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 1 2 3 0 7 Bulan : 2023
NAMA FASKES/ POSKESDES SESAOT 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 AZHAR 5 2 0 2 0 8 5 1 1 1 0 1 0 0 0 3 NURLIA SAFITRI 11-Nov-2001 GONTORAN 1 1 1 0 8 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 1 2 3 0 7 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 IMPLAN 0 0 0 0 0 0 1 1 0 0 0
2 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
3 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
4 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
5 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
6 IMPLAN 1 1 0 1 1 0 0 0 0 0 0
7 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
8 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
9 SUNTIKAN 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 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
12 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
13 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
14 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
15 IMPLAN 0 0 0 0 0 0 1 1 0 0 0
16 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
17 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
18 IMPLAN 0 0 0 0 0 0 1 1 0 0 0
19 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
20 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
21 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
22 IMPLAN 1 1 0 1 1 0 0 0 0 0 0
JUMLAH 21 2 0 2 2 0 5 4 1 0 0 0
01 - LOMBOK BARAT , 05-October-2023

Pimpinan Faskes KB/Jaringan/Jejaring*
MARTINA KUSMAYANTI, AMD.KEB

( .................................................................................................)
NIP/NRP
* Coret yang tidak perlu
1. Petugas Entri
Data
Lembar 3
1 2 3 4 5 6
5 2 0 1 0 5 0 0 1 Bulan : 2023
NAMA FASKES/ POSKESDES BUWUN SEJATI 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
2 01-Sep-2023 SUPARDI 5 2 0 1 0 3 4 1 0 7 7 0 0 2 8 0 SANIAH 31-Dec-1970 AIK NYET 2 1 0 0 8 1 0 0 1 0 0 0
1) Keterangan Kode
1 2 3 4 5 6
5 2 0 1 0 5 0 0 1 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 IMPLAN 0 0 0 0 0 0 1 1 0 0 0
3 IMPLAN 0 0 0 0 0 0 1 1 0 0 0
4 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
5 SUNTIKAN 0 0 0 0 0 0 1 1 0 0 0
6 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
7 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
8 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
9 IMPLAN 0 0 0 0 0 0 1 1 0 0 0
10 IMPLAN 0 0 0 0 0 0 1 1 0 0 0
11 SUNTIKAN 0 0 0 0 0 0 1 1 0 0 0
12 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
13 IMPLAN 0 0 0 0 0 0 1 1 0 0 0
14 SUNTIKAN 0 0 0 0 0 0 1 1 0 0 0
15 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
16 SUNTIKAN 0 0 0 0 0 0 1 1 0 0 0
17 IMPLAN 0 0 0 0 0 0 1 1 0 0 0
18 SUNTIKAN 0 0 0 0 0 0 1 1 0 0 0
19 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
20 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
21 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
22 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
JUMLAH 23 0 0 0 0 0 26 18 8 0 0 0

ROHANA, AMD.KEB
( .................................................................................................)
NIP/NRP
1. Petugas Entri
Data
Lembar 5
1 2 3 4 5 6
5 2 0 1 1 2 3 0 7 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
3 01-Sep-2023 JUMAKNI 5 2 0 1 0 3 7 0 1 2 8 9 1 0 0 1 JOHANA 30-Dec-1998 GONTORAN 2 1 0 0 8 1 0 0 1 0 0 0
4 01-Sep-2023 MUSTAKIM 5 2 0 1 0 3 4 1 0 7 9 4 0 1 9 8 SITI HADIJAH 10-May-1994 GONTORAN 1 1 1 0 8 1 0 0 1 0 0 0
5 01-Sep-2023 NURMAN 5 2 0 1 0 3 7 1 1 2 8 3 1 0 0 1 MARIATUN 31-Dec-1983 GONTORAN 2 1 0 0 8 1 0 0 1 0 0 0
1) Keterangan Kode
1 2 3 4 5 6
5 2 0 1 1 2 3 0 7 Bulan : 2023
:
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 1 0 0 0
2 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
3 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
4 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
5 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
6 IMPLAN 1 1 0 1 1 0 0 0 0 0 0
7 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
8 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
9 SUNTIKAN 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 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
12 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
13 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
14 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
15 IMPLAN 0 0 0 0 0 0 1 1 0 0 0
16 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
17 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
18 IMPLAN 0 0 0 0 0 0 1 1 0 0 0
19 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
20 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
21 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
22 IMPLAN 1 1 0 1 1 0 0 0 0 0 0
JUMLAH 21 2 0 2 2 0 5 4 1 0 0 0


( .................................................................................................)
NIP/NRP
1. Petugas Entri
Data
Lembar 7
1 2 3 4 5 6
5 2 0 1 0 5 0 0 1 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 SUPRIADI 5 2 0 2 0 9 5 7 1 0 9 7 0 0 0 1 MAYA OPIANA 17-Oct-1997 AIK NYET 2 1 0 0 8 1 0 0 1 0 0 0
1) Keterangan Kode
1 2 3 4 5 6
5 2 0 1 0 5 0 0 1 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 IMPLAN 0 0 0 0 0 0 1 1 0 0 0
3 IMPLAN 0 0 0 0 0 0 1 1 0 0 0
4 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
5 SUNTIKAN 0 0 0 0 0 0 1 1 0 0 0
6 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
7 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
8 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
9 IMPLAN 0 0 0 0 0 0 1 1 0 0 0
10 IMPLAN 0 0 0 0 0 0 1 1 0 0 0
11 SUNTIKAN 0 0 0 0 0 0 1 1 0 0 0
12 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
13 IMPLAN 0 0 0 0 0 0 1 1 0 0 0
14 SUNTIKAN 0 0 0 0 0 0 1 1 0 0 0
15 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
16 SUNTIKAN 0 0 0 0 0 0 1 1 0 0 0
17 IMPLAN 0 0 0 0 0 0 1 1 0 0 0
18 SUNTIKAN 0 0 0 0 0 0 1 1 0 0 0
19 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
20 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
21 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
22 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
JUMLAH 23 0 0 0 0 0 26 18 8 0 0 0

ROHANA, AMD.KEB
( .................................................................................................)
NIP/NRP
1. Petugas Entri
Data
Lembar 9
1 2 3 4 5 6
5 2 0 1 1 2 3 0 7 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 M.irpan 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 M. IRFAN 26-May-2000 GONTORAN 2 1 0 0 8 1 0 0 1 0 0 0
1) Keterangan Kode
1 2 3 4 5 6
5 2 0 1 1 2 3 0 7 Bulan : 2023
:
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 1 0 0 0
2 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
3 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
4 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
5 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
6 IMPLAN 1 1 0 1 1 0 0 0 0 0 0
7 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
8 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
9 SUNTIKAN 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 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
12 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
13 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
14 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
15 IMPLAN 0 0 0 0 0 0 1 1 0 0 0
16 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
17 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
18 IMPLAN 0 0 0 0 0 0 1 1 0 0 0
19 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
20 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
21 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
22 IMPLAN 1 1 0 1 1 0 0 0 0 0 0
JUMLAH 21 2 0 2 2 0 5 4 1 0 0 0


( .................................................................................................)
NIP/NRP
1. Petugas Entri
Data
Lembar 11
1 2 3 4 5 6
5 2 0 1 0 5 0 0 1 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
8 01-Sep-2023 RIZAL UTARI 5 2 0 1 0 3 4 1 0 7 8 4 0 2 5 4 MISLEH MULIATUN 09-Jun-1983 AIK NYET 2 1 0 0 8 1 0 0 1 0 0 0
9 01-Sep-2023 SAHYE 5 2 0 1 0 3 4 3 1 0 8 8 0 0 0 2 ZAENAP 18-Oct-1988 AIK NYET 2 1 0 0 8 1 0 0 1 0 0 0
1) Keterangan Kode
1 2 3 4 5 6
5 2 0 1 0 5 0 0 1 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 IMPLAN 0 0 0 0 0 0 1 1 0 0 0
3 IMPLAN 0 0 0 0 0 0 1 1 0 0 0
4 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
5 SUNTIKAN 0 0 0 0 0 0 1 1 0 0 0
6 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
7 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
8 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
9 IMPLAN 0 0 0 0 0 0 1 1 0 0 0
10 IMPLAN 0 0 0 0 0 0 1 1 0 0 0
11 SUNTIKAN 0 0 0 0 0 0 1 1 0 0 0
12 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
13 IMPLAN 0 0 0 0 0 0 1 1 0 0 0
14 SUNTIKAN 0 0 0 0 0 0 1 1 0 0 0
15 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
16 SUNTIKAN 0 0 0 0 0 0 1 1 0 0 0
17 IMPLAN 0 0 0 0 0 0 1 1 0 0 0
18 SUNTIKAN 0 0 0 0 0 0 1 1 0 0 0
19 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
20 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
21 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
22 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
JUMLAH 23 0 0 0 0 0 26 18 8 0 0 0

