Provinsi KALIAMANTAN TENGAH

Kabupaten/Kota SERUYAN
Puskesmas/Kecamatan SANDUL/ BATU AMPAR
Desa/Kelurahan DURIAN KAIT

Berat
No Kartu Keluarga NIK (Nomor Induk Tanggal Jenis Badan
No Kependudukan) Anak Ke Nama anak Lahir Kelamin (BB)
Lahir

(1) (2) (3) (4) (5) (6) (7) (8)

1
6207092912110002 6207090303140001 3 LUAS. L PAKPAHAN 03/03/2014 L 3000gr

2 6207091705160004 6207092804140001 1 RISTAN. A 28/O4/2014 L 3200gr

3 6207091705160004 6207092811160001 2 REHAN 28/11/2016 L 3300gr

4 6207093010170001 6207094311130002 1 NOVI YANA 03/11/2013 P 3300gr

5 6207091904180001 6207096209150001 1 MIKA . C 22/09/2015 P 3500gr

6 6209030311110001 2 RASTI NATASYA 20/01/2016 P 3200gr

7 6207091607180002 6207092209160001 1 OKKI 22/09/2016 L 3000gr

8 6207021410070425 6207091412150001 6 RENOL 14/12/2014 L 3150gr

9 6207091201170003 6207095209160001 5 RAYA 12/09/2016 P 3200gr

10 6207022505100009 2 SOIMAH 29/09/2016 P 3000gr

11 6207092010110001 6207090504170001 2 GABRIAN . R 05/04/2017 L 2900gr

12 6207021712080050 620709621712080050 2 MOZA .V . S 23/09/2017 P 3200gr

13 6207020608090026 3 JASRAN 08/10/2017 L 3000gr

14 6207021212080002 6207092010170001 2 ABIANSYAH 20/10/2017 L 3500gr

15 62070917051600002 6207086712170001 2 MELANI 27/12/2017 P 3000gr

16 6207021410070930 4 PASKALITO 10/04/2018 L 3600gr

17 6207022807090056 6207090206180011 2 ATTAR. A 02/06/2018 L 4000gr

18 3206271801180002 2 M . YUSUF 23/08/2018 L 3100gr

19 6207092012170001 1 AZKA 03/09/2018 L 2100gr

20 6207022605100001 2 VINCEN 27/09/2018 L 2800gr

21 6207093007150001 6207096310130001 1 RAISA SINTIA . B 23/10/2018 P 1600gr

22 6207093007150001 6207095609160001 2 SEPTRIA 16/09/2016 P 2600gr

23 6207021410070840 6207092502160001 3 RAKA P. 25/05/2016 L 3150gr

24 6207021410075721 6207094207150002 4 VELENSIA 02/07/2015 P 2700gr

25 6207022306080023 3 AXEL 15/08/2015 L 3100gr

26 6207021616108003 5 YUDA PRATAMA 25/03/2014 L 2750gr

27 6207021212080008 6207095810170001 2 RAMANDA 18/10/2017 P 3000gr

29 6207092711150001 6207092603180001 1 GIAN ALASKA 26/03/2018 L 2700gr

30 6207012506120002 6207015205180001 4 MEYLINDA P. A 12/05/2018 P 3200gr

31 1 TRESIA AVILA 01/O7/2015 P 2900gr

32 1 SYLVIA ELIA 26/06/2014 P 3000gr

33 1 MARSELINA 11/O3/2016 P 3300gr

34 2 VERREL KUSUMA 06/03/2017 L 3000gr

35 1 TIA L . GAOL 24/04/2017 P 2900gr

36 2 JEPIN 30/01/2018 L 3100gr

37 1 AUREL 07/02/2018 P 2600gr

38 1 SOLKIYANTO 17/03/2018 L 3200gr

39 2 RANGGA PRATAMA 16/07/2018 L 3000gr

40 1 CITRA 23/11/2014 P 3050gr

41 3 MELDANI 25/05/2016 P 3650gr

42 1 ADITAMA ELPAN. S 16/01/2018 L 2600gr

43 1 NAURA 18/10/2014 P 2600gr

44 2 ARJUNA 13/06/2015 L 3500gr

45 6207091305150001 3 FARELLI . M 13/05/2015 L 2750gr

46 2 SASYA 28/06/2015 P 2900gr

47 2 RAMA 25/04/2014 L 3100gr

48 2 NURUL A. S 20/04/2016 P 2500gr

49 2 M. ATTAH 29/09/2017 L 2650gr

50

51
 1

Nama Posyandu KASIH BUNDA

Bulan OKTOBER
Tahun 2018

Cara ASI
Panjang Ukur Eksklus
Tgl Badan/ 1=Telent ifF1=YA
No Tlp/ HP
Nama Ortu NIK Ortu Alamat RT RW Pengukur BB (kg) Tinggi
Ortu ang ,
an Badan 2=Berdir 2=Tida
(cm) i k

