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 : Desa/Kelurahan
Kabupaten : kkkk Posyandu
Puskesmas : mmmm
Isilah kolom yang berwarna PUTIH!

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

1 M ZAYYAN M L 02 Juli 2021 3217090207210002

2 RAYNA P P 02 Juli 2021 3217094207210003
3 M RASYA A L 26 September 2021 3217092701210001
4 AKILA P P 20 Oktober 2020 3217096001200002
5 ALESHA P 06 Agustus 2020 3217094712900004
6 SHALSABILA P 09 Maret 2020 3217095903190002
7 M HAFIZAL L 06 Juli 2019 3217090607190002
8 KHANSA N P 26 April 2017 3217096604100003
9 AYRA SHIRLY P 23 Agustus 2017 3217096308170001
10 ALVIAN RAMADHAN L 18 Mei 2018 3217091805180002
11 KANAYA P P 01 Januari 2018 3217094101180006
12 VIOLA H P 06 Mei 2021 3217094805200002
13 GHIBRAN N L 30 Juni 2021 3217093006210005
14 M HASBI AL L 04 April 2019 3217090104190001
15 M AZKA A L 27 September 2018 3217092709180002
16 RIVAL R L 17 Mei 2018 3217031705180002
17 DELISA G P P 01 Maret 2021 3217094103210003
18 ALZAM A L 12 Desember 2017 3217091212170002
19 MUHAMAD H L 12 Januari 2018 3217091211180001
20 ELZIANO L 22 Januari 2019 3217092201190002
21 SHAFIYYAH H P 10 Februari 2018 3217095012180001
22 KAMILA A P 25 Maret 2018 3217096503180003
23 REVINA P 13 September 2019 3217095309190004
24 M RAFFA S L 08 April 2019
25 FITRI P 17 Agustus 2017 3217095601190002
26 PUTRI P 16 Januari 2019 3217095601190002
27 VIONA P 12 April 2018
28 PANDI AHMAD L 11 Juli 2021 3217091107210001
29 HANIFA H P 16 Maret 2021 3217091603210003
30 ALISHA R P 25 Juni 2021 3217096506210001
31 ANNISA R P 25 Juni 2021 3217096506210002
32 HADWAR Y K L 23 Juli 2020 3217092307200001
33 TANIA SABILA P 01 September 2020 3217094109200002
34 KINAWATI B M P 17 April 2020 3217095104200003
35 ALDY HABIB A L 16 April 2020 3217091604200002
36 M KAISAR A F L 19 Agustus 2020 3217091308200002
37 FATHIA SKAYLA P 18 Maret 2020 3217095803200006
38 ELSHANUM D S P 20 Januari 2020 321709600120003
39 HAWA HUMAIRA P 20 Juli 2020 3217096007200003
40 DAMAR DE M L 19 Juli 2018 3217091971800001
41 ALI MULYADI L 14 Januari 2019 3217091401190006
42 GIO FUJI W L 11 September 2017 3217091109170002
43 RANFI M F L 05 November 2017 3217090511170003
44 KHAIRA D A P 01 November 2017 3217094111170001
45 M FARID A L 16 Oktober 2019 321709161019001
46 JESSICA A R P 05 Oktober 2017 3217094510170003
47 SHAKILA A P 20 Juli 2019 3217096007190003
48 FIKRI M R L 09 April 2018 3217094106580019
49 ALLEA Q P 29 Juli 2019 3217096907190005
50 AHTAR W L 02 Oktober 2019 3204330210190006
51 ADIBA R S P 17 Maret 2018 3217095703180003
52 NABILA A L P 04 Agustus 2017 3217094408170004
53 M RIANKA L 03 Agustus 2019 3217250308190002
54 M FATAN L 08 Maret 2019 3217160803190003
55 AL QODRI L 23 April 2018 3217092304180005
56 MISBHALL M L 16 Desember 2018 3217091612180001
57 NAFISHA A W P 05 Desember 2019 3217094512190003
58 DESWITA A S P 10 Desember 2017 3204465012170001
59 KAILA JAHRAINA P 13 September 2019 3217095303190007
60 INDRA M L 31 Januari 2018 3217093101180003
61 RADIANSYAH L 12 Juli 2018 3217091207180004
62 KIRANIA A M P 28 Agustus 2018 3217096808180003
63 AUZAN AL F L 22 Mei 2018 3217092205180003
64 WILLY L 07 September 2018 3217090709180005
65 MIKO A L 04 Juni 2019 3217090406190002
66 M KHOWILJU L 20 Mei 2019 321709
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TOTAL
IP Vaksin:
MR = 8
OPV = 8
IPV = 4
DPT-HB-Hib = 4
Catatan:
Anak yang sudah mendapatkan ORI Campak Rubela, tidak perlu mendapatkan imunisasi tambahan Campak Rubela s
Total kebutuhan vial yang dibutuhkan yang mengacu pada perhitungan baris total vial vaksin
Anak usia 18-24 bulan yang pada saat bersamaan mendapatkan imunisasi rutin (DPT-HB-Hib4 dan Campak rubella 2)
Kebutuhan Vaksin Khusus Campak Rubela = (Total Sasaran - Sudah Mendapatkan ORI Campak Rubela sejak Januar
SASARAN IMUNISASI BIAN:
Imunisasi Kejar : Lahir pada bulan Sept 2017 - bulan Agust 2021
Imunisasi CR : Lahir pada bulan Sept 2017 - bulan Oktober 2021

