FORMULIR JUMANTIK

Hasi Pemeriksaan : :PERUM CANDRA KARTIKA

Tanggal/Bbln :….../….../20….
RT/RW : ,03/10
Desa/Kec Suwayuwo
Kec/Puskesmas : Sukorejo

NO NAMA KEPALA KELUARGA ALAMAT JENTIK KETERANGAN

[+] [-]
1 Bp putut
2 Bp M Sibly
3 Bp Nasik
4 Bp Zaenal
5 Bp Ismono/Sunaryo
6 Bp Samudi
7 Bp Yofi
8 Bp Fauzi
9 Bp Frandyas
10 Bp Bisri
11 Bp Rendra
12 Kosong kosong
13 Bp Adi
14 Kosong kosong
15 Bp Kotot
16 Kosong kosong
17 Kosong kosong
18 Bu Cik
19 Bp Kanif
20 Kosong B
21 Proyek

keterangan : Suwayuwo: …...../….../…..

positif [+] di mana kaleng bekas
contoh : -Bak Mandi Ban bekas Petugas Jumantik.
Drum Dispenser
Tempayan Tempat Minum Burung
Pecahan Botol
BU ANIK D
…...../….../…..
 DATA VAKSINASI WARGA RT 06 / 10 YANG SUDAH DIVAKSIN
PERUM CANDRA KARTIKA
SUWAYUWO
No Nama Umur NI K Tgl Vaksin 1 Tgl Vaksin 2
`1 Catur Widiastuti 54 .3514096102670002 8/31/2021 9/27/2021
2 Wahyu Drajaty puspita N 24 .3514095905970001 8/31/2021 9/27/2021
3 Muhammad Suradi 45 .3514141208760004 1/18/2021 4/1/2021
4 Khusnul Farida 44 .3514145705770007 10/25/2021 -
4 Muhammad Alif Alfaruq 16 .3514141606050003 9/6/2021 10/5/2021
6 Syifau Ardhina D 13 .3514145511080001 9/1/2021 9/30/2021
7 Mahmudi 65 .3514092303560002 5/3/2021 5/31/2021
8 Elyya Magfirly 48 .3573014907730009 5/6/2021 6/3/2021
9/D Wahmudji 54 .3578121206670003 6/26/2021 8/9/2021
10/D Sulastri 55 .3678125503660002 10/14/2021 -
11/D Rahmad Doni 22 .3578120612999002 9/22/2021 10/23/2021
12 Ilham Santoso 40 .3514090502810002 7/10/2021 8/7/2021
13 Fitri Kusyuliarti 38 .3514096207830001 - -
14 Muhammad Gilang R 15 .3514091210060003 9/21/2021 -
15 Tutik Indayani 43 .3514096401780001 8/15/2021 -
16 Refansha Road 15 .3514091207060001 9/6/2021 10/4/2021
17 Sudirman 68 .3514092008630002 5/24/2021 6/22/2021
18 Urip Nanik 66 .3514095407550002 5/24/2021 6/22/2021
19 Afrizal yusuf puto U 22 .3514091606990001 10/24/2021 -
20 Enny Femiliana 44 .3514094205770002 10/25/2021 -
21 Sutanto 37 .3514090106840004 8/15/2021 9/16/2021
22 Ruth Martha Christina 40 .3514094505810005 7/23/2021 9/29/2021
23 Ivander Nathan Gavrila 13 .3514091304080001 10/13/2021 -
24 Bernad Nainggolan 52 .3514090909690002 6/8/2021 7/6/2021
25 Dwi Ari Kusyanti 43 .3514090202780002 3/24/2021 4/7/2021
