NO

NO JUMLAH ALAMAT
NO
RUMAH
RUMAH NO KK NAMA KK ANGGOTA NAMA ANGGOTA KELUARGA NIK
KK KELUARGA

SESUAI KK DOMISILI
1 2 3 4 5 6 7 8 9 10

1 1 1 5207012708101484 Fuad,S.H 4 Fuad,S.H 5207012906690001 RT. 07 DESA GOA KEC. JEREWEH RT. 07 DESA GOA KEC. JEREWEH

2 Rukaiyah,A.d.Keb 5207015110700001 RT. 07 DESA GOA KEC. JEREWEH RT. 07 DESA GOA KEC. JEREWEH

3 Sri Azizah Hudani 5207014201020001 RT. 07 DESA GOA KEC. JEREWEH LOMBOK BARAT

4 2 2 5207012708102156 Madiolo 4 Madiolo 5207010603690001

5 Subaini 5207015602760001

6 Firdaus Zulhakiman 5207011003970001

7 Febri Zizka Kausar 5207014802020001.

3 3 5207012066190001 Misnawati 1 Misnawati 5207015501690001

8 4 4 5207012708101466 Tuhur 3 Tuhur 5207010105620001

9 Tasnim 5207016702730001

10 M.Supiandi Asri 5207011710000003

11 5 5 5207012708101472 Kamrullah ,S.E 5 Kamrullah ,S.E 5207012109660001

12 Masita MS.s.Pd 5207014410620001

13 Kemas Basral Sabili 5207012111980001

14 Rheza Hidayatullah 5207012304000001

15 6 6 5207012708102382 Hadi Sufrianto,S.E 5 Hadi Sufrianto,S.E 5207011911840001

16 Sulis Ekawati 5207016610820001

17 Rozila Ramadhan PH 5207012809060001

18 Latiza Fadilah PH 5207017105110001

19 Bilal Afdal PH 5207012709210001

20 7 7 5207012708101482 Bayhaqi 6 Bayhaqi 5207011008750001

21 Sripawan 5207015608760001

22 Rafli Insani Al'Faqih 5207011710020001

23 Zulfauzan Albani 5207010101070001

24 Hilwa Zuhratul Ain 5207012606090001

25 M. Faizul haq 5207012708101482

26 8 8 5207010706110002 Hj.Rafiah 1 Hj.Rafiah 5207017012460001

27 9 9 5207012708101522 Zainul Aqli 3 Zainul Aqli 5207011011700001

28 Arjuna Restu Putra 520701081000001

29 Wina
30 10 10 5207012708101902 Lisen Okta Lalang 3 Lisen Okta Lalang 5207010510610001

31 Marlina 5207015506660001

32 Marthen Pitherson 5207011903930001

33 11 11 5207012708102212 Rato Hendra, SH 4 Rato Hendra, SH 5207011008860001

34 Yuyun Nurhayati,SH 5207015306860002

35 Aditya Harun.A
5207011001080001
36 Aira Mantika
5207016608120001

37 12 12 5207012708101506 Sanadin 5 Sanadin 5207032710660001

38 Rohani 5207014404730001

39 Ihsan Kamaluddin 5207032909020003

40 Sahira 5207036511100001

41 13 13 5207012708101470 Abdul Wahid,S.Sos 5 Abdul Wahid,S.Sos 5207010307750002

42 Iswantari 5207014407780001

43 M.Wisnu Ademulia 5207011104990001

44 Wahyu Hidayat N 5207012612020001

45 Dinda Aisya Layna W 5207016804060001

46 Putri Dwi Setiana Muliadi 5203034810980004

47 14 14 5207012708101517 H.Sailan Jabir 4 H.Sailan Jabir 5207011711610001

48 Rati Kuadrattika 5207015011890001

49 Siti NurJabir 5207015212700001

50 15 5207012202160001 Indra Abikusno 3 Indra Abikusno 5207010506830001

51 Rahmawati 5204117608850001

52 Almar Al Ghifari 5207016112160001

53 15 16 5207012708101489 M.Nasir S.Ag 6 M.Nasir S.Ag 5207012109730001

54 Mimi Erni 5207015504830001

55 Lala Sri Manunggal 5207015207060001.

56 Lala Sri Dewi A 5207014411080001.

57 Prabu Panji K 5207010102110001

58 Prabu Eling Jagat 5207010102110001.

59 Lala Sri Miranti 5207014108170001

60 Prabu Pattah Albarroh

61 16 17 5207012708102165 Subhan 5 Subhan 5207011812840001

62 Mascawan 5207016912780001

63 Kirana Ayulia 5207015804080001

64 Dwi Noval 5207011710120001

66 18 5207012788101477 Asiah 2 Asiah 5207014303540001

67 Mualimin 5207011308790001

68 17 19 5207012708101529 Rahmawati 2 Rahmawati 5207016101600001

69 Rahmat 5207011010820001

520701710200002 Burhanuddin Burhanuddin 5201031508941001

Nur Azlinda 5203124301010011

70 20 52070115021972 Ade Wardana 3 Ade Wardana 5207010608860001

71 Desi Susanti 5207014812880001

72 M. Gibran 5207012004190001

73 18 21 3573012602150013 Gandi Novonsen 3 Gandi Novonsen 3573011811840001

74 Triana Susanti 5207016907860001

75 Ralintya Guiena Q 3573016003150002

76 19 22 5207012708101487 Sarima 1 Sarima 5207014507630001

77 23 Hendri Sugianto 4 Hendri Sugianto 5207010208820001

5207012812110002
78 Suci Ramdayanti 5204055204900005

79 Daffa Anshari P 5207010312140001

80 Aisyilla Husna 5207014112170001

81 20 24 5207010310130001 Hj. Safauyah 1 Hj.Safauyah 5207015103550001

82 21 25 5207012708101513 M.Ali Hasan 1 M.Ali Hasan 5207011404520001

83 26 520701300512002 Indra Gunawan 4 Indra Gunawan 5207013004810001

84 Nunung Sulastri 5207014102820003

85 Nabila Sabrina G.P 5207014904120001

86 Nazila Sabrani G.P 5207014809140001

87 22 27 5207012708101896 Erwansyah 4 Erwansyah 5207010101770001

88 Nunik Cokrawati 5207015303790001

89 R.Gustavo Hamfara 5207010511070001

90 R.Alfido Hamfara 5207010401100001

91 23 28 52070107121712001 Hj.Jawiyah 1 Hj.Jawiyah 5207015011630001

92 24 29 5207012708101504 Mulyadi 5 Mulyadi 5207011307720001

93 Rusmiati 5207014806730001

94 Adrian Maulana 5207012207010001

95 Ezy Aditya M 5207012906060001

96 Cantika Putri H 5207017010130001

97 25 30 5207012708101470 Kamaluddin 4 Kamaluddin 5207012601740001

98 Sriani 5207016604720001

99 Nadine Rizky A 5207016903070002

100 Tri Maulida 5207016309110001

101 31 5207012708101996 Fatimah 1 Fatimah 5207017112530011

102 26 32 5207012708101495 M.Safer 1 M.Safer 5207013112550001

103 27 33 5207012708101485 Abdul Kadir 3 Abdul Kadir 5207013112630006

104 Mariatul 5207014303660001

105 Sigit Cahyadi Putra 5207011107970001

106 28 34 5207012708101471 Mustakin 6 Mustakin 5207010803790001

107 Hafniatunnisa 5207014101800017

108 F.Hamida 5207015008050001

109 Zhulaika R 5207014809090001.

110 M.Kenzi 5207010702150001

5207012402210001 Hj. Salma 1 Hj. Salma 5207017112450005

111 29 35 527012708101519 Amril Wijaya 6 Amril Wijaya 5207011405790001

112 Neli Puspitasari 5207015509840001

113 M.Arya Pratama 5207012105040001

114 Ariel Wijaya 5207012911080001

115 Alfino Ibra Wijaya 5207012910080001

116 Rajendra Altap 5207010507060001

117 30 36 5207010806110005 Wirasandi 3 Wirasandi 5207011206760002

118 Rabiya 5207016806760002

119 Tamawana,R.A 5207014608140001

120 31 37 ,57012708101503 Sarilan Saputra 6 Sarilan Saputra 5207010601740001

121 Iriani 5207015810740001

122 M.Irfan Ansari 5207010810980001

123 Nurul Alani A 5207014409000001

124 M.Irsa Surya Putra 5207010909050001

125 M.Fauzan Anwar 5207010904110001

126 Intan syaifatul 5207014502160001

127 32 38 5207012708101483 A.Hamid 3 A.Hamid 5207011501660001

128 Juhaena 5207012012660001

129 Dwi Atmaja 5207012309980001.

130 33 39 5207012708101469 Indir 4 Indir 5207010507600001

131 Hairiawati 5207014302620001

132 M.Hidayatullah 5207010810010001

133 34 40 5207012708101469 Kurnia Agustina Kurnia Agustina 5207014208910001

134 35 41 520701278102557 Saharuddin 6 Saharuddin 5207010202740002

135 Salmah 5207014503770002

136 M.Sahrul 5207011004980001

137 M.Fahrul 5207011205020001

138 M.Rosidi 5207011403070001

139 Miral Iftihan 5207016009080001

140 Humairah Zahrah 5207016910140001

141 36 42 5207012708101520 Muslimin Sabil S.E 6 Muslimin Sabil S.E 5207013007750002

142 Musdalifah .S.E 5207016907790001

143 Mrga Olifiah C 5207016303990001

144 Prisma Regina D 5207016004020001

145 Iona Permata Z 5207016202100003

146 Iola Permata 5207016202100001

147 37 43 5207012708100836 H.M.Sirad 4 H.M.Sirads 5207011204420001

148 Riska Prihartini 5207011506950001

149 43 5207012907200001 Abdul Rasyid Abdul Rasyid 5272010108700003

150 Hj. Sri Asmawati, S.Pd 5207015204690002

151 38 44 520702708101491 Junaidi, S.P.t 5 Junaidi, S.P.t 5207011004690001

152 Alfiani 5207016605730001

153 Hafida Jumratul 5207015404000001

154 M.Rahbini Mahendra 5207012601050001

155 M.Gibran Aufaqry 5207010204120001

156 39 45 5207010806110002 Zainul Hurman 5 Zainul Hurman 5207011005820002

157 Nurhasanah 5207017008810002

158 Risana Ayu R 52070126909080002

159 Rizal Aidil R 5207012708120001

160 Riska Annur 520701700915001

161 40 46 5207012708101792 M.Hatta S.E 6 M.Hatta S.E 5207011201760001

162 Sumarti 5207014106750001

163 Taufik Hatiala 5207010607000002

164 Gilang Akbar 5207010910030001

165 Olinda Elysia 5207015601110001

166 Chalida Elysia 5207016202170001

167 41 47 5207012708101498 Susanti 5 Susanti 5207016812780001

168 Rifqi Apriliano 5207012004990001

169 Jascha Aprilyano 5207010604020001

170 Daffa Nabil Fasih 5207010201080001

171 Andien Khaliqa R 5207015307110001

172 42 48 5207012708101448 Irwansyah Dewantara 4 Irwansyah Dewantara 5207011608720001

173 Siti Aminah 520701570572001

174 Isra Ardiansyah 5207013008050001

175 Imam Judiansyah 5207012006070001

176 43 49 5207012806120002 Bukhri Sany 6 Bukhri Sany 5207012611790001

177 Lin Mustainingsih 5207015010900001

178 M.Ghezzal Mirshany 5207012510100001

179 Ghazia Hafiza M 5207016703140001

180 Gharizah Jalillah M 5207014312160001

181 M. Gifari Hamzah

182 44 50 5207012708101332 Sulaeman 5 Sulaeman 5207012801730001

Fathel Aini ,S.Pd 5207016008760001

183
184 Maedy Sulfani 5207015405040001

Fannia Refiani 5207015805070001

185
186 Fauzul Inzanul K 5207012511090001

5207010204130002 Sagafuddin Sagafuddin 5207070303760002

187 45 51 5
Husnia Pawida 5207014205870001
188
Rizky Aditya 5207010807130001
189
M.Devan Rafandra 5207011110150001
190
Yasmin Anindya 5207015402190001
191

52070110004140001 Zaetulliah Zaetulliah 5207015208740001

192 46 52 5
M.Riki Muzakki '5207013108960001
193
L.Said Alzulman 5207012303050001
194
L.M.Fadhil Ilham 5207013101090001
195
Baiq Zaenal Fathinz 5207014309150001
196

5207012708102542 Juhardi Tommy Juhardi Tommy 5207012107850001

197 47 53 6
Susan Rina F 5207015602880002
198
Firshani Rezzara 5207010808090001
199
Alfayad Ibra 5207012802130001
200
Apu Jaidan Abrar
201 520701011170001
Ibnu Khaitam
202 5207012711190001

5207012708101510 Bustanul Arifin Bustanul Arifin 5207013006820001

203 48 54 8
Yuli Handrani 5207016207850001
204
 Radista Artamesia 5207017008060001
205
Kayla Almagfira 5207014607080001
206
Azcha Dewangga P 5207011402120001
207
Fincha Kalista 5207015707140001
208
Dani Rangga P 5207010212030001
209
Danu Zulfikar 5207011509050001
210

'5207012405820002
520701130610009 Rolly yansyah Rolly yansyah
211 49 55 6
Susmawati
212 5207014511830001
Yunus Alfareza
213 5207011202100001
Daffa hifzul Akbar
214 5207012704160001
Faiq Kenzie Hamizan
215 5207013103180001
Nadif Zidan Khadafi
216 5207202101221695

Jumaris AM.Usman Jumaris AM.Usman 5207010301730001

217 50 56 5207012708101257 4
Hj.Kamariah 5207017005700001
218
ikhsan hamdani jumaris 5207012400001
219
Lilis Hakusmanian 5207016109020001
220

