15 Zhahira Shahwa Nafidha '3312174702110001 7/2/2011 081294538718 P 30 143
16 Lutfi putra ramadan '3312161508110002 15/08/2011 085335988446 L 23 57
NB KOLOM
UHAN
KET
PANCA INDRA
12 13

KELAS : IV
JENIS KELAMIN ISPA ( Infeksi KELUHAN

NO NAMA SISWA NIK SISWA NO HP SISWA TGL LAHIR BB TB Saluran
L P Pernafasan GIGI & MULUT
1 2 3 4 5 6 7 8 9 10 11
1 Afarrel El Navaka HP '3312170603090001 087824208523 6/3/2009 L
2 Allisa Asanisa Nur KH '3312175403100001 083166358005 24/03/2010 P 31 144
3 Bintang Adhi Rully Rahman '3312170906090001 081227903266 9/6/2009 L 28 133
4 Cahyo Panji Dermawan 3312172408090001 085330785253 24/8/2009 L
5 Callista Queen Azzahra '3312176708090001 08814157376 27/08/2009 P 40 152
6 Daryuz Octa Anggara '3312171310090002 088886531697 13/10/2009 L
7 Dea Amarta '3312176003100001 082005634397 20/09/2021 P 60 148
8 Dwi Aisyah Ramadhani '3271066308100002 088806006883 23/08/2010 P 40 153
9 Faiz Firmansyah '3312170706100001 082272016424 7/6/2010 L 28 130
10 Fanesya Putri Ramadhani '3312177008090001 082136948140 30/08/2021 P 38 148
11 Kartika Sitia Bella '3312177011090002 085327151053 30/11/2021 P 30 132
12 Lucky Ardiansyah '3312170906100002 081227534150 9/6/2010 L
13 Lulu Veronica Putri '3312177012090001 081392853203 29/12/2010 P
14 Miftakhul Ganneza Queen '3312256511090001 085330800287 25/11/2009 P 28 137
15 Muchamad Iqbal Al Maudodi '3312170309090001 082323468284 3/9/2009 L 40 135
16 Muhammad Nur Aziz M '3312171701100001 081227907735 17/01/2010 L 34 160
17 Muhammad Raka Pambudi '3312172511080002 082138431021 26/09/2008 L 63 164
19 Natasya Fitria Almahira '3312176809090003 082329717122 25/09/2009 P 37 140
20 Naufal Ikbar Maulana '3312170807100002 089518180890 8/7/2010 L 42 145
21 Rafida Sekar Pambayun '3312175312100002 081357096598 10/12/2021 P 35 143
22 Safitri '3312177007100001 082133840892 30/06/2010 P 40 145
23 Sofyan Aqdamana '3312172103100001 085227068119 21/03/2010 L 27 141
24 Vian Ardiansah '3312170506100002 081228002459 5/6/2010 L
25 Vivit Setyowati '3312176501100001 082133928359 25/01/2010 P 38 140
26 Winda Hidayatul Fitriana '3312174402100001 082325410676 4/2/2010 P 31 146
27 Zanuarta Dika Pratama '3312171001100001 081326162630 10/1/2010 L 37 144
29 Ahmat Rifa'i '3312162601100001 081218997215 26/01/2021 L 68 155
30 Rizqi Maulana Akram '3174012602091000 085875589389 26/02/2009 L 25 130
31 Pria Genggam Linggar AP '3312170605090001 088805489188 6/5/2009 L
32 Ferdiant Satria Wijaya '3515131901100006 081332780412 19/01/2010 L 34 145
NB KOLOM
UHAN
KET
PANCA INDRA
12 13

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PENJARINGAN KESEHATAN ANAK SEKOLAH

PUSKESMAS PURWANTORO I TAHUN 2022

NAMA SEKOLAH : MIM SANGGRONG

JENIS KELAMIN KELUHAN

NAMA SEKOLAH : MIM SANGGRONG

JENIS KELAMIN KELUHAN

NAMA SEKOLAH : MIM SANGGRONG

JENIS KELAMIN KELUHAN

NAMA SEKOLAH : MIM SANGGRONG

JENIS KELAMIN KELUHAN

NAMA SEKOLAH : MIM SANGGRONG

NAMA SEKOLAH : MIM SANGGRONG

JENIS KELAMIN KELUHAN

NAMA SEKOLAH : MIM SANGGRONG

JENIS KELAMIN ISPA ( Infeksi KELUHAN

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