DAFTAR PEKERJA PT.

GUNUNG MARAS LESTARI- PALM OIL MILL

KIP. ISAMAR
TANGGAL :

Pemeriksaan Umum KULIT MATA LEHER GIGI DADA ABDOMEN GENETALIA DAN ANOREKTAL ANGGOTA GERAK REFLEK-REFLEK

INSTANSI
UMUR
TENGGOROK JANTUNG Paru-Paru GENETALIA LAKI-LAKI GENETALIA WANITA
TANGGAL KESAN RIWAYAT TINGGI BERAT STATUS
NO. NAMA TANGGAL LAHIR JENIS KELAMIN BMI Keterangan BMI MEROKOK TELINGA AN DAN

HERNIA
ATAS BAWAH

HEPAR
PEMERIKSAAN UMUM PENYAKIT BADAN BADAN ALERGI

LIMPA
TENSI BUTA MULUT Lain- Lain- SPINCTER
DARAH
NADI RR TEMP Inspeksi Palpasi
WARNA
Penglihatan Lain-Lain Inpeksi Palpasi
Lain
Karies
Lain TUMOR Lain-Lain HERNIA HAEMOROID
ANI
KANAN/KI KANAN/KIR EDEMA CACAT-CACAT PUPIL PATELLA
BATAS- AUSCULTASI Lain-Lain KAPASITAS AUSKULTASI Lain-Lain EPIDIDIMIS UTERHRA FLOUR FLUXUS HAID SIKLIS HAID RI I
BATAS VITAL DISCHARGE ALBUS

Dengan Tidak Tampak Tidak Tampak Tidak Tidak

1 SUNG TJHAN 10/4/1970 52 LAKI-LAKI 22-09-2022 KIP ISAMAR Baik 172/110 88 24HT, Mata
36.2Kanan Post Op 6 Bln167
Yg Lalu 87 31.2 OBESITAS Tidak - NORMAL HANGAT Tidak
Kacamata
- NORMAL NORMAL
Benjolan Benjolan
- tidak - Normal Normal - 98% Normal - Normal Normal Normal Normal -
Ada
Tidak Ada
Ada
Normal Normal - - - - Normal Normal Tidak Ada Tidak Ada Normal Normal

Tanpa Pterigium Tidak Tampak Tidak Tampak Tidak Tidak

2 DOLLY ABDILLAH 6/13/1996 26 LAKI-LAKI 22-09-2022 KIP ISAMAR Baik 130/80 87 24 36 Asma 167 57.5 20.6 NORMAL Ya - NORMAL HANGAT Tidak
Kacamata OS
NORMAL NORMAL
Benjolan Benjolan
- tidak - Normal Normal - 96% Normal - Normal Normal Normal Normal -
Ada
Tidak Ada
Ada
Normal Normal - - - - Normal Normal Tidak Ada Tidak Ada Normal Normal

Tanpa Tidak Tampak Tidak Tampak Tidak Tidak

3 M. MULYADI 6/12/1992 30 LAKI-LAKI 22-09-2022 KIP ISAMAR Baik 140/80 80 24 36.2 - 168 71 25.2 Over Weight Ya - NORMAL HANGAT Tidak
Kacamata
- NORMAL NORMAL
Benjolan Benjolan
- tidak - Normal Normal - 99% Normal - Normal Normal Normal Normal -
Ada
Tidak Ada
Ada
Normal Normal - - - - Normal Normal Tidak Ada Tidak Ada Normal Normal

Tanpa Tidak Tampak Tidak Tampak Tidak Tidak

4 AGUNG FAJAT SUBEKTI 8/14/1993 29 LAKI-LAKI 22-09-2022 KIP ISAMAR Baik 130/90 87 24 36.2 - 180 84 25.9 Over Weight Ya - NORMAL HANGAT Tidak
Kacamata
- NORMAL NORMAL
Benjolan Benjolan
- tidak - Normal Normal - 97% Normal - Normal Normal Normal Normal -
Ada
Tidak Ada
Ada
Normal Normal - - - - Normal Normal Tidak Ada Tidak Ada Normal Normal

Tanpa katarak Tidak Tampak Tidak Tampak Tidak Tidak

5 PAULUS PATODING 6/11/1974 48 LAKI-LAKI 22-09-2022 KIP ISAMAR Baik 140/76 77 22 36 AU 152 56.2 24.3 NORMAL Tidak - NORMAL HANGAT Tidak
Kacamata immature
NORMAL NORMAL
Benjolan Benjolan
- tidak - Normal Normal - 99% Normal - Normal Normal Normal Normal -
Ada
Tidak Ada
Ada
Normal Normal - - - - Normal Normal Tidak Ada Tidak Ada Normal Normal

