MEDICAL REPORT

No. Lab : -
Name : KARTOBI
Sex : MALE Date Issue: 04 July 2018
Age : 38 Years Nationality: Indonesian
Adress : DS, MEKAR SEKUNTUM, TEBAS

PUT MARK (V) NORMAL PUT MARK (X) ABNORMAL

History of Illnes
1. Height : 165 cm 2. Weight : 69 kg 3. Pulse : 84 /min
4. Blood Pressure 5. Systolic : 110 mm Hg 6. Diastolic : 80 mmHg
MEDICAL EXAMINATION
Eyes : Right Eye ( v ) Skin Disease ( v ) Hematology:
Hb ( 16,6 )
Left Eye ( v ) Blood Pressure ( v ) Leukosit ( 9600 )
Ears : Right Ear ( v ) Eritrosit ( 4.50 )
Trombosit ( 246000 )
Left Ear ( v ) Urinalysis : Hematokrit ( 36,9 )
Berat Jenis ( 1.015 )
Lekosit ( Neg )
Internal Disease: Nitrit ( Neg ) Kimia Darah :
pH (7) GDP ( 85 )
Heart ( v )
Protein ( Neg ) Chol (218)
Lungs ( v)
Glukosa (Normal) TG (308 )
Liver ( v )
Keton (Neg ) HDL-Chol ( 43 )
Spleen ( v )
Urobilinogen (Neg ) LDL-Chol ( 160)
Kidney ( v )
Bilirubin (Normal) Uric Acid ( 5.8 )
Darah (Neg ) Creatinine ( 0.99 )
Hasil Rontgen : Urea ( 49,0)
Sediment :
Foto Thorax : Dalam batas normal
Eri 0-1/LPB HbsAg (Negatif)
Lekosit 0-1/LPB
Silinder Neg
Kristal Neg
Sel + Ephitel

Warna : Kuning

Kejernihan :
Jernih ( v )

Above medical report of Mr/Mrs/Miss : KARTOBI

He/She is : UN FIT for employment Iternist Elisabeth Hospital

Expire Date : October 04th 2018

 Stamp of Agencies dr. Nurhadi Saputra, Sp.PD

MEDICAL REPORT
No. Lab : -
Name : JASMINE JIHAN
Sex : FEMALE Date Issue : February 05th 2014
Age : 19 Years Nationality : Indonesian
Adress : Dsn. Serayu Rt.002/001
Teluk Keramat
PUT MARK (V) NORMAL PUT MARK (X) ABNORMAL
History of Illnes
1. Height : 151 cm 2. Weight : 49 kg 3. Pulse : 84 /min
4. Blood Pressure 5. Systolic : 110 mm Hg 6. Diastolic : 80mmHg
MEDICAL EXAMINATION
Eyes : Right Eye ( v ) Skin Disease ( v ) Serology :
Left Eye ( v ) Blood Pressure ( v ) VDRL (v)

Ears : Right Ear ( v ) HIV (v)

Left Ear ( v ) Urinalysis: HbsAg (v)

Berat Jenis (1.010 ) Gol darah ( B ) Rh ( + )

Leukosit ( Neg ) Prognostiocon test (v)

Nitrit ( Neg )
Internal Disease: Sedimen :
pH ( Pos )
Heart ( v ) Eri 0-1
Protein ( Neg )
Lungs ( v ) Leko 0-1
Glukosa ( Normal )
Liver ( v ) Sel + episel
Keton ( Normal )
Spleen ( v ) Warna :
Urobilinogen (Neg )
Kidney ( v ) Kuning
Bilirubin ( Normal )
Kejernihan :
Darah ( Neg )
Jernih v Keruh
 Above medical report of Mr/Mrs/Miss : JASMINE JIHAN

He/She is : FIT for employment Hospital Phsychian

Expire Date : April 05th 2014

Stamp of Agencies dr. Bonefasius Bone, MM