FORMAT PENDATAAN POSYANDU SASARAN BIAN

SASARAN IMUNISASI TAMBAHAN CAMPAK RUBELA ADALAH 9-59 BULAN DAN SASARAN IMUNISASI KEJAR
PELAKSANAAN : AGUSTUS 2022 14 Agustus 2022
Provinsi : Desa/Kelurahan
Kabupaten : kkkk Posyandu
Puskesmas : mmmm
Isilah kolom yang berwarna PUTIH!

Tanggal Lahir
No. Nama Anak Jenis Kelamin (L/ P) NIK

1 YUMNA P 20/08/2021
2 FATIMAH P 30/06/2021
3 SHAVA P 18/06/2021
4 FIKRI L 04/05/2021
5 SHABIRA P 04/03/2021
6 ZAYN L 20/02/2021
7 BARKAH L 04/02/2021
8 LASHIRA AULIA P 25/11/2020
9 RESA LISTIAWATI P 13/10/2020
10 PANJI PATIH L 05/10/2020
11 NAZWA SEPTIANI P 18/09/2020
12 HANI P 02/07/2020
13 WULAN DARI P 27/05/2020
14 KALISA ASMI P 21/04/2020
15 ALMIRA HUMAIRA P 21/04/2020
16 AKSYELINA HUMAIRA P 29/01/2020
17 DESTI P 22/10/2019
18 KASTARA IBRAHIM L 15/09/2019
19 MUH SYAFIK L 09/08/2019
20 CHAIRIL AHTAR L 15/06/2019
21 MUH HAFIDZ L 11/04/2019
22 DAFFA L 11/04/2019
23 GANTA L 04/03/2019
24 PAREL L 01/05/2018
25 SHELA SAQILLA P 16/10/2018
26 GALUH L 09/10/2018
27 ZESIKA HARTIANA P 14/09/2018
28 AQILA KHANZA P 12/09/2018
29 KANAYA NURSANTIKA P 11/09/2018
30 GUSTINA SUKMA P 17/08/2018
31 AHYAR L 10/08/2018
32 HILYA SABRINA P 31/07/2018
33 PIPI TRISNAWATI P 22/07/2018
34 ABIDZAR L 07/07/2018
35 ADAM PUTRA DARAJAT L 27/05/2018
36 KAYLA ALFISAHRI P 24/04/2018
37 KIRANA AYU PUSPITA P 04/04/2018
38 RASYA L 31/03/2018
39 ATQIA GUSKAR P 12/03/2018
40 MELAN HAULAN P 11/02/2018
41 REVAN L 25/12/2017
42 NUR ANISA P 15/12/2017
43 TOMI TOPANI L 02/12/2017
44 NIZAM PUTRA ARIPIN L 27/11/2017
45 FAHMI MUHARAM L 24/09/2017
46 ASIPA NUR CAHYANI P 04/09/2017
47 MAHIRA HASNA P 12/07/2017
48 ANUGRAH SAPARI L 20/06/2017
49 FAHRUL L 13/06/2021
50 FARZAN L 04/04/2021
51 MARTASYA P 10/03/2021
52 SYAKIRA P 08/02/2021
53 BAGAS L 13/02/2021
54 NAZIA P 21/02/2021
55 ALIF L 20/11/2020
56 SINTIA P 18/10/2020
57 KARINA P 17/09/2020
58 M REHAN L 11/08/2020
59 SUSANTI P 15/06/2020
60 SHAKIR L 04/06/2020
61 M WILDAN L 22/05/2020
62 RAFKI L 24/05/2020
63 CANTIKA P 04/04/2020
64 FAJAR P 09/02/2020
65 GHAISAN L 30/10/2019
66 M DZAKI L 30/10/2019
67 YOGA L 30/08/2019
68 SALSABILA P 22/07/2019
69 RENZUN L 07/07/2019
70 M IKBAL L 31/07/2019
71 M ARFAN L 19/07/2019
72 RAMDAN L 27/05/2019
73 M FIKRI L 20/04/2019
74 ASYLA P 15/01/2019
75 DWI ALIA P 03/09/2018
76 RIZKI L 31/07/2018
77 RANGGA L 08/07/2018
78 M ARBANI L 06/05/2018
79 AIYRA P 10/04/2018
80 ARSYLA P 05/03/2018
81 M FAZRI P 10/02/2018
82 ARIMBI P 26/01/2018
83 SYAKILA P 14/08/2018
84 M KELVIN L 12/09/2017
85 ASYFA P 13/08/2017
86 RAFA L 20/08/2017
87 GALIH L 21/06/2017
88 NAISYA P 23/06/2017
89 NAISYLA P 23/06/2017
90 SARAH P 12/11/2017
91 ZAHRA P 07/08/2017
92 RAISA P 07/02/2021
93 ADINDA P 15/09/2021
94 IMELDA P 23/08/2021
95 NADYA P 03/06/2021
96 M KAHFI L 26/06/2021
97 AL MEERA P 16/06/2021
98 MEYRA P 25/05/2021
99 AKMAL L 06/03/2021
100 SYAFIAH P 31/03/2021
101 TIARA P 26/04/2021
102 ZAIDAN P 26/03/2021
103 ANNISA P 31/03/2021
104 M RIZKY L 24/02/2021
105 ILHAM ARYA L 19/10/2020
106 SYAZAN M ATARUHA L 24/10/2020
107 DEVANO REZKY L 09/06/2020
108 NAURA QUENSHA P 08/04/2020
109 AZKHA NUR RIZKY L 02/05/2020
110 RAFI L 25/02/2020
111 NAWAF L 19/12/2019
112 FALAH L 19/12/2019
113 LIVIA P 29/10/2019
114 ALDI L 17/07/2019
115 ALDIRA P 17/07/2019
116 ARSYLA P 29/07/2019
117 REZVAN L 29/06/2019
118 M ALWI L 03/05/2019
119 AZMIYA L 04/04/2019
