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09 Juni 2022 Posyandu Pardamean Ajibata
09 Juni 2022 Posyandu Pardamean Ajibata
09 Juni 2022 Posyandu Pardamean Ajibata
Jenis Kelamin
No. Nama Anak Tgl lahir Umur
(L/P)
a b c d e
1 Andean Devan Parodi Gurning 7/19/2020 3 L
2 Rodigro Sirait 9/7/2019 3 L
3 Yoselin Gultom 4/6/2019 4 P
4 yael Gultom 10/9/2016 6 L
5 Yunaira Gultom 3/22/2019 4 P
6 Ijen Hutajulu 9/26/2017 5 L
7 Johan Hutajulu 5/12/2021 2 L
8 Renovan Sirait 11/27/2020 2 L
9 Natasya Situmorang 11/1/2018 4 P
10 Fery Sinaga 1/7/2019 4 L
11 Sanni Sara Sirait 2/6/2018 5 P
12 Naston Siallagan 11/27/2020 2 L
13 Deffin Arsen Sinaga 5/11/2018 5 L
14 Diego Alvano Sinaga 2/16/2021 2 L
15 Hanifa Evelina Kesuma 1/14/2021 2 P
16 Naora Simatupang 11/4/2016 6 P
17 Devina Ola Mafsha Sembiring 8/3/2019 4 P
18 Aditya Sembiring 4/13/2021 2 L
19 Yuki Pranata Saragi 5/11/2020 3 L
20 Aska Jordy Gultom 2/2/2020 3 L
21 Joy Leondro Simanjuntak 10/6/2017 5 L
22 Qwenza Sijabat 7/1/2021 2 P
23 Ruria Sinaga 9/18/2019 3 P
24 Cantika Sitinjak 8/31/2021 1 P
25 Aspa Selom Sinaga 7/13/2021 2 L
26 Xavier Sihombing 4/9/2019 4 L
27 Cleona Sihombing 8/23/2017 5 P
28 Nathanael Gultom 12/2/2020 2 L
29 Mistak Gultom 10/9/2017 5 L
30 Ririn Dwita 2/25/2019 4 P
31 Muhammad Adam 7/6/2021 2 L
32 Sarah Manurung 2/15/2020 3 P
33 Maudy Sianipar 6/15/2018 5 P
34 Axell Sianipar 12/18/2015 7 L
35 Alfaro Gurning 3/15/2016 7 L
36 Prawira Gurning 8/31/2018 4 L
37 Aditia Sibero 3/10/2016 7 L
38 Hikmal 12/6/2016 6 L
39 Daniel Sibiro 3/20/2018 5 L
40 Martian Bonardo Simatupang 21 Sep 2018 4 L
41 Artha Ade Laura Gurning 28 Jul 2021 2 P
42 Brian Tua Arimatio Sirait 31 Jul 2017 6 L
43 Alysia Geovani Sirait 22 Oct 2013 9 P
44 Methania Gloria Simatupang 2 Jan 2014 9 P
45 Gracya Simatupang 123
46 Elegan Sirait 2/10/2020 3 P
47 Erlangga Sirait 2/10/2020 3 L
48 Lyoni Sirait 8/8/2017 6 P
49 Laurent Sinaga 10/15/2019 3 P
50 Edward Sinaga 7/22/2020 3 L
51 Exel Sinaga 1/11/2017 6 L
52 Felicia Silaen 5/4/2021 2 P
53 Jacob Gultom 7 Feb 2017 6 L
54 Jesse Gultom 12/5/2018 4 L
55 Clara Sinaga 11/1/2016 6 P
56 Syahkila 6/23/2016 7 P
57 Isabel Gurning 2/27/2019 4 P
58 Alfaro Sitinjak 8/17/2016 6 L
59 Clarissa Sibagariang 2/6/2020 3 P
60 Haganta Tarigan 11/18/2016 6 L
61 Harsel Situmeang 2/5/2021 2 L
62 Jordy Paul Manurung 6/5/2020 3 L
63 Geonatan Napitu 8/18/2018 4 L
64 Elias Napitu 15 Jan 2017 6 L
65 Haruka Manurung 1/2/2021 2 P
66 Jodi Siringo-ringo 7/5/2017 6 L
67 Nevida siringo-ringo 10/23/2018 4 P
68 Frans Hawer nadeak 12/12/2016 6 L
69 Rapha Jordan Sibuea 7/10/2020 3 L
70 paulus Sinaga 3/18/2020 3 L
71 Rafael Christian Sirait 11/28/2017 5 L
72 Panca Aliando Simarmata 8/25/2017 5 L
73 Ivana Maureen Siallagan 10/17/2020 2 P
Jumlah vaksin (vial)
Jenis logistik OPV IPV DPT-HB-HIB
Jumlah 0 0 0
Catatan ss
