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PEMERINTAH

KABUPATEN MOJOKERTO
DINAS
KESEHATAN
UPT PUSKESMAS
KUPANG
JL.PB.SOEDIRMAN 76 JETIS
TELEPON (0321) 362853

MOJOKERTO
NAMA :
L/P
ALAMAT :
HASIL LAB.IBU HAMIL

GOL DARAH :

DARAH
NORMAL

Hb : .......................................
... 12 16 g %

PCV : ........................................
... 35 48 vol %

GDA : .........................................
.. < 180 mg / dl

PMTCT : ..........................................
. Non Reaktif

HBs
Ag : ...........................................
Non Reaktif
Sipilis : .........................................
.. Negatif

Reduksi Urine : ...........................................


Negatif

Protein Urine : ...........................................


Negatif

KUPANG, .............................

LABORAT

M.
MUCHAIYAT

PEMERINTAH
KABUPATEN MOJOKERTO
DINAS
KESEHATAN
UPT PUSKESMAS
KUPANG
JL.PB.SOEDIRMAN 76 JETIS
TELEPON (0321) 362853

MOJOKERTO
NAMA :
L/P
ALAMAT :
HASIL LAB.IBU HAMIL

GOL DARAH :

DARAH
NORMAL

Hb : .......................................
... 12 16 g %

PCV : ........................................
... 35 48 vol %

GDA : .........................................
.. < 180 mg / dl

PMTCT : ..........................................
. Non Reaktif

HBs
Ag : ...........................................
Non Reaktif

Sipilis : .........................................
.. Negatif

Reduksi Urine : ...........................................


Negatif

Protein Urine : ...........................................


Negatif

KUPANG, ..................................
LABORAT

M.
MUCHAIYAT

PEMERINTAH
KABUPATEN MOJOKERTO
DINAS
KESEHATAN
UPT PUSKESMAS
KUPANG
JL.PB.SOEDIRMAN 76 JETIS
TELEPON (0321) 362853

MOJOKERTO
NAMA :
L/P
ALAMAT :
HASIL LAB.IBU HAMIL

GOL DARAH :

DARAH
NORMAL

Hb : .......................................
... 12 16 g %

PCV : ........................................
... 35 48 vol %

GDA : .........................................
.. < 180 mg / dl

PMTCT : ..........................................
. Non Reaktif

HBs
Ag : ...........................................
Non Reaktif

Sipilis : .........................................
.. Negatif

Reduksi Urine : ...........................................


Negatif

Protein Urine : ...........................................


Negatif

KUPANG, ................................
LABORAT

M.
MUCHAIYAT