Nirwana 1

FORMAT PENDATAAN POSYANDU SASARAN BIAN
SASARAN IMUNISASI TAMBAHAN CAMPAK RUBELA ADALAH 9-59 BULAN DAN SASARAN IMUNISASI KEJAR ADALA
PELAKSANAAN 1 Aug 2022
Provinsi : Jawa Barat Desa/Kelurahan : Pancawati
Kabupaten : Bogor Posyandu : Posyandu Nirwana 1
Puskesmas : Ciderum
Tanggal Lahir
No. Nama Anak Umur (bulan) NIK Nama Orang Tua
1 ABDUL MUFLIH 5/23/2021 14 3201902305218364 SITI HENA SARAH
2 ABDUL MUFLIN 5/23/2021 14 3201902305211320 SITI HENA SARAH
3 ABDUL MUPLIH 5/23/2021 14 3201902305219505 bobi
MUHIDIN/
4 ABDUL MURON ALMUIS 11/20/2017 56 3201272011170003 SUARSIH
5 ABDULLAH ALWI H 7/13/2020 24 3201271307200003 otoh/sani
6 ABDULLAH ALWI HUSAINI 7/13/2020 24 3201271407200003 SANIA/TOROH
7 AHMAD ARSYAD IBRAHIM 12/6/2017 55 3201270612170001 DEDEN/YULI

8 AHMAD MAULANA 9/12/2019 34 3201271209190002 CICIH MINTARSIH
9 AMANDA SEPTIANI 9/5/2018 46 3201274509180004 BUBUN/IMAS
10 ANJANI SYAKIRA 1/27/2021 18 3201276701210001 ZAYA/DINY.F
11 APRILIA 4/22/2018 51 3201276204180003 HENDRIK/LENI
12 AYSILA HUSNA 8/17/2018 47 3201275708180001 EKA/SITI LATIFAH
abdul
13 AZAM LUTFI RAHMANI 8/28/2018 47 3201272808180004 kodir/saryunah
14 AZMI MURHAFIID 12/28/2018 43 3175102812180001 rahmat/uut
15 AZZAM LUTFI RAHMANI 8/28/2018 47 3201902808187917 SAIYUNAH
16 DEFFAN DWI SAPUTRA 3/6/2020 28 3201275310403320 JUWA
ADE HERMAWAN-
17 ELEN SYAQIYYA 11/24/2017 56 3201276411170001 ANIS
18 FAIZ ALFIANSYAH 11/29/2019 32 3201272911190003 hakim/mita
19 FUTRI KAMELIA 5/21/2021 14 3201906105213682 encep
HASANUDIN/
20 HADIBAIJATUS SYAHRA 3/31/2019 40 3201277103190004 SARAH
21 HANA LAUNA 7/14/2020 24 3201275407200001 BUNYAMIN/TRI
TRI
22 HANNA LAUNA 7/14/2020 24 320127540720001 WAHYUNINGSIH
23 HILYAH RUMAISA 6/24/2018 49 3201276406180003 miftah/halimah
HILYAH RUMAISA AL
24 KHOIR 6/24/2018 49 320127640618003 HALIMAH
25 LABIBA NAZIATUNISA 3/29/2020 28 3201276903200006 yusup/lia sari
26 LAIBAH NAZIATUN NISA 3/29/2020 28 3201276403200006 LIA/YUSUP
27 LAURA RAMDANI 5/21/2020 26 3201276105200006 SUMRIS/TITA
28 m balqis 8/21/2018 47 3201902108180000 iman-yeni
SURYADI-SITI
29 M FATUR ROHMAN 7/22/2018 48 3201902207180000 NURHALIA
30 M HANIF R 5/18/2018 50 3201271805182000 MUBAROK-WATI
31 m rizki maulana 7/13/2017 60 3201271307140002 aep-nurhayati
32 m taufiq 10/28/2017 57 3201902810170000 jakiyah-toni
dedi mulyadi-
33 m varell 8/3/2018 47 3201900308180000 aheni
34 M ZAINUL MALIK 9/11/2018 46 3201271109180003 jayadi / Nenah
35 M. ABDUL RASYID 8/23/2020 23 329122308200003 MASLIAH
36 M. AKMAR NADAFA 3/16/2019 40 320127160319004 EKA
37 M. AKMAR NADAFI 3/16/2019 40 3201271603190005 APIPUDIN/EKA
38 M. AKRAM NADAFA 3/16/2019 40 3201901603197039 apipudin/eka
ABDUL
39 M. ALFARIZI 10/30/2018 45 3201273010180009 PAHMI/ANAH
40 M. ALWI AL FAUZAN 12/20/2017 55 3201272012170007 UUS/SITI HAPSOH

