LAPORAN HASIL IMUNISASI DASAR DAN LANJUTAN - BY NAME

KLINIK : RAMDHANI HUSADA

BULAN : JANUARI 2023

NAMA ANAK/ NAMA TANGGAL HB-

NO. L/P ALAMAT (RT/RW) HB UNIJECT DPT-HB- DPT-HB- DPT-HB- CAMPAK CAMPAK
ORANG TUA / NIK LAHIR BCG POLIO 1 PCV 1 POLIO 2 PCV 2 POLIO 3 IPV POLIO 4 PCV 3 HIB
<24 jam 0-7 hr HIB 1 HIB 2 HIB 3 MR LANJUTAN
LANJU
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
1 By. Ny. Sri Puji Astutik L 12/25/2022 JL. Ir. Soekarno 14/4 12/25/2022
Tn. Ikhwanul Ikhsan , jatiguwi

2 By. Ny. Khosiatul P 12/27/2022 JL. Sidomulyo 1/1 12/27/2022

Tn. Sugeng Riyadi Ngadilangkung

3 By. Ny. Kiki Pawestri P 12/28/2022 Dsn. Tegaron 3/5 12/28/2022

Tn. Haris Panggungrejo

4 By. Ny. Vivi Diavani P 12/28/2022 JL. Sadru 4/2 12/28/2022

Tn. Muzzammil tegalsari

5 By. Ny. Agata Valentina L 12/29/2022 Ngebruk 17/3 12/29/2022

Tn. Faizal Huda

6 By. Ny. Desi Winda L 12/30/2022 Turus 36/10 12/30/2022

Tn. Choirul mahmudi Ternyang

7 By. Ny. Intan Puji P 12/30/2022 JL. Durian 7/8 12/30/2022

Tn. In Fadkhurrozi Tumpangrejo

8 By. Ny. Imroatul Imamah L 1/6/2023 Sundan 1/9 Plaosan 1/6/2023

Tn. Sido Jatmiko

9 By. Ny. Wiwin Rahayu P 1/7/2023 Boro Selatan 5/1 1/7/2023

Tn. Akhmadin Curungrejo

10 By. Ny. Ida Eva Yunita L 1/8/2023 Jl. Anusopati 30/03 1/8/2023
Tn. M. Fathur Sumberpucung

11 By. Ny. Vanesa Gebita L 1/9/2023 Krajan 1A, 9/3 1/9/2023

Tn. Hadi Widhi Lebakharjo

12 By. Ny. Risa Budianti L 1/11/2023 Bangelar 2/5 1/11/2023

Tn. Feri Arifin

13 By. Ny. Vindi Faiqotun P 1/13/2023 JL. Adikarya 1/3 1/13/2023

Tn. M. Didi s kepanjen

14 By. Ny. Wilasarita P 1/17/2023 Banjarsari 3/5 1/17/2023

Tn. Oky Frediar

15 By. Ny. Putri Dewi P 1/18/2023 JL. A. Yani 9/5 1/18/2023

Tn. Nika Nurianto Senggreng
16 By. Ny. Dela D L 1/19/2023 Bangunrejo 001 1/19/2023
Tn. Wahyu Dwi Suko anyar

17 By. Ny. Fitri Lukmana P 1/21/2023 JL. Lawu 18/5 1/21/2023

Tn. Imam Zainul Mangunrejo

18 By. Abrizam M L 12/3/2022 Sambigede 1/1 1/8/2023 1/8/2023

Ny. Eni Susanti Sbr.pucung
Tn. Anton Widodo

19 By. Mizaela Dio Disha P 11/25/2022 Ternyang 2/1 1/8/2023 1/8/2023

Ny. Ida Maimunah Sbr. pucung
Tn. Rais

20 By. Niscala Wisnu L 10/4/2022 JL. Sidomulyo 1/8/2023 1/8/2023

Ny. Vitriya O Kepanjen
Tn. Bontot Bronto

21 By. Nayyara Deviana P 12/18/2022 JL. Kauman 37/5 1/8/2023 1/8/2023

Ny. Elviqa Indriani Jatikerto
Tn. Deni Yulianto

22 By. Naewari putri P 11/20/2022 Krantil 7/3 1/8/2023 1/8/2023

Ny. Devi Putri Kromengan
Tn. Nizar Roizul

23 By. Aradhana R L 12/15/2022 JL. A. Yani 9/3 1/8/2023 1/8/2023

Ny. Ulfa Tri Senggreng
Tn. M. Rizal

24 By. Sonya Pangayu P 10/31/2022 Dsn. Maduarjo 1/2 1/8/2023 1/8/2023

Ny. Wahyu Retno Babadan
Tn. Sukardi

25 By. Nararya Damara L 1/28/2022 Pandan Ploso 29/5 1/8/2023 1/8/2023

Ny. Vera Andrian (sdh Matoux test)
Tn. Rizki Hendrik

26 By. Khayra Sheevana P 11/22/2022 Tawang 31/6 1/8/2023 1/8/2023

Ny. Anis Karnila Sukowilangun
Tn. Fredi

27 By. Alenaya Candy P 11/7/2022 Perum griya Upaya 1/8/2023 1/8/2023

Ny. Resky Novia 1/1 Kepanjen
Tn. Devi Sety

28 By. Arsyanendra L 6/21/2022 Talangagung 16/3 1/8/2023 1/8/2023

Ny. Meisa
Tn. Kotibul

29 An. Anindira Syazani A P 5/4/2020 JL. Plasemen 38/2 1/15/2023

Ny. Nadia Dwi Jatikerto
Tn. Satria Seno

30 An. Sultan L 11/1/2022 Sembon Timur 3/7 1/15/2023 1/15/2023

Ny. Susiah
 Tn. Agung

31 By. Shanum P 6/10/2021 JL. Ir. Soekarno 1/4 1/15/2023

Ny. Indah Vidi Jatiguwi
Tn. Subektiono

32 An. Niswatul Karimah P 9/24/2022 Sumberpucung 22/3 1/15/2023 1/15/2023

Ny. Farchatut Tamah
Tn. M. Sandy

33 An. Shabira Ayudiyah P 2/25/2022 JL. Surya Sukoyuwono 1/15/2023

Ny. Erik Imalia 1/7 Ngajum
Tn. Ramadhan

34 By. Marvel Barra L 9/17/2022 JL. Raya 24/3 1/22/2023 1/22/2023

Ny. Mega Putri Jatikerto
Tn. Deny Surya
DARI : KLINIK RAMDHANI HUSADA
KECAMATAN : KROMENGAN
KABUPATEN : MALANG
TANGGAL : 25 Desember 2022
DAFTAR PERMINTAAN VAKSIN KE PUSKESMAS KROMENGAN

NO JENIS VAKSIN SATUAN PERSEDIAAN PENGELUARAN DIMINTA DIBERIKAN NO BATCH TANGGAL ED VVM
SEKARANG

1 HB UNIJECT FIAL
2 BCG FIAL
3 POLIO BOPV FIAL
4 DPT-HB-HIB FIAL
5 CAMPAK MR FIAL
6 IPV FIAL
7 PVC FIAL
8 Td/TT FIAL
9 spuit 0,5 cc biji
10 spuit 0,05 cc biji
11 spuit 5cc biji

Malang,..............................

PJ Imunisasi Mengetahui Yang mengajukan

Puskesmas Kromengan Direktur klinik Ramdhani Husada

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