FORMULIR PEMANTAUAN PERTUMBUHAN BALITA DI POSYANDU

Provinsi : Kepulauan Riau Nama Posyandu : Melati I

Kabupaten/Kota : Natuna Tanggal : 10 Juli 2019
Puskesmas/Kecamatan : Pulau Tiga Tahun : 2019
Desa/Kelurahan : Sabang Mawang

Berat
Badan
NIK (Nomor Induk Anak Nama Ortu
No No Kartu Keluarga Nama Anak Tanggal Lahir JK (BB) NIK Ayah RT RW BB (kg)
Kependudukan) Ke (Ayah)
Lahir
(Kg)

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (13) (14) (15)

1 2103112101090001 2103111108140001 3 Alyando 8/11/2014 L 3.5 Nasrun 2103110407820001 2 1 30.7

2 2103110402090001 2103114109140001 2 Septi Hermiza 9/1/2014 P 3.0 Heri Supiar 2103110107821013 1 1 16.1

3 2103112001090004 2103115609140001 4 Munaworah 16/09/2014 P 3.7 Firdaus 2103110704701002 2 1 11.3

4 1 Dezzifa Wanda 12/1/2014 L Hendi 15.0

5 2103112803080001 2103110212140001 2 Paris Paisal 12/2/2014 L 2.9 Yusuf 2103110206680001 1 2 15.7

6 5 Muhammad Arial Nur 26/3/2015 L 16.4

7 210311070209001 2103116204150001 4 Winanda Afrianti 22/4/2015 P 3.0 Amirham 2103112803711002 3 2 11.6

8 2103111308150001 2103114106150001 1 Desta Revi Yanti 6/1/2015 P 3.0 Reki Harianto 2103062609920001 2 1 14.8

9 2103110410100002 2103111906150001 2 Ghafir Ramadhan 19/6/2015 L 2.8 Nurdin 2103110406880001 1 2 12.7

Muhammad Al-Zian
10 2103111403160001 2103110508150001 1 7/5/2015 L 3.2 Andika 2103071505950001 1 1 12.2
Al-Fizri

Muhammad Azis Al-

11 2103112902120001 2103110908150001 2 8/9/2015 L 3.0 Aspi 2103080601830001 3 1 13.5
Apik

Muhammad Fatur
12 2103112212080002 2103111607150003 4 16/07/2015 L 3.0 Suardi 2103110901761002 3 2 14.0
Rahman

13 2103113107080006 2103112608150000 3 Muhammad Az-Zikry 26/08/2015 L 3.5 Zurni 2103110503661002 3 2 14.3

14 2103110810140001 2103112309150001 1 Aditya Rifki Hamizan 23/09/2015 L 3.0 Rusli 2103112106860001 2 1 13.6

15 2103111105150004 2103110211150001 1 Al-Piansah 11/2/2015 L 2.8 Jumardi 2103050107791010 2 2 12.5

16 2103112108080002 2103116310150001 4 Al-Syahira 23/10/2015 P 3.0 Abdul Gapur 2103110105780001 1 1 11.8

17 4 Assurahman 23/10/2015 L 2.6 Zulkarnaini 14.3

18 1 Haikal Okprilian 10/12/2015 L 4.0 13.7

19 2 Yudas Patmawati 28/10/15 P 2.7 Yuda Asmara 16.1

20 2103110606080001 2103116611150001 3 Niesya Adelia 26/11/2015 P 3.5 Mardianto 2103110810800001 2 2 19.6

Muhammad
21 2103111701090016 2103112512150001 4 Al-Abiyu 25/12/2015 L 3.8 2103110409780001 2 1 13.7
Syarif

Muhammad
22 2103112609120001 2103112202160001 2 Dzihan Al-Farisyi 22/02/2016 L 2.6 2103111303871002 1 1 12.1
Daud

Adi Putro
23 2103112604190000 6471060705160002 3 Rafi Aufa Syahputro 5/5/2016 L 3.0 6471051608830000 2 2 12.9
Yusmianto

Muhammad Rizqi
24 2103112403110001 2103110606160001 2 6/6/2016 L 3.6 Saripudin 2103111605840001 2 1 14.0
Ramadhan

25 2103110211090001 2103112907160001 3 Azka Dzuhairi Hisyam 29/07/2016 L 2.9 Adendi 2103112104870001 2 2 12.3

26 2103110702090002 2103116309160003 4 Tia Natasa 23/09/2016 P 3.5 Tarmizi Muni 2103110303721002 3 2 15.6

27 2103112305120001 2103112310160001 2 Dzaki Zulhakim 23/10/2016 L 3.0 Teddy 6101043103850004 3 1 18.9

28 2103113103170001 2103115310160001 1 Herniva Okta Ermawati 13/10/2016 P 3.0 Hobir 2103101011860001 3 2 9.0

29 4 Zahra Dawiyah 11/13/2016 P 3.5 Masri 11.2

2103115007890001 (NIK
30 2103112706130001 2103117112160001 3 Alin Asinta 31/12/2016 P 4.0 Hasan IBU) 2 2 11.5

31 2103111502180001 2103110801170001 1 Evan Mizuar 1/18/2017 L 3.6 Dedi Mazuar 2103110707911003 3 1 13.2
32 2103112701090006 2103115702170001 3 Kaina Habrilia 17/02/2017 P 2.8 Harjono 2103110107841014 1 1 10.5

33 2103072708170000 3 Abdurrahman Addakhil 8/27/2017 L 3.5 Della Pulda 2103073012820001 11.2

Muhammad Fauzan
34 2103112903170001 2103110208170001 1 8/2/2017 L 2.8 Suh 2105010107860001 1 2 10.7
Surahman

35 4 Yuza Bilqis Alfiani 10/4/2017 P 3.0 Karim 10.5

Muhammad Hannan
36 2103110407170001 2103111710170001 1 17/10/2017 L 3.2 Herman 2172020207900003 2 1 10.1
Al-Hakim

37 2103051809130002 2103204602180002 4 Evafania Sijabat 2/6/2018 P 2.5 Jonni Sijabat 2103052708700001 2 4 11.1

38 2103112110080002 2103114703180001 5 Adzkia Nayla 3/7/2018 P 3.3 Makruf 2103110402790001 3 1 8.7

39 2103111601190002 2103111502180001 1 Rafasya Febriansyah 15/02/2018 L 2.8 Susanti 2103115907971002 2 1

40 2103112406140001 2 Aiza Nada Zahwa 28/04/2018 P 3.2 Bahrul Amin 2105062002890001 2 1 7.1

41 3 Abyan Zakir Sarparas 26/06/2018 L 3.3 Sutarman 8.2

42 2 Maratussholeha 19/06/18 P 3.3 Siti Arma 10.2

43 2103111302180001 2103115206180001 1 Nihayatul Hafifah 6/12/2018 P 3.0 Okvian Andicka 2103112310870001 3 1 7.2
44 2103110702090001 4 Onur Alvaro 7/9/2018 L 2.8 M. Ikhsan 2103111008780001 3 2 7.8

45 1 Raffa Alif Gharkan 8/14/2018 L 2.7 Ropi

46 2 Muhammad Athar 12/7/2018 L 3.1 Ilas 7.7

Dafanka

Muhammad Afka
47 2103110107090003 1 14/12/2018 L 2.4 Rojemah 210311500551102 1 2 6.5
Gilang Kartika

48 2103073011070030 - 4 Harrun Ar-Rasyid 25/12/2018 L 3.5 Della Pulda 2103073012820001 1 5 8.0

A DI POSYANDU

Cara
ASI IMD Kepemil
PB/TB Ukur Eksklusi
1=Telent ikan Umur
Bulan 1=YA, Buku Nama IBU
ang f 1=YA,
ini 2=Berdir 2=Tidak 2=Tidak KIA
i

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

111.8 2 2 2 1 Tri Wahyuni

58

106.5 2 2 2 1 Wan Minarti

58

98.3 2 1 1 1 Meli Yana PMT

57

102.8 2 2 1 1 Herpina
55

100.3 2 1 1 1 Mislina
55

102.1 2 2 2 1 Zainariah
51

98.3 2 2 1 1 Hazian
50
99.0 2 2 2 1 Novita Sari
49

94.4 2 2 2 1 Patina
48
Devi Mustika
95.0 2 2 2 1 Sari
48

99.0 2 2 2 1 Rasmi
47

96.0 2 1 1 1 Jumrat
47

97.8 2 1 1 1 Yunani
46

94.0 2 1 1 1 Samsiah
45

97.1 2 1 1 1 Asmiwati PMT

44

96.0 2 1 1 1 Majalena
44

2 2 1 1 Marya
44

100.0 2 2 2 1 Rahayu
44

98.0 2 2 1 Desmawati
44
100.0 2 1 1 1 Baiti
43

97.0 2 2 2 1 Umi Kalsum

42

93.5 2 2 1 1 Dewi Lasmi

40

92.5 2 2 1 1 Surtina
38

92.3 2 1 1 1 Hayati
37

95.3 2 1 1 1 Wan Asmira

35

93.0 2 2 2 1 Nentinar
33
Dina Inari
95.0 2 2 1 1 Memory
32

83.1 2 2 2 1 Minarsih PMT

32

81.9 2 1 1 1 Fatimah Baru

31

84.5 2 2 1 1 Zam Zanarita

30

98.0 2 1 2 1 Eli Ermawati

29
85.2 2 1 1 1 Betti Hadayani
28

81.9 2 1 1 1 Nur Aisyah Baru

22

82.5 1 1 1 1 Zuleha
23

78.5 2 2 1 1 Yunita Baru

21

83.7 1 2 2 1 Riawati
20

80.1 1 1 1 1 Juni Moralina

17

78.0 1 1 1 1 Masroni
16

1 2 2 1 Sri Susanti
16

75.0 1 1 1 1 Eka Selpia

14

73.6 1 1 1 1 Susilawati
12

75.0 1 2 2 1 Siti Atma

12

71.3 1 2 1 1 Yuli
12
72.3 1 2 1 1 suryani
12

1 2 1 1 Sri Tati
10

67.2 1 2 2 1 Dentiema
7

65.0 1 2 1 1 Deti Pusika Sari

6

67.8 1 1 1 1 Nur Aisyah

6
 FORMULIR PEMANTAUAN PERTUMBUHAN BALITA DI POSYANDU

Provinsi : Kepulauan Riau Nama Posyandu : Melati II

Kabupaten/Kota : Natuna Tanggal : 11 JULI 2019
Puskesmas/Kecamatan : Pulau Tiga Tahun : 2019
Desa/Kelurahan : Sabang Mawang Barat

Berat
Badan
NIK (Nomor Induk Anak Nama Ortu BB PB/ TB
No No Kartu Keluarga Nama anak Tanggal Lahir JK (BB) NIK Ayah RT RW
Kependudukan) Ke (Ayah) (KG) (CM)
Lahir
(Kg)

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14)

1 2103112610180001 2103077007140001 3 Alisa Ramadani 30/07/2014 P 3.0 Aminudin 2103072808770001 2 1 14.6 98.5

2 2 Nida Ronia Fitria 28/07/2014 P 2.8 Herman

3 2103116907140001 2 Rayya Safitri 29/07/2014 p 3.5 Reno 103.0

4 2103113110080003 2103116408140001 2 Helmi Swasma 24/08/2014 P 3.0 Asir 2103112303830001 1 2 17.0 105.0

Muhammad Al-
5 2103112310140001 2 23/10/2014 L Hanka 16.2 108.5
Dapa Hanka

6 2103112910080004 2103116010140001 3 Nur Insyira 20/10/2014 P 3.1 Indra 2103110101741002 2 2 18.1 105.1

7 2103112203110004 2103115111140001 3 Frisca 11/11/2014 P 3.1 Roni 2103110511790001 1 1 14.5 96.9

8 1 Muhammad Syukri 12/12/2014 L 3.0 Jumardian 13.6 100.3

9 2103111710120001 2103115912140001 2 Sandi Lata Mausadi 1/10/2015 P 3.0 Umar 2103111703820001 2 1 14.6 100.0

10 2103182310120001 2103181902150002 2 Febri Saputra 2/19/2015 L 3.0 Alim 2103113010790002 2 1 12.7 98.0

Muhammad Sa`ban
11 1 Al-Farid 6/1/2015 L 3.0 Toni

Muhammad Zidane
12 2104011607120005 2104062207150001 2 Al Fahsya Mahendra 22/07/2015 L 3.4 Hendra 2104010201820003 1 1 14.5 100.0

13 2103110212100001 2103111908150001 1 Raffi Radiansyah 19/08/2015 L 2.8 Rasidi 2103111710870001 1 1 14.4 101.5

14 2103111110160002 2103110912150001 1 Muhammad Haikal 9/12/2015 L 3.8 Herdi 2103111003931005 1 1 14.4 97.0

Amir Imam
15 2103112601150003 2103114610150001 1 Alvira Rahayu Oktani 10/6/2015 P 3.1 2103071512890001 2 2 17.2 99.5
Santoso

Keisha Hasna Muhammad 2103110606721002

16 2103110201190002 2103056310150002 2 23/10/2015 P 3.5 2 2 13.0 95.8
Humaira Suip

17 2103111007080002 2103112510150001 3 Muhammad Zhulva 25/10/2015 L 3.8 Heryanto 2103113010800001 1 2 13.7 94.0

