Anda di halaman 1dari 73

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 RT 36

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

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

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

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

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

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

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


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

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

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


12 jambi Kota Jambi Kota Baru pall x Kenali Asam Bawah RT 36

13 Jambi Kota Jambi Kota Baru pall x Kenali Asam Bawah RT 36

14 Jambi Kota Jambi Kota Baru pall x Kenali Asam Bawah RT 36

15 Jambi Kota Jambi Kota Baru pall x Kenali Asam Bawah RT 36

16 Jambi Kota Jambi Kota Baru pall x Kenali Asam Bawah RT 36

17 jambi kota jambi kota baru pall x kenali asam bawah RT 36

18 Jambi Kota Jambi Kota BaruPuskesmas Pal XKenali Asam Bawah RT 36


19 Jambi Kota Jambi Kota BaruPuskesmas Pal XKenali Asam Bawah RT 36

20 Jambi Kota Jambi Kota BaruPuskesmas Pal XKenali Asam Bawah RT 36

21 Jambi Kota Jambi Kota BaruPuskesmas Pal XKenali Asam Bawah RT 36

22 Jambi Kota Jambi Kota BaruPuskesmas Pal XKenali Asam Bawah RT 36

23 Jambi Kota Jambi Kota BaruPuskesmas Pal XKenali Asam Bawah RT 36

24 Jambi Kota Jambi Kota BaruPuskesmas Pal XKenali Asam Bawah RT 36

25 Jambi Kota Jambi Kota BaruPuskesmas Pal XKenali Asam Bawah RT 36

26 Jambi Kota Jambi Kota BaruPuskesmas Pal XKenali Asam Bawah RT 36

27 Jambi Kota Jambi Kota BaruPuskesmas Pal XKenali Asam Bawah RT 36

28 Jambi Kota Jambi Kota BaruPuskesmas Pal XKenali Asam Bawah RT 36

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

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


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

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

33 jambi Muaro jambi Kota Baru Pall 10 Kenali Asam Bawah RT 36

34 jambi Muaro jambi Kota Baru Pall 10 Kenali Asam Bawah RT 36

35 jambi Muaro jambi Kota Baru Pall 10 Kenali Asam Bawah RT 36

36 jambi Muaro Jambi Kota Baru Pall 10 Kenali Asam Bawah RT 36

37 jambi Muaro Jjambi Kota Baru Pall 10 Kenali Asam Bawah RT 36

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

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

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


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

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

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

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

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

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

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

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

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

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

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

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


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

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

55 jambi Kota Jambi Kota Baru Paal X Kenali Asam Bawah RT 36

56 jambi Kota Jambi Kota Baru Paal X Kenali Asam Bawah RT 36

57 jambi Kota Jambi Kota Baru Paal X Kenali Asam Bawah RT 36

58 jambi Kota Jambi Kota Baru Paal X Kenali Asam Bawah RT 36

59 jambi Kota Jambi Kota Baru Paal X Kenali Asam Bawah RT 36

60 jambi Kota Jambi Kota Baru Paal X Kenali Asam Bawah RT 36

61 Jambi kota Jambi Kota Baru Paal X Kenali Asam Bawah RT 36

62 Jambi Kota Jambi Kota Baru Paal X Kenali Asam Bawah RT 36

63 Jambi Kota Jambi Kota Baru Paal X Kenali Asam Bawah RT 36


64 Jambi Kota Jambi Kota Baru Paal X Kenali Asam Bawah RT 36

65 Jambi Kota Jambi Kota Baru Paal X Kenali Asam Bawah RT 36

66 Jambi Kota Jambi Kota Baru Paal X Kenali Asam Bawah RT 36

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

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

69 Jmabi Kota Jambi Kota Baru Pal X Kenali Asam Bawah RT 36

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

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

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

73 Jambi Kota Jambi Kota Baru Kenali Asam Bawah RT. 36

74 Jambi Kota Jambi Kota Baru Kenali Asam Bawah RT. 36

75 Jambi Kota Jambi Kota Baru Kenali Asam Bawah RT. 36


76 Jambi Kota Jambi Kota Baru Kenali Asam Bawah RT. 36

77 Jambi Kota Jambi Kota Baru Kenali Asam Bawah RT. 36

78 Jambi Kota Jmabi Kota Baru Kenali Asam Bawah RT. 36

79 Jambi Kota Jambi Kota Baru Kenali Asam Bawah RT 36

80 Jambi Kota Jambi Kota Baru Kenali Asam Bawah RT 36

81 Jambi Kota Jambi Kota Baru Kenali Asam Bawah RT 36

82 Jambi Kota Jambi Kota Baru Kenali Asam Bawah RT 36

83 Jambi Kota Jambi Kota Baru Kenali Asam Bawah RT 36

84 Jambi Kota Jambi Kota Baru Kenali Asam Bawah

85 jambi Kota Jambi Kota Baru K.A Bawah RT 36

86 jambi Kota Jambi Kota Baru K.A.Bawah RT 36


87 jambi Kota Jambi Kota Baru K.A.Bawah RT 36

88 jambi kota Jambi Kota Baru K.A.Bawah RT 36

89 jambi Kota Jambi Kota Baru K.A.Bawah RT 36

90 jambi Kota Jambi Kota Baru K.A.Bawah RT 36

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

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

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

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

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

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

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


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

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

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

YANTO 4 2 1 3 1
1
1
1
HEFRIYANSYAH 3 2 1 2 1
1
1
KOMERI 5 3 1 1 4 1
1
1
1
1
ARUJI 3 2 1 3 1
1
1
MAT HISOM 4 2 1 1 2 1
1
1
1
Iskowandi 6 1
1
1
1
1
1
SUPRIYADI 5 5 1 1
1
1
1
1
AHMAD TEKAD 4 2 1 1 2 1
1
1
1
JOKO JUMADI 5 2 1 3 1
1
1
1
1
USMAN 3 2 1 2 1
1
1
SALBIYAH 1 1 1 1
MAHFUD YASIN 6 4 1 6 2
2
2
2
2
2
BRAYUDDINAGOR 5 5 1 5 1
1
1
1
1
1
HERMANSYAH 2 2 1 1 1
1
APRIANTO 5 4 1 4 1
1
1
1
1
NURHAYATI 4 4 1 3 2
2
2
2
AMAT DAMIRI 8 8 1 6 1
1
1
1
1
1
1
1
Bunangin 9 5 1 7 1
1
1
1
1
1
1
1
1
Rosita Br. Sirait 3 3 1 3 1
1
1
Ismail 4 2 1 4 1
1
1
1
Heriyono 3 3 1 3 1
1
1
Sucipto 4 4 1 4 1
1
1
1
Muslim Rangkuti 3 3 1 3 1
1
1
Adi Kusplus 4 2 2 1 2 1
1
1
1
Hengki 3 2 1 2 1
1
1
Zulkarnain 2 2 1 2 1
1
A. Rido 8 8 1 8 1
1
1
1
1
1
1
1
Teguh Jatmiko 4 2 1 1 2 1 1
1
1
1
A. RAHMAN 3 2 1 3 1
1
1
WANDY PRANATA 4 3 1 3 1
1
1
1
EDI SAPUTRA 7 3 1 7 1
1
1
1
1
1
1
SUSILO 4 2 1 4 1
1
1
1
Anton Dermawan 4 2 1 1 2 0 1
1
1
1
1
Binsar Manurung 5 5 0 1 5 0 1
1
1
1
1
Abu Hasan Sazali 3 2 1 1 2 0 1
1
1
Nurhadi 7 4 0 1 7 0 1
1
1
1
1
1
M Syarif Hidayatullah 8 5 0 1 7 0 1
1
1
1
1
1
1
1
R.DEDI OKA .A. 3 2 1 1 2 1
1
1
MUKHSIN 2 2 1 2 1
1
AMAT SUKATMAN 5 4 1 4 1
1
1
1
1
SUGIYO 4 3 2 4 1
1
1
1
IRWANSYAH 5 3 1 1 3 1
1
1
1
1
SUNARTO 3 2 1 3 1
1
1
LAGI YANTO 3 2 1 3 1
1
1
M. HARTO 4 2 1 3 1
1
1
1
SOPIRIN 4 4 1 4 1
1
1
1
IMAN TEGUH PRASYO 5 2 1 1 3 1
1
1
1
1
FERIYANI 3 1 1 1 2 1
1
1
NASRULLAH 6 4 1 5 2
2
2
2
2
2
AFRI YANTO 2 2 1 2 2
2
FITRIANTO 4 2 1 1 2 1
1
1
1
JAELANI 6 6 2 5 1
1
1
1
1
1
TONY WAHYUDI 5 2 2 1 2 1
1
1
1
1
SUPARDI 6 5 1 6 1
1
1
1
1
1
Anton Saputra 5 2 2 3 1 1
1
1
1
1
Wagiman 2 2 2 2 1
1
Agus Tanjung 2 2 1 2 1
1
Arman 5 3 1 3 1 1
1
1
1
1
Rachmat 2 2 1 1
1
Angga Saputra 5 3 1 2 1
1
1
1
1
Nuryanto 6 2 3 5 1 1
1
1
1
1
1
Baharudin. MA 4 1 4 2 1
1
1
1
Hendri Prengki Sihite 6 1 2 4 1 1
1
1
1
1
1
T.Sibuea 6 4 2 3 2 2
2
2
2
2
2
Arianto 3 2 3 1
1
1
Anwar 3 2 2 2 1 1
1
1
PARNINGOTAN MANURURNG 2 2 1 2 1
1
ABDUL WAHAB 3 3 1 3 1
1
1
LUMI SETIA BR SITUMORANG 3 3 1 3 1
1
1
HENDRY MULYADI 4 2 1 3 1
1
1
1
AGUS SUSANTO 4 2 1 1 3 1
1
1
1
SUKIDI 5 4 1 5 1
1
1
1
1
Didik Ahmadi 6 5 1 6 1
1
1
1
1
1
Romo Sukiran 4 3 1 2 1
1
1
1
Darmadi 4 3 1 4 1
1
1
1
Amat Kasiman 5 5 1 4 1
1
1
1
1
Tuban 3 3 1 1
1
1
Ahmad Suwandi 5 4 1 5 1
1
1
1
1
Eko Juniardi 5 3 1 1 4 - 1
1
1
1
1
Mariman 4 3 1 4 - 1
1
1
1
Supkiman 5 2 - 1 5 - 1

1
1
1
Wage 6 5 1 5 1
1
1
1
1
1
Supriyanto 6 5 1 6 1
1
1
1
1
1
Julifni Nasution 4 2 1 2 1
- 1
1
1
Usman Affandi 4 4 1 4 1
1
1
1
Bambang Sutrisno 3 2 1 2 1
1
1
Untung Prayitno 3 2 1 2 1
1
1
Sahri Rejeki 5 3 1 1 3 1
1
1
1
1
Suratno 5 3 1 3 1
1
1
1
1
M. Sumardjo 6 5 5 1
1
1
1
1
1
SUPARJAK 3 2 1 2 1
1
1
YONGKI IRAWAN 4 2 1 2 1
1
1
1
ADI PRIYONO 2 2 1 2 1
1
BONCEL BERNAND SILALAHI 6 4 2 4 2
2
2
2
2
2
SARMIN 4 2 2 4 1
1
1
1
SABTU 6 4 1 5 1
1
1
1
1
1
HARNUBI 6 4 1 6 1
1
1
1
1
1
M.ARIFIN 5 2 1 1 4 1
1
1
1
1
EDY DIANTO S 4 4 1 4 1

