FORMAT PENCATATAN PELAKSANAAN VAKSINASI COVID 19

TINGKAT PUSKESMAS/JEJARING

MUARA BASUNG HARI/ TANGGAL : Sabtu, 19 NOVEMBER 2022

: BENGKALIS
: RIAU PFIZER
Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I Dosis 3 Keterangan
Jenis Umur sesuai) Non Merek Tanggal Tanggal Tanggal (Contoh:
No No. Registrasi NIK Nama Penerima Vaksin Pekerjaan* Alamat No. Hp BPJS BPJS
Kelamin Anggot Vaksin*** Screening Pemberian No. Batch Pemberian No. Batch Ditunda/Dir
PBI Non PBI ujuk/….)
a Vaksinasi Vaksinasi
1 MANUAL `1403131810850000 PARLINDUNGAN L UMUM 37 Pinggir `082236314390 YA PFIZER 11/19/2022 11/19/2022 FX2761 LANJUT
2 UU-01FVKQ2 `1403132805940004 BEDI ARIADES L UMUM 28 Pinggir `085263894800 YA PFIZER 11/19/2022 11/19/2022 FX2761 LANJUT
3 UU-000NNID `1403134303690003 MIS NETTY P UMUM 53 Pinggir `082317573050 YA PFIZER 11/19/2022 11/19/2022 FX2762 LANJUT
4 UU-012OPUV `1403135203920004 SITI NURHASANAH P UMUM 30 Pinggir `082384762233 YA PFIZER 11/19/2022 11/19/2022 FX2763 LANJUT
1 = Petugas Medis dan Non Medis di Fasilitas Pelayanan Kesehatan
2 = Petugas pelayanan publik yang berhadapan langsung dengan masyarakat
3 = Administrator Pemerintahan
4 = Lainnya
5 = Tidak Bekerja
12-17 0 BPJS Non PBI 3
18-30 1 Non Anggota
31-45 1 Total 3
46-59 1
60-73 0 Pemberian Dosis
73-86 0 Dosis 1 218
Total 3 Dosis 2 16
Total 234

Pekerjaan:
1
2
3 REMAJA 0
4 234 UMUM 3
5 PRALANSIA 0
Total 234 LANSIA 0
PUBLIK LAINNYA 0
GURU 0
PNS 0
LK 2 MAHASISWA 0
PR 1 SMP 0
3 SMA 0

3
NO NAMA PENERIMA VAKSIN DOSIS 1 DOSIS 2 NO HP
1 HENDRI SENIN,28-06-2021 SENIN, 26-7-2021 081261837100
2 ERIK PRABOWO SENIN,28-06-2021 SENIN, 26-7-2021 085278080528
3 DENI AFRIAN SENIN,28-06-2021 SENIN, 26-7-2021 085225545308
4 A SALIM SENIN,28-06-2021 SENIN, 26-7-2021 082176083721
5 ROMI SENIN,28-06-2021 SENIN, 26-7-2021 082388025955
6 MUHAJIR SENIN,28-06-2021 SENIN, 26-7-2021 085781129196
7 NASARIUS HORAS SENIN,28-06-2021 SENIN, 26-7-2021 082278957308
8 TITA ASWATI SENIN,28-06-2021 SENIN, 26-7-2021 082284525667
9 OSMAR SIBORO SENIN,28-06-2021 SENIN, 26-7-2021 081374908420
10 DESI MURIATI SENIN,28-06-2021 SENIN, 26-7-2021 085376779897
11 YENTI ARLINDA SENIN,28-06-2021 SENIN, 26-7-2021 085375477084
12 ASPIZAR SENIN,28-06-2021 SENIN, 26-7-2021 081260446650
13 REDIKA REGINA SENIN,28-06-2021 SENIN, 26-7-2021 082258584649
14 IQBAL ZAKI SENIN,28-06-2021 SENIN, 26-7-2021 082284571018
15 ANGGIAT TM TAMBA SENIN,28-06-2021 SENIN, 26-7-2021 085264560534