ROHANA, AMD.KEB
( .................................................................................................)
NIP/NRP
1. Petugas Entri
Data
Lembar 13
1 2 3 4 5 6
5 2 0 1 1 2 3 0 2 Bulan : 2023
NAMA FASKES/ POSKESDES PAKUAN 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
10 01-Sep-2023 NAHRI 5 2 0 1 0 3 4 1 0 7 7 8 0 0 4 4 MUNARAH 01-Jul-1978 KUMBI 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 1 2 3 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 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 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
5 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
6 IMPLAN 1 1 0 1 1 0 0 0 0 0 0
7 IMPLAN 1 1 0 1 1 0 0 0 0 0 0
8 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
9 SUNTIKAN 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 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
12 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
13 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
14 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
15 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
16 SUNTIKAN 0 0 0 0 0 0 0 0 0 0 0
17 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
18 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
19 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
20 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
21 IMPLAN 1 1 0 1 1 0 0 0 0 0 0
22 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
JUMLAH 35 4 0 4 4 0 10 0 10 0 0 0

H. BILIA MILKAN, SST

( .................................................................................................)
197104241993031009
NIP/NRP
1. Petugas Entri
Data
Lembar 15
1 2 3 4 5 6
5 2 0 1 1 2 3 0 7 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 JUNAIDI 5 2 0 1 0 1 4 1 0 7 9 1 0 3 6 1 NURIMAH 01-Jul-1991 GONTORAN 2 1 0 0 8 1 0 0 1 0 0 0
1) Keterangan Kode
1 2 3 4 5 6
5 2 0 1 1 2 3 0 7 Bulan : 2023
:
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 1 0 0 0
2 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
3 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
4 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
5 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
6 IMPLAN 1 1 0 1 1 0 0 0 0 0 0
7 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
8 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
9 SUNTIKAN 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 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
12 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
13 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
14 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
15 IMPLAN 0 0 0 0 0 0 1 1 0 0 0
16 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
17 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
18 IMPLAN 0 0 0 0 0 0 1 1 0 0 0
19 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
20 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
21 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
22 IMPLAN 1 1 0 1 1 0 0 0 0 0 0
JUMLAH 21 2 0 2 2 0 5 4 1 0 0 0


( .................................................................................................)
NIP/NRP
1. Petugas Entri
Data
Lembar 17
1 2 3 4 5 6
5 2 0 1 0 5 0 0 1 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 HARTAWAN 5 2 0 1 0 3 4 1 0 7 9 9 0 0 2 0 SUMIATI 01-Jan-1998 AIK NYET 2 1 0 0 8 1 0 0 1 0 0 0
AIK NYET,BUWUNSEJATI,NARMADA,
13 26-Sep-2023 INDRE 5 2 0 1 0 3 7 1 1 2 7 5 0 0 4 6 SUMIATI 31-Dec-1975 1 1 0 0 3 0 0 1 0 0 1 0
LOBAR,NTB
14 26-Sep-2023 SALEHUDIN 5 2 0 1 0 3 5 0 0 3 8 5 0 0 0 1 AMISAH 10-Mar-1985 1 1 0 0 3 0 0 1 0 0 1 0
LOBAR,NTB
15 26-Sep-2023 AYADI 5 2 0 1 0 3 4 1 0 7 8 1 0 2 0 0 SUARNI 31-Dec-1980 AIK NYET 1 1 0 0 3 0 0 1 0 0 1 0
WAHID INDRA
16 26-Sep-2023 5 2 0 1 0 3 5 9 0 9 9 8 0 0 0 2 IKA LUFIA NURMAYANTI 19-Sep-1998 AIK NYET 1 1 0 0 3 0 0 1 0 0 1 0
SYARIF HIDAYAT
17 26-Sep-2023 NURISAH 5 2 0 1 0 3 4 9 1 2 8 3 0 0 0 1 MUSLIHATUN 09-Dec-1983 LEMBUAK KEBON 1 1 0 0 2 0 0 1 0 0 1 0
18 26-Sep-2023 SENATOR 5 2 0 1 0 3 6 1 0 6 8 6 0 0 0 1 FITRIANINGSIH 21-Jun-1986 AIK NYET 3 1 0 0 3 0 0 1 0 0 1 0
19 26-Sep-2023 SAHWAN NAWADIN 1 2 0 8 2 3 4 8 1 2 9 0 0 0 0 3 VERA JULIANA PASARIBU 08-Dec-1990 AIK NYET 1 1 0 0 2 0 0 1 0 0 1 0
AIKNYET,BUWUNSEJATI,NARMADA,
20 26-Sep-2023 ABDUL WAHAB 5 2 0 1 0 3 4 3 0 6 8 8 0 0 0 3 SEKAR 31-Dec-1979 1 1 0 0 3 0 0 1 0 0 1 0
LOBAR,NTBK
21 26-Sep-2023 ADRI 5 2 0 1 0 3 4 1 0 7 8 1 0 2 0 1 SARIDAH 09-Sep-1981 AIK NYET 3 1 0 0 3 0 0 1 0 0 1 0
22 26-Sep-2023 SAMSUL HADI 5 2 0 1 0 3 4 1 0 7 8 0 0 1 5 5 RABIAH 01-Jul-1980 AIK NYET 2 1 0 0 3 0 0 1 0 0 1 0
23 26-Sep-2023 ASRARUDIN 5 2 7 1 0 3 4 8 0 7 9 7 0 0 0 3 RIA UTAMI 08-Jul-1997 AIK NYET 1 1 0 0 3 0 0 1 0 0 1 0
24 26-Sep-2023 MAWAR 5 2 0 1 0 3 7 1 1 2 7 3 0 2 2 4 SUARTINI 31-Dec-1973 AIK NYET 1 1 0 0 3 0 0 1 0 0 1 0
25 26-Sep-2023 JUMANTI 5 2 0 1 0 3 4 5 0 4 7 7 0 0 0 1 RUSDIANI 05-Apr-1977 AIK NYET 1 1 0 0 3 0 0 1 0 0 1 0
26 26-Sep-2023 WARDI 5 2 0 1 0 3 4 5 0 4 9 1 0 0 0 2 RINA APRIANI 05-Apr-1991 AIK NYET 1 1 0 0 2 0 0 1 0 0 1 0
27 26-Sep-2023 SUPRIADI 5 2 0 2 0 9 5 7 1 0 9 7 0 0 0 1 MAYA OPIANA 17-Oct-1997 AIK NYET 2 1 0 0 8 1 0 0 1 0 0 0
28 26-Sep-2023 DANANG KRISTANTO 5 2 0 1 0 3 6 3 0 4 8 7 0 0 0 1 KARTINI WAHYUNI,SPD 23-Apr-1987 AIK NYET 1 1 0 0 2 0 0 1 0 0 1 0
29 26-Sep-2023 REPE 5 2 0 1 0 3 5 5 0 9 8 1 0 0 0 1 MUNIRAH 10-Jul-1983 1 1 0 0 3 0 0 1 0 0 1 0
LOBAR,NTB
30 26-Sep-2023 MAWARDI 5 2 0 1 0 3 4 1 0 7 8 5 0 3 6 7 BAIQ CITRE 31-Dec-1974 AIK NYET 2 1 0 0 3 0 0 1 0 0 1 0
31 26-Sep-2023 SANIRAH 5 2 0 1 0 3 7 1 1 2 7 6 0 1 5 8 MARIAH 31-Dec-1975 AIK NYET 3 1 0 0 3 0 0 1 0 0 1 0
32 26-Sep-2023 RIZAL UTARI 5 2 0 1 0 3 4 1 0 7 8 4 0 2 5 4 MISLEH MULIATUN 09-Jun-1983 AIK NYET 2 1 0 0 8 1 0 0 1 0 0 0
33 26-Sep-2023 SUPARDI 5 2 0 1 0 3 4 1 0 7 7 0 0 2 8 0 SANIAH 31-Dec-1970 AIK NYET 2 1 0 0 8 1 0 0 1 0 0 0
34 26-Sep-2023 JUMIRI 5 2 0 1 0 3 7 1 1 2 8 6 1 0 0 6 MIATI 31-Dec-1986 3 1 0 0 3 0 0 1 0 0 1 0
LOBAR,NTB
35 26-Sep-2023 ISTARIADI 5 2 0 1 0 3 6 5 1 1 0 7 0 0 0 5 MARDIANA 31-Dec-1985 3 1 0 0 3 0 0 1 0 0 1 0
LOBAR,NTB
36 26-Sep-2023 HARTAWAN 5 2 0 1 0 3 4 1 0 7 9 9 0 0 2 0 SUMIATI 01-Jan-1998 AIK NYET 2 1 0 0 3 0 0 1 0 0 1 0
37 26-Sep-2023 RINAMIN 5 2 0 1 0 3 4 6 0 7 8 1 0 0 0 1 SAHMIN 06-Jul-1978 3 1 0 0 3 0 0 1 0 0 1 0
LOBAR,NTB
38 26-Sep-2023 SAPRUDIN 5 2 0 1 0 3 7 1 1 2 8 8 0 1 2 6 YUNI 31-Dec-1988 AIK NYET 1 1 0 0 3 0 0 1 0 0 1 0

