LAPORAN

NAMA UNIT PELAYANAN KESEHATAN

ALAMAT
RUMAH SAKIT
BULAN
TAHUN

JENIS
NO NAMA KELAMI TANGGAL LAHIR
N

1 AN. AL. FARAZEL L 22/12/2017

2 AN. M. KAI L 7/1/2018
3 BY. NY. ANIS RESTI P 9/1/2018
4 AN. VELOVE P 7/1/2018
5 AN. HAFIDSAH P 7/1/2018
6 AN. SABILA P 12/1/2018
7 BY. NY. PIPIT P 11/1/2018
8 AN. RASENDRIA L 20/09/2017
9 AN. NANYANG L 17/07/2017
10 AN. M. RADILSHYAH L 11/4/2017
11 AN. ARSENIO L 3/11/2017
12 AN. INAYAH P 2/1/2017
13 AN. ALTERIO L 30/03/2017
14 AN. AIJAZ L 16/12/2017
15 AN. N. ALWI L 22/11/2017
16 BY. NY. ACHILIA P 18/01/2018
17 BY. NY. VIRGINIA P 19/01/2018
18 AN. FADILLAN L 14/07/2017
19 BY. NY. ITA L 17/01/2018
20 AN. FARAH P 10/1/2018
21 AN. PIETER L 2/11/2017
22 AN. KALUNA P 25/10/2017
23 AN. QAFISHA P 17/12/2017
24 AN. AZRINA NAHDA P 25/11/2017
25 AN. GHAISAN L 18/01/2018
26 AN. JASMINE P 21/01/2018
27 AN. NUSAIBAH P 24/09/2017
28 BY. NY. SITI KUMAIRAH L 24/01/2018
29 AN. LADY JENITA P 30/10/2017
30 AN. NAFISAH HANNA P 27/02/2017
31 BY. NY. SITI KUMAIRAH L 24/01/2018
32 BY. NY. PUTRI L 13/01/2018
33 AN. LADY JANITA P 30/10/2017
34 AN. JAVED DREW L 23/01/2018
35 AN. ALUNA P 30/06/2017
36 AN. FADLI L 28/10/2017
37 AN. AQIO BARKI L 24/12/2017
38 AN. ALKA L 9/8/2017
39 AN. SHAQEENA P 21/08/2017
40 AN. ADIBAH P 26/01/2018
41 AN. MA'RIFATUHA P 27/01/2018
42 BY. NY. SUZAN ZUHRA L 1/1/2018
43 AN. QUENSHA P 30/11/2017
44 AN. AZMYA ZAHRA P 19/01/2018
45 AN. ARETHA P 27/01/2018
46 AN. AL-FATAR L 31/07/2017
47 AN. DEAN ERZA L 27/01/2018
48 AN. NATHANIA P 9/1/2018
49 AN. AALEYA P 3/1/2018
50 AN. ISMAIL RASID L 3/1/2018
51 AN. ZERINA P 3/1/2018
52 AN. CLEYRINE P 05/12/.2017
53 AN. ALESHA P 31/01/2018
54 AN. KIANDRA P 19/09/2017
55 BY. NY. KENSIA P 29/01/2018
56 AN. KEAN R L 30/12/2017
57 AN. ALUNA HINATA P 30/06/2017
58 AN. CLAIREN P 3/1/2018
59 AN.ARYA SATYA L 9/12/2017
60 AN. ZIVANA P 3/10/2017
61 AN. ANINDYA P 9/12/2018
62 AN. FATHIM P 2/4/2017
63 AN. SIRHAN RIZA P 11/9/2017
64 AN. ASTAGINA P 5/2/2018
65 AN. DIAN S P 11/1/2018
66 AN. NAY HILMI P 30/09/2017
67 AN. CANTIKA P 3/2/2018
68 AN. M. ARKAN L 25/01/2018
69 AN. AHZAREL L 13/12/2017
70 By Ny Rehal P 1/17/2018
71 By Ny Yanih L 1/18/2018
72 By Ny Nike Astria L 1/18/2018
73 By Ny Nurhayat L 1/18/2018
74 By Ny Meta Aldera P 1/19/2018
75 By Ny Subiyatul P 1/20/2018
76 By Ny Diandra P 1/21/2018
 77 By Ny Yulan P 1/22/2018
78 By Ny Melitha L 1/23/2018
79 By Ny Sit Komariyah L 1/24/2018
80 By Ny Huzaimah L 1/25/2018
81 By Ny Desi L 1/25/2018
82 By Ny Ikah L 1/25/2018
83 By Ny Amanah P 1/25/2018
84 By Ny Rifqi L 1/26/2018
85 Ny Sri Lestari L 1/26/2018
86 By Ny Imas P 1/27/2018
87 By Ny Indiraya P 1/27/2018
88 By Ny Reni L 1/27/2018
89 By Ny Retno L 1/27/2018
90 By Ny Revi P 1/28/2018
91 By Ny Rosmaliyah L 1/28/2018
92 By Ny Kensia P 1/29/2018
93 By Ny Ist P 1/29/2018
94 By Ny Rowiyah L 1/30/2018
95 By Ny Sinta P 1/30/2018
96 By Ny Sulistya P 12/30/2017
97 By Ny Maria Ulfa P 2/1/2018
98 By Ny Dwi Yunita P 2/1/2018
99 By Ny Sit Robiyah L 2/2/2018
100 By Ny Eha.S L 2/2/2018
101 By Ny Indah P 2/3/2018
102 By Ny Neneng L 2/3/2018
103 By Ny Putri P 2/4/2018
104 By Ny Laksmita P 2/5/2018
105 By Ny Sept. D L 2/5/2018
106 By Ny Nur.R P 2/5/2018
107 By Ny Puji L 2/6/2018
108 By Ny Rahma L 2/6/2018
109 By Ny Mayang P 2/6/2018
110 By Ny Anisa P 2/7/2018
111 By Ny Letty P 2/7/2018
112 By Ny Lina.S L 2/8/2018
113 By Ny Tri Aulia L 2/8/2018
114 By Ny Marlin L 2/10/2018
115 By Ny Maimunah L 2/12/2018
116 By Ny Tjong L 2/12/2018
117 By Ny Lia L 2/12/2018
118 By Ny Nina L 2/13/2018
119 By Ny Juhairiah L 2/13/2018
120 By Ny Nuryat P 2/14/2018
121 By Ny Mirna P 2/14/2018
122 By Ny Intan P 2/14/2018
123 By Ny Bernadetta L 2/14/2018
124 By Ny Sit Rohyat P 2/15/2018
125 By Ny Irma wari L 2/15/2018
126 By Ny Ayu Radatun P 2/15/2018
127 By Ny Sri A P 2/15/2018
128 By Ny Mia Indah P 2/15/2018

