2023 - Data Pasien Umum Berdasarkan Sim

DATA PASIEN UMUM BULAN JANUARI 2023 BERDASARKAN SIM
NO. RAWAT NAMA PASIEN

202425 ALEXANDRA ANANDA PETUGAS TANGGAL PERIKSA
AYUNINGTYAS (Poli : Mega Tri Wulandari,
2023/01/31/000050 LABORATORIUM) A.Md. 1/31/2023
202423 AINUN NAJWA (Poli : Mega Tri Wulandari,
202424 NOVA ANDRIYANTI Mega Tri Wulandari,
2023/01/31/000045 202418 SILVERIAN UTOMO
(Poli : LABORATORIUM) A.Md. 1/31/2023
SAPUTRO (Poli : Ela Yulianti,
2023/01/30/000121 LABORATORIUM) A.Md.Kes. 1/30/2023
027319 JESICA PERMATA Ela Yulianti,
2023/01/30/000120 197427 ERLANGGA
PUTRI (Poli PRADANA A.Md.Kes.
: LABORATORIUM) 1/30/2023
ALFARIZKI (Poli : Ela Yulianti,
202410 NINDI EKA PUTRI (Poli : Mega Tri Wulandari,
2023/01/30/000054 113611 RINTAN PUTRI
LABORATORIUM) A.Md. 1/30/2023
HAPSARI (Poli : Ragil Pangestu W.,
176002 SUDARYANTI (Poli : Ragil Pangestu W.,
2023/01/29/000118 193364 FEBY ARTANI
KUSUMADJATI (Poli : Ragil Pangestu W.,
202396 ARI YULIANTI (Poli : Ragil Pangestu W.,
2023/01/29/000122 032315 SOEHARDJO DARTO
SUMARTO (Poli : Abbas Herlan,
2023/01/29/000100 LABORATORIUM) A.Md.Kes 1/29/2023
118816 WAGIMAH (Poli : Abbas Herlan,
2023/01/29/000098 165688 DIENA SYAFIRA
LABORATORIUM) A.Md.Kes 1/29/2023
SULISTIYONO (Poli : Abbas Herlan,
2023/01/29/000109 143679 HARSONO WIRO
PRODJO (Poli : Ela Yulianti,
098720 ARIQ FARHAN ALTHAF Ela Yulianti,
2023/01/28/000066 091022 ADITYA AGUS
(Poli : LABORATORIUM) A.Md.Kes. 1/28/2023
SETIYANTO (Poli : Abbas Herlan,
128022 SURYANTO (Poli : Mega Tri Wulandari,
030603 AGUNG ADI BADRA Yuni Nurul Azizah, A.
2023/01/25/000147 (Poli : LABORATORIUM) Md. 1/25/2023
120285 WAGINEM (Poli : Mega Tri Wulandari,
2023/01/25/000052 126444 DYAH AYU
CANDRARINI (Poli : Mega Tri Wulandari,
202336 FIBRIANA SARI (Poli : Ragil Pangestu W.,
181347
190170 ARRASYA
SUWARSIH (Poli : Ragil Pangestu W.,
2023/01/24/000149 ALBIFARDZAN
LABORATORIUM) ALTHARIO A.Md. 1/24/2023
NUGROHO (Poli : Ragil Pangestu W.,
2023/01/24/000144 202331 XATARINA YESY
DAHLIA (Poli : Ragil Pangestu W.,
179513 MARTINA SUNARTINI Annies Fadhilah,
2023/01/24/000104 (Poli : LABORATORIUM) A.Md. 1/24/2023
202327 KUSWANDI (Poli : Annies Fadhilah,
162989 KRISWANTORO (Poli : Annies Fadhilah,
2023/01/24/000041 202326 ALIVIA BUNGA
KURNIAWAN (Poli : Annies Fadhilah,
202325 ARKINAN GEA
SARASWATI (Poli : Annies Fadhilah,
202322 BAGIA SUHARTONO Annies Fadhilah,
2023/01/24/000028 202315 ALETHA APRILIANI
SABIRA (Poli : Ela Yulianti,
2023/01/23/000092 202315 ALETHA APRILIANI
LABORATORIUM) A.Md.Kes. 1/23/2023
SABIRA (Poli : Ela Yulianti,
2023/01/23/000092 126444 DYAH AYU
CANDRARINI (Poli : Yuni Nurul Azizah, A.
2023/01/23/000055 LABORATORIUM) Md. 1/23/2023
202313 ELFIRA AULIA (Poli : Yuni Nurul Azizah, A.
2023/01/23/000052 073356 RAMA APRIARDIKA
LABORATORIUM) Md. 1/23/2023
WIDHIHARTO (Poli : Yuni Nurul Azizah, A.
2023/01/23/000053 088992 ANGGER SYAHRU
RAMADHANA (Poli : Yuni Nurul Azizah, A.
2023/01/23/000054 085312 TIFFANI JATI IZZAH
ZABRINA (Poli : Yuni Nurul Azizah, A.
2023/01/23/000043 LABORATORIUM) Md. 1/23/2023
202308 EZHAR HIRA M (Poli : Yuni Nurul Azizah, A.
2023/01/23/000035 LABORATORIUM) Md. 1/23/2023
200578 AJI PRASTYO (Poli : Yuni Nurul Azizah, A.
2023/01/23/000025 LABORATORIUM) Md. 1/23/2023
202304 DURROTUN NIKHAYAH Mega Tri Wulandari,
202301 RANI MAY SAPUTRI Ragil Pangestu W.,
2023/01/22/000027 202296 MUHAMMAD OKTA
FIANTO (Poli : Annies Fadhilah,
202295 BEJO MUHAMAD RIFAI Annies Fadhilah,
201984 CHORY PRASEPTIANA Annies Fadhilah,
2023/01/22/000011 116286 ANEIRA QUINN
NAIFAH FAUSTA (Poli : Ragil Pangestu W.,
2023/01/21/000039 173469 MUHAMMAD RAKA
RAHMADI (Poli : Ragil Pangestu W.,
2023/01/21/000016 202280 KEINA ANANDA
AURORA NURAISYAH (Poli : Ragil Pangestu W.,
2023/01/21/000022 144849 YUVITA CHANTRI
LUMBANTOBING (Poli : Abbas Herlan,
202262 SARIYANTO (Poli : Ragil Pangestu W.,
2023/01/20/000183 202253 MAULIDA FAIZATUL
CHUSNA (Poli : Ela Yulianti,
155030 WIWIK SOYICHATI (Poli Ragil Pangestu W.,
2023/01/20/000174 : LABORATORIUM) A.Md. 1/20/2023
169253 BAGUS ARYA WIJAYA Ragil Pangestu W.,
2023/01/20/000173 170427 SUWARDI
SURYOKUSUMO (Poli : Mega Tri Wulandari,
2023/01/19/000133 079243 MUHAMMAD
FADGHAM ASSIDIQI (Poli : Mega Tri Wulandari,
2023/01/19/000118 069096 MUHAMMAD AUFA
AHDILLAH (Poli : Mega Tri Wulandari,
127251 ABDUL HAKIM (Poli : Ela Yulianti,
200262 FAHESH ALANO (Poli : Annies Fadhilah,
067405 ANTON BUDIMAN (Poli Yuni Nurul Azizah, A.
2023/01/18/000107 167450 ANAYA HUMAIRA
: LABORATORIUM) Md. 1/18/2023
RADITY (Poli : Yuni Nurul Azizah, A.
2023/01/17/000381 202107 AZDHANI ALFIYYA
TASBIHA (Poli : Yuni Nurul Azizah, A.
2023/01/17/000365 LABORATORIUM) Md. 1/17/2023
189241 CHANDRA (Poli : Yuni Nurul Azizah, A.
2023/01/17/000363 LABORATORIUM) Md. 1/17/2023
171268 C. SRI BUDIYATI (Poli : Yuni Nurul Azizah, A.
2023/01/17/000359 200844 ABDILLAH AQSHA
UTOMO (Poli : Yuni Nurul Azizah, A.
2023/01/17/000336 LABORATORIUM) Md. 1/17/2023
202229 ELLIZA AURA AMALIA Mega Tri Wulandari,
2023/01/17/000309 190038 PUJI NASTITI
ROCHANIA (Poli : Mega Tri Wulandari,
2023/01/17/000273 202203 IKA HERLIANA
ANGGITAPUTRI (Poli : Mega Tri Wulandari,
2023/01/16/000097 202204 DIAN NAILUL
FADHILAH (Poli : Mega Tri Wulandari,
2023/01/16/000098 134447 DIAH AYU SUKMA
FEBRIANI (Poli : Mega Tri Wulandari,
186391 ARIF YULIANTO (Poli : Mega Tri Wulandari,
2023/01/17/000251 073911 MONIKA RISKA
MAHANANI (Poli : Mega Tri Wulandari,
2023/01/17/000249 202073 NOFTI BERLIANA
VEBIANTI (Poli : Mega Tri Wulandari,
2023/01/17/000232 141498 MUHAMMAD RAYYAN A.Md.
LABORATORIUM) 1/17/2023
ALFATIH (Poli : Mega Tri Wulandari,
195079 DEFA NUR AZIZAH (Poli Mega Tri Wulandari,
202221 AMANIA (Poli : Annies Fadhilah,
2023/01/16/000172 202219 NADIA MEILANA
YASMIN (Poli : Annies Fadhilah,
202207 MARTINI (Poli : Mega Tri Wulandari,
2023/01/16/000102 202175 MUHAMMAD
RAJENDRA ALVAREZEL P. (Poli : Annies Fadhilah,
2023/01/14/000072 198345 VIRGINIA PUTRI
AGUSTY (Poli : Mega Tri Wulandari,
127251 ABDUL HAKIM (Poli : Mega Tri Wulandari,
2023/01/14/000040 132832 DYVIANIA ELENA
AZZAHRA (Poli : Mega Tri Wulandari,
2023/01/14/000029 132830 DYVIANISA CALYA
AZZAHRA (Poli : Mega Tri Wulandari,
2023/01/14/000030 045885 PARASTIKA ANGGI
DWINAYA (Poli : Annies Fadhilah,
009076 ABDURROHMAN (Poli : Mega Tri Wulandari,
065530 DJATI SUROSO (Poli : Mega Tri Wulandari,
188611 SRI WIDAYATI (Poli : Mega Tri Wulandari,
2023/01/13/000053 112525 MUHAMMAD
KHOIRUL AZAM (Poli : Mega Tri Wulandari,
202160 WIWIN PUJIATI (Poli : Mega Tri Wulandari,
202159 MUNDAKIR (Poli : Mega Tri Wulandari,
2023/01/13/000046 202149 ALYA AZARA
RISNAWATI (Poli : Mega Tri Wulandari,
2023/01/12/000105 202142 APRILIANA
WIDIASTUTI (Poli : Annies Fadhilah,
2023/01/12/000065 202144 ELINGGA WIDI
PANGESTU (Poli : Annies Fadhilah,
047633 BADEMI (Poli : Annies Fadhilah,
202071 MARJONO (Poli : Annies Fadhilah,
202137 FITRIANA (Poli : Ela Yulianti,
2023/01/11/000110 158841 ALMAHYRA TISHA
NINDYA (Poli : Abbas Herlan,
2023/01/11/000102 123646 KRISTIAN TRI
WULANDARI (Poli : Yuni Nurul Azizah, A.
2023/01/11/000054 LABORATORIUM) Md. 1/11/2023
202128 RUBIANTO (Poli : Ragil Pangestu W.,
202127 YOGI NOVIANTO (Poli : Ragil Pangestu W.,
2023/01/10/000143 202039 FAISAL DINO
PRASETYO (Poli : Abbas Herlan,
2023/01/09/000137 202039 FAISAL DINO
PRASETYO (Poli : Annies Fadhilah,
073083 ANDI ITA SUFITA (Poli : Annies Fadhilah,
011818 RIWAYATI (Poli : Annies Fadhilah,
036141 ANDREW NABIL ALYAFI Yuni Nurul Azizah, A.
197660 LINDA (Poli : Abbas Herlan,
156532 RESTI SETYO WARDANI Ela Yulianti,
2023/01/08/000014 202097 CARISSA ALMAHYRA A.Md.Kes.
(Poli : LABORATORIUM) 1/8/2023
ADRIENNE (Poli : Ela Yulianti,
090855 RUMIYATI (Poli : Yuni Nurul Azizah, A.
2023/01/08/000006 LABORATORIUM) Md. 1/8/2023
194397 ASYAH AYU ANJAR Ela Yulianti,
2023/01/08/000008 SARI (Poli : LABORATORIUM) A.Md.Kes. 1/8/2023
202077 DANANG SUPRIYANTO Yuni Nurul Azizah, A.
202094 SITI AISYAH TRI I (Poli : Abbas Herlan,
202089 SANTI DIYAH FATIMAH Abbas Herlan,
2023/01/07/000057 202073 NOFTI BERLIANA
(Poli : LABORATORIUM) A.Md.Kes 1/7/2023
VEBIANTI (Poli : Mega Tri Wulandari,
2023/01/07/000053 202088 HARRIS ALASDAIR
STAINLEY (Poli : Mega Tri Wulandari,
010232 SRI REDJEKI (Poli : Mega Tri Wulandari,
2023/01/07/000051 202079 RAHARDIAN
AYUNINGSIH (Poli : Annies Fadhilah,
202080 RIA YUNINGSIH (Poli : Annies Fadhilah,
106054 RADHITA AURELIA (Poli Yuni Nurul Azizah, A.
2023/01/06/000186 : LABORATORIUM) Md. 1/6/2023
177811 PUJI HANDOYO (Poli : Yuni Nurul Azizah, A.
2023/01/06/000147 LABORATORIUM) Md. 1/6/2023
042339 HARNOKO (Poli : Yuni Nurul Azizah, A.
2023/01/06/000115 123646 KRISTIAN TRI
WULANDARI (Poli : Ragil Pangestu W.,
2023/01/06/000082 198960 ALDIANO BAGUS
PRADANA (Poli : Ragil Pangestu W.,
2023/01/06/000066 197231 MUHAMMAD HAFIZ A.Md.
PRADANA (Poli : Ragil Pangestu W.,
118521 ARGYA SAHAR FEDORA Ragil Pangestu W.,
2023/01/06/000058 186293 ADIBA ALTHEA
DURGANDINI A.A (Poli : Ragil Pangestu W.,
007699 dr. SRI WAHYUNI, Mega Tri Wulandari,
202039(Poli
2023/01/05/000094 Sp.PD FAISAL DINO
: LABORATORIUM) A.Md. 1/5/2023
PRASETYO (Poli : Ela Yulianti,
202044 MINANTI RIZKI (Poli : Abbas Herlan,
2023/01/05/000001 174539 ADAM GHAZI
MALMSTEEN (Poli : Annies Fadhilah,
146329 AFIQ INDRA PERMANA Annies Fadhilah,
007699 dr. SRI WAHYUNI, Annies Fadhilah,
2023/01/04/000082 202031 RAVELINA
Sp.PD (Poli MAIA
: LABORATORIUM) A.Md. 1/4/2023
ARTANTI (Poli : Mega Tri Wulandari,
007699 dr. SRI WAHYUNI, Mega Tri Wulandari,
2023/01/04/000049 202036 MUHAMMAD
Sp.PD (Poli : LABORATORIUM) A.Md. 1/4/2023
FATURRAHMAN WIJAYA (Poli : Mega Tri Wulandari,
2023/01/04/000037 189176 RODERIKUS RAYDITYA A.Md.
MILANIO (Poli : Yuni Nurul Azizah, A.
2023/01/03/000137 LABORATORIUM) Md. 1/3/2023
201928 BY.NY DJONAH DEDEH Yuni Nurul Azizah, A.
2023/01/03/000134 K. (Poli : LABORATORIUM) Md. 1/3/2023
192760 JIHAN ALJANA LATIFA Yuni Nurul Azizah, A.
041368 NOVITA PERMATASARI Ragil Pangestu W.,
202023 NUR HIDAYAT (Poli : Ragil Pangestu W.,
087820 HENDRA KUSNADI (Poli Ela Yulianti,
2023/01/03/000024 095748 MUHAMMAD HUDA A.Md.Kes.
: LABORATORIUM) 1/3/2023
NUR SAFA (Poli : Abbas Herlan,
176000 SATARI (Poli : Abbas Herlan,
202010 NAUFAL AZKA RIADI Yuni Nurul Azizah, A.
197880 ANITA YUSTIYANTI Yuni Nurul Azizah, A.
188219 RACHMA AISYA PUTRI Yuni Nurul Azizah, A.
059256 M RAIHAN FADEL Abbas Herlan,
2023/01/01/000022 200933 AMALI UBAYDILLAH
(Poli : LABORATORIUM) A.Md.Kes 1/1/2023
ZAKIMURA (Poli : Abbas Herlan,
2023/01/01/000021 091203 FAUZI PUTRA
MAHENDRA (Poli : Abbas Herlan,
040191 CHEVAZ ALBAN NOYA Yuni Nurul Azizah, A.
125105 TUT AMINAH (Poli : Yuni Nurul Azizah, A.
2023/01/01/000005 LABORATORIUM) Md. 1/1/2023
UARI 2023 BERDASARKAN SIM
JAM PERIKSA DOKTER PERUJUK PENANGGUNG JAWAB

