Mikroplaning Kejar Puskesmas Krejengan

NAMA PUSKESMAS :
NAMA KABUPATEN/KOTA :
NAMA PROVINSI :
1 Lengkapilah identitas pelayanan imunisasi di halaman cover
2 Gunakan format pelacakan sebagai sumber instrumen untuk mencatat anak yang tidak datang
pada saat pelayanan imunisasi sesuai jadwal
3 Isilah data sasaran kejar berdasarkan lembar daftar pelacakan. Data sasaran dilengkapi berdasarkan
data by name by address
4 Pahami hal-hal yang akan diisi pada setiap sheet mikroplaning. Mohon diperhatikan jumlah
total pendataan sasaran harus sama dengan total di lembar sumber daya (a) dan (b)
untuk langkah 1 a, lembar ini digunakan untuk pendataan sasaran yang masih bisa melengkapi status imunisasi dasar
lengkap (0-11 bln) atau melengkapi status imunisasi baduta lengkap (12-23 bln)
Tabel yang tersedia pada langka 1a, 1b, 1c adalah pendataan sasaran untuk 1 desa. Mohon untuk di perbanyak sesuai
jumlah desa dengan cara, blok dari judul sampai tabel bagian bawah lalu klik copy atau (ctrl + C).
Lalu klik paste atau (ctrl+V).
5 Pada langkah sumber daya 2 a dan 2 b, perhatikan Langkah berikut ini
-Perhatikan jumlah dosis yang diisi harus sama dengan lembar pendataan sasaran kejar sebelumnya
-Isilah IP Vaksin telebih dahulu pada tabel pendataan sumber daya. IP Vaksin merujuk pada hasil perhitungan di mikroplaning imunisasi rutin
-Isilah kebutuhan logistik seperti, plastik limbah medis, Wadah/kontainer limbah medis, Anafilaktik, dan Vaccine carrier yang tersedia
6 Pada langkah 3, isilah lembar rencana kerja. Mikroplanning yang sudah disusun dapat dilakukan
pembaruan sesuai dengan kebutuhan
7 Pada langkah 4, adalah rekapan anak yang sudah mendapatkan imunisasi kejar lengkap.
Mohon untuk petugas klik pilihan lengkap atau tidak lengkap imunisasi kejar per individu
FORMAT P
No Nama Bayi/Balita/Anak Usia Sekolah Tanggal Lahir Jenis Kelamin

FORMAT PELACAKAN
Nama Orang Tua/Pengasuh Alamat No. Tlp/HP

Ket:
Jenis Imunisasi/Antigen
(√) Hadir Tindak Lanjut
yang belum diberikan
(×) Tidak Hadir
OPV v
IPV v
Lembar ini digunakan untuk pendataan sasaran yang masih bisa melengkapi status imunisasi dasar lengkap (0
Provinsi : jawa timur
Kabupaten : probolinggo
Puskesmas : krejengan
No. NIK ANAK NAMA ANAK TANGGAL LAHIR
1 3513151047710001 AZZURA AFRA 5/17/2022

2 3513153183296003 ARUMI SALSABILA 6/16/2022
3 DEWI MASITA
4 3513159220274009 NUFA AHSAN 9/11/2022
5 3513153503975003 M. RAFASYA A. 1/25/2023
6 3513151842544001 M. DWI FEBRIANSYAH 2/8/2023
7 3513152204770002 WARDAH NUHA 2/15/2023
8 3513150511925000 M. DANISH 3/25/2023
9 3513153685088003 KUNI HASNA SIBIL 4/8/2023
10 3513155858444005 AMALINA 4/29/2023
11 3513157007950007 M ALAIKA ANNAJAH 5/10/2023
12 3513158819080008 NARA SETYA PRAMUDYA 5/24/2023
13 3513158307155008 M. ARSYAKA AL 5/9/2023
14 3513154409540004 NAMIRA LAIBA G 6/10/2023
15 3513156614310006 KIANA MAZAYA S 6/15/2023
16 3513154740352004 IBRAHIM LEO PRAYOGA 8/16/2023
17 3513159937172009 M. ATHAR PUTRA Y 9/12/2023
18 3513155976729005 M. ALFARAZKY IBNU HAIDAR 11/21/2023
19 3513150992436000 SYAKIRA NUR RIZQIANA 12/17/2023
20 3513153615904003 NAZRIL ILHAM AHMAD 1/12/2024
TOTAL

2 3513152606220002 M. DILAN ALFARISQI 6/26/2022

3 3513154107220001 BILQIS PUTRI ARIFIN 7/1/2022
4 3513152408220001 M. RIFQI 8/24/2022
5 3513156210220002 GHINA BINNURIKA 10/22/2022
6 3513155412220002 ANINDITA SALSABILA 12/14/2022
7 3513152012220036 M. AFILLAH 12/20/2022
8 3513156011220037 SAFFIYA RUHI 11/20/2022
9 3513150202230038 ARRASYA BINTANG A. 2/2/2023
10 3513151703230039 M. AIMAN NABIL AKBAR 3/17/2023
11 3513151909230000 IBRAHIM MAULANA A. 9/19/2023
12 3513150710230000 M. HASAN AL MALIK 10/7/2023
13 3513155202240000 ZAKIYATIL FAHIRO 2/12/2024
TOTAL

1 3513154105220004 FITRIA RAMADANI 5/1/2022

2 3513151412220035 M. AL FATIH 12/14/2022
3 3513150708230001 A. AZRIL HASAN 8/7/2023
4 3513151112230003 M. UMAR 12/11/2023
5 3513151501240001 M. AZKA FADILLAH 1/15/2024
6 3513155802240000 AYU SYAKBANIAH D 2/18/2024
TOTAL

1 3513154605220001 DINAR FALESTIN M 5/6/2022

2 3513152307220001 M KIN MAULANA 7/23/2022
3 3513151480318001 M. ALFAROBI ALFARISI 2/1/2023
4 3513157220477007 AHZA RUMAIZA 3/1/2023
5 3513159968586009 M. AZRIL HASAN 3/18/2023
6 3513156645724006 REFINA ILMA REZA 6/6/2023
7 3513156582896006 M. HAIKAL 6/24/2023
8 3513158425440008 A. IZZAN HAFIDZ 8/20/2023
9 3513155743936005 RIVAN AHMAD FAHRIYAN 2/4/2024
10 3513152975744002 HANA MAYAZA RIZKYANI 2/16/2024
TOTAL
Provinsi : Jawa Timur
Kabupaten : Probolinggo
Puskesmas : Krejengan
18 MOH. ABBAD MAJDI 04/06/2023

19 RATU ASYIFA 09/06/2023
20 MOH. RIDHO 07/07/2023
25 MUH. ELZIO FEBRYAN 26/10/2023
26 ALVIN HIDAYATULLAH 28/10/2023
27 EKTADA BILLADI MUHAMMAD 23/11/2023
TOTAL

8 ARSYILA FAZA. A 13/12/2022

10 MIKAILA AURORA. A 01/03/2023
13 MOH. DHEVIN 14/05/2023
15 RATU DELISHA SAKINAH 16/06/2023
21 PARAMITHA MAHARANI 11/09/2023
22 MOH. FILDAN HOSEN.A 18/11/2023
TOTAL

1 MUH. RENDRA WIJAYA 06/05/2022

4 SOFIEYATUL HASANAH 13/09/2022
5 KANZA ZAHROTUS SITA 02/10/2022
6 MUH. KAMIL HASAN 05/11/2022
8 ZAHWA MAULIDA. R 30/03/2023
11 QOONITAH KAMILATUN NUHAA 07/07/2023
TOTAL
Provinsi : JAWA TIMUR
Kabupaten : PROBOLINGGO
Puskesmas : KREJENGAN
5 3513150501230001 M JIBRIL 07/01/2023

20 AHMAD ROYYAN ALFARIZKI 7/12/2023
TOTAL

TOTAL
1 NURIL ALIFAH ZAIN 5/25/2022

2 M. NURUL AMIN 7/16/2022
3 M. NAILUL HAMDI 7/16/2022
4 IKRAR 5/8/22
5 DIAJENG NAJWA AZKIA 21/08/2022
6 KAVIN ARGHADANA 21/08/2022
7 IKAYLA SALSABILA 18/09/2022
8 MUHAMMMAD KHOLI 9/23/2022
9 AQILA ALAWIYAH FIRDAUSI 11/26/2022
10 AHMAD ABIDZAR A 3/12/22
11 DANIA 12/15/2022
12 AKHMAD FAHKRI 1/17/2023
13 AZMI MAULANA 2/12/2023
14 AFRA NUR ALINA 2/22/2023
15 NAYSILA AYU R 3/3/23
16 AHMAD NUVEL D 3/19/2023
17 KALISHA SALSABILA 3/26/2023
18 RAMADANIA NAURIN M 5/4/23
19 BASAGITA ZEVANA 4/20/2023
20 MIKAYLA HAFIDZA 5/5/23
21 WARDATUL HASANAH 6/28/2023
22 RANA AQILA HUMAIRA 10/25/2023
23 M ALFATIH MAULANA 11/16/2023
24 FILZAH MAHIRA 11/17/2023
25 ARUMI RAISSA MIKAYLA 11/24/2023
26 M ALTHAF ISRAQ 11/26/2023
27 ILMIRA NABA 5/12/23
28 ARINI MANZILA SYARIFAH 11/12/23
TOTAL

TOTAL

7 ABIZAR KEENAN ATHARAZKA 29/01/2024

TOTAL
Provinsi :
Kabupaten :
Puskesmas :
1 3513151606220001 AHMAD BRILLIAN AZHAR 6/16/2022

2 3513156408220002 AISYAH AZKAIRA 8/24/2022
3 IZZAH AFKARINA 10/26/2022
4 MOHAMMAD ARSLAN R. 3/24/2023
5 SYARIFATUL MUMTAZAM 5/11/2023
6 FAZA FAIZAH 10/7/2023
7 INARA ASYA FEBRIANA 2/9/2024
TOTAL
Provinsi :
Kabupaten :
Puskesmas :
1 RAISYASEPTIANA ARROZAQ 9/28/2022

2 CHOIRUL NISA 6/16/2022
3 AZQAIRA DIANTA 6/27/2022
4 M. REYNALDY A 8/30/2022
5 MAQFIROH AZZAHRA 8/3/2022
6 MAYALISA SALSABILLA 9/13/2022
7 CERIKA NARAYA NASIFA 3/15/2022
8 ADELIA RAHDIYA AMANDA 11/21/2022
9 AGITA SOFIANA 11/9/2022
10 AULIA ARSY SAFARA 1/21/2023
11 NAKHLA SABRINA 2/25/2023
12 VILLIA ADINDA MAHARANI 2/2/2023
13 M. ZAINAL AKASYA 12/21/2022
14 DEVINDRA AZNAN MAUZAN 5/6/2023
15 UWAIS AL QORNI 5/1/2023
16 MOHAMMAD. REYHAN 7/5/2023
17 NADHIRA ANNDYA AYUNDA 7/19/2023
18 NABILA TSANIA AKBARI 7/6/2023
19 NAUFAL MAULANA 8/3/2023
20 KHODIJAH ANINDYA ARUM 9/22/2023
21 QINARA SHANUM ZAFIRA I. 9/22/2023
22 ZAHIRA NIRMALA 1/18/2024
23 PUTRI KEYSA LAILATUL M. 1/25/2024
24 M. KINAN 2/26/2024
25 ELSHANUM 2/18/2024
TOTAL
Provinsi :
Kabupaten :
Puskesmas :
1 M. FATTAH 4/29/2022
2 DINDA AULIA ZAIN 5/7/2022
3 M. DION DARMA KUSUMA 5/17/2022
4 M.KENZI EL MUBARROK 6/29/2022
5 NIKO ALZAM 7/29/2022
6 DJENAR MAESA J. 7/6/2022
7 AMEERA NOURA J. 7/2/2022
8 NASHA SEPTIANA A. 9/5/2022
9 AGHISNA AZ ZAHRA 9/9/2022
10 ZAKIYAH HUMAIROH 5/19/2022
11 NAURA HUSNA 10/4/2022
12 ZIDQIYAH MURDIFAH 10/18/2022
13 AHMED FATHAR Z 10/20/2022
14 M. BURHAN ARFA 10/22/2022
15 KANZA AULIA 12/29/2022
16 M. ARSAKA ALFAHRESA 2/26/2023
17 NADEERA ALBIRRU I. 3/24/2023
18 FAHQI ELZIO SABILUL 4/1/2023
19 EMERIL KHAN MUMTAZ 4/6/2023
20 KAYLA SHEERIN J. 5/21/2023
21 M. FARIS MAULANA 7/16/2023
22 PUTRI VELLY SEPTIANA 9/17/2023
23 ALIESHA KINAN SALSABILLA 8/25/2023
24 M. ALFINO RAZKA MUAFFAQ 12/1/2023
25 ZAINAB ELMASARIFA 12/21/2023
26 M. ARSYA ALFARIZKI 12/29/2023
27 ALZENA JASMIN SYAKYLA 12/30/2023
TOTAL
Puskesmas : Puskesmas krejengan
3 3513150605220001 RAFAEL 5/7/2022

4 3513155005220001 ST HOTIJAH CHAIRUNISA 5/18/2022
18 JASMINE 4/27/2023
19 MOH ASIMI ARIFIN 4/20/2023
20 YASHWA 14/9/2022
22 FATIMAH MUNAWAROH 12/31/2023
TOTAL
1 3513154606220002 NAYYARA 06/06/2022

2 3513154607220001 NUR AYA ANISA 26/07/2022
3 3513150108220001 M KAFA BILA 02/08/2022
4 3513150408220001 M AKMAL RAYHAN 04/08/2022
5 3513156508220001 ANINDITA 25/08/2022
6 3513150109220002 M IZZA A 01/09/2022
7 3513150109220002 M NUR SAHID ARSYA 01/09/2022
8 3513150509220001 MIQDAD ALI HAYKAL 05/09/2022
9 3513150110220001 M AZRIEL 03/10/2022
10 3513150710220002 ALVARO 07/10/2022
11 3513150302230001 MOCH ARSHAKA BIANTARA 03/02/2023
12 3513154402230002 KAYRA 02/03/2023
13 3513154402230001 KAYLA 02/03/2023
14 TIARA 22/03/2023
15 3513156303230001 SHEIKA MAHRA 23/03/2023
16 3513154305230002 ELSA DWI MEILINDA 03/05/2023
17 3513161305230001 BINTANG MAHARDIKA 13/05/2023
18 3513151105230003 ABIZAR MAULANA R 5/15/2023
19 3513156005230002 SHOFA QOLBA N 5/20/2023
20 3513177005230002 GENDIS 5/30/2023
21 ARINI 8/11/2023
22 3513156808230003 DELLA ZAHIRA 23/8/2023
23 3513153008230002 M ASYRAF KHAIRUL AZAM 30/8/2023
24 3513157009230002 PUTRI TANIA 30/9/2023
25 3513153009230001 FAHRIZAL AH KAHFI 2/10/2023
26 3513156810230001 ANINDA DWI PUSPITA 29/10/2023
27 3513154911230002 FATHIMAH HASINA 9/11/2023
TOTAL
Provinsi :
Kabupaten :
Puskesmas :
1 3513156304220001 DEBYANASARI 4/23/2022

2 3513151606220001 MOH BRYLIAN 6/16/2022
3 3513156007220002 NADEERA FATIMAH 7/20/2022
4 RAFASYA FAIRIL 8/8/2022
5 3513152309220002 MOCH GIBRAN 9/23/2022
6 3513154810220002 NADIA AZAHROH 10/18/2022
7 KINAYA OKTAVIA 10/22/2022
8 VILLANIETA OKTAVIA 10/22/2022
9 3513155101220002 NADIVA 11/1/2022
10 3513151411220001 DELVIN MAHADIKA 11/14/2022
11 3513156401230001 SESILIA GEBII ANANDITA 1/24/2023
12 3513151602230002 GAVIN DIRGANTARA 2/16/2023
13 3513156502230001 NUR SYIFA PUTRI ENJELIA 2/27/2023
14 3513150307230001 ABRISAN BRIAN 3/7/2023
15 3513150803230001 MOCH KAFANA RISKY OBINA 3/8/2023
16 3513155223230003 MOCH RISKI ADITYA 3/19/2023
17 3513152003230004 MOCH RIDHO 3/19/2023
18 3513151803230003 MUHAMMAD HAIDAR MAULANA 3/18/2023
19 3513157102230002 ST NUR AISYAH 3/31/2023
20 MOCH ANDI 27/5/2023
21 FAGANZIO RAFIANDA 12/6/2023
22 FARADILA ADIBA ZAHRA 4/7/2023
23 ANINDITA KEYLA A 11/8/2023
24 MOCH WILDAN 30/9/2023
25 ALENA SERIN N 23/11/2023
26 HAWA JIHAN SALSABILA 3/12/2023
27 AMARA MEDINA A 14/12/2023
28 INDIRA NAYLA 13/12/2023
TOTAL
1 3513154905220001 SOFIATUN NISAK 9/5/2022

2 3513152608220001 KAMAL TAMAMI 8/26/2022
3 3513152608220002 KAMEEL MUSTOFA 8/26/2022
4 3513154708220002 AYRA SHERLY 8/7/2022
5 MUHAMMAD RYAN 12/12/2022
6 3513152303230002 MUH. ILZAM BAIHAQQI 3/23/2023
7 3513153004220002 RAMADHANI SAMUEL 4/30/2022
TOTAL
1 3513154604220002 NIMAS AYU CANDRAWINATA 06.04.2022

2 3513155304220001 NASYWA JENNAIRA ANDHISA 13.04.2022
3 3513155404220001 ANINDA ARSYILA SAVINA 14.04.2022
4 3513154910220001 GITA PRAMA PUTRI 09.10.2022
5 3513157110220002 ADZKIYA ALMIRA ANANDA AHMAD 31.10.2022
6 3513151112220001 MAULANA ISHAQ 11.12.2022
7 3513151112210001 MUHAMMAD SIHABUDDIN 11.12.2022
8 3513155612220002 ZHAKEELA AZZAHRA PUTRI 16.12.2022
9 3513152412220001 KENZO ALFARIZKY 24.12.2022
10 3513156512220001 NORA INAYATUL MAULA 25.12.2022
11 3513151601230001 M FAJRI SYAHDAN NOVAL 16.01.2023
12 3513150603230001 M DEVRIAN SYAH 06.03.2023
13 3513152003230002 DAFRI HAFIZH ISKANDAR 20.03.2023
14 3513154504230003 RA ISSA ELSHANUM R 05.04.2023
15 3513155104230001 KHOIRUN ALFISAH 11.04.2023
16 3513151304230002 AHMAD KHOIRUZZAD 13.04.2023
17 3513156504230001 SYIFA ZAHIDAN AL AQLI 25.04.2023
18 3513156309230001 KANIA DINI SEPTIANA PUTRI 22.09.2023
19 3513150912230001 M DARUL HIDAYAT 09.12.2023
20 3513142512230002 M DANIEL ANDREANSYAH 25.12.2023
21 3513152101240001 HAMDAN JAZAA USY SYUKRI ROHMAN 21.01.2024
22 3513154102240002 KANZA ALIYA SALSABILA 01.02.2024
23 KK BLM JADI ANINDA YASMIN JINAN RISKI 25.02.2024
TOTAL

1 3513156104220002 FARAH NUR FITRIA 21.04.2022

2 3513154610220001 FATIMAH ZAYNA AHMAD 06.10.2022
3 3513150611220002 MOCH GIBRAN ATTARAZQA 13.11.2020
4 KK BKL JADI M JARJIS AD DAKHIL 10.01.2023
5 3513151305230001 M ALFAN AHSANUL K 13.05.2023
6 3513155501240001 ARUMI NASHA RAZETA 15.01.2024
7 3513150503240001 M IQDAM ALFARIZKI 05.03.2024
hh/bb/tttt
TOTAL
1 3513151105220001 SAYOGO DEWANANDA RAHMAN 5/11/2022

2 3513151108220001 RENO MUBAROK 8/11/2022
3 3513155009220002 SYALWA AZKIYA QOTRUN NADA 9/10/2022
4 3513155009220001 AYESHA RIZQIA SHALEHAH 9/10/2022
5 3513155709220002 SHOFIYANA WIBOWO 9/17/2022
6 3513154510220001 LUBNA HUMAIRA 10/5/2022
7 3513154802230001 SYIFAUR ROHMAH 2/8/2023
8 MUHAMMMAD VIRZHA ROMADHON 3/31/2023
9 3513156904230005 ARSYI RAUDLATUL JANNAH 4/29/2023
10 3513152605230001 MUHAMMAD ULUL AZMI 5/26/2023
11 3513157004230002 FATIMAH NUR AGNIA 4/30/2023
12 3513140506230002 M ALFARIZKY ALIF M 6/5/2023
13 AHMAD ABABIL 1/15/2024
14 M ZULFIKAR HAFIDZ ALIFAR RIFQY 1/30/2024
15 MUHAMMAD KENZO RAMADHANI 3/13/2024
TOTAL

1 3513151607220004 MUHAMMAD KARUNIA ZAFRAN 7/16/2022

2 3513154410220002 ANINDITA KEISHA ZAHRA 10/4/2022
3 3513156104230001 CANDRAGITHA AYU SASIKIRANA BAHRONI 4/21/2023
4 3513155909230001 HELENA WAFDA ELRAHBINI 9/19/2023
TOTAL

1 3513153105220001 MUHAMMAD AL FATIH 5/31/2022

2 3513152506220001 ALFA KEANO MAULANA I 6/25/2022
3 3513155907220002 PUTRI ALYA S 7/29/2022
4 3513150809220001 AHMAD SHOLEH AL IDDRUS 9/8/2022
5 3513150612220001 MUHAMMAD ARFAN ATHAR RAZKA 12/6/2022
6 3513154812220001 ADIBA SHAKILA PUTRI MAHARANI 12/8/2022
7 3513152510220002 AKBAR MAULANA IBRAHIM 10/25/2022
8 3513155003230001 ANINDITA KEISHA ZAHRA 3/10/2023
9 3513151203230001 ELZIO NAZRIL ABQARY NUGROHO 3/12/2023
10 3513150307230003 ARYAN DAFI FAHRIAN 7/3/2023
11 3513155007230002 KHOLISA SALSABILA 7/10/2023
TOTAL
Provinsi JAWA TIMUR
Kabupaten PROBOLINGGO
Puskesmas KREJENGAN
1 3513176709010002 KANIA BILBINA HANIFF 11/11/2023

2 3513156006230001 HODIZA ANISA AZZAHRA 6/20/2023
3 3513150804230001 M.MAULANA MALIK I 4/8/2023
4 3513151912220001 SAIF ZAFFRAN ARRAZY 12/19/2022
5 3513157110220001 AINUUN RAHMA ANASYA O 10/31/2022
6 351315180922000 ARKANZA K.REGADEVAN 9/18/2022
7 351315090822000 AZKA ARANSHA 8/9/2022
8 351315030922000 YOKI ARYA SAPUTRA 9/3/2022
9 351315020822000 M.HASN AR RIFAI 8/2/2022
10 '351315570722000 BIANI SHAKILA 7/17/2022
Provinsi JAWA TIMUR

Puskesmas KREJENGAN
1 351315090224000 TSAUQIFA DIVYA PUTRI 2/9/2024

2 3513152112230001 SANDHIKA AHMAD S 12/21/2023
3 MUH.DANIYAL FAYYAD K 7/7/2023
4 QIRANI ALVIA RAMADHANI 3/30/2023
5 3513155312230002 AISHWA DIVANIA INARA 12/13/2023
6 35131511100230001 MUHAMMAD REVAN A 10/11/2023
7 3513151010230002 MUHAMMAD GIBRAN D 10/10/2023
8 351315140823000 M.ZYAN ARIFIN 8/14/2023
9 3513151408230001 AZZAM ALFARUQ 8/18/2023
10 351315110823000 ZAYN MALIK YUDANA P 8/11/2023
11 351315020823000 AHMAD FAIZ SU'UDI 8/2/2023
12 3513151407230001 M.HASBI ALFARISKI 7/14/2023
13 3513151906230002 M.VERO SYAIFULLAH 6/19/2023
14 351315560623001 HOFIDATUR ROFIKAH 6/16/2023
15 3513153004230002 M.ATTAQQI RAFANDRA 4/30/2023
16 3513150804230002 M.EMMERIL ROMADHON 4/8/2023
17 3513155303230001 TIARA DWI RENATA 3/13/2023
18 351315470323000 ZASQIA HALIMA.H.P 3/7/2023
19 3513152702230002 M.MUMTAZ HIBRIZI 2/27/2023
20 351315630123001 JASMINE ANASTASYA 1/23/2023
21 351315421222000 ALIFAH NUR AISYAH 12/2/2022
22 351315190822000 M.GALVIN SAPUTRA 8/19/2022
23 351315090822000 M.ELGIO AGUSTIN P 8/9/2022
24 NUR AINI 8/2/2022
25 351315570722000 NAFISYA KAILA PUTRI 7/24/2022
26 351315630622000 AEERA CANTIKA RAHAYU 6/23/2022
27 351315140622000 M.ZILAN AL FATIH 6/14/2022
28 3513150905220000 M.N.BAUYRZHAN A 5/9/2022
29 351315070422000 M.ROMZI ARIFI 4/7/2022
30 351315240322000 M.ZAFRAN ELZIO 3/24/2022
TOTAL
Provinsi JJAWA TIMUR

Puskesmas KREJENGAN
1 3513153309230001 SHANUM NIDA AISYAH 9/13/2023

2 3513152704230001 ARSHAD SABILUL NAFIS 4/27/2023
3 3513151904230001 FAGAN ZIO ELFANDER 4/19/2023
4 3513152912220001 RYUGA REZILDAN ASTARA 12/29/2023
5 351315270822000 MUHAMMAD ZAKA 8/27/2023
6 351315250822000 MUHAMMAD HAIKAL 8/25/2022
7 351315640622000 NUR ALIFAH HIBATILLAH 6/24/2022
8 351315630622000 ADZKIA MAR'ATUS S 6/23/2022
9 351315100522000 M.ALGAFFARUL HASAN 5/10/2022
10 351315040522000 EKA RANSHA ALVARO 5/4/2022
12
Provinsi :
Kabupaten :
Puskesmas :
7 RAFIF FATIR ALFARIZI 26/8/2022

13 MUHAMMAD RAYYANZA GHIBRAN AL 9/7/2023
TOTAL
Provinsi :
Kabupaten :
Puskesmas :
3 NIA ILMA RADIKA ZAHRA 7/4/2022

4 SITI LAILATUL AISWA 22/4/2022
TOTAL
Provinsi :
Kabupaten :
Puskesmas :
2 NAILA WILFA SHARIFAH 7/3/2022

3 IQLIMATUZ ZAHRO 23/3/2022
4 MUHAMMAD REYFAN ALFARISQI 23/5/2022
16 ZAHRA FIRDAUSIA 25/06/2023
TOTAL
3 3513155306220001 NASHITA JIHAN AZUSA 6/13/2022

4 3513156906220002 MAUREN AYDA ELSANUM 6/26/2022
3 3513154209220003 FATIMATUS ZAHRO 2/9/2022
4 3513156208220002 ZIDNI ILMA 22/08/2022
TOTAL
Kabupaten : kabupaten
1 Bintang Erlangga 3/1/2023

2 Taufiq Rahman Habibi 3/7/2023
3 Fatimatuszahro 3/31/2023
4 Hawa Aqila Romadoni 4/1/2023
5 Nadziratul Maula R 4/5/2023
6 Fatimah Azahra 6/14/2023
7 Kuntum Fii AmanIllah 6/17/2023
8 Zahra Kamilatun Nuha 7/7/2023
9 daffa Ghifar Atharazka 7/9/2023
10 M.Miftah AL Hidayah 8/11/2023
11 Faradisa Aulia P 8/12/2023
12 Dilan Alfarizki 10/12/2023
13 Aira Syahnuna 10/29/2023
14 Khadijah Aliah 10/29/2023
15 Naureen Ananda 11/3/2023
16 Nora Farhana 11/6/2023
18 M.Dzaka Arkansa 4/23/2023
19 Sylvia Vania Sela 12/12/2023
20 Nawira Asyifa 12/23/2023
21 Hafiza Zidna Meidina H 12/27/2023
22 Ahmad Azriel Yanuar 1/1/2024
23 Saka Abisatya 1/5/2024
24 Hafshotul Azizah 1/11/2024
25 Nur Muhammad Maher 2/9/2024
26 Ayana Riska N 2/15/2024
27 Abyan Ahmad Alfarisi 5/4/2022
TOTAL
Provinsi :
Kabupaten :
Puskesmas :
1 3513151904220002 M.Saifullah 4/19/2022

2 3513152403220002 M.Reyfan.P 3/24/2022
3 3513150605220002 Muh.Arka Syarif ibrohim 5/6/2022
4 3513151406220002 Muh.Ahzam Habibi alkatiri 6/14/2022
5 3513154306220001 Keisha azkiya khaila 6/3/2022
7 3513154806220001 Bilqis Zahira Lis wulandari 6/8/2022
8 3513155507220001 Syarifah mujahidah 7/15/2022
9 3513151007220001 Muh.Alvaro nur rayanza 7/10/2022
10 3513154308220001 Haura Ezra Zakira 8/3/2022
11 3513151210220001 Alan ardiansyah 10/12/2022
12 3513154512220001 Putri Dwi veranita 12/5/2022
13 3513156511220001 Malika tuhfatul aulia 11/25/2022
14 3513150712220001 M.Azril hasan 12/7/2022
15 3513152511220001 Moh.Qaidul akhyar 11/25/2022
16 3513082209220001 Muh.Abyan biantara 9/22/2022
17 3513156912220002 Viona nur khanza 12/29/2022
18 3513151501230001 Moh.Arsya abdullah 1/15/2023
19 3513155301230002 Jelita Izzatul Hafkarina 1/13/2023
20 A.Rayyan labib Alfa rizqi 1/1/2023
21 3513154902230001 Saidatun Nafisah 2/9/2023
22 3513152003230001 Muh.Bimantara firdaus 3/20/2023
23 35131558003230002 Najma zahira 3/18/2023
24 3513152802230001 M.Azril Hasan 2/28/2023
25 Izhan Malik Ramadnsyah 3/30/2023
26 Ainun Fitriah Ramadhan 4/4/2023
27 Fitria Ghania Ramadhan 4/22/2023
28 Muh Abdullah Fatih 5/27/2023
29 3513152309230001 Ayla Adkiatul 9/23/2023
30 Khalifano Albaria 9/26/2023
31 Wardatul Zahira 8/8/2023
32 Aisyah Ayu Diah 9/22/2023
33 3513153110230001 Muhammad Ali Fakih Pradana 10/31/2023
34 3513150611230001 M.Arsyad Zayyan Ibrahim 11/6/2023
35 "3513152210230001 M. Haikal Yusup 10/22/2023
36 Muhammad Hafiz Hidayatullah 11/22/2023
37 M. Alwi Sofi 11/27/2023
38 Fatiatus Zahro 12/22/2023
39 Aufa 1/16/2024
TOTAL
Provinsi :
Kabupaten :
Puskesmas :
1 3513152507230001 Kenzil Bidayatil Kamil 7/25/2023

2 3513152709220001 Mohammad Rayhan Kasyafani 9/27/2022
3 3513151705230001 Muhammad Syakir Niam 5/17/2023
4 3513151101230002 Muhammad Gibran Assyauqi 1/11/2023
5 3513150201230001 Muh.Zaki Al Fatih 1/2/2023
6 3513155808220001 Aqila Hilyatul Aulia 8/18/2022
TOTAL
2 NAURA MAZIDATUL ULFA 12/13/2022

7 M.SYAWAL ALFARIZKI 4/26/2023
17 KHALIZA RAMADANI 3/28/2023
23 HAFIDATUN NAJWA 6/12/2022
TOTAL
1 3513157107220001 MARIO AL QIBTIYAH 21.07.2022

2 3513153112220001 MUHAMMAD ASKA MAULANA 12/31/2022
3 3513150102230003 AHMAD NASR ALFAROBI 2/1/2023
4 3513156502230002 AYRA ASYFA MECCA 25/02/2023
5 3513154303230001 ERYNA 3/3/2023
6 3513150603230003 SABRIEL ARSHA AHMAD 3/6/2023
7 3513151403230001 MUHAMMAD SAQEEL RAFIANDRA 3/14/2023
8 3513151703230002 AHMAD AHSAN HOLIQI 3/17/2023
9 3513151903230002 M. ILYAS SYAKBANA 3/19/2023
10 3513154804230001 SASKIA DAFINAH RAMADHANI 4/8/2023
11 3513155905230001 SYAKILA NOURA ADZKIYA 5/19/2023
12 3513150311230001 AL VINO DAFFA MUWAFFAQ 11/3/2023
13 SHAQUILLE HAFIZ KASENDRIA 28.02.2024
14 M ALVINNUR AL HAKIM 07.03.2024
15 M MAULANA IBRAHIM 16.03.2024
1 3513155111220002 NURIL AQILA H 11/11/2022
2 3513155111220001 NOVITA KANZAL ARSY 11.11.2022
3 3513155711220002 ANISA SHAFIYYAH EL-RAHMAN 11/17/2022
4 3513156211220002 TSABITA NUSAIBAH AISYAH 11/22/2022
5 3513154612220001 ZEBY AGHNIA SHANUM Z 12/6/2022
6 3513156503230002 NAYLA AZKIYA RAMADHANI 3/25/2023
7 3513150705230001 M. ALDI ALFA RISKI 5/7/2023
8 3513151708230001 M. MIQDAD HASAN J 8/17/2023
9 3513154509230001 HILYATUL JANNAH ASYIFA 9/5/2023
10 RAIHANUN AIDA NAFIKA 12.01.2024
11 AYU FITRIA 29.02.2024
12 MIZYANA BELLE NAZIRA 29.02.2024
13 ANINDYA QALESYA SA'DINA 13.02.2024
14 CLARA SALSABILA 25.02.2024
15 R YOGA SUGERRA 10.03.2024
16 4.2024
9
FORMAT PENDATAAN POSYA
SASARAN IMUNISASI KEJAR <24 BULAN
gkapi status imunisasi dasar lengkap (0-11 bln) atau melengkapi status imunisasi baduta lengkap (12-23 bln)
Desa/Kelurahan : Widoro
Posyandu : matahari
Isilah kolom yang tidak berwarna!
UMUR (BULAN) NIK ORANG TUA NAMA ORANG TUA ALAMAT
22 3513151206840000 RIZKI AYUDIA/MASRUHA Desa KREJENGAN-Posy. MATAHARI

21 3513151207840000 USWATUN H/MUCAFI Desa KREJENGAN-Posy. MATAHARI
20 Desa KREJENGAN-Posy. MATAHARI
18 3513150710840000 FAHMIAWATI/KOMARI Desa KREJENGAN-Posy. MATAHARI
14 3513152002850000 DYANAH/FILDA Desa KREJENGAN-Posy. MATAHARI
13 3513150603850000 AGUSTINI/A WAHED Desa KREJENGAN-Posy. MATAHARI
13 3513151303850000 WIWIK/ WIDI Desa KREJENGAN-Posy. MATAHARI
12 3513152004850000 NUR AINI/SUGENG Desa KREJENGAN-Posy. MATAHARI
11 3513150405850000 KHAIRUN NISA/SHOLEHUDIN Desa KREJENGAN-Posy. MATAHARI
11 3513152505850000 SHOLEHATUN N/SUROSO Desa KREJENGAN-Posy. MATAHARI
10 3513150506850000 YULI WULANDARI/RONI Desa KREJENGAN-Posy. MATAHARI
10 3513151906850000 HALIMATUS S/HADI Desa KREJENGAN-Posy. MATAHARI
10 3513150406850000 WAHYUNI DWI Desa KREJENGAN-Posy. MATAHARI
9 3513150607850000 INDAH DWI Desa KREJENGAN-Posy. MATAHARI
9 3513151107850000 SANTI S/MISBAHUL Desa KREJENGAN-Posy. MATAHARI
7 3513151109850000 IKE NUR/ HERU P Desa KREJENGAN-Posy. MATAHARI
6 3513150810850000 MARHAMAH/ROBY Desa KREJENGAN-Posy. MATAHARI
4 3513151712850000 BAWON SAFITRI/ NIZAR I Desa KREJENGAN-Posy. MATAHARI
3 3513151201860000 ERMA N/ SYAIFUL H Desa KREJENGAN-Posy. MATAHARI
2 3513150702860000 FAIQATUL/ Desa KREJENGAN-Posy. MATAHARI
TOTAL
Desa/Kelurahan : krejengan
Posyandu : teratai
21 3513152207840000 LILIK SUHAIRIYAH/MUH RISAL Desa KREJENGAN-Posy. TERATAI