SUDIRMAN JAYA
39 26-Sep-2023 5 2 0 1 0 3 8 7 6 5 8 8 0 0 0 1 SRIANA AYU SAPUTRI 27-May-1988 AIK NYET 2 1 0 0 3 0 0 1 0 0 1 0
KUSUMA
40 26-Sep-2023 SATIMAH 5 2 0 1 0 3 4 3 0 7 5 2 0 0 0 2 SALMAWATI 03-Jul-1982 AIK NYET 2 1 0 0 3 0 0 1 0 0 1 0
41 26-Sep-2023 HERI SETIAWAN 5 2 0 1 1 5 4 1 0 7 9 5 0 1 3 3 WILIA HASANAH 21-Feb-1995 3 1 0 0 3 0 0 1 0 0 1 0
LOBAR,NTB
42 26-Sep-2023 EDI 5 2 0 1 0 3 6 7 0 8 8 2 0 0 0 2 SENUM 27-Aug-1982 AIK NYET 2 1 0 0 3 0 0 1 0 0 1 0
43 26-Sep-2023 SAHRUL HADI 5 2 0 1 1 2 6 9 0 4 9 5 0 0 0 1 SRI WAHYUNI 31-Dec-1994 1 1 0 0 3 0 0 1 0 0 1 0
LOBAR,NTB
44 26-Sep-2023 KURDI 5 2 0 1 0 3 7 0 1 2 9 0 0 0 0 4 SITI HADIJAH 31-Dec-1990 AIK NYET 1 1 0 0 3 0 0 1 0 0 1 0
1) Keterangan Kode
1 2 3 4 5 6
5 2 0 1 0 5 0 0 1 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 IMPLAN 0 0 0 0 0 0 1 1 0 0 0
3 IMPLAN 0 0 0 0 0 0 1 1 0 0 0
4 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
5 SUNTIKAN 0 0 0 0 0 0 1 1 0 0 0
6 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
7 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
8 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
9 IMPLAN 0 0 0 0 0 0 1 1 0 0 0
10 IMPLAN 0 0 0 0 0 0 1 1 0 0 0
11 SUNTIKAN 0 0 0 0 0 0 1 1 0 0 0
12 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
13 IMPLAN 0 0 0 0 0 0 1 1 0 0 0
14 SUNTIKAN 0 0 0 0 0 0 1 1 0 0 0
15 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
16 SUNTIKAN 0 0 0 0 0 0 1 1 0 0 0
17 IMPLAN 0 0 0 0 0 0 1 1 0 0 0
18 SUNTIKAN 0 0 0 0 0 0 1 1 0 0 0
19 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
20 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
21 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
22 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
JUMLAH 23 0 0 0 0 0 26 18 8 0 0 0

ROHANA, AMD.KEB
( .................................................................................................)
NIP/NRP
1. Petugas Entri
Data
Lembar 20
1 2 3 4 5 6
5 2 0 1 1 2 3 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
45 26-Sep-2023 ATISAH 5 2 0 1 0 3 4 1 0 7 8 3 0 3 3 3 JUMIRI 01-Jul-1985 KUMBI 1 1 0 0 3 0 0 1 0 0 1 0
ALKHAIRU
46 26-Sep-2023 5 2 0 2 0 8 6 0 0 9 0 4 0 0 0 2 ULVA DWI CAHYANTI 20-Nov-2004 KUMBI 1 1 0 0 3 0 0 1 0 0 1 0
MAKRIFATUL ASGOR
47 26-Sep-2023 NURSENAH 5 2 0 1 0 3 5 2 0 2 8 6 0 0 0 9 WADIAH 12-Feb-1986 KUMBI 1 1 0 0 3 0 0 1 0 0 1 0
48 26-Sep-2023 RAWI 5 2 0 1 0 3 4 1 0 7 8 3 0 5 7 6 SENIAH 01-Jul-1983 KUMBI 1 1 0 0 3 0 0 1 0 0 1 0
49 26-Sep-2023 SUPRIANDI 5 2 0 1 0 3 4 4 0 7 9 7 1 0 0 2 YULIANA 17-Apr-1997 KUMBI 1 1 0 0 3 0 0 1 0 0 1 0
50 26-Sep-2023 HERIN WIJAYA 5 2 0 1 0 3 6 3 9 1 0 3 0 0 0 1 HERLINA 23-Jan-2003 KUMBI 3 1 0 0 3 0 0 1 0 0 1 0
51 26-Sep-2023 SADLIMIN 5 2 0 1 0 3 7 1 1 2 6 8 0 0 0 7 MARIATI 31-Dec-1968 JURANG MALANG 3 1 0 0 3 0 0 1 0 0 1 0
52 26-Sep-2023 TOHRIADI 5 2 0 1 0 3 4 1 0 7 9 9 0 3 1 1 HERNIYANTI 01-Jul-1999 KUMBI 1 1 0 0 3 0 0 1 0 0 1 0
53 26-Sep-2023 JUPRI 8 2 0 1 0 3 6 1 0 6 7 7 0 0 0 1 PARTIAH 21-Jun-1977 KUMBI 1 1 0 0 3 0 0 1 0 0 1 0
54 26-Sep-2023 SUTRISNO 5 2 0 1 0 3 5 2 0 8 9 1 0 0 0 4 TITIK NURMAESARAH 12-Aug-1991 KUMBI 1 1 0 0 3 0 0 1 0 0 1 0
55 26-Sep-2023 HUSNUL WATONI 5 2 0 1 0 3 5 2 1 0 9 8 0 0 0 1 NURUL UMAMI 12-Oct-1998 KUMBI 3 1 0 0 3 0 0 1 0 0 1 0
H.SUHENDI
56 26-Sep-2023 5 2 8 1 0 3 4 1 0 7 8 5 0 4 0 3 RUMENI 31-Dec-1987 KUMBI 1 1 0 0 3 0 0 1 0 0 1 0
SUPRIADI
57 26-Sep-2023 BURHANUDIN 5 2 0 1 0 3 6 7 0 7 9 6 1 0 0 1 LIA ASTRIANI 27-Jul-1996 KUMBI 1 1 0 0 3 0 0 1 0 0 1 0
58 26-Sep-2023 JUNAEDI 5 2 0 1 0 3 4 1 0 7 7 7 0 6 5 0 FARIDA ULFA 01-Jul-1978 KUMBI 1 1 0 0 3 0 0 1 0 0 1 0
59 26-Sep-2023 MUNAHIR HARIS 5 2 8 1 0 3 7 0 1 2 9 9 0 0 0 3 SRIANI 30-Dec-1999 JURABGMEKAR 3 1 0 0 3 0 0 1 0 0 1 0
60 26-Sep-2023 SUPARDI 5 2 0 1 0 3 4 1 0 7 8 0 0 3 1 3 MILASEH 01-Jul-1980 KUMBI 1 1 0 0 3 0 0 1 0 0 1 0
61 26-Sep-2023 REDI 5 2 0 1 0 3 4 1 0 7 7 9 0 2 9 2 SAIMAH 01-Jul-1979 KUMBI 3 1 0 0 3 0 0 1 0 0 1 0
62 26-Sep-2023 SAHARUDIN 5 2 0 1 0 3 5 8 1 2 8 5 0 0 0 1 DIA ISWATUL 19-Dec-1986 KUMBI 1 1 0 0 3 0 0 1 0 0 1 0
63 26-Sep-2023 SIDIK 5 2 0 1 0 3 4 1 0 7 8 8 0 4 0 5 SALMAH 01-Jul-1988 KUMBI 1 1 0 0 3 0 0 1 0 0 1 0
64 26-Sep-2023 H MUHAMAD FAUZI 3 2 0 3 1 1 6 5 0 5 8 2 0 0 0 7 HJ ANISA 25-May-1982 KUMBI 1 1 0 0 3 0 0 1 0 0 1 0
65 26-Sep-2023 HAMDI 5 2 0 1 0 3 4 5 1 1 9 4 1 0 0 1 SUKIAWATI 11-May-1994 KUMBI 1 1 0 0 3 0 0 1 0 0 1 0
JASMANANDI
66 26-Sep-2023 5 2 0 1 0 3 4 1 0 7 9 2 0 4 3 2 MUNIAH 31-Dec-1992 KUMBI 1 1 0 0 3 0 0 1 0 0 1 0
WIRANTO
67 26-Sep-2023 NAHRI 5 2 0 1 0 3 4 1 0 7 7 8 0 0 4 4 MUNARAH 01-Jul-1978 KUMBI 1 1 1 0 8 1 0 0 1 0 0 0
68 26-Sep-2023 ANE 5 2 0 3 1 6 5 3 0 5 8 4 0 0 0 2 MARIYONI 13-May-1984 KUMBI 1 1 0 0 3 0 0 1 0 0 1 0
69 26-Sep-2023 JUMITE 5 2 0 1 0 3 7 1 1 2 9 1 0 0 0 8 MAISAH 31-Dec-1991 KUMBI 1 1 0 0 3 0 0 1 0 0 1 0
70 26-Sep-2023 Sahri 5 2 0 1 0 3 4 2 1 2 8 1 0 0 0 1 SUHATI 30-Jan-1981 KUMBI 1 1 1 0 8 1 0 0 1 0 0 0
71 26-Sep-2023 SAPARUDIN 5 2 0 1 0 3 4 1 0 7 7 7 0 6 1 7 SANISAH 01-Jul-1977 KUMBI 1 1 0 0 3 0 0 1 0 0 1 0

