HASIL PELAKSANAAN RAPID TEST COVID-19 TAHAP TRACKING

KABUPATEN INDRAMAYU PROVINSI JAWA BARAT

DESA : KOPYAH  (Tanda Kuning

Kuning = Belum Rapid Test; Tanda m
merah
erah = Reakf; Tanda Biru = Pembatas
Pembatas jabat
jabatan)
an)

JENIS
KELAMIN WARGA
NO NAMA NIK UMUR TANGGAL LAHIR ALAMAT TEMPAT TINGGAL
NEGARA
L P

PPS

1 ACENG SUGIARTO 3212231904810004   39   4/19/1981   L DESA KOPYAH RT004/RW003

WNI

2 SAEFUL FIKRI 3212230306840001   34   6/3/1984   L DESA KOPYAH RT005/RW003

WNI

3 NURAKHMAN 3212233108930003   27   8/31/1993   L DUSU

DUSUN
N KE
EBO
BON
N W AR
ARU R T0
T0 03
03 //R
RWW0
0 01
01
WNI

4 DONI HARDIANSYAH 3212231010890001   31   10/10/1989   L DESA KOPYAH RT004/RW003

WNI

5 MUCHAMMAD ROATIB 3212231005710001   41   5/10/1971   L DESA KOPYAH RT003/RW04

WNI

6 SAMSUDIN 3212230406700004   50   6/4/1970   L DESA KOPYAH RW005/RW004

WNI
KPPS

7 MUSAHIDIN 3212232708890001   31   8/27/1989   L BLOK KEBON WARU RT003/RW001

WNI

8 IMAM SAFE'I 3212231102970003   23   2/11/1997   L BLOK KEBON WARU RT002/RW001

WNI

9 AJI FADILAH ISRO 3212230412960002   24   12/4/1996   L BLOK KEBON WARU RT003/RW001

WNI

10 RINTO YUSWANDI 3212232802000006   20   2/28/2000   L BLOK KEBON WARU RT001/RW002

WNI

11 AJAN 3212232005800006   40   5/20/1980   L BLOK KEBON WARU RT002/RW001

WNI

12 SUPRIYANTO 3212230502830006   37   2/5/1983   L BLOK SUKA MAJU RW001/RW001

WNI

13 MUHAMMA D RIAN A PR
PRIYANTO 3212232604970001   23   4/26/1997   L BLOK SUKA MAJU RW001/RW002
WNI

14 MUNTASIR 3212230812780001   42   12/8/1978   L BLOK KEBON WARU RT003/RW001

WNI

15 REDI 321223081178004   42   11/8/1978   L BLOK KEBON WARU RT002/RW001

WNI

16 BUKHORI 321223203890002   33   8/16/1987   L BLOK KEBON WARU RT003/RW001

WNI

17 DEDE MAULIDDIAN 3212235506990002   21   6/15/1999 p   BLOK KEBON WARU RT003/RW001

WNI

18 BARON SUGITO 3212231506890003   31   6/15/1989   L BLOK KEBON WARU RT002/RW001

WNI

19 IING RUDIANTO 321223180778005   40   7/18/1980   L BLOK KEBON WARU RT002/RW001

WNI

20 ALEX MASHURI 3212231010880002   32   10/10/1988   L BLOK KEBON WARU RT002/RW001

WNI

21 FUAD HASAN 3212230407870001   33   7/4/1987   L BLOK KEBON WARU RT004/RW001

WNI

22 NUR LELA 3212234606930008   27   6/6/1993   L BLOK KEBON WARU RT004/RW001

WNI

23 DARMADI 3212231201920005   28   1/12/1992   L BLOK KEBON WARU RT004/RW001

WNI

24   NANANG GALIH HAN

HANGGANA
GGANA ROBIS
ROBIS   3212231506850006   35   6/15/1985   L BLOK KEBON WARU RT004/RW001
WNI

25 RIFQI HIDAYATTULLAH 3212232003980001   22   3/20/1998   L BLOK KEBON WARU RT001/RW002

WNI

26 NUR FAUZI 32122327060000001   20   2/14/2000   L BLOK KEBON WARU RT001/RW002

WNI

27 DIMAS PRAYOGI 3212231408000003   20   8/14/2000   L BLOK KEBON WARU RT001/RW002

WNI

28 SUMARTO 3212230901740004   46   1/9/1974   L DUSUN KONCA RT 002/RW 002

WNI

29 INDRA SETIAWAN 3212010511930001   27   11/5/1993   L DUSUN KONCA RT 003/RW 002

WNI

30 ENDI LIANTO 3212231210860003   34   10/12/1986   L DUSUN KONCA RT 002/RW 002

WNI

31 MUNTAHA 3212230205740005   46   5/2/1974   L DUSUN KONCA RT 002/RW 002

WNI
 

32 TUKIYEM 3212235712710001   49   12/17/1971 p   DUSUN KONCA RT 002/RW 002

