FORMULIR PEMANTAUAN BALITA STUNTING PERTUMBUHAN BALITA DI POSYANDU

Provinsi : Lampung Nama Posyandu :-

Kabupaten/Kota : Pringsewu Bulan : Maret
Puskesmas : Rejosari Tahun : 2019

Jenis Status Gizi

Nama Ortu PB/TB
No Nama anak Tanggal Lahir Kelamin Alamat RT RW Tgl Pengukuran BB (kg)
(Ayah) (cm)
(L,P) TB/U
1 Rafifah 10/04/2017 P Mislani Bumi Arum 2 4 04/03/2018 8,9 76 Pendek
2 Melfian 08/02/2017 L Wahjudi Bumi Arum 2 3 04/03/2018 10,1 81 Pendek
3 Abhizar 06/02/2017 L Miftahudin Bumi Arum 1 3 06/03/2019 11 78 Pendek
4 Rehan 29/06/2014 L Rosit Bumi Arum 3 3 06/03/2019 13,5 98 Pendek
5 Celsi 10/20/2017 P Kuatin Bumi Arum 3 3 06/03/2019 8,3 72 Pendek
6 Gauron Ashadi 2/22/2016 L Kastinah Pringsewu Barat 9 5 14/03/2019 10 80 Pendek
7 Fadli Amatul A 3/16/2018 L Zaenal Pringsewu Barat 4 5 14/03/2019 7,2 69 Pendek
8 Emily Shera 4/25/2018 P Okta Pringsewu Barat 4 5 14/03/2019 7,3 66 Pendek
9 Dewi Mulya 11/12/2017 P Yusuf Pringsewu Barat 4 5 14/03/2019 7,8 69 Sangat Pendek
10 M. Tsaqif Arrasya 9/30/2018 L Rachmad Pringsewu Barat 4 5 14/03/2019 7,4 60 Pendek
11 Haflani Ayu Disa Khayra 2/19/2019 P Beni Pringsewu Barat 4 5 14/03/2019 4 47 Pendek
12 Florentina 8/20/2018 P Mudana Bumi Arum 05/03/2019 7,1 60 Pendek
13 Dina 5/24/2015 P Novi Bumi Arum 1 2 05/03/2019 11,3 91 Pendek
14 Amel 11/30/2015 P Sugiarso Bumi Arum 3 1 05/03/2019 11,5 88 Pendek
15 Gibran 8/10/2017 L Winarto Bumi Arum 2 1 05/03/2019 9,6 74 Sangat Pendek
16 Sofyan 10/9/2018 L Anggi Bumi Arum 1 1 05/03/2019 7,1 57 Sangat Pendek
17 Sally 11/30/2016 P Kusnadi Bumi Arum 1 2 05/03/2019 8 78 Sangat Pendek
18 Ayu 6/7/2017 P Riatin Bumi Arum 1 1 05/03/2019 8,7 73 Sangat Pendek
19 Diki 6/30/2017 L Pariman Bumi Arum 2 2 05/03/2019 9,3 7,5 Sangat Pendek
20 M. Alifiandra Rahmat 9/30/2015 L Rahmat Podosari 08/03/2019 12 85 Sangat Pendek
21 Adib Karim Azizan 4/4/2014 L Kuswantoro Podosari 08/03/2019 14 96 Pendek
22 Karaisa Naraya Nabilla 8/10/2018 P Rudi Podosari 08/03/2019 9,1 74 Pendek
23 Rivano 12/19/2015 L Badiran Podosari 08/03/2019 13 83 Sangat Pendek
24 Rafif Fahreza 1/12/2019 P Hardi Podosari 08/03/2019 8,1 74 Sangat Pendek
25 Alifa Putri Felicia 12/20/2017 P Joni Podosari 08/03/2019 10 79 Pendek
26 Irsyad 12/16/2017 L Partino Podosari 08/03/2019 7,8 64 Sangat Pendek
27 Furqon Nurohman 9/7/2018 L Bayani Podosari 08/03/2019 6 61 Pendek
28 M. Khairul Ridwan 5/1/2017 L Samino Podosari 08/03/2019 8,5 70 Sangat Pendek