(9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19)

M.Pakpahan/Reni 6207090203810001 085248593079 Durian Kait 4 2 17/10/2018 19 kg 109cm 2 1

Rujiono/Lista 6207020504920002 082252886043 Durian Kait 3 2 17/10/2018 16,2 kg 102cm 2 1

Rujiono/Lista 6207020504920002 082252886043 Durian Kait 3 2 17/10/2018 8,1 kg 74,6 cm 1 1

Susanto/Nika 6207022812850001 Durian Kait 3 2 17/10/2018 16,2 kg 103cm 2 2

Jetro/Aing 6207021004940002 Durian Kait 3 2 17/10/2018 12,6 kg 96,7cm 2 1

Harahap/Fitri 6209031511890001 082285663435 Durian Kait 1 2 17/10/2018 11,7 kg 86,6 cm 2 1

Suberto/Llinawat 620702700890002 Durian Kait 4 2 17/10/2018 11,3 kg 81,8cm 2 1

Marekam/Rasia 6207020510720001 Durian Kait 4 2 17/10/2018 13,7 kg 96,4 cm 2 1

Dude/Dina 620702661160002 Durian Kait 4 2 17/10/2018 9,5 kg 81 cm 2 1

Ismal/Wiwin 6207020705810001 Durian Kait 4 2 17/10/2018 9,6 kg 82 cm 2 1

Yohanes/Icenawat 6207022804880001 082299084225 Durian Kait 4 2 17/10/2018 8,6 kg 74,3 cm 2 2

Kingming/Nurmala 62070202210830002 082250791465 Durian Kait 4 2 18/10/2018 8,3 kg 72,1 cm 2 1

Santoso/Marlina 6207020508820007 Durian Kait 3 2 17/10/2018 8,9 kg 72 cm 1 1

Egis/Wangi 6207021504800002 085246935320 Durian Kait 3 2 17/10/2018 8,5 kg 73,5 cm 1 1

Suharto/Rini Durian Kait 1 2 18/10/2018 7,6 kg 69,1 cm 1 1

Mikhael/Veronika 620702300470001 Durian Kait 2 2 17/10/2018 7,4 kg 66,8 cm 1 1

Sugianto/Agha L. 6207020103860001 081251942324 Durian Kait 4 2 17/10/2018 8,8 kg 64,4 cm 1 1

Tatang/Neri 62070241078400057 082148118135 Durian Kait 4 2 18/10/2018 4,3 kg 54 cm 1 1

Jeki/Marniat 6207024409010001 081348308400 Durian Kait 4 2 18/10/2018 3,6 kg 49 cm 1 1

Cancang/Lida 62070221038400001 082152642813 Durian Kait 1 1 19/10/2018 3,4 kg 48,2 cm 1 2

Junadi/Susi 6207090707930001 Durian Kait 4 2 17/10/2018 13,2 kg 97,9 cm 2 1

Junadi/Susi 6207090707930001 Durian Kait 4 2 17/10/2018 11,9 kg 91,8 cm 2 1

Sutoyo/Sayu 6207022811720001 Durian Kait 3 2 19/10/2018 11,7 kg 93,1 cm 2 1

Siong/Ernawat 6207022608780001 Durian Kait 1 1 20/10/2018 11 kg 90 cm 2 1

U'ung/Rasitah 6207022891730001 Durian Kait 1 1 16/10/2018 10,4 kg 95,1 cm 2 1

Wawan/Nanda 6201040407820001 Durian Kait 2 1 15/10/2018 16,3 kg 102,1 cm 2 1

Belli/Ita 6207020101830003 Durian Kait 4 2 7/10/2018 7,1 kg 70 cm 1 1

Ardiono/Siska R. 6207020504840002 085252728809 Durian Kait 1 1 7/10/2018 9,2 kg 64,2 cm 2 1

Yulian/Sylvia 6207011307860001 082251151314 Durian Kait 4 2 10/10/2018 6,9 kg 62,8 cm 2 1

Rambodi/Martha 6207020107930011 081256583207 Durian Kait 1 1 17/10/2018 11,4 kg 91 cm 2 1

Supran/I'is nawat 620702610890001' 085389598499 Durian Kait 1 1 17/10/2018 15,1 kg 101,9 cm 2 1

Hindru/Mita 620702580600001 Durian Kait 3 2 17/10/2018 10,4 kg 84,1 cm 2 1

Rani 6207024111950001 Durian Kait 4 2 17/10/2018 8,5 kg 73,5 cm 2 1

P.L Gaol/Rini 12160224108800001082270183074 Durian Kait 4 2 17/10/2018 8,9 kg 76,2 cm 2 1

Suberto/lilinawat 6207027008970002 Durian Kait 4 2 17/10/2018 8,2 kg 70,3 cm 1 1

Ari W. / Nisa 6207022912950001 082251925632 Durian Kait 2 1 17/10/2018 7 kg 66,2 cm 1 1

