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 UPTD LABORATORIUM KESEHATAN DAERAH
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PROVINSI BANTEN
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FORMULIR PENERIMAAN SAMPEL COVID-19
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Asal Instansi : DINKES PANDEGLANG
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Tanggal Terima Sampel :
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Jam Terima Sampel :
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Kode Sampel Pengirim (Kab/Kota)Kode Sampel Penerima (Labkesda)Tanggal LaporanTanggal SwabSwab Ke-NAMA LENGKAPTGL , BULAN TAHUN LAHIRJKNOMOR INDUK KEPENDUDUKAN (NIK)STATUSInstansi Asal SampelSPESIMENAlamat (Jalan/Kampung)Telp/ Hp
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18-11-202011/18/20201AJIE MUJINARTO10/04/1973L3273131004730003MenikahLabkesda Pandeglangnaso - oroJL. PELANDUK DALAM NO.18/106, RT/RW 008/010, KEL/DESA. MALABAR, KEC. LENGKONG, KOTA BANDUNG.082160122552
11
18-11-202018/11/20201PUTRIE NOVIETA DEWI19/11/1983P3673055911830003MenikahLabkesda Pandeglangnaso - oroRAHAYU RESIDENCE CLUSTER ABIMANYU BLOK A5, NO.1, RT/RW 003/009, KEL/DESA. KAGUNGAN, KEC. SERANG, KOTA SERANG, BANTEN085959920020
12
18-11-202018-11-20201Hj. MEMI SURATMI S.Pd19/08/1963P3604025908530611Menikah
Labkesda Pandeglang
naso - oro
Jl. Cendrawasih No.230, RT/RW 004/009, Kel/Desa. Panancangan, Kec. Cipocok Jaya, Kota Serang, Banten
087877605605
13
18-11-202018-11-20201YAYAN INDRIYANI10/02/1983P3604015002831498Menikah
Labkesda Pandeglang
naso - oro
CENDRAWASIH NO.230, RT/RW 004/009, KEL/DESA. PANANCANGAN, KEC. CIPOCOK JAYA, KOTA SERANG, BANTEN
081907384164
14
23-11-202023-11-20201ERRU INDRA R10/06/1993L3601341006930001Belum Menikah
Puskesmas Pandeglang
naso - oro
KP. BABAKAN KARATON, RT/RW 001/012, DESA KARATON, KEC MAJASARI, KAB PANDEGLANG
081314148382
27
11-01-202111-01-20211ATINA SALAMA
Pandeglang, 20-08-1992
P3601231010900003KONTAK ERATPMI
NASO-ORO
Kp. KADU RONYOK, RT/RW.006/003, CISATA, PANDEGLANG81212045474
28
11-01-202111-01-20211DEDE LESMANASerang, 24-02-1972L3604052402720002KONTAK ERATPMI
NASO-ORO
JL. PURI ASRI 5 NO.16 PURI HIJAU REGENCY, TOYOMERTO, KEC. KRAMATWATU, SERANG
81219666363
29
11-01-202111-01-20211DEDE ZAENUDINSerang, 10-05-1980L3601341005800004KONTAK ERATPMI
NASO-ORO
kp. Sukasari RT/RW.006/005, SUKASARI, KADUHEJO, PANDEGLANG87771224474
30
11-01-202111-01-20211ERIN RACHMATIKASARILEBAK, 24-04-1989P3601196909890002KONTAK ERATPMI
NASO-ORO
JALAN AMD KP. CIPACING NO.90 RT/RW.001/003, KADU HEJO, PANDEGLANG
82123929676