72 26-Sep-2023 USMAN MULIADI 5 2 0 1 0 3 7 1 1 2 9 5 0 0 1 9 RAPIAH 31-Dec-1995 KUMBI 1 1 0 0 3 0 0 1 0 0 1 0
73 26-Sep-2023 HUSAINI 5 2 0 1 0 3 7 1 1 2 7 7 0 0 1 0 SARIMAH 31-Dec-1977 KUMBI 1 1 0 0 3 0 0 1 0 0 1 0
74 26-Sep-2023 AZMAN ALPAEDI 5 2 0 1 0 3 6 3 0 2 0 2 1 0 0 1 SRIYANI 25-Feb-2001 KUMBI 3 1 0 0 8 1 0 0 1 0 0 0
75 26-Sep-2023 Junaidi 5 2 0 1 0 3 3 1 1 2 6 6 0 0 2 1 RAHMAN 31-Dec-1966 KUMBI 1 1 1 0 8 1 0 0 1 0 0 0
76 26-Sep-2023 REDOAN 5 2 0 1 0 3 4 1 0 7 8 9 0 3 8 8 SITI HAJAR 01-Jul-1989 KUMBI 1 0 0 0 3 0 0 1 0 0 1 0
77 26-Sep-2023 RUSDIANA 5 2 0 1 0 3 7 0 1 1 0 3 0 0 0 1 RATMINI 08-Aug-1984 KUMBI 1 1 0 0 3 0 0 1 0 0 1 0
78 26-Sep-2023 DENI SUKRIADI 5 2 0 2 0 8 6 7 0 6 9 5 0 0 0 2 NILA HERPIYANTI 27-Jun-1995 KUMBI 1 1 0 0 3 0 0 1 0 0 1 0
79 26-Sep-2023 JAMIIL 5 2 0 2 0 2 2 6 1 2 9 7 0 0 0 4 DIANA SAPITRI 30-Dec-1997 KUMBI 1 1 0 0 3 0 0 1 0 0 1 0
80 26-Sep-2023 ZAENAL ABIDIN 8 2 0 1 0 3 4 1 0 7 8 4 0 3 2 3 ARISAH 01-Jul-1984 KUMBI 3 1 0 0 3 0 0 1 0 0 1 0
81 26-Sep-2023 SARMAN MULIADI 5 2 0 1 0 3 4 1 0 7 9 3 0 0 1 7 SURIATUL AINI 01-Jul-1993 KUMBI 1 1 0 0 3 0 0 1 0 0 1 0
82 26-Sep-2023 EDI SUKRIADI 5 2 0 2 0 2 5 6 1 2 9 9 0 0 0 3 YUN ARTIKA 16-Dec-1999 KUMBI 1 1 0 0 3 0 0 1 0 0 1 0
83 26-Sep-2023 SAHRIADI 5 2 0 1 0 3 4 1 0 7 8 7 0 3 6 7 SAKNAH 01-Jul-1989 KUMBI 1 1 0 0 3 0 0 1 0 0 1 0
84 26-Sep-2023 NASRI 5 2 0 1 0 3 4 1 0 7 8 3 0 2 9 4 MURNAH 01-Jul-1983 KUMBI 1 1 0 0 3 0 0 1 0 0 1 0
85 26-Sep-2023 SUARMAN 5 2 0 1 0 3 7 1 1 2 7 1 0 2 0 1 SUHAINI 31-Dec-1974 3 1 0 0 3 0 0 1 1 0 0 0
86 26-Sep-2023 MUHDI 5 2 0 1 0 3 4 1 0 7 9 4 0 1 9 0 HUSNATUL AINI 31-Dec-1990 KUMBI 1 1 0 0 3 0 0 1 0 0 1 0
87 26-Sep-2023 NURSINAWANDI 5 2 0 1 0 3 4 1 0 7 8 0 0 3 1 4 MINAH 31-Dec-1973 KUMBI 1 1 0 0 3 0 0 1 0 0 1 0
88 26-Sep-2023 DAHRI 5 2 0 2 0 1 4 5 0 8 8 9 0 0 0 2 SUHAIMI 15-Jun-1987 KIMBI 3 1 0 0 3 0 0 1 0 0 1 0
89 26-Sep-2023 IRWAN SAPTIADI 5 2 0 1 0 3 4 1 0 2 0 2 0 0 0 4 YULIA AININ. NISA 01-Jul-2002 KUMBI 3 1 0 0 3 0 0 1 0 0 1 0
1) Keterangan Kode
1 2 3 4 5 6
5 2 0 1 1 2 3 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 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 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
5 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
6 IMPLAN 1 1 0 1 1 0 0 0 0 0 0
7 IMPLAN 1 1 0 1 1 0 0 0 0 0 0
8 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
9 SUNTIKAN 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 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
12 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
13 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
14 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
15 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
16 SUNTIKAN 0 0 0 0 0 0 0 0 0 0 0
17 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
18 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
19 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
20 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
21 IMPLAN 1 1 0 1 1 0 0 0 0 0 0
22 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
JUMLAH 35 4 0 4 4 0 10 0 10 0 0 0

H. BILIA MILKAN, SST

( .................................................................................................)
197104241993031009
NIP/NRP
1. Petugas Entri
Data
Lembar 23
1 2 3 4 5 6
5 2 0 1 1 2 3 0 4 Bulan : 2023
NAMA FASKES/ POSKESDES SURANADI 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
I NYOMAN
90 26-Sep-2023 5 2 0 1 0 3 5 8 0 1 9 7 0 0 0 1 NI MADE AYU SUARTINI 18-Jan-1997 PEMUNUT 3 1 0 0 3 0 0 1 0 0 1 0
SULASTRA
I GEDE AGUS JAYA NI MADE AYU TRISNA
91 26-Sep-2023 5 2 0 1 0 3 4 1 0 7 8 9 0 4 6 0 17-Jul-1989 PEMUNUT 3 1 0 0 3 0 0 1 0 0 1 0
SAPUTA WATI
92 26-Sep-2023 I KOMANG WIRTA 5 2 0 1 0 3 7 1 1 2 7 4 0 2 1 9 NI NYOMAN SRI 31-Dec-1974 PEMUNUT 1 1 1 0 8 0 0 1 1 0 0 0
I KOMANG AGUS
93 26-Sep-2023 5 2 0 1 0 3 4 5 1 2 9 0 1 0 0 1 NI MADE WANAH 05-Dec-1990 PEMUNUT 1 1 0 0 3 0 0 1 0 0 1 0
PARKA
NI WAYAN AYU
94 26-Sep-2023 I WAYAN BUDIANA 5 2 0 1 0 3 4 1 0 7 9 5 0 5 7 1 21-Feb-1995 PEMUNUT 1 1 0 0 3 0 0 1 0 0 1 0
MEGAWATI
95 26-Sep-2023 DEDI SISWANDI 5 2 0 1 0 3 6 0 0 9 9 8 0 0 0 1 NURUL WAHYUNI 20-Sep-1998 PEMUNUT 1 1 0 0 3 0 0 1 0 0 1 0
I NENGAH
96 26-Sep-2023 5 2 0 1 0 3 4 7 0 6 8 7 0 0 0 1 NI KETUT SUWENI 11-Feb-1984 PEMUNUT 1 1 0 0 3 0 0 1 0 0 1 0
SUKARTHA
97 26-Sep-2023 I WAYAN SUARDANA 5 2 0 1 0 3 7 1 1 2 7 8 0 0 6 3 NI NENGAH MURNI 31-Dec-1978 EAT KANDEL 1 1 0 0 8 0 0 1 1 0 0 0
98 26-Sep-2023 MUHAMAD REDOAN 5 2 0 1 0 3 4 1 0 7 8 2 0 0 1 9 SUNIATI 01-Jul-1982 SURANADI 3 1 0 0 3 0 0 1 0 0 1 0
99 26-Sep-2023 RUMLI 5 2 0 1 0 3 5 4 1 2 8 9 1 0 0 1 DEVI RIANIA 14-Dec-1989 ORONG SDALEM 1 1 0 0 8 0 0 1 1 0 0 0
100 26-Sep-2023 I KETUT SUKADANA 5 2 0 1 0 3 4 1 0 7 9 4 0 0 4 3 NI WAYAN SERI 01-Jul-1994 SURANADI 1 1 0 0 3 0 0 1 0 0 1 0
101 26-Sep-2023 I WAYAN DARMA 5 2 0 1 0 3 4 1 0 7 7 4 0 2 8 8 NI WAYAN SUWATI 01-Jul-1974 PEMUNUT 3 1 0 0 3 0 0 1 0 0 1 0
102 26-Sep-2023 I KETUT CANDRA 5 2 0 1 0 3 4 1 0 4 9 5 0 0 0 1 NI LUH APRILIA DEWI 01-Apr-1995 PEMUNUT 3 1 0 0 3 0 0 1 1 0 0 0
I NENGAH PURNE
103 26-Sep-2023 5 2 0 1 0 3 5 2 0 4 9 1 0 0 0 1 NI NYOMAN PURNAMA 12-Apr-1991 SURANADI SELATAN 1 1 0 0 3 0 0 1 1 0 0 0
YASA
I KOMANG NI PUTU SUWANGI
104 26-Sep-2023 5 2 7 1 0 3 5 9 0 6 9 1 0 0 0 2 19-Jun-1991 PEMUNUT 3 1 0 0 3 0 0 1 0 0 1 0
SUWARDIKA UTAMI
105 26-Sep-2023 SUHARTAWAN 5 2 0 1 0 3 6 9 0 8 9 7 1 0 0 1 HUSNUL HOTIMAH 29-Aug-1997 SURANADI UTARA 1 1 0 0 3 0 0 1 1 0 0 0
106 26-Sep-2023 I WAYAN SUPARTA 5 2 0 1 0 3 5 7 0 5 9 1 0 0 0 1 NI MADE RUSTINI 17-May-1991 PEMUNUT 1 1 0 0 3 0 0 1 0 0 1 0
NI MADE WETYA
107 26-Sep-2023 I NENGAH ARTAN 5 2 0 1 0 3 6 4 0 8 8 4 0 0 0 2 24-Aug-1984 PEMUNUT 3 1 0 0 3 0 0 1 0 0 1 0
MUNARA
NI NYOMAN AYU
108 26-Sep-2023 I NENGAH SUPARTA 5 2 0 1 0 3 4 7 0 2 8 6 0 0 0 3 07-Feb-1988 PEMUNUT 3 1 0 0 3 0 0 1 1 0 0 0
SINARWATI
109 26-Sep-2023 I KOMANG SUNARTA 5 2 7 1 0 1 5 9 0 2 9 2 0 0 0 2 NI KOMANG SRI B. 19-Feb-1992 EYAT KANDEL 1 1 0 0 3 0 0 1 1 0 0 0
NI MADE ERNI JOHAN

