Physician :

dr. Ni Ketut Puspa Sari, Sp.PK

LABORATORY EXAMINATION RESULT

Sending Doctor : dr. Hendra Wijaya, S.Ked Referrer : Nusa Medica Clinic

Doctor's Address : Nusa Medica Clinic Referrer's Address : Nusa Medica Nusa Penida, Nusa Medica
Pecatu, Nusa Medica Canggu

Lab. No. / Reg. Date : 2301290006D1 / 29-01-2023 Sex : Female

Patient ID : IB-BD001202300033 Date of Birth / Age : 01-03-2000 / 22 Year(s) 10 Month(s) 28
Day(s)
Patient Name : Roos Lotte Alexandra Bukman Phone Number : 81238465656
Address : Jalan Matahari Terbit Sanur Kaja, Denpasar

TEST RESULT REFERENCE VALUE UNIT NOTE

FAECES
FAECES
Faeces Rutin
Makroskopik
Color (FL) Brown
Consistency(FL) Liquid

Mucus (FL) Positive

Mikroskopik
Leukocyte (FL) 8 - 10 /LPB
Erythrocyte (FL) 0-1 /LPB
Epitel 2-5
Amoeba (FL) Negative
Helminth Eggs (FL) Negative
Plant Fibers 1-3
Amylum Negative

Sampling Time :
- Faeces : 29/01/2023 20:02:08

Authorized by

( Dewa Ayu Diah Iswari A.Md.AK )

Numeric result using dot separator

(*) Sign represented high or low value from reference value
Result has been interpreted by doctor/clinist
Authorized by : Dewa Ayu Diah Iswari A.Md. AK 29-01-2023 20:06:20 Laboratory value must have been correlated by other clinical data
Printed by : Dewa Ayu Diah Iswari A.Md. AK 29-01-2023 20:08:59

The results have been verified and validated electronically so there is no need for a signature Page 2 from 2
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