TOTAL
 LAPORAN HASIL IMUNISASI RUTIN DI RUMAH S
: RAWAT JALAN
: JLN. JOMBANG RAYA NO. 56
: IMC BINTARO
: FEBRUARI
: 2018

NAMA ORANG TUA ALAMAT RT / RW

NY. MAWAR GG MEKAR SARI 2 RT 01/03 NO. 12

NY. PUTRI LARISMA RT 01/09 NO. 60
NY. ANIS RESTI KP. PARIGI RT 04/021 NO. 31
TN. DONI JLN. LOKA BLOK B 18 NO.13 PJMI
NY. ANGGITA JLN. RAYA JOMBANG RT 01/013 NO. 16
NY. MARIZKA JLN. MASJID BAITURAHMAN RT 01/04 NO. 11
NY. PIPIT ADORA PERMATA B5 NO. 26
NY. LORASELI PURI BINTARO INDAH BLOK H NO. 29 RT 02/01
NY. SINTA JLN. H. SARMILI NO. 12 RT 02/06
NY. ARSINTA JLN. BETAWI NO. 126 RT 03/09
NY, WINA JLN. GRAHA BINTARO KP. LIO PARIGI BARU RT 02/04
NY. FENI JLN. H. SARMILI RT 02/02 NO. 38
NY.ASRI JLN. CENDRAWASIH NILLA DAGO NO. 24 RT 03/07
NY. REBAIKA JLN. MAHONI BLOK E ARINDA 2 RT 02/06
TN. AGUNG JLN. RAYA JOMBANG RT 06/03 NO. 23
NY. ACHILIA JLN. MADURA BLOK C/77 PPI
NY. VIRGINIA KOMP RAWA RT 005/016 NO. 11
TN. SONI JLN. FLAMINGGO JC 18 N0.02
NY. ITA JLN. RUSA 7 RT 05/04
NY. SANA JLN. RAYA PONDOK AREN RT 03/04
NY. ANASTASYA JLN. PARIGI BARU NO. 11 RT 02/04
TN. FADEL JLN. H. DJABIR RT 02/07 NO. 23
TN. FABIAN GG. AL HIDAYAH RT 01/15 NO. 30
NY. DIAN JLN. BINTYARO ASRI RESIDENCE BLOK JK 4A
NY. FATIM JLN. RAYA PONDOK AREN RT 003/002 NO. 32
TN. HARIF PONDOK AREN 3 RT 12/03 NO.01
NY. PUTRI JLN. GG BAKTI NO. 27 B
NY. SITI KHUMAIRAH JLN. CEGER RAYA NO. 12 RT 03/07
NY. TARI JLN. PUTER V11/25 BINTARO
NY. MARINA JLN. BUMI SUDIMARA RT 02/05 M0. 23
NY. SITI KHUMAIRAH JLN. CEGER RAYA RT 03/02 NO. 11
NY. PUTRI JLN. MASJID AL HUDA RAWA LELE NO. 141 RT 04/0
TN. IBRA JLN. PUTER V11/25 BINTARO
NY. EZRA JLN. JURANG MANGU BAREAT NO.09 RT02/07
NY. DESI S KP. PONDOK JATI UTRA RT 05/05 NO. 2
NY. SITI JLN. TARUMANEGARA A23/01 RT 02/07
NY. MUTIA JLN. MERAK NO.98 RT 02/05
NY. AFIFAH JLN. SENOPATI TERRACE C 12
NY. FAJAR KP. CEGER NO. 127 JURANG MANGU BARAT
TN. FAIZ PPI D3 NO. 16
NY. IMAS KP. GUNUNG RT 03/016 NO. 12
NY. SUZAN ZUHRA JLN. SUMATRA PERUMAHAN UTARA GARDEN BINTAR
NY. VIKI S JLN. HJ SAMAH RT 02/07
NY. META ALDERA VBI BLOK B 8/18 RT 04/12
