NAMA : KRISMAN HAMONANGAN
INSTANSI : MEDIKA PLAZA
PEMERIKSAAN MEDICAL CHECK-UP
I. TANGGAL : 22 Maret 2016
DATE
NAMA : KRISMAN HAMONANGAN SIAHAAN
NAME
KELAMIN : Laki-Laki
SEX
II. KELUHAN : Check-Up routine
REASON FOR VISIT
III. RIWAYAT PENYAKIT DAHULU :
PAST HISTORY
- Do not have a history the disease
Riwayat Alergi : - Do not have a history of allergy
History of Allergy
Riwayat Operasi : - Do not have a history of the operation
Operating History
Riwayat Kecelakaan : - Do not have a history of the accident
History of Accidents
Riwayat Haid (Khusus Wanita) : -
Menstrual History
Riwayat Penyakit Dalam Keluarga : - Do not have a history of the disease in family
Family History
IV. KEBIASAAN : - Examination habit swimming and bicycle two times a week
HABIT
V. PEMERIKSAAN FISIK
PHYSICAL EXAMINATION
Suhu ( Temperature ) : 36.1 oC
Nadi ( Pulse ) : 79 x / minute
Tinggi Badan ( Height ) : 166 cm Berat Badan ( Weight ) : 58 kg
Tekanan Darah : 110/80 mm/Hg
Blood Pressure
Pernapasan : 19 x / minute
Respiration Rate
Telinga, Hidung dan Tenggorokan : Normal
Ear, Nose and Throat
Leher : No palpable and larged thyroid
Neck
Tekanan Vena Jugularis : Normal (5-2 cm H2O)
Jugular Venous Pressure
Hal. 1
VI. JANTUNG : Reguler, not gallop, not murmur
HEART
VII. PARU : Breath sounds: vesiculer, ronchi (-)/(-), wheezing (-)/(-)
LUNGS
VIII. PERUT : Bowel normal, not tenderness,hepar,lien not palpable
ABDOMEN
IX. EXSTREMITAS : - Oedem (-)/(-)
EXTREMITIES
X. FOTO THORAX : - Normal Chest
CHEST X-RAY
XI. ULTRASONOGRAPHY : - Normal Abdominal Sonogram
XII. TREADMILL : - Ischemic myocard response negative
- Treadmill Test Negative 12.8 mets
XIII. PAP'SMEAR : - Not including package
XIV. LABORATORIUM : Attachment
Hal. 2
XV. SPIROMETRY : - Mild Restrictive
LUNG FUNCTION TEST
XVI. ECG : - Normal Resting ECG
ELEKTRO CARDIOGRAM
XVII. ECHOCARDIOGRAPHIC : - Not including package
XVIII.AUDIOMETRY : - ADS Normal
XIX. Pemeriksaan T H T : - Normal
Ear, Nose, and Throat
Examiation
XX. Pemeriksaan G I G I : - Calculus
Dental Examination - Iritation pulpa
- Missing
XXI. Pemeriksaan M A T A : - Visus Fair OD 1.0 OS 1.0
Eye Examination - Visus Near OD 20 OS 20
- No color blind
XXII.Pemeriksaan : -
GYNECOLOGY
Gynecology Examination
XXIII.MAMOGRAPHY : - Not including package
Hal. 3
XIV. KESIMPULAN : 1.Examination habit swimming and bicycle two times a week
RESULT 2.No color blind
3.Teeth : Calculus, iritation pulpa and missing
4.Not to have immunity against hepatitis B virus
5.Drug Test: Morphine, Ampetamine, Cocain and Mariyuana ( negative)
6.Mild Restrictive
XV. ANJURAN : 1.Consult to dentist for scalling, filling and protese
REMARK 2.Vaccination hepatitis B
3.Exercise jogging 4 km in 30 minutes at least three times a week.
Jakarta, 22 Maret 2016
Margarita Dewi, dr .SpOk
Koordinator Check-up
Hal. 4
