FORMAT BANK DATA IBU HAMIL TAHUN 2016

puskesmas : Ampana Timur

Desa : Sabulira Toba

tgl/bln/
UK Nama
NO Nama Ibu (mggu) Pendidikan Pekerjaan Alamat No Hp Pendidikan Pekerjaan HPHT TP GPAH Riw. KB GD
K1 Suami
Umur Ibu
(thn)
1 Erni 30 14/01/ 21 mgg SD IRT S. TOBA Rifai SD SOPIR ### 5/26/2016 V II 0 II
2 Rita 27 14/01/ 6 mgg SD IRT S. TOBA Asrin SD TANI ?/12/2015?/09/2016 IV II I II
3 Musliawat 34 15/01/ 40 mgg SD IRT S. TOBA Muhajir SD TANI lupa ? II I 0 I
4 Sri Rahayu 23 15/01/ 21 mgg SD IRT S. TOBA Ramadan SD TANI ### 5/19/2016 I000
5 Wirni 33 15/01/ 29 mgg SMP IRT S. TOBA Samsudin SD TANI ### 4/24/2016 II I 0 I
6 Nisma 22 15/01/ 20 mgg SD IRT S. TOBA Umar SMA WS ### 5/3/2016 II I 0 I
7 Hamida 19 15/01/ 16 mgg SMA IRT S. TOBA Irfan SMA WS ### 6/5/2016 I000
8 Susan 24 15/01/ 26 mgg SMP IRT S. TOBA Suardi SMP TANI lupa ? IV II I II
9 Asni Tomba 21 15/01/ 34 mgg IRT S. TOBA Rizal lupa ? I000
10 Fatmawat 27 15/01/ 12 mgg IRT S. TOBA Arif ### 7/24/2016 II I 0 I
11 Hawa 38 15/01/ 19 mgg SD IRT S. TOBA 0822 9106 5222 Gust SD TANI lupa ? V IV 0 IV
12 Hasni 30 15/01/ 28 mgg IRT S. TOBA 0812 2437 1323 Haryono ?/06/2015 ?/03/2016 IV III 0 III
13 Rosmawat 45 15/01/ 12 mgg IRT S. TOBA 0813 8074 1416 Muhamad ### 7/10/2016 V III I III
14 Salwia 29 15/01/ 34 mgg IRT S. TOBA 0821 9334 8879 Rustam lupa ? II I 0 I
15 Yusna 21 15/01/ 28 mgg SMA IRT S. TOBA Ahmad lupa ? I000
16 Fatmawat 20 15/01/ 28 mgg IRT S. TOBA Usman TANI ### 2/15/2016 I000
17 Hamifa 26 15/02/ 32 mgg IRT S. TOBA Ahmad TANI ?/07/2015 ?/04/2016 III II 0 II
18 Sri Delvi 23 15/02/ 24 mgg IRT S. TOBA Usdin Ntae TANI ### 5/1/2016 I000
19 Masriani 30 15/02/ 12 mgg SD IRT S. TOBA Riswan SMP TANI ### 8/28/2016 IV II 0 II
20 Mahyuni 23 15/02/ 32 mgg SD IRT S. TOBA Jumardin SD TANI ?/06/2015 ?/03/2016 II I 0 I
21 Sarlina 21 15/02/ 24 mgg IRT S. TOBA Saharudin TANI ### 5/12/2016 I000
22 Hidra 22 15/02/ 36 mgg IRT S. TOBA Talib TANI lupa ? I000
23 Sulfia 20 15/02/ 8 mgg IRT S. TOBA Irwan TANI ### 9/2/2016 I000
24 Marlin 22 15/02/ 14 mgg SD IRT S. TOBA Rahman TANI ?/10/201?/07/2016 II I 0 I
25 Lisnawat 20 15/02/ 16 mgg SD IRT S. TOBA Muhlis SD TANI ### 8/29/2016 II I 0 I
26 Asmawat 34 15/02/ 4 mgg SD IRT S. TOBA Lukman SD TANI ### 10/25/2016 II I 0 I
27 Nurlina 29 ### 35 mgg IRT S. TOBA Ibrahim TANI ### 4/22/2016 III II 0 II
28 Ratna 38 ### 35 mgg IRT S. TOBA Karsin TANI lupa ? VI V 0 V
29 Yerni 23 ### 16 mgg SD IRT S. TOBA Sofyan SMA TANI ### 8/16/2016 II I 0 I
30 Yuyun 18 ### 36 mgg SD IRT S. TOBA Sarpan SMA TANI lupa ? I000
31 Nurfisna 30 ### 34 mgg SD IRT S. TOBA Aswin SD TANI ### 3/25/2016 II I 0 I
32 Wat 36 ### 20 mgg SD IRT S. TOBA Irfan SD TANI ?/06/2016 ?/03/2017 VII VII II
33 Syafitra 18 ### 27 mgg SMP IRT S. TOBA Andri SMP TANI ### 2/3/2017 I000
34 Nurlin 26 ### 14 mgg SD IRT S. TOBA Ridwan SMP TANI ### 6/5/2017 III I 0 I
35 Masna 19 14/04/ 8 mgg SD IRT S. TOBA Sarman SD TANI ?/02/201?/11/2016 I000
36 Nurjanah 28 ### 12 mgg SD IRT S. TOBA Muhtar SD TANI ### 4/28/2017 IV III 0 III
37 Marlina 29 16/05/ 20 mgg D II PNS S. TOBA Sulaeman SMA POLPP ?/12/2015 ?/09/2016 II I 0 I
38 Maryam 24 17/05/ 18 mgg SD IRT S. TOBA Arul SD TANI lupa ? I000
39 Marlina 26 23/05/ 27 mgg SD IRT S. TOBA Arjan SD TANI ### 8/23/2016 III II 0 II
40 Titn 18 ### 17 mgg SMA IRT S. TOBA 0822 9999 0729 Abd. Hafid SMA TANI ?/06/2016 ?/02/2017 I000
41 Nurhayat 31 19/06/ 8 mgg SD IRT S. TOBA 0852 4208 6464 Fitrin SMP TUKANG ### 2/26/2017 III II 0 II
42 Asma 23 ### 21 mgg SMA IRT S. TOBA 0822 9383 9225 Andriyudi SMA WS ### 2/3/2017 I000
43 Masita 26 ### 14 mgg SD IRT S. TOBA 0852 4016 6346 Slamet SMA TANI ?/08/20016?/05/2017 III II 0 II
44 Nurmin 19 ### 27 mgg SMP IRT S. TOBA Suprianto SD TANI ### 12/27/2016 I000
45 Nurhayat 23 13/08/ 36 mgg SD IRT S. TOBA Akri SMP TANI ?/11/2015 ?/08/2016 III II 0 II
46 Sarina 19 13/08/ 16 mgg SD IRT S. TOBA 0822 9383 1653 Arman SD TANI ### 1/8/2017 I000
47 Wisda 16 13/08/ 16 mgg SD IRT S. TOBA 0821 8704 3106 Amran SD TANI ### 1/21/2017 I000
48 Sarlin 27 13/08/ 6 mgg SMA IRT S. TOBA 0813 4155 0313 Sumarto SMA WS ?/07/2016 ?/04/2017 II I 0 I
49 Safyuni 36 31/08/ 7 mgg D II PNS S. TOBA 0821 9441 4991 Sudarman S1 PNS ### 4/30/2017 IV III 0 III
50 Zulfaizah 19 15/09/ 20 mgg SMP IRT S. TOBA Jalil SMP TANI ### 1/15/2017 I000
51 Novi A. Sulaema 27 15/09/ 20 mgg SD IRT S. TOBA 0821 9173 6901 Nani SD TANI ### 1/13/2016 III II 0 II
 Alwia 40 16/09/ 33 mgg SD IRT S. TOBA Rahman SD TANI ### 10/8/2016 III I 0 I

52
53 Magfirah 18 16/09/ 38 mgg SD IRT S. TOBA Hajrin SD TANI ?/03/2016 ?/10/2016 I000
54 Atn 28 ### 32 mgg SD IRT S. TOBA Haris SD TANI lupa ? III II 0 II
55 Nurafni 26 ### 14 mgg SD IRT S. TOBA Mohamad SD TANI lupa ? II I I
56 Eni 38 23/09/ 32 mgg SD IRT S. TOBA Rustam SD TANI lupa ? V IV 0 IV
57 Rosmin 43 18/10/ 12 mgg SMP IRT S. TOBA 0852 4220 6456 Amir SD TANI ### 4/8/2017 V IV 0 IV
58 Nursitafyu 24 25/10/ 20 mgg SMA IRT S. TOBA Arkam SMA TANI ?/06/2016 ?/03/2017 II I 0 I
59 Rahmawat 25 27/10/ 28 mgg SMA IRT S. TOBA 0853 9307 1908 Mustari SMA SOPIR ### 1/25/2017 II I 0 I
60 Fadila 20 27/10/ 8 mgg SMA IRT S. TOBA 0823 9918 5653 Sofyan SMA TANI ### 6/5/2017 I000
61 Nurlina 31 14/11/ 16 mgg SD IRT S. TOBA Herman SD TANI ### 4/24/2017 III I I I
62 Risna 26 14/11/ 12 mgg SD IRT S. TOBA Abu Bakar k. SMA WS ?/08/2016 ?/05/2017 III II 0 II