Tanpa Tidak Tampak Tidak Tampak Tidak Tidak

6 RIZKI AMANDA 7/22/1998 24 LAKI-LAKI 22-09-2022 KIP ISAMAR Baik 126/86 74 22 36 - 165 63.2 23.2 NORMAL Tidak - NORMAL HANGAT Tidak
Kacamata
- NORMAL NORMAL
Benjolan Benjolan
- tidak - Normal Normal - 98% Normal - Normal Normal Normal Normal -
Ada
Tidak Ada
Ada
Normal Normal - - - - Normal Normal Tidak Ada Tidak Ada Normal Normal

Tanpa katarak Tidak Tampak Tidak Tampak Tidak Tidak

7 MUHAMAD ALI 1/1/1975 47 LAKI-LAKI 22-09-2022 KIP ISAMAR Baik 134/90 81 24 36.2 - 171 73.2 25.0 Over Weight Tidak - NORMAL HANGAT Tidak
Kacamata immature
NORMAL NORMAL
Benjolan Benjolan
- tidak - Normal Normal - 98% Normal - Normal Normal Normal Normal -
Ada
Tidak Ada
Ada
Normal Normal - - - - Normal Normal Tidak Ada Tidak Ada Normal Normal

Tanpa Tidak Tampak Tidak Tampak Tidak Tidak

8 LUKMAN PRATAMA 4/1/1985 37 LAKI-LAKI 22-09-2022 KIP ISAMAR Baik 136/83 95 24 36.2 - 157 69.5 28.2 Over Weight Ya - NORMAL HANGAT Tidak
Kacamata
- NORMAL NORMAL
Benjolan Benjolan
- tidak - Normal Normal - 98% Normal - Normal Normal Normal Normal -
Ada
Tidak Ada
Ada
Normal Normal - - - - Normal Normal Tidak Ada Tidak Ada Normal Normal

Tanpa Tidak Tampak Tidak Tampak Tidak Tidak

9 A. RENDI SETIAWAN 8/6/1991 31 LAKI-LAKI 22-09-2022 KIP ISAMAR Baik 128/87 94 24 36.2 - 171 82 28.0 Over Weight Ya - NORMAL HANGAT Tidak
Kacamata
silinrids NORMAL NORMAL
Benjolan Benjolan
- tidak - Normal Normal - 98% Normal - Normal Normal Normal Normal -
Ada
Tidak Ada
Ada
Normal Normal - - - - Normal Normal Tidak Ada Tidak Ada Normal Normal

Tanpa Tidak Tampak Tidak Tampak Tidak Tidak

10 ANGGA SEPTI ANDIKA 9/5/1992 30 LAKI-LAKI 22-09-2022 KIP ISAMAR Baik 114/76 98 20 36.2 - 163 49.7 18.7 NORMAL Ya - NORMAL HANGAT Tidak
Kacamata
- NORMAL NORMAL
Benjolan Benjolan
- tidak - Normal Normal - 96% Normal - Normal Normal Normal Normal -
Ada
Tidak Ada
Ada
Normal Normal - - - - Normal Normal Tidak Ada Tidak Ada Normal Normal

YOHANNES ADITIYA EKA 5/22/2001 Tanpa Tidak Tampak Tidak Tampak Tidak Tidak
11
PUTRA 21 LAKI-LAKI 22-09-2022 KIP ISAMAR Baik 140/77 83 24 36.2 - 167 77 27.6 Over Weight Ya - NORMAL HANGAT Tidak
Kacamata
- NORMAL NORMAL
Benjolan Benjolan
- tidak - Normal Normal - 98% Normal - Normal Normal Normal Normal -
Ada
Tidak Ada
Ada
Normal Normal - - - - Normal Normal Tidak Ada Tidak Ada Normal Normal

Dengan Tidak Tampak Tidak Tampak Tidak Tidak

12 NANA KARYANA 10/9/1964 58 LAKI-LAKI 22-09-2022 KIP ISAMAR Baik 178/98 97 22 36.2 HT 165 65.7 24.1 NORMAL Tidak - NORMAL HANGAT Tidak
Kacamata
Presbiop NORMAL NORMAL
Benjolan Benjolan
- tidak - Normal Normal - 98% Normal - Normal Normal Normal Normal -
Ada
Tidak Ada
Ada
Normal Normal - - - - Normal Normal Tidak Ada Tidak Ada Normal Normal

