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FORMULIR PEMANTAU

Provinsi : LAMPUNG
Kabupaten/Kota : LAMPUNG TENGAH
Puskesmas/Kecamatan : SUKANEGARA/BANGUNREJO
Desa/Kelurahan : SIDODADI

NIK (Nomor Induk


No No Kartu Keluarga Kependudukan) IBU Nama Ibu Hamil NIK Suami
HAMIL

(1) (2) (3) (4)


1 1802020105120016 1802024304900013 ASMAWATI 0
2 1802020608180014 1802015708930002 HARI AGUSTINI 1802020402900013
3 1802022310120019 1802026705910003 WIYANTI 1802021505840006
4 1802021301110039 1802024908890006 EKA LESTARI 1802022707880004
5 1802021807180002 3175036804791001 DARSINI 3175031004720019
6 1802021104120002 1802026107890001 ERNAH 1802020211850002
7 1802021301110057 1802024706780004 SUNARTI 1802021204680004
8 1802021706110025 1802026008920002 ENI PUTRI LESTARI 1802021609870002
9 1802020601140009 1802025611850002 ERNAWATI 1802020111870008
10 1802021105120012 18020267009900001 KUSTANTI HANDAYANI 1802020107850263
11 1802021711170023 1802016412990004 NATALIA PRISKILA 1802020801970001
12 1802020608180012 1802026903940003 ASTRI HASAN NUR FITRI 1802021108860002
13 1802020204100013 1802026212810002 PONIAH 1802021007830006
FORMULIR PEMANTAUAN IBU HAMIL

Nama Posyandu :
Bulan : NOVEMBER
Tahun : 2018

Berat Berat Tinggi


Badan Tanggal
Nama Suami Alamat RT RW Tanggal Lahir pengukuran Badan Badan
sebelum (kg) (cm)
hamil

(5) (6) (7) (8) (9) (10) (11) (12)


48 SIDODADI 003 004 3-04-1990 20-11-2018 59 156
WAHYUDI 38 SIDODADI 010 005 17-08-1993 20-11-2018 47 149
GUNTORO 45 SIDODADI 010 005 27-05-1991 20-11-2018 52 153
SAIIN ARIANTO 42 SIDODADI 011 005 09-08-1989 18-11-2018 50 155
TUGIWAN 70 SIDODADI 012 005 28-04-1979 18-11-2018 74 150
SLAMET 84 SIDODADI 012 005 21-07-1989 18-11-2018 89 156
PONIRIN 60 SIDODADI 012 005 07-06-1978 18-11-2018 66 152
SIGIT RIFANI 47 SIDODADI 003 002 20-08-1992 14-11-2018 65 154
YASIN ADI NUGROHO 49 SIDODADI 006 003 16-11-1985 15-11-2018 53 150
TUGIMAN 51 SIDODADI 002 001 27-09-1990 13-11-2018 57 153
HANIF ROMADONI 48 SIDODADI 003 002 24-12-1999 14-11-2018 53 155
LUKMANUL HAKIM 55 SIDODADI 005 003 29-03-1994 15-11-2018 69 153
SLAMET PAHRUDIN 61 SIDODADI 003 002 21-12-1981 14-11-2018 68 155
TTD
(Tablet Jika YA,
Lingkar
Lengan Hamil ke Tambah brp butir
darah) TTD
Atas (LiLA) 1=YA, didapat
2=Tidak

(13) (14) (15) (16)


27 2 1 30
23.5 1 1 30
24 4 1 30
23 2 1 30
28 3 1 30
30 2 1 30
30 3 1 30
24 2 1 30
25 2 1 30
26 1 1 30
24 2 1 30
29 2 1 30
32 2 1 30
FORMULIR PEMANTAUAN PERTUMBUHAN BALITA DI POSYANDU

Provinsi : LAMPUNG Nama Posyandu : MAWAR


Kabupaten/Kota : LAMPUNG TENGAH Bulan NOVEMBER
Puskesmas/Kecamatan : SUKANEGARA/BANGUNREJO Tahun : 2018
Desa/Kelurahan : SIDODADI

Panjang
Berat
NIK (Nomor Induk Jenis Tgl Badan/
No No Kartu Keluarga Anak Ke Nama anak Tanggal Lahir Kelamin Badan Nama Ortu (Ayah) NIK Ayah No Tlp/ HP Ortu Alamat RT RW Pengukuran BB (kg)
Kependudukan) Tinggi
(BB) Lahir Badan (cm)

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17)
1 1802022704160003 1802020509160001 1 ALTHAF FADIL GHANIM 5-Sep-16 L 2790 MUHAMMAD TAMAM 1802020101870003 082281680800 SIDODADI 001 001 13-Nov-18 13.2 89
2 1802022410120030 1802024901150003 2 ZAHRA AFIFAH 9-Jan-15 P 3000 EDI SUSIANTO 1802021505860016 082281680800 SIDODADI 002 001 13-Nov-18 13.5 97
3 1802021803180005 1802022403160002 3 DANIS ALMUBAROK 24-Mar-16 L 2300 ERWIN RISWANTO 1802020406810004 082281680800 SIDODADI 001 001 13-Nov-18 11 86
4 1802022008150004 1802021609160001 1 ARSAKA VIRENDRA SAFWAN 16-Sep-15 L 3200 EDI PURNOMO 1802022708880005 082281680800 SIDODADI 001 001 13-Nov-18 15.5 100
5 1802021701130001 1802025412150001 2 DESTIA BAHRI P 14-Dec-15 P 3100 SAMSUL BAHRI 1802020704860008 082281680800 SIDODADI 001 001 13-Nov-18 11.2 86
6 1802021405054322 1802026211140004 3 GALIYA GINA ABILA 22-Nov-14 P 3200 SUTIYO 1802021204700002 082281680800 SIDODADI 002 001 13-Nov-18 11.1 92
7 1802020903150008 1802025109160001 2 ZIA NAFIZA QODRIYA 11-Sep-16 P 3200 BUDIANTO 1802020902880001 082281680800 SIDODADI 002 001 13-Nov-18 9.9 80
8 1802021405054245 1802023108160004 2 STEVEN BERLIYANO 31-Aug-16 L 3300 MARZUKI 1802020612800004 082281680800 SIDODADI 002 001 13-Nov-18 12.2 85
9 1802021501180004 1802026206160003 3 LAILA ARUM RAMADHANIA 22-Jun-16 P 3000 M. SANI 1802023012820001 082281680800 SIDODADI 001 001 13-Nov-18 12.5 88
10 1802021003140004 1802021004160004 2 IBNU CHANDRA FIRDAUS 10-Apr-16 L 3000 TRI SUTRISNO 1802021302890002 082281680800 SIDODADI 002 001 13-Nov-18 13.2 93
11 1802020709150004 1802024811150003 1 KEYSA ALMIRA PUTRI 8-Nov-15 P 2900 DWI HANTORO 1802020712830004 082281680800 SIDODADI 002 001 13-Nov-18 11.7 88
12 1802010807140001 1802016401140003 1 VANELA AZZAHRA 24-Jan-14 P 2800 ANDRI RIYANTO 1802012704900008 082281680800 SIDODADI 004 002 13-Nov-18 15.2 101
13 1802022002180015 1802026909170001 3 INAYAH KHOIRUNNISA 29-Sep-17 P 1800 SUGIRAN 1804091605710001 082281680800 SIDODADI 002 001 13-Nov-18 9.1 73
14 1802021702110063 1802026109170002 2 ELENA NIKMATUL JANNAH 21-Sep-17 P 2700 SABAR SANTOSO 1802021507830008 082281680800 SIDODADI 002 001 13-Nov-18 8.2 69
15 1802020702180021 1802026312170001 2 AULIA NATASYA PERMATA H 23-Dec-17 P 3100 AMIN HIDAYAT 3201020908830008 082281680800 SIDODADI 002 001 13-Nov-18 9.5 75
16 1802021405054276 1802022703160001 6 M. FAISAL SAHRI 27-Mar-16 L 3200 TURIMAN 1802020909710001 082281680800 SIDODADI 001 001 13-Nov-18 11.4 87
17 1802020710110011 1802022012140002 2 AHMAD FARHAN 20-Dec-14 L 3100 SAMSUDIN 1802021908770002 082281680800 SIDODADI 002 001 13-Nov-18 14.2 99
18 1802022912070007 1802020905150003 2 ALVIAN RIZKI ARDIANTO 9-May-15 L 3400 ARI MUJIONO 1802022302820001 082281680800 SIDODADI 003 002 13-Nov-18 14.1 92
19 1802021405053547 1802021711170001 3 AHMAD FARIS MAULANA 17-Nov-17 L 3200 MARSINDON 1802021011540002 082281680800 SIDODADI 001 001 13-Nov-18 9.1 73
20 1802020502180002 1802030101170002 2 ALFINO SETIAWAN 1-Jan-17 L 2800 MAHFUDIN 1802022509800002 082281680800 SIDODADI 002 001 13-Nov-18 9.7 81
21 1802022408090014 1802023001140003 2 SATRIA MANDALA PUTRA 30-Jan-14 L 3200 SUSANTO 1802022804830001 082281680800 SIDODADI 002 001 13-Nov-18 18.2 104
22 1802022408090014 1802021509160001 3 ARJUNA PURBAJAYA 15-Sep-16 L 3300 SUSANTO 1802022804830001 082281680800 SIDODADI 002 001 13-Nov-18 9.8 83
23 - - 2 ABIZAR 21-Oct-17 L 2800 ALDI - 082281680800 SIDODADI 002 001 13-Nov-18 10.6 76
24 - - 2 PUTRI AULIA 22-Dec-14 P 3100 BASORI - 082281680800 SIDODADI 002 001 13-Nov-18 13.5 98
25 1802021809120018 1802024704180004 2 ALISHA AMIRA FAHIMA 7-Apr-18 P 3200 ANDI SAPUTRA 1802020811860004 082281680800 SIDODADI 002 001 13-Nov-18 8.5 65
26 1802020704160003 1802022005170003 1 ATHAFARIS ADNAN ALHADI 20-May-17 L 3000 SAIPUL HADI 1806111110880001 082281680800 SIDODADI 002 001 13-Nov-18 9.6 79
27 - - 2 ZAKI MIRZA 12-Dec-15 L 3700 TEDI K - 082281680800 SIDODADI 002 001 13-Nov-18 15.5 98
28 - - 3 FARIDA 25-May-17 P 2600 KUWAT - 082281680800 SIDODADI 002 001 13-Nov-18 8.4 75
29 2 ARSYLA FHARA FARZANA 11-Apr-18 P 3000 HENDRIK 082281680800 SIDODADI 002 001 13-Nov-18 7.5 70
30 1 ALFIAN MALIQ ZAKIN 26-1--2018 P 3200 SUPRIANTO 1802020704930001 082281680800 SIDODADI 002 001 13-Nov-18 3.5 50
31 1802021801160001 2 WIRA ALJABU 31-10-2018 L 2900 JUNAEDI 1802031505930005 082281680800 SIDODADI 002 001 13-Nov-18 4.1 51
32 1802022302150005 2 M. NAZRIEL 7/10/2018 L 3300 SUKAR 1802020802780001 082281680800 SIDODADI 002 001 13-Nov-18 3.5 50
33 1802020505150001 1802024104150001 1 NABILLA CHINTYA PUTRI 01-04-2015 P 2900 MIFTAKHUL MUNIR 1802021407850003 082281680800 SIDODADI 001 001 13-Nov-18 15,5 96
34 1802021405054330 1802026012160002 5 AINUN MUTIARA PUTRI 20-12-2016 P 2800 SAMSUL KOMAR 1802021006650004 082281680800 SIDODADI 001 001 13-Nov-18 10,5 79
Cara Ukur ASI Vitamin A Vitamin A
1=Telenta Eksklusif IMD Februari Agustus Kepemilika
1=YA,
ng F1=YA, 1=YA 1=YA n Buku KIA
2=Tidak
2=Berdiri 2=Tidak 2=Tidak 2=Tidak