120 NAZWA P 15/04/2019
121 AURELIA P 09/01/2019
122 CAMELIA P 15/12/2018
123 NIZAR L 15/11/2018
124 CALISTA P 21/09/2018
125 FEBRIANI P 03/08/2018
126 NABILA P 13/07/2018
127 ALYKA P 04/08/2018
128 NAZWA P 15/04/2019
129 M CHAIRIL L 21/08/2021
130 KAYLA P 10/05/2021
131 HAFIZAN L 11/03/2021
132 RAFASYA L 27/12/2020
133 ARKA L 10/12/2020
134 DIANA P 29/08/2020
135 NASYA P 14/06/2020
136 ANAPI L 22/10/2019
137 GIBRAN L 21/12/2019
138 HANA P 21/10/2019
139 ARASYID L 04/05/2019
140 KINARA P 04/01/2020
141 SAILA P 23/12/2018
142 M LUTFI L 09/12/2017
143 KINAN L 24/12/2017
144 SAKILA P 16/10/2017
145 HARI L 21/07/2017
146 ALBY L 29/06/2020
147 NURLENI P 23/06/2020
148 FATIN P 17/10/2020
149 ADZIKRI L 23/03/2019
150 EL GIBRAN L 23/02/2019
151 M HADI L 26/12/2019
152 M AZRIL L 19/07/2017
153 M SYAKIR L 14/06/2021
154 NADIRA P 30/01/2021
155 M AZRIL L 05/05/2020
156 M AHDAN L 27/04/2020
157 NIA P 06/03/2018
158 GHANIA P 20/12/2018
159 ATTA L 29/04/2019
160 M RAIM L 08/04/2018
161 RAFASYA L 21/01/2019
162 Refan.A L 27/07/2021
163 Quenara P 18/06/2021
164 Nadira P 15/06/2021
165 Aira P 03/01/2021
166 M.Nauval.K L 02/11/2020
167 Asyaukie L 12/11/2020
168 M.Jahral L 16/10/2020
169 Abizar L 09/10/2020
170 Kenji L 26/09/2020
171 Dwi Arimbi P 14/08/2020
172 M.Gibran L 29/03/2020
173 Arsaka L 27/03/2020
174 M.Arsena L 10/02/2020
175 Lutfi L 04/02/2020
176 M.Abizar L 07/10/2019
177 Adila P 10/09/2019
178 Aqila P 10/09/2019
179 Riska P 28/10/2019
180 M.Rayhan L 28/03/2019
181 Nova Aulia P 23/03/2019
182 M.Rezfan L 03/02/2019
183 M.Nurfikri L 22/01/2019
184 M.Arsya L 22/05/2018
185 Mirsya P 20/05/2018
186 Raisa P 27/02/2018
187 Winda P 30/12/2017
188 Irham L 12/12/2017
189 Syakila P 08/08/2017
190 Zila.M P 10/07/2021
191 Arsila P 17/06/2021
192 Yuli Papilaya P 24/07/2020
193 Renata P 12/01/2020
194 Renita P 12/01/2020
195 Kaira P 21/12/2019
196 Akbar L 09/10/2019
197 M.Dani L 05/07/2019
198 Sarah P 14/09/2019
199 Habil L 18/05/2019
200 Silvi P 08/03/2019
201 Rahmawati P 19/03/2018
202 Liana P 07/01/2018
203 Gibran L 27/08/2017
204 DAVID L 13/06/2021
205 ALTAHIR L 10/06/2021
206 ARYA L 05/03/2021
207 ALPA L 17/03/2021
208 M.ISHAN L 09/10/2020
209 AZRIL L 27/05/2020
210 RESTI P 01/08/2020
211 SINDI P 13/04/2020
212 HUSNA P 19/03/2020
213 SELI P 10/03/2020
214 GHAYA L 03/02/2020
215 ALMA P 05/01/2020
216 A.SIFA P 02/10/2019
217 M.GIO L 11/06/2019
218 ADIT L 20/11/2018
219 M.SADIKIN L 29/09/2018
220 TASYA P 18/10/2017
221 GHEZIA L 22/08/2021
222 ANANDIA L 14/06/2021
223 NAURA P 24/05/2020
224 NARESH P 02/05/2021
225 ALQIANO P 21/11/2020
226 ALZAN P 01/02/2020
227 ALAYA P 17/12/2020
228 BILAL L 11/06/2020
229 REINAND P 14/05/2020
230 AKBAR P 10/05/2020
231 HAMZAH L 07/09/2020
232 AZALEA P 03/01/2020
233 MOH.TIRTA L 26/04/2019
234 SRI.HANA L 09/12/2019
235 HILYA L 11/10/2019
236 RIKI SOPIAN L 02/09/2019
237 LINA MUTIARA L 16/09/2019
238 SYALWA P 08/06/2019
239 PUTRI P 14/05/2019
240 NABIL.ARFA P 21/03/2019
241 ALFATIH L 14/03/2019
242 ARSAKA L 01/12/2018
243 NURMALA P 26/12/2018
244 RAINA P 07/06/2018
245 SYAFIA P 27/04/2018
246 HANIFAH P 15/03/2018
247 ALMIRA P 05/01/2018
248 SHIMPONI P 25/12/2017
249 ABI.UWAIS L 05/11/2017
250 DIFTA L 07/09/2017
251 DIAS.M L 01/02/2021
252 SA"AD L 05/10/2017
253 KHOLID L 01/09/2019
254 FHATAN L 22/05/2020
255
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257