16 REDINA ADELIA SENIN,28-06-2021 SENIN, 26-7-2021 085763516044
17 ADRI NUGROHO SENIN,28-06-2021 SENIN, 26-7-2021 085272340586
18 RIKA MAYA SARI SENIN,28-06-2021 SENIN, 26-7-2021 081236626965
19 ROSENLIH SIHOMBING SENIN,28-06-2021 SENIN, 26-7-2021 082172421893
20 OKTRI SETIA NINGSIH SENIN,28-06-2021 SENIN, 26-7-2021 082169482730
21 RISMADIANTO SENIN,28-06-2021 SENIN, 26-7-2021 081365203045
22 SUSI LONANDA SENIN,28-06-2021 SENIN, 26-7-2021 081275518457
23 AZURA PUTRI SENIN,28-06-2021 SENIN, 26-7-2021 081268707879
24 ROZIMAH SENIN,28-06-2021 SENIN, 26-7-2021 082170445707
25 IRSAM VILIA SENIN,28-06-2021 SENIN, 26-7-2021 081317319298
26 SRI TRISNA MURNI SENIN,28-06-2021 SENIN, 26-7-2021 08127564060
27 PUJI RESTANTO SENIN,28-06-2021 SENIN, 26-7-2021 081371050526
28 ROSMA SIMANULANG SENIN,28-06-2021 SENIN, 26-7-2021 081365697498
29 BINSAR PARULIAN SENIN,28-06-2021 SENIN, 26-7-2021 081397634088
30 ENDANG SULASTRI SENIN,28-06-2021 SENIN, 26-7-2021 081363632493
31 NIA SAPUTRI SENIN,28-06-2021 SENIN, 26-7-2021 081360233314
32 ANDI SAPUTRA SENIN,28-06-2021 SENIN, 26-7-2021 082285175724
33 MULIANA LUBIS SENIN,28-06-2021 SENIN, 26-7-2021 081264283832
34 ASRIANI SENIN,28-06-2021 SENIN, 26-7-2021 082114172616
35 TRI HERIANDI SENIN,28-06-2021 SENIN, 26-7-2021 081364143061
36 MHD. ZUCHRI FACHRUN SENIN,28-06-2021 SENIN, 26-7-2021 081280843338
37 FAHMITA SEFRINA SENIN,28-06-2021 SENIN, 26-7-2021 085272434988
38 SAIFUL ARIFIN SENIN,28-06-2021 SENIN, 26-7-2021 082390578939
39 YANTI SENIN,28-06-2021 SENIN, 26-7-2021 085376458753
40 ROZA EKA FITRIA SENIN,28-06-2021 SENIN, 26-7-2021 081378752917
41 DEDE KURNIAWAN SENIN,28-06-2021 SENIN, 26-7-2021 081268951177
42 ELSI NOVITA SENIN,28-06-2021 SENIN, 26-7-2021 082284027337
43 FITA WIRANTI SENIN,28-06-2021 SENIN, 26-7-2021 08111466882
44 MAYA BENUKU SENIN,28-06-2021 SENIN, 26-7-2021 082290561802
45 NOVI OKTAVIA SENIN,28-06-2021 SENIN, 26-7-2021 082171991138
46 INDRI SRI RAHAYU SENIN,28-06-2021 SENIN, 26-7-2021 081213294692
47 ANITA A. BUZAR SENIN,28-06-2021 SENIN, 26-7-2021 081268087744
48 HAYATI SENIN,28-06-2021 SENIN, 26-7-2021 085278533158
49 M SYAFA SENIN,28-06-2021 SENIN, 26-7-2021 081268036437
50 GERDON SENIN,28-06-2021 SENIN, 26-7-2021 085364250381
51 EDI JUANDA SENIN,28-06-2021 SENIN, 26-7-2021 082238630079
52 NIBUKAT ZARADAN SENIN,28-06-2021 SENIN, 26-7-2021 085272526835
53 PEATRICE ANASTASIA SENIN,28-06-2021 SENIN, 26-7-2021 082283676046
54 SITI AISYAH SENIN,28-06-2021 SENIN, 26-7-2021 081360233316