1
1
USWAN 6 1
1
1
1
1
1
1
h tangga IV. Kete

8. minum obat secara teratur (jika ia)


5. memiliki jamban sehat

7. diagnosis sakit jiwa

9. ada ART dipasung


4. jenis sumber air

3. hubungan ART
6. jenis jamban

2. Nama
1 1 1 2 2 YANTO 1
2 RUKMINI 2
2 NANDITO ABILAH PRATAMA 3
2 STEFANI AULIA ANGGITA 3
1 1 1 2 2 HEFRIYANSYAH 1
2 INDAH TRI WANDA 2
2 FIDA SUSANTI 3
1 1 1 2 2 KOMERI 1
2 SULASTRI 2
2 FUJI HERMAWATI 3
2 BUDI SANTOSO 3
2 AISYAH SALSABILA 3
2 1 1 2 2 ARUJI 1
2 HENI YANTI 2
2 WAHYU FEBRI YANSYAH 3
1 1 1 2 2 MAT HISOM 1
2 NANI RACHMAWATI 2
2 REYQA SYIFA CHALILA 3
2 MUHAMMAD AIDAN FACHRY 3
1 1 1 2 2 Iskowandi 1
2 Santi Wulandari 2
2 Joni Candra 3
2 Reni Apriani 3
2 Rani Septiani 3
2 Rini Marisya 3
2 1 1 2 2 2 SUPRIYADI 1
2 SITI SARYANI 2
2 M.FADHIL FAKHRUDDIN 3
2 MAHARANI 3
2 SALSABILA 3
2 1 1 2 2 2 AHMAD TEKAD 1
2 TRI MULYANI 2
2 SENO ALBUHORI 3
2 SENA PRATIWI 3
2 1 1 2 2 2 JOKO JUMADI 1
2 LAMINAH 2
2 CAHYA FADHILA 3
2 FAIZ ABDILLAH 3
2 ZAHRA ANISA PT 7
2 1 1 2 2 2 USMAN 1
2 YEYEN 2
2 INDAH CAHYA LESTARI 3
2 1 1 2 2 2 SALBIYAH 1
1 1 1 2 2 2 MAHFUD YASIN 1
2 MARDALENA 2
2 EKA SAFITRI 3
2 SUCI SEFTIANI 3
2 SANDI NUGRAHA 3
2 MAYSIN CEFIRA 3
1 1 1 2 2 2 BRAYUDDINAGOR 1
2 MISLINA WATI 2
2 MEISY ANANDA PUTRI 3
2 BRALIN DEFRIANDO 3
2 TIARA CINTA KITANA 3
2 KAMEL ROZAMAN 7
2 1 1 2 2 2 HERMANSYAH 1
2 HENNI 2
1 1 1 2 2 2 APRIANTO 1
2 ADISMAR 2
2 LOLITA RIANIS 3
2 DIPO ADRIANSYAH 3
2 ANNISA RIANIS 3
1 1 1 2 2 2 NURHAYATI 2
2 ROBI WIRANZANI 3
2 WIRA SAMUDRA 3
2 DANDI SURYONO 3
1 1 1 2 2 2 AMAT DAMIRI 1
2 SUREP 2
2 ATMIATI 3
2 SUGINARSIH 3
2 AGUS KURNIANTO 3
2 AGUS KURNIAWAN 3
2 MISTIONO 3
2 MASUGIYO 3
1 1 1 2 2 2 Bunangin 1
2 Nurani 2
2 Arya Dwipangga 3
2 Destia Silvana 3
2 Nadia Sabila 3
2 Najwa Chara Putri 3
2 Nayra Fitriani 3
2 Beby Aqilla 3
2 Nina Manda Sari 7
1 1 1 2 2 2 Rosita Br. Sirait 1
2 Nurlita Br. Sijabat 3
2 Lisna Br. Sijabat 3
1 1 2 2 2 Ismail 1
2 Sumarse 2
2 Raisya Mutiara Ramadhan 3
2 Muhammad Al. Khudri 3
1 1 1 2 2 2 Heriyono 1
2 Rusmayani 2
2 ridho cahyadi 3
1 1 2 2 2 Sucipto 1
2 Isminarsih 2
2 Aninditya Suciati 3
2 Leginem 6
1 1 1 2 2 2 Muslim Rankuti 1
2 Juminem 2
2 Firman Rankuti 3
1 1 1 2 2 2 Adi Kusplus 1
2 Mita Ria 2
2 Muhammad Khidayat 3
2 Muhammad Rohman 3
1 1 1 2 2 2 Hengki 1
2 Pitriyanti 2
2 Annisa Putri Soleha 3
1 1 1 2 2 2 Zulkarnain 1
2 Intan Tania 2
1 1 1 2 2 2 A. Rido 1
2 Markona 2
2 Zaidi Rahman 3
2 Amelia 3
2 Rodi Santosa 3
2 Ardiansyah 3
2 Alma Yudi 7
2 Radiansyah 7
1 1 1 2 2 2 Teguh Jatmiko 1
2 Siti Soidah 2
2 Rizki Jatmiko 3
2 Muhammad Khalif Jatmiko 3
2 1 1 2 2 2 A. RAHMAN 1
2 SITI KHOTIJAH 2
2 SITI AYSAH 3
2 1 1 2 2 2 WANDY PRANATA 1
2 YUSNAINI 2
2 ARDHI ARAHMAN P 3
2 DHINA AMARI P 3
2 1 2 2 2 2 EDI SAPUTRA 1
2 SUPARMI 2
2 SULIS SETIA WATI 3
2 KARINA 3
2 M. RENO ARDI 3
2 PUTRI NAZWA 3
2 ERNI YUSNITA 3
2 1 1 2 2 2 SUSILO 1
2 SITI KHOTIMAH 2
2 ZAHRA KAMILA P 3
2 UABAY HAMDAN 3
1 1 1 2 2 Anton 1
2 OSA 2
2 Airin Azahra 3
2 Riana Aprilia 3
2 Fatian Akbar 3
1 1 1 2 2 Binsar Manurung 1
2 Delvina Sirait 2
2 Friska Dewi Manurung 3
2 Johanes Parlin Manurung 3
2 Roy Rolles 7
1 1 1 2 2 Abu Hasan Sazali 1
2 Krisna Harahap 2
2 Keyza Mazidah 3
1 1 1 2 2 Nurhadi 1
2 Suyatni 2
2 Mahdi Ghufron Hidyat 3
2 Nur Rahmat Abadi 3
2 Salwa Abdillah 3
2 Sugiyanto 7
1 1 1 2 2 M Syarif Hidayatullah 1
2 Nursyamsiah 2
2 Mahmudafi Nur Syarif 3
2 Munib Ahmad 4
2 Lateef Ahmad 5
2 Bashier Ahmad 6
2 Mutmainah Amtul Wakeel 7
2 Rasheed Noor Ahmad 8
1 1 1 2 2 2 R.DEDI OKA .A. 1
2 HARMITA 2
2 RTS. KALILA MIKA .R. 3
1 1 1 2 2 2 MUKHSIN 1
2 ZOSMARNI 2
1 1 1 2 2 2 AMAT SUKATMAN 1
2 NUR FATIMAH 2
2 AMANDA EGA RISKI 3
2 ADELA ROSI 3
2 AEGATHA RISKI BAGAS 3
1 1 1 2 2 2 SUGIYO 1
2 HARNI 2
2 MEY LIAWATIK 3
2 CINTHIYA AMBARAWATI 3
1 1 1 2 2 2 IRWANSYAH 1
2 LENA 2
2 INTAN SARI 3
2 DEA AMELIA 3
2 DINDA ANISA 3
1 1 1 2 2 2 SUNARTO 1
2 FITRIA 2
2 GILANG SAPUTRA 3
1 1 1 2 2 2 LAGI YANTO 1
2 RIWANA 2
2 SALWA RAMADANI 3
1 1 1 2 2 2 M. HARTO 1
2 EKA PATRIANTI 2
2 NDUFAL HAEKAL ADAMS 3
2 FATHAN KHOIRUL ALFAHREZI 3
1 1 1 2 2 2 SOPIRIN 1
2 NURLOHOT 2
2 WINDA APRIYANTI 3
2 ILHAM WIDAKSONO 3
1 1 2 2 2 2 IMAN TEGUH PRASTYO 1
2 LINDA LESTARI 2
2 FIKAR FIRJATULLAH 3
2 ARKAN DWI SYAHPUTRA 3
2 MUHAMMAD ADAZKA AZFAR 3
1 1 1 2 2 2 FERIYANI 1
2 AMELIA ARDIANI 3
2 ALEX MARDIANSYAH 3
2 1 1 2 1 2 NASRULLAH 1
2 MAHDALENA 2
1 AMANAH DIAN PUTRA 3
2 RATNA YULI MAULANA 3
2 M. YASSAR AMANULLAH 3
2 M. FARIS AMANULLAH 3
2 1 1 2 2 2 AFRI YANTO 1
2 ANGGI KURNIAWATI 2
1 1 1 2 2 2 FITRIYANTO 1
2 KURNIA RAMADHANI 2
2 ALFIAN MAULANA 3
2 FADLAN AFFANDI 3
1 1 1 2 2 2 JAELANI 1
2 SUNARSIAH 2
2 DEWI NOVITA 3
2 RATNA WILIA 3
2 TUGIANA 3
2 ADE SAPUTRA 3
2 1 1 2 2 2 TONY WAHYUDI 1
2 RATNA WILIS 2
2 REVI ARPITO 3
2 HANA KHOIRINNISA 3
2 AFIFA FATIHAH 3
2 1 1 2 2 2 SUPARDI 1
2 BOYEM 2
2 TRIYANTO 3
2 SAPARI 3
2 BESARI 3
2 SUCI WULANDARI 3
1 1 1 2 2 Anton Saputra 1
1 2 Nurul Jannah 2
1 2 Andika Saputra 3
1 2 Muhammad Riski Aditya 3
1 2 Fitria Anggraini 3
1 1 1 2 2 Wagiman 1
1 2 Paijah 2
1 1 1 2 2 Agus Tanjung 1
1 2 Nurhaida 2
1 1 1 2 2 Arman 1
1 2 Sriyani 2
1 2 Aster Pramesti Elvana Arman 3
1 2 Raki Rizky Anu Arman 3
1 2 Sisilia Syifatunnisa Arman 3
1 1 1 2 2 Rachmat 1
1 2 Tusilah 2
1 1 1 2 2 Angga Saputra 1
1 2 Junia Octavia 2
1 2 Regina Sifa Anggraini 3
1 2 Kanza Olivia Anggraini 3
1 2 Hamida 6
2 1 1 2 2 2 Nuryanto 1
2 Riyanah 2
2 Amanda Nur 3
2 Ageng Ayu Nurhaliza 3
2 Alisya 3
2 Aliya 3
1 1 1 2 2 2 Baharudin. MA 1
2 Yeliati 2
2 Bheny 3
2 Robby Elvany 3
1 1 1 2 2 2 Hendri Prengki Sihite 1
2 Resta Kartika Br Hutabarat 2
2 Adril Riski Sihite 3
2 Immanuel Togu Pangarisan Sihi 3
2 Shella Mardiana 3
2 Nadin Monika 3
2 1 1 2 2 2 T.Siboea 1
2 Eva Br Sinurat 2
2 Natasya Sibuea 3
2 Nadya Andina Siboea 3
2 Nanda Romaria Sibuea 3
2 Danil Gavriel Sibuea 3
1 1 1 2 2 2 Arianto 1
2 Yusnimar 2
2 Azwar 3
1 1 1 2 2 2 Anwar 1
2 Novia Lestari 2
2 Bondan Pratama 3
1 1 1 2 2 2 PARNINGOTAN MANURURNG 1
2 SEVA SUSANTI SINAGA 2
1 1 1 2 2 2 ABDUL WAHAB 1
2 JAMILAH 2
2 ALDY 3
1 1 1 2 2 2 R PANDAPOTAN SINAGA 1
2 LUMI SETIA BR SITUMORANG 2
2 MURNI BR SITUMORANG 7
1 1 1 2 2 2 HENDRY MULYADI 1
2 YULIANA WATI 2
2 REZA FIRMANSYAH 3
2 NEYZHA CHARISCA MULYANA 3
1 1 1 2 2 2 AGUS SUSANTO 1
2 ADMIANTI 2
2 MUHAMMAD RAYHAN 3
2 ANGGITA ANAYA PUTRI 3
1 1 1 2 2 2 SUKUDI 1
2 SUTINI 2
2 TIKA MAWAR SARI 3
2 ANITA MAYASARI 3
2 ISKARIMUN WALADIN 7
1 1 1 2 2 2 Didik Ahmadi 2
2 Nurhayati 2
2 M. Fit Abadan 3
2 Zulkifli Fadillah 3
2 Ahmad Yusuf 3
2 Muhammda Lutfi Najib 3
1 1 1 2 2 2 Romo Sukiran 2
2 Rosnita 2
2 Nur Muja Yana 3
2 Santosa Geger 3
1 1 1 2 2 2 Darmadi 2
2 Suryana 2
2 Yudhistira 3
2 M. Fadillah Abil Laksanadi 3
1 1 1 2 2 2 Amat Kasiman 3
2 Suwaso 6
2 Sainah 7
2 Wagiyem 7
2 Legianto 7
1 1 1 2 2 2 Tuban 2
2 Ningsih 2
2 Liakomala Santi 3
1 1 1 2 2 2 Ahmad Suwandi 2
2 Nurhasanah 2
2 Alfian Nurhadi 3
2 Alfino Destriadi 3
2 Sahroni 7
2 1 1 2 2 2 Eko Juniardi 1
2 Sutri 2
2 Triska Nursonia 3
2 Afridho Aldi Fadhila 3
2 Safiah Nur Indah Sari 3
2 1 1 2 2 2 Mariman 1
2 Nurwilah 2
2 Imas Aprilia 3
2 Riyan Nurrohman 3
1 1 1 2 2 2 Supkiman 1
2 Sariyana Nasution 2
2 Mico Ponda 3
2 Mecel Aditya 3
2 Marvel Julian 3
1 1 1 2 2 2 Wage 1
2 Irmawati 2
2 Yesi Novianti 3
2 Retno Widiana 3
2 Muhammad Ibrahim 3
2 Sirman 6
1 1 1 2 2 2 Supriyanto 1
2 Wijayanti 2
2 Restu Veriyan Wijaya 3
2 Wanda Prayuda 3
2 Ardiya Pangesti 3
2 Diva Pramuja 3
1 1 1 2 2 2 Julifni Nasution 1
2 Azriani 2
2 Marpel Ifni Nasution 3
2 Mendiastara Ifni Nasution 3
1 1 1 2 2 Usman Affandi 1
1 2 Yuliana 2
1 2 Mario Madaliansyah 3
1 2 Mahendra Dinata 3
1 1 1 2 2 Bambang Sutrisno 1
1 2 Yuli Purwanti 2
1 2 Jihan Indah Syafitri 3
1 1 1 2 2 Untung Prayitno 1
1 2 Nurhayani 2
1 2 Cahaya Islamiyah 3
1 1 1 2 2 Sahri Rejeki 1
1 2 Ismiyati 2
1 2 Ahmat Safari 3
1 2 Khoirul Janah 3
1 2 Akbar Rejeki 3
1 1 1 2 2 2 Suratno 1
1 2 Maruyah 2
1 2 Rita Ambarwati 3
1 2 Marisa Tri Ningsih 3
1 2 Eka Julianti 3
1 1 1 2 2 2 M.Sumardjo 1
1 2 Tumini 2
1 2 Untung Prayetno 3
1 2 Adi Priyono 3
1 2 Tugo Syaputro 3
1 2 Anggi Kurniwati 3
1 1 1 2 2 2 SUPARJAK 1
2 JULIANA 2
2 SASY WIJAYANA 3
1 1 1 2 2 2 YONGKI IRAWAN 1
2 TIKAYENI 2
2 NASYA IRAWAN 3
2 NAFDIL DWI IRAWAN 3
1 1 1 2 2 2 ADI PRIONO 1
2 Pundut Hastaji 2
2 1 1 2 2 2 BONCEL BERNAND SILALAHI 1
2 IDA ROYANI 2
2 TRISNO DS SILALAHI 3
2 DEDY PETRUS SILALAHI 3
2 RAHUL MARKUS SILALAHI 3
2 SERGIO PAULUS RAMOS SILALAHI 3
2 1 1 2 2 2 SARMIN 1
2 ROSNAH 2
2 HEMELIA FASTATRIK 5
2 MUHAMMAD IQBAL NOVANTO 7
2 1 1 2 2 2 SABTU 1
2 IRMAYANTI 2
2 RISCA PUTRI CAHYANI 3
2 MUHAMMAD HAIKAL 3
2 ARBIYAN 7
2 NOVIA SARI 7
2 1 1 2 2 2 HARNUBI 1
2 MUTBIAH 2
2 MUHAMMAD IQBAL 3
2 SITI IQLIMA 3
2 BAITIAH 7
2 SURYANA 7
2 1 1 2 2 2 M.ARIFIN 1
2 ERI SURIFAH 2
2 KHANAYA PUTRI RAMADHANI 3
2 REHAN ERFIANSYAH 3
2 RANIA ANNISA ANGGRAINI 3
2 1 1 2 2 2 EDY DIANTO S 1
2 YULIASTUTI 2
2 RENY SAPITRI W 3
2 JEPRYEDY SETIAWAN 3
2 1 1 2 2 2 USWAN 2
2 EMALIA 2
2 YANBASTIAN TITO 3
2 MUHAMMAD AKBAR 3
2 PIPIN ARYANI 3
2 ADI SAPUTRA 7
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