Sarlina 43 14/11/ 27 mgg SD IRT S. TOBA Moh. Naim SD TANI ?/04/2016 ?/01/2017 XII VIII III IV

63
64 Yuli R. Tolii 33 14/11/ 32 mgg SD IRT S. TOBA Erwin SD TANI lupa ? II I 0 I
65 Yuliawat 33 21/11/ 12 mgg SMA IRT S. TOBA 0823 1189 7488 Ihksan S1 Honorer ### 6/14/2017 II I 0 I
66 RahmI 26 ### 12 mgg SMA IRT S. TOBA Agus Y. Ung SMA WS ?/08/2016 ?/05/2017 II I 0 I
FORMAT BANK DATA IBU HAMIL TAHUN 2017

puskesmas : Ampana Timur

Desa : Sabulira Toba

tgl/bln/
UK Nama
NO Nama Ibu (mggu) Pendidikan Pekerjaan Alamat No Hp Pendidikan Pekerjaan HPHT TP GPAH Riw. KB GD
K1 Suami
Umur Ibu
(thn)
1 Rosmin 43 18/10/ 12 mgg SMP IRT S. TOBA 0852 4220 6456 Amir SD TANI ### 4/8/2017 V IV 0 IV
2 Nursitafyu 24 25/10/ 20 mgg SMA IRT S. TOBA Arkam SMA TANI ?/06/2016 ?/03/2017 II I 0 I
3 Fadila 20 27/10/ 8 mgg SMA IRT S. TOBA 0823 9918 5653 Sofyan SMA TANI ### 6/5/2017 I000
4 Masita 26 ### 14 mgg SD IRT S. TOBA 0852 4016 6346 Slamet SMA TANI ?/08/20016?/05/2017 III II 0 II
5 RahmI 26 ### 12 mgg SMA IRT S. TOBA Agus Y. Ung SMA WS ?/08/2016 ?/05/2017 II I 0 I
6 Nurlina 31 14/11/ 16 mgg SD IRT S. TOBA Herman SD TANI ### 4/24/2017 III I I I
7 Risna 26 14/11/ 12 mgg SD IRT S. TOBA Abu Bakar k. SMA WS ?/08/2016 ?/05/2017 III II 0 II
8 Yuliawat 33 21/11/ 12 mgg SMA IRT S. TOBA 0823 1189 7488 Ihksan S1 Honorer ### 6/14/2017 II I 0 I
9 Nurlin 26 ### 14 mgg SD IRT S. TOBA Ridwan SMP TANI ### 6/5/2017 III I 0 I
10 Nurhayat 31 19/06/ 8 mgg SD IRT S. TOBA 0852 4208 6464 Fitrin SMP TUKANG ### 2/26/2017 III II 0 II
11 Nurafni 26 ### 14 mgg SD IRT S. TOBA Mohamad SD TANI lupa ?/08/2017 III I I I
12 Husna 35 ### 24 mgg SD IRT S. TOBA Lirman SD TANI ?/06/2016 ?/03/2017 III II 0 II
 Isna 44 ### 8 mgg SD IRT S. TOBA Arman SD TANI ?/10/2016 ?/07/2017 X VI III III

13
14 Isna 34 ### 21 mgg SD IRT S. TOBA Najamudin SD TANI ?/09/2016 ?/06/2017 III II 0 II

Asma 36 30/01/ 28 mgg SD IRT S. TOBA Astar SMA TANI lupa ? V IV 0 IV

15
16 Nilasari 18 30/01/ 20 mgg SD IRT S. TOBA Asdik SMP TANI ### 6/9/2017 I000
17 Novriyant 24 ### 8 mgg SMA IRT S. TOBA Maryono SMP WS ?/12/2016 ?/09/2017 II I 0 I
18 Fatma 18 ### 10 mgg SD IRT S. TOBA Isran SD TANI ### 7/30/2017 II I 0 I

Erni 30 ### 16 mgg SD IRT S. TOBA Rifai SD SOPIR lupa ? V II 0 II

19
20 Salma 17 ### 28 mgg SD IRT S. TOBA Jalim SMA TANI ?/07/2016 ?/04/2017 I000
21 Yant 21 ### 28 mgg SD IRT S. TOBA Irfan SMP TANI ### 4/14/2017 II I 0 I

Nurafni 36 ### 16 mgg SD IRT S. TOBA Astam SD TANI lupa ? II I 0 I

22
23 Selvia 18 14/02/ 28 mgg SMP IRT S. TOBA Sahril SMP TANI lupa ? I000
24 Wini 14 ### 16 mgg SD IRT S. TOBA Jamal SMP Bangunan lupa ? I000
25 Rismawat 23 ### 12 mgg SD IRT S. TOBA Kasman SD TANI ### 14/10/2017 II I 0 I
26 Nurlin 26 ### 14 mgg SD IRT S. TOBA Ridwan SMP TANI ### 6/5/2017 III I 0 I
27 Nurhayat 33 ### 12 mgg SD IRT S. TOBA Adam SD TANI ### 18/10/2017 III II 0 II
28 Rita 30 ### 8 mgg SD IRT S. TOBA Asrin SD TANI lupa ? V III I III
29 Wat 28 ### 4 mgg SD IRT S. TOBA Jamaludin SD Bangunan lupa ? II I 0 I
30 Hasni 29 ### 8 mgg SD IRT S. TOBA I Wayan SD WS ?/01/2017 ?/10/2017 III II 0 II
Fauziah 33 ### 10 mgg S1 PNS S. TOBA Sahjudin SMA POLISI 25/02/20172/12/2017 III II 0 I
31
32 Maulida 27 8 mgg S. TOBA Amran ?/03/2017 ?/12/2017
33 Syafrilda 27 20 mgg S. TOBA ?/11/2016 ?/08/2017
34 Sarlin 27 8 mgg SMA IRT S. TOBA Sumarto SMA SOPIR ?/03/2017 ?/12/2017 III II 0 I
35 Helmiyat 21 24 mgg SMA IRT S. TOBA Ismail SMA TANI 13/10/201620/07/2017 I000
36 Diana 25 18/05/ 4 mgg SD IRT S. TOBA Al-insan SMP TANI lupa ? III II I I
37 Nafa 20 24/05/ 4 mgg SD IRT S. TOBA Sahrul SD WS lupa ? III II I I
38 Fitriani 20 22/05/ 5 mgg SMP IRT S. TOBA 0822 9317 6994 Ismail SMA TANI 18/04/201725/01/2018 I000
39 Jurada 27 29/05/ 16 mgg SMA IRT S. TOBA Sainudin SD WS ?/02/2017 ?/11/2017 I000
40 Susan S. TOBA Wardi
41 Rosmini 27 ### 9 mgg SMA IRT S. TOBA Arman SMP WS ?/04/2017 ?/01/2018 III II 0 II

Inaya 20 30 mgg SD IRT S. TOBA Edi lupa ? II I 0 I

42 SD TANI
43 Mira 31 34 mgg SD IRT S. TOBA Hamran SD TANI lupa ? VII VI I V
44 Syafira 18 SD IRT S. TOBA Fikri SD TANI lupa ? II I 0 I
45 Trisna 19 ### 20 mgg SMK IRT S. TOBA Moh. Arton SD TANI 30/01/20176/11/2017 I000
46 Nurlin 21 17/07/ 20 mgg SMK IRT S. TOBA Moh. Arfan SMK TANI lupa ? I000
47 Nurlaela 35 17/07/ 10 mgg SD IRT S. TOBA 0823 4793 5246 Okrin SD TANI ### 14/02/2018 III II 0 II
48 Hasmia 36 17/07/ 24 mgg SD IRT S. TOBA Zainal SD TANI lupa ? V IV 0 IV
49 Sartn 34 17/07/ 12 mgg SD IRT S. TOBA 0853 4028 6539 Sarip SD TANI 24/04/201731/01/2018 IV III 0 III
50 Nurhaida 37 24 mgg SD IRT S. TOBA Ismail SMA TANI lupa ? IV III 0 II
51 Safyuni 37 24/07/ 16 mgg D II PNS S. TOBA Sudarman S1 PNS ?/04/2017 ?/01/2018 V III I III
52 Masna 27 ### 20 mgg SD IRT S. TOBA Andri SD SOPIR lupa ? II I 0 I
 FORMAT BANK DATA IBU HAMIL TAHUN 2018
Puskesmas : Ampana Timur
Desa : Sabulira Toba

