Jadwal Dosis 2 Hari Senin 3 Mei 2021

Nama Puskesmas : KIBIN
Kabupaten : SERANG
Provinsi : BANTEN
No. No. Registrasi NIK Nama Penerima Vaksin Jenis Kelamin
1 2 3 4 5
1 S-5F63052F 3604165403840001 DEWI INDRAWATI P
2 S-B2D2274B 3604294108950004 MAMAY MAESAROH P
3 S-DB25B420 3604095812840001 KHOTIMAH P
4 S-747D68D 3604165006860005 SITI QOMARIYAH P
5 S-8084047C 3604165707940001 EEM NURHIKMAH P
6 3604164910660001 ROHYATI P
7 S-D8D91E4C 3604165206890002 ROHAENI P
8 S-1B37BD42 3604164807990001 RANI SAPITRI P
9 P-P9CBF150 3604057009000001 POPON RUSLINDA P
10 S-16684BF6 3604164507670003 HJ.ULPAH P
11 S-B3018056 3604166606760001 LELI KHULISOH P
12 S-A9A2D1D 3604124504850006 SUHARIYAH P
13 S-91671FB0 3604160403600002 KEMIS L
14 S-77AD4ED9 3604156004910003 IDA LAELA P
15 S-65740090 3604110303670002 HASAN MAFTUHI L
16 P-P1FQ504 3604116203900001 ARUM RUMELA P

17 3604165207610001 ETI BUDIATI P
18 PDB3LPADS 3604164203780001 HAMAMAH P
19 S-1270E2DC 3604165503900003 LIA MUDRIKAH P
20 S-BB670A35 3604166112800002 SITI KOTIMAH P
21 S-5A813B3F 3604164206970003 SURYANAH P
22 S-473680A7 3604165660000003 SURYANTI P
23 S-4B96CB09 3604160609700001 MUHIJI L
24 S-4B96CB09 3604166007900003 MARIA MAGDALENA P
25 3604165812860001 MARIA PUSPITA P
26 S-EEEE823F 3604165610890001 KHUSNUL KHOTIMAH P
27 S-AF48EE73 3604126104000002 UMMY RIZQIYAH P
28 S-53E8A0BB 3604165502810001 RUSTINI P
29 S-459B380C 3604166510820002 IDA P
30 S-B301C700 3604165806690001 SALBIAH P
31 S-C4F5B7F2 3604167004850002 ROHANAWATI P
32 S-787D00EF 3604112603930002 DEDI WAHYUDI L
33 S-0EA898CE 3604160510670001 H.NURYASIN L
34 S-4A401332 3604164709660001 MARSINAH P
35 P-PHBFZ8H2 3524114202890002 ENDRIK SULISTIONINGSIH P
36 P-PHMVMBXA 3604016102010827 SINDI P
37 S-BF23BB8F 3604334409940001 VIKA FAWA P
38 S-D2ECDS3 3604165405920003 SUMIYATI DEWI ASTUTI P
39 S-FF1EE1F6 3604105807960454 ISTIQOMAH P
40 S-57BAD493 3604164111650001 NINING SUHANI P
41 S-9CE1F18E 3604166007000002 IQLIMA P
42 S-221ECDFC 3604165605740001 AMI SUHAEMI P
43 S-AC830654 3604175410940001 SITI KHUMAEROH P
44
45
JUMLAH
Keterangan :
* Pekerjaan dikelompokkan menjadi
1. Petugas medis dan non medis di faskes Pelayanan Kesehatan
2. Petugas Pelayanan yang berhubungan langsung dengan masyarakat
PENCATATAN PELAKSANAAN VAKSINAS
TINGKAT PUSKESMAS KAB. SERANG
TANGGAL 05 APRIL 2021
Kepesertaa
n BPJS
(Tulis 'Ya'
pada kolom
yang
sesuai)
Umur (18
Kelompok
Pekerjaan s/d 59 Aalamat No HP
Umur
Tahun)
BPJS PBI
6 7 8 9 10 11
GURU 36 KP.POS TAMBAK 01/01 DS TAMBAK 081387573801
GURU 26 KP.LINGK TURUS 02/02 PANANCANGAN 0838149424
GURU 36 PERUM.PURI TAMBAK BLOK A3 NO 15 081284139535
GURU 34 KP.NAGARA 01/01 DS. NAGARA 087772460717
GURU 26 KP.KEDALEMAN 03/02 DS KETOS 08962787554
GURU 55 KP.CIAGEL /081385372880
GURU 31 KP.CIWAJIK 05/02 DS KIBIN 083818520155
GURU 32 KP.CIWAJIK 05/02 DS KIBIN 088213584819
GURU 21 KP.WANASABA 01/01 DS.TOYO MERTO 087873973959
GURU KP.POS TAMBAK 01/01 DS TAMBAK 087809656208
GURU 43 KP.JEMPLING 03/04 DS. NAMBOILIR 085213835476
GURU 36 PERUM TAMBAK GEMILANG BOKB.9 NO 20 087775493070
GURU 58 KP.PASIR JAMBE 04/01 DS.NAMBOILIR 081287320943
GURU 40 KP.SAWO 18/03 DSJULANG CIKANDE 08951879783
GURU 54 KP.PABUARAN INDAH 04/04 KRAGILAN 081214330121
GURU 24 KP.CIGEUNG 02/01 DS.SOLEAR 085283230572

