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    PIN Polio Posyandu Annisa RW 19

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    Puskesmas Bhaktijaya
    This document contains a record of immunization services provided at Posyandu Annisa in Bhaktijaya village on April 8, 2023. It lists 50 children who received the nOPV2 polio vaccine, including their name, date of birth, age, gender, ID number, parent/guardian's name and contact information. The total number of nOPV vaccine vials used and remaining is recorded at the bottom.

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    PIN Polio Posyandu Annisa RW 19

    Uploaded by

    Puskesmas Bhaktijaya
    11 views12 pages
    This document contains a record of immunization services provided at Posyandu Annisa in Bhaktijaya village on April 8, 2023. It lists 50 children who received the nOPV2 polio vaccine, including their name, date of birth, age, gender, ID number, parent/guardian's name and contact information. The total number of nOPV vaccine vials used and remaining is recorded at the bottom.

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    This document contains a record of immunization services provided at Posyandu Annisa in Bhaktijaya village on April 8, 2023. It lists 50 children who received the nOPV2 polio vaccine, including their name, date of birth, age, gender, ID number, parent/guardian's name and contact information. The total number of nOPV vaccine vials used and remaining is recorded at the bottom.

    Copyright:

    © All Rights Reserved
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    Download as xlsx, pdf, or txt
    11 views12 pages

    PIN Polio Posyandu Annisa RW 19

    Uploaded by

    Puskesmas Bhaktijaya
    This document contains a record of immunization services provided at Posyandu Annisa in Bhaktijaya village on April 8, 2023. It lists 50 children who received the nOPV2 polio vaccine, including their name, date of birth, age, gender, ID number, parent/guardian's name and contact information. The total number of nOPV vaccine vials used and remaining is recorded at the bottom.

    Copyright:

    © All Rights Reserved
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    of 12

    FORMAT PENCATATAN HASIL PELAYANAN S

    Nama Posyandu/Sekolah/Pos layanan : Posyandu Annisa - RW.019


    Nama Desa/kelurahan : Bhaktijaya
    Tanggal : 08/04/2023

    * Tuliskan alasan jika anak tidak bisa diimunisasi dan rencana jadwal pemberian imunisasi susulan pada kolom keterangan

    Jenis
    No. Nama Anak Tgl lahir Umur Kelami NIK
    n (L/P)

    a b c d e f

    1 P
    ALINDYA HARMONI 21.12.2018 50 3175056112160000
    2 P
    NADHIRA 14.07.2019 43 3276051407190005
    3 P
    GHUMAISHA 02.08.2019 42 3276054208190001
    4 P
    NINAYARA 19.09.2018 53 3276055909180001
    5 P
    NASYITHA SARAH 25.11.2020 27 3276056511200004
    6 P
    HAGIA SOFIA 18.11.2021 15 3214031811210001
    7 P
    KAYYISA INDIRA 14.04.2021 22 327305404215448
    8 P
    FANIA ALESHA 31.10.2021 15 3174087110210003
    9 P
    KHALILAH HUMAIRA 12.07.2020 31 3276305207207695
    10 P
    AQNA SAKHIYA 02.06.2021 20 3276054206210001
    11 P
    KHAYLA ZHARIFA 02.11.2021 15 3276050211210004
    12 P
    FAZIA H.P. 23.10.2018 52 3276056310180004
    13 P
    PUTRI DYAH S. 10.12.2019 38 3276051012190001
    14 P
    MIQAILA 23.06.2019 44 3276052306190006
    15 P
    NAUREEN QUINSHA 14.12.2020 26 3276051412205352
    16 L
    HAFIDZAN 28.06.2019 44 32763028061901
    17 L
    M. DIRHAM M. 20.07.2018 45 3276052007180006
    18 L
    IBRAHIM ATHAAR 31.01.2021 24 3276053101210003
    19 L 3276302105224600 /
    NUHA FIRAZ ATHARI 21.05.2022 9 3276052105220002
    20 L
    HAMIZ AIRLANGGA 02.01.2019 49 3214040201190001
    21 L
    M. RUMI AKBAR 18.10.2020 28 3276051810200008
    22 L
    KHAIRAN ABIDZAR 20.01.2019 49 32763020019537
    23 L
    AMMAR MUMTAZ 14.09.2019 41 2171101409190002
    24 L
    FATIH ABHISEVA 23.02.2022 12 3276052302220003
    25 L
    UMAR ABD.JABAR 04.03.2021 23 3276300403214669
    26 L
    ASHAR F.R. 24.06.2018 56 3276052406180001
    27 L
    ALARIC NAWASENA 21.08.2018 54 3276052108180002
    28 L
    ROBBY GHANI M 09.01.2019 49 3276051901190003
    29 L
    FAQIH GHAZI A 15.08.2020 30 3276051508200002
    30 p
    LEANARA WINESA 09.12.2020 27 3276054912200002
    31 L
    ATHALA SABRANG 23.02.2023 1 3276052302230004
    32 GIANNI AISYAH 29.03.2020 P

