TOTAL DATA :

TANGGAL NO TELP/HP JENIS

NO NAMA TRAVEL
VAKSIN TRAVEL PERMOHONAN

1 1-Feb-20 Bina Isnani 085377541653 Vaksin Meningitis

2 1-Feb-20 Bina Isnani 085377541653 Vaksin Meningitis
3 1-Feb-20 Bina Isnani 085377541653 Vaksin Meningitis
4 1-Feb-20 Bina Isnani 085377541653 Vaksin Meningitis
5 1-Feb-20 Bina Isnani 085377541653 Vaksin Meningitis
6 1-Feb-20 Bina Isnani 085377541653 Vaksin Meningitis
7 1-Feb-20 Bina Isnani 085377541653 Vaksin Meningitis
8 1-Feb-20 Bina Isnani 085377541653 Vaksin Meningitis
9 1-Feb-20 Bina Isnani 085377541653 Vaksin Meningitis
10 1-Feb-20 Bina Isnani 085377541653 Vaksin Meningitis
11 1-Feb-20 Bina Isnani 085377541653 Vaksin Meningitis
12 1-Feb-20 Bina Isnani 085377541653 Vaksin Meningitis
13 1-Feb-20 Bina Isnani 085377541653 Vaksin Meningitis
14 1-Feb-20 Bina Isnani 085377541653 Vaksin Meningitis
15 1-Feb-20 Bina Isnani 085377541653 Vaksin Meningitis
16 1-Feb-20 Bina Isnani 085377541653 Vaksin Meningitis
17 1-Feb-20 Bina Isnani 085377541653 Vaksin Meningitis
18 1-Feb-20 Bina Isnani 085377541653 Vaksin Meningitis
19 1-Feb-20 Bina Isnani 085377541653 Vaksin Meningitis
20 1-Feb-20 Bina Isnani 085377541653 Vaksin Meningitis
21 1-Feb-20 Bina Isnani 085377541653 Vaksin Meningitis
22 1-Feb-20 Bina Isnani 085377541653 Vaksin Meningitis
23 1-Feb-20 MM Tour 081267726622 Vaksin Meningitis
24 1-Feb-20 MM Tour 081267726622 Vaksin Meningitis
25 1-Feb-20 MM Tour 081267726622 Vaksin Meningitis
26 1-Feb-20 MM Tour 081267726622 Vaksin Meningitis
27 1-Feb-20 MM Tour 081267726622 Vaksin Meningitis
28 1-Feb-20 MM Tour 081267726622 Vaksin Meningitis
29 1-Feb-20 MM Tour 081267726622 Vaksin Meningitis
30 1-Feb-20 MM Tour 081267726622 Vaksin Meningitis
31 1-Feb-20 MM Tour 081267726622 Vaksin Meningitis
32 1-Feb-20 MM Tour 081267726622 Vaksin Meningitis
33 1-Feb-20 MM Tour 081267726622 Vaksin Meningitis