(18) (19) (20) (21) (22) (23)


1 1 1 Ya
2 2 1 Ya
1 2 1 Ya
2 1 1 Ya
2 2 1 Ya
2 1 2 Ya
2 2 1 Ya
1 2 1 Ya
2 2 1 Ya
2 2 1 Ya
1 1 1 Ya
2 2 1 Ya
1 2 1 Ya
1 2 1 Ya
1 1 1 Ya
1 1 1 Ya
2 2 1 Ya
2 1 1 Ya
1 2 1 Ya
1 1 1 Ya
1 1 1 Ya
2 2 1 Ya
1 1 1 Ya
2 1 1 Ya
1 2 1 Ya
2 1 1 Ya
2 2 1 Ya
2 2 1 Ya
2 2 1 Ya
1 1 1 YA
1 1 1 YA
1 1 1 YA
1 1 1 YA
1 1 1 YA
FORM

Provinsi : LAMPUNG Nama Posyandu


Kabupaten/Kota : LAMPUNG TENGAH Bulan
Puskesmas/Kecamatan : SUKANEGARA/BANGUNREJO Tahun
Desa/Kelurahan : SIDODADI

NIK (Nomor Induk Jenis


No No Kartu Keluarga Anak Ke Nama anak Tanggal Lahir Kelamin
Kependudukan)

(1) (2) (3) (4) (5) (6) (7)


1 1802021405055925 1802026903160001 6 Areta Khanza Zhayna 29-Mar-16 P
2 1802022605140002 1802020510130003 1 Daffa Nauffal Adzaki 5-Oct-14 L
3 1802021405055032 1802023010150003 3 Mikail Gibran Fahreza 30-Oct-15 L
4 1802021405055833 1802025009170001 3 Muslimah 10-Sep-17 P
5 1802022901150007 1802026611170002 1 Andini Ashyla Putri 26-Nov-17 P
6 1802021209090021 1802024410150003 2 Inayah Fatiyatuurahmah 4-Oct-15 P
7 1802022111170014 1802022803180001 2 Abidzar Rizki Pratama 28-Mar-18 L
8 1802021405054347 1802020908150001 3 M. Bagas Prayoga 9-Aug-15 L
9 1802021304170009 1802022307150001 1 Azka Maulana Sidik 23-Jul-15 L
10 1802022912070016 1802020711160001 3 M. Faqih Alfiansyah 7-Nov-16 L
11 1802022912070016 1802020301180001 4 M. Alfiansyah 3-Jan-18 L
12 1802022912070015 1802024711160002 2 Novi Alfiani Aulia 7-Nov-16 P
13 1802022912070015 1802024711160001 3 Nova Alfiana Aulia 7-Nov-16 P
14 1802021803110056 1802023110140002 2 M. Abu Hanifah 31-Oct-14 L
15 1802022701120007 1802024308160003 2 Aulia Adila Rachma 3-Aug-16 P
16 1802022001100007 1802027006150002 2 Hafiza Silviana Putri 30-Jun-15 P
17 1802021803110034 1802020809160001 2 Rosyid Assoleh 8-Sep-16 L
18 1802010807140001 1802016401140003 1 Vanela Azzahra 24-Jan-14 P
19 1802023108170002 1802021502170002 1 Mauza Agraha Alfahrezi 15-Feb-17 L
20 1802021206120011 1802021504170002 2 Fazli Ibni Fikhar 15-Apr-17 L
21 1802022708090013 1802026811140002 3 Nadia Maulida Husna 8-Nov-14 P
22 1802022609130017 1802026910130003 1 Keisha Assiva Agustin 29-Oct-13 P
23 1802010109160004 1802015010140002 1 Ainun Syahrifa Ahmad 10-Oct-14 P
24 1802022106100002 1802025503140001 2 Najwa Anisa 15-Mar-14 P
25 1802021006140020 1802026508150003 2 Ananda Dwi Syakila 25-Aug-15 P
26 1802021209090019 1802026103150002 2 Itsnaini Khoiriyatul Ulum 21-Mar-15 P
27 1902021405054314 1802022712140002 2 Dava Mahendra 27-Dec-14 L
28 1802020712150002 1802020903150002 1 Ahmad Dzaki Istamir 9-Mar-15 L
29 1802021509140007 1802024302150001 2 Ferliana Dahlan 3-Feb-15 P
30 1802021410140009 - 2 Arsya Dwi Saputra 19-Jul-17 L
31 1802021207170010 1802022810170001 1 Faris Eka Pratama 28-Oct-17 L
32 1802021909140004 1802026009140001 1 Agam Abdillah 20-Sep-14 L
33 1802021207120016 2 Damara 7/4/2018 p
34 1 M. Farhan habib 8/8/2018 l
35 1802022701120007 1802025710180001 2 nina nurdiansa 17-10-2018 p
36 1802022912170010 1 alifa hibatillah 19-10-2018 p
37 1802021803110035 1802020710160001 4 albert ihya'ulumudin 10/7/2016 l
38 2 yumna afza 9/3/2018 p
39 1802021304170008 2 m rohan aditia 18-08-2017 l
40 1802022609170001 1802025812170002 1 zhafira muna azizah 18-12-2017 p
41 1802020604180006 1 eka dirga patria 17-08-2018 l
42 1802020112140002 2 Aqifa Naila 8/14/2018 P
43 1802022703170006 1802022105170002 1 M. angga firmansyah 21-05-2017 L
44 M. Nur Kholik 31-052017 L
45 1802023011170005 1 Alvin Fajar 06-08-018 L
46 1802021405055073 1802026112170002 6 Azkaira Tanisha Hulya 12/21/2017 P
47 1802221712150002 1802225502160001 1 Kinara Syafani 15-02-2016 p
48 180202290118005 1802026702180002 2 Hafiza Khaira lubna 2/27/2918 P
49 1 Rizki Ramadhan 6/27/2015 L
50 1802020412140003 1802022301160001 1 Ahmad Maulana 1/23/2016 L
51 1802021408120021 2 Delia diah ayu Cahyani 24-09-2018 p
52 2 al fatih rizky 27-06-2016 l
53 1 ainnuha soraya 26-09-2018 p
54 1802022908160012 1802010308160002 1 Hafidhotul mahfudhoh 03-08-2016 p
FORMULIR PEMANTAUAN PERTUMBUHAN BALITA DI POSYANDU

