Tahap II

PUSKESMAS : PUSKESMAS
KECAMATAN : PADEMAWU
TAHUN : 2022
Nomor No. Porsi Nama Bin/Binti Tempat Lahir Tgl. Lahir Umur L P Alamat Kab TD TB BB

1 1300530889 Sudiyanto Saimim Pamekasan 31-12--1965 45 L DsnRenggoh Tambung PMK 110/70 166 66

2 1300530887 Hatijah Sajus Pamekasan 31-12-1963 43 P Dsn Renggoh Tambung PMK 190/100 150 70

22 1300537217 A Zainol Hasan Sunarto Pameekasan 14-05-1976 44 L Dsn Biris Laok Ds Tambung PMK 120/80 160 54
23 1300537224 Rohmah Atmo Abdullah Pamekasan 14-041979 45 P Dsn Biris Laok Ds Tambung PMK 100/80 141 54

39 1300524976 m.aliwafi BA busra'I muallam Pamekasan 30-12-1961 59 L dsn.rengah ds.tambung PMK 160/90 163 75

40 1300524977 Siti suhartini moh.hasan Pamekasan 23-9-1964 56 P dsn.rengah ds.tambung PMK 120/80 152 67

49 1300519324 nurul aini moh.musa najib Pamekasan 17-07-1977 43 P dsn.biris dajah ds.tambung PMK 100/60 152 46
50 1300519322 abdurrahman jamaludin boesra'i Pamekasan 27-12-1969 51 L dsn.biris dajah ds.tambung PMK 120/80 165 77
51 1300474903 mohammad hairi marsu'i Pamekasan 11/7/1968 52 L dsn.rengoh ds.tambung PMK 120/70 158 78
52 1300474907 homizah moh.safiuddin Pamekasan 31-12-1973 47 P dsn.rengoh ds.tambung PMK 130/70 150 50
21 1300541273 Juhairiyah Mohammad Said Pamekasan 1/1/1950 70 P Dsn Assemmanis Ds Buddagan PMK 140/90 145 52
3 1300543766 Siti Fatimah M Jamaluddin Pamekasan 01/04/1969 49 P Jl Jokotole158 PMK 140/90 154 76

4 1300543772 Moh Fadli Astewan Pamekasan 23-05-1969 49 L Jl Jokotole158 PMK 110/70 169 78

5 1300523365 Muhellis.SH Moh Hosen Pamekasan 27-8-1958 38 L Kel Lada RT 07/ Rw08 PMK 100/60 153 57

6 1300533637 Nanik Budiningsih Sukarno Sleman 12/12/1962 42 P Kel Lada RT 07/ Rw08 PMK 100/60 154 73

7 1300523322 Moh Cipto Alim H ABD Dja'i Pamekasan 4/1/1974 54 L Jl Jokotole GgV PMK 120/80 152 66

8 1300523323 St Nurul Syamsiyah Moh Zini Pamekasan 5/4/1971 51 P Jl Jokotole GgV PMK 140/90 145 54

17 1300541339 Moh Halili Moh Hasyim Sumenep 7/8/1966 46 L Jl Darma Permai I/9 PMK 130/80 167 69

18 1300541342 Fifin Lukmaniyah M abdul Gafur Pamekasan 22-01-1967 47 P Jl Darma Permai I/9 PMK 120/80 145 68

9 1300544114 Al Faqih Ma'sum Sa'dullah Lamongsn 1/12/1964 44 L Dsn tegal Sari Ds Pad barat PMK 130/80 165 74

10 1300544111 Zainatun Munawaroh H Ali Hamid Pamekasan 18-01-1967 47 P Dsn tegal Sari Ds Pad barat PMK 110/84 147 58

11 1300538037 Nur Rodli Moh Ali Sidoarjo 16-02-1963 46 L Ds n tegal Sari Ds Pad Barat PMK 110/70 167 72

12 1300558040 Umi Kulsum Sumantri Cilacap 15-04-1974 54 P Dsn Tegasl Sari Ds Pad Barat PMK 100/60 158 42

13 1300521811 Togiman Oerip Matlawi Sumenep 23-07-1966 51 L Jl Jokotole Indah Bartim PMK 120/80 169 75

14 1300521614 Diyani Sidin Partodiran Tasikmalaya 28-08-1965 45 P Jl Jokotole Indah Bartim PMk 130/90 158 78

24 1300524567 Maimun Nawawi Pamekasan 7/4/1977 42 P Kel Barurambat Timur PMK 110/70 163 50

25 1300624562 Ulfatun Hasanah Mu'tafi Probolinggo 16-05-1984 35 P Kel Barurambat Timur PMK 110/70 156 52

15 1300545240 Enny Krisnawati Bahram Pamekasan 14-04-1965 45 P Dsn Murtajih Ds Murtajih PMK 130/80 155 61

16 1300545238 ToniSoehardi Soedirman Bojonegoro 18-02-1960 40 L Dsn Murtajih ds Murtajih PMK 130/90 159 56

19 1300536438 Supeno Sumowidjoyo Kediri 27-09-1959 71 L Jl Asta Rabeh ds Murtajih PMK 120/80 163 65

20 1300536436 Sundusiyah H Ach Sarbini Pamekasan 01-091959 61 P Jl Asta Rabeh ds Murtajih PMK 130/80 160 61

26 1300529228 Avira Sulistyaouni Moh Adra'i Sumenep 8/2/1978 50 P Jl Jokotole No 96 PMK 100/70 145 51

27 1300529224 Tomsil Nur Alam Maroedin Pamekasan 10/10/1964 55 L Jl Jokotole No 96 PMK 180/100 169 77
72 1300522762 ratih uttari hapi Pamekasan 18-09-1961 59 P Jl.jokotole 5/37 PMK 120/80 153 67
28 1300532630 yuli rosidah moh.ma'shum Pamekasan 7/7/1972 48 p dsn.asam pitu rt.2/rw.3 PMK 100/60 156 69