GURU 50 KP. CIROKE 04/01 DS TAMBAK 087774325666
GURU 43 KP.OCIT 04/01 DS CIAGEL 083806753409
GURU 31 KP.LAES NAMBO 05/02 DS SUKAMAJU 089668609286
GURU 39 KP.JERING KIBIN 083890983752
GURU 27 KP.CIBUNGUR 12/03 DS CIAGEL 085888270373
GURU 21 KP.PAYA 09 /02 DS KETOS 083820290552
GURU 51 KP.CITENGENG 05/02 DS KIBIN 085201799036
GURU 24 KP.TALAGA 08/01 DS KIBIN
GURU 34 KP KADINGDING DS KIBINN 081319667147
GURU 32 KP. POS TAMBAK 01/01 DS KIBIN 087774080669
GURU 21 KP. DOMAS 08/02 DS DOMAS 085939232127
GURU 40 KP.PANEBONG 01/01 DS NAMBOILIR 082114783271
GURU 39 KP.GAMBAR 02/06 DS NAMBOILIR 083890783338
GURU KP.PASIR TEGAL DS. KETOS 081311977520
GURU 36 KP. PANEBONG 01/01 DS NAMBOILIR 081287320942
GURU 28 KP.PAYA 09 /02 DS KETOS 085880006359
GURU 31 KP.NOGO 03/01 NOGOJATISARI 08129867077
GURU 20 KP CIMUNCANG WARAKAS 01/16 SERANG 08393884899
GURU 27 KP CITOLOG 08/03 DS.TAMIYANG GUNUNG SARI 085212416743
GURU 25 KP.JAMI 07/02 DS.KALODRAN 08773195057
GURU 57 KP.POS TAMBAK 01/01 DS KIBIN 081384274824
GURU 21 KP.POS TAMBAK 01/01 DS KIBIN 08138573953
GURU 26 KP.ASTANARAGAS 087809576914

** Komorbid *** Merk Vaksin
1. Hipertensi 1. Sinovax
2. Diabetes 2. …...........
3. Penyakit Jantung 3. …...........
NAAN VAKSINASI COVID 19
AS KAB. SERANG 2021
05 APRIL 2021
Komorbid ** Dosis 1
Merk Vaksin *** Tanggal Screening
BPJS non Non Ada (sebutkan Tidak ada

