ABCDEFGHIJKLMNOPQRSTUVWXYZAAABACADAEAFAGAHAIAJAKALAMANAOAPAQARASATAUAVAWAXAYAZBABBBCBDBEBFBGBHBIBJBK
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
12
1Abbiya Alzena SorayaPSD1A3195952644
3276034307190003
DEPOK3-Jul-20197 tahunJl. Melati082261569145
13
2Abela hilya mafazaPSD1A3194298312
3276095605190001
Jakarta16-Mei-20197 tahun 2bulan
Jl.Pintu Air III No.5-A
085775238105vv00v00vv34,6128
90/60
vvvvvv1MR20/08/2026O125N174B
14
3Afiza Sauqiya AnanditaPSD1A3190694164
3276094207190002
DEPOK2-Jul-20197th,1 bln
JL. H. JAMHUR
085714614972vv00v00vv18119
97/63
vvvvvv>3MR20/08/2026O125N174B
15
4Auliya Azzahra jaminPSD1A3193745895
3276095902190001
JAKARTA19-Feb-20197th 5bulan
JL. H. MENDIK GG. DUA DARA
083804756442vv00v00vv27109
71/59
vvvvvv1MR20/08/2026O125N174B
16
5BALYA IBNU SAIDLSD1A3195166200
3209102806190001
Cirebon28-Jun-20197 THN 1 bulan
Blok Sigelap
087786421721vv00v00vv41135
98/73
vvvvvv3
17
6Bella kania safitriPSD1A3205344523
3174034504200002
JAKARTA5-Apr-20206 tahun 3 bulan
BANGKAIX NO 16
0895322513187vv00v00vv24127
99/51
vvvvvvvMR20/08/2026O125N174B
18
7Dea AlvinaPSD1A3192478887
3276096901190001
JAKARTA29-Jan-20197 tahun
Jl. Jati Murni No. 31 Pangkalan Jati Kec. Cinere Kota Depok
0857169109649
19
8DINA FAHIRA MAHMUDPSD1A3187399571
3276094512180003
Depok5-Des-20187 tahun
Jl. Pintu Air III Gandul kec. cinere Kota Depok
081298622860
20
9DIRA ULFAIRAH RAHMATPSD1A3193835535
3276096908190003
Jakarta29-Agu-20197 tahun
JL. ERHA BLOK B NO. 173
085776628936MR20/08O125N174B
21
10Evano Zaflan alfarezLSD1A3191808208
3276091802190002
Depok18-Feb-20197 tahun 5 bulan
Jl. Melati II Blok A No 77-A
085384670708vv10v01vv
87/56
vvvvvv>3MR20/08/2026O125N174B
22
11Janzio Adipati RachmatanLSD1A3190882169
3275081007190005
Kabupaten Lampung Selatan
10-Jul-20197
JL. PLN Gandul
085781518202vv00v00vv21118
82/66
vvvvvvvMR20/08/2026O125N174B
23
12Kayla Aulia Humairah LubisPSD1A3197251592
3276095807190003
Jakarta18-Jul-20197 tahun
Jl.Pintu Air III No.67
085210238468vv00v00vv19119
80/52
vvvvvvvMR20/08/2026O125N174B
24
13Muhamad Rasyid khaizuranLSD1A3190426175
3327142406190001
Pemalang24-Jun-20197 tahun 3 bulan
Dusun Kranding
085802580569vv00v00vv19,5118
120/71
vvvvvv>3MR20/08/2026O125N174B
25
14Muhammad Adnan KhiarLSD1A3196802644
3276090809190001
Brebes29-Sep-20197 tahun
JL. H. MENDIK GG. DUA DARA
0895373244343vv03v00vv22119
101/67
vvvvvv0MR20/08/2026O125N174B
26
15Muhammad Al fatih sanjayaLSD1A3196438677
3174070209190005
Jakarta2-Sep-20196 tahun 10 bulan
Jl.Pintu Air III Rt.27 Rw.08 N0. 75 E Gandul Cinere Depok
087742524651vv00v00vv
74/57
vvvvvv>3
27
16Muhammad sechanLSD1A3192724298
3276090807190001
JAKARTA8-Jul-20197 tahun
JL. ERHA GG. WAREN
085892058775vv0v00vv22118
90/60
vvvvvv1MR20/08/2026O125N174B
28
17Muhammad Syafiq Al-FathirLSD1A3190192393
3276091008190001
Jakarta10-Agu-20196 tahun 11 bulan
Jl. Lestari No. 45-D
085692439658
29
18Nadira putri davaniPSD1A3193454085
3276096401190002
Jakarta24-Jan-20197 tahun 7 bulan
Jl. Raya Gandul Gang Ikhlas
085889805214
30
19Naura hafizahPSD1A3196249203
3276094408190005
Jakarta4-Agu-20196tahun 11 bualn
Jl. Masjid Al Akhyar N.24 Rt.029 Rw.002 Gandul Cinere Depok
082310945292vv00v00vv16,5116
52/39
vvvvvv3MR20/08/2026O125N174B
31
20Raka AdhitamaLSD1A3191169024
3276092006190001