20 3513152707840000 YUNI LAILATUL F/MAHMUD Desa KREJENGAN-Posy. TERATAI
19 3513151909840000 HAFIFA/HASA Desa KREJENGAN-Posy. TERATAI
17 3513151711840000 MUSAIYADATUR/MUSAQI Desa KREJENGAN-Posy. TERATAI
15 3513150901850000 SITI RUSMINA/WAHED Desa KREJENGAN-Posy. TERATAI
15 3513151501850000 YUNI UNSILA/JONI Desa KREJENGAN-Posy. TERATAI
16 3513151612840000 ITA KURNIA/MAHFUD Desa KREJENGAN-Posy. TERATAI
13 3513152802850000 NURUL BADRIA/FIRDAUS Desa KREJENGAN-Posy. TERATAI
12 3513151204850000 SITI FATIMAH/AKBAR Desa KREJENGAN-Posy. TERATAI
6 3513151510850000 ANISAIL/ADITYA Desa KREJENGAN-Posy. TERATAI
5 3513150211850000 HERLINDA/KHOLILIL Desa KREJENGAN-Posy. TERATAI
1 3513151003860000 SALIMATUL Desa KREJENGAN-Posy. TERATAI
TOTAL
Posyandu : anggrek
22 3513152705840000 HOLIP/SAMSUL Desa KREJENGAN-Posy. ANGGREK

15 3513150901850000 MUSYAROFAH/HASYIM Desa KREJENGAN-Posy. ANGGREK
7 3513150209850000 UMI ZAHRO/SAIFUL B Desa KREJENGAN-Posy. ANGGREK
3 3513150601860000 FARIDA/SILAHUL Desa KREJENGAN-Posy. ANGGREK
2 3513151002860000 FITRI A/ Desa KREJENGAN-Posy. ANGGREK
1 3513151603860000 ROFIDAYANTI / HARTONO Desa KREJENGAN-Posy. ANGGREK
TOTAL
Posyandu : rosela
22 3513150106840000 SAPUATIN/USMAN U Desa KREJENGAN-Posy. ROSELA

20 3513151808840000 KARUNIA/INDRA Desa KREJENGAN-Posy. ROSELA
13 3513152702850000 SUSILOWATI/ A BASIRI Desa KREJENGAN-Posy. ROSELA
12 3513152703850000 ILMIYATI/MISBAHUL Desa KREJENGAN-Posy. ROSELA
12 3513151304850000 SUSI HIDAYATI Desa KREJENGAN-Posy. ROSELA
9 3513150207850000 KARIMA/SAIFUR Desa KREJENGAN-Posy. ROSELA
9 3513152007850000 INAYATUR/NURHASAN Desa KREJENGAN-Posy. ROSELA
7 3513151509850000 ELMA T/M ARIFIN Desa KREJENGAN-Posy. ROSELA
1 3513150203860000 QURROTU AINI / FERY ANANG Desa KREJENGAN-Posy. ROSELA
1 3513151403860000 YUNI RIZKI / SUDIYANTO Desa KREJENGAN-Posy. ROSELA
TOTAL

Desa/Kelurahan : Sentong
Posyandu : Matahari
11 MOH. ADIB DUSUN KRAJAN

11 DEDI DEBIANTORO DUSUN KRAJAN
10 M. LUTFI DUSUN KRAJAN
6 FEBRY INDRA DUSUN KRAJAN
6 MOH. ANAS DUSUN KRAJAN
5 ALVAN FATHONY DUSUN KRAJAN
TOTAL
Posyandu : Rembulan
17 MAISANDI DUSUN KADEMANGAN

14 EDY SUHENDRI DUSUN KADEMANGAN
12 GUNTUR S.P DUSUN KADEMANGAN
11 MUSTAGHFIRIN DUSUN KADEMANGAN
MUZAYYIN DUSUN KADEMANGAN
SAIFUL ISLAM DUSUN KADEMANGAN
TOTAL
Posyandu : Bintang
24 HOSEN DUSUN SELOLEMBU

20 RAMA JAYA. P DUSUN KEDUNG BERINGIN
19 FARABI FARHAN DUSUN SELOLEMBU
18 ANSORI DUSUN KEDUNG BERINGIN
13 SATRIO WAHYUDI DUSUN SELOLEMBU
10 NUR HASAN DUSUN KEDUNG BERINGIN
TOTAL

Desa/Kelurahan : TANJUNGSARI
Posyandu : ANGGREK
16 QONITA WALIYA KRAJAN

10 IMAY ROSITA/PUTRA KUSUMA KRAJAN
TOTAL
Desa/Kelurahan : TANJUNGSARI
Posyandu : MAWAR
TOTAL

Desa/Kelurahan : JATIURIP
Posyandu : KRAJAN
24 IMA KRAJAN
22 SA'DIYAH KRAJAN
22 NUR HASANAH KRAJAN
24 ILHAM S KRAJAN
21 ELOK KRAJAN
21 IKA RIZKIYAWATI KRAJAN
20 NUR AINI KRAJAN
20 ERNAWATI KRAJAN
18 ITAUL HAQIQOH KRAJAN
26 LAILATUS SHONIYA KRAJAN
17 NURUL BAHRIYA KRAJAN
16 DIANA ULFA KRAJAN
15 LAILATUS SA'ADAH KRAJAN
15 NUR SYAMSIAH KRAJAN
14 SITI FAIQOH KRAJAN
14 SHOLEHATI KRAJAN
14 SHOFWATUL Q KRAJAN
12 NUR LAILATUL KRAJAN
13 INTAN PUTRI KRAJAN
12 MUTMAINNAH KRAJAN
10 LINDA KRAJAN
6 NUR SAATIN KRAJAN
6 TITIN NAIMA KRAJAN
6 UMI HABIBAH KRAJAN
5 MAFTUHATUL FIKRYAH KRAJAN
5 EVA MUSAHALIFAH KRAJAN
12 IKE WIDYAWATI KRAJAN
6 FADILATUL ISTIQOMAH KRAJAN
TOTAL
Posyandu : KURIPAN
TOTAL
Posyandu : LAMUR BUARAN
3 USISA LAMUR BUARAN

TOTAL
Desa/Kelurahan : TEMENGGUNGAN
Posyandu : KAMBOJA TEGALAN
23 HALIMATUS S TEGALAN
21 LAILATUL QURAINI TEGALAN
19 ANI SUPRIYANI TEGALAN
14 ELSA FERNANDA TEGALAN
12 NOVI ARISANTI TEGALAN
7 JUMAATI TEGALAN
3 DWI QOMSIATUN TEGALAN
TOTAL
Posyandu : ANGGREK ASEM LEDOK
19 SAFITRI ASEM
23 MAISAROH LEDOK
23 ARINATUL ASEM
20 MUSYAROFAH LEDOK
21 SUNARIYA ASEM
20 MURNI JAYANTI ASEM
26 ERICA HAYATI LEDOK
18 SILAWATI LEDOK
18 SOFIATUL H LEDOK
16 HOSNAWIYAH ASEM
14 SITI LATIFA ASEM
15 JUMAATI ASEM
17 SITI ROISAH LEDOK
12 EVA FEBRIYANTI ASEM
12 EVA SOLEHATIN ASEM
10 SISTA AYU LEDOK
10 FITRIYANTI LEDOK
10 DIAH ASEM
9 FITRI WULANDARI LEDOK
8 ALFINA DAMAYANTI LEDOK
8 DIANA ULFA LEDOK
4 ELISA LEDOK
3 ALIFA LEDOK
2 DESI ASEM
3 EGA ASEM
TOTAL
Posyandu : FLAMBOYAN KRAJAN DAN PARSEH
25 SAMSIATUN HOIRIYAH PARSEH

24 VIDIA DWI PUJI RAHAYU KRAJAN
24 DWI WULANDARI KRAJAN
23 HUSNUL HOTIMAH PARSEH
22 SITI MARYAM KRAJAN
22 INA DIANA SUSI KRAJAN
22 QURROTUL AINI L KRAJAN
20 SITI MUTMAINNAH KRAJAN
20 NANDA IKA F KRAJAN
24 SHOFIATUR R. KRAJAN
19 LAILATUL F KRAJAN
19 SHOFIATUN N. KRAJAN
19 NOVRISKA DEWI PARSEH
19 NAIBA KRAJAN
16 RUHANA KRAJAN
14 SITI AMINATUS Z KRAJAN
14 HABIBAH PARSEH
13 NIA NURHAYATI PARSEH
13 HOLIA ILMI KRAJAN
12 ALDA ROSITA D PARSEH
10 SOLIHATIN KRAJAN
8 JAMIAH PARSEH
8 UMI HUSNUL KRAJAN
5 RAHMAWATI KRAJAN
5 SARIFATUL LAILI KRAJAN
4 EKA ROHAYU PARSEH
4 WINA AMELIA KRAJAN
TOTAL
Desa/Kelurahan : Patemon
Posyandu : Krajan
24 SANTI KRAJAN
24 ST SHOLEHAH KRAJAN
12 NIKMATUL AMALIA KRAJAN
13 HAPSAWATI KRAJAN
CITRA KRAJAN
4 DEWI SANENA KRAJAN
TOTAL

Desa/Kelurahan Patemon
Posyandu : mawar
23 BERLIAN KELORAN
22 LINDIATUL F KELORAN
21 FIDAWATI KELORAN
21 EVI MAQFIROH KELORAN
21 LUSTI YULIS KELORAN
20 SANETI KELORAN
20 WARSIDA KELORAN
20 FITRIA KELORAN
19 RISKA KELORAN
19 SEPTIANA KELORAN
15 SHOLEHATUN U KELORAN
14 ST MAURO KELORAN
14 ST MAURO KELORAN
14 BELLA KELORAN
14 SUCIK YULIATI KELORAN
12 LINDA WULANDARI KELORAN
12 SRI WAHYUNI KELORAN
12 ST NUR HALISA KELORAN
12 SUSI JINANIL F KELORAN
10 FITRIYAWATI KELORAN
5 HUZAIMAH KELORAN
7 UHYULIS SUNNAH KELORAN
7 LUSI ISMAWATI KELORAN
6 IKA ANDINI KELORAN
5 DWI LESTARI KELORAN
5 LILIK Y KELORAN
4 ITA KELORAN
TOTAL

Desa/Kelurahan : Patemon
Posyandu : Kenanga
25 SRI HOTIMAH PATEMON UTARA

23 DEWI RAHAYU PATEMON UTARA
22 ST ELVIANANUR PATEMON UTARA
21 TUTIK H PATEMON UTARA
20 QUROTUL AINI PATEMON UTARA
19 SITI FATIMAH PATEMON UTARA
19 MAULANA YULIA PATEMON UTARA
19 MAULANA YULIA PATEMON UTARA
18 APRILIA PATEMON UTARA
18 AYU WANDIRA PATEMON UTARA
16 ERNI WAHYUNI PATEMON UTARA
15 RENI P PATEMON UTARA
14 NURHIDAYATI PATEMON UTARA
14 ST AISYAH PATEMON UTARA
14 SULAIHA PATEMON UTARA
14 DESY JUNARIDA PATEMON UTARA
14 DESY JUNARIDA PATEMON UTARA
14 FITRI RUHAYATI PATEMON UTARA
13 SUSANTI NUR DEVIA PATEMON UTARA
10 UMIDATUR PATEMON UTARA
9 PUTRI PATEMON UTARA
8 MAULIN PATEMON UTARA
6 FIANA Z PATEMON UTARA
5 BUADI PATEMON UTARA
4 YULIANA PATEMON UTARA
3 EFA YULIANA PATEMON UTARA
3 PUTRI RAHAYU PATEMON UTARA
3 LILIK KURNIASIH PATEMON UTARA
TOTAL

Desa/Kelurahan : OPO-OPO
Posyandu :
20 HERMANTO GUNUNG WURUNG

21 SOLIKHIN SUMBER BANGER
21 SOLIKHIN SUMBER BANGER
21 FAIS GUNUNG WURUNG
17 SOLEHUDDIN GUNUNG WURUNG
14 SUBAIRI GUNUNG WURUNG
25 AGUS SALIM KRAJAN
TOTAL

Desa/Kelurahan : RAWAN
Posyandu : MAWAR
23 SAIFUL ULUM / ARTIKA PETTE 01/II

23 YUDI DWI YULIANTO / USISA A KRAJAN 03/I
23 RUDI HARYANTO / DIA PUJI AST PETTE 02/II
17 ULFA SAFIAH / GUGUN G KRAJAN 02/I
17 OKTAVIA KINANTI WULAN DINI / PETTE 02/II
15 SITI MUAWANAH / SUPRIYADI KRAJAN 01/I
15 SITI MUAWANAH / SUPRIYADI KRAJAN 01/I
15 UMI KULSUM / HASAN KRAJAN 01/I
15 ENDANG P / YUDI HARSONO PETTE 01/II
15 ALPIYATUL M / JUNAIDI PETTE 02/II
14 ANIS / SYAIFUL ULUM KRAJAN 03/I
12 SUBAIYAH / SUMANTO PETTE 02/II
12 UMRIATUL HASANAH / JONI ISK PETTE 02/II
11 RINA OKTAVIA / AHMAD DANI KRAJAN 01/I
11 HENI NURIS / M ROHIM KRAJAN 02/I
11 HERLIN MAYANGSARI / IMDATU KRAJAN 03/I
11 WINDA MARDIANA / ROSIFUL AQ KRAJAN 03/I
6 TITIK KURNIAWATI / ANDIKA PETTE 01/II
3 SITI ZULAIHA / TAUFIQ HIDAYAT PETTE 02/II
3 WAHYUNI / SULI KRAJAN 01/I
2 ZULFAWATI / HASBULLAH KRAJAN 02/I
1 YATI OKTAVIA / HASBULLAH PETTE 02/II
1 ISMANIAH / SHOLEH HUDDIN PETTE 02/II
TOTAL
Desa/Kelurahan : RAWAN
Posyandu : ANGGREK
23 SAMSUL ARIFIN / AISYAH SEMAR 02/III

17 AHMAD FA'IZ / ROFIATUS UND SEMAR 02/III
16 NIMAN / IRA WINARSIH SEMAR 03/III
14 M SYAKUR / ISMAWATI SEMAR 02/III
10 SYAIFUL BAHRI / NUWARUL KA SEMAR 01/III
2 ROSIANA / DIAN FIRDAUS SEMAR 01/III
0 NOVIATUL UMAMI / BAIDAWI SEMAR 01/III
#VALUE!
TOTAL

Desa/Kelurahan : SEBORO
Posyandu : CEMPAKA/ KEMBANG
24 ALIYAH/ LANGGENG C KEMBANG

21 MUSDALIFA /M ARIF KEMBANG
20 HERLINA/ M HOSEN KRAJAN
20 LULUK / KARSUDI KEMBANG
20 YULIANA/ SUHARTO W KEMBANG
19 NUR AINI/ MUH ZAINI KEMBANG
15 NANIK / SHOFIUDDIN KEMBANG
13 MITA WAHYUNI/ A FAUZAN KRAJAN
12 NUR CHALIMAH/ M LUTFI ALI KRAJAN
11 NUR HAMIDA/ MOCH WAHYUNI KEMBANG
12 SITI HALIMA/ DONI ARIDANATA KEMBANG
11 ATIK W/ IMRON MUFTI KEMBANG
4 UMI SUILA/ANDI K KEMBANG
3 IRMA KARTKA /EKO S KEMBANG
2 NUR KHOTIMA/FAIZAL AMIEN KRAJAN
TOTAL
Posyandu : TERATAI/ GILIH
22 MURNISA/ ASIM GILIH

19 HABIBATUN/SOLEHUDDIN GILIH
13 CHARISHMA EKA/ RONI GILIH
8 NUR HOLIFAH/ ATIQ GILIH
TOTAL
Posyandu : MELATI/ JEJE'EH
23 YULIA NINGSIH/ ANDIKA JEJE'EH

23 SITI MAULINA/ IMAM JEJE'EH
22 HALIMATUS S/ M ALIMI JEJE'EH
20 NUR FADILLAH/ SAYYID A JEJE'EH
17 WINDI MAULINA/ ABDUR RAHIM JEJE'EH
17 NURHAYATI/ SUDIARTO JEJE'EH
19 IMROATUS S/ AKBAR W JEJE'EH
14 LENI LISTIANI/ RONI W JEJE'EH
14 SUTIANI / NANANG JEJE'EH
10 IIS MAWATI/ NURUL HUDA JEJE'EH
10 USWATUN H/ SUPRIADI JEJE'EH
TOTAL

Desa/Kelurahan KARANGREN
Posyandu MAWAR
6 M.GAZALI/ NURUL FADILAH SUKUN 02/02

11 HERMAN / NOVA SUKUN 05/02
13 IRHAM/ALFIATUL SUKUN 03/02
17 UNAIDI/NUR FAZILA SUKUN 03/02
18 SAMSUL/DEWI SUKUN 02/02
20 MUHAMMAD/SITI SUKUN 03/02
21 VERY/VIVIN SUKUN 04/02
20 SAMSUL/SUPRIYATIN SUKUN 04/02
21 KAMIRULLAH/HANIFAH SUKUN 02/02
22 MAULUDDIN/RUBIYATUL SUKUN 03/02
Posyandu ANGGREK
3 MASIAN WAHYUDI GERDU 03/02

5 SANDI SUJADI KRAJAN 4/1
10 YUDI KISDIYANTO
13 SAUJIK
5 MASTUKI GERDU 2/3
7 SUGENG H KRAJAN 2/1
7 A.MUFID.M GERDU 3/3
9 M.SYAMSUL A KRAJAN 01/01
9 HOSNAN KRAJAN 01/01
9 YUDA A.AMIN KRAJAN 05/01
9 MISBAHUL M KRAAN 03/01
10 AGUS SETIA B KRAJAN 04/01
11 SYAIFULLAH GERDU 01/03
11 SYAIFUL ISLAM GERDU 02/03
12 M.ZUHRI KRAJAN 01/01
13 A.JUNAIDI KRAJAN 01/01
14 SAUFA KRAAN 02/01
14 SLAMET H GERDU 3/3
14 SULHAN W KRAJAN 05/01
14 ABD.ANAS KRAJAN 04/01
15 HOLIQ GERDU 01/03
19 A.SYAIFUL KRAJAN 01/01
19 FAUZI ARISANDI KRAJAN 02/01
19 BAHARUDDIN KRAJAN 04/01
20 A.FAUZI GERDU 03/03
21 SUMARNO KRAJAN 01/01
21 S.ABDULLAH KRAJAN 04/01
22 DORI NUR R KRAJAN 01/01
23 RAHMAT KRAJAN 03/01
26 JUMARI KRAJAN 04/01
TOTAL
Posyandu KENANGA
8 MOH.WAQI' K.TIMUR 04/04

12 WIDI PRIYANTO K.TIMUR 03/04
13 KHAIRUL ANAM K.TIMUR 04/04
16 DAWIL ALBAB K.TIMUR 03/04
20 MOH.ZUBAIRI K.TIMUR 04/04
20 SYAMSURI K.TIMUR 01/04
22 ZAINULLAH K.TIMUR 04/04
22 SOLIHIN K.TIMUR 02/04
23 ABU HASAN K.TIMUR 04/04
23 BAHRAWI K.TIMUR 02/04
12

Desa/Kelurahan :
Posyandu : SUMBERMENDO /ANGGREK
#VALUE! DION WAHYUDI SUMBER MENDO

8 ANDI KURNIAWAN SUMBER MENDO
TOTAL
Desa/Kelurahan :
Posyandu : KASENGAN/MELATI
22 MUHAMMAD SAMSUUL ARIFI KASENGAN

#VALUE! ASMADI KASENGAN
TOTAL

Desa/Kelurahan : sumber katimoho
Posyandu : KRAJAN / MAWAR
22 ZAINUL HASAN KRAJAN

#VALUE! TAUFIQUURRQHQMN KRAJAN
#VALUE! CHAIRUL KRAJAN
#VALUE! HENDRIK KRAJAN
TOTAL

Desa/Kelurahan : DAWUHAN
Posyandu : ANGGREK

23 SITI ELIZA KRAJAN

23 CITRA ANTIKA KRAJAN
27 NURR JANNAH TOGUR
#VALUE! DIANA HOLIDA TOGUR
TOTAL

Desa/Kelurahan : widoro
Posyandu : aster
14 Siti Hamimah SUKUN

14 Siti Maryam ASEM
13 Halimatussakdiya SUKUN
13 Tutik Hidayati ASEM
13 Fatimatul zahro SUKUN
11 Nur Elvina ASEM
11 Siti Salma SUKUN
10 Ainur Rofiqoh ASEM
10 Febriana Ayu L ASEM
9 Eliza Khoirunnisa SUKUN
9 Sumiasih Eka SUKUN
6 Eny Yuliana ASEM
6 Aimatul maulidia ASEM
6 Fatimah Zahrah ASEM
5 Astrid Wahyu Arin ASEM
5 Indah P ASEM
11 Siri Faizah SUKUN
3 Lely Khotijah ASEM
3 Yulistyawati ASEM
4 Halia SUKUN
4 Veni SUKUN
4 fatimatuzzahro SUKUN
4 Susi Yunita ASEM
3 Siti Romlah SUKUN
3 Yuliati SUKUN
24 Lailatul Maghfiroh Sukun
TOTAL
Desa/Kelurahan : GEBANGAN
Posyandu : Krajan
25 Yasin/Fadila Krajan
26 Salim/Nur azizah Krajan
24 M.Ibrahim Rahman/Dhefi zaeKrajan
23 Haris Alkatiri/Sofiatun Nisak Krajan
23 Abd.Mughni/Rusyana Krajan
23 Mukhlis/Suciani wulandari Krajan
22 Puji Hartono/Siti khoiriyah Krajan
22 Achmad Kholili/Siti nura Krajan
21 Gilang Ramadan/Hilfa nur aziKrajan
19 M.Irfan/Arbaiya Krajan
17 Moh.Holili/Ika yulianingsih Krajan
18 Sahirudin/Wahyu rini Krajan
17 Sendi Ariyanto/Linda herlina Krajan
18 Moh.Hamidi/Robiatul adawiyKrajan
20 Zainul Agus Sholeh/Khoirotu Krajan
16 M.Eko Budi/Nur aini Krajan
16 Samsul Arifin/Riski wulandariKrajan
16 Hafid/Nurul karimah Krajan
16 Misbahus salam/Siti aisah Krajan
15 Syaifullah/Hamidah Krajan
14 Moh.Hendrik/Siti khoiriyah Krajan
14 A.Yakub/Ummul mahdania Krajan
14 M.Ariyanto/Mega yuliana Krajan
13 Hendra Ferdiansyah/QomariyKrajan
13 Astamar/Yuliana safirah Krajan
13 Joni pranata/Heni Susanti Krajan
11 Nina/M Faiz Krajan
7 Nazilatur/M Ainun Najib Krajan
7 Rena Angrraini/Ferdy FirdausKrajan
9 Lailatul surur/M rokip Krajan
8 Rofiatul Amaliyah Krajan
6 Lina/Fendi Krajan
6 Dlaefy/Irbahim Krajan
7 suci Nur jannah/Faris Krajan
5 Tutik Handayani Krajan
5 Khoirun nisa Krajan
4 Sofia Krajan
4 Ratna kumalasari Krajan
TOTAL
Desa/Kelurahan :
Posyandu : KOLORAN
9 Umarul Faruq/Inayatur RohmKOLORAN

20 Mohammad Kholil / Novi MagKOLORAN
12 Sario Priyanto/Lia Wulandari KOLORAN
16 Akhmad Fauzi Ansori/Nur wasKOLORAN
16 Sukirman/Ardiana KOLORAN
21 Rasid/Fadilatul Mukaromah
TOTAL

Desa/Kelurahan : Sokaan
Posyandu : Mawar
17 WASILAH PENANGAN
12 NUR AZIZAH PENANGAN
13 RIRIN PENANGAN
23 UMI KULSUM PENANGAN
TOTAL

Desa/Kelurahan : KAMAL KUNING
Posyandu : MELATI
20 RINI HIDAYATUL / SAMAN KRAJAN 2/I

15 KOMARIYAH KRAJAN 1/1
13 WARDATUS SHOLIHAH KRAJAN 4/2
11 NISA AULIA PUTRI Kkrajan 4/3
12 ZULFAWATI KRAJAN 1/1
9 SITI MUSAROFAH KRAJAN 4/2
12 ENDANG K KRAJAN 4/2
12 LAILATUL MASRURO KRAJAN 4/2
12 RIZA HUZAIMA KRAJAN 3/1
11 KHOFIDATUR ROFI'AH KRAJAN 1/1
10 SITI MARYAM KRAJAN 1/1
12 SOFIYAH KRAJAN 2/1
1 ILWANI KRAJAN
0 FAIZAATUL QODRIYAH KRAJAN
0 AFIFA KRAJAN
16 FITRIA IKA W KARANG ASEM 6/3
16 IKA MALTUS S / MOH DARUL F JATIAN 9/5
16 SITI MAMNUNA KARANG ASEM 5/3
16 LAILATUS SHAIMAH JATIAN 8/4
15 TUTIK HIDAYAH / SUPYANTO KARANG ASEM 5/3
12 SITI INAYATUL H KARANG ASEM 7/4
10 ARLIYA JATIAN 8/4
7 ILMI MUFIDATUL I JATIAN 7/4
6 SITTI FATIMA JATIAN 8/4
3 KHOLIFATUN KARANG ASEM
1 MASRUROH KARANG ASEM
1 RAHMATUL UMAH JATIAN
1 SITI LULUK JATIAN
1 LAILATUL QOMARIA JATIAN
0 DESI FITRIA NINGSIH KARANG ASEM
0 IIN TARLINA KARANG ASEM
9
ENDATAAN POSYANDU SASARAN IMUNISASI KEJAR
DOSIS IMUNISASI (BELUM DITERIMA=1, SUDAH DITERIMA ATAU BELUM WAKTUNYA MENERIMA = 0)
DPT-HB-Hib 1
DPT-HB-Hib 2
DPT-HB-Hib 3
DPT-HB-Hib 4
(0-11 BLN)
OPV 1
OPV 2
OPV 3
OPV 4
PCV 1
MR 1
MR 2
IPV 2
IPV1
BCG
0 0 0 0 0 0 0 0 0 0 1 0 0 0
0 0 0 0 0 0 0 0 0 0 1 0 0 0
0 0 0 0 0 0 0 0 0 0 1 0 1 0
0 0 0 0 0 0 0 0 0 0 1 0 1 0
0 0 0 0 0 0 0 0 0 0 1 0 1 0
0 0 0 0 0 0 0 0 0 0 1 1 1 0
0 0 0 0 0 0 0 0 0 0 1 0 1 0
0 0 0 0 0 0 1 0 0 0 1 1 1 0
0 0 0 0 0 0 0 0 0 0 1 1 1 0
0 0 0 0 0 0 1 0 0 0 1 1 1 0
0 0 0 0 0 0 0 0 0 0 1 0 1 0
0 0 0 0 0 0 0 0 0 0 1 0 1 0
0 0 0 0 0 0 0 0 0 0 1 0 1 0
0 0 0 0 0 0 1 0 0 0 1 1 1 0
0 0 0 0 0 0 0 0 0 0 1 0 1 0
0 0 0 0 1 1 1 0 0 1 1 1 1 0
0 0 0 1 1 1 1 0 1 1 1 1 1 0
0 0 1 1 1 1 1 1 1 1 1 1 1 1
0 0 1 1 1 0 1 0 1 1 1 1 1 0
0 0 1 1 1 1 1 1 1 1 1 1 1 1
0 0 3 4 5 4 8 2 4 5 20 10 18 2
DPT-HB-Hib 1
DPT-HB-Hib 2
DPT-HB-Hib 3
DPT-HB-Hib 4
OPV 1
OPV 2
OPV 3
OPV 4
PCV 1
MR 1
MR 2
(0-11
IPV 2
BLN)
IPV1
BCG
0 0 0 0 0 0 0 0 0 0 1 0 0 0
0 0 0 1 1 0 1 0 1 1 1 1 1 0
0 0 0 0 0 0 0 0 0 0 1 0 0 0
0 0 0 0 0 0 0 0 0 0 1 0 1 0
0 0 0 0 0 0 0 0 0 0 1 0 1 0
0 0 0 0 0 0 0 0 0 0 1 0 1 0
0 0 0 0 0 0 0 0 0 0 1 0 1 0
0 0 0 0 0 0 0 0 0 0 1 0 1 0
0 0 1 1 1 1 1 1 1 1 1 1 1 1
0 0 0 0 1 1 0 0 0 1 1 1 1 0
0 0 0 0 1 1 0 0 0 1 1 1 1 0
0 0 1 1 1 1 1 1 1 1 1 1 1 1
0 0 2 3 5 4 3 2 3 5 12 5 10 2
DPT-HB-Hib 1
DPT-HB-Hib 2
DPT-HB-Hib 3
DPT-HB-Hib 4
OPV 1
OPV 2
OPV 3
OPV 4
PCV 1
MR 1
MR 2
IPV 2
IPV1
(0-
BC
11
BL
N)
G
0 0 0 0 0 0 0 0 0 0 1 0 1 0
0 0 0 0 0 0 0 0 0 0 1 0 1 0
0 0 0 0 0 0 1 0 0 0 1 1 1 0
0 0 1 1 1 1 1 1 1 1 1 1 1 1
0 0 0 1 1 1 1 0 1 1 1 1 1 0
0 0 1 1 1 1 1 1 1 1 1 1 1 1
0 0 2 3 3 3 4 2 3 3 6 4 6 2
DPT-HB-Hib 1
DPT-HB-Hib 2
DPT-HB-Hib 3
DPT-HB-Hib 4
OPV 1
OPV 2
OPV 3
OPV 4
PCV 1
MR 1
MR 2
IPV 2
IPV1
(0-
BC
11
BL
N)
G
0 0 0 0 0 0 0 0 0 0 1 0 1 0
0 0 0 0 0 0 0 0 0 0 1 0 1 0
0 0 0 0 0 0 0 0 0 0 1 0 1 0
0 0 0 0 0 0 0 0 0 0 1 0 1 0
0 0 0 0 0 0 0 0 0 0 1 1 1 0
0 0 0 0 0 0 0 0 0 0 1 0 1 0
0 0 0 0 0 0 0 0 0 0 1 0 1 0
0 0 0 0 1 0 1 0 0 1 1 1 1 0
0 0 1 1 1 1 1 1 1 1 1 1 1 1
0 0 1 1 1 1 1 1 1 1 1 1 1 1
0 0 2 2 3 2 3 2 2 3 10 4 10 2
DPT-HB-Hib 1
DPT-HB-Hib 2
DPT-HB-Hib 3
DPT-HB-Hib 4
OPV 1
OPV 2
OPV 3
OPV 4
PCV 1
MR 1
MR 2
IPV 2
IPV1
(0-
BC
11
BL
N)
G
0 0 0 0 0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 0 0 0 0 1 0 0
0 0 1 1 0 0 0 0 1 1 0 0 0 0
0 0 0 1 0 0 0 0 0 1 0 0 0 0
0 0 0 1 0 0 0 0 0 1 0 0 0 0
0 0 1 3 0 0 0 0 1 3 0 3 0 0
DPT-HB-Hib 1
DPT-HB-Hib 2
DPT-HB-Hib 3
DPT-HB-Hib 4
OPV 1
OPV 2
OPV 3
OPV 4
PCV 1
MR 1
MR 2
IPV 2
IPV1
(0-
BC
11
BL
N)
G
0 0 0 0 0 0 1 0 0 0 0 0 0 1
0 0 0 1 1 0 0 0 1 1 0 0 0 0
0 0 0 0 1 0 0 0 0 1 0 0 0 0
0 0 0 0 1 0 0 0 0 1 0 0 0 1
0 0 0 0 0 0 0 0 0 0 0 0 0 1
0 0 0 1 0 0 0 0 0 1 0 0 0 1
0 0 0 2 3 0 1 0 1 4 0 0 0 4
DPT-HB-Hib 1
DPT-HB-Hib 2
DPT-HB-Hib 3
DPT-HB-Hib 4
OPV 1
OPV 2
OPV 3
OPV 4
PCV 1
MR 1
MR 2
IPV 2
IPV1
(0-
BC
11
BL
N)
G
0 0 0 1 1 0 0 0 1 1 0 0 0 0
0 0 0 0 1 0 0 0 0 1 0 0 0 0
0 0 0 1 1 1 0 0 1 1 0 1 0 1
0 0 0 0 1 0 0 0 0 1 0 0 0 1
0 0 0 1 1 1 0 0 1 1 0 1 0 1
0 0 0 1 1 1 0 0 1 1 0 1 0 1
0 0 0 4 6 3 0 0 4 6 0 3 0 4
DPT-HB-Hib 1
DPT-HB-Hib 2
DPT-HB-Hib 3
DPT-HB-Hib 4
OPV 1
OPV 2
OPV 3
OPV 4
PCV 1
MR 1
MR 2
IPV 2
IPV1
(0-
BC
11
BL
N)
G
0 0 0 0 0 0 0 0 0 1 1 1 0 1
0 0 0 1 1 0 0 0 1 1 0 0 0 0
0 0 0 1 1 0 0 0 1 2 1 1 0 1
DPT-HB-Hib 1
DPT-HB-Hib 2
DPT-HB-Hib 3
DPT-HB-Hib 4
OPV 1
OPV 2
OPV 3
OPV 4
PCV 1
MR 1
MR 2
IPV 2
IPV1
(0-
BC
11
BL
N)
G
#REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF!

