ABCDEFGHIJKLMNOPQRSTUVWXYZAAABACAKAPAQARASATAUAVAWAXAYAZBABBBCBFBGBHBIBJBK
7
8
NoNamaJenis KelaminJenjangKelasNISNNIKTempat Lahir Tgl LahirUsia (Ulang tahun terakhir)AlamatNo. HPDisabilitasHasil Pemeriksaan FisikIMUNISASI 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)mmHgTajam 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)YaTidakYaTidakNormalCuriga GangguanTidak AdaAdaTidak AdaAdaNormalCurigaNormalCuriga GangguanTidakYaTidak AdaKaries (1/2/3/>3)Imunisasi Yang di TerimaTanggal ImunisasiNo. BatchImunisasi Yang di TerimaTanggal ImunisasiNo. Batch
12
1ANNISA HUMAIRA BATRISYAPSD/MI1A
317408421019004
JAKARTA2/10/2019KALIBATA TENGAH RT 004 RW 003 KALIBATA PANCORAN JAKSEL
081283852172
VV00V00VV21,90115,590/60VVVVVV1MR
19/08/2026
0125N174B
13
2BARKAH MAIMUN ZUBAIRLSD/MI1A
3326110310190006
PEKALONGAN
3/10/2019Jl. Pangkalan Jati 1 No. 79 Rt 002/002 Pangkalan Jati Kec. Cinere Kota Depok Pangkalan Jati, Cinere, Kota Depok, Jawa Barat, 16513, 16513081317338880VV00VOOVV21,6126,590/60VVVVVVV
14
3CALLISTA LEORA ZEVANYAPSD/MI1A
3174084608180005
JAKARTA6/8/2018Jl. Pintu Air Ii Gandul Duren Tiga, Pancoran, Kota Adm. Jakarta Selatan, Daerah Khusus Ibukota Jakarta, 16512, 16512
087862213123
VV00V00VV32,20139,784/69VVVVVVV
15
4
DARIELLE PUTRA RAMADHAN
LSD/MI1A3206398127
3174062305200006
DEPOK
23/05/2020
Jl Madrasah 1 Rt 04 Rw 05 No 68 Pangkalan Jati, Cinere, Kota Depok, Jawa Barat, 16513, 1651387885736882vv00v00vv18,30kg109,7cm16/61vvvvvvv
16
5DEVAN ARKANA PUTRALSD/MI1A3197164999
3276090604190001
DEPOK6/4/2019Jl. Persatuan, Cinere 81295690375vv00v00vv51, 10 13460/70vvvvvv3MR
19/08/2026
0125N174B
17
6FARADILLA IZZATUNNISAPSD/MI1A
18
7FARZAN RAFIF ATHARIZKYLSD/MI1A
19
8FATHAN RADEYA APRILIOLSD/MI1A
3501075409640002
PACITAN4/4/2019Gandul Gandul, Cinere, Kota Depok, Jawa Barat, 16512, 16512
20
9GHANIA NIZA SALSABILAPSD/MI1A
3215035102190003
TANGERANG
11/2/2019Jl. Masjid Al-Akhyar Rt 0010/002 Gandul Kec. Cinere Kota Depok Gandul, Cinere, Kota Depok, Jawa Barat, 16512, 1651287889361468vv00v00vv22,5121,194/76vvvvvv1MR
19/08/2026
0125N174B
21
10KEYSA AMEERA AZZAHRAPSD/MI1A
1802016006190001
SRIMULYO
20/06/2019
P.Jati Pangkalan Jati, Cinere, Kota Depok, Jawa Barat, 16513, 16513
22
11KHAYLA NADHIRA AZZAHRAPSD/MI1A
3207195808190001
BanjarMR
19/08/2026
0125N174B
23
12
M. BUSYRA GHULAM ASKARY
LSD/MI1A
3276092712190002
JAKARTA
27/12/2019
Jl. Masjid Al-Akhyar Rt 009.002 Gandul Kec. Cinere Kota Depok Gandul, Cinere, Kota Depok, Jawa Barat, 16512, 1651287741600328vv00v00vv18,3114,790/60vvvvvvvMR
19/08/2026
0125N174B
24
13MAUZA HANIEF ATALLAHLSD/MI1A3194181223
3276090403190006
JAKARTA2019-04-03Jl Masjid Al-Akhyar No 75 Rt 029 Rw 002 Gandul, Cinere, Kota Depok, Jawa Barat, 16512, 16512
25
14MIKHAYLA ADIBAHPSD/MI1A
3326114305190001
PEKALONGAN
2019-03-05P. Jati Pangkalan Jati, Cinere, Kota Depok, Jawa Barat, 16513, 16513082112526311VV00V00VV20,35120,290/60VVVVV>3MR