* Tuliskan alasan jika anak tidak bisa diimunisasi dan rencana jadwal pemberian imunisasi susulan pada kolom keterangan
FORMAT PENCATATAN HASIL PELAYANAN
Nama petugas
Puskesmas
Kabupaten
Imunisasi Kejar
(Ya = 1, Tidak=0)
Campak
Rubela
Nama orang tua Alamat No.Hp NIK
(Ya=1,
Tidak=0)
OPV
f g h i j k
Devita Sinaga Pardamean Ajibata 0000000000000000 1
Flora Sitio Pardamean Ajibata 0000000000000000 1
Irma Tampubolon Pardamean Ajibata 0000000000000000 1
Irma Tampubolon Pardamean Ajibata 0000000000000000 1
Irma Tampubolon Pardamean Ajibata 0000000000000000 1
Jessy Sidabutar Pardamean Ajibata 0000000000000000 1
Jessy Sidabutar Pardamean Ajibata 0000000000000000 1
Santa Sinaga Pardamean Ajibata 0000000000000000 1
Evi Sipakkar Pardamean Ajibata 0000000000000000 1
Lewenglina Nainggolan Pardamean Ajibata 0000000000000000 1
Jurnal Sirait Pardamean Ajibata 0000000000000000 1
Rentauli Panjaitan Pardamean Ajibata 0000000000000000 1
Elis simanjuntak Pardamean Ajibata 0000000000000000 1
Elis simanjuntak Pardamean Ajibata 0000000000000000 1
Rini Bakkara Pardamean Ajibata 0000000000000000 1
Matilda Situmorang Pardamean Ajibata 0000000000000000 1
Lenni Sihombing Pardamean Ajibata 0000000000000000 1
Lenni Sihombing Pardamean Ajibata 0000000000000000 1
Nurhaijah Sitohang Pardamean Ajibata 0000000000000000 1
Elfrida Siburian Pardamean Ajibata 0000000000000000 1
Tina Melinda Sirait Pardamean Ajibata 0000000000000000 1
Elsa Sirait Pardamean Ajibata 0000000000000000 1
Lusinta Malau Pardamean Ajibata 0000000000000000 1
Fitri Sirait Pardamean Ajibata 0000000000000000 1
Lusinta Malau Pardamean Ajibata 0000000000000000 1
Debora Sitanggang Pardamean Ajibata 0000000000000000 1
Debora Sitanggang Pardamean Ajibata 0000000000000000 1
Ebta Sinaga Pardamean Ajibata 0000000000000000 1
Ebta Sinaga Pardamean Ajibata 0000000000000000 1
Eka Verawati Pardamean Ajibata 0000000000000000 1
Eka Manurung Pardamean Ajibata 0000000000000000 1
Lidya Marpaung Pardamean Ajibata 0000000000000000 1
Enni Simanjuntak Pardamean Ajibata 0000000000000000 1
Enni Simanjuntak Pardamean Ajibata 0000000000000000 1
Diana Tampubolon Pardamean Ajibata 0000000000000000 1
Diana Tampubolon Pardamean Ajibata 0000000000000000 1
Gembira Sihombing Pardamean Ajibata 0000000000000000 1
Tri Wahyuni Pardamean Ajibata 0000000000000000 1
Gembira Sihombing Pardamean Ajibata 0000000000000000 1
Oki Sirait Pardamean Ajibata 0000000000000000 1
Devita Sinaga Pardamean Ajibata 0000000000000000 1
Hendri Sirait Pardamean Ajibata 0000000000000000 1
Imelda Samosir Pardamean Ajibata 0000000000000000 1
Oky Sirait Pardamean Ajibata 0000000000000000 1
0000000000000000 1
Kristina Manihuruk Pardamean Ajibata 0000000000000000 1
Kristina Manihuruk Pardamean Ajibata 0000000000000000 1
Kristina Manihuruk Pardamean Ajibata 0000000000000000 1
Lidiana Situmorang Pardamean Ajibata 0000000000000000 1