110 26-Sep-2023 I MADE YASMAWAN 5 2 0 1 0 3 7 1 1 2 8 4 0 1 7 3 31-Dec-1984 PEMUNUT 1 1 0 0 3 0 0 1 0 0 1 0
AMEL
111 26-Sep-2023 I WAYAN SUKENDRA 5 2 0 1 0 3 4 6 0 8 9 1 1 0 0 1 NI WAYAN SUKERTI 06-Aug-1991 PEMUNUT 3 1 0 0 3 0 0 1 0 0 1 0
112 26-Sep-2023 I WAYAN SASKARA 5 2 0 1 0 3 4 1 0 7 8 0 4 0 4 0 NI KADEK LABA ASTUTI 01-Jul-1984 PEMUNUT 3 1 0 0 3 0 0 1 0 0 1 0
113 26-Sep-2023 I GEDE MUDIARE 5 2 0 1 0 3 4 1 0 7 7 6 0 3 2 8 NI NENGAH MARNI 01-Jul-1976 SURANADI 1 1 0 0 3 0 0 1 0 0 1 0
114 26-Sep-2023 SAULI 5 2 0 1 1 4 4 1 0 7 9 9 0 1 3 4 WITA RUSMIATI 27-Jul-2000 KALIMANTING 1 0 0 0 4 0 0 1 1 0 0 0
115 26-Sep-2023 I WAYAN SUDIANE 5 2 0 1 0 3 4 1 0 7 8 5 0 4 7 7 NI LOH BUDA WATI 17-Jan-1986 EYAT KANDEL 1 1 1 0 8 0 0 1 1 0 0 0
116 26-Sep-2023 RASITA 5 2 0 1 0 3 7 1 1 2 8 7 0 0 3 2 MADE ARIANI 12-Dec-1985 EYAT KANDEL 1 1 0 0 3 0 0 1 1 0 0 0

117 26-Sep-2023 I PUTU ARIANA 5 2 0 1 0 3 5 3 0 7 0 0 0 0 0 2 NI MADE JULIANTI 13-Jul-2000 SURANADI 1 1 0 0 3 0 0 1 0 0 1 0
118 26-Sep-2023 I KOMANG SUARDKA 5 2 0 1 0 3 4 1 0 7 8 2 1 0 1 8 NI KADEK PRAPTI 01-Jul-1982 PEMUNUT 3 1 0 0 3 0 0 1 1 0 0 0
119 26-Sep-2023 SAMSUL HADI 5 2 0 2 0 1 6 3 0 4 0 0 0 0 0 5 RINI 04-Jan-2000 LOTENG 1 1 1 0 9 1 0 0 1 0 0 0
120 26-Sep-2023 I NENGAH SUPARTA 5 2 0 1 0 3 5 8 0 6 8 7 0 0 0 4 NI LUH SULASMI 18-Jun-1987 PEMUNUT 1 1 0 0 3 0 0 1 0 0 1 0
I KOMANG
121 26-Sep-2023 5 2 0 1 1 5 4 1 0 6 9 5 0 0 0 2 NI WAYAN WARTINI 01-Jun-1993 PEMUNUT 3 1 0 0 3 0 0 1 0 0 1 0
SUARDIASE
122 26-Sep-2023 I MADE SUDANA 5 2 0 1 0 3 6 1 0 6 8 9 0 0 0 3 NI MADE YUKTI 21-Jun-1989 PEMUNUT 3 1 0 0 3 0 0 1 0 0 1 0
123 26-Sep-2023 I KETUT SANDI ARTA 5 2 0 1 0 3 6 1 0 4 8 7 0 0 0 7 NI MADE SUKERNI 21-Apr-1987 KUANG MAYUNG 1 1 0 0 3 0 0 1 0 0 1 0
124 26-Sep-2023 I WAYAN URIF 5 2 0 1 0 3 5 2 0 1 8 0 1 0 0 1 NI WAYAN MANIS 12-Jan-1980 PEMUNUT 3 1 0 0 3 0 0 1 0 0 1 0
NYOMAN LIANA
125 26-Sep-2023 I GEDE LANUS 5 2 0 1 0 3 6 9 0 7 9 3 0 0 0 1 29-Jul-1993 KUANG MAYUNG 3 1 0 0 3 0 0 1 1 0 0 0
SAPTARINI
DESAK KOMANG
126 26-Sep-2023 I GEDE LODRA 5 2 0 1 0 1 7 1 1 2 9 4 0 0 1 6 31-Dec-1994 PEMUNUT 3 1 0 0 3 0 0 1 0 0 1 0
PURNAMASARI
NI NENGAH AYU
127 26-Sep-2023 I MADE SUARDANA 5 2 0 1 0 3 4 1 0 7 8 5 0 2 6 7 01-Jul-1985 PEMUNUT 3 1 0 0 3 0 0 1 0 0 1 0
SUARDANI
128 26-Sep-2023 I NENGAH ARSANA 5 2 0 1 0 3 5 6 0 8 8 9 0 0 0 6 NI KOMANG NIYARTI 16-Aug-1989 KUANG MAYUNG 1 1 0 0 8 0 0 1 1 0 0 0
129 26-Sep-2023 I KETUT KARIYASA 5 2 0 1 0 3 7 1 1 2 7 5 1 0 3 4 NI NYOMAN SRIWATI 31-Dec-1975 PEMUNUT 3 1 0 0 3 0 0 1 0 0 1 0
I GEDE PUJA ARI

