R1 Yankb

1.
Petugas Entri
Data
REGISTER PELAYANAN KB R/I/KB/20
Lembar 1
1 2 3 4 5 6
5 2 0 1 0 5 2 0 6 Bulan : 2023
NAMA FASKES/ POSKESDES KERU 7 8 V 10 11 12
:
JARINGAN/JEJARING Kode Provinsi Kode No. Register Faskes No. Jaringan/
Kabupaten/ Jejaring Faskes
Kota
PESERTA KB JENIS TINDAKAN Kasus PENGGUNAAN SUMBER ALOKON

(Kode) (Kode) ASURANSI
PELAYANAN BERGERAK
STATUS PESERTA KB
INFORMED CONSENT
PASCA KEGUGURAN
PASCA PERSALINAN
ISTRI
BPJS KESEHATAN
NO. TANGGAL ALAMAT NO. HANDPHONE
PEMASANGAN
PENCABUTAN
PENCABUTAN
KEGAGALAN
PEMBERIAN/
KOMPLIKASI
NAMA SUAMI
OPERATIF/
LAINNYA
TANGGAL
MANDIRI
NIK (NOMOR INDUK KEPENDUDUKAN) NAMA
BERAT
LAHIR
(Kode)
TIDAK
APBN
APBD
DAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
1 01-Sep-2023 SAHMIN 5 2 0 1 0 3 4 1 0 7 9 0 0 7 7 7 RAOHUNI 31-Jul-1979 SABA LENDANG 3 0 0 0 3 0 0 1 1 0 0 0
2 01-Sep-2023 SARIMAN 5 2 0 1 0 3 7 1 1 2 7 1 0 0 9 3 SARIMIN 31-Dec-1971 LEMBUAK TENGAH 3 0 0 0 3 1 0 0 1 0 0 0
1) Keterangan Kode
STATUS PESERTA KB KODE JENIS ALOKON (Diisi Pada Jenis Tindakan dan Kasus)
1 : Peserta KB Baru 3 : Peserta KB Ulangan 1 : Suntikan 1 Bulanan 3 : Suntikan 3 Bulanan 5 : Pil Progestin 7 : Implan 1 Batang 9 : IUD 11 : Tubektomi
2 : Peserta KB Ganti 4 : Komplikasi 2 : Suntikan 3 Bulanan 4 : Pil Kombinasi 6 : Kondom 8 : Implan 2 Batang 10 : Vasektomi
2) SELAIN STATUS PESERTA KB, JENIS TINDAKAN DAN KASUS DIISI TANDA CENTANG (V)
1. Petugas Entri Lamp.R/I/KB/20
Data LAMPIRAN R/I/KB/20 Lembar 2
1 2 3 4 5 6
5 2 0 1 0 5 2 0 6 Bulan : 2023
:
Kota
RINGKASAN HASIL PELAYANAN KB
PESERTA KB BARU (PB) PESERTA KB ULANGAN PELAYANAN KASUS
PEMBERIAN
PEMBERIAN INFORMED PB DAN KESERTAAN JKN INFORMED CONSENT
METODE
NO. CONSENT (Untuk Peserta KB
KONTRASEPSI
(Untuk PB) PB PASCA PB PASCA Ulangan) PELAYANAN ULANG KOMPLIKASI BERAT
GANTI CARA PENCABUTAN KEGAGALAN
PERSALINAN KEGUGURAN
PB JKN PB NON JKN TOTAL PB
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
2 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
3 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
4 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
5 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
6 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
7 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
8 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
9 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
10 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
11 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
12 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
13 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
14 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
15 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
16 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
17 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
18 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
19 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
20 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
21 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
22 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
JUMLAH 0 0 0 0 0 0 1 0 24 0 0 0
Lombok Barat , 09-October-2023

Pimpinan Faskes KB/Jaringan/Jejaring*
JUNAIDI, S.Kep
( .................................................................................................)
197304151992031007
NIP/NRP
* Coret yang tidak perlu
1. Petugas Entri
Data
Lembar 3
1 2 3 4 5 6
5 2 0 1 0 5 1 0 2 Bulan : 2023
NAMA FASKES/ POSKESDES BATU KUTA 7 8 V 10 11 12
:
Kota

PELAYANAN BERGERAK
STATUS PESERTA KB
INFORMED CONSENT
PASCA KEGUGURAN
PASCA PERSALINAN
ISTRI
BPJS KESEHATAN
PEMASANGAN
PENCABUTAN
PENCABUTAN
KEGAGALAN
PEMBERIAN/
KOMPLIKASI
NAMA SUAMI
OPERATIF/
LAINNYA
TANGGAL
MANDIRI
BERAT
LAHIR
(Kode)
TIDAK
APBN
APBD
DAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
3 01-Sep-2023 MAAD ADNAN 5 2 0 1 0 3 5 6 0 9 8 5 0 0 0 2 ZULBIDAYATI 16-Sep-1985 BATU KUTA PAROA 1 1 0 0 3 0 1 0 1 0 0 0
1) Keterangan Kode
1 2 3 4 5 6
5 2 0 1 0 5 1 0 2 Bulan : 2023
:
Kota
PEMBERIAN
METODE
KONTRASEPSI
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
2 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
3 SUNTIKAN 1 0 1 1 0 0 0 0 0 0 0
4 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
5 SUNTIKAN 1 0 1 1 0 0 0 0 0 0 0
6 IMPLAN 0 0 0 0 0 0 1 0 1 0 0
7 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
8 IMPLAN 1 1 0 1 1 0 0 0 0 0 0
9 IMPLAN 1 0 0 0 0 0 0 0 0 0 0
10 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
11 IMPLAN 1 0 1 1 1 0 0 0 0 0 0
12 PIL 0 0 0 0 0 0 0 0 1 0 0
13 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
14 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
15 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
16 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
17 SUNTIKAN 0 0 0 0 0 0 1 1 0 0 0
18 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
19 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
20 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
21 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
22 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
JUMLAH 13 2 5 7 2 0 32 1 35 0 0 0

Dr.I.Dewa Gede Ngurah Agung

( .................................................................................................)
196504281996031003
NIP/NRP
1. Petugas Entri
Data
Lembar 5
1 2 3 4 5 6
5 2 0 1 0 5 2 0 6 Bulan : 2023
:
Kota

PELAYANAN BERGERAK
STATUS PESERTA KB
INFORMED CONSENT
PASCA KEGUGURAN
PASCA PERSALINAN
ISTRI
BPJS KESEHATAN
PEMASANGAN
PENCABUTAN
PENCABUTAN
KEGAGALAN
PEMBERIAN/
KOMPLIKASI
NAMA SUAMI
OPERATIF/
LAINNYA
TANGGAL
MANDIRI
BERAT
LAHIR
(Kode)
TIDAK
APBN
APBD
DAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
4 01-Sep-2023 MUHAMMAD ZAIDUN 5 2 0 1 0 3 5 5 1 1 6 9 0 0 0 3 MARILAH 14-Nov-1959 SABA LENDANG 3 0 0 0 3 1 0 0 1 0 0 0
5 01-Sep-2023 MUHAIDI 5 2 0 1 0 3 4 1 0 5 8 2 0 0 0 5 NURUL HIDAYATI 01-Jun-1982 DARMASABA DASAN 1 3 0 0 0 3 0 0 1 1 0 0 1
1) Keterangan Kode
1 2 3 4 5 6
5 2 0 1 0 5 2 0 6 Bulan : 2023
:
Kota
PEMBERIAN
METODE
KONTRASEPSI
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
2 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
3 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
4 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
5 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
6 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
7 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
8 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
9 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
10 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
11 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
12 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
13 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
14 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
15 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
16 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
17 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
18 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
19 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
20 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
21 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
22 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
JUMLAH 0 0 0 0 0 0 1 0 24 0 0 0

JUNAIDI, S.Kep
( .................................................................................................)
197304151992031007
NIP/NRP
1. Petugas Entri
Data
Lembar 7
1 2 3 4 5 6
5 2 0 1 0 5 1 0 2 Bulan : 2023
:
Kota

PELAYANAN BERGERAK
STATUS PESERTA KB
INFORMED CONSENT
PASCA KEGUGURAN
PASCA PERSALINAN
ISTRI
BPJS KESEHATAN
PEMASANGAN
PENCABUTAN
PENCABUTAN
KEGAGALAN
PEMBERIAN/
KOMPLIKASI
NAMA SUAMI
OPERATIF/
LAINNYA
TANGGAL
MANDIRI
BERAT
LAHIR
(Kode)
TIDAK
APBN
APBD
DAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
6 01-Sep-2023 ABDUL HAFIZ 5 2 0 1 0 3 4 1 0 7 7 9 0 4 6 1 SALMIAH 01-Jul-1979 BATUKUTA LENTING 1 1 0 0 3 0 1 0 1 0 0 0
1) Keterangan Kode
1 2 3 4 5 6
5 2 0 1 0 5 1 0 2 Bulan : 2023
:
Kota
PEMBERIAN
METODE
KONTRASEPSI
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
2 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
3 SUNTIKAN 1 0 1 1 0 0 0 0 0 0 0
4 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
5 SUNTIKAN 1 0 1 1 0 0 0 0 0 0 0
6 IMPLAN 0 0 0 0 0 0 1 0 1 0 0
7 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
8 IMPLAN 1 1 0 1 1 0 0 0 0 0 0
9 IMPLAN 1 0 0 0 0 0 0 0 0 0 0
10 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
11 IMPLAN 1 0 1 1 1 0 0 0 0 0 0
12 PIL 0 0 0 0 0 0 0 0 1 0 0
13 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
14 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
15 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
16 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
17 SUNTIKAN 0 0 0 0 0 0 1 1 0 0 0
18 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
19 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
20 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
21 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
22 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
JUMLAH 13 2 5 7 2 0 32 1 35 0 0 0


( .................................................................................................)
196504281996031003
NIP/NRP
1. Petugas Entri
Data
Lembar 9
1 2 3 4 5 6
5 2 0 1 0 5 2 0 6 Bulan : 2023
:
Kota

PELAYANAN BERGERAK
STATUS PESERTA KB
INFORMED CONSENT
PASCA KEGUGURAN
PASCA PERSALINAN
ISTRI
BPJS KESEHATAN
PEMASANGAN
PENCABUTAN
PENCABUTAN
KEGAGALAN
PEMBERIAN/
KOMPLIKASI
NAMA SUAMI
OPERATIF/
LAINNYA
TANGGAL
MANDIRI
BERAT
LAHIR
(Kode)
TIDAK
APBN
APBD
DAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
7 01-Sep-2023 atin 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 INAQ MURNI 31-Dec-1945 DARMASABA 3 0 0 0 3 0 0 1 1 0 0 0
RAHMAN
8 01-Sep-2023 3 5 7 3 0 3 4 9 0 9 8 9 0 0 1 0 DIAN AYU PARAMITA 09-Sep-1989 DARMASABA 3 1 0 0 3 0 0 1 1 0 0 0
SUPENDING.ST
1) Keterangan Kode
1 2 3 4 5 6
5 2 0 1 0 5 2 0 6 Bulan : 2023
:
Kota
PEMBERIAN
METODE
KONTRASEPSI
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
2 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
3 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
4 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
5 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
6 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
7 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
8 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
9 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
10 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
11 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
12 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
13 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
14 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
15 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
16 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
17 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
18 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
19 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
20 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
21 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
22 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
JUMLAH 0 0 0 0 0 0 1 0 24 0 0 0

JUNAIDI, S.Kep
( .................................................................................................)
197304151992031007
NIP/NRP
1. Petugas Entri
Data
Lembar 11
1 2 3 4 5 6
5 2 0 1 0 5 1 0 2 Bulan : 2023
:
Kota

PELAYANAN BERGERAK
STATUS PESERTA KB
INFORMED CONSENT
PASCA KEGUGURAN
PASCA PERSALINAN
ISTRI
BPJS KESEHATAN
PEMASANGAN
PENCABUTAN
PENCABUTAN
KEGAGALAN
PEMBERIAN/
KOMPLIKASI
NAMA SUAMI
OPERATIF/
LAINNYA
TANGGAL
MANDIRI
BERAT
LAHIR
(Kode)
TIDAK
APBN
APBD
DAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
9 01-Sep-2023 roni rosidin 5 2 0 1 0 3 6 8 0 3 0 1 0 0 0 1 LUBNA AMALIA 28-Mar-2001 Dusun batukuta lenting 1 1 0 0 3 0 1 0 1 0 0 0
10 01-Sep-2023 ABDUL KASIM 5 2 0 1 0 3 4 1 0 7 8 3 0 4 4 9 SURYANI 01-Jul-1983 BATU KUTA UTARA 1 1 1 0 8 1 0 0 1 0 0 0
1) Keterangan Kode
1 2 3 4 5 6
5 2 0 1 0 5 1 0 2 Bulan : 2023
:
Kota
PEMBERIAN
METODE
KONTRASEPSI
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
2 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
3 SUNTIKAN 1 0 1 1 0 0 0 0 0 0 0
4 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
5 SUNTIKAN 1 0 1 1 0 0 0 0 0 0 0
6 IMPLAN 0 0 0 0 0 0 1 0 1 0 0
7 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
8 IMPLAN 1 1 0 1 1 0 0 0 0 0 0
9 IMPLAN 1 0 0 0 0 0 0 0 0 0 0
10 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
11 IMPLAN 1 0 1 1 1 0 0 0 0 0 0
12 PIL 0 0 0 0 0 0 0 0 1 0 0
13 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
14 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
15 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
16 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
17 SUNTIKAN 0 0 0 0 0 0 1 1 0 0 0
18 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
19 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
20 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
21 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
22 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
JUMLAH 13 2 5 7 2 0 32 1 35 0 0 0