29 Radit 12/25/2016 L Sarun Podomoro 3 1 06/03/2019 11 79 Pendek
30 Aghina Halim 12/9/2016 P Ahmad Podomoro 6 1 06/03/2019 9 77 Sangat Pendek
31 Iqbal 11/24/2016 L Parlan Podomoro 1 1 06/03/2019 11 82 Pendek
32 Angga 12/4/2017 L Sugiarto Podomoro 1 1 06/03/2019 10 70 Sangat Pendek
33 Kanaka 1/20/2017 L Rudianto Podomoro 3 1 06/03/2019 10 75 Sangat Pendek
34 Rasyid Raditia 7/14/2016 L Yatino Podomoro 1 1 06/03/2019 10,5 85 Pendek
35 Pangeran Arsyah 1/3/2017 L Kris Podomoro 2 1 06/03/2019 11 77 Sangat Pendek
36 Zakia 9/11/2017 P Sujarwo Podomoro 6 1 06/03/2019 8,5 70 Sangat Pendek
37 Rajik H 3/11/2017 L Wasiyo Podomoro 5 2 13/03/2019 10,2 78 Sangat Pendek
38 Difa 5/29/2017 P Budiman Podomoro 4 2 13/03/2019 9,9 79 Pendek
39 Faizal 6/11/2017 P Munir Podomoro 3 2 13/03/2019 10,2 78 Pendek
40 Dhea Reseva 5/25/2018 P Rani Bumi Ayu 3/14/2019 7,7 65 Pendek
41 Aditya Firmansyah 12/13/2016 L Siti Aminah Bumi Ayu 3/14/2019 10 82 Pendek
42 Farel 7/25/2016 L Hartati Bumi Ayu 3/14/2019 11 84 Pendek
43 Mutia 1/5/2015 P Ema bumi Ayu 3/14/2019 13 90 Pendek
44 Quena Sabila 7/22/2019 P Nanang Bumi Ayu 3/14/2019 9 58 Pendek
45 Lutfi 3/8/2017 L Wasgino Bumi Ayu 3/14/2019 9 80 Pendek
46 Jihan 5/7/2016 P Manisa Bumi Ayu 3/14/2019 10.2 84 Pendek
47 Jelita 8/13/2018 P Kumhantio Bumi ayu 3/14/2019 9 79 Sangat Pendek
48 Kinan 9/29/2014 P Lilik Bumi Ayu 3/14/2019 12 96 Pendek
49 Fika Kenisha Dewi 8/17/2015 P Sujono Pringsewu Utara 5 3/14/2019 13.6 90 Pendek
50 Arfan Abimana 11/29/2017 L Pendi Pringsewu Utara 5 3/14/2019 10 73 Pendek
51 Lutfa 11/7/2015 P Pendi Pringsewu Utara 5 3/14/2019 13.4 89 Pendek
52 Aisyah Aulia S 3/29/2017 P Didin Pringsewu Utara 5 3/14/2019 9.5 75 Pendek
53 Fedrico Putra P 5/14/2017 L Umi Pringsewu Utara 6 5 3/13/2019 9 74 Pendek
54 Gilang 5/19/2017 L Ibrohim Pringsewu Utara 3 5 3/11/2019 8.7 79 Pendek
55 Yogi 4/21/2017 L Agus Riyadi Pringsewu Utara 5 5 3/11/2019 8.9 80 Pendek
56 Kalila farzana 10/24/2018 P Farida Rejosari 3/5/2019 6 58 PENDEK
57 Abrisam 12/31/2017 L Susi Rejosari 3/5/2019 8.5 73 PENDEK
58 Bel Fani 11/14/2017 P Diana Rejosari 3/5/2019 7.5 70 SANGAT PENDEK
59 Alvero 5/31/2018 L Aris Rejosari 3/5/2019 8.5 68 PENDEK
60 Keanu 1/1/2018 L Bayu Rejosari 3/5/2019 6.5 60 SANGAT PENDEK
61 Mouna 10/30/2014 P Rudi Rejosari 3/5/2019 15 95 PENDEK
62 Fatiyah 10/16/2018 P Sopan Rejosari 3/5/2019 6 58 PENDEK

