JUMLAH SPESIMEN 13

PJ DATA : SUTIK ANDRIYANI NO TLP 088216998077

NO NAMA UMUR STATUS NIK JENIS KELAMIN ALAMAT KTP ALAMAT DOMISILI KOTA NO. TELP RS/PUSKESMAS JENIS SAMPEL SAMPEL KE- TANGGAL SWAB TANGGAL KIRIM
TGL LAHIR

1 MISTURI ANTO 50 SKRINNING 3578170509720007 3578170509720007 6/3/1972 L BULAK BANTENG WETAN 2/6 BULAK BANTENG WETAN 2/6 SURABAYA 08787880660 Puskesmas Sidotopo Wetan NS 1 2/11/2022 2/11/2022

2 AFSIDAH 48 SKRINNING 3578174009740001 3578174009740001 6/9/1974 P BULAK BANTENG WETAN 2/6 BULAK BANTENG WETAN 2/6 SURABAYA 08787880660 Puskesmas Sidotopo Wetan NS 1 2/11/2022 2/11/2022

3 FRIGET RUSIANTO 53 SKRINNING 3578172109690001 3578172109690001 21/9/1969 L SIDOTOPO WETAN BARU 4/46 SIDOTOPO WETAN BARU 4/46 SURABAYA 081331361857 Puskesmas Sidotopo Wetan NS 1 2/11/2022 2/11/2022

4 SITI ARIKO 47 SKRINNING 35781174903750002 35781174903750002 9/3/1975 P SIDOTOPO WETAN BARU 4/46 SIDOTOPO WETAN BARU 4/46 SURABAYA 081331361857 Puskesmas Sidotopo Wetan NS 1 2/11/2022 2/11/2022

5 ACH BAIHAQI 40 SKRINNING 3578100712820003 3578100712820003 7/12/1982 L KAPAS BARU 9/6 KAPAS BARU 9/6 SURABAYA 08819512553 Puskesmas Sidotopo Wetan NS 1 2/11/2022 2/11/2022

6 DESI NUR 26 SKRINNING 3578177112960003 3578177112960003 31/12/1996 P SIDOTOPO WETAN INDAH 2/59 SIDOTOPO WETAN INDAH 2/59 SURABAYA Puskesmas Sidotopo Wetan NS 1 2/11/2022 2/11/2022

7 SUPARMI 77 SKRINNING 3578177006450066 3578177006450066 30/6/1945 P PLATUK RELA 5 PLATUK RELA 5 SURABAYA 081394208761 Puskesmas Sidotopo Wetan NS 1 2/11/2022 2/11/2022

8 KHAYRA SHAREEN 4 SKRINNING 3578176609180002 3578176609180002 26/9/2018 P KEDUNG MANGU 2/1 KEDUNG MANGU 2/1 SURABAYA 083856599702 Puskesmas Sidotopo Wetan NS 1 2/11/2022 2/11/2022

9 RIKWAN ARIS 25 SKRINNING 3578172703970006 3578172703970006 27/3/1997 L KEDUNG MANGU SELATAN 1/15 KEDUNG MANGU SELATAN 1/15 SURABAYA 0877547722066 Puskesmas Sidotopo Wetan NS 1 2/11/2022 2/11/2022

10 SUPRIYANTO 44 SKRINNING 3578172407780004 3578172407780004 24/7/2978 L PLATUK DONOMULYO 13/10 PLATUK DONOMULYO 13/10 SURABAYA Puskesmas Sidotopo Wetan NS 1 2/11/2022 2/11/2022

11 DARUJI 35 SKRINNING 3505120301860001 3505120301860001 3/1/1986 L SIDOTOPO WETAN BARU 3/28 SIDOTOPO WETAN BARU 3/28 SURABAYA 081331000847 Puskesmas Sidotopo Wetan NS 1 2/11/2022 2/11/2022

12 ELOK C 40 SKRINNING 3578175806820001 3578175806820001 18/6/1982 P KEDUNG MANGU 89 KEDUNG MANGU 89 SURABAYA 085790691281 Puskesmas Sidotopo Wetan NS 1 2/11/2022 2/11/2022

13 EL FARIZI 6 SKRINNING 3578172603160001 3578172603160001 26/3/2016 L KEDUNG MANGU 89 KEDUNG MANGU 89 SURABAYA 085790691281 Puskesmas Sidotopo Wetan NS 1 2/11/2022 2/11/2022