ABCDEFGHIJKLMNOPQRSTUVWXYZAAABACADAEAFAGAHAIAJAKALAMANAOAPAQARASATAUAVAWAXAYAZBABBBCBDBEBFBGBHBIBJBK
8
NoNamaJenis KelaminJenjangKelasNISNNIKTempat Lahir Tgl LahirUsia (Ulang tahun terakhir)AlamatNo. HPDisabilitasHasil Pemeriksaan FisikKesimpulanIMUNISASI MRIMUNISASI DT
9
Faktor Resiko Gula Darah AnakResiko MalariaGejala Depresi AnakRiwayat Imunisasi Rutin Anak SekolahResiko HepatitisFaktor Resiko TBPenyakit Kusta Anak SekolahPenyakit SkabiesGiziTekanan DarahTelingaMataJumlah Gigi Karies
10
BB (kg)TB (cm)Indeks Massa Tubuh (kg/m2)IMT/U (SD)Status GizimmHgKlasifikasiTajam PendengaranSerumenInfeksi (cairan)Mata Juling / Pupil PutihTajam PenglihatanPenggunaan Kacamata
11
PLYaTidakYaTidakYa (1/2/3/4)Ya (1/2/3)YaTidakYa (1/2/3/4)Ya (1/2/3/4)YaTidakYaTidakGizi Buruk
< -3SD
Gizi Kurang
-3SD sampai < -2SD
Gizi Baik
-2SD sampai +1SD
Gizi Lebih
> +1SD sampai +2SD
Obesitas
> +2SD
Normal: Sistolik dan diastolik < persentil 90Prahipertensi: Sistolik dan diastolik ≥ persentil 90 tetapi <persentil 95, atau 120/80 mmHg tetapi < persentil 95Hipertensi tingkat 1: Sistolik dan diastolik diantara persentil 95 dan persentil 95 +12 mmHg
atau 130/80 mmHg -138/89 mmHg
Hipertensi tingkat 2: Sistolik atau Diastolik ≥ persentil
95 + 12 mmHg atau ≥140/90 mmHg
NormalCuriga GangguanTidak AdaAdaTidak AdaAdaNormalCurigaNormalCuriga GangguanTidakYaTidak AdaKaries (1/2/3/>3)RujukTidak RujukImunisasi Yang di TerimaTanggal ImunisasiNo. BatchImunisasi Yang di TerimaTanggal ImunisasiNo. Batch
12
1Abizar Pratama NoviantoLSD1A31968629103276092809190003Depok2019-09-28JL. H Usman No.79 A089508440160VVV0V00VV1203390/60VVVVVV>316/8/2026
13
2ADLINA PUTRIPSD1A32092001253276094203200003JAKARTA2020-03-02JL.PULO PANJANG8990969054vv00v00vv1172490/60vvvvvv>316/8/2026
14
3AFIFAH NAHDA RAFANDAPSD1A31972707673276045010190002DEPOK2019-10-10Jl. H. Saimin Kp Utan85810500795vv00v00vv1202287/62vvvvvvv16/8/2026
15
4Akhtar Ziorazqa Aryan PutraLSD1A31884209563174031608180002Jakarta2018-08-16Jl. Kapten Tendean Gg. Jati No. 2681281811861VV00V00VV1202090/60VVVVVV116/8/2026
16
5ALFIAN YASSIR HAMZAHLSD1A31956119303276091206190005JAKARTA2019-06-12JL. MELATI I NO. 3785771972027vv00v00vv1201990/60vvvvvv316/8/2026
17
6Amelia JuliyantiPSD1A31928716703201147107190001Depok2019-07-31Jl. Raya PLN Gg. Bhotoh No. 11 B89512125673vv00v00vv90/60vvvvv>316/8/2026
18
7Anbiya Tita ZahiraPSD1A31967488393276095812190001Depok2019-12-18Jalan Masjid Nurul Amin No. 8881290413847vv00v00vv88/42vvvvvv116/8/2026
19
8ANNISA NAZWA RAMADHANIPSD1A31983950193276097005190007JAKARTA2019-05-30KOMPLEK BPK V BLOK D NO. 18895365354962vv00v00vv1202090/65vvvvvvv16/8/26
20
9ARVIN ARSHAD FATURRAHMANLSD1A320062848832760925042000018131980131VV00V00VV1212090/65VVVVVV116/8/2026
21
10BILAL RAMADHANLSD1A31921652163174090404190009JakartaVV00V00VV1192079/58VVVVVVV16/8/2026
22
11Brinar haziraPSD1A31952031043276095109190001Jakarta2019-09-11jln PLN Gg. bhotoh no33 RT 022/00885694961659vv00v00vv1172070/55vvvvv216/8/2026
23
12Devano Afnan AlfarizkyLSD1A31994303093276091703190003DEPOK2019-03-17JL. MELATI ll BLOK A NO. 2785780724969VVV0V00VV1282290/65VVVVVV116/8/2026
24