26 vincentus Azzi Nainggolan 13 .3514090107080002 7/1/2021 -
27 Lasiatin 66 .3514095008550001 - -
28 Denny Falintin0 17 .3514090407040006 10/4/2021 -
29 Ruddy Hernawan 44 .3514093101770001 4/29/2021 7/28/2021
No Nama Umur NI K Tgl Vaksin 1 Tgl Vaksin 2
30 Novie Yohana M 48 .3514093111730001 10/12/2021 -
31 Chris Nazareta A 16 .3514090105050001 9/14/2021 10/12/2021
32 Edy Sapto Yogiono 61 .3514090407600002 5/24/2021 6/22/2021
33 Hervin Tiasih 59 .3514094107620002 - -
34 Hartono 54 .3514092711670004 6/8/2021 0607-21
35 Amik Wilujeng 45 .3514094010760001 9/18/2021 10/20/2021
36 Afrizal wilton Pratama 22 .3614090611990001 9/6/2021 10/7/2021
37 Andika Wilton Ramadhan 16 .3714091310050004 8/5/2021 10/2/2021
38 Siswo Polandono 62 .3814090501590001 5/21/2021 6/17/2021
39 Sri Harminingsih 55 .3914095610660001 6/8/2021 7/6/2021
40/D RA Martha Ratu Riskiyah 36 .3528046003850005 10/11/2021 -
41/D Rizki Kurniawan Putra 28 .3528041610930001 10/18/2021 11/17/2021
42 Jelly Mangesa 54 .3514097006670004 5/5/2021 6/2/2021
43 Fira Nafiri 40 .3515046801810001 9/22/2021 10/23/2021
44 Teguh Hari Wibowo 43 .4414090609780002 6/26/2021 7/26/2021
45 Nina Yulistiana 42 .4514094407790006 6/26/2021 7/26/2021
46 Nadira Berliana Cyril 16 .4614096404050004 9/9/2021 10/14/2021
47 Raditya Syarifatur Riyad 14 .4714092008070001 8/28/2021 10/11/2021
48 Lorensius Sulistyono 57 .3514111008640002 6/9/2021 7/7/2021
49 Cicilia Indraswari 49 .4914115009720003 7/10/2021 9/11/2021
50 Agata Irine Wulandari 23 .5014114201980001 7/10/2021 9/11/2021
51 Benidiktus Briannata 19 .5114112809020002 7/10/2021 9/11/2021
52 Suwoto 56 .5214090611990001 6/26/2021 8/9/2021
53 Titik Suyati 50 .5314090611990001 9/14/2021 10/18/2021
54 Novia Triswayanti 26 .5414090611990001 8/7/2021 9/4/2021
55 Akbar Dwi Wirananda 21 .5514090611990001 9/15/2021 10/13/2021
56 Sukhartono 51 .5614090803700002 6/8/2021 -
57 Yety Sandrarini 47 .5714095006740001 9/22/2021 10/23/2021
58/D Muhammad Imron Syam 49 .3514110803720007 3/18/2021 4/1/2021
59/D Novie Diah Angraini 45 .3514114911760002 3/18/2021 4/1/2021
60/D Muhrandy Adiwinata 17 .3514111501040002 8/16/2021 9/18/2021
61 Lukman Hakim 38 .3520061709830003 8/4/2021 8/25/2021
62 Jefri Farisa 30 .3516120501910006 9/25/2021 -