14/05/1970 49 588 1 1 1 4 6
10/02/1982 37 444 2 1 2 1 5 1
22/10/2006 13 156 1 2 1 3 2
04/11/2010 9 108 2 2 1 2 2
01/01/1988 31 372 1 1 1 4 5
27/08/1993 26 312 2 1 2 1 2 1
17/05/2014 5 60 2 2 1 1 1
16/07/1970 49 588 1 1 1 4 5
19/07/1979 40 480 2 1 2 1 3 1
02/12/1998 21 252 2 2 1 5 2
03/06/2006 13 156 1 2 1 3 2
19/12/2016 3 36 2 2 1 1 1
03/08/1983 36 432 1 1 1 4 5
17/08/1985 34 408 2 1 2 1 4 1
09/04/2008 11 99 1 2 1 2 2
10/11/1985 34 408 1 1 1 7 4
05/05/1986 33 396 2 1 1 1 7 1
01/05/2011 8 96 2 2 1 2 2
11/06/2015 4 48 1 2 1 1 1
12/08/1975 44 528 1 1 1 4 5
14/09/1982 37 444 2 1 2 1 5 1
12/04/1999 20 240 1 2 1 5 2
27/12/2001 18 216 2 2 1 4 2
23/09/2009 10 120 2 2 1 2 2
29/03/2013 6 72 2 2 1 1 1
21 42 1 1 1 1 5 5
10 41 3 2 1 1 5 1
25 15 11 1 2 1 1 1
21 14 1 2 2 1 1 1
07 5 5 2 2 1 1 1
9 36 1 1 1 1 4 8
9 34 9 2 1 1 4 1
21 6 11 1 2 1 1 1
16 1 1 2 2 1 1 1
3 38 1 1 1 5 5
10 30 5 2 1 1 4 1
22 12 2 2 1 2 2
17 6 10 1 2 1 1 1
10 7 8 2 2 1 1 1
25 33 6 1 1 1 5 8
13 26 4 2 1 1 1 5 1
8 5 2 2 2 1 1 1
31 66 3 2 4 1 1 1
28-07-1973' 46 1 1 1 4 8
18-06-1971' 48 2 1 2 1 5 1
21-01-1997' 22 2 2 2 1 5 2
28-09-1999' 20 2 2 2 1 5 2
05-10-2003' 16 1 2 1 4 2
09-03-2006' 13 2 2 2 1 3 2
06-08-1969' 50 1 1 1 5 8
25-01-1972' 47 2 1 2 1 3 1
15-05-2000' 19 2 2 2 1 5 2
30-06-2001' 18 1 2 1 5 2
20-06-2007' 12 2 2 2 1 3 2
22-11-1992' 27 1 2 1 3 8
03-12-1954' 65 1 1 1 3 8
02-04-1965' 54 2 1 2 1 4 1
01-02-1973' 46 1 1 1 5 5
12-08-1974' 45 2 1 2 1 5 5
21-11-2001' 18 2 2 2 1 4 2
10-12-2002' 17 1 2 1 4 2
26-01-2013' 6 2 2 2 1 1 1
03-04-1962' 57 2 4 2 1 5 9
18-09-1991' 28 1 2 1 5 1
20-09-1995' 24 1 2 1 5 2
28-10-1999' 20 1 2 1 5 2
26-02-1954' 65 1 1 1 3 6
31-12-1959' 60 2 1 2 1 3 1
22-09-1979' 40 2 1 2 1 5 1
26-01-1981' 38 2 1 2 1 5 1
31-08-1986' 33 1 1 1 4 9
31-08-1986' 33 1 1 1 4 8
27-09-1990' 29 1 2 1 4 8
27-09-1993' 26 1 2 1 3 8
31/12/1980 38 4 1 1 1 2 8
31/12/1982 36 4 2 1 1 2 1
14/8/2002 17 8 2 2 1 4 2
1/4/2003 16 0 2 2 1 4 2
3/3/2005 14 1 2 2 1 3 2
15/4/2009 10 0 2 2 1 2 2
1/9/2011 7 7 2 2 1 1 1
9/5/2013 6 11 2 2 1 1 1
7/3/1993 26 1 2 2 1 4 1
18/8/1968 50 8 2 4 2 5 1
16/7/1994 25 9 2 2 2 5 9
28/8/1996 23 8 2 2 2 5 9
17/7/1973 46 9 1 1 1 5 5
7/7/1983 35 9 2 1 1 4 1
29/9/2007 11 6 2 2 1 2
12/9/2009 9 6 1 2 1 2
4/9/1970 48 7 1 1 1 3 5
31/5/1971 47 11 2 1 1 3 1
28/12/1994 24 4 1 2 1 4 1
17/8/1968 50 7 1 1 1 5 8
10/10/1970 48 5 2 1 1 5 1
18/9/2000 18 7 2 2 1 4 2
1/7/1948 70 8 2 2 1 1 1
17/6/1966 52 9 1 1 1 3 5
15/6/1960 58 9 2 1 1 3 1
8/9/1992 26 6 1 2 1 3 1
18/10/1988 30 6 1 1 1 3 5
21/03/1993 26 1 2 1 1 3 1
24/01/2016 3 2 1 2 1 2 1
07/07/2017 1 9 1 2 1 1 1
12/12/1988 30 4 1 1 1 4 5
30/06/1990 28 9 2 1 1 4 1
20/08/2013 5 8 2 2 1 1 1
01/07/1996 22 9 1 1 1 5 5
19/12/2000 18 4 2 1 2 1 4 1
14/05/1965 53 11 1 1 1 3 5
07/04/1966 53 0 2 1 2 1 3 1
17/10/1985 33 6 1 2 1 5 1
13/03/1988 30 6 2 2 2 1 5 1
16/06/1989 29 10 1 2 1 4 1
22/05/1998 20 11 1 2 1 2 2
03/01/1986 33 3 1 2 1 4 1
07/06/1988 30 10 1 2 1 4 1
02/05/1983 35 11 1 1 1 5 5
29/09/1989 29 6 2 1 2 1 5 1
23/03/2011 8 1 1 2 1 2 2
12/02/2019 0 2 1 2 1 1 1
2 52 1 1 1 5 9
2 44 2 1 1 4 1
25 14 2 2 1 5 2
12 44 1 1 1 5 5
12 35 2 1 1 3 1
8 17 1 2 1 1 1
2 13 2 2 1 1 1
5 42 1 1 1 3 6
15 39 2 1 1 3 6
26 19 2 2 1 4 1
25 14 2 2 1 1 2
6 11 1 2 1 3 2
1 9 2 2 1 3 2
27 8 2 2 1 1 1
24 35 1 1 1 4 5
16 31 2 1 1 5 1
26 12 2 2 1 2
3 8 1 2 1 2
1/19/1988 41 492 1 1 2 1 5 8
11/9/1991 28 336 2 1 2 1 4 1
4/23/2011 8 96 2 2 2 1 2 2
4/23/2017 6 72 2 2 2 1 2 2
4/21/2017 2 24 1 2 2 1 1 1
6/2/1962 57 684 1 1 2 3 4 8
12/7/1962 57 684 2 1 2 3 5 1
31/09/1989 30 360 2 2 2 3 5 1
31/09/1990 29 348 1 2 2 3 5 1
5/11/1969 50 600 1 1 2 3 5 9
10/8/1988 31 372 1 1 2 1 4 8
5/3/1999 20 240 2 1 2 1 5 1
2/20/2013 6 72 2 2 2 1 1 1
5/23/1971 50 600 1 1 2 1 5 4
1/4/1977 44 528 2 1 2 1 6 4
9/27/1997 22 264 1 2 2 1 4 2
10/14/2002 17 204 1 2 2 1 2 2
8/4/2006 13 156 2 2 2 1 1 1
6/6/1976 45 540 1 2 2 1 2 4
7/2/1959 58 696 1 1 2 1 2 6
7/27/1964 53 636 2 1 2 1 2 1
11/29/1996 21 252 2 2 2 1 5 2
3/29/2000 19 228 1 2 2 1 4 2
9/8/2001 18 216 1 2 2 1 4 2
8/23/2007 12 144 1 2 2 1 2 2
10/1/2008 11 132 2 2 2 1 2 2
4/23/2010 9 108 1 2 2 1 1 1
10/25/1990 28 1 1 1 5 5
11/11/1990 28 2 1 1 6 1
7/3/2014 4 2 2 1 1 2
3/3/1962 57 1 1 1 5 5
12/7/1963 55 2 1 1 5 1
2/13/1966 52 1 1 1 5 9
8/5/1974 45 2 1 1 6 1
3/18/1999 20 2 2 1 5 2
3/11/2003 16 2 2 1 4 2
31-09-09 9 1 2 1 1 2
5/8/1979 39 1 1 1 4 8
1/2/1982 37 2 1 1 3 1
5/23/2003 15 2 2 1 4 2
10/21/2009 9 2 2 1 1 2
41 1 1 1 3 9
38 2 1 1 3 1
18 2 2 1 5 2
12 2 2 1 1 2
5 2 2 1 2
11/12/1978 40 1 1 1 2 8
5/9/1972 46 2 1 1 5 1
1/12/2007 12 1 2 1 1 2
26/03/1981 38 1 1 1 1 4 5
10/03/1984 35 1 2 1 1 3 1
07/10/2007 11 6 2 2 1 1 2
7/03/1979 40 1 1 1 5 9
10/02/1980 39 1 2 1 1 5 1
22/04/2006 13 1 2 1 1 2
11/12/2010 8 4 1 2 1 1 2
04/01/1967 52 1 1 1 6 5
09/09/1967 51 7 2 1 1 6 4
13/04/1995 24 2 2 1 6 2
12/06/2001 17 10 1 2 1 4 2
25/10/1983 35 6 1 1 1 5 5
19/01/1987 32 3 2 1 1 5 1
02/02/2008 11 2 1 2 1 2 2
03/03/2011 8 1 1 2 1 2 2
20/05/2015 3 11 1 2 1 1 1
10/04/1989 30 2 1 1 3 1
06/09/2008 10 7 2 2 1 2 2
09/12/2016 2 4 1 2 1 1 1
6 48 1 1 1 4 3
24 45 2 1 1 5 1
11 24 1 2 1 3 1
27 21 2 2 1 2 1
29 11 1 2 1 3 1
11 6 1 2 1 1 1
7 32 1 1 1 2 5
8 28 2 1 1 4 1
25 33 1 1 1 4 8
2 27 2 1 1 5 1
1 5 1 2 1 1
2 10 1 2 1 1
9 59 1 1 1 2 8
16 53 2 1 1 2 1
9 34 2 1 1 5 1
3 32 2 1 1 5 1
27 31 2 1 1 4 1
15 21 1 2 1 2 1
20 54 1 1 1 5 8
3 54 2 1 1 5 1
24 9 1 2 1 2 1
15 2 2 2 1 2 1
14 1 2 2 1 1 1
