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2=Non Gakin

No Nama Balita L/P Tgl Lahir Nama Orang tua

1=Gakin
1 IRAYA SAFITRO P HATMADI
2 LUSI MAWARNI P MULYASIP
3 ELENA P NURYADI
4 RADIL L MULDAN
5 NELY YUWANSIH P PARWADI
6 ZIFARA ANISA P YULIADII
7 MUNDING IRWAN L NUSIADI
8 MAEDI YUSUF L HATMALIF
9 ASIPA DWI P P RATJINON
10 SISKA DWI A P YUDI
11 ANZAR RAMADAN L IKHSAN
12 SILKA KAISYA P P UCI ARMIADI
13 HAWA STEFANI O P SURYADII
14 M. KHOIRRUL ANAM L NURUL IBAT
15 MAULIDA FITRIA K P R.KERTA B
16 RADIT DWI MARTA L SIRNATI
17 ROBY YALDI P L ARDI NATA
18 OLIVIA WULAN D P RISNADI
19 RAHMA LATIFA P RUMADI
20 RAGIL BISMA L JULIADI
21 LEONAL TANAKA L RUSDI
22 NAISYA AULIA R P SUWARIO
23 AZKA FAEZA G L SUPRIADI
24 AZIS ALFA REZI L IRANA
25 ADREAN FAESAL L IRA KUSUMA
26 LIANA SALSA BILA P MERCANEM
27 RINJA RISKI L SAPTONO
28 RISKA SILVIA P ASTRATII
29 FADIR ISRAQ L ZAENUDINA
30 WINDA FELISA P WAHYUDI
31 AFIFA FATIYA P TUDI MAYANA
32 ADISTTA L RUMASIP
33 M. DZAKWAN L GUENADI
34 NABIL FIRMAN HADI L NARIASIP
35 DIKI PRADANA L SUKARDI
36 REZA GENJIO L UPUN
37 PUSPIITA NAURUN P USMAN
38 RIZKI MAULANA L JUMALIP
39 RENA P MULIADI
40 RAKA ZIQRI AKBAR L CARWANDI
41 FIKA YULIANTIKA P TONI
42 BANLI DZAKWAN L SUGASIP
43 DIDING ARWAN L MAEDI SP.d
44 RINDA ADIZAH P JIDASIF
45 M. PIRNADA A L M. RIFA'I
46 JIBRAN MAULANA L JIWANOM
47 PIAN IRWANDI L ISMARAWADI
48 TEGUH SASTRA W L MISNAYU
49 RIZA APRILIA P SUHRIF
50 ADRIAN PRATAMA L

52 DIANA P 5/14/2010 INDRASIP/DIRANEP


53 MIKA P 5/10/2010 RISTANEM/AYUNIM
54 SEPDIANTO L 7/10/2010 RIADI/MIRANTEN
55 WANDIKA L 5/11/2010 MAEDI/SIRJANIM
56 AGUSWANDI L 8/10/2010 RISTANEM/ SUNIATI
57 SUCI REMAYANI P 8/12/2010 PILIASIP/JIMANIM
58 R.RANU OKA PATRA L 9/30/2010 R. BANGRAS/NUTRIANIM
59 SARDI L 10/16/2010 SAPARI/LISANEP
60 D. DIA RAHMAWATI P 5/17/2011 L. SUPARWADI/D.PITRIANI
61 FITRIANI P 10/20/2010 SITRALIP/ARSINTEN
62 MIKA AYUNIKA P 3/3/2011 UDIN/LUSASIH
63 GUNTUR L 5/25/2011 SUMANOM/ASNGEN
64 MISTANEM L 11/10/2011 SUKARDI/SIRSANEP
65 ARI KURNIAWAN L 4/3/2011 NURSADI /D.PININGEN
66 NAORA HUMAEROH P 20/05/2 NURADI/RATIH
67 BAJANG MAULANA L 7/6/2011 MARZUKI/RATNUSIH
68 ERNIATI P 9/10/2011 CANDIALIP/RATSANEM
69 RIKIYANDI L 5/27/2011 RUDIONO/RIANAH
70 HENGKI L 5/24/2011 SINGASIP/LASANIM
71 HUSNA FARIZA P 9/21/2011 JUMANEM/ANISAH
72 HERIANDIKA L 3/27/2012 NUTRIADI/KARNIATI
73 YOPIANA L 2/3/2012 JANDRANOM/NEPSANIM
74 YOGA L 11/2/2012 RUTANEM/ARSANEP
75 YANA MINASTRI P 9/30/2012 NURIASIP/MULIANI
76 RONAL L 7/3/2012 SUTRADI/NICANEP
77 RENDIKA L 11/14/2012 NAWADI/SARINEP
78 PUTRI AMBULANI P 9/20/2012 SAIRAN/MASENIATI
79 NIMIKA PURI P 12/13/2012 ASMAWADI/MANDRIANI
80 MEINIKA P 10/05/2012 RINASIP/NURSANIM
81 GALANG YUDI DARMA L 5/30/2012 EDI SWANDI ARSADRA/YULIANI
82 EFGAN RAMDANI L 8/9/2012 ITRASIM/MASITAH
83 ALGADINATA L 2/25/2012 PITASIP/RIANTI
84 AULIA TIA MAULINDA P 9/1/2013 MAYADI/AYUNEP
85 ARJUNA HENDRIK L 6/6/2013 JUMANEM/SINANGEN
86 DANITA P 7/18/2013 RINASIP/MINANGEN
87 HERMAN L 5/22/2013 JUMASIP/SAPMINEP
88 JASTIN L 6/12/2013 RIADI/KARNIATI
89 LIANI P 4/23/2013 HATMADI/NARISIP
90 M. ZAL ALGI PARI L 6/19/2013 HUSNUL/HADI
91 RUMI ANTIKA TIRA P 3/10/2013 REBASIP/MURNIANI
92 SAHDI L 10/28/2013 RIMADI/SARI
93 SOTIPA ALIA P 12/29/2013 NEGASIP/BUNGADIA
94 MAE LISTARI P 5/23/2013 SARDI/LASANEP
95 WATI P 12/22/2013 ISWANDI/SITI ARTINI
96 YULNI BAYANI P 1/23/2013 RIWATI/SAPNI
97 ZAHRAENI P 5/29/2013 HAMDAN/SARINI
98 JELITA JULIANTI P 5/9/2014 JASMAN /RAPIAH
99 LISTINA P 8/16/2014 SRIANTO/SUMINGEN
100 M.FAHRI AZHAR L 21/06/20 KERTASIH/JUNAENI
101 NAERA ALPAENA LACITA P 10/9/2014 RIASIP/JUNIATI
102 PITA RAHNIATI P 2/24/2014 NURSATIM/SAPTIANIM
103 PUTRI AZRA ANISA P 11/30/2014 ASTANEM/MAENI
104 RIMA OKTAVIA P 10/21/2014 MAWARI/RINAWATI
105 SUTRIAWINI P 8/5/2014 R.GITA KUSUMA/RISANTEN
106 SEEHAN SHATILA AL-AMIN P 10/3/2014 DEDI IRAWAN/MULIA HARTINI
107 TUNA PATMALA P 9/29/2014 RITAMAN/MISNEP
108 NOPI ASTUTI P 11/23/2014 NURMADI//SARTINI
109 ZIELDA CERIA AYU P 12/15/2014 AWAN/DEWI
110 MURNI HABIBA TUL LAELA P 11/13/2014 SAPMONO/ROHANA
111 IGA HARDANI L 2/28/2014 IKRAM/MULIANA
112 TRI AYU BUANA P 3/23/2015 MARZUKI/RATNUSIH
113 RIANEP P 3/23/2015 MERSANOM/SUTRINEP
114 JUNIASTRI P 6/7/2015

115 R.ARIS L 3/11/2010 R.NYAKRA/ARIAN


116 FERDIAN ARJUNAA L 6/26/2010 MARZOAN/MAHNUN
117 ARINI P ABDUL AZIZ/MAEMANAH
118 ANISA F P 10/2/2010 DEDI ILHAM/MISNAWATI
119 NADIRA P 11/12/2010 BAHARUDIN/DIAN PURWANTI
200 RADIT PRATAMA L 12/10/2010 SEME/SEMBAH
201 PUTRI ADELIA P 1/26/2011 SUDARMAN/KARTINI
202 VIKI DANANG P L 12/18/2011 ZULKIFLI/YUNITA
203 ARI SETIAWAN L 3/8/2011 FADLI/SUCIARAH
204 DINA MAESAROH P 4/12/2011 MAHSUN/KAMARIAH
205 ERLINA P 5/11/2011 HASAN/SUMIATI
206 ATIYA HUSAL SABILA P 5/9/2011 USTD.WAHAB/ROHANI
207 LUKMAN HAKIM L 5/9/2011 RAMDAN/HERNAWATI
208 M.ALFATIH P 6/10/2011 KASMAN/MASITAH
209 DEA GIAN CANDRA P 6/15/2011 SANCANDRA/NURJANAH
210 SALEHUDIN L 11/23/2011 H.JUNAIDI/HAMDIAH
211 IRAYU ANJARWATI P 1/13/2012 HAM/ROHIMIN
212 M.KHOIRIL AZZAM L 1/14/2012 DRH.SARUDI/RONI A
213 MAHARANI D.C P 3/5/2012 MAHIDIN/SRI YUNIARTI
214 LIZA APRIANI L 4/9/2012 USMAN/SUARNI
215 RISA IZI .A P 11/04/2012 R.EDI KUSUMA/ZOHRUL AENI
216 ARYA A.S L 6/26/2012 A.TINA/I.TINA
217 R.FADIL.M L 6/15/2012 R.BUDI/D.ANJA
218 M.RAYYAN AL-F L 6/26/2012 LUKMAN/ELI
219 R.DEDEN A.W L 11/26/2012 R.AGUS.K/APRIANA
220 AZRIL IRWANDI L 12/26/2012 WAWANDI/KHOLINI
221 LISA ANASTASYA P 1/6/2012 INDRASI/NISANEP
222 SYAFANA P 10/17/2013 RAHMAN/HAFIFAH
223 RISKI BAITURRAHMAN L 12/21/2013 RAHMAN.M/KAMARIAH
224 ISTIQOMAH P 4/10/2013 M.TAHIIR/SAHRUNI
225 HARIANDITO L 10/2/2013 SENALAM/SAFIANI
226 MAWANDI L SAHNUN/SUMARNI
227 ALDIAN RISKI M L 6/2/2013 ALWAN SUADI/RIANAH
228 M. TEGAR.A.P L 05/17/201 ASRI/SUCIKA ARMIANI
229 REVAN L 6/24/2013 M. HUSNUL/OKIANA ZAEN
230 AKHIRA P 8/7/2013 SAHNAN/SELEMAH
231 M.AQILA A.H L 1/2/2014 ASHFFYZEE.H/KARNIASIH
232 HAIKAL L 1/13/2013 L. KERTIADI/RATNISA
233 FADIL AKBAR L 3/29/2014 VIKI ILHAM/MUSNAWATI
234 UWAIS QORNI NEDIR L 8/23/2014 SARTONO/HURNIATI
235 DWI IRA K P 3/29/2014 ZULKIFLI/YUNITA
236 DEO GIAH CHANDRA L 5/27/2014 SANCANDRA/LASINEP
237 KHAILA INNARA L P 6/28/2014 ASRI/SUCIKA ARMIANI
238 ARFAN ADAM L 7/9/2014 YASMAN/NURHAYATI
239 RESTI RAHAYU P 8/18/2014 SARAH/HURIAH
TGL
Alamat Posyandu Desa PENIMBA Umur BB B Vit A
NGAN

