DATA SASARAN BALITA

Provinsi : Banten
Kabupaten/Kota : Pandeglang
Puskesmas : Cikeusik

NIK (Nomor Induk ANAK JENIS Berat Badan

No NAMA ANAK TANGGAL LAHIR Nama Orang Tua NIK Orang Tua
Kependudukan) KE KELAMIN Lahir (Kg)

1 3601046203160001 2 Vira 23-Mar-2016 P 2800 Asep/et 3601041805850002

2 3601040303150001 1 Devan 3-Mar-2015 L 3000 Nurhani/Rasminah 3601041107940004

3 3601040407140001 2 Nizam 4-Jul-2014 L 2700 Sumi/Ibrohim 360104090520002

4 3601040907180001 1 Akhtar 9-Jul-2018 L 2500 Riza/Rian 3205021201960008

5 3601041601150001 1 al-muiz 16-Jan-2015 L 2700 Suminar/Arhadi 3601040107870151

6 3601042306140001 2 afirza 23-Jun-2014 p 3200 Ratna/Jarmin 3601040106760004

8 3601040106140002 3 naysah 29-Sep-2014 p 2500 Rumsi/Saman 360104107730003

9 3601044402170001 3 maryani 4-Feb-2014 p 2700 Miah/Rasmana 3601040507590001

4 Juan 13-Apr-2018 l 2800 Miah/Rasmana 3601040507590001

3601046605150002 3 Vera 26-May-2015 P 2500 Unis/Margawai 3601040305750001

2 Aira 22-Aug-2018 P 2700 Sit /Edi 36010406060810001

3601045609170001 2 Erika 30-Apr-2017 P 3000 Kartni/Emen 3601041007810002

3601045402150003 3 Anindita 16-Sep-2017 P 2700 Kamah/Sugianto 3601041007810002

3 Lina 24-May-2018 P 3500 Dede/Tata 3601042407740001

3601045402150003 1 Revi 14-Feb-2015 P 2700 Ilah/Saep 3601040511800004

3601045204160001 1 Nataly 24-Dec-2016 P 3000 Warinah.Alm/ Tarmin

3601041206140001 2 Hafiza 20-May-2014 P 3100 Sarnat/Idris 3601040907850002

3601045204160002 4 adila 12-Apr-2016 P 300 Raswi/Dariwan 3601040107680294

3601041206140001 3 pasha 12-Jun-2014 L 2800 Maman/Sumyat 3601040707830004

3601044906170001 1 Sabila 9-Jun-2017 P 2800 Naah/Sunarta 360104107820010

3601044201170002 3 Dita 22-Jan-2017 P 2500 dart/Sarmani 3601040111710002

1 Akila 12-Aug-2018 P 2500 Dini/Suhar 3601040110910001

3 Rayyan 7-Apr-2018 L 3000 tnah/agus 3601044107860191

2 Jihan 10-Sep-2014 P 3200 leli/jojon

3601042712160001 2 Aldi 27-Dec-2016 L 3000 uun/durohman 3601041308750001

3601044107160002 2 Irma 1-Jul-2016 P 3000 Muryat/Pudin 3601041702850002

360104130180001 3 Yudi 13-Jan-2018 L 2700 Armit/Sarim 3601040702610001

3601042406140001 4 M.angga 24-Jun-2014 L 2900 Fatma/Atang 3601040107690094

3601040604150001 3 Akbar 6-Apr-2015 L 3000 Marsah/Suhri 360104040378003

2 Reja 25-Jan-2018 L 2900 Sunart/Isnen

2 Ian supyadi 11-Aug-2014 L 2600 Mumun/Jumhara

1 Safitri 14-Jun-2017 P 2600 Aisyah/Darna

1 Asyifa 10-Mar-2018 P 2700 Rohet/Juheni

1 Aldo 30-Aug-2014 L 2800 Marlina/Nanda

2 Razka 6-Mar-2017 L 2800 Marlina/Nanda

3 Rilvan 22-Jun-2018 L 3000 Marlina/Nanda

1 Laila 14-Jul-2015 P 2900 Jujun/Kusnadi

4 fikri 13-Jan-2017 L 3100 Sumyat/Maman

5 nadia 30-Jan-2015 P 2800 Asih/Dadang

2 raden 8-Dec-2014 L 2800 Sanimah/Suheli

1 aldan 16-Sep-2014 L 2700 Caswat/Rohman

1 ramdani 31-06-2018 L 3000 Euis/Barna

3 m.rizky 1-Jun-2014 L 3600 Ratna/Muhrokan

2 mikaila 30-Sep-2015 P 2700 Sit/Kusna

3 fitri 7-Jul-2016 P 3000 Ani/kusnadi.Alm

2 melat 31-Jan-2018 P 2900 Karminih/Munir

2 bahikal 6-Jan-2016 L 3200 Ira/Castana

2 azkia 11-Nov-2017 P 3000 Tarmeni/Dedi

1 yusuf 13-Aug-2015 L 3200 Sutni/Sunika

2 muta 11-Jan-2018 P 2600 Rustni/Muhidin

2 raisa 14-Apr-2014 P 3500 Rasitem/Apud

1 riskian 9-Aug-2016 L 3000 Nurtah/Karsim

2 priatna 7-Apr-2017 L 3100 Tarwit/Nana

2 raka 8-Jun-2015 L 3000 Ika/Ade

3 reza 8-Jun-2015 L 3000 Ika/Ade

2 alisia 16-Feb-2016 P 3700 Abedah/Engkus

BALITA

Vitamin A Vitamin A Ada Buku

Cara Ukur ASI Eksklusif IMD
Tanggal BB Februari Agustus KIA
No Tlp/HP Orang Tua ALAMAT RT RW TB (Cm) 1=Telentang 1=YA, 1=YA,
pengukuran (Kg) 1=YA, 1=YA, 1=ya
2=Berdiri 2=Tidak 2=Tidak 2=Tidak 2=Tidak 2=tidak