31
11-01-202111-01-20211FANI APRILYANI
PANDEGLANG, 20-04-1983
P3601256005830002KONTAK ERATPMI
NASO-ORO
KOMPLEK KARANG INDAH RT/RW.004/007, KADUMERAK, KARANG TANJUNG, PANDEGLANG
81286346848
32
11-01-202111-01-20211FELIKSIANUS RENOL
SUMBAWA BESAR, 30-08-1987
L3602183008870001KONTAK ERATPMI
NASO-ORO
BTN GRIYA KADU AGUNG INDAH A/17, CIBADAK, LEBAK82124009419
33
11-01-202111-01-20211M. ABDUL RAHMAN NLEBAK, 30-05-1995L3602183005950001KONTAK ERATPMI
NASO-ORO
KP. PASAR KEONG RT/RW.0002/001, CIBADAK, LEBAK87806769694
34
11-01-202111-01-20211MOCHAMAD FAISAL NUR
PANDEGLANG, 14-09-1994
L3601191202950001KONTAK ERATPMI
NASO-ORO
KP. PABUARAN RT/RW.006/002, PALURAHAN, KADUHEJO, PANDEGLANG
82240342627
35
11-01-202111-01-20211RIZKA AMELIA
SERANG, 16-08-1997
P3604325608970002KONTAK ERATPMI
NASO-ORO
KP. PERAPATAN RT/RW.008.002, LABUAN, MANCAK, SERANG85219202955
36
11-01-202111-01-20211TIA YULIANITA RAHMAN
PANDEGLANG, 22-06-1992
P3601176206920001KONTAK ERATPMI
NASO-ORO
LINGK. KRAMAT JATI RT/RW.005/002, WARNASARI, CITANGKIL, CILEGON87880300576
37
11-01-202111-01-20211YANTI HAYATI NUFUS
PANDEGLANG, 10-06-1978
P3602145006780001KONTAK ERATPMI
NASO-ORO
BTN NARIMBANG C6 NO.20/RT/RW.005/007, JATIMULYA RANGKASBITUNG, LEBAK
85287887743
38
11-01-202111-01-20211YUYUN YUNARSIH
PANDEGLANG, 23-05-1972
P3601346305720001KONTAK ERATPMI
NASO-ORO
KP. CIEKEK KARATON RT/RW.001/008, KARATON, MAJASARI, PANDEGLANG
87878086808
58
59
115/02/202115-02-20211Hj. IRNA NARULITA, SE, MM23-07-1970P3173056307700004KONTAK ERATDINKESNP/OPcigadung, 001/005, kel/desa. cigadung, karang Tanjung
60
215/02/202115-02-20211NUR ROHMAN TRI WIDAGDO13-06-1986L3601171306860003KONTAK ERATDINKESNP/OPKADU JAMPANG, 001/002, PARI, MANADALAWANGI
61
315/02/202115-02-20211IMAM ABDURRAHMAN21-11-1991L3402092111910001KONTAK ERATDINKESNP/OPBAKULAN KULON, BANTUL, YOGYAKARTA
62
415/02/202115-02-20211FATMAH26-02-1998P3601116602980001KONTAK ERATDINKESNP/OPKP. CANGKEUTEUKEUN, 022/005, KADUBERA, PICUNG
63
515/02/202115-02-20211IMAS MASRIFAH15-10-1984P3601345510840001KONTAK ERATDINKESNP/OPSARUNI, 003/001, SARUNI, MAJASARI
64
615/02/202115-02-20211SUGALI16-09-1990L3601341609900001KONTAK ERATDINKESNP/OPMAJA TIMUR, 005/001, SUKARATU, MAJASARI
65
715/02/202115-02-20211SITI MAESYAROH10-07-1980P3601214107810068KONTAK ERATDINKESNP/OPKEBON CAU CIWASIAT, 001/012, PANDEGLANG
66
815/02/202115-02-20211MUNAH18-03-1971P3601315803710002KONTAK ERATDINKESNP/OPKP. KADUMALATI, 012/007, KADUMALATI, SINDANGRESMI
67
68
117/02/202117/02/2021H. ENTUS BAKTI, SH, MM20-10-1967L3601342010670004SUSPEKDINKESNP/OPKP. CIPACUNG RT/RW. 003/005, SARUNI, MAJASARI PANDEGLANGVVIP
