I.

pengenalan tempat

4. nama puskesmas
2. kabupaten/kota

5. desa/kelurahan
3. kecamatan
1. provinsi

6. RT/RW
NO

1 Jambi Kota Jambi Kota Baru Pal X Kenali Asam Bawah RT24

2 Jambi Kota Jambi Kota Baru Pal X Kenali Asam Bawah RT24

3 Jambi Kota Jambi Kota Baru Pal X Kenali Asam Bawah RT 24

4 Jambi Kota Jambi Kota Baru Pal X Kenali Asam Bawah RT 24

5 Jambi Kota Jambi Kota Baru Pal X Kenali Asam Bawah RT 24

6 Jambi Kota Jambi Kota Baru Pal X Kenali Asam Bawah RT 24

7 Jambi Kota Jambi Kota Baru Pal X Kenali Asam Bawah RT 24

8 Jambi Kota Jambi Kota Baru Pal X Kenali Asam Bawah RT 24

9 Jambi Kota Jambi Kota Baru Pal X Kenali Asam Bawah RT 24

10 Jambi Kota Jambi Kota Baru Pal X Kenali Asam Bawah RT 24

11 Jambi Kota Jambi Kota Baru Pal X Kenali Asam Bawah RT 24

12 Jambi Kota Jambi Kota Baru Pal X Kenali Asam Bawah RT 24

13 Jambi Kota Jmbi Kota Baru Pal X Kenali Asam Bawah RT 24

14 Jambi Kota Jambi Kota Baru Pal X Kenali Asam Bawah RT 24

15 Jambi Kota Jambi Kota Baru Pal X Kenali Asam Bawah RT 24

16 Jambi Kota Jambi Kota Baru Kenali Asam Bawah RT 24

17 JAMBI kota jambi kota baru kenali asam bawah RT 24

18 JAMBI kota jambi kota baru kenali asam bawah rt 24

19 jambi kota jambi kota baru kenali asam bawah rt 24

20 jambi kota jambi kota baru kenali asam bawah rt 24

0:00 Jambi Jambi Kota Baru Paal X Kenali Asam Bawah RT 24

22 Jambi Jambi Kota Baru Paal X Kenali Asam Bawah RT 24

23 Jambi Jambi Kota Baru Paal X Kenali Asam Bawah RT 24

24 Jambi Jambi Kota Baru Paal X Kenali Asam Bawah RT 24

25 Jambi Jambi Kota Baru Paal X Kenali Asam Bawah RT 24

26 Jambi Jambi Kota Baru Paal X Kenali Asam Bawah RT 24

27 Jambi Kota Jambi Kota Baru Pal X Kenali Asam Bawah RT 24

28 Jambi Kota Jambi Kota Baru Pal X Kenali Asam Bawah RT 24

29 Jambi Kota Jambi Kota Baru Pal X Kenali Asam Bawah RT 24

30 Jambi Kota Jambi Kota Baru Pal X Kenali Asam Bawah RT 24

31 Jambi Kota Jambi Kota Baru Pal X Kenali Asam Bawah RT 24

32 Jambi Kota Jambi Kota Baru Pal X Kenali Asam Bawah RT 24

33 Jambi kota Jambi kota Baru Pal X Kenali Asam Bawah RT 24

34 Jambi Kota Jambi Kota Baru Pal X Kenali Asam Bawah RT 24

35 Jambi Kota Jambi Kota Baru Pal X Kenali Asam Bawah RT 24

36 Jambi Kota Jambi Kota Baru Pal X Kenali Asam Bawah RT 24

37 Jambi Kota Jambi Kota Baru Pal X Kenali Asam Bawah RT 24

38 Jambi Kota Jambi Kota Baru Pal X Kenali Asam Bawah RT 24

39 Jambi Kota Jambi Kota Baru Pal X Kenali Asam Bawah RT 24

40 Jambi Kota Jambi Kota Baru Pal X Kenali Asam Bawah RT 24

41 Jambi Kota Jambi Kota Baru Pal X Kenali Asam Bawah RT 24

43 Jambi Kota Jambi Kota Baru Pal X Kenali Asam Bawah RT 24

44 Jambi Kota Jambi Kota Baru Pal X Kenali Asam Bawah RT 24

45 Jambi Kota Jambi Kota Baru Pal X Kenali Asam Bawah RT 24

46 Jambi Kota Jambi Kota Baru Pal X Kenali Asam Bawah RT 24

47 Jambi Kota Jambi Kota Baru Pal X Kenali Asam Bawah RT 24

48 Jambi Kota Jambi Kota Baru Kenali Asam Bawah RT 24

49 Jambi Kota Jambi Kota Baru Kenali Asam Bawah RT 24

50 Jambi Kota Jambi Kota Baru Kenali Asam Bawah RT 24

51 Jambi Kota Jambi Kota Baru Kenali Asam Bawah RT 24

52 Jambi Kota Jambi Kota Baru Kenali Asam Bawah RT 24

53 Jambi Kota Jambi Kota Baru Kenali Asam Bawah RT 24

54 Jambi Kota Jambi Kota Baru Kenali Asam Bawah RT 24

55 Jambi Kota Jambi Kota Baru Kenali Asam Bawah RT 24

56 Jambi Kota Jambi Kota Baru Kenali Asam Bawah RT 24

57 Jambi Kota Jambi Kota Baru Kenali Asam Bawah RT 24

58 Jambi Kota Jambi Kota Baru Pal X Kenali Asam Bawah RT 24

59 Jambi Kota Jambi Kota Baru Pal X Kenali Asam Bawah RT 24

60 Jambi Kota Jambi Kota Baru Pal X Kenali Asam Bawah RT 24

61 Jambi Kota Jambi Kota Baru Pal X Kenali Asam Bawah RT 24

62 Jambi Kota Jambi Kota Baru Pal X Kenali Asam Bawah RT 24

63 Jambi Kota Jambi Kota Baru Pal X Kenali Asam Bawah RT 24

64 Jambi Kota Jambi Kota Baru Kenali Asam Bawah RT 24

65 Jambi Kota Jambi Kota Baru Kenali Asam Bawah RT 24

66 Jambi Kota Jambi Kota Baru Kenali Asam Bawah RT 24

67 Jambi kota Jambi Kota Baru Kenali Asam Bawah RT 24

68 Jambi Kota Jambi Kota Baru Kenali Asam Bawah RT 24

69 Jambi KOTA JMABI KOTA BARU PAL X KENALI ASAM BAWAH RT 24

70 JAMBI KOTA JAMBI KOTA BARU PAL X KENALI ASAM BAWAH RT 24

71 JAMBI Kota Jambi KOTA BARU PAL X KENALI ASAM BAWAH RT 24

72 JAMBI KOTA JAMBI KOTA BARU PAL X KENALI ASAM BAWAH RT 24

73 JAMBI KOTA JAMBI KOTA BARU PAL X KENALI ASAM BAWAH RT 24

74 JAMBI KOTA JAMBI KOTA BARU PAL X KENALI ASAM BAWAH RT 24

75 Jambi Kota Jambi Kota Baru Pal X Kenali Asam Bawah RT 24

76 Jambi Kota Jambi Kota Baru Pal X Kenali Asam Bawah RT 24

77 JAMBI Kota Jambi Kota Baru Pal X kenali Asam Bawah RT 24

78 JAMBI Kota Jambi Kota Baru Pal X Kenali Asam Bawah RT 24

79 JAMBI Kota Jambi Kota Baru Pal X Kenali Asam Bawah RT 24

80 Jambi Kota JambiKota Baru Pal XKenali Asam BawahRT 24

81 Jambi Kota JambiKota Baru Pal XKenali Asam BawahRT 24

82 Jambi Kota JambiKota Baru Pal XKenali Asam BawahRT 24

83 Jambi Kota JambiKota Baru Pal XKenali Asam BawahRT 24

84 Jambi Kota JambiKota Baru Pal XKenali Asam BawahRT 24

85 Jambi kota JambiKota Baru PalXKenali Asam BawahRT 24

86 Jambi Kota Jambi Kota Baru Kenali Asam Bawah RT 24

87 Jambi Kota Jambi Kota Baru Kenali Asam Bawah RT 24

88 Jambi Kota Jambi Kota Baru Kenali Asam Bawah RT 24

89 Jambi Kota Jambi Kota Baru Kenali Asam Bawah RT 24

90 Jambi Kota Jambi Kota Baru Kenali Asam Bawah RT 24

 II. Keterangan rumah tangga
2. Jumlah anggota rumah tangga

e. jumlah ART usia 10 - 54 tahun

c. jumlah ART usia 12-59 bulan

f. jumlah ART usia 0-11 bulan

b. jumlah ART dewasa (> 15)