5207012708101475 M.Ali M.Ali

221 51 57 2 5207013112600016
Suliati
222 5207017112700010

520701912910130001 Arwansyah Arwansyah

222 52 58 4 5207010803860001
Rahmawati
223 5207014303930001
Alif Rizky.A
224 5207011009130001
M.Raffa.A
225 520701912170001

5207012708101884 Tajuddin Tajuddin

226 53 59 4 5207011109670001
Nurul Ani
227 5207016509690001
M.Zainuddin
228 5207012506010003
Ayu Lestari
229 5207014208160001

5207012808170004 Ardiansyah Ardiansyah

230 54 60 4 5207011006890001
Heriyati
231 5204055205820002
Nabila Azzahra
232 5207016402180001
Nadya alysa Azzahra
233 5207016910190001

5207010907120002 Nasripin Rasidin Nasripin Rasidin

237 55 61 5 5207011006840002
Suli Amiah
238 5203066505880004
Nadila Ulfa
239 5207014804120001
Alinda Riski
240 5207016912130001
M.Alif Adabi
241 5207012007180001

520701020303160001 Syamsul Syamsul

242 56 63 5 5207080504600001
Nurmayani
243 5207085312840001
 M.Fauzan Saputra
244 5207080207090001
Febriyani
245 5207086502120001
M.Fala Saputra
246 52070110044180001

5207012703190001 Bagus M. Faruqi Bagus M. Faruqi

247 57 64 4 5204180401930003
Rizky Ratu Dyahfani
248 5207016609910001
Ahmad Rizky Pranaja
249 5207011107180001

250 ARUMI DWI FATHINA 5207205501229240

L 132

P 118

Ugdranap2022*
 PENDERI
BAYI PENDERI
TANGGAL SASARAN Gol. TA
Umur Ketik IBU BALITA TA
No BPJS UMUR LAYANAN DIABETE LAHIR MATI
LAHIR Manual)
POSYANDU UMUR HAMIL STUNTIN HIPERTE
S
G NSI
MILITUS

11 12 13 14 15 16 17 18 19 20 21 22

0001789017434 6/29/1969 54,11 53.8 Produktif

0000146599187 10/11/1970 53,8 52.4 Produktif

Keluar 1/2/2002 22,5 21.2 Produktif

124,5 123.2 Lansia

0001575864854 3/6/1969 55,3 54.0 Produktif

0001575864865 2/16/1976 48,4 47.0 Produktif

5/10/1997 27,1 25.9 Produktif

0001575864887 2/8/2002 22,4 21.0 Produktif

124,5 123.2 Lansia

1/15/1969 55,5 54.1 Produktif

124,5 123.2 Lansia

124,5 123.2 Lansia

0001581249813 5/1/1962 62,1 60.1 Lansia

0001581249824 2/27/1973 51,3 50.0 Produktif

0001581249846 10/17/2000 23,8 22.4 Produktif

124,5 123.2 Lansia

Keluar atas
9/21/1966 57,9 56.5 Produktif kemauan
sendiri

10/4/1960 63,8 62.5 Lansia

11/21/1998 25,7 24.3 Produktif

4/23/2000 24,1 22.1 Produktif

124,5 123.2 Lansia

0000161703134 11/19/1984 39,7 38.3 Produktif

00167801084 10/28/1982 41,7 40.4 Produktif

0000167801106 9/28/2006 17,8 16.5 Remla

0000167801128 5/31/2011 13,0 11.9 Remaja

9/27/2021 2,8 1.5 Balita

124,5 123.2 Lansia

0001575908065 8/10/1975 48,10 47.6 Produktif

0001575908076 8/16/1976 47,10 46.6 Produktif

0001575908087 10/17/2002 21,8 20.4 Produktif

0001575908098 1/1/2007 17,5 16.2 Remla

6/26/2009 14,11 13.8 Remaja

1/17/2018 6,5 5.1 Prasek

124,5 123.2 Lansia

124,5 123.2 Lansia

0001811129332 12/31/1948 75,5 74.2 Lansia

124,5 123.2 Lansia

0001575908021 11/10/1970 53,7 52.3 Produktif

10/8/2000 23,8 22.4 Produktif

124,5 123.2 Lansia

 124,5 123.2 Lansia

0001093644415 10/5/1961 62,8 61.5 Lansia

0001100363815 6/15/1966 58,0 56.8 Produktif

0001658042741 3/19/1993 31,3 29.1 Produktif

124,5 123.2 Lansia

8/10/1986 37,10 36.6 Produktif

6/13/1986 38,0 36.8 Produktif

0000161722449
15,10 14.6 Remaja
0000199580815 8/11/2008
11,9 10.6 Remaja
0001900706409 8/26/2012
124,5 123.2 Lansia

0000846543611 10/27/1966 57,7 56.4 Produktif

0002441220175 4/19/1973 51,2 49.1 Produktif

0000846544555 9/29/2002 21,8 20.5 Produktif

0002584415169 12/31/2010 13,5 12.2 Remaja

124,5 123.2 Lansia

0001963748654 7/30/1975 48,10 47.7 Produktif

0002251449246 7/4/1978 45,11 44.8 Produktif

0002251449292 4/11/1999 25,2 23.1 Produktif

0002251449325 12/26/2002 21,5 20.2 Produktif

0002251449279 4/28/2006 18,1 16.1 Remla

10/8/1998 25,8 24.4 Produktif

124,5 123.2 Lansia

0001853520849 11/17/1961 62,7 61.3 Lansia

0001853523044 11/10/1989 34,7 33.3 Produktif

0001853524091 12/12/1970 53,6 52.2 Produktif

124,5 123.2 Lansia

0001576134066 6/5/1983 41,0 39.9 Produktif

8/6/1985 38,10 37.7 Produktif

0002234741253 12/21/2016 7,6 6.2 Prasek

124,5 123.2 Lansia

0001581250083 21/9/1973 #VALUE! 49.5 Produktif

0001581250094 4/14/1983 41,2 39.1 Produktif

0001581250105 7/12/2006 17,11 16.7 Remla

0001575864527 11/4/2008 15,7 14.4 Remaja

0001581250116 2/1/2011 13,4 12.1 Remaja

0001581250116 4/23/2014 10,1 8.1 Usek

8/1/2017 6,10 5.7 Prasek

3/2/2021 3,3 2.0 Balita

124,5 123.2 Lansia

0001581249587 12/18/1984 39,6 38.2 Produktif

0001581249598 12/28/1978 45,5 44.2 Produktif

0001581249609 4/18/2008 16,2 14.1 Remaja

0001581249611 10/17/2012 11,8 10.4 Remaja

124,5 123.2 Lansia

0001581249958 3/3/1954 70,3 69.0 Lansia

0001581249969 8/13/1979 44,10 43.6 Produktif

124,5 123.2 Lansia

0000146600201 1/21/1960 64,5 63.1 Lansia

0001581249879 10/10/1982 41,8 40.4 Produktif

124,5 123.2 Lansia

8/15/1994 29,10 28.6 Produktif

1/3/2001 23,5 22.2 Produktif

124,5 123.2 Lansia

0001576311671 8/6/1986 37,10 36.7 Produktif

0001581249881 12/8/1988 35,6 34.2 Produktif

00013051123142 4/20/2019 5,2 3.1 Balita

124,5 123.2 Lansia

0001578675611 11/18/1984 39,7 38.3 Produktif

0001578675609 7/29/1986 37,10 36.7 Produktif

0001578675622 3/20/2015 9,3 7.1 Usek

124,5 123.2 Lansia

0001802436838 7/5/1963 60,11 59.8 -

124,5 123.2 Lansia

0001575851253 8/2/1982 41,10 40.7 Produktif

0001575851264 4/12/1990 34,2 32.1 Produktif

12/3/2014 9,6 8.3 Usek

12/1/2017 6,6 5.3 Prasek

124,5 123.2 Lansia

0001880736849 3/11/1955 69,3 67.1 Lansia

124,5 123.2 Lansia

0002070944482 4/14/1952 72,2 70.1 Lansia

124,5 123.2 Lansia

0001093334376 4/30/1981 43,1 41.1 Produktif

0000173788457 2/1/1982 42,4 41.1 Produktif

0001099033402 9/4/2012 11,9 10.1 Remaja

0002032134996 9/8/2014 9,9 8.5 Usek

124,5 123.2 Lansia

1/1/1977 47,5 46.2 Produktif

3/13/1979 45,3 43.1 Produktif

11/1/2007 16,7 15.4 Remla

1/4/2010 14,5 13.2 Remaja

124,5 123.2 Lansia

0001581250072 11/10/1963 60,7 59.3 -

124,5 123.2 Lansia

0001576672773 7/13/1972 51,11 50.7 Produktif

0001576672784 6/8/1973 51,0 49.8 Produktif

0001576672795 6/22/2001 23,0 21.8 Produktif

0001576672806 6/29/2006 17,11 16.8 Remla

0001576672817 10/30/2013 10,7 9.4 Usek

124,5 123.2 Lansia

0001579682676 1/26/1974 50,4 49.1 Produktif

0001579682687 8/26/1973 50,9 49.6 Produktif

3/29/2007 17,2 15.1 Remla

9/23/2014 9,8 8.5 Usek

124,5 123.2 Lansia

0002067148135 12/31/1953 70,5 69.2 Lansia

124,5 123.2 Lansia

0001581250037 12/31/1955 68,5 67.2 Lansia

124,5 123.2 Lansia

0000146890629 12/31/1963 60,5 59.2 -

0000146766497 3/9/1966 58,3 56.1 Produktif

0000146766521 7/11/1997 26,11 25.7 Produktif

124,5 123.2 Lansia

0002061981325 3/8/1979 45,3 43.1 Produktif

0002895554081 1/1/1980 44,5 43.2 Produktif

8/10/2005 18,10 17.6 Remla

9/8/2009 14,9 13.5 Remaja

2/7/2015 9,4 8.1 Usek

124,5 123.2 Lansia

31/11/1945 #VALUE! #VALUE! #VALUE!

124,5 123.2 Lansia

0001574854143 5/14/1979 45,1 43.9 Produktif

0001321657277 9/15/1984 39,9 38.5 Produktif

0001574855212 5/21/2004 20,1 18.9 Produktif

0001574857844 7/5/2006 17,11 16.8 Remla

11/29/2008 15,6 14.3 Remaja

00015748566606 6/12/2017 7,0 5.8 Prasek

124,5 123.2 Lansia

0001148056637 6/12/1976 48,0 46.8 Produktif

5/28/1978 46,0 44.9 Produktif

0001483157935 8/6/2004 19,10 18.7 Produktif

124,5 123.2 Lansia

0001579611554 1/6/1974 50,5 49.2 Produktif

0002252287416 18/10/1974 #VALUE! 48.4 Produktif

10/8/1998 25,8 24.4 Produktif

9/4/2000 23,9 22.6 Produktif

0002252287888 9/9/2005 18,9 17.5 Remla

000207736244 4/9/2011 13,2 11.1 Remaja

2/5/2016 8,4 7.1 Usek

124,5 123.2 Lansia

PREMI 1/15/1966 58,5 57.1 Produktif

PREMI 11/20/1966 57,7 56.3 Produktif

PREMI 12/26/1998 25,5 24.2 Produktif

124,5 123.2 Lansia

0000146599075 7/5/1960 63,11 62.8 Lansia

0000146599053 2/3/1962 62,4 61.1 Lansia

0002312200089 10/8/2001 22,8 21.4 Produktif

124,5 123.2 Lansia

8/2/1991 32,10 31.7 Produktif TKW

124,5 123.2 Lansia

0001297621719 22/9/1974 #VALUE! 48.5 Produktif

0001479468914 3/5/1977 47,3 46.0 Produktif

0001581249216 4/10/1998 26,2 24.1 Produktif

0001581249227 5/7/2003 21,1 19.1 Produktif

0001581249238 3/14/2007 17,3 15.1 Remla

0001581249249 8/20/2008 15,10 14.6 Remaja

0001479917665 10/29/2014 9,7 8.4 Usek

124,5 123.2 Lansia

0001575332919 7/30/1975 48,10 47.7 Produktif

0001575332921 7/29/1979 44,10 43.7 Produktif

3/23/1999 25,2 23.1 Produktif

0001575332943 4/20/2002 22,2 20.1 Produktif

2/22/2010 14,4 13.0 Remaja

0001575332954 2/22/2010 14,4 13.0 Remaja

124,5 123.2 Lansia

4/12/1942 82,2 80.1 Lansia

6/15/1995 29,0 27.8 Produktif

124,5 123.2 Lansia

0000145617873 8/1/1970 53,10 52.7 Produktif

0000146762638 4/12/1969 55,2 53.1 Produktif

124,5 123.2 Lansia

PREMI 4/10/1969 55,2 53.1 Produktif

PREMI 6/25/1973 50,11 49.8 Produktif

PREMI 4/14/2000 24,2 22.1 Produktif

PREMI 1/26/2005 19,4 18.1 Produktif

PREMI 4/24/2014 10,1 8.1 Usek

124,5 123.2 Lansia

0000146762752 5/10/1982 42,1 40.9 Produktif

0000146762763 8/30/1981 42,9 41.6 Produktif

9/29/2008 15,8 14.5 Remaja

0001812389848 8/27/2012 11,9 10.6 Remaja

0002049588011 9/30/2015 8,8 7.5 Usek

124,5 123.2 Lansia

0001575906197 1/12/1976 48,5 47.1 Produktif

0003145033664 5/1/1976 48,1 46.1 Produktif

7/5/2000 23,11 22.8 Produktif

0001575906221 10/9/2003 20,8 19.4 Produktif

0001575906232 1/6/2011 13,5 12.2 Remaja

2/22/2017 7,4 6.0 Prasek

124,5 123.2 Lansia

0001575367435 2/28/1978 46,3 45.0 Produktif

4/21/1999 25,2 23.1 Produktif

0001575367492 4/6/2002 22,2 20.1 Produktif

0001575367514 1/2/2008 16,5 15.2 Remla

0001581249857 7/13/2013 10,11 9.7 Usek

124,5 123.2 Lansia

0001575852243 8/16/1972 51,10 50.6 Produktif

0001575852254 5/17/1972 52,1 50.9 Produktif

0001575852265 8/30/2005 18,9 17.6 Remla

0001575852276 6/20/2007 17,0 15.8 Remla

124,5 123.2 Lansia

0002920207252 44,6 43.3 Produktif

11/26/1979
0001805488288 10/10/1990 33,8 32.4 Produktif

0001575885971 10/25/2010 13,7 12.4 Remaja

0001575886026 3/27/2014 10,2 8.1 Usek

12/3/2016 7,6 6.3 Prasek

27/8/ #VALUE! #VALUE! #VALUE!