Mengetahui,
Ka. UPT Puskesmas Rejosari Pelaksana Program Gizi

Muhammad Subagja, SKM. MM Putry Prada Mayangsari, S.Gz

NIP.19670430 198710 1 001
 FORMULIR PEMANTAUAN BALITA STUNTING PERTUMBUHAN BALITA DI POSYANDU

Provinsi : Lampung Nama Posyandu :-

Kabupaten/Kota : Pringsewu Bulan : Maret
Puskesmas : Rejosari Tahun : 2019

Jenis Status Gizi

Umur Nama Ortu PB/TB
No Nama anak Tanggal Lahir Kelamin Alamat RT RW Tgl Pengukuran BB (kg)
(Bulan) (Ayah) (cm)
(L,P) TB/U
1 Rafifah 10/04/2017 20 P Mislani Bumi Arum 2 4 04/03/2018 8,9 76 Pendek
2 Dinara 07/04/2018 11 P Budi Bumi Arum 1 4 04/03/2018 7,4 67 Pendek
3 Rania 23/08/2015 43 P Lukman Bumi Arum 1 3 06/03/2019 13,1 91 Pendek
4 Melfian 08/02/2017 25 L Wahjudi Bumi Arum 2 3 06/03/2019 10,1 81 Pendek
5 Abhizar 06/02/2017 25 L Miftahudin Bumi Arum 1 3 06/03/2019 11 78 Pendek
6 Rehan 29/06/2014 57 L Rosit Bumi Arum 3 3 06/03/2019 13,5 98 Pendek
7 Faza Alya 21/12/2014 27 P Nandar Bumi Arum 1 3 06/03/2019 13 93 Pendek
8 Al Fathan 12/07/2018 8 L Aminudin Bumi Arum 2 3 06/03/2019 6,7 62 Sangat Pendek
9 Alif 16/09/2018 6 L Topan Bumi Arum 1 3 06/03/2019 7 58 Sangat Pendek
10 Faqi 5/4/2017 22 L Ahmad Bumi Arum 3 3 06/03/2019 9,9 78 Pendek
11 Celsi 10/20/2017 17 P Kuatin Bumi Arum 3 3 06/03/2019 8,3 72 Pendek
12 Gauron Ashadi 2/22/2016 37 L Kastinah Pringsewu Barat 9 5 14/03/2019 10 80 Pendek
13 Fadli Amatul A 3/16/2018 12 L Zaenal Pringsewu Barat 4 5 14/03/2019 7,2 69 Pendek
14 Emily Shera 4/25/2018 11 P Okta Pringsewu Barat 4 5 14/03/2019 7,3 66 Pendek
15 Dewi Mulya 11/12/2017 15 P Yusuf Pringsewu Barat 4 5 14/03/2019 7,8 69 Sangat Pendek
16 M. Tsaqif Arrasya 9/30/2018 5 L Rachmad Pringsewu Barat 4 5 14/03/2019 7,4 60 Pendek
17 Haflani Ayu Disa Khayra 2/19/2019 1 P Beni Pringsewu Barat 4 5 14/03/2019 4 47 Pendek
18 Florentina 8/20/2018 7 P Mudana Bumi Arum 05/03/2019 7,1 60 Pendek
19 Dina 5/24/2015 46 P Novi Bumi Arum 1 2 05/03/2019 11,3 91 Pendek
20 Sukma 5/26/2014 58 P Sukarya Bumi Arum 2 2 05/03/2019 12,2 97 Pendek
21 Faizal 3/26/2015 48 L Supriyanto Bumi Arum 3 1 05/03/2019 13 94 Pendek
22 Amel 11/30/2015 40 P Sugiarso Bumi Arum 3 1 05/03/2019 11,5 88 Pendek
23 Gibran 8/10/2017 19 L Winarto Bumi Arum 2 1 05/03/2019 9,6 74 Sangat Pendek
24 Sofyan 10/9/2018 5 L Anggi Bumi Arum 1 1 05/03/2019 7,1 57 Sangat Pendek
25 Sally 11/30/2016 28 P Kusnadi Bumi Arum 1 2 05/03/2019 8 78 Sangat Pendek
26 Ayu 6/7/2017 21 P Riatin Bumi Arum 1 1 05/03/2019 8,7 73 Sangat Pendek
27 Diki 6/30/2017 21 L Pariman Bumi Arum 2 2 05/03/2019 9,3 7,5 Sangat Pendek
28 Fahmi Akbar 4/8/2017 23 L Sunarno Podosari 08/03/2019 10 76 Sangat Pendek
29 M. Fatan 8/17/2017 18 L Rahmat Podosari 08/03/2019 9 71 Sangat Pendek
30 M. Alifiandra Rahmat 9/30/2015 41 L Rahmat Podosari 08/03/2019 12 85 Sangat Pendek
31 Adib Karim Azizan 4/4/2014 59 L Kuswantoro Podosari 08/03/2019 14 96 Pendek
32 Karaisa Naraya Nabilla 8/10/2018 18 P Rudi Podosari 08/03/2019 9,1 74 Pendek
33 Rivano 12/19/2015 38 L Badiran Podosari 08/03/2019 13 83 Sangat Pendek