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TOTAL
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 s
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)
Kebutuhan Vaksin Khusus Campak Rubela = (Total Sasaran - Sudah Mendapatkan ORI Campak Rubela sejak Januar
SASARAN IMUNISASI BIAN:
Imunisasi Kejar : Lahir pada bulan Sept 2017 - bulan Agust 2021
Imunisasi CR : Lahir pada bulan Sept 2017 - bulan Oktober 2021

Kolom Tambahan:
*) Jumlah Dosis Vaksin yang pernah didapat
JENIS KELAMIN
L
P
RAN IMUNISASI KEJAR ADALAH 12-59 BULAN
(Disesuaikan dengan tgl pelaksanaan di masing-masing Posyandu)
: Setia (Contoh)
: 1. Posyandu Mawar

Apakah anak *) Jumlah Dosis Vaksin yang

mendapatkan ORI pernah didapat
Nama Orang Tua (IBU) Alamat Campak Rubela sejak
Januari 2022
(Ya =1, Tidak=0)
OPV IPV DPT-HB-Hib

WAHYUDIN RT 01/01 0 4 1 3
YANYAN RT 01/01 0 4 1 3
ALDI RT 01/01 0 4 1 3
JAYA RT 01/01 0 4 1 3
AGUS RT 02/01 0 4 1 3
HADIAN RT 02/01 0 4 1 3
DENI RT 02/01 0 4 1 3
UJANG RT 01/01 0 4 1 3
WAWAN RT 02/01 0 4 1 4
ADIT RT 02/01 0 4 1 4
AGUS J RT 02/01 0 4 1 4
RIKI RT 02/01 0 4 1 4
ENDANG RT 01/01 0 4 1 4
PAHMI RT 01/01 0 4 1 4
DANI RT 01/01 0 4 1 4
DEDI RT 02/01 0 4 1 3
WARSO RT 01/01 0 4 1 4
MELVIANA RT 02/01 0 4 1 4
UJANG RT 01/01 0 4 1 4
BAYU RT 01/01 0 4 1 4
ALI RT 01/01 0 4 1 4
ARIS RT 02/01 0 4 1 4
ANDRI RT 02/01 0 4 1 4
ERNA RT 01/01 0 4 1 4
USEP RT 01/01 0 4 1 4
JUJU RT 02/01 0 4 1 4
PANJI RT 02/01 0 4 1 4
IWAN RT 02/01 0 4 1 4
AGUNG RT 02/01 0 4 1 4
ANGGA RT 02/01 0 4 1 4
ANGGA RT 02/01 0 4 1 4
SANI RT 02/01 0 4 1 4
CEPI RT 01/01 0 4 1 4
ADE R RT 01/01 0 4 1 4
ASEP D RT 02/01 0 4 1 4
ASEP RT 02/01 0 4 1 4
HENDAR RT 02/01 0 4 1 4
HENDRI RT 01/01 0 4 1 4
GUSKAR RT 01/01 0 4 1 4
SUKARNA RT 02/01 0 4 1 4
RIANTO RT 01/01 0 4 0 4
SUPARMAN RT 02/01 0 4 0 4
HILMAN RT 02/01 0 4 0 4
JAENAL RT 02/01 0 4 0 4
KOSASIH RT 01/01 0 4 0 4
UTEP RT 02/01 0 4 0 4
OMAN RT 02/01 0 4 0 4
DENI RT 02/01 0 4 0 4
SUZANA RT 02/02 0 4 1 3
INDRA RT 01/02 0 4 1 3
ASEP RT 01/02 0 4 1 3
DERI RT 04/02 0 4 1 3
ARGI RT 04/02 0 4 1 3
DEDEN RT 04/02 0 4 1 3
ATANG RT 05/02 0 4 1 3
IDAN RT 04/02 0 4 1 3
SOPIAN RT 03/02 0 4 1 3
AGUS RT 03/02 0 4 1 3
DASEP RT 02/02 0 4 1 4
EEP RT 05/02 0 4 1 4
DEDEN RT 03/02 0 4 1 4
ASEP S RT 02/02 0 4 1 4
DEDEN RT 02/02 0 4 1 4
UJANG S RT 05/02 0 4 0 4
RIZAL RT 02/02 0 4 1 4
IWAN RT 04/02 0 4 1 4
HENDI RT 01/02 0 4 1 4