18 2103110512110001 2103112602160001 2 Alby Assagit 26/02/2016 L 3.0 Tamrin 2103110703820001 2 1 15.3 99.0
19 2103182310120001 2103184403160001 3 Marsya Rawdah 4/3/2016 P 3.1 Alim 2103113010790002 2 1 12.0 90.0

Edy
20 2103110608180001 2103116004160001 4 Dinda Andini 20/04/2016 P 3.8 1404090507840009 2 2 12.1 88.9
Kurniawan

21 2103112001100001 2103116704160001 2 Zea Aprilia 27/04/2016 P 2.9 Ari Kusmiran 2103110110890002 1 1 13.0 91.0

Citra Veranissa
22 2103111901090002 2103116006160001 3 20/06/2016 P 3.4 Hermanto 2103110606811004 1 2 15.3 95.8
Ramadhani

23 2103112910080001 2103115706160001 4 Juwita Ramadani 17/06/2016 P 3.0 Khairol 2103111007740001 1 1 12.0 95.0

24 1 Selfia Aklima 19/06/2016 P 3.0 Dani 14.2 91.0

Natasha Zahwa
25 2103111103130001 2103116707160001 2 27/07/2016 P 2.7 Herman 2103112703900002 2 1 9.5 88.1
Aqila

26 1 Aisyah 9/12/2016 P 2.9 Zurdi

27 2103112501110001 2103110812160001 2 Sahdan Salqi 8/12/2016 L 3.0 Arjon 2103083006780001 2 1 9.7 89.0

Iyas Muzaki Al-

29 2103111202090002 210311010170001 3 1/1/2017 L 3.8 Yantono 2103110401841003 2 2 14.0 89.0
Fathrul

Muhammad Abib
30 2 16/12/2016 L 3.6 Riki Ahmad 9.8 85.0
Pratama
 Bujang
31 2103111602090014 2103110901170001 3 Muhammad Faisal 1/9/2017 L 3.0 2103110811731002 1 2 16.0 94.0
Tarmizi

32 2103111406160001 2103115702170005 1 Zila Zahera Safitri 17/02/2017 P 3.0 Zulfahri 1404091009900002 2 1 12.7 87.5

33 2103112001100001 3 Aprilia 4/11/2017 P 2.9 Ari Kusmiran 2103110110890002 1 1 10.4 83.5

Geubrina Salsabila
34 2103110604090001 2103114906170001 3 Ramadani 6/9/2017 P 3.0 Andry 2103110808840001 1 1 11.0 82.5

35 2103112306160001 2103115805170001 2 Rania Humai Rahayu 18/05/2017 P 3.8 Jumarin 2103060707900000 2 1 10.8 86.3

Muhammad Azka
36 2103112004090005 2103112307170001 3 23/07/2017 L 3.0 Supardi 2103110204820001 2 1 9.9 82.0
Saputra

37 2103112810080009 2103116507170001 3 Selfiyona Isma 25/07/2017 P 2.7 Dedi Yanto 2103110801860001 1 2 9.7 82.0

38 2103110504120001 2103112908170001 2 Agesti Saputra 29/08/2017 L 2.8 Marianto 2103082609790001 1 2 9.8 80.6

39 2103112011150001 2103116808170001 2 Balqis Ulfa Salsabila 28/08/2017 P 3.1 Suprianto 2103111403791003 1 1 10.0 80.2

40 2103111207170001 2103115809170001 1 Fitri Nazifa Wilri 18/09/2017 P 3.0 Luthpi 2103111712870001 9.1 78.0

Raditia Damar
41 2103112910080024 2103111610170001 4 16/09/2017 L 3.3 Alip 2103110403811002 1 1 10.0 81.0
Saurangga
42 2103113110080005 2103112010170001 3 Aril Okta Ardiansyah 20/10/2017 L 3.2 Pardi 2103110503760001 1 1 11.7 80.0

43 1 Ahmad Farhan 23/11/2017 L 12.8 82.4

Najwan Nur Rifatul

44 2103111904110001 2103111911170001 2 19/11/2017 L 3.0 Wahyudi 2103111608840002 2 2
Dzikri

45 2103113110080003 2103115503180001 3 Habibah Marleni 15/03/2018 P 3.0 Asir 2103112303830001 1 2 7.5 73.0

Meyra Nadhira
46 2103112504180001 2103114305180001 1 3/5/2018 P 3.0 Sofri Darma 2103110811911002 1 2 8.0 77.0
Zulaikha

Nuraini Azizah
47 1 9/10/2018 P 3.2 Hakim 8.6 70.0
Hakim

48 2 Nur Husna 4/2/2019 P 2.5 Pipit Triyatul 6.8 57.7

44 NUMPANG KK Tg. Batang 1 Aysha Izatumisa 29/12/2016 P 3.0 Zuldi 12.7 85.5

49 NUMPANG NUMPANG 1 Assifa Nur Afika 8/5/2016 P 3.7 Supardi

TUMBUHAN BALITA DI POSYANDU

Cara ASI IMD

Ukur Eksklu Kepemil
1=Telent sifF1= ikan Umur
1=YA, Buku Nama IBU
ang YA, 2=Tida
2=Berdir 2=Tid KIA
i k
ak

(15) (16) (17) (18) (19) (20)

2 2 1 1 59 Yang Iti

2 2 1 1 59 Emawati

2 2 1 1 59 Ema Sumatri

2 2 1 1 58 Milah

2 2 1 1 56 Idam

2 2 1 1 56 Reni Martina

2 2 1 1 56 Yesi
2 2 1 1 54 Mekrahayu

2 2 2 1 54 Anita

2 2 2 1 52 Titik Tiranti

1 49 Neti

2 2 1 1 47 Ema

2 2 1 1 46 Sarika

2 2 1 1 45 Desti

2 2 1 1 45 Lila

2 2 1 1 44 Khairunisak

2 2 1 1 44 Julia

2 2 1 1 40 Aisyah
2 2 2 1 39 Titik Tiranti

2 2 1 1 38 Hendriyani

2 2 1 1 38 Tri

2 2 1 1 36 Maizah

2 2 1 1 36 Wahidah

2 1 1 1 36 Hastuti

2 2 1 1 35 Wardah

2 2 1 1 33 Milah

2 2 1 1 34 Adraleni

2 2 2 1 30 Nur Hasiah

2 1 30 Wan Nopi
2 2 1 1 30 Sudarmi

2 2 1 1 28 Santi Sartika

2 2 1 1 27 Tiyamah

1 2 1 1 25 Rita

1 1 1 1 25 Mekarahayu

1 2 2 1 23 Hasanah

1 2 1 1 23 Sakdiah

1 2 1 1 22 Darlina

1 2 1 1 22 Monalisa

1 1 1 1 21 Tri Fitriana

1 2 1 1 21 Ernita
1 2 1 1 20 Harlina

1 19 Linda

1 1 1 1 19 Rupi Junita

1 2 1 1 15 Milah

1 2 1 1 16 Riawati

Nur Putri
1 2 1 1 10 Hendriana

1 2 1 1 3 Henny

2 2 1 1 30 Rupiara

2 1 Yessi
 FORMULIR PEMANTAUAN PERTUMBUHAN BALITA DI POSYANDU

Provinsi : Kepulauan Riau Nama Posyandu : Nusa Indah II

Kabupaten/Kota : Natuna Tanggal : 12 juli 2019
Puskesmas/Kecamatan : Pulau Tiga Tahun : 2019
Desa/Kelurahan : Teluk Labuh

Berat
Badan
NIK (Nomor Induk Anak Nama Ortu
No No Kartu Keluarga Nama anak Tanggal Lahir JK (BB) NIK Ayah RT
Kependudukan) Ke (Ayah)
Lahir
(Kg)

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11)

1 2103110305080001 2103112210140002 2 Alan Juranka 22/10/2014 L 3.2 Baharullazi 2103110701730001 2

2 2103110205080001 2103112612140001 3 Muslim 25/12/2014 L 1.0 Saptono 2103111208760001 2

3 2103113004080009 2103110701150001 2 Rioni Mauliadi 1/7/2015 L 3.0 Dini Sufiadi 2103112312830001 2

4 2103111804080005 2103115501150001 2 Yesa Ameliya 15/01/2015 P 4.6 Edi Susanto 2103110604861004 1

Daeng Muhammad
5 2103113004080006 2103110503150001 3 5/3/2015 L 4.0 Daeng Sunari 2103110703790002 2
Riski

6 2103111806150002 2103115404150001 1 Putri Aurellia 14/4/2015 P 2.5 Edi Kusman 2103110810860001 2

 Abraham Alexa
7 3 7/11/2015 L 4.0 Alpiyan
Pratama

8 2103092104080021 2103095307150001 3 Aisha Ramadani 13/07/2015 P 3.0 Awian 2103090108840001 2

9 2103112803160001 2103052509150001 1 Muhammad Al-Fajri 25/09/2015 L 3.0 Sirojudin 2103112309931002 1

10 2102112104080009 2103114911150001 3 Raysa Akira Wilda 11/9/2015 P 4.0 Abd Hadi 2103110108800001 2

11 2103112104080019 2103111411150001 3 Ilham Kholid 14/11/2015 L 3.0 Eriyanto 2103111209800001 2

12 2103110305080002 2103112912150001 4 Ikhfa Sapawi 29/12/2015 L 2.9 Murjana 2103112604710001 1

13 2103111806150001 2103111002160001 1 Ilham Wirawan 2/10/2016 L 3.0 Erwanto 2103111007920001 1

14 2103112411100001 2103115202160002 2 Regina Bahar 2/12/2016 P 2.8 Baharuddin 2103110102871002 1

15 2103111606090001 3 Olivia Veronika 28/02/2016 P 5.2 Sahroni 2103110602841002 2

Reko
17 2103112904080005 2103112605160001 3 Fikri Saputra 26/05/2016 L 4.1 2103111009771002 2
Martadian

18 2103052211160002 2103112103000001 2 Faris Al-Rifky 1/3/2017 L 3.0 Muslimin 6101070107870001 2

20 2103111604130001 2103115302170001 2 Farsa Alora Devi 13/02/2017 P 3.5 Sudarwin 2103110602930001 1

21 2 Rendy Ramdani 28/05/2017 L 3.5 Sabilah 1

22 2103112605150001 2103110810170001 1 Nouval Egi Oktareza 8/10/2017 L 2.5 Usman 2103110506911003 1

23 2103112104080031 5 Aulia Az-zahra 26/12/2017 P 2.5 Sudirman 2103111212701002 1

26 4 Leviana Qaila 8/10/2018 P 2.7 B. Eli

27 2 Anggita Novelia 11/2/2018 P 3.0 Iwan Gunawan 2

28 2103111606090001 5 Raka Ardiansyah 14/02/2019 L 5.1 Sahroni 2103110602841002 2

DI POSYANDU

ASI IMD
Cara Eksklus Kepemi
PB/TB Ukur ifF1=YA
BB likan Umur
RW (kg) Bulan 1=Telent 1=YA, Buku Nama IBU
,
ini ang 2=Tida KIA
2=Berdiri 2=Tida k
k

(12) (14) (15) (17) (18) (19) (20) (21) (22)

2 13.1 99.7 2 2 2 1 56 Anaya

1 11.0 96.0 2 2 1 1 54 Jumiyati PMT

2 2 2 2 1 54 Yeni Yati

1 13.0 97.2 2 2 2 1 53 Yenti

2 15.7 102.5 2 2 1 1 50 Sukarina

2 13.2 99.5 2 2 2 1 50 Meryanti S

 13.5 97.3 2 2 2 1 48 Artati

1 11.0 94.1 2 2 2 1 47 Sumiati PMT

2 11.6 92.8 2 2 2 1 45 Wilmi

1 14.1 94.1 2 2 2 1 44 Yeyet

2 12.0 91.0 2 2 2 1 43 Zainab

2 17.4 95.0 2 2 2 1 42 Aminah

2 10.9 91.0 2 2 2 1 41 Evi PMT

2 17.2 98.0 2 2 2 1 41 Sartika

2 14.4 93.0 2 2 1 1 40 Eka Romi

1 14.8 95.9 2 2 2 1 37 Ernida

1 12.8 91.0 2 2 1 1 30 Marleni

2 8.3 77.8 2 2 2 1 28 Merawati PMT

2 11.4 87.0 1 2 2 1 25 Sunarti

2 10.7 83.3 1 2 2 1 23 Herawarti

1 9.1 78.0 1 2 2 1 18 Darmala

8.5 70.0 1 2 1 1 11 Hatijah

1 7.2 67.5 1 2 1 1 8 Masitah

2 6.4 66.0 1 2 1 1 4 Eka Romi

 FORMULIR PEMANTAUAN PERTUMBUHAN BALITA DI POSYANDU

Provinsi : Kepulauan Riau Nama Posyandu : Nusa Indah I

Kabupaten/Kota : Natuna Tanggal : 13 JULI 2019
Puskesmas/Kecamatan : Pulau Tiga Tahun : 2019
Desa/Kelurahan : Sededap

Berat
Badan
No Kartu Keluarga NIK (Nomor Induk Ana Tanggal Nama Ortu BB
No Kependudukan)
Nama anak JK (BB) NIK Ayah RT RW
k Ke Lahir (Ayah) (kg)
Lahir
(Kg)

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13)

Azkia Sauma
1 2103110111060100 2103114108140000 2 8/1/2014 P 4.0 Sawaludin 2103111212811001 1 1 17.1
Saufa

SY. Syahrina
2 2103111812140001 2103114101150001 1 1/1/2015 P 3.0 Said Syahrizal 2103062606941002 1 1 14.5
Maulida

