BIDAN SUSI MOVITA

No. STR. 120252271-1427297

No. SIPB. 1/B.17/31.75.07.1004/-1.779.3/e/2019
RSIA Sayyidah Jl. Taman Malaka Selatan Jl. Kelurahan Raya No.6, RT.8/RW.6, Pd. Klp,
Kec. Duren Sawit, Kota Jakarta Timur, Daerah Khusus Ibukota Jakarta 13450

PELAYANAN KEGIATAN PRAKTIK PROFESI / PELANAYANAN KEBIDANAN

PELAYANAN IMUNISASI PADA BAYI, BALITA, ANAK SEKOLAH

TEMPAT : RSIA SAYYIDAH

PERIODE : 2021

No. Tanggal Nama pasien Tgl lahir Alamat Nama orang Imunisasi
tua yang
diberikan
1. 29-3-2021 By. Aisyah 16-12-2020 Jl. Gedung Ny.Mia Dpt 2 +
Bilqis raya Rt. 009/ polio 3
Rw. 016.
pulogadung
2. 31-3-2021 By. Aisyah 15-11-2020 Jl. Diman Rt. Ny. Asni Dpt 3 +
004/ Rw. 007 polio 4
jati sari
3. 7-4-2021 By. ichald 19-1-2021 Jl. Kav pdk Ny. Diena Dpt 2 +
kelapa blok polio 3
C/28. dursa
4. 8-4-2021 By. Tazkia 27-11-2020 Jl. Perum Ny. Miranty Dpt 3 +
bintara jaya polio 4
Rt. 008/ Rw.
15
5. 8-4-2021 By. Nahla 8-3-2021 Kav DKI 015 Ny. Bcg +
Rt. 006/ Rw. Wandita polio 1
009 pon-kel.
Duren sawit
6. 12-4-2021 By. Alesha 29-11-2020 Duren sawit Ny. Shavira Dpt 3 +
baru, a912 polio 4
Rt. 006/ Rw.
11. Duren
sawit
7. 14-4-2021 By. Raffa 13-3-2021 Jl. Kav DKI Ny. Amira Bcg +
karim Rt. 008/ Rw. polio 1
009
8. 17-4-2021 By. Zaina 18-3-2021 Jl. Cipinang Ny. Kiki Bcg +
muara Rt. 13/ polio 1
Rw. 003.
 Cipinang
besar utara
9. 19-4-2021 By. Adreena. 17-2-2021 Jl. Rawa Ny. Indah Dpt 1 +
M bebek Rt. polio 2
005/ Rw.
001. Pulo
gebang ,
cakung
10. 20-4-2021 By. Sulthan 16-1-2021 Jl. H. Naman Ny. Wina Dpt 3 +
thabrani no. 20 Rt. polio 4
002/ Rw.
003, rumah
kopel
11. 21-4-2021 By. Aisyah 16-12-2020 Jl. Gedung Ny.Mia Dpt 3 +
Bilqis raya Rt. 009/ polio 4
Rw. 016.
pulogadung
12. 21-4-2021 By. Abdullah 11-3-2021 Jl. Upaya Ny. Ika Bcg +
utara, Rt. polio 1
009/ 001
kebon
bawang
13. 23-4-2021 By. Nafisa 17-3-2021 Kav DKI Tn. Olga Bcg +
Blok B 10 polio 1
No. 19 Rt.
008/ Rw. 009
malaka sari
14. 26-4-2021 By. Maulana 1-12-2020 Jl. Pangkalan Ny. Dewi Dpt 3 +
Z jati No. 25 polio 4
Rt. 10/ Rw.
005
15. 5-4-2021 By. Karin S 31-3-2021 Jl. Mawar Ny. Kaviar Bcg +
merah Rt. R polio 1
007/ Rw. 001
16. 10-5-2021 By. Nahla. M 8-2-2021 Kav DKI Rt. Ny. Wandih Dpt 1 +
15/ Rw. 18 polio 2
17. 25-5-2021 By. Bahrudin 25-02-2021 Jl. Malaka Ny. Rossy Dpt 1 +
barat no 2 polio 2
18. 25-5-2021 By. Raizel 24-3-2021 Jl. Tegal . Ny. shinta Dpt 1 +
duren sawit polio 2
19. 1-6-2021 By. Samuel 13-5-2021 Jl. Ny. septiana Bcg +
Pengarengan polio 1