Kp.Pendeuy 07 02 8/21/2017 15 98 2 1 1 1 1 1

Kp.Pendeuy 07 02 8/21/2017 17 105 2 1 1 1 1 1

Kp.Pendeuy 07 02 8/21/2017 20 105 2 1 1 1 1 1

Kp.Pendeuy 07 02 8/21/2017 6 63 2 1 1 2 2 1

Kp.Sukajadi 08 02 8/21/2017 18 103 2 1 1 1 1 1

Kp.Pendeuy 06 02 8/21/2017 20 103 2 1 2 1 1 1

Kp.Pendeuy 06 02 8/21/2017 21 101 2 2 1 1 1 1

Kp.Pendeuy 06 02 8/21/2017 20 103 2 2 1 1 1 1

Kp.Pendeuy 06 02 8/21/2017 8 68 2 1 1 1 1 1

Kp.Sukajadi 08 02 8/21/2017 18 100 2 1 1 1 1 1

Kp.Pendeuy 07 02 1 1 1 2 2 1

Kp.Pendeuy 07 02 8/21/2017 15 98 2 1 1 1 1 1

Kp.Pendeuy 07 02 8/21/2017 15 85 2 1 1 2 1 1

Kp.Pendeuy 06 02 8/21/2017 8 68 1 1 1 1 1 1
Kp.Pendeuy 07 02 8/21/2017 17 90 2 1 1 1 1 1

Kp.Pendeuy 09 02 8/21/2017 15 95 2 1 1 1 1 1

Kp.Pendeuy 09 02 8/21/2017 17 102 2 1 1 1 1 1

Kp.Pendeuy 09 02 8/21/2017 18 95 2 1 1 1 1 1

Kp.Pendeuy 09 02 8/21/2017 20 102 2 1 1 1 1 1

Kp.Sukajadi 08 02 8/21/2017 15 103 2 1 1 1 1 1

Kp.Sukajadi 08 02 8/21/2017 17 102 2 1 1 1 1 1

Kp.Pendeuy 09 02 8/21/2017 3 50 1 1 1 2 2 1

Kp.Pendeuy 07 02 8/21/2017 9 68 2 1 1 2 2 1

Kp.Pendeuy 06 02 8/21/2017 17 101 2 1 1 1 1 1

Kp.Sukajadi 08 02 8/21/2017 16 100 2 1 1 1 1 1

Kp.Sukajadi 08 02 8/21/2017 17 101 2 1 1 1 1 1

Kp.Sukajadi 08 02 8/21/2017 9 70 1 1 1 2 2 1

Kp.Sukajadi 08 02 8/21/2017 15 101 2 1 1 1 1 1

Kp.Sukajadi 08 02 8/21/2017 17 100 2 1 2 1 1 1

Kp.Sukajadi 08 02 8/21/2017 9 75 1 1 1 2 2 1

Kp.Sukajadi 08 02 8/21/2017 16 102 2 1 1 1 1 1

Kp.Sukajadi 08 02 8/21/2017 15 100 2 1 1 1 1 1

Kp.Sukajadi 08 02 8/21/2017 7 78 1 1 1 2 2 1

Kp.Pendeuy 07 02 8/21/2017 15 101 2 1 1 1 1 1

Kp.Pendeuy 07 02 8/21/2017 15 95 2 1 1 1 1 1

Kp.Pendeuy 07 02 8/21/2017 9 70 1 1 1 1 1 1

Kp.Pendeuy 07 02 8/21/2017 20 102 2 1 1 1 1 1

Kp.Sukajadi 08 02 8/21/2017 18 101 2 1 1 1 1 1

Kp.Pendeuy 09 02 8/21/2017 16 103 2 1 1 1 1 1

Kp.Pendeuy 09 02 8/21/2017 16 102 2 1 1 1 1 1

Kp.Pendeuy 06 02 8/21/2017 18 101 2 1 1 1 1 1

Kp.Pendeuy 06 02 8/21/2017 7 76 1 1 1 2 2 1

Kp.Pendeuy 06 02 8/21/2017 18 101 2 1 1 1 1 1

Kp.Pendeuy 06 02 8/21/2017 16 100 2 1 1 1 1 1

Kp.Pendeuy 06 02 8/21/2017 17 102 2 1 1 1 1 1

Kp.Pendeuy 06 02 8/21/2017 10 85 1 1 1 2 1 1

Kp.Pendeuy 06 02 8/21/2017 16 98 2 1 1 1 1 1

Kp.Pendeuy 06 02 8/21/2017 10 87 2 1 1 1 1 1

Kp.Pendeuy 09 02 8/21/2017 15 100 2 1 1 1 1 1

Kp.Pendeuy 06 02 8/21/2017 9 80 1 1 1 2 1 1

Kp.Pendeuy 06 02 8/21/2017 18 102 2 1 2 1 1 1

Kp.Pendeuy 09 02 8/21/2017 17 99 2 1 1 1 1 1

Kp.Pendeuy 09 02 8/21/2017 18 95 2 1 1 1 1 1

Kp.Pendeuy 09 02 8/21/2017 15 96 2 1 1 1 1 1
Kp.Pendeuy 07 02 8/21/2017 18 94 2 1 1 1 1 1

Kp.Pendeuy 07 02 8/21/2017 20 99 2 1 1 1 1 1
 DATA SASARAN BALITA

Provinsi : Banten
Kabupaten/Kota : Pandeglang
Puskesmas : Cikeusik

ANAK JENIS Berat Badan

No NIK (Nomor Induk Kependudukan) NAMA ANAK TANGGAL LAHIR Nama Orang Tua NIK Orang Tua No Tlp/HP Orang Tua
KE KELAMIN Lahir (Kg)