Tanpa Tidak Tampak Tidak Tampak Tidak Tidak

13 SYAMSURI 4/27/1992 30 LAKI-LAKI 22-09-2022 KIP ISAMAR Baik 140/83 85 22 36.2 - 163 57 21.5 NORMAL Ya - NORMAL HANGAT Tidak
Kacamata
- NORMAL NORMAL
Benjolan Benjolan
- tidak - Normal Normal - 98% Normal - Normal Normal Normal Normal -
Ada
Tidak Ada
Ada
Normal Normal - - - - Normal Normal Tidak Ada Tidak Ada Normal Normal

Tanpa Tidak Tampak Tidak Tampak Tidak Tidak

14 LEONARDI 8/5/2004 18 LAKI-LAKI 22-09-2022 KIP ISAMAR Baik 126/77 105 24 36.2 - 160 79.3 31.0 OBESITAS Ya - NORMAL HANGAT Tidak
Kacamata
- NORMAL NORMAL
Benjolan Benjolan
- tidak - Normal Normal - 98% Normal - Normal Normal Normal Normal -
Ada
Tidak Ada
Ada
Normal Normal - - - - Normal Normal Tidak Ada Tidak Ada Normal Normal

Dengan Tidak Tampak Tidak Tampak Tidak Tidak

15 WARTAM 1/16/1973 49 LAKI-LAKI 22-09-2022 KIP ISAMAR Baik 140/86 65 20 36.2 - 148 39.3 17.9 BB Kurang Ya - NORMAL HANGAT Tidak
Kacamata
Presbiop NORMAL NORMAL
Benjolan Benjolan
- tidak - Normal Normal - 96% Normal - Normal Normal Normal Normal -
Ada
Tidak Ada
Ada
Normal Normal - - - - Normal Normal Tidak Ada Tidak Ada Normal Normal

Tanpa Tidak Tampak Tidak Tampak Tidak Tidak

16 MUHAMMAD SAPA'I 1/10/2002 20 LAKI-LAKI 22-09-2022 KIP ISAMAR Baik 115/73 65 24 36.2 - 170 90.3 31.2 OBESITAS Ya Udang NORMAL HANGAT Tidak
Kacamata
- NORMAL NORMAL
Benjolan Benjolan
- tidak - Normal Normal - 98% Normal - Normal Normal Normal Normal -
Ada
Tidak Ada
Ada
Normal Normal - - - - Normal Normal Tidak Ada Tidak Ada Normal Normal

Dengan Tidak Tampak Tidak Tampak Tidak Tidak

17 ADHA 19-04-1995 27 LAKI-LAKI 22-09-2022 KIP ISAMAR Baik 133/93 73 22 36.2 magh 173 63.6 21.3 NORMAL Tidak - NORMAL HANGAT Tidak
Kacamata
- NORMAL NORMAL
Benjolan Benjolan
- tidak - Normal Normal - 96% Normal - Normal Normal Normal Normal -
Ada
Tidak Ada
Ada
Normal Normal - - - - Normal Normal Tidak Ada Tidak Ada Normal Normal

Tanpa Tidak Tampak Tidak Tampak Tidak Tidak

18 MINGGUS SAVELY 3/25/1973 49 LAKI-LAKI 22-09-2022 KIP ISAMAR Baik 140/80 91 22 36 - 159 73.5 29.1 Over Weight Ya - NORMAL HANGAT Tidak
Kacamata
- NORMAL NORMAL
Benjolan Benjolan
- tidak - Normal Normal - 98% Normal - Normal Normal Normal Normal -
Ada
Tidak Ada
Ada
Normal Normal - - - - Normal Normal Tidak Ada Tidak Ada Normal Normal

Tanpa Tidak Tampak Tidak Tampak Tidak Tidak

19 SUHANDRI 5/25/1997 25 LAKI-LAKI 22-09-2022 KIP ISAMAR Baik 130/85 81 24 36.2 - 161 52.3 20.2 NORMAL Ya - NORMAL HANGAT Tidak
Kacamata
- NORMAL NORMAL
Benjolan Benjolan
- tidak - Normal Normal - 98% Normal - Normal Normal Normal Normal -
Ada
Tidak Ada
Ada
Normal Normal - - - - Normal Normal Tidak Ada Tidak Ada Normal Normal

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40 122 #DIV/0! #DIV/0!