Rt. 007/ Rw.
12
20. 1-6-2021 By. Karin S 31-3-2021 Jl. Mawar Ny. Kaviar Dpt 2 +
merah Rt. R polio 3
007/ Rw. 001
21. 5-6-2021 By. Nafisa 17-3-2021 Kav DKI Tn. Olga Dpt 2 +
Blok B 10 polio 3
No. 19 Rt.
 008/ Rw. 009
malaka sari
22. 7-6-2021 By. Indira .p 2-9-2020 Kp. Rawadas Ny. Ririn Campak
Rt. 002/ Rw.
007
jatinegara
23. 8-8-2021 By. M. 6-3-2021 Jl. H. Dogon Ny. Dewi Dpt 2 +
Raffasha Rt. 11/ Rw. polio 3
001 No. 57,
pondok
kelapa
24. 14-6-2021 By. Lunara 5-5-2021 Jl. Swakarsa Ny. Dita Bcg +
putri 1B No. 25A polio 1
25. 15-4-2021 By. Raffa 13-3-2021 Jl. Malaka iv Ny. Ratna Dpt 2 +
karim 69. No. 5 Rt. polio 3
002/ Rw. 008
26. 17-6-2021 By. Nahla. M 8-2-2021 Kav DKI Rt. Ny. Wandih Dpt 2 +
15/ Rw. 18 polio 3
27. 21-6-2021 By. chrissyta 21-5-2021 Jl. Marzuki Ny. shinta Bcg +
1x No. 06 Rt. polio 1
004/ Rw. 14,
cakung
28. 21-6-2021 By. Atha. R 23-5-2021 Jl. Pangkalan Ny. febriani Bcg +
jati No. 27 polio 1
cipinang
melayu
29. 21-6-2021 By. M. Gilar. 25-5-2021 Pulo gebang Ny. Ana. L Bcg +
E permai Blok polio 1
H17
30. 23-7-2021 By. Atha. R 23-5-2021 Jl. Pangkalan Ny. febriani Dpt 1 +
jati No. 27 polio 2
cipinang
melayu
31. 26-7-2021 By. chrissyta 21-5-2021 Jl. Marzuki Ny. shinta Dpt 1 +
1x No. 06 Rt. polio 2
004/ Rw. 14,
cakung
32. 31-7-2021 By. Karin S 31-3-2021 Jl. Mawar Ny. Kaviar Dpt 3 +
merah Rt. R polio 4
007/ Rw. 001
33. 31-7-2021 By. Lunara 5-5-2021 Jl. Swakarsi Ny. Gita Dpt 1 +
putri IB No. 25 A polio 2
Rt. 004/ Rw.
003 pondok
kelapa
34. 31-7-2021 By. Nahla. M 8-2-2021 Kav DKI Rt. Ny. Wandih Dpt 3 +
15/ Rw. 18 polio 4
35. 31-7-2021 By. Alana 19-4-2021 Jl. Mayang NY. Dwi Dpt 2 +
thirta IV 8 Blok polio 3
 AKI/5
36. 10-8-2021 By. Sulthan. 5-7-2021 Jl. Binta Ny. Citra Bcg +
S karya No.19 sari polio 1
37. 10-8-2021 By. tata 12-7-2021 Jl. Ny. Qnita Bcg +
Apartemen rahmah polio 1
east pants
tower
38. 14-8-2021 By. Calista 12-7-2021 Pondok Ny. Umi. F Bcg +
maryam kelapa 7B polio 1
Blok H1/6
39. 26-8-2021 By. Haura. A 5-1-2020 Jl. Cempaka Ny. Fika Campak
bau
40. 27-8-2021 By. 17-11-2021 Pondok Tn. Campak
Prabaswara kelapa barat Prihardadi
Kav blok
DKI A 15
No. 11
41. 28-8-2021 By. Raina 28-7-2021 Pondok Ny. Metty Bcg +
kelapa polio 1
Rt.007/ Rw.
007
42. 1-9-2021 By. M. Gilar. 25-5-2021 Pulo gebang Ny. Ana. L Dpt 3 +
E permai Blok polio 4
H17
43. 1-9-2021 By. Abayomi 1-8-2021 Cipinang Ny. wiwi Bcg +
loutar rt. polio 1
10/rw 009
44. 1-9-2021 By. Vina 16-8-2021 Pondok Ny. Agnes Bcg +