29 1300532614 mohammad anis.s a.burjadi Pamekasan 7/5/1972 48 L dsn.asam pitu rt.2/rw.3 PMK 100/60 156 64

30 1300542221 nurul kamariyah wa.baihaki sampang 8/8/1962 58 p Jl.darma gg1/11 PMK 120/80 154 60

31 1300545098 ika nursyamsiyah h.badrut tamam surabaya 28-02-1981 39 p Jl.veteran no.195A PMK 120/80 150 78

32 1300545097 ali wafa abbas bondowoso 14-4-1976 44 L Jl.veteran no.195A PMK 110/80 160 56

33 1300526720 yudi hasibuan sribuwaki moh.kasim Pamekasan 4/2/1974 46 L JL.Darma permai 1/8 PMK 110/80 155 64

34 1300526721 ratna dewi ambarwati sucipto moh.amin malang 14-12-1978 42 p JL.Darma permai 1/8 PMK 110/80 152 62

35 1300526670 yusi hari purnama sribuwaki moh.kasim Pamekasan 26-5-1983 37 L JL.NUGROHO 1 NO.9 PMK 130/70 157 59
36 1300526671 yoyok anugerah hadi sribuwaki moh.kasim Pamekasan 7/10/1981 39 L JL.NUGROHO 1 NO.9 PMK 130/70 163 78

37 1300539550 syamsul arifin abd.karim Pamekasan 12/1/1957 63 L dsn.bunder barat PMK 160/90 163 76

38 1300539549 sitti halimah m.wardi Pamekasan 27-10-1967 53 P dsn.bunder barat PMK 140/90 151 65

41 1300488068 h.hosen DRS djudin tona Pamekasan 4/14/1957 63 L dsn.tegal sari ds.pad.barat PMK 100/60 156 60

42 1301151222 suaidah h.abd.karim basyid Pamekasan 18-8-1965 55 P dsn.tegal sari ds.pad.barat PMK 130/80 145 70
68 1300541853 suparno moh.amir Pamekasan 14-12-1958 62 L dsn.mungsapada PMK 130/80 157 82
69 1300541850 yetti herawati moh.zain Sumenep 21-01-1959 61 P dsn.mungsapada PMK 140/90 154 50
43 1300520849 amin taksir h.moezani sampang 26-11-1962 58 L Jl.nugroho 31 PMK 120/80 151 76
44 1300520851 sri wahyuni achmad Pamekasan 21-06-1968 52 P Jl.nugroho 31 PMK 100/70 151 68
45 1300523366 samsul hidayat abdul mu'im Pamekasan 12/5/1953 67 L Jl.bonorogo 78 PMK 130/80 156 60
46 1300523363 malehah m.ali ambrusi Pamekasan 16-12-1956 64 P Jl.bonorogo 78 PMK 150/90 151 38
47 1300513050 Nurul laili moh.rais yusuf Pamekasan 5/11/1980 40 P Jl.bonorogo rt.10/rw.04 PMK 110/70 146 52
48 1300513051 Moh.erliyanto wafa Pamekasan 4/8/1974 46 L Jl.bonorogo rt.10/rw.04 PMK 100/60 155 64
53 1300533322 wiwin kusumawati mohammad hasyim Pamekasan 7/9/1972 48 P dsn.asam pitu PMK 120/80 157 64
54 1300533321 a.zuchro mawardi muhammad basrawi Pamekasan 1/11/1969 51 L dsn.asam pitu PMK 100/60 160 58
55 1300520071 AL mukarrobin samhaji kembar Pamekasan 13-11-1971 49 L dsn.tengah ds.lemper PMK 140/100 160 63
56 1300520072 nur jannah h.muntaha jumin Pamekasan 27-03-1973 47 P dsn.tengah ds.lemper PMK 110/80 155 84
57 1300531859 djuhairiyah bunayan hamudin Pamekasan 31-12-1961 59 P Dsn.genteng timur PMK 180/100 153 55
58 1300532364 Muhammad fajarisman ach.sanhadji Pamekasan 2/1/1989 31 L Jl.veteran muda 1/5 PMK 120/80 167 62
59 1300545695 sunarto mukri asturah Pamekasan 24-07-1961 59 L genteng barat rt.02/rw.04 PMK 120/80 155 59
60 1300545694 Hatimah tronah martija Pamekasan 15-03-1965 55 P genteng barat rt.02/rw.04 PMK 120/80 150 67
61 1300532746 endang sri kustinah somolalito yogyakarta 18-08-1958 62 P Jl.veteran 131 PMK 120/80 152 66
62 1300540706 ahmad baihaki mohammad nor sumenep 10/4/1955 65 L dsn.bunder barat PMK 120/80 154 48
63 1300540710 Siti khotijah kh.abd.karim yakin Pamekasan 12/6/1967 53 P dsn.bunder barat PMK 130/90 156 56
64 1300524745 Moh.rum yudoprawiro sumenep 11/12/1958 62 L Jl.stadion 8 no.55 PMK 100/60 162 54
65 1300524752 suryati sastroatmojo surawi sumenep 31-12-1961 59 P Jl.stadion 8 no.55 PMK 120/80 157 67
66 1300534118 kustantina ramli moh.ramli Pamekasan 20-01-1958 62 P Jl.veteran 2 no.10 PMK 120/80 148 47
67 1300534123 azidius andhy rp.azis syufendy sumenep 2/4/1960 50 L Jl.veteran 2 no.10 PMK 130/80 166 59
70 1300875995 moh.asraji zainullah munim Pamekasan 29-07-1963 57 L dsn.sompor ds.sentol PMK 100/60 158 49
71 1300485115 siti musyrifah ghazali Pamekasan 21-08-1973 47 P dsn.sompor ds.sentol PMK 160/90 156 73

