Data Sasaran BIAN Posyandu BANGAU 13-6-22

FORMAT PENCATATAN HASIL PELAYANAN
Posyandu/Pos Layanan BIAN lainnya : SDN 10 bantai Nama Petugas : TERESIA, PETRUS R, LIANA RINA
Desa/Kelurahan : BANTAI Puskesmas : Bonti
Tanggal : 23 MEI 2022 Kabupaten : Sanggau
Ket** (bila anak mendapatkan dosis

Jenis Imunisasi Kejar (Ya = 1, Tidak = 0) kedua/ketiga/keempat OPV/Penta
No Nama Anak Tgl Lahir Umur Kelamin Nama Orang Tua/IBU Alamat No.Hp NIK Campak Rubela saat BIAN, maka tetap dicatat
(L/P) (Ya=1, Tidak=0) namun tidak dimasukkan sebagai
OPV IPV DPT-HB- cakupan BIAN)
Hib
a b c d e f g h i j k l m n
1 ADE MIHEL SAPUTRA 2012-04-25 L MIRA Bantai 6103052504120001 1
2 ADELIA ASWARANI 2011-03-30 P MARLIAN Dusun Serupih 6103057003110001 1
3 ADIT ARAHMAN 2011-04-19 L NURBETI Serupih 6103051904110001 0
4 AGUENS FEMI JAMAIKEL TUSA 2011-08-13 L SARENA Bantai 6103051308110001 1
5 AGUSTINUS 2011-08-20 L MARIANA AMOI Sum Tembawang 6101011608110002 0
6 AGUSTINUS LIYAN 2012-07-30 L MARTINA SUYAH SUM RAYA 6103053007120001 0
7 AGUSTINUS RYGEO 2011-08-04 L EMILIA JANUWATI Sum 6103050408110001 0
8 AHMAD REHANDI 2011-08-15 L YUPINA APRA Sum Raya 6103051508110002 1
9 AHMAT ARDANI 2010-09-01 L HAMSIYAH Serupih 6103050109100002 1
10 Ahmat Sasli 2011-07-31 L Lona Serupih 6103053107110001 1
11 ALEX 2012-05-25 L SUMIN Bantai 6103052505120003 0
12 ALIF SAFIQRI 2010-07-26 L DY NILA WATI Serupih 6103052607100002 1
13 ALIYA HENNY 2012-01-10 P LISA Bantai 6103055001120001 1
14 ALVIRA GUSTIA 2011-08-01 P MAGDALENA SAKIN Bantai 6103054108110002 1
15 AMELIA APRA 2011-05-31 P BIBIANA SUM 6103057105110001 0
16 AMELIA ELIN 2013-06-11 P ADE IRMA SURYANI BANTAI 6103055106130001 1
17 Angela Fortunata 2014-03-30 P Emiliana Jolita Sum 0
18 Anisa Febriana 2015-02-02 P Nurliawati Serupih 6103054202150001 1
19 Aniva Taisa 2012-01-15 P Katarina Labore Anyo Sum 6103055501120001 1
20 Antonius Steefend 2012-02-13 L Maria Melda Sum 6103051302120001 0
21 apriana manda 2012-04-22 P maria ana Bantai 6103056204120001 1
22 APRIL GLORIA 2012-04-16 P DEBORA YESI Bantai 6103055804120001 1
23 April Rio 2015-04-08 P Martina Yanti Sum Raya 6103050804150002 1
24 APRILIANA RIRIN 2011-04-29 P LUSIA GOJIN Bantai 6103056904110002 1
25 Apriliando Marvel 2015-04-11 L Lusia Iras Sum 6103051104150003 0
26 Aramando Arsani 2011-10-31 L Veronika Nerdina Sum 6103053110120002 0
27 ARDI CANI 2011-07-09 L SELIANA Serupih 6103050807110002 1
28 ARDIAN 2010-07-20 L CAHAYA ONGAL Serupih 6103052007100002 1
29 ARIYA SAFUTRA 2011-05-12 L YUNA INDRIANI SerupIh 6103051205110002 1
30 Arumi Dianti 2012-09-09 P Kristina Neli Sum 6103054909120004 0
31 ARYA PRATAMA 2010-08-25 L SITI KUMALA Bantai 6103052508100001 1
32 ATIAN JELSI 2013-03-09 P JULIANA Sum 6103054309130003 0
33 AULIA NIKEN 2011-08-06 P ISODORA NORA Bantai 6103054608110001 1
34 Avri 2013-04-05 L Selvia Seria Bantai 6103050504130001 1
35 Ayu Herlina 2011-12-18 P Sopiyani Serupih 6103055812110002 1
36 AYU WIDIYA ERNANDA 2011-04-02 P DAYANG YUNIANTI Serupih 6103054204110001 1
37 BENEDIKTA NERI LOSI VELY 2011-03-01 P Asteria Loren Bantai 6103054103110001 1
38 BENEDIKTUS BIKKI 2012-02-15 L MARTA MINAH Serupih 6103051502120001 1
39 benediktus willyam saputra 2012-07-11 L isabela Sum Raya 6103051107120001 1
40 Boni Faiza Amanda 2012-08-28 L Lesesia Andoi Sum 6103056808120001 0
41 carrol sabda stfa 2012-11-03 P detty meilani Bantai 6103054311120001 1
42 Chlorian Marselino Angrylda 2014-09-14 L Katarina Anita Bantai 6103051409140001 0
43 Coldion Tender 2012-12-10 L Herni Sum 6103051012140002 0
44 Cristian Pabayo 2014-09-07 L Gaudensia Wawanti Sum Raya 6103050709140001 0
45 DAMIANUS GALINGGING 2011-06-18 L YOHANA POIN Bantai 6103051806110004 1
46 DANIEL SAPUTRA 2010-06-14 L MARSIANA RIKA BANTAI 6103201406100002 0
47 Delis Egito 2013-03-31 L Bertha Anti Sum 6103053103130001 0
48 DELSIANA VIRGINIA MARLIANTY 2011-12-05 P ULIYANTI Bantai 6103054512110002 1
49 desta rosnihayati 2011-12-30 P rosni Bantai 6103057012110001 1
50 Destalia Nessti 2013-12-23 P Natalia SUm Raya 6103056312130002 1
51 Destiyanto Yegi 2013-12-23 L Natalia Sum Raya 6103052312130001 1
52 Deyca Septi Hanny 2014-09-09 P AdrianaMonalisa Sum Raya 6103054909140001 1
53 DINDA 2011-06-28 P Nela Sum Raya 6103056806110001 1
54 Donita 2014-05-05 P Doyang Serupih 0
55 Drasius Arnel 2011-12-19 L Natalia Yasinta Sum Raya 6103051912110001 1
56 Elgia Corina Radistha 2012-03-18 P Delima Ita Sum Raya 6103055803120002 1
57 ELIA SEMA 2012-05-09 P MARIA DELIMA Bantai 6103054905120001 1
58 elkana putri pemias 2012-01-27 P amiyani irau Bantai 6103056701120001 0
59 ELLIS NURFAIZUN 2010-06-22 P NURSIAH SERUPIH 6103056206100002 0
60 ENJEL AGNESTA 2012-08-06 P SURYANI BANTAI 6103054608120001 1
61 Eva Tamara 2012-09-04 P Sita Sum RAya 6103054409120002 0
62 FIKTORIUS RAHEL 2010-09-11 L YOHANA LUSIA SUM 6103051109100001 0
63 Flaviber Haikel 2012-10-05 L Natalia Jeriana Sum Raya 6103050510120001 0
64 FLORA LIA ANTONY 2011-08-15 P Yustina Bogin Bantai 6103055508110001 1
65 FRANSISKA DESNA SUMARLINA 2010-12-28 P Marsia Soni Empiyang 6103046812100001 1
66 FRANSISKUS DAPUL 2012-01-04 L TERES BANTAI 6103050401120002 0
67 FRANSISKUS RIDO 2010-07-03 L ANASTASIA IIS SUM 6103050307100001 0
68 Fulgensius Janeri 2014-01-01 L Zita Sulpa Sum 6103050101140001 0
69 Gabriello Solomasi Waruwu 2013-08-28 L Yasiria Telaumbanua Bantai 6103052808130001 1
70 Geisa Ulandai 2014-12-22 P Yohana Da'a Sum 6103056212140001 0
71 HENDRA 2011-05-11 L JUNI YANTI Bantai 6103101105110002 1
72 Herdianus Mardi 2014-01-11 L Lusia Gojin Bantai 6103051101140002 1
73 Herkulanus Apkri 2014-01-04 L Maria Cucen Sum 6103050401140002 0
74 Herkulanus Raka 2014-08-20 L Margareta Lipi Sum Raya 6103052008140001 0
75 HERLI ANDITUS NADI 2012-10-28 L MAGDALENA AWON SUM 6103052610120004 0
76 Herman Petrus Yuki 2012-06-11 L Desi Teri Fena Serupih 6103051106120001 1
77 HERMAWAN DAVID 2013-03-03 L LUSIA IRAS SUM 6103050303130001 0
78 Heskiel Bagaskara 2014-09-13 L Delima Ita Sum Raya 6103051309140002 1
79 Imamat 2013-08-05 L Rosa Bantai 6103050508130001 1
80 IMANUEL RAPLI 2011-03-26 L Klara Agata Sum Raya 6103052603110001 0
81 Inka Ezora 2013-06-27 P Lida Kristina Sum Raya 6103056706130001 1
82 Irman Pasia 2012-04-07 L Rupina Marisa Sum Raya 6103050704120001 0
83 JALINUS L.D 2011-01-19 L Dalena Bantai 6103051901110001 1
84 jeparhan gabriel 2012-01-06 L dorothea ayu Bantai 6103050601120002 0
85 Jipa Supardi 2011-09-19 L Marta Sum Raya 6103051909110001 0
86 Joshua Kristian Can 2012-02-20 L Ina Bantai 6103052002120002 1
87 Julian Roben 2015-07-03 L Anisa Sliana Bantai 6103050307150001 1
88 JUNIARDI SIHOMBING 2012-06-26 L MARIA NIRMALA SUM RAYA 6103052606120002 1
89 Kaila Faizatin 2015-02-27 P Dayang Masriani Serupih 6103056702150001 0
90 Karina Aurel 2014-11-10 P Yustina Novi Serupih 6103056011140001 1
91 Kayla Rahma Ryanda 2015-02-27 P Elvida Susanti Serupih 6103056702150002 1
92 Kresensius Apriliando 2012-04-10 L Christina Tanewa Sum 6103051004120002 0
93 KRISTIAN FERNANDO YUDA 2010-11-05 L KATARINA ANITA Bantai 6103050511100001 0
94 KRISTINA PILA SAPUTRI 2011-09-18 P KRISTINA PAMIA Bantai 6103055809110001 1
95 KRISTUS SAULTI 2013-01-19 L YOHANA JUNI SUM 6103051901130002 0
96 Laura Pebidiandra 2012-02-04 P Basilia Ida Serupih 6103104402120002 1
97 Linser Anita 2012-10-16 P Yopita Seri Sum 6103055610120001 1
98 ludovika marchhena 2012-03-15 P merima Bantai 6103056503120001 1
99 M.REPAN 2010-05-31 L ROSITA Bantai 6103053105100003 0
100 Magdalena Ramona 2012-02-13 P Martina Anim Sum Raya 6103055302120001 1
101 Magdalena Waisa 2012-09-13 P Margareta Lipi Sum Raya 6103055309120003 0
102 Makaria Kalista 2014-04-06 P Maria Herma Sum 6103054601140001 1
103 MALIANA MANTIR 2011-07-27 P MAGDALINA LINO SUM 6103056707110003 0
104 Marco 2014-11-05 L Fransilia Sinti SUm Raya 6103050511140001 1
105 Marelina Suliana 2012-06-22 P Pelagia Rino Ajes Sum 6103056206120001 0
106 Margareta Aini 2012-02-25 P Theresia Rafea Sum 6103056502120001 1
107 MARGARETA SEMBELIA 2013-04-29 P VERONIKA SUSANTI SUM 6103056904130001 0
108 MARGARETA WILDA 2010-07-20 P M. AWIN SUM 6103056007100001 0
109 maria renata 2012-05-06 P domiana mika Bantai 6103054605120002 1
110 Markus Vino 2014-10-04 L Seria Elya Wati Sum Raya 6103050410140001 0
111 Marsa Marsela 2015-03-21 P Agustina Utin Bantai 6103056103150001 1
112 MARSELA 2012-03-05 P LUSIA AYANG SE Bantai 6103054503120001 1
113 Marsela Elsa 2013-10-30 P Silvina Elpi Sum 6103057010130002 1
114 Marsela Gerti 2014-03-08 P Yuliana Lona Sum 6103054803140001 1
115 Marselia Ucak 2013-07-19 P Agata Ase Sum Raya 6103055907130002 0
116 Marselina 2013-07-20 P Sinjung Sum Raya 6103056007130003 0
117 Marselus Miki 2012-02-20 L Emiliana Jolita Sum 6103052002120004 0
118 Marsia Claudia 2012-03-10 P Margareta Ira Dsn. Muara Beduai 6103065003120002 0
119 Martina Semi 2014-10-28 P Muni Sum 6103056810140001 0
120 Martinus 2015-03-20 L Mariana Amoi Sum 6101012003150001 0
121 maternus elsar rahandy 2011-09-14 L rosalia elan Sumum Raya 6103051409110001 1
122 MATEUS RANGGA 2011-03-29 L Cristina Dodo Sum Raya 6103052903110001 1
123 MAULINA DWI MEILIANI 2012-05-20 P IDIA ELI SUM RAYA 6103056005130001 1
124 Maychel Imanuel Pemi AS 2012-01-27 L Amiyani Irau Bantai 6103052701120001 0
125 Meidiyanto Endri 2014-05-30 L Dalena Erna Sum 6103053005140001 0
126 Meliana Herlin 2013-05-14 P Herni Sum 6103055405160001 0
127 MELINA MASETA AKBAR 2011-07-04 P A. Nuraini Usman Bantai 6103054407110002 0
128 Milagres Meicha 2015-05-18 P Eka Bantai 6103055805150001 1
129 MITALIA 2011-04-18 P Dionisia Nion Bantai 6103055804110002 1
130 Muhamad Marvel 2014-05-03 L Rusni Bantai 6103050305140001 1
131 MUHAMMAD FUTUHAL ARIFIN 2012-07-15 L MARIA LORIN Serupih 6103131507120001 0
132 MUHAMMAD RISKY ARDIANSYAH 2011-04-08 L Rupina Romi Sum 6103080804110002 0
133 Nada Rani 2012-07-05 P Suryani Serupih 6103054507120001 1
134 NADIEN KIRANA DESTARI 2012-03-15 P DY.INDRA SARI Badol 6103055503120002 1
135 NAOMI SELVINA BRS 2011-06-21 P Dona Suhil Bantai 6103056106110001 0
136 Natasya Tea 2011-12-28 P Sita Uteh Sum 6103056812110001 1
137 Naya Reva Lina 2012-05-18 P Paulina Sribuana Sum 6103055805120003 1
138 NIKITA LARAS 2011-02-10 P Margareta Mida Yanti Bantai 6103055002110001 1
139 NIKOLAUS CLAYMOND 2010-07-28 L MARIA MELDA Sum 6103052807100001 0
140 Nita 2011-11-15 P Marta Johani Bantai 6103055511110001 1
141 NOPERA HELENA 2010-11-13 P Lukasma Lukak Sum Raya 6103055311100001 1
142 Nowela 2014-08-02 P Santi Serupih 6103054208140002 1
143 OKTAKIAN ORDIO 2010-10-01 L ROSALIA NINA BANTAI 6103050110100001 1
144 Oktavia Winnola 2014-10-27 P Pojin Sum Raya 6103056710140002 0
145 Oliver Gianteza 2012-05-12 L Katarina Tiara Sum Raya 6103051205120001 0
146 OLIVIA CHELSHE 2010-10-20 P MARSELINA INUN BANTAI 6103056010100001 0
147 PARMA NESOS 2011-02-28 L P. Parun Sum 6103052802110002 0
148 Paulina Jera 2011-10-30 P Dominika Jamila Bantai 6103057010110001 1
149 PAULUS JUNAIDI 2010-06-11 L YUNIN Serupih 6103051106100001 1
150 PELISIA KETI 2012-07-12 P SUSI SUM 6103055211120002 0
151 Penti 2012-01-02 P Rona Bantai 6103054201120001 1
152 Perana Perti 2014-02-11 P Ena Bantai 6103055102140001 1
153 PERDEANUS GUNTUR 2012-07-13 L DEWI SARTIKA BANTAI 6103051307120001 1
154 Petrus Bili 2014-09-17 L Yunin Serupih 6103051709140001 0
155 Petrus Bintang 2012-02-24 L Marta Yanti Serupih 6103052402120001 1
156 PETRUS JENI PENOLOSA 2011-05-28 L Andrea Ratna Sum 6103052805110001 0
157 Piana Erin 2014-02-04 P Lukas Kedeng Sum 6103054402140002 0
158 PICA ELINA 2013-04-11 P CADO BANTAI 6103055104130001 1
159 Pina 2014-01-24 P Nyit Serupih 6103056401140002 1
160 Pricila Angelica Sibuea 2015-07-07 6 P Wiwik Triani Sum Raya 6103054707150001 1
161 putra sanlisia 2011-05-22 L lusia Bantai 6103052205120001 1
162 Rafael Putra Yeki 2013-11-06 L Yetnawati Bantai 6108090611130001 1
163 RAFI AHMAT 2010-07-31 L NURHAYATI Serupih 6103053107100002 0
164 RAHMAT SUDARSAH 2011-01-01 L Kartina Serupih 6103050101110001 1
165 Rapayel 2014-03-09 L Pana Sum Raya 6103050903140002 0
166 RAPEL SUJITO 2011-04-27 L Maretta Susi Sum Raya 6103052704110001 1
167 REGIANUS HERWIN 2010-08-01 L ELISABETH LILIS Sum 6103050108100002 0
168 Regina 2015-02-08 P Tiara Wasika Serupih 6103054802150001 1
169 Rehan 2012-01-24 L Unyil Bantai 6103052401120002 1
170 Reja Pebriyandi 2014-01-09 L Basilia Rita Sum 6103050901140001 0
171 Renta Angelena Sieso 2012-03-08 P Lusia Lusiyati Sum 6103054803120001 0
172 Reysha Wang Xiaode 2015-07-13 6 L Desi Elisa Pardede Sum 6103201307150001 0
173 REZA ADITIYA 2011-02-11 L Mia Astuti Sum Raya 6103051102110001 1
174 REZA SOMANTO 2012-12-01 L MARIA RINO BANTAI 6103050112120001 1
175 Ria Rianti Ayuningtyas 2013-09-06 P Lusiana Sum Raya 6103054609130001 1
176 RIANUS ARGA 2013-03-22 L ISODORA NORA BANTAI 6103052203130001 1
177 Rifka Delnitha 2013-12-06 P Agata Winati Sum Raya 6103054612130001 0
178 Riki 2013-05-17 L Jelita Bantai 6103041705130001 1
179 rina senia 2012-05-18 P marselina lina ayu Sum Raya 6103055805120001 0
180 Rinus Isel 2012-10-19 L Selpina Santi Serupih 6103051910120002 1
181 Riski 2012-06-30 L Nester Rusadi Lili Bantai 6103133006120002 1
182 RISKI RAMADAN 2010-08-28 L EFI YUNITA Serupih 6103052808100002 1
183 Risma Donita Manurung 2015-03-26 P Klara Bantai 6103056603150002 1
184 Rizky 2013-07-14 L Yiyin Bantai 6103051407130001 0
185 Ronsius Anderiyen 2012-06-29 L Yulia Alta Sum 6103050609130001 0
186 ROSA LINDA 2011-06-15 P Mariati Darwin Sum Raya 6103055509110001 1
187 Rosari Mira 2014-10-18 P Martina Bunga Sum 6103055806140001 0
188 sahata sihombing 2011-01-19 L agnes mino Sum Raya 6103051901120001 1
189 Sakius Jas 2013-06-09 L Sumarti Bantai 6103050906130002 1
190 SARTIKA BENING 2010-06-13 P Ina Sum 6103055306100002 0
191 Selvina Nurul 2015-06-19 P Martina Donin Sum 6103055906150001 0
192 SENSIUS RANGGA 2010-09-19 L LUSIA DORA SERUPIH 6103051909100001 0
193 SEPANUS CRISTO 2010-09-18 P DONATA IDO Sum 6103051809100001 0
194 Septian Rama Dani 2012-08-06 L Suryani Bantai 6103054608120003 0
195 SISILIA YIYIM 2011-11-27 P MARIA LUSIA Sum Raya 6103056711110002 1
196 Skolastika Corine Yuliasha 2014-01-21 P Maria Shanty Oktavia Sum 6171056101140001 1
197 sofania ekaristiani 2011-12-06 P darianis ira Sum Raya 6103054612110002 0
198 Sofiana Lolita 2014-09-11 P Maria Mariani Sum 6103055109140001 0
199 Sopiya 2014-09-21 P Elisabet Cin Sum 6103056109140001 0
200 Stemitha 2013-09-13 P LiIdawina Herawati Bantai 6103055309130002 1
201 SURTIA ELTI 2011-04-15 P Tikai Bantai 6103055504110002 1
202 SYAFIRA BETTY AGUSTINA 2010-08-07 P LENA WATI Serupih 6103054708100003 1
203 SYAHRINA NUR FITRI 2014-07-17 P WISMIWATI SERUPIH 6103055707140002 1
204 SYAHRUL HERLI RAMADHAN 2010-08-15 L NURLIAWATI Serupih 6103051508100001 0
205 Tania Khanza Azahra 2015-01-23 P Fitriani Serupih 6103056301150001 1
206 Theo Felixs Raffael 2015-04-11 L Rosti Elisa Bantai 6103051104150001 1
207 Tiara Ahtifa Syahiba 2013-12-23 P Efi Yunita Serupih 6103056312130004 0
208 TRIRADIK PUTRA 2011-11-09 L JUMLI Bantai 6103050911110001 1
209 Valentina Prilli 2014-11-23 P Mariana Eci Serupih 6103056311140001 1
210 Valentina Wika Quenly 2015-07-29 6 P Lusia Cenfi Sum 6103056907150001 0
211 VERONIKA KENY 2013-02-28 P KORNELIA IRMA SUM 6103056802130002 0
212 Visensius Riefen Sean 2011-11-22 L Rini Ajui Sum 6103052211110001 0
213 WELI MANDRIA REPA 2012-11-22 P PANA SUM RAYA 6103056211120001 0
214 Winny Apriliany Lewinsky Manalu 2014-04-01 P TIAMBUN BR. SIMALANGO Sum Raya 6103054104140001 0
215 Yehezkiel 2014-02-07 L Marta Nita Serupih 1
216 yepiana 2011-11-12 P siti Bantai 6103055211110002 0
217 Yosefa Chellsy Laura 2014-01-22 P Maria Meji Bantai 6103086201140001 1
218 YULIANA MELISA 2010-07-06 P ALBINA TUTU Sum 6103054607100002 0
219 Yuliana Viska 2015-06-13 6 P Sabinus Sataria Sum 6103055306150001 1
220 Yulius Jimi 2013-07-30 L Yustina Novi Serupih 6103053007130001 1
221 Yulius Tian 2014-06-03 L Paulina Nonsindi Sum 6103050306140001 0
222 YUSITA ASNI 2012-12-27 P TIKAI BANTAI 6103056712120001 1
223 ZEKIEL JORDAN 2012-06-15 L RIBKA SITI NORHAYATI Bantai 6103051506120001 0
124
Jumlah vaksin (vial) dan logistik yang digunakan
Jumlah logistik OPV IPV DPT-HB- CAMPAK RUBELA Pelarut Campak Dropper ADS 0,5 ML ADS 5 ML Safety Pen
HIB Rubela Mark
Jumlah
Posyandu/ pos anyaman BIAN Lainnya : SDN 8 Lanong Nama Petugas : Pranky Paskah
Desa/ Kelurahan : Desa Upe Puskesmas : BONTI
Tanggal : 25 Mei 2022 Kabupaten : Sanggau
Imunisasi Kejar ( Ya=1, Tidak
=0) Ket**( Bila Anak
Mendapatkan dosis
kedua/ketiga / keempat
Jenis Campak Rubela
No Nama Anak Tgl Lahir Umur Nama Orang Tua Alamat No.HP NIK OPV/penta saat
Kelamin Ya=1,Tdak =0 DPT+H
OPV IPV BIAN,maka tetap dicatat
B-Hib namun tidak dimasukan
sebagai cakupan BIAN )
1 ANDREAS BON SAGA 2012-05-16 L Maria Ani Lanong 6103051605120001 1 kls 1

