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    Vaksinasi Moderna (Dokter)

    Uploaded by

    Silfi Cipoo
    1. This document contains records of COVID-19 vaccinations provided at the Anutapura Public Health Center in Palu, Central Sulawesi Province. 2. It includes details such as the names, identification numbers, dates of screening and vaccination of 42 individuals who received their first dose of the Moderna vaccine between August 10-21, 2021. 3. The records also note that none of the recipients reported any issues or complaints after receiving their initial dose.

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    © All Rights Reserved
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    Vaksinasi Moderna (Dokter)

    Uploaded by

    Silfi Cipoo
    28 views16 pages
    1. This document contains records of COVID-19 vaccinations provided at the Anutapura Public Health Center in Palu, Central Sulawesi Province. 2. It includes details such as the names, identification numbers, dates of screening and vaccination of 42 individuals who received their first dose of the Moderna vaccine between August 10-21, 2021. 3. The records also note that none of the recipients reported any issues or complaints after receiving their initial dose.

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    1. This document contains records of COVID-19 vaccinations provided at the Anutapura Public Health Center in Palu, Central Sulawesi Province. 2. It includes details such as the names, identification numbers, dates of screening and vaccination of 42 individuals who received their first dose of the Moderna vaccine between August 10-21, 2021. 3. The records also note that none of the recipients reported any issues or complaints after receiving their initial dose.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Download as xlsx, pdf, or txt
    28 views16 pages

    Vaksinasi Moderna (Dokter)

    Uploaded by

    Silfi Cipoo
    1. This document contains records of COVID-19 vaccinations provided at the Anutapura Public Health Center in Palu, Central Sulawesi Province. 2. It includes details such as the names, identification numbers, dates of screening and vaccination of 42 individuals who received their first dose of the Moderna vaccine between August 10-21, 2021. 3. The records also note that none of the recipients reported any issues or complaints after receiving their initial dose.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Download as xlsx, pdf, or txt
    of 16

    03 PALU

    Nama Puskesmas/Jejaring : Anutapura


    Kabupaten/Kota : Palu
    Provinsi : Sulawesi tengah

    No No. Registrasi NIK Nama Penerima Vaksin

    1 U-000063T4 317404******0002 MARSHA SRI REZEKI SIHOMBING


    2 U-0000IIE0 727103******0004 dr. ARDIYANTO PANGGESO
    3 U-0000IIW5 727103******0001 dr. SYAMSUL FAHRI
    4 U-0000IJ17 727103******0004 dr. MUHAMMAD SALAHUDDIN
    5 U-0000IJ57 727103******0003 dr. ANDRY HAMDANI, Sp.B
    6 U-0000IJD3 727103******0008 DR. FRANS FADLI DATUK ISMAIL, SP.KFR
    7 U-0000IKFN 727103******0003 drg. Rosnainy
    8 U-0000IM69 727103******0003 MAGDALENA SUMENAP, Sp.S
    9 U-0000LY4P 737113******0011 SARI HANDAYANI PUSADAN, Sp.KK
    10 U-0000LYQQ 737113******0001 dr.SUKMA ANJAYANI,Sp.KK.,M.Kes
    11 U-0000M2EJ 737114******0010 SRI SIKSPIRIANI CIPTANINGSIH HARUN
    12 MANUAL DR. DAFRIANA
    13 MANUAL DR. AINUN
    14 MANUAL DR. ATIKAH
    15 U-00002G8M 317202******0011 dr. DIMAS BAGUS PRASTYO, Sp.A.,M.Ked
    16 U-0000LD0L 737109******0011 DR. CITRA AZMA ANGGITA, Sp.M
    17 U-0000P4TZ 760102******0003 NURHALIS MAJID
    18 MANUAL 727104******0004 MOHAMMAD REZAL
    19 U-0000ICEJ 727101******0001 dr. NUR FITRIANI JURAIJ
    20 U-0000IE77 727102******0004 M. ADJIS RASYIDI
    21 U-0000K7ZU 731812******0002 AJUTOR DONNY TANDIARRANG
    22 U-0000LVQM 737113******0011 dr. WINARTI ARIFUDDIN
    23 U-0000RA0D 727103******0012 dr.Yuliawati
    24 U-0000IEGF 727102******0001 dr. ARISTO
    25 U-0000IES2 727102******0006 dr. Muhammad Rezza
    26 U-0000IK1K 727103******0006 RENNY
    27 U-0000IODG 727103******0007 MARIA ROSA DA LIMA RUPA
    28 U-0000IM7X 727103******0006 JULIA SARI
    29 U-0000WCWE 727102******0007 dr. CHRISTINE LISTER SUMAMPOW, Sp.A
    30 MANUAL 7271015210750002 dr. RATNA SETYAWATI
    31 U-0000IK29 727103******0001 dr. ASTRI SARI YUNITA LESTARI
    32 MANUAL dr. Muh. Akbar, M.Kes
    33 U-0000P5YZ 760103******0003 SITI HANISA MALIK LUTUH
    34 U-0000WCPD 727104******0001 ABDUL FARIS
    35 MANUAL dr. A. Wahyudi, Sp.Pd
    36 MANUAL dr. Soraya Sp.KJ
    37 U-0000E83C 727105******0001 dr. RUSDA
    38 U-0000IETK 727102******0002 Zaki mubarak
    39 U-0000IJZM 727103******0002 DJUHAEDAH
    40 U-0000Y2ED 727102******0008 Injte norma
    41 MANUAL 7201044409950001 FARAIHIN BACHMID
    FORMAT PENCATATAN PELAKSANAAN V
    TINGKAT PUSKESMAS/JEJ

