ABCDEFGHIJKLMNOPQRSTUVWXYZAAABACADAEAFAGAHAIAJAKALAMANAOAPAQARASATAUAVAWAXAYAZBABBBCBDBEBFBGBHBIBJBKBLBMBNBOBPBQBRBSBTBU
7
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. BatchNo. Batch
12
2Abyandra Zidni SyawalLSD1 A31827614133276092606180001Jakarta,
26/06/2018
7
Jl. H. Mendik No. 30
083870268263v00000000vv2612188/61vvvv6/9v1vv
13
3Adreena Nasha ShaqeenaPSD1 A31841332123276095703180003Depok,
17/03/2018
8
Jl.Puring No.64
087889545438v00000000vv20115
93/64
vvvvvv3
14
4Aisya Hasna ShofiyaPSD1 A31814819103276097108180001Jakarta,
31/08/2018
7
Jl. H. Mendik No. 194
081372616363v00000000vv23117
90/60
vvvvvv0
15
5Alfan Putra RaffiskiLSD1 A31830439413276092105180005Jakarta,
21/05/2018
7
JL. GANDUL GG. H. DOBENG NO.71
081514205643v00000000vv26125
93/70
vv Kivvvv3
16
6Annisa AzzahraPSD1 A31897165993276095808180005Sigli,
18/08/2018
7
JL. RAYA PLN GG. H. JOAN NO. 19
088809085055V00000000VV1911391/75VVV6/9V211V
17
7Ashila SalsabilaPSD1 A03276096803180002Depok,
28/03/2018
8
JL PURING
0895421868840V00000000VV2512290/60VVV6/15011V
18
8Axl FaniyanzaPSD1 A31747280713174034808170002Jakarta,8/8/20178
Jl. Puring No.77.A
085881390588v00000000vv20115
90/60
vvvv6/9v511
19
9Devan Ali Ramadhan (KTP)LSD1 A31810585493276091705180001Jakarta,
17/05/2018
7
JL. MELATI I NO. 48
081212300838v00000000vv23118100/71vvvv6/9v111
20
10Faisal Hafiz AlfariziLSD1 A31887420163276090602180003Depok,6/2/20188
JL. ERHA NO. 78
085716248292v00000000vv251181
100/62
vvvv6/9v0
21
11Hayfa Talina ArsyaPSD1 A31820550163276094902180002Depok,9/2/20188
JL. ERHA GG. PRIBADI
081317143731V00000000VV22117106/70VVV6/9V3
22
12Ibrahim Nur AlfariziLSD1 A31829329843276091508180005
Sukabumi,
15/08/2018
7
JL. Musholla At Taqwa
081573960483v00000000vv23121
98/72
vvvv6/9v2
23
13Irena AsheeqaPSD1 A31895505953325014408180004Batang,4/8/20187
Jl. H. Mendik
085813421226V00000000VV23115107/64VVVV6/9V1
24
14Izhar MaulidiLSD1 A31895505953276092205170002Bogor,
22/05/2017
8
JL. MELATI II NO.122
085692451901v00000000vv23118125/86vvvv6/7,5v
25
15
Keanu Yagami Putra Kuswoyo
LSD1 A03276090510170002Depok,5/10/20178
JL. PLN GG.BHOTOH NO.5 GANDUL
085158699716V00000000VV2312290/71VVVV6/15V0V
26
16M. Abdul RafiLSD1 A01806031106180001
Tanggamus,
11/6/20187
Jl. Erha Gg.Pertamina
083139918858V00000000VV2210393/62VVVV6/9V3
27
17Meiccazea Razita RafandiPSD1 A31890563713276096804180001Depok,
28/04/2018
8
Jalan H. Mendik No. 10
089533217370945126
28
18Melati Amelia MegaPSD1 A31853061463276095202180003Jakarta,12/2/20188
Jl. Melati II
081283129410v00000000vv36131
102/86
vvvv6/18v1
29
19Muhamad Azril RafisqyLSD1 A03276091707170003Jakarta,
17/07/2017
8
JL.ERHA GG. WAREN NO.64
085711096148v00000000vv28126
90/60
vvvv6/18v0
30
20Muhamad Fatih Al BannaLSD1 A31858195053276091010180002Depok,10/10/20187
Jl. H. Usman No. 54
082128802178v00000000vv23118106/72vvvv6/12v1v
31
21Muhamad Raka FebrianLSD1 A03276092208170004Jakarta,
