DAFTAR HADIR PESERTA VAKSINASI COVID-19

PUSKESMAS TIKUNG TANGGAL ……………………………………….

DI SMK ISLAM TIKUNG LAMONGAN

JENIS DOSIS
NO NAMA NIK UMUR KELAMIN TANDA TANGAN
(L/P) 1/2

1 A'AN DARUL ZURNALIS 3524190606040001 17 L 2 1

2 ABD. AZIZ MUZADI 3524231001040002 17 L 2 2

3 ACHMAD IKHSAN 3524193001030001 18 L 2 3

4 AGUS SANTOSO 3524231708030002 18 L 2 4

5 AHMAD BAGAS ADIANTO 3524191901040002 17 L 2 5

6 AHMAD MEYCOLA SATYA KUSUMA 3576022805030009 18 L 2 6

7 AKHMAD DHIYA'U ROKHMAN 3524192104040001 17 L 2 7

8 AKHMAD MUHAJIR 3524232702040002 17 L 2 8

9 ANGGA ADI SETIAWAN 3524190112030003 16 L 2 9

10 ARIF EFENDI 3524231109030001 18 L 2 10

11 ARIS SUTOMO 3524190701040006 17 L 2 11

12 DANANG SAWALA 3524232912030001 17 L 2 12

13 DAVID DWI HERMAWAN 3524162309040001 17 L 2 13

14 EKA RAMA SYAIFUDDIN 3524230111030001 17 L 2 14

15 HELMI HERMAWAN 3524232511040001 16 L 2 15

16 IMAM HAMBALI 3524233008040004 17 L 2 16

17 INDRA KURNIAWAN 3524120204040003 17 L 2 17

18 IRSADUL IBAD NASRULLAH 3524272707040001 17 L 2 18

19 M. TONI PRASTIYO 3524190607040001 17 L 2 19

20 MOCH. ILHAM INZAGHI 3524190701040004 17 L 2 20

21 MOH. ILHAM ADIT SAPUTRA 3524162104040002 17 L 2 21

22 MOHAMMAD ABDUL GHONI MASKUR F. 3524190305040005 17 L 2 22

23 MOHAMMAD NUR SHOCHEH 3524191010030003 18 L 2 23

24 MUHAMAD ILHAM HANAFI 9116050211010002 17 L 2 24

25 MUHAMAD WAHYU SUTRISNO 3524190410030003 18 L 2 25

26 MUHAMAD WANTO SUTIKNO 3524190410030002 18 L 2 26

27 MUHAMMAD FATKHUR ROZIKIN 3524232312040002 16 L 2 27

28 MUHAMMAD SYAIFUDDIN 3524191710040001 16 L 2 28

29 MUHAMMAD WILDAN MAULANA 3524190206040001 17 L 2 29

30 MUKHAMAD FAIZAL MAULANA 3524230709030003 18 L 2 30

31 ROBET 3524190608030001 18 L 2 31

32 SAHIDINA MAULANA 3524190109030001 18 L 2 32

33 THIRTA AGAM ADY RAMADHANI 3524160401040002 17 L 2 33

34 ACHMAD ANDIK ARI SETYAWAN 3524192004040002 17 L 2 34

35 ACHMAD MUFTI FAHREZY 3524190809040001 17 L 2 35

36 ACHMAD SALMAN 3524161512030001 17 L 2 36

37 AHMAD ZAINURI PRADANA 3524230601040002 17 L 2 37

38 ALDO DIO PAMUNGKAS 3524190907030002 18 L 2 38

39 AMALIYAH FITRIANI 3524174612030001 17 P 2 39

40 AMIN PRASTIYO 3524162701040001 17 L 2 40

41 ANDREANO WIBOWO PUTRO 3524190203040002 17 L 2 41

42 APRINDA DWI PRASTIKA 3524235104040001 17 P 2 42

43 ARIPIN WAHYU SAPUTRA 6471051403040002 17 L 2 43

44 DEDY EKO SAPUTRA 3524172204040001 17 L 2 44

45 DICKY RAMADHANI 3524172110040001 16 L 2 45

46 DIDY EKI SAPUTRA 3524172204040002 17 L 2 46

47 DIMAS NUR ROKHIM 3524190411030002 17 L 2 47

48 DWITA RAHMA FIRDANIS 3524195910040001 16 P 2 48

49 ERKHAM MARZUKI 3524160607040001 17 L 2 49

50 FARIDATUS SA'DIYAH 3524176102040001 17 P 2 50

51 FIKRI ARIEF RAHMAN 3524190212030001 17 L 2 51

52 GALANG EKA SAPUTRA 3524191407040002 17 L 2 52

53 HARIYANTO 3524231409030001 18 L 2 53

54 JEFRI ROMADHONI 3524192310040002 16 L 2 54

55 KIKI OKTAVIYANI 3524195410030001 17 P 2 55

56 M. ALDI PRATAMA PUTRA 3524171706040001 17 L 2 56