2 ANGELO 2011-05-10 L Angela Lanong 6103051005110001 1
3 APRILIO MARSEL 2014-04-02 L Elisabet Dusun Kelompu 6103050204140002 1
4 AURILIA CAROLINE 2012-08-10 P Mita Lediwati Lanong 6103055008120001 1
5 CHERI DAHLIA 2015-07-20 6 P Titik Nawati Dusun Lanong 6103056007150001 0
6 DIMAS REVANDI 2012-09-04 L Lusiana Lanong 6103050409120001 1
7 FANA FRINIKA 2013-06-17 P IKA PRIMAWATI Dusun Lanong 6103055706130002 1
8 FEBBY STEFANNY 2012-09-30 P Elia Magdalena Lanong 6103057009120001 1
9 HERKULANUS EPENDI 2014-04-11 L Bernadeta Sumiati Dusun Kelompu Mayau 6103051104140001 1
10 KORNELIUS YOSIL 2015-05-25 7 L Imewiyati Dusun Lanong 6103052201200002 1
11 KRISTIANSA SABIL 2012-05-20 L ANENG Sungai Kunang 6103012005120001 1
12 Libertus Aril 2010-08-07 L Eni Mariati Kelompu 6103050708100001 0
13 MAGDALENA JELITA 2013-04-12 P YUPINA MUHIN Dusun Lanong 6101305520413000 1
14 Marfianto Firdaus 2011-05-31 L Lusiana Lanong 082148317884 6103053105110001 1
15 MARIANA 2012-03-25 P Yupina Muhin Lanong 6103056503120001 1
16 MARSELUS OZI 2013-03-12 L YUSTINA Dusun Lanong 6103051203130001 1
17 Michael Pratama 2012-08-21 L Gerda Sidabutar Lanong 6103052108120003 1
18 NADA ILUMINATA 2012-11-13 P Ana Kelompu 6103055311110001 0
19 NATALIA 2013-12-13 P Maria Magdalena LonyDusun Kelompu Mayau 6103055312130001 1 ks 3
20 NATALIUS ERISTO 2010-12-23 L Yasinta Elisonia Dusun Lanong 6103052312100002 1
21 NOVENA NURLELA 2012-11-12 P MARTINA Kelompu Mayau 6103055211120003 0
22 OKTAVIA MARSYANTI 2015-10-14 6 P Lodopika Limberta Dusun Lanong 081253223220 1
23 PATRICIA OLIVIA AFINA 2013-09-01 P DEWI SAVITRI SARAGI Dusun Lanong 6103044109130001 0 kls 3
24 Preditus Perdi 2011-09-26 L Donita Lanong 6103052609110001 1
25 RAPKA YUBI TIRA 2013-01-11 L Lilis Susanti Kelompu 6103051101130001 1
26 RASTYTA 2012-01-31 P Natalia Tata Kelompu 6103057101120001 1
27 SILVANUS SUSENO 2014-02-05 L Yohana Polot Kelompu 6103050502140001 0
28 VALENA CINTA KIRANA 2013-05-14 P Felisia Piya Kelompu Mayau 6103055405130003 0
29 VIOLA AGATHA 2012-08-04 P Endang Estarina Kelompu 6103054408120001 0
30 VIRZCHA IRAWANI 2011-01-23 P Lodopika Limberta Lanong 081253223220 6103056301110001 1
31 VITA NATASYA 2013-06-10 P YULIA LUSIA Dusun Lanong 6103055006130001 1
32 YULIUS KEVIN 2012-10-21 L Sisilia Sonen Kelompu 6103052110120001 1
33 YUZREL JUDIKA 2015-09-17 6 L Santiana Tika Dusun Lanong 6103051709150001 0 kls 4
jumlah 24
Jumlah Vaksin ( Vial ) dan Logistik yang digunakan
Jenis Logistik OPV IPV DPT-HB-HIB CAMPAK LUBELA Pelarut Campak RubeDropper ADS ),5 ML ADS Safety Pen Merak
Jumlah
Catatan
* Tuliskan jika anak tidak bisa diimunisasikan dan rencana jadwal pemberian imunisasi susulan pada kolom keterangan
Posyandu/Pos Layanan BIAN lainnya : SDN 01 Bonti Nama Petugas : meta ,guana, mira, dini
Desa/Kelurahan : Bonti Puskesmas : Bonti
Tanggal : 24 mei 2022 Kabupaten : Sanggau
Imunisasi Kejar (Ya = 1, Tidak Ket** (bila anak mendapatkan dosis