( .................................................................................................)
196504281996031003
NIP/NRP
1. Petugas Entri
Data
Lembar 13
1 2 3 4 5 6
5 2 0 1 0 5 2 0 6 Bulan : 2023
:
Kota

PELAYANAN BERGERAK
STATUS PESERTA KB
INFORMED CONSENT
PASCA KEGUGURAN
PASCA PERSALINAN
ISTRI
BPJS KESEHATAN
PEMASANGAN
PENCABUTAN
PENCABUTAN
KEGAGALAN
PEMBERIAN/
KOMPLIKASI
NAMA SUAMI
OPERATIF/
LAINNYA
TANGGAL
MANDIRI
BERAT
LAHIR
(Kode)
TIDAK
APBN
APBD
DAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
11 01-Sep-2023 LALU JAMIL SAID 5 2 0 1 0 3 4 1 1 2 7 3 0 0 1 4 RUSNIATI 31-Dec-1973 DARMASABA 3 0 0 0 3 0 0 1 1 0 0 0
1) Keterangan Kode
1 2 3 4 5 6
5 2 0 1 0 5 2 0 6 Bulan : 2023
:
Kota
PEMBERIAN
METODE
KONTRASEPSI
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
2 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
3 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
4 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
5 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
6 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
7 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
8 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
9 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
10 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
11 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
12 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
13 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
14 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
15 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
16 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
17 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
18 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
19 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
20 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
21 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
22 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
JUMLAH 0 0 0 0 0 0 1 0 24 0 0 0

JUNAIDI, S.Kep
( .................................................................................................)
197304151992031007
NIP/NRP
1. Petugas Entri
Data
Lembar 15
1 2 3 4 5 6
5 2 0 1 0 5 1 0 2 Bulan : 2023
:
Kota

PELAYANAN BERGERAK
STATUS PESERTA KB
INFORMED CONSENT
PASCA KEGUGURAN
PASCA PERSALINAN
ISTRI
BPJS KESEHATAN
PEMASANGAN
PENCABUTAN
PENCABUTAN
KEGAGALAN
PEMBERIAN/
KOMPLIKASI
NAMA SUAMI
OPERATIF/
LAINNYA
TANGGAL
MANDIRI
BERAT
LAHIR
(Kode)
TIDAK
APBN
APBD
DAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
12 01-Sep-2023 SAEFUDIN ZOHRI 5 2 0 1 0 3 4 1 0 7 9 0 0 4 5 0 YUNIATIN FATRIANA 08-Aug-1990 BATU KUTA PAROA 1 1 1 0 8 0 1 0 1 0 0 0
13 01-Sep-2023 MUSLEHUDIN 5 2 0 1 0 3 4 1 0 7 7 9 0 4 5 7 HASANAH 01-Jul-1979 BATU KUTA PAROA 1 1 0 0 3 0 1 0 1 0 0 0
14 01-Sep-2023 AHMAD JAUHARI 5 2 0 1 0 3 5 4 1 0 7 9 0 0 0 1 SALMI 14-Oct-1979 BATU KUTA 3 1 0 0 3 0 1 0 1 0 0 0
1) Keterangan Kode
1 2 3 4 5 6
5 2 0 1 0 5 1 0 2 Bulan : 2023
:
Kota
PEMBERIAN
METODE
KONTRASEPSI
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
2 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
3 SUNTIKAN 1 0 1 1 0 0 0 0 0 0 0
4 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
5 SUNTIKAN 1 0 1 1 0 0 0 0 0 0 0
6 IMPLAN 0 0 0 0 0 0 1 0 1 0 0
7 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
8 IMPLAN 1 1 0 1 1 0 0 0 0 0 0
9 IMPLAN 1 0 0 0 0 0 0 0 0 0 0
10 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
11 IMPLAN 1 0 1 1 1 0 0 0 0 0 0
12 PIL 0 0 0 0 0 0 0 0 1 0 0
13 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
14 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
15 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
16 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
17 SUNTIKAN 0 0 0 0 0 0 1 1 0 0 0
18 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
19 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
20 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
21 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
22 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
JUMLAH 13 2 5 7 2 0 32 1 35 0 0 0


( .................................................................................................)
196504281996031003
NIP/NRP
1. Petugas Entri
Data
Lembar 17
1 2 3 4 5 6
5 2 0 1 0 5 2 0 6 Bulan : 2023
:
Kota

PELAYANAN BERGERAK
STATUS PESERTA KB
INFORMED CONSENT
PASCA KEGUGURAN
PASCA PERSALINAN
ISTRI
BPJS KESEHATAN
PEMASANGAN
PENCABUTAN
PENCABUTAN
KEGAGALAN
PEMBERIAN/
KOMPLIKASI
NAMA SUAMI
OPERATIF/
LAINNYA
TANGGAL
MANDIRI
BERAT
LAHIR
(Kode)
TIDAK
APBN
APBD
DAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
15 01-Sep-2023 NAJMUL AKHYAR 5 2 0 3 1 9 6 6 1 1 9 9 0 0 0 2 KHUSNUL KHOTIMAH A 26-Nov-1999 REPOK ATAS 3 0 0 0 3 0 0 1 1 0 0 0
16 01-Sep-2023 JUAN ASYURO' 5 2 0 1 1 2 6 4 0 2 9 7 0 0 0 2 HUSNUL HIDAYATI .SI. 26-Feb-1997 TANAK BEAK DASAN 3 0 0 0 3 0 0 1 1 0 0 0
MUHAMMAD
17 01-Sep-2023 5 2 0 1 0 3 5 7 0 5 8 2 0 0 0 1 MINAWATI 17-May-1982 DARMASABA 3 0 0 0 0 0 1 0 0 1 0
SULAEMAN
ROY ZULKARNAEN
18 01-Sep-2023 5 2 0 1 0 3 5 2 0 5 9 1 0 0 0 6 TITIK MARIANI 12-May-1991 DARMASABA 3 0 0 0 3 0 0 1 0 0 1 0
W
1) Keterangan Kode
1 2 3 4 5 6
5 2 0 1 0 5 2 0 6 Bulan : 2023
:
Kota
PEMBERIAN
METODE
KONTRASEPSI
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
2 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
3 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
4 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
5 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
6 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
7 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
8 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
9 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
10 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
11 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
12 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
13 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
14 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
15 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
16 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
17 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
18 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
19 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
20 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
21 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
22 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
JUMLAH 0 0 0 0 0 0 1 0 24 0 0 0

JUNAIDI, S.Kep
( .................................................................................................)
197304151992031007
NIP/NRP
1. Petugas Entri
Data
Lembar 19
1 2 3 4 5 6
5 2 0 1 0 5 1 0 2 Bulan : 2023
:
Kota

PELAYANAN BERGERAK
STATUS PESERTA KB
INFORMED CONSENT
PASCA KEGUGURAN
PASCA PERSALINAN
ISTRI
BPJS KESEHATAN
PEMASANGAN
PENCABUTAN
PENCABUTAN
KEGAGALAN
PEMBERIAN/
KOMPLIKASI
NAMA SUAMI
OPERATIF/
LAINNYA
TANGGAL
MANDIRI
BERAT
LAHIR
(Kode)
TIDAK
APBN
APBD
DAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
19 19-Sep-2023 DARWISAH 5 2 0 1 0 3 4 1 0 7 8 0 0 6 3 5 SUKIAH 01-Jul-1980 BATU KUTA LENTING 3 1 0 0 8 1 0 0 1 0 0 0
MAHMUDAH KHAERANI
20 23-Sep-2023 SAIFUDIN ZUHRI 5 2 0 1 0 3 6 1 1 0 8 3 0 0 0 1 21-Oct-1983 BATU KUTA PAROA 1 1 0 0 8 1 0 0 1 0 0 0
EF
1) Keterangan Kode
1 2 3 4 5 6
5 2 0 1 0 5 1 0 2 Bulan : 2023
:
Kota
PEMBERIAN
METODE
KONTRASEPSI
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
2 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
3 SUNTIKAN 1 0 1 1 0 0 0 0 0 0 0
4 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
5 SUNTIKAN 1 0 1 1 0 0 0 0 0 0 0
6 IMPLAN 0 0 0 0 0 0 1 0 1 0 0
7 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
8 IMPLAN 1 1 0 1 1 0 0 0 0 0 0
9 IMPLAN 1 0 0 0 0 0 0 0 0 0 0
10 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
11 IMPLAN 1 0 1 1 1 0 0 0 0 0 0
12 PIL 0 0 0 0 0 0 0 0 1 0 0
13 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
14 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
15 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
16 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
17 SUNTIKAN 0 0 0 0 0 0 1 1 0 0 0
18 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
19 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
20 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
21 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
22 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
JUMLAH 13 2 5 7 2 0 32 1 35 0 0 0


( .................................................................................................)
196504281996031003
NIP/NRP
1. Petugas Entri
Data
Lembar 21
1 2 3 4 5 6
5 2 0 1 0 5 1 1 3 Bulan : 2023
NAMA FASKES/ POSKESDES LEMBUAK 7 8 V 10 11 12
:
Kota

PELAYANAN BERGERAK
STATUS PESERTA KB
INFORMED CONSENT
PASCA KEGUGURAN
PASCA PERSALINAN
ISTRI
BPJS KESEHATAN
PEMASANGAN
PENCABUTAN
PENCABUTAN
KEGAGALAN
PEMBERIAN/
KOMPLIKASI
NAMA SUAMI
OPERATIF/
LAINNYA
TANGGAL
MANDIRI
BERAT
LAHIR
(Kode)
TIDAK
APBN
APBD
DAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
21 25-Sep-2023 M.HUSNUL HAMIDI 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 YENI SULAILI 12-Dec-1994 LEMBUAK MEKAR INDAH 3 1 0 0 3 1 0 0 1 0 0 0
22 25-Sep-2023 IMAM HARSALIM H. 5 2 7 1 0 5 6 8 0 9 8 8 0 0 0 1 YUTRI ISMARGAYU, SE 28-Sep-1988 LEMBUAK MEKAR INDAH 3 1 0 0 3 1 0 0 1 0 0 0
1) Keterangan Kode
1 2 3 4 5 6
5 2 0 1 0 5 1 1 3 Bulan : 2023
NAMA FASKES/ POSKESDES LEMBUAK 7 8 V 10 11 12
:
Kota
PEMBERIAN
METODE
KONTRASEPSI
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
2 IMPLAN 1 1 0 1 1 0 0 0 0 0 0
3 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
4 IMPLAN 1 1 0 1 1 0 0 0 0 0 0
5 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
6 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
7 IMPLAN 1 1 0 1 1 0 0 0 0 0 0
8 IUD 1 1 0 1 1 0 0 0 0 0 0
9 IUD 1 1 0 1 1 0 0 0 0 0 0
10 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
11 IUD 1 1 0 1 1 0 0 0 0 0 0
12 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
13 IMPLAN 1 1 0 1 1 0 0 0 0 0 0
14 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
15 IUD 0 0 0 0 0 0 1 1 0 0 0
16 IUD 1 1 0 1 1 0 0 0 0 0 0
17 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
18 IUD 1 1 0 1 1 0 0 0 0 0 0
19 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
20 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
21 IUD 0 0 0 0 0 0 1 0 1 0 0
22 IUD 1 1 0 1 1 0 0 0 0 0 0
JUMLAH 15 15 0 15 15 0 16 1 15 0 0 0


( .................................................................................................)
196504281996031003
NIP/NRP
1. Petugas Entri
Data
Lembar 23
1 2 3 4 5 6
5 2 0 1 0 5 2 0 4 Bulan : 2023
NAMA FASKES/ POSKESDES PERESAK 7 8 V 10 11 12
:
Kota