dr. Dwi Retnoningrum,
10:02:31 dr. Hernanda Sp.PK
Dr. Akbar Kurniawan, dr. Dwi Retnoningrum,
9:50:32 M.Kes., M.H Sp.PK
20:46:17 M.Kes., M.H Sp.PK
20:21:29 Dr. Erna Purwati S Sp.PK
19:41:11 M.Kes., M.H Sp.PK
10:15:58 M.Kes., M.H Sp.PK
dr. Rahmawati dr. Dwi Retnoningrum,
19:57:39 Adhiutami Sp.PK
dr. Mohamad Arif, dr. Dwi Retnoningrum,
19:50:05 Sp.PD Sp.PK
dr. Dwi dr. Dwi Retnoningrum,
18:10:51 Retnoningrum, Sp.PK Sp.PK
10:33:43 M.Kes., M.H Sp.PK
10:20:16 M.Kes., M.H Sp.PK
10:37:31 M.Kes., M.H Sp.PK
10:02:25 dr. Erna Purwati S. Sp.PK
8:55:37 Sp.PD Sp.PK
8:00:45 - Sp.PK
17:22:15 M.Kes., M.H Sp.PK
8:59:08 Sp.PD Sp.PK
DR. dr. Moedrik dr. Dwi Retnoningrum,
8:08:00 Tamam. Sp.A.K Sp.PK
20:15:55 -- Sp.PK
17:00:54 -- Sp.PK
16:46:37 - Sp.PK
dr. Dyah Nuraini dr. Dwi Retnoningrum,
14:56:36 Widhiana, Sp.S Sp.PK
dr. Sri Wahyuni, dr. Dwi Retnoningrum,
10:42:47 M.Kes., M.H Sp.PK
dr. Annisa Fasichatul dr. Dwi Retnoningrum,
8:29:32 Laila Samdani Sp.PK
dr. Adhi Midjaja, dr. Dwi Retnoningrum,
17:42:18 Sp.A.,M.Kes Sp.PK
11:48:59 M.Kes., M.H Sp.PK
11:39:57 M.Kes., M.H Sp.PK
11:39:34 M.Kes., M.H Sp.PK
10:24:53 M.Kes., M.H Sp.PK
21:35:45 dr. M Ramzy Ghifari Sp.PK
19:21:47 - Sp.PK
12:11:29 M.Kes., M.H Sp.PK
12:11:09 M.Kes., M.H Sp.PK
11:53:55 M.Kes., M.H Sp.PK
16:05:13 M.Kes., M.H Sp.PK
dr. Benedictus Kartika dr. Dwi Retnoningrum,
9:40:58 W., Sp.B Sp.PK
8:30:52 - Sp.PK
7:58:10 - Sp.PK
20:10:48 M.Kes., M.H Sp.PK
17:25:02 M.Kes., M.H Sp.PK
17:24:42 M.Kes., M.H Sp.PK
8:21:25 - Sp.PK
dr. Wahyu dr. Dwi Retnoningrum,
3:08:19 Trianggono Sp.PK
18:59:47 M.Kes., M.H Sp.PK
17:27:11 M.Kes., M.H Sp.PK
16:46:01 M.Kes., M.H Sp.PK
15:46:46 M.Kes., M.H Sp.PK
12:14:43 M.Kes., M.H Sp.PK
11:23:25 M.Kes., M.H Sp.PK
11:03:24 - Sp.PK
8:46:02 - Sp.PK
18:49:41 M.Kes., M.H Sp.PK
16:48:23 M.Kes., M.H Sp.PK
12:08:14 M.Kes., M.H Sp.PK
15:43:20 M.Kes., M.H Sp.PK
13:54:02 M.Kes., M.H Sp.PK
13:39:41 M.Kes., M.H Sp.PK
10:18:01 M.Kes., M.H Sp.PK
15:21:07 M.Kes., M.H Sp.PK
12:13:44 M.Kes., M.H Sp.PK
12:13:26 M.Kes., M.H Sp.PK
8:45:25 Sp.PD Sp.PK
8:25:07 Sp.PD Sp.PK
22:29:35 M.Kes., M.H Sp.PK
18:31:36 - Sp.PK
18:31:14 - Sp.PK
10:48:33 M.Kes., M.H Sp.PK
19:18:13 M.Kes., M.H Sp.PK
dr. Hervyasti dr. Dwi Retnoningrum,
13:36:33 Purwiandari, Sp.OG Sp.PK
8:36:25 Sp.PD Sp.PK
21:00:07 M.Kes., M.H Sp.PK
dr.Audy Marsha dr. Dwi Retnoningrum,
15:38:40 Melinda Sp.PK
dr. Dwi
14:46:52 Retnoningrum, Sp.PK dr. Budi Palarto, Sp.OG
14:41:50 - Sp.PK
14:16:10 M.Kes., M.H Sp.PK
23:57:09 M.Kes., M.H Sp.PK
23:56:55 M.Kes., M.H Sp.PK
20:25:13 M.Kes., M.H Sp.PK
9:13:02 - Sp.PK
dr. Wahyu dr. Dwi Retnoningrum,
0:19:29 Trianggono Sp.PK
20:46:58 M.Kes., M.H Sp.PK
19:43:47 M.Kes., M.H Sp.PK
10:25:41 W., Sp.B Sp.PK
9:22:57 Sp.PD Sp.PK
18:07:18 - Sp.PK
dr. Dwi dr. Adhi Midjaja,
17:09:36 Retnoningrum, Sp.PK Sp.A.,M.Kes
10:51:22 M.Kes., M.H Sp.PK
dr. Prabu Ekalaya dr. Dwi Retnoningrum,
20:44:42 Utama, Sp.B Sp.PK
19:52:28 dr. Melda Angelin Sp.PK
11:49:44 - Sp.PK
10:39:33 M.Kes., M.H Sp.PK
15:52:49 M.Kes., M.H Sp.PK
15:52:41 M.Kes., M.H Sp.PK
15:51:38 M.Kes., M.H Sp.PK
13:09:57 M.Kes., M.H Sp.PK
8:27:42 - Sp.PK
DATA PASIEN UMUM BULAN FEBRUARI 2023 BERDASARKAN SIM
NO. RAWAT NAMA PASIEN PETUGAS TANGGAL PERIKSA JAM PERIKSA
132862
ALTAFUNNAURA
ADARA
032315 WINARTA
2023/02/28/0003 (Poli :
SOEHARDJO Abbas Herlan,
29 LABORATORIUM)
DARTO SUMARTO A.Md.Kes 2/28/2023 18:01:55
2023/02/28/0002 (Poli
202802: SYAQILLA Yuni Nurul Azizah,
24 LABORATORIUM)
FATIMA AZZAHRA A. Md. 2/28/2023 11:26:04
2023/02/28/0002 (Poli : Yuni Nurul Azizah,
41 LABORATORIUM)
029776 DIAN A. Md. 2/28/2023 8:46:39
2023/02/27/0001 JULIKA
202791W (Poli :
DHANIRA Yuni Nurul Azizah,
71 LABORATORIUM)
SYAKILLA LABIBAH A. Md. 2/27/2023 20:03:19
2023/02/27/0000 (Poli : Ragil Pangestu W.,
73 LABORATORIUM)
093327 BACHTIAR A.Md. 2/27/2023 8:55:37
2023/02/25/0000 AFFENDY (Poli : Ela Yulianti,
58 LABORATORIUM)
019218 ISMOYO A.Md.Kes. 2/26/2023 11:37:32
2023/02/26/0000 (Poli
202777: ESTER BR Abbas Herlan,
03 LABORATORIUM)
SIRINGORINGO A.Md.Kes 2/26/2023 8:23:51
2023/02/25/0000 DEDA
202768 (Poli :
ARKHA Mega Tri
64 LABORATORIUM)
ARZAQUNA Wulandari, A.Md. 2/25/2023 15:32:59
2023/02/24/0002 PRIYONO (Poli :
181011 NADHIFA Yuni Nurul Azizah,
00 LABORATORIUM)
PUTRI ANDANI A. Md. 2/24/2023 21:37:09
2023/02/24/0001 (Poli
112924: MARIA Ragil Pangestu W.,
98 LABORATORIUM)
MAGDALENA A.Md. 2/24/2023 21:08:26
167927 GISKAINCE
2023/02/24/0001 (Poli
FAWZIA: Ragil Pangestu W.,
50 LABORATORIUM)
AZKADINAYU A.Md. 2/24/2023 16:38:33
2023/02/23/0001 (Poli
200489: ERIKA Yuni Nurul Azizah,
27 LABORATORIUM)
QIANA NAUFALYN A. Md. 2/23/2023 20:31:42
2023/02/22/0001 (Poli
202740: ERNI Abbas Herlan,
49 LABORATORIUM)
RIANA WULAN A.Md.Kes 2/22/2023 19:10:45
2023/02/22/0001 SARI
104443(Poli :
HASNA Abbas Herlan,
48 LABORATORIUM)
FARIDAH DHIYA UL A.Md.Kes 2/22/2023 19:10:19
2023/02/21/0001 HAQ (Poli : Annies Fadhilah,
74 LABORATORIUM)
147869 A.Md. 2/21/2023 20:15:53
202715 REYNAND
ELIZABETH
2023/02/21/0001 DIWIRYA
VIONETA (Poli
BESTARI: Annies Fadhilah,
52 LABORATORIUM)
WIRATMOKO A.Md. 2/21/2023 18:37:28
202714
2023/02/21/0000 (Poli :
REYHANANDA Ragil Pangestu W.,
36 LABORATORIUM)
EDEN LESMANA A.Md. 2/21/2023 9:55:30
2023/02/21/0000 (Poli
202302: PANJI Ragil Pangestu W.,
35 LABORATORIUM)
MUHAMMAD A.Md. 2/21/2023 9:43:43
2023/02/21/0000 KHAKIM (Poli :
202706 ADHITYA
26 LABORATORIUM)
RENDY Sulistyani, A.Md. 2/21/2023 8:53:36
2023/02/20/0001 SEPTIAWAN (Poli : Yuni Nurul Azizah,
37 LABORATORIUM) A. Md. 2/20/2023 18:20:50
202697 SARYATI
86 LABORATORIUM)
189024 SHABILA A. Md. 2/20/2023 14:31:07
2023/02/20/0000 SHITOQI (Poli :
202693 INGGRID Annies Fadhilah,
70 LABORATORIUM)
KUSUMANING A.Md. 2/20/2023 12:25:53
2023/02/20/0000 AGATA
104443 (Poli
HASNA: Annies Fadhilah,
38 LABORATORIUM)
FARIDAH DHIYA UL A.Md. 2/20/2023 8:24:11
2023/02/19/0000 HAQ
154061 (Poli :
BALQIS Ela Yulianti,
28 LABORATORIUM)
MEGAN MAHFUDI A.Md.Kes. 2/19/2023 22:25:12
22 LABORATORIUM)
145881 CINDY A. Md. 2/19/2023 19:27:52
2023/02/19/0000 NADIA
192270ELVIRA
SHABRINA (Poli Yuni Nurul Azizah,
14 :ARIEVIA
LABORATORIUM)
PUTRI A. Md. 2/19/2023 14:31:11
2023/02/18/0000 (Poli
202678 ALDHIRA Annies Fadhilah,
:
48 LABORATORIUM)
YUSHIARI RIZKIE A.Md. 2/18/2023 21:00:03
2023/02/18/0000 (Poli : Annies Fadhilah,
45 LABORATORIUM)
202666 LAILATUR A.Md. 2/18/2023 20:57:38
2023/02/18/0000 ROSYIDA (Poli : Mega Tri
32 LABORATORIUM)
202669 SITI Wulandari, A.Md. 2/18/2023 17:11:41
2023/02/18/0000 SUBAEDAH (Poli : Mega Tri
27 LABORATORIUM)
202663 SUSI Wulandari, A.Md. 2/18/2023 17:09:26
2023/02/18/0000 WINARNI (Poli : Mega Tri
20 LABORATORIUM)
202667 ATIK Wulandari, A.Md. 2/18/2023 17:06:54
2023/02/18/0000 SUSILOWATI (Poli : Mega Tri
23 LABORATORIUM)
20 LABORATORIUM)
202666 LAILATUR Wulandari, A.Md. 2/18/2023 14:20:30
32 LABORATORIUM)
202669 SITI Wulandari, A.Md. 2/18/2023 14:17:19
27 LABORATORIUM)
202664 RAHAYU Wulandari, A.Md. 2/18/2023 14:17:04
2023/02/18/0000 (Poli : Mega Tri
24 LABORATORIUM)
23 LABORATORIUM)
202665 TITIS Wulandari, A.Md. 2/18/2023 14:14:32
2023/02/18/0000 WIARTI (Poli : Mega Tri
22 LABORATORIUM)
202668 TITI Wulandari, A.Md. 2/18/2023 14:12:48
2023/02/18/0000 ISNAINI (Poli : Mega Tri
21 LABORATORIUM)
20 LABORATORIUM)
2023/02/18/0000 (Poli : Mega Tri
24 LABORATORIUM)
23 LABORATORIUM)
22 LABORATORIUM)
21 LABORATORIUM)
202666 LAILATUR Wulandari, A.Md. 2/18/2023 13:48:35
32 LABORATORIUM) Wulandari, A.Md. 2/18/2023 13:17:47
202669 SITI
27 LABORATORIUM)
2023/02/18/0000 (Poli : Mega Tri
24 LABORATORIUM)
22 LABORATORIUM)
21 LABORATORIUM)
202658 SHAKILA Wulandari, A.Md. 2/18/2023 12:29:10
2023/02/17/0001 AFRINA H S (Poli : Annies Fadhilah,
60 LABORATORIUM)
055934 A.Md. 2/17/2023 19:42:23
199245 DIANAUDREY
2023/02/17/0000 PANUNTUN
MANNUELA (Poli : Mega Tri
70 LABORATORIUM)
CHARITY BIYANG Wulandari, A.Md. 2/17/2023 12:37:42
2023/02/17/0000 BARRA (Poli : Mega Tri
51 LABORATORIUM)
010232 Wulandari, A.Md. 2/17/2023 9:20:31
026957 SRI
2023/02/16/0000 REDJEKI
MAHAMERU (Poli : Annies Fadhilah,
54 LABORATORIUM)
PASUDEWA A.Md. 2/16/2023 12:14:03
2023/02/16/0000 FAUZAN (Poli : Annies Fadhilah,
60 LABORATORIUM)
202639 HERI A.Md. 2/16/2023 9:40:06
2023/02/15/0001 PRAMONO
202637 NAURA (Poli : Abbas Herlan,
32 LABORATORIUM)
SABILA FAJARANI A.Md.Kes 2/15/2023 19:02:30
2023/02/15/0001 (Poli
062226 : EVI Abbas Herlan,
31 LABORATORIUM)
KUMALASARI A.Md.Kes 2/15/2023 18:49:43
2023/02/15/0001 (Poli : Abbas Herlan,
26 LABORATORIUM)
061160 ZAHRA A.Md.Kes 2/15/2023 18:02:01
2023/02/15/0001 KARIMA (Poli :
202633 DRAJAT Abbas Herlan,
24 LABORATORIUM)
PUTRA A.Md.Kes 2/15/2023 17:48:57
2023/02/15/0001 WICAKSONO (Poli : Ragil Pangestu W.,
00 LABORATORIUM)
202631 DIDIK A.Md. 2/15/2023 14:39:19
2023/02/15/0000 HENDRAWAN (Poli Ragil Pangestu W.,
74 :202630
LABORATORIUM)
DEVI A.Md. 2/15/2023 11:21:40
2023/02/15/0000 INDRIASTUTI (Poli : Ragil Pangestu W.,
72 LABORATORIUM)
150879 AGUS A.Md. 2/15/2023 11:02:41
2023/02/15/0000 SRIYANTO (Poli : Ragil Pangestu W.,
67 LABORATORIUM)
202624 TETI DWI A.Md. 2/15/2023 11:01:20
2023/02/15/0000 LESTARI (Poli :
202623 DEBBY Ragil Pangestu W.,
60 LABORATORIUM)
NIRMA SARI A.Md. 2/15/2023 10:48:39
2023/02/15/0000 SEJAHTERA (Poli : Ragil Pangestu W.,
56 LABORATORIUM)
202625 IR LELY A.Md. 2/15/2023 10:44:11
2023/02/15/0000 LAKSMISITA
022629 FERRY (Poli : Ragil Pangestu W.,
63 LABORATORIUM)
SADHITYA KRESNA A.Md. 2/15/2023 10:20:47
2023/02/15/0000 S (Poli : Ragil Pangestu W.,
61 LABORATORIUM)
175337 BELA A.Md. 2/15/2023 9:52:04
2023/02/15/0000 VIRAWATI
202621 RAFFA(Poli : Ragil Pangestu W.,
59 LABORATORIUM)
ALVARO DZAKY A.Md. 2/15/2023 9:36:31
54 143368
LABORATORIUM) A.Md. 2/15/2023 9:08:44
008005
WIRATAMA AHMADI
OKTA
2023/02/15/0000 (Poli :
RADITYA Ragil Pangestu W.,
31 LABORATORIUM)
MAULANA PAKKA A.Md. 2/15/2023 8:13:40
2023/02/15/0000 (Poli : Mega Tri
160970 ASKA
2023/02/14/0001 PRATAMA
110434 OKNAN (Poli : Ragil Pangestu W.,
50 LABORATORIUM)
SALFAZAR A.Md. 2/14/2023 21:02:40
2023/02/14/0001 WIRAGA (Poli : Annies Fadhilah,
28 LABORATORIUM)
146385 THOHIR A.Md. 2/14/2023 18:02:33
2023/02/14/0000 (Poli : Annies Fadhilah,
45 LABORATORIUM)
163097 WARTONO A.Md. 2/14/2023 9:13:16
10 LABORATORIUM)
102275 A.Md. 2/13/2023 17:58:38
202552 SUMARNO
2023/02/13/0000 (Poli :
Y.ANDRESSA Mega Tri
59 LABORATORIUM)
NUGROHO W Wulandari, A.Md. 2/13/2023 10:39:28
2023/02/13/0000 (Poli : Mega Tri
52 LABORATORIUM)
202597 SALMA Wulandari, A.Md. 2/13/2023 9:42:30
2023/02/12/0000 SYAFIRA
153588 AL FARIQ Ragil Pangestu W.,
(Poli :
31 LABORATORIUM)
PUTRA CIPTA A.Md. 2/12/2023 17:14:59
2023/02/12/0000 (Poli
152494 : M Ragil Pangestu W.,
29 LABORATORIUM)
EXELENO RAJA A.Md. 2/12/2023 16:56:17
2023/02/12/0000 SALMAN (Poli : Abbas Herlan,
25 202593
LABORATORIUM) A.Md.Kes 2/12/2023 14:26:05
075582
MUHAMMAD DZAKI
2023/02/12/0000 ARGA
DAFFA(Poli : Abbas Herlan,
22 LABORATORIUM)
ARDIANSYAH A.Md.Kes 2/12/2023 13:53:41
19 LABORATORIUM)
091681 KEANU A.Md.Kes 2/12/2023 13:32:48
2023/02/12/0000 BARRA
184985RQUEENZA
(Poli : Abbas Herlan,
14 LABORATORIUM)
AZALIA AMAYRA A.Md.Kes 2/12/2023 12:35:18
2023/02/12/0000 (Poli
198390 : Abbas Herlan,
13 LABORATORIUM)
MUHAMMAD A.Md.Kes 2/12/2023 12:22:46
2023/02/12/0000 ATHAYA SULA (Poli Abbas Herlan,
07 :177034
LABORATORIUM)
ISMIYATI A.Md.Kes 2/12/2023 9:51:49
2023/02/11/0000 (Poli
202582 RAYHAN Annies Fadhilah,
:
87 LABORATORIUM)
TYAS KIRANADYAH A.Md. 2/11/2023 21:15:16
2023/02/11/0000 (Poli
173906: MIKHAYLA
62 LABORATORIUM)
ALEXANDRIA NUR Sulistyani, A.Md. 2/11/2023 11:25:16
2023/02/10/0001 AZZAHRANIE
156435 ARIFAH (Poli : Mega Tri
86 LABORATORIUM)
NUR PRABAWATI Wulandari, A.Md. 2/10/2023 20:44:18
2023/02/10/0001 (Poli
156435: ARIFAH Mega Tri
70 LABORATORIUM)
NUR PRABAWATI Wulandari, A.Md. 2/10/2023 19:02:59
2023/02/10/0001 (Poli : Mega Tri
70 LABORATORIUM)
064448 Wulandari, A.Md. 2/10/2023 19:00:53
042067 BAYU
2023/02/10/0000 CHONDORI
KRESNA (Poli :
38 LABORATORIUM)
MUTTAQIN Sulistyani, A.Md. 2/10/2023 9:51:04
202552
2023/02/09/0000 HIDAYAT
Y.ANDRESSA(Poli : Mega Tri
56 LABORATORIUM)
NUGROHO W Wulandari, A.Md. 2/9/2023 10:06:20
2023/02/09/0000 (Poli : Mega Tri
51 LABORATORIUM)
202551 ASIH Wulandari, A.Md. 2/9/2023 8:42:33
2023/02/09/0000 SETIATIN (Poli :
201417 NADHAM Mega Tri
37 LABORATORIUM)
AULIA HAKIM Wulandari, A.Md. 2/9/2023 7:23:48
39 LABORATORIUM)
158532 AHMAD A. Md. 2/8/2023 18:40:56
2023/02/08/0001 SONIDIN (Poli : Yuni Nurul Azizah,
18 LABORATORIUM) A. Md. 2/8/2023 16:12:32
202541 AISHA
ROSHAFA
2023/02/08/0001 AGASTAF (Poli :
101702 FATHIR Yuni Nurul Azizah,
05 LABORATORIUM)
RAMADHAN A. Md. 2/8/2023 14:52:47
2023/02/08/0000 IBRAHIM (Poli :
147493 THERESIA Ela Yulianti,
81 LABORATORIUM)
SRI ARDIYATI A.Md.Kes. 2/8/2023 12:05:29
19 LABORATORIUM)
030603 AGUNG A.Md. 2/8/2023 10:03:53
2023/02/08/0000 ADI BADRA (Poli : Ela Yulianti,
60 LABORATORIUM)
182970 SISTA A.Md.Kes. 2/8/2023 9:39:58
2023/02/08/0000 SAHITA
144967 PUTRI (Poli Ela Yulianti,
58 :SULISTYANINGRU
LABORATORIUM) A.Md.Kes. 2/8/2023 9:28:26
2023/02/08/0000 M (Poli :BLANDINO Ragil Pangestu W.,
202533
10 LABORATORIUM)
ZIGGY ALFA REZEL A.Md. 2/8/2023 6:11:42
2023/02/07/0001 (Poli
063215: DR Annies Fadhilah,
75 LABORATORIUM)
MOEDRIK TAMAM, A.Md. 2/7/2023 21:42:44
2023/02/07/0001 Sp.A.K (Poli : Annies Fadhilah,
74 LABORATORIUM)
202520 A.Md. 2/7/2023 21:32:49
202521 MOJTABA
RADEVA
2023/02/06/0001 TAJALLA
ZYANDRU(Poli : Abbas Herlan,
47 LABORATORIUM)
SHANKARA PUTRA A.Md.Kes 2/6/2023 21:18:06
2023/02/06/0001 (Poli
202519: Abbas Herlan,
48 LABORATORIUM)
AMBARWATI A.Md.Kes 2/6/2023 20:05:52
46 LABORATORIUM)
029195 IPUNG A.Md.Kes 2/6/2023 19:19:20
2023/02/06/0001 PURWONO (Poli : Annies Fadhilah,
202511 M ARVINO
45 LABORATORIUM)
NAZRIL RASHAAD A.Md. 2/6/2023 19:06:09
2023/02/06/0000 (Poli
168769: M AZZEL Annies Fadhilah,
62 LABORATORIUM)
AQQLY A.Md. 2/6/2023 10:24:43
202503
2023/02/06/0000 ABIANSYAH
MUHAMMAD (Poli : Annies Fadhilah,
57 LABORATORIUM)
CHAFIDZ A.Md. 2/6/2023 9:05:54
134950 HABIBIE
2023/02/05/0000 (Poli :
MUHAMMAD Yuni Nurul Azizah,
16 LABORATORIUM)
REVAN PUTRA A. Md. 2/5/2023 16:48:02
2023/02/05/0000 PRATAMA
202495 EMMA (Poli : Yuni Nurul Azizah,
10 LABORATORIUM)
SOVIA FITRIANA A. Md. 2/5/2023 11:16:03
2023/02/04/0000 (Poli
110867: NAYLA Abbas Herlan,
88 LABORATORIUM)
PUTRI ARDELIA A.Md.Kes 2/4/2023 21:02:31
2023/02/04/0000 (Poli
202494: MUSA Abbas Herlan,
86 LABORATORIUM)
ALFARONIZAM A.Md.Kes 2/4/2023 20:34:28
2023/02/04/0000 NUGROHO
202493 ORYZA (Poli : Abbas Herlan,
85 LABORATORIUM)
SATIVA ADERA A.Md.Kes 2/4/2023 20:20:59
84 LABORATORIUM)
202472 AMELIA A.Md.Kes 2/4/2023 20:01:16
2023/02/03/0000 PUTRI (Poli : Ragil Pangestu W.,
39 LABORATORIUM)
198778 MEI TRI A.Md. 2/3/2023 9:12:54
2023/02/03/0000 MULYANTI (Poli :
096776 CHANDRA
28 LABORATORIUM)
RAHMAN Sulistyani, A.Md. 2/3/2023 8:57:41
202466 RADITYA
2023/02/03/0000 (Poli :
MUHAMMAD
26 LABORATORIUM)
ANDIKA Sulistyani, A.Md. 2/3/2023 8:24:49
202464 UMAR
2023/02/02/0002 FARUQ
MUHAMMAD (Poli : Abbas Herlan,
06 LABORATORIUM)
RUDY HERMAWAN A.Md.Kes 2/2/2023 17:56:11
74 LABORATORIUM) A.Md.Kes 2/2/2023 15:18:35
181600 ZULFIKAR
SHAHEER FIRDAUS
2023/02/02/0001 (Poli
057370: KHANIFA Annies Fadhilah,
32 LABORATORIUM)
AYU FADHILA A.Md. 2/2/2023 10:26:40
2023/02/01/0001 (Poli
171520: DINAR Abbas Herlan,
47 LABORATORIUM)
PUTRI HANDAYANI A.Md.Kes 2/1/2023 20:46:39
2023/02/01/0001 (Poli
153756: ANGGORO Abbas Herlan,
44 LABORATORIUM)
EKO BUDIMAN A.Md.Kes 2/1/2023 20:31:44
2023/02/01/0000 (Poli : Mega Tri
89 LABORATORIUM)
202439 AHMAD Wulandari, A.Md. 2/1/2023 14:11:23
2023/02/01/0000 FARIH AL KAFI (Poli Mega Tri
72 :080476
LABORATORIUM)
PRADIPA Wulandari, A.Md. 2/1/2023 12:15:21
2023/02/01/0000 ATHALA R (Poli : Mega Tri
55 LABORATORIUM)
127251 ABDUL Wulandari, A.Md. 2/1/2023 9:31:43
2023/02/01/0000 HAKIM (Poli : Mega Tri
23 BERDASARKAN SIM
DOKTER PERUJUK PENANGGUNG JAWAB

dr. Y Andressa Sp.PK
- Sp.PK
- Sp.PK
- Sp.PK
Tamam. Sp.A.K Sp.PK
- Sp.PK
M.Kes., M.H Sp.PK
M.Kes., M.H Sp.PK
Tamam. Sp.A.K Sp.PK
dr. Hernanda Sp.PK
dr. Hernanda Sp.PK
M.Kes., M.H Sp.PK
M.Kes., M.H Sp.PK
dr. Hernanda Sp.PK
Tamam. Sp.A.K Sp.PK
Retnoningrum, Sp.PK Sp.PK
dr. Hernanda Sp.PK
- Sp.PK
- Sp.PK
Adhiutami Sp.PK
dr. Debby Nirma Sari dr. Dwi Retnoningrum,
Sejahtera, M.M Sp.PK
dr. Erna Purwati S. Sp.PK
Adhiutami Sp.PK
M.Kes., M.H Sp.PK
M.Kes., M.H Sp.PK
M.Kes., M.H Sp.PK
M.Kes., M.H Sp.PK
M.Kes., M.H Sp.PK
M.Kes., M.H Sp.PK
M.Kes., M.H Sp.PK
M.Kes., M.H Sp.PK
M.Kes., M.H Sp.PK
M.Kes., M.H Sp.PK
M.Kes., M.H Sp.PK
M.Kes., M.H Sp.PK
M.Kes., M.H Sp.PK
M.Kes., M.H Sp.PK
M.Kes., M.H Sp.PK
M.Kes., M.H Sp.PK
M.Kes., M.H Sp.PK
M.Kes., M.H Sp.PK
M.Kes., M.H Sp.PK
M.Kes., M.H Sp.PK
M.Kes., M.H Sp.PK
M.Kes., M.H Sp.PK
M.Kes., M.H Sp.PK
Tamam. Sp.A.K Sp.PK
M.Kes., M.H Sp.PK
M.Kes., M.H Sp.PK
M.Kes., M.H Sp.PK
M.Kes., M.H Sp.PK
M.Kes., M.H Sp.PK
Dr. Akbar Kurniawan,
dr. Erna Purwati S. M.Kes., M.H
M.Kes., M.H Sp.PK
dr. Wildana Aqila dr. Dwi Retnoningrum,
Dzakiy Sp.PK
Dzakiy Sp.PK
Sp.PD Sp.PK
Dzakiy Sp.PK
Dzakiy Sp.PK
dr. Hernanda Sp.PK
- Sp.PK
Dzakiy Sp.PK
Tamam. Sp.A.K Sp.PK
Widhiana, Sp.S Sp.PK
M.Kes., M.H Sp.PK
Tamam. Sp.A.K Sp.PK
dr. Hernanda Sp.PK
dr. Sri Wahyuni, Sp.PD Sp.PK
dr. Hernanda Sp.PK
M.Kes., M.H Sp.PK
Adhiutami Sp.PK
Tamam. Sp.A.K Sp.PK
M.Kes., M.H Sp.PK
Adhiutami Sp.PK
Tamam. Sp.A.K Sp.PK
M.Kes., M.H Sp.PK
M.Kes., M.H Sp.PK
M.Kes., M.H Sp.PK
M.Kes., M.H Sp.PK
M.Kes., M.H Sp.PK
dr. Hernanda Sp.PK
dr. Hernanda Sp.PK
dr. Riska Camalia, dr. Dwi Retnoningrum,
Sp.A Sp.PK
M.Kes., M.H Sp.PK
Tamam. Sp.A.K Sp.PK
dr. Hernanda Sp.PK
Tamam. Sp.A.K Sp.PK
Tamam. Sp.A.K Sp.PK
Tamam. Sp.A.K Sp.PK
Tamam. Sp.A.K Sp.PK
M.Kes., M.H Sp.PK
M.Kes., M.H Sp.PK
Tamam. Sp.A.K Sp.PK
- Sp.PK
Dr. Erna Purwati S Sp.PK
-- Sp.PK
Tamam. Sp.A.K Sp.PK
Tamam. Sp.A.K Sp.PK
Tamam. Sp.A.K Sp.PK
dr. Rr Widya dr. Dwi Retnoningrum,
Kusumaningsih, Sp.DV Sp.PK
Tamam. Sp.A.K Sp.PK
Tamam. Sp.A.K Sp.PK
M.Kes., M.H Sp.PK
Tamam. Sp.A.K Sp.PK
Tamam. Sp.A.K Sp.PK
- Sp.PK
Sp.A Sp.PK
M.Kes., M.H Sp.PK
M.Kes., M.H Sp.PK
DATA PASIEN UMUM BULAN MARET 2023 BERDASARKAN SIM
NO. RAWAT NAMA PASIEN PETUGAS TANGGAL PERIKSA