Dokter Pemeriksa

dr.Jeni Novita Anggraini

NIP. 19870127 201409 2 001

sdh periksa
tdk masuk daftar kemenag 71-11 60 org
Tahap II

Tgl. Periksa Dr Pemeks Diagn I Diagn 2 Diag 3 Gol D Tgl.Imun No. hp

19-03-2020 dr JeniNA B 082337921802
19-03-2020 dr JeniNA DM/HT DM/HT B
4/14/2022 dr Jeni NA O 08179311840
4/14/2022 dr Jeni NA A

4/14/2022 dr Jeni NA HT HT B
4/14/2022 dr Jeni NA O

4/14/2022 dr Jeni NA B
4/14/2022 dr Jeni NA B

4/14/2022 dr Jeni NA O

4/14/2022 dr Jeni NA B
21/04/2022 dr Jeni NA B 082333657880
19-03-2020 dr Jeni NA B 081938005675
19-03-2020 dr Jeni NA A

19-03-2020 dr Jeni NA O

19-03-2020 dr Jeni NA B 085204926662

19-03-2020 dr Jeni NA O 087850676389
19-03-2020 dr Jeni NA O

23-032020 dr Jeni NA DM DM A 081913738988

23-032020 dr Jeni Na B

19-03-2020 dr Jeni NA DM DM A 081939356735

19-03-2020 dr Jeni NA O

19-03-2020 dr Jeni NA A 082334818753

19-03-2020 dr Jeni Na DM DM A

23-032020 dr Jeni NA O 081216158584

23-032020 dr Jeni Na JTG JTG O

23-032020 dr Jeni NA A 081332533319

23-032020 dr Jeni NA B

23-032020 dr Jeni NA O 081330732020

23-032020 dr Jeni NA DM DM B

23-032020 dr Jeni NA AB 087850673636

23-032020 dr Jeni Na O

23-032020 dr Jeni NA O 08123126167

23-032020 dr Jeni NA DM DM O
30-03-2020 dr Jeni NA AB 085231068261
23-032020 dr Jeni NA O 087850441810
23-032020 dr Jeni NA O 085230825010
26-03-2020 dr Jeni NA A 081939367975
26-03-2020 dr Jeni NA O 081231999139
26-03-2020 dr Jeni NA B

26-03-2020 dr Jeni NA O 08121646881

26-03-2020 dr Jeni NA AB

26-03-2020 dr Jeni NA B 087850568044

26-03-2020 dr Jeni NA O 082337596768
26-03-2020 dr Jeni NA HT HT O 087815787867
26-03-2020 dr Jeni NA B

26-03-2020 dr Jeni NA A 087750616277

26-03-2020 dr Jeni NA O
30-03-2020 dr Jeni NA JTG JTG B 081999931045
30-03-2020 dr Jeni NA DM+HT DM/HT B
28-03-2020 dr Jeni NA B 081330033420
28-03-2020 dr Jeni NA A
28-03-2020 dr Jeni NA O

28-03-2020 dr Jeni NA HT HT O 082333981010

28-03-2020 dr Jeni NA B

28-03-2020 dr Jeni NA O 082186175059

28-03-2020 dr Jeni NA O 085233936662
28-03-2020 dr Jeni NA O 082244136346
28-03-2020 dr Jeni NA O 082335366866
28-03-2020 dr Jeni NA B 085231427272
28-03-2020 dr Jeni NA HT HT O 087750813343
28-03-2020 dr Jeni NA O 085236417101
30-03-2020 dr Jeni NA O 085104030475
30-03-2020 dr Jeni NA B
30-03-2020 dr Jeni NA O 081330049097
30-03-2020 dr Jeni NA O 085258075903
30-03-2020 dr Jeni NA O
30-03-2020 dr Jeni NA O 085338783556
30-03-2020 dr Jeni NA O
30-03-2020 dr Jeni NA O 087850603058
30-03-2020 dr Jeni NA B
30-03-2020 dr Jeni NA B 081939055549
30-03-2020 dr Jeni NA HT B 087757444805

Mengetahui
Kepala Puskesmas Pademawu

dr.Achmad Muzzamil
NIP. 19690828 200212 1 007
 Tahap I
PUSKESMAS : PUSKESMAS
KECAMATAN : PADEMAWU
TAHUN : 2020
Nomor No. Porsi Nama Bin/Binti Tempat Lahir Tgl. Lahir Umur L P Alamat Kab TD TB BB Tgl. Periksa