DPT-HB-Hib 1
DPT-HB-Hib 2
DPT-HB-Hib 3
DPT-HB-Hib 4
OPV 1
OPV 2
OPV 3
OPV 4
PCV 1
MR 1
MR 2
IPV 2
IPV1
(0-
BC
11
BL
N)
G
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 28 0 0 0 0 0 0 0
DPT-HB-Hib 1
DPT-HB-Hib 2
DPT-HB-Hib 3
DPT-HB-Hib 4
OPV 1
OPV 2
OPV 3
OPV 4
PCV 1
MR 1
MR 2
IPV 2
IPV1
(0-
BC
11
BL
N)
G
#REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF!
DPT-HB-Hib 1
DPT-HB-Hib 2
DPT-HB-Hib 3
DPT-HB-Hib 4
OPV 1
OPV 2
OPV 3
OPV 4
PCV 1
MR 1
MR 2
IPV 2
IPV1
(0-
BC
11
BL
N)
G
0 0 1 0 0 0 0 0 0 0 0 0 0 0
0 0 1 0 0 0 0 0 0 0 0 0 0 0
DPT-HB-Hib 1
DPT-HB-Hib 2
DPT-HB-Hib 3
DPT-HB-Hib 4
OPV 1
OPV 2
OPV 3
OPV 4
PCV 1
MR 1
MR 2
IPV 2
IPV1
(0-
BC
11
BL
N)
G
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 1 1 1 0
0 0 1 1 1 1 1 1 1 1 1 1 1 0
0 0 1 1 1 1 1 1 1 1 1 1 1 1
0 0 2 2 2 2 2 2 2 2 3 3 3 1
DPT-HB-Hib 1
DPT-HB-Hib 2
DPT-HB-Hib 3
DOSIS IMUNISASI (BELUM DITERIMA=1, SUDAH DITERIMA ATAU BELUM WAKTUNYA MENERIMA = 0) DPT-HB-Hib 4
OPV 1
OPV 2
OPV 3
OPV 4
PCV 1
MR 1
MR 2
IPV 2
IPV1
(0-
BC
11
BL
N)
G
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 1 1 1 0 0 0 1 0 1 0
0 0 0 0 1 1 1 0 0 0 1 1 1 0
0 0 0 1 1 1 1 0 1 1 1 1 1 0
0 0 1 1 1 1 1 1 1 1 1 1 1 1
0 0 1 1 1 1 1 1 1 1 1 1 1 1
0 0 1 1 1 1 1 1 1 1 1 1 1 1
0 0 1 1 1 1 1 1 1 1 1 1 1 1
0 0 4 5 7 7 7 4 5 5 7 6 7 4
DPT-HB-Hib 1
DPT-HB-Hib 2
DPT-HB-Hib 3
DPT-HB-Hib 4
OPV 1
OPV 2
OPV 3
OPV 4
PCV 1
MR 1
MR 2
IPV 2
IPV1
(0-
BC
11
BL
N)
G
0 0 0 0 0 0 1 0 0 0 0 0 0 1
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0 0 1 0 0
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0 1 0 1 0
0 0 0 0 0 0 1 0 0 0 1 0 1 0
0 0 0 0 0 0 1 0 0 0 1 0 1 0
0 0 0 0 0 0 1 0 0 0 1 0 1 0
0 0 0 0 0 0 1 0 0 0 1 0 1 0
0 0 0 0 0 0 1 0 0 0 1 1 1 0
0 0 0 0 0 0 1 0 1 1 1 1 1 0
0 0 0 1 1 1 1 0 1 1 1 1 1 0
0 0 0 1 1 1 1 0 1 1 1 1 1 0
0 0 0 1 1 1 1 0 1 1 1 1 1 0
0 0 0 1 1 1 1 0 1 1 1 1 1 0
0 0 0 4 4 4 27 0 5 5 11 7 11 1
DPT-HB-Hib 1
DPT-HB-Hib 2
DPT-HB-Hib 3
DPT-HB-Hib 4
OPV 1
OPV 2
OPV 3
OPV 4
PCV 1
MR 1
MR 2
IPV 2
IPV1
(0-
BC
11
BL
N)
G
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 0 0 0 0 1 0 0
0 0 0 1 1 0 0 0 1 1 1 0 0 0
0 0 0 1 1 0 0 0 1 1 1 3 0 0

DPT-HB-Hib 1
DPT-HB-Hib 2
DPT-HB-Hib 3
DPT-HB-Hib 4
OPV 1
OPV 2
OPV 3
OPV 4
PCV 1
MR 1
MR 2
IPV 2
IPV1
(0-
BC
11
BL
N)
G
0 0 0 0 0 0 1 0 0 0 0 0 1 1
0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 1 0 0 0 1 0 1 0
0 0 0 0 0 0 1 0 0 0 1 0 1 0
0 0 0 0 0 0 1 0 0 0 1 0 1 0
0 0 0 0 0 0 1 0 0 0 1 0 1 0
0 0 0 0 0 0 1 0 0 0 1 0 1 0
0 0 0 0 0 0 1 0 0 0 1 0 1 0
0 0 0 0 0 0 1 0 0 0 1 0 1 1
0 0 0 0 0 0 1 0 0 0 1 1 1 0
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 1 1 1 0 0 1 0 0 0 0
0 0 0 0 1 1 1 0 0 1 0 0 0 0
0 0 0 0 1 1 1 0 0 1 0 0 0 0
0 0 0 0 1 1 0 0 0 1 0 0 0 0
0 0 0 1 1 0 0 0 1 0 0 0 0
0 0 0 1 1 0 0 0 0 1 0 0 0 0
0 0 0 0 1 0 0 0 0 1 0 0 0 0
0 0 0 1 7 5 23 0 0 7 8 1 18 2
DPT-HB-Hib 1
DPT-HB-Hib 2
DPT-HB-Hib 3
DPT-HB-Hib 4
OPV 1
OPV 2
OPV 3
OPV 4
PCV 1
MR 1
MR 2
IPV 2
IPV1
(0-
BC
11
BL
N)
G
1 1 1 1 0 1 0 1 1 0 0 0 0 1
1 0 1 1 1 0 1 0 1 1 1 0 1 1
0 0 0 0 0 0 1 0 0 0 0 0 1 1
0 0 0 0 0 0 1 0 0 0 1 1 1 1
0 0 0 0 0 0 1 0 0 0 0 0 1 1
0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 1 0 0 0 1 0 1 0
0 0 0 0 0 0 1 0 0 0 1 0 1 0
0 0 0 0 0 0 1 0 0 0 1 0 1 0
0 0 0 0 0 0 1 0 0 0 1 0 1 1
0 0 0 0 0 0 1 0 0 0 1 0 1 1
0 0 0 0 0 0 1 0 0 0 1 0 1 1
0 0 0 0 0 0 1 1 1 1 0 0 1 0
0 0 0 0 0 0 1 0 0 0 1 0 1 1
0 0 0 0 0 0 1 0 0 0 1 0 1 1
0 0 0 0 0 0 1 0 0 0 0 0 1 1
0 0 0 0 0 0 1 0 0 0 0 0 1 1
0 0 0 0 0 0 0 0 0 0 0 0 1 1
0 0 0 0 0 0 0 0 0 0 0 0 1 1
0 0 0 0 0 1 1 0 0 0 1 1 1 0
0 0 0 0 0 1 1 0 0 0 1 1 1 0
0 0 0 0 1 1 1 0 0 1 1 1 1 0
0 0 0 1 1 1 1 0 1 1 1 1 1 0
0 0 0 0 1 1 1 0 1 1 1 1 1 1
0 0 0 1 1 1 1 0 1 1 1 1 1 0
0 0 0 1 1 1 1 0 1 1 1 1 1 0
0 0 0 1 1 1 1 0 1 1 1 1 1 0
0 0 0 1 1 1 1 0 1 1 1 1 1 1
2 1 2 7 8 10 25 2 9 9 19 10 27 16
DPT-HB-Hib 1
DPT-HB-Hib 2
DPT-HB-Hib 3
DPT-HB-Hib 4
OPV 1
OPV 2
OPV 3
OPV 4
PCV 1
MR 1
MR 2
IPV 2
IPV1
(0-
BC
11
BL
N)
G
0 0 1 1 1 1 1 1 1 1 1 1 1 1
0 0 1 1 1 1 1 1 1 1 1 1 1 1
0 0 1 1 1 1 1 1 1 1 1 1 1 1
0 0 0 0 1 1 1 0 0 1 1 1 1 1
0 0 0 1 1 1 1 0 1 1 0 1 0 1
0 0 0 1 1 1 1 0 1 1 0 1 0 1
1 1 1 1 1 1 1 1 1 1 1 1 1 1
1 1 4 6 7 7 7 4 6 7 5 7 5 7

DPT-HB-Hib 1
DPT-HB-Hib 2
DPT-HB-Hib 3
DPT-HB-Hib 4
OPV 1
OPV 2
OPV 3
OPV 4
PCV 1
MR 1
MR 2
IPV 2
IPV1
(0-
BC
11
BL
N)
G
0 0 0 0 0 0 0 0 0 0 1 0 0 0
0 0 0 0 0 0 0 0 0 0 1 0 0 0
0 0 0 0 0 0 0 0 0 0 1 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 9 0 9 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 1 0 0 0 1
0 0 0 0 0 0 0 0 0 1 0 1 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 0 0 1 0 1 0 0
0 0 0 0 0 1 0 0 0 1 0 1 0 0
0 0 0 0 0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 1 0 0 0 1 0 1 0 0
0 0 0 0 0 1 0 0 0 0 0 1 0 0
0 0 0 0 0 1 0 0 0 0 0 1 0 1
0 0 1 1 1 1 1 1 1 1 0 1 0 1
1 1 1 1 1 1 1 1 1 1 0 1 0 1
1 1 1 1 1 1 1 1 1 1 0 1 0 1
1 1 1 1 1 1 1 1 1 1 0 1 0 1
1 1 1 1 1 1 1 1 1 1 0 1 0 1
1 1 1 1 1 1 1 1 1 1 0 1 0 1
5 5 6 6 6 10 6 6 6 11 12 14 9 8
DPT-HB-Hib 1
DPT-HB-Hib 2
DPT-HB-Hib 3
DPT-HB-Hib 4
OPV 1
OPV 2
OPV 3
OPV 4
PCV 1
MR 1
MR 2
IPV 2
IPV1
(0-
BC
11
BL
N)
G
0 0 0 0 1 0 1 0 0 0 1 0 1 0
0 0 0 0 1 0 1 0 0 0 0 0 0 0
0 0 0 0 1 0 1 0 0 1 0 0 0 0
0 0 0 0 1 0 1 0 0 1 0 0 1 1
0 0 0 0 1 1 1 0 0 1 0 1 0 0
1 1 1 1 1 1 1 1 1 1 0 1 0 1
1 1 1 1 1 1 1 1 1 1 0 1 0 1
2 2 2 2 7 3 7 2 2 5 1 3 2 3

DPT-HB-Hib 1
DPT-HB-Hib 2
DPT-HB-Hib 3
DPT-HB-Hib 4
OPV 1
OPV 2
OPV 3
OPV 4
PCV 1
MR 1
MR 2
IPV 2
IPV1
(0-
BC
11
BL
N)
G
0 0 0 0 0 0 1 0 0 0 1 0 1 1
0 0 0 0 0 0 1 0 0 0 1 0 1 0
0 0 0 0 0 0 1 0 0 0 1 0 1 0
0 0 0 0 0 0 1 0 0 0 1 0 1 0
0 0 0 0 0 0 1 0 0 0 1 0 1 0
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0 0 1 0 0
0 0 0 0 0 0 1 0 0 1 0 1 0 0
0 0 0 0 0 0 1 0 0 0 0 1 0 0
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 12 0 0 1 5 3 5 1
DPT-HB-Hib 1
DPT-HB-Hib 2
DPT-HB-Hib 3
DPT-HB-Hib 4
OPV 1
OPV 2
OPV 3
OPV 4
PCV 1
MR 1
MR 2
IPV 2
IPV1
(0-
BC
11
BL
N)
G
0 0 0 0 0 0 1 0 0 0 1 0 1 0
0 0 0 0 0 0 1 0 0 0 1 0 1 0
0 0 0 0 0 0 1 0 0 0 0 1 0 0
0 0 0 0 1 1 0 0 0 1 0 0 0 0
0 0 0 0 1 1 3 0 0 1 2 1 2 0
DPT-HB-Hib 1
DPT-HB-Hib 2
DPT-HB-Hib 3
DPT-HB-Hib 4
OPV 1
OPV 2
OPV 3
OPV 4
PCV 1
MR 1
MR 2
IPV 2
IPV1
(0-
BC
11
BL
N)
G
0 0 0 0 0 0 1 0 0 0 1 0 1 1
0 0 0 0 0 0 1 0 0 0 1 0 1 1
0 0 0 0 0 0 1 0 0 0 1 0 1 0
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 1 0 0 0 0
0 0 0 0 0 0 10 0 0 1 3 0 3 2
DPT-HB-Hib 1
DPT-HB-Hib 2
DPT-HB-Hib 3
DPT-HB-Hib 4
OPV 1
OPV 2
OPV 3
OPV 4
PCV 1
MR 1
MR 2
IPV 2
IPV1
(0-
BC
11
BL
N)
G
0 0 1 1 1 1 1 1 1 1 1 1 1 1
0 1 1 1 1 1 1 0 1 1 1 0 1 1
0 0 0 0 0 0 1 0 0 0 1 1 1 0
0 0 0 0 0 0 0 0 0 0 1 0 1 0
0 0 0 0 0 0 0 0 0 0 1 0 0 0
0 0 0 0 0 0 0 0 0 0 1 0 1 0
0 0 0 0 0 0 0 0 0 0 1 0 1 0
0 0 0 0 0 0 0 0 0 0 1 0 1 0
0 0 0 0 0 0 0 0 0 0 1 0 1 0
0 0 0 0 0 0 0 0 0 0 1 0 1 0
0 1 2 2 2 2 3 1 2 2 10 2 9 2
DPT-HB-Hib 1
DPT-HB-Hib 2
DPT-HB-Hib 3
DPT-HB-Hib 4
OPV 1
OPV 2
OPV 3
OPV 4
PCV 1
MR 1
MR 2
IPV 2
IPV1
(0-
BC
11
BL
N)
G
0 0 1 1 1 1 1 1 1 1 1 1 1 1
1 0 1 1 1 1 1 1 1 1 1 1 1 1
0 0 1 1 1 0 1 0 0 1 1 0 0 0
1 0 1 1 1 1 1 1 1 1 1 1 1 1
0 0 0 1 1 1 1 0 1 1 1 1 1 0
0 0 0 1 1 1 1 1 1 1 1 1 1 0
0 0 0 1 1 1 1 0 1 1 1 1 1 0
0 0 0 0 1 0 1 0 0 1 1 1 1 0
0 0 0 0 1 0 1 0 0 1 1 1 1 0
0 0 0 1 1 0 1 0 0 1 1 1 1 0
1 1 1 1 1 1 1 1 1 1 1 1 1
0 0 0 0 0 1 1 0 0 0 1 1 1 1
0 0 0 0 1 1 1 0 0 1 1 1 1 0
0 0 0 0 1 1 0 0 0 1 1 1 1 0
0 0 0 0 0 0 0 0 0 0 0 1 1 0
0 0 0 0 0 0 0 0 0 0 0 1 1 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 1 1 1 1 0 1 1 1 1 1 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 1 0 1 0
0 0 0 0 0 0 0 0 0 0 1 0 1 0
0 0 0 0 0 0 0 0 0 0 1 0 1 0
0 0 0 0 0 0 0 0 0 0 1 0 1 0
0 0 0 0 0 0 0 0 0 0 1 0 1 0
0 0 0 0 0 0 0 0 0 0 0 0 1 0
0 0 0 0 0 0 0 0 0 0 1 0 1 0
0 0 0 0 0 0 0 0 0 0 1 0 1 0
0 0 0 0 0 0 0 0 0 0 1 0 1 0
0 0 0 0 0 0 0 0 0 0 1 0 1 0
0 0 0 0 0 0 0 0 0 0 0 0 1 0
3 1 5 10 14 10 14 5 8 14 24 16 27 5
DPT-HB-Hib 1
DPT-HB-Hib 2
DPT-HB-Hib 3
DPT-HB-Hib 4
OPV 1
OPV 2
OPV 3
OPV 4
PCV 1
MR 1
MR 2
IPV 2
IPV1
(0-
BC
11
BL
N)
G
0 0 1 1 1 1 1 1 1 1 1 1 1 1
0 0 0 0 0 0 0 0 0 0 1 1 1 0
0 0 0 0 0 0 0 0 0 0 1 1 1 0
0 0 0 0 0 0 0 0 0 0 1 0 1 0
0 0 0 0 0 0 0 0 0 0 1 0 1 0
0 0 0 0 0 0 0 0 0 0 1 0 1 0
0 0 0 0 0 0 0 0 0 0 1 0 1 0
0 0 0 0 0 0 0 0 0 0 1 0 1 0
0 0 0 0 0 0 0 0 0 0 1 0 1 0
0 0 0 0 0 0 0 0 0 0 1 0 1 0
0 0 1 1 1 1 1 1 1 1 10 3 10 1

DPT-HB-Hib 1
DPT-HB-Hib 2
DPT-HB-Hib 3
DPT-HB-Hib 4
OPV 1
OPV 2
OPV 3
OPV 4
PCV 1
MR 1
MR 2
IPV 2
IPV1
(0-
BC
11
BL
N)
G
0 0 0 0 0 1 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 1 0 0 0 1
0 0 0 0 0 1 0 0 0 1 0 0 0 1
DPT-HB-Hib 1
DPT-HB-Hib 2
DPT-HB-Hib 3
DPT-HB-Hib 4
OPV 1
OPV 2
OPV 3
OPV 4
PCV 1
MR 1
MR 2
IPV 2
IPV1
(0-
BC
11
BL
N)
G
0 0 0 0 0 1 1 0 0 0 1 0 1 0
0 0 0 0 0 1 1 0 0 0 1 0 1 0
0 0 0 0 0 2 2 0 0 0 2 0 2 0

DPT-HB-Hib 1
DPT-HB-Hib 2
DPT-HB-Hib 3
DPT-HB-Hib 4
OPV 1
OPV 2
OPV 3
OPV 4
PCV 1
MR 1
MR 2
IPV 2
IPV1
(0-
BC
11
BL
N)
G
0 0 0 0 0 0 0 0 0 0 1 0 1 0
0 0 0 0 0 1 1 0 0 0 1 0 1 0
0 0 0 0 0 0 0 0 0 0 1 0 1 0
0 0 0 0 0 1 0 0 0 1 0 0 0 0
0 0 0 0 0 2 1 0 0 1 3 0 3 0

DPT-HB-Hib 1
DPT-HB-Hib 2
DPT-HB-Hib 3
DPT-HB-Hib 4
OPV 1
OPV 2
OPV 3
OPV 4
PCV 1
MR 1
MR 2
IPV 2
IPV1
(0-
BC
11
BL
N)
G
0 0 1 1 1 0 1 0 0 1 1 0 0 0
1 0 1 1 1 1 1 1 1 1 1 1 1 1
0 0 1 1 1 0 1 0 0 1 1 0 0 0
1 0 1 1 1 1 1 1 1 1 1 1 1 1
1 0 2 2 2 1 2 1 1 2 2 1 1 1
DPT-HB-Hib 1
DPT-HB-Hib 2
DPT-HB-Hib 3
DPT-HB-Hib 4
OPV 1
OPV 2
OPV 3
OPV 4
PCV 1
MR 1
MR 2
IPV 2
IPV1
(0-
BC
11
BL
N)
G
0 0 0 0 0 0 0 0 0 0 1 0 1 0
0 0 0 0 0 0 0 0 0 0 1 0 1 0
0 0 0 0 0 0 0 0 0 1 1 0 1 0
0 0 0 0 0 0 0 0 0 0 1 0 1 0
0 0 0 0 0 0 0 0 0 0 1 0 1 0
1 1 1 1 1 1 1 1 1 1 1 1
0 0 1 1 1 1 1 0 1 1
0 0 0 0 0 0 0 0 0 0 1 0
0 0 0 0 0 0 0 0 0 0 1 0
0 0 0 0 0 0 0 0 0 0 1 0
0 0 0 0 0 0 0 0 0 0 1 0
0 0 1 1 1 1 1 1 1 1 1
0 0 1 1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1 1 1 1
0 0 0 0 0 0 0 0 0
0 0 1 1 1 1 1 1 1 1 1
0 0 0 0 0 0 0 0 0 1
0 0 1
0 0
0 0
0 0 0
0 0
1 1 1 1 1
1 1 1
1 1
0 0 0 0 0 0 1 1 1 1 1
5 5 8 6 6 7 6 8 7 8 5 7 5 6
DPT-HB-Hib 1
DPT-HB-Hib 2
DPT-HB-Hib 3
DPT-HB-Hib 4
OPV 1
OPV 2
OPV 3
OPV 4
PCV 1
MR 1
MR 2
IPV 2
IPV1
(0-
BC
11
BL
N)
G
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 0 0 0 0 0 1 1 0
0 0 0 0 0 0 1 0 0 0 0 1 1 0
0 0 0 0 0 0 1 0 0 0 0 1 1 0
0 0 0 0 0 0 0 0 0 0 0 1 1 0
0 0 0 0 0 0 0 0 0 0 0 1 1 0
0 0 0 0 0 0 1 0 0 0 0 1 1 0
0 0 0 0 0 0 1 0 0 0 0 1 1 0
0 0 0 0 0 0 1 0 0 0 0 1 1 0
0 0 0 0 0 0 1 0 0 0 0 1 1 0
0 0 0 0 0 0 1 0 0 0 0 1 1 0
0 0 0 0 0 0 1 0 0 0 0 1 1 0
0 0 0 0 0 0 1 0 0 0 0 1 1 0
0 0 0 0 0 0 1 0 0 0 0 1 1 0
0 0 0 0 0 0 1 0 0 0 0 1 1 0
0 0 0 0 0 0 1 0 0 0 0 1 1 0
0 0 1 1 1 1 1 1 1 1 1 1 1 1
0 0 1 1 1 1 35 1 1 1 1 16 33 1
koloran
DPT-HB-Hib 1
DPT-HB-Hib 2
DPT-HB-Hib 3
DPT-HB-Hib 4
OPV 1
OPV 2
OPV 3
OPV 4
PCV 1
MR 1
MR 2
IPV 2
IPV1
(0-
BC
11
BL
N)
G
0 0 0 0 0 0 1 0 0 0 1 0 1 0
0 0 0 0 0 0 1 0 0 0 1 0 1 0
0 0 0 0 0 0 1 0 0 0 1 0 1 0
0 0 0 0 0 0 1 0 0 0 1 0 1 0
0 0 0 0 0 0 1 0 0 0 1 0 1 0
0 0 0 0 0 0 1 0 0 0 1 0 0 0
0 0 0 0 0 0 6 0 0 0 6 0 5 0

DPT-HB-Hib 1
DPT-HB-Hib 2
DPT-HB-Hib 3
DPT-HB-Hib 4
OPV 1
OPV 2
OPV 3
OPV 4
PCV 1
MR 1
MR 2
IPV 2
IPV1
(0-
BC
11
BL
N)
G
0 0 0 0 0 0 0 0 0 0 0 0 0 1
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 1
0 0 0 0 0 0 0 0 0 0 0 0 0 2

DPT-HB-Hib 1
DPT-HB-Hib 2
DPT-HB-Hib 3
DPT-HB-Hib 4
OPV 1
OPV 2
OPV 3
OPV 4
PCV 1
MR 1
MR 2
IPV 2
IPV1
(0-
BC
11
BL
N)
G
1 1 1 1 1 1 1
1
1
1
1
1 1 1
1 1 1 1 1
1
1 1
1 1
1
1 1
1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1
1
1 1
1
1`
1 1 1
1 1 1 1 1
1 1 1 1
1 1 1 1 1 1 1 1
1 1 1 1 1
1 1 1 1 1 1 1
1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1
1 1 1 1 1 1 1
1 1 1 1 1 1 1
1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1
0 0 4 8 10 12 8 7 9 11 0 4 1 8
DOSIS YANG DIBUTUHKAN UNTUK MELENGKAPI
WAKTUNYA MENERIMA = 0)
IMUNISASI
RV*(diberikan
DPT-HB-Hib
(0-11 BLN)
(<6 BLN)
(<6 BLN)
(<6 BLN)
<6 BLN)
PCV 2
PCV 3
RV 1
RV 2
RV 3
OPV
BCG
PCV
IPV
MR
0 0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 0 1 1 0 0
0 0 0 0 0 0 0 0 1 1 0 0
0 0 0 0 0 0 0 0 1 1 0 0
0 0 0 0 0 0 0 0 1 2 0 0
0 0 0 0 0 0 0 0 1 1 0 0
0 0 0 0 0 0 0 1 1 2 0 0
0 1 0 0 0 0 0 0 1 2 1 0
0 1 0 0 0 0 0 1 1 2 1 0
0 1 0 0 0 0 0 0 1 1 1 0
0 1 0 0 0 0 0 0 1 1 1 0
0 1 0 0 0 0 0 0 1 1 1 0
0 1 0 0 0 0 0 1 1 2 1 0
0 1 0 0 0 0 0 0 1 1 1 0
0 1 0 0 0 0 1 2 2 2 1 0
1 1 0 1 0 0 2 2 3 2 2 0
1 1 1 1 1 0 3 2 4 2 3 3
1 1 0 1 1 3 1 3 2 2
1 1 1 1 1 3 2 4 2 3
4 12 2 4 3 0 12 12 31 28 18 3

IMUNISASI
DPT-HB-Hib
(<6 BLN)
(<6 BLN)
(<6 BLN)
RV*(dib
<6 BLN)
erikan
PCV 2
PCV 3
(0-11
BLN)
RV 1
RV 2
RV 3
OPV
BCG
PCV
IPV
MR
0 0 0 0 0 0 0 0 1 0 0 0
1 0 0 1 1 0 2 1 3 2 1 0
0 0 0 0 0 0 0 0 1 0 0 0
0 0 0 0 0 0 0 0 1 1 0 0
0 0 0 0 0 0 0 0 1 1 0 0
0 0 0 0 0 0 0 0 1 1 0 0
0 1 0 0 0 0 0 0 1 1 1 0
0 0 0 0 0 0 0 0 1 1 0 0
1 1 1 1 1 0 3 2 4 2 3 0
0 1 0 0 1 0 1 1 2 2 1 0
0 1 0 0 1 0 1 1 2 2 1 1
1 1 1 1 1 0 3 2 4 2 3 3
3 5 2 3 5 0 10 7 22 15 10 4

WAKTUNYA MENERIMA = 0) DPT-HB-Hib
IMUNISASI
PCV 2
PCV 3
OPV
PCV
IPV
MR
RV
RV
RV
RV
(0-
BC
rik
be
an
11
<6
BL
BL
BL
BL
BL
N)
N)
N)
N)
N)
*(
(<
(<
(<
di
G
1
6
2
6
3
0 0 0 0 0 0 0 0 1 1 0 0
0 0 0 0 0 0 0 0 1 1 0 0
0 1 0 0 0 0 0 1 1 2 1 0
1 1 1 1 1 0 3 2 4 2 3 3
1 1 0 1 1 0 2 2 3 2 2 2
1 1 1 1 1 0 3 2 4 2 3 3
3 4 2 3 3 0 8 7 14 10 9 8

DPT-HB-Hib
IMUNISASI
PCV 2
PCV 3
OPV
PCV
IPV
MR
RV
RV
RV
RV
(0-
BC
rik
be
an
11
<6
BL
BL
BL
BL
BL
N)
N)
N)
N)
N)
*(
(<
(<
(<
di
G
1
6
2
6
3
0 0 0 0 0 0 0 0 1 1 0 0
0 0 0 0 0 0 0 0 1 1 0 0
0 0 0 0 0 0 0 0 1 1 0 0
0 0 0 0 0 0 0 0 1 1 0 0
0 1 0 0 0 0 0 0 1 2 1 0
0 1 0 0 0 0 0 0 1 1 1 0
0 1 0 0 0 0 0 0 1 1 1 0
0 1 0 0 1 0 1 1 2 2 1 0
1 1 1 1 1 0 3 2 4 2 3 3
1 1 1 1 1 0 3 2 4 2 3 3
2 6 2 2 3 0 7 5 17 14 10 6
DPT-HB-Hib
IMUNISASI
PCV 2
PCV 3
OPV
PCV
IPV
MR
RV
RV
RV
RV
(0-
BC
rik
be
an
11
<6
BL
BL
BL
BL
BL
N)
N)
N)
N)
N)
*(
(<
(<
(<
di
G
1
6
2
6
3
0 0 0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 2 0 2 0 0 0
0 0 0 0 0 0 1 0 1 0 0 0
0 0 0 0 0 0 1 0 1 0 0 0
0 0 0 0 0 0 4 0 4 3 0 0

DPT-HB-Hib
IMUNISASI
PCV 2
PCV 3
OPV
PCV
IPV
MR
RV
RV
RV
RV
(0-
BC
rik
be
an
11
<6
BL
BL
BL
BL
BL
N)
N)
N)
N)
N)
*(
(<
(<
(<
di
G
1
6
2
6
3
1 0 0 0 0 0 0 1 0 0 2 0
0 0 0 0 0 0 2 0 2 0 0 0
0 0 0 0 0 0 1 0 1 0 0 0
1 0 0 0 0 0 1 0 1 0 2 0
1 0 0 0 0 0 0 0 0 0 2 0
1 0 0 0 0 0 1 0 1 0 2 0
4 0 0 0 0 0 5 1 5 0 8 0

DPT-HB-Hib
IMUNISASI
PCV 2
PCV 3
OPV
PCV
IPV
MR
RV
RV
RV
RV
(0-
BC
rik
be
an
11
<6
BL
BL
BL
BL
BL
N)
N)
N)
N)
N)
*(
(<
(<
(<
di
G
1
6
2
6
3
0 0 0 0 0 0 2 0 2 0 0 0
0 0 0 0 0 0 1 0 1 0 0 0
1 0 0 0 0 0 2 1 2 1 2 0
1 0 0 0 0 0 1 0 1 0 2 0
1 0 0 0 0 0 2 1 2 1 2 0
1 0 0 0 0 0 2 1 2 1 2 0
4 0 0 0 0 0 10 3 10 3 8 0
DPT-HB-Hib
IMUNISASI
PCV 2
PCV 3
OPV
PCV
IPV
MR
RV
RV
RV
RV
(0-
BC
rik
be
an
11
<6
BL
BL
BL
BL
BL
N)
N)
N)
N)
N)
*(
(<
(<
(<
di
G
1
6
2
6
3
1 1 0 0 0 2 1 3 0
1 0 1 1 1 0 2 0 2 0 1 0
2 1 1 1 1 0 2 0 4 1 4 0

DPT-HB-Hib
IMUNISASI
PCV 2
PCV 3
OPV
PCV
IPV
MR
RV
RV
RV
RV
(0-
BC
rik
be
an
11
<6
BL
BL
BL
BL
BL
N)
N)
N)
N)
N)
*(
(<
(<
(<
di
G
1
6
2
6
3
#REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF!

DPT-HB-Hib
IMUNISASI
PCV 2
PCV 3
OPV
PCV
IPV
MR
RV
RV
RV
RV
(0-
BC
rik
be
an
11
<6
BL
BL
BL
BL
BL
N)
N)
N)
N)
N)
*(
(<
(<
(<
di
G
1
6
2
6
3
0 1 1 1 1 0 0 1 0 0 1 0
0 1 1 1 1 0 0 1 0 0 1 0
0 1 1 1 1 0 0 1 0 0 1 0
0 1 1 1 1 0 0 1 0 0 1 0
0 1 1 1 1 0 0 1 0 0 1 0
0 1 1 1 1 0 0 1 0 0 1 0
0 1 1 1 1 0 0 1 0 0 1 0
0 1 1 1 1 0 0 1 0 0 1 0
0 1 1 1 1 0 0 1 0 0 1 0
0 1 1 1 1 0 0 1 0 0 1 0
0 1 1 1 1 0 0 1 0 0 1 0
0 1 1 1 1 0 0 1 0 0 1 0
0 1 1 1 1 0 0 1 0 0 1 0
0 1 1 1 1 0 0 1 0 0 1 0
0 1 1 1 1 0 0 1 0 0 1 0
0 1 1 1 1 0 0 1 0 0 1 0
0 1 1 1 1 0 0 1 0 0 1 0
0 0 1 1 1 0 0 1 0 0 0 0
0 0 1 1 1 0 0 1 0 0 0 0
0 0 1 1 1 0 0 1 0 0 0 0
0 0 1 1 1 0 0 1 0 0 0 0
0 0 1 1 1 0 0 1 0 0 0 0
0 0 0 1 1 0 0 1 0 0 0 2
0 0 0 1 1 0 0 1 0 0 0 2
0 0 0 1 1 0 0 1 0 0 0 2
0 0 0 1 1 0 0 1 0 0 0 2
0 0 1 1 1 0 0 1 0 0 0 0
0 0 0 1 1 0 0 1 0 0 0 2
0 17 23 28 28 0 0 28 0 0 17 10

DPT-HB-Hib
IMUNISASI
PCV 2
PCV 3
OPV
PCV
IPV
MR
RV
RV
RV
RV
(0-
BC
rik
be
an
11
<6
BL
BL
BL
BL
BL
N)
N)
N)
N)
N)
*(
(<
(<
(<
di
G
1
6
2
6
3
#REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF!