34 1-Feb-20 MM Tour 081267726622 Vaksin Meningitis
35 1-Feb-20 MM Tour 081267726622 Vaksin Meningitis
36 1-Feb-20 PT. AET 085355299234 Vaksin Meningitis
37 1-Feb-20 PT. AET 085355299234 Vaksin Meningitis
38 1-Feb-20 PT. AET 085355299234 Vaksin Meningitis
39 1-Feb-20 PT. AET 085355299234 Vaksin Meningitis
40 1-Feb-20 PT. AET 085355299234 Vaksin Meningitis
41 1-Feb-20 PT. AET 085355299234 Vaksin Meningitis
42 1-Feb-20 PT. AET 085355299234 Vaksin Meningitis
43 1-Feb-20 PT. AET 085355299234 Vaksin Meningitis
44 1-Feb-20 PT. AET 085355299234 Vaksin Meningitis
45 1-Feb-20 PT. AET 085355299234 Vaksin Meningitis
46 1-Feb-20 PT. AET 085355299234 Vaksin Meningitis
47 1-Feb-20 PT. AET 085355299234 Vaksin Meningitis
48 1-Feb-20 PT. AET 085355299234 Vaksin Meningitis
49 1-Feb-20 PT. AET 085355299234 Vaksin Meningitis
50 1-Feb-20 PT. AET 085355299234 Vaksin Meningitis
51 1-Feb-20 PT. AET 085355299234 Vaksin Meningitis
52 1-Feb-20 PT. AET 085355299234 Vaksin Meningitis
53 1-Feb-20 PT. AET 085355299234 Vaksin Meningitis
54 1-Feb-20 PT. AET 085355299234 Vaksin Meningitis
55 1-Feb-20 PT. AET 085355299234 Vaksin Meningitis
56 1-Feb-20 PT. AET 085355299234 Vaksin Meningitis
57 1-Feb-20 PT. AET 085355299234 Vaksin Meningitis
58 1-Feb-20 PT. AET 085355299234 Vaksin Meningitis
59 1-Feb-20 PT. AET 085355299234 Vaksin Meningitis
60 1-Feb-20 PT. AET 085355299234 Vaksin Meningitis
61 1-Feb-20 PT. AET 085355299234 Vaksin Meningitis
62 1-Feb-20 PT. AET 085355299234 Vaksin Meningitis
63 1-Feb-20 PT. AET 085355299234 Vaksin Meningitis
64 1-Feb-20 PT. AET 085355299234 Vaksin Meningitis
65 1-Feb-20 PT. AET 085355299234 Vaksin Meningitis
66 1-Feb-20 PT. AET 085355299234 Vaksin Meningitis
67 1-Feb-20 PT. AET 085355299234 Vaksin Meningitis
68 1-Feb-20 PT. AET 085355299234 Vaksin Meningitis
69 1-Feb-20 PT. AET 085355299234 Vaksin Meningitis
 PERIODE