DEGUS RT 01/02 0 4 1 4
DEDI RT 02/02 0 4 1 4
ERUK RT 04/02 0 4 1 4
IYAN RT 03/02 0 4 1 4
YUSUF RT 03/02 0 4 1 4
YAYAN RT 04/02 0 4 1 4
AGUS S RT 02/02 0 4 1 4
TUBAGUS RT 03/02 0 4 1 3
RAHMAT RT 02/02 0 4 1 4
TARDI RT 05/02 0 0 0 0
ASEP RT 04/02 0 4 1 4
A SUPRIADI RT 03/02 0 4 1 4
AMIN RT 05/02 0 4 1 4
U SUMARNA RT 05/02 0 4 1 4
NURCAHYA RT 04/02 0 4 1 4
DASEP RT 02/02 0 4 1 4
SUSANTO RT 02/02 0 4 0 4
HENDI RT 01/02 0 4 0 4
AYI S RT 04/02 0 4 0 4
AGUS RT 03/02 0 4 0 4
UUS RT 02/02 0 4 0 4
UUS RT 02/02 0 4 0 4
MUSLIM RT 03/02 0 4 0 4
TIAN RT 04/02 0 4 0 4
RIDWAN RT 02/05 0 3 1 2
AANG RT 02/05 0 4 1 3
ROHMAN RT 02/05 0 4 1 3
YOPI RT 01/05 0 4 1 3
CECEP RT 01/05 0 4 1 3
NANDANG RT 03/05 0 4 1 3
DIAN RT 01/05 0 4 1 3
UUS RT 02/05 0 4 1 3
USEP RT 03/05 0 4 1 3
RIFKI RT 01/05 0 4 1 3
DIKI RT 01/05 0 4 1 3
RUDIAT RT 02/05 0 4 1 3
GUMILAR RT 02/05 0 4 1 3
MAMAN RT 03/05 0 4 1 3
SALMAN RT 02/05 0 4 1 3
DENI RT 02/05 0 4 1 4
INDRAWAN RT 01/05 0 4 1 4
ENCEP RT 03/05 0 4 1 4
ANDRI RT 02/05 0 4 1 4
HENDI RT 02/05 0 4 1 4
SUTARYAT RT 01/05 0 4 1 4
ARIS RT 02/05 0 4 1 4
ASEP S RT 01/05 0 4 1 4
AAS S RT 01/05 0 4 1 4
ADIT RT 02/05 0 4 1 4
A RIDWAN RT 02/05 0 4 1 4
KIKIN RT 02/05 0 4 1 4
RIDWAN RT 01/05 0 4 1 4
DENI RT 03/05 0 4 1 4
ATEP RT 02/05 0 4 0 4
DASEP RT 02/05 0 4 0 4
CEP IWAN RT 01/05 0 4 0 4
DENI RT 01/05 0 4 0 4
FERI RT 02/05 0 4 0 4
IYUS RT 02/05 0 4 0 4
MAMAN RT 03/05 0 4 0 3
DENI RT 03/05 0 0 0 0
ANDRI RT 02/06 0 3 1 2
WAWAN RT 01/06 0 4 1 3
AGUS RT 01/06 0 4 1 3
BAGUS RT 02/06 0 4 1 3
SOPIAN RT 03/06 0 4 1 3
ISON RT 03/06 0 4 1 4
YAYAT RT 01/06 0 3 1 4
AGUNG RT 03/06 0 1 0 0
DADAN RT 02/06 0 4 1 4
HARI RT 02/06 0 4 1 4
YADI RT 03/06 0 4 1 4
UDIN RT 02/06 0 4 1 4
AGUNG RT 03/06 0 4 1 4
TUBAGUS RT 02/06 0 4 0 4
DODI RT 02/06 0 4 0 4
WISMA RT 03/06 0 4 0 4
UDEN RT 03/06 0 4 0 4
AMIR RT 01/09 0 4 1 3
SUGIH RT 01/09 0 4 1 3
HENRDA RT 01/09 0 4 1 3
ADIANSYAH RT 01/09 0 4 1 4
HERI RT 01/09 0 4 1 3
OBAN RT 01/09 0 4 1 3
AYAT RT 01/09 0 4 0 4
DEDE L RT 02/09 0 4 1 3
ANKA RT 02/09 0 4 1 3
TEDI W RT 02/09 0 4 1 4
NANA RT 02/09 0 0 0 0
TONI RT 02/09 0 4 1 4
ANKA RT 02/09 0 4 1 4
REZI RT 02/09 0 4 1 4
ENAN RT 02/09 0 4 1 4
ASEP RT 02/09 0 4 1 4
Nurdiana Rancasuni 01/07 0 4 1 3
Adiana Rancasuni 04/07 0 4 1 3
Kurniawan Rancasuni 04/07 0 4 1 3
Soleh Rancasuni 02/07 0 4 1 3
Agus Rancasuni 02/07 0 4 1 3
Arditia Rancasuni 03/07 0 4 1 3
Edi Rancasuni 02/07 0 4 1 3