PELAYANAN BERGERAK
STATUS PESERTA KB
INFORMED CONSENT
PASCA KEGUGURAN
PASCA PERSALINAN
ISTRI
BPJS KESEHATAN
PEMASANGAN
PENCABUTAN
PENCABUTAN
KEGAGALAN
PEMBERIAN/
KOMPLIKASI
NAMA SUAMI
OPERATIF/
LAINNYA
TANGGAL
MANDIRI
BERAT
LAHIR
(Kode)
TIDAK
APBN
APBD
DAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
23 26-Sep-2023 SURDI 5 2 0 1 0 3 5 7 0 7 8 5 0 0 0 1 ROHANA 01-Jul-1985 TEBAO EAT 3 1 0 0 2 0 0 1 1 0 0 0
24 26-Sep-2023 DARWISAH 5 2 0 1 0 3 4 1 0 7 7 5 0 5 7 6 MARIANI 01-Jul-1975 TEBAO EAT 3 1 0 0 2 0 0 1 1 0 0 0
25 26-Sep-2023 HANDIAMUDIN 5 2 0 1 0 3 7 1 1 2 8 2 0 2 1 9 KHAIRIL UNIK 31-Dec-1982 TEBAO EAT 3 0 0 0 4 0 0 1 1 0 0 0
BAMBANG KARYONO
26 26-Sep-2023 5 2 0 1 0 3 4 1 0 3 8 1 0 0 0 1 SUFIATI ADNIAH SPD 01-Mar-1981 TEBAO EAT 3 1 0 0 2 0 0 1 1 0 0 0
SPDI
27 26-Sep-2023 MARDIAN HARIANTO 5 2 0 1 0 3 4 8 0 3 9 6 1 0 0 1 MEGA ISWANA 08-Mar-1996 TEBAO EAT 3 1 0 0 2 0 0 1 1 0 0 0
MONANDA ADE
28 26-Sep-2023 5 2 0 1 1 2 6 2 0 2 0 3 0 0 0 1 MUSTIKA SARI 22-Feb-2003 TEBAO EAT 3 1 0 0 2 0 0 1 1 0 0 0
PUTRA
29 26-Sep-2023 SALIHIN 5 2 0 1 0 3 4 1 0 7 7 9 0 0 8 0 NURLAELI 01-Jul-1979 TEBAO EAT 3 1 0 0 2 0 0 1 1 0 0 0
30 26-Sep-2023 HIRMAN 5 2 0 1 0 3 4 1 0 7 9 4 1 0 0 2 SUTAMI 01-Jul-1994 TEBAO EAT 3 1 0 0 2 0 0 1 1 0 0 0
31 26-Sep-2023 GUSMAN 5 2 0 1 0 3 7 1 1 2 7 3 0 0 6 3 RUSMAINI 31-Dec-1973 TEBAO EAT 3 1 0 0 2 0 0 1 1 0 0 0
32 26-Sep-2023 ZAINUDIN 5 2 0 1 0 3 4 3 0 5 9 7 1 0 0 1 MEIRINA WULANDARI 03-May-1997 TEBAO EAT 3 1 0 0 2 0 0 1 1 0 0 0
33 26-Sep-2023 PURWADI 5 2 0 1 0 3 7 1 1 2 9 4 0 0 3 4 DEWI YANTI 31-Dec-1995 TEBAO EAT 2 0 0 0 4 0 0 1 1 0 0 0
34 26-Sep-2023 SAHDAN 5 2 0 1 0 3 7 1 1 2 8 3 0 1 1 7 ISNAENI 31-Dec-1983 TEBAO EAT 3 1 0 0 2 0 0 1 1 0 0 0
35 26-Sep-2023 MUHLIADI 5 2 0 1 0 3 7 1 1 2 8 5 0 2 0 0 NINING SURIANTI 31-Dec-1985 TEBAO EAT 3 0 0 0 4 0 0 1 1 0 0 0
SURMANYADI
36 26-Sep-2023 5 2 0 1 0 3 6 6 1 2 9 6 0 0 0 3 NISWATUN AUDAH 26-Dec-1996 TEBAO EAT 3 1 0 0 2 0 0 1 1 0 0 0
SAFUTRA
37 26-Sep-2023 IRMAN 5 2 0 1 0 3 5 0 0 5 8 5 0 0 0 3 SUMIATI 01-May-1985 TEBAO EAT 3 1 0 0 2 0 0 1 1 0 0 0
38 26-Sep-2023 SAPII 5 2 0 1 0 3 5 8 0 6 8 9 0 0 0 1 HURIANIK 18-Jun-1989 TEBAO EAT 3 1 0 0 2 0 0 1 1 0 0 0
39 26-Sep-2023 SUKIRMAN 5 2 0 1 0 3 6 3 1 1 8 5 0 0 0 2 NURUL HIDAYAH 01-Jul-1985 TEBAO EAT 3 1 0 0 2 0 0 1 1 0 0 0
40 26-Sep-2023 TOHRI 5 2 0 1 0 3 4 1 0 7 7 5 0 4 9 6 HAERIAH 31-Dec-1974 TEBAO EAT 3 0 0 0 4 0 0 1 1 0 0 0
41 26-Sep-2023 SAHME 5 2 0 1 0 3 4 1 0 7 7 8 0 2 2 8 SAPII 01-Jul-1978 TEBAO EAT 3 1 0 0 2 0 0 1 1 0 0 0
42 26-Sep-2023 MURKI 5 2 0 1 0 3 6 7 0 7 8 5 0 0 0 5 MUSLEHANAH 27-Jul-1985 TEBAO EAT 3 1 0 0 2 0 0 1 1 0 0 0
43 26-Sep-2023 HARTAWAN 5 2 0 1 0 3 4 1 0 7 8 6 0 1 2 2 NURUL HIDAWATI 31-Dec-1986 TEBAO EAT 3 1 0 0 2 0 0 1 1 0 0 0
44 26-Sep-2023 YAHYA 5 2 0 1 0 3 7 1 1 2 7 6 0 0 3 5 MINIWATI 31-Dec-1976 TEBAO EAT 3 1 0 0 2 0 0 1 1 0 0 0
45 26-Sep-2023 SUKMAWADI 5 2 0 1 0 3 4 1 0 7 7 8 0 4 3 3 NURHIDAYATI 01-Jul-1978 TEBAO EAT 3 1 0 0 2 0 0 1 1 0 0 0
46 26-Sep-2023 M. JULIADI 5 2 7 1 0 2 4 5 0 2 9 5 0 0 0 4 SUPIANI 05-Feb-1995 TEBAO EAT 3 1 0 0 2 0 0 1 1 0 0 0
47 26-Sep-2023 SARMULIADI 5 2 0 1 0 3 7 1 1 2 8 5 0 1 7 4 MAHARANI 31-Dec-1985 TEBAO EAT 3 1 0 0 2 0 0 1 1 0 0 0
48 26-Sep-2023 SUKLIARDI 5 2 0 1 0 3 7 1 1 2 9 1 0 0 3 0 MARIANI 31-Dec-1991 TEBAO EAT, PERESAK, NARMADA 3 1 0 0 2 0 0 1 1 0 0 0
49 26-Sep-2023 HERMAN JAYADI 5 2 0 1 0 3 7 1 1 2 9 3 0 0 5 5 NURMAWATI 31-Dec-1993 TEBAO EAT 3 1 0 0 2 0 0 1 1 0 0 0

50 26-Sep-2023 RAHMAD 5 2 0 1 0 3 7 1 1 2 8 2 0 1 0 4 MISLEHANA 31-Dec-1982 TEBAO EAT 3 1 0 0 2 0 0 1 1 0 0 0
51 26-Sep-2023 HASAN NASRI 5 2 0 1 0 3 4 1 0 7 7 9 0 5 0 2 SOHRI 01-Jul-1979 TEBAO EAT 3 1 0 0 2 0 0 1 1 0 0 0
52 26-Sep-2023 MUZHARI, S.PD 5 2 0 1 0 3 5 8 0 8 9 2 0 0 0 5 ZOHRATUL AINI 18-Aug-1992 TEBAO EAT, PERESAK, NARMADA 3 1 0 0 2 0 0 1 1 0 0 0
53 26-Sep-2023 JUMADIL AWAL 5 2 0 1 0 3 7 1 1 0 9 5 0 0 0 2 NOVI SILVIA NINGSIH 31-Oct-1995 TEBAO EAT 3 1 0 0 2 0 0 1 1 0 0 0
54 26-Sep-2023 HURIANTO 5 2 0 1 0 3 7 1 1 2 8 1 0 1 5 9 NURHAYATI 31-Dec-1981 TEBAO EAT 3 1 0 0 2 0 0 1 1 0 0 0
55 26-Sep-2023 NASDI 5 2 0 1 0 3 4 6 0 5 9 1 1 0 0 1 HUSMA ELI 06-May-1991 TEBAO EAT 3 1 0 0 2 0 0 1 1 0 0 0
56 26-Sep-2023 RAISIN 5 2 0 1 0 3 4 1 0 7 7 4 0 0 5 9 DARWATI 01-Jul-1974 TEBAO EAT 3 1 0 0 2 0 0 1 1 0 0 0
57 26-Sep-2023 AHMAD SAHIRIN 5 2 0 1 0 3 4 1 0 7 7 8 0 2 2 9 USWATUN HASANAH 01-Jul-1978 TEBAO EAT 3 1 0 0 2 0 0 1 1 0 0 0
58 26-Sep-2023 MUHAMAD MAHFUZ 5 2 0 1 0 3 4 1 0 7 8 3 0 4 9 1 MARNI 01-Jul-1984 TEBAO EAT 3 1 0 0 2 0 0 1 1 0 0 0
59 26-Sep-2023 SUKRIADI 5 2 0 1 3 7 1 1 2 7 5 5 0 2 4 2 ROHANI 31-Dec-1975 TEBAO EAT 3 1 0 0 2 0 0 1 1 0 0 0
60 26-Sep-2023 RUSDI 5 2 0 1 0 3 4 6 0 3 7 7 1 0 0 1 UDIANAH 06-Mar-1977 TEBAO EAT 3 1 0 0 2 0 0 1 1 0 0 0
61 26-Sep-2023 SAHRI 5 2 0 1 0 3 4 1 0 7 7 8 0 4 5 4 IYAH 01-Jul-1978 TEBAO EAT,PERESAK ,NARMADA 3 1 0 0 2 0 0 1 1 0 0 0
62 26-Sep-2023 SAMSUL 5 2 0 1 0 3 6 1 0 4 9 3 0 0 0 2 NURUL SUSANTI 21-Apr-1998 TEBAO EAT,PERESAK,NARMADA 3 1 0 0 2 0 0 1 1 0 0 0
63 26-Sep-2023 HARPAN 5 2 0 1 0 3 4 1 0 7 8 5 0 6 1 5 NURHAYATI 01-Jul-1985 TEBAO EAT 3 1 0 0 2 0 0 1 1 0 0 0
64 26-Sep-2023 SULARDI 5 2 0 1 0 3 4 1 0 7 6 8 0 4 0 2 HURNIATI 31-Dec-1977 TEBAO EAT 3 1 0 0 2 0 0 1 1 0 0 0
65 26-Sep-2023 WIRMAN 5 2 0 1 0 3 5 0 0 6 6 2 0 0 0 4 SUKMAWATI 10-Jun-1982 TEBAO EAT 3 1 0 0 2 0 0 1 1 0 0 0
66 26-Sep-2023 SAPRI JULIANDI 5 2 0 2 0 8 5 0 0 3 9 9 0 0 0 3 MARSUNI 10-Mar-1999 TEBAO EAT 3 1 0 0 2 0 0 1 1 0 0 0
67 26-Sep-2023 RAHMAT SANTOSA 5 2 0 1 0 3 4 1 0 7 9 1 0 0 3 0 HERNAWATI 31-Dec-1988 TEBAO EAT, PERESAK, NARMADA 3 1 0 0 2 0 0 1 1 0 0 0
68 26-Sep-2023 SAHNUN 5 2 0 3 1 1 5 5 0 5 8 7 0 0 0 3 PURIAH 15-May-1987 TEBAO EAT 3 1 0 0 2 0 0 1 1 0 0 0
1) Keterangan Kode
1 2 3 4 5 6
5 2 0 1 0 5 2 0 4 Bulan : 2023
:
Kota
PEMBERIAN
METODE
KONTRASEPSI
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
2 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
3 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
4 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
5 PIL 0 0 0 0 0 0 0 0 1 0 0
6 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
7 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
8 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
9 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
10 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
11 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
12 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
13 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
14 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
15 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
16 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
17 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
18 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
19 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
20 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
21 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
22 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
JUMLAH 0 0 0 0 0 0 63 1 66 0 0 0

JUNAIDI, S. Kep
( .................................................................................................)
197304151992031007
NIP/NRP
1. Petugas Entri
Data
Lembar 26
1 2 3 4 5 6
5 2 0 1 0 5 2 Bulan : 2023
NAMA FASKES/ UPT BLUD PUSKESMAS SEDAU 7 8 V 10 11 12
:
Kota