22/08/2017
8
jl. pln raya
082123023986V00000000VV2512390/74VVVV6/9V2
32
22Muhammad Al Fatih PratamaLSD1 A31821102783276092109180002Depok,
21/09/2018
7
Jl.H.Mendik No. 17
087894969930V00000000VV2512498/59VVV6/242
33
23Muhammad Azril Al FariqLSD1 A31835162373315040603180004
Grobogan,
6/3/20188
Jl. Pangkalan Jati II
08129391913830128
34
24Nabilla AgustianiPSD1 A31816085463276095208180001Depok,12/8/20187
Jl. H. Jamhur No. 82
0895616235226v00000000vv23119105/69vvvv
6/15 ka
v5
35
25Nadhifa Alisha HasinaPSD1 A31793578863276096205170001Jakarta,
22/05/2017
8
Jl. H. M. Nasir No.15
089529731089V00000000VV2813098/81VVVV6/24V0
36
26Riyani Mutiya AsharahPSD1 A31824108793328084709180003Tegal,7/9/20187
Jl. Yayasan RT 08/08
;087810418777v02000000vv2210391/73vvvv6/9v3
37
27Selly OktavianaPSD1 A03276095107180003Depok,11/7/20187
JL. Masjid al akhyar no 30
081383354739v00000000vv2210982/59vvvv6/9v3v
38
28Sultan Hadi PratamaLSD1 A31896660203276040112180002Depok,01/12/20187
JL. PLN GG. DAMAI NO.67
088211702277v00000000vv22114100/69vvvv6/18v0
39
29Sumahera FatimahPSD1 A31865618373276094104180003Depok,01/04/20188
Jl. Perwakilan RT 045/05
08141011359023124
40
30Zahwa Zaira AsyaniPSD1 A31796607113327075810170001
Pemalang,
18/10/2017
8
JL. PERTAMINA BUNTU ERHA DALAM
083844706955V00000000VV2311795/69VKAVV6/7.5V2
41
31Zhiva Princes ErzePSD1 A03276096509180001
Pekanbaru,
25/09/2018
7
Jl. Mushola AT Attaqwa
081347454600V00000000VV23113110/74VVVVV6/9V0
42
32Abizard Altan Almuttaqin HLSD1B31841939193276090107180002Depok,01/07/20187
JL.SAWO NO.33B
085721290930v00000000vv25128121/104vvvv6/24v1
43
33ADHARA MAKAILA PUTRIPSD1B31842003193276095610180003Depok,
16 /10/ 2018
6
Jl. Lestari No. 1
087878780786V00000000VV28124100/70VKA/KIVV6/24V2
44
34Adinda Kirana SantosoPSD1B31851367573276096203180001Depok,
22/03/2018
7
JL.SAWO III NO.115
081384759483v00000000vv2312798/69vvvv6/15v2
45
35Ahsan RamadhanLSD1B31962721173276091005190002Jakarta,10/5/20196
komplek BPK V Blok F No.14
081513447588v00000000vv2711599/72vvvv6/18v0
46
36Albian VieriLSD1B31898946763276090504180001Jakarta,5/4/20187
Jl. PLN Gandul No. 28 B
0895403254023v00000000vv2812384/74vvvv6/18v2
47
37Alfan Zidan RafisqiLSD1B31811636203276053103180005Depok,
31/03/2018
7
JL. GANDUL GG. H. DOBENG NO.71
081514205643v00000000vv2111787/70vvvv6/18v0
48
38Andita RamadaniPSD1B31899376773276095607180001Depok,
16/07/2018
7
Jl. Lestari No.38 RT.034 RW.007
085711120592v20000000vv2311690/65vvvv6/9v4
49
39Annisah RamadhaniPSD1B31875006503276096805180001Depok,
28/05/2018
7
JL. MASJID AL-AKHYAR NO.45
081221839030v00000000vv23116100/74vvvv6/9v3
50
40Aqilla Yamaguci GinantiPSD1B31844421823276095008180001Depok,10/8/20187
Jl. Raya Gandul No.18 C RT.007/008
085719120687V00000000VV2011390/71VVVV6/9V3
51
41Aulian Arvino XavierLSD1B31890859943276112308180002Depok,
23/08/2018
7
JL. MELATI II BUNTU