    33 ARWEN RAMIZAH ADISTY 26.08.2022 P 3174096608220006

    34 KIANDRA MELVIANTO 10.10.2022 L 3172021010220005

    35 M RIZKY YUDISTIRO 23.10.2018 L 3216062310180007

    36 AISYA GIANINA 24.08.2022 P 3273126408220002

    37 ARKAN NATA A 21.08.2022 L 3175092108220003

    38 RIFKY AL FAIQ 24.04.2019 L 3276052404190004

    39 MOZIDANLOUISE 09.09.2019 L 3216090909190002

    40 ANGEL 17.12.2018 P 3172035712160001

    41 SHABIRA BANAFSHA 05.12.2020 P 3276054512200005

    42 BIANGO ALFARAZKA 01.11.2019 L 3276020111190001

    43 FATHIMAH M M 18.04.2019 P 3276055804190006

    44 ALESHA KINARIAN PRAYASTI 28.09.2021 P 3276056809210002

    45 CHATERINE 28.09.2020 P 3214036805950006

    46 CLARINE 14.02.2023 P 3214036805950006

    47 SYABIL ARKANANTA 27.04.2019 P 3276052704190002

    48 GHINA RAIHANA S 04.03.2020 P 3201104402200004


    49 GIBRAN A K 03.07.2018 L 3201100307180001

    50 P
    ZIVANA MALISKA 27.10.2020 28 3276062710620006
    51

    52

    53

    54

    56
    57
    58
    59
    60
    61
    62
    63
    64
    65
    66
    67
    68
    69
    70
    71
    72
    73
    74
    75
    76
    77
    78
    79
    80
    81
    82
    83
    84
    85
    86
    87
    88
    89
    90
    91
    92
    93
    94
    95
    96
    97
    98
    99
    100
    TOTAL

    Jumlah Jumlah
    Jumlah vial dibawa vial vial Jumlah Vial Sisa
    Jumlah Vial nOPV dipakai rusak
    AN HASIL PELAYANAN SUBPIN POLIO