    Umur
    No. Handphone Tanggal Lahir Kelompok Umur Rentang Usia
    (18-59 tahun)

    081341065611 40 40 31-45 MASYARAKAT UMUM


    0811450415 43 43 31-45 MASYARAKAT UMUM
    08114509035 30 30 18-30 MASYARAKAT UMUM
    082191756789 41 41 31-45 MASYARAKAT UMUM
    081230346661 37 37 31-45 MASYARAKAT UMUM
    082191462434 43 43 31-45 MASYARAKAT UMUM
    08114584469 54 54 46-59 MASYARAKAT RENTA
    081241064215 49 49 46-59 MASYARAKAT RENTA
    081392003969 42 42 31-45 MASYARAKAT UMUM
    081342597858 38 38 31-45 MASYARAKAT UMUM
    08114531907 43 43 31-45 MASYARAKAT UMUM
    NAKES
    NAKES
    NAKES
    085234777277 37 37 31-45 MASYARAKAT UMUM
    08114509174 37 37 31-45 MASYARAKAT UMUM
    08114548144 30 30 18-30 MASYARAKAT UMUM
    081343789894 31 31 31-45 MASYARAKAT UMUM
    08114531114 30 30 18-30 MASYARAKAT UMUM
    085343711265 29 29 18-30 MASYARAKAT UMUM
    081310471818 44 44 31-45 MASYARAKAT UMUM
    081341174074 43 43 31-45 MASYARAKAT UMUM
    08124271587 42 42 31-45 MASYARAKAT UMUM
    081341039250 44 30 18-30 MASYARAKAT UMUM
    082396673552 35 29 18-30 MASYARAKAT UMUM
    085242729898 32 30 18-30 MASYARAKAT UMUM
    081341007005 52 44 31-45 MASYARAKAT UMUM
    08124228997 43 43 31-45 MASYARAKAT UMUM
    081354589797 41 41 31-45 MASYARAKAT UMUM
    081354492888 46 46 46-59 MASYARAKAT RENTA
    085241473549 27 27 18-30 MASYARAKAT UMUM
    0 0
    082291318840 28 28 18-30 MASYARAKAT UMUM
    081354469686 52 52 46-59 MASYARAKAT RENTA
    12/30/1899 12/30/1899
    12/30/1899 12/30/1899
    082311188826 33 33 31-45 MASYARAKAT UMUM
    081242391901 44 44 31-45 MASYARAKAT UMUM
    08114565137 54 54 46-59 MASYARAKAT RENTA
    081242992464 37 37 31-45 MASYARAKAT UMUM
    082237365668 26 26 18-30 MASYARAKAT UMUM
    AKSANAAN VAKSINASI COVID-19
    KESMAS/JEJARING