Jenis = 0) kedua/ketiga/keempat OPV/Penta
Hib
AIRIN MOUZA RISTA 2014-08-21 7
P SITI LESTARI 610305610
1 8140001 1
AISYAH MILANI 2015-06-23 6 P INDRIANI 610305630
2 HAMZAH 6150001 1
alexander mekel 2015-01-03 7 L donata junita 610305030
3 frandiko 1150001 1
Allisa Dewi 2014-10-02 7 P Dewi Sinta 610305421
4 0140003 0
Benedictus sergio 2014-07-13 7 L regina wiwit 610309130
5 Dienovan 7140001 1
BINTANG HILDA NUR ASIA 2015-01-20 7 P ONIYATI 610305600
6 1150001 1
BIYANSAH 2014-12-12 7 L ELNI 610305121
7 2140001 1
BONIFASIUS BUBAZA 2014-05-08 7 L MARIA SISKA 610305080
8 5140001 1
DESTI MAHARANI 2012-12-24 9 P PUJIATI 610305641
9 2120001 1
dzaky salman ari 2014-10-03 7 P paleria pranciska 610305431
10 0140001 1
ezra krisnovadi abel 2014-11-04 7 L margareta dina 610305041
11 1140001 0
FADYA NADIFA KANITA 2014-11-21 7 P TIKA NURMALA SARI 610305611
12 1140001 1
feliksius yuniko 2015-06-23 6 L yulianti 610305230
13 6150001 0
IRVAN SYAHPUTRA 2014-08-21 7 L RITA HIDAYATI 610305210
14 8140001 1
Juan Leander 2015-01-30 7 L Rini Puspita Sari 610307300
15 1150001 1
LUTHFI OMAR 2015-01-15 7 L SITI SALMI HIDAYATI 610305150
16 KANASTA'IN 1150001 1
mardisius dino 2015-03-13 7 L paula pula 610305130
17 3150001 1
MARSIANA DEWI 2014-03-30 7
P MARIA MENI 610305700
18 3140001 1
mikael galang bonua 2015-05-25 6
L maria lisa 610305250
19 5150001 1
MUHAMMAD ASRAP 2012-08-06 9 L YUSNI 610305060
20 DENIS 8120001 0
oktavianus rosicky 2014-10-18 7 L julita 6103051810140001
21 0
patmawati 2014-11-05 7 P dahlia wati 610305451
22 1140001 1
SEPTIAN HERIAWAN 2014-09-30 7 L MARIANA EKA 610309300
23 9140002 1
SERGIO CHARLIE 2015-01-18 7 L Petronila 610305180
24 PUTRA 1150001 0
SIMA SITI NUR ALIZA 2014-08-09 7 P DEDEH 610305490
25 8140001 1
Sintya Fani 2015-02-15 7 P maria elia neli 610305550
26 2150001 1
sukri albakri 2014-09-25 7 L margareta yuni 610305250
27 9140001 1
VATIO MEDA 2015-06-24 6 L SABINA AYONG 610305240
28 RAMADANI 6150002 0
ZAHIRUDDIN MAULANA 2013-08-24 8 L INENG 610305240
29 8130001 1
ADE AZRIL DIWAN 2014-05-17 8 L ELISABET SERAPIN 610305170
30 ASKARI 5140002 0
ADVENTOS BARBARA 2013-12-02 8 L MARYA ANA 610305021
31 2130001 1
AGUSTINUS BORNEO 2013-08-25 8
L LUSIANA 6103092508130001
32 DWIMORA 1
ALIEF MAULANA 2013-11-05 8
L EVA SUSANTI 610305051
33 AFANDI 1130001 1
CHRISTIAN RONALDO 2013-06-07 8 L LEO MIKI 610305070
34 TERENSIUS 6130001 1
DANIEL OSCAR 2013-12-29 8 L THERESIA GUANA 610901291
35 SITUMORANG 2130001 1
DIMAS ANDREAS 2013-09-20 8 L EPA WATI 610305200
36 SAPUTRA 9130001 1
FARIS ARFA RISQI 2014-03-22 8 L SITI ROHANI 610305220
37 3140003 0
FEBRIAN ANTONY 2014-02-07 8 L JUNI ARIHTA GIRSANG 610305070
38 BI'DOIH 2140001 1
FRANSISKUS DEFA BELA 2012-10-04 9 L ALEX SANDORA 610305041
39 BUNDA 0120001 1
GENANDA HERMOINE 2013-07-24 8 P ANANIAS DAYANG 610308640
40 GENESIUS 7130001 1
HEKAEL YOPI 2013-10-10 8 L HELENA SISKA 610305101
41 PENGKORAS 0130002 1
JULIUS VIANTO 2013-06-04 8 L NOVEVA EVIMULYAN 610305040
42 ELDIERO TI 6130001 1
KENZOU GHALY 2013-10-17 L FITRIZAME TA MAHRIS 610301171
43 IZDIHAR SIREGAR 8 0130001 1
M. RAFLI PRATAMA 2013-02-13 L JULIANA 610305130
44 9 2130002 1
MEYLANI 2014-05-09 P YULIANI 610305490
45 8 5140001 1
OLGA SYAPUTRA 2014-04-16 L ERLIZA 610306160
46 8 4140001 1
PUTRI ZAUZAH 2014-02-08 P ELIS RITA 320522480
47 SOLEHA 8 2120007 1
RAFI ARDIANSYAH 2014-05-18 L MAYYANA 610305180
48 8 5140002 1
RERE AZZAHRA 2014-01-22 P KARMILA 610305620
49 8 1140002 1
ROBERTUS WARDI 2014-01-30 L TRISNA WATI PUPUT 610305300
50 8 1140003 1
SHIMEON SANTOSA 2013-07-10 L MARTI 610305100
51 8 7130001 1
SURYA ANUGRAH 2014-04-16 L RIZKA OKTAVIA DWI 610305160
52 FATARA 8 AMANDA 4140001 1
TEMI SAPUTRA 2013-03-04 L FITRI MARDIANA 610305040
53 9 3130003 1
VARISKI FRATAMA 2013-07-27 L NINI RATNA SARI 610305270
54 7130002 1
WANDI 2013-06-17 L HUSNAWAT I 610305170
55 6130002 1
ABANG MUHAMMAD AL 2012-12-05 L GALUH IDHAYANI 610305051
56 MUIZ 2120002 1
AFIKA TAUSYAH 2012-09-07 P YANTI 610305470
57 9120001 1
AHMAD RIZKI ALVIGO 2013-01-06 L IRA MAYA SOPA 610305060
58 1130001 0
AHNAF SYAUQI 2012-07-09 L HAMIDAH 610305090
59 7120001 1
AJENG SALWA NUR 2013-05-10 P MUSAWATI 610305500
60 REZKY 5130001 1
ALFINUS KELFIN 2012-11-20 L APRILINDA LINI 610305201
61 1120002 0
ALIF NAFIL 2013-02-28 L YUNIAR 610305280
62 AZZAKWAN 2130001 1
ANGGELA 2012-02-09 P LIHON NURHALIMAH 610320490
63 2120002 1
ANISA 2012-10-30 P EKA LESTARI 610305701
64 0120001 1
DAFIAN 2012-06-19 L SANDARI 610305190
65 6120001 1
ECA JUNIATI 2012-06-03 P ASIAH 610305430
66 6120002 1
ELI ISMAWATI 2011-05-03 P SUSI 610320430
67 5110001 1
FAZRA NADIFA 2012-12-05 P INDRIANI 610305451
68 HAMZAH 2120001 1
FHADILA AGISYA 2012-08-23 P NURSIH 610305630
69 8120001 1
GILANG KURNIAWAN 2012-07-19 L LUSIANA 610305190
70 7120001 1
GUSTI GIRI AL MALIK 2013-04-13 L TITIN SENIWATI 610305130
71 4130001 1
HIZKIA OKTAVIA 2012-10-11 P YULIANA RIYA 610310511
72 GIRSANG 0120001 1
73 IRDZA AL ASHARI 2012-11-02 L MARYANI "6103050211120001 1
ISKAN KURNIAWAN 2013-05-02 L SUANA 610305020
74 5130001 1
JANUARIUS CIKO 2009-01-15 L MARIA CONING 610305150
75 1090001 1
JUITA KURNIA 2012-08-26 P NENGSIH 610305660
76 8120001 1
KESSHIA PASLA 2012-10-14 P NELIS MAWATI 610305541
77 0120001 1
KRISTINA AULIA 2013-04-10 P YULIANA LENA 610305500
78 TERUSIANI 4130002 1
MIRNA WATI 2013-02-24 P HARTATI 610305640
79 2130001 1
MOZAN TRIYADI 2012-08-26 L TITIN MARIANI 610305260
80 8120002 1
MUHAMMAD HABIBIE 2012-05-21 L YANTI 610305210
81 5120002 1
82 MUHAMMAD HAIKAL 2013-05-06 L HERMINA SANDRA 6103050605130002 1
NAYZRIELLIFA SEPTI 2012-09-16 P SUMIATI ANAI 610305560
83 SURYANI 9120001 1
PANDU ARDI 2013-05-13 L ASMAH 610305130
84 5130001 1
PUTRI MAHARANI 2012-01-08 P NURSANTI 610305480
85 1120001 1
RAHMAD 2012-11-28 L ALIYA 610305281
86 1120001 1
RIFKY NUR FALAH 2012-07-11 L SUTINIK 610305110
87 7120002 1
RISNA ULITA CEASAR 2012-07-10 P KRISFINA RUPINA 610305500
88 SITORUS 7120001 1
ROMI 2011-12-13 L ASTUTI 610305131
89 2110002 1
RONAL ASRI 2011-07-06 L HASUNAH 610305460
90 7110001 1
SAFITRI RAMANDANI 2012-07-29 P YUSTINA RANI 610305690
91 7120005 1
SAGITA SILVINA 2012-09-12 P SURYANI 610305520
92 MAYLANY 9120001 1
93 SAKIRA ZAHRA 2013-03-17 P ETIN FARTINI 6103055703130001 1
SALSABILA MARADO 2012-11-16 P DAYANG NINING 610305561
94 ASTUTI 1120001 1
SARIVA NINTRI 2012-11-28 P DEWI SARTIKA MATEA 610305681
95 PILO 1120001 1
SAVIRA 2012-12-25 P YANTI 610305651
96 2120002 1
SAYYIKA FAEYZA 2013-05-13 L EKA 610305130
97 AZHAR 5130003 1
SEVTIANI 2012-09-01 P NUNSIL 610305410
98 9120002 1
SILSIBILA MARADO 2012-11-16 P DAYANG NINING 610305561
99 ASTUTI 1120002 1
SITI PAJRIAH 2013-06-24 P EMAH 360429640
100 6130001 1
SUPAR PRASETYO 2013-03-05 L SUTIYEM 331704050
101 3130003 1
SURIADINATA 2012-04-12 L SRI NINGSIH 610807120
102 4120002 1
VICTORY URY ANRI 2013-06-09 P MARGARET A 610305490
103 6130001 1
VUTRI A'SYAH 2011-04-12 P JULITA 610305520
104 4110001 1
ZALIKA 2012-06-14 L NINI 610305140
105 6120001 1
ZASQIA MEISHA 2013-05-14 P ISTIANA 610305540
106 DARMAWAN 5130001 1
AGUST PRABOWO 2011-08-08 L ASNI 610305080
107 8110001 1
AKHMAD SATRIA 2012-02-29 L YUSNANI 610305290
108 PRATAMA 2120001 1
AMIRA SYAFITRI 2011-08-20 P SUMIATI 610305600
109 8110001 1
ANDIKA PRATAMA 2011-12-25 L EPAWATI 610305251
110 2110001 1
ARYANI FEBRIANA 2012-02-02 P YASINTA 610305420
111 GRISIENDA 2120001 1
AULIYA ARISKHA 2012-01-20 P CUMBIYATI 610305670
112 1120002 1
DEO APRILIO 2012-04-11 L KATARINA 610305110
113 4120001 1
DZAKY FAKHRY 2012-07-03 L Dwi Jayanti 610312030
114 SUKMA 7120002 1
FAJAR KURNIAWAN 2012-05-11 L SUMARNI 610305110
115 5120001 1
GHIFARA AZCAESAR 2012-01-09 L UTIN ILYAS 610305090
116 1120001 1
HALIMATUS SA'DIYAH 2012-02-12 P MARDIANA DEWI 610305520
117 2120001 1
HENDRY AMANDA 2012-05-25 L DAYANG MURYANI 610305250
118 PRATAMA 5120001 1
IFIBRIENISARI 2012-01-21 P RAMAINI 610305610
119 1120001 1
INAS FABIOLA 2012-01-19 P LEHAWATI 610305590
120 1120001 1
JISIENA FINI 2011-07-04 P TEMI 610305440
121 7110001 1
LIBERTUS RIYOS 2011-04-20 L Yuliana Domi 610305240
122 4110001 1
MEY INDRIANI 2012-05-22 P SUYANTI 610305620
123 5120001 1
MUHAMMAD FAZLI AL 2012-01-31 L HAYATUNI ZA 610305310
124 HAFIZ 1120001 1
OKTAVIANUS DENO 2010-10-31 L DONA TELA ELA 610305311
125 PRATAMA 0100001 1
PUTRI NUR AINI 2012-02-14 P MURNI 610305540
126 2120001 1
REFAL ALZIQRA 2011-07-21 L DAYANG ENDANG 610305210
127 ERNAWATI 7110001 1
RISKI 2011-06-12 L YULIA 610305120
128 6110002 1
STEPANUS JERIKO 2010-09-22 L DONATA JUNITA 610305220
129 9100001 1
TABITHA VALEN 2011-12-22 P KHRISTINE DEASY 610310621
CHRISTMAR Br. NATALIA 2110001
130 RUMAHORBO Br. PAKPAHAN 1
TITANIA RAHMAYUDA 2012-03-14 P SABINA AYONG 610305540
131 PUTRI 3120001 1
132 UTIN ASYIFA AZILA 2011-09-17 P TITIN SENIWATI 610305570911001 1
ZAHIRA 2012-01-05 P SENATI SITI 610305450
133 1120001 1
ZIVILIA ANGGRAENI 2011-10-26 P ETRI DIANI 610305661
134 0110001 1
A'AM FAHROZI 2011-05-25 L PURNIA SARI 610305250
135 SHANTHY 5110003 1
ADRIAN NEGO ODA 2010-11-25 L MARIA ROMAWATI 610305251
136 1100001 1
AFDAL LA HAMBALI 2010-11-21 L LILIS SURYANI 610305211
137 1100001 1
APRA HILARIA META 2011-04-20 P MELAN 610305600
138 4110001 1
AYUNING TYAS 2011-07-20 P SETINI 610305600
139 7110001 1
AZAHRA 2011-05-02 P ISNAENI 610305420
140 6110001 1
BASILIA OKTAFIANA FITA 2010-12-19 P MARIA ELIA NELI 610305591
141 2100001 1
DAMAS ARYA 2010-11-19 L ROKHATUN 330316191
142 PRADIPTA 1100001 1
DIEGO VIRGO GLEUS 2011-09-05 L MARIA WIENDA 610309050
143 9110001 1
DINA AURA 2011-08-26 P LISAWATI 610305660
144 8110001 1
DWI MUSTIKA 2011-03-06 P JAMIATI 610305460
145 3110002 1
EKA WAHYUNI 2011-01-29 P ETY SURYATIK 610305690
146 1110001 1
GARCINI PALIKO 2010-12-21 L KRISTINA CITON 610305211
147 2100001 1
GIBBIL OKTIANA 2010-10-12 L AGUS SUMARNI 610305121
148 0100001 1
GRECIA APRIELA 2011-04-16 P THERESIA GUANA 610901560
149 SITUMORANG SISWANTI 4110002 1
HESTI ALDIRA FITRI 2011-08-30 P SANTI HARIYANTI 610308700
150 8110001 1
ILHAM 2010-05-31 L NURMALA 610305310
151 5100002 1
IMANUEL PONTIAN JOSIE 2011-01-08 L LUSIANA 610304080
152 1110001 1
INDRA FAHRIYANDA 2011-06-22 L ASYANTI 610305220
153 6110002 1
KAILA AUREL 2011-01-04 P KATHARINA BIRON 610305440
154 1100001 1
LAU WIDIA KAVIAH 2011-07-14 P LAU DESI SUSANTI 610305540
155 7110001 1
LENDRA ARJUNA 2011-05-15 L RITA WANI 610305150
156 6110003 1
MAINA MAHARANI 2011-05-09 P DAYANG NORMIATI 610305490
157 5110001 1
MOHAMMAD RISKY 2010-08-16 L ASRI 610305160
158 RAMADHAN 8100001 1
NELZI LATIFAH 2010-07-14 P NELISMAW ATI 610301540
159 7100003 1
NUR FANYZZA FERIKA 2011-09-11 P ERLIN RISTISKA 610308510
160 9110001 1
NURHAMIDA S 2011-01-02 P NURUL AMINAH 760209420
161 1110002 1
Prisilia Anggraini 2011-09-11 P Lusia Rupia 610305510
162 9110001 1
PRISKILA DELI 2011-04-01 P LIJA 610305410
163 PENTOJIS 4110001 1
RAFA 2011-01-31 L ENDANG 611203310
164 1110001 1
RAFAEL ZERA 2011-04-04 L TEODORA 610309040
165 PRAPASKA 4110001 1
RAHWINA 2011-05-30 P NORLELA 610305700
166 5110001 1
SABILA KHATIMA 2011-04-07 P MURNI MN 610305470
167 4110002 1
SHAFA CITRA 2011-05-21 P NURUL KHAMIDAH 332108610
168 AZZAHRA 5110003 1
SRI DEVI LASTARI 2010-07-14 P LISA 610305540
169 7100001 1
TIRANINAISYAH 2011-07-07 P KARTINI 610305470
170 7110003 1
ULFI NUR RESKY 2011-07-14 P HAMSIAH 617106540
171 7110001 1
VIKTOR MALDINI 2011-07-23 L KRISTINA UCA 610305230
172 7110001 1
ZAIDA 2011-01-04 P HASNAH 610305440
173 1110002 1
ZAKHI ALFAREZY 2010-11-17 L NONG ERNAWATI 610305171
174 1100001 1
ZOVI RIZFIAR GANA 2011-08-15 L FIT RIZAMETA MAHRIS 610301150
175 SIREGAR 8110001 1
AJENG WENING SARI 2010-08-09 P INDAH SUCI REZEKI 610305490
176 8100002 1
AMEL NOVIPEBRIANI 2010-10-29 P ANA 610305691
177 1100001 1
ARIFIN AGUS 2010-08-07 L TRI NUR AINI 610305607
178 SAHPUTRA 0810002 1
AURA RANY 2010-06-20 P DANIATI 610305600
179 6100001 1
AURELL SYAFIRA 2010-09-10 P AGUSTINA YULI 610305500
180 AUSTIN 9100003 1
CRISTOFORUS TEGUH 2010-07-25 L YULIANA LIYE 610305250
181 7100001 1
EARLY AZRA RISTA 2010-07-02 P SITI LESTARI 610305420
182 7100001 1
MEISYA RAMADHANI 2010-08-26 P LENI DIANA 610305660
183 8100001 1
NUR ELLIZA GONITA 2010-10-07 P SITI HAYATI 610305471
184 0100002 1
185 YULIA KISABELA 2010-07-11 P SITI ROHANI 6103055107100001 1
174
DPT-HB- Pelarut Campak Pen
Jumlah logistik OPV IPV HIB CAMPAK RUBELA Rubela Dropper ADS 0,5 ML ADS 5 ML Safety Mark
Jumlah
18 18 175 18 2
Posyandu/Pos ayanan BIAN lainnya : PAUD TUNAS BANGSA Nama petugas : Fitrizameta Mahris
Desa/kelurahan : BONTI Puskesmas : Bonti
Tanggal : 23/5/22 Kabupaten : Sanggau
Imunisasi Kejar
(Ya = 1, Tidak=0)
Ket** (bila anak mendapatkan
Campak dosis kedua/keetiga/keempat
Jenis
Rubela OPV/Penta saat BIAN, maka
No. Nama Anak Tgl lahir Umur Kelamin Nama orang tua Alamat No.Hp NIK
(Ya=1, tetap dicatat namun tidak
(L/P)
Tidak=0) DPT-HB- dimasukkan sebagai cakupan
OPV IPV BIAN)
Hib
1 AHMAD SABILI INDRA JAYA0 7/29/2015 6L ERIK PURNA BONTI 6103052907160000 1
2 ERLANGGA WIJAYA 11/23/2015 6L BUDI UTOMO BONTI 6103052311150001 1
3 KAIRUL AZAM 10/11/2015 6L MARIANA BONTI 610305110150002 1

4 NAWADIRA 12/15/2015 6P NANANG BONTI 6103055512150001 0
5 AKBAR ALKATIRI 2/27/2016 6L ABDUL HADI BONTI 6103052702160001 1
6 APOLONIUS BOYZEN 2/9/2016 6L FINSENSIUS DOLI TERUSAN 6103050902160001 1
7 VIOLETA ANGGI 2/26/2016 6P FERONIKA TERUSAN 6103056602160001 1
8 YUDI 5/1/2016 6L HELENA SISKA TERUSAN 6103050105160001 1

9 F.O.NARO 10/30/2015 6L MARIA BONTI 6103053010150001 1
10 CALFIN 12/30/2015 6L CANDRA GUNAWAN BONTI 6103053122150001 1
11 AZKA YUDISTIRA 10/2/2015 6L NOPITA SARI BONTI 61030502101150001 1

12 AQYLA NAUFALIN 1/21/2016 6P NINDI AZZILA BONTI 3174106101160004 1
13 M.ZAKI MIRZA 2/12/2016 6L SUHAITIANI BONTI 6103051202160002 1
14 MERRY RIANA 7/1/2016 6P YANTI UPE 6103054107160003 1
15 RAYA ALISKA 6/22/2017 4P SANTI BONTI 6103056206170000 1
16 LIONEL PUTRA.R. 11/23/2016 6L LUSIA RUPIA TERINTING 6103052311150002 1
17 SYCHA AISYAH SAFIRA 5/13/2017 5 + P DEWI RITA BONTI 6103055303170001 1

18 PATERNUS KAREL 8/23/2016 6L YOSEP AKON TERINTING 6103052308160001 1
19 M.IBRAHIM ADAM 9/29/2016 6L YUSNAENI BONTI 6103052909160001 1

20 MANUEL EVADO 1/29/2016 6L PALERIA DESI TERINTING 6103052901160001 1
21 ALVENSIUS LUIS NENG 11/17/2016 6L VEGENIUS YANTO TERUSAN 610305171160002 0
22 YOHANES NOVIRUS JERI 11/7/2016 6L A.JO.OL TERUSAN 6103050711160001 1

23 NURI SAMSIATI 1/24/2017 5+ P TARMIZI BONTI 6103056401170001 1
24 GEOGRIUS APRILIO 4/21/2017 5+ L DOMINIKUS DONI TERUSAN 6103052104170001 1
25 GEOGRIA APRILIANI 4/21/2017 5+ P DOMINIKUS DONI TERUSAN 6103056604170001 1

26 A.SURYA SAPUTRA 8/30/2016 5+ L AHMAD ROSIDIN BONTI 6103053008160000 1
27 RATU ANANDA PUTRI 2/5/2016 6P TRISNAWti TERINTING 6103054502160001 1

28 DOMINIKUS DONATAN 12/3/2016 5+ L ANTONIUS ADI TERINTING 6103050312160002 0
29 CARISA GRISELDA 12/29/2016 5+ P MARKUS RIKO UPE 6103056912160001 1
30 HILARI JI ARESHA 1/1/2017 5+ P TERESIA BULAN TERINTING 6103054101170001 1
31 ALANG KAENAN 6/29/2016 6L RISWANDI BONTI 6103052906160001 1
32 JULIAN LIBERTO 7/10/2016 5+ L ELIGIA LILI TERINTING 6103052311160002 1
33 VALENTINUS TRISTO 7/16/2016 5+ L MONIKA IKA TERUSAN 6103051607160002 1

34 NURI ALIFA 6/22/2016 6+ P UTIN ILYAS BONTI 6103056206160001 1
35 MARSIANUS YONUS 9/7/2016 5+ L NATALIA MARNI TERINTING 6103050709160001 1
36 REZA 1/6/2016 6L NENI BONTI 61030500601160001 1
33
Jenis logistik OPV IPV DPT-HB-HIB CAMPAK RUBELA Pelarut Campak Dropper ADS 0,5 ML ADS 5 ML Safety Box Pen
Rubela Marker
Jumlah
Catatan
* Tuliskan alasan jika anak tidak bisa diimunisasi dan rencana jadwal pemberian imunisasi susulan pada kolom keterangan
Posyandu/Pos ayanan BIAN lainnya : SD N 04 Seribot Nama petugas :Maria L K, A.Md.Keb, Agnes E, A.Md.Kep, Nova D, A.Md. Keb
Desa/kelurahan : Desa Upe Puskesmas : Bonti
Imunisasi Kejar
(Ya = 1, Tidak=0)
Campak Ket** (bila anak mendapatkan dosis