    Nama petugas : Nafisah & Febri Handayani


    Puskesmas : Baktijaya
    Kabupaten : Jawa Barat

    n pada kolom keterangan


    Dosis 1

    Nama orang tua NIK Orang Tua Alamat No.Hp Tanggal


    Diimunisasi nOPV2

    g h Komplek Pelni (i) j k

    4/8/2023
    RININDA 3175056112160000 BLOK I-4/3 8568044320
    4/8/2023
    VONNY 3276057006820000 BLOK A-6/8 81574750685
    4/8/2023
    TACHORI 3276051204780010 BLOK J-3/3 81296893982
    4/8/2023
    NADIA 3276055507880010 BLOK A-6/9 8128775876
    4/8/2023
    NADIA 3276055507880010 BLOK A-6/9 8128775876
    4/8/2023
    DANU 3322181712870000 BLOK J-2/2
    089671717272 4/8/2023
    POLEY D 3276022607910000 BLOK H-5/5
    4/8/2023
    FARIED 3276050708810000 BLOK 9-3/10
    4/8/2023
    FARIZA 3275120907940000 BLOK J-5/3
    DONY 081225048699 4/8/2023
    KURNIAWAN 3275042306770010 BLOK G-6/12
    081388623148 4/8/2023
    CITRO B 3173072401850000 BLOK A-5/3
    087887082312 4/8/2023
    M. RAMLAN 3175550405890000 BLOK H-4/7
    4/8/2023
    DANANG 3276051706790000 BLOK H-3/19
    088296453547 4/8/2023
    SYTHA 3276054908920000 BLOK I-2/11
    4/8/2023
    ALDY 3276052305730000 BLOK L-1/7
    08111479300 4/8/2023
    AGUNG 3276051101820000 BLOK I-2/11
    083182688701 4/8/2023
    MAULANA 327605260840008 BLOK I-1/9
    083182688701 4/8/2023
    MAULANA 327605260840008 BLOK I-1/9
    4/8/2023
    NADIA 3276055507880010 BLOK A-6/9 8128775876
    081918993611 4/8/2023
    DANU 3322181712870000 BLOK J-2/2
    4/8/2023
    BAYU D. 3276052203770000 BLOK H-2/5
    4/8/2023
    ALDRIN 3276060107800000 BLOK J-3/13
    4/8/2023
    TRIYANTO 2171101210750000 BLOK J-2/16
    0811854958 4/8/2023
    NUGROHO 3372032711850000 BLOK J-3/12
    4/8/2023
    TACHORI 3276051204780000 BLOK J-3/3
    4/8/2023
    FACHRI 3275101506900120 BLOK H-3/2
    08128712834 4/8/2023
    RIZKI SYARIF 3215131410810000 BLOK H-3/1
    08988014526 4/8/2023
    HARDI .'327605160489008 BLOK H-3/12
    4/8/2023
    M. RAMLAN 3175350405890000 BLOK H-4/7
    87703003964 4/8/2023
    GATOT C. 3276022101950000 BLOK L-1 NO. 8
    4/8/2023
    RIZKI SYARIF 3215131410810000 BLOK H-3/1 08128712834
    AKMAL
    PELNI 25 NO.3 081291864844 4/8/2023
    SULISTOMO
    M IQBAL RT 002 RW 28 082113139732 4/8/2023
    AMELIA
    RT 002 RW 28 081298565238 4/8/2023
    FRANSISCA
    RENI ANGGRAENI RT 002 RW 28 087741600071 4/8/2023

    AKHMAD IAN BLOK C5 NO.9 081298694952 4/8/2023

    SETYADI BLOK R NO.1 085774905984 4/8/2023


    WIDIANA
    RT 002 RW 18 087882068947 4/8/2023
    RAHMAWATI
    DANNIS EFENDIE BEKASI 081278858855 4/8/2023

    MARLYNA PELNI G7/8 085817319618 4/8/2023

    M IDRAKI PELNI G1/17 081210444418 4/8/2023

    DANANG BLOK A4/8 0811955462 4/8/2023

    RIDWAN H JELUTUNG 4/214 08888764265 4/8/2023

    OKY HERMAWATI 081513323699 4/8/2023

    DIANA 081293080138 4/8/2023

    DIANA 081293080138 4/8/2023

    INDAH 081717301843 4/8/2023

    ZAINAL ABIDIN 085711865011 4/8/2023


    ZAINAL ABIDIN 085711865011 4/8/2023

    4/8/2023
    ZULFAHMI 3175042604880000 BLOK G-7/11
    0
    ah & Febri Handayani

    Dosis 1 Dosis 2

    Tangg
    al No Ketera
    No Batch Vaksin Diimu Batch ngan
    nisasi Vaksin
    nOPV2

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