d. jumlah ART diwawancara

3. sarana air besih

a. jumlah ART
1. Nama KK

BENI HENDRO 3 2 1 2 1 1

TRISUNU 3 3 1 3 1

NUKMAN 5 5 1 5 1

RICO 4 2 1 2 1

SYARIAL 4 4 1 4 1

Akhmad Suarsa 4 3 2 4 1

Mahariyan Diika S 2 2 2 2 1

Jumhadi 4 3 2 2 1

Hasan Basri Harun 2 2 1 1

Hesni Fikri 4 2 1 3 1
M. RAMADHAN 4 2 1 1 2 1

A. ROY 4 4 1 4 1

SAIFUL ISLAM 2 2 1 2 1

IDRUS 2 1 1 2 1

DEDI A 5 2 1 1 2 1

HERI RAHIM 5 5 1 5 1

DOMI 3 2 1 2 1

fx toto waluyo 4 4 1 4 1

arwinsyah 4 3 1 3 1

bernardus 5 2 1 4 1

1
Reno Zahrofi 5 5 1 4 1
 Teguh 6 6 1 3 1

Saipul Anwar 4 3 1 3 1

Zulkisman 4 2 1 3 1

Syaripudin 3 3 1 3 1

Arief Komarudin 6 3 1 4 1

M. HARIS 5 5 1 5 1

ERWINSYAH 4 2 2 2 1

LILI SETIAWAN 4 3 1 4 1

PAIRIN 4 2 1 2 1

ZUSSEVIA HENDRA 4 3 1 3 1

KHRISTIAN M 4 3 1 4 1
 AIDIL FITRA 3 2 1 2 1 1

ADIOS EFENDI 4 2 1 3 1

AHMAD RIAN 5 3 1 5 1

MUSTAKIM 5 4 1 5 1

Zulkarnain Zaini 4 4 1 4 1

Andri Saputra 3 2 1 3 1

Nata Kesuma 4 2 1 2 1

Makmur 3 3 1 3 1

Abu Bakar Sidiq 5 5 1 5 1

MEISWENDRI 6 2 1 3 1

KOMERI 3 3 1 4 1
 BUDIYONO 4 3 1 3 1

HERAWATI 4 2 1 1 2 1

WILPEN SIMAJUNTAK 7 4 1 5 1

SYAHARUDDIN. AK 2 2 1 1

PARWADI 4 3 3 1 3 1

DEDI 4 2 0 1 2 1 1

ARDLI ALFIANSYAH 4 2 2 1 2 1

SUPARMI 2 1 1 2 1

Zulkifli B. 5 5 1 3 1
1
1
1
1
Silvia Marnita 1 1 1 1 1
Eijgenius Da Costa 4 2 1 3 1
1
1
1
Rajema 3 2 1 1 1
1
1
Beng Siswanto 3 2 1 1 2 1
1
1
ARONI 3 3 1 3 1
 Syahrial 4 4 1 4 1

HARMEN 7 1 5 6 1 1

HARTATI 3 1 3 3 1

TOBING ERIKA 3 1 1 4 2

CIK AZIS 3 1 3 3 1

RIDUAN SYARIF 4 3 1 3 1

SAMANI 3 3 1 3 1

ZALINUR 2 2 1 2 1

ROBERT ADIYANI ARDIANSYAH 2 2 1 2 1

HASAN 4 4 1 4 1

SABAR 3 2 1 3 1

SYARFI 4 2 1 2 2 1

PAULUS EFENDY 6 4 1 4 1
 KHRISTIAN 4 3 1 3 1

KRISAL TAMBA 5 3 1 1 4 1

DWI RESKI YOLAND 3 2 1 1 2 1

JUPRIAL 3 2 1 2 1

SOBLI 5 4 1 1 5 1

EDY SUYANTO 5 2 1 3 1

SYAKRODI 4 3 2 3 1

RIZON EKA PUTRA 3 3 1 3 1

Supradi 3 3 1 3 1

ZULKARNAIN 2 2 1 2 1

AULIA TRI P 4 2 1 1 2 1
A MUSLICH 5 4 2 4 1

JUFRI 3 3 1 1

RICO R P 4 2 1 3 1

DONI 5 5 1 5 1

DESPRIADI 4 4 1 4 1

CENDRA WARDI 5 2 1 3 1

DODY HUTMAN 6 3 1 1 4 1

HENDRA YUNALDI 5 3 1 5 1
h tangga IV. Kete

8. minum obat secara teratur (jika ia)

7. diagnosis sakit jiwa

9. ada ART dipasung

4. jenis sumber air

3. hubungan ART
6. jenis jamban
5. jamban

2. Nama
1 1 1 BENI HENDRO 1
SEPTIA ASKI 2
1 1 1 TRISUNNU 1
LISTU HAYU 2
REDHA PRATAMA 3
1 1 1 NUKMAN 1
AZINAR 2
FAIZAR RIZA 3
RENI ARNELA 3
NOVA 7
1 1 1 RICO 1
SARI 2
ANDRIESA 3
ANINDYA 3
1 1 1 SYARIAL 1
EMY 2
ANGELIANY 3
MUHAMMAD RIDHO 3
1 1 1 2 2 2 Akhmad Suarsa 1
Rini Afriana S 2
Yudhistira Pramanda 3
Bariq Nabil Permana 3
1 1 1 2 2 2 Mahariyan Dika S 1
Monica Astarii 2
1 1 1 2 2 2 Jumhadi 1
Rosida 2
Irfan Agustiam 3
Syahira Khairani 3
1 1 1 2 2 2 Hasan Basri Harun 1
Hartini 2
1 1 1 2 2 2 Hesni Fikri 1
Diyana 2
Muhammad Alfian 3
 Abdan Muhammad Khafif 3
2 1 1 2 2 2 M. RAMADHAN 1
LILIS SURYANU 2
M. MUKHLISIN 3
M. HARI SEPTIANSYAH 3
2 1 1 2 2 2 A. ROY 1
SAUNAH 2
YULI HASNA 3
ASMAH 6
2 1 1 2 2 2 SAIFUL ISLAM 1
HAMMAD M 3
2 1 1 2 2 2 IDRUS 1
UMMI NADIA 3
2 1 1 2 2 2 DEDI A 1
SITI AMINAH T 2
M. AZKA F S 3
M. EL GHIFARI S 3
MUNZIATISSABIQOH 3
2 1 1 2 2 2 HERI RAHIM 1
MAIMUNAH 2
REZZA ADE HERMANSYAH 3
NURIMA CINTIA 3
ZOLLA REFANI PUTRA 3