1 1300530889 Sudiyanto Saimim Pamekasan 31-12--1965 45 L DsnRenggoh Tambung PMK 110/70 166 66 15.1.2020
2 1300530887 Hatijah Sajus Pamekasan 31-12-1963 43 P Dsn Renggoh Tambung PMK 190/100 150 70 15-1-2020
3 1300543766 Siti Fatimah M Jamaluddin Pamekasan 01/04/1969 49 P jl Jokotole158 PMK 140/90 151 76 15-1-2020
4 1300543772 Moh Fadli Astewan Pamekasan 23-05-1969 49 L jl Jokotole158 PMK 110/70 169 78 15-1-2020
5 1300523365 Muhellis.SH Moh Hosen Pamekasan 27-8-1958 38 L Kel Lada RT 07/ Rw08 PMK 100/60 153 57 15-1-2020
6 1300533637 Nanik Budiningsih Sukarno Sleman 12/12/1962 42 P Kel Lada RT 07/ Rw08 PMK 100/60 154 73 15-1-2020
7 1300523322 Moh Cipto Alim H ABD Dja'i Pamekasan 4/1/1974 54 L Jl Jokotole GgV PMK 120/80 152 66 15-1-2020
8 1300523323 St Nurul Syamsiyah Moh Zini Pamekasan 5/4/1971 51 P Jl Jokotole GgV PMK 140/90 145 54 15-01-2020
9 1300544114 Al Faqih Ma'sum Sa'dullah Lamongsn 1/12/1964 44 L Dsn tegal Sari Ds Pad barat PMK 130/80 165 74 15-01-2020
10 1300544111 Zainatun Munawaroh H Ali Hamid Pamekasan 18-01-1967 47 P Dsn tegal Sari Ds Pad barat PMK 110/84 147 58 15-01-2020
11 1300538037 Nur Rodli Moh Ali Sidoarjo 16-02-1963 46 L Ds n tegal Sari Ds Pad Barat PMK 110/70 167 72 15-01-2020
12 1300558040 Umi Kulsum Sumantri Cilacap 15-04-1974 54 P Dsn Tegasl Sari Ds Pad Barat PMK 100/60 158 42 15-01-02020
13 1300521811 Togiman Oerip Matlawi Sumenep 23-07-1966 51 L Jl Jokotole Indah Bartim PMK 120/80 169 75 15-02-2020
14 1300521614 Diyani Sidin Partodiran Tasikmalaya 28-08-1965 45 P Jl Jokotole Indah Bartim PMk 130/90 158 78 15-01-2020
15 1300545240 Enny Krisnawati Bahram Pamekasan 14-04-1965 45 P Dsn Murtajih Ds Murtajih PMK 130/80 155 61 17-01-2020
16 1300545238 ToniSoehardi Soedirman Bojonegoro 18-02-1960 40 L Dsn Murtajih ds Murtajih PMK 130/90 159 56 17-01-2020
17 1300541339 Moh Halili Moh Hasyim Sumenep 7/8/1966 46 L Jl Darma Permai I/9 PMK 130/80 167 69 17-01-2020
18 1300541342 Fifin Lukmaniyah M abdul Gafur Pamekasan 22-01-1967 47 P Jl Darma Permai I/9 PMK 120/80 145 68 17-01-2020
19 1300536438 Supeno Sumowidjoyo Kediri 27-09-1959 71 L Jl Asta Rabeh ds Murtajih PMK 120/80 163 65 17-01-2020
20 1300536436 Sundusiyah H Ach Sarbini Pamekasan 01-091959 61 P Jl Asta Rabeh ds Murtajih PMK 130/80 160 61 17-01-2020
21 1300541273 Juhairiyah Mohammad Said Pamekasan 1/1/1950 70 P Dsn Assemmanis Ds Buddagan PMK 140/90 145 52 17-01-2020
22 1300537217 A Zainol Hasan Sunarto Pameekasan 14-05-1976 44 L Dsn Biris Laok Ds Tambung PMK 120/80 160 54 17-01-2020
23 1300537224 Rohmah Atmo Abdullah Pamekasan 14-041979 45 P Dsn Biris Laok Ds Tambung PMK 100/80 141 54 17-01-2020
24 1300524567 Maimun Nawawi Pamekasan 7/4/1977 42 P Kel Barurambat Timur PMK 110/70 163 50 17-01-2020
25 1300624562 Ulfatun Hasanah Mu'tafi Probolinggo 16-05-1984 35 P Kel Barurambat Timur PMK 110/70 156 52 17-01-2020
26 1300529228 Avira Sulistyaouni Moh Adra'i Sumenep 8/2/1978 50 P Jl Jokotole No 96 PMK 100/70 145 51 18-01-2020
27 1300529224 Tomsil Nur Alam Maroedin Pamekasan 10/10/1964 55 L Jl Jokotole No 96 PMK 180/100 169 77 18-01-2020
28 1300532830 yuli rosidah moh.ma'shum Pamekasan 7/7/1972 48 p dsn.asam pitu rt.2/rw.3 PMK 100/60 156 69 18-01-2020
29 1300532614 mohammad anis.s a.burjadi Pamekasan 7/5/1972 48 L dsn.asam pitu rt.2/rw.3 PMK 100/60 156 64 18-01-2020
30 1300542221 nurul kamariyah wa.baihaki sampang 8/8/1962 58 p jl.darma gg1/11 PMK 120/80 154 60 18-01-2020
31 1300545098 ika nursyamsiyah h.badrut tamam surabaya 28-02-1981 39 p jl.veteran no.195A PMK 120/80 150 78 18-01-2020
32 1300545097 ali wafa abbas bondowoso 14-4-1976 44 L jl.veteran no.195A PMK 110/80 160 56 18-01-2020
33 1300526720 yudi hasibuan sribuwaki moh.kasim Pamekasan 4/2/1974 46 L JL.Darma permai 1/8 PMK 110/80 155 64 18-01-2020
34 1300526721 ratna dewi ambarwati sucipto moh.amin malang 14-12-1978 42 p JL.Darma permai 1/8 PMK 110/80 152 62 18-01-2020
35 1300526670 yusi hari purnama sribuwaki moh.kasim Pamekasan 26-5-1983 37 L JL.NUGROHO 1 NO.9 PMK 130/70 157 59 18-01-2020
36 1300526671 yoyok anugerah hadi sribuwaki moh.kasim Pamekasan 7/10/1981 39 L JL.NUGROHO 1 NO.9 PMK 130/70 163 78 18-01-2020
37 1300539550 syamsul arifin abd.karim Pamekasan 12/1/1957 63 L dsn.bunder barat PMK 160/90 163 76 20-01-2020
38 1300539549 sitti halimah m.wardi Pamekasan 27-10-1967 53 P dsn.bunder barat PMK 140/90 151 65 20-01-2020
39 1300524976 m.aliwafi BA busra'I muallam Pamekasan 30-12-1961 59 L dsn.rengah ds.tambung PMK 160/90 163 75 20-01-2020
40 1300524977 Siti suhartini moh.hasan Pamekasan 23-9-1964 56 P dsn.rengah ds.tambung PMK 120/80 152 67 20-01-2020
41 1300488068 h.hosen DRS djudin tona Pamekasan ;14-4-1957 63 L dsn.tegal sari ds.pad.barat PMK 100/60 156 60 20-01-2020
42 1301151222 suaidah h.abd.karim basyid Pamekasan 18-8-1965 55 P dsn.tegal sari ds.pad.barat PMK 130/80 145 70 20-01-2020
43 1300520849 amin taksir h.moezani sampang 26-11-1962 58 L jl.nugroho 31 PMK 120/80 151 76 20-1-2020
44 1300520851 sri wahyuni achmad Pamekasan 21-06-1968 52 P jl.nugroho 31 PMK 100/70 151 68 20-01-2020
45 1300523366 samsul hidayat abdul mu'im Pamekasan 12/5/1953 67 L jl.bonorogo 78 PMK 130/80 156 60 22-01-2020
46 1300523363 malehah m.ali ambrusi Pamekasan 16-12-1956 64 P jl.bonorogo 78 PMK 150/90 151 38 22-01-2020
47 1300513050 Nurul laili moh.rais yusuf Pamekasan 5/11/1980 40 P jl.bonorogo rt.10/rw.04 PMK 110/70 146 52 22-01-2020
48 1300513051 Moh.erliyanto wafa Pamekasan 4/8/1974 46 L jl.bonorogo rt.10/rw.04 PMK 100/60 155 64 22-01-2020
49 1300519324 nurul aini moh.musa najib Pamekasan 17-07-1977 43 P dsn.biris dajah ds.tambung PMK 100/60 152 46 22-01-2020
50 1300519322 abdurrahman jama boesra'i Pamekasan 27-12-1969 51 L dsn.biris dajah ds.tambung PMK 120/80 165 77 22-01-2020