Nama Posyandu : WIJAYA KUSUMA


: NOVEMBER
: 2018

Berat
Badan Nama Ortu (Ayah) NIK Ayah No Tlp/ HP Ortu Alamat RT RW
(BB) Lahir

(8) (9) (10) (11) (12) (13) (14)


3100 Sutiman 1802020603720001 082281680800 Sidodadi 001 001
3200 Sodikin 1802020303850006 082281680800 Sidodadi 004 002
3400 Bambang - 082281680800 Sidodadi 003 002
1000 Untung 1802021607710001 082281680800 Sidodadi 001 001
2800 Agus Budianto 1802022504920003 082281680800 Sidodadi 003 002
3000 Purnawan 1802020906810002 082281680800 Sidodadi 003 002
2900 Nasib Santoso 1802020105850002 082281680800 Sidodadi 004 004
3000 Suroso 1802020107670018 082281680800 Sidodadi 003 002
3300 Hermawan 1802020903810004 082281680800 Sidodadi 004 004
2700 Herlianto 1802020108790004 082281680800 Sidodadi 003 004
1800 Herlianto 1802020108790004 082281680800 Sidodadi 003 004
2000 Imam Muhdori 1802020305800001 082281680800 Sidodadi 004 002
2300 Imam Muhdori 1802020305800001 082281680800 Sidodadi 004 002
2950 M. Nadi 1802020506800004 082281680800 Sidodadi 003 002
2800 Nur Udin 1802022806850001 082281680800 Sidodadi 002 002
2200 Ides 1802022306800002 082281680800 Sidodadi 006 003
3000 Ahmad Samsuri 1802023012740004 082281680800 Sidodadi 003 002
2600 Andri Riyanto 1802012704900008 082281680800 Sidodadi 004 002
2900 M. Jabir 1802021004810003 082281680800 Sidodadi 003 002
3100 Sodiran 1802022306790003 082281680800 Sidodadi 004 002
3200 Sutaryo 1802020312750002 082281680800 Sidodadi 003 002
3100 Agus Susanto 1802020202890002 082281680800 Sidodadi 004 002
3200 Ahmad Supeno 1802011404900004 082281680800 Sridadi 007 004
3800 Nur Udin 1802020205770009 082281680800 Sidodadi 003 002
3100 Sobirin 1802021909740001 082281680800 Sidodadi 004 002
2600 Wiyono 1802021707790001 082281680800 Sidodadi 004 002
3000 Sumakun 1802021507800007 082281680800 Sidodadi 003 002
3100 Salman Alfaris 1802030107880049 082281680800 Sidodadi 004 002
2900 Sosiyanto 1802020605750001 082281680800 Sidodadi 003 002
3000 Tusiman 1802021607870004 082281680800 Sidodadi 004 002
3100 Sugeng hariyadi 1802020201880001 082281680800 Sidodadi 003 002
3000 Jemino 1802021504860002 082281680800 Sidodadi 003 002
2800 nur kholis 1802020805810005 082281680800 Sidodadi 003 002
3200 muhaimin 082281680800 Sidodadi 003 002
3300 nur udin 1802022806850001 082281680800 Sidodadi 003 002
3200 jamaludin 1802021512870002 082281680800 Sidodadi 003 002
3100 rosidin 1802022604760003 082281680800 Sidodadi 003 002
2900 sodikin 082281680800 Sidodadi 003 002
3300 budi 1802030906930006 082281680800 Sidodadi 003 002
3000 Roy Jordy Riki MV 1802152503920001 082281680800 Sidodadi 003 002
3200 R. Agung D 1802020207950001 082281680800 Sidodadi 003 002
3000 Sukri 082281680800 Sidodadi 003 002
3200 suyono 1802022506870004 082281680800 Sidodadi 003 002
3400 Suwarno 082281680800 Sidodadi 003 002
3000 Anif Hidayat 1802011605900002 082281680800 Sidodadi 003 002
2700 Saun Asrori 1802022612730001 082281680800 Sidodadi 003 002
3300 Saiful ikhwan 1802221510900001 082281680800 Sidodadi 004 001
3200 Suyanto 1802022211870002 082281680800 Sidodadi 006 002
3200 Satman 082281680800 Sidodadi 003 002
3200 Hermawan 1802021201880004 082281680800 Sidodadi 003 002
3500 suroso 1802021020770010 082281680800 Sidodadi 003 002
3300 satman 082281680800 Sidodadi 003 002
3100 M.C Noefendi 1571012810860141 082281680800 Sidodadi 003 002
3200 syamsul basri 1802010404900006 082281680800 Sidodadi 003 002
Panjang
Badan/ Cara Ukur ASI IMD Vitamin A Vitamin A Kepemilik
Tgl 1=Telenta EksklusifF Februari Agustus an Buku
BB (kg) Tinggi 1=YA,
Pengukuran ng 1=YA, 1=YA 1=YA
Badan 2=Tidak KIA
2=Berdiri 2=Tidak 2=Tidak 2=Tidak
(cm)
(15) (16) (17) (18) (19) (20) (21) (22) (23)
14-Nov-18 11.9 88 2 1 1 Ya
14-Nov-18 15.2 101 2 1 1 Ya
14-Nov-18 14.3 97 1 2 2 Ya
14-Nov-18 6.5 66 1 2 2 Ya
14-Nov-18 8.5 75 1 1 1 Ya
14-Nov-18 11.1 90 2 1 1 Ya
14-Nov-18 8.6 71 1 1 1 Ya
14-Nov-18 15.6 102 2 1 1 Ya
14-Nov-18 12.1 93 2 1 1 Ya
14-Nov-18 11.3 84 2 1 1 Ya
14-Nov-18 7.2 68 1 1 1 Ya
14-Nov-18 8.9 82 2 1 2 Ya
14-Nov-18 10.4 83 2 1 2 Ya
14-Nov-18 16.4 102 2 1 1 Ya
14-Nov-18 10.2 84 2 1 1 Ya
14-Nov-18 13 94 2 1 1 Ya
14-Nov-18 11.2 84 1 1 1 Ya
14-Nov-18 15 89 2 1 1 Ya
14-Nov-18 10.2 83 1 1 1 Ya
14-Nov-18 11.2 85 1 1 1 Ya
14-Nov-18 13.4 92 2 1 1 Ya
14-Nov-18 18.8 110 2 1 1 Ya
14-Nov-18 14.6 95 2 1 1 Ya
14-Nov-18 15.9 104 2 1 1 Ya
14-Nov-18 11.4 86 2 1 1 Ya
14-Nov-18 11.6 88 2 1 1 Ya
14-Nov-18 13.2 97 2 1 1 Ya
14-Nov-18 14.2 96 2 1 1 Ya
14-Nov-18 12.2 91 2 1 1 Ya
14-Nov-18 11.4 76 1 1 1 Ya
14-Nov-18 8.2 73 1 1 1 Ya
14-Nov-18 16.3 106 2 1 1 Ya
14-Nov-18 6.4 68 1 1 1 Ya
14-Nov-18 7 69 1 1 1 Ya
14-Nov-18 4.4 51 1 1 1 Ya
14-Nov-18 4.4 50 1 1 1 Ya
14-Nov-18 10.5 85 1 1 1 Ya
14-Nov-18 4.8 58 1 1 1 Ya
14-Nov-18 9.9 74 1 1 1 Ya
14-Nov-18 7.3 74 1 1 1 Ya
14-Nov-18 6.3 66 1 1 1 Ya
14-Nov-18 4.9 63 1 1 1 Ya
14-Nov-18 10.1 76 1 1 1 Ya
14-Nov-18 9.9 79 1 1 1 Ya
14-Nov-18 7.3 64 1 1 1 Ya
14-Nov-18 7.4 72 2 1 1 Ya
14-Nov-18 11.4 88 1 1 1 Ya
14-Nov-18 6.2 62 1 1 1 Ya
14-Nov-18 13.5 98 2 1 1 Ya
14-Nov-18 12 90 2 1 1 Ya
14-Nov-18 5.9 58 1 1 1 Ya
14-Nov-18 13.7 85 1 1 1 Ya
14-Nov-18 4.2 60 1 1 1 Ya
14-Nov-18 10 90 1 1 1 Ya
FORMULI

Provinsi : LAMPUNG Nama Posyandu


Kabupaten/Kota : LAMPUNG TENGAH Bulan
Puskesmas/Kecamatan : SUKANEGARA/BANGUNREJO Tahun
Desa/Kelurahan : SIDOADI

NIK (Nomor Induk Anak Ke Jenis


No No Kartu Keluarga Nama anak Tanggal Lahir
Kependudukan) Kelamin

(1) (2) (3) (4) (5) (6) (7)


