FORMAT REKAPITULASI DESA PENDATAAN POSYANDU SASARAN BIAN

SASARAN IMUNISASI TAMBAHAN CAMPAK RUBELA ADALAH 9-59 BULAN DAN SASARAN IMUNISASI KEJAR
PELAKSANAAN : AGUSTUS 2022
Provinsi : JAWA BARAT
Kabupaten : GARUT
Puskesmas : CISURUPAN

Apakah anak sasaran

Apakah anak Imunisasi Kejar Apakah Anak
merupakan sasaran (Ya = 1, Tidak = 0) merupakan sasaran
No. Nama Posyandu
Imunisasi Tambahan imunisasi KEJAR
Campak Rubella (Ya=1, OPV IPV DPT-HB-Hib (Ya = 1 , Tidak = 0)
Tidak = 0)
1 GANDA MEKAR 1 144 17 16 16 31
2 GANDA MEKAR 2 139 91 118 100 119
3 GANDA MEKAR 3 39 4 3 4 5
4 GANDA MEKAR 4 58 2 8 9 13
5 GANDA MEKAR 5 70 5 9 5 11
6 GANDA MEKAR 6 15 0 0 3 3
TOTAL 465 119 154 137 182
TOTAL VIAL VAKSIN (Jumlah Vial = Jumlah

IP Vaksin:
MR = 8
OPV = 8
IPV = 4
DPT-HB-Hib = 4
Catatan:
Anak yang sudah mendapatkan ORI Campak Rubela, tidak perlu mendapatkan imunisasi tambahan Campak Rubela s
Total kebutuhan vial yang dibutuhkan yang mengacu pada perhitungan baris total vial vaksin
Anak usia 18-24 bulan yang pada saat bersamaan mendapatkan imunisasi rutin (DPT-HB-Hib4 dan Campak rubella 2)
Kebutuhan Vaksin Khusus Campak Rubela = (Total Sasaran - Sudah Mendapatkan ORI Campak Rubela sejak Januar
SASARAN IMUNISASI BIAN:
Imunisasi Kejar
: Lahir pada bulan Sept 2017 - bulan Agust 2021
Imunisasi :CR
Lahir pada bulan Sept 2017 - bulan Oktober 2021

Kolom Tambahan:
*) Jumlah Dosis Vaksin yang pernah didapat

= Diisi manual
SASARAN IMUNISASI KEJAR ADALAH 12-59 BULAN

Jumlah dosis yang dibutuhkan untuk Rencana Pemberian Dosis Sasaran

melengkapi status imunisasi Imunisasi Kejar & CR Pada Bulan Agustus Suntikan
Bulan Agustus
OPV IPV DPT-HB-Hib OPV IPV DPT-HB-Hib CR

20 16 20 17 16 16 144 176
344 118 354 91 118 100 139 357
4 3 4 4 3 4 39 46
8 8 16 2 8 9 58 75
5 9 6 5 9 5 70 84
0 0 3 0 0 3 15 18
381 154 403 119 154 137 465 756
VAKSIN (Jumlah Vial = Jumlah Total Sasaran/IP Vaksin) 15 39 35 59

si tambahan Campak Rubela sejak Januari 2022

B-Hib4 dan Campak rubella 2) maka tetap masuk dalam Sasaran Imunisasi Kejar
Campak Rubela sejak Januari 2022)/IP vaksin
Apakah anak
sasaran BIAN
(Agustus)

144
139
39
58
70
15
465
FORMAT PENDATAAN KEBUTUHAN TENAGA DAN JADWAL PELAKSANAAN BULAN IMUNISASI ANAK NASIONAL
Provinsi : : JAWA BARAT
Kabupaten: : GARUT
Puskesmas: : CISURUPAN

Rencana Pemberian Dosis Sasaran

Imunisasi Kejar & CR Pada Bulan Agustus
Nama
No. Nama Pos Pelayanan
Desa/Kelurahan
OPV IPV DPT-HB-Hib CR

1 DESA SUKARASA GANDA MEKAR 1 17 16 16 144

2 GANDA MEKAR 2 91 118 100 139
3 GANDA MEKAR 3 4 3 4 39
4 GANDA MEKAR 4 2 8 9 58
5 GANDA MEKAR 5 5 9 5 70
6 GANDA MEKAR 6 0 0 3 15
7
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55
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57
58
59
60
119 154 137 465

= link ke pendataan sasaran per posyandu

= Diisi manual
UNISASI ANAK NASIONAL

Jumlah Kebutuhan Tenaga

Jumlah Total Jumlah anak
sasaran BIAN
Suntikan
(Agustus) Supervisor
Nakes lainnya Guru/Kader
Vaksinator (1 Supervisor -->
(1 org/posy) (2 org/posy)
3 posyandu)
176 144 4
357 139 8
46 39 1
75 58 2
84 70 2
18 15 1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
 0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
756 465
 Tanggal
Daftar Nama Tim Pelaksana Pelaksanaan
Layanan
FORMAT PENDATAAN KEBUTUHAN LOGISTIK DAN COLD CHAIN

Nama Provinsi : JAWA BARAT

Nama Kabupaten : GARUT
Nama Puskesmas : CISURUPAN

Jumlah TOTAL Rencana Kebutuhan Vaksin (Vial) Pada Bulan

Nama Pos Agustus-September
No. Nama Desa/Kelurahan
Pelayanan OPV IPV DPT-HB-Hib

DESA SUKARASA GANDA MEKAR 1 3 4 4

GANDA MEKAR 2 12 30 25
GANDA MEKAR 3 1 1 1
GANDA MEKAR 4 1 2 3
GANDA MEKAR 5 1 3 2
GANDA MEKAR 6 0 0 1

TOTAL

= link ke pendataan sasaran per posyandu

= Diisi manual
han Vaksin (Vial) Pada Bulan
Rencana Jumlah Kebutuhan Logistik
ptember
Campak Rubela Dropper Pelarut MR ADS 5 ml ADS 0.5 ml Pen Marker Safety box

18 3 18 18 176 1 1
18 12 18 18 357 1 1
5 1 5 5 46 1 1
8 1 8 8 75 1 1
9 1 9 9 84 1 1
2 0 2 2 18 1 1

18 60 60 756 6 6
Jumlah Cold Chain Tersedia Jumlah
dan Berfungsi Kebutuhan
Vaccine Vaccine
Refrigerator
Carrier Carrier
 FORMAT PENDATAAN POSYANDU SASARAN BIAN
SASARAN IMUNISASI TAMBAHAN CAMPAK RUBELA ADALAH 9-59 BULAN DAN SASARAN IMUNISASI KEJAR
PELAKSANAAN : AGUSTUS 2022 01 Agustus 2022
Provinsi : JAWA BARAT Desa/Kelurahan
Kabupaten : GARUT Posyandu
Puskesmas : CISURUPAN
Isilah kolom yang berwarna PUTIH!

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

1 A HANIF 9/19/2018 3205201909180002 

2 ABIZAR 7/14/2018 3205201407180011 
3 ADAWIYAH 2/5/2020 3205204502200001 
4 ADEEVA 8/25/2018 3205206508180004 
5 ADINDA H 12/17/2020 3205205712200001 
6 AGIS WIJAYANTO 3/17/2018 3205201703180045 
7 AGISNI NADIA 1/2/2018 3205204201180003 
8 AGNIA 9/30/2020 3205203009206125 
9 AHMAD NIZAM 2/12/2020 3205201202200024 
10 AHNAF 5/30/2020 3205203005200003 
11 AI RINDA 4/11/2018 3205205104180007 
12 AI ROPI R 9/13/2017 3205201309170027 
13 AINUN 10/10/2019 3205201010190031 
14 AISHAD 3/6/2020 3205200603200001 
15 AISYAH 4/23/2020 3205202304208163 
16 AKRAM 1/5/2020 3205200501200026 
17 AKSA 8/3/2020 3205200308200001 
18 ALFIYAH 10/16/2019 3205201610190036 
19 ALIFAH 9/3/2017 3205430920170010 
20 ALIYA YASNA M 4/2/2018 3205204204180006 
21 ALMAIRA 11/2/2019 3205200211190034 
22 ALMIRA 6/6/2020 3205204606200002 
23 ALWIYATU 9/19/2018 3205201909180029 
24 ANASYA 1/11/2019 3205205103190002 
25 ANDIN 12/2/2018 3205204212180002 
26 ARAS M 6/14/2018 3205201406180010 
27 ARSILA D 2/4/2021 3205200402217521 
28 ARSY 11/24/2017 3205202411172128 
29 ASKILA 10/22/2019 3205202210190037 
30 AZFER 11/27/2018 3205202711180053 
31 AZHARIL 4/13/2018 3205201304180003 
32 AZKA 9/2/2019 3205200209190001 
33 AZKIYA 12/14/2018 3205201412180398 
34 CLARISSA 7/8/2020 3205200807207126 
35 DAFA 12/3/2019 3205200312190022 
36 DAFA M D 2/3/2020 3205200302200001 
37 DAFIYA 9/6/2020 3205200609207372 
38 DANI A 12/18/2019 3205201912190043 
39 DELA NURHASANAH 12/13/2018 3205201312180347 
40 DELISA A 11/29/2019 3205206911190002 
41 DIN DIN 12/12/2017 3205201212170001 
42 DINA N P 9/19/2020 3205201909207123 
43 DIVA N 3/13/2019 3205201303190405 
44 FADIL 2/5/2019 3205200502190017 
45 FAHMI 1/18/2019 3205201801190002 
46 FAHRI 12/14/2019 3205201412190033 
47 FAISAL 8/18/2020 3205201808200003 
48 FATUR 11/11/2019 3205201111190019 
49 FITRIANI 12/6/2017 3205204612170008 
50 GINA 7/30/2020 3205203007203516 
51 GOZALI 11/14/2019 3205201411190020 
52 HANDIKA P 2/28/2021 3205202802218384 
53 HASAN 8/19/2019 3205201908190002 
54 HOPIPAH 9/18/2020 3205201809207361 
55 HUMAIRA 2/15/2020 3205201502200041 
56 ISAN 12/12/2017 3205201212170004 
57 ISMAIL 11/25/2019 3205202511190021 
58 JIHAN TALITA 2/9/2018 3205204902180002 
59 JULIYANTI 6/19/2019 3205205906190002 
60 KELVIN 5/28/2020 3205202805290001 
61 LUSI 3/13/2018 3205201303180028 
62 M ADRIAN 8/2/2019 3205200208190390 
63 M ALI 10/17/2017 3205201011170002 
64 M ARKAN 1/22/2018 3205202201180003 
65 M ARKAN 2/22/2018 3205202202180003 
66 M ARYAN 1/5/2018 3205200501182615 
67 M AZRIL 1/1/2019 3205200101190015 
68 M DIKRI 4/13/2018 3205201304180008 
69 M HUSEN 5/8/2018 3205200805180009 
70 M IRSYAM 11/29/2020 3205202911200002 
71 M JIBRIL 1/4/2019 3205200401190004 
72 M MIRAJ S 2/24/2021 3205202402218379 
73 M MUJIB 9/9/2018 3205200909180001 
74 M NABHAN 5/8/2018 3205200805180003 
75 M NAUFAL 1/1/2021 3205200101217328 
76 M NAUPAL 2/29/2020 3205202902200025 
77 M NURALFAN 9/29/2017 3205202909170001 
78 M RADITIA 1/27/2021 3205202701218373 
79 M RAFA 11/6/2020 3205200611207372 
80 M RIDO 12/12/2019 3205201212190021 
81 M RIDWAN 9/13/2020 3205201309207361 
82 M RIFAUL 11/22/2018 3205202211180392 
83 M RIVAL 11/11/2020 3205201111200003 
84 M YUSUF N 4/29/2018 3205202904180002 
85 M ZIDAN 9/11/2017 3205201109170002 
86 M. AFNAN 11/14/2018 3205201411180001 
87 M. SIDIQ 1/23/2019 3205202301190016 
88 M.ALFIAN 3/11/2019 3205201103190003 
89 M.ALVIN 5/9/2019 3205200905190006 
90 M.ARIFAN 10/19/2019 3205201910190018 
91 M.AZWAN 5/17/2019 3205201705190002 
92 M.HAFIDZ 5/31/2019 3205203105190002 
93 M.HISAN 9/25/2019 3205202509190003 
94 M.MIRWAN 6/21/2019 3205202106190038 
95 M.REHAN 2/20/2019 3205202002190004 
96 M.RIZKI S 6/13/2019 3205201307190021 
97 MAULANA 4/11/2019 3205201104190005 
98 MEISYA 5/14/2018 3205205405180004 
99 MIRA M 12/22/2019 3205202212190038 
100 MIRAJ 3/25/2020 3205202503208382 
101 MISBAHUL 7/5/2018 3205200507180005 
102 MUTIARA 9/21/2019 3205202109190030 
103 NADIA 2/21/2019 3205202102190402 
104 NADIRA 12/8/2019 3205204612190004 
105 NAIRA 4/19/2020 3205201904201583 
106 NARENDRA 12/22/2017 3205202212175247 
107 NAZWA 2/13/2020 3205201302200023 
108 NENG AMELIA 1/29/2019 3205209901190004 
109 NENG RESTI 1/2/2018 3205204201180033 
110 NIZAM 8/29/2020 3205202908203723 
111 NOUREEN 2/13/2019 3205201302190404 
112 NOVA 10/1/2019 3205204110190004 
113 NURMILAH 12/11/2017 3205511220170000 
114 NURZAKIYAH 10/11/2019 3205205110190001 
115 PINA 12/10/2019 3205201012190043 
116 RADIP P 12/22/2017 3205202212170002 
117 RAFHA 11/17/2017 3205201711170044 
118 RAFKA 5/24/2020 3205202405206238 
119 RAHMAWATI 1/16/2019 3205201601190400 
120 RAHMI F 7/8/2020 3205204807200002 
121 RAISA A 8/14/2020 3205205408200002 
122 RAISA PUTRI D 11/28/2017 3205206811170001 
123 RAMDAM 5/29/2019 3205202905190007 
124 RANGGA 8/2/2018 3205200208180012 
125 REZFAN 12/19/2018 3205201912180014 
126 RISA N 12/23/2020 3205202312208216 
127 RISAN S 5/22/2020 3205202205208371 
128 RISKI F 7/19/2019 3205201907190002 
129 SAILAA 3/13/2020 3205205303200003 
130 SANIA 5/7/2018 3205204705180004 
131 SANSAN 2/5/2019 3205200502190002 
132 SHAFA 10/14/2020 3205201410208316 
133 SHERIL NAJWA 12/18/2017 3205205812170003 
134 SITI RUKAYAH 5/20/2019 3205206605190001 
135 SITI SOPIAH 3/13/2018 3205201303180406 
136 SYAKILA 2/1/2020 3205200102200039 
137 TAMIM 9/2/2020 3205200209208372 
138 TARI 7/17/2020 3205205707200001 
139 THALITA 5/21/2019 3205206105190002 
140 YAUMI 4/29/2020 3205202904208126 
141 Z SAKILA 11/4/2019 3205200411190033 
142 ZAHIRA N 10/24/2019 3205202410190035 
143 ZAHIRA Q 10/30/2019 3205203010190032 
144 ZEN ABDUL 4/10/2020 3205201004200001 
145
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203
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332
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357
358
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360
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368
369
370
371
372
373
374
375
376
377
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379
380
381
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383
384
385
386
387
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389
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391
392
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394
395
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398
399
400
401
402
403
404
405
406
407
408
409
410
411
412
413
414
415
416
417
418
419
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421
422
423
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430
431
432
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434
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449