BATU MENJANGKONG ANYAR


DASAN GRISAK

NUTRIANIM

DI/D.PITRIANI

M/NEPSANIM

MANDRIANI

ARSADRA/YULIANI
MA/RISANTEN
N/MULIA HARTINI

MAEMANAH
MISNAWATI
DIAN PURWANTI
/NURJANAH

MA/ZOHRUL AENI

OKIANA ZAEN

/KARNIASIH

MUSNAWATI
ASI
KBM

Pengurangan
N/T
2T
O

Tidak Hadir

Batas BGM
BGM/Tdk

L
0-5
S K

0-5 6-11 12-23 24-59 0-5 6-11

P L P L P L P L P L
K D

6-11 12-23 24-59 0-5 6-11 12-23

P L P L P L P L P L
D N

12-23 24-59 0-5 6-11 12-23 24-59

P L P L P L P L P L
T

24-59 0-5 6-11 12-23 24-59 0-5

P L P L P L P L P L
O B

0-5 6-11 12-23 24-59 0-5 6-11

P L P L P L P L P L
B TIDAK HADIR

6-11 12-23 24-59 0-5 6-11 12-23

P L P L P L P L P L
K HADIR 2T

12-23 24-59 0-5 6-11 12-23 24-59

P L P L P L P L P L
BGM Bayi ASI E

24-59 0-5 6-11 12-23 24-59 0-5 bln

P L P L P L P L P L
Bayi ASI E Bayi Tidak ASI E

0-5 bln 0-5 bln

P L P
P
HASIL PENIMBANGAN BALITA DI POSYA

Nama Posyandu :
Alamat : PLABASARI

2=Non
Gakin
No Nama Balita L/P Tgl Lahir Nama Orang tua

1=Gakin
AGS VIT A SEP OKT NOP

M/B

10

11

12

13

14

15

16

17

18

19

20

21

22
2=Non
Gakin
No Nama Balita L/P Tgl Lahir Nama Orang tua

1=Gakin
AGS VIT A SEP OKT NOP

M/B

23

24

25

26

27

28

29

30

31

32

33

34

35

36

37

38

39

40

41

42

43

44

45

46

47

48
2=Non
Gakin
No Nama Balita L/P Tgl Lahir Nama Orang tua

1=Gakin
AGS VIT A SEP OKT NOP

M/B

49

50

51

52

53

54

55

56

57

58

59

60

61

62

63

64

65

66

67

68

69

70

71

72

73

74
2=Non
Gakin
No Nama Balita L/P Tgl Lahir Nama Orang tua

1=Gakin
AGS VIT A SEP OKT NOP

M/B

75

76

77
AN BALITA DI POSYANDU

BB TIAP BULAN

DES JAN FEB VIT A MAR APR MEI JUN JULI KET

M/B
BB TIAP BULAN

DES JAN FEB VIT A MAR APR MEI JUN JULI KET

M/B
BB TIAP BULAN

DES JAN FEB VIT A MAR APR MEI JUN JULI KET

M/B
BB TIAP BULAN

DES JAN FEB VIT A MAR APR MEI JUN JULI KET

M/B
P
HASIL PENIMBANGAN BALITA DI POSYAN

Nama Posyandu MUMBUL SARI


Alamat MUMBUL SARI

2=Non
B

Gakin
No Nama Balita L/P Tgl Lahir Nama Orang tua

1=Gakin
AGS VIT A SEP OKT NOP DES

M/B

1 AQILA IMANNA HANIPA P 3/10/2011

2 RIKI MAULANA L 4/13/2011

3 JAYA KUSUMA L 6/27/2011

4 DAHMAN HAKIM L 7/5/2011

5 AL HIDAYAH P 7/27/2011

6 HAIRIL GUSLAFI IMAMA L 7/17/2011

7 YUDANI L 11/30/2011

8 SOLIHIN L 10/25/2011

9 ALIYA SAFA GANESSA P 10/24/2011

10 DANI RAPLI SANJAYA L 11/27/2011

11 YUSUF UBAIDILLAH L 11/28/2011

12 JIDAN PRATAMA L 2/18/2012

13 YUNA LESTARI P 4/9/2012

14 KERTI SARI P 4/16/2012

15 HARIYADI L 5/14/2012

16 ASYIPA AYU LESTARI P 7/9/2012

17 DESITA APRIANI P 12/1/2012

18 TRY ANDIKA PRATAMA L 9/3/2013

19 HAWAITUN AULIA P 5/25/2013

20 ALIYA DESTI P 12/31/2013

21 YODNI L

22 MUHAMAD SAUMIL AKBAR L 8/2/2013


2=Non
B

Gakin
No Nama Balita L/P Tgl Lahir Nama Orang tua

1=Gakin
AGS VIT A SEP OKT NOP DES

M/B

23 AHMAD ZUANDI L 11/20/2013

24 LENI APRIANA P 4/18/2013

25 IYAN FIKRI L 2/17/2014

26 DINI ARTIKA P 3/5/2014

27 SESI ANGGRENI P 5/16/2014

28 HAIKAL FIKRI L

29 GUSNIA P 8/16/2014

30 ZIVANA LESTIA ANINDITA P 9/18/2014

31 ASMAUL HUSNA YAHYA L 10/30/2014

32 KARTIKA PUTRI P

33 DESTA SASTRA WIGUNA L 8/31/2015

34 DAVID F L 11/17/2015

35 AFIFA ZAHRATUL QOLBI P 11/4/2015

37

38

39
2=Non
B

Gakin
No Nama Balita L/P Tgl Lahir Nama Orang tua

1=Gakin
AGS VIT A SEP OKT NOP DES

M/B
2=Non
B

Gakin
No Nama Balita L/P Tgl Lahir Nama Orang tua

1=Gakin
AGS VIT A SEP OKT NOP DES

M/B
A DI POSYANDU

BB TIAP BULAN

JAN FEB VIT A MAR APR MEI JUN JULI KET

M/B

3/8/2016 59

3/8/2016 58

3/8/2016 56

3/8/2016 56

3/8/2016 55

3/8/2016 55

3/8/2016 51

3/8/2016 52

3/8/2016 52

3/8/2016 51

3/8/2016 51

3/8/2016 48

3/8/2016 46

3/8/2016 46

3/8/2016 45

3/8/2016 43

3/8/2016 39

3/8/2016 30

3/8/2016 33

3/8/2016 26

3/8/2016

3/8/2016 31
BB TIAP BULAN

JAN FEB VIT A MAR APR MEI JUN JULI KET

M/B

3/8/2016 27

3/8/2016 34

3/8/2016 24

3/8/2016 24

3/8/2016 21

3/8/2016

3/8/2016 18

3/8/2016 17

3/8/2016 16

3/8/2016

3/8/2016 6

3/8/2016 3

3/8/2016 4
BB TIAP BULAN

JAN FEB VIT A MAR APR MEI JUN JULI KET

M/B
BB TIAP BULAN

JAN FEB VIT A MAR APR MEI JUN JULI KET

M/B
HASIL PENIMBANGAN BALITA DI POSYA

Nama Posyandu :
Alamat : LOKOK MUMBUL

2=Non
Gakin
No Nama Balita L/P Tgl Lahir Nama Orang tua

1=Gakin
AGS VIT A SEP OKT NOP

M/B

1 RINDIANI P 10/27/2010

2 YENI SEPTIANA P 11/5/2010

3 ZULFIAN HADI L 11/21/2010

4 HERIL AZMI L 11/26/2010

5 BQ.RENA P 12/12/2010

6 REFAN S L 12/16/2010

7 MAUDATUL HUSNA P 1/25/2011

8 MAULANA L 2/8/2011 JUMAIDI/YANTI

9 RANI KARMILA P 2/15/2011 RATSADI / DEBUK

10 SUSAN MAULINA P 2/17/2011 MARIANEM/RABINEM

11 SYAHIBUL AMRIL L 4/12/2011 NURBAYA /SINGAYU

12 NAZIA AULIA P 4/2/2011

13 APRILIA P 4/27/2011

14 LAURA LESTARI P 5/24/2011

15 REHAN L 5/26/2011 H. SUMARDI/WARNI

16 EBI ELIZA P 7/7/2011 SABRI/RATMINEM

17 MUHAMAD SAHRIL ALPIAN L 7/9/2011

18 REFAL HAMDANI L 7/27/2011

19 AGUS RAMDANI L 8/27/2011 ZAENUDIN/RIANIK

20 NANDA HIDAYAT L 8/30/2011

21 JOHANDA L 10/2/2011 SUHARMAN / RONI

22 JULIADI L 12/13/2011 AGUS MAYA/DAYANG


2=Non
Gakin
No Nama Balita L/P Tgl Lahir Nama Orang tua

1=Gakin
AGS VIT A SEP OKT NOP

M/B

23 IKLIUMA AZIZA P 12/16/2011

24 VELIONA P 12/31/2011 PENDI/DESI

25 AFRILIANI P 4/3/2012 RATMADI / AYU S

26 GIO SEPTIADAI L 4/10/2012

27 EVA APRIANI P 4/24/2012 ARDAN/RASIANIM

28 DWE.GEDE VERIKA L 5/8/2012 DW GDE RAI

29 HENDI L 5/11/2012

30 AMELIA SANTIKA P 5/13/2012 HERMADI/BILHAIRI

31 OLITA UTARI P 6/18/2012

32 AHMAD PARMIN L 6/16/2012 SUPAR/ SINTEN

33 ADE ADIANTARA L 7/4/2012

34 RIDO JUANA L 7/10/2012

35 DIMA AZLI L 7/27/2012

36 HAIDIL ABADI L 7/22/2012

37 YULIANDITO L 7/1/2012 SANEM/RUK

38 RIKO SETIAWAN L 8/9/2012

39 L. ABIMANYU L 8/12/2012 HAMDAN KARTINI

40 ABDUL KHOLID L 8/26/2012

41 AHMAD RIFAL L 8/29/2012 ZEPRI/ US

42 DELISA PUTRI P 12/6/2012 RENDI/SENIATI

43 ANDIKA L 12/30/2012

44 ADES L 12/5/2012

45 BQ. ISRO P 2/2/2013 ARPAN/SITI

46 ARINI FADILA L 2/2/2013

47 LIANA ULANDARI P 2/11/2013 EMA/YULI

48 VEKI JOKOWI L 7/6/2013 RIDWAN/SAMINGEN


2=Non
Gakin
No Nama Balita L/P Tgl Lahir Nama Orang tua

1=Gakin
AGS VIT A SEP OKT NOP

M/B

49 BAGAS L 7/10/2013 SUPRI/NURHAINI

50 VITRI P 8/10/2013 ISNAWADI/SULIA

51 VONIA ANTIKA P 9/13/2013 SUKMAWA/SITI

52 NABILA L P 9/26/2013 HERMADI/SANIM

53 IHSAN HADINATA L 9/6/2013

54 MELDA P 8/21/2013 GUNARI

55 BOY L 11/6/2013 SADOT/NUR

56 HAIRUL FAHMI L 11/27/2013

57 ALFIAN HABIB L 12/27/2013

58 AJWI ALISA PUTRI P 12/29/2013

59 HENDI ADRIAN L 12/7/2013

60 PUTRI KALIMANJA 12/31/2013

61 JUD P 2/3/2013

62 AHZADANI L 3/19/2014 JUMADIL/ETIK

63 PADIL GIO L 3/19/2014

64 MAURADIPATUL H L 6/2/2014

65 CIKA AMELIA P 6/7/2014

66 YUNITA P 6/13/2014

67 WENDI SAPUTRA L 6/25/2014 ADAM/RAMIO

68 BAYU ADINATA L 6/29/2014

69 KAILA M L 8/8/2014

70 SOPIAN HADI L 8/25/2014 SUPIANA/HENI

71 IFTINA P 9/14/2014 RASIMAH/NURHAYATI

72 DIFA GHALI ANANDA P 11/19/2014 MASUDIN/NURUL

73 AMELIA PUTRI P 12/3/2014