ludin
51 1300474903 mohammad hairi marsu'i Pamekasan 11/7/1968 52 L dsn.rengoh ds.tambung PMK 120/70 158 78 22-01-2020
52 1300474907 homizah moh.safiuddin Pamekasan 31-12-1973 47 P dsn.rengoh ds.tambung PMK 130/70 150 50 22-01-2020
53 1300533322 wiwin kusumawati mohammad hasyim Pamekasan 7/9/1972 48 P dsn.asam pitu PMK 120/80 157 64 22-01-2020
54 1300533321 a.zuchro mawardi muhammad basrawi Pamekasan 1/11/1969 51 L dsn.asam pitu PMK 100/60 160 58 22-01-2020
55 1300520071 AL mukarrobin samhaji kembar Pamekasan 13-11-1971 49 L dsn.tengah ds.lemper PMK 140/100 160 63 22-01-2020
56 1300520072 nur jannah h.muntaha jumin Pamekasan 27-03-1973 47 P dsn.tengah ds.lemper PMK 110/80 155 84 22-01-2020
57 1300531859 djuhairiyah bunayan hamudin Pamekasan 31-12-1961 59 P Dsn.genteng timur PMK 180/100 153 55 22-01-2020
58 1300532364 Muhammad faja ach.sanhadji Pamekasan 2/1/1989 31 L jl.veteran muda 1/5 PMK 120/80 167 62 23-01-2020

risman
59 1300545695 sunarto mukri asturah Pamekasan 24-07-1961 59 L genteng barat rt.02/rw.04 PMK 120/80 155 59 23-01-2020
60 1300545694 Hatimah tronah martija Pamekasan 15-03-1965 55 P genteng barat rt.02/rw.04 PMK 120/80 150 67 23-01-2020
61 1300532746 endang sri kustinah somolalito yogyakarta 18-08-1958 62 P jl.veteran 131 PMK 120/80 152 66 23-01-2020
62 1300540706 ahmad baihaki mohammad nor sumenep 10/4/1955 65 L dsn.bunder barat PMK 120/80 154 48 23-01-2020
63 1300540710 Siti khotijah kh.abd.karim yakin Pamekasan 12/6/1967 53 P dsn.bunder barat PMK 130/90 156 56 23-01-2020
64 1300524745 Moh.rum yudoprawiro sumenep 11/12/1958 62 L jl.stadion 8 no.55 PMK 100/60 162 54 27-01-2020
65 1300524752 suryati sastroatmojo surawi sumenep 31-12-1961 59 P jl.stadion 8 no.55 PMK 120/80 157 67 27-01-2020
66 1300534118 kustantina ramli moh.ramli Pamekasan 20-01-1958 62 P jl.veteran 2 no.10 PMK 120/80 148 47 27-01-2020
67 1300534123 azidius andhy rp.azis syufendy sumenep 2/4/1960 50 L jl.veteran 2 no.10 PMK 130/80 166 59 27-01-2020
68 1300541853 suparno moh.amir Pamekasan 14-12-1958 62 L dsn.mungsapada PMK 130/80 157 82 27-01-2020
69 1300541850 yetti herawati moh.zain Sumenep 21-01-1959 61 P dsn.mungsapada PMK 140/90 154 50 27-01-2020
70 1300875995 moh.asraji zainullah munim Pamekasan 29-07-1963 57 L dsn.sompor ds.sentol PMK 100/60 158 49 27-01-2020
71 1300485115 siti musyrifah ghazali Pamekasan 21-08-1973 47 P dsn.sompor ds.sentol PMK 160/90 156 73 27-01-2020
72 1300522762 ratih uttari hapi Pamekasan 18-09-1961 59 P jl.jokotole 5/37 PMK 120/80 153 67 27-01-2020

Dokter Pemeriksa

dr.Jeni Novita Anggraini

NIP. 19870127 201409 2 001
 Tahap II
PUSKESMAS : PUSKESMAS
KECAMATAN : PADEMAWU
TAHUN : 2020
Nomor No. Porsi Nama Bin/Binti Tempat Lahir Tgl. Lahir Umur L P Alamat Kab TD TB BB Tgl. Periksa