55 SALBET INTANJAYA SENIN,28-06-2021 SENIN, 26-7-2021 082383226996
56 NIKO PRATAMA SENIN,28-06-2021 SENIN, 26-7-2021 082386786037
 57 BASUKI SENIN,28-06-2021 SENIN, 26-7-2021 081266812550
58 SON HOOKY SIHOMBING SENIN,28-06-2021 SENIN, 26-7-2021 082268242093
59 GABRIELA CLARA SENIN,28-06-2021 SENIN, 26-7-2021 081275563928
60 WINDA KARMILA SENIN,28-06-2021 SENIN, 26-7-2021 085374506602
61 DEWI YUTIKA SENIN,28-06-2021 SENIN, 26-7-2021 081276216742
62 YULIA KARTIKA SENIN,28-06-2021 SENIN, 26-7-2021 085272526836
63 MANUNTUN SIAHAAN SENIN,28-06-2021 SENIN, 26-7-2021 081266245981
64 NETRAWATI SENIN,28-06-2021 SENIN, 26-7-2021 08127662129
65 MULYONO SENIN,28-06-2021 SENIN, 26-7-2021 085271520336
66 PAULUS HASOLOAN SENIN,28-06-2021 SENIN, 26-7-2021 085363243298
67 JUNI SUSANTI SENIN,28-06-2021 SENIN, 26-7-2021 081268732704
68 SITI NURHAYANI SENIN,28-06-2021 SENIN, 26-7-2021 081364942326
69 ARDANA YUDHA SENIN,28-06-2021 SENIN, 26-7-2021 08127012280
70 JULIANTI PURBA SENIN,28-06-2021 SENIN, 26-7-2021 082266245981
71 EKI FEBRIANTI SENIN,28-06-2021 SENIN, 26-7-2021 081377216017
72 ELPI WIDIAWATY SENIN,28-06-2021 SENIN, 26-7-2021 082250055767
73 KURNIA MUSHARIANDI SENIN,28-06-2021 SENIN, 26-7-2021 082387126388
74 TRI FATMI SENIN,28-06-2021 SENIN, 26-7-2021 081268935936
75 SAIFUL RAHMAN SENIN,28-06-2021 SENIN, 26-7-2021 082285013453
76 UMIRA WATI SENIN,28-06-2021 SENIN, 26-7-2021 081268077063
77 IRNITA SENIN,28-06-2021 SENIN, 26-7-2021 085269974334
78 GUSRIYANI SENIN,28-06-2021 SENIN, 26-7-2021 082172247662
79 MERRY SAFERA SENIN,28-06-2021 SENIN, 26-7-2021 082283233379
80 DM SUSI LIANTI SENIN,28-06-2021 SENIN, 26-7-2021 081365432377
81 PAINI SENIN,28-06-2021 SENIN, 26-7-2021 081268939057
82 RIJADI BUDIMAN SENIN,28-06-2021 SENIN, 26-7-2021 081311263088
83 RENGKY ASWADI SENIN,28-06-2021 SENIN, 26-7-2021 081363731309
84 SEPTIA SILALAHI SENIN,28-06-2021 SENIN, 26-7-2021 085225589491
85 OKTA FITRI YENI SENIN,28-06-2021 SENIN, 26-7-2021 081266383138
86 PARTO SENIN,28-06-2021 SENIN, 26-7-2021 08127640201
87 DEDI SETIAWAN SENIN,28-06-2021 SENIN, 26-7-2021 081267515379
88 DHEYU SUHAIMI SENIN,28-06-2021 SENIN, 26-7-2021 082283841010
89 TIKA INDAH YANTI SENIN,28-06-2021 SENIN, 26-7-2021 082347322448
90 JELLI GUSTIANA SENIN,28-06-2021 SENIN, 26-7-2021 081374876607
91 SAFITRI SENIN,28-06-2021 SENIN, 26-7-2021 082384331138
92 ROZALIA SENIN,28-06-2021 SENIN, 26-7-2021 082391558106
93 HASBIANTO SENIN,28-06-2021 SENIN, 26-7-2021 082391558106