Setriso/Yerni 6207021511940001 Durian Kait 3 2 17/10/2018 7,7 kg 66,2 cm 1 1

Parima/Julita Durian Kait 3 2 18/10/2018 5,4 kg 52 cm 1 1

Martnus/Rencani 6207026111920001 Durian Kait 3 2 18/10/2017 10,9 kg 91,2 cm 2 1

Bancai/Eliana 6207021509720001 Durian Kait 3 2 19/10/2018 9 kg 72 cm 2 1

Diansyah/Murt 6207024706980003 Durian Kait 4 2 19/10/2018 6,4 kg 65,1 cm 1 1

Aris/Nursit 6207025901940001 Durian Kait 3 2 20/10/2018 7,8 kg 68,8 cm 1 1

Silvanus/S'ii 6207024107840010 Durian Kait 2 1 20/10/2018 12,6 kg 102,3 cm 2 2

Teoder/Margaret 6207020703760001 Durian Kait 2 2 20/10/2018 12,2 kg 102,3 cm 2 1

Roby/Hermiyat 620702460880001 Durian Kait 3 2 16/10/2018 11,4 kg 81,3 cm 2 1

Supardi/Ratnawat 6207025309910001 Durian Kait 4 2 10/10/2018 15,1 kg 108 cm 2 1

Utami 6207026110910001 Durian Kait 1 1 17/10/2018 11,3 kg 87,3 cm 2 1

Trai 6207021210890004 Durian Kait 1 1 17/10/2018 9,3 kg 75,9 cm 2 1

 Vitamin Vitamin
IMD A A Kepemili
1=YA, Februari
2=Tida 1=YA Agustus kan Buku
1=YA KIA
k 2=Tidak 2=Tidak

(20) (21) (22) (23)

1 1 1 YA

1 1 1 YA

1 1 1 YA

1 1 1 YA

1 `1 1 YA

1 1 1 YA
1 1 1 YA

1 1 1 YA

1 1 1 YA

1 1 1 YA

1 1 1 YA

1 1 1 YA

1 2 1 YA

1 1 1 YA

1 2 1 YA

1 2 2 YA

1 2 2 YA

1 2 2 YA
1 2 2 YA

2 2 2 YA

1 1 1 YA

1 1 1 YA

1 1 1 YA

1 1 1 YA

1 1 1 YA

1 1 1 YA

1 2 1 YA

1 1 1 YA

1 1 1 YA

1 1 1 YA

1 1 1 YA

1 1 1 YA

1 1 1 YA
1 1 1 YA

1 2 1 YA

1 2 2 YA

1 2 2 YA

1 2 2 YA

1 1 1 YA

1 1 1 YA

1 1 1 YA

2 2 1 YA

1 1 1 YA

1 1 1 YA

1 1 1 YA

1 1 1 YA

1 1 1 YA

1 1 1 YA
 FORMULIR PEMANTAUAN IBU HAMIL

Provinsi KALIMANTAN TENGAH Nama Posyandu HATI BUNDA

Kabupaten/Kota SERUYAN Bulan OKTOBER
Puskesmas/Kecamatan SANDUL/BATU AMPAR Tahun 2018
Desa/Kelurahan DURIAN KAIT

Berat Badan
NIK (Nomor Induk Tanggal Berat
No No Kartu Keluarga Nama Ibu Hamil sebelum Alamat RT RW Tanggal Lahir
Kependudukan) hamil pengukuran Badan (kg)

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11)

1 6207025508970001 NURATI 43 kg Durian Kait 01 01 15/08/1997 21/10/2018 53,5 kg

2 6207021212080001 6207026911820001 RIKI 40,7 kg Durian Kait 04 01 29/11/1982 21/10/2018 48,3 kg

3 6207024712910001 SRI HAYA 48 kg Durian Kait 03 02 07/12/1991 10/10/2018 56,5 kg

4 SULAMITA 54 kg Durian Kait 03 02 16/08/1993 11/10/2018 63 kg

5 JULIANTI 49,5 kg Durian Kait 01 01 15/07/1978 11/10/2018 58,7 kg

6
6207030864716297003 6207025007840003 ROHANI 48 kg Durian Kait 01 01 10/07/1984 06/10/2018 52,5 kg

9
10

11

12

13

14

15
 TTD
(Tablet Jika YA,
Tinggi Lingkar Kehamilan Tambah brp butir
Badan Lengan
(cm) Atas (LiLA) ke darah) TTD
1=YA, didapat
2=Tidak

(12) (13) (14) (15) (16)

155 cm 25,8 1 1 10

156 cm 24,6 2

159 cm 24,2 1 1 10

150 cm 26,6 3

158 cm 26,1 3 1 10

152 cm 24,1 2