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KEMENTERIAN KESEHATAN RI

DIREKTORAT JENDRAL PELAYANAN KESEHATAN


RSUP Dr. MOHAMMAD HOESIN PALEMBANG
Jl. Jendral Sudirman, KM 3,5 Palembang 30126, Telp. (071) 354088

TES ALERGI (SKIN PRICK TEST)

Nama : ......................................................................................................................................
Usia : ......................................................................................................................................
Alamat : ......................................................................................................................................

No Alergen Hasil No. Alergen Hasil


.
1 D. pteronyssinus (tungau debu 11 Aedes Mosquito (nyamuk)
rumah)
2 Cat Fur (bulu kucing) 12 Latex (getah)
3 Dog Hair (bulu anjing) 13 Banana (pisang)
4 Feathers Mixture (bulu 14 Wheat Fluor (tepung terigu)
campuran)
5 Aspergilus Mix 15 Cockroach (kecoa)
6 Candida albicans 16 Egg (telur)
7 Shrimp (udang) 17 D. Farinae (tungau debu rumah)
8 Crab (kepiting) 18 Blomia (tungau debu rumah)
9 Chicken (ayam) 19 Peanut (kacang)
10 Soya (kedelai) 20

Saran :
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Palembang, ............................20.....

Dokter

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