3 2103111404150001 2103116003150001 3 Kania Aliya 20/03/2015 P 2.5 Riadi 2 1 11.8

Marizkilla
4 2103110506080010 2103115604150001 3 16/04/2015 P 3.5 Muslim 2103112701771002 2 2 13.0
Pionona

Khairussabil
5 2103110704080002 2103112305150001 4 23/05/2015 L 3.2 Ustariadi 2103111207791002 1 1 14.0
Mu`azzam

6 21031117060800010 _ 1 Bela Patmawati 27/06/2015 P 3.7 Wahyudi _ 2 1 12.1

Wan
7 2103111205090000 2103112806150000 2 Wan Akbar Dilah 28/06/2015 L 3.0 2103110701901002 1 2
Burhanudin
8 2103111506080000 4 Alika Naila 29/08/2015 P 3.0 Agus Tabrani 2103112512751002 1 2 13.5

9 2 Al-Furqon 9/12/2015 L 3.0 Junaid 14.1

10 2103113103080000 2103110911150001 3 Refan Al-Rizki 11/9/2015 L 4.0 Auzar 2103112105761003 2 2 13.8

Bambang
11 1 Ardian Saputra 23/12/2015 L 2.4 2103111403941002 1 1 11.5
Saputra

12 2103110901170000 2103115512150001 1 Desti Nurjannah 15/12/2015 P 2.8 Ali 2103070602850003 2 2

Ahmad Albab
13 1 2/6/2016 L 3.0
Amati

14 2103071205160000 2103072002160001 1 Febri Al Farisi 2/20/2016 L 3.0 Dani 2103112108981002 10.7

15 2103110108170000 2103115106160000 Putri Aqila 6/11/2016 P 3.0 2103115907920001 10.2

Naifa Ghania
16 2103110704140000 2 22/05/2016 P 2.8 Abdul Razak 2103041805831003 2 2 15.1
Akila

17 2 Azril 28/06/2016 L 2.8 Sulaiman 13.2

18 2103112811130000 1 Zahira Almaira 23/09/2016 P 2.8 Rozali 2103110201830001 2 1 13.0

19 2103112811130000 1 Zahiya Kamila 23/09/2016 P 3.0 Rozali 2103110201830001 2 1 13.2

20 2103112305080010 2103115910160001 4 Nurmalisa 19/10/2016 P 3.0 Hermiyanto 2103112709801002 2 2 11.0

21 2103110505080000 2103116910160001 4 Saidatunnafisa 29/10/2016 P 3.1 Abu Bakar 2103111006701002 1 2

22 2103111206080000 3 Ovalia 27/1/2017 P 3.2 Anuar 2103110602711000 2 1 11.4

23 2103110407080000 3 Farhan Arsenio 25/03/2017 L 3.0 Farizal 2103111212820001 1 1 12.1

Madinatun
24 2103111006080000 5 5/2/2017 P 3.0 Muhammad 2103112402740000 2 1 9.5
Munawaroh

25 1 Aqwal Arrabifatir 26/06/2017 L 2.3 Robi Agusti 12.2

26 2103112305080010 5 Raniatul Jannah 29/11/2017 P 3.2 Hermiyanto 2103112709801002 2 2 8.7

27 1 Khairol Akmal 26/11/2017 L 2.6 Agus Salim 1 2 12.9

Dian
28 4 2/6/2018 L 3.0 Halim 14.0
Febriansyah

Muhammad Muhammad
29 2103111101110000 2 4/3/2018 L 2.7 2103110203890001 2 2 12.9
Rafael Al-Fatih Arifin

Rahmad
30 210311090117001 2 24/05/2018 L 2.9 Ali 2103112701771002 2 2
Mauliadi
31 5 Ar-Rasyid 28/07/2018 L 3.9 Khairuz Zaid 2 2

Maizarifah Al-
32 3 27/09/2018 P 2.8 Haliza 1 2 8.0
Hanum

33 4 Jatiya Al-Waqiya 30/01/2019 P 3.4 Abdur Rauf 6.2

34 2103110506080010 4 Muhanamar 4/12/2019 L 3.4 Muslim 2103112701771002 7.6

BALITA DI POSYANDU

Cara ASI
IMD
Ukur Eksklu Kepem
PB/TB
1=Tele sif ilikan
Bulan 1=YA, Umur Nama IBU
ntang 1=YA, Buku
Ini 2=Tida
2=Berd 2=Tida KIA
k
iri k

(14) (15) (16) (17) (18) (19) (20)

103.6 2 2 1 1 59 Habibah

99.0 2 2 1 1 54 Erna

94.5 2 2 2 1 51 Sahara

91.3 2 2 1 1 50 Kamariah

98.4 2 1 1 1 49 Siti Baro`ah

93.7 2 2 2 1 48 Hasmawati

2 2 2 1 48 Indyanty
92.6 2 2 1 1 46 Zaitun

92.0 2 2 1 1 46 Alea

100.9 2 2 2 1 44 Asnawati

87.3 2 2 1 1 42 Yarnita

2 2 2 1 42 Mayatul Umroh

2 2 1 1 41 Desi Kumala Sari

83.5 2 2 1 1 40 Novi

85.5 1 37 Sakdiah

96.4 2 2 2 1 37 Sumiati

81.5 2 2 1 1 36 Rahmah

89.4 2 2 2 1 33 Rohmi

89.3 2 2 2 1 33 Rohmi
83.3 2 2 2 1 32 Fatimah

32 Halimatussakdia
2 2 2 1
h

84.0 2 2 1 1 29 Muntiara

82.0 2 2 1 1 27 Rati Halijah

80.0 2 2 2 1 26 Anisah

85.0 1 2 2 1 24 Popi Istari

77.0 1 2 1 1 19 Fatimah

80.0 1 2 1 1 19 Betti

84.0 1 2 1 1 17 Azma

80.4 1 2 2 1 15 Zila Wati

13 Mayatul
1 2 1 1
Munaaroh
 1 1 1 1 11 Rita Rusmiati

71.0 1 2 1 1 9 Masyitah

66.5 1 1 1 1 5 Siti Aisah

61.0 1 2 1 1 3 Kamariah
 FORMULIR PEMANTAUAN PERTUMBUHAN BALITA DI POSYANDU

Provinsi : Kepulauan Riau Nama Posyandu : Anggrek

Kabupaten/Kota : Natuna Tanggal : 15 JULI 2019
Puskesmas/Kecamatan : Pulau Tiga Tahun : 2019
Desa/Kelurahan : Serantas

Berat
Jenis Badan
NIK (Nomor Induk Anak Nama Ortu
No No Kartu Keluarga Nama anak Tanggal Lahir Kela (BB) NIK Ayah RT RW BB (kg)
Kependudukan) Ke (Ayah)
min Lahir

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13)

1 2103112005110001 2103115507140001 2 Safitri 3.0 Amiruddin 2103112611850001 1 1 16.1

25/07/2014 P
Ramadhani

2 2103112411090001 2103112107140001 2 Muhammad 3.0 Zulkifli 2103110602790001 1 2 13.5

21/07/2014 L
Abdu Ramadhan

3 2103110111100001 2103112609140001 2 Ahmad Doni 26/09/2014 L 3.0 Azwan 2103111006871002 1 2 14.2

4 2103110802110003 2103115411140001 2 Novia Maria Ulfa 14/11/2014 P 3.0 Nasrun 2103110206851002 1 2 14.6

5 2103111602150001 2103110401150001 1 Said Danis Al- 3.1 Said Ahmadi 2103180109930001 1 1 16.1
04/01/2015 L
fajri
6 2 Bilqis 14/2/2015 P 3.0 Hasbillah 14.3

7 2103110805090007 2103112805150001 2 Al-Furkon 28/05/2015 L 3.2 Firamli 2103110906850001 1 2 12.6

8 2103111702090011 2103116609150001 2 Mahmudatul 3.0 Dedi Aulia 2103110303860001 2 1 13.3

26/09/2015 P
Hubbi Aulia

9 2103112204160001 2103111901160001 1 Fadilah 19/01/2016 L 3.2 Dediyanto 2103082907860001 3 2 13.5

10 2103110302160001 2103115202160001 1 Kanaya Salsabila 12/02/2016 P 2.8 Hasbillah 2103111301851004 1 1 14.4

11 2 Asifa Azahra 02/03/2016 P 3.0 Rohimi 12.8

12 2103112704100006 2103115802160001 4 Sahida Alwafa 18/02/2016 P 2.8 Ibrahim 2103111010700003 3 2 14.8

Diva Anugrah Muhammad

13 2103111910170003 2103116307160001 2 23/07/2016 P 3.1 2103112904830001 2 1 11.1
Putri Toib
 Azril Rahandika
14 2103110604190000 2103112108160000 1 21/08/2016 L 4.5 Haridan 2103110707640000 14.1
Alfariq

15 2103110306080019 2103110211160001 3 Muhammad 3.5 Zuridan 2103112507720001 1 2 11.3

02/11/2016 L
Kholqi

16 2103111801090001 2103111811160001 3 Ghozali Musanif 18/11/2016 L 2.9 Bahari 2103111208740000 1 1 12.6

17 2103110706080023 _ 3 Muhammad 4.2 Arman 2103110712700001 1 1 10.5

27/03/2017 L
Marsel

Muhammad
18 2103110304120000 2103110004170000 2 Fatih Al Rasyid 3 Marsha 2103073005860000 2 1 10.5
02/04/2017 L
Permana Permana

19 2103112005110001 3 Asad Humam 10/05/2017 L 3.0 Amiruddin 2103112611850001 1 1 11.9

20 2103113107180001 2103115006170001 2 Syahira Naipa 2.8 Pirdaus 2103050403890002 3 2 11.2

10/06/2017 P
Fadella

21 2103112905080005 2103112406170001 6 Muhammad Aidil 3.0 Tarli 2103110510680001 1 2 11.4

24/06/2017 L
Fitrah
22 2103110910170001 2103116009170001 1 Naura Azkia Putri 20/09/2017 P 3.0 Hardianto 2103110501890001 3 2 10.3

23 2103110803100001 2103116610170001 3 Nur Assyifa 2.8 Abdul Halim 2172041212800003 1 2 9.6

26/10/2017 P
Octaviany

Delviana
24 2103051807130001 2103054111170001 2 Khairunnisa 01/11/2017 P 3.4 Khoirol 2103110712791002 1 1 10.5
Khairi

25 2103110604090004 2103114211170001 4 Lunifa 4.0 Mustafaruddin 2103111201720001 2 1 9.5

3/11/2017 P
Qotrunnada

26 2103110302160001 2103114101180001 2 Qila Misha 3 Hasbillah 2103111301851004 1 1 8.6

01/01/2018 P
Safana

27 2103111602150001 2 Syarifah Nauwal 2.8 Said Ahmadi 2103180109930001 1 1 9.3

01/03/2018 P
Husna

28 2103113007120001 2 Famela Larasati 31/03/3018 P 2.8 Supryanto 2103111012880001 3 2 7.7

29 1 Muhammad 3.0 Anggi Maulana

22/04/2018 L
Hafiz
30 2103112005110001 - 4 Muhammad Azra 10/06/2018 L 2.7 Amiruddin 2103112611850001 1 1 8.8

31 2103113101170001 2103115807180001 1 Alesha Zahra 18/07/2018 P 2.8 Gustiawarman 2103112208091002 1 2 8.0

32 2103111207180000 2103114610180000 1 Najwa Al Mariyanti 06/10/2018 P 3 Hanafi 2103112203910000 1 1 6.7

33 2103112202190000 2103114210180000 1 Annisa Hidayati 02/10/2018 P 3 Juan Danil 2103110405951000 7.2

Muhammad
34 2103112411090001 3 Salahudin Al- 20/10/2018 L 2.8 Zulkifli 2103110602790001 1 2 8
Ayubi

35 2103110612110001 2103115101190001 2 Naina Mikayla 1/11/2019 P 3 Sahidan 2103111005751005 1 1 61

HAN BALITA DI POSYANDU

Cara
Ukur ASI Kepemil
PB/TB 1=Telen Eksklusif IMD ikan Umur
1=YA, Buku Nama Ibu
(cm) tang 1=YA 2=Tidak
2=Berdi 2=Tidak KIA
ri

(15) (16) (17) (18) (19) (20) (21)

103.0 2 2 2 1 Pipi Zuriana

99.0 2 1 1 1 Yuliana Emy

99.0 2 2 1 1 Juni

98.6 2 2 1 1 Siti Rokiah

100.0 2 2 2 1 Sy. Marsaidah

96.6 2 2 1 2 Nursia

91.0 2 1 1 1 PMT

93.0 2 2 1 1 PMT

95 2 1 2 1 Fitri

Wan Eni
92 2 2 2 1 Safitri

91.7 2 2 2 1 Urwani

92.1 2 2 1 1 PMT

89.0 2 1 1 1 Rasi Elmi

92.0 2 2 1 1 Kamsiah

88.0 2 2 1 1 Nordiana

88.0 2 2 1 1 Jumaidah

84 2 2 2 1 Jumarni

81.8 2 2 2 1 PMT

85.4 2 2 2 1 Pipi Zuriana

85.0 1 2 1 1 Nani

84.0 1 2 1 1 Reda
74.0 1 2 1 1 Tika

Zayanti Maya
80.0 1 1 1 1 Sari

80.0 1 1 1 1 Dewi

73.0 1 1 1 1 Susanti

Wan Eni
76 1 2 2 1 Safitri

76.0 1 2 2 1 Sy. Marsaidah

74.0 1 2 1 1 Hapita

1 2 1 1
76.0 2 1 2 1 Pipi Zuriana

71.0 1 2 1 1 Mila Sari

68 1 2 2 1 Renny

69 1 1 1 1 Wahyuni

7.1 1 1 2 1 Yuliana Emy

64 1 2 1 1 Asnawati
 FORMULIR PEMANTAUAN PERTUMBUHAN BALITA DI POSYANDU

Provinsi : Kepulauan Riau Nama Posyandu : Melur

Kabupaten/Kota : Natuna Tanggal : 16 JULI 2019
Puskesmas/Kecamatan : Pulau Tiga Tahun : 2019
Desa/Kelurahan : Serantas