kelapa jakarta polio 1
timur
45. 1-9-2021 By. Samuel 13-5-2021 Jl. Ny. septiana Dpt 3 +
Pengarengan polio 4
Rt. 007/ Rw.
12
46. 6-9-2021 By. Lunara 5-5-2021 Jl. Swakarsi Ny. Gita Dpt 3 +
IB No. 25 A polio 4
Rt. 004/ Rw.
003 pondok
kelapa
47. 6-9-2021 By. Byantara 12-5-2021 Kav DKI Ny. Desi Dpt 3 +
Blok k15 Rt. polio 4
002/ Rw. 009
48. 8-9-2021 By. Luna 5-5-2021 Jl. Swakarsa Ny. Gita Dpt 3 +
1B polio 4
49. 9-9-2021 By. Lisa 4-8-2021 Jl. Asrama Ny. Lia Bcg +
yon belakang polio 1
3. Tinggi
barat no 5
50. 11-9-2021 By. Rania. Z 12-7-2021 Jl. Swakarsa Ny. Inestia Dpt 1 +
 IV No 40 Rt. polio 2
008/ Rw. 003
pondok
kelapa
51. 28-08- By. Raizel 24-03-2021 Jl. Tegal Rt. Ny. Shinta Dpt 3 +
2021 003/ Rw. 013 polio 4
no 4
52. 01-09- By. M. 06-03-2021 Jl. H. Dogol Ny. Dewi Dpt 3 +
2021 Raffasa S Rt. 011 / Rw. polio 4
001 Pondok
Kelapa
53. 01-09- By. M Gitar 25-05-2021 Jl. Ny. Ara Dpt 3 +
2021 E Pulogebang polio 2
Permai Blok
H
54. 01-09- By. Abayomi 01-08-2021 Jl. Cipinang Ny. Wiwi BCG
2021 Kala Lontar Rt.
010/ Rw. 009
Jaktim
55. 01-09-21 By. Agnes 16-08-2021 Jl. Pondok Ny. Ria BCG
Kelapa
Jakarta Timur
56. 01-09-21 By anindra 24-05-21 Jl irda barat Ny annisa Dpt
3+Polio4
57 4-09-21 By samuel 13-5-21 Jl kp pangga nyseptiana Dpt
jatinegara 3+polio 4
58 6-09-21 By lunara 5-05-21 Jl swakarsa1b Ny gita Dpt
no 25A rt4/3 3+Polio 4
59 6-10-21 By adrena 17- Jl rawa bebek Ny indah Campak
pulo gebang
rt5/1
60 6-9-21 By byantara s 12-5-21 Kav dki blok Ny rini Dpt 3+
k 15 polio 4
61 8-9-21 By lunara 5-5-21 Swakarsa 1b Ny gita Dpt+polio
4
62 9-9-21 An azzlan 04-02-21 Pulau dana Ny divya Dpt
no 5 3+polio 4
rt004/009
63 9-9-21 An hana 5-01-2021 Jl cempaka Ny vika Campak
baru ix no 27
rt3/7
64 9-9-21 By lepita 4-8-21 Jl asrama yon Ny lia Bcg
belakang 3
65 9-9-21 By anindra 24-5-2021 Jl irda barat Ny annisa Dpt
meidina blok c 3+polio3
66 9-9-2021 An arkana 3-11-2020 Kampung Ny amelia Campak
pisangan rt
10/5
penggilingan
67 11-9-2021 By raizel 24-03-2021 Jl tegal amba Ny shinta Dpt
3/13 no 4 3+Polio 4
duren sawit
68 11-9-2021 By rania z 12-07-2021 Jl swakarsa 4 Ny inestia Dpt
no 40 rt 1+polio 2
008/003 pd
kelapa
69 14-9-2021 By sulthon 5-7-2021 Jl bina karya Ny ichsah Dpt
rt 07/01 pdk 1+polio 2
kelapa
70 14-9-2021 By atha r 23-5-2021 Pangkalan Ny febriani Dpt 3+
jati no 17 Polio 4
cipinang
melayu
71 17-9-2021 By velika 5-6-2021 Buaran Ny tiara Dpt
antier regency blok puspita 2+polio 2