tgl/bln/thn Umur UK Pendidikan Umur

NO Nama Ibu Ibu (mggu) Pekerjaan Alamat No Hp Desa Kecamatan Nama Suami Suami Pendidikan Pekerjaan HPHT TP
K1 (thn)
1 Fatma 16/08/2017 18 8 mgg SD IRT DSN II 0813 4203 6129 S. TOBA RATOLINDO Yurlis 23 SMA PETANI 25/06/2017 2/4/2018
2 Nurlin 21/08/2017 20 8 mgg SD IRT DSN III S. TOBA RATOLINDO Sumardin 25 SMP PETANI 26/06/2017 3/4/2018
3 Delfi 28/09/2017 18 6 mgg SD IRT CAM 0822 9003 4807 S. TOBA RATOLINDO Wendi 25 SD PETANI 17/08/2017 24/05/2018
4 Ruslin 12/9/2017 28 8 mgg SD IRT CAM S. TOBA RATOLINDO Dafris 31 SD PETANI 27/06/2017 4/4/2018
5 Yana 4/9/2017 22 8 mgg SD IRT DSN II S. TOBA RATOLINDO Ilham 29 SD KADUS 28/06/2017 14/10/2017
6 Irma 23/10/2017 36 16 mgg SD IRT DSN IV S. TOBA RATOLINDO Rahin 38 SD PETANI 20/06/2017 27/03/2018
7 Lidia 6/11/2017 17 13 mgg SMP IRT DSN III S. TOBA RATOLINDO Ramdan 20 SD PETANI 24/07/2017 1/5/2018
8 Yulnita 23/11/2017 33 7 mgg SMP IRT DSN I S. TOBA RATOLINDO Abd. Samad 39 SD PETANI ?/09/2017 ?/06/2018
9 Serly 28/11/2017 21 8 mgg SD IRT DSN II S. TOBA RATOLINDO Hamdan 23 SMA BANGUNAN 18/10/2017 25/07/2018
10 Erna 8/11/2017 33 16 mgg Tdk T. SD IRT DSN I S. TOBA RATOLINDO Muhajir 33 SD PETANI ? ?
11 Rasmin 23/12/2017 23 14 mgg SMP IRT DSN II 0853 9698 2355 S. TOBA RATOLINDO Muhajir 33 SD PETANI ?/09/2017 ?/06/2018
12 Ayuni 6/1/2018 19 25 mgg SMP IRT DSN I 0822 9318 2072 S. TOBA RATOLINDO Iksal 23 SMA PETANI ?/07/2017 ?/04/2018
13 Fitriani 6/1/2018 21 9 mgg SMP IRT DSN II S. TOBA RATOLINDO Supardin 27 SD PETANI 6/11/2017 13/08/2018
14 Magfirah 6/1/2018 16 18 mgg SD IRT DSN I S. TOBA RATOLINDO Andri 15 SD WS ?/09/2017 ?/06/2018
15 Norma 17/02/2018 17 8 mgg SMP IRT CAM 0822 9247 3233 S. TOBA RATOLINDO Sarip 22 SD PETANI ?/12/2017 ?/09/2018
16 Warni 12/2/2018 31 20 mgg SD IRT DSN II S. TOBA RATOLINDO Ayub 38 SD PETANI 21/10/2017 28/07/2018
17 Salmawat 7/2/2018 15 12 mgg SD IRT DSN I S. TOBA RATOLINDO M. Ahmad 21 Tdk T. SD PETANI 2/11/2017 9/8/2018
18 Syafiah 12/2/2018 20 10 mgg SMP IRT DSN I 0822 7148 7208 S. TOBA RATOLINDO Moh. Syahdan 21 SMP PETANI 27/11/2017 4/9/2018
19 Arini 1/2/2018 17 26 mgg SD IRT DSN II S. TOBA RATOLINDO Faisal 16 Tdk T. SD PETANI ? ?
20 Nisfa 7/2/2018 16 20 mgg SMP IRT DSN I S. TOBA RATOLINDO Ismail 16 SMP PETANI ?/10/2017 ?/07/2018
21 Sit Ramadhani 2/3/2018 18 20 mgg SD IRT DSN IV S. TOBA RATOLINDO Rahim 33 SMA WS 10/10/2017 17/07/2018
22 Sarlin 6/3/2018 30 5 mgg SMP IRT DSN II S. TOBA RATOLINDO Sumarto 29 SD SOPIR 28/01/2018 5/11/2018
23 Noviani 8/3/2018 26 4 mgg SMA IRT DSN III S. TOBA RATOLINDO Samsul 28 SD PETANI ?/01/2018 ?/10/2018
 Fakt Jamin
or an Status Resiko Nama Dukun /
HB gr% LILA KET
Resik Keseh (KRR/KRT/KRST) Kader
o atan

KTP KRT PARTUS

21 KTP KRT PARTUS
KTP KRR PARTUS
KTP KRR PARTUS
KTP KRR PARTUS
23.5 KTP KRR PARTUS
KTP KRR PARTUS
KTP KRT PARTUS
KTP KRR PARTUS
26 KTP KRR PARTUS
32 KTP KRR PARTUS
28 KTP KRT PARTUS
23 KTP KRT PARTUS
26 KTP KRT PARTUS
27 KTP KRR PARTUS
25 KTP KRR PARTUS
KTP KRR PARTUS
KTP KRR PARTUS
JKM KRR PARTUS
KTP KRR PARTUS
KIS KRR PARTUS
20 KTP KRR PARTUS
22 KTP KRR PARTUS
 JKM KRR PARTUS
KIS PARTUS
KIS PARTUS
KTP KRR PARTUS
KTP KRT PARTUS
26.5 KTP KRT PARTUS
KTP KRR PARTUS
POST SC KTP KRST PARTUS
KTP KRR PARTUS
21 KIS KRR Mama Asma PARTUS
KTP KRR PARTUS
24.5 JKD KRR Kamaria PARTUS
26 KTP KRR ABORTUS
ASKES KRR Kamaria PARTUS
KIS KRR Kamaria PARTUS
BB 113,5KTP KRT Mali PARTUS
19.6 JKD KRR Mama Asma PARTUS
30 HDK JKD KRST Iram PARTUS
22 KTP KRR Mama Asma PARTUS
KTP KRR PARTUS
23 KTP KRR PARTUS
20.5 KIS KRR PARTUS
20 KTP KRR Mama Asma PARTUS
Terla KIS KRT Mama Asma PARTUS
24.7 JKD KRR Mama Asma PARTUS
28 ASKES KRR ABORTUS
23.5 KTP KRR Mali PARTUS
26 KIS KRR Mali PARTUS
 Jarak
Keha
28 mila KIS KRT Kamaria PARTUS
n 12
thn

KTP KRR Kamaria PARTUS

KTP KRR Mama Asma PARTUS
KTP KRR ABORTUS
23.5 KIS KRST PARTUS
31 Terlal KTP KRST PARTUS
20 KIS KRR PARTUS
23 BPJS KRR PARTUS
22 KTP KRR PARTUS
KTP KRR PARTUS
28.5 KTP KRR PARTUS

Terla
lu
Tua,j
arak
keha
mila
n,ab KIS KRST Mama Asma PARTUS
ortus
,terla
lu
bany
ak
anak
 27 KTP KRR Kamaria PARTUS
30 KTP KRR PARTUS
26 KTP KRR PARTUS

Fakt Jamin
or an Status Resiko Nama Dukun /
HB gr% LILA KET
Resik Keseh (KRR/KRT/KRST) Kader
o atan

31 Terlal KTP KRST Partus

20 KIS KRR Partus
22 KTP KRR Partus
KTP KRR Partus
26 KTP KRR Partus
KTP KRR Partus
28.5 KTP KRR Partus
30 KTP KRR Partus
KTP KRR Partus
30 HDK JKD KRST Iram Partus
KTP KRR
24 KTP KRR Partus
 terlal
u
31 tua,t KTP KRST Partus
erlal
u
bany
ak
anak
,abor
tus
3x,
30 KTP KRR Partus

terlal
u
bany
ak
anak
24 ,jara KTP KRT Partus
k
keha
mila
n>
10
tahu
n,riw
ayat
pers
alina
n
duku
n
 24.5 KTP KRR Partus
24.9 KTP KRR
25.6 KTP KRR

jarak
keha
mila KTP KRT Partus
n7
bula
n

24 KTP KRR Partus

24.2 KTP KRR Partus

jarak
24.5 keha KTP KRR Partus
mila
n>
10
tahu
n
TB kurang
20 dariKIS
145 KRR Partus
terlalu mudah
JKD KRR
23 KTP KRR
KTP KRR Partus
23 KTP KRR
23 KTP KRR
KIS KRR Abortus
31 KTP KRR Abortus
30 ASK KRST
sc 3x
KTP KRR
KTP KRR
 KTP KRR Abortus
KTP KRR Partus
20,5 KTP KRR
21 BPJS KRR
21 KTP KRR
23,5 KTP KRR