No Nama Umur NI K Tgl Vaksin 1 Tgl Vaksin 2

63 Muoch. Syaiful Anwar 51 .3514091008700003 6/8/2021 7/6/2021
64 Inawaroh 44 .3514094603770001 9/10/2021 -
65 Egtsani Alfatkhus Shivana 18 .3514096905030001 9/10/2021 -
66 Moch.Syamsudin 27 .3514092707940001 10/14/2021 -
67 Frisca Vega Hardin 21 .3514086109000003 10/14/2021 -
68 Nurul Alfiyah 30 .3514095212910009 9/25/2021 -
69 Isnawati 68 .3514112811530001 - -
70 Deannaz Jasmine Ananda 31 .3514096503900001 7/28/2021 -
71 Ahmad Ilyasa 23 .3573011209980004 8/31/2021 -
72 Afif Yusra Abrisam 13 .3573012004080002 10/12/2021 -
73 Mulyadi 60 .3514091706610001 6/26/2021 8/9/2021
74 Anis Farida 53 .3514094604680001 7/14/2021 8/4/2021
75 Dinda Maydita Rahma 23 .3514095205980001 9/22/2021 10/27/2021
76 Syahanda Boby Adiansyah 20 .3514090108010002 7/21/2021 8/19/2021
KSIN
 DATA VAKSINASI WARGA RT 03 / 10 YANG SUDAH DIVAKSIN
PERUM CANDRA KARTIKA
SUWAYUWO
No Nama Umur NI K Tgl Vaksin 1 Tgl Vaksin 2
`1 B sumarniyanti 64 .3514096403570001 5/5/2021 6/2/2021
2 wawan kristanto 34 .3514090705870001 8/3/2021 8/31/2021
3 Heru suprawito 49 .3514091302720001 4/29/2021 7/28/2021
4 Anik Dwi R 47 .3514095104740001 9/21/2021 -
4 Nur Rizki Rahmatulloh 20 .3514092204010005 7/6/2021 8/3/2021
6 Laily Roudhotul Jannah 13 .3514096905080001 10/2/2021 -
7 Siti Asiyah 62 .3514097006590008 - -
8 Arif Yuwono 38 .3514091409830001 - -
9 Rendra Kurniawan 25 .3514090103960004 9/25/2021 -
10 ELI Agustina 25 .3514095608960002 7/14/2021 8/11/2021
11 Sunarti 58 .3514096707630001 8/15/2021 9/16/2021
12 Cindy Ratna kurniawati 17 .3514094401040001 9/14/2021 -
13 M Salman Alfarisi 31 .3524260909900002 8/16/2021 9/19/2021
14 Anita Dwi Siswanti 37 .3519106912840003 8/16/2021 9/19/2021
15 Suparlan 55 .3514090908660001 7/10/2021 8/11/2021
16 Sunarti 56 .3514094606650002 7/10/2021 8/11/2021
17 Ainun Husnia Susanti 24 .3514094209970003 6/30/2021 8/9/2021
18 Ari Sulistiono 43 .3570306608780009 - -
19 Ririn Holida 38 .3573036005830011 - -
20 Annisa Putri Rahmania 17 .3573034310040002 - -
21 Aisyah Ezza Fira Rodiana 12 .3573035701090003 - -
22 Muji Hartono 49 .3514091406720004 5/27/2021 6/24/2021
23 Kasmiyati 43 .3514095111780003 sakit sakit
24 Dani Rahmad Hartono 23 .3514091312980001 9/19/2021 belum
25 M Aang Ariadin utama 35 .3506040806860002 - -
26 Paulina Meri Andayani 34 .3573026901870002 - -
27/D Wiwit Kurniawan 39 .3517141711820002 7/16/2021 9/11/2021
28/D Nur Iswati 33 .3517145902880001 - -