15 59 1 1 1 1 8
15 55 2 1 1 1 1
18 28 2 1 1 2 1
10 25 1 1 1 2 2
6 22 1 2 1 2 2
14 15 2 2 1 1 1
11/08/1986 33 396 1 1 1 4 5
22/08/1985 34 408 2 1 2 1 4 1
05/01/2009 10 120 1 2 1 2 2
18/01/2012 7 84 1 2 1 2 2
16/06/2018 9 2 2 1 1 1
20/05/1971 48 576 1 1 1 3 8
04/07/1973 46 552 2 1 2 1 3 1
17/08/1967 52 624 1 1 1 4 5
03/02/1970 49 588 2 1 2 1 4 1
12/10/1973 46 552 1 1 1 5 5
12/12/1979 40 480 2 1 2 1 4 1
03/01/2003 16 192 2 2 2 1 4 2
04/04/2012 7 84 1 2 1 2 1
19/06/2018 9 2 2 1 1 1
25/09/1946 73 876 1 1 1 3 8
02/04/1959 60 720 2 1 1 3 1
12/11/1985 34 408 1 1 1 4 5
17/10/1986 33 396 2 1 2 1 4 1
23/03/2011 8 96 2 2 1 2 2
13/06/2014 5 60 2 2 1 1 1
15/07/1954 65 780 2 4 1 3 5
9/10/1971 47 7 1 1 1 1 5
1/13/1978 41 3 2 1 2 1 2 1
7/12/1998 20 9 2 2 2 1 3 5
1/25/2005 14 3 2 2 2 1 4 2
8 2 2 1 5 2
3/11/2019 2 2 1 1 1
12/21/1960 59 3 1 1 1 4 5
6/5/1961 57 10 2 1 1 3 1
7/25/1981 37 9 1 2 1 5 5
4/14/1999 20 1 2 1 5 1
8/27/1983 35 8 1 1 2 5 5
12/14/1982 34 4 2 1 2 2 5 1
8/1/2009 9 8 1 2 2 3 2
12/7/2010 8 4 1 2 2 2 2
1/26/2014 5 3 2 2 2 2 2
7/27/2017 21 2 2 2 1 1
7/19/1979 39 9 1 1 2 5 5
4/14/1984 25 2 1 2 2 5 1
7/8/2008 10 8 2 2 2 2 2
10/16/2010 8 6 2 2 2 2 2
11/27/2014 4 5 2 2 2 2 2
9/28/2016 2 7 1 2 2 1 1
2/25/1961 58 1 1 1 1 4 5
3/21/1961 58 1 2 1 1 5 1
6/4/1996 22 9 1 2 1 5 5
3/3/1994 25 1 1 1 1 4 5
11/23/1998 20 5 2 1 2 1 4 1
5/22/2016 2 11 1 2 1 1 1
28/03/1986 33 396 1 1 2 5 5
28/04/1989 30 360 2 1 2 5 1
20/11/1953 65 780 1 1 1 5 9
17/10/1957 61 732 2 1 1 3 1
08/12/2000 18 216 1 2 1 5 2
17/10/1980 38 456 1 1 2 4 5
26/11/1988 30 360 2 1 2 5 1
26/05/1996 22 264 2 2 2 2
16/02/1982 37 444 1 1 1 5 9
16/07/1982 36 432 2 1 1 5 1
10/03/2008 11 132 1 2 1 2 2
30/03/2011 8 96 2 2 1 2 2
19/01/1980 39 468 1 1 1 4 5
22/09/1979 39 468 2 1 1 5 1
12/11/2007 11 132 1 2 1 2 2
19/03/2014 5 60 2 2 1 1 2
06/08/1974 44 528 1 1 1 3 5
24/02/1976 43 516 2 1 1 3 1
28/01/1996 23 276 2 2 1 5 2
21/05/2006 12 144 2 2 1 2 1
'11/07/1991 27 324 1 2 1 5 5
18/06/1962 56 10 1 1 1 7 5
10/05/1967 52 11 2 1 2 1 7 1
06/07/1967 24 9 1 2 1 2 1
25/08/1998 21 8 1 2 1 1 1
21/12/2000 18 4 1 2 1 1 1
12/06/2007 11 10 1 2 1 1 1
01/07/1942 76 9 1 1 1 3 6
03/07/1981 37 9 2 1 2 1 2 6
03/05/2001 17 11 2 2 1 2 1
14/12/2009 9 4 1 2 1 2 1
13/07/1973 45 9 1 1 1 5 3
10/09/1976 42 7 2 1 2 1 4 1
20/10/2001 17 6 1 2 1 4 1
25/06/2007 11 10 1 2 1 3 1
26/04/1979 40 0 1 2 1 4 5
31/12/1940 78 4 2 4 2 1 3 5
11/07/1984 35 9 2 2 2 1 4 5
21/04/1988 31 0 2 2 2 1 5 5
26/03/1981 38 1 1 2 1 4 5
31/12/1955 64 1 1 1 3 8
02/04/1959 60 2 1 2 1 3 1
21/05/1991 28 2 2 2 1 3 2
13/02/1980 39 2 1 1 1 5 5
20/03/1979 40 1 2 1 2 1 5 1
20/04/2000 18 0 1 2 1 2 1
20/12/2007 11 8 1 2 1 1 1
23/06/1983 35 10 1 2 1 4 8
07/06/1979 39 10 1 1 2 1 4 5
21/08/1984 34 7 2 1 1 1 4 1
28/07/2003 15 8 2 2 2 1 4 2
21/04/2009 9 11 1 2 2 1 2 2
20/02/2017 2 0 2 2 2 1 1 1
14/06/1971 47 10 1 1 2 1 4 5
15/08/1980 38 8 2 1 2 1 4 1
18/04/2001 18 0 2 2 2 1 5 2
23/02/2009 10 1 1 2 2 1 3 2
13/02/1972 47 2 1 1 2 1 5 8
19/12/1982 36 3 2 1 2 1 3 1
15/01/2005 14 3 1 2 2 1 3 2
15/05/2007 11 11 1 2 2 1 3 2
04/07/2008 10 9 1 2 2 1 3 2
10/10/1969 49 6 1 1 1 5 3
10/08/1970 48 7 2 1 2 1 5 1
02/08/1996 22 8 2 2 2 1 5 5
19/03/2003 16 0 2 2 2 1 4 2
01/05/2009 9 11 1 2 2 1 2 2
24/07/1944 74 7 1 2 1 3 6
05/07/1957 61 9 1 1 2 1 5 5
10/10/1970 48 6 2 1 2 1 5 1
17/11/1993 25 5 1 2 2 1 7 5
21/12/1999 19 3 1 2 2 1 5 2
11/03/2002 17 1 2 2 2 1 2 2
17/01/2007 12 3 1 2 2 1 2 2
27/07/1984 34 8 1 1 2 1 5 5
09/07/1989 29 9 2 1 2 1 5 1
20/05/2010 8 10 1 2 2 1 2 2
31/12/2013 5 3 1 2 2 1 2 2
4/14/1970 48 576 1 1 1 1 8
10/28/1978 40 480 2 1 2 1 5 1
7/4/1999 19 228 1 2 1 5 1
8/17/2003 15 180 1 2 1 4 1
2/10/1973 46 552 1 1 1 5 5
7/3/1974 45 540 2 1 2 1 5 5
9/27/2011 7 84 2 2 1 1 2
4/30/1984 34 408 1 1 1 5 8
11/4/1984 33 396 2 1 2 1 5 1
11/22/2011 7 84 2 2 1 1 1
8/8/1985 33 396 1 1 1 4 8
9/26/1977 41 492 2 1 2 1 4 1
6/7/1997 21 252 1 2 1 5 8
7/1/2010 8 96 2 2 1 2 1
3/29/2018 1 12 1 2 1 1 1
6/26/1972 46 552 1 1 1 3 8
7/12/1973 45 540 2 1 1 4 1
5/7/1998 20 240 2 2 1 5 1
2/16/2005 14 168 2 2 1 4 1
7/11/2010 8 96 2 2 1 2 1
10/3/1947 71 852 1 1 1 4 1
4/4/1955 60 720 2 1 1 2 1
5/30/1984 34 408 1 1 1 4 5
5/30/1986 32 384 1 1 1 4 5
5/30/1989 29 348 1 1 1 4 8
1/8/1991 28 336 2 1 2 1 4 1
10/06/1961. 58 1 1 1 2 8
23/01/1982 38 2 1 1 5 1
8/8/2011 8 2 2 1 2 2
27/121988 31 1 1 1 4 5
15/06/1991 28 2 1 1 3 1
27/10/2011 8 2 2 1 2 2
28/09/2015 4 1 2 1 2 2
30/05/1986 33 1 1 1 5 5
9/12/1988 31 2 1 1 5 1
5/10/1977 41 1 1 3 5 9
22/09/1976 42 2 1 3 5 1
28/06/2001 17 1 2 3 2 1
15/10/2003 15 1 2 3 2 1
20/09/2010 8 1 2 3 1 1
9/6/2014 4 1 2 3 1 1
3/7/1942 77 1 1 1 5 9
5/9/1946 73 2 1 1 4 1
7/7/1991 28 2 2 1 5 2
18/11/1999 20 1 2 1 4 2
15/05/1977 41 11 1 1 1 5 8
01/01/1961 58 3 2 1 1 4 1
09/07/2004 14 9 2 2 1 5 1
30/08/2010 8 6 1 2 1 5 1
10/8/1993 25 6 1 2 1 3 1
8/11/1996 23 5 2 2 1 1 1
8/8/1972 46 11 1 1 1 5 5
6/11/1976 42 5 2 2 1 5 1
5/3/2005 14 1 2 1 1 3 2
7/8/2007 11 11 1 2 1 2 1
22/02/1954 65 2 2 2 1 3 9
7/6/1993 25 10 1 2 1 3 1
13/09/1978 40 7 1 1 1 5 5
14/02/1984 35 2 2 1 2 1 5 9
11/10/2006 12 6 2 2 2 1 2 2
15/12/2011 7 4 1 2 1 1 1
29/07/2015 3 3 2 2 1 1 1
13/03/1974 44 1 1 1 1 4 9
12/3/1975 43 1 2 1 2 1 4 1
10/1/1994 25 3 2 2 2 1 3 2
17/01/2000 19 5 1 2 1 3 2
1 1 1 5 8
2 1 1 5 1
1 2 1 5 1
1 2 1 5 2
2 2 1 2 2
1 2 1 3 9
V. Keterangan individu (anggota ART )
A. Identitas anggota rumah tangga B. Gangguan Keseh