203283 CANDRA
IRAWAN (Poli : Ragil Pangestu W.,
203288 PUJI ASTUTI
(Poli : Mega Tri Wulandari,
014012 UMMI NEILI
MURODAH (Poli : Mega Tri Wulandari,
074419 ADITYA
NURSASANGKA (Poli :
2023/03/30/000055 LABORATORIUM) Sulistyani, A.Md. 3/30/2023
038200 TRI CITRA
NURJIHAN (Poli : Abbas Herlan,
2023/03/29/000258 LABORATORIUM)
194826 NAFASHA A.Md.Kes 3/29/2023
KHUMAIRA ARSY
(Poli : Yuni Nurul Azizah, A.
2023/03/29/000254 LABORATORIUM)
203256 DEVINA Md. 3/29/2023
ETHELIND BUDIANTO
(Poli : ALISYA
203248 Yuni Nurul Azizah, A.
2023/03/29/000251 LABORATORIUM)
AFIFAH M AULIDINA Md. 3/29/2023
PUTRI ABDILLAH
2023/03/29/000216 LABORATORIUM) Md. 3/29/2023
203237 NUR
AMANAH (Poli : Ragil Pangestu W.,
023815 KASIRAH
074384 MUHAMMAD
ASLIANTO, SE (Poli : Mega Tri Wulandari,
163549 SAPTO
WIYONO (Poli : Mega Tri Wulandari,
203232 SRI TAMPI
203222 JOKO ERDA
PRAYITNO (Poli : Mega Tri Wulandari,
065930 SUTIMAH
2023/03/27/000067 LABORATORIUM)
107845 BILQIS A.Md. 3/27/2023
MAULIDA NADHIFA
055002 BINTANG
SURYA PURNAMA
2023/03/26/000018 LABORATORIUM)
199057 VALENCIA A.Md.Kes 3/26/2023
NOVENA LARASATI
2023/03/26/000013 LABORATORIUM)
203202 ARSYA Md. 3/26/2023
ARDHANA PUTRA
MEUTUWAH (Poli : Annies Fadhilah,
184379 HANNA AULIA
ZAMIRA (Poli :
2023/03/24/000300 LABORATORIUM) Ela Yulianti, A.Md.Kes. 3/24/2023
202807 RAFARDHAN
EDO ARSENIO (Poli : Yuni Nurul Azizah, A.
2023/03/24/000230 LABORATORIUM) Md. 3/24/2023
195079 DEFA NUR
AZIZAH (Poli : Mega Tri Wulandari,
101922 DIAN
RIYANTO (Poli :
101922 DIAN
RIYANTO (Poli :
2023/03/23/000122 LABORATORIUM)
172162 ARKANA Ela Yulianti, A.Md.Kes. 3/23/2023
PUTRA MAHENDRA
(Poli : Ragil Pangestu W.,
2023/03/23/000037 LABORATORIUM)
180681 ZEFANO A.Md. 3/23/2023
OMKARA
WICAKSONO (Poli :
2023/03/22/000026 LABORATORIUM)
147052 HENDRA Ela Yulianti, A.Md.Kes. 3/22/2023
WAHYU SAPUTRA
(Poli :
2023/03/22/000025 LABORATORIUM)
152233 JOSHUA Ela Yulianti, A.Md.Kes. 3/22/2023
INDRA CHRISTIANO
(Poli :
155681 ABBASY
GALANG IHSAN (Poli : Annies Fadhilah,
203161 ALLYA
ALTHAFUNNISA (Poli : Annies Fadhilah,
2023/03/22/000005 LABORATORIUM)
180681 ZEFANO A.Md. 3/22/2023
OMKARA
WICAKSONO (Poli : Ragil Pangestu W.,
2023/03/21/000209 LABORATORIUM)
203154 ARKHAN A.Md. 3/21/2023
ABIYASA PRASETIA
2023/03/21/000206 LABORATORIUM)
203151 DAVA A.Md. 3/21/2023
MAULANA MUFAROK
203143 NASTITI
KHOFIANA (Poli : Ragil Pangestu W.,
203142 DYAH SRI
MAHARANI (Poli : Ragil Pangestu W.,
189176 RODERIKUS
RAYDITYA MILANIO
2023/03/21/000091 LABORATORIUM)
173977 INDY ARYONA A.Md. 3/21/2023
(Kamar :
FLAMBOYAN1, Mega Tri Wulandari,
2023/03/20/000151 FLAMBOYAN)
173977 INDY ARYONA A.Md. 3/21/2023
(Kamar :
FLAMBOYAN1, Abbas Herlan,
2023/03/20/000151 FLAMBOYAN)
173977 INDY ARYONA A.Md.Kes 3/20/2023
(Kamar :
FLAMBOYAN1, Abbas Herlan,
2023/03/20/000151 FLAMBOYAN)
198917 PANDU A.Md.Kes 3/20/2023
ATHAYA
TJAKRAWISESA (Poli : Abbas Herlan,
203117 KHOLIFATU
ROSITA (Poli : Ragil Pangestu W.,
203111 VIDA ATIATUL
IZZA (Poli : Yuni Nurul Azizah, A.
2023/03/19/000014 LABORATORIUM) Md. 3/19/2023
203108 REYNALDI
ZUBRIAN (Poli : Yuni Nurul Azizah, A.
2023/03/18/000441 LABORATORIUM) Md. 3/18/2023
063215 DR MOEDRIK
TAMAM, Sp.A.K (Poli : Yuni Nurul Azizah, A.
2023/03/18/000429 LABORATORIUM)
195398 ARSEA Md. 3/18/2023
KIRANA MAHARKI
(Poli :
2023/03/18/000383 LABORATORIUM)
203093 ZHAFRAN Ela Yulianti, A.Md.Kes. 3/18/2023
FARRAS
ALKHWARIZMI (Poli : Abbas Herlan,
203092 AZALIANTY
AULIAH (Poli : Ragil Pangestu W.,
164027 ANNISA
HERRINDA (Poli : Ragil Pangestu W.,
116563 SAKIYEM (Poli Ragil Pangestu W.,

200667 TIKA PRATIWI
032666 SITI SUNDARI
065530 DJATI
SUROSO (Poli : Abbas Herlan,
2023/03/17/000160 LABORATORIUM)
203075 SINTIA A.Md.Kes 3/17/2023
MAHARANI PUTRI
(Poli : Annies Fadhilah,
2023/03/16/000120 LABORATORIUM)
203074 MICHELINA A.Md. 3/16/2023
MIKHAELA HANNALEA
199051 AZALIA DAFFA
NAYYIRA (Poli : Annies Fadhilah,
164044 IRFA GEVIRA
ARDHANIA (Poli : Yuni Nurul Azizah, A.
2023/03/15/000064 LABORATORIUM) Md. 3/15/2023
164044 IRFA GEVIRA
ARDHANIA (Poli : Yuni Nurul Azizah, A.
2023/03/15/000064 LABORATORIUM)
191599 LAELA Md. 3/15/2023
SALLIMA
MEGAHARSIWI (Poli : Abbas Herlan,
2023/03/14/000117 LABORATORIUM)
203044 NABILA A.Md.Kes 3/14/2023
ANINDYA NUGROHO
203041 RITA YULIANI
2023/03/13/000162 LABORATORIUM)
064560 MUHAMAD A.Md. 3/13/2023
ALDITTO PUTRA
CHARIRIN (Poli : Ragil Pangestu W.,
2023/03/13/000161 LABORATORIUM)
203027 AHMAD A.Md. 3/13/2023
FAHMI FATHONI
KAYYIS (Poli : Yuni Nurul Azizah, A.
2023/03/13/000066 LABORATORIUM) Md. 3/13/2023
200430 MUHAMMAD
ARJUNO LATIF (Poli : Yuni Nurul Azizah, A.
2023/03/13/000065 LABORATORIUM)
138604 NOUVAL Md. 3/13/2023
IMAM ALFIANSYAH
2023/03/13/000064 LABORATORIUM) Md. 3/13/2023
116188 STEPHANI
SANTIKA DEWI (Poli : Ragil Pangestu W.,
2023/03/13/000035 LABORATORIUM)
189515 MUHAMMAD A.Md. 3/13/2023
ZAYN PUTRA
PRASETYO (Poli : Ragil Pangestu W.,
025366 DJOKO
SURJONO (Poli : Mega Tri Wulandari,
148801 M RAFI
WILDAN H (Poli : Mega Tri Wulandari,
153043 L WARIS,
S.SOS (Poli : Annies Fadhilah,
202992 FAHMI
HAIDAR (Poli : Abbas Herlan,
202989 FERNANDO
HUTABARAT (Poli :
2023/03/10/000162 LABORATORIUM)
202928 NYOMAN Ela Yulianti, A.Md.Kes. 3/10/2023
PUTRI ARI AMELINDA
202975 SYASYA AILA
INTAN QONAAH (Poli :
202603 GIOKENZO
AQUINO (Poli :
042339 HARNOKO
116188 STEPHANI
SANTIKA DEWI (Poli : Mega Tri Wulandari,
170427 SUWARDI
SURYOKUSUMO
202956 MOKHAMAD (Poli : Annies Fadhilah,
2023/03/08/000130 LABORATORIUM)
BANGKIT A.Md. 3/8/2023
NUGRAHANDHIKA
202954 TAQIYYA
QALBI MAZIYYA (Poli : Annies Fadhilah,
202947 RIFKY ARIF
AMINANTO (Poli :
2023/03/07/000139 LABORATORIUM)
202928 NYOMAN Ela Yulianti, A.Md.Kes. 3/7/2023
PUTRI ARI AMELINDA
2023/03/07/000047 LABORATORIUM)
156734 REINER A.Md. 3/7/2023
RAVENDRA ATMAJA
2023/03/06/000076 LABORATORIUM) Md. 3/6/2023
058887 KUSMANTO
2023/03/05/000025 LABORATORIUM) Md. 3/5/2023
036519 HJS
WIDIARTO, DRS (Poli : Abbas Herlan,
202898 DINAR AYU
NINGRUM (Poli : Annies Fadhilah,
065011 RIZQO FAAIQ
F (Poli : Abbas Herlan,
202883 NUNUNG
OKTAVIABIOS
202849 (Poli : Annies Fadhilah,
2023/03/03/000175 LABORATORIUM)
CENDEKIA A.Md. 3/3/2023
WIGATININGTYAS
093327 BACHTIAR
AFFENDY (Poli : Annies Fadhilah,
2023/03/03/000133 LABORATORIUM)
155213 FARANIA A.Md. 3/3/2023
AINUN RAMADHINA
157008 ARKAN AL
ABBASY (Poli : Annies Fadhilah,
2023/03/03/000108 LABORATORIUM)
093912 HABIB A.Md. 3/3/2023
MAULANA HARSAN
2023/03/03/000038 LABORATORIUM) Md. 3/3/2023
202860 MUH YAZID
ABDULLOH. H (Poli : Annies Fadhilah,
202861 ANDRE ZO
PINDO (Poli : Annies Fadhilah,
2023/03/02/000156 LABORATORIUM)
051828 ANNISA A.Md. 3/2/2023
SALSABILLA
HERMANSYAH (Poli : Annies Fadhilah,
084286 RINDU KHOIRI
084286 RINDU KHOIRI
202843 RAVABESTA
RASENDRIYA (Poli : Mega Tri Wulandari,
MARET 2023 BERDASARKAN SIM


13:19:35 M.Kes., M.H Sp.PK

19:57:48 - Sp.PK

9:02:57 - Sp.PK

23:36:11 M.Kes., M.H Sp.PK






11:15:22 M.Kes., M.H Sp.PK

10:42:54 M.Kes., M.H Sp.PK

10:32:43 M.Kes., M.H Sp.PK

11:57:40 M.Kes., M.H Sp.PK

9:09:05 dr. Y Andressa Sp.PK

dr. Prabu Giusti dr. Dwi Retnoningrum,
14:12:13 Nugraha Sp.PK

11:00:29 Nugraha Sp.PK


16:02:39 M.Kes., M.H Sp.PK


7:37:30 - Sp.PK





17:55:28 M.Kes., M.H Sp.PK

17:15:32 Dzakiy Sp.PK

9:24:21 Dzakiy Sp.PK






14:37:49 - Sp.PK
13:52:42 M.Kes., M.H Sp.PK

8:23:54 Sp.PD Sp.PK


dr. Ayu Mekar Sumila, dr. Dwi Retnoningrum,

17:10:24 Sp.KJ Sp.PK




17:42:21 - Sp.PK

dr. Redyaksa dr. Dwi Retnoningrum,

21:19:27 Drestanta Ariandoko Sp.PK


17:22:03 Drestanta Ariandoko Sp.PK

16:11:58 - Sp.PK

14:54:40 dr. Sri Wahyuni, Sp.PD Sp.PK


10:31:24 M.Kes., M.H Sp.PK

21:15:15 M.Kes., M.H Sp.PK




15:39:26 M.Kes., M.H Sp.PK


21:52:18 - Sp.PK










18:23:25 M.Kes., M.H Sp.PK

16:52:06 M.Kes., M.H Sp.PK


15:40:59 - Sp.PK



19:20:02 M.Kes., M.H Sp.PK



19:54:02 M.Kes., M.H Sp.PK



16:08:04 Utama, Sp.B Sp.PK

10:51:47 M.Kes., M.H Sp.PK



19:57:20 M.Kes., M.H Sp.PK


16:59:54 M.Kes., M.H Sp.PK



20:07:21 M.Kes., M.H Sp.PK

20:07:15 M.Kes., M.H Sp.PK

19:51:35 M.Kes., M.H Sp.PK

15:13:34 M.Kes., M.H Sp.PK

14:04:56 M.Kes., M.H Sp.PK

DATA PASIEN UMUM BULAN APRIL 2023 BERDASARKAN
NO. RAWAT NAMA PASIEN PETUGAS TANGGAL PERIKSA
066286 INKA JANUAR AN

NADWA (Poli :
2023/04/30/000035 LABORATORIUM) Annies Fadhilah, A.Md. 4/30/2023
Cara Bayar : Umum Pemeriksaan Hasil
TLAB00032 Rapid Covid

19 Antigen 80,000
Rapid Antigen SARS Cov-

20 Negatif
Biaya Periksa : 80,000
195040 MAKEM (Poli : Dana Krismonika,

2023/04/30/000026 IGD) A.Md.Kep. 4/30/2023
TLAB00006 GLUKOSA
DARAH SEWAKTU 28,000
Glukosa Darah - Sewaktu

0 182

147273 MUHAMMAD
ARIF YULDAN ASWIN
2023/04/30/000023 (Poli : LABORATORIUM) Annies Fadhilah, A.Md. 4/30/2023

19 Antigen 80,000
20 Negatif

203730 BAYU WIDYADI
NUGROHO (Poli :

19 Antigen 80,000

20 Negatif

203731 CHRISANO
JORDAN AKBAR (Poli :

19 Antigen 80,000

20 Negatif

200913 MUHAMMAD
HAZEL FULVIAN N (Poli :

19 Antigen 80,000

20 Negatif
151827 MUHAMMAD
AZKADRYANO PUJAKA Mega Tri Wulandari,

19 Antigen 80,000

20 Negatif
167059 ENDANG Ns. Durrotun Nikhayah,

2023/04/30/000005 HIDAYAT (Poli : IGD) S.Kep. 4/30/2023
TLAB00006 GLUKOSA

0 113

203696 AMMAR SYAFIQ
HASAN (Kamar :
PERINABED11,
2023/04/28/000061 PERINATOLOGI) Ragil Pangestu W., A.Md. 4/30/2023
J002114 DARAH
LENGKAP 100,500
Leukosit 0 4.61
Eritrosit 0 4.42
Hemoglobin 0 11.1
Hematokrit 0 33.3
Trombosit 0 25
HITUNG JENIS LEUKOSIT

0
Neutrofil 0 26.6
Limfosit 0 58.4
Monosit 0 13.2
Eosinofil 0 1.8
Basofil 0 0
INDEX ERITROSIT 0
MCV 0 75.3
MCH 0 25.2
MCHC 0 33.5
RDW-CV 0 15
NLR 0 0.46

203696 AMMAR SYAFIQ
HASAN (Kamar :
PERINABED11,
2023/04/28/000061 PERINATOLOGI) Abbas Herlan, A.Md.Kes 4/29/2023
TLAB00361 GOLONGAN
DARAH 33,000
Golongan Darah 0 O (+) Rhesus

203696 AMMAR SYAFIQ
HASAN (Kamar :
PERINABED11,
2023/04/28/000061 PERINATOLOGI) Abbas Herlan, A.Md.Kes 4/29/2023
J000220 Jasa Kurir PMI

50,000

152830 NURHAYATI
(Kamar : ISOBED4,
2023/04/28/000223 ISOLASI) Abbas Herlan, A.Md.Kes 4/29/2023
TLAB00365 GLUKOSA

0 452
0 GDS JAM 19
TLAB00421 HBA1C
205,000
HBAIC 0 6.7
130822 REYHAN MEIZA
DARUSSALAM (Poli :
2023/04/29/000110 LABORATORIUM) Abbas Herlan, A.Md.Kes 4/29/2023

19 Antigen 80,000

20 Negatif
175974 WIJI SUMARNI Ns. Devi Indriastuti,

2023/04/29/000089 (Poli : Penyakit Dalam) S.Tr.Kep. 4/29/2023
TLAB00006 GLUKOSA

0 191
183864 SOLEKAH (Poli :

2023/04/29/000087 Penyakit Dalam) Mudrik Wulandari 4/29/2023
TLAB00006 GLUKOSA

0 185

203696 AMMAR SYAFIQ
HASAN (Kamar :
PERINABED11,
2023/04/28/000061 PERINATOLOGI) Ragil Pangestu W., A.Md. 4/29/2023
J002114 DARAH
LENGKAP 100,500
Leukosit 0 3.38
Eritrosit 0 4.67
Hemoglobin 0 11.5
Hematokrit 0 35.2
Trombosit 0 32

0
Neutrofil 0 14.3
Limfosit 0 77.9
Monosit 0 7.2
Eosinofil 0 0.6
Basofil 0 0
INDEX ERITROSIT 0
MCV 0 75.4
MCH 0 24.5
MCHC 0 32.6
RDW-CV 0 14.8
NLR 0 0.18

152830 NURHAYATI
(Kamar : ISOBED4, Mega Tri Wulandari,
2023/04/28/000223 ISOLASI) A.Md. 4/29/2023
J002014 GLUKOSA
SLEEDING 1 99,000
GLUKOSA DARAH
SEWAKTU J 04 0 198
GLUKOSA DARAH
SEWAKTU J 08 0 318
GLUKOSA DARAH
SEWAKTU J 12 0 363
203716 RESMIYATI (Poli :

2023/04/29/000041 LABORATORIUM) Ragil Pangestu W., A.Md. 4/29/2023

19 Antigen 80,000

20 Negatif
021251 SETYAWAN
JAYADI (Poli :
J000036 GLUKOSA
DARAH PUASA 28,000
Glukosa Puasa 0 105
J002060 LIPID 89,500
Cholesterol 0 257
Triglycerida 0 130
TLAB00010 ASAM URAT

43,000
ASAM URAT 0 5.1

192230 SINTASARI DEWI
SETYANINGRUM (Poli :
J000036 GLUKOSA
DARAH PUASA 28,000
Glukosa Puasa 0 96
J002111 DARAH
LENGKAP 90,000
Leukosit 0 9,10
Eritrosit 0 5,14
Hemoglobin 0 14,2
Hematokrit 0 42,5
Trombosit 0 342

0
Neutrofil 0 70,4
Limfosit 0 24,2
Monosit 0 4,6
Eosinofil 0 0,8
Basofil 0 0,0
INDEX ERITROSIT 0
MCV 0 82,7
MCH 0 27,7
MCHC 0 33,5
RDW-CV 0 12,1
NLR 0 2,91
TLAB00061 HBA1C
195,000
HBAIC 0 5,4

152830 NURHAYATI
(Kamar : ISOBED4, Mega Tri Wulandari,
2023/04/28/000223 ISOLASI) A.Md. 4/29/2023
TLAB00245 GLUKOSA

0 83
0 JAM 24.00

008787 YULIA
WIDYANINGSIH (Poli :
J002077 HCG TEST

27,500
HCG Test 0 Negatif

152830 NURHAYATI
(Kamar : ISOBED4, Dana Krismonika,
2023/04/28/000223 ISOLASI) A.Md.Kep. 4/28/2023
TLAB00006 GLUKOSA

0 142

176588 SHERIN AZALEA
LUVYNDA (Poli :
J002111 DARAH
LENGKAP 90,000
Leukosit 0 7.34
Eritrosit 0 5.13
Hemoglobin 0 13.3
Hematokrit 0 41.1
Trombosit 0 217

0
Neutrofil 0 62.4
Limfosit 0 28.7
Monosit 0 8.8
Eosinofil 0 0.1
Basofil 0 0
INDEX ERITROSIT 0
MCV 0 80
MCH 0 25.9
MCHC 0 32.4
RDW-CV 0 12.1
NLR 0 2.17
TLAB00022 WIDAL
59,500
Salmonella typhi O 0 Negatif
Salmonella typhi H 0 Negatif
Salmonella paratyphi A-
H0 Negatif
Salmonella paratyphi B-H

0 Negatif

152830 NURHAYATI
2023/04/28/000223 ISOLASI) A.Md.Kep. 4/28/2023

TLAB00006 GLUKOSA

0 94

152830 NURHAYATI
(Kamar : ISOBED4,
2023/04/28/000223 ISOLASI) Abbas Herlan, A.Md.Kes 4/28/2023
J002045 FUNGSI GINJAL

2 86,000
UREUM 0 11.3
CREATININ 0 0.3
J002111 DARAH
LENGKAP 90,000
Leukosit 0 10.36
Eritrosit 0 4.07
Hemoglobin 0 11.6
Hematokrit 0 34.9
Trombosit 0 305

0
Neutrofil 0 89
Limfosit 0 6.4
Monosit 0 4.5
Eosinofil 0 0.1
Basofil 0 0
INDEX ERITROSIT 0
MCV 0 85.8
MCH 0 28.6
MCHC 0 33.3
RDW-CV 0 13.7
NLR 0 13.91
TLAB00006 GLUKOSA

0 31

152830 NURHAYATI
2023/04/28/000223 ISOLASI) A.Md.Kep. 4/28/2023
TLAB00006 GLUKOSA
0 36
097077 SUDADI (Poli : Ns. Hafidz Delby Cahyadi,

2023/04/28/000125 IGD) S.Kep. 4/28/2023
TLAB00006 GLUKOSA

0 110
203698 NIRWANA (Poli :


2 86,000
UREUM 0 31,4
CREATININ 0 0,6
TLAB00061 HBA1C
195,000
HBAIC 0 9,1

032303 ENDAH
KUSUMANINGSIH (Poli :

19 Antigen 80,000

20 NEGATIF

154350 SHIDQIYAH
RONAA BASIR (Kamar :
PERINABED12,
2023/04/25/000001 PERINATOLOGI) Sulistyani, A.Md. 4/28/2023
TLAB00381 WIDAL
69,500
Salmonella typhi O 0 Positf 1/160
Salmonella typhi H 0 Positf 1/320
H0 Negatif

0 Positf 1/80

203696 AMMAR SYAFIQ
HASAN (Kamar :
PERINABED11,
TLAB00506 DENGUE
ANTIBODI 215,000
Dengue Ig M 0 POSITIF
Dengue Ig G 0 NEGATIF

062041 WAHYU SETYO
PURNOMO (Poli :

19 Antigen 80,000

20 NEGATIF

184002 ARFI RISKY
HUDOYO (Poli :

19 Antigen 80,000

20 NEGATIF

154350 SHIDQIYAH
PERINABED12,
J002114 DARAH
LENGKAP 100,500
Leukosit 0 10,60
Eritrosit 0 4,04
Hemoglobin 0 10,6
Hematokrit 0 31,4
Trombosit 0 235

0
Neutrofil 0 62,8
Limfosit 0 19,6
Monosit 0 12,4
Eosinofil 0 5,2
Basofil 0 0,0
INDEX ERITROSIT 0
MCV 0 77,6
MCH 0 26,1
MCHC 0 33,6
RDW-CV 0 13,3
NLR 0 3,20
TLAB00386 DENGUE
ANTIBODI 210,000
Dengue Ig M 0 POSITIF
Dengue Ig G 0 POSITIF

203696 AMMAR SYAFIQ
HASAN (Kamar :
PERINABED11,
J002111 DARAH
LENGKAP 90,000
Leukosit 0 2,40
Eritrosit 0 4,69
Hemoglobin 0 11,5
Hematokrit 0 34,8
Trombosit 0 54

0
Neutrofil 0 22,6
Limfosit 0 73,2
Monosit 0 4,2
Eosinofil 0 0,0
Basofil 0 0,0
INDEX ERITROSIT 0
MCV 0 74,3
MCH 0 24,5
MCHC 0 33,0
RDW-CV 0 14,7
NLR 0 0,31
163031 SUNARSO (Poli : Mega Tri Wulandari,

2023/04/28/000004 IGD) A.Md. 4/28/2023
J002111 DARAH
LENGKAP 90,000
Leukosit 0 4,00
Eritrosit 0 4,58
Hemoglobin 0 13,1
Hematokrit 0 38,5
Trombosit 0 130

0
Neutrofil 0 73,8
Limfosit 0 19,8
Monosit 0 6,3
Eosinofil 0 0,1
Basofil 0 0,0
INDEX ERITROSIT 0
MCV 0 84,1
MCH 0 28,6
MCHC 0 34,1
RDW-CV 0 13,7
NLR 0 3,73
203138 SUNTARI (Poli :

2023/04/27/000076 Penyakit Dalam) dr. Sri Wahyuni, Sp.PD 4/27/2023

TLAB00006 GLUKOSA

0 134
203685 HARIYANTONO
2023/04/27/000093 (Poli : IGD) Annies Fadhilah, A.Md. 4/27/2023
J002111 DARAH
LENGKAP 90,000
Leukosit 0 13,50
Eritrosit 0 4,86
Hemoglobin 0 14,2
Hematokrit 0 41,5
Trombosit 0 300

0
Neutrofil 0 80,1
Limfosit 0 9,8
Monosit 0 8,7
Eosinofil 0 1,4
Basofil 0 0,0
INDEX ERITROSIT 0
MCV 0 85,4
MCH 0 29,2
MCHC 0 34,2
RDW-CV 0 12,3
NLR 0 8,17
TLAB00006 GLUKOSA

0 257

203648 NGADIRAN
(Kamar : FLAMBOYAN3,
2023/04/25/000042 FLAMBOYAN) Yuni Nurul Azizah, A. Md. 4/26/2023
TLAB00512 URINE RUTIN

