ABCDEFGHIJKLMNOPQRSTUVWAIAJAKALAMANAOAPAQARASATAUAVAWAXAYAZBABBBCBDBEBFBGBHBIBJBKBLBMBNBOBPBQBRBSBTBUBVBWBXBYBZCACBCCCDCECFCGCHCICJCKCLCMCNCOCPCQCRCSCTCUCVCWCXCYCZDADBDCDDDEDFDG
1
2
85974045795
3
SUMBER DATA/WILAYAHNOPENGENTRI PKGSUDAH/BERMASALAH/ MENUNGGU LABBELUM MENIKAHNIKAH/CERAI/JANDA/DUDATanggal periksaNama(*)Tanggal LahirJenis KelaminPekerjaanNO HPAlamatKelurahanPuskesmasRiwayat Penyakit Keluarga (*)Riwayat Penyakit Diri Sendiri (*)Riwayat Penyakit Diri Sendiri (*)Riwayat Penyakit Diri Sendiri (*)Apakah peserta pernah merokok? (*)JIKA YA, berapa batang rokok per hari?JIKA Ya, berapa lama merokok (dlm tahun)Tinggi badan,
dalam cm (#) (*)
Berat Badan, dalam kg (##) (*)Lingkar perut,
dalam cm
Sistolik (#) (*)Diastolik (##) (*)Gula darah sewaktu (GDS)Gula darah puasa (GDP)Gula darah 2 jam PP (Setelah TTOG)HbA1CKolesterol TotalHDLLDLTrigliseridePemeriksaan IVA
(khusus Wanita)
Pemeriksaan HPV-DNA (Lab)
(khusus wanita)
Pemeriksaan Sadanis (khusus wanita)Pemeriksaan USG
(khusus wanita)
Diagnosis (#)Terapi Farmakologi (obat) (jika diberikan) - (##)Diagnosis (#)Terapi Farmakologi (obat) (jika diberikan) - (##)Diagnosis (#)Terapi Farmakologi (obat) (jika diberikan) - (##)Edukasi berhenti merokokEdukasi menjauhi asap rokokEdukasi seputar dietEdukasi aktivitas fisikPemeriksaan Elektrokardiogram (EKG) / Rekam Irama JantungRujuk (*)Tajam Penglihatan :
Mata Kanan_Pemeriksaan Visus Rabun Jauh (#) (*)
Tajam Penglihatan: Mata Kiri_Pemeriksaan Visus Rabun Jauh (##) (*)Tajam Penglihatan : Mata Kanan_Pemeriksaan Visus Rabun Dekat (#)Tajam Penglihatan : Mata Kiri_Pemeriksaan Visus Rabun Dekat (##)Katarak : Mata Kanan_Pemeriksaan Pinhole (#)Katarak : Mata Kiri_Pemeriksaan Pinhole (##)Katarak : Mata Kanan_Pemeriksaan Pupil (#)Katarak : Mata Kiri_Pemeriksaan Pupil (##)Mata Kanan_Dicurigai Glaukoma (#)Mata Kiri_Dicurigai Glaukoma (##)Mata Kanan_Dicurigai Retinopati (#)Mata Kiri_Dicurigai Retinopati (##)Telinga Kanan_Tajam Pendengaran (#) (*)Telinga Kiri_Tajam Pendengaran (##) (*)Telinga Kanan_Curiga Presbikusis (#)Telinga Kiri_Curiga Presbikusis (##)Telinga Kanan_Serumen Impaksi (#)Telinga Kiri_Serumen Impaksi (##)Telinga Kanan_Congek (OMSK) (#)Telinga Kiri_Congek (OMSK) (##)Diagnosis #Terapi Farmakologi (obat) (jika diberikan) - (##)Diagnosis #Terapi Farmakologi (obat) (jika diberikan) - (##)Diagnosis #Terapi Farmakologi (obat) (jika diberikan) - (##)Edukasi berhenti merokokEdukasi menjauhi asap rokokEdukasi seputar dietEdukasi aktivitas fisikRujuk (*)Status GiziTuberkulosisTekanan darahGula darahTes tajam pendengaranTes tajam penglihatanPemeriksaan pinholePemeriksaan pupilGigiKesehatan jiwaMerokokTalasemiaTingkat Aktivitas FisikFaktor Resiko HatiHepatitis BHepatitis CFibrosis /Sirosis Hati
