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    This document is a medical form from Klinik Medic Bestari containing fields to record test results for a patient. It includes sections to document results of urine analysis, blood tests, sputum tests, chest x-rays, and a declaration by the examining doctor certifying the patient's medical fitness.

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    This document is a medical form from Klinik Medic Bestari containing fields to record test results for a patient. It includes sections to document results of urine analysis, blood tests, sputum tests, chest x-rays, and a declaration by the examining doctor certifying the patient's medical fitness.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as doc, pdf, or txt
    5 views2 pages

    Form

    Uploaded by

    lanyau
    This document is a medical form from Klinik Medic Bestari containing fields to record test results for a patient. It includes sections to document results of urine analysis, blood tests, sputum tests, chest x-rays, and a declaration by the examining doctor certifying the patient's medical fitness.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
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    of 2

    MEDIC BESTARI

    ___________________________________
    _
    NO.31 JALAN USJ 1/19 TAMAN SUBANG PERMAI 47600 SUBANG JAYA
    SELANGOR
    TEL: 03-56384137

    MALARIA PARASITE :

    URINE
    ANALYSIS PH : _________________________

    BLOOD : _________________________

    SUGAR : _________________________

    PROTIEN : _________________________

    MICROSCOPY : _________________________

    OPIATE/CANNABIS : _________________________

    URINE PREGNANCY TEST : _________________________

    SPUTUM AFB : _________________________

    CXR : _________________________

    COMMENTS

    DECLARATION

    I hereby certify that I have personally verified the identity and examined ___________________
    holder of I.C / Passport No: ____________________ at Klinik Medic Bestari on this _________
    day of __________,20___ at ______ a.m. / p.m. and I have found him / her to be FIT / UNFIT.

    Examiner’s Name : ________________________________

    Signature :
    Clinic Stamp :

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