Pemantauan Pertumbuhan Balita

FORMULIR PENCATATAN PEMANTAUAN PERTUMBUHAN BALITA DI POSYANDU
Provinsi : Sumatera Selatan Nama Posyandu : Melati

Kabupaten / Kota : Empat Lawang Bulan : Januari
Puskesmas/ Kecamatan : Nanjungan Tahun : 2019
Desa / Kelurahan : Talang Padang
Kepemili
kan
Berat IMD
Buku
Anak Nik (Nomor Induk Badan 1=Ya Nama No tlp/ HP
No Tanggal Lahir JK No Kartu Keluarga Nama Anak KIA/KM Nik Ayah Alamat RT
ke Kependudukan) (BB) 2=Tida Ayah Ayah
S 1=Ya
Lahir k
2=Tidak
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15)
Refa Talang
1 2 25 -5 -2017 P 1611070402140004 1611076505170000 2900 1 1 Yalni 1611070701830001 081255347560 0
Kurniawati Padang
Talang
2 1 19-10-2015 P 1611072610150001 1611075910150001 Yelse Oktary 3100 1 1 Harmoko 1611071206660003 082370987645 0
Padang
Arsya Talang
3 2 30-8-2015 L 1611073008120008 1611073008150001 2800 1 1 Ali Arsoni 1611071509690001 081276480102 0
Fanhoten Padang
Frans Talang
4 1 25-12-2014 L 1611072802140008 1611072512140001 3300 1 1 Firman 1611071507920003 085337688374 0
Pratama Padang
Talang
5 2 10-10-2016 L 1611070608120003 1611071010160001 Afif Pranaja 2800 1 1 Desman 1611071011820001 085256602782 0
Padang
Talang
6 2 26-02-2017 L 1611070402140003 1611072602170000 Novan Alriziq 3000 1 1 M. Gupron 1611071602910001 081344657390 0
Padang
Talang
7 2 25-07-2017 L 16110701105090010 1611076403800000 Akbar 2700 1 1 Irawan 1611071603830001 081281976544 0
Padang
Talang
8 2 16-04-2015 P 1611071306090004 1611075604150001 Aqila Aprilia 2900 1 1 Suprapto 1611072504820001 081377315230 0
Padang
Talang
9 2 15-01-2015 L 1611072010080008 1611075205800000 Pandu 3200 1 1 Ardi 1611071901750001 082172638321 0
Padang
Talang
10 3 05-07-2018 L 1611071306090003 1611075211800000 M. Haby 3000 1 1 Supardi 1611071212770003 085355056067 0
Padang
Talang
11 3 16-03-2016 L 1611072506090013 1611071603160001 M. Martin 2800 1 1 Rosidi 1611070707770006 081231400560 0
Padang
Talang
12 4 04-12-2015 p 1611072902120004 1611075109870003 Naza 3100 1 1 Gunawan 1611070202770002 081241116550 0
Padang
Talang
13 1 16-09-2013 P 1611071804130005 1611071804130005 Lhutvia 2900 1 1 Eko 1611070308900002 081271334551 0
Padang
Talang
14 3 10-01-2014 P 1611070207090009 1611075001140001 Klara 3300 1 1 Elseksidi 1611071412760001 081201566033 0
Padang
Talang
15 1 03-07-2013 P 1611072208130011 1611074307130001 Zhera 2800 1 1 Renton 1611073006870003 081271629812 0
Padang
Talang
16 1 10-03-2013 P 1611072801140017 1611075003120001 Refi 2900 1 1 Sunanto 1611070705800001 081271222671 0
Padang
Talang
17 2 26-07-2016 P 1611072801140017 1611076605160001 Natasya 3100 1 1 Sunanto 1611070705800001 081271222671 0
Padang
Talang
18 3 24-06-2013 P 1611071206090020 1611076408800000 Cahaya 2800 1 1 Sahar 1611072503820001 082177983221 0
Padang
ASI Ekslusif1=YA,2=Tidak
Cara Vitamin Vitamin
Panjang
Ukur A A
Badan/
tgl 1=Telent Februari Agustus
RW BB (kg) Tinggi umur 0 umur 1 umur 2 umur 3 umur 4 umur 5 1= Ya
pengukuran ang 1=Ya
Badan bln bln bln bln bln bln 2=
(cm)
2=Berdiri Tidak 2=Tidak
(16) (17) (18) (19) (20) (21) (22) (23) (24) (25) (26) (27) (28)
0 10-09-2018 9 72 2 1 1 1 1 1 1 1 1
0 10-09-2018 12 90 2 1 1 1 1 1 1 1 1
0 10-09-2018 11 84 2 1 1 1 1 1 1 1 1
0 10-09-2018 11 66 2 1 1 1 1 1 1 1 1
0 10-09-2018 11 81 2 2 1 1 1 1 2 1 1
0 10-09-2018 11 83 2 1 1 1 1 1 1 1 1
0 10-09-2018 10 73 2 1 1 1 1 1 1 1 1
0 10-09-2018 11 94 2 1 1 1 1 1 1 1 1
0 10-09-2018 12 96 2 1 1 1 1 1 1 1 1
0 10-09-2018 7 66 2 1 1 1 1 1 1 2 2
0 10-09-2019 13 99 2 1 1 1 1 1 1 1 1
0 10-09-2020 14 87 2 1 1 1 1 1 1 1 1
0 10-09-2021 15 92 2 1 1 1 1 1 1 1 1
0 10-09-2022 14 84 2 1 1 1 1 1 1 1 1
0 10-09-2023 15 98 2 1 1 1 1 1 1 1 1
0 10-09-2024 16 102 2 1 1 1 1 1 1 1 1
0 10-09-2025 13 85 2 1 1 1 1 1 1 1 1
0 10-09-2026 16 99 2 1 1 1 1 1 1 1 1
FORMULIR P
Provinsi : Sumatera Selatan Nama Posyandu :K
Kabupaten / Kota : Empat Lawang Bulan :j
Puskesmas/ Kecamatan : Nanjungan Tahun :2
Desa / Kelurahan : Pulau Tengah
Jenis Nik (Nomor Induk

No Anak ke Tanggal Lahir No Kartu Keluarga Nama Anak
Kelamin Kependudukan)
(1) (2) (3) (4) (5) (6) (7)
1 2 18-10-2016 P 1611071306110001 1611075810160000 Azzah
2 1 21-11-2014 L 1611070603170016 1604062111140001 Aziz
3 2 02-12-2017 L 1611070603170016 1611070212170000 Wildan
4 2 11-07-2016 L 1611073001090045 1611071107160000 Permana
5 1 07-05-2015 L 1611072402150003 1611070705150001 Meizan
6 1 05-05-2015 P 1611071504150004 1611074505150002 Winda
7 3 01-01-2018 L 1611071103081743 1611070101180001 M. Rizki
8 1 26-03-2014 P 1611072611120001 1611076603110000 Valencia
9 2 30-05-2017 P 1611072611120001 1611077005170001 Paula
10 3 04-05-2016 P 1611071103081752 1611074107800000 Pera
11 1 10-042015 P 1611070610090009 1611075004150001 Chika
12 2 26-11-2014 P 1611070311100038 1611075511140001 Andesa
13 2 29-09-2014 P 1611070402130002 1611076909140001 Sekaram
14 1 10-04-2018 P 1611072001170002 1611075004180000 Dwi Putri

15 1 31-05-2018 P 1611072008180003 1611077105180001 Afania
16 1 01-04-2017 L 1611072909160004 1611070104170002 M. Azka
17 1 06-05-2013 L 1611073001170002 1611070605170001 Gibran
18 2 07-04-2018 L 1611070701130000 1611074506800000 Difran
19 1 11-08-2016 L 1611070401160003 1611075108160001 Zhafran
20 2 24-12-2015 P 1611072510170001 1611076412150001 Natania
21 1 26-11-2013 L 1611071007140002 1611072611130001 Andika
22 2 03-02-2016 L 1611072712110011 1611070302160001 Andrian
23 2 31-07-2013 L 1611071103081762 1611073107130002 Rezi
24 1 08-03-2016 L 1611073005180001 1611070803160001 Haikal
25 1 13-01-2018 L 1611072301180001 1611071301180001 Rafkha
26 2 06-09-2016 P 1611070303160007 1611070609160001 Geysa
27 2 19-06-2016 L 1611070402090002 1611071906160001 M. Zazili
28 2 31-12-2016 P 1611070808170005 1611077112160002 Celsia

FORMULIR PENCATATAN PEMANTAUAN PERTUMBUHAN BALIT
ma Posyandu : Kamboja 2
lan : januari
hun : 2019
:
Kepemil
ikan
Berat Buku
IMD
Badan KIA/K No tlp/ HP
1=Ya Nama Ayah Nik Ayah Alamat
(BB) MS Ayah
2=Tidak
Lahir 1=Ya
2=Tidak
(8) (9) (10) (11) (12) (13) (14)
08124567753
3000 1 1 Zailan Efendi 1611070105850001 Pulau Tengah
2
08534450899
2800 1 1 Sipri Rohman 1604060904850001 Pulau Tengah
6
08534450899
3100 1 1 Sipri Rohman 1604060904850001 Pulau Tengah
6
08213537688
2700 1 1 Wiyono 1611071812800001 Pulau Tengah
1
08127341556
2900 1 1 Saparudin 161107034910001 Pulau Tengah
0
08526636828
3200 1 1 Edi Saputra 1611071611930004 Pulau Tengah
5
08532175995
3300 1 1 Sino Arfandi 1611070212800000 Pulau Tengah
6
08537661228
2900 1 1 Amsirin 1611070509850002 Pulau Tengah
0
08537661228
3100 1 1 Amsirin 1611070509850002 Pulau Tengah
0
08230704655
2800 1 1 Irwan 1611070107810015 Pulau Tengah
4
08215443784
3200 1 1 Juni Arsan 1611071511870000 Pulau Tengah
1
08220717844
3100 1 1 Manijo 1611072503850003 Pulau Tengah
7
08235160918
3300 1 1 Usman Yuni 1611072708790001 Pulau Tengah
0
08132290812
3600 1 1 Frengki 1611071607960001 Pulau Tengah
8
08539832526
3400 1 1 Lover 1611070707990002 Pulau Tengah
9
08525361809
2900 1 1 M. Dwi Anggoro 1673082605830005 Pulau Tengah
6
08217463803
3800 1 1 Ahmad Fauzi 1611071407940001 Pulau Tengah
4
08526954256
3500 1 1 Dahlan 1611071403750001 Pulau Tengah
7
08526656835
3200 1 1 Hendri Dunan 1611071309770003 Pulau Tengah
2
08538734557
3600 1 1 Imron 1702222606890001 Pulau Tengah
6
08138794563
2900 1 1 Mustomi 1611072601880001 Pulau Tengah
1
08532151795
3100 1 1 Salam 1611072909860004 Pulau Tengah
6
08526676482
2600 1 1 Yanto 1611071105620002 Pulau Tengah
0
08120856873
3400 1 1 Supri 1611070107870080 Pulau Tengah
7
08525053616
3300 1 1 Robi 1611070204800001 Pulau Tengah
0
08227673827
3600 1 1 Gogo 1611071212780004 Pulau Tengah
1
08534344505
2800 1 1 Runsulni 1611070606730004 Pulau Tengah
3
08523154667
3000 1 1 Aluki 1611070101860006 Pulau Tengah
5
MBUHAN BALITA DI POSYANDU
Cara
Panjang
Ukur
Badan/
tgl 1=Telent
RT RW BB (kg) Tinggi umur 0 umur 1 umur 2 umur 3
pengukuran ang
Badan bln bln bln bln
(cm)
2=Berdiri
(15) (16) (17) (18) (19) (20) (21) (22) (23) (24)
0 0 12-09-2018 11 84 2 1 1 1 1
0 0 12-09-2018 12 88 2 1 1 1 1
0 0 12-09-2018 8'5 69 2 1 1 1 1
0 0 12-09-2018 11 82 2 1 1 1 1
0 0 12-09-2018 14 98 2 1 1 1 1
0 0 12-09-2018 15 86 2 1 1 1 1
0 0 12-09-2018 10 75 2 1 1 1 1
0 0 12-09-2018 14 88 2 1 1 1 1
0 0 12-09-2018 7,9 73 1 1 1 1 1
0 0 12-09-2018 10 82 2 1 1 1 1
0 0 12-09-2018 13 98 2 1 1 1 1
0 0 12-09-2018 11 89 2 2 2 2 2
0 0 12-09-2018 13 99 2 1 1 1 1
0 0 12-09-2018 6 57 1 1 1 1 1
0 0 12-09-2018 5,7 59 1 1 1 1 1
0 0 12-09-2018 8,5 76 2 1 1 1 1
0 0 12-09-2018 10 77 1 1 1 1 1
0 0 12-09-2018 8,6 72 1 2 2 2 2
0 0 12-09-2018 12 80 2 1 1 1 1
0 0 12-09-2018 11 87 2 1 1 1 1
0 0 12-09-2018 17 105 2 1 1 1 1
0 0 12-09-2018 11 82 2 1 1 1 1
0 0 12-09-2018 15 108 2 1 1 1 1
0 0 12-09-2018 15 90 2 1 1 1 1
0 0 12-09-2018 8,5 65 1 1 1 1 1
0 0 12-09-2018 11 83 2 1 1 1 1
0 0 12-09-2018 10 90 2 1 1 1 1
0 0 12-09-2018 11,5 75 2 1 1 1 1
1=YA,2=Tidak
Vitamin Vitamin
A A
Februari Agustus
umur 4 umur 5 1= Ya 1=Ya
bln bln 2=
Tidak 2=Tidak
(25) (26) (27) (28)
1 1 1 1
1 1 1 1
1 1 1 2
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 2
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
2 2 1 1
1 1 1 1
1 1 2 2
1 1 1 1
1 1 1 1
1 1 1 1
2 2 2 2
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 2
1 1 1 1
1 1 1 1
1 1 1 1
FOR
Provinsi : Sumatera Selatan Nama Posyandu : Ed
Kabupaten / Kota : Empat Lawang Bulan : Ja
Desa / Kelurahan : Muara Rungga

(1) (2) (3) (4) (5) (6) (7)

1 1 28-12-2015 L 1611072606090009 1611071211900000 M. Zidan
2 1 04-01-2018 L 1611070701160002 1611070401160001 Raditiya
3 1 03-03-2018 P 1611070204180002 1611074211000000 Adel
4 2 07-11-2016 p 1611070808160004 1611074711160001 Jihan
5 1 18-07-2017 L 1611071405180003 1611071807170001 M. Abi
6 3 23-10-2017 L 1611070108120001 1611075111800000 Al Aszka
7 1 02-05-2014 P 1611070302140001 1611074205140001 Salsabila
8 3 01-05-2017 L 1611070311100074 1611070105170001 Hafidz
9 3 22-08-2018 P 1611070411100010 1611075606800000 Agita
10 1 20-07-2016 P 1611071208160003 1611076007160001 Ririn
11 1 01-02-2015 P 1611070104140002 1611074102150001 Putri
12 3 23-05-2015 L 1611072603150001 1611072305150001 Reynand
13 4 04-04-2018 P 1611072603150001 1611074404180001 Assyfa
14 2 21-05-2018 L 1611072407120001 1611072105180001 Alzam
15 2 15-03-2017 P 1611070411100006 1611075503170001 Alika
16 2 18-05-2018 L 1611070205130001 1611077010800000 Adnan
17 1 05-07-2014 L 1611071407140001 1611070507140001 Cyhiko

18 2 08-08-2015 P 1611070601120003 1611074808150001 Beti
FORMULIR PENCATATAN PEMANTAUAN PERTUMBUHAN BALITA DI P
ma Posyandu : Edelweis
an : Januari
hun : 2019
Berat kan Buku