Alam

TEST
NAMA JK
KEHAMILAN

Syamsiar Syamsul Bahri P

Muhammad Tabroni Abdullah L
Hamzah Sudirman Saran L
Suparti Paiman Jasma P
Razali Abdul Somad L
Erota Fitri Nazarudin L
Ety Rohaeti Abdul Rahman P Neg
Kurniawan Tri Saputra L
Radiah Jinta Mas P
Ruslan Lauceng Singgik L
Slamet Karyo Utomo L
Fatimah Zakaria Bakri P Neg
Rantau Hermawan Slamet L
Ali Akup Mara Gunung L
Erman Ripat Jemat L
Julaiha Husin Wahid P
Jusar Lutan Marajo L
Yalimah Mislab Pakmu P Neg
Karmilawati Hasan Riyanto P Neg
Hasan Rianto Akib L
Elfi Sulastri P
Mugiyanti Maryadi Samarja P Neg
Masdewani Siregar Mulatua Siregar P
Abdul Latif L
Diesy Dwi Rendra P Neg
Hendri Agustian Angga Sagala L
Farida P
Ma'as L
Samsimar P
Chairun Nisya Sirait P Neg
Siska Arwani P Neg
Heni Nurhayati P Neg
Yusmini P
Samini Juhariah P
Sunarto L
Paini P
Kodiman L
Sarikun L
Nuriyati P
Karti P
Tukini P
Windi Fatmawati Sari P Neg
Marni P
Marmin Paimen Samardi P Neg
Sari Warsok Marto P
Suwarni Wagiman Kromojo P
Suwarti P Neg
Suwirmanto L
Mayke Indra Yani P Neg
Nurmaini Ukuf Binti Ukuf P
Suarman Mat Resyah L
Syamsinar P Neg
Syafarudin L
Zainal Bahri L
Masrida Abdul Latif P
Jariah P
A.Jurjani L
Lindarni P
Yuni Astuti P Neg
Suyatun Kasan Dikrom P
Musngidah P
Samikem P
Atmorejo L
Yuswandi Saripudin Pawiro Rejo P
Sahlan L
Siti Masnuah Mustoni P Neg
Siti Khotijah P Neg
Warno L
Rini Setiawati Suyoko P Neg
 REKAPITULASI ICV
PERIODE TANGGAL 01 Febuari 2020 S/D TANGGAL 06Febuari 2020
KLINIK SYIFA MEDIKA
Alamat : Desa Tenam Kec. Tanah Sepenggal, Kab. Bungo
No. Telepon : 085275075141