450
451
452
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455
456
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459
460
461
462
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473
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482
483
484
485
486
487
488
489
490
491
492
493
494
495
496
497
498
499
500

TOTAL
IP Vaksin:
MR = 8
OPV = 8
IPV = 4
DPT-HB-Hib = 4
Catatan:
Anak yang sudah mendapatkan ORI Campak Rubela, tidak perlu mendapatkan imunisasi tambahan Campak Rubela s
Total kebutuhan vial yang dibutuhkan yang mengacu pada perhitungan baris total vial vaksin
Anak usia 18-24 bulan yang pada saat bersamaan mendapatkan imunisasi rutin (DPT-HB-Hib4 dan Campak rubella 2)
Kebutuhan Vaksin Khusus Campak Rubela = (Total Sasaran - Sudah Mendapatkan ORI Campak Rubela sejak Januar
SASARAN IMUNISASI BIAN:
Imunisasi Kejar : Lahir pada bulan Sept 2017 - bulan Agust 2021
Imunisasi CR : Lahir pada bulan Sept 2017 - bulan Oktober 2021

Kolom Tambahan:
*) Jumlah Dosis Vaksin yang pernah didapat
JENIS KELAMIN
L
P
RAN IMUNISASI KEJAR ADALAH 12-59 BULAN
(Disesuaikan dengan tgl pelaksanaan di masing-masing Posyandu)
: SIRNAJAYA
GANDA MEKAR 1 9-59 BLN

*) Jumlah Dosis Vaksin yang

pernah didapat
Nama Orang Tua (IBU) Alamat Umur (bulan)

OPV IPV DPT-HB-Hib

ENJANG KP CIWARU 4 1 4 46
JAJANG R KP.CIWARU 4 1 4 48
ASUM KP.CIWARU 4 1 4 29
ASEPUL KP BARU 4 1 4 47
HAYATUL F CIWARU 4 1 4 19
PEY KP.CIWARU 4 1 4 52
SUHENDAR KP. CIWARU 01/01 3 1 3 54
ULIS CIWARU 4 0 4 22
ADE S KP.CIWARU 4 1 4 29
ABDUL M CIWARU 4 1 4 26
IWIT KP BARU 4 0 4 51
ERIK S KP.CIWARU 4 0 4 58
MU KP.CIWARU 3 0 2 33
ANDRI PASIR EURIH 2 1 2 28
M DEDI R CIWARU 2 1 3 27
ENJANG KP.CIWARU 3 1 3 30
SUPRIATNA BARU 3 1 3 23
AYI SOLAH KP.CIWARU 4 1 4 33
RAHMAT KP.CIWARU 4 1 4 58
AYI H KP.CIWARU 3 1 3 51
PATUROHMAN KP.CIWARU 4 1 4 32
DEDE CIKEDUNG 4 0 3 25
AYI S KP.CIWARU 4 1 4 46
II H KP.CIWARU 4 1 4 42
NINDI KP BARU 4 0 4 43
SUBHAN KP.CIWARU 4 0 4 49
M MAULANA CIWARU 3 1 3 17
SOLEHADIN CIWARU 3 1 3 56
SAHRUL KP.CIWARU 4 1 4 33
ENCON KP.CIWARU 4 1 4 44
ATEP KP.CIWARU 4 1 4 51
SAHID KP.CIWARU 4 1 4 34
AJANG KP CIWARU 4 1 4 43
HARIS CIWARU 4 1 4 24
JAJANG KP.CIWARU 4 1 4 31
AJAT BARU 4 1 4 29
ADE H CIWARU 4 1 4 22
DADANG KP.CIWARU 4 1 4 31
DANI KP.BARU 4 0 4 43
HERI KP.CIWARU 4 0 4 32
ISAK KP BARU 4 1 4 55
AYI CIWARU 4 1 4 22
ENDANG KP PASIR EURIH 4 1 4 40
DENI KP.CIWARU 4 1 4 41
JAJANG KP.CIWARU 4 1 4 42
TOTOH H KP.CIWARU 4 1 4 31
YANA CIWARU 4 1 4 23
AHMAD KP.CIWARU 4 1 4 32
ACENG K KP.CIKEDUNG 4 1 4 55
AKUB BARU 4 0 4 24
ASOP KP.CIWARU 4 1 4 32
M ANDI CIWARU 4 1 3 17
RUHIAT KP.CIWARU 4 1 4 35
APIP BARU 4 1 4 22
DEDI H KP.BARU 4 1 4 29
ASEP KP BARU 4 1 4 55
RUDI KP.CIWARU 4 1 4 32
HERMAN KP. PASIR EURIH 10/05 4 1 4 53
JAJANG ISAK KP CIWARU 4 1 4 37
IWAN BARU 4 1 4 26
RAPSAN KP.CIWARU 4 1 4 52
AEP H KP CIWARU 3 1 4 35
JANA KP CIWARU 3 1 4 57
M ANSOR KP CIWARU 4 1 4 54
IMAM KP CIWARU 4 1 4 53
GUPRON CIWARU 4 1 4 54
NOVA A KP.CIWARU 4 1 4 43
MULYANA KP.CIWARU 3 0 3 51
HUSNI M KP.CIWARU 3 1 3 50
ABDUSSALAM CIELA 4 1 4 20
A GOZALI KP.CIWARU 4 1 4 42
AGUS CIWARU 4 1 3 17
MAKSUDIN KP CIWARU 4 1 4 46
AYI R KP CIWARU 4 1 4 50
DADAN CIWARU 4 1 4 19
RIYAN KP.CIWARU 4 1 4 29
BURHANUDIN KP.BARU 4 1 4 58
NURJAMAH CIKEDUNG 4 0 4 18
ABDUL H PASIR EURIH 4 1 4 20
ISEP KP.CIWARU 4 1 4 31
HILMAN CIWARU 4 1 4 22
ADE RUDI KP BARU 4 1 4 44
HERMAWAN CIWARU 4 1 4 20
ENDANG K KP.BARU 4 1 4 51
ATEP KP CIWARU 4 1 4 58
SALMAM KP.BARU 4 1 4 44
MANDANG KP.CIWARU 4 1 4 42
DANI KP.CIWARU 4 0 2 40
JAJANG KP.CIKEDUNG 4 0 2 38
AEP KP.CIWARU 4 1 4 33
YUDI A KP.CIWARU 4 1 4 38
AGUS KP.CIWARU 4 1 4 38
JUHANA KP.CIWARU 4 1 4 34
DEDE R KP.CIWARU 4 1 4 37
MUHLIS KP.CIWARU 4 1 4 41
RONI KP.CIWARU 4 1 4 37
SAMSUL KP.CIWARU 4 1 4 39
MIFTAH KP CIWARU 4 1 4 50
DENI KP.CIWARU 4 1 4 31
ILHAM CIWARU 4 1 4 28
SUHENDAR KP.BARU 4 1 4 48
IIN KP.CIWARU 4 1 4 34
RAHMAN KP CIWARU 4 0 4 41
SARIF H KP.CIWARU 4 0 4 31
SUANDIWAN BARU 4 1 4 27
KOSTIWANA CIWARU 4 1 4 55
GUNGUN KP.CIWARU 4 1 4 29
DIMAN KP.CIWARU 4 1 4 42
DADAN KP.CIWARU 4 1 4 54
AEP CIWARU 4 1 4 23
SOLAHUDIN KP CIWARU 4 1 4 41
JAJANG CIWARU 4 1 4 34
HISANUDIN KP. CIWARU 11/01 4 1 4 55
TATANG KP.CIWARU 4 1 4 33
AYI ITANG KP.CIWARU 4 1 4 31
OO S KP. CIWARU 02/01 4 1 4 55
AJIS S KP.CIWARU 3 1 3 56
DADAN PASIR EURIH 3 1 3 26
KOKO KP CIWARU 4 1 4 42
UWAN CIWARU 3 1 3 24
IWIT BARU 4 1 4 23
HARDIANA KP. BARU 04/05 4 1 4 56
ARA KP.BARU 4 1 4 38
UUS KP.PASIR EURIH 4 1 4 47
TOTOH KP.CIWARU 4 1 4 43
ISLAN CIWARU 4 1 4 19
HASAN CIWARU 4 1 4 26
ADIN KP.CIWARU 4 1 4 36
WAWAN CIWARU 4 1 4 28
AGUS KP PASIR EURIH 4 1 4 50
IWAN KP.BARU 4 1 4 41
A ROHENDI CIKEDUNG 4 1 4 21
UUS K KP. CIKEDUNG 01/05 4 1 4 55
ADID H KP.CIWARU 2 1 4 38
SODIKIN KP CIWARU 4 1 4 52
RAHAYU KP.CIWARU 4 1 4 30
IYAN CIWARU 4 1 4 22
SYARIF CIWARU 4 1 4 24
ABIB KP.CIWARU 4 1 4 38
HISANUDIN CIWARU 4 1 4 27
SUTISNA KP.CIWARU 4 1 4 32
EUTIK KP.CIWARU 4 1 4 33
ENDANG KP.CIWARU 4 1 4 33
IWAN H CIWARU 4 1 4 27
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bahan Campak Rubela sejak Januari 2022

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

an Agust 2021
an Oktober 2021
Apakah anak merupakan Apakah anak sasaran Imunisasi Kejar Apakah Anak Jumlah dosis yang dibutuhkan untu
sasaran Imunisasi (Ya = 1, Tidak = 0) merupakan sasaran melengkapi status imunisasi
Tambahan
Campak Rubella (Ya=1,
imunisasi KEJAR
Tidak = 0) (Ya = 1 , Tidak = 0)
OPV IPV DPT-HB-Hib OPV