IMD
Badan KIA/KM No tlp/ HP
1=Ya Nama Ayah Nik Ayah Alamat
(BB) S 1=Ya Ayah
2=Tidak
Lahir
(8) (9) (10) (11) (12) (13) (14)
4000 Ya 1 Muara Rungga
08233738991
3800 Ya 1 Jum 1611071906870001 Muara Rungga
9
08523560766
3600 Ya 1 Nanda 1611070503970004 Muara Rungga
4
08537929635
3800 Ya 1 Azhan 1708041511820002 Muara Rungga
4
08536948177
3300 Ya 1 Sofian 1611071504840001 Muara Rungga
8
08523053442
3600 Ya 1 Agus 1611070505790006 Muara Rungga
0
08230404663
2900 Ya 1 Yudi 1611071212820005 Muara Rungga
0
08127664465
3200 Ya 1 Faizal 1611071007800003 Muara Rungga
4
08235990717
3400 Ya 1 Mintarja 1611071708770002 Muara Rungga
4
08525906259
2800 Ya 1 Ronal 1611071010850005 Muara Rungga
0
08526961535
3200 Ya 1 Rayem 1611072808820001 Muara Rungga
0
08532340261
3100 Ya 1 Mardiansyah 1611070107820093 Muara Rungga
6
08532340261
3500 Ya 1 Mardiansyah 1611070107820093 Muara Rungga
6
08537179355
2800 Ya 1 Rusli 1611070910850002 Muara Rungga
0
08131454655
2900 Ya 1 Yulianto 1611070609850001 Muara Rungga
8
08233215502
3300 Ya 1 Mariska 1611071303860002 Muara Rungga
0
08237275993
3800 Ya 1 Anggi 1611071205910002 Muara Rungga
4
08126674686
2800 Ya 1 Indra 1611071608780001
5
BUHAN BALITA DI POSYANDU
Panjang
Cara Ukur ASI Ekslusif1=YA,2=Tidak
Badan/
tgl 1=Telentang
RT RW BB (kg) Tinggi umur 0 umur 1 umur 2
pengukuran
Badan bln bln bln
2=Berdiri
(cm)
(15) (16) (17) (18) (19) (20) (21) (22) (23)
0 0 13-09-2018 14 92 2 1 1 1
0 0 13-09-2018 12 81 1 1 1 1
0 0 13-09-2018 7,5 66 1 1 1 1
0 0 13-09-2018 12 86 2 1 1 1
0 0 13-09-2018 10 79 1 1 1 1
0 0 13-09-2018 10 74 1 2 2 2
0 0 13-09-2018 14 104 2 1 1 1
0 0 13-09-2018 9,8 79 1 1 1 1
0 0 13-09-2018 4,8 56 1 1 1 1
0 0 13-09-2018 12,5 85 2 1 1 1
0 0 13-09-2018 15 95 2 1 1 1
0 0 13-09-2018 15 93 2 1 1 1
0 0 13-09-2018 7,6 64 1 1 1 1
0 0 13-09-2018 6,2 63 2 2 2 2
0 0 13-09-2018 9,4 79 1 1 1 1
0 0 13-09-2018 7,5 62 1 1 1 1
0 0 13-09-2018 16 83 2 1 1 1
0 0 13-09-2018 10 96 2 1 1 1
I Ekslusif1=YA,2=Tidak A A
Februari Agustus
umur 3 umur 4 umur 5 1= Ya 1=Ya
bln bln bln 2=
(24) (25) (26) (27) (28)
1 1 1 1 1
1 1 1 1 2
1 1 1 2 2
1 1 1 1 1
1 1 1 1 1
2 2 2 1 1
1 1 1 1 1
1 1 1 1 1
1 1 1 2 2
1 1 1 1
1 1 1 1 1
1 1 1 1 1
1 1 1 2 2
2 2 2 2 2
1 1 1 1 1
1 1 1 2 2
1 1 1 1 1
1 1 1 1 1
Provinsi : Sumatera Selatan Nama Posyandu : Anggrek Inda
Desa / Kelurahan : Muara Aman

(1) (2) (3) (4) (5) (6) (7)

161107100913000 161107700590000
1 2 04-07-2017 L Fazel
1 0
161107031110015 161107560780000
2 2 04-04-2016 L Dimas
3 0
161107071215000 161107600490000
3 2 12-03-2016 L Ardiansyah
3 0
161107310517000 161107620717000
4 1 22-07-2017 P Afifah
1 1
161107110308430 161107300516000
5 2 30-05-2016 L Zoni
9 1
161107080218000 167107491014000
6 2 09-10-2014 P Serli
2 7
161107080218000 167102440990000
7 3 18-01-2018 L Rafinda
2 0
161107100413000 161107101011000
8 2 10-10-2014 L Ferdiansa
9 3
161107110112000 161107180916000
9 2 18-09-2016 L Mukmah
8 1
161107200110000 161107461115000
10 3 06-11-2015 P Lega
3 1
161107030414000 161107460790000
11 1 17-02-2018 P Alesya
2 0
161107200314000 161107421117000
12 1 02-11-2017 P Zhoya
1 1
161107550580000
13 3 06-12-2017 L 161107065130008 Derfando
0
161107020913001 161107550780000
14 3 03-04-2015 P Elisia
8 0
161107060609000 161107250714000
15 4 25-07-2014 L Arkah
9 1
161107021110005 161107151215000
16 3 15-12-2015 L Fadlan
5 1
161107050315001 161107410315000
17 2 01-03-2015 P Marsya
5 1
18 2 26-0616 L 161107230412000 161107260616000 Ahmad

1 1
161107030718000 161107590514000
19 1 19-05-2014 P Kanza
1 1
161107110308434 161107300515000
20 2 30-05-2015 L Agra
0 1
21
AN BALITA DI POSYANDU
Nama Posyandu : Anggrek Indah
Bulan : Januari
ahun : 2019
Kepemili
Berat kan Buku
IMD
Badan KIA/KM No tlp/ HP
1=Ya Nama Ayah Nik Ayah Alamat RT
(BB) S 1=Ya Ayah
2=Tidak
Lahir
2=Tidak
(8) (9) (10) (11) (12) (13) (14) (15)

161107050588000 0823772443
2900 1 1 Candra Muara Aman 0
2 56
161107171184000 0821899054
3300 1 1 Doni Muara Aman 0
3 32
161107201288000 0853873465
2700 1 1 Dwi Muara Aman 0
2 41
161107110492000 0853247455
3100 1 1 Wendi Muara Aman 0
2 84
161107070378000 0822677463
3400 1 1 Arpin Muara Aman 0
1 60
167102030582001 0852367622
2800 1 1 Masluri Muara Aman 0
3 60
167102030582001 0813677848
3200 1 1 Masluri Muara Aman 0
3 44
161107090385000 0853606984
2700 1 1 Ruslan Muara Aman 0
3 43
161107230680000 0812452014
2900 1 1 Muktar Muara Aman 0
1 54
161107020777000 0823838041
3400 1 1 G.Winnetow Muara Aman 0
3 47
161107150687000 0853229046
3000 1 1 Lukman Muara Aman 0
1 67
161107251168000 0852988532
3200 1 1 Warsono Muara Aman 0
2 20
161107010181000 0853126585
2800 1 1 Edi Muara Aman 0
8 34
161107250376000 0853663653
3000 1 1 Edi Muara Aman 0
1 28
161107250714000 0812433256
2900 1 1 Mukti Muara Aman 0
1 63
161107060478000 0853421584
3100 1 1 Wawan Muara Aman 0
3 68
161107250583000 0813784635
3300 1 1 Medi Muara Aman 0
5 55
2800 1 1 Kamaludin 161107060683000 0852351466 Muara Aman 0

3 75
161107070583000 0812774256
4000 1 1 Noli Muara Aman 0
1 67
161107010170000 0852311246
3100 1 1 Minha Muara Aman 0
4 54
Panjang
Cara Ukur
Badan/
tgl 1=Telentang
RW BB (kg) Tinggi umur 0 umur 1 umur 2 umur 3
pengukuran
2=Berdiri
(cm)
(16) (17) (18) (19) (20) (21) (22) (23) (24)
0 10-09-2018 10 79 1 1 1 1 1
0 10-09-2018 13 86 2 1 1 1 1
0 10-09-2018 12 85 2 1 1 1 1
0 10-09-2018 9 72 1 1 1 1 1
0 10-09-2018 10 85 2 2 2 2 2
0 10-09-2018 10 99 2 1 1 1 1
0 10-09-2018 10 72 1 1 1 1 1
0 10-09-2018 14 104 2 1 1 1 1
0 10-09-2018 11 105 2 1 1 1 1
0 10-09-2018 11 86 2 1 1 1 1
0 10-09-2018 8 83 2 2 2 2 2
0 10-09-2018 11 87 2 1 1 1 1
0 10-09-2018 8,5 73 1 1 1 1 1
0 10-09-2018 10 86 2 1 1 1 1
0 10-09-2018 20 104 2 1 1 1 1
0 10-09-2018 12 102 2 1 1 1 1
0 10-09-2018 14 89 2 1 1 1 1
0 10-09-2018 13 86 2 1 1 1 1
0 10-09-2018 25 89 2 2 1 1 1
0 10-09-2018 14 87 2 2 1 1 1
1=YA,2=Tidak
Vitamin Vitamin
A A
Februari Agustus
bln bln 2=
Tidak 2=Tidak
(25) (26) (27) (28)
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
2 2 1 1
1 1 1 1
1 1 1 2
1 1 1 1
1 1 1 1
1 1 1 1
2 2 1 2
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
FOR
Provinsi : Sumatera Selatan Nama Posyandu : Anggrek
Desa / Kelurahan : Penantian
Berat
Tanggal Jenis Nik (Nomor Induk Nama Badan
No Anak ke No Kartu Keluarga
Lahir Kelamin Kependudukan) Anak (BB)
Lahir
(1) (2) (3) (4) (5) (6) (7) (8)

15-06-
1 4 L 1611071705100004 1611071506160001 Argifran 2800
2016
26-08-
2 2 L 1611071003140011 1611072608160001 Fauzan 2700
2016
26-10-
3 2 L 1611070809090024 1611072610160001 serkan 2800
2016
06-12-
4 2 P 1611071809130003 1611071809130002 Hazika 2600
2016
06-12-
5 3 P 1611071809130003 1611071809130003 Hazirah 2500
2016
23-09-
6 1 P 1611070701140002 1611076309130001 Utari 3300
2013
04-12-
7 2 P 1611073107120003 1611074412170001 Airin 3700
2017
08-09-
8 2 L 1611072111110018 1611070809130002 faqi 2900
2013
07-04-
9 1 L 1611071008170001 1611070704130001 Risky 3100
2013
18-06-
10 2 L 1611071008170001 1611071806170001 Rendra 3500
2017
01-01-
11 2 P 1611072709130001 1611074101140001 Caca 3800
2014
07-06- M.
12 1 L 1611070711160003 1611070706150002 3000
2015 Handra
16-11- Dwi
13 2 P 1611070711160003 1611075611160001 3400
2016 Awani
01-09-
14 2 L 1611071103080996 1611070109140001 Rafa 3200
2014
14-01-
15 4 L 1611070911090002 1611075006800000 M. Rizki 2900
2016
24-01-
16 5 P 1611072904110001 1611076401150000 Rere 3100
2015
28-02-
17 1 L 1611073103150002 1611072802150001 Deo 2900
2015
31-05-
18 2 L 1611071310090004 1611073105160002 Putra 3000
2016
25-01-
19 1 P 1611072812160006 3275056501140002 Aisyah 3600
2014
02-03-
20 1 P 1611072505160002 1611074203150002 Saljea 3200
2015
16-01-
21 2 L 1611072505160002 1611071601180001 Ammar 2900
2018
04-05-
22 1 L 1611072507130001 1611070405130003 M. Ibra 2800
2013
26-03-
23 2 P 1611072507130001 1611076603170000 Azahra 3300
2017
28-03-
24 3 P 1611070403150016 1611076803160001 Meisyah 3800
2016
06-03-
25 1 L 1611072209140001 1611070603140003 Gilang 3100
2014
06-06-
26 1 p 1611071907130002 1611074606130002 Vemy 3200
2013
24-12-
27 1 L 1611070701140001 1611072412130002 Enji 2800
2013
25-03-
28 1 P 1611070807150002 1611076603160001 Azih 2700
2015
09-06-
29 2 P 1611070807150002 1611071906170001 Sari 2900
2017
11-10-
30 2 P 1611072905130001 1611074808900000 Rahel 3200
2017
24-06-
31 1 L 1611072802180003 1603115008900000 Habib 2800
2017
26-08-
32 1 P 1611071107180001 1611076608170001 Sahsya 3600
2017
27-12-
33 2 P 1611070709120004 1611076707800000 Nada 3100
2017
18-06-
34 2 L 1611071511110002 1611075004800000 Aksa 2800
2017
22-11- Alkahata
35 1 L 1611072112100001 1611072211130001 3100
2013 n
36 2 16-05-
P 1611070811110008 1611075605170001 Ivanka 3300
2017
yandu : Anggrek
: Januari
: 2019
Kepemili
kan Buku
IMD tgl
KIA/KM Nama No tlp/ HP
1=Ya Nik Ayah Alamat RT RW pengukur
S 1=Ya Ayah Ayah
2=Tidak an
2=Tidak
(9) (10) (11) (12) (13) (14) (15) (16) (17)