34 Rafif Fahreza 1/12/2019 2 P Hardi Podosari 08/03/2019 8,1 74 Sangat Pendek
35 Alifa Putri Felicia 12/20/2017 14 P Joni Podosari 08/03/2019 10 79 Pendek
36 Irsyad 12/16/2017 14 L Partino Podosari 08/03/2019 7,8 64 Sangat Pendek
37 Furqon Nurohman 9/7/2018 6 L Bayani Podosari 08/03/2019 6 61 Pendek
38 M. Khairul Ridwan 5/1/2017 22 L Samino Podosari 08/03/2019 8,5 70 Sangat Pendek
39 Radit 12/25/2016 27 L Sarun Podomoro 3 1 06/03/2019 11 79 Pendek
40 Aghina Halim 12/9/2016 27 P Ahmad Podomoro 6 1 06/03/2019 9 77 Sangat Pendek
41 Iqbal 11/24/2016 26 L Parlan Podomoro 1 1 06/03/2019 11 82 Pendek
42 Angga 12/4/2017 15 L Sugiarto Podomoro 1 1 06/03/2019 10 70 Sangat Pendek
43 Kanaka 1/20/2017 26 L Rudianto Podomoro 3 1 06/03/2019 10 75 Sangat Pendek
44 Rasyid Raditia 7/14/2016 32 L Yatino Podomoro 1 1 06/03/2019 10,5 85 Pendek
45 Pangeran Arsyah 1/3/2017 26 L Kris Podomoro 2 1 06/03/2019 11 77 Sangat Pendek
46 Zakia 9/11/2017 18 P Sujarwo Podomoro 6 1 06/03/2019 8,5 70 Sangat Pendek
47 Rajik H 3/11/2017 24 L Wasiyo Podomoro 5 2 13/03/2019 10,2 78 Sangat Pendek
48 Difa 5/29/2017 24 P Budiman Podomoro 4 2 13/03/2019 9,9 79 Pendek
49 Faizal 6/11/2017 20 P Munir Podomoro 3 2 13/03/2019 10,2 78 Pendek
50 Dhea Reseva 5/25/2018 9 P Rani Bumi Ayu 3/14/2019 7,7 65 Pendek
51 Aditya Firmansyah 12/13/2016 27 L Siti Aminah Bumi Ayu 3/14/2019 10 82 Pendek
52 Farel 7/25/2016 32 L Hartati Bumi Ayu 3/14/2019 11 84 Pendek
53 Mutia 1/5/2015 48 P Ema bumi Ayu 3/14/2019 13 90 Pendek
54 Quena Sabila 7/22/2019 20 P Nanang Bumi Ayu 3/14/2019 9 58 Pendek
55 Lutfi 3/8/2017 24 L Wasgino Bumi Ayu 3/14/2019 9 80 Pendek
56 Jihan 5/7/2016 34 P Manisa Bumi Ayu 3/14/2019 10.2 84 Pendek
57 Jelita 8/13/2018 31 P Kumhantio Bumi ayu 3/14/2019 9 79 Sangat Pendek
58 Kinan 9/29/2014 53 P Lilik Bumi Ayu 3/14/2019 12 96 Pendek
59 Fika Kenisha Dewi 8/17/2015 43 P Sujono Pringsewu Utara 5 3/14/2019 13.6 90 Pendek
60 Arfan Abimana 11/29/2017 16 L Pendi Pringsewu Utara 5 3/14/2019 10 73 Pendek
61 Lutfa 11/7/2015 42 P Pendi Pringsewu Utara 5 3/14/2019 13.4 89 Pendek
62 Aisyah Aulia S 3/29/2017 24 P Didin Pringsewu Utara 5 3/14/2019 9.5 75 Pendek
63 Fedrico Putra P 5/14/2017 22 L Umi Pringsewu Utara 6 5 3/13/2019 9 74 Pendek
64 Gilang 5/19/2017 22 L Ibrohim Pringsewu Utara 3 5 3/11/2019 8.7 79 Pendek
65 Yogi 4/21/2017 23 L Agus Riyadi Pringsewu Utara 5 5 3/11/2019 8.9 80 Pendek
66 Kalila farzana 10/24/2018 P Farida Rejosari 3/5/2019 6 58 PENDEK
67 Abrisam 12/31/2017 L Susi Rejosari 3/5/2019 8.5 73 PENDEK
68 Bel Fani 11/14/2017 P Diana Rejosari 3/5/2019 7.5 70 SANGAT PENDEK
69 Alvero 5/31/2018 L Aris Rejosari 3/5/2019 8.5 68 PENDEK
70 Keanu 1/1/2018 L Bayu Rejosari 3/5/2019 6.5 60 SANGAT PENDEK
71 Mouna 10/30/2014 P Rudi Rejosari 3/5/2019 15 95 PENDEK
72 Fatiyah 10/16/2018 P Sopan Rejosari 3/5/2019 6 58 PENDEK

Mengetahui,
Ka. UPT Puskesmas Rejosari Pelaksana Program Gizi

Muhammad Subagja, SKM. MM Putry Prada Mayangsari, S.Gz

NIP.19670430 198710 1 001