21,5 KTP KRR

Riwa
yat KRST
SC KTP Partus
KTP KRT Partus
KTP KRR Partus
25,7 KTP KRR
22,5 KTP KRR
24,5 KTP KRR
26 HDK KTP KRT
24,5 KTP KRR
KTP KRR Partus
24 KTP KRR
25,5 KTP KRR
 Status Resiko Jaminan
GPAH Riw. KB GD LILA (KRR/KRT/KRST) KET
Persalinan
I000 24 KRR/skor 2 KIS MANDIRI
II I 0 I SUNTIK 28 KRST/ skor 12 KIS
II I 0 I PIL 24,5 KRT/skor 6 KTP
II I 0 I SUNTIK 24,5 KRR/skor 2 KIS
II I 0 I SUNTIK 26,5 KRR/skor 2 KIS MANDIRI
IV III 0 III PIL 23,5 KRT/skor 6 KTP
I000 23,5 KRR/skor 2 KIS
II I 0 I 24 KRT/skor 6 KTP
I000 26,7 KRR/skor 2 KIS
IV III 0 II 25 KRT/skor 6 KIS
I000 23 KRT/skor 6 KIS MANDIRI
I000 26 KRR/skor 2 KTP
II I 0 I SUNTIK 27 KRR/skor 2 KIS
I000 18,5 KRT/skor 6 KIS MANDIRI
I000 20 KRT/skor 6 KIS
II I 0 I 28,5 KRT/skor 6 KIS
I000 B 22 KRT/skor 6 KIS
I000 AB 23,5 KRR/skor 2 KTP
I000 23 KRR/skor 2 KIS
I000 21 KRT/skor 6 KTP
II I I 0 24,5 KRT/skor 6 KTP
IV III I I O 26 KRT/skor 6 KIS
III II 0 II PIL 26 KRR/skor 2 KIS
 FORMAT BANK DATA BAYI BARU LAHIR TAHUN 2017

puskesmas : Ampana Timur

Desa : Sabulira Toba
Bulan : Januari 2017

NAMA ORANG TUA NAMA SAKSI

PANJANG
NO NAMA BAYI L/P TTL AGAMA ALAMAT BERAT BAYI URUTAN ANAK KET
AYAH IBU BAYI SAKSI 1 SAKSI 2
KE BERAPA
1 HALIFA HALIMATULLAH P 8/1//2017 ISLAM S. TOBA Tn. Nani Ny. Novi A. 3100gr 48cm III (Tiga) Bid. Fitriani Hawa
Sulaeman
2 MOH. SAHRIL A. MANAF L 25/1/2017 ISLAM S. TOBA Tn. Arman Ny. Sarina 2800gr 48cm I (Satu) Bid. Fitriani Sawia
3 NURJANNAH p 26/1/2017 ISLAM S. TOBA Tn. Amran Ny. Wisda 2200gr 45cm I (Satu) Bid. Fitriani Sawia

FORMAT BANK DATA BAYI BARU LAHIR TAHUN 2017

puskesmas : Ampana Timur
Desa : Sabulira Toba
Bulan : Februari 2017

NAMA ORANG TUA PANJANG URUTAN ANAK NAMA SAKSI

NO NAMA BAYI L/P TTL AGAMA ALAMAT BERAT BAYI KET
AYAH IBU BAYI KE BERAPA SAKSI 1 SAKSI 2
1 FAHIRA M. ALI P 6/2/2017 ISLAM S. TOBA Tn. Andri Ny. Syafitra 2200gr 45cm I (Satu) Bid. Fitriani Sawia
2 NURHAFIZ L 6/2/2017 ISLAM S. TOBA Tn. Jalil Ny. Zulfaizah 2600gr 48cm I (Satu) Bid. Fitriani Hawia
3 NURHALISA P 6/2/2017 ISLAM S. TOBA Tn. Moh. Naim Ny. Sarlina 3000gr 49cm 11 (sebelas) Bid. Fitriani Sawia
4 FADEL L 8/2/2017 ISLAM S. TOBA Tn. Abd. Hafid Ny. Titn 2800gr 49cm I (Satu) Bid. Fitriani Sawia
5 KHAIRUL AZAM L 11/2/2017 ISLAM S. TOBA Tn. Haris Ny. Atn 2500gr 48cm III (Tiga) Bid. Fitriani Sawia
6 MOH. FAHMI F. AYAHU L 22/2/2017 ISLAM S. TOBA Tn. Fitrin Ny. Nurhayat 3500gr 50cm III (Tiga) Dokter Bid. RS SC

FORMAT BANK DATA BAYI BARU LAHIR TAHUN 2017

puskesmas : Ampana Timur
Desa : Sabulira Toba
Bulan : Maret 2017

NAMA ORANG TUA PANJANG URUTAN ANAK NAMA SAKSI

NO NAMA BAYI L/P TTL AGAMA ALAMAT BERAT BAYI KET
AYAH IBU BAYI KE BERAPA SAKSI 1 SAKSI 2
1 ARSYILA A. ISHAK P 10/3/2017 ISLAM S. TOBA Tn. Amir Ishak Ny. Rosmin 2500gr 46cm 5 (Lima) Dokter Bid. RS SC
1 SISKAILA P 14/3/2017 ISLAM S. TOBA Tn. Jalim Ny. Salma 2500gr 45cm I (Satu) Bid. Fitriani Sawia
2 MOH. ABIZAR L 15/3/2017 ISLAM S. TOBA Tn. Arkam Ny. Nursitafyu 2600gr 51cm II (Dua) Bid. Fitriani Kamaria
 FORMAT BANK DATA BAYI BARU LAHIR TAHUN 2017
puskesmas : Ampana Timur
Desa : Sabulira Toba
Bulan : April 2017

NAMA ORANG TUA PANJANG URUTAN ANAK NAMA SAKSI

NO NAMA BAYI L/P TTL AGAMA ALAMAT BERAT BAYI KET
AYAH IBU BAYI KE BERAPA SAKSI 1 SAKSI 2
1 ANDIKA PRASETIYO L 1/4/2017 ISLAM S. TOBA Tn. Slamet Ny. Masita 3000gr 48cm 3 (Tiga) Bid. RS Bid. RS
2 HUKMAINNAH HERMAN P 8/4/2017 ISLAM S. TOBA Tn. Herman Ny. Nurlina 2550gr 48cm II (Dua) Bid. Fitriani Sawia
3 By.Ny. FADILA L /4/2017 ISLAM S. TOBA Tn. Sofyan Ny. Fadila 3000gr 48cm I (Satu) Bid. PKM
4 SILFA P 30/4/2017 ISLAM S. TOBA Tn. Lirman Ny. Husna 2800gr 46cm II (Dua) Bid. Fitriani Kamaria

FORMAT BANK DATA BAYI BARU LAHIR TAHUN 2017

puskesmas : Ampana Timur
Desa : Sabulira Toba
Bulan : Mei 2017

NAMA ORANG TUA PANJANG URUTAN ANAK NAMA SAKSI

NO NAMA BAYI L/P TTL AGAMA ALAMAT BERAT BAYI KET
AYAH IBU BAYI KE BERAPA SAKSI 1 SAKSI 2
1 ALVIN L 8/5/2017 ISLAM S. TOBA Tn. Rifai Ny. Erni 3600gr 50cm 3 (Tiga) Bid. RS Bid. RS
2 NALFA I.T.UNGA P 10/5/2017 ISLAM S. TOBA Tn. Irfan Ny. Yant 3000gr 49cm II (Dua) Bid. Fitriani Sawia
3 By. Ny. ISNA P 10/5/2017 ISLAM S. TOBA Tn. Najamudin Ny. Isna 2800gr 47cm 3 (Tiga) Bid. Fitriani Sawia
4 By. Ny. RISNA L 11/5/2017 ISLAM S. TOBA Tn. Abu Bakar Ny. Risna 3100gr 49cm 3 (Tiga) Bid. Fitriani Sawia
 5 By. Ny. ASMA P 17/5/2017 ISLAM S. TOBA Tn. Astar Ny. Asma 3200gr 50cm V (Lima) Bid. Fitriani Keluarga
6 ADIB AMINULLAH L 17/05/2017 ISLAM S. TOBA Tn. Ridwan Ny. Nurlin 3000gr 48cm 3 (Tiga) Dokter SC
7 By. Ny. NILASARI L 24/05/2017 ISLAM S. TOBA Tn. Asdik Ny. Nilasari 2750gr 44cm I (Satu) Bid. Fitriani Sawia
8 By. Ny. SELVIA P 26/05/2017 ISLAM S. TOBA Tn. Sahril Ny. Selvia 2600gr 44cm I (Satu) Bid. Fitriani Keluarga