94 BAMBANG SAPUTRA SENIN,28-06-2021 SENIN, 26-7-2021 085265814472
95 SITI AMINAH SENIN,28-06-2021 SENIN, 26-7-2021 081275624272
96 IKHWAN AFFANDI SENIN,28-06-2021 SENIN, 26-7-2021 082294501152
97 RUDI AHMAD EFENDI SENIN,28-06-2021 SENIN, 26-7-2021 081268074419
98 ZUZANE SENIN,28-06-2021 SENIN, 26-7-2021 082176688258
99 LEDDI GODIVA SENIN,28-06-2021 SENIN, 26-7-2021 082217141736
100 JUFRIZAL SENIN,28-06-2021 SENIN, 26-7-2021 081365482841
101 SANTO JEMSY LUMI SENIN,28-06-2021 SENIN, 26-7-2021 08114344033
102 JEFREN SENIN,28-06-2021 SENIN, 26-7-2021 085264711489
103 NURHAHATI SENIN,28-06-2021 SENIN, 26-7-2021 081276736826
104 ALWIS SENIN,28-06-2021 SENIN, 26-7-2021 081371923706
105 LA IBRAHIM SENIN,28-06-2021 SENIN, 26-7-2021 085342214705
106 HERI SUSILO SENIN,28-06-2021 SENIN, 26-7-2021 082362274490
107 BENTAR BARUS SENIN,28-06-2021 SENIN, 26-7-2021 081261412529
108 MAYUNIS SENIN,28-06-2021 SENIN, 26-7-2021 081374570204
109 IRWAN SENIN,28-06-2021 SENIN, 26-7-2021 085264582329
110 HASNI SENIN,28-06-2021 SENIN, 26-7-2021 082268825959
111 ZULFAN EFENDI SENIN,28-06-2021 SENIN, 26-7-2021 08126843310
112 RUSDA SENIN,28-06-2021 SENIN, 26-7-2021 081365637152
113 SASTRA WIJAYA SENIN,28-06-2021 SENIN, 26-7-2021 081268431876
114 MARWAN IIIKHLAS SENIN,28-06-2021 SENIN, 26-7-2021 081368488552
115 DEDI IRAWAN SENIN,28-06-2021 SENIN, 26-7-2021 085296220511
116 EKA SARI SENIN,28-06-2021 SENIN, 26-7-2021 082210741717
117 NOVRI MAYANG SARI SENIN,28-06-2021 SENIN, 26-7-2021 082288587094
118 AFRIYATI SENIN,28-06-2021 SENIN, 26-7-2021 082367466777
119 ZULFAN EFENDI SENIN,28-06-2021 SENIN, 26-7-2021 085363148006
120 MISIAH SENIN,28-06-2021 SENIN, 26-7-2021 081277847809
121 RINTO LUBIS SENIN,28-06-2021 SENIN, 26-7-2021 082173110531
122 DEDI SUROSO SENIN,28-06-2021 SENIN, 26-7-2021 082365520670
123 PARIADI SENIN,28-06-2021 SENIN, 26-7-2021 083160422141
124 ARDIANSYAH SENIN,28-06-2021 SENIN, 26-7-2021 082273649693
125 SUHAIMI SENIN,28-06-2021 SENIN, 26-7-2021 081366142146
126 IRMAYANTI SINAGA SENIN,28-06-2021 SENIN, 26-7-2021 082385346117
127 ZULHELMI SENIN,28-06-2021 SENIN, 26-7-2021 082391408591
128 SAID HAMDI SENIN,28-06-2021 SENIN, 26-7-2021 082387206868
129 SRI MULYANI SENIN,28-06-2021 SENIN, 26-7-2021 085278761839
130 ROIDA SENIN,28-06-2021 SENIN, 26-7-2021 085262415936
131 RINI ASTIKA SENIN,28-06-2021 SENIN, 26-7-2021 082387212202
132 SAMSUL S SENIN,28-06-2021 SENIN, 26-7-2021 081266352554