Berat
Jenis
NIK (Nomor Induk Anak Badan Nama Ortu (Ayah)
No No Kartu Keluarga Nama anak Tanggal Lahir Kela NIK Ayah RT RW
Kependudukan) Ke (BB)
min Lahir

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12)

1 2103111107090001 2103115808140001 3 Nurjanah 18/08/2014 P 3.0 Murad 2103110406751001 1 2

2 2103111411130001 2103113009140001 1 Aqil Ulwan Saputra 30/09/2014 L 3.5 Burhanuddin 2103110304920001 1 2

3 2103111602090002 2103114910150001 2 Veren Gracella 09/10/2015 P 3.0 Jusiang 2103113105820001 1 1

Muhammad Al-
4 2103111802090001 2103110209160001 5 02/09/2016 L 3.4 Anuar 2103111705810001 1 2
Rasyid

5 2103111006080009 _ 3 Al-Furqon 03/01/2017 L 3.2 Mukorhobin 2103112411740001 1 1

6 2103111608170001 2103115302170002 1 Tantri 13/02/2017 P 2.5 Daumar 2103112905870001 1 2

7 2103111910170001 2103118605170001 1 Selvia Ramadan 26/05/2017 P 3.2 Rusli Abidin 2103111603871002 1 1

8 2103112010170001 2103114212170001 3 Nuraiani 02/12/2017 P 3.2 Hamdan 2103110507910001 1 2

9 2103111909140001 _ 2 Ilham 11/04/2018 L 3.1 Sarip 2103072008770001 2 1

10 1 Al-Adwa 29/04/2018 L 3.2 Sawal

Muhammad
11 2103110110120004 2103110307180001 2 Muhammad Fahri 03/07/2018 L 2.5 2103113011900001 2 1
Zuhdi

Muhammad
12 2103110210160001 _ 2 Muhammad Devan 15/08/2018 L 2.7 2103114101881003 1 1
Maknur

13 1 Agela Kazia 11/09/2018 P 3.0 Asbudi

14 2103112010170001 2103114212170001 4 Nuraina 3/14/2019 P 3.5 Hamdan 2103110507910001 1 2

15 1 Safiki Arbani 4/16/2019 P 3.1 Sarif

16 2103115102140001 3 M Azka Al-Qarni 6/14/2019 L 3.4 Muhammad Umar 2103111905900001 1 1

ALITA DI POSYANDU

ASI IMD
Cara Ukur Eksklus Kepemi
PB/TB 1=Telenta if likan UMU
BB (kg) bulan 1=YA, Buku Nama Ibu
ng 1=YA, R
ini 2=Berdiri 2=Tida 2=Tida KIA
k
k

(13) (14) (15) (16) (17) (18) (19) (20)

14.6 102.9 2 2 1 1 Farida

12.7 99.0 2 1 2 1 Yuliana

16 94.8 2 2 1 1 Juriah

10.7 87.0 2 2 1 1 Jumiah

12.5 92.0 2 1 1 1 Latifah

9.0 79.7 1 2 1 1 Halimah

9.7 83.0 1 2 2 1 Misna

9.5 80.0 1 2 2 1 Fatimah

9.5 79.0 1 1 1 1 Darti

2 1 1 Kiki Desika

8.9 75 1 1 1 1
R. Zaratul
Nung Aini

9.0 69.5 1 2 2 1 Ajumawati

7.5 71.0 1 2 1 1 Rasmi

8.1 63 1 2 2 1 Fatimah

5.9 58.1 1 2 1 1 Mega Baru

5.0 63.0 1 1 1 1 Nuni Baru

 FORMULIR PEMANTAUAN PERTUMBUHAN BALITA DI POSYANDU

Provinsi : Kepulauan Riau Nama Posyandu : Anggrek Dan Melur

Kabupaten/Kota : Natuna Tanggal : 15 & 16 Juli 2019
Puskesmas/Kecamatan : Pulau Tiga Tahun : 2019
Desa/Kelurahan : Serantas

Berat
Jenis
NIK (Nomor Induk Anak Badan Nama Ortu
No No Kartu Keluarga Nama anak Tanggal Lahir Kela NIK Ayah RT
Kependudukan) Ke (BB) (Ayah)
min Lahir

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (13)

1 2103112005110001 2103115507140001 2 Safitri Ramadhani 25/07/2014 P 3.0 Amiruddin 2103112611850001 1

Muhammad Abdu
2 2103112411090001 2103112107140001 2 21/07/2014 L 3.0 Zulkifli 2103110602790001 1
Ramadhan

3 2103111107090001 2103115808140001 3 Nurjanah 18/08/2014 P 3.0 Murad 2103110406751001 1

4 2103110111100001 2103112609140001 2 Ahmad Doni 26/09/2014 L 3.0 Azwan 2103111006871002 1

5 2103111411130001 2103113009140001 1 Aqil Ulwan Saputra 30/09/2014 L 3.5 Burhanuddin 2103110304920001 1

6 2103110802110003 2103115411140001 2 Novia Maria Ulfa 14/11/2014 P 3.0 Nasrun 2103110206851002 1

7 2103111602150001 2103110401150001 1 Said Danis Al-fajri 04/01/2015 L 3.1 Said Ahmadi 2103180109930001 1

8 2 Bilqis 14/2/2015 P 3.0 Hasbillah

9 2103110805090007 2103112805150001 2 Al-Furkon 28/05/2015 L 3.2 Firamli 2103110906850001 1

Mahmudatul Hubbi 26/09/2015

10 2103111702090011 2103116609150001 2 P 3.0 Dedi Aulia 2103110303860001 2
Aulia

11 2103111602090002 2103114910150001 2 Veren Gracella 09/10/2015 P 3.0 Jusiang 2103113105820001 1

12 2103112204160001 2103111901160001 1 Fadilah 19/01/2016 L 3.2 Dediyanto 2103082907860001 3

13 2103110302160001 2103115202160001 1 Kanaya Salsabila 12/02/2016 P 2.8 Hasbillah 2103111301851004 1

14 2 Asifa Azahra 02/03/2016 P 3.0 Rohimi

15 2103112704100006 2103115802160001 4 Sahida Alwafa 18/02/2016 P 2.8 Ibrahim 2103111010700003 3

16 2103111910170003 2103116307160001 2 Diva Anugrah Putri 23/07/2016 P 3.1 Muhammad Toib 2103112904830001 2

Azril Rahandika
17 2103110604190000 2103112108160000 1 21/08/2016 L 4.5 Haridan 2103110707640000 1
Alfariq

Muhammad Al-
18 2103111802090001 2103110209160001 5 02/09/2016 L 3.4 Anuar 2103111705810001 1
Rasyid

19 2103110306080019 2103110211160001 3 Muhammad Kholqi 02/11/2016 L 3.5 Zuridan 2103112507720001 1

20 2103111801090000 2103111811160000 1 Gozali Musarif 18/11/2016 L 2.9 Bahari 2103111208740000 1

21 2103111006080009 _ 3 Al-Furqon 03/01/2017 L 3.2 Mukorhobin 2103112411740001 1

22 2103111608170001 2103115302170002 1 Tantri 13/02/2017 P 2.5 Daumar 2103112905870001 1

23 2103110706080023 _ 3 Muhammad Marsel 27/03/2017 L 4.2 Arman 2103110712700001 1

Fatih Al Rasyid Muhammad

24 2103110304120000 2103110004170000 2 L 3 Marsha Permana 2103073005860000
02/04/2017 2
Permana

25 2103112005110001 3 Asad Humam 10/05/2017 L 3.0 Amiruddin 2103112611850001 1

26 2103111910170001 2103118605170001 1 Selvia Ramadan 26/05/2017 P 3.2 Rusli Abidin 2103111603871002 1

27 2103113107180001 2103115006170001 2 Syahira Naipa Fadella 10/06/2017 P 2.8 Pirdaus 2103050403890002 3

Muhammad Aidil
28 2103112905080005 2103112406170001 6 Fitrah 24/06/2017 L 3.0 Tarli 2103110510680001 1

29 2103110910170001 2103116009170001 1 Naura Azkia Putri 20/09/2017 P 3.0 Hardianto 2103110501890001 3

30 2103110803100001 2103116610170001 3 Nur Assyifa Octaviany 26/10/2017 P 2.8 Abdul Halim 2172041212800003 1

Delviana Khairunnisa
31 2103051807130001 2103054111170001 2 Khairi 01/11/2017 P 3.4 Khoirol 2103110712791002 1

32 2103110604090004 2103114211170001 4 Lunifa Qotrunnada 11/3/2017 P 4.0 Mustafaruddin 2103111201720001 2

33 2103112010170001 2103114212170001 3 Nuraini 02/12/2017 P 3.2 Hamdan 2103110507910001 1

34 2103110302160001 2103114101180001 2 Qila Misha Safana 01/01/2018 P 3 Hasbillah 2103111301851004 1

35 2103111602150001 2 Syarifah Nauwal Husna 01/03/2018 P 2.8 Said Ahmadi 2103180109930001 1

36 2103113007120001 2 Famela Larasati 31/03/2018 P 2.8 Supryanto 2103111012880001 3

37 2103111909140001 _ 2 Setia Ilham 11/04/2018 L 3.1 Sarip 2103072008770001 2

38 1 Muhammad Hafiz 22/04/2018 L 3.0 Anggi Maulana

39 1 Al-Adwa 29/04/2018 L 3.2 Sawal

40 2103112005110001 _ 4 Muhammad Azra 10/06/2018 L 2.7 Amiruddin 2103112611850001 1

Muhammad
41 2103110110120004 2103110307180001 2 Muhammad Fahri 03/07/2018 L 2.5 Zuhdi 2103113011900001 2

42 2103113101170001 2103115807180001 1 Alesha Zahra 18/07/2018 P 2.8 Gustiawarman 2103112208091002 1

Muhammad
43 2103110210160001 _ 2 Muhammad Devan 15/08/2018 L 2.7 Maknur 2103114101881003 1

44 1 Agela Kazia 11/09/2018 P 3.0 Asbudi

45 2103111207180000 2103114610180000 1 Najwa Al Mariyanti 06/10/2018 P 3 Hanafi 2103112203910000 1

46 2103112202190000 2103114210180000 1 Annisa Hidayati 02/10/2018 P 3 Juan Danil 2103110405951000

Muhammad Salahudin 20/10/2018

47 2103112411090001 - 3 Al-Ayubi L 2.8 Zulkifli 2103110602790001 1

48 2103110612110001 2103115101190001 2 Naina Mikayla 1/11/2019 P 3 Sahidan 2103111005751005 1

49 2103112010170001 2103114212170001 4 Nuraina 3/14/2019 P 3.5 Hamdan 2103110507910001 1

50 1 Safiki Arbani 4/16/2019 P 3.1 Sarif

Muhammad
51 2103115102140001 3 M Azka Al-Qarni 6/14/2019 L 3.4 2103111905900001 1
Umar
TA DI POSYANDU

Cara Ukur ASI IMD Kepemi

1=Telenta Eksklusif 1=YA, likan
RW BB (kg) PB/TB ng 1=YA, 2=Tidak Buku Umur Nama Ibu posy
2=Berdiri 2=Tidak KIA

(14) (16) (17) (18) (19) (20) (23) (24)