1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 1 0 1 1 1
1 0 1 0 1 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 1 0 1 0
1 0 1 0 1 0
1 1 1 1 1 1
1 1 0 1 1 2
1 1 0 1 1 2
1 1 0 1 1 1
1 1 0 1 1 1
1 0 0 0 0 0
1 0 0 0 0 0
1 1 0 1 1 1
1 0 0 0 0 0
1 0 1 1 1 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 1 0 1 0
1 0 1 0 1 0
1 1 0 0 1 1
1 1 0 1 1 1
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 1 0 1 0
1 0 1 0 1 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 1 0 1 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 1 0 0 1 1
1 1 0 0 1 1
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 1 1 1 1 1
1 1 0 1 1 1
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 1 0 1 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 1 1 1 0
1 0 1 1 1 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 1 0 1 0
1 0 1 0 1 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 1 0 1 1 1
1 1 0 1 1 1
1 0 0 0 0 0
1 1 0 1 1 1
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 1 0 0 1 2
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

144 17 16 16 31 20

TOTAL VIAL VAKSIN (Jumlah Vial = Jumlah Total Sasaran/IP V

Jumlah dosis yang dibutuhkan untuk Rencana Pemberian Dosis Sasaran
melengkapi status imunisasi Imunisasi Kejar & CR Pada Bulan Agustus Sasaran Apakah anak
Suntikan sasaran BIAN
Bulan Agustus (Agustus)
IPV DPT-HB-Hib OPV IPV DPT-HB-Hib CR

0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 1 1 0 1 1 2 1
1 0 0 1 0 1 2 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
1 0 0 1 0 1 2 1
1 0 0 1 0 1 2 1
1 2 1 1 1 1 3 1
0 2 1 0 1 1 2 1
0 1 1 0 1 1 2 1
0 1 1 0 1 1 2 1
0 1 1 0 1 1 2 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 1 1 0 1 1 2 1
0 0 0 0 0 1 1 1
1 1 0 1 1 1 3 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
1 0 0 1 0 1 2 1
1 0 0 1 0 1 2 1
0 0 1 0 0 1 1 1
0 1 1 0 1 1 2 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
1 0 0 1 0 1 2 1
1 0 0 1 0 1 2 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
1 0 0 1 0 1 2 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 1 0 0 1 1 1
0 0 1 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
1 1 1 1 1 1 3 1
0 1 1 0 1 1 2 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
1 0 0 1 0 1 2 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
1 2 0 1 1 1 3 1
1 2 0 1 1 1 3 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
1 0 0 1 0 1 2 1
1 0 0 1 0 1 2 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 1 1 0 1 1 2 1
0 1 1 0 1 1 2 1
0 0 0 0 0 1 1 1
0 1 1 0 1 1 2 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 1 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
16 20 17 16 16 144 176 144

ah Vial = Jumlah Total Sasaran/IP Vaksin) 3 4 4 18

Diisi pada saat pelayanan imunisasi Kejar & CR bulan Agustus (termasuk Sweeping pada Diisi pada saat pelayanan im
September) 2022 September 2
(JIKA DIIMUNISASI, ISI TANGGAL PELAYANAN) (JIKA DIIMUNISASI, ISI TANG

OPV IPV DPT-HB-Hib CR OPV

0 0 0 0 0
0 0 0 0 0
si pada saat pelayanan imunisasi Kejar pada
September 2022
KA DIIMUNISASI, ISI TANGGAL PELAYANAN)

IPV DPT-HB-Hib
0 0
0 0
 FORMAT PENDATAAN POSYANDU SASARAN BIAN
SASARAN IMUNISASI TAMBAHAN CAMPAK RUBELA ADALAH 9-59 BULAN DAN SASARAN IMUNISASI KEJAR
PELAKSANAAN : AGUSTUS 2022 01 Agustus 2022
Provinsi : JAWA BARAT Desa/Kelurahan
Kabupaten : GARUT Posyandu
Puskesmas : CISURUPAN
Isilah kolom yang berwarna PUTIH!

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

1 A HASBI 1/14/2019 3205201401190454 

2 A SAHRIL 9/23/2018 3205202309180031 
3 ABIJAR 7/4/2020 3205200407201267 
4 ACENG K A 12/16/2020 3205201612207162 
5 AFIFAH 2/1/2018 3205200102180026 
6 AISYAH RAHAYU 12/9/2018 3205200912180014 
7 AJHAR 10/22/2017 3205201001170009 
8 AKILA 8/16/2020 3205201608207126 
9 ALARIK F 1/4/2021 3205200401210006 
10 ALDA 12/3/2020 3205200312206125 
11 ALFAN 11/2/2018 3205200211180001 
12 ALFI A 7/1/2018 3205201210780001 
13 ALPIYAH 6/26/2020 3205206803200002 
14 ALIPIYA 1/31/2018 3205207101180033 
15 ALPAN 4/11/2018 3205200107000090 
16 ALYA 7/14/2018 3205205407180002 
17 ALYA L 1/15/2020 3205201501208372 
18 ALZAM 5/30/2019 3205203005190433 
19 AMIRA 5/20/2018 3205202005180436 
20 ANDINI 5/16/2018 3205201605180417 
21 ANISA K 6/21/2019 3205202106190429 
22 APIPAH 12/20/2020 3205206012200001 
23 ARSYI M 10/18/2020 3205201810207162 
24 ARSYILA 1/11/2019 3205201101190421 
25 ARUMI 1/2/2020 3205200201207217 
26 AZKAYNA HASHA 11/4/2018 3205204411180014 
27 AZMI M 4/27/2018 3205202704180001 
28 AZZAHRA KAMILA 1/11/2018 3205205101180003 
29 BILKIS 1/7/2020 3205202401190010 
30 BILQIS MULKIYAH 7/2/2019 3205204207190005 
31 CANDRA 1/1/2018 3205200101180443 
32 DANIES B 12/30/2018 3205203012180412 
33 DIANA 1/19/2020 3205205901200001 
34 ERI NURYANTI 5/8/2019 3205200815190448 
35 FATHUL ULUMUDIN 8/4/2019 3205200408190009 
36 FEBIAN M 4/23/2018 3205202304180411 
37 FISA 2/25/2019 3205202502190414 
38 HANA 8/2/2019 3205200208190018 
39 HANA HANIPAH 3/17/2019 3205201803190450 
40 HASAN 9/10/2018 3205201009180424 
41 HASNA 9/9/2019 3205204909190002 
42 HESTI M 9/10/2019 3205201009190021 
43 HIKMAH 1/18/2020 3205201801202616 
44 HILMA 10/21/2018 3205202005820001 
45 HILYA 2/7/2020 3205202001200001 
46 HILYA N 12/20/2020 3205202012208812 
47 HISAM 10/13/2018 3205201310180422 
48 HISNI N 11/17/2017 3205205711170002 
49 HUSEN 9/10/2018 3205201009180425 
50 HUSNATUL 11/19/2020 3205201911208912 
51 ILMA 10/17/2018 3205205709180003 
52 INDRI I 5/20/2020 3205206005200003 
53 IRMA N 8/8/2018 3205200808180415 
54 IRSAM 11/29/2020 3205202911207871 
55 IRSYAD A 10/10/2020 3205201010208217 
56 JAFAR 1/31/2018 3205203001180004 
57 JUAHIRAH 4/3/2020 3205200304201217 
58 KAPIKA 8/21/2018 3205204205180001 
59 KARINA 4/20/2019 3205206004190001 
60 KAYLA AZAHRA 5/8/2019 3205204805190001 
61 KISWAN 1/20/2020 3205202001200017 
62 LANGGAR 8/31/2018 3205203108180409 
63 LUTFI 12/28/2018 3205202812180015 
64 M ABDUL 3/13/2018 3205201303180029 
65 M ALFIN 3/27/2018 3205200808900102 
66 M ARKAN 11/11/2018 3205201104860001 
67 M ATHAR 8/2/2020 3205202019180001 
68 M AZKA 6/10/2020 3205341006200001 
69 M DZAKIRIL 1/1/2019 3205200101190408 
70 M FADIL 2/1/2020 3205200102200022 
71 M FARHAN 12/8/2019 3205200812190006 
72 M FAUZAN 9/29/2020 3205201909208612 
73 M HAFID 3/21/2020 3205202103208372 
74 M HAFIZD 2/7/2020 3205200702200016 
75 M HASANUDIN 12/2/2018 3205202309660002 
76 M JUMHUR 12/14/2018 3205201412180004 
77 M KAHFI 5/31/2019 3205203105190025 
78 M MALQI R 10/15/2018 3205201510182156 
79 M NABIL 12/18/2017 3205181220170000 
80 M NADIP 8/21/2018 3205202108180008 
81 M RAYAN 3/23/2020 3205202303208712 
82 M RIZKI A 12/11/2020 3205201112208827 
83 M ROFI 10/23/2017 3205202310170002 
84 M SALAAM 9/28/2020 3205202809203713 
85 M SALMAN 1/20/2020 3205201702160006 
86 M SAPUTRA 11/1/2019 3205200111197216 
87 MAHERA 12/14/2019 3205201412198216 
88 MASPUPAH 8/17/2018 3209285708180002 
89 MIYAZ 5/3/2019 3205200305190432 
90 MUDRIKA 5/28/2018 3205202806180005 
91 MUHAMMAD 11/7/2019 3205200711190003 
92 NABILA 9/28/2019 3205202809190027 
93 NADIRA 4/12/2020 3205201204208372 
94 NASEP 6/16/2019 3205201606190427 
95 NASYATUL 1/5/2020 3205204501200003 
96 NATAN 4/1/2020 3205200104207182 
97 NAZIL M 1/13/2018 3205201301180413 
98 NIA KALESYA 8/13/2019 3205201308190452 
99 NIJAM 8/27/2018 3205200702150004 
100 NIZAR 2/12/2018 3205201207180001 
101 NOVAL 7/1/2019 3205200107190431 
102 NUR NAIRA 7/23/2020 3205206307200002 
103 NURLA INSIROH 1/5/2020 3205204501200002 
104 NURUL 2/10/2019 3205201002190416 
105 PARHATU 3/17/2018 3205201807700001 
106 RAFKA A 12/11/2020 3205201112208172 
107 RAISA 6/1/2018 3205200106180444 
108 RASYID 7/27/2019 3205202707190434 
109 RAYAN 7/22/2018 3205202207180001 
110 RIFDA 1/26/2020 3205206601200004 
111 RIFIKSI 6/17/2020 3205201706208862 
112 RISTI AIRA 12/23/2019 3205202312190010 
113 RIZKAN 3/8/2018 3205200803180001 
114 RIZKI 9/7/2019 3205200709190023 
115 SAFA 8/10/2020 3205205008200001 
116 SAHIRA 10/9/2019 3205204910190003 
117 SAHNAS 8/1/2019 3205200108190011 
118 SALSABILA 4/27/2019 3205206704190002 
119 SALWA 2/18/2019 3205201802190036 
120 SALWA 6/26/2020 3205202606208391 
121 SAPIRA 2/4/2020 3205200402200012 
122 SIFA 8/8/2019 3205200808190019 
123 SILMI 6/14/2018 3205205410718001 
124 SITI NUR 3/8/2019 3205200803190033 
125 SITI NUR H 7/27/2018 3205206707180004 
126 SITI SALWA 5/5/2018 3205204505180004 
127 SOPWAN 1/11/2019 3205201101190002 
128 TAOPIK 8/1/2019 3205200108190013 
129 TASYA 4/17/2018 3205201704180440 
130 U SUKRON 10/15/2018 3205201510180002 
131 WAFI 12/11/2019 3205201112190435 
132 WILDAN R 6/13/2018 3205201306180003 
133 WIRDA NAINATUL HASANAH 6/29/2018 3205202906180447 
134 WISHA 9/5/2020 3205200509208713 
135 YASMIN NAZWA 3/27/2019 3205202703190449 
136 YUNA 2/18/2019 3205201802190455 
137 ZAHIDA 12/2/2017 3205204212170004 
138 ZIHAN H 2/3/2018 3205204302180002 
139 ZULFA 12/25/2018 3205206512180005 
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
200
201
202
203
204
205
206
207
208
209
210
211
212
213
214
215
216
217
218
219
220
221
222
223
224
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239
240
241
242
243
244
245
246
247
248
249
250
251
252
253
254
255
256
257
258
259
260
261
262
263
264
265
266
267
268
269
270
271
272
273
274
275
276
277
278
279
280
281
282
283
284
285
286
287
288
289
290
291
292
293
294
295
296
297
298
299
300
301
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320
321
322
323
324
325
326
327
328
329
330
331
332
333
334
335
336
337
338
339
340
341
342
343
344
345
346
347
348
349
350
351
352
353
354
355
356
357
358
359
360
361
362
363
364
365
366
367
368
369
370
371
372
373
374
375
376
377
378
379
380
381
382
383
384
385
386
387
388
389
390
391
392
393
394
395
396
397
398
399
400
401
402
403
404
405
406
407
408
409
410
411
412
413
414
415
416
417
418
419
420
421
422
423
424
425
426
427
428
429
430
431
432
433
434
435
436
437
438
439
440
441
442
443
444
445
446
447
448
449