Lidiana Situmorang Pardamean Ajibata 0000000000000000 1
Leli Siahaan Pardamean Ajibata 0000000000000000 1
Yenni Pardamean Ajibata 0000000000000000 1
Lidia Sinaga Pardamean Ajibata 0000000000000000 1
Lidia Sinaga Pardamean Ajibata 0000000000000000 1
Marlinang Sianipar Pardamean Ajibata 0000000000000000 1
Lenni Sihombing Pardamean Ajibata 0000000000000000 1
Remelkina Sinaga Pardamean Ajibata 0000000000000000 1
Fitri Sirait Pardamean Ajibata 0000000000000000 1
Elisa Siadari Pardamean Ajibata 0000000000000000 1
Olivia Karo Pardamean Ajibata 0000000000000000 1
Minar Manik Pardamean Ajibata 0000000000000000 1
Santa Sinaga Pardamean Ajibata 0000000000000000 1
Kevin Sirait Parsaoran Ajibata 0000000000000000 1
Kevin Sirait Parsaoran Ajibata 0000000000000000 1
Erik Manurung Pardamean Ajibata 0000000000000000 1
Desi K Sihombing Pardamean Ajibata 0000000000000000 1
Pardamean Ajibata 0000000000000000 1
Lipron Nadeak Pardamean Ajibata 0000000000000000 1
Helprida Gurning Pardamean Ajibata 0000000000000000 1
Rosalina Nainggolan Pardamean Ajibata 0000000000000000 1
Tumpal Marudut Tua Sirait Pardamean Ajibata 0000000000000000 1
Christina Siregar Pardamean Ajibata 0000000000000000 1
Dermawan Simatupang Pardamean Ajibata 0000000000000000 1
Jumlah vaksin (vial) dan logistik yang digunakan
CAMPAK RUBELA Pelarut Campak Rubela Dropper ADS 0,5 ML ADS 5 ML Safety Box
73 7 73 7 1
Imunisasi Kejar
(Ya = 1, Tidak=0)
Ket** (bila anak mendapatkan
dosis kedua/keetiga/keempat
OPV/Penta saat BIAN, maka
tetap dicatat namun tidak
dimasukkan sebagai cakupan
IPV DPT-HB-Hib BIAN)
l m n
Pen Marker
1
FORMAT REKAPITULASI HASIL PELAYANAN BULAN IMUNISASI ANAK NASIONAL
Desa/kelurahan : Pardamean Ajibata dan Parsaoran Ajibata
Puskesmas : Ajibata
Isilah pada kolom yang berwarna
OPV
a b c
1 Posy. Mawar Pardamean Ajibata 0
TOTAL 0
Catatan :
IP = Jumlah yang diimunisasi/jumlah vial vaksin yang digunakan
FORMAT REKAPITULASI LOGISTIK PUSKESMAS
Indeks
Jumlah Vial Indeks Pemakaian Jumlah Vial Jumlah
Jumlah diimunisasi Pemakaian
digunakan Vaksin digunakan diimunisasi
Vaksin
d e f g h i
0 #DIV/0! 0 0 #DIV/0! 0
#DIV/0! #DIV/0!
#DIV/0! #DIV/0!
#DIV/0! #DIV/0!
#DIV/0! #DIV/0!
#DIV/0! #DIV/0!
#DIV/0! #DIV/0!
#DIV/0! #DIV/0!
#DIV/0! #DIV/0!
#DIV/0! #DIV/0!
#DIV/0! #DIV/0!
#DIV/0! #DIV/0!
#DIV/0! #DIV/0!
#DIV/0! #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0
LOGISTIK PUSKESMAS
Jumlah Vial
IP Jumlah diimunisasi Jumlah Vial IP Pelarut Dropper
digunakan
j k l m n o p
0 #DIV/0! 73 7 10.42857143 7 0
#DIV/0! #DIV/0!
#DIV/0! #DIV/0!
#DIV/0! #DIV/0!
#DIV/0! #DIV/0!
#DIV/0! #DIV/0!
#DIV/0! #DIV/0!
#DIV/0! #DIV/0!
#DIV/0! #DIV/0!
#DIV/0! #DIV/0!
#DIV/0! #DIV/0!
#DIV/0! #DIV/0!
#DIV/0! #DIV/0!
#DIV/0! #DIV/0!
0 #DIV/0! 73 7 10.42857143 7 0
Jumlah Logistik yang digunakan
q r s t
73 7 1 1
73 7 1 1