41 122 #DIV/0! #DIV/0!

42 122 #DIV/0! #DIV/0!

43 122 #DIV/0! #DIV/0!

44 122 #DIV/0! #DIV/0!

45 122 #DIV/0! #DIV/0!

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1437 122 #DIV/0! #DIV/0!

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1441 122 #DIV/0! #DIV/0!

1442 122 #DIV/0! #DIV/0!

1443 122 #DIV/0! #DIV/0!

1444 122 #DIV/0! #DIV/0!

1445 122 #DIV/0! #DIV/0!

1446 122 #DIV/0! #DIV/0!

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1448 122 #DIV/0! #DIV/0!

1449 122 #DIV/0! #DIV/0!

1450 122 #DIV/0! #DIV/0!

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1452 122 #DIV/0! #DIV/0!

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1454 122 #DIV/0! #DIV/0!

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1457 122 #DIV/0! #DIV/0!

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1472 122 #DIV/0! #DIV/0!

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1498 122 #DIV/0! #DIV/0!

1499 122 #DIV/0! #DIV/0!

1500 122 #DIV/0! #DIV/0!

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DOKTER PEMERIKSA

dr. ZAINAL ARPAN, MARS

dr. ZAINAL ARPAN, MARS

dr. ZAINAL ARPAN, MARS

dr. ZAINAL ARPAN, MARS

dr. ZAINAL ARPAN, MARS

dr. ZAINAL ARPAN, MARS

dr. ZAINAL ARPAN, MARS

dr. ZAINAL ARPAN, MARS

dr. ZAINAL ARPAN, MARS

dr. ZAINAL ARPAN, MARS

dr. ZAINAL ARPAN, MARS

dr. ZAINAL ARPAN, MARS

dr. ZAINAL ARPAN, MARS

dr. ZAINAL ARPAN, MARS

dr. ZAINAL ARPAN, MARS

dr. ZAINAL ARPAN, MARS

dr. ZAINAL ARPAN, MARS

dr. ZAINAL ARPAN, MARS

dr. ZAINAL ARPAN, MARS

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DARAH LENGKAP Hitung Jenis Gula Darah

No. NAMA TANGGAL LAHIR JK TANGGAL
PEMERIKSAAN Eritrosit Hematokrit Hemoglobi Trombosit LED 1 Jam
Leukosit Basofil Eosinofil Neutrofil Lomfosit Monosit GDS
n
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 SUNG TJHAN 04-10-1970 LAKI-LAKI 22-09-2022 5.57 47 16.5 270 7.6 0 7 55 27 11 9 114
2 DOLLY ABDILLAH 13-06-1996 LAKI-LAKI 22-09-2022 5.31 41 13.5 365 8.4 1 4 44 42 9 14 126
3 M.MULYADI 12-06-1962 LAKI-LAKI 22-09-2022 5.56 55 18.6 203 7.6 0 5 50 40 5 2 119
4 AGUNG FAJAR SUBEKTI 14-08-1993 LAKI-LAKI 22-09-2022 5.80 52 17.5 282 7.7 0 4 60 31 6 2 133
5 PAULUS PATODING 11-16-1974 LAKI-LAKI 22-09-2022 4.25 40 13.6 199 8.8 1 3 51 36 10 6 183
6 RIZKI AMANDA 20-07-1998 LAKI-LAKI 22-09-2022 6.65 46 14.9 260 8.9 0 4 47 42 7 6 142
7 MUHAMAD ALI 01-01-1976 LAKI-LAKI 22-09-2022 5.09 48 16.6 194 6.7 1 1 38 41 19 11 107
8 LUKMAN PRATAMA 1-4-1985 LAKI-LAKI 22-09-2022 6.33 50 16.4 330 13.0 1 3 55 35 6 6 194
9 A.RENDI SETIAWAN 06-08-1991 LAKI-LAKI 22-09-2022 5.41 48 16.7 358 8.7 0 2 58 34 6 1 166
10 ANGGA 05-09-1992 LAKI-LAKI 22-09-2022 5.03 47 15.5 259 7.4 0 5 48 38 9 4 129
11 YOHANNES ADITYA EKA PUTRA 22-05-2001 LAKI-LAKI 22-09-2022 4.42 42 14.1 352 6.5 1 7 40 44 8 4 141
12 NANA KARYANA 09-10-1964 LAKI-LAKI 22-09-2022 5.54 48 17.0 256 6.8 1 2 57 34 7 3 132
13 SYAMSURI 27-04-1997 LAKI-LAKI 22-09-2022 6.05 39 12.8 284 8.3 1 8 46 37 8 4 135
14 LEONALDI 05-08-2004 LAKI-LAKI 22-09-2022 7.46 49 15.8 314 11.1 0 3 38 50 9 3 123
15 WARTAM 1/16/1973 LAKI-LAKI 44826.00 4.62 42 13.9 281 7.3 0 6 47 37 10 38 116
16 ADHA 4/19/1995 LAKI-LAKI 44826.00 5.52 48 16.0 192 8.1 0 4 69 20 7 2 207
17 MINGGUS SAVELY 25-03-1973 LAKI-LAKI 22-09-2022 5.34 49 16.3 330 10.2 1 4 49 41 5 1 120
18 MUHAMMAD SAPI'I 10-01-2002 LAKI-LAKI 22-09-2022 6.31 44 15.0 321 11.6 0 14 53 24 9 7 118
19 SUHANDRI 25-5-1997 LAKI-LAKI 22-09-2022 4.98 46 15.2 262 7.0 1 7 46 38 9 8 104
20
21
22
23
24
25
26
27
28
29
30
31
32
33

