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No.

NIK Nama Bayi Tanggal Lahir L/P


Urut

1 2 3 4 5

1 6503031108200000 AZMI AZHARI 8/11/2020 L


2 NISA UFAIRA P
3 MUHAMMAD RISMAN 10/23/2020 L
4
5 AL AZZAM 12/28/2020 L
6 QOLISYA NUR A 1/13/2021 P
7 REZA RAMADHANSYAH 5/10/2021 L
8 DEDE RAMADHANI 4/24/2021 P
Nama Ibu Alamat RT/RW No. Telp./HP Punya Buku KIA

6 7 8

JULIANA/HELMI JL. Ujang Anop RT. 007 Salid √


SONIA/M. SADRI JL. Ujang Kadir RT.006 Tembelunu √
RAMLA/LAMRI JL. Ujang Kadir RT.006 Tembelunu √

HIJRAH A JL. Ujang Kadir RT.006 Tembelunu √


HAJRIAH JL. Ujang Anop RT. 007 Salid √
INAH WAHYUNI JL. Ujang Anop RT. 007 Salid √
SUTRA JL. Ujang Kadir RT.006 Tembelunu √
MASA NEONATAL
Berat Lahir (Gram)/Panjang Lahir Kunjungan Neonatal
(Cm) Saat Lahir s.d 5
jam Pertama 6 s.d Kedua, Hari ke 3 Ketiga, Hari ke 8
48 jam s.d 7 s.d 28
9 10 11 12 13

3500 GR, 49 CM
3925 GR, 52 CM 5/17/2021
3100 GR, 48 CM
Jan Feb Mar
14 15 16

BB : 7,2 KG 13-02-2021, PY, *, BB : 7,4


-
BB : 6,0 KG 13-02-2021, PY, *, BB :6,5 13-03-2021, PY, *, BB : 7 KG

13-02-2021, PY, *, BB : 3,6 13-03-2021, PY, *, BB : 5,3 KG


13-02-2021, PY, *BB : 4,6
KOHOR BAYI

Kunjungan Bayi
Tahun : 2021

Apr Mei
17 18

17-05-2021, PY, *, BB : 8 KG

12-04-2021, PY, *, BB : 7,2 KG 17-05-2021, PY, *, BB : 7,2 KG

17-05-2021, PY, *, BB : 6,3 KG


12-04-2021, PY, *, BB : 5,7 KG 17-05-2021, PY, *, BB : 6,7 KG
Jun Jul Ags Sep Okt
19 20 21 22 23

17-06-2021, PY, *, BB : 8,9 KG

17-06-2021, PY, *, BB : 7,6 KG 12-07-2021, PY, *, BB : 7,7 KG

17-06-2021, PY, *, BB : 6,7 KG 12-07-2021, PY, *, BB : 7 KG


17-06-2021, PY, *, BB : 6,5 KG 12-07-2021, PY, *, BB : 6,8 KG
17-06-2021, PY, *, BB : 4,8 KG 12-07-2021, PY, *, BB : 6,2 KG
17-06-2021, PY, *, BB : 5,3 KG 12-07-2021, PY, *, BB : 6 KG
Vit. A 6
Bulan hb 0-7 Hari BCG / Polio 1
Nov Des
24 25 38 39 40

√ 8/11/2020 9/19/2020
3/6/2020 4/14/2020
10/23/2020 11/12/2020

12/28/2020 POLIO 1 13-02-2021/ BCG : 17-05-2021


1/14/2021 POLIO 1 13-02-2021/ BCG 12-04-2021
5/17/2021 POLIO 1 17-06-2021
4/24/2021 POLIO 1 17-06-2021
IMUNISASI

DPT-HB-Hib 1 / Polio 2 DPT-HB-Hib 2 / Polio 3

41 42

10/17/2020 12/15/2020
6/13/2020 7/13/2020
1/25/2021 4/12/2021

12-07-2021, POLIO 2 17-06-2021


POLIO 2 17-06-2021, DPT 1 17-05-2021 7/12/2021
POLIO 2 12-07-2021
7/12/2021
DPT-HB-Hib 3 Kematian Post
Polio 4 Campak IDL Natal
IVP
43 44 45 46

25/01/2021, IPV : 17-06-2021 5/17/2021


10/17/2020
6/17/2021
Keterangan

47

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