(September) Pencatatan Vaksin 2021 UPT Puskesmas Medan Labuhan

Tabel 10.
Format Pencata
FORMAT PENC
TINGKAT P
Nama Puskesmas/Fasyankes/Pos : UPT PUSKESMAS MEDAN LABUHAN

Kabupaten/Kota : MEDAN
Provinsi : SUMATERA UTARA
Nama Penerima Umur

No No.Registrasi NIK JK Pekerjaan Kel. Umur
Vaksin
(> 60Tahun)
1 W-94CCE547 1271121311800004 CHARLES SINAGA, AMD L B 40
2 P-A5NRPSI3 127113620490003 APRILDA P B 29
3 P-BBDK6QWF 1271136102020004 MARIANA FEBRIANTI MA P UMUM 19
4 P-BBDK6QWF 1271134409790005 ROSIDA SUMARNI SARAG P UMUM 42
5 P-BUAO0UK8 1207231105070009 HENRI J SILALAHI L B 52
6 P-CCY2PTMR 1273041601960001 FENDI L B 25
7 P-DUKCWL5A 1271135108760003 OSIN SIMAMORA p UMUM 30
8 P-CQWVVDCI 1271080406870001 ANTONI P B 34
9 P-EV7QAJ0P 1212033001930001 SUPARMAN DEKKA PANJ L B 28
10 P-1IOUKUTU 1271130707700003 JUNIOR SIREGAR L B 51
11 P-EB20GV2U 1271136506760006 MARUDUR SITUMORANG L UMUM 44
12 P-G1HGK8PF 1505024305871001 VERA WATI SIMAMORA P B 34
13 P-24QUAQ8B 1271065607790002 ETIKA SARI P B 42
14 P-0AT6219Z 1271135510780003 PRISTIWATI P B 43
15 P-36GPPKKP 1271130105680004 ZEFRI L B 53
16 S-11B643D8 1271135505570001 SAMALIA BR MARBUN P LANSIA 64
17 P-07UH9TU0 1271135102950001 SABRINA P UMUM 28
18 J-0000M1WE 1271131506810007 MHD EFFENDI L B 41
19 S-C6BAE06E 1271134408570005 HJ. SALMAH P LANSIA 64
20 J-0000M1XG 1271131402850007 MUHAMMMAD RAFII, S.K L B 34
21 P-6TVGZVG1 1273031404800003 RIRIS SUSANTO HUTABA L B 41
22 J-0000M206 1271131012720004 ATENG L B 48
23 Q-000ANVJE 1271132804850002 JEFRI L B 36
24 P-FJEHFUG3 1271137112810026 RENNY JULIANA T. BOL P B 40
25 P-J40CTJWB 1271135409030004 MESYA NUR SEPTIA P UMUM 18
26 P-7LIE2MKM 127113511080004 KARMILA P UMUM 40
27 P-78X08PQR 127113450680002 GUNAWAN BR SIAHAAN P UMUM 38
28 P-6DI7HYRZ 1271132712940005 RIFAN KEVIN L B 26
29 P-AT7PXPNQ 1209110801010002 OBET EDO SIRAIT L UMUM 21
30 Q-0001GF7Q 1271134509940001 HERNITA FLORIDA SIAH P B 27
31 P-9SBU2GOT 1271134202690004 NURKIA BR NABABAN P RENTAN 52
32 P-8Q275F8Q 127113611202005 JOJOR DELIMA BR PAN P UMUM 18
33 P-83VSQT24 1271131809680004 JONI PANGGABEAN L B 53
34 P-DLYVDJZ8 1205111005730003 ISNAN L B 49
35 P-CQ9RQ476 1205115112990007 TARI RAMADHANI P B 21
36 P-BSHX1QRJ 1209111504630001 SAUT SIRAIT P RENTAN 58
37 P-GFO6CAQK 1271093110930001 ZAINUDDIN MUTHAHIR L B 28
38 P-EJIOMDLZ 1271094908990001 RIZKI ASRIDA L UMUM 22
39 P-GS5ZGLGY 1271135201000002 PRESTY HIDAYATI P UMUM 21
40 J-0000WE8W 1271124501000007 EKA SAFITRI HARAHAP P B 21
41 P-H8INJXGQ 1271133110030001 MUHAMMAD SYAHDAN P L UMUM 18
42 J-00014XD3 1271130908020007 ANGGIE L UMUM 19
43 P-J95J3H3I 1271135111690004 RISTAULINA SIMAMORA P RENTAN 52
44 P-ILKQRJ87 1271200505040001 RICKY ANDRIAN PASARI L UMUM 18
45 P-IWSX8DJP 1271200111760004 TOGA PARULIAN PASARI L B 45
46 P-IROVI7G2 1271206204770003 DELPI SINAGA P UMUM 44
47 S-6050BEEA 1271135906590003 WARNI WATI P LANSIA 62
48 P-JXF0MHTA 1271130506790006 RINALDY L B 42
49 P-JMP8ML7Y 1271132001700004 MANGOLBE SILABAN L B 52
50 P-KPKZFQ4X 1271066410620002 ALBINE NAINGGOLAN P RENTAN 59
51 P-LCWSKVM4 1271135204030002 ISNAINI P UMUM 18
52 J-0000NZTG 1271135003960004 SHERLY WIDYANINGSIH P UMUM 25
53 P-MDB79QZE 1271122707000006 MUHAMMAD KHOZIN HID L UMUM 21
54 P-M0LDIUPG 1271136012750002 IMANIAH P UMUM 45
55 P-LRI9IZLV 1271136702000002 MURIA P UMUM 21
56 P-AT7PXPNQ 1271134505730010 ANAH P UMUM 48
57 P-NNQTG2QW 1271134210990003 DARA AULIA SARAGIH P UMUM 22
58 P-N23MYXRO 1271134802640001 NURHASANAH P RENTAN 57
59 P-NF869P2Z 1310086410960001 DENI YANTI P UMUM 25
60 P-AT7PXPNQ 1271135909720004 ERLINAWATI P UMUM 49
61 P-O1FY211J 1271134512740002 IRDAYANI P UMUM 47
62 Q-000191MG 1271136512760006 NELLY KRISTIN TINA P B 43
63 P-PBBVN7HQ 1205214201020001 MUTHIA KAMILA P UMUM 19
64 P-OWONIRTW 1207260612780001 MICHA DESLON P DONG L B 42
65 P-PC5PP5LK 1271134809000004 SEPRIYANTI PURBA P B 20
66 P-PBX0FHO8 1271134703690002 SITI SAHARA P RENTAN 52
67 P-PCGV313U 1271134905750001 MARDIATI P UMUM 46
68 P-PCIQEOUH 1271135411920002 NURIANA P B 29
69 P-PCO2FXLZ 1209104102890001 SUSANTI P UMUM 32
70 P-PD61XBVQ 1271134204790006 RITA FRANSISKA BR MA P UMUM 42
71 P-PCTQWNDY 1271130801010006 FIRQI IRGI FAHROZI L UMUM 20
72 P-PCZONCML 1271134509650002 TIO MINAR BR MARPAUN P RENTAN 56
73 P-ON3NVBRE 1271134309980007 LENTA AYU FOLORITA P UMUM 23
74 P-PDBS93DL 1271131512780009 ANTHONY TP BOLON L B 43
75 P-PDIKSIC6 1271132705690003 RIKA ARDIYANINGSIH, S P B 30
76 P-PDO3Y1HP 1271130607720001 UMAR ANANG HSB L B 49
77 P-PE6VWP7L 1271136107790006 RAHMAH P B 42
78 P-PE083BX2 1271033004900006 DADANG TRIYANTO L B 31
79 P-PDPEOMUN 1271130304760005 MHD ARIQ TOHIRUDDIN L UMUM 18
80 P-PEOJ8XC5 1208057011620002 MANTARIA HUTASOIT P RENTAN 59
81 P-PEJA6RTN 1508126412950001 DESI NATALIA SIMANJU P UMUM 25
82 P-PEDHN3QY 1271133112710001 SYAHRI L B 49
83 P-PEX3RNG3 1271131205750003 DEDI SYAHPUTRA NST L B 46
84 J-0001CSVS 1271061811970003 HASBI AL AZIZ L B 24
85 P-PFN6GDA4 1271131807020001 WAHYUDIN L UMUM 19
86 P-PFIT4GG2 1116062104940004 APRI ANANDA L B 27
87 P-PFEF70N0 1271030811830003 FADIL HARYANATA L B 38
88 P-PF2DT3WE 1271140212740005 BUDI YANTO L B 47
89 P-PF90FQ0T 1271134510800008 ADLIANI HARAHAP P UMUM 41
90 P-PFZS4INE 1271120301850004 ARI WITANTO L B 36
91 P-PFY8NBSZ 1271131010920003 DZULFIKAR L B 28
92 P-PFFDKLQR 1271135202820011 KORLINA SAMOSIR P B 39
93 Z-F7308FD2 1212076505410001 TIURLAN HUTAJULU P LANSIA 80
94 P-PGUN1FFW 1204224108990001 NIKE ARDILA HALAWA P UMUM 22
95 P-PGAN2PBW 1271135501680003 HOTMA IDA BR SIMAMO P RENTAN 53
96 P-PG5F30XC 1271124307950008 JUNIATI BR SINAGA P UMUM 26
97 P-PHDC1J5Q 1271132009980001 KRISTIAWAN TELAUMBA L UMUM 18
98 Q-0001GF81 1271134611960001 CHRISTINA MAGDALENA P B 24
99 P-PGJRAER2 1207262210800005 HARDI SUSILO L B 41
100 P-PGNX114F 1204136306030001 CITRA MUTIARA P UMUM 18
101 J-0000NRVX 1271205705810002 TIENRI S L B 40
102 S-0731A2D3 1271200312530001 DJOSIAMAN SARAGIH L LANSIA 68
103 P-PHHHWKNA 1204064505030002 ADESTINA LAWOLO P UMUM 18
104 P-PH5MDNNT 1204130304630001 SAMAHATI NAZARA L RENTAN 58
105 P-PIF1N3JL 1271131105750008 YAHYA ZULKARNAIN L B 46
106 S-5D74EFE4 1271131912530001 RATDY MUKHTAR L LANSIA 68
107 P-PI4PIUYL 1271135809900004 SARTIKA DEWIYANI S P UMUM 31
108 P-PI0UBEV9 1271134403630002 RAKIMAH BR HOMBING P RENTAN 58
109 P-PHX5MJDB 1271136212980002 IRMA YANTI P UMUM 24
110 Q-000HG2Q7 1271200705670008 SUMARNO L B 54
111 P-IN7XU77 1271131606960006 JONATAN T HERYANTO L B 25
112 P-PIHNZNSJ 1271135505800003 MARDIANA BR SIMANJU P B 41
113 Q-000HFX83 1271086103870002 NOVA MARDIAH HRP P UMUM 34
114 P-PJOUVZQO 1212105206990002 JUNIANTI W H SIRAIT P UMUM 23
115 P-PILVXMEN 1271130105970002 MUHAMMAD ARDI L UMUM 24
116 P-PJD8E2LN 1271130906960006 SERGIO JOHNNI SITORU L B 26
117 P-PJEBPFJA 1271131409680003 ARWIN L B 52
118 P-PJAJQOAB 1271137108910002 AINIL GUSTARI P UMUM 30
119 P-PJ7PUH8E 1272031504810003 SUFIAN ARBANSYAH R L B 40
120 P-PK4KGQBD 3204325007890021 LENA SILALAHI P B 26
121 P-PJZBUA5I 1271130801030004 HENDRA L UMUM 18
122 P-PJVXS4E9 1271132911780001 HISAR HENDRIANDY S L B 43
123 P-PJU126HQ 1271130101690003 SAMUDIN L B 52
124 Y-011BLONC 1271130401040003 KHAIRIA AMILDA HRP P UMUM 20
125 P-PJQZSORB 1271135403830001 RINI DANIATI SIHOMBIN P UMUM 38
126 P-PJK4CX29 1271132309870004 IBRAHIM HARAHAP L B 34
127 Q-0009IZOY 1271061201940002 SUHARTA ATMAJA L B 27
128 P-PJFQNQQ2 1271134310860009 DONNA SITOMPUL P B 35
129 J-00013OTB 1271204502790000 MAWARNI NURMITA S L UMUM 42
130 P-PL6RQ5DP 1271135009830004 KHAIRUN NISA P B 38
Keterangan
Pekerjaan dikelompokkan menjadi :
A : Petugas Medis dan Non Medis di Fasilitas Pelayanan Kesehatan
B : Petugas Pelayanan Publik Yang Berhadapan Langsung Dengan Masyarakat
C : Administrator Pemerintahan
D : Lainnya
E : Tidak Bekerja
Kelompok Umur
18-30
31-45
46-59
Total
Pekerjaan
A
B
C
D
E
Total
Tabel 10. Format Pencatatan Pelayanan Vaksinasi COVID-19 di Tingkat Fasyankes
FORMAT PENCATATAN PELAYANAN VAKSINASI COVID-19

TINGKAT PUSKESMAS/FASYANKES/POS VAKSINASI
MEDAN LABUHAN
Kepersertaan BPJS (tulis 'Ya'

pada kolom yang sesuai)
Alamat Kelurahan Kecamatan No.Hp
BPJS Non Non
BPJS PBI
PBI Anggota
LK 13 MARELAN TERJUN Medan Marelan 081362215507 √

LK VII MARTUBUNG MARTUBUNG Medan Labuhan 082122255593 √
JLN BAKTI ABRI LINGK III MARTUBUNG Medan Labuhan 085765443641 √
LK VI SISI TOL PAJAK RAMBAI MARTUBUNG Medan Labuhan 082168692111 √
JLN PAJAK INPRES NO. 39 LK VII MARTUBUNG Medan Labuhan 085263630555 √
LK VI PAJAK RAMBAI MARTUBUNG Medan Labuhan 081260277751 √
JLN MESJID LK VI R. PULAU Medan Marelan 085276635566 √
LK I MARTUBUNG MARTUBUNG Medan Labuhan 081375093258 √
JLN TELUK HARU LK II MARTUBUNG Medan Labuhan 082274442738 √
LK VI P RAMBAI MARTUBUNG Medan Labuhan 081260635296 √
LK I BAHARI MARTUBUNG Medan Labuhan 083800208673 √
JLN PAYA BAKUNG LK V MARTUBUNG Medan Labuhan 082375195315 √
JLN. TELUK HARU REL PJKA MARTUBUNG Medan Labuhan 082267384027 √
LINGK VI PAJAK RAMBAI MARTUBUNG Medan Labuhan 082370744844 √
JLN YOS SUDARSO LK VI MARTUBUNG Medan Labuhan 081263008885 √
LK VIII SEI MATI SEI MATI Medan Labuhan 081396089949 √
JLN ILYAS NO. 1 LK VI MARTUBUNG Medan Labuhan 081284004517 √
LK VIII SEI MATI SEI MATI Medan Labuhan 081326925100 √
JLN YOS SUDARSO LK IV MARTUBUNG Medan Labuhan 082168284249 √
JLN PANCING LK IV BESAR Medan Labuhan 083830527026 √
LK VII SEI MATI SEI MATI Medan Labuhan 081260784803 √
JLN PANCING LK IV BESAR Medan Labuhan 081375955367 √
JLN PULAU RIMAU LK V MARTUBUNG Medan Labuhan 085361725760 √
JLN PULAU RIMAU LK V MARTUBUNG Medan Labuhan 081370327695 √
JLN KAMBES LK IV MARTUBUNG Medan Labuhan 085261670525 √
LK III MARTUBUNG MARTUBUNG Medan Labuhan 082175597955 √
JLN KAMBES LK IV MARTUBUNG Medan Labuhan 082268694758 √
JLN PANCING LK III MARTUBUNG Medan Labuhan 083170404942 √
JLN KUMBAH LK I MARTUBUNG Medan Labuhan 082364949697 √
KOMP TKBM BLOK C SEI MATI Medan Labuhan 081368953242 √
JLN YOS SUDARSO LK II MARTUBUNG Medan Labuhan 082168387059 √
JLN KUMBAH LK I MARTUBUNG Medan Labuhan 082364949697 √
LK III KP BESAR MARTUBUNG Medan Labuhan 085296453805 √
JLN. ASAM LK 7 SIMPANG KANTOR MARTUBUNG Medan Labuhan 089619367500 √
LINGK 8 PSR 4 TERJUN TERJUN Medan Marelan 085760601013 √
LK V PAYA BAKUNG MARTUBUNG Medan Labuhan 083871170879 √
LINGK VII MARTUBUNG MARTUBUNG Medan Labuhan 081264748345 √
JLN MEDAN BELAWAN LK 30 PEKAN LABUHAN Medan Labuhan 081375821294 √
JLN ASAM LINK VII S. KANTOR MARTUBUNG Medan Labuhan 083862043830 √
JLN SRI BULAN LK III MARTUBUNG Medan Labuhan 087867347267 √
JLN PANCING V LK III MARTUBUNG Medan Labuhan 088261732524 √
LK VI SISI TOL PAJAK RAMBAI MARTUBUNG Medan Labuhan 082284671961 √
JLN KUBAH LINGK I MARTUBUNG Medan Labuhan 081375093258 √
DSN III HAMPARAN PERAK H. PERAK DELI SERDANG 0895611670924 √
JLN KANTOR CAMAT LK IV MARTUBUNG Medan Labuhan 081375031722 √
JLN KANTOR CAMAT LK IV MARTUBUNG Medan Labuhan 0821757048885 √
LK V GG FAMILI MARTUBUNG Medan Labuhan 083199862200 √
JLN MESJID LK I MARTUBUNG Medan Labuhan 085296890005 √
LK IV KP BESAR MARTUBUNG Medan Labuhan 085274357140 √
JLN MANGAAN LK 4 MABAR Medan Deli 081361298886 √
JLN YOS SUDARSO LK VI TITI P TITI PAPAN Medan Deli 081263753378 √
LINGK VI PAJAK RAMBAI MARTUBUNG Medan Labuhan 082166775755 √
LINGK 7 SEI MATI SEI MATI Medan Labuhan 082261888219 √
JLN YOS SUDARSO LK VI TITI PAP TITI PAPAN Medan Deli 082298110105 √
LINGK V PAYA BAKUNG MARTUBUNG Medan Labuhan 081370824981 √
LK VI PINGGIR REL MARTUBUNG Medan Labuhan 088216896426 √
LK IX SEI MATI SEI MATI Medan Labuhan 082272681388 √
PSR II BARAT LK 16 RENGAS PULAU Medan Marelan 08126575851 √
JLN MARELAN 5 PSR 2 TERJUN Medan Marelan 085244126148 √
JLN MANGAAN LK 4 MABAR HILIR Medan Deli 081361019930 √
LK VI MARTUBUNG MARTUBUNG Medan Labuhan 082268806260 √
KL VI PAJAK RAMBAI MARTUBUNG Medan Labuhan 085297534048 √
LK VII SEI MATI SEI MATI Medan Labuhan 081370728614 √
LK VI KOMP RAMBE MAS MARTUBUNG Medan Labuhan 085261669968 √
LINGK I MARTUBUNG MARTUBUNG Medan Labuhan 081370807916 √
LK IV MARTUBUNG MARTUBUNG Medan Labuhan 081269619676 √
LINGK IX SEI MATI SEI MATI Medan Labuhan 081279262320 √
JLN YOS SUDARSO LK VII MARTUBUNG Medan Labuhan 082274154816 √
Merek Vaksin
A : Sinovac
B : Lainnya (Mohon Disebutkan Jenis Vaksin Yang Dit
Kepersertaan BPJS
BPJS PBI
BPJS Non PBI
Non Anggota
Total
Pemberian Dosis
Dosis 1
Dosis 2
Total
nkes
Dosis I Dosis 2
Tanggal KETERANGAN
Merek Vaksin Tanggal Tanggal
Screening
Pemberian No.Batch Pemberia No.Batch
Vaksin n Vaksin
CORONAVAC 9/1/2021 9/1/2021 24005121 LANJUT VAKSIN 2
CORONAVAC 9/1/2021 - 9/1/2021 24202321 SELESAI
CORONAVAC 9/1/2021 9/1/2021 24202321 - LANJUT VAKSIN 2
CORONAVAC 9/1/2021 24202321 9/1/2021 24202321 SELESAI
CORONAVAC 9/1/2021 24202321 9/1/2021 24202321 SELESAI
sebutkan Jenis Vaksin Yang Diterima Puskesmas/Faskes)
Kepersertaan BPJS
Tabel 10. Format Penc
FORMAT PEN
TINGKAT

Umur
No No.Registrasi NIK Nama Penerima Vaksin JK Pekerjaan Kel. Umur
(> 60Tahun)
1 P-0FNDV7Q7 3515070607000003 MARSIANTO BIN MARSIM ( L UMUM 50
2 P-9JOFAHFA 1271061905840001 MAHDALI BIN WARIS L UMUM 36
3 P-CNFO2QXE 1271081010860006 DODI IRAWAN SIAHAAN BI L UMUM 35
4 P-FDOE4CKM 1271120109800002 ANDI SUHARDI BIN SADAMI L UMUM 41
5 P-PIJHA4NF 1271040910750008 FITRI SYAH BIN M. YUNUS L UMUM 46
6 P-4DWUUZXK 1271142103840002 MARDYANTO SYAH BIN M L UMUM 37
7 P-3E5OGECQ 1271060412750005 JEMAEN BIN RAMIN L UMUM 46
8 P-PNWFZVU4 1207250403950002 MUHAMMAD PENDI HUZAIN L UMUM 26
9 P-PM9POSZ8 1271201211710009 YUSMA ZULFIKAR BIN M. L UMUM 49
10 P-26PSPTUL 1210080110630002 MISNO BIN TUKIMAN (ALM) L RENTAN 57
11 P-F6HBPDPA 1207231308860007 SUNARYO PRAYOGA BIN L UMUM 35
12 P-A9EKG3ER 1271060203870001 SAMSIR YASFENDER SIMBO L UMUM 33
13 P-92GRXKAS 1271061309930004 MUHAMMAD RIDWAN BIN H L UMUM 26
14 S-D29BB02F 1207241710520001 PAIMAN BIN ISMAIL (ALM) L LANSIA 67
15 P-PE5CNCFQ 1271132004690006 SUPARMAN BIN SUGIMAN L RENTAN 52
16 P-PGFUNFSK 1219072006760001 HERU SANTOSO BIN SUGIR L UMUM 45
17 P-BGCOEJDR 1271022805890005 AFANDI AHMAD NASUTION L UMUM 32
18 P-BW29BBYJ 1271131506680006 DARMADI NUR BIN KUSNAN L RENTAN 53
19 P-MITE48RT 1271202407980002 REZA FAHLEVI BIN KHAIRU L UMUM 23
20 P-EKYDM9BO 1271052310830004 CHANDRA SYAHPUTRA BIN L UMUM 38
21 P-J3JE7EBU 1271061602850001 WELLI BUTAR BUTAR BIN L UMUM 36
22 P-OP2GYTD3 6102080501970001 WANDI BIN M. TAHIR (ALM) L UMUM 44
23 P-PIBJ9CQL 1271141209890004 MUHAMMAD DEDEK IRAWA L UMUM 32
24 P-LFMWEF18 1207232311020011 RAJA NOVRAL BIN POLTAK L UMUM 18
25 P-K08CGKSP 1271132004810001 HENDRA BIN HONGSUNGG L UMUM 40
26 P-KTQZPDLG 1271121708950006 TONI ANGGARA BIN MUHA L UMUM 27
27 P-PL44BA8O 1271021307780012 JULIAN FADLI BIN H. SUW L UMUM 43
28 P-N6HQDHC2 1271062108800002 RAHMUDDIN BIN UMAR (AL L UMUM 40
29 P-M0S6QGI8 1209151206910009 RAHMAT HIDAYAT BIN ABU L UMUM 31
30 P-NRU0VIPL 1271111205740006 MHD YUSUF HASIBUAN BIN L UMUM 46
31 P-PM17PAQ4 1271062701990001 AJI KURNIAWAN BIN WIDIO L UMUM 30
32 P-P6GMRM6F 3329111909780003 SASMITO BIN MARSIDI L UMUM 43
33 P-PHR0LMT2 1271060303840013 SUPRAPTO BIN ISMAIL (AL L UMUM 37
34 P-PLJCUJ7L 1271130204900005 FAISAL RAMADHANI PURBA L UMUM 31
35 P-NIBA0BBC 1273011310890001 ANDRIANSYAH SIMATUPAN L UMUM 32
36 P-O2PDSKCU 1271061804820008 GUNAWAN BIN LEGIMIN L UMUM 39
37 P-PBAVUFBZ 1207232402990007 RURI ANDIKA BIN ANDRIY L UMUM 22
38 P-PC3IETKJ 1207240111840003 SUINDRA BIN SAFRI L UMUM 30
39 P-PBJEORR5 1271061006870001 HENDRA SAHPUTRA BIN S L UMUM 22
40 P-PBVIJ6LA 1271121712870005 SUPRIADI S BIN SUKARDI L UMUM 33
41 P-PH1QB7IW 1271063101820003 TONI ARMANTO BIN ARMA l UMUM 39
42 P-PC9Q7XOO 1271132906850003 SAMUEL ANGGIAT MANURU L UMUM 36
43 P-PD2O6XKI 1275030510960005 DIO PRAYOGA BIN DODI L UMUM 24
44 P-PDT2YRYF 1271132604900002 JOHAN SAPUTRA BIN SOP L UMUM 21
45 P-PEA8IQ2C 1271120606820012 ARMANSYAH BIN NGATIMIN L UMUM 39
46 P-PCE5AKBE 1271130507880002 BUDI SETIAWAN BIN SUHE L UMUM 33
47 P-PL0EKEFF 1271080904890001 ANDI SYAHRIZAL BIN ZAIN L UMUM 31
48 P-PDYEHROT 1271081401020001 JHON PRANCIS GABE SITIN L UMUM 20
49 P-PMXFRYKY 1271200401800003 DONI SUSWOYO BIN AMIR L UMUM 41
50 P-LQPHRMWD 1271080505010002 RUDI RAJAGUKGUK BIN B L UMUM 20
51 P-JI3KNSAM 1207261510760006 SUDARWONO BIN GOMBL L UMUM 45
52 P-PMJV32I7 1271062308930003 SANDY SYAPUTRA BIN BAH L UMUM 29
53 P-IN2Z2NB9 1217020207010001 DONNI PASARIBU BIN JUD L UMUM 20
54 P-PDJH0UUD 1271090102940001 JUHARI BIN PONIRIN (ALM) L UMUM 27
55 P-PDOF1Z4V 1271060402820001 M. FAISAL BIN NGATEMIN L UMUM 39
56 P-PPRRBIAO 1271080312880006 MUHAMMAD ANDRI BIN MU L UMUM 32
57 P-PLMCQVTB 2171030807930002 DERY WARDANA TANJUNG L UMUM 28
58 P-PCUWLPGO 1271021402860001 ANDI BIN ARDI (ALM) L UMUM 35
59 P-PDABAOCK 1271122908890001 ISMAIL BIN AL BUSRA L UMUM 32
60 P-PHTYCMSX 1271130111810001 FRANS JOHANNES SIMAN L UMUM 41
61 P-PMEJ3FBJ 1271061304900001 JOHAN SYAHDAN BIN SUPR L UMUM 30
62 P-POFPVDFW 1271063012770003 EDY SYAHPUTRA BIN LEGI L UMUM 45
63 P-PL2E2UDI 1271121612890002 KHAIDIR BIN ABDUS SALA L UMUM 32
64 P-PMBL4PZF 1271122505950004 TOMI ALAZHAR BIN DANIA L UMUM 27
65 P-PGCSPO9F 1271060511950003 IRSAL EFENDI NASUTION L UMUM 25
66 P-PEM7W6NL 1207262007750009 SAPRI BIN ABDUL JALIL (A L UMUM 46
67 P-PF6QSCXA 1207261610810007 RONI SUWARNO BIN SUWA L UMUM 40
68 P-PFPFXAJA 1271131902960001 HENGKI BIN SRI MULYONO L UMUM 25
69 P-POEK2AVR 1271142705810006 PANGERAN LUBIS BIN BA L UMUM 40
70 P-8D3WBSFX 1401102911800004 HERLIADI L UMUM 41
71 P-PFL21D09 1207241403860005 KIKI REJEKI BIN SURYONO L UMUM 35
72 P-PNXMH7QH 1271122912940002 MUHAMMAD ZEIN AL BANT L UMUM 24
73 P-PFFX1Q5P 1408040101740008 T. ZULYANDI BIN ZULKIFLI L UMUM 46
74 P-PN7R2DCJ 1271130305800003 MUHAMMAD IQBAL BIN SAI L UMUM 41
75 P-PFCPFJUV 1271121808910003 SYAFRIZAL BIN ABU BAKAR L UMUM 29
76 P-PG6RP12J 1271122505700013 SOFYAN BIN KASIM (ALM) L RENTAN 51
77 P-PGILLPW5 1207231509950006 TEO AKMAL BIN M. SYAFRI L UMUM 25
78 P-PGN3PJPG 1108030102940001 MUHAMMAD BUKHARI BIN L UMUM 35
79 P-PGW4KTNY 1271152612870004 YOGI SUGAMA BIN SUKRE L UMUM 32
80 P-PFXTGLRE 1271131309960005 M.SAHID BIN MULYADI L UMUM 24
81 P-PHFEKP0C 1108071712680001 SYUKRI BIN ISMAIL (ALM) L RENTAN 53
82 P-PMRFIN5E 1171010302730001 SULAIMAN BIN TUNGGAL ( L UMUM 48
83 P-PGSF3THM 1271131102770001 JUNAIDI BIN NISRAN (ALM) L UMUM 40
84 P-PMI91H9W 1271120101010006 ARIADI KESUMA BIN KAMA L UMUM 20
85 P-PLHFY193 1207262207970005 ILLYAS ANUGROH ANGKOS L UMUM 24
86 P-PQ3TDY6G 1207252603900001 MUHAMMAD SUBASTIAN BI L UMUM 21
87 P-PHISXOIR 1207261711930003 RUDI SETIAWAN BIN GON L UMUM 27
88 P-PNYU9HY0 1271141504940002 AHMAD SYAHRIL RANGKUTI L UMUM 27
89 P-PH6HXUQD 1271061002890003 FEBRI SUPRAPTO BIN BA L UMUM 32
90 P-PM57XCZO 1406160101690001 SUPRIYADI BIN SUPADI (A L UMUM 40
91 P-PHMFVCSX 1271122904810001 AHMAD SUHENDRA BIN AHM L UMUM 40
92 P-PLWMXLRU 1271201211900003 BENNI SYAHPUTRA BIN SY L UMUM 30
93 P-PLKYHEAQ 1211041707970001 ARISTON RAJAGUKGUK B L UMUM 30
94 P-PLNHFRKE 1271060906910005 SUHERIK BIN KAMARUDIN L UMUM 30
95 P-PI1KMTTV 1207261003870010 HENDRA PURWANTO BIN S L UMUM 34
96 P-PMT0KJMV 1271132909980006 MULIA GUNAWAN PAKUALA L UMUM 22
97 P-PMPJHLNZ 1207242304900007 SUHENDRA BIN SUHARTO L UMUM 50
98 P-PIFEXO2H 1207222010890001 WENDY ANDIKA PUTRA BIN L UMUM 28
99 P-PMLQ65Z6 1271121801970002 IKBAL SUJATMIKO BIN SY L UMUM 24
100 P-PLFBR3MM 1271080404860004 WALTER MARINGAN PURBA L UMUM 35
101 P-PLGBVDYE 1271130508930001 DELI SUPRATMAN BIN NG L UMUM 28
102 P-PLDYFGFS 1271022708980001 HASFAN RIANSYAH BIN TU L UMUM 23
103 P-PLCPNPWT 1271060111780011 DEDI SUTENDI BIN INAN T L UMUM 43
104 P-PIHIIHPK 1271121506960007 SAMSUL BAHRI NASUTION L UMUM 43
105 P-POMJ8DLT 1271120106710003 SUNARNO BIN BOIMAN (AL L UMUM 50
106 P-POTGUYBB 1207242905950005 UMAR SAHRI LUBIS BIN A L UMUM 26
107 P-PP7MG4VU 1271131701920002 ARI AKBAR BIN AMAD L UMUM 29
108 P-PP0UGD2H 1271080505800007 EKO HARIANTO BIN SUMA L UMUM 41
109 P-PHOPXDGM 1271020606950006 MAHLIL MUHAMMAD BIN HA L UMUM 27
110 P-PQ1MTYUM 1271082905000006 RIDHO ALWIANSYAH BIN M L UMUM 21
111 P-PPEH1ZQC 1207212808960004 YUDA INDRA KESUMA BIN L UMUM 26
112 P-PLQOGF3C 1271121011970006 FAHMI NOVRIANDI BIN PU L UMUM 23
113 P-PO0P8QVX 1209131010811001 TOMMY CANDRA WIJAYA BI L UMUM 39
114 P-PFSGSO62 1271131908770004 ALFIAN NAZRI BIN SURIAN L UMUM 44
115 P-PLP4A4BS 1207250310970002 DANI RENALDI BIN AMAT L UMUM 23
116 P-PEYX3XJO 1271031205850002 DONI HARIANTO BIN SUW L UMUM 36
117 P-PLB9DPR7 1271050807830003 DODY SAHPUTRA HASIBUA L UMUM 38
118 P-PLY94QVH 9102011909920002 IWAN KURNIAWAN BIN SU L UMUM 29
119 P-PLURVEMR 1271062903950001 MOH.EGI BIN SUTRISNO L UMUM 26
120 P-PG1L0JS5 3206013008940001 ALAN SETIAWAN BIN WAG L UMUM 27
121 P-PP6IYF70 1271080501720003 FACHRULLAH BIN MAHIDDI L UMUM 49
122 P-PM3MH6C0 1271062912840001 PAISAL REZA BIN MAHMUD L UMUM 37
123 P-PPDJSVOX 1271182701830002 ABDUL RAZAQ BIN HASIDI L UMUM 38
124 P-POVQAFI4 1207262006990001 CANDRA PRATAMA BIN SE L UMUM 22
125 P-PPTGUKGK 1271022506800002 IRLAN MARPAUNG BIN PE L UMUM 40
126 P-PPVOG6X9 1207230107950006 ILHAM ALMUZAHIT SIREGA L UMUM 26
127 P-PM7TKD9G 1207260507730016 RUDI BIN RUDI (ALM) L UMUM 48
128 P-PP4CPKVI 1271120708980005 DWI PANJI HIDAYAT BIN P L UMUM 24
129 P-PCPMMSBN 1207262210970003 FATHER EBEN ESER SILA L UMUM 23
130 P-PEIPTU26 1113020203750004 LUMBAN.HENDRIK PANGG L UMUM 46
131 P-PIHIIHPK 1271121406780002 SAMSUL BAHRI L UMUM 43
132 S-40B77046 1207250412700001 SAIDURRAHMAN.M.AG L UMUM 50
133 P-PMYXT1SG 1271122112920003 AFRAN JUNAIDI L UMUM 29
134 P-PNEDHQQK 1207233105950003 HENDRASYAH MARPAUNG L UMUM 26
135 P-PN40ROIY 1271082007830002 SURIADI PANGARIBUAN L UMUM 38
136 P-PN5N9F3H 1271200510750004 AIDIL SYOFYAN L UMUM 45
137 P-PNAE7ZSO 1207263003870008 MARTHIN GUNAWAN SIMA L UMUM 34
138 P-POWW4FGQ 1271040212830009 DEDY ISWANTO L UMUM 38
139 P-PP5BBYIY 1271061408700001 HENDYI TARIGAN L UMUM 51
140 P-PPHON040 1207231708990010 PRIONES AGUS SIBUEA L UMUM 22
141 P-PPW9J3B3 1209162103780001 ROCHIM SYAHPUTRA L UMUM 49
142 P-PPX4ZSEE 1276020811980001 BAGAS PRABOWO L UMUM 22
143 P-PPXXFSU8 1271061409870004 MUHAMMAD RIVAI L UMUM 33
144 P-PQ0IEBYP 1271120707790008 ABDULLAH L UMUM 43
145 P-PQ128PTT 1271062304800005 APRIL AMZAH SOLIN L UMUM 41
146 P-PQ31CFHD 1271061005020008 MUHAMMAD DANIL FIRMA L UMUM 21
147 P-PQ6EXTWX 1271131808870006 ANDRISYAH PUTRA L UMUM 34
148 1802160411790001 IWAN BIN SALLAM L UMUM 35
149 3175021006821001 ZUTAWAN SYAHPUTRA L UMUM 39
150 0200050282000003 AGUS KURNIAWAN L UMUM 40
151 6409042608870003 SUPRIANTO L UMUM 44
152 1807210311800004 MUHAMMAD RAJID L UMUM 33
153 3321021206670003 WARDONO L RENTAN 55
154 5201011512040001 MUHAMMAD YAHYA/ AHYA L RENTAN 55
155 7604160210960002 JULIADI L UMUM 37
156 1207242304900007 SUHENDRA L UMUM 32
157 1207261503800024 PUJIONO L UMUM 40
158 1207261502770006 DEDI SUHERI L UMUM 44
159 1271202711020068 GILANG RAMADHAN L UMUM 19
160 1207251906910003 SUHEMI L UMUM 27
161 1207261010690012 RIZKY ARIANTO L UMUM 37
162 1207262510940006 SUHENDRI L UMUM 32
163 1207251906910003 M. YUSUF L UMUM 30
164 1207232102980002 SUHENDRA PRATAMA L UMUM 23
165 1207232711990005 ANDREAS SINAGA L UMUM 21
166 1271142601890003 MURSID L UMUM 32
167 3174082202820007 WAWAN L UMUM 38
168 3275122103880006 PETER EDWARD L UMUM 33
169 1271061010880006 ANDIKA L UMUM 32
170 360320270500002 REMALDI L UMUM 21
171 3306123004670001 SUGIANTO L UMUM 39
172 1207282906810003 JUMIANTO L UMUM 37
173 3519131203760001 KUWANDI L UMUM 45
174 1208170101870002 M. ROBBANI SIREGAR/ HA L UMUM 34
175 6303150406180001 MUHAMMAD RAJU/ MUHAM L UMUM 29
176 7371100705820002 NASRUN L UMUM 39
177 1306021408800001 ERWIN L UMUM 41
178 3215053103170010 ERDIANSYAH L UMUM 31
179 1271042306990004 ALFIANDI L UMUM 22
180 1207230801960004 M. ARIF SETIADI L UMUM 25
Keterangan
D : Lainnya
E : Tidak Bekerja
Kelompok Umur
18-30
31-45
46-59
Total
Pekerjaan
A
B
C
D
E
Total

MEDAN LABUHAN

BPJS Non Non
BPJS PBI
PBI Anggota
JL. BALAI DESA MEDAN SUNGGAL 082390624542 √

PASAR 8 GG. BAROKAH TANAH PASAR 8 Gg. BAROKAH TJ. MULIA 082162694420 √
MEDAN BELAWAN BLOK. VII S SICANANG MEDAN BELAWAN 085296219030 √
Pasar 2 Barat Gg. Mawar Rengas Pulau Medan Marelan 081211004711 √
JL. PASAR IV TENGAH TAMBAK TAMBAK REJO PS. TUAN 085275510547 √
JL. SAUDARA Gg. KELUARGA TJ. MULIA MEDAN DELI 081377053226 √
JL. SEPAKAT TJ. MULIA MEDAN DELI 081256654243 √
: JL. JAMBU GG. MELUR PSR. IV HELVET MEDAN HELVETIA 085358182540 √
JL. PERWIRA II NO. 5 PULO B PULO BRAYAN MEDAN TIMUR 081375407549 √
JL. DUSUN XV SIDOARJO KEMPONG H. PERAK 085276388963 √
JL. KARYA 3 UJUNG NO. 52 HEL HELVETIA MEDAN SUNGGAL 082166930724 √
JL. KAWAT 3 Gg. MEKAR TK. MULIA MEDAN DELI 082282801428 √
JL. ALFALA 9 LK. 6 TJ. MULIA MEDAN DELI 082286073447 √
DUSUN V PALUH MANAN HAMP PALUH MANAN H. PERAK 081262276473 √
PASAR VI MARTUBUNG LK. V MARTUBUNG MEDAN LABUHAN 081396314412 √
JL. BAMBU GG. SEROJA HELVE P. LABUHAN MEDAN LABUHAN 082275452200 √
KOMP. SRI GUNTING BLOK J SUNGGAL MEDAN SUNGGAL 81362475152 √
JL. RAWE 2 LK. 3 TANGKAHAN MEDAN LABUHAN 82364481779 √
JL. MABAR PASAR IV MEDAN DE MABAR HILIR MEDAN DELI 082151730840 √
JL. SEKATA GG. KULIT KEC. M SEI PUTIH MEDAN BARAT 081360630979 √
JL. ALUMINIUM IV LK. XX MEDA TJ. MULIA MEDAN DELI 082286331393 √
JL. BELIBIS VII NO. 436 PERU MANDALA PS. TUAN 085296804316 √
JL. MAKMUR GG. TAQWA MEDJL. MAKMUR Gg. TAKKAMEDAN TEMBUNG 085359819932 √
B. KATAMSO PANTAI BURUNG P. BURUNG MEDAN MAIMUN 082164060000 √
JL. PANCING 1 LK. IV KEC MED PANCING MEDAN DELI 081264347957 √
JL. MANGAAN 1 GG. SEPAKAT LK TITI PAPAN MEDAN DELI 081263123333 √
JL. SUNGGAL NO. 68 JL. SUNGGAL N0. 68 MEDAN SUNGGAL 081263888098 √
JL. MANGAAN 1 MABAR MEDAN MABAR MEDAN DELI 081264348385 √
JL. MANGAAN 9 GG. RAHMAT M MABAR MEDAN DELI 085276984324 √
JL. KAMBES PJKA NO. 3 LK. I MARTUBUNG MEDAN LABUHAN 085361736687 √
JL. PLATINA I GG. TRATAI LK. TITI PAPAN MEDAN DELI 082172387150 √
LOR. 1 UMUM KEC. MEDAN LA BELAWAN BAHARI MEDAN BELAWAN 081260816901 √
JL. PLATINA V LK. XII MEDAN D JL. PLATINA MEDAN LABUHAN 081361698616 √
JL. PANCING I LK. 3 GG. SEH MARTUBUNG MEDAN LABUHAN 081396495600 √
JL. COMER KOTA SIBOLGA SIBOLGA 081375407549 √
JL. PLATINA 3 LK. 14 TIT PAPAN TITI PAPAN MEDAN DELI 085206467555 √
JL. PEMBANGUNAN MULO REJ MULO REJO MEDAN SUNGGAL 081376590681 √
DUSUN 1 KOTA RANTENG HAM KOTA RANTANG H. PERAK 082277822100 √
JL. YOS SUDORSO LK. XI TANJ TJ. MULIA MEDAN DELI 081262942695 √
JL. KEBUN RAMBUNG LK. V RE RENGAS PULAU MEDAN MARELAN 085362315987 √
JL. PLATINA 7A LK. 2 MARELAN RENGAS PULAU MEDAN MARELAN 081375407549 √
JL. JERMAL RAYA PASAR 6 PASAR 6 PS. TUAN 081375407549 √
JL. MANGAAN PASAR 2 MABAR MABAR MEDAN DELI 085270801921 √
JL. TITI PAHLAWAN SIOMBAK TITI PAHLAWAN MEDAN MARELAN 082168555571 √
JL. MARELAN RAYA PAYA PASI PAYA PASIR MEDAN MARELAN 081375407549 √
JL. ASAM SIMP. KANTOR LK. 7 MARTUBUNG MEDAN LABUHAN 085361273934 √
JL. SEMBILAN LK. 13 PAJAK B PAJAK BARU MEDAN BELAWAN 082274001161 √
JL. PARDOMUAN LK. XIII MED BELAWAN BAHARI MEDAN BELAWAN 081266849310 √
JL. ALUMINIUM I GG. JASMIN M TITI PAPAN MEDAN DELI 085265702665 √
JL. PARDOMUAN LK. XIII MED BELAWAN BAHARI MEDAN BELAWAN 081396317906 √
JL. PERHUBUNGAN LAUT DEND LAU DENDANG PS. TUAN 081375407549 √
JL. PLATINA 1 LK. 9 GG. AKS R. PULAU MEDAN MARELAN 081396082829 √
JL. GERMANIA TJ. GUSTA H. PERAK 081260927216 √
JL. LUKA MEDAN AMPLAS MENTENG MEDAN AMPLAS 082362521522 √
JL. ALUMINIUM LK. 2 GG. BANT TJ. MULIA MEDAN DELI 081264160108 √
KP. SALAM LK. XII BELAWAN MEDAN BELAWAN 082168584422 √
JL. KAMBOJA XIII HELVETIA DWI KORA MEDAN HELVETIA 081364905643 √
JL. PINANG BARIS GG. BAMBU PINANG BARIS MEDAN SUNGGAL 082369341585 √
JL. TITI PAHLAWAN RENGAS P RENGAS MEDAN MARELAN 082167970087 √
PERUM MARTUBUNG V BLOK X MARTUBUNG MEDAN LABUHAN 081375407549 √
JL.PRUNGGU KOTA BANGUN MEDAN DELI MEDAN DELI 081265713782 √
JL. PLATINA 3 LK. 14 KEC. MED TITI PAPAN MEDAN DELI 081375030210 √
JL. ILENG LOR. NANGKAJL. REN
ILENG LOR. NANGKA RENGAS
MEDAN MARELAN 085276235806 √
JL. JALA IX GG. KAMBING ME RENGAS PULAU MEDAN MARELAN 082181808881 √
JL. BOXIT MATA BANGUN TJ. MULIA MEDAN DELI 082360628449 √
JL. KAMBOJA DUSUN 6 BANDAR DUSUN 5 H. PERAK 081265015990 √
PASAR V SIDUMULIO MEDAN SIDOMULYO MEDAN TEMBUNG 085370000322 √
JL. JERMAL RAYA SEI MATI SEI MATI MEDAN LABUHAN 082363331124 √
JL. PASAR IX SEMANGKA XVI PS. TUAN PS. TUAN 081269104343 √
JL. SUPRINO GG. JADI DESA SUNGGAL MEDAN SUNGGAL 081376282066 √
JL. KLAMBIR V SIDOMULYO KELAMBIR BINJAI 081310512852 √
PAYA PASIR GG. MANAF LK. II P. PASIR MEDAN MARELAN 081376796889 √
JL. BARU MEDAN MARELAN TE TERJUN MEDAN MARELAN 082172703913 √
JL. MESJID KEL. RENGAS PUL RENGAS PULAU MEDAN MARELAN 082368888929 √
JL. PLATINA 7 TITI PAPAN TITI PAPAN MEDAN DELI 085362209705 √
JL. GATOT RUBIAH RENGAS P RENGAS PULAU MEDAN MARELAN 0895611187002 √
JL. DANU TEMPE BINJAI BINJAI 081360718204 √
JL. ALUMINIUM 111 LK. 12 TJ MULIA MEDAN DELI 082364933783 √
JL. MULTATULI MEDAN MAIMUN MEDAN MAIMUN 08527078022 √
JL. MENTENG BARU LK. 25 PE P. LABUHAN MEDAN LABUHAN 081310668972 √
DUSUN SEMPURNA DESA SAMP DESA SEMPO BIRUEN 081290554575 √
RUSUNAWA KAYU PUTIH P. LABUHAN MEDAN LABUHAN 081273253711 √
JL. RAWE 7 LK. 9 MARTUBUNG MARTUBUNG MEDAN LABUHAN 082273012105 √
JL. TITI PAYUNG DESA HAMPA TITI PAYUNG H. PERAK 081263073979 √
SAINTIS DUSUN 15 SEMAR PERCUT PS. TUAN √
MEDAN HELVETIA MEDAN HELVETIA 081375029132 √
JL. PERBATASAN PASAR 13. SE JL. PERBATASAN PSR 082276661782 √
JL. PASAR X TEMBUNG PS. TU TEMBUNG PS. TUAN 085261790682 √
PASAR 1 MABAR HILIR MABAR HILIR MEDAN DELI 082274267287 √
LK. 21 KP. KOLAM BELAWAN P. BARU MEDAN BELAWAN 082363883050 √
TANAH 600 MEDAN MARELAN TANAH ENAM RATUS MEDAN MARELAN 082362880089 √
MABAR HILIR JL. PANCING 1 JL. PANCING MABAR HILIR 081264819086 √
JL. MULIA GG. PADI TJ. MULIA MEDAN DELI 081362619696 √
PLATINA 3 LK. 13 P. RUMPUT P. RUMPUT MEDAN DELI 082289960487 √
PASAR 7 TEMBUNG GG. SEMPPSR 7 JL. SEMPURNA MEDAN TEMBUNG 085265908420 √
KOMP. UKA MENTENG MARTUBUNG MEDAN LABUHAN 082165332273 √
JL. RAWI IV TANGKAHAN MED TANGKAHAN MEDAN LABUHAN 0813468813932 √
JL. BRIGJEND ZEIN HAMID GG. A JL. BRIGJEN HAMID MEDAN 081375407549 √
KOMPL. UKA TERJUN TERJUN MEDAN MARELAN 082285908776 √
LAPAS LABUHAN DELI MARTUBUNG MEDAN LABUHAN 081375407549 √
TEMBUNG LAU DENDANG LAU DENDANG MEDAN TEMBUNG 082361967292 √
JL. SEROJA GG. ANGGREK NO.JL. SEROJA Gg. ANGGREK MEDAN 081361374749 √
JL. MANGAAN 1 LK. 6 MABAR MABAR MEDAN DELI 082168258155 √
GRAHA MARTUBUNG N0. 36 GRAHA MARTUBUNG MEDAN LABUHAN 081263114547 √
PASAR I REL GG. AMAN LK. I R. PULAU MEDAN MARELAN 083194011476 √
BATANG SERE HAMPARAN PER BATANG SERE H. PERAK 081396484284 √
KP. KELUARGA LK. 8 MEDAN L KP. KELUARGA MEDAN LABUHAN 081362139725 √
MARELAN PASAR I TENGAH P. PASIR MEDAN MARELAN 081346056868 √
JL. TB. SIMATUPANG NO. 65 JL. TB. SIMATUPANG 085362950858 √
PAJAK BARU BELAWAN MEDAN BELAWAN 085361661295 √
MARELAN PASAR 7 R. PULAU MEDAN MARELAN 081375573881 √
LK. 29 RENGAS PULAU MAREL R. PULAU MEDAN MARELAN 081275432034 √
JL. ENGGANG RAYA UJUNG PE MANDALA PS. TUAN 085261246015 √
JL. TELUK HARU LK. II MARTU MARTUBUNG MEDAN LABUHAN 082363292389 √
MARELAN PASAR 4 TIMUR GG. MARELAN MEDAN HELVETIA 082273978056 √
JL. SETIA LUHUR HELVETIA DWI KORA MEDAN HELVETIA 082280439466 √
JL. KARYA CILINCING JOHOR MEDAN JOHOR 081262694420 √
MARELAN PASAR 4 TIMUR R. PUAU MEDAN MARELAN 085270848083 √
JL. MANGAAN 8 LK. 17 MABAR MABAR MEDAN DELI 081264011912 √
JL. MAKMUR PASAR VII TEMBU SIDOMULYO MEDAN TEMBUNG 081362130474 √
BELAWAN MEDAN BELAWAN 081375407549 √
JL. ALUMINIUM GG. BARU TJ. M TJ. MULIA MEDAN DELI 081264399366 √
JL. IBRAHIM UMAR GG. RAHMAD MEDAN 082364217295 √
JL. SEDERHANA PASAR 7 KEC. PS. TUAN PS. TUAN 085270103420 √
JL. SUNGGAL GG. PENDIDIKAN MEDAN SUNGGAL 082272034159 √
SRI GUNTING SUNGGAL MEDAN SUNGGAL 082165577797 √
TAMBA REJO PASAR II MEDAN TEMBUNG MEDAN TEMBUNG 081273095234 √
MARELAN RAYA LOR. 2 MARELAN RAYA 081265864472 √
JL. RAHAYU PASAR 6 KEC. PS. PASAR 6 PS. TUAN 085207737422 √
JL. DONDONG 1 MEDAN BELA BELAWAN BAHARI MEDAN BELAWAN 081376921292 √
GRAHA MARTUBUNG N0. 36 MARTUBUNG MEDAN BELAWAN 081263114547 √
JL. ADINEGORO NO. 3 MEDAN SERDANG MEDAN PERJUANGAN 081292777713 √
JL. TITI PAHLAWAN GG. PRIN RENGAS PULAU MEDAN MARELAN 081218029590 √
JL. BINJAI KM. 13 GG. DAMAI SEI SEKAMBING MEDAN BARAT 081375130414 √
JL. TAMBAK SICANANG BELAWSICANANG MEDAN BELAWAN 081377215239 √
JL. JEMADI NO. 325 MEDAN 081376511376 √
JL. METEOROLOGI UJUNG NO. 1 PS. TUAN PS. TUAN 081269987062 √
JL. MAKMUR TEMBUNG TEMBUNG PS. TUAN 085362989254 √
JL, RPH LK. IX MEDAN DELI TITI PAPAN MEDAN DELI 082367836970 √
JL. BINJAI KM. 13 PASAR KECILPSR KECIL BINJAI 081269615071 √
TJ MULIA MEDAN DELI TJ. MULIA MEDAN DELI 085358044310 √
SAINTIN PERCUT SEI TUAN PS. TUAN 085351050866 √
MARELAN PASAR 3 TERJUN MEDAN MARELAN 082362249221 √
YP. HIJAU RENGAS PULAU P. HIJAU MEDAN MARELAN 085761563656 √
YP. HIJAU RENGAS PULAU TITI PAPAN MEDAN DELI 085761563656 √
PASAR 1 MABAR MABAR MEDAN DELI 085373242808 √
YOS SUDARSO KM. 15 MEDAN LABUHAN 082388059652 √
DUSUN 1 KOTA RANTANG HAMPARAN PERAK 085261908075 √
MARELAN BARAT PASAR 3 087880188442 √
JL. JOHOR PASAR 1 STABAT 081380523477
DUSUN 2A JL. MANUNGGAL GG. ABADI LABUHAN DELI 081262418070 √
TULUN KENAS NAMO SURO SIBIRU BIRU 085275533088 √
PASAR 7 BENTENG DESA TEMBUNG 081263826108 √
BAGAN DELI LORONG PROYEK BELAWAN 082182382252 √
JL. PASAR V TEMBUNG KEC. PS. TUAN √
BULUCINA HAMPARAN PERAK 085361801300 √
JL. BERINGIN TEMBUNG 081370711501 √
DUSUN I DESA TEMBUNG 082360038865 √
MARELAN PASAR 2 085262412198 √
BAGAN DELI BELAWAN √
JL. PANCING I DUSUN 1 RENGAS PULAU 082166919990 √
JL. USMAN SIDDIK 081260918744 √
PASAR 8 HELVETIA 082276737030 √
MABAR HILIR 081361312670 √
JL. KAPTEN SUMARSONO VII HELVETIA 082274482214 √
JL. BERSAMA GG. MUSHOLLA 082362557989 √
JL. MANGAAN LR. JAYA LK. 16 MEDAN DELI √
JL. KAPTEN MUSLIM GG. BERSAMA 082275873624 √
PAJAK BARU JL. SEMBILANG BELAWAN 085370443898 √
DUSUN XII PASAR 2 KLAMBIR HAMPARAN PERAK 081315780434 √
JL. SERDANG LK. 7 MEDAN LABUHAN 081260042082 √
LK. VI PAJAK RAMBE MEDAN LABUHAN √
JL. PANCING II KOMP. ANUGRAH ASRI 082361488478 √
KLAMBIR V GG. BUNGA PASAR 4 √
JL. PERUNGGU LK. V √
LK. XXII KOMP. YUKA TERJUN 082163327278 √
KLAMBIR V PASAR 11 081265313154 √
JL. PLATINA 1 LK. 9 TITI PAPAN 082361713183 √
PASAR 7 BERINGIN TEMBUNG 085268266078 √
JL. PRINGGAN HELVETIA 081369710588 √
Merek Vaksin
A : Sinovac
B : Lainnya (Mohon Disebutkan Jenis Vaksin Yang
Kepersertaan BPJS
BPJS PBI
BPJS Non PBI
Non Anggota
Total
Pemberian Dosis
Dosis 1
Dosis 2
Total
nkes
Dosis I Dosis 2
Tanggal KETERANGAN
Merek Vaksin Tanggal
Screening Tanggal
Vaksin n Vaksin
CORONAVAC 9/1/2021 9/1/2021 2021071341 - - LANJUT VAKSIN 2
sebutkan Jenis Vaksin Yang Diterima Puskesmas/Faskes)
Kepersertaan BPJS
Tabel 10. Format Pencatatan Pelayanan
FORMAT PENCATATAN PEL

TINGKAT PUSKESMAS/F

Nama Penerima Umur

No No.Registrasi NIK JK Pekerjaan Kel. Umur Alamat
Vaksin
(> 60Tahun)
1 J-0001146P 1271131910030001 ALDI GHIFFARY S L REMAJA 17 LINGKUNGAN
2 P-PRZFF7A5 1271132601030001 AJI SATRIA L REMAJA 17 LK I SEI MAT
3 P-PTHXI9E8 12711366020004 HIZRATUS SANIA MAHA P UMUM 19 LK 2 SEI MA
4 J-0000QMB2 1271136401860001 SALBIAH P B 35 LK II SEI MA
5 P-PRDK6J0G 1271130202810002 SUPRIONO L B 40 LK II SEI MA
6 P-PUGVLXU6 1271131507020004 YUSUF PRATAMA NASUT L UMUM 19 LK II SEI MA
7 P-PRAILU2T 1271136507820001 SELI SURIATI P B 38 LINK XVIII S
8 P-KGG16V7U 1271131001140012 RAMDANI L B 35 LK III B KIL
9 P-6YGELZT6 1271135207840002 VITTA SAFITRI P B 38 LK III SEI MA
10 P-ASXXVZ7A 1271132201740001 JOHANNES SIMARSOIT L B 47 LK III SEI MA
11 P-AXNJ4UUP 1271136305770003 RITAWANI SIANTURI P B 44 LK III SEI MA
12 J-00010LOP 1271132504990005 CANDRA ADI SAPUTRA L UMUM 22 LK III SEI MA
13 P-N3YE2RMR 1271186603920007 SAFINAH TUN NAJA P UMUM 29 JL KAMPUNG
14 P-PQYYKW8W 1271136312910004 DEVIA L UMUM 30 LK IV SEI MA
15 P-OQOTFJ7S 3522010107900014 EKA WAHYUDI HUTAPEA L UMUM 31 LK V SEI MA
16 P-OF6TAQ1C 1271135304660002 NANI P RENTAN 55 LK V SEI MA
17 P-O0L2OXPI 1271134606880002 AMINAH L UMUM 32 LK V SEI MA
18 P-PYVLWGKI 1271136909670003 SUNARSIH P RENTAN 53 LK V SEI MA
19 P-Q2HGQXNJ 1271134706690004 ROTUA BATUBARA P B 52 LK VII SEI M
20 P-PROZR7IC 1271131302840001 HASUDUNGAN HARIANJ L B 38 LK VII SEI M
21 P-BE3KOVGO 1271135511750012 JULI BR GINTING P B 45 LINGK VIII S
22 P-PX34MGJ9 1271130810930005 SAUT RODO SIMANUNGK L B 27 LK VIII SEI
23 P-PUTRKI8E 1275013006720006 ARTABAN SIMARMATA L B 49 LK VIII SEI
24 P-CE5A3CG3 1271130302960001 TORANG FHEBRIAN VAL L UMUM 25 LINGK VIII S
25 P-I9WABEEE 1271136611960002 NOVENTASARI SINAMBE P UMUM 25 LK IX SEI MA
26 P-12SWFFJ2 1271131201030004 ABED PRATAMA PANGAR L UMUM 18 LK IX SEI MA
27 P-HRKKCIZB 1207261601740002 GINDO PANGARIBUAN L B 47 JLN KIWI II
28 P-BE9G0MFJ 1271135112820003 DESMA KARTIKA SITUM P B 38 LINGK IX SE
29 P-CKSMX7YR 1271136612030002 DELLA CHRISTINE NATA P UMUM 18 LK IX SEI MA
30 P-HFMRLJKO 1271135502950002 SUSI SUSANTI TAMBA P UMUM 26 LK III SEI MA
31 S-A72806CE 1271132708600002 SUWARDI L LANSIA 61 LK X SEI MA
32 P-PK8DTVQ7 1271134705620002 SUMIAH P RENTAN 59 LINGK X SEI
33 P-CPB54RHJ 1271085009840005 ANI P B 37 LK XI SEI MA
34 P-FHEUTMQ5 1271130805840004 RONI GIRSANG L B 33 LK XI SEI MA
35 P-D340LM5B 1271131003910003 MARTIN GIRSANG L B 30 LK XI SEI MA
36 P-BOBZ8JZ4 1271131602780002 DARWIN P SIMBOLON L B 43 LK XII SEI M
37 P-DYG7P27S 1271134606020003 UTAMI RISWANDARI SI P UMUM 19 LK XII SEI M
38 P-PWEQU3VQ 1271135406850004 AMILIA P UMUM 26 LK XII SEI M
39 P-PUCWMFV8 1271135208990002 TIO AENJELY BR SIMAT P UMUM 22 LK XII SEI M
40 P-PUL0W1VH 1271132106030001 TIO FULALO SIMATUPAN L UMUM 18 LK XII SEI M
41 P-PSBWLSZS 1271136207020005 FURY ANGREANI SIMBO P UMUM 19 LK XVIII SEI
42 J-0000XJAU 1271132104030003 ANDREAS KURNIAWAN L UMUM 18 LK XV SEI M
43 P-GHAMCWMJ 1271131208010004 VEDERICO GUSMAN SIJ L UMUM 20 LK XIII SEI
44 P-NNVJ3ELJ 1271131403930001 GANDA SAPUTRA SIAGI L B 28 LK XIV SEI
45 P-D9K7UMHK 1271131311030002 DARWIN NAPITUPULU L UMUM 18 LINGK XIV S
46 P-JTNVK1ST 1271130905000003 ZEUS HOTLAN SALIM NA L UMUM 21 LK XIV SEI
47 P-A3FF1FHU 1271135104920002 AFRIANTY SIHOMBING P B 29 LR PARDAME
48 P-2FN1QUTR 1271131007750004 MARISI ARUAN L B 46 LK XV SEI M
49 J-0000XI9V 1208195610000001 CINDY THERESIA PANG P UMUM 21 LK XV SEI M
50 P-J56CK4Z3 1271135704690003 ERNALINA MARPAUNG P B 52 LK XV SEI M
51 J-0003C8V7 1271134311640004 HELENA PANGGABEAN P RENTAN 56 LK XV SEI M
52 P-CN1I76ZL 1271131507020001 RIZALDY IMMANUEL HU L UMUM 19 LINGK XVI S
53 P-PVSK0LRT 3175085510780004 POYBE ROHANA ARITO P UMUM 42 LK XVI SEI
54 P-ALUCQZ1X 1271134111720002 ROSMINA SINAGA P B 44 LINGK XVI S
55 P-M8958VJ1 1208121111830003 SOPIAN RIANTO MANUR L B 37 LK XVI SEI
56 P-PXRQ6K4Q 1271136701740096 DAMERIA SILITONGA P B 46 LK XVI SEI
57 P-PS3ZO00H 1271136806980001 MIKA CHAROLINA SIANI P UMUM 23 LK XVI SEI
58 P-LSZ2UMYX 1271135011920005 RINI P UMUM 28 LK XVII SEI
59 P-PX9GK8CY 1271131503730008 DIDI SUHARTONO L B 48 LK XVII SEI
60 J-0000DF5T 1271061002750001 RAHMAN SILABAN L B 45 LK 18 SEI M
61 P-PRJKURP3 1271065808810001 AGUSTINA BR PANGARI P B 40 KOMP TKBM
62 P-PSL00ZFT 1271086511030003 DIA SYAHFITRI LUBIS P REMAJA 17 LK 18 SEI M
63 P-PT0VEI7N 1271082810010004 MUHAMMAD RIANDI LUBI L UMUM 19 LK 18 SEI M
64 P-PVHIU0ZF 1207266007720004 SUSANTI BORU GINTING P B 49 LK 18 SEI M
65 P-PY2RR4FU 1271132405710001 SERUYA TARIDAH SILAL P RENTAN 53 LK XI SEI MA
66 P-BMOIOO2J 1271130104910003 OLOAN SIRAIT L B 30 LK II SEI MA
67 P-CV515TI6 1271184203910005 SITI YOHANA SIRAIT P UMUM 30 LK XI SEI MA
68 P-8G2MLZI9 1271136606970000 NANDA TRIANA P UMUM 29 LK VI SEI MA
69 P-BQXEMPXW 1271134808690002 SUSIATIN NINGSIH P B 52 LK VI SEI MA
70 P-DUK2E2P4 1271133105670001 KHAIRUDDIN L RENTAN 54 LK VI SEI MA
71 P-F81PUH6B 1271135303040009 AYU TRISNA BR. LUBIS L REMAJA 17 LK XIII SEI
72 P-CUCJ5JS9 1271136603940004 DINA SIAGIAN P B 27 LK XVII SEI
73 P-K58QXTCM 1271131307030005 MAULANA SIGIT L UMUM 18 LK XI SEI MA
74 P-KR4OXHYP 1271130501040003 YOSUA ARDI PRANATA L REMAJA 17 LK XIV SEI
75 P-L35DOHGG 1271136408700002 NURHAIDA BR SIHOMBI L B 51 LK XIII SEI
76 J-0000GC7T 1271136301750003 DASLI BUATON P B 46 LINGKUNGAN
77 P-MKPOZCND 1271135706010001 ROBYATUL RAHMAH P UMUM 20 LK 17 SEI M
78 P-MYJGW004 1271135908640003 ROSLINDA MURNI NAPIT P RENTAN 57 LK XIII SEI
79 P-NXE00PMH 1207244605020013 ANNISA AULIA SARI P UMUM 19 JL MATAHARI
80 P-PSG3QXVE 1271130204020005 M ZULFAN FAHRI L UMUM 18 LK II SEI MA
81 P-PTB56PZE 1271136210030002 ANANDA SABRINA MAHA P UMUM 18 LK II SEI MA
82 J-0001C6H1 1271136711890011 IMELDA SIMANJUNTAK P B 31 LK XV SEI M
83 Q-000BR799 1271135704000002 FENTI TANIA SIAGIAN P UMUM 21 LINGK. XV S
84 S-F8D376AF 1271122202590002 BINTANG TIMBUL HUTA L LANSIA 62 JLTITI PAHL
85 P-PUPRPEQ8 1271134404030001 DELLA FILIPI BR ARUAN P UMUM 18 LK 16 SEI M
86 P-PUAFNZT5 1271134908940001 NURMALA SARI P B 27 jl kail lk v sei
87 P-PVXM4BGH 1271131112750001 LASBON SINAGA L B 45 LK VII SEI M
88 P-PVNZ87FE 1207265412020007 THALYA MARCANDA TAR P UMUM 18 LK 18 SEI M
89 J-0000VHVC 1214082209980004 PILIPUS HALAWA L UMUM 23 LK 15 SEI M
90 S-90203913 1271136301920005 IKA MELATI PUJI P B 29 LK. II SEI MA
91 P-PW4GJXEF 1271136210030003 SANDORA DEWI OKTAVI P REMAJA 17 LK XVII SEI
92 P-PV7QHWVJ 1271135709930004 SINTHA NOVILA BR.GINT P B 28 LK V SEI MA
93 P-PVCSP6I6 1271130906910003 PAHMI SAHAB L UMUM 30 LK III SEI MA
94 P-PWSVIQTE 1271082611720001 HENDRA KESUMA NAIN L B 49 LK XV SEI M
95 P-PWXEJ5HU 1271131106770004 ABD HALIM L B 44 LK X SEI MA
96 P-PWJEM5ZD 1271135004980001 KARMILA DELINA P UMUM 23 LK XII SEI M
97 J-0000G8K5 1271132008020005 GILANG ANGGARA L UMUM 19 JL. SUNGAI
98 P-PWO9QQSO 1271135405790006 APOLIDA SIAGIAN P B 42 LK XV SEI M
99 P-PXN6LLP4 1271136406840004 JUNIKA SIAGIAN P B 37 LK XV SEI M
100 P-PXHE6QTE 1173047101940003 SARY ASNYA P B 27 LK III SEI MA
101 P-PYAZPJ60 1271135002620003 LASMARIA SITUMORANG P RENTAN 59 LK VII SEI M
102 P-PYFLXW5M 1271136808700003 NURAINI SITORUS L B 51 LK XV SEI M
103 P-PXWYXGFV 1271130304780002 SALOM SAPARI SIANTUR L B 42 LK VII SEI M
104 P-PZINT96R 1271130907990006 MUHAMMAR L UMUM 22 LK II SEI MA
105 P-PZ1WDKUB 1271132502000002 AGUNG PEBRI SETIAWA L UMUM 21 LK XI SEI MA
106 P-PZ7O2G8V 1271131811790004 BINAL SIMANGUNSONG L B 41 LK IX SEI MA
107 P-PYQQWEUU 1271136304740002 SAMAIYAH P B 47 LK XI SEI MA
108 P-PYLCSKE2 1271132310750002 VIKTOR NAPITUPULU L B 46 LK VIII SEI
109 P-PZVQOQK7 1271132310750002 BERTUA DOLOK SARIBU P B 36 LINGK XIV S
110 P-PZDSCEAN 1271136503000004 ULFA AULYA P UMUM 21 LK 16 SEI M
111 Q-000KCMDZ 1271131002790005 MISRIADI L UMUM 42 JL KAMBES
112 P-Q0BWPPQK 1271135706950004 TIA MONIKA SARI PANJA P B 26 LINGK XIV S
113 P-Q0NL1GRD 1271130304030002 RIVALDO ROBE M SIMA L UMUM 18 LK XV SEI M
114 1271134912900001 DEVINA NABABAN P B 30 LINGK. VII S
115 P-Q1FQWFGJ 1271133112630006 RUSLI AMAN SITOMPUL L RENTAN 57 JL KAIL LOR
116 P-Q1SOJXW9 1271085005030001 KRISNAWATI TESALONI P UMUM 18 TKBM SEI M
117 P-Q1Z3K36A 1271136904710003 PINTAULI SIAGIAN P B 50 LK VIII SEI
118 P-Q2CLF7B1 1271136109030003 CHRISTIN ULINA ANGEL P UMUM 18 LK VII SEI M
119 P-Q2LJM72B 1271131808810006 RAHMAD SAPUTRA SITE L B 40 LK XVII SEI
120 P-Q37LRJES 1271130107700004 MUSA PARDAMEAN NAPI L B 51 LK VII SEI M
121 S-D1E01998 1271131107570003 BANGUN NAINGGOLAN L LANSIA 64 LINGK IX KO
122 S-852128AA 1271130206580003 PARLINDUNGAN SIMAM L LANSIA 63 LINGK 7 LR
123 P-Q4J3RZU4 1271064801830005 RENSI PURBA P B 38 JLN KAWAT I
124 P-Q4PH4DPU 1271135804990003 RAYSA REJEKI P UMUM 22 LK X SEI MA
125 P-Q4TMLMI0 1271135911960002 RINA ANGRAINI P B 25 LOR 3 MESJI
126 P-3OVDUH3Y 1271060405010001 ARI ABEDNEGO PANGG L UMUM 20 JLN PLATINA
127 P-Q5GJC3KK 1271061612610001 DIAPARI DANIEL PANGG L RENTAN 59 LN PLATINA
128 P-Q5KNV65Z 1271061903960003 JOSEPH PRANANDA PA L B 25 JLN PLATINA
129 P-PTQ8BN28 1271131805870002 MEINDRA ILHAM L B 34 LK III B KILA
130 P-Q26JG3PW 1271130108020004 JOHANNES WANAGUS T L UMUM 19 LK XIV SEI
Keterangan
D : Lainnya
E : Tidak Bekerja
Kelompok Umur
18-30
31-45
46-59
Total
Pekerjaan
A
B
C
D
E
Total
encatatan Pelayanan Vaksinasi COVID-19 di Tingkat Fasyankes
PENCATATAN PELAYANAN VAKSINASI COVID-19