2 1 1 2 2 2 DOMI 1
MELANI ANGGITA NOVALISA 1
SITI AISYAH ZAHRATU 3

2 1 2 2 2 fx toto waluyo 1
enny heri yanty 2
eko pasetya 3
ade dwi sulistyo 3

2 1 1 2 2 2 arwinsyah 1
mardiana 2
mario satria 3
mareno alfiansyah 3

2 1 1 2 2 2 laurentius bernardus 1
marlina singgalinging 2
fabianus rizkymangulahi 3
grace maysel felicitas 3
hillarius kevin malau 3
1 1 1 2 Reno Zhrofi 1
Naimah 2
Muhammad Hipzi 3
Izmalina 3
Ummi Malika Umairoh 3
1 1 1 2 Teguh 1
Salamah 2
Febrianto 3
Gianto Hariwibowo 3
Taufik Rahman 3
Sopiah 6
1 1 1 2 Saipul Anwar 1
Paridah 2
Putri Mayang Sari 3
M. Fajri Syaputra 3
1 1 1 2 Zulkisman 1
Kartini 2
Sri Wahyu Zet 3
Muhammad Arief 4
M. Fadlan Rizki 5
1 1 1 2 Syaripudin 1
Eny Lisda 2
Erlangga Alif Pradana 3
1 1 1 2 Arief Komarudin 1
Wahyuni 2
Kaisar Rahman Wisesa 3
Arjun Ahsa 4
Muhammad Zulkarnain 5
Amiruddin 6
1 1 1 2 M.HARIS 1
SUSAN HARIYANTI 2
TANTY SEPTYANI 3
DENNIS NOFRANDO 3
MAHA PRADANA 7
1 1 1 2 ERWINSYAH 1
DWI WARTA AGUSTINA 2
NAISYAH HANNY 3
MUHAMMAD RISKY NABIL 3
1 1 1 2 LILI SETIAWAN 1
MERIANI 2
ADHITYA RAMADHAN SETIAWAN 3
RAFI AKBAR SETIAWAN 3
DZAKA MAULANA SETIAWAN 3
1 1 1 2 PAIRIN 1
APRIYANTI 2
ADRIANA SHENA 3
ARTHUR RAMADHAN 3
1 1 1 2 ZUSSEVIA HENDRA 3
MAHMUDAH HAYATI 3
AL FIANDRE 3
ALFIKRI ZILFA HANDRA 1
1 1 1 KHRISTIAN 1
 CHATERINE 2
GABRIELLA 3
MICHELLE 3
1 1 1 AIDIL FITRA 1
INDAH NOVIANTI 2
SAUQY AZMI 3
1 1 1 ADIOS EFENDI 1
KURNIATI 2
ADINI NUZULA 3
RAEESA AQILA 3
1 1 1 AHMAD RIAN 1
NELY NOVRITA 2
KIRANA 3
ABIMAYU 3
MUTIARA 3
1 1 1 MUSTAKIM 1
ROHAYATI 2
SITI HALIMAH 3
AGUSTINA 3
AHMAD ARIF 7
1 1 1 2 2 2 Zulkarnain Zaini 1
Rafiah 2
Riza Mardika 3
Dinda Dila Nazura 3
1 1 1 2 2 2 Andri Saputra 1
Okta Avia Syuryani 2
Kende Algan Noviansyah 3
1 1 1 2 2 2 Nata Kesuma 1
Yesi Usni 2
Igrin Prescila Yanci 3
M. Ibran Atila Yanci 3
1 1 1 2 2 2 Makmur 1
Susmawati 2
Pine Agnisza 3
1 1 1 2 2 2 Abu Bakar Sidiq 1
Bona Nadapdap 2
Rahmawati 3
Rahmat Syah 3
Rahmi Haafizhah 3
1 1 1 2 2 2 MEISWENDRI 1
INDRAWATI 2
NAYSHEILLA PUTRI SALSALBILAH WENDRA3
TEUKU MARCEL HARIANSYAH WENDRA 3
TEUKU MICHEL HARIANSYAH WENDRA 3
NEURELIA 3
1 1 1 2 2 2 ABAS 1
JUNAIDA 2
ADITIA PRATAMA 3
1 1 1 2 2 2 BUDIYONO 1
YUNIATI 2
RANTI EKA SAPUTRI 3
RISKI DWI SYAFIRA 3
1 1 1 2 2 2 HERAWATI 1
AYURA REIZKI 3
ASYRAF ALWAHDI 5
ASTYAR ALGIFRI 5
1 1 1 2 2 2 WILPEN SIMAJUNTAK 1
HISTORY S 2
RYON S 3
RAYNOLD S 3
LIA S 3
LENI S 3
KRISTIAN JUSTIN 3
1 1 1 2 2 2 SYAHARUDDIN. AK 1
YUNIDAR 2
1 1 1 2 2 2 PARWADI 1
MASITAH 2
HAIKAL ALPARIZI 3
ZAHWA AZZAHRA 3
1 1 1 2 2 2 DEDI 1
SILLYAH 2
ANGGRAINI 3
DAFA FEBRIANSYAH 3
1 1 1 2 2 2 ARDLI ALFIANSYAH 1
SUPRIYANTI 2
AULIA RAHMAN AL-HAKIM 3
FAQIH KHAIRY ARRAHMAN 3
1 1 1 2 2 2 SUPARMI 1
TINA JESSICA SITORUS 3
1 1 1 2 2 Zulkifli B 1
1 2 Siti Zawanis 2
1 2 Harry Azwan 3
1 2 Dwiki Andrian 3
1 2 Muhammad Araffy 3
1 1 1 2 2 Silvia Marnita 3
1 1 1 2 2 Eijgenius Da Costa 1
1 2 Cicilia Risa Wati 2
1 2 Yohanes Richard Gilbert 3
1 2 Chriswilda Margaretha De Papa 3
1 1 1 2 2 Rajema 1
1 2 M. Ikraan Al Awwalun 3
1 2 Amnah 4
1 1 1 2 2 Beng Siswanto 1
1 2 Mefri Susanti 2
1 2 Azqiara Putri Syakila 3
2 1 1 2 2 2 ARONI 1
 DARSIAH 2
HIDAYATUL ARDI 3
1 1 1 2 2 2 SYAHRIAL 1
ENY SUSANTI 2
ANGELINA SYAHMI 3
M. RIDHO R 3
1 1 1 2 2 2 HARMEN 1
INA ISNAYAN 2
HUSNUL ARIF 3
WIDYA MARISKA 3
M.RAFASYA ADITYA 3
IHPAN SYAHPUTRA 3
RENALDI 3
1 1 1 2 2 2 HARTATI 1
RIKO SAPUTRA 2
ROLANDO 3
1 1 1 2 2 2 TOBING ERIKA 1
MIKHAEL.G.P.SIRINGGO 2
ANA MARIA 3
1 1 1 2 2 2 CIK AZIS 1
ROHATI 2
M AR RAZAQ 3
1 1 1 2 2 2 RIDUAN SYARIF 1
SURAIYA 2
PUTRI RIA RANIAH RIDUAN 3
ATIQAH QADIRAH RIDUAN 3
1 1 1 2 2 2 SAMANI 1
SATIMAH 2
HARIS ZULPIKAR PAUZI 3
1 1 1 2 2 2 ZALINUR 1
FITRA HUMAIRA 2
1 1 1 2 2 2 ROBERT ADIYANI ARDIYANSYAH 1
SURYANI 6
1 1 1 2 2 2 HASAN 1
SITI MARYAM 2
AHMAT SAKIRIN 3
WAHYUDI 7
2 1 1 SABAR 1
SUWANTI 2
M.FADIL ZAKI 3
1 1 1 SYARFI 1
FARIDAH 2
AULIA AZZARA 3
DINDA MOZALIA 3
1 1 1 PAULUS EFENDY 1
MAGDALENA BURA 2
ANDREAS RAHUL PRATAMA 3
FLORENSIA DWI ANGELICA 3
 STEFANUS FERNANDO T 3
AGUSTINA MARDA 6
1 1 1 KHRISTIAN MATULLESSYA 1
CATHERINE W LEATEMEA 3
GABRIELLA PRO VIDENCYA 3
MICHEBELLE ADRIANA 3
1 1 1 KRISAL TAMBA 1
TITIK CAMELIA 2
REVA NOVIKA 3
FEBRINA DWI SAHRANI 3
RIHAM AZALEA PUTRI 3
1 1 1 DWI RESKI YOLANDI 1
VERA ROSITA SITOMPUL 2
M SATYA YOLANDI 3
1 1 1 2 2 2 JUPRIAL 1
ROSA ANDRIANA 2
ADIB NAIL MAHDI 3
1 1 1 2 2 2 SOBLI 1
HARTINI 2
OFI INDRA FRATAMA 3
ALDI JULIANDI 3
ALYA AMMARA 3
1 1 1 2 2 2 EDY SUYANTO 1
JUHATI 2
EBIEZA JAZRAQI 3
EISTESIA OBELIA 3
MUHAMMAD SATRIA 3
1 1 1 2 2 2 SYAKRODI 1
NURBAYA 2
DEDY RIZKY WIAJAYA 3
SALWA RAMADHANI 3
1 1 1 2 2 2 RIZON EKA PUTRA 1
NURHASANAH 2
MELFIA PRATIWI PUTR 3
1 1 1 2 2 2 SUPRADI 1
TITMIATISH 2
TASYA SEKARDILA 3
1 1 1 2 2 2 ZULKARNAIN 1
KASMINAH 2

1 1 1 2 2 2 AULIA TRI P 1
ASRIYAH 2
MUHAMMAD SYAIKHA 3
 ALIFA SYAKIRA 3

1 1 1 2 2 2 A MUSLICH 1
MARDIANA 2
TANTI ANGELIA 3
SHALSA ANANDA 3
SHAVA RESKIA 3

1 1 1 2 2 2 JUFRI 1
PASMI 2
TRI ANTONI 3

1 1 1 2 2 2 RICO R P 1
SARI 2
ANDRIESA 3
ANINDYA 4
1 1 1 2 2 2 DONI 1
SITI ANISAH 2
MAULIDA PUTRI 3
DONA CUNIKA PUTRI 3
M. SOHEH 7
1 1 1 2 2 2 DESPRIADI 1
YULISMAR 2
YUDHI SEPTIAN 3
YUDHA DWI JULPRIADI 3
1 1 1 2 2 2 CENDRA WARDI 1
SRI RAHAYU 2
SALWA ZAAHIROH 3
AMIRA HUMAIROH 3
AFIFA HUMAIRO 3
1 1 1 2 2 2 DODY HUTMAN 1
ERNAWILIS 2
AREMBI JULPA BUANDRA 3
BINTANG DWI PUTRA 3
MUHAMMAD GHALY 3
SULTHAN AMMAR AWWAB 3
1 1 1 2 2 2 HENDRA YUNALDI 1
LENI DESNI 2
RANI MARSYANDA 3
RARA YULIANDA 3
RASYA SYLVANANDA 3
 IV. Keterangan anggota rumah tangga

7. status perkawinan
5. umur (tahun)

8. sedang hamil
6. jenis kelamin

10. pendidikan

11. pekerjaan
Umur (Bulan)