NY. INDIRAYA BARATA TARA 11 NO. 138
NY. STELLA NUR JLN. SUKA MULYA RT 05/07 NO. 12A
NY. DESI KEBON MANGGIS GG MADUN 2 RT 01/05
NY. TJONG KB. KACANG 1 NO.03 RT 03/05
NY. NURLAILA JLN. ANGGREK NO. 11 RT 06/05
TN . ALIF VILLA BINTARO REGENCY BLOK A 2/12
NY. ANDINI JLN. H RASAM PARIGI BARU RT 05/02 NO. 23
NY. SANTY JLN. MASJID NURUL FAJRI RT 07/03
NY. FIFAH JLN. MUSHOLA NURUL HUDA RT 05/01 NO 11
NY. DESI PARKIT IV BLOK Z1 NO.7 BINTARO
NY. KENSIA JLN. PURI BINTARO INDAH BLOK B3 NO. 18
NY. FARAS JLN. CENDRAWASIH RAYA NO. 12 RT 03/05
NY. JIHAN JLN. KP JATI UTARA RT 05/03 NO. 25
NY. CINTA JLN. SUMATRA UTAMA GRAHA BINTARO B16 RT 03/
TN. DONI JLN. PEMBANGUNAN CLUSTER SUDIMARA BINTARO
NY. PUTRI PERUM PURI BINTARO INDAH RT 05/022 NO. 12
TN. RIDHO KOMP TAMAN PERMATA NEO BLOK J NO. 21
NY. LAILA JLN. RAYA PONDOK AREN RT 05/01 NO.09
NY. DIAN JLN. RIAU 1 VILLA BINTARO REGENCY RT 11/12
NY. PUTRI JLN. KINAYUNGAN 2 RT 03/09
NY. PIPIT ADORA PERMATA B5/26
NY. FARIDA JLN. GRAHA BINTARO ALTHIA PARK NO. 11 RT 02/06
TN. FABIAN JLN PENINGGILAN BARAT 3 RT 12/11
NY. HUZAIRAH PONDOK JAYA RT 03/02 NO. 20
NY. VIOLA JLN. AKASIA 2 BLOK B2 NO.5 RT 05/07
Ny Rehal / Tn Dhimas Jln Perdagangan I, Jaksel
Ny Yanih / Tn Johan Riza Jln H. Juanda III
Ny Nike Astria / Tn Gusman Kara Jln Raya Pondok Aren Rt 003/02 No.16
Ny Nurhayat / Tn Wahyudi Kp Perigi
Ny Meta Aldera / Tn Doni VBI Blok B8/18A
Ny Subiyatul / Tn Andi Pondok Pucung
Ny Diandra / Tn Panji Pondok Surya Blok
Ny Yulan / Tn Budi
Ny Melitha / Tn John Steve
Ny Sit Komariyah / Tn Poniman
Ny Huzaimah / Tn Irdah
Ny Desi / Tn Robby
Ny Ikah / Tn Saidi
Ny Amanah / Tn Daru Dwi
Ny Rifqi / Tn Panji Nugroho
Ny Sri Lestari / Tn M.Hendro
Ny Imas / Tn M Syahrul
Ny Indiraya / Tn Wahyu
Ny Reni / Tn Andi
Ny Retno / Tn Erry
Ny Revi / Tn Deanah
Ny Rosmaliyah / Tn M.Yusuf
Ny Kensia / Tn Amir
Ny Ist / Tn Almio
Ny Rowiyah / Tn Fahyumi
Ny Sinta / Tn Nurohman
Ny Sulistya / Tn Rino
Ny Maria Ulfa / Tn Didi
Ny Dwi Yunita / Tn M.Helmi
Ny Sit Robiyah / Tn Syahrullah
Ny Eha.S / Tn Agung
Ny Indah / Tn Benny
Ny Neneng / Tn Otong
