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    Form General Check Up Rsud

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    Anonymous F0eeZBMK
    This document is a medical check-up report for an individual. It includes their identity information, physical examination results including weight, height and vital signs. It also lists the results of several medical tests conducted including x-rays, EKG, blood tests checking blood count, liver and kidney function, cholesterol levels, and urine analysis. The tests were performed at the Zainal Abidin Public Hospital in Blambangan Umpu.

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    Form General Check Up Rsud

    Uploaded by

    Anonymous F0eeZBMK
    41 views1 page
    This document is a medical check-up report for an individual. It includes their identity information, physical examination results including weight, height and vital signs. It also lists the results of several medical tests conducted including x-rays, EKG, blood tests checking blood count, liver and kidney function, cholesterol levels, and urine analysis. The tests were performed at the Zainal Abidin Public Hospital in Blambangan Umpu.

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    FORM GENERAL CHECK UP RUMAH SAKIT

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    This document is a medical check-up report for an individual. It includes their identity information, physical examination results including weight, height and vital signs. It also lists the results of several medical tests conducted including x-rays, EKG, blood tests checking blood count, liver and kidney function, cholesterol levels, and urine analysis. The tests were performed at the Zainal Abidin Public Hospital in Blambangan Umpu.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    41 views1 page

    Form General Check Up Rsud

    Uploaded by

    Anonymous F0eeZBMK
    This document is a medical check-up report for an individual. It includes their identity information, physical examination results including weight, height and vital signs. It also lists the results of several medical tests conducted including x-rays, EKG, blood tests checking blood count, liver and kidney function, cholesterol levels, and urine analysis. The tests were performed at the Zainal Abidin Public Hospital in Blambangan Umpu.

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    of 1

    PEMERINTAH DAERAH KABUPATEN WAY KANAN

    RUMAH SAKIT UMUM DAERAH ZAINAL ABIDIN PAGAR ALAM


    Jl. Raya Lintas Sumatera, Kamp Negeri Baru, Kec Blambangan Umpu
    BLAMBANGAN UMPU 34764
    email : rsudwaykanan@gmail.com

    HASIL PEMERIKSAAN KESEHATAN


    (MEDICAL GENERAL CHECK UP)
    No. : 445/ /V.06-WK/2017
    A. IDENTITAS
    Nama : ……………………………………………………
    Tanggal Lahir : ……………………………………………………
    Alamat : ……………………………………………………
    Pekerjaan : ……………………………………………………
    B. PEMERIKSAAN FISIK
    Berat Badan : ……. kg
    Tinggi Badan : ……. cm
    Tanda-tanda Vital :
    Tekanan Darah : .…../…... mmHg
    Pernafasan : ……. x/menit
    Nadi : ……. x/menit
    C. PEMERIKSAAN PENUNJANG
    1. X- Foto Thorax : ……………………………………...................................
    …………………………………………………………………
    ………………………………………………………………..
    2. EKG : ……………………………………..................................
    …………………………………………………………………
    3 Laboratorium :
    Darah Rutin : Hb : ……………………………………………………
    Hematokrit : ……………………………………………………
    Eritrosit : ……………………………………………………
    Lekosit : ……………………………………………………
    Hitung Jenis : ……………………………………………………
    LED : ……………………………………………………
    Trombosit : ……………………………………………………
    Lemak Darah : HDL : ……………………………………………………
    LDL : ……………………………………………………
    Kolesterol Total LDL : ……………………………………………………
    Trigliserid : ……………………………………………………
    Fungsi Hati : SGOT : ……………………………………………………
    SGPT : ……………………………………………………
    Protein total : ……………………………………………………
    HbS Ag : ……………………………………………………
    Kimia Darah : GDS : ……………………………………………………
    GDP : ……………………………………………………
    GD2PP : ……………………………………………………
    Metabolisme : Asam Urat : ……………………………………………………
    Urin Rutin : ……………………………………...................................
    ……………………………………...................................
    Sedimen Urin : ……………………………………..................................
    ……………………………………..................................
    Fungsi Ginjal : Ureum : ……………………………………………………
    Kreatinin : ……………………………………………………
    PP Test : ……………………………………………………
    Cek Narkoba : ……………………………………...................................
    Blambangan Umpu, …………………………………
    Dokter yang memeriksa,

    (………………………………………)
    NIP.

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