1611071012 0812887654 Penantia 10-09-
1 1 Arwansa 0 0
730001 32 n 2018
1611070101 0812883414 Penantia 10-09-
1 1 supar 0 0
810010 54 n 2018
1611072809 0852678834 penantia 10-09-
1 1 Adi 0 0
780003 32 n 2018
1611071807 1611071807 penantia 10-09-
1 1 Zulpi 0 0
680001 680001 n 2018
1611071807 1611071807 penantia 10-09-
1 1 Zulpi 0 0
680001 680001 n 2018
1611072505 0813454423 penantia 10-09-
1 1 Wahid 0 0
940002 20 n 2018
1611070807 0853766549 penantia 10-09-
1 1 Met 0 0
840001 90 n 2018
1611071101 0852665433 penantia 10-09-
1 1 Zelpi 0 0
860002 90 n 2018
1611071806 0823070655 penantia 10-09-
1 1 Nicky 0 0
890004 40 n 2018
1611071806 0823070655 penantia 10-09-
1 1 Nicky 0 0
890004 40 n 2018
1611071206 0821336560 penantia 10-09-
1 1 Ansori 0 0
810002 48 n 2018
1611070101 0822077124 penantia 10-09-
1 1 Amirwan 0 0
790006 45 n 2018
1611070101 0822077124 penantia 10-09-
1 1 Amirwan 0 0
790006 45 n 2018
1611072405 0812667832 penantia 10-09-
1 1 Paino 0 0
720001 21 n 2018
1611072307 0853446772 penantia 10-09-
1 1 Ardi 0 0
700001 34 n 2018
1611070109 0812544267 penantia 10-09-
1 1 Alpiyan 0 0
820001 71 n 2018
1611070612 0823677354 penantia 10-09-
1 1 Ade 0 0
940002 42 n 2018
1611071010 0812445663 penantia 10-09-
1 1 Debi 0 0
800008 61 n 2018
3275051810 0812206088 penantia 10-09-
1 1 Candra 0 0
840017 41 n 2018
1611072510 0822667654 penantia 10-09-
1 1 Heri 0 0
850000 43 n 2018
1611072510 0822667654 penantia 10-09-
1 1 Heri 0 0
850000 43 n 2018
1611070804 0852108189 penantia 10-09-
1 1 Daudi 0 0
820002 68 n 2018
1611070804 0852108189 penantia 10-09-
1 1 Daudi 0 0
820002 68 n 2018
M. 1611072608 0853728860 penantia 10-09-
1 1 0 0
Irwansyah 850009 61 n 2018
1611070507 0812677256 penantia 10-09-
1 1 Yuliadri 0 0
530003 40 n 2018
1611070509 0813817958 penantia 10-09-
1 1 Roli 0 0
890001 42 n 2018
1611071408 0813566270 penantia 10-09-
1 1 Yoga 0 0
920004 61 n 2018
1611070107 0852713991 penantia 10-09-
1 1 Dufran 0 0
910033 16 n 2018
1611070107 0852713991 penantia 10-09-
1 1 Dufran 0 0
910033 16 n 2018
1611071605 0823601173 penantia 10-09-
1 1 Megi 0 0
920004 82 n 2018
1611071612 0822588631 penantia 10-09-
1 1 Renal 0 0
910001 27 n 2018
1611072704 0853407291 penantia 10-09-
1 1 Heru 0 0
940001 93 n 2018
1611070611 0812501578 penantia 10-09-
1 1 Safrial 0 0
860001 48 n 2018
1611070505 0852211566 penantia 10-09-
1 1 Doni 0 0
810003 70 n 2018
1611072101 0823546002 penantia 10-09-
1 1 Lahizandri 0 0
700001 25 n 2018
1611071203 0812774662 penantia 10-09-
1 1 Ivan 0 0
870001 30 n 2018
YANDU
Cara Vitamin
Panjang
Ukur A
Badan/
1=Telent Februari
BB (kg) Tinggi umur 0 umur 1 umur 2 umur 3 umur 4 umur 5 1= Ya
ang
(cm)
2=Berdiri Tidak
(18) (19) (20) (21) (22) (23) (24) (25) (26) (27)
14 84 2 1 1 1 1 1 1 1
13 80 2 1 1 1 1 1 1 1
12 90 2 1 1 1 1 1 1 1
11 79 2 1 1 1 1 1 1 1
10 76 2 1 1 1 1 1 1 1
16 102 2 1 1 1 1 1 1 1
12,6 82 2 1 1 1 1 1 1 1
15 91 2 1 1 1 1 1 1 1
14 82 2 1 1 1 1 1 1 1
11 79 2 1 1 1 1 1 1 1
13,4 82 2 1 1 1 1 1 1 1
11 78 2 1 1 1 1 1 1 1
10 75 2 1 1 1 1 1 1 1
13 81 2 1 1 1 1 1 1 1
11 74 2 1 1 1 1 1 1 1
12 78 2 1 1 1 1 1 1 1
13 83 2 1 1 1 1 1 1 1
12 84 2 1 1 1 1 1 1 1
14 88 2 1 1 1 1 1 1 1
14 79 2 1 1 1 1 1 1 1
8'8 68 2 1 1 1 1 1 1 1
15 79 2 1 1 1 1 1 1 1
11 72 2 1 1 1 1 1 1 1
10 78 2 1 1 1 1 1 1 1
15 81 2 1 1 1 1 1 1 1
16 98 2 1 1 1 1 1 1 1
16 94 2 1 1 1 1 1 1 1
13 77 2 1 1 1 1 1 1 1
10 71 2 1 1 1 1 1 1 1
10 73 2 1 1 1 1 1 1 1
11 78 2 1 1 1 1 1 1 1
11 76 2 1 1 1 1 1 1 1
10 74 2 1 1 1 1 1 1 1
10 73 2 1 1 1 1 1 1 1
13 85 2 1 1 1 1 1 1 1
11 78 2 1 1 1 1 1 1 1
Vitamin
A
Agustus
1=Ya
2=Tidak
(28)
1
1
1
1
Provinsi : Sumatera Selatan Nama Posyandu : Melati
Desa / Kelurahan : Padang Bindu
Kepemili
Berat kan Buku Panjang Cara Ukur Vitamin A Vitamin A
IMD
Jenis Nik (Nomor Induk Badan KIA/KM No tlp/ HP Badan/ 1=Telentang Februari Agustus
No Anak ke Tanggal Lahir No Kartu Keluarga Nama Anak 1=Ya Nama Ayah Nik Ayah Alamat RW tgl pengukuran BB (kg) umur 0 umur 1 umur 2 umur 3 umur 4 umur 5 1= Ya
Kelamin Kependudukan) (BB) S 1=Ya Ayah Tinggi 1=Ya
2=Tidak bln bln bln bln bln bln
Lahir Badan (cm) 2=Berdiri 2= Tidak 2=Tidak
2=Tidak
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (16) (17) (18) (19) (20) (21) (22) (23) (24) (25) (26) (27) (28)
08536848229 Padang
1 1 22-09-2014 P 1611070408150003 1611075209140001 Adzkya 2900 ya 1 Hendra 1611071208920003 0 14-09-2018 15 109 2 1 1 1 1 1 1 1 1
0 Bindu
08210707843 Padang
2 1 27-11-2013 P 1611070302140004 1611076711130001 Meyza 3300 ya 1 Miltra 1611071607930003 0 14-09-2018 15 105 2 1 1 1 1 1 1 1 1
0 Bindu
08526636536 Padang
3 1 19-07-2015 L 1611071608170004 1611071907150002 Syahid 2800 ya 1 Triono 1611072607880001 0 14-09-2018 9'3 71 1 1 1 1 1 1 1 1 1
2 Bindu
08234560556 Padang
4 1 20-07-2017 L 1611071304170002 1611072007170002 M. farid 3100 ya 1 Juni 1611070106880001 0 14-09-2018 12 90 2 1 1 1 1 1 1 1 1
4 Bindu
08127242356 Padang
5 2 16-05-2015 L 1611070610090007 1611071605150003 M.Ridho 2900 ya 1 Amril 1611071011690002 0 14-09-2018 15 91 2 1 1 1 1 1 1 1 1
5 Bindu
08532122466 Padang
6 3 07-022016 L 1611072701090048 1611070702160001 Jiean 3400 ya 1 Aan 1611071506800001 0 14-09-2018 14 86 2 1 1 1 1 1 1 1 1
0 Bindu
08126778484 Padang
7 1 28-10-2015 P 1611070812150003 1611076810150002 Anindita 2700 ya 1 Herwana 1611071507870005 0 14-09-2018 10'2 86 2 1 1 1 1 1 1 1 1
5 Bindu
08525330144 Padang
8 2 28-10-2015 P 1611070812150003 1611076810150003 Anindiya 2600 ya 1 Herwana 1611071507870005 0 14-09-2018 10,2 83 2 1 1 1 1 1 1 1 1
4 Bindu
08129091229 Padang
9 1 13-08-2015 L 1611072505150001 1611071308150001 Abdullah 2900 ya 1 Hengki 1611071411870001 0 14-09-2018 14 93 2 1 1 1 1 1 1 1 1
0 Bindu
08214042663 Padang
10 2 22-05-2017 L 1611072505150001 1611072205170000 Abid 3200 ya 1 Hengki 1611071411870001 0 14-09-2018 12 84 2 1 1 1 1 1 1 1 1
4 Bindu
08127864281 Padang
11 2 28-04-2017 L 1611073110100030 1611071206900000 Iksan 2700 ya 1 Dani 1611071010860003 0 14-09-2018 8 78 2 1 1 1 1 1 1 1 1
6 Bindu
08230520533 Padang
12 2 01-03-2017 L 1611070706110004 1611070103170001 Zidan 2900 ya 1 Diki 1611070108920003 0 14-09-2018 12 85 2 1 1 1 1 1 1 1 1
8 Bindu
08237646822 Padang
13 2 06-03-2017 L 1611070107110005 1611070503170001 Meyzhel 3300 ya 1 Adi 1611070206810002 0 14-09-2018 11 78 2 1 1 1 1 1 1 1 1
5 Bindu
08234560876 Padang
14 3 11-06-2018 L 1611071103083992 1611074107800000 Redo 2900 ya 1 Radin 1611070107800054 0 14-09-2018 6,6 64 1 1 1 1 1 1 1 2 2
8 Bindu
08213556477 Padang
15 3 07-05-2018 L 1611070610100003 1611074511800000 Raja 3400 ya 1 Veri 1611071512790003 0 14-09-2018 7,0 65 1 1 1 1 1 1 1 2 2
8 Bindu
08237174556 Padang
16 2 26-01-2018 P 1611073110100033 1611075006800000 Clara 3600 ya 1 April 1611070504640002 0 14-09-2018 8,2 72 1 1 1 1 1 1 1 1 2
0 Bindu
08224351651 Padang
17 3 21-07-2018 P 1611072506090001 1611076606800000 Astri 2500 ya 1 Supriadi 1611072601800001 0 14-09-2018 4 59 1 1 1 1 1 1 1 2 2
5 Bindu
08534221655 Padang
18 1 06-12-1013 P 1611070802140001 1611074612130001 Kayla 2900 ya 1 Gustap 1611071708920003 0 14-09-2018 18 108 2 1 1 1 1 1 1 1 1
0 Bindu
08534221655 Padang
19 2 16-12-2016 L 1611070802140001 1611075703900000 Renal 3200 ya 1 Gustap 1611071708920003 0 14-09-2018 9,8 86 1 1 1 1 1 1 1 1 1
0 Bindu
Provinsi : Sumatera Selatan Nama Posyandu : Stowber
Desa / Kelurahan : Kebanjati
Tanggal Jenis Nik (Nomor Induk Nama

No Anak ke No Kartu Keluarga
Lahir Kelamin Kependudukan) Anak
(1) (2) (3) (4) (5) (6) (7)

M.
1 2 04-05-2016 L 1611071302150000 1611070405160001
Yudha
2 1 02-09-2015 L '1611071506150002 1611070209150001 Tegar
3 2 26-11-2016 P 1611071103081479 1611076611160000 Agiya
4 2 31-10-2015 L 1611070311100117 1611073110150002 Zonatan
5 1 19-07-2014 L 1611071504150008 1611071907140001 Arsyad
6 3 03-03-2013 P 1611072610100002 1611074303130001 Naila
7 1 24-06-2017 L 1611071104170002 1611072406170001 Abidzar
8 2 20-03-2017 L 1611072802120010 1611072003170001 Arsy
9 2 10-03-2013 P 1611071702100005 1611075003130000 Melinda
10 1 05052015 P 1611071806150001 1611074505150001 Afiqa
11 3 31-12-2016 L 1611070305170003 1611073112160001 Rey
12 1 27-07-2014 P 1611070311140003 1611076707140001 Noela
13 1 15-10-2015 L 1611071511160005 1611071510150001 Faza
14 2 21-09-2013 L 1611070311120012 1611072109130001 Arka

15 2 21-02-2016 L 1611071208100002 1611072702160001 M. Iqbal
16 1 10-09-2014 L 1611070311140005 1611071009140001 Kelpin
17 2 14-05-2015 P 1611073011110004 1611075405150001 Nadila
18 1 26-05-2014 P 1611072910130000 1611076605140001 Aqilla
19 2 19-11-2014 L 1611070311100106 1611071911140001 Achmad
20 2 23-07-2015 L 1611070311100089 1611072307150001 Gibran
21 1 20-11-2017 P 1611070702180002 1611076011170001 Cahaya
22 2 12-10-2017 L 1611070311100104 1611071210170001 M. Gio

BALITA DI POSYANDU
Nama Posyandu : Stowberry 1
Bulan : Januari
Tahun : 2019
Kepemil
ikan
Buku
Berat IMD
KIA/K No tlp/ HP
Badan 1=Ya Nama Ayah Nik Ayah Alamat RT
MS Ayah
(BB) Lahir 2=Tidak
1=Ya
2=Tidak
(8) (9) (10) (11) (12) (13) (14) (15)
161107250590000 0823542096
3300 Ya 1 Anggi Kebanjati 0
4 90
161107010683000 0852764552
3100 Ya 1 Amin Kebanjati 0
1 27
161107010779001 0853416113
3600 Ya 1 Suryadi Kebanjati 0
7 14
161107010786006 0823070722
2900 Ya 1 Amrizon Kebanjati 0
0 81
161107200791000 0853660678
2800 Ya 1 Julian Kebanjati 0
1 35
161107110479000 0822934172
3500 Ya 1 Suwito Kebanjati 0
2 53
161107110417000 0853365262
2900 Ya 1 Donal Kebanjati 0
2 11
161107051086000 0823646672
3200 Ya 1 Didi Kebanjati 0
2 36
161107040279000 0852121190
3100 Ya 1 Muriyadi Kebanjati 0
2 71
161107030183000 0822546576
3500 Ya 1 Jepi Kebanjati 0
0 87
320432070580000 0853818264
2800 Ya 1 Evan Kebanjati 0
0 84
161107010788005 0812310672
4000 Ya 1 Mispon Kebanjati 0
8 42
161107070187000 0812408577
3200 Ya 1 Mikki Kebanjati 0
1 08
161107170880000 0812578188
2800 Ya 1 Riswandi Kebanjati 0
7 23
161107100681000 0853534026
3100 Ya 1 Andi Kebanjati 0
1 16
161107210181000 0822524175
2700 Ya 1 Diki Kebanjati 0
3 22
161107540515000 0813099176
3800 Ya 1 Didi Kebanjati 0
1 64
161107080590000 0852455098
3400 Ya 1 Gito Kebanjati 0
7 90
161107251280000 0813211943
2900 Ya 1 Ajibun Kebanjati 0
4 11
161107230580000 0813442433
3100 Ya 1 Gunawan Kebanjati 0
1 20
161107280891000 0812535271
3700 Ya 1 Engga Kebanjati 0
1 78
161107030480000 0813606672
2800 Ya 1 Afriadi Kebanjati 0
7 21
Cara
Panjang Ukur
tgl Badan/ 1=Telent
RW pengukur BB (kg) Tinggi ang umur 0 umur 1 umur 2 umur 3 umur 4
an Badan bln bln bln bln bln
(cm) 2=Berdi
ri
(16) (17) (18) (19) (20) (21) (22) (23) (24) (25)
12-09-
0 15 75 2 1 1 1 1 1
2018
12-09-
0 15 89 2 1 1 1 1 1
2018
12-09-
0 8 70 2 1 1 1 1 1
2018
12-09-
0 13 80 1 1 1 1 1 1
2018
12-09-
0 15 93 2 1 1 1 1 1
2018
12-09-
0 15 106 2 1 1 1 1 1
2018
12-09-
0 10 70 2 1 1 1 1 1
2018
12-09-
0 9 74 2 1 1 1 1 1
2018
12-09-
0 16 107 2 1 1 1 1 1
2018
12-09-
0 17 93 2 1 1 1 1 1
2018
12-09-
0 16 82 2 1 1 1 1 1
2018
12-09-
0 14 92 2 1 1 1 1 1
2018
12-09-
0 14 93 2 1 1 1 1 1
2018
12-09-
0 16 107 2 1 1 1 1 1
2018
12-09-
0 11 89 2 1 1 1 1 1
2018
12-09-
0 14 98 2 1 1 1 1 1
2018
12-09-
0 12 92 2 1 1 1 1 1
2018
12-09-
0 15 98 2 1 1 1 1 1
2018
12-09-
0 15 96 2 1 1 1 1 1
2018
12-09-
0 14 97 2 1 1 1 1 1
2018
12-09-
0 7,5 68 1 1 1 1 1 1
2018
12-09-
0 10 78 1 1 1 1 1 1
2018
Tidak
Vitamin Vitamin
A A
Februari Agustus
umur 5 1= Ya 1=Ya
bln 2=
Tidak 2=Tidak
(26) (27) (28)

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
FORMULIR PENC
Provinsi : Sumatera Selatan Nama Posyandu
Kabupaten / Kota : Empat Lawang Bulan
Puskesmas/ Kecamatan : Nanjungan Tahun
Desa / Kelurahan : Air Belondo
Berat
Anak Tanggal Jenis Nik (Nomor Induk Nama Badan
No No Kartu Keluarga
ke Lahir Kelamin Kependudukan) Anak (BB)
Lahir
(1) (2) (3) (4) (5) (6) (7) (8)
1 3 29-08-2013 L 1611070209130021 1611072908130001 Edo 2800
2 1 17-02-2014 P 1611070503140013 1611075702140001 Enjel 3100
3 1 26-04-2014 P 1611070901140002 1611076604140001 Callyata 3400
4 2 02-02-2013 P 1611072808130003 1611074202130001 Jihan 2900
5 3 31-5-2016 P 1611071401090006 1611074101700000 Bella 3100
6 2 15-02-2015 P 1611072808130005 1611075502150000 Jesika 3000
7 2 30-12-2017 L 1611071604130000 1611076802840001 Aditia 2800
8 2 09-11-2016 L 1611071712130003 1611070911160001 Dewa 3400
9 2 03-10-2013 L 1611071308090015 1611070310130002 Bintang 3700
10 3 05-07-2013 L 1611071305090001 1611070507130001 Shohibul 2900
11 2 09-07-2015 P 1611070311100098 1611074907150001 Salsabila 3300
12 2 02-06-2016 P 1611071501090041 1611074206160001 Arsyila 3100
13 2 18-07-2014 P 1611071103081685 1611075607140001 Ulan 2800

14 2 20-11-2015 P 1611071604130003 1611078011150001 Laura 3300
MULIR PENCATATAN PEMANTAUAN PERTUMBUHAN BALITA DI P
Nama Posyandu : strowberry 2
Bulan : Januari
Tahun : 2019
Kepemili
kan Buku
IMD
KIA/KM Nama
1=Ya Nik Ayah No tlp/ HP Ayah Alamat RT RW
S 1=Ya Ayah
2=Tidak
2=Tidak
(9) (10) (11) (12) (13) (14) (15) (16)
1 1 Sobri 1611071706710002 082355679881 Air Belondo 0 0
1 1 Jumino 1611073004900001 082345651711 Air Belondo 0 0
1 1 Eka 1611070808880003 085266511342 Air Belondo 0 0
1 1 Lasimin 1611071109850004 082177809225 Air Belondo 0 0
1 1 Budiman 1611071303740001 082207078288 Air Belondo 0 0
1 1 Juni 1611070510900006 081210877551 Air Belondo 0 0
1 1 Irin 1611071808800002 081276612290 Air Belondo 0 0
1 1 Paulan 1611071206840002 081245513321 Air Belondo 0 0
1 1 Jimi 1611075412820001 081244135120 Air Belondo 0 0
1 1 Zaenal 1611070410790001 082321098282 Air Belondo 0 0
1 1 Triono 1611070211850002 081277814315 Air Belondo 0 0
1 1 Tumino 1611073001790002 082316413244 Air Belondo 0 0
1 1 Rohman 1611070107720115 082331505606 Air Belondo 0 0