1 3 Mela 20-Dec-2013 P 3000 Carilah/Sanip

2 1 Adit 2-Jan-2014 L 3200 Rara/Amir

3 3 Sit Maesaroh 3-Apr-2014 2700 Minah/Wakir

4 1 zio karvano 28-Feb-2014 2500 Mimin/Karnawa

5 2 Akmal Latf 9-Jun-2014 2700 Ira/Ateng

6 1 Zahra 26-Jun-2014 2700 Ermawat/Asep

8 3 Citra 7-Aug-2014 3000 Arwat/Asna

9 2 Lest Maharani 12-Aug-2014 2700 Sanimah/Atma

10 3 Ahmad Mujib A 28-Aug-2014 2800 martnah/judin

11 4 Fitriani 1-Sep-2014 3800 unah/samanan

12 4 Ian S 4-Oct-2014 2700 at/arman

13 2 Azril 7-Feb-2014 2700 sanah/aca

2 M.Alif 31/11/2014 3500 nengsih/yudi

3 Sit Nurhayat 14-Feb-2015 3000 kamah/muktar

 3 Rohayat 11-Mar-2015 3100 umsinah/satria

1 Riki 25-Apr-2015 2800 aisah/irman

2 Lest 27-Apr-2015 2500 eni/warso

4 Casriah 16-Jun-2015 2500 eni/sanen

4 Sit Aryat 1-Jul-2015 3000 jumhaet/kamo

2 Susant 25-Jul-2015 3200 lilis/jajuli

3 Alipudin 12-Jul-2015 3100 mutah/edi

2 Suhendar 26-Jul-2015 3000 tni/dedi

4 Isnen 10-Aug-2015 2700 sani/caming

2 M.Cepi 22-Sep-2015 2900 mae/asep

1 Sit Saniah 9-May-2015 3000 sarniah/sapen

2 Het 2-Oct-2015 2900 samirah/herman

3 Juliant 6-Nov-2015 2600 tnah/asmir

3 Fadlan 12-Jul-2015 2600 imi/bai 3601040107800272

36010465150001 1 Selviani 25-May-2015 P 2700 Eha/jumali 3601040107820105

3 Faisal 13-Dec-2015 L 2800 asmariah/supyadi

1 Indra 22-Dec-2015 L 2800 indah/ade

2 Siska 15-Nov-2015 P 3000 ocah/mistar

1 Khaerul 12-Jan-2016 L 3300 suminar /bakri

3 Anggi F 7-Feb-2016 P 3100 nart/kalim

 4 Asilah 20-Feb-2016 P 2800 in/suhro

2 Pitaloka 5-May-2016 P 2800 jarniah/asep

1 Fazia 10-Jan-2016 P 2700 atk/cece

3 Sinta 17-Mar-2016 P 3000 roheni/samsudin

1 Nurul A 9-May-2016 P 3600 fitri/endi

2 Irwansyah 27-Jun-2016 L 2700 ciah/pulung

2 Inayah 13-Jun-2016 P 3000 eva/wardi

2 Deden 15-Sep-2016 L 2900 eroh/tsna

1 Miftahudin 14-Jan-2017 L 3200 rosinah/wardi

360104112170001 2 Irawan 10-Feb-2017 L 3000 rumsiah/rasman 3601040107750214

1 Nasya 11-Mar-2017 P 3200 nent/sardi

2 Aprilia 1-May-2017 P 2600 ijah/karna

2 Nagita 2-May-2017 P 3500 acih/narsa

1 M.Lucky 3-Aug-2017 L 3000 susi/erul

2 Eka H 26-Jun-2017 L 3100 tat/atma

2 Sit Julia 3-Aug-2017 P 3000 jumi/eli

3601044408170002 2 Wina 14-Jul-2017 P 3000 ttn/endi 3601041405860009

1 Rio 12-Aug-2017 L 3700 Nuryat/Ato

360104471150001 1 Talia P 7-Nov-2017 P 3000 Atun/Bani 3601041412910002

2 Fahru 13-Sep-2017 L 3600 Sukat/Saiman

 1 Alvian 6-Sep-2017 L 3200 Arni/Erwin

2 Sit Ropiah 5-Dec-2017 P 3000 Yuni/Kubro

2 Nurshofa 20-Jan-2018 L 3000 Nasriah/Matn

3 Agus 15-Feb-2018 L 2700 Uwar/Sabda

1 Sit Asyifa 10-Mar-2018 P 3500 Rohet/Juhedi

1 Robi Alvian 16-Mar-2018 L 3400 Sumaah/Karim

1 Bastan 27-Mar-2018 L 2700 Sit Maryat/Dadan

1 Saepudin 5-Apr-2018 L 2700 Marnah/Ajat

36010441-1180002 2 Vika 1-Jan-2018 P 3000 Kurnata/Jumi

3 M.Fauzan 11-Jul-2018 L 2800 yayah/Tatang

1 Nadit 15-May-2018 L 3000 kusniawat/umar

3 Melinda 20-May-2018 P 3000 rumsi/jupri

3 m.ardiansyah 9-Jun-2018 L 2700 Sukmanah/santosa

 Vitamin A Vitamin A Ada Buku
Cara Ukur ASI Eksklusif IMD
Tanggal BB TB Februari Agustus KIA
ALAMAT RT RW (Cm) 1=Telentang 1=YA, 1=YA,
pengukuran (Kg) 1=YA, 1=YA, 1=ya
2=Berdiri 2=Tidak 2=Tidak 2=Tidak 2=Tidak 2=tidak