DPT-HB-Hib
IMUNISASI
PCV 2
PCV 3
OPV
PCV
IPV
MR
RV
RV
RV
RV
(0-
BC
rik
be
an
11
<6
BL
BL
BL
BL
BL
N)
N)
N)
N)
N)
*(
(<
(<
(<
di
G
1
6
2
6
3
0 0 0 0 0 0 1 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0 0 0
DPT-HB-Hib
IMUNISASI
PCV 2
PCV 3
OPV
PCV
IPV
MR
RV
RV
RV
RV
(0-
BC
rik
be
an
11
<6
BL
BL
BL
BL
BL
N)
N)
N)
N)
N)
*(
(<
(<
(<
di
G
1
6
2
6
3
0 1 6 1 0 0 0 0 0 1 0
0 1 1 0 0 0 0 0 1 0
0 1 1 0 0 0 0 0 1 0
0 1 1 0 0 0 0 0 1 0
0 1 1 0 0 0 1 2 1 0
0 1 1 0 3 2 4 2 1 0
1 1 1 0 3 2 4 2 3 1
1 7 7 0 0 0 6 4 9 6 9 1

DPT-HB-Hib
IMUNISASI
PCV 2
PCV 3
OPV
PCV
IPV
MR
RV
RV
RV
RV
(0-
BC
rik
be
an
11
<6
BL
BL
BL
BL
BL
N)
N)
N)
N)
N)
*(
(<
(<
(<
di
G
1
6
2
6
3
1 1 1 1 1 0 0 0 0 0 2 0
1 1 1 1 1 0 0 0 0 0 2 0
1 1 1 1 1 0 0 0 0 0 2 0
1 1 1 1 1 0 0 0 0 0 2 0
1 1 1 1 1 0 0 0 0 0 2 0
1 1 1 1 1 0 0 0 0 0 2 0
1 1 1 1 1 0 0 0 0 0 2 0
1 1 1 1 1 0 0 0 0 0 2 0
1 1 1 1 1 0 0 0 0 0 2 0
0 1 1 1 1 0 0 0 0 0 1 0
0 1 1 1 1 0 0 0 0 0 1 0
0 1 1 1 1 0 0 0 0 0 1 0
0 1 1 1 1 0 0 0 0 0 1 0
0 1 1 1 1 0 0 0 0 0 1 0
0 1 1 1 1 0 0 0 0 0 1 0
0 1 1 1 1 0 0 0 0 0 1 0
0 1 1 1 1 0 0 0 0 0 1 0
0 1 1 1 1 0 0 0 0 0 1 0
0 1 1 1 1 0 0 0 0 0 1 0
0 1 1 1 1 0 0 0 0 0 1 0
1 1 1 1 1 0 0 0 0 0 2 0
1 1 1 1 1 0 0 1 1 0 3 3
1 1 1 1 1 0 0 1 1 0 3 3
1 1 1 1 1 0 1 1 1 0 3 3
1 1 1 1 1 0 1 1 1 0 3 3
14 25 25 25 25 0 2 4 4 0 43 12
DPT-HB-Hib
IMUNISASI
PCV 2
PCV 3
OPV
PCV
IPV
MR
RV
RV
RV
RV
(0-
BC
rik
be
an
11
<6
BL
BL
BL
BL
BL
N)
N)
N)
N)
N)
*(
(<
(<
(<
di
G
1
6
2
6
3
1 0 1 1 1 0 0 1 0 0 2 0
1 1 1 1 1 0 0 1 0 0 2 0
0 1 1 1 1 0 0 1 0 1 1 0
0 1 1 1 1 0 0 1 0 0 1 0
0 1 1 1 1 0 0 1 0 0 1 0
0 1 1 1 1 0 0 1 0 0 1 0
0 1 1 1 1 0 0 1 0 0 1 0
0 1 1 1 1 0 0 1 0 0 1 0
0 1 1 1 1 0 0 1 0 0 1 0
0 0 1 1 1 0 0 1 0 0 0 0
0 0 1 1 1 0 0 1 0 0 0 0
0 0 1 1 1 0 0 1 0 0 0 0
0 0 1 1 1 0 0 1 0 0 0 0
0 0 1 1 1 0 0 1 0 0 0 0
0 0 1 1 1 0 0 1 0 0 0 0
0 0 1 1 1 0 0 1 0 0 0 0
0 1 1 1 1 0 0 1 1 1 1 0
0 1 1 1 1 0 0 1 1 1 1 0
0 1 1 1 1 0 0 1 1 1 1 0
0 1 1 1 1 0 0 1 1 1 1 0
0 1 1 1 1 0 0 1 1 1 1 0
0 1 1 1 1 0 0 1 1 2 1 0
0 1 1 1 1 0 0 1 3 2 1 0
0 1 1 1 1 0 2 2 3 2 1 3
0 1 1 1 1 0 2 2 3 2 1 3
0 1 1 1 1 0 2 2 3 2 1 3
1 1 1 1 1 0 2 2 3 2 2 3
3 19 27 27 27 0 8 31 21 18 23 12
DPT-HB-Hib
IMUNISASI
PCV 2
PCV 3
OPV
PCV
IPV
MR
RV
RV
RV
RV
(0-
BC
rik
be
an
11
<6
BL
BL
BL
BL
BL
N)
N)
N)
N)
N)
*(
(<
(<
(<
di
G
1
6
2
6
3
1 0 6 0 0 0 0 0 0 0 0 1 0
0 1 0 0 0 0 0 0 0 0 1 0
0 0 0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 0 1 0
0 0 0 0 0 2 0 3 0 0
1 1 0 0 0 0 2 0 3 3 2 0

DPT-HB-Hib
IMUNISASI
PCV 2
PCV 3
OPV
PCV
IPV
MR
RV
RV
RV
RV
(0-
BC
rik
be
an
11
<6
BL
BL
BL
BL
BL
N)
N)
N)
N)
N)
*(
(<
(<
(<
di
G
1
6
2
6
3
1 1 1 1 1 0 0 1 0 1 3 0
1 1 1 1 1 0 0 1 0 1 2 0
0 1 1 1 1 0 0 1 0 1 1 0
1 1 1 1 1 0 0 1 0 1 2 0
0 1 1 1 1 0 0 1 0 1 1 0
1 1 1 1 1 0 0 1 0 1 2 0
0 1 1 1 1 0 0 1 0 1 1 0
0 1 1 1 1 0 0 1 0 1 1 0
0 1 1 1 1 0 0 1 0 1 1 0
0 1 1 1 1 0 0 1 0 1 1 0
0 1 1 1 1 0 0 1 1 1 1 0
0 1 1 1 1 0 0 1 1 1 1 0
0 1 1 1 1 0 0 1 1 1 1 0
0 1 0 1 1 0 0 1 1 1 1 0
0 1 0 1 1 0 0 1 1 1 1 0
0 1 0 1 1 0 0 1 1 1 1 0
1 1 1 1 1 0 0 1 1 1 3 0
1 1 1 1 1 0 0 1 1 2 2 0
0 0 0 0 0 0 0 1 0 0 0 0
0 0 0 0 0 0 1 0 0 0
0 0 0 0 0 1 2 1 0 0
0 0 0 0 0 1 2 1 0 0
0 0 0 0 0 1 2 1 0 0
0 0 0 0 0 1 1 1 0 0
0 0 0 0 0 1 1 0 0
0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 1 0 0
6 18 15 18 18 0 4 28 15 19 26 0

DPT-HB-Hib
IMUNISASI
PCV 2
PCV 3
OPV
PCV
IPV
MR
RV
RV
RV
RV
(0-
BC
rik
be
an
11
<6
BL
BL
BL
BL
BL
N)
N)
N)
N)
N)
*(
(<
(<
(<
di
G
1
6
2
6
3
1 0 1 1 1 0 3 1 2 0 2 0
1 0 1 1 1 0 3 1 3 1 2 0
1 1 1 1 1 0 0 1 0 1 3 0
1 1 1 1 1 0 0 1 1 2 3 0
1 1 1 1 1 0 0 1 0 1 3 0
0 0 1 1 1 0 0 1 0 1 0 0
1 1 1 1 1 0 0 1 1 1 2 0
1 1 1 1 1 0 0 1 1 1 2 0
0 0 1 1 1 0 0 1 1 1 0 0
1 1 1 1 1 0 0 1 1 1 3 0
1 1 1 1 1 0 0 1 1 1 3 0
1 1 1 1 1 0 0 1 1 1 3 0
0 1 1 1 1 0 0 1 3 1 1 0
1 1 1 1 1 0 0 1 1 1 3 0
1 1 1 1 1 0 0 1 1 1 3 0
1 1 1 1 1 0 0 1 0 1 3 0
1 1 1 1 1 0 0 1 0 1 3 0
1 1 1 1 1 0 0 0 0 1 3 0
1 1 1 1 1 0 0 0 0 1 3 0
0 1 1 1 1 0 0 2 1 2 1 0
0 1 1 1 1 0 0 2 1 2 1 0
1 1 1 1 1 0 1 2 2 2 2 0
1 1 1 1 1 0 2 2 3 2 2 0
1 1 1 1 1 0 1 2 3 2 3 3
1 1 1 1 1 0 2 2 3 2 2 3
1 1 1 1 1 0 2 2 3 2 2 3
1 1 1 1 1 0 2 2 3 2 2 3
1 1 1 1 1 0 2 2 3 2 3 3
23 24 28 28 28 0 18 35 39 37 63 15
DPT-HB-Hib
IMUNISASI
PCV 2
PCV 3
OPV
PCV
IPV
MR
RV
RV
RV
RV
(0-
BC
rik
be
an
11
<6
BL
BL
BL
BL
BL
N)
N)
N)
N)
N)
*(
(<
(<
(<
di
G
1
6
2
6
3
1 1 1 1 1 0 3 2 4 2 3 0
1 1 1 1 1 0 3 2 4 2 3 0
1 1 1 1 1 0 3 2 4 2 3 0
1 1 1 1 1 0 1 2 2 2 3 0
1 1 1 1 1 0 2 2 2 1 3 0
1 1 1 1 1 0 2 2 2 1 3 0
1 1 1 1 1 0 4 2 4 2 3 0
7 7 7 7 7 0 18 14 22 12 21 0

DPT-HB-Hib
IMUNISASI
PCV 2
PCV 3
OPV
PCV
IPV
MR
RV
RV
RV
RV
(0-
BC
rik
be
an
11
<6
BL
BL
BL
BL
BL
N)
N)
N)
N)
N)
*(
(<
(<
(<
di
G
1
6
2
6
3
0 0 0 0 0 0 0 0 1 0 0 0
0 0 0 0 0 0 0 0 1 0 0 0
0 0 0 0 0 0 0 0 1 0 0 0
0 1 0 0 0 0 0 0 0 0 1 0
0 1 0 0 0 0 0 0 9 9 1 0
1 1 0 0 0 0 0 0 0 0 2 0
1 1 0 0 0 0 0 0 1 0 3 0
1 1 0 0 0 0 0 0 1 1 2 0
1 1 0 0 0 0 0 0 0 0 2 0
1 1 0 0 0 0 0 0 0 0 2 0
0 1 0 0 0 0 0 0 0 1 1 0
1 1 0 0 0 0 0 0 1 1 2 0
0 1 0 0 0 0 0 1 1 1 1 0
1 1 0 0 0 0 0 0 0 1 2 0
1 1 0 0 0 0 0 1 1 1 2 0
0 1 0 0 0 0 0 1 0 1 1 0
1 1 0 0 0 0 0 1 0 1 3 0
1 1 1 1 1 0 3 2 3 1 3 0
1 1 1 1 1 1 4 2 3 1 3 3
1 1 1 1 1 1 4 2 3 1 3 3
1 1 1 1 1 1 4 2 3 1 3 3
1 1 1 1 1 1 4 2 3 1 3 3
1 1 1 1 1 1 4 2 3 1 3 3
15 20 6 6 6 0 23 16 35 23 43 15

DPT-HB-Hib
IMUNISASI
PCV 2
PCV 3
OPV
PCV
IPV
MR
RV
RV
RV
RV
(0-
BC
rik
be
an
11
<6
BL
BL
BL
BL
BL
N)
N)
N)
N)
N)
*(
(<
(<
(<
di
G
1
6
2
6
3
0 0 0 0 0 0 1 1 1 1 0 0
0 1 0 0 0 0 1 1 0 0 1 0
0 1 0 0 0 0 1 1 1 0 1 0
1 1 0 0 0 0 1 1 1 1 3 0
0 1 0 0 0 0 1 2 1 1 1 0
1 1 1 1 1 1 4 2 3 1 3 3
1 1 1 1 1 1 4 2 3 1 3 3
#VALUE! 0 0 0 0 0 #VALUE!
3 6 2 2 2 #VALUE! 13 10 10 5 12 #VALUE!

DPT-HB-Hib
IMUNISASI
PCV 2
PCV 3
OPV
PCV
IPV
MR
RV
RV
RV
RV
(0-
BC
rik
be
an
11
<6
BL
BL
BL
BL
BL
N)
N)
N)
N)
N)
*(
(<
(<
(<
di
G
1
6
2
6
3
1 1 1 1 1 0 0 1 1 1 3 0
0 0 1 1 1 0 0 1 1 1 0 0
0 1 1 1 1 0 0 1 1 1 1 0
0 0 1 1 1 0 0 1 1 1 0 0
0 0 1 1 1 0 0 1 1 1 0 0
0 0 1 1 1 0 0 1 0 0 0 0
0 1 1 1 1 0 0 1 0 0 1 0
0 1 0 0 0 0 0 1 0 0 1 0
0 1 0 0 0 0 0 1 0 1 1 0
0 0 0 0 0 0 0 1 1 1 0 0
0 1 1 1 1 0 0 1 0 1 1 0
0 0 0 0 0 0 0 1 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
1 6 8 8 8 0 0 12 6 8 8 0

DPT-HB-Hib
IMUNISASI
PCV 2
PCV 3
OPV
PCV
IPV
MR
RV
RV
RV
RV
(0-
BC
rik
be
an
11
<6
BL
BL
BL
BL
BL
N)
N)
N)
N)
N)
*(
(<
(<
(<
di
G
1
6
2
6
3
0 0 1 1 1 0 0 1 1 1 0 0
0 0 1 1 1 0 0 1 1 1 0 0
0 0 1 1 1 0 0 1 0 1 0 0
1 1 0 1 1 0 1 1 1 0 2 0
1 1 3 4 4 0 1 4 3 3 2 0

DPT-HB-Hib
IMUNISASI
PCV 2
PCV 3
OPV
PCV
IPV
MR
RV
RV
RV
RV
(0-
BC
rik
be
an
11
<6
BL
BL
BL
BL
BL
N)
N)
N)
N)
N)
*(
(<
(<
(<
di
G
1
6
2
6
3
1 1 1 1 1 0 0 1 1 1 3 0
1 1 1 1 1 0 0 1 1 1 3 0
0 0 1 1 1 0 0 1 1 1 0 0
0 0 1 1 1 0 0 1 0 0 0 0
0 0 1 1 1 0 0 1 0 0 0 0
0 0 1 1 1 0 0 1 0 0 0 0
0 1 1 1 1 0 0 1 0 0 1 0
0 0 1 1 1 0 0 1 0 0 0 0
0 0 1 1 1 0 0 1 0 0 0 0
0 0 0 0 0 0 0 1 0 0 0 0
0 0 0 0 1 0 0 0 1 0 0 0
2 3 9 9 10 0 0 10 4 3 7 0
DPT-HB-Hib
IMUNISASI
PCV 2
PCV 3
OPV
PCV
IPV
MR
RV
RV
RV
RV
(0-
BC
rik
be
an
11
<6
BL
BL
BL
BL
BL
N)
N)
N)
N)
N)
*(
(<
(<
(<
di
G
1
6
2
6
3
1 1 1 1 1 0 3 2 4 2 3 3
1 1 1 1 1 0 4 2 3 1 3 0
0 1 1 1 1 0 0 1 1 2 1 0
0 0 0 0 0 0 0 0 1 1 0 0
0 0 0 0 0 0 0 0 1 0 0 0
0 0 0 0 0 0 0 0 1 1 0 0
0 0 0 0 0 0 0 0 1 1 0 0
0 0 0 0 0 0 0 0 1 1 0 0
0 0 0 0 0 0 0 0 1 1 0 0
0 0 0 0 0 0 0 0 1 1 0 0
2 3 3 3 3 0 7 5 15 11 7 3

DPT-HB-Hib
IMUNISASI
PCV 2
PCV 3
OPV
PCV
IPV
MR
RV
RV
RV
RV
(0-
BC
rik
be
an
11
<6
BL
BL
BL
BL
BL
N)
N)
N)
N)
N)
*(
(<
(<
(<
di
G
1
6
2
6
3
1 1 1 1 1 0 3 2 4 2 3 3
1 1 1 1 1 1 3 2 4 2 3 3
1 1 1 1 1 0 3 1 2 0 2 0
1 1 1 1 1 0 3 2 4 2 3 0
1 1 1 1 1 0 2 2 3 2 2 3
0 1 1 1 1 0 2 2 4 2 1 0
0 0 1 1 1 0 2 2 3 2 0 0
0 0 1 1 1 0 1 1 2 2 0 0
0 1 1 1 1 0 1 1 2 2 1 0
0 1 1 1 1 0 2 1 2 2 1 0
1 1 1 1 1 1 4 1 4 2 3 0
1 1 1 1 1 0 0 2 1 2 3 0
0 1 1 1 1 0 1 2 2 2 1 0
0 1 1 1 1 0 1 1 2 2 1 0
0 1 1 1 1 0 0 0 0 2 1 0
0 1 1 1 1 0 0 0 0 2 1 0
0 0 1 1 0 0 0 0 0 0 0 0
1 1 1 1 1 0 2 2 3 2 2 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 1 1 0
0 0 0 0 0 0 0 0 1 1 0
0 0 0 0 0 0 0 0 1 1 0
0 0 0 0 0 0 0 0 1 1 0
0 0 0 0 0 0 0 0 1 1 0
0 0 0 0 0 0 0 0 0 1 0
0 0 0 0 0 0 0 0 1 1 0
0 0 0 0 0 0 0 0 1 1 0
0 0 0 0 0 0 0 0 1 1 0
0 0 0 0 0 0 0 0 1 1 0
0 0 0 0 0 0 0 0 0 1 0 0
8 15 18 18 17 1 30 24 51 43 28 9

DPT-HB-Hib
IMUNISASI
PCV 2
PCV 3
OPV
PCV
IPV
MR
RV
RV
RV
RV
(0-
BC
rik
be
an
11
<6
BL
BL
BL
BL
BL
N)
N)
N)
N)
N)
*(
(<
(<
(<
di
G
1
6
2
6
3
1 1 1 1 1 0 3 2 4 2 3 0
0 1 0 0 0 0 0 0 1 2 1 0
0 1 0 0 0 0 0 0 1 2 1 0
0 0 0 0 0 0 0 0 1 1 0 0
0 0 0 0 0 0 0 0 1 1 0 0
0 0 0 0 0 0 0 0 1 1 0 0
0 0 0 0 0 0 0 0 1 1 0 0
0 0 0 0 0 0 0 0 1 1 0 0
0 0 0 0 0 0 0 0 1 1 0 0
0 0 0 0 0 0 0 0 1 1 0 0
1 3 1 1 1 0 3 2 13 13 5 0
DPT-HB-Hib
IMUNISASI
PCV 2
PCV 3
OPV
PCV
IPV
MR
RV
RV
RV
RV
(0-
BC
rik
be
an
11
<6
BL
BL
BL
BL
BL
N)
N)
N)
N)
N)
*(
(<
(<
(<
di
G
1
6
2
6
3
6
0 0 0 0 0 #VALUE! 0 1 0 0 0 #VALUE!
1 1 1 1 1 0 0 0 1 0 3 0
1 1 1 1 1 #VALUE! 0 1 1 0 3 #VALUE!
DPT-HB-Hib
IMUNISASI
PCV 2
PCV 3
OPV
PCV
IPV
MR
RV
RV
RV
RV
(0-
BC
rik
be
an
11
<6
BL
BL
BL
BL
BL
N)
N)
N)
N)
N)
*(
(<
(<
(<
di
G
1
6
2
6
3
0 0 0 0 0 0 0 2 1 1 0 0
0 0 0 0 0 #VALUE! 0 2 1 1 0 #VALUE!
0 0 0 0 0 #VALUE! 0 4 2 2 0 #VALUE!

DPT-HB-Hib
IMUNISASI
PCV 2
PCV 3
OPV
PCV
IPV
MR
RV
RV
RV
RV
(0-
BC
rik
be
an
11
<6
BL
BL
BL
BL
BL
N)
N)
N)
N)
N)
*(
(<
(<
(<
di
G
1
6
2
6
3
0 0 0 0 0 0 0 0 1 1 0 0
0 0 0 0 0 #VALUE! 0 2 1 1 0 #VALUE!
0 0 0 0 0 #VALUE! 0 0 1 1 0 #VALUE!
1 0 0 0 0 #VALUE! 0 1 1 0 1 #VALUE!
1 0 0 0 0 #VALUE! 0 3 4 3 1 #VALUE!
DPT-HB-Hib
PCV 2 IMUNISASI
PCV 3
OPV
PCV
IPV
MR
RV
RV
RV
RV
(0-
BC
rik
be
an
11
<6
BL
BL
BL
BL
BL
N)
N)
N)
N)
N)
*(
(<
(<
(<
di
G
1
6
2
6
3
6
1 1 1 1 1 0 3 1 2 0 2 0
1 1 1 1 1 0 3 2 4 2 3 0
1 1 1 1 1 0 3 1 2 0 2 0
1 1 1 1 1 #VALUE! 3 2 4 2 3 #VALUE!
2 2 2 2 2 #VALUE! 6 3 6 2 5 #VALUE!
DPT-HB-Hib
IMUNISASI
PCV 2
PCV 3
OPV
PCV
IPV
MR
RV
RV
RV
RV
(0-
BC
rik
be
an
11
<6
BL
BL
BL
BL
BL
N)
N)
N)
N)
N)
*(
(<
(<
(<
di
G
1
6
2
6
3
0 0 1 1 1 0 0 0 1 1 0 0
0 0 1 1 1 0 0 0 1 1 0 0
0 0 1 1 1 0 0 0 2 1 0 0
0 0 1 1 1 0 0 0 1 1 0 0
0 0 1 1 1 0 0 0 1 1 0 0
1 1 1 1 1 1 4 2 3 1 3 0
0 3 2 2 0 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 0 1 0 0
1 1 1 1 1 0 3 2 3 0 3 0
1 1 1 1 1 0 3 2 3 0 3 0
1 1 1 1 1 1 4 2 3 0 3 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 3 2 3 0 1 0
0 0 0 0 1 0 0
0 1 0 0 0 0 0
0 1 1 1
0 0 0 1 0 0 0 0
0 0 0 1 1 0 0 0
0 0 0 1 1 0 0 0
1 2 1 1 0 0 0
1 1 1 1 0 0 0
1 1 0 0 0 0 0
1 0 0 0 3 1 2 0
5 4 9 9 9 0 25 18 31 12 16 0
DPT-HB-Hib
IMUNISASI
PCV 2
PCV 3
OPV
PCV
IPV
MR
RV
RV
RV
RV
(0-
BC
rik
be
an
11
<6
BL
BL
BL
BL
BL
N)
N)
N)
N)
N)
*(
(<
(<
(<
di
G
1
6
2
6
3
0 0 6 0 0 0 0 0 1 0 0 0 0
0 0 0 0 0 0 0 1 0 0 0 0
0 1 0 0 0 0 0 1 0 0 1 0
0 1 0 0 0 0 0 1 0 0 1 0
0 1 0 0 0 0 0 1 0 0 1 0
0 1 0 0 0 0 0 1 0 1 1 0
0 1 0 0 0 0 0 1 0 1 1 0
0 1 0 0 0 0 0 1 0 1 1 0
0 1 0 0 0 0 0 1 0 1 1 0
0 0 0 0 0 0 0 1 0 1 0 0
0 0 0 0 0 0 0 1 0 1 0 0
0 0 0 0 0 0 0 1 0 1 0 0
0 0 0 0 0 0 0 1 0 1 0 0
0 0 0 0 0 0 0 1 0 1 0 0
0 0 0 0 0 0 0 1 0 1 0 0
0 0 0 0 0 0 0 1 0 1 0 0
0 0 1 1 1 0 0 1 0 1 0 0
0 0 1 1 1 0 0 1 0 1 0 0
0 0 1 1 1 0 0 1 0 1 0
0 0 1 1 1 0 0 1 0 1 0
0 0 1 1 1 0 0 1 0 1 0
0 0 1 1 1 0 0 1 0 1 0
0 0 1 1 1 0 0 0 0 2 0
0 0 1 1 1 0 0 1 0 2 0
0 0 1 1 1 0 0 1 0 2 0
0 0 1 1 1 0 0 0 0 2 0
0 0 1 1 1 0 0 0 0 2 0
0 0 1 1 1 0 0 1 0 2 0
0 0 1 1 1 0 0 1 0 2 0
0 0 1 1 1 0 0 1 0 2 0
0 0 1 1 1 0 0 1 0 2 0
0 0 1 1 0 0 0 1 0 2 0
0 0 1 1 0 0 0 1 0 2 0
0 0 1 1 0 0 0 1 0 2 0
0 0 1 1 0 0 0 1 0 2 0
0 0 1 1 0 0 0 1 0 2 0
0 0 1 1 0 0 0 1 0 2 0
1 1 0 1 1 0 3 2 4 2 3
1 8 21 22 16 0 3 36 4 49 10 0
DPT-HB-Hib
IMUNISASI
PCV 2
PCV 3
OPV
PCV
IPV
MR
RV
RV
RV
RV
(0-
BC
rik
be
an
11
<6
BL
BL
BL
BL
BL
N)
N)
N)
N)
N)
*(
(<
(<
(<
di
G
1
6
2
6
3
6
0 1 0 0 0 0 0 1 1 1 1 0
0 1 0 1 1 0 0 1 1 1 1 0
0 1 0 0 0 0 0 1 1 1 1 0
0 1 0 0 0 0 0 1 1 1 1 0
0 1 1 1 1 0 0 1 1 1 1 0
0 1 1 1 1 0 0 1 1 0 1 0
0 6 2 3 3 0 0 6 6 5 6 0

DPT-HB-Hib
IMUNISASI
PCV 2
PCV 3
OPV
PCV
IPV
MR
RV
RV
RV
RV
(0-
BC
rik
be
an
11
<6
BL
BL
BL
BL
BL
N)
N)
N)
N)
N)
*(
(<
(<
(<
di
G
1
6
2
6
3
1 1 1 1 1 0 0 0 0 0 1 0
0 1 1 1 1 0 0 0 0 0 1 0
0 1 1 1 1 0 0 0 0 0 1 0
1 1 1 1 1 0 0 0 0 0 3
2 4 4 4 4 0 0 0 0 0 6 0

DPT-HB-Hib
IMUNISASI
PCV 2
PCV 3
OPV
PCV
IPV
MR
RV
RV
RV
RV
(0-
BC
rik
be
an
11
<6
BL
BL
BL
BL
BL
N)
N)
N)
N)
N)
*(
(<
(<
(<
di
G
1
6
2
6
3
1 2
0 0 0 0 1 0 0
0 0 1 0 0 0 0
1 1
1 0 1 2 1 1 1 0
0 0 1 0 0 0 0
1 1 0 0 1 0 1 2 0
1 1 0 0 1 0 1 2 0
1 0 0 1 0 0 1 0
0 1 0 1 0 0 0
1 1 1 1 0 3
1 1 1 1 1 3
1 1 1 1 0 3
1
1
1
1
1
1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
8 6 7 7 7 0 0 0 0 0 0 0
KETERANGAN
didalam kolom keterangan, dapat
dituliskan misalkan sasaran pindah
pindah
KETERANGAN
MENOLAK
MENOLAK
KETERANGAN
IMUNISASI DI DSA
MENOLAK
KETERANGAN
KETERANGAN
KETERANGAN
KETERANGAN
KETERANGAN
PINDAHAN
KETERANGAN
KETERANGAN
KETERANGAN
KETERANGAN
KETERANGAN
KETERANGAN
KETERANGAN
KETERANGAN
KETERANGAN
KETERANGAN
KETERANGAN
KETERANGAN
KETERANGAN
KETERANGAN
KETERANGAN
KETERANGAN
KETERANGAN
KETERANGAN
KETERANGAN
KETERANGAN
KETERANGAN
KETERANGAN
KETERANGAN
KETERANGAN
KETERANGAN
KETERANGAN
KETERANGAN
KETERANGAN
FORM
Desa/Kelurahan KREJENGAN
Puskesmas KREJENGAN
Kecamatan KREJENGAN
No. NIK Nama Anak Tanggal Lahir
14 3513150907200001 NABIL ALFAREZI 7/9/2020

8 3513151008200003 GINA AULIA 8/10/2020
11 3513152307220001 M KIN MAULANA 7/23/2022
TOTAL
FORM
Desa/Kelurahan Sentong
Puskesmas Krejengan
Kecamatan Krejengan
1 3513156805190002 QIANA CALLISTA AZZAHRA 28/05/2019

2 3513156905190001 SALSABILA RAMADHANIA 29/05/2019
3 3513154106190001 PUTRI AUFA USWATUN HASANAH 01/06/2019
4 3513150806190001 AHMAD AZKA ZAKARIA 08/06/2019
5 3513151106190001 REVANO DWI ANUGRAH PURNOMO 11/06/2019
6 3513150607190002 MUHAMMAD MAULANA IBRAHIM 06/07/2019
7 3513151607190002 BILLAH HAFIZH ATHAILLAH 16/07/2019
8 3513152107190001 MOH.TAUFIK HIDAYATULLAH 21/07/2019
9 3513152507190001 MUHAMMAD AZRIEL RAFIF AL FAREZI 25/07/2019
10 3513156707190001 ZEEANA FARADILA 27/07/2019
11 3513157007190001 NAILA KAROMATUL KAMILA 30/07/2019
12 3513156608190002 AINUN MARDLIYAH HASYIM 26/08/2019
13 3513156708190001 INDAH AULIA PUTRI 27/08/2019
14 3513150209190001 MUHAMMAD RIZKI KURNIAWAN 02/09/2019
15 3513152009190001 MUHAMMAD AKMAL FATAN 20/09/2019
16 3513154510190002 SYAVINA WIRASTRI ZAHRA 05/10/2019
17 3513154710190002 UMI TAZKIYAH KAMILA 07/10/2019
18 3513155010190001 NUR JAMILAH 10/10/2019
19 3513155810190001 SALSABILUNA RIFDA 18/10/2019
20 3513156910190002 KAYLA NADIRA EKA WATI 29/10/2019
21 3513157010190002 SALWA HUSNA HASAN 30/10/2019
22 3513157010190001 NUR ADINDA 30/10/2019
23 3513153110190002 MOHAMMAD DAFFA ALFARIZI 31/10/2019
24 3513154211190002 SYARIFAH AINIYAH HOLISHI 02/11/2019
25 3513150701200001 MOHAMMAD ARKANUL HASAN 07/01/2020
26 3513151001200002 MALIQ KAMAL ATHAUFAR 10/01/2020
27 3513152001200001 MUHAMMAD NAZRIL ATHIF FARZAN 20/01/2020
28 3513152401200001 MUHAMMAD HADZIQ ABDILLAH 24/01/2020
29 3513155002200002 AIRA IZZATUNNISA 10/02/2020
30 3513155803200001 BELA SAFIRA AINI 18/03/2020
31 3513150204200002 MUHAMMAD NADHIF SYA'BANI 02/04/2020
32 3513154304200001 SHAFIRA AULIA AZZAHRO 03/04/2020
33 3513154804200003 IQLIMATUL JANNAH ALESHA SA'BANIA 08/04/2020
34 3513155004200001 AQILAH ZALFA RAHMANI 10/04/2020
35 3513155304200002 KANAYA MARSYA AL HUMAIROH 13/04/2020
36 3513154305200002 ZAHRA AULIA ULFA 03/05/2020
37 3513155005200001 NAYLA ZULFA 10/05/2020
38 3513151705200002 MUHAMMAD FADLULLAH KHOLIL 17/05/2020
39 3513151705200004 MUHAMMAD AFKA BITAUFIQILLAH 17/05/2020
40 3513151705200005 MUHAMMAD ASADULLAH 17/05/2020
41 3513155705200001 ALINKA LANIA PUTRI 17/05/2020
42 3513151805200001 MUHAMMAD AYYUBI AULIA AZIZURAHMAN 18/05/2020
43 3513150306200001 MUHAMMAD ZAFRAN ALFARIZQI 03/06/2020
44 3513151106200001 AHMAD RAYYAN MAULANA 11/06/2020
45 3513151806200002 MUHAMMAD NUR ARAFA RAMADHANI 18/06/2020
46 3513154107200002 MARINA DWI YULIANTI 01/07/2020
47 3513150507200002 MUHAMMAD KANZUL FAWAID 05/07/2020
48 3513155507200001 KHARINA DIANA AYU UTAMAM 15/07/2020
49 3513152007200001 MUHAMMAD MAULANA ABRI SYAM 20/07/2020
50 3513154608200001 SYAQILA PUTRI PERMATA 06/08/2020
51 3513154109200001 SAKINAH RUHIYAH PUTRI 01/09/2020
52 3513154309200002 SHAREEFA JIHAN AMIRA 03/09/2020
53 3513154409200001 AURELIA AZZAHRA 04/09/2020
56 3513156409200001 CEISYA SAFITRI 24/09/2020
57 3513156110200001 NUHA SALWA MAULIDAH 21/10/2020
58 3513155311200001 ALYA MAULIDATUL JAZILAH 13/11/2020
60 3513152612200002 AHMAD FAHREZI FATAHILLAH 26/12/2020
61 3513153012200001 ADZRIL RAFIF ALFAREZI 30/12/2020
65 3513150502210003 AHMAD RASYA DWI ANUGRAH 05/02/2021
67 3513150803210004 AHMAD RIDHO ILAIKA 08/03/2021
68 3513151003210002 MUHAMMAD DZULFIQAR 10/03/2021
69 3513155203210001 QOMARIYAH RIZQA KAMILAH 12/03/2021
70 3513151903210002 MOH. REHZA FAUZI IRAWAN 19/03/2021
71 3513150604210001 MUHAMMAD HASBY AL GHIFARI 06/04/2021
72 3513151604210001 FANDI AHMAD 16/04/2021
73 MOH. RIFKI 22/04/2021
77 M. RAYYAN AL FARISKI 01/08/2021
78 NUR HAYATI 03/08/2021
79 NASHWA ZAHIRA 09/08/2021
80 M. AL FATIH 16/08/2021
81 M. ZIYAN HAKIM 23/08/2021
82 M. RIFKI YASID. A 06/09/2021
86 MOH. REZA ROMADHONI 26/10/2021
87 KHOIRUNA KAUNI 02/12/2021
88 ALMAHYRA RIZQIANA 23/12/2021
90 RATU ALIFA 17/01/2022
91 AYRA ZALFA. S 29/01/2022
93 MUH. VARDES ADITYA 09/02/2022
94 AULIA AFKARINA 21/03/2022
97 LEXI ANGGARISKA 14/04/2022
99 AISYAH ANUM SUGIANTO 21/04/2022
TOTAL
FORM
Desa/Kelurahan tanjungsari
Puskesmas Krejengan
Kecamatan Krejengan
4 NI'MATUL JANNAH 9/4/2019

5 RODHIYAH ISTIQOMAH 2/2/2020
6 ROHMATUL LIANA 4/22/2020
7 DAISA ARSILA HAFSA 7/29/2020
8 MOHAMMAD AZMI ILMA 12/20/2020
9 M. NAUVAL ALTEZZA RADITYA 7/29/2021
10 MOH. HADI IBRAHIM 6/16/2021
TOTAL
Desa/Kelurahan Temenggungan
Puskesmas Krejengan
Kecamatan Krejengan
1 M DARMAWANGSA 6/24/2019
2 M. HAIKAL 6/24/2019
3 AZZAHRA RADYA 7/16/2019
4 ANINDIRA ARLINDA 8/2/2019
5 ZULFA AINUN 8/15/2019
6 M AZRAQIRAFAN ZAHRAN 8/21/2019
7 M HAIKAL DIRGANTARA 8/28/2019
8 M IRFAN MAULANA 9/4/2019
9 M ABDULLAH HAFIDZ 11/10/2019
10 ABIDA AZZAHRA APRILIA 6/4/2019
11 FADIYATUL KEYZA APRILIA 4/16/2019
12 FIRDAUS 10/20/2019
13 M ALFIAN RAMADHANI 5/2/2020
14 MAULIDIL MAQFIROH 11/10/2020
15 MOH. IBRAHIM FIRDAUS 11/27/2020
16 MUHAMMAD ALFI FATHUR R 5/20/2021
17 MUHAMMAD GIO IRFAN 9/27/2021
18 ANDINI KHARISMA PUTRI 3/19/2021
19 RIZKI PRAYOGA 2/19/2021
20 SITI FALISFA ASKIA 1/21/2021
21 M. FARIDUL AHKAM 1/31/2022
1 MUJAHIT FISABILILLAH 4/2/2019
2 AHMAD SABRIEL AR RAYAN 4/2/2019
3 M.IRAWAN WIJAYA KUSUMA 5/30/2019
4 M.ALKHALIFI ZIKI 6/8/2019
5 AHMAD ALKAHFI ABDUL AZIS 6/15/2019
6 KAYLA MUTIARA 8/21/2019
7 SANDRINA FATIMA AZZAHRA 8/28/2019
8 M. AZIZAN AL KHAIBAR 9/18/2019
9 AHSAN NADHIFA H 9/25/2019
10 GIBRAN AL GHIFARY ZHAFRAN L. 11/8/2019
11 M. FAREL ARYA PRATAMA 11/14/2019
12 MAULIDIA AZ ZAHRA 11/20/2019
13 M FAREL MAULANA 11/14/2019
14 HANA SAKINAH 1/22/2020
15 HAIDAR ZHAFRAN 3/19/2020
16 M RIZAL 4/23/2020
17 AISYAH SALSABILA 6/8/2020
18 AZLAN ZIDAN H 6/8/2020
19 IZZATUL M 6/30/2020
20 NADHIFAH Q.A 5/22/2020
21 MAULANA NOVAN 7/10/2020
22 ALDAFI DANIYAL 5/22/2020
23 FAIQOH MUTHIA 9/30/2020
24 ZERINA NADHIFAH 10/8/2020
25 MUHAMMAD TRIZA AKMAL 10/13/2020
26 AINUN FATIMAH AZZAHRO 12/7/2020
27 M HASAN 12/23/2020
28 EDWARD YANUAR 1/7/2021
29 NUR ALIFAH 5/30/2021
30 SITI AISYAH 6/18/2021
31 M. ABIAN FAREZA 6/6/2021
32 AINA PUTRI AZZAHRA 7/10/2021
33 SYAKILA SHANUM AZZAHRA 9/10/2021
34 AFRINA FATIMA AZZAHRO 11/23/2021
35 NIZAM EL SYARIF 12/24/2021
36 HAFEIS MAULANA 12/5/2021
37 CHIKA ARUMITHA PUTRI 12/24/2021
38 M AZRILRAFIF 12/31/2021
39 DELISHA ANNIRA 1/9/2022
40 SITI NA'IMA 1/31/2022
41 FATIMAH AZZAHRA 2/4/2022
42 RIANI MUTIA AZZAHRA 2/20/2022
TOTAL
FORM
Desa/Kelurahan PATEMON
Puskesmas KREJENGAN
Kecamatan KREJENGAN
11 3513151411190001 IVANO 11/13/2019