PELAYANAN BERGERAK
STATUS PESERTA KB
INFORMED CONSENT
PASCA KEGUGURAN
PASCA PERSALINAN
ISTRI
BPJS KESEHATAN
PEMASANGAN
PENCABUTAN
PENCABUTAN
KEGAGALAN
PEMBERIAN/
KOMPLIKASI
NAMA SUAMI
OPERATIF/
LAINNYA
TANGGAL
MANDIRI
BERAT
LAHIR
(Kode)
TIDAK
APBN
APBD
DAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
69 26-Sep-2023 AHYAR JUNAEDI 5 2 0 1 0 3 7 1 1 2 8 4 0 1 7 7 SALMINI 31-Dec-1984 TANAK TEPONG UTARA 3 0 0 0 3 0 0 1 1 0 0 0
70 26-Sep-2023 MUJAHIDIN 0 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 ROSALINDA 23-Aug-2001 TANAK BEAK BARAT II 1 1 1 0 8 1 0 0 1 0 0 0
71 26-Sep-2023 JUNI HARDI 5 2 0 2 0 8 4 1 0 7 7 7 1 1 2 2 MURNIATI 01-Jul-1977 PEMEPEK2 3 0 0 0 3 0 0 1 1 0 0 0
72 26-Sep-2023 MUHAMMAD SAHDI 5 2 0 1 0 3 4 3 0 2 9 0 0 0 0 5 ASIAH 03-Feb-1990 REPOK ATAS 3 0 0 0 3 1 0 0 1 0 0 0
73 26-Sep-2023 AHMAT 5 2 0 2 0 8 6 8 0 4 8 6 0 0 0 3 TITIN NURIYANTI 28-Apr-1986 REPOK PIDENDANG 1 0 0 0 3 0 0 1 1 0 0 0
74 26-Sep-2023 I MADE PARSA 5 2 0 1 0 3 6 7 0 7 8 6 0 0 0 6 NI NENGAH PUTU ASTI 27-Jul-1985 DUSUN PENINJAUAN DESA GOLONG 3 0 0 0 3 0 0 1 1 0 0 0
75 26-Sep-2023 BUKHARI 5 2 0 1 0 3 4 1 0 7 8 6 0 0 6 0 TUTIK HARIANI 01-Jul-1986 DARMASABA 3 0 0 0 3 1 0 0 1 0 0 0
1) Keterangan Kode
1 2 3 4 5 6
5 2 0 1 0 5 2 Bulan : 2023
NAMA FASKES/ UPT BLUD PUSKESMAS SEDAU 7 8 V 10 11 12
:
Kota
PEMBERIAN
METODE
KONTRASEPSI
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 IMPLAN 1 1 0 1 1 0 0 0 0 0 0
2 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
3 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
4 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
5 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
6 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
7 SUNTIKAN 0 0 0 0 0 0 0 0 0 0 0
JUMLAH 1 1 0 1 1 0 0 0 5 0 0 0

JUNAIDI, S.Kep
( .................................................................................................)
197304151992031007
NIP/NRP
1. Petugas Entri
Data
Lembar 28
1 2 3 4 5 6
5 2 0 1 0 5 2 0 4 Bulan : 2023
:
Kota

PELAYANAN BERGERAK
STATUS PESERTA KB
INFORMED CONSENT
PASCA KEGUGURAN
PASCA PERSALINAN
ISTRI
BPJS KESEHATAN
PEMASANGAN
PENCABUTAN
PENCABUTAN
KEGAGALAN
PEMBERIAN/
KOMPLIKASI
NAMA SUAMI
OPERATIF/
LAINNYA
TANGGAL
MANDIRI
BERAT
LAHIR
(Kode)
TIDAK
APBN
APBD
DAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
76 26-Sep-2023 UKARDI 5 2 0 1 0 3 4 1 0 7 8 9 0 0 8 2 HAERIAH 01-Jul-1989 TEBAO EAT 3 1 0 0 2 0 0 1 1 0 0 0
77 26-Sep-2023 RAHIMAN 5 2 0 1 0 3 4 1 0 7 9 2 1 0 1 0 MARNI 01-Jul-1992 TEBAO EAT 3 1 0 0 2 0 0 1 1 0 0 0
78 26-Sep-2023 HUSRIN 5 2 0 1 0 3 5 2 0 2 8 6 0 0 0 7 SITI ANISAH 12-Feb-1986 TEBAO EAT 3 1 0 0 2 0 0 1 1 0 0 0
79 26-Sep-2023 PAHRUDIN 5 2 0 2 0 8 4 1 0 7 8 7 0 6 1 0 ROHINI 01-Jul-1987 TEBAO EAT 3 1 0 0 2 0 0 1 1 0 0 0
80 26-Sep-2023 SAHURUN 5 2 0 1 0 3 4 1 0 7 7 9 0 4 8 1 JOHAERIAH 01-Jul-1979 TEBAO EAT 3 1 0 0 2 0 0 1 1 0 0 0
81 26-Sep-2023 HASAN BASRI 5 2 0 1 0 3 7 1 1 2 7 7 0 0 6 7 ANISAH 31-Dec-1977 TEBAO EAT 3 1 0 0 2 0 0 1 1 0 0 0
82 26-Sep-2023 UMAR HARUN 5 2 0 1 0 3 4 1 0 7 7 7 0 7 7 7 AYATI 01-Jul-1977 TEBAO EAT 3 1 0 0 2 0 0 1 1 0 0 0
83 26-Sep-2023 KARDIMAN 5 2 0 1 0 3 4 1 0 7 7 7 0 3 1 0 INDRIWATI 01-Jul-1977 TEBAO EAT 3 1 0 0 2 0 0 1 1 0 0 0
84 26-Sep-2023 SUPIANDI 5 2 0 1 0 3 5 4 0 7 9 2 0 0 0 1 MISLEH 14-Jul-1992 TEBAO EAT 3 1 0 0 2 0 0 1 1 0 0 0
85 26-Sep-2023 MULIADI 5 2 0 1 0 3 4 8 0 8 9 2 0 0 0 4 ELMIYATI 08-Aug-1992 TEBAO EAT 3 1 0 0 2 0 0 1 1 0 0 0
86 26-Sep-2023 SUPANDI 5 2 0 1 0 3 4 1 0 7 8 9 0 0 0 4 SULISTIANINGSIH 01-Jul-1989 TEBAO EAT 3 1 0 0 2 0 0 1 1 0 0 0
87 26-Sep-2023 MULIAMAN DERIADI 5 2 0 1 1 0 3 5 1 2 9 2 0 0 0 5 SUMAENI 12-Dec-1992 TEBAO EAT 3 1 0 0 2 0 0 1 1 0 0 0
88 26-Sep-2023 SUKARDI 5 2 0 1 0 3 4 1 0 7 7 4 1 0 1 5 MANIYAH 01-Jul-1974 TEBAO EAT 3 1 0 0 2 0 0 1 1 0 0 0
89 26-Sep-2023 NURINAH 5 2 0 1 0 3 7 1 1 2 7 6 0 1 4 2 SUMIATI 31-Dec-1978 TEBAO EAT 3 1 0 0 2 0 0 1 1 0 0 0
90 26-Sep-2023 MAHYUDIN 5 2 0 1 0 3 4 5 0 8 8 2 0 0 0 3 NURHIDAYATI 05-Aug-1982 TEBAO EAT 3 1 0 0 2 0 0 1 1 0 0 0
91 26-Sep-2023 JUNAEDI 5 2 0 1 0 3 7 1 1 2 8 2 0 0 6 4 SRIATI 31-Dec-1982 TEBAO EAT 3 1 0 0 2 0 0 1 1 0 0 0
92 26-Sep-2023 NURISAH 5 2 0 1 0 3 4 1 0 7 8 7 0 6 7 5 MISNAWATI 01-Jul-1987 TEBAO EAT 3 1 0 0 2 0 0 1 1 0 0 0
93 26-Sep-2023 RUSDI 5 2 0 1 0 3 4 1 0 7 8 4 0 0 9 9 SUMAENI 01-Jul-1984 TEBAO EAT 3 1 0 0 2 0 0 1 1 0 0 0
MUHAMMAD
94 26-Sep-2023 5 2 0 1 0 3 4 1 0 7 7 9 0 4 7 0 SURIANAH 01-Jul-1979 TEBAO EAT 3 1 0 0 2 0 0 1 1 0 0 0
ROHANA
95 26-Sep-2023 HENDRA WAHYUDI 5 2 0 1 0 3 6 2 0 8 8 4 1 0 0 1 JOHRIATUN TOYIBAH 22-Aug-1984 TEBAO EAT 3 1 0 0 2 0 0 1 1 0 0 0
96 26-Sep-2023 WISNU SUPRATOMO 5 2 0 1 1 2 4 1 0 7 9 5 0 0 1 1 LINIA DEVI 20-Nov-1995 TEBAO EAT 3 1 0 0 2 0 0 1 1 0 0 0
1) Keterangan Kode
1 2 3 4 5 6
5 2 0 1 0 5 2 0 4 Bulan : 2023
:
Kota
PEMBERIAN
METODE
KONTRASEPSI
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
2 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
3 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
4 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
5 PIL 0 0 0 0 0 0 0 0 1 0 0
6 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
7 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
8 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
9 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
10 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
11 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
12 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
13 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
14 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
15 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
16 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
17 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
18 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
19 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
20 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
21 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
22 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
JUMLAH 0 0 0 0 0 0 63 1 66 0 0 0

JUNAIDI, S. Kep
( .................................................................................................)
197304151992031007
NIP/NRP
1. Petugas Entri
Data
Lembar 30
1 2 3 4 5 6
5 2 0 1 0 5 2 0 6 Bulan : 2023
:
Kota

PELAYANAN BERGERAK
STATUS PESERTA KB
INFORMED CONSENT
PASCA KEGUGURAN
PASCA PERSALINAN
ISTRI
BPJS KESEHATAN
PEMASANGAN
PENCABUTAN
PENCABUTAN
KEGAGALAN
PEMBERIAN/
KOMPLIKASI
NAMA SUAMI
OPERATIF/
LAINNYA
TANGGAL
MANDIRI
BERAT
LAHIR
(Kode)
TIDAK
APBN
APBD
DAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
97 27-Sep-2023 minah 5 2 0 1 0 3 0 1 7 6 5 0 0 5 3 2 SARUJI 01-Jul-1965 DARMASABA 3 0 0 0 3 0 0 1 1 0 0 1
1) Keterangan Kode
1 2 3 4 5 6
5 2 0 1 0 5 2 0 6 Bulan : 2023
:
Kota
PEMBERIAN
METODE
KONTRASEPSI
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
2 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
3 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
4 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
5 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
6 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
7 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
8 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
9 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
10 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
11 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
12 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
13 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
14 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
15 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
16 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
17 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
18 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
19 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
20 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
21 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
22 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
JUMLAH 0 0 0 0 0 0 1 0 24 0 0 0

JUNAIDI, S.Kep
( .................................................................................................)
197304151992031007
NIP/NRP
1. Petugas Entri
Data
Lembar 32
1 2 3 4 5 6
5 2 0 1 0 5 1 0 2 Bulan : 2023
:
Kota

PELAYANAN BERGERAK
STATUS PESERTA KB
INFORMED CONSENT
PASCA KEGUGURAN
PASCA PERSALINAN
ISTRI
BPJS KESEHATAN
PEMASANGAN
PENCABUTAN
PENCABUTAN
KEGAGALAN
PEMBERIAN/
KOMPLIKASI
NAMA SUAMI
OPERATIF/
LAINNYA
TANGGAL
MANDIRI
BERAT
LAHIR
(Kode)
TIDAK
APBN
APBD
DAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
98 27-Sep-2023 SAMSUL HADI 5 2 0 1 0 3 4 3 1 2 8 3 0 0 0 5 HUSNUL LAELA 03-Dec-1983 BATU KUTA PAROA 3 1 0 0 3 1 0 0 1 0 0 0
1) Keterangan Kode
1 2 3 4 5 6
5 2 0 1 0 5 1 0 2 Bulan : 2023
:
Kota
PEMBERIAN
METODE
KONTRASEPSI
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
2 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
3 SUNTIKAN 1 0 1 1 0 0 0 0 0 0 0
4 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
5 SUNTIKAN 1 0 1 1 0 0 0 0 0 0 0
6 IMPLAN 0 0 0 0 0 0 1 0 1 0 0
7 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
8 IMPLAN 1 1 0 1 1 0 0 0 0 0 0
9 IMPLAN 1 0 0 0 0 0 0 0 0 0 0
10 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
11 IMPLAN 1 0 1 1 1 0 0 0 0 0 0
12 PIL 0 0 0 0 0 0 0 0 1 0 0
13 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
14 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
15 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
16 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
17 SUNTIKAN 0 0 0 0 0 0 1 1 0 0 0
18 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
19 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
20 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
21 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
22 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
JUMLAH 13 2 5 7 2 0 32 1 35 0 0 0


( .................................................................................................)
196504281996031003
NIP/NRP
1. Petugas Entri
Data
Lembar 34
1 2 3 4 5 6
5 2 0 1 0 5 2 0 3 Bulan : 2023
NAMA FASKES/ POSKESDES GOLONG 7 8 V 10 11 12
:
Kota

