DATA SASARAN BALITA

Provinsi :
Kabupaten/kota :
Puskesmas :

Ada
No. Vit A Vit A
Berat Cara Ukur Asi ekslusif IMD Buku
NIK (Nomor Induk Anak Nama Tanggal Jenis Nama Tlp/Hp Tanggal BB TB feb Agust
No
Kependudukan) Ke Anak Lahir Kelamin
Badan
Ayah
NIK ayah
Orang
Alamat RT RW
Pengukuran (Kg) (cm)
1=terlentang 1=ya 1=ya kia
Lahir (gr) 2= berdiri 2=tidak 2=Tdk 1=ya 1= ya
Tua 1=ya
2=Tidak 2=tdk
2=Tdk
1 1803076601140 2 Nita 26/1/1 P 3000 Hendro 180307040 - saung 00 00 10/04/17 13 81 2 1 1 1 2 1
003 yuliani 4 susilo 6870005 marga 3 2
2 1803074403130 3 Enah 04/03/ P 2900 Suprahon 180307250 - saung 00 00 10/04/17 14 83 2 1 1 1 2 1
001 wijianti 13 o 5700003 marga 3 2
3 1803071103150 2 Dzky 11/3/1 L 2900 Hartono 180307010 - saung 00 00 10/04/17 12 78 2 1 1 1 2 1
001 antonio 5 9850007 marga 3 2
4 1803070603130 2 Marwah 28/6/1 P 2900 Japrak 180307170 - saung 00 00 10/04/17 12 78 2 1 1 1 2 1
005 aulia 3 tohari 800014 marga 1 1
5 1803076407120 1 Martin 6/3/13 L 3100 Hadi 180307060 - saung 00 00 10/04/17 14 83 2 1 1 1 2 1
001 fabiano susanto 3130005 marga 4 3
6 1803076401120 Wila 24/7/1 P 2800 Johan 180307020 - saung 00 00 10/04/17 17 87 2 1 1 1 2 1
001 arinda 2 syah 1740001 marga 4 2
7 1803071808130 2 Keyla 24/1/1 P 3000 Daryono 180307150 - saung 00 00 10/04/17 19 87 2 1 1 1 2 1
001 amelia 2 9830005 marga 3 2
8 1803071008030 2 Aimar 18/8/1 L 3000 Anwar 180307090 - saung 00 00 10/04/17 14 83 2 1 1 1 2 1
001 tahtadu 3 sani 4820006 marga 3 2
9 1803075408130 2 Aditda 10/08/ L 3000 Waridin 180307210 - saung 00 00 10/04/17 14 82 2 1 1 1 2 1
001 muhamm 13 180003 marga 4 2
ad
10 1803071704150 2 Maura 14/08/ P 3200 Ranto 180307280 - saung 00 00 10/04/17 14 83 2 1 1 1 2 1
001 khanza 13 raka 7910002 marga 3 2
11 1803076108130 1 Ferel 17/4/1 L 3100 Eko w 180307020 - saung 00 00 10/04/17 12 61 2 1 1 1 2 1
001 gandha 5 4820004 marga 4 2
12 1803076301140 2 Yeni 21/8/1 P 2900 Agus 180307110 - saung 00 00 10/04/17 14 83 2 1 1 1 2 1
001 agustin 3 riyadi 8850005 marga 2 2
13 1803072207150 2 Naela 23/1/1 P 3000 Julianto 180307190 - saung 00 00 10/04/17 12 80 2 1 1 1 2 1
001 saputri 4 7840002 marga 4 2
14 1803072609140 2 m. zulfian 22/7/1 L 3100 Ardi 180307040 - saung 00 00 10/04/17 12 80 2 1 1 1 2 1
001 5 hardani 8060004 marga 3 2
15 1803075809140 1 Fauzi 26/9/1 L 3300 suwardi 180307210 - saung 00 00 10/04/17 12 83 2 1 1 1 2 1
002 rasyid 4 3860002 marga 4 2
 DATA SASARAN BALITA