Ny Putri / Tn Saleh
Ny Laksmita / Tn Riki Widodo
Ny Sept.D / Tn Eko.P
Ny Nur.R / Tn Aswin
Ny Puji / Tn Edy Gunawan
Ny Rahma / Tn Dwi Yudho
Ny Mayang / Tn M.Yusuf
Ny Anisa / Tn Wahyudi
Ny Letty / Tn Mukhlis
Ny Lina.S / Tn Febrian
Ny Tri Aulia / Tn Sugeng
Ny Marlin / Tn Ade
Ny Maimunah / Tn Eka Septa
Ny Tjong / Tn Yoppy
Ny Lia / Tn Aryo
Ny Nina / Tn Tri
Ny Juhairiah / Tn Rudi
Ny. Nuryat / Tn. Slamet Ichsan
Ny Mirna / Tn. Machdani
Jombang No.76 Rt 002/04
Perum Sobar Glowdia Jln jurang Mangu
Jln Ceger Raya Jurang Mangu Timur
Pondok Jaya Rt 003/02
VBI Blok A2/14
Pd Kacang Timur Rt 003/04
Jln Jombang Raya PPI I D3/16
Jln Raden Patah Gg Cempaka Rt 001/05 Parung Ser
Jln Kemajuan Rt 002/011 Petukangan Jaksel
Kp Cikuya Desa Maja
Jln Baratama I/138 Karang Tengah
Kp Lio Parigi Baru
Kp Alpukat No 27
Pd Maharta Blok A10/18
Jln H.Sarmah Rt 003/07
Puri Bintaro Indah Blok B3 No.18
Ciater Serpong
Pd Kacang Timur Rt 005/07 No.33
Kp Perigi Rt002/04
Jln Mushollah Nurul Huda Rt 005/01
Puri Bintaro PB 14 No.6AA
Pd Kacang Prima A2/25 Rt 009/08
Jln H.Rasam Rt 003/02
Kp Lio Rt 002/03
Jln Peninggilan Barat III Rt 012/011 No.87
Jln Japos Pd Jat Rt 001/13
Jln Kinayungan Rt 003/09
Jln Cipto Mangunkusumo
Perumahan Villa Dago Tol Blok I 5/09
Gracia Residence L9
Perum Pd Jaya Sektor 3A
Cattleya Bintaro Residence A-13 Ciputat
Jln Anggrek No.24 PPI Rt 002/04
Jln Manunggal Rt 001/03
Kp Lio Rt 001/01
Jln Swadaya 2 Rt 003/02
Delman Indah Rt 008/01
Jln Lio Garut No.51 Rt 004/04
Jln K.H. Dewantara Rt 002/04
Gg Damai No 58
Jln H. Beno No 44
Jln Al-Barkah Poncol 2
Jln Swadaya II No 9 Rt 004/03
Jl. Wadasari III No. 50 RT 01/02 Pd. Betung
Discoveri Flore Blok I No. 26
Ny Intan / Tn Angga
Ny Bernadetta / Tn Dony S
Ny Sit Rohyat / Tn Asep
Ny Irma Wari / Tn Hendra W
Ny Ayu Radatun / Tn Sugiarto
Ny Sri A / Tn Rudi
Ny Mia Indah / Tn M Andi
TOTAL
Jl Cinta Raya 5 RT 04/06 No. C 9
Jl Bintang No 26 Jombang
Kp Blok Kelapa Rt 06/04
Griya Pipit Bintaro Blok B3 No 32
Jombang Raya
Kp Parigi Baru art 03/06
Jl. Clater RT 04/09
RUTIN DI RUMAH SAKIT / UNIT PELAYANAN SWASTA