48,000
Warna 0 Kuning Agak Keruh
P.H. 0 6.5
B.J. 0 1.025
Protein 0 Negatif
Reduksi 0 Negatif
Urobilinogen 0 Negatif
Bilirubin 0 Negatif
Keton 0 Positif (+)
Sedimen 0
Leukosit 0 0-1
Eritrosit 0 0-1
Epitel Sel 0 1-Feb
Silinder 0 Negatif
Kristal 0 Negatif
Lain-lain 0 Negatif

154350 SHIDQIYAH
PERINABED12,
2023/04/25/000001 PERINATOLOGI) Yuni Nurul Azizah, A. Md. 4/26/2023
J002115 DARAH
LENGKAP 105,500
Leukosit 0 12.01
Eritrosit 0 4.04
Hemoglobin 0 10.8
Hematokrit 0 31.7
Trombosit 0 146

0
Neutrofil 0 77.3
Limfosit 0 7.6
Monosit 0 7.6
Eosinofil 0 7.5
Basofil 0 0
INDEX ERITROSIT 0
MCV 0 78.4
MCH 0 26.6
MCHC 0 33.9
RDW-CV 0 13.1
NLR 0 10.17
203654 MAHFUT (Poli :

2023/04/25/000076 IGD) Yuni Nurul Azizah, A. Md. 4/25/2023

2 86,000
UREUM 0 25.4
CREATININ 0 0.8
J002111 DARAH
LENGKAP 90,000
Leukosit 0 9.51
Eritrosit 0 4.7
Hemoglobin 0 14.6
Hematokrit 0 43.2
Trombosit 0 183

0
Neutrofil 0 83.2
Limfosit 0 4.9
Monosit 0 10.3
Eosinofil 0 1.6
Basofil 0 0
INDEX ERITROSIT 0
MCV 0 91.8
MCH 0 31.2
MCHC 0 33.9
RDW-CV 0 11.8
NLR 0 16.98

165409 ARSA
RAMADHANY PRASETYO
2023/04/25/000080 (Poli : IGD) Yuni Nurul Azizah, A. Md. 4/25/2023
J002111 DARAH
LENGKAP 90,000
Leukosit 0 12.12
Eritrosit 0 4.85
Hemoglobin 0 13.1
Hematokrit 0 38.7
Trombosit 0 347

0
Neutrofil 0 68.5
Limfosit 0 23.2
Monosit 0 7.4
Eosinofil 0 0.9
Basofil 0 0
INDEX ERITROSIT 0
MCV 0 79.9
MCH 0 27
MCHC 0 33.7
RDW-CV 0 12.1
NLR 0 2.95
203653 DWI PRIYONO


19 Antigen 80,000

20 NEGATIF
203653 DWI PRIYONO


2 86,000
UREUM 0 72.1
CREATININ 0 0.7
J002111 DARAH
LENGKAP 90,000
Leukosit 0 15.17
Eritrosit 0 4.31
Hemoglobin 0 12.4
Hematokrit 0 36.8
Trombosit 0 500

0
Neutrofil 0 87.9
Limfosit 0 6.8
Monosit 0 5.2
Eosinofil 0 0.1
Basofil 0 0
INDEX ERITROSIT 0
MCV 0 85.4
MCH 0 28.7
MCHC 0 33.6
RDW-CV 0 12.2
NLR 0 12.93

119909 ALDI RIFQI
PRAYOGI (Poli :
2023/04/25/000077 LABORATORIUM) Yuni Nurul Azizah, A. Md. 4/25/2023

19 Antigen 80,000

20 NEGATIF
203655 GARDA AMRA

2023/04/25/000079 YUDISTIRA (Poli : IGD) Yuni Nurul Azizah, A. Md. 4/25/2023

19 Antigen 80,000

20 NEGATIF
203654 MAHFUT (Poli :

2023/04/25/000076 IGD) Yuni Nurul Azizah, A. Md. 4/25/2023

19 Antigen 80,000

20 POSITIF
203653 DWI PRIYONO

TLAB00006 GLUKOSA

0 644
0 GDS LAB
203653 DWI PRIYONO

TLAB00006 GLUKOSA

0 HIGH
0 IGD

108447 MUHAMAD IVAN
MAHARDIKA PUTRA (Poli Mega Tri Wulandari,

19 Antigen 80,000

20 Negatif

053646 GHANIA AFRIN
FAZILA (Poli : Mega Tri Wulandari,

19 Antigen 80,000

20 Negatif
197195 FAJAR TRI
KURNIAWAN (Poli : Mega Tri Wulandari,

19 Antigen 80,000

20 Negatif

203648 NGADIRAN
(Kamar : FLAMBOYAN3, Mega Tri Wulandari,
2023/04/25/000042 FLAMBOYAN) A.Md. 4/25/2023

1 174,000
ASAM URAT 0 6,2
UREUM 0 39,8
CREATININ 0 1,1
J002064 LIPID 119,500
Cholesterol 0 166
Triglycerida 0 92

066286 INKA JANUAR AN
NADWA (Poli : Mega Tri Wulandari,

19 Antigen 80,000

20 Negatif

200913 MUHAMMAD
HAZEL FULVIAN N (Poli : Mega Tri Wulandari,

19 Antigen 80,000

20 Negatif

203649 GAUM
MERBAWANI (Poli : Mega Tri Wulandari,

19 Antigen 80,000

20 Negatif

203648 NGADIRAN
(Kamar : FLAMBOYAN3, Mega Tri Wulandari,
2023/04/25/000042 FLAMBOYAN) A.Md. 4/25/2023
J002111 DARAH
LENGKAP 90,000
Leukosit 0 6,99
Eritrosit 0 4,70
Hemoglobin 0 13,7
Hematokrit 0 41,4
Trombosit 0 191

0
Neutrofil 0 76,0
Limfosit 0 14,1
Monosit 0 7,0
Eosinofil 0 2,9
Basofil 0 0,0
INDEX ERITROSIT 0
MCV 0 88,2
MCH 0 29,2
MCHC 0 33,1
RDW-CV 0 12,7
NLR 0 5,39
TLAB00006 GLUKOSA

0 100

154350 SHIDQIYAH
PERINABED12, Mega Tri Wulandari,
2023/04/25/000001 PERINATOLOGI) A.Md. 4/25/2023
TLAB00245 GLUKOSA

0 108

130822 REYHAN MEIZA
DARUSSALAM (Poli : Mega Tri Wulandari,

19 Antigen 80,000
20 Negatif

201135 MUHAMMAD
GHIBRAN ALFARUQ Mega Tri Wulandari,
J002111 DARAH
LENGKAP 90,000
Leukosit 0 6,62
Eritrosit 0 4,86
Hemoglobin 0 11,6
Hematokrit 0 35,3
Trombosit 0 269

0
Neutrofil 0 64,4
Limfosit 0 27,1
Monosit 0 8,4
Eosinofil 0 0,1
Basofil 0 0,0
INDEX ERITROSIT 0
MCV 0 72,6
MCH 0 23,9
MCHC 0 32,9
RDW-CV 0 13,2
NLR 0 2,38
TLAB00022 WIDAL
59,500
H0 Negatif

0 Negatif

147273 MUHAMMAD
ARIF YULDAN ASWIN Mega Tri Wulandari,

19 Antigen 80,000

20 Negatif
203644 AZZALEA ALIFAH
KHALIQA DZAHIN (Poli : Mega Tri Wulandari,
J002111 DARAH
LENGKAP 90,000
Leukosit 0 12,74
Eritrosit 0 4,50
Hemoglobin 0 11,1
Hematokrit 0 33,4
Trombosit 0 473

0
Neutrofil 0 55,2
Limfosit 0 37,4
Monosit 0 6,7
Eosinofil 0 0,7
Basofil 0 0,0
INDEX ERITROSIT 0
MCV 0 74,2
MCH 0 24,7
MCHC 0 33,3
RDW-CV 0 12,5
NLR 0 1,48
TLAB00022 WIDAL
59,500
H0 Negatif

0 Negatif

043409 RAMADHANDI
RAIHAN FATIH
WIJAYANTO (Poli : Mega Tri Wulandari,

19 Antigen 80,000

20 Negatif

203640 RIDHO AMAAJID Mega Tri Wulandari,

19 Antigen 80,000

20 Negatif

203637 REYNALDI SAKHA
ADIWINATA (Poli : Mega Tri Wulandari,

19 Antigen 80,000

20 Negatif

154350 SHIDQIYAH
PERINABED12,
2023/04/25/000001 PERINATOLOGI) Annies Fadhilah, A.Md. 4/25/2023
J002111 DARAH
LENGKAP 90,000
Leukosit 0 10,35
Eritrosit 0 4,50
Hemoglobin 0 11,7
Hematokrit 0 35,7
Trombosit 0 191

0
Neutrofil 0 89,3
Limfosit 0 4,4
Monosit 0 5,7
Eosinofil 0 0,6
Basofil 0 0,0
INDEX ERITROSIT 0
MCV 0 79,4
MCH 0 26,0
MCHC 0 32,7
RDW-CV 0 13,2
NLR 0 20,30

154350 SHIDQIYAH
PERINABED12,
2023/04/25/000001 PERINATOLOGI) Annies Fadhilah, A.Md. 4/25/2023

19 Antigen 80,000

20 Negatif

131204 ZIYAD RIZKY
MAHAMERU (Poli :
J002111 DARAH
LENGKAP 90,000
Leukosit 0 13,21
Eritrosit 0 4,96
Hemoglobin 0 13,0
Hematokrit 0 38,3
Trombosit 0 265

0
Neutrofil 0 70,6
Limfosit 0 25,7
Monosit 0 3,6
Eosinofil 0 0,1
Basofil 0 0,0
INDEX ERITROSIT 0
MCV 0 77,1
MCH 0 26,2
MCHC 0 33,9
RDW-CV 0 13,9
NLR 0 2,75

063555 MIMI
PARYUSEMAHU (Poli : Ns. Durrotun Nikhayah,
2023/04/24/000028 IGD) S.Kep. 4/24/2023
TLAB00006 GLUKOSA

0 89
186391 ARIF YULIANTO

2023/04/24/000026 (Poli : LABORATORIUM) Sulistyani, A.Md. 4/24/2023

19 Antigen 80,000

20 Negatif
183909 PETER HARIA

2023/04/23/000032 SUNARTO (Poli : IGD) Ela Yulianti, A.Md.Kes. 4/23/2023
TLAB00006 GLUKOSA

0 682

069985 NURRISKA CITRA
SARI (Poli :
J002111 DARAH
LENGKAP 90,000
Leukosit 0 10.55
Eritrosit 0 4.65
Hemoglobin 0 12.8
Hematokrit 0 39.4
Trombosit 0 280

0
Neutrofil 0 64.6
Limfosit 0 28.9
Monosit 0 3.7
Eosinofil 0 2.8
Basofil 0 0
INDEX ERITROSIT 0
MCV 0 84.7
MCH 0 27.6
MCHC 0 32.6
RDW-CV 0 13.6
NLR 0 2.24
202249 DYLAN KHAN

2023/04/23/000026 NAY OWAIS (Poli : IGD) Ela Yulianti, A.Md.Kes. 4/23/2023

J002111 DARAH
LENGKAP 90,000
Leukosit 0 15.92
Eritrosit 0 4.22
Hemoglobin 0 11.6
Hematokrit 0 35.2
Trombosit 0 500

0
Neutrofil 0 21.9
Limfosit 0 67.5
Monosit 0 9.1
Eosinofil 0 1.5
Basofil 0 0
INDEX ERITROSIT 0
MCV 0 82.8
MCH 0 27.5
MCHC 0 33.2
RDW-CV 0 14.6
NLR 0 0.32

125234 ELLEONORA
PUTRI LARASATI (Poli :
2023/04/23/000025 IGD) Ela Yulianti, A.Md.Kes. 4/23/2023

19 Antigen 80,000

20 Negatif

125234 ELLEONORA
PUTRI LARASATI (Poli :
J002111 DARAH
LENGKAP 90,000
Leukosit 0 4.8
Eritrosit 0 4.75
Hemoglobin 0 12.9
Hematokrit 0 39.7
Trombosit 0 222
0
Neutrofil 0 83.6
Limfosit 0 7.1
Monosit 0 8.6
Eosinofil 0 0.7
Basofil 0 0
INDEX ERITROSIT 0
MCV 0 83.4
MCH 0 27.1
MCHC 0 32.5
RDW-CV 0 12.9
NLR 0 11.77
189354 SUTARMI (Poli : Dana Krismonika,

2023/04/23/000023 IGD) A.Md.Kep. 4/23/2023
TLAB00006 GLUKOSA
0 232
157891 MUKINAH (Poli :

J002111 DARAH
LENGKAP 90,000
Leukosit 0 18.63
Eritrosit 0 3.81
Hemoglobin 0 9.2
Hematokrit 0 28.7
Trombosit 0 424

0
Neutrofil 0 84.4
Limfosit 0 10.1
Monosit 0 5.3
Eosinofil 0 0.2
Basofil 0 0
INDEX ERITROSIT 0
MCV 0 75.5
MCH 0 24.3
MCHC 0 32.2
RDW-CV 0 18.3
NLR 0 8.36
074179 RUDI KRISTANTO

2023/04/23/000020 (Poli : IGD) Ela Yulianti, A.Md.Kes. 4/23/2023

2 86,000
UREUM 0 75.1
CREATININ 0 2.2
TLAB00006 GLUKOSA

0 106
TLAB00014 ALBUMIN
40,000
Albumin 0 3.3
TLAB00019 ELEKTROLIT
237,000
Kalium 0 4
Natrium 0 134
Clorida 0 107
TLAB00023 HBSAG
59,500
HBSAG 0 Negatif
074179 RUDI KRISTANTO

2023/04/23/000020 (Poli : IGD) Ela Yulianti, A.Md.Kes. 4/23/2023
J002065 HEMOSTASIS
30,000
Waktu Perdarahan ( BT )
0 1
Waktu Pembekuan ( CT )
0 11
J002111 DARAH
LENGKAP 90,000
Leukosit 0 13.64
Eritrosit 0 4.09
Hemoglobin 0 12.3
Hematokrit 0 36
Trombosit 0 223

0
Neutrofil 0 85.8
Limfosit 0 5.6
Monosit 0 8.4
Eosinofil 0 0.2
Basofil 0 0
INDEX ERITROSIT 0
MCV 0 88.1
MCH 0 30.1
MCHC 0 34.1
RDW-CV 0 12.4
NLR 0 15.32

203611 NUR HAYANTI
2023/04/23/000019 (Poli : LABORATORIUM) Ela Yulianti, A.Md.Kes. 4/23/2023
J002111 DARAH
LENGKAP 90,000
Leukosit 0 7.03
Eritrosit 0 4.83
Hemoglobin 0 13.4
Hematokrit 0 39.6
Trombosit 0 143

0
Neutrofil 0 82.6
Limfosit 0 14.2
Monosit 0 3
Eosinofil 0 0.2
Basofil 0 0
INDEX ERITROSIT 0
MCV 0 82
MCH 0 27.8
MCHC 0 33.9
RDW-CV 0 12.5
NLR 0 5.82

157725 ALEXANDRA
INEZ NATHANIA (Poli :
J002111 DARAH
LENGKAP 90,000
Leukosit 0 3.9
Eritrosit 0 4.56
Hemoglobin 0 13.3
Hematokrit 0 40
Trombosit 0 186

0
Neutrofil 0 71.6
Limfosit 0 20.3
Monosit 0 7.9
Eosinofil 0 0.2
Basofil 0 0
INDEX ERITROSIT 0
MCV 0 87.7
MCH 0 29.2
MCHC 0 33.3
RDW-CV 0 13.6
NLR 0 3.53
TLAB00022 WIDAL
59,500
Salmonella typhi O 0 POSITIF 1/80
H0 Negatif

0 Negatif
126538 SUWATNI (Poli : Siti Assyifa Innayah,

2023/04/23/000012 IGD) A.Md.Kep. 4/23/2023
TLAB00006 GLUKOSA

0 194

203608 BY NY NOVITA
KHUSNUL AZIZAH (Poli :

TLAB00602 GLUKOSA
DARAH SEWAKTU BAYI
33,000
Glukosa Darah Sewaktu

Bayi 0 87

167389 KAYLA NOR
ASYANI (Poli :
J002111 DARAH
LENGKAP 90,000
Leukosit 0 9.99
Eritrosit 0 4.72
Hemoglobin 0 12.3
Hematokrit 0 37.5
Trombosit 0 300

0
Neutrofil 0 67.9
Limfosit 0 24.9
Monosit 0 6.2
Eosinofil 0 1
Basofil 0 0
INDEX ERITROSIT 0
MCV 0 79.4
MCH 0 26.1
MCHC 0 32.8
RDW-CV 0 12.6
NLR 0 2.73
114747 SUYAMI (Poli : Siti Assyifa Innayah,

2023/04/22/000026 IGD) A.Md.Kep. 4/22/2023

TLAB00006 GLUKOSA

0
076882 SITI MARYAM

2023/04/22/000007 (Poli : LABORATORIUM) Yuni Nurul Azizah, A. Md. 4/22/2023
J002111 DARAH
LENGKAP 90,000
Leukosit 0 7.5
Eritrosit 0 4.46
Hemoglobin 0 12.9
Hematokrit 0 38.9
Trombosit 0 238

0
Neutrofil 0 57.5
Limfosit 0 34.4
Monosit 0 6
Eosinofil 0 2.1
Basofil 0 0
INDEX ERITROSIT 0
MCV 0 87.4
MCH 0 29
MCHC 0 33.1
RDW-CV 0 12
NLR 0 1.67

203587 ELYSIA VALA
MAHARANI (Poli :
J002111 DARAH
LENGKAP 90,000
Leukosit 0 11,85
Eritrosit 0 4,91
Hemoglobin 0 13,3
Hematokrit 0 39,6
Trombosit 0 471
0
Neutrofil 0 79,3
Limfosit 0 13,9
Monosit 0 4,1
Eosinofil 0 2,7
Basofil 0 0,0
INDEX ERITROSIT 0
MCV 0 80,7
MCH 0 27,2
MCHC 0 33,7
RDW-CV 0 13,2
NLR 0 5,71
TLAB00002 GOLONGAN
DARAH 23,000
Golongan Darah 0 A RH (+)
TLAB00022 WIDAL
59,500

H0 Negatif

0 Negatif

129276 HJ.YULIATIN
KARDINAH (Poli :

19 Antigen 80,000

20 Negatif

194452 RADEN RARA
YULIA ANINDYA
PRANAWANINGSIH

19 Antigen 80,000

20 POSITIF
201933 GANJAR Siti Assyifa Innayah,

2023/04/21/000034 GANDARA (Poli : IGD) A.Md.Kep. 4/21/2023

TLAB00006 GLUKOSA

0 128

124300 ADZKIA SAMHA
SAUFA (Poli :
J002111 DARAH
LENGKAP 90,000
Leukosit 0 8,26
Eritrosit 0 4,20
Hemoglobin 0 12,0
Hematokrit 0 36,0
Trombosit 0 220

0
Neutrofil 0 62,0
Limfosit 0 28,6
Monosit 0 8,9
Eosinofil 0 0,5
Basofil 0 0,0
INDEX ERITROSIT 0
MCV 0 85,8
MCH 0 28,5
MCHC 0 33,2
RDW-CV 0 13,1
NLR 0 2,17
TLAB00022 WIDAL
59,500
H0 Negatif

0 Negatif
165512 PARLIAH (Poli :

2023/04/21/000012 IGD) Sulistyani, A.Md. 4/21/2023
J002111 DARAH
LENGKAP 90,000
Leukosit 0 10,10
Eritrosit 0 3,80
Hemoglobin 0 10,6
Hematokrit 0 32,8
Trombosit 0 393

0
Neutrofil 0 66,7
Limfosit 0 21,4
Monosit 0 7,4
Eosinofil 0 4,5
Basofil 0 0,0
INDEX ERITROSIT 0
MCV 0 86,4
MCH 0 27,8
MCHC 0 32,2
RDW-CV 0 12,9
NLR 0 3,12
TLAB00006 GLUKOSA

0 140

175911 NARAYA
HAFIDZAH AL NILAM
2023/04/21/000006 (Poli : LABORATORIUM) Ela Yulianti, A.Md.Kes. 4/21/2023
J002111 DARAH
LENGKAP 90,000
Leukosit 0 10.79
Eritrosit 0 4.45
Hemoglobin 0 12.6
Hematokrit 0 38.1
Trombosit 0 196

0
Neutrofil 0 65.1
Limfosit 0 29
Monosit 0 5.9
Eosinofil 0 0
Basofil 0 0
INDEX ERITROSIT 0
MCV 0 85.7
MCH 0 28.3
MCHC 0 33.1
RDW-CV 0 13.2
NLR 0 2.24
TLAB00022 WIDAL
59,500
H0 Negatif

0 Negatif
132020 MARKINI (Poli :


2 86,000
UREUM 0 27.4
CREATININ 0 0.9
237,000
Kalium 0 3.9
Natrium 0 140
Clorida 0 105


33,000
Warna 0 Kuning Keruh
P.H. 0 6
B.J. 0 1.025
Protein 0 Negatif
Reduksi 0 Negatif
Bilirubin 0 Negatif
Keton 0 Negatif
Sedimen 0
Leukosit 0 >25
Eritrosit 0 2-Mar
Epitel Sel 0 3-Apr
Silinder 0 Negatif
Kristal 0 Negatif
Lain-lain 0 Blood (+) Leukosit (+)

J002111 DARAH
LENGKAP 90,000
Leukosit 0 9.28
Eritrosit 0 4.31
Hemoglobin 0 10.7
Hematokrit 0 33.7
Trombosit 0 496

0
Neutrofil 0 46.6
Limfosit 0 43.1
Monosit 0 3.9
Eosinofil 0 6.4
Basofil 0 0
INDEX ERITROSIT 0
MCV 0 78.2
MCH 0 24.8
MCHC 0 31.7
RDW-CV 0 13.8
NLR 0 1.08
132020 MARKINI (Poli : Azin Aulia Dewatri,

2023/04/20/000100 Poli Bedah) A.Md.Kep 4/20/2023
TLAB00006 GLUKOSA

0 135
169869 ARIYANTO (Poli :


19 Antigen 80,000

20 NEGATIF

115846 EVAN BAYANAKA
FAUZI (Poli :
J002111 DARAH
LENGKAP 90,000
Leukosit 0 4.13
Eritrosit 0 6.26
Hemoglobin 0 13.7
Hematokrit 0 41.6
Trombosit 0 245

0
Neutrofil 0 55.7
Limfosit 0 37.2
Monosit 0 4.6
Eosinofil 0 2.5
Basofil 0 0
INDEX ERITROSIT 0
MCV 0 66.5
MCH 0 21.9
MCHC 0 32.9
RDW-CV 0 13.1
NLR 0 1.5

203576 MAURITZA
KALYNN PRADITYO (Poli :

19 Antigen 80,000

20 NEGATIF

203577 RAFARDANISH
FABYAN PRADITYO (Poli :

19 Antigen 80,000

20 NEGATIF
187697 ADITYO CAHYADI

2023/04/20/000092 (Poli : LABORATORIUM) Yuni Nurul Azizah, A. Md. 4/20/2023

19 Antigen 80,000

20 POSITIF
203566 MUZAENAH (Poli

2023/04/20/000057 : Poli Kandungan) Annies Fadhilah, A.Md. 4/20/2023
J002111 DARAH
LENGKAP 90,000
Leukosit 0 8,21
Eritrosit 0 3,96
Hemoglobin 0 11,3
Hematokrit 0 34,5
Trombosit 0 327

0
Neutrofil 0 57,0
Limfosit 0 34,1
Monosit 0 7,1
Eosinofil 0 1,8
Basofil 0 0,0
INDEX ERITROSIT 0
MCV 0 87,1
MCH 0 28,6
MCHC 0 32,9
RDW-CV 0 13,3
NLR 0 1,67
055135 HAKEYAH (Poli :

TLAB00006 GLUKOSA

0 107
TLAB00010 ASAM URAT

43,000
ASAM URAT 0 5,0
TLAB00015
CHOLESTEROL 41,500
Cholesterol 0 181

203565 ALIF BINTHA
FACHRUDIN (Poli :
J002111 DARAH
LENGKAP 90,000
Leukosit 0 8,71
Eritrosit 0 5,14
Hemoglobin 0 15,1
Hematokrit 0 43,5
Trombosit 0 333

0
Neutrofil 0 52,1
Limfosit 0 37,5
Monosit 0 5,6
Eosinofil 0 4,7
Basofil 0 0,1
INDEX ERITROSIT 0
MCV 0 84,6
MCH 0 29,4
MCHC 0 34,7
RDW-CV 0 13,2
NLR 0 1,39
TLAB00022 WIDAL
59,500
H0 Negatif

0 Negatif

170418 RANGGA
BIMANTARA (Kamar :
ANGGREKBED3,
2023/04/19/000004 ANGGREK) Ela Yulianti, A.Md.Kes. 4/20/2023
J002112 DARAH
LENGKAP 90,000
Leukosit 0 6.09
Eritrosit 0 4.36
Hemoglobin 0 11.6
Hematokrit 0 35.1
Trombosit 0 175

0
Neutrofil 0 58.8
Limfosit 0 27.7
Monosit 0 13.1
Eosinofil 0 0.3
Basofil 0 0.1
INDEX ERITROSIT 0
MCV 0 80.4
MCH 0 26.6
MCHC 0 33.1
RDW-CV 0 13.4
NLR 0 2.12
TLAB00146 DENGUE
ANTIBODI 200,000
Dengue Ig M 0 Negatif
Dengue Ig G 0 Negatif