1 1300530889 Sudiyanto Saimim Pamekasan 31-12--1965 45 L DsnRenggoh Tambung PMK 110/70 166 66 19-03-2020
2 1300530887 Hatijah Sajus Pamekasan 31-12-1963 43 P Dsn Renggoh Tambung PMK 190/100 150 70 19-03-2020
3 1300543766 Siti Fatimah M Jamaluddin Pamekasan 01/04/1969 49 P jl Jokotole158 PMK 140/90 154 76 19-03-2020
4 1300543772 Moh Fadli Astewan Pamekasan 23-05-1969 49 L jl Jokotole158 PMK 110/70 169 78 19-03-2020
5 1300523365 Muhellis.SH Moh Hosen Pamekasan 27-8-1958 38 L Kel Lada RT 07/ Rw08 PMK 100/60 153 57 19-03-2020
6 1300533637 Nanik Budiningsih Sukarno Sleman 12/12/1962 42 P Kel Lada RT 07/ Rw08 PMK 100/60 154 73 19-03-2020
7 1300523322 Moh Cipto Alim H ABD Dja'i Pamekasan 4/1/1974 54 L Jl Jokotole GgV PMK 120/80 152 66 19-03-2020
8 1300523323 St Nurul Syamsiyah Moh Zini Pamekasan 5/4/1971 51 P Jl Jokotole GgV PMK 140/90 145 54 19-03-2020
9 1300544114 Al Faqih Ma'sum Sa'dullah Lamongsn 1/12/1964 44 L Dsn tegal Sari Ds Pad barat PMK 130/80 165 74 19-03-2020
10 1300544111 Zainatun Munawaroh H Ali Hamid Pamekasan 18-01-1967 47 P Dsn tegal Sari Ds Pad barat PMK 110/84 147 58 19-03-2020
11 1300538037 Nur Rodli Moh Ali Sidoarjo 16-02-1963 46 L Ds n tegal Sari Ds Pad Barat PMK 110/70 167 72 19-03-2020
12 1300558040 Umi Kulsum Sumantri Cilacap 15-04-1974 54 P Dsn Tegasl Sari Ds Pad Barat PMK 100/60 158 42 19-03-2020
13 1300521811 Togiman Oerip Matlawi Sumenep 23-07-1966 51 L Jl Jokotole Indah Bartim PMK 120/80 169 75 23-032020
14 1300521614 Diyani Sidin Partodiran Tasikmalaya 28-08-1965 45 P Jl Jokotole Indah Bartim PMk 130/90 158 78 23-032020
15 1300545240 Enny Krisnawati Bahram Pamekasan 14-04-1965 45 P Dsn Murtajih Ds Murtajih PMK 130/80 155 61 23-032020
16 1300545238 ToniSoehardi Soedirman Bojonegoro 18-02-1960 40 L Dsn Murtajih ds Murtajih PMK 130/90 159 56 23-032020
17 1300541339 Moh Halili Moh Hasyim Sumenep 7/8/1966 46 L Jl Darma Permai I/9 PMK 130/80 167 69 23-032020
18 1300541342 Fifin Lukmaniyah M abdul Gafur Pamekasan 22-01-1967 47 P Jl Darma Permai I/9 PMK 120/80 145 68 23-032020
19 1300536438 Supeno Sumowidjoyo Kediri 27-09-1959 71 L Jl Asta Rabeh ds Murtajih PMK 120/80 163 65 23-032020
20 1300536436 Sundusiyah H Ach Sarbini Pamekasan 01-091959 61 P Jl Asta Rabeh ds Murtajih PMK 130/80 160 61 23-032020
21 1300541273 Juhairiyah Mohammad Said Pamekasan 1/1/1950 70 P Dsn Assemmanis Ds Buddagan PMK 140/90 145 52 23-032020
22 1300537217 A Zainol Hasan Sunarto Pameekasan 14-05-1976 44 L Dsn Biris Laok Ds Tambung PMK 120/80 160 54 23-032020
23 1300537224 Rohmah Atmo Abdullah Pamekasan 14-041979 45 P Dsn Biris Laok Ds Tambung PMK 100/80 141 54 23-032020
24 1300524567 Maimun Nawawi Pamekasan 7/4/1977 42 P Kel Barurambat Timur PMK 110/70 163 50 23-032020
25 1300624562 Ulfatun Hasanah Mu'tafi Probolinggo 16-05-1984 35 P Kel Barurambat Timur PMK 110/70 156 52 23-032020
26 1300529228 Avira Sulistyaouni Moh Adra'i Sumenep 8/2/1978 50 P Jl Jokotole No 96 PMK 100/70 145 51 23-032020
27 1300529224 Tomsil Nur Alam Maroedin Pamekasan 10/10/1964 55 L Jl Jokotole No 96 PMK 180/100 169 77 23-032020
28 1300532830 yuli rosidah moh.ma'shum Pamekasan 7/7/1972 48 p dsn.asam pitu rt.2/rw.3 PMK 100/60 156 69 23-032020
29 1300532614 mohammad anis.s a.burjadi Pamekasan 7/5/1972 48 L dsn.asam pitu rt.2/rw.3 PMK 100/60 156 64 23-032020
30 1300542221 nurul kamariyah wa.baihaki sampang 8/8/1962 58 p jl.darma gg1/11 PMK 120/80 154 60 26-03-2020
31 1300545098 ika nursyamsiyah h.badrut tamam surabaya 28-02-1981 39 p jl.veteran no.195A PMK 120/80 150 78 26-03-2020
32 1300545097 ali wafa abbas bondowoso 14-4-1976 44 L jl.veteran no.195A PMK 110/80 160 56 26-03-2020
33 1300526720 yudi hasibuan sribuwaki moh.kasim Pamekasan 4/2/1974 46 L JL.Darma permai 1/8 PMK 110/80 155 64 26-03-2020
34 1300526721 ratna dewi ambarwati sucipto moh.amin malang 14-12-1978 42 p JL.Darma permai 1/8 PMK 110/80 152 62 26-03-2020
35 1300526670 yusi hari purnama sribuwaki moh.kasim Pamekasan 26-5-1983 37 L JL.NUGROHO 1 NO.9 PMK 130/70 157 59 26-03-2020
36 1300526671 yoyok anugerah hadi sribuwaki moh.kasim Pamekasan 7/10/1981 39 L JL.NUGROHO 1 NO.9 PMK 130/70 163 78 26-03-2020