Barengkok 017 005 8/15/2018 15 103 2 1 1 1 1 1

Barengkok 018 005 8/15/2018 17 105 2 1 1 1 1 1

Gadel 015 005 8/15/2018 20 105 2 1 1 1 1 1

Barengkok 018 005 8/15/2018 18 102 2 1 1 1 1 1

Gadel 015 005 8/15/2018 18 103 2 1 1 1 1 1

Gadel 016 005 8/15/2018 20 103 2 1 2 1 1 1

Barengkok 019 005 8/15/2018 21 101 2 2 1 1 1 1

Barengkok 019 005 8/15/2018 20 103 2 2 1 1 1 1

Barengkok 019 005 8/15/2018 20 103 2 1 1 1 1 1

Barengkok 019 005 8/15/2018 18 102 2 1 1 1 1 1

Gadel 019 005 8/15/2018 17 101 2 1 1 1 1 1

Barengkok 019 005 8/15/2018 17 100 2 1 1 1 1 1

Gadel 015 005 8/15/2018 15 102 2 1 1 1 1 1

Barengkok 019 005 8/15/2018 15 100 2 1 1 1 1 1

Barengkok 019 005 8/15/2018 17 102 2 1 1 1 1 1

Barengkok 019 005 8/15/2018 15 103 2 1 1 1 1 1

Barengkok 019 005 8/15/2018 17 102 2 1 1 1 1 1

Barengkok 019 005 8/15/2018 18 102 2 1 1 1 1 1

Barengkok 017 005 8/15/2018 18 103 2 1 1 1 1 1

Barengkok 017 005 8/15/2018 17 101 2 1 1 1 1 1

Barengkok 017 005 8/15/2018 16 100 2 1 1 1 1 1

Barengkok 017 005 8/15/2018 17 101 2 1 1 1 1 1

Barengkok 017 005 8/15/2018 15 101 2 1 1 1 1 1

Barengkok 017 005 8/15/2018 15 101 2 1 1 1 1 1

Barengkok 017 005 8/15/2018 17 100 2 1 2 1 1 1

Barengkok 017 005 8/15/2018 16 100 2 1 1 1 1 1

Barengkok 017 005 8/15/2018 16 102 2 1 1 1 1 1

Barengkok 018 005 8/15/2018 15 100 2 1 1 1 1 1

Gadel 016 005 8/15/2018 16 98 2 1 1 1 1 1

Barengkok 019 005 8/15/2018 15 101 2 1 1 1 1 1

Barengkok 019 005 8/15/2018 15 105 2 1 1 1 1 1

Barengkok 019 005 8/15/2018 20 101 2 1 1 1 1 1

Barengkok 019 005 8/15/2018 20 102 2 1 1 1 1 1

Barengkok 019 005 8/15/2018 18 101 2 1 1 1 1 1

Barengkok 019 005 8/15/2018 16 103 2 1 1 1 1 1

Gadel 014 005 8/15/2018 16 102 2 1 1 1 1 1

Gadel 014 005 8/15/2018 18 101 2 1 1 1 1 1

Gadel 014 005 8/15/2018 20 98 2 1 1 1 1 1

Gadel 014 005 8/15/2018 18 101 2 1 1 1 1 1

Barengkok 018 005 8/15/2018 16 100 2 1 1 1 1 1

Barengkok 018 005 8/15/2018 17 102 2 1 1 1 1 1

Barengkok 018 005 8/15/2018 17 96 2 1 1 1 1 1

Barengkok 018 005 8/15/2018 16 98 2 1 1 1 1 1

Barengkok 018 005 8/15/2018 15 99 2 1 1 1 1 1

Barengkok 018 005 8/15/2018 15 100 2 1 1 1 1 1

Barengkok 018 005 8/15/2018 13 91 2 1 1 1 1 1

Barengkok 018 005 8/15/2018 14 93 2 1 2 1 1 1

Gadel 018 005 8/15/2018 13 90 2 1 1 1 1 1

Barengkok 018 005 8/15/2018 10 91 2 1 1 1 1 1

Barengkok 018 005 8/15/2018 12 88 2 1 1 1 1 1

Barengkok 019 005 8/15/2018 12 91 2 1 1 1 1 1

Barengkok 019 005 8/15/2018 11 90 2 1 1 1 1 1

Barengkok 019 005 8/15/2018 10 86 2 1 1 2 1 1

Barengkok 019 005 8/15/2018 10 88 2 1 1 2 1 1

Barengkok 019 005 8/15/2018 9.5 86 2 1 1 2 1 1

Barengkok 019 005 8/15/2018 10 85 2 1 1 2 1 1

Gadel 014 005 8/15/2018 10 82 2 1 1 1 1 1

Barengkok 019 005 8/15/2018 9 80 2 1 1 2 1 1

Barengkok 019 005 8/15/2018 8.5 80 1 1 1 2 2 1

Barengkok 019 005 8/15/2018 7 78 1 1 2 2 2 1

Barengkok 019 005 8/15/2018 8 76 1 1 1 2 2 1

Barengkok 019 005 8/15/2018 7 60 1 1 1 2 2 1

Barengkok 019 005 8/15/2018 8 71 1 1 1 2 1 1

Barengkok 018 005 8/15/2018 7 70 1 1 1 2 2 1

Barengkok 018 005 8/15/2018 7.5 67 1 1 1 2 2 1

Barengkok 018 005 8/15/2018 7 65 1 1 1 2 2 1

Barengkok 018 005 8/15/2018 6.4 60 1 1 1 2 2 1

 DATA SASARAN BALITA

Provinsi : Banten
Kabupaten/Kota : Pandeglang
Puskesmas : Cikeusik

ANAK JENIS Berat Badan

No NIK (Nomor Induk Kependudukan) NAMA ANAK TANGGAL LAHIR Nama Orang Tua NIK Orang Tua No Tlp/HP Orang Tua
KE KELAMIN Lahir (Kg)