9. agama
4. TGL

19/04/1991 28 1 1 1 5 9
4/9/1993 26 2 1 1 6 4
23/02/1956 63 1 1 1 5 4
21/01/1955 62 2 1 1 5 1
23/12/1991 28 1 2 1 6 4
25/06/1958 61 1 1 1 5 4
20/04/1965 54 2 1 1 5 1
30/08/1984 35 1 2 1 6 9
4/4/1987 32 2 2 1 6 9
20/04/1984 35 2 2 1 6 9
1/5/1980 49 1 1 1 5 5
17/041989 44 2 1 1 6 4
30/05/2008 9 2 2 1 1 1
17/101012 6 1 2 1 1 1
21/06/1968 51 1 1 1 5 5
22/05/1970 48 2 1 1 5 1
28/01/1995 24 2 2 1 5 1
31/12/1999 20 1 2 1 5 1
9/7/1968 51 1 1 1 6 4
12/4/1976 43 2 1 1 7 4
16/07/1997 22 1 2 1 5 2
17/09/2005 14 1 2 1 3 2
12/10/1987 32 1 1 1 7 4
11/3/1990 29 2 1 1 5 4
4/4/1971 48 1 1 1 5 5
1/7/1972 47 2 1 1 5 1
12/8/1996 23 1 2 1 5 2
26/2/2012 7 2 2 1 2 2
17/10/1946 73 1 1 1 5 4
15/08/1955 64 2 1 1 5 1
7/3/1978 41 1 1 1 5 5
22/6/1987 32 2 1 1 5 5
15/7/2008 11 1 2 1 2 2
21/6/2014 5 1 2 1 1 1
3/17/1986 33 1 1 1 3 5
### 29 2 1 1 2 1
10/7/2011 7 1 2 1 2 2
9/3/2016 30 1 2 1 1 1
8/15/1953 65 1 1 1 5 4
6/10/1972 46 2 1 1 4 1
7/23/1998 20 2 2 1 5 2
9/20/1948 70 2 1 1 2 1
7/24/1943 75 1 1 1 7 4
5/26/1988 31 1 2 1 7 2
3/23/1973 45 1 1 1 5 9
### 13 2 2 1 3 1
05/04/1984 35 1 1 1 6 4
8/21/1987 32 2 1 1 6 1
7/4/2010 9 1 2 1 2 1
1/7/2013 6 1 2 1 2 1
4/21/2017 23 2 2 1 1 1
31 50 1 1 1 4 8
25 46 2 1 1 4 1
13 25 1 1 1 5 2
24 22 2 2 1 5 2
18 17 1 2 1 3 2

16 32 1 1 1 5 9
02 27 2 1 1 5 1
22 6 2 2 1 1 1

01 54 1 1 3 5 5
17 60 2 1 3 5 1
08 28 1 1 3 5 2
14 28 1 2 3 3 2

14 51 1 1 1 5 5
01 49 2 1 1 5 1
28 22 1 2 1 3 1
06 10 1 2 1 2 1

10 48 1 1 3 6 5
24 39 2 1 3 5 1
3 12 1 2 3 2 2
13 11 2 2 3 2 1
08 3 1 2 3 1 1
4/6/1963 56 1 1 1 7 4
3/14/1976 43 2 1 1 5 9
6/3/1995 24 1 2 1 5 2
7/14/1999 20 2 2 1 5 2
2/23/2003 16 2 2 1 4 2
 2/2/1964 55 1 1 1 7 4
12/19/1962 52 2 1 1 3 9
2/16/1988 31 1 2 1 6 5
1/2/1990 29 1 2 1 5 2
1/5/1994 25 1 2 1 5 2
12/31/1936 83 2 4 1 2 9
1/6/1973 46 1 1 1 6 4
4/20/1978 43 2 1 1 5 9
1/12/2001 18 2 2 1 2 2
4/12/2011 8 1 2 1 1 1
4/6/1960 59 1 1 1 5 5
4/21/1968 51 2 1 1 5 5
2/2/1990 29 2 2 1 5 2
9/27/1992 27 1 2 1 2 2
7/5/2008 11 1 2 1 1 1
6/15/1972 47 1 1 1 5 5
9/28/1969 50 2 1 1 7 4
11/10/2000 19 1 2 1 5 2
3/1/1979 40 1 1 1 6 5
5/15/1980 39 2 1 1 7 4
11/21/2007 11 1 2 1 1 1
3/28/2011 8 1 2 1 1 1
10/22/2017 2 1 2 1 1 1
3/27/1989 30 1 2 1 5 2
### 57.48056 1 1 1 4 5
### 51.38333 2 1 1 5 4
9/14/1995 23.54167 2 2 1 5 2
11/9/1998 20.38889 1 2 1 5 2
### 28.34722 1 2 1 5 9
### 43.43889 1 1 1 5 4
3/28/1978 40.98611 2 1 1 7 1
7/3/2009 9.722222 1 2 1 2 1
2/11/2011 8.116667 2 2 1 2 1
7/16/1978 40.70556 1 1 1 4 4
5/11/1980 38.88611 2 1 1 3 3
11/1/2005 13.41389 1 2 1 2 1
4/2/2009 9.994444 1 2 1 2 1
9/16/2011 7.538889 1 2 1 2 1
5/14/1970 48.87778 1 1 1 5 4
4/5/1976 42.98611 2 1 1 7 4
8/7/2010 8.647222 2 2 1 2 1
7/21/2013 5.691667 1 2 1 2 1
### 46.35833 1 1 1 5 5
6/1/1980 38.81111 2 1 1 6 4
10/1/1997 21.47778 1 2 1 5 1
9/18/2009 9.513889 1 2 1 2 1
29/05/1963 55 1 1 2 6 5
29/06/1969 49 2 1 2 5 1
8/4/2004 15 2 2 2 4 2
11/4/2007 12 2 2 2 3 2
16/04/1991 28 1 1 1 6 5
9/11/1991 27 2 1 1 6 1
12/6/2018 9 1 2 1 1 1
20/04/1974 45 1 1 1 5 5
15/11/1976 42 2 1 1 1 5 1
10/2/2005 14 2 2 1 3 2
5/4/2012 7 2 2 1 2 2
18/08/1972 46 1 1 1 5 5
5/11/1976 42 2 1 1 5 1
7/1/2000 19 2 2 1 5 2
21/12/2005 14 1 2 1 3 2
27/09/2007 12 2 2 1 2 2
5/3/1975 44 1 1 1 2 5
28/11/1979 39 2 1 1 2 1
27/08/1999 19 2 2 1 4 2
3/8/2008 10 2 2 1 2 2
14/07/1995 23 1 2 1 4 5
13/03/1960 59 708 1 1 1 6 9
13/07/1962 57 684 2 1 1 5 1
11/11/1997 22 264 1 2 1 5 1
22/06/2002 17 204 2 2 1 4 2
18/05/1983 36 432 1 1 1 6 9
12/10/1991 28 335 2 1 1 1 5 9
26/11/2014 5 60 1 2 1 1 9
23/11/1980 39 468 1 1 1 5 5
18/02/1985 34 408 2 1 1 5 1
30/03/2012 7 84 2 2 1 1
30/10/2016 3 36 1 2 1
28/12/1970 49 588 1 1 1 3 6
20/07/1971 48 576 2 1 1 3 1
27/11/2003 16 192 2 2 1 3 2
31/12/1965 54 648 1 1 1 5 4
12/09/1967 52 624 2 1 1 5 4
18/12/1994 25 300 2 2 1 6 9
14/01/1997 22 265 1 2 1 5 9
28/03/2001 18 216 2 2 1 4 9
15 43 1 1 1 5 3
12 38 2 1 1 6 9
25 11 2 2 1 1 2
2 8 1 2 1 1 2
1 5 1 2 1 1 1
25 21 2 2 1 1 1
2 49 1 1 1 7 5
21 40 2 1 1 7 4
10 21 2 2 1 6 9
 2 44 1 1 1 5 5
25 39 2 1 1 4 9
1 19 2 2 1 5 2
15 8 2 2 1 2 2
24 57 2 4 1 5 1
13 30 2 4 1 6 9
6 10 1 2 1 2 2
11 5 1 2 1 1 2
28 57 1 1 2 4 5
53 50 2 1 2 5 9
12 22 1 2 2 5 1
10 19 1 2 2 5 2
16 17 2 2 2 5 2
13 11 2 2 2 2 2
27 10 1 2 2 2 2
21/8/1949 70 1 1 1 5 5
16/6/1959 60 2 1 1 6 4
14/6/1973 46 1 1 1 5 5
11/9/1976 43 2 1 2 1 5 1
11/1/2004 15 1 2 1 4 2
1/1/2013 6 2 2 1 2 1
3/2/1990 29 1 1 1 3 8
20/12/1991 28 2 1 2 1 3 1
14/6/2012 7 2 2 1 2 2
5/12/2018 3 1 2 1 1 1
17/3/1985 34 1 1 1 7 9
3/7/1985 34 2 1 2 1 6 9
24/12/2013 5 1 2 1 1 1
20/05/2016 3 1 2 1 1 1
4/4/1977 42 2 4 2 1 4 5
26/1/2008 11 2 2 1 2 1
2/5/1956 63 756 1 1 1 6 4
9/13/1962 57 684 2 1 1 5 9
1/29/1988 31 372 1 2 1 6 9
1/10/1993 26 312 1 2 1 6 9
10/14/2002 17 204 1 2 1 3 9
3/11/1997 22 264 2 2 2 1 5 9
5/31/1967 52 624 1 1 3 5 5
9/1/1977 42 504 2 1 2 3 5 9
8/24/2006 13 156 1 2 3 3 2
6/12/2012 7 84 2 2 3 2 2
7/1/1983 36 432 2 4 2 1 6 4
1/30/2013 6 72 1 2 1 2 2
12/31/1953 66 792 2 4 1 2 9
7/18/1989 30 360 1 1 1 5 5
8/18/1991 28 336 2 1 2 1 6 5
6/29/2018 1 12 2 2 1 1 1
24/04/1964 55 1 1 1 5 5
31/12/1963 56 2 1 1 5 4
03/10/1997 22 1 2 1 5 2
21 50 1 1 1 5 5
22 49 2 1 1 5 1
28 24 1 2 1 5 9
31 20 2 2 1 5 9
22 46 1 1 1 4 8
14 39 2 1 1 4 1
24 17 1 2 1 2 2
20 9 2 2 1 2 2
01 2 1 2 1 1 1
25 23 1 2 1 5 1
19 14 2 2 1 1 1
01/01/1967 52 2 4 1 5 1
20/02/1992 27 1 2 1 5 5
21/01/1993 26 1 2 1 5 4
13/06/1954 64 2 1 2 5 1
21/10/1988 30 1 2 2 5 2
01/01/1993 26 2 2 2 5 2
09/09/1964 55 1 1 1 5 5
15/04/1967 52 2 1 1 5 1
12/06/2001 18 1 2 1 4 2
15 47 1 1 1 6 5
12 39 2 1 1 6 4
26 16 2 2 1 3 2
10 7 2 2 1 2 2
23 51 1 1 1 4 8
5 53 2 1 1 5 9
14 25 1 2 1 5 5
10 45 1 1 1 5 5
11 46 2 1 1 5 9
21 25 1 2 1 6 5
14 50 1 3 1 5 9
01 46 1 1 1 4 5
10 45 2 1 1 4 9
15 26 1 2 1 5 2
23 32 1 2 1 4 1
21 48 1 1 1 3 8
14 47 2 1 1 3 9
29 6 2 2 1 1 1
25 48 1 1 1 5 9
8 44 2 1 1 5 9
3 9 2 2 1 2 1
23 4 2 2 1 1 1
9 43 1 1 3 5 5
23 41 2 1 3 5 1
21 17 1 2 3 5 2
06 13 2 2 3 4 2
 20 6 1 2 3 1 1
15 61 2 1 3 5 9
29 56 1 1 2 6 5
29 50 2 1 2 5 9
8 15 2 2 2 1 1
11 12 2 2 2 2 1
14 32 1 1 1 5 5
2 41 2 1 1 5 9
21 20 2 2 1 5 1
4 10 2 2 1 2 2
29 3 2 2 1 1 1
5 31 1 1 1 6 5
26 31 2 1 1 5 4
17 3 1 2 1 1 1
21/06/1978 41 490 1 1 1 6 5
17/121986 33 388 2 1 1 5 5
22/08/2012 7 80 1 2 1 1 2
11/07/1967 52 621 1 1 1 5 5
1503/1972 47 565 2 1 1 5 9
21/04/1994 25 300 1 2 1 6 2
11/07/1999 20 237 1 2 1 5 2
27/01/2006 13 159 2 2 1 3 2
12/06/1974 45 538 1 1 1 5 9
13/04/1979 40 480 2 1 1 5 9
19/04/2005 14 168 1 2 1 3 2
05/07/2011 8 93 2 2 1 2 2
01/02/2018 1 14 1 2 1 1 1
15/05/1975 44 527 1 1 1 4 8
0107/2975 44 525 2 1 1 4 9
15/05/2005 16 191 1 2 1 3 2
17/08/2011 8 92 2 2 1 2 2
12/04/1972 47 564 1 1 1 6 9
12/11/1977 42 497 2 1 1 5 9
30/01/2000 19 231 2 2 1 5 2
15 50 1 1 1 7 4
03 47 2 1 1 5 1
25 19 2 2 1 5 2
22 59 1 1 1 5 5
07 47 2 1 1 5 1

