PEMERINTAH KABUPATEN SOLOK ( )

DINAS KESEHATAN PEMERINTAH KABUPATEN SOLOK

DINAS KESEHATAN
UPT PUSKESMAS JUA GAEK
Jalan Lintas Solok-Padang Km.8 Kecamatan Gunung Talang Kode Pos 27364 PUSKESMAS JUA GAEK
Telp: 085216515453 e-mail: puskesmasjuagaek@gmail.com Jalan Lintas Solok-Padang Km.8 Kecamatan Gunung Talang Kode Pos 27364
Telp: 085216515453 e-mail: puskesmasjuagaek@gmail.com

HASIL PEMERIKSAAN LABORATORIUM

No. / LAB / PKM-JG / 20 HASIL PEMERIKSAAN LABORATORIUM
No. / LAB / PKM-JG / 20
NAMA : ................................... NO RM : ........................
UMUR/ TL : ................................... NO BPJS : ......................... NAMA : ................................... NO RM : ........................
ALAMAT : ................................... STATUS : BPJS UMUR /TL : ................................... NO BPJS : .........................
UMUM ALAMAT : ................................... STATUS : BPJS
I. HEMATOLOGI UMUM
Kadar Hemoglobin : .............. (Pr 12-14 gr%) Hitung Jenis Leukosit : Bas............... (0-1) I. HEMATOLOGI
: ................(Lk 14-16 gr%) Eos ............. (1-3) Kadar Hemoglobin : .............. (Pr 12-14 gr%) Hitung Jenis Leukosit : Bas.............. (0-1)
Jumlah Leukosit : ............... (5.000-10.000/mm3) Seg .......... (50-70) : ................(Lk 14-16 gr%) Eos ............ (1-3)
Jumlah Eritrosit : ............... (Pr 4-5 juta/mm3) Bat ........... ....(2-6) Jumlah Leukosit : ............... (5.000-10.000/mm3) Seg ..........(50-70)
: .................(Lk 4,5-5,5 juta/mm3) Limpo........(20-40) Jumlah Eritrosit : ............... (Pr 4-5 juta/mm3) Bat ........... ...(2-6)
Jumlah Trombosit : ............... (150.000-450.000/mm3) Mono.............(2-8) : .................(Lk 4,5-5,5 juta/mm3) Limpo......(20-40)
Hematokrit : ............... (Pr 37- 43%) Jumlah Trombosit : ............... (150.000-450.000/mm3) Mono............(2-8)
: .................(Lk 40 – 48%) Hematokrit : ............... (Pr 37- 43%)
Laju Endap Darah : ................ (Pr 0- 20/mm) Golongan Darah : .......................... : .................(Lk 40 – 48%)
: ..................(Lk 0 – 15/mm) Laju Endap Darah : ................ (Pr 0- 20/mm) Golongan Darah : ..........................
: ..................(Lk 0 – 15/mm)
II. URINALISA III.KIMIA KLINIK
Warna : ............... Gula Darah Puasa :................ 130mg/dl II. URINALISA III.KIMIA KLINIK
Kejernihan : ................ GulaDarahRandom : .............. 200mg/dl Warna : ............... Gula Darah Puasa :............. 130mg/dl
BeratJenis : ................ Gula Darah 2 Jam PP: ............... 140mg/dl Kejernihan : ................ GulaDarahRandom : ............ 200mg/dl
pH : ................ Asam Urat :.............. Pr2-6mg/dl BeratJenis : ................ Gula Darah 2 Jam PP: ............. 140mg/dl
Protein : ................ (-) ................ Lk3-7mg/dl pH : ................ Asam Urat :...............Pr2-6mg/dl
Bilirubin : ................ (-) Cholesterol Total :................ 210 mg/dl Protein : ................ (-) ...............Lk3-7mg/dl
Reduksi : ................ (-) Bilirubin : ................ (-) Cholesterol Total :..............210 mg/dl
Sedimen Eryt: ................. (-) IV. SEROLOGI Reduksi : ................ (-)
Leuko: ................ (-) HIV : ........................(Non Reaktif) Sedimen Eryt: ................. (-) IV. SEROLOGI
Cylinder:............. (-) HBsAG : ........................(Non Reaktif) Leuko: ................ (-) HIV : ........................(Non Reaktif)
Nitrit : ................. .(-) Syphilis : ........................(Non Reaktif) Cylinder:............. (-) HBsAG : ........................(Non Reaktif)
Keton : .................. (-) Widal : ....................... Nitrit : ................. .(-) Syphilis : ........................(Non Reaktif)
Tes Kehamilan :................... Keton : .................. (-) Widal : .......................
Tes Kehamilan :...................
V. MIKROBIOLOGI VI. FECES
BTA Sputum : ................ Makroskopis : .................. V. MIKROBIOLOGI VI. FECES
Malaria : .................. Mikroskopis : .................. BTA Sputum : ................ Makroskopis : ..................
Malaria : .................. Mikroskopis : ..................
Cupak, 20
Pelaksana Laboratorium Cupak, 20
Jam sampel Jam Hasil Jam sampel Jam Hasil Pelaksana Laboratorium
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