PENCATATAN HASIL BUL

KABUPATEN/ KOTA : Kotawaringin Timur

PUSKESMAS : Ketapang 2
SEKOLAH : SDN 7 Pelangsian Desa Pelangsian
TAHUN : 2023

Tanggal Lahir/
N0 Nama NIK
Umur

1 2 3 4
1 ALVIANUR 6202062304150000. 4/23/2015
2 Ahmad ARVIANSYAH 620206051160004. 1/5/2016
3 Ahmad RAKHA ATHAYA 620206220716002. 7/22/2016
4 Ahmad MUAD 6202062401160002. 1/24/2016
5 AISYLA PUTRI 6202065910160001. 5/4/2016
6 AMANDA LESTARI 6202064308160002. 8/3/2016
7 ANAYA MULISA 6206106109150002. 9/21/2015
8 AFRIL LIYASAPUTRI 6202066404170003. 4/24/2017
9 AQILA ADHWA RAHMAN 6202064510160001. 10/5/2016
10 BALQIS INARA 6202066406160003. 6/24/2016
11 ELIANA RENATA 6202065909160001. 9/19/2016
12 FUTRI ANANDA 6202066308160002. 8/23/2016
13 HARYANTA 6202062609160003. 9/26/2016
14 JESIKA APRILIA 0000000000000000. 4/3/2015
15 KHENZIE DHAFIN A 6202063001170004. 1/30/2017
16 M ALFIAN RISQIE 6202062411150003. 11/24/2015
17 M ANDRA AL FAJAR 6202061404160000. 4/14/2016
18 M BISRI 6202061909160002. 9/19/2016
19 M SYARIF MAULANA 6202062405160001. 5/24/2016
20 NAIRA ARSYILA M 6206084812160001. 12/8/2016
21 NOVI FEBRIANTI 6202136410150001. 10/24/2015
22 NUR AYRA 6202064412160003. 12/4/2016
23 PERI SETIAWAN 6202060309160002. 9/3/2016
24 RAMAYUDA 6202062605160001. 5/26/2016
25 REFANI SAFA RANDA 6202067011160001. 11/30/2016
26 SITI HOFIYAH 6202064302160003. 2/3/2016
27 SULTAN Ahmad 6202063107160001. 7/31/2016
28 SYURATUL MAULIDA 6202066312160002. 12/23/2016
1 Amelia Putri 6202065501130003 1/15/2013
2 Nur Keyla Sifa 6202065604130003 4/16/2013
 3 Nurhajizah 6202067003120003 3/30/2012
4 Qamariyah 6202066203130002 3/22/2013
5 Windi Meilisa Handayani 6202065905130005 5/19/2013
6 Abida Azahra 6202067006130003 6/30/2013
7 Aisyah 6202067107120003 7/31/2012
8 Feby Aulia 6202065909120002 9/19/2012
9 Natasha Saufi
10 Naysiyla Shifa 6202025012120001 12/10/2012
11 Nor Rohanisa Putri 6202066208120002 8/22/2012
12 Nur Afifa Azra 6202066206130003 6/23/2013
13 Siti Algina Rahayu 6202065109120001 9/11/2011
14 Trisma Aina Putri 6202065103130005 3/11/2013

Mengetahui,
Kepala Sekolah

(…........................................)
NIP.
PENCATATAN HASIL BULAN IMUNISASI ANAK SEKOLAH (BIAS)
DI UNIT PELAYANAN

Tanggal Imunisasi
Nama Orang Tua Campak Rubella
DT (Kelas 1) TD (Kelas 2)
(Kelas 1)
5 6 7 8
M SUKRON/IRA PURWATI 8/10/2023
RIKIY/ SANTI NURMALA DEWI 8/10/2023
SURIANSYAH 8/10/2023
ASWARI/NAWIYAH 8/10/2023
SUPRIYADI/RENA ARIANTI 8/10/2023
ANDUNG H/ MELSIANA 8/10/2023
YULIANTO/ MITA S 8/10/2023
BAHTIAR/RUSIDAH 8/10/2023
RAHMAN/MILAWATI 8/10/2023
RAHMAT/MELIYAWATI 8/10/2023
EFFENDI/JUMIATI DEWI 8/10/2023
ASNAN/WINARSIH 8/10/2023
IWAN/SYAFITRI 8/10/2023
HENDRO P/AYU SAFITRI 8/10/2023
HEPPY CHAN/SRI HARTATI 8/10/2023
BAHRUDIN/NIA D 8/10/2023
JAINAL/ MIMIS 8/10/2023
MIRI/MULYATI 8/10/2023
HARTONO/LISA FERA M 8/10/2023
SUWIRNO/SUSI SUSANTI 8/10/2023
SIMON/NURIYANTI 8/10/2023
M NUR/NURSOLEHAH 8/10/2023
HADRIANSYAH/YANTI 8/10/2023
PURWADI/TINI PURWATI 8/10/2023
AGUSTIN R/ANNA HALIMAH N 8/10/2023
ABD JALIL/YUMINA SAFITRI 8/10/2023
ASPANJI/LISA 8/10/2023
KURSANI/NUR ASIAH 8/10/2023
Padlianur/Norma yunita
Jainuriansyah/Ana Safitri
Suhardi/Mubainah
Sutrisno/Satiawati
Chandra/Sri Wahyuni

Anugrah Irwanto/Yessi

Sampit, Agustus 2023

Petugas Pelaksana

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Tanggal Imunisasi

TD (Kelas 5) HPV1 (Kelas 5) HPV2 (Kelas 6)

9 10 11

8/26/2023
8/26/2023
 8/26/2023
8/26/2023
8/26/2023
8/26/2023
8/26/2023
8/26/2023
8/26/2023
8/26/2023
8/26/2023
8/26/2023
8/26/2023
8/26/2023

Agustus 2023
Pelaksana

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