74 FADILA SUHAINI P 2/6/2015


2=Non
Gakin
No Nama Balita L/P Tgl Lahir Nama Orang tua

1=Gakin
AGS VIT A SEP OKT NOP

M/B

75 AL KAUSAR L 4/9/2015 ADI S/ YULI

76 ALBY ONERA E L 4/9/2015

77 APRILIA PATIR R P 4/23/2015

78 AKIYA APRILIA P 4/24/2015

79 NI NENGAH AYU W P 6/16/2015

80 HARFAN RAMDANI L

81 YULFA SAPUTRI P 6/17/2015

82 ALFAD FAEZAN L 6/23/2015

83 NUNUNG ALIFA P 7/31/2015 ZULFANDI/MARTINI

84 EGI ADRIAN L 8/7/2015 LASMADI/LIASARI

85 DEA AULIA ANANDA P 8/11/2015 H. SUMARDI/ ZURIATI

86 NINA SUSILAWATI P 6/29/2015

87 YAHYA ALGOJALI L 9/9/2015 JUMAIDI/YANTI

88 CICI AGUSTIN P 8/19/2015

89 DESTA RIADI L

90 SAFA NAZLI L 1/8/2016

91 KELUM L 4/14/2012 ALIASMAN / NURSAKMAH

92

93

94

95

96

97

98

99

100
2=Non
Gakin
No Nama Balita L/P Tgl Lahir Nama Orang tua

1=Gakin
AGS VIT A SEP OKT NOP

M/B

101

102

103

104

105

106

107

108

109

110

111

112

113

114

115

116

117

118

119

120

121

122

123

124

125

126
2=Non
Gakin
No Nama Balita L/P Tgl Lahir Nama Orang tua

1=Gakin
AGS VIT A SEP OKT NOP

M/B

127

128

129

130

131

132

133

134

135

136

137

138

139

140

141

142

143

144

145

146

147

148

149

150

151

152
2=Non
Gakin
No Nama Balita L/P Tgl Lahir Nama Orang tua

1=Gakin
AGS VIT A SEP OKT NOP

M/B

153

154

155

156

157
AN BALITA DI POSYANDU

BB TIAP BULAN

DES JAN FEB VIT A MAR APR MEI JUN JULI KET

M/B
BB TIAP BULAN

DES JAN FEB VIT A MAR APR MEI JUN JULI KET

M/B
BB TIAP BULAN

DES JAN FEB VIT A MAR APR MEI JUN JULI KET

M/B
BB TIAP BULAN

DES JAN FEB VIT A MAR APR MEI JUN JULI KET

M/B
BB TIAP BULAN

DES JAN FEB VIT A MAR APR MEI JUN JULI KET

M/B
BB TIAP BULAN

DES JAN FEB VIT A MAR APR MEI JUN JULI KET

M/B
BB TIAP BULAN

DES JAN FEB VIT A MAR APR MEI JUN JULI KET

M/B
P

3/8/2016 64

3/8/2016 64

3/8/2016 63

3/8/2016 63

3/8/2016 62

3/8/2016 62

3/8/2016 61

3/8/2016 61

3/8/2016 60

3/8/2016 60

3/8/2016 58

3/8/2016 59

3/8/2016 58

3/8/2016 57

3/8/2016 57

3/8/2016 56

3/8/2016 55

3/8/2016 55

3/8/2016 54

3/8/2016 54

3/8/2016 53

3/8/2016 50
P

3/8/2016 50

3/8/2016 50

3/8/2016 47

3/8/2016 46

3/8/2016 46

3/8/2016 46

3/8/2016 45

3/8/2016 45

3/8/2016 44

3/8/2016 44

3/8/2016 44

3/8/2016 43

3/8/2016 43

3/8/2016 43

3/8/2016 44

3/8/2016 42

3/8/2016 42

3/8/2016 42

3/8/2016 42

3/8/2016 39

3/8/2016 38

3/8/2016 39

3/8/2016 37

3/8/2016 37

3/8/2016 36

3/8/2016 32
P

3/8/2016 31

3/8/2016 30

3/8/2016 29

3/8/2016 29

3/8/2016 30

3/8/2016 30

3/8/2016 28

3/8/2016 27

3/8/2016 26

3/8/2016 26

3/8/2016 27

3/8/2016 26

3/8/2016 37

3/8/2016 23

3/8/2016 23

3/8/2016 21

3/8/2016 21

3/8/2016 20

3/8/2016 20

3/8/2016 20

3/8/2016 19

3/8/2016 18

3/8/2016 17

3/8/2016 15

3/8/2016 15

3/8/2016 13
P

3/8/2016 10

3/8/2016 10

3/8/2016 10

3/8/2016 10

3/8/2016 8

3/8/2016

3/8/2016 8

3/8/2016 8

3/8/2016 7

3/8/2016 7

3/8/2016 6

3/8/2016 8

3/8/2016 5

3/8/2016 6

3/8/2016

3/8/2016 2

3/8/2016 46
HASIL PENIMBANGAN BALITA DI POSYA

Nama Posyandu :
Alamat MUMBUL SARI

2=Non
Gakin
No Nama Balita L/P Tgl Lahir Nama Orang tua

1=Gakin
AGS VIT A SEP OKT NOP

M/B

1 AFIFA FATIA P 6/24/2014

2 RIKO RIPANDI L 5/22/2014

3 UMAEDI SAPUTRA L 5/7/2014

4 GIPARI L 4/22/2014

5 ULPA APRIANTI P 4/2/2014

6 SITI MAESARAH P 5/6/2014

7 M.FIKRI GOZALI L 12/31/2013

8 PIPI AULIA ZAHRON P 1/18/2014

9 DESTI AURA P 12/27/2013

10 ANISA RUHMANIA P 11/24/2013

11 AIFA IKDAN HUSNA P 11/24/2013

12 HILAL APRIAN L 4/27/2013

13 LAILATUL HIKMAH P 5/23/2013

14 IZWAN HAEIPIT L 4/12/2013

15 HAIRUL HABIDI L 3/16/2013

16 ANDIAK YUSRON L 2/13/2013

17 ALPIN MAULANA L 11/28/2012

18 NOVITA ISTIKOMAH P 11/15/2012

19 KAELA KARYATUL P 6/25/2012

20 EPI ULANDARI P 5/19/2012

21 ZAMBARILAULA P 5/22/2012

22 M ARIPIN L 3/14/2012
2=Non
Gakin
No Nama Balita L/P Tgl Lahir Nama Orang tua

1=Gakin
AGS VIT A SEP OKT NOP

M/B

23 RAI ADRIAN L 3/10/2012

24 ALPIN MAULANA L 11/17/2012

25 ROKYAL P 9/25/2011

26 AZILA SELPIANI P 7/22/2011

27 HALIL MUZADIN L 7/12/2011

28 M, AHADAN MUSARI L 4/10/2011

29 HASFI MAULANA L 4/7/2011

30 FITRI HANDAYANI P 1/30/2011

31 M, HAIRUL HAKIKI L 11/22/2011

32 FAHRIZAL L 11/20/2011

33 AZALIA AYUNABILA P 4/10/2014

34 OLIPIA PUTRI P 6/16/2015

35 IZWAINI P 7/1/2014

36 HIPZAH DEWISASMITA P 8/28/2014

37 SAHRIL ARIS L 7/15/2014

38 AMIRA SYAZWANI KARIM P 9/22/2014

39 FIKI ARLENA L 8/1/2014

40 M, RENDI L 8/1/2014

41 AULIA ULANDARI P 12/5/2014

42 M. ZAINUL L 12/31/2014

43 GEZA PRATAMA L 1/31/2015

44 DAPA AZIZI L 12/16/2014

45 HIKMATUL AULIA P 2/11/2015

46 MOZA ADITIA L 1/6/2015

47 ALIPA APRIANA P 4/13/2015

48 AJI BURAHMAN L 12/21/2014


2=Non
Gakin
No Nama Balita L/P Tgl Lahir Nama Orang tua

1=Gakin
AGS VIT A SEP OKT NOP

M/B

49 M. TOLIP L 5/22/2015

50 SUCI MURI P 6/21/2015

51 FARIH NAJIHIY L 8/19/2015

52 FARIHA NAJIHA P 8/19/2015

53 IQBAL L 1/3/2014

54 QHOIRIL L 12/20/2015

55 NAZIFUL HAIRI L 10/29/2015

56

57

58

59

60

61

62

63

64

65

66

67

68

69

70

71

72

73

74
2=Non
Gakin
No Nama Balita L/P Tgl Lahir Nama Orang tua

1=Gakin
AGS VIT A SEP OKT NOP

M/B

75

76

77
AN BALITA DI POSYANDU

BB TIAP BULAN

DES JAN FEB VIT A MAR APR MEI JUN JULI KET

M/B
BB TIAP BULAN

DES JAN FEB VIT A MAR APR MEI JUN JULI KET

M/B
BB TIAP BULAN

DES JAN FEB VIT A MAR APR MEI JUN JULI KET

M/B
BB TIAP BULAN

DES JAN FEB VIT A MAR APR MEI JUN JULI KET

M/B
3/8/2016 20

3/8/2016 21

3/8/2016 22

3/8/2016 22

3/8/2016 23

3/8/2016 22

3/8/2016 26

3/8/2016 25

3/8/2016 26

3/8/2016 27

3/8/2016 27

3/8/2016 34

3/8/2016 33

3/8/2016 34

3/8/2016 35

3/8/2016 36

3/8/2016 39

3/8/2016 39

3/8/2016 44

3/8/2016 45

3/8/2016 45

3/8/2016 47
3/8/2016 47

3/8/2016 39

3/8/2016 53

3/8/2016 55

3/8/2016 55

3/8/2016 58

3/8/2016 59

3/8/2016 61

3/8/2016 51

3/8/2016 51

3/8/2016 22

3/8/2016 8

3/8/2016 20

3/8/2016 18

3/8/2016 19

3/8/2016 17

3/8/2016 19

3/8/2016 19

3/8/2016 15

3/8/2016 14

3/8/2016 13

3/8/2016 14

3/8/2016 12

3/8/2016 14

3/8/2016 10

3/8/2016 14
3/8/2016 9

3/8/2016 8

3/8/2016 6

3/8/2016 6

3/8/2016 26

3/8/2016 2

3/8/2016 4
HASIL PENIMBANGAN BALITA DI POSYA

Nama Posyandu :
Alamat : LOKOK REBAN

2=Non
Gakin
No Nama Balita L/P Tgl Lahir Nama Orang tua

1=Gakin
JAN PEB VIT A MAR APR

M/B

1 ITRIA SIFAYANI P 4/23/2011 MAHRIF/ YANIK

2 ZULIADI L 7/27/2011 R NURJANTO/SITI AMINAH

3 WILDAN P. L 8/8/2011 SAHID/NURHALIMAH

4 NOVAN SATRAWAN L 11/11/2011 SUPAR/ODAH

5 EDI ADRIAN L 11/18/2011 RUPI/SUTIANIM

6 LISA AMELIA P 1/31/2012 M. NASIR/ISAH

7 B. CITRA LESTARI P 1/11/2012 RAHMAN/RENI

8 NAYA KANZA AFIKA L 4/10/2012 HADI MARDIAN/IRMAYATI

9 ALFANDI AZRIL R L 5/11/2012 SAHLAN/SAINI

10 SWI AMELIA P 7/7/2012 MISTANOM / TITIN

11 HIDAYAT RAMDAN L 8/1/2012 YUDI/ NURUL

12 RAYA AMELIA L 7/15/2012 SUPARDI/MARLINA

13 SAHIDIN L 8/25/2012 DAHAM/MARNIATI

14 B, SITI AZIZAH P 9/11/2012 L TAKWAN/MUTMAINAH

15 M. OPAN HAKIKI L 8/28/2012 MUKSAN / ANI