1 1 Suwindi 1611072804860001 085211017312 Air Belondo 0 0
Cara
Panjang
Ukur
Badan/
tgl 1=Telent
BB (kg) Tinggi umur 0 umur 1 umur 2 umur 3 umur 4 umur 5
pengukuran ang
Badan bln bln bln bln bln bln
(cm)
2=Berdiri
(17) (18) (19) (20) (21) (22) (23) (24) (25) (26)
12-09-2018 15 101 2 1 1 1 1 1 1
12-09-2019 15 104 2 1 1 1 1 1 1
12-09-2020 13 99 2 1 1 1 1 1 1
12-09-2021 12 101 2 1 1 1 1 1 1
12-09-2022 11 83 2 1 1 1 1 1 1
12-09-2023 11 90 2 1 1 1 1 1 1
12-09-2024 10 81 2 1 1 1 1 1 1
12-09-2025 11 77 2 1 1 1 1 1 1
12-09-2026 16 109 2 1 1 1 1 1 1
12-09-2027 14 103 2 1 1 1 1 1 1
12-09-2028 12 88 2 1 1 1 1 1 1
12-09-2029 10 84 2 1 1 1 1 1 1
12-09-2030 12 96 2 1 1 1 1 1 1
12-09-2031 11 98 2 1 1 1 1 1 1
Vitamin Vitamin
A A
Februari Agustus
1= Ya 1=Ya
2=
Tidak 2=Tidak
(27) (28)
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
FORMULIR PEN
Provinsi : Sumatera Selatan
Kabupaten / Kota : Empat Lawang
Puskesmas/ Kecamatan : Nanjungan
Desa / Kelurahan : Muara Sindang
Anak Tanggal Jenis Nik (Nomor Induk Nama

ke Lahir Kelamin Kependudukan) Anak
(1) (2) (3) (4) (5) (6) (7)
1 1 8/13/2014 P 1611072206160000 1611075308140000 Tasya
2 2 2/12/2018 P 1611072206160000 1611034708970000 Bela
M.
3 2 12/12/2015 L 1611072610110000 1611071212150000
Adazka
4 1 4/10/2013 P 1611070504130000 1611075004130000 Saffa
5 2 4/1/2013 L 1611071103083520 161107401130001 Sepani
6 1 10/18/2013 L 1611071407150000 1611071510130000 Achmad
7 1 1/28/2013 L 1611070603140000 1611022801130000 Agra
8 2 4/12/2013 P 1611070708090000 1611075204130000 Enjel
9 3 5/3/2016 L 1611070510090000 1611070305160000 Ahmad
10 1 4/22/2017 L 1611071005170000 1611072204170000 Gibran
11 1 7/31/2015 L 1611072908160000 1611073107150000 Rizky

12 4 7/14/2015 P 1611071701110000 1611075210700000 Anisa
13 2 4/24/2016 L 1611071001120020 1611072404160000 Aldi
14 2 5/8/2016 L 1611071805110000 1611071805160000 Ramadan
15 1 6/7/2017 p 1611070707170000 1611074706170000 Zazela
16 1 6/13/2014 P 1611072501160000 1611075306140000 Tifatul
17 2 1/22/2015 P 1611070510090000 1611076201150000 Rindu
18 3 4/27/2017 P 1611070510090000 1611076704170000 Raisa
19 1 11/16/2016 L 1611071509160000 1611071611160000 M. Rio
20 1 1/17/2014 P 1611071001120020 1611075701140000 Jesikha
21 2 2/21/2018 P 1611071001120020 1611075505900000 Azira
22 2 8/16/2015 P 1611073006110000 1611075608150000 Hanifah
23 2 9/3/2016 L 1611073009090020 1611070309160000 Rafli
24 1 4/10/2017 P 1611072102170000 1611077007040000 Kayla

Nama Posyandu : Sehat 1
Bulan : Januari
Tahun : 2019
Kepemili
Berat kan Buku
IMD
Badan KIA/KM Nama
1=Ya Nik Ayah No tlp/ HP Ayah Alamat RT
(BB) S 1=Ya Ayah
2=Tidak
Lahir
2=Tidak
(8) (9) (10) (11) (12) (13) (14) (15)

Muara
2700 ya 1 Leka 1611070510920000 082373554867 0
Sindang
Muara
2900 ya 1 Leka 1611070510920000 082293746273 0
Sindang
Muara
3100 ya 1 Hendra 1611073010770000 085283736384 0
Sindang
Muara
3500 ya 1 Widodo 1611070808830000 082374782737 0
Sindang
Muara
2800 ya 1 Erwan 1611071510820000 082364827364 0
Sindang
Muara
3200 ya 1 Parizon 1611070311880000 082374692903 0
Sindang
Muara
2900 ya 1 Dodi 1611022707900000 082384927239 0
Sindang
Muara
3300 ya 1 Yatiman 1611071506700000 085835829372 0
Sindang
Muara
2800 ya 1 Anca 1611071211730000 082382010182 0
Sindang
Muara
2900 ya 1 Dinal 1611070207920000 085826390381 0
Sindang
Muara
3300 ya 1 Ludi 1611070107830020 082273682938 0
Sindang
Muara
2700 ya 1 Zainudin 1611072210730000 082287473290 0
Sindang
Muara
3100 ya 1 Adi 1611070908820000 085293728111 0
Sindang
Muara
2900 ya 1 Pito 1611070507860000 085273937252 0
Sindang
Muara
3500 ya 1 Ario 1611071001910000 082373713863 0
Sindang
M. Muara
3800 ya 1 1611072010790000 085820372611 0
Mas'ud Sindang
Samsudi Muara
3100 ya 1 1611070808750000 085280373661 0
n Sindang
Samsudi Muara
3300 ya 1 1611070808750000 085293716171 0
n Sindang
Muara
2800 ya 1 Ariadi 1611070107810050 082323618291 0
Sindang
Muara
3300 ya 1 Okos 1611072304890000 085283917163 0
Sindang
Muara
3700 ya 1 Okos 1611072304890000 085836293611 0
Sindang
Muara
2700 ya 1 Rego 1611071807810000 082336382362 0
Sindang
Muara
3000 ya 1 Tarman 1611071705810000 085238351831 0
Sindang
Muara
2900 ya 1 Palinto 1611071205770000 082271839351 0
Sindang
HAN BALITA DI POSYANDU
Cara
Panjang
Ukur
Badan/
tgl 1=Telent
RW BB (kg) Tinggi umur 0 umur 1 umur 2 umur 3 umur 4
pengukuran ang
Badan bln bln bln bln bln
(cm)
2=Berdiri
(16) (17) (18) (19) (20) (21) (22) (23) (24) (25)
0 9/13/2018 12 83 2 1 1 1 1 1
0 9/13/2018 7 66 1 1 1 1 1 1
0 9/13/2018 16 83 2 1 1 1 1 1
0 9/13/2018 15 102 2 1 1 1 1 1
0 9/13/2018 14 113 2 1 1 1 1 1
0 9/13/2018 18 106 2 1 1 1 1 1
0 9/13/2018 15.5 106 2 2 1 1 1 1
0 9/13/2018 16 106 2 1 1 1 1 1
0 9/13/2018 12 89 2 1 1 1 1 1
0 9/13/2018 9'5 78 1 1 1 1 1 1
0 9/13/2018 12 86 2 1 1 1 1 1
0 9/13/2018 12 82 2 1 1 1 1 1
0 9/13/2018 16 86 2 1 1 1 1 1
0 9/13/2018 14 80 2 1 1 1 1 1
0 9/13/2018 11 74 2 1 1 1 1 1
0 9/13/2018 16 81 2 1 1 1 1 1
0 9/13/2018 10 75 2 1 1 1 1 1
0 9/13/2018 13 91 2 1 1 1 1 1
0 9/13/2018 12.5 80 2 1 1 1 1 1
0 9/13/2018 16 97 2 1 1 1 1 1
0 9/13/2018 8 66 1 1 1 1 1 1
0 9/13/2018 13.5 89 2 1 1 1 1 1
0 9/13/2018 13 89 2 1 1 1 1 1
0 9/13/2018 11 75 1 1 1 1 1 1
idak
Vitamin Vitamin
A A
Februari Agustus
umur 5 1= Ya 1=Ya
bln 2=
Tidak 2=Tidak
(26) (27) (28)
1 1 1
1 1 2
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
2 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
FORMULIR PENC
Desa / Kelurahan : Nanjungan
Berat
Lahir
(1) (2) (3) (4) (5) (6) (7) (8)
1 1 6/1/2013 L 1611071103082640 1611070106130000 M. Zidan 3000
2 2 8/21/2015 P 1611071103082640 1611076108150000 Jihane 3000
3 1 12/8/2013 L 1611072511130000 1611070812130000 Ashraf 3000
4 2 4/5/2017 L 1611072704090000 1611070504170000 Tian 2900
5 1 7/10/2014 L 1611072502150000 1611071007140000 M. Razel 3000
6 1 11/12/2014 P 1611070209090000 1611075211110000 Zahwa 2800
7 2 3/4/2017 P 1611070209090000 1611074403170000 Anindita 2900
8 3 10/31/2013 P 1611070609120000 1611075205700000 Naura 2900
9 2 7/4/2016 P 1611070901140000 1611074407160000 Raya 2900
10 1 10/11/2013 L 1611071810120000 1611071110120000 Azril 2800
11 1 9/6/2014 L 1611072306140000 1611074809140000 Zahra 3300
12 2 3/22/2017 P 1611070802120000 1611076205170000 Belkis 3000
M.raffas
13 2 3/15/2017 L 1611072607160000 1611074305900000 3300
ya
14 1 12/17/2013 P 1611072607160000 1611075712130000 Vania 3500

15 3 12/16/2017 P 1611072906090000 1611074405500000 Alesta 3400
16 3 9/18/2014 P 1611075004810000 Angelina 3300
17 2 5/27/2017 L 1611070802120000 1611072705170000 M. Ardi 3300
18 2 6/13/2016 L 1611072508090010 1611074107600040 Ramadan 3300
19 2 9/22/2015 P 1611072604110000 1611075209150000 Shakira 3200
20 2 5/8/2018 L 1611070610090020 1611075012800000 Hamza 3100
21 2 2/18/2018 P 1611071803110000 1611075707800000 Kanaya 2800
22 1 10/28/2017 P 1611071506170000 1611076810170000 Dianka 2700
23 2 12/14/2015 P 1611070103110000 1611075412150000 Aliya 2700
24 2 4/28/2015 P 1611070503140000 1611076804150000 Keisa 2900
25 2 12/3/2015 P 1611071108090000 1611074312150000 Jenita 3200
26 2 4/1/2014 L 1611072912110000 1611075602890000 Alba 3300
27 1 4/15/2018 L 1611040401120010 1611047007800000 Zumi 3200
28 4 12/9/2016 P 1611072102120000 1611076810800000 Gisela 3100
29 3 12/17/2015 P 1611072102120000 1611075708150000 Azzahara 3100
A.
30 2 4/27/2016 L 1611071610120010 1611072704160000 3100
Sabian
31 2 1/8/2015 L 161071108100010 1611070801150000 Azza 2900
32 1 11/17/2017 P 1611072108170000 1611070409950000 Oria 3300
33 2 7/26/2015 L 1611071508160000 1611072607150000 Gilang 3300
34 1 3/7/2018 L 1611070703180000 Raditya 3000
35 2 1/5/2015 P 1'611070211100040 1611074501150000 Yeva 2800

36 1 4/7/2016 P 1'611071107170000 1611074704160000 Kinda 2800
37 2 10/19/2014 L 1'611071011100000 1611071810140000 Deygo 3400
38 5 2/6/2017 L 1611072802120010 1611070802170000 Arka 3100
Rhamand
39 2 5/24/2018 P 1611071210090000 1611074501740000 3400
a
40 3 10/12/2017 P 1611070409090000 1611074307600000 Cinta 3200
41 3 2/8/2018 P 1611071103082450 1611074101700000 Adriasya 2800
42 2 2/17/2018 L 1611070710090000 1611074107800000 Depano 3100
Humayir
43 3 4/24/2016 P 1611071109090000 1611076408160000 3000
oh
44 1 7/2/2016 P 1611071508160000 1611074207160000 Aldalia 3000
45 2 12/21/2016 P 1611070211160000 1611078112180000 Laura 3200
46 1 11/8/2015 L 1611070112160000 1611070811150000 M. Adam 2900
47 2 3/21/2017 P 1611070910090000 1611076101170000 Hahza 3300
48 2 6/4/2018 P 1611070204120000 1611075703940000 Yuliska 3100

Nama Posyandu : Nusa Indah
Bulan : Januari
Tahun : 2019
Kepemili
kan Buku
IMD
KIA/KM Nama
S 1=Ya Ayah
2=Tidak
2=Tidak
(9) (10) (11) (12) (13) (14) (15) (16)
0 0 Sastra 1611072103810000 082375649451 Nanjungan 0 0
0 0 Sastra 1611072103810000 082375649451 Nanjungan 0 0
0 0 Adi 1611073107840000 082374557481 Nanjungan 0 0
A.
0 0 1611070505740000 085803846731 Nanjungan 0 0
Muliani
0 0 Novan 1611071110870000 085693846374 Nanjungan 0 0
0 0 Suseno 1611071210770000 082364743322 Nanjungan 0 0
0 0 Suseno 1611071210770000 082364743322 Nanjungan 0 0
Hardians
0 0 1611071803770000 082347873482 Nanjungan 0 0
yah
0 0 Tanto 1611072310860000 085878375839 Nanjungan 0 0
0 0 Debi 1611071008820000 082294757392 Nanjungan 0 0
0 0 Gogo 1611071908870000 082264846592 Nanjungan 0 0
0 0 Sipuntri 1611070803840000 085866354892 Nanjungan 0 0
0 0 Miki 1611072808890000 085264364542 Nanjungan 0 0
0 0 Miki 1611072808890000 085264364542 Nanjungan 0 0

0 0 Turino 161107020160001 085344273522 Nanjungan 0 0
0 0 Edwar 1611070603810000 081334833791 Nanjungan 0 0
0 0 Arifin 1611071603800000 082384394373 Nanjungan 0 0
0 0 Jumadi 1611070107670090 085864682922 Nanjungan 0 0
0 0 Andike 1611071010890000 081375638242 Nanjungan 0 0
0 0 Selamat 1611071104840000 081274653222 Nanjungan 0 0
0 0 Prayudha 1611072607650000 085284403722 Nanjungan 0 0
0 0 Junianto 1611070504870000 081254633849 Nanjungan 0 0
0 0 Sakri 1611070103110000 085374893622 Nanjungan 0 0
Mugiant
0 0 1611070503140000 081365748382 Nanjungan 0 0
o
0 0 Idham 161107020560001 081246463822 Nanjungan 0 0
0 0 Riko 1611070105860000 085274836281 Nanjungan 0 0
0 0 Ujang 1611041201630000 085899036455 Nanjungan 0 0
0 0 Ripal 1611072102120000 085343728422 Nanjungan 0 0
0 0 Ripal 1611072102120000 085343728422 Nanjungan 0 0
0 0 Sigit 1611071411880000 082354664563 Nanjungan 0 0
0 0 Faizullah 1611070408780000 082354427381 Nanjungan 0 0
0 0 Rendi 1771020511890000 085283633649 Nanjungan 0 0
0 0 Ade 1611072903960000 085276482731 Nanjungan 0 0
0 0 Mimit 1611072312920000 085346482664 Nanjungan 0 0
0 0 Andri 1611071207830000 082364545771 Nanjungan 0 0

0 0 Sukiman 1611072403850000 085287345374 Nanjungan 0 0
0 0 Asnawi 1611071304780000 082254437563 Nanjungan 0 0
Abdul
0 0 1611070808720000 085893645382 Nanjungan 0 0
zahri
0 0 Yasman 1611070103710000 082345647589 Nanjungan 0 0
0 0 Heri 161107140880001 085364552462 Nanjungan 0 0
0 0 Suhar 1611070608730000 085836438362 Nanjungan 0 0
0 0 Ersan 1611070707650000 082376463494 Nanjungan 0 0
0 0 Sapriadi 1611071010770000 082354537328 Nanjungan 0 0
0 0 Ya'al 1611070812960000 085264634636 Nanjungan 0 0
Hamzaln
0 0 1611030107890030 082235454752 Nanjungan 0 0
i
0 0 Rando 1611070809820000 085659676574 Nanjungan 0 0
0 0 Hariensa 1611072606800000 085247585445 Nanjungan 0 0
0 0 Andri 1611071005850000 085268465749 Nanjungan 0 0

