TEMPAT PELAKSANAAN :

TAHUN :

JENIS
KELAMIN

NO NIK / NO INDEX NAMA BAYI/BATITA TGL LAHIR NAMA ORANG TUA

L P

1 2 3 4 5 6 7

1 07-86-00 SANIYYAH HANA AZKIYA. AN 13-Dec-16 Maman Sudarman,Tn

2 07-80-92 Wikan Abdul Aziz, An 28-Oct-16 Tri Jaka,Tn

3 08-01-32 ARDIANSYAH NUGRAHA, AN 1-Apr-17 Roma Hermawan,Tn

4 07-83-55 ALFATHAN AZKA PUTRA, AN 23-Nov-16 Hendra.Tn

5 07-77-82 Khaizan tabrizi, An 5-Oct-16 Sofwatul Laylah, Ny

6 07-93-42 M. Banyu ,An 3-Jan-17 Muso,Tn

7 08-16-87 By Ny Gitta Matarani 25-Jul-17 Hermanrto,Tn

8 08-07-69 M. Abdillah Faza Isthafa,An 14-May-17 Maslah Salim,Tn

9 08-06-92 Muhammad Artoni Sariffudin, 9-Feb-17 Budianto,Tn

10 08-13-60 Safira, By 1-Jul-17 Ramlan,Tn

11 07-92-03 Aisyah Putri Shalehah, An. 21-Jan-17 R. M Bachroni, Tn

12 07-98-36 Cahaya Cinta,An 9-Mar-17 Irwan Syah,Tn

13 08-07-19 Juaneta Ailen,An 11-May-17 Yustinus Marcel Rico K,Tn

14 07-78-20 Altrezza Keano,An 15-Oct-16 Agung Pribdai,Tn

15 08-15-78 Arsyila Romeesa F,An 17-Jul-17 Eni M,Ny

16 08-09-84 Narendra Putra,An 29-May-17 Rizky Meis Putra,Tn

17 07-85-94 Fil Alif Tofani,An 12-Dec-16 Ferry Topani,Tn

18 08-02-77 M. Salman Syabani,An 10-Apr-17 Suroso,Tn

19 08-08-12 Aisya Ayudia Rahma,An 17-May-17 Sopyan,Tn

20 08-09-90 Ar Sakha,An 29-May-17 Ainur Rofiq,Tn

21 08-14-62 Arsyila Ramadhania,An 21-Jun-17 Abdriyanto,Tn

22 08-09-61 Maulana Kenzie,An 27-May-17 Agus B,Tn

23 08-18-50 Ibrahim Firnas Ubay,An 23-Dec-14 Fatkhullah,Tn

24 08-12-00 Arsyila Nafiah,An 15-Jun-17 Wahyunianto,Tn

25 08-10-13 By Ny Siti Hardiyanti 1-Jun-17 H. Donni Susatyo Dewantoro,

26 08-09-04 By Ny Ayu Pratiwi 23-May-17 Gusye Ginanjar,Tn

27 08-00-48 Jiro Sakha Rasendria,An 25-Mar-17 Puput Hariadi,Tn

28 08-08-62 Muhammad Auladi Zhafran,An 20-May-17 Doddy Lesmono,Tn

29 08-06-56 SYABILA SAFA KINARA 5-Jan-17 AGRISA EKA NUGRAHAENI. N

30 07-80-61 M. Alby Khalid,An 2-Nov-16 Eko Purwanto,Tn

31 06-42-82 Zidane Fathan Altair,An 18-Dec-14 Edwin Tri Putra,Tn

32 08-19-45 Mikhayla Putri,An 10-Aug-17 Tomi Yulianto,Tn

33 08-18-27 By Ny Ijah 4-Aug-17 Ahim Durahim,Tn

34 08-13-25 Dzikra Izzaty M.An 19-Mar-17 m. Rifqi,Tn

35 06-90-19 Muhammad Al-Fatih,An 5-Aug-15 Nur Hasan,Tn

36 08-19-47 By Ny Dr. Siti Zahroh 10-Aug-17 Hariki,Tn

