Provinsi :

Kabupaten/Kota :
Puskesmas :

No. No Kartu Keluarga ANAK KE- NAMA ANAK

NIK (Nomor Induk TANGGAL LAHIR
Kependudukan) (YYYYMMDD)
1 3203030702130057 3203031601140005 1 Moch Haris Maulana 2014-01-16
2 3203030804090066 3203035509130004 3 Selfi Selfiana 2013-09-15
3 3203031212080072 3203036802140002 4 Siti Aisyah 2014-02-28
4 3203031411055062 3203031805140004 4 Moch Rajib 2014-05-18
5 3203032506120006 3203031207140001 3 Zaki 2018-07-12
6 3203032710150001 3203031103140001 1 Moch Naufal 2014-03-11
7 3203032510130006 3203035102140006 1 Almira Salsabila 2014-02-11
8 3203031907110022 3203034102140003 2 Anisa 2014-02-01
9 3203031411057907 3203037004140003 4 Raisya 2014-04-30
10 3203032404120011 3203031906140005 4 Moch Denis 2014-06-19
11 3203033007110004 3 203031608140002 2 Damar 2014-08-16
12 3203030 3203031460140000 1 Moch Nadif Fadilah 2014-10-14
13 3203031706080069 3203036704140003 2 Lulu Latifah 2014-04-27
14 3203032008150002 3203036906140002 1 siti syafia 2014-06-29
15 3203030412140019 3203036307140003 1 shela fitriani 2014-07-23
16 3203030909110029 3203033010140002 2 ahmad rafiq hariri 2014-10-20
17 3203033110140019 3203032310140002 1 moch alif arasyid 2014-01-23
18 3203030 3203032911140000 3 dafa joko s 2014-11-29
19 3203031502111536 3203037008140003 2 st zahira anastasya 2014-08-31
20 3203033007130002 3203035908140002 2 raisya aulia 2014-08-19
21 3203031704090007 3203036609140003 2 iswatu hiarotinisa 2014-09-26
22 3203030 3203032911140000 1 hafiz 2014-11-29
23 3203031811140020 3203030512140004 1 alfan muhamad 2014-11-05
24 3203031411057893 3203030802140004 3 moch fajar 2014-02-08
25 3203031001120005 3203035910140004 2 neng wardah 2014-10-19
26 3203031512080121 3203034510140000 2 naya fitria 2014-10-05
27 3203031003140009 3203030802140005 1 moch rasyid 2015-02-08
28 3203032711140020 3203031902150001 1 latif pikulub 2015-02-19
29 3203032611140010 3203031403150000 6 moch haris 2015-03-14
30 3203031811160014 3203035301140000 2 rara oktafia 2014-01-13
31 3203032212080073 3203034112140005 3 ginan salisatul w 2014-10-01
32 3203031811140012 3203035011140001 1 talita arum 2014-11-09
33 3203031511170015 3203030504150004 2 deden suherlan 2015-05-04
34 3203030501110004 3203031205150001 4 m riski alfarisi 2015-05-12
35 3203030 3203030806150000 2 moch alif fadilah 2015-06-08
36 3203030104110017 3203035012140003 2 ai aulia nurliah 2014-12-10
37 3203031103140003 3203037103150004 1 nadira 2015-03-31
38 3203032108170006 3203036106150004 1 helmi aulia r 2015-06-21
39 3203032701150007 3203032710150003 1 moch fadil azam 2015-10-27
40 3203032205130025 3203033151215000 3 m rendi ardiansyah 2015-12-15
41 3203030506090030 3203031701160001 2 alif hafiz sarkan 2015-01-17
42 3203030 3203036008150000 1 diana putri destari 2015-08-20
43 3203031507130015 3203034709150001 1 kinanti 2016-09-07
44 3203030804140008 3203037010150001 1 aska ines adelia 2016-10-30
45 3203031907110021 3203036710150002 1 aisyah nurzahira 2016-10-27
46 3203032411150003 3203030412150007 2 moch fardan 2015-12-05
47 3203030 3203031401160000 1 farel ardaga 2016-01-14
48 3203031907110021 3203031004160003 2 moch fahri 2016-04-10
49 3203030706120018 3203034403160003 3 mutiara solihat 2016-03-04
50 3203033009170020 3203036906160005 1 salsa saumi 2016-03-29
51 3203031509110037 3203037108160005 2 hilma 2016-08-31
52 3203030108080036 3203031204160001 6 m rafa maulana 2016-04-12
53 3203030205080006 3203031305160004 2 moch fazril 2016-05-13
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
 81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
 DATA SASARAN BALITA