124,5 123.2 Lansia

0001575864584 1/28/1973 51,4 50.1 Produktif

47,9 46.6 Produktif

0001575864595 8/28/1976
20,1 18.9 Produktif
0001575864628 5/19/2004
17,1 15.9 Remla
0001575864639 5/18/2007
14,6 13.3 Remaja
0003275024444 11/25/2009
124,5 123.2 Lansia

48,3 47.0 Produktif

0001581076438 3/3/1976
37,0 35.9 Produktif
0001583978275 5/25/1987
10,11 9.7 Usek
0001581076449 7/8/2013
8,8 7.4 Usek
0001581076451 10/11/2015
5,4 4.0 Balita
002663522109 ( May 2/14/2019
124,5 123.2 Lansia

49,10 48.6 Produktif

0002111694941 8/12/1974
27,9 26.6 Produktif
8/31/1996
19,2 17.1 Remla
0001058175639 3/23/2005
15,4 14.1 Remaja
0002111694974 1/31/2009
8,9 7.6 Usek
0002661274192 9/3/2015
124,5 123.2 Lansia

38,11 37.7 Produktif

0001874184939 7/21/1985
36,4 35.0 Produktif
0001576857644 2/16/1988
14,10 13.6 Remaja
0001874188326 8/8/2009
11,3 10.0 Usek
0001874188967 2/28/2013
6,9 5.5 Prasek
9/8/2017
6,6 5.3 Prasek
11/27/2017
124,5 123.2 Lansia

42,0 40.9 Produktif

0001575850702 6/3/1982
38,11 37.7 Produktif
0001575850713 7/22/1985
 17,9 16.6 Remla
0001575850724 8/30/2006
15,11 14.8 Remaja
0001575850735 7/6/2008
12,4 11.0 Remaja
0001575850746 2/19/2012
9,11 8.7 Usek
0003041433415 7/17/2014
21,4 20.0 Produktif
0002847996279 2/12/2003
18,9 17.5 Remla
0002847996279 9/15/2005
124,5 123.2 Lansia

42,0 40.9 Produktif

0001575286042 5/24/1982
40,6 39.2 Produktif
0001575286064 12/15/1983
14,4 13.0 Remaja
0001575286075 2/12/2010
8,1 6.1 Prasek
0002280782632 4/27/2016
6,2 4.1 Balita
0002474449659 3/31/2018
2,5 1.1 Balita
1/21/2022
124,5 123.2 Lansia

51,5 50.2 Produktif

0001581250151 1/3/1973
49,0 47.9 Produktif
0001581250162 5/30/1975
24,1 22.1 Produktif
4/24/2000
21,10 20.6 Produktif
0001581250184 8/21/2002
124,5 123.2 Lansia

63,5 62.2 Lansia

0001581250127 12/31/1960
53,5 52.2 Produktif
0001581250138 12/31/1970
124,5 123.2 Lansia

38,5 37.1 Produktif

0001648644467 1/8/1986
31,3 30.0 Produktif
0001648644478 3/3/1993
10,9 9.5 Usek
0001648644489 9/10/2013
6,6 5.2 Prasek
12/19/2017
124,5 123.2 Lansia

56,9 55.5 Produktif

0002111695086 9/11/1967
54,8 53.5 Produktif
0002111695097 9/25/1969
23,0 21.9 Produktif
0002111695108 5/25/2001
7,10 6.7 Prasek
0002111695121 8/2/2016
124,5 123.2 Lansia

35,0 33.8 Produktif

0000845471518 6/10/1989
42,1 40.9 Produktif
0002285840799 5/12/1982 v
6,3 5.0 Balita
0002460667566 2/24/2018
4,7 3.4 Balita
0002922085833 10/29/2019
124,5 123.2 Lansia

40,2 38.1 Produktif

0001575467043 4/10/1984
35,9 34.6 Produktif
00015754667054 8/25/1988
12,0 10.8 Remaja
0001575467065 6/8/2012
11,1 9.1 Usek
0001575467076 4/29/2013
6,3 4.1 Balita
0003127162566 3/20/2018
124,5 123.2 Lansia

69,5 68.2 Lansia

Tidak Aktif 12/31/1954
39,5 38.2 Produktif
Tidak Aktif 12/31/1984
 14,11 13.8 Remaja
Tidak Aktif 7/2/2009
12,3 11.0 Remaja
Tidak Aktif 2/25/2012
6,2 4.1 Balita
Tidak Aktif 4/10/2018
124,5 123.2 Lansia

30,8 29.4 Produktif

10/14/1993
32,8 31.5 Produktif
9/26/1991
5,11 4.7 Balita
7/11/2018
2,5 1.1 Balita
1/15/2022
 Tanggal Lahir Tahun Bulan Hari
000157586
Madiolo 4 Madiolo 5207010603690001 4854 3/6/1969 55 55 3 16
000157586
Subaini 5207015602760001 4865
2/16/1976 48 48 4 6
Firdaus Z 5207011003970001 5/10/1997 27 27 1 12
000157586
Febri Zizk 5207014802020001. 4887
2/8/2002 22 22 4 14

2023
54
55years;3months; 55,3

48,4
27,1

22,4
 FORMAT SASARAN PER RT WILAYAH KERJA PUSKESMAS JEREWEH
TAHUN 2023
DESA : Goa
DUSUN : Mekar
RT : 07

JENIS
SASARAN LAYANAN POSYANDU KONDISI KESEHATAN TINDAKAN
LAYANAN

USIA PRODUKTIF (18-59)

JUMLAH

PRODUKTIF//REMAJA
USIA SEKOLAH( 7-10)
NO RUMAH

REMAJA AWAL 10-15

PRA SEKOLAH (5-7 )
NIK No BPJS TANGGAL LAHIR

LANSIA (> 60 THN)

NO NO RUMAH KK NO KK NAMA KK ANGGOTA NAMA ANGGOTA KELUARGA UMUR KETERANGAN

LANJUT (15-18)
KELUARGA

BALITA( 1-5)
BAYI (0-12)
PEMERIKSAAN

BUMIL
/ SKRENING

USIA
BERMASALAH
KESEHATAN SEHAT KESEHATAN KIE RUJUK
SEBUTKAN... SEBUTKAN...

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

1 1 1 5207012708101484 Fuad,S.H 4 Fuad,S.H 5207012906690001 0001789017434 6/29/1969 55 - v - DM,COL

2 Rukaiyah,A.d.Keb 5207015110700001 0000146599187 10/11/1970 54 v

3 Sri Azizah Hudani 5207014201020001 Keluar 1/2/2002 22 v

FALSE

4 2 2 5207012708102156 Madiolo 4 Madiolo 5207010603690001 0001575864854 3/6/1969 55 v HT

5 Subaini 5207015602760001 0001575864865 2/16/1976 48 v

6 Firdaus Zulhakiman 5207011003970001 5/10/1997 27 v

7 Febri Zizka Kausar 5207014802020001. 0001575864887 2/8/2002 22 v

5 FALSE

3 3 5207012066190001 Misnawati 1 Misnawati 5207015501690001 1/15/1969 55

8 4 4 5207012708101466 Tuhur 3 Tuhur 5207010105620001 0001581249813 5/1/1962 62 v

9 Tasnim 5207016702730001 0001581249824 2/27/1973 51 v DM

10 M.Supiandi Asri 5207011710000003 0001581249846 10/17/2000 24 v

11 5 5 5207012708101472 Kamrullah ,S.E 5 Kamrullah ,S.E 5207012109660001 9/21/1966 58 v Keluar atas kemauan sendiri

12 Masita MS.s.Pd 5207014410620001 10/4/1960 64 v

13 Kemas Basral Sabili 5207012111980001 11/21/1998 26 v

14 Rheza Hidayatullah 5207012304000001 4/23/2000 24 v

15 6 6 5207012708102382 Hadi Sufrianto,S.E 5 Hadi Sufrianto,S.E 5207011911840001 0000161703134 11/19/1984 40 v

16 Sulis Ekawati 5207016610820001 00167801084 10/28/1982 42 v

17 Rozila Ramadhan PH 5207012809060001 0000167801106 9/28/2006 18 v

18 Latiza Fadilah PH 5207017105110001 0000167801128 5/31/2011 13 v

19 Bilal Afdal PH 5207012709210001 9/27/2021 3

20 7 7 5207012708101482 Bayhaqi 6 Bayhaqi 5207011008750001 0001575908065 8/10/1975 49

v
21 Sripawan 5207015608760001 0001575908076 8/16/1976 48
v
22 Rafli Insani Al'Faqih 5207011710020001 0001575908087 10/17/2002 22
v
23 Zulfauzan Albani 5207010101070001 0001575908098 1/1/2007 17
v
24 Hilwa Zuhratul Ain 5207012606090001 6/26/2009 15
v
25 M. Faizul haq 5207012708101482 1/17/2018 6

26 8 8 5207010706110002 Hj.Rafiah 1 Hj.Rafiah 5207017012460001 0001811129332 12/31/1948 76

v

27 9 9 5207012708101522 Zainul Aqli 3 Zainul Aqli 5207011011700001 0001575908021 11/10/1970 54

v
28 Arjuna Restu Putra 520701081000001 10/8/2000 24

29 Wina

30 10 10 5207012708101902 Lisen Okta Lalang 3 Lisen Okta Lalang 5207010510610001 0001093644415 10/5/1961 63 DM
v
31 Marlina 5207015506660001 0001100363815 6/15/1966 58
v
32 Marthen Pitherson 5207011903930001 0001658042741 3/19/1993 31
v

33 11 11 5207012708102212 Rato Hendra, SH 4 Rato Hendra, SH 5207011008860001 8/10/1986 38

34 Yuyun Nurhayati,SH 5207015306860002 6/13/1986 38

0000161722449
35 Aditya Harun.A 16
5207011001080001 0000199580815 8/11/2008
36 Aira Mantika 12
5207016608120001 0001900706409 8/26/2012

37 12 12 5207012708101506 Sanadin 5 Sanadin 5207032710660001 0000846543611 10/27/1966 58

v
38 Rohani 5207014404730001 0002441220175 4/19/1973 51
v
39 Ihsan Kamaluddin 5207032909020003 0000846544555 9/29/2002 22
v
40 Sahira 5207036511100001 0002584415169 12/31/2010 13
v

41 13 13 5207012708101470 Abdul Wahid,S.Sos 5 Abdul Wahid,S.Sos 5207010307750002 0001963748654 7/30/1975 49

v
42 Iswantari 5207014407780001 0002251449246 7/4/1978 46
v
43 M.Wisnu Ademulia 5207011104990001 0002251449292 4/11/1999 25
v
44 Wahyu Hidayat N 5207012612020001 0002251449325 12/26/2002 22
v
45 Dinda Aisya Layna W 5207016804060001 0002251449279 4/28/2006 18
v
46 Putri Dwi Setiana Muliadi 5203034810980004 10/8/1998 26

47 14 14 5207012708101517 H.Sailan Jabir 4 H.Sailan Jabir 5207011711610001 0001853520849 11/17/1961 63

v
48 Rati Kuadrattika 5207015011890001 0001853523044 11/10/1989 35
v
49 Siti NurJabir 5207015212700001 0001853524091 12/12/1970 54
v

50 15 5207012202160001 Indra Abikusno 3 Indra Abikusno 5207010506830001 0001576134066 6/5/1983 41

v
51 Rahmawati 5204117608850001 8/6/1985 39
v
52 Almar Al Ghifari 5207016112160001 0002234741253 12/21/2016 8
v

53 15 16 5207012708101489 M.Nasir S.Ag 6 M.Nasir S.Ag 5207012109730001 0001581250083 21/9/1973 #VALUE!

v
54 Mimi Erni 5207015504830001 0001581250094 4/14/1983 41
v
55 Lala Sri Manunggal 5207015207060001. 0001581250105 7/12/2006 18
v
56 Lala Sri Dewi A 5207014411080001. 0001575864527 11/4/2008 16
v
57 Prabu Panji K 5207010102110001 0001581250116 2/1/2011 13
v
58 Prabu Eling Jagat 5207010102110001. 0001581250116 4/23/2014 10
v
59 Lala Sri Miranti 5207014108170001 8/1/2017 7

60 Prabu Pattah Albarroh 3/2/2021 3

61 16 17 5207012708102165 Subhan 5 Subhan 5207011812840001 0001581249587 12/18/1984 40

v
62 Mascawan 5207016912780001 0001581249598 12/28/1978 46
v
63 Kirana Ayulia 5207015804080001 0001581249609 4/18/2008 16
v
64 Dwi Noval 5207011710120001 0001581249611 10/17/2012 12
v

66 18 5207012788101477 Asiah 2 Asiah 5207014303540001 0001581249958 3/3/1954 70 HT

v
67 Mualimin 5207011308790001 0001581249969 8/13/1979 45
v

68 17 19 5207012708101529 Rahmawati 2 Rahmawati 5207016101600001 0000146600201 1/21/1960 64

v
69 Rahmat 5207011010820001 0001581249879 10/10/1982 42
v

520701710200002 Burhanuddin Burhanuddin 5201031508941001 8/15/1994 30

Nur Azlinda 5203124301010011 1/3/2001 23

70 20 52070115021972 Ade Wardana 3 Ade Wardana 5207010608860001 0001576311671 8/6/1986 38

v
71 Desi Susanti 5207014812880001 0001581249881 12/8/1988 36
v
72 M. Gibran 5207012004190001 00013051123142 4/20/2019 5 v