KAT PUSKESMAS/FASYANKES/POS VAKSINASI
LABUHAN

Dosis I
Merek Tanggal
Kelurahan Kecamatan No.Hp Tanggal
BPJS Non Non Vaksin Screening
BPJS PBI Pemberian
PBI Anggota
Vaksin
SEI MATI MEDAN LABUHAN 082165016609 √ CORONA VAC 9/2/2021 9/2/2021
KENANGAN PS. TUAN 082166268199 √ CORONA VAC 9/2/2021 9/2/2021
SEI MATI MEDAN LABUHAN : 081220515449 √ CORONA VAC 9/2/2021 9/2/2021
HELVETIA MEDAN HELVETIA 0895602129824 √ CORONA VAC 9/2/2021 9/2/2021
SEI MATI MEDAN LABUHAN 082365668984 √ CORONA VAC 9/2/2021 -
PAYA PASIR MEDAN MARELAN 081396689575 √ CORONA VAC 9/2/2021 9/2/2021
MARTUBUNG MEDAN LABUHAN 081260673600 √ CORONA VAC 9/2/2021 -
SEI MATI MEDAN LABUHAN √ CORONA VAC 9/2/2021 9/2/2021
TJ. MULIA HILIR MEDAN DELI 082163194419 √ CORONA VAC 9/2/2021 9/2/2021
TITI PAPAN MEDAN DELI 082268065411 √ CORONA VAC 9/2/2021 9/2/2021
Merek Vaksin
A : Sinovac
B : Lainnya (Mohon Disebutkan Jenis Vaksin Yang Diterima Puskesmas/Faskes)
Kepersertaan BPJS
BPJS PBI
BPJS Non PBI
Non Anggota
Total
Pemberian Dosis
Dosis 1
Dosis 2
Total
Dosis I Dosis 2
Tanggal KETERANGAN
No.Batch Pemberia No.Batch
n Vaksin
2021071341 - - LANJUT VAKSIN 2
- 9/2/2021 2021071341 SELESAI
- 9/2/2021 2021071341 SELESAI
skesmas/Faskes)
Tabel 10. Format Pencatatan Pelayanan Vaks
FORMAT PENCATATAN PELAYAN

TINGKAT PUSKESMAS/FASYA

Umur
Nama Penerima
Vaksin
(18-59Tahun)
1 U-000008UA 1271174607769002 Dr. Heva Julietta Sinaga P A 51 46-59 Jln. Sei Bula
2 U-0000MAQO 1271014105820005 Dr. Sasmita Mayasari P A 38 31-45 Jln Kail Lk.5
3 U-0000HKUI 1204161404810001 Drg. Alfred P. Pasaribu L A 39 31-45 Jln. Titi Pah
4 U-0000VCEV 127119581163001 Novelyna P A 57 46-59 Jln. Panci No
5 U-00004GZ8 1671084312780003 Fauziah P A 42 31-45 Jln Pasar Ni
6 U-0000J2KY 1207264803860008 Buhairoh M. P A 34 31-45 Tembung
7 U-0000V9FH 1274026002900002 Fitri Handayani P A 30 18-30 Medan Johor
8 U-0000ICMY 1206065806970001 Corah Astuti P A 24 18-30 Jln. Bilal gg.
9 U-000004D6 1271114102720004 Aliyanti P A 49 46-59 JL. PINTU A
10 U-0000KT9L 1213085808870001 Iin Mayasari P A 32 31-45 Jln Letda Suj
11 1271084804660003 Hernalom P A 55 46-59 Jln. B Wijay
JL. BAUNG
12 1208305202860003 Sri Rahayu Purba P A 35 31-45 NO. II LK
XVI
Jln.
13 1271136509650005 Lolo Sondang Manurung p A 55 46-59 Tempirai
Lestar
14 1207235601760008 Renti Marlina Sihombing p A 45 31-45 Dusun XII Se
Keterangan
D : Lainnya
E : Tidak Bekerja
Kelompok Umur
18-30
31-45
46-59
Total
Pekerjaan
A
B
C
D
E
Total
tatan Pelayanan Vaksinasi COVID-19 di Tingkat Fasyankes
CATATAN PELAYANAN VAKSINASI COVID-19

PUSKESMAS/FASYANKES/POS VAKSINASI
LABUHAN
Kepersertaan BPJS (tulis 'Ya' pada kolom

Dosis 3 Keterangan
yang sesuai)
Merek Tanggal
No.Hp
Non Vaksin Screening Tanggal
BPJS PBI BPJS Non PBI
Anggota
Pemberia No.Batch Ditunda/Tidak Diberikan
n Vaksin
08126623032 √ MODERNA 02/09/2021 02/09/2021 939900 SELESAI
082166657195 √ MODERNA 02/09/2021 02/09/2021 939900 SELESAI
082363349000 √ MODERNA 02/09/2021 02/09/2021 939900 SELESAI
08126396370 √ MODERNA 02/09/2021 02/09/2021 939900 SELESAI
081371179100 √ MODERNA 02/09/2021 02/09/2021 939900 SELESAI
081396976019 √ MODERNA 02/09/2021 02/09/2021 939900 SELESAI
082366106833 √ MODERNA 02/09/2021 02/09/2021 939900 SELESAI
085761465215 √ MODERNA 02/09/2021 02/09/2021 939900 SELESAI
081362396248 √ MODERNA 02/09/2021 02/09/2021 939900 SELESAI
085297511523 √ MODERNA 02/09/2021 02/09/2021 939900 SELESAI
081361064831 √ MODERNA 02/09/2021 02/09/2021 939900 SELESAI
085261673428 √ MODERNA 02/09/2021 02/09/2021 939900 SELESAI
081361574631 √ MODERNA 02/09/2021 02/09/2021 939900 SELESAI
085275761441 √ MODERNA 02/09/2021 02/09/2021 939900 SELESAI

Merek Vaksin
A : Sinovac
Kepersertaan BPJS
BPJS PBI
BPJS Non PBI
Non Anggota
Total
Pemberian Dosis
Dosis 1
Dosis 2
Total
Keterangan
Ditunda/Tidak Diberikan/Lanjut
SELESAI
SELESAI
SELESAI
SELESAI
SELESAI
SELESAI
SELESAI
SELESAI
SELESAI
SELESAI
SELESAI
SELESAI
SELESAI
SELESAI
Tabel 10. Format Pencatata
FORMAT PENCA
TINGKAT PU

Umur
Nama Penerima
Vaksin
(> 60Tahun)
1 P-8R1VM6H0 1201074110880003 ELENDA JUNITA SIMAMOR P UMUM 33
2 P-8UK91OYV 1271130502830002 SAHALA SITANGGANG L B 38
3 P-7WO5NS1E 1271186504790009 MELLA PANJAITAN P B 42
4 P-7MM18LDX 1271181110780005 ADISTON MARBUN L B 42
5 P-5AKR1B1S 1271135902020004 NABILLA AULIA PUTRI P UMUM 19
6 P-8HRV86NN 1271136808740001 HAMIDAH P B 47
7 P-8FF72UND 1271135204990004 RINI FEBIYOLA P UMUM 22
8 P-9R5C9MH3 1271120110880008 ANDI KARISHANDI L B 32
9 J-0003D55N 1271135007960001 SARRAH SUKARSYAH P UMUM 24
10 P-B4DHTSOI 1271135208010002 KASFUNNISYA P UMUM 20
11 P-3EWOZ67E 1271136105720002 SYAHRIANA P B 49
12 P-82RAOGZ2 1271136311630002 DERISMA SIHOMBING P RENTAN 59
13 P-CW7TAHVI 1207265012880005 TATY SIHOMBING P UMUM 32
14 P-8CUKU0DU 1271060107730006 ACHMAD L B 48
15 P-7LUB8JMQ 1207021008910010 INDRA BAYU L UMUM 30
16 P-8NU0UA07 1271136010770002 SRI YANTI AR P B 44
17 P-E8DJOJK5 1271135107830002 DOSMA FRISKA MERYANTI P B 38
18 P-CJPYEVWC 1271132501780005 MUKTAR KENEDI SINAGA L B 41
19 P-COX8EKJ6 1208056808870002 CHANDRA LISNANI SIMAN L B 34
20 P-9KP4ATQI 1271131907970002 ADI SAPUTRA TAMBUNAN P UMUM 24
21 J-0001C6PG 1271060507680001 GOLFER NAINGGOLAN L B 54
22 J-0001C6CN 1271067004660001 ROSITA BR MANURUNG P B 56
23 P-AA6MMOWF 1271137112660027 HELMINA BR PURBA P B 54
24 P-AK4VTLPW 1271132207620002 FERDINAN SARAGIH L RENTAN 59
25 J-0000C0SB 1271135606970003 ELFRIDA OKTAVIANI SARA P UMUM 24
26 P-AZNJVJC9 1271134111000004 NOVI SAPRIANI P UMUM 20
27 Y-01307A7W 3172015507830014 MEILYANA P B 38
28 P-FKYLPHQX 1271134110680004 ANI P B 52
29 J-0000WRML 1271136112850006 VINOLIA P B 36
30 P-BZCLGBPN 1271061612770003 HISAR HASUDUNGAN L B 43
31 P-CE6CAMN4 1271064504780002 POLAMRIS TAMBA L B 43
32 S-FBC54FAD 1271136908560001 RUSNIDAR P LANSIA 65
33 P-4JHTX7ZI 1271131205980001 MUHAMMAD RIAN HASSAN L UMUM 23
34 P-CRS2N39T 1271086906770001 HARAPAN SINURAT L B 44
35 P-GIU0XNDE 1271135012840005 AYU RAHMAN BB P B 37
36 P-APBGVRC6 1271134603790001 ABNIDA P B 42
37 P-8Y8UUKIS 1271131408720003 JAN HARDI ARITONANG L B 49
38 P-BSLHZGU9 1271135207760003 FIKA EPELINA NADEAK P B 45
39 P-7ZESNLEE 1271134107750011 LIE NA P B 47
40 J-000114H9 1271135007470002 AVEEMANDO L UMUM 32
41 P-9FNZ8WU6 1271135112810001 DEWI SARTIKA SIMANGU P B 40
42 P-EG82X6E2 1271135107030004 VINA ANGRENI P UMUM 18
43 P-ENDSJ0AS 1271136802970001 ERVINA P UMUM 24
44 P-H18KT2GF 1271135304820004 ERLIA LAIA P B 39
45 P-CTXAFSMM 1271136910830001 KARTIKA PUSPA P B 38
46 P-BHIRTX7Q 1271134301740004 WIWI SUWISTA P B 47
47 J-0000WJ30 1271132505650003 RUSDIANTO L B 56
48 P-FCLK4MHF 1271130501770001 OSKAR MASHURI PURBA L B 44
49 P-A37MPNIW 1271132012700007 MANGASITUA NAPITUPUL L B 51
50 J-0003J26C 1271134603990001 VENESSA CHELSIA P UMUM 22
51 Q-000LEBA1 1271134608940004 CITRA MAYA SARI P UMUM 27
52 G-01335ISJ 1271131608960002 MUHAMMAD RIZAL TANJU L UMUM 25
53 Q-000HYEDH 1271080310730006 DEDY ANDITA L B 47
54 P-1VN7QNTA 1271061011610003 BONI PONSUS MANURUN L RENTAN 55
55 P-8RPMVNEO 1271041011790008 DEDEK VERIYAN L B 41
56 Q-000C8DY1 1271136901890001 UMMUL BARIYAH ROKAN P B 32
57 P-ASB6DCT6 1207260505710028 AKMAL ANAS L B 50
58 P-61HYADAQ 1209126301900001 SRI UTAMI P UMUM 31
59 P-BDKQT35D 1271135912790001 DESWITA SARI LUBIS P B 41
60 W-0000BU67 1271092308890003 ANDI HERMAWAN L B 32
61 Q-000HXKR0 1271136403750003 TEUKU CUT MALAHAYATI L B 45
62 P-BN7D8T2X [1271062403870001 AZHARI S L UMUM 33
63 P-BUT61860 1271122904010001 SURIYATRI HARTANTO L UMUM 21
64 Q-000IJK20 1208140403870004 BRANSIUS PARULIAN SIM L B 34
65 P-C3E5HCBG 1271064408760003 RUSMAULINA P B 45
66 J-0001CA45 1271020508960001 JAMES GERSON SINAGA L UMUM 25
67 P-C6UGQKKU 1271064602980001 DINDA FERDINA P UMUM 23
68 P-CHBEXLS6 1271065412000002 LEWI PURNAMA BR SIMA L UMUM 20
69 P-C9EMLEZA 1271132603010001 FRANDIGO SAUT MARTUA L UMUM 20
70 Q-000BLFPJ 1271082105670002 SUHERMAN L B 54
71 W-0000BU10 1271082907970002 ARI BHAWANA L B 30
72 P-BK2IKIML 1271066412850002 SUGIHARTI. S P UMUM 35
73 P-D7PI0G9O 1223014611880006 LULIANTI BR NABABAN P UMUM 32
74 J-0003H6MT 1207287012890001 HANA MARIANA P UMUM 32
75 P-FI4G3JTG 1271134410730001 ROSALINA BR HUTABALIA P B 48
76 P-F8O9ILKN 1271131608660001 LASBEN GULTOM P B 55
77 P-EYLVYTXE 1271135710870002 LELA DERITA HUTAURUK, P UMUM 33
78 P-G5JGYBX6 1271131507040001 MUHAMMAD AQILA SYAH L UMUM 18
79 P-F0LN2JHB 1271135606800004 SANLIZUN WINARTI HUTA P B 41
80 P-EVGOREO7 1271135707820003 NISMA SARLINA TONDAN P B 39
81 P-GKX0TRUK 1271135403030001 MAISAH NABILA P UMUM 18
82 P-GFRAZRQJ 9109012304850007 MARSUNDUNG J. PAKPAH L UMUM 36
83 P-GD6AKU5O 1271131006720001 BAHARUDDIN PANE L B 49
84 P-G9DXD84I 1271136810770004 YEMMI NASUTION P B 44
85 W-0000BR3S 1271201211730004 MUKHLIS DAULAY L B 47
86 Q-00039JQM 1271134801810009 KERTINA SITUMORANG P B 40
87 Q-000BZYH4 1271082011820003 ADISON NAKASONE PASA L B 39
88 P-H4QEJ5NO 1271130507770005 LAMBINSAR SAGALA L B 44
89 P-GWNUIZOW 1271132702810002 I W A N L B 40
90 Q-000KBWVR 1271134307700002 ROSITA SIHALOHO P B 51
91 Q-000JXJS0 1271052506830003 M. MUCHLIS SUHADA LUBI L B 38
92 Q-00093VDD 1271135306830002 SRI RAHMADANI P B 37
93 P-HUDVSY19 1271136112860009 KARTINI P B 35
94 P-HV9N7DZC 1271130903880002 ANTONI ANGKUSUMA L UMUM 33
95 P-HWERDOL0 1271134204670001 SAN HAW P B 54
96 P-HSW3845J 1271136001910002 SARTIKA KUSUMA P UMUM 31
97 P-I3XX4TT8 1271131806030001 JHONATAN PARTOGI SIA L UMUM 18
98 Q-000A3BXV 1271137108030001 MARIANI MANALU P UMUM 18
99 P-I1WMB3TV 1271132612920001 ANDRI ANGKUSUMA P UMUM 29
100 S-3A2CF3AB 1271135911600001 RUSMINA SIANIPAR P LANSIA 62
101 P-I03C15QJ 1271135009710003 SRI ISMAYANTI P B 50
102 P-I6TDCVQM 1271130709800002 LEGIMIN L B 41
103 P-HQSETQ50 1209200611990006 VAN RENALDO PAKPAHAN L UMUM 21
104 J-0000S31D 1271136406970002 MIKA SARI LINGGA P UMUM 24
105 Q-000BR27N 1271174104980001 SARACH PUTRI APRILIA P UMUM 23
106 S-87DF9BAE 1271135607720005 AIDA LAILANI PANJAITAN P B 49
107 P-IB6PBM0N 1271134810000002 CINDY THERESIA SIMORA P UMUM 20
108 Q-000JZKBO 1271131209010005 KRISTOPHORUS DODI SI L UMUM 19
109 P-IEIJXZZZ 1271135507670003 PAINDOAN DOLOK SARIB L B 54
110 Q-000LRR3D 1271132503030001 ELIYAS SIDABUTAR L B 18
111 P-IFNR2AT0 1271131806920005 HARRI ARDIANSYAH L UMUM 29
112 P-IF6DHSVV 1271135609800002 MARNI JUDITA SINAGA P B 41
113 P-ICKEQYK3 1271135402930001 LINDAWATI P UMUM 28
114 J-0003L7YJ 1208130409860002 PANTAS SIHOMBING P UMUM 35
115 P-IMEBK0D0 1271135808880002 AGUSTINA MANURUNG P UMUM 33
116 P-IMXDKD5D 1271134205850004 ELDA TAMPUBOLON P B 35
117 P-IOLEYSRE 1271176703030002 OLIVIA MONICA ANDREA P UMUM 18
118 P-IO0KQUI1 1271134601930004 ENNI JERNIKA BR SITORU P UMUM 28
119 G-01334RCH 1202092112820001 LUGA SITOHANG L B 39
120 P-IPWU314M 1272033010990001 IZHAQ MAHENDRA L UMUM 21
Keterangan
D : Lainnya
E : Tidak Bekerja
Kelompok Umur
18-30
31-45
46-59
Total
Pekerjaan
A
B
C
D
E
Total

MEDAN LABUHAN

Merek
BPJS Non Non Vaksin
BPJS PBI
PBI Anggota
JL. KUBAH LINGK.I MARTUBUNG MEDAN LABUHAN 081262499702 √ CORONA VAC

JL. KUBAH LINGKUNGA MARTUBUNG MEDAN LABUHAN 081262499702 √ CORONA VAC
JL. KUBA GG.SEPAKAT MARTUBUNG MEDAN LABUHAN 081264318300 √ CORONA VAC
JL. KUBA GG.SEPAKAT MARTUBUNG MEDAN LABUHAN 081264318300 √ CORONA VAC
JL. KL. YOS SUDARSO MARTUBUNG MEDAN LABUHAN 0853 7339 7821 √ CORONA VAC
LINGK.I BAHARI PEKA MARTUBUNG MEDAN LABUHAN 0812 6148 8081 √ CORONA VAC
LINGK.I BAHARI PEKA MARTUBUNG MEDAN LABUHAN 0822 6809 9395 √ CORONA VAC
JL. KL. YOS SUDARSO LMARTUBUNG MEDAN LABUHAN 085262734413 √ CORONA VAC
JL. KL YOS SUDARSO N MARTUBUNG MEDAN LABUHAN 0821 6138 0575 √ CORONA VAC
JL. TELUK HARU GG.HA MARTUBUNG MEDAN LABUHAN 0878 2283 8595 √ CORONA VAC
LINGK.II KP.BESAR MARTUBUNG MEDAN LABUHAN 0821 7325 5062 √ CORONA VAC
JL. BAKTI ABRI LR.TEN MARTUBUNG MEDAN LABUHAN 0853 5946 7343 √ CORONA VAC
LINGK.III MARTUBUNG MEDAN LABUHAN 0821 6806 0446 √ CORONA VAC
JL. JAKSA LINGK.III MARTUBUNG MEDAN LABUHAN 0853 7039 3490 √ CORONA VAC
JL. KANTOR CAMAT LI MARTUBUNG MEDAN LABUHAN 0812 6132 4292 √ CORONA VAC
JL. KANTOR CAMAT LI MARTUBUNG MEDAN LABUHAN 813 6132 4292 √ CORONA VAC
LINGK.IV MARTUBUNG MEDAN LABUHAN 814 6132 4292 √ CORONA VAC
GG.KARYA LINGK.IV MARTUBUNG MEDAN LABUHAN 0852 6025 1455 √ CORONA VAC
JL. PAYA BAKUNG .SE MARTUBUNG MEDAN LABUHAN 0853 7702 2084 √ CORONA VAC
JL. PAYA BAKUN GG. MARTUBUNG MEDAN LABUHAN 0853 7702 2084 √ CORONA VAC
P.RAMBAI LINGK.VI MARTUBUNG MEDAN LABUHAN 0812 6050 4929 √ CORONA VAC
JL. PAJAK RAMBAI LIN MARTUBUNG MEDAN LABUHAN 0812 7442 3969 √ CORONA VAC
LK VII SIMPANG KANT MARTUBUNG MEDAN LABUHAN 0812 6230 6604 √ CORONA VAC
JL.P.INPRES NO.58 LIN MARTUBUNG MEDAN LABUHAN 0853 6360 8899 √ CORONA VAC
JL. P.INPRES SP.KANT MARTUBUNG MEDAN LABUHAN 0812 6673 6537 √ CORONA VAC
LINGK.VII MARTUBUNG MEDAN LABUHAN 0853 7063 0510 √ CORONA VAC
LINGK.VII MARTUBUNG MEDAN LABUHAN 0853 7063 0510 √ CORONA VAC
JL. ASAM LR SEKOLAH MARTUBUNG MEDAN LABUHAN 0858 3317 7356 √ CORONA VAC
JL. H.PERAK LINGK.VII MARTUBUNG MEDAN LABUHAN 0857 6313 3186 √ CORONA VAC
JL. ASAM LOR SEKOLAHMARTUBUNG MEDAN LABUHAN 0822 7411 6622 √ CORONA VAC
JL. ASAM LR SEKOLAH MARTUBUNG MEDAN LABUHAN 0895 3854 39401 √ CORONA VAC
JL. ASAM LINGK.VII MARTUBUNG MEDAN LABUHAN 0812 7267 6721 √ CORONA VAC
JL. ASAM LOR SEKOLAHMARTUBUNG MEDAN LABUHAN 0852 1140 3107 √ CORONA VAC
JL. ASAM LRG SEKOLAHMARTUBUNG MEDAN LABUHAN 0812 6021 2679 √ CORONA VAC
JL. P.INPRES 41 LINGK. MARTUBUNG MEDAN LABUHAN 0895635711543 √ CORONA VAC
JL.ASAM LRG SEKOLAHMARTUBUNG MEDAN LABUHAN 0812 7693 7557 √ CORONA VAC
JL. ASAM LRG SEKOLAHMARTUBUNG MEDAN LABUHAN 0812 6343 7002 √ CORONA VAC
GG MELATI LK. II P. LABUHAN MEDAN LABUHAN 0822 7695 9136 √ CORONA VAC
GG MELATI LK. II P. LABUHAN MEDAN HELVETIA 0853 6128 8187 √ CORONA VAC
JL. KL.YOS SUDARSO GMARTUBUNG MEDAN LABUHAN 0813 7669 9989 √ CORONA VAC
JL. ASAM LR SEKOLAH MARTUBUNG MEDAN MARELAN 0812 3036 2083 √ CORONA VAC
LINGK.VII SP.KANTOR MARTUBUNG MEDAN LABUHAN 0852 7601 4305 √ CORONA VAC
JL. ASAM NO.1 LINGK.V MARTUBUNG MEDAN LABUHAN 0813 7044 3712 √ CORONA VAC
JL. H.PERAK LK.VII MARTUBUNG MEDAN LABUHAN 0821 6256 7822 √ CORONA VAC
JL. H.PERAK NO.11 LIN MARTUBUNG MEDAN LABUHAN 0821 6845 7225 √ CORONA VAC
JL. KL.YOS SUDARSO L MARTUBUNG MEDAN LABUHAN 0811 6008 03 √ CORONA VAC
LING 29 KM 20 MEDAN MARTUBUNG MEDAN LABUHAN 082171031889 √ CORONA VAC
JL. KL YOS SUDARSO P MARTUBUNG MEDAN LABUHAN 083179795374 √ CORONA VAC
P RAMBAI LINGK VI MARTUBUNG MEDAN LABUHAN 0895618558398 √ CORONA VAC
JLN BAKTI ABRI LK V MARTUBUNG MEDAN LABUHAN 081262420899 √ CORONA VAC
JLN UDANG I TANGKA MARTUBUNG MEDAN LABUHAN 085296651321 √ CORONA VAC
JL JARING UDANG 1 L MARTUBUNG MEDAN LABUHAN 081260989883 √ CORONA VAC
JLN BAKTI ABRI LK III MARTUBUNG MEDAN LABUHAN 085262775919 √ CORONA VAC
LK I BAHARI MARTUBUNG MEDAN LABUHAN 0882016008668 √ CORONA VAC
LK II MARTUBUNG MARTUBUNG MEDAN LABUHAN 081264595896 √ CORONA VAC
JL M NAWI HARAHAP MARTUBUNG MEDAN LABUHAN 085262606000 √ CORONA VAC
LINGK VI GG.AMAL M MARTUBUNG MEDAN LABUHAN 081260092300 √ CORONA VAC
JLN MANGAAN I LK XI MABAR MEDAN DELI 081370994568 √ CORONA VAC
JLN MARELAN I LK VII TERJUN MEDAN MARELAN 082166573467 √ CORONA VAC
JL. TUAR I LINGK. XXI BESAR MEDAN LABUHAN 085381803017 √ CORONA VAC
JLN MEGA NO 36 LK I TJ. REJO MEDAN SUNGGAL 085264988464 √ CORONA VAC
JLN MANGAAN VI LK X MABAR MEDAN DELI 08566683273 √ CORONA VAC
LK VII MARTUBUNG MABAR MEDAN DELI 085370630510 √ CORONA VAC
JL.TG.SENTOSA 5 NO BESAR MEDAN LABUHAN 081996849547 √ CORONA VAC
JL KAKAP LK VIII BLWBELAWAN BAHAGIAMEDAN BELAWAN 081361010789 √ CORONA VAC
LINK XIV BAGAN DELI BAGAN DELI MEDAN BELAWAN 081373904226 √ CORONA VAC
jln kambes lk iv MARTUBUNG MEDAN LABUHAN 081216286732 √ CORONA VAC
Jln Yos Sudarso Lk VII MARTUBUNG MEDAN LABUHAN 082362200265 √ CORONA VAC
LK VI MARTUBUNG MARTUBUNG MEDAN LABUHAN 082129124688 √ CORONA VAC
LK VI MARTUBUNG MARTUBUNG MEDAN LABUHAN 082129124688 √ CORONA VAC
LK VI PAJAK RAMBAI MARTUBUNG MEDAN LABUHAN 081370721794 √ CORONA VAC
JLN P LOMBOK LK 27 P. LABUHAN MEDAN LABUHAN 083874610067 √ CORONA VAC
JLN KAMBES LK IV M MARTUBUNG MEDAN LABUHAN 081263910897 √ CORONA VAC
JLN P LOMBOK LK 27 P. LABUHAN MEDAN LABUHAN 08199032650 √ CORONA VAC
LK VI P RAMBAI MARTUBUNG MEDAN LABUHAN 082370744844 √ CORONA VAC
JLN KAMBES LK IV MARTUBUNG MEDAN LABUHAN 081361220254 √ CORONA VAC
JLN KAMBES LK IV MARTUBUNG MEDAN LABUHAN 081361953438 √ CORONA VAC
JL. MUSTAFA NO. 466- GLUGUR DARAT MEDAN TIMUR 085206829288 √ CORONA VAC
JL RAWE 6 LK. VIII TANGKAHAN MEDAN LABUHAN 081239882240 √ CORONA VAC
KOMP TKBM BLOK C N SEI MATI MEDAN LABUHAN 081361506982 √ CORONA VAC
JLN YOS SUDARSO GG MARTUBUNG MEDAN LABUHAN 081376699989 √ CORONA VAC
JL.STASIUN LK IV KP MARTUBUNG MEDAN LABUHAN 082165935109 √ CORONA VAC
JL CUCUT RAYA NO 29 TANGKAHAN MEDAN LABUHAN 085261275550 √ CORONA VAC
JL. PAJAK RAMBE GG.S MARTUBUNG MEDAN LABUHAN 085360310691 √ CORONA VAC
JLN P. INPRES LK VII MARTUBUNG MEDAN LABUHAN 082366350277 √ CORONA VAC
LK XII SEI MATI SEI MATI MEDAN LABUHAN 082274786110 √ CORONA VAC
LINGK IX SEI MATI , SEI MATI MEDAN LABUHAN 081261531668 √ CORONA VAC
LINGK VIII KEL SEI MAT SEI MATI MEDAN LABUHAN 081361006856 √ CORONA VAC
JLN ASAM LOR SEKOLAMARTUBUNG MEDAN LABUHAN 082181879664 √ CORONA VAC
JLN BAKTI ABRI GG S MARTUBUNG MEDAN LABUHAN 081239886654 √ CORONA VAC
JLN BAKTI ABRI GG P MARTUBUNG MEDAN LABUHAN 085262783848 √ CORONA VAC
LK 25 P. LABUHAN P. LABUHAN MEDAN LABUHAN 081264640643 √ CORONA VAC
JLN SBATANG SERANG BABURA MEDAN BARU 08983465257 √ CORONA VAC
JLN ASAM LK VII MAR MARTUBUNG MEDAN LABUHAN 081263460302 √ CORONA VAC
JLN TEMPIRAI BLOK VI BESAR MEDAN LABUHAN 081370104308 √ CORONA VAC
LINGK XI SEI MATI L SEI MATI MEDAN LABUHAN 081263103566 √ CORONA VAC
LK VI SISI REL MART MARTUBUNG MEDAN LABUHAN 085372239568 √ CORONA VAC
SEI MATI LABUHAN SEI MATI MEDAN LABUHAN 085361290778 √ CORONA VAC
LINGK XI SEI MATI SEI MATI MEDAN LABUHAN 082362221573 √ CORONA VAC
LINGK VI P. RAMBAI MARTUBUNG MEDAN LABUHAN 085260422474 √ CORONA VAC
JLN K. L YOS SUDARSO MARTUBUNG MEDAN LABUHAN 081263721665 √ CORONA VAC
JLN PERBATASAN NO TEGAL REJO MEDAN PERJUANGAN 085215052705 √ CORONA VAC
LK VI SISI REL MART MARTUBUNG MEDAN LABUHAN 085275324010 √ CORONA VAC
LK VI P. RAMBAI MARTUBUNG MEDAN LABUHAN 082360746475 √ CORONA VAC
JLN SEI BATANG SERA BABURA MEDAN BARU 0895602894419 √ CORONA VAC
LK. XIII SEI MATI MARTUBUNG MEDAN LABUHAN 085373030126 √ CORONA VAC
LINGK VI MARTUBUNG MARTUBUNG MEDAN LABUHAN 085362314405 √ CORONA VAC
Merek Vaksin
A : Sinovac
B : Lainnya (Mohon Disebutkan Jenis Vaksin Yang Diterima Pus
Kepersertaan BPJS
BPJS PBI
BPJS Non PBI
Non Anggota
Total
Pemberian Dosis
Dosis 1
Dosis 2
Total
Dosis I Dosis 2
Tanggal KETERANGAN
Screening Tanggal Tanggal
Vaksin n Vaksin
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 4
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 - - 9/6/2021 2021071341 SELESAI
9/6/2021 - - 9/6/2021 2021071341 SELESAI
9/6/2021 - - 9/6/2021 2021071341 SELESAI
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - SELESAI
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 - - 9/6/2021 2021071341 SELESAI
9/6/2021 - - 9/6/2021 2021071341 SELESAI
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - SELESAI
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 - - 9/6/2021 2021071341 SELESAI
9/6/2021 - - 9/6/2021 2021071341 SELESAI
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 - - 9/6/2021 2021071341 SELESAI
9/6/2021 - - 9/6/2021 2021071341 SELESAI
9/6/2021 - - 9/6/2021 2021071341 SELESAI
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 - - 9/6/2021 2021071341 SELESAI
9/6/2021 - - 9/6/2021 2021071341 SELESAI
9/6/2021 - - 9/6/2021 2021071341 SELESAI
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 - - 9/6/2021 2021071341 SELESAI
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 - - 9/6/2021 2021071341 SELESAI
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 - - 9/6/2021 2021071341 SELESAI
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 - - 9/6/2021 2021071341 SELESAI
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
9/6/2021 - - 9/6/2021 2021071341 SELESAI
9/6/2021 9/6/2021 2021071341 - - LANJUT VAKSIN 2
Vaksin Yang Diterima Puskesmas/Faskes)

PJS
Tabel 10. Format Pencatatan Pelayanan Vaksinasi C
FORMAT PENCATATAN PELAYANAN V

TINGKAT PUSKESMAS/FASYANKE

Nama Umur
No No.Registrasi NIK Penerima JK Pekerjaan Kel. Umur Alamat No.Hp
Vaksin (18-59Tahun)
1 U-0000V6IZ
1277025310850002
ROMATIUR M P A 35 31-45 Perum Grand 082360638285
2 U-000005J0
1271125211700003
RAMDASARI P A 50 46-59 Lk.10 Terjun081362188912
3 U-0000VDSU
1271124402790005
FRYSKA FA P A 42 31-45 Lk.9 Terjun 081269221873
4 U-00000662
1271136503770002
MASRIATI, P A 43 31-45 pajak Rambai 081370814142
5 U-0000MGRO
1271030909720003
TONGGI MA L A 48 46-59 Jln. Parwitay081260959355
6 U-0000IWLO
1207236002790002
HENNY SIAN P A 42 31-45 Jln. Pemasya 081375308100
7 U-00000618
1271135505810002
MAILINDA MARIANI
P SILITONGAA 39 31-45 Kpt. R. Budin082161388180
8 U-000005QT
1271130503950001
RIKI HAMDAYANI L A 25 18-30 Jln. Pancing085837845832
9 U-0000VDRU
1271125310790004
ERTINA BR TARIGAN
P A 41 31-45 Lk.13 Terjun081263313074
10 U-0000VISO
1207245607740001
NUR AIDA M P A 46 46-59 Ds.3 PT. IRA085270664998
TANJUNG
11 U-0000MRS4
1271065208630001
RIRIS PAKP P A 57 46-59 MULIA 085261665800
HILIR
12 1271127008890002
AGUSTINA S P A 31 31-45 JL. MARELAN 085261920015
TERJUN
13 1271124807600003
SABARLAH P A 52 46-59 085270862784
MARELAN
14 1271136512670002
WINA LISMA P A 53 46-59 Jln. Pulo Ba082161516292
Keterangan
Pekerjaan dikelompokkan menjadi : Merek Vaksin
A : Petugas Medis dan Non Medis di Fasilitas Pelayanan Kesehatan A : Sinovac
B : Petugas Pelayanan Publik Yang Berhadapan Langsung Dengan Masyarakat B : Lainnya (Mohon Disebu
D : Lainnya
E : Tidak Bekerja
Kelompok Umur Keperserta

18-30 BPJS PBI
31-45 BPJS Non PBI
46-59 Non Anggota
Total To
Pekerjaan Pemberian Dosis
A Dosis 1
B Dosis 2
C To
D
E
Total
Pelayanan Vaksinasi COVID-19 di Tingkat Fasyankes
ATAN PELAYANAN VAKSINASI COVID-19

KESMAS/FASYANKES/POS VAKSINASI
Kepersertaan BPJS (tulis 'Ya' pada kolom

Dosis 3 Keterangan
yang sesuai) Merek Tanggal Tanggal
Non Vaksin Screening Pemberia No.Batch Ditunda/Tidak Diberikan/Lanjut
BPJS PBI BPJS Non PBI
Anggota
n Vaksin
082360638285 √ MODERNA 9/6/2021 9/6/2021 939900 SELESAI
081362188912 √ MODERNA 9/6/2021 9/6/2021 939900 SELESAI
081269221873 √ MODERNA 9/6/2021 9/6/2021 939900 SELESAI
081370814142 √ MODERNA 9/6/2021 9/6/2021 939900 SELESAI
081260959355 √ MODERNA 9/6/2021 9/6/2021 939900 SELESAI
081375308100 √ MODERNA 9/6/2021 9/6/2021 939900 SELESAI
082161388180 √ MODERNA 9/6/2021 9/6/2021 939900 SELESAI
085837845832 √ MODERNA 9/6/2021 9/6/2021 939900 SELESAI
081263313074 √ MODERNA 9/6/2021 9/6/2021 939900 SELESAI
085270664998 √ MODERNA 9/6/2021 9/6/2021 939900 SELESAI
085261665800 √ MODERNA 9/6/2021 9/6/2021 939900 SELESAI
085261920015 √ MODERNA 9/6/2021 9/6/2021 939900 SELESAI

085270862784 √ MODERNA 9/6/2021 9/6/2021 939900 SELESAI
082161516292 √ MODERNA 9/6/2021 9/6/2021 939900 SELESAI
Merek Vaksin
A : Sinovac
Kepersertaan BPJS
BPJS PBI
BPJS Non PBI
Non Anggota
Total
Pemberian Dosis
Dosis 1
Dosis 2
Total
Keterangan
idak Diberikan/Lanjut
SELESAI
SELESAI
SELESAI
SELESAI
SELESAI
SELESAI
SELESAI
SELESAI
SELESAI
SELESAI
SELESAI
SELESAI
SELESAI
SELESAI
Tabel 10. Format Pencatatan Pelayanan V
FORMAT PENCATATAN PELA

TINGKAT PUSKESMAS/FA

Nama Penerima Umur

Vaksin
(> 60Tahun)
1 P-BWZOCKDJ 1271135104900004 SARTIKA NAINGGOLAN P UMUM 31
2 S-4D2C90A3 127113150960001 SYAMSUL BAHRI L LANSIA 61
3 P-D00GWBOA 1271201508710002 POSMA MANGARAP SIN L PP 50
4 S-981820F1 1271130202560001 KIRAMAN SITUMEANGL LANSIA 65
5 P-E2U3H5I1 1271131011630004 DONNI FANAHATAN SIREGAR
L PP 58
6 P-F57CAIO4 1271135406760006 ASMIDAR POSMA NAPI P UMUM 45
7 P-EHK7XKV8 1271135212780002 DEASY YATI P PP 42
8 Q-000HYS1X 1271135402840006 SRI HANDAYANI P UMUM 37
9 P-FPHWNJUN 1271132004640004 AZHAR ROEDI SUDH L PP 57
10 P-H7S0WTR1 1271135011670003 LASMAULI PANJAITAN P PP 54
11 P-HKKWCL0P 1271134307970005 MEGASARI P UMUM 24
12 P-HZJFNO3V 1271132307990002 YUDIRANDA DIZKY THANTOWI
L UMUMS 22
13 P-IIM2PYDI 1271136307630002 WARSIH P PP 58
14 P-IZSRKKVM 1271134811950002 LIA RAHAYU P UMUM 26
15 P-JIEZP37Q 1271131510680005 TUGIATO L PP 53
16 P-JX4XRAOU 1271134907680001 ADELINA LUMBANGA P PP 53
17 P-KCXYJBAS 1271135210610003 A LAU P PRA LANSIA 59
18 P-LD9J48BI 1271130409020003 MUHAMMAD MIRZA L UMUM 19
19 Q-000LF3F1 1271132408060001 ALFIAN HADI L UMUM 15
20 P-0ZAC0VQR 1271135406030001 NAOMI CLAUDIA NAP L UMUM 19
21 P-22JS306Z 1271135110620001 DONAR SITUMORAN L RENTAN 59
22 P-3DMW36DQ 1271136304980001 MONICA LESTARI SITORUS
P PP 23
23 P-51D1WBYN 1271133010840004 RONAL HORAS PARDINGINAN
L SIREGAR
PP 37
24 S-6094A4C4 1271130808590006 B. MANULLANG L LANSIA 62
25 J-0000RUPU 1271131409870005 JAMESBON SITANGG L PP 34
26 P-8NNCBW8A 1271136305940001 NURUL AFRIZA P UMUM 27
27 P-ACJI5R99 1271135611800005 SRI WAHYUNI L UMUM 41
28 P-BRD7S9CR 1271132605020004 TRISATYA ABIDZAR L PP 18
29 P-CP5I8W47 1271136304800005 LASTIAR SITUMORANGP UMUM 41
30 P-PQQM06YF 1271135303700002 PRINCE MARTIANNA PANGGABEAN
P RENTAN 51
31 J-0003D7V8 1271134107030005 DITA VIRJI SIMAMORA P UMUM 18
32 P-FZ4Q0QP0 1271135303780002 ROSMERIANI MALAU P PP 43
33 P-GWNQXDYA 1271130908920003 AGUS RIANTO L PP 29
34 P-HTQJA32V 1271132608800006 PARUNGGUAN SITANGGANGL PP 41
35 S-2D8A5440 1271132101690003 RUSLIANTO L PP 52
36 P-KH1QCVHZ 1271131302790002 LINDUNG SIHOTANG L PP 42
37 P-N3MODDY3 1207261112840001 RISKI LUBIS L PP 37
38 P-MQLE71VX 1271136002030002 HOTMARIA FEBRIANI P UMUM 18
39 P-RGR6BA5L 1271131802930001 SABAR P PP 28
40 Q-0DBC2D9A 1271204505870003 FRIDA P UMUM 34
41 P-RGMJ67UF 1271132808710002 SURGIA P PP 50
42 P-RGXIYO0I 1271202712980004 M RAMADANI ALIANTO L PP 22
43 P-RGIAZRAE 1271130904720001 MARDIONO L PP 49
44 P-RHH8VOK5 1271134107920006 HEPPY PANJAITAN L UMUM 29
45 P-RGDNOBO6 1271142501850005 CARLOS SANTANA GULTOML PP 36
46 S-EFAB4418 1271131501570001 BONAR MARPAUNG L LANSIA 64
47 P-RHE29BF2 1271085607770001 NUR JULIANA S. P PP 44
48 P-RI1SXD4Q 1409086708780002 EMIDAH FITRIA P PP 43
49 P-RHVYD76R 1271137008020002 THERESIA BR SIJABAT P PP 19
50 P-RIBJIQSF 1271126201010001 SASMITA P PP 22
51 P-RIML5MZP 1271130407740006 HENRI SIHOMBING P PP 47
52 Q-000AJUZV 1271086707010005 WIDI AYU ANANDA P PP 20
53 P-RIF4UHLV 1271132709760001 HOTLER SIAGIAN L PP 45
54 S-1DE28F0E 1271133107850001 ARIVIN RIVAI MARPAUNGL PP 36
55 P-RIQR61S7 1271134610710002 HERLINA S L UMUM 49
56 S-B8193526 1271135508560002 BENGSINA BR SIMANJUNTAK
L LANSIA 65
57 P-RJ4Z4M7A 1271134711930003 JELIMAROITO GULTOML UMUM 28
58 P-RITIXGG5 1271132105770008 BINSAR LAMBOK TA L PP 44
59 P-RG8ITUGV 1271134809950002 SAFNA FADILLAH L PP 26
60 P-RG3EF3L3 1205184508010005 RINA L PP 20
61 P-RFXXNK06 1271134604980003 NURIANA P PP 23
62 P-RJMGE4S5 1271131301950002 DANIEL SIMANJUNTAKL PP 26
63 P-RJGX3TQC 1201124311010002 SUSI ASTIKA TAMBUNAN P PP 22
64 P-RI7E934D 1271136908000002 NURMANJA PUSPITA SARIP DALIMONTE
PP 21
65 P-RJCYVZMH 1201126103000003 ROSLI MARIANI SIMANJUNTAK
P PP 21
66 P-RJJSV1MI 1271131005920003 SOPAR SIAMANJUNT L PP 29
67 S-3C0AF140 1271132212540002 BUSMIN SIANIPAR L LANSIA 67
68 Q-000DCURH 1271122604850002 IRVAN L PP 36
69 P-RIJOJ3FI 1271135609990001 NURUL IZZAH P UMUM 22
70 Y-00000DKV 1271130101530008 JANNUS SIMATUPANGL LANSIA 68
71 P-RFI22MXO 1271134505920001 MAISARAH SULASTRI P UMUM 29
72 P-RFM54VFB 1271132508780004 M HASAN L PP 42
73 P-RFE0BOZ2 1271134805790002 ZUBAIDAH P PP 42
74 P-RKDXDJ1Q 1271134101640003 SARMAIDA P LANSIA 66
75 P-RL7PYIIH 1271064409700003 SRI HARTATI P RENTAN 51
76 P-RL4SJBQS 1271064409960001 CHAIRUNISA P UMUM 25
77 P-RKQL7Y4U 1271132807030002 MHD IZWAN L UMUM 18
78 P-07B94LGG 1271051507740002 SAHATMA PETRUS D L PP 47
79 P-RKX1EUAS 1271135110790002 HAIRAH P PP 41
80 J-0000YC8K 1210206401000001 TRI ANITA BR SILITO P UMUM 21
81 J-0001AD83 1271131007960006 SAMUEL SIJABAT L UMUM 26
82 P-RJPBC3JB 1271131604890001 DANIEL PANGGABEAN L PP 32
83 S-A397A8F2 1271136102560001 DELFRITA HUTAGAOL L LANSIA 65
84 P-RJTBVY09 1271134110850003 SANTI SIAGIAN P PP 35
85 J-0003DDHO 1271085505810006 ASMIDAR P PP 40
86 P-RKO15ADQ 1271131902040001 FAUZAN SYAHIDA ARI L REMAJA 17
87 P-RK1GUWL0 2171096906780001 EVAWANI HUTABARATP PP 43
88 P-RF9B88SY 1271030507770001 SURYA DARMA L PP 43
89 P-RF3N4FSX 1271136902960001 FITRI WAHYUNI P PP 25
90 P-RAPLUF4E 1271136606990002 META MAULIDINA P UMUM 22
91 J-0003DL5L 1271130205700001 MUHAMMAD AR L PP 51
92 P-RDRUAUKF 1271130405930005 M DANDY DIPO PRATAMA L PP 28
93 J-0003NWK5 1205202604970002 PANGIHUTAN SIHOTANG L PP 24
94 Q-000BF1HT 1271131607920003 ASRARUDDIN L PP 25
95 P-RE9ZQ05V 1271131006730003 ANTONIUS GINTING L PP 48
96 P-REL0OU1A 2171104909819005 DESINTA OLIVIA P UMUM 39
97 P-REPXAG5L 1271136010700005 YUSNAWATI P RENTAN 50
98 P-LX87NBVZ 1271062509890004 INDRA SYAHPUTRA C L PP 32
99 P-REEZCTUM 2171102909779004 JHON PIETER SIAGIAN L PP 43
100 S-24710CC5 1271132204820003 JUNIAR SIMANJUNTAKL PP 39
101 P-RDI1H253 1271136008000003 DEWI WIJAYA P PP 21
102 P-RD7Y6AEE 1271134112870002 NANA EKAPUTRI PURBA P UMUM 34
103 P-RD2FQVDF 1271135103030001 JESSICA TANIA P PP 18
104 J-0000BWUS 1271134205000002 PETRIANI SIHALOHO P UMUM 21
105 Q-000LT3Q9 1271135412920006 NORA SIMANJUNTAK P PP 28
106 P-RCSCUZMD 1271137107020006 MUTIARA RESTU NINGSIH
P UMUM 19
107 P-RCO9A3NF 1271084802880007 DONER PASARIBU P UMUM 33
108 P-RCH1R6VE 1271132202640001 ZULKIFLI L PP 57
109 P-RBXDHTPJ 1271135209930001 ERNAWATI P PP 28
110 P-RBGCNM1M 1271080406970004 RUDIANTO L PP 22
111 J-0001AAY6 1271136610010002 DWI AMANDA PRATIW P UMUM 19
112 P-RAXREQJP 1271135208980002 MARDIAH P UMUM 23
113 S-D2EE0479 1271136212570001 ERITA SILITONGA P LANSIA 64
114 S-C3802D91 1271134607570002 HERMIN SIMANJUNTAK P LANSIA 64
115 Z-00090LMR 1271133112440011 UMAR MARPAUNG L LANSIA 77
116 S-D19885CD 1271080208700001 AGUS SUPRIANTO L PP 51
117 P-NJCIAIMX 1271130103030003 ANGGA TOMINGSE SIBARANI
P UMUM 18
118 P-NTPPUILQ 1271133112900005 PIKSON SIHOMBING L PP 31
119 P-FKNJDZTM 1271134407640001 LINDA SITANGGANG P RENTAN 57
120 Q-000CLQQ6 1271132706010004 HIDAYAT MATUDENY L PP 21
121 P-FOAUPD7H 1271133006640002 AMRI SIAGIAN L PP 57
122 P-PNTOTW1Q 1271135810810004 DORMAWATI BR TINAMBUNAN
P PP 40
123 P-QOS3PLVM 1271135305790002 RASMA SARAGIH P PP 43
124 P-QD73CHXB 1271134905850004 SITI HAJAR P UMUM 37
125 P-R7RJD2VP 1271131908790001 BINSAR G HASIHOLA L PP 43
126 P-R7Z58MWQ 1271136702700001 LILIS PANJAITAN P PP 51
127 P-R8BSEPSB 1271136110870001 NUR AIDAH P PP 34
128 P-R9G4E660 1271131211860002 ERIKSON JAMES REG L PP 34
129 P-R8KXKXCZ 1271135704750002 SRI ULINA KARO KAR P UMUM 46
130 Q-000CLQPF 1271131710010004 CHANDRA ABDUL FA L UMUM 19
131 P-R9QASJ5X 1271132506790002 SAHAT MARULI MAR L PP 42
132 S-DE3198BE 1271082405780001 BAMBANG HERIADI L PP 44
133 P-R9WAKU5M 1171011508850006 MUNAWIR JUBAIDI L PP 36
134 S-2BE538F0 1271131404570003 JAMALUDDIN GULTO L PP 64
135 P-RAC2EFTI 1271131209930002 MUHAMMAD SEFTIA L PP 28
136 P-7842BTY9 1271133012610002 SADIK L PP 59
137 Q-000BFY8S 1207243006960002 ARJUN WAIS ALQUMI L PP 25
138 P-RAJ4UIB2 1271131909730001 ROBERT SIMBOLON L PP 48
139 Q-000BBSBH 1271081707930003 RINTO SINAGA L PP 28
140 Q-000LFFFJ 1271130309970002 M. RAMADANI L PP 24
Keterangan
D : Lainnya
E : Tidak Bekerja
Kelompok Umur
18-30
31-45
46-59
Total
Pekerjaan
A
B
C
Format Pencatatan Pelayanan Vaksinasi COVID-19 di Tingkat Fasyankes
ORMAT PENCATATAN PELAYANAN VAKSINASI COVID-19

MEDAN LABUHAN

pada kolom yang sesuai) Merek
BPJS Non Non Vaksin
BPJS PBI
PBI Anggota
LK. IX SEI MATI SEI MATI Medan Labuhan 085267867483 √ CORONAVAC

LOR VII LK. XVI SEI MAT SEI MATI Medan Labuhan 085360968224 √ CORONAVAC
LK. 9 SEI MATI SEI MATI Medan Labuhan 081397505040 √ CORONAVAC
LK. XVII SEI MATI SEI MATI Medan Labuhan 082166124390 √ CORONAVAC
LK. XVI SEI MATI SEI MATI Medan Labuhan 081375031566 √ CORONAVAC
LK. VII SEI MATI SEI MATI Medan Labuhan 082168120480 √ CORONAVAC
LK. XIII SEI MATI SEI MATI Medan Labuhan 087813072159 √ CORONAVAC
LK. XII SEI MATI SEI MATI Medan Labuhan 085275322242 √ CORONAVAC
LK. III SEI MATI SEI MATI Medan Labuhan 082362302148 √ CORONAVAC
JL. JERMAL RAYA LOR. 5 SEI MATI Medan Labuhan 0895612495993 √ CORONAVAC
LK. VIII SEI MATI SEI MATI Medan Labuhan 085362534929 √ CORONAVAC
JL. KAIL LK. VI LR. 1 LA SEI MATI Medan Labuhan 085270692743 √ CORONAVAC
JL. KAIL LK. VI LR. 1 LA SEI MATI Medan Labuhan 081267152378 √ CORONAVAC
LOR 2 MASJID SEI MATI Medan Labuhan 085362188544 √ CORONAVAC
LK. IV DESA BESAR SEI MATI Medan Labuhan 082168263433 √ CORONAVAC
JL. KAIL LK. VI SEI MATI Medan Labuhan 082275219840 √ CORONAVAC
LK. X SEI MATI SEI MATI Medan Labuhan 085372781413 √ CORONAVAC
LRG SEKOLAH LK. XIV SEI MATI Medan Labuhan 0895611005933 √ CORONAVAC
LK XV SEI MATI SEI MATI Medan Labuhan 085270698943 √ CORONAVAC
LR IV NO. 33 LK. XI SEI MATI Medan Labuhan 081370736380 √ CORONAVAC
LK. II SEI MATI SEI MATI Medan Labuhan 0823633365405 √ CORONAVAC
LK. XII SEI MATI SEI MATI Medan Labuhan 081360240571 √ CORONAVAC
SIMPANG KANTOR LK. SEI MATI Medan Labuhan 082366559830 √ CORONAVAC
LK. XV SEI MATI SEI MATI Medan Labuhan 0895626499210 √ CORONAVAC
YOS. SUDARSO KM 6 LK. SEI MATI Medan Labuhan 085372177333 √ CORONAVAC
KOMPLEK TKBM LING SEI MATI Medan Labuhan 082175919172 √ CORONAVAC
LINGKUNGAN XV SEI SEI MATI Medan Labuhan 081265526670 √ CORONAVAC
JL. KAIL LK. V SEI MATI Medan Labuhan 08196041432 √ CORONAVAC
YOS. SUDARSO GG. DAMARTUBUNGMedan Labuhan 081370931894 √ CORONAVAC
JL. KAIL LK. IV SEI MATI Medan Labuhan 081266223811 √ CORONAVAC
JL. KAIL LK. VI LR. 2 SEI MATI Medan Labuhan 082165192045 √ CORONAVAC
JL. TEMPIRAI SEJATI BESAR Medan Labuhan 081263816468 √ CORONAVAC
JL. PLATINA V NO.62 MEDAN DELI MEDAN DELI 082360725213 √ CORONAVAC
MARELAN VI LK. 24 R MARELAN MARELAN 085274701341 √ CORONAVAC
JL. KEADILAN LK. IV SEI MATI Medan Labuhan 082273930548 √ CORONAVAC
LR. PARSAORAN LK. 1 SEI MATI Medan Labuhan 085834965837 √ CORONAVAC
LK. XI SEI MATI SEI MATI Medan Labuhan 081281935278 √ CORONAVAC
LOR. 3 LK. 7 SEI MATI Medan Labuhan 081266974543 √ CORONAVAC
JL. KAIL LK. V SEI MAT SEI MATI Medan Labuhan 085832272172 √ CORONAVAC
JL. KAIL LK. VI LR. II SEI MATI Medan Labuhan 085358628665 √ CORONAVAC
LK. IV SEI MATI SEI MATI Medan Labuhan 082362519846 √ CORONAVAC
LK. XIV SEI MATI SEI MATI Medan Labuhan 081264284425 √ CORONAVAC
LK. I SERUAI SEI MATI SEI MATI Medan Labuhan 081264219811 √ CORONAVAC
LR. PARSAORAN LK. X SEI MATI Medan Labuhan 081316633492 √ CORONAVAC
JL. ILENG LK. 2 R. PU MARELAN MARELAN 085275094149 √ CORONAVAC
LK. III BATANG KILAT SEI MATI Medan Labuhan 081263006481 √ CORONAVAC
LOR. 7 LK. VIII SEI MATI Medan Labuhan 082369942473 √ CORONAVAC
JL. KAIL LK. V SEI MAT SEI MATI Medan Labuhan 081260408269 √ CORONAVAC
LRG. 3 LK. VII SEI MATI Medan Labuhan 081220515427 √ CORONAVAC
YOS. SUDARSO GG. B TITI PAPAN MEDAN DELI 085262669483 √ CORONAVAC
YOS. SUDARSO GG. B TITI PAPAN MEDAN DELI 081376146933 √ CORONAVAC
DANAU MELINTANG SEI AGUL MEDAN BARAT 08126503197 √ CORONAVAC
JL. PASUNDAN GG. SEI PUTIH TIMUR
MEDAN
II PETISAH082267595220 √ CORONAVAC
JL. JERMAL RAYA LK. X SEI MATI Medan Labuhan 0895611007774 √ CORONAVAC
LOR. PARSAORAN LK. SEI MATI Medan Labuhan 081313012489 √ CORONAVAC
LRG. PELITA 3 LK. VII SEI MATI Medan Labuhan 082391774650 √ CORONAVAC
LRG. PELITA 3 LK. VII SEI MATI Medan Labuhan 081362142478 √ CORONAVAC
MARELAN VII LK. 04 TANAH 600MEDAN MARELAN081260732042 √ CORONAVAC
LK. XII LOR. 6 SEI MATI Medan Labuhan 081534715505 √ CORONAVAC
LK. V SEI MATI SEI MATI Medan Labuhan 081264503090 √ CORONAVAC
KOMP. TKBM BLOK F NO.SEI MATI Medan Labuhan 085356234619 √ CORONAVAC
YOS. SUDARSO NO. 21KOTALK BANGUNMEDAN DELI 081263996073 √ CORONAVAC
KOMP. TKBM BLOK F NO.SEI MATI Medan Labuhan 085356234619 √ CORONAVAC
LK. 9 BATANG KILAT SEI MATI Medan Labuhan 087893888833 √ CORONAVAC
LK VI LOR. 1 NO. 19 SEI MATI Medan Labuhan 081397374581 √ CORONAVAC
LK. XVIII SEI MATI SEI MATI Medan Labuhan 083133992724 √ CORONAVAC
LOR III LK. VII SEI MATI Medan Labuhan 081370990181 √ CORONAVAC
LRG. 3 LK. VII SEI MATI Medan Labuhan 082160619361 √ CORONAVAC
LK. 9 PEKAN LABUHAN PEKAN LABUHAN
Medan Labuhan 082166517626 √ CORONAVAC
LOR. PARSAORAN LK. X SEI MATI Medan Labuhan 082167138561 √ CORONAVAC
JL. MESJID LK. 1 MARTUBUNGMedan Labuhan 085765679676 √ CORONAVAC
BATANG KILAT LK. I SEI MATI Medan Labuhan 085260958348 √ CORONAVAC
LK. III MARTUBUNG MARTUBUNGMedan Labuhan 088263248927 √ CORONAVAC
KOMP. TKBM BLOK E NO SEI MATI Medan Labuhan 081262256445 √ CORONAVAC
LK. XII LOR. 6 SEI MATI SEI MATI Medan Labuhan 081397611191 √ CORONAVAC
LOR. III LK. VII SEI MATI Medan Labuhan 082161880959 √ CORONAVAC
LK. I SEI MATI SEI MATI Medan Labuhan 08972087661 √ CORONAVAC
DUSUN KARANG TURI BULU CINAHAMPARAN PERAK082161096739 √ CORONAVAC
BLOK 31 LK. XVII BEL SICANANGMEDAN BELAWAN082166463912 √ CORONAVAC
JL. ASAM LOR. SEKOLAH MARTUBUNGMedan Labuhan 085788684986 √ CORONAVAC
Merek Vaksin
A : Sinovac
B : Lainnya (Mohon Disebutkan Jenis Vaksin Yang Diterima Puskesmas/Fa
Kepersertaan BPJS
BPJS PBI
BPJS Non PBI
Non Anggota
Total
Pemberian Dosis
Dosis 1
Dosis 2
Total
Dosis I Dosis 2
Tanggal KETERANGAN
Screening Tanggal Tanggal
Vaksin n Vaksin
9/9/2021 9/9/2021 24004521 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 24004521 SELESAI
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 24004521 SELESAI
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 24004521 SELESAI
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 24004521 SELESAI
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 24004521 SELESAI
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 24004521 SELESAI
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 24004521 SELESAI
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 24004521 SELESAI
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 24004521 SELESAI
9/9/2021 9/9/2021 LANJUT VAKSIN 2
9/9/2021 9/9/2021 24004521 SELESAI
9/9/2021 9/9/2021 9/9/2021 24004521 SELESAI
Vaksin Yang Diterima Puskesmas/Faskes)
PJS
Tabel 10. Format Pencatatan Pelayanan Va
FORMAT PENCATATAN PELAY

TINGKAT PUSKESMAS/FASY

Nama Umur
No No.Registrasi NIK Penerima JK Pekerjaan Kel. Umur Alamat
Vaksin
(> 60Tahun)
ZAINUDDIN
1108170107
1 P-GCRL6BTJ BIN ALI L UMUM 41 Desa Batu 12 Kec. Cotgirek Kab. Aceh Utara Provinsi Aceh
790209
BASYAH
AULIA
2 P-IVDGUICZ
1271072512870002
AFANDI BIN L UMUM 34 Jln. Setia Budi Ujung Gg. Pribadi Kel. Medan Selayang Kec.
LEO (ALM)
ZAINAL
3 P-IB8URY4T
1207240703820001
ABIDIN BIN L UMUM 39 Jln. Besar Tembung Gg. Pisang No. 51 Kel Tembung Kec. P
M.KASIM
WAHYUDI
4 P-HYF7Y52O
1271083112780012
BIN L UMUM 43 Komplek TKBM Blok. B No. 11 Kel. Sei Mati Kec. Medan La
WARTIJO
FAHMI BIN
5 P-H23FWQG7
1271072706850002 L UMUM 36 JlN.Karya Ujung Gg Keluarga Link XI Kel. Helvetia Timur Ke
LUKMAN
DIAN
SAPUTRA
6 P-HMKZJ9HN
1271061111920007 L UMUM 29 Jln. Manggaan 1 Link. 4 Kel. Mabar Hilir Kec. Medan Deli
BIN
HARYONO
RUDI
DARWIN
7 P-J7PH1JL1
1271120104730001
BIN ABDUL L UMUM 48 Jln. IV Lr Melati LK 33 Kebun Bundar Kel. Pulau Kec. Medan
MANAN
(ALM)
DAYU DODI
PREDIKA
8 P-06SUSDN6
1271060512940007 L UMUM 26 Jln. Manggaan VII Lor Jaya Lk.16 Kel. Mabar Kec. Medan D
BIN
NGATIMIN
DIO
SUNDANA
9 P-3OWOS8GY
1207252508980002 L UMUM 23 Jln. Marelan Pasar 2 Barat Gg. Bersama Kel Terjun Kec. Me
BIN AHMAD
RIDWAN
TEGUH BIN
10 P-AN6QGCR7
1271122104830005
NASRIH L UMUM 39 Jln. M. Basir Gg. Marsidi Link. 31 Kel. Rengas Pulau Kec. M
(ALM)
11 P-1RXTZ4X9
1271062107960004
BRAMMANTY L UMUM 25 Jln. Kayu Putih Perumahan Rumah Susun KAyu Putih Kel. T
INDRA
12 P-9NBV7R1P
1271102510830006
YUSUF BIN L UMUM 37 Jln. Bromo Lorong Karya No. VIII Kel. Tegal Sari III Kec. Me
FIRDAUS
MULKAN
BIN ZAINAL
13 P-8QK8E1YN
1271121703860001 L UMUM 35 Jln. Rahmad Buddin Link.15 Kel. Terjun Kec. Medan Marela
ARIFIN
(ALM)
BENI
SUHADA
14 P-5Z3AL7FK
1207260504800001
BIN L UMUM 41 Jalan Terusan Dusun V Desa Bandar Setia Kec.PS Tuan
RADANI
(ALM)
15 P-4QK6POC5
1271122806740002
MUHAMMAD EL UMUM 47 Jln. Young Panah Hijau Link. IX Kel. Labuhan Deli Kec. Med
16 P-07XMAHPZ
1271081708950015
LEONARDO HL UMUM 26 Jln. Slebes No. I Lk. 43 Kel. Belawan II Kec. Medan Belawan
RENDI
AIRLANGG
17 P-MDTAHSF0
1103040207020001 L UMUM 19 GRIYA 2 MARTUBUNG PSR VI BLOK F KEL. TANGKAHAN
A BIN
JUNAIDI
WARSIDI
18 P-HMAMD2G2
1207212306680003 L RENTAN 53 Jln. Pertanian Desa Marindal I Kec. Patumbak Kab. Deli Ser
BIN TURUT
PAISAL BIN
T. SARIL
19 P-GYNBV0O7
1207230504800009 L UMUM 41 Jln. Suka Bumi Komplek Perumahan PTPN II Desa Sei Sem
LUTHAN
(ALM)
20 P-FHWEBYNC
1207231106000009
JUANDA PRA L UMUM 21 Dusun III Blok Gading Desa Tanjung Gsuta Kec. Sunggal Ka
BOBY
HARIADI
21 P-BEWHZGTZ
1271210407950001 L UMUM 26 Jln Bunga Asoka Gg. Sekolah No.18 Kel. Asam Kumbang K
BIN
SUMARNO
INDRA
GUNAWAN
22 P-CX9B9SAB
1271182005750008 L UMUM 46 Jln. Yos Sudarso Km. 7,8 Gg. Tape Kel. Tanjung Mulia Kec.
BIN GIMAN
(ALM)
23 P-EMMVKRZO
1272061308900004
RENO RAMADL UMUM 31 Jln.Pancing V Gg.Lontong Kebun Lada Martubung Kel.Besa
24 P-JKM2TAML
1271081209910002
DEDI HARIA L UMUM 29 Jln. Kl Yos. Sudarso Simpang Sicanang Kel. Belawan Bahag
M.AMIN
SIREGAR
BIN
25 P-I8MUCDQI
1209081305790001 L UMUM 43 Dusun VI Kel. Meranti Kec. Meranti Kab. Asahan
RUSLAN
SIREGAR
(ALM)
INDRA
SAPUTRA
26 P-KS1LUB1S
1271201404700006 L RENTAN 51 Jln. Pasar IV Mabar Hilir Kel. Mabar Hilir Kec. Medan Deli Ko
BIN
SYAHIRAN
LEGIMAN
BIN
27 P-JSC02GHF
1271120406640002 L RENTAN 57 Jln. Baut Link. IX Kel. Tanah 600 Kec. Medan Marelan
KLIWON
(ALM)
PUTRA
AGUNG
28 P-JYTKRVHG
1207242807900003 L UMUM 31 Jln. Besar Klumpang Dusun III Depok Jaya No. 5 Desa Klum
PRASETYO
BIN IRIYADI
LENDRO
SYAHPUTR
29 P-LRG8FE4A
1271203107930002 L UMUM 28 Jl.Perjuangan Porta Lk.1 Kel.Tanjung Mulia Kec.Medan Deli
A BIN
SALINO
IPAL TRI
SANDI BIN
30 P-IZ0AT4JH
1207230409820010 L UMUM 39 Jln. Sei Mencirim Desa Suka Maju
USLUDIN
(ALM)
ANTONI
BIN
31 P-OFSSIP9D
1271060606960003 L UMUM 42 Jln. Konggo Kongsi Dusun XII Desa Sei Semayang Kec. Su
SOFYAN
(ALM)
JOHAN
GULTOM
32 P-KYHEWPJ8
1207261408910012
BIN ALI L UMUM 30 Jln. Benteng Hulu Desa Tembung Kec. Percut Sei Tuan
PORANG
GULTOM
HARI
SAHPUTRA
33 P-KGYYEZWC
1271061705810005 L UMUM 40 Jln. Dusun 11 Sidoarjo Desa Pematang Johar Kec. Labuhan
BIN SARIF
(ALM)
WAHYU
ILHAM
34 P-LJMPQQWH
1210012807970005
MUNTHE L UMUM 24 Kampung Jawa Kel Padang Matinggi.Kec Rantau Utara Kab
BIN IBNU
MUNTHE
HARUNSYA
35 P-LBG2SXW7
1271121104940003
H BIN L UMUM 27 Jln. Titi Pahlawan Paya Pasir Gg. Sapar Link. V Kel. Rengas
MAHMIR
36 P-MNSNA6ZF
1207270404980002
MUHAMMAD L UMUM 23 Jln.Batang Kuis Desa Baru Dusun V Kec.Batang Kuis
MAHADI
37 P-YS24BXZT
1271141706900003
PUTRA BIN L UMUM 31 Jln.Padang No.68 Kel.Banten Kec.Medan Tembung
SUKUR
ABD
MANAN BIN
38 P-QQ3SFZ0V
1271060612870001 L UMUM 34 Jalan Platina VII B No. 21 Lingk. II Kel. Titi Papan Kec. Med
SUYANTO
(ALM)
DARMA
PRATAMA
39 P-NEP5G01O
1222050102020001 L UMUM 19 Jln.Veteran Pasar X Tanah Garapan Desa Manunggal
BIN
AFRIZAL
40 P-NQ0JMF1G
1271080408970003
JUNAIDI SYA L UMUM 24 Jln. Baru Link. XIV Bagan Deli Kec. Medan Belawan Kota M
BUDI
HARIANTO
41 P-RS1QX6RN
1271032309800006 L UMUM 41 Jln. Istiqomah Gg.Rukun Link. XI Kel. Helvetia Timur Kec. M
BIN
SUDARWIN
BOBY
SYAHPUTR
42 P-RKRXZ3F3
1271042801990002
A BIN L UMUM 22 Jln. Jermal 12 No.36 Kel. Denai Kec. Medan Denai
SUPRIK
(ALM)
RAHMAD
HIDAYAD
43 P-RRX8EN3B
1271131609840003 L UMUM 37 Kp. Bahari Link. X Kel. Besar Kec. Medan Labuhan Kota Me
BIN
ANWAR
FACHRI
44 P-R43KUYRU KURNIA L UMUM 22 Jln. Rumah Potong Hewan Link. X Kel. Mabar Kec. Medan D
BIN IRWAN
1271060110980002
HEKI
SUWANDI
45 P-RS9T3LJV
1271062309940005
BINTI L UMUM 27 Jln.Aluminium III Gg.Legiman No. 80 Kel. Tanjung Mulia kec
ISKAK
(ALM)
ADE
INDRAWAN
46 P-NYQ3G8SL
1271132104910002 L UMUM 30 Jln. Chaidir Perum Kampung Nelayan Indah Blok GG No. 20
BIN
AMRINUR
47 P-ONLJIOS7
1271120505910001
JEFRI UZYAI L UMUM 30 Jln. Pasar Nipon Link.1 Siombak Kel. Labuhan Deli Kec. Me
48 P-RV8P0IWB
1271043006930001
JUNIUS HOT L UMUM 28 Jln. Datuk Kabu Gg. Datuk VI Pasar III Desa Lamtoro Kec. P
VICTOR
SINAGA
49 P-RSCTKSD5
1271030411760007
BIN TAHI L UMUM 44 Jln. Perjuangan Gg. Musyawarah No. 9 Kel. Sidorejo Kec. M
SINAGA
(ALM)
50 P-OW57DGPM
1271080510850001
INDRA MAHA L UMUM 36 Jln. Stasion Lor Perhatian Kel. Belawan II
51 P-RVVPZXIL
1271130606710001
ABDUL RAHM L RENTAN 50 Jl.Yos Sudarso Lk.XXI Kel.Pekan Labuhan Kec.Medan Labu
52 P-QC3Z5O8W
1271122202940002
RAMADANI B L UMUM 27 Jln.Marelan I Lk.07 Pasar IV Kel.Terjun Kec.Medan Marelan
BOWO
ARDIANTO
53 P-RSSETF9S
1271121606820001 L UMUM 39 Jln. Marelan III Barat Kel. Rengas Pulau Kec. Medan Marela
SUJADI BIN
SUJADI
ZAINUL
54 P-RSRE8MHM
1271193112730006
ARIFIN BIN L UMUM 48 Jln. Zainul Arifin Kp. Kubur No.102 Kel. Petisah Tengah Kec
ARIFIN
LUKMAN M
JAMIL BIN
55 P-RTBWVVFB
1271121108800009 L UMUM 41 Jln.Marelan Raya Gg. Keluarga Lk. 1 Kel. Tanah 600 Kec. M
M.JAMIL
(ALM)
ABDUL
HAMID BIN
56 P-RUO352YN
1271081603830002 L UMUM 38 Jln. Slebes Paluh Perta Kandang Lembu Depan Mesjid Jam
ABDUL
MUIS
KOKO
MEIRYAN
57 P-RUVDAXOK
1271102305800003
ANWAR L UMUM 41 Jln.Medan Area Gg.Puri No.918 Kel. Kota Matsum III Kec. M
BIN
SAMSUL
ANGGA
LESMANA
58 P-RV4KOEYH
1271062004950003 L UMUM 26 Jln. Alumunium Raya Sanusi Link 20 Kel. Tanjung Mulia Kec
BIN
SAKINO
EDI
WIBOWO
59 P-RV47OHSF
1271061707860004
BIN L UMUM 35 Jln.Kuala Simpang Desa Terang Bulan Kec. Aek Natas Kab
MISNAN
(ALM)
RIZKY
RIVALDI
60 P-RVOW5HTE
1271201704000004 L UMUM 21 Jln. Mesjid 7 Pulo Brayan Bengkel Kec. Medan Timur Gg. M
BIN
JULIANTO
BENI
NASUTION
61 P-RVJSYIEM
1271082206890002
BIN L UMUM 32 Jln. Kl.Yos Sudarso Km. 21,5 Link. X kel. Belawan Bahari
HOTLAN
EFENDI
JUANDA
BIN M.
62 P-RVYGVG5C
1271050101790001 L UMUM 42 Sekata Lor II Gg.Nusa Indah Kel. Agul Kec.Medan Barat Ko
NURDIN
(ALM)
63 P-RWF0ZBNH
1207042804830007
IRWANTO BI L UMUM 39 Jln.Suka Damai No.47 Lk.IV Kel.Suka Ramai Kec.Binjai Bar
64 P-RWQLNJJM
1207243003940001
MUHAMMAD BIL UMUM 27 Dsn. II Timer Desa Klambir Lima Kampung Kec. Hamparan
FERRY
IRAWAN
65 Y-0117K6PB
1271032912740003
BIN L UMUM 46 Jln. Dahlia Raya No. VI Blok. 15 Perumnas Helvetia Link. XI
SALMAN
(ALM)
66 P-RWNVIOVA
1275032303800001
M. IDRIS L UMUM 41 Jln. Danau Blidah Link. III Kel. Sumber Karya Kec. Binjai Tim
AGUS BIN
67 P-RWI7UUDS
1271131708620008
JAMALUDD L RENTAN 59 Jln. Bakti ABRI Gg. Panitera Link. III Kel. Martubung Kec. M
IN (ALM)
HASYIM
BIN
68 P-RW2LAYN7
1271060805940005 L UMUM 27 Jl.Yos Sudarso Lk.II Kel.Mabar Kec.Medan Deli
MUKLIS
HANIPUDIN
YUDHISTIR
A BIN
69 P-RWCBPCDU
1271025110890002 L UMUM 31 Jln. Sei Kapuas No. 63 Kel. Batubara kec. Medan Sunggal
RUSUYUS
(ALM)
DEKA
PUTRA BIN
70 P-RW9HQEHE
1271200605810003 L UMUM 40 Jln. Kepribadian Gg. Setia Abadi No.10 Link.I Kel. Pulo Bray
YANTO
(ALM)
71 P-RWTUGAIA
1271060201710002
BAHARUDDINL RENTAN 50 Jln. RPH Kel. Mabar Kec. Medan Deli Kota Medan
LEGIRIN
BIN
72 P-RUKHHLAL
1271042804830007 L UMUM 38 Jln.Tangguk Bongkar III No.47 Kel.Tegal Sari II Kec.Medan
JAMINGUN
(ALM)
NAIM BIN
73 S-E56C4D2A
1207251107600002 L UMUM 25 PSR IV JL PABRIK ES DUSUN 9 DS PEMATANG JOHAR K
ARMAYA
DIAN
SUGARA
74 P-RTHIGQ7D
1271130404920001 L UMUM 29 Jln. Pancing V Link II Rt. 000 Rw. 000 Kel. Besar Kec. Meda
BIN
SUGITO
SOFIAN
SIHOMBIN
75 S-3ADEDD80
1271062106860004
G BIN L LANSIA 63 Jln.Platina III Gg.Alfalah No.109 Lk.12 Kel.Titi Papan Kec.M
M.SIHOMBI
NG (ALM)
IFYAN NUR
SALSABILA
76 P-RU6G1T3T
1271212707910001 L UMUM 30 Jln. Bunga Mawar IV Dalam No.16 Kel. PB Selayang II Kec.
BIN RAMLI
KARDI
77 P-RUAMYB9A
1271210109810001
DODI IRAWA L UMUM 40 Jl. Setia Budi Tj. Sari. Psr 2 Medan Selayang
78 P-7GFYYNZD
1271140512980004
NIKO ABDUR L UMUM 22 SIDOMULYO PASAR IX DESA BANDAR KHALIFAH
79 P-G6BPXYCP
1271061110970002
ANDREAN Y L UMUM 23 JL. MANGAAN 1 GG. BAHAGIA B NO. 50 LK. VII MABAR
80 P-RTBXE8Z4
1207260112000002
AMI AMAND L UMUM 26 DUSUN VIII PERMADI SAENTIS PERCUT SEI TUAN
81 P-RTM6IKDG
1207263008670003
SUJONO L RENTAN 54 JL. SAINTIS PERCUT SEI TUAN
82 P-DWQCOHB1
1271183108990002
MUHAMMAD L UMUM 22 PSR VII TENGAH DEPAN GG. MAWAR DESA TEMBUNG
83 P-RT2B06NM
1271052511860002
HANAFI L UMUM 35 JL. PANCING 1 MARTUBUNG
84 P-RU8UDB59
1271130310960001
ARWIANLI L UMUM 25 JLN.MARELAN RAYA LIK.08 GG.SUMARSO
DICKY
SAPUTRA
85 1207242309010000 L UMUM 19 Gg. Sedar Dusun II Desa Kelambir V Kebun Kec. Hamparan
BIN
MISGIANTO
HERIAWAN
SUMANTRI
86 1207230309100003 L UMUM 40 Jln. Kompos Dusun III Desa Pujimulyo Kec. Sunggal Kab. D
BIN
M.IDRIS
IRWAN
RUDIANSA
87 1207042804830007
H BIN L UMUM 39 Dusun IX Desa Besar Desa Sei Semayang Kec. Sunggal Ka
SAMSUL
(ALM)
OEKIE
BENFIKA
88 1271120117800002
ADAMY BIN L UMUM 42 Jln. R.A Kartini No. 9 Medan Polonia Kota Medan
USMAN
(ALM)
FAHRUL
89 1271260601930005 L UMUM 28 Jln.Setia Budi No.28 Kel.Tanjung Rejo Kec.Medan Sunggal
ROZI
MUHAMMA
90 1207262701000000
D AIDIR BIN L UMUM 21 Jln. Bala Adat Kel .Sampali Kec. Percut Sei Tuan Kab. Deli S
AWALUDIN
HARUN BIN
91 127112170718790003
M. YUNUS L UMUM 42 Jln. Datuk Rubiah Gg. Edy Sepakat Link. 29 Kel. Rengas Pu
(ALM)
PANDU
PRANATA
92 196706161985031022 L UMUM 22 Dusun Pasar I Barat Desa Paya Bakung Kec. Hamparan Pe
BIN
SURYONO
93 1271060712550003
DEDI SYAHP L UMUM 40 Jln. Pancing Gg. Talem Indah Kel. Mabar Kec. Medan Deli K
ERWIN
LUBIS BIN
94 1271200902060007
M. SAFII L RENTAN 55 JL H ANIF DS SAMPALI KEC PERCUT SEI TUAN KAB DEL
LUBIS
(ALM)
DEDI
DERMAWA
95 1271132104910002
N BIN L UMUM 30 Jln. Young Panah Hijau Link. 07 Kel. Labuhan Deli Kec. Med
ISKANDAR
MUDA
96 1271201706880022
GANDA SOE L UMUM 33 Jl. Sidomulyo No. 33 B Kel Pulo Brayan Barat Kec. Medan T
JOKO BIN
97 120761601190033 l UMUM 19 Desa Saentis Dusun 9 Kec. Percut Sei Tuan Kab. Deli Serda
PERAN
SUTEJO
BIN M.
98 12072604406780013 L UMUM 43 Jln. Bunga Raya Kel. Asam Kumbang Kec. Medan Selayang
YUSUF
(ALM)
JASRUDDI
N BIN
99 11081915803860001 L UMUM 35 Desa lhokiboh Kec.Baktia Kab.Aceh Utara
M.SARIF
(ALM)
ANGGA
SYAHPUTR
100 0250182708910003
A BIN L UMUM 30 Jln.Bustaman Gg.Wijaya Kesuma Bandra Khalipa Kec.PS T
SUDARSIM
(ALM)
Keterangan
D : Lainnya
E : Tidak Bekerja
Kelompok Umur
18-30
31-45
46-59
Total
Pekerjaan
A
B
C
D
E
Pencatatan Pelayanan Vaksinasi COVID-19 di Tingkat Fasyankes
T PENCATATAN PELAYANAN VAKSINASI COVID-19