BERAT
JENS NO.TLP/HP
BADAN NIK AYAH ALAMAT RT
KELAMIN LAHIR (Kg) Orang Tua
NAMA ORANG TUA
L 3.2 Ramdan/Rina 3203030507880022 085795602264 Pasir Gede 2
P 3.2 Holid/Aisyah 3203032707750003 085795602264 Pasir Gede 2
P 3.4 Sa'ban/Ayi 3203031811670001 085320203971 Pasir Gambir 6
L 3.2 Jujun/Yanti 3203031105810011 083820258729 Pasir Dogong 1
L 3.4 Endum/Wawa 3203030601710004 085795602264 Pasir Dogong 1
L 2.5 Agus/Yani 3203030808960011 083820258729 Kebon Carang 1
P 3.2 Suparman/S Robi'ah 3203030306910011 085795602264 Pasir Gede 2
P 3 Jalaludin/Ai R 3203030101660030 085795602264 Pasir Gede 2
P 3.2 Heri/Dewi 3203030205740008 085795602264 Pasir Gede 2
L 3.5 Sadili/Isam 3203031808680004 085795602264 Pasir Dogong 1
L 3 Erwin/Lilis 3203031011810016 083820258729 Pasir Dogong 1
L 3.4 Hadimi/Ika 3203030269890000 085795602264 Pasir Dogong 1
P 3.2 Wahyu/Rita 3203031206840005 083820258729 Kebon Carang 1
P 3.2 Rudiansyah 3203036204890008 083820258729 Pasir Dogong 1
P 3.2 Hendra 3203033008930003 083820258729 Pasil Laos 6
L 3.4 Tomi 3203030702600008 083820258729 Kebon Carang 1
L 3.5 Nurzaman 3203030412880015 083820258729 Pasir Gede 2
L 4 Joko 3203031206740000 083820258729 Pasir Dogong 1
P 3.2 Kosasih 3203031403880002 083820258729 Kebon Carang 1
P 3.2 Arif 3203031106870007 083820258729 Pasir Laos 6
P 3.5 Pepen 3203031807890000 085795602264 Kebon Carang 1
L 4 Dede 3203010411890001 085795602264 Pasir Dogong 1
L 3.4 Hamdan 3203010411890001 085795602264 Pasir Dogong 1
L 3.2 Muksin 3203032006780003 085795602264 Pasir Gede 2
P 3 H apep 3203031207860024 085795602264 Kebon Carang 1
P 3.2 Jajam 3203031907650003 085795602264 Pasir Gede 2
L 3 Muhtar 3203031809850002 085795602264 Pasir Laos 6
L 3.4 Jam-jam 3203030503810005 085795602264 Jalan Cagak 1
L 3.2 Puloh 3203030805780003 085320203971 Pasir Dogong 1
P 3.4 Dede 3203031506820023 085320203971 Pasir Gede 2
P 3.2 Sofwanudin 3203030803740004 085320203971 Pasir Laos 6
P 3 Irfan 3203030902900004 085320203971 Pasir Gede 2
L 3.3 Abas 3203031911750003 085320203971 Pasir Laos 6
L
L
P
P
P
L
L
L
P
P
P
P
L
L
L
P
P
P
L
L
 Vitamin A Vitamin A
Cara Ukur Asi ekslusifIMD
Tanggal Februari Agustus
RW BB (Kg) TB (cm)
Pengukuran 1= terlent 1=Ya 1=Ya 1=Ya 1=Ya
2= berdiri 2= Tidak 2= Tidak 2= Tidak 2= Tidak
2 6/8/2018 16 100 2 1 2 1 1
2 6/8/2018 20.4 108 2 1 2 1 1
1 6/8/2018 15.3 99.7 2 1 2 1 1
2 6/8/2018 16 100.7 2 1 2 1 1
2 6/8/2018 14.6 97 2 1 2 1 1
1 6/8/2018 14.1 100 2 1 2 1 1
2 6/8/2018 15 98 2 1 2 1 1
2 6/8/2018 14.7 99 2 1 2 1 1
2 6/8/2018 15 99.7 2 1 2 1 1
2 6/8/2018 17.4 100 2 1 2 1 1
2 6/8/2018 14.5 96 2 1 2 1 1
2 6/8/2018 14.5 94 2 1 2 1 1
1 6/8/2018 14.5 96.1 2 1 2 1 1
2 6/8/2018 14 97 2 1 2 1 1
1 6/8/2018 12.4 97 2 1 2 1 1
1 6/8/2018 13.1 96.5 2 1 2 1 1
2 6/8/2018 15.4 96 2 1 2 1 1
2 6/8/2018 17 100 2 1 2 1 1
1 6/8/2018 13 96.3 2 1 2 1 1
1 6/8/2018 13.6 95 2 1 2 1 1
1 6/8/2018 15 97 2 1 2 1 1
2 6/8/2018 16.6 97 2 1 2 1 1
2 6/8/2018 14.5 97 2 1 2 1 1
2 6/8/2018 13.5 99 2 1 2 1 1
1 6/8/2018 12.7 96 2 1 2 1 1
2 6/8/2018 14 94 2 1 2 1 1
1 6/8/2018 12.3 94 2 1 2 1 1
1 6/8/2018 14 94 2 1 2 1 1
2 6/8/2018 14.8 96 2 1 2 1 1
2 6/8/2018 15.4 99 2 1 2 1 1
1 6/8/2018 13.2 97 2 1 2 1 1
2 6/8/2018 13.2 96 2 1 2 1 1
1 6/8/2018 15.5 95 2 1 2 1 1
6/8/2018 2 1 2 1 1
6/8/2018 2 1 2 1 1
6/8/2018 2 1 2 1 1
6/8/2018 2 1 2 1 1
6/8/2018 2 1 2 1 1
6/8/2018 2 1 2 1 1
6/8/2018 2 1 2 1 1
6/8/2018 2 1 2 1 1
6/8/2018 2 1 2 1 1
6/8/2018 2 1 2 1 1
6/8/2018 2 1 2 1 1
6/8/2018 2 1 2 1 1
6/8/2018 2 1 2 1 1
6/8/2018 2 1 2 1 1
6/8/2018 2 1 2 1 1
6/8/2018 2 1 2 1 1
6/8/2018 2 1 2 1 1
6/8/2018 2 1 2 1 1
6/8/2018 2 1 2 1 1
6/8/2018 2 1 2 1 1
6/8/2018 1 2 1 1
6/8/2018 1 2 1 1
6/8/2018 1 2 1 1
6/8/2018 1 2 1 1
6/8/2018 1 2 1 1
6/8/2018 1 2 1 1
6/8/2018 1 2 1 1
6/8/2018 1 2 1 1
6/8/2018 1 2 1 1
6/8/2018 1 2 1 1
6/8/2018 1 2 1 1
6/8/2018 1 2 1 1
6/8/2018 1 2 1 1
6/8/2018 1 2 1 1
6/8/2018 1 2 1 1
6/8/2018 1 2 1 1
6/8/2018 1 2 1 1
6/8/2018 1 2 1 1
6/8/2018 1 2 1 1
6/8/2018 1 2 1 1
6/8/2018 1 2 1 1
6/8/2018 1 2 1 1
6/8/2018 1 2 1 1
6/8/2018 1 2 1 1
6/8/2018 1 2 1 1
6/8/2018 1 2 1 1
6/8/2018 1 2 1 1
 6/8/2018 1 2 1 1
6/8/2018 1 2 1 1
6/8/2018 1 2 1 1
6/8/2018 1 2 1 1
6/8/2018 1 2 1 1
6/8/2018 1 2 1 1
6/8/2018 1 2 1 1
6/8/2018 1 2 1 1
6/8/2018 1 2 1 1
6/8/2018 1 2 1 1
6/8/2018 1 2 1 1
6/8/2018 1 2 1 1
6/8/2018 1 2 1 1
6/8/2018 1 2 1 1
6/8/2018 1 2 1 1
6/8/2018 1 2 1 1
6/8/2018 1 2 1 1
6/8/2018 1 2 1 1
6/8/2018 1 2 1 1
6/9/2018 1 2 1 1
6/10/2018 1 2 1 1
6/11/2018 1 2 1 1
6/12/2018 1 2 1 1
6/13/2018 1 2 1 1
6/14/2018 1 2 1 1
6/15/2018 1 2 1 1
6/16/2018 1 2 1 1
6/17/2018 1 2 1 1
 DATA SASARAN IBU HAMIL