16 3513156007190004 ALIKA GISKA NAZARIA 7/20/2019
22 3513155007210001 GHEFIRA NAWJA 13/09/2021
25 3513154210220002 A BAYDURI HUSNAN 27/12/2021
TOTAL
FORM
Desa/Kelurahan Opo-Opo
Puskesmas Krejengan
Kecamatan Krejengan
1 3513154504210001 KAFFANI HIMMATUL ADIMAH 5/4/2021

2 3513150505210002 MUH. ADAM FARUQ SYAUQILLAH 5/5/2021
3 3513151605210002 MUH. ALIF FAJAR ALFIAN 5/16/2021
4 MOH. RAFKA DHIAUL HAQ 6/30/2021
5 3513157107210002 FEBI NUR FAIZAH 7/31/2021
6 3513156405190002 ABDULLAH MADA ALGHAZALI 3/17/2022
7 3513155803220002 ERINA ZIYAN SYA'BANIYAH 3/18/2022
8 3513155402220002 RIANI MUTIA 2/14/2022
TOTAL
FORM
Desa/Kelurahan rawan
Kecamatan : KREJENGAN
5 3513152008190001 RISQILLAH NABIL AKBAR 20.08.2019

8 3513152402200001 MOH REZA PRATAMA 24.02.2020
3513152704210001 M RIFKI RAMADHON 27.04.2021
3513150605210002 M GABRIL RAMADHAN 06.05.2021
TOTAL
Desa/Kelurahan Seboro
1 3513152205190001 M FATTAHUR RIZQI 5/22/2019

2 3513151707190001 PANDU PUTRA P 7/17/2019
3 3513155907190002 SITI KHODIJAH 7/19/2019
4 3513155008190002 ELSHA NURIL FITRIA 8/10/2019
5 3513155008190001 ZAFIRA FATIMATUZ Z 8/19/2019
6 3513152508190001 DAISHA 8/25/2019
7 3513151009190002 MUHAMMAD SALIM 9/10/2019
8 3513150910190001 RESTU DIPTA ADINATA 10/9/2019
9 3513151310190003 M HIDAYATULLAH 10/12/2019
10 3513152510190002 M REIHAN 10/25/2019
11 3513150111190001 M JAMALUDDIN 11/1/2019
12 3513151911190002 M TRISTAN ALVREDO 11/19/2019
13 3513152611190001 M IQBAL 11/26/2019
14 ABDULLAH 12/6/2019
15 3513156202200002 KHANZA AMELIA P 2/22/2020
16 3513155903200001 KHODIJAH FADILATUL R 3/19/2020
17 3513155304200001 ZAHIRA FELA AULIA 4/13/2020
18 3513154905200001 AYUNDYA AQILA R 5/9/2020
19 3574040807200001 M UAIS AL QORNI 7/8/2020
20 3513151910200001 DEVIN CANDRA WAHYUDI 10/19/2020
21 3513156112200001 ARUMY KENZA DESTIANA 12/21/2020
22 3513150901210002 MUHAMMAD ALIF ZAIDAN RAMDAN 1/9/2021
23 3513155801210001 FAIZAH NURUL IZZAH 1/18/2021
24 3513153001210001 MIYAZ NUZULAN S 1/30/2021
25 3513152302210001 M RAFKA M 2/23/2021
26 3513156802210001 HANA AULYA Z 2/28/2021
27 3513155103210001 PUTRI NUR FAIZAH 3/11/2021
28 3513151002210001 AHMAD NAZRIL F 2/10/2021
29 3513152403210001 M RAFKA ARSHA FATHAN 3/24/2021
30 ALI MASHUR 5/12/2021
31 3513152207210001 MUHAMMAD RIFKY HABIBI 7/22/2021
32 3513156310210002 ALMIRA MIKHAYLA AL GHOZALI 10/23/2021
33 3513150811210002 M KAUTSAR AL FATIH JUAN SALIM 11/8/2021
34 3513150811210001 MUHAMMAD AYDAN ATHALLAH PRANATA 11/8/2021
35 3513151711210001 DENIS SAJJAD AMRULLAH 11/17/2021
36 3513157001220001 FATIMATUZZAHRO ALBATUL 1/30/2022
37 3513154202220004 ZAENAB 2/3/2022
38 3513150406200001 NYAWANG RIKO ALIF 6/4/2020
39 3513154209200001 LANIKA ZOYA ALIFIYA JAKFAR 9/2/2020
40 3513091703210001 M IHKSAN HAJIT IBRAHIM 3/17/2021
41 3513153005210001 A HAIDAR AZZAM N 5/30/2021
42 3513155806210001 ANINDYA NALISHA ISMAIL 6/18/2021
43 3513155311210001 LAURA ALMAIRA 11/13/2021
44 3513156006190001 HANIYYAH ZHAFIRA 6/20/2019
45 3513151209180002 M RAFFAN ALMAN S 9/12/2019
46 3513154508200001 ZAHIRO NUR KHOLISA 8/5/2020
47 3513152112200001 MUHAMMAD AZZAM AULIAN PUTRA 12/21/2020
48 3513151903210001 M AKBAR MAULANA WAHID 3/19/2021
49 3513152604210001 A FARIS NAUFAL R 4/26/2021
50 3513156904210002 BALQIS APRILIA A 4/29/2021
51 3513154807210001 WILDATUL FIRDAUSIAH 7/8/2021
52 3513150409210002 MUHAMMAD DEVANDRA PUTRA SANTOSO 9/4/2021
TOTAL
FORM
Desa/Kelurahan 0
Puskesmas 0
Kecamatan KREJENGAN
1 351315280322000 AHMAD AKMAL HUSEIN 3/28/2022

4 351315461121000 NAGITA SYAKILA 11/6/2021
8 351315420721000 RANIA ZAINA ABIDAH 2/27/2021
9 351315010721000 M.AZMI QUMARIZZAMAN 7/1/2021
10 351315410721000 SERLI DWI RISKIANA 7/1/2021
12 351315050621000 BEQYUZA ASYIRIL ABDILLAH 6/5/2021
13 351315050621000 MUHAMMAD ATIF RABBANI 6/5/2021
14 351315610521000 DAIZI FITRIA MAEZURA 5/21/2021
15 351315530521000 FITRI AISYAH SALSABILA 5/13/2021
16 351315210421000 ASWINDRA ABIYAS TRIYAJI 4/21/2021
17 351315421220000 ANINDIRA SURYA FAUZIYAH 12/2/2020
19 35131551042000 NADIA TIARA ASYIFA 4/11/2020
20 35131559032000 KHOIRINA LATIFAH 3/19/2020
21 35131570012000 YUSHIFATUL KHUMAIROH 1/30/2020
22 351315681219000 DESBYRA KAMARATIH 12/28/2019
23 351315011219000 AKSEL FACHRY A.KIEVLER 12/1/2019
24 351315211119000 MALIEK ALAMSYAH AI M 11/16/2019
25 351315411119000 CHEISYA FARADISA P.A 11/1/2019
26 351315250919000 M.HAFIZH MUBAROK 9/25/2019
1 351315170220000 RAUDATUL RIZKIYAH 2/17/2022
2 351315420322000 KEYSHA ANDINI PUTRI 3/2/2022
5 351315181221000 MUHAMMAD BAISUNI 12/18/2021
6 351315701021000 SYAFARA AISYAH MAULIDA 10/30/2021
7 351315591021000 ARUMI NUR MAULIDAH H 10/19/2021
8 351315551021000 LAILI DWI OKTA VIA 10/15/2021
9 351315150521000 M.IQBAL FATAHILLAH 5/15/2021
10 351315520521000 ROBI'AH AL ADAWIYAH 12/23/2020
11 351315231220000 ABQORI HAFIDZUL UMAMI 12/23/2020
12 351315430920000 SYAFAATUL UZHMA 9/3/2020
13 351315240520000 RAFFI HAMZAH 5/24/2020
14 351315060520000 MOCH.AFTAH MISBAHUL M 5/6/2020
15 351315290420000 AZRIEL ALBY AMRILLAH 4/29/2020
16 351315520420000 AINUL QOLBY FADILAH 4/12/2020
17 351315510320000 ANDINI CINTA QALEESHA 3/11/2020
18 351315220819000 M.DAFI AL HAFIDZ 8/22/2019
19 351315260719000 MUHAMMAD ALBY ALFATIH 7/26/2019
1 351315240322000 M.ZAFRAN ELZIO 3/24/2022
2 351315590222000 MAGISYA FATIMATUS Z 2/19/2022
9 351315560419000 AMIRAH AINUN BASHIROH 4/16/2019
10 351315490621000 AURELLIYA KANZA 6/29/2021
11 351315430321000 CHALYA DEWI HANIFAH 3/3/2021
12 351315271220000 ARGA EKA SETIAWAN 12/27/2020
13 3513155611200000 CHAYLA NADHIFA AZ ZAHRA 11/18/2020
15 351315690520000 INTAN SUKMA CIPTA S 5/29/2020
16 351315440520000 FARAH RAMADANI 5/4/2020
17 351315480420000 HALIMATUS ZAHRO 4/8/2020
18 351315110220000 M.ALBY DAVIE 11-Feb
19 351315161219000 M.MUNTADIR BILLAH 12/16/2019
20 351315111119000 GIANT ADITYA 11/11/2019
21 351315451019000 KHUMAIRA R.MARWA 10/5/2019
22 351315560919000 ATIKAH RUMMAN S 9/16/2019
23 351315450819000 BRILIAN CLARIZZA SUCAHYA 8/5/2019
24 AMARA KAYLA FELISIA 7/23/2019
25 351315230619000 MOH.ROISUN NAJIH 6/23/2019
TOTAL
FORM
Desa/Kelurahan Sumber katimoho

Puskesmas krejengan
Kecamatan krejengan
33 3513154407210001 WARDATUL NISA 4/7/2021

34 3513150707210001 ZAFRAN RABBANI TAHFIZ 2/8/2021
35 3513151708210001 AHMAD ZAYYIDURRAHMAN 17/8/2021
36 3513156508210001 EKA PUTRI ANDANI 25/8/2021
37 3513150707210001 M FAIZ HARIYANTO 7/7/2021
TOTAL
Desa/Kelurahan : Kedungcaluk
Kecamatan : Krejengan
7 3513150311190001 M. FURQON H 11/3/2019

8 3513151911190001 AHMAD MUZAKKI 11/19/2019
9 3513156801200001 HAFIZA KHAIRA 1/28/2020
10 3513156803200001 FATIMAH KANZA 3/28/2020
11 3513154105200001 ALIKA PUTRI 5/1/2020
12 3513154405200002 DITA ALFIANA 5/4/2020
26 3513156803220001 REGINA NUR AZIZAH 3/28/2022
27 3513156803220002 REGITA NUR AZIZAH 3/28/2022
5 3513156709190002 FATIMA LAILI MAFAZA 27/9/2019
6 3513151802200001 AHMAD MAULANA 2/18/2020
15 3513157108210002 KAYLA AZKIA AGUSTIN 8/31/2021
18 3513151512210002 FARUQ PUTRA ARIFIN 12/15/2021
2 3513151507190002 MUH FATIHILLAH 7/15/2019
5 351315912190002 ALIFAH ZAHRA ULUMILLAH 12/20/2019
6 3513154501200001 DISTA AYUNDIRA 1/4/2020
7 3513155102200001 NAJWA PUTRI ABDILLAH 2/11/2020
8 3513156002200001 FARANISA PRIATNA 2/20/2020
12 3513152210000001 MUH ALFAN 10/22/2020
13 3513152210000002 MUH ALFIN 10/22/2020
14 3513151011200002 ABDUL LATIF 11/10/2020
22 3513152511210002 PANDRA ARSYAD IRAWAN 11/25/2021
23 3513155112210001 ARSYLIA 12/11/2021
24 3513156312210002 ZELLIN DESTIANA 12/23/2021
25 3513152207210001 M. SYARIFUDDIN 1/29/2022
29 3513151409190001 MOH HASAN HABIBI 14/9/2019
32 3513142712190001 SAFINATUS SAADAH 12/7/2019
33 3513155312190001 SHOLEHATUN NAFISA 12/14/2019
34 3513156802200002 ASIAH MUKAROMAH 2/28/2020
35 3513150604200002 M AZZAM NABIL 4/6/2020
37 3513151003200001 M. ILYAS AINUL YAQIN 3/10/2020
38 3513154505200001 SRI AYUNI WULANDARI 5/5/2020
39 351315150920001 ANDIKA 9/15/2020
8 3513152211190001 M. TAUFIQ 11/22/2019
9 3513151902200001 HASAN HILMI 2/19/2020
TOTAL
FORM
Desa/Kelurahan Dawuhan
Puskesmas :KREJENGAN
Kecamatan :KREJENGAN
1 3513150605190000 AHMAD AZIAN KOSYI 5/6/2019

2 3513124707190001 ALEENA KANZIL FARICHAN 7/7/2019
3 3513156107090002 HALIMATUS SAKDIYA 8/23/2019
4 3513155911190001 AIRA YAZIN UMAIZA 11/19/2019
5 3513151201200001 MOH SOLIHIN 1/12/2020
6 AKSA ABI PUTRA 4/13/2020
7 3513152004200001 M RAUL SANJAYA 4/20/2020
8 3513152106200001 MOH ARYA SATYA 5/21/2020
9 3513150209150001 AHMAD HASAN IDHAM HAKIKI 5/22/2020
10 3513154206200001 ARUMI PRASISTA BELA 6/3/2020
11 3513150209200001 MOH GILANG 9/2/2020
12 3513151110200001 MOH RAFISQI HAIKAL 10/11/2020
13 3513151910200002 MOH ALFARISKI MAULANA 10/19/2020
14 3513153001110027 ALMAIRA AZAHRO 12/16/2020
15 3513154401210001 HASNA SOFWATUL HAKIMAH 1/4/2021
16 3513156701210001 PUTRI MEDINA ISNAINI 1/27/2021
17 3513154204210001 FATHIMA 4/2/2021
18 AKHMAD RAFIZQI AL-FARIQ 8/12/2021
28 3513152104220001 AHMAD FAYAT ALFA RENDRA 4/21/2022
29 3513151404220001 MOH IHSAN RAMADAN 4/14/2022
30 3513155306220001 NASHITA JIHAN AZUSA 6/13/2022
32 3513154907220001 NASHA AULIYA 7/9/2022
35 INARAH ZALFA FITRIAH 2/12/2023
37 3513151209230002 RASYA RIZKY DWINATA 9/12/2023
39 MOH. ADAM RAFANI 10/21/2023
40 GHINA MAZIYAH A 01/22/2023
41 LINTANG AYU N 11/12/2023
94 3513151207230001 M. KAYFAN ATA .R 5/6/2023
98 3513150609230002 FAIMATUS ZAHRO 25/08/2023
99 3513156109230001 MOH. FAHMI HIDAYATULLAH 6/9/2023
100 GINA NUR ZAKIYAH 9/21/2023
101 3513417009230001 M. HASAN AZZAIMI 1/10/2023
102 3513154303190001 NAILURROHMAH 30/09/2023
103 3513155210230001 DIVA 9/30/2023
104 SYAHDA TAQIYA 10/12/2023
105 MOH ALVIN HASAN 10/14/2023
106 NURUL HIDAYATI 12/8/2023
107 3513151412230002 ZIDAH ZAHROTUL KAMILAH 12/8/2023
109 3513155210230002 KHALISA AULIYA PUTRI 12/24/2023
8 3513154207200001 AMANDA RAFANIAH 7/2/2020
18 ISTI ROHIMAH 5/2/2020
30 3513150307230002 MOH RISKI 7/3/2023
31 3513150307230002 MOH RASKA 7/3/2023
TOTAL
FORM
Desa/Kelurahan Widoro
Puskesmas 0
Kecamatan :
1 Ahmad Absori 5/6/2019

2 Anggita Putri Nufazilah 5/19/2019
3 Fatan Alfarizqi 6/18/2019
4 Hafidatul Fahiroh 6/8/2019
5 Arinta Wahyuni 7/15/2019
6 Edina Mufina Z 8/11/2019
7 M. Haidar Pratama 9/24/2019
8 Adeeva Kirana Palupi 9/19/2019
9 Muhammad Fafan A 9/23/2019
10 Ahmad Dika P 12/30/2019
1 Nabila Sabana 3/9/2020
15 Muhammad Shohibul M 3/19/2020
16 Moh.fahmi 4/16/2020
17 Aseeqa Naurin A 5/5/2020
18 Muhammad Fatian R 5/10/2020
19 Rafianza Grawi A 5/21/2020
20 Ayesha Fatimah Azahra 6/16/2020
21 Azkiya Nur Syifa Azahra 6/16/2020
22 Helmy Fabian 8/14/2020
23 Muhammad Yudis 10/23/2020
24 Cyntia Riqzi azalia 10/26/2020
25 Mykayla Farzana A 11/3/2020
26 M.Darel Hasan 11/3/2020
27 Chayra Maulida Jazila 11/9/2020
28 Kamil Nufail Zafran A 1/21/2021
29 Moh.fahmi Putra S 11/14/2019
30 izza khadijatul M 3/18/2021
31 BilQis Putri K 3/22/2021
32 Ras Muhammad 3/30/2021
33 Fatimah aulia azzahra 4/4/2021
34 Nur Riskia Ara 4/8/2021
35 Nurin Aprilia Ramadhani 4/24/2021
36 Aprilia Nur Khofifah 4/25/2021
37 Diki Maulana Hasan 9/2/2021
38 Naura zakiyah 9/19/2021
39 Azka Alkaleena 6/14/2021
40 Naziyah Naina zahira 6/25/2020
41 Fatimah Zahra 10/6/2021
42 M.Ferliansyah P 10/21/2021
43 Maulana Agis 8/24/2021
44 Fayes Balqis M 7/19/2019
45 Putri Viona Janingtyas 1/18/2022
46 Nur Alisha Aira 1/28/2022
47 Nazifa Marzia 2/2/2022
48 Keisha Putri m 3/27/2022
49 Salsabila al-Jannati 3/26/2022
50 Putra Sunaya 3/29/2022
TOTAL
FORM
Desa/Kelurahan kamal kuning

1 3513154704220002 AISYAH APRILIA RAMADANI 4/7/2022

2 3513151905220002 ADAM PRADIPTA 5/19/2022
3 3513152405220001 AHMAD ALDI HASAN 24/05/2022
4 3513154406220001 WARDAH GENDHIS ABRORI 6/4/2022
5 3513153006220001 REYHAN DZAKA AL KARIM 6/30/2022
6 3513152906220002 ADZKA ZIAN ROBBANI 6/29/2022
7 3513157107220001 MARIA AL QIBTIYAH 7/31/2022
1 3513150903210001 MUHAMMAD KHOLIL 3/9/2021
2 3513152410210001 MUHAMMAD ARDIANSYAH WIJAYA 10/24/2021
3 3513154612210002 HILALIYA 12/6/2021
4 3513150612210003 M GIBRAN / NOVAL 12/6/2021
5 3513152112210001 MUHAMMAD SHOFIYULLAH / M AL FATIH 12/21/2021
6 3513150405220003 MUHAMMAD ZIDAN SYABANI 5/4/2022
7 3513151105220002 M. AZMI ALFARISI 5/11/2022
8 3513152805220001 AKBAR RAYYAN 5/28/2022
9 3513152805220002 AL AYYUBI ADITIYAH 5/28/2022
10 3513150306220002 MUHAMMAD RIVAN AL GHAZALI 6/3/2022
11 3513152206220002 AHMAD TAUFIQILLAH 6/23/2022
12 3513156306220001 ALISHA SYAFA NUR BALQIS 6/23/2022
13 3513155307220002 MIKEYLA JIHAN 7/13/2022
14 3513151607220000 GIBRAN 7/16/2022
15 3513151408220001 RIFKI ARDIAN / SYAFUL RIFKY WIJAYA 8/14/2022
16 3513157009220001 AMIRA MAULIDIA 9/30/2022
17 3513153009220003 M. MAULANA MALIK I 9/30/2022
hh/bb/tttt
TOTAL
FORM
Desa/Kelurahan 0
Puskesmas 0
Kecamatan :
40 M rafa Aska Putra 3/4/2022

FORMAT PENDATAAN POSYANDU SASARAN IMUNISASI KEJAR
SASARAN IMUNISASI KEJAR 24 - 59 BULAN
Kabupaten/Kota PROBOLINGGO
Provinsi JAWA TIMUR
Posyandu Matahari
Umur (bulan) NIK Nama Orang Tua
44 3513150508820000 ANA NUR

43 3513150609820000 ERNAWATI/ABU SOLEH
20 3513151808840000 KARUNIA/INDRA
TOTAL

Kabupaten/Kota probolinggo
Provinsi Jawa timur
60 HOSEN
60 DWI FITRI QOMARIYAH
60 SYAFI'I
60 SUDI WARNO
60 FAFAN PURNOMO
59 MUHAMMAD FARISI
58 RAHMAT SAIFUL ANAM
58 INDAH SRI AGUSTIN
58 AJI KUSNANDRI
58 RYAN ADI PRATAMA
58 MUKHLISIN
57 MUHAMMAD WAHID HASYIM
57 ZAINUL
57 AGUS HARIYANTO
56 SAIFUL ISLAM
56 SHOLEHUDDIN
56 USMAN EFENDI
56 PRIMA HASAN
55 MOHAMMAD REGIK
55 SYAIFULLAH
55 NUR HASAN
55 MUZAMMIL
55 SUDIYONO
55 NOER HOLISH
53 RASIKIN
53 IWAN SYAIFUDIN
52 BASORI ALWI
52 MAHFUD ALI
52 SAIFUL ALIMUDDIN
50 BABUL ILMI
50 MOHAMMAD NANANG MAHARUD
50 MISTARI
50 SATRIO WAHYUDI
49 ABD. RAHMAN
49 JUNAIDI
49 SAPIK UDIN
48 SUPRIYANTO
48 MISBAHUL MUNIR
48 MOH. MUKHLISIN
48 RIDLAUR RAHMAN
48 GUSTAF BASOFI
48 M. IMAM AZIEZ
48 ACHMAD HIDAYATULLAH
47 MUKADI
47 ABDUR RAHMAN
47 SUKRON
47 ATOK MAULA
46 HILAL UTAMAM
46 MUHAMAD NUR SAMSI
46 ZAINUL ARIFIN
45 MUHAMMAD RUHIL AMIN
45 JENY DARMAWAN ABADI
45 ALI ZAINAL ABIDIN
44 FITRIA MULYANA
43 HERI BUDIYANTO
42 MOH. HIDAYATULLAH
41 SANIMAN
41 ANSORI
39 SAHER
38 YUDI HARTONO
38 ABDUL HADI
38 BATU KOMAR
38 FAUZI
37 SHALEHUDIN
37 ZAINUL ARIFIN
37 BUDI HARTONO
34 AHMAD ZUHRI
34 NURUL ARIFIN
33 M. SHOLEH
33 DWI FITRI QOMARIYAH
33 LUKMAN
32 MAHMUD. P
31 M. ROMADHONI
29 KHOIRIL ASKAR
29 ROMLI
28 M. JUNAIDI
28 NURUL HUDA
27 SALMAN FARISI
26 SOLEHODIN
25 BUDI HARYONO
25 NANANG HARI
TOTAL

57 JUMAATI
52 EKA YULIANA
49 RIRIN
46 FITRIA
41 NITA NURMALA
34 LUSIANA
35 SITI KHOIRIYAH
TOTAL
Kabupaten/Kota Probolinggo
Provinsi Jawa timur
59 EVA FEBRIANTI
59 EKA INDRIWATI
58 SRI WAHYUNI
58 LINDA
57 AYUM
57 ROBIATUL UMAMI
57 DINA
57 ERNI
55 SIZE ASTUTIK
60 HOSNAWIYATI
62 ROMLAH
55 HALIMATUS
49 DESI
42 ROMLAH
42 SIZE LIANA
36 ROMYATI
32 LILIK RAHMITA
38 ARTI BULAN MAULANI
39 YULIANA
40 SRI HANITA
27 BADIATUL ILMI
62 ROHMANA
62 SILMI
60 FARIDA
60 SUPARMI
60 SITI ZULAIHA
57 HALIMATUS S
57 IKA WULANDARI
56 MEGA RAHAYU
56 AZIZATUL
55 YAYUK UMIYATI
54 KARTINI
54 JUMAATI
54 RIRIN
52 AVITA
50 AINUN JAZILAH
49 MAIMUNA
48 ANITA
48 UMUL WASILAH
47 HUSNUL
48 NURUL HABIBAH
46 LINGGA
48 SUBAIDAH
44 ANI ROHANI
43 USWATUN H
43 ENDAH DWI PUJI
41 USWATUN H
41 ANIK ANDRIYANI
40 NOVITA ANGGRAENI
36 RIFATIN
35 BAWON
35 MAULIDA
34 PUTRI MILIANA
32 HAMIDAH
30 IKLIMAH FIRDAUSIYAH
29 YUNITA
29 NUR KHOLIFATUL F
29 YENI WULANDARI
29 ALIYA
28 LINDA RUGUS
27 RISKI FATMAWATI
27 SURATMI
27 HALIMATUS S
TOTAL

Provinsi JAWA TIMUR
54 LITA UTAMI
58 ST AISYAH
32 NUR AZIZAH
#VALUE! ERNAWATI
TOTAL

Provinsi JAWA TIMUR
37 HAIRUL ANAM
37 SALAM
36 HARIYANTO
35 DIAUL HAQ
34 KAMAL
26 SIPUADI
26 SULTHON
27 MOH IKROM
TOTAL

Provinsi Jawa Timur
55 SA'AT / RINIATUL A
49 MOH. MUHLISIN HR / WARDATUS
35 DIKI SEPTIAN / FITRIA
34 M ZAKI G / RINI WIDIYA A
TOTAL

Kabupaten/Kota Probolinggo
Provinsi jawa Timur

60 SRI NINGSIH/ HASAN

58 NOVITA DWI/ YOGA
58 SULISTIA/ HODRI
58 MARIA OFA/ NURLINA
57 MUSDALIFA /M ARIF
57 MIGA S/ DEDI
57 PUPUT J/ M KHOLIL
56 NUR AZIZAH/ BAYU
56 SENIWATI/ MALIHEN
55 YUNI H/ ERIK
55 YULIK M/ SOLEHUDIN
54 JUM'ANIS T/ WAHYUDI
54 SUTILA/ MUHAMMAD
54 NI'MAH/ABDUL QODIR
51 NUR HAMIDA/ MOCH WAHYUNI
50 LAILATUS SHOIMAH/ IMAM
49 ANISA NUR J/ FENDI S
49 DEVI NANDA / GUSTIAN
47 WIGIANA N/ TONY R
43 SUMIYATI/ FAISAL Q
41 HALIMATUS S/ RIVAN M
40 NINIK S/ ABDUL WAQI
40 SITI AMINATUS S/ AS'AD
40 SALEHA/ LUKMANUL HAKIM
39 SITI SOFIANA/ SUDIANTO
39 SOFIA A/ ZAINAL A
38 YULIATI / A HOSNAN
39 SUPIATUN H/ ZAINUL HAKIM
38 WAHYUNINGSIH/ HENDRIK
36 NI'MAH/ABDUL QODIR
34 WAHYUNI/ M KUFFAL
31 SUMAIYA/ M GHOZALI
30 JUMIANIS/ AGUS SALIM
30 DWI INDAH / JONI P
30 IVA AGUSTINA/ ZAINUL YAKIN
28 ROFIQOH/ BUDI HARTONO
27 PUPUT J/ M KHOLIL
48 YULIATIN/ TAUFIK
45 SIDDIKAH/ M JA'FAR
38 WIWIK W/ VERDI I
36 SITI AISA/ ZAFRA D
35 KHOLISATUL J / ISMAIL
30 LINDA M/ FENDIK
59 SUTIANI/ HOSEN
57 SUTIANA/ SAIFUL BAHRI
46 RAHMAWATI/ M TOHA
41 DWI SULISTYO/ M ARIF
38 SUMILA/ ABD WAHAB
37 SOLEHATUN/ MALIK M
37 SUHAIMI/ HASYIM A
34 AMINATUL M/ DARI K
32 SITI KHODIJAH/ EDI SANTOSO
TOTAL

Kabupaten/Kota 0
Provinsi 0
26 SEPTIAN A
30 IMA LATIF
39 M.ZAINI
35 ABDULLAH H
35 ILYASIN
35 M.GHAZALI
35 M.GUFRON
36 RICA APRIAN
36 MISBAHUS S
37 SURAJI
42 SURIYANTO
49 RIYAN HIDAYAT
50 A.PUSAIRI
52 A.YUSUF
53 FARIS NUR H
54 SA'DULLAH
54 MUSLEH
55 NURUL HUDA
56 IRHAM ZAKI
27 M.ZAINI
26 RUDI HARTONO
29 BUNARI
31 EFENDI
31 AGUNG H
31 A.M.AINUL Y
36 SYAIFUL ULUM
41 A.BADRU
41 MISNARI
45 SUKISNO
48 ABDULLAH
49 SULAIMAN
49 A.ZAINI
49 ATMOJO
51 EDI SUPARTO
57 UMAR
58 SAMSUDIN
26 JUMARI
27 ISWANTO
62 SUMARNO
35 A.GUNAWAN
39 ABDUL GHOFUR
41 AGUS S
42 AGUS P
48 ABD.KADIR I
49 ABDURRAHMAN
50 SYAIFULLAH
51 IMAM M
53 BAHARUDDIN
55 IRWAN
56 M.GAZALI
56 TIO PANJI M
58 EKA EDI S
58 ABDUL GHOFUR
59 SUBAIRI
TOTAL

Provinsi JAWA TIMUR
SENERI
HANDRIAN
M NURUDDIN
MUHAMMAD ANTONI WIJAYA
HARIYANTO
TOTAL

Kabupaten/Kota : Probolinggo
52 ZAINULLAH
52 ABD HAKIM
50 RIKE SANTUSO
48 MAIMON
46 RIDWAN
46 M. AGUS
24 RIDWAN
24 RIDWAN
54 KHOLIS
49 BAKRI
31 M. TOHIR
27 SYAMSUL ARIFIN
56 MUJIONO
51 SAIFUL ULUM
50 AMSARI
49 DENI ABDILLAH
49 NANANG
41 MAHFUD
41 MAHFUD
40 QOMARUDIN
28 DEDI IRAWAN
27 MAHFUD
27 ISHAK
26 KHOLILI
54 UTSMAN
51 ABDUR RAHMAN
51 M. SOHIB
49 MUH. URIP
47 M. FAUZI
48 SAMSUL ARIFIN
46 SAHIRUDIN
42 ABD. WAHID
52 ABD.RAHMAN
49 MUSTOFA
TOTAL

Kabupaten/Kota 0
Provinsi 0
MUTMAINAH
NOVI RISALATUL
LASIANA
NORA
ILFAUL HASANAH
KIKI SUSILAWATI
NUR LAILATUL FAIZAH
WAHYUNI
RAFIKA
MARATUL KARIMAH
ANITA
BAHIATUR
NUR HAYATI
ISMAISAH
41 RIKA APRILIA
40 WAISILATUL ARHAM
38 KIPTIATUL HASANAH
33 WASIK
25 SOFIANA
25 HUSFATUL
23 SITI ELIZA
22 NUR AZIZAH
15 MARIATUL HASANAH
MARFU'AH
7 FANIA
SAUDA
NUR SRI
IKA AGUSTIN
NUR AINI
YETI
YUSROWIYAH
NUR FARIDAH
SITI TOYYIBA
FIFIN
CHOIRUN NISAK
SEPTY AYU
NURUL HIDAYAH
FAUZEH
YENI
ENDANG
IMRO'ATUS S
HALIMATUS S
HALIMATUS S
TOTAL

Kabupaten/Kota 0
Provinsi 0
61 Rahmawati
60 Siti Romlah
59 Sulung KS
60 Holidah
59 Mardiyah
58 Siti Amina
56 Lailatul Qodriyah
56 Rian Tanzilurrahmi
56 UUL Mulyawati
53 HASIDAH
51 Meli Suciati
50 Nunung HJ
49 Subaidah
49 Kholila
49 Yeni Dwi
48 Ririn
47 Umi Rabiah
47 Nurul Jannah
45 Ulan Agustin
43 Indah Wahyuni
43 Rina Andira
43 Eliza Khoirunnisa
43 Sulastri
42 Riska Dwi H
40 Nita Nur Aini
54 Sumiasih Eka
38 Wiwit Ermawati
38 Hairiyah
38 Nurur Rahmah
38 Irawati
37 Santi Noviatul I
37 Melida dwi U
37 Dahlia
33 Hasidah
32 Umi Salamah
35 Nur Rohimah
47 Norma
31 Yusi Nafiatun
31 Herlina
33 Siti
58 umi Lailatus
28 Nur Istiqomah
28 Liswati
27 Mely suciati
26 Juana Herlinda
26 Tutik Hidayati
26 Sri Rahayu
TOTAL
Kabupaten/Kota 0
Provinsi 0
23 FARIDA
22 EKA NOPETRIA
22 MAHMUDA
21 YUSRONIA
21 HANIFAH
21 NUR HAVIDHOH HIDAYATI
20 RINI HIDAYATUL
36 MARIA ULFA
29 LUTFIYA
27 SIROJUM MUNIRO
27 ULIN NIKMAH
27 SHOFIYATUN JAMILA
22 IKA WARDATUL
22 SITI AMINA
22 LILIK
22 MUSRIFAH
21 SITI JANNATI
21 UMI MALIKA B
21 ITA MUSYARAFFA
20 SYARIFAH
20 YAYUK
19 HUSNUL F
18 UMI HABIBA
18 WAHEDA
#VALUE!
TOTAL