41 M. ARIFIN ILHAM 4/15/2018 51 3201271564180005 BADRU/ALIS
42 M. AZMI A 11/14/2019 32 3201211411180001 MASUM/PIPIN
KAMALUDIN/
43 M. AZMI AR RIZQI 2/15/2021 17 3201271502211003 ST.JUBAEDAH
44 M. EL FATIH DUMIYATI 9/22/2019 34 3201272209190003 NUNUNG/ACE
M. FARREL SEPTIAN
45 ARIZKI 8/3/2018 47 321270309180001 DEDI/ AHENI
46 M. GIBRAN ATTARAZKA 2/14/2021 17 3201271402210003 ROJA\'I/ELIH
47 M. GILANG RAFFSYA 4/20/2018 51 3201272004180004 MULYANA/ISMA
48 M. HISYAM KHAMIL 10/1/2020 22 3201270110200001 UUS/SITI HAPSOH

49 M. KHAIDAR MUZAQIR 5/25/2020 26 3201272505200003 m. eki/kiki
50 M. LUTFI ADAMI 12/18/2018 43 3201271812180004 ROHMAN
51 M. REHAN ASOBARI 2/17/2018 53 3201271702180218 SOBARI/KARTIKA
52 M. RIDWAN 7/10/2017 60 3201271007170003 edi suherman/rini

53 M. RIDWAN 7/10/2020 24 3201271007570003 RINI
54 M. RIFKI ABDULLAH 4/25/2020 27 3201272504200004 MUHIDIN/ELINDA

55 M. ZAENAL MALIK 9/11/2018 46 3202127110918000 ZAYADI/NENAH
56 MALIK ALFIYANSYAH 3/3/2020 28 3201270303200007 MIFTAH/ERINA
57 MAULIA LAISYA SAFITRI 6/29/2019 37 32127696190001 SITI HASMAH
58 MAULIYA LAISA S 6/29/2019 37 3201276906190001 asep/siti hasmah
59 MENDRU KHOIRUL PAJAR 2/12/2020 29 3201271202200003 RAHMA

60 MUHAMAD AL IKRAM 4/3/2020 27 3201270304200004 dede/wida
61 MUHAMAD AL KRAM 4/3/2020 27 3201900304201117 WIDA
62 MUHAMAD AL PARIZI 10/30/2018 45 320127310180009 ANAH NURHAYATI

MUHAMAD ARFAN
63 MUTAQIN 4/10/2018 51 3201272902210003 ALIMIN/EPA
64 MUHAMAD AZMI ALRIZKI 2/15/2021 17 3201901502215035 SITI JUBAEDAH

65 MUHAMAD FARHAN 4/6/2018 51 3201900604183259 NYAI CICAH
66 MUHAMAD FARZAN 10/28/2020 21 3201272810200001 deri/mita
KUSMITA
67 MUHAMAD FARZAN 10/28/2020 21 3201902810203216 SULASTARI
68 MUHAMAD HAFIZ JUNDI 8/12/2019 35 3201900303226784 SITI NURLELA
SUHANDA/
69 MUHAMAD HAIQAL HAFIS 8/6/2018 47 3201270608180002 NURLAELAH
MUHAMAD HISAM
70 KHAMIL 10/1/2020 22 320127011020001 SITI HAPSOH
71 MUHAMAD HISNU MASIZ 8/22/2020 23 3201902208208737 MAESAROH