73 18 21 3573012602150013 Gandi Novonsen 3 Gandi Novonsen 3573011811840001 0001578675611 11/18/1984 40

v
74 Triana Susanti 5207016907860001 0001578675609 7/29/1986 38
v
75 Ralintya Guiena Q 3573016003150002 0001578675622 3/20/2015 9
v

76 19 22 5207012708101487 Sarima 1 Sarima 5207014507630001 0001802436838 7/5/1963 61 HT

v

77 23 Hendri Sugianto 4 Hendri Sugianto 5207010208820001 0001575851253 8/2/1982 42

5207012812110002 v
78 Suci Ramdayanti 5204055204900005 0001575851264 4/12/1990 34 HT,DM,Jantung
v
79 Daffa Anshari P 5207010312140001 12/3/2014 10
v
80 Aisyilla Husna 5207014112170001 12/1/2017 7
v

81 20 24 5207010310130001 Hj. Safauyah 1 Hj.Safauyah 5207015103550001 0001880736849 3/11/1955 69

v

82 21 25 5207012708101513 M.Ali Hasan 1 M.Ali Hasan 5207011404520001 0002070944482 4/14/1952 72

v

83 26 520701300512002 Indra Gunawan 4 Indra Gunawan 5207013004810001 0001093334376 4/30/1981 43

v
84 Nunung Sulastri 5207014102820003 0000173788457 2/1/1982 42
v
85 Nabila Sabrina G.P 5207014904120001 0001099033402 9/4/2012 12
v
86 Nazila Sabrani G.P 5207014809140001 0002032134996 9/8/2014 10
v

87 22 27 5207012708101896 Erwansyah 4 Erwansyah 5207010101770001 1/1/1977 48

v
88 Nunik Cokrawati 5207015303790001 3/13/1979 45
v
89 R.Gustavo Hamfara 5207010511070001 11/1/2007 17
v
90 R.Alfido Hamfara 5207010401100001 1/4/2010 14
v

91 23 28 52070107121712001 Hj.Jawiyah 1 Hj.Jawiyah 5207015011630001 0001581250072 11/10/1963 61 COL,DM,HT

v

92 24 29 5207012708101504 Mulyadi 5 Mulyadi 5207011307720001 0001576672773 7/13/1972 52

v
93 Rusmiati 5207014806730001 0001576672784 6/8/1973 51
v
94 Adrian Maulana 5207012207010001 0001576672795 6/22/2001 23
v
95 Ezy Aditya M 5207012906060001 0001576672806 6/29/2006 18
v
96 Cantika Putri H 5207017010130001 0001576672817 10/30/2013 11
v

97 25 30 5207012708101470 Kamaluddin 4 Kamaluddin 5207012601740001 0001579682676 1/26/1974 50

v
98 Sriani 5207016604720001 0001579682687 8/26/1973 51 DM,HT
v
99 Nadine Rizky A 5207016903070002 3/29/2007 17
v
100 Tri Maulida 5207016309110001 9/23/2014 10
v

101 31 5207012708101996 Fatimah 1 Fatimah 5207017112530011 0002067148135 12/31/1953 71 HT

v

102 26 32 5207012708101495 M.Safer 1 M.Safer 5207013112550001 0001581250037 12/31/1955 69

v

103 27 33 5207012708101485 Abdul Kadir 3 Abdul Kadir 5207013112630006 0000146890629 12/31/1963 61

v
104 Mariatul 5207014303660001 0000146766497 3/9/1966 58 DM
v
105 Sigit Cahyadi Putra 5207011107970001 0000146766521 7/11/1997 27
v
106 28 34 5207012708101471 Mustakin 6 Mustakin 5207010803790001 0002061981325 3/8/1979 45
v
107 Hafniatunnisa 5207014101800017 0002895554081 1/1/1980 45
v
108 F.Hamida 5207015008050001 8/10/2005 19
v
109 Zhulaika R 5207014809090001. 9/8/2009 15
v
110 M.Kenzi 5207010702150001 2/7/2015 9
v

5207012402210001 Hj. Salma 1 Hj. Salma 5207017112450005 31/11/1945

111 29 35 527012708101519 Amril Wijaya 6 Amril Wijaya 5207011405790001 0001574854143 5/14/1979 45

v
112 Neli Puspitasari 5207015509840001 0001321657277 9/15/1984 40 DM,HT,CDL
v
113 M.Arya Pratama 5207012105040001 0001574855212 5/21/2004 20
v
114 Ariel Wijaya 5207012911080001 0001574857844 7/5/2006 18
v
115 Alfino Ibra Wijaya 5207012910080001 11/29/2008 16
v
116 Rajendra Altap 5207010507060001 00015748566606 6/12/2017 7

117 30 36 5207010806110005 Wirasandi 3 Wirasandi 5207011206760002 0001148056637 6/12/1976 48

v
118 Rabiya 5207016806760002 5/28/1978 46
v
119 Tamawana,R.A 5207014608140001 0001483157935 8/6/2004 20
v

120 31 37 ,57012708101503 Sarilan Saputra 6 Sarilan Saputra 5207010601740001 0001579611554 1/6/1974 50

v
121 Iriani 5207015810740001 0002252287416 18/10/1974 #VALUE!
v
122 M.Irfan Ansari 5207010810980001 10/8/1998 26
v
123 Nurul Alani A 5207014409000001 9/4/2000 24
v
124 M.Irsa Surya Putra 5207010909050001 0002252287888 9/9/2005 19
v
125 M.Fauzan Anwar 5207010904110001 000207736244 4/9/2011 13
v
126 Intan syaifatul 5207014502160001 2/5/2016 8

127 32 38 5207012708101483 A.Hamid 3 A.Hamid 5207011501660001 PREMI 1/15/1966 58

v
128 Juhaena 5207012012660001 PREMI 11/20/1966 58 DM
v
129 Dwi Atmaja 5207012309980001. PREMI 12/26/1998 26
v

130 33 39 5207012708101469 Indir 4 Indir 5207010507600001 0000146599075 7/5/1960 64

v
131 Hairiawati 5207014302620001 0000146599053 2/3/1962 62 HT
v
132 M.Hidayatullah 5207010810010001 0002312200089 10/8/2001 23
v

133 34 40 5207012708101469 Kurnia Agustina Kurnia Agustina 5207014208910001 8/2/1991 33 TKW

134 35 41 520701278102557 Saharuddin 6 Saharuddin 5207010202740002 0001297621719 22/9/1974 #VALUE!

v
135 Salmah 5207014503770002 0001479468914 3/5/1977 47
v
136 M.Sahrul 5207011004980001 0001581249216 4/10/1998 26
v
137 M.Fahrul 5207011205020001 0001581249227 5/7/2003 21
v
138 M.Rosidi 5207011403070001 0001581249238 3/14/2007 17
v
139 Miral Iftihan 5207016009080001 0001581249249 8/20/2008 16
v
140 Humairah Zahrah 5207016910140001 0001479917665 10/29/2014 10
v

141 36 42 5207012708101520 Muslimin Sabil S.E 6 Muslimin Sabil S.E 5207013007750002 0001575332919 7/30/1975 49
v
142 Musdalifah .S.E 5207016907790001 0001575332921 7/29/1979 45 HT,DM
v
143 Mrga Olifiah C 5207016303990001 3/23/1999 25
v
144 Prisma Regina D 5207016004020001 0001575332943 4/20/2002 22
v
145 Iona Permata Z 5207016202100003 2/22/2010 14
v
146 Iola Permata 5207016202100001 0001575332954 2/22/2010 14
v

147 37 43 5207012708100836 H.M.Sirad 4 H.M.Sirads 5207011204420001 4/12/1942 82

v
148 Riska Prihartini 5207011506950001 6/15/1995 29
v

149 43 5207012907200001 Abdul Rasyid Abdul Rasyid 5272010108700003 0000145617873 8/1/1970 54

v
150 Hj. Sri Asmawati, S.Pd 5207015204690002 0000146762638 4/12/1969 55
v

151 38 44 520702708101491 Junaidi, S.P.t 5 Junaidi, S.P.t 5207011004690001 PREMI 4/10/1969 55 JANTUNG ,HT
v
152 Alfiani 5207016605730001 PREMI 6/25/1973 51
v
153 Hafida Jumratul 5207015404000001 PREMI 4/14/2000 24
v
154 M.Rahbini Mahendra 5207012601050001 PREMI 1/26/2005 19
v
155 M.Gibran Aufaqry 5207010204120001 PREMI 4/24/2014 10
v

156 39 45 5207010806110002 Zainul Hurman 5 Zainul Hurman 5207011005820002 0000146762752 5/10/1982 42

v
157 Nurhasanah 5207017008810002 0000146762763 8/30/1981 43
v
158 Risana Ayu R 52070126909080002 9/29/2008 16
v
159 Rizal Aidil R 5207012708120001 0001812389848 8/27/2012 12
v
160 Riska Annur 520701700915001 0002049588011 9/30/2015 9

161 40 46 5207012708101792 M.Hatta S.E 6 M.Hatta S.E 5207011201760001 0001575906197 1/12/1976 48

v
162 Sumarti 5207014106750001 0003145033664 5/1/1976 48
v
163 Taufik Hatiala 5207010607000002 7/5/2000 24
v
164 Gilang Akbar 5207010910030001 0001575906221 10/9/2003 21
v
165 Olinda Elysia 5207015601110001 0001575906232 1/6/2011 13
v
166 Chalida Elysia 5207016202170001 2/22/2017 7
167 41 47 5207012708101498 Susanti 5 Susanti 5207016812780001 0001575367435 2/28/1978 46
v
168 Rifqi Apriliano 5207012004990001 4/21/1999 25
v
169 Jascha Aprilyano 5207010604020001 0001575367492 4/6/2002 22
v
170 Daffa Nabil Fasih 5207010201080001 0001575367514 1/2/2008 16
v
171 Andien Khaliqa R 5207015307110001 0001581249857 7/13/2013 11
v

172 42 48 5207012708101448 Irwansyah Dewantara 4 Irwansyah Dewantara 5207011608720001 0001575852243 8/16/1972 52

v
173 Siti Aminah 520701570572001 0001575852254 5/17/1972 52
v
174 Isra Ardiansyah 5207013008050001 0001575852265 8/30/2005 19
v
175 Imam Judiansyah 5207012006070001 0001575852276 6/20/2007 17
v

176 43 49 5207012806120002 Bukhri Sany 6 Bukhri Sany 5207012611790001 0002920207252 34

11/26/1979 v
177 Lin Mustainingsih 5207015010900001 0001805488288 10/10/1990 #REF!
v
178 M.Ghezzal Mirshany 5207012510100001 0001575885971 10/25/2010 14
v
179 Ghazia Hafiza M 5207016703140001 0001575886026 3/27/2014 10
v
180 Gharizah Jalillah M 5207014312160001 12/3/2016 8

181 M. Gifari Hamzah 27/8/ #VALUE!

182 44 50 5207012708101332 Sulaeman 5 Sulaeman 5207012801730001 0001575864584 1/28/1973 51 DM

v
Fathel Aini ,S.Pd 5207016008760001 48
183 0001575864595 8/28/1976 v
184 Maedy Sulfani 5207015405040001 20
0001575864628 5/19/2004 v
Fannia Refiani 5207015805070001 17
185 0001575864639 5/18/2007 v
186 Fauzul Inzanul K 5207012511090001 15
0003275024444 11/25/2009 v

5207010204130002 Sagafuddin Sagafuddin 5207070303760002 48

187 45 51 5 0001581076438 3/3/1976 v
Husnia Pawida 5207014205870001 37
188 0001583978275 5/25/1987 v
Rizky Aditya 5207010807130001 11
189 0001581076449 7/8/2013 v
M.Devan Rafandra 5207011110150001 9
190 0001581076451 10/11/2015 v
Yasmin Anindya 5207015402190001 5
191 002663522109 ( Maysaro 2/14/2019 v

52070110004140001 Zaetulliah Zaetulliah 5207015208740001 50

192 46 52 5 0002111694941 8/12/1974 v
M.Riki Muzakki '5207013108960001 28
193 8/31/1996 v
L.Said Alzulman 5207012303050001 19
194 0001058175639 3/23/2005 v
L.M.Fadhil Ilham 5207013101090001 15
195 0002111694974 1/31/2009 v
Baiq Zaenal Fathinz 5207014309150001 9
196 0002661274192 9/3/2015 v
125

5207012708102542 Juhardi Tommy Juhardi Tommy 5207012107850001 39

197 47 53 6 0001874184939 7/21/1985 v
 Susan Rina F 5207015602880002 36
198 0001576857644 2/16/1988 v
Firshani Rezzara 5207010808090001 15
199 0001874188326 8/8/2009 v
Alfayad Ibra 5207012802130001 11
200 0001874188967 2/28/2013 v
Apu Jaidan Abrar 7
201 520701011170001 9/8/2017 v
Ibnu Khaitam 7
202 5207012711190001 11/27/2017 v

5207012708101510 Bustanul Arifin Bustanul Arifin 5207013006820001 42

203 48 54 8 0001575850702 6/3/1982 v DM
Yuli Handrani 5207016207850001 39
204 0001575850713 7/22/1985 v
Radista Artamesia 5207017008060001 18
205 0001575850724 8/30/2006 v
Kayla Almagfira 5207014607080001 16
206 0001575850735 7/6/2008 v
Azcha Dewangga P 5207011402120001 12
207 0001575850746 2/19/2012 v
Fincha Kalista 5207015707140001 10
208 0003041433415 7/17/2014 v
Dani Rangga P 5207010212030001 21
209 0002847996279 2/12/2003 v
Danu Zulfikar 5207011509050001 19
210 0002847996279 9/15/2005 v