32 32 1 1 1 4 9
29 29 2 1 1 6 5
7 7 1 2 1 2 2
 3 3 2 2 1 1 1

17/03/1969 50 1 1 1 7 4
21 48 2 1 1 7 4
25 22 2 2 1 7 5
02 19 2 2 1 5 2
05 9 2 2 1 2 2

### 60 1 1 1 4 5
### 56 2 1 1 3 5
### 29 1 2 1 5 5

### 33 1 1 1 5 4
### 30 2 1 1 5 1
### 11 1 2 1 2 2
### 7 2 2 1 1 1
12/21/1974 44 1 1 1 5 4
3/9/1974 45 2 1 1 6 4
5/28/2000 19 2 2 1 5 2
31/01/2002 17 2 2 1 4 2
11/22/1985 33 1 2 1 5 2
12/21/1969 49 1 1 1 6 5
7/25/1972 47 2 1 1 5 1
9/28/1999 19 1 2 1 5 2
7/4/2001 18 1 2 1 5 2
10/12/1979 39 1 1 1 5 4
8/24/1977 42 2 1 1 5 5
3/24/2007 12 2 2 1 2 2
4/19/2011 8 2 2 1 2 2
4/19/2011 8 2 2 1 2 2
12/12/1974 44 1 1 1 6 4
5/15/1978 41 2 1 1 6 4
7/29/2001 18 1 2 1 5 2
12/18/2005 13 1 2 1 3 2
6/20/2010 9 1 2 1 2 2
2/2/2015 4 1 2 1 1 1
6/22/1974 45 1 1 1 5 4
2/18/1981 38 2 1 1 6 1
8/31/2003 16 2 2 1 4 2
7/11/2005 14 2 2 1 4 2
8/28/2006 13 2 2 1 3 2
 V. Keterangan individu (anggota ART )
A. Identitas anggota rumah tangga B. Gangguan Keseh

2. BAB di jamban
1. no urut ART

3. TGL puldat

5. air bersih
3. merokok

4. TBC
1. JKN
2. NIK

1 1501171904910002 23/03//2019 1 1 2 2 1
2 15710744099320021 23/03/2019 1 1 2 2 1
1 1571072302560001 23/03/2019 1 1 2 2 1
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1 1505031611870001 3/29/2019 1 1 2 2
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1571076210140009 3/29/2019 1 1 2 2

1 1571070102620101 3/23/2019 1 1 2 2
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4 571071111910061 3/23/2019 1 1 1 2

1 1571071401680101 3/29/2019 1 1 1 2
2 571074102700141 1/28/1900 1 1 2 2
3 57107280397008 3/29/2019 1 1 1 2
4 571070604090041 3/29/2019 1 1 2 2