69
217/02/202117/02/2021NANI WINARNI13-03-1968P3601341303680002SUSPEKDINKESNP/OPKP. CIPACUNG RT/RW. 003/005, SARUNI, MAJASARI PANDEGLANGVVIP
70
317/02/202117/02/2021TINI PRIHATINI02-01-2002P3601301030110002SUSPEKDINKESNP/OPKP. KADU DAMPIT RT/RW.003/001, KADU MALATI, SINDANG RESMIVVIP
71
72
126/02/202124/02/20212INDAH DINARSIANI23-01-1961P3601216301610001SUSPEKDINKESNP/OPJL. PUWOSENJOTO NO.6, 001/001, KEL. PUNTEN, KEC. BUMIAJI08129426188
73
226/02/202124/02/20211SIATI19-04-1973P3601215904730006KONTAK ERATDINKESNP/OPJL. PUWOSENJOTO NO.6, 001/001, KEL. PUNTEN, KEC. BUMIAJI08129426188
74
326/02/202124/02/20213TRI WASKITO BUDININGRAT23-07-1957L3601212307570001KONTAK ERATDINKESNP/OPJL. PUWOSENJOTO NO.6, 001/001, KEL. PUNTEN, KEC. BUMIAJI08129426188
75
76
102-03-202101-03-20213DONI MAULANA01-04-1974L3601121004740001KONTAK ERATDINKESNP/OPBUMI CIPACUNG INDAH BLOK D NO.3, 003/005, SARUNI, MAJASARI85215934530
77
202-03-202101-03-20212YETTY NURHAYATI28-09-1963P3601126809630001KONTAK ERATDINKESNP/OPKP. PANGUSEUPAN, 003/014. LABUAN, LABUAN8128963840
78
302-03-202101-03-20211ANDIKA EKO KRISTANTO02-01-1996L3601340201960005KONTAK ERATDINKESNP/OPKOMPLEK SARUNI PERMAI BLOK II NO.18, 002/009, SARUNI , MAJASARI85755656992
79
402-03-202101-03-20212AYU ELA BADRIAH, S.Sos29-10-1969P3601216910690002KONTAK ERATDINKESNP/OPKP. CIKONDANG, 002/010, PANDEGLANG81299134821
80
502-03-202101-03-20211MUHAMMAD MIRZA FARIS17-02-1995L3604011702950951KONTAK ERATDINKESNP/OPJL. KIAJURUM NO.38, 002/018, CIPARE, KOTA SERANG81911031436
81
602-03-202101-03-20211MARINA MEGA SARI15-01-1989P3672055501890002KONTAK ERATDINKESNP/OP
JL. PAUS NO.9, KAV. BLOK C, 001/006, MASIGIT, KEC. JOMBANG, CILEGON
85921566490
82
702-03-202101-03-20212ENDANG SUJANA24-12-1979L3601232412790001KONTAK ERATDINKESNP/OPPERUM RIKA RESIDEN BLOK E 9, 005/004, BABAKANLOR, CIKEDAL81398490855
83
802-03-202101-03-20212NENNY IRNAWATI20-09-1978P3601216009780001KONTAK ERATDINKESNP/OPKP. KADU GAJAH, 006/008, PANDEGLANG89512768000
84
902-03-202101-03-20212ASEP PAYUMI16-04-1975L3601141604750001KONTAK ERATDINKESNP/OPKP. CIANDUR, 004/002, CIANDUR, SAKETI87773075240
85
1002-03-202101-03-20212CICIH NURLAELA, SE. MM19-04-1978P3601214107800004KONTAK ERATDINKESNP/OPKP. JAJAWAY, 002/003, KADOMAS, PANDEGLANG87870878770
86
1102-03-202101-03-20213YAYU TRESNANI16-06-1965P3601215606650001KONTAK ERATDINKESNP/OPKP. CURUG SAWER, 003/009, PANDEGLANG81281632831
87
1202-03-202101-03-20211NANA MULYANA, S.Kom30-01-1983L3601343001830002KONTAK ERATDINKESNP/OPJL. RAYA LABUAN KM. 04, KP. CIPACUNG, 002/005, SARUNI, MAJASARI85217119986