130 26-Sep-2023 5 2 0 1 0 3 4 1 0 7 9 5 0 4 1 9 NI MADE SUARTINI 05-Dec-1995 KUANG MAYUNG 1 1 0 0 3 0 0 1 0 0 1 0
SUDANA
131 26-Sep-2023 I NENGAH KEMBAR 5 2 0 1 0 3 7 1 1 2 7 5 0 2 4 3 NI KETUT RAKIH 31-Dec-1975 PEMUNUT 3 1 0 0 3 0 0 1 0 0 1 0
132 26-Sep-2023 CHAERUL IMAM 5 2 0 1 1 2 4 1 0 7 9 4 0 3 2 4 OKI SUHAINI 01-Jul-1994 SURANADI UTARA 1 1 0 0 8 0 0 1 1 0 0 0
133 26-Sep-2023 I NYOMAN SATRA 5 2 0 1 0 3 7 1 1 2 8 2 1 0 1 1 NI WAYAN SUSANTI 31-Dec-1982 PEMUNUT 3 1 0 0 3 0 0 1 0 0 1 0
134 26-Sep-2023 JUMARDI .S. PD.I 5 2 0 1 0 3 4 8 0 9 8 8 1 0 0 1 HIKMATUN NUBUWWAH 08-Sep-1988 SURANADI UTARA 1 1 0 0 8 0 0 1 1 0 0 0
135 26-Sep-2023 DENANDI 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 KURNESI 01-Jul-2000 EAT KANDEL 1 1 1 0 8 0 0 1 1 0 0 0
136 26-Sep-2023 I NEGAH SUDARMA 5 2 0 1 0 3 5 3 0 6 6 9 0 0 0 1 NI NYOMAN MARNI 13-Jun-1989 PEMUNUT 1 1 0 0 3 0 0 1 0 0 1 0
NI NYOMAN AYU ANA

137 26-Sep-2023 I NYOMAN GUTIA 5 2 0 1 0 3 4 7 0 3 9 0 0 0 0 2 07-Mar-1990 PEMUNUT 3 1 0 0 3 0 0 1 0 0 1 0
LESTARI
138 26-Sep-2023 AMRILLAH 5 2 0 1 0 3 4 1 0 7 8 0 0 1 3 5 NURUL AENI 01-Jul-1980 SURANADI UTARA 1 1 0 0 3 0 0 1 1 0 0 0
139 26-Sep-2023 IRPAN SYAH 5 2 0 8 0 4 4 1 0 1 9 5 0 0 0 4 ROHMIATUN 01-Jan-1995 SURANADI UTARA 4 1 0 0 8 0 0 0 0 0 0 0
140 26-Sep-2023 I MADE PARKA 5 2 0 1 0 3 4 1 0 7 7 5 0 3 9 2 NI MADE MIATI 18-Aug-1980 PEMUNUT 3 1 0 0 3 0 0 1 0 0 1 0
I NYOMAN IDA AYU WAYAN

141 26-Sep-2023 5 2 0 1 0 3 7 1 1 2 8 8 0 1 1 6 04-Jan-1988 PEMUNUT 3 1 0 0 3 0 0 1 0 0 1 0
SUDARTHA SANTIKA
I MADE RUPA
142 26-Sep-2023 5 2 0 1 0 3 4 1 0 7 8 2 0 6 2 0 NI NYOMAN SUARNI 05-May-1982 PEMUNUT 1 1 0 0 3 0 0 1 0 0 1 0
ARTANA
143 26-Sep-2023 I KOMANG SRIGATA 5 2 0 1 0 3 5 2 0 2 8 0 0 0 0 9 AYU MANIK GATRI 14-Dec-1980 SURANADI SELATAN 1 1 0 0 3 0 0 1 1 0 0 0
I NENGAH RONI
144 26-Sep-2023 5 2 7 1 0 3 4 2 0 1 0 0 0 0 0 4 NI WAYAN SRIANI 02-Jan-2000 PEMUNUT 3 1 0 0 3 0 0 1 0 0 1 0
MAHARDIKA
145 26-Sep-2023 KUSMAYADI 5 2 0 1 0 3 4 2 1 2 8 8 1 0 0 1 MARIANA 02-Dec-1988 BATU ASAK 1 1 1 0 8 0 0 1 1 0 0 0
146 26-Sep-2023 ZOHIRIN SIDIK 5 2 0 2 0 2 6 3 0 4 0 0 0 0 0 5 SRI HANDAYANI 23-Apr-2000 DUSUN KALIMANTING 1 1 1 0 8 0 0 1 1 0 0 0
147 26-Sep-2023 I KOMANG YASTANA 5 2 0 1 0 3 4 1 0 1 9 1 0 0 1 1 NI WAYAN SUWARNI 01-Jan-1991 PEMUNUT 3 1 0 0 3 0 0 1 0 0 1 0
148 26-Sep-2023 SAPTURI 5 2 0 1 0 3 3 4 9 0 2 8 1 0 0 0 SRI RAHMAYANTI 31-Dec-1981 KALIMNTING 1 1 0 0 3 0 0 1 1 0 0 0
149 26-Sep-2023 I NENGAH ARTA 5 2 0 1 0 3 4 4 0 2 9 7 0 0 0 1 NI KETUT SEKARDIANTI 04-Feb-1998 PEMUNUT 1 1 0 0 3 0 0 1 0 0 1 0
150 26-Sep-2023 I WAYAN PUTRA 5 2 0 1 0 3 4 1 0 7 9 4 0 0 6 8 NI WAYAN TAGEL 01-Jul-1994 PEMUNUT 3 1 0 0 3 0 0 1 0 0 1 0
151 26-Sep-2023 IDA KOMANG ADEG 5 2 0 1 0 3 4 1 0 7 6 5 0 4 5 5 IDA AYU KETUT KIRTI 01-Jul-1965 EYAT KANDEL 1 1 0 0 3 0 0 1 1 0 0 0
152 26-Sep-2023 I GEDE PUTRAYASA 5 2 0 1 1 5 4 6 0 1 9 1 0 0 0 1 NI KOMANG MERTE 06-Jan-1990 PEMUNUT 3 1 0 0 3 0 0 1 0 0 1 0

1) Keterangan Kode

1 2 3 4 5 6
5 2 0 1 1 2 3 0 4 Bulan : 2023
NAMA FASKES/ POSKESDES SURANADI 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 SUNTIKAN 1 0 0 0 0 0 0 0 0 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 1 0 0 0 0 0 0 0 0 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 1 0 0 0 0 0 0 0 0 0 0
9 SUNTIKAN 1 0 0 0 0 0 0 0 0 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 1 0 0 0 0 0 0 0 0 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 IMPLAN 1 0 0 0 1 0 0 0 0 0 0
16 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
17 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
18 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
19 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
20 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
21 IMPLAN 1 0 0 0 1 0 0 0 0 0 0
22 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
JUMLAH 34 1 0 1 6 0 27 0 27 1 0 0

GITA APRILIA, AMD.KEB

( .................................................................................................)
NIP/NRP
1. Petugas Entri
Data
Lembar 26
1 2 3 4 5 6
5 2 0 1 1 2 3 0 7 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
153 26-Sep-2023 SENAN 5 2 0 1 0 3 7 1 1 2 6 7 1 0 0 1 KAMAR 01-Dec-1976 GONTORAN 1 1 0 0 2 0 0 1 0 0 1 0
154 26-Sep-2023 BAHARUDIN 5 2 0 1 0 3 6 6 0 6 8 0 0 0 0 1 SIPAKYAH 26-May-1982 GONTORAN 1 1 0 0 2 0 0 1 0 0 1 0
155 26-Sep-2023 UDIN 5 2 0 1 0 3 4 1 0 7 8 8 0 2 9 2 SAPIAH 01-Jul-1988 GONTORAN 1 1 0 0 2 0 0 1 0 0 1 0
156 26-Sep-2023 ATI 5 2 0 1 0 3 4 1 0 7 8 7 0 3 6 1 SALNAH 01-Jul-1987 GONTORAN 1 1 0 0 2 0 0 1 0 0 1 0
157 26-Sep-2023 M. SONAH 5 2 0 1 0 3 4 2 1 0 7 6 0 0 0 1 SITI ROHANI 02-Oct-1976 GONTORAN 3 1 0 0 2 0 0 1 0 0 1 0
158 26-Sep-2023 IMAM SAPII 5 2 0 1 0 3 5 7 0 1 9 2 0 0 0 2 SUSILAWATI 17-Jan-1992 GONTORAN 1 1 0 0 2 0 0 1 0 0 1 0
159 26-Sep-2023 MAHSUN HUSNI 5 2 0 1 0 3 7 1 1 2 9 4 0 0 1 5 SUNIATI 17-Mar-1995 GONTORAN 1 1 0 0 2 0 0 1 0 0 1 0
160 26-Sep-2023 JUNAIDI 5 2 0 1 0 1 4 1 0 7 9 1 0 3 6 1 NURIMAH 01-Jul-1991 GONTORAN 1 1 0 0 2 0 0 1 0 0 1 0
161 26-Sep-2023 SAIMIN 5 2 0 1 0 3 7 1 1 2 9 2 0 0 3 2 MARINI 17-Dec-1992 GONTORAN 1 1 0 0 2 0 0 1 0 0 1 0
162 26-Sep-2023 MULIHASAN 6 2 0 7 0 4 4 5 0 7 9 6 0 0 0 1 FATIMAH 18-Aug-1997 GONNTORAN 1 1 0 0 2 0 0 1 0 0 1 0
163 26-Sep-2023 NURINAH 5 2 0 8 0 4 7 1 1 2 8 8 0 0 8 0 PARIDAH 31-Dec-1988 GONTORAN 1 1 0 0 2 0 0 1 0 0 1 0
164 26-Sep-2023 BARSAH 5 2 0 1 0 3 7 1 1 2 8 0 0 1 4 3 LASTURI 31-Dec-1980 GONTORAN 1 1 0 0 2 0 0 1 0 0 1 0
165 26-Sep-2023 FENDI 5 2 0 1 0 8 5 1 0 7 9 0 0 0 0 4 MULIANA 11-Jul-1990 GONTORAN 1 1 0 0 2 0 0 1 0 0 1 0
166 26-Sep-2023 ISHAK 5 2 0 1 0 3 4 1 1 0 9 7 0 0 0 4 YULIANI 01-Oct-1997 GONTORAN 1 1 0 0 2 0 0 1 0 0 1 0
167 26-Sep-2023 SAIMIN 5 2 0 1 0 3 5 2 0 6 7 7 0 0 0 1 MUNIAH 12-Jun-1977 GONTORAN 1 1 0 0 2 0 0 1 0 0 1 0
168 26-Sep-2023 SARINAH 5 2 0 1 0 3 5 1 3 0 4 8 0 0 0 1 FATIMAH 13-Apr-1980 GONTORAN 1 1 0 0 2 0 0 1 0 0 1 0
169 26-Sep-2023 RUDI IRAWAN 5 2 0 3 0 5 7 1 1 2 9 4 0 1 3 1 ZOHRATUL AZMI 31-Dec-1994 GONTORAN 1 1 0 0 2 0 0 1 0 0 1 0
170 26-Sep-2023 BAHMAN 5 2 0 1 0 3 6 5 0 3 9 6 0 0 0 3 MURNAH 25-Mar-1996 GONTORAN 1 1 0 0 2 0 0 1 0 0 1 0
171 26-Sep-2023 SALMAN 5 2 0 1 0 3 4 1 0 7 8 2 0 1 1 9 SITI SALNAH 31-Dec-1981 GONTORAN 1 1 0 0 2 0 0 1 0 0 1 0
1) Keterangan Kode
1 2 3 4 5 6
5 2 0 1 1 2 3 0 7 Bulan : 2023
:
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 1 0 0 0
2 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
3 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
4 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
5 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
6 IMPLAN 1 1 0 1 1 0 0 0 0 0 0
7 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
8 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
9 SUNTIKAN 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 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
12 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
13 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
14 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
15 IMPLAN 0 0 0 0 0 0 1 1 0 0 0
16 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
17 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
18 IMPLAN 0 0 0 0 0 0 1 1 0 0 0
19 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
20 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
21 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
22 IMPLAN 1 1 0 1 1 0 0 0 0 0 0
JUMLAH 21 2 0 2 2 0 5 4 1 0 0 0


