DATA DASAR SASARAN PENCEGAHAN

PUSKESMAS : Wakaokli
DESA : Waanguangu

TANGGAL
JUMLAH
NO. NAMA KEPALA NIK KEPALA LAHIR
NOMOR KK ANGGOTA
Rumah KELUARGA KELUARGA KEPALA
KELUARGA KELUARGA

026 7404110706100009 Ilham 7404111505750003 15/51975 4

075 7404111011100125 La Hamu 7404111507800001 1/7/1970 6
081 7404110806100100 Ilyas 7404112107800001 21/7/1980
043 7404110706100005 La Arif 7404110107850084 1/7/1984 4
058 7404110802180004 Sarifudin 7404112005920002 20/51992 2
051 7404110806100108 Bahtiar 7404110312710002 12/3/1971 5
043 7404110706100011 Muhaimin 7404110403850001 3/4/1985 3
7404111405130001 Lamuni 7404111101870001
038 7404111006100015 Arifin 7404110208820002 8/2/1982 8
049 7404110103100005 La Hamani 7404110107790143 7/1/1989 6
017 7404111006100010 La Bou 7404110107680077 1/71968 6
030 7404111501140003 Umar Ali 7404112507820001 25/71982 3
7404113110170003 Dani 7404113009950001
7404111409170002 Efu 7404112509910001
7404111610180004 Jabal 7404110312930001
Edo
1 7404110903170003 Ld Asfin 7404261407880001 7/14/1988 4
La Edo
025 La Haria 7404113112730013 31/121973 7
7404110702180006 La Yardin 7404100107930018
052 7404110506170006 Hardin 7404112504930001 4/25/1993 3
030 7404112509130007 Daharu 740411180390001 3/18/1990 3
078 7404111505080003 Darman 7404110609720001 9/6/1972 7
Rahmat
Jaema
059 7404111911090001 La Kini 740411017770106 7/1/1977 5
045 7404110412140002 La Idi 7472010312800001 12/3/1980 6
7404112605100004 La Ige 7404110107760065
073 7404111006100012 Amir 7404110511810002 11/5/1981 5
087 7404112302120001 Safrin 7404112307670002 7/23/1987 5
085 7404112302120001 Nusdin 7404110107820030 7/1/1982
7404111412150007 Miswati 7404100907870001
Aswin
Bambang
036 7404112301130001 Saini 7404110107780084 7/1/1978 5
 Salimi
Saimin
Matsir
Untu
071 Helmin 12/1/1995 5
034 7404110204140004 Hariadin 7404111009890001 9/10/1989 3
Ladiana
Marsan
La Ufi
074 7404112509180001 Heri 7404110107860027 7/1/1986 4
062 Nurdin 7404110107830068 7/1/1983 4
Suparman
Hendrik
055 Aci 7404110107900022 7/1/1990 3
Laiba
Rizal
Hasimin
064 Arudin 7404110103810001 3/1/1981 5
7404111605190003 Basuki Rahmat 7404110101900008 1/1/1990 1
7404111107120005 Rudin 7404111210880002 ### 3
7404116407950001 La Ode Muh. Asludin 7404092706930001 6/27/1996 2
7404110706100043 La Ilu 7404114107860040 7/1/1982 3
7404111401200005 La Juhadi 7404110310940001 10/3/1994 1
7404113005170003 Rizal Umagap 7404113005170003 11/8/1986 5
7404111503100001 Benny 7404110107680081 7/1/1968 7
7404110907120003 Suhardin 7404110106840001 6/1/1984 2
7404116109970001 La Alianti 7404112004920001 5/20/1992 1
7404111012180002 Nasrin 7404113012870003 ### 2
7404110806100017 Muhammad Danial A 7404110612760001 12/8/1976 4
7404111011100133 La Heri 7404110107860027 7/1/1986 3
Jamil

ctt : data status gizi menyusul setelah pengukuran di bulan Februari

PENCEGAHAN STUNTING MELALUI INTERVENSI 1000 HARI PERTAMA KEHIDUPAN

JUMLAH PEND
JUMLAH KEPA

DATA SASARAN 1000 HPK

IBU HAMIL BADUTA (0-23 BULAN)
STATU
UMUR
NAMA IBU TGl LAHIR
NIK BUMIL KEHAMILAN NAMA BADUTA NIK BADUTA TGl LAHIR
HAMIL BUMIL BB/TB
(MINGGU)