57 MIFTAKHUL ULUMUDDIN 3524171809040003 17 L 2 57

58 MOCHAMAD ADITYA YUDHA NUGRAHA 3524161512030002 17 L 2 58

59 MOH. ARIL SUDIYO 3524162206030002 18 L 2 59

60 MOKHAMMAD RUDIANTO 3524111509040002 17 L 2 60

61 MUHAMMAD NAUFAL HISYAM 3521100610030005 18 L 2 61

62 NAHDIYATUR ROSIDAH 3524236312030001 17 P 2 62

63 RAHMAH AULIA PUTRI 3524167009040001 17 P 2 63

64 SARI RAGIL KEMUNING 3524194601030002 18 P 2 64

65 SHOLIHATUL IRSYADAH UMMAH 3524146803040003 17 P 2 65

66 VIRDANASUDIN 3524162002040001 17 L 2 66

67 WAHYU EKO SAPUTRO 3524230104040003 17 L 2 67

68 ZENNY DWI AGUSTIN 3524196508040002 17 P 2 68

69 ADINDA EKA IHTIHAR SAHWANA 3524195301040001 17 P 2 69

70 AMANDA LESTARI 3524195209040002 17 P 2 70

71 AMELYA QUROTUL AINI 3524025507640001 17 P 2 71

72 AMINATUN HERLIS 3524237001050001 16 P 2 72

73 ANANG FANANI 3524230710030003 18 L 2 73

74 BAGUS TRI PRADANA 3524231303040002 17 L 2 74

75 DINI NURMIA AVIDA 3525056503040001 17 P 2 75

76 ELVANI AMBARWATI 3524236705040002 17 P 2 76

77 ELVINA AMELIA SORAYA 3524116006040001 17 P 2 77

78 FAJRIFATIN SHAILLAISANIA 3524195008040001 17 P 2 78

79 ISLAKHATUL ANNISAK 3524194103030002 18 P 2 79

80 JHEA HELVANDRA WULANDARI 3524236507040001 17 P 2 80

81 JONI RAHMAT 3524190206040001 17 L 2 81

82 KHISOM IRFANDI 3524231003040001 17 L 2 82

83 KHOFIFA SINDI SAVIRA 3524195804040002 17 P 2 83

84 LEVINA EKA SEPTIANEEN PUTRI 3524234909050001 16 P 2 84

85 MOCHAMMAD YUSUF 3524232705040003 17 L 2 85

86 MUTHIFAH 3524194407040002 17 P 2 86

87 NIKMATUSSAHADAH KUSUMA ZUBEYDUMILAH3524167008040001 17 P 2 87

88 NOVI DWI AMBARWATI 3524195811030001 17 P 2 88

89 NUR AMALIYATUS SHOLIKHAH 3524227012030001 17 P 2 89

90 PUSPITA SARI 3524194505040002 17 P 2 90

91 PUTRI MAILIYAH KUSUMA NING AYU 3524166605040002 17 P 2 91

92 RAHMAH SALISA 3524190101050002 16 P 2 92

93 RIFATUL WINDI CHOTIMAH 3524194206040003 17 P 2 93

94 RIRIS EKA SULISTYOWATI 3524195011030001 17 P 2 94

95 TAUFIK ISMAIL 3524190101040001 17 L 2 95

96 USWATUN KHAROMAH 3524234606040001 17 P 2 96

97 WAHYU BUDIANTO 3524230708050001 16 L 2 97

98 A. SUAIFI ROZI 3524231806040002 17 L 2 98

99 ACHMAD ARIS 3524232308040001 17 L 2 99

100 AHMAD ZAKARIYAH 3524230202040002 17 L 2 100

101 AKHMAD SYAIFUDIN 3524232903040001 17 L 2 101

102 ANANDA FITRI NADIA 3524236711040004 17 P 2 102

103 APRILIA PUTRI LISTIYANI 3524236504040001 17 P 2 103

104 BAMBANG CANDRA IRAWAN 3524232307040004 17 L 2 104

105 DEWI SINTHA WATI 3524234805040001 17 P 2 105

106 DWI FEBRIANA 3524196002040001 17 P 2 106

107 DWI ISMAWATUS SHOLEKHAH 3524235410030001 17 P 2 107

108 DWI PUTRI MALASARI 3524236401040003 17 P 2 108

109 EKA SEPTIAN PRATIWI 3524196311040002 17 P 2 109

110 ELSA ZUNI ARDIANTI 3524115610030001 17 P 2 110

111 ENI PUJI LESTARI 3524235309040003 17 P 2 111

112 EVI NUR KUSUMA 3525116504040001 17 P 2 112

113 FADLLUR ROHMAN 3525161311030001 17 L 2 113

114 FA'IS FITRIYAH 3524196502040001 17 P 2 114