5. minum obat secara teratus (jika ia)


2. BAB di jamban
1. no urut ART

3. TGL puldat

3. merokok

4. TBC
1. JKN
2. NIK

1 1603121706760001 3/29/2019 2 1 2 2
2 1603125002820001 3/29/2019 2 1 2 2
3 1603126210060001 3/29/2019 2 1 2 2
4 1603124411100002 3/29/2019 2
1 1673080101880011 3/26/2019 2 1 1 2
2 1605076708930001 3/26/2019 2 1 2 2
3 1571075705140008 3/26/2019 2
1 1571071607700021 3/26/2019 1 1 1 2
2 1571075506790321 3/26/2019 1 1 2 2
3 1571074212990021 3/26/2019 1 1 2 2
4 1571070306060081 3/26/2019 1
5 1571075912160002 3/26/2019 1
1 1506160308830001 24/03/2019 2 1 1 2
2 1506165706890002 24/03/2019 2 1 2 2
3 1506160904060001 24/03/2019 2
1 1571011011860121 3/31/2019 1 1 2 2
2 1571014505860082 3/31/2019 1 1 2 2
3 1571014105110021 3/31/2019 1
4 15710711106150001 3/31/2019 1
1 31/03/2019 1 1 1 2
2 31/03/2019 1 1 2 2
3 31/03/2019 1 1 2 2
4 31/03/2019 1 1 2 2
5 31/03/2019 1
6 31/03/2019 1
1 1571082104770001 24/03/2019 1 1 2 2
2 1571085012770001 24/03/2019 1 1 2 2
3 1571082304010000 24/03/2019 1 1 2 2
4 1571086102050001 24/03/2019 1
5 1571074710130000 24/03/2019 1
1 1571070902830061 24/03/2019 1 1 1 2
2 1571074906840141 24/03/2019 1 1 2 2
3 1571072104120001 24/03/2019 1
4 1571073602180000 24/03/2019 1
1 1571070304810041 24/03/2019 1 1 2 2
2 1571075010880081 24/03/2019 1 1 2 2
3 1571076203070021 24/03/2019 1
4 1571071705120002 24/03/2019 1
5 1571075007110023 24/03/2019 2
1 1571072509850101 29/03/2019 2 1 1 2
2 1571015311920021 29/03/2019 1 1 2 2
3 157109480114002 29/03/2019 2 1 2 2
1 1571077112520041 31/03/2019 1 1 2 2
1 1571072807730021' 3/31/2019 1 1 2 2 2
2 1571075806710001' 3/31/2019 1 1 2 2 2
3 1571076101970041' 3/31/2019 1 1 2 2 2
4 1571076809990041' 3/31/2019 1 1 2 2 2
5 1571070510030001' 3/31/2019 1 1 2 2 2
6 15710749030380041' 3/31/2019 1
1 1571070608690001' 3/29/2019 1 1 1 1 2
2 1571076501720081' 3/29/2019 1 1 2 2 2
3 1571075505000041' 3/29/2019 1 1 2 2 2
4 1571073006010121' 3/29/2019 1 1 2 2 2
5 1571076006070041' 3/29/2019 1
6 1571072211920022' 3/29/2019 1 1 1 2 2
1 1571073112540582' 3/24/2019 1 1 1 2 2
2 1571074204650061' 3/24/2019 1 1 2 2 2
1 157102010273010' 24/03/2019 2 1 1 2 2
2 1571025208740041' 24/03/2019 2 1 2 2 2
3 1571026111010081' 24/03/2019 2 1 2 2 2
4 1571021012020101' 24/03/2019 2 1 2 2 2
5 1571026601130001'' 24/03/2019 2
1 1571074304620001' 24/032019 2 1 2 2 2
2 1571071809910001' 3/24/2019 2 1 1 2 2
3 1571072009950001' 3/24/2019 2 1 1 2 2
4 1571072810990001' 3/24/2019 2 1 1 2 2
1 1571072602540001' 3/29/2019 1 1 2 2 2
2 1571077112590121' 3/29/2019 1 1 2 2 2
3 1571076209790021' 3/29/2019 1 1 2 2 2
4 1571073108860001' 3/29/2019 1 1 2 2 2
5 1571073108860002' 3/29/2019 1 1 1 2 2
6 1571073108860002' 3/29/2019 1 1 1 2 2
7 1571072709900041' 3/29/2019 1 1 1 2 2
8 1571072709930001' 3/29/2019 1 1 1 2 2
1 1571073112800280 24/03/2019 1 1 1 2
2 1571073112820302 24/03/2019 1 1 2 2
3 1571071403020040 24/03/2019 1 1 2 2
4 1571074104030102 24/03/2019 1 1 2 2
5 1571074303060121 24/03/2019 1
6 1571075504090041 24/03/2019 1
7 1571074109110001 24/03/2019 1
8 1571074905130004 24/03/2019 1
9 157107473930021 24/03/2019 1 1 2 2
1 1571075808680061 24/03/2019 1 1 2 2
2 1571075607940021 24/03/2019 1 1 2 2
3 1571076808960081 24/03/2019 1 1 2 2
1 1404011707730003 24/03/2019 2 1 1 2
2 1404014707830004 24/03/2019 2 1 2 2
3 1404012909070001 24/03/2019 2
4 140401120909001 24/03/2019 2
1 1671070409700021 24/03/2019 1 1 1 2
2 1671077105710041 24/03/2019 1 1 2 2
3 1671072812940160 24/03/2019 1 1 1 2
1 1571071708680181 29/03/2019 1 1 1 2
2 1571075010700121 29/03/2019 1 1 2 2
3 1571074809000061 29/03/2019 1 1 2 2
4 1571074107480081 29/03/2019 1 1 2 2
1 1571071708660181 31/03/2019 2 1 2 2
2 1571075506600061 31/03/2019 2 1 2 2
3 1571070809920081 31/03/2019 2 1 1 2
1 1605041008890002 24/03/2019 2 1 1 2
2 1571076103930043 24/03/2019 2 1 2 2
3 1571072401160001 24/03/2019 2
4 1571090707170001 24/03/2019 2
1 1571011212880080 24/03/2019 1 1 2 2
2 157101700690002 24/03/2019 1 1 2 2
3 1571086008130001 24/03/2019 1
1 1571010107960041 24/03/2019 1 1 1 2
2 1571075912000062 24/03/2019 1 1 2 2
1 1571011405660021 24/03/2019 1 1 1 2
2 1571014704600021 24/03/2019 1 1 2 2
3 1571011710850041 24/03/2019 1 1 1 2
4 1571015303880040 24/03/2019 1 1 2 2
5 157101160589001 24/03/2019 1 1 1 2
6 1571012205980021 24/03/2019 1 1 1 2
7 15710010301860021 24/03/2019 2 1 1 2
8 1571010706880042 24/03/2019 2 1 1 2
1 1571070205830001 26/03/19 1 1 2 2
2 1571076909890041 26/03/2019 1 1 2 2
3 1571072303110002 26/03/2019 1
4 1571071202190001 26/03/2019 1
1 1571070208670061 24/03/2019 1 1 1 2
2 1571074205750021 24/03/2019 1 1 2 2
3 1571076504050081 24/03/2019 1
1 1571011209750041 31/03/2019 1 1 1 2
2 1571015206840041 31/03/2019 1 1 2 2
3 1571010807020021 31/03/2019 1 1 2 2
4 1571014206060201 31/03/2019 1
1 1505050510770004 24/03/2019 2 1 1 2
2 1505055504800004 24/03/2019 1 1 2 2
3 1505056603000003 24/03/2019 2 1 2 2
4 1505056504050002 24/03/2019 2
5 1505050606080003 24/03/2019 2
6 1505054105100002 24/03/2019 2
7 1505056712110001 24/03/2019 2
1 1571072403840021 29/03/2019 1 1 1 2
2 1571075606880061 29/03/2019 1 1 2 2
3 1571076607070081 29/03/2019 1
4 1571070310110021 29/03/2019 1
1 1571071901880081 3/24/2019 2 1 1 2
2 1571074911920121 3/24/2019 2 1 2 2
3 1571076304110004 3/24/2019 2
4 1571076204130002 3/24/2019 2
5 1571072104170003 3/24/2019 2
1 1571070205620061 3/29/2019 2 1 1 2
2 1571074712820001 3/29/2019 2 1 2 2
3 1571077101890041 3/29/2019 2 1 2 2
4 1571072906980061 3/29/2019 2 1 2 2
5 1571071105690034 3/29/2019 2 1 1 2
1 1571070810880122 3/29/2019 2 2 2 2
2 1571023430590021 3/29/2019 2 2 2 2
3 1571076002130002 3/29/2019 2
1 1571072305710021 3/24/2019 1 1 1 2
2 1571074401720041 3/24/2019 1 1 2 2
3 1571072709970061 3/24/2019 1 1 1 2
4 1571071410020121 3/24/2019 1 1 2 2
5 1571074408060001 3/24/2019 1
6 1571070606760361 3/24/2019 1 1 2 2
1 1709031402750004 3/29/2019 1 1 1 2
2 1700034806740001 3/29/2019 1 2 2 2
3 1771044602990006 3/29/2019 1 2 2 2
4 1771042905000002 3/29/2019 1 2 2 2
5 1771040606010001 3/29/2019 1 2 2 2
6 1771042306070005 3/29/2019 1
7 1771044110080001 3/29/2019 1
8 3174092302101010 3/29/2019 1
1 1571012510900020 24/03/2019 1 1 1 2
2 1571085111900001 24/03/2019 1 1 2 2
3 1571084307140001 24/03/2019 1
1 1571080303620001 24/03/2019 1 1 1 2
2 1571084712630001 24/03/2019 1 1 2 2
1 24/03/2019 1 1 2 2
2 24/03/2019 1 1 2 2
3 24/03/2019 1 1 2 2
4 24/03/2019 1 1 2 2
5 24/03/2019 1
1 3313130805790007 29/03/2019 2 1 1 2
2 3313134901820004 29/03/2019 2 1 2 2
3 3313136305030003 29/03/2019 2 1 2 2
4 3313136110090001 29/03/2019 2
1 31/03/2019 1 1 1 2
2 31/03/2019 1 1 2 2
3 31/03/2019 1 1 2 2
4 31/03/2019 1
5 31/03/2019 1
1 1571071211780021 31/03/2019 1 1 1 2
2 1571074906720041 31/03/2019 1 1 2 2
3 157107120107004 31/03/2019 1
1 1571072603810041 24/03/2019 2 1 1 2
2 1571076003840161 24/03/2019 2 1 2 2
3 1671074710070061 24/03/2019 2
1 1671070703790001 29/03/2019 1 1 2 2
2 1671075002850041 29/03/2019 1 1 2 2
3 1671072204060001 29/03/2019 1
4 1671071112100001 29/03/2019 1
1 1571070407670021 24/03/2019 1 1 1 2
2 1571074909670041 24/03/2019 1 1 2 2
3 1571075304950001 24/03/2019 1 1 2 2
4 1571071206010001 24/03/2019 1 1 2 2
1 1571072610830121 24/03/2019 1 1 1 2
2 1571075901870081 24/03/2019 1 1 2 2
3 1571070202080121 24/03/2019 1 1 2 2
4 1571070303110001 24/03/2019 1
5 1571072005150004 24/03/2019 1
1 3315045004890008 31/03/2019 2 1 2 2
2 3315044609080004 31/03/2019 2
3 1571070912160004 31/03/2019 2
1 1571010606700061 24/03/2019 1 1 1 2
2 1571016405730141 24/03/2019 1 1 2 2
3 1571011109940040 24/03/2019 1 1 2 2
4 1571016707970061 31/03/2019 1 1 2 2
5 1571012911070061 31/03/2019 1
6 1571071107110061 31/03/2019 1
1 1571070704670141 31/03/2019 1 1 1 2
2 1571084801910021 31/03/2019 1 1 2 2
1 1571072508850061 31/03/2019 2 1 2 2