PELAYANAN BERGERAK
STATUS PESERTA KB
INFORMED CONSENT
PASCA KEGUGURAN
PASCA PERSALINAN
ISTRI
BPJS KESEHATAN
PEMASANGAN
PENCABUTAN
PENCABUTAN
KEGAGALAN
PEMBERIAN/
KOMPLIKASI
NAMA SUAMI
OPERATIF/
LAINNYA
TANGGAL
MANDIRI
BERAT
LAHIR
(Kode)
TIDAK
APBN
APBD
DAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
99 27-Sep-2023 SUPRATMAN 5 2 0 1 0 3 6 1 0 7 8 7 0 0 0 8 ZAHRATUN HASANAH 21-Jul-1987 BANGKET PUNIK 3 1 0 0 3 0 0 1 1 0 0 0
100 27-Sep-2023 SUDIONO 5 2 0 1 0 3 4 1 0 7 7 7 0 3 9 1 JOHAERIAH 01-Jul-1977 BANGKET PUNIK 3 0 0 0 3 0 0 1 1 0 0 0
101 27-Sep-2023 DARWISAH 5 2 0 1 0 3 7 1 1 2 7 9 0 0 6 4 MISNAWATI 31-Dec-1979 TANAK BEAK DAYE 3 0 0 0 3 0 0 1 1 0 0 0
102 27-Sep-2023 JUMISAH 5 2 0 1 0 3 5 3 1 1 8 6 0 0 0 2 ERNA HIDAYATI 12-Nov-1986 BANGKET PUNIK 1 0 0 0 3 0 0 1 1 0 0 0
103 27-Sep-2023 AHMAD YANI 5 2 0 1 0 3 5 3 0 4 9 9 0 0 0 2 LINDAWATI 13-Apr-1999 BANGKET PUNIK 3 0 0 0 3 0 0 1 1 0 0 0
DUSUN KEBUN NYIUH DESA

104 27-Sep-2023 SUPIANDI 5 2 0 1 0 3 4 1 0 7 7 9 0 5 4 4 SAKNAH 01-Jul-1978 3 0 0 0 3 0 0 1 1 0 0 0
GOLONG KECAMATAN NARMADA
105 27-Sep-2023 DENDI FIRMAN 5 2 0 3 0 3 4 6 0 5 9 1 0 0 0 2 FITRIA HERAWATI 06-May-1991 BANGKET PUNIK 3 0 0 0 3 0 0 1 1 0 0 0
106 27-Sep-2023 DANI ARISTA 5 2 0 1 0 7 7 1 1 2 8 5 0 1 8 4 KURNIATI 31-Dec-1985 GOLONG 3 0 0 0 3 0 0 1 1 0 0 0
107 27-Sep-2023 PARMITA 5 2 0 1 0 3 7 1 1 2 7 6 0 2 2 3 AMINAH 31-Dec-1976 BANGKET PUNIK 3 0 0 0 3 0 0 1 1 0 0 0
108 27-Sep-2023 MUNADI 5 2 0 1 0 3 4 5 0 3 8 9 0 0 0 2 DEWI RAHMAWATI 05-Mar-1989 BANGKET PUNIK 3 0 0 0 3 0 0 1 1 0 0 0
109 27-Sep-2023 MUTTAADI 5 2 0 1 0 3 6 7 0 7 9 3 0 0 0 5 SURYATI 27-Jul-1993 BANGKET PUNIK 3 0 0 0 3 0 0 1 1 0 0 0
110 27-Sep-2023 AMAQ RUSDI 5 2 0 1 0 3 4 1 0 7 6 3 0 1 7 8 SAHRI 01-Jul-1953 BANGKET PUNIK 3 0 0 0 3 0 0 1 1 0 0 0
111 27-Sep-2023 SUPANDI 5 2 0 1 0 3 4 1 0 7 8 9 0 0 0 4 SULISTIANINGSIH 01-Jul-1989 TEBAO EAT 3 0 0 0 3 0 0 1 1 0 0 0
112 27-Sep-2023 MUNADI 5 2 0 1 0 3 7 1 1 2 8 4 0 1 7 6 RAKMAH 31-Dec-1984 LEMBUAK TENGAH 3 0 0 0 3 0 0 1 1 0 0 0
113 27-Sep-2023 RAHMAN 5 2 0 1 0 3 4 1 0 7 7 7 0 7 9 0 MAHNI 01-Jul-1977 BANGKET PUNIK 3 0 0 0 3 1 0 0 1 0 0 0
114 27-Sep-2023 HAMDANI 5 2 0 1 0 3 7 1 1 2 9 2 0 0 5 2 ZAHRATUL ANWARIYAH 31-Dec-1985 BANGKET PUNIK 3 0 0 0 3 0 0 1 1 0 0 0
1) Keterangan Kode
1 2 3 4 5 6
5 2 0 1 0 5 2 0 3 Bulan : 2023
NAMA FASKES/ POSKESDES GOLONG 7 8 V 10 11 12
:
Kota
PEMBERIAN
METODE
KONTRASEPSI
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
2 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
3 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
4 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
5 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
6 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
7 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
8 SUNTIKAN 0 0 0 0 0 0 0 0 0 0 0
9 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
10 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
11 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
12 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
13 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
14 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
15 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
16 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
JUMLAH 0 0 0 0 0 0 1 0 15 0 0 0

JUNAIDI, S.Kep
( .................................................................................................)
197304151992031007
NIP/NRP
1. Petugas Entri
Data
Lembar 36
1 2 3 4 5 6
5 2 0 1 0 5 2 0 5 Bulan : 2023
NAMA FASKES/ POSKESDES SEDAU 7 8 V 10 11 12
:
Kota

PELAYANAN BERGERAK
STATUS PESERTA KB
INFORMED CONSENT
PASCA KEGUGURAN
PASCA PERSALINAN
ISTRI
BPJS KESEHATAN
PEMASANGAN
PENCABUTAN
PENCABUTAN
KEGAGALAN
PEMBERIAN/
KOMPLIKASI
NAMA SUAMI
OPERATIF/
LAINNYA
TANGGAL
MANDIRI
BERAT
LAHIR
(Kode)
TIDAK
APBN
APBD
DAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
115 27-Sep-2023 SAHNAN 5 2 0 1 0 3 7 1 1 2 8 0 0 0 8 9 RUSNIATI 31-Dec-1980 EYAT BINTANG SEDAU NARMADA 3 1 0 0 3 0 0 1 1 0 0 0
SEDAUDESE SEDAU NARMADA

116 27-Sep-2023 DENI SUPRIADI 5 2 0 2 1 2 6 8 0 6 0 4 0 0 0 2 YULIANA SAFITRI 28-Jun-2004 3 1 0 0 3 0 0 1 1 0 0 0
LOBAR
SEDAU DESE SEDAU NARMADA
117 27-Sep-2023 WISNU 5 2 0 1 0 3 4 1 0 7 7 2 0 5 9 7 INAH 01-Jul-1978 3 1 0 0 3 0 0 1 1 0 0 0
LOBAR
118 27-Sep-2023 Saputra 5 2 0 3 2 0 4 2 1 2 8 6 0 0 0 1 ANI 02-Dec-1986 3 1 0 0 3 0 0 1 1 0 0 0
LOBAR
119 27-Sep-2023 ASDIANTO 5 2 0 1 0 3 6 8 0 7 9 7 1 0 0 1 WILLYA ANNISA 28-Jul-1997 3 1 0 0 3 0 0 1 1 0 0 0
LOBAR
SEDAI DESE SESAU NARMADA
120 27-Sep-2023 MUHAMMMAD DAHLI 5 2 0 2 1 0 5 7 0 5 9 1 0 0 0 1 SUHARNI 17-May-1991 3 1 0 0 3 0 0 1 1 0 0 0
LOBAR
121 27-Sep-2023 Riadi 5 2 0 1 0 3 0 1 0 7 6 7 0 4 3 5 ASIM 03-Feb-1973 3 1 0 0 3 0 0 1 1 0 0 0
LOBAR
122 27-Sep-2023 LAMIANTO 5 2 0 2 0 8 5 0 0 4 0 3 0 0 0 2 WINDA WIDIAWATI 10-Apr-2003 3 1 0 0 3 0 0 1 1 0 0 0
LOBAR
SEDAU DESE,SEDAU,NARMADA,
123 27-Sep-2023 UDE 5 2 0 1 0 3 4 1 0 7 6 0 0 2 3 4 GINET 01-Jul-1960 3 1 0 0 3 0 0 1 1 0 0 0
LOBAR
DUSUN SEDAU DESE DESA SEDAU
124 27-Sep-2023 MURDANI 5 2 0 1 0 3 5 0 1 2 8 7 0 0 0 2 SITI HAJAR 10-Dec-1987 3 1 0 0 3 0 0 1 1 0 0 0
KEC.NARMADA KAB.LOBA
125 27-Sep-2023 SANI 5 2 0 1 0 3 4 1 0 7 8 7 0 5 3 7 IDAH 02-Jul-1987 3 1 0 0 3 0 0 1 1 0 0 0
LOBAR
126 27-Sep-2023 DODI ASRIL 5 2 0 2 0 8 5 3 0 6 0 3 0 0 0 1 ROSITA 13-Jun-2003 SEDAU DESE SEDAU NARMADA 3 1 0 0 3 0 0 1 1 0 0 0

127 27-Sep-2023 JUMENIM 5 2 0 1 0 3 4 1 0 7 7 4 0 0 1 5 MAHNIM 01-Jul-1974 3 1 0 0 3 0 0 1 1 0 0 0
LOBAR
128 27-Sep-2023 AMAK MURNAH 5 2 0 1 0 3 4 1 0 7 7 1 0 0 1 3 INAK MURNAH 01-Jul-1971 3 1 0 0 3 0 0 1 1 0 0 0
LOBAR
129 27-Sep-2023 Usman 5 2 0 1 0 3 0 1 0 7 5 8 0 1 3 9 SEMAN 01-Jul-1958 3 1 0 0 8 0 0 1 1 0 0 0
LOBAR
130 27-Sep-2023 AMAQ MARINAH 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 INAQ MARINAH 05-Jun-1963 3 1 0 0 3 0 0 1 1 0 0 0
LOBAR
SEDAU DESA,SEDAU,NARMADA,
131 27-Sep-2023 JULIADI 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 ROSIDA 12-Jul-1998 3 1 0 0 3 0 0 1 1 0 0 0
LOBAR
SEDAI DESE SEDAU NARMADA
132 27-Sep-2023 SAINAH 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 INAQ ILAH 01-Jul-1958 3 1 0 0 3 0 0 1 1 0 0 0
LOBAR
133 27-Sep-2023 SAHRAM 5 2 0 1 0 3 4 1 0 7 8 9 0 0 2 9 NURME 01-Jul-1989 3 1 0 0 3 0 0 1 1 0 0 0
LOBAR
134 27-Sep-2023 SAIDIN 5 2 0 1 0 3 4 1 0 7 8 7 0 0 0 6 ANISWA HIDAYATI 05-Jun-1995 3 1 0 0 3 0 0 1 1 0 0 0
LOBAR
135 27-Sep-2023 JUNARDI 5 2 0 1 0 3 5 2 1 2 9 1 0 0 0 1 FAHRIANA 12-Dec-1991 3 1 0 0 3 0 0 1 1 0 0 0
LOBAR
136 27-Sep-2023 ARIFIN 5 2 0 1 0 3 4 1 0 7 6 5 0 2 8 0 MURNI 01-Jul-1965 3 1 0 0 3 0 0 1 1 0 0 0
LOBAR
137 27-Sep-2023 IRAWAN 5 2 0 1 0 7 4 1 0 7 8 7 0 1 8 7 SANTI 01-Jul-1987 3 1 0 0 3 0 0 1 1 0 0 0
LOBAR
138 27-Sep-2023 SAHMAN 5 2 0 1 0 3 4 1 0 1 9 9 0 0 0 2 RINI AYU ANTARI 01-Jan-1999 3 1 0 0 3 0 0 1 1 0 0 0
LOBAR
SEDSU DESE SEDAU NARMADA
139 27-Sep-2023 Sapute 5 2 0 1 0 3 3 0 0 6 7 2 1 0 0 1 BIKAN 30-Aug-1972 3 1 0 0 3 0 0 1 1 0 0 0
LOBAR
SEDAU DESE,SEDAU NARMADA,
140 27-Sep-2023 Hasan 5 2 0 1 0 3 4 1 0 7 7 0 0 4 3 3 SAMINAH 30-Dec-1970 3 1 0 0 3 0 0 1 1 0 0 0
LOBAR
141 27-Sep-2023 HASAN BASRI 5 2 0 1 0 3 4 1 0 7 8 7 0 5 6 0 SAHARAWATI 01-Jul-1985 3 1 0 0 3 0 0 1 1 0 0 0
LOBAR
SEDAU DESE,SEDSU,NARMADA,
142 27-Sep-2023 JOHAN HARTARTO 5 2 0 1 0 3 7 1 1 2 9 6 0 0 1 6 SUSILAWATI 31-Dec-1996 3 1 0 0 3 0 0 1 1 0 0 0
LOBAR
143 27-Sep-2023 Wan 5 2 0 1 0 3 4 1 0 7 6 0 0 3 0 5 SAIMAH 01-Jul-1960 3 1 0 0 3 0 0 1 1 0 0 0
LOBAR
144 27-Sep-2023 IKHSAN 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 WINDA 08-Dec-2004 3 1 0 0 3 0 0 1 1 0 0 0
LOBAR
145 27-Sep-2023 AMAK LISAH 5 2 0 1 0 3 4 1 0 7 5 6 0 0 7 8 RAWITI 01-Jul-1956 3 1 0 0 3 0 0 1 1 0 0 0
LOBAR
146 27-Sep-2023 NURSAH 5 2 0 1 0 3 4 1 0 7 7 0 0 4 3 5 SERINAH 30-Jun-1970 3 1 0 0 3 0 0 1 1 0 0 0
LOBAR
147 27-Sep-2023 SAINUDI 5 2 0 1 0 3 4 1 0 7 7 2 0 5 6 2 SUTIAH 30-Jun-1975 3 1 0 0 3 0 0 1 1 0 0 0
LOBAR
DUSUN SEDAU DESE DESA SEDAU
148 27-Sep-2023 Irwan 5 2 0 1 0 3 0 1 0 7 6 6 0 0 3 1 AWAN 01-Jul-1966 3 1 0 0 3 0 0 1 1 0 0 0
KEC. NARMADA KAB. LOBAR
149 27-Sep-2023 HERI SETIAWAN 5 2 0 1 1 2 4 1 0 7 9 9 0 3 0 9 LIDIA OKTAFIANA 01-Jul-1999 3 1 0 0 3 0 0 1 1 0 0 0
LOBAR
SEDAU DESE,SEDAU,NARMADA
150 27-Sep-2023 MULIADI 5 2 0 1 0 3 4 1 0 7 9 2 0 0 2 6 USWATUN HASANAH 01-Jul-1992 3 1 0 0 3 0 0 1 1 0 0 0
LOBAR
151 27-Sep-2023 IMAN 5 2 0 1 0 3 4 1 0 7 8 5 8 5 3 7 SUMIATI 01-Jul-1988 3 1 0 0 3 0 0 1 1 0 0 0
LOBAR
SADRI USMAN SEDAU DESE SEDAU NARMADA
152 27-Sep-2023 5 2 0 1 0 6 0 9 0 5 9 2 0 0 0 3 SRI HAYATI 09-May-1992 3 1 0 0 3 0 0 1 1 0 0 0
JAYADI LOBAR
153 27-Sep-2023 SUDIANTO 5 2 0 2 0 2 4 7 0 6 9 5 0 0 0 3 ZAITUN IKHLAS 07-Jul-1996 3 1 0 0 3 0 0 1 1 0 0 0
LOBAR
154 27-Sep-2023 SUDIARTE 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 MISKIAH 01-Jul-1979 SEDAU DESE SEDAU NARMADA 3 1 0 0 3 0 0 1 1 0 0 0
SEDAI DESE SEDAU NARMADA