1 2 M.Fahri 6-Oct-2013 L 2800 asni/Jumhar 3601046610130001

2 2 Rizky 10-Oct-2013 L 3000 Dasmi/Suparyo

3 2 Salvia 15-Nov-2013 P 2700 Linda/Purta

4 3 Deni Ibnu 2-Dec-2013 L 2500 Lasminawat/Tarsono

5 3601041912130003 1 Danis 19-Dec-2013 L 2700 Ipah/Jojon 360104100850003

6 1 Sit Lailatul J 25-Dec-2013 P 3200 Eneng/Jamani

8 3601046301140002 3 Desvita 23-Jan-2014 P 2500 Sanirah/Dampe 3601041112770002 0878020090616

9 3601046301140001 3 Diant 24-Jan-2014 P 2700 Sanirah/Dampe 3601041112770002 0878020090616

10 3 Sigit 23-Jan-2014 L 2800 Acih/Umar

11 1 M.fadlan 15-Feb-2014 L 2500 Konah/Karto

12 1 Sri 17-Feb-2014 L 2700 Rahayu/Emed

13 2 Anis 18-Mar-2014 P 2700 Karni/Aep

1 Sit Aqifah 30/03/2014 P 3500 Uum/Juanta

3601045005140001 3 Alisa 10/05/2014 P 3000 Susan/Agan

360142505140007 3 Rehan 25-May-2014 L 3100 Dewi/Rodi

4 Ayu 17-Jun-2014 P 2800 Sarit/Waska

3601041506140000 2 M.Aldi 17-Jun-2014 L 2500 Piah/Asep 360104107800217

3601041506140002 2 M.Aldo 17-Jun-2014 L 2500 Piah/Asep 360104107800217

3 Riko 17-Jun-2014 L 3000 Saminah/Ucu 3601043107140001

4 Adelia 2-Sep-2014 P 3200 Saminah/Toha

3 Dafa 10-Sep-2014 L 3100 Sawianah/Dani

3 Abdul Basit 1-Oct-2014 L 3000 Sumyanah/Wahyudin

2 Nukita 1-Oct-2014 P 2700 Omah/Arif

2 Calista 12-Oct-2014 P 2900 Cucum/Ajis

3601044711140012 1 Mela Sahwa 7-Nov-2014 P 3000 Mega/Asep 3601046512950005

3601044117701121 2 M.Haiban 8-Nov-2014 L 2900 Satnah/Sadip 3601043810140001

3601044811140001 2 Naila 8-Nov-2014 P 2600 Juminah/Rohedi 360104590334001

3601041412140002 1 M.Arda Alfath 14-Dec-2014 L 2600 Rosita/Haetami 3601041701850002 081574738171

360216600790002 1 Nadia 1-Jan-2015 P 2700 Nengsih/H.Sarman

1 Sit Vanesa 16-Jan-2015 P 2800 Sofi/Edi 3601041004620006

3 Alya 22-Jan-2015 P 2800 Lamrah/Juned 36010414407820004

1 Fathan 23-Jan-2015 L 3000 Yayah/Eli

360104502150001 3 Sit Arum 14-Feb-2015 P 3300 Marsih/Mursid 3601040107790160 085819320225