115 FARAH IMATUZ ZAHRA 3524165205040005 17 P 2 115

116 FITRIA KHUMAIROH 3524165312030002 17 P 2 116

117 GUNAWAN BINTANG PRATAMA 3524190706040001 17 L 2 117

118 IRSYA DHATUL FADHILAH 3524235601040001 17 P 2 118

119 KHOIRIYATUN NISA 3524226904040003 17 P 2 119

120 MAULINA IMAH 3524195004040001 17 P 2 120

121 MEGA ANGGRAINI SAFITRI 3524195604040002 17 P 2 121

122 NOVITASARI 3524235410040002 16 P 2 122

123 NUR AFIFA 3524196307040001 17 P 2 123

124 NUR SHOLIKHAH 3524167012030003 17 P 2 124

125 NURAINI 3524164804030001 18 P 2 125

126 RISALATIN NISA' 3524234109040001 17 P 2 126

127 RUMIATI 3524195212040001 17 P 2 127

128 SAHIDUL IHSAN 3524141411030006 17 L 2 128

129 SERLINA DWI SAFITRI 3524195111040001 16 P 2 129

130 SITI NUR AZIYATUROHMAH 3524235204030001 18 P 2 130

131 ULIFA NURBAYA RIKA D.P. 3524164510040001 17 P 2 131

132 ABDUL ROKMAD 3524230712040001 16 L 2 132

133 ACHMAD FARIED ALFARIZI 3524232104040001 17 L 2 133

134 ADITYA NUR ROKHMAN 3524162408040001 17 L 2 134

135 AGUNG SAPUTRO 3524270108040001 17 L 2 135

136 AHMAD FARIS MAGHRIZA 3524160103040004 17 2 136

137 AHMAD ILHAM WAHYUDI 3524191810030004 17 L 2 137

138 AHSANUDDIN 3524230506030001 18 L 2 138

139 AYNUL YAQIN 3524162804040001 17 L 2 139

140 BAYU ANANTA YUDHA 3524162707040001 17 L 2 140

141 DELLA DIANA SARI 3524166112040001 16 P 2 141

142 DICKY DWI HERLANGGA SYAH PUTRA 3524160506040001 17 L 2 142

143 EKA RAHMAWATI 3524165007040001 17 P 2 143

144 FANDRA MARETA TRIFANSYAH 3524192003040001 17 L 2 144

145 FERDI ARDIANSYAH 3524192807040003 17 L 2 145

146 FITA DWI SEPTIANI 3524234309030001 18 P 2 146

147 HASAN AINUR ROFIK 3524230410030001 18 L 2 147

148 HUSSEIN BAHROSY 3524232606040001 17 L 2 148

149 IMAM GHOZALI 3524231311030002 17 L 2 149

150 LUTHFI HIDAYAT 3524231303040003 17 L 2 150

151 MASKUR FAKIH 3524162107040001 17 L 2 151

152 MASRIFATUL FA'DIYAH 3525014305050002 16 P 2 152

153 MOH. NANDA ADI PRATAMA 3521160107010002 17 L 2 153

154 MOHAMMAD HERMANSYAH 3524190104040001 17 L 2 154

155 MUHAJIR DWI PURNOMO 3524240311030001 17 L 2 155

156 MUHAMMAD ARMADANI 3524231705040001 17 L 2 156

157 MUHAMMAD KHARIS DZUL QORNAIN 3524231212030002 17 L 2 157

158 NATHANIA AZARIA SHAFIRA 3524167004040001 17 P 2 158

159 PUTRI MEGA WIDA YANTI 3524165903040002 17 P 2 159

160 RINTO BINARKO 3524161704040001 17 L 2 160

161 SANDRA DWI SEPTIYA 3524235910030001 17 P 2 161

162 SEPTI EKA WATI 3524165809030001 18 P 2 162

163 SISKA NUR HIDAYATI 3524196702030002 18 P 2 163

164 SUGIANTO 3524230602030002 18 L 2 164

165 SUMALI 3524190802010002 20 L 2 165

166 WAFIYYUL AHDI 3524231508020001 19 L 2 166

Lamongan, ……………………..2021
KORIM Mengetahui,
Kepala Puskesmas Tikung

ARLIS NURLAILI NI'MAH, A.Md.Keb Dr. SULISMI WIJATI

NIP ; 19791018 200801 2 014 NIP : 19690324 200212 2 006
 DAFTAR HADIR PESERTA VAKSINASI COVID-19
PUSKESMAS TIKUNG TANGGAL ……………………………………….
DI SMK ISLAM TIKUNG LAMONGAN

