Anita Dewi Lestari - MCU - Eka 1 [PDF]

Citation preview

KWITANSI Bukti Pembayaran



Invoice No. Visit No. Patient PRN Payer



: : : : :



RF16-0154939/F16-1406347 BS0072294359 ANITA DEWI LESTARI 0072294882 ANITA DEWI LESTARI



Page Location Date/Time Admission Date



: : : :



1 of 1 BSD_KSR01 24-OCT-2020 12:47 24-OCT-2020 14:02



_________________________________________



Date



Item Code



Description



Quantity



Amount (Rp)



Admin Fee 24/10/20



ADM002



ADM PASIEN



1



50,000



MEDICAL CHECKUP PACKAGE - FEMALE (dr. Suwendi, SpPD)1



1,600,000



Extemp Items 24/10/20



MCU002



Medication



-



OP-Consultation 24/10/20



DCR001



KONSULTASI DOKTER SPESIALIS (dr. Suwendi, SpPD)



1



250,000



1



0



Medical Room 24/10/20



CBR003



RUANG MCU



Reference : SELF ONE MILLION NINE HUNDRED THOUSAND RUPIAH.



TOTAL DEPOSIT PATIENT ROUNDING



: : :



NET PAYABLE PAID BY CASH/CREDIT



: :



1,900,000 0 0 ----------1,900,000 1,900,000



Tangerang Selatan, 24-OCT-2020



_______________



____________



Tanda Tangan pasien/Penanggung Jawab Patien Sign/Guarantor 1. Invoice ini merupakan tanda terima pembayaran resmi, setelah di stempel oleh kasir This is an official payment receipt, upon cashier stamp 2. Barang yang sudah di beli tidak dapat ditukar/dikembalikan Change or return after purchase are not allowed 3. Untuk Barang kena pajak, harga termasuk PPN N.P.W.P VAT is included for taxable goods



NIA NURJANAH Cashier



: 02.275.900.5-411.000



PT. PELITA RELIANCE INTERNATIONAL HOSPITAL Central Business District Lot IX, BSD City, Tangerang. 15321. Phone : (021) 3100 928 | Fax : (021) 3100 929 Email : [email protected]



Invoice No. Visit No. Patient PRN Payer



: : : : :



Page Location Date/Time Admission Date Lab Blood Type



RF16-0154939/F16-1406347 BS0072294359 ANITA DEWI LESTARI 0072294882 ANITA DEWI LESTARI



: : : : : :



1 of 3 BSD_KSR01 24-OCT-2020 12:47 24-OCT-2020 14:02 1 Of 3 O



_________________________________________ _________________________________________ _________________________________________ Detail



Pemeriksaan



Hasil



Nilai Rujukan



Satuan



HEMATOLOGI HEMOGLOBIN



14.8



14.0-18.0



g/dl



LED



1



0.101



mm



LEKOSIT



6800



5.000-10.000



/uL



HITUNG JENIS BASOFIL



0



0-1



%



EOSINOFIL



3



1-3



%



BATANG



2



2-6



%



SEGMEN



51



50-70



%



LIMFOSIT



23



21-40



%



MONOSIT



4



2-8



%



HEMATOKRIT



52



42-52



VOL%



TROMBOSIT



367.000



150.000-450.000



/uL



ERITROSIT



5.27



4.50-5.50



juta/uL



M C V, M C H, M C H C MCV



81



81-92



fL



MCH



32



27-31



pg



MCHC



31



32-36



%



KOAGULASI MASA PENDARAHAN



3.1



1.0-6.0



menit



MASA PEMBEKUAN



12.2



10.0-15.0



menit



SGOT



32



0-35



u/L



SGPT



33



0-45



u/L



GAMMA GT



19



15-85



u/L



FUNGSI GINJAL UREUM



25



15-39



mg/dL



Keterangan



KIMIA FUNGSI HATI



PT. PELITA RELIANCE INTERNATIONAL HOSPITAL Central Business District Lot IX, BSD City, Tangerang. 15321. Phone : (021) 3100 928 | Fax : (021) 3100 929 Email : [email protected]



Invoice No. Visit No. Patient PRN Payer



: : : : :



Page Location Date/Time Admission Date Lab Blood Type



RF16-0154939/F16-1406347 BS0072294359 ANITA DEWI LESTARI 0072294882 ANITA DEWI LESTARI



: : : : : :



2 of 3 BSD_KSR01 24-OCT-2020 12:47 24-OCT-2020 14:02 2 Of 3 O



_________________________________________ _________________________________________ _________________________________________ Detail



Pemeriksaan



Hasil



Nilai Rujukan



Satuan



. CREATININ



1.2



0.6-1.3



mg/dl



ASAM URAT



3.6



3.5-7.2



mg/dl



DIABETES GLUKOSA PUASA GLUKOSA DARAH PUASA



122



mg/dl



HBA1C



7.8



%



LEMAK CHOLESTEROL TOTAL



241



mg/dl



LDL CHLOSTEROL DIREK



162



mg/dl



HDL CHLOSTEROL DIREK



47



mg/dl



TRIGLISERIDA



215



mg/dl



WARNA



KUNING JENUH



KUNING JENUH



BJ



1.050



1.005-1.030



pH



64



5.0-8.5



KETON



NEGATIVE



NEGATIVE



PROTEIN/ALBUMIN



NEGATIVE



NEGATIVE



GLUKOSA



NEGATIVE



NEGATIVE



BILIRUBIN



NEGATIVE



NEGATIVE



URINALISA



BP 139/90



PT. PELITA RELIANCE INTERNATIONAL HOSPITAL Central Business District Lot IX, BSD City, Tangerang. 15321. Phone : (021) 3100 928 | Fax : (021) 3100 929 Email : [email protected]



Keterangan



BAIK : 80-109 SEDANG : 110-125 BURUK : >=126 BAIK : 4-5.9 SEDANG : 6-8 BURUK : >8 BAIK : =240 BAIK : =160 BAIK : =45 BAIK : =200



Invoice No. Visit No. Patient PRN Payer



: : : : :



Page Location Date/Time Admission Date Lab Blood Type



RF16-0154939/F16-1406347 BS0072294359 ANITA DEWI LESTARI 0072294882 ANITA DEWI LESTARI



: : : : : :



3 of 3 BSD_KSR01 24-OCT-2020 12:47 24-OCT-2020 14:02 3 Of 3 O



_________________________________________ _________________________________________ _________________________________________ Detail



Pemeriksaan



Hasil



Nilai Rujukan



Satuan



. DARAH SAMAR



NEGATIVE



NEGATIVE



NITRAT



NEGATIVE



NEGATIVE



UROBILINOGEN



1.0



0.2-1.0



LEKOSIT



0-1



0-5



/LPB



ERITROSIT



0-1



0-2



/LPB



SILINDER



NEGATIVE



NEGATIVE



EPITEL



POSITIVE



POSITIVE



BAKTERI



NEGATIVE



NEGATIVE



KRISTAL



NEGATIVE



NEGATIVE



LAIN-LAIN



NEGATIVE



NEGATIVE



SEDIMEN URINE



PT. PELITA RELIANCE INTERNATIONAL HOSPITAL Central Business District Lot IX, BSD City, Tangerang. 15321. Phone : (021) 3100 928 | Fax : (021) 3100 929 Email : [email protected]



Keterangan