Depok20-Jun-20267/1 bulan
Jl. PLN Gandul
08982331853vv00v00vv19118
86/55
vvvvvv>3MR20/08/2026O125N174B
32
21Rasya Ahmad ZafiyarLSD1A3191873023
3276091107190002
Depok11-Jul-20197 tahun
Jl. PLN Gandul
08589174996vv00v00vv42138
103/65
vvvvvvvMR20/08/2026O125N174B
33
22Revalina Alesha SofyanPSD1A3186211997
3276094112180002
DEPOK1-Des-20187 tahun 7 bulan
Jl. Ahmad Family
0852 8346 4583
34
23Ruby azzahraPSD1A3199041724
3276094808190005
Padang8-Agu-20196 tahun 11 bulan
Jl. Raya Gandul Gg. Ikhlas
082170149648vv10v00vv36123
102/65
vvvvvvvMR20/08/2026O125N174B
35
24Safeea Najma RedjaniPSD1A3190953600
3174065005190007
DEPOK5-Okt-20197 tahun 2 bulan
PONDOK LABU 1A NO 22
0895329430173vv00v00vv36126
97/66
vvvvvvvMR20/08/2026O125N174B
36
25Sakha Ibadil KiramLSD1A3193850261
3276090305190002
DEPOK3-Mei-20191tahun 2bulan
Jl. Raya Gandul
087865406211vv00v00vv36123
102/72
vvvvvvvMR20/08/2026O125N174B
37
26Syahna Dea AnindyaPSD1A3193978086
3276095104190001
DEPOK11-Apr-20197 tahun
Jl Pintu air III
085883596987vv00v00vv25115
120/70
vvvvvvvMR20/08/2026O125N174B
38
27Vanesha putriPSD1A3198121407
3174025209190001
JAKARTA12-Sep-20197
Jl. Pintu Air III Gandul kec. cinere Kota Depok
087883014258vv00v00vv18114
79/59
vvvvvvvMR20/08/2026O125N174B
39
28Zidan Nur FadillahLSD1A3185921242
3174040310180006
Jakarta10-Mar-20187 tahun 9 bulan
Jl. H.saumin rt. 028 rw. 008 no. 48
085814486766
40
29Adilla Syaqilla PutriPSD1B3190442578
3276096604190001
Depok26-Apr-20197 tahun 3 bulan
Jl.Cilobak IV No.112
089505987922vv00v00vv20115
103/88
vvvvvv>3MR20/08/2026O125N174B
41
30Aina Talita zahranPSD1B3193772165
3276094706190002
Depok7-Jun-20197,2
Aina Talita zahran
085883741427vv00v00vv18,2115
92/64
vvvvvvvMR20/08/2026O125N174B
42
31Aleeya Yumna HardiPSD1B3197327208
3276095808190001
Depok18-Agu-20196 tahun 11 bulan
Jl h mendik GG duadara no 58b RT 04 RW 01 Kel gandul kec Cinere
081294881973
43
32Alfarizki Putra AhmadLSD1B3183609753
3276092112180001
Depok21-Des-20187 th
Jl.Pln GG.Bhotoh RT.22/06,gandul
082124739943vv00v00vv21120
89/58
vvvvvv2MR20/08/2026O125N174B
44
33
Almeera Khanza Khairunissa Ramadhani
PSD1B3193053497
3276096405190001
Depok24-Mei-20197 tahun 2 bulan
jln h jamhur no 30 n gandul , rt03 rw 01cinere depok
087883007621vv00v00vv19120
90/160
vvvvvv2MR20/08/2026O125N174B
45
34Annisa karuniaPSD1B3191947229
3276095206190001
Depok12-Jun-20197 tahun 1 bulan
Annisa karunia
081387581326vv00v0123vv20122
90/60
vvvvvv>3MR20/08/2026O125N174B
46
35Atharauf Falah ArsalanLSD1B3195466578
3276090808190005
Lampung Tengah
8-Agu-20196th 11bln 22hari
Jl. Erha GG waren RT RW 005/007 Kel. Gandul Cinere Depok
081325258940vv0019.5121.5
90/60
vvvvvv3MR20/08/2026O125N174B
47
36Atharauf Falah HabibiLSD1B3197792444
3276041403190001
Depok14-Mar-20197th 5bln
Jl Raya PLN Gg H Joan
087760982019 / 0881012530908
vv00
79/59
vvvvvvvMR20/08/2026O125N174B
48
37Athaya AisyaturrohmahPSD1B3192948281
3301136709190001
Tanggerang selatan
27-Sep-20196thn 10bln
Jln musola attaqwa no15D rt08 rw08 gandul
082191726276vv00v00vv34.3120
82/63
vvvvvv>3MR20/08/2026O125N174B
49
38Ayudissa Putri AqillaPSD1B3196652800
3276055405190003
Jakarta14-Mei-20197 Tahun 2 Bulan
Jl.Puring No.49A RT.06 RW.07 Gandul, Cinere Kota Depok
0895-1395-5055
vv00v00vv19116
95/70
vvvvvv3MR20/08/2026O125N174B
50