JENIS
NO NAMA NIK UMUR KELAMIN DOSIS TANDA TANGAN
1/2
(L/P)
1 ABDUL AZIS 3524192809030001 15 L 2 1

2 AHMAD ZIDNI NURODDIN 3524162004050003 15 L 2 2

3 AKHMAD NIZAAR AL BAIHAQI 3524193005050001 15 L 2 3

4 ALI IFAN NUR RAMADHAN 3524162110040001 16 L 2 4

5 CANDRA ISWANTORO 3524232209060002 15 L 2 5

6 DAFIT CANDRA PRASSTIO 3524231105050001 16 L 2 6

7 DENI DWI SETIAWAN 3524231612050001 15 L 2 7

8 DIMAS ADI PRASETIYO 3524190405050002 15 L 2 8

9 EGA ANDHIKA PUTRA 3524192807050003 16 L 2 9

10 EKO NUR DYANSYAH 3524192412040002 15 L 2 10

11 FERDIANSYAH 3524172511040001 16 L 2 11

12 FIRDAUS PUTRA BUANA 3524192512040003 15 L 2 12

13 HALIM RIYANTO PUTRA 3524163003060001 15 L 2 13

14 M ARJUN FIRMANSYAH 3524190403050001 15 L 2 14

15 MOH. BAYAZID KHASAN 3524191205040001 15 L 2 15

16 MUHAMMAD ARIS DWI PRASTYO 3524191507050002 15 L 2 16

17 MUHAMMAD IRWANSYAH 3524233108050001 15 L 2 17

18 MUHAMMAD LEOARDYANSYAH 3524112409040002 16 L 2 18

19 ONI AFRIZA KURNIAWAN 3524162003050004 15 L 2 19

20 RIZAL ABDILLAH 3524192212040002 15 L 2 20

21 RIZKY BAGUS ADITYA 3524195007840002 15 L 2 21

22 SANTOSO LANGGENG K 3524192701050001 15 L 2 22

23 ZAINUL ARIFIN 3524190801060002 15 L 2 23

24 AFRIZA KUSUMA 3524114710050003 15 L 2 24

25 AHMAD SAIFUDDIN 3524231808060001 16 L 2 25

26 AKHMAD SYAHAL 3578140804050003 15 L 2 26

27 BAYU SUPRIYANTO 3524161011040001 15 L 2 27

28 FERY ARDIANSYAH 3524171807060001 15 L 2 28

29 GALLE TIRTA RABBANA 3524192602040001 15 L 2 29

30 HAMZADZUL FATKHURRAHMAN 3524162209040001 17 L 2 30

31 JONI MARSALENDO 3524192206050001 16 L 2 31

32 M. BUDI SETIAWAN 3524232602050001 16 L 2 32

33 M. GUSTIAFIN 3524110808050001 16 L 2 33

34 MAULANA ADI WIJAYA 3524232304050002 16 L 2 34

35 MUHAMMAD IFFANDI 3524111301050001 15 L 2 35

36 MUHAMMAD KHARIS SAPUTRA 3524191612040002 16 L 2 36

37 MUSTAKIM 3524170402050001 16 L 2 37

38 NOFIAN ECHA SUSANTO 3524160511050002 15 L 2 38

39 NOVANDY ADITYA RAMADHAN 3524160510050001 15 L 2 39

40 RAMA ARMANSYAH 3524190606050001 16 L 2 40

41 RENDI AGUS SETIAWAN 3524190109050002 15 L 2 41

42 SETIYO PERMADI 3524192907050001 16 L 2 42

43 SYAMSUDIN NUR FACHUR RAHMAN 3524192501040001 16 L 2 43

44 YUSUF 3524191710050001 15 L 2 44

45 ABDUL AZIS 3524160805050004 15 L 2 45

46 ABDUL ZUBAIRI ROHMAN 3524192709040001 15 L 2 46

47 ADELIA DISTA RAHMADANI 3524197010040004 16 P 2 47

48 ADI SASONO 3524110912040002 16 L 2 48

49 AHMAD RIO FEBRIAN 3524192911040001 14 L 2 49

50 AHMAD ZAINUL AZHAR 3524160101050008 15 L 2 50

51 ANDRE KURNIAWAN 3524230909060002 15 L 2 51

52 ANDRYAN DWI FERDANSYAH 3524112411040001 17 L 2 52

53 ANI SUGIARTI 3524164212040001 15 P 2 53

54 DAWAM MAULANA 3524163011050002 16 L 2 54

55 DEWI RAHMAWATI 3524196212040001 16 P 2 55

56 DINI MEI ANGGRAINI 3524165105050001 16 P 2 56

57 EKY HERDIANSYAH 3524160509040001 15 L 2 57

58 GILANG SATRIA NANDA PUTRA 3524162304050001 15 L 2 58

59 HANUM LAILATUL A 3524234107040001 16 P 2 59

60 HARLIYANIH 3525075209050001 15 P 2 60

61 HESTIANA SARI 3525075909050001 16 P 2 61

62 M. AGUS GILANG PERDANA 3524112708050002 16 L 2 62

63 M. RIZKY BAGUS P 3524080508050002 15 L 2 63

64 M. WAHYU ARDY A.K 3524193105050002 15 L 2 64

65 MUHAMMAD RIZAL ABDUL AZIZ 3524111902050003 15 L 2 65

66 SUPRIANTO 3524231906090003 15 L 2 66

67 SYAIFUL RIZAL 3525072105050002 15 L 2 67

68 TRI SOFIYANA 3524166108040003 16 P 2 68

69 VALENTINO ROSSY N 3578060501050008 15 L 2 69

70 ALFAIZAH AGUSTIN ISLAMI PASHA 3524166108050001 16 P 2 70

71 ANDINI PUTRI APRILIANTI 3524194405050001 15 P 2 71

72 ARDI NUR FIAN WAHYUDI 3524231308040001 15 L 2 72

73 BELLA FITRIATIN SHOLIKAH 3524234711050001 14 P 2 73

74 CIKA OKTA RAMADANI 352423..110050003 15 P 2 74

75 DIVA AGUSTINA RAHAYU 3524194608050001 15 P 2 75

76 DONA ALIANDA FITRI 3525075308050001 15 P 2 76

77 DWI ARDIANTO 3524191602050001 16 L 2 77

78 EKA SILFIYA PUTRI ANDRIANI 3524236306050003 15 P 2 78

79 ELISA NOVITA JULIANTI 3524234607050002 15 P 2 79

80 ERNAWATI WIDYA PRATIWI 3524195908050002 15 P 2 80

81 ESIA PUTRI VERONIKA 3524235111040001 15 P 2 81

82 FAJRIYATUL ALAMIYAH 3524195304050005 16 P 2 82