16 RISKA IRMAYANI P 10/19/2012 SUHIRMAN/ HAERANI

17 KENDI L 10/22/2012 ASNADI/SAINI

18 KEYSA OKTAVIANA P 10/1/2012 SISWADI/IRMAYATI

19 ALWI PIRMAN M. 2/4/2013 USMAN HADI/DEWI BAYANI

20 KARIMATUS S. P 3/1/2013 HAERUL/ELI SUKMAWATI

21 AFIFA P. P 4/3/2013 HERMAN/SAFAIYAH

22 JULIA RAFA PRATAMA L 4/4/2013 JUNAIDI/NURLINDA


2=Non
Gakin
No Nama Balita L/P Tgl Lahir Nama Orang tua

1=Gakin
JAN PEB VIT A MAR APR

M/B

23 ABDI SUHAMDI L 5/20/2013 UMAR/ROHANI

24 JULIANA M. L 5/4/2013 KARIAWAN/JANAH

25 M.K NITYA SARI P 10/8/2013 AGUS GUNARTA/KADEK

26 SINTIYA DEWI P 12/22/2013 KAMAL/MURIATIP

27 M. IHWAN JULIANTO L 7/8/2013 ANTO/SALMIAH

28 ALIF ZIADUL A. L 6/10/2013 WIRA SUBARMAN/RAUHUN

29 DIKA PRATAMA l 10/4/2013 SAHDAN/ATI

30 IRFANSAH L 4/20/2011 ZULKARNAEN/ROSIDA

31 HERA AFSERA P 11/13/2012 SUPRIADI/SARMINI

32 ATIKA REHAN N. P 11/23/2013 SARIUN/SUMIATI

33 ILAJMIA SAJIDA AS P 1/8/2014 ARMAN/RENI

34 NURULAINI P 1/12/2014 M SABAR/NURHASANAH

35 AIRIN NISMARA A. P 10/7/2014 HADI SUSANTO/ROHAYANI

36 DIAS RIZMATUL IZMA L 10/21/2014 RODIANSAH/ASTINI

37 PRISKA HUMAIRAH P 2/18/2014 SAEDUL / NURHAYATI

38 DANU NATA INSANUL NATA L 12/25/2014 ISKANDAR/ MAESARAH

39 JIHAN SAFA AMALA L 12/31/2015

40 AHMAD FATIH ALHABSI L ALIFTRIYATMONO/NURISNAINI

41 M, AZMI MAULANA L

42 AZAM FAHRIZI L

43 YAOMI AZKA FITRI P

44 ELFA SABILA P 7/27/2015

45 M.AZAM FARIZI L

46 ZIRA SELFIANA P 9/14/2015

47 ELA SOFIA P 8/30/2015

48 IDA INAYA P 10/9/2015


2=Non
Gakin
No Nama Balita L/P Tgl Lahir Nama Orang tua

1=Gakin
JAN PEB VIT A MAR APR

M/B

49 AINUN MULIANI P 6/14/2015

50

51

52

53

54

55

56

57

58

59

60

61

62

63

64

65
AN BALITA DI POSYANDU

BB TIAP BULAN

MEI JUN JULI AGS VIT A SEP OKT NOV DES KET

M/B
BB TIAP BULAN

MEI JUN JULI AGS VIT A SEP OKT NOV DES KET

M/B
BB TIAP BULAN

MEI JUN JULI AGS VIT A SEP OKT NOV DES KET

M/B
P

3/8/2016 58

3/8/2016 55

3/8/2016 55

3/8/2016 51

3/8/2016 51

3/8/2016 49

3/8/2016 49

3/8/2016 46

3/8/2016 45

3/8/2016 44

3/8/2016 43

3/8/2016 43

3/8/2016 42

3/8/2016 41

3/8/2016 42

3/8/2016 40

3/8/2016 40

3/8/2016 41

3/8/2016 37

3/8/2016 36

3/8/2016 35

3/8/2016 35
P

3/8/2016 33

3/8/2016 34

3/8/2016 29

3/8/2016 26

3/8/2016 32

3/8/2016 32

3/8/2016 29

3/8/2016 58

3/8/2016 39

3/8/2016 27

3/8/2016 26

3/8/2016 25

3/8/2016 17

3/8/2016 16

3/8/2016 24

3/8/2016 14

3/8/2016 2

3/8/2016

3/8/2016

3/8/2016

3/8/2016

3/8/2016 7

3/8/2016

3/8/2016 5

3/8/2016 6

3/8/2016 4
P

3/8/2016 8
HASIL PENIMBANGAN BALITA DI POSYA

Nama Posyandu :
Alamat : PAWANG KUNYIT II

2=Non
Gakin
No Nama Balita L/P Tgl Lahir Nama Orang tua

1=Gakin
JAN PEB VIT A MAR APR

M/B

1 NADHIFA HUNAIRA P 1/16/2011 TAUPIQURAHMAN/YUNITA

2 MAR,ATUN BAYANI P 4/22/2011 JULKANAEN/HJ MARIANI

3 LISNAWATI P 12/31/2011 MARZUKI/SRI

4 SAPATUL EINI P 10/1/2011 MARSUDIN /SIFAIYAH

5 HENDRI KURNIAWAN L 10/31/2011 SAPURI/SAPURI

6 AZMI MAZDUDIN RAIS L 2/21/2012 ABDOLAH/ SANURIAH

7 NURUL AINI P 4/18/2012 ASMADI/D WIRNI

8 FAHRU ROZI L 5/17/2012 PARMAN/PILIATI

9 GUSTINA SILVIANI P 1/24/2013 AGUS/SITI

10 RANGGA PRATAMA L 3/3/2013 IWANDI/SARTINI

11 ALAN ALPALENDRA L 12/8/2013 AHMADI/HJ NURSENA

12 EVA YANTI P 2/21/2013 ANYAR/HJ FADILAH

13 EJI ALPARIJI P 1/4/2014 IKMALUDIN/MARTINI

14 ALSYA AZZAHRA P 2/4/2014 HERMAN/NURJANAH

15 ZAINMI MUZZAINUDIN L 2/10/2014 AHMADI/MAENAH

16 M.NAUFAL KAISON L 3/24/2014 TAUPIQURAHMAN/YUNITA

17 ZALLFA HUMAERA P 5/4/2014 HERMATO/SARE'AH

18 ALPIAN MAULANA L 6/8/2014 KARTONO/ASNAH

19 ZIYAD KHADURAHMAN L 8/17/2014 FATHURAHMAN/SURNAH

20 AKIFAH NAILA P 8/31/2014 BUDI/NURHASANAH

21 ULFA FARISA PUTRI P 9/12/2014 MUNIRI/HJ SUHAR

22 AVINA AWAFA P 10/11/2014 MARHUN/SUHARNI


2=Non
Gakin
No Nama Balita L/P Tgl Lahir Nama Orang tua

1=Gakin
JAN PEB VIT A MAR APR

M/B

23 INDA HAYATUL UHRA P 11/10/2014 MAHKIN /MULIATI

24 DWI RAHAYU CAHYANI P 12/22/2014 IBRAHIM/NASMIRAH

25 DAVIN ALI AL-FAHREZI L 3/22/2015 DANANG/NOVISAGITA

26 YADZAN DIMAS CAHYADI L 5/14/2015 AHMADI /MARZAN

27 ANGGUN OLIVIA P 8/7/2015 MASHURI/YURNI

28 REVAN ALI SOPIAN L 11/12/2015 SOPIAN/ERNAWATI

29 AIDATUL HAKIKI L 11/27/2015 ABDL AZIS/NURHAYATI

30

31

32

33

34

35

36

37

38

39

40

41

42

43

44

45

46

47

48
2=Non
Gakin
No Nama Balita L/P Tgl Lahir Nama Orang tua

1=Gakin
JAN PEB VIT A MAR APR

M/B

49

50

51

52

53

54

55

56

57

58

59

60

63

64

65

66

67

68

69

70

71

72

73

74

75

76
2=Non
Gakin
No Nama Balita L/P Tgl Lahir Nama Orang tua

1=Gakin
JAN PEB VIT A MAR APR

M/B

77
AN BALITA DI POSYANDU

BB TIAP BULAN

MEI JUN JULI AGS VIT A SEP OKT NOV DES KET

M/B
BB TIAP BULAN

MEI JUN JULI AGS VIT A SEP OKT NOV DES KET

M/B
BB TIAP BULAN

MEI JUN JULI AGS VIT A SEP OKT NOV DES KET

M/B
BB TIAP BULAN

MEI JUN JULI AGS VIT A SEP OKT NOV DES KET

M/B
P

3/8/2016 61

3/8/2016 58

3/8/2016 50

3/8/2016 53

3/8/2016 52

3/8/2016 48

3/8/2016 46

3/8/2016 45

3/8/2016 37

3/8/2016 36

3/8/2016 27

3/8/2016 36

3/8/2016 26

3/8/2016 25

3/8/2016 24

3/8/2016 23

3/8/2016 22

3/8/2016 21

3/8/2016 18

3/8/2016 18

3/8/2016 17

3/8/2016 16
P

3/8/2016 15

3/8/2016 14

3/8/2016 11

3/8/2016 9

3/8/2016 7

3/8/2016 3

3/8/2016 3
HASIL PENIMBANGAN BALITA DI POSYA

Nama Posyandu :
Alamat : PAWANG KUYIT 1

2=Non
Gakin
No Nama Balita L/P Tgl Lahir Nama Orang tua

1=Gakin
JAN PEB VIT A MAR APR

M/B

1 KEFIN ALGAFARI L 1/18/2011

2 USNUL HOTIMAH P 1/7/2011

3 YUDA PRATAMA L 1/7/2011

4 Denda BENING WALADE P 10/10/2011

5 YUNI ALPIAN P 4/11/2012

6 M.PARIS MALOBI L 4/22/2012

7 PIOLA AGUSTINA P 8/26/2012

8 YAYAN ALPATIN L 10/27/2012

9 HAPId ISBULLAH L 9/3/2014

10 HULFA YANI P 4/25/2014

11 GINA AGUSTINA P 3/11/2013

12 M.Yasir L 5/21/2013

13 M.YAZID L 5/21/2013

14 DANIL ANDIKA L 3/20/2013

15 WALID L 9/26/2013

16 M.ANIL MUZAKI L 4/26/2013

17 FINO ANANTA L 10/28/2013

18 WAHYU ALI MAHPUS L 11/18/2013

19 DAFI HULIDA AZIZ L 12/30/2014

20 ICA RAHMA AULIA P 2/13/2014

21 LALU GIAN MAHENDRA L 3/4/2014

22 DIFA WAHYUNI P 6/26/2014


2=Non
Gakin
No Nama Balita L/P Tgl Lahir Nama Orang tua

1=Gakin
JAN PEB VIT A MAR APR

M/B

23 AuLIA OKTAFINA P 10/1/2014

24 DIMAS ALIANDO L 11/25/2014

25 M.RAFA AZKA L 11/27/2014

26 DEVI AULIA P 1/29/2015

27 AULIA DEVITA HANDAYANI P 1/4/2015

28 NAZWA KHAIRA CAHYANI P 5/17/2015

29 BENI BAEHAKI L 4/27/2015

30 DAFA MAULANA L 7/18/2015

31 ALI AKBAR L 8/14/2015

32 DEVA MISFARA P 12/3/2015

33 ZAHIRATUL AINI P 12/7/2015

34

35

36

37

38

39

40

41

42

43

44

45

46

47

48
2=Non
Gakin
No Nama Balita L/P Tgl Lahir Nama Orang tua

1=Gakin
JAN PEB VIT A MAR APR

M/B

49

50

51

52

53

54

55

56

57

58

59

60

61

62

63

64

65

66

67

68

69

70

71

72

73

74
2=Non
Gakin
No Nama Balita L/P Tgl Lahir Nama Orang tua

1=Gakin
JAN PEB VIT A MAR APR

M/B

75

76

77
AN BALITA DI POSYANDU

BB TIAP BULAN

MEI JUN JULI AGS VIT A SEP OKT NOV DES KET