4
POLI PKG1LESTIsudah/ 21-1SUDAH MENIKAH02-01-2026
3576025703800003
MARIANA INDARTI17-03-1980PWIRASWASTAJALAN PANDERMAN 3 NO 21WATESWATES15560891207098
5
POLI PKG2LESTIsudah/ 21-1BELUM MENIKAH03-01-2026
3576021309970002
ANGGI DWI SANCOKO13-09-1997LBELUM BEKERJAKARANGLO VI/29WATESWATES----YA23160868812080100
6
POLI PKG3LESTIsudah/ 21-1BELUM MENIKAH NIKAH05-01-2026
3576025211060001
RENITA NOVINDA SARI12-11-2006PSWASTAWATES GG FLAMBOYAN 7-AWATESWATES----1465575906070KARIES
7
POLI PKG4LESTIsudah/ 21-1BELUM MENIKAH NIKAH05-01-2026
3575013006050002
MOCHAMMAD ABDI RAKHMAD DANY30-06-2005LSWASTAPENANGGUNGANWATESWATES----165558510070155
8
POLI PKG5LESTIsudah/ 21-1BELUM MENIKAH NIKAH05-01-2026
3576026308050002
AGNES STESIA WIRANDRASARI23-08-2005P
BELUM BEKERJA
JL. RAYA BATOK 12WATESWATES----159738910070104
9
POLI PKG6ditaprissudahBELUM MENIKAH NIKAH05-01-2026
3516181808050001
DWI YANTORIZKITULLOH18-08-2005L
BELUM BEKERJA
LENGKONGLENGKONGWATES----Ya23171648514080127KARIES
10
POLI PKG7ditaprissudahSUDAH MENIKAH06-01-2026
3576026909660001
ELIZABETH SRI SUDARLINAH29-09-1966P
IBU RUMAH TANGGA
WELIRANG I NO 19WATESWATES-HT KOLESTROL-157598512080144220
11
POLI PKG8ditaprissudahSUDAH MENIKAH06-01-2026
3576026705660002
SUMARLINAH27-05-1966P
IBU RUMAH TANGGA
JL KELUD II/13WATESWATES-HT KOLESTROL-149628613080144
12
POLI PKG9ditaprissudahSUDAH MENIKAH06-01-2026
3576024506700002
SUMARLIYAH05-08-1969P
IBU RUMAH TANGGA
KARANGLO VI/69WATESWATES----153738613080112
13
POLI PKG10ditaprissudahSUDAH MENIKAH06-01-2026
3576026008700001
SITI MUNJAROTIN20-08-1970P
IBU RUMAH TANGGA
JL TENGGERWATESWATES---DM155588610060125
14
POSYANDU WELIRANG11RESMASUDAHSUDAH MENIKAH06-01-2026
3576024403850001
YUSTINA SUKMAWATI04-03-1985P
IBU RUMAH TANGGA
JL. WELIRANG VI/4WATESWATES----15052,37812784113
15
POSYANDU WELIRANG12RESMASUDAHSUDAH MENIKAH06-01-2026
3576026107900002
YUNIDA21-07-1990P
IBU RUMAH TANGGA
JL. WELIRANG VI/06WATESWATESASMA15377911328297
16
POSYANDU WELIRANG13RESMASUDAHSUDAH MENIKAH06-01-2026
3515016106960002
NIKA VIVI ROHMATIN21-06-1996P
IBU RUMAH TANGGA
JL. WELIRANG V/2WATESWATES----15869891278584KARIES
17
POSYANDU WELIRANG14RESMASUDAHSUDAH MENIKAH06-01-2026
3576026803900002
TRISNA PERMATA FURQONI28-03-1990P
IBU RUMAH TANGGA
JL. WELIRANG VI/02WATESWATES----14850761005998
18
POSYANDU WELIRANG15RESMASUDAHSUDAH MENIKAH06-01-2026
3525085510000001
VINDRIA AYUNITA NINGSIH15-10-2000P
IBU RUMAH TANGGA
JL. WELIRANG II/28WATESWATES----135708413570110
19
POSYANDU WELIRANG16LUSIASUDAHSUDAH MENIKAH06-01-2026
3576025010970001