83 FERDI INDRA LUKMANA 3524230612040001 15 L 2 83

84 ILFIN NADZIROH 3524235005040003 17 P 2 84

85 LAUDYNDA ALVIONI NUR E 3524194907050001 16 P 2 85

86 LULUK MAULIDDIYAH 3525074704050001 15 P 2 86

87 M. EDHIKA IRZAM MAULANA 3524162308050001 15 L 2 87

88 M. SLAMET WAHYU SOFI YALLOH 3524161712040002 16 L 2 88

89 MAYA ANDRIYANI 3524114506060001 15 P 2 89

90 MILKA ICHA ERAN TIKA 3524196305050002 16 P 2 90

91 MUANAH INDAH SARI 3524234205050002 15 P 2 91

92 NABELLA EKA ERLINA 3524194805050001 15 P 2 92

93 NADIA EKA KUSUMA 3524115508040002 15 P 2 93

94 NAJWA PUTRI SALSABILLA 3524195206050001 15 P 2 94

95 NOVA DWI SAFITRI 3524196207060001 15 P 2 95

96 NUR WJAYATI 3524235404050002 15 P 2 96

97 NURUL HIDAYATI 3524235801050001 15 P 2 97

98 PUTRI MEI LISA 3524196105020003 15 P 2 98

99 RIKA WULANDARI 3524195609050003 16 P 2 99

100 SABITA DELIA HASANAH 3516174703050001 15 P 2 100

101 SAFILA HIDAYATUR ROHMAH 3524194906050002 14 P 2 101

102 SHANDY ASIFUDDIN 3524231003050001 14 L 2 102

103 SINTA DWI RAHAYU 3524114409060001 16 P 2 103

104 SOMA ABIDIN 3524192508050001 15 L 2 104

105 TABITA MADANA 3524236704050001 16 P 2 105

106 TIKA MULIYA SARI 3524215705050002 15 P 2 106

107 TITIK NURUL ISLAMIYAH 3524115004050001 15 P 2 107

108 AHMAD SYAFI'I 3524232404180005 15 L 2 108

109 AINUL YAKIN 3524192908109866 15 P 2 109

110 AISYAH AULIYAH RAHMATULLAH 3524162608100831 16 P 2 110

111 ALIFFIYAH 3524233110100022 16 P 2 111

112 ANDRIAN AJI PRATAMA 3525161803090002 15 L 2 112

113 AYU SYAHIDAH 3524192908108107 16 P 2 113

114 AZUFNI AFROH 3524193008100688 15 L 2 114

115 BELLA AURIANTI AGUSTIN 3524192908104181 15 P 2 115

116 DELVIANA VIVA WAHYUNI 3524192908108724 15 P 2 116

117 DESY NATASYA RAHMAWATI 3524192908103969 16 P 2 117

118 DEVINA NUR ANGGRAENI 3524190904150001 15 P 2 118

119 EKA PUTRI MEI LINDA 3524192908107840 15 P 2 119

120 INESSA DEVI AGUSTIN 3524192908108068 16 P 2 120

121 JOHAN ANTONI 3524193008102570 16 L 2 121

122 KHUSNUL KHOTIMAH 3524233110103324 15 P 2 122

123 LIVANA MEI ARINI 3524192908108082 15 P 2 123

124 MOHAMMAD ISKAK 3524192908103685 15 L 2 124

125 MUH. SHAHIBIL ILMI LUQMAN 3524192908107072 14 L 2 125

126 MUHAMMAD ANWAR SANUSI 3524190110120002 15 L 2 126

127 MUHAMMAD RIZQI PRATAMA 3524172808102799 15 L 2 127

128 MUHAMMAD TOMI PRASETYO 3524192008107288 16 L 2 128

129 NABILA PERMATA SURYA DEWI 3524162608103898 15 P 2 129

130 NABILA PUTRI AMELIA GUNARTO 3578270701150002 15 P 2 130

131 NOVY NUR AZIZAH 3524195203050001 15 P 2 131

132 PUTRI AYU NUR AVIVAH 3524176709050002 15 P 2 132

133 RIYANTI MEVA YULI WULANDARI 3524236707050001 15 P 2 133

134 SEKAR AYU FEBRIANTI 3524195702050001 15 P 2 134

135 SELFIANA MELANI PUTRI 3524194205050001 15 P 2 135

136 SEPTIAN GILANG ANDI 3524220309040002 15 P 2 136

137 SILVIA DWI FEBRIANTI 3524236702040002 16 P 2 137

138 TIA IZZATUL AWALIA 3524166405050001 16 P 2 138

139 VANIA DHITA HANGGRAINI 3524197007050001 15 P 2 139

140 WINDA SRI UTAMI 3524165504050004 15 P 2 140

141 AFIFATUN NAIMAH 3524195110040001 15 P 2 141

142 AGUNG ABDUL FATAH 3524232908050001 15 L 2 142

143 AMALIA HUSNA 3524164408040002 15 P 2 143

144 ANDIKA FEBRIANTO 3524231805050001 15 L 144

145 ASISKA NINDA MASFUFAH 3524196806050001 15 P 145

146 CINDY NOVITA RANI 3524194807040002 15 P 146

147 DEA AYU ERISTA 3524194901050001 15 P 147

148 FARADIBA KHOLFATUL ULA 3524146507050003 16 P 148

149 HENIS AGUSTIN 3524166208050001 16 P 149

150 M. FAJAR HADI 3524232809050002 15 L 150

151 MOCH DICKY BAGUS SETYA 3524190704050001 16 L 151

152 MUHAMMAD JAWAH ASRORI 3524191611050001 15 L 152

153 NEVANDRIAN ARDWIKY J.P 3524194201050001 15 L 153

154 NIRINA DWI OLIVIA 3524235112040001 15 P 154

155 NUR LATIFAH 3524225510040002 16 P 155

156 VANES HERA OKTAVIA 3524231503040002 15 P 156
157 ZAINAL 3524231503040002 14 L 157

Lamongan, ……………………..2021
KORIM Mengetahui,
Kepala Puskesmas Tikung

ARLIS NURLAILI NI'MAH, A.Md.Keb Dr. SULISMI WIJATI

NIP ; 19791018 200801 2 014 NIP : 19690324 200212 2 006
 DAFTAR HADIR PESERTA VAKSINASI COVID-19
PUSKESMAS TIKUNG TANGGAL ……………………………………….
DI SMK ISLAM TIKUNG LAMONGAN