Provinsi :
Kabupaten/Kota :
Puskesmas :

BB SEBELUM ALAMAT
No. No Kartu Keluarga NAMA RT RW
HAMIL
NIK (Nomor Induk
Kependudukan)
SASARAN IBU HAMIL

TTD (Tablet Jika Ya

TANGGAL TANGGAL KEHAMIL Tambah Darah) berapa
BB (Kg) TB (cm) LILA (cm) AN KE-
LAHIR PENGUKURAN butir TTD
1=Ya di dapat
2= Tidak
Provinsi :
Kabupaten/Kota :
Puskesmas :

No. No Kartu Keluarga ANAK KE- NAMA ANAK

NIK (Nomor Induk TANGGAL LAHIR
Kependudukan) (YYYYMMDD)
1 3203030702130057 3203031601140005 1 Moch Haris Maulana 2014-01-16
2 3203030804090066 3203035509130004 3 Selfi Selfiana 2013-09-15
3 3203031212080072 3203036802140002 4 Siti Aisyah 2014-02-28
4 3203031411055062 3203031805140004 4 Moch Rajib 2014-05-18
5 3203032506120006 3203031207140001 3 Zaki 2018-07-12
6 3203032710150001 3203031103140001 1 Moch Naufal 2014-03-11
7 3203032510130006 3203035102140006 1 Almira Salsabila 2014-02-11
8 3203031907110022 3203034102140003 2 Anisa 2014-02-01
9 3203031411057907 3203037004140003 4 Raisya 2014-04-30
10 3203032404120011 3203031906140005 4 Moch Denis 2014-06-19
11 3203033007110004 3 203031608140002 2 Damar 2014-08-16
12 3203030 3203031460140000 1 Moch Nadif Fadilah 2014-10-14
13 3203031706080069 3203036704140003 2 Lulu Latifah 2014-04-27
14 3203032008150002 3203036906140002 1 siti syafia 2014-06-29
15 3203030412140019 3203036307140003 1 shela fitriani 2014-07-23
16 3203030909110029 3203033010140002 2 ahmad rafiq hariri 2014-10-20
17 3203033110140019 3203032310140002 1 moch alif arasyid 2014-01-23
18 3203030 3203032911140000 3 dafa joko s 2014-11-29
19 3203031502111536 3203037008140003 2 st zahira anastasya 2014-08-31
20 3203033007130002 3203035908140002 2 raisya aulia 2014-08-19
21 3203031704090007 3203036609140003 2 iswatu hiarotinisa 2014-09-26
22 3203030 3203032911140000 1 hafiz 2014-11-29
23 3203031811140020 3203030512140004 1 alfan muhamad 2014-11-05
24 3203031411057893 3203030802140004 3 moch fajar 2014-02-08
25 3203031001120005 3203035910140004 2 neng wardah 2014-10-19
26 3203031512080121 3203034510140000 2 naya fitria 2014-10-05
27 3203031003140009 3203030802140005 1 moch rasyid 2015-02-08
28 3203032711140020 3203031902150001 1 latif pikulub 2015-02-19
29 3203032611140010 3203031403150000 6 moch haris 2015-03-14
30 3203031811160014 3203035301140000 2 rara oktafia 2014-01-13
31 3203032212080073 3203034112140005 3 ginan salisatul w 2014-10-01
32 3203031811140012 3203035011140001 1 talita arum 2014-11-09
33 3203031511170015 3203030504150004 2 deden suherlan 2015-05-04
34 3203030501110004 3203031205150001 4 m riski alfarisi 2015-05-12
35 3203030104110017 3203035012140003 2 ai aulia nurliah 2014-12-10
36 3203031103140003 3203037103150004 1 nadira 2015-03-31
37 3203032108170006 3203036106150004 1 helmi aulia r 2015-06-21
38 3203032701150007 3203032710150003 1 moch fadil azam 2015-10-27
39 3203030506090030 3203031701160001 2 alif hafiz sarkan 2015-01-17
40 3203031507130015 3203034709150001 1 kinanti 2016-09-07
41 3203030804140008 3203037010150001 1 aska ines adelia 2016-10-30
42 3203030804140008 3203037010150001 1 aska ines adelia 2016-10-30
43 3203030 3203031401160000 1 farel ardaga 2016-01-14
44 3203031907110021 3203031004160003 2 moch fahri 2016-04-10
45 3203030706120018 3203034403160003 3 mutiara solihat 2016-03-04
46 3203033009170020 3203036906160005 1 salsa saumi 2016-03-29
47 3203031509110037 3203037108160005 2 hilma 2016-08-31
48 3203030108080036 3203031204160001 6 m rafa maulana 2016-04-12
49 3203030205080006 3203031305160004 2 moch fazril 2016-05-13
50 3203031706110037 3203030509160002 2 Moch Ade Fauzan 2016-09-05
51 3203030408150012 3203035311160000 2 Maura 2016-11-13
52 3203032606120028 3203036101170001 2 Anida Aulia 2017-01-21
53 3203031411053735 3203035602170002 3 Gisya Suci Rahayu 2017-02-16
54 3203032609170001 3203035202170001 1 Siti Maryam 2017-02-12
55 3203031709130028 3203031810160002 5 Moch Saefuloh 2016-10-18
56 3203033009170031 3203032203170003 1 Moch Restu Sajal 2017-03-22
57 3203031411055062 3203030903170004 4 Moch Zikri 2017-03-09
58 3203032104170003 3203030604170003 1 M Fahri Alfarisi 2017-04-06
59 3202361505150004 3202364206150002 1 Adara 2015-06-02
60 3203031411056479 3203035810140001 4 Ajeng 2014-10-18
61 3203031012080074 3203035403140003 4 Nova Indriani 2014-03-14
62 3203030611140008 3203030309140000 1 Seftian 2014-09-03
63 3203031502110553 3203036001150004 1 S Andin Maulida 2015-01-20
64 3203030310160009 3203036901150004 2 Indriani 2015-01-29
65 3203030812140012 3203034605150002 1 Salwa Alfiatu H 2015-05-06
66 3203031108120010 3203036902160003 2 Sakira Anandita 2016-02-29
67 3203031509110052 3203035301160004 1 Hana Liliana F 2016-01-13
68 3203032809063592 3203032604160000 2 Al Hanif 2016-04-26
69 3203032308160012 3203030605170000 1 Adam 2017-05-06
70 3203032711130003 3203036705170000 2 Naya 2017-05-27
71 3203031010170001 3203035702170003 1 Salfa 2017-02-17
72 3203030 3203035806170000 2 Zahra Alia 2016-06-18
73 3203033006120015 3203035107170000 4 Sela Silvia 2017-07-11
74 3203030 3203030207170000 1 M Alan 2017-07-02
75 3203031110110007 3203035907170001 2 Anita Putri 2017-07-18
76 3203032705080044 3203033108170000 2 M Sahal 2017-08-31
77 3203033012110035 3203035710170001 2 Zira Silvia 2017-10-17
78 3203030412140018 3203031009170005 2 M Akbar Alpariji 2017-09-01
79 3203030507080078 3203035209170000 3 Silviani 2017-09-12
80 3203030 3203030208170000 2 M Hauzan Irhab 2017-08-02
81 3203033007110004 3203034709170003 3 Wulan Septiani 2017-09-07
82 3203031003140009 3203031506170005 2 M Rais 2017-05-20
83 3203030 3203036709170000 3 Vina Rahayu 2017-09-27
84 3203030 3203032810170000 3 Moh Rasid 2017-10-28
85 3203031403080003 3203036410170000 4 Shabila 2017-10-24
86 3203030401170015 3203031211170001 1 M Arda Arzanka 2017-11-21
87 3203030511080005 3203033011170003 2 M Abizar Putra 2017-11-30
88 3203032212080070 3203036211170000 3 Nazmi Nurkamilah 2017-11-22
89 3203032410170003 3203031111170000 1 Moh Kaka Suryana 2017-11-11
90 3203032501120035 3203032611170000 4 Ahmad Anwar 2017-11-26
91 3203032510120004 3203034711170000 2 Salsa Salsabila 2017-11-07
92 3203030610160001 3203032201180000 1 M Najril 2018-01-22
93 3203030 3203035405180000 2 Meilani Dini 2018-05-14
94 3203032011170008 3203030203180000 1 Althaf Rirkib 2018-03-02
95 3203032606130019 3203035307180000 4 Siti Sovia 2018-07-13
96 3203032807150027 3203032302150004 1 M Pebriansayah 2015-02-23
97 3203032807150027 3203036104170000 2 Jesita Apriani 2017-04-21
98 3203030 3203035201180000 1 Saffa Qurotunnada 2018-01-12
99 3203030108110009 3203034608180000 2 Siti Azkya Jalaliah 2018-08-06
 DATA SASARAN BALITA

