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LABORATORIUM LABORATORIUM LABORATORIUM

KLINIK DUTA SION KLINIK DUTA SION


Alamat: Jln. Komba Kampung Yobeh KLINIK DUTA SION Alamat : Jln. Komba Kampung Yobeh
Kabupaten Jayapura- Papua 99352 Alamat : Jln. Komba Kampung Yobeh Kabupaten Jayapura- Papua 99352
Kabupaten Jayapura- Papua 99352

NOMOR LAB : ......................../ LAB NOMOR LAB : ......................../ LAB NOMOR LAB : ......................../ LAB

NAMA : ...................................... NAMA : .....................................


NAMA : .....................................
UMUR : ...................................... UMUR : .....................................
UMUR : .....................................
JENIS KELAMIN : ...................................... JENIS KELAMIN : .....................................
JENIS KELAMIN : .....................................
ALAMAT : ...................................... ALAMAT : .....................................
ALAMAT : .....................................

HASIL PEMERIKSAAN: HASIL PEMERIKSAAN:


 DDR/MALARIA :.......................  DDR/MALARIA :.......................
HASIL PEMERIKSAAN:

 LEKOSIT :.......................  LEKOSIT :.......................  DDR/MALARIA :.......................

 GULA DARAH :.......................(> 200 mg/dl)  GULA DARAH :.......................(> 200 mg/dl)  LEKOSIT :.......................

 ASAM URAT :........................( L: 3,4-7 mg/dl)  ASAM URAT :.......................( L: 3,4-7 mg/dl)  GULA DARAH :.......................(> 200 mg/dl)

(P : 2,4-6 mg/dl) (P : 2,4-6 mg/dl)  ASAM URAT :........................( L: 3,4-7 mg/dl)

 KOLESTEROL :.......................(< 200 mg/dl)  KOLESTEROL :........................(< 200 mg/dl) (P: 2,4-6 mg/dl)

 TENSI :.........................(120/80 mmHg)  TENSI :........................(120/80 mmHg)  KOLESTEROL :.......................(< 200 mg/dl)

 TES KEHAMILAN :....................  TES KEHAMILAN :....................  TENSI :.........................(120/80 mmHg)

 HARGA :..........................  HARGA :..........................  TES KEHAMILAN :....................


 HARGA :..........................

PEMERIKSA
PEMERIKSA PEMERIKSA
FUNSUP AP, A.Md.Kes
FUNSUP AP, A.Md.Kes FUNSUP AP, A.Md.Kes

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