19/08/2026
0125N174B
26
15
MUHAMMAD AFFAN KURNIAWAN
LSD/MI1A3180677435
3276091812180004
JAKARTA
18/12/2018
Jl Jati Murni No 76 Rt 03 Rw 06 Pangkalan Jati, Cinere, Kota Depok, Jawa Barat, 16513, 1651389601571621vv00v00vv23,7121,479/53vvvvvv1MR
19/08/2026
0125N174B
27
16MUHAMMAD AFIF AFLAHLSD/MI1A3192565439
3276090405190001
JAKARTA2019-04-05Jl. Madrasah 5 Pangkalan Jati, Cinere, Kota Depok, Jawa Barat, 16513, 16513
085771641705
VV00VOOVV20,9120,691/57VVVVVV1MR
19/08/2026
0125N174B
28
17
MUHAMMAD FAHRI FARDIANSYAH
LSD/MI1A
3276093007190001
DEPOK
30-07-2019
Jl. Rawa Kopi 2 Rt. 07/0785893596368vv00v00vv25,25123,685/65vvvvvv>3MR
19/08/2026
0125N174B
29
18
MUHAMMAD RAJENDRA ARSHAQUELL
LSD/MI1A
3276092409190001
JAKARTA
24-09-2019
Jl. Haji Jamhur 2, no. 348131155391vv00v00vv19,6117,584/63vvvvvv>3MR
19/08/2026
0125N174B
30
19
MUHAMMAD ZAINI ABDUL GHANI
LSD/MI1A
3174062501200001
JAKARTA
25/01/2020
Jl. Pondok Labu I No.7 Rt 005/007 Pondok Labu, Cilandak, Kota Adm. Jakarta Selatan, Daerah Khusus Ibukota Jakarta, 12450, 1245081513704317vv00v00vv28,10124,390/64vvvvvvMR
19/08/2026
0125N174B
31
20NAYLA KHOIRUNNISAPSD/MI1A
3674068002190001
TANGERANG SELATAN
20/02/2026
Jl. Kenari Iii Reni Jaya Baru Blok Ad-1/19 Rt004/0017 Pamulang Barat, Pamulang, Kota Tangerang Selatan, Banten, 15435, 1543588211370902VV00V00VV19,95115,391/69VMR
19/08/2026
0125N174B
32
21NUFA AISYAH RAMADHANIPSD/MI1A3196207222
3276097005190005
DEPOK
30/05/2019
Jl Madrasah Rt 002 Rw 006 No 113 Pangkalan Jati, Cinere, Kota Depok, Jawa Barat, 16513, 16513VVVVVV
33
22RADITYA KEVIN ALFATIHLSD/MI1A3192303011
3309160510190001
SRAGEN05-10-2019Tempel Rt 042/012 Sempu, Andong, Boyolali, Jawa Tengah, 57384, 57384
34
23RANIA AYU HIFZAPSD/MI1A
3674055109190002
KOTA DEPOK
2019-11-09Jl. Madrasah Ii Rt 005/002 Pangkalan Jati Cinere Kota Depok Pangkalan Jati, Cinere, Kota Depok, Jawa Barat, 16513, 16513895326438757vv00v00vv16,7kg114,481/63vvvvvv1MR
19/08/2026
0125N174B
35
24RIZKI PRATAMA SANJAYALSD/MI1A3190173695
3376030110190001
TEGAL2019-01-10Casa Rose Residance no. 4A Jl. Darakan 10981326687228vv00v00vv25,70118,290/60vvvvvvvMR
19/08/2026
0125N174B
36
25RUBINA AKLEEMA KURNIADIPSD/MI1A
3276094912190001
DEPOK2019-09-12Komplek Bpk V Blok C No.19 Rt 019/009 Gandul-Cinere Gandul, Cinere, Kota Depok, Jawa Barat, 16512, 16512VV00V00VV18,2011790/65VVVVVV>3MR
19/08/2026
0125N174B
37
26SHIREEN NAILA RAHMANIAPSD/MI1A
3276094701200003
JAKARTA2020-07-01Jl. Ismaya No.22 Rt 003/008 Cinere Kec. Cinere Kota Depok Cinere, Cinere, Kota Depok, Jawa Barat, 16014, 1601485819386474vv00v00vv19,9115,484/63vvvvvv>3MR
19/08/2026
0125N174B
38
27
STANLEY ADHITAMA RAMADHAN
LSD/MI1A
3202401305190002
DEPOK
13/05/2019
Jl. Pangkalan Jati Pangkalan Jati, Cinere, Kota Depok, Jawa Barat, 16513, 1651387844583669vv00v00vv22,80123,8110/70vvvvvvvMR
19/08/2026
0125N174B
39
28TEVY ANINDITA FLORENCIAPSD/MI1A3198013533