FORMAT BANK DATA BAYI BARU LAHIR TAHUN 2017

puskesmas : Ampana Timur
Desa : Sabulira Toba
Bulan : Juni 2017

NAMA ORANG TUA PANJANG URUTAN ANAK NAMA SAKSI

NO NAMA BAYI L/P TTL AGAMA ALAMAT BERAT BAYI KET
AYAH IBU BAYI KE BERAPA SAKSI 1 SAKSI 2
1 FATHIA AZ-ZAHRA P 1/6/2017 ISLAM S. TOBA Tn. Fikri Ny. Syafira 2600gr 49cm II (Dua) Bid. Fitriani Keluarga
2 AULIA AZZAHRA P 2/6/2017 ISLAM S. TOBA Tn. Agus Ny. Rahmi 3480gr 50cm II (Dua) Bid. RS Sawia
3 By. Ny. MIRA P 14/6/2017 ISLAM S. TOBA Tn. Hamran Ny. Mira 2800gr 47cm VII (Tujuh) Bid. Fitriani Sawia
4 By. Ny. HELMIYATI P 14/6/2017 ISLAM S. TOBA Tn. Ismail Ny. Helmiyat 2550gr 45cm I (Satu) Bid. Fitriani Keluarga
5 FATIN P 14/6/2017 ISLAM S. TOBA Tn. Luksan Ny. Yuliawat 3700gr 50cm II (Dua) Bid. RS Keluarga

FORMAT BANK DATA BAYI BARU LAHIR TAHUN 2017

puskesmas : Ampana Timur
Desa : Sabulira Toba
Bulan : Juli 2017
 NAMA ORANG TUA PANJANG URUTAN ANAK NAMA SAKSI
NO NAMA BAYI L/P TTL AGAMA ALAMAT BERAT BAYI KET
AYAH IBU BAYI KE BERAPA SAKSI 1 SAKSI 2
1 By. Ny. YANI L 2/7/2017 ISLAM S. TOBA Tn. Amar Ny. Yani 3000gr 49cm I (Satu) Bid. Fitriani Sawia
2 FITRIANI P 10/7/2017 ISLAM S. TOBA Tn. Edi Ny. Inayah 2340gr 47cm II (Dua) Dokter SC
3 MOH. FAIZ L 17/7/2017 ISLAM S. TOBA Tn. Ismail Ny. Nurhaida 3000gr 50cm IV (Empat) Bid. Fitriani Keluarga
4 ALDIYANSAH L 23/7/2017 ISLAM S. TOBA Tn. Astam Ny. Nurafni 3000gr 50cm II (Dua) Bid. RS Keluarga
 FORMAT BANK DATA IBU HAMIL TAHUN 201
puskesmas : Ampana Timur
Kelurahan : DONDO

tgl/bln/thn Umur UK Pendidik Pekerjaa Umur

NO Nama Ibu Ibu Alamat No Hp Kelurahan Kecamatan Nama Suami
K1 (thn) mgg an n Suami
` NURMIYATI 9/15/2017 26 5 SMP IRT JL.WRTL MONGISIDI 82291287730 DONDO RATOLINDO MOH.ASRI 30
2 SURIANI 12/20/2017 34 8 D2 PNS JL.PULAU LINDU 85298028566 DONDO RATOLINDO RIO.S.LADJUMA
3 PUTRI ADELIA 10/31/2017 21 12 SMU IRT JL.AHMAD YANI.05 DONDO RATOLINDO AFRIANSYAH 23
4 FITRIA M 10/11/2017 25 4 S1 HONOR JL. AHMAD YANI 82188318511 DONDO RATOLINDO FIDIYANTO H 27
5 FADLIA S 1/31/2018 32 12 SMP IRT KEL.DONDO 85825016112 DONDO RATOLINDO JOHN 39
6 WARDA W 12/12/2017 31 12 SMU WS JL. AHMAD YANI 81341100070 DONDO RATOLINDO DWI NOVIANTO 41
7 WIDIA SARI 2/7/2018 31 7 S1 PNS JL.AHMAD YANI 85340441751 DONDO RATOLINDO KISMAN 29
8 MASWAH 3/31/2018 27 7 S1 HONOR JL.BATAMPOLO 82291669317 DONDO RATOLINDO MOH.MUNAWIR
9 KARTINI 1/20/2018 33 12 D3 HONOR JL.WRTL MONGISIDI 81241013507 DONDO RATOLINDO ZIKRULLAH 34
10 NISWA 2/28/2018 37 10 D3 HONOR JL.TANJUNG SANTIGI 82292471175 DONDO RATOLINDO AGUS 28
11 REKAWATI DG 1/8/2018 36 13 S1 PNS BTN BATAMPOLO 82347481689 DONDO RATOLINDO SAFRUDIN 38
12 FERAWATI 2/2/2018 31 12 JL.WRTL MONGISIDI DONDO RATOLINDO SUGI
13 HASNI IBRAHIM 11/1/2017 31 5 IRT KEL.DONDO DONDO RATOLINDO BAMBANG 38
14 MURNI 11/14/2017 10 SD IRT JL.TANJUNG KARANG 82346532857 DONDO RATOLINDO JEFRI
15 RISKAYANATI 10/2/2017 32 9 SMU PNS JL.WRTL MONGISIDI 82189510991 DONDO RATOLINDO SUPRIYANTO 38
16 NANI 1/3/2018 38 9 SMU IRT KEL.DONDO 82187132326 DONDO RATOLINDO LIKSON 36
17 RAHMAWATI 11/13/2017 26 11 SMP IRT JL.WRTL MONGISIDI 82293687808 DONDO RATOLINDO SUAIB 27
18 WINDI 11/27/2017 17 11 SMU IRT KEL.DONDO DONDO RATOLINDO NASER 17
19 KALSUM 10/13/2017 33 12 SMK IRT JL.AHMAD YANI 81339381786 DONDO RATOLINDO RONI SAMAN 33
20 MASULAN 10/23/2017 32 5 S1 HONOR JL.TG KRAMAT 81341338996 DONDO RATOLINDO SAHABUDIN 31
21 WIDYANINGSIH 11/1/2017 26 5 S1 IRT JL.TG KRAMAT 85242206836 DONDO RATOLINDO ACO 27
22 NENENG 12/14/2017 36 9 SMU IRT JL.PSR SORE LAMA 85241021162 DONDO RATOLINDO AGUNG SUBEKTI 41
23 AFNI 1/9/2018 36 13 S1 PNS JL.TG KRAMAT 82349223606 DONDO RATOLINDO HAFIT 35
24 EVA 3/27/2018 26 12 S2 WS JL.TG KRAMAT 81286992777 DONDO RATOLINDO ZIA ULHAS A 26
25 LIAN ABID 8/24/2017 25 6 SD IRT JL.WRTL MONGISIDI 82292938965 DONDO RATOLINDO RENDI RAJAKU 28
26 MASITA 2/9/2018 36 13 S1 PNS JL.TG KRAMAT 85393236164 DONDO RATOLINDO UUN UNARSO 37
27 EKA PRATIWI P 9/13/2017 25 12 S1 IRT JL.AHMAD YANI 82348762295 DONDO RATOLINDO RAHMAN LASIBU 25
28 ROSMIN R.L 6/8/2017 32 4 S1 HONOR JL.AHMAD YANI 85394279279 DONDO RATOLINDO AGUSSALIM S 38
29 RUYAN 6/3/2017 27 8 S1 HONOR BATAMPOLO 85242919925 DONDO RATOLINDO RUSDIANTO 28
30 EKA 9/19/2017 25 12 SMP IRT JL.PSR SORE BARU 81241889965 DONDO RATOLINDO UMAR 29
31 SRI KARTINI 8/7/2017 34 7 SMA IRT JL.WRTL MONGISIDI 81364326635 DONDO RATOLINDO TAKWIN SALEH 36
32 FITRIANI 10/19/2017 29 8 SMP IRT KEL.DONDO 85298621080 DONDO RATOLINDO SUHARDI 40
33 SUMIYATI 7/29/2017 36 4 S1 PNS JL.TG KRAMAT DONDO RATOLINDO HAIRUL D
34 SOFIA 6/5/2017 16 7 SD IRT BATAMPOLO DONDO RATOLINDO FADLI 19
35 RASNI ONI 7/20/2017 19 5 SD IRT BATAMPOLO 85340268439 DONDO RATOLINDO ERWIN 26
36 CAHYANI 6/22/2017 19 7 SMU MHSSW BATAMPOLO BTN 82291952577 DONDO RATOLINDO AAN KURNIAWAN 20
37 RATNA 5/6/2017 31 5 SMP IRT KEL.DONDO KOST DONDO RATOLINDO JONI 35
38 NURMIN 6/14/2017 30 5 SD IRT JL.TG KRAMAT 85342795818 DONDO RATOLINDO DONI 34
39 ARNI AYU 6/9/2017 24 8 S1 IRT JL.AHMAD YANI 81354971357 DONDO RATOLINDO MOH ALI AKBAR 25
40 SALMA M L 6/22/2017 33 7 S1 PNS JL.WRTL MONGISIDI 85299612008 DONDO RATOLINDO RINTO KUSIKA 35
41 NOFRITA 5/18/2017 46 4 SD IRT JL.WRTL MONGISIDI DONDO RATOLINDO YUNUS 47
42 RATNI 6/13/2017 28 7 SD IRT JL.TG KARANG 85396966002 DONDO RATOLINDO MIRWAN 38
43 NURMI 5/2/2017 25 5 SMP IRT JL.TG KRAMAT 82347434816 DONDO RATOLINDO BAMBANG 50
44 NURHAIDA 8/19/2017 19 12 SMP IRT JL.AHMAD YANI 82296589309 DONDO RATOLINDO RAFDI 18
45 ROSMIATI 9/23/2017 43 7 SD IRT JL.TG KRAMAT DONDO RATOLINDO ALSAFRI 43
46 ELFI 10/3/2017 23 13 SMK IRT JL. TG KRAMAT 82292115480 DONDO RATOLINDO M RIDWAN 24
47 SITI FATIMAH 8/6/2017 19 5 SMU IRT JL. WRTL MONGISIDI 82271282624 DONDO RATOLINDO ABD RAHMAD M 25
48 ELFI 8/10/2017 38 12 S1 PNS JL. WRTL MONGISIDI 85341230362 DONDO RATOLINDO SUTARNO 39
49 KASMATANG 8/4/2017 27 9 SD IRT JL. WRTL MONGISIDI 82189383836 DONDO RATOLINDO TAMSIL 40
50 RAHMAIKA R T 7/16/2017 19 5 SMP IRT JL.WRTL MONGISIDI DONDO RATOLINDO RONI S P 25
51 SALBIA 9/19/2017 28 8 SMP IRT JL.TG KRAMAT 85341228008 DONDO RATOLINDO MOH MOLFI 40
52 IKA ANGGRIANI 12/2/2017 24 13 SD IRT DKT PASAR SORE 85299555160 DONDO RATOLINDO MAHADI
53 SITI FATIMANG 12/9/2017 23 4 D3 IRT KEL.DONDO KOST 82337098019 DONDO RATOLINDO SAHIR 29
54 ERVINA 11/13/2017 23 7 SMP IRT JL.TG KRAMAT DONDO RATOLINDO SUANDI 30
55 RUSNI 9/22/2017 43 4 SD IRT JL.TG KRAMAT 81354476320 DONDO RATOLINDO RENI RAHMAN 45
56 JESTELLA P M 8/4/2017 21 5 SMA IRT DEKAT AMPNA MART 82395037764 DONDO RATOLINDO YAHYA SUMAILA 22
57 YANTI 10/19/2017 38 7 SMP IRT DKT LAPANGAN 85256814188 DONDO RATOLINDO HUSEN MAPU 39
58 DEWI 9/15/2017 28 5 SD IRT BATAMPOLO 82211138500 DONDO RATOLINDO RAM 32
59 SUSANTI 3/8/2017 37 11 SMP IRT DKT LAMPU MERAH 85240499209 DONDO RATOLINDO DENY 38
60 ATIKA 10/6/2017 19 8 SMU IRT JL. WRTL MONGISIDI 82290491518 DONDO RATOLINDO RAMA YASIN 19
61 AINUN 12/6/2017 18 6 SD IRT JL. LRNG MERDEKA DONDO RATOLINDO SUMAIL 23
62 MASNUN 10/5/2016 36 5 SMA WS BTN BATAMPOLO 81243439343 DONDO RATOLINDO HIDAYAT M 38
63 SULASTRI 10/20/2017 27 6 SMU HONOR PSR SORE LAMA 82349794001 DONDO RATOLINDO ISHAK 28
64 RAHMA TAHER 11/1/2017 34 10 S1 IRT JL.WRTL MONGISIDI 82290044344 DONDO RATOLINDO YOS FREDI 39
65 NOVRIYANTI 8/20/2017 21 6 SMP IRT BATAMPOLO DONDO RATOLINDO ARDIANSYAH 27
66 SRI HANDAYANI 10/23/2017 26 12 S1 IRT JL.TG KRAMAT 81393375678 DONDO RATOLINDO IBRAHIM 30
67 NAHDA 12/9/2017 25 4 D3 IRT JL.TG KRAMAT 82290848141 DONDO RATOLINDO HARUN 25
68 FARIDA 9/5/2017 25 6 S1 IRT PSR SORE LAMA DONDO RATOLINDO FITRACIN 27
69 RAHMATIA A L 1/30/2017 25 10 SMA IRT JL.TG KRAMAT 82291114949 DONDO RATOLINDO HARAHAP 41
70 VENI NOLIYANA 9/12/2017 22 13 SMK IRT KEL.DONDO 82395088959 DONDO RATOLINDO EKA PUTRA P 27
71 SILVANA 9/1/2017 22 11 SMU IRT JL.TG KRAMAT 82291686857 DONDO RATOLINDO KAMIL 22
AHUN 2018

