ABCDEFGHIJKLMNOPQRSTUVWXYZAAABACADAEAFAGAHAIAJAKALAMANAOAPAQARASATAUAVAWAXAYAZBABBBCBDBEBFBGBHBIBJBKBLBMBNBOBPBQBRBS
8
NoNamaJenis KelaminJenjangKelasNISNNIKTempat Lahir Tgl LahirUsia (Ulang tahun terakhir)AlamatNo. HPDisabilitasHasil Pemeriksaan FisikKesimpulanIMUNISASIIMUNISASI MRIMUNISASI DT
9
Resiko Gula Darah AnakResiko MalariaGejala Cemas RemajaKesehatan Reproduksi PutriKelayakan Tes KebugaranPerilaku Merokok Resiko HepatitisResiko TBPenyakit Kusta Anak SekolahPenyakit SkabiesRiwayat Imunisasi Rutin LengkapGiziTekanan DarahTelingaMataGigiKebugaran (Kelas 4-6)
10
BB (kg)TB (cm)Indeks Massa Tubuh (kg/m2)IMT/U (SD)Status GizimmHgKlasifikasiTajam PendengaranSerumenInfeksi (cairan)Mata LuarTajam PenglihatanPenggunaan KacamataWaktuKlasifikasi
11
PLYaTidakYa (1/2/3/4/5)Ya (1/2/3/4)Ya (1/2/3)Ya (1/2/3)Ya (1/2/3/4)Ya (1/2)Ya (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
Dapat mengulang kata lebih dari 80% (minimal 4 dari 5)Tidak dapat mengulang kata lebih dari 80% (kurang dari 4 dari 5)YaTidakYaTidakMata sehatMata tidak sehat/julingNormal: Visus 6/6 - 6/12Gangguan Penglihatan (visus <6/12)YaTidakNormalKaries 1/2/3/4/5Baik sekali/ BaikCukupKurang/Kurang sekaliRujukTidak RujukImunisasi Yang di TerimaTanggal ImunisasiNo. BatchImunisasi Yang di TerimaTanggal ImunisasiNo. BatchImunisasi Yang di TerimaTanggal ImunisasiNo. Batch
12
1ABRAHAM RAYNAND RIZKIANDRAL1 A3174078041800054/18/2018JL. H. SAIMIN N0.18v00000000000027115
20/20
20/25
DT
26/11/2025
13
2ADREENA IHZAP1 A32760947121800037/12/2017Cendana No.8 Cinere89636907749v00010000vv3512396/73vvvv6/9v2DT
26/11/2025
14
3AHMAD ARASHL1 A32760903031900013 Maret 2019JL. CINERE RAYA NO. 10 Av00000000000021,91W296/62VV6/7,5DT
26/11/2025
15
4AISYAH AFRAH FAIHANAHP1 A327609640618000124 Juni 2018Jl. H. Saleh 2 Rt.06/07 Pangkalan Jati 85780666911v000000000023,7511087/62vv6/96/9v 6
16
5AISYAH AYUDIA INARA RKP1 A317305520418000612/4/2018Jl. Rawakopi I Gg H. Dahlan No.115 Rt.02/04 v00000000000019,9511894/57vvvv6/9
20/30
v1DT
26/11/2025
17
6AIZA KIRANA DEWANTOROL1 A327609710818000231 Agustus 2018
JL. PERSATUAN RT. 03 RW.04 CINERE, DEPOK
816170447V00000000000020,40110105/65VV6/96/91DT
26/11/2025
18
7ALMAIRA RAHMANINAP1 A32760943011900013/1/2019Jl. bhotoh Rt.22/06 No.27 Gandul85855768288v00000000000021,310898/71vvv6/9
20/30
v0DT
26/11/2025
19
8ANNASYA DRIYA RAJABANIP1 A32760441041800014/1/201887887968868v1000000000002212092/666/96/7.5v1
20
9AQMAR NADHIF ALFARABYL1 A327609241218000224/12/2018Jl. Ibnu Armah Rt.06/03 Pangkalan Jati Baru 85210201460v00000000000025110109/61vvv
20/40
6/9v0DT
26/11/2025
21
10ARINI SHAFIYAH HALWATUNNISAP1 A367403420518000302 Mei 2018Jl. Pinang Pangkalan jati
081770874497
V000000000025135106/90VVVV6/96/9VV0DT
26/11/2025
22
11ARSENIO YUSUF BACHTIARL1 A317402021118000111/2/2018Jl. Rawa Kopi rt.02/04
089676152830
V000000000020.7115120/82VVVV
20/30
6/9VV1DT
26/11/2025
23
12AZAREIN SHANNON CIPTAP1 A317409620319000427/03/2019H. Terin 1 No.21 Pangkalan Jati Baru812993042241v00000000vv18,510192/61vvvv6/9
