USULAN PESERTA JAMKESDA BULAN JUNI 2022

PUSKESMAS CUGUNG LALANG

PISAT Tgl Lahir Jenis Status

Kelamin Kawin
NAMA YANG DAPAT
NAMA GADIS IBU Kode Nomor Telepon DIHUBUNGI KALAU
No KANDUNG No KK NIK/KITAS/KITAP Nama Lengkap 1 = Peserta Alamat Tempat Tinggal RT RW Pos Nama Kecamatan Nama Desa Nama Kabupaten Nama Faskes Tk.I Peserta/Bides/Pe TMT Aktif KARTU TERBIT ( Boleh
2 = Suami tugas JKN nama Bides/Ptugas
3 = Istri Tempat Lahir dd/mm/yyyy 1=L 2=P 1=B, 2=K, JKN/Nakes lainnya)
4 = Anak 3=C
5 = Tambahan

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21

1 baina 1708022711200001 1708025209600001 Remaida 3 Pagar 12/09/1996 2 3 Meranti Jaya 2 Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
2 Dainan 1708021402220005 1708024107480042 Halipa 3 Pagar Talo 01/07/1947 2 3 Meranti Jaya 2 Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
6 Renima 1708022701090344 1708022509670004 Tamrin 2 Pagar 25/09/1967 1 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
7 Nur Afiah 1708022701090344 1708026505670003 Nurhayati 3 Pelembang 25/05/1967 2 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
8 Nurhayati 1708022701090344 1708024205040001 Natasyah Melinda Putri 4 Meranti Jaya 02/05/2004 2 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
9 Waini 1708021006090021 1708020703790002 Wamin Effendi 2 Pungguk Meranti 07/03/1979 1 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
10 Salbiah 1708021006090021 1708024906790003 Susmarinda 3 Tanjung Alam 09/06/1979 2 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
11 Susmarinda 1708021006090021 1708021804000002 Devry Andre Pratam 4 Tanjung Alam 18/04/2000 1 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
12 Elsi Sridensi 1708021006090021 1708026910000001 Wella Lara Lexia Novianti 4 Curup 29/10/2000 2 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
13 Elsi Sridensi 1708021006090021 1708024805050002 Angela Mela Elminda 4 Curup 08/05/2005 2 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
14 Nurbaya 1708021808170001 1708025006650003 Mardiana 3 Durian Depun 16/12/1966 2 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
15 Mardiana 1708021808170001 1708025706020004 Putri Junita 4 Bumi Sari 17/06/2002 2 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
16 Desniati 1708022303210001 1702180910950002 Andras Pranata 2 Curup 26/12/1996 1 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
17 Azra 1708022501090161 1708026312800003 Erlelawati 4 Bumi Sari 23/12/1980 2 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
18 Hamida 1708020301120005 1708020701540005 Dasla 2 Batu Ampar 07/01/1954 1 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
19 Sari'a 1708020301120005 1708022805900001 Andri Iskandar 4 Bumi Sari 28/05/1990 1 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
20 Sari'a 1708020301120005 1708020408980003 Candra Adiwinata 4 Bumi Sari 16/06/1993 1 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
21 Nafisa 1708020911090009 1708021702670002 Wahidin 2 Pagar 17/02/1967 1 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
22 Hatima 1708020911090009 1708026107710001 Yuhaini 3 Seluma 21/07/1971 2 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
23 Yuhaini 1708020911090009 1708020406970001 Windra Jayadi 4 Pungguk Meranti 14/06/1997 1 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
24 Mahani 1708021004100002 1708024304620001 Anazia 2 Muara Simpur 03/04/1962 1 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
25 Anazia 1708021004100002 1708021108920001 Darmansyah 3 Bumi Sari 11/08/1992 2 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
26 Anazia 1708021004100002 1708025603000003 Hajida Nur Fadila 4 Pungguk Meranti 16/03/2000 2 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
27 Reka Melia 1708022607110001 1708020101080002 Farel Vanfedrik 4 Meranti Jaya 01/01/2008 1 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
28 Kuriati 1708051401090044 1708051212830001 Diosi Putra 2 Pulo Geto 12/12/1983 1 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
29 Emi Parida 1708051401090044 1708056210860001 Santi Anggraini 3 Tanjung Alam 21/10/1985 2 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
30 Santi Anggraini 1708051401090044 1708022410080001 Muhammad Afif Al. Faro 4 Meranti Jaya 24/10/2008 1 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
31 Santi Anggraini 1708051401090044 1708026606190001 Azelea Khaliqa 4 Meranti Jaya 26/09/2019 2 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
32 Nurana 1708022101150004 1708022403850002 Robi Nike Prowosera 2 Bumi Sari 24/03/1985 1 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
33 Wahida 1708022101150004 1708024401860002 Erlensi Respitasari 3 Bumi Sari 04/01/1986 2 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