Jamina
Pendidik Pekerjaa Riw. GD LILA Status Resiko n
HPHT TP GPAH Persali KET
an n KB (KRR/KRT/KRST)
nan
SD WS LUPA LUPA V-II-II O 25 GRAVID JKD
SMA WS 10/10/2017 7/12/2018 III-II-0 A 25 SC 2X KIS
SMU 7/24/2017 5/31/2018 I-0-0 B 27 KTP
SMU WS 9/3/2017 6/10/2018 III-I-I 24.5 ABORTUS KIS
SMU WS 10/19/2017 7/26/2018 III-II-0 O 27 SC 2X JKD
S1 BUMN 9/10/2017 6/17/2018 III-0-II B 34 ABORTUS 2 KIS
D3 TNG KTR 12/20/2017 9/27/2018 I-0-0 A 25 KIS
S1 WS 2/14/2018 11/21/2018 I-0-0 A 25.5 KIS
SMU HONOR 10/10/2017 7/17/2018 II-I-0 B 24.5 JARAK KTP
S1 WS 12/17/2017 9/24/2018 I-0-0 A 29 UMUR U
SMU WS 11/22/2017 8/29/2018 III-II-0 27 UMUR, GRAVID KIS
LUPA LUPA III-II-0 25 JARAK,GRAVID KIS
PETANI LUPA LUPA V-IV-0 A 30 JARAK,GRAVID KTP
SD WS 9/7/2017 6/14/2018 III-I-I AB 34 ABORTUS,JARAK JKD
SMU SWASTA 8/5/2017 5/22/2018 V-I-III O 27 SC,ABORTUS, KIS
S1 PNS 10/31/2017 8/7/2018 IV-III-0 O 30 UMUR,GRAVID KIS
SD NELAYAN 8/28/2017 6/4/2018 IV-III-0 O 28 GRAVID KIS
SMU SUPIR 9/3/2017 6/10/2018 II-I=0 O 19 UMUR JKD
S1 PNS 7/16/2017 4/23/2018 III-I-I O 29 GRAVID KIS
SMU WS ?/09/2017 ?/06/2018 II-I-0 O 26 GRAVID KIS
SMU 9/12/2017 6/29/2018 I-0-0 O 19.5 GRAVID U
SMP WS 10/11/2017 7/18/2018 II-I-0 28.5 UMUR,GRAVID KTP
D3 WS ?/10/2017 ?/07/2018 II-I-0 O 23 UMUR KIS
SMU POLRI 12/25/2017 10/2/2018 I-0-0 AB 25.1 GRAVID KIS
 SD WS ?/06/2017 ?/03/2018 II-I-0 30 GRAVID KIS
S1 WS 11/8/2017 8/15/2018 III-II-0 O 26 UMUR,GRAVID KIS
SMU WS 6/21/2017 3/28/2018 I-0-0 AB 24 GRAVID KIS
SMU WS 4/28/2017 2/4/2018 IV-II-I B 30 GRAVID KTP
WS 4/1/2017 1/8/2018 I-0-0 26 GRAVID KIS
SMP WS ?/06/2017 ?/03/2018 I-0-0 AB 37 U
S1 PNS 6/18/2017 3/25/2018 III-II-0 B 26 JARAK KIS
SMA PETANI 8/1/2017 5/8/2018 III-II-0 AB 25 JKD
SMA WS 6/25/2017 4/1/2018 II-I-0 A 26 MAAG,VERTIGO KIS
SMU WS ?/04/2017 ?01/2018 I-0-0 A 23.5 UMUR KIS
SD PETANI 6/15/2017 3/22/2018 I-0-0 AB 24 UMUR KIS
SMU MHSSW 6/2/2017 3/9/2018 I-0-0 O 26 UMUR KTP
SMP WS ?/04/2017 ?/01/2018 III-II-0 A 25 U
SMP PETANI 5/10/2017 2/17/2018 II-I-0 28 KTP
S1 WS 4/14/2017 1/21/2018 I-0-0 A 26 KIS
SMU WS 4/27/2017 2/3/2018 I-0-0 O 29 BPJS
SD SUPIR ?/04/2017 ?/01/2018 V-IV-0 O 34 UMUR,JARAK KTP
SMU WS 4/25/2017 2/1/2018 I-0-0 B 25 KTP
SMA PNS 3/28/2017 1/4/2018 III-I-I 29 U
SMP WS LUPA LUPA I-0-0 20.5 UMUR KIS
SMU PETANI 8/6/2017 5/13/2018 IV-III-0 B 36 UMUR KIS
SMK WS 7/3/2017 4/10/2018 II-I-0 O 24 KIS
SMU WS 6/24/2017 4/1/2018 II-I-0 O 24.2 UMUR KIS
SMU HONOR 6/27/2017 4/4/2018 III-II-0 B 29 UMUR KIS
SMP WS 6/2/2017 3/9/2018 II-I-0 B 28 KIS
SMA WS 6/11/2017 3/18/2018 II-I-0 23.5 UMUR KTP
SMU WS 7/25/2017 5/2/2018 III-II-0 O 28 U
SD WS 8/18/2017 5/25/2018 II-I-0 B 23.5 GRAVID KIS
SD WS 11/11/2017 8/18/2018 I-0-0 B 21 GRAVID KTP
SMU WS ?/09/2017 ?/05/2018 II-I-0 O 27 KTP
SD NELAYAN 8/25/2017 6/1/2018 VI-IV-I AB 32.5 ABORTUS U
SMA MHSSW 7/3/2017 4/3/2018 I-0-0 O 25 GRAVID KIS
SMU WS 9/1/2017 6/8/2018 III-II-0 A 30 UMUR U
SMP WS 8/11/2017 08/15/2018 I-0-0 27 GRAVID U
SMP WS 12/25/2017 01/20/2018 V-III-I B 27.9 UMUR U
SD BURUH 8/11/2017 5/18/2018 I-0-0 20.5 UMUR U
SD WS ?/10/2017 ?/07/2018 I-0-0 25.5 UMUR,GRAVID U
SMA HONOR 8/6/2016 5/13/2018 I-0-0 B 30 UMUR KIS
S1 WS 9/8/2017 6/15/2018 II-I-0 A 26 KTP
S1 WS ?/08/2017 ?/03/2018 IV-III-0 26 KIS
SMA WS 7/9/2017 4/16/2018 II-I-0 A 26 GRAVID KIS
SMU WS ?/07/2017 ?/04/2018 I-0-0 AB 23 KIS
S1 HONOR 11/11/2017 8/18/2018 I-0-0 23.6 GRAVID BPJS
SMK WS 8/14/2017 5/21/2018 I-0-0 O 21.5 U
SMA WS LUPA LUPA IV-II-I 34 KTP
SMA WS LUPA 4/10/2018 I-0-0 26.5 KTP
SMU WS LUPA LUPA I-0-0 23 GRAVID U
Puskesmas : Ampana Timur
Kelurahan : Dondo