Cara
Panjang
Ukur
Badan/
1=Telent
tgl pengukuran BB (kg) Tinggi umur 0 umur 1 umur 2 umur 3 umur 4 umur 5
ang
(cm)
2=Berdiri
(17) (18) (19) (20) (21) (22) (23) (24) (25) (26)
9/8/2018 20 110 2 1 1 1 1 1 1
9/8/2018 13 94 2 1 1 1 1 1 1
9/8/2018 10 107 2 1 1 1 1 1 1
9/8/2018 8.6 75 2 1 1 1 1 1 1
9/8/2018 14 97 2 1 1 1 1 1 1
9/8/2018 12.5 94 2 1 1 1 1 1 1
9/8/2018 9 79 2 1 1 1 1 1 1
9/8/2018 13 94 2 1 1 1 1 1 1
9/8/2018 10 85 2 1 1 1 1 1 1
9/8/2018 11.3 89 2 1 1 1 1 1 1
9/8/2018 13.3 93 2 1 1 1 1 1 1
9/8/2018 10 88 2 1 1 1 1 1 1
9/8/2018 10.3 90 2 1 1 1 1 1 1
9/8/2018 15 107 2 1 1 1 1 1 1
9/8/2018 11 95 2 1 1 1 1 1 1
9/8/2018 13 100 2 1 1 1 1 1 1
9/8/2018 11 82 2 1 1 1 1 1 1
9/8/2018 9 90 2 1 1 1 1 1 1
9/8/2018 14.5 95 2 1 1 1 1 1 1
9/8/2018 8 70 2 1 1 1 1 1 1
9/8/2018 9 77 2 1 1 1 1 1 1
9/8/2018 13 78 2 1 1 1 1 1 1
9/8/2018 12.6 100 2 1 1 1 1 1 1
9/8/2018 12.3 98 2 1 1 1 1 1 1
9/8/2018 12.3 90 2 1 1 1 1 1 1
9/8/2018 14 103 2 1 1 1 1 1 1
9/8/2018 9 87 2 1 1 1 1 1 1
9/8/2018 8.5 67 2 1 1 1 1 1 1
9/8/2018 13 94 2 1 1 1 1 1 1
9/8/2018 13 88 2 1 1 1 1 1 1
9/8/2018 15 102 2 1 1 1 1 1 1
9/8/2018 9 78 2 1 1 1 1 1 1
9/8/2018 11.3 83 2 1 1 1 1 1 1
9/8/2018 8 66 2 1 1 1 1 1 1
9/8/2018 8.3 77 2 1 1 1 1 1 1
9/8/2018 11 70 2 1 1 1 1 1 1
9/8/2018 13 95 2 1 1 1 1 1 1
9/8/2018 9 86 2 1 1 1 1 1 1
9/8/2018 9 81 2 1 1 1 1 1 1
9/8/2018 10 67 2 1 1 1 1 1 1
9/8/2018 7.9 70 2 1 1 1 1 1 1
9/8/2018 7.5 65 2 1 1 1 1 1 1
9/8/2018 11 84 2 1 1 1 1 1 1
9/8/2018 12 95 2 1 1 1 1 1 1
9/8/2018 11 84 2 1 1 1 1 1 1
9/8/2018 20 99 2 1 1 1 1 1 1
9/8/2018 11 69 2 1 1 1 1 1 1
9/8/2018 6 63 2 1 1 1 1 1 1
Vitamin Vitamin
A A
Februari Agustus
1= Ya 1=Ya
2=
Tidak 2=Tidak
(27) (28)
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
2 2
2 1
1 1
1 1
1 1
1 1
1 1
2 2
1 1
1 1
1 1
1 1
1 1
1 1
2 2
1 1
1 1
1 1
1 1
2 2
1 1
1 1
2 1
1 1
1 1
1 1
1 1
1 1
2 2
FORMULIR P
Desa / Kelurahan : Air Mayan
Anak Tanggal Jenis Nik (Nomor Induk

No No Kartu Keluarga Nama Anak
ke Lahir Kelamin Kependudukan)
(1) (2) (3) (4) (5) (6) (7)

1 2 3/11/2016 P 1611072911120000 1611075107160000 Amelia
2 1 1/18/2018 L 1611072301180000 1611071301180000 Rahka
3 1 10/28/2014 L 1611070304140000 1611072810140000 Alchi
4 2 1/10/2017 L 1611070304140000 1611075205800000 M. Gauzan
5 2 12/24/2017 L 1611072905120000 1611074401900000 M. Altalah
6 1 1/28/2018 L 1611071103082850 1611076607900000 Rahan
7 1 12/29/2017 L 1611072210090010 1611076210930000 Aska
8 1 5/7/2018 L 1611070511120000 1611075910930000 M. Randa
9 2 5/4/2018 L 1611070705120000 1611075907840000 A. Azam
10 2 2/5/2017 L 1611071211120000 1611075306900000 Asselo
11 2 6/27/2017 L 1611071603120000 1611076303800000 Panji
12 2 4/11/2018 L 1611071103083390 1611070502650000 Bintang
FORMULIR PENCATATAN PEMANTAUAN PERTUMBUHAN BALI
Nama Posyandu : Kasih Bunda 1
Bulan : Januari
Tahun : 2019
Kepemili
Berat kan Buku
IMD
Badan KIA/KM
1=Ya Nama Ayah Nik Ayah No tlp/ HP Ayah Alamat
(BB) S 1=Ya
2=Tidak
Lahir
2=Tidak
(8) (9) (10) (11) (12) (13) (14)

2900 1 1 Samri 1611071002820000 082345262533 Air Mayan
3000 1 1 Robi 1611070204900000 085823527323 Air Mayan
3400 1 1 Alyas 1611072303760000 082364653637 Air Mayan
3100 1 1 Alyas 1611072303760000 085372654723 Air Mayan
2800 1 1 Pobi 1611072606900000 085346273532 Air Mayan
3000 1 1 Wawan 1611070510920000 085273645622 Air Mayan
3300 1 1 Rahman 1611075706930000 082234525302 Air Mayan
2800 1 1 Niko 1611071407930000 085835728392 Air Mayan
3100 1 1 Feri 1611070302820000 085273452828 Air Mayan
3200 1 1 Mailan 1611070906860000 085372836527 Air Mayan
3200 1 1 Rigen 1611072704880000 082253723752 Air Mayan
3100 1 1 Dedi 1611071708890000 082352534629 Air Mayan
BUHAN BALITA DI POSYANDU
Cara
Panjang
Ukur
Badan/
tgl 1=Telent
pengukuran ang
(cm)
2=Berdiri
(15) (16) (17) (18) (19) (20) (21) (22) (23) (24)
0 0 9/8/2018 11 80 2 1 1 1 1
0 0 9/8/2018 8.5 68 1 1 1 1 1
0 0 9/8/2018 25 105 2 1 1 1 1
0 0 9/8/2018 12 77 2 1 1 1 1
0 0 9/8/2018 8'4 90 2 1 1 1 1
0 0 9/8/2018 8.6 90 2 1 1 1 1
0 0 9/8/2018 9 93 2 1 1 1 1
0 0 9/8/2018 7 66 1 1 1 1 1
0 0 9/8/2018 6.9 64 1 1 1 1 1
0 0 9/8/2018 11 84 2 1 1 1 1
0 0 9/8/2018 12 82 2 1 1 1 1
0 0 9/8/2018 9 83 1 1 1 1 1
1=YA,2=Tidak
Vitamin Vitamin
A A
Februari Agustus
bln bln 2=
Tidak 2=Tidak
(25) (26) (27) (28)

1 1 1 1
1 1 2 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 2 2
1 1 2 2
1 1 1 1
1 1 1 1
1 1 2 2
FORMULIR P
Desa / Kelurahan : Pagar Jati
Tanggal Jenis Nik (Nomor Induk

No Anak ke No Kartu Keluarga Nama Anak
Lahir Kelamin Kependudukan)
(1) (2) (3) (4) (5) (6) (7)
1 3 4/21/2016 P 1611072103120000 1611076104160000 KYNAN
2 3 11/3/2016 P 1611071710120000 1611074311160000 BELKA
CAHAYA
3 2 6/24/2015 P 1611071710120000 1611078406150000
DWI
4 2 8/23/2013 P 16110729010900000 1611076308130000 ZELVA
5 1 4/20/2013 P 1611072506130000 1611076904130000 AISYAH
6 2 9/15/2017 P 1611072506130000 1611076101900000 BELZA
7 2 9/5/2017 L 1611072405120000 1611076506900000 HAFIS
8 1 2/2/2015 P 1611072202170000 1611074202150000 ANDINI
9 5 1/30/2018 L 1611071103681300 1611073001190000 TITO
10 1 2/12/2017 P 1611071801100000 1611076706900000 SANIYA
11 1 7/7/2017 P 1611071303150000 1611074707150000 CELLY
12 2 10/7/2013 P 1611072510120000 1611076506800000 INDA
13 1 7/2/2017 L 1611070206170000 1611070207170000 M. RIZQI
14 1 12/20/2013 L 1611072912150000 1611072012130000 AGRI

15 3 6/14/2017 L 1611071407100110 1611074706700000 DERI
16 1 3/22/2017 L 1611072211160000 1611076905800000 FAREL
17 2 9/27/2017 P 1611071103081210 1611071103081210 JESIKA
18 2 2/20/2018 L 1611070403100000 1611070403100000 HERO
19 3 5/12/2017 P 1611070707100000 1611075205170000 HOFIFA
20 2 5/5/2016 L 1611070601120010 1611070505160000 ZELQI
21 2 6/9/2017 L 1611070112160000 1611070906170000 RIJADIN
22 2 10/31/2013 P 1611071103081290 161107110130001 AQILLA
23 2 3/7/2016 P 1611071709130000 1611074703160000 YELLI
24 2 1/18/2018 L 1611072111110000 1611074105800000 RASKA
25 2 10/11/2014 P 1611070303100000 1611075110140000 DARA
AIRLANGG
26 1 4/25/2013 L 1611072405130000 1611072504130000
A
27 1 5/24/2015 P 161071203150001 1611076405150000 ANENDYA
28 1 4/16/2017 L 1611071406170000 1611071804170000 RASYA
M.
29 3 8/14/2014 L 1611071103081210 1611071406140000 FRANDESK
I
30 2 3/25/2018 L 1611070911110000 1611074107900000 JEJE
RAMADHA
31 1 6/21/2016 L 1611070812150000 1611072106160000
NI
32 3 12/7/2016 L 1611072408100000 1611075007700000 REHAN
33 3 7/15/2017 L 1611070302090020 1611071507170000 DRAZOR
34 4 2/19/2018 P 1611070302150000 1611074410800000 HEFIFA

35 3 1/15/2013 L 1611071103081240 1611071103081240 PALCO
36 1 8/20/2016 L 1611071210160000 1611071210160000 ALFATAN
37 3 9/4/2013 L 1611070810090000 1611070810090000 RESTU
38 4 4/4/2016 P 1611070810090000 1611070810090000 CITRA

FORMULIR PENCATATAN PEMANTAUAN PERTUMBUHAN BAL
Nama Posyandu : Kamboja
Bulan : Januari
Tahun : 2019
Kepemili
Berat kan Buku
IMD
Badan KIA/KM
(BB) S 1=Ya
2=Tidak
Lahir
2=Tidak
(8) (9) (10) (11) (12) (13) (14)

M.
2800 1 1 1611071206840000 082393637489 PAGAR JATI
JUSIANTO
FIRMAN
3000 1 1 1611071502900000 085837483928 PAGAR JATI
RULI
FIRMAN
3100 1 1 1611071502900000 085837474989 PAGAR JATI
RULI
2800 1 2 MINHARDI 1611070107600060 085284746821 PAGAR JATI
2900 1 2 RULI 1611072107850000 085326728362 PAGAR JATI
3000 1 1 RULI 1611072107850000 085342625371 PAGAR JATI
3300 1 1 DUENSER 1611072401920000 082344261788 PAGAR JATI
2800 1 1 PISLI 1611072005860000 082356275322 PAGAR JATI
3000 1 1 RUSLAN 1611071507670000 082343836628 PAGAR JATI
3100 1 1 SUGENG 1611076101920000 085326635362 PAGAR JATI
2800 1 1 ZAINAL 1611070307840000 082335275253 PAGAR JATI
2700 1 2 NOPRIANSA 1611071502840000 082236482635 PAGAR JATI
3200 1 1 HERLI 1611071802800000 085263646272 PAGAR JATI
3000 1 2 LEO 1611070208900000 085253554729 PAGAR JATI

BURHANUD
2900 1 1 1611071312710000 085683462821 PAGAR JATI
IN
3300 1 1 DICO 1611070304860000 085863628281 PAGAR JATI
3100 1 1 RIPI 1611070101610360 082347372527 PAGAR JATI
3200 1 1 HERIYANTO 1611070107870070 085243448362 PAGAR JATI
3300 1 1 APRAN 1611070605750000 082364742821 PAGAR JATI
3200 1 1 MARSONO 1611071008840000 085253637221 PAGAR JATI
2800 1 1 HERI 1611071711850000 082345646278 PAGAR JATI
3000 1 2 RAHMAN 161107090960001 082345336272 PAGAR JATI
3100 1 1 JULI 1611071007780000 082364653637 PAGAR JATI
2900 1 1 WELLY 1611070606770000 085372654723 PAGAR JATI
3100 1 2 ANJANG 1611071505820000 085346273532 PAGAR JATI
3200 1 2 ROMI 1611071105660000 085273645622 PAGAR JATI
3000 1 1 JUMARDI 1611070104660000 082234525302 PAGAR JATI
2800 1 1 ASWAR 1611070306840000 085835728392 PAGAR JATI
2900 1 2 JASURI 1611070203730000 085273452828 PAGAR JATI
2900 1 1 JANTER 1611070102890000 085372836527 PAGAR JATI
3200 1 1 DIDI 1611070702890000 082253723752 PAGAR JATI
3000 1 1 INDISON 1611072303720000 082352534629 PAGAR JATI
2800 1 1 ILAN 1611072012780000 085826354529 PAGAR JATI
2800 1 1 KHARIS 1611071206670000 085637465278 PAGAR JATI

2900 1 2 LISON 1611070107670020 085327362721 PAGAR JATI
3000 1 1 LENO 1611072312910000 085283645521 PAGAR JATI
3300 1 2 SUPRAN 1611070205770000 082263457218 PAGAR JATI
2800 1 1 SUPRAN 1611070205770000 085362735428 PAGAR JATI