1 1571071008710081 29/03/2019 1 1 1 2
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1 1571070202640121 3/23/2019 1 1 1 2 1
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3 1571071602880082 3/23/2019 1 1 1 2 1
4 1571070201900081 3/23/2019 1 1 1 2 1
5 1571070501940121 3/23/2019 1 1 1 2 1
6 1571077112360341 3/23/2019 1 1 2 2 1
1 1571080601730001 3/29/2019 1 1 2 2 1
2 1571085004780001 3/29/2019 1 1 2 2 1
3 1571085201020001 3/29/2019 1 1 2 2 1
4 1571080204110001 3/29/2019 1 1 2 2 1
1 1571070604600041 3/29/2019 1 1 2 2 1
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1 1571070103790081 3/29/2019 1 1 1 2 1
2 1571075505800061 3/29/2019 1 1 2 2 1
3 1571032111070061 3/29/2019 1 1 2 2 1
4 1571072803110022 3/29/2019 1 1 2 2 1
5 1571072210170001 3/29/2019 1 1 2 2 1
6 1571072703890041 3/29/2019 1 1 1 2 1
1 1571070610610001 3/29/2019 1 1 1 2 1
2 1571075111670021 3/29/2019 1 1 2 2 1
3 1571075409950021 3/29/2019 1 1 2 2 1
4 1571070911980001 3/29/2019 1 1 2 2 1
5 1571072411900101 3/29/2019 1 1 1 2 1
1 1371021610750009 3/23/2019 1 1 1 2 1
2 1371026803780008 3/23/2019 1 1 2 2 1
3 1371024307090002 3/23/2019 1 1 2 2 1
4 1371021102110001 3/23/2019 1 1 2 2 1
1 1571071507780061 3/30/2019 1 1 1 2 1
2 1571074103800081 3/30/2019 1 1 2 2 1
3 1571070111050001 3/30/2019 1 1 2 2 1
4 1571070204090021 3/30/2019 1 1 2 2 1
5 1571071509110001 3/30/2019 1 1 2 2 1
1 1571071405700001 3/30/2019 1 1 1 2 1
2 1571074504750101 3/30/2019 1 1 2 2 1
3 1571074708100001 3/30/2019 1 1 2 2 1
4 1571072107130001 3/30/2019 1 1 2 2 1
1 1571071411720061 3/23/2019 1 1 1 2 1
2 1571074106800181 3/23/2019 1 1 2 2 1
3 1571070101970144 3/23/2019 1 1 2 2 1
4 1571071809090041 3/23/2019 1 1 2 2 1
1 1506012905630001 30/03/2019 1 1 1 2 1
2 1506016906690001 30/03/2019 1 1 2 2 1
3 1506014804040001 30/03/2019 1 1 2 2 1
4 150606510407002 30/03/2019 1 1 2 2 1
1 23/03/2019 1 1 2 1
2 23/03/2019 1 1 2 2 1
3 23/03/2019 1 1 2 2 1
1 1571092004740021 29/03/2019 1 1 2 2 1
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4 1571082112050021 29/03/2019 1 1 2 2 1
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5 1571071407950102 23/03/2019 1 1 2 2 1
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2 150202025210810003 31/03/2019 1 1 2 2
3 1571082611140001 31/03/2019 1 1 2 2
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5 1571076903010081 24/03/2019 1 1 2 2
1 1571011505760131 3/23/2019 1 1 1 2 1
2 1571015205810081 3/23/2019 1 1 2 2 1
3 1571016511070031 3/23/2019 1 1 2 2 1
4 1571010205110002 3/23/2019 1 1 2 2 1
5 1571070110130006 3/23/2019 1 1 2 2 1
6 1571052507170031 3/23/2019 1 1 2 2 1
1 1571070204600021 3/29/2019 1 1 2 2 1
2 1571076110620021 3/29/2019 1 1 2 2 1
3 1571071606910021 3/29/2019 1 1 2 2 1
1 1571070211740121 3/29/2019 2 1 1 2 1
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3 1571074103000101 3/29/2019 2 1 2 2 1
4 1571075503110001 3/29/2019 2 1 2 2 1
1 1571036408610001 3/29/2019 1 1 2 2 1
2 1571035304880061 3/29/2019 1 1 2 2 1
3 1571036060509001 3/29/2019 1 1 2 2 1
4 1571031105140061 3/29/2019 1 1 2 2 1
1 1571072607610001 3/29/2019 1 1 1 2 1
2 1571076611580021 3/29/2019 1 1 2 2 1
3 1571071308060061 29/03/2019 1 1 1 2 1
4 1571071002000101 29/03/2019 1 1 1 2 1
5 1571076810010061 29/03/2019 1 1 2 2 1
6 1571075302060041 29/03/2019 1 1 2 2 1
7 1571072710100102 29/031019 1 1 2 2 1
1 1571072108490001 23/03/2019 1 1 2 2 1
2 1571075606590041 23/03/2019 1 1 2 2 1
1 1571071405730001 23/03/2019 1 1 2 2 1
2 1571075109760001 23/03/2019 1 1 2 2 1
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4 1571074101130002 23/03/2019 1 1 2 2 1
1 1571010302900042 23/03/2019 1 1 1 2 1
2 1571016012910023 23/03/2019 1 1 2 2 1
3 1571015408120002 23/03/2019 1 1 2 2 1
4 1571070512180002 23/03/2019 1 2 2 1
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1 1571074404770021 29/03/2019 1 1 2 2 1
2 1571076601060123 29/03/2019 1 1 2 2 1
1 1571070502560061. 3/23/2019 1 1 2 2
2 1571075309620001. 3/23/2019 1 1 2 2
3 1571072901880021. 3/23/2019 1 1 2 2
4 1571071001930021. 3/23/2019 1 1 2 2
5 1571071410020021. 3/23/2019 1 1 2 2
3 1502205103970001. 3/23/2019 1 1 2 2
1 1571073105670001. 3/23/2019 1 1 2 2
2 1571074109770041. 3/23/2019 1 1 2 2
3 1571072408050022. 3/23/2019 1
4 1571075206120007. 3/23/2019 1
1 1571034107830063. 3/29/2019 1 1 2 2
2 1571033001130002. 3/29/2019 1
3 1571037112530442. 3/29/2019 1 1 2 2
1 1571041807890001. 3/29/2019 1 1 1 2
2 1571075808910041. 3/29/2019 1 1 2 2
3 1571076906280002. 3/29/2019 1
1 1571072404640041 24/03/2019 1 1 1 2
2 1571073112630021 24/03/2019 1 1 2 2
3 1571070310970021 24/03/2019 1 1 2 2
1 1571072108680021 31/03/2019 1 1 1 2
2 1571076205700041 31/03/2019 1 1 2 2
3 1571076801950001 31/03/2019 1 1 2 2
4 1571073112990021 31/03/2019 1 1 2 2
1 1571071607700021 31/03/2019 1 1 1 2
2 1571075506790321 31/03/2019 1 1 2 2
3 1571074212990021 31/03/2019 1 1 2 2
4 1571070306060081 31/03/2019 1 1 2 2
5 1571075912160002 3/31/2019 1 1 2 2
6 1571072504950102 31/03/2-19 1 1 2 2
7 1571071408970001 31/03/2-19 1 1 2 2
1 1505050101670004 24/03/2019 1 1 2 2
2 1505052002970004 24/03/2019 1 1 1 2
3 1505052101930003 24/03/2019 1 1 1 2
1 1571075306540021 29/03/2019 1 1 2 2
2 1571072110880081 29/03/2019 1 1 2 2
3 1571074101930081 29/03/2019 1 1 2 2
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2 1571025206800061 3/23/2019 1 1 2 2 1
3 1571026607030001 3/23/2019 1 1 2 2 1
4 1571075012120002 3/23/2019 1 1 2 2 1
1 1571072306680021 3/23/2019 1 1 2 2 1
2 1571074502660041 3/23/2019 1 1 2 2 1
3 1571071407940081 3/23/2019 1 1 2 2 1
1 1571071011740122 3/23/2019 1 1 2 2 1
2 1571075106730161 3/23/2019 1 1 2 2 1
1 1571072102940041 3/23/2019 1 1 2 2 1
2 1571075406690041 3/23/2019 1 1 2 2 1
1 1571070102730001 3/29/2019 1 1 1 2 1
2 1571075010740101 3/29/2019 1 1 2 2 1
3 1571071509930041 3/29/2019 1 1 1 2 1
4 1571072301870021 3/29/2019 1 1 1 2 1
1 1571072106710102 3/29/2019 2 1 2 2 1
2 1571075404720102 3/29/2019 2 1 2 2 1
3 1571072908130004 3/29/2019 2 1 2 2 1
1 1571072510710021 3/23/2019 1 1 1 2 1
2 1571074810750061 3/23/2019 1 1 2 2 1
3 1571074303090004 3/23/2019 1 1 2 2 1
4 1571076304150007 3/23/2019 1 1 2 2 1
1 1571070912760082 3/23/2019 1 1 2 2 1
2 1571076305780041 3/23/2019 1 1 2 2 1
3 1571072111020041 3/23/2019 1 1 2 2 1
4 1571074504060021 3/23/2019 1 1 2 2 1
5 1571072006130002 3/23/2019 1 1 2 2 1
6 1571075508560021 3/23/2019 1 1 2 2 1
1 '1506012905630001 3/29/2019 1 1 1 2 1
2 1506015905690001 3/29/2019 1 1 2 2 1
3 1506014304040001 3/29/2019 1 1 2 2 1
4 156065104070002 3/29/2019 1 1 2 2 1
1 1571071408870161 3/29/2019 1 1 2 2 1
2 1905054202780001 29/032019 1 1 2 2 1
3 1905056111980001 29/03/2019 1 1 2 2 1
4 1905054402090001 29/03/2019 1 1 2 2 1
5 1571076908160004 29/03/2019 1 1 2 2 1
1 1571070512880101 23/032019 1 1 1 2 1
2 157108660880041 3/23/2019 1 1 2 2 1
3 1571071708160003 3/23/2019 1 1 2 2 1
1 1671072106780062 3/2/2019 1 1 1 2 1
2 1671075712850082 3/23/2019 1 1 2 2 1
3 1571072208120003 3/23/2019 1 1 2 2 1
1 157107107670041 3/23/2019 2 1 1 2 1
2 1571015503720061 3/23/2019 2 1 1 2 1
3 15710721104940081 3/23/2019 2 1 2 2 1
4 1971071107990041 3/23/2019 2 1 2 2 1
5 1971076701060061 3/23/2019 2 1 2 2 1
1 1571071206740121 3/23/2019 1 1 2 2 1
2 1571075304790222 3/23/2019 1 1 2 2 1
3 1571071904050021 3/23/2019 1 1 2 2 1
4 1571074507110021 3/23/2019 1 1 2 2 1
5 1571070102180002 3/23/2019 1 1 2 2 1
1 1571071505750101 3/29/2019 1 1 1 2 1
2 1571074107750201 3/29/2019 1 1 2 2 1
3 1571071505030061 3/29/2019 1 1 2 2 1
4 1571075706110001 3/29/2019 1 1 2 2 1
1 1571071204720081 3/29/2019 1 1 1 2 1
2 '1571075211770121 3/29/2019 1 1 2 2 1
3 1571077001000021 29/03/2019 1 1 2 2 1
1 1671071606500051
23/03/2019 1 1 1 2
2 1671004304120001
23/03/2019 1 1 2 2
3 1671076400000021
23/03/2019 1 1 2 2
1 1571072212600021
29/03/2019 1 1 1 2
2 1571074707720001
29/03/2019 1 1 2 2