Provinsi :
Kabupaten/kota :
Puskesmas :

Ada
No. Vit A Vit A
Berat Cara Ukur Asi ekslusif IMD Buku
NIK (Nomor Induk Anak Nama Tanggal Jenis Nama Tlp/Hp Tanggal BB TB feb Agust
No
Kependudukan) Ke Anak Lahir Kelamin
Badan
Ayah
NIK ayah
Orang
Alamat RT RW
Pengukuran (Kg) (cm)
1=terlentang 1=ya 1=ya kia
Lahir (gr) 2= berdiri 2=tidak 2=Tdk 1=ya 1= ya
Tua 1=ya
2=Tidak 2=tdk
2=Tdk
1 1803075809130 1 Gesa febi 18/9/1 P 3000 Septo 180307100 - saung 00 00 10/04/17 14 83 2 1 1 1 2 1
002 3 irawan 9910003 marga 3 2
2 1803070405160 2 m. arifin 04-05- L 3000 Nanang 180307220 - saung 00 00 10/04/17 11 58 2 1 1 1 2 1
003 16 8840008 marga 4 5
3 1803075510130 2 Heira 15/10/ P 3100 Muntaho 180307050 - saung 00 00 10/04/17 14 83 2 1 1 1 2 1
003 nazwa 13 7730003 marga 4 2
4 1803070705140 3 Raka al 07/05/ L 3000 wagiran 180307060 - saung 00 00 10/04/17 13 78 2 1 1 1 2 1
001 afnan 14 7690002 marga 4 2
5 1903074110140 1 Bilqis 1/10/1 P 2900 Supratno 180307060 - saung 00 00 10/04/17 14 83 2 1 1 1 2 1
002 4 3130005 marga 4 3
6 1803074703120 3 Marti 07/03/ P 3100 Paiman 180307020 - saung 00 00 10/04/17 17 87 2 1 1 1 2 1
001 yanti 12 1740001 marga 4 2
7 1803071207120 2 Aditya 12/07/ L 2800 Nurkholik 180307150 - saung 00 00 10/04/17 19 87 2 1 1 1 2 1
001 pradita 12 9830005 marga 3 2
8 1803070411130 2 Dimas 04/11/ L 3400 180307090 - saung 00 00 10/04/17 14 83 2 1 1 1 2 1
001 anggra 13 4820006 marga 3 2
9 1803076708130 1 Aulia 27/08/ P 3700 Waridin 180307210 - saung 00 00 10/04/17 14 82 2 1 1 1 2 1
002 zahwa 13 180003 marga 4 2
10 1803074604120 1 Nadira 6/4/12 P 2900 Ranto 180307280 - saung 00 00 10/04/17 14 83 2 1 1 1 2 1
003 mariska raka 7910002 marga 3 2
11 1803022505140 5 Yusuf 25/5/1 L 3000 Eko w 180307020 - saung 00 00 10/04/17 12 61 2 1 1 1 2 1
001 4 4820004 marga 4 2
12 1803071107120 1 Rifa 11/7/1 L 3500 Agus 180307110 - saung 00 00 10/04/17 14 83 2 1 1 1 2 1
002 yakiza 2 riyadi 8850005 marga 2 2
13 1803072909130 1 Rizky 28/9/1 L 2800 Julianto 180307190 - saung 00 00 10/04/17 12 80 2 1 1 1 2 1
001 aditya 3 7840002 marga 4 2
14 1803076003160 2 Inaya 20/3/1 p 3100 Ardi 180307040 - saung 00 00 10/04/17 12 80 2 1 1 1 2 1
001 ramadan 6 hardani 8060004 marga 3 2
15 suwardi 180307210 - saung 00 00 10/04/17 12 83 2 1 1 1 2 1
3860002 marga 4 2