MBUHAN BALITA DI POSYANDU
Cara
Panjang
Ukur
Badan/
tgl 1=Telent
pengukuran ang
(cm)
2=Berdiri
(15) (16) (17) (18) (19) (20) (21) (22) (23) (24)
0 0 9/13/2018 12.5 84 2 1 1 1 1
0 0 9/13/2018 12 85 2 1 1 1 1
0 0 9/13/2018 14 88 2 1 1 1 1
0 0 9/13/2018 15 104 2 1 1 1
0 0 9/13/2018 15 102 2 1 1 1 1
0 0 9/13/2018 10.5 75 2 1 1 1 1
0 0 9/13/2018 11 85 2 1 1 1 1
0 0 9/13/2018 14 96 2 1 1 1 1
0 0 9/13/2018 7 52 1 1 1 1 1
0 0 9/13/2018 10 70 2 1 1 1 1
0 0 9/13/2018 14 94 2 1 1 1 1
0 0 9/13/2018 10.3 95 2 1 1 1 1
0 0 9/13/2018 10 76 2 1 1 1 1
0 0 9/13/2018 15 100 2 1 1 1 1
0 0 9/13/2018 10 77 2 1 1 1 1
0 0 9/13/2018 11 90 2 1 1 1 1
0 0 9/13/2018 12 72 1 1 1 1 1
0 0 9/13/2018 10 73 2 1 1 1 1
0 0 9/13/2018 10 75 2 1 1 1 1
0 0 9/13/2018 13 85 2 1 1 1 1
0 0 9/13/2018 11 73 2 1 1 1 1
0 0 9/13/2018 18 105 2 1 1 1 1
0 0 9/13/2018 11 83 2 1 1 1 1
0 0 9/13/2018 7.4 62 1 1 1 1 1
0 0 9/13/2018 14 98 2 1 1 1 1
0 0 9/13/2018 13 108 2 1 1 1 1
0 0 9/13/2018 11 89 2 1 1 1 1
0 0 9/13/2018 9.3 77 2 1 1 1 1
0 0 9/13/2018 12 89 2 1 1 1 1
0 0 9/13/2018 8.9 66 1 1 1 1 1
0 0 9/13/2018 10 86 2 1 1 1 1
0 0 9/13/2018 10 97 2 1 1 1 1
0 0 9/13/2018 9.3 75 2 1 1 1 1
0 0 9/13/2018 7 62 1 1 1 1 1
0 0 9/13/2018 20 114 2 1 1 1 1
0 0 9/13/2018 11 82 2 1 1 1 1
0 0 9/13/2018 14 102 2 1 1 1 1
0 0 9/13/2018 10.5 84 2 1 1 1 1
1=YA,2=Tidak
Vitamin Vitamin
A A
Februari Agustus
bln bln 2=
Tidak 2=Tidak
(25) (26) (27) (28)
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 2 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 2
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 2
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1
FORMULIR PE
Kabupaten / Kota : Empat Lawang Bulan :
Puskesmas/ Kecamatan : Nanjungan Tahun :
Desa / Kelurahan : Talang Randai
Berat
Anak Tanggal Jenis No Kartu Nik (Nomor Induk Badan
No Nama Anak
ke Lahir Kelamin Keluarga Kependudukan) (BB)
Lahir
(1) (2) (3) (4) (5) (6) (7) (8)

16110711121700 161107690300000
1 1 2/15/2018 L ilham 3.0
00 00
16110701121600 161107140816000
2 1 8/14/2016 L M. Agio 3.3
00 0
16110719030900 161107410781000
3 4 2/15/2017 L abid 3.0
00 00
16110724081100 161107600182000
4 2 9/24/2017 P keysa 2.9
00 0
Nama Posyandu : Dahlia
Bulan : Januari
Tahun : 2019
Kepemili
kan Buku
IMD
KIA/KM
S 1=Ya
2=Tidak
2=Tidak
(9) (10) (11) (12) (13) (14)
1 1 renggi 1611072706970000 082365474812 Talang Randai
1 1 gunawan 1611070611910000 085236774837 Talang Randai
1 1 joni 1611070304740000 085892354648 Talang Randai
1 1 dudi 1611070202820000 082335454772 Talang Randai

UMBUHAN BALITA DI POSYANDU
Cara
Panjang
Ukur
Badan/
tgl 1=Telent
pengukuran ang
(cm)
2=Berdiri
(15) (16) (17) (18) (19) (20) (21) (22) (23) (24)
0 0 9/14/2018 9 67 1 1 1 1 1
0 0 9/14/2018 12 83 1 1 1 1 1
0 0 9/14/2018 9 74 1 1 1 1 1
0 0 9/14/2018 10 70 1 1 1 1 1
1=YA,2=Tidak
Vitamin Vitamin
A A
Februari Agustus
bln bln 2=
Tidak 2=Tidak
(25) (26) (27) (28)
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
FORMULIR PEN
Desa / Kelurahan : Bandar Agung
Anak Tanggal Jenis Nik (Nomor Induk Nama

ke Lahir Kelamin Kependudukan) Anak
(1) (2) (3) (4) (5) (6) (7)

1 1 8/22/2014 P 1611070812170000 2171026209140000 mihira
2 3 3/18/2018 P 1611070202090040 1611076110620000 audri
3 2 4/1/2017 p 1611071105100000 1611074104170000 apriliani
4 3 5/22/2018 L 1611071805100000 1611074509830000 pabian
5 2 9/7/2015 P 1611071103081790 1611074708250000 raysa
6 2 10/22/2014 L 1611070501150000 1611072210140000 m. adhafis
7 2 10/23/2015 L 1611070909130010 1611072310150000 raditya
8 1 6/20/2013 L 1611070909130010 16110726061130000 rizki
9 2 7/19/2015 L 1611072312110000 1611071807150000 m.padil
10 4 11/12/2017 L 1611071103081980 1611074405800000 Bernis

11 4 5/13/2016 L 1611071103081990 1611074811800000 wahyu
12 2 3/9/2013 P 1611072104110000 1611074903130000 masrila
13 3 7/14/2016 L 1611071610120000 1611071407160000 rio
14 2 5/5/2016 L 1611071103081980 1611070505160000 m. irsya
15 2 8/22/2013 L 161072011120007 1611074707800000 afgan
16 1 11/19/2016 P 1611070311100040 dini
17 1 5/12/2018 L 1611071103081800 aldan
18 2 4/7/2013 L 1611071805100010 1611074704130000 dhea
19 3 9/27/2015 L 1611070604150000 1611076709150000 kalingga
FORMULIR PENCATATAN PEMANTAUAN PERTUMBUHAN BALITA
Nama Posyandu : Kamboja 1
Bulan : Januari
Tahun : 2019
Kepemili
Berat kan Buku
IMD
Badan KIA/KM Nama
1=Ya Nik Ayah No tlp/ HP Ayah Alamat RT
(BB) S 1=Ya Ayah
2=Tidak
Lahir
2=Tidak
(8) (9) (10) (11) (12) (13) (14) (15)

2800 1 1 radius 217110208869004 082393637489 bandar agung 0
2800 1 1 rigandi 1611070410770000 085837483928 bandar agung 0
2900 1 1 yanto 1611071812740000 085837474989 bandar agung 0
3200 1 1 budianto 1611072107800000 085284746821 bandar agung 0
3100 1 2 antoni j 1611071501320000 085326728362 bandar agung 0
3400 1 1 meriadi 1611071050000000 085342625371 bandar agung 0
3100 1 1 rian 1611072506950000 082344261788 bandar agung 0
3000 1 1 rian 1611072506950000 082356275322 bandar agung 0
khoerum
3000 1 1 161071508050001 082343836628 bandar agung 0
an
3300 1 1 windi 1611070108800000 085326635362 bandar agung 0
2900 1 1 abdul 1611071101700000 082335275253 bandar agung 0
3000 1 2 imran 1611071506800000 082236482635 bandar agung 0
2800 1 1 sarbini 1611071610120000 085263646272 bandar agung 0
2900 1 2 sandianto 1611072710840000 085253554729 bandar agung 0
3100 1 1 apriyanto 1611070605790000 085683462821 bandar agung 0
2900 1 1 wro 1611070506900010 085863628281 bandar agung 0
3300 1 1 ari 1611070711940000 082347372527 bandar agung 0
2800 1 1 rafles 1611070107850030 085243448362 bandar agung 0
2900 1 1 alvisi 1611074702720000 082364742821 bandar agung 0
Panjang
Cara Ukur
Badan/
tgl 1=Telentan
RW BB (kg) Tinggi umur 0 umur 1 umur 2 umur 3 umur 4
pengukuran g
2=Berdiri
(cm)
(16) (17) (18) (19) (20) (21) (22) (23) (24) (25)
0 9/12/2018 13 98 2 1 1 1 1 1
0 9/12/2018 9 70 1 1 1 1 1 1
0 9/12/2018 9 75 2 1 1 1 1 1
0 9/12/2018 7,5 67 1 1 1 1 1 1
0 9/12/2018 11,2 84 2 1 1 1 1 1
0 9/12/2018 15 95 2 1 1 1 1 1
0 9/12/2018 12,4 86 2 1 1 1 1 1
0 9/12/2018 16,5 103 2 1 1 1 1 1
0 9/12/2018 15 97 2 1 1 1 1 1
0 9/12/2018 10 73 2 1 1 1 1 1
0 9/12/2018 12 89 2 1 1 1 1 1
0 9/12/2018 11,8 91 2 1 1 1 1 1
0 9/12/2018 12 80 2 1 1 1 1 1
0 9/12/2018 12 87 2 1 1 1 1 1
0 9/12/2018 19 50 2 1 1 1 1 1
0 9/12/2018 5,9 53 1 1 1 1 1 1
0 9/12/2018 6,7 57 1 1 1 1 1 1
0 9/12/2018 15,4 107 2 1 1 1 1 1
0 9/12/2018 13 86 2 1 1 1 1 1
Tidak
Vitamin Vitamin
A A
Februari Agustus
umur 5 1= Ya 1=Ya
bln 2=
Tidak 2=Tidak
(26) (27) (28)

1 1 1
1 2 2
1 1 1
1 2 2
1 1 1
1 1 1
1 1 1
1 1 1
1 2 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 2 2
1 2 2
1 1 1
1 1 1
FORMULIR PENCA
Desa / Kelurahan :
Berat
Lahir
(1) (2) (3) (4) (5) (6) (7) (8)
1 3 3/24/2017 P 1611071103083290 1611075111840000 Citra 3000
2 1 7/10/2014 L 1708071201180000 1611071007140000 Pedli 2700
3 2 7/21/2018 L 1611071103082920 1611074403800000 Rainer 2900
4 2 11/4/2016 L 1611071801170000 161107041118000 Azam 3000
5 1 11/14/2013 L 161172310130002 1611071711130000 Alvaro 2900
6 2 4/16/2017 L 161172310130002 1611071604170000 Jiroli 2800
7 2 2/21/2016 L 1611072510100000 1611072102180000 M. Fadli 2800
8 2 9/13/2017 L 1611071103083080 1611071309170000 Toto 2700
9 2 11/4/2016 P 1611073009090000 1611074411160000 Zahwa 2800
10 1 7/28/2016 P 1611070304180000 1611076404980000 Zivana 3000

Nama Posyandu : Kasih Bunda 2
Bulan : Januari
Tahun : 2019
Kepemili
kan Buku
IMD
KIA/KM Nama
S 1=Ya Ayah
2=Tidak
2=Tidak
(9) (10) (11) (12) (13) (14) (15) (16)
1 1 M. Dini 1611070503830000 085826354529 sidomulyo 0 0
1 1 Pezi 1708070204960000 085637465278 sidomulyo 0 0
1 1 Irawan 1611070401840000 085327362721 sidomulyo 0 0
M.
1 1 1611070908880000 085283645521 sidomulyo 0 0
Anang
1 1 Broli 1611070707890010 082263457218 sidomulyo 0 0
1 1 Broli 1611070707890010 085362735428 sidomulyo 0 0
1 1 Irawan 1611070107800070 082354727284 sidomulyo 0 0
1 1 Musiopa 1611070210810000 082373752728 sidomulyo 0 0
1 1 Dodi 1611071209840000 085372836458 sidomulyo 0 0
1 1 Jimi 1611071807940000 082243644241 sidomulyo 0 0

N BALITA DI POSYANDU
Cara
Panjang
Ukur
Badan/
tgl 1=Telent
pengukuran ang
(cm)
2=Berdiri
(17) (18) (19) (20) (21) (22) (23) (24) (25) (26)
9/8/2018 10 70 2 1 1 1 1 1 1
9/8/2018 8,9 86 2 1 1 1 1 1 1
9/8/2018 11.5 82 1 1 1 1 1 1 1
9/8/2018 13 85 2 1 1 1 1 1 1
9/8/2018 15 112 2 1 1 1 1 1 1
9/8/2018 8.5 100 2 1 1 1 1 1 1
9/8/2018 10 124 2 1 1 1 1 1 1
9/8/2018 8.9 90 2 1 1 1 1 1 1
9/8/2018 10.2 16 2 1 1 1 1 1 1
9/8/2018 11 95 2 1 1 1 1 1 1
Vitamin Vitamin
A A
Februari Agustus
1= Ya 1=Ya
2=
Tidak 2=Tidak
(27) (28)
1 1
2 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
FORMULIR PENCATA
Provinsi : Sumatera Selatan Nama Posyandu :S
Kabupaten / Kota : Empat Lawang Bulan : Ja
Desa / Kelurahan : Lubuk Mabar
Kepemili
Berat kan Buku
Nik (Nomor
Tanggal Jenis No Kartu Nama Badan KIA/KM
No Anak ke Induk
Lahir Kelamin Keluarga Anak (BB) S 1=Ya
Kependudukan)
Lahir
2=Tidak
(1) (2) (3) (4) (5) (6) (7) (8) (9)

1 2 12/20/2017 P dinda 3000 1
2 2 3/17/2016 L arsya 2700 1
3 1 6/1/2016 P revi 2900 1
4 3 3/3/2017 L pien 3000 1
5 3 3/16/2017 P kiara 2900 1
6 2 5/5/2016 P zahra 2800 1
7 2 1/10/2018 P vanisa 2800 1
8 1 1/11/2018 L irlas 2700 1
IR PENCATATAN PEMANTAUAN PERTUMBUHAN BALITA DI POSY
osyandu : Sehat 2
: Januari
: 2019
IMD
Nama tgl
Ayah pengukuran
2=Tidak
(10) (11) (12) (13) (14) (15) (16) (17)

1 dodi 085826354529 lubuk mabar 0 0 9/17/2018
1 toni 085637465278 lubuk mabar 0 0 9/17/2018
1 suryadi 085327362721 lubuk mabar 0 0 9/17/2018
1 kendi 085283645521 lubuk mabar 0 0 9/17/2018
1 iwan 082263457218 lubuk mabar 0 0 9/17/2018
1 pandi 085362735428 lubuk mabar 0 0 9/17/2018
1 joni 082354727284 lubuk mabar 0 0 9/17/2018
1 iksan 082373752728 lubuk mabar 0 0 9/17/2018
ALITA DI POSYANDU
Cara Vitamin
Panjang
Ukur A
Badan/
BB 1=Telent Februari
Tinggi umur 0 umur 1 umur 2 umur 3 umur 4 umur 5 1= Ya
(kg) ang
(cm)
2=Berdiri Tidak
(18) (19) (20) (21) (22) (23) (24) (25) (26) (27)
9 71 2 1 1 1 1 1 1 1
13 89 2 1 1 1 1 1 1 1
14 84 2 1 1 1 1 1 1 1
11 78 2 1 1 1 1 1 1 1
9,2 77 2 1 1 1 1 1 1 1
13 94 2 1 1 1 1 1 1 1
8,6 75 1 1 1 1 1 1 1 2
12,5 92 1 1 1 1 1 1 1 2
Vitamin
A
Agustus
1=Ya
2=Tidak
(28)
1
1
1
1
1
1
1
1
FORMULIR PENCA
Desa / Kelurahan : Tanjung Beringin
Berat
Lahir
(1) (2) (3) (4) (5) (6) (7) (8)