2 1571074204920021 31/03/2019 2 1 2 2
3 1571070112130002 31/03/2019 2
4 1571070206180001 31/03/2-19 2
1 1571070904600041 24/03/2019 2 1 1 2
2 1571075007450021 24/03/2019 2 1 2 2
3 15710749126400021 24/03/2019 2 1 2 2
4 1571074203850021 24/03/2019 2 1 2 2
5 1571076705870021 24/03/2019 2 1 2 2
6 1571071506920001 24/03/2019 2 1 1 2
1 1571073009840081 29/03/2019 1 1 1 2
2 1571074303850160 29/03/2019 1 1 2 2
3 1571072402090002 29/03/2019 1
4 1571075505160001 29/03/2019 1
5 1571075412170001 24/03/2019 1
1 1571071507590001 3/24/2019 2 1 2 2
2 1501075507630081 24/03/2019 2 1 2 2
3 1571076801910061 29/03/2019 2 1 2 2
4 1571071008930021 29/03/2019 2 1 1 2
5 1571070605950042 29/03/2019 2 1 1 2
6 1571075410040080 3/29/2019 2 1 2 2
1 1571071108860141. 24/3/2019 1 1 1 2
2 1571076208850141. 24/3/2019 1 1 2 2
3 1571070501090041. 24/3/2019 1
4 1571071801120041. 24/3/2019 1
5 1571075606180002. 24/3/2019 2
1 1571072005710041. 24/3/2019 1 1 1 2
2 1571074407730021. 24/3/2019 1 1 2 2
1 1505081708570003. 24/3/2019 1 1 1 2
2 1505084302700002. 24/3/2019 1 1 2 2
1 1506011210730001. 27/3/2019 1 1 1 2
2 1506015212790001. 27/3/2019 1 1 2 2
3 1506014301030001. 27/3/2019 1 1 2 2
4 1506060404120001. 27/3/2019 1
5 1571075906180004. 27/3/2019 1
1 1571072509460001. 27/3/2019 1 1 2 2
2 1571074204590001. 27/3/2019 1 1 2 2
1 1571071211850121. 31/3/2019 1 1 1 2
2 1571075710850121. 31/3/2019 1 1 2 2
3 1571076303110122. 31/3/2019 1
4 1571075306140002. 31/3/2019 1
5 1571075507540001. 31/3/2019 1 1 2 2
1 1571073009710001. 3/24/2019 2 1 1 2
2 1571076301780021. 2 1 2 2
3 1571076207980021. 2 1 2 2
4 1571076501050001. 2
5 2
6 2
1 1571071112600041. 31/04/2019 1 1 2 2
2 1571074506620061. 1 1 2 2
3 1571072507810001. 1 1 2 2
4 1571071404990041. 1 1 2 2
1 1571072708830041. 4/26/2019 1 1 1 2
2 1571075412820021. 1 1 2 2
3 1571070108090021. 1
4 1571070712100101. 1
5 1
6 1
1 1571071907790081. 4/29/2019 2 1 1 2
2 1571075404840181. 2 1 2 2
3 1571074807080061. 2 1 2
4 1571075610100021. 2
5 1571076711140004. 2
6 1571072809160002. 2
1 1571072502610001. 29/04/2019. 1 1 1 2
2 1571076103610041. 1 1 2 2
5 1571070406960042. 1 1 1 2
1 1571070303940101. 4/29/2019 1 1 1 2
2 1571076311980001. 1 1 2 2
3 1571072205160001. 1
1 1206112803860003 24/03/2019 1 1 1 2 2
2 1222036804890009 24/03/2019 1 1 2 2
1 1507013112530003 3/24/2019 1 1 1 2 2
2 1507015710570001 3/24/2019 1 1 2 2
3 1507010812000001 3/24/2019 1 1 2 2
1 1571071710800101 24/03/2019 1 1 1 2 2
2 1571076611880062 24/03/2019 1 1 2 2
3 1218096605960002 24/03/2019 1 1 2 2
1 1571091612820040 24/03/2019 1 1 1 2 2
2 1571075507620141 24/03/2019 1 1 2 2
3 1571071003080040 24/03/2019 1
4 1571077003110021 24/03/2019 1
1 1571071907800061 29/03/2019 1 1 1 2 2
2 1571076209790080 29/03/2019 1 1 2 2
3 1571071711070161 29/03/2019 1
4 1571075903140002 29/03/2019 1
1 1571070608740161 3/29/2019 1 1 1 2 2
2 1571076402760021 3/29/2019 1 1 2 2
3 1571076801960082 3/29/2019 1 1 2 2
4 15710761050600121 3/29/2019 1
5 1571071107010002 3/29/2019 1 1 1 2 2
1 1571071806620001 24-03-2019 1 1 2 2
2 1571075005670021 24-03-2019 1 1 2 2
3 1571070607950001 24-03-2019 1 1 2 2
4 1571072508980041 24-03-2019 1 1 2 2
5 1571072112000021 24-03-2019 1 1 2 2
6 1571071206070081 24-03-2019 1
1 1571070107420242 24-03-2019 1 1 1 2
2 1571074107810121 24-03-2019 1 1 2 2
3 1571074305010041 24-03-2019 1 1 2 2
4 1571071412090022 24-03-2019 1
1 1571011307730001 24-03-2019 1 1 2 2
2 1571015009760001 24-03-2019 1 1 2 2
3 1571012010010001 24-03-2019 1 1 2 2
4 1571012506070021 24-03-2019 1
1 1571072604790061 24-01-2019 2 1 1 2
2 1571077112400121 24-01-2019 2 1 2 2
3 1571075107840021 24-01-2019 2 1 2 2
4 1571076104880001 24-01-2019 2 1 2 2
5 1571072603810001 24-01-2019 2 1 2 2
1 1571073112550081 26-03-2019 2 1 2 2
2 1571074204590021 26-03-2019 2 1 2 2
3 1571076105910001 26-03-2019 2 1 2 2
1 1571071302800001 26-03-2019 2 1 1 2
2 1571076003790021 26-03-2019 2 1 2
3 1571072004000081 26-03-2019 2 1 2
4 1571072012070081 26-03-2019 2
5 1571072306830061 26-03-2019 2 1 2
1 1571070706790001. 24/03/2019 1 1 2 2
2 1571076108840001. 24/03/2019 1 1 2 2
3 1571076807030001. 24/03/2019 1 1 2 2
4 1571072104090021. 24/03/2019 1
5 1571076003170002. 24/03/2019 1
1 1505051408715001. 24/03/2019 1 1 1 2
2 1505055608804002. 24/03/2019 1 1 2 2
3 1505055804015001. 24/03/2019 1 1 2 2
4 1505052302095001. 24/03/2019 1
1 1571071302720121. 24/03/2019 1 1 2 2
2 1571075912820041. 24/03/2019 1 1 2 2
3 1571071501040041. 24/03/2019 1
4 1571071205070021. 24/03/2019 1
5 1571070407080001. 24/03/2019 1
1 1571071010690302 24/03/2019 1 1 2 2
2 1571075008700141 24/03/2019 1 1 2 2
3 1571074208960001 24/03/2019 1 1 2 2
4 1571075903030081 24/03/2019 1 1 2 2
5 24/03/2019 1
6 24/03/2019 1 1 2 2
1 1571070507670001 24/03/2019 1 1 2 2
2 1571075010700001 3/24/2019 1 1 2 2
3 1571071711930001 3/24/2019 1 1 2 2
4 1571072112990001. 3/24/2019 1 1 2 2
5 1571075103020001. 3/24/2019 1 1 2 2
6 1571071701070001. 3/24/2019 1
1 1571032707840201 3/24/2019 1 1 2 2
2 1571034907890161 24/03/2019 1 1 2 2
3 1571032005100001. 24/03/2019 1
4 1571033112130002. 24/03/2019 1
1 1571071404700081. 3/24/2019 1 1 1 2
2 1571076810780041. 3/24/2019 1 1 2 2
3 1571070407990021. 3/24/2019 1 1 2 2
4 1571071708030021. 3/24/2019 1 1 2 2
1 1571021001760181. 3/24/2019 1 1 2 2
2 1571024307740021. 3/24/2019 1 1 2 2
3 1571026709110002. 3/24/2019 1
1 1571073004840082. 3/24/2019 1 1 1 2
2 1571074411840281. 3/24/2019 1 1 2 2
3 1505015109830000. 3/24/2019 1
1 1571070808850261. 3/26/2019 1 1 1 2
2 1571076609770041. 3/26/2019 1 1 2 2
3 1571070706970041. 3/26/2019 1 1 2 2
4 1571074107100022. 4/26/2019 1
5 1571072903180002. 3/26/2019 1
1 1571072006720101. 3/26/2019 1 1 1 2
2 1571075207730182. 3/26/2019 1 1 2 2
3 1571074705980061. 3/26/2019 1 1 2 2
4 1571075602050081. 3/26/2019 1
5 1571075107100061. 3/26/2019 1
1 1571080310470001. 3/29/2019 1 1 2 2
2 1571084404560001. 3/29/2019 1 1 2 2
3 1571083004840001. 3/29/2019 1 1 1 2
4 1571083005800001. 3/29/2019 1 1 1 2
5 1571083005890021. 3/29/2019 1 1 1 2
6 1571084801910021.. 3/29/2019 1 1 2 2
1 1571070610810180* 24/03/2019 1 1 1 2
2 1571076301820121* 24/03/2019 1 1 2 2
3 1571074808110021* 24/03/2019 1
1 1571072712880141* 31/03/2019 1 1 2 2
2 1571075508910081* 31/03/2019 1 1 2 2
3 1571075007110021* 31/03/2019 1
4 1571072809160003* 31/03/2019 1
1 1671083006980001* 31/03/2019 1 1 2 2
2 3/31/2019 1 1 2 2
1 16710705107701121* 24/03/2019 1 1 1 2
2 1671076209760021* 24/03/2019 1 1 2 2
3 1671072806010081* 24/03/2019 1 1 2 2
4 1671071610030061* 24/03/2019 1 1 2 2
5 16710772009100061* 24/03/2019 1 1 2
6 1671070906140002* 24/03/2019 1
1 1571070307420021* 29/03/2019 1 1 1 2
2 1571074609460021* 29/03/2019 1 1 2 2
3 1571074707910040* 29/03/2019 1 1 2 2
4 1508131811990000 29/03/2019 1 1 1 2
1 1571011506770261 24/03/2019 1 1 1 2
2 1571074205750021 24/03/2019 1 1 2 2
3 1571076504050081 24/03/2019 1 2 2
4 1571011209750041 24/03/2019 1 2 2
5 1571011608970081 24/03/2019 1 1 2 2
3 1571014811950082 24/03/2019 1 1 2 2
1 1571070808720101 24/03/2019 2 1 2 2
2 1571074611780021 24/03/2019 2 1 2 2
3 157107050305004 24/03/2019 2 2 2
4 1571074708070102 24/03/2019 2 2 2
5 1506118202540001 24/03/2-19 2 1 2 2
6 1571074706930101 24/03/2019 2 1 2 2
1 1571071308780041 24/03/2019 1 1 2 2
2 1571075402840161 24/03/2019 1 1 2 2
3 1571075110060041 24/03/2019 1 2 2
4 1571071512110041 24/03/2019 1 2 2
5 1571076907150001 24/03/2019 1 2 2
1 1571071708740081 29/03/2019 1 1 2 2
2 1571075707750041 29/03/2019 1 1 2 2
3 1571075008950041 29/03/2019 1 1 2 2
4 15710701000101 29/03/2019 1 1 2 2
1 1571011012750081 30/03/2019 1 1 2 2
2 1571014707790241 30/03/2019 1 2 2 2
3 1571010711970081 30/03/2019 1 2 2 2
4 1571012904990041 30/03/2019 1 2 2 2
5 1571015405080181 30/03/2019 1 2 2 2
6 15710110088901601 30/03/2019 1 2 2 2
a ART )