1 16.1 103.0 2 2 2 1 59 Pipi Zuriana

anggrek

2 13.5 99.0 2 1 1 1 59 Yuliana Emy

anggrek

2 14.6 102.9 2 2 1 1 58 Farida

melur

2 14.2 99.0 2 2 1 1 57 Juni

anggrek

2 12.7 99.0 2 1 2 1 57 Yuliana

melur
2 14.6 98.6 2 2 1 1 56 Siti Rokiah

anggrek

1 16.1 100.0 2 2 2 1 54 Sy. Marsaidah

anggrek

14.3 96.6 2 2 1 2 53 Nursia

anggrek

2 12.6 91.0 2 1 1 1 49 Rohimah

anggrek

1 13.3 93.0 2 2 1 1 45 Erma

anggrek

1 16 94.8 2 2 1 1 45 Juriah

melur

2 13.5 95 2 1 2 1 41 Fitri

anggrek

1 14.4 92 2 2 2 1 41 Wan Eni Safitri

anggrek
 12.8 91.7 2 2 2 1 40 Urwani

anggrek

2 14.8 92.1 2 2 1 1 40 Yuliana

anggrek

1 11.1 89.0 2 1 1 1 35 Rasi Elmi

anggrek

1 14.1 92.0 2 2 1 1 34 Kamsiah

anggrek

2 10.7 87.0 2 2 1 1 34 Jumiah

melur

2 11.3 88.0 2 2 1 1 32 Nordiana

anggrek

1 12.6 88.0 2 2 1 1 31 Jumaidah

anggrek

1 12.5 92.0 2 1 1 1 30 Latifah

melur
2 9.0 79.7 1 2 1 1 29 Halimah

melur

1 10.5 84 1 2 2 1 27 Jumarni

anggrek

1 10.5 81.8 1 2 2 1 27 Munawaroh

anggrek

1 11.9 85.4 2 2 2 1 26 Pipi Zuriana

anggrek

1 9.7 83.0 1 2 2 1 25 Misna

melur

2 11.2 85.0 1 2 1 1 25 Nani

anggrek

2 11.4 84.0 1 2 1 1 24 Reda

anggrek

2 10.3 74.0 1 2 1 1 21 Tika

anggrek
2 9.6 80.0 1 1 1 1 20 Zayanti Maya Sari
anggrek

1 10.5 80.0 1 1 1 1 20 Dewi

anggrek

1 9.5 73.0 1 1 1 1 20 Susanti

anggrek

2 9.5 80.0 1 2 2 1 19 Patinah

melur

1 8.6 76 1 2 2 1 18 Wan Eni Safitri

anggrek

1 9.3 76.0 1 2 2 1 16 Sy. Marsaidah

anggrek

2 7.7 74.0 1 2 1 1 15 Hapita

anggrek

1 9.5 79.0 1 1 1 1 15 Darti

melur
 1 2 1 1 14 Ai Siti Barokah

anggrek Baru

2 1 1 14 Kiki Desika

melur

1 8.8 76.0 2 1 2 1 13 Pipi Zuriana

anggrek

R. Zaratul Nung
1 8.9 75 1 1 1 1 12 Aini
melur

2 8.0 71.0 1 2 1 1 11 Mila Sari

anggrek

1 9.0 69.5 1 2 2 1 11 Ajumawati

melur

7.5 71.0 1 2 1 1 10 Rasmi

melur

1 6.7 68.0 1 2 2 1 9 Renny

anggrek
 7.2 69.0 1 1 1 1 9 Wahyuni

anggrek

2 8 71 1 1 2 1 8 Yuliana Emy

anggrek

1 61 64 1 2 1 1 6 Asnawati Baru

anggrek

2 8.1 63 1 2 2 1 4 Fatimah
melur

5.9 58.1 1 2 1 1 2 Mega Baru

Melur
1 5.0 63.0 1 1 1 1 1 Nuni Baru
Melur
 FORMULIR PEMANTAUAN PERTUMBUHAN BALITA DI POSYANDU
Provinsi : Kepulauan Riau Nama Posyandu : Mawar
Kabupaten/Kota : Natuna Tanggal : 17 & 18 Juni 2019 6/17/2019
Puskesmas/Kecamatan : Pulau Tiga Tahun : 2019 6/18/2019
Desa/Kelurahan : Tanjung Batang

Berat
Bada
NIK (Nomor Induk Ana Tanggal Nama Ortu
No No Kartu Keluarga Nama anak JK n (BB) NIK Ayah
Kependudukan) k Ke Lahir (Ayah)
Lahir
(Kg)
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10)

1 2103163010120001 2103080508169001 2 Usman Fadhillah 05/08/2014 L 3.5 Yurnadi 2103051008820003

Wan Muhammad
2 2 Wan Fahri 29/8/2014 L 3.0
Yusuf

3 2103112303110003 2103116107840001 2 Sabiya Nadira 10/09/2014 P 3.0 Saryoyo 2103112107840001

4 2103111609150001 2103112409140001 1 Muhammad AlFatih Zaki 24/09/2014 L 3.0 Zulzaki 2103112005850001

5 2103111707080003 2103115010140001 4 Rohani 10/10/2014 P 3.0 Rohandi 2103110705780001

6 2103112609130001 6101170910140001 1 Ariqul Khairi 09/10/2014 L 2.8 Idris 2103112608810001

7 2103112301140002 2103111610140001 2 Larizky 16/10/2014 L 2.8 Busli 2103070110820001

8 5 Rangga Liandra 16/11/2014 L 3.6 Johan

9 2103110507110002 2103116612140001 3 Aufa Desi Nabil 26/12/2014 P 3.0 Roni 2103112409790001

10 2103110611130002 21031102011500001 1 Abdul Rahman 01/02/2015 L 3.0 Adam Tono 2103110603870001

11 2103110111060072 2103111202150001 2 Debbi Gipson 12/02/2015 L 2.9 Sutaslim 2103111512841001

12 2103112402150001 _ 1 Alfandi 21/03/2015 L 3.5 Amirudin 2103111008841002

13 2103112101100004 2103116804150001 2 Yolanda Zulva 28/04/2015 P 3.2 Zamzabir 2103112006800001

14 2103111801110001 2103112505150001 2 Mahesa Afif Al-arkhan 25/5/2015 L 3.0 Jeki Litraludin 2103112606901002

15 2103111104190000 2101074406150000 1 Gisela Aminah 04/06/2015 P 2.7 Rodi Hartono 2103110408790000

16 2103110112110001 2103114606160001 2 Nuriska 06/06/2015 P 3.5 Idris 2103110201821003

17 2103113003090016 2103110707160001 3 Fiqhri Bastian Saputra 07/07/2015 L 3.0 Ibrahim 2103111202820001

18 2103112303090001 2103111607150001 4 Khiar Khatam 16/07/2015 L 3.0 Muslim 2103112303090001

19 2103110306080006 2103114708150001 4 Faiza Alia Aziza 07/08/2015 P 2.6 Zaini 2103110403741002

20 2103113101110001 2103116608150001 3 Novita Sari 26/08/2015 P 3.5 Sabli 2103111309790001

21 2103111707080007 2103115509150001 5 Wan Balqis Hufairah 15/09/2015 P 3.5 Wan Mukorobin 2103112909701002

22 Febri 02/10/2015 P

23 2103110603090007 2103115010150001 3 Triya Santika 10/10/2015 P 2.5 Edi Sumarno 2103111203800001

24 2103110401160001 2103114511150001 1 Nurasyifa Nofia Okta 05/11/2015 P 3.0 Syaprizal 2103062312910001

25 2 Azka Arya Tama 11/11/2015 L 3.1 Ridwan

26 2103110603090008 2103116311150001 4 Rania Novitasari 23/11/2015 P 3.8 Kusnadi 2103110806790001

27 2103111803090017 2103112711150001 3 Rendi Saputra 27/11/2015 L 3.0 Efendi 2103112403741002

28 2103111107090003 2103115502160001 4 Hasifah Azira Uzman 13/02/2016 P 3.0 Hairani 2103110404721003

29 2103112303160001 2103112703160001 1 Abib Akila Pranaja 27/03/2016 L 3.0 Rudi Saprika 2103112104900001

30 2103111803090006 2103115004160001 3 Cristina Ellen 10/04/2016 P 2.8 Troy Atius 2103110505820001

31 2103111903090003 2103110604160001 7 Steven Tetsen 06/04/2016 L 3.0 Salip 2103111202711002

32 2103111707080005 2103114404160001 4 Kayla Azahra 04/04/2016 P 3.0 Zulkifli 2103110505771002

33 2103112906160001 2103112004160001 1 Fatur Rahman Afiq 20/04/2016 L 3.0 Yumadi 2103112109870001

 Wan Muhammad
34 3 Wan Faris Al-Fabian 30/4/2016 L 3.5
Yusuf

35 2103050309180002 2103054906160001 1 Edwa AlZahell 09/06/2016 L 3.0 2103115009960001

36 2103111007090002 2103114706160001 3 Tri Rahmadani 07/06/2016 P 3.0 Abu Mansur 2103111008750001

37 2103110906090001 2103115106160001 3 Zulva Ramadani 11/06/2016 P 2.4 Zukri 210311120683000

38 2103110609160001 2103112006160001 1 Ahmad Faris Ramadan 20/06/2016 L 3.1 Suparni 2103061105820001

39 2103111104160001 2103114908160001 1 Syaidatul Nafisa 09/08/2016 P 2.7 Mustapa 2103070607880001

40 2103112802090008 2103112908160001 3 Wan Yusril 29/08/2016 L 3.8 W.Yadi Yanto 2103110711750001

41 2103111008150001 2103112408160001 1 Arka Raffa Al-Farizki 24/08/2016 L 3.2 Kadarisman 2103110711851002

42 2103111107080001 2103115708150001 3 Arsyfa Salsabila 17/08/2016 P 3.0 Aziar 2103111403840001

43 2103110806160001 2103110109160001 1 Muhammad Hafis 01/09/2016 L 2.2 Zubaini 2103050906930001

44 2103111208160001 2103110410160001 1 Muhammad Haris Al-Fajri 04/10/2016 L 3.0 Hamiruddin 2103111208160001

45 2103110503090006 2103115611160001 4 Osilya Shrena Putri 16/11/2016 P 3.0 Solihin 2103110502741002

46 2103112402150001 2 Anggie Adriani 11/11/2016 P 3.3 Amirudin 2103111008841002

47 2103113003090005 2103111512160001 2 Muhamad Reszki Dhapa 15/12/2016 L 3.0 Santri 2103110303860002

48 2103111803090022 2103114612160001 4 R. Sakhiya Hafifahana 06/12/2016 P 3.2 R. Joni Indra 2103110306821003

49 4 Wan Azril 05/12/2016 L 3.9 Wan Roni

50 2103111109090001 2103115812160001 3 Derly Zanti 18/12/2016 P 2.5 Abu Zahit 2103110706751002

51 2103113010120001 2103116112160001 2 Sheza Aqila Nadria 28/12/2016 P 3.0 Sanusi 2103111010790001

52 1 Aysha Izatumisa 29/12/2016 P 3.0 Zuldi

53 2103110311100001 2103114902170001 4 Sakila Nurahmawati 09/02/2017 P 2.8 Darmawi 2103110705740001

54 2 Aditya Al-Mutakim 10/02/2017 L Herman

55 2103110507120001 2103115702170004 2 Mica Aulia 17/02/2017 P 2.5 Asri Makrip 2103110107871018

56 2103112603180001 2103112402170001 1 Wan Muhammad Rafi 24/02/2017 L 4.0 Wan Syah Alam 2103070811920001

57 2103190103170001 2103191303170001 1 Restu Aidil Rahmat 13/03/2017 L 3.2 Yusdi Rahmat 2103070804910001

58 2103112904100004 2103115803170001 1 Aqila 18/03/2017 P 3.5 Sabtono 2103110504850001

59 2103110706080005 2103112903170001 5 Arziora Deazti 29/03/2017 P 2.5 Zamri 2103112909680001

60 1 Muhammad Farazi 31/03/2017 L

61 2103110502130003 2103110406170001 2 Sapari 06/04/2017 L 3.0 Syafrizal 2103111201841002

62 2105012706130001 2105014904170001 2 Salsabila Aprilia 09/04/2017 P 3.0 Novi Yurnadi 2105011611860002

Samsul Budi
63 3314030202170005 3314033004170001 1 Muhammad Dzaky Arbani 30/04/2017 L 2.9 3314031802900001
Pebrianto

64 2103110207080001 2103112404170002 4 Wan Syauqi Habibie 24/04/2017 L 3.0 Wan Anjas 2103110710770001

65 2103111801110001 2103112505150001 2 Bersa Jepitra 21/04/2017 L 3.0 Burhan 2103110809791002

66 2103110902090009 2103112404170001 3 Al Habsy 24/04/2017 L 3.9 Mustaridi 2103111105721002

67 2103110610170001 2103112405170001 1 Daeng Haikal Saputra 24/05/2017 L 3.0 Daeng Herman Edy 2103110307961002

68 2103111806090002 2103111406170001 2 Ramadani Ilhamudin 14/06/2017 L 3.0 Hanapi 2103110605860001

Aurelia Fransiska
69 2103112303160001 2103114806170001 2 27/06/2017 P 3.0 Rudi Saprika 210311210490001
Ramadani
 Intan Permata Jagad
70 2103071211150002 2103075806170002 2 18/06/2017 P 3.0 Abdul Hasyim 1611011709850002
(Violinshe)

71 2103112503090002 3 Hafizah 26/07/2017 P 2.5 Muhammad Rais 2103110807751002

72 2103112705090001 2103117107170001 3 Annisa Putri 31/07/2017 P 3.3 Sahril 2103112706750001

73 2103111803090012 2103111908170001 4 Muhammad Azraki Pazal 19/08/2017 L 3.0 Pirdaus 2103112706760001

74 2103110508090001 2103110209170001 4 Rendi Breggi 02/09/2017 L 3.0 Mustar Hadi 2103110107811017

75 3 M. Rizki Adha 05/09/2017 L Sulaiman

Muhammad Dzakir
76 2103111905170001 2103112409170001 1 24/09/2017 L 2.7 Fitra Handayani
Farghali

77 2103111306130002 2103111310170001 3 Panji Al-Khadafi Riyadi 13/10/2017 L 4.0 Sugeng Riadi 2172040307820003

78 2103112312090001 6 Okta Saputra 17/10/2017 L 3.0 Junaidi 2103110310770001

79 2103111311130001 2103112310170001 2 Khaliq Mirza Zikri 23/10/2017 L 3.0 Aswardi 2103110501850001

80 2103111511080002 5 Sinta Nuryati 07/11/17 P 2.5 Muchtaridi 2103111202760001

81 2103111609150001 2103116001189001 3 Latifah Qolbi 20/01/2018 P 2.9 Zulzaki 2103112005850001