Kabupaten/Kota 0
Provinsi 0
26 Sa'id/Toria
UNISASI KEJAR
AN
DOSIS IMUNISASI (BELUM DITERIMA=1, SUDAH DITERIMA ATAU BELUM WAK
DPT-HB-Hib 1
DPT-HB-Hib 2
DPT-HB-Hib 3
Alamat
OPV 1
OPV 2
OPV 3
OPV 4
IPV1
IPV2
Desa KREJENGAN-Posy. MATAHARI 0 0 1 1 1 1 0 1 1
Desa KREJENGAN-Posy. ANGGREK 0 0 0 0 0 0 0 0 0
Desa KREJENGAN-Posy. ROSELA 0 0 0 0 0 0 0 0 0
0 0 1 1 1 1 0 1 1
UNISASI KEJAR
AN
DPT-HB-Hib 1
DPT-HB-Hib 2
DPT-HB-Hib 3
OPV 1
OPV 2
OPV 3
OPV 4
Alamat
IPV1
IPV2
DUSUN SELOLEMBU 0 0 0 0 0 1 0 0 0
DUSUN KADEMANGAN 0 0 0 0 0 1 0 0 0
DUSUN SILOLEMBU 0 0 0 0 0 1 0 0 0
DSN KEDUNG BRINGIN 0 0 0 0 0 0 0 0 0
DUSUN KRAJAN 0 0 0 0 0 0 0 0 0
DUSUN KEDUNG BRINGIN 0 0 0 0 0 0 0 0 0
DUSUN KRAJAN 0 0 0 0 0 0 0 0 0
DUSUN KRAJAN 0 0 0 0 0 0 0 0 0
KP. KRAJAN 0 0 0 0 0 1 0 0 0
DUSUN KRAJAN 0 0 0 0 0 0 0 0 0
DUSUN KRAJAN 0 0 0 0 0 1 0 0 0
DUSUN KRAJAN 0 0 0 0 0 0 0 0 0
DUSUN KRAJAN 0 0 0 0 0 0 0 0 0
DUSUN KRAJAN 0 0 0 0 0 0 0 0 0
DUSUN KRAJAN 0 0 0 0 0 0 0 0 0
DUSUN KRAJAN 0 0 0 0 0 1 0 0 0
DUSUN KRAJAN 0 0 0 0 0 0 0 0 0
DUSUN KRAJAN 0 0 0 0 1 0 0 0 0
DUSUN KRAJAN 0 0 0 0 0 1 0 0 0
DUSUN KRAJAN 0 0 0 0 0 1 0 0 0
DUSUN KRAJAN 0 0 0 0 0 0 0 0 0
DUSUN KRAJAN 0 0 0 0 1 0 0 0 0
DUSUN KEDUNG BERINGIN 0 0 0 0 1 0 0 0 0
DUSUN KRAJAN 0 0 0 0 0 0 0 0 0
DUSUN KRAJAN 0 0 0 0 0 0 0 0 0
DUSUN KRAJAN 0 0 0 0 1 0 0 0 0
DUSUN KRAJAN 0 0 0 0 0 0 0 0 0
DUSUN KRAJAN 0 0 0 0 0 0 0 0 0
DUSUN KRAJAN 0 0 0 0 1 0 0 0 0
DUSUN KRAJAN 0 0 0 0 1 1 0 0 0
DUSUN KRAJAN 0 0 0 0 0 1 0 0 0
DUSUN KRAJAN 0 0 0 0 1 0 0 0 0
DUSUN KRAJAN 0 0 0 0 0 1 0 0 0
DUSUN KRAJAN 0 0 0 0 0 1 0 0 0
DUSUN KRAJAN 0 0 0 0 0 0 0 0 0
DUSUN KRAJAN 0 0 0 0 0 0 0 0 0
DUSUN KRAJAN 0 0 0 0 1 1 0 0 0
DUSUN KRAJAN 0 0 0 0 1 0 0 0 0
DUSUN KRAJAN 0 0 0 0 1 0 0 0 0
DUSUN KRAJAN 0 0 0 0 1 0 0 0 0
DUSUN KRAJAN 0 0 0 0 0 1 0 0 0
DUSUN KRAJAN 0 0 0 0 0 1 0 0 0
0 0 0 0 21 28 0 0 0
UNISASI KEJAR
AN
DPT-HB-Hib 1
DPT-HB-Hib 2
DOSIS IMUNISASI (BELUM DITERIMA=1, SUDAH DITERIMA ATAU BELUM WAK DPT-HB-Hib 3
OPV 1
OPV 2
OPV 3
OPV 4
Alamat
IPV1
IPV2
TEGALAN 0 0 0 0 0 1 0 0 0
TEGALAN 0 0 0 0 0 1 0 0 0
TEGALAN 0 0 0 0 0 1 0 0 0
TEGALAN 0 0 0 0 0 1 0 0 0
TEGALAN 0 0 0 0 0 1 0 0 0
TEGALAN 0 0 0 0 0 1 0 0 0
TEGALAN 0 0 0 0 0 1 0 0 0
0 0 0 0 0 7 0 0 0
AN
DPT-HB-Hib 1
DPT-HB-Hib 2
DPT-HB-Hib 3
OPV 1
OPV 2
OPV 3
OPV 4
Alamat
IPV1
IPV2
ASEM 0 0 0 0 0 1 0 0 0
ASEM 0 0 0 0 0 1 0 0 0
LEDOK 0 0 0 0 0 1 0 0 0
ASEM 0 0 0 0 0 1 0 0 0
ASEM 0 0 0 0 0 1 0 0 0
LEDOK 0 0 0 0 0 1 0 0 0
LEDOK 0 0 0 0 0 1 0 0 0
ASEM 0 0 0 0 0 1 0 0 0
LEDOK 0 0 0 0 0 1 0 0 0
ASEM 0 0 0 0 0 1 0 0 0
ASEM 0 0 0 0 0 1 0 0 0
ASEM 0 0 0 0 0 1 0 0 0
ASEM 0 0 0 0 0 1 0 0 0
ASEM 0 0 0 0 0 1 0 0 0
LEDOK 0 0 0 0 0 1 0 0 0
LEDOK 0 0 0 0 0 1 0 0 0
LEDOK 0 0 0 0 0 1 0 0 0
ASEM 0 0 0 0 0 1 0 0 0
ASEM 0 0 0 0 0 1 0 0 0
ASEM 0 0 0 0 0 1 0 0 0
ASEM 0 0 0 0 0 1 0 0 0
PARSEH 0 0 0 0 0 0 0 0 0
KRAJAN 0 0 0 0 0 0 0 0 0
KRAJAN 0 0 0 0 0 0 0 0 0
PARSEH 0 0 0 0 0 0 0 0 0
KRAJAN 0 0 0 0 0 0 0 0 0
KRAJAN 0 0 0 0 0 0 0 0 0
KRAJAN 0 0 0 0 0 0 0 0 0
KRAJAN 0 0 0 0 0 0 0 0 0
PARSEH 0 0 0 0 0 0 0 0 0
KRAJAN 0 0 0 0 0 0 0 0 0
KRAJAN 0 0 0 0 0 0 0 0 0
KRAJAN 0 0 0 0 0 0 0 0 0
KRAJAN 0 0 0 0 0 0 0 0 0
KRAJAN 0 0 0 0 0 0 0 0 0
PARSEH 0 0 0 0 0 0 0 0 0
KRAJAN 0 0 0 0 0 0 0 0 0
KRAJAN 0 0 0 0 0 0 0 0 0
PARSEH 0 0 0 0 0 0 0 0 0
PARSEH 0 0 0 0 0 0 0 0 0
PARSEH 0 0 0 0 0 0 0 0 0
PARSEH 0 0 0 0 0 0 0 0 0
KRAJAN 0 0 0 0 0 0 0 0 0
KRAJAN 0 0 0 0 0 0 0 0 0
KRAJAN 0 0 0 0 0 0 0 0 0
KRAJAN 0 0 0 0 0 0 0 0 0
KRAJAN 0 0 0 0 0 0 0 0 0
PARSEH 0 0 0 0 0 0 0 0 0
PARSEH 0 0 0 0 0 0 0 0 0
KRAJAN 0 0 0 0 0 0 0 0 0
KRAJAN 0 0 0 0 0 0 0 0 0
PARSEH 0 0 0 0 0 0 0 0 0
KRAJAN 0 0 0 0 0 0 0 0 0
KRAJAN 0 0 0 0 0 0 0 0 0
PARSEH 0 0 0 0 0 0 0 0 0
PARSEH 0 0 0 0 0 0 0 0 0
KRAJAN 0 0 0 0 0 0 0 0 0
KRAJAN 0 0 0 0 0 0 0 0 0
KRAJAN 0 0 0 0 0 0 0 0 0
PARSEH 0 0 0 0 0 0 0 0 0
PARSEH 0 0 0 0 0 0 0 0 0
KRAJAN 0 0 0 0 0 0 0 0 0
PARSEH 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
UNISASI KEJAR
AN
DPT-HB-Hib 1
DPT-HB-Hib 2
DPT-HB-Hib 3

OPV 1
OPV 2
OPV 3
OPV 4
Alamat
IPV1
IPV2
PATEMON UTARA 0 0 0 0 0 0 0 0 1
PATEMON UTARA 0 0 0 0 0 0 0 0 0
KRAJAN 3/1 0 0 0 0 0 0 0 0 0
KRAJAN 2/1 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 1
UNISASI KEJAR
AN
DPT-HB-Hib 1
DPT-HB-Hib 2
DPT-HB-Hib 3
OPV 1
OPV 2
OPV 3
OPV 4
Alamat
IPV1
IPV2
GUNUNG WURUNG 0 0 0 1 1 1 0 0 1
GUNUNG WURUNG 0 0 1 1 1 1 0 1 1
GUNUNG WURUNG 0 0 1 1 1 1 0 1 1
KRAJAN 1 1 1 1 1 1 1 1 1
GUNUNG WURUNG 0 0 1 1 1 1 0 1 1
DARUNGAN 0 0 0 1 1 1 0 0 1
SUMBER BANGER 0 0 1 1 1 1 1 1 1
KRAJAN 0 1 1 1 1 1 1 1 1
1 2 6 8 8 8 3 6 8
UNISASI KEJAR
AN
DPT-HB-Hib 1
DPT-HB-Hib 2
DPT-HB-Hib 3
OPV 1
OPV 2
OPV 3
OPV 4
Alamat
IPV1
IPV2
PETTE 02/II 0 0 0 0 0 0 0 0 0
PETTE 02/II 0 0 0 0 0 0 0 0 0
KRAJAN 01/I 0 0 0 0 0 0 0 0 0
PETTE 02/II 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
AN POSYANDU SASARAN IMUNISASI KEJAR

AN
DPT-HB-Hib 1
DPT-HB-Hib 2
DPT-HB-Hib 3
OPV 1
OPV 2
OPV 3
OPV 4
Alamat
IPV1
IPV2
KRAJAN 0 0 0 0 0 1 0 0 0
KEMBANG 0 0 0 0 0 1 0 0 0
KEMBANG 0 0 0 0 0 1 0 0 0
KRAJAN 0 0 0 0 0 1 0 0 0
KEMBANG 0 0 0 0 0 1 0 0 0
KEMBANG 0 0 0 0 0 1 0 0 0
KEMBANG 0 0 0 0 0 1 0 0 0
KRAJAN 0 0 0 0 0 1 0 0 0
KEMBANG 0 0 0 0 0 1 0 0 0
KEMBANG 0 0 0 0 0 1 0 0 0
KRAJAN 0 0 0 0 0 1 0 0 0
KEMBANG 0 0 0 0 0 1 0 0 0
KEMBANG 0 0 0 0 0 1 0 0 0
KRAJAN 1 1 1 1 1 1 1 1 1
KEMBANG 0 0 0 0 0 1 0 0 0
KRAJAN 0 0 0 0 0 1 0 0 0
KEMBANG 0 0 0 0 0 1 0 0 0
KEMBANG 0 0 0 0 0 1 0 0 0
KRAJAN 0 0 0 0 0 1 0 0 0
KEMBANG 0 0 0 0 0 1 0 0 0
KRAJAN 0 0 0 0 0 1 0 0 0
KEMBANG 0 0 0 0 0 1 0 0 0
KRAJAN 0 0 0 0 0 1 0 0 0
KEMBANG 0 0 0 0 0 1 0 0 0
KRAJAN 0 0 0 0 0 1 0 0 0
KEMBANG 0 0 0 0 0 1 0 0 0
KEMBANG 0 0 0 0 0 1 0 0 0
KEMBANG 0 0 0 0 0 1 0 0 0
KRAJAN 0 0 0 0 0 1 0 0 0
KRAJAN 0 1 1 1 0 1 1 1 1
KEMBANG 0 0 0 0 0 1 0 0 0
KRAJAN 0 0 0 0 0 1 0 0 0
KRAJAN 0 0 0 0 0 1 0 0 0
KEMBANG 0 0 0 0 0 1 0 0 0
KEMBANG 0 0 0 0 0 1 0 0 0
KRAJAN 0 0 0 0 0 1 0 0 0
KEMBANG 0 0 0 0 0 1 0 0 0
GILIH 0 0 0 0 0 1 0 0 0
GILIH 0 0 0 0 0 1 0 0 0
GILIH 0 0 0 0 0 1 0 0 0
GILIH 0 0 0 0 0 1 0 0 0
GILIH 0 0 0 0 0 1 0 0 0
GILIH 0 0 0 0 0 1 0 0 0
JEJE'EH 0 0 0 0 0 1 0 0 0
JEJE'EH 0 0 0 0 0 1 0 0 0
JEJE'EH 0 0 0 0 0 1 0 0 0
JEJE'EH 0 0 0 0 0 1 0 0 0
JEJE'EH 0 0 0 0 0 1 0 0 0
JEJE'EH 0 0 0 0 0 1 0 0 0
JEJE'EH 0 0 0 0 0 1 0 0 0
JEJE'EH 0 0 0 0 0 1 0 0 0
JEJE'EH 0 0 0 0 0 1 0 0 0
1 2 2 2 1 52 2 2 2
UNISASI KEJAR
AN
DPT-HB-Hib 1
DPT-HB-Hib 2
DPT-HB-Hib 3
OPV 1
OPV 2
OPV 3
OPV 4
Alamat
IPV1
IPV2
SUKUN 4/2 0 0 0 0 0 0 0 0 0
SUKUN 1/2 0 0 0 0 0 0 0 0 0
SUKUN 4/2 0 0 0 0 0 0 0 0 0
SUKUN 5/2 0 0 0 0 0 0 0 0 0
SUKUN 2/2 0 0 0 0 0 0 0 0 0
SUKUN 2/2 0 0 0 0 0 0 0 0 0
SUKUN 5/2 0 0 0 0 0 0 0 0 0
SUKUN 4/2 0 0 0 0 0 0 0 0 0
SUKUN 4/2 0 0 0 0 0 0 0 0 0
SUKUN 4/2 0 0 0 0 0 0 0 0 0
SUKUN 1/2 0 0 0 0 0 0 0 0 0
SUKUN 5/5 0 0 0 0 0 0 0 0 0
SUKUN 5/2 0 0 0 0 0 0 0 0 0
SUKUN 2/2 0 0 0 0 0 0 0 0 0
SUKUN 3/2 0 0 0 0 0 0 0 0 0
SUKUN 2/2 0 0 0 0 0 0 0 0 0
SUKUN 1/2 0 0 0 0 0 0 0 0 0
SUKUN 2/2 0 0 0 0 0 0 0 0 0
SUKUN 3/2 0 0 0 0 0 0 0 0 0
TIMUR 1/1 0 0 0 0 0 0 0 0 0
TIMUR 1/4 0 0 0 0 0 0 0 0 0
TIMUR 1/1 0 0 0 0 0 0 0 0 0
TIMUR 4/4 0 0 0 0 0 0 0 0 0
TIMUR 2/2 0 0 0 0 0 0 0 0 0
TIMUR 4/4 0 0 0 0 0 0 0 0 0
TIMUR 3/4 0 0 0 0 0 0 0 0 0
TIMUR 2/4 0 0 0 0 0 0 0 0 0
TIMUR 3/4 0 0 0 0 0 0 0 0 0
TIMUR 3/4 0 0 0 0 0 0 0 0 0
TIMUR 2/4 0 0 0 0 0 0 0 0 0
TIMUR 1/4 0 0 0 0 0 0 0 0 0
TIMUR 4/4 0 0 0 0 0 0 0 0 0
TIMUR 4/4 0 0 0 0 0 0 0 0 0
TIMUR 3/4 0 0 0 0 0 0 0 0 0
TIMUR 3/4 0 0 0 0 0 0 0 0 0
TIMUR 2/4 0 0 0 0 0 0 0 0 0
KRAJJAN 4/1 0 0 0 0 0 0 0 0 0
KRAJAN 2/1 0 0 0 0 0 0 0 0 0
KRAJAN 1/1 0 0 0 0 0 0 0 0 0
KRAAN 1/1 0 0 0 0 0 0 0 0 0
GERDU 3/3 0 0 0 0 0 0 0 0 0
KRAJAN 5/1 0 0 0 0 0 0 0 0 0
GERDU 1/3 0 0 0 0 0 0 0 0 0
GERDU 1/3 0 0 0 0 0 0 0 0 0
KRAJAN 1/1 0 0 0 0 0 0 0 0 0
GERDU 3/3 0 0 0 0 0 0 0 0 0
GERDU 1/3 0 0 0 0 0 0 0 0 0
KRAAN 4/1 0 0 0 0 0 0 0 0 0
GERDU 1/3 0 0 0 0 0 0 0 0 0
KRAJAN 3/1 0 0 0 0 0 0 0 0 0
KRAJAN 3/1 0 0 0 0 0 0 0 0 0
GERDU 3/3 0 0 0 0 0 0 0 0 0
KRAJAN 1/1 0 0 0 0 0 0 0 0 0
GERDU 3/3 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
UNISASI KEJAR
AN
DPT-HB-Hib 1
DPT-HB-Hib 2
DPT-HB-Hib 3

OPV 1
OPV 2
OPV 3
OPV 4
Alamat
IPV1
IPV2
KRAJAN 0 0 0 0 0 0 0 0 0
KRAJAN 0 0 0 0 0 0 0 0 0
KRAJAN 0 0 0 0 0 0 0 0 0
KRAJAN 0 0 0 0 0 0 0 0 0
KRAJAN 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
SASI KEJAR
AN
DPT-HB-Hib 1
DPT-HB-Hib 2
DPT-HB-Hib 3
DOSIS IMUNISASI (BELUM DITERIMA=1, SUDAH DITERIMA ATAU BE
MENERIMA = 0)
OPV 1
OPV 2
OPV 3
OPV 4
Alamat
IPV1
IPV2
Dusun Tambakrejo 0 0 0 0 0 0 0 0 0
Dusun Jawaan 0 0 0 0 0 0 0 0 0
Dusun Jawaan 0 0 0 0 0 0 0 0 0
Dusun Jawaan 0 0 0 0 0 0 0 0 0
Dusun Jawaan 0 0 0 0 0 0 0 0 0
Dusun Karanganyar
Dusun Karanganyar 0 0 0 0 0 0 0 0 0
DUSUN BANTUL 0 0 0 0 0 0 0 0 0
DUSUN BANTUL 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
UNISASI KEJAR
AN
DPT-HB-Hib 1
DPT-HB-Hib 2
DPT-HB-Hib 3
OPV 1
OPV 2
OPV 3
OPV 4
Alamat
IPV1
IPV2
KRAJAN 0 0 0 0 0 0 0 0 0
KRAJAN 0 0 0 0 0 0 0 0 0
KRAJAN 0 0 0 0 0 0 0 0 0
KRAJAN 0 0 0 0 0 0 0 0 0
KRAJAN 0 0 0 0 0 0 0 0 0
KRAJAN 0 0 0 0 0 0 0 0 0
KRAJAN 0 0 0 0 0 0 0 0 0
KRAJAN 0 0 0 0 0 0 0 0 0
KRAJAN 0 0 0 0 0 0 0 0 0
KRAJAN 0 0 0 0 0 0 0 0 0
KRAJAN 0 0 0 0 0 0 0 0 0
KRAJAN 0 0 0 0 0 0 0 0 0
KRAJAN 0 0 0 0 0 0 0 0 0
KRAJAN 0 0 0 0 0 0 0 0 0
KRAJAN 0 0 0 0 0 0 0 0 0
KRAJAN 0 0 0 0 0 0 0 0 0
KRAJAN 0 0 0 0 0 0 0 0 0
KRAJAN 0 0 0 0 0 0 0 0 0
KRAJAN 0 0 0 0 0 0 0 0 0
KRAJAN 0 0 0 0 0 0 0 0 0
KRAJAN 0 0 0 0 0 0 0 0 0
KRAJAN 0 0 0 0 0 0 0 0 0
KRAJAN 0 0 0 0 0 0 0 0 0
KRAJAN 1 1 1 1 1 1 1 1 1
KRAJAN 0 0 0 1 1 1 1 1 1
KRAJAN 0 0 0 1 1 1 1 1 1
KRAJAN 0 0 1 1 1 1 1 1 1
TOGUR 0 1 1 1 1 1 1 1 1
TOGUR 0 0 0 1 0 0 1 1 1
TOGUR 0 0 0 1 1 0 1 1 1
TOGUR 0 0 0 0 1 0 1 1 1
TOGUR 0 1 1 1 1 1 1 1 1
TOGUR 0 1 1 1 1 1 1 1 1
TOGUR 0 1 1 1 1 1 1 1 1
TOGUR 0 1 1 1 1 1 1 1 1
TOGUR 0 1 1 1 1 1 1 1 1
TOGUR 0 0 1 1 1 1 1 1 1
TOGUR 0 0 0 0 0 0 0 1 0
TOGUR 0 1 1 1 1 1 1 1 0
CITRA 0 0 0 0 0 0 0 0 0
MONTORAN 0 0 0 0 0 0 0 1 1
MONTORAN 0 0 1 1 0 0 0 1 1
MONTORAN 0 0 1 1 0 0 0 1 1
1 8 12 16 14 12 15 19 17
UNISASI KEJAR
AN
DPT-HB-Hib 1
DPT-HB-Hib 2
DPT-HB-Hib 3
OPV 1
OPV 2
OPV 3
OPV 4
Alamat IPV1
IPV2
SUKUN 0 0 0 0 0 1 0 0 0
SUKUN 0 0 0 0 0 1 0 0 0
SUKUN 0 0 0 0 0 1 0 0 0
SUKUN 0 0 0 0 0 1 0 0 0
SUKUN 0 0 0 0 0 1 0 0 0
SUKUN 0 0 0 0 0 1 0 0 0
ASEM 0 0 0 0 0 1 0 0 0
SUKUN 0 0 0 0 0 1 0 0 0
SUKUN 0 0 0 0 0 1 0 0 0
ASEM 0 0 0 0 0 1 0 0 0
ASEM 0 0 0 0 0 1 0 0 0
ASEM 0 0 0 0 0 1 0 0 0
ASEM 0 0 0 0 0 1 0 0 0
ASEM 0 0 0 0 0 1 0 0 0
SUKUN 0 0 0 0 0 1 0 0 0
ASEM 0 0 0 0 0 1 0 0 0
ASEM 0 0 0 0 0 1 0 0 0
ASEM 0 0 0 0 0 1 0 0 0
SUKUN 0 0 0 0 0 1 0 0 0
SUKUN 0 0 0 0 0 1 0 0 0
ASEM 0 1 1 1 1 1 1 1 1
SUKUN 0 0 0 0 0 1 0 0 0
ASEM 0 0 0 0 0 1 0 0 0
ASEM 1 1 1 1 1 1 1 1 1
SUKUN 0 0 0 0 0 1 0 0 0
SUKUN 1 1 1 1 1 1 1 1 1
ASEM 0 0 0 0 0 1 0 0 0
SUKUN 0 0 0 0 0 1 0 0 0
ASEM 0 0 0 0 0 1 0 0 0
ASEM 0 0 0 0 0 1 0 0 0
ASEM 0 0 0 0 0 1 0 0 0
ASEM 0 0 0 0 0 1 0 0 0
SUKUN 0 0 0 0 0 1 0 0 0
ASEM 0 0 0 0 0 1 0 0 0
SUKUN 0 0 0 0 0 1 0 0 0
ASEM 0 0 0 0 0 1 0 0 0
ASEM 0 0 0 0 0 1 0 0 0
ASEM 0 0 0 0 1 1 0 0 0
SUKUN 0 0 0 0 0 1 0 0 0
SUKUN 0 0 0 0 0 1 0 0 0
ASEM 0 1 1 1 1 1 0 1 1
SUKUN 0 0 0 0 0 1 0 0 0
SUKUN 0 1 1 1 1 1 0 1 1
ASEM 0 0 0 0 0 1 0 0 0
ASEM 0 0 0 0 0 1 0 0 0
ASEM 0 0 0 0 0 1 0 0 0
ASEM 1 1 1 1 1 1 1 1 1
3 6 6 6 7 47 4 6 6
UNISASI KEJAR
DPT-HB-Hib 1
DPT-HB-Hib 2
DPT-HB-Hib 3

OPV 1
OPV 2
OPV 3
OPV 4
Alamat
IPV1
IPV2
KRAJAN 1/1
KRAJAN 1/1
KRAJAN 2/1
KRAJAN 3/2
KRAJAN 2/1
KRAJAN 2/1
KRAJAN 2/1
JATIAN 8/4
KARANG ASEM 5/3
KARANG ASEM 5/3
JATIAN 9/5
JATIAN 9/5
JATIAN 8/5
KARANG ASEM 5/3
JATIAN 9/5
JATIAN 9/5
KARANG ASEM 7/4
KARANG ASEM 5/3
JATIAN 9/5
KARANG ASEM 7/4
JATIAN 9/5
KARANG ASEM 5/3
KARANG ASEM 5/3
KARANG ASEM 7/4
0 0 0 0 0 0 0 0 0
UNISASI KEJAR
AN
DPT-HB-Hib 1
DPT-HB-Hib 2
DPT-HB-Hib 3
OPV 1
OPV 2
OPV 3
OPV 4
Alamat
IPV1
IPV2
Tengah 0 0 0 0 0 0 0 0 0
DOSIS YANG DIBUTUHKAN
DITERIMA ATAU BELUM WAKTUNYA MENERIMA = 0) UNTUK MELENGKAPI KETERANGAN
DPT-HB-Hib 4
DPT-HB-Hib
IMUNISASI didalam kolom keterangan,
dapat dituliskan misalkan
PCV 1
PCV 2
PCV 3
MR 1
MR 2
OPV
PCV
sasaran pindah
IPV
MR
1 1 1 1 1 1 12 2 3 2 3 MENOLAK
1 0 1 0 0 0 0 0 1 1 0 MENOLAK
1 0 1 0 0 0 0 0 1 1 0
3 1 3 1 1 1 12 2 5 4 3

DPT-HB-Hib 4
KETERANGAN
DPT-HB-Hib
DITERIMA ATAU BELUM WAKTUNYA MENERIMA = 0) UNTUK MELENGKAPI didalam kolom keterangan,
PCV 1
PCV 2
PCV 3
IMUNISASI
MR 1
MR 2
OPV
PCV

IPV
MR
sasaran pindah
0 0 0 1 1 1 4 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 3 0 0 0 3
1 0 0 1 1 1 0 1 1 0 3
0 0 0 1 1 1 3 0 0 0 3
0 0 0 1 1 1 0 0 0 0 3
0 0 0 1 1 1 3 0 0 0 3
0 0 0 1 1 1 0 0 0 0 3
0 0 0 1 1 1 3 0 0 0 3
0 0 0 1 1 1 0 0 0 0 3
1 0 0 1 1 1 4 0 1 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 3 0 0 0 3
0 0 0 1 1 1 0 0 0 0 3
0 0 0 1 1 1 4 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
1 0 0 1 1 1 4 0 1 0 3
0 0 0 1 1 1 0 0 0 0 3
0 0 0 1 1 1 3 0 0 0 3
0 0 0 1 1 1 0 0 0 0 3
0 0 0 1 1 1 4 1 0 0 3
0 0 0 1 1 1 0 0 0 0 3
1 0 0 1 1 1 4 0 1 0 3
0 0 0 1 1 1 0 0 0 0 3
0 0 1 1 1 1 5 1 0 1 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 3 0 0 0 3
0 0 0 1 1 1 0 0 0 0 3
0 0 0 1 1 1 3 0 0 0 3
1 0 0 1 1 1 0 1 1 0 3
0 0 0 1 1 1 4 1 0 0 3
0 0 1 1 1 1 0 1 0 1 3
0 0 0 1 1 1 3 0 0 0 3
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
1 0 1 0 0 0 0 1 1 1 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 1 0 0 0
1 0 0 0 0 0 2 1 1 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 1 1 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 1 0 0 0 3 2 0 1 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 1 1 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
1 0 1 0 0 0 0 1 1 1 0
0 0 0 0 0 0 1 1 0 0 0
0 0 0 0 0 0 0 1 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 1 0 0 0 0 1 0 1 0
1 0 0 0 0 0 1 0 1 0 0
0 0 0 0 0 0 0 1 0 0 0
0 0 1 0 0 0 0 2 0 1 0
1 0 0 0 0 0 1 0 1 0 0
0 0 0 0 0 0 1 1 0 0 0
0 0 0 0 0 0 1 1 0 0 0
0 0 1 0 0 0 0 0 0 1 0
0 0 0 0 0 0 1 1 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 1 1 0 0 0
0 0 0 0 0 0 0 1 0 0 0
0 0 1 0 0 0 3 2 0 1 0
0 0 0 0 0 0 1 1 0 0 0
1 0 0 0 0 0 0 0 1 0 0
0 0 1 0 0 0 1 0 0 1 0
0 0 0 0 0 0 0 2 0 0 0
0 0 0 0 0 0 2 2 0 0 0
1 0 0 0 0 0 0 1 1 0 0
0 0 0 0 0 0 0 1 0 0 0
0 0 0 0 0 0 1 1 0 0 0
1 0 0 0 0 0 0 1 1 0 0
0 0 0 0 0 0 0 2 0 0 0
0 0 0 0 0 0 1 1 0 0 0
1 0 0 0 0 0 2 1 1 0 0
0 0 0 0 0 0 0 1 0 0 0
0 0 0 0 0 0 1 1 0 0 0
1 0 0 0 0 0 2 1 1 0 0
15 0 10 33 33 33 88 49 15 10 99

DPT-HB-Hib 4
KETERANGAN
DPT-HB-Hib
PCV 1
PCV 2
PCV 3
IMUNISASI
MR 1
MR 2
OPV
PCV

IPV
MR
sasaran pindah
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 7 7 7 0 7 0 0 21
DPT-HB-Hib 4
KETERANGAN
DPT-HB-Hib
PCV 1
PCV 2
PCV 3
IMUNISASI
MR 1
MR 2
OPV
PCV
IPV
MR
sasaran pindah
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 0 0 1 0 0 2
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 0 0 0 3
0 0 0 1 1 1 0 0 0 0 3
0 0 0 1 1 1 0 0 0 0 3
0 0 0 1 1 1 0 0 0 0 3
0 0 0 1 1 1 0 0 0 0 3
0 0 0 1 1 1 0 0 0 0 3
0 0 0 1 1 1 0 0 0 0 3
0 0 0 1 1 1 0 0 0 0 3
0 0 0 1 1 1 0 0 0 0 3
0 0 0 1 1 1 0 0 0 0 3
0 0 0 1 1 1 0 0 0 0 3
0 0 0 1 1 1 0 0 0 0 3
0 0 0 1 1 1 0 0 0 0 3
0 0 0 1 1 1 0 0 0 0 3
0 0 0 1 1 1 0 0 0 0 3
0 0 0 1 1 1 0 0 0 0 3
0 0 0 1 1 1 0 0 0 0 3
0 0 0 1 1 1 0 0 0 0 3
0 0 0 1 1 1 0 0 0 0 3
0 0 0 1 1 1 0 0 0 0 3
0 0 0 1 1 1 0 0 0 0 3
0 0 0 1 1 1 0 0 0 0 3
0 0 0 1 1 1 0 0 0 0 3
0 0 0 1 1 1 0 0 0 0 3
0 0 0 1 1 1 0 0 0 0 3
0 0 0 1 1 1 0 0 0 0 3
0 0 0 1 1 1 0 0 0 0 3
0 0 0 1 1 1 0 0 0 0 3
0 0 0 1 1 1 0 0 0 0 3
0 0 0 1 1 1 0 0 0 0 3
0 0 0 1 1 1 0 0 0 0 3
0 0 0 1 1 1 0 0 0 0 3
0 0 0 1 1 1 0 0 0 0 3
0 0 0 1 1 1 0 0 0 0 3
0 0 0 1 1 1 0 0 0 0 3
0 0 0 1 1 1 0 0 0 0 3
0 0 0 1 1 1 0 0 0 0 3
0 0 0 1 1 1 0 0 0 0 3
0 0 0 1 1 1 0 0 0 0 3
0 0 0 1 1 1 0 0 0 0 3
0 0 0 1 1 1 0 0 0 0 3
0 0 0 1 1 1 0 0 0 0 3
0 0 0 42 42 42 0 21 0 0 188

DPT-HB-Hib 4
KETERANGAN
DPT-HB-Hib
PCV 1
PCV 2
PCV 3
IMUNISASI
MR 1
MR 2
OPV
PCV

IPV
MR
sasaran pindah
1 1 1 0 0 0 4 0 2 2 0
0 0 1 0 0 0 1 0 0 1 0
0 0 1 0 0 0 0 0 0 1 0
0 0 1 0 0 0 0 0 0 1 0
1 1 4 0 0 0 5 0 2 5 0
DPT-HB-Hib 4
KETERANGAN
DPT-HB-Hib
DITERIMA ATAU BELUM WAKTUNYA MENERIMA = 0) PCV 1 UNTUK MELENGKAPI didalam kolom keterangan,
PCV 2
PCV 3
IMUNISASI
MR 1
MR 2
OPV
PCV
IPV
MR
sasaran pindah
1 1 1 1 1 1 1 2 2 2 3
1 1 1 1 1 1 2 2 3 2 3
1 1 1 1 1 1 2 2 3 2 3
1 1 1 1 1 1 4 2 4 2 3
1 1 1 1 1 1 2 2 3 2 3
1 1 1 1 1 1 1 2 2 2 3
1 1 1 1 1 1 2 2 4 2 3
1 1 1 1 1 1 3 2 4 2 3
8 8 8 8 8 8 17 16 25 16 24

DPT-HB-Hib 4
KETERANGAN
DPT-HB-Hib
PCV 1
PCV 2
PCV 3
IMUNISASI
MR 1
MR 2
OPV
PCV

IPV
MR
sasaran pindah
1 0 1 0 0 0 0 0 1 1 0
1 0 1 0 0 0 0 0 1 1 0
1 0 1 0 0 0 0 0 1 1 0
1 0 1 0 0 0 0 0 1 1 0
4 0 4 0 0 0 0 0 4 4 0
DPT-HB-Hib 4
KETERANGAN
DPT-HB-Hib
PCV 1
PCV 2
PCV 3
IMUNISASI
MR 1
MR 2
OPV
PCV
IPV
MR
sasaran pindah
0 0 0 1 1 1 4 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
1 1 1 1 1 1 4 2 4 2 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
1 0 1 1 1 1 3 1 4 1 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
0 0 0 1 1 1 0 1 0 0 3
2 1 2 52 52 52 11 53 8 3 156

DPT-HB-Hib 4
KETERANGAN
DPT-HB-Hib
PCV 1
PCV 2
PCV 3
MR 1
MR 2
IMUNISASI
OPV
PCV
IPV

MR
sasaran pindah
0 0 1 0 0 0 0 0 0 1 0
0 0 1 0 0 0 0 0 0 1 0
1 0 0 0 0 0 0 0 1 0 0
1 0 0 0 0 0 0 0 1 0 0
1 0 0 0 0 0 0 0 1 0 0
1 0 0 0 0 0 0 0 1 0 0
1 0 0 0 0 0 0 0 1 0 0
1 0 0 0 0 0 0 0 1 0 0
1 0 0 0 0 0 0 0 1 0 0
1 0 0 0 0 0 0 0 1 0 0
1 0 0 0 0 0 0 0 1 0 0
1 0 1 0 0 0 0 0 1 1 0
1 0 1 0 0 0 0 0 1 1 0
1 0 1 0 0 0 0 0 1 1 0
0 0 1 0 0 0 0 0 0 1 0
1 0 1 0 0 0 0 0 1 1 0
1 0 0 0 0 0 0 0 1 0 0
1 0 0 0 0 0 0 0 1 0 0
1 0 0 0 0 0 0 0 1 0 0
1 0 1 0 0 0 0 0 1 1 0
0 0 1 0 0 0 0 0 0 1 0
1 0 1 0 0 0 0 0 1 1 0
0 0 1 0 0 0 0 0 0 1 0
1 0 1 0 0 0 0 0 1 1 0
0 0 1 0 0 0 0 0 0 1 0
1 0 0 0 0 0 0 0 1 0 0
1 0 0 0 0 0 0 0 1 0 0
1 0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 0 0 0 0
1 0 1 0 0 0 0 0 1 1 0
1 0 1 0 0 0 0 0 1 1 0
0 0 1 0 0 0 0 0 0 1 0
0 0 1 0 0 0 0 0 0 1 0
1 0 1 0 0 0 0 0 1 1 0
1 0 1 0 0 0 0 0 1 1 0
0 0 1 0 0 0 0 0 0 1 0
0 0 1 0 0 0 0 0 0 1 0
0 0 1 0 0 0 0 0 0 1 0
1 0 1 0 0 0 0 0 1 1 0
1 0 0 0 0 0 0 0 1 0 0
0 0 1 0 0 0 0 0 0 1 0
1 0 0 0 0 0 0 0 1 0 0
1 0 0 0 0 0 0 0 1 0 0
1 0 1 0 0 0 0 0 1 1 0
0 0 1 0 0 0 0 0 0 1 0
1 0 1 0 0 0 0 0 1 1 0
1 0 1 0 0 0 0 0 1 1 0
1 0 0 0 0 0 0 0 1 0 0
1 0 1 0 0 0 0 0 1 1 0
1 0 0 0 0 0 0 0 1 0 0
1 0 0 0 0 0 0 0 1 0 0
1 0 1 0 0 0 0 0 1 1 0
0 0 1 0 0 0 0 0 0 1 0
0 0 1 0 0 0 0 0 0 1 0
38 0 32 0 0 0 0 0 38 32 0