2 Mawar Sari 18-Feb-2015 P 3100 Jamiah/Tarsiman

 2 Sit Nurfadilah 16-Mar-2015 P 2800 Nani/Miharja

2 M.Aji 22-Apr-2015 L 2800 Imas/Memed

1 Sit Raudotul 28-Apr-2015 P 2700 Kurnaesih/Firdaus

3 M.Sahrul 11-May-2015 L 3000 Rohmah/Kosim

1 Intan 24-Jun-2015 P 3600 Sailah/Rudi

2 M.Riki 4-Jul-2015 L 2700 Saminih/Karpin

3601046108150002 1 Satuni 21-Aug-2015 P 3000 Warnit/Andi 3601040607950003

2 Hafiz 15-Sep-2015 L 2900 Sukarah/Wahyu

2 Arifan 16-Sep-2015 L 3200 Lusi/Arsam 3601043109830004

3 M.Jaenal Abidin 5-Nov-2015 L 3000 Jenab/Asra 3601040101150002

2 M.Wildan 15-Nov-2015 L 3200 Neng Yuli/Rohman 3601041003840003

1 Boy 12-Dec-2015 L 2600 Sarwiah/Jeje 3601042311150002

3601045101160002 5 Suliah 16-Dec-2015 P 3500 Surhenah/Karim 3601040107580231

3 Ila 16-Dec-2015 P 3000 Sumarni/Karmin

2 Radit 28-Dec-2015 L 3100 Ida laila/Andi 3601042711150002

3601044701160001 2 Indah 6-Jan-2016 P 3000 Saniah/Aep 3601041011184002

2 M.Yazid Altamis 18-Jan-2016 L 3000 Enok/Yayang

1 Dasa 29-Jan-2016 L 3700 Tat/Juandi 08158262575

1 Sit Alaika 1-Mar-2016 P 3000 Minah/Salam

3 Chandra 4-Mar-2016 L 3000 Erna/Jamal

 2 Sit Kiah Nurhasanah 10-Feb-2016 P 3200 Dewi/Komar

2 M.Teguh Maliki 6-Mar-2016 L 3000 Rohenah/Jajang 360104201510699002

7 Khaerul Anam 5-Mar-2016 L 3000 Masitoh/Pa'i 3601040405690001 08531918507

3 Melawat 11-May-2016 P 2700 Suharyat/Badri

3 M.Hafiz 14-Jun-2016 L 3500 Sunt/Arman

3601040107160001 5 M.Azka 1-Jul-2016 L 3800 Euis/endang 360104530485001

1 Sit Naila 7-Jul-2016 P 2700 Anis/Asmir

1 Ardiansyah 23-Jun-2016 L 3000 Rumsinah/Arta

1 Amel Alfi 8-Aug-2016 P 2800 Aisah/Suharta

2 Julia Awali 27/08/2016 P 2800 Maryamah/Murdi 087773230227

3 M.Halim 22/09/2016 L 3000 Surniah/Rusman 3601041909770004

1 Jihan 13-Oct-2016 P 3000 Erna/Erik 360104470100004

1 Dicky 13-Oct-2016 L 2700 Lilis/Oji 08158262575

2 Juwita 17-Nov-2016 P 2600 Arum/Juanda

360104111116001 7 M.Subki 11/11/2016 L 3000 Ratnengsih/Antawi 360104010778002

3601046712160001 3 Sit Ayu M 12/25/2016 P 3700 resmi/kamsari

36010401170001 2 M.Bonang 1/1/2017 L 3000 Rosita/Haetami 3601041701850002

1 Nurul Anjani 1/5/2017 P 3000 Iin/Gunawan

1 Rini 1/10/2017 P 2600 Wartni/Supandi

1 M.Albi 3/7/2017 L 2700 Lia/Yudi

 1 Dian Maharani 3/30/2017 P 2800 Cucu/Rujani 3601040107930245

2 vina 3/23/2017 P 3000 Tarinih/Armin

1 M.Labib 4/5/2017 L 2800 Elis/Ade

2 Sit Asyiah 3/29/2017 P 3000 Uum/Juanta

3 M.Abiyan 4/14/2017 L 3800 Imas/Acim

2 M.Adlan 4/4/2017 L 3000 Bayi/Rasna 3601041103730001

3601044205170002 2 Nestalia 5/3/2017 P 2700 Surniah/Agus 3601041150362005

5 Puteri Puspita L 5/9/2017 P 3000 Cicih/Rosidi

M.Algis 6/13/2017 L 2900 Suminar/Dedi

2 M.Ubaidilah 7/24/2017 L 3500 Juju/Muarif 3601043109830004

3 Sit Aisyah 7/4/2017 P 3000 Iroh/Sayut 360104062780004

4 Sit Nurhayat 6/25/2017 P 2800 Sukat/Oneng

1 Rasya 6/15/2017 L 3000 Nanda/Yudi 3601042808960003

3 Fatonah 8/11/2017 P 3000 Esih/Uhen 3601040107740105

4 Diva 8/16/2017 P 3200 Jumanah/Daya

4 Dewi Sartka 8/14/2017 P 2800 Enol/Prapto

2 Vika 8/24/2017 P 2600 Et/Darto

3 M.Hamid 8/10/2017 L 2900 Akem/Hadim

2 Egi 8/11/2017 L 3000 Eroh/Eni

2 Nuraisyah 8/11/2017 P 2850 Suherah/Jaenudin

4 Agustan Anggara 8/21/2017 L 3000 Sanah/Rapin

3 Ayu Rosita 9/22/2017 P 3000 Ari/Rosyid 3601045207780002

3 M.Hafifudin 9/23/2017 L 2700 Tut

3 Syakila Anggraeni 10/10/2017 P 4000 Inih/Soleh

1 Alvia 10/12/2017 P 3500 Septani/Sahrul

3 Nisa 10/12/2017 P 3000 Bayi/Jana 3601045210730005

2 Deqita 10/15/2017 P 3000 Een/Udin

2 Robi 11/4/2017 L 3200 Rohayat/Mulyadi 087882349045

2 Zaskia 11/19/2017 L 2900 Rohenah/Ican 3601041805810001

5 Nurbaet 1/8/2018 P 4000 Eroh/Surhani 3601040107730354 085211563402

2 Adila Nisa 1/10/2018 P 2600 Masitoh/Kodir 360104460790001

4 M.Saepullah 2/8/2018 L 3000 Asminah/Asrun 3601041310750001

3 Silva 3/7/2018 P 3100 Iis/Samin

3 Inayah 3/27/2018 P 3000 Junisah/Hasan 3601041004820001

4 M.Epan A 8/29/2018 L 3200 Saman/Marni 3601040107780385

1 Tita Aprilia 4/16/2018 P 3000 Hert/Misnan

4 Sit Ihfa S 4/20/2018 P 3500 minah/mukri 36010401077502005

3 m.salim 31/04/2018 L 3000 sit aisyah/ubandi 3601041103870000

2 M.Fajar 5/13/2018 L 3500 Nengsih/H.Sarman

3 M.Rizal 6/24/2018 L 3600 Sanamah/Sudin

2 Rest A J 7/1/2018 P 4000 yant/rusdi 3601041000870008

2 alifa 7/2/2018 P 3500 sunengsih/arsam

1 M.Fazri 7/8/2018 L 3000 aas/erik 3601044002960004

1 Miranda 8/8/2018 P 3200 ita/mirhat

4 Ika 8/19/2018 P 3000 Sanah/Rapin

1 Aisyah 8/9/2018 P 3300 sit latfah/dede
2 Risky 8/21/2018 L 3000 Ipah/Jojon 360104100850003
2 m.nabil S 9/24/2018 L 3000 emay/dadih 3601041017870148
3 sit sri 9/25/2018 P 3500 arum/abdurrahman
 Vitamin A Vitamin A Ada Buku
Cara Ukur ASI Eksklusif IMD
Tanggal BB TB Februari Agustus KIA
ALAMAT RT RW (Cm) 1=Telentang 1=YA, 1=YA,
pengukuran (Kg) 1=YA, 1=YA, 1=ya
2=Berdiri 2=Tidak 2=Tidak 2=Tidak 2=Tidak 2=tidak