29/D Muhammad Wildan Akbar 12 .3517140511090002 - -
30 Rio - -
31 Imam 59 .3525180912620001 6/26/2021 7/14/2021
32 Kemiati 55 .3514096212660001 6/26/2021 7/14/2021
33 Puput Larasati Sutopo 23 .3514094611980001 malang malang
 No Nama Umur NI K Tgl Vaksin 1 Tgl Vaksin 2
34 Rahmawanto 62 .3514092401590001 5/5/2021 6/4/2021
35 Juliati Pangesti 61 .3514095007600002 9/21/2021 -
36 Arma losa Pangestian 36 .3514090512850001 9/21/2021 -
37 Ardy Tirta Pranata 31 .3514090709900002 9/21/2021 -
38 Ida Hardjanti 58 .3514097112630001 9/9/2021 10/9/2021
39 Muhammad Langgeng Prako 26 .3514091411950001 3/28/2021 6/17/2021
40 Muuammad GeryKhalid 16 .3514092207050002 10/5/2021 -
41 Moh Kosaeri 49 .3514091708720003 7/14/2021 9/2/2021
42 Farida 48 .3514095908730001 10/11/2021 -
43 Moch jibril Nofa 16 .3514090911050007 10/5/2021 -
44 Moch Syafig Nofa 12 .3514090510090003 10/22/2021 -
45 Dariyati 55 .3514096702660001 6/23/2021 7/26/2021
46 Dhoni Prasetyo 37 .3514090512840003 10/25/2021 -
47 Vina Indrikumalasari 24 .3514090003870001 10/11/2021 -
48 Claryza Yuniar Prasvinansya 12 .3514096406090001 - -
49 I Wayan Sudiastika 56 .3514090105650003 6/23/2021 7/26/2021
50 Ni MadeNurani 53 .3514095401680001 6/23/2021 8/7/2021
51 Putu DeviYulianingsih 25 .3514096607960001 6/30/2021 7/31/2021
52 Kadek RahayuWidiastari 18 .3514096006030001 9/20/2021 -
53/D Supriyanto 47 .3514101512740004 6/16/2021 7/14/2021
54/D Indah Dwiyanti 38 .3514106206830004 3/31/2021 4/14/2021
55/D M.Amiruzzaky 15 .3514102404060001 8/11/2021 9/13/2021
56/D Firmandes Amalo 42 .3525141402790002 9/18/2021 10/16/2021
57/D Khalifatus Saadah 42 .3524226106790001 9/18/2021 10/16/2021
58 Eko Dadang Irawan 47 .3507253001740006 7/13/2021 8/12/2021
59 Adminah 45 .3507255002760006 - -
61 Lugianto 30 .3523150410910001 surabaya surabaya
62 Amanda Sheila Putri B 21 .3507255209000002 - -
63 Ismono 60 .3514092204610001 10/12/2021 -
64 Moendi Astuti 61 .3514096305610001 10/6/2021 -
66 M uchammad Rizal R 26 .3578032707950003 8/24/2021 9/21/2021
67 Eka Fitrianingsih 26 .3514094203950003 9/6/2021 10/4/2021
68 M. Untung Yahya 60 .3573041608610005 6/8/2021 7/6/2021
69 Suyati 63 .3573046807658004 6/9/2021 7/8/2021
70 Fauzan 53 .351409512680001 6/26/2021 8/4/2021
71 suparsih 49 .3514094809720002 8/31/2021 9/28/2021
72 M. Revo Ferniadi 19 .3514091306020001 8/25/2021 9/22/2021
73 Sunarti 47 .3514097006740014 9/9/2021 10/6/2021
74 Achmad Akbar Sanjani 27 .3578042301620002 10/15/2021 10/10/2021