ANTIGEN (DI ISI TANGGAL IMUNISASI)

KELURAHAN
HB 0 BCG POLIO 1 PENTA 1POLIO 2

PONDOK AREN 16/01/2018

PONDOK AREN 16/01/2018
PARIGI 16/01/2018
PONDOK AREN 16/01/2018
JOMBANG 17/01/2018
PONDOK AREN 17/01/2018
PONDOK AREN 18/01/2018
PONDOK AREN
PONDOK AREN
PONDOK AREN 18/01/2018
PONDOK AREN 18/01/2018
PONDOK AREN
PONDOK AREN
PONDOK AREN 20/01/2018
PONDOK KACANG TIMUR 23/01/2018
23/01/2018
JOMBANG 23/01/2018
PONDOK AREN 23/01/2018
PONDOK AREN
PONDOK RANJI 23/01/2018
PONDOK AREN 23/01/2018
PONDOK AREN 26/01/2018
PARIGI 26/01/2018
PONDOK AREN 26/01/2018
PONDOK AREN 27/01/2018
PONDOK AREN 27/01/2018
PONDOK AREN 27/01/2018
PONDOK KARYA 27/01/2018
PONDOK AREN 29/01/2018
PONDOK AREN 29/01/2018
29/01/2018
JOMBANG
PONDOK AREN 29/01/2018
RAWA LELE 29/01/2018
PONDOK AREN 29/01/2018
29/01/2018
JURANG MANGU 30/01/2018
PONDOK AREN
PONDOK AREN 31/01/2018
PARIGI 31/01/2018
PONDOK AREN
PONDOK AREN
JOMBANG 1/2/2018
JOMBANG 02/02/0218
PONDOK AREN 02/02/208
PONDOK AREN 3/2/2018 3/2/2018
JOMBANG 03/02/108
PONDOK AREN 3/2/2018
SERUA INDAH
PONDOK AREN 3/2/2018
PONDOK KACANG TIMUR 3/2/2018
PONDOK AREN 3/2/2018
PONDOK AREN 3/2/2018
PONDOK AREN 5/2/2018
PONDOK AREN 5/2/2018 5/2/2018
PONDOK AREN 5/2/2018
PONDOK AREN 6/2/2018
PONDOK AREN
PONDOK AREN 6/2/2018
PONDOK AREN
PONDOK AREN 6/2/2018
JOMBANG 9/2/2018 9/2/2018
PONDOK AREN
PONDOK AREN 9/2/2018 9/2/2018
PONDOK AREN
PONDOK AREN
PONDOK AREN 10/2/2018
BINTARO 10/2/2018
PONDOK AREN
PONDOK AREN 10/2/2018
PONDOK KARYA 10/2/2018
PONDOK AREN 13/02/2018
13/02/2018
1/18/2018 20/1/2018
Ciputat 1/19/2018 20/1/2018
PONDOK AREN 1/19/2018 20/1/2018
PARIGI 1/19/2018 20/1/2018
Jombang 1/20/2018 22/1/2018
Pd Pucung 1/21/2018 22/1/2018
CILEDUG 1/22/2018 24/1/2018
Jombang 1/23/2018 24/1/2018
JURANG MANGGU 1/24/2018 26/1/2018
JURANG MANGGU 1/25/2018 26/1/2018
BINTARO 1/25/2018 26/1/2018
Jombang 1/26/2018 27/1/2018
PONDOK KACANG TIMUR 1/26/2018 27/1/2018
Pd Pucung 1/26/2018 27/1/2018