JENIS
NO NAMA NIK UMUR KELAMIN DOSIS TANDA TANGAN
1/2
(L/P)
1 ACHMAD DIMAS ARDANI 3524232405060001 15 L 2 1

2 ACHMAD DWI RISQI 3524232302060003 15 L 2 2

3 ACHMAD RENDI JUNI ARTO 3524230406060001 15 L 2 3

4 ADAM ADI SEPTIAN 3524192307050001 16 L 2 4

5 AGUNG ARIL MUSTOFA 3320021312050002 15 L 2 5

6 AHMAD ANDIKA FAHAMI HASAN 3524231410050001 16 L 2 6

7 AHMAD AULIA ILHAM SAPUTRA 3524192805060002 15 L 2 7

8 AHMAD FIRMAN AL FARUQ 3524190907060001 15 L 2 8

9 AHMAD NUR SYAHRUDIN RAHMADANI 3524233010050001 16 L 2 9

10 AHMAD SYAMSUDIN 3525012504060001 15 L 2 10

11 AINUL YAKIN 3524191205050001 16 L 2 11

12 ANDRA DWI FIRMANSYAH 3524191608060004 15 L 2 12

13 ARDANA SAPUTRA 3524192610050004 15 L 2 13

14 ARLY SEPTIA FAUZI 3524230709060001 15 L 2 14

15 BAYU ALFAREZA 3524232104060001 15 L 2 15

16 DANANG MAULANA 3524190302060002 15 L 2 16

17 ERIQ ARDIANSYAH 3524090705060001 15 L 2 17

18 FAIZAL HENDRA ILHAMSAH 3524192309050001 16 L 2 18

19 FERI ARDIANSYAH 3524190312050002 16 L 2 19

20 GATOT SUKOCO SANDI SUSILO 3524192406060003 15 L 2 20

21 ILHAM MAULANA 3524192708050002 15 L 2 21

22 INDRA MARDIANSYAH 3524190203060002 15 L 2 22

23 IVAN NURFERDIANSYAH 3524230803060003 15 L 2 23

24 KHOIRUL ROZIQIN 3524192203030001 15 L 2 24

25 M. IRWANSYAH 3524170606060002 15 L 2 25

26 MOH. WAHYU SAPUTRA 3524162906060002 15 L 2 26

27 MOHAMMAD NAJA NURDIANSYAH 3524192409050001 16 L 2 27

28 MOHAMMAD NOVAL AFNANI 3524222802060003 15 L 2 28

29 MUHAMMAD ANDIKA PUTRA 3524161408060001 15 L 2 29

30 MUHAMMAD FATHONI 3525072001060001 15 L 2 30

31 MUHAMMAD ILHAM ROMADHON 3578282710050001 16 L 2 31

32 MUHAMMAD IRFAN 3524230412060002 15 L 2 32

33 OKTAFIAN SURA MAHENDRA 3525031210060002 16 L 2 33

34 RAHMAD SUDARMANTO 3524160903060001 15 L 2 34

35 RIFQY ANDREAS FAHREZY 3524231208060001 15 L 2 35

36 RIZKY FEBRIANSYAH 3515181002060006 15 L 2 36

37 SAHRUL ROMADHON 12.0821.101104.0001 17 L 2 37

38 SAMSUDIN HAMZAH JAKARIA 3524190109050001 16 L 2 38

39 TIO SUSANTO PUTRA 3524192305050001 16 L 2 39

40 TRI SUHANDOYO 3524232212050002 16 L 2 40

41 ACH. CHARIS ISA BUKHORY 3524190408050002 16 L 2 41

42 ACHMAD SHOHIBUL FADLI 3524231511050002 16 L 2 42

43 AHMAD ANGGUN JUNAIDI 3524232901060001 15 L 2 43

44 ANDREAS PRAMADANI 3524162212050003 16 L 2 44

45 ANDRIANO WIBOWO LAKSONO 3524192908050001 16 L 2 45

46 ARHAM AL-AGHNY 3524191508060003 15 L 2 46

47 ARJUNA DIRGA GALANG SUKMA 3524112306060001 15 L 2 47

48 DENDY BUSJAERI MASJID 3524162912050001 16 L 2 48

49 FERDINAN DAVY ROHANDHIKA 3524186109150001 15 L 2 49

50 GAYUH DWI SYHARISMAN 3524110606060002 15 L 2 50

51 ILHAM MAULANA PUTRA 3524160104060002 15 L 2 51

52 KAILA RIFKI ARDANIS 3524110610050002 16 L 2 52

53 MIFTAKHUL ASRORI 3524191709050001 16 L 2 53

