LAPORAN HASIL PELAYANAN IMUNISASI RUTIN DI KLINIK/RUMAH

NAMA UNIT PELAYANAN : Klinik siti azaria

Alamat : Jl. Citra Kebun Mas rt 06/rw 03, Ds kondnag jaya
NAMA BAYI
NO NIK Tanggal Lahir L/P NAMA IBU

1 Nakula 3/25/2023 L Lintang

2 Briliant 3215212112220001 12/21/2022 L Siti
3 Giselyn 3215266212220000 11/22/2022 P Hana
4 Rayhan 2/24/2023 L Refa
5 Aliyana 5/20/2023 p Siti
6 Alfarizki 3215261311210001 11/13/2021 L Rizki ayu
7 Ralinka 3215214612220001 12/6/2022 P Meli
8 Damaresh 3215211111220001 11/11/2022 L Siska
9 Syafinatu 5/22/2023 P Nurjanah
10 Jennaira 2/17/2023 P Leni
11 Kinanti 3215215810220001 10/18/2022 P Siti
12 Shaeza 3215055111220002 11/11/20222 P Elih
13 Adiva 3215214206220003 6/2/2022 P Septy
14 Khairrazky 3215260204230001 4/2/2023 L Fitri
15 Enzhelea 321521680223001 2/28/2023 P Salsabila
16 Kamila 321521440223001 2/4/2023 P Tria bonita
17 Febiyora 3215054402230001 2/4/2023 P Ita
18 Bima 2/3/2023 L Nanda
19 Zevan 3215051508220001 8/15/2022 L Elin
20 Ahmad Abyan 5/29/2023 L Via
21 Ibbara 5/2/2023 L Rahmawati
22 Uwais 32152602052300023 5/2/2023 L Aisyah
23 Arshaka 3215212308220002 8/23/2022 L Lia
24 Rafanza 3311072708220003 8/27/2022 L Riska
25 Alfeandra 3212131407220001 7/14/2022 L Ani
26 Sagara elang 3401102308220001 8/23/2022 L savitriningtyas
27 Nasyifa 4/10/2023 p Mia
28 Ratu revalina 5/5/2023 P Enzy
29 Cyra mafaza 9/7/2022 P cici
30 Gus arya 3215210406220002 6/4/2022 L Iis
31 Sandra 3215012804230001 4/28/2023 P Ezra
32 Sanari 3215014104220001 4/1/2023 P Mebi
33 Chairunnisa 3215265302230001 2/13/2023 P Usih
34 M.Sina 3215211903230001 3/19/2023 L Dyah
35 Fawaz 3/28/2023 L Tuty
36 M Fathian 3216010804230001 4/8/2023 L Winda
37 Kinanti 3215215810220001 10/18/2022 p sity
38 Fathan 08/03/203 L Silvi
39 Devanka 11/22/2021 L Gita
40 Keenan yuka 3/9/2023 L Cika
41 Khalif 321501103230004 3/10/2023 L Ina
42 Abdurrahman 3172041112220003 12/11/2022 L Rohana
43 Elzan 3215052911220006 1/24/2023 L Devi
44 M Harun 3/9/2023 L Cika
45 Eowyn 3/16/2023 p Marshelin
46 Ksatrio 3215210301180005 1/2/2023 L veni
47 Elzan 3215052911220006 11/26/2022 L Sri
48 Rizkya 3215264602230003 2/6/2023 P diah
49 Nabila khayra 3/8/2023 p Eni
50 Khabib 3215211304230001 4/13/2023 L Heru
51 Adhiatama 3215262109220001 9/21/2022 L Yudha
52 Yoshi 3215055303230002 3/13/2023 p Carnia
53 Arshaka 3175101111220004 4/4/2023 L Vivi
54 Arrasya 3215213011220001 11/30/2022 L Muji
55 M.Hilbram 3217091201230002 6/14/2023 L Nanda
56 M.Rashdan 321521130220001 2/13/2023 L Fitriani
57 Arshaka 4/4/2023 L Sri
58 Adzkia 2/3/2023 P Maya
59 Anindira 3215212510190003 2/4/2023 P Hesti
60 Bryan joseph 3215211603230002 3/16/2023 L Romauli
61 Humaira qairen 3325125906220001 6/19/2022 p wahyunigsih
63 M.Azzam 3215212003230002 3/20/2023 L Diene
64 Aisyah B 3510205302230001 2/13/2023 P Siti
65 Rafasya 6/11/2023 L Reni
66 Farraz 12/3/2022 L Raras
67 Arkhan Zayn 4/4/2023 L Alm.Sri
68 Syafinatu 3215266205230003 5/22/2023 P Nurjanah
69 Aliyana 3215216005230003 5/20/2023 P Siti
70 kenes jenna 3215265405230001 5/14/2023 p Zulistiana
71 Khalisa 5/22/2023 P Heppy
72 Zayd Rafisqy 3215261909220001 4/13/2023 L Gian
73 Kalandra 3215261909220001 9/19/2022 L wina
74 Zea Almaira 3215221590922001 9/19/2022 P Cahya
75 Andra 11/8/2021 L Tarnengsih
76 Humaira qairen 3215211905230001 5/19/2023 p Winda
77 Hafidzan 4/20/2023 L Ira
78 Sahilna 3215056004230001 4/20/2023 P Yeyen
79 Naumi 6/14/2023 p Neng tuti
80 Reyvan 3315052002230003 2/20/2023 L Ayu
81 Naila 11/29/2022 L Poppy
82 Arkhatama 3215211706230001 6/17/2023 L Bening
83 Aghinya 3/5/2023 p Halimatus
84 Hanna 4/25/2023 P Lestari
85 M.Ashraf 3304040802230004 2/8/2023 L Lety
86 Briliant 3215212112220001 12/21/2022 L Siti
87 ByNy Via 5/29/2023 L Via nurapiani
88 By.Ny Reni 6/11/2023 L Reni
89 Naumi Ummaiza 6/14/2023 p Neng tuti
90 By.Ny Lestari 6/16/2023 P Poppy
91 By.Ny Siska 6/20/2023 L Siska
92 By Ny Ai maetugah 6/20/2023 L Maetugah
93 By.Ny Reni Herlina 6/23/2023 L Reni
MUNISASI RUTIN DI KLINIK/RUMAH SAKIT/FASILITAS KESEHATAN SWASTA

