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    Form Pencatatan Sementra Vaksin

    Uploaded by

    Muhammad Nashrullah Ilham
    The document is a registration form for COVID-19 vaccinations at PUSKESMAS MAKKASAU health center in Makassar, South Sulawesi. It includes details of 50 individuals receiving their first dose of vaccination such as their name, age, occupation, address and phone number. The form also tracks vaccination details like date, batch number and next dose.

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    © All Rights Reserved
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    Form Pencatatan Sementra Vaksin

    Uploaded by

    Muhammad Nashrullah Ilham
    21 views7 pages
    The document is a registration form for COVID-19 vaccinations at PUSKESMAS MAKKASAU health center in Makassar, South Sulawesi. It includes details of 50 individuals receiving their first dose of vaccination such as their name, age, occupation, address and phone number. The form also tracks vaccination details like date, batch number and next dose.

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    form pencatatan sementra vaksin

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    The document is a registration form for COVID-19 vaccinations at PUSKESMAS MAKKASAU health center in Makassar, South Sulawesi. It includes details of 50 individuals receiving their first dose of vaccination such as their name, age, occupation, address and phone number. The form also tracks vaccination details like date, batch number and next dose.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Download as xlsx, pdf, or txt
    21 views7 pages

    Form Pencatatan Sementra Vaksin

    Uploaded by

    Muhammad Nashrullah Ilham
    The document is a registration form for COVID-19 vaccinations at PUSKESMAS MAKKASAU health center in Makassar, South Sulawesi. It includes details of 50 individuals receiving their first dose of vaccination such as their name, age, occupation, address and phone number. The form also tracks vaccination details like date, batch number and next dose.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Download as xlsx, pdf, or txt
    of 7

    FORMAT PENCATATAN SEMENTARA PELAKSANAAN VAKSINASI COVID-19

    NAMA PUSKESMAS / KLINIK / RS: PUSKESMAS MAKKASAU


    FASKES ID :
    KOTA : MAKASSAR
    PROPINSI : SULAWESI SELATAN

    Umur
    TANGGAL Tanggal
    No NIK Nama Penerima Vaksin JK Pekerjaan INSTANSI (18-59 Alamat KELURAHAN KECAMATAN No. Hp
    LAHIR Screening
    tahun)

    1 737132305970006 EDWARD GANI L COASS FK UNHAS 5/23/1997 24 JL TONDONG KURA 10, TORAJA 089526296043 2/3/2021

    2 7326116312980001 VIOLA SALLO P COASS FK UNHAS 12/3/1998 22 JL SADDAN 2 NO 7 082194799811 2/3/2021

    3 3174094608981002 A FANIA IHDIYAH SARI P COASS FK UNHAS 8/16/1998 23 BTN AGRARIA BLOK B/9 081241549105 2/3/2021

    4 7471082604960003 ANDRA PRATAMA PUTRA L COASS FK UNHAS 4/26/1996 25 JL A KADIR 2/3/2021

    5 121 2/3/2021

    6 121 2/3/2021

    7 121 2/3/2021

    8 121 2/3/2021

    9 121 2/3/2021

    10 121 2/3/2021

    11 121 2/3/2021

    12 121 2/3/2021

    13 121 2/3/2021

    14 121 2/3/2021

    15 121 2/3/2021

    16 121 2/3/2021

    17 121 2/3/2021

    18 121 2/3/2021

    19 121 2/3/2021

    20 121 2/3/2021

    21 121 2/3/2021

    22 121 2/3/2021

    23 121 2/3/2021

    24 121 2/3/2021
    25 121 2/3/2021

    26 121 2/3/2021

    27 121 2/3/2021

    28 121 2/3/2021

    29 121 2/3/2021

    30 121 2/3/2021

    Kelompok Umur: Kepesertaan BPJS Pemberian Dosis


    18-30 #REF! BPJS #REF! Dosis 1 0
    31-45 #REF! Non BPJS #REF! Dosis 2 0
    46-59 #REF! Total #REF! Total
    Total #REF!
    Dosis I Dosis 2