34 Erlensi Respitasari 1708022101150004 1708024206140001 Khenza Prowosera 4 Rejang Lebong 02/06/2014 1 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
35 Nursidah 1708023112090005 1708024505810006 Nurefri Rataini 3 Padang 10/05/1981 2 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
36 Nurefri Rataini 1708023112090005 1708021401180002 Muhammad Alhussein Ar-ra 4 Kepahiang 14/01/2018 1 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
37 Nurhayati 1708020907100001 1708020709760001 Firmansyah 2 Pasma 07/09/1976 1 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
38 Rosmawati 1708020907100001 1708026606800001 Julita Hartati 3 Bumi sari 26/06/1980 2 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
39 Julita Hartati 1708020907100001 1708025405100001 Fazza Firta Pratama 4 Curup 14/05/2010 1 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
40 Herti Yunaita 1708021912110004 1708020407030001 Deta Restu Abadi Wijaya 4 Meranti Jaya 04/07/2003 2 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
41 Nurbaiti 1708021111090018 1708021711860001 Novi Putra Dewata 2 Pungguk Meranti 17/11/1986 1 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
42 Sunai 1708021111090018 1708027009880001 Desti Eentri 3 Pungguk Meranti 30/09/1988 2 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
43 Desti Entri 1708021111090018 1708026610090001 Namirma Okviona 4 Meranti Jaya 26/10/2009 2 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
44 Desti Entri 1708021111090018 1708025505170001 Sabiya Nasira Putri 4 Rejang Lebong 15/05/2017 2 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
47 Helmi Sugiarty 1708020508100004 1708025904170001 Athira Rahel Rafanda 4 Kepahiang 19/04/2017 2 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
48 Helmi Sugiarty 1708020508100004 1708020107200001 Arshaka Rahel Raziq Rizky 4 Kepahiang 01/07/2022 1 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
49 Kasma Buti 1708021508090007 1708021708770001 Herman Susanto 2 Penago 17/08/1977 1 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
50 Asia 1708021508090007 1708025001790002 Desti Herawati 3 Pungguk Meranti 10/01/1979 2 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
51 Desti Herawati 1708021508090007 1708021007030001 M. Zakki Susanto 4 Pungguk Meranti 10/07/2003 1 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
52 Desti Herawati 1708021508090007 1708021602110001 Ahmad Dirga Al Fakhir 4 Meranti Jaya 16/02/2011 1 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
53 Desti Herawati 1708021508090007 1708021602190003 Muhammad Alfatih 4 Rejang Lebong 16/02/2019 1 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
54 Nuraini 1708023001090530 1708020108820005 Yopi Agus Feriyanto 2 Bumi Sari 01/08/1982 2 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
55 Patima 1708022112090004 1708020707770009 Nurdin Sidik 2 Tempel Rejo 07/07/1977 1 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
56 Sunalia 1708022112090004 1708026207770001 Surmi Yuslita 3 Bumi Sari 22/07/1977 2 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
57 Surmi Yuslita 1708022112090004 1708025508090001 Siti Khairun nisa 4 Meranti Jaya 15/08/2009 2 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
58 Surmi Yuslita 1708022112090004 1708025103130001 Syifa Khumairoh 4 Kepahiang 11/03/2013 2 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
59 Suarni 1708022504150002 1708032905840001 Guspian 2 Tapak Gedung 29/05/1984 1 2
60 Zuryati 1708022504150002 1708025005770003 Sumratul Aini 3 Talang Rimbo 20/05/1977 2 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
61 Sumriatu Aini 1708022504150002 1708021207160001 Ramadhan Dirza Pratama 4 Rejang Lebong 12/07/2015 1 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
62 Ramsia 1708020211160005 1705091208780003 Sahran 2 Kota Agung 12/08/1978 1 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
63 Kasyawati 1708020211160005 1708026808870006 Wiwik Gusni 3 Bumi Sari 28/08/1987 2 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
64 wiwik Gusni 1708020211160005 1708027103170001 Nur Mufidah 4 Rejang Lebong 31/03/2017 2 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
65 Rosni 1708021301090002 1708022505870001 Rizalli 2 Pasmah Air Keruh 25/05/1987 1 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
66 Marlena 1708021301090002 1708025108860001 Elis Madesa 3 Bumi Sari 11/06/1986 2 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
67 Elisma Desa 1708021301090002 1708026712080001 Rely Cintya Bella 4 Meranti Jaya 27/12/2008 2 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