    Kepesertaan BPJS (tulis 'Ya' pada kolom yang sesuai) Dosis I


    Merek Vaksin*** Tanggal Screening Tanggal Pemberian
    BPJS PBI BPJS Non PBI Non Anggota
    Vaksinasi

    Ya Moderna 8/10/2021
    Ya Moderna 8/10/2021
    Ya Moderna 8/10/2021
    Ya Moderna 8/10/2021
    Ya Moderna 8/10/2021
    Ya Moderna 8/10/2021
    Ya Moderna 8/10/2021
    Ya Moderna 8/10/2021
    Ya Moderna 8/10/2021
    Ya Moderna 8/10/2021
    Ya Moderna 8/10/2021
    Ya Moderna 8/10/2021
    Ya Moderna 8/10/2021
    Ya Moderna 8/10/2021
    Ya Moderna 8/12/2021
    Ya Moderna 8/12/2021
    Ya Moderna 8/12/2021
    Ya Moderna 8/12/2021
    Ya Moderna 8/13/2021
    Ya Moderna 8/13/2021
    Ya Moderna 8/13/2021
    Ya Moderna 8/13/2021
    Ya Moderna 8/13/2021
    Ya Moderna 8/13/2021
    Ya Moderna 8/13/2021
    Ya Moderna 8/13/2021
    Ya Moderna 8/13/2021
    Ya Moderna 8/16/2021
    Ya Moderna 8/16/2021
    Ya Moderna 8/16/2021
    Ya Moderna 8/18/2021
    Ya Moderna 8/18/2021
    Ya Moderna 8/19/2021
    Ya Moderna 8/19/2021
    Ya Moderna 8/19/2021
    Ya Moderna 8/19/2021
    Ya Moderna 8/21/2021
    Ya Moderna 8/21/2021
    Ya Moderna 8/21/2021
    Ya Moderna 8/21/2021
    Ya Moderna 8/21/2021
    Dosis I Dosis 2 Dosis
    Keterangan
    Tanggal Pemberian Tanggal Pemberian (Contoh: Ditunda/Dirujuk/….)
    No. Batch No. Batch No. Batch
    Vaksinasi Vaksinasi