13Hafiz RizkyLSD1A3174061903190005Depok2019-03-19-895367807800VVV0V00VV1202090/66VVVVVVV16/8/2026
25
14Hana Maulida ZulfaPSD1A3276094201190001Depok2019-01-02-8871752822
26
15Jasmin Aulia AzzahraPSD1A31842286923276095612180001Depok2018-12-16Jln.Masjid al akhyar rt.40/0285717395270
27
16KHAIRA HASNA DIENDROPSD1A31980049173276095511190001JAKARTA2019-11-15-81510275954vv01v00vv1201990/60vvvvvvv16/8/26
28
17Khawla Sofia AnindyaPSD1A31987525913276096002190002Depok2019-02-20Jl. Raya gandul gg. ikhlas rt 23 rw 06 no. 39 B82118000414VV00v00vv1181893/64VVVvvv216/8
29
18MAHESA THIRZA MAULANALSD1A31968249323174070207190004Depok2019-07-02Jl. H. Jamhur I83897617127
30
19Megumi Putri KheyraPSD1A31956895223276094804190004
Tangerang Selatan
2019-04-08Jl. H. Nasir85691189738vv00v00vv1281984/71vvvvvv116/8/2026
31
20Meisha Putri RamadhaniPSD1A31910281053276094605190001Jakarta2019-05-06Jl. Masjid Nurul Amin82299568427VV00V00VV13340VVVVVVV16/8/20260125N174B
32
21MUHAMMAD AZRAFF ALFATIHLSD1A31956015233174090309190001JAKARTA2019-09-03RAWA BADAK NO. 38812846396616/8/2026
33
22Muhammad Diaz PratamaLSD1A3276090802190003Depok2019-02-08-89601873138vv00v00vv1202190/60vvvvv316/8/2026
34
23Muhammad El-Farabi RahmanLSD1A31870024803174092012180009Serang2018-12-20Jalan Bambu II89621827061
35
24Muhammad Geza RamadhanLSD1A31968922403276091305190002Depok2019-05-13JL. PLN GANDUL85893446089VVV0V00VV1202092/78VVVVVVV16/8/2026
36
25Muhammad WildanLSD1A32028148933276091511190001Depok2019-11-15Jl.Masjid Al Akhyar Np.1385198683191vv00v00vv1281786/69vvvvvvv16/8/26
37
26Nathan Adesa MahendraLSD1A3276090809190002Jakarta2019-09-08-88290942567
38
27NAYZA ZAFIRA AMILA FAUZIYANPSD1A31828236403276096012180002JAKARTA2018-12-20JL. PERWAKILAN NO.35487882879354vv00v00vv90/69vvvvvv116/8/26
39
28Rasyka Azura AmamiPSD1A32036939933276094301200002Jakarta2020-01-03Swadaya895343353081vv00v00vv1151681/58vvvvvv316/8/26
40
29SAFFANA HIFZA KHANZAPSD1A31934057563276094708190001DEPOK2019-08-07-81264493802VV00V00VV12019VVVVVVV16/8/2026
41
30SALMA ISNAINI AQILLAPSD1A31950533333174094402190005DEPOK2019-02-04JL. DAMAI KP. SETU NO. 481290717741vv00v00vv11719,195/74vvvvvvv16/8/2026
42
31Sya'ban AlghifariLSD1A31917960153276092104190001Depok2019-04-21Jl. Raya PLN81210421709VV00V00VV1202090/60VVVVVV316/8/2026
43
32TSABITA AISYAH SHIRANPSD1A31935908751471087003190003PEKANBARU2019-03-30PERUM BRP BLOK G NO 188566325460vv00v00vv11921102/69vvvvvv216/8/2026
44
33ADIRA AZZAHRAPSD1B3276095005190001Depok2019-05-10-881012433696vv00v00vv1201990/60vvvvvv216/8/2026
45
34AIZAR MUHAMAD YUSUFLSD1B31998880933276092501190005DEPOK2019-01-25JL. H. MENDIK87744325682VV00V00VV12222100/83VVVVVV216/8/2026
46
35ALISHA MIKAYLA PUTRIPSD1B31931635493276095208190002TANGERANG SELATAN2019-08-12JL. PURING NO. 6 RT 06/0789666771455VVV0V00VV1182592/74VVVVVVV16/8/2026
47
36ALMEERA ZAINA ARSYILLAHPSD1B31928289913276095210190003DEPOK2019-10-12JL. LERENG INDAH NO. 158881357183vv00v00vv1161590/60vvvvvv116/8/2026
0125N174B
48
37Alsya Khoirul NisaPSD1B31959588563276094805190002Jakarta2019-05-08Madrasah85881648449
49