'5207012405820002
520701130610009 Rolly yansyah Rolly yansyah 42
211 49 55 6 0001575286042 5/24/1982 v
Susmawati 41
212 5207014511830001 0001575286064 12/15/1983 v
Yunus Alfareza 14
213 5207011202100001 0001575286075 2/12/2010 v
Daffa hifzul Akbar 8
214 5207012704160001 0002280782632 4/27/2016 v
Faiq Kenzie Hamizan 6
215 5207013103180001 0002474449659 3/31/2018 v
Nadif Zidan Khadafi 2
216 5207202101221695 1/21/2022 v

Jumaris AM.Usman Jumaris AM.Usman 5207010301730001 52

217 50 56 5207012708101257 4 0001581250151 1/3/1973 v
Hj.Kamariah 5207017005700001 49
218 0001581250162 5/30/1975 v DM,HT
ikhsan hamdani jumaris 5207012400001 24
219 4/24/2000 v
Lilis Hakusmanian 5207016109020001 22
220 0001581250184 8/21/2002

5207012708101475 M.Ali M.Ali 64

221 51 57 2 5207013112600016 0001581250127 12/31/1960 v
Suliati 54
222 5207017112700010 0001581250138 12/31/1970 v HT

520701912910130001 Arwansyah Arwansyah 38

222 52 58 4 5207010803860001 0001648644467 1/8/1986 v
Rahmawati 31
223 5207014303930001 0001648644478 3/3/1993 v
Alif Rizky.A 11
224 5207011009130001 0001648644489 9/10/2013 v
M.Raffa.A 7
225 520701912170001 12/19/2017 v

5207012708101884 Tajuddin Tajuddin 57

226 53 59 4 5207011109670001 0002111695086 9/11/1967 v
Nurul Ani 55
227 5207016509690001 0002111695097 9/25/1969 v
M.Zainuddin 23
228 5207012506010003 0002111695108 5/25/2001 v
 Ayu Lestari 8
229 5207014208160001 0002111695121 8/2/2016 v

5207012808170004 Ardiansyah Ardiansyah 35

230 54 60 4 5207011006890001 0000845471518 6/10/1989 v
Heriyati 42
231 5204055205820002 0002285840799 5/12/1982 v v
Nabila Azzahra 6
232 5207016402180001 0002460667566 2/24/2018 v
Nadya alysa Azzahra 5
233 5207016910190001 0002922085833 10/29/2019 v

5207010907120002 Nasripin Rasidin Nasripin Rasidin 40

237 55 61 5 5207011006840002 0001575467043 4/10/1984 v
Suli Amiah 36
238 5203066505880004 00015754667054 8/25/1988 v
Nadila Ulfa 12
239 5207014804120001 0001575467065 6/8/2012 v
Alinda Riski 11
240 5207016912130001 0001575467076 4/29/2013 v
M.Alif Adabi 6
241 5207012007180001 0003127162566 3/20/2018 v

520701020303160001 Syamsul Syamsul 70

242 56 63 5 5207080504600001 Tidak Aktif 12/31/1954 v
Nurmayani 40
243 5207085312840001 Tidak Aktif 12/31/1984 v
M.Fauzan Saputra 15
244 5207080207090001 Tidak Aktif 7/2/2009 v
Febriyani 12
245 5207086502120001 Tidak Aktif 2/25/2012 v
M.Fala Saputra 6
246 52070110044180001 Tidak Aktif 4/10/2018 v

5207012703190001 Bagus M. Faruqi Bagus M. Faruqi 31

247 57 64 4 5204180401930003 10/14/1993
Rizky Ratu Dyahfani 33
248 5207016609910001 9/26/1991
Ahmad Rizky Pranaja 6
249 5207011107180001 7/11/2018
2
250 ARUMI DWI FATHINA 5207205501229240 1/15/2022
L 132

P 118
Ugdranap2022*
 FORMAT SASARAN PER RT WILAYAH KERJA PUSKESMAS JEREWEH
TAHUN 2023
DESA : Goa Bayi
DUSUN : Mekar
RT : 07

BULAN LAYANAN
NAMA ANGGOTA KETERANG
NO NO KK NAMA KK NIK No BPJS TANGGAL LAHIR UMUR
KELUARGA AN

MAR

AUG

OKT
APR

JUN
MEI

DES
JAN

FEB

SEP
JUL
1 2 3 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21

1 5207012708102382 Hadi Sufrianto,S.E Bilal Afdal PH 5207012709210001 9/27/2021 3

2 520701130610009 Rolly yansyah Nadif Zidan Khadafi 5207202101221695 1/21/2022 2

3 5207012703190001 Bagus M. Faruqi ARUMI DWI FATHINA 5207205501229240 1/15/2022 2

L 1
P 2
 FORMAT SASARAN PER RT WILAYAH KERJA PUSKESMAS JEREWEH
TAHUN 2023
DESA : Goa balita
DUSUN : Mekar
RT : 07

BULAN LAYANAN
NO NO KK NAMA KK NAMA ANGGOTA KELUARGA NIK No BPJS TANGGAL LAHIR UMUR KETERANGAN

MAR

AUG

OKT
APR

JUN
MEI

DES
JAN

FEB

SEP
JUL
1 2 3 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21

1 5207012708101482 Bayhaqi M. Faizul haq 5207012708101482 1/17/2018 6

2 5207012708101489 M.Nasir S.Ag Lala Sri Miranti 5207014108170001 8/1/2017 7

3 5207012708101489 M.Nasir S.Ag Prabu Pattah Albarroh 3/2/2021 3

4 52070115021972 Ade Wardana M. Gibran 5207012004190001 00013051123142 4/20/2019 5

5 5207012812110002 Hendri Sugianto Aisyilla Husna 5207014112170001 12/1/2017 7

6 527012708101519 Amril Wijaya Rajendra Altap 5207010507060001 00015748566606 6/12/2017 7

7 5207010204130002 Sagafuddin Yasmin Anindya 5207015402190001 002663522109 ( Maysaroh 2/14/2019 5

8 5207012708102542 Juhardi Tommy Apu Jaidan Abrar 520701011170001 9/8/2017 7

10 5207012708102542 Juhardi Tommy Ibnu Khaitam 5207012711190001 11/27/2017 7

11 520701130610009 Rolly yansyah Faiq Kenzie Hamizan 5207013103180001 0002474449659 3/31/2018 6

12 520701130610009 Rolly yansyah Nadif Zidan Khadafi 5207202101221695 1/21/2022 2

13 520701912910130001 Arwansyah M.Raffa.A 520701912170001 12/19/2017 7

14 5207010907120002 Nasripin Rasidin M.Alif Adabi 5207012007180001 0003127162566 3/20/2018 6

15 520701020303160001 Syamsul M.Fala Saputra 52070110044180001 Tidak Aktif 4/10/2018 6

16 5207012703190001 Bagus M. Faruqi Ahmad Rizky Pranaja 5207011107180001 7/11/2018 6

L 12
P 4
 FORMAT SASARAN PER RT WILAYAH KERJA PUSKESMAS JEREWEH
TAHUN 2023
DESA : Goa pra sekolah
DUSUN : Mekar
RT : 07

BULAN LAYANAN
KETERA
NO NO KK NAMA KK NAMA ANGGOTA KELUARGA NIK No BPJS TANGGAL LAHIR UMUR
NGAN

MAR

AUG

OKT
APR

MEI

JUN

DES
JAN

FEB

SEP
JUL
1 2 3 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
1 5207012202160001 Indra Abikusno Almar Al Ghifari 5207016112160001 0002234741253 12/21/2016 8

2 ,57012708101503 Sarilan Saputra Intan syaifatul 5207014502160001 2/5/2016 8

3 5207010806110002 Zainul Hurman Riska Annur 520701700915001 0002049588011 9/30/2015 9

4 5207010204130002 Sagafuddin M.Devan Rafandra 5207011110150001 0001581076451 10/11/2015 9

5 52070110004140001 Zaetulliah Baiq Zaenal Fathinz 5207014309150001 0002661274192 9/3/2015 9

6 520701130610009 Rolly yansyah Daffa hifzul Akbar 5207012704160001 0002280782632 4/27/2016 8

7 5207012708101884 Tajuddin Ayu Lestari 5207014208160001 0002111695121 8/2/2016 8

L 3
P 4
 FORMAT SASARAN PER RT WILAYAH KERJA PUSKESMAS JEREWEH
TAHUN 2023
DESA : Goa usia sekolah 7 - 10 t
DUSUN : Mekar
RT : 07

BULAN LAYANAN
KETERA
NO NO KK NAMA KK NAMA ANGGOTA KELUARGA NIK No BPJS TANGGAL LAHIR UMUR
NGAN

MAR

AUG

OKT
APR

MEI

JUN

DES
JAN

FEB

SEP
JUL
1 2 3 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
1 3573012602150013 Gandi Novonsen Ralintya Guiena Q 3573016003150002 0001578675622 3/20/2015 9

2 5207012812110002 Hendri Sugianto Daffa Anshari P 5207010312140001 12/3/2014 10

3 520701300512002 Indra Gunawan Nazila Sabrani G.P 5207014809140001 0002032134996 9/8/2014 10

4 5207012708101504 Mulyadi Cantika Putri H 5207017010130001 0001576672817 10/30/2013 11

5 5207012708101470 Kamaluddin Tri Maulida 5207016309110001 9/23/2014 10

6 5207012708101471 Mustakin M.Kenzi 5207010702150001 2/7/2015 9

7 520701278102557 Saharuddin Humairah Zahrah 5207016910140001 0001479917665 10/29/2014 10

8 520702708101491 Junaidi, S.P.t M.Gibran Aufaqry 5207010204120001 PREMI 4/24/2014 10

9 5207010806110002 Zainul Hurman Rizal Aidil R 5207012708120001 0001812389848 8/27/2012 12

10 5207012708101498 Susanti Andien Khaliqa R 5207015307110001 0001581249857 7/13/2013 11

11 5207010204130002 Sagafuddin Rizky Aditya 5207010807130001 0001581076449 7/8/2013 11

12 5207012708102542 Juhardi Tommy Alfayad Ibra 5207012802130001 0001874188967 2/28/2013 11

13 5207012708101510 Bustanul Arifin Fincha Kalista 5207015707140001 0003041433415 7/17/2014 10

14 520701912910130001 Arwansyah Alif Rizky.A 5207011009130001 0001648644489 9/10/2013 11

15 5207010907120002 Nasripin Rasidin Alinda Riski 5207016912130001 0001575467076 4/29/2013 11

L 7
P 8
 FORMAT SASARAN PER RT WILAYAH KERJA PUSKESMAS JEREWEH
TAHUN 2023
DESA : Goa remaja
DUSUN : Mekar
RT : 07

BULAN LAYANAN
KETERA
NO NO KK NAMA KK NAMA ANGGOTA KELUARGA NIK No BPJS TANGGAL LAHIR UMUR
NGAN

MAR

AUG

OKT
APR

MEI

JUN

DES
JAN

FEB

SEP
JUL
1 2 3 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
1 5207012708102382 Hadi Sufrianto,S.E Latiza Fadilah PH 5207017105110001 0000167801128 5/31/2011 13

2 5207012708101482 Bayhaqi Hilwa Zuhratul Ain 5207012606090001 6/26/2009 15

3 5207012708101506 Sanadin Sahira 5207036511100001 0002584415169 12/31/2010 13

4 5207012708101489 M.Nasir S.Ag Lala Sri Dewi A 5207014411080001. 0001575864527 11/4/2008 16

5 5207012708101489 M.Nasir S.Ag Prabu Panji K 5207010102110001 0001581250116 2/1/2011 13

6 5207012708102165 Subhan Kirana Ayulia 5207015804080001 0001581249609 4/18/2008 16

7 520701300512002 Indra Gunawan Nabila Sabrina G.P 5207014904120001 0001099033402 9/4/2012 12

8 5207012708101896 Erwansyah R.Gustavo Hamfara 5207010511070001 11/1/2007 17

9 5207012708101896 Erwansyah R.Alfido Hamfara 5207010401100001 1/4/2010 14

10 5207012708101471 Mustakin Zhulaika R 5207014809090001. 9/8/2009 15

11 527012708101519 Amril Wijaya Alfino Ibra Wijaya 5207012910080001 11/29/2008 16

12 ,57012708101503 Sarilan Saputra M.Fauzan Anwar 5207010904110001 000207736244 4/9/2011 13

13 520701278102557 Saharuddin Miral Iftihan 5207016009080001 0001581249249 8/20/2008 16

14 5207012708101520 Muslimin Sabil S.E Iona Permata Z 5207016202100003 2/22/2010 14

15 5207012708101520 Muslimin Sabil S.E Iola Permata 5207016202100001 0001575332954 2/22/2010 14

16 5207010806110002 Zainul Hurman Risana Ayu R 52070126909080002 9/29/2008 16

17 5207012708101792 M.Hatta S.E Olinda Elysia 5207015601110001 0001575906232 1/6/2011 13

18 5207012708101498 Susanti Daffa Nabil Fasih 5207010201080001 0001575367514 1/2/2008 16

19 5207012806120002 Bukhri Sany M.Ghezzal Mirshany 5207012510100001 0001575885971 10/25/2010 14

20 5207012708101332 Sulaeman Fauzul Inzanul K 5207012511090001 0003275024444 11/25/2009 15

21 52070110004140001 Zaetulliah L.M.Fadhil Ilham 5207013101090001 0002111694974 1/31/2009 15

22 5207012708102542 Juhardi Tommy Firshani Rezzara 5207010808090001 0001874188326 8/8/2009 15

23 5207012708101510 Bustanul Arifin Kayla Almagfira 5207014607080001 0001575850735 7/6/2008 16

24 5207012708101510 Bustanul Arifin Azcha Dewangga P 5207011402120001 0001575850746 2/19/2012 12

25 520701130610009 Rolly yansyah Yunus Alfareza 5207011202100001 0001575286075 2/12/2010 14

26 5207010907120002 Nasripin Rasidin Nadila Ulfa 5207014804120001 0001575467065 6/8/2012 12