( .................................................................................................)
NIP/NRP
1. Petugas Entri
Data
Lembar 28
1 2 3 4 5 6
5 2 0 1 0 5 0 0 1 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
172 26-Sep-2023 NURCAHYE 5 2 0 1 0 3 7 1 1 2 8 5 0 2 6 5 YANI 31-Dec-1987 AIK NYET 2 1 0 0 3 0 0 1 0 0 1 0
1) Keterangan Kode
1 2 3 4 5 6
5 2 0 1 0 5 0 0 1 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 IMPLAN 0 0 0 0 0 0 1 1 0 0 0
3 IMPLAN 0 0 0 0 0 0 1 1 0 0 0
4 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
5 SUNTIKAN 0 0 0 0 0 0 1 1 0 0 0
6 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
7 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
8 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
9 IMPLAN 0 0 0 0 0 0 1 1 0 0 0
10 IMPLAN 0 0 0 0 0 0 1 1 0 0 0
11 SUNTIKAN 0 0 0 0 0 0 1 1 0 0 0
12 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
13 IMPLAN 0 0 0 0 0 0 1 1 0 0 0
14 SUNTIKAN 0 0 0 0 0 0 1 1 0 0 0
15 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
16 SUNTIKAN 0 0 0 0 0 0 1 1 0 0 0
17 IMPLAN 0 0 0 0 0 0 1 1 0 0 0
18 SUNTIKAN 0 0 0 0 0 0 1 1 0 0 0
19 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
20 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
21 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
22 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
JUMLAH 23 0 0 0 0 0 26 18 8 0 0 0

ROHANA, AMD.KEB
( .................................................................................................)
NIP/NRP
1. Petugas Entri
Data
Lembar 30
1 2 3 4 5 6
5 2 0 1 1 2 3 0 7 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
173 26-Sep-2023 MALIKI 5 2 0 1 0 3 6 6 0 4 9 2 0 0 0 1 HERLINA 26-Apr-1992 GONTORAN 1 1 0 0 2 0 0 1 0 0 1 0
1) Keterangan Kode
1 2 3 4 5 6
5 2 0 1 1 2 3 0 7 Bulan : 2023
:
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 1 0 0 0
2 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
3 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
4 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
5 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
6 IMPLAN 1 1 0 1 1 0 0 0 0 0 0
7 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
8 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
9 SUNTIKAN 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 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
12 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
13 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
14 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
15 IMPLAN 0 0 0 0 0 0 1 1 0 0 0
16 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
17 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
18 IMPLAN 0 0 0 0 0 0 1 1 0 0 0
19 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
20 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
21 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
22 IMPLAN 1 1 0 1 1 0 0 0 0 0 0
JUMLAH 21 2 0 2 2 0 5 4 1 0 0 0


( .................................................................................................)
NIP/NRP
1. Petugas Entri
Data
Lembar 32
1 2 3 4 5 6
5 2 0 1 0 5 0 0 1 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
174 26-Sep-2023 NURJAYADI 5 2 0 1 0 3 4 3 1 2 7 6 0 0 0 1 SITI PATIMATUZZAHRAH 03-Dec-1976 AIK NYET 2 1 0 0 3 0 0 1 0 0 1 0
175 26-Sep-2023 SAMI'IN 5 2 0 2 0 8 4 1 0 7 8 0 0 8 6 0 KANIM 01-Jul-1980 AIK NYET 1 1 0 0 2 0 0 1 0 0 1 0
176 26-Sep-2023 SALEH 5 2 0 1 1 2 7 1 1 2 7 9 0 0 4 8 SAKINAH 31-Dec-1979 AIK NYET 2 1 0 0 3 0 0 1 0 0 1 0
177 26-Sep-2023 SUKRIADI 5 2 0 1 0 9 4 8 1 1 9 7 0 0 0 1 BAIK MARIA PAKASARI 08-Nov-1997 AIK NYET 1 1 0 0 3 0 0 1 0 0 1 0
178 26-Sep-2023 EMAN SURATMAN 5 2 0 1 0 3 4 1 0 7 8 8 0 2 9 8 LINDA JAYANTI 05-Jul-1988 AIK NYET 1 1 0 0 3 0 0 1 0 0 1 0
179 26-Sep-2023 MUHAMMAD HARI 5 2 0 1 0 3 4 1 0 7 8 3 0 0 1 9 SUMALENI 01-Jul-1983 1 1 0 0 3 0 0 1 0 0 1 0
LOBAR,NTB
180 26-Sep-2023 SUHAEDI 5 2 0 1 1 2 4 1 0 3 9 5 0 0 0 3 RO'YA TUL AINI 01-Mar-1995 1 1 0 0 3 0 0 1 0 0 1 0
LOBAR,NTB
181 26-Sep-2023 RAMLI AHMAD 5 2 0 1 1 2 5 2 0 9 0 2 0 0 0 1 HARUM HIDAYATI 12-Dec-1999 AIK NYET 2 1 0 0 3 0 0 1 0 0 1 0
182 26-Sep-2023 AGUS RATNADI 5 2 0 1 0 3 4 1 0 7 7 5 0 2 4 2 RAHAYU 01-Jul-1975 AIKNYET,BUWUNSEJATI,NARMADA 1 1 0 0 3 0 0 1 0 0 1 0
183 26-Sep-2023 TASEH 5 2 0 1 0 3 5 4 0 7 7 4 0 0 0 1 SENIATI 14-Jul-1974 AIK NYET 3 1 0 0 3 0 0 1 0 0 1 0
184 26-Sep-2023 MARDI 5 2 0 1 0 3 5 7 0 7 7 6 0 0 0 1 RUSMIATI 17-Jul-1976 1 1 0 0 3 0 0 1 0 0 1 0
LOBAR,NTB
1) Keterangan Kode
1 2 3 4 5 6
5 2 0 1 0 5 0 0 1 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 IMPLAN 0 0 0 0 0 0 1 1 0 0 0
3 IMPLAN 0 0 0 0 0 0 1 1 0 0 0
4 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
5 SUNTIKAN 0 0 0 0 0 0 1 1 0 0 0
6 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
7 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
8 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
9 IMPLAN 0 0 0 0 0 0 1 1 0 0 0
10 IMPLAN 0 0 0 0 0 0 1 1 0 0 0
11 SUNTIKAN 0 0 0 0 0 0 1 1 0 0 0
12 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
13 IMPLAN 0 0 0 0 0 0 1 1 0 0 0
14 SUNTIKAN 0 0 0 0 0 0 1 1 0 0 0
15 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
16 SUNTIKAN 0 0 0 0 0 0 1 1 0 0 0
17 IMPLAN 0 0 0 0 0 0 1 1 0 0 0
18 SUNTIKAN 0 0 0 0 0 0 1 1 0 0 0
19 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
20 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
21 SUNTIKAN 0 0 0 0 0 0 1 0 1 0 0
22 SUNTIKAN 1 0 0 0 0 0 0 0 0 0 0
JUMLAH 23 0 0 0 0 0 26 18 8 0 0 0

ROHANA, AMD.KEB
( .................................................................................................)
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1.