A38 pdk
kelapa
72 18-9-2021 By jenaira 27-5-2021 Jl kimia 2 Ny sonia Dpt
bumi pulo 3+polio 4
6/24
73 18-9-2021 By cristya 21-5-2021 Jl marjuki 9 Ny sinta Dpt
no 6 cakung 3+polio 4
jakarta timur
74 20-9-2021 By keysa 5-01-2021 Jl h jamat Ny keuis Campak
salawa jakarta timur
75 21-9-2021 By M syauqi 3-8-2021 Jl bina karya Ny devi Bcg
no 11 rt
006/001 pdk
kelapa
76 21-9-2021 By revandra 18-8-2021 Jl tembah Ny niken Bcg
palem blok j
8/33 pd
kelapa
77 21-9-2021 By seika 6-8-2021 Jl batu ampar Ny danielah Bcg
areta 11 no 3A
duren sawit
78 22-9-2021 By 14-8-2021 Perumahan Ny titin Bcg
albiansyah malaka utara
79 27-9-2021 By byantara 12-5-2021 Kav dki blok Ny lusi Dpt
kk no 9 rt 2/9 anggita 3+polio 4
pondok
kelapa
80 30-10- By enzy 4-9-2021 Jl kemafar x Ny eti Bcg
2021 danim blok f rt4/1
81 1-10-2021 Bygilar 25-5-2021 Pulo gadung Ny ana Dpt
permai blok 3+polio 4
H 17 no 19
82 1-10-2021 By adreena 17-2-2021 Jl rawa bebek Ny tiara Campak
 rt 5/1 pulo
gebang
cakung
83 5-10-2021 By velika 5-6-2021 Buaran Ny tiara Dpt
regency blok 3+polio 4
A/38
rt012/006
84 11-10- By harsa 4-9-2021 Jl lembah Ny prima Bcg
2021 ibrahim niur 8 blok L
3
85 11-10- By lunara 5-5-2021 Jl swakarsa Ny gita Dpt
2021 1b pd kelapa 3+polio 4
86 11-10- By kanaya 6-9-2021 Jl kemuning Ny Bcg
2021 13 no 10 mawadah
87 13-10- By syabir 6-9-2021 Jl agung Ny lidia Bcg
2021 barat 21 b/7
sunter
89 13-10- By byantara 6-9-2021 Kav dki blok Ny lusi Dpt
2021 salcha k 15 no 9 rt 3+polio4
002/09
90 14-10- By atha r 12-5-2021 Pangkalan Ny feloriani Dpt
2021 jati jakarta 3+polio 4
timur
91 16-10- By felicia 25-4-2021 Pondok Ny melia Dpt
2021 kelapa duren 3+polio 4
sawit
92 16-10- By anes 16-8-2021 Jl cempaka Ny agnes Dpt
2021 raya no 7 rt 1+polio 2
002/006
93 23-10- By chrisya 21-5-2021 Jl marzuki Ny sinta Dpt
2021 rt4/14 cakung 3+polio 4
94 25-10- By athaar 31-8-2021 Jl mesjid Al Ny vivi Bcg
2021 falah ni 1 rt
004/003
duren sawit
95 25-10- By M gelar 15-5-2021 Pulo gebang Ny ana Dpt 3+
2021 permai blok h polio 4
no 19 rt 6/4
96 25-10- An asyila s 19-1-2021 Jl cipinang Ny derry Campak
2021 pulo rt 3/15
97 25-10- By naziha a 24-9-2021 Jl garuda 2 Ny yulianti Bcg
2021 13/006
cakung
98 26-10- By seika 6-8-2021 Jl batu ampar Ny daniela Dpt
2021 2 duren sawit 2+polio 3
99 1-11-2021 By aisyah 1-10-2021 Jl Ny supri Bcg
penggilingan
baru
rt008/003 no
 16
100 4-11-2021 By safaira 19-1-2021 Jl cipoinang Ny santy Campak
muara 1 rt
8/1 no 7