ABCDEFGHIJKLMNOPQRSTUVWXYZAAABACADAEAFAGAHAIAJAKALAMANAOAPAQARASATAUAVAWAXAYAZBABBBCBDBEBFBGBHBIBJBK
1
2
NAMA SATUAN PENDIDIKAN
: MI RAUDLATUL ATHFAL
3
KELAS
: 1
4
KAB/KOTA
: DEPOK
5
PROVINSI
: JAWA BARAT
6
TAHUN AJARAN:
: 2025/2026
7
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
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1M HAIQAL NAZRILLMI13205091703170002JAKARTA17/03/2017GANDUL85777423880VV00V00VV25127107/67VVVVVV118/8/20260125N174B
14
2RAHMA SAFIRA PMI13276094504200001DEPOK 2020-05-04GANDUL 87761897316VV00V00VV1911190/71VVVVVV318/8/20260125N174B
15
3ARKA ALVARO RAMNADHAN LMI13276090306190001DEPOK 2019-03-06GANDUL VV00V00VV4513599/84vvvvvvv18/8/20260125N174B
16
4MUHAMMAD NUR ERLANGGA LMI13174060910190001JAKARTA2019-09-10GANDUL 82124685470VV00V00VV30123102/82vvvvvv218/8/20260125N174B
17
5ADAM KASYAFA ALI LMI13175093001190007JAKARTA30/01/2019GANDUL85718738581VV00V00VV18119102/80vvvvvv>318/8/20260125N174B
18
6QUEENARA SUCI SAFIRA PMI1JAKARTA04/07/2019GANDUL85773240062VV00V00VV2011085/65VVVVVV318/8/20260125N174B
19
7ASHALINA SAFA MALAIKA PMI13174065102190004DEPOK2019-11-02GANDUL89502976433VV00V00VV16116100/77VVVVVVV18/8/20260125N174B
20
8NUR SYIFA FAUZIAH P MI13174064403190003DEPOK2019-04-03GANDULVV00V00VV1511588/63VVVVVVV18/8/20260125N174B
21
9MUHAMAD YUSUF AL GHIFARI LMI13276092906190001BOGOR 29-6-2019GANDUL85693964997VV00V00VV20118102/68VVVVVV>318/8/20260125N174B
22
10ZAFFRATUNNISA RAMDAHANI PMI13276094906180002DEPOK19-6-2018GANDUL81288293286VV00V00VV22121145/95VVVVV218/8/20260125N174B
23
11
KINARA FAHIRA FEBRIKA ATAFANA
PMI13301136202190001CILACAP22/2/2019GANDUL83847437442VV00V00VV2011393/70VVVVVV118/8/20260125N174B
24
12ISABELLA AROFAH ZAHIRA PMI13327086108190006PEMALANG21/8/2019GANDUL81292978902VV00V00VV21126120/80vvvvvv218/8/20260125N174B
25
13MUHAMMAD BEBI RULLY YANDILMI13276091408190002DEPOK14/08/2019GANDUL082124520878VV00V00VV1611590/62vvvvvv3
Campak Rubela
14/9/20260125N174B
26
14GIBRAN ALFATIHLMI13213160507190002SUBANG05-07-2019GANDUL083815577052VV00V00VV19117VVVVVV3
Campak Rubela
14/9/20260125N174B
27
15SITI AMINAH AULIAPMI13526185104190002BOGOR 11-04-2019GANDUL087798162690VV00V00VV
28
16YUSUF MAULANALMI13215013006190003KARAWANG30-06-2019GANDUL083153338382VV00V00VV1911397/81VVVVVV1
Tidak Imunisasi
14/9/20260125N174B
29
17MUHAMAD DZAKY ALFARIZILMI13211021512190002SUMEDANG15-12-2019GANDUL083844383427VV00V00VV20113114/77VVVVVV>3
Campak Rubela
14/9/20260125N174B
30
18ALESHA ALIFA HIBATILLAHPMI13674046209190004
KOTA TANGERANG SELATAN
22-09-2019GANDUL085187885727VV00V00VV19120112/81VVVVVVV
Tidak Imunisasi
14/9/20260125N174B
31
19PUTRI NUR RAMADHANIPMI13278054505190001DEPOK05-05-2019GANDUL083892154162VV00V00VV18119VVVVVV>3
Campak Rubela
14/9/20260125N174B
32
20RISKI ZIYYAN SYAPUTRALMI13327061106190001PEMALANG11-06-2019GANDUL085773065421VV00V00VV20122VVVVVV>3
Tidak Imunisasi
14/9/20260125N174B
33
21ARSYA PUTRIPMI13174094110190008JAKARTA01-10-2019GANDUL081915678383VV00V00VV21110100/62VVVVVVV
Campak Rubela
14/9/20260125N174B
34
22RIRIN AIRINPMI13215085008190003JAKARTA10-08-2019GANDUL085727718214VV00V00VV2011887/76VVVVVVV
Tidak Imunisasi
14/9/20260125N174B
35
23MAULANA ADZRIELLMI13376042704190001BREBES27-04-2019GANDUL083862866129VV00V00VV22123104/59VVVVVV2 14/9/20260125N174B
36
24MUHAMMAD FITRADI AMRULLOHLMI1Belum memilikiCIREBON10-06-2019GANDUL08568562108VV00V00VV16118103/66VVVVVV>3
Campak Rubela
14/9/20260125N174B
37
25MUHAMMAD NUR ROHMANLMI1Belum memilikiDEPOK04-08-2020GANDUL08568562108VV00V00VV14103102/67VVVVVV>3
Campak Rubela
14/9/20260125N174B
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