450
451
452
453
454
455
456
457
458
459
460
461
462
463
464
465
466
467
468
469
470
471
472
473
474
475
476
477
478
479
480
481
482
483
484
485
486
487
488
489
490
491
492
493
494
495
496
497
498
499
500

TOTAL
IP Vaksin:
MR = 8
OPV = 8
IPV = 4
DPT-HB-Hib = 4
Catatan:
Anak yang sudah mendapatkan ORI Campak Rubela, tidak perlu mendapatkan imunisasi tambahan Campak Rubela s
Total kebutuhan vial yang dibutuhkan yang mengacu pada perhitungan baris total vial vaksin
Anak usia 18-24 bulan yang pada saat bersamaan mendapatkan imunisasi rutin (DPT-HB-Hib4 dan Campak rubella 2)
Kebutuhan Vaksin Khusus Campak Rubela = (Total Sasaran - Sudah Mendapatkan ORI Campak Rubela sejak Januar
SASARAN IMUNISASI BIAN:
Imunisasi Kejar : Lahir pada bulan Sept 2017 - bulan Agust 2021
Imunisasi CR : Lahir pada bulan Sept 2017 - bulan Oktober 2021

Kolom Tambahan:
*) Jumlah Dosis Vaksin yang pernah didapat
JENIS KELAMIN
L
P
RAN IMUNISASI KEJAR ADALAH 12-59 BULAN
(Disesuaikan dengan tgl pelaksanaan di masing-masing Posyandu)
: SIRNAJAYA
GANDA MEKAR 2

*) Jumlah Dosis Vaksin yang

pernah didapat
Nama Orang Tua (IBU) Alamat Umur (bulan)

OPV IPV DPT-HB-Hib

A WAHID KP CIELA 4 0 4 42
IRAD KP.PASIR POGOR 4 1 4 46
HASAN CIELA 4 1 4 24
AROH CIELA 0 0 0 19
ADE KURNIAWAN KP.CIELA 0 0 0 54
ABDUL HOLIK KP.CIELA 0 0 0 43
M TATANG KP CIELA 0 0 0 57
ODIN CIELA 4 1 4 23
NURASIAH CIELA 0 0 0 18
ANISA CIELA 4 1 4 19
DADANG KP CIELA 0 0 0 44
AYI MA KP CIELA 0 0 0 49
UUS CIELA 2 0 2 25
ALIMAN KP.CIELA 0 0 0 54
ISAN KP CIELA 0 0 0 51
UBAIDILAH KP CIELA 0 0 0 48
SAEPUL R PASIR POGOR 0 0 0 30
ROHMAT KP CIELA 4 1 4 38
H DENI KP CIELA 0 0 0 50
DEDE R KP CIELA 0 0 0 50
EGI KP CIELA 0 0 0 37
IIS PASIR POGOR 4 1 4 19
AI SOLIHAH CIELA 4 0 4 21
PURNAMA KP CIELA 0 0 0 42
KINA PUSPA N 0 0 0 30
A IDAN KP CIELA 4 1 4 44
DEDE ISEP KP CIELA 0 0 0 51
MUHLIS KP CIELA 0 0 0 54
IWAN KP.CIELA 4 0 4 30
ENTIS KP CIELA 2 0 2 36
ABDUROHMAN KP CIELA 0 0 0 55
ALAM KP CIELA 0 0 0 43
DEDE NURJAMAN KP.CIELA 4 0 4 30
KARSUM KP CIELA 4 0 4 38
MUSTIKA KP.PASIR POGOR 0 0 0 35
ENTIS KP CIELA 0 0 0 51
CUNILAY KP CIELA 0 0 0 41
ABDUL MALIKUL KP.CIELA 4 1 4 35
ABDUL FATAH KP CIELA 4 1 4 40
H MARA KP CIELA 0 0 0 46
TATANG KP.CIELA 4 0 4 34
TATANG S KP.PASIR POGOR 4 0 4 34
IBAH CIELA 4 0 4 30
JAJANG KP CIELA 0 0 0 45
DEDE SAEPULROHMAN KP.CIELA 4 1 4 29
ANI N CIELA 0 0 0 19
SOPIYULOH KP CIELA 0 0 0 45
ILHAM KP. CIELA 01/03 4 0 3 56
H MARA KP CIELA 0 0 0 46
FITRIANI CIELA 4 1 4 20
INA PUSPA N 0 0 0 45
ST SAADAH PUSPA N 4 1 4 26
ANDRES KP CIELA 0 0 0 47
ST NUR P PUSPA N 0 0 0 20
H MARYANI CIELA 4 0 4 21
UJANG A KP CIELA 0 0 0 54
SOLIHAH CIELA 4 0 3 27
TATANG KP CIELA 4 1 4 47
SUPRIYADI KP CIELA 1 0 1 39
RIKI KP CIELA 2 0 2 38
SANUSI KP.CIELA 4 0 3 30
MUHIBIN KP CIELA 0 0 0 47
PERI KP.CIELA 0 0 0 43
IDIN KP.PASIR POGOR 0 0 0 52
MUMU KP PASIR POGOR 0 0 0 52
JUJUN KP CIELA 0 0 0 44
DEDE ABDUL KP CIELA 2 0 2 23
ASEP C PASIR POGOR 0 0 0 25
ANDI R KP CIELA 4 0 4 43
ALI KP.PASIR POGOR 0 0 0 30
AZIZ KP.PASIR POGOR 0 0 0 31
MASRIPAH PASIR POGOR 0 0 0 22
AI SAN SAN CIELA 4 1 4 28
DEDE MUTAQIN KP.CIELA 4 0 3 29
A ROHMAN KP CIELA 0 0 0 43
IWAN S KP CIELA 0 0 0 43
HAMDANI KP.CIELA 2 1 2 38
IIS PUSPA N 0 0 0 45
SASA SAEPUL KP. CIELA 04/03 0 0 0 55
NURDIN KP.PASIR POGOR 0 0 0 47
DONI CIELA 1 0 1 28
YANI PUSPA N 0 0 0 19
MUSLIM PASIRPOGOR 05/02 4 0 3 57
ST NURJANAH CIELA 0 0 0 22
NURHADIN KP.CIELA 0 0 0 30
ASEP PASIR POGOR 0 0 0 33
LAELI CIELA 4 0 4 31
WAWAN KP.CIELA 0 0 0 47
RIZAL KP CIELA 2 0 2 38
EUTIK KP CIELA 0 0 0 50
IYAN KP.CIELA 0 0 0 32
AGUS KP.CIELA 3 0 2 34
IMRON PASIR POGOR 0 0 0 27
0 KP CIELA 0 0 0 37
ROMU KP.CIELA 0 0 0 30
ADE A PASIR POGOR 0 0 0 28
ALI HUSEN KP CIELA 0 0 0 54
JAENAL ABIDIN KP CIELA 4 1 4 35
NURDIN KP CIELA 4 0 3 47
ADE AAN KP.PASIR POGOR 0 0 0 53
ATEP KP CIELA 4 0 3 37
ST SOPIAH CIELA 0 0 0 24
ROMU KP.CIELA 0 0 0 30
AAB S KP CIELA 4 0 4 41
HOLIDIN KP CIELA 0 0 0 52
YANI PUSPA N 0 0 0 19
DIAN MARDIANA KP CIELA 0 0 0 50
ENGKUS KP CIELA 4 1 4 36
A MALIK KP PASIR POGOR 4 0 4 48
IIP KP.CIELA 2 0 2 30
ST AMINAH PUSPA N 4 1 4 25
ABDUL ROHMAN KP.PASIR POGOR 0 0 0 31
SAEPUL KP.CIELA 0 0 0 52
OMIH KP.PASIR POGOR 4 0 4 34
AGIS CIELA 4 1 4 23
HIDAYAT PUSPA N 4 0 3 33
IHAN KP.PASIR POGOR 0 0 0 36
UUN KP CIELA 4 0 4 39
H.DEDE KP.PASIR POGOR 0 0 0 41
ST HALIMAH CIELA 4 1 4 25
DANI KP.CIELA 4 0 4 29
SOLAHUDIN KP.CIELA 0 0 0 35
YAJID KP CIELA 4 1 4 49
NADIM KP.PASIR POGOR 4 0 4 40
A SOLEH KP CIELA 0 0 0 48
ENIP KP CIELA 0 0 0 50
DEDE A K KP CIELA 4 0 3 42
JANG HIDAYAT KP.CIELA 0 0 0 36
H DEDE KP CIELA 0 0 0 51
MU KP CIELA 0 0 0 45
IWAN KP CIELA 1 0 1 31
AAB KP CIELA 0 0 0 49
RIDWAN KP CIELA 0 0 0 49
WINDA CIELA 4 0 4 22
CUCU KP CIELA 0 0 0 40
0 KP CIELA 4 0 4 41
TAMAN KP CIELA 0 0 0 55
WILDAN PUSPANENGGANG 06/03 0 0 0 53
MUSLIM KP CIELA 0 0 0 43
1471
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bahan Campak Rubela sejak Januari 2022

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

an Agust 2021
an Oktober 2021
Apakah anak merupakan Apakah anak sasaran Imunisasi Kejar Apakah Anak Jumlah dosis yang dibutuhkan untu
sasaran Imunisasi (Ya = 1, Tidak = 0) merupakan sasaran melengkapi status imunisasi
Tambahan
Campak Rubella (Ya=1,
imunisasi KEJAR
Tidak = 0) (Ya = 1 , Tidak = 0)
OPV IPV DPT-HB-Hib OPV

1 0 1 0 1 0
1 0 0 0 0 0
1 0 0 0 0 0
1 1 1 1 1 4
1 1 1 1 1 4
1 1 1 1 1 4
1 1 1 1 1 4
1 0 0 0 0 0
1 1 1 1 1 4
1 0 0 0 0 0
1 1 1 1 1 4
1 1 1 1 1 4
1 1 1 1 1 2
1 1 1 1 1 4
1 1 1 1 1 4
1 1 1 1 1 4
1 1 1 1 1 4
1 0 0 0 0 0
1 1 1 1 1 4
1 1 1 1 1 4
1 1 1 1 1 4
1 0 0 0 0 0
1 0 1 0 1 0
1 1 1 1 1 4
1 1 1 1 1 4
1 0 0 0 0 0
1 1 1 1 1 4
1 1 1 1 1 4
1 0 1 0 1 0
1 1 1 1 1 2
1 1 1 1 1 4
1 1 1 1 1 4
1 0 1 0 1 0
1 0 1 0 1 0
1 1 1 1 1 4
1 1 1 1 1 4
1 1 1 1 1 4
1 0 0 0 0 0
1 0 0 0 0 0
1 1 1 1 1 4
1 0 1 0 1 0
1 0 1 0 1 0
1 0 1 0 1 0
1 1 1 1 1 4
1 0 0 0 0 0
1 1 1 1 1 4
1 1 1 1 1 4
1 0 1 1 1 0
1 1 1 1 1 4
1 0 0 0 0 0
1 1 1 1 1 4
1 0 0 0 0 0
1 1 1 1 1 4
1 1 1 1 1 4
1 0 1 0 1 0
1 1 1 1 1 4
1 0 1 1 1 0
1 0 0 0 0 0
1 1 1 1 1 3
1 1 1 1 1 2
1 0 1 1 1 0
1 1 1 1 1 4
1 1 1 1 1 4
1 1 1 1 1 4
1 1 1 1 1 4
1 1 1 1 1 4
1 1 1 1 1 2
1 1 1 1 1 4
1 0 1 0 1 0
1 1 1 1 1 4
1 1 1 1 1 4
1 1 1 1 1 4
1 0 0 0 0 0
1 0 1 1 1 0
1 1 1 1 1 4
1 1 1 1 1 4
1 1 0 1 1 2
1 1 1 1 1 4
1 1 1 1 1 4
1 1 1 1 1 4
1 1 1 1 1 3
1 1 1 1 1 4
1 0 1 1 1 0
1 1 1 1 1 4
1 1 1 1 1 4
1 1 1 1 1 4
1 0 1 0 1 0
1 1 1 1 1 4
1 1 1 1 1 2
1 1 1 1 1 4
1 1 1 1 1 4
1 1 1 1 1 1
1 1 1 1 1 4
1 1 1 1 1 4
1 1 1 1 1 4
1 1 1 1 1 4
1 1 1 1 1 4
1 0 0 0 0 0
1 0 1 1 1 0
1 1 1 1 1 4
1 0 1 1 1 0
1 1 1 1 1 4
1 1 1 1 1 4
1 0 1 0 1 0
1 1 1 1 1 4
1 1 1 1 1 4
1 1 1 1 1 4
1 0 0 0 0 0
1 0 1 0 1 0
1 1 1 1 1 2
1 0 0 0 0 0
1 1 1 1 1 4
1 1 1 1 1 4
1 0 1 0 1 0
1 0 0 0 0 0
1 0 1 1 1 0
1 1 1 1 1 4
1 0 1 0 1 0
1 1 1 1 1 4
1 0 0 0 0 0
1 0 1 0 1 0
1 1 1 1 1 4
1 0 0 0 0 0
1 0 1 0 1 0
1 1 1 1 1 4
1 1 1 1 1 4
1 0 1 1 1 0
1 1 1 1 1 4
1 1 1 1 1 4
1 1 1 1 1 4
1 1 1 1 1 3
1 1 1 1 1 4
1 1 1 1 1 4
1 0 1 0 1 0
1 1 1 1 1 4
1 0 1 0 1 0
1 1 1 1 1 4
1 1 1 1 1 4
1 1 1 1 1 4
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