GKAT PUSKESMAS/FASYANKES/POS VAKSINASI

Dosis I
Merek Tanggal
BPJS PBI Pemberian
PBI Anggota
Vaksin
c. Cotgirek Kab. Aceh Utara Provinsi Aceh 085276657296 √ CORONAVAC 9/10/2021 9/10/2021
ung Gg. Pribadi Kel. Medan Selayang Kec. Med 085361711316 √ CORONAVAC 9/10/2021 9/10/2021
ung Gg. Pisang No. 51 Kel Tembung Kec. Percut 085270687339 √ CORONAVAC 9/10/2021 9/10/2021
Blok. B No. 11 Kel. Sei Mati Kec. Medan Labuhan 082239622363 √ CORONAVAC 9/10/2021 9/10/2021
Gg Keluarga Link XI Kel. Helvetia Timur Kec. Me 085373244246 √ CORONAVAC 9/10/2021 9/10/2021
Link. 4 Kel. Mabar Hilir Kec. Medan Deli 085262775637 √ CORONAVAC 9/10/2021 9/10/2021
LK 33 Kebun Bundar Kel. Pulau Kec. Medan Mar 085261145095 √ CORONAVAC 9/10/2021 9/10/2021
II Lor Jaya Lk.16 Kel. Mabar Kec. Medan Deli Ko 083801667701 √ CORONAVAC 9/10/2021 9/10/2021
ar 2 Barat Gg. Bersama Kel Terjun Kec. Medan M 085270808805 √ CORONAVAC 9/10/2021 9/10/2021
Marsidi Link. 31 Kel. Rengas Pulau Kec. Medan 085361680633 √ CORONAVAC 9/10/2021 9/10/2021
erumahan Rumah Susun KAyu Putih Kel. Tanjung 082269010976 √ CORONAVAC 9/10/2021 9/10/2021
g Karya No. VIII Kel. Tegal Sari III Kec. Medan Ar 085372782380 √ CORONAVAC 9/10/2021 9/10/2021
din Link.15 Kel. Terjun Kec. Medan Marelan 082360653733 √ CORONAVAC 9/10/2021 9/10/2021
usun V Desa Bandar Setia Kec.PS Tuan 085761293759 √ CORONAVAC 9/10/2021 9/10/2021
h Hijau Link. IX Kel. Labuhan Deli Kec. Medan Ma 081264130634 √ CORONAVAC 9/10/2021 9/10/2021
Lk. 43 Kel. Belawan II Kec. Medan Belawan 081249516897 √ CORONAVAC 9/10/2021 9/10/2021
UBUNG PSR VI BLOK F KEL. TANGKAHAN KEC 081260331224 √ CORONAVAC 9/10/2021 9/10/2021
sa Marindal I Kec. Patumbak Kab. Deli Serdang 081283972083 √ CORONAVAC 9/10/2021 9/10/2021
omplek Perumahan PTPN II Desa Sei Semayang K085275520220 √ CORONAVAC 9/10/2021 9/10/2021
ading Desa Tanjung Gsuta Kec. Sunggal Kab. Del 082360799587 √ CORONAVAC 9/10/2021 9/10/2021
Gg. Sekolah No.18 Kel. Asam Kumbang Kec. Me 082161107578 √ CORONAVAC 9/10/2021 9/10/2021
Km. 7,8 Gg. Tape Kel. Tanjung Mulia Kec. Medan 082160719091 √ CORONAVAC 9/10/2021 9/10/2021
g.Lontong Kebun Lada Martubung Kel.Besar Kec. 082172376846 √ CORONAVAC 9/10/2021 9/10/2021
rso Simpang Sicanang Kel. Belawan Bahagia Ke 081310668972 √ CORONAVAC 9/10/2021 9/10/2021
eranti Kec. Meranti Kab. Asahan 081397380135 √ CORONAVAC 9/10/2021 9/10/2021
bar Hilir Kel. Mabar Hilir Kec. Medan Deli Kota M 085206437620 √ CORONAVAC 9/10/2021 9/10/2021
Kel. Tanah 600 Kec. Medan Marelan 082361530987 √ CORONAVAC 9/10/2021 9/10/2021
ang Dusun III Depok Jaya No. 5 Desa Klumpang 081263454528 √ CORONAVAC 9/10/2021 9/10/2021
rta Lk.1 Kel.Tanjung Mulia Kec.Medan Deli Kota 082361922891 √ CORONAVAC 9/10/2021 9/10/2021
Desa Suka Maju 085275654810 √ CORONAVAC 9/10/2021 9/10/2021
gsi Dusun XII Desa Sei Semayang Kec. Sunggal K 082273580863 √ CORONAVAC 9/10/2021 9/10/2021
u Desa Tembung Kec. Percut Sei Tuan 081263584345 √ CORONAVAC 9/10/2021 9/10/2021
doarjo Desa Pematang Johar Kec. Labuhan Deli K 085213906857 √ CORONAVAC 9/10/2021 9/10/2021
Kel Padang Matinggi.Kec Rantau Utara Kab. Labu 081326182190 √ CORONAVAC 9/10/2021 9/10/2021
n Paya Pasir Gg. Sapar Link. V Kel. Rengas Pul 082175942026 √ CORONAVAC 9/10/2021 9/10/2021
Desa Baru Dusun V Kec.Batang Kuis 085270342247 √ CORONAVAC 9/10/2021 9/10/2021

8 Kel.Banten Kec.Medan Tembung 085296449774 √ CORONAVAC 9/10/2021 9/10/2021
B No. 21 Lingk. II Kel. Titi Papan Kec. Medan De 082274095923 √ CORONAVAC 9/10/2021 9/10/2021
r X Tanah Garapan Desa Manunggal 082367665040 √ CORONAVAC 9/10/2021 9/10/2021
V Bagan Deli Kec. Medan Belawan Kota Medan 085265705371 √ CORONAVAC 9/10/2021 9/10/2021
g.Rukun Link. XI Kel. Helvetia Timur Kec. Medan 08566015936 √ CORONAVAC 9/10/2021 9/10/2021
o.36 Kel. Denai Kec. Medan Denai 082391604075 √ CORONAVAC 9/10/2021 9/10/2021
X Kel. Besar Kec. Medan Labuhan Kota Medan 082162795134 √ CORONAVAC 9/10/2021 9/10/2021
ng Hewan Link. X Kel. Mabar Kec. Medan Deli Ko 082361531851 √ CORONAVAC 9/10/2021 9/10/2021
Gg.Legiman No. 80 Kel. Tanjung Mulia kec. Meda 081260110602 √ CORONAVAC 9/10/2021 9/10/2021
m Kampung Nelayan Indah Blok GG No. 20 Kel. 082274411933 √ CORONAVAC 9/10/2021 9/10/2021
Link.1 Siombak Kel. Labuhan Deli Kec. Medan M 085276459906 √ CORONAVAC 9/10/2021 9/10/2021
Gg. Datuk VI Pasar III Desa Lamtoro Kec. Percut 082274697746 √ CORONAVAC 9/10/2021 9/10/2021
Gg. Musyawarah No. 9 Kel. Sidorejo Kec. Medan 085353533678 √ CORONAVAC 9/10/2021 9/10/2021
Perhatian Kel. Belawan II 081310668972 √ CORONAVAC 9/10/2021 9/10/2021

k.XXI Kel.Pekan Labuhan Kec.Medan Labuhan K 085262660246 √ CORONAVAC 9/10/2021 9/10/2021
07 Pasar IV Kel.Terjun Kec.Medan Marelan 08126587730 √ CORONAVAC 9/10/2021 9/10/2021
arat Kel. Rengas Pulau Kec. Medan Marelan 082161001393 √ CORONAVAC 9/10/2021 9/10/2021
Kp. Kubur No.102 Kel. Petisah Tengah Kec. Me 081396546266 √ CORONAVAC 9/10/2021 9/10/2021
a Gg. Keluarga Lk. 1 Kel. Tanah 600 Kec. Medan 085206472780 √ CORONAVAC 9/10/2021 9/10/2021
h Perta Kandang Lembu Depan Mesjid Jamik Wasliy081310668972 √ CORONAVAC 9/10/2021 9/10/2021
Gg.Puri No.918 Kel. Kota Matsum III Kec. Medan 085361288501 √ CORONAVAC 9/10/2021 9/10/2021
Raya Sanusi Link 20 Kel. Tanjung Mulia Kec. Med 085276084778 √ CORONAVAC 9/10/2021 9/10/2021
ng Desa Terang Bulan Kec. Aek Natas Kab. Labuh 082360572588 √ CORONAVAC 9/10/2021 9/10/2021
o Brayan Bengkel Kec. Medan Timur Gg. Mawar Pa082165333427 √ CORONAVAC 9/10/2021 9/10/2021
rso Km. 21,5 Link. X kel. Belawan Bahari 081375018752 √ CORONAVAC 9/10/2021 9/10/2021
Nusa Indah Kel. Agul Kec.Medan Barat Kota Med 081377486886 √ CORONAVAC 9/10/2021 9/10/2021
No.47 Lk.IV Kel.Suka Ramai Kec.Binjai Barat 082288874158 √ CORONAVAC 9/10/2021 9/10/2021
sa Klambir Lima Kampung Kec. Hamparan Perak K082388368389 √ CORONAVAC 9/10/2021 9/10/2021
No. VI Blok. 15 Perumnas Helvetia Link. XIII Kel. 085274835994 √ CORONAVAC 9/10/2021 9/10/2021
h Link. III Kel. Sumber Karya Kec. Binjai Timur 081397665266 √ CORONAVAC 9/10/2021 9/10/2021
Gg. Panitera Link. III Kel. Martubung Kec. Medan 082391617849 √ CORONAVAC 9/10/2021 9/10/2021
k.II Kel.Mabar Kec.Medan Deli 081260134392 √ CORONAVAC 9/10/2021 9/10/2021
No. 63 Kel. Batubara kec. Medan Sunggal 082362523742 √ CORONAVAC 9/10/2021 9/10/2021
Gg. Setia Abadi No.10 Link.I Kel. Pulo Brayan B 085763140446 √ CORONAVAC 9/10/2021 9/10/2021
bar Kec. Medan Deli Kota Medan 083803089002 √ CORONAVAC 9/10/2021 9/10/2021
gkar III No.47 Kel.Tegal Sari II Kec.Medan Denai 082164635400 √ CORONAVAC 9/10/2021 9/10/2021
IK ES DUSUN 9 DS PEMATANG JOHAR KEC. 082361833434 √ CORONAVAC 9/10/2021 9/10/2021
nk II Rt. 000 Rw. 000 Kel. Besar Kec. Medan Lab 082361956685 √ CORONAVAC 9/10/2021 9/10/2021
Alfalah No.109 Lk.12 Kel.Titi Papan Kec.Medan D 082365599934 √ CORONAVAC 9/10/2021 9/10/2021
r IV Dalam No.16 Kel. PB Selayang II Kec. Meda 081396319143 √ CORONAVAC 9/10/2021 9/10/2021
Sari. Psr 2 Medan Selayang 081269682900 √ CORONAVAC 9/10/2021 9/10/2021

SAR IX DESA BANDAR KHALIFAH 082360167517 √ CORONAVAC 9/10/2021 9/10/2021
GG. BAHAGIA B NO. 50 LK. VII MABAR 085206122077 √ CORONAVAC 9/10/2021 9/10/2021
MADI SAENTIS PERCUT SEI TUAN 085262682676 √ CORONAVAC 9/10/2021 9/10/2021
RCUT SEI TUAN 081397025676 √ CORONAVAC 9/10/2021 9/10/2021
H DEPAN GG. MAWAR DESA TEMBUNG 081263807463 √ CORONAVAC 9/10/2021 9/10/2021
MARTUBUNG 081370168888 √ CORONAVAC 9/10/2021 9/10/2021
RAYA LIK.08 GG.SUMARSO 085371130333 √ CORONAVAC 9/10/2021 9/10/2021
n II Desa Kelambir V Kebun Kec. Hamparan Perak 085296999100 √ CORONAVAC 9/10/2021 9/10/2021
un III Desa Pujimulyo Kec. Sunggal Kab. Deli Ser 082144506418 √ CORONAVAC 9/10/2021 9/10/2021
esar Desa Sei Semayang Kec. Sunggal Kab. Deli 082273034457 √ CORONAVAC 9/10/2021 9/10/2021
o. 9 Medan Polonia Kota Medan 082268613848 √ CORONAVAC 9/10/2021 9/10/2021
.28 Kel.Tanjung Rejo Kec.Medan Sunggal 082376730749 √ CORONAVAC 9/10/2021 9/10/2021
el .Sampali Kec. Percut Sei Tuan Kab. Deli Serdan 082370436901 √ CORONAVAC 9/10/2021 9/10/2021
h Gg. Edy Sepakat Link. 29 Kel. Rengas Pulau K 085296611723 √ CORONAVAC 9/10/2021 9/10/2021
arat Desa Paya Bakung Kec. Hamparan Perak Kab082259392615 √ CORONAVAC 9/10/2021 9/10/2021
Talem Indah Kel. Mabar Kec. Medan Deli Kota M 081375816137 √ CORONAVAC 9/10/2021 9/10/2021
AMPALI KEC PERCUT SEI TUAN KAB DELI SE 082361922891 √ CORONAVAC 9/10/2021 9/10/2021
h Hijau Link. 07 Kel. Labuhan Deli Kec. Medan M 082274411933 √ CORONAVAC 9/10/2021 9/10/2021
. 33 B Kel Pulo Brayan Barat Kec. Medan Timur K 081375017002 √ CORONAVAC 9/10/2021 9/10/2021
sun 9 Kec. Percut Sei Tuan Kab. Deli Serdang 081310668972 √ CORONAVAC 9/10/2021 9/10/2021
Kel. Asam Kumbang Kec. Medan Selayang Kec. 081310668972 √ CORONAVAC 9/10/2021 9/10/2021
ec.Baktia Kab.Aceh Utara 081370652919 √ CORONAVAC 9/10/2021 9/10/2021
.Wijaya Kesuma Bandra Khalipa Kec.PS Tuan 085370882272 √ CORONAVAC 9/10/2021 9/10/2021
Merek Vaksin
A : Sinovac
Kepersertaan BPJS
BPJS PBI
BPJS Non PBI
Non Anggota
Total
Pemberian Dosis
Dosis 1
Dosis 2
Total
Dosis I Dosis 2
Tanggal KETERANGAN
No.Batch Pemberian No.Batch
Vaksin









uskesmas/Faskes)
Tabel 10. Format Pencatatan Pelayanan V


Nama Penerima Umur

Vaksin
(> 60Tahun)
1 P-15HNPRT8 1271130305690004 SUKARDI L B 52 LK 2 BATANG
2 P-1JO4VGP0 1271134208020001 LOLA AMANDA AGUSTIN P UMUM 19 LK XII LOR V
3 P-1INNDCCX 1271132010010005 INDRA LESMANA L B 19 LK XII SEI M
4 P-2T6FPCNW 1271123005820002 EDIKA P B 39 LK I SEI MAT
5 Q-000N4UB3 1271134911820001 RIAMA AGUSTINA SIMA P UMUM 32 LK. XV SEI
6 P-2XHHW3R6 1271134911820001 ADEK L B 38 LK IV SEI MA
7 P-32RREWIT 1271134810720004 MARIA P UMUM 48 JL. KAIL LK
8 J-0003OY4X 1271130405000001 DANIEL YOSEF L UMUM 21 LR 7 LK VIII
9 P-3MUBKZ36 1271132906920005 ERWIN JUNIANTO PAND L UMUM 29 LK II SEI MA
10 S-EF5B8E75 1271130505450001 MARIFIN SIPAHUTAR L LANSIA 76 LK XIV SEI
11 P-4DT9GUO8 1271135805890006 SINTA ROSLINA SIRAIT P UMUM 32 LK XVII SEI
12 P-48OEDIWD 1201174208920001 FITRI YUNITA SIMATUP P UMUM 28 LK VIII SEI
13 P-4NJMN6RZ 1271136702030003 TIO FEBIOLA BR SIMAN P UMUM 18 LK XVII SEI
14 P-4T4KL8JQ 1271134206640002 RESTERIDA TAMPUBOL P RENTAN 57 LK XIV SEI
15 P-5C6PO4GJ 1271130501880006 ALI HIDAYAT L B 33 LIK. 12 SEI
16 P-56F3PP8B 1271134212850002 DEMSE MARJUITA SIM P UMUM 35 LOR 5 LK XI
17 P-5CMKGD6U 1271134702850002 DESI MAULANI P B 35 LOR 5 LK XI
18 P-5ILNK5IK 1271132802740003 JURAGAN EDISON SIBU L B 47 JL. KAIL LK
19 P-0K7VO9R3 1211034101010001 JANITA PUTRI NAINGG P UMUM 21 LK IX KOMP
20 S-31AFC919 1271135609590001 DERMAWAN BR SIMBO P LANSIA 62 LINGK IX KE
21 P-1STEDCEX 1271134308810004 AGUSTINA SIMANJUNT P B 40 LK XIV SEI
22 P-52NMQK7A 1271132704800005 M SYAHRUL FAHMI L B 41 LK VII SEI M
23 Q-000MZ40M 1271066804080003 ADELI FEBIOLA KABAN P REMAJA 13 PERUMAHAN
24 P-2NQ96W1E 1271135008040001 VANNI INTAN MEDIKA S P REMAJA 17 LK VII SEI M
25 P-3I06LYWC 1271133112010003 FAKHRIZULMI L UMUM 20 LK VI LOR II
26 P-4CUQHVO8 1271135708040003 GRECIA AGUSTIN M M P REMAJA 17 LK VII SEI M
27 J-0000UPX8 1271131212960001 WERILEO JANTER SIMA L UMUM 24 SEI MATI LIN
28 J-0003H1EK 1271136003030001 YOSIA DEVI ANDINI BR P UMUM 18 LK IX SEI MA
29 P-5VRJCFY8 1271135512780006 SATIYAH P B 43 LK I SEI MAT
30 P-62KVEFWV 1271136505880005 MUTIAH P B 32 LK I SEI MAT
31 P-6FSUFJDY 1271134701010004 RIZKI WULANDARI P UMUM 20 LK XII SEI M
32 P-6JYQEISO 1271133105970002 R INSAN FAJRIN CANIA L UMUM 24 LK XII SEI M
33 P-6OUYLC2X 1271136310710003 LISBET GULTOM P B 50 LK VII SEI M
34 P-7L1E8K6O 1271184604700001 AGNES SIHOMBING P B 51 JL. PELITA
35 P-7RMHI7OJ 1271180605980001 DAVID ERWIN SILITONG L UMUM 23 JL. PELITA
36 S-1753BA26 1271133010520001 RUBEN SITORUS L LANSIA 69 LK IX SEI MA
37 S-3283863A 1271130406600003 JANNUS SITORUS L LANSIA 61 LK VIII SEI
38 P-7GOX2O5V 1271134308020002 RARA NABILA SYAHNUR P UMUM 19 LK XII SEI M
39 P-7WQ9WIQI 1271136806830001 JUNITA CHANDRA DEW P B 38 LK IX SEI MA
40 P-80N26XMK 1271082511860002 HERIANTO L B 34 LK XII SEI M
41 P-896LNZCM 1207263009960009 ABDUL KHOLIQ L B 25 LK II SEI MA
42 P-79EETW4P 1271131410030003 MHD ANGGI RIZKI LUBI L UMUM 18 LK IV SEI MA
43 P-8P9GN0IQ 1271135411850005 ELVINA TAMBA P B 36 LK XIII SEI
44 P-8U10CT8A 1271131510000002 GABRIEL FRICHLES SIR L UMUM 21 LK III SEI MA
45 P-8Z894C7V 1271131412740002 MANGARA MAJU MARP L B 46 LK XIII SEI
46 S-883421B2 1271132207450001 JASMEN TAMPUBOLON L LANSIA 76 LK IX SEI MA
47 P-9M8LVW75 1271130310870003 KHAIRUL BAHAR L B 35 LK V SEI MA
48 P-9AVLCAV8 1271030105840008 DENNY HALOMOAN HUT L B 37 LK. V SEI MA
49 Q-000MZ40M 1271066804080003 ADELI FEBIOLA KABAN P REMAJA 13 PERUMAHAN
50 Q-000ITFZN 1271131809860004 EDUWIN L B 35 LOR VI LING
51 J-0003D2F7 1271135709000001 MAHARANI SAHPUTRI P B 21 LINGK. XI SE
52 J-0003J4IZ 1271134203960002 VINA AUDINA P UMUM 25 LK. I SERUW
53 P-9R13FB7F 1271136111940002 LIA ANGGRIANI HUSAIN P B 26 LK X SEI MA
54 P-9WJ9YBZM 1271135505770009 FITRIANI P B 44 LK III SEI MA
55 P-A23ML4JI 1271136012780007 VERAWATI P B 42 LK V SEI MA
56 P-A7SA4MW8 1271131609030002 NURSIDIQ L UMUM 18 LK II SEI MA
57 P-AJLJATUV 1271132705840003 PRIO PRUTO SINAGA L B 37 LINGK. VIII
58 P-AZJMRXHH 1271136512630004 RIAMA MAYA SIPAHUTA P RENTAN 57 LK. VI SEI M
59 P-B3LLVIUB 1271136712800005 LINCE SINAGA P B 41 LINGK.VII SE
60 P-B73ZDOY4 1271134207780003 JULI SUSILAWATI SIPA P B 43 LINGK. VII S
61 P-BAES9MXG 1271136303750007 ROSITA PANJAITAN P B 46 LING. XI SEI
62 P-BDMH1VAB 1271134604000002 ESTER PAULINA PURBA P UMUM 21 LINGK. XI SE
63 P-BFTYTLZ6 1271135602900002 SRI MALASARI P B 31 JL KAIL LK.
64 P-BMADY7VQ 1271131601020001 MUHAMMAD AGUNG NUR L UMUM 19 LINGK. I SE
65 P-BP2R2GFJ 1271121104910002 ARIFIN RAMADHANA SI L B 30 LINGK. V SE
66 P-BS2SXRZ1 1271131411770001 MOANG THIN PURBA L B 44 LINGK. XV S
67 P-BUZA03TH 1271085210820001 NUR AMITA P UMUM 38 KOMP. TKBM
68 P-BY54P9WD 1271085104020002 AYU NURFADILLAH P UMUM 19 KOMP. TKBM
69 P-C9CDHEKW 1271134701850006 SARDA SIMALANGO L B 36 LINGK. VIII
70 P-CBXADDTB 1211112205620001 MADONG PANJAITAN L RENTAN 59 LINGK. XIV
71 P-CEHI4TLF 1271135311030002 BUNGA TRESYA SIMAN P REMAJA 17 LINGK. XIV
72 P-CIROQKBO 1271130101870003 HELMI SAFRIAN L B 33 LINGK. III B
73 P-CLJQQTPU 1271056606960001 DEA SASABILA IRAWAN P UMUM 25 JL.KAIL LK.
74 P-CWE1KCDX 1271136412860001 ESTI BR NAINGGOLAN P B 35 LK XIV SEI
75 P-D4TCXJB3 1271131303910004 PANGIHUTAN TUA SIHA L B 30 LINGK. XIV
76 P-D78NQOQN 1271136107800002 JULIANA SIMANJUNTAK P B 41 LK VII SEI M
77 P-D8UGCMAR 1271135406040003 ANGGI CANITA BR SIM P REMAJA 17 LINGK. IX SE
78 P-DBML4GOS 1271131107720002 TORUS SIMANJUNTAK L B 49 LINGK. IX SE
79 P-DFE3BI4S 1271134811780001 NURI ANDRIANI P UMUM 43 LINGK. X SE
80 P-DI0VEVJY 1271135806020003 WIDIA ANISA PARAPAT P UMUM 19 LINGK. IX K
81 P-DRAVGTQZ 1271126007760003 WANTI SIRINGORINGO P UMUM 45 PERUM TKBM
82 P-DRWEZDBS 1271133108900003 TRISNADI L B 31 LINGK. II BT
83 P-DUZHE0MI 1271121007820002 ANDRI WIJAYA L B 39 JL. KAIL LK.
84 P-EBI6FJJG 1271136201040006 VENY FERONIKA SIMA P REMAJA 17 KOMP. TKBM
85 P-ELRQBYUH 1271131009790001 JO HAN L B 42 LINGK. XVII
86 P-EPOCLDCD 1271135009000002 ELFRIDA PUTRI A BR P UMUM 21 KOMP. TKBM
87 P-ESUEPBE7 1271134612690001 LEMPINA SIMANJUNTAK P B 51 LOR. 5 LINGK
88 P-F0QAESYJ 1271134510740003 MURNIATY HUTASUHUT P B 46 LINGK. X SE
89 P-F2PXTUID 1271134908000005 MAHARANI P B 21 LK XI SEI MA
90 P-F4CNMKCG 1271135708720007 SEMI P UMUM 49 LINGK. XI SE
91 P-F7QAEL1O 1271135604660001 NURITA MARPAUNG P B 55 LINGK. XIII
92 P-FAUHPBT5 1271136106840006 TIURMA BR PURBA P B 37 LINGK. VIII
93 P-FEYWD0QO 1271131207030005 FRIYAN REVALDI SIAGI L UMUM 18 LINGK. XV S
94 P-FNGXUXBC 1271134904890001 RISA MANDAKINI P UMUM 32 LOR.VI LING
95 P-FQNXXOPW 1271131808780003 RAJA A MANURUNG L B 43 LINGK. XIII
96 P-FSYCEAPT 1271131909930003 M SYARIF L B 28 LINGK. XVI
97 P-G25F2JOV 1271135112020001 GRACE HILDA DINIKOV P UMUM 18 LK XV SEI M
98 P-G868P17P 1271134409760003 ELFRIDA BUTAR-BUTAR P UMUM 45 LINGK. XVIII
99 P-GATU1QCL 1271087007820001 EVA HERLINA BR SIAL P UMUM 39 KOMP. TKBM
100 P-GDAOTE2B 1201014501910003 RISNAWATI MANALU P B 30 LINGK. XIII
101 P-GJ0IQ8WL 1271141604900002 M RAHMAD DANIANSYA L B 30 LINGK. XV S
102 P-GMHEU9JG 1271130205750004 JUMADI GULTOM L B 34 LINGK. VIII
103 P-GOUROXT2 1201125004000002 ORIANTI SIMBOLON P B 21 LINGK. XV S
104 P-GTYRCNHZ 1271134705070001 MALIKAH SOFIA RAHMA P REMAJA 14 PAJAK RAMB
105 P-GXI8VHJW 1271131808790002 RAMSES TOGATOROP L B 42 JL. KAIL LK.
106 P-HAOYTRJS 1271137108890003 META ROSA SILALAHI P B 31 LINGK. XIII
107 P-HG5VUXLS 1271133008860002 FAUZI L B 35 JL. SYAHBU
108 P-HJ5VY7YE 1271060511010002 ANGGARDA DERMAWA L UMUM 19 LINGK. X SE
109 P-HOS6S8NJ 1271133008990005 AMIR HAMZAH ANTASO L UMUM 22 LINGK. X SE
110 P-HSL6N2PJ 1271131005000001 ADAM SUMAN HARAHA L UMUM 21 LINGK. X LOR
111 P-HVWLPAAI 2171036107859015 JULIA SITORUS P B 36 JL. JERMAL
112 P-I2CQ4XZO 1207246408810001 ETTA ELFRIDA SIHOMB P B 40 KOMPLEK TK
113 P-I91OCQJA 1271131708620006 TINGGI SIRAIT L RENTAN 59 LK XIII SEI
114 P-IKNBTFD6 1271135005890004 FITRIA NINGSIH P B 32 LK XVI SEI
115 P-IMT5IQJT 1271130807940007 ANDRI SURYA PANDI L UMUM 27 LK X SEI MA
116 P-JCBUO5CG 1271135302710004 DIAH KUSDIARTINI P B 50 LK V SEI MA
117 P-JFMSEMGW 1271134808990006 NURUL FILDZAH P UMUM 23 LK V SEI MA
118 S-1EA426AD 1271136311600001 MARINCE BR. TARIHOR P LANSIA 61 LK XVII SEI
119 S-396E97EF 1271135508580001 ROSMADALENA BR TAR P LANSIA 64 LINGK.XVII
120 S-E34FFA52 1271134504550002 TITI H P LANSIA 66 LINGK. XIII
Keterangan
D : Lainnya
E : Tidak Bekerja
Kelompok Umur
18-30
31-45
46-59
Total
Pekerjaan
A
B
C
D
E
Total
Pencatatan Pelayanan Vaksinasi COVID-19 di Tingkat Fasyankes

LABUHAN

Dosis I
Merek Tanggal
BPJS PBI Pemberian
PBI Anggota
Vaksin
SEI MATI MEDAN LABUHAN 085277931896 √ CORONAVAC 9/11/2021 9/11/2021
SEI MATI MEDAN LABUHAN 082381836253 √ CORONAVAC 9/11/2021 -
SEI MATI MEDAN LABUHAN - √ CORONAVAC 9/11/2021 9/11/2021
SIDORAMEMEDAN PERJUANGAN 08126565254 √ CORONAVAC 9/11/2021 9/11/2021
SIDORAMEMEDAN PERJUANGAN081365743819 √ CORONAVAC 9/11/2021 9/11/2021
SEI MATI MEDAN LABUHAN : 082167516684 √ CORONAVAC 9/11/2021 9/11/2021
MARTUBUNG MEDAN LABUHAN 081375399974 √ CORONAVAC 9/11/2021 9/11/2021
P. LABUHAN MEDAN LABUHAN 082161532807 √ CORONAVAC 9/11/2021 9/11/2021
Merek Vaksin
A : Sinovac
Kepersertaan BPJS
BPJS PBI
BPJS Non PBI
Non Anggota
Total
Pemberian Dosis
Dosis 1
Dosis 2
Total
Dosis I Dosis 2
Tanggal KETERANGAN
n Vaksin
- 9/11/2021 2021071341 SELESAI
202107140K - - LANJUT VAKSIN 2
- 9/11/2021 2021071341 SELESAI
- 9/11/2021 202107140K SELESAI
uskesmas/Faskes)
Tabel 10. Format Pencatatan Pelay
FORMAT PENCATATAN
TINGKAT PUSKESM

Umur
Nama Penerima Kel.
No No.Registrasi NIK JK Pekerjaan Alamat
Vaksin Umur
(> 60Tahun)
1 J-0000GO8X 1207234907690007 NURMAIDA BR.SIRAIT P B 52 JLN.KAYU PU
2 J-0000M29M 1271074612900002 FELINA SARI KARTINI L UMUM 30 JL. MANGAAN
3 J-00016KRZ 1271132108030001 FELIX L UMUM 18 JLN.PASAR
4 J-00019XN1 1271135011970003 LINDA MUTIARA DEWI P B 23 JL. MESJID
5 J-0003NGLE 1271132007030001 VINCENT WIZLEY L UMUM 18 LINGK. VI P
6 J-0003QS8S 1271130201750004 MUHAMMAD NOOR L B 46 LIK.01 BAH
7 J-0003QVDG 1271121012990003 M RIDWAN DANATA L B 21 LINGKUNGAN
8 J-0003RU0Q 1271126402970005 WULAN PUTRI P B 24 LINGKUNGAN
9 J-0003UQY1 1271133108960001 MUHAMMAD KHAIRUL L B 25 JL. Jermal r
10 P-0ASWV09O 1222035404870007 EMMI SINAGA P UMUM 34 LIGKUNGAN
11 P-0V20NOHG 1271131503810001 DORKAS ADIRIANTO SI P B 40 JL. KAMBES
12 P-16VIGRJG 1271131202890001 FEBRIYANDI HARAHAP L B 32 JLN.SRIBUL
13 P-1RXQTGHG 1271136410700006 ROSMIANI PURBA P RENTAN 50 LIK.01 MAR
14 P-31ISVR4L 1202046808870002 DORTINA SINAGA P B 34 LIK.01 KP.
15 P-3MUWINZO 1271134607690004 RUSMINI SINAGA P RENTAN 52 JL KAMBES
16 P-3Y1ZXH10 1271132112980002 MUHAMMAD AFIF AL GH L UMUM 22 JLN.YOSUDA
17 P-527O9WOC 1271134711670001 IRMAWATI P RENTAN 53 P. RAMBAI
18 P-5IBSTZA3 1271132210690001 MARIHOT PARDOSI L B 51 LIK.01 KEL
19 P-6AOBQOF3 1223015410800005 ROSANNA DEBORA BR P UMUM 40 JL. BAKTI A
20 P-757MFI7N 1271135609860001 RIAMA SINAGA P UMUM 34 JL.KUBAH NO
21 P-7SZJ2QUD 1271136006020001 CAHAYA FAJAR GIANTI P UMUM 19 JL. KL. YO
22 P-90FVRV6A 1271134502790002 ASNAH P UMUM 42 JLN.PAYA B
23 P-9RP5DRU1 1271124712030003 WINNY WIJAYA P REMAJA 17 LINGKUNGAN
24 P-AEI7O0CW 1271135812700001 ASNI P B 50 P.RAMBAI L
25 P-B50BT5WU 1271062705750004 PONIMAN SITINJAK L B 46 LIK.01 BAH
26 P-BLTCW4YM 1271081209810001 TONI L B 40 LINHKUNGA
27 P-C2PCH5QI 1276016104950003 KARTINI SITORUS P UMUM 26 JLN.TELUK
28 P-C4D83UWV 1371036111670001 ROSIANNA NAINGGOLA P RENTAN 53 JL. TELUK H
29 P-C8R7J953 1271131605790001 CHAN WIJAYA L B 42 LIK.VI P.R
30 P-CQGUEDZL 1271136810800005 ERNAWATY P UMUM 40 LIK..VI P.R
31 P-CR0JOM8M 1274064311990002 INDAH PRATIWI P UMUM 21 GG. TENANG
32 P-CVGMH5NU 1216094205930002 DELILA JUBLIATE RUM P UMUM 28 JLN.TELUK
33 P-D1UQXP8H 1271137105840002 SUYANTI P UMUM 37 JL.PULAU RI
34 P-DGOKESWJ 1271080206770002 CUM CIN P B 44 JL. PASAR
35 P-DNIM1DUQ 1271061312750003 MESIDUHU GULO L B 45 LINGKUNGAN
36 P-DT5LO08E 1271086611820003 NOVIYANA P B 38 JLN.PASAR
37 P-EKN6XYK0 1271081510770003 SELAMAT L UMUM 43 LINGKUNGAN
38 P-FBQQFXU3 1271135402010005 FANNY AMELIA DWI AN P UMUM 20 JLN.ANGGRE
39 P-FF6JVBJK 1271134612970004 DESSRIANI ZEBUA P B 23 JL. BAKTI A
40 P-FIHFTFGC 1271086002790009 FILE LISTIANG L UMUM 42 LINGKUNGAN
41 P-G136U1ZM 1271132005650003 MUHAMMAD L B 56 P. RAMBAI
42 P-GFK5QRO7 1271134712690004 ROSMENNY SIPAYUNG P B 46 LINGKUNGA
43 P-GM0L9IF9 1271186502750002 REBEKKA LAMRIA ELFR P UMUM 32 JLN.PAJAK R
44 P-GPLZ2LNX 1271136207640001 ZURIATI P B 57 P. RAMBAI L
45 S-8677D27F 271066008530002 AZLI EFENDI, ST. L B 37 JLN.PULAU R
46 P-HJJUTDR8 1271087003020001 VANNY P B 19 LIGKUNGAN
47 P-HL2D9GT4 1271130404000006 DANDY L UMUM 21 JLN.KL YOS
48 P-HNLQWRXF 1271131107990001 IDZA MAULIDY P B 22 P. RAMBAI L
49 P-HP3I3MTM 1271132907910004 PREDDI PANE L B 30 LIK.01 KP.
50 P-HPTTKOAW 1205116802920005 SUPIANA P B 29 LINGK. I M
51 P-HRKF51WB 1271135612730001 YANIRIA ZEGA P UMUM 47 JL. BAKTI A
52 P-HSSLBUK4 1271134712690004 TUTI HANDAYANI P RENTAN 51 JLN.BAKTI A
53 P-HTEMVPCT 1271130506990004 MUHAMMAD WAHYU RI L UMUM 22 JL. KAMBES
54 P-HXA3XK3P 1271130902760004 ALDEMAR SIREGAR L B 45 JLN.STASIU
55 P-I0GWA4KS 1271034707740010 DEDEK ISNAINI P UMUM 47 JL. ANGGREK
56 P-I3VEWG2Q 1271131012880002 ERI L B 32 JL. P. RAMB
57 P-I73FKSPP 1271132012690002 M. ILHAM SIBARANI L B 51 LIK.VI P.R
58 P-I91HRHAY 1271136702800002 ERNIYAWATI P UMUM 49 JLN.PAYA B
59 P-IBEGOX5C 1271134501690004 REFIDA BR SINAGA P RENTAN 52 LIK.IV KP.
60 P-ICWA03TS 1271060602020001 ABDUL WAHAB SEMBIR L UMUM 19 JLN.CINGUA
61 P-IEFWKPK0 1271130511750001 MUKHLIS SIBARANI L B 45 JL. KL. YOS
62 P-IKY8JTXC 1271132708990003 FAJAR KRSTIAN ZEBUA L UMUM 22 JL. BAKTI A
63 P-IMLCVRGV 1271135603040001 AURELIA ANGGA P REMAJA 17 JL. PAJAK R
64 P-INS4MCIE 1271132608970001 MUHAMMAD TAUFIQ L UMUM 24 JL. SRI BUL
65 P-IOICJ7SZ 1271136702800002 LINDAWATI BR SINAGA P UMUM 41 JLN.KAMBES
66 P-IPRGDU9E 1271131711960001 DINO WIRA SATRIA L B 24 LINGK. I B
67 P-IRPPU8CW 1271130208700003 ZULKARNAIN L B 51 LINGK. I B
68 P-ITGXM2D6 1271134902790002 SOFAHERYATI P UMUM 42 JLN.ANGGRE
69 P-IV84T2WL 1271132205880002 SUAKBAL L UMUM 33 JLN.PULAU
70 P-IVXDLG4Y 1271064407730002 SARMA LINA PANE P UMUM 48 JL. MANGAN
71 P-IWN11DRA 1271131909840002 SYAFRIZAL L B 36 JLN.KAMBES
72 P-IYGG11VC 1271083010990003 YOSIA ASIH SIMANJUN L UMUM 21 JLN.KAMBES
73 P-J8226RR1 1207232211860010 CARLES SIHOMBING L B 34 LINGKUNGAN
74 P-J8LOZCSV 1271121111010001 ORI ENDO PRATAMA P L B 19 LINGKUNGAN
75 P-JBII2HFE 1271134407030006 MAWAR NATASYA MAR P B 18 JL. BAKTI A
76 P-JDA4NQHP 1216042109980001 CANDRA A. SIHOMBING L UMUM 22 LIK.VII KE
77 P-JE8EQBGP 1271136312830006 NAFLIA P B 37 JLN.KL YOS
78 P-JMNV3FS4 1271132607940001 A IAN SUKARSYAH P UMUM 27 JLN.KL YOS
79 P-JUY70WRY 1271136209970002 ANGGRY SULASTRI SIH P UMUM 23 JLN.KAMBES
80 P-JX1W1X8E 1271132211980005 YOGI WAHYU ADAM L B 22 LINGKUNGA
81 P-JYZAQ65K 1271135512700000 JUNIAR BR SINAGA P RENTAN 50 JLN.KL.YOS
82 P-KEI730LX 1201064704970004 FRISKA NIRAWATI HUT P B 24 JL. KANTOR
83 P-KL0JF7SY 1271137006700000 ROSITA SIMANJUNTAK P RENTAN 51 JLN.KAMBES
84 P-KPUDDDW4 1271135909850004 NURHAYATI P UMUM 35 :JLN.KAMBE
85 P-KSTEGAQE 1505025206910002 EFI ANGGRAENI P UMUM 30 P. RAMBAI
86 P-L2HNWHWW 1271134610700002 SABARIAH P RENTAN 51 LIK.V PAYA
87 P-L9CNZCRM 1205125507000002 SISKA SETIAWATI P UMUM 21 LINGKUNGAN
88 P-LDPQVQZS 1271135010780004 DEWI P UMUM 42 LIK.03 SP.
89 P-LG8HZOON 1271130908030003 AGUSTIAN L UMUM 18 JLN.KL YOS
90 P-LIS8SG6B 1271132706950003 MULIA ADIGUNA PINA L B 26 LIK.VII AS
91 P-LLBAFUQT 1271134507010002 CHICHA ANGGRAINI P B 20 LIK.07 JLN
92 P-LNNXEFPZ 1271131106010001 SYAHPUTRA HABIBI MU L UMUM 20 ASPOL LAB
93 P-LVLJWHXW 1271136504830001 SRI ASTUTI P UMUM 38 KP.BAHARI
94 P-M2BHAMAC 1271064101710012 SAMSIAH P B 50 JLN.MANGAA
95 P-M5ZNQJZ1 1271134208780005 SUTINAH TAN P UMUM 43 JLN.PAJAK
96 P-M9I3PBVG 1207245806870002 JUNITA P UMUM 34 JLN.PAJAK
97 P-MEYCCY28 1271081408020003 BOBY SETIAWAN NAPIT L UMUM 19 JLN.JERMAL
98 P-MH8K1VQK 1271136809010003 SEPTHIA BELLA ALDAM P UMUM 19 JLN.BAKTI
99 P-ML9IOW5M 1271122010800004 SRIANTO L B 40 PAJAK RAMB
100 P-MO15W7PS 1271021111860001 SUTAN SYAHRIAL HAR L B 34 JLN.KL.YOS
101 P-MU7VRC59 1271135502880002 SUWAIDA P UMUM 33 PAJAK RAMB
102 P-MZKO9BXP 1271133010920006 NOFERANDI BAMBANG L B 28 JLN TAUT 1
103 P-N4X2ENDN 1202090511970002 OKKI PASARIBU L UMUM 23 JL. KL. YOS
104 P-N5WIHG5K 1271132609730001 SUPARDI L B 47 P. RAMBAI
105 P-N6RWVGF6 1271131102730002 SUNASEP L B 48 JLN.AMAL L
106 P-N7LRG2CW 1271132108980002 AGUS SETIAWAN L B 23 JLN.AMAL L
107 P-N8YBIF1T 1271131904950001 ALPRI MUNAWWAR L B 26 P.RAMBAI L
108 P-NDZZ5U6O 1271124810020002 WIDIYA LESTARI P B 18 JLN.MARELA
109 P-NGQ7MIHR 1271134411010004 SELLA AMANDA P UMUM 19 P.RAMBAI L
110 Q-0002OKTH 1271131806000005 VAHRIANSYAH L B 21 LINGK XI SE
111 Q-000A4VT4 1215034210680001 TIDORA RAJAGUKGUK P RENTAN 52 LINGK. II SI
112 Q-000NCDUJ 1207267008010003 OEI PUN GI P RENTAN 55 JL PANCING
113 S-021BE871 1271131708920002 YUDHA HANDRIANSYAH L B 29 LINGK. VI P
114 S-28A5A4E9 1271131708560002 SYAHRIL AM L LANSIA 65 LIK.05 PAJ
115 S-8168C7CC 1271130301770003 M.SYAHBUDIN L B 44 JLN.KAIL LI
116 S-8677D27F 1271066008530002 TJIE A HENG P RENTAN 58 LIK.VII KO
117 S-8959D5DE 1271021303940003 MUHAMMAD JAFAR SIR L UMUM 27 JLN.H M YA
118 S-AB4D4ADF 1271134512570003 GONTI NABABAN P LANSIA 63 LIK.08 PEK
119 S-D02B6B84 1271131204560003 LINSON SIMARE MARE L LANSIA 65 LIK.IV DES
120 S-E8E893B9 1271137003580001 ANIZAR L LANSIA 63 LIK.05 PA
121 Y-0111VNOX 6172024802790003 HIELVITA LUDIYA, SE, M P B 42 JL. YOS SUD
122 P-SN0DU0LZ 1207240407030005 M ANDRIANSYAH L B 18 LINGKUNGA

D : Lainnya
E : Tidak Bekerja
Kelompok Umur
18-30
31-45
46-59
Total
Pekerjaan
A
B
C
D
E
Total
. Format Pencatatan Pelayanan Vaksinasi COVID-19 di Tingkat Fasyankes

AN LABUHAN

Tanggal
Kelurahan Kecamatan No.Hp Merek Vaksin
BPJS Non Non Screening
BPJS PBI
PBI Anggota
MARTUBUNG MEDAN LABUHAN 085246015527 √ CORONAVAC 9/14/2021

B : Lainnya (Mohon Disebutkan Jenis Vaksin Yang Diterima Puskesmas/Fa

Kepersertaan BPJS
BPJS PBI
BPJS Non PBI
Non Anggota
Total
Pemberian Dosis
Dosis 1
Dosis 2
Total
Dosis I Dosis 2
Tanggal Tanggal KETERANGAN

Vaksin n Vaksin
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140k - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 20210714OK - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140o - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
- - 9/14/2021 202107140K SELESAI
- - 9/14/2021 202107140K SELESAI
- - 9/14/2021 202107140K SELESAI
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
9/14/2021 202107140K - - LANJUT VAKSIN 2
Yang Diterima Puskesmas/Faskes)

Tabel 10. Format Pencatatan
FORMAT PENCATA
TINGKAT PUSK

Umur Kel.
No No.Registrasi NIK Nama Penerima Vaksin JK Pekerjaan Alamat
Umur
(> 60Tahun)
1 P-NP1XTQXM 1271134504940002 RINA HASTUTI P UMUM 27 LK I SEI MATI
2 P-PTF2DP6T 1271135606930004 WILLY ANI HUTAJULU L B 19 LK III SEI MATI
3 P-Q2ITMN7K 1271136811020001 SRI RAMADANI P B 19LINGK. II SEI MATI
4 P-S8FJXLIQ 127113280402004 RUSYDI RAHMAN KHALID L UMUM 19 LK VI SEI MATI
5 P-QB03I3OZ 1271132211030003 RANGGA ADHITIA L B 18LINGK. II SEI MATI
6 P-KJGL8UBC 1271132007910003 DIMAS PUJI SAPUTRA L B 30 LK III SEI MATI
7 P-Q0XQ55JO 1271133005020001 MHD ALHAFIZAN NUR L B 19 LK III SEI MATI
8 P-I3BPCIZB 1271134804780003 HARMA YANTI P UMUM LK
43 XII LOR VI SEI MATI
9 P-0LQY3EBZ 1271136204890007 SITI AMINAH P B JL KAIL LK IV SEI MATI
30
10 P-QTOUBJ87 1271136909790009 Siti saani P UMUM 41 LK IV SEI MATI
11 P-PKQP2GJS 1271131501700001 wilisanto L B 51 LK V SEI MATI
12 P-G37XP1E6 1271135606770003 MARSAULINA P UMUM JL KAIL LK V SEI MATI
44
13 P-KXB4JMWF 1271130812750003 SUBIYANTO L B JL46TUNDA LK V SEI MATI
14 J-00015O1H 1271135511000005 feni widiani P UMUM JL.21
KAIL LINGK. V SEI MATI
15 S-59EF92DC 1271136011720003 FATONAH P UMUM 49LINGK. VI SEI MATI
16 P-JOQMYL8Y 1271136310740001 SUHIBATUL ISLAMIAH P UMUM 47LR 2 LK VI SEI MATI
17 P-RAAMICJN 1271130407990001 M IRFAN HIDAYAT L B JL. JERMAL
22 RAYA LOR. 6 SEI MATI
18 P-R0KPY161 1271132412820001 SUGIANTO L B JL KAIL LK IV SEI MATI
39
19 P-R3KYK05C 1271135404030003 putri bona ria napitupulu P UMUM JL. JERMAL 18RAYA NO. 34 LK. VII SEI MATI
20 P-H71YEVSE 1271136901760001 LUSIANA GIRSANG P UMUM LOR
45 IV LK VII SEI MATI
21 P-S97TDLMI 1271132803140004 sri astuti nur efendy ompusu P UMUM 36 LK VII SEI MATI
22 P-Q2D75UDL 1271132209960003 JULPAN EFFENDY HUTAHU L UMUM LINGK. VIII SEI MATI
25
23 P-RPWJVO30 1271131509800001 JOEL SITOMPUL L B 41 LK VIII SEI MATI
24 P-MLL5GXUB 1271134507730007 MESRYA SIAGIAN P UMUM 48 LK VIII SEI MATI
25 P-M8UNFE4V 1271134312740003 SONDANG HERNAWATI SIA L UMUM 47 LK VII SEI MATI
26 P-RMC20DQ3 1271136306720007 SONDANG GULTOM P B 49 LK VIII SEI MATI
27 P-LGBSXKZD 1271134906660002 SURNI PAKPAHAN P RENTAN 55 LK IX SEI MATI
28 P-RP50QFZQ 1371120712780001 Fery Wahyu wandeli L B 43 LK X SEI MATI
29 P-PWWDBXHH 1271131109630001 Darwin tarihoran L RENTAN 58 LK X SEI MATI
30 P-PYE2NR3Y 1271136112640001 Rianum Napitupulu P RENTAN 57 LK X SEI MATI
31 P-RX7GMD6J 1207064808910002 NURHALIMAH MANIK P B 30 LK XI SEI MATI
32 P-RKIW5LKW 1217066005960001 ARYESTINA SINAGA P B 25 LK XI SEI MATI
33 P-RE4G3HTW 1208211705940001 AGUS FERNANDO SIMANJ L B 27LR 5 LK XI SEI MATI
34 P-S8XRB3Z9 1271136002780002 DERSINA SIDABUTAR P UMUM 43 LK XII SEI MATI
35 Q-000I0C7P 1271136102010002 ESRA FRETTY SITORUS P UMUM 20SEI MATI LINGK 12
36 P-S87V2UKS 1271131607010003 BAGUS PRAMANA L B 20 LK XII SEI MATI
37 Q-000BP8OC 1271135007020001 DEWI JULIANA SIHOTANG P B LINGK
20 XII KELSEI MATI
38 J-0003D812 1271135111010007 Diana Romansa Simamora P UMUM 20 LK IX SEI MATI
39 P-QMWT3GKB 1271136811930001 ARTA NOPITA SARI MARP P UMUM 27 LK XIV SEI MATI
40 J-0000W2PG 1271134209950002 Herawati Simanjuntak P B JL JERMAL
26 RAYA LK XIV SEI MATI
41 P-S7V6JHJB 1271132801040004 Koko Parulian Napitupulu L REMAJA 17 LK XIV SEI MATI
42 P-RGC3SUMD 1271135403660002 RAHEL HUTABARAT P RENTAN 55 LK XV SEI MATI
43 P-RBKORN11 1271132512890004 SAHAT MARULITUA SIAMN L B LR PARSAORAN
32 LK XV SEI MATI
44 P-S8SVIB2D 1216044803020001 Antalilis Siburian L UMUM 19 LK XV SEI MATI
45 P-QFBNHA60 1271135512000001 RINA FERAWATY SIMANJU P UMUM 21 LK XV SEI MATI
46 P-DBG7PBR9 1271132702790002 JOGI TOHO PARULIAN TAM L B 42 LK XVI SEI MATI
47 P-QRLZJ4U4 1271136912850003 DESI ELISABETH PANGGA P B 36 LK XVI SEI MATI
48 P-QVRO1N4P 1271133107750003 BISMAR EDWIN SILAEN L B LOR
46 5 LK XVI SEI MATI
49 P-QGF44JSC 1271132709820001 ZULHAM HASIBUAN L B 37 LK XVII SEI MATI
50 P-P4N3WVNU 1271130404720003 KHAIRUL BAHRI L UMUM 49 LK XVII SEI MATI
51 P-Q5GH57XF 1271134101810007 LENNI P UMUM LINGK. XVII SEI MATI
40
52 P-RFA703AM 1271134708720003 ROSIDA BR PAKPAHAN P UMUM 49 LK XVIII SEI MATI
53 P-S9DL24EI 1271064505850016 Dewi ghinarti P UMUM 36LINGK. XVIII SEI MATI
54 P-RHGS1FGS 1271131711020004 Yudha maulana L B 20 LK XVIII SEI MATI
55 P-RUUGYP63 1271230611980001 Panca novananda L B KOMP TKBM23 BLOK A NO.8 LK XVIII SEI MATI
56 Q-000NOVNA 1271121101090001 HENDIKA DIJANRY SITORU L REMAJA PERUM TUT WURI
12 HANDAYANI 4 BLOK B LINGK 9
57 S-B85697BB 1271133108480001 R HOTLAN TOGATOROP L LANSIA JL KAIL LK VI SEI MATI
71
58 S-8626F5E9 1271132911590001 MAJU LUMBANTOBING L LANSIA 62 LK IX SEI MATI
59 S-AA994AFE 1271130506520002 MARSANGKAP LUMBANTO L LANSIA 69 LK IX SEI MATI
60 P-HAFGZ2LB 1271136509780004 LESNARIA PURBA P UMUM 43 LK XV SEI MATI
61 S-D0B29CCB 1271135505550004 MINCE MARBUN P LANSIA 66 LK VIII SEI MATI
62 S-E629CDEA 1271136908570001 SUMIHAR SIHOMBING L LANSIA 64 LK VIII SEI MATI
63 S-11CA9E59 1271135606600001 MERLIANA SIANTURI P LANSIA 61 LK VIII SEI MATI
64 P-LWPKB211 1271131310970002 ROMIANDO P. SIMANJUNT L UMUM 23 LK IX SEI MATI
65 P-7FH5E2RO 1271134606620001 MASTA LUMBAN TOBING P RENTAN 59 LK IX SEI MATI
66 J-00010OXB 1271136309850001 ELLY FAZRIN TAMBUNAN P UMUM 36 LK IX SEI MATI
67 J-00010OO3 1271134811630001 BERNIKE NURLINDA SILAB P RENTAN 58 LK III SEI MATI
68 P-8SBQK38L 1271131908610001 ARIS MARTUA HAPOSAN H L LANSIA 60 LK VIII SEI MATI
69 S-E0976950 1271135510600003 MARISI BR MARPAUNG P LANSIA 61 LK IX SEI MATI
70 S-E0F28987 1271134202530004 INTAN BR SIAGIAN P LANSIA 68 LK IX SEI MATI
71 P-O0FJ3NYW 1216094212870003 ERNITA MAWANTIKA SIM P UMUM 33 LK II SEI MATI
72 P-OSBKF2ZN 1271131604030004 RICKI WAHYUDI SYAHPUT L B 18JL KAIL LK V SEI MATI
73 P-PJ0PKUJM 1271135807910002 JULIANTI SIMANUNGKALIT P UMUM 30 LK III SEI MATI
74 S-9AFCC1DA 1271131708530001 ERNIS SINAMBELA L LANSIA LK III68BATANG KILAT SEI MATI
75 P-POEDP7XU 1271136603020006 YUSNITA MARITO PURBA P B 19 LK XI SEI MATI
76 S-BE140A10 1271135505600002 DENSI SITUMORANG P LANSIA LK III61BATANG KILAT SEI MATI
77 S-0D55A521 1271131307570002 ARIS PITULA SITUMORANG L LANSIA 64 LK VII SEI MATI
78 P-QD62DB0M 1271016610690001 LISBET BR MANURUNG P RENTAN KOMPLEK
52 GABION LK IX SEI MATI
79 P-QBUS0G2Q 1271133009020002 JOSUA SIPAHUTAR L UMUM 19 LK IX SEI MATI
80 P-QPD0R9NY 1271134902790001 VERAWATI BR SILABAN P UMUM 42 LK XII SEI MATI
81 P-QQLDYULZ 1271135502690001 MARIANA BR RAMBE P RENTAN 52 LK IV SEI MATI
82 P-QE7JE6FZ 1271136411020002 NOVENA MARIA PANDIAN P UMUM 18 LK IX SEI MATI
83 P-RIGRN5RQ 1271131707030003 MHD ICHSAN L B 18 LK III SEI MATI
84 P-Q9OL6VLV 1271136208010005 CITRA ANANDA NABABAN P UMUM 20LINGK. IX SEI MATI
85 Q-000A2OC2 1202012012960002 RIVANLY CHRISTMAN I.P. L B LINGK. XVII SEI MATI
24
86 J-0000SDL4 1401065603030002 INDIRA MAHARANI AZRA P UMUM 18 LK IX SEI MATI
87 P-RQVVH5VE 1271135609030004 PUTRI WULANDARI P UMUM 18 LK III SEI MATI
88 J-0000WQSA 1271135106900003 GRACE AGAVE SILITONGA P B 31 LK XIII SEI MATI
89 P-RTVFF89X 1271130604650001 KHAIRUL SARAGIH L B 56 LK III SEI MATI
90 P-RW4T4JJ4 1271130211700002 ALBARIN MARPAUNG L B 50 LK XIII SEI MATI
91 S-58B3F41E 1271062208580001 ALEN SITORUS L LANSIA 64 JL PLATINA
92 P-S5WVWIIH 5103055705720010 LINCE SIAGIAN P UMUM 49 LK XV SEI MATI
93 P-RYA5EQUO 1271136408000002 ANGGUN ADELINA VALEN P B LOR 8 LK XIII SEI MATI
18
94 P-S6IG6ESM 1271064407860002 JULIANA SITORUS P UMUM 35 JL PLATINA
95 P-S0C23DYX 1271132409950004 JONINDO SIAHAAN L UMUM 26 LK VIII SEI MATI
96 P-S4EOTS32 1271134309850001 TETY ROMAULI BR BUTAR P B 36 LK XI SEI MATI
97 J-0000NNXT 1207026409910005 DEWI PURNAMA SARIFINA P UMUM 30 LK XIII SEI MATI
98 P-S31NHBWL 1271131110850005 ASHARI NASUTION L B KOMPLEK
35 TKBM LK XVIII SEI MATI
99 P-S6WBY0Z5 1271056303800007 KARDINA P B JL PLATINA
41V LK XII GG ABADI TITI PAPAN
100 P-S749TWQ5 1271135205790003 SUSILAWATI P UMUM 42 LK XII SEI MATI
101 P-S70TDD4A 1271134602780004 SUTINAH P UMUM 43 LK XI SEI MATI
102 P-S7IBQBTA 1271136701870002 MELITA SINAMBELA P UMUM 34 LK VIII SEI MATI
103 S-791A42DB 1271202502860003 PEBRUANCO L B JL GAHARU
35 COMP PTPN IX NO.47
104 Q-3F1EC1BA 1271134505890002 JULIANA P B LINGK IV KELSEI MATI
32
105 J-0003D1IK 1271134911020004 HANNA NOVITA BR REGAR P UMUM 18 LK XIII SEI MATI
106 P-S8BUJDPT 1271132504760002 BENG SUA L B 45 LK IV SEI MATI
107 P-S91EEZO2 1271136010000014 POSMARITO BR PASARIBU P UMUM 20 LK XVIII SEI MATI
108 S-615A94A9 1271130612770003 SOSRIN PANGARIBUAN L B 44 LK X SEI MATI
109 P-S9JOREPG 1202016303810004 DONNA KRISTINA TELAU P UMUM 38 LK VI SEI MATI
110 P-S9RI7IYX 1271135809820003 HENGNILA BR HOMBING P UMUM 39 LK VII SEI MATI
111 P-S9UKV6MD 1271132811820004 DONAL SIMANJUNTAK L B 38 LK XIV SEI MATI
112 P-SA0X5KO9 1271134208810001 AWALIAH SIMANJUNTAK L UMUM 40 LK VII SEI MATI
113 P-SA2UY5F1 1271131711960005 ANDI L B 25 LK I SEI MATI
114 P-SA7FWOYN 1271130903850001 ABDI HIZKIA ALWENTA T L B 36 LK VII SEI MATI
115 P-SAB6RRVG 1271135107880002 PUTRI SARI NAVITA SIMA P UMUM 33 LK VII SEI MATI
116 P-SACVO17P 1271132603780002 BESLIN SINAMBELA L B 43 LK XIV SEI MATI
117 P-SAHLTZ0J 1271131111640003 HOTMAN LUMBAN TOBIN L B 56 LK XVII SEI MATI
118 P-SAKNUGKN 1271135908670002 ROSINTAN SINAGA P RENTAN 54 LK XVI SEI MATI
119 P-SANPZMGX 1271134502740001 KAMALIAH P UMUM 48 LK XV SEI MATI
120 P-SAPV4KE2 1271135104900005 RUMIRIS SIMANJUNTAK P B 31 LK XIII SEI MATI
121 P-SARAAT4D 1271135711730005 SAMINAH M.ARITONANG P UMUM 47 LK XVI SEI MATI
122 P-SATRY0SE 1271136907010003 TETTY JULIANTY P UMUM 20 LK XI SEI MATI
123 P-SAV71MET 1271146904930001 DITA YOHANA SARA SIMA P B 28 LKXVIII SEI MATI
124 P-SAWRNFFE 1201126711990002 ANISA SINAGA P B 22 LK XV SEI MATI
125 P-SBFWFX98 1271061906040003 ADAM PUTRA KESUMA L REMAJA 17 LK X SEI MATI
126 P-QNZI3AIO 1271134703040004 EUNIKE SIMANJUNTAK P REMAJA 17 LK XIV SEI MATI
127 P-MWGICBGG 1271134112640004 NURHAYATI LUMBAN GAO P RENTAN 57 LK XIV SEI MATI
128 J-0000AYXV 1271136008660002 ROSMINA SIMANJUNTAK P RENTAN 55LINGK. VIII SEI MATI
D : Lainnya
E : Tidak Bekerja
Kelompok Umur
18-30
31-45
46-59
Total
Pekerjaan
A
B
C
D
E
Total
10. Format Pencatatan Pelayanan Vaksinasi COVID-19 di Tingkat Fasyankes

AN LABUHAN

Dosis I
pada kolom yang sesuai) Merek Tanggal
BPJS PBI Pemberian
PBI Anggota
Vaksin
TERJUN MEDAN MARELAN 081269221873 √ CORONAVAC 9/15/2021 -
KEL. TITI PAPAN MEDAN DELI 085207670071 √ CORONAVAC 9/15/2021 9/15/2021
KEL. TITI PAPAN MEDAN DELI 082167484767 √ CORONAVAC 9/15/2021 9/15/2021
B : Lainnya (Mohon Disebutkan Jenis Vaksin Yang Diterima Puskesmas/Fas
Kepersertaan BPJS
BPJS PBI
BPJS Non PBI
Non Anggota
Total
Pemberian Dosis
Dosis 1
Dosis 2
Total
Dosis I Dosis 2 Keterangan
Tanggal
No.Batch Pemberia No.Batch Ditunda / Tidak Diberikan/Lanjut
n Vaksin
- 9/15/2021 202107140K SELESAI
- 9/15/2021 202107140K SELESAI
- 9/15/2021 202107140K SELESAI
- 9/15/2021 202107140K SELESAI
- 9/15/2021 202107140K SELESAI
g Diterima Puskesmas/Faskes)
FORMAT PENCATA
TINGKAT PUSK