68 Elisma Desa 1708021301090002 1708044905160001 Asyfa Bilqis Malaleka 4 Kepahiang 09/05/2016 2 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
69 Emi Parida 1708021404100013 1708020604040002 Arian Fedro Afrianda 4 Meranti Jaya 06/04/2004 1 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
70 Darleha Hartini 1708020207180002 1708024405890002 Eki Peronika 3 Bumi Sari 04/05/1989 2 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
71 Eki Peronika 1708020207180002 1708020506090002 Alvin Tiyon Saputra 4 Bengkulu 05/06/2009 1 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
72 Eki Peronika 1708020207180002 1708022008180001 Kevin Anuggra Diyon Saputr4 Kepahiang 20/08/2018 1 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
73 Rohmah 1708020406100006 1708020701710004 Muchtar Yusup 2 Bengkulu 07/01/1971 1 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
74 Inas 1708020406100006 1708024107720076 Ermaini 3 Pungguk Meranti 01/07/1972 2 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
75 Ermaini 1708020406100006 1708020501050001 Andri Ade Saputra 4 Pungguk Meranti 05/01/2016 1 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
76 Kuriati 1708051401090044 1708051212830001 Diosi Putra 2 Pulo Geto 12/12/1983 1 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
77 Emi Parida 1708051401090044 1708056210860001 Santi Anggraini 3 Tanjung Alam 21/10/1985 2 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
78 Santi Anggraini 1708051401090044 1708022410080001 Muhammad Afif Al. Faro 4 Meranti Jaya 24/10/2008 1 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
79 Santi Anggraini 1708051401090044 1708026606190001 Azelea Khaliqa 4 Kepahiang 26/06/2019 2 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
80 Riha 1708022409160002 1708021702870006 Aladin 2 Bumi Sari 17/02/1987 2 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
81 Sulastri 1708022409160002 1705036510950001 Meta Oktapanda 3 Serambi Gunung 25/10/1995 2 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
82 Meta Oktapanda 1708022409160002 1708022104170001 Arkhan Althafarizki 4 Kepahiang 21/04/2017 1 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
83 Riha 1708022302100008 1708022410850001 Inasrin 2 Bumi Sari 24/10/1985 1 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
84 Jumaisi 1708022302100008 1708026112890001 Widya Haryani 3 Napal Melintang 21/12/1988 2 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
85 Widya Haryani 1708022302100008 1708025611110002 Windy Novita Sari 4 Kepahiang 16/11/2011 2 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
86 Mal 1708022801090224 1708021406650001 Herma A. 2 Meranti Jaya 14/05/1965 1 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
87 Sinar 1708022801090224 1708024305870001 Rukiya 3 Daspetah 03/05/1987 2 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
88 Rukiyah 1708022801090224 1708022208050001 Muhammad Mirdo 4 Bumi Sari 22/08/2005 1 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
89 Rukiyah 1708022801090224 1708024303100002 Mariza Heryani 4 Meranti Jaya 03/03/2010 2 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
90 Cikani 1708022601090087 1708024206710002 Haria Wania 2 Desa Kandang 02/06/1971 2 3 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
91 Haria Wania 1708022601090087 1708020703880001 Lio Andi Wijaya 4 Pungguk Meranti 31/03/1988 1 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
92 Haria Wania 1708022601090087 1708026401050003 Sinta Lara Anggi Anggraini 4 Meranti Jaya 24/01/2005 2 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
93 Nur Aini 1708051102170001 1708050302930001 Ferdian Gunawan 2 Simpang Kota Bingi 18/02/1994 1 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
94 Zetmi 1708051102170001 1708024501940002 Sesi Dewanti 3 Tanjung Alam 05/01/1994 2 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
95 Sesi Dewanti 1708051102170001 1708050305170001 Azril Daffa Al Fariq 4 Kepahiang 03/05/2017 2 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
96 Sesi Dewanti 1708051102170001 1708052202200001 Azlan Dhafin Al Aiz 4 Kepahiang 22/02/2020 2 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
97 Nur 1708051401090042 1708056707830001 Siti Hermi 3 Lubuk Betung 30-05-1983 2 2 Batu Ampar Merigi Batu Ampar Kepahiang PKM Cugung Lalang 082282417792 Rince CL
98 Siti Hermi 1708051401090042 1708056708020001 Melda Monika 4 Pulo Geto 27-08-2002 1 2 Batu Ampar Merigi Batu Ampar Kepahiang PKM Cugung Lalang 082282417792 Rince CL
99 Siti Hermi 1708051401090042 1708053001140001 Anugrah Haiqal Fadila 4 Kepahiang 30-01-2014 1 1 Batu Ampar Merigi Batu Ampar Kepahiang PKM Cugung Lalang 082282417792 Rince CL
 USULAN PESERTA JAMKESDA BULAN JUNI 2022
PUSKESMAS CUGUNG LALANG