Adrian 7404112302180003 23/02/18

Astania 07/01/18
Azizah 25/01/18
Alifa 28/03/18
Nur alfatunisya 11/04/18
Arsy Azdarani 29/03/18
Misyel 7404115105180004 11/05/18
Sivana Sukmawati 7404115505180001 11/05/18
Arsifa 11/06/18
Harzolan 07/05/18
Delia Sri Ramadani 01/06/18
Zulfa 7404115206180002 12/06/18
Ataya Ardan Oppi 7404112805180001 28/05/18
Zayan Alwabi 740112307180001 23/07/18
Inaya kanita 7404114808180001 08/08/18
Ghina 31/07/18
Wd.Anisa Azzahra 7404115109180001 11/09/18
Abdul Ramadan 03/06/18
Ifarni Belum ada nik 11/09/18
Fazila Salsabila 7404115708180001 15/08/18
Azharia R 7404116709180003 27/09/18
Delsa 7404116209180001 22/09/18
Syakira 7404111481118000 08/11/18
Reza 25/12/18
Alfami 20/12/18
Fatin Febriana 7404115802190002 18/02/19
Erlan 7404110102190001 01/02/19
Suriatmi 7404114402190002 04/02/19
Afifa 06/03/19
Astrid Belum ada nik 01/03/19
Farzana Belum ada nik 25/03/19
Elfano 25/03/19
Triainun Dzahra 03/03/19
Zakir 22/03/19
Azril 7404111705160001 05/04/19
 Rayan 7/5/2019
Atar 03/07/2019
Nasya 07/07/2019
Aisa Fitri 26/05/2019
Zafira 03/05/2019
Oliv 7404116505930002 5/25/1993 32 mgg Harfan 08/02/2018
Jelita 17/06/2018
Nobel 17/07/2018
Aqila 7/30/2019
Aska Herfiar 11/5/2019
Nugra Agam 10/3/2019
Rizky Maulana 7/17/2019
Ayratanosha 10/15/2019
Azlan 9/7/2019
Fianti 8/16/2019
Aliza 7/15/2019
Yerin 7/20/2019
Puspa Juliani 7/29/2019
Nurwati 7404116401960001 1/24/1996 10 minggu
Asni 7404115410930002 10/14/1993 28 mgg
Juliana 7404116407950001 7/24/1995 28 mgg
Yusniar 7404114107860040 7/1/1986 32 mgg
Fitri 7404116607010001 7/26/2001 28 mgg
Jamila 7404115006880004 6/10/1988 24 mgg
Wa Higu 7404114107840067 7/1/1984 24 mgg
Suriani 7472054509860001 9/5/1986 24 mgg
Irma 7404116109970001 9/21/1997 32 mgg
Ana Bahtiar 7404113012870003 12/30/1987 16 mgg
Jayati 7404116504890002 4/25/1989
Satrianti 7404115702920005 2/17/1992 20 mgg
Murni 16 mgg
AN

AH PENDUDUK : ....... JIWA

AH KEPALA KELUARGA : ...... KK

KONDISI RUMAH

STATUS GIZI AIR TEMPAT

JAGA SPAL CTPS BERSIH SAMPAH
BB/U TB/U

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Kaongkeongkea, Februari 2020