3302024711190001
Banyumas2019-07-11Jl. Gang H. Siman rt 05/rw 287886277371vv00v00vv19,20121,886/63vvvvvv1MR
19/08/2026
0125N174B
40
29UMAR MULYANDANULSD/MI1A
3272010312180001
Sukabumi03-12-2018Jl. Madrasah no. 10585724307183vv00v00vv2312695/65vvvvvv>3MR
19/08/2026
0125N174B
41
30AFIFAH IRMAYANIPSD/MI1B
3201134103190003
BOGOR2019-01-04Jl. Gandul Raya Gandul, Cinere, Kota Depok, Jawa Barat, 16512, 16512
087814741300
VV00V00VV15,55112,384/61VVVVVVV
42
31ALFAREZEL RAYYAN ARAKALSD/MI1B3199380746
3276040805190005
JAKARTA2019-08-05Jl. H.Midi Ii Rt 001/02 Limo Kec. Limo Kota Depok Limo, Limo, Kota Depok, Jawa Barat, 16531, 16531
085894935200
VV00V00VV35,85122.787/63VVVVVV2MR10/08/20260125N174B
43
32
ALIFIANDRA ELFAN SYAHREZA
LSD/MI1B3192079057
3501072305190001
Jakarta
44
33ALINA VALDA NUR’AISHAPSD/MI1B
45
34ALLAL SEKAR MELATIPSD/MI1B
46
35AQSA FADHIL ALFATIHLSD/MI1B
3174061410190004
DEPOK
14/10/2026
Jl. Kramat no. 81f 82111233780vv00V00vv28,6 kg123,2cm 108/83vvvvvv>3MR
19/08/2026
0125N174B
47
36ASHIMA NURUL WAHIDAHPSD/MI1B1202526
3174064510200003
DEPOK2020-06-10Jl. Parisakti Rt 002/001 Cipete Selatan Dki Jakarta Cipete Selatan, Cilandak, Kota Adm. Jakarta Selatan, Daerah Khusus Ibukota Jakarta, 12410, 1241085775246328vv00v00vv33,15kg132,2cm122/81vvvvvv1MR
19/08/2026
0125N174B
48
37ASIYAH NUWAIRA SALMANPSD/MI1B3191409165
5315034512190001
WAE NAKENG
2019-05-12Pongtopak Rt 006 Rw 003 Siru, Lembor, Manggarai Barat, Nusa Tenggara Timur, 86753, 86753
49
38
ASMARA DIANA ALFATHUNNISA
PSD/MI1B3192604917
3175045110190005
JAKARTA11/10/2019jl inarbang 1rt 006 rw 003085319513965vv00v00vv17,011585/64vvvVvv3MR
19/08/2026
0125N174B
50
39AYSHA INARA AYUDIA BETAPSD/MI1B3209322620AMBON
20/03/2020
Apt. Green Palace Kalibata City Unit L/18/Bj Rt 001/001 Rawajati, Pancoran, Kota Adm. Jakarta Selatan, Daerah Khusus Ibukota Jakarta, 12750, 12750
085233149912
VV00V00VV20,65115,590/60VVVVVVVMR
19/08/2026
0125N174B
51
40AZZURA IZZATIPSD/MI1B3193483991
3174064807190002
JAKARTA08/07/2019Jl Terogong I No 35 Rt 006/010 Cilandak Barat, Cilandak, Kota Adm. Jakarta Selatan, Daerah Khusus Ibukota Jakarta, 12430, 12430
52
41FAIZAN AZRIL MANNAFLSD/MI1B
3276090611190001
DEPOK2019-06-11Jl. Pangkalan Jati Ii Rt 003/002 Pangkalan Jati Kec. Cinere Kota Depok Pangkalan Jati, Cinere, Kota Depok, Jawa Barat, 16513, 16513
53
42FARIZ NAUFAL OKTAFIANLSD/MI1B
3174072310190002
JAKARTA
23/10/2019
Jl.Pangkaan Jati Baru Pangkalan Jati Baru, Cinere, Kota Depok, Jawa Barat, 16513, 16513085773551164VV00V00VV17,05112,867/51VVVVVV>3MR10/08/20260125N174B
54
43GAVIN ADLI SYAHREZALSD/MI1B3194438444
3305261508190003
Kebumen
55
44HANA RYZQIA ANGELYPSD/MI1B
3327145211180001
PEMALANG
2018-12-11Jl. Gandul Gandul, Cinere, Kota Depok, Jawa Barat, 16512, 16512
083845482066
VV00V00VV38,4512590/65VVVVVV3MR
19/08/2026
0125N174B
56
45
HANINDYA SYAFIRA AZZAHRA
PSD/MI1B
3521037001200001
Ngawi