OKTAVIA AYU ALFIDA SALSABILA PUTRI10-10-1997P
IBU RUMAH TANGGA
JL. WELIRANG VI/9WATESWATES----14450,38510070104
20
POSYANDU WELIRANG17LUSIASUDAHSUDAH MENIKAH06-01-2026
3576026702950002
KHASANAH27-02-1995P
IBU RUMAH TANGGA
JL. WELIRANG III/3WATESWATES----1428210112078130KARIES
21
POSYANDU WELIRANG18LUSIASUDAHSUDAH MENIKAH06-01-2026
3576010505790004
EKA PATRIA HARMAWAN05-05-1979LSWASTAJL. WELIRANG II/25WATESWATES----16985,910614994149
22
POSYANDU WELIRANG19LUSIASUDAHSUDAH MENIKAH06-01-2026
3525154907950005
ADIKA ALRIANA 09-07-1995P
IBU RUMAH TANGGA
JL. WELIRANG II/13WATESWATES----15854751247787
23
POSYANDU WELIRANG20LUSIASUDAHSUDAH MENIKAH06-01-2026
3278075208910006
ENUR HAYATI11-08-1991P
IBU RUMAH TANGGA
JL. WELIRANG I/7WATESWATES----14344,37113497106
24
POSYANDU WELIRANG21yanisudahSUDAH MENIKAH06-01-2026
3515016503950003
RISTA DWIJAYANTI25-03-1995P
IBU RUMAH TANGGA
JL. WELIRANG I/19WATESWATES----16061751207099
25
POSYANDU GPI22sudah entrySUDAH MENIKAH07-01-2026
3515016510810003
YUNIVA OKTAVIA25/10/1981PIBU RUMAH TANGGA
GRIYA PERMATA IJEN C-3/24 (05/04)
WATESWATES----15771,58713362120
26
POSYANDU GPI23yanisudahSUDAH MENIKAH07-01-2026
3516186205840002
JUNITA DIANA22/05/1984PIBU RUMAH TANGGA
GRIYA PERMATA IJEN C-4/24 (05/04)
WATESWATES--15667,18711971125
27
POSYANDU GPI24yanisudahSUDAH MENIKAH07-01-2026
3515012001700001
LULUS SUKAHARI20/01/1970LINDUSTRI
GRIYA PERMATA IJEN C-3/24 (05/04)
WATESWATES----17359,88112070111
28
POSYANDU GPI25yanisudahSUDAH MENIKAH07-01-2026
3576025505810008
CITRA AMORELCO AYKURSI, MNW15/05/1881PIBU RUMAH TANGGA
GRIYA PERMATA IJEN D-4/1 (04/04)
WATESWATES----15444,27411175106
29
POSYANDU GPI26fatmasudahSUDAH MENIKAH07-01-2026
3576024906660002
INDAH JUNIARDANI09/06/1966PIBU RUMAH TANGGA
GRIYA PERMATA IJEN C2/17 (10/04)
WATESWATES
DIABETES MELITUS
DIABETES MELITUS
DIABETES MELITUS
DIABETES MELITUS154,576,69511868107193
30
POSYANDU GPI27fatmasudahSUDAH MENIKAH07-01-2026
3576025902770004
YUROIDA CHAMNAH19/02/1977PKARYAWAN SWASTA
GRIYA PERMATA IJEN C-1/04 (10/04)
WATESWATESHIPERTENSI---15458,38011060
31
POSYANDU GPI28fatmasudahSUDAH MENIKAH07-01-2026
3576026709720002
KHOIRIL PURNOMOWATI27/09/1972PKARYAWAN SWASTA
GRIYA PERMATA IJEN B-2/23 (06/04)
WATESWATES-
HIPERTENSI DAN DIABETES
HIPERTENSI DAN DIABETES
HIPERTENSI DAN DIABESTES
145,566,6969753221
32
POSYANDU GPI29bernasudahSUDAH MENIKAH07-01-2026
3304055809990001
SEPTIKA YUNIARTI17/09/1998PBURUH HARIAN LEPASGPI C1/05 (10/04)CIHAURBEUTIWATES----15256,7831036576
33
POSYANDU GPI30fatmasudahSUDAH MENIKAH07-01-2026
1472027110940021
PUTRI OKTAYANI31/10/1994PIBU RUMAH TANGGAGPI 04/04BANJARSARIWATES
DIABETES MELITUS
---15461,7879564108
34