161107011121500 Muhama
1 3 12/1/2015 L 1611071412100000 3
00 d parozi
161107610470000
2 2 5/13/2016 L 1611071103080790 jasen 2.8
0
161107461080000
3 3 8/12/2016 P 1611072511130010 aqila 3.2
0
161107621270000
4 1 7/15/2017 P 1611072908130000 silva 2.8
0
161107430714000
5 2 7/3/2014 P 1611071004130010 jihan 3.5
0
161107010417000
6 1 4/1/2017 L 1611071804170000 azril 2.6
0
161107571115000
7 2 11/3/2015 P 1611071911120000 kisi 3.8
0
161107171214000
8 5 12/17/2014 L 1611071512140000 rohid 3.4
0
161107411090000
9 1 5/1/2014 P 1611072002 klara
0
161107410617000
10 2 6/1/2016 P 1611072604120000 gea 3.6
0
161107100660000
11 1 8/23/2015 L 1611071801090000 arziki 3
0
161107610514000
12 3 5/21/2014 P 1611071103080730 kasih 3
0
161107470590000
13 2 8/10/2018 P 1611071902140000 amanda 2.8
0
161107010915000
14 2 9/1/2015 P 1611071103080780 tania 3.5
0
1611072011112000 161107420317000 mira
15 2 3/2/2017 P 3.7
0 0 mariska
161107110617000 mika
16 2 6/1/2017 P 1611071103080780 2.9
0 hilova
161107220416000
17 3 4/22/2016 P 1611071103080830 dopin 2.5
0
161107010790000
18 1 2/12/2016 L 1611070107930000 abi 3
0
161107471180000
19 3 1/12/2013 P 1611070911120000 dewi 3
0
161107420314000
20 1 3/2/2014 P 1611071203140000 reirya 3.2
0
161107061016000
21 1 10/8/2016 L 1611070211100040 m yuda 3
0
161107681114000
22 1 11/28/2014 P 1611071011140000 novie 3.8
0
161107430117000
23 2 1/3/2017 P 1611071011140000 syakira 3.4
0
161107130413000 afif
24 2 4/13/2013 L 1611071103080850 2.8
0 albaroka
161107090516000 arga
25 2 5/9/2016 L 1611070711120000 3
0 alfami
317204640980000
26 2 11/25/2017 P 3172041611150020 shara 3.2
0
161107420780000
27 2 6/2/2018 P 1611073012130000 meika 2.4
0
161107630913000 flora
28 1 8/13/2013 P 1611072108170000 3
0 cahaya
161107580614000
29 1 6/18/2014 P 1611070208160000 zahira 2.7
0
161107060116000
30 2 11/6/2016 L 1611070208160000 zhahidal 3
0
161107201117000 muhmad
31 3 11/20/2017 L 1611072809100000 2.8
0 azam
170804100890000
32 1 6/2/2018 L 1708041008940000 ricat 3.8
0
161107190496000
33 1 3/7/2018 P 1611071904960000 bilkis 3.4
0
161107051216000
34 1 12/5/2017 L 1611070709160000 ferzo 3.2
0
161107511114000
35 1 11/11/2014 P 1611072104150000 nabila 3.2
0
161107410509000
36 1 5/1/2015 P 1611072806100000 aurellia 3
0
161107061014000
37 1 10/6/2014 P 1611070508140000 fauzan 3.1
0
161107520715000
38 3 7/12/2015 P 1611072302100000 tri rahma 3.4
0
161107640817000
39 1 8/24/2017 P 1611070503140010 sofia 3
0
161107520715000
40 2 4/5/2017 P 1611072601160000 tri rahma 3.4
0
161107150117000
41 2 4/6/2017 P 1611072601160000 rindu 2.8
0
161107650917000 anugra
42 1 9/5/2017 P 1611072410160000 3
0 zahra
Nama Posyandu : Bunga Citra
Bulan : Januari
Tahun : 2019
Kepemili
kan Buku
IMD
KIA/KM Nama No tlp/
1=Ya Nik Ayah Alamat RT RW
S 1=Ya Ayah HP Ayah
2=Tidak
2=Tidak
(9) (10) (11) (12) (13) (14) (15) (16)

0823767
1 1 hapni 1611071206640000 tanjung beringin 0 0
87778
1611070206765000 0852566
1 1 jon tanjung beringin 0 0
0 65541
1 1 elip 1611070703800000 tanjung beringin 0 0
1 1 sukran 1611070403730000 tanjung beringin 0 0
1 1 mopiter 1611072403860000 tanjung beringin 0 0
1 1 rican 1611070906890000 tanjung beringin 0 0
1 1 hartono 1611070111182000 tanjung beringin 0 0
1 1 robbi 1611071111830000 tanjung beringin 0 0
1 1 1611074110940000 tanjung beringin 0 0
1 1 andi 1611074106170000 tanjung beringin 0 0
1 1 wiko 1611070107980020 tanjung beringin 0 0
1 1 samsidin 1611072612760000 tanjung beringin 0 0
1 1 icuk 1611070707900000 tanjung beringin 0 0
1 1 hendri 1611070107800000 tanjung beringin 0 0

1 1 marles 1611070101880010 tanjung beringin 0 0
1 1 muksin 1611070307730000 tanjung beringin 0 0
1 1 pajar 161107224160001 tanjung beringin 0 0
1 1 syarul 1611070107930000 tanjung beringin 0 0
1 1 doni 1611070609620000 tanjung beringin 0 0
1 1 apep 1611070603980000 tanjung beringin 0 0
1 1 nando 1611071712610000 tanjung beringin 0 0
1 1 tuman 1611070411780000 tanjung beringin 0 0
1 1 tuman 161107041180001 tanjung beringin 0 0
1 1 waryono 1611072111740000 tanjung beringin 0 0
herman
efendi
iwan
irawan
1 1 rigo 1611071106820000 tanjung beringin 0 0
ahmat
rifal
1 1 heri 1611070303850000 tanjung beringin 0 0
1 1 heri 1611070303850000 tanjung beringin 0 0
1 1 apendi 1611070202660000 tanjung beringin 0 0
1 1 tarmizi 1708041008940000 tanjung beringin 0 0
1 1 edwin 1611071904960000 tanjung beringin 0 0
1 1 bilgo 1611072412940000 tanjung beringin 0 0
1 1 risa 1611076808860000 tanjung beringin 0 0

yuharma
n
1 1 ari 1611072404880000 tanjung beringin 0 0
herman
subsi
1 1 candra 1611070107790000 tanjung beringin 0 0
herman
subsi
1 1 rianto 1611074501170000 tanjung beringin 0 0
ahmat
kudir
Cara
Panjang
Ukur
Badan/
tgl 1=Telent
pengukuran ang
(cm)
2=Berdiri
(17) (18) (19) (20) (21) (22) (23) (24) (25) (26)
9/10/2018 11,5 78 2 1 1 1 1 1 1
9/10/2018 15,3 75 2 1 1 1 1 1 1
9/10/2018 8 72 2 1 1 1 1 2 2
9/10/2018 7,7 83 1 1 1 1 1 2 2
9/10/2018 12,5 85 2 1 1 1 1 2 2
9/10/2018 10 77 1 1 1 1 1 2 2
9/10/2018 12 85 2 1 1 1 1 1 1
9/10/2018 10.5 92 2 1 1 1 1 1 1
9/10/2018 7.2 58 2 1 1 1 1 1 1
9/10/2018 12 78 2 1 1 1 1 1 1
9/10/2018 9 69 2 1 1 1 1 1 2
9/10/2018 14 99 2 1 1 1 1 1 1
9/10/2018 3,8 51 2 1 1 1 1 2 2
9/10/2018 15 94 1 1 1 1 1 1 1
9/10/2018 10,9 782 2 1 1 1 1 2 2
9/10/2018 11 83 1 1 1 1 1 2 2
9/10/2018 10 84 1 1 1 1 1 2 2
9/10/2018 10 75 1 1 1 1 1 2 2
9/10/2018 5 53 1 1 1 1 1 2 2
9/10/2018 16 99 2 1 1 1 1 2 2
9/10/2018 13 78 2 1 1 1 1 2 2
9/10/2018 16 94 1 1 1 1 1 1 1
9/10/2018 11 74 2 1 1 1 1 1 1
9/10/2018 15 103 1 1 1 1 1 1 1
9/10/2018 14 82 2 1 1 1 1 1 1
9/10/2018 7,9 71 1 1 1 1 1 2 2
9/10/2018 6 56 1 1 1 1 1 2 2
9/10/2018 15 101 1 1 1 1 1 2 2
9/10/2018 14 95 2 1 1 1 1 2 2
9/10/2018 11 85 2 1 1 1 1 2 2
9/10/2018 1 1 1 1 1 2 2
9/10/2018 10 63 1 1 1 1 1 2 2
9/10/2018 7 56 1 1 1 1 1 2 2
9/10/2018 10,6 72 1 1 1 1 1 1 1
9/10/2018 7 56 1 1 1 1 1 1 1
9/10/2018 8 65 2 1 1 1 1 1 1
9/10/2018 15,3 97 2 1 1 1 1 2 2
9/10/2018 11 52 2 1 1 1 1 1 1
9/10/2018 8 70 2 1 1 1 1 1 1
9/10/2018 11 52 1 1 1 1 1 2 2
9/10/2018 8 75 1 1 1 1 1 2 1
9/10/2018 10 71 1 1 1 1 1 1 1
Vitamin Vitamin
A A
Februari Agustus
1= Ya 1=Ya
2=
Tidak 2=Tidak
(27) (28)
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
FORMULI
Desa / Kelurahan : Lawang Agung
Tanggal Jenis Nik (Nomor Induk

No Anak ke No Kartu Keluarga Nama Anak
Lahir Kelamin Kependudukan)
(1) (2) (3) (4) (5) (6) (7)

PARZEL TRI
1 3 3/29/2014 L 1611070407110000 1611072903140000
ANUGRA
AGHA ASRAP
2 1 3/23/2015 L 1611071504150000 1611072003150000
NOPAL
3 2 12-01 18 P '1611071504150000 1611075201180000 AFIFA
MUHAMAD
4 2 5/3/2018 L 1611070305180000
1611071109120000 RAFASIA
PARZEL TRI
5 3 3/28/2014 L 161107047110006 1611072903140000
ANUGRA
AKKAAN
6 2 8/4/2018 L 1611072811120000 1611070408180000
ANDRIANSA
HIKAL JUSTIN
7 1 11/7/2013 L 1611072909160000 161107071160001
GILBERT
DIDA DEWI
8 2 5/28/2016 P 1611071601120000 1611076805160000
SAPUTRI
ZAHRA
9 1 4/2/2018 P 1611072507180000 1611074204180000
AVRILIA
10 1 11/2/2015 P 1611070903150000 1611070211150000 FADIL ADRIAN
11 2 8/13/2016 P 1611070309130000 1611074611800000 REFKI
12 2 7/4/2015 P 1611072312110000 1611074407150000 KHAIRA NISA
13 1 5/22/2017 P 161107630100000 FAEZA

14 1 10/24/2014 P 161107160112007 1611075507910000 afifa
15 1 2/18/2016 P 1611071504130000 1611071802110000 vanzen
16 2 8/13/2016 P 1611075308160000 1611075308600000 alika alta talia
17 1 7/15/2017 P 1611074704850000 1611074704800000 faizan
18 1 5/26/2018 P 1611076204950000 1611076204900000 aria guna
19 1 5/3/2015 P 1611071103082160 161107400001 naila
20 1 12/10/2014 P 1611072509120000 1611071612140000 hanam saputra
21 1 11/10/2014 L 1611070112100000 1611071011140000 vincen
22 2 6/16/2018 L 1611070112100000 1611078004900000 saga
23 2 8/24/2013 L 1611070311120000 1611076011900000 glen prabowo
24 1 9/21/2017 L 1611071808750000 1611071808700000 audri
25 2 4/24/2017 L 1611071701120000 1611075212900000 m jaka
muhamad rafi
26 1 11/6/2015 L 1611072906090000 161107061110001
ahmat
muhamad habib
27 1 7/26/2017 L 1611071103082090 1611072607170000
alfariq
28 1 2/13/2017 P 1611072911130000 1611075307170000 karinA
29 2 12/6/2018 P 1611070410110000 1611074812180000 aurel
30 1 10/24/2017 P 1611071601120000 1611076410090000 olivia silvina
31 2 2/13/2012 L 1611070909150000 1611071302120000 yukes revaldi

32 4 7/24/2014 P 1611071206120000 1611076707150000 gigfi airas
34 1 9/22/2015 P 1611071601120000 1611076209180000 talita zarani
wilona putri
33 1 05/05/20113 P 1611072909160000 1611074503160000
denia
33 3 6/7/2016 L 1611072806100010 1611071209800000 imam ramadan
33 2 6/28/2015 L 1611071304090000 1611072006150000 gibram ramadani

33 2 10/4/2017 L 1611074709790000 1611074709700000 guzio
alghaly
33 3 4/12/2014 L 1611072901090060 1611071204140000
phattulislam
33 4 12/2/2016 P 1611072901090060 1611074212160000 syakina pharisya
Nama Posyandu : Anggrek Bulan
Bulan : Januari
Tahun : 2019
Kepemili
Berat kan Buku
IMD
Badan KIA/KM
1=Ya Nama Ayah Nik Ayah No tlp/ HP Ayah
(BB) S 1=Ya
2=Tidak
Lahir
2=Tidak
(8) (9) (10) (11) (12) (13)
2,8 KG 1 1 CANDRA 1611070107720100 081273189991
AHMAD
3 1 1 1611072708850000 085357585554
GADAPI
AMAAD
2.8 1 1 1611072708850000 083575855541
GADAPI
3.2 1 1 ANDI LALA 1611070305180000 082356748934
3 1 1 CANDRA 1611070107720100 082248853464
ANDRI
2.9 1 1 1611072305860000 081563486996
SAPUTRA
3 1 1 RIGO 1611070703860000 082281414864
3 1 1 MERIZAH 1611070508850000 082248683268
3 1 1 SELDI 1611071410900000 082281484646
2.7 1 1 CANDRA 161107005910002 082324252606
2.9 1 1 JUMARDI 1611071405770000 081213345660

YON
3 1 1 1611072312110000 082365787671
SAYONO
2.8 1 1 AYU 1611076301990000 085654676789
2.7 1 1 meliana 1611075507910000 082376789098
3 1 1 hairul usman 1611071802110000 082376181918
2.9 1 1 rahka 1611072311810000 085667898909
3.2 1 1 deti 1611074704850000 081245465667
3 1 1 diah 1611076204950000 085384920090
2.6 1 1 lani 1611072107400000 085765612345
3 1 1 apiktor 16110708800004 085686545688
3.5 1 1 noval 161107310885003 085256463737
1 1 noval 161107310885003 085256463737
2.9 1 1 ratumi 1611071110890000 082365787687
3 1 1 agus 1611071808750000 085214167628
2.9 1 1 wisi 1611071212840000 082315456717
2.7 1 1 ula 1611071004710000 085324769878
3 1 1 hendri 1611071008770000 085378909823
Rahmat
2.8 1 1 161107040278003 081237652727
jailani
2.7 1 1 diansya 1611030610870000 085647892022
seplan
2.5 1 1 085214167628
andustri
3 1 1 farigan azuar 1611070304870000 082315456717
3.4 1 1 rasyidi yunus 1611070106600000 081273189991
2 1 1 riki harianto 1611071010870000 085364720980
2.4 1 1 ridi sapurta 1611072505940000 081323456652
widra
2.7 1 1 1611071209800000 085677425643
apransah
2 1 1 rano karno 1611070201770000 085302029947
2.2 1 1 puspita 1611074709790000 081599871243
3.4 1 1 eko pranata 1611070107770090 081599000752
2 1 1 eko pranata 1611070107770090 081277770807

ERTUMBUHAN BALITA DI POSYANDU
ASI Ekslusif1=YA,2=
Cara
Panjang
Ukur
Badan/
tgl BB 1=Telent
Alamat RT RW Tinggi umur 0 umur 1
pengukuran (kg) ang
Badan bln bln
(cm)
2=Berdiri
(14) (15) (16) (17) (18) (19) (20) (21) (22)
Lawang Agung 0 0 9/12/2018 13,2 103 2 1 1
Lawang Agung 0 0 9/12/2018 9,6 175 2 1 1
Lawang Agung 0 0 9/12/2018 10 70 1 1 1
Lawang Agung 0 0 9/12/2018 8,5 58 1 1 1
Lawang Agung 0 0 9/12/2018 13 103 1 1 1
Lawang Agung 0 0 9/12/2018 11,7 81 2 1 1
Lawang Agung 0 0 9/12/2018 11 82 1 1 1
Lawang Agung 0 0 9/12/2018 10 76 2 1 1
Lawang Agung 0 0 9/12/2018 8 6.7 2 1 1
Lawang Agung 0 0 9/12/2018 13,5 90 1 1 1
Lawang Agung 0 0 9/12/2018 10,7 78 1 1 1
Lawang Agung 0 0 9/12/2018 11 90 2 1 1
Lawang Agung 0 0 9/12/2018 10.3 74 1 1 1

Lawang Agung 0 0 9/12/2018 9 64 2 1 1
Lawang Agung 0 0 9/12/2018 10 66 1 1 1
Lawang Agung 0 0 9/12/2018 11,4 77 2 1 1
Lawang Agung 0 0 9/12/2018 10,6 77 2 1 1
Lawang Agung 0 0 9/12/2018 9 64 1 1 1
Lawang Agung 0 0 9/12/2018 12,3 92 1 1 1
Lawang Agung 0 0 9/12/2018 12,1 90 1 1 1
Lawang Agung 0 0 9/12/2018 14 92 1 1 1
Lawang Agung 0 0 9/12/2018 8 63 2 1 1
Lawang Agung 0 0 9/12/2018 12,5 72 2 1 1
Lawang Agung 9/12/2018 9 79 2 1 1
Lawang Agung 0 0 9/12/2018 10,6 73 1 1 1
Lawang Agung 0 0 9/12/2018 15,3 90 2 1 1
Lawang Agung 0 0 9/12/2018 10 75 1 1 1
Lawang Agung 0 0 9/12/2018 8,9 80 1 1 1
Lawang Agung 0 0 9/12/2018 8,9 71 1 1 1
Lawang Agung 0 0 9/12/2018 9 43 2 1 1
Lawang Agung 0 0 9/12/2018 13,3 38 1 1 1