Umur
(> 60Tahun)
1 P-DFRC0GRO 1271182901850004 TOGAP TAMBUNAN L UMUM 36
2 S-0F94E9DE 1271131807540001 HASANUDDIN L LANSIA 67
3 P-FYZODEOX 1271130511960005 HERI DWI KOMANDALA L PP 24
4 P-H2ITR45S 1271136106990004 NADIA WAHYULISA P PP 22
5 P-HOQIYFCP 1271135207000003 NURUL AUREL SHABRINA P UMUM 20
6 P-J084Q09R 1207241401760002 HARIYONO L UMUM 45
7 P-HXXXXF2L 12711131704040004 DIMAS IHSAN L REMAJA 17
8 P-JYOGPFQF : 1271207103750003 MIMI ANDRIANI L PP 46
9 Y-00000DO0 1271136512560002 MANGINAR BR. HUTAJULU L LANSIA 64
10 P-JPBKVU5D 1271131010740015 JONTER N. SIANGA L PP 47
11 P-NE2OJXBR 1271134511030006 FITRI RAHMADANI P REMAJA 17
12 P-OET988B3 1271132812920007 RAMLI LUMBAN TOBING L RENTAN 53
13 P-0HOYYEIN 1271130103780002 HENGKI S RIADY L PP 43
14 P-4GTBOGWW 1271135111720001 HENNI DEWI KURNIATI L UMUM 49
15 P-7RNITL4Y 1271136707770005 NURBAITI P UMUM 44
16 P-IXJ0ARW8 1403032604810001 JOKO SUSANTO L PP 40
17 P-EZPL0LTU 1271125008770006 WAHYU SUSANTI P UMUM 44
18 P-CCUAWKAL 1271136102990001 KARIN KATIANGGI DEWI P UMUM 22
19 P-ASVSUAXH 1271131403740001 AGUS SALIM L PP 47
20 S-A7903998 1271130208490001 AUGUSTAR SINAGA L LANSIA 72
21 P-QBIKCJUD 1271080503770001 JONSER SIMARE MARE L PP 44
22 P-R7O7M6IR 1271132611970003 AHMAT BANI L PP 24
23 P-NDSL1VJJ 1271085205030002 CLARA SIMARE - MARE P UMUM 18
24 P-OWT73UOB 1271135105000002 INDAH SARI BR. PANGABEAN P PP 21
25 P-PO3JOORU 1271084907760004 RONTY SIHOMBING P PP 45
26 S-7581BAAE 1271133009000002 MUHAMMAD LUFHI L PP 20
27 P-SGT8M7CV 1271132607660002 SARIM L RENTAN 55
28 P-SGLB9AJD 1271131502030001 ZUKHAMDI L PP 18
29 P-SH1LE80C 1271131602990001 CHOKY ANDREAS L UMUM 22
30 J-0000TDZO 1271136105880003 FITRI LESTARI ARITONANG P UMUM 33
31 P-SHMUUDE8 1271132104960002 ABDUL AZIS ARITONANG L PP 25
32 P-SM5YUSDE 1271135706840001 FITRIANI P PP 33
33 P-SI4TMNOU 1271135904800002 PURNAMAWATI P UMUM 41
34 P-SICX9T4D 1271132709000002 SAPRIJAL WAHYUNI L PP 33
35 P-SIRG89NI 1271135512810011 SALMI SRI KANDI P UMUM 40
36 P-SIKYOA0E 1271131409030003 DAVID ANGKASA L UMUM 18
37 P-SJ0R53YE 1271134510850002 NINA ASTUTI P UMUM 36
38 S-559D0916 1271120104870003 MHD. IQBAL AZHAR L PP 34
39 P-SJQ1JIA5 1271062712890001 HANDIKA ARDIANSYAH L PP 31
40 P-SJXT064I 1271121501970002 YUDA RAMADANI L PP 24
41 J-0003V8W6 1271132907850001 WHERWIND CHANDRA L PP 36
42 J-0003V5G6 1271136207830001 DEWI SUYANTI P UMUM 38
43 P-SKKZ9SGN 1271135707970001 DILLA YULIANDA P PP 24
44 J-0001GV3K 1271146001990001 ADE FITRIA P PP 22
45 P-SL0X37BE 1271081809020002 RIZKY PANCA SEPTIADI L PP 18
46 P-SL8FQONJ 1271087007980003 EVINA SURYA P UMUM 24
47 P-SLPFQA3U 1271132603030006 ANGGI AMIRIL LUBIS L UMUM 18
48 Y-0135ZFKE 1271145404830010 LENNY OMBUN ROMANNA SI P PP 38
49 P-SLEL5I3S 1271136605970002 NURMINA ANGGRENY LUBIS P PP 47
50 S-E3083821 1278062805760001 EVRAIN ZEBUA P PP 45
51 S-61259AF3 1271131702680001 ANTONIUS MANURUNG L RENTAN 53
52 P-SN9TR0VM 1271134509840002 WIJAYANTI PANJAITAN L UMUM 37
53 P-SNG40MOA 1271130403860005 LILI SUHAIRI L PP 35
54 P-SNRITI31 1271134306700002 RISTA NILAWATI P RENTAN 51
55 P-SLWQ8XIJ 1271134211820008 LORENSIA P UMUM 39
56 P-SOIKPDKZ 3175012008760013 SANGGUM SAUN L PP 45
57 P-SNZAZXHM 1271132510680002 WALISTON SIANTURI L RENTAN 53
58 P-SOCIXR1U 1271132509770003 ROBERT JIMMY L PP 44
59 J-0001C710 1271061701940001 CARLES NAINGGOLAN L PP 27
60 S-549BCDC1 1271135911540001 RUSTANI SIAHAAN L LANSIA 66
61 P-SPGZD24V 1271134804960003 NURUL HIDAYAH P UMUM 25
62 P-SMACXQXJ 1271137012670001 KARTINI NABABAN P RENTAN 54
63 P-SPN972GI 1271132702950003 SUTRISNO L PP 25
64 P-SQ3PORGE 1271131310970001 ANGGI PRANATA SIRINGO R L UMUM 24
65 P-SQGQAWNA 1271136908950003 ALIZHA AISYAH P PP 26
66 P-SQN4P1NF 1271131407830002 SAHAT JULIANTO L PP 38
67 P-SQU53ZL7 1271080803840006 PARULIAN SIMANUNGKALIT L PP 36
68 P-SRP1UUJI 1271216107740001 SANDRA J PANGARIBUAN P UMUM 47
69 P-SRTPC1PU 1271131712770004 SUBARI L PP 43
70 P-SRJCUYDT 1271212110690002 OBERLIN SIHOTANG L RENTAN 51
71 P-SSL1VZPM 1271137805780001 RODIANA P UMUM 43
72 P-SSDB5IVD 1271070810830005 JERAS L UMUM 37
73 P-SSR014DR 1271137011030003 FIRA YUNITA NST P PP 17
74 P-ST3FB8YI 1271136201710003 JURIAH P RENTAN 51
75 P-STDQ4H1I 1210020307890008 RIKO SITORUS L PP 32
76 P-ST92C261 1271136412000001 ADINDA DESYA NST P PP 20
77 P-STJBHCTU 120726510798006 RITA PRATIWI P PP 23
78 P-STO9VKV0 1271135709790004 NURASIAH P UMUM 42
79 P-STSTDSZC 1271136005830007 SALBIAH P UMUM 38
80 P-SUENCAUK 1271201410030004 LUKMAN ALDIANSYAH L REMAJA 17
81 P-SU91Q7MT 1271131512800005 SYAHRIL RAMADONI L PP 40
82 P-SUL0X8UD 1271130404990001 DION WINNER SITUMORANG L UMUM 22
83 Q-000NOTPC 1271124812750003 YUSNIDA SARI P PP 43
84 P-SPSY9JE7 1271134109020003 VIKA ANASTASIA SIHOMBING P PP 19
85 P-SVH2ENVR 1271135808970007 OSIN MURNI BATU BARA P UMUM 24
86 P-SVACSFO6 1271057007870003 LESTERIA LIMBONG P UMUM 34
87 P-SV5D33NA 1271135202770002 DESI P UMUM 44
88 P-SUXE7ABF 1271135010890008 ERLINA BR. SIREGAR P UMUM 32
89 P-SU2XSBNM 1271135112840001 EMMA DESIMA P UMUM 37
90 J-0000W4S2 1271082706010004 TOMY SAPUTRA L UMUM 20
91 P-SVKLTI0A 1271134509930003 SULASTRI P PP 28
92 P-SVOEFOXO 1271131002990001 DODI TRI PEFRI BARUS L UMUM 22
93 P-SVSBN5FI 1271066904980001 YUNDA AMALIA PRATIWI P UMUM 23
94 P-SVXF7CC5 1216081006780001 JAMES SIGALINGGING L UMUM 43
95 Q-0008ZB22 1275012102890002 HARI KURNIADI L PP 33
96 P-SW4RAQI4 1271134303000003 ELISABET TAMBA P UMUM 21
97 P-SWA1YEZZ 1271131706020002 ANDRE MAULANA L UMUM 19
98 Q-0008ZB0S 1271135308910002 SYAFRINA P PP 30
99 P-SWJJ6EC1 1271130804000003 JASON SITUMORANG L UMUM 21
100 P-SWN7LGLO 1271130608740003 SUYONO L PP 47
101 P-SWEPBIGB 1271132510680001 SENG SAN L RENTAN 53
102 P-SWVI42FM 1271124309840005 SANIAH P UMUM 36
103 P-SX22VKJW 1271125010030002 KUNENG ROMAULI P REMAJA 17
104 Q-000JK8S3 1271130801950006 READY BOY PANJAITAN L PP 27
105 P-SXBCRFVC 1271132905030001 WILDAN HUMAIDI L UMUM 18
106 P-SXGFNUQV 1271011707770007 JONATHAN TARIGAN L PP 44
107 P-SXT6EY7C 1271080308990002 MUHAMMAD ARDIANSYAH L PP 22
108 P-SXMT2IM8 1271133112650013 SYAHRUL L RENTAN 56
109 P-SY8K4ZV6 1271134109670004 LAMTURUT SAMOSIR L RENTAN 54
110 J-0003R1SQ 1271135006920003 HIRA HERNILA P UMUM 29
111 J-0003EUJB 1271136310990005 NOVITA P PP 21
112 P-SWYUVMGM 1271085611030002 SALSHA BULAN MARPAUNG P REMAJA 17
113 P-SY07T0QI 1271135211750002 FARIDA HANUM P UMUM 45
114 Q-000NOTVP 1271175104080001 ANGEL DEVARYATI P REMAJA 14
Keterangan
D : Lainnya
E : Tidak Bekerja
Kelompok Umur
18-30
31-45
46-59
Total
Pekerjaan
A
B
C
D
E
Total
MEDAN LABUHAN

BPJS Non
BPJS PBI
PBI
JL. MADID UTAM MEDAN PERJUANGAN T TEGAL REJO Medan Perjuangan 081375409595 √
PAJAK RAMBE LK VI MARTUBUNG Medan Labuhan 085270544139 √
LK. VI MARTUBUNG MARTUBUNG Medan Labuhan 085262811782 √
JL. KL. YOS. SUDARSO LK. IV MARTUBU MARTUBUNG Medan Labuhan 088261452159 √
: PAJAK RAMBER VI PINGGIR REL MARTUBUNG Medan Labuhan 081263823837 √
JL. BAKTI ABRI GG. KELUARGA LK. III MARTUBUNG Medan Labuhan 082166636271 √
JL. KL. YOS. SUDARSO LK. IV MARTUBU MARTUBUNG Medan Labuhan 08822015897626 √
: JL. BAKTI ABRI GG. KELUARGA LK. III MARTUBUNG Medan Labuhan 081264158875 √
LK. IX SEI MATI SEI MATI Medan Labuhan 082160525446 √
JL. HAKIM LK. III MARTUBUNG Medan Labuhan 082118064280 √
LK. I BAHARI MARTUBUNG Medan Labuhan 081367916367 √
KOMP. GABION LK. IX MARTUBUNG Medan Labuhan 081361373259 √
JL. ASAM LR. SEKOLAH LK. VII MARTUBUNG Medan Labuhan 081396430478 √
JL. KAMBES LK. IV MARTUBUNG Medan Labuhan 082195791951 √
LK. II MARTUBUNG MARTUBUNG Medan Labuhan 082161034923 √
LK. III MARTUBUNG MARTUBUNG Medan Labuhan 082367004078 √
LK. III MARTUBUNG MARTUBUNG Medan Labuhan 081370333510 √
KAMBES LK. IV MARTUBUNG Medan Labuhan 082362541156 √
GRAHA MARTUBUNG 1 JL. TULIP 19 MARTUBUNG Medan Labuhan 081370314381 √
JL. KUBA LK. I MARTUBUNG Medan Labuhan 081376478662 √
JL. TELUK HARU REL PJKA LK. II MARTUBUNG Medan Labuhan 085384387691 √
JL. PAYA BAKUNG LK. V MARTUBUNG Medan Labuhan 082276197905 √
LK. III KP. BESAR MARTUBUNG Medan Labuhan 0895346418597 √
P. RAMBAI LK. VI MARTUBUNG Medan Labuhan 082274195345 √
LK. V PAYA BAKUNG MARTUBUNG Medan Labuhan 082362215222 √
JL. T. DALAM GG. HAKIM NO. 28 LK. III MARTUBUNG Medan Labuhan 085277864516 √
JL. KANTOR LURAH LK. VII MARTUBUNG Medan Labuhan 082369002771 √
JL. T. DALAM GG. HAKIM NO. 28 LK. III MARTUBUNG Medan Labuhan 082365061096 √
LK. V MARTUBUNG MARTUBUNG Medan Labuhan 082165834280 √
PAJAK RAMBE GG. RAMBE BARU LK. 6 MARTUBUNG Medan Labuhan 085296487088 √
PAJAK RAMBE GG. RAMBE BARU LK. 6 MARTUBUNG Medan Labuhan 085359978081 √
PAJAK RAMBE LK VI MARTUBUNG Medan Labuhan 085270213351 √
LK. IV KAMBER GG. KARYA MARTUBUNG Medan Labuhan 087748867193 √
JL. BAKTI ABRI LK. III MARTUBUNG Medan Labuhan 0895334616846 √
JL. BAKTI ABRI LK. III MARTUBUNG Medan Labuhan 082362559519 √
JL MANGAAN I / JL SUASA LK IV MARTUBUNG Medan Labuhan 081269537544 √
JL.KAMBES GG KARYA LK IV MARTUBUN MARTUBUNG Medan Labuhan 083113660597 √
JL,BAKTI ABRI LK III MARTUBUNG MARTUBUNG Medan Labuhan 081260662545 √
LINGKUNGAN VI SISI REL MARTUBUNG MARTUBUNG Medan Labuhan 085372239568 √
LK. IV KP. BESAR MARTUBUNG Medan Labuhan 081368617226 √
KL. YOS. SUDARSO KM. 14,8 LK. II MARTUBUNG Medan Labuhan 085763281067 √
LK. II PINGGIR REL MARTUBUNG Medan Labuhan 081360676136 √
P. BAKUNG GG. SEKOLAH LK. V MARTUBUNG Medan Labuhan 081397167380 √
GRAHA MARTUBUNG 1 JL. TULIP 19 MARTUBUNG Medan Labuhan 087851005560 √
KAMBES GG. KARYA LK. IV MARTUBUNG Medan Labuhan 088263549002 √
JL. ELLYAS DALAM LK. VI MARTUBUNG Medan Labuhan 081396924165 √
JL. PAYA BAKUNG LK. V MARTUBUNG Medan Labuhan 088263258849 √
KAMBES GG. KARYA LK. IV NO. 307 MARTUBUNG Medan Labuhan 089613183946 √
KL. YOS. SUDARSO LK. II KP. BESAR MARTUBUNG Medan Labuhan 088271902993 √
LK. IV MARTUBUNG MARTUBUNG Medan Labuhan 081261326404 √
SEI PADANG GG. PRIBADI NO. 9 PB. SELAYANG I MEDAN SELAYANG 081260010716 √
LK. I KP. BAHARI MARTUBUNG Medan Labuhan 085362939431 √
SEI PADANG GG. PRIBADI NO. 9 PB. SELAYANG I MEDAN SELAYANG 085261628414 √
LK. I KP. BAHARI MARTUBUNG Medan Labuhan 085261716978 √
JL. BUNGA RAMPE II LK. II SIMALINGKAR B MEDAN TUNTUNGAN 082272536851 √
JL. CINGUAN LK. V PAYA BAKUNG MARTUBUNG Medan Labuhan 085830249364 √
LK. VII MARTUBUNG MARTUBUNG Medan Labuhan 081260916940 √
JL. EMPAT NO. 8 PULO BRAYAN BENGKELMEDAN TIMUR 089521080815 √
JL. ELLYAS DALAM LK. VI MARTUBUNG Medan Labuhan 089524217896 √
LK. IX LOR BAMBU PAYA PASIR MARELAN 085361572861 √
JL. KANTOR CAMAT LK. IV KP. BESAR MARTUBUNG Medan Labuhan 085362467839 √
JL. KANTOR CAMAT LK. IV KP. BESAR MARTUBUNG Medan Labuhan 081262618387 √
LK. VI MARTUBUNG MARTUBUNG Medan Labuhan 081377194078 √
JL. GARUDA LK. VII MARTUBUNG Medan Labuhan 082363114188 √
GG. MUSHOLLA LK. VI MARTUBUNG Medan Labuhan 081260943667 √
JL. TULIP NO. 18 GRAHA MARTUBUNG MARTUBUNG Medan Labuhan 082110190380 √
JL. CINGUAN NO. 50 LK. II MARTUBUNG Medan Labuhan 081335971491 √
JERMAL RAYA GG. SAHABAT LK. XVII MARTUBUNG Medan Labuhan 085361893575 √
LK. XIV SEI MATI SEI MATI Medan Labuhan 085217159656 √
JL. JERMAL RAYA GG. SAHABAT LK. XVII SEI MATI Medan Labuhan 085297822031 √
P. RAMBE LK. VI MARTUBUNG Medan Labuhan 081335647080 √
LK. 2 GG. PRIBADI SIMPANG KANTOR PEKAN LABUHAN Medan Labuhan 082369055558 √
JL. P. INPRES GG. KENARI NO. 7 MARTUBUNG Medan Labuhan 085261464891 √
PASAR 2 BARAT LK. 2 TERJUN MARELAN 081371269305 √
JL. PANCING V LK. III MARTUBUNG Medan Labuhan 082269367437 √
JL. KAMBES LK. IV KP. BESAR MARTUBUNG Medan Labuhan 081260916020 √
JL. TIRTO SARI UJUNG NO. 136 BANTAN MEDAN TEMBUNG 085362331541 √
JL. ANGGREK 1 BLOK D LK. V MARTUBUNG Medan Labuhan 0895611647463 √
P. RAMBAI LK. VI GG. AMAL MARTUBUNG Medan Labuhan 081362331644 √
P. RAMBAI L.K. VI SISI REL MARTUBUNG Medan Labuhan 081370404522 √
P. RAMBAI LK. VI GG. AMAL MARTUBUNG Medan Labuhan 081397966020 √
JL. P. INPRES GG. MERPATI NO. 16 MARTUBUNG Medan Labuhan 085270155119 √
JL. TENGGIRI NO. 17 LK. III BELAWAN BELAWAN BAHAGIAMEDAN BELAWAN 081385825629 √
JL. KAMBES LK. IV KP. BESAR MARTUBUNG Medan Labuhan 081269782363 √
JL. BUNGA CEMPAKA PASAR III TITI RANTAI MEDAN BARU 082363813339 √
Merek Vaksin
A : Sinovac
B : Lainnya (Mohon Disebutkan Jenis Vaksin Yan
Kepersertaan BPJS
BPJS PBI
BPJS Non PBI
Non Anggota
Total
Pemberian Dosis
Dosis 1
Dosis 2
Total
rtaan BPJS (tulis 'Ya'
Dosis I Dosis 2
kolom yang sesuai)
Tanggal KETERANGAN
Merek Vaksin Tanggal
Non Screening Tanggal
Anggota
Vaksin n Vaksin
CORONAVAC 9/16/2021 9/16/2021 202107140K LANJUT VAKSIN 2
CORONAVAC 9/16/2021 9/16/2021 202107140K SELESAI
CORONAVAC 9/16/2021 9/16/2021 202107140K SELESAI
(Mohon Disebutkan Jenis Vaksin Yang Diterima Puskesmas/Faskes)
Kepersertaan BPJS
PBI
ota
Total
Dosis
Total
FORMAT PENCA
TINGKAT PUS

Nama Umur Kel.

No No.Registrasi NIK Penerima JK Pekerjaan Alamat
Umur
Vaksin (> 60Tahun)
1 P-0Z1AR11M 1207244906080001 SYAQILLA P REMAJA 13 DSN XX TJG
2 P-1N87FN3G 1271126109080006 ANISA RAMA P REMAJA 12 JLN MARELAN
3 P-3JFA54GR 1271125404080003 NURIN AQIL P REMAJA 13 JLN MARELA
4 P-5DHMF25N 1271125310070005 FITRI PERM P REMAJA 13 LK 6 MEDAN
5 P-70LVUKJT 1271125401090001 ADINDA RA P REMAJA 12 LK I GG SE
6 P-9964MZEZ 1271121701090001 EL VANIS A L REMAJA 12 PERUM MEDI
7 P-E8XBYQOY 1271126110080004 BALQIS NAIL L REMAJA 12 KOMP UKA
8 P-F5BCO5PT 1271124409080003 ANNISA RAM P REMAJA 13 PSR I REL L
9 P-FKB1KG7Y 1271125208080001 SILVIA MAH P REMAJA 13 JLN MARELA
10 P-GA2RFDOP 1271125806080005 NAZWA SYA P REMAJA 13 GG INDAH PS
11 P-GJKVSEJ7 1271127110070004 SELI SYAHFI P REMAJA 13 LK 2 TERJU
12 P-GRXMUB7P 1271124105080001 DWI KIRANA P REMAJA 13 JLN MARELA
13 P-HD44QBF9 1271125003080004 FEBBY MARI P REMAJA 13 LK 7 PSR 4
14 P-HLIOJNUT 1271125911070004 DIANA AMEL P REMAJA 13 JLN MARELA
15 P-I4WQMR6T 1271124909080009 NADINE FEL P REMAJA 13 KOMP GRAH
16 P-IMQAASXE 1371107004080003 KEISHA NAD P REMAJA 13 KOMP MARE
17 P-INEPPVLJ 1271126810080003 FITRI LESTA P REMAJA 12 JLN SERBA
18 P-JR6XNNCZ 1271206712080004 NADIN NUSA P REMAJA 12 PSR II BARA
19 P-K24H9XKG 1271126001080004 RIZQI PUTRI P REMAJA 13 JLN MARELAN
20 P-KCDSK81J 1271124807080003 SYIFA NABI P REMAJA 13 JL. MARELAN
21 P-L0E1CW0B 1271122404080003 NAUFAL PR L REMAJA 13 JLN MARELA
22 P-L4OP5SHE 1271126004080001 SILVY KART P REMAJA 13 JL. MARELAN
23 P-MOEOPAEM 1271052801080004 DAVA FATH L REMAJA 13 JLN MARELA
24 P-NRXFQ7PO 1271121212080004 HERU SETI L REMAJA 12 PSR 2 LK II
25 P-O2JYWWLO 1271055101080003 MAHFUZHAH P REMAJA 13 JLN MARELAN
26 P-ONEWFWVK 1271126108070001 BUNGA PERTP REMAJA 14 JLN MARELAN
27 P-PG0DDOND 1271120709080002 M. ILHAM R L REMAJA 13 JL MARELAN
28 P-PG6F6L08 1271120408080003 MUHAMMAD L REMAJA 13 PSR 2 BARA
29 P-PTLAHDXM 1271120712080001 MUHAMMAD L REMAJA 12 JLN MARELAN
30 P-QCLIGMYP 1205021801080001 LEFI ANDRI L REMAJA 13 PSR I TENGA
31 P-QQIALG0Q 1271123105080003 RENDI PRA L REMAJA 13 PSR I TENGA
32 P-RJE32X5N 1271066707080001 ASTI FADHI P REMAJA 13 JLN MARELA
33 P-RSXAEQGQ 1271126809080001 BUNGA SAFI P REMAJA 12 JL ILENG G
34 P-SEJBUPYU 1271124908070004 SUFINA ANG P REMAJA 14 JL BAUT LK
35 P-SGSD23KX 1271124603080003 SYAFIRA ZA P REMAJA 13 JLN MARELAN
36 P-SGZPKCBP 1271061611070008 M JUANDA I L REMAJA 13 PASAR 2 BAR
37 P-SH2OAR9C 1271122509080004 RADIT NUG L REMAJA 12 LK 18 PSR 6
38 P-SHJBS06H 1271060702070005 FEBRIANSY L REMAJA 14 JLN MARELA
39 P-SHPJ5OVN 1271065309080003 CATURIKA G P REMAJA 13 PSR 1 MARE
40 P-SHWHEWJ5 1271135706840001 FITRIANI P B 37 P,RAMBAI L
41 P-SHYMUDSC 1271126507080004 NADIA ZIZLA P REMAJA 13 JLN SIKU LK
42 P-SI3JLFIL 1271122406080008 RAKHA ABY P REMAJA 13 KOMP MAREL
43 P-SI9BBYMQ 1205206712080001 ANDHINI SA P REMAJA 12 JLN PSR II
44 P-SIKWWLTG 1271122004090001 DIMAS ADIT L REMAJA 12 JLN PSR 3 R
45 P-SIPWC468 1271126508080005 AURA SALWAP REMAJA 13 JLN MARELAN
46 P-SIW0EUJP 1271124807080002 SAKILA ANJA P REMAJA 13 JLN MARELA
47 P-SJ0KZB1Y 1271122904080004 HABIB PRA L REMAJA 13 LINGKUNGAN
48 P-SJ3BTI3H 1271121711080004 ADITYA PRA L REMAJA 12 JLN MARELA
49 P-SJ77GRLO 1271122903090003 ARIEL FINZ L REMAJA 12 JL. MARELA
50 P-SJAP4UXY 1271124903080004 SYAH DILLA P REMAJA 13 PSR I LK I
51 P-SJCOVMH3 1271126112080002 ZASKIA HUM P REMAJA 12 LINGK 21 M
52 P-SJFRFSRF 1271125810080001 TRI ANDINI P REMAJA 12 MEDAN MARE
53 P-SJM3NFQX 1271126006080003 LISA JUNIAR P REMAJA 13 MARELAN VII
54 P-SJSLBL0W 1271125811080003 ANISA ZAHA P REMAJA 12 PASAR 02 LI
55 P-SJUNXOOZ 1271124208080010 AJENG DWI P REMAJA 13 LK I PSR I
56 P-SJYC4F0E 1271121001080004 RANGGA MU L REMAJA 13 MARELAN PA
57 P-SK4851ET 1271120401090006 ABDULLAH L REMAJA 12 JL. MARELAN
58 P-SKB56IRS 1271204604070004 KEYLA NADI P REMAJA 14 JL. MARELAN
59 P-SKE4SVJA 1271121001070001 YUDHA PRA L REMAJA 14 Jln marelan i
60 P-SKISKD1G 1271126602070003 SUCI KHAIR P REMAJA 14 LINHGK. V
61 P-SKMRXMV2 1271122706070002 DAKA IKHW L REMAJA 14 LINGKUNGAN
62 P-SKT891JA 1271125004070005 MAULI DINA P REMAJA 14 JLN PAKU LK
63 P-SKTQ17DA 1207254412060003 DEA PERMATP REMAJA 14 JL. DURUNG
64 P-SKZCCE6W 1271121712070004 DIMAS IND L REMAJA 13 LINGK. 3 P
65 P-SL57ILA1 1271122802070003 MHD RAHHI L REMAJA 14 JL. MARELAN
66 P-SLB7CVUD 1207240406070004 MUHAMMAD L REMAJA 14 DUSUN XX TJ
67 P-SLF96VVF 1271125004070004 MIMI PRATIW P REMAJA 14 JL. ABDUL S
68 P-SLP6YELD 1271126701070007 NABILA ADE P REMAJA 14 LINGK 22 K
69 P-SLT78OY5 1271144409070004 ELLA SELVI P REMAJA 14 MARELAN JL
70 P-SLUAH57P 1271036209070004 NUR SYAHID P REMAJA 13 JLN MARELA
71 P-SLXPJI2X 1271126903070003 CHITIYA NAB P REMAJA 14 JL. MARELAN
72 P-SM0JBHYV 1207231206070005 ADRIAN KH L REMAJA 14 JLN MARELAN
73 P-SMBB2SLA 1271126012060003 DELA SAFITRP REMAJA 14 JL. MARELAN
74 P-SMCB0SL0 1271182211070005 RAIHAN SYA L REMAJA 13 PSR II BAR
75 P-SMGKRTP2 1271125204070001 AVRILIA EKA P REMAJA 14 JLN MARELAN
76 P-SMLABFAG 1271126201070002 SARAH SUHEP REMAJA 14 PSR T Gg.
77 P-SMQ8S1KL 1271120704070002 M FAREL L REMAJA 14 JL. MARELA
78 P-SND0QOJL 1271126804070005 DINI KHAIR P REMAJA 14 JLN MARELAN
79 P-SNHFRGWY 1271064507070005 ZULAIKA SY P REMAJA 14 JLN MARELAN
80 P-SNLU2GOO 1271126405070001 SELLY SABI P REMAJA 14 JLN SERBA
81 P-SNQLPPPC 1271064712070006 KIRANA AR P REMAJA 13 JLN A SANI
82 P-SNYWYWTF 1271191807060001 ALIF ALFHA L REMAJA 15 JLN MARELA
83 P-SO5OJ6LS 1271056003070005 ZASKIA AYU P REMAJA 14 JLN MARELA
84 P-SOE82ZYL 1271201703070001 AHMAD ALD L REMAJA 14 JLN KAPT R
85 P-SOLHR5OS 1271146608060003 NURUL SYIF P REMAJA 15 KOMP GRIYA
86 P-SP3WIKI8 1271124706070007 SYIFA IVAN P REMAJA 14 PSR 4 BARA
87 P-SPAIYEV4 1271021603070002 IBNU FARHA L REMAJA 14 JLN MARELA
88 P-SPEKJ7S5 1271125410060005 DELLA SYHA P REMAJA 14 LINGK VI TA
89 P-SPINGR8Z 1271051508070001 MUHAMMAD L REMAJA 14 PSR 2 BARAT
90 P-SPXLBHUW 1271120510070003 DIAN SUTRI L REMAJA 13 JLN MARELAN
91 P-SQG6LJBA 1271120208070002 DEVANDRA AL REMAJA 14 JLN PUKAT
92 P-SQPLFKIH 1213180511060001 AIDIL HANA L REMAJA 14 JLN MARELAN
93 P-SQSMZYZV 1271121505060006 M RIAN L REMAJA 15 PSR I MAREL
94 P-SQTS5GR9 1271124403080002 RIZKY WULA L REMAJA 13 PSR II BARA
95 P-SQZK07O9 1271122301070002 MUHAMMAD L REMAJA 14 JLN A. SANI
96 P-SR4XHFBI 1271123001070002 M ROBBI L REMAJA 14 JLN MARELAN
97 P-SRAX7CO4 1271125209070005 SARAH SELV P REMAJA 14 JLN MARELA
98 P-SRG80UQ9 1271121906070004 SANJAYA L REMAJA 14 JLN MARELA
99 P-SRKFQCKD 1271181510060001 AHMAD HAF L REMAJA 14 LK 3 MEDIT
100 P-SRNYK6HZ 1271122109070001 RIO RAMAD L REMAJA 13 KOMP MARE
101 P-SRRF9CIQ 1271122105070001 SIGIT SURY L REMAJA 14 JL. MARELAN
102 P-SRRXA7A6 1271205406080004 TRIA CAHAY P REMAJA 13 JLN SELAMA
103 P-SRWK1YC8 1271121610060003 MAHOLI OK P REMAJA 14 JLN MARELA
104 P-SRYAR8SI 1206131508060002 ALBERT AL L REMAJA 15 JL. PSR IV
105 P-SS2M9LE6 1271124910070005 FITRIA RAM P REMAJA 13 JLN MARELA
106 P-SS59K1O7 1271120905070003 MUHAMMAD L REMAJA 14 JL. MARELA
107 P-SSCQTOH6 1271122309060004 DHANDY AC L REMAJA 14 JLN A. SAN
108 P-SSF6S8EP 1271124611070006 IRA SAFIRA P REMAJA 13 PSR 1 REL
109 P-SSIIDMAW 1271124909060007 AMELIA RIST P REMAJA 15 PSR 1 REL
110 P-SSK8I0VZ 1271205412070004 DHEA YURIZ P REMAJA 13 JLN PSR 3
111 P-SSLJMJSH 1271125402070007 SILVI ANTI P REMAJA 14 JL. MARELAN
112 P-SSOPA7N3 1271125707070007 DIAN NADIR P REMAJA 14 JL. MARELA
113 P-SSQ8Z3WA 1271122806080008 FIKRI ATMA L REMAJA 13 JLN PAKU T
114 P-SST7QSZS 1271124705070005 MARSYA AM P REMAJA 14 JLN MARELA
115 P-SSVWXN5B 1207245808080005 CINDI AGUS P REMAJA 13 DUSUN XX T
116 P-ST2OH82G 1207256810070004 ALYA PRAUT P REMAJA 13 JLN MARELAN
117 P-STC9UW7E 1271064511070003 NOVA ANISA P REMAJA 13 JLN PLATINA
118 P-STHHBQUB 1271180908080001 MHD RADITI L REMAJA 13 JLN MESJID
119 P-STNQBAGT 1271122707070011 MUHAMMAD L REMAJA 14 PSR I REL
120 P-STRWSUYF 1271125411070002 INGKA CANT P REMAJA 13 KOMP YUKA
121 P-STTSFUBW 1271126604080004 KEYSIA DZA P REMAJA 13 JL. MARELAN
122 P-STVYVRGF 1207250907080002 JULIADI L REMAJA 13 DSN VI JL.
123 P-SU0HJWF0 1271015707070006 MEYSHA AU P REMAJA 14 JL. KARYA B
124 P-SU0K7VYS 1207250210070002 ANDHIKA A L REMAJA 13 DSN II JLN
125 P-SU4WPVZD 1271062009070003 YOGA WARD L REMAJA 13 LK. 5 Gg. R
126 P-SU7SOT1E 1218042701070003 BAMBANG L L REMAJA 14 MARELAN VI
127 P-SUDFODOC 1218045306080001 SITI RAHMA P REMAJA 13 JLN MARELA
128 P-SUGU5KH8 1271121704070004 AHMAD YOG L REMAJA 14 LK I PSR IT
129 P-SUJO61HR 1271120505080007 ANDIKA SY L REMAJA 13 JLN SERBA
130 P-SUOHKVPR 1271123108070001 MHD IBNU A L REMAJA 14 LK I PSR I
131 P-SUS46XQH 1271122306070001 YUDHA PRASL REMAJA 14 LK 23 RENG
132 P-SUV2V6XD 1271072710060001 MHD REIHAN L REMAJA 14 KOMP WAIKI
133 P-SV0ZIXO7 1271120612070005 M. SYAHKA L REMAJA 13 LK 2 PSR 2
134 P-SV62GZ67 1271127103040001 UMMI APSAR P REMAJA 17 JLN SUMBAW
135 P-SVSISSNK 1271122602070004 M. RIO L REMAJA 14 JLN MARELAN
136 P-SZEZ7VQT 1209206805990001 NUR HAFNI P B 22 JL PINTU AI
137 P-SZFYOWBH 1271061408980006 RIZKY NAND L B 23 Jln Perbatas
138 P-SZI1OOOS 1271204709020006 AMANDA MU P B 19 JLN G SEU
139 P-SZJR9WEY 1271126511030013 ARBANAIYAHP REMAJA 17 JLN MARELA
140 P-SZO4KF56 1271125906030006 DIA UHSWA P B 18 PSR I REL
141 P-SZQECJYQ 1271122706000004 DIMAS AJI L B 21 MARELAN PS
142 P-SZTJC8BA 1206112611080001 WAHYU BAS L REMAJA 13 KOMP NIPP
143 P-SZWMWJN9 1271123005070001 HIMAWAN P L REMAJA 14 KOMP CITR
144 P-SZYSVU2L 1271134910990002 RIZKA DWI L B 21 JLN TU 12
145 P-T02OBFTM 1271120707090001 FAEYZA GU L REMAJA 12 PSR I TENG
146 P-T0A2TYLJ 1271121911070006 MUHAMMAD L REMAJA 13 JL SERBA JA
147 P-T0BJUTKQ 1271121902080001 MUHAMMAD L REMAJA 13 LK 9 MEDAN
148 P-T0JD11DP 1271067101070002 ANNISA KE P REMAJA 14 LK 29 RENG
149 P-T0JQRX53 1271124110070001 ANNISA AUL P REMAJA 13 KOMP GRAN
150 P-T0MKFTPS 1271136705080002 AMELIA PUT P REMAJA 13 KOMP GRAH
151 P-T0OW80OV 1207052207070004 DEDE PRAM L REMAJA 14 JLN ILENG
152 P-T0S0D41K 1271124112080001 ANNISA AN P REMAJA 12 JLN JALA 9
153 P-T0VCEFHT 1207064505070001 ALYA MUKHBP REMAJA 14 PSR I REL N
154 P-T0XDT99R 1271121010070000 RASIL HAKI L REMAJA 13 JL MARELAN
155 P-T0XUMCVC 1271121911070003 REYCAN SY L REMAJA 13 JLN KAPT R
156 P-T11CYWBG 1271081311070001 MUHAMMAD L REMAJA 13 KP SALAM
157 P-T15FB1H4 1271081003070001 MUHAMMAD HL REMAJA 14 JLN PASAR
158 P-T19OJDMU 1271035802070001 DHIYA ALFIA L REMAJA 14 MARELAN RA
159 P-T1CL4CF0 1271082002070001 AIZAT FIQRI L REMAJA 14 JLN INSPEK
160 P-T1FJS65W 1271162701080002 MUHAMMAD L REMAJA 13 PASAR I MA
161 P-T1INRR0O 1271067011080005 CINDY AULI P REMAJA 12 JLN MARELA
162 P-T1KZYA7T 1271131805080007 ZHONATAN L REMAJA 13 JLN MARELAN
163 P-T1N0I0D8 1271126003080001 SYIFA MAUL P REMAJA 13 LINGK 19 R.
164 P-T1PCYQGD 1271124405070001 SITI FAHMA P REMAJA 14 JLN MARELA
165 P-T1QXZSAJ 1271124909070003 RASYA INTA P REMAJA 14 JLN H. A. M
166 P-T1SVBSGY 1271061803080005 RENO PRAN L REMAJA 13 JLN A. SAN
167 P-T1VNYK8V 1271136410070001 MUTIA HAFI P REMAJA 13 PSR 2 BARAT
168 P-T1ZKZFYO 1207246509080002 CINDY LARA P REMAJA 12 DSN XX TAN
169 P-T259BCYM 1271206702080004 INDRI KHAIR P REMAJA 13 JLN BILAL
170 P-T29B2YPQ 1271120502070002 ADAM FIRM L REMAJA 14 JLN MARELAN
171 P-T2CB1V8N 1271126305080001 LIZA KHUMA P REMAJA 13 LK 20 R. PU
172 P-T2FQ2S2M 1271065809070003 AISKA KHEI P REMAJA 13 JLN MARELA
173 P-T2HP911P 1271126201080006 NAZWA KHODP REMAJA 13 MARELAN PS
174 P-T2JYDJCN 1271125910070001 RESA ALVIT P REMAJA 13 JLN MARELAN
175 P-T2NH1BFU 1271066411060005 NOVI RIZQI P REMAJA 14 JLN A. SAN
176 P-T2PQGR4M 1271124304070007 ZUPITA ANDI P REMAJA 14 JLN CERUT
177 P-T2SE5L87 1271055506070001 ANNISA AUL P REMAJA 14 JLN PAKU G
178 P-T2UQMXGS 1271024109080002 CHAIRUNNIS P REMAJA 13 PSR IV BAR
179 P-T2WTYKD2 1207254409070003 CHAIRANI A P REMAJA 14 JLN ANDAN
180 P-T2ZHSIK4 1207256901070004 NUR INDAH P REMAJA 14 PSR 2 GG A
181 P-T322DSR6 1104136203090001 NAZWA KHA P REMAJA 12 JLN MARELA
182 P-T34KGL3Q 1271066106070002 SANDRINA O P REMAJA 14 JLN PAKU G
183 P-T36S4GAL 1171016010070002 VIRA SAFIT P REMAJA 13 JLN ASRAMA
184 P-T3ATDTSI 1207266505080006 LUCKIYANA P REMAJA 13 JLN JALA X
185 P-T3C8MWYH 1271066201080001 RIFA CHALI P REMAJA 13 JLN KL YOS
186 P-T3DPZ4DD 3314044404070003 SEKAR AYU P REMAJA 14 JLN PANCIN
187 P-T3FE5P58 1271124910070001 LUTHFIYAH P REMAJA 13 JLN PAKU L
188 P-T3H1BOTS 1271066208070005 WIRA AGUST P REMAJA 14 JLN MANGAAN
189 P-T3P0B5QP 1271120912070001 ATHIRTA RI L REMAJA 13 JL. SUMBAWA
190 P-T3R0JWVJ 1271146112080004 AQILA ZAHR L REMAJA 12 JL. MARELAN
191 P-T3RJYNWD 1277016411060002 ASHMA SHA P REMAJA 14 JLN MARELAN
192 P-T3T6CH1G 1271062905080001 KEIZA IBRA P REMAJA 13 JLN PLATINA
193 P-T3WBGLMA 1271120711070009 SYAHIB ZIBR L REMAJA 13 PSR I REL
194 P-T3XNTHCH 1271066101080001 VIVI BADRIY P REMAJA 13 MARELAN AN
195 P-T3Y6GL74 1271127009070003 TIARA SEFTI P REMAJA 13 JLN Y.. P. H
196 P-T40B73K7 1271121512070004 SHIVA ADIT P REMAJA 13 GG. PRINGG
197 P-T45EEZZO 1271140810070003 FATHAN MUBL REMAJA 13 JLN MARELA
198 P-T49EMHIM 1271126005080005 ZAKHIRA MA P REMAJA 13 LK 3 GG PE
199 P-T4AZVQ5H 1207256512070002 ZAHFIRA YA L REMAJA 13 DSN VII PSR
200 Q-000NOTVP 1271175104080001 ANGEL DEVA P REMAJA 13 JL. BUNGA C

D : Lainnya
E : Tidak Bekerja
Kelompok Umur
18-30
31-45
46-59
Total
Pekerjaan
A
B
C
D
E
Total

AN LABUHAN

Kelurahan Kecamatan No.Hp BPJS Non Non Merek Vaksin
BPJS PBI
PBI Anggota
KLUMPANG KEBUN HAMPARAN PERAK 0895712910902 CORONA VAC
TANAH ENAM RATUS MEDAN MARELAN 085358591953 CORONA VAC
RENGAS PULAU MEDAN MARELAN 081397753484 CORONA VAC
TERJUN MEDAN MARELAN 085361440989 CORONA VAC
TABING BANDA GADANG NANGGALO 0895602758775 CORONA VAC
GAHARU MEDAN TIMUR 082168112044 CORONA VAC
DURIAN MEDAN TIMUR 082287208976 CORONA VAC
PULO BRAYAN BENGKEL MEDAN TIMUR 0895334632133 CORONA VAC
TITI PAPAN MEDAN DELI 082168179878 CORONA VAC
TEGAL REJO MEDAN PERJUANGAN 081370511110 CORONA VAC
MANUGGAL LABUHAN DELI 082369837739 CORONA VAC
SELEMAK HAMPARAN PERAK 087792091865 CORONA VAC
TANJUNG SELAMAT MEDAN TUNTUNGAN 085296125359 CORONA VAC
SITIREJO I MEDAN KOTA 081285683903 CORONA VAC
GLUGUR DARAT I MEDAN TIMUR 082277161294 CORONA VAC
RIMO KAYU PAYUNG 081311112085 CORONA VAC
BESAR MEDAN LABUHAN 082273744937 CORONA VAC
MARTUBUNG MEDAN LABUHAN 081265209111 CORONA VAC
PAYA PASIR MEDAN MARELAN 081264038325 CORONA VAC
DELI TUA NAMO RAMBE 082167698978 CORONA VAC
BELAWAN II MEDAN BELAWAN 081261324085 CORONA VAC
HELVETIA MEDAN HELVETIA 0895622916674 CORONA VAC
BELAWAN I MEDAN BELAWAN 082370437392 CORONA VAC
PEKAN LABUHAN MEDAN LABUHAN 081263771382 CORONA VAC
PULO BRAYAN KOTA MEDAN BARAT 081361779375 CORONA VAC
PULO BRAYAN DARAT I MEDAN TIMUR 087899471253 CORONA VAC
KARANG BEROMBAK MEDAN BARAT 082166120365 CORONA VAC
TANJUNG REJO MEDAN SUNGGAL 082361051762 CORONA VAC
HELVETIA LABUHAN DELI 085261372547 CORONA VAC
PULO RAYAN BENGKEL MEDAN TIMUR 081275124315 CORONA VAC
TEMBUNG PS. TUAN 081265722271 CORONA VAC
MABAR MEDAN DELI 081265841115 CORONA VAC
SIDOREJO MEDAN TEMBUNG 082164093707 CORONA VAC
WEK I PD. SIDEMPUAN UTARA 081264411261 CORONA VAC
TJ. MULIA HILIR MEDAN DELI 088210816606 CORONA VAC
LABUHAN DELI MEDAN MARELAN 082363530162 CORONA VAC
BANTAN MEDAN TEMBUNG 082368840965 CORONA VAC
B : Lainnya (Mohon Disebutkan Jenis Vaksin Yang Diterima P
Kepersertaan BPJS
BPJS PBI
BPJS Non PBI
Non Anggota
Total
Pemberian Dosis
Dosis 1
Dosis 2
Total
Fasyankes
19
Dosis I Dosis 2 Keterangan

Tanggal Tanggal Tanggal
Screening Pemberian No.Batch Pemberia No.Batch Ditunda / Tidak Diberikan/Lanjut
Vaksin n Vaksin
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
9/16/2021 9/16/2021 202108152G - - LANJUT VAKSIN 2
enis Vaksin Yang Diterima Puskesmas/Faskes)
PJS
Tabel 10. Format Pencatatan Pel
FORMAT PENCATATA
TINGKAT PUSKES

Umur Kel.
No No.Registrasi NIK Nama Penerima Vaksin JK Pekerjaan Alamat
Umur
(> 60Tahun)
1 P-UDNAT3GM 1271135512990005 TYA RAMADANI P B 22 LINGK.I
2 P-U41HIDTY 1271136910720001 KHAIRIAH P B 43 LINGK.I
3 S-3096AFAD 1271137112600021 ERNI P LANSIA 61 LINGK.I
4 S-718461EC 1272231410490001 NURSAL EFFENDI L LANSIA 72 LINGK.I
5 P-U2RY5PAV 1271132507040008 RIFKY PRASETIYA L REMAJA 17 LINGK.I
6 P-U3EF3NTP 1271130104040004 FARHAN ABDILLAH L REMAJA 17 LINGK.I
7 P-UFD8DCUZ 1271130705010001 MUHAMMAD ANGGARA L B 20 LINGK.I
8 P-UEML1LOU 1271130108020006 ANDREANO PRATAMA L B 19 LINGK.I
9 P-U3AA2A9L 1271136111880001 WINDA NOVITA SARI P UMUM 33 LINGK.I
10 P-UFWRUK2E 1271130905010003 MHD SYAFRIL L B 20 LINGK.I
11 P-9Y2PEL12 1271132207950001 MUHAMMAD ANDREA RIZKI L UMUM 26 LINGK.I
12 P-UCWI72JW 1271136509000001 LOIS JOIS PRANTIKA P B 21 LINGK.I
13 P-QEFQ4I9O 1271130305020008 FARHAN AKBAR L UMUM 19 LINGK.I
14 P-MYD5UBB0 1271135212700002 FAUZIA N P RENTAN 50 LINGK.I
15 P-TY5SZZ2R 1271131302980003 MHD RIZKI L UMUM 23 LINGK.I
16 P-TYKS5WYO 1406125911930001 RUSLI WATI SIHOMBING P UMUM 28 LINGK.II
17 P-UEWRS2AW 1271130801810003 JAINAL HUTASOIT L B 40 LINGK.II
18 P-UDGW5K9V 1201162012870001 PEDIANTO MANALU L B 34 LINGK.II
19 P-UFGXXHO2 1271131301750002 ZULHAMDI L UMUM 46 LINGK.II
20 P-TZHNQMSI 1271134508040004 NADIA PERMATA BR PANG P REMAJA 17 LINGK.II
21 P-UF19FIK3 1271086412020004 NATALIA LUBIS P UMUM 18 LINGK.II
22 P-UG6QN0TB 1271086606910009 YOHANA P UMUM 30 LINGK.II
23 P-UG9ICTF5 1271132902840004 SYAMSYUL BAHRI L b 37 LINGK.II
24 P-UEFP5WKZ 1271131602030001 MUHAMMAD DURRUN NAFI L UMUM 18 LINGK.II
25 P-UCE9Y7U2 1271136509780002 ARIA NINGSIH P B 43 LINGK.II
26 P-UEV5GM1U 1271135105770005 NONSE M SIMAMORA P B 44 LINGK.II
27 P-UG7YW2BP 1271132908820005 HAIRUL AKMAL L B 39 LINGK.II
28 J-0000S9B6 1271132505880003 LEO BOSTON SILALAHI L B 32 LINGK.III
29 P-U0BBFPU7 1271066810820001 KRISTINA FLORIDA SITIND P UMUM 38 LINGK.III
30 P-U0NPRSE5 1271184401800005 MEGASARI DEWI P UMUM 41 LINGK.III
31 P-U1IBMRNT 1271131104020004 YOSEF AFRIANUS RINALDY L UMUM 19 LINGK.III
32 P-UCHE9ZON 1271131105750005 HENRY TINAMBUNAN L B 46 LINGK.III
33 P-PPGIGONG 1210147005030002 MEI ARTINA SIBURIAN P UMUM 18 LINGK.III
34 J-0003RFQH 1271130805980003 SAHAR L B 23 LINGK.III
35 P-UDERCOB6 1271065508720006 NURHAYATI P UMUM 49 LINGK.III
36 P-TXUV3XAG 1271202012710001 ZULKIFLI SIAHAAN L B 49 LINGK.III
37 P-RIWZ7C57 1271135104820004 APRILIA SARI P UMUM 39 LINGK.III
38 P-UCS7XFVG 1271064803750006 ROSINTAULI BR TAMBA P UMUM 47 LINGK.III
39 P-UCO7M44T 1271061111730010 DEMSON SINAGA L B 49 LINGK.III
40 P-U13JLG0C 1271065505000008 MEI INTAN SARAH BR SINA P B 21 LINGK.III
41 P-UCUA2QEN 1271061506020001 JULI HERMANTO SINAGA L UMUM 19 LINGK.III
42 S-701B65A3 1271136512880002 RIZKI IVO DESWITA P UMUM 33 LINGK.III
43 P-U0HR4LEJ 1271066704660003 M SURIANI P RENTAN 55 LINGK. III
44 P-5EYJJNDJ 1271133107990001 MUHAMMAD IQBAL L B 22 LINGK.IV
45 P-TY0I4SBK 1271131908950003 RICHAD BOY NARO L B 26 LINGK.IV
46 P-TZ5OEMFU 1271134709020005 NANDA LIANA P UMUM 19 LINGK.IV
47 P-UFIJXKTR 1207236707710004 ROSMITA SARAGIH P RENTAN 50 LINGK.IV
48 P-UFEKZEJY 1271016606860008 EVA RIA SUSANTI P B 35 LINGK.IV
49 P-UFBXOB50 1272075203860005 DAHLIANA GALINGGING P UMUM 35 LINGK.IV
50 P-UFAIDGLM 1271134702810001 ERNY P UMUM 35 LINGK.IV
51 P-UF5HQBJL 1271135404730005 ROSMAULI SIMAMORA P UMUM 48 LINGK.IV
52 P-UEZFWW16 1202111109820001 LISBER MANALU L B 39 LINGK.IV
53 J-000432OZ 1271131706730002 MUSLIMAN L B 48 LINGK.IV
54 P-UF3FZIGD 1271130305860004 FAJAR IRAWAN L B 35 LINGK.IV
55 S-14CC429D 1271130308580001 ZURAIDIN HARAHAP L LANSIA 63 LINGK.IV
56 P-TYZFQDML 1271136105020003 PUTRI MAULIDA P B 19 LINGK.IV
57 S-CF94DB91 1271132111990003 REZA ANDIKA L B 22 LINGK.IV
58 P-U3RKKVFM 1271134110910002 AYU INDAH LESTARI P UMUM 30 LINGK.IV
59 P-TXQYV4BC 1271131304000001 FARHAN MUHAJJI L B 21 LINGK.IV
60 P-TYBBWBYA 1271136711820004 NURJANNAH PANE P UMUM 39 LINGK.IV
61 P-TYFD8IDV 1271132608770007 AHMAD FAISAL LUBIS L B 44 LINGK.IV
62 P-UFFY3YMG 1271063004880005 DANIEL SIMANGUNGSONG L B 33 LINGK.V
63 P-UFSJY3OL 1271067108750004 LING HET W TAMBA P B 46 LINGK.V
64 P-30OMKLSV 1271133112790015 SUHENDRI L B 42 LINGK.V
65 P-U0SNEO1P 1271135011760002 RUBIAH P UMUM 45 LINGK.V
66 P-U86ML0LR 1271137008990001 SUCI PRATIWI P B 22 LINGK.V
67 P-U9LD1CEQ 1271135609750002 ASNITA SIHITE P UMUM 46 LINGK.V
68 P-LWUR29ZK 1271130302760001 SURATMAN L B 45 LINGK.V
69 P-MWLVIN7X 1271134812030005 DWINA MURNIATI P REMAJA 17 LINGK.V
70 P-1P19QWQ9 1271130702800004 SUHERI L B 41 LINGK.V
71 P-U04W4BIS 1271130810770007 SUHENDRA L B 44 LINGK.V
72 P-U2ZAXFQC 1271065608880004 AGUSTINA HUTAHAEAN P B 33 LINGK.V
73 P-UCZDGVLH 1271131802810005 SAMUEL PAIDO TUA SINAG L B 40 LINGK.V
74 P-UF79B45A 1271131207810005 LAMBOK PANDINGAN L UMUM 39 LINGK.V
75 S-8501949E 1209311610550001 M.ARIEF ZULKARNAEN SIR L LANSIA 66 LINGK.V
76 P-U2L2RERG 1271131803760002 MUCHLIS L B 45 LINGK.V
77 P-TZVMHR7Q 1271135606920005 YUNI YANTI SYARAH NASU P B 29 LINGK.V
78 P-UFLSBQM5 1202070905790001 TANAKA SITOMPUL L B 42 LINGK.VI
79 P-UD8ZZ18B 1271135812930001 SUCI SYAFRINA P UMUM 28 LINGK.VI
80 P-PNMG4KJN 1271136112780002 MISRAWATI HUTABARAT P B 43 LINGK.VI
81 P-SIQQXIFG 1271134512750004 RIAMA BR SIMAMORA P UMUM 46 LINGK.VI
82 P-UET5UPVP 1271130304750002 BERMAN SIMAMORA L B 46 LINGK.VI
83 P-UC1ECJ66 1271132311970001 SYANDI PRATAMA L UMUM 23 LINGK.VI
84 P-UFTMHPA4 1271134202610002 DELIMA SILITONGA P LANSIA 60 LINGK.VI
85 Q-000BMOUF 1271135803830004 FATIMAH NASUTION P B 38 LINGK.VI
86 P-UDCFBB1R 1271106904880002 SUCI PUSPITA P UMUM 33 LINGK.VI
87 1271134101030004 NADYA ZAFIRA NASUTION P UMUM 19
P. RAMBAI LK. VI Gg. SAUDARA
88 P-UFKEDGSY 1271130210820005 RUDI HENDRA WIBOWO L B 39 LINGK.VI
89 P-U2GBLHS9 1209194504040006 JESLIN P REMAJA 17 LINGK.VI
90 P-TX5DOJJW 1271123112820017 AHMAD SYAFRIZAL L B 39 LINGK.VII
91 P-TOZREZDZ 1271134604810001 ELVINA SINAGA P UMUM 40 LINGK.VII
92 P-UDPGG8OV 1271132804650001 SUGIATNO L RENTAN 55 LINGK.VII
93 P-UDKXIIUP 1271137112730006 SRI MANINGSIH P B 48 LINGK.VII
94 J-00043BHL 1271136303960001 SANTI P UMUM 25 LINGK.VII
95 P-TZRCDMJN 1271134308980001 FEBY AMALIA P B 23 LINGK.VII
96 Y-0132KLLI 3172011307810012 RUDI L B 39 LINGK.VII
97 P-U47M91CJ 1271124611020003 NUR AINI P B 18 LINGK.VII
98 P-U9VTAAEV 1271124106030006 MUTIA ARFANI P B 18 LINGK.VII
99 P-U3WUSETL 1271126404990003 DEDEK SARI HARFIANTI P B 24 LINGK.VII
100 P-SXS2XP1J 1271136811740002 EMI P UMUM 47 JLN.BANGKA
101 P-RX29T7W0 1271086008840001 YANTI P UMUM 37 JLN.PARANG
102 Q-000JHW2D 1271087004740003 SUYANTI MANULLANG P UMUM 47 JL DELI D
103 Q-000LJJHH 1271136801760005 ROSMAIDA BR SIPAYUNG P UMUM 45 JL. PANCING
104 Q-000I3ZSA 1271131307740005 MARIHOT SITUMORANG L B 48 JL PANCING
105 Q-000I3XLJ 1216013010760001 RUBEN SITUMORANG L B 45 HUMBANG HA
106 P-U1BE7F45 1271136011030002 TIONI NOVITA BR LUMBAN P REMAJA 17 LINGK. II
107 P-U3M2CIEV 1271083008010003 MUHAMMAD FIRMANSYAH L B 20 JL. SELEBES
108 P-U3I3EVKX 1271134806690002 SRI WAHYUNI P RENTAN 52 JL. KAMBES
109 P-U8IGQD6C 1212024103020001 YOHANA JESICA HUTAJULU P B 19 LINGK. VI
110 Q-000OJGWI 1271205503670002 KATIKA P RENTAN 54 JL. GAHARU
111 P-UAVNJLVN 1471114507030042 RUTH VENESIA PARDEDE P UMUM 18 JL. BELANGA
112 P-UATIIHTF 1216024503830004 JETHOTBINA MUNTHE P B 38 LK. XV SEI
113 P-UAP3E3KA 1207234701700003 ROLIDA SILABAN P RENTAN 51 LK. XV SEI
114 P-UALVMMHY 1216022604840001 YOSPITER HUTAHAEAN L B 38 LK. XV SEI
115 P-UAIUZRZC 1271062402650002 JONNY SIMBOLON L RENTAN 56 JL. MANGAAN
116 P-UA5AX5L7 1271132301780001 EKO L B 43 JL. ASAM LR
117 J-0000P357 1271196507950003 PRISCILLA KATHERINE ANA P UMUM 26 JL. BUNGA
118 P-U8WR0N29 1271132005800003 WARDIYANTO L B 41 PAJAK RAMBA
119 P-U4YPA97O 1271131003710002 MARDIYANTO L B 49 LK. VI P. RA
120 P-U4TLKO88 1271136207660003 SARTINI P RENTAN 55 KL. YOS SUD
121 P-U4PKXLFO 9103010109909003 DARTO JONATHAN SIMAMO L B 31 LK. VI MAR
122 P-UAAN3MGF 1271084102920007 YUNI SARAH P UMUM 29 JL. SRI BULAN
123 P-UA06FSOF 1271084609020004 SEPRINA PATRISIA SIANIP P UMUM 19 KP. BESAR L
124 DOUBE NIK 1271136105020003 SINTA NAINGGOLAN P B 19 LINGK.IV
125 Q-000N0K9V 1271082207030001 RENDY YOHANES GULTOM L UMUM 18 PELABUHAN
126 DUKCAPIL 1218036102950001 SUSANTI P B 26 LINGK. II
127 Q-000I3WA8 1271136303930003 SITI FATIMAH P B 28 Jl Mesjid Lin
128 P-U97O7VX2 1271130908940002 REZA ISWANDA SYAHPUTR L B 22 JL. KUBAH L
129 P-U4FX9LFJ 1271136401740003 YURNALIS P UMUM 47 LK. VI P. RA
130 P-U4C1Z4L0 1271122709980002 RIZKY AULIA L B 23 LK. II MAR
131 P-U81KP708 1271081905750004 TIAN IYU L B 48 JL. PARANG
132 P-U8AJO7UN 1271135312620001 ANIEK BINTI YUSUF P RENTAN 59 LINGK. V
133 P-U91L6A5K 1219052101790002 SYAFARUDDIN L B 42 LK. VI PAJA
134 P-U9F0Y2SA 1271136101040003 CHRISTINE GANI P REMAJA 17 LK. VII SP
135 P-U9I5OU4N 1271134211760001 DENTI NAINGGOLAN P UMUM 45 JL. ILYAS L
136 P-UC44O280 1271131904000002 MUHAMAD NANDA SYAHPU L B 21 LK. V PAYA
137 P-UC6YZF67 1271133110880003 SYAHPUTRA L B 33 JL. SRI BULAN
138 P-UCBV8LV3 1209315410850001 MUHLIZA SIREGAR P B 36 JL. TULIP
139 P-U8EMIRFS 1271035009830001 TIRZA LAILI HAFNI POHAN P UMUM 38 LK. II MAR
140 P-U9Q01360 1271132301750002 BANGSO T. MARBUN L B 46 JL. BAKTI
141 P-U9CALFCS 1271134302940002 RINI PAKPAHAN P B 27 LK. IV DESA
142 P-UDSNJZKU 1271137004060003 GRISELA LAURENSIA BR SI P REMAJA 15 LK. 15 SEI M
143 P-UDVW78E8 1271132309960004 SEPTIADI SURYA L B 25 JLN.MESJID
144 Q-000OIOGL 1211034908060001 LEONITA SIMANULLANG P REMAJA 15 JLN BINJE K
145 Q-000OISA8 1207235102050004 DEBBY ANGGRENI PANGG P REMAJA 16 JLN. BINJE
146 P-UFR8F9HS 1271130511000002 RIZALI TIGOR DAPOT HUTA L B 20 JL. T. SENT
147 P-UEPX1P7E 1271134506670001 MESI SIHOMBING P RENTAN 54 JL. SENTOSA
148 P-UFIJXKTR 1207236707710004 ROSMITA SARAGI P RENTAN 50 KAMBES LK.
149 S-2DBA2AB7 1212045206580001 RESMI TAMBUNAN P LANSIA 63 LK. IV MAR
150 P-UGBGRKJU 1271136011640001 NURLI BR SITORUS P RENTAN 57 JL. KANTOR
151 P-UG08AGBE 1271135908010004 NIA ELVIRA P UMUM 20 LK. V MART
152 P-UFN1TRKC 1271132712000005 MUHAMMAD FAWAZ RIZAKA L B 21 LK. I KP. BA
153 P-UFFY3YMG 1271063004880005 DANIEL SIMANGUNSONG L UMUM 33 LK. 5 MART
154 P-UFZ10AQP 1271130706750002 JAYA SAPUTRA L B 46 JL. MASJID L
155 P-UG315WER 1271085809810004 ELISA NABABAN P UMUM 40 JL. KP. BESA
156 P-UG1UQF0Q 1271135210640005 TOBERITA HUTABARAT P RENTAN 57 JL. KANTOR
157 P-UFVRHOSU 1271064502860004 KAROLINA GINTING P UMUM 35 KL. YOS SUD
158 P-UFPCOJ7K 1271132704650001 GALPEN HUTASOIT L RENTAN 56 JL. T. SENT
159 P-UFXOYJIG 1271084908980005 NADIA SYAFRIANI P UMUM 23 JL. SELEBES LK. 35 TITI PANJANG
160 P-UFUO9ZZF 1271064612900004 UMMI SALAMAH P UMUM 31 KL. YOS SUD
161 J-0000FLEG 1202030909830001 JONEDI HUTAGALUNG L B 38 jl.tulip10
162 J-0000FLB3 1271196308870003 TETTY FRIDAWATI HUTAGA P UMUM 34 jl.tulip10 n
Keterangan
D : Lainnya
E : Tidak Bekerja
Kelompok Umur
18-30
31-45
46-59
Total
Pekerjaan
A
B
C

AN LABUHAN

pada kolom yang sesuai) Tanggal
BPJS PBI Screening
PBI Anggota
MARTUBUNG MEDAN LABUHAN 085263574129 CORONAVAC 9/21/2021
PB. SELAYANG I MEDAN LABUHAN 082360043672 √ CORONAVAC 9/21/2021
PB. SELAYANG I MEDAN LABUHAN 082360043672 √ CORONAVAC 9/21/2021
PAYA PASIR MEDAN LABUHAN 081263868067 √ CORONAVAC 9/21/2021
SEI MATI MEDAN LABUHAN 0895618274199 √ CORONAVAC 9/21/2021
PEKAN LABUHAN MEDAN LABUHAN 082275187718 √ CORONAVAC 9/21/2021
TERJUN MEDAN LABUHAN 085265337933 √ CORONAVAC 9/21/2021
MARTUBUNG MEDAN LABUHAN √ CORONAVAC 9/21/2021
BELAWAN II MEDAN BELAWAN 082284403882 √ CORONAVAC 9/21/2021
GAHARU MEDAN TIMUR 085296623808 √ CORONAVAC 9/21/2021
SEI PUTIH TENGAH MEDAN PETISAH 081265407475 √ CORONAVAC 9/21/2021
MANGGA MEDAN TUNTUNGAN 082370847980 √ CORONAVAC 9/21/2021
PEKAN LABUHAN MEDAN LABUHAN 082363391655 √ CORONAVAC 9/21/2021
LAUMIL TIGALINGGA 082164600749 √ CORONAVAC 9/21/2021
SEI SEMAYANG MEDAN SUNGGAL 082285906397 √ CORONAVAC 9/21/2021
BESAR MEDAN LABUHAN 082126244029 √ CORONAVAC 9/21/2021
JL. SELEBES LK. 35 TITI PANJANG 0895401237012 √ CORONAVAC 9/21/2021
Merek Vaksin
A : Sinovac
Kepersertaan BPJS
BPJS PBI
BPJS Non PBI
Non Anggota
Total
Pemberian Dosis
Dosis 1
Dosis 2
Total
Dosis I Dosis 2
Vaksin n Vaksin
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202107140K - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202107140K - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202107140K - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202107140K - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202107140K - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202107140K - - LANJUT VAKSIN 2
9/21/2021 202107140K - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202107140K - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202107140K - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202107140K - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202107140K - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
- - 9/21/2021 202108152G SELESAI
- - 9/21/2021 202108152G SELESAI
- - 9/21/2021 202108152G SELESAI
- - 9/21/2021 202108152G SELESAI
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
- - 9/21/2021 202108152G SELESAI
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202107140K - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
- - 9/21/2021 202108152G SELESAI
9/21/2021 202108152G - - LANJUT VAKSIN 2
- - 9/21/2021 202108152G SELESAI
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202107140K - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
- - 9/21/2021 202108152G SELESAI
- - 9/21/2021 202108152G SELESAI
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202107140K - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
9/21/2021 202108152G - - LANJUT VAKSIN 2
iterima Puskesmas/Faskes)
Tabel 10. Format Pencatatan Pela
FORMAT PENCATATA
TINGKAT PUSKESM