200095 MUHAMMAD
ATTARAZKA AL MUZAKKI
(Kamar : ANGGREKBED4,
J002112 DARAH
LENGKAP 90,000
Leukosit 0 4.44
Eritrosit 0 5.5
Hemoglobin 0 11.1
Hematokrit 0 34.2
Trombosit 0 246

0
Neutrofil 0 32
Limfosit 0 64.3
Monosit 0 3.2
Eosinofil 0 0.4
Basofil 0 0.1
INDEX ERITROSIT 0
MCV 0 62.2
MCH 0 20.1
MCHC 0 32.4
RDW-CV 0 15.8
NLR 0 0.5

200614 SAMUEL KENZIE
PUTRA WIBOWO (Poli :
J002111 DARAH
LENGKAP 90,000
Leukosit 0 11.09
Eritrosit 0 4.42
Hemoglobin 0 12.2
Hematokrit 0 35.5
Trombosit 0 218

0
Neutrofil 0 62.3
Limfosit 0 30.5
Monosit 0 7.2
Eosinofil 0 0
Basofil 0 0
INDEX ERITROSIT 0
MCV 0 80.2
MCH 0 27.6
MCHC 0 34.4
RDW-CV 0 13.6
NLR 0 2.04

195337 GEOVANO
ZAYDAN RAFENDRA (Poli
2023/04/19/000117 : LABORATORIUM) Yuni Nurul Azizah, A. Md. 4/19/2023
J002111 DARAH
LENGKAP 90,000
Leukosit 0 18,11
Eritrosit 0 4,39
Hemoglobin 0 10,8
Hematokrit 0 32,5
Trombosit 0 261

0
Neutrofil 0 62,6
Limfosit 0 28,3
Monosit 0 7,9
Eosinofil 0 1,2
Basofil 0 0,0
INDEX ERITROSIT 0
MCV 0 74,0
MCH 0 24,5
MCHC 0 33,1
RDW-CV 0 13,4
NLR 0 2,21

203556 ERMA PUSPITA
DEWI (Poli :

J002111 DARAH
LENGKAP 90,000
Leukosit 0 14.35
Eritrosit 0 3.48
Hemoglobin 0 12
Hematokrit 0 35.5
Trombosit 0 152

0
Neutrofil 0 84.6
Limfosit 0 10.8
Monosit 0 4.1
Eosinofil 0 0.5
Basofil 0 0
INDEX ERITROSIT 0
MCV 0 102.1
MCH 0 34.5
MCHC 0 33.8
RDW-CV 0 14.7
NLR 0 7.82

203553 MUHAMMAD
RIFQI (Poli : Mega Tri Wulandari,
J002111 DARAH
LENGKAP 90,000
Leukosit 0 4,91
Eritrosit 0 5,20
Hemoglobin 0 13,7
Hematokrit 0 41,3
Trombosit 0 223

0
Neutrofil 0 51,1
Limfosit 0 39,8
Monosit 0 8,3
Eosinofil 0 0,8
Basofil 0 0,0
INDEX ERITROSIT 0
MCV 0 79,5
MCH 0 26,4
MCHC 0 33,3
RDW-CV 0 12,7
NLR 0 1,28
TLAB00022 WIDAL
59,500
H0 Negatif

0 Negatif
111619 ANDRIYANI Mega Tri Wulandari,

J000036 GLUKOSA
DARAH PUASA 28,000
Glukosa Puasa 0 101

1 129,000
ASAM URAT 0 5,2
UREUM 0 21,2
CREATININ 0 0,8
TLAB00015
CHOLESTEROL 41,500
Cholesterol 0 199

086836 SUPARDI
(Kamar : MLT.03-02,
2023/04/17/000051 MELATI) Ragil Pangestu W., A.Md. 4/19/2023
J002113 DARAH
LENGKAP 95,500
Leukosit 0 6.62
Eritrosit 0 4.19
Hemoglobin 0 13
Hematokrit 0 38
Trombosit 0 110
0
Neutrofil 0 65.7
Limfosit 0 25.2
Monosit 0 8.8
Eosinofil 0 0.3
Basofil 0 0
INDEX ERITROSIT 0
MCV 0 90.9
MCH 0 31
MCHC 0 34.1
RDW-CV 0 12.7
NLR 0 2.6

170418 RANGGA
BIMANTARA (Kamar :
ANGGREKBED3,
2023/04/19/000004 ANGGREK) Ragil Pangestu W., A.Md. 4/19/2023
J002111 DARAH
LENGKAP 90,000
Leukosit 0 8.37
Eritrosit 0 4.62
Hemoglobin 0 12.1
Hematokrit 0 36.9
Trombosit 0 197

0
Neutrofil 0 77.2
Limfosit 0 14.3
Monosit 0 8.4
Eosinofil 0 0.1
Basofil 0 0
INDEX ERITROSIT 0
MCV 0 79.9
MCH 0 26.3
MCHC 0 32.9
RDW-CV 0 13.6
NLR 0 5.4
TLAB00006 GLUKOSA

0 102

203547 SHOLEKHA
ARYANI (Poli :
J002111 DARAH
LENGKAP 90,000
Leukosit 0 13.22
Eritrosit 0 4.69
Hemoglobin 0 12.9
Hematokrit 0 39.4
Trombosit 0 258

0
Neutrofil 0 76.2
Limfosit 0 19.7
Monosit 0 4
Eosinofil 0 0.1
Basofil 0 0
INDEX ERITROSIT 0
MCV 0 84
MCH 0 27.5
MCHC 0 32.8
RDW-CV 0 12.2
NLR 0 3.87

163560 MUHAMMAD
ABRIZAM ARSHAD AL
FAREZI (Poli :
J002111 DARAH
LENGKAP 90,000
Leukosit 0 18,31
Eritrosit 0 4,98
Hemoglobin 0 10,7
Hematokrit 0 33,6
Trombosit 0 570

0
Neutrofil 0 84,7
Limfosit 0 9,6
Monosit 0 5,0
Eosinofil 0 0,7
Basofil 0 0,0
INDEX ERITROSIT 0
MCV 0 67,5
MCH 0 21,5
MCHC 0 31,9
RDW-CV 0 12,6
NLR 0 8,82
TLAB00022 WIDAL
59,500

H0 Negatif

0 Negatif

086836 SUPARDI
(Kamar : MLT.03-02,
J002113 DARAH
LENGKAP 95,500
Leukosit 0 7.26
Eritrosit 0 4.71
Hemoglobin 0 14.3
Hematokrit 0 42.4
Trombosit 0 123

0
Neutrofil 0 72.4
Limfosit 0 18.6
Monosit 0 8.8
Eosinofil 0 0.2
Basofil 0 0
INDEX ERITROSIT 0
MCV 0 90
MCH 0 30.3
MCHC 0 33.6
RDW-CV 0 12.8
NLR 0 3.89

086836 SUPARDI
(Kamar : MLT.03-02,
J002072 LFT 90,000
SGOT / ASTL 0 210
SGPT / ALTL 0 178
203529 MUJONO (Poli :


J002029 PROFIL LIPID
139,000
CHOLESTEROL 0 158
TRIGLYCERIDA 0 176
HDL CHOLESTEROL 0 54
LDL CHOLESTEROL 0 69
J002111 DARAH
LENGKAP 90,000
Leukosit 0 4.69
Eritrosit 0 4.53
Hemoglobin 0 13.4
Hematokrit 0 41
Trombosit 0 163

0
Neutrofil 0 40.3
Limfosit 0 46.8
Monosit 0 11
Eosinofil 0 1.8
Basofil 0 0.1
INDEX ERITROSIT 0
MCV 0 90.6
MCH 0 29.6
MCHC 0 32.7
RDW-CV 0 13
NLR 0 0.86

043409 RAMADHANDI
RAIHAN FATIH
WIJAYANTO (Poli :

19 Antigen 80,000

20 NEGATIF

203530 MIFTA
KHUSAKDIAH ABDUL
JALAL (Poli :
J002111 DARAH
LENGKAP 90,000
Leukosit 0 10.77
Eritrosit 0 3.56
Hemoglobin 0 9.9
Hematokrit 0 31.7
Trombosit 0 194

0
Neutrofil 0 72.7
Limfosit 0 21.4
Monosit 0 5
Eosinofil 0 0.9
Basofil 0 0
INDEX ERITROSIT 0
MCV 0 89.2
MCH 0 27.9
MCHC 0 31.3
RDW-CV 0 13.3
NLR 0 3.4

203519 IDRIS ADI
SUDIBYO (Poli : Poli
2023/04/17/000082 Umum) Ela Yulianti, A.Md.Kes. 4/17/2023
J002125 NARKOBA
150,000
Opiat / Morphin 0 Negatif
Ganja / Canabis 0 Negatif
Amphetamin 0 Negatif
Methamphetamin 0 Negatif
Benzodiazepin 0 Negatif
Cocain 0 Negatif

169593 AYATUL HUSNA
ALFATHUNISA (Poli :
J002111 DARAH
LENGKAP 90,000
Leukosit 0 6.14
Eritrosit 0 4.27
Hemoglobin 0 11.2
Hematokrit 0 34.6
Trombosit 0 247

0
Neutrofil 0 35.2
Limfosit 0 58.2
Monosit 0 6.3
Eosinofil 0 0.3
Basofil 0 0
INDEX ERITROSIT 0
MCV 0 81
MCH 0 26.3
MCHC 0 32.4
RDW-CV 0 14.7
NLR 0 0.6
TLAB00022 WIDAL
59,500
H0 Negatif

0 Negatif

093327 BACHTIAR
AFFENDY (Poli :
J002060 LIPID 89,500
Cholesterol 0 173
Triglycerida 0 279
TLAB00012 CREATININ
43,000
CREATININ 0 1.1

177439 BAYU ISNANDI
SAPUTRA (Poli :

J002111 DARAH
LENGKAP 90,000
Leukosit 0 16.39
Eritrosit 0 4.96
Hemoglobin 0 12.5
Hematokrit 0 38.1
Trombosit 0 489

0
Neutrofil 0 74.9
Limfosit 0 20.1
Monosit 0 3.5
Eosinofil 0 1.5
Basofil 0 0
INDEX ERITROSIT 0
MCV 0 76.9
MCH 0 25.1
MCHC 0 32.7
RDW-CV 0 13.4
NLR 0 3.73
TLAB00022 WIDAL
59,500
H0 Negatif

0 Negatif

086836 SUPARDI
(Kamar : MLT.03-02,
2023/04/17/000051 MELATI) Ela Yulianti, A.Md.Kes. 4/17/2023
J002111 DARAH
LENGKAP 90,000
Leukosit 0 4.28
Eritrosit 0 4.71
Hemoglobin 0 14.4
Hematokrit 0 43.2
Trombosit 0 110
0
Neutrofil 0 74.9
Limfosit 0 19.1
Monosit 0 5.7
Eosinofil 0 0.3
Basofil 0 0
INDEX ERITROSIT 0
MCV 0 91.7
MCH 0 30.7
MCHC 0 33.4
RDW-CV 0 12.6
NLR 0 3.92
TLAB00006 GLUKOSA

0 135
TLAB00022 WIDAL
59,500
H0 Negatif

0 Negatif

200095 MUHAMMAD
ATTARAZKA AL MUZAKKI
(Kamar : ANGGREKBED4,
J002111 DARAH
LENGKAP 90,000
Leukosit 0 10.25
Eritrosit 0 5.37
Hemoglobin 0 10.8
Hematokrit 0 34.1
Trombosit 0 317

0
Neutrofil 0 34.6
Limfosit 0 53.9
Monosit 0 10.5
Eosinofil 0 1
Basofil 0 0
INDEX ERITROSIT 0
MCV 0 63.4
MCH 0 20.1
MCHC 0 31.7
RDW-CV 0 15.6
NLR 0 0.64

203513 BARTHOLOMEUS
BALOK (Kamar : MLT.04-
2023/04/16/000030 02, MELATI) Ragil Pangestu W., A.Md. 4/16/2023
J002111 DARAH
LENGKAP 90,000
Leukosit 0 10.6
Eritrosit 0 5.55
Hemoglobin 0 13.4
Hematokrit 0 39.5
Trombosit 0 280

0
Neutrofil 0 76.4
Limfosit 0 16.3
Monosit 0 6.3
Eosinofil 0 1
Basofil 0 0
INDEX ERITROSIT 0
MCV 0 71.2
MCH 0 24.1
MCHC 0 33.8
RDW-CV 0 13.1
NLR 0 4.69
086836 SUPARDI (Poli :

J002111 DARAH
LENGKAP 90,000
Leukosit 0 4,82
Eritrosit 0 4,75
Hemoglobin 0 14,9
Hematokrit 0 43,1
Trombosit 0 119

0
Neutrofil 0 74,3
Limfosit 0 19,4
Monosit 0 6,2
Eosinofil 0 0,1
Basofil 0 0,0
INDEX ERITROSIT 0
MCV 0 90,8
MCH 0 31,4
MCHC 0 34,5
RDW-CV 0 12,5
NLR 0 3,83
TLAB00022 WIDAL
59,500
H0 Negatif

0 Negatif

196423 DUFAN ACHMAD
FEBRIYUWANA (Poli : Mega Tri Wulandari,
TLAB00002 GOLONGAN
DARAH 23,000
Golongan Darah 0 A / Positif (+)
152830 NURHAYATI (Poli Siti Assyifa Innayah,

2023/04/15/000026 : IGD) A.Md.Kep. 4/15/2023

TLAB00006 GLUKOSA

0 117

203493 MANARUL
HIDAYAT (Poli :
TLAB00026 ANTI HIV

59,500
REAGEN 1 0 Non Reaktif
TLAB00115 VDRL
139,000
VDRL 0 Negatif
TLAB00116 TPHA
172,000

203495 DJAMIYEM
(Kamar : BOUGENVBED1, Mega Tri Wulandari,
2023/04/14/000079 BOUGENVILLE) A.Md. 4/14/2023

2 86,000
UREUM 0 17.7
CREATININ 0 0.6
TLAB00006 GLUKOSA

0 161
TLAB00014 ALBUMIN
40,000
Albumin 0 4.1
237,000
Kalium 0 4.1
Natrium 0 143
Clorida 0 109
TLAB00023 HBSAG
59,500
HBSAG 0 Negatif

203495 DJAMIYEM
(Kamar : BOUGENVBED1, Mega Tri Wulandari,
2023/04/14/000079 BOUGENVILLE) A.Md. 4/14/2023

J002065 HEMOSTASIS
30,000
0 1
0 10
J002111 DARAH
LENGKAP 90,000
Leukosit 0 16,34
Eritrosit 0 4,73
Hemoglobin 0 13,7
Hematokrit 0 40,9
Trombosit 0 403

0
Neutrofil 0 93,4
Limfosit 0 4,4
Monosit 0 0,9
Eosinofil 0 1,3
Basofil 0 0,0
INDEX ERITROSIT 0
MCV 0 86,5
MCH 0 29,1
MCHC 0 33,6
RDW-CV 0 12,8
NLR 0 21,23

045470 H KOENARYO
HADIKUSUMO (Poli : Mega Tri Wulandari,
2023/04/14/000038 IGD) A.Md. 4/14/2023
TLAB00006 GLUKOSA

0 145
TLAB00010 ASAM URAT

43,000
ASAM URAT 0 6,4

193449 GUSTI ANNASA
SHADIQ (Poli :
J002125 NARKOBA
150,000
Cocain 0 Negatif

016237 AMAT YATIN
(Poli : Poli Kulit dan
2023/04/13/000052 Kelamin) Ayu Aryani 4/13/2023
TLAB00006 GLUKOSA

0 132

203474 ABISATYA ARYA
MURTI (Poli :
J002111 DARAH
LENGKAP 90,000
Leukosit 0 5.59
Eritrosit 0 5.06
Hemoglobin 0 15.1
Hematokrit 0 43.8
Trombosit 0 238

0
Neutrofil 0 48.5
Limfosit 0 43.4
Monosit 0 7.4
Eosinofil 0 0.7
Basofil 0 0
INDEX ERITROSIT 0
MCV 0 86.6
MCH 0 29.8
MCHC 0 34.4
RDW-CV 0 12.9
NLR 0 1.12
TLAB00022 WIDAL
59,500
H0 Negatif

0 Negatif

175146 SITI
SULISTYOWATI (Poli :
J000036 GLUKOSA
DARAH PUASA 28,000
Glukosa Puasa 0 111
J002060 LIPID 89,500
Cholesterol 0 172
Triglycerida 0 133
TLAB00010 ASAM URAT

43,000
ASAM URAT 0 4.7

203469 AFNAN ATMA
PRAYOGA (Poli : Mega Tri Wulandari,
J002111 DARAH
LENGKAP 90,000
Leukosit 0 9,07
Eritrosit 0 4,20
Hemoglobin 0 11,9
Hematokrit 0 33,9
Trombosit 0 429

0
Neutrofil 0 57,7
Limfosit 0 33,4
Monosit 0 8,4
Eosinofil 0 0,5
Basofil 0 0,0
INDEX ERITROSIT 0
MCV 0 80,5
MCH 0 26,6
MCHC 0 33,0
RDW-CV 0 13,8
NLR 0 1,73
TLAB00022 WIDAL
59,500
H0 Negatif

0 Negatif
203469 AFNAN ATMA

2023/04/12/000158 PRAYOGA (Poli : IGD) Bela Virawati, A.Md.Kep 4/12/2023
J002111 DARAH
LENGKAP 90,000
TLAB00022 WIDAL
59,500

202782 ALIYYAH
KHOIRUNNISSA (Poli : Mega Tri Wulandari,
J002111 DARAH
LENGKAP 90,000
Leukosit 0 9,09
Eritrosit 0 5,23
Hemoglobin 0 12,8
Hematokrit 0 39,8
Trombosit 0 292

0
Neutrofil 0 67,2
Limfosit 0 24,9
Monosit 0 5,4
Eosinofil 0 2,5
Basofil 0 0,0
INDEX ERITROSIT 0
MCV 0 76,2
MCH 0 24,6
MCHC 0 32,2
RDW-CV 0 12,6
NLR 0 2,70
TLAB00022 WIDAL
59,500
Salmonella typhi O 0 Positif 1/80
H0 Negatif

0 Negatif

203459 NABILLA AYU
ADILIA PRAMESTI (Poli :
J002111 DARAH
LENGKAP 90,000
Leukosit 0 7,04
Eritrosit 0 4,89
Hemoglobin 0 12,3
Hematokrit 0 37,4
Trombosit 0 237

0
Neutrofil 0 54,4
Limfosit 0 37,5
Monosit 0 7,6
Eosinofil 0 0,5
Basofil 0 0,0
INDEX ERITROSIT 0
MCV 0 76,5
MCH 0 25,1
MCHC 0 32,8
RDW-CV 0 13,2
NLR 0 1,45
TLAB00022 WIDAL
59,500

H0 Negatif

0 Negatif

174275 NOVA AYU
SULISTIOWATI (Poli :
2023/04/12/000004 IGD) Annies Fadhilah, A.Md. 4/12/2023

19 Antigen 80,000

20 Negatif
167298 SULTHONI (Poli : Brillyana Artamevia,

2023/04/12/000001 IGD) A.Md.Kep. 4/12/2023
TLAB00006 GLUKOSA

0 156

203439 ANNY
KURNIAWATI (Poli :
TLAB00026 ANTI HIV

59,500

197661 ALZENA MISHALL
SAMAIRA FIRDAUS (Poli :
J002111 DARAH
LENGKAP 90,000
Leukosit 0 6.6
Eritrosit 0 4.78
Hemoglobin 0 9.7
Hematokrit 0 30.3
Trombosit 0 227

0
Neutrofil 0 34.8
Limfosit 0 54.9
Monosit 0 9.9
Eosinofil 0 0.4
Basofil 0 0
INDEX ERITROSIT 0
MCV 0 63.3
MCH 0 20.2
MCHC 0 31.9
RDW-CV 0 18.8
NLR 0 0.63

006705 SUCI
WULANSARI (Poli :
J002111 DARAH
LENGKAP 90,000
Leukosit 0 4.74
Eritrosit 0 5.01
Hemoglobin 0 14.8
Hematokrit 0 44.3
Trombosit 0 181

0
Neutrofil 0 55.1
Limfosit 0 33.1
Monosit 0 11.1
Eosinofil 0 0.7
Basofil 0 0
INDEX ERITROSIT 0
MCV 0 88.4
MCH 0 29.5
MCHC 0 33.3
RDW-CV 0 12.8
NLR 0 1.66
TLAB00022 WIDAL
59,500
H0 Negatif

0 Negatif
200701 AQILA
NAFISATUZ ZAHRA (Poli :
2023/04/11/000001 IGD) Abbas Herlan, A.Md.Kes 4/11/2023
J002111 DARAH
LENGKAP 90,000
Leukosit 0 7.41
Eritrosit 0 4.77
Hemoglobin 0 13.2
Hematokrit 0 39.5
Trombosit 0 382

0
Neutrofil 0 49
Limfosit 0 38.6
Monosit 0 6.9
Eosinofil 0 5.4
Basofil 0 0.1
INDEX ERITROSIT 0
MCV 0 82.8
MCH 0 27.6
MCHC 0 33.3
RDW-CV 0 12
NLR 0 1.27
TLAB00022 WIDAL
59,500
H0 Negatif

0 Negatif
203428 KAYLA TIMOTY

2023/04/10/000158 (Poli : LABORATORIUM) Abbas Herlan, A.Md.Kes 4/10/2023
J002111 DARAH
LENGKAP 90,000
Leukosit 0 7.96
Eritrosit 0 4.31
Hemoglobin 0 11.6
Hematokrit 0 34.3
Trombosit 0 219

0
Neutrofil 0 60.8
Limfosit 0 28.3
Monosit 0 10.9
Eosinofil 0 0
Basofil 0 0
INDEX ERITROSIT 0
MCV 0 79.5
MCH 0 27
MCHC 0 33.9
RDW-CV 0 13.2
NLR 0 2.15
TLAB00022 WIDAL
59,500
H0 Negatif

0 Negatif
198263 KALIMAN (Kamar

2023/04/09/000017 : MLT.02-01, MELATI) Annies Fadhilah, A.Md. 4/10/2023
TLAB00277 FAECES
RUTIN 38,000
Makroskopis 0
Warna 0 Coklat
Konsistensi 0 Lembek
Lendir 0 Negatif
Darah 0 Negatif
Lain Lain 0 Negatif
Mikroskopis 0
Leucosit 0 Negatif
Erytrosit 0 Negatif
Amoeba 0 Negatif
Kista 0 Negatif
Telur ascaris 0 Negatif
Ankylos 0 Ancylostoma (+)
Oxyuris 0 Negatif
Lain Lain 0 Negatif

203421 MUHAMMAD
UBAIDILLAH NUR IMAN
TLAB00026 ANTI HIV

59,500
196029 MUH.RIFAT AL
2023/04/09/000039 HANAN (Poli : IGD) Abbas Herlan, A.Md.Kes 4/9/2023
TLAB00027 DENGUE
ANTIBODI 243,000
Dengue Ig M 0 Negatif
Dengue Ig G 0 Negatif
186123 TUMINI (Poli :

2023/04/09/000041 IGD) Ribut T 4/9/2023
TLAB00006 GLUKOSA

0 351

196029 MUH.RIFAT AL
HANAN (Poli :
J002111 DARAH
LENGKAP 90,000
Leukosit 0 5.56
Eritrosit 0 4.72
Hemoglobin 0 12.2
Hematokrit 0 37.7
Trombosit 0 207
0
Neutrofil 0 43.7
Limfosit 0 46.9
Monosit 0 9.2
Eosinofil 0 0.2
Basofil 0 0
INDEX ERITROSIT 0
MCV 0 79.8
MCH 0 25.7
MCHC 0 32.3
RDW-CV 0 12.8
NLR 0 0.93
TLAB00022 WIDAL
59,500
H0 Negatif
0 Negatif
023149 MURYANI
2023/04/09/000036 LESTARI (Poli : IGD) Yuni Nurul Azizah, A. Md. 4/9/2023

139,000
CHOLESTEROL 0 169
TRIGLYCERIDA 0 161
TLAB00006 GLUKOSA

0 113
TLAB00010 ASAM URAT

43,000
ASAM URAT 0 5.4

203406 DINDA KURNIA
MUKTI (Kamar : MLT.03-
2023/04/09/000013 01, MELATI) Yuni Nurul Azizah, A. Md. 4/9/2023
J002115 DARAH
LENGKAP 105,500
Leukosit 0 9.65
Eritrosit 0 4.42
Hemoglobin 0 12.8
Hematokrit 0 38.4
Trombosit 0 263

0
Neutrofil 0 74.5
Limfosit 0 21.1
Monosit 0 3.9
Eosinofil 0 0.5
Basofil 0 0
INDEX ERITROSIT 0
MCV 0 86.9
MCH 0 28.9
MCHC 0 33.2
RDW-CV 0 11.8
NLR 0 3.53

203409 NATASHA
JORDAN (Poli :

19 Antigen 80,000

20 NEGATIF
198263 KALIMAN (Kamar

2023/04/09/000017 : MLT.02-01, MELATI) Yuni Nurul Azizah, A. Md. 4/9/2023
J002111 DARAH
LENGKAP 90,000
Leukosit 0 10.36
Eritrosit 0 3.93
Hemoglobin 0 12
Hematokrit 0 35.9
Trombosit 0 220

