SASARAN MP ASI PABRIKA BALITA UMUR 6-59 BULAN

UPTD PUSKESMAS WONOSOBO 2018

No.Kartu NIK Anak Tanggal Jenis Nama Orangtua No Telp/HP Tgl BB PB/TB Cara ukur ASI Ekslusif IMD VIT A VIT A Ke
Keluarga Nomor Induk ke Lahir Kelamin BB Lahir (Ayah) Ortu Pengukuran (kg) (cm) 1. Terlentang 1. Ya 1. Ya Pebruari Agustus pemilikan
No Nama Anak NIK Ayah Alamat RT RW
Kependudukan (Kg) 2. Berdiri 2. Tidak 2. Tidak 1. Ya 1. Ya Buku
2. Tidak 2. Tidak KIA
1 1806030204090030 1806033008150001 4 ARSYA DANUARTA 30/08/2015 L 3.3 MISTIONO 1806030402740001 Soponyono 001 - 10 97 2 1 1 1 1 1

2 1806031109150001 1806035109150001 1 AYU SEPTIYANI 11/09/2015 P 3.4 DWI KRISDIANTO 1806032209850002 Soponyono - - 9.3 97 2 2 1 1 1 1

3 Soponyono 2 1 1 1 1
1806031909130001 1806036710160001 2 NIHAYATUN NAFIZA 27/10/2016 P 3.4 ARI ISTANTO 3216191507850019 - - 7.5 99 1
4 Soponyono 2 1 1 1 1
1806031608100004 1806032410150004 2 IQBAL GHIBRAN ASSEGAF 24/10/2015 L ENSUMA IRAWAN 1806032012860002 003 - 10 86 1
5 1806031201110039 1806030308160002 2 HAIRUL.A 3-8-16 L 3 SAEPI 1806030907830006 s.saudara 01 03 9.1 79 2 2 2 1 1 1

6 1806033105170002 1806035807170002 1 VANESA.A 18-7-2017 P 3 ALI ROSID 1806031705800006 s.saudara 02 02 7.2 71 2 2 1 1 1 1

7 1806030410170002 2 ANGGELIA.O 21-10-2017 P 2.8 BA'I 1802021308880003 s.saudara 01 03 6.8 70 1 2 2 2 1 1

8 1806036309150001 2 WARDA 23-09-2015 P 3.3 NURYASIN 1806031508770003 Banyuurip 3 3 9,9 85 2 2 2 1 1 1

9 1806034706170003 2 VELINA Z 07-06-2017 P 3.2 PURWANTO 1806030903840002 Banyuurip 1 1 7.2 75 2 1 2 1 1 1

10 1806034406170001 4 TIRTA C 04-06-2017 P 3.5 SUKISMAN 1806032401740001 Banyuurip 1 1 7.6 72 2 2 1 1 1 1

11 1806036503170002 4 SYAKILA S 25-03-2017 P 2.2 WIDODO 1806031306770001 Banyuurip 2 2 8.3 74 2 2 1 1 1 1

12 1806034910150003 1 SENJA A 09-10-2015 P 2.7 RONI A 1806032206930003 Banyuurip 2 2 9 79 2 2 2 1 1 1

13 1806034904170002 2 Anindiya 09/01/2017 2.4 Afif A. 1806032211850004 Wonosobo 8.2 80 2 1 1 1 1 1

14 Wonosobo 2 1 1 1 1 1
1806032804100003 1806034604160001 2 Alia Meliana Putri 06/04/2016 2.9 Trimo Rubiyanto 1806030118700001 9 87
15 Wonosobo 2 1 1 1 1 1
1806031304170002 1806032305170001 1 Alan Azka Pratama 23/05/2017 2.5 Apria Kurniawan 1806032104910004 002 001 7.2 74
16
1806030604100010 1806036704160002 3 APRILIA KHUMAIROH 27/04/2016 P 3 PURNOMO 1806030405720006 DADISARI 001 001 9 83 2 1 2 1 1 1

17 1806030703110003 1806032807160002 3 IMRAN AR RAHMAN 28/07/2016 L 3,2 UNTUNG S 1806032104770004 DADISARI 001 001 8,6 77 2 1 2 1 1 1
1806030810100204 1806032604170002 2 AKMAL NAIM 4/26/2017 L 2.9 ISMIANTO 1806030306790003 DADISARI 001 001 7.5 73,2 2 2 1 1 1 1
18
19 1806031709100018 1806031211160001 2 CAHYO DWI SAPUTRA 11/12/2016 L 3.4 SUTIKNO 1806031511850002 DADISARI 002 001 8.4 81 2 1 1 1 1 1

