Lembar

No No porsi Nama L/P Tanggal Lahir

1 1100438776 SRIYATI BUDI HARTOYO P 08/12/1963 1963
2 1100439026 ZUMROTUN P 03/12/1954 1954
3 1100439543 SAMIYATI P 05/06/1961 1961
4 1100439545 SUKISNO L 10/01/1961 1961
6 1100439765 SRI DARMIYATI P 13/09/1963 1963
7 1100441603 M. ARIF TOM TOM AB L 16/12/1972 1972
8 1100441951 SUDILAH P 31/12/1932 1932
9 1100441958 ANITA HERDIAWATI P 24/07/1974 1974
10 1100442579 SODIK SUJATMIKO SE L 05/01/1973 1973
11 1100443137 TAKUWAT L 31/12/1956 1956
12 1100443138 JUMINTEN P 31/12/1961 1961
13 1100443294 SUTARDI L 13/02/1959 1959
14 1100444768 HERMAWAN SULISTIYANTA L 12/12/1965 1965
15 1100444774 SRI KHOLIFAH P 08/08/1968 1968
16 1100447427 SUNYOTO L 05/08/1957 1957
17 1100447435 WAHYUNI P 07/12/1962 1962
18 1100447452 MUHDI , SPD L 18/02/1954 1954
19 1100448393 AZIS SUBARKAH L 24/01/1979 1979
20 1100448394 ARFITA DEWI P 10/06/1982 1982
21 1100448601 EDI ARI RISMAWANTO L 06/01/1986 1986
22 1100448687 SETIA ASYANTI P 13/01/1976 1976
23 1100449558 MARTINEM P 27/12/1950 1950
24 1100450695 MUJADI L 01/01/1953 1953
25 1100450698 SUNARMI P 12/10/1959 1959
26 1100454899 RISTINA HANDAYANI ASFAH P 15/01/1976 1976
27 1100454911 SITI MUAWANAH P 15/12/1967 1967
28 1100454912 MUJIB HARSONO L 26/04/1969 1969
29 1100454931 ACHMAD HARYANA L 27/02/1964 1964
30 1100457459 FAHRIYAH P 11/10/1956 1956
31 1100457819 UMI ROKHMAH P 20/05/1971 1971
33 1100458066 ABDUL AZIZ L 31/12/1959 1959
34 1100460703 NY SUGIYATI P 31/12/1960 1960
35 1100461737 SRI MULYATI P 08/02/1956 1956
36 1100462013 ZAHROWI L 11/06/1965 1965
37 1100462018 MUH KLASIN L 01/05/1967 1967
38 1100462802 NY SARWENI ARWIDIYANTI P 16/08/1960 1960
39 1100462812 MUH JAELANI L 08/02/1958 1958
40 1100465940 SURAMI P 31/12/1943 1943
41 1100466049 NURJANAH P 31/12/1969 1969
42 1100466050 SUYUTHI L 10/11/1959 1959
43 1100466051 SUMARDI AHMAD MUHTADI L 24/04/1964 1964
44 1100466166 NURUL ABADI L 04/10/1964 1964
45 1100456736 MAISAROH P 5/8/1962 1962
46 1100456741 SUWANTO P 3/3/1961 1961
47 1100520781 KURNIAWAN SETIADI L 3/2/1974 1974
48 110051256 HINDUN P 12/31/1950 1950
49 110579535 EMI SETYORINI P 1/18/1975 1975

50 L 7/4/1953
3000774849 SOEJONO 1953

51 P 3/19/1955
3000774850 SUJATINAH 1955
52 3000776652 ENI SURITI P 2/22/1974 1974
53 3000776651 ARIFIN L 8/12/1961 1961
54 110067034 SITI MARYATI P 12/12/1960 1960
 Lembar bantu manual vaksinasi COVID-19 pada Jemaah Haji Lansia
PUSKESMAS SALAM KAB. MAGELANG