Jenis Kelamin Rubela kedua/keetiga/keempat
No. Nama Anak Tgl lahir Umur Nama orang tua Alamat No.Hp NIK OPV/Penta saat BIAN, maka tetap
(L/P) (Ya=1,
dicatat namun tidak dimasukkan
Tidak=0)
OPV IPV DPT-HB-Hib sebagai cakupan BIAN)
1 Brigitta Charine 18/10/2014 8P Gabriel Edi Purnomo Dsn. Seribot M 6103055810140001 0 Tidak masuk(posyandu bln juni)
2 Bysel Gracia Wanda 01/03/2015 7P Yohanes Budi Yosafat Dsn. Seribot M 6103050103150001 1
3 Dika Adittiya 22/03/2015 7L Paulus Dedi Dsn. Seribot M 6103052203160001 0 Tidak masuk(posyandu bln juni)
4 Ekky Noliandi 27/11/2014 8L Marselinus Kudi Dsn. Seribot M 6103052711140001 1
5 Elsa Prinata 26/08/2014 7P Rupi K Dsn. Seribot M 6103106608140001 1
6 Esya Perida 07/06/2015 6P Agustinus Dsn. Seribot M 6103054706160001 1
7 Fransiskus Yory 07/03/2015 7L Yohanes Sudi Dsn. Seribot M 6103050703150001 1
8 Gideon Rhichie 06/09/2014 7L Ewaldus Dsn. Seribot M 6103050609140001 0 Tidak masuk(posyandu bln juni)
9 Imanuel Roni 30/04/2015 8L Fransiskus Andi Dsn. Seribot M 6103053004150001 1
10 Irena Rasianiday 08/05/2015 7P P. Aljasari Dsn. Seribot M 6103054805150001 1
11 Yunika Mejiani Onako 12/06/2015 6P Selbinus Jemi Dsn. Seribot M 6103055206150001 0 Tidak masuk(posyandu bln juni)
12 Luky Hernandes 04/08/2014 7L Albanus Lukas Dsn. Seribot M 6103050408140001 1
13 Nobertus Aliyando 27/06/2015 6L Cing Dsn. Seribot M 6103052706150001 0 Tidak masuk(posyandu bln juni)
14 Nopiana Eca 14/11/2014 7P Lipinus Dsn. Seribot M 6103055411140001 0 Tidak masuk(posyandu bln juni)
15 Rafael Agung 26/02/2015 7L Heronemus Felixs Dsn. Seribot M 6103052602150001 1
16 Rehfan Narbetto 28/10/2014 7L Kuspulus Nadi Dsn. Seribot M 6103052810140001 1
17 Teodorus Mahun 16/06/2015 6L Donatus Sabin Dsn Entiop 6103051606150001 1
18 Windiyus Adrian 16/11/2014 7L Markus Dsn Entiop 6103051611140001 1
### 19 Abiezer Dawanto Ramos 02/10/2012 9L Mawan Dsn. Seribot M 6103050210120001 1
### 20 Aurelius Yoga Saputra 27/07/2013 8L Matheus Dsn Entiop 6103052707130001 1
21 Chrystian Deki 09/12/2013 8L Kasino Dsn. Seribot M 6103050912130001 1
22 Desika Natalia 13/12/2013 8P Basyulius Acikh Dsn. Seribot M 6103055312130002 1
23 Dodi Apriza Pratama 09/04/2013 9L Yumarko Dsn. Seribot M 6103050904130001 1
24 Feronika Yuvi 18/03/2014 8P Mateus Dsn. Seribot M 6103055803140001 1
25 Fidelis Erlin Eno 24/04/2014 8P Apeng Dsn. Seribot M 6103056404140001 1
26 Florensius Steven 26/10/2013 8L Tatamsius Dsn. Entiop 6103052610130001 1
27 Fransiska Nika Pila 16/12/2013 8P Lasanis Jumit Dsn. Seribot M 6103055612130001 1
28 Geia Chantika Aprilia 05/04/2014 8P Lia Piana Dsn. Seribot M 6103054504140001 1
29 Gever 18/09/2013 8L Bonigasius Dsn. Semadu 6103051809130001 1
30 Gracia Grittine Febriani 17/02/2014 8P Rupinus Alpianto Dsn. Entiop 6103095702140001 1
31 Hugo Fernando T. A 02/04/2014 8L Yenti Dsn. Seribot M 6103050204140001 1
32 Januarisa Faleria 23/01/2014 8P Norpio Rigo Dsn. Seribot M 6103056301140001 0 Tidak masuk(posyandu bln juni)
33 Jesika Ananda 29/07/2013 8P Burhadi Dsn. Entiop 6104166907130002 1
34 Kristian Eji Novanus 12/11/2013 8L Anwar Guntur Dsn. Seribot M 6103051211120001 1
35 Kristuanus Riski 15/11/2012 9L Diana Mariana Dsn. Seribot M 6103051611120001 1
36 Margareta 16/03/2014 8P Echim Iloe Dsn. Seribot M 6103055603140001 0 Tidak masuk(posyandu bln juni)
37 Marsela Ersya 17/05/2014 8P Marius Putra Jaya Dsn. Entiop 6103055705140001 0 Tidak masuk(posyandu bln juni)
38 Maylio Tori Wandisel 17/05/2014 8L Tolen Riskus Dsn. Seribot M 6103051706140001 1
39 Marisa Ivana 25/01/2014 8P Moses Ekolius Dsn. Seribot M 6103055501140001 1
40 Natalia Fitri Yanti 09/12/2013 8P Juki Dsn. Seribot M 6103056912130002 1
41 Natalicia Alicia 09/12/2012 9P Tjhau Siau Min Dsn. Entiop 6103054912120001 1
42 Priska Indah Naisila 03/01/2014 8P Darius Bambang Dsn. Seribot M 6103054301140001 1
43 Rafael Gracio 01/05/2014 8L Basius Ages Dsn. Seribot M 6103050105140001 1
44 Septiana Paulin Kasih 11/09/2013 8P Paulus Dsn. Seribot M 6103056109130001 1
45 Stepanus Dio 30/04/2014 8L Liman Dsn. Seribot M 6103053004140001 1
46 Stevanus Deni 31/05/2013 8L Herkulanus Dsn. Seribot M 6103053105120001 1
47 Timoteus Andila 22/05/2013 8L Ivo Riadi Dsn. Entiop 6103052206130001 1
48 Ardiyanus Desparado 14/12/2012 9L Aprianus Gino Dsn. Entiop 6103051412120001 1
49 Betogun Carles 22/11/2010 11 L Madi Dsn. Seribot M 6103052211100001 0 Tidak masuk(posyandu bln juni)
50 Christiano Helian Dapri 14/04/2012 10 L H. Polem Dsn. Entiop 6103051404120001 1
51 Christiee A Desnawantara 14/12/2012 9P A Edi Kurniawan Dsn. Entiop 6103055412120001 1
52 Derizico Arquarest 07/12/2011 10 L Kartinus Dsn. Seribot M 6103050712110001 1
53 Ernati 09/12/2011 10 P Yodi Dsn. Entiop 6108104912110001 1
54 Esteria Viona Chrisa 09/03/2013 9P Leo Dsn. Seribot M 6103054803130001 1
55 Gregorius Pedro Meikhel 25/05/2013 9L Ubertus Mandora J Dsn. Entiop 6103052505130001 0 Tidak masuk(posyandu bln juni)
56 Kalitus Puris 26/08/2012 9L Pinsensius Puhin Dsn. Seribot M 6103052608120001 1
57 Kristen Rafli 06/05/2013 9L Pikal Dsn. Seribot M 6103090605130003 1
58 Kris. Ade Putra 05/05/2012 10 L Wihelinus Dsn. Seribot M 6103050606120001 1
59 Mairia Hana 20/05/2011 11 P Harsono Dsn. Seribot M 6103056005110001 1
60 Mikaela Vanya 12/01/2013 9P Andrianus G Dsn. Seribot M 6103056201130001 1
61 Natalia A Putri 18/12/2012 9P Bonipasius Wiro Dsn. Entiop 6103055812120001 1
62 Nopilia Dahlia Seli 26/11/2011 10 P Arselius Bo'on Dsn. Seribot M 6103056611110001 1
63 Trivano Kam Kim Lai 02/05/2013 9L Ana Maria Linson Dsn. Seribot M 6103050205130001 1
64 Vio Maharani 03/12/2012 9P Muliadi Dsn. Entiop 6103054312120001 1
65 Dwi Ayu Filadelfia 01/07/2012 10 P Flabianus Abong Dsn. Entiop 6103054107120001 1
66 Eva Esterina 04/11/2010 11 P Yakobus Dsn. Seribot M 6103054107120002 0 Tidak masuk(posyandu bln juni)
67 Fransiskus Daniel 27/07/2011 10 L Minas Cun Dsn. Seribot M 6103054411100001 1
68 Hardi Marbun 22/08/2011 10 L Jontor Marbun Dsn. Seribot M 6103052707110001 1
69 Jesika Sintia Arini 05/01/2012 10 P Salpinus Seris Dsn. Seribot M 6103052208110001 1
70 Kalista Serli 05/04/2011 11 P Magdalena M Dsn. Seribot M 6103054501120001 0 Tidak masuk(posyandu bln juni)
71 Marselinus Rendi 07/06/2011 10 L Antonius Anto Dsn. Seribot M 6103054504110001 0 Tidak masuk(posyandu bln juni)
72 Merliana Tori 21/03/2012 10 P Tdenrikus Dsn. Seribot M 6103056103120001 1
73 Muhammad Nidzam I 26/04/2011 11 L Abang Indra Yana Dsn. Seribot M 6103052604110001 1
74 Natalia Ester 04/12/2010 11 P Rupinus Dsn. Seribot M 6103054412100001 0 Tidak masuk(posyandu bln juni)
75 Novia Stevy 27/11/2011 10 P Paleliyus Dsn. Seribot M 6103056711110003 1
76 Novita Theresia A 14/10/2011 10 P Paternus Taher Dsn. Seribot M 6103015410110001 1
77 Yohana Emelda 07/05/2012 10 P Kasianus K Dsn. Seribot M 6103054705120001 1
78 Yuliana Wati Sabrina 27/06/2011 10 P Sabinus Dsn. Seribot M 6103056706110002 1
79 Agapitus Yusni 28/08/2010 11 L Yosep Serusanto Dsn. Seribot M 6103052808100001 0 Tidak masuk(posyandu bln juni)
80 Asari Elvanita 26/07/2010 11 P Matius Mido Dsn. Entiop 6103056607100001 1
81 Damianus Yuki Subastian 04/12/2011 10 L Lorensius Abin Dsn. Entiop 6103050412100001 1
82 Dian Marselia Arpa 26/06/2011 10 P Arisno Dsn. Entiop 6103056606110001 1
83 Fitria Monika 19/06/2011 10 P Yopinus Dsn. Seribot M 6103056906110001 1
84 Gabriel Jenery 20/01/2011 11 L Amonius Sudin Dsn. Seribot M 6103057079300002 1
85 Gracio Ravel Matije 01/04/2011 11 L Marus Dsn. Entiop 6103050104110001 1
86 Gresia Novela 06/11/2011 10 P Simon Dsn. Seribot M 6103054611110001 1
87 Marchel Eleveno 27/3/2011 11 L Atinmus Dsn. Seribot M 6103052703110001 1
88 Mikael Anthony 13/11/2010 11 L Dermanus Hery Dsn. Seribot M 6103051311100001 1
89 Rafael 05/10/2010 11 L Kayetanus Dsn. Seribot M 6103050510100003 0 Tidak masuk(posyandu bln juni)
90 Rafael Richad Juan Pedro 03/11/2010 11 L Yohanes Budi Yosafat Dsn. Seribot M 6103050311100001 1
91 Stepanus Reno Pelianma 30/9/2010 11 L Teresia Andalia Julin Dsn. Seribot M 6103053009100001 0 Tidak masuk(posyandu bln juni)
92 Tritoni Barbara 11/12/2010 11 L P. Aljasari Dsn. Entiop 6103051112100001 1
93 Virgilia Junifer 26/6/2011 10 P Alkadius Henri I N Dsn. Seribot M 6103056606110001 1
94 Victoria Olivia 04/08/2010 11 P Leonius Rokianus Dsn. Entiop 6103054408100001 1
76
Jumlah vaksin (Vial) dan logistik yang digunakan
Pelarut Campak
Jenis logistik OPV IPV DPT-HB-HIB CAMPAK RUBELA Dropper ADS 0,5 ML ADS 5 ML Safety Box Pen Marker
Rubela
Jumlah 8 Vial 8 76 8 1
Catatan
* Tuliskan alasan jika anak tidak bisa diimunisasi dan rencana jadwal pemberian imunisasi susulan pada kolom keterangan
Posyandu/ pos anyaman BIAN Lainnya : SDN 20 TUNGGUL BOYOK Nama Petugas : ILUMINATA KRISTINA & APRIYANTO
Desa/ Kelurahan : Desa Tunggul Boyok Puskesmas : BONTI
Imunisasi Kejar ( Ya=1, Tidak
=0) Ket**( Bila Anak
Mendapatkan dosis
kedua/ketiga / keempat
Jenis Campak Rubela
No Nama Anak Tgl Lahir Umur Nama Orang Tua Alamat No.HP NIK OPV/penta saat
Kelamin Ya=1,Tdak =0 DPT+H
OPV IPV BIAN,maka tetap dicatat
B-Hib namun tidak dimasukan
sebagai cakupan BIAN )
1 FEBRIANUS YUDA 2/15/2015 7 L PINUS TOMAS Dsn. Petuo 6103051502150001 0 kls 1

2 HELINA CITRA 11/18/2014 7 P UL Dsn. Tunggul Boyok 6103055811140002 1
3 JESLYN CALLASIA 3/2/2015 7 P THOMAS BAMBANG Dsn. Tunggul Boyok 6103054203150001 1
4 MELANIA MORE 6/23/2015 6 P DEDI Dsn. Tunggul Boyok 6103056306150002 0
5 MESIAS RAMA 5/14/2015 7 L THOMAS DIN Dsn Petuo 6103051405150001 1
6 OKTAVIANUS SABRIANTO 10/5/2014 7 L TITUS SUPAR Dsn Petuo 6103050510140001 1
7 PONYANUS HENDRA SAGIRI 7/23/2015 6 L SEPEANUS PONI Dsn Petuo 6103052307150001 1
8 AGUS TINUS RIZKI SAPUTRA 8/12/2014 7 TH L NIUS PURA Dusun petuo 6103051208140001 1 kls 2
9 ANDERIAZ ANDRE 05 /10 2013 8 TH L PETRUS LINGGANG Dusun petuo 6103050510130001 1
10 DIAN SARRIVIN 25 / 8 /2014 7 TH L SARGIUS ANDE Tunggul Boyok 6103052508140002 1
11 DUSTAN IFO 1/23/2014 7 TH L YAKOBUS AKIYUNG Tunggul Boyok 6103052301140001 0
12 FRANSISKUS ARDELO 4/8/2014 7 TH L MARSELUS Tunggul Boyok 6103050804140001 1
13 JUL PRENDI 3/7/2013 8 TH L PHILIPUS CUTIN Tunggul Boyok 6103050307130002 1
14 MATEUS DIEGO MALDINI 5/9/2014 7 TH L BIANUS Tunggul Boyok 6103050509140001 1
15 SARASEHANA DENIA 26 / 9 2013 8 TH p SABINUS RUDE Tunggul Boyok 6103056609130001 1
16 MARGARETA TRIFOSA LALA 6/3/2014 7 TH P PILIPUS EKO Dusun petuo 6103054603140001 1
17 NOVA ANDRIANI 14 /05 / 2014 7 TH P SIMON JAMEL Dusun petuo 6103055405140001 1
18 NIRVAN SELAYANG 27 / 11 2013 8 TH L MARSIANUS KARDIYONO Dusun petuo 6103052711130001 1
19 REVIN SETIAWAN 16 / 02 /2014 7 TH L SIRILUS SUPIYANTO Tunggul Boyok 6103051602140001 1
20 SABRY 1/2/2014 7 TH L ANDREAS ABERAM Tunggul Boyok 6103050102140002 1
21 STEPANUS RAPAEL 1/8/2013 8 TH L CLANDIUS EDI BUGA Dusun petuo 6103050108130001 1
22 TURIBIUS RIYAN 17 / 03 / 2014 7 TH L PILIPUS SUDIRMAN Dusun petuo 6103051703140001 1
23 ALDO BARETO 4/3/2013 8 TH L KONOLERIUS KOLAS Dusun Petuo 6103050304120001 1 ks 3
24 ANJELLI 7/15/2012 9 TH P ANTHONIUS SUMARTHO Tunggul Boyok 6103055507120001 1
25 APRIANUS BENNI 4/22/2013 8 TH L ISKANDAR. A Tunggul Boyok 6103052204130001 1
26 ASHILA DECI 10/13/2012 9 TH P SIRILUS SUPIYANTO Tunggul Boyok 6103055310120001 1
27 CHRISTIAN PEBO 8/23/2013 8 TH L DAPIT Tunggul Boyok 6103052308130001 1 kls 3
28 FABIO LORENZO AHIONG 2/15/2013 8 TH L SUPARDI APHIN Tunggul Boyok 6103061602130001 1
29 LAURA HELINA 2/20/2013 8 TH P K.S .A'AN Tunggul Boyok 6103056002130002 1
30 LONISA 8/3/2012 9 TH P ANDREAS SIGIN Dusun petuo 6103054308120001 1
31 IMELDA MELI 5/4/2012 9 TH P SABINUS MIJI Dusun Petuo 6103054405120003 1
32 MARKUS MAXSI 3/25/2013 8 TH L BARTOLOMEUS Tunggul Boyok 6103052503130001 1
33 MEY FASKRY CHECY 5/9/2013 8 TH P ANSELMUS SUPARJO Tunggul Boyok 6103054905130001 1
34 NERI ROSITA 6/26/2013 8 TH P MARKUS MONDO Tunggul Boyok 6103056606130001 1
35 PAULUS IMANUEL 6/17/2013 8 TH L BERTUS EMRAN Tunggul Boyok 6103051706130001 1
36 REFAN 5/5/2013 8 TH L ALPINUS Dusun Petuo 6103050505130001 1
37 SILVIA CHIKA 6/28/2013 8 TH P JALI Tunggul Boyok 6103056806130001 1
38 ZILA MELIZA SARI 5/4/2013 8 TH P MUHAMAD RIKI Tunggul Boyok 6103054405130001 1
39 ANDIKA RISKI 8/9/2012 9 TH L PETRUS DODO Tunggul Boyok 6103050908120001 1 kls 4
40 ARDIANUS RICI 8/27/2011 10 TH L LILI Tunggul Boyok 6103052708110001 1
41 ARLON DILIP 9/16/2011 10 TH L YOHANES MARET Tunggul Boyok 6103051609110002 1
42 DEDEN SAPUTRA 3/24/2012 9 TH L BEATUS ANSELMUS Tunggul Boyok 6103052403120001 1
43 ENJEL 1/5/2011 10 TH P YUSUF UCU Tunggul Boyok 6103054501110002 1
44 ERNI JULIANI 7/29/2012 9 TH P PABIANUS LEMON Tunggul Boyok 6103056907120003 1
45 HASANUDDIN AHMAD 11/2/2011 10 TH L AHMAD KHOERUDDIN Tunggul Boyok 6103210211110002 1
46 HERDIANUS SEGITO 3/5/2012 9 TH L NIKO DIMUS Tunggul Boyok 6103050503120001 1
47 MARGARETA OLIVIA 3/18/2012 9 TH P PETRUS TAJEK Dusun petuo 6103055803120001 1
48 MARSELIA JUNITA 6/2/2012 9 TH P KIRDI Tunggul Boyok 6103054206120001 1
49 MIKAEL FLORENSIUS 5/19/2012 9 TH L BONIFASIUS HAMDANI Tunggul Boyok 6103051905120002 1
50 PAULUS RANDI 2/6/2011 10 TH L YOSEF SIMON Dusun Petuo 6103050602110001 1
51 PITRORIUS YUDI 2/15/2011 10 TH L VIKTOR ADOT Dusun Petuo 6103051602110002 0
52 SIMON PETRUS PARIP 2/3/2010 11 TH L BARTOLOMEUS JUNAIDI Tunggul Boyok 6103050302100001 1
53 RUTMIATI 2/15/2012 9 TH P LASARUS COIN Dusun Petuo 6103055502120001 0
54 YULIA ANISA 7/13/2012 9 TH P AGUSTINUS CAMPIN Tunggul Boyok 6103095307120001 1
55 SALVATORE CASEY ROSEPATI 7/19/2012 9 TH L SEPTIMIUS ATUNG Tunggul Boyok 6103091907120002 0
56 MARKUS ELZAL ALDIYANTO 5/8/2010 11 TH L PAULUS GONDO Tunggul Boyok 6103050805100003 0 kls 5
57 AGUSTINUS ANGGARA 2/16/2011 10 TH L AGUSTINUS SUJANTO Dusun Petuo 6103051602110001 1
58 AMANDA 7/23/2010 11 TH L JIDAN Dusun Petuo 6103056307100001 1
59 APOLONIA KETRI 3/8/2011 10 TH P AGUSTINUS BONG Dusun Petuo 6103054803110003 1
60 CLAURUS JUSTIN 10/23/2010 11 TH L ISKANDAR A. Tunggiul Boyok 6103052310100001 1
61 ELISABET BRITNEI 4/28/2011 10 TH P ANYIH Tunggul Boyok 6103056804110002 1
62 INDAH LESTARI 3/8/2011 10 TH P YOHANES JAKI RAHARJO Dusun Petuo 6103054803110002 0
63 INTAN PANISI 12/13/2010 11 TH P BURHAN Bonti 6103055312100001 1 kls 5
64 KIMSUYI 7/2/2011 10 TH P AMIR Tunggul Boyok 6103054207110001 1
65 LUSIA CICI 10/21/2010 11 TH P MARKUS TAHU Dusun Petuo 6103056110100001 1
66 MAGARETA NATA 3/7/2011 10 TH P BESELIUS TONO Tunggul Boyok 6103054703110001 1
67 NERISIUS ADITIYA 5/12/2011 10 TH L MARTINUS ANTO Dusun Petuo 6103051205110001 1
68 PASKA APRINATA 4/24/2011 10 TH P LINUS Tunggul Boyok 6103056404110001 1
69 RASTI 5/6/2011 10 TH P ADRIANUS YADIT Tunggul Boyok 6103054605110001 1
70 SEPANUS RIKO 9/5/2010 11 TH L KOCEL Tunggul Boyok 6103050509100001 1
71 TANTI MARIANA 7/18/2011 10 TH P DODO Dusun Petuo 6103055807110001 1
72 RESTINA CIU 7/3/2011 10 TH P SUTANTO ALIF Tunggul Boyok 6103054307110001 1
73 ANDIKA DIRLI 11-07-2010 11 TH L YULIUS YADI Dusun Petuo 6103051007100001 1 kls 6
74 FINSENSIUS MIKO 19-07-2010 11 TH L JOKO RAHARJO Dusun Petuo 6103052107100001 1
jumlah 66
Jumlah Vaksin ( Vial ) dan Logistik yang digunakan
Jenis Logistik OPV IPV DPT-HB-HIB CAMPAK LUBELA Pelarut Campak RubeDropper ADS ),5 ML ADS Safety Pen Merak
Jumlah
Catatan
* Tuliskan jika anak tidak bisa diimunisasikan dan rencana jadwal pemberian imunisasi susulan pada kolom keterangan
Posyandu/Pos Layanan BIAN lainnya : Posyandu Bangau Nama Petugas : PETRUS RAHANDI
Desa/Kelurahan : MAJEL Puskesmas : Bonti
Tanggal : 13 JUNI 2022 Kabupaten : Sanggau