TTL UMUR ALAMAT KAB/PROV

Metro, 19-Juli-1961 59 Jambi Jambi

Teluk Rendah, 26-Desember-1968 52 Jambi Jambi
Kurai Taji, 15-Desember-1993 27 Jambi Jambi
Pati, 02-Mei-1962 58 Jambi Jambi
Teluk, 10-September-1953 67 Jambi Jambi
Jambi, 04-Januari-1964 56 Jambi Jambi
Jambi, 13-Oktober-1971 49 Jambi Jambi
Jambi, 12-Juli-2005 15 Jambi Jambi
Kuala Tungkal, 15-Juli-1963 57 Jambi Jambi
Mendahara Tengah, 15-Juli-1960 60 Jambi Jambi
Kebumen, 12-Juli-1960 60 Jambi Jambi
Teluk Rendah, 05-Oktober-1975 44 Jambi Jambi
Kebumen, 09-Januari-2000 20 Jambi Jambi
Medan, 05-April-1980 40 Jambi Jambi
Jambi, 10-Maret-1985 35 Jambi Jambi
Teluk, 13-September-1952 68 Jambi Jambi
Padang Laweh, 23-Mei-1946 74 Jambi Jambi
Jember, 12-September-1968 52 Jambi Jambi
Jambi, 01-April-1995 25 Jambi Jambi
Madura, 15-Juli-1957 63 Jambi Jambi
Jambi, 01-Juni-1965 55 Jambi Jambi
Kebumen, 13-Agustus-1968 53 Jambi Jambi
Parsulumah, 13-Mei-1965 55 Jambi Jambi
Klaten, 12-Febuari-1974 45 Jambi Jambi
Jambi, 01-Juni-1965 44 Jambi Jambi
Jambi, 03-Juli-1963 57 Jambi Jambi
Padang, 20-Desember-1961 59 Jambi Jambi
Padang, 25-Oktober-1958 62 Jambi Jambi
kerinci, 28-Juni-1958 62 Jambi Jambi
Air Joman, 01-Desember-1992 28 Jambi Jambi
Bangko, 23 Feb 1978 42 Bangko Jambi
Semarang, 02-Juni-1971 49 Kayu Aro Kerinci
Kersik Tuo, 10-Mei-1958 62 Kerisik Tuo Kerinci
Kapuas, 12-April-1959 61 Kayu Aro Kerinci
Kayu Aro, 12-September-1965 55 Kayu Aro Jambi
Gunung Labu, 12-Maret-1964 56 Kayu Aro Kerinci
Kersik Tuo, 03-Desember-1954 66 Kerisik Tuo Kerinci
Bedeng Duo, 07-Maret-1954 66 Bedeng Delapan Kerinci
Bedeng Delapan, 14-Mei-1958 62 Bedeng Delapan Kerinci
Batu Hampar, 10-Mei-1955 65 Kayu Aro Kerinci
Kayu Aro, 04-Desember-1950 70 Kayu Aro Kerinci
Kersik Tuo, 04-Mei-2000 20 Kayu Aro Kerinci
Kerinci, 05-Maret-1967 53 Kayu Aro Kerinci
Kersik Tuo, 18-April-1973 46 Kersik Tuo Kerinci
Keris Tuo, 24-Juni-1963 57 Kersik Tuo Kerinci
Batu Hampar, 01-Juli-1960 62 Batu Hampar Kerinci
Padang, 22-Apil-1974 46 Desa Sungai Lintang Jambi
Batu Hampar, 25-Agustus-1971 49 Desa Sungai Lintang Jambi
Sungai Penuh, 06-Mei-1997 23 Sungai Penuh Jambi
Koto Keras, 12-Mei 1951 69 Koto Keras Jambi
Koto Keras, 27-Agustus-1970 50 Desa Koto Keras Jambi
Padang Sidampua, 15-Juli-1978 42 Jl.H.Usman Suid Jambi
Padang, 29-Agustus-1968 53 Jl.H.Usman Suid Jambi
Belui, 12-Desember-1947 73 Desa Simpang Beluwi Jambi
Belwi, 01-Agustus-1950 70 Desa Simpang Beluwi Jambi
Lubuk Mayan, 01-Januari-1943 77 Bedaro Jambi
Tanjung Agung, 02-April-1947 73 Baru Pusat Jalo Jambi
Tebing Tinggi, 03-Febuari-1965 55 Baru Pusat Jalo Jambi
Wonogiri, 20-Juni-1969 51 Jl.Pekalongan Jambi
Wonogiri, 03-Januari-1950 71 Jl.Ambarawan Jambi
Ciamis, 12-Juli-1965 55 Tebo Jambi
Ciamis, 06-Juni-1958 62 Jl.Melati Jambi
Wonogiri, 01-Januari-1947 73 Jl.Pekalongan Jambi
Cilacap. 12-Juli-1971 49 Jl.Imam Bonjol Jambi
Wonogiri, 21-April-1954 66 Jl.Pekalongan Jambi
Ciamis, 12-April-1980 40 Jl.Melati Jambi
Sukoharjo, 10-September-1977 43 Jl.Indra Jambi
Wonogiri, 06-Juli-1968 52 Jl.Indra Jambi
Sarolangun, 06-April-1997 23 Dusun Rambe Jaya Jambi
AL 06Febuari 2020