No Nama Umur NI K Tgl Vaksin 1 Tgl Vaksin 2

75 Usman 59 .3578042301620002 8/15/2021 10/9/2021
76 Suwaibah 53 .3578046301680007 8/15/2021 10/9/2021
77 Wildan Triana Putri 20 .3513095409010005 7/10/2021 8/7/2021
78 Samudi 60 .3514092303610001 6/8/2021 7/6/2021
79 Nur Ichmawati 54 .3514095602670001 6/8/2021 7/6/2021
80 Layyinatur Rahmawatie 23 .3514095306980001 7/22/2021 8/19/2021
82 Muchammad Ari Hidayat 19 .3514091102020001 9/15/2021 -
83 M Abdullah Sibli 50 .3514090410710003 8/15/2021 9/16/2021
84 Kuma'inah 48 .3514095909730001 8/26/2021 -
85 Muhammad Afif Bahram 22 .3514091409990002 8/15/2021 9/16/2021
86 Muhammad Sholahuddin Ala 16 .3513091604050002 9/9/2021 10/20/2021
87 Cahyo Heri Putut Sulindra 51 .3514090304700003 7/7/2021 6/9/2021
88 Tri Susilowati 53 .3514096505680001 7/7/2021 6/9/2021
89 Ivella Indra Cahyawati 21 .3514096811000002 6/12/2021 7/12/2021
90 Fidela Cahyawati 13 .3514095112080003 8/29/2021 9/27/2021
91 Frans Raharjo 59 .3514090706620001 6/23/2021 8/9/2021
92 Suhartati 54 .3514094503670001 6/23/2021 8/15/2021
93 Satria Beta Suharjoputra 23 .3514092301980001 10/4/2021 -
94 Gery Gamawanto 18 .3514092909030001 10/4/2021 -
95 Thomas Sudirman 60 .3514112904610001 7/22/2021 8/19/2021
96 Sri Wahyuni 57 .3514114202640001 7/26/2021 8/24/2021
97 Theresia Dina Lestari 27 .3514116001940001 7/26/2021 8/24/2021
98 Julius Gidion Winarto 19 .3514111507020001 7/26/2021 8/24/2021
99/D David Satriani 29 .3506251305920001 9/10/2021 10/8/2021
100/D Novita Yuliarta 29 .3506246607920001 9/11/2021 7/26/2021
101 Nonor Basworo 54 .3514092601670001 10-07021 8/7/2021
102 Uswatun Khasanah 54 .3514094304670003 6/23/2021 7/26/2021
103 Fathony Nur Bastian 25 .3514090108960001 10/15/2021 -
104 Rahma Nur Rafina 20 .3514096103010003 7/31/2021 10/24/2021
105/D Endang Utami 55 .357823309660001 7/17/2021 8/20/2021
106/D Gunawan 50 .3573041810710008 10/11/2021 -
107 Frandiyas Agusmanto 43 .1671092508780010 - -
108 Liza Dewi Lestari 44 .1671096103770007 - -
109 Rendra Graha 36 .3577031406950002 jakarta jakarta
110 Siti Yayak Mardiyati 36 .3524135501860001 7/10/2021 8/7/2021
111 BM Arif Syarifudin Romadho 35 .3524011205860001 10/8/2021 -
112 Yesi Nisa Ariani 28 .6474016307930004 7/30/2021 10/8/2021

No Nama Umur NI K Tgl Vaksin 1 Tgl Vaksin 2

113/D Khanif 55 .3578031102650002 9/6/2021 10/4/2021
114/D Muawiyah 54 .3578036712670001 sakit sakit
115/D Ainin diahDewi Sakina 21 .3578034306000004 9/2/2021 10/4/2021
116/D Ahmad Fadlan Aliyafi 20 .3578030111000001 9/2/2021 10/2/2021
117 Hendra Sulistyowati 43 .3573046708780008 10/11/2021 -
118 Kotot Saktiono 61 .3514090409600001 6/8/2021 7/6/2021
119 Sri Darnanik 61 .3514096301600001 6/8/2021 7/6/2021
120 Dwi wayu Oktavianto 31 .3514090310900005 10/11/2021 -
121 Ulfa Rida 33 .3512028110880001 10/11/2021 -
122 Muhammad Nasikh 50 .3514092308710001 6/28/2021 7/27/2021
123 Astutik 46 .3514095509750008 7/12/2021 8/7/2021
124 Fauzyyah Alya Ludya 21 .3514096807000002 8/15/2021 10/3/2021
125 Arbiyan Syauqinur Muhamm 14 .3514092102070001 8/15/2021 10/3/2021
126/D Sunaryo 52 .3277022712690010 7/22/2021 8/19/2021
127/D Alfiyah Kusumaningsih 46 .3277026507750019 8/15/2021 9/19/2021
131/D Yosita Kusuma Dewi 22 .3277025301990018 8/2/2021 10/23/2021
129 Tzar Daud Ariayudha 29 .3514112807920002 9/21/2021 -
130 Dewi Arta Utami Lidya Sendi 28 .3514096401930001 9/21/2021 -
131/D Zaenal Alim 35 .3514100606860004 8/3/2021 8/24/2021
132/D Fitri Wulandari 30 .3514105640910002 7/10/2021 8/7/2021
133/D Achmad Fauzi 53 .3578122502880001 8/26/2021 -
134/D Liberty Bintang Anasti 30 .3306156206910004 10/16/2021 -
No Nama Umur NI K Tgl Vaksin 1 Tgl Vaksin 2
No Nama Umur NI K Tgl Vaksin 1 Tgl Vaksin 2
k
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 PEMBERIAN VIT A /C
Juli 2021