0
Neutrofil 0 83.7
Limfosit 0 8.5
Monosit 0 7.3
Eosinofil 0 0.5
Basofil 0 0
INDEX ERITROSIT 0
MCV 0 91.4
MCH 0 30.6
MCHC 0 33.4
RDW-CV 0 14
NLR 0 9.85
TLAB00006 GLUKOSA

0 160
0
203406 DINDA KURNIA
2023/04/09/000013 01, MELATI) Yuni Nurul Azizah, A. Md. 4/9/2023
J002115 DARAH
LENGKAP 105,500
Leukosit 0 14.12
Eritrosit 0 4.5
Hemoglobin 0 12.8
Hematokrit 0 38.5
Trombosit 0 297

0
Neutrofil 0 83
Limfosit 0 14
Monosit 0 2.9
Eosinofil 0 0.1
Basofil 0 0
INDEX ERITROSIT 0
MCV 0 85.7
MCH 0 28.6
MCHC 0 33.3
RDW-CV 0 11.9
NLR 0 5.93

203408 DEBORA
LITADYSNA (Poli :
J002111 DARAH
LENGKAP 90,000
Leukosit 0 1.44
Eritrosit 0 5.2
Hemoglobin 0 13.4
Hematokrit 0 40.1
Trombosit 0 82

0
Neutrofil 0 44.8
Limfosit 0 36.6
Monosit 0 18.4
Eosinofil 0 0.2
Basofil 0 0
INDEX ERITROSIT 0
MCV 0 77.2
MCH 0 25.8
MCHC 0 33.4
RDW-CV 0 13.3
NLR 0 1.22

090361 ALEXANDER
BAYU (Poli :

19 Antigen 80,000

20 Negatif

036519 HJS WIDIARTO,
DRS (Poli :

2 86,000
UREUM 0 40.8
CREATININ 0 1.5
J002111 DARAH
LENGKAP 90,000
Leukosit 0 9.13
Eritrosit 0 4.67
Hemoglobin 0 11
Hematokrit 0 34.2
Trombosit 0 247

0
Neutrofil 0 73.9
Limfosit 0 23.5
Monosit 0 2.2
Eosinofil 0 0.4
Basofil 0 0
INDEX ERITROSIT 0
MCV 0 73.2
MCH 0 23.7
MCHC 0 32.3
RDW-CV 0 14.5
NLR 0 3.14
TLAB00006 GLUKOSA

0 93
237,000
Kalium 0 3.8
Natrium 0 142
Clorida 0 106

203406 DINDA KURNIA
2023/04/09/000013 01, MELATI) Ragil Pangestu W., A.Md. 4/9/2023

J002111 DARAH
LENGKAP 90,000
Leukosit 0 14.27
Eritrosit 0 4.72
Hemoglobin 0 13.8
Hematokrit 0 41.1
Trombosit 0 271

0
Neutrofil 0 84.5
Limfosit 0 11.1
Monosit 0 4.1
Eosinofil 0 0.3
Basofil 0 0
INDEX ERITROSIT 0
MCV 0 87
MCH 0 29.3
MCHC 0 33.6
RDW-CV 0 11.9
NLR 0 7.61
TLAB00006 GLUKOSA

0 88
149195 LULUKIN
2023/04/09/000014 MARPUAH (Poli : IGD) Ragil Pangestu W., A.Md. 4/9/2023
J002111 DARAH
LENGKAP 90,000
Leukosit 0 10.73
Eritrosit 0 4.84
Hemoglobin 0 13.6
Hematokrit 0 40.1
Trombosit 0 284

0
Neutrofil 0 84.2
Limfosit 0 11.2
Monosit 0 4.2
Eosinofil 0 0.4
Basofil 0 0
INDEX ERITROSIT 0
MCV 0 82.8
MCH 0 28.1
MCHC 0 33.9
RDW-CV 0 13.3
NLR 0 7.52
TLAB00006 GLUKOSA

0 105
188316 FAIZHA PUTRI

2023/04/09/000009 PUSPITA (Poli : IGD) Ragil Pangestu W., A.Md. 4/9/2023
J002111 DARAH
LENGKAP 90,000
Leukosit 0 14.65
Eritrosit 0 4.05
Hemoglobin 0 11.2
Hematokrit 0 33.4
Trombosit 0 377

0
Neutrofil 0 52.2
Limfosit 0 41.2
Monosit 0 6.5
Eosinofil 0 0.1
Basofil 0 0
INDEX ERITROSIT 0
MCV 0 82.5
MCH 0 27.7
MCHC 0 33.5
RDW-CV 0 12.3
NLR 0 1.27
TLAB00022 WIDAL
59,500
H0 Negatif

0 Negatif

203403 ANS NATSWA
TSANIA WARDHANI
2023/04/09/000004 (Poli : LABORATORIUM) Ragil Pangestu W., A.Md. 4/9/2023
J002125 NARKOBA
150,000
Cocain 0 Negatif

150087 RAKESH KUMAR
2023/04/08/000114 ANEJA (Poli : IGD) Abbas Herlan, A.Md.Kes 4/8/2023
J002111 DARAH
LENGKAP 90,000
Leukosit 0 3.82
Eritrosit 0 4.61
Hemoglobin 0 13.4
Hematokrit 0 40.1
Trombosit 0 215

0
Neutrofil 0 48.6
Limfosit 0 43.7
Monosit 0 7.6
Eosinofil 0 0.1
Basofil 0 0
INDEX ERITROSIT 0
MCV 0 86.8
MCH 0 29
MCHC 0 33.4
RDW-CV 0 12.6
NLR 0 1.11

201182 CEISYA IHZA
ZELMIRA (Poli : Poli
2023/04/08/000056 Anak) Annies Fadhilah, A.Md. 4/8/2023
J002111 DARAH
LENGKAP 90,000
Leukosit 0 8,46
Eritrosit 0 4,35
Hemoglobin 0 11,6
Hematokrit 0 34,9
Trombosit 0 350

0
Neutrofil 0 44,8
Limfosit 0 51,9
Monosit 0 3,0
Eosinofil 0 0,3
Basofil 0 0,0
INDEX ERITROSIT 0
MCV 0 80,2
MCH 0 26,7
MCHC 0 33,2
RDW-CV 0 13,3
NLR 0 0,86
TLAB00003 LED 20,000
LED I 0 8
LED II 0 12
159229 RISKA CAMALIA

J000036 GLUKOSA
DARAH PUASA 28,000
Glukosa Puasa 0 94

139,000
CHOLESTEROL 0 170
TRIGLYCERIDA 0 90
TLAB00010 ASAM URAT

43,000
ASAM URAT 0 5,6

201182 CEISYA IHZA
ZELMIRA (Poli : Poli
2023/04/08/000056 Anak) Annies Fadhilah, A.Md. 4/8/2023

TLAB00285 Gambaran
Darah Tepi ( GDT )
260,000
0
0
163195 NUR KANDIQ

2023/04/08/000045 (Poli : IGD) Annies Fadhilah, A.Md. 4/8/2023
J002060 LIPID 89,500
Cholesterol 0 127
Triglycerida 0 65
TLAB00006 GLUKOSA

0 122
TLAB00010 ASAM URAT

43,000
ASAM URAT 0 3,4

33,000
P.H. 0 6,0
B.J. 0 1,030
Protein 0 Negatif
Reduksi 0 Negatif
Bilirubin 0 Negatif
Keton 0 Negatif
Sedimen 0
Leukosit 0 6-Aug
Eritrosit 0 1-Feb
Epitel Sel 0 8-Oct
Silinder 0 Negatif
Kristal 0 Negatif
Lain-lain 0 Leukosit (+)

203378 DON TORNADO
ROSA (Kamar : MLT.04-
2023/04/07/000019 02, MELATI) Annies Fadhilah, A.Md. 4/8/2023

38,000
Warna 0 Kuning Jernih
P.H. 0 7,0
B.J. 0 1,015
Protein 0 Negatif
Reduksi 0 Negatif
Bilirubin 0 Negatif
Keton 0 Keton (+)
Sedimen 0
Leukosit 0 1-Feb
Eritrosit 0 2-Mar
Epitel Sel 0 2-Mar
Silinder 0 Negatif
Kristal 0 Negatif
Lain-lain 0 Blood (+)

153995 GIBRAN
MAULANA SYARIF
2023/04/08/000003 (Kamar : HCUBED3, HCU) Ela Yulianti, A.Md.Kes. 4/8/2023
J002111 DARAH
LENGKAP 90,000
Leukosit 0 9.77
Eritrosit 0 5.91
Hemoglobin 0 14.5
Hematokrit 0 42.9
Trombosit 0 296

0
Neutrofil 0 54.8
Limfosit 0 36.4
Monosit 0 6.5
Eosinofil 0 2.3
Basofil 0 0
INDEX ERITROSIT 0
MCV 0 72.6
MCH 0 24.5
MCHC 0 33.7
RDW-CV 0 14
NLR 0 1.51
187594 ZAHRA FITRI Dana Krismonika,

2023/04/07/000042 AINIYYAH (Poli : IGD) A.Md.Kep. 4/7/2023
TLAB00006 GLUKOSA

0 104
078892 SUPARDI (Poli : Brillyana Artamevia,

2023/04/07/000041 IGD) A.Md.Kep. 4/7/2023
TLAB00006 GLUKOSA

0 205

203378 DON TORNADO
ROSA (Kamar : MLT.04-
2023/04/07/000019 02, MELATI) Annies Fadhilah, A.Md. 4/7/2023

1 144,000
ASAM URAT 0 4,4
UREUM 0 25,1
CREATININ 0 0,7
J002062 LIPID 99,500
Cholesterol 0 174
Triglycerida 0 69

203378 DON TORNADO
ROSA (Kamar : MLT.04- Mega Tri Wulandari,
2023/04/07/000019 02, MELATI) A.Md. 4/7/2023
J002111 DARAH
LENGKAP 90,000
Leukosit 0 11,78
Eritrosit 0 4,80
Hemoglobin 0 13,7
Hematokrit 0 40,7
Trombosit 0 245

0
Neutrofil 0 90,7
Limfosit 0 5,9
Monosit 0 3,4
Eosinofil 0 0,0
Basofil 0 0,0
INDEX ERITROSIT 0
MCV 0 84,8
MCH 0 28,5
MCHC 0 33,5
RDW-CV 0 13,0
NLR 0 15,37
TLAB00006 GLUKOSA

0 114
0
009841 CHUSNU YAZID Mega Tri Wulandari,

TLAB00006 GLUKOSA

0 339
TLAB00010 ASAM URAT

43,000
ASAM URAT 0 4,2
TLAB00015
CHOLESTEROL 41,500
Cholesterol 0 226

092491 YOLANDA RIZKY
ROSTIANA (Poli :
J002111 DARAH
LENGKAP 90,000
Leukosit 0 4,37
Eritrosit 0 4,81
Hemoglobin 0 11,8
Hematokrit 0 42,2
Trombosit 0 240

0
Neutrofil 0 42,3
Limfosit 0 45,7
Monosit 0 11,8
Eosinofil 0 0,2
Basofil 0 0,0
INDEX ERITROSIT 0
MCV 0 87,9
MCH 0 28,9
MCHC 0 32,9
RDW-CV 0 11,4
NLR 0 0,93
TLAB00022 WIDAL
59,500

Salmonella typhi H 0 Positif 1/160
H0 Negatif

0 Negatif
199811 FAEYZA AFAF Mega Tri Wulandari,

2023/04/07/000008 ALTHARIO (Poli : IGD) A.Md. 4/7/2023
J002111 DARAH
LENGKAP 90,000
Leukosit 0 4,62
Eritrosit 0 4,87
Hemoglobin 0 13,5
Hematokrit 0 40,4
Trombosit 0 232

0
Neutrofil 0 70,0
Limfosit 0 23,0
Monosit 0 6,9
Eosinofil 0 0,1
Basofil 0 0,0
INDEX ERITROSIT 0
MCV 0 82,9
MCH 0 27,8
MCHC 0 33,5
RDW-CV 0 12,9
NLR 0 3,04
TLAB00022 WIDAL
59,500
H0 Negatif

0 Negatif
203371 AYUK BINTI

2023/04/06/000130 ASWARI (Poli : IGD) Ela Yulianti, A.Md.Kes. 4/6/2023

J002111 DARAH
LENGKAP 90,000
Leukosit 0 8.72
Eritrosit 0 4.77
Hemoglobin 0 13.2
Hematokrit 0 40.3
Trombosit 0 256

0
Neutrofil 0 75.6
Limfosit 0 15.6
Monosit 0 8.7
Eosinofil 0 0.1
Basofil 0 0
INDEX ERITROSIT 0
MCV 0 84.4
MCH 0 27.6
MCHC 0 32.7
RDW-CV 0 12.5
NLR 0 4.85
TLAB00022 WIDAL
59,500
H0 Negatif

0 Negatif

111341 MUHAMAD
ILHAM PUTRA
LESTIANTO (Poli :
TLAB00002 GOLONGAN
DARAH 23,000
Golongan Darah 0 O Rhesus (+)

029195 IPUNG
PURWONO (Poli :
TLAB00006 GLUKOSA
0 204
010096 PARMI (Poli : Ns. Durrotun Nikhayah,

2023/04/06/000124 IGD) S.Kep. 4/6/2023
TLAB00006 GLUKOSA

0 164

053435 RAHMAYANTA
ADI SAPUTRA (Poli :
TLAB00002 GOLONGAN
DARAH 23,000
Golongan Darah 0 A (+)

020107 SUPANGAT RAJO
MUDO (Poli :

19 Antigen 80,000
20 Negatif

149807 MOHAMAD AZIS
SETIADI (Poli :

19 Antigen 80,000

20 Negatif

203355 AHMAD
KHAIRUL AMMAR (Poli :
2023/04/05/000111 IGD) Abbas Herlan, A.Md.Kes 4/5/2023
J002111 DARAH
LENGKAP 90,000
Leukosit 0 13.54
Eritrosit 0 5.12
Hemoglobin 0 11.7
Hematokrit 0 35
Trombosit 0 363

0
Neutrofil 0 79.6
Limfosit 0 10.9
Monosit 0 9.3
Eosinofil 0 0.2
Basofil 0 0
INDEX ERITROSIT 0
MCV 0 68.5
MCH 0 23
MCHC 0 33.5
RDW-CV 0 13.4
NLR 0 7.3
TLAB00006 GLUKOSA

0 126
196681 HARIYANTO (Poli

2023/04/05/000096 : IGD) Abbas Herlan, A.Md.Kes 4/5/2023

2 86,000
UREUM 0 21.5
CREATININ 0 0.8
J002111 DARAH
LENGKAP 90,000
Leukosit 0 8.43
Eritrosit 0 5.33
Hemoglobin 0 15.1
Hematokrit 0 44.7
Trombosit 0 256

0
Neutrofil 0 83.3
Limfosit 0 8.1
Monosit 0 8.6
Eosinofil 0 0
Basofil 0 0
INDEX ERITROSIT 0
MCV 0 83.8
MCH 0 28.4
MCHC 0 33.8
RDW-CV 0 12.3
NLR 0 10.28
TLAB00006 GLUKOSA

0 109

111341 MUHAMAD
ILHAM PUTRA
LESTIANTO (Poli : Poli
2023/04/05/000099 Radiologi) Abbas Herlan, A.Md.Kes 4/5/2023
J002111 DARAH
LENGKAP 90,000
Leukosit 0 8.35
Eritrosit 0 4.47
Hemoglobin 0 12
Hematokrit 0 35.8
Trombosit 0 468

0
Neutrofil 0 68.7
Limfosit 0 25.9
Monosit 0 5
Eosinofil 0 0.4
Basofil 0 0
INDEX ERITROSIT 0
MCV 0 80.1
MCH 0 26.9
MCHC 0 33.6
RDW-CV 0 14
NLR 0 2.65

203353 IVANIA AYU
PANINGGAR (Poli :
J002111 DARAH
LENGKAP 90,000
Leukosit 0 16.96
Eritrosit 0 4.65
Hemoglobin 0 12.1
Hematokrit 0 35.2
Trombosit 0 298

0
Neutrofil 0 72.3
Limfosit 0 19.9
Monosit 0 7.8
Eosinofil 0 0
Basofil 0 0
INDEX ERITROSIT 0
MCV 0 75.8
MCH 0 26.1
MCHC 0 34.4
RDW-CV 0 14.6
NLR 0 3.63
TLAB00022 WIDAL
59,500
H0 Positif 1/80

0 Positif 1/80

203286 MIFATHUDIN
BIMASAYFULLAH
(Kamar : MLT.03-01,
2023/04/05/000040 MELATI) Yuni Nurul Azizah, A. Md. 4/5/2023
J002067 HEMOSTASIS
40,000
0 1
0 10
J002113 DARAH
LENGKAP 95,500
Leukosit 0 9,98
Eritrosit 0 5,22
Hemoglobin 0 14,0
Hematokrit 0 40,4
Trombosit 0 159

0
Neutrofil 0 72,6
Limfosit 0 21,5
Monosit 0 5,5
Eosinofil 0 0,4
Basofil 0 0,0
INDEX ERITROSIT 0
MCV 0 77,5
MCH 0 26,9
MCHC 0 34,7
RDW-CV 0 13,2
NLR 0 3,38
242,000
Kalium 0 4,5
Natrium 0 141
Clorida 0 107

129720 SRI RUSWIJANTI
(Poli : Poli Kulit dan Karla Kurnia Oktaviani,
2023/04/05/000020 Kelamin) A.Md.Keb 4/5/2023
TLAB00006 GLUKOSA

0 114
203343 RATINAH (Poli :

2023/04/04/000180 IGD) Ribut T 4/4/2023
TLAB00006 GLUKOSA

0 127
198082 ANTONI Asep Supriyanto,

2023/04/04/000089 SIMBOLON (Poli : IGD) A.Md.Kep. 4/4/2023
TLAB00006 GLUKOSA

0 191
203334 ROPIATUN (Poli : Dana Krismonika,

2023/04/04/000058 IGD) A.Md.Kep. 4/4/2023
TLAB00006 GLUKOSA

0 400

184730 YY. AGUS
SUPRIJANTO (Poli :

2 86,000
UREUM 0 27,7
CREATININ 0 1,2

203331 CAHYONO
HANDRIO (Poli :

19 Antigen 80,000

20 Negatif

132793 QONITA
HUMAIRA (Kamar :
ANGGREKBED4,
2023/04/03/000009 ANGGREK) Yuni Nurul Azizah, A. Md. 4/3/2023
J002111 DARAH
LENGKAP 90,000
Leukosit 0 6.11
Eritrosit 0 4.99
Hemoglobin 0 13.1
Hematokrit 0 39.4
Trombosit 0 303

0
Neutrofil 0 76.9
Limfosit 0 14.4
Monosit 0 8.5
Eosinofil 0 0.2
Basofil 0 0
INDEX ERITROSIT 0
MCV 0 78.9
MCH 0 26.2
MCHC 0 33.2
RDW-CV 0 12.9
NLR 0 5.34
194797 MOHAMAD ARIF

2023/04/02/000024 (Poli : LABORATORIUM) Ragil Pangestu W., A.Md. 4/2/2023

19 Antigen 80,000

20 Negatif

203309 ELNANDA
KHAIBAR YAHYA (Poli :

TLAB00002 GOLONGAN
DARAH 23,000
Golongan Darah 0 AB (+)

203310 INGGIT BAYU
FISYABILILLAH (Poli :

19 Antigen 80,000

20 Negatif

203309 ELNANDA
KHAIBAR YAHYA (Poli :
J002111 DARAH
LENGKAP 90,000
Leukosit 0 4,39
Eritrosit 0 4,60
Hemoglobin 0 11,9
Hematokrit 0 35,4
Trombosit 0 232
0
Neutrofil 0 40,4
Limfosit 0 52,9
Monosit 0 6,0
Eosinofil 0 0,7
Basofil 0 0,0
INDEX ERITROSIT 0
MCV 0 77,1
MCH 0 25,8
MCHC 0 33,5
RDW-CV 0 12,6
NLR 0 0,76
TLAB00022 WIDAL
59,500
H0 Negatif
0 Negatif

132185 ALVIAN AKBAR
FATHURRAHMAN (Poli :
J002111 DARAH
LENGKAP 90,000
Leukosit 0 6,21
Eritrosit 0 4,85
Hemoglobin 0 13,2
Hematokrit 0 38,6
Trombosit 0 218

0
Neutrofil 0 64,9
Limfosit 0 29,1
Monosit 0 5,7
Eosinofil 0 0,3
Basofil 0 0,0
INDEX ERITROSIT 0
MCV 0 79,6
MCH 0 27,2
MCHC 0 34,2
RDW-CV 0 13,3
NLR 0 2,23
TLAB00022 WIDAL
59,500
H0 Negatif

0 Negatif
184357 RAFFAN AZFER

2023/04/02/000001 ARKATAMA (Poli : IGD) Yuni Nurul Azizah, A. Md. 4/2/2023
J002111 DARAH
LENGKAP 90,000
Leukosit 0 8.14
Eritrosit 0 4.29
Hemoglobin 0 11.6
Hematokrit 0 34.2
Trombosit 0 241

0
Neutrofil 0 34.3
Limfosit 0 54.5
Monosit 0 10
Eosinofil 0 1.2
Basofil 0 0
INDEX ERITROSIT 0
MCV 0 79.6
MCH 0 27.1
MCHC 0 34
RDW-CV 0 14.3
NLR 0 0.63
TLAB00022 WIDAL
59,500
H0 Negatif

0 Negatif

041473 SARAH PUTRI
WULANDARI (Poli :

19 Antigen 80,000

20 Negatif

203287 KEVIN PRASETYA
WIBOWO (Kamar :
2023/04/01/000053 FLAMBOYAN) A.Md. 4/1/2023

2 116,000
UREUM 0 19,6
CREATININ 0 0,8
TLAB00485 GLUKOSA

0 95
TLAB00493 ALBUMIN
55,000
ALBUMIN 0 4,6
252,000
Kalium 0 4,4
Natrium 0 141
Clorida 0 104
TLAB00502 HBSAG
74,500
HBSAG 0 Negatif

197263 ZAINATUL
RAHMAWATI (Kamar :
2023/03/31/000097 FLAMBOYAN) A.Md. 4/1/2023

48,000

P.H. 0 6,0
B.J. 0 1,015
Protein 0 Negatif
Reduksi 0 Negatif
Bilirubin 0 Negatif
Keton 0 Negatif
Sedimen 0
Leukosit 0 1-Feb
Eritrosit 0 1-Feb
Epitel Sel 0 >50
Silinder 0 Negatif
Kristal 0 Negatif
Lain-lain 0 Negatif

203287 KEVIN PRASETYA
WIBOWO (Kamar :
2023/04/01/000053 FLAMBOYAN) A.Md. 4/1/2023
J002069 HEMOSTASIS
60,000
0 1
0 9
J002115 DARAH
LENGKAP 105,500
Leukosit 0 6,03
Eritrosit 0 4,76
Hemoglobin 0 14,4
Hematokrit 0 42,2
Trombosit 0 340

0
Neutrofil 0 57,4
Limfosit 0 34,5
Monosit 0 6,3
Eosinofil 0 1,8
Basofil 0 0,0
INDEX ERITROSIT 0
MCV 0 88,6
MCH 0 30,3
MCHC 0 34,2
RDW-CV 0 12,1
NLR 0 1,66
203300 FAJAR Mega Tri Wulandari,

2023/04/01/000046 MARYANTO (Poli : IGD) A.Md. 4/1/2023

19 Antigen 80,000

20 Negatif
>> Total : 23,718,000

APRIL 2023 BERDASARKAN SIM

18:55:59 M.Kes., M.H Sp.PK
Satuan Nilai Rujukan Keterangan
- Negatif
Kesan : Saran :
17:09:11 dr. Erna Purwati S. -
mg/dl 70 - 200
Kesan : Saran :

16:44:26 M.Kes., M.H Sp.PK

- Negatif
Kesan : Saran :

16:44:18 M.Kes., M.H Sp.PK
- Negatif
Kesan : Saran :

16:44:13 M.Kes., M.H Sp.PK
- Negatif
Kesan : Saran :

15:35:01 M.Kes., M.H Sp.PK
- Negatif
Kesan : Saran :

10:30:28 M.Kes., M.H Sp.PK
- Negatif
Kesan : Saran :
9:16:04 dr. Prabu Giusti Nugraha -
mg/dl 70 - 200
Kesan : Saran :

6:54:43 dr. Riska Camalia, Sp.A Sp.PK
10³/mm³ 4,00 - 10,00
10^6/mm³ 4,00 - 5,50

g/dL 13,0 - 18,0 L
% 40,0 - 54,0 L
10³/mm³ 150 - 450 L
% 50.0 - 70,0 L
% 20,0 - 40,0 H
% 3,0 - 12,0 H
% 0,5 - 5,0
% 0,0 - 1,0
fL 80,0 - 100,0 L
pg 27,0 - 34,0 L
g/dL 32,0 - 36,0
% 11,0 - 16,0
Kesan : Saran :
Kesan : Saran :

Kesan : Saran :

19:17:17 dr. Mohamad Arif, Sp.PD Sp.PK
mg/dl 70 - 200 H
% < 5,7 H
Kesan : Saran :