39Ayunindya citraniPSD1B3194653393
3276094801190001
Depok8-Jan-20197thun 6 bulan
Jl. Sawo RT 13 RW 05
085939068344vv00v00vv20117
102/75
vvvvvv>3MR20/08/2026O125N174B
51
40Farel Ghazi FatulleniLSD1B3199160991
3276062503190005
Jakarta25-Mar-20197 tahun 4 bulan
Jl. H. M. Nasir Jl. Puring No.77b, RT.06/RW.07, Gandul, Kec. Cinere, Kota Depok, Jawa Barat 16541
087771827685vv00v00vv26123
103/65
vvvvvvvMR20/08/2026O125N174B
52
41Febrianabsiani FatimahPSD1B3194910045
3276095802190002
Jakarta18-Feb-20197 tahun
Jl Erha Gg Waren No 42a, Kel. Gandul, Kec. Cinere, Kota Depok 16512
083173628586vv00v00vv22119
85/63
vvvvvvvMR20/08/2026O125N174B
53
42Gian Altarra SetiawanLSD1B31935966913193596691Banyumas8-Mei-20197 Tahun
Jln. Pln raya gang mushola 1 rt 11/05 gandul , cinere , depok jawa barat
081299081575vv00v00vv23120
103/77
vvvvvv2MR20/08/2026O125N174B
54
43harum kiranaPSD1B3180946866
3276095909180001
depok19-Sep-20187th 10bln
jl. h.usman no 112 RT 13/05 ganduk cinere depok
081388507864vv00v00vv20121
96/67
vvvvvvvMR20/08/2026O125N174B
55
44Hasna Adiba HumairaPSD1B3194244363
3276094403190000
Depok3-Apr-20197 Tahun 4 Bulan
Jalan haji usman rt 13 rw 05 no 48 gandul, cinere depok
089696913750vv00v00vv17116
86/58
vvvvvv>3MR20/08/2026O125N174B
56
45Hermawan saepurohmanLSD1B3188538889
3304182312180003
Banjarnegara23-Des-20187Tahun 7 Bulan
Komplek bpk v gandul blok H nomer 3a
087865797142vv00v00vv20114
97/63
vvvvvv3MR20/08/2026O125N174B
57
46Jihan ayu astriyantaryPSD1B3194125043
3276094401190002
Depok4-Jan-20197thn, 7 bulan
Jl. Madrasah gandul PLN no. 15, gandul, cinere
085719203797vv00v00vv22117
93/75
vvvvvv2MR20/08/2026O125N174B
58
47Kapin waldan wardanaLSD1B3191266962
3276042211190003
Jakarta22-Nov-20196th 9 buln
Jaln raya gandul RT 07, RW 8
087878841733vv00v00vv22130
92/68
vvvvvvvMR20/08/2026O125N174B
59
48Marcella daania putriPSD1B3183315269
3201244406180005
Tangerang selatan
4-Jun-20188 tahun
Jl.musholla at-taqwa rt 08/ rw 08
0895331321291vv00v00vv18123
81/65
vvvvvv3MR20/08/2026O125N174B
60
49Muhammad Azlan AlkhairiLSD1B3191046303
3276091709190001
Jakarta17-Sep-20196,9 tahun
Jln.Pln Raya Gg.mushala 1 No.93 Rt.11/05 cinere gandul
081210266539vv00v00vv46136
110/78
vvvvvvvMR20/08/2026O125N174B
61
50
Muhammad Azzam firmansyah
LSD1B3195177829
3276091806190003
Tangerang selatan
18-Jun-201986 bulan
Jln H.usman no 50 gandul RT 013/RW 005 kec Cinere kota depok prov Jawa barat
082122779935vv00v00vv22129
90/57
vvvvvvvMR20/08/2026O125N174B
62
51Muhammad Bilal AzzayyidLSD1B3194508161
3276090806190001
Depok8-Jun-20197 tahun
Jl.h.usman RT 13/05 no 62 gandul Cinere depok
089620777771vv00v00vv40129
95/58
vvvvvvvMR20/08/2026O125N174B
63
52Qiana izzatunnisaPSD1B3192168034
3276096803190001
Depok28-Mar-20197tahun 4bulan
Jl. PLN gang mushola 1 rt 011/ rw 005 gandul cinere
081400384522vv00v00vv23122
99/66
vvvvvvvMR20/08/2026O125N174B
64
53SyahrianiPSD1B3192241058
3276094707190001
Jakarta7-Jul-20267 tahun
jl. perwakilan RT 46 RW 05
087814120957vv00v00vv20118
85/54
vvvvvvvMR20/08/2026O125N174B
65
54Yusuf AmmarLSD1B3193859533
3276090507190002
Depok5-Jun-20197 thn
Jln.Raya gandul pintu Air 3 No.62 RT.027085/08 gandul cinere depok
085692723828vv00v00vv17115
92/64
vvvvvv>3MR20/08/2026O125N174B
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