PBI Anggota komorbidnya) (centang)
Tanggal Pemberian
Imunisasi
12 13 14 15 16 17 18
ⱽ COVID-19 05/04/02021 05/04/02021
ⱽ COVID-19 05/04/02021 05/04/02021
ⱽ COVID-19 05/04/02021 05/04/02021
ⱽ COVID-19 05/04/02021 05/04/02021
ⱽ COVID-19 05/04/02021 05/04/02021
ⱽ COVID-19 05/04/02021 05/04/02021
ⱽ COVID-19 05/04/02021 05/04/02021
ⱽ COVID-19 05/04/02021 05/04/02021
ⱽ COVID-19 05/04/02021 05/04/02021
ⱽ COVID-19 05/04/02021 05/04/02021
ⱽ COVID-19 05/04/02021 05/04/02021
ⱽ COVID-19 05/04/02021 05/04/02021
ⱽ COVID-19 05/04/02021 05/04/02021
ⱽ COVID-19 05/04/02021 05/04/02021
ⱽ COVID-19 05/04/02021 05/04/02021
ⱽ COVID-19 05/04/02021 05/04/02021

ⱽ COVID-19 05/04/02021 05/04/02021
ⱽ COVID-19 05/04/02021 05/04/02021
ⱽ COVID-19 05/04/02021 05/04/02021
ⱽ COVID-19 05/04/02021 05/04/02021
ⱽ COVID-19 05/04/02021 05/04/02021
ⱽ COVID-19 05/04/02021 05/04/02021
ⱽ COVID-19 05/04/02021 05/04/02021
ⱽ COVID-19 05/04/02021 05/04/02021
ⱽ COVID-19 05/04/02021 05/04/02021
ⱽ COVID-19 05/04/02021 05/04/02021
ⱽ COVID-19 05/04/02021 05/04/02021
ⱽ COVID-19 05/04/02021 05/04/02021
ⱽ COVID-19 05/04/02021 05/04/02021
ⱽ COVID-19 05/04/02021 05/04/02021
ⱽ COVID-19 05/04/02021 05/04/02021
ⱽ COVID-19 05/04/02021 05/04/02021
ⱽ COVID-19 05/04/02021 05/04/02021
ⱽ COVID-19 05/04/02021 05/04/02021
ⱽ COVID-19 05/04/02021 05/04/02021
ⱽ COVID-19 05/04/02021 05/04/02021
ⱽ COVID-19 05/04/02021 05/04/02021
ⱽ COVID-19 05/04/02021 05/04/02021
ⱽ COVID-19 05/04/02021 05/04/02021
ⱽ COVID-19 05/04/02021 05/04/02021
ⱽ COVID-19 05/04/02021 05/04/02021
ⱽ COVID-19 05/04/02021 05/04/02021
ⱽ COVID-19 05/04/02021 05/04/02021

Serang, 05-APRI
Pengelola Imunisasi (Penangg
ENDANG LESTAR
NIP.19840707 201
Dosis 2
Keterangan (Contoh :
Ditunda/ Dirujuk/
….........)
Tanggal
No Batch Pemberian No Batch
Imunisasi
19 20 21 22
24,000,821 DI VAKSIN
Serang, 05-APRIL-2021
Pengelola Imunisasi (Penanggungjawab Covid 19)
ENDANG LESTARI Amd.Keb

NIP.19840707 201704 2 001

Jadwal Dosis 2 Hari Senin 3 Mei 2021

Diunggah oleh

Informasi Dokumen

Hak Cipta

Format Tersedia

Bagikan dokumen Ini

Bagikan atau Tanam Dokumen

Opsi Berbagi

Apakah menurut Anda dokumen ini bermanfaat?

Apakah konten ini tidak pantas?

Hak Cipta:

Format Tersedia

Jadwal Dosis 2 Hari Senin 3 Mei 2021

Diunggah oleh

Hak Cipta:

Format Tersedia

Nama Puskesmas : KIBIN

No. No. Registrasi NIK Nama Penerima Vaksin Jenis Kelamin

2 S-B2D2274B 3604294108950004 MAMAY MAESAROH P

3 S-DB25B420 3604095812840001 KHOTIMAH P

4 S-747D68D 3604165006860005 SITI QOMARIYAH P

5 S-8084047C 3604165707940001 EEM NURHIKMAH P

7 S-D8D91E4C 3604165206890002 ROHAENI P

8 S-1B37BD42 3604164807990001 RANI SAPITRI P

9 P-P9CBF150 3604057009000001 POPON RUSLINDA P

10 S-16684BF6 3604164507670003 HJ.ULPAH P

11 S-B3018056 3604166606760001 LELI KHULISOH P

12 S-A9A2D1D 3604124504850006 SUHARIYAH P

13 S-91671FB0 3604160403600002 KEMIS L

14 S-77AD4ED9 3604156004910003 IDA LAELA P

15 S-65740090 3604110303670002 HASAN MAFTUHI L

16 P-P1FQ504 3604116203900001 ARUM RUMELA P

18 PDB3LPADS 3604164203780001 HAMAMAH P

19 S-1270E2DC 3604165503900003 LIA MUDRIKAH P

20 S-BB670A35 3604166112800002 SITI KOTIMAH P

21 S-5A813B3F 3604164206970003 SURYANAH P

22 S-473680A7 3604165660000003 SURYANTI P

23 S-4B96CB09 3604160609700001 MUHIJI L

24 S-4B96CB09 3604166007900003 MARIA MAGDALENA P

25 3604165812860001 MARIA PUSPITA P

26 S-EEEE823F 3604165610890001 KHUSNUL KHOTIMAH P

27 S-AF48EE73 3604126104000002 UMMY RIZQIYAH P

28 S-53E8A0BB 3604165502810001 RUSTINI P

29 S-459B380C 3604166510820002 IDA P

30 S-B301C700 3604165806690001 SALBIAH P

31 S-C4F5B7F2 3604167004850002 ROHANAWATI P

32 S-787D00EF 3604112603930002 DEDI WAHYUDI L

33 S-0EA898CE 3604160510670001 H.NURYASIN L

34 S-4A401332 3604164709660001 MARSINAH P

35 P-PHBFZ8H2 3524114202890002 ENDRIK SULISTIONINGSIH P

36 P-PHMVMBXA 3604016102010827 SINDI P

37 S-BF23BB8F 3604334409940001 VIKA FAWA P

38 S-D2ECDS3 3604165405920003 SUMIYATI DEWI ASTUTI P

39 S-FF1EE1F6 3604105807960454 ISTIQOMAH P

40 S-57BAD493 3604164111650001 NINING SUHANI P

41 S-9CE1F18E 3604166007000002 IQLIMA P

42 S-221ECDFC 3604165605740001 AMI SUHAEMI P

43 S-AC830654 3604175410940001 SITI KHUMAEROH P

GURU 26 KP.LINGK TURUS 02/02 PANANCANGAN 0838149424

GURU 36 PERUM.PURI TAMBAK BLOK A3 NO 15 081284139535

GURU 34 KP.NAGARA 01/01 DS. NAGARA 087772460717

GURU 26 KP.KEDALEMAN 03/02 DS KETOS 08962787554

GURU 55 KP.CIAGEL /081385372880

GURU 31 KP.CIWAJIK 05/02 DS KIBIN 083818520155

GURU 32 KP.CIWAJIK 05/02 DS KIBIN 088213584819

GURU 21 KP.WANASABA 01/01 DS.TOYO MERTO 087873973959

GURU KP.POS TAMBAK 01/01 DS TAMBAK 087809656208

GURU 43 KP.JEMPLING 03/04 DS. NAMBOILIR 085213835476

GURU 36 PERUM TAMBAK GEMILANG BOKB.9 NO 20 087775493070

GURU 58 KP.PASIR JAMBE 04/01 DS.NAMBOILIR 081287320943

GURU 40 KP.SAWO 18/03 DSJULANG CIKANDE 08951879783

GURU 54 KP.PABUARAN INDAH 04/04 KRAGILAN 081214330121

GURU 24 KP.CIGEUNG 02/01 DS.SOLEAR 085283230572

GURU 43 KP.OCIT 04/01 DS CIAGEL 083806753409

GURU 31 KP.LAES NAMBO 05/02 DS SUKAMAJU 089668609286

GURU 39 KP.JERING KIBIN 083890983752

GURU 27 KP.CIBUNGUR 12/03 DS CIAGEL 085888270373

GURU 21 KP.PAYA 09 /02 DS KETOS 083820290552

GURU 51 KP.CITENGENG 05/02 DS KIBIN 085201799036

GURU 24 KP.TALAGA 08/01 DS KIBIN