2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
batuk > 2 minggu, darah, BB turun, dll

2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
6. Hipertensi
B. Gangguan Kesehatan

7. Minum obat secara teratur

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

9.bersalin di faskes ART < 12 Bulan

10. ASI eksklusif ART 7-23 Bulan

11. imunisasi lengkap ART 12-13 Bulan

12. pemantauan balita

1
1

No
Indikator Pola Hidup B
1 1 1
2 2
2 2 1

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

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

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

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

2 2
2 2 1

2 2
2 2 1

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

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

2 2
2 2 1 1
2 2

2
2 2
2 2 2 1

2
2 1

2
1 1 1

1 1
2 1
2
2
2
2 1
2

1
2 1

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

2 2
2 2 2
2 2
2 1 2 2

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

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

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

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

2 2
2 2
2 2 1
2 2

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

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

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

2 1 2
2 2 2
2 2

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

2 2
2 2
2 2 2
2 2

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

2 2
2 2 2 1

2 1 2
2 1 1 1
2 2
2 2

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

2 2
2 2 1 1

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

2 2
2 2 1

2 2
2 2 1
2 2

2 2 1 1
2 2
2 2 1
2 2

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

2 2
2 2 1

1
2 2
2 2 2
2 2
2 2 1
2 2
2 2
2 2
1
2 2
2 2 1
2 2
2 2
2 2
2 2 1 1
2 2
2 2
2 2
2 2
2 2
2 2 1 1
2 2
2 2
2 2
2 2
2 2
2 2 1 1
2 2
2 2
2 2
2 2
2 2 2 2
2 2
2 2
2 2
2 2 1 1
2 2
2 2
2 2
2 2
Indikator Pola Hidup Bersih dan Sehat dalam tatanan Rumah tangga

