Anda di halaman 1dari 2

Klinik Fakhira

Jl. Swadaya II No. 29


Manggarai Selatan, Tebet, Jakarta Selatan
P- 021 – 83707648

Name : KATHELEEN VIONA DAISY Request Lab : 2112010024


Medeical Record : 042891 Doctor : dr. Aryando Pradana, Sp. OG
Birth Date/Age : 20/01/1997 (24y) Location : BIC – MORULA
Gender : Female Insurance :-
Address :- Samping time : 01/12/2021 /12.45
Order time : 01/12/2021 /12.45.27
Phone / E-mail :-

LABORATORY TEST RESULT UNITS INTERVAL RANGES

IMMUNO – SEROLOGY
Endocrine
Beta HCG 78.14 mIU/mL Weeks of gestation
Positif/± 6.1-78.14 3 : 5.8-71.2
4 : 9.5-750
5 : 217-7138
6 : 158-11795
7 : 3697-163563
8 : 32065-149571
9 : 63803-151410
10 : 46509-186977
12 : 27832-210612
14 : 13950-62530
15 : 12039-70971
16 : 9040-5641
17 : 8175-55868
18+ : 8099-58176
Perumahan Pondok Lestari Blok C1 No. : 1-2 Ciledug
Kotamadya Tangeang Telp: 5847473 – 5854858 Fax : 7304150

SURAT KETERANGAN SAKIT


Yang bertanda tangan dibawah ini, adalah:

Dokter : ................................................................................................................................, menerangkan


Bahwa :
Nama : ........................................................................................................................................................

Jenis Kelamin : ...........................................................................................................................................


Umur : ...........................................................................................................................................
Pekerjaan : ...........................................................................................................................................
Alamat : ...........................................................................................................................................
...........................................................................................................................................
...........................................................................................................................................

Oleh karena sakit/hamil, tidak dapat menjalankan pekerjaan/Istirahat, selama .........................................


Hari /Minggu/Bulan. Terhitung mulai tanggal .............................. s/d .........................................................
Demikianlah agar dapat dipergunakana semestinya.

Ciledug, ....................................
Dokter yang memeriksa

Anda mungkin juga menyukai