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  • Instalasi Laboratorium Klinik Rsud Pratama Kabupaten Melawi

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    Abang Suprianto
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    This document provides a form for requesting laboratory tests from the RSUD Pratama Melawi Public Hospital in Melawi Regency. The form includes fields for patient information like name, medical record number, date of birth, gender, job, insurance status, room number, date, and referring doctor's signature. It then lists the various types of laboratory tests available in categories like hematology, blood chemistry, urinalysis, serology, feces examination, and others. The tests listed include complete blood count, blood typing, glucose, liver enzymes, uric acid, cholesterol, urinalysis, VDRL, stool exam, sputum analysis, and more.

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    PERMINTAAN LABORATORIUM

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    This document provides a form for requesting laboratory tests from the RSUD Pratama Melawi Public Hospital in Melawi Regency. The form includes fields for patient information like name, medical record number, date of birth, gender, job, insurance status, room number, date, and referring doctor's signature. It then lists the various types of laboratory tests available in categories like hematology, blood chemistry, urinalysis, serology, feces examination, and others. The tests listed include complete blood count, blood typing, glucose, liver enzymes, uric acid, cholesterol, urinalysis, VDRL, stool exam, sputum analysis, and more.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    50 views1 page

    Instalasi Laboratorium Klinik Rsud Pratama Kabupaten Melawi

    Uploaded by

    Abang Suprianto
    This document provides a form for requesting laboratory tests from the RSUD Pratama Melawi Public Hospital in Melawi Regency. The form includes fields for patient information like name, medical record number, date of birth, gender, job, insurance status, room number, date, and referring doctor's signature. It then lists the various types of laboratory tests available in categories like hematology, blood chemistry, urinalysis, serology, feces examination, and others. The tests listed include complete blood count, blood typing, glucose, liver enzymes, uric acid, cholesterol, urinalysis, VDRL, stool exam, sputum analysis, and more.

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    © All Rights Reserved
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    of 1

    INSTALASI LABORATORIUM KLINIK RSUD PRATAMA KABUPATEN MELAWI

    Nama :
    PERMINTAAN LABORATORIUM No. RM :
    Tgl. Lahir : Laki-laki Perempuan
    Pangkat : Status : BPJS Umum
    NRP : Ruangan :
    Kesatuan : Tanggal :
    Anak/Istri/Suami dari : Permintaan dr. :
    Sampel diambil pukul : Tanda tangan dr. :
    Diagnosa Klinik :
    HEMATOLOGI KIMIA DARAH
    Darah Lengkap Hitung Jenis Leukosit Glukosa R Globulin
    Darah Rutin Waktu Perdarahan Glukosa N SGOT
    Hemoglobin Waktu Pembekuan Glukosa 2 Jam PP SGPT
    Leukosit Malaria Hb A 1 C Bill Direct
    Eritrosit Golongan Darah ABO Ureum Bill Total
    Trombosit Creatinin Alkali Phosphatase
    Hematokrit Uric Acid Gamma - Gt
    LED Cholesterol Total K
    MCV Triglyseride Ca
    MCH HDL Cholesterol Na
    MCHC LDL Cholesterol Cl
    Protein CK - MB
    Albumin CK – Nac

    URINALISA SEROLOGI FESES LAIN-LAIN


    Urin rutin VDRL Feses Rutin Sekret
    Reduksi ASTO Makroskopis LCS
    Bilirubin CRP Mikroskopis Sputum (BTA)
    Keton RF Analisa Sperma
    BJ Widal
    Sedimen HbSAg
    Tes Kehamilan HCV
    Narkoba IgM Dengue
    IgG Dengue
    NS-1
    Malaria
    HIV
    Syphillis

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