Bulan Juni
Tahun: 2023
ALAMAT JENIA ANTIGEN IMUNISASI YANG TANGGAL PEMBERIAN
(RT/RW/DESA/KEL/KECAMATAN DIBERIKAN IMUNISASI
Serasi alam elok A11/12 DPT 1+POLIO 2+pcv 1 5/27/2023
Ckm J1/39 PCV 1 5/27/2023
Krajan 1 DPT 2 5/27/2023
Tamelang 06/02 DPT2+POLIO3+PCV 2 5/7/2023
CKM U1/18 polio1 5/27/2023
BTSR E4/26 DPT Lanjut 5/27/2023
Graha Asri Residence GA 55/12 Ipv 5/28/2023
Ckm Blok 14A POLIO 4+PCV 2 5/29/2023
cibungur indah 01/14 polio1 5/29/2023
Green Garden A2/10 DPT 2+POLIO 2+PCV 1 5/30/2023
CKM N7/6 IPV 6/1/2023
Rumambe DPT 3+pcv 1 6/1/2023
Klari Pcv 6/2/2023
NTR B3/23 Dpt1+Pcv 1 6/2/2023
Ckm RH/14 Polio 6/3/2023
CKM F8/02 DPT 3/POLIO 4 6/4/2023
Arafa residence DPT 3+POLIO 4 6/4/2023
GAR DPT 3 6/4/2023
CKM 07/20 IPV 6/5/2023
Krajan 1 polio 6/5/2023
Bengle BCG 6/5/2023
Khalisa permata A2/3 BCG 6/5/2023
CKM H1/19 MR 6/5/2023
CKM P05/01 MR 6/5/2023
NTr A1r/16 MR 6/5/2023
CKM 5e/12 MR 6/5/2023
Sukaresmi 15/05 BCG 6/5/2023
CKM G3/26 BCG 6/5/2023
Gintung salam MR 6/5/2023
CKM MR lanjut 6/5/2023
NTR BCG 6/5/2023
Graha Puspa PCV 3 6/6/2023
Ntr PCV 1 6/6/2023
CKM T14/12 DPT1+polio 2+pcv1 6/7/2023
Tammamul minah DPT 1+POLIO 2+pcv 1 6/7/2023
Shanaya Bintang DPT 1 6/8/2023
CKM N7/6 PCV 1 6/8/2023
Graha asri DPT 1 6/8/2023
Serasi indah DPT lanjut 6/8/2023
Klari regency DPT 2+POLIO 3+PCV 2 6/9/2023
CMA residence DPT 2+POLIO 3+PCV 2 6/10/2023
GKA BB5/14 DPT 3 6/10/2023
GPI B2/09 DPT 3/POLIO 4 6/10/2023
Klari DPT 1+POLIO 2+pcv 1 5/9/2023
Kartika E11/09 POLIO 2+PCV 2 10/06/202
CKM D1/2 DPT 3+POLIO 4+pcv 2 11/06/202
Gintug kebon DPT 3+POLIO 4 6/11/2023
PKA A9/9 DPT 3 6/12/2023
Kartika Residemce B/5 DPT 1+POLIO 2+PCV 1 6/13/2023
CKM Q13/12A DPT 1 6/13/2023
BTSR E1/32 PCV 2 6/14/2023
Rumambe 2 DPT 2 6/14/2023
CKM Pcv 2 6/14/2023
CKM DPT 3 6/14/2023
GML DPT 3+POLIO 4 6/14/2023
MAP J/01 DPT 3 6/14/2023
jatimulya DPT 1+POLIO 2+Pcv 1 6/15/2023
Green Harmoni A4/8 DPT 3+POLIO 4+pcv 2 6/15/2023
CKM Q7/04 DPT 3+POLIO 4+PCV 2 15/06/0223
Saung kebon A3/08 DPT 2+POLIO 3+PCV 2 6/17/2023
Graha Asri 3 Mp 28/21 pcv 2 6/17/2023
GAR 2 GA 30/03 DPT 1+POLIO 2+pcv 1 6/17/2023
Puri raya F2/2 DPT 2+POLIO 2+PCV 1 6/18/2023
CKM Q3/34 polio 1 6/18/2023
Al jazera POLIO 4 6/18/2023
jatimulya DPT 1+POLIO 2+pcv 1 6/19/2023
Cibungur 01/14 BCG 6/19/2023
CKM Q1/+8 BCG 6/19/2023
GKA BB Q/05/ BCG 6/19/2023
Sadjati garden B5/4 BCG 6/19/2023
GKA D6/33 DPT 1+POLIO 2+pcv 1 6/19/2023
Krajan ll MR 6/19/2023
Kartika G18/11 MR 6/19/2023
Cibalado MR lanjut 6/19/2023
Babakan tamiang BCG 6/19/2023
Kondang jaya DPT 1+POLIO 2+pcv 1 6/20/2023
Rumambe 3/2 DPT 1+POLIO 2+pcv 1 6/20/2023
Wagir polio 1 6/20/2023
Karaba 2 DPT 3+Polio4 6/21/2023
klari D5 polio 6/23/2023
Graha Asri POLIO 23/06/202
GAR 2 54/22 DPT 1+POLIO 2 6/23/2023
Gading elok 2 G4/06 Dpt1+Polio 2 6/25/2023
Krajan 2 DPT 3+POLIO 4 6/26/2023
CKM J1/39 DPT 3 6/26/2023
Krajan 1 HBO 5/29/2023
CkM Q8/34 HBO 6/12/2023
Wagir 1 009/004 HBO 6/14/2023
Perum KRR D/5 HBO 6/17/2023
Sukamakmur 12/04 HBO 6/20/2023
Anggadita 19/06 HBO 6/21/2023
CKM 01/45 HBO 6/24/2023