88
1302-03-202101-03-20212A. SUTRESNA WAHYU25-04-1975L3601160107740006KONTAK ERATDINKESNP/OPKP. JIPUT, 002/001, JIPUT, PANDEGLANG85245879353
89
1402-03-202101-03-20212IDA JAHIDATULFALAH17-04-1970P3601215704700001KONTAK ERATDINKESNP/OPKP. KADU PANDAK, 004/011, PANDEGLANG8129793171
90
1502-03-202101-03-20212ANDRY EFFENDY, ST27-10-1981L3601212710810003KONTAK ERATDINKESNP/OPKP. KABAYAN MASJID NO,17, 004/002, KABAYAN, PANDEGLANG81315276226
91
1602-03-202101-03-20212MULYANTO11-12-1980L3172051812800005KONTAK ERATDINKESNP/OPKP. LEGOK SUKMAJAYA, 001/001, DRANGONG, TAKTAKAN, SERANG8176640960
92
1702-03-202101-03-20212YUDIA MUCHLISIN25-07-1990L3601212501900002KONTAK ERATDINKESNP/OPKP. KADUGEDONG, 004/001, BANJAR, PANDEGLANG -
93
1802-03-202101-03-20211Ir. GIRGIJANTORO11-09-1962L3601251109620001KONTAK ERATDINKESNP/OPKOMPLEK CIGADUNG SMA GIRI ELOK I, 001/013, CIGADUNG87878817999
94
1902-03-202101-03-20212AGUS ROPAUDIN25-10-1981L3601202510810001KONTAK ERATDINKESNP/OPKP. KADUGEDONG, 004/001, BANJAR, PANDEGLANG85710890018
95
2002-03-202101-03-20212AJAT JUHAEDI05-02-1983L3601250502830004KONTAK ERATDINKESNP/OPKP. PASIR HAUR, 001/004, KADUMERAK, KARANG TANJUNG81292647590
96
2102-03-202101-03-20212ANNISA DIAN FEBRYANTI22-02-1992P3601346202920001KONTAK ERATDINKESNP/OPKP. CIEKEK LOR, 003/005, KARATON, MAJASARI89628612168
97
2202-03-202101-03-20213SUWARDI27-01-1967L3601341702680002KONTAK ERATDINKESNP/OPJL. GARUDA, 003/009, SARUNI, MAJASARI87888833804
98
2302-03-202101-03-20212EVAL ARIFAL ZEIN30-09-1975L3601213009750002KONTAK ERATDINKESNP/OPKOMP. SARUNI INDAH RESIDEN BLOK B, 007/009, SARUNI, MAJASARI81299162430
99
2402-03-202101-03-20212AYU UMI RURY DESYANI23-12-1986P3601216312860001KONTAK ERATDINKESNP/OPKP. CIDANGIANG, 003/002, SARUNI, MAJASARI81218599279
100
2502-03-202101-03-20213ARIEF SETIADY25-12-1981L3601212512810004KONTAK ERATDINKESNP/OPKP. CIHASEUM, 002/006, PANDEGLANG85282553456
101
2602-03-202101-03-20212LINDA SULASTRI01-02-1984P3601056505860002KONTAK ERATDINKESNP/OPKOMPLEK GREEN HILLS, 006/002, SARUNI, MAJASARI81398374493
102
2702-03-202101-03-20211LUKIANA HAKIM08-07-1979L3601210807790001KONTAK ERATDINKESNP/OPKP. CIKONDANG, 004/010, PANDEGLANG87741099333
103
104
105
102/03/202102/03/20213AL ANSHAR NUR05/10/1982L3601210510820005KONTAK ERATDINKESNP/OPKP. KADUGAJAH, 003/008, PANDEGLANG87771113635
106
202/03/202102/03/20214CANTHIKA TRINAYA03/03/1996P3601214303960001KONTAK ERATDINKESNP/OPKP. KABAYAN KOTA, 001/013, KABAYAN, PANDEGLANG81250062244
107
302/03/202102/03/20211FALAH ERDI PERMASANDI13/12/2008L3601341312080002KONTAK ERATDINKESNP/OPPAHLAWAN SALMIN, 001/001, KADOMAS, PANDEGLANG85939981287