WNI

33 PUTRI YANI 3212234111990005   21   11/1/1999 p   DUSUN KONCA RT 003/RW 002

WNI

34 RAMITO 3212232507830008   37   7/25/1983   L DUSUN KONCA RT 003/RW 002

WNI

35 TATANG SUKIRNO 3212232709750001   45   9/27/1975   L BLOK KONCA RT 004 / RW 002

WNI
36 VIVI AL VIOLA FITRI 3212235503940003   26   3/15/1994 p   BLOK KONCA RT 005 / RW 002
WNI

37 WARNOTO 3212230804840005   32   4/8/1988   L DUSUN KONCA RT 004 / RW 002

WNI

38 SURYA 3212231007940005   26   7/10/1994   L RT 004 / RW 002

WNI

39 SUTRISNO 3212232808710001   49   8/28/1971   L BLOK KONCA RT 005 / RW 002

WNI

40 SALMAN ALFARIZI 3212231812970002   23   12/18/1997   L RT 005 / RW 002

WNI

41 RAHMAWATI INDAHSARI 3212235708970007   29   4/21/1991 p   RT 005 / RW 002

WNI

42 JULIANA SUKARSA 3212232407820002   38   7/24/1982   L JL RAYA KOPYAH RT004/RW003 WNI

43 UUL ULWIYATIN 3212235110890002   31   10/11/1989   P GANG ASEM RT001/RW003

WNI

44 RANGGI 3212230805960005   24   5/8/1996   L GANG SALAK RT 005/RW 003

WNI

45 JUJU JULEHA 3212234705830018   37   5/7/1983 p   GANG BALAIDESA RT003/RW003

WNI

46 PUTRI SEKAR 3212234609200007   20   9/6/2000 p   GANG MANGGA RT004/RW003

WNI

47 SUGANDI 3212232412950001   35   12/28/1995   L GANG MANG G

GA
A RT 004/RW 003
WNI

48 TEPI SANTIKA 3212234409960001   24   9/4/1996 p   GANG JAMBU RT002/RW003

WNI

49 OPAN SAEFUL HAMDANI 3212230604900008   30   4/6/1990   L GANG MANG G

GA
A RT004/RW003
WNI

50 DIDI SUPRIYADI 3212230212830001   37   12/2/1983   L GANG MANG G

GA
A RT004/RW003
WNI

51 HERI KISWANTO 3212230505800003   40   5/5/1980   L KOPYAH RT004/RW003

WNI

52 LUSI YULISTIA 3212235207000002   20   7/12/2000   P GANG MANG G

GA
A RT004/RW003
WNI

53 CARNITA 3212230904820004   38   4/9/1982   L BL

BLO
OK K EBO
EBON
N WAR
ARU
U RT
T0
0001
1 //R
RWW0
0002
2
WNI

54 MULYANI 3213036812720002   48   12/28/1972 p   KOPYAH RT005/RW003

WNI

55 UCI SANUSI 3212230404770002   43   4/4/1977   L GANG MANG G

GA
A RT004/RW003
WNI

56 SUHENDRI 3212232504780002   42   4/25/1978   L GANG SALAK RT006/RW003

WNI

57 SUNTARA 3212230108760008   44   8/1/1976   L GANG JERUK RT004/RW004

WNI

58 SOBANA 3212230510790008   41   10/5/1979   L GANG SALAK RT006/RW003

WNI

59 HIDAYAT 3212230101900017   30   1/1/1990   L GANG JAMBU RT002/RW003

WNI

60 ALNIYAH 3212234703950005   25   3/7/1995 p   GANG SALAK RT006/RW003

WNI

61 IMRON ROSIDI 3275041612760012   44   12/16/1976   L JALA

JALAN
N RA
AY
Y A K OPY
OPYAH
AH R T
T0
0005
5 //R
RW OO
OO 3
WNI

62 SUMARNO 3212230207710003   49   7/2/1971   L GANG SALAK RT006/RW003

WNI
63 SYAEFUDDIN ZUHRI 3212232209840002   36   9/22/1984   L BLOK KOPYAH RT002/RW004
WNI

64 JOHAN PUJIANTORO 3212232103900005   30   3/21/1990   L GANG PISANG RT002/RW004

WNI

65 SHOLIKHAN 3212231307810009   39   7/13/1981   L GANG MANG G

GIIS RT001/RW004
WNI

66 SITI ROMLAH 3212236712970001   23   12/27/1997 p   GANG MANGGIS RT001/RW004

WNI

67 SUPENDI 3212231010790003   37   10/10/1983   L GANG MANG G

GA
A RT001/RW004
WNI
 

68 ADE TARMONO 3212231805880002   32   5/18/1988   L GANG MANGGIS RT001/RW004

WNI