139 91 118 100 119 344

TOTAL VIAL VAKSIN (Jumlah Vial = Jumlah Total Sasaran/IP V

Jumlah dosis yang dibutuhkan untuk Rencana Pemberian Dosis Sasaran
melengkapi status imunisasi Imunisasi Kejar & CR Pada Bulan Agustus Sasaran Apakah anak
Suntikan sasaran BIAN
Bulan Agustus (Agustus)
IPV DPT-HB-Hib OPV IPV DPT-HB-Hib CR

1 0 0 1 0 1 2 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
1 4 1 1 1 1 3 1
1 4 1 1 1 1 3 1
1 4 1 1 1 1 3 1
1 4 1 1 1 1 3 1
0 0 0 0 0 1 1 1
1 4 1 1 1 1 3 1
0 0 0 0 0 1 1 1
1 4 1 1 1 1 3 1
1 4 1 1 1 1 3 1
1 2 1 1 1 1 3 1
1 4 1 1 1 1 3 1
1 4 1 1 1 1 3 1
1 4 1 1 1 1 3 1
1 4 1 1 1 1 3 1
0 0 0 0 0 1 1 1
1 4 1 1 1 1 3 1
1 4 1 1 1 1 3 1
1 4 1 1 1 1 3 1
0 0 0 0 0 1 1 1
1 0 0 1 0 1 2 1
1 4 1 1 1 1 3 1
1 4 1 1 1 1 3 1
0 0 0 0 0 1 1 1
1 4 1 1 1 1 3 1
1 4 1 1 1 1 3 1
1 0 0 1 0 1 2 1
1 2 1 1 1 1 3 1
1 4 1 1 1 1 3 1
1 4 1 1 1 1 3 1
1 0 0 1 0 1 2 1
1 0 0 1 0 1 2 1
1 4 1 1 1 1 3 1
1 4 1 1 1 1 3 1
1 4 1 1 1 1 3 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
1 4 1 1 1 1 3 1
1 0 0 1 0 1 2 1
1 0 0 1 0 1 2 1
1 0 0 1 0 1 2 1
1 4 1 1 1 1 3 1
0 0 0 0 0 1 1 1
1 4 1 1 1 1 3 1
1 4 1 1 1 1 3 1
1 1 0 1 1 1 3 1
1 4 1 1 1 1 3 1
0 0 0 0 0 1 1 1
1 4 1 1 1 1 3 1
0 0 0 0 0 1 1 1
1 4 1 1 1 1 3 1
1 4 1 1 1 1 3 1
1 0 0 1 0 1 2 1
1 4 1 1 1 1 3 1
1 1 0 1 1 1 3 1
0 0 0 0 0 1 1 1
1 3 1 1 1 1 3 1
1 2 1 1 1 1 3 1
1 1 0 1 1 1 3 1
1 4 1 1 1 1 3 1
1 4 1 1 1 1 3 1
1 4 1 1 1 1 3 1
1 4 1 1 1 1 3 1
1 4 1 1 1 1 3 1
1 2 1 1 1 1 3 1
1 4 1 1 1 1 3 1
1 0 0 1 0 1 2 1
1 4 1 1 1 1 3 1
1 4 1 1 1 1 3 1
1 4 1 1 1 1 3 1
0 0 0 0 0 1 1 1
1 1 0 1 1 1 3 1
1 4 1 1 1 1 3 1
1 4 1 1 1 1 3 1
0 2 1 0 1 1 2 1
1 4 1 1 1 1 3 1
1 4 1 1 1 1 3 1
1 4 1 1 1 1 3 1
1 3 1 1 1 1 3 1
1 4 1 1 1 1 3 1
1 1 0 1 1 1 3 1
1 4 1 1 1 1 3 1
1 4 1 1 1 1 3 1
1 4 1 1 1 1 3 1
1 0 0 1 0 1 2 1
1 4 1 1 1 1 3 1
1 2 1 1 1 1 3 1
1 4 1 1 1 1 3 1
1 4 1 1 1 1 3 1
1 2 1 1 1 1 3 1
1 4 1 1 1 1 3 1
1 4 1 1 1 1 3 1
1 4 1 1 1 1 3 1
1 4 1 1 1 1 3 1
1 4 1 1 1 1 3 1
0 0 0 0 0 1 1 1
1 1 0 1 1 1 3 1
1 4 1 1 1 1 3 1
1 1 0 1 1 1 3 1
1 4 1 1 1 1 3 1
1 4 1 1 1 1 3 1
1 0 0 1 0 1 2 1
1 4 1 1 1 1 3 1
1 4 1 1 1 1 3 1
1 4 1 1 1 1 3 1
0 0 0 0 0 1 1 1
1 0 0 1 0 1 2 1
1 2 1 1 1 1 3 1
0 0 0 0 0 1 1 1
1 4 1 1 1 1 3 1
1 4 1 1 1 1 3 1
1 0 0 1 0 1 2 1
0 0 0 0 0 1 1 1
1 1 0 1 1 1 3 1
1 4 1 1 1 1 3 1
1 0 0 1 0 1 2 1
1 4 1 1 1 1 3 1
0 0 0 0 0 1 1 1
1 0 0 1 0 1 2 1
1 4 1 1 1 1 3 1
0 0 0 0 0 1 1 1
1 0 0 1 0 1 2 1
1 4 1 1 1 1 3 1
1 4 1 1 1 1 3 1
1 1 0 1 1 1 3 1
1 4 1 1 1 1 3 1
1 4 1 1 1 1 3 1
1 4 1 1 1 1 3 1
1 3 1 1 1 1 3 1
1 4 1 1 1 1 3 1
1 4 1 1 1 1 3 1
1 0 0 1 0 1 2 1
1 4 1 1 1 1 3 1
1 0 0 1 0 1 2 1
1 4 1 1 1 1 3 1
1 4 1 1 1 1 3 1
1 4 1 1 1 1 3 1
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
118 354 91 118 100 139 357 139

ah Vial = Jumlah Total Sasaran/IP Vaksin) 12 30 25 18

Diisi pada saat pelayanan imunisasi Kejar & CR bulan Agustus (termasuk Sweeping pada Diisi pada saat pelayanan im
September) 2022 September 2
(JIKA DIIMUNISASI, ISI TANGGAL PELAYANAN) (JIKA DIIMUNISASI, ISI TANG

OPV IPV DPT-HB-Hib CR OPV

0 0 0 0 0
0 0 0 0 0
si pada saat pelayanan imunisasi Kejar pada
September 2022
KA DIIMUNISASI, ISI TANGGAL PELAYANAN)

IPV DPT-HB-Hib
0 0
0 0
 FORMAT PENDATAAN POSYANDU SASARAN BIAN
SASARAN IMUNISASI TAMBAHAN CAMPAK RUBELA ADALAH 9-59 BULAN DAN SASARAN IMUNISASI KEJAR
PELAKSANAAN : AGUSTUS 2022 01 Agustus 2022
Provinsi : JAWA BARAT Desa/Kelurahan
Kabupaten : GARUT Posyandu
Puskesmas : CISURUPAN
Isilah kolom yang berwarna PUTIH!

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

1 A LUTPI 2/14/2020 3205201402200001 

2 AGUNG 8/20/2018 3205202008180061 
3 AKILA 7/8/2019 3205204807190003 
4 ALBAR M 3/8/2019 3205200803190001 
5 ANGGI 5/9/2018 3205200905180014 
6 ARKA 2/13/2018 3205201302180001 
7 BIYAN F H 9/3/2018 3205200309180001 
8 ELSA 1/8/2020 3205204801200001 
9 EZAR 10/5/2019 3205200510190466 
10 GANGAN A G 3/30/2018 3205203003180002 
11 GANI 8/29/2018 3205202508180003 
12 HAFIDZ 8/14/2019 3205201408190465 
13 HASAN 7/22/2018 3205202207180006 
14 HUSEN 7/22/2018 3205202207180007 
15 IKRIMAH 7/14/2018 3205201407180470 
16 JAKIYA N 7/20/2018 3205202007180031 
17 JIDNI S 11/16/2017 3205201161170002 
18 KARISA 11/8/2019 3205200811190004 
19 KHIAN 12/26/2019 3205202612190003 
20 LIBIA 1/11/2019 3205201101190469 
21 LUKMAN 4/1/2019 3205200104190463 
22 LUTFI 2/25/2018 3205202502180012 
23 M IHSAN 7/20/2018 3205202007180475 
24 M LUTFI 5/5/2018 3205200505180005 
25 M REZA 4/10/2018 3205201004180001 
26 M RIZKI 4/19/2019 3205201904190459 
27 M RIZKI 9/6/2019 3205200609190464 
28 M ZAKI 10/21/2019 3205202110190002 
29 MUHAMAD MALKI 1/3/2019 3205200301190002 
30 MUKSIN D 5/2/2019 3205200205190456 
31 NAZAR 2/27/2019 3205202702190461 
32 NURANIS A 8/20/2018 3205206008180003 
33 PARID 3/18/2018 3205201803180004 
34 PATIYAH 12/12/2017 3205201212170467 
35 YANDI M 5/2/2019 3205200205190457 
36 ZAHRA 2/18/2019 3205205802190004 
37 ZAHWA 9/15/2019 3205201509190458 
38 ZAHWA 11/11/2017 3205201111170001 
39 ZENAB 7/16/2019 3205201607190460 
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
200
201
202
203
204
205
206
207
208
209
210
211
212
213
214
215
216
217
218
219
220
221
222
223
224
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239
240
241
242
243
244
245
246
247
248
249
250
251
252
253
254
255
256
257
258
259
260
261
262
263
264
265
266
267
268
269
270
271
272
273
274
275
276
277
278
279
280
281
282
283
284
285
286
287
288
289
290
291
292
293
294
295
296
297
298
299
300
301
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320
321
322
323
324
325
326
327
328
329
330
331
332
333
334
335
336
337
338
339
340
341
342
343
344
345
346
347
348
349
350
351
352
353
354
355
356
357
358
359
360
361
362
363
364
365
366
367
368
369
370
371
372
373
374
375
376
377
378
379
380
381
382
383
384
385
386
387
388
389
390
391
392
393
394
395
396
397
398
399
400
401
402
403
404
405
406
407
408
409
410
411
412
413
414
415
416
417
418
419
420
421
422
423
424
425
426
427
428
429
430
431
432
433
434
435
436
437
438
439
440
441
442
443
444
445
446
447
448
449

450
451
452
453
454
455
456
457
458
459
460
461
462
463
464
465
466
467
468
469
470
471
472
473
474
475
476
477
478
479
480
481
482
483
484
485
486
487
488
489
490
491
492
493
494
495
496
497
498
499
500

TOTAL
IP Vaksin:
MR = 8
OPV = 8
IPV = 4
DPT-HB-Hib = 4
Catatan:
Anak yang sudah mendapatkan ORI Campak Rubela, tidak perlu mendapatkan imunisasi tambahan Campak Rubela s
Total kebutuhan vial yang dibutuhkan yang mengacu pada perhitungan baris total vial vaksin
Anak usia 18-24 bulan yang pada saat bersamaan mendapatkan imunisasi rutin (DPT-HB-Hib4 dan Campak rubella 2)
Kebutuhan Vaksin Khusus Campak Rubela = (Total Sasaran - Sudah Mendapatkan ORI Campak Rubela sejak Januar
SASARAN IMUNISASI BIAN:
Imunisasi Kejar : Lahir pada bulan Sept 2017 - bulan Agust 2021
Imunisasi CR : Lahir pada bulan Sept 2017 - bulan Oktober 2021