20/40
vv
24
13BENJAMIN LAKSMANA DEVELAL1 A327609160218000116 Februari 2018v00000000002112793/69vvvv6/9vV0
25
14DIANDA QIREI ARETTAP1 A32760970118000230 November 2018Jl Pintu Air 3 Rt.27/08 Gandul 87857103896v000000000018,3108101/77vvvv6/9v1DT
26/11/2025
26
15FATIMAH NUR AZIZAH HAFIZAHP1 A327609600818000120 Agustus 2018v00000000029121111/82vv6/24vV0DT
26/11/2025
27
16HIZAM ATHALLAH ZHAFRANL1 A327609180118000318 Januari 2018Jl PLN GG Musholla I Rt.11/05 No.40 Gandul 82258097813v00000000002512196/74vvvv
20/25
6/9v0
28
17KHAIRA NURI NARARYAP1 ADT
26/11/2025
29
18MAULID DHIYAP1 A327609701118000130 November 2018Gg. H. Biih RT. 09 RW. 02 No. 1185780014211v0000000000002711884/576/7,56/61DT
26/11/2025
30
19MUHAMMAD AMMAR FAYYADHL1 A317406200718000120 JULI 2018Gg. Melati 1 rt.001/00385782015550v0003000018.511580/63vvvv6/7.5v4
31
20MUHAMMAD AZZAM PAHLEVIL1 A32760908041800018 April 2018Jl Melati Rt.03/01 Gandulv000000000002212395/73vvvv
20/20
6/6v2DT
26/11/2025
32
21MUHAMMAD FATIH AYDIN ALFAREZKYL1 A3276092812180001
28 Desember 2018
jl. rawa Kopi 1 no.132 rt. 002/004 PJB
089650214099
V000000000026126114/70VVVV
20/40
6/9VV0DT
26/11/2025
33
22MUHAMMAD IRSYAD HADZAMIL1 A327609130418000312 April 2028JL. CINERE RAYA NO. 17V00000000000023,712092/666/7.5DT
26/11/2025
34
23MUHAMMAD RIZKY PRATAMAL1 A31710608051700038 Mei 2017JL PINTU AIR III NO.98V110000000000024,15118113/90v
20/30
6/12DT
26/11/2025
35
24REINA ALISHA RUMANDAP1 A327609420718000302 Juli 2018Jl. lestari no.45 rt.039/007 Gandul88294221392v5000400000159055/62vvvv6/24vv2
36
25SABIL ANAM ALFARIZIL1 A327609290818000329 Agustus 2018Jl. H saumin no.50 rt.28/008 -v000000000020.711881/57VVVV
20/30
6/9VV0
37
26SABRIYA ZULAIKHA HIDAYATP1 A
38
27SALWA ALIYA AISYAHRAP1 A31740641081700011 Agustus 2017Jl. Kampung sawah 7 Depok895800080706v00000000000019,1010988/7vv6/7.5
20/30
v1DT
26/11/2025
39
28SAYYIDAH SYAMMA HUSEINP1 A317306680418000628 April 2018v0000000000002012885/69VV6/66/7,5VV0DT
26/11/2025
40
29SHIFAN ALKHALIFI FAUZIL1 A317406181118000118 November 2018jl. pertanian II Lebak bulusv0000000000001711679/50vvvv6/15vV0
41
30SYAMILA LUBNA YUSUFP1 A327609531218000213 Desember 2018Jl Pintu Air 3 Rt.28/08 Gandul Cinere85694537145v000000000019134105/81vvvv6/9
20/40
vV0DT
26/11/2025
42
31ZHAFIRA KHAIRUNNISAP1 A32760948121700018 Desmber 2017Jl. masjid nurul amin gandul85710800943v000000000028120101/78vv
20/20
6/12vv0
43
32ACHMAD DEVANO ALFARIZQI EDWARDL1B327609301118000230/11/2018DT
26/11/2025
44
33AHMAD ZIYAD HAITAMIL1 B3276091010180006Jakarta10/10/2018Gg. H. Mayanih Rt.07/08 No.5185716242023v00000000000020110120/90vv
20/40
6/12v2DT
26/11/2025
45
34AINAYYA FATHIYYATURAHMAP1 B327609551018000115/10/2018Masjid Al-Akhyar GG H.acing Gandul852110070084v00000000vv2612072/58vvv
20/25
6/12vvDT
26/11/2025
46
FAISYAH AYUDIA INARA CNRP1 B32760945081800015/8/2018Jl Persatuan GG H. Musran Rt.03/04 Cinere83808063883v00000000vv22,1512697/69vvv
20/50
6/15v0
47
36ALMAHYRA ZAHRA HARTONOP1 B317403691018000229/10/2018Rw Kopi83890004074v0000000000v2212782/74vvvv