PESERTA KB JENIS TINDAKAN Kasus PENGGUNAAN SUMBER ALOKON

1 01-Sep-2023 AZHAR 5 2 0 2 0 8 5 1 1 1 0 1 0 0 0 3 NURLIA SAFITRI 11-Nov-2001 GONTORAN 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

01 - LOMBOK BARAT , 05-October-2023

MARTINA KUSMAYANTI, AMD.KEB

PESERTA KB JENIS TINDAKAN Kasus PENGGUNAAN SUMBER ALOKON

2 01-Sep-2023 SUPARDI 5 2 0 1 0 3 4 1 0 7 7 0 0 2 8 0 SANIAH 31-Dec-1970 AIK NYET 2 1 0 0 8 1 0 0 1 0 0 0

RINGKASAN HASIL PELAYANAN KB

PESERTA KB BARU (PB) PESERTA KB ULANGAN PELAYANAN KASUS

01 - LOMBOK BARAT , 05-October-2023

PESERTA KB JENIS TINDAKAN Kasus PENGGUNAAN SUMBER ALOKON

3 01-Sep-2023 JUMAKNI 5 2 0 1 0 3 7 0 1 2 8 9 1 0 0 1 JOHANA 30-Dec-1998 GONTORAN 2 1 0 0 8 1 0 0 1 0 0 0

4 01-Sep-2023 MUSTAKIM 5 2 0 1 0 3 4 1 0 7 9 4 0 1 9 8 SITI HADIJAH 10-May-1994 GONTORAN 1 1 1 0 8 1 0 0 1 0 0 0

5 01-Sep-2023 NURMAN 5 2 0 1 0 3 7 1 1 2 8 3 1 0 0 1 MARIATUN 31-Dec-1983 GONTORAN 2 1 0 0 8 1 0 0 1 0 0 0

RINGKASAN HASIL PELAYANAN KB

PESERTA KB BARU (PB) PESERTA KB ULANGAN PELAYANAN KASUS

01 - LOMBOK BARAT , 05-October-2023

MARTINA KUSMAYANTI, AMD.KEB

PESERTA KB JENIS TINDAKAN Kasus PENGGUNAAN SUMBER ALOKON

6 01-Sep-2023 SUPRIADI 5 2 0 2 0 9 5 7 1 0 9 7 0 0 0 1 MAYA OPIANA 17-Oct-1997 AIK NYET 2 1 0 0 8 1 0 0 1 0 0 0

RINGKASAN HASIL PELAYANAN KB

PESERTA KB BARU (PB) PESERTA KB ULANGAN PELAYANAN KASUS

01 - LOMBOK BARAT , 05-October-2023

PESERTA KB JENIS TINDAKAN Kasus PENGGUNAAN SUMBER ALOKON

7 01-Sep-2023 M.irpan 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 M. IRFAN 26-May-2000 GONTORAN 2 1 0 0 8 1 0 0 1 0 0 0

RINGKASAN HASIL PELAYANAN KB

PESERTA KB BARU (PB) PESERTA KB ULANGAN PELAYANAN KASUS

01 - LOMBOK BARAT , 05-October-2023

MARTINA KUSMAYANTI, AMD.KEB

PESERTA KB JENIS TINDAKAN Kasus PENGGUNAAN SUMBER ALOKON

8 01-Sep-2023 RIZAL UTARI 5 2 0 1 0 3 4 1 0 7 8 4 0 2 5 4 MISLEH MULIATUN 09-Jun-1983 AIK NYET 2 1 0 0 8 1 0 0 1 0 0 0

9 01-Sep-2023 SAHYE 5 2 0 1 0 3 4 3 1 0 8 8 0 0 0 2 ZAENAP 18-Oct-1988 AIK NYET 2 1 0 0 8 1 0 0 1 0 0 0

RINGKASAN HASIL PELAYANAN KB

PESERTA KB BARU (PB) PESERTA KB ULANGAN PELAYANAN KASUS

01 - LOMBOK BARAT , 05-October-2023

PESERTA KB JENIS TINDAKAN Kasus PENGGUNAAN SUMBER ALOKON

10 01-Sep-2023 NAHRI 5 2 0 1 0 3 4 1 0 7 7 8 0 0 4 4 MUNARAH 01-Jul-1978 KUMBI 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

01 - LOMBOK BARAT , 05-October-2023

H. BILIA MILKAN, SST

PESERTA KB JENIS TINDAKAN Kasus PENGGUNAAN SUMBER ALOKON

11 01-Sep-2023 JUNAIDI 5 2 0 1 0 1 4 1 0 7 9 1 0 3 6 1 NURIMAH 01-Jul-1991 GONTORAN 2 1 0 0 8 1 0 0 1 0 0 0

RINGKASAN HASIL PELAYANAN KB

PESERTA KB BARU (PB) PESERTA KB ULANGAN PELAYANAN KASUS

01 - LOMBOK BARAT , 05-October-2023

MARTINA KUSMAYANTI, AMD.KEB

PESERTA KB JENIS TINDAKAN Kasus PENGGUNAAN SUMBER ALOKON

12 01-Sep-2023 HARTAWAN 5 2 0 1 0 3 4 1 0 7 9 9 0 0 2 0 SUMIATI 01-Jan-1998 AIK NYET 2 1 0 0 8 1 0 0 1 0 0 0

15 26-Sep-2023 AYADI 5 2 0 1 0 3 4 1 0 7 8 1 0 2 0 0 SUARNI 31-Dec-1980 AIK NYET 1 1 0 0 3 0 0 1 0 0 1 0

17 26-Sep-2023 NURISAH 5 2 0 1 0 3 4 9 1 2 8 3 0 0 0 1 MUSLIHATUN 09-Dec-1983 LEMBUAK KEBON 1 1 0 0 2 0 0 1 0 0 1 0

18 26-Sep-2023 SENATOR 5 2 0 1 0 3 6 1 0 6 8 6 0 0 0 1 FITRIANINGSIH 21-Jun-1986 AIK NYET 3 1 0 0 3 0 0 1 0 0 1 0

19 26-Sep-2023 SAHWAN NAWADIN 1 2 0 8 2 3 4 8 1 2 9 0 0 0 0 3 VERA JULIANA PASARIBU 08-Dec-1990 AIK NYET 1 1 0 0 2 0 0 1 0 0 1 0

21 26-Sep-2023 ADRI 5 2 0 1 0 3 4 1 0 7 8 1 0 2 0 1 SARIDAH 09-Sep-1981 AIK NYET 3 1 0 0 3 0 0 1 0 0 1 0

22 26-Sep-2023 SAMSUL HADI 5 2 0 1 0 3 4 1 0 7 8 0 0 1 5 5 RABIAH 01-Jul-1980 AIK NYET 2 1 0 0 3 0 0 1 0 0 1 0

23 26-Sep-2023 ASRARUDIN 5 2 7 1 0 3 4 8 0 7 9 7 0 0 0 3 RIA UTAMI 08-Jul-1997 AIK NYET 1 1 0 0 3 0 0 1 0 0 1 0

24 26-Sep-2023 MAWAR 5 2 0 1 0 3 7 1 1 2 7 3 0 2 2 4 SUARTINI 31-Dec-1973 AIK NYET 1 1 0 0 3 0 0 1 0 0 1 0

25 26-Sep-2023 JUMANTI 5 2 0 1 0 3 4 5 0 4 7 7 0 0 0 1 RUSDIANI 05-Apr-1977 AIK NYET 1 1 0 0 3 0 0 1 0 0 1 0

26 26-Sep-2023 WARDI 5 2 0 1 0 3 4 5 0 4 9 1 0 0 0 2 RINA APRIANI 05-Apr-1991 AIK NYET 1 1 0 0 2 0 0 1 0 0 1 0

27 26-Sep-2023 SUPRIADI 5 2 0 2 0 9 5 7 1 0 9 7 0 0 0 1 MAYA OPIANA 17-Oct-1997 AIK NYET 2 1 0 0 8 1 0 0 1 0 0 0

28 26-Sep-2023 DANANG KRISTANTO 5 2 0 1 0 3 6 3 0 4 8 7 0 0 0 1 KARTINI WAHYUNI,SPD 23-Apr-1987 AIK NYET 1 1 0 0 2 0 0 1 0 0 1 0