Kolom Tambahan:
*) Jumlah Dosis Vaksin yang pernah didapat
JENIS KELAMIN
L
P
RAN IMUNISASI KEJAR ADALAH 12-59 BULAN
(Disesuaikan dengan tgl pelaksanaan di masing-masing Posyandu)
: SIRNAJAYA
GANDA MEKAR 3

*) Jumlah Dosis Vaksin yang

pernah didapat
Nama Orang Tua (IBU) Alamat Umur (bulan)

OPV IPV DPT-HB-Hib

DIAMAN KP NARINGGUL 4 1 4 29
DIDIN KP CILIMUS 4 1 4 47
RUS KP NARINGGUL 4 1 4 36
ENTIS KP NARINGGUL 4 0 4 40
WANDI KP NARINGGUL 4 1 4 50
MUKSIN KP NARINGGUL 4 1 4 53
HASAN A R KP NARINGGUL 4 1 4 46
ENJU IKBAL KP NARINGGUL 3 1 3 30
MARDI KP CILIMUS 4 1 4 33
DADANG KP NARINGGUL 3 0 3 52
NURDIN KP CILIMUS 3 0 3 47
DEDE KP CILIMUS 3 1 3 35
ENTIS KP CILIMUS 4 1 4 48
ENTIS KP CILIMUS 4 1 4 48
ANDIN KP CILIMUS 4 1 4 48
ITANG KP NARINGGUL 4 1 4 48
DEDE NURDIN KP NARINGGUL 4 1 4 56
RIDWAN KP NARINGGUL 4 1 4 32
SAMSUL KP NARINGGUL 4 1 4 31
HASAN KP CILIMUS 4 1 4 42
SARIPUDIN KP CILIMUS 4 1 4 40
OLEH KP CILIMUS 4 1 4 53
HASANUDIN KP CILIMUS 4 1 4 48
ENCENG KP CILIMUS 4 1 4 50
H RUHIYAT KP CILIMUS 4 1 4 51
IRPAN KP CILIMUS 4 1 4 39
PIAN KP CILIMUS 4 1 4 34
ACENG KP NARINGGUL 4 1 4 33
AYI KP NARINGGUL 4 1 4 42
DAYAT KP CILIMUS 4 1 4 38
ALI KP CILIMUS 4 1 4 41
OHAN KP NARINGGUL 4 1 4 47
ERUS KP CILIMUS 4 1 4 52
EMUL KP CILIMUS 4 1 4 55
YAYAT H KP CILIMUS 4 1 4 38
DENIS KP NARINGGUL 4 1 4 41
AWAN KP CILIMUS 4 1 4 34
EMAN KP CILIMUS 4 1 4 56
EMUL KP CILIMUS 4 1 4 36
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bahan Campak Rubela sejak Januari 2022

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

an Agust 2021
an Oktober 2021
Apakah anak merupakan Apakah anak sasaran Imunisasi Kejar Apakah Anak Jumlah dosis yang dibutuhkan untu
sasaran Imunisasi (Ya = 1, Tidak = 0) merupakan sasaran melengkapi status imunisasi
Tambahan
Campak Rubella (Ya=1,
imunisasi KEJAR
Tidak = 0) (Ya = 1 , Tidak = 0)
OPV IPV DPT-HB-Hib OPV

1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 1 0 1 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 1 0 1 1 1
1 0 0 0 0 0
1 1 1 1 1 1
1 1 1 1 1 1
1 1 0 1 1 1
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
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39 4 3 4 5 4

TOTAL VIAL VAKSIN (Jumlah Vial = Jumlah Total Sasaran/IP V

Jumlah dosis yang dibutuhkan untuk Rencana Pemberian Dosis Sasaran
melengkapi status imunisasi Imunisasi Kejar & CR Pada Bulan Agustus Sasaran Apakah anak
Suntikan sasaran BIAN
Bulan Agustus (Agustus)
IPV DPT-HB-Hib OPV IPV DPT-HB-Hib CR

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0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
3 4 4 3 4 39 46 39

ah Vial = Jumlah Total Sasaran/IP Vaksin) 1 1 1 5

Diisi pada saat pelayanan imunisasi Kejar & CR bulan Agustus (termasuk Sweeping pada Diisi pada saat pelayanan im
September) 2022 September 2
(JIKA DIIMUNISASI, ISI TANGGAL PELAYANAN) (JIKA DIIMUNISASI, ISI TANG

OPV IPV DPT-HB-Hib CR OPV

0 0 0 0 0
0 0 0 0 0
si pada saat pelayanan imunisasi Kejar pada
September 2022
KA DIIMUNISASI, ISI TANGGAL PELAYANAN)

IPV DPT-HB-Hib
0 0
0 0
 FORMAT PENDATAAN POSYANDU SASARAN BIAN
SASARAN IMUNISASI TAMBAHAN CAMPAK RUBELA ADALAH 9-59 BULAN DAN SASARAN IMUNISASI KEJAR
PELAKSANAAN : AGUSTUS 2022 01 Agustus 2022
Provinsi : JAWA BARAT Desa/Kelurahan
Kabupaten : GARUT Posyandu
Puskesmas : CISURUPAN
Isilah kolom yang berwarna PUTIH!

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

1 ADITIA M 12/5/2020 3205200812070857 

2 ANISA 7/23/2018 3205204307180004 
3 ARSYA M 6/14/2019 3205201406190004 
4 ASYFATUL 3/15/2020 3205206503200001 
5 AYUMI DELLA 12/12/2018 3205201212180043 
6 AZMI M 6/18/2018 3205201806180003 
7 D AKBAR N 11/18/2018 3205204305120007 
8 DIKA N 5/5/2020 3205202505200001 
9 DIPA 9/28/2018 3205206809180002 
10 FAHMI 6/18/2018 3201132906780001 
11 FAIZ 1/25/2019 3205204107960071 
12 FAIZAN 10/21/2018 3205202110180002 
13 FINA N 10/5/2020 3205200308170020 
14 HAJAH TIARA 5/17/2019 3205205705190004 
15 HANIP 2/19/2019 3205201902190012 
16 HAPIZ 9/9/2017 3205200909170013 
17 HIPDI 12/15/2018 3205201512180004 
18 JULFAN 5/18/2018 3205202104120016 
19 KAILA RAHMAWATI 1/3/2019 3205200301190022 
20 KEYLA A 3/2/2019 3205204293190003 
21 KHANZA 10/9/2018 3205025910180001 
22 LULU 12/22/2017 3205206212179994 
23 M AHDIANA 2/16/2020 3205200412920003 
24 M ALFAN 6/16/2019 3205201606190477 
25 M ALI 12/12/2017 3205204204060004 
26 M FAZRI 5/26/2019 3205202605190476 
27 M HAMJAH 5/23/2018 3205202305186261 
28 M HAMJAH A 6/18/2020 3205201806205251 
29 M IRPAN 11/27/2018 3205202711180003 
30 M PADIL 10/27/2017 3205202710172512 
31 M PAHRI 1/27/2018 3205202701180032 
32 M RIPALDI 3/7/2021 3205200703210001 
33 M RIZKI 4/17/2018 3205201704180004 
34 M SOPWAN 6/20/2018 3205202006180072 
35 M WILDAN 7/22/2020 3205602207205728 
36 M YASAI S 11/11/2020 3205201503190017 
37 MARWAH MUPTIAH 1/3/2018 3205200301180005 
38 MAULIDAN 12/4/2017 3205200412170001 
39 MESYA ALMAIRA 12/14/2019 3205201412190003 
40 MI 12/30/2018 3205203012180004 
41 MUTIARA 1/29/2019 3205206901190002 
42 NAJWA 2/8/2019 3205204802190052 
43 NURSALWA 4/2/2018 3205204204180004 
44 RANIA S 8/26/2020 3205206608200001 
45 RAPA 2/26/2019 3205202602190002 
46 RESTI 5/4/2019 3205204405190003 
47 RISMA 4/3/2019 3205204304140005 
48 SAFIQ 11/28/2018 3205202811180012 
49 SALSA M 10/27/2020 3205200110200021 
50 SALSABILA 1/16/2018 3205201018300061 
51 SILFIA 10/5/2018 3205204510180002 
52 SITI PATIMAH 11/24/2019 3205206411190003 
53 SOFIA DALIYATUL 12/23/2019 3205200604920008 
54 TIARA JAHSA 7/27/2019 3205207007190003 
55 WIDARI 1/20/2018 3205206001180003 
56 YUSUP 7/19/2018 3205201907180001 
57 ZAERINA 4/7/2018 3205204704180002 
58 ZAINUL 1/28/2018 3205202801180002 
142
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155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
200
201
202
203
204
205
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207
208
209
210
211
212
213
214
215
216
217
218
219
220
221
222
223
224
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239
240
241
242
243
244
245
246
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252
253
254
255
256
257
258
259
260
261
262
263
264
265
266
267
268
269
270
271
272
273
274
275
276
277
278
279
280
281
282
283
284
285
286
287
288
289
290
291
292
293
294
295
296
297
298
299
300
301
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320
321
322
323
324
325
326
327
328
329
330
331
332
333
334
335
336
337
338
339
340
341
342
343
344
345
346
347
348
349
350
351
352
353
354
355
356
357
358
359
360
361
362
363
364
365
366
367
368
369
370
371
372
373
374
375
376
377
378
379
380
381
382
383
384
385
386
387
388
389
390
391
392
393
394
395
396
397
398
399
400
401
402
403
404
405
406
407
408
409
410
411
412
413
414
415
416
417
418
419
420
421
422
423
424
425
426
427
428
429
430
431
432
433
434
435
436
437
438
439
440
441
442
443
444
445
446
447
448
449

450
451
452
453
454
455
456
457
458
459
460
461
462
463
464
465
466
467
468
469
470
471
472
473
474
475
476
477
478
479
480
481
482
483
484
485
486
487
488
489
490
491
492
493
494
495
496
497
498
499
500

TOTAL
IP Vaksin:
MR = 8
OPV = 8
IPV = 4
DPT-HB-Hib = 4
Catatan:
Anak yang sudah mendapatkan ORI Campak Rubela, tidak perlu mendapatkan imunisasi tambahan Campak Rubela s
Total kebutuhan vial yang dibutuhkan yang mengacu pada perhitungan baris total vial vaksin
Anak usia 18-24 bulan yang pada saat bersamaan mendapatkan imunisasi rutin (DPT-HB-Hib4 dan Campak rubella 2)
Kebutuhan Vaksin Khusus Campak Rubela = (Total Sasaran - Sudah Mendapatkan ORI Campak Rubela sejak Januar
SASARAN IMUNISASI BIAN:
Imunisasi Kejar : Lahir pada bulan Sept 2017 - bulan Agust 2021
Imunisasi CR : Lahir pada bulan Sept 2017 - bulan Oktober 2021

Kolom Tambahan:
*) Jumlah Dosis Vaksin yang pernah didapat
JENIS KELAMIN
L
P
RAN IMUNISASI KEJAR ADALAH 12-59 BULAN
(Disesuaikan dengan tgl pelaksanaan di masing-masing Posyandu)
: SIRNAJAYA
GANDA MEKAR 4

*) Jumlah Dosis Vaksin yang

pernah didapat
Nama Orang Tua (IBU) Alamat Umur (bulan)

