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    Formulir Pemeriksaan Lab

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    andi ansori
    This document is a medical record from Klinik Griya Sehat clinic located in East Kalimantan, Indonesia. It contains the patient's name, age, address, diagnosis, and doctor. There are lists of various medical tests that can be performed, including hematology, urine analysis, lipid panel, hepatitis and HIV tests, drug screening, microbiology exams, and more. The record leaves space for the doctor's signature and notes on any additional tests.

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    Formulir Pemeriksaan Lab

    Uploaded by

    andi ansori
    3K views2 pages
    This document is a medical record from Klinik Griya Sehat clinic located in East Kalimantan, Indonesia. It contains the patient's name, age, address, diagnosis, and doctor. There are lists of various medical tests that can be performed, including hematology, urine analysis, lipid panel, hepatitis and HIV tests, drug screening, microbiology exams, and more. The record leaves space for the doctor's signature and notes on any additional tests.

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    This document is a medical record from Klinik Griya Sehat clinic located in East Kalimantan, Indonesia. It contains the patient's name, age, address, diagnosis, and doctor. There are lists of various medical tests that can be performed, including hematology, urine analysis, lipid panel, hepatitis and HIV tests, drug screening, microbiology exams, and more. The record leaves space for the doctor's signature and notes on any additional tests.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    3K views2 pages

    Formulir Pemeriksaan Lab

    Uploaded by

    andi ansori
    This document is a medical record from Klinik Griya Sehat clinic located in East Kalimantan, Indonesia. It contains the patient's name, age, address, diagnosis, and doctor. There are lists of various medical tests that can be performed, including hematology, urine analysis, lipid panel, hepatitis and HIV tests, drug screening, microbiology exams, and more. The record leaves space for the doctor's signature and notes on any additional tests.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    of 2

    KLINIK GRIYA SEHAT

    Alamat : Jalan Raya Kutosari Kec.Belitang III Kab.OKU TIMUR


    Email : [email protected] Tlp: 0813-7785-1213
    Izin Operasional : 503/004/KLINIK/DPMPTSP/OKUT/XII/2019

    Nama Pasien : .................................... L / P Diagnosis : .......................................


    Umur : .................................... Th / Hr Tanggal : .......................................
    Alamat : .................................... Dokter : .......................................

    HEMATOLOGI URINE LEMAK AIDS Test


     Rutin (Hb, Leukosit,  Lengkap  Triglyserida  Anti HIV
    Eritrosit, Diff, LED)  Urobilinogen  Kolesterol
     Hemoglobin  Protein  HDL / LDL
     Leukosit  Glukosa  Total Lipids SEROLOGI
     Hitung Jenis  Keton  VDRL
     LED  Billirubin DIABETES  TPHA
     Malaria  Berat Jenis  Glukosa Puasa  Rheumatoid
     Eritrosit  Reaksi / pH  Glukosa 2 jam PP Faktor (RF)
     Trombosit  Glukosa sewaktu  ASTO
     Hematokrit KIMIA DARAH  GTT  CRP
     Retikulosit FUNGSI HATI  Widal
     W. Perdarahan  Alk. Phosphatase DRUG ABBUSED  DHF/Dengue
     W. Pembekuan  Bill Total/Dir/Indir  Amphetamine IgG/IgM
     Coomb’s Test  Protein Total/Alb/Glob  Marihuana  Myco Dot TBC
     Rumple Leede  Gamma GT  Methamphetamine
     MCV  SGOT / ASAT  Morpine / Opiate MIKROSKOPIS
     MCH  SGPT / ALAT  PAKET DRUG ABUSED  Gram
     MCHC (AMP, MET, THC, BZO, MOR)  Uretra
     Sel LE FUNGSI JANTUNG  Coccaine  Vagina
     Filaria  aHBDH/LDH  GO
     Eosinofil Total  CPK/CKMB IMMUNOLOGI / SEROLOGI  Jamur
     Gol. Darah HEPATITIS  BTA
     Rh. Faktor FUNGSI GINJAL  HBsAg
     Ureum  Anti HBs LAIN-LAIN
    TEST KEHAMILAN  Creatinine  Anti HCV  An. Sperma
     Event Test  Uric Acid/Asam Urat
     Test Pack TEST LAIN-LAIN
     ………………………………………………
     ………………………………………………
     ………………………………………………

    Tanda Tangan Dokter

    (………………...)
    (………………...)

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