BERAT
JENS NO.TLP/HP
BADAN NIK AYAH ALAMAT RT
KELAMIN LAHIR (Kg) Orang Tua
NAMA ORANG TUA
L 3.2 Ramdan/Rina 3203030507880022 085795602264 Pasir Gede 2
P 3.2 Holid/Aisyah 3203032707750003 085795602264 Pasir Gede 2
P 3.4 Sa'ban/Ayi 3203031811670001 085320203971 Pasir Gambir 6
L 3.2 Jujun/Yanti 3203031105810011 083820258729 Pasir Dogong 1
L 3.4 Endum/Wawa 3203030601710004 085795602264 Pasir Dogong 1
L 2.5 Agus/Yani 3203030808960011 083820258729 Kebon Carang 1
P 3.2 Suparman/S Robi'ah 3203030306910011 085795602264 Pasir Gede 2
P 3 Jalaludin/Ai R 3203030101660030 085795602264 Pasir Gede 2
P 3.2 Heri/Dewi 3203030205740008 085795602264 Pasir Gede 2
L 3.5 Sadili/Isam 3203031808680004 085795602264 Pasir Dogong 1
L 3 Erwin/Lilis 3203031011810016 083820258729 Pasir Dogong 1
L 3.4 Hadimi/Ika 3203030269890000 085795602264 Pasir Dogong 1
P 3.2 Wahyu/Rita 3203031206840005 083820258729 Kebon Carang 1
P 3.2 Rudiansyah 3203036204890008 083820258729 Pasir Dogong 1
P 3.2 Hendra 3203033008930003 083820258729 Pasil Laos 6
L 3.4 Tomi 3203030702600008 083820258729 Kebon Carang 1
L 3.5 Nurzaman 3203030412880015 083820258729 Pasir Gede 2
L 4 Joko 3203031206740000 083820258729 Pasir Dogong 1
P 3.2 Kosasih 3203031403880002 083820258729 Kebon Carang 1
P 3.2 Arif 3203031106870007 083820258729 Pasir Laos 6
P 3.5 Pepen 3203031807890000 085795602264 Kebon Carang 1
L 4 Dede 3203010411890001 085795602264 Pasir Dogong 1
L 3.4 Hamdan 3203010411890001 085795602264 Pasir Dogong 1
L 3.2 Muksin 3203032006780003 085795602264 Pasir Gede 2
P 3 H apep 3203031207860024 085795602264 Kebon Carang 1
P 3.2 Jajam 3203031907650003 085795602264 Pasir Gede 2
L 3 Muhtar 3203031809850002 085795602264 Pasir Laos 6
L 3.4 Jam-jam 3203030503810005 085795602264 Jalan Cagak 1
L 3.2 Puloh 3203030805780003 085320203971 Pasir Dogong 1
P 3.4 Dede 3203031506820023 085320203971 Pasir Gede 2
P 3.2 Sofwanudin 3203030803740004 085320203971 Pasir Laos 6
P 3 Irfan 3203030902900004 085320203971 Pasir Gede 2
L 3.3 Abas 3203031911750003 085320203971 Pasir Laos 6
L 2.7 Adin 3203030302650011 085320203971 Pasir Gede 2
P 3.4 U Zaenal 3203030112820015 085320203971 Pasir Dogong 1
P 3.2 Ridwan 3203031903840007 085320203971 Pasir Dogong 1
P 3.4 Irfan 3203030903930003 085320203971 Pasir Laos 6
L 3 Asep 3203035811930004 085320203971 Pasir Laos 6
L 3.2 Hermawan 3203030107890013 085320203971 Jalan Cagak 1
P 3.2 Deden 3203032805860009 085320203971 Pasir Gede 2
P 3.2 Dedi 3203041909790004 085320203971 Pasir Gede 2
P 3.2 Dedi 3203041909790004 085320203971 Pasir Gede 2
L 3 Agus/Yani 3203030709910000 085320203971 Pasir Gede 2
L 3.4 Iwan 3203032402850003 085320203971 Pasir Dogong 1
P 3.2 Abdurohman 3203030405840015 085320203971 Kebon Carang 1
P 3.2 Beni 3203032704900002 085320203971 Pasir Dogong 1
P 3.2 Jejen 3203030304820026 085320203971 Pasir Dogong 1
L 2.7 Yayah 3203031704770002 085320203971 Pasir Gede 2
L 2.7 Ade 3203032309800001 085320203971 Pasir Gede 2
L 4 Nazmudin 3203030508800019 085320203971 Kebon Carang 1
P 3.2 Zeni 3203035105800021 085320203971 Pasir Gede 2
P 4 Ali 3203030311880009 085320203971 Pasir Gede 2
P 3.2 R Abdurohman 3203031008700004 085320203971 Kebon Carang 1
P 3.2 Endang 3203031908930010 085320203971 Kebon Carang 1
L 2.7 Emus 3203035308750004 085320203971 Pasir Dogong 1
L 3.2 Darman 3203031303930002 085320203971 Pasir Laos 6
L 3 Jujun/Yanti 3203031105810011 085320203971 Pasir Dogong 1
L 1.7 Solihin 3203032010930004 085320203971 Pasir Dogong 1
P 1.6 Yani 3202351608920028 085320203971 Pasir Gede 2
P 3.2 Rahmat 3203031006790002 085320203971 Pasir Puyuh 5
P 3.1 Dani 3203030609740005 085320203971 Pasir Puyuh 5
L 3 Dede 3203030510920014 085320203971 Pasir Puyuh 5
P 3.2 Afit 3203031005840011 085320203971 Pasir Puyuh 5
P 3.2 Dangdang 3203030804810016 085320203971 Pasir Puyuh 5
P 3.2 M Baehaqi 3203030402890008 085320203971 Pasir Puyuh 5
P 3.4 Sutisna 3203030408830007 085320203971 Pasir Puyuh 5
P 3.2 Herawandi 3203032708890005 085320203971 Kebon Carang 1
L 3.4 Idan 3203030101810013 085320203971 Pasir Dogong 1
L 3.2 Miftah 3202440103910002 085320203971 Pasir Dogong 1
P 3 Novianto 3203030404880012 085320203971 Kebon Carang 1
P 3.4 Yudi 3203032005880007 085320203971 Pasir Laos 6
P 2.7 Tito 3203032002920000 085320203971 Pasir Laos 6
P 3.2 Herman 3203030711820011 085320203971 Pasir Gede 2
L 3 Dede 3203031909830000 085320203971 Pasir Gede 2
P 3.2 M Sepuloh 3203030308800011 085320203971 Pasir Gede 2