Kepala Puskesmas Wakaokili

ABDUL SAMAD ALI

NIP. 19750624 200604 1 009
 DATA DASAR SASARAN PENCEGAHAN STUNTING MELALUI INTERVENSI 1000 HARI PER

PUSKESMAS : Wakaokli
DESA : Kaongkeongkea

DATA SASARAN 1000 HPK

TANGGAL LAHIR JUMLAH IBU HAMIL

NO. NAMA KEPALA NIK KEPALA
NOMOR KK KEPALA ANGGOTA
Rumah KELUARGA KELUARGA KELUARGA KELUARGA UMUR
NAMA IBU TGl LAHIR
NIK BUMIL KEHAMILAN
HAMIL BUMIL
(MINGGU)

021 74041104101200BASRI 740411210687000 6/21/1987 4

092 74041105061002LA KAYO 740411010759008 7/1/1959 7
087 74041111120800LA TENDA 740411121274000 12/12/1974 4
020 74041105061001LA NANE 740411190880003 8/19/1980 5
035 74041105061001IRJAN 740411570511000 12/14/1996 2
051 74041116051800LA DIANI 740411010779007 7/1/1979 4
111 74041111891200LA LUDU 740411010284000 2/1/1984 3
042 74041106021400JUKRI 740411070483000 4/7/1983 2
067 74041108081700ARSYAD 740411050989000 9/5/1989 2
001 74041120101000HADIRI 740411010777012 7/1/1977 4
74041123071500LA DIANI 7404110107790076
098 74041119121800ANJAR 740512150995000 9/16/1995 3
Rahim
5/ 098 74041109051700SAMHARI 740411211292000 12/21/1992 2
088 74041130011800LA EHU 740411020386000 7/1/1986 3
LA DASA
005 74041108070800LAMPARA 740411230377000 3/23/1977 6
74041125091800ASWAN 7472061210940001
109 74041120021400SARAKA 7404110107770027/71977 5
039 74041119101000ALIMUDDIN 740411010779013 7/1/1979 6
052 74041130077120DARFIN 740411100590001 5/10/1991 3
 74041101061000JAHINUDDIN 7404112703770001
047 74041112507180 DARWIN 740411230184000 1/23/1992 3 Elisna 740411630192001 1/23/1992 28
74041103031800LARANTIKA 7404280305830001
74041129081800HASRUNI HALIK 7471102301880002
024 74041110070800JAFAR 740411100880000 8/10/1980 6
097 74041102061000LA JUDA 740411010777010 7/1/1977 6 Ina Rita 7404114107820103 7/1/1977 16
017 74041119121800HASADA 747110130788000 7/13/1988 2
ERWIN
74720321121800ZAINAL 7472032412850001
077 LA HISAMU 6/1/1974 2
74720321121800ZAINAL 7472032412850001
011 74041123061600RAFIK 740411020389000 3/2/1989 3
008 Muh. Abdul David 740411650398004 2/24/1997 2
100 74041129111800Farli 740411010791004 9/22/1991 2
068 74041120101000LA MAMPU 740411010781010 7/1/1984 6
057 74041105091900Isram 747202021199000 11/2/2019 2
Buyung
Hanaidi
Maluddin
La diri
Sarima
74041124101900Jahruddin 737112151092000 10/15/1992 2 Yeni Yati 7404114502950003 2/5/1995 18
74041112091700Jaelani 740428061083000 10/6/1983 4 Rasmin 740414107970057 12/22/1994 22
74041105041900Erick 747206171296001 12/17/1996 3 Yesti. A 7404116110990001 10/21/1999 20
Rahmat 12/31/1977 5 Afida 7404114108860001 8/1/1986 12
74041107031800Burhan 740507250879001 8/22/1919 5 Alija 7405074107850047 10/27/1924 24