DPT-HB- cakupan BIAN)
OPV IPV Hib
1 ELISCIA EVANIA MEYHANI 5/8/2018 4 P YUSTINA LENI BANGAU 6103054805180001 1
2 LANISA RLINA 8/3/2019 3 P LIYES GINIS 6103054308190001 1
3 BAGAS SAPUTRA 10/11/2015 6,8 BLN L MARIANA AGUSTIRA GINIS 6103051110150001 1
4 REVA 1/31/2016 6 P ELI BANGAU 6103057101160002 1
5 MARIANI PUTRI 6/23/2021 1 P RIYA BANGAU 6103057306200001 1 MR BULAN MEI
6 BAYU BUNUO 7/19/2020 2 L YOHANA NORA GINIS 6103051907200002 1
7 VIKTORYNUS BILLY 3/29/2021 1 L ANA MARIA BANGAU 6103052903210001 1
8 SELENA 8/13/2017 4,10BLN P JUPIN GINIS 6103055308170001 1
9 MELKI SEBASTIAN 5/29/2021 1 L ONA BANGAU 6103052905210001 1
10 PITALIA SAPIRA 11/18/2017 4,7 BLN P SULIA SUNETA GINIS 6103055811170001 1
11 IDAN DATRI 1/8/2020 2 L TRIWAHYUNI GINIS 6103050801200001 1
12 NOMI 7/1/2018 4 P NIA BANGAU 6103054107180003 1
13 PETRUS ERLAN 12/21/2019 3 L SABINA BANGAU 6103052112190001 1
14 ELICIA 5/8/2018 4 P YUSTINA LENI BANGAU 6103054805180001 1
15 PETRUS ERIK 5/29/2020 2 L NATALIA NANI BANGAU 6103052905200001 1
16 HENDRIKA 1/19/2021 1 P YOHANA PENI BANGAU 6103051901210001 1
17 ELIA EVANI SUSANTI 3/16/2018 3 P FITRI EKA SUSANTI GINIS 6103055603180001 1
6103055603180001 17
Jumlah
2 2 17 1 1
Posyandu/Pos Layanan BIAN lainnya : Sposyandu Majel Nama Petugas : PETRUS RAHANDI

DPT-HB- cakupan BIAN)
OPV IPV Hib
1 FLIPE JOE ALLEN PURBA 12/21/2018 L LISNAWATI SINAGA MAJEL 6103052112180001 1
2 GREGORIUS FITO 5/13/2021 L LUSIA ONI MAJEL 6103051305210002 1
3 AGUSTINA SINTIA 1/1/2017 P YULIANA LOSIN MAJEL 6103054101170002 1
4 HANA TASIA 4/13/2016 P MEAN MAJEL 6103056304160001 1
5 RACHELIYA ESTHERICA OLIVA 8/25/2015 L NEDYA SISWANTI MAJEL 6103076508150004 1
6 BRIGITA IMANUELA 7/24/2018 P YULITA WIRO MAJEL 6103056407180002 1
7 NOBERTUS KRISTAN 11/18/2018 L NATALIA MAWATANTA 6103051811180001 1
8 NATALIUS 12/25/2018 L YULIANA LOSIN MAJEL 6103052512180001 1
9 DEATALITA LEONY MARBUN 12/19/2016 P KOLETA MARSE MAJEL 6103056912160001 1
10 JUISKA AGISTA 7/29/2015 P ELIANA MAJEL 6103056907150002 1
11 GHILBET HOLYFIELO 11/9/2020 L LUSIA ELAN MAWATANTA 6103050911200001 1
12 IGNASIUS REINO 9/27/2020 L ROPINA MAWATANTA 6103052709200001 1
13 NATALIS GLEDIS 12/26/2020 L MINA KAMELIA MAJEL 6103056612200001 1
14 ALDOPA ARMAN 9/24/2017 L ATO MAWATANTA 6103042409170001 1
15 MEYFRISA JENIE 5/20/2020 P MAEGAWATI MEME MAJEL 6103046005200001 1
16 GREGODIUS LIRDO 11/24/2015 L LUSIA ONI MAJEL 6103052411150001 1
17 GREGORIUS FITO 5/13/2021 L LUSIA ONI MAJEL 6103051305210002 1
18 YEREMIA REY 3/15/2021 L KASIA MAJEL 6103051503210001 1
19 MARGARETA YUNINA 3/23/2018 P INLARIA YULIDA MAJEL 6103056003180002 1
20 BILLY CAHYADI CHIN 10/30/2017 L MELDINATASIANA MAJEL 6103203010170001 1
21 VIRGINA LOVELY PURBA 6/25/2018 P YOHANES EVI MAJEL 6103056506180001 1
22 HENDRIKA SAMUEL 9/27/2018 L EKA SUSILAWATI MAJEL 6103052709180001 1
23 AGUSTINA TASYA 8/15/2017 P MARIA NENTI MAJEL 6103055508170001 1
24 KEYLA ADILA 2/12/2021 P BIYON MAJEL 6103055202210001 1
25 SELENA GUANYAR 7/31/2016 P DOMINIKA DOMI MAJEL 6103057107160001 1
26 FELISIA TOGGIMA MANALU 11/21/2020 P - MAJEL 6103056111200001 1
27 YOHANES MELSON 5/25/2020 L - MAJEL 6103052505200001 1
28 FADTRISIA FAUSTA 8/19/2016 P - MAJEL 6103055908160001 1
29 AISYAH SAKIRA 6/18/2020 P - MAJEL 6103055806200003 1
30 FERDIAN 4/23/2018 L - MAJEL 6103052304180001 1
31 BILLY SAPUTRA 5/7/2020 L - MAJEL 6103050705200001 1 SUDAH MR BULAN MEI 2022
32 TANIA WILONA 5/15/2020 P - MAJEL 6103051505200001 1 SUDAH MR BULAN MEI 2022
33 STEPANUS PIO 12/16/2018 L - MAJEL 6103051508190001 1
34 GUTARI VIANA 1/18/2021 P - MAJEL 6103055801210001 1
35 DESTIA KLAUDIA JENIFER 12/6/2018 P - MAJEL 6103054812180001 1
36 SEPANUS YOWEL 10/21/2019 L - MAJEL 6103052110190001 1
37 RAFAEL 10/27/2018 L FRASILIA SINTI SUM RAYA 6103052710180001 1
37
Jumlah logistik OPV IPV CAMPAK RUBELA Dropper ADS 0,5 ML ADS 5 ML Safety
HIB Rubela Mark
Jumlah
4 4 37 4 1
Posyandu/Pos Layanan BIAN lainnya : SDN 15 MAJEL Nama Petugas : O.TEJO,PETRUS R, LISNAWATI S, APRIYANTO