155 27-Sep-2023 MURNE 5 2 0 1 0 3 0 1 0 7 8 9 0 3 9 6 KARNIWATI 01-Jul-1989 3 1 0 0 3 0 0 1 1 0 0 0
LOBAR
156 27-Sep-2023 Asim 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 IJAH 01-Jul-1962 3 1 0 0 3 0 0 1 1 0 0 0
LOBAR
157 27-Sep-2023 HAERIL ANWAR 5 2 0 1 0 3 7 1 1 2 9 4 1 0 0 3 ERNA 31-Dec-1994 3 1 0 0 3 0 0 1 1 0 0 0
LOBAR
SEDAU DESR SEDAU NARMADA
158 27-Sep-2023 AHMAD RIADI 5 2 0 1 0 3 4 1 0 7 0 4 0 2 2 1 DIAN SUSILA 14-Mar-2003 3 1 0 0 3 0 0 1 1 0 0 0
LOBAR
159 27-Sep-2023 RENE 5 2 0 1 0 3 4 1 0 7 8 9 1 0 1 0 INI 01-Jul-1980 3 1 0 0 3 0 0 1 1 0 0 0
LOBAR
160 27-Sep-2023 ALAMUDIN 5 2 0 2 0 8 4 1 0 7 9 1 0 1 7 6 HURNI 01-Jul-1991 3 1 0 0 3 0 0 1 1 0 0 0
LOBAR
161 27-Sep-2023 SAHDAN 5 2 0 1 0 3 4 1 0 7 7 0 0 4 7 6 RUMISAH 01-Jul-1970 3 1 0 0 3 0 0 1 1 0 0 0
LOBAR
162 27-Sep-2023 AYUNE BUDIMAN 5 2 0 1 0 3 4 1 0 7 8 2 0 5 6 7 NOVIA YULIAWATI 02-Aug-1992 3 1 0 0 3 0 0 1 1 0 0 0
LOBAR
163 27-Sep-2023 HERMANTO 5 2 0 1 0 3 4 5 0 3 7 9 0 0 0 1 NURHASANAH 05-Mar-1979 SEDAU GONDANG 3 1 0 0 3 0 0 1 1 0 0 0

164 27-Sep-2023 HERMANTIO 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 ERLIATIK 11-Dec-2002 3 1 0 0 3 0 0 1 1 0 0 0
LOBRAR
165 27-Sep-2023 MURDIANTO 5 2 0 1 0 3 7 1 1 2 9 5 0 0 2 7 ERNA NOPIANA 31-Dec-1998 3 1 0 0 3 0 0 1 1 0 0 0
LOBAR
1) Keterangan Kode
1 2 3 4 5 6
5 2 0 1 0 5 2 0 5 Bulan : 2023
NAMA FASKES/ POSKESDES SEDAU 7 8 V 10 11 12
:
Kota
PEMBERIAN
METODE
KONTRASEPSI
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 IMPLAN 0 0 0 0 0 0 1 0 1 0 0
2 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
3 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
4 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
5 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
6 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
7 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
8 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
9 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
10 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
11 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
12 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
13 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
14 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
15 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
16 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
17 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
18 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
19 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
20 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
21 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
22 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
JUMLAH 0 0 0 0 0 0 51 0 51 0 0 0

JUNAIDI, S.Kep
( .................................................................................................)
197304151992031007
NIP/NRP
1. Petugas Entri
Data
Lembar 39
1 2 3 4 5 6
5 2 0 1 0 5 2 0 6 Bulan : 2023
:
Kota

PELAYANAN BERGERAK
STATUS PESERTA KB
INFORMED CONSENT
PASCA KEGUGURAN
PASCA PERSALINAN
ISTRI
BPJS KESEHATAN
PEMASANGAN
PENCABUTAN
PENCABUTAN
KEGAGALAN
PEMBERIAN/
KOMPLIKASI
NAMA SUAMI
OPERATIF/
LAINNYA
TANGGAL
MANDIRI
BERAT
LAHIR
(Kode)
TIDAK
APBN
APBD
DAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
166 27-Sep-2023 SARME 5 2 0 1 0 3 4 1 0 7 7 7 0 7 6 5 SALMAH 01-Jul-1977 GONDANG 3 0 0 0 3 0 0 1 0 0 1 0
167 27-Sep-2023 USMAN JAYADI 5 2 0 2 0 8 4 1 0 7 8 8 0 2 4 0 NURHAYATI 01-Jul-1988 REPOK ATAS 3 0 0 0 3 0 0 1 1 0 0 0
168 27-Sep-2023 WINARNO SUYADI 5 2 0 1 0 3 5 2 0 9 9 5 0 0 0 8 RISTIKAYANTI 10-Jul-1994 DARMASABA 3 0 0 0 3 1 0 0 1 0 0 0
FARID HAJIRI M.TR.

169 27-Sep-2023 5 2 0 3 0 7 6 5 0 2 9 2 0 0 0 1 NURLAELY WARDANI 25-Feb-1992 DARMASABA 3 0 0 0 3 0 0 1 1 0 0 0
KP
MUHAMMAD
170 27-Sep-2023 5 2 0 1 0 3 5 7 0 5 8 2 0 0 0 1 MINAWATI 17-May-1982 DARMASABA 3 0 0 0 3 0 0 1 1 0 0 0
SULAEMAN
171 27-Sep-2023 SANUDIN SPD 5 2 0 1 0 3 4 3 1 2 7 6 0 0 0 2 SENI SUSILAWATI SPD 03-Dec-1976 SABA LENDANG 3 0 0 0 3 0 0 1 1 0 0 0
RAHMAN
172 27-Sep-2023 3 5 7 3 0 3 4 9 0 9 8 9 0 0 1 0 DIAN AYU PARAMITA 09-Sep-1989 DARMASABA 3 0 0 0 3 0 0 1 1 0 0 0
SUPENDING.ST
RAHMAN
173 27-Sep-2023 5 2 0 1 0 2 4 1 0 7 9 4 0 2 8 0 DEBI INDAH YULIANA 12-Sep-1994 LEMBUAK BARAT 3 0 0 0 3 0 0 1 1 0 0 0
MIRSAHUDIN
174 27-Sep-2023 ARSI 5 2 0 1 0 3 3 0 1 2 8 2 0 0 0 1 MARHAENI 22-Sep-1966 DARMASABA 3 0 0 0 0 0 1 1 0 0 0
175 27-Sep-2023 m nasir 5 2 0 1 0 3 0 1 0 7 7 2 0 4 3 4 REME 01-Jul-1972 DARMASABA DASAN 3 0 0 0 3 0 0 1 1 0 0 1
176 27-Sep-2023 SUYANTO SPD 5 2 0 1 0 3 7 1 1 2 6 1 0 0 8 3 ATMI PURWIATI 13-Dec-1961 DARMASABA 3 0 0 0 3 0 0 1 1 0 0 0
177 27-Sep-2023 MUHIDI 5 2 0 1 0 3 4 1 0 7 5 3 0 0 9 3 I JUMARI 20-May-1954 DARMASABA 3 0 0 0 3 0 0 1 1 0 0 0
1) Keterangan Kode
1 2 3 4 5 6
5 2 0 1 0 5 2 0 6 Bulan : 2023
:
Kota
PEMBERIAN
METODE
KONTRASEPSI
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
2 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
3 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
4 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
5 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
6 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
7 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
8 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
9 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
10 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
11 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
12 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
13 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
14 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
15 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
16 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
17 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
18 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
19 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
20 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
21 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
22 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
JUMLAH 0 0 0 0 0 0 1 0 24 0 0 0

JUNAIDI, S.Kep
( .................................................................................................)
197304151992031007
NIP/NRP
1. Petugas Entri
Data
Lembar 41
1 2 3 4 5 6
5 2 0 1 0 5 1 0 2 Bulan : 2023
:
Kota

PELAYANAN BERGERAK
STATUS PESERTA KB
INFORMED CONSENT
PASCA KEGUGURAN
PASCA PERSALINAN
ISTRI
BPJS KESEHATAN
PEMASANGAN
PENCABUTAN
PENCABUTAN
KEGAGALAN
PEMBERIAN/
KOMPLIKASI
NAMA SUAMI
OPERATIF/
LAINNYA
TANGGAL
MANDIRI
BERAT
LAHIR
(Kode)
TIDAK
APBN
APBD
DAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
AKHMAD MIRA
178 29-Sep-2023 5 2 0 1 0 3 5 2 1 2 8 1 0 0 0 3 ELY FATMAWATI 12-Dec-1981 BATU KUTA PAROA 3 1 0 0 3 0 0 1 1 0 0 0
ISLAHUDI
179 29-Sep-2023 HENDRA HARIANTO 5 2 0 1 0 3 5 9 1 0 9 1 0 0 0 4 HERVINA YANI 19-Oct-1991 BATU KUTA PAROA 3 1 0 0 3 0 0 1 1 0 0 0
180 29-Sep-2023 TONI HARTONO 5 2 0 1 0 3 7 1 1 2 9 1 1 0 1 4 IRMA YANTI 31-Dec-1991 BATU KUTA PAROA 3 0 0 0 4 0 0 1 1 0 0 0
181 29-Sep-2023 ASPUL KAIYADI 5 2 0 1 0 3 4 2 0 1 8 6 0 0 0 2 DEWI YUSMANITA 05-Apr-1986 BATU KUTA PAROA 3 0 0 0 4 0 0 1 1 0 0 0
182 29-Sep-2023 AS HARTONO 5 2 0 1 0 3 6 4 1 2 9 7 0 0 0 1 ELI RISTIANA 24-Dec-1997 BATU KUTA PAROA 3 1 0 0 3 0 0 1 1 0 0 0
183 29-Sep-2023 IWAN SANTOSO 5 2 0 1 0 3 6 8 0 7 7 9 0 0 0 1 ZOHRIANA 28-Jul-1979 BATU KUTA PAROA 3 1 0 0 3 0 0 1 1 0 0 0
184 29-Sep-2023 ISWADI 5 2 0 1 0 3 5 5 0 6 8 7 0 0 0 8 SITI ZULAIHA 15-Jun-1987 BATU KUTA PAROA 3 1 0 0 3 0 0 1 1 0 0 0
185 29-Sep-2023 KAMARUL 5 2 0 1 0 3 7 1 1 2 7 5 0 3 1 9 NURLAELA ASSURAK 31-Dec-1975 BATU KUTA PAROA 3 0 0 0 4 0 0 1 1 0 0 0
186 29-Sep-2023 SAMSUL HADI 5 2 0 1 0 3 4 3 1 2 8 3 0 0 0 5 HUSNUL LAELA 03-Dec-1983 BATU KUTA PAROA 3 1 0 0 3 0 0 1 1 0 0 0
187 29-Sep-2023 ANDRE SETIAWAN 5 2 0 1 1 2 4 4 0 7 0 0 0 0 0 1 MELAELATUL JANNAH 04-Jul-2000 BATU KUTA PAROA 3 1 0 0 3 0 0 1 1 0 0 0
188 29-Sep-2023 SUSANTO 5 2 0 1 0 3 6 0 0 5 9 2 0 0 0 2 WAHYUNI AMD 20-May-1992 BATU KUTA PAROA 3 1 0 0 3 0 0 1 1 0 0 0
189 29-Sep-2023 ABDU HADI 5 2 0 1 0 3 6 4 0 4 8 7 0 0 0 1 ROHANA FATIMAH 24-Apr-1987 BATU KUTA PAROA 3 1 0 0 3 0 0 1 1 0 0 0
ARIF FIRMANSYAH S HERA PARLINA WAHIDA