133 RESTIKA SENIN,28-06-2021 SENIN, 26-7-2021 081276601921
134 FERNANDO SENIN,28-06-2021 SENIN, 26-7-2021 081365776207
135 YUSMAN SENIN,28-06-2021 SENIN, 26-7-2021 081268214553
136 MUHAMMAD DARIS SENIN,28-06-2021 SENIN, 26-7-2021 081319772332
137 M. SYAFRIYANTO SENIN,28-06-2021 SENIN, 26-7-2021 082284833259
138 MINDYO SENIN,28-06-2021 SENIN, 26-7-2021 082268027675
139 POLINDAH SENIN,28-06-2021 SENIN, 26-7-2021 082383383166
140 EVA SEFANI SENIN,28-06-2021 SENIN, 26-7-2021 082213539857
141 SUDIRWANTO SENIN,28-06-2021 SENIN, 26-7-2021 081268939057
142 YENI HARTATI SENIN,28-06-2021 SENIN, 26-7-2021 085271405310
143 SYAFRI SENIN,28-06-2021 SENIN, 26-7-2021 082385196553
144 NIKEN SUMIATI SENIN,28-06-2021 SENIN, 26-7-2021 082268553024
145 HARI ANDRIANI SENIN,28-06-2021 SENIN, 26-7-2021 082365520670
146 HORAS MANIK SENIN,28-06-2021 SENIN, 26-7-2021 085363138700
147 JASRIL SENIN,28-06-2021 SENIN, 26-7-2021 082170444018
148 HASIHOLAN SENIN,28-06-2021 SENIN, 26-7-2021 081260112234
149 LENNI TIURMAIDA SENIN,28-06-2021 SENIN, 26-7-2021 081363517782
150 BONA SAMSON SENIN,28-06-2021 SENIN, 26-7-2021 081268018835
151 FATMAWATI SENIN,28-06-2021 SENIN, 26-7-2021 081261050707
152 YULIA NINGSIH SENIN,28-06-2021 SENIN, 26-7-2021 082272303978
153 AIDA SAFINA SENIN,28-06-2021 SENIN, 26-7-2021 081268852518
154 RIZKI WAHYUDI SENIN,28-06-2021 SENIN, 26-7-2021 085374887029
155 ERI AYENG LIZA SENIN,28-06-2021 SENIN, 26-7-2021 081378800110
156 ABDUL RACHMAN SENIN,28-06-2021 SENIN, 26-7-2021 081267111217
157 ANDIKA SISWANTO SENIN,28-06-2021 SENIN, 26-7-2021 081371656353
158 BERSIN TAHAN SENIN,28-06-2021 SENIN, 26-7-2021 082385207348
159 YUKSEN EFENDI SENIN,28-06-2021 SENIN, 26-7-2021 081365533873
160 RINI AGUSTIN SENIN,28-06-2021 SENIN, 26-7-2021 082364345578
161 IMAM SUMA SENIN,28-06-2021 SENIN, 26-7-2021 085264471135
162 FITRA IRAWAN SENIN,28-06-2021 SENIN, 26-7-2021 081268466153
163 WANDI SENIN,28-06-2021 SENIN, 26-7-2021 082216903529
164 RUDIANTO SENIN,28-06-2021 SENIN, 26-7-2021 085274573304
165 SUGIARTO SENIN,28-06-2021 SENIN, 26-7-2021 082386234822
166 AGUS ISMAIL SENIN,28-06-2021 SENIN, 26-7-2021 081276513088
167 RIRI ANDRIANI SENIN,28-06-2021 SENIN, 26-7-2021 081364095838
168 ADE SUMAILANI SENIN,28-06-2021 SENIN, 26-7-2021 085374122042
169 HARNI SENIN,28-06-2021 SENIN, 26-7-2021 082235566424
170 IIN SUSANTO SENIN,28-06-2021 SENIN, 26-7-2021 085278200536
171 TETUS MALEMBI SENIN,28-06-2021 SENIN, 26-7-2021 081374418451