Karawang, 26 Juni 2023

Siti Komarianingsih, SST, M.Kes

KETERANGAN

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sih, SST, M.Kes

 REKAPITULASI HASIL PELAYANAN IMUNISASI
PUSKESMAS : BULAN :
KELURAHAN/DESA : TAHUN :
KECAMATAN :
KOTA/KAB :
JUMLAH BAYI/BADUTA YANG DI IMUNISASI
HB0<24 DPT-HB- DPT-HB- DPT-HB- CAMPA DPT-HB- CAMPA
NO POSYANDU BCG OPV 1 PCV 1 RTV 1 OPV 2 PCV 2 RTV 2 OPV 3 IPV RTV 3 PCV 3
JAM HIB 1 HIB 2 HIB 3 K/MR HIB 4 KMR 2
L P L P L P L P L P L P L P L P L P L P L P L P L P L P L P L P L P
 REGISTER IMUNISASI BAYI DAN BADUTA
NAMA POSYANDU : PUSKESMAS : ADIARSA
NAMA DUSUN KOTA/KAB. : KARAWANG
NAMA DESA
JENIS JENIS IMUNISASI
NAMA KELAMIN TGL NAMA
NO BAYI/BADUTA LAHIR NIK ORANG TUA ALAMAT HB DPT- DPT- DPT- CAMP DPT-
0<24JA BCG OPV 1 HB-HIB PCV 1 RTV 1 OPV 2 HB-HIB PCV 2 RTV 2 OPV 3 HB-HIB IPV 1 RTV 3 OPV 4 AK/ IPV2 PCV 3 HB-HIB MR 2
L P M 1 2 3 MR 1 4