M/B
BB TIAP BULAN

MEI JUN JULI AGS VIT A SEP OKT NOV DES KET

M/B
BB TIAP BULAN

MEI JUN JULI AGS VIT A SEP OKT NOV DES KET

M/B
BB TIAP BULAN

MEI JUN JULI AGS VIT A SEP OKT NOV DES KET

M/B
P

3/8/2016 61

3/8/2016 62

3/8/2016 62

3/8/2016 52

3/8/2016 46

3/8/2016 46

3/8/2016 42

3/8/2016 40

3/8/2016 18

3/8/2016 22

3/8/2016 35

3/8/2016 33

3/8/2016 33

3/8/2016 35

3/8/2016 29

3/8/2016 34

3/8/2016 28

3/8/2016 27

3/8/2016 14

3/8/2016 24

3/8/2016 24

3/8/2016 20
P

3/8/2016 17

3/8/2016 15

3/8/2016 15

3/8/2016 13

3/8/2016 14

3/8/2016 9

3/8/2016 10

3/8/2016 7

3/8/2016 6

3/8/2016 3

3/8/2016 3
HASIL PENIMBANGAN BALITA DI POSYA

Nama Posyandu :
Alamat : MUNDER

2=Non
Gakin
No Nama Balita L/P Tgl Lahir Nama Orang tua

1=Gakin
JAN PEB VIT A MAR APR

M/B

1 KADEK KUSUMA L 6/26/2011

2 RISKI MAULANA L 6/29/2011

3 SALINI P 8/30/2011

4 OPENDI L 9/9/2011

5 WINDA WULANDARI P 12/3/2011

6 PUTU PRAJAYA L 1/1/2012

7 ANDIKA PRATAMA L 2/12/2012

8 ALPIN L 4/17/2012

9 DANU ARDANA L 6/6/2012

10 ALPINA AULIA P 7/26/2012

11 DODI L 12/12/2012

12 INDRIANTO L 2/3/2013

13 ADELIA ZAHARA P 2/14/2014

14 RONA DEWI P 3/9/2012

15 MEI HENDRA L 5/21/2013

16 PUTU KRISNA BAYU L 6/30/2013

17 TONI DINATA L 7/8/2013

18 ROBI IRAWAN L 8/31/2013

19 KADEK PIKA KONARI P 10/3/2013

20 DELIA FERISKA P 6/5/2014

21 ZASKIA P 8/3/2014

22 GILANG L 9/8/2014
2=Non
Gakin
No Nama Balita L/P Tgl Lahir Nama Orang tua

1=Gakin
JAN PEB VIT A MAR APR

M/B

23 LUH CITRA P 9/3/2014

24 REZA FAHRIZI L 10/13/2014

25 DILATUL AENI P 2/15/2015

26 AMELIA P 1/25/2015

27 ALDIMAN L 4/7/2015

28 DANIL ARILANDO L 4/19/2015

29 ARTANA L 4/20/2015

30 RISKO AMANDANA L 6/18/2015

31 RAMADANA L 6/18/2015

32 ALDA L 7/30/2015

33 ZAHARATUL AINI P 8/7/2015

34 RIAN AFANDI L 9/14/2013

35 RISMA AGUSTIN P 8/18/2013

36

37

38

39

40

41

42

43

44

45

46

47

48
2=Non
Gakin
No Nama Balita L/P Tgl Lahir Nama Orang tua

1=Gakin
JAN PEB VIT A MAR APR

M/B

49

50

51

52

53

54

55

56

57

58

59

60

61

62

63

64

65

66

67

68

69

70

71

72

73

74
2=Non
Gakin
No Nama Balita L/P Tgl Lahir Nama Orang tua

1=Gakin
JAN PEB VIT A MAR APR

M/B

75

76

77
N BALITA DI POSYANDU

BB TIAP BULAN

MEI JUN JULI AGS VIT A SEP OKT NOV DES KET

M/B
BB TIAP BULAN

MEI JUN JULI AGS VIT A SEP OKT NOV DES KET

M/B
BB TIAP BULAN

MEI JUN JULI AGS VIT A SEP OKT NOV DES KET

M/B
BB TIAP BULAN

MEI JUN JULI AGS VIT A SEP OKT NOV DES KET

M/B
P

3/8/2016 56

3/8/2016 56

3/8/2016 54

3/8/2016 53

3/8/2016 51

3/8/2016 50

3/8/2016 48

3/8/2016 46

3/8/2016 45

3/8/2016 43

3/8/2016 38

3/8/2016 37

3/8/2016 24

3/8/2016 47

3/8/2016 33

3/8/2016 32

3/8/2016 32

3/8/2016 30

3/8/2016 29

3/8/2016 21

3/8/2016 19

3/8/2016 18
P

3/8/2016 18

3/8/2016 16

3/8/2016 12

3/8/2016 13

3/8/2016 11

3/8/2016 10

3/8/2016 10

3/8/2016 8

3/8/2016 8

3/8/2016 7

3/8/2016 7

3/8/2016 29

3/8/2016 30
HASIL PENIMBANGAN BALITA DI POSYA

Nama Posyandu :
Alamat ;BELENCONG

2=Non
Gakin
No Nama Balita L/P Tgl Lahir Nama Orang tua

1=Gakin
JAN PEB VIT A MAR APR

M/B

1 REZA ADIPUTRA L 5/15/2010 HERMAN / YANTI KUSUMA 16.6

2 OFAN AZMI L 5/20/2011 JAMALUDIN / SARTINE 15.0

3 LAELI PURNIA P 7/7/2011 SIRMAWATI / FURIAH 16.5

4 PAREL RAMDANI L 8/28/2011 SAMSUDIN / NENSANEP 11.7

5 ANJAS WIDODO L 11/30/2011 SURIANEP / SERIANTI 15.0

6 SARTINI P 10/10/2011 SITRAWALI / MURTINEP 14.0

7 EDVIN HARDIONO L 12/21/2011 SAFRUDIN / HARTINI 15.8

8 DIANA NOPITA P 2/24/2012 BAYATI / MASYATUN 15.0

9 DEA SASKIA P 2/26/2012 NUTRASIH / KARIATUN 17.0

10 YALA AOLIA P 10/26/2012 PAOJAN / NURJANAH 12.3

11 DAFIT WAHYUDI L 12/24/2012 MAHYUDIN / ANAH 16.0

12 JIHAN PAZILA P 7/17/2013 AJAHARUDIN / JOHARIAH 9.1

13 PEBIN L 10/1/2013 SUHARTONO / ASNIAH 12.0

14 ARPANDI L 4/6/2013 HARWADI / SARTINEP 10.2

15 EPA PATMASARI P 10/6/2013 MISWADI / SARINI 11.0

16 OPIA PUSPITA P 10/25/2013 ISNAINI / PITRI 12.0

17 PUTU PERDANA YASA L 9/29/2013 NGH NARSO / KD SURIANTINI 12.0

18 ADELINA NATASIA P 2/9/2014 MAHNUM 10.5

19 YUNA APRILIA SOLEHA P 4/30/2014 MISTANEP / ASIAH 10.0

20 RENO RAMANDIKA L 2/10/2014 SAPARWADI / SAMIZAH 10.0

21 IBRAHIM AL BAYANI L 4/7/2014 KAIM / NURBAYANI 10.1

22 RAPA BULJABRAN L 5/8/2014 KARMADI / DINI HANDAYANI 10.4


2=Non
Gakin
No Nama Balita L/P Tgl Lahir Nama Orang tua

1=Gakin
JAN PEB VIT A MAR APR

M/B

23 LESTI JULIANA P 7/7/2014 HAMNAN / SEKYAH 9.0

24 DANIL RAMDANI L 7/22/2014 DANA SEPRIANTO / PURNAWATI 9.1

25 PAJILA LAPIA P 8/16/2014 SUPRIANTO / SURTIP 10.0

26 EKA SEPTI AMELIA P 9/7/2014 HAERUL ANWAR / NURHASANAH 9.3

27 HAPIS ALJAILANI L 10/2/2014 MAESUDIN / RASMIN 11.2

28 SOPI SELPIA P 10/9/2014 BAYATI / MASYATUN 9.0

29 DEWI TANIA P 12/25/2014 AWALUDIN / ENISULASTRI 9.0

30 NIZZAM ALHALIF L 2/27/2015 MASHURI / ASTI KAMAH 10.0

31 NIKA YUPITA P 4/6/2015 JUMANEM / SURYANI 9.0

32 RISKA APRILIA L 4/12/2015 M. RIZAL / SANTIKA 6.0

33 HABIB AZKA PRANATA L 5/26/2015 JUNAIDI / TITIN AGUSTINA 9.4

34 NAMIA KAILA ARMA DANI P 7/14/2015 SUPARMAN / DEWI HERMA DIANA 8.3

35 KARISATUL AZIZAH P 9/18/2015 SUKADI / SARINEP 6.7

36

37

38

39

40

41

42

43

44

45

46

47

48
2=Non
Gakin
No Nama Balita L/P Tgl Lahir Nama Orang tua

1=Gakin
JAN PEB VIT A MAR APR

M/B

49

50

51

52

53

54

55

56

57

58

59

60

61

62

63

64

65

66

67

68

69

70

71

72

73

74
2=Non
Gakin
No Nama Balita L/P Tgl Lahir Nama Orang tua

1=Gakin
JAN PEB VIT A MAR APR

M/B

75

76

77
BALITA DI POSYANDU

BB TIAP BULAN

MEI JUN JULI AGS VIT A SEP OKT NOV DES KET

M/B
BB TIAP BULAN

MEI JUN JULI AGS VIT A SEP OKT NOV DES KET

M/B
BB TIAP BULAN

MEI JUN JULI AGS VIT A SEP OKT NOV DES KET

M/B
BB TIAP BULAN

MEI JUN JULI AGS VIT A SEP OKT NOV DES KET

M/B
P

3/8/2016 69

3/8/2016 57

3/8/2016 56

3/8/2016 54

3/8/2016 51

3/8/2016 52

3/8/2016 50

3/8/2016 48

3/8/2016 48

3/8/2016 40

3/8/2016 38

3/8/2016 31

3/8/2016 29

3/8/2016 35

3/8/2016 29

3/8/2016 28

3/8/2016 29

3/8/2016 24

3/8/2016 22

3/8/2016 24

3/8/2016 23

3/8/2016 22
P

3/8/2016 20

3/8/2016 19

3/8/2016 18

3/8/2016 18

3/8/2016 17

3/8/2016 16

3/8/2016 14

3/8/2016 12

3/8/2016 11

3/8/2016 10

3/8/2016 9

3/8/2016 7

3/8/2016 5
HASIL PENIMBANGAN BALITA DI POSYA

Nama Posyandu :
Alamat ;JERUJU

2=Non
Gakin
No Nama Balita L/P Tgl Lahir Nama Orang tua

1=Gakin
JAN PEB VIT A MAR APR

M/B

1 KHAERUNNISA P 7/3/2011 SELAMET/SITI

2 AULIA P 7/30/2011 SAHRI/HADIJAH

3 WIDYA SAFITRI P 9/9/2011 SUKIAWAN/MUSTIKA

4 ZAKITUN A. P 12/31/2011 KIRTUDI/HUMAINI

5 M.RIFKI IRAWAN L 1/31/2012 MUNAWIR/MARYUN

6 M.ZULFAN A. L 1/21/2012 SUARDI/SUKIAH

7 M.ROBBANI L 2/11/2012 MAS'UN/SAPIYAN

8 M.RIDWAN L 4/30/2012 MASJUDIN/SIRAH

9 HAFIZATUL ILMI P 6/1/2012 SUKANDI/MUKMINAH

10 M.HAZIQ A. L 6/3/2012 HERNAWAN/DIAN R

11 IRFAN HADI L 7/8/2012 MASRUN/MULIANA

12 SINTA P 6/8/2012 DIPA/SITI A

13 WAHYU AIDIL A. L 10/26/2012 ZAENAL/MAKNAH

14 MUTIA LESTARI P 11/1/2012 HERMAN/HAERIYAH