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34
35
36
37
38
39
40
41
42
43
44

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FAAL HATI LEMAK FAAL GINJAL URINE

Kolesterol Berat
SGOT SGPT Trigliserida HDL LDL UREUM Kreatinin Asam Urat Protein Glukosa Urobilin Bilirubin Reaksi/PH
Total Jenis/BJ

18 19 20 21 22 23 24 25 26 27 28 29 30 31 32
25 19 323 133 37 31 46 1.3 6.0 NEGATIF NEGATIF NEGATIF NEGATIF 6.0 1.020
32 42 124 226 57 144 35 1.0 7.0 NEGATIF NEGATIF NEGATIF NEGATIF 6.0 1.020
37 115 294 145 58 31 42 1.0 6.0 NEGATIF NEGATIF NEGATIF NEGATIF 6.0 1.025
21 33 509 181 34 45 34 1.1 8.2 NEGATIF NEGATIF NEGATIF NEGATIF 6.0 1.020
25 32 166 185 63 89 34 0.8 9.8 NEGATIF NEGATIF NEGATIF NEGATIF 5.0 1.010
18 9 78 175 51 108 51 34 7.1 NEGATIF NEGATIF NEGATIF NEGATIF 6.5 1.025
24 28 339 173 36 70 14 0.8 5.7 NEGATIF NEGATIF NEGATIF NEGATIF 6.0 1.025
15 21 274 121 28 38 20 0.8 7.6 NEGATIF NEGATIF NEGATIF NEGATIF 6.0 1.020
21 24 157 176 45 99 24 1.1 5.4 NEGATIF NEGATIF NEGATIF NEGATIF 6.0 1.015
21 25 115 166 45 98 29 1.0 5.9 NEGATIF NEGATIF NEGATIF NEGATIF 6.0 1.015
21 24 179 127 46 45 34 1.3 8.6 NEGATIF NEGATIF NEGATIF NEGATIF 6.0 1.025
19 19 163 155 35 87 30 0.9 5.7 NEGATIF NEGATIF NEGATIF NEGATIF 5.0 1.025
22 20 114 239 58 158 30 1.2 8.5 NEGATIF NEGATIF NEGATIF NEGATIF 7.0 1.015
48 82 282 138 38 45 37 1.3 7.5 NEGATIF NEGATIF NEGATIF NEGATIF 5.0 1.020
26 16 170 156 49 73 35 0.9 5.5 NEGATIF NEGATIF NEGATIF NEGATIF 5.0 1.020
23 17 134 120 55 38 37 1.2 5.7 NEGATIF NEGATIF NEGATIF NEGATIF 5.0 1.020
22 37 424 149 31 33 20 1.4 6.0 NEGATIF NEGATIF NEGATIF NEGATIF 6.0 1.020
27 40 331 144 40 38 40 1.2 6.5 NEGATIF NEGATIF NEGATIF NEGATIF 5.0 1.025
49 80 198 139 53 46 35 1.1 5.7 NEGATIF NEGATIF NEGATIF NEGATIF 5.0 1.020