1 1802021107120002 1802020507140001 3 Bintang Ramadhan 5-Jul-14 L
2 1802021806120004 1802022303160001 3 Sahrurrozi 22-Mar-16 L
3 1802022009170015 1802021101170002 1 Shauqi Zidhan Willdansyah 11-Jan-17 L
4 1802020508090001 1802020111150004 2 Azmi Nizar Tsaqib 1-Nov-15 L
5 1802021508140002 1802020503170001 2 Madina Alfatin 5-Mar-17 P
6 1802021112120015 1802025410150001 2 Felicia Gita Cahyoda 14-Oct-15 P
7 1802021812140005 1802020408170003 2 Dava Ubay Hanafi 1-Sep-17 L
8 1802021905090001 1802026911160001 3 Assyava Amala 29-Nov-16 P
9 1802021112170002 1802222712130001 1 Devin Bagus Prasetyo 27-Dec-13 L
10 1802020903110021 1802025810170002 2 Syakilla Mar'atus Soleha 18-Oct-17 P
11 1802021301110002 1802024906170001 3 Alma Salsabila 9-Jun-17 P
12 1802020808170003 1802022511170002 1 Dio Pratama 25-Nov-17 L
13 1802022909090016 1802025210170002 2 Rahma Choirunnisa 12-Oct-17 P
14 1802020903110023 1802025112160002 2 Dinda Humaimah Khalilah 11-Dec-16 P
15 3 Salsabila Khoiri 2-Mar-18 P
16 1802022605140001 1802026402160001 2 Adella Mysha 24-Feb-16 P
17 1802021301110022 1802022604140001 2 Safiq Al Mubaroq 26-Apr-14 L
18 1802021601170006 1802020910170002 2 Aulian Fahreza 9-Oct-17 L
19 3 Noval Aryana 8-Aug-17 L
20 1802020709170001 1 M. Fahmi Al Azam 20-Apr-18 L
21 1802020812170003 1802025210140004 2 Nanda Oktavia 12-Oct-14 P
22 1802021601170006 1802025003140002 1 Fatimatu Zahra 10-Mar-14 4
23 1802022407090011 1802022208150002 2 Nugraha Marvel 22-Aug-15 L
24 1802021405055869 1802024304140001 3 Aprilia Dahayu 3-Apr-14 P
25 2 Nurida 27-May-17 P
26 1802020812170003 1802024612170001 2 Cahya Tri M 6-Dec-17 P
27 18020227111700005 1 Satria Fahrezi Danendra 4-Mar-18 L
28 1802021112120015 1802026503180002 2 Fayza Arshi Cahyoda 25-Mar-18 P
29 1802021712080003 2 Andini Maharani 20-Dec-17 P
30 1 Ikhsan Maulana 24-Jul-16 L
31 1 Ratu Aminun 16-Nov-17 L
32 1802020709150003 1802025910140001 1 Cecilya Nur Azizah 19-Oct-14 P
33 3 Suci Amelia 25-Feb-18 P
34 1802021905140002 1802020707180001 2 M. Nasrulloh 7-Jul-18 L
35 1802022609160007 1802025212150002 2 Sofi Kristanti 12-Dec-15 P
36 1802020712150001 1802021904150002 1 Gibran Alvin Pranata 19-Apr-15 L
37 2 Luthfiana Ika P 16-Nov-17 p
38 1802021803110064 1802026407160001 2 Dinda Permatasari 24-Jul-16 P
39 2 Afika 29-Jun-18 P
40 1802021202180025 1802024508180001 1 Khalisa Aulia 5-Aug-18 P
41 2 Masya Ulfairah 27-Sep-14 P
42 3 Rasya Zahra R 10-May-16 p
43 1802021503180007 1802020808180001 1 Ahmad Husyen Maulana 8-Aug-18 L
44 1802021603110025 1802023107140003 3 M. Faza syauqillah 31-Aug-14 L
45 1802020609180001 1 Devina Azahra 4-Oct-18 P
46 1802020608180012 2 Nakhla Humaira 18-Sep-18 P
47 1802021809120011 1802021104170001 4 Ferdi Kurniawan 11-Apr-17 L
49 1802021301110009 1802023108170002 3 Aftab Rizki fatihan 8/31/2017 L
50
FORMULIR PEMANTAUAN PERTUMBUHAN BALITA DI POSYANDU

Nama Posyandu : ANGGREK


: NOVEMBER
: 2018

Berat Tgl
Badan Nama Ortu (Ayah) NIK Ayah No Tlp/ HP Ortu Alamat RT RW
(BB) Lahir Pengukuran

(8) (9) (10) (11) (12) (13) (14) (15)


3100 Giman 1802021402680001 082281680800 Sidodadi 005 003 15-Nov-18
3600 Juweni 1802022212840002 082281680800 Sidodadi 005 003 15-Nov-18
2750 Defi Ardiansyah 1802023112900001 082281680800 Sidodadi 006 003 15-Nov-18
3200 Munawar 1802020605840001 082281680800 Sidodadi 005 003 15-Nov-18
2900 Khusni 1802022306880003 082281680800 Sidodadi 003 003 15-Nov-18
3300 Sutoyo 1802022101780005 082281680800 Sidodadi 006 003 15-Nov-18
3300 Adi Muhyidin 1802020112880002 082281680800 Sidodadi 005 003 15-Nov-18
3100 Ismail 1802021108720003 082281680800 Sidodadi 006 003 15-Nov-18
3300 Hariyanto 1802021605880001 082281680800 Sidodadi 006 003 15-Nov-18
3000 Muhtadi 1802020810770003 082281680800 Sidodadi 005 003 15-Nov-18
3000 Sarijan 1802020309780001 082281680800 Sidodadi 006 003 15-Nov-18
3100 Dibyo Sutrisno 1802020901870002 082281680800 Sidodadi 005 003 15-Nov-18
2900 Edi Erwan 1802022303820007 082281680800 Sidodadi 006 003 15-Nov-18
2800 Komarudin 1802022804850001 082281680800 Sidodadi 005 003 15-Nov-18
2700 M. Talkis 082281680800 Sidodadi 005 003 15-Nov-18
2800 Amin Mustofa 1802020704820007 082281680800 Sidodadi 006 003 15-Nov-18
3200 Agus Supriyanto 1802022708800004 082281680800 Sidodadi 006 003 15-Nov-18
3000 Lesmanto 1804141012780004 082281680800 Sidodadi 005 003 15-Nov-18
2700 Zaelani 082281680800 Sidodadi 006 003 15-Nov-18
3400 Fauzul Amin 1802022103920002 082281680800 Sidodadi 005 003 15-Nov-18
3200 Dani Wijayanto 1802022912900004 082281680800 Sidodadi 006 003 15-Nov-18
3300 Lesmanto 1804141012780004 082281680800 Sidodadi 005 003 15-Nov-18
3100 Iswanto 1802021604820001 082281680800 Sidodadi 006 003 15-Nov-18
3100 Kartiman 1802021207740004 082281680800 Sidodadi 006 003 15-Nov-18
2800 Sukartono 082281680800 Sidodadi 005 003 15-Nov-18
3200 Dani Wijayanto 1802022912900004 082281680800 Sidodadi 005 003 15-Nov-18
3300 Rendra 1802022706890003 082281680800 Sidodadi 006 003 15-Nov-18
3100 Sutoyo 1802022107800005 082281680800 Sidodadi 006 003 15-Nov-18
3200 Suyanto 1802021709830002 082281680800 Sidodadi 006 003 15-Nov-18
3500 Kaswanto 082281680800 Sidodadi 006 003 15-Nov-18
3800 Yulius 082281680800 Sidodadi 006 003 15-Nov-18
3000 Sudiono 1802020201830012 082281680800 Sidodadi 006 003 15-Nov-18
2800 Suhelmi 082281680800 Sidodadi 006 003 15-Nov-18
3200 Darusin 1802022606840002 082281680800 Sidodadi 006 003 15-Nov-18
2900 Suhelmi 1802012808840004 082281680800 Sidodadi 006 003 15-Nov-18
3000 Tursiman 1802031006850001 082281680800 Sidodadi 005 003 15-Nov-18
3100 Ngalimun 082281680800 Sidodadi 005 003 15-Nov-18
2800 Mulyono 1802020101800009 082281680800 Sidodadi 001 001 15-Nov-18
3100 Irham 082281680800 Sidodadi 005 003 15-Nov-18
3400 Paino 1802021504890006 082281680800 Sidodadi 005 003 15-Nov-18
2900 Dwi Sungkono 082281680800 Sidodadi 005 003 15-Nov-18
3200 Dwi Sungkono 082281680800 Sidodadi 005 003 15-Nov-18
3400 Hayatulloh 1802022103940001 082281680800 Sidodadi 001 001 15-Nov-18
3100 Indaman 1802020705720002 082281680800 Sidodadi 005 003 15-Nov-18
3700 Teguh Ariyanto 1802021209930002 082281680800 Sidodadi 006 003 15-Nov-18
2700 Lukman Al Hakim 1802021108860002 082281680800 Sidodadi 005 003 15-Nov-18
3000 Sudar 1802021606730006 082281680800 Sidodadi 006 003 15-Nov-18
2900 Saiman 1802023001680001 082281680800 Sidodadi 6 3 15-Nov-18
Panjang Cara ASI Vitamin A Vitamin A Kepemilik
Badan/ Ukur EksklusifF1 IMD Februari Agustus an Buku
BB (kg) Tinggi 1=Telent 1=YA,
Badan ang =YA, 2=Tidak 1=YA 1=YA KIA
(cm) 2=Berdiri 2=Tidak 2=Tidak 2=Tidak