27 520701020303160001 Syamsul M.Fauzan Saputra 5207080207090001 Tidak Aktif 7/2/2009 15

28 520701020303160001 Syamsul Febriyani 5207086502120001 Tidak Aktif 2/25/2012 12
L 6
P 22
 FORMAT SASARAN PER RT WILAYAH KERJA PUSKESMAS JEREWEH
TAHUN 2023
DESA : Goa
DUSUN : Mekar
RT : 07

BULAN LAYANAN
NO NO KK NAMA KK NAMA ANGGOTA KELUARGA NIK No BPJS TANGGAL LAHIR UMUR KETERANGAN

MAR

AUG

OKT
APR

JUN
MEI

DES
JAN

FEB

SEP
JUL
1 2 3 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
1 5207012708102382 Hadi Sufrianto,S.E Rozila Ramadhan PH 5207012809060001 0000167801106 9/28/2006 18

2 5207012708101482 Bayhaqi Zulfauzan Albani 5207010101070001 0001575908098 1/1/2007 17

3 5207012708101470 Abdul Wahid,S.Sos Dinda Aisya Layna W 5207016804060001 0002251449279 4/28/2006 18

4 5207012708101489 M.Nasir S.Ag Lala Sri Manunggal 5207015207060001. 0001581250105 7/12/2006 18

5 5207012708101504 Mulyadi Ezy Aditya M 5207012906060001 0001576672806 6/29/2006 18

6 5207012708101470 Kamaluddin Nadine Rizky A 5207016903070002 3/29/2007 17

7 5207012708101471 Mustakin F.Hamida 5207015008050001 8/10/2005 19

8 527012708101519 Amril Wijaya M.Arya Pratama 5207012105040001 0001574855212 5/21/2004 20

9 527012708101519 Amril Wijaya Ariel Wijaya 5207012911080001 0001574857844 7/5/2006 18

10 5207010806110005 Wirasandi Tamawana,R.A 5207014608140001 0001483157935 8/6/2004 20

11 ,57012708101503 Sarilan Saputra M.Irsa Surya Putra 5207010909050001 0002252287888 9/9/2005 19

12 520701278102557 Saharuddin M.Rosidi 5207011403070001 0001581249238 3/14/2007 17

13 520702708101491 Junaidi, S.P.t M.Rahbini Mahendra 5207012601050001 PREMI 1/26/2005 19

14 5207012708101792 M.Hatta S.E Gilang Akbar 5207010910030001 0001575906221 10/9/2003 21

15 5207012708101332 Sulaeman Fannia Refiani 5207015805070001 0001575864639 5/18/2007 17

16 52070110004140001 Zaetulliah L.Said Alzulman 5207012303050001 0001058175639 3/23/2005 19

17 5207012708101510 Bustanul Arifin Radista Artamesia 5207017008060001 0001575850724 8/30/2006 18

18 5207012708101510 Bustanul Arifin Danu Zulfikar 5207011509050001 0002847996279 9/15/2005 19
L 14
P 4
Ugdranap2022*
 FORMAT SASARAN PER RT WILAYAH KERJA PUSKESMAS JEREWEH
TAHUN 2023
DESA : Goa usia produktif
DUSUN : Mekar
RT : 07

BULAN LAYANAN
JUMLAH
NO NO KK NAMA KK ANGGOTA NAMA ANGGOTA KELUARGA NIK No BPJS TANGGAL LAHIR UMUR KETERANGAN
KELUARGA

MAR

AUG

OKT
APR

JUN
MEI

DES
JAN

FEB

SEP
JUL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
1 5207012708101484 Fuad,S.H 4 Fuad,S.H 5207012906690001 0001789017434 6/29/1969 55 DM,COL
2 Rukaiyah,A.d.Keb 5207015110700001 0000146599187 10/11/1970 54
3 Sri Azizah Hudani 5207014201020001 Keluar 1/2/2002 22

4 5207012708102156 Madiolo 4 Madiolo 5207010603690001 0001575864854 3/6/1969 55 HT

5 Subaini 5207015602760001 0001575864865 2/16/1976 48
6 Firdaus Zulhakiman 5207011003970001 5/10/1997 27
7 Febri Zizka Kausar 5207014802020001. 0001575864887 2/8/2002 22

8 5207012066190001 Misnawati 1 Misnawati 5207015501690001 1/15/1969 55

9 5207012708101466 Tuhur Tasnim 5207016702730001 0001581249824 2/27/1973 51 DM

10 M.Supiandi Asri 5207011710000003 0001581249846 10/17/2000 24

11 5207012708101472 Kamrullah ,S.E 5 Kamrullah ,S.E 5207012109660001 9/21/1966 58

12 Masita MS.s.Pd 5207014410620001 10/4/1960 64
13 Kemas Basral Sabili 5207012111980001 11/21/1998 26
14 Rheza Hidayatullah 5207012304000001 4/23/2000 24

15 5207012708102382 Hadi Sufrianto,S.E 5 Hadi Sufrianto,S.E 5207011911840001 0000161703134 11/19/1984 40

16 Sulis Ekawati 5207016610820001 00167801084 10/28/1982 42

17 5207012708101482 Bayhaqi 6 Bayhaqi 5207011008750001 0001575908065 8/10/1975 49

18 Sripawan 5207015608760001 0001575908076 8/16/1976 48
19 Rafli Insani Al'Faqih 5207011710020001 0001575908087 10/17/2002 22

20 5207012708101522 Zainul Aqli 3 Zainul Aqli 5207011011700001 0001575908021 11/10/1970 54

21 Arjuna Restu Putra 520701081000001 10/8/2000 24
23 Wina

24 5207012708101902 Lisen Okta Lalang 3 Lisen Okta Lalang 5207010510610001 0001093644415 10/5/1961 63 DM
25 Marlina 5207015506660001 0001100363815 6/15/1966 58
26 Marthen Pitherson 5207011903930001 0001658042741 3/19/1993 31

27 5207012708102212 Rato Hendra, SH 4 Rato Hendra, SH 5207011008860001 8/10/1986 38

28 Yuyun Nurhayati,SH 5207015306860002 0000161722449 6/13/1986 38

29 5207012708101506 Sanadin 5 Sanadin 5207032710660001 0000846543611 10/27/1966 58

30 Rohani 5207014404730001 0002441220175 4/19/1973 51
31 Ihsan Kamaluddin 5207032909020003 0000846544555 9/29/2002 22
32 5207012708101470 Abdul Wahid,S.Sos 5 Abdul Wahid,S.Sos 5207010307750002 0001963748654 7/30/1975 49
33 Iswantari 5207014407780001 0002251449246 7/4/1978 46
34 M.Wisnu Ademulia 5207011104990001 0002251449292 4/11/1999 25
35 Wahyu Hidayat N 5207012612020001 0002251449325 12/26/2002 22

36 5207012708101517 H.Sailan Jabir 4 H.Sailan Jabir 5207011711610001 0001853520849 11/17/1961 63

37 Rati Kuadrattika 5207015011890001 0001853523044 11/10/1989 35
38 Siti NurJabir 5207015212700001 0001853524091 12/12/1970 54

39 5207012202160001 Indra Abikusno 3 Indra Abikusno 5207010506830001 0001576134066 6/5/1983 41

40 Rahmawati 5204117608850001 8/6/1985 39

41 5207012708101489 M.Nasir S.Ag 6 M.Nasir S.Ag 5207012109730001 0001581250083 21/9/1973 #VALUE!

42 Mimi Erni 5207015504830001 0001581250094 4/14/1983 41

43 5207012708102165 Subhan 5 Subhan 5207011812840001 0001581249587 12/18/1984 40

44 Mascawan 5207016912780001 0001581249598 12/28/1978 46

45 5207012788101477 Asiah Mualimin 5207011308790001 0001581249969 8/13/1979 45

46 5207012708101529 Rahmawati 2 Rahmawati 5207016101600001 0000146600201 1/21/1960 64

47 Rahmat 5207011010820001 0001581249879 10/10/1982 42

48 520701710200002 Burhanuddin Burhanuddin 5201031508941001 8/15/1994 30

49 Nur Azlinda 5203124301010011 1/3/2001 23

50 52070115021972 Ade Wardana 3 Ade Wardana 5207010608860001 0001576311671 8/6/1986 38

51 Desi Susanti 5207014812880001 0001581249881 12/8/1988 36

52 3573012602150013 Gandi Novonsen 3 Gandi Novonsen 3573011811840001 0001578675611 11/18/1984 40

53 Triana Susanti 5207016907860001 0001578675609 7/29/1986 38

54 5207012708101487 Sarima 1 Sarima 5207014507630001 0001802436838 7/5/1963 61 HT

55 5207012812110002 Hendri Sugianto 4 Hendri Sugianto 5207010208820001 0001575851253 8/2/1982 42

56 Suci Ramdayanti 5204055204900005 0001575851264 4/12/1990 34 HT,DM,Jantung

57 5207012708101513 M.Ali Hasan 1 M.Ali Hasan 5207011404520001 0002070944482 4/14/1952 72

58 520701300512002 Indra Gunawan 4 Indra Gunawan 5207013004810001 0001093334376 4/30/1981 43

59 Nunung Sulastri 5207014102820003 0000173788457 2/1/1982 42

60 5207012708101896 Erwansyah 4 Erwansyah 5207010101770001 1/1/1977 48

61 Nunik Cokrawati 5207015303790001 3/13/1979 45

62 52070107121712001 Hj.Jawiyah 1 Hj.Jawiyah 5207015011630001 0001581250072 11/10/1963 61 COL,DM,HT

63 5207012708101504 Mulyadi 5 Mulyadi 5207011307720001 0001576672773 7/13/1972 52

64 Rusmiati 5207014806730001 0001576672784 6/8/1973 51
65 Adrian Maulana 5207012207010001 0001576672795 6/22/2001 23
66 5207012708101470 Kamaluddin 4 Kamaluddin 5207012601740001 0001579682676 1/26/1974 50
67 Sriani 5207016604720001 0001579682687 8/26/1973 51 DM,HT

68 5207012708101485 Abdul Kadir 3 Abdul Kadir 5207013112630006 0000146890629 12/31/1963 61

69 Mariatul 5207014303660001 0000146766497 3/9/1966 58 DM
70 Sigit Cahyadi Putra 5207011107970001 0000146766521 7/11/1997 27

71 5207012708101471 Mustakin 6 Mustakin 5207010803790001 0002061981325 3/8/1979 45

72 Hafniatunnisa 5207014101800017 0002895554081 1/1/1980 45

74 5207012402210001 Hj. Salma 1 Hj. Salma 5207017112450005 31/11/1945 #VALUE!

75 527012708101519 Amril Wijaya 6 Amril Wijaya 5207011405790001 0001574854143 5/14/1979 45

76 Neli Puspitasari 5207015509840001 0001321657277 9/15/1984 40 DM,HT,CDL

77 5207010806110005 Wirasandi 3 Wirasandi 5207011206760002 0001148056637 6/12/1976 48

78 Rabiya 5207016806760002 5/28/1978 46
79 Tamawana,R.A 5207014608140001 0001483157935 8/6/2004 20

80 ,57012708101503 Sarilan Saputra 6 Sarilan Saputra 5207010601740001 0001579611554 1/6/1974 50

81 Iriani 5207015810740001 0002252287416 18/10/1974 #VALUE!
82 M.Irfan Ansari 5207010810980001 10/8/1998 26
83 Nurul Alani A 5207014409000001 9/4/2000 24

84 5207012708101483 A.Hamid 3 A.Hamid 5207011501660001 PREMI 1/15/1966 58

85 Juhaena 5207012012660001 PREMI 11/20/1966 58 DM
86 Dwi Atmaja 5207012309980001. PREMI 12/26/1998 26

87 5207012708101469 Indir 4 Indir 5207010507600001 0000146599075 7/5/1960 64

88 Hairiawati 5207014302620001 0000146599053 2/3/1962 62 HT
89 M.Hidayatullah 5207010810010001 0002312200089 10/8/2001 23

90 5207012708101469 Kurnia Agustina Kurnia Agustina 5207014208910001 8/2/1991 33

91 520701278102557 Saharuddin 6 Saharuddin 5207010202740002 0001297621719 22/9/1974 #VALUE!