37 08-13-52 Zhafran Akbar Arazki,An 29-Jun-17 M. Rizki,Tn

38 07-80-65 Valeria Abinaya,An 2-Nov-16 Yohanes N,Tn

39 07-80-15 Raihan,An 30-Oct-16 Ardiansyah A,Tn

40 08-02-70 By Ny Sri Handayani 10-Apr-17 Agus Setiawan,Tn

41 07-79-16 Ridwan Maulana M,An 22-Oct-16 Widodo,Tn

42 08-19-81 Daffa Altaf,An 22-Jan-17 Tatik S,Ny

43 08-19-94 By Ny Suyaningsih 12-Aug-17 Sutardjo,Tn

44 08-12-21 By Ny Titah Wulandari 17-Jun-17 Heri Wijayanto,Tn

45 06-38-28 Khaira Athaleta,An 30-Nov-14 Cristian Indra Putra,Tn

46 08-19-95 By Ny Nina Sarmina 12-Aug-17 Bambang Suhartono,Tn

47 08-19-75 By Ny Destyanah Husein 12-Aug-17 Ihsan Bayu Merdeka,Tn

48 08-14-55 By Ny Selvi Anggraini 7-Jul-17 Eris Kurniawan,Tn

49 07-79-50 Arkha Wildan Setiawan,An 25-Oct-16 Tri Setiawan,Tn

50 08-04-52 Emir Bosa,An 11-Apr-17 Albert,Tn

51 08-00-46 Elfareza Fatharian,An 25-Mar-17 Siswanto,Tn

52 08-19-76 Luthfi Adrian,An 17-Jun-15 Joni Adrizal,Tn

53 07-91-30 Kanesayu,An 23-Jan-17 Dimas Arya,Tn

54 07-20-52 Queenza Zhafeera,An 22-Dec-15 Dedi Supriadi,Tn

55 08-19-78 Widi Muhamad Naufal,An 24-Dec-16 Yadi Cahyani,Tn

56 08-09-97 Btary Autum,An 30-May-17 Agus S,Tn

57 07-90-38 Nazmi Angga N.An 8-Oct-15 Indra Syarif,Tn

58 08-19-80 Daffi Altaf W,An 2-Oct-17 Wijarnako,Tn

59 07-81-88 Christal , An 10-Nov-16 Johan ,Tn

60 08-18-74 By Ny Lingga Hapsari 6-Aug-17 Ricky J,Tn

61 08-15-92 Dadlan A,An 17-Jul-17 Aguis Winarto,Tn

62 08-12-87 Sabrina Ramadhan S,An 17-Jun-17 Rizky Septiawan,Tn

63 07-75-58 Deandra A,An 23-Sep-16 Sudiono,Tn

64 06-66-33 Gibran Al Farabi,An 4-Apr-15 Indra Kosworo,Tn

65 08-16-51 Fadian,A,An 15-Jun-17 Yusrizal,Tn

66 08-20-31 Viandar Chatabella P,An 1-Jun-14 Hendricus Banar A,Tn

67 07-93-99 Nafisha Shareen,An 15-Nov-16 Dwi Riyanto,Tn

68 07-85-71 Mevlana Linggarjati,An 9-Dec-16 Indra,Tn

69 08-80-48 Serafina Naomi Putri,An 11-Mar-14 Hary P,Tn

70 07-83-38 Mikhayla Chalinda P,An 22-Nov-16 Satria Perdana,Tn

71 08-19-45 Mikhayla Putri,An 10-Aug-17 Tomi Yulianto,Tn

72 08-04-16 Nata Sahid,An 11-Apr-17 Nanag Rudy,Tn

73 07-92-34 M. Al. Fatah,An 31-Jan-17 Heppi Frans,Tn
74 08-12-51 Orlie Moses,An 17-May-17 Hasan Basri,Tn
 PENCATATAN HASIL IMUNISASI

PUNYA BUKU KIA

Berat Lahir (gr) / Panjang Lahir
ALAMAT RT/RW NO HP (cm)