30-01-2020
Jl. Kramat 2 no. 51 Pangkalan Jati85755144963vv00v00vv21,55 kg118 cm90/69vvvvvvvMR
19/8/2026
0125N174B
57
46KEINARA TAVISHA ADZKIYAPSD/MI1B3194321780
3276095006190001
Depok2026-10-06JL.PINTU AIR 2 RT 30 RW 02 NO 38 GANDUL DEPOK085939030525VV00V00VV19,25119,5100/70VVVVVVVMR10/08/20260125N174B
58
47M. IRFAN LUTHFILSD/MI1B
3601192811180001
PANDEGLANG
28/11/2018
Gandul Gandul, Cinere, Kota Depok, Jawa Barat, 16512, 16512
59
48
MUHAMMAD ABIDZAR ABIMANA
LSD/MI1B
3276091512190002
JAKARTA
15/10/2019
JL. MASJID ALAKHYAR RT 03/02 GANDUL CINERE81617662534VV00V00VV31,10129,757/42VVVVVVVMR
19/08/2026
0125N174B
60
49
MUHAMMAD AR RAYYAN WINANTO
LSD/MI1B3194243167
3304182812190001
BANJARNEGARA
28/12/2019
Sikumpul Rt01 Rw 03 Sikumpul, Kalibening, Banjarnegara, Jawa Tengah, 53458, 53458
61
50MUHAMMAD FAISALLSD/MI1B3198950308
3276090107190003
Depok
62
51
MUHAMMAD SALMAN AL FARISI PAHLEVI
LSD/MI1B
3276092111190002
JAKARTA
21/11/2019
Jl. Masjid Al-Akhyar Rt 040/02 Gnadul Kec. Cinere Kota Depok Gandul, Cinere, Kota Depok, Jawa Barat, 16512, 16512
63
52NADHIFA ZAREEN ASHEEQAPSD/MI1B
3276095001190001
JAKARTA2019-10-01P.Jati Pangkalan Jati, Cinere, Kota Depok, Jawa Barat, 16513, 1651381807415720vv10v00vv19,25kg120cm100/70vvvvvvvMR
19/08/2026
64
53NAHADIPA SHAFINAPSD/MI1B
65
54NESYA LITUHAYU PRATISTAPSD/MI1B3195159296
3215134708190006
KABUPATEN BANYUMAS
2019-07-08Jl.Madrasah Pangkalan Jati Pangkalan Jati, Cinere, Kota Depok, Jawa Barat, 16513, 1651385691000767vv00v00vv17,55kg113,8cm95/60vvvvvvvMR
19/08/2026
66
55RAFIE CAHYA MUNAYAHLSD/MI1B
3276092710180001DEPOK
27/10/2018
JL. MADRASAH 2 RT 002/006 PANGKALAN JATI CINERE08567567697VV00V00VV23,1012290/60VVVVVV2MR
19/08/2026
0125N174B
67
56RUBY AYESHAPSD/MI1B
3276095907190001
JAKARTA
19/07/2019
Jl. Cilobak 1 No.25 Rt 003/001 Pangkalan Jati Kec. Cinere Kota Depok Pangkalan Jati, Cinere, Kota Depok, Jawa Barat, 16513, 16513
68
57
SAFFANA AYUNINDYA DANITA
PSD/MI1B
3328024807190001
TEGAL2019-08-07Jl. Cilobak Pangkalan Jati, Cinere, Kota Depok, Jawa Barat, 16513, 16513
69
58SILVIA GHANIA MECCAPSD/MI1B
3207134907190001
CIAMIS2019-09-07Gandul Gandul, Cinere, Kota Depok, Jawa Barat, 16512, 16512
081223671891
VV00V00VV30,60125,2101/78VVVVVVVMR10/08/20260125N174B
70
59TAJIR ALFITRAHLSD/MI1B3203092237
3276092001200003
BIMA
20/01/2020
Jl Taman Jati Indah Rt 001 Rw 003 No 11 Pangkalan Jati, Cinere, Kota Depok, Jawa Barat, 16513, 16513
081934132170
VV00V00VV17,0511090/60VVVVVV1MR10/08/20260125N174B
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75
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77
78
79
80
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82
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85
86
87
88
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90
91
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101
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