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Formulir Pemeriksaan Lab

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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andi ansori
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4K views2 pages

Formulir Pemeriksaan Lab

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.

Uploaded by

andi ansori
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOC, PDF, TXT or read online on Scribd
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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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