37 1300539550 syamsul arifin abd.karim Pamekasan 12/1/1957 63 L dsn.bunder barat PMK 160/90 163 76 26-03-2020
38 1300539549 sitti halimah m.wardi Pamekasan 27-10-1967 53 P dsn.bunder barat PMK 140/90 151 65 26-03-2020
39 1300524976 m.aliwafi BA busra'I muallam Pamekasan 30-12-1961 59 L dsn.rengah ds.tambung PMK 160/90 163 75 26-03-2020
40 1300524977 Siti suhartini moh.hasan Pamekasan 23-9-1964 56 P dsn.rengah ds.tambung PMK 120/80 152 67 26-03-2020
41 1300488068 h.hosen DRS djudin tona Pamekasan ;14-4-1957 63 L dsn.tegal sari ds.pad.barat PMK 100/60 156 60 26-03-2020
42 1301151222 suaidah h.abd.karim basyid Pamekasan 18-8-1965 55 P dsn.tegal sari ds.pad.barat PMK 130/80 145 70 26-03-2020
43 1300520849 amin taksir h.moezani sampang 26-11-1962 58 L jl.nugroho 31 PMK 120/80 151 76 28-03-2020
44 1300520851 sri wahyuni achmad Pamekasan 21-06-1968 52 P jl.nugroho 31 PMK 100/70 151 68 28-03-2020
45 1300523366 samsul hidayat abdul mu'im Pamekasan 12/5/1953 67 L jl.bonorogo 78 PMK 130/80 156 60 28-03-2020
46 1300523363 malehah m.ali ambrusi Pamekasan 16-12-1956 64 P jl.bonorogo 78 PMK 150/90 151 38 28-03-2020
47 1300513050 Nurul laili moh.rais yusuf Pamekasan 5/11/1980 40 P jl.bonorogo rt.10/rw.04 PMK 110/70 146 52 28-03-2020
48 1300513051 Moh.erliyanto wafa Pamekasan 4/8/1974 46 L jl.bonorogo rt.10/rw.04 PMK 100/60 155 64 28-03-2020
49 1300519324 nurul aini moh.musa najib Pamekasan 17-07-1977 43 P dsn.biris dajah ds.tambung PMK 100/60 152 46 28-03-2020
50 1300519322 abdurrahman jama boesra'i Pamekasan 27-12-1969 51 L dsn.biris dajah ds.tambung PMK 120/80 165 77 28-03-2020
ludin 28-03-2020
51 1300474903 mohammad hairi marsu'i Pamekasan 11/7/1968 52 L dsn.rengoh ds.tambung PMK 120/70 158 78 28-03-2020
52 1300474907 homizah moh.safiuddin Pamekasan 31-12-1973 47 P dsn.rengoh ds.tambung PMK 130/70 150 50 28-03-2020
53 1300533322 wiwin kusumawati mohammad hasyim Pamekasan 7/9/1972 48 P dsn.asam pitu PMK 120/80 157 64 28-03-2020
54 1300533321 a.zuchro mawardi muhammad basrawi Pamekasan 1/11/1969 51 L dsn.asam pitu PMK 100/60 160 58 28-03-2020
55 1300520071 AL mukarrobin samhaji kembar Pamekasan 13-11-1971 49 L dsn.tengah ds.lemper PMK 140/100 160 63 28-03-2020
56 1300520072 nur jannah h.muntaha jumin Pamekasan 27-03-1973 47 P dsn.tengah ds.lemper PMK 110/80 155 84 28-03-2020
57 1300531859 djuhairiyah bunayan hamudin Pamekasan 31-12-1961 59 P Dsn.genteng timur PMK 180/100 153 55 28-03-2020
58 1300532364 Muhammad faja ach.sanhadji Pamekasan 2/1/1989 31 L jl.veteran muda 1/5 PMK 120/80 167 62 28-03-2020
risman
59 1300545695 sunarto mukri asturah Pamekasan 24-07-1961 59 L genteng barat rt.02/rw.04 PMK 120/80 155 59 30-03-2020
60 1300545694 Hatimah tronah martija Pamekasan 15-03-1965 55 P genteng barat rt.02/rw.04 PMK 120/80 150 67 30-03-2020
61 1300532746 endang sri kustinah somolalito yogyakarta 18-08-1958 62 P jl.veteran 131 PMK 120/80 152 66 30-03-2020
62 1300540706 ahmad baihaki mohammad nor sumenep 10/4/1955 65 L dsn.bunder barat PMK 120/80 154 48 30-03-2020
63 1300540710 Siti khotijah kh.abd.karim yakin Pamekasan 12/6/1967 53 P dsn.bunder barat PMK 130/90 156 56 30-03-2020
64 1300524745 Moh.rum yudoprawiro sumenep 11/12/1958 62 L jl.stadion 8 no.55 PMK 100/60 162 54 30-03-2020
65 1300524752 suryati sastroatmojo surawi sumenep 31-12-1961 59 P jl.stadion 8 no.55 PMK 120/80 157 67 30-03-2020
66 1300534118 kustantina ramli moh.ramli Pamekasan 20-01-1958 62 P jl.veteran 2 no.10 PMK 120/80 148 47 30-03-2020
67 1300534123 azidius andhy rp.azis syufendy sumenep 2/4/1960 50 L jl.veteran 2 no.10 PMK 130/80 166 59 30-03-2020
68 1300541853 suparno moh.amir Pamekasan 14-12-1958 62 L dsn.mungsapada PMK 130/80 157 82 30-03-2020
69 1300541850 yetti herawati moh.zain Sumenep 21-01-1959 61 P dsn.mungsapada PMK 140/90 154 50 30-03-2020
70 1300875995 moh.asraji zainullah munim Pamekasan 29-07-1963 57 L dsn.sompor ds.sentol PMK 100/60 158 49 30-03-2020
71 1300485115 siti musyrifah ghazali Pamekasan 21-08-1973 47 P dsn.sompor ds.sentol PMK 160/90 156 73 30-03-2020
72 1300522762 ratih uttari hapi Pamekasan 18-09-1961 59 P jl.jokotole 5/37 PMK 120/80 153 67 30-03-2020