16:39:31 M.Kes., M.H Sp.PK
- Negatif
Kesan : Saran :
15:37:41 dr. Mohamad Arif, Sp.PD -
mg/dl 70 - 200
Kesan : Saran :
15:29:42 dr. Mohamad Arif, Sp.PD -
mg/dl 70 - 200
Kesan : Saran :
10³/mm³ 4,00 - 10,00 L
10^6/mm³ 4,00 - 5,50
g/dL 13,0 - 18,0 L
% 40,0 - 54,0 L
10³/mm³ 150 - 450 L
% 50.0 - 70,0 L
% 20,0 - 40,0 H
% 3,0 - 12,0
% 0,5 - 5,0
% 0,0 - 1,0
fL 80,0 - 100,0 L
pg 27,0 - 34,0 L
g/dL 32,0 - 36,0
% 11,0 - 16,0
Kesan : Saran :

mg/dl 70 - 200
mg/dl 70 - 200 H
mg/dl 70 - 200 H
Kesan : Saran :
dr. Dwi Retnoningrum, dr. Dwi Retnoningrum,

9:16:10 Sp.PK Sp.PK
- Negatif
Kesan : Saran :

8:34:40 - Sp.PK
mg/dl 70 - 126
mg/dl < 200 H
mg/dl < 200
mg/dl 3,4 – 7,2
Kesan : Saran :

8:09:32 - Sp.PK
mg/dl 70 - 126
10³/mm³ 4,00 - 10,00
10^6/mm³ 3,50 - 5,00 H
g/dL 11,0 - 15,0
% 35,0 - 47,0
10³/mm³ 150 - 450
% 50,0 - 70,0 H
% 20,0 - 40,0
% 3,0 - 12,0
% 0,5 - 5,0
% 0,0 - 1,0
fL 80,0 - 100,0
pg 27,0 - 34,0
g/dL 32,0 - 36,0
% 11,0 - 16,0
% < 5,7
Kesan : Saran :

mg/dl 70 - 200
Kesan : Saran :

19:42:29 - Sp.PK
- Negatif
Kesan : Saran :
19:37:53 dr. Sri Wahyuni, Sp.PD -

mg/dl 70 - 200
Kesan : Saran :

10³/mm³ 4,00 - 10,00
10^6/mm³ 3,50 - 5,00 H
g/dL 11,0 - 15,0
% 35,0 - 47,0
10³/mm³ 150 - 450
% 50,0 - 70,0
% 20,0 - 40,0
% 3,0 - 12,0
% 0,5 - 5,0 L
% 0,0 - 1,0
fL 80,0 - 100,0
pg 27,0 - 34,0 L
g/dL 32,0 - 36,0
% 11,0 - 16,0
- Negatif
- Negatif
- Negatif
- Negatif
Kesan : Saran :
19:18:15 dr. Hernanda -

mg/dl 70 - 200
Kesan : Saran :

mg/dl 16,6 - 48,5 L
mg/dl 0,5 - 0,9 L
10³/mm³ 4,00 - 10,00 H
10^6/mm³ 3,50 - 5,00
g/dL 11,0 - 15,0
% 35,0 - 47,0 L
10³/mm³ 150 - 450
% 50,0 - 70,0 H
% 20,0 - 40,0
% 3,0 - 12,0
% 0,5 - 5,0 L
% 0,0 - 1,0
fL 80,0 - 100,0
pg 27,0 - 34,0
g/dL 32,0 - 36,0
% 11,0 - 16,0
mg/dl 70 - 200 L
Kesan : Saran :

mg/dl 70 - 200
Kesan : Saran :
13:46:32 dr. Erna Purwati S. -
mg/dl 70 - 200
Kesan : Saran :

12:14:24 - Sp.PK
mg/dl 16,6 - 48,5
mg/dl 0,5 - 0,9
% < 5,7 H
Kesan : Saran :

11:51:44 - Sp.PK
- Negatif
Kesan : Saran :

- Negatif H
- Negatif H
- Negatif
- Negatif H
Kesan : Saran :

- Negatif H
- Negatif
Kesan : Saran :

10:47:26 - Sp.PK
- Negatif
Kesan : Saran :

10:46:47 - Sp.PK
- Negatif
Kesan : Saran :

10³/mm³ 4,00 - 12,00 H

10^6/mm³ 3,50 - 5,20
g/dL 12,0 - 16,0 L
% 35,0 - 49,0 L
10³/mm³ 150 - 450
% 50.0 - 70,0
% 20,0 - 40,0 L
% 3,0 - 12,0 H
% 0,5 - 5,0 H
% 0,0 - 1,0
fL 80,0 - 100,0 L
pg 27,0 - 34,0 L
g/dL 31,0 - 37,0
% 11,0 - 16,0
- Negatif H
- Negatif H
Kesan : Saran :

10³/mm³ 4,00 - 12,00 L
10^6/mm³ 3,50 - 5,20
g/dL 12,0 - 16,0 L
% 35,0 - 49,0 L
10³/mm³ 150 - 450 L
% 50,0 - 70,0 L
% 20,0 - 40,0 H
% 3,0 - 12,0
% 0,5 - 5,0 L
% 0,0 - 1,0
fL 80,0 - 100,0 L
pg 27,0 - 34,0 L
g/dL 31,0 - 37,0
% 11,0 - 16,0
Kesan : Saran :

6:09:26 dr. Okky Firmansyah Sp.PK
10³/mm³ 4,00 - 10,00
10^6/mm³ 4,00 - 5,50
g/dL 13,0 - 18,0
% 40,0 - 54,0 L
10³/mm³ 150 - 450 L
% 50,0 - 70,0 H
% 20,0 - 40,0 L
% 3,0 - 12,0
% 0,5 - 5,0 L
% 0,0 - 1,0
fL 80,0 - 100,0
pg 27,0 - 34,0
g/dL 32,0 - 36,0
% 11,0 - 16,0
Kesan : Saran :
14:06:48 dr. Sri Wahyuni, Sp.PD -

mg/dl 70 - 200
Kesan : Saran :

10³/mm³ 4,00 - 10,00 H
10^6/mm³ 4,00 - 5,50
g/dL 13,0 - 18,0
% 40,0 - 54,0
10³/mm³ 150 - 450
% 50,0 - 70,0 H
% 20,0 - 40,0 L
% 3,0 - 12,0
% 0,5 - 5,0
% 0,0 - 1,0
fL 80,0 - 100,0
pg 27,0 - 34,0
g/dL 32,0 - 36,0
% 11,0 - 16,0
mg/dl 70 - 200 H
Kesan : Saran :

Kuning Jernih
4,8 - 7,5
1,015 - 1,025
Negatif
Negatif
mg/dl Negatif
Negatif
Negatif
Positif ( 1 - 4 )/LPB
Positif ( 1 - 15 )/LPK
Negatif
Negatif
Negatif
Kesan : Saran :


10³/mm³ 4,00 - 12,00 H
10^6/mm³ 3,50 - 5,20
g/dL 12.0 - 16,0 L
% 35,0 - 49,0 L
10³/mm³ 150 - 450 L
% 50,0 - 70,0 H
% 20,0 - 40,0 L
% 3,0 - 12,0
% 0,5 - 5,0 H
% 0,0 - 1,0
fL 80,0 - 100,0 L
pg 27,0 - 34,0 L
g/dL 31,0 - 37,0
% 11,0 - 16,0
Kesan : Saran :
dr. Redyaksa Drestanta dr. Dwi Retnoningrum,

23:25:03 Ariandoko Sp.PK
mg/dl 16,6 - 48,5
mg/dl 0,6 - 1,1
10³/mm³ 4,00 - 10,00
10^6/mm³ 4,00 - 5,50
g/dL 13,0 - 18,0
% 40,0 - 54,0
10³/mm³ 150 - 450
% 50,0 - 70,0 H
% 20,0 - 40,0 L
% 3,0 - 12,0
% 0,5 - 5,0
% 0,0 - 1,0
fL 80,0 - 100,0
pg 27,0 - 34,0
g/dL 32,0 - 36,0
% 11,0 - 16,0
Kesan : Saran :

10³/mm³ 4,00 - 12,00 H
10^6/mm³ 3,50 - 5,20
g/dL 12,0 - 16,0

% 35,0 - 49,0
10³/mm³ 150 - 450
% 50,0 - 70,0
% 20,0 - 40,0
% 3,0 - 12,0
% 0,5 - 5,0
% 0,0 - 1,0
fL 80,0 - 100,0 L
pg 27,0 - 34,0
g/dL 31,0 - 37,0
% 11,0 - 16,0
Kesan : Saran :

- Negatif
Kesan : Saran :

mg/dl 16,6 - 48,5 H
mg/dl 0,6 - 1,1
10³/mm³ 4,00 - 10,00 H
10^6/mm³ 4,00 - 5,50
g/dL 13,0 - 18,0 L
% 40,0 - 54,0 L
10³/mm³ 150 - 450 H

% 50,0 - 70,0 H
% 20,0 - 40,0 L
% 3,0 - 12,0
% 0,5 - 5,0 L
% 0,0 - 1,0
fL 80,0 - 100,0
pg 27,0 - 34,0
g/dL 32,0 - 36,0
% 11,0 - 16,0
Kesan : Saran :

- Negatif
Kesan : Saran :

- Negatif
Kesan : Saran :

- Negatif H
Kesan : Saran :

mg/dl 70 - 200 H
Kesan : Saran :

mg/dl 70 - 200 H
Kesan : Saran :

20:47:09 M.Kes., M.H Sp.PK
- Negatif
Kesan : Saran :

19:41:39 M.Kes., M.H Sp.PK
- Negatif
Kesan : Saran :

19:32:30 M.Kes., M.H Sp.PK
- Negatif
Kesan : Saran :

mg/dl 3,4 - 7,2
mg/dl 16,6 - 48,5
mg/dl 0,6 - 1,1
mg/dl < 200
mg/dl < 200
Kesan : Saran :
17:38:20 M.Kes., M.H Sp.PK
- Negatif
Kesan : Saran :

16:56:06 M.Kes., M.H Sp.PK
- Negatif
Kesan : Saran :

15:31:34 M.Kes., M.H Sp.PK
- Negatif
Kesan : Saran :

14:07:58 dr. Wildana Aqila Dzakiy Sp.PK
10³/mm³ 4,00 - 10,00
10^6/mm³ 4,00 - 5,50
g/dL 13,0 - 18,0
% 40,0 - 54,0
10³/mm³ 150 - 450
% 50,0 - 70,0 H
% 20,0 - 40,0 L
% 3,0 - 12,0
% 0,5 - 5,0
% 0,0 - 1,0
fL 80,0 - 100,0
pg 27,0 - 34,0
g/dL 32,0 - 36,0
% 11,0 - 16,0
mg/dl 70 - 200
Kesan : Saran :

mg/dl 70 - 200
Kesan : Saran :

12:52:07 M.Kes., M.H Sp.PK

- Negatif
Kesan : Saran :

10³/mm³ 4,00 - 12,00
10^6/mm³ 3,50 - 5,20
g/dL 12,0 - 16,0 L
% 35,0 - 49,0
10³/mm³ 150 - 450
% 50,0 - 70,0
% 20,0 - 40,0
% 3,0 - 12,0
% 0,5 - 5,0 L
% 0,0 - 1,0
fL 80,0 - 100,0 L
pg 27,0 - 34,0 L
g/dL 31,0 - 37,0
% 11,0 - 16,0
- Negatif
- Negatif
- Negatif
- Negatif
Kesan : Saran :

11:27:10 M.Kes., M.H Sp.PK
- Negatif
Kesan : Saran :

10³/mm³ 4,00 - 12,00 H
10^6/mm³ 3,50 - 5,20
g/dL 12,0 - 16,0 L
% 35,0 - 49,0 L
10³/mm³ 150 - 450 H
% 50,0 - 70,0
% 20,0 - 40,0
% 3,0 - 12,0
% 0,5 - 5,0
% 0,0 - 1,0
fL 80,0 - 100,0 L
pg 27,0 - 34,0 L
g/dL 31,0 - 37,0
% 11,0 - 16,0
- Negatif
- Negatif
- Negatif
- Negatif
Kesan : Saran :

10:15:46 M.Kes., M.H Sp.PK
- Negatif
Kesan : Saran :
10:15:39 M.Kes., M.H Sp.PK
- Negatif
Kesan : Saran :

- Negatif
Kesan : Saran :

10³/mm³ 4,00 - 12,00
10^6/mm³ 3,50 - 5,20
g/dL 12,0 - 16,0 L

% 35,0 - 49,0
10³/mm³ 150 - 450
% 50,0 - 70,0 H
% 20,0 - 40,0 L
% 3,0 - 12,0
% 0,5 - 5,0
% 0,0 - 1,0
fL 80,0 - 100,0 L
pg 27,0 - 34,0 L
g/dL 31,0 - 37,0
% 11,0 - 16,0
Kesan : Saran :

- Negatif
Kesan : Saran :

10³/mm³ 4,00 - 12,00 H
10^6/mm³ 3,50 - 5,20
g/dL 12,0 - 16,0
% 35,0 - 49,0
10³/mm³ 150 - 450
% 50,0 - 70,0 H
% 20,0 - 40,0
% 3,0 - 12,0
% 0,5 - 5,0 L
% 0,0 - 1,0
fL 80,0 - 100,0 L
pg 27,0 - 34,0 L
g/dL 31,0 - 37,0
% 11,0 - 16,0
Kesan : Saran :
14:27:33 dr. Y Andressa -
mg/dl 70 - 200
Kesan : Saran :

13:18:02 - Sp.PK

- Negatif
Kesan : Saran :

mg/dl 70 - 200 H
Kesan : Saran :

18:04:42 M.Kes., M.H Sp.PK
10³/mm³ 4,00 - 10,00 H
10^6/mm³ 3,50 - 5,00
g/dL 11,0 - 15,0
% 35,0 - 47,0
10³/mm³ 150 - 450
% 50,0 - 70,0
% 20,0 - 40,0
% 3,0 - 12,0
% 0,5 - 5,0
% 0,0 - 1,0
fL 80,0 - 100,0
pg 27,0 - 34,0
g/dL 32,0 - 36,0
% 11,0 - 16,0
Kesan : Saran :


10³/mm³ 4,00 - 12,00 H
10^6/mm³ 3,50 - 5,20
g/dL 12,0 - 16,0 L
% 35,0 - 49,0
10³/mm³ 150 - 450 H
% 50,0 - 70,0 L
% 20,0 - 40,0 H
% 3,0 - 12,0
% 0,5 - 5,0
% 0,0 - 1,0
fL 80,0 - 100,0
pg 27,0 - 34,0
g/dL 31,0 - 37,0

% 11,0 - 16,0
Kesan : Saran :

- Negatif
Kesan : Saran :

10³/mm³ 4,00 - 10,00
10^6/mm³ 3,50 - 5,00
g/dL 11,0 - 15,0
% 35,0 - 47,0
10³/mm³ 150 - 450

% 50,0 - 70,0 H
% 20,0 - 40,0 L
% 3,0 - 12,0
% 0,5 - 5,0
% 0,0 - 1,0
fL 80,0 - 100,0
pg 27,0 - 34,0
g/dL 32,0 - 36,0
% 11,0 - 16,0
Kesan : Saran :

mg/dl 70 - 200
Kesan : Saran :

10³/mm³ 4,00 - 10,00 H
10^6/mm³ 3,50 - 5,00
g/dL 11,0 - 15,0 L
% 35,0 - 47,0 L
10³/mm³ 150 - 450
% 50,0 - 70,0 H
% 20,0 - 40,0 L
% 3,0 - 12,0
% 0,5 - 5,0 L
% 0,0 - 1,0
fL 80,0 - 100,0 L
pg 27,0 - 34,0 L
g/dL 32,0 - 36,0
% 11,0 - 16,0 H
Kesan : Saran :

mg/dl 16,6 - 48,5 H
mg/dl 0,6 - 1,1 H
mg/dl 70 - 200
gr/dl 3,5 – 5,2 L
mEq/L 3,5 - 5,5
mEq/L 135 - 145
mEq/L 96 - 106
Negatif
Kesan : Saran :

Menit 1-Jun
Menit Sep-15
10³/mm³ 4,00 - 10,00 H
10^6/mm³ 4,00 - 5,50

g/dL 13,0 - 18,0 L
% 40,0 - 54,0 L
10³/mm³ 150 - 450
% 50,0 - 70,0 H
% 20,0 - 40,0 L
% 3,0 - 12,0
% 0,5 - 5,0 L
% 0,0 - 1,0
fL 80,0 - 100,0
pg 27,0 - 34,0
g/dL 32,0 - 36,0
% 11,0 - 16,0
Kesan : Saran :
10³/mm³ 4,00 - 10,00
10^6/mm³ 3,50 - 5,00
g/dL 11,0 - 15,0
% 35,0 - 47,0
10³/mm³ 150 - 450 L
% 50,0 - 70,0 H
% 20,0 - 40,0 L
% 3,0 - 12,0
% 0,5 - 5,0 L
% 0,0 - 1,0
fL 80,0 - 100,0
pg 27,0 - 34,0
g/dL 32,0 - 36,0
% 11,0 - 16,0
Kesan : Saran :

10³/mm³ 4,00 - 10,00 L
10^6/mm³ 3,50 - 5,00
g/dL 11,0 - 15,0
% 35,0 - 47,0
10³/mm³ 150 - 450
% 50,0 - 70,0 H
% 20,0 - 40,0
% 3,0 - 12,0
% 0,5 - 5,0 L
% 0,0 - 1,0
fL 80,0 - 100,0
pg 27,0 - 34,0
g/dL 32,0 - 36,0
% 11,0 - 16,0
- Negatif H
- Negatif
- Negatif
- Negatif
Kesan : Saran :

mg/dl 70 - 200
Kesan : Saran :

mg/dl 50 - 80 H
Kesan : Saran :

10³/mm³ 4,00 - 12,00
10^6/mm³ 3,50 - 5,20
g/dL 12,0 - 16,0
% 35,0 - 49,0
10³/mm³ 150 - 450
% 50,0 - 70,0
% 20,0 - 40,0
% 3,0 - 12,0
% 0,5 - 5,0
% 0,0 - 1,0
fL 80,0 - 100,0 L
pg 27,0 - 34,0 L
g/dL 31,0 - 37,0
% 11,0 - 16,0
Kesan : Saran :
16:54:09 dr. Prabu Giusti Nugraha -

mg/dl 70 - 200
Kesan : Saran :

10³/mm³ 4,00 - 10,00
10^6/mm³ 3,50 - 5,00
g/dL 11,0 - 15,0
% 35,0 - 47,0
10³/mm³ 150 - 450
% 50,0 - 70,0
% 20,0 - 40,0
% 3,0 - 12,0
% 0,5 - 5,0
% 0,0 - 1,0
fL 80,0 - 100,0
pg 27,0 - 34,0
g/dL 32,0 - 36,0
% 11,0 - 16,0
Kesan : Saran :

10³/mm³ 4,00 - 12,00
10^6/mm³ 3,50 - 5,20
g/dL 12,0 - 16,0
% 35,0 - 49,0
10³/mm³ 150 - 450

% 50,0 - 70,0 H
% 20,0 - 40,0 L
% 3,0 - 12,0
% 0,5 - 5,0
% 0,0 - 1,0
fL 80,0 - 100,0
pg 27,0 - 34,0
g/dL 31,0 - 37,0
% 11,0 - 16,0
- Negatif
- Negatif
- Negatif
- Negatif
Kesan : Saran :

17:03:58 M.Kes., M.H Sp.PK
- Negatif
Kesan : Saran :

17:03:45 M.Kes., M.H Sp.PK
- Negatif H
Kesan : Saran :

mg/dl 70 - 200
Kesan : Saran :

10³/mm³ 4,00 - 12,00
10^6/mm³ 3,50 - 5,20
g/dL 12,0 - 16,0
% 35,0 - 49,0
10³/mm³ 150 - 450
% 50,0 - 70,0
% 20,0 - 40,0
% 3,0 - 12,0
% 0,5 - 5,0
% 0,0 - 1,0
fL 80,0 - 100,0
pg 27,0 - 34,0
g/dL 31,0 - 37,0
% 11,0 - 16,0
- Negatif
- Negatif
- Negatif
- Negatif
Kesan : Saran :


10³/mm³ 4,00 - 10,00 H
10^6/mm³ 3,50 - 5,00
g/dL 11,0 - 15,0 L
% 35,0 - 47,0 L
10³/mm³ 150 - 450
% 50,0 - 70,0
% 20,0 - 40,0
% 3,0 - 12,0
% 0,5 - 5,0
% 0,0 - 1,0
fL 80,0 - 100,0
pg 27,0 - 34,0
g/dL 32,0 - 36,0
% 11,0 - 16,0
mg/dl 70 - 200
Kesan : Saran :

6:54:31 dr. Prabu Giusti Nugraha Sp.PK
10³/mm³ 4,00 - 12,00
10^6/mm³ 3,50 - 5,20
g/dL 12,0 - 16,0
% 35,0 - 49,0
10³/mm³ 150 - 450
% 50,0 - 70,0
% 20,0 - 40,0
% 3,0 - 12,0
% 0,5 - 5,0 L
% 0,0 - 1,0
fL 80,0 - 100,0
pg 27,0 - 34,0
g/dL 31,0 - 37,0
% 11,0 - 16,0
- Negatif
- Negatif
- Negatif
- Negatif
Kesan : Saran :

20:19:30 W., Sp.B Sp.PK
mg/dl 16,6 - 48,5
mg/dl 0,5 - 0,9
mEq/L 3,5 - 5,5
mEq/L 135 - 145
mEq/L 96 - 106
Kesan : Saran :

20:07:53 W., Sp.B Sp.PK
Kuning Jernih H
4,8 - 7,5
1,015 - 1,025
Negatif
Negatif
mg/dl Negatif
Negatif
Negatif
Positif ( 1 - 4 )/LPB H
Negatif
Negatif
Negatif
Kesan : Saran :

20:03:48 W., Sp.B Sp.PK
10³/mm³ 4,00 - 10,00

10^6/mm³ 3,50 - 5,00
g/dL 11,0 - 15,0 L
% 35,0 - 47,0 L
10³/mm³ 150 - 450 H
% 50,0 - 70,0 L
% 20,0 - 40,0 H
% 3,0 - 12,0
% 0,5 - 5,0 H
% 0,0 - 1,0
fL 80,0 - 100,0 L
pg 27,0 - 34,0 L
g/dL 32,0 - 36,0 L
% 11,0 - 16,0
Kesan : Saran :
dr. Benedictus Kartika

19:57:24 W., Sp.B -
mg/dl 70 - 200
Kesan : Saran :

- Negatif
Kesan : Saran :

10³/mm³ 4,00 - 12,00
10^6/mm³ 3,50 - 5,20 H

g/dL 12,0 - 16,0
% 35,0 - 49,0
10³/mm³ 150 - 450
% 50,0 - 70,0
% 20,0 - 40,0
% 3,0 - 12,0
% 0,5 - 5,0
% 0,0 - 1,0
fL 80,0 - 100,0 L
pg 27,0 - 34,0 L
g/dL 31,0 - 37,0
% 11,0 - 16,0
Kesan : Saran :
16:58:24 M.Kes., M.H Sp.PK
- Negatif
Kesan : Saran :

16:58:06 M.Kes., M.H Sp.PK
- Negatif
Kesan : Saran :

14:43:22 M.Kes., M.H Sp.PK
- Negatif H
Kesan : Saran :

10:32:28 dr. Budi Palarto, Sp.OG Sp.PK
10³/mm³ 4,00 - 10,00
10^6/mm³ 3,50 - 5,00
g/dL 11,0 - 15,0
% 35,0 - 47,0 L
10³/mm³ 150 - 450
% 50,0 - 70,0
% 20,0 - 40,0
% 3,0 - 12,0
% 0,5 - 5,0
% 0,0 - 1,0
fL 80,0 - 100,0
pg 27,0 - 34,0
g/dL 32,0 - 36,0
% 11,0 - 16,0
Kesan : Saran :

mg/dl 70 - 200
mg/dl 2,4 – 5,7
mg/dl 0 – 200
Kesan : Saran :


10³/mm³ 4,00 - 10,00
10^6/mm³ 4,00 - 5,50
g/dL 13,0 - 18,0
% 40,0 - 54,0
10³/mm³ 150 - 450
% 50,0 - 70,0
% 20,0 - 40,0
% 3,0 - 12,0
% 0,5 - 5,0
% 0,0 - 1,0
fL 80,0 - 100,0
pg 27,0 - 34,0
g/dL 32,0 - 36,0
% 11,0 - 16,0
- Negatif
- Negatif
- Negatif
- Negatif
Kesan : Saran :

10³/mm³ 4,00 - 12,00
10^6/mm³ 3,50 - 5,20
g/dL 12,0 - 16,0 L
% 35,0 - 49,0
10³/mm³ 150 - 450

% 50,0 - 70,0
% 20,0 - 40,0
% 3,0 - 12,0 H
% 0,5 - 5,0 L
% 0,0 - 1,0
fL 80,0 - 100,0
pg 27,0 - 34,0 L
g/dL 31,0 - 37,0
% 11,0 - 16,0
- Negatif
- Negatif
Kesan : Saran :