Ridwan Rancasuni 02/07 0 4 1 3
Dasep Rancasuni 03/07 0 4 1 3
Epsa Rancasuni 02/07 0 4 1 4
Asep Rancasuni 02/07 0 4 1 4
Dedi Rancasuni 02/07 0 3 0 2
Agung Rancasuni 03/07 0 4 1 3
Asep Rancasuni 04/07 0 4 1 4
Dimas Rancasuni 03/07 0 4 1 4
Dasep.W Rancasuni 04/07 0 4 1 4
Dasep.W Rancasuni 04/07 0 4 1 4
Windi Rancasuni 04/07 0 4 0 3
Sukmana Rancasuni 04/07 0 4 1 4
Supriatna Rancasuni 04/07 0 4 1 4
Sunandar Rancasuni 04/07 0 4 1 4
Koko Rancasuni 03/07 0 4 1 4
Soleh Rancasuni 02/07 0 4 1 3
Asep Rancasuni 03/07 0 4 1 3
Usman Rancasuni 04/07 0 4 1 4
Kosasih Rancasuni 04/07 0 4 1 4
Dendi Rancasuni 01/07 0 4 1 4
Asep.D Rancasuni 02/07 0 4 1 4
Rizal Rancasuni 03/08 0 4 0 3
Yadi Rancasuni 04/08 0 4 1 3
Odir Rancasuni 02/08 0 4 1 3
Rohmat Rancasuni 0 4 1 4
Rohmat Rancasuni 0 4 1 4
Apep Rancasuni 0 4 1 4
Asep Rancasuni 0 4 1 4
Didin Rancasuni 0 4 1 4
Asep Rancasuni 0 4 0 4
Suparman Rancasuni 0 4 0 4
Yana Rancasuni 0 4 1 4
Wawan Rancasuni 0 4 0 3
Lukman Rancasuni 0 4 1 4
 Hendra Rancasuni 0 4 0 4
BUDI Cipanganten 0 4 1 3
TEDI Cipanganten 0 4 1 3
EKO Cipanganten 0 4 1 3
EPI Cipanganten 0 4 1 3
NANDI Cipanganten 0 4 1 3
RAMDAN Cipanganten 0 4 1 4
HENDRA Cipanganten 0 2 1 3
AGUS Cipanganten 0 4 1 4
EVA Cipanganten 0 4 1 4
AGUS Cipanganten 0 4 1 3
ERI Cipanganten 0 4 1 4
DIRMAN Cipanganten 0 4 1 4
WAWAN Cipanganten 0 4 1 4
ASEP Cipanganten 0 4 1 4
RAHMAT Cipanganten 0 4 1 4
ASEP.D Cipanganten 0 4 1 3
DASEP Cipanganten 0 4 1 4
DASEP Rahayu 01/11 0 4 1 3
TATAN Rahayu 01/11 0 4 1 3
RENDI Rahayu 02/11 0 4 1 4
ADIT Rahayu 02/11 0 4 1 3
NIZAR Rahayu 02/11 0 4 1 4
ACEP Rahayu 02/11 0 4 1 4
ALDY Rahayu 02/11 0 4 1 4
AGUS Rahayu 03/11 0 4 1 4
H.YUYU.S Rahayu 03/11 0 4 1 4
RUSWAN Rahayu 01/11 0 4 1 4
ENTIS Rahayu 01/11 0 4 1 4
A.ERIK Rahayu 01/11 0 4 1 4
DESTA Rahayu 01/11 0 4 1 4
EPUL Rahayu 01/11 0 4 1 4
RIDA Rahayu 03/11 0 4 1 4
ROBANI Rahayu 01/11 0 4 1 4
AGUNG Rahayu 01/11 0 4 1 4
SUMARNA Rahayu 01/11 0 4 1 4
RONI Rahayu 02/11 0 4 1 4
HENDRA Rahayu 02/11 0 4 1 4
RIAN Rahayu 03/11 0 4 1 4
KUSNANDAR Rahayu 02/11 0 4 1 4
IWAN Rahayu 03/11 0 4 1 4
RAHMAT Rahayu 01/11 0 4 1 4
BUDI Rahayu 01/11 0 4 1 4
 RAHMAT Rahayu 01/11 0 4 1 4
ADE.S Rahayu 02/11 0 4 1 4
RIANTO Rahayu 03/11 0 4 0 4
NANDANG Rahayu 03/11 0 4 0 4
AGUS Rahayu 03/11 0 4 0 4
SANI Rahayu 01/11 0 4 1 4
UDEN Rahayu 03/11 0 4 1 4
UDEN Rahayu 03/11 0 4 0 3
ABDUL.W Rahayu 03/11 0 4 0 4