tgl/bln/thn Umur Ibu

NO Nama Ibu UK mgg Pendidika Pekerjaan Alamat
K1 (thn) n
1 RAHMAIKA 11/21/2018 21 8 SMP IRT JL.WRTL MONGINSIDI
2 SARI EVAYANTI 10/26/2018 28 4 S1 HONOR JL. AHMAD YANI
3 NURHALIMA 12/22/2018 21 12 SD IRT JL.WRTL MONGINSIDI
4 AMINAH 3/26/2019 23 12 SMU IRT JL.WRTL MONGINSIDI
5 MISIANA 1/16/2019 26 12 DIII HONOR JL.WRTL MONGINSIDI
6 JUWITA 1/7/2019 29 10 SMU IRT JL.WRTL MONGINSIDI
7 NURMILA 11/15/2018 32 13 S1 IRT JL.AHMAD YANI
8 NURAIN 11/10/2018 27 10 SMU IRT JL.AHMAD YANI
9 YUNITA YUDRIN 11/14/2018 26 7 SMU WS JL.TANJUNG LAWAKA
10 SARTIN 1/8/2019 28 13 SMP IRT JL.TG KRAMAT
11 AULIA 1/3/2019 17 5 SMP IRT JL.WRTL MONGINSIDI
12 ELFIRA 1/26/2019 34 10 SMU IRT JL.TG KRAMAT
13 FITRINA 12/23/2018 21 8 SMU HONOR JL TANJUNG LAWAKA
14 DIKA ELDINI 4/2/2019 30 10 S1 IRT JL.TG KRAMAT
15 NELCE 9/28/2018 28 6 SMU WS JL.WRTL MONGINSIDI
16 RAMLAH 9/6/2018 31 5 S1 IRT JL.TG KRAMAT
17 FITRI 9/22/2018 23 4 S1 IRT JL.WRTL MONGINSIDI
18 FEBRIANSYAM 10/8/2018 18 6 SMU IRT JL.AHMAD YANI
19 WINDA WILIANTI 11/29/2018 21 13 SD IRT JL.AHMAD YANI
20 JUHNIA 1/2/2019 29 8 SMU IRT JL.WRTL MONGINSIDI
21 FITRIANINGSIH 4/5/2019 26 4 S1 IRT JL.TANJUNG SANTIGI
22 WILDA 11/12/2018 28 4 S1 HONOR JL.TG KRAMAT
23 SITI RAHMAWATI 8/13/2018 30 8 SMU IRT JL.TG KRAMAT
24 SELVI 8/20/2018 29 6 SMP IRT JL.WRTL MONGINSIDI
25 MAGFIRAH 8/1/2018 25 9 S1 PNS JL.TG KRAMAT
26 MIRNAWATI 3/23/2019 22 9 SMU IRT JL.WRTL MONGINSIDI
27 MIFTAHULJANAH 3/11/2019 21 11 SMU IRT JL.TANJUNG API
28 NUR DIAN 3/16/2019 21 10 SMU IRT JL.TANJUNG LAWAKA
29 SRI HARTATI 3/27/2019 32 8 S1 PNS JL.WRTL MONGINSIDI
30 RENNY DEVI 3/12/2019 24 13 S1 IRT JL.TG KRAMAT
31 ZULIANA 2/8/2019 27 10 S1 IRT JL.WRTL MONGINSIDI
32 RISMA 2/19/2019 30 5 DIII HONOR JL.TANJUNG KARANG
33 WIWIN K ABA 2/23/2019 30 12 SMP IRT JL.TG KRAMAT
34 HANITA 2/28/2019 31 8 SD IRT JL.TANJUNG LAWAKA
35 NANIK INDARTI 2/20/2019 38 12 SMU WS JL.TG KRAMAT
36 NURFIYANTI 11/12/2018 27 6 SMU IRT JL.TG KRAMAT
37 MARNI 11/28/2018 39 13 S1 PNS JL.AHMAD YANI
38 DWI NANDITA 12/24/2018 20 13 SMU IRT JL.TANJUNG LAWAKA
39 ZAENAB 11/21/2018 28 13 SMP IRT JL.WRTL MONGINSIDI
40 NURJANAH 12/11/2018 38 12 DII PNS JL.WRTL MONGINSIDI
41 WINING DAUD 11/19/2019 20 13 SMU IRT JL.AHMAD YANI
42 FAUZIAH 12/2/2018 30 12 S1 PNS JL.WRTL MONGINSIDI
43 HARTINA EKA 11/16/2019 27 12 SMU IRT JL.TG KRAMAT
44 HARDIANTI 11/18/2018 28 12 DIII HONOR JL.TG KRAMAT
45 FADILAH 8/27/2018 19 12 SMU IRT JL.TANJUNG LAWAKA
46 WAHYUNI 11/18/2018 21 11 SMU IRT JL.WRTL MONGINSIDI
47 ASURA 10/29/2018 21 11 SMU IRT JL.WRTL MONGINSIDI
48 JESTELLA P M 9/17/2018 21 11 SMU IRT JL.AHMAD YANI
49 SAFITRI 12/22/2018 24 12 SMP WS JL.TG KRAMAT
50 WINDA HAYANI 12/27/2018 30 10 DIII PNS JL.TG KRAMAT
51 SAKINAH 11/10/2018 23 9 DIII IRT JL.TG KRAMAT
52 HARIANI 2/4/2019 39 12 SMP IRT JL.WRTL MONGINSIDI
53 YURIYANTI 11/26/2018 31 13 DIII WS JL.AHMAD YANI
54 DARNAWATI 7/1/2018 23 10 SMU IRT JL.WRTL MONGINSIDI
55 YASTIANI PETRUS 3/14/2019 23 30 DIII IRT JL.TANJUNG SANTIGI
56 RIRIN MAGFIRAH 3/4/2019 19 32 SMU IRT JL.TANJUNG SANTIGI
57 DELVITA 3/12/2019 34 25 SMU IRT JL.TG KRAMAT
58 FAUZIAH 4/8/2019 28 29 SMU IRT JL.AHMAD YANI
 FORMAT BANK DATA IBU HAMIL TAHUN 2019