PISAT Tgl Lahir Jenis Status

Kelamin Kawin
NAMA YANG DAPAT
Nomor Telepon DIHUBUNGI KALAU
NAMA GADIS IBU Kode
No KANDUNG No KK NIK/KITAS/KITAP Nama Lengkap 1 = Peserta Alamat Tempat Tinggal RT RW Pos Nama Kecamatan Nama Desa Nama Kabupaten Nama Faskes Tk.I Peserta/Bides/Pe TMT Aktif KARTU TERBIT ( Boleh
2 = Suami tugas JKN nama Bides/Ptugas
3 = Istri Tempat Lahir dd/mm/yyyy 1=L 2=P 1=B,3=C
2=K, JKN/Nakes lainnya)
4 = Anak
5 = Tambahan

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
1 Suryani 1708022309130002 1702091211810002 Hanafiah 2 Bengkulu 12/11/1981 1 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
2 Nurma 1708022309130002 1708024910880003 Deka Puspita Sari 3 Bumi Sari 09/10/1988 2 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
3 Deka Puspita Sari 1708022309130002 1708022602140004 Haikal Hidayah 4 Kepahiang 26/02/2014 1 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
4 Deka Puspita Sari 1708022309130002 1708021104160001 Muhammad Hafidz 4 Kepahiang 11/04/2016 1 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
5 Legiyah 1708021705220002 1771024709820009 Ria Anggraini 3 Tugu Mulyo 07/09/1982 2 3 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
6 Ria Anggraini 1708021705220002 1771022301000005 Randio Sandori Putra 4 Bengkulu 23/01/2000 1 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
7 Ria Anggraini 1708021705220002 1771021302080001 Anugrah Tri Febrian 4 Bengkulu 13/02/2008 1 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
8 Maryatul 1708020207180002 1771021302080001 Parlin Endang Jaya 2 Curup 03/06/1979 2 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
 USULAN PESERTA JAMKESDA BULAN JUNI 2022
PUSKESMAS CUGUNG LALANG