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0
0
0
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0
0
0
0
0
0
0
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0
0
0
0
0
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0
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0
0
0
0
0
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0
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0
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0
0
0
0
0
0
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0
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0
0
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0
0
0
0
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0
0
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0
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0
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0
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0
0
0
0
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0
0
0
0
0
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0
0
0
0
0
0
0
0
0
0
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0
0
0
0
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0
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0
0
0
0
0
0
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0
0
0
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0
0
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0
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0
bahan Campak Rubela sejak Januari 2022

4 dan Campak rubella 2) maka tetap masuk dalam Sasaran Imunisasi Kejar
pak Rubela sejak Januari 2022)/IP vaksin

an Agust 2021
an Oktober 2021
 Apakah anak merupakan Apakah anak sasaran Imunisasi Kejar Apakah Anak
sasaran Imunisasi (Ya = 1, Tidak = 0) merupakan sasaran
Umur (bulan) Tambahan
Campak Rubella (Ya=1,
imunisasi KEJAR
Tidak = 0) (Ya = 1 , Tidak = 0)
OPV IPV DPT-HB-Hib

11 1 0 0 0 0
13 1 0 0 0 0
13 1 0 0 0 0
15 1 0 0 0 0
17 1 0 0 0 0
17 1 0 0 0 0
18 1 0 0 1 1
20 1 0 0 1 1
22 1 0 0 0 0
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30 1 0 0 1 1
33 1 0 0 0 0
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36 1 0 0 0 0
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40 1 0 0 0 0
40 1 0 0 0 0
41 1 0 0 0 0
51 1 0 0 0 0
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48 1 0 0 0 0
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55 1 0 1 0 1
55 1 0 1 0 1
56 1 0 1 0 1
56 1 0 1 0 1
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59 1 0 1 0 1
61 0 0 0 0 0
61 0 0 0 0 0
14 1 0 0 0 0
16 1 0 0 0 0
17 1 0 0 0 0
18 1 0 0 1 1
18 1 0 0 1 1
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22 1 0 0 1 1
24 1 0 0 1 1
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28 1 0 0 0 0
30 1 0 1 0 1
33 1 0 0 0 0
33 1 0 0 0 0
35 1 0 0 0 0
36 1 0 0 0 0
37 1 0 0 0 0
36 1 0 0 0 0
36 1 0 0 0 0
38 1 0 0 0 0
39 1 0 0 0 0
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47 1 0 0 1 1
48 1 0 0 0 0
49 1 1 1 1 1
51 1 0 0 0 0
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53 1 0 0 0 0
54 1 0 0 0 0
54 1 0 0 0 0
48 1 0 0 0 0
59 1 0 1 0 1
60 0 0 0 0 0
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61 0 0 0 0 0
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61 0 0 0 0 0
57 1 0 1 0 1
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18 1 1 0 1 1
10 1 0 0 0 0
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14 1 0 0 0 0
13 1 0 0 0 0