8 9 10 11

Jl. Pemuda No. 3 Kreo Selatan Larangan Selatan 0811147718 - BB 7.7kg, PB 67.5cm

JL. H SYAIP RT 005/01 NO 10A CILANDAK 085998060917 PB7.9kg, PB 73.5 cm

JL. MANGGAR III NO 13 RT 04/11 LARANGAN SELATAN, Kec. LARANGAN 021-7316319 BB 7.4kg, PB 65.5cm

KOMPLEK DEPLU 74 BLOK F NO 7 087872222507 BB8.2 kg, PB 72 cm

JL. FLA,MBOYAN Q 74 04/16 Paninggilan Kec. Ciledug 081932786862 PB 8.8 kg , PB 75cm

Jl. Kp Parung Kored Rt 01/02 Prung Jaya Karang Tengah 08136832534 BB 7.9kg PB74cm

Jl. Inpres 18 Rt 001/08 No 36 Larangan Selatan Ciledug 08128802553

Jl. Kejaksaan 3A No 59 /34 Rt 01/06 Kreo Larangan 085215605673 BB 5.9kg, PB 60cm

Jl. Japos Raya Rt 07/013 No 102 Jurang Mangu Pdk Aren 082112523149 BB 6.4kg PB 67cm

Komp DKI Joglo Blok M No 6 085214147777 BB 4.1 kg , PB 55cm

Jl Cendana 06/12 Jurang Mangun Barat Kec. Pondok Aren 082325176666 BB 7.4 kg, PB 67.5 cm

Komplek DKI Joglo Blok BB7 Rt 08/04 0215849355 BB 7.4kg PB 66cm

Jl. Pdk Maharta Blok C 15 No 1 Rt 007/011 081286512457 BB 3.4kg, PB 50cm

Jl. Sunan Guning Jati Gg H. Batuk Rt 02/04 No 14 Paninggilan Ciledug Tange - BB 8kg, PB 70.5cm

Jl. H. Mencong Gg H. Jum II No 32 Rt 01/010 Paninggilan 085692886254 BB 2.4kg

Jl. Prof Dr. Hamka No 12 Rt 01/10 BB 5.3kg, PB 58cm

Jl. Joglo RTt 06/01 No 374 Kel. Joglo Kec. Kembangan Jakbar 089672820389 BB 7.8 kg PB 70cm
Jl. H. Misan No 92 Rt 013/03 Kel. Pesanggrahan P[etukangan BB 6kg,PB 62.5cm

Jl. H. Mencong 28 a Paninggilan Utara Ciledug 081297961549 BB 6.2kg PB 58cm

Komplek Deplu 7 A Blok A No 3 Pdk Aren Tangerang Selatan 08128816656 BB 6.4 kg, PB 65cm

Jl. Perum Metro Permata 2 Blok 07 No 22 Kel. Karang Tengah Kec, Ciledug T 081219625484 BB 4.3kg PB 54cm

Parung Serab Rt 004/005 Ciledug 083893327077 BB 4.4 kg PB 57cm

Jl. Puri Beta 2 Taman Buah VII No 8 Rt 01/13 Tangerang 081321858908 BB 11kg

Kp. Blok Wareg No 112 Rt 003/004 Kec. Larangan Selatan Tangerang 08129036435 BB 5.2kg PB 57cm

Komplek Departemen Keuangan Jl. Merbabu No 6 Rt 06/006 Karang Tengah081219225323 BB5.9kg PB 60.5cm

Jl, Karya Bersama No 49 Rt 02/06 Larangan 081280059837 BB 6.2kg PB 63cm

Jl. Komplek Sawah Indah Rt 01/03 No 104 Kel. Larangan Selatan Kec. Larang- BB 6.9kg PB 71cm