NO NAMA BALITA NAMA ORANG TUA TGL LAHIR UMUR

1 M RASKA ANDIKA/AYU FITRI 12/5/2020 8 BlN

2 NADIA ST KHUSNUL/RULLY 12/2/2018 2th 4bln
3 RAFQI ALFARFAREL IRENG ELISABET/DONY 2/17/2021 6 BLN
4 NAORA SALSABILA EKA LUTFAL/SULTON 8/17/2020 11 BLN
5 HERA FELISIA ANGGUN/ARISKI 3/10/2020 1th 5bl
6 MALIKA SAFIYA DIAH SAFITRI/M RIZZA 10/10/2020 10 BLN
7 FEIVEL GABRIEL KARTIKA SARI/DAVIN 8/18/2020 11 BLN
8 ESHA L RASYAF H HEGY TASYA/EFENDY 12/3/2020 9 BLN
9 SUDIRMAN SHAHZAD DEWI ARTA/TZAR DAUD 8/5/2019 2 th
10 ASKA ABIMANYU Y RESA/YOGI 4/19/2020 1th 4bl
11 ANELLA SRIWULANSARI/BUDI S 10/30/2020 9 BLN
12 EDGAR SAGARA ISMA/WASITTA 8/27/2020 11BLN
13 M. JIBRIL AL FATIH RIZKI/ARI IRAWAN 10/1/2018 2th 8bln
14 CHELSY ANISA/SLAMET 7/3/2019 2 th
15 CLEMIRA ELY/HENDRA 3/29/2019 2 th 5bln
16 NOVALIN TIARA EKA/RIZAL 10/23/2019 1th 9 bln
17 KENJI LINDA/YOFI 7/10/2017 3th 1 bln
18 ARKA MARDHA/ARIFIANTO 2/8/2018 3TH 6BL
19 GLORIA ALEXANDRA FELY/FERDY 4/7/2020 1TH 4 BL
20 NATASA FELY/FERDY 4/22/2018 2th 4bln
21 PRITA YULIA P MARTINI/YULIANTO 7/17/2018 3TH 2 BLN
22 NAFISA DIAN/ENGSUN 10/23/2020 1th 10bln
23 keano isma/wasitta 12/5/2016 4th 8bln
24 SAKILA AU;IA LILIS /ARMA LOSA 12/23/2010 4th 8bln
25 ZAFIRA INDAH/ M WAHID 5/30/2018 3th3bln
26 AURA MEGA PAULINA/AANG 6/14/2016 3TH 2 BLN
27 NOUVAL ZAKI APRILIA/DAVID 1/13/2020 1tn 7bln
28 BAGAS DWI S DWI ARINI/EFENDI 1/30/2019 2TH 7BLN
29 KENS0 ULFA/AFI 1TH
30 RAISANG DAMAR ANISA/SULUH 12/15/2019 1.5 TH
31 NALLA ANITA/FARIS 7/25/2017 3.9 TH
32 HAIDAR INDAH/SUPRIYANTO 5/6/2017 4.5 TH
33 CAKRA INDAR P VINA/DONI 4/27/2016 4.5 TH
34 MIKAILO ALI M/MIKE 4/28/2016 4.5 TH
35 LEANDER DEVI/LUCKYTA 2/10/2017 4.5 TH
36 SAMUE STEVAUS/INEKE 4/15/2017 4.5 TH
37 ATISA MIKAILA RUDY/YUNI A 5/17/2016 4,5TH
38 WILONA AJENG/TRI SUGIANTO 5/18/2016 4,5TH
39 ADHIYATSA FRANDYAS/LISA 9/2/2016 2TH
40 GENIO SALSABILA RIO C/SRI R 5/27/2018 3TH
41 REY AL FATIH SULI/AYU 9/9/2019 2TH
42 NAFISA IMAMA/MUJAINI 12/5/2019 2TH
43 AZKA ABIMANYU REZA F/YOGI
44 NAOVALIN TIARA R eka fitria
 VIT A/C