13 1 0 0 0 0
14 1 0 0 0 0
17 1 0 0 0 0
16 1 0 0 0 0
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16 1 0 0 0 0
17 1 0 0 0 0
21 1 0 0 1 1
21 1 0 0 1 1
26 1 0 0 0 0
28 1 0 0 0 0
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29 1 0 0 0 0
31 1 0 0 0 0
31 1 0 0 0 0
33 1 0 0 0 0
36 1 0 0 0 0
36 1 0 0 0 0
36 1 0 0 0 0
37 1 0 0 0 0
39 1 0 0 0 0
40 1 0 0 0 0
39 1 0 0 0 0
43 1 0 1 0 1
43 1 0 1 0 1
44 1 0 1 0 1
46 1 0 1 0 1
48 1 0 1 0 1
49 1 0 1 0 1
48 1 0 1 1 1
39 1 1 1 1 1
11 1 0 0 0 0
15 1 0 0 0 0
17 1 0 0 0 0
19 1 0 0 1 1
20 1 0 0 1 1
23 1 0 0 0 0
26 1 1 0 0 1
33 1 1 1 1 1
31 1 0 0 0 0
33 1 0 0 0 0
39 1 0 0 0 0
31 1 0 0 0 0
43 1 0 0 0 0
56 1 0 1 0 1
55 1 0 1 0 1
57 1 0 1 0 1
60 0 0 0 0 0
25 1 0 0 1 1
25 1 0 0 1 1
21 1 0 0 1 1
40 1 0 0 0 0
41 1 0 0 1 1
31 1 0 0 1 1
60 0 0 0 0 0
14 1 0 0 0 0
18 1 0 0 1 1
27 1 0 0 0 0
27 1 1 1 1 1
53 1 0 0 0 0
43 1 0 0 0 0
39 1 0 0 0 0
52 1 0 0 0 0
42 1 0 0 0 0
12 1 0 0 0 0
13 1 0 0 0 0
13 1 0 0 0 0
19 1 0 0 1 1
21 1 0 0 1 1
21 1 0 0 1 1
21 1 0 0 1 1
22 1 0 0 1 1
22 1 0 0 1 1
24 1 0 0 0 0
28 1 0 0 0 0
28 1 1 1 1 1
30 1 0 0 1 1
30 1 0 0 0 0
34 1 0 0 0 0
35 1 0 0 0 0
35 1 0 0 0 0
33 1 0 1 1 1
40 1 0 0 0 0
40 1 0 0 0 0
42 1 0 0 0 0
42 1 0 0 0 0
50 1 0 0 1 1
50 1 0 0 1 1
53 1 0 0 0 0
55 1 0 0 0 0
56 1 0 0 0 0
60 0 0 0 0 0
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13 1 0 0 0 0
24 1 0 0 1 1
31 1 0 0 0 0
31 1 0 0 0 0
31 1 0 0 0 0
34 1 0 0 0 0
37 1 0 0 0 0
35 1 0 1 0 1
38 1 0 1 0 1
41 1 0 0 0 0
52 1 0 1 1 1
55 1 0 0 0 0
59 1 0 1 0 1
14 1 0 0 0 0
14 1 0 0 0 0
17 1 0 0 0 0
16 1 0 0 0 0
22 1 0 0 1 1
26 1 0 0 0 0
24 1 1 0 1 1
28 1 0 0 0 0
28 1 0 0 0 0
29 1 0 0 1 1
30 1 0 0 0 0
31 1 0 0 0 0
34 1 0 0 0 0
38 1 0 0 0 0
44 1 0 0 0 0
46 1 0 0 1 1
57 1 0 0 0 0
11 1 0 0 0 0
14 1 0 0 0 0
26 1 0 0 0 0
15 1 0 0 0 0
20 1 0 0 0 0
30 1 0 0 0 0
19 1 0 0 0 0
26 1 0 0 0 0
27 1 0 0 0 0
27 1 0 0 0 0
23 1 0 0 0 0
31 1 0 0 0 0
39 1 0 0 0 0
32 1 0 0 0 0
34 1 0 0 0 0
35 1 0 0 0 0
34 1 0 0 0 0
38 1 0 0 0 0
39 1 0 0 0 0
40 1 0 0 0 0
41 1 0 0 0 0
44 1 0 0 0 0
43 1 0 0 0 0
50 1 0 0 0 0
51 1 0 0 0 0
 52 1 0 0 0 0
55 1 0 0 0 0
55 1 0 1 0 1
57 1 0 1 0 1
59 1 0 1 0 1
18 1 0 0 0 0
58 1 0 0 0 0
35 1 0 1 1 1
26 1 0 1 0 1
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1471 0 0 0 0 0
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1471 0 0 0 0 0
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1471 0 0 0 0 0
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1471 0 0 0 0 0
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1471 0 0 0 0 0
1471 0 0 0 0 0
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1471 0 0 0 0 0
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1471 0 0 0 0 0
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1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
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1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
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1471 0 0 0 0 0
1471 0 0 0 0 0
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1471 0 0 0 0 0
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1471 0 0 0 0 0
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1471 0 0 0 0 0
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1471 0 0 0 0 0
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1471 0 0 0 0 0
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1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0

