PEMERINTAH KABUPATEN BOGOR

DINAS KESEHATAN
PUSKESMAS CIANGSANA
Jalan KH. Rafei RT 02 RW 30 Desa Ciangsana Kecamatan Gunung Putri Kabupaten Bogor
Kode Pos 16968 Telp. (021) 84930448 Email:upfciangsana@gmail.com

LAPORAN IMUNISASI
BPM / KLINIK : RUMAH SEHAT CIKEAS
TAHUN:2023
BULAN:JULI
IMUNISASI
NAMA IBU /
NO NAMA TGL LAHIR UMUR NIK BB/TB HB.O BCG PENTABION POLIO IPV
BAPAK
1 2 3 1 2 3 4
1 jenaira 3/25/2023 4 bln fuji/heru 0003515252207 8,6/52 7/9/2023 7/9/2023
2 revalin 1/7/2023 8 bln finta/radit 3272027001939 10,4/65 7/9/2023 7/9/2023
3 ganesh 5/2/2023 2 bln saras/sugianto 3674071803830 4,8/50 7/9/2023 7/9/2023 7/9/2023
4 madinah 6/8/2023 1 bln kiki/akbar 3276080750023 3,8/49 7/9/2023 7/9/2023
5 algifari 5/9/2023 2 bln entin/edi 32010200905023 4,2/51 7/9/2023 7/9/2023
6 zihan okta 5/1/2023 2 bln iin/asep 32010201052300 5,0/51 7/9/2023 7/9/2023
7 pandhega 3/23/2023 4 bln sri/aris 3202065705930 8,4/52 7/10/2023 7/10/2023
8 viosya 2/25/2023 5 bln indri/rio 3201024906970 10,2/60 7/10/2023 7/10/2023
9 hawari 11/5/2022 8 bln andria/isma 320102001001 11,8/69 7/10/2023 7/10/2023
10 sean 11/2/2023 8 bln heti/amos 320102002112023 12,1/70 7/11/2023 7/11/2023
11 shanum 1/5/2023 5 bln ulfia/saiful 320102150102023 10,8/60
12 rasya 4/5/2023 3 bln ricka/irwan 20210201504020 4,7/49 7/21/2023 7/21/2023
13 yuna 6/2/2023 1 bln eriyana/abduloh 58358245865002 4,2/52 7/23/2023 7/23/2023
14 reyzan 6/7/2023 1 bln nanda/irfan 320207062023001 5,3/55 7/23/2023 7/23/2023
15 arjuna r 6/3/2023 1bln susi/rohim 320102030062300 4,0/51 7/23/2023 7/23/2023
16 mikhaila s 6/5/2023 1 bln mimin/andri 320102050602300 4,3/52 7/23/2023 7/23/2023
17 keenan a 6/2/2023 1 bln sri/toni 320102020602300 3,9/50 7/23/2023 7/23/2023
18 adzila h 4/8/2023 3 bln arfah/ari 3201010084023000 5,0/58
19 khanza 3/7/2023 4 bln hanin/musa 302102545200084 5,7/60 7/28/2023 7/28/2023
 BOSTER BOSTER
MR /
PCV PENTABION CAMPAK
CAMPAK
1 2 18-23 BLN 19-24 BLN

7/25/2023
7/28/2023

BOGOR,…...............
PENGIRIM LAPORAN

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