54 MOHAMMAD RENDRA 3524162204060001 15 L 2 54

55 MUHAMAD FAISOL ROFIUDIN 3524230603060002 15 L 2 55

56 MUHAMAD IMAM ZAKY 3524190203060001 15 L 2 56

57 MUHAMMAD HILMI 3524231908060001 16 L 2 57

58 MUHAMMAD SYAFARUDDIN 3524192412050001 16 L 2 58

59 MUKHAMAD ADITYA MAULANA 3524230204070001 14 L 2 59

60 MUSLIMIN 3524235002680001 15 L 2 60

61 PUTRA HEAVEN RAMADHANI 35242232210060003 15 L 2 61

62 RIAN FAJAR PRATAMA 3527021008040005 17 L 2 62

63 RICKO AGUS RAMADHANI 3524160910060001 15 L 2 63

64 RIFKI PRATAMA 3524192209050001 16 L 2 64

65 SATRIA WIBAWA IKRIANSYAH PUTRA 352411511050003 16 L 2 65

66 ZIDAN ATHALAH 3524112010050004 16 L 2 66

67 AHMAD RAFI'IF AL DZAKIYYAH 3524230709060003 15 L 2 67

68 ALFINA TRI AMANDA 3524236707060003 15 P 2 68

69 ALFIYAH NURUL SHOLIKHAH 3524164509050003 16 P 2 69

70 AMELIA EKA PUSPITASARI 3524197001060002 15 P 2 70

71 ANDHIKA PRATAMA RAMADHANI 3524190910050003 16 L 2 71

72 ANIN NUR AI'SA 3524196103050002 16 P 2 72

73 APRILLIANITA DIAZ ROLANDA 3524166604060004 15 P 2 73

74 BUNGA NOVI ANGGRAINI 3524195607060001 15 P 2 74

75 CARISSA FEBRIYANTI 3524194102060001 15 P 2 75

76 DIMAS ALI MUDDIN 3524233108060001 15 L 2 76

77 ELIS LISTIANA 3523155511060002 15 P 2 77

78 HERU SETIAWAN FERDIYANSYAH 3524190312050001 16 L 2 78

79 IMROATHUS SOLIKAH 3524236709060001 15 P 2 79

80 LULUK NATALIA 3524194703050004 16 P 2 80

81 MARETHA GALUH DWI PURWANTI 3524164703060001 15 P 2 81

82 MARITSYA NINDIA ARTA 3524236709060002 15 P 2 82

83 MERRY CRISTINA WULANDARI 3524196704070004 14 P 2 83

84 MOCH. ALFIN VERY FIRMANSYAH 3524232706060001 15 L 2 84

85 MOCH. ASLAM HAKIM 3524232003060002 15 L 2 85

86 MUHAMMAD ABDUL RHOKIM 3524231108060002 15 L 2 86

87 MUHAMMAD ALIF ARASID 3175031905050011 16 L 2 87

88 NABILA SASKIYA ZAHRANI 3524175307050001 15 P 2 88

89 NAFISA SALSABILA R 3524196309060002 15 P 2 89

90 NUR MAULANA ISHAK 3524232703060001 15 L 2 90

91 NUR VITA 3524234501060001 15 P 2 91

92 RADITYA ARINAL PUTRA 3524110201050001 16 L 2 92

93 RAHMAWATI EKA PUTRI 3526036105060001 15 P 2 93

94 RATNA FADILAH NOVARIYANTI 3524194211040001 17 P 2 94

95 RETNO DWI NOVIANTI 3524195111050002 16 P 2 95

96 RIA AYU ANDINI 3524165601060001 15 P 2 96

97 RISKA ILHAM FAHMITA 3524234805060001 15 P 2 97

98 RISMA DIVA ADELIA PUTRI 3578106804050007 16 P 2 98

99 SISKA WAHYUNI 3524196206060001 15 P 2 99

100 TZUFAH ALLAWIYAH 3524196208050001 16 P 2 100

101 VITA DWI AMALIA 3524194405060001 15 P 2 101

102 YUNI WIDYA NINGSIH 3525034606060001 15 P 2 102

103 AFIFAH RIZKI NUR HIDAYAH 3524195203060001 15 P 2 103

104 AHMAD ALI SIHAB 3524260701060002 15 L 2 104

105 AHMAD RAFLI KAMALUDDIN 3524232810060002 15 L 2 105

106 AJENG PUTRI KINANTI 3524196001060001 15 P 2 106