(16) (17) (18) (19) (20) (21) (22) (23)


14.2 97 2 1 Ya
13.7 93 2 1 Ya
9.9 86 1 1 Ya
14.9 97 2 1 Ya
9.4 78 1 1 Ya
13.4 99 2 1 Ya
11 79 1 1 Ya
13.6 85 1 1 Ya
19.2 110 2 1 Ya
8 71 1 1 Ya
11.7 80 1 1 Ya
9.1 77 1 1 Ya
7.9 71 1 1 Ya
10.4 83 1 1 Ya
8.9 70 1 1 Ya
11.5 85 1 1 Ya
13.4 98 2 1 Ya
9.9 74 1 1 Ya
9.7 74 1 1 Ya
9.4 66 1 1 Ya
13.8 98 2 1 Ya
15.4 100 2 1 Ya
12.2 89 2 1 Ya
14.6 99 2 1 Ya
9.3 77 1 1 Ya
8.8 72 1 1 Ya
9.7 72 1 1 Ya
8.5 67 1 1 Ya
8.2 69 1 1 Ya
11.5 82 2 1 Ya
12.9 75 1 1 Ya
14.4 94 2 1 Ya
7.6 67 1 1 Ya
8.2 65 1 1 Ya
11.2 88 2 1 Ya
12.7 93 2 1 Ya
7.6 64 1 1 Ya
11.9 89 1 1 Ya
6.5 63 1 1 Ya
6.3 63 1 1 Ya
14.3 95 2 1 Ya
13.1 90 2 1 Ya
7.3 64 1 1 Ya
19 106 2 1 Ya
5.2 59 1 1 Ya
4.5 59 1 1 Ya
13.4 83 1 1 Ya
10.5 75 1 1
FORMUL

Provinsi : LAMPUNG Nama Posyandu


Kabupaten/Kota : LAMPUNG TENGAH Bulan
Puskesmas/Kecamatan : SUKANEGARA/BANGUNREJO Tahun
Desa/Kelurahan : SIDOADI

NIK (Nomor Induk Jenis


No No Kartu Keluarga Anak Ke Nama anak Tanggal Lahir Kelamin
Kependudukan)

(1) (2) (3) (4) (5) (6) (7)


1 1802020202120012 1802026801150001 2 Naviya Khoirunisa 28-Jan-15 P
2 1802022112170001 1802022209170002 1 Adam Hafis 22-Sep-17 L
3 1802021306170006 1802022305170001 1 Reyval Diksa 23-May-17 L
4 1802021509160006 1802021709140002 1 Devan Adi 17-Oct-14 L
5 1802021301110048 1802025809170003 2 Naura Vita 18-Sep-17 P
6 1802022509170007 1802025009170002 1 Andreana Kamila M 10-Sep-17 P
7 1802022401170013 1802020106170002 1 M. Rasya 1-Jun-17 L
8 1802022606150004 1802020906150001 1 M. Razan al gifari 9-Jun-15 L
9 1802021012150002 1802021810150003 1 Revan Ferdika 18-Oct-15 L
10 1802023012070027 1802024304150001 1 Syahra Khaira 3-Apr-15 P
11 1802021405059246 1802025202150001 4 Andinda Alya F 13-Feb-15 P
12 1802022801150001 1802022712140001 1 Rafael Aditama H 27-Dec-14 L
13 1802021608110002 1802021609140001 2 Aldi Adriansyah 16-Sep-14 L
14 1802021912130008 1802024102160002 1 Ismiati Aulia 1-Feb-16 L
15 1802021110160008 1802025104170001 1 Aqila Nur Rahmawati 11-Apr-17 P
16 1802022608090009 1802020405150001 2 David Faza K 4-May-15 L
17 1 Savina 16-Dec-15 P
18 1802021701110003 1802025106170001 2 Mufida Nuzulul Q 11-Jun-17 P
19 1802021307130007 1802026104160001 2 Afiqa Zahira 12-Apr-16 P
20 1802022304130013 1802022906160001 2 M. Riski Aditya 19-Jun-16 L
21 1802021701110008 1802024408140002 2 Luxviona yunita S 4-Aug-14 P
22 1802020502160009 1802024305160002 2 Maylin A.P 3-May-16 P
23 2 M. Jalaludin 2-Aug-18 L
24 2 Nur Tadho Alfarizi 14-Jul-18 L
25 1802021701140005 1802025012130001 1 Alvian Gavriel 10-Dec-13 L
26 1802021508120011 1802021102170002 2 M. Hasbi Maulana 11-Feb-17 L
27 1 Arsenio Dirgantara 17-Aug-18 L
28 1802022310120013 1802021009180003 2 M. Wisnu Novansyah 10-Sep-18 L
29 1802022701140010 1802020801140002 1 Kevin Aditya 8-Jan-14 L
30 1802021701140005 2 Syanum ayudia 3-Nov-18 P
31 1802022912110013 2 Raihanun zhaswa 14-10-2018 L
32 1802022607180004 2 Dila Sivaziza 8/10/2018 P
33 1802022105110012 2 Iftina Fauziyah 6/11/2018 P
34 1802020304170003 1802020811180002 2 Rafli Misdiyansyah 11/8/2018 L
FORMULIR PEMANTAUAN PERTUMBUHAN BALITA DI POSYANDU

Nama Posyandu : MELATI


: NOVEMBER
: 2018

Berat
Badan Nama Ortu (Ayah) NIK Ayah No Tlp/ HP Ortu Alamat RT RW
(BB) Lahir

(8) (9) (10) (11) (12) (13) (14)


2900 Agus 1802022208880003 082281680800 Sidodadi 012 005
3000 Iman Saputra 1802021201950005 082281680800 Sidodadi 012 005
2950 Endrik 1802021205940005 082281680800 Sidodadi 011 005
3200 Dian 1802022306960003 082281680800 Sidodadi 012 005
2400 Muhaimin 1802020205860008 082281680800 Sidodadi 012 005
2950 Teguh Trianto 1802021611890001 082281680800 Sidodadi 002 001
3000 Masdar 1802011212910003 082281680800 Sidodadi 011 005
2900 Masrudiyanto 1802020712930001 082281680800 Sidodadi 012 005
3100 Kamaludin 1802021809910003 082281680800 Sidodadi 011 005
2800 Mujianto 1802022108840002 082281680800 Sidodadi 010 005
2750 Sarbini 1802020708760002 082281680800 Sidodadi 012 005
3200 Suherman 1802020907890003 082281680800 Sidodadi 011 005
2950 Mustakim 1802023101870001 082281680800 Sidodadi 012 005
2800 Yusuf - 082281680800 Sidodadi 011 005
2700 Tri 1802020809930002 082281680800 Sidodadi 011 005
3200 Sukamto 1802021612730002 082281680800 Sidodadi 012 005
3400 Daud 082281680800 Sidodadi 012 005
3400 Saryono 1802022707870005 082281680800 Sidodadi 011 005
2800 Amin Wahyudi 1802020206860003 082281680800 Sidodadi 012 005
3000 Seno 1802021007810008 082281680800 Sidodadi 012 005
3100 Toni Setiawan 1802020206880004 082281680800 Sidodadi 011 005
3000 Nurohman 1802020303860010 082281680800 Sidodadi 010 005
2700 Daud 082281680800 Sidodadi 010 005
2900 Agus 082281680800 Sidodadi 010 005
3000 Bowo 1802022602870001 082281680800 Sidodadi 012 005
3100 Suradi 1802021703830005 082281680800 Sidodadi 011 005
3300 Tugino 082281680800 Sidodadi 011 005
3000 Kasriono 1802021606850008 082281680800 Sidodadi 011 005
3400 Heri 1802022802890001 082281680800 Sidodadi 011 005
3500 bowo 1802022602870001 082281680800 Sidodadi 012 005
3200 JARWO 1802021507850010 082281680800 Sidodadi 011 005
3300 M aziz 1811031510900001 082281680800 Sidodadi 011 005
3000 Sutarmin 1802020507810006 082281680800 Sidodadi 011 005
3700 Darni 1802020505850014 082281680800 Sidodadi 011 005
Panjang
Tgl Badan/ Cara Ukur ASI IMD Vitamin A Vitamin A Kepemilik
1=Telenta EksklusifF Februari Agustus an Buku
Pengukura BB (kg) Tinggi 1=YA,
ng 1=YA, 1=YA 1=YA
n Badan 2=Berdiri 2=Tidak KIA
2=Tidak 2=Tidak 2=Tidak
(cm)
(15) (16) (17) (18) (19) (20) (21) (22) (23)
18-Nov-18 14.2 94 2 1 1 Ya
18-Nov-18 9.4 73 1 1 1 Ya
18-Nov-18 8.6 76 1 2 1 Ya
18-Nov-18 14.9 97 2 1 1 Ya
18-Nov-18 6.3 66 1 1 1 Ya
18-Nov-18 7.6 75 1 1 1 Ya
18-Nov-18 10.6 82 1 1 1 Ya
18-Nov-18 13.3 99 2 1 1 Ya
18-Nov-18 15 98 2 1 1 Ya
18-Nov-18 13.3 97 2 1 1 Ya
18-Nov-18 13.9 97 2 1 1 Ya
18-Nov-18 16.3 103 2 1 1 Ya
18-Nov-18 14.2 98 2 1 1 Ya
18-Nov-18 11.9 90 1 1 1 Ya
18-Nov-18 9 73 1 1 1 Ya
18-Nov-18 14.2 95 2 1 1 Ya
18-Nov-18 11.9 89 2 1 1 Ya
18-Nov-18 9.7 74 1 1 1 Ya
18-Nov-18 11.4 91 1 1 1 Ya
18-Nov-18 13.7 95 1 1 1 Ya
18-Nov-18 14.1 95 2 1 1 Ya
18-Nov-18 10.2 83 2 1 1 Ya
18-Nov-18 5.4 59 1 1 2 Ya
18-Nov-18 6.1 63 1 1 2 Ya
18-Nov-18 15.7 103 2 2 1 Ya
18-Nov-18 13 76 1 1 1 Ya
18-Nov-18 6.8 64 1 1 1 Ya
18-Nov-18 5.5 58 1 2 1 Ya
18-Nov-18 18 105 2 1 1 Ya
18-Nov-18 4.7 49 1 1 1 Ya
18-Nov-18 3.7 50 1 1 1 Ya
18-Nov-18 5 50 1 1 1 Ya
18-Nov-18 3.4 49 1 1 1 Ya
18-Nov-18 3.5 50 1 1 1 Ya
FORMUL