92 Salmah 5207014503770002 0001479468914 3/5/1977 47
93 M.Sahrul 5207011004980001 0001581249216 4/10/1998 26
94 M.Fahrul 5207011205020001 0001581249227 5/7/2003 21

95 5207012708101520 Muslimin Sabil S.E 6 Muslimin Sabil S.E 5207013007750002 0001575332919 7/30/1975 49
96 Musdalifah .S.E 5207016907790001 0001575332921 7/29/1979 45 HT,DM
97 Mrga Olifiah C 5207016303990001 3/23/1999 25
98 Prisma Regina D 5207016004020001 0001575332943 4/20/2002 22

99 5207012708100836 H.M.Sirad Riska Prihartini 5207011506950001 6/15/1995 29

100 5207012907200001 Abdul Rasyid Abdul Rasyid 5272010108700003 0000145617873 8/1/1970 54

101 Hj. Sri Asmawati, S.Pd 5207015204690002 0000146762638 4/12/1969 55

102 520702708101491 Junaidi, S.P.t 5 Junaidi, S.P.t 5207011004690001 PREMI 4/10/1969 55 JANTUNG ,HT
103 Alfiani 5207016605730001 PREMI 6/25/1973 51
104 Hafida Jumratul 5207015404000001 PREMI 4/14/2000 24

105 5207010806110002 Zainul Hurman 5 Zainul Hurman 5207011005820002 0000146762752 5/10/1982 42

106 Nurhasanah 5207017008810002 0000146762763 8/30/1981 43

107 5207012708101792 M.Hatta S.E 6 M.Hatta S.E 5207011201760001 0001575906197 1/12/1976 48

108 Sumarti 5207014106750001 0003145033664 5/1/1976 48
109 Taufik Hatiala 5207010607000002 7/5/2000 24

110 5207012708101498 Susanti 5 Susanti 5207016812780001 0001575367435 2/28/1978 46

111 Rifqi Apriliano 5207012004990001 4/21/1999 25
112 Jascha Aprilyano 5207010604020001 0001575367492 4/6/2002 22

113 5207012708101448 Irwansyah Dewantara 4 Irwansyah Dewantara 5207011608720001 0001575852243 8/16/1972 52

114 Siti Aminah 520701570572001 0001575852254 5/17/1972 52

115 5207012806120002 Bukhri Sany 6 Bukhri Sany 5207012611790001 0002920207252 11/26/1979 45

116 Lin Mustainingsih 5207015010900001 0001805488288 10/10/1990 34

117 5207012708101332 Sulaeman 5 Sulaeman 5207012801730001 0001575864584 1/28/1973 51 DM

118 Fathel Aini ,S.Pd 5207016008760001 0001575864595 8/28/1976 48

119 5207010204130002 Sagafuddin 5 Sagafuddin 5207070303760002 0001581076438 3/3/1976 48

120 Husnia Pawida 5207014205870001 0001583978275 5/25/1987 37

121 52070110004140001 Zaetulliah 5 Zaetulliah 5207015208740001 0002111694941 8/12/1974 50

122 M.Riki Muzakki '5207013108960001 8/31/1996 28
123 L.Said Alzulman 5207012303050001 0001058175639 3/23/2005 19
124 L.M.Fadhil Ilham 5207013101090001 0002111694974 1/31/2009 15
125 Baiq Zaenal Fathinz 5207014309150001 0002661274192 9/3/2015 9
125
126 5207012708102542 Juhardi Tommy 6 Juhardi Tommy 5207012107850001 0001874184939 7/21/1985 39
127 Susan Rina F 5207015602880002 0001576857644 2/16/1988 36

128 5207012708101510 Bustanul Arifin 8 Bustanul Arifin 5207013006820001 0001575850702 6/3/1982 42 DM

129 Yuli Handrani 5207016207850001 0001575850713 7/22/1985 39
130 Dani Rangga P 5207010212030001 0002847996279 2/12/2003 21

131 520701130610009 Rolly yansyah 6 Rolly yansyah '5207012405820002 0001575286042 5/24/1982 42

132 Susmawati 5207014511830001 0001575286064 12/15/1983 41

133 5207012708101257 Jumaris AM.Usman 4 Jumaris AM.Usman 5207010301730001 0001581250151 1/3/1973 52

134 Hj.Kamariah 5207017005700001 0001581250162 5/30/1975 49 DM,HT
135 ikhsan hamdani jumaris 5207012400001 4/24/2000 24
136 Lilis Hakusmanian 5207016109020001 0001581250184 8/21/2002 22

137 5207012708101475 M.Ali Suliati 5207017112700010 0001581250138 12/31/1970 54 HT

138 520701912910130001 Arwansyah 4 Arwansyah 5207010803860001 0001648644467 1/8/1986 38

139 Rahmawati 5207014303930001 0001648644478 3/3/1993 31
140 5207012708101884 Tajuddin 4 Tajuddin 5207011109670001 0002111695086 9/11/1967 57
141 Nurul Ani 5207016509690001 0002111695097 9/25/1969 55
142 M.Zainuddin 5207012506010003 0002111695108 5/25/2001 23

143 5207012808170004 Ardiansyah 4 Ardiansyah 5207011006890001 0000845471518 6/10/1989 35

144 Heriyati 5204055205820002 0002285840799 5/12/1982 42

145 5207010907120002 Nasripin Rasidin 5 Nasripin Rasidin 5207011006840002 0001575467043 4/10/1984 40

146 Suli Amiah 5203066505880004 00015754667054 8/25/1988 36

147 520701020303160001 Syamsul 5 Syamsul 5207080504600001 Tidak Aktif 12/31/1954 70

148 Nurmayani 5207085312840001 Tidak Aktif 12/31/1984 40

149 5207012703190001 Bagus M. Faruqi 4 Bagus M. Faruqi 5204180401930003 10/14/1993 31

150 Rizky Ratu Dyahfani 5207016609910001 9/26/1991 33
L 78
P 72
Ugdranap2022*
 FORMAT SASARAN PER RT WILAYAH KERJA PUSKESMAS JEREWEH
TAHUN 2023
DESA : Goa lansia
DUSUN : Mekar
RT : 07

BULAN LAYANAN
JUMLAH
NO NO KK NAMA KK ANGGOTA NAMA ANGGOTA KELUARGA NIK No BPJS TANGGAL LAHIR UMUR KETERANGAN
KELUARGA

MAR

AUG

OKT
APR

MEI

JUN

DES
JAN

FEB

SEP
JUL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
1 5207012708101466 Tuhur 3 Tuhur 5207010105620001 0001581249813 5/1/1962 62 v

2 5207012708101472 Kamrullah ,S.E Masita MS.s.Pd 5207014410620001 10/4/1960 64 v

3 5207010706110002 Hj.Rafiah 1 Hj.Rafiah 5207017012460001 0001811129332 12/31/1948 76 v

4 5207012708101902 Lisen Okta Lalang 3 Lisen Okta Lalang 5207010510610001 0001093644415 10/5/1961 63 v DM

5 5207012708101517 H.Sailan Jabir 4 H.Sailan Jabir 5207011711610001 0001853520849 11/17/1961 63 v

6 5207012788101477 Asiah 2 Asiah 5207014303540001 0001581249958 3/3/1954 70 v HT

7 5207012708101529 Rahmawati 2 Rahmawati 5207016101600001 0000146600201 1/21/1960 64 v

8 5207010310130001 Hj. Safauyah 1 Hj.Safauyah 5207015103550001 0001880736849 3/11/1955 69 v

9 5207012708101513 M.Ali Hasan 1 M.Ali Hasan 5207011404520001 0002070944482 4/14/1952 72 v

10 5207012708101996 Fatimah 1 Fatimah 5207017112530011 0002067148135 12/31/1953 71 v HT

11 5207012708101495 M.Safer 1 M.Safer 5207013112550001 0001581250037 12/31/1955 69 v

12 5207012402210001 Hj. Salma 1 Hj. Salma 5207017112450005 11/30/1945 79

13 5207012708101469 Indir 4 Indir 5207010507600001 0000146599075 7/5/1960 64 v

14 5207012708101469 Indir Hairiawati 5207014302620001 0000146599053 2/3/1962 62 v HT

15 5207012708100836 H.M.Sirad 4 H.M.Sirads 5207011204420001 4/12/1942 82 v

16 5207012708101475 M.Ali 2 M.Ali 5207013112600016 0001581250127 12/31/1960 64 v

17 520701020303160001 Syamsul 5 Syamsul 5207080504600001 Tidak Aktif 12/31/1954 70 v

L 10
P 7
Ugdranap2022*
 FORMAT SASARAN PER RT WILAYAH KERJA PUSKESMAS JEREWEH
TAHUN 2023
DESA : Goa WANITA USIA 15-49 TH
DUSUN : Mekar
RT : 07

BULAN LAYANAN
NO NO KK NAMA KK NAMA ANGGOTA KELUARGA NIK No BPJS TANGGAL LAHIR UMUR KETERANGAN

MAR

AUG

OKT
APR

MEI

JUN

DES
JAN

FEB

SEP
JUL
1 2 3 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
1 5207012708101484 Fuad,S.H Sri Azizah Hudani 5207014201020001 Keluar 1/2/2002 22

2 5207012708102156 Madiolo Subaini 5207015602760001 0001575864865 2/16/1976 48

3 5207012708102156 Madiolo Febri Zizka Kausar 5207014802020001. 0001575864887 2/8/2002 22

4 5207012708101466 Tuhur M.Supiandi Asri 5207011710000003 0001581249846 10/17/2000 24

5 5207012708101472 Kamrullah ,S.E Masita MS.s.Pd 5207014410620001 10/4/1960 64

6 5207012708102382 Hadi Sufrianto,S.E Sulis Ekawati 5207016610820001 00167801084 10/28/1982 42

7 5207012708101482 Bayhaqi Sripawan 5207015608760001 0001575908076 8/16/1976 48

8 5207012708102212 Rato Hendra, SH Yuyun Nurhayati,SH 5207015306860002 0000161722449 6/13/1986 38

9 5207012708101506 Sanadin Rohani 5207014404730001 0002441220175 4/19/1973 51

10 5207012708101470 Abdul Wahid,S.Sos Iswantari 5207014407780001 0002251449246 7/4/1978 46

11 Dinda Aisya Layna W 5207016804060001 0002251449279 4/28/2006 18
12 Putri Dwi Setiana Muliadi 5203034810980004 10/8/1998 26

13 5207012708101517 H.Sailan Jabir Rati Kuadrattika 5207015011890001 0001853523044 11/10/1989 35

14 5207012202160001 Indra Abikusno Rahmawati 5204117608850001 8/6/1985 39

15 5207012708101489 M.Nasir S.Ag Mimi Erni 5207015504830001 0001581250094 4/14/1983 41

16 5207012708101489 M.Nasir S.Ag Lala Sri Manunggal 5207015207060001. 0001581250105 7/12/2006 18

17 5207012708102165 Subhan Mascawan 5207016912780001 0001581249598 12/28/1978 46

18 5207012708102165 Subhan Kirana Ayulia 5207015804080001 0001581249609 4/18/2008 16

19 52070115021972 Ade Wardana Desi Susanti 5207014812880001 0001581249881 12/8/1988 36

20 3573012602150013 Gandi Novonsen Triana Susanti 5207016907860001 0001578675609 7/29/1986 38

21 5207012812110002 Hendri Sugianto Suci Ramdayanti 5204055204900005 0001575851264 4/12/1990 34 HT,DM,Jantung

22 5207010310130001 Hj. Safauyah Hj.Safauyah 5207015103550001 0001880736849 3/11/1955 69

23 520701300512002 Indra Gunawan Nunung Sulastri 5207014102820003 0000173788457 2/1/1982 42

24 5207012708101896 Erwansyah Nunik Cokrawati 5207015303790001 3/13/1979 45

25 52070107121712001 Hj.Jawiyah Hj.Jawiyah 5207015011630001 0001581250072 11/10/1963 61 COL,DM,HT

26 5207012708101504 Mulyadi Rusmiati 5207014806730001 0001576672784 6/8/1973 51

27 5207012708101470 Kamaluddin Sriani 5207016604720001 0001579682687 8/26/1973 51 DM,HT

28 5207012708101470 Kamaluddin Nadine Rizky A 5207016903070002 3/29/2007 17

29 5207012708101471 Mustakin Hafniatunnisa 5207014101800017 0002895554081 1/1/1980 45

30 5207012708101471 Mustakin F.Hamida 5207015008050001 8/10/2005 19

31 527012708101519 Amril Wijaya Neli Puspitasari 5207015509840001 0001321657277 9/15/1984 40 DM,HT,CDL

32 5207010806110005 Wirasandi Rabiya 5207016806760002 5/28/1978 46

33 ,57012708101503 Sarilan Saputra Iriani 5207015810740001 0002252287416 18/10/1974 #VALUE!

34 ,57012708101503 Sarilan Saputra Nurul Alani A 5207014409000001 9/4/2000 24

35 5207012708101483 A.Hamid Juhaena 5207012012660001 PREMI 11/20/1966 58 DM

36 5207012708101483 A.Hamid Dwi Atmaja 5207012309980001. PREMI 12/26/1998 26

37 5207012708101469 Kurnia Agustina Kurnia Agustina 5207014208910001 8/2/1991 33

38 520701278102557 Saharuddin Salmah 5207014503770002 0001479468914 3/5/1977 47

39 5207012708101520 Muslimin Sabil S.E Musdalifah .S.E 5207016907790001 0001575332921 7/29/1979 45 HT,DM
40 5207012708101520 Muslimin Sabil S.E Mrga Olifiah C 5207016303990001 3/23/1999 25
41 5207012708101520 Muslimin Sabil S.E Prisma Regina D 5207016004020001 0001575332943 4/20/2002 22

42 5207012708100836 H.M.Sirad Riska Prihartini 5207011506950001 6/15/1995 29

43 5207012907200001 Abdul Rasyid Hj. Sri Asmawati, S.Pd 5207015204690002 0000146762638 4/12/1969 55

44 520702708101491 Junaidi, S.P.t Hafida Jumratul 5207015404000001 PREMI 4/14/2000 24

45 5207010806110002 Zainul Hurman Nurhasanah 5207017008810002 0000146762763 8/30/1981 43

46 5207012708101792 M.Hatta S.E Sumarti 5207014106750001 0003145033664 5/1/1976 48

47 5207012708101498 Susanti Susanti 5207016812780001 0001575367435 2/28/1978 46

48 5207012708101448 Irwansyah Dewantara Siti Aminah 520701570572001 0001575852254 5/17/1972 52

49 5207012806120002 Bukhri Sany Lin Mustainingsih 5207015010900001 0001805488288 10/10/1990 34

50 5207012708101332 Sulaeman Fathel Aini ,S.Pd 5207016008760001 0001575864595 8/28/1976 48

51 5207012708101332 Sulaeman Maedy Sulfani 5207015405040001 0001575864628 5/19/2004 20
52 5207012708101332 Sulaeman Fannia Refiani 5207015805070001 0001575864639 5/18/2007 17

53 5207010204130002 Sagafuddin Husnia Pawida 5207014205870001 0001583978275 5/25/1987 37

54 52070110004140001 Zaetulliah Zaetulliah 5207015208740001 0002111694941 8/12/1974 50

55 5207012708102542 Juhardi Tommy Susan Rina F 5207015602880002 0001576857644 2/16/1988 36

56 5207012708101510 Bustanul Arifin Yuli Handrani 5207016207850001 0001575850713 7/22/1985 39

57 5207012708101510 Bustanul Arifin Radista Artamesia 5207017008060001 0001575850724 8/30/2006 18

58 520701130610009 Rolly yansyah Susmawati 5207014511830001 0001575286064 12/15/1983 41