DPT-HB-Hib 4
KETERANGAN
DPT-HB-Hib
PCV 1
PCV 2
PCV 3
MR 1
MR 2
IMUNISASI
OPV
PCV
IPV

MR
sasaran pindah
1 0 1 0 0 0 0 0 1 1 0
1 0 1 0 0 0 0 0 1 1 0
1 0 1 0 0 0 0 0 1 1 0
1 0 1 0 0 0 0 0 1 1 0
1 0 1 0 0 0 0 0 1 1 0
5 0 5 0 0 0 0 0 5 5 0
KETERANGAN
DPT-HB-Hib 4
DOSIS YANG
DPT-HB-Hib
SUDAH DITERIMA ATAU BELUM WAKTUNYA didalam kolom
DIBUTUHKAN UNTUK
ERIMA = 0)
PCV 1
PCV 2
PCV 3
keterangan, dapat
MR 1
MR 2
OPV
PCV
MELENGKAPI IMUNISASI
IPV
MR
dituliskan misalkan
1 0 0 0 0 0 0 0 1 0 0 sasaran pindah
1 0 0 0 0 0 0 0 1 0 0
1 0 0 0 0 0 0 0 1 0 0
1 0 0 0 0 0 0 0 1 0 0
1 0 0 0 0 0 0 0 1 0 0
1 0 0 0 0 0 0 0 1 0 0
0 0 1 0 0 0 0 0 0 1 0
0 0 1 0 0 0 0 0 0 1 0
1 0 0 0 0 0 0 0 1 0 0
1 0 0 0 0 0 0 0 1 0 0
1 0 1 0 0 0 0 0 1 1 0
0 0 1 0 0 0 0 0 0 1 0
1 0 0 1 0 0
1 0 0 0 0 0 0 0 1 0 0
1 0 0 0 0 0 0 0 1 0 0
1 0 0 0 0 0 0 0 1 0 0
1 0 0 0 0 0 0 0 1 0 0
1 0 0 0 0 0 0 0 1 0 0
1 0 0 0 0 0 0 0 1 0 0
1 0 0 0 0 0 0 0 1 0 0
1 0 0 0 0 0 0 0 1 0 0
1 0 0 0 0 0 0 0 1 0 0
0 0 1 0 0 0 0 0 0 1 0
0 0 1 0 0 0 0 0 0 1 0
0 0 1 0 0 0 0 0 0 1 0
1 0 0 0 0 0 0 0 1 0 0
1 0 0 0 0 0 0 0 1 0 0
1 0 0 0 0 0 0 0 1 0 0
1 0 0 0 0 0 0 0 1 0 0
1 0 0 0 0 0 0 0 1 0 0
1 0 0 0 0 0 0 0 1 0 0
1 0 0 0 0 0 0 0 1 0 0
1 0 0 0 0 0 0 0 1 0 0
1 0 0 0 0 0 0 0 1 0 0
28 0 7 0 0 0 0 0 28 7 0

DPT-HB-Hib 4
KETERANGAN
DPT-HB-Hib
PCV 1
PCV 2
PCV 3
MR 1
MR 2
IMUNISASI
OPV
PCV
IPV
MR
sasaran pindah
0 0 0 0 0 1 0 0 0 0 1
0 0 0 0 0 1 0 0 0 0 1
0 0 0 0 0 1 0 0 0 0 1
0 0 0 0 0 1 0 0 0 0 1
0 0 0 0 0 1 0 0 0 0 1
0 0 0 0 0 1 0 0 0 0 1
0 0 0 0 0 1 0 0 0 0 1
0 0 0 0 0 1 0 0 0 0 1
0 0 0 0 0 1 0 0 0 0 1
0 0 0 0 0 1 0 0 0 0 1
0 0 0 0 0 1 0 0 0 0 1
0 0 0 0 0 1 0 0 0 0 1
0 0 0 0 0 1 0 0 0 0 1
0 0 0 0 0 1 0 0 0 0 1
0 0 0 0 0 1 0 0 0 0 1
0 0 0 0 0 1 0 0 0 0 1
0 0 0 0 0 1 0 0 0 0 1
0 0 0 0 0 1 0 0 0 0 1
0 0 1 0 0 0 0 0 0 1 0
1 0 0 0 0 0 0 0 1 0 0
1 0 0 0 0 0 0 0 1 0 0
1 0 0 0 0 0 0 0 1 0 0
1 0 0 0 0 0 0 0 1 0 0
1 1 1 1 0 0 4 2 4 2 1
1 1 1 1 1 1 1 2 4 2 3
1 1 1 0 1 1 1 2 4 2 2
1 1 1 1 1 1 2 2 4 2 3
1 0 0 0 0 0 3 2 4 0 0
0 0 0 0 0 0 1 0 3 0 0
1 0 0 0 0 0 1 1 4 0 0
1 0 0 0 0 0 0 1 4 0 0
1 0 0 1 1 1 3 2 4 0 3
1 0 0 0 0 0 3 2 4 0 0
1 0 0 0 0 0 3 2 4 0 0
1 0 0 0 0 0 3 2 4 0 0
1 0 0 0 0 0 3 2 4 0 0
1 0 0 0 0 0 2 2 4 0 0
0 0 0 0 0 0 0 0 1 0 0
1 1 1 1 1 1 3 2 3 2 3
1 0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 0 2 0 0
0 0 0 0 0 0 2 0 2 0 0
0 0 0 0 0 0 2 0 2 0 0
19 5 6 5 5 23 37 26 70 11 33

DPT-HB-Hib 4
KETERANGAN
DPT-HB-Hib
PCV 1
PCV 2
PCV 3
MR 1
MR 2
IMUNISASI
OPV
PCV
IPV

MR
sasaran pindah
0 0 0 0 1 0 0 0
0 0 0 0 1 0 0 0
0 0 0 0 1 0 0 0
0 0 0 0 1 0 0 0
0 0 0 0 1 0 0 0
0 0 0 0 1 0 0 0
0 0 0 0 1 0 0 0
0 0 0 0 1 0 0 0
0 0 0 1 0 0 0
0 0 0 0 1 0 0 0
0 0 0 0 1 0 0 0
0 0 0 0 1 0 0 0
0 0 0 0 1 0 0 0
0 0 0 0 1 0 0 0
0 0 0 0 1 0 0 0
0 0 0 0 1 0 0 0
0 0 0 0 1 0 0 0
0 0 0 0 1 0 0 0
0 0 0 0 1 0 0 0
0 0 0 0 1 0 0 0
0 3 2 3 0 0
0 0 0 1 0 0 0
0 0 0 1 0 0 0
0 0 4 2 3 0 0
0 0 0 1 0 0 0
0 4 2 3 0 0
0 0 0 0 1 0 0 0
0 0 0 0 1 0 0 0
0 0 0 0 1 0 0 0
0 0 0 1 0 0 0
0 0 0 0 1 0 0 0
0 0 0 0 1 0 0 0
0 0 0 0 1 0 0 0
0 0 0 0 1 0 0 0
0 0 0 1 0 0 0
0 0 0 1 0 0 0
0 0 0 1 0 0 0
0 0 0 2 0 0 0
0 0 0 0 1 0 0 0
0 0 0 0 1 0 0 0
1 1 3 2 3 1 0
0 0 0 0 1 0 0 0
1 1 3 2 3 1 0
0 0 0 0 1 0 0 0
0 0 0 0 1 0 0 0
0 0 0 0 1 0 0 0
1 1 4 2 4 1 0
3 3 0 0 0 0 21 54 19 3 0

DPT-HB-Hib 4
KETERANGAN
DPT-HB-Hib
PCV 1
PCV 2
PCV 3
MR 1
MR 2
IMUNISASI
OPV
PCV
IPV

MR
sasaran pindah
1 1 0 0 1 1 0
1 1 0 0 1 1 0
1 1 0 0 1 1 0
1 1 0 0 1 1 0
1 1 0 0 1 1 0
1 1 0 0 1 1 0
1 1 0 0 1 1 0
1 1 0 0 1 1 0
1 0 0 0 1 0
1 0 0 0 1 0
1 0 0 0 1 0
1 0 0 0 1 0
1 1 0 0 1 1 0
1 1 0 0 1 1 0
1 1 0 0 1 1 0
1 1 0 0 1 1 0
1 1 0 0 1 1 0
1 1 0 0 1 1 0
1 1 0 0 1 1 0
1 1 0 0 1 1 0
1 1 0 0 1 1 0
1 1 0 0 1 1 0
1 1 0 0 1 1 0
1 1 0 0 1 1 0
0 0 0 0 0 0
13 0 17 0 0 0 0 0 13 17 0 0

DPT-HB-Hib 4
KETERANGAN
DPT-HB-Hib
PCV 1
PCV 2
PCV 3
MR 1
MR 2
IMUNISASI
OPV
PCV
IPV

MR
sasaran pindah
0 0 1 0 0 0 0 0 0 1 0
FOR
Provinsi jawa timur

Kabupaten probolinggo
Puskesmas puskesmas krejengan
No. NIK Nama Anak Tanggal Sekarang
4 3513155803160001 KAMELIA 22-Apr-2024

3 3513151712140001 ALEX ZAIDAN HABIBI FILLAH 4/22/2024
6 3513155109150002 ALIYA KHAIRUNNISA 4/22/2024
7 3513155809150001 ALIZA HILYA NAFISAH 4/22/2024
9 3512165501160001 ELIKA MUSLIHATUN NISA' 4/22/2024
19 3513151908150001 MUH. ALANA AMZAR HAMIZAN 4/22/2024
21 3513152804150001 MUHAMMAD IBRAHIM FASHA 4/22/2024
TOTAL
FOR
Provinsi jawa timur

Kabupaten probolinggo
Puskesmas puskesmas krejengan
ADZKIA NAILIN NAJIHA 2015-11-27

1 Abdul Malik Azmatkhan 2/13/2017
12 SDN Sentong Mohammad Ali Khadaffi 2014-12-28
43 Aulia Frizka Ramadhani 2012-08-16
10 MI TARBIATUL ISLAM Naylatus Zakiyyah 24-Jul-15
11 Muhammad Candra Syahputra 9-Jan-15
12 Muhamma Hasan Salim 22 Ags 2015
13 Muhammad Safiy 6-Jul-15
14 Zhahra Nurjannah 5-Jul-15
15 Ahmad Azzam Hafidz Al Ayiz 15-Oct-15
16 Berliana Lukluil Maknunah 24 Sep 2014
30 Hilyatul Adzhan 16 Ags 2013
31 Lu'luil Maknunah 25-May-14
32 Muhammad Rifki Aditya 29-Sep-14
33 Moh. Ma'ruf Maulana 16 Ags 2013
34 Syakira Adelia Putri 5-Mar-14
47 Abi Mashuri 15 Juni 2011
48 Arifah 27 Apr 2011
49 Aulia Qotrun Nada 08 Des 2011
50 Chairul Mufid 20 Peb 2010
51 Elok Nur Azizah 21 Mar 2012
52 Halimatus Sa'diyah 21 Mar 2011
53 Mar'atus Zahiratun Nabila 10 Peb 2012
68 Ibrohim Muhammad Syafi' Yusuf 27-Jun-12
3 mi irtiqoiyah ANDIKA ZAINUR RAMADHAN 6/8/2016
18 M QOMARUZ ZAMAN 2013-03-09
19 MOH FERDI RAHMATULLAH 2015-07-02
20 MOH. NAZRIL ROMADHONI 2015-06-25
22 MOHAMMAD SIROJUL MUNIR 2015-11-09
23 MUHAMMAD ANTON ALI SYAKBANI 2015-05-21
24 MUHAMMAD ALY ZAIN 2015-09-09
25 MUHAMMAD AZKA MUZAKKA 2015-09-25
27 NADHIRA FIDDARAINI HASAN 2016-01-27
28 NAKILA PUTRI 2015-04-25
30 SALSABILA AL JANNAH 2015-06-22
TOTAL
FORMAT PE
S
Provinsi Jawa Timur

Kabupaten Probolinggo
Puskesmas Krejengan
12 3513155206110002 Zahira Laili 12/06/2011

13 Jihan Fauziah Abbas 2015-12-26
14 Mohammad Izzuddin 2015-09-30
TOTAL
FORMAT PE
S
Provinsi 0
Kabupaten 0
Puskesmas 0
13 MI SYUBATUL AZKIA KHANZA RAMADHANI 2016-06-25

15 HASAN TAUFIQUR ROHMAN 2016-10-21
16 KHOFIFAH AULIA PUTRI 2016-12-29
17 MUHAMMAD ZIDAN LATIF 2016-11-11
20
44
45 SD 2 PP RAGIL 2016-12-12
TOTAL
FORMAT PE
S
Provinsi 0
Kabupaten 0
Puskesmas 0
No. Nama Anak Tanggal Lahir

NIK
1 3513154708160001 ADIBA SHAKILA ATMARINI 2016-08-07
2 3513152112150001 AHMAD ALI IMRON 2015-12-21
2 3513155708120001 AGUSTINA 2012-08-17
3 3513152403140001 AHMAD TAUFIQ HIDAYATULLOH 2014-03-24
4 3513155002140001 AISYAH AZ ZAHRA 2014-02-10
5 3513156312130001 DESTIAN SAPUTRA 2013-12-23
6 3513155708130001 FITRI AGUSTINA 2013-08-17
TOTAL
FORM
Provinsi 0
Kabupaten 0
Puskesmas 0
1 Adiva Nayla Putri 2016-08-11
sdi darut tauhid

Araseli Salsabela Marshel 2017-01-29
Farham Adam 2016-05-29
sdi darut tauhid ROBIATUL ADAWIYAH 2016-01-05
1 3513154811160001 ABELLIA SAFRIANA PUTRI 11/8/16
3513156006150000 AFIF FATHIMI 7/20/2015
PROBOLINGGO, 06
3513154612120001 SITI ROMLA
Desem 2012
PROBOLINGGO, 01
3513150101120001 MUHAMMAD NURUL FAQIH
Januari 2012
PROBOLINGGO, 24 April
3513152404120003 MOH. NABIL ALIFATUL MAROM
2012
97 5171021909140001 ADELIA ANANDITA Denpasar, 22/03/2013
9 3513155704160003 APRILIA CINTA BELLA 2016-04-17
19
20 3513151512150001 MOCH FARIS MAULANA 2015-12-15
3513150508160001 SUWARIEL HUSNIL ANWAR 2016-08-05 TOTAL
FORMAT PE
S
Provinsi 0
Kabupaten 0
Puskesmas 0
M. NURUL ANWAR 2011-06-01

NOVELYA ASYANTI 2012-05-12
TOTAL
FORMAT PE
S
Provinsi 0
Kabupaten 0
Puskesmas 0
16 '3513155703150001 AMIRA AZKA LATIFATUS SHOLEHAH 17/03/2015

17 '3513154909150001 KHILDA TAZKIYAH ARIFAH 10/9/2015
18 '3513152910150001 MOH.HENDRA ALIF KHUMAIRI 29/10/2015
19 '3513154507150001 NAYLA MUAZZARA ZULFA 05/07/2015
20 '3513151912150001 M. ALVIFAUZI AL HAKIM 19/12/2015
21 '3513155309150002 ADIRA NISA ARDANI 13/09/2015
22 '3513156406150001 AMIRA SHINTIYA RAMADHANI 24/06/2015
23 '3513154510150001 ZAHIYAH ARSYIFA MUFARROHAH 5/10/2015
24 '3513155909150001 JAMILATUS SYAMSIYAH 19/09/2015
35 '3513152807130001 MUHAMMAD AINUR ROMADONI 28/07/2013
36 '3513152402120001 ACHMAD BAIHAQI 24/02/2012
37 '3513151611120001 ACHMAD DAFFA HIDAYATULLAH 16/11/2012
38 '3513151702130001 MUHAMMAD ALFAN FATHONI 17/02/2013
39 '3513154909120001 LAILATUR RIZQOH NUR HASANIAH 9/9/2012
1 3513152008160001 ARKA RAFASSYA MUHAMMAD 20 Agustus 2016
2 3513162112160001 M FAUZAN MAULUDBI 21 Desember 2016
TOTAL

Desa : Seboro
No. Nama Sekolah Nama Anak Tanggal Lahir
1 AHMAD ABYZAR NOUVAL 21/10/2017

SDN Seboro
24 Aliya Anindira 25/05/2015
TOTAL

Kabupaten/Kota : PROBOLINGGO
Desa : KARANGREN
13 Mohammad Najih Mubarok 8/1/2016

27 Alvi Septiana Putri Rahayu 9/23/2015
32 Charissa Milena Hariyadi Putri 7/31/2016
43 Siti Humairoh 10/23/2015
51 Fina Af Idatus Safa 4/7/2013
1 MI AL AZHAR FEBRYAN NUR HIDAYATULLLAH 2/27/2017
10 KRISNA ADITYA CIPTA SADEWO 4-Nov-14
16 LINTANG MELINDA SARI 28-Jun-13
17 FAUZIAH NAIFA YUMNA 4-Feb-13
18 SYARIFATUL MAGHFIROH 4-Feb-13
19 AINIYA FAIDA AZMI 23-Aug-12
1 SD KARANGREN 2 ACHMAD AFIFUDDIN HIDAYATULLAH Prob, 01/07/2016
TOTAL

Desa : SUMBERKATIMOHO
19 sdn sumber katimoho Muhammad Abdil Bar 2015-02-24

29 LINTANG MUBASSYIRATUL JANNAH 2012-08-28
30 MI Raudatul Ulum HERLANGGA AHMAD HENDI S 1/20/2017
34 MOH ABDUL BASIT EFENDI 2/18/2016
35 MUHAMMAD ADAM SUPRIADI 7/30/2016
37 HAURAUL JANNAH FEBRIYANTI 2/12/2015
41 MUHAMMAD RIEKO ALFIANSYAH 11/15/2015
45 NUR DIANA MAULIDIYAH 1/15/2015
46 DZAKIROTUL FAIZAH 6/11/2015
47 MUHAMMAD HASAN MU'TASIM BILLAH 3/10/2015
56 MUZDINA ZATUL MARHAMAH
67 MI Nurul Ulum FATINATUL MUSLIMAH 2016-06-09
68 AISAH AYUDIA INARA 2016-02-14
69 M. SAIFURRIDZAL 2016-05-09
70 MUH. ALEX MAULANA IBRAHIM 2016-03-11
75 SULAIMAN AS SAJJAD 2015-07-26
76 NIA RAMADANI 2015-06-29
77 MUHAMMAD HAMKA ISMULLAHIL AQDA 2015-05-06
78 M. ALFAN ABBAS 2014-10-23
88 RIANZAH FAHRIAN AHMAD 2013-07-29
TOTAL

Desa : Kedung caluk
19 MOHAMMAD HIDAYATULLAH 2015-06-05

20 MUHAMMAD AFIS RAMADHANI 2015-07-09
27 DEVI LUCYANA 2013-01-09
28 DWI LEILY KAMALIA NURILLAH 2012-06-11
29 FATIMATUZ ZAIEN 2012-01-11
40 Ahmad Fatih Ferdiansyah 21/12/2016
45 Hanindia Aqila Putri 03/05/2016
58 Siti Rokayah 14/08/2016
94 Moch. Legio Syahputra 3/14/2011
TOTAL

Desa : DAWUHAN
MOHAMMAD NAUVAL FAUZAH 7/29/2016

sdn dawuhan FADIYAH FIRDAUSIAH 2/2/2013
MUHAMMAD FIRDAUS SILLAH 2016-12-04
mi raudatul m AHMAD MAULIDI HUZEN 2016-01-05
1 AHMAD FAUZUL AKBAR 2016-07-19
3 BINTANG RIFKY ABDILLAH RAMADHAN 2016-06-13
29 ABDUL JABBAR EGI BAHTIAR 2015-12-23
38 M.RAFAEL FAIRUZ 2015-05-29
43 MUHAMMAD AL GHAZALI 2015-12-03
44 MUHAMMAD 'ALIM AKRAM ZIYAD 2016-07-02
45 MUHAMMAD AZZAM AMIRUDDIN 2016-04-20
50 Muhammad lukman Agung
59 MUKRIMAH NURIL FIRDAUS 2013-04-05
60 NUR SAIDAH 2012-12-08
61 RIMA DWY CAMELIA 2012-04-23
62 SALSABILA FITRI 2012-07-30
63 SOFIATUN NUFUS 2013-10-18
64 YURINDA MAYSAROH 2013-05-21
65 ZAHROTUL AINI 2013-03-20
66 ZEA ULI ANANDA 2013-03-04
TOTAL

Kabupaten/Kota : probolinggo
Desa : WIDORO
MOH FAWAS FATIH HANAN 11/30/2016

DUROTU NAFILAH 2/8/2017
FERDIAN MUSLIM ZAINI 6/14/2017
Ahmat Riski 6/11/2012
TOTAL

Desa : Gebangan
1 APRILIA HAMIDAH NILA WATI 2017-04-28

2 MILLATUN KHOLIDAH 2016-09-28
3 MOHAMMAD RIZKY PRATAMA PUTRA 2016-03-19
TOTAL
Desa : SOKAAN
10 MOH. DANIAL WALIYULLAH QUTBI 11-Oct-16

11 MOH. HASAN MU'TASIM BILLAH 21-Dec-16
38 M.Rifki Maulana ###
42 Muhammad Alif ###
145 Intan Novi Fildayanti 5/25/2012
146 Irmawati 6/23/2013
150 Muhammad Hilmi Mu'tasimbillah 5/24/2012
151 Muhammad Ilham 7/14/2013
152 Muhammad Malik Ulumuddin 7/25/2012
KHOIRUZ ZAMANI 2015-12-01
316 MI RAUDLATUL ISLAMMIY
319 MI RAUDLATUL ISLAMMIYALDIAN SUNDARI 2015-10-19
322 MI RAUDLATUL ISLAMMIYFELISYA EARLYTA SHAKILA UMAM 2015-05-25
323 MI RAUDLATUL ISLAMMIYNUR TAUFIQUR ROHMAN 2016-02-03
343 ADIS RADITYA RAMADHANI 2013-07-11
344 AHMAD ZAKI 2013-08-15
345 DESY NURHAYATI 2013-12-27
346 FIKRA MUTDMAINAH 2013-11-08
347 HAIKAL IBNU KHOLIL 2014-06-15
348 HASAN HAMDANI 2013-11-16
349 HIMAMY HAFSAWATI FIRDAUSIYAH 2013-08-30
350 IFFATSANSA IBRAHIM 2013-08-30
351 ILIA ZAINUBAH ZAHRO 2014-02-28
352 MAYA DINA SAFITRI 2014-03-30
TOTAL
SASARAN IMUNISASI KEJAR ANAK USIA SEKOLAH
Desa/Kelurahan krejengan
sekolah sd krejengan ( kelas 1 )
Tanggal Lahir Umur (tahun) NIK Nama Orang Tua Alamat
18-Mar-2016 8 MOH. BASIRAN SENTONG

12/17/2014 9 ISMAIL KREJENGAN
9/11/2015 9 AHMAD RIDHOI KREJENGAN
9/18/2015 9 HASINUDIN KREJENGAN
1/15/2016 8 SUROSO KREJENGAN
8/19/2015 9 MUHAMMAD HUSEN OPO-OPO
4/28/2015 9 HASAN HALIF ZAKARIYA KREJENGAN
TOTAL

Desa/Kelurahan sentong
sekolah

DOSIS IMUNISASI (BELUM D
Umur (tahun) NIK Nama Orang Tua Alamat WAK
OPV 1
8 '351315671115000 DWI WAHYUNI krejengan 0

1
7 3513151302170001 Abdur Rahman Sentong 0
9 3513152812140002 Abd. Rauf Desa/Kel. Sentong 0
12 3513155608120003 Hairudin Sentong 0
9 Sugianto Sentong 0
9 Muhammad Rofiq Sentong 0
#VALUE! Moh. Khofidz Semampir 0
9 Nurul Huda Sentong 0
9 Misbah Pegalangan kdl 0
9 Akhmad Taufik Pakuniran 0
#VALUE! Sahri Sentong 0
#VALUE! Moh. Khofidz Semampir Krak 0
10 Suhendra Sentong 0
10 Salman Farisi Sentong 0
#VALUE! Mohammad Ali Pakuniran 0
10 Abdul Mukti Sentong 0
#VALUE! Buhari Sentong 0
#VALUE! Abd. Rasiq Sentong 0
#VALUE! Fattah Sentong 0
#VALUE! Ramla Sentong 0
#VALUE! Abd Hadi SBK - Krej 0
#VALUE! Muzammil Sentong 0
#VALUE! Sujoto Sentong 0
12 R. Muhammad Syafi'un Gumantuk 0
8 '351315080616000 MUHAMMAD TAUFIQ DUSUN KRAJAN RT 004 0
1
'351314090313000 MUHAMMAD TAUFIQ RW 001Krajan Desa
Dusun
11 SUMBERKATIMOHO, 0
1
'351314020715000 MESNADI Sumber
dusun Katimoho
sumber rt 002 rw
9 KREJENGAN,
SUMBERKATIMOHO, 0
2
'351311250615000 FADLI 001 BULU,
DUSUN KRAKSAAN,
KOKONAN
9 KREJENGAN,
PROBOLINGGO, JAWA 0
2
'351315091115000 NURUL ARIFIN SIDOREJO,
DUSUN KRAJANKOTAANYAR,
RT 002
8 TIMUR, 67282,
PROBOLINGGO, 67282
JAWA 0
1
'351315210515000 ASNAWI RW 001 sentong
DUSUN KRAJAN RT 004
9 TIMUR,
SENTONG,67293, 67293
KREJENGAN, 0
1
'351315090915000 SUNARI RW 001
DUSUN BANTUL JAWART 01 RW
9 PROBOLINGGO,
SUMBERKATIMOHO, 0
4
'351315250915000 MUKIM 02 KEDUNGCALUK,
DUSUN KRAJAN RT 001
9 KREJENGAN,
KREJENGAN, 0
2
'351315670116000 HASAN RW 001 KRAJAN
DUSUN SENTONG,RT 003
8 PROBOLINGGO,
KREJENGAN, JAWA 0
1
'351315650415000 M ROFII RW 001 SENTONG,
SENTONG SENTONG,
9 PROBOLINGGO,
KREJENGAN, JAWA 0
1
'351315620615000 SUSANDRI AGUS KREJENGAN,
dusun krajan rt 003 rw 01
9 PROBOLINGGO,
PROBOLINGGO, JAWA
JAWA 0
3 PURNOMO sentong SENTONG,
TOTAL TIMUR, 67284, 67284
KREJENGAN, 0
PROBOLINGGO, JAWA
Desa/Kelurahan Tanjungsari
Posyandu 0

DOSIS IMUNISASI (BELUM
WAK
OPV 1
Umur (tahun) NIK Nama Orang Tua Alamat
13 Fitrianto KRAJAN 0
8 KRAJAN 0
9 KRAJAN 0
TOTAL 0
Desa/Kelurahan Jatiurip
Posyandu 0

WAK
OPV 1
8 SIPYANI Jatiurip 0
8 THALLIB Jatiurip 0
7 SIPUADI Opo-opo 0
7 MOKHAMMAD FUAD Jatiurip 0
124 0
124 0
7 NUR KAMIL PATEMON 0
TOTAL 0
Desa/Kelurahan Temenggungan
Posyandu :

WAK
OPV 1
8 3513155511810002 ARPUSANA Krajan 0

8 3509034107900611 RAHMAWATI BULAK BANTENG LOR BHINEKA 2/27 0
12 3513154107750003 SATIK ASEM 0
10 3513156705790002 TOYYIBAH KRAJAN 0
10 3513156706850002 HENY AMELLINDANUR TEGALAN 0
10 3513154305880002 SITI ROHANI KRAJAN 0
11 3513154107750090 MARYAM LEDOK 0
TOTAL 0

Desa/Kelurahan Patemon
Posyandu

DOSIS IMUNISASI (BELUM D
Umur (tahun) NIK Nama Orang Tua Alamat WAK
OPV 1
8 3513155108160001 Sigit Antoni PATEMON 0

7 3513156901170003 Heriyanto PATEMON 0
8 3513152905160001 Saipul PATEMON 0
8 3513154501160002 Ahmad Wagiarto PATEMON 0
7 Edi Susanto PATEMON 0
9 Thoyib PATEMON 0
12 ABD. RAHMAN PATEMON 0
12 MUHAMMAD MUJIB PATEMON 0
12 JUMARI PATEMON 0
11 ABDUL MUTHOLIP PATEMON 0
8 MOH. HASIM 0
9 MOCH WAHYUDI 0
TOTAL ANWAR 0

Desa/Kelurahan Opo-Opo
Posyandu 0

WAK
OPV 1
MI NURUL ISLAM 0
MI NURUL ISLAM 0
TOTAL 0

Desa/Kelurahan Kamal Kuning

Posyandu MI IZZUL ISLAM

WAK
OPV 1
9 Mi izzul islam SALEHUDIN KAMALKUNING 0

9 MOH ARIP SUHANDI KAMALKUNING 0
9 HERMANTO KAMALKUNING 0
9 MISNARI KAMALKUNING 0
9 LUKMANUL HAKIM KAMALKUNING 0
9 ACHMAD EDI KURNIA KAMALKUNING 0
9 ALI WAFA KAMALKUNING 0
9 MUHAMMAD DARUL FKAMALKUNING 0
9 ZAINUL HASAN KAMALKUNING 0
11 MUSTAIN KEDUNGCALUK 0
12 SAHRI KAMALKUNING 0
12 ABRORI KREJENGAN 0
11 ABDUR ROHIM KREJENGAN 0
12 HASANI KAMALKUNING 0
8 sdn kama kuning JAMALUDDIN Kamalkuning 0
8 NUR FAUZI Kamalkuning 0
TOTAL 0
Umur (bulan) NIK Nama Orang Tua Alamat
OPV 1
#VALUE! 3513152110170001 SULIHATIN Seboro
#VALUE! 3513090505150002 Abdul Hadi Mojolegi
#REF! 0
Umur (bulan) NIK Nama Orang Tua Alamat

OPV 1
8 Ghufron Karangren 0
9 Luqman Hakim SumberKatimoho 0
8 Slamet Hariyadi Karangren 0
9 Samsul Ma'arif Karangren 0
11 Moh. Zaini Karangren 0
7 3513152702170001 SAMSUL ARIFIN Karangren 0
9 3513150411140002 ABD KADIR ISWANTO Karangren 0
11 3513156805140002 SARU Karangren 0
11 3513156003140003 ZAINUL ALI AKBAR Karangren 0
11 3513154402130001 ZAINUL ALI AKBAR Karangren 0
12 3513156308120002 SUHADI Sumberkatimoho 0
8 3513150107160002 Kusnadi Seboro 0
0 0 0 0

NIK
Umur (bulan) Nama Orang Tua Alamat
OPV 1
9 3513152402150001 Chairul KRAJAN 0
12 3513156808120001 NANANG EFENDI KRAJAN 0
7 KASENGAN 0
8 '3513151802160003 KASENGAN 0
8 '353153007160001 KASENGAN 0
9 '3513155202150001 KASENGAN 0
9 '3513151805150001 KASENGAN 0
9 '3513152601160001 KASENGAN 0
9 '3513145501150002 KASENGAN 0
9 '3513145106150004 KASENGAN 0
11 KASENGAN 0
8 '3513154906160002 MUSTAQIM KASENGAN 0
8 '3513155403160001 SUPENO KASENGAN 0
8 '3513150905160001 HIZBULLAH KASENGAN 0
8 '3513151103160001 MUH. SOLEHUDIN KASENGAN 0
9 '3513152607150001 MUSYIDIN KASENGAN 0
9 '3513156806150001 HERMANSYAH KASENGAN 0
9 '3513150605150001 MUHAMMAD MAKMOKASENGAN 0
10 '3513152310140002 ABDUL BASIT KASENGAN 0
11 '3513152907130001 HAFID KASENGAN 0
#REF! #REF! #REF! 0
NIK
OPV 1
9 3513150506150001 SITI AMINAH SDN KEDUNGCALUK 2 0
9 3513130907150004 SAMIATI SDN KEDUNGCALUK 2 0
11 3513154901130002 AISYAH SDN KEDUNGCALUK 2 0
12 3513155106120001 INAYAH SDN KEDUNGCALUK 2 0
12 3513155101120001 SUKARTATIK SDN KEDUNGCALUK 2 0
7 3513152112160001 Ahmad Mansur SDN KEDUNGCALUK 1 0
8 3513184305160003 Haris Effendi SDN KEDUNGCALUK 1 0
8 3513155408160001 Zainul Hasan SDN KEDUNGCALUK 1 0
13 3512031403110001 Uuk Rudi Wahyudi SDN KEDUNGCALUK 1 0
#REF! #REF! 0

NIK

OPV 1
8 3513152907160001 HALIL DAWUHAN 0

11 3513154202130001 JUNAIDI KEDUNGCALUK 0
7 3513150412160002 SUMIATI Dawuhan 0
8 3513150501160001 SITI ASIMA Dawuhan 0
8 35130266230002 KOMARIAH DAWUHAN 0
8 35130266230009 KHAIRUN NISA' DAWUHAN 0
8 35130266220002 JAMILATUL FAIDAH DAWUHAN 0
9 35130266220011 BUNDA M.RAFAEL FAI DAWUHAN 0
8 35130266220016 BUNDA MUHAMMAD AL DAWUHAN 0
8 35130266220017 INDAH NURHAYATI DAWUHAN 0
8 35130266220018 BUNDA MUHAMMAD A DAWUHAN 0
124 35130266220023 DAWUHAN 0
11 35130266190017 MUHAMMAD DAWUHAN 0
11 35130266190018 MOH FIRDAUS DAWUHAN 0
12 35130266190019 ABD.AZIZ DAWUHAN 0
12 35130266190020 M.MISBAHUL MUNIR DAWUHAN 0
11 35130266190021 DAWUHAN 0
11 35130266190022 DAWUHAN 0
11 35130266190024 DIDIK SUPRIADI DAWUHAN 0
11 35130266190030 KHOIRUL ULUM DAWUHAN 0
#REF! #REF! #REF! 0

NIK
OPV 1
7 3513153011160001 UCI MARYAM WIDORO SUKUN 0
7 SALAMA KEDUNGCALUK BANTUL 0
7 3528042305170002 NUR ROHIMAH WIDORO ASEM 0
12 3513151106120004 Ismiyati Dusun Togor 0
#REF! #REF! #REF! 0