20/30, 6/15
v2DT
26/11/2025
48
37ALULA GWEN SALWA RINALDYP1 B31740643101800053/10/2018Palestina No.2381287203531v00000000vv2011562/54vvvv
20/40
6/9vvDT
26/11/2025
49
38ANNASYA SHAFAA AZIZAHP1 B327609550219000115/02/2019Jl. Masjid Al-Akhyar No.3 Gandul 85692613391v00000000001612562/74vvvv6/24
20/120
v0DT
26/11/2025
50
39ARFAN ARBANI ALIL1 B31740606111700016/11/2017Bango II No.26 Rt.03/07 87877793779v00000000vv2412884/62vvvv6/6
20/20
vv
51
40ARUNA RISYA KANAYYAP1 B3.1741E+156/12/2017Cinere Hijau Residence No. 23 Limo Depok81806708929v0000000000002512882/64vv6/36
20/120
v0
52
41ATHALLA ARRAFIF SHAFWANL1 B327609100218000110/02/2011Jl Erha pertamina87786635508v00000000002110882/64vvvv
6/12, 20/30
v4DT
26/11/2025
53
42CORDELIA RAFANIP1 BDT
26/11/2025
54
43DIVYANKA DARIN NASHWAP1 B3276096812180002
28 Desember 2018
Komplek BPK V Blok 6126 Gandul Cinere Depok
81296991604v0000000000002511682/60vv
20/80
6/36v2DT
26/11/2025
55
44FAZIAN MAUZA ANDARUL1 B331108190518000119 Mei 2018
jl. pasir 3 no. 33 Rt. 02/ 06 Ciganjur, Jagakarsa, Jakarta Selatan
82161280354v0000000000002812889/68vv6/26/9v1DT
26/11/2025
56
45HANA HUMAIRAHP1 B327604591018000119/10/2018
57
46KENDRA ARSHAQ PRADANAL1 B3276092912180001Jakarta
29 Desember 2018
Jl. masjid Al-Akhyar No. 19, gandul87888419166v00000000000021,112580/56vv6/9
20/25
vv
58
47KHALEED MUHAMMAD IBRAHIML1 B327609270317000227 Maret 2017Jl. Pintu Air III No. 98, Gandul Depokv00000000000023118104/74vv6/186/18vv0DT
26/11/2025
59
48M. RAKHA MIRZA HANIFL1 B
60
49MAFAZA IZMI RAFINAP1 B327609640918000224 September 2018Gandulv00000000vvv25129115/80vvvv
2//30, 6/15
vv0DT
26/11/2025
61
50MUHAMMAD ARFAN ADIANSYAHL1 B
62
51MUHAMMAD FATIH SOLIHUDDIN HAFIZL1 B327609200818000120/08/2018Gandul87873630878v00000000vvv4012889/78vvvv6/24vv0DT
26/11/2025
63
52MUHAMMAD HAZIQ ALKHALIFIL1 B
64
53QINARA PUTRI RUSLANP1 B327609691218000229/12/2018Jl Melati gandul81298523606v00000000vvv1911297/64vvvv
20/25, 6/9
vv0DT
26/11/2025
65
54RASSYA ADITYA WIJAYAL1 B327603181018000418/10/2018
66
55RUMAISHA SYAFIRA MALAYEKAP1 B317406620518000122/05/2018Jl. Mushola Al. Barkah Rt.28/ 885781099808v00000000000029120110/63vv6/12
20/40
v0DT
26/11/2025
67
56SAFWAN JABILL1 B28/08/2017DT
26/11/2025
68
57SAYYIDAH SYAHLAP1 B327609590718000319/07/2018Pintu Air III Rt.28/08 Gandulv00000000vvv2212272/64vvvv6/18
20/80
vv0DT
26/11/2025
69
58SHAFIRA ALESHA SHAREENP1 B327609610818000421/08/2018GG H. Biih No.20 Gandul 8977845552v00000000vv20130104/80 v1vv6/9
20/30
DT
26/11/2025
70
59SYAQILLA AZZAHRA RAMADHANIP1 B3171044606180006
Mojokerto
06 Juni 2018Jl. H. Jeman No. 5385784088370v00000000000033.75119vv
20/80
6/24vv0DT
26/11/2025
71
60ZHUFAIRAH AUFA ALBUSTOMYP1 B327609630718000123 Juli 2018Bikit Cinere81911199211v0000000000v2913093/75vvvv
6/5, 20/25
v0DT
26/11/2025
72
61MIKHAYLA AZZAHRA MULYA WIJAYA1 B
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
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100
101
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