Nama Penerima Umur

Vaksin
(> 60Tahun)
1 P-UU2PP58A 1271132002860005 MAHRUZAR L B 35 LINGK.I
2 P-KKYRPV90 1271132606730004 ROBERT AZAN SURYA L B : JL
48MESJID LK I MARTUBUNG
3 P-JV3QTYM7 1271131208990004 ARMANSYAH l UMUM : JL
22MESJID LK I MARTUBUNG
4 P-UV2GGZ8N 1271136711720001 RODIAH P UMUM 48 LINGK.I
5 P-UMEJTQCG 1271131801030004 FATHUR RAHMAN SIR L UMUM 18 LINGK.I
6 P-ULTJQGZA 1271132009000002 HERI SEPTIAN SIREGA L B 21 LINGK.I
7 P-UVHWMN57 1271131206040003 ARDIANSYAH SIREGAR L REMAJA 17 LINGK.I
8 P-LBWBDFUK 1271135908750002 LINDAWATI P UMUM 46 LINGK.I
9 P-N0111LTD 1271135105660001 MAHANUM NASUTION P RENTAN 55 LINGK.I
10 P-UPCBUBT8 1271136402970001 NELLY ZEBUA P UMUM 24 LINGK.II
11 P-USPUPA7W 1271130512700002 SUPRIADI L B 50 LINGK.II
12 P-UO8X22SD 1271135909720002 NURBAITI P UMUM 48 LINGK.II
13 P-UNNH1ZKM 1271136508020001 SITI AUNI BALQIS P UMUM 19 LINGK.II
14 P-UNJLRIP9 1271132201940003 M.JEFRI SUTEJA SITA L B 27 LINGK.II
15 S-714AA052 1271131802800005 VICTOR PURBA L B 21 LINGK.II
16 P-UO2KG5TZ 1271132102870002 YAN SATRIA L B 34 LINGK.II
17 P-UWXXUIR6 1271132211830002 IRVIN ADI PUTRA.SE L UMUM 38 LINGK.II
18 P-UPTVEPX5 1271136306620003 FAUZIAH P RENTAN 59 LINGK.II
19 P-UPG3C41P 1271135202910002 DEWI SARTIKA GANI P UMUM 30 LINGK.II
20 P-UPZ6E4WK 1208012704840001 HUSIN BARDANI L B 37 LINGK.II
21 S-F321FBAD 1271125905560001 ZARIANA P LANSIA 65 : LK III MARTUBUNG
22 P-62V82ICW 1271142105730004 LIYAN NASUTION L B : JL BAKTI
48 ABRI GG PANITRA LING III
23 P-QBEYBCOQ 1271136810850005 NOVA SAFRIYANTI P B 36 LINGK.III`
24 P-OYPTDJMO 1271136802910001 LIAWATI P UMUM : JL TELUK DALAM29 GG HAKIM 18 LK III MARTUBUNG
25 P-3MQ6GLRV 1207324105920001 YUSTIANI P UMUM : JL TELUK 29 DALAM GG HAKIM LK III MARTUBUNG
26 P-Q9K4WXVM 1271131201810003 RAHMAD ZULFANSYAH P B : LK
40III CINGWAN MARTUBUNG
27 P-UJWDPIPL 1271134109730003 LASMARIA SINAGA P B 48 LINGK.III`
28 P-UODRXCS7 1207235306770002 MADA MARTALINA SIM P UMUM 44 LINGK.III`
29 P-UHUAZ6EO 1271124102900002 EVA WAHYUNI P B 31 LINGK.III
30 P-HBZBJZ99 1271134110770005 FAUZIAH BR PURBA P B 44 : LK IV MARTUBUNG
31 P-BGOTPFLV 1271135102780002 JURIANI P UMUM 43 LINGK.IV
32 P-LAQEGLFS 1271135005030002 PARAMITA ZAHARANI P UMUM 18 LINGK.IV
33 P-UTUR7MG0 1271131109030003 RIYO ALATAN NABABA L B 18 LINGK.IV
34 P-UIJQVT6L 1271132105760004 SAUT TUA HARIANJA L B 45 LINGK.IV
35 P-UIEDVHRA 1271136512770006 APEN TIRUAN PASARI L B 44 LINGK.IV
36 P-UJMYQZF7 1271132901920001 BONARDO JEFRI SIHA L UMUM 29 LINGK.IV
37 P-ZB5K66GS 1271136502650002 RUMINTANG MANURU P RENTAN 56 LINGK.IV
38 P-UJCQQXCH 1271131204620006 HERBIN SIHALOHO L B 58 LINGK.IV
39 J-00040RIV 1271130404020005 JURIANDA SINAGA L B 19 LINGK.IV
40 P-NFQVY4OV 1271120102750001 ZULKARNAIN LUBIS L B 46 LINGK.IV
41 P-UKKU59MT 1271135707840011 DEWI SARTIKA BR SIN P UMUM 37 LINGK.IV
42 S-3AEA07DE 1271090712790012 MUHAMMAD IKHBAL SA L B 41 LINGK.V
43 Q-000K42G7 1271065208740004 NUR AYNUN P UMUM 47 LINGK.V
44 Q-000K46AK 1271206103770003 SRI ISNAINI P UMUM 44 LINGK.V
45 Q-000K46AN 1271055601750004 NUR SURATI P B 46 LINGK.V
46 P-UWGQ3YI3 1271062705800006 PONADI L B 41 LINGK.V
47 P-PU34K1V0 1271135805950001 FILZATUNNAFSI P B 26 LINGK.V
48 P-UNET7DRO 1271131010850005 HENDRI GUNAWAN L B 35 LINGK.V
49 P-UQIOGMZQ 1271136303720004 RATNA DEWI P UMUM 49 LINGK.V
50 P-UM0KH1OK 1271195704910001 AYU FITRIASARI P B 30 LINGK.V
51 J-0003LX8A 1271070408000004 AGFA GILBERT SIDAB L B 21 LINGK.V
52 P-OM2I0TDF 1271130101020004 RAHMAT DANI B B : LK 19
V PAYA BAKUNG MARTUBUNG
53 P-5F17D1SP 1271132106000001 MHD ANDRIAN P B : LK 21
V PAYA BAKUNG MARTUBUNG
54 P-UM5WKJGH 1271135912940002 DESI SABRINA P UMUM 26 LINGK.V
55 P-MEFP4W2J 1271131608870006 IRWAN L B 34 : LK V MARTUBUNG
56 P-USRDLAPM 1271136609780002 NEITI HERTATI PANGA P UMUM 42 LINGK.VI
57 P-UNSAWRDX 1271130211850010 ROTUA PARDAMEAN G L UMUM 35 LINGK.VI
58 P-8M6M9XF7 1271132807020002 MUHAMMAD TAQWA L UMUM 19 : LK VI MARTUBUNG
59 P-URLTPDTN 1271135106810002 RAMAYANI P B 40 LINGK.VI
60 J-0003Z9J1 1271134109700001 SANIA WARDANI P RENTAN : LK
51VI P RAMBAI MARTUBUNG
61 J-0003Z82E 1271136906000002 FITRI AULIA P UMUM 21 LINGK.VI
62 P-UMNQ6T84 1271135507660007 LIE SIN P RENTAN 55 LINGK.VI
63 P-M758NZD2 1271135502020001 RISKA NURSAIFAH P B : LK VI P.RAMBE
19 GG AMAL S. TOL MARTUBUNG
64 P-G6M2AIHY 1271130812980002 RIZKY FAHROZA MAUL L B 23 : LK VI MARTUBUNG
65 P-EUCQC7VA 1271135805740003 SRI YUWANTI P UMUM 47 : LK VI MARTUBUNG
66 P-S7IG1PEJ 1271130210780001 MUHAMMAD ILHAM P B : LK
67 P-UQZ6W1DV 1271131003880001 NISPAN AL HAFAT L B 33 LINGK.VI
68 P-UMSOLJXX 1207255509670001 HASOLOAN BR HUTAB P B 54 LINGK.VI
69 P-RVXXSIHM 1271131205710001 RUSLI L B 49 LINGK.VI
70 P-UFLTTMIN 1271134401950005 MAYA ARTIKA P UMUM 26 LINGK.VI
71 P-AJ0P349E 1271181705950003 MUHAMMAD RAJA KUR L UMUM 25 LINGK.VII
72 P-UWLXVQR7 1271134408770003 ROSDIANA SINAGA P UMUM 42 LINGK.VII
73 P-URZ7UD5D 1271127112620067 SARIA PASARIBU P LANSIA 64 LINGK.VII
74 P-UQR0WP7U 1407065204880001 LINA FAUJI P B 33 LINGK.VII
75 P-UIZJEK52 1271061708680016 GEDOR TAMBA L B 53 LINGK.VII
76 P-UIU1KYGZ 1271067009960005 YOSI EMALINDA TAMB P UMUM 25 LINGK.VII
77 P-U3DBBOBU 1271120201990007 BUKHARI RAMADHAN L B 22 LINGK.VII
78 P-TBXQESAQ 1271122107930001 MHD FAHRI L B 28 LINGK.VII
79 P-URF2MBZB 1207232009680001 FUK CIN L B 54 LINGK.VII
80 P-UIPH82PB 1271130408830001 SUSANTO L B 39 LINGK.VII
81 P-RR05U4T5 1271127108000002 TASYA AGUSTINA P UMUM 21 : LK VII MARTUBUNG
82 J-0003MZJA 1271124210950005 NOVI DAMAYANTI P B 25 : LK VII MARTUBUNG
83 P-D7KHLH87 1205101111850007 RUDI HERMANSYAH L UMUM 35 LINGK.VII
84 P-TKZXTWKX 1271130707740007 ZAINAL ARIFIN L B : LK 47 I BAHARI PEKAN MARTUBUNG
85 Q-000I1O02 1271107005820002 Sri Wulandari P UMUM JL. BAKTI 39 ABRI LINGK. III MARTUBUNG
86 S-AFEA9D0F 1271135201600001 MAHARANI P LANSIA :61
LK I BAHARI MARTUBUNG
87 P-OBN7ZB9V 1219064604990005 MELINDA P B 22LINGK. III MARTUBUNG
88 P-UHYTR68Y 1271075708620006 TIOGUR CHRISTINA SI P RENTAN : JL PANCING59 GG RELA NO.3 KEL BESAR
89 P-UI9ZA3UO 1271134701770002 MUNAWARAH P UMUM 43 : LK I MARTUBUNG
90 P-UK32LOPZ 1271130712930001 NANDA GUNAWAN L B 27 : LK IV MARTUBUNG
91 P-7JQCA1VO 1207261302660002 HASNAN. B L B : JL BAKTI 55 ABRI GG PANITRA MARTUBUNG
92 Z-0006CMVF 1271081612560001 M ARIFIN SIREGAR L LANSIA : JL TULIP 65 NO 28A GRAHA MARTUBUNG
93 P-UL3CUE28 1271136308850005 EFRIDA TETI SRI SIANT p UMUM 36 : LK IV MARTUBUNG
94 P-UMJ3UPQH 1271120202010003 FACHRI PANGESTU L B 20LINGK. V MARTUBUNG
95 P-UMAPWIGM 1271125101920004 MELY AFVUANI HALIM P B 29 : LK IV MARTUBUNG
96 P-UOOCCWVQ 1271135008690002 FLORES SIHOTANG P RENTAN 52 : LK IV MARTUBUNG
97 Q-000NPIHV 2171031003809021 DODI SAPUTRA L : JL PARANG
B PARANG LK III RT/RW 41 000/000 BELAWAN BAHAGIA, MEDA
98 P-UNABI2AP 1271133105940003 MUHAMMAD IMAM L B 27 : LK III MARTUBUNG
99 P-UQEULSSW 1271137101920001 RINA KHAIRINA P UMUM 28 : LK IV MARTUBUNG
100 S-71BF2AF3 1271132906860004 MUHAMMAD AKHYAR L B : LK35 II KP BESAR MARTUBUNG
101 P-UR6AUXN5 1207267003900013 WILDAH FITRIYANI NA P UMUM 31 : LK V MARTUBUNG
102 P-URPDHB0B 1271131406690003 ARIFIN L B 52 : LK IV MARTUBUNG
103 P-URUEW58A 1271135211760004 KUMALASARI P UMUM 44 : LK IV MARTUBUNG
104 P-USWMZB26 1271132108010002 BAI HAKI L UMUM :20
105 P-UTER4GPS 1271131312720001 YOYON ARIFIN L B 49 : LK VI MARTUBUNG
106 P-UT9OR2ME 1271133010710002 IRWAN FAUZI L B 50 : LK VI MARTUBUNG
107 P-UT3SQREV 1271132404710004 HASAN BASR L B : LK 50IV KP BESAR MARTUBUNG
108 P-UTLX4QTM 1271135703700001 RAMEULI BUTAR BUTA P B : LK 52IV KP BESAR MARTUBUNG
109 P-UTYR1E6L 1271136201890005 FEBRI HANDAFIT YANA L UMUM :32
110 P-UU7WXJYQ 1271134307690001 INSAN SITUMEANG P RENTAN 52 : LK VI MARTUBUNG
111 P-UUCPHKYE 1271136110710001 CHAIRUL BANIN P B : LK50 II KP BESAR MARTUBUNG
112 S-EB368400 1271135805780003 KHAMISATUN AZNUR P B 43 : LK V MARTUBUNG
113 P-UUKD5CE9 1271135204950005 RIZKY SYAFRIL YANI B P B 26 : LK V MARTUBUNG
114 Q-000C1OCQ 1271084806900001 YUNI HERAWANI SIRE P UMUM : jl31
tulip no 28a graha martubung
115 P-UUV75LOX 1271132908770003 DJASIMAN L B : LK 44IV KP BESAR MARTUBUNG
116 P-UV7KYII6 1271055505860003 KURNIA NINGSIH P UMUM 34 : LK V MARTUBUNG
117 P-UVCTDSCQ 1207250403030002 ROY MARTIN LUMBAN L B : LK 21IV P RAMBAI MARTUBUNG
118 P-UVKNXP2T 1271136605860003 MILDAN SILVINA P UMUM 35 : LK VI MARTUBUNG
119 P-UVNTMMWP 1219072610870001 SARISAH BANA L B 43 : LK II MARTUBUNG
120 P-UVQD2AYC 1271134105760004 MULYANI RIDU P UMUM 45 : LK V MARTUBUNG
121 P-UVT632SD 1271120308030001 M. FAUZIE SAHIL L UMUM 18 : LK III MARTUBUNG
122 P-UVVP7JYF 1271132701010002 DEDE RANGGA YUDHA L B 20 : LK VII MARTUBUNG
123 P-UWDP8ECZ 1271131305030001 GILBERT APOSTEL SIA L UMUM 18 : LK IV MARTUBUNG
124 P-UWJJQERJ 1271135712020002 NATALIA FITRIANI P UMUM 18 : LK VII MARTUBUNG
125 P-UWOIGPJA 1271131201960001 ARDIYANSYAH L B 24 : LK III MARTUBUNG
126 P-UWR47GSU 1271181307630004 SORITUA HARAHAP L B 58 : LK V MARTUBUNG
127 S-5236D7D1 1271130908930004 AHMAD CHAIRY L B 28 : LK II MARTUBUNG
128 J-0000BW58 1271130811960003 LUKMANUL HAKIM L B : JL KL YOS 24 SUDARSO SP ATAP LK VII KEL BESAR
129 P-6BT6LKAG 1271136506670001 ELFI ZAHARA P UMUM
: JL KL YOS SUDARSO SP 54 ATAP LK VII KEL.BESAR KEC.MEDAN LA
130 P-V1C7G7V1 1204166309810001 SAYANGI MARIA HAL P UMUM : JL TITI
39 PAHLAWAN KOMPLEK BM C-4
131 P-V1NJ6NIA 1208171012780004 ZULKIFLI LUBIS L B : JL SIDORUKUN GG 41 BAKARAN BATU NO.15 PULO BRAYAN DAR
132 P-V1RTKSHD 1271124612670003 SRI SUPRATI P B : JL MARELAN
54 VI LK 24 RENGAS PULAU
133 P-V2J06VNP 1271134606770002 SRI MISRIANI P B 44: JL KAIL LK V SEI MATI
134 P-PQKRFM3R 1271121701030001 FARHAN L B :18
LK VII ,BESAR M LABUHAN
135 P-V1JYML1B 1208177107820001 SYAMSIAH FITRI PUL P UMUM: JL SIDORUKUN GG 39 BAKARAN BATU NO.15 PULO BRAYAN DAR
136 P-V2E3CK7B 1271134807680001 SRI ANUM P UMUM : LK
137 P-V29IOZTI 1271135205020002 ALIFA NADZHARA SHA P UMUM 19: JL KAIL LK V SEI MATI
138 P-V3R3O14P 1401120209030005 AKMAL HUSAINI L UMUM : JL TITI PAHLAWAN SIMP 18 PLN PAYA PASIR NO 50 LK V RENGAS
139 S-FB0F4EE7 1271124505870001 SRI RAMADANI P B JL.KAPT.
35 RAHMAD BUDIN LK. XIII
140 P-UW4XPAD3 1271132112940006 MUHAMMAD FADHLANL B : LK26IV KP BESAR MARTUBUNG
141 P-UX4OQCQC 1271134304870002 ISMAYANI P UMUM 34 : LK V MARTUBUNG
142 P-UX7C1VC5 1271126002700001 HJ. ROUDAH P B 50 : LK VII MARTUBUNG
143 P-UXAEQ7U1 1271031212010004 ABDILLAH MAHWAL L B 19 : LK VI MARTUBUNG
144 1271065704790009 SURYANI P UMUM LINGK.42V PAYA BAKUNG MARTUBUNG
145 1271134306470001 RUMINTA BR. MUNTE P LANSIA 74 LK. IV KP. BESAR
146 MARIANI P B 41
f
Keterangan
D : Lainnya
E : Tidak Bekerja
Kelompok Umur
18-30
31-45
46-59
Total
Pekerjaan
A
B
C

LABUHAN

BPJS PBI Screening
PBI Anggota
MARTUBUNG MEDAN LABUHAN 0853 8185 0017 √ CORONAVAC 9/21/2021
MARTUBUNG MEDAN LABUHAN 08319769 8672 √ CORONAVAC 9/21/2021
BELAWAN BAHAGIAMEDAN BELAWAN 085364301444 √ CORONAVAC 9/21/2021
LABUHAN DELI MEDAN MARELAN 081361483104 √ CORONAVAC 9/21/2021
PULO BRAYAN DARAT IIMEDAN TIMUR 085384771233 √ CORONAVAC 9/21/2021
RENGAS PULAU MEDAN MARELAN 085373550062 √ CORONAVAC 9/21/2021
PULO BRAYAN DARAT IIMEDAN TIMUR 081220411294 √ CORONAVAC 9/21/2021
RENGAS PULAU MEDAN MARELAN 087867784888 √ CORONAVAC 9/21/2021
TERJUN MEDAN MARELAN 081264505112 √ CORONAVAC 9/21/2021
√ CORONAVAC 9/21/2021
Merek Vaksin
A : Sinovac
Kepersertaan BPJS
BPJS PBI
BPJS Non PBI
Non Anggota
Total
Pemberian Dosis
Dosis 1
Dosis 2
Total
Dosis I Dosis 2
Vaksin n Vaksin
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202107140k LANJUT VAKSIN 2
9/21/2021 202107140k LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152g LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202107140k LANJUT VAKSIN 2
9/21/2021 202107140k LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202107140k LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202107140k LANJUT VAKSIN 2
9/21/2021 202107140k LANJUT VAKSIN 2
9/21/2021 202107140k LANJUT VAKSIN 2
9/21/2021 202107140k LANJUT VAKSIN 2
9/21/2021 202107140k LANJUT VAKSIN 2
9/21/2021 202107140k LANJUT VAKSIN 2
9/21/2021 202107140k LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202107140k LANJUT VAKSIN 2
9/21/2021 202107140k LANJUT VAKSIN 2
9/21/2021 202107140k LANJUT VAKSIN 2
9/21/2021 202107140k LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202107140k LANJUT VAKSIN 2
9/21/2021 202107140k LANJUT VAKSIN 2
9/21/2021 202107140k LANJUT VAKSIN 2
9/21/2021 202107140K LANJUT VAKSIN 2
9/21/2021 202107140k LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202107140k LANJUT VAKSIN 2
9/21/2021 202107140k LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G SELESAI
9/21/2021 202108152G SELESAI
9/21/2021 202108152G SELESAI
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202107140k LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202107140k LANJUT VAKSIN 2
9/21/2021 202107140k LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202107140k LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202107140k LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202107140k LANJUT VAKSIN 2
9/21/2021 202107140k LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202107140k LANJUT VAKSIN 2
9/21/2021 202107140k LANJUT VAKSIN 2
9/21/2021 202107140k LANJUT VAKSIN 2
9/21/2021 202107140k LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202107140k LANJUT VAKSIN 2
9/21/2021 202107140k LANJUT VAKSIN 2
9/21/2021 202107140k LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202107140K LANJUT VAKSIN 2
9/21/2021 202107140k LANJUT VAKSIN 2
9/21/2021 202107140k LANJUT VAKSIN 2
9/21/2021 202107140k LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202107140k LANJUT VAKSIN 2
9/21/2021 202107140k LANJUT VAKSIN 2
9/21/2021 202107140k LANJUT VAKSIN 2
9/21/2021 202107140k LANJUT VAKSIN 2
9/21/2021 202107140k LANJUT VAKSIN 2
9/21/2021 202107140k SELESAI
9/21/2021 202107140k LANJUT VAKSIN 2
9/21/2021 202107140k LANJUT VAKSIN 2
9/21/2021 202107140k LANJUT VAKSIN 2
9/21/2021 202107140k LANJUT VAKSIN 2
9/21/2021 202107140K LANJUT VAKSIN 2
9/21/2021 202107140K LANJUT VAKSIN 2
9/21/2021 202107140k SELESAI
9/21/2021 202107140K LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G SELESAI
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G SELESAI
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
9/21/2021 202108152G LANJUT VAKSIN 2
FORMAT PENCA
TINGKAT PUS

Umur
No No.Registrasi NIK Nama Penerima Vaksin JK Pekerjaan Kel. Umur Alamat
(> 60Tahun)
1 P-V7VHKVWX 1271131101830000HORAS PANDAPOTAN PARSAORAL S PP 38 LK. VIII
2 P-V86U7QJP 1271081302880004 FIRMAN SIAHAAN L PP 33 LOR. 6 LK. VIII
3 P-279BHJOA 1271134310020002 HELMANIA PUTRI P UMUM 18 JL. KAIL LK. III
4 P-V8ICQQDD 1271135704770003 RINA SRI WAHYUNI P UMUM 44 JL. KAIL LK. III
5 P-491LJODT 1271130708750001 SUGIMAN L PP 46 LK. IV
6 P-5KI4HHR1 1271132205910002 BRITIS JUNIOR HUTAURUK L PP 29 LK. XVII
7 P-76W6PIQ2 1271081708870006 JACKSON MANULLANG L PP 34 LK. VII
8 P-8ILZAPKW 1271132007890008RONI EDI SYAHPUTRA L. TOBINGL PP 32 LK. VII
9 P-BK672XDF 1271131607710003 ORPEN SIHOMBING L PP 50 LK. VII
10 P-D3QX0ALX 1271135805660001 SUMARSIH L RENTAN 55 LK. III
11 P-EF5N97ZA 1271134603830003 RISDA SIMANJUNTAK P UMUM 38 JL. ILYAS LK. VII
12 P-FLWCQ0HG 1271136308040003 DAHLIA PUSPITA P REMAJA 17 LK. IV
13 P-GLZCIM6B 1271136710030004 ADINDA RAMADHANI P UMUM 18 LK. IV
14 P-I3FHFCF4 1271131404900002 ERWIN SYAHPUTRA PARAPAT L PP 31 LK. IX
15 P-JBERZZ20 1271130602980003 BONI VB SIRAIT L UMUM 23 BATANG KILAT LK. III
16 P-KQZ4R037 1271131808970007 CHRISTORI SIREGAR L UMUM 24 LK. XVI
17 P-MAYGRUQ1 1271137112740011 TUMI P PP 44 LK. XVII
18 P-NK3BMYSK 1271130408650001 KASPI HARAHAP L PP 35 LK. XII
19 P-OTNQ7IWR 1472020509820024 TOLAN P. GULTOM L PP 39 LK. VIII
20 P-Q4IXUQYA 1271131001830003 JANWAR PANDIANGAN L PP 38 LK. XVIII
21 P-T4XOH4C7 1271130111940001 RIKI PRATAMA NASUTION L PP 26 LK. XVI
22 P-V9YL0YMD 1271135210820001 ERGIYANTI S P UMUM 39 LK. IV
23 P-VAH2O61O 1271134311030001 AMANDA PUTRI P REMAJA 17 LK. II
24 P-V98XC9E6 1271130605750003 AMRON SIMATUPANG L PP 46 LK. VIII
25 J-0000B8GH 1271134909900001 MARLINA P UMUM 31 LK. II
26 P-VBA6WDS2 7603084707990002 JULIANTI P UMUM 22 LK. XVII
27 P-UH92JIJM 1271131911960003 TIMUR FRANCISCUS SITORUS L PP 25 LK. XVII
28 Y-0135ILV6 1271130611900003 JONES WEDA SITORUS L PP 31 LK. VIII
29 P-VDI8IP6S 1271130512980001 IMAM HARIS MUNANDAR L UMUM 22 LK. XI
30 P-VDMK26B3 1271134511030002 MARIA EVA SURYANI P UMUM 18 LK. IX
31 Z-0007KKQE 1271081110990003 RAIHAN FAHROZI L PP 22
JL. BANGKA BARAT NO 20
32 P-VFAX3F22 1271132311730004 SAMSUDIN NABABAN L PP 48 LK. IX
33 P-VFFMSGCW 1271136810740004 TUTY SIMANUNGKALIT P UMUM 47 LK. VIII
34 P-VG88FBXB 1271132110840003 MARINGAN SIMATUPANG P PP 37 LK. VI LOR 3
35 P-VGEK6JUG 1271136008730002 NURMAIDA BR. SAGALA P UMUM 48 LK. VII
36 P-VGOCH0J 1271134310650002 SUYATINI P RENTAN 56 LK. I SERUWAI
37 P-VFFU9FMC 1271134807000002 RUT EVIKAULI SITUMEANG P PP 21LR. PARSAORAN LK. XV
38 P-VH7O2XBU 1271131403760003 ABDUL MURAD L PP 45 LK. X
39 P-VTI4UMOY 1271135909720003 MARIBUN DOLOK SARIBU P UMUM 49 LK. XVIII
40 S-7FF785EE 1271132311930004DENNY FERNANDO KARO SEKALIL UMUM 28 LK. XII
41 P-VDZ5SUIL 3275091605910013 MUHAMMAD FADLIND L PP 30 LK. XVI
42 P-VDU82HGI 1271134409020002 SEVIRA ALFIANI P PP 19 LK. XVI
43 P-VEE22P5U 1271082809760003DARWIN PARLAUNGAN SINURATL PP 45TKBM BLOK. D LK. 18
44 P-VCQMIBUK 1271136402040003SERTINA BR. LUMBAN TORUANP REMAJA 17 LK. IX
45 P-VEMU47W0 1271136010740001 NURMIAN BR. GULTOM P UMUM 46 LK. XIV
46 G-01334Q9G 1271136111640002 ERMINA P RENTAN 56 LK. XVIII
47 P-VUHBEH15 1271136308970001 AGIS TIARA P UMUM 24 LK. VI LR. I LAMA
48 P-VUG7NZMA 1271130806950006 TUMBUR ISMANTO L PP 26 LK. XII
49 P-VS4EKEYV 1271131211740002 ZULKIFLI L PP 46 LK. III
50 P-VHEDDTYV 1217056609010001 DORMIANA JELIANTI SINAGA P UMUM 20 LK. XVII
51 P-VLKKPKBQ 1271134302730002 LENNI SIMATUPANG P PP 48 LK. IX
52 Z-0008Z5CN 1271135105780002 MINARSIH P UMUM 43JL. P. ENGGANO LK. 26
53 P-VN6IVSO8 1271082302760002 SOPAR SIAGIAN L PP LK.46XVII KOMP. TKBM BLOK BB
54 P-VNCQVSY1 1208131312840001 HOTASI SITORUS L PP 37 LK. XIV
55 S-1E64C3B3 1271135704600001 HANNA BR SIRAIT P LANSIA 61 LK. XIV LOR. 9
56 P-VNMNI6GC 1271131403810002 HERBET PARDEDE L PP 40 LK. III
57 P-VNJP6ZWS 1271136504750003 SUSANTI P UMUM 46
JL. KAIL LK. VI LR. 2 LAMA
58 P-VNH3VAU9 1271130606760002 SANDI TOGAR NAPITUPULU L PP 45 LK. VII
59 P-VR6A5KOY 1271136707990002 GADIS ARIVIA P UMUM 22 LK. II
60 P-VRBHYM0R 3202244608820005 LIKA HENDAYANI P UMUM 38 LK. II
61 P-VRDO1AOB 1271135207760001 YULIA MAYO PARDEDE P PP 45 JL.KAIL LO
62 P-VROZLUBL 1271135311890004 RELINA SARIANA SIANIPAR P PP 31 LINGKUNGAN
63 P-VRMSEOAX 1271136502020001 IKA AYU ASARI SITORUS P PP 19 LR PARDAME
64 P-VR3PQH9X 1271135410920003 DWI AULIA FRISKA P UMUM 29 LK. II
65 P-VR0FF240 1406095211830007 SURYA RUPINA BR.SIRAIT L UMUM 38 LK. XV
66 P-VRKMMZP2 1271136010800001 ASMAYANI P UMUM 40 LK. III
67 P-VOEJEY8H 1271132202790002 MIDUK ARTA PASARIBU L PP 39TKBM BLOK BB LK. XVIII
68 P-VBOGAAK2 1271135806030001
PINTA ULINA BR LUMBANTORUANP UMUM 18 LK. IX
69 P-VRHJKKTW 1271135903630001 ESMI SIHOMBING P RENTAN 58LR. PARSAORAN LK. XV
70 Q-000OL6EF 1271130304970003 WIDODO SEPRIANTO L UMUM 24 LK. XI
71 J-0003DKZJ 1271131009990002 MUCHLAS SHAPUTRA L UMUM 22 LK. XI
72 P-VO3CQLCK 1271130206780005 USNER SIMANJUNTAK L PP 43 LK. III
73 P-VO066S9H 1271134106670005 LINDA P RENTAN 54 LK. XVII
74 P-VNXNB1ML 1271137009860001 LASTIARMA SIMANJUNTAK P UMUM 35 LK. XIV
75 P-VES7YCE1 3374085809790004 EMI TARMIASIH P UMUM 42 LK. X LOR. MASJID
76 P-VNS377TF 1271134905620001 RIORITA BR. SIHOMBING P RENTAN 57 LK. XII
77 P-VT9D3CG9 1271134103780002 MARTALENA SIMANUNGKALITP UMUM 43 LOR. 8 LK. XIII
78 P-VT2QU5IP 1218150206930002 PUTRA LUIS SAMOSIR L PP 28 LK. VII
79 P-VT0AX5HN 1271134602700003 FATIMA SIAGIAN P PP 51LR. PARSAORAN LK. XV
80 P-VTEFDGUG 1271130401800002 DEDI HANDOYO P PP 41 LK. XIII
81 P-VS25HU5S 1271137011740005 NURIATI SINAMBELA P UMUM 46 LK. VIII
82 P-VRYPSQCK 1271136009720003 SRI ARSITA P UMUM 49 LK. IX LR. 5
83 P-VRX48GV9 1271135505660003 SURYANINGSIH P RENTAN 55 LK. IX
84 P-VTRRRW68 1271136011770001 ROSMARLINA TAMPUBOLON P UMUM 44 LK. IX
85 P-VTQESEWQ 1218051606860003 RUSMADIANTO L PP 35 LK. I
86 P-VTONCPEP 1271135011760009 MARIANI PURBA P UMUM 44 LK. XIV
87 Q-0003AXBQ 1271135406030002NATASYA MARINTA SINAMBELAP UMUM 18 LK. XIII
88 P-VUKLSFOB 1271136911820002 NOFA YANTI E MARPAUNG P PP 38 LK. XV
89 P-VULR67PE 1271133001040003 ROMI MARPAUNG L REMAJA 17 LK. IX
90 Q-000BZE7G 1271136504790003 LEGIANI P UMUM 42 LK. X
91 S-F848A07B 1271133112580019 PARADA GULTOM L PP 63 LK. VII
92 P-VUV3CLF9 1271130903830004 CHARLES PUTRA MANULLANGL PP 38 LK. X
93 P-FLZLIRVO 1271127008750002 RIEMSI ERNAMINI PASARIBU L UMUM 46 LK. IX
94 P-VTY3LRVW 1271130208990006 ILYAS L UMUM 22 LK. II
95 P-VUCTGT1P 1271133004820002BUTNER HALOMOAN SIAHAANL UMUM 39 LK. XV
96 P-VRQYMZQ9 1271135111890003 AULIA NOVITASARI P UMUM 31 JL. KAIL LK. V
97 P-VRTK7UBL 1271134606880005 JUWI LASRINA PURBA P PP 33 LK. IX
98 Q-0003AS0Q 1271135801660003 TARULI RAJAGUKGUK P RENTAN 55 LK. XIII
99 P-VUEAHIN7 1271134307670001 RUHUT HUTABARAT L RENTAN 54 LK. III
100 P-VTSZ7AS8 1271134710030001 PUTRI RAHMASARI P REMAJA 17 LK. XVII
101 J-0003PC06 1271135508940002 ERNAWATI SIMANGUNSONG P UMUM 27LK. XIII LR. KESEHATAN
102 P-VHLRHIRZ 1271131204620005 WILTER SIMANUNGKALIT L PP 59 LK. III
103 P-RN0W4CEB 1271131708800017 ISKANDAR L PP 42 LK. XI
104 P-VTUF9EBN 1271134805840007 WAGIYEM P UMUM 38 LK. II
105 P-VTZUPJDC 1271130902970004 RAMJUL L UMUM 24 LK. II
106 P-VU1UXK3Y 1271134306720006 KAMSINI P UMUM 48 LK. II
107 P-VU3DUKH4 1271126305010007 SYAFIRA MUKHAIRA P UMUM 20
JL. TITI PAHLAWAN GG. PRINGGAN LK. 5
108 P-UDBZDAGR 1271136008630002 IKA KARTIKA P RENTAN 56 LK. X
109 P-VU6AS400 1271131205020004 FAUZAN HANIF L UMUM 19
JL. KAIL LK. IV LR. II LAMA
110 P-VTVJBM32 1271132102970002 MUSLIMIN L PP 24 LK. II
111 P-VUA22DYS 1271134202840006 DAME SRIANI SIANTURI P UMUM 38 LK. XV
112 P-VHT9818C 1218155107840002 MINTA RIAULI PANGARIBUAN P UMUM 36 TKBM BLOK BB LK. XVIII
KOMP.
113 P-VTBA6HR3 1271134907970006 DINDA BAHRAINI P UMUM 24 LK. II
114 P-VSX0JC8H 1271134803780002 JURAIDAH P PP 43 LK. X
115 P-VSYJT8IA 1271137108030005 RAFIKA HASANAH P UMUM 18 LK. X
116 P-VRVFZJU3 1271132705950010 ANDI PRAMONO MARPAUNG L PP 26 LK. XI
117 P-VS6BCDEE 1271134405820010 SERLI NAINGGOLAN P UMUM 39TKBM BLOK BB LK. XVIII
118 P-VS9AQGYQ 1271130204650002 SUKRI L PP 56 LK. XI
119 P-VSBV3SX4 1271136006690003 RITA SIMANJUNTAK P RENTAN 52 LK. XIV
120 P-VSE2Y5SD 1271134606680004 DUMASARI BR. SIMAMORA P RENTAN 53 LK. XIV
121 P-VSG1Z65S 1271135407740003 RAMIDA BR. SIMANJUNTAK P PP 47 LK. XIV
122 P-VSHVULPB 1271054106620002
ADELINA ROSMAWATI SITUMORANG
P RENTAN 59 LK. XIII
123 P-VSK29V85 1271131412020003 DAUD SINTONG OLOAN TAMBAL PP 19 LK. XIV
124 P-VSMMCF39 1271135308660001 RETNI HUTABARAT P RENTAN 55 LK. XIII
125 P-VSOR9SSX 1271136702930004 WINDA WALFRIDA SIAHAAN P UMUM 28LR. PARSAORAN LK. XV
126 P-VSQOFKSJ 1271133004680001 TIOPAN SIAHAAN L RENTAN 53LR. PARSAORAN LK. XV
127 P-VSSA747V 1271136001840006 EPI MULIZAR P UMUM 37 LK. XIII
128 P-VSU4IU6L 1271124902950001 PUTRI RAHMAH NINGSIH P PP JL. MARELAN
26 RAYA GG. SEROJA LK. X

LABUHAN

BPJS PBI Screening
PBI Anggota
PEKAN LABUHAN
MEDAN LABUHAN 085362418123 √ CORONAVAC 9/23/2021
PAYA PASIR MARELAN 085362459389 √ CORONAVAC 9/23/2021
TANAH 600 MEDAN MARELAN 082370209350 √ CORONAVAC 9/23/2021
Dosis I Dosis 2
Vaksin n Vaksin
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021202108152G SELESAI
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021202108152G SELESAI
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021202108152G SELESAI
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021202108152G SELESAI
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021202108152G SELESAI
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021202108152G SELESAI
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021202108152G SELESAI
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
9/23/2021 202108152G LANJUT VAKSIN 2
Tabel 10. Format Pencatatan Pelay
FORMAT PENCATATAN
TINGKAT PUSKESM

Nama Penerima Umur

Vaksin
(> 60Tahun)
1 P-P2OFDDFL 1271130311900002 SARING MULYONO L B 31 LINGKUNGAN
2 P-W1WBJ68L 1271136801850003 SUSIANA TAKUREKE P UMUM 42 JL. TUNDA U
3 P-W1ZAU5LX 1271130809030003 FADLIAN SYAHPUTR L B 18 JL. TUNDA LI
4 P-VWMPNQEZ 1271131005950007 IRMANSYAH L B 26 JL. LANGGAI
5 P-VXI6EAON 1271132709980002 HENDRA TAMPUBOL L b 23 JL. KAYU BE
6 P-W3WPDUAX 1271131409030001 MUHAMMAD FAUZAN L UMUM 18 LINGKUNGAN
7 P-W3OHCPIY 1271130301000003 REZA ANDRIANSYAH L UMUM 21 LINGKUNGAN
8 P-VWTGAMKW 1271134410020003 SITI MULIANI P UMUM 19 LINGKUNGAN
9 P-W26WMBBL 1271030302860004 ARI SYAHPUTRA L B 35 JL. KAIL LIN
10 S-A09A75E0 1271134304560001 HOLIJAH TAMBUNAN P LANSIA 65 JL. KAIL LIN
11 P-K8H08EH7 1271085008860005 EVA DAME RIA GOR P UMUM 35 KOMP. TKBM
12 P-EOXE7IGI 1271132612870001 PESTA NAPITUPULU L B 33 JL. KAIL LIN
13 P-W2SIDMAE 1271130307010005 Irza faizul alfi siregar L UMUM 20 JL. KAI; LIN
14 P-W38WLUQG 1271132508990003 Daniel arsenal napitup L B 22 JL. KAIL LIN
15 P-S2QOYW0L 1271132308720002 SYAFARUDDIN P B 49 JL. KAIL LIN
16 P-UTCKPWHX 1271133112770021 PONIMAN L B 44 JL. KAIL LIN
17 P-U7STUMHP 1271137311820005 WIRDA NINGSIH P B 39 JLN.KAIL LIK
18 P-V4UVCGY1 1271137004740002 SALMAH P UMUM 47 JL. TUNDA L
19 P-VXYUFP55 1271131007860004 HERIANTO L B 35 JLN.TUNDA L
20 P-W15XJBND 1271135607930004 Ratna purnama sari P B 28 JL. JERMAL
21 P-VZBCJQD6 1271134805800003 PATMAH P UMUM 41 LIK.V SEI.MA
22 S-6CC19FF0 1271132711550001 ANG A HENG L LANSIA 66 JL. KAIL LIN
23 P-W33HHTZT 1271134907720001 NURIAH P RENTAN 51 JLN.KAIL LI
24 P-W43IBZBZ 1271132404010002 DENI SAFRIAL L B 20 LINGKUNGAN
25 P-VWE8RWX7 1271135512730001 EKA SARI P B 48 LINGKUNGAN
26 P-VW7KMD28 1271131710840001 TOMI SIMANJUNTAK L B 38 LINGKUNGAN
27 P-VXVZTUOC 1271135001010001 SARAH SILABAN P B 20 LINGKUNGAN
28 P-VYH7AJ0H 1271132409910002 BESTARI GULTOM L B 30 LINGKUNGAN
29 P-QE33B77S 1212096903890002 LINCE SINAGA P UMUM 32 LINGKUNGAN
30 P-TQIXPVAY 1271136205770002 TIADUR TERESIA SI P UMUM 44 LINGKUNGAN
31 P-VZ3WZMXU 1271137005030001 PUTRI WAHYU MELI P UMUM 18 LINGKUNGAN
32 P-VW21ZFQN 1271136210810005 HERLI PANJAITAN P UMUM 42 LINGKUNGAN
33 P-UI5V95ZH 1271133108830004 LAMBAS ADIGUNA L B 38 LINGKUNGAN
34 P-H58H51OW 1271136412030001 RUTH NOVI MARIATI P REMAJA 17 LINGKUNGAN
35 P-VXRATDKA 1271132406790006 JOHANES ASIDO PA L B 42 LINGKUNGAN
36 P-VXOSF1D1 1271134407780003 MARTHA ML SIMAN P B 43 LINGKUNGAN
37 P-W0XQB6HM 1401060702800006 INDRA GUNAWAN L B 41 LINGKUNGAN
38 P-VX5SRM3I 1271135506770003 Juniar heleria opusun P B 44 LINGKUNGAN
39 1271130707690004 Jumadi parsaoran Si L B 48 LINGKUNGAN
40 P-VY322QZC 1271136804860002 Githa Afni Ambarita P B 25 LINGKUNGAN
41 P-W1BDW3C4 1271131106700002 SYAMSUDIN MARPA L RENTAN 51 LINGKUNGAN
42 P-JEQPGJRG 1271131111910008 JIMMI SIMORANGKIR L UMUM 30 LINGKUNGAN
43 W-B4E9FC7A 1271132108930001 Ahmad Fadly siregar L B 28 LINGKUNGA
44 Y-00000DMA 1271132508590002 YUSUF L LANSIA 70 LINGKUNGA
45 P-GEAOIT0Y 1271130106990002 Bagas Aditya p harian L UMUM 22 LINGKUGAN
46 P-LFCI9AEZ 1271130207010001 Andre Marco Prayoga L B 20 LINGKUNGA
47 P-BHNAIGL1 1271144606680001 RATNA KOMALA P RENTAN 53 LINGKUNGAN
48 P-IGJC3ERL 1223034602930004 MUPIDA P B 28 LOR. 5 LINGK
49 P-W1R3RD8H 1271135806780002 WAHYUNI NASUTION P UMUM 43 LINGK XII SE
50 J-0003QMOJ 1271132505990001 JOSUA CHRISDIAN L B 22 LINGK XII SE
51 P-W11X7YXB 1271136211030005 INDAH PUTRI PARAM P REMAJA 17 LINGK XII SE
52 P-W1EIA1EW 1271135511000003 ASMIDAR P B 20 LINGK XII SE
53 P-VEQMZ4IO 1271132611010001 Sergio Butar-butar L B 20 LINGKUNGAN
54 P-VZEAQKBO 1271135109010002 Anggie pitta Maria Ma P B 20 LINGKUNGAN
55 P-W59RHL81 1271135908860004 Lervina br Pasaribu P RENTAN 54 LINGKUNGAN
56 P-VZTFYX22 1271131511940002 David Riwaldi L B 27 KOMP. BARU
57 P-W3Q4QDXV 1271132401010001 Vanjoel Nicolaus sima L UMUM 20 LINGKUNGAN
58 P-VWGJLDWS 1271132404960007 RICAT PANGARIBUA L B 25 LINGKUNGAN
59 P-87ODELEA 1271131212780011 Maruba Gregorius Ta L B 43 LINGKUNGAN
60 P-VWJHE77N 1271136210700002 Dameria siregar P RENTAN 51 LINGKUNGAN
61 P-W0UXSRWM 1271135802720005 Demak Nurintan br Ma P UMUM 49 LINGKUNGAN
62 S-12C85845 1271131001670001 GIAT MANAOR SIRE L RENTAN 55 LINGKUNGA
63 P-PXA6MNYB 1271132611650002 YUSRIN SITUMEANG L B 56 LOR. PARSA
64 P-PMEMFL50 1271135901720001 NURMAWATI PANDI P UMUM 49 LOR. PARSA
65 P-W0R6JJEZ 1216045604900003 SEDIANA SIBURIAN P UMUM 31 LR. PARDAM
66 P-W06NI5WC 1210085307980004 Mindaria Verawati br P B 23 LINGKUNGAN
67 P-VYEIWJE0 1271135705980002 EVITA BUDI LESTAR P B 23 LINGKUNGAN
68 P-VYOTECBN 1271124202020007 SHOPYA ROUDATUN P UMUM 19 LINGKUNGAN
69 Y-0119Q2VZ 1271130809760004 HENKI KOSHITA L B 47 LINGKUNGAN
70 P-CI6NCCN3 1271134103010001 Erdina Purba P B 20 LINGKUNGAN
71 P-NRZOKKUC 1271132506810003 DAHLAN ROBINSON L B 40 LINGKUNGAN
72 P-M0X36HVL 1271135810810001 NINA HERVITA TUA P UMUM 40 JL. ILYAS LI
73 P-AFZS894H 1271135112640004 Desmiati Sitompul P RENTAN 56 LINGKUNGAN
74 P-OSWRN5BJ 1271130906640005 PANTUN SILALAHI L RENTAN 56 LINGKUNGAN
75 P-W22UQMBV 1271081010620006 Panigoran siregar L RENTAN 59 LINGKUNGAN
76 P-W3BF0YA8 1271085007020006 Elsa anggreini hasibu P UMUM 19 LINGKUNGAN
77 P-R02F8900 1271135008010005 Armila Syahputri P UMUM 20 Lingk 19 Pek
78 P-QNVC4UYB 1271134601980002 Ferra Hasriyati P B 23 Lingk 19 Pek
79 Z-829C4967 1271135406540001 TIORLAN SILALAHI P LANSIA 68 LIGKUNGAN
80 Q-000LERRG 1207241605040004 DANIEL L REMAJA 17 PERUM YUK
81 S-1BBC3F5D 1271135310600002 LAMRIA TAMPUBOL P LANSIA 61 LIK.VII SEI.
82 S-01B6FCB8 1407076507600001 NESTY BR.HUTAGAO P LANSIA 61 LK.XV SEI.
83 P-VWQ4KXL3 1271132702030007 RIVALDO SITORUS L UMUM 18 LIK.IX SEI.M
84 S-A1777817 1271132711580003 SANUSI L LANSIA 63 LIK.III SEI.M
85 P-VXA2HD4X 1271131804780001 ALBERT SITUMORA L B 43 LIK.VII SEI.
86 P-VXF6UDBF 1271134410780003 SURYANI SIMANUNG p B 43 KOMP.GABIO
87 S-BFED76D7 1271132507600003 PANUSUNAN TAMP L LANSIA 61 SEI.MATI LIK
88 P-VXTDBZ6E 1271135501860002 TIOLINA SIMANJUN P UMUM 35 SEI.MATI LI
89 P-VYBGVIWO 1271135304030004 ROULINA INDRI YA P UMUM 18 JLN.KAYU BE
90 G-0133SRSO 1271084902880001 TIPAH P UMUM 33 KOMPRSK LK
91 Q-000C8EUJ 1271132508020002 ADE WIRANATA L B 20 KOMP PERU
92 G-01334IU9 1271042002740004 ASRIL L B 47 LOR IV UMU
93 P-VZ84KP3H 1271131812000001 MHD REZA REVANA L UMUM 21 LIK.V SEI.MA
94 P-VZLMSQ5D 1271126404900003 HIRAH MAYANI P B 31 JLN.T PAHL
95 P-VZPAJLPK 1271080503630002 MULYAMIN L RENTAN 59 KOMPLEK.TK
96 P-W0CKGKRY 1271134205950008 SITI MASYITHAH HRP P B 26 SEI.MATI L
97 P-W1ITZRPH 1271135501010001 EVIETA SARI P UMUM 20 LK.II BATAN
98 P-W1NDANMR 1271096109720007 SARI HAYATI NASUT P UMUM 49 SEI.MATI BA
99 Q-000BZ2ZT 1271081703860001 RONAL NADAPDAP L B 36 KOMP TKBM B
100 P-W2OH8DXH 1208291212010001 RONAL PERNANDO L UMUM 18 SEI.MATI LR.
101 P-W3DKDPUV 1271133009000005 MUHAMMAD FADINSL UMUM 21 JLN,KAIL LIK
102 P-W3FLHMGH 1271134304650004 ADE RANCE MARBU P RENTAN 56 JLN.PARDAM
103 P-W3IR6HDC 1271136401010001 TESALONIKA SIMA P B 20 LIK. XIV SEI
104 P-W3SH5YV2 1271134303010003 SAFRIDA P UMUM 20 LIK.XI SEI.M
105 P-W47685C0 1271135204810003 INTAN JULIANI P UMUM 40 JL KAIL LI
106 P-W4A6ZBDH 1271095212820014 KRISTINA RODIANA P UMUM 39 LINGKUNGAN
107 G-0133T84O 1271194309930004 SHELY WILLA AMAN P UMUM 28 JL. MERBAU
108 P-W4CCRHZP 1210087101000001 ERVI ERISA ROSALI P B 21 LINGJUNGAN
109 P-W4ES7JOM 1271134207990003 AULIA UL HUSNA P UMUM 22 LINGKUGAN I
110 P-W4I7GXUW 1271131310920005 ANDREAS GINTING L B 28 LIMGKUNGA
111 P-W4K2NZ2V 1271135703740002 ELI HERLINA P UMUM 47 LINGKUNGAN
112 P-W4GDPIWY 1271134808000007 FLORENSIA AGUSTI P UMUM 21 LINGKUNGAN
113 P-W4L9QVNX 1271136505680005 SITI ASRAINI P RENTAN 53 LINGKUNGAN
114 P-W4N5EDAI 1271137011690001 SARNAULI OMPUSU P RENTAN 51 LINGKUMGAN
115 P-W4OS3GX9 1271132209940001 KHAIRUL AMAR DA L B 27 BATANG KILA
116 W-E9215799 1271081010930002 EKO ALFIANDI L B 28 KOMP. RSK L
117 P-W4YCULVV 1271082403770002 AHMAD L B 43 LOR.KOMPLE
118 P-W4ZWXZQH 1271064109000002 AYU SRIWAYUNI P B 21 JLN.MANGAAN
119 P-W4SEX9VC 1407076911020002 ESTER NOPIANTI P B 19 LOR. PARSA
120 P-W4TPPUEY 1271136306010002 SINTA DEWI LESTARI P B 20 LINGKUGAN I
121 P-W4UT3FL0 1271132106000002 CINDY AULIA P UMUM 21 LINGKUNGAN
122 P-W4WERF88 1207242409800001 SURIANTO L B 31 JL. KAIL LIN
123 P-W51MV4JV 1271055403010001 NINDI SULVIANI TA P B 21 JLN.KL YOS
124 P-W53T6OJ9 1271136412880004 NATALIA TOGATOR P UMUM 32 JL. KAIL LIN
125 G-01338PSA 1205084304930005 apri yanti yasa P UMUM 28 LINGKUNGAN
126 P-W5I3KT6X 1271134612800002 HOTMA SIMATUPA P UMUM 41 LIGKUNGAN I
127 P-W5GWEBRJ 1218156409770004 NURLINCE BR ARUA P UMUM 44 KOMP. TKBM
128 P-W5FVGANJ 1271134602890001 ROSMAWATI NAING P UMUM 32 LINGKUNGAN
129 Q-000AGBU5 1271135302810002 RINI SUSANTI HUTA P B 40 P. RAMBAIL
130 P-W5EMFB6X 1271131310960003 ANDEREAS SITORUS L B 24 LINGKUNGAN
131 P-KLPV0ODI 1271130603760003 CHARLES BRONSON L B 45 LINGK. XIV
132 P-W55XW3ZO 1271131910740002 BOBBY NIKSON SIHI L B 47 LINGKUNGAN
133 S-C66A7E93 1271136006560003 ESRA BR HUTAPEA P LANSIA 65 LINGKUNGAN
134 P-W5B4XQ7G 1271062303860004 M ALPIN NANDA L B 39 JL. KAIL LIN
135 P-W5J4RVG3 1218152405790001 NAEK PARSAORAN L B 42 KOMP. TKBM
136 P-W5PA3WVQ 1271133004910002 POLMER LIBERTRY S L B 30 LINGKUNGAN
137 P-W5Q0ZDXT 1271132008970001 BOY GUNAWAN SIA L B 24 LINGKUNGAN
138 P-W5QSGQKX 1271132706030002 IQBAL PRATAMA PU L UMUM 18 LOR. I MESJ
139 P-W5RU7TKC 1271136511750004 ROSMIKO SIAHAAN P UMUM 46 LINGKUNGAN
140 P-W5TFEFKM 2171095903939004 MANNA ROKAYA SI P UMUM 28 LINGKUNGAN
141 P-W5UP12SF 1403131003883378 JHON FRESLY LUMB L UMUM 33 JL. ILYAS LIN
142 P-W5WKHY2C 1271124612680003 MINAR BR SIREGAR P RENTAN 53 LINGK. VII
143 P-W57DA2MY 1207033108950002 RADEN SENJAYA L B 26 LINGKUNGAN
144 P-W8YUXIVA 1271065906950001 TENGKU ELFANI RA P B 26 JL. PAKE GG
Keterangan

D : Lainnya
E : Tidak Bekerja
Kelompok Umur
18-30
31-45
46-59
Total
Pekerjaan
A
B
C

LABUHAN

BPJS PBI Screening
PBI Anggota
SEI MATI MEDAN LABUHAN +6285261553470 √ CORONAVAC 9/24/2021
SEI MATI MEDAN MARELAN 083161392421 √ CORONAVAC 9/24/2021
PEKAN LABUHANMEDAN LABUHAN 082381536746 √ CORONAVAC 9/24/2021
HAMPARAN PERAK
HAMPARAN PERAK 083141576784 √ CORONAVAC 9/24/2021
SEI MATI MEDAN LABUHAN : 081261323832 √ CORONAVAC 9/24/2021
BELAWAN SICANANGMEDAN BELAWAN 085261304416 √ CORONAVAC 9/24/2021
BAGAN DELI MEDAN BELAWAN 085261304416 √ CORONAVAC 9/24/2021
LABUHAN DELI MEDAN MARELAN 081397886830 √ CORONAVAC 9/24/2021
SEI PUTIH BARATMEDAN PETISAH 082366625656 √ CORONAVAC 9/24/2021
BELAWAN SICANANGMEDAN BELAWAN 082165288724 √ CORONAVAC 9/24/2021
MABAR HILIR MEDAN DELI 082273334332 √ CORONAVAC 9/24/2021
PULO BRAYAN KOTAMEDAN TIMUR 082167339102 √ CORONAVAC 9/24/2021
NELAYAN INDAHMEDAN LABUHAN 085362352621 √ CORONAVAC 9/24/2021
RENGAS PULAUMEDAN MARELAN 081269620353 √ CORONAVAC 9/24/2021
TANAH ENAM RATUS
MEDAN MARELAN 085664033336 √ CORONAVAC 9/24/2021
Merek Vaksin
A : Sinovac
Kepersertaan BPJS
BPJS PBI
BPJS Non PBI
Non Anggota
Total
Pemberian Dosis
Dosis 1
Dosis 2
Total
Dosis I Dosis 2
Vaksin n Vaksin
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 2021071341 - - LANJUT VAKSIN 2
9/24/2021 2021071341 - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 2021071341 - - LANJUT VAKSIN 2
9/24/2021 2021071341 - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 2021071341 - - LANJUT VAKSIN 2
9/24/2021 2021071341 - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
- - 9/22/2021 202108152G SELESAI
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 2021071341 - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 2021071341 - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 2021071341 - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 2021071341 - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
- - 9/24/2021 202108152G SELESAI
- - 9/24/2021 202108152G SELESAI
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
- - 9/24/2021 202108152G SELESAI
- - 9/24/2021 202108152G SELESAI
9/24/2021 202108152G - - SELESAI
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 202108152G - - LANJUT VAKSIN 2
- - 9/24/2021 202108152G SELESAI
9/24/2021 202108152G - - LANJUT VAKSIN 2
9/24/2021 2021071341 - - LANJUT VAKSIN 2
9/24/2021 2021071341 - - LANJUT VAKSIN 2
9/24/2021 2021071341 - - LANJUT VAKSIN 2
9/24/2021 2021071341 - - LANJUT VAKSIN 2
9/24/2021 2021071341 - - LANJUT VAKSIN 2
9/24/2021 2021071341 - - LANJUT VAKSIN 2
- - 9/24/2021 2021071341 SELESAI
9/24/2021 2021071341 - - LANJUT VAKSIN 2
9/24/2021 2021071341 - - LANJUT VAKSIN 2
9/24/2021 2021071341 - - LANJUT VAKSIN 2
9/24/2021 2021071341 - - LANJUT VAKSIN 2
9/24/2021 2021071341 - - LANJUT VAKSIN 2
9/24/2021 2021071341 - - LANJUT VAKSIN 2
9/24/2021 2021071341 - - LANJUT VAKSIN 2
9/24/2021 2021071341 - - LANJUT VAKSIN 2
- - 9/24/2021 2021071341 SELESAI
9/24/2021 2021071341 - - LANJUT VAKSIN 2
9/24/2021 2021071341 - - LANJUT VAKSIN 2
9/24/2021 2021071341 - - LANJUT VAKSIN 2
9/24/2021 2021071341 - - LANJUT VAKSIN 2
9/24/2021 2021071341 - - LANJUT VAKSIN 2
9/24/2021 2021071341 - - LANJUT VAKSIN 2
9/24/2021 2021071341 - - LANJUT VAKSIN 2
9/24/2021 2021071341 - - LANJUT VAKSIN 2
- - 9/24/2021 2021071341 SELESAI
9/24/2021 2021071341 - - LANJUT VAKSIN 2
9/24/2021 2021071341 - - LANJUT VAKSIN 2
9/24/2021 2021071341 - - LANJUT VAKSIN 2
- - 9/24/2021 2021071341 SELESAI
9/24/2021 2021071341 - - LANJUT VAKSIN 2
9/24/2021 2021071341 - - LANJUT VAKSIN 2
9/24/2021 2021071341 - - LANJUT VAKSIN 2
9/24/2021 2021071341 - - LANJUT VAKSIN 2
9/24/2021 2021071341 - - LANJUT VAKSIN 2
9/24/2021 2021071341 - - LANJUT VAKSIN 2
9/24/2021 2021071341 - - LANJUT VAKSIN 2
9/24/2021 2021071341 - - LANJUT VAKSIN 2
9/24/2021 2021071341 - - LANJUT VAKSIN 2
9/24/2021 2021071341 - - LANJUT VAKSIN 2
9/24/2021 2021071341 - - LANJUT VAKSIN 2
9/24/2021 2021071341 - - LANJUT VAKSIN 2
9/24/2021 2021071341 - - LANJUT VAKSIN 2
9/24/2021 2021071341 - - LANJUT VAKSIN 2
9/24/2021 2021071341 - - LANJUT VAKSIN 2
Tabel 10. F
FO

Umur
(> 60Tahun)
1 P-0L9GBUMF 1271131111070001 MARCO J.N. SARAGIH L REMAJA 13
2 P-2B3ACBES 1271066006070001 HELENA HEZA P REMAJA 14
3 P-6PFVIPP3 1271134512070001 MONITA LAURA PARDEDE P REMAJA 14
4 P-7HI5GP39 1271135012060003 MEUTIA MAHIRA P REMAJA 14
5 P-AJY9UU9N 1271136009080007 TRI SUKMA AYU P REMAJA 14
6 P-B2BA29T5 1207254111070002 NADIN ENDRIANI P REMAJA 13
7 P-E8BLRU52 1271065601070001 RUT EVI SONIA SITUMEA P REMAJA 14
8 P-DC34D6NY 1271136512070005 LAURA AYU FEBRIYANTI P REMAJA 13
9 P-ERG7LJGU 1271136607070001 EKA NABILAH P REMAJA 14
10 P-IMEYOYZK 1271134312070001 YOHANA DESRIA P REMAJA 13
11 P-I51AUHDD 1271136409070004 ELLYA SEPTIANI PANJAIT P REMAJA 14
12 P-HGPD42P6 1271134911070003 RINDI ARVIKA P REMAJA 14
13 P-LTRYGIH0 1271132711060003 FIKIH ADRIANSYAH L REMAJA 15
14 P-N1MIZK5Z 1271132107070001 REZEKI MARPAUNG L REMAJA 14
15 P-KFERYULW 1113022504070002 ALVINO BAHARI L REMAJA 14
16 P-OT2OV4ES 1271130607070008 KEVIN IMMANUEL ARITON L REMAJA 14
17 P-QBRT963G 1271130904070004 ALWASI SETIAWAN HARE L REMAJA 14
18 P-S1VR7QO6 1271132811070002 MUHAMMAD DAVA L REMAJA 15
19 P-SZCOMHMC 1271131202070004 MUHAMMAD RAIHAN AL F L REMAJA 14
20 P-TMTIADLN 1271132612070006 RICARDO HASUDUNGAN S L REMAJA 13
21 P-UB4O53VT 1271130406070004 CHRISTIAN MANUEL ANU L REMAJA 14
22 P-UXAGE50J 1271132904070006 HENDI SYAHBANDI L REMAJA 14
23 P-VDYCAGMF 1271131102070003 ADJIE FEBRYANDO L REMAJA 14
24 P-UXTYNCCP 1207242309060008 SYAHRUL RAMADHAN L REMAJA 15
25 P-VX9H5UY3 1207210710070005 ALFIN TORA FRANSENA L REMAJA 13
26 P-W1F4WTDN 1271130402080003 ANDIKA BONA TUA L REMAJA 13
27 P-WPQJ7BAB 1271131704080001 SATRIA PRATAMA L REMAJA 13
28 P-WBM2RW3P 1271135408070005 PUAN SAHARA P REMAJA 14
29 P-WVHI3QKH 1271134411070004 SESILIA A. BR. TAMPUBO L REMAJA 13
30 P-WVESIIKW 1271136207080002 REVY DERMAWATI BB P REMAJA 13
31 P-WVC5EGMK 1271082405080003 ANGGIAT D'ANDRA HUTA L REMAJA 13
32 P-WVRALGZ8 1271130606070003 ANDREAS TARIHORAN L REMAJA 13
33 P-WWRPPEAV 1271134202090003 LUCY GRACIA CIBRO P REMAJA 12
34 P-WW8YGOX8 1271130105090006 DAFA BAIHAQI FRASETYO L REMAJA 12
35 P-WWFHWXWI 1271111110080010 ABDUL PADLI L REMAJA 12
36 P-WVWXV13K 1271134609080003 ALENTA FORTALITA PANG P REMAJA 13
37 P-WWED08SB 1271131512070001 ARDI PRATAMA HUTAGAO L REMAJA 13
38 P-WWWR4P6H 1271134105080006 SISKA AINUN FADHILAH P REMAJA 13
39 P-WWOC14MX 1271137006080005 HELEN LAURA SIMANGUN P REMAJA 13
40 P-WWP7JDJD 1271066712080002 ADITA UTARI P REMAJA 12
41 P-WX5FHCG0 1271135107080001 RUTH DEWI SEHATI P REMAJA 13
42 P-WXDWBZSO 1271132912060001 RIZKI SAPUTRA PURBA L REMAJA 15
43 P-WXE8H2U1 1271132706080001 MUHAMMAD SYAHPUTRA L REMAJA 12
44 P-WXQCG6JA 1271026102090002 RIFA AUDREY ZAHRA P REMAJA 12
45 P-WXSFSDCD 1271016703070002 GRECIA RAHMAWATI P REMAJA 15
46 P-WXM5EDEU 1271062212080004 JONATAN ALFREDO L REMAJA 12
47 P-WYESM165 1271132808080002 AHMAD KHALID SYAIFULL L REMAJA 13
48 P-WYNLJOTO 1271135511060005 ERITA SELVIANA SIREGAR P REMAJA 14
49 P-WXWS48JH 1271135206080005 IRMA RUHAWA MARBUN L REMAJA 13
50 P-WZ6YIA7J 1271064101060002 NADINFREDIANA P REMAJA 15
51 P-WZMWEIPD 1271061007080007 AULIA FALISA BILHAQ L REMAJA 13
52 P-WZCYXPU0 1271064603040001 ALHUDA ASYIFA P REMAJA 17
53 P-WZ00R3M6 1271181804070009 DEDI ARDIANSYAH SITU L REMAJA 14
54 P-X05I0GJM 1271135310080004 ANGGITA AULIA P REMAJA 13
55 P-WZUCYQD5 1271136205080001 MUTIA KHUMAIROH P REMAJA 13
56 P-X0PQV80F 1271044309080007 HAFIDZAH SALSABILA P REMAJA 13
57 P-X0NMHPYN 1271136412070002 NURUL MARHAMA P REMAJA 13
58 P-X1AXO8OC 1271135703080002 EMILIA PUTRI P REMAJA 13
59 P-X265LMVZ 1271135909070006 RASYA FIDYAH P REMAJA 14
60 P-X1T39KHL 1271134807080005 SALSA JULIA PUTRI P REMAJA 13
61 P-X1RPUXPD 1271135102080007 AULIA PRADISKA P REMAJA 13
62 P-X3CACX3Z 1271135904080006 DWI APRILIA P REMAJA 13
63 P-X35CO2CO 1207264901090005 YOLANDA PRATIWI P REMAJA 12
64 P-X4V34NEN 1271134308070001 AMANDA SAPUTRI P REMAJA 14
65 P-X4JZ5GOW 1271133112070002 PANDU ADIT ALAMSYAH L REMAJA 13
66 P-X50PDGYS 1271061706080001 FAHRI IRFANSYAH L REMAJA 13
67 P-X56QUO1V 1271132601090001 MHD. MIRZA HAZLIE L REMAJA 12
68 P-X522NPSQ 1271131405080006 ASRUL HAMZAH L REMAJA 13
69 P-X4EH731I 1271132603080001 TOMI PRATAMA L REMAJA 13
70 P-X489LIRD 1271136011080002 FRANSISKA ANGRAINI P REMAJA 13
71 P-X446P5WE 1271136109080001 DEWIT KARINA SEMBIRIN P REMAJA 13
72 P-X5MC241B 1205071803080002 HABIB AZHAR L REMAJA 13
73 P-X1XG8BE6 1271135503080003 DEKVINA GLADYS P REMAJA 13
74 P-X5DXWG30 1271121402080001 RIFKINTA WIDIATAMA L REMAJA 13
75 P-X66DBWCJ 1271137005090002 NURUL HAFIZAH P REMAJA 12
76 P-X6QQFLXF 1271137007080001 ULI PRATIWI TAMPUBOLO P REMAJA 13
77 P-X6LLF3Q5 1271136805090002 ALKESIS MEISILIA P REMAJA 12
78 P-X6BLB3XS 1271134407090004 SUKMA WULANDARI P REMAJA 12
79 P-X6IG2RXQ 1271134202090005 ALSYIFA YULISNA P REMAJA 12
80 P-X77N5U8O 1271135905090001 ZAHRA P REMAJA 12
81 P-X71I6Y7C 1271216207080002 INDRI ALESSIA SILABAN P REMAJA 13
82 P-X6VXR0A3 1275036305090001 LIVFIA MAY SYAHRANI P REMAJA 12
83 P-X5CDT79M 1271060212080013 GALIH SATRIA L REMAJA 13
84 P-X5QG66HY 1271137103080002 CHIKA AMALIA P REMAJA 13
85 P-X5IRTF8P 1173020405080006 AFDIL FATHIR L REMAJA 13
86 P-X5GVM90B 1271061404070001 MUHAMMAD BAGAS L REMAJA 14
87 P-X66MB8C0 1271136506080005 SRI HANUM P REMAJA 13
88 1271132809090005 ESTER PANJAITAN P REMAJA 12
89 1271134810090007 RONA ULI SILITONGA P REMAJA 12
90 1271136512090005 KASIH DEVELINA P REMAJA 12
91 127113510189009 SULIS TIA P REMAJA 13
92 P-X61T6DKG 1271134803090001 MUTIARA MAULIDIA NST P REMAJA 12
93 P-X5WXKQKK 1271135207080002 VINA ADELIA PUTRI P REMAJA 13
94 P-X6E5ELYR 1207190205090001 AFGAN PRATAMA L REMAJA 12
95 P-X6AJI4RO 1271131502090002 DAVI MAULANA L REMAJA 12
96 P-X60Z336Z 1271072907080002 JEREMIA MARVELINO L REMAJA 13
97 P-X7UALLXX 1271061004090004 M. TRIANSYAH L REMAJA 12
98 P-X7Q8C407 1271132102090002 IMRAN ALI L REMAJA 12
99 P-X7QZWYJH 1271132611080005 TEXAS REIHAN RAJAGUK L REMAJA 12
100 P-XAP0A0GE 1271131209090004 CHRISTIAN EWALDO PAN L REMAJA 12
101 P-XALGPUW3 1271201607090003 JOSHUA SAUT L REMAJA 12
102 P-XAIJLN5M 1218051010080005 RANTO PASARIBU L REMAJA 14
103 1271132909090005 TAHAN PARULIAN P REMAJA 12
104 P-X7DQMT79 1271135101090003 PARAS ANGGUN P REMAJA 12
105 P-X7H0OUJI 1271132708090005 MHD. ABDI BERUTU L REMAJA 12
106 P-X7KPJKGH 1407105204090003 CHIKA DEWI PRATAMA P REMAJA 12
107 P-X81CZYWW 1271136501090002 GRACE MAULINA TAMBA P REMAJA 12
108 P-X86UCJA2 1271137004090002 DIANA MAURA SIRINGO - P REMAJA 12
109 P-X7XFEKS2 1271063105090005 CHRISTIAN PERMANA GIN L REMAJA 12
110 P-X8VEDAGX 1271135005090004 MIRANDA CHRONICA SIAG P REMAJA 12
111 : P-X90HVTVC 1271136908090002 NABILA RAMADHANI P REMAJA 12
112 P-X8LTAHJH 1271135210070002 FITRIA RAMADHANI P REMAJA 13
113 P-X8IH2N0T 1271135807090001 KASIH ZEFANYA SITUMO P REMAJA 12
114 P-X8B9FR4Z 1207265703090003 NIWIS AKWILA JENICE P REMAJA 12
115 P-X8FNHCPP 1271136205090001 ANABEL TABITHA PUTRI P REMAJA 12
116 P-X9PA3G2G 1271135407090003 FITRIA LESTARI P REMAJA 12
117 P-X9FEZAXF 1271134909090007 TRESYA MEDIANA MARBU P REMAJA 12
118 P-X983HGZQ 1271065204090006 SHEERIN APRILIA P REMAJA 12
119 P-X94RADVL 1271135411080002 DELYA ANGGIA P REMAJA 13
120 P-X8PUJMZC 1271135309090002 AYUM MADHANI P REMAJA 12
121 P-XA2C2XKR 1271135910080003 YEMIMA SITUMORANG P REMAJA 12
122 P-X9VD1BUT 1271135909090002 HIZKYA NESTI SEPTIYANT P REMAJA 12
123 P-X9YFUQPB 1271136008090001 NORA LEONA HUTABARAT P REMAJA 12
124 P-XAC4RYRG 1271131509090002 ALDI RAMADHAN L REMAJA 12
125 P-XA9MRT4U 1271061108090001 JOSUA EZEKIEL MANURU L REMAJA 12
126 P-XA6LNKMK 1271134203090005 VIDIA CITRA P REMAJA 12
127 P-XCNWXNYM 1276045805990003 RARA SARI P REMAJA 14
128 P-XCPGTS77 1273031406080002 TRISNAULI SAPUTRA P REMAJA 13
129 P-XCMGTC9V 1271206608080001 TIARA ADISTI LARASATI P REMAJA 13
130 P-XBPZYB3S 1271132009090001 MARTUA ABET NEGO L REMAJA 12
131 P-XBSCW5CN 1271131607090001 SEBASTIAN NAINGGOLAN L REMAJA 12
132 P-XBVNO14Z 1271130510070007 RIFKI DWI RAMADHAN L REMAJA 13
133 P-XBNFP2GD 1271131106090003 EBEN HEIZER MATTEHEW L REMAJA 12
134 P-XC1LZ4L5 1271095505080004 PUTRI MELISA SIHOMBIN P REMAJA 13
135 P-XC4CPXNP 1271135211080002 ZENITHA RIA P REMAJA 12
136 P-XC6W7ZZ1 1271067008080006 AULIA BUNGA P REMAJA 13
137 P-XBHG7HLQ 1271132801090004 GINDO SYAHPUTRA HUTA L REMAJA 12
138 PUTRI AYU P REMAJA 12
139 P-XC9DZOGF 1271134607080004 CHAHYA AL ZAHRA P REMAJA 13
140 P-XCBEWTCX 1271136407080003 NURSAIDAH P REMAJA 13
141 P-XBZSABEY 1271136909080001 GRECIA EXELINA SIBURIA P REMAJA 13
142 P-XCJNJHMB 1271204205080002 MEISYLA ARZEDTI P REMAJA 13
143 P-XCL6MB0Z 1271136910080003 XENA P REMAJA 12
144 P-XCG0SK24 1206106807080001 KANIA BR. LIMBONG P REMAJA 13
145 P-XEL48UZD 1271064402040003 RATIH HANDA YANI P REMAJA 14
146 P-XE1KPJQ5 1207262302080012 HANS FELIX SIAHAAN L REMAJA 13
147 P-XEKE0W4Z 1271062002070005 MUHAMMAD ILHAM L REMAJA 14
148 P-XEL6CYPH 1271065404070005 DITA SALSABILA P REMAJA 14
149 P-XCI9SGEM 1271135507080005 METHA CLAUDIA SIMBOL P REMAJA 13
150 P-XCDNRLAC 1271135407070010 DEVI JUSSIN NABABAN P REMAJA 14
151 P-XCQLYNBK 1271133105080005 REMON GULTOM L REMAJA 14
152 P-XD1DBJPY 1271132509080005 TIRTA RAMADHAN L REMAJA 13
153 P-XCRP8DPM 1271131709080002 ANDREAS ALDIANSYAH B L REMAJA 13
154 P-XCT91HYS 1271062411080002 FATHAN ASSABILI IHSAN L REMAJA 13
155 P-XCWDHR9G 1271130208080004 DIMAS GUSTI PRATAMA L REMAJA 13
156 P-4FDFRG35 1271137108830002 WAHIDAWATI P REMAJA 13
157 P-XCUQPD4G 1271060601070007 STEVAN ANATASIUS L REMAJA 15
158 P-XDCXWPCI 1271135704090002 SAFA NURAIYAH PUTRI P REMAJA 12
159 P-XDBHSW1J 1271064702090005 CHIKA ZIE MUSLIMAH P REMAJA 12
160 P-XDAHNGFI 1271134802090002 MARINI HUTABARAT P REMAJA 12
161 P-XD6VFQZJ 1271130111080003 NANDA SYAHPUTRA L REMAJA 12
162 P-XD33JZ9Q 1271131108080002 RICKY PRATAMA L REMAJA 13
163 P-XD4NX87D 1271130208080001 ADITYA WIJAYA L REMAJA 13
164 P-XDEAXCHS 3674055810070004 SEPTRIDA NAULI HUTAPE P REMAJA 14
165 P-XDFJQS5W 1271131101090004 RENO ADRIAN L REMAJA 12
166 P-XDHCQ2J2 1271138707090004 NAURA RAHMACHINTIYA P REMAJA 12
167 P-XDMNHDMW 1207262107080007 L REMAJA 12
RANGGA JULIANSYAH
168 P-XDKXRRTO 1271120905090003 REYNALD CANDY L REMAJA 12
169 P-XDJV7WJV 1271133008090001 TYO DWI JAYA L REMAJA 12
170 P-XDIMS8WC 1271130909090004 FATHIN NUR ZAKI L REMAJA 12
171 P-XEDIR6HJ 1207216104620003 DARMAWATY SITUMEANG P RENTAN 59
172 P-XEKJTMVR 1271061012070001 DWI ANDIKA L REMAJA 13
173 P-XEFIOW0D 1271092210080005 LUTHFI CHAIRIL TAN L REMAJA 13
174 P-XEGU1BLE 1271085905810003 HERAWATI TAMPUBOLON P PP 40
175 P-XEGHHCIR 1271135405090004 DEVI YULIANI P REMAJA 12
176 P-XEI1JZJO 1271066711070006 DWI KRISTINA HUTABARA P REMAJA 13
177 P-XEJ3YFFE 12711305080700004 DIEGO FIRMAN MARBUN L REMAJA 14
178 P-XEIZG9AR 1271136502770001 TEGUH PRATAMA L REMAJA 13
179 P-XEHQRKBY 1271061711070003 MARHASIL MARBUN L REMAJA 14
180 P-XEJS1FGU 1207232402070009 M. NUR RIZKI L REMAJA 14
181 P-XEHDI6ML 1271132707090005 ANDRE ALFIANO L REMAJA 12
182 P-XEJOAHIL 1271060111060005 RANGGA WIRA ARDANA L REMAJA 14
183 P-XDQ6AH3A 1271132005090003 WIRA ADMAZA L REMAJA 12
184 P-XDOGIFSE 1271132408090001 M. FADHIL RIYANDI L REMAJA 12
185 P-XDTYSVDV 1271134412080004 IRMAYANI P REMAJA 12
186 P-XDRLY3D4 1271133108090006 MHD. ANDIKA PUTRA L REMAJA 12
187 P-XDWSBMUH 1271135703090003 SYAHVIRA PUTRI ARMAN P REMAJA 12
188 P-XDVNXWTT 1271135007090007 SITI AULIYAH P REMAJA 12
189 P-XDSON9CI 1271136403090006 ALECHA P REMAJA 12
190 P-XE7LJKTF 1271135007090001 LARASWATI P REMAJA 12
191 P-XE669UJS 1271131004080001 MUHAMMAD AZRYL L REMAJA 13
192 P-XE3BX2DC 1202034701060002 LIDYA TIATIRA SITUMEAN P REMAJA 15
193 P-XE08KULI 1207254406090004 DWI ULAN DARI P REMAJA 12
194 J-0003U20O 1271201707620002 LUKMAN L RENTAN 59
195 P-XE28NME4 1207250209080002 ARYA RAMA DYANSYAH L REMAJA 13
196 P-XE8TV3U3 1271120502090004 ARZA ANGGARA L REMAJA 12
197 P-XECCGKUI 1271135705090002 ANNISA MEIDINA DAULAY P REMAJA 12
198 P-XDZS5HHR 1271134608080001 SITI SURYANI P REMAJA 13
199 P-XE15VXJP 1271130912080001 DAVIT KRISTIAN HAREFA L REMAJA 13
200 AULIA ZAHRA P REMAJA 11