L 4 Kusnadi 3203031608870001 085320203971 Pasir Gede 2
P 3.4 Aceng 3203030311850004 085320203971 Pasir Gede 2
L 3.4 Hendra 3203033008930003 085320203971 Pasir Laos 6
P 3 Usup 3203032701700001 085320203971 Pasir Dogong 1
L 3.4 Pajar 3203030112860000 085320203971 Pasir Dogong 1
P 3.2 Erwin 3203031011810016 085320203971 Pasir Dogong 1
L 3 Muhtar 3203031809850002 085320203971 Pasir Laos 6
P 3.2 Dede tarlan 3203031506820023 085320203971 Pasir Gede 2
L 3.2 Jujun 3203032407890000 085320203971 Pasir Dogong 1
P 3.2 Mamduh 3203031404750003 085320203971 Pasir Dogong 1
L 4 Erwin 3203031010820028 085320203971 Pasir Laos 6
L 1.8 Ade 3203032802800005 085320203971 Jalan Cagak 1
P 3.4 Ahyar 3203030804780004 085320203971 Pasir Puyuh 5
L 3.2 Mirat 3203030705910004 085320203971 Pasir Puyuh 5
L 3.4 Abung 3203030107700539 085320203971 Pasir Puyuh 5
P 3.5 Agus 3203031406740002 085320203971 Pasir Puyuh 5
L 3.4 Sukandi 3203030907920004 085320203971 Pasir Gede 2
P 3.2 Dasep 3203031604910000 085320203971 Pasir Dogong 1
L 3.2 H apep 3203031207860024 085320203971 Pasir Gede 2
P 3.2 Moh Ahmad 3203031010820027 085320203971 Kebon Carang 1
L 4 Jaenudin 3203032605930004 085320203971 Pasir Puyuh 5
P 3.2 Jaenudin 3203032605930004 085320203971 Pasir Puyuh 5
P 3.4 Rono 3203034611960010 085320203971 Pasir Puyuh 5
P 3 Satisna 3203031606880006 085320203971 Kebon Carang 1
 Vitamin A Vitamin A
Cara Ukur Asi ekslusifIMD
Tanggal Februari Agustus
RW BB (Kg) TB (cm)
Pengukuran 1= terlent 1=Ya 1=Ya 1=Ya 1=Ya
2= berdiri 2= Tidak 2= Tidak 2= Tidak 2= Tidak
2 6/8/2018 16 100 2 1 2 1 1
2 6/8/2018 20.4 108 2 1 2 1 1
1 6/8/2018 15.3 99.7 2 1 2 1 1
2 6/8/2018 16 100.7 2 1 2 1 1
2 6/8/2018 14.6 97 2 1 2 1 1
1 6/8/2018 14.1 100 2 1 2 1 1
2 6/8/2018 15 98 2 1 2 1 1
2 6/8/2018 14.7 99 2 1 2 1 1
2 6/8/2018 15 99.7 2 1 2 1 1
2 6/8/2018 17.4 100 2 1 2 1 1
2 6/8/2018 14.5 96 2 1 2 1 1
2 6/8/2018 14.5 94 2 1 2 1 1
1 6/8/2018 14.5 96.1 2 1 2 1 1
2 6/8/2018 14 97 2 1 2 1 1
1 6/8/2018 12.4 97 2 1 2 1 1
1 6/8/2018 13.1 96.5 2 1 2 1 1
2 6/8/2018 15.4 96 2 1 2 1 1
2 6/8/2018 17 100 2 1 2 1 1
1 6/8/2018 13 96.3 2 1 2 1 1
1 6/8/2018 13.6 95 2 1 2 1 1
1 6/8/2018 15 97 2 1 2 1 1
2 6/8/2018 16.6 97 2 1 2 1 1
2 6/8/2018 14.5 97 2 1 2 1 1
2 6/8/2018 13.5 99 2 1 2 1 1
1 6/8/2018 12.7 96 2 1 2 1 1
2 6/8/2018 14 94 2 1 2 1 1
1 6/8/2018 12.3 94 2 1 2 1 1
1 6/8/2018 14 94 2 1 2 1 1
2 6/8/2018 14.8 96 2 1 2 1 1
2 6/8/2018 15.4 99 2 1 2 1 1
1 6/8/2018 13.2 97 2 1 2 1 1
2 6/8/2018 13.2 96 2 1 2 1 1
1 6/8/2018 15.5 95 2 1 2 1 1
2 6/8/2018 11 90 2 1 2 1 1
2 6/8/2018 16.6 96 2 1 2 1 1
2 6/8/2018 14 94 2 1 2 1 1
1 6/8/2018 12.6 90 2 1 2 1 1
1 6/8/2018 11 86.5 2 1 2 1 1
1 6/8/2018 15.4 96 2 1 2 1 1
2 6/8/2018 11.9 87 2 2 2 1 1
2 6/8/2018 10.6 90 2 1 2 1 1
2 6/8/2018 10.6 90 2 1 2 1 1
2 6/8/2018 11 88 2 1 2 1 1
2 6/8/2018 11.3 89 2 1 1 1 1
1 6/8/2018 11.1 87 2 1 2 1 1
2 6/8/2018 10.7 83 2 1 1 1 1
2 6/8/2018 11 84 2 1 2 1 1
2 6/8/2018 10.3 84 2 1 2 1 1
2 6/8/2018 10.2 87 2 1 2 1 1
1 6/8/2018 10.3 83 2 1 2 1 1
2 6/8/2018 10.2 82 2 1 2 1 1
2 6/8/2018 10.3 78 2 1 2 1 1
1 6/8/2018 10.7 78 2 1 2 1 1
1 6/8/2018 9 76 2 1 2 1 1
2 6/8/2018 10 76.3 2 1 2 1 1
1 6/8/2018 11.2 81 2 1 2 1 1
2 6/8/2018 8.6 76 2 1 2 1 1
2 6/8/2018 9.1 76.3 2 1 2 1 1
2 6/8/2018 13.6 89 2 1 2 1 1
1 6/8/2018 13.5 97 2 1 2 1 1
1 6/8/2018 14 98 2 1 2 1 1
1 6/8/2018 13 96 2 1 2 1 1
1 6/8/2018 14.2 97 2 1 2 1 1
1 6/8/2018 12 96 2 1 2 1 1
1 6/8/2018 12.1 90.2 2 1 2 1 1
1 6/8/2018 11.5 86 2 1 2 1 1
1 6/8/2018 11.2 86 2 1 2 1 1
2 6/8/2018 14 90.3 2 1 2 1 1
2 6/8/2018 9 73 2 1 2 1 1
1 6/8/2018 8.2 74 2 1 2 1 1
1 6/8/2018 9.4 79 2 1 2 1 1
1 6/8/2018 8.7 76 2 1 2 1 1
2 6/8/2018 8 74 2 1 2 1 1
2 6/8/2018 9.4 77 2 1 2 1 1
2 6/8/2018 9.3 77 2 1 2 1 1
2 6/8/2018 9.4 74.3 2 1 2 1 1
2 6/8/2018 9.2 71 1 1 2 1 1
1 6/8/2018 9.3 74 2 1 2 1 1
2 6/8/2018 7.2 69 2 1 2 1 1
2 6/8/2018 10.4 75 2 1 2 1 1
2 6/8/2018 7.1 70 2 1 2 1 1
1 6/8/2018 8.6 77 2 1 2 1 1
2 6/8/2018 8.5 74 2 1 2 2 1
2 6/8/2018 9 77 1 1 2 2 1
2 6/8/2018 8.3 74 1 1 2 2 1
1 6/8/2018 8.7 75 1 1 2 2 1
1 6/8/2018 8 66 1 1 2 2 2
1 6/8/2018 8 67 1 1 2 2 1
1 6/8/2018 8 70 1 1 2 2 1
1 6/8/2018 7.7 73 1 1 2 2 2
1 6/8/2018 8.5 75 1 1 2 2 2
2 6/8/2018 8.6 69 1 1 2 2 2
2 6/8/2018 6 60 1 1 2 2 2
2 6/9/2018 7 67 1 1 2 2 1
1 6/13/2018 6 63 1 1 2 2 2
1 6/14/2018 13 96 1 1 2 2 1
1 6/15/2018 9.5 74 1 1 2 2 1
1 6/16/2018 8 67 1 1 2 2 1
1 6/17/2018 3 46 1 1 2 2 2
Provinsi :
Kabupaten/Kota :
Puskesmas :