PISAT Tgl Lahir Jenis Status

Kelamin Kawin
NAMA YANG DAPAT
NAMA GADIS IBU Kode Nomor Telepon DIHUBUNGI KALAU
No KANDUNG No KK NIK/KITAS/KITAP Nama Lengkap 1 = Peserta Alamat Tempat Tinggal RT RW Pos Nama Kecamatan Nama Desa Nama Kabupaten Nama Faskes Tk.I Peserta/Bides/Pe TMT Aktif KARTU TERBIT ( Boleh
2 = Suami tugas JKN nama Bides/Ptugas
3 = Istri Tempat Lahir dd/mm/yyyy 1=L 2=P 1=B, 2=K, JKN/Nakes lainnya)
4 = Anak 3=C
5 = Tambahan

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21

1 Sera 1708021902210001 1708021902210001 Wahida 3 Pagar 07/01/1952 2 3 Meranti Jaya 2 Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
2 Nurma 1708022601090103 1708022601090103 Nurma 3 Talo 01/07/1953 2 3 Meranti Jaya 2 Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
6 Suwilah 1708022002200001 17080147069400001 Suyati 3 Bukit Menyan 07/06/1994 2 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
7 Hamana Hatati 1708021004100008 1708022011810002 Effrodin 2 Pungguk Meranti 20/11/1981 1 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
8 Bannia 1708021808170001 1708021204650002 Sapuan 2 Bumi Sari 12/04/1965 1 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
9 Lesita Mayang Sari 1708022303210001 1708026809210001 Zerin Keyla Pranata 4 Kepahiang 28/09/2021 2 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
10 Lesita Mayang Sari 1708022303210001 1708026809210001 Zerin Keyla Pranata 4 Kepahiang 28/09/2021 2 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
11 Nur Halima 1708022501090161 1708024107530125 Azra Amelia 2 Talo 01/07/1953 2 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
12 Dunia 1708020301120005 1708024701500006 Sari'a 3 Taba Macang 07/01/1950 2 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
13 Sari'a 1708020301120005 1708020408980003 Candra Adiwinata 4 Bumi Sari 16/06/1993 1 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
14 Siti Saiba 1708022607110001 1708022603770002 Sangkut Asdianto 2 Bumi Sari 26/03/1977 1 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
15 Hayuna 1708022607110001 1708025012820002 Reka Melia 3 Durian Depun 10/12/1982 2 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
16 Reka 1708022607110001 1708022612020006 Frezi Melandri 4 Bumi Sari 26/12/2002 1 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
17 Reka Melia 1708022607110001 1708026306110001 Mesya Candani Putri 4 Meranti Jaya 23/06/2011 2 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
18 Erlensi Respitasari 1708022101150004 1708020706200002 Khaizu Aqzeel Prowosera 4 Rejang Lebong 07/06/2020 1 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
19 Nurtini 1708023112090005 1708020911780002 Nofriadi 2 Padang 09/11/1978 1 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
20 Nurefri Rataini 1708023112090005 1708022012050001 M. Fajri Ar. Rayyan 4 Jakarta 20/12/2005 1 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
21 Nurefri Rataini 1708023112090005 1708025410080003 Sylvana Letisa Ar. Rayyan 4 Durian Depun 14/10/2008 2 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
22 Nurefri Rataini 1708023112090005 1708021401180002 Muhammad Alhussein Ar-ra 4 Kepahiang 14/01/2018 1 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
23 Julita Hartati 1708020907100001 1708025406160001 Bhilqis Fazee zee 4 Kepahiang 14/06/2016 2 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
24 Julita Hartati 1708020907100001 1708026002210001 Fazila Ataya Azzahra 4 Kepahiang 20/02/2021 2 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
25 Sauya 1708021404100014 1708020306780002 Sakarudin 2 Pungguk Meranti 03/06/1978 1 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
26 Musliana 1708021404100014 1708025603780002 Eli Yana 3 Bumi Sari 16/03/1978 2 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
27 Eli yana 1708021404100014 1708022808050002 Davit Satrio Pangestu 4 Bumi Sari 28/08/2005 1 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