Kab. Bungo

PEKERJAAN NO.TEL NO.PASPORT/NIK TUJUAN TGL BRGKT

IRT 085377541653 B7190464 Arab Saudi 17-Feb-20

Swasta 085377541653 C5669779 Arab Saudi 17-Feb-20
Swasta 085377541653 C5669783 Arab Saudi 17-Feb-20
IRT 085377541653 C5669792 Arab Saudi 17-Feb-20
Swasta 085377541653 C6105681 Arab Saudi 17-Feb-20
Swasta 085377541653 C5669776 Arab Saudi 17-Feb-20
IRT 085377541653 C5669778 Arab Saudi 17-Feb-20
Pelajar 085377541653 C5669780 Arab Saudi 17-Feb-20
IRT 085377541653 C5669505 Arab Saudi 17-Feb-20
Swasta 085377541653 C5669506 Arab Saudi 17-Feb-20
Swasta 085377541653 C5668393 Arab Saudi 17-Feb-20
IRT 085377541653 C5669775 Arab Saudi 17-Feb-20
Mahasiswa 085377541653 C5668442 Arab Saudi 17-Feb-20
Wiraswasta 085377541653 C5669788 Arab Saudi 17-Feb-20
Swasta 085377541653 C6106230 Arab Saudi 17-Feb-20
IRT 085377541653 C6105653 Arab Saudi 17-Feb-20
Swasta 085377541653 C5669686 Arab Saudi 17-Feb-20
IRT 085377541653 C5669412 Arab Saudi 17-Feb-20
Swasta 085377541653 C5669422 Arab Saudi 17-Feb-20
Swasta 085377541653 C5669410 Arab Saudi 17-Feb-20
IRT 085377541653 B8608736 Arab Saudi 17-Feb-20
IRT 085377541653 C5668440 Arab Saudi 17-Feb-20
IRT 085377541653 C6106184 Arab Saudi 17-Feb-20
Swasta 085377541653 C6105162 Arab Saudi 17-Feb-20
IRT 085377541653 C6105178 Arab Saudi 17-Feb-20
Swasta 085377541653 C6453591 Arab Saudi 17-Feb-20
IRT 085377541653 1571036012610001 Arab Saudi 17-Feb-20
Swasta 085377541653 1571032510580001 Arab Saudi 17-Feb-20
IRT 085377541653 1571036806580021 Arab Saudi 17-Feb-20
Swasta 085377541653 C6105176 Arab Saudi 17-Feb-20
Swasta 085377541653 1508084101430004 Arab Saudi 17-Feb-20
IRT 085377541653 1501094206710001 Arab Saudi 17-Feb-20
IRT 085377541653 1501095005580004 Arab Saudi 17-Feb-20
IRT 085377541653 1501095204590003 Arab Saudi 17-Feb-20
Guru 085377541653 B8608736 Arab Saudi 29-Feb-20
Petani 085377541653 1501095203640001 Arab Saudi 29-Feb-20
Petani 085355299234 C5669792 Arab Saudi 29-Feb-20
Pensiunan 085355299234 1501090703540002 Arab Saudi 29-Feb-20
 BUMN 085355299234 1501095405580001 Arab Saudi 29-Feb-20
Wiraswasta 085355299234 1501095005550001 Arab Saudi 29-Feb-20
IRT 085355299234 1501194412500001 Arab Saudi 29-Feb-20
Mahasiswi 085355299234 C3177502 Arab Saudi 29-Feb-20
IRT 085355299234 C3177505 Arab Saudi 29-Feb-20
Petani 085355299234 C3177503 Arab Saudi 29-Feb-20
Petani 085355299234 C3177498 Arab Saudi 29-Feb-20
BUMN 085355299234 C3177214 Arab Saudi 29-Feb-20
Petani 085355299234 C5668440 Arab Saudi 29-Feb-20
Petani 085355299234 1501092508710001 Arab Saudi 29-Feb-20
Mahasiswi 085355299234 C31757119 Arab Saudi 20-Feb-20
Pensiunan 085355299234 B7186828 Arab Saudi 20-Feb-20
Wiraswasta 085355299234 C3177229 Arab Saudi 19-Feb-20
Pedagang 085355299234 1508115507780001 Arab Saudi 29-Feb-20
Pedagang 085355299234 1508112906680001 Arab Saudi 29-Feb-20
Swasta 085355299234 B9320572 Arab Saudi 29-Feb-20
IRT 085355299234 B9320571 Arab Saudi 29-Feb-20
IRT 085355299234 1508084101430004 Arab Saudi 29-Feb-20
Swasta 085355299234 1508080204470001 Arab Saudi 29-Feb-20
IRT 085355299234 1508084302650001 Arab Saudi 29-Feb-20
Petani 085355299234 C6463149 Arab Saudi 29-Feb-20
IRT 085355299234 C6463147 Arab Saudi 29-Feb-20
IRT 085355299234 B6421039 Arab Saudi 29-Feb-20
Petani 085355299234 C6463150 Arab Saudi 29-Feb-20
Petani 085355299234 C6463146 Arab Saudi 29-Feb-20
Petani 085355299234 C6463151 Arab Saudi 29-Feb-20
PNS 085355299234 C6463148 Arab Saudi 29-Feb-20
Petani 085355299234 150910520480002 Arab Saudi 29-Feb-20
Petani 085355299234 1509065006770002 Arab Saudi 29-Feb-20
Petani 085355299234 1509080607680004 Arab Saudi 29-Feb-20
Mahasiswi 085355299234 C4194146 Arab Saudi 29-Feb-20
 NO
TGL KEMBALI VAKSIN BACH ICV LEGALISASI
BARCODE ICV