No. No Kartu Keluarga ANAK KE- NAMA ANAK

NIK (Nomor Induk TANGGAL LAHIR
Kependudukan) (YYYYMMDD)
1 3203031411053648 3203030702140003 3 Ilham Maulana 2014-02-07
2 3203032308070012 3203030801140003 3 Maulana Putra 2014-01-08
3 3203032308070012 3203030805150001 4 Rudiansyah 2015-05-08
4 3203032511110058 3203033103150001 2 Al Gipari Ikhsan 2015-03-31
5 3203031706090051 3203032904150002 2 Delima 2015-04-29
6 3203031712130007 3203035902140004 4 Aya Musopa 2014-02-19
7 3203032003150012 3203031006150003 1 M Raja 2015-06-01
8 3203032402140006 3203031706150003 1 M Azam 2015-06-17
9 3203031411053662 3203034406150007 4 Siti Azizah 2015-06-04
10 3203033005140006 3203031803150001 1 M Rizki 2015-03-18
11 3203031812080029 3203030610150003 3 M Najar 2015-11-06
12 3203032203160009 3203032311150002 1 Robi Aditia 2015-11-23
13 3203032702150001 3203031204150002 1 Kinan 2015-04-13
14 3203032901140017 3203036705160002 2 Delia 2016-05-27
15 3203030602130034 3203036009160001 4 Delisa Nurul 2016-09-20
16 3203032908160016 3203036402170002 1 Alipa Nur Jamilah 2017-02-24
17 3203031703110010 3203031003170003 3 Muayad Balya 2017-03-10
18 3203032111140042 3203034409160002 1 Mikaila Ayu 2016-09-04
19 3203032611140018 3203032511160001 2 M Arkan 2016-11-25
20 3203032111070014 3203031202170002 3 M Edwar 2017-02-22
21 3203032912120007 3203035409140001 1 Nazira 2014-09-14
22 3203011111140014 3203032612130007 1 M Rehan 2013-12-26
23 3203031812121004 3203032104160002 2 Sana Hamidah 2013-12-26
24 3203031905150025 3203030109150002 1 Atar Rizki 2015-09-01
25 3203031008110003 3203030303150002 1 Hisam 2015-03-03
26 3203031008110003 3203032310160001 1 M Ropi 2016-01-23
27 3203032909110018 3203031603140001 2 M Sehab 2014-03-16
28 3203032706110010 3203035608140005 3 Salwa Sopiyah 2014-08-16
29 3203032704120004 3203031508140005 3 Gusnandar 2016-08-15
30 3203031911080076 3203035506160003 2 Isna Inayah 2016-06-15
31 3203030706160008 3203034804170001 1 Alisya Nazipa 2017-04-08
32 3203032306140015 3203032610140003 3 Salsa 2014-10-26
33 3203031305150004 3203032607140002 2 Zidni Ilma 2014-07-26
34 3203219091100030 3203034505150002 1 Siti Nurlela 2015-05-05
35 3203030 3203031601140006 2 Misbah 2014-01-16
36 3203030051140006 3203031803150001 1 M Rizki 2015-03-18
37 3203031150411001 3203035812150001 3 Nurul Maulida 2015-12-18
38 3203032071300029 3203034209150003 2 Mila Napisah 2015-09-12
39 3203032810140004 3203030202170003 3 Riham 2017-02-02
40 3203031108110024 3203037108160004 3 Nazwa 2016-08-31
41 3203032004090047 3203034705140003 2 Rasya Sahia 2014-05-07
42 3203030511080048 3203031211140003 2 Arsad Aabdalah 2014-11-12
43 3203030601140002 3203036811130004 2 Hasya Sidkiya 2013-11-28
44 3203036011140002 3203030703150001 3 M Paurkan 2014-03-07
45 3203032301090092 3203036201140006 2 Hoerunisa 2014-01-12
46 3203030511000049 3203035011130002 4 Siti Adawiyah 2013-11-10
47 3203032510120003 3203034304140003 2 Asila Siti Aulia 2014-03-04
48 3203032909110030 3203031811160003 3 M Pardan 2016-11-18
49 3203031411053665 3203030103170002 3 Asep Abdul 2017-05-01
50 3203031212110018 3203030611170002 2 M Rapa Paisal 2017-11-06
51 3203032301090092 3203036201140006 2 M Saepuloh 2014-01-22
52 3203031703140010 3203032608170002 2 M Rafi 2017-08-26
53 3203030412080029 3203031406170003 3 Adam 2017-06-14
54 3203031612140023 3203030107170002 2 Zayin 2017-07-01
55 3203030706160008 3203034502180002 2 Aira 2018-02-15
56 3203032205090008 3203034104180003 3 Sahila saidah 2018-04-11
57 3203030511000049 3203031106180001 1 Altap Ramadhan 2018-06-11
58 3203032004090047 3203032905180003 3 M Rajib 2018-05-29
59 3203031108110020 3203031303180003 3 M Abdul Salam 2018-03-13
60 3203031108110020 3203030 3 Zalaludin Anip
 DATA SASARAN BALITA

