Head Office : Jl. Siliwangi Ni. 106 Telp./Fax.

(0266) - 533456 Sekarwangi Cibadak Sukabumi

Branch Office : Jl. Raya Manglad Km. 18 Kalapanunggal Telp./Fax. (0266) 620234 - Sukabumi
Jawa Barat - Indonesia

Excellence in Quality and Service

Since 1998

Name : Mr. Enjang Suryana Occupasion or Job : Driver

Date of Birth : August, 11, 1976 Date of Examination : December, 23, 2017
Age : 41, Year, Old From Company : PT. BARAMA DUTA PRATAMA
Sex : Male

PHYSICAL EXAMINATION RESULT

Number : 00001

Height : 175 Cm Blood Pressure : 110 / 80 mmHg

Weight : 69 Kg Pulse Rate : 90 x/minute

KINDS OF PHYSICAL EXAMINATION RESULT

- Head Normal
- Eyes Right eye normal
Left eye normal
- Visus Visus oculi dextri normal
Visus oculi sinistri normal
- Ears Normal
- Nose Normal
- Throat Normal
- Mouth and Tooth Normal
- Neck and Thyroid Normal
- Breasts Normal
- Lung Normal
- Heart Normal
- Abdomen Normal
- Hernia Normal
- Genitalia Normal
- Rectal / Prostate Exam Normal
- Pelvic Exam Normal
- Lymph Nodes Normal
- Skin Normal
- Musculoskeletal
- Reflexes

- Color Blindness Normal

HISTORY OF MEDICAL ILLNES

- Epilepsy None
- Asthma None
- Diabetes None
- Hypertensi None
- Cardiovascular Diseases None
- Surgery None
- Tubercolosis None
- Skin None
- Typhoid None
- Stroke None
 Head Office : Jl. Siliwangi Ni. 106 Telp./Fax. (0266) - 533456 Sekarwangi Cibadak Sukabumi
Branch Office : Jl. Raya Manglad Km. 18 Kalapanunggal Telp./Fax. (0266) 620234 - Sukabumi
Jawa Barat - Indonesia

Excellence in Quality and Service

Since 1998

Name : Mr. Enjang Suryana Occupasion or Job : Driver

Date of Birth : August, 11, 1976 Date of Examination : December, 23, 2017
Age : 41, Year, Old From Company : PT. BARAMA DUTA PRATAMA
Sex : Male

LABORATORY EXAMINATION RESULT

Kind of Examination Result Normal Value Unit

HEMATOLOGI
Hemoglobin 15,8 Male : 13 – 18 gr/dl
Female : 12 – 16
Leucosit 8.100 Adult : 4.000 - 1 0.000 /ul
Baby : 7.000 - 17.000
Eritrosit 5.172.000 Male : 4.410.000 - 6.000.000 /ul
Female : 4.500.000 – 5.500.000
Trombosit 271.000 150.000 – 410.000 /ul
Hematocrit 45 Male : 40 - 50 vol %
Female : 35 - 45
BLOOD GROUP A
Diff. Count
Eosinopil 3 1 – 3 %
Basopil 0 0 – 1 %
Stem 4 2 – 6 %
Segment 51 50 – 68 %
Limposit 36 20 – 41 %
Monosit 4 2 – 8 %

GLUCOSE BLOOD TEST

Glucose While 132 < 180 mg/dl
FUNCTION RENAL TEST
Ureum 25,3 10 – 50 mg/dl
Creatinin 0,7 Male : 0,6 – 1,1 mg/dl
Female : 0,5 – 0,9
Uric Acid 4,4 Male : 3,4 – 7,0 mg/dl
Female : 2,4 – 5,7

CHOLESTEROL TEST
Cholesterol Total 186 < 220 mg/dl
Trigliserida 167 < 200 mg/dl
HDL Cholesterol 37,3 > 35 mg/dl
LDL Cholesterol 158,3 < 150 mg/dl

FUNCTION LIVER TEST

Billirubin Total 0,71 until 1,0 gr%
Billirubin Direct 0,23 until 0,42 gr%
Billirubin Indirect 0,47 until 0,8 gr%
SGOT 25 Female : until 42 ( 362 ) U/L
Male : until 37 ( 362 )
SGPT 26 Female : until 42 ( 362 ) U/L
Male : until 37 ( 362 )

HBsAg Negatif Negatif

 Head Office : Jl. Siliwangi Ni. 106 Telp./Fax. (0266) - 533456 Sekarwangi Cibadak Sukabumi
Branch Office : Jl. Raya Manglad Km. 18 Kalapanunggal Telp./Fax. (0266) 620234 - Sukabumi
Jawa Barat - Indonesia

Excellence in Quality and Service

Since 1998

Name : Mr. Enjang Suryana Occupasion or Job : Driver

Date of Birth : August, 11, 1976 Date of Examination : December, 23, 2017
Age : 41, Year, Old From Company : PT. BARAMA DUTA PRATAMA
Sex : Male

LABORATORY EXAMINATION RESULT

Kind of Examination Result Normal Value Unit

ROUTINE URINE

Leucosit Negatif Negatif

Nitrit Negatif Negatif
BJ 1.017
pH 6
Protein Negatif Negatif
Glucose Negatif Negatif
Ceton Negatif Negatif
Urobillin Negatif Negatif
Billirubin Negatif Negatif
Eritrosit Negatif Negatif

Sediment

Leucosit 1 – 3 1 – 5 /LPB
Eritrosit 0 – 1 0 – 2 /LPB
Ephitel Positif Positif
Crystal Negatif Negatif
Cylinder Negatif Negatif