1806032704090011 1806032312140001 1806030506720007 002 003

20 3 M. ALLAN AJIJAN 12/23/2014 L 3.4 PARSONO B.NEGORO 10.2 98 2 1 2 1 1 1
1806030908100006 1806035307150002 1806030903770002 001 003
21 2 ZULFIANAORTISA 7/13/2015 P 2.9 MUSIBAN B.NEGORO 9.1 87 2 1 1 1 1 1
1806031011090009 1806032712150002 1806030105760002 002 002
22 2 BERRIL ALFATAA 12/27/2015 L 3.3 TURAHNO B.NEGORO 8.6 82 2 1 1 1 1 1
1806030309120012 1806036411150001 1806032108840004 002 001
23 2 AFSHEEN MEISIE H 11/24/2015 L 3 UMASTIK SANDEWA KALIREJO 9.7 88 2 1 2 1 1 1
1806032006140001 1806035602150002 1806030504860010 001 002
24 1 WARA RESTIVA 2/16/2015 L 2.8 WAGIONO KALIREJO 10.6 91 2 1 1 1 1 1
1806030710100055 1806036611160001 1806031308780005 002 003
25 4 NADDIA HUMAYRA 11/26/2016 P 3.7 SUDARMONO KALIREJO 8 75 2 2 2 1 1 1
1806032710100047 1806030307140002 1806031705740003 001 001
26 2 CANDRA RISKI R 7/3/2014 L 3.6 BASORI KALIREJO 11.5 99 2 1 2 1 1 1
18060121705160001 1806122702160001 1806121203860003 004 002
27 1 FEBRI SOBHARNAN 2/27/2016 L 2.6 IMAM SUROSO BANJARSARI 9.6 89 2 1 2 1 1 1
1806030803160001 1806030502160001 1806032008900005 002 001
28 1 M. FAIZ ALHAFID 2/5/2016 L 3 SULYANTO BANJARSARI 10 90 2 1 1 1 1 1
1806030204081000 1806035906160002 1806031412720002 001
29 5 NAZWA NUR RAMADHANI 6/19/2016 P 2.7 SARIFUDIN DADIREJO 8 74 2 1 1 1 1 1
1806030712160001 1806036203170003 1806010406920002 001 001
30 1 ANNISYA ALMAIRA 3/22/2017 P 3 JIMMY SATRIA ARI DADIREJO 7 68 2 1 1 1 1 1
1806030102160002 1806036511170001 1806030705890005 001 001
31 1 ANISSA ZALFA QIRANI 11/25/2017 P 3.3 NOVIANTO DADIREJO 6.8 66 1 1 1 1 1 1
1806031212170004 1806031909160001 3402032908930001 002 003
32 1 ALIF ALFATTA 9/19/2016 L 2.8 AGUS DWI SUSILO KALISARI 8.7 79 1 1 1 1 1 1
 FORMULIR PEMANTAUAN IB
No.Kartu NIK Nama Ibu BB
No Keluarga Nomor Induk Hamil Sebelum Alamat
Kependudukan Hamil
1 1806032404090001 1806034406920005 MELATI WIBISONO 40 SOPONYONO
2 1806032403150001 1806036303940003 SUTINI 39 SOPONYONO
3 1806036608920003 Lia Ariyani 55 WONOSOBONO
4 1372025006890002 Ulvi Lailatul 38 WONOSOBONO
5 1806031908110002 1806034905770004 KOMARIYAH 48 SINAR SAUDARA

6 1806251309160001 1806256606930002 MAISAROH 43 SINAR SAUDARA

7 1806031109150002 1806035409840002 EKA RUSTIYENI 51 SOPONYONO

8 1806035106930006 RENI YUNITA 68 BANYUURIP
9 1806036812840002 ERNANIK 40 BANYUURIP
10 1006032511130002 1806036107870003 DWISUSILAWATI 44 B. NEGORO
11 1806034702680006 MISRINGATI 52 DADISARI
12 1806031001110044 1806034108900003 NANI AGUS WULANDARI 47 KALIREJO
13 1806030907180006 1805025311930004 YESSY SUWARNI 52 BANJAR SARI
14 1806030507120005 1806035303930004 SITI LESTARI 44 BANJAR SARI
15 1806030206160002 1806036006870002 EKA YUNI SAFITRI 45 KALISARI
ULIR PEMANTAUAN IBU HAMIL
Tanggal Tanggal Berat Tinggi Kehamilan TTD
RT RW lahir Pengukuran Badan Badan LILA Ke 1. ya
(kg) (cm) 2. tidak
003 03 04/06/1992 10/09/2018 43 154 22.5 2 1
002 002 23/03/1994 10/09/2018 40 159 22 2 1
001 002 8/26/1992 11/09/2018 55 162 23 2 1
001 002 6/10/1989 12/09/2018 44 155 23 2 1
003 001 9/5/1977 13/09/2018 49 162 22 1 1

002 002 26-06-1993 14/09/2018 52 161 23 2 1

01 004 14/09/1984 10/09/2018 58 172 23 1 1
1 1 11/06/1993 55 165 23 2 1
3 3 28/12/1984 49 158 22.5 2 1
001 002 21/07/1987 51 168 23 2 1
003 001 07/02/1968 55 170 22.7 1 1
002 002 01/05/1997 52 165 23 2 1
003 002 13/11/1993 57 173 22 1 1
005 003 13/03/1993 46 153 23 1 1
002 003 20/06/1987 52 168 22.5 2 1
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