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Page 56 of
 Bagian JANGAN di Edit
TANGGAL
TEMPAT TANGGAL JENIS
NO NAMA INTANSI PEMERIKSAA
LAHIR KELAMIN
N
1 2 3 4 5 6
1 SUNG TJHAN 04 - 10 - 1970 LAKI-LAKI KIP ISAMAR 22 - 09 - 2022
2 DOLLY ABDILLAH 13 - 06 - 1996 LAKI-LAKI KIP ISAMAR 22 - 09 - 2022
3 M. MULYADI 12 - 06 - 1992 LAKI-LAKI KIP ISAMAR 22 - 09 - 2022
4 AGUNG FAJAT SUBEKTI 14 - 08 - 1993 LAKI-LAKI KIP ISAMAR 22 - 09 - 2022
5 PAULUS PATODING 11 - 06 - 1974 LAKI-LAKI KIP ISAMAR 22 - 09 - 2022
6 RIZKI AMANDA 22 - 07 - 1998 LAKI-LAKI KIP ISAMAR 22 - 09 - 2022
7 MUHAMAD ALI 01 - 01 - 1975 LAKI-LAKI KIP ISAMAR 22 - 09 - 2022
8 LUKMAN PRATAMA 01 - 04 - 1985 LAKI-LAKI KIP ISAMAR 22 - 09 - 2022
9 A. RENDI SETIAWAN 06 - 08 - 1991 LAKI-LAKI KIP ISAMAR 22 - 09 - 2022
10 ANGGA SEPTI ANDIKA 05 - 09 - 1992 LAKI-LAKI KIP ISAMAR 22 - 09 - 2022
11 YOHANNES ADITIYA EKA PUTRA 22 - 05 - 2001 LAKI-LAKI KIP ISAMAR 22 - 09 - 2022
12 NANA KARYANA 09 - 10 - 1964 LAKI-LAKI KIP ISAMAR 22 - 09 - 2022
13 SYAMSURI 27 - 04 - 1992 LAKI-LAKI KIP ISAMAR 22 - 09 - 2022
14 LEONARDI 05 - 08 - 2004 LAKI-LAKI KIP ISAMAR 22 - 09 - 2022
15 WARTAM 16 - 01 - 1973 LAKI-LAKI KIP ISAMAR 22 - 09 - 2022
16 MUHAMMAD SAPA'I 10 - 01 - 2002 LAKI-LAKI KIP ISAMAR 22 - 09 - 2022
17 ADHA 19 - 04 - 1995 LAKI-LAKI KIP ISAMAR 22 - 09 - 2022
18 MINGGUS SAVELY 25 - 03 - 1973 LAKI-LAKI KIP ISAMAR 22 - 09 - 2022
19 SUHANDRI 25 - 05 - 1997 LAKI-LAKI KIP ISAMAR 22 - 09 - 2022
20 00 - 01 - 1900 00 - 01 - 1900
21 00 - 01 - 1900 00 - 01 - 1900
22 00 - 01 - 1900 00 - 01 - 1900
23 00 - 01 - 1900 00 - 01 - 1900
24 00 - 01 - 1900 00 - 01 - 1900
25 00 JAN 1900 00 JAN 1900
26 00 JAN 1900 00 JAN 1900
27 00 JAN 1900 00 JAN 1900
28 00 JAN 1900 00 JAN 1900
29 00 JAN 1900 00 JAN 1900
30 00 JAN 1900 00 JAN 1900
31 00 JAN 1900 00 JAN 1900
32 00 JAN 1900 00 JAN 1900
33 00 JAN 1900 00 JAN 1900
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1148 00 JAN 1900 00 JAN 1900
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 DOKTER PEMFIS LAB EKG RONTGEN