1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
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1471 0 0 0 0 0
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1471 0 0 0 0 0
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1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0

244 8 36 44 72

TOTAL VIAL VAKSIN (Jumlah Vial = Jum

Jumlah dosis yang dibutuhkan untuk Rencana Pemberian Dosis Sasaran
melengkapi status imunisasi Imunisasi Kejar & CR Pada Bulan Agustus

OPV IPV DPT-HB-Hib OPV IPV DPT-HB-Hib CR

0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 1 0 0 1 1
0 0 1 0 0 1 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 1 0 0 1 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 1 0 0 1 0 1
0 1 0 0 1 0 1
0 1 0 0 1 0 1
0 1 0 0 1 0 1
0 1 0 0 1 0 1
0 1 0 0 1 0 1
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 1 0 0 1 1
0 0 1 0 0 1 1
0 0 0 0 0 0 1
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0 0 1 0 0 1 1
0 0 1 0 0 1 1
0 0 1 0 0 1 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 1 0 0 1 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
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0 0 1 0 0 1 1
0 0 0 0 0 0 1
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0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 1 0 0 1 0 1
0 0 0 0 0 0 0
0 1 0 0 1 0 1
0 0 0 0 0 0 0
0 0 0 0 0 0 0
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0 0 0 0 0 0 0
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0 1 0 0 1 0 1
0 1 0 0 1 0 1
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0 0 0 0 0 0 1
0 0 0 0 0 0 1
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0 0 1 0 0 1 1
0 0 1 0 0 1 1
0 0 0 0 0 0 1
1 0 0 1 0 0 1
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0 0 0 0 0 0 1
0 0 0 0 0 0 1
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0 0 0 0 0 0 1
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0 0 0 0 0 0 0
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0 0 0 0 0 0 1
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0 0 0 0 0 0 1
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0 0 0 0 0 0 1
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20 36 58 8 36 44 244

AL VAKSIN (Jumlah Vial = Jumlah Total Sasaran/IP Vaksin) 1 9 11 31

 Diisi pada saat pelayanan imunisasi Kejar & CR bulan Agustus (termasuk Sweeping pada
Sasaran Apakah anak September) 2022
Suntikan sasaran BIAN (JIKA DIIMUNISASI, ISI TANGGAL PELAYANAN)
Bulan Agustus (Agustus)
OPV IPV DPT-HB-Hib

1 1 18 Agustus 2022
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324 244 0 0 1
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gustus (termasuk Sweeping pada Diisi pada saat pelayanan imunisasi Kejar pada September
2022
ELAYANAN) (JIKA DIIMUNISASI, ISI TANGGAL PELAYANAN)

CR OPV IPV DPT-HB-Hib

18 Agustus 2022
1 0 0 0
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