Hib
1 ANCILLIA KESYA Domang Jaya, 05/07/201 7 P LILIS SURYANI S.Pd.K Dusun Domang Jaya 610305450 7140001 1
2 BOBBY EVAN PURBA Pontianak, 10/09/2014 7 L LISNAWATI SINAGA Dusun Majel 610305100 9140001 1
3 CATHY SHARON MANALU Kembayan, 06/06/2015 6 P JUNI MONIKA HETTI SILABAN, S.Pd Dusun Majel 610305460 6150001 1
DAVIA RINA MERLI Domang Jaya, 04/12/201 7 P ISIDORA DARA GODA Dusun Domang Jaya
610305441
4 2140002 1
5 DELMANSIUS DERYL Ponda Jaya, 15/12/2014 7 L MARIA MARNI Dusun Ponda Jaya 610305151 2140001 1
DIGO RIUSKRISMON Domang Jaya, 24/07/201 7 L MONIKA BENI SUNARTI Dusun Domang Jaya
610305240
6 7140002 1
FRANSISKUS DERLI Domang Jaya, 05/07/201 7 L MARIA MERIANDANI Dusun Domang Jaya
610305050
7 7140002 1
IMMANUEL STIPHEN EDWARD FOEH Kembayan, 01/07/2015 6 L LIDIA KANDAU Dusun Majel
610305290
8 7150001 1
IRWAN SYAPUTRA Tapa, 02/08/2014 7 L MARSELINA WATI Dusun Rondam
610305020
9 8140002 1
JESICA FIRLI Rondam, 16/04/2015 7 P LORENTIA DUMAI Dusun Rondam
610305560
10 4150001 1
JESIKA Mawa Tanta, 01/06/2015 6 P ALUN Dusun Mawa Tanta
610305410
11 6150001 1
JUNIFER JOSUA Empoyu, 01/06/2015 6 L YOHANA MEGA Dusun Mawa Tanta
610304010
12 6150001 1
JUNIKA ERNI Majel, 24/06/2015 6 P MARLINA RAMOT Dusun Mawa Tanta
610305640
13 6160001 1
KANDIANUS APRA Rondam, 29/09/2014 7 L MAKDALENA EMI Dusun Rondam
610305290
14 9140001 0
KARNILA MIA Domang Jaya, 21/03/201 7 P MARIANA DEPIN Dusun Domang Jaya
610305610
15 3150002 0
KRISTAN Domang Jaya, 11/08/201 7 L DEPI Dusun Domang Jaya
610305110
16 8140001 1
LOREANUS DIMAS Domang Jaya, 30/10/201 7 L HERLINA LONI YATI Dusun Domang Jaya
610305301
17 0140002 1
MARGARETA ANITA LESTARI Mawa Tanta, 01/07/2015 6 P MARIYA UYEH Dusun Mawa Tanta
610305410
18 7150001 1
MARSELINA NATASYA LAURA Kelompu, 08/07/2014 7 P NIRA Dusun Ponda Jaya
610305480
19 7140001 1
NAUMI Ponda Jaya, 25/10/2014 7 P ERMA Dusun Ponda Jaya
610305651
20 0140001 1
NOVIYANI DELTA Rondam, 30/11/2014 7 P LIDIA KANDAU Dusun Domang Jaya
610305701
21 1140001 1
PRISKA APRILIA Majel, 03/04/2015 7 P MEGAWATI IDA HERLINA Dusun Majel
610305430
22 4150001 1
REALDI NEYMAR Rondam, 13/05/2015 7 L KRISTINA LENNY MARLINA Dusun Rondam
610305130
23 5150001 0
REZAL PRATAMA Ngira, 24/06/2014 7 L KASIA Dusun Majel
610305240
24 6140001 1
RISKI DAFRIL Ponda Jaya, 30/09/2014 7 L YUSTINA LOSI Dusun Ponda Jaya
610305300
25 9140001 1
SAKIB KRISTANTO Romdam, 26/01/2015 7 L PAULA TANYA Dusun Rondam
610305260
26 1150003 1
27 SAMUEL DENO Mawa Tanta, 07/07/2015 6 L MRLINA PIPIL Dusun Mawa Tanta 1
SELMA Rondam, 31/12/2014 7 P MISWATI Dusun Rondam
610305711
28 2140001 1
SEPTIANA ANA Majel, 24/09/2014 7 P MARGARETA CIMPOS Dusun Majel
610305640
29 9140001 1
30 VINO ADRYAN Mawa Tanta, 29/09/2014 7 L ROPINA Dusun Mawa Tanta 6103052909140002 1
YEREMIAS MIKHO Mawa Tanta, 13/05/2015 7 L KOLETA SARTIKA Dusun Mawa Tanta
610305130
31 5160002 1
32 AURELIA HALONA Ponda Jaya, 13/04/2015 7 P MARTINA ASNI Dusun Majel 610305530 4150001 1
33 ADRIYANSAH Ginis, 01/01/2014 8 L JENIMIA Dusun Ginis 610305010 1140002 1
34 BURGAN BURAMI Ginis, 14/05/2015 7 L SOIL Dusun Ginis 610305140 5150002 1
GRASTIA KENENSIH Ginis, 02/10/2014 7 P SULINA Dusun Ginis
610305421
35 0140002 1
GRESELLA ASGI Sanggau, 08/03/2015 7 P ASTERIA ASTINI Dusun Ginis
610305480
36 3150001 0
IRINA DIPA Ginis, 31/03/2015 7 P MARIA MARI Dusun Ginis
610305710
37 3150001 1
NARTO Bangau, 26/05/2015 7 L TASIN Dusun Bangau
610306260
38 5150001 1
OKTA SHENA MAURA Bungok, 10/10/2014 7 L EGERIANA RUMIN Dusun Bangau
610305501
39 0140001 1
RENDIANTO Bangau, 25/11/2014 7 L MARIA RANCE Dusun Bangau
610305251
40 1140001 0
RINA NOSE Bangau, 30/08/2014 7 P RIYA Dusun Bangau
610305700
41 8140001 1
ROSIMAH NURDINATA Bangau, 15/02/2015 7 P LISABET Dusun Bangau
610305650
42 2160002 1
WILSEN Bangau, 15/04/2014 8 L DOMEN Dusun Bangau
610305150
43 4140003 1
YOHANES VIKTORINUS Bangau, 10/12/2014 7 L ELISABET EMI Dusun Bangau
610305101
44 2140001 1
45 PETRUS ANDRE Ginis, 25/08/2015 6 L Bidin Dusun Ginis 6103052508150001 1
46 YOHANES HENDRIK Bangau,18/09/20 6 L Martha Nelis Dusun Bangau 6103051809160001 1
ADITIYA DOMANG JAYA, 29/07/2013 L TEOFILUS HERU / YUSTINA AYO Dusun Domang Jaya 610305290
47 7130001 1
AGUSTINUS FIKO PONDA JAYA, 27/08/2013 L PHILIPUS PELIPI / MARIA SERAPIDusun Ponda Jaya
610305270
48 8130001 1
AHMAD SYAIFULLAH RONDAM, 20/10/2013 L WAHYUDIN / DONA Dusun Rondam
610305201
49 0130001 1
AISAH CACA BEDIGONG, 27/11/2013 P LIBERTUS CU / YULITA RIDA Dusun Rondam
610305671
50 1130001 1
ALVARO BRILLIANT DOMANG JAYA, 27/05/2014 L SINANG, SE / MARIA ANJELA Dusun Domang Jaya
610305270
51 5140001 1
AMELIA SERLI MAWA TANTA, 13/11/2013 P GREGORIUS SORAGI / TERONIS Dusun Mawa Tanta
610305531
52 1130002 1
53 ARDIYANUS A'AN PONDA JAYA, 09/09/2013 L ACUM / DADONG Dusun Ponda Jaya 6103050909130001 1
ARDIYANUS RESO RONDAM, 19/10/2013 L HERKULANUS DEYUS / AGNESA G Dusun Rondam
610305191
54 0130002 1
ARIA FAEL RONDAM, 19/05/2014 L ANDREAS LUKAS / ELISABET Dusun Domang Jaya 610305190
55 5140001 1
ARMIANUS REFSEL DOMANG JAYA, 10/05/2014 L LUCIUS MIROI / MAKDALENA Dusun Rondam 610305100
56 5140001 1
ARTHA GENOVA GIRSANG MAJEL, 30/05/2014 P / JUNIARTIK Dusun Majel 610305700
57 5140003 1
ATHEN NIJAP PONDA JAYA, 10/10/2013 L MAMANG / LUSIA SUWATI Dusun Ponda Jaya 610305101
58 0130003 1
BETALIA KARNELA MAWA TANTA, 13/04/2013 P EFENDI BARET / IDA Dusun Mawa Tanta 610305530
59 4130001 1
BLENDINO ANDINA MAJEL, 18/03/2014 L ADI / WINA APRILIA Dusun Majel
610305180
60 3140001 1
DANIEL DASILVA RONDAM, 11/02/2014 L VINSENSIUS ENDANG / MEGA Dusun Rondam
610305110
61 2140002 1
DEBBY PEBRIANTI MAJEL, 10/02/2014 P MARTINUS JOHAR / YULIANA NETI IYUL Dusun Majel
610305500
62 2140001 1
DESIRIA AURA PONDA JAYA, 18/12/2013 P JUMIUS / HELIDA Dusun Ponda Jaya
610305481
63 2130001 1
DESIRIA AURELLIA PONDA JAYA, 18/12/2013 P JUMIUS / HELIDA Dusun Ponda Jaya
610305481
64 2130002 1
ERWIN MINARDI MAJEL, 14/08/2013 L PAULUS MUNDUNG / DEPI Dusun Mawa Tanta
610305140
65 8130001 1
FLORENSIUS VALKO RONDAM, 05/03/2014 L JAKARIUS JAKAR / ANASTASIA ADusun Domang Jaya
610305050
66 3140001 1
FRANSISKUS FARLAN RONDAM, 10/08/2013 L PAULUS AJI / LORENTIA DUMAI Dusun Rondam 610305100
67 8130001 1
68 JELSI OLIVIARA PONDA JAYA, 26/01/2014 P AJON / LUSIA NONONG Dusun Ponda Jaya 6103056501140001 1
JULIANA TAISIA MAJEL, 20/07/2013 P IGNASIUS BUYUNG / MARIA KARTDusun Majel 610305600
69 7130002 1
LORIN NATASA BUNGOK, 12/02/2014 P JIMBAI / YOHANA RINA Dusun Bungok 610305520
70 2140001 1
MARGARETA MARSHA RONDAM, 07/03/2014 P WIBOWO / TERESIA DEWI Dusun Rondam 610305470
71 3140001 1
MARIA RONA ULY BULAN MANALU BONTI, 13/10/2013 P HARMOKO MANALU / JUNI MONIKA HETTI SILABAN, S.Pd Dusun Majel 610305531
72 0130001 1
MARIANUS MAWA TANTA, 26/03/2013 L SERIAN / SOPIN Dusun Mawa Tanta 610305260
73 3130001 1
MERSIANA MAJEL, 13/03/2014 P BINSA / LENI ANGGREANA Dusun Majel 610305530
74 3140001 1
MUHAMMAT RAMDANI SERUPIH, 21/07/2013 L SRI YANTO / ROSALIA DELA Dusun Rondam 610305210
75 7130001 1
NARNI BUNGOK, 04/09/2013 P HEPOLITUS LAEK / EFROSINA SUDusun Bungok
610305440
76 9130001 1
NEZAR MAJEL, 06/05/2013 L SURANTO / MARSELINA BUTET Dusun Majel
610305060
77 5130001 1
NUR HAFIZAH KUBU RAYA, 04/02/2014 P ANWAR / LUSIA ISAH Dusun Majel
610305440
78 2140001 1
OKTAVIA KEYLA BANTAI, 17/10/2013 P MARTINUS MEON / ANASTASIA TDusun Majel
610305571
79 0130001 1
PAULA LESTARI RONDAM, 17/07/2013 P ANTONIUS PENI / YUNI ASTIKA Dusun Rondam
610305570
80 7130002 1
PISKA BUNGOK, 09/09/2013 P ALIYAS / ANYIN Dusun Bungok
610305490
81 9130003 1
RATU SAINA NAILA DOMANG JAYA, 30/05/2014 P DONATUS MAREN / YOSEPA AMADusun Domang Jaya
610305700
82 5140001 1
ROKI APRINO DOMANG JAYA, 08/04/2014 L SECOLISTICA SULUTAM / MARCIANA MADusun Domang Jaya
610305080
83 4140002 1
SINTIA KARLINA DOMANG JAYA, 16/02/2014 P STEPANUS AKIONG / MARGARETA LDusun Domang Jaya
610305560
84 2140002 1
TERESIA ANGGUN RONDAM, 16/05/2013 P ADRIANUS RUDI / ANGELINA LOGDusun Rondam 610305560
85 5130002 1
VINSEN RONDAM, 18/12/2013 L BUWONO / VERAWATI Dusun Rondam 610305181
86 2130001 1
YOHANES SABAT ACTUR PONDA JAYA, 14/12/2013 L YOHANES KANTOT / SUPINA ME Dusun Ponda Jaya 610305141
87 2130001 1
YONATHAN SEPTINO MAJEL, 14/09/2013 L HERDIANUS AHEN / EKA SUSILA Dusun Majel
610305140
88 9130001 1
YULIA CICI MAWA TANTA, 06/03/2014 P YOHANES JUKIM / TOINA DOHIN Dusun Mawa Tanta
610305460
89 3140002 1
CRISTIANDRI JHONATAN DARIT, 02/05/2014 L PERUDIYAN HERO / MONITA KURNIAWATDusun Majel
610305020
90 5140002 1
ABET GINIS, 25/03/2013 L LIEM / ROSIN YANTI Dusun Ginis
610305250
91 3130002 1
ARIL BANGAU, 22/04/2014 L JAMAL / BUKANG Dusun Bangau
610305220
92 4140001 1
AVENIRA SAHARA KRISTIANI GINIS, 01/04/2013 P PIUS ANANIAS JONO / EMERENSIANA GORDANIDusun Ginis
610305410
93 4130002 1
DEKA SANG VUTRA GINIS, 16/05/2014 L LORENSIUS DARIUS / PIYANTI SARTIKA Dusun Ginis
610305160
94 5140001 1
DELTA BANGAU, 23/06/2014 L LIKOI / LUSIA UPE Dusun Bangau 610305630
95 6140001 1
ENDI GINIS, 16/06/2012 L AJAU / MUJI Dusun Ginis 610305160
96 6120001 1
KERESENSIA YOLENTA GINIS, 28/06/2014 P PETRUS ULUS / KELIA IYON Dusun Ginis 610305680
97 6140001 1
KLARA SURANA GINIS, 01/08/2013 P STAPANUS TINUS / SERINA ANTIDusun Ginis 610305410
98 8130001 1
MARIA DWI KHARISMA BONTI, 27/03/2014 P GERINUS / LENI Dusun Bangau 610305670
99 3140001 0
MIKHA ELPIKA PUTRI BABUT, 27/05/2014 P SAPUTRA / NATALIA SUSI SUSANDusun Bangau 610305670
100 5140001 1
NIKIA SASA GINIS, 22/03/2014 P /YULIA SINDIA Dusun Ginis 610305620
101 3140002 1
PETRUS SENDRI GINIS, 18/01/2013 L YAKOBUS SELAN / BENEDIKTA RDusun Ginis 610305180
102 1130002 1
RASTI ELIA LOVA GINIS, 07/05/2014 P FERI SAPUTRA / ARNI Dusun Ginis 610305470
103 5140002 1
SUGNA SAFIRA BANGAU, 01/10/2013 P KILIN / MARIANA Dusun Bangau 610305411
104 0130001 1
TONI ANDRE GINIS, 26/03/2014 L / ELISABET CUCINI Dusun Ginis 610305260
105 3140001 1
WILLE BANGAU, 23/05/2013 L ONDON / KADI Dusun Bangau
610305230
106 5130001 1
YAKOBUS ALDO BANGAU, 15/08/2013 L HENDRI / TASIN Dusun Bangau
610305150
107 8130001 1
ABIANUS DANILO DOMANG JAYA, 17/09/2012 L AGUSTINUS DEPI / KATARINA LODsn Domang Jaya
610305170
108 9120002 1
BUNGOK, 17/08/2012 L DONATUS SUPARDI / TERESIA ERDsn Ponda Jaya
610305170
109 AGUS SUMARDI 8120001 1
MAJEL, 04/06/2013 P HENDRIK / ANDREA ANDER Dsn Majel
610305440
110 ANGEL LUVI 6130001 1
BUNGOK, 06/01/2013 L YOHANES ALA / PASILITAS PITE Dsn Ponda Jaya
610305060
111 ARIANUS 1130002 1
AURELLIA NABILLA MAJEL, 02/06/2013 P DEONESIUS YOYON / FRANSISKA ALISA Dsn Majel
610305420
112 6130001 1
RONDAM, 02/01/2013 L SUHARDI / HERLINA SERI Dsn Majel 610305020
113 CHRISTIAN SERDIO 1130001 1
GISELA MAJEL, 12/08/2012 P DENDIANUS / BIYON Dsn Majel 610305520
114 8120001 1
L Dsn Majel 610305010
115 GREG JEZKO RAFAEL MAJEL, 01/09/2012 MARTINUS JOKO / SUMIATI 9120001 1
L Dsn Bungok
610305301
116 JIKA BUNGOK, 30/11/2012 JUNAIDI / SUNYIN 1130001 0
JULFIKO YUZAK L Dsn Majel
610305170
117 RONDAM, 17/07/2012 DEODATUS BUSTANIL / MARTHA 7120001 1
L Dsn Majel
610305100
118 KENDI APRI MAJEL, 10/04/2013 AGUSTINUS AWENG / TEKLA NO 4130001 1
KLAUDIUS DORI L Dsn Rondam
610305080
119 RONDAM, 08/02/2013 KANISIUS URAI / RUPINA TIYAM 2130002 1
LIDIA CIKA P Dsn Bungok
610305711
120 BUNGOK, 31/10/2012 BERNADUS / SURYA 0120002 1
P Dsn Ponda Jaya
610305430
121 MARGARET RINDIANI ADUS PONDA JAYA, 03/03/2013 MATIUS ADUS / DOMINIKA KUND 3130001 1
P Dsn Domang Jaya
610305651
122 NATASYA AURELLEA DOMANG JAYA, 25/12/2012 HERKULANUS SERAGI / YOHANA NOVA 2120001 1
L Dsn Rondam 610304061
123 OKTAVIAN NANDES RIKI RONDAM, 06/10/2012 YOHANES LIAN / LUCIA LOJI 0120002 1
OKTAVIANUS GABRIEL PURBA MAJEL, 28/12/2012 L HARIANTO PURBA / YOHANA EVIDsn Majel 610305281
124 2120001 1
PETRONELA MEILA MAWA TANTA, 04/05/2013 P DEONESIUS RUDI / ERMA Dsn Mawa Tanta 610305440
125 5130002 1
PETRUS WENDI RONDAM, 17/05/2013 L LAURENSIUS HENRI / SMPRONIUS SAYODsn Rondam
610305170
126 5130001 1
KROSIAK, 11/09/2012 L / LINSUN Dsn Bungok 610305110
127 PITO 9120001 1
BUNGOK, 08/11/2012 L MARTINUS MUDIN / YUSTINA JONDsn Ponda Jaya 610305081
128 REPIANUS 1120001 1
ROBECA RECO MAJEL, 01/11/2012 P YOHANES MIJI / DEWI SARTIKA SINYOH Dsn Majel 610305411
129 1120001 1
RONDAM, 01/07/2012 L ADONG / DIAS Dsn Rondam 610305010
130 ROKI 7120001 1
SERGIO RENO RONDAM, 07/04/2013 L HERNIMUS ELIPUS / ANTONIA TINDsn Domang Jaya 610305070
131 4130001 1
STEPHEN HAGAI SENAKIN, 24/12/2012 L SERIANUS BABA /SUSMAIDA MARSELIN Dsn Domang Jaya
610305241
132 2120001 1
RONDAM, 20/02/2013 P MARKUS LELENG / ELISABET WADsn Rondam 610305600
133 VANESA 2130001 1
VIKTORIUS DODI L Dsn Rondam
610305080
134 RONDAM, 08/02/2013 KANISIUS URAI / RUPINA TIYAM 2130001 1
VIOLA P Dsn Domang Jaya
610305440
135 RONDAM, 04/09/2012 YOHANES JOKO / YOHANA MITAI 9120001 1
WILMAR JANUAR ALDIF L Dsn Majel
610308260
136 KEMBAYAN, 26/01/2013 HERMANUS ARMAN / YULITA WI 1130001 1
YEREMIAS IRE L Dsn Domang Jaya
610305200
137 DOMANG JAYA, 20/03/2013 BARTOLOMEUS / YOVITA IMELD 3130001 1
YULIANA MARNI P Dsn Domang Jaya
610305710
138 RONDAM, 31/07/2012 BINES / MARGARETA SURIYA 7120001 0
L
610305210
139 ARDINIUS GINIS, 21/08/2012 JAHUN / JENIMIA Dsn Ginis 8120002 1
L 610305091
140 ARJUNA GINIS, 08/10/2012 LUKAS ANDI / AMELIA YESI Dsn Ginis 2110011 1
P 610305610
141 DESY SETIYA WATI BANGAU, 21/05/2011 SUDARNO / BETARIKAR LINDAWADsn Bangau 5130002 1
DISTO BASUKI BANGAU, 26/12/2011 L MIKAEL SAPUTRA / YUYAH Dsn Bangau 610305261
142 2110001 1
ELVIRA NATALI BANGAU, 15/12/2012 P SAPOI / NURIA Dsn Bangau 610305120
143 1070013 1
KANISA ROSI BANGAU, 01/01/2013 P EV. YOHANES PANDIMAN / LUSIANA GU Dsn Bangau
610305410
144 1130001 1
NUR SYAHIRA BANGAU, 30/04/2012 P RUSLAN / NUR AISAH Dsn Bangau
610305700
145 4120001 1
RISKI RANDI GINIS, 10/05/2011 L AJIS / TINA Dsn Ginis
610305100
146 5110002 1
SANTO PETRUS RISKI BANGAU, 20/07/2013 L BENITUS HERI / NATALIA NANI Dsn Bangau
610305200
147 7130002 1
YUVENSIUS KELVIN BANGAU, 13/02/2013 L TONO / LUSIA REKA Dsn Bangau
610305130
148 2130003 1
ENJELINA RONDAM, 28/07/2010 P MARTINUS YUS / ALENA JULIA Dsn Rondam
610305680
149 7100002 1
JERI BUNGOK, 18/07/2010 L JINADI / SONYIN Dsn Bungok
610305180
150 7100001 1
MELATI BUNGOK, 03/11/2010 P ALIN / YUSIA WATI Dsn Bungok 610305590
151 5110001 1
MEISYA ENELIS MAJEL, 19/05/2011 P AGUSTINUS ROMINUS / META ARMI SUSANTI Dsn Majel 610305590
152 5110001 1
PETRUS UNGGUL PRATAMA RONDAM, 03/01/2011 L YOHANES RAJAN / THERESIA SUDARDsn Rondam
610305030
153 1110001 0
PUTRAMINUS BIMO RONDAM, 19/08/2010 L YEREMIAS AN / CRISTINA JIO Dsn Domang Jaya 610305190
154 8100001 1
YUDANI MAJEL, 14/12/2010 L PARKALES SONO / YULIANA MIRDsn Mawa Tanta 610305141
155 2100001 1
L Dsn Bungok 610305210
156 AKIANG BUNGOK, 24/04/2011 KUANG / SANTI 4110001 1
DAMIANUS TIBO L Dsn Domang Jaya 610305140
157 RONDAM, 14/03/2012 THOMAS BARLIN / LUSIA SION 3120001 1
DIEGO RAFAEL L Dsn Rondam 610305261
158 RONDAM, 26/11/2011 YOHANES YAPOL / KATARINA W 1110001 1
L Dsn Mawa Tanta 610305030
159 DIMASIOCING RUBIA, 03/03/2012 AMINOKI / SODIN 3120001 1
L Dsn Mawa Tanta 610305080
160 HERMANUS HENDRIKO MAJEL, 08/05/2011 DOMINIKUS ARIS / NATALIA 5120001 1
L Dsn Domang Jaya
610305230
161 KELPIN ALIRLEO RONDAM, 23/06/2012 NIKOLAUS HAIDIR / LOGAN MARI 6120001 1
P
610305420
162 LUSIA YANA BUNGOK, 02/03/2012 SAHAN / PEGI Dsn Ponda Jaya 3120001 1
L Dsn Majel
610310260
163 MAYWEADER CHAVES JR TA'EK BINJAI, 26/05/2012 JOHN NIXON TA'EK / KLIMES NOMNAFA 5120001 1
PERDIANUS FERLY L Dsn Majel
610305140
164 MAJEL, 14/04/2012 FELIK / MERI 4120002 1
RENDIANUS SBI MULIADI BUNGOK, 28/12/2011 L DIBAS / FISILIA SOMET
610305281
165 Dsn Ponda Jaya 2110001 1
REZA ISKAN MAJEL, 11/03/2012 L MARSELINUS DIMAN / UNIT Dsn Majel
610305110
166 3120001 1
RIYAN MAJEL, 10/04/2012 L JUMAN / ALUN Dsn Mawa Tanta
610305100
167 4120003 1
SAPIRA BUNGOK, 08/08/2011 P AMOK / RENA Dsn Bungok 610305480
168 8110001 1
BUNGOK, 17/09/2011 L AGUNG / TELA 610305170
169 SELKI Dsn Ponda Jaya 9110001 1
MAJEL, 28/07/2011 P MARTINUS / KENENG Dsn Majel 610305680
170 SELPINA 7110001 1
BANTAI, 06/02/2012 P MARTINUS MEON / ANASTASIA TDsn Majel 610305460
171 TASIA ANGELINA FEBRI 2120001 0
TRISTAN DONADEL PURBA PONTIANAK, 15/04/2012 L FAJAR PURBA / LISNAWATI SINADsn Majel 610305150
172 4120001 1
MAJEL, 29/05/2012 P SIMIN / NIMUN Dsn Majel 610305690
173 YASMIN 5110001 1
YUSTINUS RAKA MAJEL, 21/09/2011 L HERKULANUS / LUCIANA RENI Dsn Mawa Tanta 610305210
174 9110002 1
MARSIANUS REPAL RONDAM, 06/03/2012 L MARSIYANUS YAYUK ASMIN / KATARINA MITA Dsn Rondam 610305060
175 3120002 1
YULIA SISIL BANTAI, 01/10/2011 P MATIUS SYAHRIL / MARSELINA KINJ Dsn Bungok
610305411
176 0110001 1
WELIANA EMPUTIH, 19/03/2012 P BELO / DESI Dsn Majel 610303590
177 3120001 1
YOHANES LEOKARDOF MARBUN SANGGAU, 14/08/2012 L MARADONA MARBUN / KOLETA MARDsn Majel
610305140
178 8120002 1
P
610305501
179 ANITA FENTI GINIS, 10/10/2011 SUBAGIO / ELIANA JERI Dsn Ginis 0110001 1
P
610305560
180 CAHAYA KARTINA KEMBAYAN, 17/07/2012 BABONG / PAULINA SOPEN Dsn Bangau 7120002 1
L
610305040
181 ERVAN BANGAU, 04/01/2012 WEDI / KARMILA Dsn Bangau 1170003 1
P
610305530
182 JULIANA RINA BANGAU, 13/07/2012 MARIUS / DWI MUSTIKA DAYANGDsn Bangau 7120001 0
L
610305280
183 KRISTIAN MATIUS SILALAHI PONTIANAK 28/04/2012 MELKI MARIANTO ANTON / NTI ESTI Dsn Bangau 4120001 1
L
610305060
184 LANGKAN FANTULI GINIS, 06/03/2011 ANDREAS CICUNG / SIOL Dsn Ginis 3110001 1
P 610305440
185 LUSIATI ANDINI GINIS, 04/01/2012 MOSES MITO / MARIA RINO Dsn Ginis 1120001 1
L 610305300
186 MARIUS EFRI GINIS, 30/07/2011 HONORIUS AKAU / LUSIANI Dsn Ginis 7110001 1
L 610305210
187 MICCEL MARSELA ELLEN GINIS, 21/03/2012 LANDRE / YOHANA NORA Dsn Ginis 3120002 1
P 610305411
188 OLIMPIA GINIS, 01/11/2011 PETRUS TIUS / SUSANA CUMBI Dsn Ginis 1110002 1
P
610305560
189 RANI SUCI GINIS, 01/09/2011 ALOYSIUS NIKO / MARIETA RIGINDsn Ginis 9110002 1
P
610305421
190 REESHOFIANKA ALWI BANGAU, 02/10/2011 ALWI / MARTINA Dsn Bangau 0110001 1
P
610305540
191 ROSITA SELI GINIS, 14/08/2011 ELISABET CUCIN Dsn Ginis 8110002 1
P
610312680
192 VERONIKA MELLY BANGAU, 28/01/2012 PETRUS US / ANA MARIA Dsn Bangau 1120002 1
P
610305060
193 YULIANA GINIS, 2011-08-20 YOHANES YANI / YULIANA IRA Dsn Ginis 8110001 1
ARIP DWI WIJAKSONO MAJEL, 07/03/2011 L ANDREAS SUKASNO / ROSALINADsn Majel
610305070
194 3110001 1
DONATA RIANA RONDAM, 28/02/2011 P TOJAN / USIL Dsn Rondam
610305680
195 2110001 1
ELSARI OKTAVIANA RONDAM, 08/01/2011 P PETRUS RUDI YANTO /YUSTINA Dsn Rondam 610305480
196 1110001 1
ENDO BUNGOK, 20/10/2010 L AJIS / MIRIN Dsn Bungok 610305201
197 0100002 1
FRANSISKUS REKARDO RONDAM, 21/12/2010 L KUNDRAD MULIANTO JONSON / LUSIA MILUS Dsn Rondam 610305211
198 2100003 1
LIANA LASTRI RONDAM ,31/10/2010 P SALOMON LOMON SUPAR / OKTAVIA JIA Dsn Domang Jaya
610305711
199 0100001 1
MARIA ANASTASIA DIAN SERLINA BUNGOK, 19/10/2011 P DERY FEBRIANSYAH / ANASTASIA SERI Dsn Bungok
610305590
200 1110001 1
NICHOLAS ALLVES PURBA SANGGAU, 07/05/2011 L HARIANTO PURBA / YOHANA EVIDsn Majel 610305070
201 5110001 1
PARLODUAN SANGGAU, 20/06/2011 L SISIUS AJAS / ERKAYANA DOMINDsn Majel 610305200
202 6110001 1
RANTI MAJEL, 10/01/2011 P DIBON / YULIANA Dsn Majel 610305500
203 1110001 1
REZO BURANTO BUNGOK, 14/02/2011 L ANSELMUS LANA / YOHANA INA Dsn Bungok 610305140
204 2110001 1
ROBERTUS ROMJI BUNGOK, 07/04/2011 L LAURENSIUS ASPANDI / YUSTINA ANYU Dsn Ponda Jaya
610305070
205 4110001 1
SERLY JAMU, 14/05/2011 P BUWONO / VERAWATI Dsn Rondam 610305540
206 5110001 1
TERESIA HESTI MAJEL, 04/09/2010 P AMIR / EMILIANA KEMI Dsn Mawa Tanta
610305440
207 9100001 1
TIARA BANGAU, 12/11/2010 P AMIR / JUNIARTI Dsn Bungok
610305521
208 1100001 1
VALERIA NEFA EMPOYU, 08/04/2011 P BONG NYI MIN / FLORA TITIEK LIDsn Majel
610320480
209 4110001 1
VRONIKA RASTI MAJEL, 17/07/2011 P YOHANES / MARIA MINIK Dsn Mawa Tanta
610305570
210 7110001 1
WITNA KRISTINA BONTI, 04/01/2011 P SUPENO / NYAWIN Dsn Majel
610305440
211 1110001 1
MARSELUS ALDO MAJEL, 21-07-2010 L MARKUS DERON / YUSTINA KIM Dsn Majel
610305210
212 7100002 1
AGUSTIANA AKWILA BANGAU, 01/08/2011 P BANGHI, S Pd / MUNIKA Dsn Bangau 610305410
213 8110001 1
CINTA BANGAU, 05-07-2011 P ISKANDAR / DONA Dsn Bangau 610305450
214 7110001 0
DENILIA LENA GINIS, 05-12-2010 P LUKAS LINAR MOJO / NIKA RAH Dsn Ginis 610305451
215 2100001 1
DEWI WIDAYANTI BANGAU,05-05-2011 P SUDARNO / BETARIKAR LINDA WDsn Bangau 610305450
216 5110001 1
IMELDA INDAH SARI BANGAU, 19-10-2010 P YAKOBUS JUGO / MULIN Dsn Bangau
610305591
217 0100001 1
KHALIPAH BANTAI, 19-03-2011 P LIKOI / LUSIA URE Dsn Bangau
610305590
218 3110002 1
KINA AULINA GINIS, 22-02-2011 P PRADI SANTOSO / LIYES Dsn Ginis
610305620
219 2110001 1
MELTI BANGAU, 20-10-2010 P PENDI / ONA Dsn Bangau
610305480
220 5110001 1
RAY MONDO BANGAU, 04-09-2010 L MARPAUNG / SOPIA Dsn Bangau
610305040
221 9100004 1
SITI SAYHIRA AMIRALIATI GINIS, 20-03-2011 P AMAD SABLI / SURYA ABDULAH Dsn Ginis
610305600
222 3110001 1
YOHANES BIMO BANGAU, 20-10-2010 L HENDRI / TANSIN Dsn Bangau
610305201
223 0100001 1
DANISIUS WILDA BUNGOK, 31-07-2010 PIRDAUS/MARTINA RUDI Dsn Bungok 610305710
224 7100001 1
LEONARDO AVANZA RONDAM, 24-07-2010 SINANG, SE / MARIA ANJELA Dsn Domang Jaya 610305240
225 7100001 1
BLASIUS DERI BANGAU, 01-08-2010 NAMYUN / DATI Dsn Bangau 610305010
226 8100001 1
HANA SULCE LABATAR BANGAU, 03-08-2010 EFRAIM LABATAR / NETI SURIYATDsn Bangau 610305430
227 8100001 1
ILHAM TONI YADINATA BANGAU, 28-06-2010 RAMDANI / LISABET Dsn Bangau 610305280
228 6100001 1
NIKA SARI BANGAU, 10-08-2010 YAKOBUS LIMBONG / SURYA WATI MEDIDsn Bangau
610305500
229 8100002 1
SETEPANUS ALDI GINIS, 03-06-2010 YOHANES YANI / YULIANA IRA Dsn Ginis 610305030
230 6100001 1
SINTA SINDI BANGAU, 28-06-2010 SERENUS SELEGAR / NESIA ATI Dsn Bangau 610305680
231 6100002 1
YUSTINA MELATI BANGAU, 03-08-2010 YOHANES SUHARTO APIN / MATEA LENSA SARIDsn Bangau 610305430
232 8100002 1
220 29
Jumlah logistik OPV IPV DPT-HB- CAMPAK RUBELA Pelarut Campak Dropper ADS 0,5 ML ADS 5 ML Safety Pen
HIB Rubela Mark
Jumlah
20 20 192 20 2
Posyandu/Pos Layanan BIAN lainnya : SDN 21 MUAN Nama Petugas : dr. ABDUL FAHMA & PETRUS R
Desa/Kelurahan : TG BOYOK Puskesmas : Bonti