Lawang Agung 0 0 9/12/2018 14 79 1 1 1
Lawang Agung 0 0 9/12/2018 19 49 1 1 1
Lawang Agung 0 0 9/12/2018 16 90 2 1 1
Lawang Agung 0 0 9/12/2018 13 87 1 1 1
Lawang Agung 0 0 9/12/2018 16 49 2 1 1

Lawang Agung 0 0 9/12/2018 14 46 2 1 1
Lawang Agung 0 0 9/12/2018 18 52 2 1 1
Lawang Agung 0 0 9/12/2018 15,7 47 2 1 1

Vitamin Vitamin
A A
Februari Agustus
umur 2 umur 3 umur 4 umur 5 1= Ya 1=Ya
bln bln bln bln 2=
Tidak 2=Tidak
(23) (24) (25) (26) (27) (28)
1 1 1 1 1 1
1 1 2 2 1 1
1 1 2 2 1 1
1 1 2 2 1 1
1 1 2 2 1 1
1 1 1 2 1 1
1 1 1 2 1 1
1 1 1 2 1 1
1 1 1 2 1 1
1 1 2 2 1 1
1 2 2 2 1 1
1 1 2 2 1 1
1 1 1 2 1 1
1 1 1 1 1 1
1 1 1 1 1 1
1 1 2 2 1 1
1 1 2 2 1 1
1 1 2 2 1 1
1 1 1 1 1 1
1 1 2 2 1 1
1 1 1 2 1 1
1 1 1 1 1 1
1 1 1 1 1 1
1 1 2 2 1 1
1 1 2 2 1 1
1 1 2 2 1 1
1 2 2 2 1 1
1 2 2 2 1 1
1 1 1 1 1 1
1 2 2 2 1 1
1 1 1 2 1 1
1 1 1 2 1 1
1 1 2 2 1 1
1 1 1 1 1 1
1 1 1 1 1 1
1 1 1 1 1 1
1 1 1 2 1 1
1 1 2 2 1 1
1 1 1 1 1 1
FORMULIR PE
Desa / Kelurahan : Padang Gelai
Nik (Nomor Berat
Jenis Induk Badan
Kelamin Kependuduka (BB)
n) Lahir
(1) (2) (3) (4) (5) (6) (7) (8)
MUHAMAD
161107280808001 16110717060
1 3 8/2/2018 L HAIKAL 2.8
0 90000
HABSY
161107280808001 16110763091 SOFWATUS

2 4 9/23/2015 P 3
0 50000 SALSABILAH
161107090812000 16110757041 ZOEYA

3 3 4/17/2017 P 3
0 70000 IZZATUNISA
161107180310000 16110726061 RAHIN
4 2 6/20/2016 L 3
0 40000 SAPUTRA
5 2 9/5/2017 P SIFTI 3.2
161107020811000 16110719111 NOVAL

6 2 11/19/2014 L 3
0 40000 APRIANSA
REGGI
161107280407000 16110709043
7 1 4/28/2016 L BINTANG 3.8
0 90000
PRATAMA
161107150915000 16110731011 JESEN

8 2 1/31/2016 L 2.8
0 60000 ALFAREZEN
161107140710000 16110763091 ASIAH

9 3 9/23/2016 P 2.7
0 50000 MIRANYI
161107010713000 16110706011 DIRGA IRZAM

10 2 1/6/2018 L 3
0 80000 HARZANI
161107260117000 16110769091
11 1 8/20/2017 P NUR AZIZAH 3
0 70000
MUHAMAD
161107250713000 16110716081
12 2 8/16/2018 L IKBAL 3
0 80000
RAMADHAN
161107130217000 16110768051 AFIFA NAHDA
13 1 3/26/2017 P 3.8
0 70000 RAFANDA
161107220910000 16110730061 VIRZHA

14 2 6/30/2014 L 3.2
0 40000 AZRIANSYAH
HISYAH
161107180811000 16110758041
15 2 4/18/2016 P AMELLIAH 2.6
0 60000
ANENDIA
161107291110000 16110712031 AHMADAN
16 4 3/12/2017 L 2.9
0 70000 NURMAN
161107180214001 AHMADAL
17 2 8/18/2015 L 1.61107E+15 3.5
0 AZAM
161107030613000 16110727111 SIEVEN
18 2 11/27/2015 L 2.5
0 50000 WIJAYA
161107271014000 16110741011 ALIKHA
19 1 2/1/2017 P 2.8
0 70000 PRIOELNI
161107070915001 16110767011
20 4 1/27/2016 P PUJA LERTARI 3
0 60000
161107040214001 GEBRIAMAND
21 2 6/19/2015 L 3
0 A SAPUTRA
161107070915000 16110768091 SAGHA RISVI
22 2 9/28/2016 P 3
0 60000 HAMADANI
161107201010001 16110703051 JZAKI

23 4 6/8/2017 L 3.7
0 70000 MIRYAZAWA
KINTAN
161107110308347 16110763051
24 3 5/23/2017 P PERMATA 2.9
0 70000
SARI
161107010816000 16110760081 AIRIN

25 1 8/20/2015 P 2.9
0 50000 SAWINTARI
161107180915000 16110746041 NASITA

26 1 4/6/2014 P 2.8
0 40000 KHALIFAH
161107050213000
27 2 3/16/2018 L MARSEL 2.9
0
161107110612000 16110712121 M.ALIFIA
28 3 12/12/2013 L 2.7
0 60000 ALGINO
161107140813000
29 2 9/27/2016 L citra 3
0
161107140813000 16110712241 ARIO
30 1 12/24/2013 L 3
0 00000 ANGGARA
FAIZ
161107020315000 16110718041
31 1 4/18/2015 L ANUGRAH 2.8
0 50000
ZAM ORA
161107070612000 16110745101
32 2 7/4/2017 P RAISHA 2.8
0 60000
161107210109004 16110762021 YHSH

33 2 22-02-1013 P 28
0 70000 YUNDARI
161107011111000 16110766081 DEA ARMINA

34 2 9/26/2015 P 2.6
0 50000 SARAPOPA
35 2 5/4/2015 L ZINO 2.7
161107030909001
36 5 8/5/2016 L EXSAN 2.7
0
161107110308390 16110769041 APIA MEKAR

37 2 4/29/2014 P 2.9
0 40000 HARUM
38 2 10/4/2018 P SIFA 2.5

ORMULIR PENCATATAN PEMANTAUAN PERTUMBUHAN BALITA D
Nama Posyandu : Gradiul
Bulan : Januari
Tahun : 2019
kan Buku
IMD
KIA/KM
1=Ya Nama Ayah Nik Ayah No tlp/ HP Ayah Alamat RT RW
S 1=Ya
2=Tidak
(9) (10) (11) (12) (13) (14) (15) (16)
JHONI
16110706067600
1 1 HERLAMBA padang gelai 0 0
00
NG
JHONI
16110706067600
1 1 HERLAMBA padang gelai 0 0
00
NG
16110708058600
1 1 HARLINO padang gelai 0 0
00
SUFIANTO 16110718098600
1 1 padang gelai 0 0
HARISNO 00
NOPAN 16110709090600
ARIZON 00
HARDIANS 16110725058500
YAH 00
16110724088700
1 1 RUSMIN padang gelai 0 0
00
YOZI
16110711016700
1 1 JANUARIA padang gelai 0 0
00
NTO
16110715016200
1 1 AMIR padang gelai 0 0
00
INDAH 16110710108400
SUPARTA 00
PRAIIMDO
16110719099200
1 1 DWI padang gelai 0 0
00
SAPUTRA
FRAN 16110711048000
KENERO 00
OKTO ALEK 16110728108900
SANDER 00
HARIANSY 16110729097700
AH 00
16110715117600
1 1 SISWANTO padang gelai 0 0
00
IMAM 16110728127600
NUEL 00
16110717077600
1 1 ALDENDI S padang gelai 0 0
00
JAYA ADI 16110713128800
JONSON 00
MUHAMMA 16110718098200
D ANIL 00
16110702027900
1 1 RANTO padang gelai 0 0
00
16110721058600
1 1 ZANZILI padang gelai 0 0
00
VEKI 16110701048600
AHRIANSA 00
MIRSI 16110702107500
SUSANLI 00
16110711018400
1 1 IRI padang gelai 0 0
00
SASTRI 16110708086800
ANDERSON 00
AWAN 16110705049200
KUNAIVI 00
HADI 16110706128100
SAPUTRA 00
16110716087500
1 1 FERI padang gelai 0 0
00
WAWAN
16110701078700
1 1 HADRIANT padang gelai 0 0
70
O
16110701077800
1 1 ALAMSAH padang gelai 0 0
00
DEVA
16110721109000
1 1 JANDRA padang gelai 0 0
00
ZAM ORA
SANDRA 16110731057700
GUNAWAN 00
16110701077700
1 1 DANDI padang gelai 0 0
90
DAHRIL 16110712067800
ISKANDAR 00
KADEK
1 1 SURO padang gelai 0 0
WIJAYA
INDI
KUSMANDI
RONAL
16110707048200
1 1 APRIANSY padang gelai 0 0
00
AH
HAJAR 16110710088600
HASWAI 00
N BALITA DI POSYANDU
Panjang
Ukur ASI Ekslusif1=YA,2=Tidak
Badan/
1=Telent
tgl pengukuran BB (kg) Tinggi umur 0 umur 1 umur 2 umur 3 umur 4
ang
(cm)
(17) (18) (19) (20) (21) (22) (23) (24) (25)
9/16/2018 7,5 60 2 1 1 1 1 1
9/16/2018 15,1 87 1 1 1 1 1 1
9/16/2018 18 76 1 1 1 1 1 1
9/16/2018 12,8 99 1 1 1 2 1 1
9/16/2018 9 64 1 1 1 1 1 2
9/16/2018 13 95 1 2 2 2 2 2
9/16/2018 10 72 1 1 1 1 1 1
9/16/2018 11,4 78 1 1 1 1 1 1
9/16/2018 11,9 68 1 1 1 1 1 1
9/16/2018 7,8 65 1 1 1 1 1 1
9/16/2018 10 69 1 1 1 1 1 1
9/16/2018 11,6 82 2 1 1 1 1 1
9/16/2018 8,8 72 1 2 2 2 2 2
9/16/2018 13,7 95 1 1 1 1 1 1
9/16/2018 10 75 1 1 1 1 1 1
9/16/2018 11 77 1 1 1 1 1 1
9/16/2018 15,6 89 1 2 2 2 2 2
9/16/2018 12,5 89 1 1 1 1 1 1
9/16/2018 12 79 1 1 1 1 1 1
9/16/2018 11 85 1 1 1 1 1 1
9/16/2018 12 87 1 1 1 1 1 1
9/16/2018 12 86 1 1 1 1 1 1
9/16/2018 10,9 82 1 1 1 1 1 1
9/16/2018 10 73 1 2 2 2 1 1
9/16/2018 12 90 1 1 1 1 1 1
9/16/2018 14 94 1 1 1 1 1 1
9/16/2018 8 67 1 2 2 2 2 2
9/16/2018 11,4 85 1 1 1 1 1 1
9/16/2018 16 78 1 1 1 1 1 1
9/16/2018 17 104 1 1 1 1 1 1
9/16/2018 12 88 1 1 1 1 1 1
9/16/2018 10 79 1 1 1 1 1 1
9/16/2018 12,9 80 1 1 1 1 1 1
9/16/2018 12,5 88 1 1 1 2 2 2
9/16/2018 14,7 78 1 1 1 1 1 1
9/16/2018 14,7 108 1 1 1 2 2 2
9/16/2018 18 102 1 1 1 1 1 1
9/16/2018 9 66 2 1 1 1 1 1
idak A A
Februari Agustus
umur 5 1= Ya 1=Ya
bln 2=
(26) (27) (28)
1 2 2
1 1 1
1 1 1
1 1 1
2 1 1
2 1 1
1 1 1
1 1
1 1
1 1
1 1 1
1 2 2
2 1 1
1 1 1
1 1 1
1 1 1
2 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
2 1 1
1 1 1
1 1 1
2 1 1
1 1 1
1 1 1
1 1 1
2 1 1
1 1 1
2 1 1
1 1 1
1 2 2

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FORMULIR PENCATATAN PEMANTAUAN PERTUMBUHAN BALITA DI POSYANDU

Provinsi : Sumatera Selatan Nama Posyandu : Melati

Jenis Nik (Nomor Induk

(1) (2) (3) (4) (5) (6) (7)

1 2 18-10-2016 P 1611071306110001 1611075810160000 Azzah

2 1 21-11-2014 L 1611070603170016 1604062111140001 Aziz

3 2 02-12-2017 L 1611070603170016 1611070212170000 Wildan

4 2 11-07-2016 L 1611073001090045 1611071107160000 Permana

5 1 07-05-2015 L 1611072402150003 1611070705150001 Meizan

6 1 05-05-2015 P 1611071504150004 1611074505150002 Winda

7 3 01-01-2018 L 1611071103081743 1611070101180001 M. Rizki

8 1 26-03-2014 P 1611072611120001 1611076603110000 Valencia

9 2 30-05-2017 P 1611072611120001 1611077005170001 Paula

10 3 04-05-2016 P 1611071103081752 1611074107800000 Pera

11 1 10-042015 P 1611070610090009 1611075004150001 Chika

12 2 26-11-2014 P 1611070311100038 1611075511140001 Andesa

13 2 29-09-2014 P 1611070402130002 1611076909140001 Sekaram

14 1 10-04-2018 P 1611072001170002 1611075004180000 Dwi Putri

16 1 01-04-2017 L 1611072909160004 1611070104170002 M. Azka

17 1 06-05-2013 L 1611073001170002 1611070605170001 Gibran

18 2 07-04-2018 L 1611070701130000 1611074506800000 Difran

19 1 11-08-2016 L 1611070401160003 1611075108160001 Zhafran

20 2 24-12-2015 P 1611072510170001 1611076412150001 Natania

21 1 26-11-2013 L 1611071007140002 1611072611130001 Andika

22 2 03-02-2016 L 1611072712110011 1611070302160001 Andrian

23 2 31-07-2013 L 1611071103081762 1611073107130002 Rezi

24 1 08-03-2016 L 1611073005180001 1611070803160001 Haikal

25 1 13-01-2018 L 1611072301180001 1611071301180001 Rafkha

26 2 06-09-2016 P 1611070303160007 1611070609160001 Geysa

27 2 19-06-2016 L 1611070402090002 1611071906160001 M. Zazili

28 2 31-12-2016 P 1611070808170005 1611077112160002 Celsia

(25) (26) (27) (28)

Jenis Nik (Nomor Induk

(1) (2) (3) (4) (5) (6) (7)

2 1 04-01-2018 L 1611070701160002 1611070401160001 Raditiya

3 1 03-03-2018 P 1611070204180002 1611074211000000 Adel

4 2 07-11-2016 p 1611070808160004 1611074711160001 Jihan

5 1 18-07-2017 L 1611071405180003 1611071807170001 M. Abi

6 3 23-10-2017 L 1611070108120001 1611075111800000 Al Aszka

7 1 02-05-2014 P 1611070302140001 1611074205140001 Salsabila

8 3 01-05-2017 L 1611070311100074 1611070105170001 Hafidz

9 3 22-08-2018 P 1611070411100010 1611075606800000 Agita

10 1 20-07-2016 P 1611071208160003 1611076007160001 Ririn

11 1 01-02-2015 P 1611070104140002 1611074102150001 Putri

12 3 23-05-2015 L 1611072603150001 1611072305150001 Reynand

13 4 04-04-2018 P 1611072603150001 1611074404180001 Assyfa

14 2 21-05-2018 L 1611072407120001 1611072105180001 Alzam

15 2 15-03-2017 P 1611070411100006 1611075503170001 Alika

16 2 18-05-2018 L 1611070205130001 1611077010800000 Adnan

17 1 05-07-2014 L 1611071407140001 1611070507140001 Cyhiko

Berat kan Buku

Jenis Nik (Nomor Induk

(1) (2) (3) (4) (5) (6) (7)

18 2 26-0616 L 161107230412000 161107260616000 Ahmad

(8) (9) (10) (11) (12) (13) (14) (15)

2800 1 1 Kamaludin 161107060683000 0852351466 Muara Aman 0

(16) (17) (18) (19) (20) (21) (22) (23) (24)

(25) (26) (27) (28)

(1) (2) (3) (4) (5) (6) (7) (8)

(9) (10) (11) (12) (13) (14) (15) (16) (17)

Tanggal Jenis Nik (Nomor Induk Nama

(1) (2) (3) (4) (5) (6) (7)

2 1 02-09-2015 L '1611071506150002 1611070209150001 Tegar