1 157107215870041
23/03/2019 1 1 2 2
2 1507076804800002
23/03/2019 1 1 2 2
315710715121200005
23/03/2019 1 1 2 2
4 1571075112160003
23/03/2019 1 1 2 2

1 1571071703690021
29/03/2019 1 1 2 2
2 1571076109710041
29/03/2019 1 1 2 2
3 1571076501970001
29/03/2019 1 1 2 2
4 1571074210000021
29/03/2019 1 1 2 2
515710745021000021
29/03/2019 1 1 2 2

1 1671070101590321
29/03/2019 1 1 1 2
2 1571074607630022
30/03/2019 1 1 2 2
3 1571072304900042
29/03/2019 1 1 2 2

1 1671070106850201
30/03/2019 1 1 1 2
2 157106704890141
'30/03/2019 1 1 2 2
3 1671073005080061
'30/03/2019 1 1 2 2
4 1671076710120004
'30/03/2019 1 1 2 2
1 1571072112740041 3/23/2019 1 1 2 2 1
2 1571074903740001 3/23/2019 1 1 2 2 1
3 1571076805000021 3/23/2019 1 1 2 2 1
4 1571077101020001 3/23/2019 1 1 2 2 1
5 1571072211850061 3/23/2019 1 1 2 2 1
1 1571072112690001 3/24/2019 1 1 1 2 1
2 1571076607720041 3/24/2019 1 1 2 2 1
3 1571072809930001 3/24/2019 1 1 1 2 1
4 1571070407010061 3/24/2019 1 1 2 2 1
1 1571071210790221 3/24/2019 1 1 1 2 1
2 1571076408770101 3/24/2019 1 1 2 2 1
3 1571076403070081 3/24/2019 1 1 2 2 1
4 1571075904110002 3/24/2019 1 1 2 2 1
5 1571075904110003 24/03/2-19 1 1 2 2 1
1 1571071212740061 3/29/2019 1 1 1 2 1
2 1571075506780041 3/29/2019 1 1 2 2 1
3 157107290710062 3/29/2019 1 1 2 2 1
4 1571071812060001 3/29/2019 1 1 2 2 1
5 1571072006100001 3/29/2019 1 1 2 2 1
6 1571070202150000 3/29/2019 1 1 2 2 1
1 1571072206740001 29/03/2019 1 1 2 2 1
2 1571075802810001 29/03/2019 1 1 2 2 1
3 1571077108030001 29/03/2019 1 1 2 2 1
4 1571075107050001 29/03/2019 1 1 2 2 1
5 1571072904920001 3/29/2019 1 1 2 2 1
 a ART )

2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
1
2
1
2
2
2
6. Hipertensi

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
7. gangguan jiwa
B. Gangguan Kesehatan

2
2
2
2
1
2
1
2
2
2
8. penggunaan KB

1
9.bersalin di faskes ART < 12 Bulan

10. ASI eksklusif ART 7-23 Bulan

1
11. imunisasi lengkap ART 12-13 Bulan
1

12. pemantauan balita

1

No

3
2
1
2
1
4
3
2
1
2
1
4
3
2
1
4
3
2
1
4
3
2
1
5
4
3
2
1
3
2
1
2
1

KK ke-
Indikator Pola Hidup Bersih d
2 1 1 4
2 2 1
2 2 1 2
2 2 3
2 2 1 1 1 4
2 2 1
2 2 1 2
2 2 4
2 2 5
1 2 1
2 2 2
2 2 1
2 2 2
2 2 1
2 2 1 2
2 2 3
2 2 4
2 2 1 1 2 5
2 2
2 1 1 2
2 2
2 2
2 2

2 2
2 2 1
2 2

2 2
2 1 2
2 2
2 2

2 2
2 2 1
2 2
2 2

2 2
2 2 1
2 2
2 2
2 2 1 1 2
2 2
1 2 1 1
2 2
2 2
2 2
2 2
2 2 2 1
2 2
2 2
2 2
2 2 2
2 2
2 2 1 1
2 2
2 2
2 2
2 2 2 1
2 2
2 2
2 2
1 2 1
2 2 2
2 2
2 2
2 2 1 1
2 2
2 2
2 2 1 1
2 2
2 2 2 1
2 2 2
2 2
2 2
2 2
2 2 1 2
2 2 1
2 2
2 2
2 2 1 3
2 2 1
2 2
2 2
2 2
2 2 1 4
2 2 1
2 2
2 2
2 2 2 5
2 2 2
2 2
2 2
2 2 1
2 2 2 2
2 2 3
2 2 4
2 2 1
2 2 2 1 1 1 1 2
2 2 3
1 2 1
2 2 2 2
2 2 3
2 2 4
2 2 1
2 2 2
2 2 2 3
2 2 4
2 2 5
2 2 1
1 2 2 2
2 2 3
2 2 4
2 2 5
2
2
2
2
2
1 2
2
2
2 1
2
2 1
2
1 2 1
2
1 1
2
2
2
2
2 2 1 1
2 2 1 2
2 2 3
2 2 4
2 2 5
2 2 1 1 1 6
1 2 1 1
2 2 1 2
2 2 4
2 2 2 1
2 2 2 2
2 2 3
2 2 4
2 2 2 1
2 2 2 2
2 2 3
2 2 4
2 2 2 1
2 2 2 2
2 2 3
2 2 4
2 2 5
2 2 6
2 2 7
2 2 1
2 2 2
2 2 1
2 2 1 2
2 2 4
2 2 5
2 2 1
2 2 1 2
2 2 3
2 2 1 1 4
2 2 1
2 2 1 2
2 2 1 3
2 2 1 4
2 2 1
2 2 3
2 2
2 2
2 2
2 2
2 2
2 2
2 2 2
2 1 1 2

2 2

2 1 2
2 2 1
2 2 1 1 1 1

2 2 1
2 2 1 2
2 2 3
2 2 1
2 2 1 2
2 2 3
2 2 4
2 2 1
2 2 1 2
2 2 3
2 2 4
2 2 5
2 2 6
2 2 7
2 2 2 1
2 2 2
2 2 3
2 2 1
2 2 2
2 2 3
2 2 1
2 2 2
2 2 3
2 2 1
2 2 1 2
2 2 3
2 2 4
2 2 1
2 2 1 2
2 2 3
2 2 1
2 2 2
2 2 1
2 2 2
2 2 1
2 2 1 2
2 2 3
2 2 4
2 2
1 2 1
2 2
2 2
2 2 1
2 2
2 2 2
2 2
2 2 1
2 2
2 2
2 2
2 2
2 2
2 2 1
2 2
2 2
2 2
2 2 1
2 2
2 2
2 2 2
1 2
2 2 2
2 2 2
2 2 2 1
2 2 2
2 2
2 2 2 2
2 2 2
2 2
2 2
2 2
2 2 2 3
2 2 2
2 2
2 2
2 2 1 2 1 1
2 2 1 4
2 2 1
2 2
2 2
2 2 2 5
2 2 2
2 2
2 2 1
2 2 1
2 2
2 2 2
2 2 2

2 2 3
2 2 1
2 2
2 2 1

2 2 4
2 2 2
2 2
2 2
2 2

2 1 2 5
2 2 2
2 2

2 2 6
2 2 1
2 2
2 2
2 2 1
2 2 1 2
2 2 3
2 2 4
2 2 5
2 2 1
2 2 1 2
2 2 3
2 2 4
2 2 1
2 2 1 2
2 2 3
2 2 4
2 2 5
2 2 1
2 2 2 2
2 2 3
2 2 4
2 2 5
2 2 6
2 2 1
2 2 2 2
2 2 3
2 2 4
2 2 5
Indikator Pola Hidup Bersih dan Sehat dalam tatanan Rumah tangga

2. Cuci tangan dengan sabun dan air bersih

7. Merokok di rumah
1. Persalinan Faskes

5. Makan sayur
4. Makan Buah
3. PSN 3 M

1 1 2 1 1 2
1 2 1 1 2
1 2 2 1 2
1 2 2 1 2
1 2 2 1 2
1 2 2 1 1
1 2 2 1 2
1 2 2 1 2
1 2 2 1 2
1 2 2 1 2
1 2 1 1 1
1 2 1 1 2
1 2 1 1 2
1 2 1 1 2
1 2 2 1 1
1 2 2 1 2
1 2 2 1 2
1 2 2 1 2
1 1 1 2 1
1 1 1 1
1 1 1 1 1
1 1 2 2
1 1 1 1 1
1 1 1 1
1 2 1 1 1
1 2 1 1
1 2 1 1 1
1 2 1 1
1 1 1 1
1 1 1 1
1 1 1 2 1
1 1 1 2
1 1 1 2
 1 1 1 2
1 2 2 1 1
1 2 2 1
1 2 2 1
1 2 1
1 2 1 1
1 2 1 1
1 2 1 1
1 2 1 1
1 1 1 1
1 1 1 1
1 2 1 2
1 2 1 2
1 2 1 1 1
1 2 1 1
1 2 1 1
1 1 1
1 2 1 1
1 1 2 1 1 1
2 1 2 1 1 2
3 1 2 1 1 1
4 1 2 1 1 2
5 1 2 1 1 2