Jl. Inpres 17 Rt 03/09 No 52 BB 5.3kg PB 56cm

JL SEKTOR XVI 05/10 SUDIMARA JAYA Kec. CILEDUG TANGERANG 085779969448

Jl. Wisma Tajur Blok D V/3 Rt 04/07 Tajur Ciledug BB 7.7kg PB 70cm

Jl. Japos Graha Lestari Blok D6/7 Rt 002/08 08994447778 BB 14kg, PB 95cm

Kp.Pdk Jati Rt 001/003 No 35 Jurang Mangu Pdk Aren Tangsel 082213192110 BB 2950gr PB 48cm

Jl. Betet VIII /131 Perumnas 1 Karawaci Tangerang 085310169768 BB 3.1kg

Jl. H. Gaim No 31 Rt 01/02 Petukangan Utara 0899723483 BB 6.1kg PB 61.5cm

Jl. Abdul Rahman No 121 Rt 0011/05 Cibubur BB 14 kg

Jl. Gotong Royong No 39 A Rt 05/01 Larangan Ciledug Tangerang 08126481842 BB 2800gr, PB 47.5cm

Japos Graha Blok 17/8 Rt 03/09 Jurang Mangu Barat BB 5.1kg PB 55cm

Jl. Perum Pdk Lakah Blok B Rt 001/016 087881287458 BB 6.4kg, PB 65cm

Kp. Walang Jl. Masjid No 7 Rt 011/003 Rawa Badak Selatan BB 8.3kg, PB 70cm

Jl. Tanah 100 Rt 002/01 No 10 Sudimara Jaya Ciledug BB 7.2 kg PB 65.5cm

Jl. Pdk Kacang Timur Rt 04/05 Pdk Aren 082137607290 BB 8.8kg, PB 72.5cm

Jl. Ar Rohman Rt 001/013 Pdk Jati Selatan 081387634310 BB 7.1kg PB 71 1/2

Jl. Masjid 2 Rt 02/11 Kel. Sudimara Selatan Kec. Ciledug Tangerang 08568484478 BB 3700gr PB 50cm

Jl. Inpres V Rt 02/13 No 59 Kel. Gaga Kec Larangan BB 3.9kg, PB 55.5cm

Jl.Komplek DKI Blok E 31 11. 1/2 Kg

Jl. Impres 8 No 73 Kel. Larangan Utara Kec. Larangan Tangerang 081399905055 BB 3700gr, PB 50cm

Jl. Komplek Karang Tengah Permai Blok TQ /E Rt 02/014 Kel. Karang Timur K081310283407 BB 3300gr, PB 49cm

Jl. Sarmah No 49 Rt 05/07 Kel. Pdk Kacang Timur 081348072013 BB 3.5kg [B 55cm

Jl. Barokah 1 Rt 01/10 No 46 Ciledug 08128416443 BB 7.7kg PB 67.5cm

Jl. Meruya Utara Jakbar Rt 04/04 081288865761 BB 6.7kg, PB 62.5cm

Jl. Mekar Jaya No 43 Rt 03/10 Peninggilan Utara Ciledug 02173440366 BB 7.3kg, PB 64.5cm

Jl. Griya Kencana 2 Rt 003/015 Sudimara Barat Ciledug 082310835220 BB 11kg, PB 82cm

Jl. Kyai Hsim Joglo Jakbar 085780491661 BB 6.2kg, PB 65cm

Jl. H. Gedad Rt 03/04 No 8 Paninggilan Utara Tangerang 082298356866 BB 9.8kg, PB78cm

Jl. Amli Abas Rt 01/01 Kel. Larangan Selatan Kec. Larangan Tangerang 083804395001 BB 7.8kg

Jl. H. Yusuf Paninggilan Selatan 081317637317 BB 5.5 kg, PB 60cm

Jl. Gg Las Virgo Kp Gunung Rt 02/04 Jombang Ciputat 081381628544 BB13kg PB 87cm

Jl. Ar Rahman Rt 001/013 Pdk Jati Selatan Pdk Aren 081387634310 BB 6.8 kg, PB 70cm

Jl. Hos Cokroaminoto No 47 082122273378 BB 8.6kg BB 75.5c

Jl. Kedaung I Rt 011/011 Jakut, Pesanggrahan BB 2.4kg

Jl. Lembang 2 Rt 02/07 Kel. Sudimara Barat Kec. Ciledug Tangerang 085883353924 BB 4.4kg PB 55cm