6-11 : 9

v 1-2 THN : 12
v
2-5 THN : 21
v
v
v
v
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v
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3TH 2 BLN
v
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v
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v
V
V
 DAFTAR HARGA ROKOK PER SEPTEMBER

SAMPOERNA HARGA JUAL

1 DJISAMSU 16 23000
2 DJISAMSU 12 17500
3 ULTRA MILD 16 22000
4 ULTRA MILD 12 0
5 AMILD 16 23000
6 AMILD 12 18000
7 MARLBORO All 31000
8 MARLBORO ADVEND 17500
9 MARLBORO KRETEK 8500
10 BAJA 7000
11 MARLBORO BLAC 12 19000
12 MARLBORO BLAC 16 31000
13 AGA 12700 14000
14 A G A +2 12600 14000
15 MAGNUM HITAM 18000
16 MAGUM MILD 21000
17 DJARUM SUPER 19000
18 DJ NEXT 18000
19 DJ GEO MILD 17000
20 DJ GEO KRETEK 5000 7000
DJ LA LIGHT 24000
DJ LA BOLD 20 26000
CHIEF
ZIGA
GG SURYA 12 18100 20000
GG SURYA 16 24000 25500
GG INTER 18100 20000
SURYA PRO MERAH 20000 21500
SURYA PRO PUTIH 20000 21500
GG HIJAU
GG MERAH
DUNHILL
LUCKY STRIKE
COUNTRY
ARIES HITAM 10300 12000
ARIES BIRU 10300 12000
ARIES MERAH 10300 12000
 BUKU HARGA/pk HARGA
Buku Sidu 38 28000 3500
Buku sidu 58 38000 4500
Buku vision 38 27000 3500
Buku Boxy 26000 6000
Buku Gambar Dodo 4000
Buku Gambar Sidu 4500
Buku Gambar A3 Dodo 7500
Buku Gambar A3 Sidu 8500
NO Nama Peserta BPJS Vaskes
POSYANDU :
RT / RW :
NAMA ANAK :
AYAH :
IBU :
TGL LAHIR :
UMUR :
BERAT BADAN :
TINGGI BADAN :
LING KEPALA :
IMUNISASI :
KB :

POSYANDU TGL :
RT / RW :
NAMA ANAK :
AYAH :
IBU :
TGL LAHIR :
UMUR :
BERAT BADAN :
TINGGI BADAN :
LING KEPALA :
IMUNISASI :
KB :

POSYANDU TGL :
RT / RW :
NAMA ANAK :
AYAH :
IBU :
TGL LAHIR :
UMUR :
BERAT BADAN :
TINGGI BADAN :
LING KEPALA :
IMUNISASI :
KB :
POSYANDU :
RT / RW :
NAMA ANAK :
AYAH :
IBU :
TGL LAHIR :
UMUR :
BERAT BADAN :
TINGGI BADAN :
LING KEPALA :
IMUNISASI :
KB :

POSYANDU :
RT / RW :
NAMA ANAK :
AYAH :
IBU :
TGL LAHIR :
UMUR :
BERAT BADAN :
TINGGI BADAN :
LING KEPALA :
IMUNISASI :
KB :

POSYANDU TGL :
RT / RW :
NAMA ANAK :
AYAH :
IBU :
TGL LAHIR :
UMUR :
BERAT BADAN :
TINGGI BADAN :
LING KEPALA :
IMUNISASI :
KB :
 NUR RIZKI RAHMATULL {082233825273}

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