82 2103112812170003 2103115302180001 1 Zuliana Marwa 13/02/2018 P 2.5 Zulkarnaini 2103110209880001

83 2103112802090007 2103110503180001 3 Tabrani 05/03/2018 L 3.0 Zunaini 2103111102801002

84 2103110102160001 2103112403180001 2 Reihan Syaputra 21/03/2018 L 3.3 Riansayah 2171092806879019

85 2103112212110001 2103111004180001 2 Rizqon Maulana Maghriby 10/04/2018 L 3.0 Jufadri 2103112212110001

86 2103111608180001 2103115104180001 3 Wan Aprilia Adiba 11/04/2018 P 2.6 Wan Izum 2103080107601017

Ruhi Aurora Malikha Rijal Fikri Hakim

87 2103111511160001 2103116004180001 1 20/04/2018 P 3.0 3175020602900007
Hakim Hasibuan Hasibuan
88 2103070301180006 2103076505180001 1 Rihana Meiliani 25/05/2018 P 4.2 Riko Budiyanto 2103070203900001

89 3 M. Zulfa Ramadhan 29/05/2018 L 3.0 Ridwan

90 2103112011170002 2103114406180001 1 Lizwa Thun Nazwani 04/06/2018 P 3.0 Supriadi 2103111205921003

91 2103111109120001 2 Rafa Gusti 30/06/2018 L 2.8 Agus Salim 2103112708890001

92 2103111804180001 2 Suci Lestari 23/06/2018 P 3.3 Tajudin 2103110509840001

93 2103112910180001 2103071806180001 3 Nur Ihsan Al-fatih 18/06/2018 L 3.3 M. Sri Yadi 2103072110830002

94 2103111803090010 _ 4 Daeng Amelia Utami 21/07/2018 P 2.4 Amirudin 2103110507801002

Muhammad Hasbi Al-

95 2103111104190000 2101070308180001 2 03/08/2018 L 3.9 Rodi Hartono 2103110408790000
Fariz

96 2103072107080002 2103111408180001 3 Ahmad Agus Triyadi 14/08/2018 L 3.0 Ardiansyah 2103070907830001

97 2103111601090001 2103115608180001 5 Asyifa 26/08/2018 P 2.8 Abdullah 2103111812770001

98 2103111404090001 2 Said Fauzan Akbar 18/08/2018 L 3.5 Said Jipri 2103110309861002

99 2103110709170001 2103110510189001 2 Revandi Aryansyah 05/10/2018 L 2.5 Albijianto 6103080607910002

100 2103110507180001 2103110410180001 1 Azzam Abiyyu Putra 04/10/2018 L 1.9 Iskandar 2103041302911002

101 2103111901160002 2103111510180001 1 Taufik Athallah 15/10/2018 L 2.5 Tarman 2103110808890001

Muhammad Fathan
102 2103111008150001 2103110511180001 2 05/11/2018 L 3.6 Kadarisman 2103110711851002
Alfarabi

103 2103111209180001 1 Wan Mustafira Saputra 01/11/2018 L 3.0 Wan Mustafa 2103110510901002

104 2103111803090012 3 Dea Rahmasari 25/11/2018 P 2.5 Pirdaus 2103112706760001

105 4 Ryo Saprika Pratama 08/12/2018 L 3.5 Sabli

106 3 Reysha Ananda Putri 17/01/2019 P 3.5 moran

107 3 Afifa Adelia 17/01/2019 P Yoyo

108 2103111107080001 _ 4 Atiqa Zahra Latipa 24/1/2019 P 3 Aziar 2103111403840001

109 2103111109130000 2103155405960000 Amelia Nacika 3/2/2019 P 3 Herman 21031110412911000

110 3 Delisha Farhana 3/4/2019 P 3.5 Ridwan

111 Ahmad Alfin 3/26/2019 L 3 Sofian M. Nur

112 1 Wan M Zarpan Al Hanam 4/2/2019 L 3.2 Wan Idris 2103110101950000

113 4 Aprillianti 4/13/2019 P 3.3 Riduan TS

113 Numpang Numpang Ravinza 20/02/2018 P

114 Numpang Numpang 1 Daeng Aqvina 2017-07-11 P Hendri
A DI POSYANDU

tel
maw

Cara ASI
IMD
Ukur Eksklu Kepe
PB/TB
BB 1=Tele sifF1= milikan
RT RW Bulan 1=YA, Umur Nama IBU
(kg) ntang YA, Buku
Ini 2=Tid
2=Ber 2=Tida KIA
ak
diri k
(13) (14) (15) (16) (17) (18) (19) (20) (21) (23)

2 1 13.2 97.0 2 2 1 1 59 Sarimah mawar

16.5 106.5 2 2 1 1 58 Rohima Cempaka

2 3 14.7 104.0 2 2 2 1 58 Ramadani mawar

1 3 14.4 97.1 2 2 1 1 57 Yosi Nigita Sari mawar

2 3 15.6 108.5 2 2 1 1 57 Sakdiah mawar PMT

2 2 15.8 104.6 2 2 1 1 57 Yayan mawar

2 3 17.3 104.0 2 1 1 1 57 Arbiah mawar

14.7 99.8 2 2 2 1 56 Kartini Cempaka

1 3 13.8 97.2 2 2 1 1 54 Hatijah mawar

2 1 15.1 101.3 1 53 Liza mawar

1 4 1 2 1 1 53 Wan Lidya mawar

2 4 16.3 105.1 2 2 1 1 51 warsin mawar

1 2 14.8 92.8 2 2 1 1 50 Nurul Bariah mawar

1 3 13.8 100.9 2 2 1 1 49 Arzana mawar

1 4 14.3 99.3 2 2 2 1 49 Novi Fitriani PMT

1 5 13.4 97.0 2 1 1 1 49 Melly Cempaka

2 4 26.4 101.0 2 2 2 1 48 Yuraida mawar

Halimatus
2 3 14.3 97.0 2 2 2 1 48 mawar
Sakdiyah

1 1 2 2 2 1 47 Zakiyah mawar

2 5 12.6 94.6 2 2 1 1 46 Emanilawati Cempaka

2 3 2 1 1 1 46 Sadiyah mawar

1 45 Murniati mawar

2 4 16.6 101.0 2 1 2 1 45 Siti Fatimah mawar

Wan Risa
1 2 12.7 90.0 2 2 2 1 44 mawar
Herlina
 2 2 1 1 44 Supeni mawar

2 4 12.8 91.6 2 1 1 1 43 Reni mawar

2 5 11.4 91.8 2 2 2 1 43 Supiati Cempaka

1 1 11.2 93.2 2 2 1 1 41 Ratnawati mawar

2 2 2 2 1 1 39 Ellen mawar

2 2 17.4 105.0 2 2 2 1 39 Susiana mawar

2 4 2 2 1 1 39 Akian mawar

2 2 2 2 1 1 39 Sa'diyah mawar

2 4 12.1 89.7 2 1 2 1 38 Salmi mawar

 13.3 93.1 2 1 1 1 38 Rohima Cempaka

2 1 10.8 84.6 2 2 2 1 37 Norisa mawar PMT

1 3 11.2 87.4 2 2 2 1 37 Mala mawar

1 1 12.7 94.5 2 2 1 37 Hamidah mawar

1 2 19.9 99.3 2 2 2 1 36 Sananti mawar

2 4 2 2 1 35 mawar

2 3 2 2 1 34 Anisa mawar

1 3 13.8 90.8 2 2 2 1 34 Karsum mawar

2 5 13.8 97.0 2 2 2 1 34 Ida Asnawati Cempaka

2 1 2 2 2 1 34 Nurjanah mawar

2 3 9.0 79.8 2 2 1 1 33 Rogayah mawar PMT

1 2 13.8 93.6 2 2 1 1 32 Masnah mawar

2 4 11.8 86.9 1 2 1 1 32 Warsih mawar

1 4 11.8 82.9 2 1 2 1 31 Haryanti mawar

1 2 2 2 2 1 31 Nordiana mawar

12.3 88.4 2 2 1 1 31 Yulika Cempaka

2 4 11.8 85.4 2 1 1 1 30 Jumiah mawar

2 2 12.2 83.1 2 2 2 1 30 Megawati mawar

 12.7 85.5 2 2 1 1 30 Rupiara mawar

1 5 9.1 82.0 2 2 2 1 29 Dinawati Cempaka

11.0 85.0 1 29 Endang Hesti Cempaka

2 4 11.1 84.5 2 1 1 1 29 Lita mawar

1 3 13.0 87.0 2 2 1 1 28 Ratisa Cempaka

2 2 15.6 90.4 2 1 2 1 28 Siti Maryam mawar

2 1 2 1 2 1 27 Zahara mawar

1 3 9.8 83.3 2 1 1 27 Ajurni mawar

10.6 82.3 2 1 27 Dewi mawar

1 1 1 2 1 1 27 Lia mawar

2 1 1 2 1 1 27 Umi Romadani mawar

18 6 1 2 1 1 26 Neni Dewi mawar

1 2 10.8 83.9 1 2 1 1 26 Asupitri mawar

1 4 1 2 1 1 26 Halijah mawar

2 3 13.9 87.0 1 2 2 1 26 Silaturrahmi mawar

2 4 1 2 2 1 25 Maisuri mawar

2 1 11.8 87.6 1 2 2 1 25 Saparina mawar

2 2 8.7 77.3 1 2 1 1 24 Mahdaleni mawar PMT

1 1 12.6 83.0 1 2 1 1 24 Olivia mawar

3 2 9.1 82.5 1 2 2 1 23 Sri Banun mawar

1 1 8.7 78.2 1 2 2 1 23 Umi Kalsum mawar

2 2 15.2 88.5 1 1 1 1 22 Wirdiana mawar

1 3 10.9 81.5 1 2 1 1 22 Raisa mawar

22 Jumaryat

9.7 82.0 1 2 2 1 21 Ipri Ningsih mawar

1 3 11.1 81.7 1 2 2 1 21 Zarina mawar

1 3 10.3 81.0 1 2 2 1 21 Dahlia mawar

3 4 9.3 81.0 1 2 2 1 20 Mega Silvia mawar

1 4 7.5 74.6 1 2 2 1 20 Norita mawar PMT

1 3 10.2 76.0 1 2 2 1 17 Yosi Nigita Sari mawar

2 4 1 2 2 1 17 Damnah

2 4 11.4 80.1 1 2 1 1 16 Hasrati mawar

2 4 1 2 1 1 15 Heli Putri mawar

1 3 1 2 2 1 15 Eka mawar

1 5 8.2 74.5 1 1 1 1 15 Midawati Cempaka

Daeng Sumi
1 2 7.9 71.5 1 2 2 1 14 mawar
Rusniwati
2 3 11.8 80.0 1 2 1 1 13 Armalianti mawar

7.6 69.9 1 2 2 1 13 Agus Silawati mawar

2 4 8.6 75.3 1 2 2 1 13 Rui Jupita mawar

2 3 8.7 76.3 1 2 1 1 12 Sartika mawar

2 2 7.2 72.6 1 2 2 1 12 Sitam mawar

1 2 9.4 72.9 1 2 1 1 12 Tuti Erawati mawar

2 2 7.0 69.5 1 2 2 1 11 Juli Amami mawar

1 4 9.4 74.6 1 1 2 1 11 Novi Fitriani mawar

1 1 1 2 1 1 11 Karmiati mawar
2 3 1 2 2 1 10 Endang mawar

7.4 71.2 1 2 2 1 10 Ermasuryani Cempaka

2 3 6.2 66.0 1 2 2 1 9 Hatijah mawar

2 2 8.2 67.2 1 2 1 1 9 Yuli Eka Yani mawar

1 3 6.5 67.0 1 2 1 1 9 Rohayani mawar PMT

1 3 8.6 70.5 1 2 1 1 8 Karsum mawar

6.5 66.2 1 2 2 1 8 Vivi Cempaka

2 2 6.7 66.0 1 2 1 1 7 Wirdiana mawar

7.7 69.2 1 2 1 1 7 Emilawati Cempaka

 7.0 67.3 1 2 1 1 6 Zatilawati mawar

6.9 65 1 2 1 1 6 Romadani mawar

2 5 6.3 61 1 2 1 1 5 Ida Asnawati Cempaka

2 5 5.1 59.6 1 2 2 1 4 Endang Hesti Cempaka

6.3 63.4 4 Supeni mawar Baru

1 1 1 1 3 Harnani mawar

2 5 7 62.9 1 2 1 1 3 Irawati Cempaka

5.7 60 3 Supar Dewi mawar

6.3 63.4 1 Hazanah mawar

1 Ukriah mawar
 FORMULIR PEMANTAUAN PERTUMBUHAN BALITA DI POSYANDU
Provinsi : Kepulauan Riau Nama Posyandu : Mawar
Kabupaten/Kota : Natuna Tanggal : 17 JULI 2019
Puskesmas/Kecamatan : Pulau Tiga Tahun : 2019
Desa/Kelurahan : Tanjung Batang

Berat
Badan
NIK (Nomor Induk Anak Nama Ortu
No No Kartu Keluarga Ke Nama anak Tanggal Lahir JK (BB) NIK Ayah RT RW BB
Kependudukan) Lahir (Ayah)
(Kg)

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13)

1 2103163010120001 2103080508169001 2 Usman Fadhillah 05/08/2014 L 3.5 Yurnadi 2103051008820003 2 1 13.2