085717911062v00000000vv2311386/75vvvv6/12v0
52
42Daffa Arshaka RamadhanLSD1B03276091206180002Depok,12/6/20187
JL. PLN Gang Bhotoh RT 022/006
088293098738V00000000VV2411482/65VVVVV0V2
53
43Dannin Abhinaya GhifariLSD1B31892754243276091709180003Depok,
17/09/2018
6
Jl. Puring No. 33
083871766324v00000000vv18105101/83vv kivv6/9v0
54
44Darel Wahyu AbisenaLSD1B03304180601190001
Banjarnegara,
6/1/20196
jl erha gg damai no 78
085740797738v00000000vv2410885/64vvvv
6/15ka
v2
55
45Dilan Rajab AbqoriLSD1B31873079063276090704180002Jakarta,07/04/20187
JL.SAWO
0895361180899v00000000vv2813087/65vvvv6/12v0
56
46Feyza Haziqa AliyaniPSD1B31855027383276096604180001Jakarta,
26/04/2018
7
JL. MELATI II
085691631873v00000000vv2312579/57vvvv6/9v3
57
47Hafsya Rahma SidiqPSD1B03276094305180002Depok,3/5/20187
jl masjid alakhyar no.23
089521483388v00000000vv2211297/57vvvv6/9v0
58
48Khanzana Naura SalsabilaPSD1B31803965733403105009180001Jakarta,10/9/20186
JL.MASJID AN-NI'MAH
085781749356V00000000VV33123100/70VVVV6/12V0
59
49Khaizuran Sauqi Al Hakim (KTP)LSD1B03174071704180006Jakarta,
17/04/2018
7
jl pln no 27 a
081212976505v00000000vv2312098/67v
v (kanan)
vv6/9v4
60
50
Khiara Septialika Putri (KTP)
PSD1B31841815963276096109180002Depok,
21/04/2018
7
Jl. Puring No.77 B RT.006 RW.007
089523668594v00000000vv3111895/76vvvv6/9v0
61
51Muhammad adriyasta lurfiLSD1B03276090912170002Depok,09/12/20178
jl.pintu air 3
08212452087824124
62
52Muhammad Raka RifazhanLSD1B03209162703190002
Tanggerang,
27/03/2019
6jl lestari08139989386200000vv2110989/62vvvv6/9v0
63
53
Muhammad Shidqi Al Farabi KTP
LSD1B31831055123276090712180002Jakarta,07/12/20186
JL. MELATI II GANG BAMBU 2 NO. 53
088289154585V00000000VV33114119/75VKA/KIVV6/9V3
64
54Naira Sekar AnindyaSD1B31820672623276094507180001Depok,05/07/20187
JL. ERHA GG. DAMAI
081315653598v00000000vv2512386/62vvvv6/24v2
65
55Rayyan Asyauqi (KTP)LSD1B31845057183276092707180002Depok,
27/07/2018
7
JL. MELATI II NO. 79
085159717735v00000000vv2311697/59vvvv6/9v1
66
56Seffa AlmayrahPSD1B03173076711170003Jakarta,
27/11/2017
8
JL. H Mendik
089652575681V00000000VV2211590/60VVVV6/9V1
67
57
Shelma Khaira anindya (KTP)
PSD1B3189916085VDepok,06/03/20187
JL.PINTU AIR III NO.5-A
0895800347047V00000000VV2411987/62VVVV6/12
68
58Shiha AuliaPSD1B31813585913276094109180001Depok,1/9/20186
JL. ERHA GG. WAREN
08151413322633119
69
59Umaral Ayubi (KTP)LSD1B31893322633276091010180007Depok,10/10/20186
JL. MELATI III NO.15
085863151584v00000000vv2311591/56vvv
belum bisa baca
70
60Zalfa ZulaykhaPSD1B31832070593276095604180003Jakarta,
16/04/2018
7
Jl. Madrasah No.72
085775470461v00000000vv2211573/63vvvv6/12v3
71
61
Zhafran Athaya Akbar (KTP)
LSD1B31881199283276091612180001Depok,
16/12/2018
6
Jl. Lestari No. 4
085692979076v00000000vv2211693/67vvvv6/9v3
72
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
99
100
101
102
103
104
105
106