172 AMANAT SENIN,28-06-2021 SENIN, 26-7-2021 081277086435
173 SUHENDRI SENIN,28-06-2021 SENIN, 26-7-2021 082387248051
174 RAMCES SENIN,28-06-2021 SENIN, 26-7-2021 085365670716
175 SAFRUDIN SENIN,28-06-2021 SENIN, 26-7-2021 085212432113
176 LEO SAPUTRA SENIN,28-06-2021 SENIN, 26-7-2021 082170445039
177 YONA KRISTIAWAN SENIN,28-06-2021 SENIN, 26-7-2021 082284363096
178 ABDUL SUKUR SENIN,28-06-2021 SENIN, 26-7-2021 082382206474
179 RIKI MARKIANO SENIN,28-06-2021 SENIN, 26-7-2021 085271537784
180 LAMBOK SENIN,28-06-2021 SENIN, 26-7-2021 081261456395
181 JOSTAF SENIN,28-06-2021 SENIN, 26-7-2021 081270899334
182 DEDI SATRIA SENIN,28-06-2021 SENIN, 26-7-2021 082284494607
183 RASDI SENIN,28-06-2021 SENIN, 26-7-2021 082171242281
184 TAUFIK QUROHMAN SENIN,28-06-2021 SENIN, 26-7-2021 081268302055
185 KOHLER SENIN,28-06-2021 SENIN, 26-7-2021 085271405045
186 RUDI HARTONO SENIN,28-06-2021 SENIN, 26-7-2021 081364538486
187 ARBI SENIN,28-06-2021 SENIN, 26-7-2021 085321180952
188 SUMIATI SENIN,28-06-2021 SENIN, 26-7-2021 085375849161
189 JULIAN HADI SENIN,28-06-2021 SENIN, 26-7-2021 085364592103
190 WANTA WIJAYA SENIN,28-06-2021 SENIN, 26-7-2021 082171233424
191 RAHIM SENIN,28-06-2021 SENIN, 26-7-2021 085364202926
192 ANTONI SENIN,28-06-2021 SENIN, 26-7-2021 082381643757
193 RAMLI SENIN,28-06-2021 SENIN, 26-7-2021 082388026332
194 BERLIANA SENIN,28-06-2021 SENIN, 26-7-2021 082171743493
195 EKA HENDRA SENIN,28-06-2021 SENIN, 26-7-2021 081276411504
196 ASRIADI SENIN,28-06-2021 SENIN, 26-7-2021 085271243545
197 TAMINTA SENIN,28-06-2021 SENIN, 26-7-2021 082169180650
198 DARMIATI SENIN,28-06-2021 SENIN, 26-7-2021 082387547468
199 ARI INDRAWAN SENIN,28-06-2021 SENIN, 26-7-2021 081210841125
200 PUSRI SENIN,28-06-2021 SENIN, 26-7-2021 082172850349
201 ROLAN SIHOMBING SENIN,28-06-2021 SENIN, 26-7-2021 081365586733
202 NIONI SITI KOMALAWATI SENIN,28-06-2021 SENIN, 26-7-2021 081371989676
203 RUSMIDA SITORUS SENIN,28-06-2021 SENIN, 26-7-2021 088271960992
204 MARIZAL SENIN,28-06-2021 SENIN, 26-7-2021 08127505935
205 EDY HARTONO SENIN,28-06-2021 SENIN, 26-7-2021 081362345002
206 MINDO RIA SENIN,28-06-2021 SENIN, 26-7-2021 082268053645
207 SECILIA WINI PUTRI SENIN,28-06-2021 SENIN, 26-7-2021 088271960992
208 ROMAULI SIRAIT SENIN,28-06-2021 SENIN, 26-7-2021 085271958102
209 SITI HERLINA SENIN,28-06-2021 SENIN, 26-7-2021 081275848619
210 SONTARIA SIHOMBING SENIN,28-06-2021 SENIN, 26-7-2021 081378651461
211 ELFRIDA SANTI PURBA SENIN,28-06-2021 SENIN, 26-7-2021