2. Cuci tangan dengan sabun dan air bersih


1. Persalinan ditolong tenaga kesehatan

7. Merokok didalam rumah


6. Aktivitas fisik tiap hari
5. Makan sayur tiap hari
4. Makan Buah tiap hari
3. PSN 3 M
KK ke-

1 1 1 1 1 1
1 1 1 1 1 1 1
1 1 1 1 1 1
1 1 1 1 1 1
2 1 1 2 1 1 1
2 1 1 1 2 1 1
2 1 1 2 1 1
3 1 1 2 1 1 1
3 1 1 1 2 1 1
3 1 1 2 1 1
3 1 1 2 1 1
3 1 1 2 1 1
4 1 1 2 1 1 1
4 2 1 1 2 1 1
4 1 1 2 1 1
5 1 1 1 1 1
5 1 1 1 1 1 1
5 1 1 1 1 1
5 1 1 1 1 1
6 1 1 2 1 1 1
6 1 1 1 2 1 1
6 1 1 2 1 1
6 1 1 2 1 1
6 1 1 2 1 1
6 1 1 2 1 1
7 1 1 1 1 1
7 1 1 1 1 1 1
7 1 1 1 1 1
7 1 1 1 1 1
7 1 1 1 1 1
8 1 1 2 1 2 1
8 1 1 1 2 1 2
8 1 1 2 1 2
8 1 1 2 1 2
9 1 1 1 1 1
9 1 1 1 1 1 1
9 1 1 1 1 2
9 1 1 1 1 2
9 1 1 1 1 2
10 1 1 1 1 1 1
10 1 1 1 1 1 1
10 1 1 1 1 1
11 2 2 2 1 1 2
12 1 2 2 1 1
12 1 1 2 2 1 1
12 1 2 2 1 1
12 1 2 2 1 1
12 1 2 2 1 1
12 1 2 2 1 1
13 2 1 2 1 1 1
13 1 2 1 2 1 1
13 2 1 2 1 1
13 2 1 2 1 1
13 2 1 2 1 1
13 2 1 2 1 1 1
14 1 1 1 1 1 1
14 2 1 1 1 1 1
15 1 1 2 1 1 1
15 2 1 1 2 1 1
15 1 1 2 1 1
15 1 1 2 1 1
15 1 1 2 1 1
16 2 1 1 2 1 2
16 1 2 1 1 2 1
16 2 1 1 2 1
16 2 1 1 2 1
17 2 1 2 1 2
17 1 2 1 2 1 2
17 2 1 2 1 2
17 2 1 2 1 2
5 2 1 2 1 2
6 2 1 2 1 2
7 2 1 2 1 2
8 2 1 2 1 2
1 2 1 2 1 2 1
2 1 2 1 2 1 2
3 2 1 2 1 2
4 2 1 2 1 2
5 2 1 2 1 2
6 2 1 2 1 2
7 2 1 2 1 2
8 2 1 2 1 2
9 2 1 2 1 2
1 1 2 1 2 1 2
2 2 1 2 1 2
3 2 1 2 1 2
1 2 1 2 1 2 1
2 1 2 1 2 1 2
3 2 1 2 1 2
4 2 1 2 1 2
1 2 1 2 1 1 1
2 1 2 1 2 1 1
3 2 1 2 1 1 1
1 1 1 2 1 1 1
2 1 1 1 2 1 1
3 1 1 2 1 1
4 1 1 2 1 1
1 2 1 2 1 1
2 1 2 1 2 1 2
3 2 1 2 1 1 1
1 1 1 2 2 2 1
2 1 1 2 2 2
3 1 1 1 2 2 2
4 1 1 1 2 2 2
1 1 1 2 1 1
2 1 1 1 2 1 1
3 1 1 2 1 1
1 2 1 2 1 1 1
2 1 2 1 2 1 1
1 2 1 2 1 1 1
2 2 1 2 1 1
3 1 2 1 2 1 1 1
4 2 1 2 1 1
5 2 1 2 1 1 1
6 2 1 2 1 1 1
7 2 1 2 1 1 1
8 2 1 2 1 1 1
1 1 1 2 1 2
2 1 1 1 2 1 2
3 1 2 1 2
4
1 1 1 1 1 1 1
2 1 1 1 1 1 1
3 1 1 1 1 1
1 1 1 2 1 2 1
2 1 1 1 2 1 2
3 1 1 2 1 2
4 1 1 2 1 2
1 2 1 1 1 1 1
2 1 2 1 1 1 1
3 2 1 1 1 1
4 2 1 1 1 1
5 2 1 1 1 1
6 2 1 1 1 1
7 2 1 1 1 1
1 2 1 2 1 1 1
2 1 2 1 2 1 1
3 2 1 2 1 1
4 2 1 2 1 1
2 1 2 1 2 1
1 2 1 2 1 2
2 1 2 1 2
2 2 2 1 2
2 2 2 2 2
2 2 2 2 1 1
1 2 2 2 2 1
2 2 2 2 1
2 2 2 2 1
2 2 2 2 1 1
2 1 2 1 1
1 2 1 2 1 1
2 1 2 1 1
1 1 2 1 2 1
1 1 1 2 1 1
1 1 2 1 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 1 1 1 2
1 1 1 1 1
1 1 1 1 1
1 1 1 1 1
1 1 1 1 1
1 1 1 1 2
1 1 1 1 2
1 2 1 2 1 1 1
2 1 2 1 2 1 1
3 2 1 2 1 1
1 2 1 2 1 2 1
2 2 1 2 1 2
1 1 1 2 1 2
2 1 1 1 2 1 2
3 1 1 2 1 2
4 1 1 2 1 2
5 1 1 2 1 2
1 2 1 2 1 1 1
2 1 2 1 2 1 1
3 2 1 2 1 1
4 2 1 2 1 1
1 1 1 1 1 1 1
2 1 1 1 1 1 1
3 1 1 1 1 1
4 1 1 1 1 2
5 1 1 1 1 2
1 2 1 2 1 1 1
2 1 2 1 2 1 1
3 2 1 2 1 1
1 1 1 2 1 1 2
2 1 1 1 2 1 1
3 1 1 2 1 1
1 1 1 1 1 1
2 1 1 1 1 1 1
3 1 1 1 1 2
4 1 1 1 1 2
1 1 1 1 1 2 2
2 1 1 1 1 1 2
3 1 1 1 1 2
4 1 1 1 1 2
1 1 1 2 1 2 1
2 1 1 1 2 1 2
3 1 1 2 1 2
4 1 1 2 1 2
5 1 1 2 1 2
1 1 1 1 2 1 1
2 1 1 2 1 2
3 1 1 2 1 2
1 1 1 2 2 1 1
2 1 1 1 2 2 1
3 1 1 2 2 1
4 1 1 2 2 1
5 1 1 2 2 1
6 1 1 2 2 1
1 1 1 2 1 2 1
2 1 1 2 1 2
1 2 1 2 1 2
2 1 2 1 2 1 2
3 2 1 2 1 2
4 2 1 2 1 2
1 1 1 2 1 2 1
2 1 1 1 2 1 2
3 1 1 2 1 2
4 1 1 2 1 2
5 1 1 2 1 2
6 1 1 2 1 2 1
1 1 1 2 1 2 1
2 1 1 1 2 1 2
3 1 1 2 1 2
4 1 1 2 1 2
5 1 1 2 1 2
1 1 1 2 1 1
2 1 1 1 2 1 1
3 1 1 2 1 1
4 1 1 2 1 1 2
5 1 1 2 1 1 2
6 1 1 2 1 1
1 1 1 2 1 1 1
2 1 1 1 2 1 1
3 1 1 2 1 2
4 1 1 2 1 2
5 2 1 2 1 2
1 1 1 2 1 1 1
2 1 1 1 2 1 1
1 2 2 1 2 2 1
2 1 2 2 1 2 2
1 1 1 2 1 2 1
2 1 1 1 2 1 2
3 1 1 2 1 2
4 1 1 2 1 2
5 2 1 2 1 2
1 2 1 2 1 1 2
2 1 2 1 2 1 1
1 1 1 2 1 2 1
2 1 1 1 2 1 2
3 1 1 2 1 2
4 1 1 2 1 2
5 1 1 2 1 2
2 1 2 1 1 1
1 2 1 2 1 2
2 1 2 1 1
2 1 2 1 2
2 2 2 1 2

1 1 2 2 1
1 1 1 2 2 1
1 1 2 2 1
1 1 2 2 2
2 2 2 1 1 1
1 2 2 2 1 1
2 2 2 1 2
2 2 2 1 2
2 2 2 1 2
2 2 2
1 2 2 2 1 1
1 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 2 1 1
1 2 1 2 2 2
2 1 2 2 1 1
2 1 2 2 1 1
1 2 1 2 2 2
2 1 2 2 2
1 1 2 1 1 1 1
2 1 1 2 1 1 1
1 2 1 2 1 2 1
2 1 2 1 2 1 2
3 2 1 2 1 1
1 2 1 1 1 1 1
2 1 2 1 1 1 1
3 2 1 1 1 1
1 1 1 2 1 1 1
2 1 1 1 2 1 1
3 1 1 2 1 1
4 1 1 2 1 1
1 2 1 2 1 1 1
2 1 2 1 2 1 1
3 2 1 2 1 1
4 2 1 2 1 1
1 2 1 2 1 1 1
2 1 2 1 2 1 1
3 2 1 2 1 1
4 2 1 2 1 1
5 2 1 2 1 1 1
1 1 1 2 1 1
2 1 1 1 2 1 1
3 1 1 2 1 1
4 1 1 2 1 1
5 1 1 2 1 1
6 1 1 2 1 1
1 1 1 2 1 1 1
2 2 1 1 2 1 1
3 1 1 2 1 1
4 1 1 2 1 1
1 1 1 1 1 1
2 1 1 1 1 1 1
3 1 1 1 1 2
4 1 1 1 1 1
1 1 1 2 1 1 1
2 2 1 1 2 1 2
3 1 1 1 2 1 1
4 1 1 1 2 1 1
5 1 1 2 1 1
1 1 1 2 1 2
2 1 1 1 2 1 2
3 1 1 2 1 1
1 1 1 1 1 1 1
2 1 1 1 1 1 2
3 1 1 1 1 1
4 1 1 1 1 2
5 1 1 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 1 1
2 2 2 2 1 1
1 1 2 2 2 1
2 2 2 2 1
2 2 2 2 1
1 1 1 1 1
1 1 1 1 1 1
1 1 1 1 1
1 1 1 1 1
1 1 1 1 1
1 1 1 2 1
1 1 1 1 2 2
1 1 1 2 2
1 1 1 2 2
1 1 1 2 2
1 1 1 2 2
1 1 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 2
2 1 1 1 1
1 2 1 1 1 1
2 1 1 1 1
2 1 1 1 1
1 1 1 2 1 1 1
2 1 1 1 2 1 1
3 1 1 2 1 1
4 1 1 2 1 1
1 1 1 2 1 1
2 1 1 1 2 1 1
3 1 1 2 1 1
1 1 1 2 1 1 1
2 1 1 1 2 1 2
3 1 1 2 1 2
1 1 1 2 1 1 1
2 1 1 1 2 1 1
3 1 1 2 1 1
4 1 1 2 1 1
5 1 1 2 1 2
1 1 1 2 1 1 1
2 1 1 1 2 1 1
3 1 1 2 1 1
4 1 1 2 1 1
5 1 1 2 1 1
1 1 1 2 1 2 1
2 1 1 1 2 1 2
3 1 1 2 1 1
4 1 1 2 1 1
5 1 1 2 1 1
6 1 1 2 1 1
1 1 1 2 1 1 1
2 1 1 1 2 1 1
3 1 1 2 1 1
1 1 1 2 1 1
2 1 1 1 2 1 1
3 1 1 2 1 1
4 1 1 2 1 1
1 1 1 1 1 1
2 1 1 1 1 1
1 1 2 2 1 1 1
2 1 1 2 2 1 1
3 1 2 2 1 2
4 1 2 2 1 2
5 1 2 2 1 1
6 1 2 2 1 1
1 1 1 2 1 1 1
2 1 1 1 2 1 1
3 1 1 2 1 1
4 1 1 2 1 1 1
1 1 1 1 1 1 1
2 1 1 1 1 1 1
3 1 1 1 1 1
4 1 1 2 1 2
5 1 1 2 1 2
6 1 1 2 1 2
1 1 1 2 1 1
2 1 1 2 1 1
3 1 1 2 1 1
4 1 1 2 1 1
5 1 1 2 1 1
6 1 1 2 1 1
1 2 1 1 1 1
2 2 1 1 1 1
3 2 1 1 1 1
4 2 1 1 1 1
5 2 1 1 1 1
1 1 1 1 1 1
2 1 1 1 1 1
3 1 1 1 1 1
4 1 1 1 1 1
1 1 1 1 1 1 1
2 1 1 1 1 1
3 1 1 1 1 1
4 1 1 1 1 1
5 1 1 1 1 1
6 1 1 1 1 1
6
5
4
3
2
1
No.

Jumlah
Jumlah
KK ke-

Kk ke-6
Kk ke-5
Kk ke-4
Kk ke-3
Kk ke-2
Kk ke-1

3
1
2
2
1
1
2
1. Pasangan suami istri yang mengikuti program KB

2. Ibu bersalin di fasyankes

3. Bayi memperoleh imunisasi lengkap

4. Bayi memperoleh ASI ekslusif

5. dilakukan Pemantauan balita

6. TB paru berobat secara teratur


Indikator Keluarga Sehat

7. Hipertensi berobat secara teratur


2
2
2
2
2
2
8. Gangguan jiwa

4
1
2
1
1
1
2
9. ART yang merokok

1
1
1
1
1
1
10. keluarga yang menggunakan air bersih

1
1
1
1
1
1
11. Keluarga yang memiliki jamban sehat

3
1
1
2
1
2
2
12. ART yang memiliki JKN

1
1
1
2
1
1
1

1.Persalianan ditolong oleh tenaga kesehatan

1
1
1
1
1
1

2. CTPS dengan sabun dan air bersih


1
1
1
1
1
1

3. PSN 3 M
4
2
2
1
2
2
1

4. Makan buah
Indikator PHBS Tatanan Rumah Tangga
1
1
1
1
1
1
5. Makan sayur
S Tatanan Rumah Tangga

1
1
1
1
1
1
6.Aktivitas fisik

1
1
1
1
7. Merokok di dalam rumah

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