15 RAPITA MARDIANA L 3/4/2013 ISLAHUDIN/ANIP

16 AYU JUWITA P 2/1/2013 H.M.ILHAM/SAKMAH

17 M.ULUL AZMI L 8/4/2013 SYAWAL/AISYAH

18 LAURA CITRA L. P 8/17/2013 SALAHUDIN/MARIAH

19 ZIDATUL H. L 10/26/2013 AHYAR/ZAETUN

20 NAJWATUL W. P 11/16/2013 AHMAD IKNO/MARYAM

21 ZAHRA M. P 1/13/2014 MUJTAHDIN/MUHARTIN

22 REZA ALFIANSAH L 1/14/2014 MULTAZAM/HAERANAH


2=Non
Gakin
No Nama Balita L/P Tgl Lahir Nama Orang tua

1=Gakin
JAN PEB VIT A MAR APR

M/B

23 ALBIN ARKANADIN L 7/7/2014 HAMRUDIN/JOHANA

24 SILVIA S. P 10/21/2014 MAHIRUDIN/SUCIANI

25 SILVIA ANITA P 6/6/2015 ISLAHUDIN/ANIP

26 M.ILHAM FATONI L 5/5/2012 JAMALUDIN/RAMLAH

27 SAEHUL AFZAN L 11/15/2015 SABIRIN/SUHAELAN

28 NOVITASARI P 6/19/2015 SUNIADI/MULYATUN

29

30

31

32

33

34

35

36

37

38

39

40

41

42

43

44

45

46

47

48
2=Non
Gakin
No Nama Balita L/P Tgl Lahir Nama Orang tua

1=Gakin
JAN PEB VIT A MAR APR

M/B

49

50

51

52

53

54

55

56

57

58

59

60

61

62

63

64

65

66

67

68

69

70

71

72

73

74
2=Non
Gakin
No Nama Balita L/P Tgl Lahir Nama Orang tua

1=Gakin
JAN PEB VIT A MAR APR

M/B

75

76

77
AN BALITA DI POSYANDU

BB TIAP BULAN

MEI JUN JULI AGS VIT A SEP OKT NOV DES KET

M/B
BB TIAP BULAN

MEI JUN JULI AGS VIT A SEP OKT NOV DES KET

M/B
BB TIAP BULAN

MEI JUN JULI AGS VIT A SEP OKT NOV DES KET

M/B
BB TIAP BULAN

MEI JUN JULI AGS VIT A SEP OKT NOV DES KET

M/B
P

3/8/2016 56

3/8/2016 55

3/8/2016 53

3/8/2016 50

3/8/2016 49

3/8/2016 49

3/8/2016 48

3/8/2016 46

3/8/2016 45

3/8/2016 45

3/8/2016 44

3/8/2016 45

3/8/2016 40

3/8/2016 40

3/8/2016 36

3/8/2016 37

3/8/2016 31

3/8/2016 30

3/8/2016 28

3/8/2016 27

3/8/2016 25

3/8/2016 25
P

3/8/2016 20

3/8/2016 16

3/8/2016 9

3/8/2016 46

3/8/2016 3

3/8/2016 8
FORMULIR PENDATAAN SASARAN BALITA ( 0-59 BULAN) PIN POLIO TAHUN 2016

DESA : Mumbul Sari


PUSKESMAS : Bayan
KAB/KOTA : Lombok Utara

UMUR
NO NAMA ANAK L/P NAMA ORANG TUA ALAMAT
(BLN)

1 AQILA IMANNA HANIPA P 59 MUMBUL SARI


2 RIKI MAULANA L 58 MUMBUL SARI
3 JAYA KUSUMA L 56 MUMBUL SARI
4 DAHMAN HAKIM L 56 MUMBUL SARI
5 AL HIDAYAH P 55 MUMBUL SARI
6 HAIRIL GUSLAFI IMAM L 55 MUMBUL SARI
7 YUDANI L 51 MUMBUL SARI
8 SOLIHIN L 52 MUMBUL SARI
9 ALIYA SAFA GANESSA P 52 MUMBUL SARI
10 DANI RAPLI SANJAYA L 51 MUMBUL SARI
11 YUSUF UBAIDILLAH L 51 MUMBUL SARI
12 JIDAN PRATAMA L 48 MUMBUL SARI
13 YUNA LESTARI P 46 MUMBUL SARI
14 KERTI SARI P 46 MUMBUL SARI
15 HARIYADI L 45 MUMBUL SARI
16 ASYIPA AYU LESTARI P 43 MUMBUL SARI
17 DESITA APRIANI P 39 MUMBUL SARI
18 TRY ANDIKA PRATAMA L 30 MUMBUL SARI
19 HAWAITUN AULIA P 33 MUMBUL SARI
20 ALIYA DESTI P 26 MUMBUL SARI
21 YODNI L MUMBUL SARI
22 MUHAMAD SAUMIL AK L 31 MUMBUL SARI
23 AHMAD ZUANDI L 27 MUMBUL SARI
24 LENI APRIANA P 34 MUMBUL SARI
25 IYAN FIKRI L 24 MUMBUL SARI
26 DINI ARTIKA P 24 MUMBUL SARI
27 SESI ANGGRENI P 21 MUMBUL SARI
28 HAIKAL FIKRI L MUMBUL SARI
29 GUSNIA P 18 MUMBUL SARI
30 ZIVANA LESTIA ANINDI P 17 MUMBUL SARI
31 ASMAUL HUSNA YAHYA L 16 MUMBUL SARI
32 KARTIKA PUTRI P MUMBUL SARI
33 DESTA SASTRA WIGUNA L 6 MUMBUL SARI
34 DAVID F L 3 MUMBUL SARI
35 AFIFA ZAHRATUL QOLBI P 4 MUMBUL SARI
HUN 2016

KET
FORMULIR PENDATAAN SASARAN BALITA ( 0-59 BULAN) PIN POLIO TAHUN 2016

DESA : Mumbul Sari


PUSKESMAS : Bayan
KAB/KOTA : Lombok Utara

UMUR
NO NAMA ANAK L/P NAMA ORANG TUA ALAMAT
(BLN)

1 RINDIANI P 64 LOKOK MUMBUL


2 YENI SEPTIANA P 64 LOKOK MUMBUL
3 ZULFIAN HADI L 63 LOKOK MUMBUL
4 HERIL AZMI L 63 LOKOK MUMBUL
5 BQ.RENA P 62 LOKOK MUMBUL
6 REFAN S L 62 LOKOK MUMBUL
7 MAUDATUL HUSNA P 61 LOKOK MUMBUL
8 MAULANA L 61 JUMAIDI/YANTI LOKOK MUMBUL
9 RANI KARMILA P 60 RATSADI / DEBUK LOKOK MUMBUL
10 SUSAN MAULINA P 60 MARIANEM/RABINEM LOKOK MUMBUL
11 SYAHIBUL AMRIL L 58 NURBAYA /SINGAYU LOKOK MUMBUL
12 NAZIA AULIA P 59 LOKOK MUMBUL
13 APRILIA P 58 LOKOK MUMBUL
14 LAURA LESTARI P 57 LOKOK MUMBUL
15 REHAN L 57 H. SUMARDI/WARNI LOKOK MUMBUL
16 EBI ELIZA P 56 SABRI/RATMINEM LOKOK MUMBUL
17 MUHAMAD SAHRIL ALPI L 55 LOKOK MUMBUL
18 REFAL HAMDANI L 55 LOKOK MUMBUL
19 AGUS RAMDANI L 54 ZAENUDIN/RIANIK LOKOK MUMBUL
20 NANDA HIDAYAT L 54 LOKOK MUMBUL
21 JOHANDA L 53 SUHARMAN / RONI LOKOK MUMBUL
22 JULIADI L 50 AGUS MAYA/DAYANG LOKOK MUMBUL
23 IKLIUMA AZIZA P 50 LOKOK MUMBUL
24 VELIONA P 50 PENDI/DESI LOKOK MUMBUL
25 AFRILIANI P 47 RATMADI / AYU S LOKOK MUMBUL
26 GIO SEPTIADAI L 46 LOKOK MUMBUL
27 EVA APRIANI P 46 ARDAN/RASIANIM LOKOK MUMBUL
28 DWE.GEDE VERIKA L 46 DW GDE RAI LOKOK MUMBUL
29 HENDI L 45 LOKOK MUMBUL
30 AMELIA SANTIKA P 45 HERMADI/BILHAIRI LOKOK MUMBUL
31 OLITA UTARI P 44 LOKOK MUMBUL
32 AHMAD PARMIN L 44 SUPAR/ SINTEN LOKOK MUMBUL
33 ADE ADIANTARA L 44 LOKOK MUMBUL
34 RIDO JUANA L 43 LOKOK MUMBUL
35 DIMA AZLI L 43 LOKOK MUMBUL
36 HAIDIL ABADI L 43 LOKOK MUMBUL
37 YULIANDITO L 44 SANEM/RUK LOKOK MUMBUL
38 RIKO SETIAWAN L 42 LOKOK MUMBUL
39 L. ABIMANYU L 42 HAMDAN KARTINI LOKOK MUMBUL
40 ABDUL KHOLID L 42 LOKOK MUMBUL
41 AHMAD RIFAL L 42 ZEPRI/ US LOKOK MUMBUL
42 DELISA PUTRI 39 RENDI/SENIATI LOKOK MUMBUL
43 ANDIKA L 38 LOKOK MUMBUL
44 ADES L 39 LOKOK MUMBUL
45 BQ. ISRO P 37 ARPAN/SITI LOKOK MUMBUL
46 ARINI FADILA L 37 LOKOK MUMBUL
47 LIANA ULANDARI P 36 EMA/YULI LOKOK MUMBUL
48 VEKI JOKOWI L 32 RIDWAN/SAMINGEN LOKOK MUMBUL
49 BAGAS L 31 SUPRI/NURHAINI LOKOK MUMBUL
50 VITRI P 30 ISNAWADI/SULIA LOKOK MUMBUL
51 VONIA ANTIKA P 29 SUKMAWA/SITI LOKOK MUMBUL
52 NABILA L P 29 HERMADI/SANIM LOKOK MUMBUL
53 IHSAN HADINATA L 30 LOKOK MUMBUL
54 MELDA P 30 GUNARI LOKOK MUMBUL
55 BOY L 28 SADOT/NUR LOKOK MUMBUL
56 HAIRUL FAHMI L 27 LOKOK MUMBUL
57 ALFIAN HABIB L 26 LOKOK MUMBUL
58 AJWI ALISA PUTRI P 26 LOKOK MUMBUL
59 HENDI ADRIAN L 27 LOKOK MUMBUL
60 PUTRI KALIMANJA P 26 LOKOK MUMBUL
61 JUD P 37 LOKOK MUMBUL
62 AHZADANI L 23 JUMADIL/ETIK LOKOK MUMBUL
63 PADIL GIO L 23 LOKOK MUMBUL
64 MAURADIPATUL H L 21 LOKOK MUMBUL
65 CIKA AMELIA P 21 LOKOK MUMBUL
66 YUNITA P 20 LOKOK MUMBUL
67 WENDI SAPUTRA L 20 ADAM/RAMIO LOKOK MUMBUL
68 BAYU ADINATA L 20 LOKOK MUMBUL
69 KAILA M L 19 LOKOK MUMBUL
70 SOPIAN HADI L 18 SUPIANA/HENI LOKOK MUMBUL
71 IFTINA P 17 RASIMAH/NURHAYATI LOKOK MUMBUL
72 DIFA GHALI ANANDA P 15 MASUDIN/NURUL LOKOK MUMBUL
73 AMELIA PUTRI P 15 LOKOK MUMBUL
74 FADILA SUHAINI P 13 LOKOK MUMBUL
75 AL KAUSAR L 10 ADI S/ YULI LOKOK MUMBUL
76 ALBY ONERA E L 10 LOKOK MUMBUL
77 APRILIA PATIR R P 10 LOKOK MUMBUL
78 AKIYA APRILIA P 10 LOKOK MUMBUL
79 NI NENGAH AYU W P 8 LOKOK MUMBUL
80 HARFAN RAMDANI L LOKOK MUMBUL
81 YULFA SAPUTRI P 8 LOKOK MUMBUL
82 ALFAD FAEZAN L 8 LOKOK MUMBUL
83 NUNUNG ALIFA P 7 ZULFANDI/MARTINI LOKOK MUMBUL
84 EGI ADRIAN L 7 LASMADI/LIASARI LOKOK MUMBUL
85 DEA AULIA ANANDA P 6 H. SUMARDI/ ZURIATI LOKOK MUMBUL
86 NINA SUSILAWATI P 8 LOKOK MUMBUL
87 YAHYA ALGOJALI L 5 JUMAIDI/YANTI LOKOK MUMBUL
88 CICI AGUSTIN P 6 LOKOK MUMBUL
89 DESTA RIADI L LOKOK MUMBUL
90 SAFA NAZLI L 2 LOKOK MUMBUL
91 KELUM L 46 ALIASMAN / NURSAKMAH LOKOK MUMBUL
TAHUN 2016