38ARSHILA CAHYA RAMADHINAPSD1B31995865373276094106190002JAKARTA2019-06-01JL. RAYA GANDUL NO. 485813173606VV0000VV1202397/72VVVVVV116/8/2026
50
39AYU NINDYA NAURA PUTRIPSD1B32011836123276096501200002Jakarta2020-01-25.jln sawo3 gandul /cinere rt 013/05 no 122 A. Kota depok88808512330
51
40Daffa Hanif AlfarizqiLSD1B31957556673275081807190003Bogor2019-07-18JL. PLN Gg. Bhotoh No. 10 D85771527360vv0000vv1181590/83vvvvvv116/8/2026
52
41Davian pratamaLSD1B31976860173276091405190003DEPOK2019-05-14JL. MASJID AL-AKHYAR NO.5895402461001VV00V00VV1213090/60VVVVVVV16/8/2026
53
42Gaishan Raffasya HafishLSD1B31997382893276092407190002Depok2019-07-24Jl. Lestari85855558864
54
43Humaira AbdillahPSD1B31902528693276095605190003Depok2019-05-16Jl. Raya Gandul Rt.04 Rw.01 Gandul Cinere Depok89618719689vv00v00vv1201690/60vvvvvvv16/8/2026
55
44Intan Cahaya AzizahPSD1B31940157163276096308190001Depok2019-08-23Gg.Masjid81586391739
56
45IZZAN RAMBU RADEYALSD1B31982856743276092806190002Jakarta2019-06-28-89644880176vv00v00vv1202096/75vvvvvvv16/8/2026
57
46Keinara Agista JasminePSD1B3276095708180001Depok2018-08-17-85714957547
58
47MANSEO DAEHAN ARGUELLOLSD1B31917995453276090804190003JAKARTA2019-04-08JL. CILOBAK895337565362
59
48Maryam Az ZahraPSD1B3674056202190004Tangerang Selatan2019-02-22-87882475498VV00V00VV1181992/8516/8/2026
60
49MUHAMAD NAFIZHLSD1B31868101683276091912180005SUKABUMI2018-12-19JL. RAYA GANDUL85717531974
61
50Muhammad Abrizam MannafLSD1B31910593283276090103190001Jakarta2019-03-01Pintu Air 3 No.885697153302vv00v00vv1181878/82vvvvvv316/8/26
62
51MUHAMMAD AZRIL HISYAMLSD1B31991676513276092609190001DEPOK2019-09-26JL. H. JAMHUR85710630358vv00v00vv1192090/60vvvvvvv16/8/2026
63
52Muhammad DiasLSD1B31950666973276092405190001Depok2019-05-24Jl.Masjid Al-Akhyar No.2785693236387vv001192090/60vvvvvv216/8/26
64
53MUSTAFA KEMALLSD1B31978868991671071503190003PALEMBANG2019-03-15-81272566600vv00
65
54NADHIRA HUMAIRA RAMADHANIPSD1B31967919553276095705190001DEPOK2019-05-17-82261068025VV00V000V1202087/69VVVVVV116/8/2026
66
55NADINA SHAFANA ALMAHYRAPSD1B31991160793674054511190007Jakarta2019-11-05Jalan Semanggi II No. 9385545196739vv00v00vv1181590/60vvvvvv>316/8/26
67
56NAINA SHAQUEENA JUNISAPSD1B3276096906200001JAKARTA2020-06-29-81908337361VV00V00VV1181596/80VVVVVV216/8/2026
68
57Rafasya JuliandraLSD1B31999309453276092107190001Jakarta2019-07-21Jl. PLN Gandul No. 100C895330092903
69
58Raina ahmadPSD1B3276094212190003DEPOK2019-12-28-895418397608vv00v00vv1181598/87vvvvvv316/8/26
70
59REVANO OGYA PUTRANTOLSD1B31951747483276092006190002DEPOK2019-06-20JL. H. MENDIK82298875739
71
60REYSHAD ALGHAISANLSD1B31997889503276091607190001DEPOK2019-07-16Jl. H. Usman No. 387789916302VV00V00VV1192590/60VVVVVV116/8/2026
72
61Rifani MaharaniPSD1B31987289893276095908190001Depok2019-08-19H Jeni82261108779vv00v00vv1201976/82vvvvvv316/8/2026
73
62SEANNA JENNAIRA HARAHAPPSD1B31918751333276096607190002DEPOK2019-07-26JL. H. JAMHUR II NO. 10785946475418VVV0V00VV12020101/64VVVVVVV16/8/2026
74
63Sintya Natama DewiPSD1B31841630523276097007180003Depok2018-07-30Jl. Sawo N0. 93 D81290900901VV00V00VV1171890/60VVVVVV216/8/2026
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