POSYANDU GPI31dinasudahSUDAH MENIKAH07-01-2026
3576022702680003
SUHARDI27/02/1968LPENSIUNAN
GRIYA PERMATA IJEN B-3/20 (10/04)
WATESWATES----TIDAKTIDAKTIDAK16559,88513483108
35
POSYANDU GPI32dinasudahSUDAH MENIKAH07-01-2026
3576024904740001
SULIATIK09/04/1974PIBU RUMAH TANGGA
GRIYA PERMATA IJEN B3/24 (10/04)
WATESWATES----158,576,4951558897
36
POSYANDU GPI33dinasudahSUDAH MENIKAH07-01-2026
3516135506820004
WAHYUNINGTYAS15/06/1982PIBU RUMAH TANGGA
GRIYA PERMATA IJEN B1 (08/04)
SOOKOWATESANEMIAANEMIAANEMIAANEMIA14776,49011678101
37
POSYANDU GPI34dinasudahSUDAH MENIKAH07-01-2026
3576024803970002
WAHYU SETYARINI08-03-1997PIBU RUMAH TANGGA
GRIYA PERMATA IJEN B1/11 (08/04)
WATESWATES----15891939873127
38
POSYANDU GPI35dinasudahSUDAH MENIKAH0701-2026
3576026707670002
NURHAMIDAH27/07/1967PIBU RUMAH TANGGA
GRIYA PERMATA IJEN D3/8 (01/04)
WATESWATESHIPERTENSIHIPERTENSIHIPERTENSIHIPERTENSI 16068,910116792143
39
POSYANDU GPI36dinasudah 22/01SUDAH MENIKAH 07-01-2026
3576024301710004
NURLAILA03/01/1971PIBU RUMAH TANGGA
GRIYA PERMATA IJEN A2/11 (09/04)
WATESWATES----14757,68312886132
40
POSYANDU GPI37dinasudah 22/01SUDAH MENIKAH07-01-2026
3576026908730004
ILFATIN29/08/1973PIBU RUMAH TANGGA
GRIYA PERMATA IJEN D4/05 (04/04)
WATESWATES----15465,89613473108
41
POSYANDU GPI38dinasudah 22/01SUDAH MENIKAH07-01-2026
3576027103940002
KHUSNUL A'YUN M31/03/1994PIBU RUMAH TANGGA
GRIYA PERMATA IJEN A2/11 (09/04)
WATESWATESHIPERTENSI---15957,3838971103
42
POSYANDU GPI39dinasudah 22/01SUDAH MENIKAH07-01-2026
3372016505720005
FERITA WIDYANINGRUM, S.SOS25/5/1972PIBU RUMAH TANGGA
081329263332
GRIYA PERMATA IJEN C2/37(07/04)
WATESWATES----15342,8841037984
43
POSYANDU GPI40dinasudah 22/01SUDAH MENIKAH07-01-2026
3516135103920001
RITA MARLIESA11/03/1992PKARYAWAN SWASTA
GRIYA PERMATA IJEN A3/16 (09/04)
WATES WATES ----16953,9809159115
44
POSYANDU GPI41dinasudah 23/01SUDAH MENIKAH07-01-2026
3576021112680001
AGUS RIYANTO11/28/1968LKARYAWAN SWASTA
GRIYA PERMATA IJEN B1/11 (08/04)
WATESWATES----15974,99711271249
45
POSYANDU GPI42dinasudah 23/01SUDAH MENIKAH07-01-2026
3576021301930003
ASGAF NARANDA PUTRA PERKASA13/01/1993LKARYAWAN SWASTA
GRIYA PERMATA IJEN A3/16 (RT09/RW 04)
WATESWATES----18787,410311664112
46
POSYANDU GPI43dinasudah 23/01SUDAH MENIKAH07-01-2026
3516106309910001
MA'RIFAH RAHMAWATI ZAKIYAH23/09/1991PIBU RUMAH TANGGA
085755341529
GRIYA PERMATA IJEN D3/20 (RT04/RW 04)
WATESWATESHIPERTENSI---152,549,58110765100
47
POSYANDU GPI44dinasudah 23/01SUDAH MENIKAH07-01-2026
3576024202690005
SITI MASROKHAMAH, ST02/02/1969PIBU RUMAH TANGGA
085230813337
GRIYA PERMATA IJEN B1/10 (RT08/RW 04)
WATESWATES----14640,57210667184
48