MEDAN LABUHAN
Kepersertaan BPJS (tulis 'Ya' pada

kolom yang sesuai)
Alamat Kelurahan Kecamatan No.Hp BPJS Non
BPJS PBI
PBI
JLN. BAWAL NO. 14 BLOK TANGKAHAN CC MEDAN LABUHAN 082288907851 √
JLN. MANGAAN III LK. 12MABAR LOR BUDI MEDAN DELI 085272475049 √
JLN. RAWE VI LK.TANGKAHAN
VIII MEDAN LABUHAN 082391751971 √
JL.TENGIGIRI 3 NO. TANGKAHAN
53 GM II MEDAN LABUHAN 085760808505 √
JL. RAWE II LK.TANGKAHAN
III MEDAN LABUHAN 085262669427 √
DUSUN V PASAR II DESA JOHAR JOHAR
PEMATANG LABUHAN DELI 088261159970 √
JL. MANGNOLIA 14 MARTUBUNG
BLOK II MEDAN LABUHAN 081262160426 √
JL. RAWE VI LK.TANGKAHAN
JL. RAWE V LK.TANGKAHAN
VII MEDAN LABUHAN 083199394202 √
IV MEDAN LABUHAN 082167056217 √
DUSUN RAKLUNUNGRAKLUNUNG GAYO BLANGKEJEREN ACEH 085359168408 √
JL. TENGGIRI VI NO. 145 B GM II
TANGKAHAN MEDAN LABUHAN 081279542973 √
JLN. RAWE II LK. III
JL. RAWE VII LK. X
JL. TAUT II LK.TANGKAHAN
II MEDAN LABUHAN 081264214974 √
JL. RAWE III LK.TANGKAHAN
V MEDAN LABUHAN 082166132287 √
L. JALA RAYA NO. 04 LK.BESAR 23 BLOK XII MEDAN LABUHAN 085270233370 √
JL. RAWE IV LK.TANGKAHAN
GRIYA MARTUBUNG II
DSN VI MARINDAL II
MARINDAL II PATUMBAK 081367915481 √
JL. TENGGIRI RAYA NO.TANGKAHAN
68 A LK. 5 MEDAN LABUHAN 085261469969 √
KOMP. YUKA JL. RAWE V LK. VII
L. RAWE IV LK. VIII LUMBA-LUMBA
TANGKAHAN 3 MEDAN LABUHAN 082173254739 √
JL. KAKAP IV NO. 173 GM II
L. HIU 10 NO. 278 GRYA TANGKAHAN
MARTUBUNG MEDAN LABUHAN 081370046876 √
JL. RAWE 6 LK. 8 KOMP. YUKA
JL. RAWE 6 LK.TANGKAHAN
8 MEDAN LABUHAN 082150501762 √
JL. RUMAH POTONG HEWAN MABARLK. X MEDAN DELI 089636716964 √
JL. HIU RAYA NO. 29TANGKAHAN
BLOK A MEDAN LABUHAN 082163179251 √
VI MEDAN LABUHAN 081260549117 √
JL.SEI MUSI NO.BABURA
8A MEDAN SUNGGAL 081263411038 √
JL. TENGGIRI RAYA TANGKAHAN
BLOK.C MEDAN LABUHAN 085260931993 √
JL. PLATINA 1 LK. VIIPAPAN
TITI MEDAN DELI 082181806235 √
JL. RAWE II LK. III KAMP. TEMPE
JL. RUMAH POTONG HEWAN MABAR LK. IX MEDAN DELI 082267130865 √
JL. MANGAAN IV LK. XIV
MABAR MEDAN DELI 081260289866 √
JL.MANGGANIV LK. XIV
LK. V BLOK EE 08NELAYAN
KNI INDAH MEDAN LABUHAN 088262085463 √
JL. JERMAL 14DENAI MEDAN DENAI 085668336951 √
LK. III TANGKAHAN MEDAN LABUHAN 08566229941 √
LK. V TANGKAHAN MEDAN LABUHAN 081947647352 √
JL. RAWE 3 LK. V LR.TANGKAHAN
TENGAH MEDAN LABUHAN 085359014656 √
JL. ALFAKA VIII NO. 104B LK. VI MULIA HILIR
TANJUNG MEDAN DELI 085262786210 √
JL. RAWE IV LKTANGKAHAN
L. PANCING I GG. BUNTU DLM LK. 7
BESAR MEDAN LABUHAN 081361271955 √
JL. PAUS BLOK A NO.TANGKAHAN
18 GM. II MEDAN LABUHAN 085761352168 √
JL. LUMBA-LUMBA RAYA BLOK D
JL. MANGAAN 1 GG. BUSTAMI
JL. TENGGIRI RAYA TANGKAHAN
NO. 112 MEDAN LABUHAN 081317130104 √
JL. MANGGAN I GG. BUSTAMI
PASAR VII GRIYA II BLOKTANGKAHAN B TENGGIRI 7 MEDAN LABUHAN 081316314791 √
LK. 20 KOMP. YUKA TERJUN MEDAN MARELAN 088261092646 √
JL. ENGSEL PASAR I REL TANAH LK. 600
III MEDAN MARELAN 085361932252 √
8 MEDAN LABUHAN 0895341236722 √
JL. TEMPIRAI 7 NO. 176 BLOK BESARVII GM MEDAN LABUHAN 085718244962 √
JL. RAWE LK. 14TANGKAHAN MEDAN LABUHAN 083801562380 √
JL. RAWE LK. TANGKAHAN
JL. UDANG II GRIYA IIITANGKAHAN
BLOK CC MEDAN LABUHAN 082213834411 √
JL. MANGAAN IV MABAR
LK. II HILIR MEDAN DELI 0882016049203 √
JL. KRAPU 7 BLOK ETANGKAHAN
NO. 112 MEDAN LABUHAN 081370662523 √
JL. RAWE VII LK.TANGKAHAN
IX MEDAN LABUHAN 088807751448 √
JL. PASAR III NO.GLUGUR
38 DARAT I MEDAN TIMUR 081265706315 √
DUSUN V AMPERA PEMATANG TERANG TANJUNG BERINGIN 083168969670 √
JL. RAWE IV LOR. TENGAH TANGKAHANLK. V MEDAN LABUHAN 085276077888 √
JL. TAUT I LK.TANGKAHAN
I MEDAN LABUHAN 081262167897 √
JL. RAWE II NO.TANGKAHAN
LK. IX TANGKAHAN MEDAN LABUHAN 081264717070 √
JL. RAWE I LK TANGKAHAN
JL. PLATINA VI GG. JUHANI LK. XIV
TITI PAPAN MEDAN DELI 081263233141 √
JL. RAWE 6 LK. TANGKAHAN
JL, RAWE I LK.TANGKAHAN
L. TENGGIRI 5 NO. 101 BLOK TANGKAHANB GM II MEDAN LABUHAN 081260543950 √
KOMP. PTPN IV NO. 203 TITILK. XV
PAPAN MEDAN DELI 081243159602 √
JL. RAWE I LK. VI LOR.TANGKAHAN
JL PLATINATITI PAPAN MEDAN DELI 087777863120 √
JL. MULYO NO,PULO 7 BRAYAN DARAT II MEDAN TIMUR 082260113473 √
JL. RAWE VL LK. VIIITANGKAHAN
NO. 21 MEDAN LABUHAN 0882016131768 √
LOR. TENGAH LK. V
L. SM RAJA COMP. PT ASAHAN TIMBANGLK. I
DELI MEDAN AMPLAS 082370427315 √
JL. TAUT 2 NO. 37TANGKAHAN
LK. II MEDAN LABUHAN 082181197727 √
L. RAWE IV LK. V PSR 6TANGKAHAN
GG. PISANG MEDAN LABUHAN 085261539200 √
JL. BAWAL 12 NO. 128TANGKAHAN
BLOK C MEDAN LABUHAN 085360580649 √
JL. SIDORUKUN NO.PULO 120 SBRAYAN DARAT II MEDAN TIMUR 085761770014 √
JL. RAWE 2 LK. III KAMP. TEMPE
XI MEDAN LABUHAN 082281690048 √
RUMAH POTONG HEWANMABAR NO. 109 LK. 10 MEDAN DELI 082246949635 √
DUSUN SEI EMPAT DESA LAU PAKAM DESA MARDINGDING 082288379094 √
JL. PLATINA VI LK. XIVPAPAN
JL. GELATIK IX NO. 197
KENANGAN BARU PERCUT SEI TUAN 0882015388625 √
JL. PLATINA I GG. TERATAI LK. XVI
JL. PLATINA VI NO. 30TITILK.PAPAN
XIV MEDAN DELI 088261171981 √
JL. PANCING V LK. BESARII MEDAN LABUHAN 082189257996 √
JL. TAUT II NO.TANGKAHAN
55 MEDAN LABUHAN 082276475023 √
JL. PLATINA I GG. TERATAI LK. XVI
JL. PANCING I GG. BUNTU BESAR LK. IV MEDAN LABUHAN 089637112718 √
JL. RAWE 2 LK. 4 LOR.TANGKAHAN
JL. KL. YOS SUDARSO DALAM LK. 2
KOTA BANGUN MEDAN LABUHAN 081263699211 √
JL. PLATINA VI GG. KARSO LK. XIV
JL, RAWE IV LK.TANGKAHAN
JL. RAWE IV GRIYA IITANGKAHAN
BLOK G MEDAN LABUHAN 082112857641 √
JL. RAWE VII LK. X
JL. RAWE IV LK. VI
JL. DATUK RUBIAHRENGAS
LK. 29 PULAU MEDAN MARELAN 083163658670 √
JL. LOR TENGAH TANGKAHAN
LK. VI MEDAN LABUHAN 082274379658 √
IX MEDAN LABUHAN 082160099055 √
PENDIDIKAN GG. SAWAH DUSUN IIIA
MARINDAL I PATUMBAK 085270606207 √
JL. PLATINA IV LK. IXTITI
NO.PAPAN
97 MEDAN DELI 085275106154 √
JL. BAJAK V GG. RUKUN VI
HARJOSARI II MEDAN AMPLAS 082184362735 √
BLOK 13 LK. X P. SICANANG
BELAWAN SICANANG MEDAN BELAWAN 082164957354 √
LK. XII SEI MATI
SEI MATI MEDAN LABUHAN 082267329230 √
JL. PLATINA I LK. IX PAPAN
JL. PLATINA III LK. XIII
DUSUN V JL. ISTIQOMAH
HELVETIA SUNGGAL 082268218950 √
JL. KAKAP 3 BLOK F X10 - 100
JL. PLATINA III GG. AL FALAH LK. 12
JL. BAWAL 15 NO. 380TANGKAHAN
BLOK C MEDAN LABUHAN 081263249191 √
LOR TENGAH LK. VI
4 MEDAN LABUHAN 0882015391131 √
LIMUS SIANTAR NAI POSPOS ADIANKOTING 083170403454 √
DUSUN VII PEMATANG PEMATANG
JOHAR JOHAR LABUHAN DELI 081375213046 √
ASRAMA EX YONPULO 124 BRAYAN BENGKEL MEDAN TIMUR 082164060962 √
DUSUN VII PEMATANG PEMATANG
JOHAR JOHAR LABUHAN DELI 083196821550 √
XI MEDAN LABUHAN 082277861618 √
JL. HIU 8 NO. 247
JL. RAWE II LK. III MAGNOLIA
IV MEDAN LABUHAN √
at Fasyankes
D-19
I
aan BPJS (tulis 'Ya' pada

Dosis I Dosis 2
om yang sesuai) Tanggal Tanggal Tanggal
Non Merek Vaksin
Screening Pemberian No.Batch Pemberian No.Batch
Anggota
Vaksin Vaksin
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202107140K
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
CORONAVAC 9/27/2021 9/27/2021 202108152G
KETERANGAN
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
LANJUT VAKSIN 2
Tabel 10. Format Pencatatan Pelaya
FORMAT PENCATATAN P
TINGKAT PUSKESMA

Nama Penerima Umur

Vaksin
(> 60Tahun)
1 P-SJTUPVFE 1271132108080001 GABRIEL SUMURUNG PA L REMAJA 13 : LK. VI S
MARCHEL GIDION
2 P-XMOGBVW6 1271181503090001 L REMAJA 12 : JL PELITA
GULTOM
3 P-XPWCPBLP 1271135112080001 DESI LUTHFI YANI P REMAJA 12 : JL. KL. YO
4 P-XQ2P8PKV 1271134808080006 SRI MUTIA P REMAJA 13 : LK. II BAT
5 P-XOY6IG5R 1271135404080003 ESTER WINDASARI BR L P REMAJA 12 : LK. XVII SE
6 P-XNG3SL4G 1271135303080002 RARA INDRIANI P REMAJA 13 : JL. KAMBES
ANTONIO
7 P-XH1DD4WN 1271130805080002 HERLAMBANG L REMAJA 12 : LING 29
PRATAMA
DINA SARTIKA
8 P-XOT61G97 1271124701090002 P REMAJA 12 : JL. YP. HI
ARITONANG
9 P-XP8SINMJ 1271134808100005 GUSTY WULAN DARI P REMAJA 12 : LK. XII SEI
10 P-KFJMC09D 1401062205090002 IBRA GEOFANY AZRA L REMAJA 12 : LK. IX SEI
11 P-SZPT9FRE 1271081805090005 MUHAMMAD AFFANDI L REMAJA 12 : JL. PANCIN
12 P-2RS0ICK9 1271066805080005 NUR PADILAH P REMAJA 13 : JL. TELUK
13 P-NWEZC5KS 1271136304090003 RIZKA FAIRUZ P REMAJA 12 : LK. 29 PE
14 P-XNJ2U39H 1271134702080004 RAUDA ZAHWA P REMAJA 13 : JL. JALA P
SATRIA RAMADHAN
15 P-CHYL0X74 1271132808090001 L REMAJA 12 : JL. P. SU
PRATAMA
16 P-O4DLJW9J 1271134303090005 ZULFA NUR AZIZI P REMAJA 12 : LING I B
17 P-XINKYVFX 1271061811080006 ZULHILMI L REMAJA 12 : GG. MANGG
18 P-1PWFZRIF 1271086703090001 ALVIRA CAHYA P REMAJA 12 : JL. BAKTI
ANGELLINA BR
19 P-XLRH91PY 1271134305090003 P REMAJA 12 : JL. JARING
NAPITUPULU
PUTRI HANDAYANI
20 P-JRPD0H0V 1271124604090006 P REMAJA 12 : JL. TITI
LUBIS
21 P-MBI3ZVNC 1271124605090001 SELIMA ARGIANTI P REMAJA 12 : JL TITI P
RUBEN JULIO ELIEZER

22 J-0004HM7Q 1271130507080003 L REMAJA 13 : JL. P. BA
SIMORANGKIR
SAMUEL RIZKY
23 P-PT9HLWGI 1271080906090003 L REMAJA 13 : JL. CIMAN
SIMAMORA
CRISTIAN
24 P-XLIY8LPF 1271132004070003 L REMAJA 14 : LK. VII SEI
PANGGABEAN
GADIEL MALEAKHI
25 P-XJ1B9HV7 1271132801090001 L REMAJA 12 : JL. ANGGR
HUTABARAT
KASIH FAJARINA
26 P-XPTCGZ2L 1271084801090004 P REMAJA 12 : JL. P. HA
MENDROFA
27 P-XIQRMCJ2 1271065112080008 KHAIRUNNIDA ADHANI P REMAJA 12 : jl kawat li
MUHAMMAD FERDI
28 P-XKMVPHV6 1271120510080002 L REMAJA 13 : JL. ILENG L
SUWADANA
SHAFA AULIA
29 P-3MNJPDYZ 1271134209090002 P REMAJA 12 : PAJAK RAM
RAMADHANI
SYIFA AULIA
30 P-NJCJYNNW 1271134209090003 P REMAJA 12 : PAJAK RAM
RAMADHANI
DELA ARSHAVIRA
31 P-KPSFISCT 1271137103090001 P REMAJA 12 : LK. XV SEI
HUTABARAT
32 P-QV20BY0C 1271082109090001 FIKRI ALAWI L REMAJA 12 : JL. SELEB
33 P-XOWKOH8T 1271132605090003 FIKRI HANAFI L REMAJA 12 : LING 6 P
SYAREEVA BELLA
34 P-XHCL0GJB 1271134705090001 P REMAJA 12 : LING 1 P
JASTITIA HASIBUAN
35 P-RZ882TO0 1271084206090008 YENYEN HUTABARAT P REMAJA 12 : LK. XII L
36 P-TSMCDAK4 1271132901090006 RAFI ARDIAN L REMAJA 12 : KOMP. TKB
ANDREAS VALENTINO
37 P-XKRP9JAX 1271121502090003 L REMAJA 12 : JL. YP. HI
NAPITUPULU
MUHAMMAD ALIQA
38 P-XKJC7NDR 1373022007090002 L REMAJA 12 : JL MAREL
AUFA
39 P-P9CN6K95 1271136404090003 BELVIDER BR SIBORO P REMAJA 12 : LK. IV MA
40 P-NKMCLOP6 1271136702090005 FEBRIANTI BR SITINJAK P REMAJA 12 : KOMP TKBM
MICHAEL ALDIANO
41 P-OUKCDAWO 1271120105090001 L REMAJA 12 : LK. 31 R
SIAHAAN
42 P-QJNM5LLX 1271082204090002 SANDI APRI YANSYAH P REMAJA 12 : JL. P. KRA
43 P-GX6JMVIW 1271130604070008 BESTIAN MAHULAE L REMAJA 12 : KOMP. TKB
44 P-HBUYI6YX 1271132608090002 WAHYU RAMADANA L REMAJA 12 : JL. KRAKA
45 P-ICUMMZXM 1271131811070005 UMAR HIDAYAT L REMAJA 13 : JL.KL. YOS
46 P-IKVHB2DM 1271131705080006 NAZRI ALHAMDI L REMAJA 13 : LK. 14 PE
47 P-5DKUEVIY 1271206710070001 BILQIS ANISA HADI P REMAJA 13 : JL. TELUK
48 P-A4BT2N26 1271131304080003 REVAND ALFANDY L REMAJA 13 : KP BAHAR
49 P-8P64FYP8 1271134808090002 ANDINI YUWANDIRA P REMAJA 12 : KOMP. TKB
50 P-AUXX2IL0 1271134910070002 SONIA PANCE DIAMOND P REMAJA 13 : LK. XVII SE
51 P-E2UIO78S 1271135804090002 ADELIYA PUTRI SYAHFANP REMAJA 12 : JL. KL. Y
52 P-GPJG9F3X 1271134207080002 ZASKIA AMANDA RIADY P REMAJA 14 : JL. ASAM
53 P-HZWKF1H5 1271060512080002 SAMUEL KRISTIAN NAH L REMAJA 13 : JL. KUBAH
54 P-LL4QRO0Y 1271135806090003 ZAHRA FAHIRA LBS P REMAJA 12 : KAMBES LK
55 P-N0ZWACLO 1271131305070005 IVAN LERBI HUTABARAT L REMAJA 14 : LK. XV SEI
56 P-OGYSEGQV 1271135111070002 RIKHA CHELSEA P REMAJA 14 : JL. CHAID
57 P-RD0A8QJ4 1271135703090001 ANGGI PRADITA NASUTI P REMAJA 12 : JL. P. SU
58 P-0518KSKL 1271134802060006 CHINTA AZZAHRA, AM P REMAJA 14 : LING 7 P
59 P-UXTZ1YK1 1271134802090001 BUNGA GRESIA PANGAR P REMAJA 12 : LING 17 K
60 P-XH8CQBT2 1271085008080001 MARLINA BR TAMPUBOL P REMAJA 12 : LING 17 S
61 P-XHBO82JO 1271132503090007 ARIF HERZA L REMAJA 12 : JL. KAIL LK
62 P-XIW3GTCL 1271136108070004 ANASTASIA CORENTY G P REMAJA 14 : LK. 28 PE
63 P-XJ5EUOUN 1207245307070001 HAIRUN NISA P REMAJA 14 : DUSUN IV
64 P-XIIZOBNX 1271131603090004 MARVEL NAINGGOLAN L REMAJA 12 : ling 8 sei ma
65 P-XIKNT0JB 1271134804070002 MELANIE SYAHPUTRI P REMAJA 14 : JL. KAMBES
66 P-XJHJHSBF 1271136412070004 LAURA NATALIA BR MA P REMAJA 13 : JL. PASAR
67 P-WYC9BTBO 1271132806080002 MUSYAFFA AHMAD NAUF L REMAJA 13 : ling16 sei m
68 P-XJXT282K 1271136601070004 ROSMINI SIALLAGAN P REMAJA 14 : JL. JARING
69 P-XJKYDIVL 1271086706070001 DINDA ZAHARA P REMAJA 14 : GG. MUSH
70 P-XK8WDRP4 1271136508090005 CINTA GRECIA SITORUS P REMAJA 12 : LK. XIV SE
71 P-XKFFSFV3 1271134908080002 TANIA ALEXANDRA TAM P REMAJA 13 : LK. XIV SE
72 P-XKJI5G0L 1271135501080001 NOVAULI BR TAMBUNAN P REMAJA 13 : LK. IX LOR
73 P-XKW8FTU3 1271082501090001 MHD FATIH ANANDA P REMAJA 12 : LK. VIII B
74 P-XL0BCP9J 1271137010090004 NAZWA NURKHAILA P REMAJA 12 : LK. IX SEI
75 P-XLDO0HSN 1271135207090002 NASYA SYAHIRA P REMAJA 12 : LK. XXIV
76 P-XLMNFAGH 1271135009090002 ALMIRA IRTAMI P REMAJA 12 : JL. BAKT
77 P-XLVHQ2U6 1271136409090003 JESSICA ANASTASYA L P REMAJA 12 : JL. ILYAS L
78 P-XLZGK8A6 1271130303060003 SARWHEDI BANJARNAH L REMAJA 14 : JL. JARIN
79 P-XMROXGCA 1405026211080004 KEYLA NABILA P REMAJA 12 : JL. DATUK
80 P-XMLY9KDN 1271134708080002 NAZIRA ALYA SYAFHA P REMAJA 13 : JL. PANCI
81 P-XMP2F4GS 1271132707090001 MUHAMMAD WISNU WAH L REMAJA 12 : LK. V PAY
82 P-XN199NIH 1271136006090005 INAYAH P REMAJA 12 : LK. II SEI
83 P-XN6O8X36 1271136705070002 MEILAN NAULI SITORUS P REMAJA 14 : LK. XIV SE
84 P-XNBD34NU 1271135711080003 NAZWA ANISAH P REMAJA 13 : LK. XVII SE
85 P-XNZOKNFK 1271130608070001 GABRIEL PANDAPOTAN L REMAJA 14 : JL. RAWE
86 P-XNWG96VB 1271134603090002 FINA TAMINA P REMAJA 12 : JL. KAMBES
87 P-XNSZ2NR0 1271134710080002 ADELIA EFENDI P REMAJA 13 : LK. XVII SE
88 P-XO5OVAV0 1271134601080003 JELITA FRIEDEN BR SIR P REMAJA 13 : LR. PARDO
89 P-XOD1BSAF 1271136811070004 MOZA FRISKILA PURBA P REMAJA 15 : LK. 28 PE
90 P-XOJLQMS9 1271132610070005 LAM KRISTIAN SAHPUTR L REMAJA 15 : JL. JARIN
91 P-XORIB5PQ 1271136307070005 GRESIA ELISABET PASA P REMAJA 14 : LING 28
92 P-XP207XT8 1271131707070002 ISABEL SELMITA HUTAP P REMAJA 14 : JL. PAJAK
93 P-XPBZNNNM 1271136601090005 RIRIN ANJANI P REMAJA 12 : JL. KAMBE
94 P-XPFFQL5A 1271135707080003 CHELSEA YULIANI MAR P REMAJA 13 : LK. I BAHA
95 P-XPISE6RC 1209115404080003 ANDINI P REMAJA 13 : JL. KAMBES
96 P-XPKZ6M39 1471116311080001 TERESYA FEBRYANTI S P REMAJA 12 JL. PULAU B
97 P-XPQI5RTT 1271134510070004 CHRISMANTI DELITA HU P REMAJA 13 : SISI REL P
98 P-XPYMXKF8 1271134401090004 MENTARI MARPAUNG P REMAJA 12 : JL. KL. YO
99 P-XQ5PWXOU 1271085510080007 KAYLA PRISILLA PUTRI P REMAJA 13 : JL. CIMAHI
100 P-XQ98GPMK 1271131010070003 MARTIN CRISTIAN MAR L REMAJA 14 : KP. KOLAM
101 P-XQBO3TK4 1271085006070001 RETNO ADHINA LARASAT P REMAJA 14 : LK. VIII N
102 P-XQDTOIPG 1271132503070002 MAULANA HAIKAL L REMAJA 14 : LK. XIV B
103 P-XQGAPGNC 1271085707070003 PUTRI AMELIA SIMANJU P REMAJA 14 : LK. XIV B
104 P-XQJPOYLV 1271131309060002 DIMAS SURYADI SIMAT L REMAJA 15 : LK. 28 PE
105 P-XQLQAHNH 1271131004070006 FERDY ARDIANSYAH L REMAJA 14 : JL. P. BE
106 P-XQOCVTND 1271135911070002 SALMA ULIMA BAHY P REMAJA 14 : LK. XII SEI
107 P-XQSRZCCQ 1271133110070002 HARIS KURNIAWAN L REMAJA 14 : JL. ANGGR
108 P-XQVXVM4O 1271131909070001 CHANDRA KARUNIA NAB L REMAJA 14 : JL. KAMBE
109 P-XQZVAYS7 1271132701070006 WAHYU KHALIK L REMAJA 14 : LK. 24 PE
110 P-XR24I5UJ 1271131105070003 JONATHAN SIHALOHO L REMAJA 14 : JL. STASIU
111 P-XR4Y0LVA 1271132212070005 M. FAHRI IRSAN L REMAJA 14 : LK. XVII SE
112 P-XRA5XGDB 1271136612070001 DESY ANATASYA P REMAJA 13 : LK. VI LOR
113 P-XRCBDPZ5 2171116201080008 AGNES ELDAP KRISTIA P REMAJA 13 : JL. M. BA
114 P-XRE0XIBI 1271134607070002 SALSA DILA RAHMAYANI P REMAJA 14 : JL. KAMBES
115 P-XRFIPGNW 1271135206080007 XANIA AZULA P REMAJA 13 : JL. ASAM
116 P-XRJ740BP 1271132709070001 RAHMADIAN L REMAJA 14 : LK. XII SEI
117 P-XRKRDPQG 1271131110060002 FERNANDO LIMBONG L REMAJA 15 : JL. BAKTI A
118 P-XRMRRJZP 1271135611070001 NUR FATIHA ATIRA PAN P REMAJA 14 : LK. IV DE
119 P-XROEORGB 1271085302070002 ULINA FEBRYLINDA DAM P REMAJA 14 : JL. JAKSA L
120 P-XRQTNPIO 1271134908070005 DHEA PUTRI ANGGRAINI P REMAJA 14 : JL. TELUK
121 P-XRSJVDZ9 1271122409090008 MUHAMMAD SOFYAN MA L REMAJA 12 : LK. 30 RE
122 P-XRVFQZAN 1271086108070009 RIZKIYA SYABANI L REMAJA 14 : LOR. STAS
123 P-XRXMOJBS 1271082412070001 FACHRI NAUFAL R PANJ L REMAJA 14 : JL. M. BAS
124 P-XS18PPR6 1271131405070003 AMAR TOYIBI L REMAJA 14 : P. RAMBAI
125 P-XS43IOVS 1271082308070001 MUHAMMAD B ARMANSY L REMAJA 14 : JL. TM. P
126 P-XSE0OEMS 1271061808070004 MUHAMMAD RAFIQI L REMAJA 14 : JL. KL. Y
127 P-XSCAOOV7 1271131007070002 AHMAD DEZAN KHUSAIR L REMAJA 14 : JL. KL. YO
128 P-XSAZEEAZ 1219043011070003 IMRAN AL WAFI UMRI L REMAJA 14 : JL. TELUK
129 P-XTQXZVCK 1271132802070005 RUSDI AFANDI LUBIS L REMAJA 15 : JL KAMBE
130 P-XTORE0GK 1271080505070002 ABDILAH L REMAJA 15 : JL TM PA
131 P-XTLKWGJQ 1271136902080003 FEBI OLIVIA BR HUTAPE P REMAJA 13 : LING VIII
132 P-XU2L4AQT 1271081705050005 RASYA FADIL L REMAJA 15 : LOR. PAN
133 P-XU5R9TPU 1271130205060002 RAFLES HARIANJA L REMAJA 15 : JL. KANTO
134 P-XU8Y6UB6 1271132612070002 MUHAMMAD NUR AZIZI L REMAJA 14 : JL. PANCIN
135 P-XUAV74P1 1271135307070002 MASIH DAYU P REMAJA 13 : KP. KELUAR
136 P-XUCCG3AK 1271132009060006 GILANG RAMADHAN L REMAJA 15 : LK. 29 PE
137 P-XUDVDPL1 1271135906090002 MAYLINA MENTARI PUR P REMAJA 12 : LK. 28 PE
138 P-XUF1UKCI 1271045508080002 ZAHRA GHASSANI SIRE P REMAJA 13 : JL. KL YO
139 P-XUGAM23P 1271066812060001 RIZA CHAIRUNNISA P REMAJA 14 : JL. KL. Y
140 P-XUHWED7V 1271134808070001 NAZLA PAZIRA P REMAJA 14 : GG. RAJA
141 P-XUJC24TZ 1271135703070004 NAILA FADILA P REMAJA 14 LINGKUNGAN
142 P-XUKH3YDM 1207244911070008 DINDA NOVITASARI P REMAJA 14 : KOMP. PE
143 P-XTLAKIOR 1271085407090004 KANAYA TABITHA MARP P REMAJA 12 : Jl Kakap Li
144 P-XUS8TPUE 1211024206080001 MEGA CLESSYA SINAGA P REMAJA 13 : DUSUN I
145 P-XUVQ133K 1271085304070001 ADE TASYA P REMAJA 14 : LING 1 M
146 P-XUXISUCW 1271131205060002 BILLY TAMPUBOLON L REMAJA 15 : LK. XIII SE
147 P-XUUFZKVP 1271134608070002 KEZIA NAOMI SIMANJUN P REMAJA 14 : LK. XVI SE
148 P-XUVQU3TA 1271136312070004 LAURA NATALIA BR NAB P REMAJA 14 LIGKUNGAN
149 P-XUYU05RM 1506016209070002 PUTRI RAMADHANI P REMAJA 14 : KELAGIAN
150 P-XV14B34B 1271125807080007 TIA ARMANDA P REMAJA 13 : LK. 31 M
151 P-XV41I04W 1271135805080002 MARYANI P REMAJA 14 : KOMP. PT.
152 P-XV7LOOMP 1271135906090002 NAZWA UMAIROH P REMAJA 14 : LK. 28 PE
153 P-XV9CIHCO 1271136910080002 SYAFIRA AZZAHRA P REMAJA 14 : JL. ASAM
154 P-XVBDAAEZ 1271130703080003 DIAN PERIMA DAMANIK L REMAJA 14 : LK. III SEI
155 P-XVCGGU5H 1271132610070002 M ALIF SAPUTRA L REMAJA 13 : LK. I BAH
156 P-XVDKVHYN 1271131104080002 M YASIR ALIF ALQATANI L REMAJA 13 JL. KL. YOS
157 P-XVESTHBL 1271132011080001 PATUDU AUREL CHRIST L REMAJA 13 LINGKUNGAN
158 P-XVFWQKLL 1271134712070004 MERRY KRISTINA BR S P REMAJA 13 : JL. P. BAN
159 P-XVGYX6UL 1271080402070002 CRISTIAN RONALDO HU L REMAJA 14 : JL. SUMAT
160 P-XVI2U506 1271131105070004 VERI PURBA L REMAJA 14 : LK. XIV SE
161 P-XVJ5GIA7 1271131107070002 YESSAN FIRMAN B SIT L REMAJA 14 : JL. KAMBES
162 P-XVK7MZZN 1271081502070002 PATUAN FELIX TAMPUB L REMAJA 14 : JL. PULAU
163 P-XVL82ZAT 1271132710050002 GABRIEL SINAGA L REMAJA 16 : JL. KANTO
164 P-XVMBOVGR 1271136706070001 DWI ALDAMA ADNAN P REMAJA 14 : DESA BAH
165 P-XVNFJOBN 1271131708070004 SAMUEL NAINGGOLAN L REMAJA 14 : LOR. 7 LK.
166 P-XVOKF9QJ 1271130707070005 PASYA WIBOWO L REMAJA 14 : JL. RAWE
167 P-XVR0JZ0G 1218165909050001 TRIA AMANDA P REMAJA 16 : DUSUN IV
168 P-XVYHH6V6 1471061506060027 ANDREAS FIRMANSYAH L REMAJA 15 : JL. KL. Y
169 P-XVPIRPJB 1205042112080003 RIZKY ZUANDA L REMAJA 12 : JL. ASAM
170 P-XQMTOWCU 1271135801080002 JOICE MENTARI BR NAI P REMAJA 13 : Jl Jaring U
171 P-XVSEPK2V 1271083009060003 DAVID MORALES BUTAR L REMAJA 15 : KOMP. PE
172 P-XR1M2ILQ 1271126707060004 LINDA WIDIANTO P REMAJA 15 : Jl. Ileng Lr
173 P-XVVG3K35 1271133012060001 MUHAMMAD GALIH EFFE L REMAJA 15 : JL. KL YO
174 P-XSQDC62F 1271081510060006 MOH SAHRI L REMAJA 15 : Lor. Sedar
175 P-XVWR5BQT 1220080510070004 RENALDYSAMUEL SAPUT L REMAJA 14 : BH I DES
176 P-XW1K994Q 1271087004080005 WULAN AFRILIA P REMAJA 13 : BLOK 17 LK
177 P-XW3MJWVW 1271084111070009 NOVI EVRYANTI PRATIWI P REMAJA 14 : JL. BENGK
178 P-XWBSB7RL 1271084701070002 KESYA ZAHRINA P REMAJA 14 : JL. BELAN
179 P-XSSWZJEB 1271085510060005 HARIDA ;P REMAJA 14 : Lor Sedar
180 P-XWMBQVBY 1271130201080002 BASILIUS RISKY SITORU L REMAJA 13 : LR. PARDA
181 P-XWLCHALT 1271131011070007 ANDIKA SITORUS L REMAJA 14 : LK. XV SEI
182 P-XWK5ODFZ 1223010605090007 JOSUA SITOHANG L REMAJA 12 : JL. KAMBES
183 P-XWIV8GKN 1271082507060002 HAFIZ AL AZRI L REMAJA 15 : JL. BENGK
184 P-XWHX9RP2 1271132710070003 NABAWI FADILAH AZWY L REMAJA 14 : SERUWAI LK
185 P-XWGSUXZK 1271124807090002 ALMIRA AURELIA P REMAJA 12 : JL. YP. H
186 P-XWQ59HY3 1271130811050006 ELIESER FRIEDRICH PU L REMAJA 16 : JL. P. BA
187 P-XM9SNZPM 1271080701080001 ROBBIT SYARIQ SUFRIA L REMAJA 13 : JL. BAKTI
188 P-XS6HOWTZ 1271082607070006 DONI ALFARIZI L REMAJA 14 LOR. PISANG
189 P-XS8PWKXT 1271136608070001 SAHARA AZLYA EL FITRA P REMAJA 14 : KAMBES LK
190 127113607080005 AYU ANASTASYA P REMAJA 13 JL. KAMBES
191 127106650807002 NELLY AGUSTIN SIHITE P REMAJA 15 LOR. V JL.
192 1271136706070002 CHELSEA RAMA ANGGRA P REMAJA 14 Gg,. SEKOL
193 1403134204050004 ANGGUN MUARA MANU P REMAJA 12 LINGK. XVII
194 1271134409980007 SUCI RAHMADANI P REMAJA 13 JL. PANCING
195 2171100512080004 MUHAMMAD FASYA BAH L REMAJA 12 TAMAN RAYA
196 1271134806680003 ZAHRA SYAHPUTRI P REMAJA 12 LINGKUNGAN
197 3273300209050003 SAMUEL ALBERT HALAS L REMAJA 15 LINGKUNGAN
198 1271134408060004 AFINA AQNIA P REMAJA 15 LINGKUNGAN
199 MARIA ELSADY P REMAJA 13 LINGKUNGAN
200 Z-000A02SP 1271135108760003 FRETTY SITORUS P B 45 LINGKUNGAN
Keterangan
D : Lainnya
E : Tidak Bekerja
Kelompok Umur
18-30
31-45
46-59
Total
Pekerjaan
A
B
C
mat Pencatatan Pelayanan Vaksinasi COVID-19 di Tingkat Fasyankes
MAT PENCATATAN PELAYANAN VAKSINASI COVID-19

INGKAT PUSKESMAS/FASYANKES/POS VAKSINASI
LABUHAN

BPJS PBI
PBI Anggota
SIDORAME BARAT - II MEDAN PERJUANGAN 085359104869 CORONA VAC
SEI MATI MEDAN LABUHAN 088262631497 CORONA VAC

TITIPAPAN MEDAN DELI 083191239145 CORONA VAC

BELAWAN - II MEDAN BELAWAN 081260834729 CORONA VAC

BELAWAN BAHARI MEDAN BELAWAN 082370349104 CORONA VAC

TJ. MULIA HILIR MEDAN DELI 082391767896 CORONA VAC

BAGAN DELI MEDAN BELAWAN 081218216100 CORONA VAC

RENGAS PULAU MEDAN LABUHAN 081370795707 CORONA VAC

NELAYAN INDAH MEDAN LABUHAN 082286648828 CORONA VAC
SEI BAHARU HAMPARAN PERAK 081219369952 CORONA VAC
TANGKAHAN MEDAN LABUHAN 082168966629 CORONA VAC
BELAWAN BAHAGIA MEDAN BELAWAN 085362006266 CORONA VAC
NELAYAN INDAH MEDAN LABUHAN 082277324246 CORONA VAC
BELAWAN - I MEDAN BELAWAN 081260060500 CORONA VAC
TJ. MULIA MEDAN DELI 087867083037 CORONA VAC
TITPAPAN MEDAN DELI 081377489463 CORONA VAC
TJ. BERINGIN SUMBUL 085260281631 CORONA VAC
KELAGIAN TEBING TENGGI 081375701985 CORONA VAC
BELAWAN II MEDAN BELAWAN 085266537717 CORONA VAC
TANGKAHAN MEDAN LABUHAN 082165084443 CORONA VAC
PENGGALIAN TEBING SYAHBANDAR 085276166498 CORONA VAC
AEK BARU SIMANGAMBAT 085260839914 CORONA VAC
BELAWAN SICANANG MEDAN BELAWAN 089530640900 CORONA VAC
TITIAN ANTUI PINGGIR 085361681548 CORONA VAC
BELIAN BATAM KOTA 088261136055 CORONA VAC
SEI MATI MEDAN LABUHAN CORONA VAC
SEI MATI MEDAN LABUHAN 081376464804 v CORONA VAC
Merek Vaksin
A : Sinovac
B : Lainnya (Mohon Disebutkan Jenis Vaksin Yang Diterima Puskesmas/Fask
Kepersertaan BPJS
BPJS PBI
BPJS Non PBI
Non Anggota
Total
Pemberian Dosis
Dosis 1
Dosis 2
Total
Dosis I Dosis 2
Tanggal Tanggal Tanggal KETERANGAN
Screening Pemberian No.Batch Pemberia No.Batch
Vaksin n Vaksin
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2

9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 2020852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2

9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2

9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2

9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2

9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2

9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2

9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 9/28/2021 20210852G - - LANJUT VAKSIN 2
9/28/2021 - - 9/28/2021 20210852G SELESAI
ksin Yang Diterima Puskesmas/Faskes)

JS
Tabel 10. Format Pencatatan Pelayanan Vaksinasi C
FORMAT PENCATATAN PELAYANAN V

TINGKAT PUSKESMAS/FASYANKE

Nama Umur
No No.Registra NIK Penerima JK Pekerjaan Kel. Umur Alamat Kelurahan
Vaksin (> 60Tahun)
1 1271135901090002
Q-000OV7EW DEBBY KAYL P REMAJA 12 JLN ASAM NOMartubung
2 1271195411670002
Z-000A0OAU Merta Asni S P RENTAN 53 JL. Tinta Me Sei Putih Tengah
3 1207264802880013
Q-000RULQM HERLINA L P UMUM 33 DESA CINTACinta Damai
4 1271185709630001
Q-000RX35C MELPHI PAR P RENTAN 57 : Asrma Ex kSidorame Barat
5 1271186610970002
Q-000RX327 SANTA SOPH P UMUM 23 : Asrama KoSidorame Barat
6 1271184709030004
Q-000RXAOT YOHANA SE P UMUM 18 : Asrama ex Tanah
k Enam Ratus
7 1271184506000004
Q-000RXAQC YUNITA SRI P UMUM 21 : asr. ex kowiSidorame Barat
8 1271196902960002
Q-000RXASG RUTH FEBRI P UMUM 24 : jln periuk S
n ei Putih Tengah
9 1271044607600001
Z-000A1GEH REMINTA T P LANSIA 60 : JL.RAYA Binjai
10 1271060410860006
Q-000RXIFD JEPRI SIANT L B 34 : lingk 17 sei Sei Mati
11 1271135910800003
Q-000RXI8N SUSILAWATI P UMUM 40 : SEI.MATI Sei Mati
12 1271046307840001
Q-000RXIFO JULIA NINGS P B 37 : Lingk 18 k Sei Mati
13 1271134811700003
Q-000RXP8B ASNIWATI P B 49 : JLN.PAYA Martubung
14 1271136510900001
Q-000RXPIQ BASANOVA P UMUM 30 : LK I KAMP Martubung
15 1271081508020002
Q-000RXPG9 MAJID ALWI L UMUM 19 : LINGK 18 Sei Mati
16 1271125204920002
Q-000RXUR5 FITRIYANI P UMUM 29 : JLN.PAYA Martubung
17 1271041702950001
Q-000RXUXM ALBERT PE L UMUM 26 : JLN RAYA Binjai
18 1271134511720001
Q-000RXZQB DEMSIWATI P B 48 : LINGK 14 S Sei Mati
19 1271134107700013
Q-000RXZV1 MARISA R D P B 50 : LIK.VIII S. Sei Mati
20 1271045512060001
Q-000RY5Z3 DESY RISTA P REMAJA 14 : JLN.RAYA Binjai
21 1271134511860004
Q-000RY5PX SANIMAH P B 34 : LINGK V Martubung
22 1271136110940004
Q-000RY5RZ JULIANA BR P UMUM 27 : JLN.KAMBE Martubung
23 1271130807950005
Q-000RY5U3 BENI DARIA L UMUM 26 : LINGK IV Martubung
24 1271135608750001
Q-000RY5UP SAHARAH BR L B 46 : LIK.III Martubung
25 1271135202640004
Q-000RYANL ROHANA P RENTAN 57 : JLN SISI Martubung
26 1271136401000003
Q-000RYAOL ICHA RIA A P UMUM 21 : SEI.MATI Sei Mati
27 1271132705690003
Q-000RYAU2 MANGASI MA L B 52 : LINGK VIII Martubung
28 1271136807690003
Q-000RYAUB NURHAYATI P B 52 : LIK.VII SEI Martubung
29 1271134104720008
Q-000RYFIY LAILAN SAF P B 49 : GG.FAMIL Martubung
30 1271130304760005
Z-000A1OLW TENGKU MA L B 45 : P.RAMBAI Martubung
31 1271086603800003
Q-000RYKHA ARTAIDA SI P B 41 : JL PULAUBelawan Bahari
32 Q-000RYO20
1271130108020007
IMMANUEL G L UMUM 19 : LIK.01 B Martubung
33 1209191905740004
Q-000RYO2Y PARULIAN M L B 47 : JL JERMAL Sei Mati
34 1271135211040001
Q-000RYO3M YESARI SIL P REMAJA 17 : LIK.XVI SE Sei Mati
35 1271131104010004
Q-000RYSU6 MUHAMMAD L UMUM 21 : GG. AMAL Martubung
36 1271136609790002
Q-000RYSTQ IDA ROHANI P B 42 : LK IV MA Martubung
37 1271134904020002
Q-000RYSUP RATIH P UMUM 19 : JLN. PAY Martubung
38 1271135611030004
Q-000RZ0PT ULFI RAMAD L UMUM 18 : JLN.ASAM Martubung
39 1271134606950002
Q-000RZ0Q6 NANDA GINA P UMUM 26 : LK V SEI M Sei Mati
40 1271084811750001
Q-000RZ0QI SUFFRIDA Y P B 45 : JLN.PAYA Martubung
41 1271131706840006
Q-000RZ4FD HAMDAN L B 37 : LINGK I BA Martubung
42 1271131612750003
Q-000RZ4FV EDI SOFIAN L B 45 : JLN.MESJI Martubung
43 1216066609830002
Q-000RZ4GY ROY SANNI P B 38 LIK.XV SEI Lk. XV Sei Mati
44 1271134102870001
Q-000RZ804 TAYAMI P B 34 : JLN. ASAMLk. VII Martubung
45 1271132106810007
Q-000RZ7ZV RAHMADAN L B 39 JLN.ASAM L Martubung
46 1271132507010001
Q-000RZB95 ADAM RAFLY L UMUM 20 JLN.KAIL SEI Sei Mati
47 1271120310030001
K-0000XE0Z RIFKY JUAN L REMAJA 17 LIK.II MAR Rengas Pulau
48 1271122806840001
K-0000XE7E TATANG AN L B 37 JL MARELAN Martubung
49 1271134809840001
Z-000A1SOL RATNA JUI P B 37 LINGK X SEI Sei Mati
50 1271134208560001
Z-000A1SYW ROSLINA H P LANSIA 65 LINGK X SEI Sei Mati
51 1271137112750009
Q-000RZHUB RUSMIATI P B 45 LIK.VA SEI. Sei Mati
52 1271135207780006
Q-000RZHUJ YULIAH DA P B 43 LK III SEI MA Sei Mati
53 1271065208890002
Z-000A1TGN ROSLIANA S P B 32 PASAR 01Tanah
R Enam Ratus
54 1271135108910001
Q-000RZHUU VERONIKA P UMUM 30 LK XV SEI M Sei Mati
55 1271064903970001
Q-000RZLZI NURJANA S P UMUM 24 JLN.MANGAA Mabar
56 1271130103850004
Q-000HSVF5 ANTON SIM L B 35 LINGK XVI S Sei Mati
57 1271130711820002
Q-000RZLQC JONNI BATU L B 39 JLN.KANTORMartubung
58 1271134412790002
Q-000RZLXF MAISARAH P B 42 JLN YOS SU Martubung
59 Q-000BZVGP
1271136805930002
HALIMATUS P UMUM 28 JL KAIL LIN Sei Mati
60 1271130811650001
Q-000RZP0S ZAINAL EFF L RENTAN 56 JLN.KAIL LI Sei Mati
61 1271135308950001
Q-000RZP1C ZARKA ANNI L B 26 JL AMAL NO Martubung
62 1271136209610002
Q-000RZP3E MAHNIAR P RENTAN 59 : LIK.02 M Martubung
63 1211073012950001
Q-000RZP9V YOSAFAT JE L B 26 : LINGK IX S Sei Mati
64 1271092503030002
P-XKCHSPC3 RONAL FER P UMUM 18 LK V PAYA Martubung
65 1205086309940004
Q-000RI88M SANTIKA BR P B 27 gohor lama Gohor Lama
66 1271186305910002
Q-000RZVPY MEILINDA F P UMUM 30 : JLN.BAKTI Tegal Rejo
67 1271022203880002
Q-00033XEJ AMIN SABILA L B 33 JL DR Padang
MANS Bulan Selayang I
68 1271132610850002
Q-000RZVT4 WAHYUDI G L B 36 : JLN.AMAL Martubung
69 1271134404870001
Q-000I0311 KRISTINA FR P B 35 pajak rambai lMartubung
70 1271133108700001
Q-000RZVV8 SYAHRUL L B 51 : JLN AMAL Martubung
71 1271134809640002
Q-000RZVYY RIZA HASMI P RENTAN 57 : JLN.AMAL Martubung
72 1271135407030004
Q-000OWC9K VIVI AUDYA P UMUM 18 JL.ASAM NO Martubung
73 1271135205720001
Q-000RZZBM RINA HASPI P B 49 : JLN.AMAL Martubung
74 1271135202700001
Q-000RZZFW RITA HASMI P B 51 : JLN. AMAL Martubung
75 1271136610750005
Q-000RZZJO SERI UTAMI P B 45 : LK IV MA Martubung
76 1271096605810003
Z-000A1VGZ DINA MARIA P B 40 : SUDAH DIB Sei Mati
77 1271132806940003
Q-000S0201 HARTONO L UMUM 27 : LK VII MA Martubung
78 1271130611850003
Q-000S02D9 EDI EKO SU L B 35 : JLN.BAKTI AMartubung
79 1271135303570001
Z-000A1VYQ SUMIATI AR P LANSIA 64 : LK VII SEI Sei Mati
80 1204235703900001
Q-000S02F4 MARLINA W P B 31 : JLN.SLEB Belawan
81 1271135911970003
Q-000S05GL CLARA NUR P UMUM 24 : LK XIV SEI Sei Mati
82 1271134209750002
Q-000S05FW PARIDA SIA P B 46 : LIK.XIV L Sei Mati
83 1271130912020001
Q-000S05EU ANDREAS SY L UMUM 19 : LINGK XIV Sei Mati
84 1271136802950001
Q-000S07NV PUTRINA FE P UMUM 26 : JLN YOS Martubung
85 1271134710020003
Q-000S07RJ TRI HARTAT P UMUM 19 : JLN.BAKT Martubung
86 1271131410970001
Q-000S07SA RIAN FANI L UMUM 23 : JLN TELU Martubung
87 1271134705660001
Q-000S07TS NURSITA B P RENTAN 55 : JLN TELU Martubung
88 1271130708900001
Q-000S0AD2 RYAN PACH L B 31 : JLN.AMAL Martubung
89 1271135505910003
Q-000S0AG9 INDA HERWI P B 30 : LK III BAT Sei Mati
90 1271131103990001
Q-000S0AIP IROY NASUT L UMUM 22 : LIK.XVII SE Sei Mati
91 1271135406940004
Q-000S0AJD DINI MARYA L UMUM 27 : JLN ASAM Martubung
92 1271135602670002
Q-000S0AJD DOHARNY D P B 54 : JLN. AMAL Martubung
93 1271131902660001
Q-000S0CNB IRSAN YAS L RENTAN 55 : JLN.AMAL Martubung
94 1271135209800006
Q-000S0EZF ROULINA B P B 40 : JLN PLATI Titi Papan
95 1271132011760001
Q-000S0F0B SUWARDIH S L B 43 : JLN.PLATI Titi Papan
96 1271131312060002
Q-000OU1KM YOGA MAUL L REMAJA 15 JALAN ASAMMartubung
97 1271130606590001
Z-000A1QJW SUBONO L LANSIA 62 : LK III BAT Sei Mati
98 1207041601860002
Q-000A3WUF RAJES TARI L B 35 LK XVII SE Sei Mati
99 271136712710004
Q-000I0F5F UDUR NAIN L B 49 PAJAK RAMBA Martubung
100 1276012105770001
Q-000RA7XC LUHUT SIAH L B 45 JL ILYAS L Rengas Pulau
101 1271130708760005
P-GXJEZP3O BENNI PASA L B 47 JL PASAR LPekan Labuhan
102 1271131004010001
P-J1FZW0YI ILHAM ALFA L B 20 LK III KEL. Martubung
103 1271136601970004
P-RXJFVQ1T TRIA RAMAD P B 24 JLN NAHODAMartubung
104 1271084507050002
P-XVA65HXX GEMPITA TE P REMAJA 16 LK XIII BEBelawan Sicanang
105 1271136809810004
P-48Y78BBW JENNY SHIN P UMUM 40 JLN H. PER Martubung
106 0250081205550002
M. SIMANJU L LANSIA 66 JL. HAMPARAMartubung
107 P-XWOYBA7T1407061507950004
HARTONO L B 26 JLN P. INPR Martubung
108 P-XTTXPXWD1271021607710001
LEONARD H L B 50 JL. SEI AS Tanjung Rejo
109 1271135505010002
P-XVH8COSI WARDAH AU P UMUM 20 LK I BAHARI Martubung
110 1271131705980003
P-XVKTUBAP ARIFIN FAD L B 23 LK I BAHARI Martubung
111 1271064609960003
P-XVQTVZH9 DEWI INDAS P UMUM 25 JL. R. POT Mabar
112 1271063105990001
P-XVSN91OJ ANDRI PRA L B 22 JL YOS SUDTanjung Mulia
113 P-XVUBQSY41271132507990003
M. ARDI SA L UMUM 22 LK I BAHARI Martubung
114 P-XVMHDJCX1407054802040009
VELLIN LOV P REMAJA 17 LK II PEKA Pekan Labuhan
115 1271134906030004
P-XUZJI8HN INTAN NUR'A P B 18 LK II BLOK Nelayan Indah
116 1207030212850001
P-XV4YLTG6 ERIK NUGR L B 35 JLN BESAR Martubung
117 1271136006830003
P-6K7K7XY6 LINA PURNA P UMUM 39 LK VI REL P Martubung
118 P-XW5OELQZ1271095103690003
PDT RIANA P B 51 JLN GEREJA Harjosari II
119 P-XUXTOCCN1271131004960007
WENDY APR L B 25 JLN ASAM L Martubung
120 1271134709030006
P-XVX1KIOV SABILA HUS P B 18 LK III KP Martubung
121 1271134201780002
P-XW1I9T1B FARIDAH P B 43 LK III KP Martubung
122 1209265110000001
P-XVZCVDS1 SARI AYU M P UMUM 21 DSN I JL. P Helvetia
123 P-XW3CF94M1271134101710004
TIURMA PA P B 50 JLN YOS SU Martubung
124 P-XWAD20UB1801235208850001
KARNI P UMUM 36 JLN H. PER Martubung
125 P-XWBPPEG51271136506790002
TUGINI P UMUM 42 JL. KAMBES Martubung
126 1271135908890010
P-XWF1H45 NURLAILA P UMUM 32 LK X SEI MA Sei Mati
127 P-XWLEQ55C1271205105790002
MAITIKA RIN P UMUM 42 JL ABD SAN Terjun
128 P-XWMXQKCO1271185803610001
SITI RAYA P LANSIA 60 JL DURIANSidorame Barat I
129 1271135305700001
P-XWHSVA5Q RAMLAH P B 51 PAJAK RAMBMartubung
130 1271080404040003
P-XR6UUJ9K FAHROZI L REMAJA 17 JLN Y. P. H Labuhan Deli
131 1271130507810005
P-XUHBONLI JULI HARYA L B 40 LK V PAYA Martubung
132 1271134607660001
P-XUIUEL3Q LILI ANGGR P RENTAN 55 JL. YOS SU Martubung
133 1271130711910001
P-XUK7QBSJ ARDHAN GU L UMUM 29 JL. YOS SU Martubung
134 1271136009900001
P-XULO4UGU SRI AYU AN P UMUM 30 LK 13 PEKAPekan Labuhan
135 1207234909720007
P-XURHDCOQ HABIBAH P UMUM 49 JL YOS SUDAMartubung
136 1207231003930003
P-XUTF4V3P RAMADHANI L B 28 LK II MART Martubung
137 1271132008840003
P-XUCIZPLF RODI/KOK S L B 37 JLN PAYA D Martubung
138 1271135006940005
P-XUOPRMA5 ARY ANGGRA P UMUM 27 JL KAMBES LMartubung
139 1271134205890002
P-XU4WNRML MILA REZEK P UMUM 32 JL. PAYA B Martubung
140 1271132508020001
P-XUW4U127 ACHMAD AR L B 19 LK II MART Martubung
141 1271082912720003
P-XU6XHTK7 MUHAMMAD L B 48 JL BAKTI A Martubung
142 1271084506770005
P-XU1C8BDQ JULITAWATI P B 43 JLN BAKTI Martubung
143 1271134610700005
P-XTYHCC2V DORMINE SI P RENTAN 51 SISI REL PJKMartubung
144 1271066704810001
P-XTJORCB1 NURMAYANI P UMUM 38 JL KAMBES LMartubung
145 1271135810660001
P-XOVAW11K ROHANI MA P UMUM 46 LK IV MART Martubung
146 1271136508030002
P-XTAWGBWU LAMTIAR D P UMUM 18 JL. Kantor Martubung
147 1271132812940006
P-XTDDZBBW ERWIN NAB L B 27 LK VI SISI Martubung
148 1271131308050001
P-XTFTGXKO PRANATA L L REMAJA 16 PINGGIR RE Martubung
149 1271136601850004
P-XTI2HCGR ROSMAIDA S P B 36 PINGGIR RE Martubung
150 1271132909950004
P-XVDETDZX HERYANTO S L UMUM 26 JLN KAMBES Martubung
151 1271025706440002
S-DA370CE4 MAWAR SIR P LANSIA 77 JL SEI ASA Merdeka
152 1271185001970002
P-XTOMCRYN TITA KRIST P UMUM 24 JL FLAMBOY Tanjung Selamat
153 1271184806990002
P-XTWASHE6 SHINTA BEL P UMUM 22 JL. FLAMBO Tanjung Selamat
154 1271135908800005
P-XM62BZ3H JULI SIMBO P B 41 P. RAMBE L Martubung
155 1271133105980002
P-XMOACA7O : RIKI PRAT L B 24 LK II SEI MA Sei Mati
156 1271125709010003 P UMUM 20 Jl. Young PaLabuhan Deli
J-0003CL54 RIZKA HAFI
157 1271132311000003
J-00045A71 MHD HAIQAL L B 20 Jl Pancing 1 Besar
158 1271135008030003
P-XN0FZPMP NADHIRA KH P UMUM 18 JLN MESJID Martubung
159 2171060306899003
P-PPEWUMV4 JUAN CARLO L B 32 JL RAWE LK Tangkahan
1222030909930005
160 P-XL4UTDQN RAHMAD L B 28 JL YOS SUD Martubung
1308161010020002
161 P-XO5EXEWX WAHYU PRA L UMUM 29 JLN ASAM L Martubung
1271126109020004
162 J-000427SN CINDI FATIK P UMUM 19 jalan MarelanRengas Pulau
1223025508950001
163 P-XNGVXSD0 H. AGUSTIN P UMUM 26 JLN YOS SU Martubung
1208190405910001
164 P-XNKK0QSG JUL AFDI L B 30 JL BAKTI AB Martubung
165 1207263006010008
P-XNQ5AKG4 AFRIZAL L UMUM 20 JL BAKTI AB Martubung
1308165111830001
166 P-XNUWFFVK RAFFI AHSA P UMUM 37 JLN ASAM L Martubung
167 2171065009929013
P-PPDPFC0E SEVRYANA P UMUM 29 Lingkungan Tangkahan
1271134612960003
168 P-XOEQTHMK MIRA RODIA P B 25 JLN YOS SU Martubung
169 1271135306940003
P-XOKCPJIA IVO HELEN P UMUM 26 LK VI P. RA Martubung
170 1271134808890005
P-XONR8NT4 IDA BR HUT P B 30 LK VI PAJAK Martubung
171 1271135810660001
P-XOVAW11K ROHANI MA P B 55 LK IV MART Martubung
172 1271136908990001
P-XOZPP6B3 ZUMADIL LI L UMUM 22 LK I BAHARI Martubung
173 1271130702980002
P-XP3JHMNB M FEBRIAN L UMUM 23 LK I BAHARI Martubung
174 1271130102860007
S-5F74E258 MUHAMMAD L B 35 LK V MART Martubung
1271181312020004
175 P-DX73DN6E JHONATAN L B 19 JL PASAR Sidorame
II Barat I
176 1271130502740001
P-XPUQYUY5 HOTLIN DOL L B 47 LK VI PAJAK Martubung
177 1271134801010001
P-XPGWNDZ3 MASNA MARI P UMUM 20 LK VI PAJAK Martubung
178 1271121109960003
P-XQDP0FOL MADIAN AUL L B 25 LK 8 PSR 4 Terjun
179 1271130707700012
P-XQSG66MF ONGGUNG S L B 51 LK IV MART Martubung
180 1271134503930002
P-XQHFOJ86 SARAS REZE P UMUM 28 LK V PAYA Martubung
181 1111132804820002
J-0000XRHK ROMI SAPU L B 39 LK V PAYA Martubung
182 1271120508710002
P-XR1M0HIS AKMALUDDI L B 48 JLN Y. P HI Labuhan Deli
183 1271135706660002
P-UETJJJ7V BOYNAH P RENTAN 55 JLN BAKTI A Martubung
184 1271136505650003 P RENTAN 57 JL. TELUK H Tangkahan
P-XGECMAY7 MISKA SIAL
185 1271131609600001
S-197BAD63 MANOHA TA L LANSIA 60 JLN RAWE 6 Tangkahan
186 1207092505930001
P-XGX26ER2 MUHAMMAD L B 28 GG SAUDARAMartubung
187 1271130310930001
J-00042Y4F PETHER HA L B 27 jl.rawe 6 lin Tangkahan
188 1271206308890004
P-XHLJV0QM SUARTIN SI P B 32 JL. MANGAANMabar Hilir
189 1271135506880004
P-XILS621R LIDYA VERO P UMUM 34 GG SAUDARAMartubung
190 1271130402750001
P-XIYTJTT1 FERIANTO S L B 46 JL TG SENT Besar
191 1271062708600001
S-30FEE662 PONIMIN L LANSIA 61 JLN KAMBES Martubung
192 1271135909870010
P-XLJG8YIM HELEN BR S P UMUM 34 P. RAMBAI Martubung
1271131311560001
193 S-88D7841B M RASYID L LANSIA 64 LK II KEL. Martubung
194 1271136212600003 P LANSIA 60 P. RAMBAI Martubung
Z-0006J5MH SUSILAWATI
Keterangan
D : Lainnya
E : Tidak Bekerja
Kelompok Umur
18-30
31-45
46-59
Total
Pekerjaan
A
B
C
D
E
Total
Pelayanan Vaksinasi COVID-19 di Tingkat Fasyankes
ATAN PELAYANAN VAKSINASI COVID-19

KESMAS/FASYANKES/POS VAKSINASI

Dosis I Dosis 2
pada kolom yang sesuai) Merek Tanggal Tanggal Tanggal
Kecamatan No.Hp BPJS Non Non
BPJS PBI Vaksin Screening Pemberian No.Batch Pemberia
PBI Anggota
Vaksin n Vaksin
Medan Labuhan082181977120 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Petisah085261463467 √ SINOVAC 9/28/2021 - - 9/28/2021
Percut sei Tuan
081265564860 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Perjuangan
081263829993 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Perjuangan
082223338136 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Marelan085691631597 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Perjuangan
081328301616 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Petisah081328301616 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Denai081362258926 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Belawan081264734656 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Labuhan
082276268140 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Labuhan
082181976042 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Labuhan
085358053870 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Labuhan
081997007764 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Labuhan
081377678739 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Labuhan
083164786190 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Labuhan
082276266869 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Labuhan
082167484868 √ SINOVAC 9/28/2021 - - 9/28/2021
085761079865
Medan Labuhan √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Labuhan
083181338092 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Labuhan
081265453335 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Labuhan
081261531549 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Labuhan
085362051133 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Labuhan
082365695285 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Marelan
082386168763 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Labuhan
085277932293 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Labuhan
081263112981 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Labuhan
081361366986 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Labuhan
081361517849 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Labuhan
082360746569 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Marelan
082268108249 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Labuhan
081373586389 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Deli082375933701 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Labuhan
081397832555 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Labuhan
085361590011 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Labuhan
085361454430 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Labuhan
085373393259 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Labuhan
082276132507 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Labuhan
089604347880 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Labuhan
085763438572 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Labuhan
082168264293 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Labuhan
082273668828 √ SINOVAC 9/28/2021 - - 9/28/2021
Stabat Lama083192043317 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Perjuangan
081263374978 √ SINOVAC 9/28/2021 - - 9/28/2021
081361386971
Medan Selayang √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Labuhan
081260416503 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Labuhan
081260640909 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Labuhan
081396036305 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Labuhan
081360240751 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Labuhan
082166971862 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Labuhan
081396036305 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Labuhan
081361518750 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Labuhan
085270081621 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Labuhan
081361965039 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Labuhan
085360490852 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Labuhan
082360906598 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Labuhan
082393054013 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Belawan
085361770789 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Labuhan
082168263619 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Labuhan
085261321705 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Labuhan
085924764472 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Labuhan
081265527159 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Labuhan
081361012420 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Labuhan
085275323950 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Labuhan
082360526819 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Labuhan
081977876213 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Labuhan
085296187691 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Labuhan
081263315321 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Labuhan
085360148991 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Labuhan
081361518750 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Labuhan
081396764684 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Labuhan
085364564616 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Labuhan
081375133494 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Labuhan
081267847486
082369938590 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Marelan
085361440125 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Labuhan
082276861337 √ SINOVAC 9/28/2021 - - 9/28/2021
Medan Labuhan
085297571030 √ SINOVAC 9/28/2021 9/28/2021 2021071341 -
Medan Labuhan
081933663213 √ SINOVAC 9/28/2021 9/28/2021 2021071341 -
Medan Belawan
082167762703 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
081397573232 √ SINOVAC 9/28/2021 9/28/2021 202108152G -
Medan Labuhan
081263635145 √ SINOVAC 9/28/2021 9/28/2021 202108152G -
Medan Labuhan
082368748434 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Sunggal
085261629468 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
081264420702 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
081264420720 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Deli 08887521566 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Deli085272476788 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
081264420720 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
081365600466 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
081927123818 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
081262686456 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
082274663054 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Amplas082167762703 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
087880152355 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
088261516911 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
085362925931 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Helvetia
085362506349 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
082277136129 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
085277929912 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
085376767478 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
081263535747 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Marelan
088262960868 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Perjuangan
0882016044869 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
085282978248 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Marelan
088261714487 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
0895806488869 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
081375114478 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
081375114478 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
081268857641 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
085372772553 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
081262060617 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
085297160022 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
081263309198 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
081331893013 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
081264670859 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
0895334032113 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
085255775703 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
082163037800 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
082364362725 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
087770476609 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
089503433925 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
085370672508 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
085215059725 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
081371269237 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
085210573809 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Baru082277153630 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Tuntungan
082273504031 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Tuntungan
081361837084 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
081375615441 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
081260208476 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
202108152
Medan Marelan
083191536145 √ SINOVAC 9/28/2021 9/28/2021 -
G
Medan Labuhan
085358644605 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
085696807190 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
081270483051 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
082162761511 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
083124612810 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Marelan
085261143431 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
082374165730
Medan Labuhan √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
081361516466 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
088261213814 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
082273944131 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
081270483051 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
082274548083 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
081360987342 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
082274663054 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
087770476609 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
081290639240 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
081397991306 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
081361475001 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Perjuangan
082149445874 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
081370554325 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
081396236022 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Marelan
081282582562 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
082168458007 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
085763393866 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
081269096447 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Marelan
085358772124 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
087744758390 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
202108152
Medan Labuhan
085262734959 √ SINOVAC 9/28/2021 9/28/2021 -
G
082299578513
Medan Labuhan √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
081268469390 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
082369760193 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Deli 082161513233 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
082274242852 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
081263319063 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
085275703715 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
082369506950 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
Medan Labuhan
081260231956 √ SINOVAC 9/28/2021 9/28/2021 24005721 -
082275612380
Merek Vaksin
A : Sinovac
Kepersertaan BPJS
BPJS PBI
BPJS Non PBI
Non Anggota
Total
Pemberian Dosis
Dosis 1
Dosis 2
Total
Dosis 2
KETERANGAN
No.Batch
24005721 SELESAI
24005721 SELESAI
24005721 SELESAI
24005721 SELESAI
24005721 SELESAI
24005721 SELESAI
24005721 SELESAI
24005721 SELESAI
24005721 SELESAI
24005721 SELESAI
202108152G SELESAI
2021071341 SELESAI
2021071341 SELESAI
202108152G SELESAI
202108152G SELESAI
24005721 SELESAI
24005721 SELESAI
24005721 SELESAI
202108152G SELESAI
24005721 SELESAI
2021071341 SELESAI
24005721 SELESAI
24005721 SELESAI
2021071341 SELESAI
2021071341 SELESAI
24005721 SELESAI
202108152G SELESAI
2021071341 SELESAI
24005721 SELESAI
202108152G SELESAI
24005721 SELESAI
202108152G SELESAI
24005721 SELESAI
24005721 SELESAI
24005721 SELESAI
24005721 SELESAI
202108152G SELESAI
24005721 SELESAI
24005721 SELESAI
24005721 SELESAI
2021071341 SELESAI
2021071341 SELESAI
24005721 SELESAI
24005721 SELESAI
24005721 SELESAI
24005721 SELESAI
2021071341 SELESAI
2021071341 SELESAI
24005721 SELESAI
24005721 SELESAI
24005721 SELESAI
24005721 SELESAI
24005721 SELESAI
24005721 SELESAI
24005721 SELESAI
24005721 SELESAI
24007521 SELESAI
2021071341 SELESAI
24005721 SELESAI
24005721 SELESAI
24005721 SELESAI
2021071341 SELESAI
2021071341 SELESAI
24005721 SELESAI
24005721 SELESAI
24005721 SELESAI
24005721 SELESAI
24005721 SELESAI
24005721 SELESAI
2021071341 SELESAI
2021071341 SELESAI
24005721 SELESAI
2021071341 SELESAI
2021071341 SELESAI
202108152G SELESAI
24005721 SELESAI
202108152G SELESAI
24005721 SELESAI
24005721 SELESAI
202108152G SELESAI
2021071341 SELESAI
202108152G SELESAI
2021071341 SELESAI
24005721 SELESAI
24005721 SELESAI
2021071341 SELESAI
202108152G SELESAI
24005721 SELESAI
24005721 SELESAI
2021071341 SELESAI
24005721 SELESAI
202108152G SELESAI
2021071341 SELESAI
24005721 SELESAI
24005721 SELESAI
24005721 SELESAI
24005721 SELESAI
24005721 SELESAI
24005721 SELESAI
2021071341 SELESAI
202108152G SELESAI
- LANJUT VAKSIN KE 2
-
LANJUT VAKSIN KE 2
-
LANJUT VAKSIN KE 2
202108152
G SELESAI
FORMAT PENCAT
TINGKAT PUS