KET
FORMULIR PENDATAAN SASARAN BALITA ( 0-59 BULAN) PIN POLIO TAHUN 2016

DESA : Mumbul Sari


PUSKESMAS : Bayan
KAB/KOTA : Lombok Utara

UMUR
NO NAMA ANAK L/P NAMA ORANG TUA ALAMAT
(BLN)

1 AFIFA FATIA P 20 PENGADANG


2 RIKO RIPANDI L 21 PENGADANG
3 UMAEDI SAPUTRA L 22 PENGADANG
4 GIPARI L 22 PENGADANG
5 ULPA APRIANTI P 23 PENGADANG
6 SITI MAESARAH P 22 PENGADANG
7 M.FIKRI GOZALI L 26 PENGADANG
8 PIPI AULIA ZAHRON P 25 PENGADANG
9 DESTI AURA P 26 PENGADANG
10 ANISA RUHMANIA P 27 PENGADANG
11 AIFA IKDAN HUSNA P 27 PENGADANG
12 HILAL APRIAN L 34 PENGADANG
13 LAILATUL HIKMAH P 33 PENGADANG
14 IZWAN HAEIPIT L 34 PENGADANG
15 HAIRUL HABIDI L 35 PENGADANG
16 ANDIAK YUSRON L 36 PENGADANG
17 ALPIN MAULANA L 39 PENGADANG
18 NOVITA ISTIKOMAH P 39 PENGADANG
19 KAELA KARYATUL P 44 PENGADANG
20 EPI ULANDARI P 45 PENGADANG
21 ZAMBARILAULA P 45 PENGADANG
22 M ARIPIN L 47 PENGADANG
23 RAI ADRIAN L 47 PENGADANG
24 ALPIN MAULANA L 39 PENGADANG
25 ROKYAL P 53 PENGADANG
26 AZILA SELPIANI P 55 PENGADANG
27 HALIL MUZADIN L 55 PENGADANG
28 M, AHADAN MUSARI L 58 PENGADANG
29 HASFI MAULANA L 59 PENGADANG
30 FITRI HANDAYANI P 61 PENGADANG
31 M, HAIRUL HAKIKI L 51 PENGADANG
32 FAHRIZAL L 51 PENGADANG
33 AZALIA AYUNABILA P 22 PENGADANG
34 OLIPIA PUTRI P 8 PENGADANG
35 IZWAINI P 20 PENGADANG
36 HIPZAH DEWISASMITA P 18 PENGADANG
37 SAHRIL ARIS L 19 PENGADANG
38 AMIRA SYAZWANI KAR P 17 PENGADANG
39 FIKI ARLENA P 19 PENGADANG
40 M, RENDI L 19 PENGADANG
41 AULIA ULANDARI P 15 PENGADANG
42 M. ZAINUL L 14 PENGADANG
43 GEZA PRATAMA L 13 PENGADANG
44 DAPA AZIZI L 14 PENGADANG
45 HIKMATUL AULIA P 12 PENGADANG
46 MOZA ADITIA L 14 PENGADANG
47 ALIPA APRIANA P 10 PENGADANG
48 AJI BURAHMAN L 14 PENGADANG
49 M. TOLIP L 9 PENGADANG
50 SUCI MURI P 8 PENGADANG
51 FARIH NAJIHIY L 6 PENGADANG
52 FARIHA NAJIHA P 6 PENGADANG
53 IQBAL L 26 PENGADANG
54 QHOIRIL L 2 PENGADANG
55 NAZIFUL HAIRI L 4 PENGADANG
TAHUN 2016

KET
FORMULIR PENDATAAN SASARAN BALITA ( 0-59 BULAN) PIN POLIO TAHUN 2016

DESA : Mumbul Sari


PUSKESMAS : Bayan
KAB/KOTA : Lombok Utara

UMUR
NO NAMA ANAK L/P NAMA ORANG TUA ALAMAT
(BLN)

1 ITRIA SIFAYANI P 58 MAHRIF/ YANIK LOKOK REBAN


2 ZULIADI L 55 R NURJANTO/SITI AMINAH LOKOK REBAN
3 WILDAN P. L 55 SAHID/NURHALIMAH LOKOK REBAN
4 NOVAN SATRAWAN L 51 SUPAR/ODAH LOKOK REBAN
5 EDI ADRIAN L 51 RUPI/SUTIANIM LOKOK REBAN
6 LISA AMELIA P 49 M. NASIR/ISAH LOKOK REBAN
7 B. CITRA LESTARI P 49 RAHMAN/RENI LOKOK REBAN
8 NAYA KANZA AFIKA L 46 HADI MARDIAN/IRMAYATI LOKOK REBAN
9 ALFANDI AZRIL R L 45 SAHLAN/SAINI LOKOK REBAN
10 SWI AMELIA P 44 MISTANOM / TITIN LOKOK REBAN
11 HIDAYAT RAMDAN L 43 YUDI/ NURUL LOKOK REBAN
12 RAYA AMELIA P 43 SUPARDI/MARLINA LOKOK REBAN
13 SAHIDIN L 42 DAHAM/MARNIATI LOKOK REBAN
14 B, SITI AZIZAH P 41 L TAKWAN/MUTMAINAH LOKOK REBAN
15 M. OPAN HAKIKI L 42 MUKSAN / ANI LOKOK REBAN
16 RISKA IRMAYANI P 40 SUHIRMAN/ HAERANI LOKOK REBAN
17 KENDI L 40 ASNADI/SAINI LOKOK REBAN
18 KEYSA OKTAVIANA P 41 SISWADI/IRMAYATI LOKOK REBAN
19 ALWI PIRMAN M. P 37 USMAN HADI/DEWI BAYANI LOKOK REBAN
20 KARIMATUS S. P 36 HAERUL/ELI SUKMAWATI LOKOK REBAN
21 AFIFA P. P 35 HERMAN/SAFAIYAH LOKOK REBAN
22 JULIA RAFA PRATAMA L 35 JUNAIDI/NURLINDA LOKOK REBAN
23 ABDI SUHAMDI L 33 UMAR/ROHANI LOKOK REBAN
24 JULIANA M. L 34 KARIAWAN/JANAH LOKOK REBAN
25 M.K NITYA SARI P 29 AGUS GUNARTA/KADEK LOKOK REBAN
26 SINTIYA DEWI P 26 KAMAL/MURIATIP LOKOK REBAN
27 M. IHWAN JULIANTO L 32 ANTO/SALMIAH LOKOK REBAN
28 ALIF ZIADUL A. L 32 WIRA SUBARMAN/RAUHUN LOKOK REBAN
29 DIKA PRATAMA L 29 SAHDAN/ATI LOKOK REBAN
30 IRFANSAH L 58 ZULKARNAEN/ROSIDA LOKOK REBAN
31 HERA AFSERA P 39 SUPRIADI/SARMINI LOKOK REBAN
32 ATIKA REHAN N. P 27 SARIUN/SUMIATI LOKOK REBAN
33 ILAJMIA SAJIDA AS P 26 ARMAN/RENI LOKOK REBAN
34 NURULAINI P 25 M SABAR/NURHASANAH LOKOK REBAN
35 AIRIN NISMARA A. P 17 HADI SUSANTO/ROHAYANI LOKOK REBAN
36 DIAS RIZMATUL IZMA L 16 RODIANSAH/ASTINI LOKOK REBAN
37 PRISKA HUMAIRAH P 24 SAEDUL / NURHAYATI LOKOK REBAN
38 DANU NATA INSANUL N L 14 ISKANDAR/ MAESARAH LOKOK REBAN
39 JIHAN SAFA AMALA L 2 LOKOK REBAN
40 AHMAD FATIH ALHABSI L ALIFTRIYATMONO/NURISNAINI LOKOK REBAN
41 M, AZMI MAULANA L LOKOK REBAN
42 AZAM FAHRIZI L LOKOK REBAN
43 YAOMI AZKA FITRI P LOKOK REBAN
44 ELFA SABILA P 7 LOKOK REBAN
45 M.AZAM FARIZI L LOKOK REBAN
46 ZIRA SELFIANA P 5 LOKOK REBAN
47 ELA SOFIA P 6 LOKOK REBAN
48 IDA INAYA P 4 LOKOK REBAN
49 AINUN MULIANI P 8 LOKOK REBAN
AHUN 2016

KET
FORMULIR PENDATAAN SASARAN BALITA ( 0-59 BULAN) PIN POLIO TAHUN 2016

DESA : Mumbul Sari


PUSKESMAS : Bayan
KAB/KOTA : Lombok Utara

UMUR
NO NAMA ANAK L/P NAMA ORANG TUA ALAMAT
(BLN)

1 NADHIFA HUNAIRA P 61 TAUPIQURAHMAN/YUNITA PW. KUNYIT II


2 MAR,ATUN BAYANI P 58 JULKANAEN/HJ MARIANI PW. KUNYIT II
3 LISNAWATI P 50 MARZUKI/SRI PW. KUNYIT II
4 SAPATUL EINI P 53 MARSUDIN /SIFAIYAH PW. KUNYIT II
5 HENDRI KURNIAWAN L 52 SAPURI/SAPURI PW. KUNYIT II
6 AZMI MAZDUDIN RAIS L 48 ABDOLAH/ SANURIAH PW. KUNYIT II
7 NURUL AINI P 46 ASMADI/D WIRNI PW. KUNYIT II
8 FAHRU ROZI L 45 PARMAN/PILIATI PW. KUNYIT II
9 GUSTINA SILVIANI P 37 AGUS/SITI PW. KUNYIT II
10 RANGGA PRATAMA L 36 IWANDI/SARTINI PW. KUNYIT II
11 ALAN ALPALENDRA L 27 AHMADI/HJ NURSENA PW. KUNYIT II
12 EVA YANTI P 36 ANYAR/HJ FADILAH PW. KUNYIT II
13 EJI ALPARIJI P 26 IKMALUDIN/MARTINI PW. KUNYIT II
14 ALSYA AZZAHRA P 25 HERMAN/NURJANAH PW. KUNYIT II
15 ZAINMI MUZZAINUDIN L 24 AHMADI/MAENAH PW. KUNYIT II
16 M.NAUFAL KAISON L 23 TAUPIQURAHMAN/YUNITA PW. KUNYIT II
17 ZALLFA HUMAERA P 22 HERMATO/SARE'AH PW. KUNYIT II
18 ALPIAN MAULANA L 21 KARTONO/ASNAH PW. KUNYIT II
19 ZIYAD KHADURAHMAN L 18 FATHURAHMAN/SURNAH PW. KUNYIT II
20 AKIFAH NAILA P 18 BUDI/NURHASANAH PW. KUNYIT II
21 ULFA FARISA PUTRI P 17 MUNIRI/HJ SUHAR PW. KUNYIT II
22 AVINA AWAFA P 16 MARHUN/SUHARNI PW. KUNYIT II
23 INDA HAYATUL UHRA P 15 MAHKIN /MULIATI PW. KUNYIT II
24 DWI RAHAYU CAHYANI P 14 IBRAHIM/NASMIRAH PW. KUNYIT II
25 DAVIN ALI AL-FAHREZI L 11 DANANG/NOVISAGITA PW. KUNYIT II
26 YADZAN DIMAS CAHYADI L 9 AHMADI /MARZAN PW. KUNYIT II
27 ANGGUN OLIVIA P 7 MASHURI/YURNI PW. KUNYIT II
28 REVAN ALI SOPIAN L 3 SOPIAN/ERNAWATI PW. KUNYIT II
29 AIDATUL HAKIKI L 3 ABDL AZIS/NURHAYATI PW. KUNYIT II
AHUN 2016