POSYANDU GPI45dinasudah 23/01SUDAH MENIKAH07-01-2026
3576026506760002
KOMINAH25/06/1976PIBU RUMAH TANGGA
GRIYA PERMATA IJEN D1/15 (RT 03/ RW 04)
WATESWATES----15153,5751006086
49
POSYANDU GPI46LAILISUDAH 21/01SUDAH MENIKAH07-01-2026
3576024602760001
NINING JUMA'ATI06/02/1976PIBU RUMAH TANGGA
GRIYA PERMATA IJEN D3/23 (RT01/RW04)
WATESWATES----16075,310510475177
50
POSYANDU GPI47dinasudah 23/01SUDAH MENIKAH07-01-2026
3576025409000001
ANISA RIESKI FADILA14/09/2000PKARYAWAN SWASTA
082245650569
GRIYA PERMATA IJEN C3/26 (RT 05/ RW 04)
WATESWATES----15660,586936195
51
POSYANDU GPI48dinasudah 23/01SUDAH MENIKAH07-01-2026
3524236308930002
TITIS ANGGRAINI23/08/1993PWIRASWASTA
GRIYA PERMATA IJEN B2/17 (RT08/RW04)
WATESWATES----14943,57511080115
52
POSYANDU GPI49dinasudah 23/01SUDAH MENIKAH07-01-2026
3576025204730001
SITI UMSIYAH12/04/1973PIBU RUMAH TANGGA
GRIYA PERMATA IJEN B4/04 (RT08/RW04)
WATESWATES----148689214882127
53
POSYANDU GPI50ViaSUDAHCERAI HIDUP07-01-2026
3515012806740002
YONATAN SUTANTO28/06/1974LPEDAGANG
GRIYA PERMATA IJEN C2/19 (RT10/RW04)
WATESWATES----167,547,17410271106
54
POSYANDU GPI51ViaSUDAHSUDAH MENIKAH07-01-2026
3516145807900001
RIYAN YULIANI18/07/1990PIBU RUMAH TANGGA
GRIYA PERMATA IJEN C2/19 (RT11/RW04)
WATESWATESHIPERTENSI---15457,285976989
55
POSYANDU GPI52ViaSUDAHSUDAH MENIKAH07-01-2026
3576024202740003
IDA ARIYANTI02/02/1974PIBU RUMAH TANGGA
GRIYA PERMATA IJEN C1/17 (RT10/RW04)
WATESWATES-16768,68610869101
56
POSYANDU GPI53ViaSUDAHSUDAH MENIKAH07-01-2026
3576024909690003
TUTIEK HERMAWATIE09/09/1969PIBU RUMAH TANGGAGPI D1/25 (02/04)WATESWATES-15048,8821367996
57
POSYANDU GPI54ViaSUDAHSUDAH MENIKAH07-01-2026
3576026108830001
RULLY IKA AGUSTIN 21/08/1983PIBU RUMAH TANGGAGPI A1/02 (11/04)WATESWATES---15067,7841349987
58
POSYANDU GPI55ViaSUDAHSUDAH MENIKAH07-01-2026
3576024911780003
NYU ERNA DAMAYANTI09/11/1978PIBU RUMAH TANGGAGPI C3/20 (07/04)WATESWATES-----14854721096988
59
POSYANDU GPI56ViaSUDAHSUDAH MENIKAH07-01-2026
3576025801700002
SRI DJATI PURWINDARI18/01/1970PIBU RUMAH TANGGAGPI D1/04 (03/04)WATESWATES----15261,88311375112
60
POSYANDU GPI57ViaSUDAHSUDAH MENIKAH07-01-2026
3576024602700002
NUR BANI SALEH06/02/1970PIBU RUMAH TANGGAGPI C3/25 (03/04)WATESWATESDM---155669611670121
61
POSYANDU GPI58ViaSUDAHSUDAH MENIKAH07-01-2026
3576024707710002
SRI RETNO SUMILIH07/07/1971PIBU RUMAH TANGGA85852201998
GRIYA PERMATA IJEN B3/20 (RT 10/RW 04)
WATESWATES-15664,79210973101
62
POSYANDU GPI59ViaSUDAHSUDAH MENIKAH07-01-2026
3516157010960003
DWI CITRA WULANDARI30/10/1995PIBU RUMAH TANGGA81215759183
GRIYA PERMATA IJEN A2/8 (RT 09/RW 04)
WATESWATES-15559,2821208089
63