Umur
(> 60Tahun)
1 Q-000S6NT9 1209104102890001 SUSANTI P UMUM 32
2 Q-000S3F2D RIRIS SUSANTO HUTABARAT
1273031404800003 P PP 41
3 Q-000S6K03 1271134703690002 SITI SAHARA P PP 52
4 Q-000S72MW 1271134309980007 LENTA AYU FOLORITAP PP 23
5 Q-000S33AW 1212033001930001 SUPARMAN L PP 28
6 Q-000S3KHN 1271134506830002 GUNAWAN L UMUM 38
7 Q-000SAOMT 1271137108910002 AINIL GUSTARI P UMUM 30
8 Q-000S2BHS 1271136204930003 APRILDA P PP 28
9 Q-000S58Q4 1271135204030002 ISNAINI P UMUM 18
10 Q-000S2IO5 1273041601960001 FENDI L PP 25
11 Q-000S3F3X 1271135409030004 MESYA NUR SEPTIA P UMUM 18
12 Q-000S594K 1271136702000002 MURIA P PP 21
13 Q-000S5NFS 1271134210990003 DARA AULIA SARAGIH L UMUM 21
14 Q-000S64IW 1207260612780001 MICHA DESLON P PP 42
15 P-9PTINZA7 1271130607770004 JULI PARDAMEAN M L PP 44
16 Q-000S2BKJ 1271134409790005 ROSIDA P UMUM 42
17 Z-000A2U3S 1271131912530001 RATDY MUKHTAR L LANSIA 68
18 Q-000S6NLK 1271135411920002 NURIANA P PP 29
19 Q-000S59B3 1271136012750002 IMANIAH P UMUM 45
20 Q-000SA38X MARDIANA
1271135505800003 BR. SIMANJUNTAK
P PP 41
21 P-9FOPXA0P 1271135303870006 JAMILAH P UMUM 34
22 P-42MGMPQN 1271136703800003 DORTI MARLINA P UMUM 41
23 P-0QCG7JSW 1271135711980003GREACE CLARA SIHITE P PP 22
24 P-5ASA8AGA 1271132811890002 MASRIADY L PP 31
25 Q-000SB0YS 1271132911780001 HISAR HENDRIANDY P PP 43
26 Q-000S2BKN 1271136102020004 MARIANA FEBRIANTI P UMUM 19
27 P-5YQLZI8A 1271132505940002 DARMAN NAPITUPULU L PP 27
28 P-72XRU8NC 1271132708790004SAUT MARTUA SILABANL PP 42
29 P-AMGYPHJN 1271135709710004 HALEN PATIR S P RENTAN 50
30 K-0000XS2Y 1271130908020007 ANGGIE L PP 19
31 Q-000S33A1 1271136506760006MARUDUR SITUMORANGP UMUM 44
32 Q-000S6NIW 1271134905750001 MARDIATI P UMUM 46
33 P-AWPPKR5M 1271132003750002RELMAN SITANGGANG L PP 46
34 P-7RJYQKUT FERRY ABADI HUTAURUKL
1271130707780011 PP 43
35 Q-000S6ZQK 1271130801010006 FIQRI IRGI FAHROZI L UMUM 20
36 Q-000SBYS8 1271135009830004 KHAIRUN NISA P PP 38
37 Q-000S3F3S 1271137112810026 RENNY JULIANA T P UMUM 40
38 Q-000S2OP3 1208184708900005 OSIN SIMAMORA P UMUM 31
39 Q-000S8J7D HOTMA IDA BR. SIMAMORA
1271135501680003 P RENTAN 57
40 Q-000S3K8J 1271134202690004 NURKIA BR. NABABAN P RENTAN 53
41 Q-000S3KKH 1271136112020005 JOJOR DELIMA P UMUM 18
42 Q-000S3RR4 1205111005730003 ISNAN L PP 49
43 P-BCTKAKDC 1271135511970003 SRI AYU NOVIYANTI P PP 23
44 P-BCTKAKDC 1271135511970003ROSMAIDA BR. SINAGA P UMUM 44
45 S-BE7E6512 1271130202000004 SAMUEL SARAGIH L PP 21
46 P-BFYHTY1O JHON FERI BUTAR BUTARL
1271133112000009 UMUM 21
47 P-C8VL33B2 1271130810650004 SUPARDI L PP 56
48 Q-000R81OQ 1271130101900009 RYAN ARDILLA L PP 31
49 Z-0009XZJR 1271137011600002 HJ. SURNANTY P LANSIA 60
50 Z-000A2A6T 1271135505570001 SAMALIA BR. MARBUN P LANSIA 64
51 Q-000S3R1G 1205115112990007 TARI RAMADHANI P PP 21
52 P-BLCFCC6I 1271132501800003RAMLAN SIMORANGKIR L PP 41
53 P-BQ0PVC2M 1271134603030004 DEA MARGARETHA P UMUM 18
54 P-BVL0TW0X 1271206802800002 NURLELA P PP 41
55 K-0000XS2H 1271124501000007 EKA SAFITRI P PP 21
56 Q-000S4TM8 1271130506790006 RINALDY L PP 42
57 Q-000S457E 1271135201000002 PRESTY HIDAYATI P UMUM 21
58 Q-000S9BL1 KRISTIAWAN TELAUMBANUA
1271132009980001 L UMUM 23
59 Q-000S59L9 1271134505730010 ANAH P PP 48
60 P-CPVRG9KZ 1271135106010001 KARTIKA SARI PUTRI P UMUM 20
61 K-0000XR7M 1271131012720004 ATENG L PP 48
62 P-C1FIF6GI 1271134912820004 DESI M. SIANIPAR P UMUM 39
63 P-CFFCQVY3 1218065309850001 DESI MAYA SARI P UMUM 37
64 S-953495F8 1271136206950001 GRANDI IMPIANTI P PP 26
65 P-1NUF6JUO 1271130908700001 PARLINTONGAN BB L PP 51
66 P-00L3Y9WP 1271136709020009 VANESSA NORIKA P PP 19
67 Q-000S648N 1205214201020001 MUTHIA KAMILA P UMUM 19
68 Q-000S82PB 1271134510800008 ADLIANI HARAHAP P UMUM 41
69 Z-000A2F46 1271135906590003 WARNI WANI P LANSIA 62
70 Q-000S44WA 1271093110930001 ZAINUDDIN MUTHAHIR L PP 28
71 Q-000S38A0 1271135510780003 PRISTIWATI P UMUM 42
72 - 1271136512760006 NELLY KRISTIN TINA P PP 43
73 Q-000S6L6K 1271134809000004 SEPRIYANTI PURBA P PP 21
74 Z-000A2A6W 1271134408570005 HJ. SALMAH P LANSIA 64
75 P-6ZIVA9ZP 1271136510990010 LILIS KURNIAWATI P PP 22
76 P-D0IPCKUL 1271134802000005 INTAN FEBI RIZKI P PP 21
77 K-0000XV01 1271135003960004SHERLY WIDYANINGSIHP UMUM 25
78 K-0000XQZ0 1271131402850007 MUHAMMAD RAFII L PP 35
79 K-0000XPVV 1271131506810007 MHD EFENDI L PP 40
80 J-0003D44T TOMAS FEBRIAN SEMBIRING
1271130102000007 L UMUM 21
81 P-D7HOK2SW 1271130202010002 ISMAIL EFENDI L UMUM 20
82 P-ALOITK87 1271131403850001 SEVEN TAMPUBOLON L PP 32
83 P-EM1958MB 1271132105850003 ANDRIANSYAH L PP 36
84 P-CXA8MIMD 1271134208030003 CECILIA VIONATA P UMUM 18
85 P-7ABPWHBL 1271136104700003 SUPIANI BATU BARA P RENTAN 51
86 P-2CH3LG4Y 1271132906780003JONSON MAROLOP TUAL PP 41
87 P-9GB61MIE 1271135403890002 MARTINA DAMERIA P UMUM 32
88 P-6K04DKAA 1271132308630002 RAZALI L PP 58
89 P-28245PCP 1271135410910003RINDU HOTMA SITORUSP UMUM 29
90 P-EUBO7BXF 1271136108890002 AYU ANDIRA P UMUM 32
91 P-BMSVV3T6 1271131606990005 KRISMAN ARMANDO L UMUM 22
92 Q-000SB10I 1271130801030004 HENDRA L UMUM 18
93 Q-000S3KIC 1271135110800004 KARMILA P UMUM 40
94 Q-000S5NU3 1271135909720004 ERLINAWATI P UMUM 49
95 Q-000S70EY 1271130607720001 UMAR ANANG HSB L PP 49
96 Q-000S44EX 1271094908990001 RIZKI ASRIDA P PP 22
97 Q-000S3KGO 1271132712940005 RIFAN KEVIN L PP 20
98 Q-000S3QZ0 1209111504630001 SAUT SIRAIT L PP 57
99 Q-000S3RKP 1209110801010002 OBET EDO SIRAIT L UMUM 20
100 Q-000S8ITN 1271120301850004 ARI WITANTO L PP 36
101 Q-000SAO8M SUFIAN ARBANSYAH RITONGA
1272031504810003 L PP 40
102 Z-000A2WQ4 KHAIRIA AMILDA HARAHAP
1271134106010004 P PP 20
103 J-0000FYVS 1403095305950008 NARTI DONGORAN P UMUM 26
104 P-1WCKSX7L MULA PANDAPOTAN SIMATUPANG
1271132012810006 L PP 39
105 P-EPVR4HD4 1271136801810001TIARSYAH NAINGGOLANP UMUM 40
106 S-9C4E7F09 1271136808580003DORMINA SIMANJUNTAKL LANSIA 63
107 Q-000S9BPW 1204064505030002 ADESTINA LAWOLO P UMUM 18
108 Q-000S9BDY 1204130304630001 SAMAHATI NAZARA L PP 58
109 Q-000S8ZEZ 1204136306030001CITRA MUTIARA NAZARAP UMUM 18
110 Q-000S8ZQP 1204224108990001 NIKE ARDILA HALAWA P UMUM 22
111 Q-000CW7VD 1271124506880003ENNITA SYARA FANNIA P PP 33
112 Q-000D0HDA 1271061305850002 MUHAMMAD SAFII P PP 37
113 Q-000S38AA 1271130105680004 ZEFRI L PP 53
114 Q-000S7KZR 1271136107790006 RAHMAH P PP 42
115 Q-000S38A5 1271065607790002 ETIKA SARI P PP 42
116 Q-000S7LR9 1208057011620002 MANTARIA HUTASOIT P PP 58
117 Q-000S0M4Y 1271136012780002 SERI MULIA P UMUM 43
118 Q-000S7LOF DESI NATALIA SIMANJUNTAL
1508126412950001 P PP 25
119 Q-000RG0P2 1271133010910003 FIRMASYAH L PP 29
120 Q-000RYFJH 1271080102770002JONSON SIMANJUNTAK L PP 44
121 Q-000S43O9 MUHAMMAD SYAHDAN KHOTIB
1271133110030001 L REMAJA 17
122 P-EYKUE8D0 1271132909980008 MUHAMMAD MUKHLIS L PP 23
123 P-FAQDQATA 1271132803650001 KALADIUS PANJAITAN L PP 56
124 S-7B5A0F5A 1271135112770002MEGANDHI SAFRINA SAGP PP 43
125 Q-000S59R0 MUHAMMAD KHOZIN HIDAYAT
1271122707000006 L UMUM 21
126 P-FEF57C6R 1271131903760002HARIYANTO MANURUNGL PP 45
127 P-FNNZBJXJ 1271135610980003 FAJAR FAHERA L PP 23
128 P-FJE2NOSS MEI DUMARIA BR. SIMANJUNTAK
1271135605690001 P RENTAN 52
129 P-FW31NSBN 1271135311910002 NADRA P UMUM 30
130 P-G5KLWXOG 1271135408830004 RISKA ERWANI P UMUM 38
131 P-G1OC0UJ5 1271132005750004 IRWAN MUKTAR P L PP 46
132 P-FRVEEHB0 SONDANG ERIKA J SIMANJUNTAK
1271136606010005 P PP 19
133 Q-000RZLXB 1271136604020001 ALDA DIFA APRILIA P UMUM 19
134 P-G8T21GBT MARIANTI BR. TARIHORANP
1271134104720004 PP 49
135 P-GCFBMWWK 1271132810020001 JADI AL YASER NAT L UMUM 18
136 P-GH8A5K3Z TODO MARULAK SIMAMORA
1407050505830001 L PP 39
137 Q-000RZEWG 1271131006960003 PIPIN ARVIANDA L UMUM 25
138 Q-000S9S9J 1271131105750008 YAHYA ZULKARNAIN L PP 46
139 Q-000S9RV8 1271134403630002RAKIMAH BR. HOMBINGP RENTAN 58
140 Q-000RZP71 1271136311930001 NONA PRATIWI P UMUM 27
141 P-GKPUAZEC NURUL HUDA NORYASTAA'EIN
1271135901040002 P REMAJA 17
142 Q-000S4I0L RICKY ANDRIAN PASARIBU
1271200505040001 L REMAJA 17
143 Q-000S8IQR 1271131010920003 DZULFIKAR L PP 28
144 P-GS0HWIR5 1271135308770005 TATI ROSANTI P PP 44
145 Q-000SB0YS 1271132911780001 HENDRI J SILALAHI L PP 52
146 Q-000S4F8R 1271206204770003 DELPI SINAGA P UMUM 44
147 Q-000S704S 1271204302910002 RIKA ARDIANSYAH P PP 30
148 P-GPE0SBXO 1271134405620003 RENI BR. SINAGA P RENTAN 59
149 S-C7648B5D 1271135207600001 TOMUAN HUTAJULU L LANSIA 60
150 Q-000S4FAS TOGA PARULIAN PASARIBU
1271200111760004 L PP 44
151 Q-000SB0R5 1271135403830001RINI DANIATI SIHOMBINGP PP 39
152 Q-000S4SDV 1271135111690004RISTAULINA SIMAMORAP RENTAN 52
153 Z-000A2SXL 1271200312530001 DJOSIAMAN SARAGIH L RENTAN 67
154 P-HJS3YBPJ 1271137112030005 WIDIA SRI HANDAYANI P REMAJA 17
155 Q-000S4U28 1271066410620002 ALBINE NAINGGOLAN P RENTAN 58
156 P-HGYCB1F1 1212016009650001 SONTI SIREGAR P RENTAN 56
157 Q-000S8354 1271131807020001 WAHYUDIN L UMUM 19
158 Q-000S4T3W 1271132001700004 MANGOLBE SILABAN L PP 51
159 P-I1JCY9YY 1271135806870001 HABIBAH P UMUM 34
160 Q-000S831A 1116062104940004 APRI ANANDA P PP 26
161 Q-000RZLPV 1271135905040004 SAFNA FHADILLAH P REMAJA 17
162 Q-000S3ATI 1271135102950001 SABRINA P UMUM 28
163 P-I45L8N1H AYU LESTARI SIMANJUNTAK
1271135203980002 P PP 23
164 P-I6UV5TF5 1271135612850001 SANIAH P UMUM 35
165 Q-000RYWFX 1271130907020006 FADHIL FAHROZI L UMUM 19
166 P-IYN7N7GR ARJUNA WIBI SANA LUBISL UMUM
1271132903030002 18
167 P-IVZ5LAMA 1205184106960001 TIKA AMALIA P PP 25
168 Q-000S58Q4 1271135204030002 ISNAINI P PP 28
169 P-I9Q6M1W5 1271130504780002 SUWARDI L PP 43
170 P-IPSBGN3I 1271136304940001 RIZKI RAHMAH L PP 27
171 P-IIKQHVCX 1271135410680002SERLIANA ARITONANG P RENTAN 53
172 P-IS8UG9FP 1271134702850001 RITA KUMALASARI P PP 36
173 Q-000S59P1 1271134802640001 NURHASANAH P RENTAN 57
174 Q-000S73QZ TIOMINAR BR. MARPAUNGP RENTAN
1271134509650002 56
175 Q-000RZ7ZF 1271136711710001 NURHIDAYAH L RENTAN 50
176 Q-000S334W 1271130707700003 JUNIOR SIREGAR L PP 51
177 Q-000S70RM MHD ARIQ TOHIRUDDIN MARDIA
1207240212030005 L REMAJA 17
178 Q-000S8IMH 1271135202820011 KORLINA SAMOSIR P PP 39
179 P-J2XTSL0S 1271136212870001 HARMA DEWI P UMUM 34
180 P-J0NK1ERB 1271132202990002RYANTO PANGRIBUAN L PP 22
181 Q-000S7LU3 1271131205750003DEDI SYAHPUTRA NST L PP 46
182 P-LD0Y46Z0 1271136206030003 CINDY JUNIARNY P UMUM 18
183 Q-000S9RQ6 IRMA YANTI BR. NABABANP UMUM
1271136212980002 24
184 P-LELL1ELG 1271135806780001 DEWI HAMIDAH P UMUM 43
185 P-LGQYKMFZ ANDINI AULIYA BR. HUTASUHUT
1271134105010001 P UMUM 20
186 Q-000S9RZ1 SARTIKA DEWIYANI SIAHAAN
1271135809900004 P UMUM 30
187 P-LHWB1TTJ TIALAM NURITA ROSDIANA
1271136001700005 P RENTAN 52
188 P-LJO3MK40 1271132211960001 AHMAD RAFI L UMUM 25
189 K-0000Y922 1271205705810002 TIENRI S P PP 40
190 P-LKYUG6PB 1271130309910001 RAJULI L PP 30
191 P-LMS9KGYX 1271131604900002 ERWIN SIAGIAN L PP 31
192 P-LO8XMOL9 ARSYI MAULANA SIREGARL REMAJA
1271131905040008 17
193 Q-000S82KY 1271140212740005 BUDI YANTO ST L PP 47
194 P-LQ6VPKYP 1271130805990005KORNELIUS ZENDRATO L PP 22
195 P-LRSOG2HR 1210085401950003 ARNI BR. SIDABUTAR P PP 24
196 P-LW7909IF 1271134803020005
ERIKA CESMIRANDA SIAGIANP UMUM 19
197 P-LZ2ORD3J 1277011403940003 WAHYU AKBAR L UMUM 27
198 P-LUSVM1XG 1202135506870006JUNI MELIANA SIAGAIANP UMUM 34
199 Q-000RXZPG 1271131302740002 TUMPAL NAPITUPULU L PP 47
200 Q-000SAOJ7 1271134310860009 DONNA SITOMPUL P PP 33
201 Q-000SANZS 1212105206980002 JUNIANTI W.H. SIRAIT P UMUM 23
202 Q-000S8Z60 1207262210800005 HARDI SUSILO L PP 41
203 Q-000SAORV 1271132309870004 IBRAHIM HARAHAP L PP 34
204 Q-000S5NBY 1310086410960001 DENI YANTI P UMUM 25
205 P-MCRHSBFA 1271132401000002 ROCKY NABABAN L UMUM 21
206 P-MFQS3GQ3 1271136002820003 DEWI M. SIHOMBING L UMUM 39
207 S-E02A62A3 2171111511530001 TURMAN SIMANJUNTAKL LANSIA 67
208 J-0004IMFF 1207264912020013 SABINA ALISA P PP 19
209 P-MJW5SN13 1271132702970002 IRWAN DANI SILALAHI L PP 24
210 Q-000S2OOU 1271080406870001 ANTONI L PP 34
el 10. Format Pencatatan Pelayanan Vaksinasi COVID-19 di Tingkat Fasyankes

MEDAN LABUHAN
Kepersertaan BPJS (tulis 'Ya' pada

kolom yang sesuai)
Alamat Kelurahan Kecamatan No.Hp BPJS Non Non
BPJS PBI
PBI Anggota
. ALUMINIUM IV GG. HISKAL LK. XX MULIA
TANJUNG MEDAN DELI 088261732524 √ CORONAVAC
LK. VIII SEI MATI MEDAN LABUHAN 081396089949 √ CORONAVAC
JL. SRI BULAN LK. 2 MARTUBUNG MEDAN LABUHAN 087867347267 √ CORONAVAC
JL.KUBAH MARTUBUNG MEDAN LABUHAN 081375093258 √ CORONAVAC
JL KUBA K MARTUBUNG MEDAN LABUHAN 081375093258 √ CORONAVAC
JL. AMAL LK. VI GG. OMEGA MARTUBUNG MEDAN LABUHAN 082268806260 √ CORONAVAC
LK. VII MARTUBUNG MEDAN LABUHAN 082122255593 √ CORONAVAC
LK. III KP. BESAR MARTUBUNG MEDAN LABUHAN 085296453805 √ CORONAVAC
JL. PAJAK INPRES NO. 39 LK. MARTUBUNG
VII MEDAN LABUHAN 085263630555 √ CORONAVAC
JL. ILYAS NO. 1 B SIMP. KANTOR MARTUBUNG MEDAN LABUHAN 081284004517 √ CORONAVAC
LK. III KP. BESAR MARTUBUNG MEDAN LABUHAN 083146695535 √ CORONAVAC
P. RAMBAI LK. VI MARTUBUNG MEDAN LABUHAN 088261027292 √ CORONAVAC
JL. KUBA LK. I BAHARI MARTUBUNG MEDAN LABUHAN 085765413107 √ CORONAVAC
LR. PARSAORAN LK. XV SEI MATI MEDAN LABUHAN 081370018805 √ CORONAVAC
JL. BAKTI ABRI LK. III MARTUBUNG MEDAN LABUHAN 085261252926 √ CORONAVAC
JL. TELUK HARU NO. 97 LK. II
MARTUBUNG MEDAN LABUHAN 082166349333 √ CORONAVAC
LK. III MARTUBUNG MEDAN LABUHAN 081262032872 √ CORONAVAC
LK. III KP. BESAR DALAMMARTUBUNG MEDAN LABUHAN 085296453805 √ CORONAVAC
LK. IV KP. BESAR MARTUBUNG MEDAN LABUHAN 081373517849 √ CORONAVAC
JL. KAIL LK. VI LOR. I LAMAMARTUBUNG MEDAN LABUHAN 082362547171 √ CORONAVAC
LK. XIII SEI MATI MEDAN LABUHAN 081265591732 √ CORONAVAC
LK. IX SEI MATI MEDAN LABUHAN 081365154412 √ CORONAVAC
LK. IV KP. BESAR MARTUBUNG MEDAN LABUHAN 081373517849 √ CORONAVAC
JL.. BAKTI ABRI LK. III MARTUBUNG MEDAN LABUHAN 085765443641 √ CORONAVAC
LK. IV SEI MATI MEDAN LABUHAN 082160995831 √ CORONAVAC
LK. XVII SEI MATI MEDAN LABUHAN 082166398437 √ CORONAVAC
JL. PANCING II LK. 4 BESAR MEDAN LABUHAN 081370404942 √ CORONAVAC
BAKTI ABRI CINGWAN KP. BAHARI MARTUBUNG MEDAN LABUHAN 081362095994 √ CORONAVAC
JL. KAIL LK. VI LOR. I LAMAMARTUBUNG MEDAN LABUHAN 085277755128 √ CORONAVAC
JL. KL. YOS. SUDARSO LK.MARTUBUNG
7 MEDAN LABUHAN 082274154816 √ CORONAVAC
JL. TELUK HARU REL PJKA LK. II
JL. KLAMBIR 5 GG KELUARGA TANJUNG GUSTA MEDAN HELVETIA 081277357081 √ CORONAVAC
LK. VIII KP. LAMA SEI MATI MEDAN LABUHAN 082172386864 √ CORONAVAC
JL. KAIL LK. VI SEI MATI MEDAN LABUHAN 085371352198 √ CORONAVAC
JL. KL. YOS. SUDARSO LK. II BESAR MEDAN LABUHAN 081310931090 √ CORONAVAC
JL. KL. YOS. SUDARSO LK. II BESAR MEDAN LABUHAN 081321995050 √ CORONAVAC
JL. KLAMBIR 5 GG KELUARGA TANJUNG GUSTA MEDAN HELVETIA 085271809635 √ CORONAVAC
LOR. 7 LK. VIII SEI MATI MEDAN LABUHAN 082181471439 √ CORONAVAC
JL. KAIL LK. V SEI MATI MEDAN LABUHAN 085270552279 √ CORONAVAC
PSR. V GG. ARJUNA LK. 2 TERJUN MEDAN MARELAN 082175597955 √ CORONAVAC
JL. BAKTI ABRI LK. III MARTUBUNG MEDAN LABUHAN 082165398512 √ CORONAVAC
JL. KAMBES LK. IV MARTUBUNG MEDAN LABUHAN 085261670525 √ CORONAVAC
JL. BAKTI ABRI GG. MUFAKATBESAR MEDAN LABUHAN 082277781016 √ CORONAVAC
LK. V PAYA BAKUNG MARTUBUNG MEDAN LABUHAN 083871170879 √ CORONAVAC
LK. XI SEI MATI MEDAN LABUHAN 081231303085 √ CORONAVAC
JL. KAIL LK. IV SEI MATI MEDAN LABUHAN 082140074062 √ CORONAVAC
LK. XII SEI MATI MEDAN LABUHAN 082361558737 √ CORONAVAC
JL. ASAM LK. VII SIMP. KANTOR MARTUBUNG MEDAN LABUHAN 083862043830 √ CORONAVAC
JL. MASJID LK. I MARTUBUNG MEDAN LABUHAN 082160800532 √ CORONAVAC
L. KL. YOS SUDARSO NO. 46MARTUBUNG
LK. II MEDAN LABUHAN 085358060863 √ CORONAVAC
JL. PULAU RIMAU LK. VMARTUBUNG MEDAN LABUHAN 085361725760 √ CORONAVAC
JL. PAYA BAKUNG LK. VMARTUBUNG MEDAN LABUHAN 082375195315 √ CORONAVAC
JL. MEDAN BELAWAN LK. 30 LABUHAN
PEKAN MEDAN LABUHAN √ CORONAVAC
JL. ASAM LOR. SEKOLAH LK. VII
JL. KL. YOS SUDARSO LK.MARTUBUNG
VI MEDAN LABUHAN 089627479107 √ CORONAVAC
L. KAIL LK. VI LOR I KOMP. LAMA SEI MATI MEDAN LABUHAN 0895612205368 √ CORONAVAC
LOR. 2 LK. VI SEI MATI MEDAN LABUHAN 085224245536 √ CORONAVAC
JL. ASAM SIMP. KANTORMARTUBUNG MEDAN LABUHAN 089619367500 √ CORONAVAC
JL. MASJID LK. I BAHARIMARTUBUNG MEDAN LABUHAN 081263008885 √ CORONAVAC
LK. III SEI MATI MEDAN LABUHAN 0895392620447 √ CORONAVAC
JL. KAIL LK. III SEI MATI MEDAN LABUHAN 085358036322 √ CORONAVAC
LK. VIII LOR 6 SEI MATI MEDAN LABUHAN 082167953082 √ CORONAVAC
LK. 4 SEI MATI MEDAN LABUHAN 081263661720 √ CORONAVAC
LK IX SEI MATI MEDAN LABUHAN 081375021381 √ CORONAVAC
LK VIII SEI MATI MEDAN LABUHAN 082390892393 √ CORONAVAC
JL. KAIL GG. BUNTU LK. V SEI MATI MEDAN LABUHAN 085360144134 √ CORONAVAC
LOR PARDOMUAN LK XV SEI MATI MEDAN LABUHAN 081266895130 √ CORONAVAC
JL PANCING I GG. MASJID LK. III BESAR MEDAN LABUHAN 082361550625 √ CORONAVAC
LK.XIV SEI MATI MEDAN LABUHAN 081260494365 √ CORONAVAC
KOMP. RAMBE MAS LK. VI MARTUBUNG MEDAN LABUHAN 085261669968 √ CORONAVAC
LK. 24 PEKAN LABUHAN MEDAN LABUHAN 082277224874 √ CORONAVAC
JL. PULAU RIMAU LK. VMARTUBUNG MEDAN LABUHAN 081370327695 √ CORONAVAC
V MEDAN LABUHAN 082168284249 √ CORONAVAC
. PANCING I GG. RAMBUTAN LK.BESAR IV MEDAN LABUHAN 081375055367 √ CORONAVAC
. PANCING I GG. RAMBUTAN LK.BESAR IV MEDAN LABUHAN 083830527026 √ CORONAVAC
LK. 7 PSR 4 TERJUN MEDAN MARELAN 081264668344 √ CORONAVAC
P. RAMBAI JL. ISTIQOMAH LK VI
LK. I KP. BAHARI MARTUBUNG MEDAN LABUHAN 082268075453 √ CORONAVAC
LK. VI KOMP. BEA CUKAITITI PAPAN MEDAN DELI 081381065601 √ CORONAVAC
LK. I PAYA PASIR PAYA PASIR MEDAN MARELAN 081397931353 √ CORONAVAC
JL. KAPT. RAHMAD BUDDIN LK. PAYAI PASIR MEDAN MARELAN 081370765661 √ CORONAVAC
LK. I BAHARI MARTUBUNG MEDAN LABUHAN 082363737620 √ CORONAVAC
LK. VII SP, KANTOR MARTUBUNG MEDAN LABUHAN 088263086280 √ CORONAVAC
LK. I BAHARI MARTUBUNG MEDAN LABUHAN 083800208673 √ CORONAVAC
LK. IV KANTOR CAMATMARTUBUNG MEDAN LABUHAN 081375031722 √ CORONAVAC
LK. IV KANTOR CAMATMARTUBUNG MEDAN LABUHAN 082175704885 √ CORONAVAC
JL. ASAM NO. 33 LK. VIIMARTUBUNG MEDAN LABUHAN 085270009678 √ CORONAVAC
IV MEDAN LABUHAN 082172482564 √ CORONAVAC
JL. KAMBES LK. IV MARTUBUNG MEDAN LABUHAN 082268694758 √ CORONAVAC
JL. PARDOMUAN LK. XV SEI MATI MEDAN LABUHAN 081265603592 √ CORONAVAC
LK. 8 PSR 4 TERJUN MEDAN MARELAN 085760601013 √ CORONAVAC
LOR 8 LK. XIII SEI MATI MEDAN LABUHAN 081260494365 √ CORONAVAC
JL. KAIL G SEI MATI MEDAN LABUHAN 085360144134 √ CORONAVAC
LOR. SEKOLAH LK. XIV SEI MATI MEDAN LABUHAN 085275509960 √ CORONAVAC
JL. KAIL GG. BUNTU LK. V SEI MATI MEDAN LABUHAN 082164355226 √ CORONAVAC
LK. XII SEI MATI MEDAN LABUHAN 082385250806 √ CORONAVAC
LK. X SEI MATI MEDAN LABUHAN 081375022472 √ CORONAVAC
JL. PULAU BANGKA LK. XVIISEI MATI MEDAN LABUHAN 082278959575 √ CORONAVAC
LOR 5 LK. XI SEI MATI MEDAN LABUHAN 082274374429 √ CORONAVAC
JL. PAYA BAKUNG LK. XMARTUBUNG MEDAN LABUHAN 082278761072 √ CORONAVAC
PINGGIR REL PJKA LK. VIMARTUBUNG MEDAN LABUHAN 082168096426 √ CORONAVAC
LK. XVI SEI MATI MEDAN LABUHAN 081274276352 √ CORONAVAC
KOMP. TKBM BLOK C LK. XVIIISEI MATI MEDAN LABUHAN 081368953242 √ CORONAVAC
JL. P. RAMBAIL NO. 92 LK.MARTUBUNG
LK X SEI MATI MEDAN LABUHAN 085247246160 √ CORONAVAC
P. RAMBAI LK. VI SISI TOL MARTUBUNG MEDAN LABUHAN 081373517849 √ CORONAVAC
KOMP. TKBM BLOK C NO, 15SEI MATI MEDAN LABUHAN 082272350790 √ CORONAVAC
JL. TANGKUL II GG. MELATISIDEREJO
NO. 2 HILIR MEDAN TEMBUNG 082162992643 √ CORONAVAC
LK. XIV SEI MATI MEDAN LABUHAN 082361426313 √ CORONAVAC
KOMP. TKBM BLOK C NO, 15SEI MATI MEDAN LABUHAN 085370128311 √ CORONAVAC
LK. VII SEI MATI MEDAN LABUHAN 081267986160 √ CORONAVAC
JL. KUMBAH LK. I SEI MATI MEDAN LABUHAN 082364949697 √ CORONAVAC
JL. PERBATASAN NO. 37 BRAYAN DARAT I
PULO MEDAN TIMUR 081260151405 √ CORONAVAC
LOR. SEKOLAH LK. XIV SEI MATI MEDAN LABUHAN 085275509960 √ CORONAVAC
JL. BAKTI ABRI LK. V MARTUBUNG MEDAN LABUHAN 081262420899 √ CORONAVAC
JL. STASIUN KP. BESAR LK.MARTUBUNG
IV MEDAN LABUHAN 085274357140 √ CORONAVAC
JL. KUMBAH LK. I MARTUBUNG MEDAN LABUHAN 082364949697 √ CORONAVAC
DUSUN BANDAR BARU PULAU TIGA TAMIANG HULU 082273488973 √ CORONAVAC
LK. X SEI MATI MEDAN LABUHAN 082384019523 √ CORONAVAC
LK. 6 PAJAK RAMBAI MARTUBUNG MEDAN LABUHAN 082370744844 √ CORONAVAC
JL. KAIL LK. IV SEI MATI MEDAN LABUHAN 083839320938 √ CORONAVAC
LK. II BATANG KILAT SEI MATI MEDAN LABUHAN 081373065169 √ CORONAVAC
DUSUN III TEPI GANDU LUBUK KERTANG BERANDAN BARAT 082117196239 √ CORONAVAC
JL. KAPTEN ILYAS LK. XI SEI MATI MEDAN LABUHAN 085296453805 √ CORONAVAC
JL. KAIL I LK. VI LOR LAMA SEI MATI MEDAN LABUHAN 085358397494 √ CORONAVAC
LR. PARDAMEAN LK. XV SEI MATI MEDAN LABUHAN 081376075481 √ CORONAVAC
JL. PAYA BAKUNG LK. VMARTUBUNG MEDAN LABUHAN 081263502042 √ CORONAVAC
P. RAMBAILK. VI SISI TOLMARTUBUNG MEDAN LABUHAN 082284671961 √ CORONAVAC
LK. III BATANG KILAT SEI MATI MEDAN LABUHAN 082368227145 √ CORONAVAC
DUSUN III PT. IRA BLOK D
HAMPARAN PERAK DELI SERDANG 0895611670924 √ CORONAVAC
LK. VI GG SAUDARA MARTUBUNG MEDAN LABUHAN 083190387590 √ CORONAVAC
LK. 16 LOR. 7 NO. 68 SEI MATI MEDAN LABUHAN 085767670065 √ CORONAVAC
JL. MESJID LK. I MARTUBUNG MEDAN LABUHAN 085296890005 √ CORONAVAC
JL. UJUNG PAWANG LK. XVIIISEI MATI MEDAN LABUHAN 082279791411 √ CORONAVAC
LK. XV SEI MATI MEDAN LABUHAN 085262811690 √ CORONAVAC
P. RAMBAI LK. VI REL MARTUBUNG MEDAN LABUHAN 082166775755 √ CORONAVAC
JL. PERBATASAN NO. 57 BRAYAN DARAT I
PULO MEDAN TIMUR 081370824981 √ CORONAVAC
JL. MANDALA BY PASS NO. BANTAN
50 TIMUR MEDAN TEMBUNG 082277829106 √ CORONAVAC
LR. PARDOMUAN LK. XV SEI MATI MEDAN LABUHAN 082281376385 √ CORONAVAC
LK. II SEI MATI MEDAN LABUHAN 081265225272 √ CORONAVAC
LK. IV MARTUBUNG MEDAN LABUHAN 081269619676 √ CORONAVAC
JL. MANGAAN I LK. IV MABAR HILIR MEDAN DELI 081361019930 √ CORONAVAC
JL. PUYUH XV NO. 271 KENANGAN BARU PERCUT SEI TUAN 082277890322 √ CORONAVAC
JL. MASJID LK. I MARTUBUNG MEDAN LABUHAN 081370807916 √ CORONAVAC
LK. VII MARTUBUNG MEDAN LABUHAN 081264748345 √ CORONAVAC
LK. XVIII SEI MATI MEDAN LABUHAN 083179718681 √ CORONAVAC
JL. PLATINA I LK. VII TITI PAPAN MEDAN DELI 081264989719 √ CORONAVAC
JL. JATI REJO PASAR VII SAMPALI PERCUT SEI TUAN 082175691938 √ CORONAVAC
JL. MASJID LK. VI GG. BUKHARIRENGAS PULAU MEDAN MARELAN 085276635566 √ CORONAVAC
Dosis I Dosis 2
Merek Tanggal Tanggal Tanggal KETERANGAN
Vaksin Screening Pemberian No.Batch Pemberian No.Batch
Vaksin Vaksin
CORONAVAC 9/29/2021 9/29/2021 24005721 SELESAI

Nama Penerima Umur

Vaksin
(> 60Tahun)
1 P-AAT0NXLG 1271136307090008 FATIMAH AZZAHRA S P REMAJA 12 JL. PANCING 3
2 P-16HZBSAZ 1271064906090008 DITA PRATIWI P REMAJA 12 : JL PLATINA
3 P-3Y6RJTN7 1271066604090004 NUR AINI AYU LESTAR P REMAJA 12 : JL PLATINA
4 Y-0135S2XP 1271064206820007 SRI LIA HARTATI P B 39 : JL. PLATINA
5 P-1WO5XH3P 1271065209090004 JIHAN SYAHIRAH RA P REMAJA 12 : JL PLATINA I
6 P-7D76PZO1 1271064806090001 NUR AINA SILVIANI P REMAJA 12 : jl platina raya
7 P-7XKKT1BC 1271067107090002 ANISA P REMAJA 12 : jl platina raya
8 P-8RD2APSY 1271065101080002 ALVIKA CYNTIA P REMAJA 13 : jl platina titi
9 P-9JCJOSCN 1271064803090002 RISKA INDRIANI SIRE P REMAJA 12 : jl platina raya
10 P-ACDFRG5D 1271061609090006 ROMADHAN SYAHPUT L REMAJA 12 : jl platian 4 li
11 P-AOE30M86 1271066803090002 BUNGA AYU LESTARI P REMAJA 12 : jl platina ling
12 P-ASDRBAY0 1271136706090003 ANNISA FITRI TANJU P REMAJA 12 : paya rumput g
13 P-10WWN8G6 1207265306090010 AQILLA SYAHKIRA P REMAJA 12 : JL PANCING
14 P-73ELA3A7 1271064912080004 ZHAFIRA OLIVIA P REMAJA 13 : JL MANGAAN
15 P-B1RYZGJE 1271064805080004 SYAHIRA FAUZANA P REMAJA 13 : JL PLATINA I
16 P-9BNQQL3I 1271061209090009 FAHRY RAMADHAN L REMAJA 12 : JL PLATINA
17 S-21F1834D 1271060306090004 MUHAMMAD RIDHO M L REMAJA 12 : JL PLATINA
18 P-56KS779Q 1271061502090003 RIZKI PRANATA L REMAJA 12 : JL PLATINA
19 P-6U4X629W 1271061812080007 TENGKU FIKRI FAHRI L REMAJA 12 : JL PLATINA
20 P-BGXE9W2T 1271061409090004 MUHAMMAD RADIT FA L REMAJA 12 : JL PLATINA
21 P-BLWG6LNE 1271061005090001 MUHAMMAD RAYHAN L REMAJA 12 : JL PLATINA
22 P-BYDPOGD7 1271061406090004 M RIFAI LUBIS L REMAJA 12 : JL PLATINA
23 P-C51TS2GI 1271062701090006 DAVA IRWANSYAH B L REMAJA 12 : JL PLATINAI
24 P-CCN74RBS 1206100101090002 KEVIN ALDO SYAHPU L REMAJA 12 : JL PLATINA
25 P-2DT8PE6T 1271081208090001 RIFKI ARIADI L REMAJA 12 : jl pancing 16
26 P-597PMACY 1271060603090005 NAUFAL HILMI AZZAM L REMAJA 12 : jl kl yos sudar
27 P-478IXGIJ 1271062509090007 TIO ANANTA L REMAJA 12 JL PLATINA 2
28 P-1GDKFGNU 1219024111860003 ZAHARA P B 36 : JL MARELAN
29 P-ARWRB6II 1271064509090007 SYIFA AULIA RAMAD P REMAJA 12 : JL MANGAA
30 P-CL833IZB 1271064612080002 CECILIA BERLIANA B P REMAJA 13 : JL MANGAAN
31 P-D36N4EMN 1271066511080005 LASMARIA SAMOSIR P REMAJA 13 JL MANGAAN
32 P-0W6T58GC 1211075612070001 NATASYA MANALU P REMAJA 14 : JL PLATINA
33 P-9PH326IP 1271061606090001 FAZAR HERNANDHES L REMAJA 12 : JL PLATINA
34 P-0WNUCGHG 1271063008090002 RAHMAT YOSEPH NA L REMAJA 12 : JL PLATINA
35 P-67WB6INT 1271065909090003 HANNA THRESIA PUTRP REMAJA 12 : JL MANGAA
36 P-5A6ZKYNR 1271132705090003 RIZQI ALFAHRIZA P REMAJA 12 : lalan pancing
37 P-DIMIG5QA 1208251508090001 DWIKY DARMAWAN L REMAJA 12 : JL PLATINA
38 P-DBZ3VOCN 1271131012080002 ALVIN REYVALDO NA L REMAJA 12 : JL PLATINA
39 P-09URI5MG 1271062812080002 HENDRA FRANSISCO L REMAJA 13 : JL RUMAH P
40 P-DXVELAMG 1271125802090004 KEYSA SAFITRI P REMAJA 12 : JL PLATINA
41 P-E72HGIT8 1271064912070009 IMELDA LAIA P REMAJA 14 : JL PLATINA
42 P-DTOTMDPS 1271065209080004 GRACE SEPTIANI HU P REMAJA 13 : JL PLATINA
43 P-EG4BVPNP 1271065102090005 KAYLA PEBRI YANTI P REMAJA 12 : JL KAWAT II
44 P-EK5TKCUU 1271120705080010 YOSAFAT ARITONAN L REMAJA 13 : JL PLATINA
45 P-EQXGSRQW 1271060606090002 RIKO ALBERTO MUNT L REMAJA 12 : JL PLATINA
46 P-EU52TUPY 1271064305090001 SHAKILA ZHAFIRAH P REMAJA 12 : JL MANGAA
47 P-EZYLPN8V 1271060804090001 CHRISTIAN PUTRA ZA L REMAJA 12 : JL PLATINA
48 P-F4K643ME 1207243006090002 MUHAMMAD ARDIKA L REMAJA 12 : JL RAWE PS
49 P-FAMB4B5Q 1271066201090008 RODEARMA SIANTURI P REMAJA 12 : JL PLATINA
50 P-BCUUGYCA 1271062307090009 EREY NALDI KRISTAN L REMAJA 12 : JL PLATINA
51 P-DOWARWF1 1271064505090005 RIKA HUMAIRA P P REMAJA 12 : JL KL YOS
52 P-EC8JP3JF 1271064907090002 BELLA AIRA P REMAJA 12 : MABAR LOR
53 P-FE9UAZYE 1271066704090002 MU ALIMAH P REMAJA 12 : JL MANGAAN
54 P-FHGUV5ZH 1271064506090001 NADYA RIZKA AULIA P REMAJA 12 : JLN MANGAA
55 P-FKC48ZJP 1271065207090005 TERESYA JULIANTI B P REMAJA 12 : JL PLATINA
56 P-FO2WGBOX 1271065709090002 FITRIA CINTA RAMAD P REMAJA 12 : LINGKUNGAN
57 P-FRVA8HEF 1271066303090003 AYIRA MARCHELINA P REMAJA 12 : JL MANGAA
58 P-FVB7VEJV 1271206709090003 EVA RUMIRIS SIMAM P REMAJA 12 : JL BOXIT K
59 P-G3XZC9MP 1271064601090007 NESHIA GISELA IREN P REMAJA 12 : JL BOXIT K
60 P-G8XGCBRD 1271066207090002 YUYUN SULISTIANI P REMAJA 12 : JL PLATINA
61 P-GNJTMVHV 1271065207090002 TRIANI BUULOLO P REMAJA 12 : JL BOXIT K
62 P-ENBTV47Q 1271060212080004 SAMUEL LUMBAN TOB L REMAJA 12 : JL PLATINA
63 P-GQ67L18E 1271066605090011 ELVI CHRISTIN MANU P REMAJA 12 : JL BOXIT K
64 P-GWFG546E 1271064709090002 NAYLA RAMADHANI P REMAJA 12 : JL RUMAH P
65 P-GZXAS93Q 1207052903090002 KRISTOPIUS HARDIA L REMAJA 12 : NAMO RIAM
66 P-GCSEW1TZ 1271066807090002 DEWI LESTARI P REMAJA 12 : JL MANGAA
67 P-H8JFGJEP 1271061101080001 FAHROZI SUARDI L REMAJA 13 : jlmplatina gg t
68 P-G057LH4R 1271065004090009 DIFA KHAIRUNISA P REMAJA 12 : JL PLATINA
69 P-HELSC44N 1271130106090001 JHON MICHAEL MANA L REMAJA 12 : JL RAWE V
70 P-HNER3J9B 1271062008080004 ADRIAN PRAYOGA L REMAJA 13 : JL PLATINA
71 P-HBPRLVKS 1271062610080003 AGAM YUDISTIRA L REMAJA 13 : JL PANCING
72 P-HXCXLN49 1271060409080003 KHOIRY RAMADHAN L REMAJA 13 : JL KL YOS
73 P-H4FYI2WW 1271062506090006 STENLAY GUNNY LIM L REMAJA 12 : JL K L YOS
74 P-IIUSLA7K 1271126903090008 RIBKA ADOLFIKA GU P REMAJA 12 : KOMPLEK Y
75 P-I5IGTEOQ 1271062904080002 M FADLI L REMAJA 13 : JL BOXIT K
76 P-HU4S1NP4 1271060106080001 FAREL RIANSYAH L REMAJA 13 : JL KL YOS
77 P-I8Y8H11P 1271065406020006 MOZA VANILA P REMAJA 13 : JL PLATINA
78 P-IB4FZFNR 1271066902080004 ALYA AZHARI P REMAJA 13 : JL PLATINA
79 P-IEMCMQ5V 1271065301090004 ALMIRA PUTRI SHAKI P REMAJA 12 : JL PLATINA
80 P-IGQZ3ONE 1271065305080001 T AUDRI ZAHRA ISMI P REMAJA 13 : JL PLATINA
81 P-ILUSCP2Z 1271064105070017 FITRA YANI P REMAJA 13 : JL PLATINA
82 P-INLHP6FE 1271065311080005 SILVI ANGGRAINI P REMAJA 13 : JL PLATINA
83 P-IQ0X2YSS 1271061307070005 MUHAMMAD RIFQI HA L REMAJA 15 : JL PLATINA
84 J-00042XJY 1271135212990006 NURUL AZMI P B 21 : JL PANCING
85 P-IUDCLF19 1271064210070002 DEWI MEGAT BUANA P REMAJA 14 : JL MANGAA
86 P-K20NBWOL 1271132211080002 ABDURRAHMAN AKHT L REMAJA 13 : grya martubu
87 P-JZKRXTQV 1271084303090001 NAYSILA ALMIRA P REMAJA 12 : gg tengah ba
88 P-JXVK68QT 1271122506080003 MUHAMMAD ALIF L REMAJA 13 : jl mangga gg
89 P-K3Q24C7S 1271063007080002 TRI WAHYU PRATOM L REMAJA 13 : JLMANGAAN
90 P-K69AKM47 1271131309070002 MUHAMMAD RIDHO M L REMAJA 14 : JL MANGAAN
91 P-IWNFUCN8 1271066904080007 JIHAN NABAWI P REMAJA 13 : JL MANGAAN
92 P-J5HJMYRT 1271064810080001 KHANSA ZAIN P REMAJA 12 : JL KAYU PUT
93 P-IZ3FRV5T 1271065411070004 KARIEN SAUMA P REMAJA 13 : JL MANGAAN
94 P-J17TKP59 1271065805080004 NADRA NASSER HAR P REMAJA 13 : JL MANGAA
95 P-J3BFFUM6 1219044211070003 DIVA JUMISKA AULIA P REMAJA 13 : JL PLATINA
96 P-J8915OHD 1271064809080004 SUCI NABILA P REMAJA 13 : MABAR PASA
97 P-K7MMPM8C 1271134605080001 ALICA SYAKINAH P REMAJA 13 : JLN PANCING
98 P-K9PPE0L8 1271064206080003 AURA AZKA DHIYA P REMAJA 13 : JL RUMAH P
99 P-KDFGFQHK 1271207105080006 SAVIRA PUTRI P REMAJA 13 : JL PLATINA
100 P-KBBQ1FIO 1271064909080001 DWI AILA RAMADHANI P REMAJA 13 : JL MANGAA
101 P-KF1OITNU 1271062212070001 RAFA KHAIBI PULUN L REMAJA 13 : JLN MANGA
102 P-KGK41N9Z 1271062706080001 IRWANSYAH DALIMU L REMAJA 13 : JLN MANGA
103 Y-0119MMPA 1271062507900002 MUHAMMAD ADNAN H L B 31 JL. PLATINA 4
104 P-KJGBAUMG 1271135701080002 STEVANI TAMBUNAN P REMAJA 13 : JL TAUT LK
105 P-KKZR31KL 1271056010080001 JESSICA OCTAVIA B P REMAJA 13 : JL TAUT II
106 P-KSLCP5M6 1106076205080003 HANAYA GRACELA M P REMAJA 13 : KOMPLEK PT
107 P-KQZRNMTU 1271065512070004 NATALIA PERMATA S P REMAJA 13 : JL MANGAA
108 P-KPEZAYMR 1271066202080001 TIA LORENSIA MARB P REMAJA 13 : JL PLATINA
109 P-L2TL6VA4 1271064707080003 TRI KASIH DAMAYANT P REMAJA 13 : JL RUMAH
110 P-KV2UJZFF 1271206409080001 FITRIANI LAIA P REMAJA 13 : JL PLATINA
111 P-KWB56OTV 1271066501080007 KESYA GABRIELLA M P REMAJA 13 : JL K L YOS
112 P-KXQB4PBV 1271064505080003 CHRISTIN LASMA RO P REMAJA 13 : JL KL YOS
113 P-L0R77ECH 1271135702080002 TITANIA FEBIYANTI P REMAJA 13 : JL TUAR KE
114 P-L4VLXABK 1271062108080004 MARTHA ULI MANALU P REMAJA 13 : JL MANGAAN
115 P-LCS37HZ6 1271061603080001 ADRIANO MUNTE L REMAJA 12 : JL PLATINA
116 P-L79PNHON 1271064808070002 AULYA PUTRI INDIYAN P REMAJA 14 : JL PLATINA
117 P-L90GDS75 1207264303070009 NAGITA DAVINA P REMAJA 14 : JL MANGAAN
118 P-LE74ANP2 1271060609080002 ANDRES MANALU L REMAJA 13 : JL BOXIT ME
119 P-LFIE9CYK 1271062311070004 JONATHAN JOVIANTO L REMAJA 13 : JL BOXIT K
120 P-LH1PHTU3 1214180810070004 HENDRA GUNAWAN L REMAJA 13 : JL BOXIT K
121 P-LIOW21YU 1271131102090005 EFFENDY SITUMORA L REMAJA 12 : JL PANCING
122 P-LNYWUQE3 1271062809070004 JANSEN MANGIHUT G L REMAJA 14 : JL BOXIT K
123 P-R735XBWK 1271066611020001 NAILLAH PUTRI RAMA P REMAJA 18 : JL.BAWAL5
124 P-M62TKSTG 1271062401070007 M JANUA ALAMSYAH L REMAJA 14 JL. PLATINA I
125 P-M1VLG13C 2171115601080002 RIRIN YULIA NINGSI P REMAJA 13 : JL BOXIT TI
126 P-M7841QLP 1271065006080002 CHELSE YUNITASARI P REMAJA 13 : JLN.PLATINA
127 P-M9VGNI74 1271131108070007 MUHAMMAD FARHAN L REMAJA 14 : JL PANCING
128 P-M9OJ2GGF 1271133007080002 CEVIN JOHANDRYANS L REMAJA 13 : JLN.SEMBIL
129 P-M5ZHZ1LW 1271065203080006 GEBY CRECENCIA SI P REMAJA 13 : JLN.PLATINA
130 P-MAYFHUMT 1271061607070002 EGA JUANSYAH L REMAJA 14 : JLON.PLATI
131 P-LYRACV35 1207071401080001MUHAMMAD FAREL L REMAJA 13 : JL KL YOS
132 P-LXFSH9FD 1271064504070005RANTIKA NABILA P REMAJA 14 : JL PLATINA
133 P-LROMZ7NL 1271064410060003SUCI UMAYRA P REMAJA 15 : JL MANGAA
134 P-T4XF3KHL 1271061107080005YOEL SITUMORANG L REMAJA 12 : JL KL YOS
135 P-MCIJFPW6 1271062906070005HASSAN AR-RASYID L REMAJA 14 : JL MANGAA
136 P-M47RKO0D 1271066912070003RIANA JESIKA MECCA P REMAJA 14 : JL PLATINA
137 P-M07M6OZE 1271084112070004SYAKILA ANANDA P REMAJA 14 : JL PLATINA
138 P-M7LQHQZG 1271060101080003MUHAMMAD ALFACHRIL REMAJA 13 : JL PLATINA
139 P-M46F2HNH 1271066505040004SITI RAHMA BR SIRE P REMAJA 15 : JLN.PLATINA
140 P-LBQTBFWX 1271064908070012NABILA PUTRI SERUN P REMAJA 14 : JL PLATINA
141 P-MG5C9JLR 1271061308070006MUHAMMAD TAUFIQ P L REMAJA 14 : JL MANGAAN
142 P-MEZ3PBLM 1272073005070002MUHAMMAD HAIKAL P L REMAJA 14 : JL MANGAAN
143 P-MDPF00G2 1271062808070007MUHAMMAD WISNU A L REMAJA 14 : JL MANGAA
144 P-MHBTRA4A 1214185509080001DEWI ANGGRAINI ZA P REMAJA 13 : JL BOXIT TI
145 P-MU6SDKX3 1271066511070003GRACE SIANTURI P REMAJA 13 : jl boxit gg pe
146 P-MUL6QWNV 1271065508070001KRISTINA SINURAT P REMAJA 14 : JL PLATINA
147 P-MTE8QRA9 1271065909060005FRISKA SEPTI MANU P REMAJA 15 : JL BOXIT TI
148 P-MB0PBSUI 1271060710080004TIVON WELFARE WAU L REMAJA 13 : JL BOXIT TI
149 P-MIK7ZBED 1271066704090001DEPANI MARIANA HA P REMAJA 12 : JL BOXIT TI
150 P-MJOR793L 1271064512070003KEYSHA ALIFYA GAJ P REMAJA 14 : JL PLATINA
151 P-MN2T42LW 1271065510070002DILLA AZASKIA P REMAJA 14 : JL MANGAA
152 P-MQCT6FYI 1271066010070002WULAN SRI ANGGUN P REMAJA 13 : JL PLATINA
153 P-MPB6IXV3 1271065508070003ERLIYANTI AUGUSTIN P REMAJA 14 : JL BOXIT K
154 P-MRO4JIKV 1214186602080001 MUTI ARWITA LAIA P REMAJA 13 : JL BOXIT K
155 P-MVHOOLS1 1271064105070008YOHANA MAYASARI P REMAJA 14 : JL PLATINA
156 P-MWCCYXJC 1271066605070001MELINDA SINTIA MAR P REMAJA 14 : JL BOXIT K
157 P-MYE4UYX4 1271065207070005IMELDA BR PURBA P REMAJA 14 : JL MANGAAN
158 P-NF0DUKPI 1271065704070001TANIA DELIANA P REMAJA 14 : JL PLATINA
159 P-NFJJT8PW 1271065308070005NASYA AMRIANDA P REMAJA 14 : JL PLATINA
160 P-NGAUN1RD 1271064103070010SITI MAHESA P REMAJA 14 : JL PLATINA
161 P-NGZBJV2S 1271060807070001M RASYAD ARRAFI L REMAJA 14 : JL MANGAAN
162 P-NI4BTJSK 1271062907070004FAHRI DAMANIK L REMAJA 14 : JL PLATINA
163 P-N4PL5IV1 1222016208080001NISA BAHARIZKY L REMAJA 13 : JL PLATINA
164 P-N0DIJVSH 1214184705070001FRIDA YANTI P REMAJA 14 : JL BOXIT K
165 P-N1OB5M30 1271064208080004ENI HARTATI P REMAJA 13 : JL PLATINA
166 P-NJQC4K2N 1271062907070001M RAFLY ALBANI L REMAJA 14 : JL PLATINA
167 P-N7Q2LJ3E 1271066106070005MARSHA ADELLIA P REMAJA 14 : JL PLATINA
AULIA PUTRI
168 P-NAWKRVV5 1271065509070003 P REMAJA 14 : JL PLATINA
RAMADHANI
VICKRY ADITYA
169 P-N6JNPSB1 1271060207070002 L REMAJA 14 : JL PLATINA
TELAUMBANUA
170 P-N36GBKW7 1271146907080010 KAYLA PUTRI ARIEF P REMAJA 13 : JL PLATINA
171 P-N93KX0FR 1271066402070003 HAFIZA AZZAHRA P REMAJA 14 : JL RPH HEW
ANDREAN HAFIZ
172 P-NCWFVTAC 1271061101070004 L REMAJA 15 : JL PLATINA
ALFAZAR
173 P-NLMVXFF3 1271064610070003 LAILY RAMADHANI P REMAJA 14 : jl platina 3 ke
KRISNA
174 P-NDLSB204 1271121205070001 L REMAJA 14 : JL PLATINA
ALMUNAWAR
175 P-NC4JRLDU 1271124509070004 CHEYLA SYABILLA P REMAJA 14 : JL PLATINA
MUHAMMAD
176 P-NL9RLHQJ 1271200403070004 L REMAJA 14 : JL RAWE 7
FARHAN
177 P-NEELD76Q 1271065905070003 CICI BINTANG P REMAJA 14 : JL PLATINA
178 P-N1446FN5 1271065309060004 THREE IVANKHA ANG P REMAJA 15 : JL MANGAAN
179 P-NMHHIRLQ 1271060312060001 DEDI ARDIANSYAH L REMAJA 15 : JL PLATINA
180 P-NPQBEVCF 1271064102070002 SRI AULIA DINI P REMAJA 14 : JL PLATINA
181 P-NOW45S2U 1271063006070006 DWI ANDHIKA L REMAJA 14 : JL PLATINA
182 P-NOKP347B 1271081701080002 LEVIAN SYAHDILA L REMAJA 13 : JL PLATINA
183 P-NO5BWV5T 1271060710070005 FARI RAMADAN L REMAJA 14 : JL PLATINA
184 P-NLYEV7YB 1271134804070001 DAVA DWI ASMAJA P REMAJA 13 : JL PANCING
185 P-NNHE8P0K 1271060904050006 IMAM SYAHPUTRA H L REMAJA 16 : JL PLATINA
186 1271063004800001 WINARDI L B 41 JL. PLATINA II
187 1271004302090007 ASYIFA SALSABILA P REMAJA 12 JL. MANGGAN
188 1271060111090007 ARYA DIKA L REMAJA 12 JL. PLATINA N
189 0250092101080005 CAHAYA VERLICA P REMAJA 13 JL. PLATINA I
190 1271065310090002 ALYSA P REMAJA 12
191 121451109080008 MUHAMMAD DHIO L REMAJA 12
192 1271061410090003 GHALI RAHMANDA L REMAJA 12
193 GRES KESIANA P REMAJA 14
MADINAH
194 P REMAJA 14
MAULIDINA
195 1271121407160006 ALIF PERMADI L REMAJA 15 JL. MARELAN I
196
197
198
199
200
Keterangan
D : Lainnya
E : Tidak Bekerja
Kelompok Umur
18-30
31-45
46-59
Total
Pekerjaan
A
B
C

Dosis I
pada kolom yang sesuai) Tanggal Tanggal
BPJS PBI Screening Pemberian
PBI Anggota
Vaksin
BESAR MEDAN LABUHAN 081266058095 CORONA VAC 9/29/2021 9/29/2021
TITIPAPAN MEDAN DELI 081279058840 CORONA VAC 9/29/2021 9/29/2021
TANJUNG MULIA MEDAN DELI 085358458866 CORONA VAC 9/29/2021 9/29/2021
MABAR HILIR MEDAN DELI 085212153499 CORONA VAC 9/29/2021 9/29/2021
MABAR MEDAN DELI 082161498279 CORONA VAC 9/29/2021 9/29/2021
RENGAS PULAUMEDAN MARELAN 081375112410 V CORONA VAC 9/29/2021 9/29/2021
KOTA BANGUN MEDAN DELI 083189764134 CORONA VAC 9/29/2021 9/29/2021
SIBANGUN MARIAH SILIMAKUTA 081370252156 CORONA VAC 9/29/2021 9/29/2021
RENGAS PULAUMEDAN MARELAN 081370524595 CORONA VAC 9/29/2021 9/29/2021
TJ. MULIA HILIR MEDAN DELI 082360929249 CORONA VAC 9/29/2021 9/29/2021
KOTA DATAR HAMPARAN PERAK 081265225242 CORONA VAC 9/29/2021 9/29/2021
NAMORIAM PANCUR BATU 0895325063424 CORONA VAC 9/29/2021 9/29/2021
TANGKAHAN MEDAN LABUHAN 081263103499 CORONA VAC 9/29/2021 9/29/2021
TERJUN MEDAN MARELAN 081264805576 CORONA VAC 9/29/2021 9/29/2021
BESAR MEDAN LABUHAN 081269430867 V CORONA VAC 9/29/2021 9/29/2021
BAGAN DELI MEDAN BELAWAN 088262284281 CORONA VAC 9/29/2021 9/29/2021
TJ. MULIA HILIR MEDAN DELI 085262190855 CORONA VAC 9/29/2021 9/29/2021
GLUGUR DARAT I MEDAN TIMUR 082286815735 CORONA VAC 9/29/2021 9/29/2021
MABAR MEDAN DELI 085373575581 V CORONA VAC 9/29/2021 9/29/2021

PULO BRAYAN BENGKEL
MEDAN TIMUR 085261593019 CORONA VAC 9/29/2021 9/29/2021
TITIPAPAN MEDAN DELI .081361541990 V CORONA VAC 9/29/2021 9/29/2021
083171752602 CORONA VAC 9/29/2021 9/29/2021
082288919653 CORONA VAC 9/29/2021 9/29/2021
085296187898 CORONA VAC 9/29/2021 9/29/2021
083132168584 CORONA VAC 9/29/2021 9/29/2021
082360725213 CORONA VAC 9/29/2021 9/29/2021
RENGAS PULAUMEDAN MARELAN CORONA VAC 9/29/2021 9/29/2021
Merek Vaksin
A : Sinovac
Kepersertaan BPJS
BPJS PBI
BPJS Non PBI
Non Anggota
Total
Pemberian Dosis
Dosis 1
Dosis 2
Total
Dosis I Dosis 2
Tanggal KETERANGAN
n Vaksin

kesmas/Faskes)
FORMAT PENCATA
TINGKAT PUSK

Nama Penerima Umur

Vaksin
(> 60Tahun)
1 Q-000SHJMX 1207261601740002 GINDO PANGARIBUAN L PP 47
2 Q-000SH9Z0 1271136612030002 DELLA CHRISTINE NAT P PP 18
3 Q-000R2VEU 3175105512780002 LISBET SITORUS P UMUM 41
4 Q-000SHSI9 1271131201030004 ABED PRATAMA L PP 18
5 Z-000A4X9T 1271130206580003 PARLINDUNGAN SIM L LANSIA 63
6 Q-000SGV1D 1271135112820003 DESMA KARTIKA SIT P PP 38
7 Q-000SLJ0F 1271082611720001 HENDRA KESUMA L PP 48
8 S-93729574 1271060408840003 ANDI SYAHRIAL L PP 37
9 Q-000S7L89 1271133112710001 SYAHRI L PP 50
10 Y-0119TR51 1401033011970002 MUHAMMAD PARIS P L UMUM 24
11 Q-000SH312 1271136305770003 RITAWANI SIANTURI P UMUM 44
12 Q-000SH9Z6 1271184203910005 SITI YOHANA SIRAIT P UMUM 30
13 P-P9Z15B6I 1201022707930002 IRWAN MESTA SITUM L PP 28
14 Q-000SGV0L 1271132201740001 JOHANNES SIMARSOIT L PP 47
15 P-PUFN6LX1 1201062409020002 TONI PRIMA SITUMO L PP 19
16 Q-000SIKZA 1271202605860003 RAMDANI L PP 35
17 P-PQ7TFAVH 1208202809990001 AROS ANRI SIAGIAN L PP 22
18 P-2OKTMKWV 1201126302980002 PENINA HASUGIAN P PP 23
19 Q-000SMLZA 1271131811790004 BINAL SIMANGUNSON L UMUM 42
20 P-5NPDC9YV 1271125808810007 NURLELA SIREGAR. SE P UMUM 30
21 Q-000SLXG2 1271130810930005 SAUT RODO SIMANUN L UMUM 28
22 P-8SO1UBRF 1271134105910004 TRIWARDANI L PP 30
23 Z-000A4X9P 1271131107570003 BANGUN NAINGGOLA L LANSIA 64
24 Q-000SIX18 1271186603920007 SAFINA TUN NAJAH P UMUM 29
25 Q-000SKVT4 1271134404030001 DELLA FILIPI BR. ARUA P UMUM 18
26 Q-000SHS4C 1271135207840002 VITTA SAFITRI P UMUM 37
27 P-B1BYCO1A 1271083101910001 AHMAR RAIS MARBUN L PP 30
28 P-CKI8GM4R 1271130103900003 MUHAMMAD ASWIN N L PP 31
29 Q-000SI17W 1271136606970002 NANDA TRIANA P UMUM 24
30 P-IBWD0O1P 1271080401930002 IMAN KURNIAWAN SA L PP 28
31 P-GOARYKKC 1271134504010006 SRI ASTUTI P PP 20
32 P-K4IM1TGS 1271011708670001 KHAIDIR L RENTAN 54
33 Q-000SW5RB 1271060405010001 ARI ABEDNEGO PANG L PP 20
34 Q-000SOXWH 1271061612610000 DIAPARI DANIEL PAN L PP 59
35 P-M8BOEZBZ 1271135002770002 WINDA ANTIKA P UMUM 44
36 Q-000SI1ZV 1271134808690002 SUSIATIN NINGSIH P PP 52
37 S-5F5BDFFE 1271122202540001 BACHTIAR EFFENDI L LANSIA 67
38 P-OIFUWBBN 1271035011900005 NOVI ANGGRAINI P UMUM 31
39 P-Q7C9QM2X 1271131608660005 SYAHYAR AMIR L RENTAN 55
40 1222030701800005 TIMBUL WAHYUDI L PP 41
41 Z-000A4DWA 1271132708600002 SUWARDI L LANSIA 60
42 P-QC0DVOBI 1201066705960001 MEI MUSDALIFAH MA P UMUM 25
43 P-S2EJ2WQJ 1271013005880003 TANTO WAHYONO L PP 33
44 P-Q0C0A3MW 1205126608940001 ANGGUN PUSPITA DE P UMUM 26
45 S-65DA54B5 1271133112600045 SABAR L LANSIA 60
46 Q-000SHA3O 1271130805840004 RONI GIRSANG L UMUM 37
47 Q-000SJDQL 1271134705620002 SUMIAH P RENTAN 59
48 Q-000SLYO0 1271130304780002 SALOM SAPARI SIANTU L PP 43
49 Q-000SH36X 1271134606020003 UTAMI RISWANDARI P UMUM 19
50 Q-000SH9Z3 1271085009840005 ANI P UMUM 37
51 Q-000SOYMI 1271061903960003 JOSEPH PRANANDA P L PP 25
52 Q-000SIKX2 1271131307030005 MAULANA SIGIT L UMUM 18
53 Q-000SNX2I 1271131808810006 RAHMAD SAPUTRA SI L PP 40
54 CANDA SAPUTRA PAN L PP 28
55 Q-000SH9Z9 1271131003910003 MARTIN GIRSANG P UMUM 30
56 Z-000A4GU2 1271122202590002 BINTANG TIMBUL L LANSIA 62
57 P-Q77L8ECR 1201120802960003 HARJI HASUGIAN L PP 33
58 S-0114CFB8 1271131602470002 JOKER NAPITUPULU L LANSIA 75
59 P-R5PEKYVO 1271131206650003 HOLBEN SINAGA L PP 56
60 P-RABHVMBG 1271131203650003 SAMUDIONO L PP 56
61 P-REH41CG0 1271131201990001 KEVIN FRANSISKUS L UMUM 22
62 Q-000SJPDR 1271136806980001 MIKA CHAROLINA SIA P UMUM 23
63 P-Y6UO3PKO 1207244605020001 ANNISA AULIA SARI P PP 19
64 Q-000SJA44 1271135304660002 NANI P RENTAN 55
65 Q-000SJ94L 1271134606880002 AMINAH P UMUM 33
66 Q-000SJDLY 1271136312910004 DEVIA P UMUM 30
67 P-QN4BHALZ 1102110608930001 DEDI BARUTU L PP 28
68 P-S6P4U1RN 1271134203680003 SYARIFUL AINI P RENTAN 53
69 P-SAGEMSQK 1271134901720003 FENTI NURLINCE SIM P RENTAN 50
70 1271131506990004 AGUM HAREY L PP 21
71 P-T4BR72E3 12711134202850010 JUPIKA SIRAIT L UMUM 36
72 Q-000SCL0H 1207261204840013 HENDRI L PP 37
73 Q-000SJPZ5 1271136207020005 FURY ANGGREANI L UMUM 19
74 S-5C5B5C06 1271134511400002 THE LIAN HUN P LANSIA 82
75 S-11D7A4C5 1271137112480007 ZULEHA HASIBUAN P LANSIA 72
76 P-TO2BSNXQ 1271131108990001 M. HAINUL HADI L PP 22
77 P-TU8BB5II 1271186911770006 SAUDUR SINAGA L UMUM 44
78 P-TR3545O7 1271131509640002 BENGKIONG L PP 57
79 P-U1NAZVIC 1271181208720007 DULAURI S L PP 49
80 Q-000SI23R 1271136603940004 DINA SIAGIAN P UMUM 27
81 Q-000I3GE2 1273015106990003 EFITRIANA LAIA P PP 22
82 Q-000SLZDS 1271135002620003 LASMARIA SITUMORA P RENTAN 59
83 Q-000SIL2G 1271130501040003 YOSUA ADI PRANATA L REMAJA 17
84 Q-000I3WAB 1271132807920004 IKHSAN MAULANA L PP 29
85 P-V950F51Z 1271134801810003 MARIANA P UMUM 40
86 P-UZ84DVCU 1271130910000002 TODO LEONARDO L PP 23
87 J-0001080G 3471020903850001 BAGUS DWI SASONGK L PP 36
88 P-U5P5YKBV 1271185905000005 TRESIA MEI RIRIS SI P UMUM 21
89 S-F92022F9 1274011307790002 MUHAMMAD IRFAN L PP 42
90 P-VIHWW2QY 1271124912960003 SURYANI L PP 24
91 P-WT2MXJ37 1271082203960002 ADE CUNDA PRATAMA L PP 25
92 P-W5MWTUZR 1271130804650001 AMINULLAH L PP 56
93 P-WATUGFDO 1202085609910002 LAURA PARDEDE L UMUM 30
94 P-XHVH60BA 1271132305000006 MUHAMMAD RIZKY L PP 21
95 Q-000SI36T 1271133105670001 KHAIRUDDIN L PP 53
96 Q-000SILWP 1271135303040009 AYU TRISNA BR. LUBIS P REMAJA 17
97 P-WKUKC3K0 1271124712020001 ADELIA FITRI P UMUM 48
98 P-U8W2LJQ8 1271134409850004 MELI KUNTARI P UMUM 36
99 P-WWVFMT22 1271120604990002 M. KHADAFI HSB L UMUM 22
100 K-0000YZ0T 1271136301750003 DASLI BUATON L UMUM 46
101 P-WZ6MQ61A 1271135006890003 YUNIAR P UMUM 32
102 K-0000Z2SE 1271136711890011 IMELDA SIMANJUNTA P PP 31
103 Q-000SK68S 1271136602020004 HIZRATUS SANIA MAH P UMUM 19
104 Q-000SK9RJ 1271136210030002 ANANDA SABRINA MA P UMUM 18
105 K-0000YX8O 1271134311640004 HELENA PANGABEAN P RENTAN 57
106 Q-000SIXWV 1271135908640003 ROSLINDA MURNI N P RENTAN 57
107 Q-000SINCQ 1271135704690003 ERNALINA MARPAUNG P RENTAN 52
108 P-XG1W749F 1207023107860004 HAMKA RANGKUTI L PP 33
109 P-XILCEWP3 1205141302900005 DEDE SYAHPUTRA L PP 31
110 P-XNABDATZ 1271211006040002 M. IMAM SAID AKBAR L REMAJA 17
111 P-XR8AC39F 1271064304020007 SISKA PRATIWI P UMUM 19
112 P-XTMQHVIJ 1271135510690006 WIDASIH FAIL P RENTAN 50
113 P-XZGXT5A0 1271131111010006 SULTAN SAYHRIZAL Y L PP 20
114 P-XZNXYL8Q 12711135111880004 SITI RAHMAH P UMUM 32
115 P-XZNXYL8Q 1271081210000001 RUDI RIFANDI SEMBIR L UMUM 20
116 Q-000SLX6Y 1271135405790006 APOLIDA SIAGIAN P PP 42
117 Q-000SLJDQ 1271131106770004 ABD. HALIM L PP 43
118 Q-000BLVYJ 1271135110940004 NANDA RIADI P PP 27
119 Q-000SLZMM 1271136808700003 NURAINI SITORUS P PP 51
120 Q-000SJO26 1271065808810001 AGUSTINA BR. PANGA P UMUM 40
121 Q-000SINQS 1271130905000003 ZEUS HOTLAN SALIM L UMUM 21
122 K-0000Z18L 1271061002750001 RAHMAN SILABAN L PP 46
123 Q-000SH30R 1271134111720002 ROSMINA SINAGA P PP 49
124 Q-000SK9JV 1271082810010004 MUHAMMAD RIANDI L L PP 19
125 P-Y11FTVBR 1271125510880007 RIZKY AULIA P PP 33
126 P-Y06AE37N 1271085612730001 MASMURNI P UMUM 47
127 P-Y0A7MK5Q 1207256603910002 SARTIKA SARI P UMUM 30
128 P-XZUANSFC 1205061510030001 M. FAUZAN HAKIM L UMUM 18
129 P-XZQPS0L3 1271135708880002 SITI NURHASANAH P UMUM 30
130 Q-000SH35T 1271131311030002 DARWIN NAPITUPULU L REMAJA 17
131 K-0000YDEP 1271204502790007 MAWARNI NUVITA S P UMUM 42
132 K-0000Z5QR 1214082209980004 PILIPUS HALAWA L PP 23
133 Q-000SKVQW 12711315107020000 YUSUF PRATAMA NST L UMUM 19
134 K-0000Z5UB 1271132008020005 GILANG ANGGARA L PP 19
135 K-0000YY27 1208195610000001 CINDY THERESIA PAN P UMUM 21
136 Q-000SLFPW 1271131112750001 LASBON SINAGA L PP 46
137 Q-000SK4TS 1271086511030003 DIAH SYAHFITRI LUBIS P REMAJA 17
138 Q-000SNH5D 1271136904710003 PINTAULI SIAGIAN P RENTAN 50
139 Q-000SKVQA 1271135208990002 TIO AENJELY BR. SIM P UMUM 22
140 1271134912900001 DEVINA NABABAN P PP 30
141 Q-000SJNIF 1271136507820001 SELI SURIATI P UMUM 38
142 Q-000SMMH7 217111569859007 BERTUA DOLOK SARIB P UMUM 36
143 Q-000SLI54 1271135406850004 AMILIA P UMUM 36
144 Q-000SW4SF 1271135911960002 RINA ANGRAINI P UMUM 24
145 Q-000SW4RQ 1271135804990003 RAYSA REJEKI P PP 22
146 Q-000SMMKV 1271135706950004 TIA MONICA SARI PAN P PP 26
147 Q-000SLXQQ 1173047101940003 SARY ASNYA P UMUM 27
148 Q-000SM0QT 1271132310750002 VIKTOR NAPITUPULU L PP 46
149 Q-000SH9YU 1271130302960001 TORANG FHEBRIAN VA L PP 25
150 Q-000SK4MM 1271130204020005 M. ZULFAN FAHRI L UMUM 18
151 Q-000SLFMH 3175085510780004 POYBE ROHANA ARIT P PP 42
152 Q-000SH34S 1271131507020001 RIZALDY IMMANUEL L UMUM 19
153 Q-000CMDG3 1271136407000004 HAFIZATUL HUSNA P UMUM 21
154 K-0000YV1P 1271132104030003 ANDREAS KURNIAWA L UMUM 18
155 P-Y5BJUYGV 1271135203770006 MAULIANA SIGALINGG P PP 44
156 P-Y5E1N86N 1271136008030001 NADILA AGUSTINE P UMUM 18
157 P-Y4YMY61B 1271136111730001 NURAZIAH P UMUM 48
158 P-Y4S04OVM 1207051707990002 RONI CANDRA L PP 22
159 P-Y01HPN9N 1271080401010003 FARHAN ANANDA PR L UMUM 20
160 P-Y5RJYFQK 1271134601710001 TETY ERMINA SIREGAR P UMUM 50
161 P-Y7115YK0 1271086005010002 AYU SAHFANI P UMUM 20
162 P-Y59H5R1A 1207055110950001 WENNY SISKA SARI P UMUM 26
163 Q-000SIXJM 1271135011920005 RINI P UMUM 29
164 Q-000SIXT5 1271135706010001 ROBYATUL RAHMAH P UMUM 20
165 K-0000Z1O3 1271131910030001 ALDI GHIFFARY S L PP 18
166 Q-000SK48R 1271132601030001 AJI SATRIA L UMUM 18
167 Q-000SJNJI 1271130202810002 SUPRIONO L PP 40
168 Q-000SGV08 1271135104920002 AFRIANTY SIHOMBING P PP 29
169 Q-000SMKWD 1271132502000000 AGUNG PEBRI SETIAW L UMUM 21
170 Q-000SKIZT 1271131805870002 MEINDRA ILHAM L PP 34
171 Q-000SLYDV 1271136701740005 DAMERIA SILITONGA P UMUM 47
172 Q-000SMKLM 1271136909670003 SUNARSIH P RENTAN 54
173 Q-000C7N8X 1271084102680001 MARDELINA SIREGAR P RENTAN 53
174 Q-000SKVRS 1271132106030001 TIO FULALO SIMATUP L UMUM 18
175 Q-000C5VWZ 1271086904950001 ANGGI PUSPITA SARI P UMUM 26
176 Z-000A4KQG 1271136301920005 IKA MELATI PUJI ASPU P PP 29
177 P-Y8JXM0JD 1271134202760001 MERIANA P UMUM 45
178 P-Y8HWQX02 1271130812010002 HARDY ARIYANTO L UMUM 19
179 P-Y8G0WERN 1271135208840005 ASNAH P UMUM 38
180 P-Y8BCSWZY 1271136204750001 MARIA NOPA P UMUM 46
181 J-00045NEC 1271137108980003 RINI P PP 23
182 P-Y7VL8ZJ9 1271130510940005 DIKA NUGRAHA L PP 27
183 P-Y7YSNZRY 1271081007030006 FRITZ E ANDREAS SI L UMUM 18
184 P-Y7R3S7VZ 1271134301690004 SUHERNINGSIH P PP 52
185 P-Y7PCRKCV 1207052904940001 BENI SYAHPUTRA L PP 27
186 P-Y7LM7YUT 1271130706990005 TRI AKBAR PRIMADAN L PP 22
187 P-Y7F4YWG0 1271086406970003 ADE HIDAYANTI L UMUM 24
188 P-Y7CDIBQF 1271084105880002 SRI YANTI P UMUM 33
189 P-Y80MVEVL 1271135309850004 DEDEK HALIMAH SIRE P UMUM 36
190 P-Y8DKUVCW 1271136106700002 SUMARNI P RENTAN 51
191 P-Y858JRED 1271134709930001 ERVI ORIYENTANTI P UMUM 28
192 P-Y88IXICK 1271135603020002 BELA SYAFIRA P UMUM 19
193 P-Y83D4PJF 1271137003040003 MIRANDA NIA RAHMA P UMUM 18
194 P-Y8QC9PDT 1271136002690001 NIRWANA P RENTAN 52
195 P-Y9RBZGCC 1271137003910001 MAYA FRANSISKA SI P UMUM 28
196 P-YA9WNONL 1271132702750001 ZULKHAIRI L PP 46
197 P-Y98VVOYD 1271136312910001 BANI MASTURA P UMUM 30
198 P-YAAIUXL9 1271132005730003 KHAIRUL KUDADIRI L PP 49
199 P-YA6VRSV1 1271084311920002 NENY VINDISYA CHIHO P PP 29
200 P-Y9JYRWZW 2171104707019008 SELVI SUNARTO P UMUM 20
201 P-Y92CSRRQ 1271130303970002 MULI SEMBIRING L PP 24
202 P-Y8YNP6TV 1271135406870006 LILI SYAHPITRI P PP 34
203 P-Y8WM8KBK 1271131206670002 ISNENSYAH L RENTAN 54
204 P-Y8TKVEG3 1271130102940001 OGI HARIANTO L UMUM 27
205 J-00007M7K 1271131401980003 RAHMADANI L UMUM 23
206 P-Y9OSK9CZ 1202062202810003 ROBIABRIJO SIHOMBI L PP 40
207 P-Y9WSD48X 1271135209950005 ENDANG ROSAULINA P PP 26
208 P-Y9MISN4M 1271130505970001 RIAN AJISETIO L PP 24
209 P-Y9TPDJOL 1271065604910008 SANTI KRISTINA HUT P UMUM 30
210 P-YA149748 1271130301030003 ANDRE PRAYOGA L UMUM 18
211 P-Y9ZTVGSW 1271136107680003 SUPIAH BR. SIHOTANG P RENTAN 53
212 P-YA1TAB07 1271130911020004 ADE RAHMADANI L UMUM 18
213 P-YA4A7OCO 1271066510950001 DWI HARTI NINGRUM P UMUM 25
214 P-YAKM5YKO 1271136409990001 MAHINI P UMUM 24
215 P-YA358SQG 1271134202800005 KHADIJAH P UMUM 40
216 P-YA7USIK2 1271132309970006 MHD. SYUKRI L PP 24
217 P-Y9AYA0LO 1271136308830004 HAROIDA BR. LIMBON P UMUM 37
218 P-Y9D462E6 1223017005940004 LAILAN SAKINAH P UMUM 27
219 P-Y9FHQRTN 1271137101630001 DJAMILAH P RENTAN 58
220 P-Y9HNRL69 1271185107930002 LIDIA LESTARI MANU P UMUM 28
221 P-Y8LTVMXG 1271096511030003 AISYAH FITRIANI BR. P REMAJA 17
222 P-Y95UBLZM 1271135110930005 ALFA RAHMI P UMUM 27
223 S-6585BC2D 1271135408590001 IFA LATIFAH P LANSIA 62
224 P-YA5EJAXV 1271136809730002 ROSMIAN SIANTURI P UMUM 48
225 Q-000S33F9 1505024305871001 VERA WATI SIMAMOR P PP 31
226 Q-000SLF6C 1271135709930004 SINTHA NOVITA BR. G P PP 28
227 Q-000SMKGF 1271136304740002 SAMAIYAH P UMUM 47
228 Q-000SNG3S 1271134603030001 ELVIANIS MANAO P UMUM 18
229 K-0000ZBQO 1271125402030005 JELITA HONDRO P UMUM 18
230 Q-000SNH0O 1271085005030001 KRISNAWATI TESALON P UMUM 18
bel 10. Format Pencatatan Pelayanan Vaksinasi COVID-19 di Tingkat Fasyankes