190 29-Sep-2023 5 2 0 1 0 3 5 0 0 6 9 0 0 0 0 1 10-Jun-1990 BATU KUTA PAROA 3 1 0 0 3 0 0 1 1 0 0 0
SI SPD
191 29-Sep-2023 ABIDIN 5 2 0 1 0 3 6 1 0 6 7 5 0 0 0 3 SUCIATI NINGSIH 21-Jun-1975 BATU KUTA PAROA 3 1 0 0 3 0 0 1 1 0 0 0
192 29-Sep-2023 HERI SETIAWAN 5 2 0 2 0 7 1 1 2 9 0 0 0 0 0 8 REHANIAH 30-Dec-1990 BATU KUTA PAROA 3 0 0 0 4 0 0 1 1 0 0 0
193 29-Sep-2023 IDHAM KHALID 5 2 0 1 0 3 7 1 1 2 8 6 0 0 6 7 SUHAENI 31-Dec-1986 BATU KUTA PAROA 3 1 0 0 3 0 0 1 1 0 0 0
194 29-Sep-2023 RIWAYADI 5 2 0 1 0 3 4 1 0 7 8 3 0 1 9 2 HURIAH 01-Jul-1983 BATU KUTA PAROA 3 1 0 0 3 0 0 1 1 0 0 0
195 29-Sep-2023 AHMAD RUSLI 5 2 0 1 0 3 6 1 0 1 7 8 0 0 0 1 SURIYAH 01-Jan-1978 BATU KUTA PAROA 3 1 0 0 3 0 0 1 1 0 0 0
SYUKRIN
196 29-Sep-2023 5 2 0 3 0 5 6 2 0 7 9 5 0 0 0 2 NOVIANA YULIA 22-Jul-1995 BATU KUTA PAROA 3 1 0 0 3 0 0 1 1 0 0 0
HAMDILLAH
197 29-Sep-2023 MAAD ADNAN 5 2 0 1 0 3 5 6 0 9 8 5 0 0 0 2 ZULBIDAYATI 16-Sep-1985 BATU KUTA PAROA 3 1 0 0 3 0 0 1 1 0 0 0
198 29-Sep-2023 MUHIBULLOH 5 2 0 1 0 3 7 1 1 2 7 4 0 1 6 4 SUMENAH 08-Dec-1974 BATU KUTA 3 1 0 0 3 0 0 1 1 0 0 0
199 29-Sep-2023 MAHSUN 5 2 0 1 0 3 4 1 0 7 7 7 0 7 6 4 MUKMINAH 01-Jul-1977 BATU KUTA PAROA 1 1 0 0 3 0 0 1 1 0 0 0
200 29-Sep-2023 ABDI YA' KUB 5 2 0 1 0 3 4 1 0 7 7 7 0 1 9 0 PURNIATI 01-Jul-1977 BATU KUTA PAROA 1 1 0 0 3 0 0 1 1 0 0 0
HENI ZULFITRIA
201 29-Sep-2023 MUHAMAD ZAENI ST 5 2 0 1 0 3 6 5 0 1 9 0 0 0 0 1 31-Dec-1989 BATU KUTA PAROA 3 1 0 0 3 0 0 1 1 0 0 0
HERAWATI
202 29-Sep-2023 RISKIYAN HARIS 5 2 0 1 0 3 6 2 0 2 9 9 0 0 0 3 FEBI AULIA PUTRI 22-Feb-1999 BATU KUTA PAROA 3 1 0 0 3 0 0 1 1 0 0 0
203 29-Sep-2023 MULIANI 5 2 0 1 0 3 7 1 0 0 0 1 0 0 0 1 RIZKIA 31-Oct-2001 BATU KUTE 3 1 0 0 3 0 0 1 1 0 0 0
204 29-Sep-2023 MUHAMMAD RUSLI 5 2 0 1 0 3 5 6 1 2 7 9 0 0 0 2 NURHIKMAH 16-Dec-1979 BATU KUTA PAROA 3 1 0 0 3 0 0 1 1 0 0 0

205 29-Sep-2023 ANIL FADLAH 5 2 0 1 0 3 7 1 1 2 8 5 0 1 8 9 SUDIANA 31-Dec-1985 BATU KUTA PAROA 1 1 0 0 3 0 0 1 1 0 0 0
206 29-Sep-2023 SAPUI 5 2 0 1 0 3 5 1 0 6 8 0 0 0 0 1 HAERUNIYAH 11-Jun-1980 BATU KUTA PAROA 2 1 0 0 3 0 0 1 1 0 0 0
207 29-Sep-2023 SUPARDI SURYA 5 2 0 1 0 3 7 1 1 2 7 5 0 1 0 3 SADIRAH 31-Dec-1978 BATU KUTA PAROA 3 1 0 0 3 0 0 1 1 0 0 0
208 29-Sep-2023 MURHANUDIN 5 2 0 1 0 3 4 5 1 1 8 0 0 0 0 2 ARTINI 05-Nov-1980 BATU KUTA PAROA 3 1 0 0 3 0 0 1 1 0 0 0
209 29-Sep-2023 HARIS ZULFIARIN 5 2 0 3 0 8 6 6 0 8 0 2 0 0 0 7 HILMIATI 26-Aug-2002 BATU KUTA PAROA 3 1 0 0 3 0 0 1 1 0 0 0
210 29-Sep-2023 MUSLEHUDIN 5 2 0 1 0 3 4 1 0 7 7 9 0 4 5 7 HASANAH 01-Jul-1979 BATU KUTA PAROA 3 1 0 0 3 0 0 1 1 0 0 0
MURDAH
211 29-Sep-2023 5 2 0 1 0 3 5 5 0 8 8 7 0 0 0 1 ETIK KUSMAWATI 15-Jun-1987 BATU KUTA PAROA 3 1 0 0 3 0 0 1 1 0 0 0
HENDRAWAN
MUHAMMAD
212 29-Sep-2023 5 2 0 1 0 3 4 1 0 7 8 6 0 1 4 8 ERIYAH 01-Jul-1986 BATU KUTA PAROA 1 1 0 0 3 0 0 1 1 0 0 0
SEPRIADI
213 29-Sep-2023 HUSNU ABADI 5 2 0 1 0 3 6 7 0 8 8 6 0 0 0 1 NURMIATI 27-Aug-1986 BATU KUTA PAROA 3 1 0 0 3 0 0 1 1 0 0 0
214 29-Sep-2023 ABDUL HAKIM 5 2 0 1 0 3 7 1 1 2 7 5 1 0 1 0 HALIMAH 31-Dec-1975 BATU KUTA PAROA 3 1 0 0 3 0 0 1 1 0 0 0
215 30-Sep-2023 SAHRUDIN 5 2 0 1 0 3 4 1 0 7 8 5 0 6 0 3 SAENAH 01-Jul-1985 BATU KUTA UTARA 1 1 0 0 8 0 0 1 1 0 0 0
216 30-Sep-2023 HAMDI RIDWAN 5 2 0 2 0 8 6 6 1 2 0 1 0 0 0 5 RIRIN PUTMALA 26-Dec-2001 BATU KUTA UTARA 1 1 0 0 8 0 0 1 1 0 0 0
1) Keterangan Kode
1 2 3 4 5 6
5 2 0 1 0 5 1 0 2 Bulan : 2023
:
Kota
PEMBERIAN
METODE
KONTRASEPSI
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
2 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
3 SUNTIKAN 1 0 1 1 0 0 0 0 0 0 0
4 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
5 SUNTIKAN 1 0 1 1 0 0 0 0 0 0 0
6 IMPLAN 0 0 0 0 0 0 1 0 1 0 0
7 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
8 IMPLAN 1 1 0 1 1 0 0 0 0 0 0
9 IMPLAN 1 0 0 0 0 0 0 0 0 0 0
10 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
11 IMPLAN 1 0 1 1 1 0 0 0 0 0 0
12 PIL 0 0 0 0 0 0 0 0 1 0 0
13 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
14 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
15 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
16 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
17 SUNTIKAN 0 0 0 0 0 0 1 1 0 0 0
18 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
19 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
20 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
21 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
22 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
JUMLAH 13 2 5 7 2 0 32 1 35 0 0 0


( .................................................................................................)
196504281996031003
NIP/NRP
1. Petugas Entri
Data
Lembar 44
1 2 3 4 5 6
5 2 0 1 0 5 1 1 3 Bulan : 2023
NAMA FASKES/ POSKESDES LEMBUAK 7 8 9 V 11 12
:
Kota

PELAYANAN BERGERAK
STATUS PESERTA KB
INFORMED CONSENT
PASCA KEGUGURAN
PASCA PERSALINAN
ISTRI
BPJS KESEHATAN
PEMASANGAN
PENCABUTAN
PENCABUTAN
KEGAGALAN
PEMBERIAN/
KOMPLIKASI
NAMA SUAMI
OPERATIF/
LAINNYA
TANGGAL
MANDIRI
BERAT
LAHIR
(Kode)
TIDAK
APBN
APBD
DAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
217 01-Oct-2023 ziar afandi 5 2 0 1 0 3 4 1 0 6 9 7 0 0 0 4 saebatun salamiah 01-Jun-1997 lembuak kebon 1 1 1 0 8 1 0 0 1 0 0 0
218 01-Oct-2023 sayyid tirta 5 2 0 1 0 3 6 7 0 2 0 0 0 0 0 1 farida silvia 27-Apr-2000 lembuak kebon 1 1 1 0 9 1 0 0 1 0 0 0
I.GUSTI LANANG ARI

219 04-Oct-2023 5 2 0 1 0 8 0 3 0 7 7 0 0 0 0 1 MAYA LITASANDI 10-Jul-1994 LEMBUAK MEKAR INDAH 1 1 1 0 8 1 0 0 1 0 0 0
A
AHMAD ADITIA
220 04-Oct-2023 5 2 0 1 0 9 6 0 0 4 0 1 0 0 0 3 HIJRATUL FATMA 20-Apr-2001 LEMBUAK TENGAH 1 1 1 0 8 1 0 0 1 0 0 0
FAJRIN
221 04-Oct-2023 NURSINAH 5 2 0 1 0 3 7 1 1 2 7 7 0 1 2 5 NURHAINI 10-Aug-1977 LEMBUAK BARAT 3 1 0 0 3 1 0 0 1 0 0 0
222 04-Oct-2023 SAPTURI 5 2 0 1 0 3 7 1 1 2 7 8 0 1 4 1 SURIANI 31-Dec-1981 LEMBUAK KEBON 1 1 1 0 9 1 0 0 1 0 0 0
223 04-Oct-2023 SAHABUDIN 5 2 0 1 0 3 4 1 0 7 8 1 0 4 5 2 SASMIATI 31-Dec-1978 JLN LEMBUSARI 2 LEMBUAK TIMUR 3 1 0 0 3 1 0 0 1 0 0 0
224 04-Oct-2023 ISKANDAR 5 2 0 1 0 3 5 7 0 3 8 8 0 0 0 1 KARMINI 17-Mar-1988 TELAGE NGEMBENG DASAN 1 1 1 0 8 1 0 0 1 0 0 0
225 04-Oct-2023 WARTINAH EFENDI 5 2 0 1 0 3 4 1 0 7 8 5 0 0 5 7 MULIANA 12-Aug-1985 LEMBUAK BARAT 1 1 1 0 8 1 0 0 1 0 0 0
226 04-Oct-2023 KADAR KENCANA 5 2 0 1 0 3 6 1 0 9 8 0 0 0 0 1 NURHIDAYAH 21-Sep-1980 LEMBUAK TENGAH 2 1 0 0 9 1 0 0 1 0 0 0
227 04-Oct-2023 SAIFUL BAHRI 5 2 0 1 1 2 4 1 0 7 9 4 0 3 6 0 SAHILI 01-Jul-1995 LEMBUAK KEBON 1 1 1 0 8 1 0 0 1 0 0 0
JLN LEMBUSARI 2 GANG MASJID