    Keterangan
    Tanggal Tanggal (Contoh: Ditunda/Dirujuk/….)
    Pemberian No. Batch Pemberian No. Batch
    Vaksinasi Vaksinasi

    202009007

    202009007

    202009007

    202009007

    202009007

    202009007

    202009007

    202009007

    202009007

    202009007

    202009007

    202009007

    202009007

    202009007

    202009007

    202009007

    202009007

    202009007

    202009007
    NO ANTRIAN NIK Nama Penerima Vaksin JK INSTANSI
    1 1 7371032305970006 EDWARD GANI L COASS FK
    2 2 7326116312980001 VIOLA SALLO P COASS FK
    3 2231 3174094608981002 A FANIA IHDIYAH SARI P COASS FK
    4 2241 7471082604960003 ANDRA PRATAMA PUTRA L COASS FK
    5 2251 7371036704950001 ELRA SAFARINA PRAMESTI P COASS FK
    6 2252 7371074502990006 ANGIESKA DIAN P COASS FK
    7 2266 7371142302970003 ARIEF ABDURRAZAQ DHARMA L COASS FK
    8 2276 7371146503910003 RIZKY A RAMADHAN P COASS FK
    9 2297 7305071709970003 YALDI ROSADI L COASS FK
    10 2314 7326085601980001 YUSTIN MAYUNTA P COASS FK
    11 2323 7371146504960001 DZAKIYYAH MARZUQAH P COASS FK
    12 2333 7371134202970005 ANASYA FADILLAH P COASS FK
    13 2343 7371035508980001 MICHELLE RUSLIM P COASS FK
    14 2356 7206036803970001 SUSAN MELINDA GOSAL P COASS FK
    15 2374 7306085811870009 UMMI AFIFAH P COASS FK
    16 2396 7310055303960001 NIRWANA MUSTAFA P COASS FK
    17 2410 7171074701890001 PRISIA RIANE POLII P PPDS
    18 2423 7317102704970001 ILUL HIDAYAT AR L MPPD
    19 2437 7471087105860002 WA ODE SYAKINAH P PPDS
    20 2451 7303021903950004 AZWAR INDRA P L MPPD
    21 DKK 7371095908820005 HARFIYANTI FIRMAN P DKK
    22 2485 7322115304970001 RHAODATUL JANNAH P COASS FK
    23 DKK 7371102103950007 THAMZIL H DM L DKK
    24 2504 7312045608960004 ANDI SRIANA P COASS FK
    25 2524 7308036506900001 UBUDIAH NOURMALA RASAK P COASS FK
    26 2547 7371036811970002 NOVIA WIRA TUNGADI P COASS FK
    27 2551 7371116407960004 UMMU AIMAN P COASS FK
    28 2569 7306084202010001 ADINDA FEBRIYANI P MHS FK
    29 2578 3671120710900005 HAMBRIAN WIJAYA L RESIDEN OBGYN
    30 2582 7305074910000001 ILMIA AMALIA P MHS FKG
    31 PROV 7371146708780003
    32 7371096708980001
    33 7604144107870094
    34 7372044803930001
    35 7371109711670020
    36 7371044906960001
    37 7309125907010001
    38 7306076410010001
    39
    40
    41
    42
    43
    44
    45
    46
    47
    48
    49
    50
    HP
    089526296043
    082194799811
    081241549105
    08114443126
    081245154606
    082290302980
    085399086744
    081342406515
    085398140005
    085242848915
    085145383386
    081345962714
    081543313670
    081327643222
    085298713763
    085656656381
    082187046189
    085399369993
    08114091008
    081354808036
    082291811981
    085396140831
    082395176397
    082346420967
    085399414231
    081242966220
    082189355481
    085241000742
    081293492960
    085240850420

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