69 NOTO SUSANTO 3212231506830005   37   6/15/1983   L GANG PISANG RT002/RW004

WNI

70 WASMI 3212234505750034   45   5/5/1975 p   JALAN RAYA KOPYAH RT003/RW004

WNI

71 DONY ADITYAWAN 3212233005960002   24   5/30/1996   L GANG PISANGRT003/RW004

WNI
72 RANDI IBNU HAMDHANI 3212230404860003   34   4/4/1986   L GANG PISANG RT002/RW004
WNI

73 DEWI SYARAH 3212234101880006   32   1/1/1988 p   GANG PISANG RT003/RW004

WNI

74 KARNADI 3212231806750003   45   6/18/1975   L JL R AY

AY A KOPYAH
PYAH R T0
T0 0
03
3 /R
/R W0
W0 03
03
WNI

75 YARSA 3212030104950001   25   4/1/1995   L GANG JERUK RT004/RW004

WNI

76 EDI JUNAEDI 3212232205980008   22   5/22/1998   L GANG JERUK RT004/RW004

WNI

77 AGUS SUPRATMAN 3212231309750005   45   10/13/1975   L GANG MANGGA RT004/RW003

WNI

78   ALVIN FUADY YANUAR AW

AWWALURIZZAL
WALURIZZAL   3212231901000003   20   1/19/2000   L GANG MASJ ID
ID RT004/RW004
WNI

79 SYUKRON NAWAWIE 3212230310780001   42   10/3/1978   L GANG DELIMA RT005/RW004

WNI

80 MOH. HADI SAPUTRA 3212230205000011   20   3/2/2000   L   JALAN RAYA KOPYAH RT004/RWOO4

WNI

81 JAENUDIN 3277010508780002   42   8/5/1978   L GANG MASJ ID

ID RT005/RW004
WNI

82 SUHARI 3212232407770005   43   7/24/1977   L GANG DELIMA RT005/RW004

WNI

83 MAHFUDIN 3212232901810003   39   1/29/1981   L GANG DELIMA RT005/RW004

WNI

PAMSUNG

84 CARIDIN 3212230407800002 40 7/4/1980 L BLOK SUKA MAJU RW001/RW001 WNI

85 SAIDI 3212231705910002 29 5/17/1991 L   BLOK SUKA MAJU RW001/RW002

WNI

86 AGUS 3212231203710002 49 3/12/1971 L   DUSUN KEBON WARU RT 002 RW 001

WNI

87 NURWANDI 3212230803870004 33 08/03/1987 L   DUSUN KEBON WARU RT 002 RW 001

WNI

88 IDIK IMANTO 3212230410790002 41 10/4/1979 L KOPYAH RT:001 RW:002

WNI

89 SURTAMAN 3212230408810003 39 8/4/1981 L KOPYAH RT:001 RW:002

WNI

90 EDI SUPARDI 3212231107770002 43 7/11/1977 L DUSUN KONCA RT 003/RW 002

WNI

91 DARMA 3212230703810002 39 3/7/1981 L DUSUN KONCA RT 002/RW 002

WNI

92 DADANG DARMADI 3212231110680001 52 10/11/1968 L RT 005 / RW 002

WNI

93 NURKODIM 3212232004670004 53 4/20/1967 L BLOK KONCA RT 005 RW 002

WNI

94 KOMBALI 3212230507720001 48 7/5/1972 L OPYAH RT:002 RW:003

WNI

95 HUDA AKBAR 3212232308870002 33 8/23/1987 L GANG BALAIDESA RT003/RW003

WNI

96 NANA SUKANA 3212230101840008 36 1/1/1984 L GANG MANGGA RT004/RW003

WNI

97 TARJA 3212231306770001 43 6/13/1977 L KOPYAH RT004/RW003

WNI

98 SUDARTONO 3212230101900002 30 1/1/1990 L GANG JAMBU RT002/RW003

WNI

99 KASIM 3212230205650003 55 02/05/1965 L GANG SALAK RT006/RW003

WNI

100 JUNEDI 3212231808680004 52 8/18/1968 L GANG MANGGIS RT001/RW004

WNI

101 ADON 3212231303650002 55 3/13/1965 L GANG MANGGIS RT001/RW004

WNI

102 AGUS 3212231008750007 45 8/10/1975 L KOPYAH RT:004 RW:004

WNI
 

103 SARPUDIN 3212230312750003 45 12/3/1975 L GANG PISANG RT 003/RW 004

WNI

104 TOHA 3212231709700004 50 8/18/1970 L RT 004/RW004

WNI

105 RIBAN 3212232011520002 62 11/12/1952 L RT006/ RW004

WNI
 

Form. 1

STATUS TEST
TANGGAL RAPID
NO. TELEPON PUSK/Rumah Sakit
PELAKSANAAN
NR R

PKM ANJATAN

085322679992 12/2/2020  √

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