28 Eli yana 1708021404100014 1708020804120001 April Ma'ruf 4 Bumi Sari 08/04/2012 1 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
29 Eli yana 1708021404100014 1708020212150001 Ilham Al Fikri 4 Bumi Sari 02/12/2015 1 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
30 Asmawati 1708021212130001 1708021702800001 Benny Febrianto 2 Curup 17/02/1980 1 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
31 Yusmirda 1708021212130001 1708026601850001 Ema Saputra 3 Curup 26/01/1985 2 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
32 Ema Saputri 1708021212130001 1708021611130001 M. Azril Pebrianto 4 Kepahiang 16/11/2013 1 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
33 Zaleha 1708021912110004 1708021408800007 Debi Wono Wijoyo 2 Bumi Sari 14/08/1980 1 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
34 Mahani 1708021912110004 1708024411820001 Herti Yunaita 3 Bintuhan 04/11/1982 2 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
35 Herti Yunaita 1708021912110004 1708020203110003 Reyhan Alhafiz Wijaya 4 Meranti Jaya 03/03/2011 1 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
36 Helmi Sugiarty 1708020508100004 1708020807000001 Alvaro Rahel Abdulkarami 4 Meranti Jaya 08/07/2010 1 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
37 Nuraini 1708023001090530 1708020108820005 Yopi Agus Feriyanto 2 Bumi Sari 01/08/1982 2 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
38 Waini 1708023001090530 1708024404840004 Herawati 3 Bumi Sari 04/04/1984 2 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
39 Herawati 1708023001090530 1708022905050004 Aditio Raphi Perdana 4 Bumi Sari 29/05/2005 1 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
40 Herawati 1708023001090530 1708025009080002 Khaalishah Dwi Saphyra 4 Bumi Sari 10/09/2008 1 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
41 Herawati 1708023001090530 1708022409160001 Muhammad Azka Raphi Mau4 Rejang Lebong 24/09/2016 1 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
42 Surmi Yuslita 1708022112090004 1708022502180001 Abdul Basir koko 4 Rejang Lebong 25/12/2018 1 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
43 dasia 1708023007160004 1671060507820020 Syukur Mualim 2 Semarang-Bumi Ayu05/07/1982 1 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
44 Nurmala 1708023007160004 1708024901800001 Firgusti Dianika 3 Bumi Sari 09/01/1980 2 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
45 Firgusti Dianika 1708023007160004 1708020511160001 Abdul Hafidh 4 Kepahing 05/11/2016 1 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
46 Elva Rina 1708023007160004 1708025404020002 Nur Intan Malinda 5 Bumi Sari 14/04/2002 2 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
47 Zuryati 1708022504150002 1708025005770003 Sumratul Aini 3 Talang Rimbo 20/05/1977 2 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
48 Sumriatu Aini 1708022504150002 1708021207160001 Ramadhan Dirza Pratama 4 Rejang Lebong 12/07/2015 1 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
49 Islamia 1708021007130002 1708050705740002 Heriyanto 2 Pulo Geto 07/05/1974 1 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
50 Bahuna 1708021007130002 1708055907750001 Nurwana 3 Pulo Geto 19/07/1975 2 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
51 Nurwana 1708021007130002 1708050212000003 Irvan Repaldo 4 Pulo Geto 02/12/2000 1 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
52 Nurwana 1708021007130002 1708054906090002 Winda Juni Arti 4 Pulo Geto 09/06/2009 2 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
53 Nina Rosalina 1708021107160004 1708024507200001 Naureen Khalisa 4 Kepahiang 05/07/2020 2 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
54 Nurma 1708022812110007 1702181703880007 Mustaldi 2 Curup 27/06/1988 1 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