BERAT
JENS NO.TLP/HP
BADAN NIK AYAH ALAMAT RT
KELAMIN LAHIR (Kg) Orang Tua
NAMA ORANG TUA
L 4.8 Idom 3203030304770009 081546595680 Kp Citapen 3
L 3.2 Dadan 3203035004820023 081546595680 Kp Citapen 3
L 3.5 Dadan 3203035004820020 081546595680 Kp Citapen 3
L 3.5 Agus 3203031608820009 081546595680 Kp Citapen 3
P 3.5 Anwar 3203033112840001 081546595680 Kp Citapen 3
P 3.6 Solihin 3203030708720019 081546595680 Kp Citapen 3
L 3.5 Dani '3203032408880003 081546595680 Kp Citapen 3
L 3.5 Entib 3203031203870027 081546595680 Kp Citapen 3
P 3.4 Jujuh 3203030512580005 081546595680 Kp Citapen 3
L 3.5 Asep 3203032001880010 081546595680 Pasir Tipar 4
L 4 Midarsono 3203031904790007 081546595680 Kp Citapen 3
L 2.7 Asep '3203030510890006 081546595680 Kp Citapen 3
L 3.1 Elan '32030301870001 081546595680 Kp Citapen 3
P 3.6 Dace 3217150708830002 081546595680 Kp Citapen 3
P 3.6 Enang 3203030107780951 081546595680 Kp Citapen 3
P 3 Hendrik 3203032201950007 081546595680 Kp Citapen 3
L 3.4 Beni 3203030701790008 081546595680 Kp Citapen 3
P 4 Yusup '3203032208850001 081546595680 Kp Citapen 3
L 4 Riki 3205071204850002 081546595680 Kp Citapen 3
L 3.5 Dani '3203031055790002 085864235675 Kp Citapen 3
P 3.4 Dani Ramdhani '3203030706820012 085864235675 Kp Lapang 2
L 3.5 Deni 3203011207870028 085864235675 Kp Lapang 2
P 3.5 Jejen '3203031201880004 085864235675 Kp Lapang 2
L 3.5 Asep Burdah 3203030407940010 085864235675 Kp Lapang 2
P 3.7 Iyus 3203030804920010 085864235675 Kp Lapang 2
L 3.3 Asep 3203032817860007 085864235675 Kp Lapang 2
L 3.7 Ukoh 3203030502650001 085864235675 Kp Lapang 2
P 3.5 Rahmat 3203031408780007 085864235675 Kp Lapang 2
L 3.5 Hendrik 3203030905800004 085720131996 Kp Lapang 2
P 3.5 Basir '3203032011800011 085720131996 Kp Lapang 2
P 2.3 A Yandi 3203031203930017 085720131996 Kp Lapang 2
P 2.9 Lukman 32030301907790001 085720131996 Kp Lapang 2
P 3.5 dede 32030303006790012 085720131996 Kp Lapang 2
P 3.5 Royani 3203030802870012 085720131996 Pasir Tipar 4
L 3 Nurdin 3203032308720007 085720131996 Pasir Tipar 4
L 3 Asep 3203032001880010 085720131996 Pasir Tipar 4
P 3 Ayi Jarkasih 3203030101660028 085720131996 Pasir Tipar 4
P 3.5 M Hasan 3203032508810005 087736819811 Pasir Tipar 4
P 3.4 Jajat 3203310711750001 087736819811 Pasir Tipar 4
P 3.4 Nuryadi 3203030704700011 087736819811 Pasir Tipar 4
P 3.5 Wawan 3203030508750021 087736819811 Pasir Tipar 4
L 3.5 Dedii A 3203030407810002 087736819811 Pasir Tipar 4
P 3.6 Ade 3203031310850008 087736819811 Pasir Tipar 4
L 3.6 Suparipin 3203031512780008 087736819811 Pasir Tipar 4
P 3.4 Mamun 3203032711880001 087736819811 Pasir Tipar 4
P 3.3 H Jaim 3203030304740022 087736819811 Pasir Tipar 4
P 3.7 Abas 3203032402660001 087736819811 Pasir Tipar 4
L 3 Nurodin 3203032308720007 087720007834 Pasir Tipar 4
L 4 Aceng 3203030805680009 087720007834 Kp Citapen 3
L 3.5 Ridwan 3203030804800010 087720007834 Kp Citapen 3