NIK
Umur Nama Orang Tua Alamat

OPV 1
7 3513186804170001 SULAEHA Dusun Togor II GEBANGAN 0

8 3513156809160001 HAMIDAH DUSUN KLOMPANGAN GEB 0
8 3513151903160001 SHOFIYAH DUSUN TOGOR II GEBANGA 0
#REF! #REF! #REF! 0
NIK
OPV 1
8 3513151110160001 FAUZAN ALFARISI sokaan/secangan 0
7 3513152112160003 MOH. ASMU'I Sokaan/Karanganyar 0
9 3513131908150002 Sapik 0
9 3513151006170001 Abdullah 0
12 3513136505120002 Asan 0
11 3613156306130001 Sudri 0
12 3513152405120001 Musridi 0
11 3513151407120003 Atim 0
12 3513152507120001 Nur Ulum 0
'3513150112150001 ABDUR RAHMAN Sokaan
8 0
9 '3513151910150001 SUNDARI Sokaan 0
9 '3511076505150001 KHOIRUL UMAM Sokaan
0
8 '3513150302160001 M. Luqman Sokaan 0
11 '3513141107150002 RAHMAT HADI PURN Sokaan 0
11 '3513151508130001 ABDUL ASIS Sokaan 0
10 '3513156712130002 SYAMSUDDIN Sokaan 0
10 '3513154811130001 ABU BAKAR Sokaan 0
10 '3513151506140001 JASKI Sokaan 0
10 '3513151611130001 SYAMSUL MAARIF Sokaan 0
11 '3513157008130001 KAMIL Sokaan 0
11 '3513153008130001 SAPARI Sokaan 0
10 '3513156802140001 KIROM Sokaan 0
10 '3513157003140001 MOH. ASYIKIN Sokaan 0
#REF! #REF! #REF! 0
EJAR
DOSIS YANG
DOSIS IMUNISASI (BELUM DITERIMA=1, SUDAH DITERIMA ATAU BELUM DIBUTUHKAN UNTUK
WAKTUNYA MENERIMA = 0) MELENGKAPI
IMUNISASI
HPV Kls 5
HPV Kls 6
MR Kls 1
Td Kls 2
Td Kls 5
OPV 1
OPV 2
OPV 3
OPV 4
MR 1
MR 2
OPV
HPV
MR
Td
0 0 0 0 0 0 1 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 1 6 0 0 0 0 1 6 0
EJAR
DOSIS YANG
HPV Kls 5
HPV Kls 6
MR Kls 1
WAKTUNYA MENERIMA = 0) MELENGKAPI KETERANGAN

Td Kls 2
Td Kls 5
OPV 2
OPV 3
OPV 4
MR 1
MR 2
OPV
HPV
IMUNISASI
MR
Td
0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 1 0 0 0 0 0 1 0 0
0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 1 0 0 1 0 0 1 1
0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 0 1 0 0 0 0 1 0
0 0 0 0 0 0 0 1 1 0 0 0 1 1
0 0 0 0 0 0 0 1 0 0 0 0 1 0
0 0 0 0 0 0 0 1 0 0 0 0 1 0
0 0 0 0 0 0 0 1 0 0 0 0 1 0
0 0 0 0 0 0 0 1 0 0 0 0 1 0
0 0 0 0 0 0 0 1 0 0 0 0 1 0
0 0 0 0 0 0 0 1 0 0 0 0 1 0
0 0 0 0 0 0 0 1 0 0 0 0 1 0
0 0 0 0 0 0 0 1 0 0 0 0 1 0
0 0 0 0 0 0 0 1 0 0 0 0 1 0
0 0 0 0 0 0 0 1 0 0 0 0 1 0
0 0 0 0 0 0 0 1 0 0 0 0 1 0
0 0 0 0 0 1 0 0 0 0 0 1 0 0
0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 2 20 13 1 1 0 2 33 2
DOSIS YANG
HPV Kls 5
HPV Kls 6
MR Kls 1
MELENGKAPI KETERANGAN
Td Kls 2
Td Kls 5
OPV 2
OPV 3
OPV 4
MR 1
MR 2
OPV
HPV
IMUNISASI
MR
Td
0 0 0 0 0 0 0 1 0 0 0 0 1 0
0 0 0 0 0 1 0 0 0 0 0 1 0 0
0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 1 1 1 0 0 0 1 2 0
DOSIS YANG
HPV Kls 5
HPV Kls 6
MR Kls 1
Td Kls 2
Td Kls 5
OPV 2
OPV 3
OPV 4
MR 1
MR 2
OPV
HPV
IMUNISASI
MR
Td
0 0 0 0 0 1 0 0 0 0 0 1 0 0
0 0 0 0 0 1 0 0 0 0 0 1 0 0
0 0 0 0 0 1 0 0 0 0 0 1 0 0
0 0 0 0 0 1 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 4 0 0 0 0 0 4 0 0
DOSIS YANG
HPV Kls 5
HPV Kls 6
MR Kls 1
Td Kls 2
Td Kls 5
OPV 2
OPV 3
OPV 4
MR 1
MR 2
OPV
HPV
IMUNISASI
MR
Td
0 0 0 0 0 1 0 0 0 0 0 1 0 0
0 0 0 0 0 1 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0 0 0 1 0
0 0 0 0 0 0 0 1 0 0 0 0 1 0
0 0 0 0 0 0 0 1 0 0 0 0 1 0
0 0 0 0 0 0 0 1 0 0 0 0 1 0
0 0 0 0 0 0 0 1 0 0 0 0 1 0
0 0 0 0 0 2 0 5 0 0 0 2 5 0
DOSIS YANG
HPV Kls 5
HPV Kls 6
MR Kls 1
Td Kls 2
Td Kls 5

OPV 2
OPV 3
OPV 4
MR 1
MR 2
OPV
HPV
MR
IMUNISASI
Td
0 0 0 0 0 1 0 0 0 0 0 1 0 0
0 0 0 0 0 1 0 0 0 0 0 1 0 0
0 0 0 0 0 1 0 0 0 0 0 1 0 0
0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 1 0 0 0 0 0 1 0 0
0 0 0 0 0 1 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0 0 0 0 1 0
0 0 0 0 0 0 0 1 0 0 0 0 1 0
0 0 0 0 0 0 0 1 0 0 0 0 1 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 1 0 0 0 0 0 1 0 0
0 0 0 0 0 0 1
0 0 0 0 0 0 1 0
0 0 0 0 0 6 2 3 0 0 0 6 5 0
DOSIS YANG
HPV Kls 5
HPV Kls 6
MR Kls 1
Td Kls 2
Td Kls 5
OPV 2
OPV 3
OPV 4
MR 1
MR 2
OPV
HPV
IMUNISASI
MR
Td
0 0 0 0 0 1 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 1 0 0 0 1 1
0 0 0 0 0 1 0 1 1 0 0 1 1 1
DOSIS YANG
HPV Kls 5
HPV Kls 6
MR Kls 1
Td Kls 2
Td Kls 5

OPV 2
OPV 3
OPV 4
MR 1
MR 2
OPV
HPV
MR
IMUNISASI
Td
0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 0 1 0 0 0 0 1 0
0 0 0 0 0 0 0 1 0 0 0 0 1 0
0 0 0 0 0 0 0 1 0 0 0 0 1 0
0 0 0 0 0 0 0 1 0 0 0 0 1 0
0 0 0 0 0 0 0 1 1 0 0 0 1 1
0 0 0 0 0 1 0 0 0 0 0 1 0 0
0 0 0 0 0 1 0 0 0 0 0 1 0 0
0 0 0 0 0 2 9 5 1 0 0 2 14 1 0
HPV Kls 5
HPV Kls 6
MR Kls 1
Td Kls 2
Td Kls 5 KETERANGAN
OPV 2
OPV 3
OPV 4
MR 1
MR 2
OPV
HPV
MR
Td
1 0 0 1 0 0
1 0 0 1 0
0 0 0 0 0 1 1 0 0 0 0 1 1 0
HPV Kls 5
HPV Kls 6
MR Kls 1
Td Kls 2
Td Kls 5
KETERANGAN
OPV 2
OPV 3
OPV 4
MR 1
MR 2
OPV
HPV
MR
Td
0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 1 0 0 0 0 0 1
0 0 0 0 0 0 1 0 0 0 0 0 1
0 0 0 0 0 0 1 0 0 0 0 0 1
0 0 0 0 0 0 1 0 0 0 0 0 1
0 0 0 0 0 0 1 0 0 0 0 0 1
0 0 0 0 0 0 1 1 1 0 0 0 2
0 0 0 0 0 0 0 1 1 0 0 0 1
0 0 0 0 0 0 0 1 1 0 0 0 1
0 0 0 0 0 0 0 1 1 0 0 0 1
0 0 0 0 0 0 0 1 1 0 0 0 1
0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 2 6 5 5 0 0 2 11 0
HPV Kls 5
HPV Kls 6
MR Kls 1
Td Kls 2
Td Kls 5
KETERANGAN
OPV 2
OPV 3
OPV 4
MR 1
MR 2
OPV
HPV
MR
Td
0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 0 1 1 0 0 0 1
0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 1 1 0 0 0 0 1 1
0 0 0 0 0 1 1 0 0 0 0 1 1
0 0 0 0 0 1 1 0 0 0 0 1 1
0 0 0 0 0 0 1 0 0 0 0 0 1
0 0 0 0 0 0 1 0 0 0 0 0 1
0 0 0 0 0 0 1 0 0 0 0 0 1
0 0 0 0 0 0 1 0 0 0 0 0 1
0 0 0 0 0 0 0 1 1 0 0 0 1
0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 1 0 0 0 0 0 1
0 0 0 0 0 0 1 0 0 0 0 0 1
0 0 0 0 0 0 1 0 0 0 0 0 1
0 0 0 0 0 0 1 0 0 0 0 0 1
0 0 0 0 0 0 0 1 0 0 0 0 1
0 0 0 0 0 9 11 3 2 0 0 9 14 0 0
HPV Kls 5
HPV Kls 6
MR Kls 1
Td Kls 2
Td Kls 5
KETERANGAN
OPV 2
OPV 3
OPV 4
MR 1
MR 2
OPV
HPV
MR
Td
0 0 0 0 0 0 1 0 0 0 0 0 1
0 0 0 0 0 0 1 0 0 0 0 0 1
0 0 0 0 0 0 0 1 1 0 0 0 1
0 0 0 0 0 0 0 1 0 0 0 0 1
0 0 0 0 0 0 0 1 0 0 0 0 1
0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 1 0 0 0 0 0 1
0 0 0 0 0 0 0 1 0 0 0 0 1
0 0 0 0 0 2 3 4 1 0 0 2 7 0 0
HPV Kls 5
HPV Kls 6
MR Kls 1
Td Kls 2
Td Kls 5
KETERANGAN
OPV 2
OPV 3
OPV 4
MR 1
MR 2
OPV
HPV
MR
Td
0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 0 1 0 0 0 0 1
0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 1 0 0 0 0 0 1
0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 1 0 0 0 0 0 1
0 0 0 0 0 0 1 0 0 0 0 0 1
0 0 0 0 0 0 1 0 0 0 0 0 1
0 0 0 0 0 0 1 0 0 0 0 0 1
0 0 0 0 0 0 1 0 0 0 0 0 1
0 0 0 0 0 0 1 0 0 0 0 0 1
0 0 0 0 0 0 1 0 0 0 0 0 1
0 0 0 0 0 0 1 0 0 0 0 0 1
0 0 0 0 0 0 1 0 0 0 0 0 1
0 0 0 0 0 0 1 0 0 0 0 0 1
0 0 0 0 0 0 1 1 0 0 0 0 2
0 0 0 0 0 0 1 0 0 0 0 0 1
0 0 0 0 0 0 1 0 0 0 0 0 1
0 0 0 0 0 0 1 0 0 0 0 0 1
0 0 0 0 0 4 15 2 0 0 0 4 17 0 0
WAKTUNYA MENERIMA = 0) HPV Kls 5 MELENGKAPI
HPV Kls 6
MR Kls 1
Td Kls 2
Td Kls 5
KETERANGAN
OPV 2
OPV 3
OPV 4
MR 1
MR 2
OPV
HPV
MR
Td
0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 0 1 0 0 0 0 1
0 0 0 0 0 3 0 1 0 0 0 3 1 0 0
HPV Kls 5
HPV Kls 6
MR Kls 1
Td Kls 2
Td Kls 5
KETERANGAN
OPV 2
OPV 3
OPV 4
MR 1
MR 2
OPV
HPV
MR
Td
0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 3 0 0 0 0 0 3 0 0 0
HPV Kls 5
HPV Kls 6
MR Kls 1
Td Kls 2
Td Kls 5
KETERANGAN
OPV 2
OPV 3
OPV 4
MR 1
MR 2
OPV
HPV
MR
Td
0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 1 0 0 0 0 0 1
0 0 0 0 0 0 0 1 1 0 0 0 1
0 0 0 0 0 1 0 1 1 0 0 1 1
0 0 0 0 0 1 0 1 0 0 0 1 1
0 0 0 0 0 1 0 1 0 0 0 1 1
0 0 0 0 0 1 0 1 0 0 0 1 1
0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 1 0 0 0 0 0 1
0 0 0 0 0 0 1 0 0 0 0 0 1
0 0 0 0 0 0 1 0 0 0 0 0 1
0 0 0 0 0 0 0 1 0 0 0 0 1
0 0 0 0 0 0 0 1 0 0 0 0 1
0 0 0 0 0 0 0 1 0 0 0 0 1
0 0 0 0 0 0 0 1 0 0 0 0 1
0 0 0 0 0 0 0 1 0 0 0 0 1
0 0 0 0 0 0 0 1 0 0 0 0 1
0 0 0 0 0 0 0 1 0 0 0 0 1
0 0 0 0 0 0 0 1 0 0 0 0 1
0 0 0 0 0 0 0 1 0 0 0 0 1
0 0 0 0 0 0 0 1 0 0 0 0 1
0 0 0 0 0 8 4 15 2 0 0 8 19 0 0
KETERANGAN
TOTAL SASARAN DAN KEBUTUHAN VAKSIN DAN LOGISTIK IMUNISA
Provinsi Puskesmas
Kabupaten
Isilah kolom yang tidak berwarna dan pastikan jumlah sasaran s
KEBUTUHAN VAKSIN (VIAL)
JUMLAH DOSIS
*IP Vaksin merujuk IP Vaksin pada
24-59 bln
JUMLAH POSYANDU
Mikroplaning rutin
No. Nama Desa/Kelurahan
DPT-HB-Hib
DPT-HB-Hib
OPV
OPV
PCV
IPV
IPV
MR
MR
1 Krejengan 4 12 2 5 4 3 3 1 2 2
2 Sentong 3 88 49 15 10 99 22 13 4 4
3 Tanjungsari 2 0 7 0 0 21 0 2 0 0
4 Jatiurip 3 0 0 0 0 0 0 0 0 0
5 Temenggungan 3 0 21 0 0 188 0 6 0 0
6 Patemon 3 5 0 2 5 0 2 0 1 2
7 Opo-Opo 4 17 16 25 16 24 5 4 7 6
8 Rawan 2 0 0 4 4 0 0 0 1 2
9 Kamal Kuning 2 0 0 13 17 0 0 0 4 6
10 Seboro 3 11 53 8 3 156 3 14 2 1
11 karangren 3 0 0 38 32 0 0 0 10 11
12 Sumber katimoho 3 0 0 5 5 0 0 0 2 2
13 Kedung Caluk 4 0 0 28 7 0 0 0 7 3
14 Dawuhan 3 37 26 70 11 33 10 7 18 4
15 Widoro 1 21 54 19 3 0 6 14 5 1
16 Gebangan 3 0 0 0 1 0 0 0 0 1
17 Sokaan 4 0 0 0 0 0 0 0 0 0
TOTAL 50 191 228 232 118 524 51 61 63 45
AN LOGISTIK IMUNISASI KEJAR
:
astikan jumlah sasaran sesuai pada lembar pendataan sasaran per desa
VAKSIN (VIAL)
uk IP Vaksin pada KEBUTUHAN LOGISTIK
aning rutin
Anapilaktik syok
Kebutuhan Logistik
Wadah/Kontainer
Pelarut MR (5 ml)
Safety box 2.5 L
Vaccine Carrier
Plastik limbah
Limbah Medis
Safety box 5 L
ADS 0.5 ml
PPI (pack)
medis
PCV
Kit
1 2 49 2 1
33 4 271 6 3
7 0 21 1 1
0 0 0 0 0
63 0 0 0 0
0 2 0 1 1
8 6 0 1 1
0 2 0 1 1
0 6 0 1 1
52 1 0 1 1
0 11 0 1 1
0 2 0 1 1
0 3 0 1 1
11 4 0 1 1
0 1 0 1 1
0 1 0 1 1
0 0 0 0 0
175 45 341 20 16 0 0 0 0 0
IP Vaksin merujuk IP Vaksin pada Mikroplaning rutin :
Jenis Antigen Isilah IP Vaksin
OPV 4 angka di samping hanya contoh
IPV 4
DPT-HB-Hib 4
MR 3
PCV 3
TOTAL SASARAN DAN KEBUTUHAN VAKSIN DAN LOGISTIK IM
Provinsi
Kabupaten
Isilah kolom yang tidak berwarna dan pastikan jumlah s
JUMLAH DOSIS
*IP Vaksin merujuk IP Vaksin pada
(ANAK USIA SEKOLAH)
JUMLAH POSYANDU
Mikroplaning rutin
No. Nama Desa/Kelurahan
OPV
OPV
HPV
MR
MR
Td
Td
1 Krejengan 4 0 1 6 0 0 1 1
2 Sentong 3 0 2 33 2 0 1 6
3 Tanjungsari 2 0 1 2 0 0 1 1
4 Jatiurip 3 0 4 0 0 0 1 0
5 Temenggungan 3 0 2 5 0 0 1 1
6 Patemon 3 0 6 5 0 0 2 1
7 Opo-Opo 4 0 1 1 1 0 1 1
8 Rawan 2 0 0 0 0 0 0 0
9 Kamal Kuning 2 0 2 14 1 0 1 3
10 Seboro 3 0 1 1 0 0 1 1
11 karangren 3 0 2 11 0 0 1 2
12 Sumber katimoho 3 0 9 14 0 0 3 3
13 Kedung Caluk 4 0 2 7 0 0 1 2
14 Dawuhan 3 0 4 17 0 0 1 3
15 Widoro 1 0 3 1 0 0 1 1
16 Gebangan 3 0 3 0 0 0 1 0
17 Sokaan 4 0 8 19 0 0 2 4
TOTAL 50 0 51 136 4 0 20 30
AKSIN DAN LOGISTIK IMUNISASI KEJAR
na dan pastikan jumlah sasaran sesuai pada lembar pendataan sasaran per desa
N VAKSIN (VIAL)
Kebutuhan Logistik
ujuk IP Vaksin pada
(5 ml)
planing rutin
Anapilaktik syok
Kebutuhan Logistik
Wadah/Kontainer
Pelarut MR (5ml)
Safety box 2.5 L
Vaccine Carrier
Plastik limbah
Limbah Medis
Safety box 5 L
ADS 0.5 ml
PPI (pack)
medis
HPV
Kit
0 1 10 1 1
1 1 42 1 1
0 1 6 1 1
0 1 0 1 1
0 1 0 1 1
0 2 0 1 1
1 1 0 1 1
0 0 0 0 0
1 1 0 1 1
0 1 0 1 1
0 1 0 1 1
0 3 0 1 1
0 1 0 1 1
0 1 0 1 1
0 1 0 1 1
0 1 0 1 1
0 2 0 1 1
3 20 58 16 16 0 0 0 0 0
MR 4
Td 6
HPV 6
IMUNISASI KEJAR
RENCANA KEGIATAN
PUSKESMAS :
KAB/KOTA :
PROVINSI :
NAMA BULAN PENANGGUNG

NO
KEGIATAN 1 2 3 4 5 6 7 8 9 10 11 12 JAWAB
Pendataan sasaran, vaksin, logistik dan
1
pos imunisasi
2 Identifikasi daerah sulit / risiko tinggi
3 Pembuatan mikroplanning
Advokasi / koordinasi dan sosialisasi

4
lintas sektor / program
pertemuan koordinasi dengan perangkat

5 lurah/desa dan lembanga
kemasyarakatan
Pembekalan tenaga pelaksana imunisasi

6
kejar
7 Penyebaran informasi / media KIE
8 Pelaksanaan imunisasi kejar
Monitoring dan evaluasi dan supervisi

9
supportif
Catatan : Tuliskasn jumlah target harian pada kolom tanggal baris kegiatan pelaksanaan imunisasi kejar
KETERANGAN
Pencatatan Hasil Imunisasi Kejar Anak usia (24-59 bln)
Nama Usia (bulan) Hasil imunisasi kejar
Err:509 Err:509 Lengkap
NABIL ALFAREZI 44 Lengkap
Pencatatan Hasil Imunisasi Kejar Anak usia (24-59 bln)
Nama Usia (bulan) Hasil imunisasi kejar
KINANDITA HANINA.P 27 Lengkap
MUH. VARDES ADITYA 27 Lengkap
0 0 Lengkap
0 0 Lengkap
0 0 Lengkap
0 0 Lengkap
0 0 Lengkap
0 0 Lengkap
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0 0 Lengkap
0 0 Lengkap
0 0 Lengkap
0 0 Lengkap
0 0 Lengkap
Pencatatan Hasil Imunisasi Kejar Anak usia sekolah
Nama Usia (tahun)
Err:509 Err:509
Err:509 Err:509
Err:509 Err:509
KAMELIA 8
Err:509 Err:509
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ALEX ZAIDAN HABIBI FILLAH 9.34722222222222
Err:509 Err:509
Err:509 Err:509
ALIYA KHAIRUNNISA 8.61388888888889
ALIZA HILYA NAFISAH 8.59444444444445
Err:509 Err:509
ELIKA MUSLIHATUN NISA' 8.26944444444444
Err:509 Err:509
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0 0
Err:509 Err:509
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Pencatatan Hasil Imunisasi Kejar Anak usia sekolah
Nama Usia (tahun)
0 0
0 0
0 0
0 0
0Isilah kolom yang tidak berwarna!
Nama Anak Umur (tahun)
0 0
Abdul Malik Azmatkhan 7
Lucky Apriliansyah Putra Mud Ha 8
Mohammad Alif Hafid 7
Muhammad Irfan Zamani 7
Nayla Karimah 7
Rifatul Aulia 7
Afkarina Hureem Mumtaz 9
Faizatul Munawaroh 8
Felysha Zalfa Zahira 8
Keasya Shakila Malikal Boalgis 8
Mochammad Nabil 8
Err:509 Err:509
Err:509 Err:509
Mohammad Royhan #VALUE!
Muhammad Iqbal Mubarok #VALUE!
Naila Karomah Muniroh #VALUE!
Najwa Kamilah Dinatuz Zakiyah 124.4
Nur Naylatul Rohmah #VALUE!
Muhammad Fayruz Haikal Annabil #VALUE!
Muhammad Ubaydillah Firdaus #VALUE!
Abidah Najiyah #VALUE!
Aina Talita Zahra #VALUE!
Dewy Aisyah Chumairoh Arrosyid #VALUE!
Eka Rahmawati #VALUE!
Hasan Rusydi Ridwan #VALUE!
Hilyatul Adzhan #VALUE!
Lu'luil Maknunah #VALUE!
Muhammad Rifki Aditya #VALUE!
Moh. Ma'ruf Maulana #VALUE!
Syakira Adelia Putri #VALUE!
Izzatul Jamilah #VALUE!
Ahmad Reza Hamdani #VALUE!
Adibah Najiyah #VALUE!
Jesica Vhiejay Maharani #VALUE!
Luluk Najwa Khoirani #VALUE!
Luluk Najwa Khoirina #VALUE!
Mahdiyah Wafiroh #VALUE!
Muhammad Ariel #VALUE!
Ummi Maulidiya #VALUE!
Err:509 Err:509
Muhammad Gholib #VALUE!
Ahmad Fariq Almikroj #VALUE!
Ach. Mahesa Khafi Aidin W #VALUE!
Abi Mashuri #VALUE!
Arifah #VALUE!
Aulia Qotrun Nada #VALUE!
Chairul Mufid #VALUE!
Elok Nur Azizah #VALUE!
Halimatus Sa'diyah #VALUE!
Mar'atus Zahiratun Nabila #VALUE!
Moh. Khairul Rodziqin #VALUE!
Moh. Ahsan Faradisi #VALUE!
Moh. Nizar Irhamni Maulana #VALUE!
Moh. Rendi Andika Pratama #VALUE!
Muhammad Chairul Barokah #VALUE!
Muhammad Dzi Fahmi Adzkiya' #VALUE!
Muhammad Naufal #VALUE!
Musyrifah Nur Aini #VALUE!
Mutamakin Billa #VALUE!
Nur Aurielia Az - Zahra #VALUE!
Nur Fadhilatul Kamila #VALUE!
Veronicha Septiyani #VALUE!
Ahmad Royhan Roziky #VALUE!
Jihan Qotrun Nada #VALUE!
Ibrohim Muhammad Syafi' Yusuf #VALUE!
0 0
0 0
0 0
0 0
0Isilah kolom yang tidak berwarna!
Nama Anak Umur (tahun)
0 0
AHZA ZAINIA RAMADHAN 7.86027397260274
ALIYYAH ADIBAH ZAHRA 7.38630136986301
ANDIKA ZAINUR RAMADHAN 7.88219178082192
AZHALIA PUTRI RAMADHANI 7.84657534246575
AZKADINA SYARIFAH 7.73424657534247
CHOIROTUNNISA' RAMADHANI 7.81917808219178
FADLIN NADA CHAIRI 7.03287671232877
IBNUL JALIL 7.78356164383562
M. ABQARY ISHRAQ RABBANY 7.98630136986301
ar Anak usia sekolah
Hasil imunisasi kejar
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
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Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
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Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
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Lengkap
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Lengkap
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Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
ar Anak usia sekolah
Hasil imunisasi kejar
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
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Lengkap
Lengkap
Lengkap
Lengkap
Lengkap
PUSKESMAS
KAB/KOTA
PROVINSI
Untuk kolom dataran dan keterjangkauan, tulis angka 1 jika "Ya" dan 0 jika "Tidak"
TANGGAL PELAKSANAAN
WAKTU PELAKSANAAN
JUMLAH D
NAMA DESA / NAMA

NO
KELURAHAN POSYANDU
OPV
1 OPO-OPO KRAJAN TERATAI 1-Aug-24 08.00 wib 17
2 OPO-OPO GNNG WURUNG NUSA INDAH 3-Aug-24 08.00 wib
3 OPO-OPO CURAH KATES ANGGREK 2-Aug-24 08.00 wib
4 OPO-OPO OPO-OPO LOR MELATI 4-Aug-24 08.00 wib
5 RAWAN KRAJAN MAWAR 7-Aug-24 08.00 wib 0
6 RAWAN SEMAR ANGGREK 8-Aug-24 08.00 wib
7 SEBORO KEMBANG CEMPAKA 7-Aug-24 08.00 wib 11
8 SEBORO GILI TERATAI 8-Aug-24 08.00 wib
9 SEBORO JEJE'E MELATI 9-Aug-24 08.00 wib
10 KARANGREN KARANGREN TM KENANGA 2-Aug-24 08.00 wib 0
11 KARANGREN KRAJAN ANGGREK 3-Aug-24 08.00 wib
12 KARANGREN SUKUN MAWAR 4-Aug-24 08.00 wib
13 KEDUNG CALUK KRAJAN CAMELLIA 1-Aug-24 08.00 wib 0
14 KEDUNG CALUK BANTOL KENANGA 2-Aug-24 08.00 wib
15 KEDUNG CALUK JAWAAN BOUGENVILLE 3-Aug-24 08.00 wib
16 KEDUNG CALUK KARANG ANYAR RAFFLESIA 4-Aug-24 08.00 wib
17 SOKAAN PENANGAN MAWAR 4-Aug-24 08.00 wib
18 SOKAAN KRAJAN MELATI 2-Aug-24 08.00 wib
19 SOKAAN KARANG ANYAR ANGGREK 1-Aug-24 08.00 wib
20 SOKAAN SECANGAN TERATAI 7-Aug-24 08.00 wib
21 DAWUHAN KRAJAN ANGGREK 1-Aug-24 08.00 wib 37
22 DAWUHAN MONTORAN KAMBOJA 4-Aug-24 08.00 wib
23 DAWUHAN TOGUR MAWAR 2-Aug-24 08.00 wib
24 GEBANGAN KRAJAN BERLIAN 9-Aug-24 08.00 wib 0
25 GEBANGAN TENGAH MUTIARA 8-Aug-24 08.00 wib
26 GEBANGAN KOLORAN PERMATA 7-Aug-24 08.00 wib
27 WIDORO WIDORO ASTER 7-Aug-24 08.00 wib 21
28 SUMBERKATIMOHO KRAJAN MAWAR 5-Aug-24 08.00 wib 0
29 SUMBERKATIMOHO KASENGAN MELATI 4-Aug-24 08.00 wib
30 SUMBERKATIMOHO SMBR BENDO ANGGREK 3-Aug-24 08.00 wib
31 KREJENGAN KRAJAN MENTARI 1-Aug-24 08.00 wib 12
32 KREJENGAN MOTEN I TERATAI 2-Aug-24 08.00 wib
33 KREJENGAN MOTEN 2 AZ ZAHRO 4-Aug-24 08.00 wib
34 KREJENGAN DANDAN ROSELA 5-Aug-24 08.00 wib
35 KAMAL KUNING KRAJAN MELATI 2-Aug-24 08.00 wib 0
36 KAMAL KUNING KARANG ASEM MAWAR 3-Aug-24 08.00 wib
37 TANJUNGSARI KRAJAN ANGGREK 1-Aug-24 08.00 wib 0
38 TANJUNGSARI TAMPOLONG MAWAR 3-Aug-24 08.00 wib
39 PATEMON KRAJAN MELATI 3-Aug-24 08.00 wib 5
40 PATEMON KELORAN MAWAR 4-Aug-24 08.00 wib
41 PATEMON PAT UTARA KENANGA 5-Aug-24 08.00 wib
42 TEMENGGUNGAN TEGALAN KAMBOJA 7-Aug-24 08.00 wib 0
43 TEMENGGUNGAN KRAJAN FLAMBOYAN 1-Aug-24 08.00 wib
44 TEMENGGUNGAN ASEM ANGGREK 2-Aug-24 08.00 wib
45 JATIURIP KURIPAN BINTANG 2-Aug-24 08.00 wib
46 JATIURIP KRAJAN MATAHARI 3-Aug-24 08.00 wib
47 JATIURIP LAMOR BULAN 4-Aug-24 08.00 wib
48 SENTONG KRAJAN MATAHARI 1-Aug-24 08.00 wib 88
191
JADWAL IMUNISASI KEJAR

JUMLAH DOSIS *IP Vaksin merujuk IP Vaksin pada Mikroplaning
rutin
Pelarut MR (5 ml)
DPT-HB-Hib
DPT-HB-Hib
OPV
PCV
PCV
IPV
IPV
MR
MR
16 25 16 24 5 4 7 6 8 6
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 4 4 0 0 0 1 2 0 2
0 0 0 0 0 0
53 8 3 156 3 14 2 1 52 1
0 0 0 0 0 0
0 0 0 0 0 0
0 38 32 0 0 0 10 11 0 11
0 0 0 0 0 0
0 0 0 0 0 0
0 28 7 0 0 0 7 3 0 3
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
26 70 11 33 10 7 18 4 11 4
0 0 0 0 0 0
0 0 0 0 0 0
0 0 1 0 0 0 0 1 0 1
0 0 0 0 0 0
0 0 0 0 0 0
54 19 3 0 6 14 5 1 0 1
0 5 5 0 0 0 2 2 0 2
0 0 0 0 0 0
0 0 0 0 0 0
2 5 4 3 3 1 2 2 1 2
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 13 17 0 0 0 4 6 0 6
0 0 0 0 0 0
7 0 0 21 0 2 0 0 7 0
0 0 0 0 0 0
0 2 5 0 2 0 1 2 0 2
0 0 0 0 0 0
0 0 0 0 0 0
21 0 0 188 0 6 0 0 63 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
49 15 10 99 22 13 4 4 33 4
228 232 118 524 48 57 58 40 175 40
Nama Petugas Pos
KEBUTUHAN LOGISTIK
Pelayanan
Wadah/Kontainer
Logistik PPI (pack)

Safety box 2.5 L
Vaccine Carrier
Plastik limbah
Limbah Medis
Safety box 5 L
Anapilaktik
Kebutuhan
ADS 0.5 ml
Petugas
syok Kit
medis
lainnya
Vaksinator
(kader,
dll)
284 6 3
0 0 0
0 0 0
0 0 0
0 1 1
0 0 0
0 1 1
0 0 0
0 0 0
0 1 1
0 0 0
0 0 0
0 1 1
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 1 1
0 0 0
0 0 0
0 1 1
0 0 0
0 0 0
0 1 1
0 1 1
0 0 0
0 0 0
0 1 1
0 0 0
0 0 0
0 0 0
0 1 1
0 0 0
0 0 0
0 0 0
0 1 1
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 1 1
0 1 1 0 0 0 0 0
Sarana
Nama Supervisor
Transportasi

IPV 4
DPT-HB-Hib 4
MR 3
PCV 3
amping hanya contoh

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NAMA PUSKESMAS :

5 Pada langkah sumber daya 2 a dan 2 b, perhatikan Langkah berikut ini

No Nama Bayi/Balita/Anak Usia Sekolah Tanggal Lahir Jenis Kelamin

Nama Orang Tua/Pengasuh Alamat No. Tlp/HP

No. NIK ANAK NAMA ANAK TANGGAL LAHIR

1 3513151047710001 AZZURA AFRA 5/17/2022

Provinsi : jawa timur

No. NIK ANAK NAMA ANAK TANGGAL LAHIR

2 3513152606220002 M. DILAN ALFARISQI 6/26/2022

Provinsi : jawa timur

No. NIK ANAK NAMA ANAK TANGGAL LAHIR

1 3513154105220004 FITRIA RAMADANI 5/1/2022

Provinsi : jawa timur

No. NIK ANAK NAMA ANAK TANGGAL LAHIR

1 3513154605220001 DINAR FALESTIN M 5/6/2022

No. NIK ANAK NAMA ANAK TANGGAL LAHIR

18 MOH. ABBAD MAJDI 04/06/2023

Provinsi : Jawa Timur

No. NIK ANAK NAMA ANAK TANGGAL LAHIR

8 ARSYILA FAZA. A 13/12/2022

Provinsi : Jawa Timur

No. NIK ANAK NAMA ANAK TANGGAL LAHIR

1 MUH. RENDRA WIJAYA 06/05/2022

No. NIK ANAK NAMA ANAK TANGGAL LAHIR

5 3513150501230001 M JIBRIL 07/01/2023

Provinsi : JAWA TIMUR

No. NIK ANAK NAMA ANAK TANGGAL LAHIR

No. NIK ANAK NAMA ANAK TANGGAL LAHIR

1 NURIL ALIFAH ZAIN 5/25/2022

Provinsi : JAWA TIMUR

No. NIK ANAK NAMA ANAK TANGGAL LAHIR

Provinsi : JAWA TIMUR

No. NIK ANAK NAMA ANAK TANGGAL LAHIR

7 ABIZAR KEENAN ATHARAZKA 29/01/2024

No. NIK ANAK NAMA ANAK TANGGAL LAHIR

1 3513151606220001 AHMAD BRILLIAN AZHAR 6/16/2022

No. NIK ANAK NAMA ANAK TANGGAL LAHIR

1 RAISYASEPTIANA ARROZAQ 9/28/2022

No. NIK ANAK NAMA ANAK TANGGAL LAHIR

No. NIK ANAK NAMA ANAK TANGGAL LAHIR

3 3513150605220001 RAFAEL 5/7/2022

No. NIK ANAK NAMA ANAK TANGGAL LAHIR

1 3513154606220002 NAYYARA 06/06/2022

No. NIK ANAK NAMA ANAK TANGGAL LAHIR

1 3513156304220001 DEBYANASARI 4/23/2022

No. NIK ANAK NAMA ANAK TANGGAL LAHIR

1 3513154905220001 SOFIATUN NISAK 9/5/2022

No. NIK ANAK NAMA ANAK TANGGAL LAHIR

1 3513154604220002 NIMAS AYU CANDRAWINATA 06.04.2022

Provinsi : JAWA TIMUR

No. NIK ANAK NAMA ANAK TANGGAL LAHIR

1 3513156104220002 FARAH NUR FITRIA 21.04.2022

No. NIK ANAK NAMA ANAK TANGGAL LAHIR

1 3513151105220001 SAYOGO DEWANANDA RAHMAN 5/11/2022

Provinsi : JAWA TIMUR

No. NIK ANAK NAMA ANAK TANGGAL LAHIR

1 3513151607220004 MUHAMMAD KARUNIA ZAFRAN 7/16/2022

Provinsi : JAWA TIMUR

No. NIK ANAK NAMA ANAK TANGGAL LAHIR