OPV IPV DPT-HB-Hib

IRWAN KONDANG 4 1 4 19
IRFAN KP KONDANG LELES 4 1 4 48
BUDIMAN TANJUNG 4 1 4 37
a. nawawi kp. tanjung sari 4 1 4 28
SODIKIN/ATIK KP KONDANG LELES 4 1 4 43
HANIPAH KP KONDANG LELES 4 0 4 49
IMRON TANJUNG 4 0 4 44
EKA TANJUNG 4 1 4 26
DIAT KP NARINGGUL 4 1 4 46
NURJANAH KP KONDANG LELES 4 0 4 49
TUTI KP TANJUNGSARI 4 1 4 42
DEDE KP TANJUNG SARI 4 0 4 45
IPAN KONDANG 4 1 4 21
AI TUTI KP KONDANG LELES 4 1 4 38
YUSUP KP KONDANG LELES 4 1 3 41
ALIT KP NARINGGUL 4 1 4 58
DEDE IWAN KP TANJUNGSARI 4 1 3 43
IIP/OOY KP TANJUNGSARI 4 1 4 50
RANA/RISKA KP KONDANG LELES 4 1 4 42
KOSIM TANJUNG 4 0 2 40
FITRIA KP TANJUNG SARI 4 1 4 45
D UUS KP TANJUNG SARI 4 0 3 55
MU KP TANJUNGSARI 4 1 4 29
KP SALAM NUNGGAL
SUHERMAN WATES 4 1 4 37
HODIMAN KP TANJUNG SARI 4 1 4 55
LALAN KP KONDANG LELES 4 1 4 38
EVI NARINGGUL 0 0 0 50
HOBIR TANJUNG 0 0 0 25
LILIS KP TANJUNG SARI 4 1 4 44
DEDE TANJUNG 4 1 4 57
ILHAM/SITI KP TANJUNGSARI 4 1 4 54
KURNIA TANJUNG 4 1 3 16
KURNIA TANJUNG 4 1 4 51
DIKI/SALPA KP TANJUNGSARI 4 1 4 49
muslim kp. tanjung sari 4 1 3 24
RIDWAN TANJUNG 4 1 3 20
DIDIN/WIDA KP KONDANG LELES 4 1 4 54
SAEPUL KP TANJUNG SARI 4 1 4 55
AGUNG/MIRA KP NARINGUL 4 1 4 31
MAMAT KP TANJUNG SARI 4 1 4 43
MAHDIN KP NARINGGUL 4 1 4 42
SUTIANA KP NARINGUL 4 1 4 41
MAUL KP KONDANG LELES 4 1 4 51
ADE TANJUNG 4 1 3 23
RAHMAN KP TANJUNGSARI 4 1 4 41
JAJANG KP KONDANG LELES 4 1 4 38
DADANG KP KONDANG LELES 4 1 4 39
ROHIMAT KP TANJUNGSARI 4 1 4 44
ALO TANJUNG 4 1 4 21
IDAS KP TANJUNG SARI 4 1 4 54
WIWIN KP TANJUNG SARI 4 1 4 45
SIROJUDIN/IMAS KP TANJUNGSARI 4 1 4 32
SAEPULLOH/NURUL KP KONDANG LELES 4 1 4 31
DEDE/INA KP BABAKAN 4 1 4 36
SANDI KP TANJUNG SARI 4 1 4 54
ERNAWATI KP TANJUNGSARI 4 1 4 48
UMAR KP TANJUNG SARI 4 1 4 51
YUYUN KP TANJUNG SARI 4 1 4 54
1471
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1471
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bahan Campak Rubela sejak Januari 2022

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

an Agust 2021
an Oktober 2021
Apakah anak merupakan Apakah anak sasaran Imunisasi Kejar Apakah Anak Jumlah dosis yang dibutuhkan untu
sasaran Imunisasi (Ya = 1, Tidak = 0) merupakan sasaran melengkapi status imunisasi
Tambahan
Campak Rubella (Ya=1,
imunisasi KEJAR
Tidak = 0) (Ya = 1 , Tidak = 0)
OPV IPV DPT-HB-Hib OPV

1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 1 0 1 0
1 0 1 0 1 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 1 0 1 0
1 0 0 0 0 0
1 0 1 0 1 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 1 1 0
1 0 0 0 0 0
1 0 0 1 1 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 1 1 1 0
1 0 0 0 0 0
1 0 1 1 1 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 1 1 1 1 4
1 1 1 1 1 4
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 1 1 0
1 0 0 1 1 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 1 1 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
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0 0 0 0 0 0
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0 0 0 0 0 0
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0 0 0 0 0 0
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0 0 0 0 0 0
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0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
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0 0 0 0 0 0
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0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
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0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

58 2 8 9 13 8

TOTAL VIAL VAKSIN (Jumlah Vial = Jumlah Total Sasaran/IP V

Jumlah dosis yang dibutuhkan untuk Rencana Pemberian Dosis Sasaran
melengkapi status imunisasi Imunisasi Kejar & CR Pada Bulan Agustus Sasaran Apakah anak
Suntikan sasaran BIAN
Bulan Agustus (Agustus)
IPV DPT-HB-Hib OPV IPV DPT-HB-Hib CR

0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
1 0 0 1 0 1 2 1
1 0 0 1 0 1 2 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
1 0 0 1 0 1 2 1
0 0 0 0 0 1 1 1
1 0 0 1 0 1 2 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 1 0 0 1 1 2 1
0 0 0 0 0 1 1 1
0 1 0 0 1 1 2 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
1 2 0 1 1 1 3 1
0 0 0 0 0 1 1 1
1 1 0 1 1 1 3 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
1 4 1 1 1 1 3 1
1 4 1 1 1 1 3 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 1 0 0 1 1 2 1
0 1 0 0 1 1 2 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 1 0 0 1 1 2 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
8 16 2 8 9 58 75 58

ah Vial = Jumlah Total Sasaran/IP Vaksin) 1 2 3 8

Diisi pada saat pelayanan imunisasi Kejar & CR bulan Agustus (termasuk Sweeping pada Diisi pada saat pelayanan im
September) 2022 September 2
(JIKA DIIMUNISASI, ISI TANGGAL PELAYANAN) (JIKA DIIMUNISASI, ISI TANG

OPV IPV DPT-HB-Hib CR OPV

0 0 0 0 0
0 0 0 0 0
si pada saat pelayanan imunisasi Kejar pada
September 2022
KA DIIMUNISASI, ISI TANGGAL PELAYANAN)

IPV DPT-HB-Hib
0 0
0 0
 FORMAT PENDATAAN POSYANDU SASARAN BIAN
SASARAN IMUNISASI TAMBAHAN CAMPAK RUBELA ADALAH 9-59 BULAN DAN SASARAN IMUNISASI KEJAR
PELAKSANAAN : AGUSTUS 2022 01 Agustus 2022
Provinsi : JAWA BARAT Desa/Kelurahan
Kabupaten : GARUT Posyandu
Puskesmas : CISURUPAN
Isilah kolom yang berwarna PUTIH!

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

1 ABDUL R 5/30/2018 3205203005180013 

2 ABIYAN 11/10/2017 3205201011170008 
3 ADEEVA 4/25/2019 3205206504190001 
4 ADRIAN 4/13/2019 3205201304190014 
5 ADZRIL 2/8/2020 3205200802200015 
6 AI RISKA 3/22/2018 3205206203180003 
7 ALBYAN 11/3/2018 3205200311180005 
8 ALIKA P 5/16/2020 3205205605200004 
9 ALMAHIRA 2/2/2019 3205204207190006 
10 ALYA 7/20/2018 3205202007180019 
11 ANGGA 2/9/2018 3205200902180005 
12 ANGGUN 2/6/2019 3205200602190033 
13 ARFA 6/19/2018 3205201906180001 
14 ARI 10/20/2018 3205202010180009 
15 ARIYTA 1/24/2018 3205206401180001 
16 AULIDA 10/21/2019 3205202110190020 
17 AZKA 11/29/2019 3205202911190010 
18 BUNGA D 12/30/2018 3205203012180009 
19 CACA 7/15/2019 3205205507190003 
20 DAPI 5/12/2018 3205200205180002 
21 DINDA 4/5/2018 3205200901700003 
22 FADILA 5/27/2019 3205206705190002 
23 HABIB 3/24/2020 3205602403206692 
24 HAIDAR 3/18/2018 3205201803180007 
25 HAMZAH 2/27/2020 3205202702200011 
26 ILMA 3/5/2018 3205206405830007 
27 IRA 11/11/2019 3205605111198449 
28 JIDAN 2/17/2018 3205201702180004 
29 JIHAN 6/16/2020 3205605606208649 
30 KHAFIZ 5/28/2018 3205206805180007 
31 KHALIP 7/18/2019 3205201807190012 
32 KHANSA 8/26/2019 3205202608190007 
33 M ABYASA 5/29/2019 3205202905190485 
34 M AKMAL 4/8/2018 3205200804180016 
35 M AL ARIP 5/29/2020 3205202905200011 
36 M DANIAL 6/10/2018 3205200101300058 
37 M FARID 6/26/2018 3205202606180010 
38 M HAZIM 3/21/2019 3205202103190001 
39 M HUSEN 7/3/2019 3205200307190001 
40 M NAWWA P 3/8/2020 3205200803200001 
41 M RAKA 10/5/2019 3205200510190003 
42 M. REZA 1/14/2020 3205601401204408 
43 MARWAH 8/12/2019 3205201208190016 
44 MAULANA 10/21/2017 3205202110170003 
45 MEISHA 5/22/2019 3205202205190478 
46 MIRAJUL 4/5/2018 3205202705140002 
47 NAPIS 9/28/2019 3205202809190002 
48 NIDA 4/8/2018 3205204804180002 
49 NIDA A 11/12/2019 3205201211190019 
50 PAZRI M 5/3/2018 3205200305180017 
51 PIKRI 8/16/2018 3205201608180005 
52 RAFA 6/5/2018 3205200506180001 
53 RAFA 2/23/2019 3205202303190479 
54 RAYAN 11/6/2018 3205201211170001 
55 SA 4/16/2019 3205201604190006 
56 SAHIL 9/3/2019 3205200309190003 
57 SALMA R 6/30/2018 3205207006180002 
58 SHEILA 6/1/2019 3205200106190003 
59 SILVI 4/24/2020 3205606404209063 
60 SILVIA 10/2/2017 3205200210170011 
61 TASYA 11/5/2017 3205200511170489 
62 TIA ALFIRA 1/15/2020 3205201501200012 
63 ZAHIRA 2/4/2020 3205204402200001 
64 ZIA N 1/29/2018 3205206901180004 
65 SYAQILA 5/31/2021
66 MEIDINA 5/26/2020
67 MAHDA 6/1/2021
68 LUTPI ALWAHYU 7/31/2021
69 AKSA 9/17/2021
70 DIKRA 5/5/2020
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TOTAL
IP Vaksin:
MR = 8
OPV = 8
IPV = 4
DPT-HB-Hib = 4
Catatan:
Anak yang sudah mendapatkan ORI Campak Rubela, tidak perlu mendapatkan imunisasi tambahan Campak Rubela s
Total kebutuhan vial yang dibutuhkan yang mengacu pada perhitungan baris total vial vaksin
Anak usia 18-24 bulan yang pada saat bersamaan mendapatkan imunisasi rutin (DPT-HB-Hib4 dan Campak rubella 2)
Kebutuhan Vaksin Khusus Campak Rubela = (Total Sasaran - Sudah Mendapatkan ORI Campak Rubela sejak Januar
SASARAN IMUNISASI BIAN:
Imunisasi Kejar : Lahir pada bulan Sept 2017 - bulan Agust 2021
Imunisasi CR : Lahir pada bulan Sept 2017 - bulan Oktober 2021

Kolom Tambahan:
*) Jumlah Dosis Vaksin yang pernah didapat
JENIS KELAMIN
L
P
RAN IMUNISASI KEJAR ADALAH 12-59 BULAN
(Disesuaikan dengan tgl pelaksanaan di masing-masing Posyandu)
: SIRNAJAYA
GANDA MEKAR 5

*) Jumlah Dosis Vaksin yang

pernah didapat
Nama Orang Tua (IBU) Alamat Umur (bulan)