KET
FORMULIR PENDATAAN SASARAN BALITA ( 0-59 BULAN) PIN POLIO TAHUN 2016

DESA : Mumbul Sari


PUSKESMAS : Bayan
KAB/KOTA : Lombok Utara

UMUR
NO NAMA ANAK L/P NAMA ORANG TUA ALAMAT
(BLN)

1 KEFIN ALGAFARI L 61 PW. KUNYIT I


2 USNUL HOTIMAH P 62 PW. KUNYIT I
3 YUDA PRATAMA L 62 PW. KUNYIT I
4 Denda BENING WALADE P 52 PW. KUNYIT I
5 YUNI ALPIAN P 46 PW. KUNYIT I
6 M.PARIS MALOBI L 46 PW. KUNYIT I
7 PIOLA AGUSTINA P 42 PW. KUNYIT I
8 YAYAN ALPATIN L 40 PW. KUNYIT I
9 HAPId ISBULLAH L 18 PW. KUNYIT I
10 HULFA YANI P 22 PW. KUNYIT I
11 GINA AGUSTINA P 35 PW. KUNYIT I
12 M.Yasir L 33 PW. KUNYIT I
13 M.YAZID L 33 PW. KUNYIT I
14 DANIL ANDIKA L 35 PW. KUNYIT I
15 WALID L 29 PW. KUNYIT I
16 M.ANIL MUZAKI L 34 PW. KUNYIT I
17 FINO ANANTA L 28 PW. KUNYIT I
18 WAHYU ALI MAHPUS L 27 PW. KUNYIT I
19 DAFI HULIDA AZIZ L 14 PW. KUNYIT I
20 ICA RAHMA AULIA P 24 PW. KUNYIT I
21 LALU GIAN MAHENDRA L 24 PW. KUNYIT I
22 DIFA WAHYUNI P 20 PW. KUNYIT I
23 AuLIA OKTAFINA P 17 PW. KUNYIT I
24 DIMAS ALIANDO L 15 PW. KUNYIT I
25 M.RAFA AZKA L 15 PW. KUNYIT I
26 DEVI AULIA P 13 PW. KUNYIT I
27 AULIA DEVITA HANDAYAN P 14 PW. KUNYIT I
28 NAZWA KHAIRA CAHYANI P 9 PW. KUNYIT I
29 BENI BAEHAKI L 10 PW. KUNYIT I
30 DAFA MAULANA L 7 PW. KUNYIT I
31 ALI AKBAR L 6 PW. KUNYIT I
32 DEVA MISFARA P 3 PW. KUNYIT I
33 ZAHIRATUL AINI P 3 PW. KUNYIT I
AHUN 2016

KET
FORMULIR PENDATAAN SASARAN BALITA ( 0-59 BULAN) PIN POLIO TAHUN 2016

DESA : Mumbul Sari


PUSKESMAS : Bayan
KAB/KOTA : Lombok Utara

UMUR
NO NAMA ANAK L/P NAMA ORANG TUA ALAMAT
(BLN)

1 KADEK KUSUMA L 56 MUNDER


2 RISKI MAULANA L 56 MUNDER
3 SALINI P 54 MUNDER
4 OPENDI L 53 MUNDER
5 WINDA WULANDARI P 51 MUNDER
6 PUTU PRAJAYA L 50 MUNDER
7 ANDIKA PRATAMA L 48 MUNDER
8 ALPIN L 46 MUNDER
9 DANU ARDANA L 45 MUNDER
10 ALPINA AULIA P 43 MUNDER
11 DODI L 38 MUNDER
12 INDRIANTO L 37 MUNDER
13 ADELIA ZAHARA P 24 MUNDER
14 RONA DEWI P 47 MUNDER
15 MEI HENDRA L 33 MUNDER
16 PUTU KRISNA BAYU L 32 MUNDER
17 TONI DINATA L 32 MUNDER
18 ROBI IRAWAN L 30 MUNDER
19 KADEK PIKA KONARI P 29 MUNDER
20 DELIA FERISKA P 21 MUNDER
21 ZASKIA P 19 MUNDER
22 GILANG L 18 MUNDER
23 LUH CITRA P 18 MUNDER
24 REZA FAHRIZI L 16 MUNDER
25 DILATUL AENI P 12 MUNDER
26 AMELIA P 13 MUNDER
27 ALDIMAN L 11 MUNDER
28 DANIL ARILANDO L 10 MUNDER
29 ARTANA L 10 MUNDER
30 RISKO AMANDANA L 8 MUNDER
31 RAMADANA L 8 MUNDER
32 ALDA L 7 MUNDER
33 ZAHARATUL AINI P 7 MUNDER
34 RIAN AFANDI L 29 MUNDER
35 RISMA AGUSTIN P 30 MUNDER
TAHUN 2016

KET
FORMULIR PENDATAAN SASARAN BALITA ( 0-59 BULAN) PIN POLIO TAHUN 2016

DESA : Mumbul Sari


PUSKESMAS : Bayan
KAB/KOTA : Lombok Utara

UMUR
NO NAMA ANAK L/P NAMA ORANG TUA ALAMAT
(BLN)

1 REZA ADIPUTRA L 69 HERMAN / YANTI KUSUMA BELENCONG


2 OFAN AZMI L 57 JAMALUDIN / SARTINE BELENCONG
3 LAELI PURNIA P 56 SIRMAWATI / FURIAH BELENCONG
4 PAREL RAMDANI L 54 SAMSUDIN / NENSANEP BELENCONG
5 ANJAS WIDODO L 51 SURIANEP / SERIANTI BELENCONG
6 SARTINI P 52 SITRAWALI / MURTINEP BELENCONG
7 EDVIN HARDIONO L 50 SAFRUDIN / HARTINI BELENCONG
8 DIANA NOPITA P 48 BAYATI / MASYATUN BELENCONG
9 DEA SASKIA P 48 NUTRASIH / KARIATUN BELENCONG
10 YALA AOLIA P 40 PAOJAN / NURJANAH BELENCONG
11 DAFIT WAHYUDI L 38 MAHYUDIN / ANAH BELENCONG
12 JIHAN PAZILA P 31 AJAHARUDIN / JOHARIAH BELENCONG
13 PEBIN L 29 SUHARTONO / ASNIAH BELENCONG
14 ARPANDI L 35 HARWADI / SARTINEP BELENCONG
15 EPA PATMASARI P 29 MISWADI / SARINI BELENCONG
16 OPIA PUSPITA P 28 ISNAINI / PITRI BELENCONG
17 PUTU PERDANA YASA L 29 NGH NARSO / KD SURIANTINI BELENCONG
18 ADELINA NATASIA P 24 MAHNUM BELENCONG
19 YUNA APRILIA SOLEHA P 22 MISTANEP / ASIAH BELENCONG
20 RENO RAMANDIKA L 24 SAPARWADI / SAMIZAH BELENCONG
21 IBRAHIM AL BAYANI L 23 KAIM / NURBAYANI BELENCONG
22 RAPA BULJABRAN L 22 KARMADI / DINI HANDAYANI BELENCONG
23 LESTI JULIANA P 20 HAMNAN / SEKYAH BELENCONG
24 DANIL RAMDANI L 19 DANA SEPRIANTO / PURNAWATI BELENCONG
25 PAJILA LAPIA P 18 SUPRIANTO / SURTIP BELENCONG
26 EKA SEPTI AMELIA P 18 HAERUL ANWAR / NURHASANAH BELENCONG
27 HAPIS ALJAILANI L 17 MAESUDIN / RASMIN BELENCONG
28 SOPI SELPIA P 16 BAYATI / MASYATUN BELENCONG
29 DEWI TANIA P 14 AWALUDIN / ENISULASTRI BELENCONG
30 NIZZAM ALHALIF L 12 MASHURI / ASTI KAMAH BELENCONG
31 NIKA YUPITA P 11 JUMANEM / SURYANI BELENCONG
32 RISKA APRILIA L 10 M. RIZAL / SANTIKA BELENCONG
33 HABIB AZKA PRANATA L 9 JUNAIDI / TITIN AGUSTINA BELENCONG
34 NAMIA KAILA ARMA DANI P 7 SUPARMAN / DEWI HERMA DIANA BELENCONG
35 KARISATUL AZIZAH P 5 SUKADI / SARINEP BELENCONG
HUN 2016

KET
FORMULIR PENDATAAN SASARAN BALITA ( 0-59 BULAN) PIN POLIO TAHUN 2016

DESA : Mumbul Sari


PUSKESMAS : Bayan
KAB/KOTA : Lombok Utara

UMUR
NO NAMA ANAK L/P NAMA ORANG TUA ALAMAT
(BLN)

1 KHAERUNNISA P 56 SELAMET/SITI JERUJU


2 AULIA P 55 SAHRI/HADIJAH JERUJU
3 WIDYA SAFITRI P 53 SUKIAWAN/MUSTIKA JERUJU
4 ZAKITUN A. P 50 KIRTUDI/HUMAINI JERUJU
5 M.RIFKI IRAWAN L 49 MUNAWIR/MARYUN JERUJU
6 M.ZULFAN A. L 49 SUARDI/SUKIAH JERUJU
7 M.ROBBANI L 48 MAS'UN/SAPIYAN JERUJU
8 M.RIDWAN L 46 MASJUDIN/SIRAH JERUJU
9 HAFIZATUL ILMI P 45 SUKANDI/MUKMINAH JERUJU
10 M.HAZIQ A. L 45 HERNAWAN/DIAN R JERUJU
11 IRFAN HADI L 44 MASRUN/MULIANA JERUJU
12 SINTA P 45 DIPA/SITI A JERUJU
13 WAHYU AIDIL A. L 40 ZAENAL/MAKNAH JERUJU
14 MUTIA LESTARI P 40 HERMAN/HAERIYAH JERUJU
15 RAPITA MARDIANA L 36 ISLAHUDIN/ANIP JERUJU
16 AYU JUWITA P 37 H.M.ILHAM/SAKMAH JERUJU
17 M.ULUL AZMI L 31 SYAWAL/AISYAH JERUJU
18 LAURA CITRA L. P 30 SALAHUDIN/MARIAH JERUJU
19 ZIDATUL H. L 28 AHYAR/ZAETUN JERUJU
20 NAJWATUL W. P 27 AHMAD IKNO/MARYAM JERUJU
21 ZAHRA M. P 25 MUJTAHDIN/MUHARTIN JERUJU
22 REZA ALFIANSAH L 25 MULTAZAM/HAERANAH JERUJU
23 ALBIN ARKANADIN L 20 HAMRUDIN/JOHANA JERUJU
24 SILVIA S. P 16 MAHIRUDIN/SUCIANI JERUJU
25 SILVIA ANITA P 9 ISLAHUDIN/ANIP JERUJU
26 M.ILHAM FATONI L 46 JAMALUDIN/RAMLAH JERUJU
27 SAEHUL AFZAN L 3 SABIRIN/SUHAELAN JERUJU
28 NOVITASARI P 8 SUNIADI/MULYATUN JERUJU
TAHUN 2016

KET

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