Nama Orang Tua/ NAMA Campak Rubela
No Nama Anak Tgl Lahir Umur Kelamin IBU Alamat No.Hp NIK (Ya=1, Tidak=0) saat BIAN, maka tetap dicatat
(L/P) namun tidak dimasukkan sebagai
Hib
1 Ahmad Fadlan Laib Modang,12-01-2015 7 L Hudmi/Karnila Kimoi MUAN 6103051201150001 1
2 Yuda Pratama Muan,25-08-2014 7 L Joko/Sumito MUAN 6103052508140001 1
3 Delvila Cahaya Muan,28-11-2014 7 P Diohimus DE,I/Tekla Lendi MUAN 6103056811140001 1
4 Riska Yunita Yuni Muan,01-03-2014 8 P Hendrikus Andi/Ludovika Lima MUAN 6103054103140003 0
5 Marsianus Aby Muan,06-03-2015 7 L Paulus Parda/Kresensia Yulika MUAN 6103050603150001 0
6 Lorensius Nepo Muan,21-01-2015 7 L Selestianus suren/Magdalena Ki MUAN 6103052101150001 1
7 Virgilius Kenji Bonti,26-06-2015 6 L Yohanes Jupen/Seli MUAN 6103052606150002 1
8 Asih Natasa Prapaska Muan,14-03-2014 8 p Tono / Yohana Budiana MUAN 6103055403140001 0
9 Florensius Miko Muan,12-01-2014 8 L Sebastianus Iwan/Marisiana Yohan MUAN 6103051201140001 0
10 Indra Muan,06-06-2013 8 L Joni/Angkil MUAN 6103050606130001 1
11 Masan Martinus Muan,21-02-2014 8 L Yulius Acu/Dosia Bina MUAN 6103052102140001 0
12 Monika Sisil Muan,29-08-2013 8 P Anastasius Sani/Serapina Eka MUAN 6103056908130002 0
13 Petronius Weldi Muan,14-09-2013 8 L Kasianus Nikan/Helena Lena MUAN 6103051409130002 0
14 Valentinus Fiktor Entanjan,19-02-2014 8 L Tatui/Nina MUAN 6103051902140001 1
15 Astrea Seta Muan,10-08-2012 9 P Diomedes Seten/Debi Monika MUAN 6103055008120002 0
16 Daniarti Muan,17-12-2012 9 P Karnius Sedi/Katarina Judah MUAN 6103055712120002 1
17 Fortunata Chica Muan,11-06-2013 8 P Alexander Sandero/Rosalina San MUAN 6103055106130002 1
18 Marsel Aprian Muan,01-03-2012 10 L Hendrikus Andi/Ludovika Lima MUAN 6103090103120002 0
19 Yuliana Amelia Muan,08-10-2012 9 P Yohanes Hamdi/Lusiana Lugia MUAN 6103054810120001 0
20 Adriana Enjel Muan,02-12-2011 10 P Albinus Topik/Agustina Nata MUAN 6103054212120001 1
21 Aili Malcka Padek,09-01-2012 10 P Leopol Mulyadi/Donata Artuti MUAN 6103054901120001 0
22 Dominika Ulan Muan,08-05-2012 10 P Junaidi / Lonya MUAN 6103054805120001 1
23 Putra Muan,07-05-2012 10 L Marianus Kohik/Kiristan Leni MUAN 6103050705120001 0
24 Emiliana Yelsi Muan,12-07-2011 10 P Donatus Evin/Yohana Mega MUAN 6103055207110001 1
25 Esra Veronika Muan,09-10-2010 11 P Anderias Cai/Marselina Binos MUAN 6103054910100001 0
26 Kornelius Romikus Muan,01-09-2010 11 L Yohanes Mobi/Susana Suna MUAN 6103050109100001 1
27 Oni filitania Lilastri Muan,22-10-2011 10 P Anus/Budiar MUAN 6103056210110001 1
28 Yuliana Ardela Muan,14-08-2011 10 P Theodorus Hermanto/Chatarina MUAN 6103055408110001 1
29 Priska Emi Muan,16-06-2010 11 P Anus/Budiar MUAN 6103055606100001 0
15
HIB Rubela Mark
Jumlah
Posyandu/Pos Layanan BIAN lainnya : SDN 25 BONTI Nama Petugas : Oktavianus Tejo
Desa/Kelurahan : TG BOYOK Puskesmas : Bonti

Nama Orang Tua/ NAMA Campak Rubela
No Nama Anak Tgl Lahir Umur Kelamin IBU Alamat No.Hp NIK (Ya=1, Tidak=0) saat BIAN, maka tetap dicatat
Hib
1 ADRIANUS RANDI 2015-08-13 6 L AMOE KOTUP 6103051308150001 1
2 ANGELINA MONIKA 2012-11-07 9 P YULIANA LIA KOTUP 6103054711120001 0
3 ANTONIA TUTI 2012-06-12 9 P VERONIKA TEPE KOTUP 6103055206120001 0
4 APRILINA MONA 2013-03-26 9 P BASILIA MULIN KOTUP 6103056603130001 1
5 AURELLINA SEKAR 2011-09-28 10 P SUSANA KOTUP 6103056809110001 1
6 BONUS SANJAYA 2012-08-01 9 L SISILIA DELA TEBILAI 6103050108120002 1
7 CHRISTIAN JONNYS 2010-12-05 11 L RINA NATALIA KOTUP 6103010512100002 1
8 DENIAS FELIKS 2012-05-30 10 L DIANA DEWI KOTUP 6103053005120001 1
9 DONATA CITRA 2014-12-06 7 P REGINA SURTI KOTUP 6103054612140001 1
10 FALENTINA VEBIYOLA 2014-02-15 8 P SUSI SUSANTI KOTUP 6103105502140002 0
11 FERDINANDUS 2015-03-31 7 L MARGARETA TUYUN TEBILAI 6103053103150001 0
12 GONZAGO IVO 2012-07-11 9 L YOHANA ALUNG KOTUP 6103051107120003 1
13 HAMKA HAMDANI 2011-02-15 11 L RIKA KOTUP 6103051502110001 1
14 IGNASIUS BERWIN 2010-12-11 11 L KLAUDIA ANGGITA TEBILAI 6103051112100002 1
15 KRISTIAN GANSI 2013-03-13 9 L Y.ARIANI RINI TEBILAI 6103051303130001 1
16 KRISTINA NUTRIA REBECA 2014-11-06 7 P ELVI KOTUP 6103054611140001 1
17 KRISTINA PETRA 2014-03-01 8 P ANA TONI TEBILAI 6103054103140002 1
18 KRISTINA YOLA YONATASIA 2012-12-18 9 P YOPITA KANUL Tebilai 6103055812120003 0
19 LIDOVIKA RIANI 2012-03-16 10 P LISA TEBILAI 6103055603120001 1
20 MARINA JUNIATI 2015-06-07 6 P SABINA KORI TEBILAI 6103054706150002 1
21 MARKUS DODY 2013-03-28 9 L YOSEPA SEPA KOTUP 6103052803130001 1
22 MEDARDUS DONI 2015-06-08 6 L YULIANA SIDO TEBILAI 6103050806150002 1
23 MELKIANDES KANDUS 2013-12-01 8 L JULIANA MODAH 6103090112130001 0
24 OKTAVIA DELLA 2012-10-11 9 P HONORATA DIAN PANCAWATTebilai 6103095110120001 1
25 PALA SIDA TIARA 2013-10-30 8 P REGINA SURTI KOTUP 6103057010130003 1
26 RIYANTI 2015-08-14 6 P RICI KOTUP 6103055408150001 0
27 RUFINUS OKLI 2011-04-07 11 L LUSIA JONTE TEBILAI 6103050704110002 1
28 SABINUS ANDIKA 2015-01-06 7 L LUSIA JONTE TEBILAI 6103050601150002 1
29 SERAPINUS RAPLI 2012-10-12 9 L SESILIA SUWAN KOTUP 6103051210120001 0
30 STEPANUS YONAS 2010-09-21 11 L JAMIATI TEBILAI 6103052109100001 1
31 SULPISIUS RISKI DAENG 2013-04-20 9 L DADAH TBILAI 6103052004130001 1
32 TELI 2011-05-16 11 L HALEUS YESSI KOTUP 6103051605110001 1
33 TIMOTIUS ERWIN 2010-11-26 11 L NORIA ANASTASIA BELANDUNG 6109022611100001 1
34 TRIPONIA ANGGELIN 2010-12-02 11 P SUNARTI ISYAH TEBILAI 6103054212100002 1
35 VIRGILIUS BAIM 2010-06-26 11 L YULIANA IMA KOTUP 6103052606100001 0
36 YOSUA PEBRIANUS 2012-02-27 10 L LIDIA DIANA KOTUP 6103052702120001 1
27
Jumlah
Posyandu/Pos Layanan BIAN lainnya : SDN 12 TABAU Nama Petugas :
Desa/Kelurahan : Bahta Puskesmas : Bonti
Tanggal : Kabupaten : Sanggau

Campak Rubela
No Nama Anak Tgl Lahir Umur Kelamin Nama Orang Tua/IBU Alamat No.Hp NIK (Ya=1, Tidak=0) saat BIAN, maka tetap dicatat
Hib
1 ASRI JULIANTARA 7/23/2014 7 L DAYANG MASTARY TABAU 6103052307140001
2 SASKIA 12/20/2014 7 P YENI FARIDA TABAU 6103056012140001
3 SAUFA RINA 11/20/2014 7 P TOYONG TABAU 6103056011140002
4 ADHE BINTANG RAMADHAN 7/28/2013 8 L UTIN EMY SARMIATI TABAU 6103052807130002
5 KHAIRUL FIKRI 4/9/2014 8 L SITI NORBAYA TABAU 6103050904140002
6 NAFITHA NAZWA 11/10/2013 8 P DAYANG RAPITA TABAU 6103055011130001
7 NOVITA SARI 11/9/2013 8 P ENI SULASTRI TABAU 6103054911130001
8 SUCI SAFITRI 7/4/2014 7 P DAYANG SRI MARYANI TABAU 6103054407140001
9 TIYA ANGRENI 4/16/2014 8 P MURNIATI TABAU 6103055604140001
10 WIDA 1/22/2014 8 P SITI ARDI TABAU 6103056201140003
11 ZULPIANDI 6/1/2014 7 L NOPA TABAU 6103050106140001
12 AKHMAD DANI ADE 8/15/2012 9 L CICA LESTARI TABAU 6103051508120001
13 ALDI 9/5/2012 9 L WIWIN TABAU 6103050509120001
14 AYUDIA RAHMA WATI 8/6/2012 9 P IDALIA TABAU 6103054608120002
15 AZRIEL FAHMI 11/10/2012 9 L DAYANG JAMILAH TABAU 6103051011120001
16 KAISYIA 11/2/2012 9 P LINA ASMIATI TABAU 6103054211120002
17 SATRIYA 5/6/2013 9 L JULIA TABAU 6103050605130003
18 ARDINA 4/29/2011 10 P ANITA TABAU 6103054904110003
19 NADIA SABINA 7/10/2010 11 P RD. PATMAWATI TABAU 6103051007100002
20 RISKI 2/1/2012 10 L AZIZAH TABAU 6103050102120001
21 SARISA 3/28/2012 10 P ENI TABAU 6103056803120001
22 TASYA 5/29/2012 10 P NEPI SERIANTI TABAU 6103056905120001
23 ALDO RENALDI 2/9/2011 11 L JUMIATI TABAU 6103050902110002

Jumlah
Posyandu/Pos Layanan BIAN lainnya : SDN 09 BAHTA Nama Petugas :