Provinsi : LAMPUNG Nama Posyandu


Kabupaten/Kota : LAMPUNG TENGAH Bulan
Puskesmas/Kecamatan : SUKANEGARA/BANGUNREJO Tahun
Desa/Kelurahan : SIDODADI

NIK (Nomor Induk Tanggal Jenis


No No Kartu Keluarga Anak Ke Nama anak
Kependudukan) Lahir Kelamin

(1) (2) (3) (4) (5) (6) (7)


1 1802022508090007 1802025009170003 2 Khanza Aurelia H 10-Sep-17 P
2 1802020109140015 1802026106140001 1 Nabilla Azzahra 21-Jun-14 P
3 1802022912170014 1802022308160001 2 Jovi Dirgantara 23-Aug-16 L
4 1802022912170014 1802022012170001 3 Thio Arga Adistian 20-Dec-17 L
5 1802021001180011 1802020712170001 1 Ahmad Latief Alfarizi 7-Dec-17 L
6 1802021612160001 1802024208170001 1 Milkha Hilyatus Solihah 2-Aug-17 P
7 1802022212170013 1802020210170001 2 M. Fadli Maulana 2-Oct-17 L
8 1802022307150002 1802020907150001 1 M. Ibnu Attho'illah 9-Jul-15 L
9 1802021112120011 1802025608160001 2 Ayunda Khoirunnisa 16-Aug-16 P
10 1802021112120011 1802025608160002 3 Adinda Khoirunnisa 16-Aug-16 P
11 1802023105170011 1 Niswa Hilmatun 25-Jul-17 P
12 1802022501130008 1802021208160002 2 Alvin Arasyid Prasetya 12-Aug-16 L
13 1802022303170002 1802022409170001 2 Nizam Syarif Rahman 24-Sep-17 L
14 1802021407170007 1802025203180001 2 Shinta Afiqotul Qifti 12-Mar-18 P
15 1802022312150001 1802024106150001 1 Asilah Fathin Azizah 1-Jun-15 P
16 1802022811120014 1802022609160003 2 Eren bastian 26-Sep-16 L
17 1802022108170012 1802024711170004 1 Alycia Putri 7-Nov-17 P
18 1802020609160009 1802022104160001 3 M. Althaf Rizki Alfarezi 21-Apr-16 L
19 1802020510150004 1802026005940005 1 Naura Zulfa Azzahra 3-Apr-15 P
20 1802021405056761 1802027009150003 3 Lia Habibatul Khumairoh 30-Aug-15 P
21 1802021612100002 1802027008140001 2 Septiani 30-Aug-14 P
22 1802022903170001 1802025705170001 2 Anindya Qanita 17-May-17 P
23 1802021405058312 1802025407150001 1 Arifah Ziyadatul Husna 14-Jul-15 P
24 1802021505050111 1802021307170002 1 Azril Haikal Alindra 13-Jul-17 L
25 1802022302150002 1802024305150001 1 Raihanna Jinan Ulya 3-May-15 P
26 1802021602100007 1802022104180002 2 Aden Ibrahim 21-Apr-18 L
27 - 1 Arsyla Althafunisa 5-Jan-18 P
28 3175061601093229 3 Nada Fajriyah 8-Apr-18 P
29 3175061601093229 3175062004141006 2 M Ilham nurmansyah 20-Apr-14 L
29 1802020502160001 1802022004180002 2 Alvin Salim Zarkasi 20-Apr-18 L
30 1802020303110051 1802022203180001 3 M. Ali Musyafa K 22-Mar-18 L
31 1802021210160010 2 Alifah Alfika 5-Jun-18 P
32 1802021202130011 1802022901170001 2 Ali Novansya 29-Jan-17 L
33 M. Baehaki 13-Feb-18 L
34 1802021806120007 1802025807180001 2 Aisyah Nurul husna 18-Jul-18 P
35 1802021112090010 1802025709180001 2 Alma Nur Aulia 17-Sep-18 P
36 1802021407170007 3301181207140001 1 Dava Arian R B 13-Jul-14 L
37 1802020305120013 1802025604180001 2 Miti Kusuma Ningrum 16-Apr-18 P
38 1802020205130007 2 Hanif Aqil Maulana 28-Apr-18 L
39 1802022312150001 2 Fiona Alma Qairen 3-Oct-17 P
40 180202110800001 1802022808160002 2 Reza Prastyo 28-08-2016 L
41 1802021001180010 1802022809170001 1 Anjar Albiansyah 28-Sep-17 L
42 1802020712150003 1802020604150003 1 Reza Aprilio Pratama 6-Apr-15 L
43 1802021405056770 1802025904170002 3 AriZka Intan APrilianti 19-Apr-17 P
44 5 Ramadhanis 12-Jun-18 L
45 1802021906140004 1802027105140001 1 Silvi Reviana 31-May-14 P
46
FORMULIR PEMANTAUAN PERTUMBUHAN BALITA DI POSYANDU

Nama Posyandu : TERATAI


: NOVEMBER
: 2018

Berat
Badan Nama Ortu (Ayah) NIK Ayah No Tlp/ HP Ortu Alamat RT RW
(BB) Lahir

(8) (9) (10) (11) (12) (13) (14)