Kp.Umbulan 02 02 8/16/2018 15 103 2 1 1 1 1 1

Kp.Umbulan 02 02 8/16/2018 17 105 2 1 1 1 1 1

Kp.Umbulan 03 01 8/16/2018 20 105 2 1 1 1 1 1

Kp.Umbulan 05 01 8/16/2018 18 102 2 1 1 1 1 1

Kp.Umbulan 01 01 8/16/2018 18 103 2 1 1 1 1 1

Kp.Umbulan 02 01 8/16/2018 20 103 2 1 2 1 1 1

Kp.Umbulan 04 01 8/16/2018 21 101 2 2 1 1 1 1

Kp.Umbulan 04 01 8/16/2018 20 103 2 2 1 1 1 1

Kp.Umbulan 04 01 8/16/2018 20 103 2 1 1 1 1 1

Kp.Umbulan 04 01 8/16/2018 18 102 2 1 1 1 1 1

Kp.Umbulan 04 01 8/16/2018 17 101 2 1 1 1 1 1

Kp.Umbulan 04 01 8/16/2018 17 100 2 1 1 1 1 1

Kp.Umbulan 02 01 8/16/2018 15 102 2 1 1 1 1 1

Kp.Sumberjaya 05 01 8/16/2018 15 100 2 1 1 1 1 1

Kp.Sumberjaya 05 01 8/16/2018 17 102 2 1 1 1 1 1

Kp.Sumberjaya 05 01 8/16/2018 15 103 2 1 1 1 1 1

Kp.Umbulan 03 01 8/16/2018 17 102 2 1 1 1 1 1

Kp.Umbulan 03 01 8/16/2018 18 102 2 1 1 1 1 1

Kp.Umbulan 02 02 8/16/2018 18 103 2 1 1 1 1 1

Kp.Umbulan 02 02 8/16/2018 17 101 2 1 1 1 1 1

Kp.Umbulan 03 01 8/16/2018 16 100 2 1 1 1 1 1

Kp.Umbulan 04 01 8/16/2018 17 101 2 1 1 1 1 1

Kp.Umbulan 04 01 8/16/2018 15 101 2 1 1 1 1 1

Kp.Umbulan 04 01 8/16/2018 15 101 2 1 1 1 1 1

Kp.Umbulan 03 01 8/16/2018 17 100 2 1 2 1 1 1

Kp.Umbulan 02 02 8/16/2018 16 100 2 1 1 1 1 1

Kp.Umbulan 03 01 8/16/2018 16 102 2 1 1 1 1 1

Kp.Umbulan 04 01 8/16/2018 15 100 2 1 1 1 1 1

Kp.Umbulan 02 01 8/16/2018 16 98 2 1 1 1 1 1

Kp.Umbulan 01 01 8/16/2018 15 101 2 1 1 1 1 1

Kp.Umbulan 03 01 8/16/2018 15 105 2 1 1 1 1 1

Kp.Umbulan 01 01 8/16/2018 20 101 2 1 1 1 1 1

Kp.Umbulan 02 01 8/16/2018 20 102 2 1 1 1 1 1

Kp.Sumberjaya 05 01 8/16/2018 18 101 2 1 1 1 1 1

 Kp.Umbulan 03 01 8/16/2018 16 103 2 1 1 1 1 1

Kp.Umbulan 03 01 8/16/2018 16 102 2 1 1 1 1 1

Kp.Umbulan 04 01 8/16/2018 18 101 2 1 1 1 1 1

Kp.Umbulan 04 01 8/16/2018 20 98 2 1 1 1 1 1

Kp.Umbulan 02 01 8/16/2018 18 101 2 1 1 1 1 1

Kp.Sumberjaya 05 01 8/16/2018 16 100 2 1 1 1 1 1

Kp.Umbulan 04 01 8/16/2018 17 102 2 1 1 1 1 1

Kp.Sumberjaya 05 01 8/16/2018 17 96 2 1 1 1 1 1

Kp.Umbulan 03 01 8/16/2018 16 98 2 1 1 1 1 1

Kp.Umbulan 03 1 8/16/2018 15 99 2 1 1 1 1 1

Kp.Umbulan 04 01 8/16/2018 15 100 2 1 1 1 1 1

Kp.Umbulan 01 01 8/16/2018 17 100 2 1 1 1 1 1

Kp.Umbulan 04 01 8/16/2018 18 102 2 1 2 1 1 1

Kp.Umbulan 04 01 8/16/2018 17 99 2 1 1 1 1 1

Kp.Umbulan 02 02 8/16/2018 18 95 2 1 1 1 1 1

Kp.Umbulan 03 01 8/16/2018 15 96 2 1 1 1 1 1

Kp.Umbulan 03 01 8/16/2018 18 94 2 1 1 1 1 1

Kp.Umbulan 04 01 8/16/2018 20 99 2 1 1 1 1 1

Kp.Umbulan 04 01 8/16/2018 16 96 2 1 1 1 1 1

Kp.Umbulan 02 01 8/16/2018 15 98 2 1 1 1 1 1
 Kp.Umbulan 01 01 8/16/2018 15 100 2 1 1 1 1 1