POSYANDU GPI60fitriasudahSUDAH MENIKAH07-01-2026
3576024102790006
RENNY MULIANTI01-02-1979PIBU RUMAH TANGGA8815083900
GRIYA PERMATA IJEN D2/07 (RT 02/RW.04)
WATESWATES-15157,38011079123
64
POSYANDU GPI61fitriasudahSUDAH MENIKAH07-01-2026
3576025206870001
RIZKA FITRIA MURYANTINI12/06/1987PIBU RUMAH TANGGA
GRIYA PERMATA IJEN C3/40 (RT 05/RW 04)
WATESWATESHIPERTENSIDIABETES1559011811090155
65
POSYANDU GPI62fitriasudahSUDAH MENIKAH07-01-2026
3576024204690005
BIS HARTUTIK02/04/1969PIBU RUMAH TANGGA85730442420
GRIYA PERMATA IJEN B1/11 (RT 08/04)
WATESWATES15463,98811979107
66
POSYANDU GPI63fitriasudahSUDAH MENIKAH07-01-2026
3516165809950005
ALFI SEPTY RAHAYU18/09/1995PIBU RUMAH TANGGA
GRIYA PERMATA IJEN D4/5 (RT 04/04)
WATESWATES15673,69212090116
67
POSYANDU GPI64fitriasudahSUDAH MENIKAH07-01-2026
3518084306700007
TITIN SUWARTINI03/06/1970PIBU RUMAH TANGGA
GRIYA PERMATA IJEN B3/15 (RT 06/04)
WATESWATESHIPERTENSI14579,59914110195
68
PROGRAM65fitriasudah
3576025704770001
ANA NIRNAWATI17/04/1977P
MAHASISWA
88803559863JL. TENGGER VIII / 6WATES150457411060279
69
PROGRAM66ARIPSUDAH
3576025101680002
ANDJAR ADMINARTI11/01/1968P
IBU RUMAH TANGGA
82141209303JL. ARGOPURO III / 02WATESDM,HT160708011080271
70
PROGRAM67ARIPSUDAH
3576021709820003
BONE SUGARA SAID17/09/1982LPNS85815139940JL. RAYA KAWI / 26WATESDM160608810060235
71
PROGRAM68ARIPSUDAH
3506150309910001
DIDIK MANDRASI03/09/1991LLAIN-LAIN8113001010BANCANG GG 3WATES162718810070995,9139
72
PROGRAM693SUDAH
3516145506840002
KRISMA WINARNI15/06/1984P
IBU RUMAH TANGGA
85706020700JL BROMO II/14WATES1625580120807016065
73
PROGRAM70ARIPSUDAH
3576021003730002
SUKERI10/03/1973LLAIN-LAIN81553622307JL RAJEKWESI VIII/04WATESDM157548011070122
74
PROGRAM71ARIPSUDAH
3576024803770003
TITIN WIJAYANTI08/03/1977P
IBU RUMAH TANGGA
85731705489GRIYA PERMATA IJEN D-3 / 28WATESHT145347010060134
75
PROGRAM72ARIPSUDAH
3515015910990002
TSANIYAH NABILAH RACHMAWATI19/10/1999P
KARYAWAN SWASTA
MLIRIPROWO TARIKWATES15444809060107
76
PROGRAM73ARIPSUDAH
3515012912950001
ACHMAD CHASAN AL BASRI29/12/1995L
KARYAWAN SWASTA
85895119151MOJOANYARWATES1655070907099
77
PROGRAM74ARIPSUDAH
3515016207730001
LIS YUNIATI22/07/1973PLAIN-LAIN82331390381KRAMATTEMENGGUNG TARIKWATESDM,HT165357010070134
78
PROGRAM75ARIPSUDAH
3515010306670002
SHOLIHIN03/06/1967LLAIN-LAIN89513704191DSN BLERE SEBANI TARIKWATESDM173607410070130
79
PROGRAM76ARIPSUDAH
3515014101690059
SITI RAHAYU01/01/1969P
IBU RUMAH TANGGA
89513704191DSN BLERE SEBANI TARIKWATESDM,HT169647011070129
80
PROGRAM77yaniSUDAH
3576026910810005
TATIK PONCO ISTININGRUM29/10/1981P
IBU RUMAH TANGGA
85645153110JL. ARJUNO I / 19WATES160558012070178
81
PROGRAM78ARIPSUDAH