CILEDUG 1/26/2018 29/1/2018
1/26/2018 29/1/2018
1/27/2018 29/1/2018
CILEDUG 1/27/2018 29/1/2018
PARIGI 1/28/2018 31/1/2018
Jombang 1/28/2018 31/1/2018
PONDOK KACANG TIMUR 1/29/2018 31/1/2018
PONDOK KACANG TIMUR 1/29/2018 31/1/2018
PONDOK AREN 1/30/2018 1/2/2018
SERPONG 1/30/2018 1/2/2018
PONDOK KACANG TIMUR 1/31/2018 1/2/2018
PONDOK AREN 1/31/2018 1/2/2018
PONDOK AREN 2/1/2018 3/2/2018
PONDOK AREN 2/2/2018 3/2/2018
PONDOK KACANG TIMUR 2/2/2018 3/2/2018
Perigi Baru 2/3/2018 5/2/2018
Perigi Baru 2/3/2018 5/2/2018
CILEDUG 2/3/2018 5/2/2018
2/4/2018 5/2/2018
PONDOK KACANG BARAT 2/5/2018 7/2/2018
2/6/2018 7/2/2018
2/6/2018 7/2/2018
2/6/2018 7/2/2018
BINTARO 2/7/2018 9/2/2018
CIPUTAT 2/7/2018 9/2/2018
PUCUNG 2/7/2018 9/2/2018
Perigi Baru 2/7/2018 9/2/2018
Pd Kacang Timur 2/7/2018 9/2/2018
PONDOK AREN 2/9/2018 10/2/2018
Kebayoran Lama 2/9/2018 10/2/2018
PARIGI 2/11/2018 12/2/2018
PONDOK AREN 2/13/2018 14/2/2018
2/13/2018 14/2/2018
Ciputat 2/13/2018 14/2/2018
Ciputat 2/14/2018 15/2/2018
PONDOK AREN 2/14/2018 15/2/2018
PONDOK BETUING 2/14/2018 15/2/2018
2/14/2018 15/2/2018
 2/14/2018 15/2/2018
Jombang 2/15/2018 17/2/2018
Jurangmangu 2/15/2018 17/2/2018
PONDOK KACANG TIMUR 2/15/2018 17/2/2018
JOMBANG 2/15/2018 17/2/2018
PARIGI 2/15/2018 17/2/2018
2/16/2018 17/2/2018

59 15 83 8 8
SI TANGGAL IMUNISASI) BADUTA JUMLAH WUS DI IMUNISA
CAMPA
PENTA
K
PENTA 2POLIO 3 PENTA 3POLIO 4 MR IDL BADUT Td1 Td2
BADUT
A
A

18/01/2018
18/01/2018
18/01/2018

18/01/2018
18/01/2018
18/01/2018
20/01/2018

23/01/2018

23/01/2018
23/01/2018

26/01/2018
26/01/2018
26/01/2018
26/01/2018

27/01/2018
27/01/2018

27/01/2018
27/01/2018

29/01/2018
29/01/2018
29/01/2018
29/01/2018

30/01/2018
30/01/2018
31/01/2018
31/01/2018

1/2/2018 1/2/2018
1/2/2018 1/2/2018

3/2/2018 3/2/2018

5/2/2018 5/2/2018

6/2/2018 6/2/2018

9/2/2018 9/2/2018

###
### ###

### ###

13/02/2018
12 13 5 4 4
UMLAH WUS DI IMUNISASI

Td3 Td4 Td5