KLINIK PRATAMA RAWAT INAP KLINIK PRATAMA RAWAT INAP

GRIYA SEHAT GRIYA SEHAT

Alamat: Jl.Raya Kutosari Kec.Belitang III Kab.OKU TIMUR Alamat: Jl.Raya Kutosari Kec.Belitang III Kab.OKU TIMUR
Prov. SUM – SEL Hp : 0813 7785 1213 Prov. SUM – SEL Hp : 0813 7785 1213
Email : [email protected] Email : [email protected]

Formulir Pemeriksaan Laboratorium Formulir Pemeriksaan Laboratorium

Nama Pasien : .................................... L / P Diagnosis : ....................................... Nama Pasien : .................................... L / P Diagnosis : .......................................
Umur : .................................... Th / Hr Tanggal : ....................................... Umur : .................................... Th / Hr Tanggal : .......................................
Alamat : .................................... No.Registrasi : ....................................... Alamat : .................................... No.Registrasi : .......................................
HEMATOLOGI URINE LEMAK AIDS Test HEMATOLOGI URINE LEMAK AIDS Test
 Rutin (Hb, Leukosit,  Lengkap  Triglyserida  Anti HIV  Rutin (Hb, Leukosit,  Lengkap  Triglyserida  Anti HIV
Eritrosit, Diff, LED)  Urobilinogen  Kolesterol Eritrosit, Diff, LED)  Urobilinogen  Kolesterol
 Hemoglobin  Protein  HDL / LDL  Hemoglobin  Protein  HDL / LDL
 Leukosit  Glukosa  Total Lipids SEROLOGI  Leukosit  Glukosa  Total Lipids SEROLOGI
 Hitung Jenis  Keton  VDRL  Hitung Jenis  Keton  VDRL
 LED  Billirubin DIABETES  TPHA  LED  Billirubin DIABETES  TPHA
 Malaria  Berat Jenis  Glukosa Puasa  Rheumatoid  Malaria  Berat Jenis  Glukosa Puasa  Rheumatoid
 Eritrosit  Reaksi / pH  Glukosa 2 jam PP Faktor (RF)  Eritrosit  Reaksi / pH  Glukosa 2 jam PP Faktor (RF)
 Trombosit  Glukosa sewaktu  ASTO  Trombosit  Glukosa sewaktu  ASTO
 Hematokrit KIMIA DARAH  GTT  CRP  Hematokrit KIMIA DARAH  GTT  CRP
 Retikulosit FUNGSI HATI  Widal  Retikulosit FUNGSI HATI  Widal
 W. Perdarahan  Alk. Phosphatase DRUG ABBUSED  DHF/Dengue  W. Perdarahan  Alk. Phosphatase DRUG ABBUSED  DHF/Dengue
 W. Pembekuan  Bill Total/Dir/Indir  Amphetamine IgG/IgM  W. Pembekuan  Bill Total/Dir/Indir  Amphetamine IgG/IgM
 Coomb’s Test  Protein Total/Alb/Glob  Marihuana  Myco Dot TBC  Coomb’s Test  Protein Total/Alb/Glob  Marihuana  Myco Dot TBC
 Rumple Leede  Gamma GT  Methamphetamine  Rumple Leede  Gamma GT  Methamphetamine
 MCV  SGOT / ASAT  Morpine / Opiate MIKROSKOPIS  MCV  SGOT / ASAT  Morpine / Opiate MIKROSKOPIS
 MCH  SGPT / ALAT  PAKET DRUG ABUSED  Gram  MCH  SGPT / ALAT  PAKET DRUG ABUSED  Gram
 MCHC (AMP, MET, THC, BZO, MOR)  Uretra  MCHC (AMP, MET, THC, BZO, MOR)  Uretra
 Sel LE FUNGSI JANTUNG  Coccaine  Vagina  Sel LE FUNGSI JANTUNG  Coccaine  Vagina
 Filaria  aHBDH/LDH  GO  Filaria  aHBDH/LDH  GO
 Eosinofil Total  CPK/CKMB IMMUNOLOGI / SEROLOGI  Jamur  Eosinofil Total  CPK/CKMB IMMUNOLOGI / SEROLOGI  Jamur
 Gol. Darah HEPATITIS  BTA  Gol. Darah HEPATITIS  BTA
 Rh. Faktor FUNGSI GINJAL  HBsAg  Rh. Faktor FUNGSI GINJAL  HBsAg
 Ureum  Anti HBs LAIN-LAIN  Ureum  Anti HBs LAIN-LAIN
TEST KEHAMILAN  Creatinine  Anti HCV  An. Sperma TEST KEHAMILAN  Creatinine  Anti HCV  An. Sperma
 Event Test  Uric Acid/Asam Urat  Event Test  Uric Acid/Asam Urat
 Test Pack TEST LAIN-LAIN  Test Pack TEST LAIN-LAIN
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