Dokter Pemeriksa

dr.Jeni Novita Anggraini

NIP. 19870127 201409 2 001
 Dr Pemeks Diagn I Diagn 2 Diag 3 Gol D Tgl.Imun No. hp
dr JeniNA B 082337921802
dr JeniNA DM/HT B
dr Jeni NA B 081938005675
dr Jeni NA A

dr Jeni NA O
dr Jeni NA B 085204926662
dr Jeni NA O 087850676389
dr Jeni NA O

dr Jeni NA DM A 081939356735
dr Jeni NA O
dr Jeni NA A 082334818753
dr Jeni Na DM A

dr Jeni NA O 081216158584
dr Jeni Na JTG O
dr Jeni NA O 081330732020
dr Jeni NA DM B

dr Jeni NA DM A 081913738988
dr Jeni Na B
dr Jeni NA AB 87850673636
dr Jeni Na O
dr Jeni NA B 82333657880
dr Jeni NA O 8179311840
dr Jeni NA A
dr Jeni NA A 81332533319
dr Jeni NA B

dr Jeni NA O 8123126167
dr Jeni NA DM O

dr Jeni NA O

dr Jeni NA O

dr Jeni NA A

dr Jeni NA O

dr Jeni NA B

dr Jeni NA O
dr Jeni NA AB

dr Jeni NA B

dr Jeni NA O
dr Jeni NA HT O

dr Jeni NA B
dr Jeni NA HT B

dr Jeni NA O
dr Jeni NA A
dr Jeni NA O

dr Jeni NA B

dr Jeni NA A

dr Jeni NA O

dr Jeni NA HT O

dr Jeni NA B

dr Jeni NA O

dr Jeni NA B

dr Jeni NA B

dr Jeni NA O

dr Jeni NA B

dr Jeni NA O

dr Jeni NA O

dr Jeni NA O
dr Jeni NA B

dr Jeni NA HT O

dr Jeni NA O

dr Jeni NA O

dr Jeni NA B

dr Jeni NA O

dr Jeni NA O
dr Jeni NA O

dr Jeni NA O

dr Jeni NA O

dr Jeni NA O

dr Jeni NA B
dr Jeni NA JTG B

dr Jeni NA DM+HT B

dr Jeni NA B

dr Jeni NA HT B
dr Jeni NA AB

Mengetahui
Kepala Puskesmas Pademawu

dr.Achmad Muzzamil
NIP. 19690828 200212 1 007
 Dr Pemeks Diagn I Diagn 2 Diag 3 Gol D Tgl.Imun No. hp
dr JeniNA B 082337921802
dr JeniNA DM/HT DM/HT B
dr Jeni NA B 081938005675
dr Jeni NA A

dr Jeni NA O
dr Jeni NA B 085204926662
dr Jeni NA O 087850676389
dr Jeni NA O

dr Jeni NA DM DM A 081939356735
dr Jeni NA O
dr Jeni NA A 082334818753
dr Jeni Na DM DM A

dr Jeni NA O 081216158584
dr Jeni Na JTG JTG O
dr Jeni NA O 081330732020
dr Jeni NA DM DM B

dr Jeni NA DM DM A 081913738988
dr Jeni Na B
dr Jeni NA AB 87850673636
dr Jeni Na O
dr Jeni NA B 82333657880
dr Jeni NA O 8179311840
dr Jeni NA A
dr Jeni NA A 81332533319
dr Jeni NA B

dr Jeni NA O 8123126167
dr Jeni NA DM DM O

dr Jeni NA O

dr Jeni NA O

dr Jeni NA A

dr Jeni NA O

dr Jeni NA B

dr Jeni NA O
dr Jeni NA AB

dr Jeni NA B

dr Jeni NA O
dr Jeni NA HT HT O

dr Jeni NA B
dr Jeni NA HT HT B

dr Jeni NA O
dr Jeni NA A

dr Jeni NA O

dr Jeni NA B

dr Jeni NA A

dr Jeni NA O

dr Jeni NA HT HT O

dr Jeni NA B

dr Jeni NA O

dr Jeni NA B

dr Jeni NA B

dr Jeni NA O

dr Jeni NA B

dr Jeni NA O

dr Jeni NA O
dr Jeni NA O
dr Jeni NA B
dr Jeni NA HT HT O
dr Jeni NA O

dr Jeni NA O
dr Jeni NA B
dr Jeni NA O
dr Jeni NA O
dr Jeni NA O
dr Jeni NA O
dr Jeni NA O
dr Jeni NA O
dr Jeni NA B
dr Jeni NA JTG JTG B
dr Jeni NA DM+HT DM/HT B
dr Jeni NA B
dr Jeni NA HT B
dr Jeni NA AB

Mengetahui
Kepala Puskesmas Pademawu

dr.Achmad Muzzamil
NIP. 19690828 200212 1 007