7 8 9 10 11
dr. ZAINAL ARPAN, Hipertensi,
MARS Katarak Immatur Trigliseridemia
Post Op
dr. ZAINAL ARPAN, MARS Pterigium OS Hiperkolesterolemia
Trigliseridemia,
Trigliseridemia,
dr. ZAINAL ARPAN, MARS Overweight Polisitemia
Polisitemia,
dr. ZAINAL ARPAN, MARS Overweight Hiperproteinuria
Trigliseridemia,
dr. ZAINAL ARPAN, MARS Katarak Immature Hiperproteinuria
dr. ZAINAL ARPAN, MARS SEHAT HiperProteinuria
Polisitemia,
Trigliseridemia,
dr. ZAINAL ARPAN, MARS
Overweight, Katarak Immatrue
Trigliseridemia
Hiperproteinuria,
dr. ZAINAL ARPAN, MARS Overweight Polisitemia
Trigliseridemia,
dr. ZAINAL ARPAN, MARS Overweight Polisitemia
dr. ZAINAL ARPAN, MARS SEHAT Dalam Batas Normal
Trigliseridemia,
dr. ZAINAL ARPAN, MARS Overweight Hiperproteinuria
Polisitemia,
dr. ZAINAL ARPAN, MARS Hipertensi Sedang Trigliseridemia
Trigliseridemia,
dr. ZAINAL ARPAN, MARS SEHAT Hiperproteinuria
Trigliseridemia,
dr. ZAINAL ARPAN, MARS Overweight Hiperproteinuria
dr. ZAINAL ARPAN, MARS Underweight Trigliseridemia
dr. ZAINAL ARPAN, MARS Overweight Trigliseridemia
Trigliseridemia Dan
dr. ZAINAL ARPAN, MARS SEHAT Polisitemia
dr. ZAINAL ARPAN, MARS Overweight Trigliseridemia
dr. ZAINAL ARPAN, MARS SEHAT Trigliseridemia
AUDIOMETRI SPIROMETRI KESIMPULAN

12 13 14
SEHAT Dengan Hipertensi Sedang, Katarak Immature Post Op, Trigliseridemia
SEHAT Dengan Pterigium OS Dan Hiperkolesterolemia
SEHAT Dengan Overweight, Trigliseridemia, Polisitemia
SEHAT Dengan Rendah Lemak Dan Rendah Protein
SEHAT Dengan Hipertproteinuria, Trigliseridemia, Katarak Immature
SEHAT Dengan Hiperproteinuria
SEHAT Dengan Overweight, Katarak Immature, Polisitemia, Trigliseridemia
SEHAT Dengan Overweight, Trigliseridemia, Hiperproteinuria, Polisitemia
SEHAT Dengan Overweight, Trigliseridemia, Polisitemia
SEHAT
SEHAT Dengan Overweight, Trigliseridemia, Hiperproteinuria
SEHAT Dengan Hipertensi Sedang, Polisitemia, Trigliseridemia
SEHAT Dengan Trigliseridemia, Hiperproteinuria
SEHAT Dengan Overweight, Trigliseridemia, Hiperproteinuria
SEHAT Dengan Underweight, Trigliseridemia
SEHAT Dengan Overweight, Trigliseridemia
SEHAT Dengan Trigliseridemia, Polisitemia
SEHAT Dengan Overweight, Trigliseridemia
SEHAT Dengan Trigliseridemia
 SARAN

15 16 17 18
Diet Rendah Garam Dan Rendah Lem Kontrol Rutin Tensi Kontrol Sp. M
Kurangi Makanan Yang Di Goreng Menggunakan Pelindung Mata Saat Bekerja / Naik Motor
Diet Rendah Lemak Kurangi Karbohidrat Olahraga Teratur Donor Darah Rutin
Kurangi Karbohidrat Olahraga Rutin
Diet Rendah Protein Dan Rendah Lemak
Diet Rendah Protein
Diet Rendah Lemak Kurangi Karbohidrat Olahraga Teratur
Diet Rendah Lemak Dan Protein Olahraga Teratur Donor Darah rutin
Diet Rendah Lemak Olahraga Teratur Donor Darah
Kurangi Merokok
Diet Rendah Lemak Dan Rendah
protein Olahraga Rutin
Diet Rendah Lemak Dan Rendah Gar Olahraga Ringan Teratur Cek TD Rutin / Bulan
Diet RendahLemak Dan Protein
Diet Rendah Lemak Dan Protein Olahraga Teratur Kurangi Merokok
Perbanyak Karbohidrat Stop Merokok Diet Rendah Lemak
Diet Rendah Lemak Olahraga Teratur
Diet Rendah Lemak Donor Darah Rutin
Diet Rendah Lemak Olahraga Teratur Kurangi Merokok
Diet Rendah Lemak
19 20
 NAMA :
TANGGAL LAHIR : 00 - 01 - 1900
JENIS KELAMIN :
TEMPAT KERJA :

Kesimpulan Hasil Pemeriksaan Dokter :

1 Pemeriksaan Fisik :

2 Laboratorium :

3 Pemeriksaan EKG :

4 Pemeriksaan Rontgen :

5 Pemeriksaan Audiometri :

6 Pemeriksaan Spirometri :

DATA
KESIMPULAN UMUM :

SARAN :

DATA

DATA

Sungailiat, 00 - 01 - 1900
DOKTER PEMERIKSA
 Untuk Lihat
Hasil Input
22 Nomor Pasien
Disini