2 2103112303110003 2103116107840001 2 Sabiya Nadira 10/09/2014 P 3.0 Saryoyo 2103112107840001 2 3 14.7

Muhammad AlFatih
3 2103111609150001 2103112409140001 1 24/09/2014 L 3.0 Zulzaki 2103112005850001 1 3 14.4
Zaki

4 2103111707080003 2103115010140001 4 Rohani 10/10/2014 P 3.0 Rohandi 2103110705780001 2 3 15.6

5 2103112609130001 6101170910140001 1 Ariqul Khairi 09/10/2014 L 2.8 Idris 2103112608810001 2 2 15.8

6 2103112301140002 2103111610140001 2 Larizky 16/10/2014 L 2.8 Busli 2103070110820001 2 3 17.3

7 2103110507110002 2103116612140001 3 Aufa Desi Nabil 26/12/2014 P 3.0 Roni 2103112409790001 1 3 13.8

8 '2103110611130002 21031102011500001 1 Abdul Rahman 01/02/2015 L 3.0 Adam Tono 2103110603870001 2 1 15.1

9 2103110111060072 2103111202150001 2 Debbi Gipson 12/02/2015 L 2.9 Sutaslim 2103111512841001 1 4

10 2103112402150001 _ 1 Alfandi 21/03/2015 L 3.5 Amirudin 2103111008841002 2 4 16.3

11 2103112101100004 2103116804150001 2 Yolanda Zulva 28/04/2015 P 3.2 Zamzabir 2103112006800001 1 2 14.8

Mahesa Afif Al-

12 2103111801110001 2103112505150001 2 25/5/2015 L 3.0 Jeki Litraludin 2103112606901002 1 3 13.8
arkhan

13 1 Gisela Aminah 04/06/2015 P 2.7 Rodi Hartono 14.3

 Fiqhri Bastian
14 2103113003090016 2103110707160001 3 07/07/2015 L 3.0 Ibrahim 2103111202820001 2 4 26.4
Saputra

15 2103112303090001 2103111607150001 4 Khiar Khatam 16/07/2015 L 3.0 Muslim 2103112303090001 2 3 14.3

16 2103110306080006 2103114708150001 4 Faiza Alia Aziza 07/08/2015 P 2.6 Zaini 2103110403741002 1 1

Wan Balqis
17 2103111707080007 2103115509150001 5 15/09/2015 P 3.5 Wan Mukorobin 2103112909701002 2 3
Hufairah

18 Febri 02/10/2015 P

19 2103110603090007 2103115010150001 3 Triya Santika 10/10/2015 P 2.5 Edi Sumarno 2103111203800001 2 4 16.6

Nurasyifa Nofia
20 2103110401160001 2103114511150001 1 05/11/2015 P 3.0 Syaprizal 2103062312910001 1 2 12.7
Okta

21 2 Azka Arya Tama 11/11/2015 L 3.1 Ridwan

22 2103110603090008 2103116311150001 4 Rania Novitasari 23/11/2015 P 3.8 Kusnadi 2103110806790001 2 4 12.8

Hasifah Azira
23 2103111107090003 2103115502160001 4 13/02/2016 P 3.0 Hairani 2103110404721003 1 1 11.2
Uzman

24 2103112303160001 2103112703160001 1 Abib Akila Pranaja 27/03/2016 L 3.0 Rudi Saprika 2103112104900001 2 2

25 2103111803090006 2103115004160001 3 Cristina Ellen 10/04/2016 P 2.8 Troy Atius 2103110505820001 2 2 17.4

26 2103111903090003 2103110604160001 7 Steven Tetsen 06/04/2016 L 3.0 Salip 2103111202711002 2 4

27 2103111707080005 2103114404160001 4 Kayla Azahra 04/04/2016 P 3.0 Zulkifli 2103110505771002 2 2

28 2103112906160001 2103112004160001 1 Fatur Rahman Afiq 20/04/2016 L 3.0 Yumadi 2103112109870001 2 4 12.1

29 2103050309180002 2103054906160001 1 Edwa AlZahell 09/06/2016 L 3.0 2103115009960001 2 1 10.8

30 2103111007090002 2103114706160001 3 Tri Rahmadani 07/06/2016 P 3.0 Abu Mansur 2103111008750001 1 3 11.2

31 2103110906090001 2103115106160001 3 Zulva Ramadani 11/06/2016 P 2.4 Zukri 210311120683000 1 1 12.7

Ahmad Faris
32 2103110609160001 2103112006160001 1 20/06/2016 L 3.1 Suparni 2103061105820001 1 2 19.9
Ramadan

33 2103111104160001 2103114908160001 1 Syaidatul Nafisa 09/08/2016 P 2.7 Mustapa 2103070607880001 2 4

34 2103112802090008 2103112908160001 3 Wan Yusril 29/08/2016 L 3.8 W.Yadi Yanto 2103110711750001 2 3

Arka Raffa Al-

35 2103111008150001 2103112408160001 1 24/08/2016 L 3.2 Kadarisman 2103110711851002 1 3 13.8
Farizki

36 2103110806160001 2103110109160001 1 Muhammad Hafis 01/09/2016 L 2.2 Zubaini 2103050906930001 2 1

Muhammad Haris
37 2103111208160001 2103110410160001 1 04/10/2016 L 3.0 Hamiruddin 2103111208160001 2 3 9.0
Al-Fajri
38 2103110503090006 2103115611160001 4 Osilya Shrena Putri 16/11/2016 P 3.0 Solihin 2103110502741002 1 2 13.8

39 2103112402150001 2 Anggie Adriani 11/11/2016 P 3.3 Amirudin 2103111008841002 2 4 11.8

Muhamad Reszki
40 2103113003090005 2103111512160001 2 15/12/2016 L 3.0 Santri 2103110303860002 1 4 11.8
Dhapa

R. Sakhiya
41 2103111803090022 2103114612160001 4 06/12/2016 P 3.2 R. Joni Indra 2103110306821003 1 2
Hafifahana

42 2103111109090001 2103115812160001 3 Derly Zanti 18/12/2016 P 2.5 Abu Zahit 2103110706751002 2 4 11.8

43 2103113010120001 2103116112160001 2 Sheza Aqila Nadria 28/12/2016 P 3.0 Sanusi 2103111010790001 2 2 12.2

44 1 Aysha Izatumisa 29/12/2016 P 3.0 Zuldi 12.7

45 2103110507120001 2103115702170004 2 Mica Aulia 17/02/2017 P 2.5 Asri Makrip 2103110107871018 2 4 11.1
46 2103190103170001 2103191303170001 1 Restu Aidil Rahmat 13/03/2017 L 3.2 Yusdi Rahmat 2103070804910001 2 2 15.6

47 2103112904100004 2103115803170001 1 Aqila 18/03/2017 P 3.5 Sabtono 2103110504850001 2 1

48 2103110706080005 2103112903170001 5 Arziora Deazti 29/03/2017 P 2.5 Zamri 2103112909680001 1 3 9.8

49 1 Muhammad Farazi 31/03/2017 L 10.6

50 2103110502130003 2103110406170001 2 Sapari 06/04/2017 L Syafrizal 2103111201841002 1 1

51 2105012706130001 2105014904170001 2 Salsabila Aprilia 09/04/2017 P 3.0 Novi Yurnadi 2105011611860002 2 1

Muhammad Dzaky Samsul Budi

52 3314030202170005 3314033004170001 1 30/04/2017 L 2.9 3314031802900001 18 6
Arbani Pebrianto

53 2103110207080001 2103112404170002 4 Wan Syauqi Habibie 24/04/2017 L 3.0 Wan Anjas 2103110710770001 1 2 10.8
54 2103111801110001 2103112505150001 2 Bersa Jepitra 21/04/2017 L 3.0 Burhan 2103110809791002 1 4

55 2103110902090009 2103112404170001 3 Al Habsy 24/04/2017 L 3.9 Mustaridi 2103111105721002 2 3 13.9

Daeng Haikal Daeng Herman

56 2103110610170001 2103112405170001 1 24/05/2017 L 3.0 2103110307961002 2 4
Saputra Edy

Ramadani
57 2103111806090002 2103111406170001 2 14/06/2017 L 3.0 Hanapi 2103110605860001 2 1 11.8
Ilhamudin

Aurelia Fransiska
58 2103112303160001 2103114806170001 2 27/06/2017 P 3.0 Rudi Saprika 210311210490001 2 2 8.7
Ramadani

Intan Permata Jagad

59 2103071211150002 2103075806170002 2 18/06/2017 P 3.0 Abdul Hasyim 1611011709850002 1 1 12.6
(Violinshe)

60 2103112503090002 3 Hafizah 26/07/2017 P 2.5 Muhammad Rais 2103110807751002 3 2 9.1

61 2103112705090001 2103117107170001 3 Annisa Putri 31/07/2017 P 3.3 Sahril 2103112706750001 1 1 8.7

 Muhammad Azraki
62 2103111803090012 2103111908170001 4 19/08/2017 L 3.0 Pirdaus 2103112706760001 2 2 15.2
Pazal

63 2103110508090001 2103110209170001 4 Rendi Breggi 02/09/2017 L 3.0 Mustar Hadi 2103110107811017 1 3 10.9

64 3 M. Rizki Adha 05/09/2017 L Sukiman

Muhammad Dzakir
65 2103111905170001 2103112409170001 1 24/09/2017 L 2.7 Fitra Handayani 9.7
Farghali

Panji Al-Khadafi
66 2103111306130002 2103111310170001 3 13/10/2017 L 4.0 Sugeng Riadi 2172040307820003 1 3 11.1
Riyadi

67 2103111311130001 2103112310170001 2 Khaliq Mirza Zikri 23/10/2017 L 3.0 Aswardi 2103110501850001 3 4 9.3

68 2103112312090001 6 Okta Saputra 17/10/2017 L 3.0 Junaidi 2103110310770001 1 3 10.3

69 2103111511080002 5 Sinta Nuryati 07/11/17 P 2.5 Muchtaridi 2103111202760001 1 4 7.5

70 2103111609150001 2103116001189001 3 Latifah Qolbi 20/01/2018 P 2.9 Zulzaki 2103112005850001 1 3 10.2

71 2103112812170003 2103115302180001 1 Zuliana Marwa 13/02/2018 P 2.5 Zulkarnaini 2103110209880001 2 4

72 2103112802090007 2103110503180001 3 Tabrani 05/03/2018 L 3.0 Zunaini 2103111102801002 2 4 11.4

73 2103110102160001 2103112403180001 2 Reihan Syaputra 21/03/2018 L 3.3 Riansayah 2171092806879019 2 4

Rizqon Maulana
74 2103112212110001 2103111004180001 2 10/04/2018 L 3.0 Jufadri 2103112212110001 1 3
Maghriby

Ruhi Aurora
Rijal Fikri Hakim
75 2103111511160001 2103116004180001 1 Malikha Hakim 20/04/2018 P 3.0 3175020602900007 1 2 7.9
Hasibuan
Hasibuan

76 2103070301180006 2103076505180001 1 Rihana Meiliani 25/05/2018 P 4.2 Riko Budiyanto 2103070203900001 2 3 11.8

77 3 M. Zulfa Ramadhan 29/05/2018 L 3.0 Ridwan 7.6

78 2103112011170002 2103114406180001 1 Uzwatun Nazwani 04/06/2018 P 3.0 Supriadi 2103111205921003 2 4 8.6

79 2103111109120001 2 Rafa Gusti 30/06/2018 L 2.8 Agus Salim 2103112708890001 2 3 8.7

80 2103111804180001 2 Suci Lestari 23/06/2018 P 3.3 Tajudin 2103110509840001 2 2 7.2

81 2103112910180001 2103071806180001 3 Nur Ihsan Al-fatih 18/06/2018 L 3.3 M. Sri Yadi 2103072110830002 1 2 9.4

Daeng Amelia
82 2103111803090010 _ 4 21/07/2018 P 2.4 Amirudin 2103110507801002 2 2 7.0
Utami

Muhammad Hasbi
83 2 03/08/2018 L 3.9 Rodi Hartono 9.4
Al-Fariz

Ahmad Agus
84 2103072107080002 2103111408180001 3 14/08/2018 L 3.0 Ardiansyah 2103070907830001 1 1
Triyadi

85 2103111601090001 2103115608180001 5 Asyifa 26/08/2018 P 2.8 Abdullah 2103111812770001 2 3

86 2103110709170001 2103110510189001 2 Revandi Aryansyah 05/10/2018 L 2.5 Albijianto 6103080607910002 2 3 6.2

 Azzam Abiyyu
87 2103110507180001 2103110410180001 1 04/10/2018 L 1.9 Iskandar 2103041302911002 2 2 8.2
Putra

88 2103111901160002 2103111510180001 1 Taufik Athallah 15/10/2018 L 2.5 Tarman 2103110808890001 1 3 6.5

Muhammad Fathan
89 2103111008150001 2103110511180001 2 05/11/2018 L 3.6 Kadarisman 2103110711851002 1 3 8.6
Alfarabi

90 2103111803090012 3 Dea Rahmasari 25/11/2018 P 2.5 Pirdaus 2103112706760001 2 2 6.7

