RM 24

NAMA PASIEN : DOKTER :

TANGGAL LAHIR : TGL. PEMERIKSAAN :
JENIS KELAMIN : RUANGAN :
NO. REKAM MEDIK :

DARAH LENGKAP AUTOMATIC FAAL HATI IMUNO-SEROLOGI TEST ARTRISTIS

Haemoglobin Bilirubin Total/Direk VDRLKwalitatif Rhematoid Factor
Leukosit Alkali Phosphatase VDRS Kwantitatif * Kwalitatif
Jumlah Trombosit SGOT TPHA Kwalitatif * Semi Kwantitatif
LED SGPT TPHA S.Kwantitatif ASTO
Morfologi Darah Tepi Gamma GT Tubex Salmonella * Kwalitatif
Eritrosit Total Protein Typhoid Ig M * Semi Kwantitatif
Hematokrit Albumin ICT Salmonella CRP Kwalitatif
MCV, MCH, MCHC Globulin Typhoid Ig M CRP Kwantitatif
GOLONGAN DARAH SPE Ig M/Ig G Anti Dengue Asam Urat*
ABO Cholinesterase Ig M/Ig G Anti Dengue (Elisa) ANA
Rhesus HBs Ag (Titer) Dengue Antigen NSI Anti - ds - DNA
Serum Fe & TIBC Anti HBs (Titer) Ig M/Ig G Anti HSV I (Kulit) Sel LE
Ferritin Anti HBc (Total) Ig M/Ig G Anti HSV II (Kelamin) LE Test
Fragilitas Osmotic Anti HBc IgM Ig M/Ig G Anti HSV Toxoplasma MIKROBIOLOGI
Reticulosit Count Hbe Ag Ig M/Ig G Anti HSV Rubella Kultur & Kepekaan
Agregasi Thrombosit Anti Hbe Ig M/Ig G Anti HSV CMV Kultur BTA
PROFIL HEMOLITIK Ig M Anti HAV Ig M/Ig M ACA Kultur & Kepekaan BTA
Coom'b Test Ig G Anti HAV Ig M/Ig G Anti Chlamydia Sputum BTA
G-6 PD Anti HCV (Elisa) Helicobacter Pylory Antibody Direct Smear (Gram)
PROFIL Hb AB NORMAL Ig M Anti HCV HIV Elisa Direct Smear
Hb Elektroforesis Alfa Feto Protein ICT - TB ( Jamur / Spora )
TEST KOAGULASI PROFIL JANTUNG ICT - Malaria KOH 10%
Masa Pendarahan CPK/CK - Nac Torch KOH 40%
Masa Pembekuan CK - MB Widal Test FAECES
Masa Prothrombin LDH PROFIL LIPID*) Faeces Rutin
Masa Thrombin SGOT Cholesterol* Hema Test
APTT Troponin - T HDL - Cholesterol* PROFIL PANKREAS
Fibrinogen EKG LDL - Cholesterol* Amylase
Thrombo Test Treadmill Triglycerides Lipase
Rumple Leede Test SEKRINING KANKER Lipid Total TEST NARKOBA (URINE)
D - Dimer Alfa Fetoprotein EIA Apo A1* Methamphetamine
AT III CEA EIA Apo B* (Ectasy, Shabu - Shabu)
ELEKTROLIT CA - 125 Lp(a)* Opiates (Putao, Morpine,
Natrium CA - 19 - 9 ANALISA CAIRAN Heroin)
Kalium CA - 153 Ascites THC (Ganja)
Chlorida Prostat Specific Liquor Cerebrospinal Benzodiazepines
Calsium Antigen (PSA) Cairan Pleura (Activan, Valium, Xanax)
Calsium Ion Prostat Acid Cairan Pankreas DAN LAIN - LAIN
Phosfor Phosfatase (PAP) Cairan Synovial PAP'S Smear #
Magnesium Squamous Cell Ca Sitologi Cairan PA Jaringan Besar
Analisa Gas Darah ENDOKRIN/HORMON PROFIL TIROID PA Jaringan Kecil
PARASIT DARAH Beta HCG Serum T3 Biopsi
Mikrofilaria Beta HCG Urin T4 Spirometri
Plasmodium LH TSH Audiometri
TEST GULA DARAH FSH FT4 Analisa Sperma
Glukosa Puasa* Prolactin*) FAAL GINJAL
Glukosa 2 Jam PP Testoteron Urine Lengkap
Glukosa Ad radom Progesteron Mikroaibumin Urine
HB A1C Estradiol Ureum / Urea - N
Insulin Puasa* Cortisol*) Kreatinin
Insulin 2 Jam PP Test Kehamilan Asam Urat*
Fruktosamin Klirens Kreatinin
GTT Klirens Urea Tanda tangan Dokter
Protein Urine-24 Jam