55 Limasiah 1708022812110007 1708025407920004 Julia Maya Sari 3 Bumi Sari 14/07/1992 2 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
56 Julia Maya Sari 1708022812110007 1708025602110001 Citra Okta Lestari 4 Meranti Jaya 16/10/2009 2 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
57 Julia Maya Sari 1708022812110007 1708025204180001 Nafiza Aprilia 4 Rejang Lebong 12/04/2018 2 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
58 Darwati 1708022907090002 1708021508760001 Arip Wasito 2 Kepahiang 15/08/1976 1 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
59 Halima 1708022907090002 1708026705800003 Resmawati 3 Bumi Sari 27/05/1980 2 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
60 Resmawati 1708022907090002 1708026510100002 Rissa Oktari Wasito 4 Meranti Jaya 25/10/2010 2 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
61 Resmawati 1708022907090002 1708025306180001 Rissa Oktari Wasito 4 Kepahiang 13/06/2018 2 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
62 Rosmaini 1708020410180003 1702180907870001 Julian Syahrul 2 Curup 09/07/1987 1 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
63 Waini 1708020410180003 1708025408900001 Jumiati 3 Pungguk Meranti 22/06/1989 2 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
54 Jumiati 1708020410180003 1708025203160002 Zia Naira Qadriyah 4 Kepahiang 12/03/2016 2 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
65 wiwik Gusni 1708020211160005 1708025711210001 Cici Nur Adila 4 Rejang Lebong 17/11/2021 2 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
66 Elisma Desa 1708021301090002 1708022212210001 Muhammad Azzam Fahrizal 4 Kepahiang 22/12/2021 1 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
67 Meta Oktapanda 1708022409160002 1708026306210002 Aurelia Ithnaan Althafarizki 4 Kepahiang 23/06/2021 2 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
68 Widya Haryani 1708022302100008 1708020210210001 Muhammad Rizky Aditya P 4 Kepahiang 01/10/2021 1 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
69 Titi Herlina 1708022302220002 1708021305930002 Meggi Satria Katamsi 3 Bumi Sari 13/05/1995 1 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
70 Rukiyah 1708022801090224 1708021706210001 Dafa Al Algibran 4 Kepahiang 17/05/2021 1 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
71 V. Dhartini 1708020801180001 1703072702830001 Tri Sutrisno 2 Argamakmur 27/02//1983 1 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
72 Titi Herlina 1708020801180001 1708025012900005 Kartika Ayu Lestari 3 Bumi Sari 10/12/1990 2 2 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
73 Kartika Ayu Lestari 1708020801180001 1708026607130002 Aqilla Fiorenza Sutrisno 4 Kepahiang 26/07/2013 2 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
74 Kartika Ayu Lestari 1708020801180001 1708024107190001 Adzikya Almeera Sutrisno 4 Rejang Lebong 01/07/2019 2 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
75 Sesi Dewanti 1708051102170001 1708050305170001 Azril Daffa Al Fariq 4 Kepahiang 03/05/2017 2 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
76 Sesi Dewanti 1708051102170001 1708052202200001 Azlan Dhafin Al Aiz 4 Kepahiang 22/02/2020 2 1 Meranti Jaya Ujanmas Meranti Jaya Kepahiang PKM Cugung Lalang 082282417792 Rince CL
FORM MIGRASI PESERTA
JENIS PESERTA
NAMA INSTANSI/BADAN/PERUSAHAAN PEMERINTAH KABUPATEN XXXX
KODE VIRTUAL ACCOUNT 8988800011212120
BANK TEMPAT PEMBAYARAN IURAN Mandiri
TANGGAl REGISTRASI
NOMOR PKS
KODE PKS 01149999
MASA BERLAKU
KODE TANGGUNGAN
KODE KC 0901
KODE DATI2 0114

Jenis Status
PISAT Tgl Lahir
Kelamin Kawin

Kode
No NAMA GADIS IBU KANDUNG No KK NIK/KITAS/KITAP Nama Lengkap 1 = Peserta Alamat Tempat Tinggal RT RW Pos Nama Kecamatan Nama Desa
2 = Suami 1=B,
3 = Istri Tempat Lahir dd/mm/yyyy 1=L 2=P 2=K,
4 = Anak 3=C
5 = Tambahan
1 2 3 4 5 6 7 8 9 10 11 12 13 15 17
1
2
3
4
5
6
7
8
 Nomor Telepon
Nama Kabupaten Nama Faskes Tk.I Peserta TMT Aktif

19 22 28