108
402/03/202102/03/20212R. KARNA SUYANA09/02/1981L3601190902810002KONTAK ERATDINKESNP/OPKOMPLEK BADAK PERMAI, 001/009, KADUHEJO-
109
502/03/202102/03/20212NINDYA SULISTYA ANSHAR04/09/2015P3601214409150001KONTAK ERATDINKESNP/OPKP. KADUGAJAH, 003/008, PANDEGLANG87771113635
110
602/03/202102/03/20212MUHAMAD NUR ALFIN ANSHAR25/11/2011L3601212511110001KONTAK ERATDINKESNP/OPKP. KADUGAJAH, 003/008, PANDEGLANG87771113635
111
702/03/202102/03/20211SITI NURLELA14/02/1986P3601215402860007KONTAK ERATDINKESNP/OPKP. KADUGAJAH, 003/008, PANDEGLANG87771113635
112
113
114
110-03-202109-03-20214RIZKI FAJAR RAHAYU24-06-1990L3604012406901243KONTAK ERATPENDOPONP/OPKP. MAJA BARAT, 004/003, SUKARATU, MAJASARI8176915671
115
116
118-03-202118-03-20212ALDI SEPTIADI04-09-1996L3601250409960005KONTAK ERATPENDOPONP/OP
KOMP. BOUGENVILLE BLOK B15, 003/007, KADUMERAK, KARANG TANJUNG
81290193019
117
218-03-202118-03-20211DEDI MULYADI07-07-1964L3601250707640001KONTAK ERATPENDOPONP/OP
KOMP. BOUGENVILLE BLOK B15, 003/007, KADUMERAK, KARANG TANJUNG
81290193019
118
318-03-202118-03-20211NOVA NIA MULYANI04-11-1987P3601254411870002KONTAK ERATPENDOPONP/OP
KOMP. BOUGENVILLE BLOK B15, 003/007, KADUMERAK, KARANG TANJUNG
81290193019
119
418-03-202118-03-20211SUSI SUSILAWATI09-09-1966P3601254909660001KONTAK ERATPENDOPONP/OP
KOMP. BOUGENVILLE BLOK B15, 003/007, KADUMERAK, KARANG TANJUNG
81290193019
120
121
118-03-202118-03-2021ETI SUHAETI01-01-1961P3601214101610002SUSPEKDINKESNP/OPKP. KABAYAN CITIIS, 002/001, KABAYAN, PANDEGLANG
122
218-03-202118-03-2021NELI MEGIAWATI09-02-1989P3601214902890002SUSPEKDINKESNP/OPKP. KABAYAN CITIIS, 002/001, KABAYAN, PANDEGLANG
123
318-03-202118-03-2021YAYAN PRIYATNA05-09-1958L3601210510570001SUSPEKDINKESNP/OPKP. KABAYAN CITIIS, 002/001, KABAYAN, PANDEGLANG
124
125
122-03-202122-03-20211
RATU SITI ALIFAH DZATILIZZAH
17-04-2006P3601345510060001SUSPEKPENDOPONP/OPKP. SARUNI, 003/001, SARUNI, MAJASARI
126
127
125/03/202125/03/20211SUTOYO12-03-0162L3601251203620001SUSPEKDINKESNP/OPKOMP CIGADUNG MANDIRI BLOK B3, 003/010, CIGADUNG
128
129
1128-05-202128-05-20211EUIS NOVITASARI10/06/1988LAKI LAKI3601195006880005SUSPEKPKM CIMANUK
Nasoparing + oroparing
KP.GAROKGEK DS CAMPAKA KADUHEJO87774275338
130
2228-05-202128-05-20211ANINDIA RASYA21/12/2007LAKI LAKI3601182112070002KONTAK ERATPKM CIMANUK
Nasoparing + oroparing
KP CIHIDEUNG DS BATUBANTAR KEC CIMANUK83872491719
131
3328-05-202128-05-20211ANINDIA RIFAT19/05/2012LAKI LAKI3601181905120001KONTAK ERATPKM CIMANUK
Nasoparing + oroparing
KP CIHIDEUNG DS BATUBANTAR KEC CIMANUK83872491719