3576024710700003
YATIK07/10/1970P
IBU RUMAH TANGGA
JL. PANDAN 37WATESDM172,2758212080287
82
PROGRAM79ARIPSUDAH
3516186307790001
CEMPLUK DWI HARTINI23/07/1979P
IBU RUMAH TANGGA
81359334945BANJARMLATI LENGKONGWATESDM,HT145408011070207
83
PROGRAM80ARIPSUDAH
3576020812690002
LAMBERTUS RUPANG08/12/1969L
KARYAWAN SWASTA
87819505221JL RAYA IJEN NO 99WATESDM165628811070129
84
PROGRAM81ARIPSUDAH
3576025203660001
LAMINI SETYO PANGESTUTI12/03/1966P
IBU RUMAH TANGGA
8123212836JL. MANGGA NO. 71-73WATESDM167568011080131
85
PROGRAM82megasudah6
3576012209660001
MATARIM22/09/1966LLAIN-LAIN85732406116KEDUNGMULANG 1`WATESDM178568012070114
86
PROGRAM83megasudah
3576025811700001
NUR SOMA18/11/1970P
IBU RUMAH TANGGA
81559612409JL RAJEKWESI. XV/17WATESDM177808010070115
87
PROGRAM84megasudah
3516115910990005
OCTAVIA DWI SETYORINI19/10/1999P
KARYAWAN SWASTA
87870900344JL EMPUNA;LA 243-CWATES15645761006098
88
PROGRAM85megasudah
3576022610970002
OKTAVIANUS YOGA BINDA26/10/1997LLAIN-LAINMARGOSARI III / 09WATES15750781007097
89
PROGRAM86megasudah
3576025607710001
YULI ENDAH WAHYUNINGTYAS, S.PD16/07/1971P
IBU RUMAH TANGGA
85855352625JL KAWI RAYA NO.46WATESDM152477690701708,9173126
90
PROGRAM87ARIPSUDAH
3576025105770002
EVA MAIRINA11/05/1977P
IBU RUMAH TANGGA
85852500154KELUD II/34WATES15946,776906089
91
PROGRAM88SYLVIESUDAH
3576026502830001
HANIATUL ATHIFAH25/02/1983P
IBU RUMAH TANGGA
81232191405RAYA PENANGGUNGAN 42WATES1608785100701624,713087
92
PROGRAM89SYLVIESUDAH
1671021210720009
IWAN HERMAWAN12/10/1972L
KARYAWAN SWASTA
82177802902RAJEKWESI II/02 / PALEMBANGWATES1365480906093
93
PROGRAM90SYLVIESUDAH
3515016710840003
JENIS SUSANTI27/01/1984P
IBU RUMAH TANGGA
8113195553
PAJARAN UTARA 9/4 MLIRIPROWO TARIK
WATES15558701006087173134
94
PROGRAM91SYLVIESUDAH
3576026304670002
KANI23/04/1967P
IBU RUMAH TANGGA
85790259536JL RAYA KAWI NO 21WATESDM155327610060123
95
PROGRAM92SYLVIESUDAH
3576020204730001
MOHAMMAD HAZIN02/04/1973LLAIN-LAINPENANGGUNGAN NO 42WATES1656580110809014746
96
PROGRAM93SANDRA SUDAH
3576025011780004
NGATMINI10/11/1978PLAIN-LAIN85232643392KARANGLO IV / 12WATESDM1676580120808711563
97
PROGRAM94SANDRA SUDAH
3576026601690001
NUR CHOLIFAH26/01/1969PLAIN-LAIN88231183340RAJEKWESI IIWATES163536810070123
98
PROGRAM95SANDRA SUDAH
3576025211680002
TITIS ERNANI ROFIDA12/11/1968PLAIN-LAIN85732168168GANG BANJAR/09 TRENGGILISWATESDM15664781007099
99
PROGRAM96SANDRA SUDAH
3517113010770001
ZAENAL UTOMO30/10/1977L
KARYAWAN SWASTA
81555758007JL. MALABAR V / 08WATESDM155417010070266
100
PROGRAM97SANDRA SUDAH
3576025304690001
DJUHANA13/04/1969P
IBU RUMAH TANGGA
851553842216BANJAR ANYAR GG. MASJID 18WATES15848809060244