STOOL ROUTINE
Macros Copis

Color Yelow
Consistensi Soft
Scent Normal
Mucus Negatif Negatif
Blood Negatif Negatif

Micros Copis

Eritrosit 1 - 2 1 - 2 /LPB
Leucosit 0 - 1 0 - 1 /LPB
Amoeba Negatif Negatif
Backteri Negatif Negatif

Sukabumi, December, 23, 2017

Signature
 Head Office : Jl. Siliwangi Ni. 106 Telp./Fax. (0266) - 533456 Sekarwangi Cibadak Sukabumi
Branch Office : Jl. Raya Manglad Km. 18 Kalapanunggal Telp./Fax. (0266) 620234 - Sukabumi
Jawa Barat - Indonesia

Excellence in Quality and Service

Since 1998

Analys

Name : Mr. Enjang Suryana Occupasion or Job : Driver

Date of Birth : August, 11, 1976 Date of Examination : December, 23, 2017
Age : 41, Year, Old From Company : PT. BARAMA DUTA PRATAMA
Sex : Male

LABORATORY EXAMINATION RESULT

DRUGS AND ALCHOHOL TEST

Kind of Examination Result Normal Value Unit

DRUGS TEST

-
Maryuana Negatif Negatif

-
Benzodiazepam Negatif Negatif

-
Amphetamine Negatif Negatif

-
Cocaine Negatif Negatif

-
Morphine Negatif Negatif

ALCHOHOL TEST Negatif Negatif -

Was examed for the presence of the following drugs and alcohol in the urine using
the competitive immunoassay / chromatographic absorbent method and found

Sukabumi, December, 23, 2017,

Signature
Head Office : Jl. Siliwangi Ni. 106 Telp./Fax. (0266) - 533456 Sekarwangi Cibadak Sukabumi
Branch Office : Jl. Raya Manglad Km. 18 Kalapanunggal Telp./Fax. (0266) 620234 - Sukabumi
Jawa Barat - Indonesia

Excellence in Quality and Service

Since 1998

Analys

Name : Mr. Enjang Suryana Occupasion or Job : Driver

Date of Birth : August, 11, 1976 Date of Examination : December, 23, 2017
Age : 41, Year, Old From Company : PT. BARAMA DUTA PRATAMA
Sex : Male

RADIOLOGI EXAMINATION RESULT

Result : Pulmo not appear Infiltrat

Corakan bronkhovaskular in hillus is good
Cor normal, Not wider mediastinum
Sharp sinus , and diafragma is good
No appear effusi pleura

Suggestion : -

Conclusion : Cor and pulmo normal

Sukabumi, December, 23, 2017,

Signature

dr. H. Ma’mun Wirayat, SpR

Radiologist

Name : Mr. Enjang Suryana Occupasion or Job : Driver

Head Office : Jl. Siliwangi Ni. 106 Telp./Fax. (0266) - 533456 Sekarwangi Cibadak Sukabumi
Branch Office : Jl. Raya Manglad Km. 18 Kalapanunggal Telp./Fax. (0266) 620234 - Sukabumi
Jawa Barat - Indonesia

Excellence in Quality and Service

Since 1998

Date of Birth : August, 11, 1976 Date of Examination : December, 23, 2017
Age : 41, Year, Old From Company : PT. BARAMA DUTA PRATAMA
Sex : Male

ECG EXAMINATION RESULT

Result : Normal sinus rhytm

Conclusion : Within normal limit ECG

Sukabumi, December, 23, 2017,

Signature

dr. Teungku muhammad Iqbal

Name : Mr. Enjang Suryana Occupasion or Job : Driver

Date of Birth : August, 11, 1976 Date of Examination : December, 23, 2017
Head Office : Jl. Siliwangi Ni. 106 Telp./Fax. (0266) - 533456 Sekarwangi Cibadak Sukabumi
Branch Office : Jl. Raya Manglad Km. 18 Kalapanunggal Telp./Fax. (0266) 620234 - Sukabumi
Jawa Barat - Indonesia

Excellence in Quality and Service

Since 1998

Age : 41, Year, Old From Company : PT. BARAMA DUTA PRATAMA
Sex : Male

AUDIOMETRY EXAMINATION RESULT

Name : Mr. Enjang Suryana Occupasion or Job : Driver

Date of Birth : August, 11, 1976 Date of Examination : December, 23, 2017
Age : 41, Year, Old From Company : PT. BARAMA DUTA PRATAMA
Sex : Male

CONCLUSION AND SUGGESTION

Head Office : Jl. Siliwangi Ni. 106 Telp./Fax. (0266) - 533456 Sekarwangi Cibadak Sukabumi
Branch Office : Jl. Raya Manglad Km. 18 Kalapanunggal Telp./Fax. (0266) 620234 - Sukabumi
Jawa Barat - Indonesia

Excellence in Quality and Service

Since 1998

Fhysical Phsycal ExaminationResult

He / She is Normal

Laboratory Examination result

Laboratory Wthin Normal Limit

Drug Examination result

Drugs Test Or Drug Test Negatif

Alchohol Test Alchohol Examination result

Or Alchohol Test Negatif

Rontgen Radiology Examination result

Cor and Pulmo Normal

Electrocardiography Examination Result

ECG Wthin Normal Limit ECG

Audiometry Examination result

Audiometry Listener within sill normal limit

Suggestion Keep your healt in good condition.

Reducing dietary and restrict intakes of fat

With Conclusion
Conclusion He / She Is Fit for The Mentioned Job

Sukabumi, December, 23, 2017,

Signature

dr. Teungku muhammad Iqbal