Kp.Umbulan 03 01 8/16/2018 17 101 2 1 1 1 1 1

Kp.Umbulan 04 01 8/16/2018 16 100 2 1 1 1 1 1

Kp.Umbulan 04 01 8/16/2018 17 103 2 1 1 1 1 1

Kp.Umbulan 03 01 8/16/2018 14 98 2 1 1 1 1 1

Kp.Umbulan 03 01 8/16/2018 15 98 2 1 2 1 1 1

Kp.Umbulan 03 01 8/16/2018 14 95 2 1 1 1 1 1

Kp.Umbulan 03 01 8/16/2018 16 89 2 1 1 1 1 1

Kp.Umbulan 03 01 8/16/2018 15 90 2 1 1 1 1 1

Kp.Umbulan 02 01 8/16/2018 15 96 2 1 1 1 1 1

Kp.Umbulan 04 01 8/16/2018 16 92 2 1 1 1 1 1

Kp.Umbulan 01 01 8/16/2018 15 89 2 1 1 1 1 1

Kp.Umbulan 04 01 8/16/2018 16 96 2 1 1 1 1 1

Kp.Sumberjaya 05 01 8/16/2018 14 90 2 1 1 1 1 1

Kp.Umbulan 03 1 8/16/2018 15 91 2 1 1 1 1 1

Kp.Sumberjaya 05 01 8/16/2018 14 90 2 1 1 1 1 1

Kp.Umbulan 04 01 8/16/2018 15 90 2 1 1 1 1 1

Kp.Umbulan 02 02 8/16/2018 15 99 2 1 1 1 1 1

Kp.Sumberjaya 05 01 8/16/2018 17 90 2 1 1 1 1 1

Kp.Umbulan 04 01 8/16/2018 13.3 91 2 1 1 1 1 1

 Kp.Umbulan 04 01 8/16/2018 13 92 2 1 1 1 1 1

Kp.Umbulan 02 02 8/16/2018 15 90 2 2 1 1 1 1

Kp.Umbulan 03 01 8/16/2018 14 89 2 1 1 1 1 1

Kp.Umbulan 02 02 8/16/2018 15 90 2 1 1 1 1 1

Kp.Umbulan 02 02 8/16/2018 14 90 2 1 1 1 1 1

Kp.Umbulan 03 01 8/16/2018 15 88 2 1 1 1 1 1

Kp.Umbulan 03 01 8/16/2018 15 92 2 1 1 1 1 1

Kp.Umbulan 03 01 8/16/2018 13 86 2 2 1 1 1 1

Kp.Umbulan 04 01 8/16/2018 13 80 2 2 1 1 1 1

Kp.Umbulan 03 01 8/16/2018 12 83 2 2 1 1 1 1

Kp.Umbulan 01 01 8/16/2018 12 78 2 1 2 1 1 1

Kp.Umbulan 04 01 8/16/2018 10 80 2 1 1 1 1 1

Kp.Umbulan 02 01 8/16/2018 12 76 2 1 1 1 1 1

Kp.Umbulan 04 01 8/16/2018 10 78 2 1 1 1 1

Kp.Umbulan 04 01 8/16/2018 12 80 2 1 1 1 1

Kp.Umbulan 04 01 8/16/2018 12 89 2 1 1 1 1

Kp.Umbulan 03 01 8/16/2018 14 90 2 1 1 1 1

Kp.Sumberjaya 05 01 8/16/2018 10 89 2 1 1 1 1

Kp.Umbulan 04 01 8/16/2018 12 90 1 1 1 1 1

Kp.Umbulan 02 02 8/16/2018 12 87 1 1 1 1 1
Kp.Umbulan 02 02 8/16/2018 12 88 1 1 1 1 1

Kp.Umbulan 03 01 8/16/2018 11 85 1 2 1 1 1

Kp.Umbulan 03 01 8/16/2018 10 86 1 1 2 1 1

Kp.Umbulan 03 01 8/16/2018 10.2 83 1 1 2 1 1

Kp.Umbulan 04 01 8/16/2018 9.6 80 1 1 1 1 1

Kp.Umbulan 02 02 8/16/2018 10 85 1 1 1 1 1

Kp.Umbulan 03 01 8/16/2018 10 85 1 1 1 1 1

Kp.Umbulan 02 02 8/16/2018 9.8 80 1 1 1 1 1

Kp.Umbulan 01 01 8/16/2018 10 73 1 1 1 1 1

Kp.Umbulan 04 90 8/16/2018 10 72 1 1 1 1 1

Kp.Umbulan 03 01 8/16/2018 9 75 1 1 1 1 1

Kp.Umbulan 01 01 8/16/2018 10 73 1 1 2 1

Kp.Umbulan 01 01 8/16/2018 12 70 1 1 2 1

Kp.Umbulan 02 01 8/16/2018 8,5 70 1 1 1 1

Kp.Umbulan 04 01 8/16/2018 8 71 1 1 1 1

Kp.Umbulan 04 01 8/16/2018 7.6 72 1 1 1 1

Kp.Umbulan 04 01 8/16/2018 8 70 1 1 1 1

Kp.Umbulan 02 02 8/16/2018 8.2 65 1 1 1 1

Kp.Umbulan 02 02 8/16/2018 7.2 61 1 1 1 1

Kp.Umbulan 03 01 8/16/2018 6 60 1 1 1 1
Kp.Umbulan 03 01 8/16/2018 6.5 57 1 1 1 1

Kp.Umbulan 04 01 8/16/2018 5 58 1 1 1 1

Kp.Umbulan 03 01 8/16/2018 4,5 55 1 1 1 1

Kp.Umbulan 03 01 8/16/2018 4.2 55 1 1 1 1

Kp.Umbulan 03 01 4.5 56 1
Kp.Umbulan 01 01 5 55 1
Kp.Umbulan 01 01 5.2 55 1
Kp.Umbulan 03 01 4.7 53 1
Kp.Umbulan 01 01 4.6 53 1
 DATA SASARAN IBU HAMIL

Provinsi :
Kabupaten/Kota :
Puskesmas :

TTD
NIK (Nomor Induk (Tablet Jika YA,
Kependudukan) BB sebelum TANGGAL Tanggal BB TB LILA Kehamilan Tambah brp butir
No NAMA IBU ALAMAT RT RW
atau hamil LAHIR pengukuran (Kg) (Cm) (cm) ke darah) TTD
NO. KTP 1=YA, didapat
2=Tidak