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

Apakah anak *) Jumlah Dosis Vaksin yang

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

AHRUL M RT 01/14 0 0 0 0
BUDI RT 01/14 0 0 0 0
CEPI A RT 01/14 0 4 0 2
HAGI P RT 01/14 0 0 0 0
TATANG S RT 01/14 0 4 0 4
SUPRIATNA RT 01/14 0 3 1 4
HADIANSYAH RT 01/14 0 4 1 4
RONI R RT 01/14 0 0 1 4
ALI NURDIN RT 01/14 0 4 1 4
KEMAL N RT 01/14 0 4 1 4
A KUSTIAWAN RT 01/14 0 3 1 4
DIAN N RT 01/14 0 4 1 4
DWI DODI K RT 01/14 0 4 1 3
ROHMAT RT 01/14 0 4 1 4
NOVA RT 01/14 0 3 1 4
ATEP W RT 01/14 0 4 1 4
RUSMANA RT 01/14 0 1 0 0
RAMDANI RT 01/14 0 4 1 4
ANE R RT 01/14 0 4 1 4
HENDI H RT 01/14 0 4 1 4
ANDI R RT 01/14 0 1 0 0
FAZAR N RT 01/14 0 4 1 4
A WARSIDI RT 01/14 0 2 0 1
TAUFIK RT 01/14 0 0 0 0
RUDIANA RT 01/14 0 3 0 2
RUDIANA RT 01/14 0 2 0 2
DIAN N RT 01/14 0 4 1 4
DADAN PURI RT 02/14 0 4 1 4
ANDRI H RT 02/14 0 4 1 4
YAYAN S RT 02/14 0 4 0 3
YAYAN S RT 02/14 0 4 1 3
DAWI R RT 02/14 0 4 1 4
OLEH RT 02/14 0 4 1 3
YUDI RT 02/14 0 0 0 0
ASEP SURYADI RT 02/14 0 2 0 2
FAHMI RT 02/14 0 3 0 3
FAJAR F RT 02/14 0 4 1 4
KRISNUGRAHA RT 02/14 0 4 1 4
JAJA DARYANA RT 02/14 0 4 1 3
SENDY B RT 02/14 0 4 1 4
AJAW RT 02/14 0 4 1 4
IRVAN R RT 02/14 0 3 0 3
GUNAWAN RT 02/14 0 3 0 3
ANANG S RT 02/14 0 4 1 4
WAHYUDIN RT 02/14 0 3 0 3
M RIFAL A RT 02/14 0 4 1 4
HERMULYADI RT 02/14 0 4 1 4
SOPAN SOPIAN RT 02/14 0 0 0 0
HIDAYAT RT 02/14 0 4 1 4
KUSTIWAN RT 02/14 0 0 0 0
ENDANG RT 02/14 0 0 0 0
DEDE LESMANA RT 02/14 0 4 1 4
PURNAMA RT 02/14 0 4 1 4
FAJAR F RT 02/14 0 4 1 4
IWAN A RT 02/14 0 4 1 4
JAFAR RT 02/14 0 4 1 4
NURDIANSYAH RT 02/14 0 0 1 0
HANDOKO RT 02/14 0 4 1 4
RT 02/14 0 3 0 3
MULYANA RT 02/14 0 4 1 4
ATIM RT 02/14 0 4 1 4
SAFTARANA RT 02/14 0 3 1 3
KUSTIAW RT 02/14 0 4 1 4
RUKANDA RT 02/14 0 4 1 4
ASEP S RT 02/14 0 4 1 4
VISKY RT 02/14 0 4 1 4
0
bahan Campak Rubela sejak Januari 2022