Hib
1 Ahmad Maulana 2015-03-13 7 L Nonong DSN BAHTA 6103051303150002
2 ARKA MAULIA FIRMANSYAH 2015-06-06 6 L LIYA DSN BAHTA 6103050606150001
3 DIKA SAPUTRA 2015-04-08 7 L RIKA SUSANTI DSN BAHTA 6103050804150001
4 FASSA SASKIA 2014-11-11 7 P ASIA INDON DSN BAHTA 6103055111140001
5 FATUR RAHMAN 2015-02-01 7 L HJ. DAYANG ASNIATI DSN BAHTA 6103050102150001
6 FIYA HIDAYANTI 2015-05-14 7 P MARINI DSN BAHTA 6103055405160001
7 HAFIS IRAWAN 2015-02-25 7 L ASTRI JUMIATI DSN BAHTA 6103052502150001
8 HIDANSYAH 2014-09-27 7 L KARTINI DSN BAHTA 6103052709140002
9 IZA RIYANTI 2015-01-13 7 P IDA YATI DSN BAHTA 6103055301150001
10 JIHANDA PUTRI 2014-10-21 7 P SUKARNI DSN BAHTA 6103056110140001
11 MELVIN MARDI YANSAH 2014-04-24 8 L Mida Lazi DSN BAHTA 6103052404140001
12 PANDU ISMAIL 2014-12-07 7 L NORSIAH DSN BAHTA 6103010712140002
13 PIRZI ALDIA 2015-03-14 7 P DARA WATI DSN BAHTA 6103055403150001
14 RASIT 2014-11-04 7 L NANIK DSN BAHTA 6103050411140002
15 ROSI YANI 2014-08-06 7 P IDA SARI DSN BAHTA 6103054608140001
16 SAHRUL RAMADAN 2015-06-18 6 L ERNAWATI DSN BAHTA 6103051806150001
17 SHAFIYAH 2015-05-10 7 P RENI MARIYATI DSN BAHTA 6103055005150001
18 SURIYANI 2015-04-08 7 P RATENA DSN BAHTA 6103054804150001
19 SYAHRUL RAMADHAN 2014-07-11 7 L NORHAYATI DSN BAHTA 6103051107140001
20 TRI WULANDARI 2014-11-13 7 P SARIKA DSN BAHTA 6103055311140001
21 YASIR 2011-12-08 10 L Mastina DSN BAHTA 6103050812110001
22 AGIS DINIANSYAH 2013-08-19 8 P Acaniarti DSN BAHTA 6103055908130001
23 AL AHMAD BAKRI IRWANSAH NASUT 2013-09-11 8 L Nilawati DSN BAHTA 6103051109130001
24 ALIF ANUGRAH PRATAMA 2013-03-16 9 L Sapta Purwaningsih DSN BAHTA 6103051603130001
25 ANDRIAN 2014-03-22 8 L Harpah DSN BAHTA 6103052203140001
26 DINO MAISA 2014-03-02 8 L Nursianti DSN BAHTA 6103050203140001
27 ERISKA ALYA PUTRI 2014-05-12 8 P Elli Amalia DSN BAHTA 6103055205140001
28 GINA KARDILA 2014-04-03 8 P Juliana DSN BAHTA 6103014304140001
29 HAFSOH AL MUBTAHILAH 2013-12-30 8 P Anjasmara DSN BAHTA 6103057012130001
30 KARINA UTAMI 2014-05-24 8 P Ayuti DSN BAHTA 6103056405140001
31 MAULANA SAKTI 2014-04-09 8 L Norlida DSN BAHTA 6103050904140001
32 MUHAMMAD ADENIN 2014-04-17 8 L Anita DSN BAHTA 6103051704140001
33 SURYA YANTI 2013-09-10 8 P Agus Saparnia DSN BAHTA 6103055009130001
34 WIRA HARDIANSAH 2014-05-05 8 L Norbani DSN BAHTA 6103050505140002
35 Ahmad Ikon 2013-06-25 8 L ayang liza DSN BAHTA 6103052506130001
36 Alesia 2012-11-13 11 P sarika DSN BAHTA 6103056311120001
37 aria sangka 2012-09-04 9 L rina DSN BAHTA 6103050409120002
38 aril ramadan 2013-07-17 8 L siti rohana DSN BAHTA 6103051707130001
39 azahrawardany 2012-09-13 9 P mawan DSN BAHTA 6103055309120001
40 DELVI OLIVIA 2012-05-19 10 P YUYUN KARTIKA DSN BAHTA 6103055905120001
41 Dina Wardana 2012-11-12 9 P nengsih DSN BAHTA 6103056111120001
42 Fahri 2012-02-07 10 L Minon DSN BAHTA 6103050702110001
43 Fajar Ahmad 2013-03-30 9 L Misrawani DSN BAHTA 6103053003130001
44 Fizah 2013-07-16 8 P Lijah Lijong DSN BAHTA 6103055607130001
45 IZAM 2011-09-24 10 L GALUH DSN BAHTA 6103052409110002
46 Madun 2012-10-08 11 L Sartika DSN BAHTA 6103050810120001
47 Mirzani 2012-09-30 11 P Sriana DSN BAHTA 6103057009120002
48 MUHAMMAD ARIPIN 2011-10-14 10 L IMA NANI DSN BAHTA 6103051410110001
49 Padil Zakriy 2013-03-24 9 L Mega DSN BAHTA 6103052403130001
50 PARISZAM 2012-01-04 10 L INDRA WASIH DSN BAHTA 6103050401120001
51 Radi Anugrah 2012-08-21 9 L Normi DSN BAHTA 6103052108120001
52 Rauadika 2013-03-18 9 L Asianti DSN BAHTA 6103051803130001
53 Ridwan Saputra 2013-03-26 9 L Zahara DSN BAHTA 6103052603130002
54 RIPKI ADITIASAPUTRA 2011-06-03 10 L PUTRI YANI DSN BAHTA 6103050306110001
55 Salina 2012-10-30 9 P Eviana DSN BAHTA 6103057010120002
56 Salsa Sabila 2012-11-01 9 P Duriyani DSN BAHTA 6103064111120002
57 Salwa Wulandari 2012-07-29 9 P Minon DSN BAHTA 6103056907120006
58 Satri Ani 2013-01-09 9 P Nispasari DSN BAHTA 6103054901130001
59 Tasya Wahyuni 2013-03-08 9 P Murniati DSN BAHTA 6103054803130001
60 Ahmad Evan Nurhadi 2012-03-09 10 L Rohana DSN BAHTA 6103051903120001
61 Delsa 2011-12-07 10 P ANITA DSN BAHTA 6103054712110001
62 DUWI PRASSTYO 2011-07-21 10 L ANISA WATI DSN BAHTA 6103052107110002
63 EDID TIYA 2012-07-07 10 L SRIATI DSN BAHTA 6103050707120001
64 IRMA WATI 2012-06-04 10 P YULYANA DSN BAHTA 6103054406120001
65 LUKI 2011-08-19 9 L HARPAH DSN BAHTA 6103051908110001
66 MEDI SAPUTRA 2012-05-27 10 L LIDIA DSN BAHTA 6103052705120001
68 QNARA APRILIA 2012-04-02 10 P MAYA DSN BAHTA 6103054204120001
69 ROMI 2012-02-09 10 L MASRIANI DSN BAHTA 6103050902120002
70 SAIDIN IDAPI 2010-09-16 11 L NURBANI DSN BAHTA 6103051609100002
71 SASKIA RAMADANI 2011-08-21 10 P AYANG TAT DSN BAHTA 6103056108110001
72 WAHYUNI 2012-02-21 10 P YENI NOPITA DSN BAHTA 6103056102120001
73 WILLY AZRI 2012-04-08 10 L MELA DSN BAHTA 6103050804120001
74 AHMAD SAFUDIN 2011-01-26 11 L NORYANI DSN BAHTA 6103052601110002
75 ARFIDH MUNZILIN SYAH NASUTION 2011-09-11 11 P SUMARDINI DSN BAHTA 6103055109110002
76 BIMA 2011-05-25 10 L NENGSIH DSN BAHTA 6103052505110001
77 HENGKI GUNAWAN 2010-10-24 11 L ASPAU WATI DSN BAHTA 6103052410100001
78 LILIT LDINA MAUDIA 2011-05-20 11 P ASIANTI DSN BAHTA 6103056005110002
79 MERLIN ARINI 2010-06-28 11 P MASNI DSN BAHTA 6103056806100001
80 MORJANI 2010-07-15 11 L RATENA DSN BAHTA 6103051507100001
83 NAFA FADILA 2010-10-06 11 P NORSIPAH DSN BAHTA 6103054610100001
85 NURYA TIRA 2011-04-11 11 P LILI BANA DSN BAHTA 6103055104110001
87 RIYANI 2011-08-22 10 P DEPI SRIPAWAN DSN BAHTA 6103056208110001
88 Saka Adha 2011-11-06 10 L Epa DSN BAHTA 6103050611110001
89 URIYAH 2011-06-26 10 P DARSIH DSN BAHTA 6103056606110003
91 ZAKI 2010-08-10 11 L RIKA SUSANTI DSN BAHTA 6103051008100001
92 ALDY REFYRIANDI 2010-07-13 11 L IDA SAFITRI DSN BAHTA 6103051307100001

Jumlah
Posyandu/Pos Layanan BIAN lainnya : SDN 06 DOSAN Nama Petugas :

Campak Rubela
No Nama Anak Tgl Lahir Umur Kelamin Nama Orang Tua/IBU Alamat No.Hp NIK (Ya=1, Tidak=0) saat BIAN, maka tetap dicatat
Hib
1 ALFA AULIYA 2/26/2015 7 L HALIMAH DSN DOSAN 6103052602150002,
2 AQIELA SABRINA FAIZA 9/1/2014 7 P SITI ANA DSN DOSAN 6103054109140001,
3 DAYANG ASILA NUR HAFIZAH 10/12/2014 7 P DAYANG NOVI SRI ASTUTI DSN DOSAN 6103055210140001,
4 MUHAMMAD YAZID 7/17/2014 7 L AYU FITRIANI DSN DOSAN 6103051707140001,
5 RAHMANUDIN 6/8/2015 7 L LAU MARDIAH DSN DOSAN 6103050806150001,
6 AHMAD FIKRI 8/19/2013 8 L DAYANG DAHLIA NOR DSN DOSAN 6103051908130001,
7 DAYANG RAHMATDIYANTI 4/3/2014 8 P DAYANG MARNIATI DSN DOSAN 6103054304140001,
8 DELA SAFIRA 12/29/2013 8 P DAYANG ZULAIHA DSN DOSAN 6103056912130001,
9 HIDAYAT 3/24/2014 8 L DAYANG JAMILAH DSN DOSAN 6103052403140001,
10 NEYMAR MAHARDIKA 3/22/2014 8 L DAYANG SANTI DIANA DSN DOSAN 6103052203140002,
11 RAHMAWATI 7/20/2013 8 P LILIS DSN DOSAN 6103016007130002,
12 SYAFIRA NUR KARMILA 11/28/2013 8 P SUSMILANDARI DSN DOSAN 6103056811130001,
13 ABANG RAHADIT 12/6/2012 9 L DAYANG SITI HAFSAH DSN DOSAN 6103050612120001,
14 AHMAD ARJUN 5/10/2013 9 L DAYANG MASDIANA DSN DOSAN 6103051005130002,
15 MONIKA SAFITRI IRAWAN 8/19/2012 9 P NORITA DSN DOSAN 6103055908120002,
16 RIANSAH 10/25/2012 9 L AJUM DSN DOSAN 6103052510120001,
17 HIDAYAT NURWAHID 5/28/2011 11 L SUSAN MELIYA DSN DOSAN 6103202805110001,
18 NOFAL JUANDI 11/20/2011 10 L SALMAH DSN DOSAN 6103052011110001,
19 DAYANG DESI MUHARRINI 12/18/2011 10 P DAYANG INDAH SURYANI DSN DOSAN 6103055812110003,
20 IDRIS 8/31/2011 10 L YULIANA DSN DOSAN 6103053108110001,
22 AHMAD FADIL 9/9/2010 11 L HINDUN DSN DOSAN 6103050909100001,
23 DHANI PRATAMA 5/31/2010 11,11 BLN L HALIDA DSN DOSAN 6103053105100001, KALAU PELAKSANAAN IMUNISASI PADA TGL 31 MEI KEATAS SISWA TIDAK BISA IKUT IMUNISASI LAGI
24 NOVY WIDYA NINGSIH 10/2/2010 11 P ROSMIYATI DSN DOSAN 6103054210100001,
25 GILDA MARITZA 4/28/2011 11 P WASILAH DSN DOSAN 6103056804110001,
26 FIRA WAHYUNI 5/31/2010 11,11 BLN P DAYANG ENI YANTI DSN DOSAN 6103057105100001 KALAU PELAKSANAAN IMUNISASI PADA TGL 31 MEI KEATAS SISWA TIDAK BISA IKUT IMUNISASI LAGI
27
28
29
HIB Rubela Mark
Jumlah
Posyandu/Pos Layanan BIAN lainnya : SDN 11 Sedua Nama Petugas : Oktavianus Tejo
Tanggal 24 mei 2022 Kabupaten : Sanggau

Campak Rubela
No Nama Anak Tgl Lahir Umur Kelamin Nama Orang Tua Alamat No.Hp NIK (Ya=1, Tidak=0) saat BIAN, maka tetap dicatat
Hib
1 RAFAIS 7/7/2015 7 L ISNADI DSN SEDUA 6103050706150001 0
2 RANI SAHURI 6/25/2015 7 P ABANG GUMIS DSN SEDUA 6103056506150001 1
3 ADITIYA 8/13/2014 8 L HETI KUSENDANG DSN SEDUA 6103051308140001 1
4 CIKA PATIWI 9/9/2013 9 P ZULINA DSN SEDUA 6103054909130002 1
5 DWI YANA 8/3/2014 8 P SURYANTO DSN SEDUA 6103054308140001 1
6 LINI ARDILA 3/18/2014 8 P TAGOR DSN SEDUA 6103055803140003 1
7 NAZWA FATMA 5/25/2014 8 P ABU BAKAR DSN SEDUA 6103056505140001 1
8 RAMA 4/14/2014 8 L NORAIDA DSN SEDUA 6103051404140001 1
9 AYU FITRI YANI 5/16/2013 9 P BUDI DSN SEDUA 6103055605130001 1
10 ALMIZAN 3/21/2013 9 L LUKMAN DSN SEDUA 6103052103130001 1
11 DEWI ANJANI 8/19/2013 9 P ERDANI DSN SEDUA 6103055908130002 1
12 INDAH PERMATASARI 2/8/2013 9 P RAMLI DSN SEDUA 6103054802130001 1
13 MUHAMMAD ILHAM 2/3/2013 9 L JAMALUDIN DSN SEDUA 6103050302130001 1
14 MUTIARA SALSABILA 1/16/2013 9 P MAHADI DSN SEDUA 6103055601130001 1
15 RENDI 11/10/2013 9 L ZAINUDIN DSN SEDUA 6103051001130001 1
16 RIKI DARMAWAN 2/5/2013 9 L SUDIRMAN DSN SEDUA 6103050502130001 1
17 RUBEN SATRIADI 9/5/2012 10 L SUKRI DSN SEDUA 6103050509120002 1
18 SESIL 9/24/2013 9 P MUSLIM DSN SEDUA 6103056409130001 1
19 DEDEK DELIANI 7/23/2012 10 P ALDI DSN SEDUA 6103056307120001 1
20 LILA SAFITRI 8/7/2012 10 P SURYAMAN DSN SEDUA 6103054708120001 1
21 LIYANI 9/15/2012 10 P MULYADI DSN SEDUA 6103055509120001 1
22 PAHRI HARIZKI 1/8/2012 10 L PARMAN DSN SEDUA 6103050810120002 1
23 RISKI ARMANDA 1/26/2012 10 P MARSUDI DSN SEDUA 6103056601120001 1
24 FADLI 5/1/2011 11 L JANG DSN SEDUA 6103050106110001 1
25 LUNA ERDIANA 2/7/2011 11 P ANTON DSN SEDUA 6103054702110001 1
26 SUSILAWATI 8/4/2011 11 P ASNAN DSN SEDUA 6103054408110001 1
27 YUDA 12/22/2010 12 L HERMAN DSN SEDUA 6103052212100001 1
28 RAFKI SAPUTRA 10/8/2010 12 L RABIA AMIN DSN SEDUA 6103050810100002 1
29 SAFITRI 9/16/2010 12 P RUDI DSN SEDUA 6103055609100001 1
28
Jumlah

Data Sasaran BIAN Posyandu BANGAU 13-6-22

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Data Sasaran BIAN Posyandu BANGAU 13-6-22

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FORMAT PENCATATAN HASIL PELAYANAN

Ket** (bila anak mendapatkan dosis

1 ANDREAS BON SAGA 2012-05-16 L Maria Ani Lanong 6103051605120001 1 kls 1

Imunisasi Kejar (Ya = 1, Tidak Ket** (bila anak mendapatkan dosis

2 ERLANGGA WIJAYA 11/23/2015 6L BUDI UTOMO BONTI 6103052311150001 1

3 KAIRUL AZAM 10/11/2015 6L MARIANA BONTI 610305110150002 1

5 AKBAR ALKATIRI 2/27/2016 6L ABDUL HADI BONTI 6103052702160001 1

6 APOLONIUS BOYZEN 2/9/2016 6L FINSENSIUS DOLI TERUSAN 6103050902160001 1

7 VIOLETA ANGGI 2/26/2016 6P FERONIKA TERUSAN 6103056602160001 1

8 YUDI 5/1/2016 6L HELENA SISKA TERUSAN 6103050105160001 1

10 CALFIN 12/30/2015 6L CANDRA GUNAWAN BONTI 6103053122150001 1

11 AZKA YUDISTIRA 10/2/2015 6L NOPITA SARI BONTI 61030502101150001 1

13 M.ZAKI MIRZA 2/12/2016 6L SUHAITIANI BONTI 6103051202160002 1

14 MERRY RIANA 7/1/2016 6P YANTI UPE 6103054107160003 1

15 RAYA ALISKA 6/22/2017 4P SANTI BONTI 6103056206170000 1

16 LIONEL PUTRA.R. 11/23/2016 6L LUSIA RUPIA TERINTING 6103052311150002 1

17 SYCHA AISYAH SAFIRA 5/13/2017 5 + P DEWI RITA BONTI 6103055303170001 1

19 M.IBRAHIM ADAM 9/29/2016 6L YUSNAENI BONTI 6103052909160001 1

21 ALVENSIUS LUIS NENG 11/17/2016 6L VEGENIUS YANTO TERUSAN 610305171160002 0

22 YOHANES NOVIRUS JERI 11/7/2016 6L A.JO.OL TERUSAN 6103050711160001 1

24 GEOGRIUS APRILIO 4/21/2017 5+ L DOMINIKUS DONI TERUSAN 6103052104170001 1

25 GEOGRIA APRILIANI 4/21/2017 5+ P DOMINIKUS DONI TERUSAN 6103056604170001 1

27 RATU ANANDA PUTRI 2/5/2016 6P TRISNAWti TERINTING 6103054502160001 1

29 CARISA GRISELDA 12/29/2016 5+ P MARKUS RIKO UPE 6103056912160001 1

30 HILARI JI ARESHA 1/1/2017 5+ P TERESIA BULAN TERINTING 6103054101170001 1

31 ALANG KAENAN 6/29/2016 6L RISWANDI BONTI 6103052906160001 1

32 JULIAN LIBERTO 7/10/2016 5+ L ELIGIA LILI TERINTING 6103052311160002 1

33 VALENTINUS TRISTO 7/16/2016 5+ L MONIKA IKA TERUSAN 6103051607160002 1

35 MARSIANUS YONUS 9/7/2016 5+ L NATALIA MARNI TERINTING 6103050709160001 1

36 REZA 1/6/2016 6L NENI BONTI 61030500601160001 1

Campak Ket** (bila anak mendapatkan dosis

1 FEBRIANUS YUDA 2/15/2015 7 L PINUS TOMAS Dsn. Petuo 6103051502150001 0 kls 1

Ket** (bila anak mendapatkan dosis

Ket** (bila anak mendapatkan dosis

Ket** (bila anak mendapatkan dosis

Imunisasi Kejar (Ya = 1, Tidak Ket** (bila anak mendapatkan dosis

Imunisasi Kejar (Ya = 1, Tidak Ket** (bila anak mendapatkan dosis

Imunisasi Kejar (Ya = 1, Tidak Ket** (bila anak mendapatkan dosis

Jumlah vaksin (vial) dan logistik yang digunakan

Imunisasi Kejar (Ya = 1, Tidak Ket** (bila anak mendapatkan dosis

Jumlah vaksin (vial) dan logistik yang digunakan

Imunisasi Kejar (Ya = 1, Tidak Ket** (bila anak mendapatkan dosis

Imunisasi Kejar (Ya = 1, Tidak Ket** (bila anak mendapatkan dosis

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