Formulir Pemeriksaan Lab [PDF]

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KLINIK GRIYA SEHAT



Alamat : Jalan Raya Kutosari Kec.Belitang III Kab.OKU TIMUR Email : [email protected] Tlp: 0813-7785-1213 Izin Operasional : 503/004/KLINIK/DPMPTSP/OKUT/XII/2019



Nama Pasien : .................................... L / P Diagnosis Umur : .................................... Th / Hr Tanggal Alamat : .................................... Dokter HEMATOLOGI  Rutin (Hb, Leukosit, Eritrosit, Diff, LED)  Hemoglobin  Leukosit  Hitung Jenis  LED  Malaria  Eritrosit  Trombosit  Hematokrit  Retikulosit  W. Perdarahan  W. Pembekuan  Coomb’s Test  Rumple Leede  MCV  MCH  MCHC  Sel LE  Filaria  Eosinofil Total  Gol. Darah  Rh. Faktor TEST KEHAMILAN  Event Test  Test Pack



URINE  Lengkap  Urobilinogen  Protein  Glukosa  Keton  Billirubin  Berat Jenis  Reaksi / pH KIMIA DARAH FUNGSI HATI  Alk. Phosphatase  Bill Total/Dir/Indir  Protein Total/Alb/Glob  Gamma GT  SGOT / ASAT  SGPT / ALAT FUNGSI JANTUNG  aHBDH/LDH  CPK/CKMB FUNGSI GINJAL  Ureum  Creatinine  Uric Acid/Asam Urat



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LEMAK  Triglyserida  Kolesterol  HDL / LDL  Total Lipids DIABETES  Glukosa Puasa  Glukosa 2 jam PP  Glukosa sewaktu  GTT DRUG ABBUSED  Amphetamine  Marihuana  Methamphetamine  Morpine / Opiate  PAKET DRUG ABUSED



AIDS Test  Anti HIV SEROLOGI  VDRL  TPHA  Rheumatoid Faktor (RF)  ASTO  CRP  Widal  DHF/Dengue IgG/IgM  Myco Dot TBC



MIKROSKOPIS  Gram (AMP, MET, THC, BZO, MOR)  Uretra  Coccaine  Vagina  GO IMMUNOLOGI / SEROLOGI  Jamur HEPATITIS  BTA  HBsAg  Anti HBs LAIN-LAIN  Anti HCV  An. Sperma TEST LAIN-LAIN  ………………………………………………  ………………………………………………  ……………………………………………… Tanda Tangan Dokter



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