    8/10/2021 012D21A
    8/10/2021 012D21A
    8/10/2021 012D21A
    8/10/2021 012D21A
    8/10/2021 012D21A
    8/10/2021 012D21A
    8/10/2021 012D21A
    8/10/2021 012D21A
    8/10/2021 012D21A
    8/10/2021 012D21A
    8/10/2021 012D21A
    8/10/2021 012D21A
    8/10/2021 012D21A
    8/10/2021 012D21A
    8/12/2021 012D21A Tanpa Keluhan
    8/12/2021 012D21A Tanpa Keluhan
    8/12/2021 012D21A Tanpa Keluhan
    8/12/2021 012D21A Tanpa Keluhan
    8/13/2021 012D21A Tanpa Keluhan
    8/13/2021 012D21A Tanpa Keluhan
    8/13/2021 012D21A Tanpa Keluhan
    8/13/2021 012D21A Tanpa Keluhan
    8/13/2021 012D21A Tanpa Keluhan
    8/14/2021 012D21A Tanpa Keluhan
    8/14/2021 012D21A Tanpa Keluhan
    8/14/2021 012D21A Tanpa Keluhan
    8/14/2021 012D21A Tanpa Keluhan
    8/16/2021 012D21A Tanpa Keluhan
    8/16/2021 012D21A Tanpa Keluhan
    8/16/2021 012D21A Tanpa Keluhan
    8/18/2021 012D21A Tanpa Keluhan
    8/18/2021 012D21A Tanpa Keluhan
    8/19/2021 012D21A Tanpa Keluhan
    8/19/2021 012D21A Tanpa Keluhan
    8/19/2021 012D21A Tanpa Keluhan
    8/19/2021 012D21A Tanpa Keluhan
    8/21/2021 012D21A Tanpa Keluhan
    8/21/2021 012D21A Tanpa Keluhan
    8/21/2021 012D21A Tanpa Keluhan
    8/21/2021 012D21A Tanpa Keluhan
    8/21/2021 012D21A Tanpa Keluhan
    Tanpa Keluhan
    Tanpa Keluhan
    Tanpa Keluhan
    Tanpa Keluhan
    Tanpa Keluhan
    Tanpa Keluhan
    Tanpa Keluhan
    Tanpa Keluhan
    Tanpa Keluhan
    Tanpa Keluhan
    Tanpa Keluhan
    Tanpa Keluhan
    Tanpa Keluhan
    Tanpa Keluhan
    Tanpa Keluhan
    Tanpa Keluhan
    Tanpa Keluhan
    Tanpa Keluhan
    Tanpa Keluhan
    Tanpa Keluhan
    Tanpa Keluhan
    Tanpa Keluhan
    Tanpa Keluhan
    Tanpa Keluhan
    Tanpa Keluhan
    Tanpa Keluhan
    Tanpa Keluhan
    Tanpa Keluhan
    Tanpa Keluhan
    Tanpa Keluhan
    Tanpa Keluhan
    Tanpa Keluhan
    Tanpa Keluhan
    Tanpa Keluhan
    Tanpa Keluhan
    Tanpa Keluhan
    Tanpa Keluhan
    Tanpa Keluhan
    Tanpa Keluhan
    Tanpa Keluhan
    Tanpa Keluhan
    DAFTAR DOKTER TELAH VAKSIN
    No
    MODERNA

    1 MARSHA SRI REZEKI SIHOMBING


    2 dr. ARDIYANTO PANGGESO
    3 dr. SYAMSUL FAHRI
    4 dr. MUHAMMAD SALAHUDDIN
    5 dr. ANDRY HAMDANI, Sp.B
    6 DR. FRANS FADLI DATUK ISMAIL, SP.KFR
    7 drg. Rosnainy
    8 MAGDALENA SUMENAP, Sp.S
    9 SARI HANDAYANI PUSADAN, Sp.KK
    10 dr.SUKMA ANJAYANI,Sp.KK.,M.Kes
    11 SRI SIKSPIRIANI CIPTANINGSIH HARUN
    12 DR. DAFRIANA
    13 DR. AINUN
    14 DR. ATIKAH
    15 dr. DIMAS BAGUS PRASTYO, Sp.A.,M.Ked
    16 DR. CITRA AZMA ANGGITA, Sp.M
    17 NURHALIS MAJID
    18 MOHAMMAD REZAL
    19 dr. NUR FITRIANI JURAIJ
    20 M. ADJIS RASYIDI
    21 AJUTOR DONNY TANDIARRANG
    22 dr. WINARTI ARIFUDDIN
    23 dr.Yuliawati
    24 dr. ARISTO
    25 dr. Muhammad Rezza
    26 RENNY
    27 MARIA ROSA DA LIMA RUPA
    28 JULIA SARI
    29 dr. CHRISTINE LISTER SUMAMPOW, Sp.A
    30 dr. RATNA SETYAWATI
    31 dr. ASTRI SARI YUNITA LESTARI
    32 dr. Muh. Akbar, M.Kes
    33 SITI HANISA MALIK LUTUH
    34 ABDUL FARIS
    35 dr. A. Wahyudi, Sp.Pd
    36 dr. Soraya Sp.KJ
    37 dr. RUSDA
    38 Zaki mubarak
    39 DJUHAEDAH
    40 Injte norma
    41 FARAIHIN BACHMID

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