1 1 2 1 1 2
2 1 2 1 1 2
3 1 2 1 2 2

1 2 2 1 2 2
2 2 2 1 2 2
3 2 2 1 1 2
4 2 2 1 1 1

1 1 1 1 2 1
2 1 1 1 1 2
3 1 1 1 1 1
4 1 1 1 1 2

1 1 1 2 1 1
2 1 1 2 1 2
3 1 1 2 2 2
4 1 1 2 2 2
5 1 1 2 2 2
1 1 2 1 2
1 1 2 1 2
1 1 2 1 2
1 1 2 1 1
1 1 2 1 1
1 1 1 1 2
1 1 1 1 2
1 1 1 1 2
1 1 1 1 2
1 1 1 1 2
1 1 1 1 2
2 2 1 1 1
2 2 1 1 1
2 2 1 1 1
2 2 1 1 1
1 2 1 1 2
1 2 1 1 2
1 2 1 1 2
1 2 1 1 2
1 2 1 1 2
1 2 2 1 1
1 2 2 1 2
1 2 2 1 1
2 2 1 1 2
2 2 1 1 2
2 2 1 1 2
2 2 1 1 2
2 2 1 1 2
2 2 1 1 2
1 1 1 1 1
1 1 1 1 1 2
1 1 1 1 2
1 1 1 1 2
1 1 1 1 1
1 2 1 1 1
1 1 2 1 1 2
1 2 1 1 2
1 2 1 1 2
2 2 1 1 1
1 1 2 1 1 2
1 2 1 1 2
2 2 1 1 2
2 2 1 1 2
1 1 1 1 2
1 1 1 1 1 2
1 1 1 1 2
1 1 1 1 2
1 1 1 1 1
1 1 1 1 1 2
1 1 1 1 2
1 1 1 1 2
1 2 2 2 2
1 1 2 2 2
1 2 2 2
1 2 2 2
2 2 2 1 2
1 2 2 2 1
2 2 2 1
1 2 2 1
1 1 2 2 1
1 2 2 1
1 2 2 1
1 2 2 1 1
1 1 2 2 1
1 2 2 1
1 2 2 1
1 2 2 1
1 2 2 1 1
1 1 2 2 1
1 2 2 1
1 2 2 1
1 2 2 1
1 1 2 1 2 1
1 1 2 1 2
1 1 2 1 2
1 1 2 1 2
2 1 1 1 2 2
2 1 1 1 2
2 1 1 1 2
3 1 2 1 2 2
3 1 2 1 2
3 1 2 1 2
3 1 2 1 2
4 1 2 2 2
4 1 2 2 2
4 1 2 2 2
5 1 1 1 2
5 1 1 1 2
5 1 1 1 2
5 1 1 1 2
5 1 1 1 2
1 1 1 1 1
1 1 1 1 1 2
1 1 1 1 2
1 1 1 1 2
1 1 1 1 2
1 1 1 1 2
1 2 2 1 2
1 1 2 2 1 2
1 2 2 1 2
 2 1 2 1 1
1 2 1 2 1 2
2 1 2 1 2
2 1 2 1 2
1 1 2 1 2 2
1 1 2 1 2 2
1 2 1 2 2
1 2 1 2 2
2 2 2 1 1
1 2 2 2 1 2
2 2 2 1 1
2 2 2 1 1
2 2 2 1 2
2 2 2 1 2
2 2 2 1 2
1 1 2 1
1 1 2 1
1 1 2 1
1 1 2 1
1 1 2 1
1 1 2 1
1 1 2 1 1
1 1 2 1
1 1 2 1
1
1 1 2 1 1
1 1 2 1
1 1 2 1
1 1 2 1
1 1 2 1
1 1 2 1
1 1 1 1 2
1 1 1 1 1 2
1 1 1 1 2
1 1 1 1 2
1 1 1 1 2
2 1 1 2 2
3 1 2 2 2
3 1 1 2 2 2
3 1 2 2 2
3 1 2 2 2
4 1 1 2 1 2
4 1 2 1 2
4 1 2 1 2
5 2 2 1 1 2
5 1 1 2 1 2
5 2 2 1 2
2 2 2 1 1
 2 2 2 1
2 2 2 1
2 2 1 1 1
2 2 1 1
2 2 1 1
2 2 1 1
2 2 2 1 2
2 2 2 1
2 2 2 1
2 2 2 1
2 2 2 1
2 2 2 1
2 2 2 1
1 1 2 1 1
1 1 2 1
1 1 2 1
1 2 2 1
1 2 2 1
1 2 2 1
1 1 2 1 1
1 1 2 1
1 1 2 1
1 1 1 1 1
1 1 1 1 1 2
1 1 1 1 2
1 1 1 1 2
1 2 1 1 2
1 1 2 1 1 2
1 2 1 1 2
1 2 1 2 2
1 2 1 2 2
2 2 1 1 2
1 2 2 1 1 2
1 1 1 1 1
1 1 1 1 1 2
1 1 1 1 2
1 1 1 1 2
1 1 2 1 1 2
2 1 1 2 1 1 2
3 1 2 1 1 2
1 1 2 1 1 1
2 1 1 2 1 1 2
3 1 2 1 1 2
4 1 2 1 1 2
1 1 1 1 1 2
2 1 1 1 1 1 2
3 1 1 1 1 2
4 1 1 1 1 2
5 1 1 1 1 2
6 1 1 1 1 2
1 1 1 1 1 1
2 1 1 1 1 1 2
3 1 1 1 1 2
4 1 1 1 1 2
1 1 1 1 1 2
2 1 1 1 1 1 2
3 1 1 1 1 2
4 1 1 1 1 2
5 1 1 1 1 2
1 1 1 1 1 1
2 1 1 1 1 1 2
3 1 1 1 1 2
1 2 2 2 1
1 1 2 2 1 2
1 2 2 1 2
1 2 1 1 1
1 1 2 1 1 1
1 2 1 1 2
1 2 1 1 2
1 2 1 1 2
1 2 1 1 2
1 1 2 1 1 2
1 2 1 1 2
1 2 1 1 2
1 2 1 1 2
1 1 1 1 1
1 1 1 1 1 2
1 1 1 1 2
1 1 1 1 2
1 1 1 1 1
1 1 1 1 1 2
1 1 1 1 2
1 1 1 1 2 1
2 1 1 1 2 2
3 1 1 1 2 2
1 1 2 1 2 1
2 1 2 1 2 2

1 1 1 1 2 2
2 1 1 1 2 2
3 1 1 1 2 2
4 1 1 1 2 2

1 1 1 1 1 2
2 1 1 1 1 2
3 1 1 1 1 2
4 1 1 1 1 2
5 1 1 1 1 2

1 1 2 2 2 2
2 1 2 2 2 2
3 1 2 2 2 2
4 1 2 2 2 2
1 1 1 2 2 2
2 1 1 2 2 2
3 1 1 2 2 2
4 1 1 2 2 2
1 1 1 1 2
1 1 1 1 2
1 1 1 1 2
1 1 1 1 2
1 1 1 1 2
1 2 1 1 1
1 2 1 1 2
1 2 1 1 1
1 2 1 1 2
1 2 1 1 1
1 2 1 1 2
1 2 1 1 2
1 2 1 1 2
1 2 1 1 2
1 1 2 2 1
1 1 2 2 2
1 1 2 2 2
1 1 2 2 2
1 1 2 2 2
1 1 2 2 2
1 1 1 1 2
1 1 1 1 2
1 1 1 1 2
1 1 1 1 2
1 1 1 1 2
 5
4
3
2
1
No

KK Ke-

kk Ke-2

KK Ke-5
KK Ke-4
KK Ke-3
KK Ke-1

4
2
1
2
2
2
1. Pasangan suami istri mengikuti program KB

1
2. Ibu bersalin di fasilitas pelayanan kesehatan

1
3. Bayi memperoleh imunisasi lengkap

1
4. Bayi memperoleh ASI eklusif

1
5.Bayi dan balita dilakukan pemantauan tumbuh kembang

6. TB Paru berobat sesuai standar

PROGRAM PIS-PK

2
2
2

7. Tekanan darah tinggi berobat sesuai standar

8.Gangguan Jiwa
3
2
2
2
1
1
9.Anggota rumah tangga yang tidak merokok

1
1
1
1
1
10. Keluarga menggunakan air bersih

1
1
1
1
1
11. Keluarga memiliki jamban sehat

1
1
1
1
1
12. Anggota rumah tangga memiliki JKN

1
1. Persalinan Faskes

1
1
1
1
1
2. Cuci tangan dengan sabun dan air bersih

5
2
2
2
2
2

3. PSN 3 M

2
1
1
2
2
1

4. Makan Buah
1
1
1
1
1

5. Makan sayur
3
2
2
1
2
1

6. Aktivitas fisik
3
2
2
2
1
1
7. Merokok di rumah