3200 Mariman 1802020308860002 082281680800 Sidodadi 010 005
2900 Budiyanto 1802022003790002 082281680800 Sidodadi 010 005
3400 Ernanto 1802021303870003 082281680800 Sidodadi 010 005
3600 Ernanto 1802021303870003 082281680800 Sidodadi 010 005
2900 Solihin 1802221703890002 082281680800 Sidodadi 010 005
3200 Sugeng Riyadi 1802021003900002 082281680800 Sidodadi 001 001
2700 M. Nur Hidayat 1802020505860002 082281680800 Sidodadi 007 004
3200 Miftahurohim 1802021912880002 082281680800 Sidodadi 010 005
2500 Nur Ikhsan 1802022311860001 082281680800 Sidodadi 007 004
2300 Nur Ikhsan 1802022311860001 082281680800 Sidodadi 007 004
2900 Nasrulloh 1802021410920002 082281680800 Sidodadi 007 004
3200 Suparno 1802022507690004 082281680800 Sidodadi 007 004
3000 Muhammad Khaerudin 1802021105860005 082281680800 Sidodadi 010 005
2700 Badri 1802020609840009 082281680800 Sidodadi 010 005
2800 Adi Saputra 1802021310900003 082281680800 Sidodadi 010 005
3200 Supriyono 1802020507810009 082281680800 Sidodadi 007 004
3000 Agung Priono 1802022404960004 082281680800 Sidodadi 007 004
2700 Masrurozi 1802021502720001 082281680800 Sidodadi 010 005
3200 Aryadi Putranto 1802020208930002 082281680800 Sidodadi 003 004
3200 Mukarom 1802020109670002 082281680800 Sidodadi 010 004
3300 Kasnan 1802020805800003 082281680800 Sidodadi 011 005
3100 Wagino 1802021203900001 082281680800 Sidodadi 010 005
2900 T. Farid Ma'ruf 1802021405730003 082281680800 Sidodadi 010 005
3100 Saring 1802021505800002 082281680800 Sidodadi 010 005
2800 Ahmad Tauhid 1802021405900001 082281680800 Sidodadi 010 005
2900 Casmani 1802021506840005 082281680800 Sidodadi 007 004
2900 Heri - 082281680800 Sidodadi 007 004
2800 Tursiman 3175060509780001 082281680800 Sidodadi 007 004
3200 Tursiman 3175060509780001 082281680800 Sidodadi 007 004
2700 Suwawan 1810011505840003 082281680800 Sidodadi 011 005
3000 Eko Purwanto 1802022804840003 082281680800 Sidodadi 010 005
2900 Tafsir 3276040204820007 082281680800 Sidodadi 010 005
3200 Aminudin 1802022003830010 082281680800 Sidodadi 010 005
2900 M. Saripudin 082281680800 Sidodadi 007 004
3000 Umaryono 1802021909840003 082281680800 Sidodadi 010 005
2900 Sutoyo 1802022808740004 082281680800 Sidodadi 010 005
2600 Badri 1802020609840009 082281680800 Sidodadi 010 005
3500 Sutiyono 1802020405810002 082281680800 Sidodadi 007 004
3600 Sapari 1802021312780001 082281680800 Sidodadi 007 004
3200 Adi Saputra 1802021310900003 082281680800 Sidodadi 010 005
3000 Rusmadi 1802020903830005 082281680800 Sidodadi 010 005
3000 Julianto 1802022907950005 082281680800 Sidodadi 007 004
3400 Wahidin 1802020303930004 082281680800 Sidodadi 010 005
3400 Edi Susanto 1802021806680001 082281680800 Sidodadi 007 004
3400 Jumidi 082281680800 Sidodadi 007 005
3100 Budi Sarwono 1802021003840010 082281680800 Sidodadi 010 005
Panjang
Badan/ Cara Ukur ASI IMD Vitamin A Vitamin A Kepemilik
Tgl 1=Telenta EksklusifF Februari Agustus an Buku
BB (kg) Tinggi 1=YA,
Pengukuran ng 1=YA, 1=YA 1=YA
Badan 2=Tidak KIA
2=Berdiri 2=Tidak 2=Tidak 2=Tidak
(cm)
(15) (16) (17) (18) (19) (20) (21) (22) (23)
20-Nov-18 9 75 1 1 1 Ya
20-Nov-18 11.5 95 2 1 1 Ya
20-Nov-18 13.2 87 2 1 1 Ya
20-Nov-18 11.5 77 1 1 1 Ya
20-Nov-18 9.2 75 1 1 1 Ya
20-Nov-18 9.6 77 1 1 1 Ya
20-Nov-18 8.4 72 1 1 1 Ya
20-Nov-18 12.8 98 2 1 2 Ya
20-Nov-18 10.4 77 2 1 2 Ya
20-Nov-18 11.9 79 2 1 2 Ya
20-Nov-18 9.3 78 1 1 1 Ya
20-Nov-18 11.2 83 2 1 1 Ya
20-Nov-18 9.7 76 1 1 1 Ya
20-Nov-18 6.8 69 1 1 1 Ya
20-Nov-18 12.4 90 2 1 1 Ya
20-Nov-18 10.8 86 1 1 1 Ya
20-Nov-18 7.9 73 1 1 1 Ya
20-Nov-18 11.6 85 2 1 1 Ya
20-Nov-18 13.4 95 2 1 1 Ya
20-Nov-18 13.5 95 2 1 1 Ya
20-Nov-18 14.8 98 2 1 1 Ya
20-Nov-18 9.2 79 1 1 1 Ya
20-Nov-18 13.6 97 2 1 1 Ya
20-Nov-18 10.4 81 1 1 1 Ya
20-Nov-18 12.7 94 2 1 1 Ya
20-Nov-18 7.1 64 1 1 1 Ya
20-Nov-18 8 7.1 1 1 1 Ya
20-Nov-18 6.5 68 1 1 1 Ya
20-Nov-18 12.8 98 1 1 1 YA
20-Nov-18 6.2 64 1 1 1 Ya
20-Nov-18 7.7 70 1 1 1 Ya
20-Nov-18 6.7 62 1 1 1 Ya
20-Nov-18 10.4 84 2 1 1 Ya
20-Nov-18 8.4 71 1 1 1 Ya
20-Nov-18 7.6 71 1 1 1 Ya
20-Nov-18 5.4 58 1 1 1 Ya
20-Nov-18 11.9 97 2 1 1 Ya
20-Nov-18 9.5 70 1 1 1 Ya
20-Nov-18 6.9 68 1 1 1 Ya
20-Nov-18 8.8 71 1 1 1 Ya
20-Nov-18 13 84 1 1 1 Ya
20-Nov-18 8 73 1 1 1 Ya
20-Nov-18 13.9 96 2 1 1 Ya
20-Nov-18 10.7 75 1 1 2 Ya
20-Nov-18 7.6 68 1 1 1 Ya
20-Nov-18 15 98 2 1 1 Ya
FO

Provinsi : LAMPUNG
Kabupaten/Kota : LAMPUNG TENGAH
Puskesmas/Kecamatan : SUKANEGARA/BANGUNREJO
Desa/Kelurahan : SIDODADI

NIK (Nomor Induk Tanggal


No No Kartu Keluarga Anak Ke Nama anak
Kependudukan) Lahir

(1) (2) (3) (4) (5) (6)


1 1802020303110028 1802022802160001 2 ZULMI FAKHRI FADILLAH 28-Feb-16
2 1802020303110035 1802022608170003 2 FAHRUL SETIA NOVANSYAH 26-Aug-17
3 1802020212130010 1802021912130001 1 NIKOLA ALFIANO 19-Dec-13
4 1802022909170001 1802020112170001 1 ACHTAR FAEZA DINATA 1-Dec-17
5 1802022910150002 1802022409150001 1 M. NUR HAFIZ 24-Sep-15
6 1802022910150002 2 M. ZAFRAN 21-Feb-18
7 1802020303110044 1802025803170002 3 AFRILIANA AZZAHRA 18-Mar-17
8 1802021705170006 1802021712140003 2 DAVI IRWANSYAH 17-Dec-14
9 1802022801150010 1802026512140002 1 FIRZA DESTI AULIA SARI 25-Dec-14
10 1802021610170009 1802022008160003 1 FIAN AL AZIZ 20-Aug-16
11 1802023110170008 1802024112150003 1 AQILA ALESHA ZAHRA 1-Dec-15
12 1802021705100019 1802021807170001 2 RAYZAL ANDIKA 18-Jul-17
13 1802021912140001 1802024802150003 2 FEBRINA KHOIRUNNISA 8-Feb-15
14 1802021311170012 1802025809170001 3 SEPTINA LATRI WULANDARI 18-Sep-17
15 1802021505050124 1802026506160004 2 ERLIN PUTRI RAHMADANI 25-Jun-16
16 1802021401110034 1802020902150002 2 AKMAL ZULFADLI RAHMANI 3-Sep-15
17 1802022411150001 1802026307150002 2 JIHAN BILQIS SYAKIROH 23-Jul-15
18 1802021405058285 1802020811170001 3 FIQRI WAHYU SAPUTRA 8-Nov-17
19 1802021003150003 2 ANNISA ARDELYA 9-Sep-16
20 1802021202130006 1802026604150001 2 ERIKA AVRILLIA ANJANI 26-Apr-15
21 1802021910150021 1802021609150002 1 ARSYAD RIFAI PRATAMA 16-Sep-15
22 1802021910150021 1802020108170003 2 ARKHA EL MALIQ 1-Aug-17
23 1802020812140010 1802021410170002 2 RADIT OKTAVIAN FERDIANSYAH 14-Oct-17
24 1802021311170011 1802024505160003 3 TRI LESTARI WAHYUNINGSIH 5-May-16
25 1802022909160001 1802026712150002 1 SILNA RASTA FARADISA 27-Dec-15
26 - - 2 CIKA RESIANA 29-Oct-17
27 - - 2 KHAINDRA IBRA 28-Jun-16
28 - - 1 ATAMA ALFATIH 9-Oct-17
29 1 DAFIN 18-Aug-18
30 1802021902110027 1802020309140002 2 TEGAR WICAKSONO 3-Sep-14
31 - - 2 AISYAH ALTHAFUNNISA 14-Apr-17
32 1802022007160008 1802025110160001 1 ANASYA KAILA AURISKA 11-Oct-16
33 1802011003150002 1802013110140002 1 F. GALIH PRATAMA 31-Oct-14
34 1802022801120010 1802020910150004 4 NGASIF NGANAN 9-Oct-15
35 - - 2 AZKA MARCELL 30-Mar-18
36 1802020406180004 - 1 FAIQAH MUTIA 10-Aug-18
37 - - 1 NAUVAL GAVIN 31-Dec-15
38 - - 1 MISYA 16-Nov-15
39 1802022808120002 1802024906180001 2 BELVANIA RAHMADHANI 9-Jun-18
40 1802022001110027 1802025412140001 2 DESTIANA DWI SAPUTRI 14-Dec-14
41 - - 2 NAFISA NUR RIYANI 31-Jul-14
42 2 ZAHIDAH ULINNUHA 25-10-2018
43 1802021012150007 1802026709150003 1 DITA NIRMALA 27-Sep-15
44 1802021003150004 1802022010180001 2 M FILDAN ALFAHRI 20-10-2018
45 1802022801150010 1802026512140002 1 FIRZA DESTI AULIA SARI 25-Dec-14
46 1802021902110022 1802026511130003 2 KINAR ANASTASYA 25-Nov-13
47 1802021201150008 1802022609180001 2 ARYA ARDI KURNIAWAN 26-09-2018
48 6102160412170001 6102166602180001 1 FEBRI NUR ASYIFA 26-02-2018
FORMULIR PEMANTAUAN PERTUMBUHAN BALITA DI POSYANDU