Umur Pendidika
No Hp Kelurahan Kecamatan Nama Suami Pekerjaan
Suami n
85343716227 DONDO RATOLINDO RONI 26 SMU WS
82291929993 DONDO RATOLINDO RUSLAN 30 S1 WS
82290400969 DONDO RATOLINDO YASMAN 23 SMU WS
DONDO RATOLINDO ASRIMAN 30 S1 WS
82293831592 DONDO RATOLINDO MOH IKRA 25 DIII HONOR
82191900889 DONDO RATOLINDO CHARLES 30 SMU WS
85340877786 DONDO RATOLINDO AGUS SUGIRTO 36 SMU WS
85341484148 DONDO RATOLINDO SULFAHRI 27 SMU WS
85240353297 DONDO RATOLINDO EKI TANJI 25 SMU WS
DONDO RATOLINDO RUSLI 43 SMU PETANI
85394145071 DONDO RATOLINDO SAHRUL 24 SD WS
81243191229 DONDO RATOLINDO MANSUR IBRAHIM 38 SMU POL PP
82394950030 DONDO RATOLINDO RAHMAT 28 S1 HONOR
81266768252 DONDO RATOLINDO FADLI RINALDI 32 S1 KARYAWAN SWASTA
82292506621 DONDO RATOLINDO ISMAIL ABD HAFID 28 D1 WS
82257698483 DONDO RATOLINDO ABDUL JALIL 28 S1 PETANI
85399300878 DONDO RATOLINDO BUDIARSO KEMME 26 S1 PNS
81333096275 DONDO RATOLINDO AFANDI ARFA 23 SMU WS
82296347630 DONDO RATOLINDO RAHMAN ODE 23 SD WS
82348227784 DONDO RATOLINDO HERDI 30 SD PETANI
82291595552 DONDO RATOLINDO ARISMAN 28 DIII WS
82291115383 DONDO RATOLINDO ANDRI PRIYADI 25 SMU WS
85317677793 DONDO RATOLINDO DEES ARIYANTO 32 SMU WS
82271314786 DONDO RATOLINDO KIFLI 23 SD HONOR
82191795924 DONDO RATOLINDO AYUB 27 SMU WS
82291971852 DONDO RATOLINDO AHMAD 27 SMU HONOR
82292627062 DONDO RATOLINDO AGRIYANTO 28 S1 WS
82290419941 DONDO RATOLINDO FENDI 26 SD WS
82187138741 DONDO RATOLINDO MUHAIMIN 28 S1 HONOR
85299647215 DONDO RATOLINDO FAIRUS 24 S1 HONOR
85342887213 DONDO RATOLINDO MOH RIFAI 30 S1 PNS
DONDO RATOLINDO SAIFUL R 36 S1 PNS
85241075262 DONDO RATOLINDO ABDUL RAHMAN 31 S1 WS
85242616866 DONDO RATOLINDO MAHMUD JAWARA 41 SMP WS
82136404440 DONDO RATOLINDO AGUS DURWONO 41 SMP WS
81356461072 DONDO RATOLINDO RIFKI 25 SMU WS
81354450086 DONDO RATOLINDO SAIFUL A HASAN 42 SMU WS
82259235615 DONDO RATOLINDO EKI TANJE 20 SMU WS
DONDO RATOLINDO SALIM S 32 SMP PETANI
82259038695 DONDO RATOLINDO HARDIMAN 37 SMU POLRI
82249169238 DONDO RATOLINDO AMIR R RADI 23 SMU WS
85282853181 DONDO RATOLINDO UBAID SALIM 36 S1 PNS
82192132118 DONDO RATOLINDO ERIK 31 S1 WS
DONDO RATOLINDO SADAM 30 S1 WS
82293734248 DONDO RATOLINDO NOVAL 17 SMU HONOR
81356459346 DONDO RATOLINDO MOH HADI 22 SMU MHSSW
82293515298 DONDO RATOLINDO YUDIN MAHDIN 29 SMU WS
82395037764 DONDO RATOLINDO YAHYA SUMAIRA 22 SMU WS
82293157172 DONDO RATOLINDO JEFRI 28 SMU WS
85242408013 DONDO RATOLINDO MOH RONI 54 SMU WS
82189412627 DONDO RATOLINDO TOTO SUGIARTO 28 S1 KARYAWAN SWASTA
DONDO RATOLINDO AHMAD 46 SMU PETANI
81356460478 DONDO RATOLINDO ZULKIFLI 31 DIII HONOR
82293621419 DONDO RATOLINDO SAFIK 25 SMU WS
85241310262 DONDO RATOLINDO MOH IDRIS 25 SD NELAYAN
85342924578 DONDO RATOLINDO POPO 32 SMP WS
82239856667 DONDO RATOLINDO LUTFI 34 WS
82280450020 DONDO RATOLINDO SUPRIYANTO 30 SMU PETANI
 Riw. Status Resiko Jaminan
HPHT TP GPAH GD LILA KET
KB (KRR/KRT/KRST) Persalinan
9/5/2018 6/12/2019 III-II-0 O 23 JARAK KIS
10/25/2018 8/2/2019 II-I-0 B 31 JARAK KIS
LUPA LUPA III-II-0 B 28 KIS
10/26/2018 8/3/2019 III-0-II O 24.5 ABORTUS U
10/18/2018 7/25/2019 I-0-0 A 21 KIS
LUPA LUPA II-I-0 28 KIS
8/20/2018 5/27/2019 IV-III-0 A 25 GRAVID U
8/20/2018 5/27/2019 V-II-II O 26 GRAVID,ABORTUS KIS
?/08/2018 ?/05/2019 1-0-0 O 24 KIS
?/10/2018 ?/07/2019 III-II-0 O 25 KIS
11/25/2018 9/2/2019 I-0-0 35 KIS
11/20/2018 8/27/2019 II-I-0 AB 31 KIS
11/16/2018 8/23/2019 II-0-I A 29.5 ABORTUS KIS
1/7/2019 10/14/2019 III-II-0 A 25 JARAK,SC 2X KIS
9/10/2018 6/12/2019 1-0-0 O 30 KIS
7/25/2018 5/1/2019 II-0-I O 25 ABORTUS KIS
8/11/2018 5/18/2019 I-0-0 O 26 KIS
8/5/2018 5/12/2019 I-0-0 A 23 U
?/08/2018 ?/05/2019 I-0-0 22.2 KIS
?/10/2018 ?/07/2019 II-I-0 27 JARAK,ASMA KIS
2/22/2019 11/29/2019 II-I-0 B 19 JARAK U
9/28/2018 7/4/2019 I-0-0 A 29 KIS
6/17/2018 3/24/2019 III-II-0 A 24.5 KIS
6/21/2018 3/28/2019 III-II-0 0 24.5 KIS
5/27/2018 3/4/2019 II-I-0 23.5 KIS
1/13/2019 10/20/2019 I-0-0 21 KIS
12/17/2018 9/24/2019 I-0-0 25 U
1/5/2019 10/12/2019 II-I-0 O 31.5 KIS
1/25/2019 10/1/2019 V-I-III 26 GRAVID,ABORTUS,JARAK KIS
11/30/2018 9/7/2019 II-I-0 24 JARAK KIS
LUPA LUPA II-0-I A 26 ABORTUS KIS
11/19/2018 8/26/2019 IX-IV-IV A 28.5 GRAVID,ABORTUS KIS
11/17/2018 8/24/2019 III-II-0 24 JARAK U
?/12/2018 ?09/2019 II-I-0 35 KIS
LUPA LUPA III-II-0 0 30.4 UMUR KIS
?/10/2018 ?/07/2019 II-I-0 O 29 JARAK KIS
?/08/2018 ?/05/2019 III-I-I O 29.5 UMUR,ABORTUS KIS
 LUPA LUPA I-0-0 O 21 U
LUPA LUPA V-IV-0 AB 28 GRAVID KIS
?/09/2018 ?/06/2019 III-II-0 O 23 UMUR,GEMELLY KIS
8/27/2018 6/3/2019 I-0-0 20.5 KIS
9/17/2018 6/20/2019 III-II-0 B 27.5 KIS
?/09/2018 ?/06/2019 I-O-O A 28 U
8/4/2018 5/11/2019 II-I-0 B 23 JARAK KIS
LUPA LUPA I-0-0 O 26.5 KIS
?/08/2018 ?/05/2019 I-0-0 24 U
8/28/2018 6/4/2019 I-0-0 O 24 KIS
?/07/2018 ?/04/2019 II-I-0 O 26 JARAK KIS
?/09/2018 ?/06/2019 III-II-0 27.5 U
LUPA LUPA III-II-0 B 31.5 JARAK KIS
?/08/2018 ?/05/2019 I-0-0 O 26.5 KIS
11/14/2018 8/21/2019 V-II-I 28.5 UMUR,GRAVID,ABORTUS U
9/7/2018 6/14/2019 II-I-0 29 JARAK U
LUPA LUPA II-I-0 A 28.5 KTP
8/5/2018 5/12/2019 I-0-0 AB 26.7 U
LUPA LUPA I-0-0 24.5 KIS
?/09/2018 ?/06/2019 III-II-0 O 28.5 JARAK U
LUPA LUPA III-II-0 25 KIS