72 MUHAMAD PARHAN 4/6/2018 51 3201900604184818 ugan/cicah
73 MUHAMAD RAFA 6/2/2020 25 3201900206209870 herman/sindi
MUHAMAD RAFFA
74 ALFAHRI 6/2/2020 25 3201900206209253 SINDI AULIA
75 MUHAMAD YUSUF 9/14/2019 34 3201274109190004 IIS
MUHAMMAD FAHRI
76 YUSUF 7/9/2020 24 3201270907200001 UCUP/HALIMAH
MUHAMMAD HAFIZ SUHENDRA/
77 DJUNDI 8/12/2019 35 3201271208190819 NURLELA
MUHAMMAD KHAIDAR
78 MUZAKQIR 5/25/2020 26 3210127250520000 RIZKI/EKI
MUHAMMAD RAFA
79 HAKIMI 2/24/2018 53 3201272502180003 SITI MUNIARSIH
80 MUHAMMAD YUSUF 9/14/2019 34 3201271409190004 nahrudin/iis
MUHMAD RAMA
81 RADIANSYAH 5/18/2020 26 3201901805204354 DIDAH
82 NABILA KHOIRUNNISA 6/27/2019 37 3201276104910004 ADE/RINA
ENJANG/NENENG
83 NABILA KHOIRUNNISA 10/29/2020 21 3201906910208715 DIAH
84 NATASHA 2/28/2020 29 3201276802200005 TISNA/LIA
UWAR/ST.
85 NAURA ARSYILA 12/16/2019 31 3201252061900004 NURJANAH
86 NAYA HAFIDZA 1/10/2019 42 3201274111019000 WIDAN/ROBIAH
87 NESYA SAPIRA 8/26/2020 23 3201906608203383 PIPAH
NONI SRI
88 PUTRI KAMILA SAUDIAH 5/21/2021 14 3201906105215884 HANDAYANI
89 RAHAYU SALSABILA 4/12/2018 51 3201905204182490 anwarudin/ajeng
90 RAYAN AGUSTIN 1/2/2020 30 3201270201200004 SANTI
91 READIANSYAH 2/6/2020 29 3201900602206378 kodir/rosita
92 RENDI YANSAH 2/6/2020 29 320127060270006 ROSITA
93 REVITA AULIA 12/2/2017 55 3201274212170005 IRPAN/MIRAWATI

94 SABILA FAUZIAH 9/11/2018 46 3201175109180003 IWAN-ROSITA
95 SAFIRA NURMAULIDIA 10/3/2020 21 320127431020003 SITI SAODAH
SANUM AYUDIA FADILAH/PUTRI
96 FADHEELA 9/18/2018 46 3201275809180002 RAHAYU
SANUM AYUDIA
97 FADHEELA 9/18/2018 46 3201272402180003 PUTRI RAHAYU
98 SAVIRA NUR MAULIDA 10/3/2020 21 3201274510200003 umar/st.saodah
99 SHAFANA AQILAH 3/20/2020 28 3201276003200001 PIRAMA/IKOH
100 SITI AIRIN RUKMANA 8/28/2019 35 3201276808190001 ZENAL/AISAH
UKAY/SITI
101 SITI ALIKA HUMAIRAH 7/15/2019 36 3201275507190003 RAHMAH
102 SITI JULIANA PIRLI 7/3/2018 48 3201274307180003 ALI/ONIH
103 SITI MUDSIFA NAZWA 11/10/2020 20 3201275011200002 IDIK/SITI JUFLAH
104 SITI NAPISA PIRMANSAH 11/26/2018 44 3201276611180006 YUni
105 SITI NENG RARA 9/26/2018 46 3201276609180001 USMAN/RINA
106 SITI SALMAH AL HOERIAH 6/17/2019 37 3201275706190002 HERU/SITI PARIDA