Nama Posyandu : DAHLIA


Bulan : NOVEMBER
Tahun : 2018

Berat
Jenis Badan Nama Ortu (Ayah) NIK Ayah No Tlp/ HP Ortu Alamat RT
Kelamin (BB) Lahir

(7) (8) (9) (10) (11) (12) (13)


L 4100 LUKMAN UBAEDILLAH 1802020906850002 082281680800 SIDODADI 010
L 3400 HASAN 1802020704720005 082281680800 SIDODADI 009
L 3000 SUYONO 1802022010840003 082281680800 SIDODADI 009
L 2900 MARDIYANTO 1802022503920001 082281680800 SIDODADI 001
L 2900 YURNANDO 1802020801930002 082281680800 SIDODADI 011
L 3000 YURNANDO 1802020801930002 082281680800 SIDODADI 011
P 3200 RISWANTO 1802022404790002 082281680800 SIDODADI 009
L 3000 NURI 1802021201850003 082281680800 SIDODADI 011
P 3100 AHMAD SIDIQ 1802012912860003 082281680800 SIDODADI 008
L 3200 USRIN SUPRIYANTO 1802020210920001 082281680800 SIDODADI 009
P 3200 RIO IRAWAN 1802022606930002 082281680800 SIDODADI 008
L 3100 HARIYANTO 1802021603880007 082281680800 SIDODADI 008
P 2800 ROSADI 1802021712720001 082281680800 SIDODADI 008
P 2900 PONIRAN 1802021812740001 082281680800 SIDODADI 008
P 3200 ARIFUDIN 1802022507870006 082281680800 SIDODADI 001
L 2700 MIROT 1802021401110034 082281680800 SIDODADI 008
P 3200 WAHIDIN 1802022603830002 082281680800 SIDODADI 008
L 3300 BEJO UTOMO 1802020811170001 082281680800 SIDODADI 008
P 3200 EKA PERDANA 1802020908830002 082281680800 SIDODADI 008
P 2900 SLAMET ANWAR 1802020507800017 082281680800 SIDODADI 009
L 3100 MUSTOFA 1802021609150002 082281680800 SIDODADI 006
L 3000 MUSTOFA 1802021609150002 082281680800 SIDODADI 006
L 3100 DEVIANTO 1802020812140010 082281680800 SIDODADI 008
P 3000 BAMBANG RIYANTO 1802022206820003 082281680800 SIDODADI 008
P 2800 SURANTO 1802021209890003 082281680800 SIDODADI 008
P 2980 RUDI - 082281680800 SIDODADI 010
L 3000 SUTARYANTO - 082281680800 SIDODADI 009
L 2800 SALAMAH - 082281680800 SIDODADI 009
L 3600 AMIM - 082281680800 SIDODADI 009
L 3200 LAMBANG 1802020305820005 082281680800 SIDODADI 009
P 3200 MARTIJO - 082281680800 SIDODADI 009
P 3500 ROHMAD 1802020107890188 082281680800 SIDODADI 008
L 3500 NOVENDI 1802011411840002 082281680800 SIDODADI 009
L 3300 WARSITO 1802021407660003 082281680800 SIDODADI 009
L 3100 RINO - 082281680800 SIDODADI 009
P 2900 SENDI KURNIAWAN 1802022209970002 082281680800 SIDODADI 009
L 3100 UJANG - 082281680800 SIDODADI 009
P 3100 KHOLIK - 082281680800 SIDODADI 009
P 3200 SOBIHAN 1802020508820009 082281680800 SIDODADI 008
P 3800 TRI WIDODO 1802021308860006 082281680800 SIDODADI 008
P 2400 KAWIT - 082281680800 SIDODADI 009
P 2700 PRAYITNO 082281680800 SIDODADI 009
P 3300 DEDI PRIYANTO 1802022401810002 082281680800 SIDODADI 009
L 2600 EKO SUSANTO 1802021101900001 082281680800 SIDODADI 009
P 3100 AHMAD SIDIQ 1802012912860003 082281680800 SIDODADI 008
L 3200 ISNAENI 1802021004770009 082281680800 SIDODADI 009
L 3300 DEDI KURNIAWAN 1802021410890001 082281680800 SIDODADI 008
P 3200 NUR SALIM 1802020603900004 082281680800 SIDODADI 008
Panjang
Badan/ Cara Ukur ASI IMD Vitamin A Vitamin A Kepemilik
Tgl 1=Telenta EksklusifF Februari Agustus an Buku
RW BB (kg) Tinggi 1=YA,
Pengukuran ng 1=YA, 1=YA 1=YA
Badan 2=Tidak KIA
2=Berdiri 2=Tidak 2=Tidak 2=Tidak
(cm)
(14) (15) (16) (17) (18) (19) (20) (21) (22) (23)
005 22-Nov-18 13.4 89 1 1 1 YA
006 22-Nov-18 10.2 77 1 1 1 YA
006 22-Nov-18 14.2 100 2 1 1 YA
004 22-Nov-18 8.4 71 1 1 1 YA
005 22-Nov-18 14.6 97 2 1 2 YA
005 22-Nov-18 10.2 73 1 1 2 YA
006 22-Nov-18 11.7 77 1 1 1 YA
005 22-Nov-18 14.9 98 2 1 1 YA
006 22-Nov-18 12.9 93 2 1 1 YA
006 22-Nov-18 11.3 83 1 1 1 YA
006 22-Nov-18 14.2 96 2 1 1 YA
006 22-Nov-18 11.4 81 1 1 1 YA
006 22-Nov-18 12.8 94 2 1 1 YA
006 22-Nov-18 8.2 75 1 1 1 YA
006 22-Nov-18 10.7 85 2 1 1 YA
006 22-Nov-18 14.5 97 2 1 1 YA
006 22-Nov-18 12.5 98 2 1 1 YA
006 22-Nov-18 10.2 78 1 1 1 YA
006 22-Nov-18 12.7 90 1 1 1 YA
006 22-Nov-18 16 99 2 1 1 YA
003 22-Nov-18 12.6 93 2 1 1 YA
003 22-Nov-18 9.7 79 1 1 1 YA
006 22-Nov-18 10.2 74 1 1 1 YA
006 22-Nov-18 12.4 87 2 1 1 YA
006 22-Nov-18 11.2 90 2 1 1 YA
005 22-Nov-18 8.2 74 1 1 1 YA
006 22-Nov-18 12.9 88 2 2 2 YA
006 22-Nov-18 8.2 74 1 1 1 YA
006 22-Nov-18 6.3 63 1 1 1 YA
006 22-Nov-18 15.2 98 2 1 1 YA
006 22-Nov-18 8.7 75 1 1 1 YA
006 22-Nov-18 8.7 81 2 1 1 YA
006 22-Nov-18 26 106 2 1 1 YA
006 22-Nov-18 12.2 88 2 1 1 YA
006 22-Nov-18 8.2 71 1 1 1 YA
006 22-Nov-18 6.3 62 1 1 1 YA
006 22-Nov-18 13.3 89 2 1 1 YA
006 22-Nov-18 14.3 97 2 1 1 YA
006 22-Nov-18 6.8 66 1 1 1 YA
006 22-Nov-18 15.2 97 2 1 1 YA
006 22-Nov-18 15.9 101 2 1 1 YA
006 22-Nov-18 3.8 50 1 1 1 YA
006 22-Nov-18 12.5 93 2 1 1 YA
006 22-Nov-18 4 52 1 1 1 YA
006 22-Nov-18 13.3 93 2 1 1 YA
006 22-Nov-18 14.7 100 2 1 1 YA
006 22-Nov-18 5.2 50 1 1 1 YA
006 22-Nov-18 7.7 50 1 1 1 YA