NIK Umur Alamat Nama Desa

3308044812630002 58 GEMAMPANG RT.02 RW.01 SIRAHAN
3308044312540001 67 NABIN BETENG 16/02 SELOBORO
3308044506610002 60 NGRANCAH 02/10 TIRTO
3308041001610001 60 NGRANCAH 02/10 TIRTO
3308045309630002 58 SEMEN 04/01 SUCEN
3308041612720003 49 GLAGAHOMBO 01/07 SUCEN
3308047112320161 89 GLAGAH OMBO RT. 02/07 SUCEN
3308046407740002 47 JLEGONG RT. 01/15 GULON
3308040501730004 48 SEMEN 01 RT. 01/01 SUCEN
3308043112560039 65 NABIN BETENG 03/04 SELOBORO
3308047112610018 60 NABIN BETENG 03/04 SELOBORO
3308041302590002 62 LOJIREJO RT.05 RW.20 GULON
3372041212650011 56 JAREYAN RT.01 RW.04 SALAM
3308044808680008 53 JAREYAN 01/04 SALAM
3308040508570001 64 KADILUWIH 02/01 KADILUWIH
3308044712620001 59 KADILUWIH 02/01 KADILUWIH
3308041802550001 67 JAGALAN 03/05 SALAM
3308042401790002 42 KRICAAN MESIR 01/07 SALAM
3308045006820003 39 KRICAAN MESIR 01/07 SALAM
3308040601860001 35 LOJIREJO 06/20 GULON
3308045301760002 45 LOJIREJO 03/20 GULON
3308046712500002 71 TRAYEM 08/04 SIRAHAN
3308040101530004 68 NGASEM RT.03 RW.17 GULON
3308045210590003 62 NGASEM 03/17 GULON
3308045501760004 45 BENDOSARI GEDE 04/16 SALAM
3308045512670002 54 KRAKITAN RT.05 RW.05 SUCEN
3308042604690003 52 BENDOSARI GEDE RT.04 RW.1SALAM
3308042702640001 57 KRAKITAN 05/05 SUCEN
3308045110560001 65 SUCEN NO/ 02 RT. 04/04 SUCEN
3308046005710004 50 DSN. SUCEN KIDUL 03/02 SUCEN
3308043112590017 62 KADIROGO 05/06 JUMOYO
3308047112600384 61 DUSUN. TUMBREB 10/05 TERSAN GEDE
3308044802560001 65 GEMAMPANG 01/05 KADILUWIH
3308041106650003 56 JUMOYO 06/01 JUMOYO
3308040105670002 54 JUMOYO LOR 05/01 JUMOYO
3308045608600003 61 DSN. SELOIRING 05/03 JUMOYO
3308040802580001 63 SELOIRING 05/03 JUMOYO
3308047112430198 78 SELOIRING RT.05 RW.03 JUMOYO
3308047112690106 52 DUSUN. KERON 02/02 MATINGAN
3308041011590007 62 KERON RT.01 RW.02 MATINGAN
3308042404640002 57 DUSUN KERON 02/02 MANTINGAN
3308040410640002 57 KRAKITAN 02/05 SUCEN
3308104805620002 59 SUCEN NO/ 02 RT. 04/04 SUCEN
3308100303610004 60 SUCEN NO/ 02 RT. 04/04 SUCEN
3308040203740002 47 GULON SALAM GULON
3308047112500291 71 GLAGAH OMBO SUCEN SUCEN
3308045810750002 46 SIRAHAN SALAM SIRAHAN

68
3308040407530001 JAGANG KIDUL RT 02 RW 03 SALAM

66
3308045903550001 JAGANG KIDUL RT 02 RW 04 SALAM
3308046202740001 47 CARIKAN KADILUWIH KADILUWIH
3308041208610001 60 CARIKAN KADILUWIH KADILUWIH
3308045212600009 61 JAGALAN SALAM SALAM
Haji Lansia

No Telp Kabupaten Provinsi Tgl Vaksin 1 Tgl Vaksin 2

MAGELANG JATENG 3/22/2021
3/13/2021
3/22/2021
3/22/2021
3/13/2021
3/22/2021
3/13/2021
3/22/2021
3/22/2021
3/22/2021
3/22/2021
3/13/2021
3/22/2021
3/22/2021
3/13/2021
3/22/2021
3/13/2021
MUTASI SLEMAN
MUTASI SLEMAN
3/22/2021
3/22/2021
3/13/2021
3/13/2021
3/13/2021
3/22/2021
3/22/2021
KANKER MAU KONSUL DOKTER
GOR
3/22/2021
3/13/2021
3/13/2021
3/13/2021
3/13/2021
3/22/2021
3/22/2021
3/13/2021
3/22/2021
3/13/2021
3/22/2021
3/22/2021
3/22/2021
3/22/2021
3/22/2021
3/22/2021
3/22/2021
3/22/2021
3/22/2021

3/22/2021

3/22/2021
3/22/2021
3/22/2021
3/22/2021
Nomor Batch
24000321
24000321
24000321
24000321
24000221
24000321
24000321
24000321
24000321
24000321
24000321
24000321
24000321
24000321
24000321
24000321
24000321

24000321
24000321
24000321
24000321
24000321
24000321

24000321
24000221
24000321
24000321
24000321
24000321
24000321
24000321
24000321
24000321
24000321
24000321
24000321
24000321
24000321
24000321
24000321
24000321
24000321

TUNDA

24000321
24000321
24000321
24000321
 Lembar bantu

No No porsi Nama L/P Tanggal Lahir

 Lembar bantu manual vaksinasi COVID-19 pada Jemaah Haji Lansia
PUSKESMAS ….............KAB. MAGELANG

NIK Umur Alamat Nama Desa

Jemaah Haji Lansia
NG

No Telp Kabupaten Provinsi Tgl Vaksin 1 Tgl Vaksin 2

Nomor Batch