228 04-Oct-2023 YUSDIAN HARIADI 5 2 0 1 0 3 4 1 0 7 7 5 0 6 1 6 DAHLIAWATI 01-Jul-1975 3 1 0 0 3 1 0 0 1 0 0 0
LEMBUAK TIMUR
229 04-Oct-2023 AGUS JURAEMI 5 2 0 1 0 3 7 1 0 3 9 1 0 0 0 1 BUDIATIN 30-Jan-1991 TELAGE NGEMBENG DASAN 3 1 0 0 3 1 0 0 1 0 0 0
ROSYDA WIRA
230 04-Oct-2023 NURSIAH 5 2 0 1 0 3 6 6 0 5 8 7 0 0 0 2 26-May-1987 LEMBUAK KEBON 1 1 1 0 9 1 0 0 1 0 0 0
HUSNAYATI
231 04-Oct-2023 MUSLIM 5 2 0 1 0 3 7 1 1 2 7 7 0 1 5 6 ENDANG SARIPE 01-Jul-1978 TELAGE NGEMBE DASAN 3 1 0 0 9 1 0 0 1 0 0 0
232 04-Oct-2023 SUKARMIN 5 2 0 1 0 3 6 6 0 7 7 7 0 0 0 2 MARIAH 31-Dec-1978 GONDAWARI 3 1 0 0 3 1 0 0 1 0 0 0
RESTU FIKRI RANTI MAISKI KOPIAN

233 04-Oct-2023 5 2 0 1 0 3 4 7 0 3 0 0 0 0 0 1 07-Mar-2000 LEMBUAK TIMUR 1 1 1 0 9 1 0 0 1 0 0 0
ARDIATMAN SUSILAWTI
PIHIRUDIN
234 04-Oct-2023 5 2 0 1 1 2 4 1 0 7 9 6 0 0 1 4 MARINAH 15-Jul-1999 LEMBUAK BARAT 1 1 1 0 8 1 0 0 1 0 0 0
ASBINUNADI
235 04-Oct-2023 SANISAH 5 2 0 1 0 3 0 1 0 7 0 3 0 4 8 9 MARISAH 01-Jul-1993 LEMBUAK BARAT 3 1 0 0 3 1 0 0 1 0 0 0
236 04-Oct-2023 I NENGAH SUARNA 5 2 0 1 0 3 4 1 0 9 8 8 0 0 0 4 NI MADE DIANE 01-Sep-1988 GONDAWARI BARAT 1 1 1 0 9 1 0 0 1 0 0 0
MUHAMMAD
237 04-Oct-2023 5 2 0 1 0 1 6 1 0 8 9 4 0 0 0 2 YULIANI SAHARA 21-Aug-1994 GONDAWARI 1 1 1 0 8 1 0 0 1 0 0 0
ZAINUDIN
238 04-Oct-2023 SABDUN 5 2 0 1 0 3 6 0 1 0 8 0 0 0 0 5 RATMINI 20-Oct-1981 TELAGE NGEMBENG 3 1 0 0 3 1 0 0 1 0 0 0
239 04-Oct-2023 BUDIASIH 5 2 7 1 0 4 5 6 0 4 8 5 0 0 0 2 HELMI KUSTINI 16-Apr-1985 GONDAWARI 3 1 0 0 3 1 0 0 1 0 0 0
240 04-Oct-2023 CHANDRA ARIADI 5 2 0 1 0 3 5 1 0 9 9 8 0 0 0 1 ARNI IRMAYANI 17-Sep-1998 JLN LEMBUSARI 2 LEMBUAK TIMUR 1 1 1 0 9 1 0 0 1 0 0 0
241 04-Oct-2023 SUPRIADI 5 2 0 1 0 3 5 0 0 8 7 4 0 0 0 1 SURIANAH 10-Aug-1974 TELAGE NGEMBENG 3 1 0 0 3 1 0 0 1 0 0 0
EKA ZAINAL
242 04-Oct-2023 5 2 0 1 0 3 7 1 1 2 8 9 0 1 8 2 NURMINAH 31-Dec-1989 LEMBUAK BARAT 1 1 1 0 8 1 0 0 1 0 0 0
MUTAKIM
243 04-Oct-2023 SAHAJIDUN 5 2 0 1 0 3 7 1 1 2 9 1 0 0 7 4 USNIWATI 31-Dec-1991 LEMBUAK BARAT 3 1 0 0 8 1 0 0 1 0 0 0

244 04-Oct-2023 ACHMAD JUNAIDI W 5 2 0 1 0 1 4 4 0 9 9 8 1 0 0 1 SEPTIYA HARTATI 04-Sep-1998 GONDAWARI 3 1 0 0 3 1 0 0 1 0 0 0
245 04-Oct-2023 SAMSUDIN 5 2 0 1 0 3 5 4 0 6 8 0 0 0 0 3 SUMIATI 14-Jun-1980 GONDAWARI 3 1 0 0 3 1 0 0 1 0 0 0
1) Keterangan Kode

1 2 3 4 5 6
5 2 0 1 0 5 1 1 3 Bulan : 2023
NAMA FASKES/ POSKESDES LEMBUAK 7 8 9 V 11 12
:
Kota
PEMBERIAN
METODE
KONTRASEPSI
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
2 IMPLAN 1 1 0 1 1 0 0 0 0 0 0
3 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
4 IMPLAN 1 1 0 1 1 0 0 0 0 0 0
5 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
6 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
7 IMPLAN 1 1 0 1 1 0 0 0 0 0 0
8 IUD 1 1 0 1 1 0 0 0 0 0 0
9 IUD 1 1 0 1 1 0 0 0 0 0 0
10 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
11 IUD 1 1 0 1 1 0 0 0 0 0 0
12 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
13 IMPLAN 1 1 0 1 1 0 0 0 0 0 0
14 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
15 IUD 0 0 0 0 0 0 1 1 0 0 0
16 IUD 1 1 0 1 1 0 0 0 0 0 0
17 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
18 IUD 1 1 0 1 1 0 0 0 0 0 0
19 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
20 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
21 IUD 0 0 0 0 0 0 1 0 1 0 0
22 IUD 1 1 0 1 1 0 0 0 0 0 0
JUMLAH 15 15 0 15 15 0 16 1 15 0 0 0


( .................................................................................................)
196504281996031003
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R1 Yankb

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1.

PESERTA KB JENIS TINDAKAN Kasus PENGGUNAAN SUMBER ALOKON

1 01-Sep-2023 SAHMIN 5 2 0 1 0 3 4 1 0 7 9 0 0 7 7 7 RAOHUNI 31-Jul-1979 SABA LENDANG 3 0 0 0 3 0 0 1 1 0 0 0

2 01-Sep-2023 SARIMAN 5 2 0 1 0 3 7 1 1 2 7 1 0 0 9 3 SARIMIN 31-Dec-1971 LEMBUAK TENGAH 3 0 0 0 3 1 0 0 1 0 0 0

RINGKASAN HASIL PELAYANAN KB

PESERTA KB BARU (PB) PESERTA KB ULANGAN PELAYANAN KASUS

Lombok Barat , 09-October-2023

PESERTA KB JENIS TINDAKAN Kasus PENGGUNAAN SUMBER ALOKON

3 01-Sep-2023 MAAD ADNAN 5 2 0 1 0 3 5 6 0 9 8 5 0 0 0 2 ZULBIDAYATI 16-Sep-1985 BATU KUTA PAROA 1 1 0 0 3 0 1 0 1 0 0 0

RINGKASAN HASIL PELAYANAN KB

PESERTA KB BARU (PB) PESERTA KB ULANGAN PELAYANAN KASUS

Lombok Barat , 09-October-2023

Dr.I.Dewa Gede Ngurah Agung

PESERTA KB JENIS TINDAKAN Kasus PENGGUNAAN SUMBER ALOKON

4 01-Sep-2023 MUHAMMAD ZAIDUN 5 2 0 1 0 3 5 5 1 1 6 9 0 0 0 3 MARILAH 14-Nov-1959 SABA LENDANG 3 0 0 0 3 1 0 0 1 0 0 0

5 01-Sep-2023 MUHAIDI 5 2 0 1 0 3 4 1 0 5 8 2 0 0 0 5 NURUL HIDAYATI 01-Jun-1982 DARMASABA DASAN 1 3 0 0 0 3 0 0 1 1 0 0 1

RINGKASAN HASIL PELAYANAN KB

PESERTA KB BARU (PB) PESERTA KB ULANGAN PELAYANAN KASUS

Lombok Barat , 09-October-2023

PESERTA KB JENIS TINDAKAN Kasus PENGGUNAAN SUMBER ALOKON

6 01-Sep-2023 ABDUL HAFIZ 5 2 0 1 0 3 4 1 0 7 7 9 0 4 6 1 SALMIAH 01-Jul-1979 BATUKUTA LENTING 1 1 0 0 3 0 1 0 1 0 0 0

RINGKASAN HASIL PELAYANAN KB

PESERTA KB BARU (PB) PESERTA KB ULANGAN PELAYANAN KASUS

Lombok Barat , 09-October-2023

Dr.I.Dewa Gede Ngurah Agung

PESERTA KB JENIS TINDAKAN Kasus PENGGUNAAN SUMBER ALOKON

7 01-Sep-2023 atin 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 INAQ MURNI 31-Dec-1945 DARMASABA 3 0 0 0 3 0 0 1 1 0 0 0

RINGKASAN HASIL PELAYANAN KB

PESERTA KB BARU (PB) PESERTA KB ULANGAN PELAYANAN KASUS

Lombok Barat , 09-October-2023

PESERTA KB JENIS TINDAKAN Kasus PENGGUNAAN SUMBER ALOKON

9 01-Sep-2023 roni rosidin 5 2 0 1 0 3 6 8 0 3 0 1 0 0 0 1 LUBNA AMALIA 28-Mar-2001 Dusun batukuta lenting 1 1 0 0 3 0 1 0 1 0 0 0

10 01-Sep-2023 ABDUL KASIM 5 2 0 1 0 3 4 1 0 7 8 3 0 4 4 9 SURYANI 01-Jul-1983 BATU KUTA UTARA 1 1 1 0 8 1 0 0 1 0 0 0

RINGKASAN HASIL PELAYANAN KB

PESERTA KB BARU (PB) PESERTA KB ULANGAN PELAYANAN KASUS

Lombok Barat , 09-October-2023

Dr.I.Dewa Gede Ngurah Agung

PESERTA KB JENIS TINDAKAN Kasus PENGGUNAAN SUMBER ALOKON

11 01-Sep-2023 LALU JAMIL SAID 5 2 0 1 0 3 4 1 1 2 7 3 0 0 1 4 RUSNIATI 31-Dec-1973 DARMASABA 3 0 0 0 3 0 0 1 1 0 0 0

RINGKASAN HASIL PELAYANAN KB

PESERTA KB BARU (PB) PESERTA KB ULANGAN PELAYANAN KASUS

Lombok Barat , 09-October-2023

PESERTA KB JENIS TINDAKAN Kasus PENGGUNAAN SUMBER ALOKON

12 01-Sep-2023 SAEFUDIN ZOHRI 5 2 0 1 0 3 4 1 0 7 9 0 0 4 5 0 YUNIATIN FATRIANA 08-Aug-1990 BATU KUTA PAROA 1 1 1 0 8 0 1 0 1 0 0 0

13 01-Sep-2023 MUSLEHUDIN 5 2 0 1 0 3 4 1 0 7 7 9 0 4 5 7 HASANAH 01-Jul-1979 BATU KUTA PAROA 1 1 0 0 3 0 1 0 1 0 0 0

14 01-Sep-2023 AHMAD JAUHARI 5 2 0 1 0 3 5 4 1 0 7 9 0 0 0 1 SALMI 14-Oct-1979 BATU KUTA 3 1 0 0 3 0 1 0 1 0 0 0

RINGKASAN HASIL PELAYANAN KB

PESERTA KB BARU (PB) PESERTA KB ULANGAN PELAYANAN KASUS

Lombok Barat , 09-October-2023

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PESERTA KB BARU (PB) PESERTA KB ULANGAN PELAYANAN KASUS

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19 19-Sep-2023 DARWISAH 5 2 0 1 0 3 4 1 0 7 8 0 0 6 3 5 SUKIAH 01-Jul-1980 BATU KUTA LENTING 3 1 0 0 8 1 0 0 1 0 0 0

RINGKASAN HASIL PELAYANAN KB

PESERTA KB BARU (PB) PESERTA KB ULANGAN PELAYANAN KASUS

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Dr.I.Dewa Gede Ngurah Agung

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21 25-Sep-2023 M.HUSNUL HAMIDI 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 YENI SULAILI 12-Dec-1994 LEMBUAK MEKAR INDAH 3 1 0 0 3 1 0 0 1 0 0 0