P 3.5 Mamun 3203032711880001 087720007834 Kp Citapen 3
L 3.5 Ramadani 3203030810830008 087720007834 Pasir Tipar 4
L 3.5 Dudung 320303200800012 087720007834 Pasir Tipar 4
L 3.8 Ade 3203031310850004 087720007834 Pasir Tipar 4
P 3.5 AA Yadi 3203031203930017 087720007834 Kp Lapang 2
P 3.5 Zazan 32030301924750001 087720007834 Kp Lapang 2
L 2.2 Yusup 3203032703950002 087720007834 Kp Lapang 2
L 3.3 Wawan 3203030508750021 087720007834 Pasir Tipar 4
L 3.5 Iyan 3203060707910027 087720007834 Pasir Tipar 4
L 3.5 Dadan 3203030803830008 087720007834 Pasir Tipar 4
 Vitamin A Vitamin A
Cara Ukur Asi ekslusifIMD
Tanggal Februari Agustus
RW BB (Kg) TB (cm)
Pengukuran 1= terlent 1=Ya 1=Ya 1=Ya 1=Ya
2= berdiri 2= Tidak 2= Tidak 2= Tidak 2= Tidak
1 8/4/2018 12.7 97 1 1 2 1 1
1 8/4/2018 14.3 98 1 1 2 1 1
1 8/4/2018 13.5 92 1 1 2 1 1
1 8/4/2018 12 91 1 1 1 1 1
1 8/4/2018 12 92 1 1 2 1 1
1 8/4/2018 17 104 1 1 2 1 1
1 8/4/2018 13 92 1 1 2 1 1
1 8/4/2018 14 93 1 2 2 1 1
1 8/4/2018 13 91 1 1 2 1 1
1 8/4/2018 13.7 92 1 1 2 1 1
1 8/4/2018 11.4 88 1 1 1 1 1
1 8/4/2018 12.9 88 1 1 2 1 1
1 8/4/2018 15.2 97 1 1 2 1 1
1 8/4/2018 12.5 88 1 1 2 1 1
1 8/4/2018 12.2 85 1 1 2 1 1
1 8/4/2018 10 87 1 1 2 1 1
1 8/4/2018 9 78 1 1 2 1 1
1 8/4/2018 11.5 78 1 1 2 1 1
1 8/4/2018 11 78 1 1 2 1 1
1 8/4/2018 10 81 1 1 2 1 1
1 8/4/2018 14.3 96 1 1 2 1 1
1 8/4/2018 18 106 1 1 1 1 1
1 8/4/2018 11 83 1 1 2 1 1
1 8/4/2018 12 90 1 1 2 1 1
1 8/4/2018 13.6 92 1 1 2 1 1
1 8/4/2018 12.7 83 1 1 1 1 1
1 8/4/2018 13 96 1 1 2 1 1
1 8/4/2018 14.5 97 1 1 2 1 1
1 8/4/2018 12 85 1 1 2 1 1
1 8/4/2018 12.5 85 1 1 2 1 1
1 8/4/2018 9.5 75 1 1 2 1 1
1 8/4/2018 13 97 1 1 2 1 1
1 8/4/2018 15 98 1 1 2 1 1
1 8/4/2018 13 90 1 1 2 1 1
1 8/4/2018 14 99 1 1 2 1 1
1 8/4/2018 13 98 1 1 2 1 1
1 8/4/2018 14.2 93 1 1 2 1 1
1 8/4/2018 12 89 1 1 2 1 1
1 8/4/2018 9.4 77 1 1 2 1 1
1 8/4/2018 10.7 81 1 1 2 1 1
1 8/4/2018 15.3 95 1 1 2 1 1
1 8/4/2018 13 94 1 1 2 1 1
1 8/4/2018 14 98 1 1 2 1 1
1 8/4/2018 14 94 1 1 1 1 1
1 8/4/2018 15.3 98 1 1 2 1 1
1 8/4/2018 17 99 1 1 2 1 1
1 8/4/2018 15 99 1 1 1 1 1
1 8/4/2018 10.5 81 2 1 1 1 1
1 8/4/2018 10 75 1 1 2 1 1
1 8/4/2018 8.1 72 2 1 1 1 1
1 8/4/2018 8.5 67 2 1 1 1 1
1 8/4/2018 9 73 2 1 1 1 1
1 8/4/2018 10 75 1 1 1 1 1
1 8/4/2018 10 79 2 1 1 2 2
1 8/4/2018 7.7 68 2 1 1 1 1
1 8/4/2018 6 62 2 1 1 2 2
1 8/4/2018 4.6 53 2 1 1 2 2
1 8/4/2018 6 63 2 1 1 1 1
1 8/4/2018 8 70 2 1 1 2 2
1 8/4/2018 7.5 65 2 1 1 1 1
Provinsi :
Kabupaten/Kota :
Puskesmas :

No. No Kartu Keluarga ANAK KE- NAMA ANAK

NIK (Nomor Induk TANGGAL LAHIR
Kependudukan) (YYYYMMDD)
 DATA SASARAN BALITA

BERAT
JENS NO.TLP/HP
BADAN NIK AYAH ALAMAT RT
KELAMIN LAHIR (Kg) Orang Tua
NAMA ORANG TUA
 Vitamin A Vitamin A
Cara Ukur Asi ekslusifIMD
Tanggal Februari Agustus
RW BB (Kg) TB (cm)
Pengukuran 1= terlent 1=Ya 1=Ya 1=Ya 1=Ya
2= berdiri 2= Tidak 2= Tidak 2= Tidak 2= Tidak