DATA YANG DI
DATA AWAL
CETAK

DATA AWAL

22

DATA AWAL 1
 KLINIK AL - HUSNI
Jl. Belinyu Raya No. 83 Sinar Jaya, Sungailiat - Bangka
Telp : 0821 7849 1870 / Email : Klinikalhusni@gmail.com

SURAT KETERANGAN DOKTER

Yang bertanda tangan di bawah ini, Dokter MCU Klinik Al-Husni dengan ini
menerangkan bahwa :
DATA AWAL
Nama :
Tanggal Lahir : 00 - 01 - 1900
Jenis Kelamin :
DATA AKHIR
Instansi :
Telah Melakukan Pemeriksaan Untuk Keperluan: MEDICAL CHECK UP
Pada Tanggal : 00 - 01 - 1900 RANGKAP
Dinyatakan :

Demikian surat keterangan ini dibuat untuk diketahui dan agar dapat dipergunakan
sebagaimana mestinya.

Sungailiat, 00 - 01 - 1900
KLINIK AL - HUSNI

DOKTER MCU
 Untuk Lihat Hasil
22 Input Nomor
Pasien Disini

DATA AWAL DATA YANG AKAN DI

CETAK
1

DATA AKHIR

22

RANGKAP

1
 Nama : SUNG TJHAN
Tanggal Lahir : 04 - 10 - 1970
Jenis Kelamin : LAKI-LAKI
Instansi : KIP ISAMAR
Tanggal Periksa : 22 - 09 - 2022
Dokter : dr. ZAINAL ARPAN, MARS

GENERAL MEDICAL CHECK UP

KLINIK AL - HUSNI
Jl. Belinyu Raya No. 83 Sinar Jaya, Sungailiat - Bangka

Telp : 0821 7849 1870 / Email : Klinikalhusni@gmail.com

 Untuk Lihat Hasil
Nomor Input Nomor
Pasien 1 Pasien Disini

DATA YANG DI
DATA AWAL CETAK
1

DATA AWAL

Rangkap 1
 KLINIK AL - HUSNI
Jl. Belinyu Raya No. 83 Sinar Jaya, Sungailiat - Bangka
Telp : 0821 7849 1870 / Email : Klinikalhusni@gmail.com
Nama Pasien : SUNG TJHAN Dokter MCU : dr. Zainal Arpan, MARS
Tanggal Lahir : 04 - 10 - 1970 Tanggal Older : 22 - 09 - 2022
Jenis Kelamin : LAKI-LAKI Halaman :1 /1
Instansi : KIP ISAMAR

DATA AW
PEMERIKSAAN HASIL SATUAN NILAI RUJUKAN
HEMATOLOGI
Darah Lengkap
Eritrosit 44826 10^6/uL 4.50 - 6.00 DATA AKH
Hematokrit 22 - 09 - 2022 % 40 - 48
Hemoglobin 5.57 g/dL 13.0 - 16.0
Trombosit 47 10^3/uL 150 - 450
Leukosit 16.5 10^3/uL 5.0 - 10.0 RANGKA
Hitung Jenis
Basofil 270 % <=1
Eosinofil 7.6 % 1.0 -3.0
Neutrofil 0 % 50 - 70
Limposit 7 % 20 - 40
Monosit 55 % 2-8
LED 1 Jam 27 mm/jam <10
GULA DARAH
Gula Darah Sewaktu 11 mg/dl
FAAL HATI
SGOT 9 U/L 1 - 35
SGPT 114 U/L 1 - 36
LEMAK
Trigliserida 25 mg/dL 35 - 150
Kolesterol Total 19 mg/dL 120 - 200
HDL 323 mg/dL 35 - 55
LDL 133 mg/dL <100
FAAL GINJAL
Ureum 37 mg/dL 10.00 - 50.00
Kreatinin 31 mg/dL 0.6 - 1.3
Asam Urat 46 mg/dL 3.5 - 7.2
URINE
Protein 1.3 Negatif (-)
Glukosa 6.0 Negatif (-)
Urobilin NEGATIF Negatif (-)
Bilirubin NEGATIF Negatif (-)
Reaksi / PH NEGATIF 5-7
Berat Jenis / BJ NEGATIF 1.015 - 1.025
 Untuk Lihat Hasil
1 Input Nomor
Pasien Disini

DATA AWAL DATA YANG AKAN DI

1 CETAK
DATA AKHIR

22

RANGKAP
1