Yolanda Fitria Kapitan, A.Md.

AK
PEMERINTAH KABUPATEN TTS NIP. 19920418 201902 2 011
PUSKESMAS HAUHASI
KECAMATAN TOIANAS PEMERINTAH KABUPATEN TTS
Jln. Tutu Nenometa No. 01 Toianas 85573 PUSKESMAS HAUHASI
KECAMATAN TOIANAS
Jln. Tutu Nenometa No. 01 Toianas 85573
NO I.D : TANGGAL :
NAMA PASIEN : PENGIRIM/DOKTER:
NO I.D : TANGGAL :
UMUR/ J. KELAMIN:
DIAGNOSA AWAL: NAMA PASIEN : PENGIRIM/DOKTER:
ALAMAT :
UMUR/ J. KELAMIN:
DIAGNOSA AWAL:
ALAMAT :
HASIL PEMERIKSAAN LABORATORIUM

JENIS HASIL NILAI HASIL PEMERIKSAAN LABORATORIUM

KET
PEMERIKSAAN PEMERIKSAAN NORMAL
A. KIMIA DARAH: JENIS HASIL NILAI
a. Glukose sewaktu KET
........................ mg/dL 70 - 200 mg/dL PEMERIKSAAN PEMERIKSAAN NORMAL
b. Glukose puasa ........................ mg/dL 70 - 110 mg/dL A. KIMIA DARAH:
c. Glukose 2 JPP ........................ mg/dL 75 - 140 mg/dL a. Glukose sewaktu ........................ mg/dL 70 - 200 mg/dL
d. Cholesterol ........................ mg/dL < 200 mg/dL b. Glukose puasa ........................ mg/dL 70 - 110 mg/dL
e. Asam Urat ........................ mg/dL 1,9 - 5,9 mg/dL a. Glukose 2 JPP ........................ mg/dL 75 - 140 mg/dL
b. Cholesterol ........................ mg/dL < 200 mg/dL
B. URINE c. Asam Urat ........................ mg/dL 1,9 - 5,9 mg/dL
a. Protein ............................ Negative
b. Glukose ............................ Negative B. URINE
a. Protein ............................ Negative
C. IMUNOLOGI/SEROLOGI: b. Glukose ............................ Negative
a. Golongan Darah -
................................... C. IMUNOLOGI/SEROLOGI:
b. HCG Tes Negative
...................................
c. Hepatitis B (HBs Ag) Negative a. Golongan Darah -
................................... ...................................
d. HIV screning Negative b. HCG Tes Negative
................................... ...................................
e. Syphilis Negative c. Hepatitis B (HBs Ag) Negative
................................... ...................................
f. Rapid Test IgM & IgG Non-Reaktif d. HIV screning Negative
IgM : ........................ ...................................
Covid-19 Non-Reaktif e. Syphilis Negative
IgG : ........................ ...................................
g. Rapid Test IgM & IgG Non-Reaktif
IgM : ........................
D. HEMATOLOGI Covid-19 Non-Reaktif
IgG : ........................
a. Haemoglobine L : 13,0 - 17,0 gr%
..........................gr % P : 11,4 - 15,0 gr% D. HEMATOLOGI
a. Haemoglobine L : 13,0 - 17,0 gr%
..........................gr % P : 11,4 - 15,0 gr%
E. PARASIT/BACTERIOLOGI
a BTA S...........P...........S........... Negative
b MALARIA ................................ Negative E. PARASIT/BACTERIOLOGI
a BTA S...........P...........S........... Negative
b MALARIA ................................ Negative
Hauhasi,..................................2021
PEMERIKSA
Hauhasi,..................................2021
PEMERIKSA
Yolanda Fitria Kapitan, A.Md.AK
NIP. 19920418 201902 2 011