59 5207012708101257 Jumaris AM.Usman Hj.Kamariah 5207017005700001 0001581250162 5/30/1975 49 DM,HT

60 520701912910130001 Arwansyah Rahmawati 5207014303930001 0001648644478 3/3/1993 31

61 5207012808170004 Ardiansyah Heriyati 5204055205820002 0002285840799 5/12/1982 42

62 5207010907120002 Nasripin Rasidin Suli Amiah 5203066505880004 00015754667054 8/25/1988 36

63 520701020303160001 Syamsul Nurmayani 5207085312840001 Tidak Aktif 12/31/1984 40

64 5207012703190001 Bagus M. Faruqi Rizky Ratu Dyahfani 5207016609910001 9/26/1991 33

Ugdranap2022*
 FORMAT SASARAN PER RT WILAYAH KERJA PUSKESMAS JEREWEH
TAHUN 2023
DESA : Goa
DUSUN : Mekar
RT : 07

KB BULAN LAYANAN
KETERA
NO NO KK NAMA KK NAMA ANGGOTA KELUARGA NIK No BPJS TANGGAL LAHIR UMUR SUNTI PIL IMPLA IUD MOW MOP KOND NGAN

MAR

AUG

OKT
APR
K N OM

DES
FEB

MEI

SEP
JUN
JAN

JUL
1 2 3 5 6 7 8 9 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
4 5207012708102156 Madiolo Madiolo 5207010603690001 0001575864854 3/6/1969 55
5 Subaini 5207015602760001 0001575864865 2/16/1976 48

15 5207012708102382 Hadi Sufrianto,S.E Hadi Sufrianto,S.E 5207011911840001 0000161703134 11/19/1984 40

16 Sulis Ekawati 5207016610820001 00167801084 10/28/1982 42 HT

20 5207012708101482 Bayhaqi Bayhaqi 5207011008750001 0001575908065 8/10/1975 49

21 Sripawan 5207015608760001 0001575908076 8/16/1976 48

27 5207012708101522 Zainul Aqli Zainul Aqli 5207011011700001 0001575908021 11/10/1970 54

28 Arjuna Restu Putra 520701081000001 10/8/2000 24

33 5207012708102212 Rato Hendra, SH Rato Hendra, SH 5207011008860001 8/10/1986 38

34 Yuyun Nurhayati,SH 5207015306860002 0000161722449 6/13/1986 38

41 5207012708101470 Abdul Wahid,S.Sos Abdul Wahid,S.Sos 5207010307750002 0001963748654 7/30/1975 49

42 Iswantari 5207014407780001 0002251449246 7/4/1978 46

50 5207012202160001 Indra Abikusno Indra Abikusno 5207010506830001 0001576134066 6/5/1983 41

51 Rahmawati 5204117608850001 8/6/1985 39 DM

53 5207012708101489 M.Nasir S.Ag M.Nasir S.Ag 5207012109730001 0001581250083 21/9/1973 #VALUE!

54 Mimi Erni 5207015504830001 0001581250094 4/14/1983 41

61 5207012708102165 Subhan Subhan 5207011812840001 0001581249587 12/18/1984 40 JANTUNG

62 Mascawan 5207016912780001 0001581249598 12/28/1978 46 HT/DM

66 5207012788101477 Asiah Asiah 5207014303540001 0001581249958 3/3/1954 70

67 Mualimin 5207011308790001 0001581249969 8/13/1979 45

68 5207012708101529 Rahmawati Rahmawati 5207016101600001 0000146600201 1/21/1960 64

69 Rahmat 5207011010820001 0001581249879 10/10/1982 42

520701710200002 Burhanuddin Burhanuddin 5201031508941001 8/15/1994 30

Nur Azlinda 5203124301010011 1/3/2001 23 DM

70 52070115021972 Ade Wardana Ade Wardana 5207010608860001 0001576311671 8/6/1986 38

71 Desi Susanti 5207014812880001 0001581249881 12/8/1988 36

73 3573012602150013 Gandi Novonsen Gandi Novonsen 3573011811840001 0001578675611 11/18/1984 40

74 Triana Susanti 5207016907860001 0001578675609 7/29/1986 38

77 5207012812110002 Hendri Sugianto Hendri Sugianto 5207010208820001 0001575851253 8/2/1982 42

78 Suci Ramdayanti 5204055204900005 0001575851264 4/12/1990 34

83 520701300512002 Indra Gunawan Indra Gunawan 5207013004810001 0001093334376 4/30/1981 43

84 Nunung Sulastri 5207014102820003 0000173788457 2/1/1982 42 HT/DM
 87 5207012708101896 Erwansyah Erwansyah 5207010101770001 1/1/1977 48 HT/ASMA
88 Nunik Cokrawati 5207015303790001 3/13/1979 45

97 5207012708101470 Kamaluddin Kamaluddin 5207012601740001 0001579682676 1/26/1974 50

98 Sriani 5207016604720001 0001579682687 8/26/1973 51

106 5207012708101471 Mustakin Mustakin 5207010803790001 0002061981325 3/8/1979 45

107 Hafniatunnisa 5207014101800017 0002895554081 1/1/1980 45

111 527012708101519 Amril Wijaya Amril Wijaya 5207011405790001 0001574854143 5/14/1979 45

112 Neli Puspitasari 5207015509840001 0001321657277 9/15/1984 40

117 5207010806110005 Wirasandi Wirasandi 5207011206760002 0001148056637 6/12/1976 48

118 Rabiya 5207016806760002 5/28/1978 46
119 Tamawana,R.A 5207014608140001 0001483157935 8/6/2004 20

120 ,57012708101503 Sarilan Saputra Sarilan Saputra 5207010601740001 0001579611554 1/6/1974 50

121 Iriani 5207015810740001 0002252287416 18/10/1974 #VALUE!

134 520701278102557 Saharuddin Saharuddin 5207010202740002 0001297621719 22/9/1974 #VALUE!

135 Salmah 5207014503770002 0001479468914 3/5/1977 47

141 5207012708101520 Muslimin Sabil S.E Muslimin Sabil S.E 5207013007750002 0001575332919 7/30/1975 49
142 Musdalifah .S.E 5207016907790001 0001575332921 7/29/1979 45

156 5207010806110002 Zainul Hurman Zainul Hurman 5207011005820002 0000146762752 5/10/1982 42

157 Nurhasanah 5207017008810002 0000146762763 8/30/1981 43

161 5207012708101792 M.Hatta S.E M.Hatta S.E 5207011201760001 0001575906197 1/12/1976 48

162 Sumarti 5207014106750001 0003145033664 5/1/1976 48

167 5207012708101498 Susanti Susanti 5207016812780001 0001575367435 2/28/1978 46

168 Rifqi Apriliano 5207012004990001 4/21/1999 25

172 5207012708101448 Irwansyah Dewantara Irwansyah Dewantara 5207011608720001 0001575852243 8/16/1972 52

173 Siti Aminah 520701570572001 0001575852254 5/17/1972 52

176 5207012806120002 Bukhri Sany Bukhri Sany 5207012611790001 0002920207252 11/26/1979 45

177 Lin Mustainingsih 5207015010900001 0001805488288 10/10/1990 34

182 5207012708101332 Sulaeman Sulaeman 5207012801730001 0001575864584 1/28/1973 51

183 Fathel Aini ,S.Pd 5207016008760001 0001575864595 8/28/1976 48

187 5207010204130002 Sagafuddin Sagafuddin 5207070303760002 0001581076438 3/3/1976 48

188 Husnia Pawida 5207014205870001 0001583978275 5/25/1987 37

192 52070110004140001 Zaetulliah Zaetulliah 5207015208740001 0002111694941 8/12/1974 50

193 M.Riki Muzakki '5207013108960001 8/31/1996 28

197 5207012708102542 Juhardi Tommy Juhardi Tommy 5207012107850001 0001874184939 7/21/1985 39

198 Susan Rina F 5207015602880002 0001576857644 2/16/1988 36

203 5207012708101510 Bustanul Arifin Bustanul Arifin 5207013006820001 0001575850702 6/3/1982 42

204 Yuli Handrani 5207016207850001 0001575850713 7/22/1985 39 DM
HT
211 520701130610009 Rolly yansyah Rolly yansyah '5207012405820002 0001575286042 5/24/1982 42
212 Susmawati 5207014511830001 0001575286064 12/15/1983 41

217 5207012708101257 Jumaris AM.Usman Jumaris AM.Usman 5207010301730001 0001581250151 1/3/1973 52

218 Hj.Kamariah 5207017005700001 0001581250162 5/30/1975 49

222 520701912910130001 Arwansyah Arwansyah 5207010803860001 0001648644467 1/8/1986 38

223 Rahmawati 5207014303930001 0001648644478 3/3/1993 31

230 5207012808170004 Ardiansyah Ardiansyah 5207011006890001 0000845471518 6/10/1989 35 HT

231 Heriyati 5204055205820002 0002285840799 5/12/1982 42

237 5207010907120002 Nasripin Rasidin Nasripin Rasidin 5207011006840002 0001575467043 4/10/1984 40

238 Suli Amiah 5203066505880004 00015754667054 8/25/1988 36

242 520701020303160001 Syamsul Syamsul 5207080504600001 Tidak Aktif 12/31/1954 70

243 Nurmayani 5207085312840001 Tidak Aktif 12/31/1984 40

247 5207012703190001 Bagus M. Faruqi Bagus M. Faruqi 5204180401930003 10/14/1993 31

248 Rizky Ratu Dyahfani 5207016609910001 9/26/1991 33
 FORMAT SASARAN PER RT WILAYAH KERJA PUSKESMAS JEREWEH
TAHUN 2023
DESA : Goa
DUSUN : Mekar
RT : 07

BULAN LAYANAN
NO NO KK NAMA KK NAMA ANGGOTA KELUARGA NIK No BPJS TANGGAL LAHIR UMUR KETERANGAN

MAR

AUG

OKT
APR

JUN
MEI

DES
JAN

FEB

SEP
JUL
1 2 3 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21

1 5207012708102156 Madiolo Madiolo 5207010603690001 0001575864854 3/6/1969 55 HT

2 5207012788101477 Asiah Asiah 5207014303540001 0001581249958 3/3/1954 70 HT

3 5207012708101487 Sarima Sarima 5207014507630001 0001802436838 7/5/1963 61 HT

4 5207012812110002 Hendri Sugianto Suci Ramdayanti 5204055204900005 0001575851264 4/12/1990 34 HT,DM,Jantung

5 52070107121712001 Hj.Jawiyah Hj.Jawiyah 5207015011630001 0001581250072 11/10/1963 61 COL,DM,HT

6 5207012708101470 Kamaluddin Sriani 5207016604720001 0001579682687 8/26/1973 51 DM,HT

7 5207012708101996 Fatimah Fatimah 5207017112530011 0002067148135 12/31/1953 71 HT

8 527012708101519 Amril Wijaya Neli Puspitasari 5207015509840001 0001321657277 9/15/1984 40 DM,HT,CDL

9 5207012708101469 Indir Hairiawati 5207014302620001 0000146599053 2/3/1962 62 HT

10 5207012708101520 Muslimin Sabil S.E Musdalifah .S.E 5207016907790001 0001575332921 7/29/1979 45 HT,DM

11 520702708101491 Junaidi, S.P.t Junaidi, S.P.t 5207011004690001 PREMI 4/10/1969 55 JANTUNG ,HT

12 5207012708101257 Jumaris AM.Usman Hj.Kamariah 5207017005700001 0001581250162 5/30/1975 49 DM,HT

13 5207012708101475 M.Ali Suliati 5207017112700010 0001581250138 12/31/1970 54 HT

82 5207012708101513 M.Ali Hasan M.Ali Hasan 5207011404520001 0002070944482 4/14/1952 72 HT stroke

 FORMAT SASARAN PER RT WILAYAH KERJA PUSKESMAS JEREWEH
TAHUN 2023
DESA : Goa DM
DUSUN : Mekar
RT : 07

BULAN LAYANAN
KETERANGA
NO NO KK NAMA KK NAMA ANGGOTA KELUARGA NIK No BPJS TANGGAL LAHIR UMUR
N

MAR

AUG

OKT
APR

MEI

JUN

DES
JAN

FEB

SEP
JUL
1 2 3 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
1 5207012708101484 Fuad,S.H Fuad,S.H 5207012906690001 0001789017434 6/29/1969 55 DM,COL

2 5207012708101466 Tuhur Tasnim 5207016702730001 0001581249824 2/27/1973 51 DM

3 5207012708101902 Lisen Okta Lalang Lisen Okta Lalang 5207010510610001 0001093644415 10/5/1961 63 DM

4 Hendri Sugianto Suci Ramdayanti 5204055204900005 0001575851264 4/12/1990 34 HT,DM,Jantung

5207012812110002

5 52070107121712001 Hj.Jawiyah Hj.Jawiyah 5207015011630001 0001581250072 11/10/1963 61 COL,DM,HT

6 5207012708101470 Kamaluddin Sriani 5207016604720001 0001579682687 8/26/1973 51 DM,HT

7 5207012708101485 Abdul Kadir Mariatul 5207014303660001 0000146766497 3/9/1966 58 DM

8 527012708101519 Amril Wijaya Neli Puspitasari 5207015509840001 0001321657277 9/15/1984 40 DM,HT,CDL

9 5207012708101483 A.Hamid Juhaena 5207012012660001 PREMI 11/20/1966 58 DM

10 5207012708101520 Muslimin Sabil S.E Musdalifah .S.E 5207016907790001 0001575332921 7/29/1979 45 HT,DM

11 5207012708101332 Sulaeman Sulaeman 5207012801730001 0001575864584 1/28/1973 51 DM

12 5207012708101510 Bustanul Arifin Bustanul Arifin 5207013006820001 0001575850702 6/3/1982 42 DM

13 Hj.Kamariah 5207017005700001 0001581250162 5/30/1975 49 DM,HT

Ugdranap2022*