MA\\\'MUN/
107 SITI SALSA MAULIDINA 11/24/2020 20 3201276411200002 NENG
108 SITI SALWA 6/16/2018 49 3201275606180001 SUSANDI/AISYAH
109 ZAHIRA MAULIDA 11/29/2019 32 3201276911190003 SITI FARIDAH
110 ZAHWA JULIA NISA 7/1/2019 37 3201274107190002 YUSUF/NURAENI
MADINAH-
111 ZAIFA QIRANI 8/5/2018 47 3201274508180002 MARIAM
112 ZIANA LUSIANTI 8/2/2019 35 3201274208190006 SITI HOLISOH
TOTAL
TOTAL VIAL VAKSIN (Jumlah Vial = Jumlah Total Sasaran/IP Vaksin)
IP Vaksin:
MR = 8
OPV = 8
IPV = 4
DPT-HB-Hib = 4
Catatan:
Anak yang sudah mendapatkan ORI Campak Rubela, tidak perlu mendapatkan imunisasi tambahan Campak Rubela sejak Jan
Total kebutuhan vial yang dibutuhkan yang mengacu pada perhitungan baris total vial vaksin
Anak usia 18-24 bulan yang pada saat bersamaan mendapatkan imunisasi rutin (DPT-HB-Hib4 dan Campak rubella 2) maka te
Kebutuhan Vaksin Khusus Campak Rubela = (Total Sasaran - Sudah Mendapatkan ORI Campak Rubela sejak Januari 2022)/I
SASARAN IMUNISASI BIAN:
Imunisasi Kejar : Lahir pada bulan Sept 2017 - bulan Oktober 2021
Imunisasi CR
Kolom Tambahan:
*) Jumlah Dosis Vaksin yang pernah didapat
NISASI KEJAR ADALAH 12-59 BULAN
Tambahan 2022
Kejar KEJAR *) Jumlah Dosis Vaksin yang
Campak Rubella (Ya =1, (Ya = 1, Tidak = 0) (Ya = 1 , pernah didapat
Alamat (Ya=1, Tidak = 0) Tidak=0) OPV IPV DPT-HB-Hib Tidak = 0) OPV
kp.Leuweung Larangan 1 0 1 1 1 1 4
96 0 96 96 96 96 392
12 12 24 24
mpak Rubela sejak Januari 2022
mpak rubella 2) maka tetap masuk dalam Sasaran Imunisasi Kejar

la sejak Januari 2022)/IP vaksin
*) Jumlah Dosis Vaksin yang untuk melengkapi status Suntikan
pernah didapat imunisasi Dosis Sasaran Bulan Agustus Bulan
IPV DPT-HB-Hib OPV IPV DPT-HB-Hib OPV IPV DPT-HB-Hib CR Agustus
1 4 0 0 -1 0 0 0 0 0
1 4 0 0 -1 0 0 0 0 0
1 4 0 0 -1 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 -1 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 -4 -1 -4 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 -1 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 -1 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 -4 -1 -4 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 -1 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 -1 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
1 4 0 0 0 0 0 0 0 0
98 392 -8 -2 -16 0 0 0 0 0
BIAN
(Agustus
)
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

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FORMAT PENDATAAN POSYANDU SASARAN BIAN

6 ABDULLAH ALWI HUSAINI 7/13/2020 24 3201271407200003 SANIA/TOROH

7 AHMAD ARSYAD IBRAHIM 12/6/2017 55 3201270612170001 DEDEN/YULI

40 M. ALWI AL FAUZAN 12/20/2017 55 3201272012170007 UUS/SITI HAPSOH

48 M. HISYAM KHAMIL 10/1/2020 22 3201270110200001 UUS/SITI HAPSOH

52 M. RIDWAN 7/10/2017 60 3201271007170003 edi suherman/rini

54 M. RIFKI ABDULLAH 4/25/2020 27 3201272504200004 MUHIDIN/ELINDA

59 MENDRU KHOIRUL PAJAR 2/12/2020 29 3201271202200003 RAHMA

62 MUHAMAD AL PARIZI 10/30/2018 45 320127310180009 ANAH NURHAYATI

64 MUHAMAD AZMI ALRIZKI 2/15/2021 17 3201901502215035 SITI JUBAEDAH

71 MUHAMAD HISNU MASIZ 8/22/2020 23 3201902208208737 MAESAROH

93 REVITA AULIA 12/2/2017 55 3201274212170005 IRPAN/MIRAWATI

106 SITI SALMAH AL HOERIAH 6/17/2019 37 3201275706190002 HERU/SITI PARIDA

TOTAL VIAL VAKSIN (Jumlah Vial = Jumlah Total Sasaran/IP Vaksin)

mpak Rubela sejak Januari 2022

mpak rubella 2) maka tetap masuk dalam Sasaran Imunisasi Kejar

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