OPV IPV DPT-HB-Hib

LILIS KP PASIR SEREH 4 1 4 50

CEP IRFAN KP PASIR TALANG 4 1 4 56
CECEP D KP BABAKAN 4 1 4 39
ANISAH KP PASIR SEREH 4 1 4 39
HUSNI KP PASIR SEREH 4 1 4 29
HADIAT KP BABAKAN 4 1 4 52
IRMA KP PASIR SEREH 4 1 4 44
ADI M KP BABAKAN 4 1 4 26
FARIS KP BABAKAN 4 1 4 41
YETI KP PASIR SEREH 4 1 4 48
RIKI KP PASIR TALANG 4 0 4 53
DEDE H KP PASIR TALANG 4 0 4 41
NURDIN KP SALAM NUNGGAL 4 1 4 49
DEDE S KP PASIR TALANG 4 0 4 45
SURYAMAN KP SALAM NUNGGAL 4 0 4 54
OSIM KP BABAKAN 4 1 4 33
AIP KP PASIR TALANG 4 1 4 32
ELIS KP PASIR SEREH 4 1 4 43
ELIS KP SALAM NUNGGAL 4 1 4 36
SINDI KP PASIR SEREH 4 1 4 50
OSIM KP BABAKAN 4 1 4 51
H IBROHIM KP BABAKAN 4 1 4 38
misbah kp. pasir sereh 4 1 4 28
HANI/RODI KP SALAM NUNGGAL 4 1 4 52
IPAN KP PASIR TALANG 3 0 3 29
RIDWAN KP BABAKAN 3 1 3 52
irwan kp. pasir sereh 3 0 2 32
YAN YAN KP PASIR TALANG 4 1 4 53
asep/siti kp. pasir talang 3 0 3 25
ELIS KP PASIR SEREH 4 1 4 50
NEUIS KP SALAM NUNGGAL 4 1 4 36
IDA LUSTIANI KP PASIR SEREH 4 1 4 35
JAJANG D KP PASIR SEREH 4 1 4 38
JULIANTI KP PASIR SEREH 4 1 4 51
ARIP N KP BABAKAN 4 1 4 26
DEDE J KP BABAKAN 4 1 4 49
SITI M KP PASIR SEREH 4 1 4 49
ASEP S KP BABAKAN 4 1 4 40
YASIN KP BABAKAN 4 1 4 36
TATANG KP BABAKAN 4 1 4 28
DEDE H KP BABAKAN 4 1 4 33
yusup kp. pasir sereh 4 1 4 30
SAEPULOH KP BABAKAN 4 1 4 35
MAMAN S KP BABAKAN 4 1 4 57
NYANYANG KP PASIR TALANG 4 1 4 38
OSIM KP BABAKAN 4 1 4 51
EPA/ASEP KP SALAM NUNGGAL 4 1 4 34
PIAN KP PASIR SEREH 4 1 4 51
ALIT IPIN KP BABAKAN 4 1 4 32
WINDA KP PASIR SEREH 4 1 4 50
SOHIBAH KP SALAM NUNGGAL 4 1 4 47
EPAN KP PASIR SEREH 4 1 4 49
IIK KP PASIR TALANG 4 1 4 41
AI LATIFAH KP PASIR SEREH 4 1 4 44
HENI KP PASIR SEREH 4 1 4 39
JUHANA KP SALAM NUNGGAL 4 0 4 34
PIDIN KP BABAKAN 4 1 4 49
S NURANI KP PASIR SEREH 4 1 4 38
rohman kp. pasir sereh 4 1 4 27
YANYAN KP PASIR SEREH 4 1 4 57
SAEP KP PASIR TALANG 4 1 3 56
OTANG KP PASIR TALANG 4 1 4 30
SAHIDIN KP BABAKAN 4 1 4 29
DADANG KP PASIR TALANG 4 1 4 54
HENDRI KP. SALAM NUNGGAL 4 1 3 14
AMALINA KP. SALAM NUNGGAL 3 0 4 26
AZIS KP. SALAM NUNGGAL 4 1 3 14
DEDE KP. SALAM NUNGGAL 4 1 3 12
AI HIDAYANI KP. SALAM NUNGGAL 4 1 3 10
SITI KP. SALAM NUNGGAL 4 1 4 26
1471
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bahan Campak Rubela sejak Januari 2022

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

an Agust 2021
an Oktober 2021
Apakah anak merupakan Apakah anak sasaran Imunisasi Kejar Apakah Anak Jumlah dosis yang dibutuhkan untu
sasaran Imunisasi (Ya = 1, Tidak = 0) merupakan sasaran melengkapi status imunisasi
Tambahan
Campak Rubella (Ya=1,
imunisasi KEJAR
Tidak = 0) (Ya = 1 , Tidak = 0)
OPV IPV DPT-HB-Hib OPV

1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 1 0 1 0
1 0 1 0 1 0
1 0 0 0 0 0
1 0 1 0 1 0
1 0 1 0 1 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 1 1 1 1 1
1 1 0 1 1 1
1 1 1 1 1 1
1 0 0 0 0 0
1 1 1 1 1 1
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 1 0 1 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 1 1 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 1 1 0 1 1
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

70 5 9 5 11 5

TOTAL VIAL VAKSIN (Jumlah Vial = Jumlah Total Sasaran/IP V

Jumlah dosis yang dibutuhkan untuk Rencana Pemberian Dosis Sasaran
melengkapi status imunisasi Imunisasi Kejar & CR Pada Bulan Agustus Sasaran Apakah anak
Suntikan sasaran BIAN
Bulan Agustus (Agustus)
IPV DPT-HB-Hib OPV IPV DPT-HB-Hib CR

0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
1 0 0 1 0 1 2 1
1 0 0 1 0 1 2 1
0 0 0 0 0 1 1 1
1 0 0 1 0 1 2 1
1 0 0 1 0 1 2 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
1 1 1 1 1 1 3 1
0 1 1 0 1 1 2 1
1 2 1 1 1 1 3 1
0 0 0 0 0 1 1 1
1 1 1 1 1 1 3 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
1 0 0 1 0 1 2 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 1 0 0 1 1 2 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
1 0 1 1 0 1 2 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
9 6 5 9 5 70 84 70

ah Vial = Jumlah Total Sasaran/IP Vaksin) 1 3 2 9

Diisi pada saat pelayanan imunisasi Kejar & CR bulan Agustus (termasuk Sweeping pada Diisi pada saat pelayanan im
September) 2022 September 2
(JIKA DIIMUNISASI, ISI TANGGAL PELAYANAN) (JIKA DIIMUNISASI, ISI TANG

OPV IPV DPT-HB-Hib CR OPV

0 0 0 0 0
0 0 0 0 0
si pada saat pelayanan imunisasi Kejar pada
September 2022
KA DIIMUNISASI, ISI TANGGAL PELAYANAN)

IPV DPT-HB-Hib
0 0
0 0
 FORMAT PENDATAAN POSYANDU SASARAN BIAN
SASARAN IMUNISASI TAMBAHAN CAMPAK RUBELA ADALAH 9-59 BULAN DAN SASARAN IMUNISASI KEJAR
PELAKSANAAN : AGUSTUS 2022 01 Agustus 2022
Provinsi : JAWA BARAT Desa/Kelurahan
Kabupaten : GARUT Posyandu
Puskesmas : CISURUPAN
Isilah kolom yang berwarna PUTIH!

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

1 AHMAD S 2/12/2018 3205201202180004 

2 AIRA R B A 2/11/2020 3205205102200004 
3 DINDA 4/7/2018 3205204709180001 
4 FAISAL 12/30/2019 3205203012190497 
5 HASAN 4/12/2019 3205201204190494 
6 HUSEN 4/12/2019 3205201204190495 
7 M ALWI 3/20/2018 3205203003180003 
8 M MIFTAH 9/27/2019 3205202709190006 
9 M ROHMAN 9/5/2017 3205201509180002 
10 MUHAMAD 12/26/2019 3205202612190496 
11 RADIT 4/3/2019 3205200304190002 
12 RAFA A G 6/25/2018 3205200506180003 
13 SITI AMROH 4/11/2019 3205205104190004 
14 SURYA 1/7/2019 3205200701190493 
15 ZAHRA S 9/20/2019 3205206009190002 
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
200
201
202
203
204
205
206
207
208
209
210
211
212
213
214
215
216
217
218
219
220
221
222
223
224
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239
240
241
242
243
244
245
246
247
248
249
250
251
252
253
254
255
256
257
258
259
260
261
262
263
264
265
266
267
268
269
270
271
272
273
274
275
276
277
278
279
280
281
282
283
284
285
286
287
288
289
290
291
292
293
294
295
296
297
298
299
300
301
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320
321
322
323
324
325
326
327
328
329
330
331
332
333
334
335
336
337
338
339
340
341
342
343
344
345
346
347
348
349
350
351
352
353
354
355
356
357
358
359
360
361
362
363
364
365
366
367
368
369
370
371
372
373
374
375
376
377
378
379
380
381
382
383
384
385
386
387
388
389
390
391
392
393
394
395
396
397
398
399
400
401
402
403
404
405
406
407
408
409
410
411
412
413
414
415
416
417
418
419
420
421
422
423
424
425
426
427
428
429
430
431
432
433
434
435
436
437
438
439
440
441
442
443
444
445
446
447
448
449

450
451
452
453
454
455
456
457
458
459
460
461
462
463
464
465
466
467
468
469
470
471
472
473
474
475
476
477
478
479
480
481
482
483
484
485
486
487
488
489
490
491
492
493
494
495
496
497
498
499
500

TOTAL
IP Vaksin:
MR = 8
OPV = 8
IPV = 4
DPT-HB-Hib = 4
Catatan:
Anak yang sudah mendapatkan ORI Campak Rubela, tidak perlu mendapatkan imunisasi tambahan Campak Rubela s
Total kebutuhan vial yang dibutuhkan yang mengacu pada perhitungan baris total vial vaksin
Anak usia 18-24 bulan yang pada saat bersamaan mendapatkan imunisasi rutin (DPT-HB-Hib4 dan Campak rubella 2)
Kebutuhan Vaksin Khusus Campak Rubela = (Total Sasaran - Sudah Mendapatkan ORI Campak Rubela sejak Januar
SASARAN IMUNISASI BIAN:
Imunisasi Kejar : Lahir pada bulan Sept 2017 - bulan Agust 2021
Imunisasi CR : Lahir pada bulan Sept 2017 - bulan Oktober 2021

Kolom Tambahan:
*) Jumlah Dosis Vaksin yang pernah didapat
JENIS KELAMIN
L
P
RAN IMUNISASI KEJAR ADALAH 12-59 BULAN
(Disesuaikan dengan tgl pelaksanaan di masing-masing Posyandu)
: SIRNAJAYA
GANDA MEKAR 6

*) Jumlah Dosis Vaksin yang

pernah didapat
Nama Orang Tua (IBU) Alamat Umur (bulan)

OPV IPV DPT-HB-Hib

DANI KP GUNUNG JAYA 4 1 4 53

ASEP KP GUNUNG JAYA 4 1 4 29
DONI KP GUNUNG JAYA 4 1 4 51
SOMANTRI KP GUNUNG JAYA 4 1 4 31
DUDUNG KP GUNUNG JAYA 4 1 4 39
DUDUNG KP GUNUNG JAYA 4 1 4 39
HENDRA KP GUNUNG JAYA 4 1 4 52
SUPIAN KP GUNUNG JAYA 4 1 3 34
RUSMANA KP GUNUNG JAYA 4 1 4 58
SAEPULOH KP GUNUNG JAYA 4 1 4 31
AEP KP GUNUNG JAYA 4 1 4 39
GUNAWAN KP GUNUNG JAYA 4 1 4 49
ARIP KP GUNUNG JAYA 4 1 3 39
NADIN KP GUNUNG JAYA 4 1 4 42
NYANYANG KP GUNUNG JAYA 4 1 3 34
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bahan Campak Rubela sejak Januari 2022

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

an Agust 2021
an Oktober 2021
Apakah anak merupakan Apakah anak sasaran Imunisasi Kejar Apakah Anak Jumlah dosis yang dibutuhkan untu
sasaran Imunisasi (Ya = 1, Tidak = 0) merupakan sasaran melengkapi status imunisasi
Tambahan
Campak Rubella (Ya=1,
imunisasi KEJAR
Tidak = 0) (Ya = 1 , Tidak = 0)
OPV IPV DPT-HB-Hib OPV

1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 1 1 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 0 0 0
1 0 0 1 1 0
1 0 0 0 0 0
1 0 0 1 1 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
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0 0 0 0 0 0
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0 0 0 0 0 0
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0 0 0 0 0 0
0 0 0 0 0 0
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0 0 0 0 0 0
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0 0 0 0 0 0
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0 0 0 0 0 0
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0 0 0 0 0 0
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0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
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0 0 0 0 0 0
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0 0 0 0 0 0
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0 0 0 0 0 0
0 0 0 0 0 0
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0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
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0 0 0 0 0 0
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0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
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0 0 0 0 0 0
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0 0 0 0 0 0
0 0 0 0 0 0
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0 0 0 0 0 0
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0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
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0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

15 0 0 3 3 0

TOTAL VIAL VAKSIN (Jumlah Vial = Jumlah Total Sasaran/IP V

Jumlah dosis yang dibutuhkan untuk Rencana Pemberian Dosis Sasaran
melengkapi status imunisasi Imunisasi Kejar & CR Pada Bulan Agustus Sasaran Apakah anak
Suntikan sasaran BIAN
Bulan Agustus (Agustus)
IPV DPT-HB-Hib OPV IPV DPT-HB-Hib CR

0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 1 0 0 1 1 2 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 0 0 0 0 1 1 1
0 1 0 0 1 1 2 1
0 0 0 0 0 1 1 1
0 1 0 0 1 1 2 1
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
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0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
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0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
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0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
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0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
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0 0 0 0 0 0 0 0
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0 0 0 0 0 0 0 0
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0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
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0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
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0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
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0 0 0 0 0 0 0 0
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0 0 0 0 0 0 0 0
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0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
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