Jl. Kembang KerepRt 02/02 Kel. Meruya Utara Kec. Kembangan Jakbar 085719692869 BB 4.4kg PB 55.5 cm

Jl. Harapan Rt 003/02 No 35 - BB 7.5 kg, PB 71cm

Jl. H. Najih No 7 Rt 008/01 Petukangan Utara Jaksel 08115853905 BB 9kg

Jl. Perumahan Bangun Raksa Indah Rt 01/06 Kel. Pdk Pucung Kec. Karang T 081386799907 BB 4kg PB 56.5cm

Jl. Poris PaRADICE 2 Cipondoh angerang 08158815404 BB 14.5

Jl. H. Marjuki 1 Rt 01/15 Gaga Larangan 081580634313 PB 7.1kg BB 69cm

Jl. Duren 1 No 67 Rt 05/02 Kel. Pedurenan Krang Tengah 089656508363 BB 8.2kg PB 70cm

Jl. Gg Shinta Rt 02/02 Larangan Utara Ciledug - BB 16 kg

Jl. Komplek Karang Tengah Permai Blok TK No 12 E BB 7 kg, BB 67cm

Kp.Pdk Jati Rt 001/003 No 35 Jurang Mangu Pdk Aren Tangsel 082213192110 BB 3.2kg

Jl. Mencong Gg Hj Rawit Rt 02/08 085715589255 BB 3.8kg BB 52cm

Jl. H. Jum 1 Rt 03/12 Peninggilan 08221305729 PB 68cm
Jl. GRJB Cluster Carissa F 12 Rt 02/14 Kel. Pdk Jagung Timur Kec, Serpong Ut 81222207522 BB 6kg PB 61cm
N HASIL IMUNISASI

IMUNISASI DASAR

DPT-HB-HiB (1)

DPT-HB-HiB (2)

DPT-HB-HiB (3)

DPT-HB-HiB (4)
HB 0 (24 jam)

POLIO 1

POLIO 2

POLIO 3

POLIO 4
16 BCG
17 18 19 20 21 22 23 24

1-Aug-17

2-Aug-17

2-Aug-17

2-Aug-17 2-Aug-17

2-Aug-17 2-Aug-17

2-Aug-17 2-Aug-17

3-Aug-17 3-Aug-17

2-Aug-17 2-Aug-17

4-Aug-17

4-Aug-17
 5-Aug-17

5-Aug-17

5-Aug-17 5-Aug-17

5-Aug-17 5-Aug-17

7-Aug-17

7-Aug-17 7-Aug-17

7-Aug-17

7-Aug-17 7-Aug-17

7-Aug-17

10-Aug-17 10-Aug-17

10-Aug-17 10-Aug-17

10-Aug-17

11-Aug-17
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12-Aug-17

12-Aug-17

12-Aug-17

12-Aug-17 12-Aug-17

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14-Aug-17

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14-Aug-17 14-Aug-17

15-Aug-17

15-Aug-17

16-Aug-17

16-Aug-17 16-Aug-17
 IMUNISASI
UNISASI DASAR LANJUTAN
(BOOSTER)

VIT A 6 BLN
CAMPAK / CPK
KET

(18-24 bln)
(18-24 bln)
DPT-HB-HiB
RUBELLA

Varicella
PCV 1

PCV 2

PCV 3

CAMPAK
IPV
25 26 27 28 29 30 31 32 33

1-Aug-17

1-Aug-17

1-Aug-17

1-Aug-17

2-Aug-17

2-Aug-17

3-Aug-17

5-Aug-17
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5-Aug-17

9-Aug-17

9-Aug-17

10-Aug-17

10-Aug-17

11-Aug-17
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12-Aug-17

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12-Aug-17

12-Aug-17

12-Aug-17

12-Aug-17

12-Aug-17

14-Aug-17
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14-Aug-17

15-Aug-17

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16-Aug-17