Reysha Ananda
91 3 17/01/2019 P 3.5 moran 7.0
Putri

92 3 Afifa Adelia 17/01/2019 P Yoyo 6.9

93 Ahmad Alfin 3/26/2019 L 3 Sofian M. Nur

94 4 Aprillianti 4/13/2019 P 3.3 Riduan TS 5.7

95 3 Delisha Farhana 3/4/2019 P 3.5 Ridwan 6.3

96 Numpang Numpang Ravinza 20/02/2018 P

97 Numpang Numpang 1 Daeng Aqvina 2017-07-11 P Hendri

98 Numpang Numpang 1 Abrisyam 9/22/2017 L 3.5 Arisandi 10.3

99 Numpang Numpang 2 Aftap Ari Fatihan 2/1/2019 L 2.7 Arisandi 7.9

100 Numpang Numpang 1 Gustian Affendi 8/10/2015 L 16.4

101 Numpang Numpang 2 Areta Vanesa 10/7/2018 P 7.2

KK Sabang
102 Numpang Zea Aprilia 4/27/2016 P Ari Kusmiran 13
Mawang Barat
LITA DI POSYANDU

Cara IMD
Ukur ASI Kepemi
1=Telent Eksklusi likan
TB ang f 1=YA, 1=YA, Buku Umur Nama IBU
2=Berdir 2=Tidak 2=Tida KIA
i k
(14) (15) (16) (17) (18) (19) (20)

97.0 2 2 1 1 59 Sarimah

104.0 2 2 2 1 58

97.1 2 2 1 1 57

108.5 2 2 1 1 57 Sakdiah

104.6 2 2 1 1 57 Yayan
104.0 2 1 1 1 57 Arbiah

97.2 2 2 1 1 54 Hatijah

101.3 1 53 Liza

1 2 1 1 53 Wan Lidya

105.1 2 2 1 1 51 warsin

92.8 2 2 1 1 50 Nurul Bariah

100.9 2 2 1 1 49 Arzana

99.3 2 2 2 1 49 Novi Fitriani

101.0 2 2 2 1 48 Yuraida

Halimatus
97.0 2 2 2 1 48
Sakdiyah

2 2 2 1 47 Zakiyah

2 1 1 1 46 Sadiyah

1 45 Murniati

101.0 2 1 2 1 45 Siti Fatimah

Wan Risa
90.0 2 2 2 1 44
Herlina

2 2 1 1 44 Supeni
91.6 2 1 1 1 43 Reni

93.2 2 2 1 1 41 Ratnawati

2 2 1 1 39 Ellen

105.0 2 2 2 1 39 Susiana

2 2 1 1 39 Akian

2 2 1 1 39 Sa'diyah

89.7 2 1 2 1 38 Salmi

84.6 2 2 2 1 37 Norisa
87.4 2 2 2 1 37 Mala

94.5 2 2 1 37 Hamidah

99.3 2 2 2 1 36 Sananti

2 2 1 35

2 2 1 34 Anisa

90.8 2 2 2 1 34 Karsum

2 2 2 1 34 Nurjanah

79.8 2 2 1 1 33 Rogayah
93.6 2 2 1 1 32 Masnah

86.9 1 2 1 1 32 Warsih

82.9 2 1 2 1 31 Haryanti

2 2 2 1 31 Nordiana

85.4 2 1 1 1 30 Jumiah

83.1 2 2 2 1 30 Megawati

85.5 2 2 1 1 30 Rupiara

84.5 2 1 1 1 29 Lita
90.4 2 1 2 1 28 Siti Maryam

2 1 2 1 27 Zahara

83.3 2 1 1 27 Ajurni

82.3 2 1 27 Dewi

1 2 1 1 27 Lia

Umi
1 2 1 1 27
Romadani

1 2 1 1 26 Neni Dewi

83.9 1 2 1 1 26 Asupitri
 1 2 1 1 26 Halijah

87.0 1 2 2 1 26 Silaturrahmi

1 2 2 1 25 Maisuri

87.6 1 2 2 1 25 Saparina

77.3 1 2 1 1 24 Mahdaleni

83.0 1 2 1 1 24 Olivia

82.5 1 2 2 1 23 Sri Banun

78.2 1 2 2 1 23 Umi Kalsum

88.5 1 1 1 1 22 Wirdiana

81.5 1 2 1 1 22 Raisa

22 Jumaryat

82.0 1 2 2 1 21 Ipri Ningsih

81.7 1 2 2 1 21 Zarina

81.0 1 2 2 1 20 Mega Silvia

81.0 1 2 2 1 21 Dahlia

74.6 1 2 2 1 20 Norita
 Yosi Nigita
76.0 1 2 2 1 17
Sari

1 2 2 1 17 Damnah

80.1 1 2 1 1 16 Hasrati

1 2 1 1 15 Heli Putri

1 2 2 1 15 Eka

Daeng Sumi
71.5 1 2 2 1 14
Rusniwati

80.0 1 2 1 1 13 Armalianti

Agus
69.9 1 2 2 1 13
Silawati
75.3 1 2 2 1 13 Rui Jupita

76.3 1 2 1 1 12 Sartika

72.6 1 2 2 1 12 Sitam

72.9 1 2 1 1 12 Tuti Erawati

69.5 1 2 2 1 11 Juli Amami

74.6 1 1 2 1 11 Novi Fitriani

1 2 1 1 11 Karmiati

1 2 2 1 10 Endang

66.0 1 2 2 1 9 Hatijah
 Yuli Eka
67.2 1 2 1 1 9
Yani

67.0 1 2 1 1 9 Rohayani

70.5 1 2 1 1 8 Karsum

66.0 1 2 1 1 7 Wirdiana

67.3 1 2 1 1 6 Zatilawati

65 1 2 1 1 6 Romadani

1 1 1 1 Harnani

60 Supar Dewi

63.4 Supeni Baru

1 16 Hazanah

1 24 Ukriah
89 Kiki

64.5 Kiki

Penny A

67.4 Penny A

91 Tri
 FORMULIR PEMANTAUAN PERTUMBUHAN BALITA DI POSYANDU
Provinsi : Kepulauan Riau Nama Posyandu : CEMPAKA
Kabupaten/Kota : Natuna Tanggal : 16 JULI 2019
Puskesmas/Kecamatan : Pulau Tiga Tahun : 2019
Desa/Kelurahan : Tanjung Batang

Berat
Badan
NIK (Nomor Induk Anak
No No Kartu Keluarga Nama anak Tanggal Lahir JK (BB) Nama Ortu (Ayah) NIK Ayah RT RW
Kependudukan) Ke Lahir
(Kg)

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12)

Wan Muhammad
1 2 Wan Fahri 29/8/2014 L 3.0
Yusuf

2 5 Rangga Liandra 16/11/2014 L 3.6 Johan

3 2103110112110001 2103114606160001 2 Nuriska 06/06/2015 P 3.5 Idris 2103110201821003 1 5

4 2103113101110001 2103116608150001 3 Novita Sari 26/08/2015 P 3.5 Sabli 2103111309790001 2 5

5 2103111803090017 2103112711150001 3 Rendi Saputra 27/11/2015 L 3.0 Efendi 2103112403741002 2 5

 Wan Muhammad
6 3 Wan Faris Al-Fabian 30/4/2016 L 3.5
Yusuf

7 2103111107080001 2103115708150001 3 Arsyfa Salsabila 17/08/2016 P 3.0 Aziar 2103111403840001 2 5

8 4 Wan Azril 05/12/2016 L 3.9 Wan Roni

9 2103110311100001 2103112211830001 4 Sakila Nurahmawati 09/02/2017 P 2.8 Darmawi 2103110705740001 1 5

10 2 Aditya Al-Mutakim 10/02/2017 L Herman

11 2103112603180001 2103112402170001 1 Wan Muhammad Rafi 24/02/2017 L 4.0 Wan Syah Alam 2103070811920001 1 3

12 2103111608180001 2103115104180001 3 Wan Aprilia Adiba 11/04/2018 P 2.6 Wan Izum 2103080107601017 1 5

13 2103111404090001 2 Said Fauzan Akbar 18/08/2018 L 3.5 Said Jipri 2103110309861002

14 2103111209180001 1 Wan Mustafira Saputra 01/11/2018 L 3.0 Wan Mustafa 2103110510901002

15 4 Ryo Saprika Pratama 08/12/2018 L 3.5 Sabli

16 2103111107080001 4 Atiqa Zahra Latipa 24/1/2019 Aziar 2103111403840001 2 5

_ P 3

17 2103111109130000 2103155405960000 1 Amelia Nacika 3/2/2019 P 3 Herman 21031110412911000 2 5

18 1 Wan M Zarpan Al Hanan 4/2/2019 L 3.2 Wan Idris 2103110101950001 2 5

N BALITA DI POSYANDU

PB/TB Cara Ukur ASI IMD

Eksklusif 1=YA, Kepemili
BB (kg) Bulan 1=Telenta
ng 1=YA, kan Umur Nama IBU
Ini 2=Berdiri 2=Tidak 2=Tidak Buku KIA

(13) (14) (15) (16) (17) (18) (19) (20)

16.5 106.5 2 2 1 1 58 Rohima

14.7 99.8 2 2 2 1 56 Kartini

13.4 97.0 2 1 1 1 49 Melly

12.6 94.6 2 2 1 1 46 Emanilawati

11.4 91.8 2 2 2 1 43 Supiati

13.3 93.1 2 1 1 1 38 Rohima

13.8 97.0 2 2 2 1 34 Ida Asnawati

12.3 88.4 2 2 1 1 31 Yulika

9.1 82.0 2 2 2 1 29 Dinawati

11.0 85.0 1 29 Endang Hesti

13.0 87.0 2 2 1 1 28 Ratisa

8.2 74.5 1 1 1 1 15 Midawati

7.4 71.2 1 2 2 1 10 Ermasuryani

6.5 66.2 1 2 2 1 8 Vivi

7.7 69.2 1 2 1 1 7 Emilawati

6.3 61 1 2 1 1 5 Ida Asnawati

5.1 59.6 1 2 2 1 4 Endang Hesti

7 62.9 1 2 1 1 3 Irawati
 CATATAN PEMBERIAN MAKANAN TAMBAHAN PADA IBU HAMIL DI PUSKESMAS

Puskesmas :
Kab/Kota :
Provinsi :

Tahun ……….
No Identitas Ibu Hamil Alamat Pemeriksaan
JAN FEB MAR APR MEI JUN

NIK Alamat Tanggal-bln-thn

Nama Ibu BB

Nama Suami RT TB

Kehamilan RW LILA
Ke
Tanggal Jumlah PMT
Lahir (Bungkus)

Umur Tahun Produksi

No HP
Tahun ……….
No Identitas Ibu Hamil Alamat Pemeriksaan
JAN FEB MAR APR MEI JUN

NIK Alamat Tanggal-bln-thn

Nama Ibu BB
Nama Suami RT TB

Kehamilan
RW LILA
Ke
Tanggal Jumlah PMT
Lahir (Bungkus)

Umur Tahun Produksi

No HP
DI PUSKESMAS

Tahun ……….
JUL AGU SEP OKT NOV DES

Tahun ……….
JUL AGU SEP OKT NOV DES
 CATATAN PEMBERIAN MAKANAN TAMBAHAN PADA BALITA DI PUSKESMAS

Puskesmas :
Kab/Kota :
Provinsi :

Tahun ……….
No Identitas Anak Identitas Orang Tua Pemeriksaan
JAN FEB MAR APR MEI JUN

NIK NIK Tanggal

Nama Nama BB
Anak Ayah

Anak Ke No Hp TB

Cara Ukur
Jenis Alamat 1=Telentang
Kelamin 2=Berdiri
Tanggal Jumlah PMT
RT
Lahir (Bungkus)

Umur RW Tahun Produksi

BB Lahir
Tahun ……….
No Identitas Anak Identitas Orang Tua Pemeriksaan
JAN FEB MAR APR MEI JUN

NIK NIK Tanggal

 Nama Nama BB
Anak Ayah

Anak Ke No Hp TB

Cara Ukur
Jenis Alamat 1=Telentang
Kelamin 2=Berdiri

Tanggal Jumlah PMT

RT
Lahir (Bungkus)

Umur RW Tahun Produksi

BB Lahir

CATATAN PEMBERIAN MAKANAN TAMBAHAN PADA BALITA DI PUSKESMAS

Puskesmas :
Kab/Kota :
Provinsi :

Tahun 2018
No Identitas Anak Identitas Orang Tua Pemeriksaan
JAN FEB MAR APR MEI JUN
NIK 2103112907160001 NIK 2103112104870001 Tanggal
Nama Azka Dzuhairi Hisyam Nama Adendi BB
Anak Ayah
Anak Ke 3 No Hp TB
Cara Ukur
Jenis Laki-laki Alamat Balai 1=Telentang
Kelamin 2=Berdiri
Tanggal Jumlah PMT
29/07/2016 RT 2
Lahir (Bungkus)
 Umur RW 2 Tahun Produksi
BB Lahir 2.9 kg
Tahun ……….
No Identitas Anak Identitas Orang Tua Pemeriksaan
JAN FEB MAR APR MEI JUN
NIK NIK Tanggal
Nama Nama BB
Anak Ayah
Anak Ke No Hp TB
Cara Ukur
Jenis Alamat 1=Telentang
Kelamin 2=Berdiri
Tanggal RT Jumlah PMT
Lahir (Bungkus)
Umur RW Tahun Produksi
BB Lahir
USKESMAS

Tahun ……….
JUL AGU SEP OKT NOV DES

Tahun ……….
JUL AGU SEP OKT NOV DES
USKESMAS

JUL AGU SEP OKT NOV DES

10

21
 2017

JUL AGU SEP OKT NOV DES