28-Feb-20 Meningitis J201902001 V V J00-382248

28-Feb-20 Meningitis J201902001 V V J00-382249
28-Feb-20 Meningitis J201902001 V V J00-382250
28-Feb-20 Meningitis J201902001 V V J00-382253
28-Feb-20 Meningitis J201902001 V V J00-382254
28-Feb-20 Meningitis J201902001 V V J00-382255
28-Feb-20 Meningitis J201902001 V V J00-382256
28-Feb-20 Meningitis J201902001 V V J00-382257
28-Feb-20 Meningitis J201902001 V V J00-382258
28-Feb-20 Meningitis J201902001 V V J00-382259
28-Feb-20 Meningitis J201902001 V V J00-382260
28-Feb-20 Meningitis J201902001 V V J00-382271
28-Feb-20 Meningitis J201902001 V V J00-382272
28-Feb-20 Meningitis J201902001 V V J00-382273
28-Feb-20 Meningitis J201902001 V V J00-382274
28-Feb-20 Meningitis J201902001 V V J00-382275
28-Feb-20 Meningitis J201902001 V V J00-382276
28-Feb-20 Meningitis J201902001 V V J00-382277
28-Feb-20 Meningitis J201902001 V V J00-382278
28-Feb-20 Meningitis J201902001 V V J00-382279
28-Feb-20 Meningitis J201902001 V V J00-382280
28-Feb-20 Meningitis J201902001 V V J00-382281
28-Feb-20 Meningitis J201902001 V V J00-382282
28-Feb-20 Meningitis J201902001 V V J00-382283
28-Feb-20 Meningitis J201902001 V V J00-382284
28-Feb-20 Meningitis J201902001 V V J00-382285
28-Feb-20 Meningitis J201902001 V V J00-382286
28-Feb-20 Meningitis J201902001 V V J00-382287
28-Feb-20 Meningitis J201902001 V V J00-382288
28-Feb-20 Meningitis J201902001 V V J00-382289
28-Feb-20 Meningitis J201902001 V V J00-382290
28-Feb-20 Meningitis J201902001 V V J00-382291
28-Feb-20 Meningitis J201902001 V V J00-382292
28-Feb-20 Meningitis J201902001 V V J00-382293
11-Mart-20 Meningitis J201902001 V V J00-382294
11-Mart-20 Meningitis J201902001 V V J00-382295
11-Mart-20 Meningitis J201902001 V V J00-382296
11-Mart-20 Meningitis J201902001 V V J00-382297
11-Mart-20 Meningitis J201902001 V V J00-382298
11-Mart-20 Meningitis J201902001 V V J00-382299
11-Mart-20 Meningitis J201902001 V V J00-382300
11-Mart-20 Meningitis J201902001 V V J00-382313
11-Mart-20 Meningitis J201902001 V V J00-382314
11-Mart-20 Meningitis J201902001 V V J00-382315
11-Mart-20 Meningitis J201902001 V V J00-382316
11-Mart-20 Meningitis J201902001 V V J00-382317
11-Mart-20 Meningitis J201902001 V V J00-382318
11-Mart-20 Meningitis J201902001 V V J00-382319
01-Mart-20 Meningitis J201902001 V V J00-382320
01-Mart-20 Meningitis J201902001 V V J00-382321
02-Mart-20 Meningitis J201902001 V V J00-382327
11-Mart-20 Meningitis J201902001 V V J00-382328
11-Mart-20 Meningitis J201902001 V V J00-382329
11-Mart-20 Meningitis J201902001 V V J00-382330
11-Mart-20 Meningitis J201902001 V V J00-382331
11-Mart-20 Meningitis J201902001 V V J00-382332
11-Mart-20 Meningitis J201902001 V V J00-382333
11-Mart-20 Meningitis J201902001 V V J00-382334
11-Mart-20 Meningitis J201902001 V V J00-382335
11-Mart-20 Meningitis J201902001 V V J00-382336
11-Mart-20 Meningitis J201902001 V V J00-382337
11-Mart-20 Meningitis J201902001 V V J00-382338
11-Mart-20 Meningitis J201902001 V V J00-382339
11-Mart-20 Meningitis J201902001 V V J00-382340
11-Mart-20 Meningitis J201902001 V V J00-382341
11-Mart-20 Meningitis J201902001 V V J00-382342
11-Mart-20 Meningitis J201902001 V V J00-382343
11-Mart-20 Meningitis J201902001 V V J00-382344
11-Mart-20 Meningitis J201902001 V V J00-382287
KET
 PENCATATAN DAN PELAPORAN PENERBITA

Klinik : Syifa Medika

Bulan : Februari 2020

No Tanggal Stok Awal ICV Jumlah Yang Diterbitkan Sisa ICV

1 15-Jan-20 74 69 5
3
8
30
9
24

3
8
30
9
19

5
AN PELAPORAN PENERBITAN ICV

Nomor QR Kode ICV Jenis dan Jumlah Vaksin No. Batch Vaksin

stok Meningitis (Formening) 69 J201902001

J00-382348 sd J00-382350
J00-382253 sd J00-382260
J00-382271 sd J00-382300
J00-382313 sd J00-382321
J00-382327 sd J00-382350

digunakan
J00-382348 sd J00-382350
J00-382253 sd J00-382260
J00-382271 sd J00-382300
J00-382313 sd J00-382321
J00-382327 sd J00-382345

sisa
J00-382346 sd J00-382350

Muara Bungo, 06 Feb 2020

Pimpinan Klinik Syifa Medika

dr. Tobroni, Sp.B