7/26/2019 Blanko Permintaan Pemeriksaan Laboratorium

Blanko Permintaan Pemeriksaan Laboratorium

Rumah Sakit Umum Kuningan Medical Center
0o, %4 & (((((((,, Tan##al & ((((((
0ama & (((((((((((((((((,,,
Umur &(((((((,,Ta un "P
Alamat &((((((((((((((((((
Dokter &((((((((((((((((((
0ama %uan & ((((((((((((((((((
H!MA"#L#$I URI%! KIMIA DARAH
□ !emo#lobin □ Urine %utin □ Glukosa Puasa
□ "eukosit □ Protein □ Glukosa 2 jam PP
□ !ematrokit □ Glukosa □ Glukosa Sewaktu
□ Trombosit □ 1eton □ Protein Total
□ %etikulosit □ Urobilino#en □ Albumin
□ *ritrosit □ Bilirubin □ Globulin
□ "*D □ Bilirubin Total
□ +, Pendara an □ B Se,-d,imen □ Bilirubin Direct
□ +, Pembekuan □ "eko "PB □ Bilirubin Indirect
□ +, Protombin □ *ri "PB □ SGOT
□ !it -enis "eukosit □ Sele/ "PB □ SGPT
□ Gol Dara . % esus □ 1ristal □ Ureum
□ Gambaran Dara Te/i □ Creatinin
□ S!R#L#$I □ Asam Urat
□ □ +idal Test □ C olesterol
□ Tube3 Test □ !D"
MICR#BI#L#$I □ 4aontuk Test □ "D"
□ Pre/arat Gram □ !I5 □ Tri#liserid
□ Pre/arat BTA □ !bsA#
□ S/utum SPS □ Tro/onin I A!C!S
□ □ Ck ck4B □ $aeces %utin
□ !bA6C □ "emak
!L!K"R#LI" □ sC%P □ Dara Samar
□ 0atrium □ □
□ 1alium TTD
□ Clorida S!PSIS &
□ □ Procalcitonin
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