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

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

12 1 1 1 1 1
12 1 1 1 1 1
10 1 0 0 0 0
21 1 1 1 1 1
23 1 0 1 0 1
28 1 1 0 0 1
36 1 0 0 0 0
63 0 0 0 0 0
59 1 0 0 0 0
50 1 0 0 0 0
55 1 1 0 0 1
14 1 0 0 0 0
13 1 0 0 0 0
39 1 0 0 0 0
46 1 1 0 0 1
50 1 0 0 0 0
17 1 1 1 1 1
55 1 0 0 0 0
54 1 0 0 0 0
42 1 0 0 0 0
53 1 1 1 1 1
52 1 0 0 0 0
34 1 1 1 1 1
39 1 1 1 1 1
59 1 1 1 1 1
42 1 1 1 1 1
51 1 0 0 0 0
12 1 0 0 0 0
16 1 0 0 0 0
13 1 0 1 0 1
 13 1 0 0 0 0
24 1 0 0 0 0
23 1 0 0 1 1
27 1 1 1 1 1
27 1 1 1 1 1
23 1 1 1 1 1
28 1 0 0 0 0
30 1 0 0 0 0
24 1 0 0 1 1
48 1 0 0 0 0
42 1 0 0 0 0
58 1 1 1 1 1
56 1 1 1 1 1
57 1 0 0 0 0
33 1 1 1 1 1
57 1 0 0 0 0
36 1 0 0 0 0
51 1 1 1 1 1
36 1 0 0 0 0
33 1 1 1 1 1
52 1 1 1 1 1
59 1 0 0 0 0
35 1 0 0 0 0
40 1 0 0 0 0
51 1 0 0 0 0
43 1 0 0 0 0
31 1 1 0 1 1
55 1 0 0 0 0
34 1 1 1 1 1
54 1 0 0 0 0
48 1 0 0 0 0
47 1 1 0 1 1
50 1 0 0 0 0
46 1 0 0 0 0
37 1 0 0 0 0
38 1 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
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1471 0 0 0 0 0
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1471 0 0 0 0 0
1471 0 0 0 0 0
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1471 0 0 0 0 0
1471 0 0 0 0 0
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1471 0 0 0 0 0
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1471 0 0 0 0 0
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1471 0 0 0 0 0
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1471 0 0 0 0 0
1471 0 0 0 0 0
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1471 0 0 0 0 0
1471 0 0 0 0 0
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1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
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1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
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1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
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1471 0 0 0 0 0
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1471 0 0 0 0 0
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1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0
1471 0 0 0 0 0

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

65 24 21 23 28

TOTAL VIAL VAKSIN (Jumlah Vial = Jum

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

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

4 1 3 1 1 1 1
4 1 3 1 1 1 1
0 0 0 0 0 0 1
4 1 4 1 1 1 1
0 1 0 0 1 0 1
1 0 0 1 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 0
0 0 0 0 0 0 1
0 0 0 0 0 0 1
1 0 0 1 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
1 0 0 1 0 0 1
0 0 0 0 0 0 1
3 1 3 1 1 1 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
3 1 4 1 1 1 1
0 0 0 0 0 0 1
2 1 3 1 1 1 1
4 1 4 1 1 1 1
1 1 2 1 1 1 1
2 1 2 1 1 1 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 1 0 0 1 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 1 0 0 1 1
4 1 4 1 1 1 1
2 1 2 1 1 1 1
1 1 1 1 1 1 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 1 0 0 1 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
1 1 1 1 1 1 1
1 1 1 1 1 1 1
0 0 0 0 0 0 1
1 1 1 1 1 1 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
4 1 4 1 1 1 1
0 0 0 0 0 0 1
4 1 4 1 1 1 1
4 1 4 1 1 1 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
4 0 4 1 0 1 1
0 0 0 0 0 0 1
1 1 1 1 1 1 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
1 0 1 1 0 1 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 1
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
 0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 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 21 58 24 21 23 65

AL VAKSIN (Jumlah Vial = Jumlah Total Sasaran/IP Vaksin) 3 6 6 9

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

3 1
3 1
1 1
3 1
2 1
1 1
1 1
0 0
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
3 1
1 1
1 1
1 1
3 1
1 1
3 1
3 1
3 1
3 1
1 1
1 1
1 1
2 1
1 1
1 1
2 1
3 1
3 1
3 1
1 1
1 1
2 1
1 1
1 1
3 1
3 1
1 1
3 1
1 1
1 1
3 1
1 1
3 1
3 1
1 1
1 1
1 1
1 1
1 1
2 1
1 1
3 1
1 1
1 1
2 1
1 1
1 1
1 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
109 65 0 0 0
0 0 0
gustus (termasuk Sweeping pada Diisi pada saat pelayanan imunisasi Kejar pada September
2022
ELAYANAN) (JIKA DIIMUNISASI, ISI TANGGAL PELAYANAN)

CR OPV IPV DPT-HB-Hib

0 0 0 0
0 0 0 0