ctt : data status gizi menyusul setelah pengukuran di bulan Februari

NTERVENSI 1000 HARI PERTAMA KEHIDUPAN

JUMLAH PENDUDUK : ....... JIWA

JUMLAH KEPALA KELUARGA : ...... KK

DATA SASARAN 1000 HPK KONDISI RUMAH

BADUTA (0-23 BULAN)
STATUS GIZI AIR TEMPAT
JAGA SPAL CTPS BERSIH SAMPAH
NAMA BADUTA NIK BADUTA TGl LAHIR
BB/TB BB/U TB/U

Karisa Filsari 74041145021800 02/05/18

M. Alfatir 74041104021800 02/04/18
Musawir 74041107071100 03/10/18
Marwah Ramori 74041154031800 14/3/2018 1 1
Yusran 74041110041800 10/04/18 1 1
Rifal Syahban 74041116041800 16/4/2018 1 1
Awaluddin 74041120041800 20/4/2018 1 1
Sulfati Safilin 74041104051800 05/04/18 1 1
Sabina Maira A belum ada NIK 22/5/2018 1 1
Raima belum ada NIK 31/8/2018 1 1
Fadil 30/8/2018
Raya 74041150091800 09/10/18 1 1
Elysia
TARISA AYU 74041150101800 10/10/18 1 1
SYAHIR ZAFRAN 74041125111800 25/11/18 1 1
SRI NURHAYATI 11/11/18
YAFI ALMAN belum ada NIK 18/11/18 1 1
NADIA 74041170111800 30/11/18
M. AKBAR 74041112111800 12/11/18 1 1
DEVANO 74041110121800 10/12/18 1 1
SAFIRA DARFIN belum ada NIK 13/01/19 1 1
 IMRAN NAUFAL 24/01/19
AHMAD YUSUF 74041118021900 18/02/19 1 1 1 1 1
NUR ANIFA 74041150031900 11/03/19
ALEZA ZAHIRA 74041155031900 15/03/19
FAZRAN belum ada NIK 19/03/19 1 1
ARIS BUDIMAN 74041129031900 29/03/19 1 1 1 1 1
HABIB MANAF 74041120041900 20/04/19 1 1
MUH. KENZIE 11/04/19
YUSRAN SAID 27/03/19
SANDI Y 09/04/19 1 1
BARIQ AL FATAH 74100103081600 03/08/16
RAMZI RAMADHA 74041108051900 08/05/19 1 1
AL FARIZI belum ada NIK 06/12/19 1 1
Arif Syabarin 74041130071900 30/7/2019 1 1
Wulan Salwa belum ada NIK 27/08/19 1 1
Alfis Gain 74041108081900 10/08/19 1 1
Deandra 7/13/2019
Mikaila 11/15/2019
Syafa 11/30/2019
Yusairi Mahira 12/18/2019
By Sarima 1/25/2020
1 1 1 1 1
1 1 1 1 1
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Kaongkeongkea, Februari 2020

Kepala Puskesmas Wakaokili

ABDUL SAMAD ALI

NIP. 19750624 200604 1 009
 DATA DASAR SASARAN PENCEGAHAN STUNT

PUSKESMAS : ……………………………………………
DESA : …………………………………..

TANGGAL LAHIR JUMLAH IBU

NO. NAMA KEPALA NIK KEPALA
NOMOR KK KEPALA ANGGOTA
Rumah KELUARGA KELUARGA KELUARGA KELUARGA
NAMA IBU HAMIL

7404271407160001 La Agi 7404310107890003 4

AN STUNTING MELALUI INTERVENSI 1000 HARI PERTAMA KEHIDUPAN

JUMLAH PENDUDUK : ………….. JIWA

JUMLAH KEPALA KELUARGA : …………. KK

DATA SASARAN 1000 HPK

IBU HAMIL BADUTA (0-23 BULAN)
STATUS GIZI
UMUR
TGl LAHIR
NIK BUMIL KEHAMILAN NAMA BADUTA NIK BADUTA TGl LAHIR
BUMIL BB/TB BB/U
(MINGGU)

Yusni 7404275187180001 11-07-2018 Kurus Normal

 KONDISI RUMAH

GIZI AIR TEMPAT

JAGA SPAL CTPS BERSIH SAMPAH
TB/U

Pendek 1 1 1 1 1