MEDAN LABUHAN

Alamat Kelurahan Kecamatan No.Hp BPJS Non Non
BPJS PBI
PBI Anggota
JL. KIWI II NO. 85KENANGAN PERCUT SEI TUAN 082166268199 √
LK. IX SEI MATI MEDAN LABUHAN 081260561219 √
LK. 7 LOR. 3 KOMP. LAMA SEI MATI MEDAN LABUHAN 081265201239 √
LK. XV SEI MATI MEDAN LABUHAN 081311377817 √
LK. I KP. BAHARIMARTUBUNG MEDAN LABUHAN 081375580359 √
LK. V GG. FAMILYMARTUBUNG MEDAN LABUHAN 083199862200 √
LK. I KP. BAHARIMARTUBUNG MEDAN LABUHAN 081282640917 √
JL. KAPT. ILYAS LK.SEIIII MATI MEDAN LABUHAN 081930309328 √
JL. JERMAL LOR. SVEI MATI MEDAN LABUHAN 085359457773 √
LK. I MARTUBUNG MEDAN LABUHAN 081365861384 √
JL. KAPT. ILYAS LK.SEIIII MATI MEDAN LABUHAN 082167617230 √
LK. III BATANG KILAT SEI MATI MEDAN LABUHAN 085362030310 √
JL. PAYA BAKUNG GG. MUSHOLLA MARTUBUNG MEDAN LABUHAN 085262471410 √
LK. VIII SEI MATI MEDAN LABUHAN 081264008036 √
JL. PANCING V LK.BESAR
LK. IX KOMP. GABION SEI MATI MEDAN LABUHAN 085260460219 √
JL. KAMP. TENGAH LK. SEIIV MATI MEDAN LABUHAN 081362492667 √
LOR. VI LK. XVI SEI MATI MEDAN LABUHAN 087813072120 √
LK. III BATANG KILAT SEI MATI MEDAN LABUHAN 083186590132 √
JL. LOR. I MASJID LK. MARTUBUNG
I MEDAN LABUHAN 08566219552 √
LK. I BAHARI MARTUBUNG MEDAN LABUHAN 085270802359 √
LK. VI SEI MATI MEDAN LABUHAN 082360125695 √
JL. RAWE III LK. IVTANGKAHAN MEDAN LABUHAN 082272827870 √
JL. T. BAHAGIA 13 BLOK. BESAR II MEDAN LABUHAN 085260697050 √
JL. PLATINA I LK. XVITITI PAPAN MEDAN DELI 082268065411 √
TITI PAPAN
JL. PLATINA I LK. XVI MEDAN DELI 081269665715 √
JL. P. BAKUNG LK.MARTUBUNG
LK. VI SEI MATI MEDAN LABUHAN 082276239858 √
LK. 4 GG. AMAL MARELAN TANAHVII 600 MEDAN MARELAN 081361483235 √
JL. KL. YOS SUDARSOMARTUBUNG
JL. P. BAKUNG LK.MARTUBUNG
LK. X SEI MATI MEDAN LABUHAN 081361666440 √
JL. SEPAKAT NO. 12 TANJUNG
A REJO MEDAN SUNGGAL 0819838813 √
LK. IV KAMBES BESAR MEDAN LABUHAN 085260455580 √
JL. PULAU RIMAU LK. MARTUBUNG
LK. XI SEI MATI MEDAN LABUHAN 085359457773 √
LK. VII SEI MATI MEDAN LABUHAN 082370667456 √
LK. XII SEI MATI MEDAN LABUHAN 085362395176 √
LK. XI KOMP. BARU SEI MATI MEDAN LABUHAN 081220515449 √
TITI PAPAN
JL. PLATINA I LK. XVI MEDAN DELI 082182040509 √
LK. XI LOR 5 SEI MATI MEDAN LABUHAN 081947616856 √
LK. XVII SEI MATI MEDAN LABUHAN 082365707117 √
LK. XIV SEI MATI MEDAN LABUHAN √
LK. XI SEI MATI MEDAN LABUHAN 085261252362 √
JL. TITI PAHLAWAN LK. PAYA3 PASIR MEDAN MARELAN 081396689575 √
LOR. III LK. 7 SEI MATI MEDAN LABUHAN 081263577973 √
JL. MELATI BLOK MARTUBUNG
G MEDAN LABUHAN 081263501578 √
LK. III BATANG KILATMARTUBUNG MEDAN LABUHAN 081260966002 √
G MEDAN LABUHAN 089528277700 √
LK. XVI SEI MATI MEDAN LABUHAN 085763229388 √
JL. MATAHARI H RELVETIA MEDAN HELVETIA 0895602129824 √
LK. V SEI MATI MEDAN LABUHAN 082173205196 √
JL. KAIL LK. V SEI MATI MEDAN LABUHAN 0895638550801 √
LK. VI P. RAMBAIMARTUBUNG MEDAN PABUHAN 081396451978 √
G MEDAN PABUHAN 081260320843 √
LK. V P. RAMBAIMARTUBUNG MEDAN PABUHAN 08126562151 √
LK. IV KAMBES MARTUBUNG MEDAN PABUHAN 085296868941 √
LK. VI P. RAMBAIMARTUBUNG MEDAN LABUHAN 081265892744 √
P. RAMBAI LK. IV SISIMARTUBUNG
TOL MEDAN LABUHAN 085373456988 √
LK. IV KAMBES MARTUBUNG MEDAN LABUHAN 082362083661 √
P. RAMBAI GG. AMAL MARTUBUNG MEDAN LABUHAN 081274958647 √
P. RAMBAI LK. IV SISIMARTUBUNG
TOL MEDAN LABUHAN 082274906602 √
JL. JERMAL LK. XVIISEI MATI MEDAN LABUHAN 082361156145 √
JL. OSWALD SIAHAAN SIBOLGA HILIR SIBOLGA UTARA 085262748175 √
LK. XIV SEI MATI MEDAN LABUHAN 085260070502 √
KL. YOS SUDARSO LK. MARTUBUNG
LK. VII KL. YOS SUDARSOBESAR MEDAN LABUHAN 087811993407 √
P. RAMBAI LK. IVMARTUBUNG MEDAN LABUHAN 081262195150 √
JL. NACHODA LK. MARTUBUNG
JL. MASJID LK. IMARTUBUNG MEDAN LABUHAN 081269117391 √
LK. II KP. BESARMARTUBUNG MEDAN LABUHAN 081263388883 √
LK. 4 KP. BESARMARTUBUNG MEDAN LABUHAN 085297571180 √
LK. XIII SEI MATI MEDAN LABUHAN 081264510748 √
RENGAS PULAU
JL. M. BASIR LK. 30 MEDAN MARELAN 081240464027 √
LK. III MARTUBUNG MEDAN LABUHAN 089520886489 √
LK. XV LOR X SEI MATI MEDAN LABUHAN 082277014590 √
LK. II SEI MATI MEDAN LABUHAN 088264808601 √
LK. XV LOR. PARSAORAN SEI MATI MEDAN LABUHAN 085206745451 √
JL. P. INPRES GG. WALET MARTUBUNG
LK. VII MEDAN LABUHAN 081378866914 √
MARTUBUNG
JL KL. YOS SUDARSO GG. MUSHOLLA MEDAN LABUHAN 088807237383 √
JL. RUMAH LAMA LK. MARTUBUNG
KOMP. TKBM BLOKSEI A MATI MEDAN LABUHAN 082360922960 √
LK. IV KAMBES SEI MATI MEDAN LABUHAN 081370933702 √
LK. XV LOR. PARSAORAN SEI MATI MEDAN LABUHAN 08126479026 √
KOMP. TKBM BLOKSEIC MATI MEDAN LABUHAN 081263341300 √
KOMP. TKBM BLOKSEIC MATI MEDAN LABUHAN 082166595956 √
LK. 17 GG. TRIMO T ERJUN MEDAN MARELAN 081396028358 √
JL. MESJID LK. IMARTUBUNG MEDAN LABUHAN 081269117391 √
MARTUBUNG
JL. BAKTI ABRI LOR. TENGAH MEDAN LABUHAN 082118039426 √
JL. BINJAI KUALA DSN SEIVLIMBAT SELESAI 083173996472 √
LK IX SEI MATI MEDAN LABUHAN 085358997528 √
LK. XV LOR PARSAORAN SEI MATI MEDAN LABUHAN 081273323344 √
LK. XII LOR. MULIASEI II MATI MEDAN LABUHAN 085362396349 √
LK. XVIII SEI MATI MEDAN LABUHAN 087785164081 √
LK. XIV LOR. SEKOLAH SEI MATI MEDAN LABUHAN 082267253492 √
LK. X LOR. III SEI MATI MEDAN LABUHAN 082166521754 √
LK. X LOR III SEI MATI MEDAN LABUHAN 082268653096 √
LK. III SEI MATI MEDAN LABUHAN 082286089462 √
LK. XVI LOR V SEI MATI MEDAN LABUHAN 085762193566 √
LK. IX JL. GEROPAH BAGAN DELI MEDAN BELAWAN 085262220567 √
MARTUBUNG
LK. VI SISI REL PJKA MEDAN LABUHAN 085262233077 √
MARTUBUNG
LK. III JL SRI BULAN MEDAN LABUHAN 081396431241 √
JL. MESJID LK. IMARTUBUNG MEDAN LABUHAN 085763441419 √
JL. CILACAP TIMUR NO. BELAWAN
10 II MEDAN BELAWAN 081261815180 √
LK. I SEI MATI MEDAN LABUHAN 082165016609 √
LK. I SEI MATI MEDAN LABUHAN 081365901655 √
LK. XVIII SEI MATI MEDAN LABUHAN 082275154172 √
LK. 15 LOR PARDAMEAN SEI MATI MEDAN LABUHAN 082362211032 √
LOR. 4 LK. IX SEI MATI MEDAN LABUHAN 085361678880 √
LK. III SEI MATI MEDAN LABUHAN 083167691737 √
LK. 29 PEKAN LABUHAN MEDAN LABUHAN 082267440782 √
LOR MULIA II LK XIISEI MATI MEDAN LABUHAN 085261840845 √
LK. 29 JL. PASAR LAMAPEKAN LABUHAN MEDAN LABUHAN 082267440782 √
LK. V MARTUBUNG MEDAN LABUHAN 081377455184 √
LK. IV KAMBESMARTUBUNG MEDAN LABUHAN 081269782367 √
JL. ASAM SIMP. KANTOR MARTUBUNG MEDAN LABUHAN 082275017503 √
LR. SEKOLAH NO.BELAWAN
3 II MEDAN BELAWAN 08982811372 √
JL. ASAM SIMP. KANTOR MARTUBUNG MEDAN LABUHAN 081265701838 √
JL. KL. YOS SUDARSO MARTUBUNG
LK. IV MEDAN LABUHAN 081320489585 √
JL. SELEBES II PANJANG BELAWAN II MEDAN BELAWAN 082362527104 √
LOR MESJID BAGAN DELI MEDAN BELAWAN 082168334541 √
LK. II CINGWANMARTUBUNG MEDAN LABUHAN 082277274637 √
LK. III JL BAKTI ABRIMARTUBUNG MEDAN LABUHAN 087747615145 √
LK. II MARTUBUNG MEDAN LABUHAN 081315911814 √
LK. II KP. BESARMARTUBUNG MEDAN LABUHAN 082273997661 √
LK. III JL BAKTI ABRIMARTUBUNG MEDAN LABUHAN 081218830606 √
LK. III SISI TOL MARTUBUNG MEDAN LABUHAN 081269689299 √
SIMP. KANTOR NO. 16 MARTUBUNG
BLOK VI MEDAN LABUHAN 089630801359 √
P. RAMBAI LK. VI GG. MARTUBUNG
AMAL MEDAN LABUHAN 081375116281 √
LK. III SRI BULANMARTUBUNG MEDAN LABUHAN 081396739838 √
BAKTI ABRI PERUM. TAMAN MARTUBUNG
CINGWAN MEDAN LABUHAN 085367076262 √
LK. IV KP. BESARMARTUBUNG MEDAN LABUHAN 085277197443 √
LK. V MARTUBUNG MEDAN LABUHAN 085263484721 √
LK. IV KP. BESARMARTUBUNG MEDAN LABUHAN 082363538517 √
LK. V PAYA BAKUNG MARTUBUNG MEDAN LABUHAN 089643115987 √
LK. IV KANTOR CAMAT MARTUBUNG MEDAN LABUHAN 082166636120 √
P. RAMBAI LK VIMARTUBUNG MEDAN LABUHAN 081267506611 √
JL. KL. YOS SUDARSO LK. MARTUBUNG
LK. IV KANTOR CAMAT MARTUBUNG MEDAN LABUHAN 082267490979 √
LK. VII MARTUBUNG MEDAN LABUHAN 083897455767 √
LK. VII SP. KANTOR MARTUBUNG MEDAN LABUHAN 081375678908 √
LK. V SEI MATI MEDAN LABUHAN 081264091336 √
LOR V LK. XI SEI MATI MEDAN LABUHAN 081361318227 √
JL. M. BASIR LK. 31
RENGAS PULAU MEDAN MARELAN 083176003710 √
JL. M. BASIR LK. 31
RENGAS PULAU MEDAN MARELAN 081362104877 √
TKBM BLOK E NO.SEI 12 MATI MEDAN LABUHAN 081264717285 √
s
Dosis I Dosis 2
Merek Vaksin
Screening Pemberian No.Batch Pemberian No.Batch
Vaksin Vaksin
9/30/2021 24005721 SELESAI
9/30/2021 24005721 SELESAI
9/30/2021 24005721 SELESAI
9/30/2021 24005721 SELESAI
FORMAT PENCATATAN P
TINGKAT PUSKESMA

Nama Penerima Umur

Vaksin
(> 60Tahun)
1 P-MCXAW1WE 1271146610060001 SAFIRA FITRIA P REMAJA 14 : JLN. PERT
2 P-NCMA519R 1207266505070003 RATNA SARI P REMAJA 14 : JLN PASA
3 P-NZXJURJG 1207266108070006 KARTIKA PERMANA P REMAJA 14 : DSN XI PS
4 P-OOHPRX3K 1207262607070007 RASYAH FAHREZA HRP P REMAJA 13 : PSR 7 DSN
5 P-OTSG8EMK 1271143112060003 REZA ALFARIZI L REMAJA 14 : JLN. LET
6 P-PJ3THCOF 1207261011070013 LEONY NUR RIZKY SI P REMAJA 14 : JLN PENGU
7 P-PGUXPXS7 1207266003070008 RAUDHATUL SAFINA H P REMAJA 14 : JLN BERIN
8 P-PECX5369 1271140304070011 BRIAN SYAHPUTRA PU L REMAJA 14 : JLN SEDE
9 P-PC9LF8O6 1271145510070003 TIARA SINTA BR SIMB P REMAJA 14 : JLN TIRTO
10 P-P5T4AX4S 1271146205060001 NAYLA DWI PUSPITA P REMAJA 15 : JLN TIRTO
11 P-PSC8WG19 1207265409070003 PUTRI DOLI RAMADHAN P REMAJA 14 : JLN BENT
12 P-PORHYDVB 1271140511060002 KHOYRUN HAKIM PANJ L REMAJA 14 JLN PSR VI
13 P-PLO8321H 1271142207060002 AZIZ SYAHPUTRA LUBI L REMAJA 15 JLN BERSAM
14 P-PW7SGXPG 1207260511070003 RAFKI AHMAD L REMAJA 14 JLN BERING
15 P-35E3FFHS 1271147107070003 DINA AMALIA HRP P REMAJA 14 JLN BENTEN
16 P-0NTFBNZI 1271140702080001 ANANDA RAJA ADATY P REMAJA 14 JLN PADANG
17 P-4HRA108C 1207266005060018 RIZKY WULANDARI P REMAJA 15 JLN BERING
18 P-9TF14MX5 1271144708070001 ASRYANDA NEVANKA P REMAJA 14 JLN BERSAM
19 P-6EPVNC0Z 1207266908070010 PINKAN AULIA SHAFIR P REMAJA 14 PSR 7 BERI
20 P-8HM4QSV5 1207264209070006 NAZWA AULIA P REMAJA 14 JLN BERING
21 P-AYDYE4US 1271145408070004 AYU NABILAH ZAHARA P REMAJA 14 JLN BTN HU
22 P-BWA0AB7Q 1207262206070003 RIYANDI L REMAJA 14 DSN IX KUI
23 P-CWXBRWFV 1271141705070004 AGUNG DERMAWAN L REMAJA 14 JLN BERSAM
24 P-FPBCYNBN 1207267012070006 TENGKU CHANAYA PUT P REMAJA 13 JLN KENARI
25 P-JQUKEFZI 1207266706080004 REZTY DWI SHEINA P REMAJA 13 JLN BENTEN
26 P-LEKN5TXO 1207264602070001 NAYA FEBRI NADILA P REMAJA 14 JLN. BENTEN
27 P-E3VNBU1U 1271014704070003 NAZWA FAIZA APRILIA P REMAJA 14 : JLN. BENT
28 P-GWRFV31Y 1271030902070001 ALREZCHA FARRELL H L REMAJA 14 JLN M. YAKU
29 P-IHAB34A0 1207264111070007 SURISMA CLARA P REMAJA 14 PSR 7 BERI
30 P-PXTNM3IZ 1271141703070003 RAFFI LIANTO L REMAJA 14 JL BERSAMA
31 P-PXTVRDI6 1207267101070007 STEFFANI SUMANTRI N P REMAJA 14 PSR 7 BERI
32 P-ORCEE8UM 1271145507070005 RAISYA FADILLA P REMAJA 14 Jl letda sujo
33 P-Q15F5C1H 1207262901070011 ALFARISI ANGGARA P L REMAJA 14 JLN BERING
34 P-QJD2OM3X 1271145701070007 TASYA SULISTIA SITEP P REMAJA 14 JL BENTENG
35 P-QI3SW5YC 1271147107070001 RISMA PRATIWI P REMAJA 14 JLN BERSAM
36 P-QQJAKW1D 1271186511080003 DHEA ROULINA BR PU P REMAJA 14 JLN KIWI 12
37 P-QVLFW6AN 1207265903080010 NADINE AL ZULAIKHA P REMAJA 13 JLN BERINGI
38 P-QSQ2GKL7 1271144108080003 PUTRI UMMAIRAH NAS P REMAJA 14 PSR 6 MED
39 P-QNZ8SVHK 6101010902070001 TIMOTHY ADIL PARTO L REMAJA 14 JLN PERTIWI
40 P-R2T7L2NW 1271141706080002 WILDAN L REMAJA 13 JLN TIRTOSA
41 P-QYSAYIUR 1208066512060001 LEGI CRIS NATALIA T P REMAJA 14 JLN KIWI 23
42 P-RB0G9F4A 1207265303070009 AS SYIFA QOLBINA MU P REMAJA 14 : JL BERIN
43 P-R760JCQQ 1207283004070006 JOAN PRATAMA SIMAN L REMAJA 14 JLN KIWI RA
44 P-RLDV4W0Q 1207262011060015 NICOLAS SATRIA PAN L REMAJA 14 JL PELIKAN
45 P-Q6MRGS6Q 1271146711070001 RIKA AFRIDA P REMAJA 14 JLN BERSAM
46 P-RTDKYWRE 1207264607060019 TRIA AMBAR WATI DAM P REMAJA 16 JL MAKMUR
47 P-RTVAIZDU 1207267108050011 NELLA THERESIA. A. P REMAJA 16 JLN PASAR
48 P-RQU1X52E 1207263101080009 ARYA NUGRAHA L REMAJA 13 JLN PELIKAN
49 P-RW2GLCMA 1207266703070010 NABILA SAKINA LUBIS P REMAJA 14 JLN KIWI 27
50 P-RYPC0YAM 1271046709080001 NAVDIA SHIFA P REMAJA 14 JLN TANGG
51 P-S0WKPPWA 6408025407090001 NAYLA ADARA PANE P REMAJA 12 LETDA SUJ
52 P-S65RDQQU 1271140711080003 MUHAMMAD AFKAAR A L REMAJA 14 JL TIRTOSAR
53 P-SAXTXLUW 1271145604070003 MUTIARA SYAHLIN P REMAJA 13 SEI ROTAN
54 P-SD2L56ZY 1207262802070001 AFIZ MARBUN L REMAJA 14 JL MESJID
55 P-SHBPYIMO 1271145402080007 BEBY HENSI UTAMI P REMAJA 14 JLN BENTEN
56 P-SLJ7YLRT 1223016603080004 FAIRUZ AZ-ZAHRA P REMAJA 13 JL BERINGIN
57 P-SOO4Q0XC 1271146306080002 CINTA TRIWAHYUNI P REMAJA 13 Jl Bersama n
58 P-SUGMR0YN 1271145909080004 NATASYA RAMADHANI P REMAJA 13 JL. LETDA
59 P-SWQUK1U0 1271144506080002 WINDA KHAIRINA P REMAJA 13 JL MAKMUR
60 P-T2OM50S6 1207262407080004 RADITYA ANZARIZKY L REMAJA 14 JLN PELIKAN
61 P-T9B2UV6T 1271207103080002 BUNGA NAILA BALQIS P REMAJA 14 JLN CEMARA
62 P-TE2S1EHB 1271140607080005 MICKO HANDIKA L REMAJA 13 JLN BENTEN
63 P-THMF2LGK 1207266004080011 KEYLA PUTRI P REMAJA 14 JLN PASAR
64 P-TJXND4IX 1207265404080015 EVA NIA APRISYAH P REMAJA 14 JLN BANTA
65 P-TOXMROU9 1271042507080007 AMINARDI PRATAMA S L REMAJA 14 JLN RAJAWA
66 P-TRD7XX1I 1271184901080002 BALQIS RUMBAY PRAT P REMAJA 14 JL PANCASI
67 P-TTZ73KMX 1207261902080010 MHD. SYAHRAN MAULI L REMAJA 14 JL PASAR B
68 P-TWTGCN4C 1271144211070002 SASKIA MAWARNI LUBI P REMAJA 14 JL PANCASI
69 P-U0I27E85 1207266907070010 MERRY MAYA SETIANI P REMAJA 14 : SEI ROTAN
70 P-U5SOWAGU 1207265210070006 FITRIA ANGGRAINI P REMAJA 14 : JLN BENT
71 P-UA0XIO0Q 1104037107080003 NABILA PUTRI MAHARA P REMAJA 14 : PELIKAN II
72 P-UCE0OXDO 1207264312080008 DESY CHAIRANI HARA P REMAJA 14 : JLN PELIK
73 P-UEMAMUU1 1207266507090005 JASMINE ALMIRA HAR P REMAJA 12 : JLN PSR 7
74 P-UKQHDP0O 1271044407080004 NAZWA ZAIN P REMAJA 14 : JL PASAR
75 P-UN7SKTQZ 1271146502080007 SHELY P REMAJA 14 : JLN BANTA
76 P-UPVBGK01 1271146706080001 SITI HUMAIRAH P REMAJA 14 : JL BERSAM
77 P-USLH5D9K 1271145408080003 DINDA FRYSCHA P REMAJA 14 : JL AMPERA
78 P-UXO2C5QN 1271146409080004 ASHILA SYARIF LINTA P REMAJA 14 JL . LETDA
79 P-V0TVQGOF 1271141501080005 M ERLANGGA ZUTI L REMAJA 14 JL LETDA
80 P-VAMU5AV6 1271141205080005 MHD FAJAR WIRA PRA L REMAJA 14 JLN BERSAM
81 P-VD2TLSRD 1271146111080005 JELITA NADIN IRWANS P REMAJA 14 JL BERINGI
82 P-VMREOC8Y 1207266205070013 HALIMA IRAWAN P REMAJA 14 JL PUKAT BA
83 P-VNKFZ5QJ 1207264303090005 NADINE AISYAH PUTRI P REMAJA 12 PSR III DSN
84 P-VIMLNMBQ 1207265311080004 TADZKIA HANIFAH P REMAJA 13 JLN BENTENG
85 P-VUMCNTBC 1271146510080006 KAYLA NAZWA ALIZAR P REMAJA 14 JLN PADANG
86 P-VXAMJDUX 1271146512080006 DIANDRA ANGGRAINA P REMAJA 14 JL PERTIWI
87 P-VZZYJ1DP 1207262001070012 BRAM RICHARDO L REMAJA 14 JL BENTENG
88 P-W2WPYB91 1207261908070003 AKSAY RAHADI L REMAJA 14 PSR VII DSN
89 P-W5WY2ZTJ 1271142312070004 YOHANNES NATAEL Z L REMAJA 14 JL PERTIWI
90 P-W8TNB0OX 1271144311970008 LILI OZI RAMADHANI P REMAJA 14 JLN PERTIW
91 P-WD26LOA6 1271184110080001 MARIA FEBIOLA BR SIH P REMAJA 13 TEMBUNG P
92 P-WIP9Z805 1271141309080009 MUHAMMAD HOLIDIN L REMAJA 14 JL BERSAM
93 P-WFDKACTA 1271106311070003 NAZLA AISYAH P REMAJA 14 JL MEDAN B
94 P-WSA510B5 1271044111080006 RANIA SYAQIE P REMAJA 13 JL SELAMAT
95 P-RXH1GYYT 1271141809070002 MUHAMMAD GILANG R L REMAJA 14 JL BEJO GG
96 P-WPPBKNAP 1271140507080001 IZZATI ABIYYU AL AFIF L REMAJA 14 JL BERSAMA
97 P-WVDSF4WC 1271044907080002 SELFANI ANNISA P REMAJA 14 JL RAHAYU
98 P-WXL18XFY 1271142712080004 RAFA MIDO ARISKI P REMAJA 13 JL PADANG
99 P-X0D7DXQ1 1271144804080001 SASKIA PRATIWI SIT P REMAJA 14 JLN BARU N
100 P-X4AGTHOD 1271140602080003 M FEBRI HALOMOAN B L REMAJA 14 JL LETDA S
101 P-X7Y5E3YU 1271180604080003 ADITHYA PRATAMA ALI L REMAJA 13 JLN BERSAM
102 P-XCRAIVGP 1207262210080009 RIKY ANDERSON SIMA L REMAJA 14 JLN BANTAN
103 P-XFV3ATIS 1207262001090014 KARAN MICHEAL WALSI L REMAJA 13 JL PELIKAN
104 P-XJQ8LVNY 1207262203080020 M. IKRAM LUBIS L REMAJA 13 PASAR VII
105 P-XI4F2URD 1271044206090002 TABITHA MARBUN P REMAJA 12 DSN XIV GG
106 P-XK8YRFJ4 1207264507090004 AIRA RIZKY JULIATNU P REMAJA 12 JLN PELIKA
107 P-XNWSJSNI 1207265307090002 SELLY ATHALA DINAL P REMAJA 12 JLN PELIKA
108 P-XU969F59 1207261812080003 AHMAD FAUZAN NAPA L REMAJA 13 JL PASAR 7
109 P-XU1NAHOY 1207267004090007 DINA AULIA NASUTION P REMAJA 12 JLN MESJID
110 P-XWOP8A14 1207266712080002 MARIA SINAGA P REMAJA 13 : DSN XI JL
111 P-XZH1AG0V 1271145601090003 HABIBAH NAZIAH NASU P REMAJA 12 : JL PERTI
112 P-XZE1L5GE 1271151204080003 KHOIRUL ARHAM NASU P REMAJA 13 : JLN BERS
113 P-XZJ4CSDF 1207265309070007 TIARA SYAPIRA P REMAJA 14 : JLN ISMA
114 P-XZV6LNXB 1271146807070002 SIFFA AMANDA P REMAJA 14 JL BERSAMA
115 P-XZYAPK5P 1271142703090001 AHMAD ANDIKA NASUT P REMAJA 12 JL LETDA S
116 P-Y02EXBYA 1271141302090003 MHD REVANLINO NASU L REMAJA 12 JLN BERSA
117 P-Y0AYW1YG 1207265505080009 NURIYAH SARI GIAWA P REMAJA 13 JL BERINGI
118 P-Y0E0RPVY 1271155309080002 NAKISHA ALFADA P REMAJA 13 JL BERINGI
119 P-Y07TUEW4 1271140810080003 AHMAD FAUZAN MAUL L REMAJA 13 JLN BERSAM
120 P-Y0JESLY6 1408100707080003 DIVAYO WILYAN L REMAJA 13 JLN BERSAM
121 P-Y0OIOSJI 1271141303090006 LUTVI ADELIA P REMAJA 12 JL PERINTI
122 P-Y0RYY1D1 1271105409050001 ROSA RINI KEZIA MAN P REMAJA 16 JLN G. ARC
123 P-Y1DC5TQF 1271143107090007 BENY INDRAWAN GUL L REMAJA 12 JLN BERSA
124 P-Y11M6NBF 1271046102000001 ADHA SHAFIRA P UMUM 21 JL TANGGUK
125 P-Y0Y927T8 1271045609990002 DIAN SEPTRIYANI SIJA P UMUM 22 JL HARAPAN
126 P-Y1HZFKBJ 1271144804090004 ZAHRA TUSHIFFA NAS P REMAJA 12 JL LETDA S
127 P-Y15YSV48 1207261502090009 MUHAMMAD RAUSYAN L REMAJA 12 DSN XIV PS
128 P-Y1KEUH1W 1271141103090004 WILARDI L REMAJA 12 JL BARU G
129 P-V4XI2JIM 1207266012070009 DANIA AURELIA P REMAJA 14 JL PASAR 3
130 P-Y21D3V0B 1271045607090003 ANISA ZAHRA P REMAJA 12 JL KENARI
131 P-Y1URVT4P 1271146009090008 NONA MUTIARA RITON P REMAJA 12 JL LETDA S
132 P-Y1MT06CT 1271040307090004 DAFFA AL FARIBY NAS P REMAJA 12 JL. TANGGU
133 P-Y1Q33XTW 1207265709040004 QULBI MUTHIAH NABIL P REMAJA 17 JL GAMBIR
134 P-Y25KB9F1 1207265808090010 SAKINAH LUBNA AFIYA P REMAJA 12 JL RAHAYU
135 P-Y295PHF3 1207262206090017 RANDY ADITYA L REMAJA 12 DSN IX DES
136 P-Y2BMW8LB 1271165703090004 LAURA CHINTIA KASIH P REMAJA 12 JL PERTIWI
137 P-Y2EJT3PP 1271141005080002 PRADITA MEGA NANDA P REMAJA 13 JL. P. BAN
138 P-Y43BSS26 1207264907070011 YEMIMA SITOMPUL P REMAJA 14 JLN MEDAN
139 P-Y3YVXIX7 1211090312070002 KRISTOPEL HUTAPEA L REMAJA 14 JLN TOBA B
140 P-CZULG5V2 1271042604090005 JEVRI APRILIANDI SI L REMAJA 12 JLN ELANG
141 P-Y48LJVPX 1207056607070002 SELY TRIHANDANI HU P REMAJA 14 JL WALET II
142 P-Y4HAT180 1271146906070006 CANTIKA ROMAITO BR P REMAJA 14 JLN BERSAM
143 P-Y4RMWR2P 1271142703070002 MHD HARIZ L REMAJA 15 JL PERTIWI
144 P-Y5B5BIS4 1271046305070008 DIFA SESILIA BR HOT P REMAJA 14 JL ELANG U
145 P-Y5GSRO7J 1271155903090001 ULVIA RAISSA P REMAJA 12 JL BAHAGIA
146 P-Y5GESTLA 1271066505070009 BUNGA AMELIA BR PAN P REMAJA 14 JL ELANG U
147 P-Y5LIPI20 1271145408080006 SUMARNI P REMAJA 13 JL AMPERA
148 P-Y5RBR2GL 1273031302080001 RAHID ALFAITH L REMAJA 13 JL BARU T
149 P-Y5W6JRAK 1271142608080003 REFAN RANGKUTI L REMAJA 13 JL PUKAT II
150 P-OUP6WKUS 1271181003070002 FACHREZI IRSYA AD L REMAJA 14 JL SENTOS
151 P-Y6232DV5 1207261310080006 LUTHFI ZAHRANI P REMAJA 12 DSN XVII JL
152 P-Y665SNMR 1271146410070002 LAMRIA BR NAIBAHO P REMAJA 13 JL PADANG
153 P-Y69AAXBI 1207262706070010 KHADIJAH AULIA P REMAJA 14 PSR 9 TEM
154 P-Y6BXKT8P 1207262903080003 ADITYA SYAHPUTRA L REMAJA 13 JLN M YAKU
155 P-Y6H8UPTS 1207262305080004 FAHRUL FIREZA L REMAJA 13 PERUM TAMA
156 P-Y6JK5UYM 1207261710080009 MHD. FADHIL AZMI HA L REMAJA 13 JL PENDIDIK
157 P-Y6GRCEBZ 1271142805080003 GUNAZARI HAYYUSYAH L REMAJA 13 JL LETDA S
158 P-Y6LPXEW1 1209247011060004 PUTRI NAYLA P REMAJA 16 JL SERAWAK
159 P-Y6NUO3YC 1271145706070005 AYLA AZZURA P REMAJA 14 JL PERTIWI
160 P-Y6R7LCZZ 1271044910070001 GRECSIA MARITO WA P REMAJA 14 JL ELANG N
161 P-Y6UO3PKO 1271125409090001 ANNISA RAMADHANI P REMAJA 12 JL PIMPINAN
162 P-Y6U1196O 1271145408070003 SHEREN AURELIA SU P REMAJA 14 JL. P. BAN
163 P-Y6XBJ7NG 1271063007070004 RANDY RADITYA RAH L REMAJA 14 JL PINGGIR
164 P-Y75S1DC6 1209164410070004 NAJIHA SABILLA TANE P REMAJA 13 PERUM VILL
165 P-Y74PLDEO 1207266909090011 NUR SIYA SAFITRI SI P REMAJA 12 DSN III KEL
166 P-Y775QH90 1207262509070003 REHAN SYAHRIL RAM L REMAJA 14 DSN XII JLN
167 P-Y7ABD7OA 1207264401080011 DWI FORSANTA MONIC P REMAJA 13 JL BAYAM II
168 P-Y7CAKPIU 1271142104040002 WAHYU KURNIAWAN L REMAJA 17 DSN IX GG
169 P-Y7FMXYWS 1207265803080006 CHICHI NUR ANGGRAIN P REMAJA 13 JLN JALAK 2
170 P-Y7HXE74A 1207266610070002 NURANISA P REMAJA 14 JLN BENTENG
171 P-Y7KS3OBL 1207261402080008 RIZKI SAHPUTRA L REMAJA 13 DSN II KEN
172 P-Y7ORWZUH 1271145109070003 PUTRI SAFIRA P REMAJA 14 JLN RAJAWA
173 P-Y7O78S4W 1271044304080002 MELATI NUR HANDAYA P REMAJA 13 JL PINGUIN
174 P-Y7QS6LKT 1222011310080001 NABAWI NUR LUBIS P REMAJA 13 JL BERINGI
175 P-Y7Z3UWYP 1271145111070005 TASYA AULIA P REMAJA 14 JL BARU GG
176 P-Y7MXA6BA 1271141910060009 SYAHRUL RAMADHAN L REMAJA 14 JL LETDA S
177 P-Y7YL6E92 1271144503080002 SALSABILA ARIMBI P REMAJA 13 Jln Sosro
178 P-Y81CMDY5 1271144609090001 SYARIFAH AULIA P REMAJA 12 JLN BARU G
179 P-Y89HFZL8 1271144307080004 MAYA SARI P REMAJA 12 JL LETDA S
180 P-Y8EHPXS2 1207264702090014 TIFARA AMELIA P REMAJA 13 JL NUSANTA
181 P-Y8CF06TF 1271101011070007 ANDIKA SYAPUTRA L REMAJA 14 PSR 7 TEM
182 P-Y8EFYAHG 1207267110070011 ANGGI ALYA NAFISAH P REMAJA 13 DSN XII B.
183 P-Y8H5OAKI 1207266206080005 AMANDA AULIA P REMAJA 13 JLN BALAI
184 P-Y8J3CODS 1207261905070024 ALDI ANANDA L REMAJA 14 DSN I KAMB
185 P-Y8NSYY2M 1271142602080005 AGUNG IRWANSYAH L REMAJA 13 JLN PERTIW
186 P-Y8KYYL1L 1271180408070004 RIDHO PARELDY L REMAJA 14 JL. M YAKUB
187 P-Y8RQKUBZ 1207264112080012 CHARLENE ATIKA NEU P REMAJA 12 JLN MESJID
188 P-Y8TU0KYA 1207261010080006 REYMEN CRISTIAN L REMAJA 13 DSN XX P.
189 P-Y8XOHTOQ 1271140704080001 POLMAN SIHOTANG L REMAJA 13 JLN TIRTOS
190 P-Y8Z8LHDJ 1271142210080003 AHMAD RAIHAN AL RAS L REMAJA 14 JLN BENTEN
191 P-Y8VRLDWW 1271102009070004 CIPTA SEPTIAN SIMA L REMAJA 14 DSN XII ME
192 P-Y911CKQQ 1271144809070005 SITI AZZAHRA P REMAJA 14 JLN BERSAM
193 P-Y92S1OVR 1271146202070001 RIKA ZULAIKHA NASUT P REMAJA 14 JLN LETDA
194 P-Y95SWCQA 1207266210070019 SHOFIYATUL FITRI MA P REMAJA 14 JLN PIPIT X
195 P-Y980UZGP 1271094109020001 ATIKA HANA IRBAH P B 19 JLN S.M RAJ
196 P-Y9CAVUMW 1271201211070004 BAGUS WARDANA L REMAJA 14 JLN ASRAMA
197 MANUAL 1207267006080015 CARMELITA STEVANI P REMAJA 13 DUSUN XIII
198 MANUAL 1207266111090005 SALSA BILLA P REMAJA 12 JL JATO PS
199 MANUAL 1207266306090013 KARINA MEI P REMAJA 12 JL. DATUK
200 MANUAL 107260106080014 RIVANSAH ADIGUNA L REMAJA 14 PSR 7 TEM
Keterangan
D : Lainnya
E : Tidak Bekerja
Kelompok Umur
18-30
31-45
46-59
Total
Pekerjaan
A
B
C
RMAT PENCATATAN PELAYANAN VAKSINASI COVID-19
LABUHAN

BPJS PBI
PBI Anggota
TEMBUNG PS TUAN 088267151337 CORONA VAC
KENANGAN BARU PS TUAN 082291859610 CORONA VAC
INDRA KASIH MEDAN TEMBUNG 081370088100 CORONA VAC
BANNTAN MEDAN TEMBUNG 087867684937 CORONA VAC
BANDAR KALIPPA PS TUAN 081361789196 CORONA VAC
TEMBUNG MEDAN TEMBUNG 082360192458 CORONA VAC
KENANGAN PS TUAN 082249246137 CORONA VAC
PASAR MERAH BARAT MEDAN KOTA 081918500236 CORONA VAC
HELVETIA MEDAN HELVETIA 082366642772 CORONA VAC
SIDORAME BARAT I MEDAN PERJUANGAN 085296424024 CORONA VAC
TIGA BALATA JORLANG HATARAN 082122613488 CORONA VAC
SAMBIREJO TIMUR PS TUAN 085261483861 CORONA VAC
TEGAL S MANDALA II MEDAN DENAI 082180993346 CORONA VAC
SIDEREJO MEDAN TEMBUNG 0895413123602 CORONA VAC
PULO BRAYAN DARAT II MEDAN TIMUR 08535892621 CORONA VAC
SIDOREME TIMUR MEDAN PERJUANGAN 085761272809 CORONA VAC
BANTAN TIMUR MEDAN TEMBUNG 083170649518 CORONA VAC
SEI ROTAN PS TUAN 081268469330 CORONA VAC
TEGAL S MANDALA III MEDAN DENAI 081265939996 CORONA VAC
SIDORAME BARAT I MEDAN PERJUANGAN 085359469420 CORONA VAC
TEGALSARI III MEDAN AREA 0882015966754 CORONA VAC
BINJAI MEDAN DENAI 085361035212 CORONA VAC
DENAI MEDAN DENAI 081536123661 CORONA VAC
PASAR MERAH TIMUR MEDAN AREA 081263213369 CORONA VAC
BINJAI MEDAN DENAI 083190301997 CORONA VAC
BANDAR HUTA USANG PEGAGAN HILIR 081269582475 CORONA VAC
SUKARAJA MEDAN MAIMUN 081262401090 CORONA VAC
KOTA MATSUM I MEDAN AREA 082273353519 CORONA VAC
BANTAN TIMUR MEDAN TEMBUNG 081317268890 CORONA VAC
SEI NKERA HULU MEDAN PERJUANGAN 089513065475 CORONA VAC
KOLAM PS TUAN 081377820792 CORONA VAC
BANDAR SELAMAT MEDAN TEMBUNG 081361200472 CORONA VAC
TANJUNG MULIA MEDAN DELI 082166547221 CORONA VAC
BANDAR SETIA PS TUAN 082116389607 CORONA VAC
PASAR MERAH TIMUR MEDAN AREA 082161083410 CORONA VAC
LAUT DENDANG PS TUAN 082247718060 CORONA VAC
SEI KERA HILIR II MEDAN PERJUANGAN 0889524214119 CORONA VAC
SITIREJO II MEDAN AMPLAS 082161569737 CORONA VAC
GLUGUR DARAT II MEDAN TIMUR 088708740809 CORONA VAC
BANDAR KALIPPA PERCUT SEI TUAN 088261381082 CORONA VAC
Merek Vaksin
A : Sinovac
B : Lainnya (Mohon Disebutkan Jenis Vaksin Yang Diterima Puskesmas/F
Kepersertaan BPJS
BPJS PBI
BPJS Non PBI
Non Anggota
Total
Pemberian Dosis
Dosis 1
Dosis 2
Total
Dosis I Dosis 2
Screening Pemberian No.Batch Pemberia No.Batch
Vaksin n Vaksin
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
9/30/2021 9/30/2021 24005721 - - LANJUT VAKSIN 2
aksin Yang Diterima Puskesmas/Faskes)
PJS
Tabel 11. Format Pencatatan Logistik Vaksinasi COVID-19 di Tingkat Fasyankes
FORMAT PENCATATAN LOGISTIK VAKSINASI COVID-19

TINGKAT PUSKESMAS/FASYANKES
Nama Puskesmas/Fasyankes : UPT. PUSKESMAS MEDAN LABUHAN

Provinsi : SUMUT
Hari/Tanggal :
Puskesmas/ LOGISTIK
Fasyankes VAKSIN SINOVAC MEREK LAINNYA (MODERNA) ADS 0,5 ml SAFETY BOX ALCOHOL SWAB
No Total Total Total Total Total

Total Jumlah Total Jumlah Total Jumlah Total Jumlah Total Jumlah
Pemakaia Pemakaia Pemakaia Pemakaia Pemakaia
TANGGAL Diterima Pemakian Pemakaia Sisa Diterima Pemakian Pemakaia Sisa Diterima Pemakian Pemakaia Sisa Diterima Pemakian Pemakaia Sisa Diterima Pemakian Pemakaia Sisa
n s.d Hari n s.d Hari n s.d Hari n s.d Hari n s.d Hari
Lalu n Hari Ini Lalu n Hari Ini Lalu n Hari Ini Lalu n Hari Ini Lalu n Hari Ini
Ini Ini Ini Ini Ini
1 2 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128
1/19/2021 38 0 0 0 38 38 0 0 0 38 38 0 0 0 38
29/01/2021 - 15 15 23 - 15 15 23 1 - 1 1 - - 15 15 23
3/2/2021 15 1 16 22 15 1 16 22 15 1 16 22
4/2/2021 16 2 18 20 16 2 18 20 16 2 18 20
5/2/2021 18 17 35 3 18 17 35 3 18 17 35 3
6/2/2021 35 2 37 1 35 2 37 1 35 2 37 1
8/2/2021 38 37 10 47 29 38 37 10 47 29 38 37 10 47 29
11/2/2021 47 1 48 28 47 1 48 28 47 1 48 28
13/2/2021 48 14 62 14 48 14 62 14 48 14 62 14
15/2/2021 31 62 0 62 45 31 62 0 62 45 31 62 0 62 45
16/2/2021 62 1 63 44 62 1 63 44 62 1 63 44
17/2/2021 63 1 64 43 63 1 64 43 63 1 64 43
18/2/2021 64 1 65 42 64 1 65 42 64 1 65 42
19/2/2021 65 18 83 24 65 18 83 24 65 18 83 24
20/2/2021 83 1 84 23 83 1 84 23 83 1 84 23
22/2/2021 84 3 87 20 84 3 87 20 84 3 87 20
26/2/2021 87 10 97 10 87 10 97 10 87 10 97 10
3/3/2021 97 2 99 8 97 2 99 8 97 2 99 8
04/03/2021 50 99 4 103 54 500 99 4 103 504 5 1 1 2 4 500 99 4 103 504
5/3/2021 103 4 107 50 103 4 107 500 2 0 2 4 103 4 107 500
6/3/2021 107 2 109 48 107 2 109 498 2 0 2 4 107 2 109 498
8/3/2021 109 2 111 46 109 2 111 496 2 0 2 4 109 2 111 496
9/3/2021 111 6 117 40 111 60 171 436 2 0 2 4 111 60 171 436
10/3/2021 117 7 124 33 171 70 241 366 2 1 3 3 171 70 241 366
15/3/2021 124 4 128 29 241 40 281 326 2 0 3 3 241 40 281 326
17/3/2021 128 8 136 21 281 80 361 246 3 1 4 2 281 80 361 246
3/18/2021 20 136 0 136 41 200 361 0 361 446 2 4 0 4 4 200 361 0 361 446
3/19/2021 136 4 140 37 361 40 401 406 4 0 4 4 361 40 401 406
20/3/2021 140 4 144 33 401 39 440 367 4 1 5 3 401 39 440 367
3/22/2021 144 1 145 32 440 10 450 357 5 1 5 3 440 10 450 357
3/24/2021 145 8 153 24 450 80 530 277 5 1 6 2 450 80 530 277
3/25/2021 153 6 159 18 530 59 589 218 6 1 7 1 530 59 589 218
3/27/2021 159 6 165 12 589 60 649 158 6 1 7 1 589 60 649 158
3/29/2021 165 8 173 4 649 80 729 78 7 1 8 0 649 80 729 78
3/30/2021 50 54 0 173 54 500 729 0 729 578 5 8 0 8 5 500 729 0 729 578
3/31/2021 173 5 178 49 729 50 779 528 8 1 9 4 729 50 779 528
4/1/2021 178 5 183 44 779 50 829 478 9 1 9 4 779 50 829 478
4/5/2021 183 3 186 41 829 30 859 448 9 1 10 3 829 30 859 448
4/6/2021 186 6 192 35 859 60 919 388 10 0 10 3 859 60 919 388
4/7/2021 192 17 209 18 919 170 1089 218 10 1 11 2 919 170 1089 218
4/8/2021 40 209 6 215 52 400 1089 60 1149 558 4 11 1 12 5 400 1089 60 1149 558
4/9/2021 215 16 231 36 1149 160 1309 398 12 1 13 4 1149 160 1309 398
12/4/2021 231 7 238 29 1309 70 1379 328 13 1 14 3 1309 70 1379 328
14/04/2021 238 5 243 24 1379 50 1429 278 14 0 14 3 1379 50 1429 278
15/04/2021 243 4 247 20 1429 40 1469 238 14 1 15 2 1429 40 1469 238
4/17/2021 247 5 252 15 1469 40 1509 198 15 0 15 2 1469 40 1509 198
4/19/2021 252 5 257 10 1509 50 1559 148 15 1 16 1 1509 50 1559 148
4/20/2021 40 257 9 266 41 400 1559 89 1648 459 4 16 1 17 4 400 1559 89 1648 459
4/21/2021 266 7 273 34 1648 70 1718 389 17 1 18 3 1648 70 1718 389
4/22/2021 273 9 282 25 1718 89 1807 300 18 1 19 2 1718 89 1807 300
24/04/2021 282 6 288 19 1807 60 1867 240 19 0 19 2 1807 60 1867 240
26/04/2021 288 7 295 12 1867 70 1937 170 19 1 20 1 1867 70 1937 170
4/27/2021 63 295 0 295 75 0 1937 0 1937 170 0 20 0 20 1 0 1937 0 1937 170
4/28/2021 295 6 301 69 1937 60 1997 110 20 0 20 1 1937 60 1997 110
4/29/2021 301 3 304 66 1997 30 2027 80 20 1 21 0 1997 30 2027 80
5/3/2021 304 2 306 64 2027 20 2047 60 21 0 21 0 2027 20 2047 60
5/4/2021 50 306 0 306 114 500 2047 0 2047 560 3 21 0 21 3 500 2047 0 2047 560
5/5/2021 306 6 312 108 2047 58 2105 502 21 1 22 2 2047 58 2105 502
5/6/2021 312 5 317 103 2105 50 2155 452 22 0 22 2 2105 50 2155 452
7/5/2021 317 14 331 89 2155 140 2295 312 22 1 23 1 2155 140 2295 312
5/8/2021 331 9 340 80 2295 90 2385 222 23 1 24 0 2295 90 2385 222
5/10/2021 340 7 347 73 2385 70 2455 152 24 0 24 0 2385 70 2455 152
5/11/2021 347 1 348 72 2455 10 2465 142 24 0 24 0 2455 10 2465 142
5/17/2021 348 7 355 65 2465 70 2535 72 24 0 24 0 2465 70 2535 72
5/18/2021 355 10 365 55 2535 72 2607 0 24 0 24 0 2535 72 2607 0
5/19/2021 365 5 370 50 2607 0 2607 0 24 0 24 0 2607 0 2607 0
5/20/2021 370 4 374 46 2607 0 2607 0 24 0 24 0 2607 0 2607 0
5/21/2021 374 3 377 43 2607 0 2607 0 24 0 24 0 2607 0 2607 0
5/22/2021 377 3 380 40 2607 0 2607 0 24 0 24 0 2607 0 2607 0
5/24/2021 380 3 383 37 2607 0 2607 0 24 0 24 0 2607 0 2607 0
5/25/2021 383 7 390 30 2607 0 2607 0 24 0 24 0 2607 0 2607 0
5/27/2021 390 7 397 23 2607 0 2607 0 24 0 24 0 2607 0 2607 0
5/31/2021 397 3 400 20 2607 0 2607 0 24 0 24 0 2607 0 2607 0
6/5/2021 400 9 409 11 2607 0 2607 0 24 0 24 0 2607 0 2607 0
6/7/2021 409 4 413 7 2607 0 2607 0 24 0 24 0 2607 0 2607 0
6/8/2021 413 4 417 3 2607 0 2607 0 24 0 24 0 2607 0 2607 0
6/9/2021 100 417 0 417 103 1000 2607 0 2607 1000 10 24 0 24 10 200 2607 0 2607 200
6/15/2021 417 2 419 101 2607 20 2627 980 24 1 25 9 2607 20 2627 180
6/16/2021 419 5 424 96 2627 50 2677 930 25 0 25 9 2627 50 2677 130
6/17/2021 424 2 426 94 2677 20 2697 910 25 0 25 9 2677 20 2697 110
6/19/2021 426 5 431 89 2697 50 2747 860 25 1 26 8 2697 50 2747 60
6/22/2021 431 7 438 82 2747 70 2817 790 26 0 26 8 2747 60 2807 0
6/23/2021 438 3 441 79 2817 30 2847 760 26 1 27 7 2807 0 2807 0
6/24/2021 441 7 448 72 2847 70 2917 690 27 0 27 7 2807 0 2807 0
6/29/2021 448 5 453 67 2917 50 2967 640 27 1 28 6 2807 0 2807 0
7/2/2021 453 6 459 61 2967 60 3027 580 28 0 28 6 2807 0 2807 0
7/5/2021
459 14 473 47 3027 139 3166 441 28 1 29 5 2807 0 2807 0
7/6/2021
473 16 489 31 3166 160 3326 281 29 1 30 4 2807 0 2807 0
7/7/2021
489 23 512 8 3326 230 3556 51 30 2 32 2 2807 0 2807 0
7/8/2021 3 512 0 512 11 30 3556 0 3556 81 1 32 0 32 3 30 2807 0 2807 30
7/9/2021
512 5 517 6 3556 50 3606 31 32 1 33 2 2807 30 2837 0
7/14/2021 40 517 3 520 43 400 3606 30 3636 401 33 0 33 2 400 2837 30 2867 370
7/15/2021 520 19 539 24 3636 190 3826 211 33 2 35 0 2867 190 3057 180
7/21/2021
539 5 544 19 3826 50 3876 161 35 0 35 0 3057 50 3107 130
7/27/2021 21 544 6 550 34 210 3876 60 3936 311 2 35 1 36 1 210 3107 60 3167 280
7/30/2021 1 550 27 577 8 10 3936 270 4206 51 36 1 37 0 10 3167 270 3437 20
8/2/2021
577 5 582 3 4206 50 4256 1 37 0 37 0 3437 20 3457 0
8/5/2021 60 582 0 582 63 600 4256 0 4256 601 6 37 0 37 6 600 3457 0 3457 600
8/6/2021
582 8 590 55 4256 80 4336 521 37 1 38 5 3457 80 3537 520
8/9/2021
590 16 606 39 4336 160 4496 361 38 1 39 4 3537 160 3697 360
8/10/2021
606 20 626 19 4496 200 4696 161 39 1 40 3 3697 200 3897 160
8/16/2021 40 626 0 626 59 400 4696 0 4696 561 4 40 0 40 7 400 3897 0 3897 560
8/18/2021 20 626 12 638 67 200 4696 120 4816 641 2 40 1 41 8 200 3897 120 4017 640
8/19/2021
638 17 655 50 4816 170 4986 471 41 2 43 6 4017 170 4187 470
8/21/2021
655 8 663 42 4986 80 5066 391 43 0 43 6 4187 80 4267 390
8/23/2021 21 663 0 663 63 210 5066 0 5066 601 2 43 0 43 8 210 4267 0 4267 600
8/24/2021 663 2 665 61 5066 20 5086 581 43 1 44 7 4267 20 4287 580
8/27/2021 2 665 24 689 39 20 5086 240 5326 361 44 2 46 5 20 4287 240 4527 360
8/30/2021 110 689 0 689 149 2 0 0 0 2 248 5326 0 5326 609 3 46 0 46 8 248 4527 0 4527 608
8/31/2021 250 689 16 705 383 0 0 0 2 500 5326 160 5486 949 5 46 1 47 12 500 4527 160 4687 948
9/1/2021 705 31 736 352 0 0 0 2 5486 310 5796 639 47 3 50 9 4687 310 4997 638
9/2/2021 736 65 801 287 0 1 1 1 5796 144 5940 495 50 1 51 8 4997 144 5141 494
9/6/2021 801 60 861 227 1 1 2 0 5940 134 6074 361 51 1 52 7 5141 134 5275 360
9/9/2021 861 21 882 206 6074 140 6214 221 52 1 53 6 5275 140 5415 220
9/10/2021 280 882 50 932 436 560 6214 100 6314 681 6 53 1 54 11 0 5415 100 5515 120
9/11/2021
932 60 992 376 6314 120 6434 561 54 1 55 10 5515 120 5635 0
9/14/2021
992 61 1053 315 6434 122 6556 439
9/15/2021
1053 64 1117 251 6556 128 6684 311
9/16/2021 500 1117 157 1274 594 1000 6684 314 6998 997
9/21/2021
1274 81 1355 513 6998 162 7160 835
9/22/2021
1355 73 1428 440 7160 146 7306 689
TOTAL 1868
Keterangan :
Merek Vaksin
A : Sinovac
JADWAL VAKSINASI DOSIS 2
JUMLAH
DOSIS 1 LANSIA PP RENTAN UMUM REMAJA SASARAN DOSIS 2
DOSIS 2
9/1/2021 1 0 7 172 0 180 9/29/2021
9/1/2021 5 59 11 49 0 124 9/29/2021
9/2/2021 4 58 10 50 6 128 9/30/2021
9/6/2021 2 52 3 45 0 102 10/4/2021
9/9/2021 13 75 5 31 1 125 10/7/2021
9/10/2021 1 0 8 91 0 100 10/8/2021
9/11/2021 8 57 4 42 6 117 10/9/2021
9/14/2021 4 54 10 49 2 119 10/12/2021
9/15/2021 13 52 9 46 2 122 10/13/2021
9/16/2021 5 48 9 40 6 108 10/14/2021
9/16/2021 0 2 0 4 194 200 10/14/2021
9/21/2021 6 73 13 53 8 153 10/19/2021
9/22/2021 5 79 8 48 1 141 10/20/2021

9/23/2021 1 51 13 50 6 121 10/21/2021
9/24/2021 8 65 14 45 2 134 10/22/2021
9/27/2021 0 1 2 0 197 200 10/25/2021
9/28/2021 0 0 0 0 199 199 10/26/2021
9/28/2021 6 40 4 39 4 93 10/26/2021
9/29/2021 0 6 0 0 194 200 10/27/2021
9/29/2021 3 42 7 36 3 91 10/27/2021
9/30/2021 0 1 0 2 197 200 10/28/2021
9/30/2021 6 46 11 55 2 120 10/28/2021
LOKASI KETERANGAN
RUTAN LABUHAN DELI

PUSKESMAS
PUSKESMAS
PUSKESMAS
PUSKESMAS
RUTAN LABUHAN DELI
PUSKESMAS
PUSKESMAS
PUSKESMAS
PUSKESMAS
SMP 38 MARELAN
KNTOR LURAH
MARTUBUNG
KNTOR LURAH
MARTUBUNG
SMA 19 SERUWEI
SMA 19 SERUWEI
SMP 25 TANGKAHAN
SMP 5 KAMBES
PUSKESMAS
SMP N 38 TITI PAPAN
PUSKESMAS
SMP 29 LETDA SUJONO
PUSKESMAS

(September) Pencatatan Vaksin 2021 UPT Puskesmas Medan Labuhan

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(September) Pencatatan Vaksin 2021 UPT Puskesmas Medan Labuhan

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Tabel 10.

Nama Puskesmas/Fasyankes/Pos : UPT PUSKESMAS MEDAN LABUHAN

Nama Penerima Umur

FORMAT PENCATATAN PELAYANAN VAKSINASI COVID-19

Kepersertaan BPJS (tulis 'Ya'

LK 13 MARELAN TERJUN Medan Marelan 081362215507 √

sebutkan Jenis Vaksin Yang Diterima Puskesmas/Faskes)

Nama Puskesmas/Fasyankes/Pos : UPT PUSKESMAS MEDAN LABUHAN

FORMAT PENCATATAN PELAYANAN VAKSINASI COVID-19

Kepersertaan BPJS (tulis 'Ya'

JL. BALAI DESA MEDAN SUNGGAL 082390624542 √

sebutkan Jenis Vaksin Yang Diterima Puskesmas/Faskes)

FORMAT PENCATATAN PEL

Nama Puskesmas/Fasyankes/Pos : UPT PUSKESMAS MEDAN LABUHAN

Nama Penerima Umur

PENCATATAN PELAYANAN VAKSINASI COVID-19

Kepersertaan BPJS (tulis 'Ya'

FORMAT PENCATATAN PELAYAN

Nama Puskesmas/Fasyankes/Pos : UPT PUSKESMAS MEDAN LABUHAN

CATATAN PELAYANAN VAKSINASI COVID-19

Kepersertaan BPJS (tulis 'Ya' pada kolom

085261673428 √ MODERNA 02/09/2021 02/09/2021 939900 SELESAI

081361574631 √ MODERNA 02/09/2021 02/09/2021 939900 SELESAI

085275761441 √ MODERNA 02/09/2021 02/09/2021 939900 SELESAI

Nama Puskesmas/Fasyankes/Pos : UPT PUSKESMAS MEDAN LABUHAN

FORMAT PENCATATAN PELAYANAN VAKSINASI COVID-19

Kepersertaan BPJS (tulis 'Ya'

JL. KUBAH LINGK.I MARTUBUNG MEDAN LABUHAN 081262499702 √ CORONA VAC

Vaksin Yang Diterima Puskesmas/Faskes)

FORMAT PENCATATAN PELAYANAN V

Nama Puskesmas/Fasyankes/Pos : UPT PUSKESMAS MEDAN LABUHAN

Kelompok Umur Keperserta

ATAN PELAYANAN VAKSINASI COVID-19

Kepersertaan BPJS (tulis 'Ya' pada kolom

085261665800 √ MODERNA 9/6/2021 9/6/2021 939900 SELESAI

085261920015 √ MODERNA 9/6/2021 9/6/2021 939900 SELESAI

FORMAT PENCATATAN PELA

Nama Puskesmas/Fasyankes/Pos : UPT PUSKESMAS MEDAN LABUHAN

Nama Penerima Umur

ORMAT PENCATATAN PELAYANAN VAKSINASI COVID-19

Kepersertaan BPJS (tulis 'Ya'

LK. IX SEI MATI SEI MATI Medan Labuhan 085267867483 √ CORONAVAC

Vaksin Yang Diterima Puskesmas/Faskes)

FORMAT PENCATATAN PELAY

Nama Puskesmas/Fasyankes/Pos : UPT PUSKESMAS MEDAN LABUHAN

T PENCATATAN PELAYANAN VAKSINASI COVID-19

Kepersertaan BPJS (tulis 'Ya'

Desa Suka Maju 085275654810 √ CORONAVAC 9/10/2021 9/10/2021

Desa Baru Dusun V Kec.Batang Kuis 085270342247 √ CORONAVAC 9/10/2021 9/10/2021

r X Tanah Garapan Desa Manunggal 082367665040 √ CORONAVAC 9/10/2021 9/10/2021

Perhatian Kel. Belawan II 081310668972 √ CORONAVAC 9/10/2021 9/10/2021

k.II Kel.Mabar Kec.Medan Deli 081260134392 √ CORONAVAC 9/10/2021 9/10/2021

IK ES DUSUN 9 DS PEMATANG JOHAR KEC. 082361833434 √ CORONAVAC 9/10/2021 9/10/2021

Sari. Psr 2 Medan Selayang 081269682900 √ CORONAVAC 9/10/2021 9/10/2021

o. 9 Medan Polonia Kota Medan 082268613848 √ CORONAVAC 9/10/2021 9/10/2021

.28 Kel.Tanjung Rejo Kec.Medan Sunggal 082376730749 √ CORONAVAC 9/10/2021 9/10/2021

ec.Baktia Kab.Aceh Utara 081370652919 √ CORONAVAC 9/10/2021 9/10/2021

2021071341 - - LANJUT VAKSIN 2

2021071341 - - LANJUT VAKSIN 2

2021071341 - - LANJUT VAKSIN 2

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