107 APRIL NAFA SALSABILLAH 3524116704050001 15 P 2 107

108 AYU AGUSTINA 3524194808060001 15 P 2 108

109 AYU ROMADHONI 3524196710050001 16 P 2 109

110 AYU WULANDARI 3524196405060001 15 P 2 110

111 CHERRIL AULIYA RAHMAH 3524164101070003 14 P 2 111

112 DEWI INTAN PERMATASARI 3524234401070001 14 P 2 112

113 DWI ADITYAWAN 3524193004050001 16 L 2 113

114 ELISA NUR EKA WATI 3524235605060002 15 P 2 114

115 ELSA LUTFI NUR AZIZAH 3524235406050002 16 P 2 115

116 EVA RIKHA AGUSTIN 3524165208050001 15 P 2 116

117 GISKA PADILAH 3213056606060003 15 P 2 117

118 INTAN SARI 3524164403060001 15 P 2 118

119 IRMA SILVIANI ARDILA 3524236109060001 15 P 2 119

120 JOHANA TIARA DEVIANA 3524114405060001 16 P 2 120

121 KHUSNUL KHOTIMAH 3524235403050001 16 P 2 121

122 KIKI ALLIFYA HIDAYATI 3524145301060001 15 P 2 122

123 LAILI MA'RUFA SHOFFIA 3524235106060002 15 P 2 123

124 MAZIDATUL HARISMA ANNABILAH 3524114312050001 16 P 2 124

125 MOH. TEGUH ARDIANSYAH 3525012202060001 15 L 2 125

126 MUKHAMAD HERDIYANSYAH 3524231103060002 15 L 2 126

127 NURUL SULISTYA 3524235009060001 15 P 2 127

128 RIA SEPTIANA 3524045709060002 16 P 2 128

129 RISMA BILQIST MAULIDIA 3525075301060001 15 P 2 129

130 SHERLY PUTRI NURMALA 3524194801060001 15 P 2 130

131 SUSI DIA KHOLAFITANA 3524116610040001 16 P 2 131

132 TRI ENDAINI 3524166306060002 16 P 2 132

133 UMI FADILAH 3524236108060001 15 P 2 133

134 USWATUN KHASANAH 3524194901060001 15 P 2 134

135 VIVI APRILIA 3524165804060001 15 P 2 135

136 WIDYA WATI 3524166001070002 14 P 2 136

137 ADITYA WAHYU FIRMANSYAH 3524232011060001 15 L 2 137

138 AHMAD ADITIYA MAHESA SAPUTRA 3524190803060003 15 L 2 138

139 ALI AGUS TIANSYAH 3524191308050001 16 L 2 139

140 AURA MARSYANTA TRI SIANTI 3524195303060001 15 P 2 140

141 AZIZAH RAHMAWATI 3524197001060001 15 P 2 141

142 CHANIA ROSA AMELIA 3524196604060001 15 P 2 142

143 DEFI KRISTIANAH 3524190301060001 15 P 2 143

144 DHANI PUTRA ARDIANSYAH 3524231403060002 15 L 2 144

145 FATIH ARDIANSYAH AVIANANTA 3524232302060001 15 L 2 145

146 FRANDICO ADI SLAMET 3524230909060001 15 L 2 146

147 INDRIA SISKA PUSPITASARI 3524162901060001 15 P 2 147

148 MUHAMMAD HANIF 3524160211050001 16 L 2 148

149 NADYA EKA RAHMAWATI 3524194806050001 16 P 2 149

150 NOVITA FEBY PUJI LESTARI 3524165402060001 15 P 2 150

151 RANGGA DWI ARDIANSYAH 3524162207050002 16 L 2 151

152 RISKA ELVINDAYANTI 3524234312060001 15 P 2 152

153 RIVALDO DIAN SAPUTRA 3524221006060003 15 L 2 153

154 RIZKA AYUNDA PUTRI 3524165707060002 15 P 2 154

155 ZUNISTA PERMATA SARI 3524236805060001 15 P 2 155

Lamongan, ……………………..2021
KORIM Mengetahui,
Kepala Puskesmas Tikung

ARLIS NURLAILI NI'MAH, A.Md.Keb Dr. SULISMI WIJATI

NIP ; 19791018 200801 2 014 NIP : 19690324 200212 2 006