10³/mm³ 4,00 - 12,00
10^6/mm³ 3,50 - 5,20 H
g/dL 12,0 - 16,0 L
% 35,0 - 49,0 L
10³/mm³ 150 - 450
% 50,0 - 70,0 L
% 20,0 - 40,0 H
% 3,0 - 12,0
% 0,5 - 5,0 L
% 0,0 - 1,0
fL 80,0 - 100,0 L
pg 27,0 - 34,0 L
g/dL 31,0 - 37,0
% 11,0 - 16,0
Kesan : Saran :

10³/mm³ 4,00 - 12,00
10^6/mm³ 3,50 - 5,20
g/dL 12,0 - 16,0
% 35,0 - 49,0
10³/mm³ 150 - 450
% 50,0 - 70,0
% 20,0 - 40,0
% 3,0 - 12,0
% 0,5 - 5,0 L
% 0,0 - 1,0
fL 80,0 - 100,0
pg 27,0 - 34,0
g/dL 31,0 - 37,0
% 11,0 - 16,0
Kesan : Saran :

10³/mm³ 4,00 - 12,00 H
10^6/mm³ 3,50 - 5,20
g/dL 12,0 - 16,0 L
% 35,0 - 49,0 L
10³/mm³ 150 - 450
% 50,0 - 70,0
% 20,0 - 40,0
% 3,0 - 12,0
% 0,5 - 5,0
% 0,0 - 1,0
fL 80,0 - 100,0 L
pg 27,0 - 34,0 L
g/dL 31,0 - 37,0
% 11,0 - 16,0
Kesan : Saran :

17:34:28 - Sp.PK

10³/mm³ 4,00 - 10,00 H
10^6/mm³ 3,50 - 5,00 L
g/dL 11,0 - 15,0
% 35,0 - 47,0
10³/mm³ 150 - 450
% 50,0 - 70,0 H
% 20,0 - 40,0 L
% 3,0 - 12,0
% 0,5 - 5,0
% 0,0 - 1,0
fL 80,0 - 100,0 H
pg 27,0 - 34,0 H
g/dL 32,0 - 36,0

% 11,0 - 16,0
Kesan : Saran :
DR. dr. Moedrik Tamam. dr. Dwi Retnoningrum,

10:24:23 Sp.A.K Sp.PK
10³/mm³ 4,00 - 12,00
10^6/mm³ 3,50 - 5,20
g/dL 12,0 - 16,0
% 35,0 - 49,0
10³/mm³ 150 - 450
% 50,0 - 70,0
% 20,0 - 40,0
% 3,0 - 12,0
% 0,5 - 5,0
% 0,0 - 1,0
fL 80,0 - 100,0 L
pg 27,0 - 34,0 L
g/dL 31,0 - 37,0
% 11,0 - 16,0
- Negatif
- Negatif
- Negatif
- Negatif
Kesan : Saran :


mg/dl 70 - 126
mg/dl 2,4 - 5,7
mg/dl 16,6 - 48,5
mg/dl 0,5 - 0,9
mg/dl 0 – 200
Kesan : Saran :

10³/mm³ 4,00 - 10,00
10^6/mm³ 4,00 - 5,50
g/dL 13,0 - 18,0
% 40,0 - 54,0 L
10³/mm³ 150 - 450 L

% 50,0 - 70,0
% 20,0 - 40,0
% 3,0 - 12,0
% 0,5 - 5,0 L
% 0,0 - 1,0
fL 80,0 - 100,0
pg 27,0 - 34,0
g/dL 32,0 - 36,0
% 11,0 - 16,0
Kesan : Saran :


10³/mm³ 4,00 - 10,00
10^6/mm³ 4,00 - 5,50
g/dL 13,0 - 18,0 L
% 40,0 - 54,0 L
10³/mm³ 150 - 450
% 50,0 - 70,0 H
% 20,0 - 40,0 L
% 3,0 - 12,0
% 0,5 - 5,0 L
% 0,0 - 1,0
fL 80,0 - 100,0 L
pg 27,0 - 34,0 L
g/dL 32,0 - 36,0
% 11,0 - 16,0
mg/dl 70 - 200
Kesan : Saran :

0:36:30 - Sp.PK
10³/mm³ 4,00 - 10,00 H
10^6/mm³ 3,50 - 5,00
g/dL 11,0 - 15,0
% 35,0 - 47,0
10³/mm³ 150 - 450
% 50,0 - 70,0 H
% 20,0 - 40,0 L
% 3,0 - 12,0
% 0,5 - 5,0 L
% 0,0 - 1,0
fL 80,0 - 100,0
pg 27,0 - 34,0
g/dL 32,0 - 36,0
% 11,0 - 16,0
Kesan : Saran :

10³/mm³ 4,00 - 12,00 H
10^6/mm³ 3,50 - 5,20
g/dL 12,0 - 16,0 L
% 35,0 - 49,0 L
10³/mm³ 150 - 450 H
% 50,0 - 70,0 H
% 20,0 - 40,0 L
% 3,0 - 12,0
% 0,5 - 5,0
% 0,0 - 1,0
fL 80,0 - 100,0 L
pg 27,0 - 34,0 L
g/dL 31,0 - 37,0
% 11,0 - 16,0
- Negatif
- Negatif
- Negatif
- Negatif
Kesan : Saran :

10³/mm³ 4,00 - 10,00
10^6/mm³ 4,00 - 5,50
g/dL 13,0 - 18,0
% 40,0 - 54,0
10³/mm³ 150 - 450 L
% 50,0 - 70,0 H
% 20,0 - 40,0 L
% 3,0 - 12,0
% 0,5 - 5,0 L
% 0,0 - 1,0
fL 80,0 - 100,0
pg 27,0 - 34,0
g/dL 32,0 - 36,0
% 11,0 - 16,0
Kesan : Saran :

U/L 0 - 40 H
U/L 0 - 41 H
Kesan : Saran :


mg/dl < 200
mg/dl < 200
mg/dl > = 35
mg/dl < 160
10³/mm³ 4,00 - 10,00
10^6/mm³ 4,00 - 5,50
g/dL 13,0 - 18,0
% 40,0 - 54,0
10³/mm³ 150 - 450
% 50,0 - 70,0 L
% 20,0 - 40,0 H
% 3,0 - 12,0
% 0,5 - 5,0
% 0,0 - 1,0
fL 80,0 - 100,0
pg 27,0 - 34,0
g/dL 32,0 - 36,0
% 11,0 - 16,0
Kesan : Saran :

19:01:35 M.Kes., M.H Sp.PK
- Negatif
Kesan : Saran :

18:36:42 M.Kes., M.H Sp.PK

10³/mm³ 4,00 - 10,00 H
10^6/mm³ 4,00 - 5,50 L
g/dL 13,0 - 18,0 L
% 40,0 - 54,0 L
10³/mm³ 150 - 450
% 50,0 - 70,0 H
% 20,0 - 40,0
% 3,0 - 12,0
% 0,5 - 5,0
% 0,0 - 1,0
fL 80,0 - 100,0
pg 27,0 - 34,0
g/dL 32,0 - 36,0 L
% 11,0 - 16,0
Kesan : Saran :

- Negatif
- Negatif
- Negatif
- Negatif
- Negatif
- Negatif
Kesan : Saran :

10³/mm³ 4,00 - 10,00

10^6/mm³ 3,50 - 5,00
g/dL 11,0 - 15,0
% 35,0 - 47,0 L
10³/mm³ 150 - 450
% 50,0 - 70,0 L
% 20,0 - 40,0 H
% 3,0 - 12,0
% 0,5 - 5,0 L
% 0,0 - 1,0
fL 80,0 - 100,0
pg 27,0 - 34,0 L
g/dL 32,0 - 36,0
% 11,0 - 16,0
- Negatif
- Negatif
- Negatif
- Negatif
Kesan : Saran :

10:12:18 M.Kes., M.H Sp.PK
mg/dl < 200
mg/dl < 200 H
mg/dl 0.6 - 1.1
Kesan : Saran :


10³/mm³ 4,00 - 12,00 H
10^6/mm³ 3,50 - 5,20
g/dL 12,0 - 16,0
% 35,0 - 49,0
10³/mm³ 150 - 450 H
% 50,0 - 70,0 H
% 20,0 - 40,0
% 3,0 - 12,0
% 0,5 - 5,0
% 0,0 - 1,0
fL 80,0 - 100,0 L
pg 27,0 - 34,0 L
g/dL 31,0 - 37,0

% 11,0 - 16,0
- Negatif
- Negatif
- Negatif
- Negatif
Kesan : Saran :

10³/mm³ 4,00 - 10,00
10^6/mm³ 4,00 - 5,50
g/dL 13,0 - 18,0
% 40,0 - 54,0
10³/mm³ 150 - 450 L

% 50,0 - 70,0 H
% 20,0 - 40,0 L
% 3,0 - 12,0
% 0,5 - 5,0 L
% 0,0 - 1,0
fL 80,0 - 100,0
pg 27,0 - 34,0
g/dL 32,0 - 36,0
% 11,0 - 16,0
mg/dl 70 - 200
- Negatif
- Negatif
- Negatif
- Negatif
Kesan : Saran :

10³/mm³ 4,00 - 10,00 H
10^6/mm³ 4,00 - 5,50
g/dL 13,0 - 18,0 L
% 40,0 - 54,0 L
10³/mm³ 150 - 450
% 50,0 - 70,0 L
% 20,0 - 40,0 H
% 3,0 - 12,0
% 0,5 - 5,0
% 0,0 - 1,0
fL 80,0 - 100,0 L
pg 27,0 - 34,0 L
g/dL 32,0 - 36,0 L
% 11,0 - 16,0
Kesan : Saran :

10³/mm³ 4,00 - 10,00 H
10^6/mm³ 4,00 - 5,50 H
g/dL 13,0 - 18,0

% 40,0 - 54,0 L
10³/mm³ 150 - 450
% 50,0 - 70,0 H
% 20,0 - 40,0 L
% 3,0 - 12,0
% 0,5 - 5,0
% 0,0 - 1,0
fL 80,0 - 100,0 L
pg 27,0 - 34,0 L
g/dL 32,0 - 36,0
% 11,0 - 16,0
Kesan : Saran :

13:08:40 dr. Prabu Giusti Nugraha Sp.PK
10³/mm³ 4,00 - 10,00
10^6/mm³ 4,00 - 5,50
g/dL 13,0 - 18,0
% 40,0 - 54,0
10³/mm³ 150 - 450 L
% 50,0 - 70,0 H
% 20,0 - 40,0 L
% 3,0 - 12,0
% 0,5 - 5,0 L
% 0,0 - 1,0
fL 80,0 - 100,0
pg 27,0 - 34,0
g/dL 32,0 - 36,0
% 11,0 - 16,0
- Negatif
- Negatif
- Negatif
- Negatif
Kesan : Saran :

20:56:30 M.Kes., M.H Sp.PK
Kesan : Saran :
9:16:38 dr. Wildana Aqila Dzakiy -

mg/dl 70 - 200
Kesan : Saran :

- Non Reaktif
Kesan : Saran :


mg/dl 16,6 - 48,5
mg/dl 0,5 - 0,9
mg/dl 70 - 200
gr/dl 3,5 – 5,2
mEq/L 3,5 - 5,5
mEq/L 135 - 145
mEq/L 96 - 106 H
Negatif
Kesan : Saran :


Menit 1-Jun
Menit Sep-15
10³/mm³ 4,00 - 10,00 H
10^6/mm³ 3,50 - 5,00
g/dL 11,0 - 15,0
% 35,0 - 47,0
10³/mm³ 150 - 450
% 50,0 - 70,0 H
% 20,0 - 40,0 L
% 3,0 - 12,0 L
% 0,5 - 5,0
% 0,0 - 1,0
fL 80,0 - 100,0
pg 27,0 - 34,0
g/dL 32,0 - 36,0
% 11,0 - 16,0
Kesan : Saran :

mg/dl 70 - 200
mg/dl 3,4 – 7,2
Kesan : Saran :


- Negatif
- Negatif
- Negatif
- Negatif
- Negatif
- Negatif
Kesan : Saran :
dr. Rr Widya
9:09:07 Kusumaningsih, Sp.DV -
mg/dl 70 - 200
Kesan : Saran :

8:13:08 Sp.A.K Sp.PK
10³/mm³ 4,00 - 10,00

10^6/mm³ 4,00 - 5,50
g/dL 13,0 - 18,0
% 40,0 - 54,0
10³/mm³ 150 - 450
% 50,0 - 70,0 L
% 20,0 - 40,0 H
% 3,0 - 12,0
% 0,5 - 5,0
% 0,0 - 1,0
fL 80,0 - 100,0
pg 27,0 - 34,0
g/dL 32,0 - 36,0
% 11,0 - 16,0
- Negatif
- Negatif
- Negatif
- Negatif
Kesan : Saran :

mg/dl 70 - 126
mg/dl < 200
mg/dl < 200
mg/dl 2,4 – 5,7
Kesan : Saran :
10³/mm³ 4,00 - 12,00
10^6/mm³ 3,50 - 5,20
g/dL 12,0 - 16,0 L
% 35,0 - 49,0 L
10³/mm³ 150 - 450
% 50,0 - 70,0
% 20,0 - 40,0
% 3,0 - 12,0
% 0,5 - 5,0
% 0,0 - 1,0
fL 80,0 - 100,0
pg 27,0 - 34,0 L
g/dL 31,0 - 37,0
% 11,0 - 16,0
- Negatif
- Negatif
- Negatif
- Negatif
Kesan : Saran :
Kesan : Saran :

10³/mm³ 4,00 - 10,00
10^6/mm³ 3,50 - 5,00 H
g/dL 11,0 - 15,0
% 35,0 - 47,0
10³/mm³ 150 - 450
% 50,0 - 70,0
% 20,0 - 40,0
% 3,0 - 12,0
% 0,5 - 5,0
% 0,0 - 1,0
fL 80,0 - 100,0 L
pg 27,0 - 34,0 L
g/dL 32,0 - 36,0
% 11,0 - 16,0
- Negatif
- Negatif
- Negatif
- Negatif
Kesan : Saran :

9:18:49 Sp.A.K Sp.PK
10³/mm³ 4,00 - 12,00
10^6/mm³ 3,50 - 5,20
g/dL 12,0 - 16,0
% 35,0 - 49,0
10³/mm³ 150 - 450
% 50,0 - 70,0
% 20,0 - 40,0
% 3,0 - 12,0
% 0,5 - 5,0
% 0,0 - 1,0
fL 80,0 - 100,0 L
pg 27,0 - 34,0 L
g/dL 31,0 - 37,0
% 11,0 - 16,0
- Negatif
- Negatif
- Negatif
- Negatif
Kesan : Saran :

- Negatif
Kesan : Saran :
dr. Redyaksa Drestanta

1:51:33 Ariandoko -
mg/dl 70 - 200
Kesan : Saran :

14:52:24 Sp.PK Sp.PK

- Non Reaktif
Kesan : Saran :

11:13:32 - Sp.PK
10³/mm³ 4,00 - 12,00
10^6/mm³ 3,50 - 5,20
g/dL 12,0 - 16,0 L
% 35,0 - 49,0 L
10³/mm³ 150 - 450
% 50,0 - 70,0 L
% 20,0 - 40,0 H
% 3,0 - 12,0
% 0,5 - 5,0 L
% 0,0 - 1,0
fL 80,0 - 100,0 L
pg 27,0 - 34,0 L
g/dL 31,0 - 37,0
% 11,0 - 16,0 H
Kesan : Saran :

8:49:57 - Sp.PK
10³/mm³ 4,00 - 10,00
10^6/mm³ 3,50 - 5,00 H
g/dL 11,0 - 15,0
% 35,0 - 47,0
10³/mm³ 150 - 450

% 50,0 - 70,0
% 20,0 - 40,0
% 3,0 - 12,0
% 0,5 - 5,0
% 0,0 - 1,0
fL 80,0 - 100,0
pg 27,0 - 34,0
g/dL 32,0 - 36,0
% 11,0 - 16,0
- Negatif H
- Negatif
- Negatif
- Negatif
Kesan : Saran :

10³/mm³ 4,00 - 10,00
10^6/mm³ 3,50 - 5,00
g/dL 11,0 - 15,0
% 35,0 - 47,0
10³/mm³ 150 - 450
% 50,0 - 70,0 L
% 20,0 - 40,0
% 3,0 - 12,0
% 0,5 - 5,0
% 0,0 - 1,0
fL 80,0 - 100,0
pg 27,0 - 34,0
g/dL 32,0 - 36,0
% 11,0 - 16,0
- Negatif
- Negatif
- Negatif
- Negatif
Kesan : Saran :

10³/mm³ 4,00 - 12,00
10^6/mm³ 3,50 - 5,20

g/dL 12,0 - 16,0 L
% 35,0 - 49,0 L
10³/mm³ 150 - 450
% 50,0 - 70,0
% 20,0 - 40,0
% 3,0 - 12,0
% 0,5 - 5,0 L
% 0,0 - 1,0
fL 80,0 - 100,0 L
pg 27,0 - 34,0
g/dL 31,0 - 37,0
% 11,0 - 16,0
- Negatif
- Negatif
- Negatif
- Negatif
Kesan : Saran :

Kuning
Lembek
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif H
Negatif
Negatif
Kesan : Saran :

- Non Reaktif
Kesan : Saran :


- Negatif
- Negatif
Kesan : Saran :
21:11:19 dr. Wildana Aqila Dzakiy -
mg/dl 70 - 200
Kesan : Saran :

10³/mm³ 4,00 - 12,00
10^6/mm³ 3,50 - 5,20
g/dL 12,0 - 16,0
% 35,0 - 49,0
10³/mm³ 150 - 450

% 50,0 - 70,0 L
% 20,0 - 40,0 H
% 3,0 - 12,0
% 0,5 - 5,0 L
% 0,0 - 1,0
fL 80,0 - 100,0 L
pg 27,0 - 34,0 L
g/dL 31,0 - 37,0
% 11,0 - 16,0
- Negatif
- Negatif
- Negatif
- Negatif
Kesan : Saran :

mg/dl < 200
mg/dl < 200
mg/dl > = 35
mg/dl < 160
mg/dl 70 - 200
mg/dl 2,4 – 5,7
Kesan : Saran :
dr. Prabu Ekalaya Utama, dr. Dwi Retnoningrum,

18:15:27 Sp.B Sp.PK
10³/mm³ 4,00 - 10,00
10^6/mm³ 3,50 - 5,00
g/dL 11,0 - 15,0
% 35,0 - 47,0
10³/mm³ 150 - 450
% 50,0 - 70,0 H
% 20,0 - 40,0
% 3,0 - 12,0
% 0,5 - 5,0
% 0,0 - 1,0
fL 80,0 - 100,0
pg 27,0 - 34,0
g/dL 32,0 - 36,0
% 11,0 - 16,0
Kesan : Saran :

15:24:58 M.Kes., M.H Sp.PK
- Negatif
Kesan : Saran :

10³/mm³ 4,00 - 10,00 H
10^6/mm³ 4,00 - 5,50
g/dL 13,0 - 18,0 L
% 40,0 - 54,0 L
10³/mm³ 150 - 450
% 50,0 - 70,0 H
% 20,0 - 40,0 L
% 3,0 - 12,0
% 0,5 - 5,0
% 0,0 - 1,0
fL 80,0 - 100,0
pg 27,0 - 34,0
g/dL 32,0 - 36,0
% 11,0 - 16,0
mg/dl 70 - 200
Kesan : Saran :
dr. Prabu Ekalaya Utama, dr. Dwi Retnoningrum,

14:42:17 Sp.B Sp.PK
10³/mm³ 4,00 - 10,00 H
10^6/mm³ 3,50 - 5,00
g/dL 11,0 - 15,0
% 35,0 - 47,0
10³/mm³ 150 - 450
% 50,0 - 70,0 H
% 20,0 - 40,0 L
% 3,0 - 12,0 L
% 0,5 - 5,0 L
% 0,0 - 1,0
fL 80,0 - 100,0
pg 27,0 - 34,0
g/dL 32,0 - 36,0
% 11,0 - 16,0
Kesan : Saran :

10³/mm³ 4,00 - 10,00 L
10^6/mm³ 3,50 - 5,00 H
g/dL 11,0 - 15,0
% 35,0 - 47,0
10³/mm³ 150 - 450 L
% 50,0 - 70,0 L
% 20,0 - 40,0
% 3,0 - 12,0 H
% 0,5 - 5,0 L
% 0,0 - 1,0
fL 80,0 - 100,0 L
pg 27,0 - 34,0 L
g/dL 32,0 - 36,0
% 11,0 - 16,0
Kesan : Saran :

- Negatif
Kesan : Saran :
12:51:57 - Sp.PK
mg/dl 16,6 - 48,5
mg/dl 0,6 - 1,1 H
10³/mm³ 4,00 - 10,00
10^6/mm³ 4,00 - 5,50
g/dL 13,0 - 18,0 L
% 40,0 - 54,0 L
10³/mm³ 150 - 450
% 50,0 - 70,0 H
% 20,0 - 40,0
% 3,0 - 12,0 L
% 0,5 - 5,0 L
% 0,0 - 1,0
fL 80,0 - 100,0 L
pg 27,0 - 34,0 L
g/dL 32,0 - 36,0
% 11,0 - 16,0
mg/dl 70 - 200
mEq/L 3,5 - 5,5
mEq/L 135 - 145
mEq/L 96 - 106
Kesan : Saran :


10³/mm³ 4,00 - 10,00 H
10^6/mm³ 3,50 - 5,00
g/dL 11,0 - 15,0
% 35,0 - 47,0
10³/mm³ 150 - 450
% 50,0 - 70,0 H
% 20,0 - 40,0 L
% 3,0 - 12,0
% 0,5 - 5,0 L
% 0,0 - 1,0
fL 80,0 - 100,0
pg 27,0 - 34,0
g/dL 32,0 - 36,0

% 11,0 - 16,0
mg/dl 70 - 200
Kesan : Saran :

10³/mm³ 4,00 - 10,00 H
10^6/mm³ 3,50 - 5,00
g/dL 11,0 - 15,0
% 35,0 - 47,0
10³/mm³ 150 - 450
% 50,0 - 70,0 H
% 20,0 - 40,0 L
% 3,0 - 12,0
% 0,5 - 5,0 L
% 0,0 - 1,0
fL 80,0 - 100,0
pg 27,0 - 34,0
g/dL 32,0 - 36,0
% 11,0 - 16,0
mg/dl 70 - 200
Kesan : Saran :

10³/mm³ 4,00 - 10,00 H

10^6/mm³ 3,50 - 5,00
g/dL 11,0 - 15,0
% 35,0 - 47,0 L
10³/mm³ 150 - 450
% 50,0 - 70,0
% 20,0 - 40,0 H
% 3,0 - 12,0
% 0,5 - 5,0 L
% 0,0 - 1,0
fL 80,0 - 100,0
pg 27,0 - 34,0
g/dL 32,0 - 36,0
% 11,0 - 16,0
- Negatif
- Negatif
- Negatif
- Negatif
Kesan : Saran :

8:27:20 - Sp.PK
- Negatif
- Negatif
- Negatif
- Negatif
- Negatif
- Negatif
Kesan : Saran :
10³/mm³ 4,00 - 10,00 L
10^6/mm³ 4,00 - 5,50
g/dL 13,0 - 18,0
% 40,0 - 54,0
10³/mm³ 150 - 450
% 50,0 - 70,0 L
% 20,0 - 40,0 H
% 3,0 - 12,0
% 0,5 - 5,0 L
% 0,0 - 1,0
fL 80,0 - 100,0
pg 27,0 - 34,0
g/dL 32,0 - 36,0
% 11,0 - 16,0
Kesan : Saran :

10³/mm³ 4,00 - 12,00
10^6/mm³ 3,50 - 5,20
g/dL 12,0 - 16,0 L
% 35,0 - 49,0 L
10³/mm³ 150 - 450
% 50,0 - 70,0 L
% 20,0 - 40,0 H
% 3,0 - 12,0
% 0,5 - 5,0 L
% 0,0 - 1,0
fL 80,0 - 100,0
pg 27,0 - 34,0 L
g/dL 31,0 - 37,0
% 11,0 - 16,0
mm/jam 0 - 15
mm/jam 0 - 20
Kesan : Saran :


mg/dl 70 - 126
mg/dl < 200
mg/dl < 200
mg/dl > = 35
mg/dl < 160
mg/dl 2,4 – 5,7
Kesan : Saran :


Kesan : Saran :

mg/dl < 200
mg/dl < 200
mg/dl 70 - 200
mg/dl 3,4 – 7,2
Kuning Jernih H
4,8 - 7,5
1,015 - 1,025
Negatif
Negatif
mg/dl Negatif
Negatif
Negatif
Negatif
Negatif
Negatif H
Kesan : Saran :


Kuning Jernih
4,8 - 7,5
1,015 - 1,025
Negatif
Negatif
mg/dl Negatif
Negatif
Negatif H
Negatif
Negatif
Negatif
Kesan : Saran :
10³/mm³ 4,00 - 12,00
10^6/mm³ 3,50 - 5,20 H
g/dL 12,0 - 16,0
% 35,0 - 49,0
10³/mm³ 150 - 450
% 50,0 - 70,0
% 20,0 - 40,0
% 3,0 - 12,0
% 0,5 - 5,0
% 0,0 - 1,0
fL 80,0 - 100,0 L
pg 27,0 - 34,0 L
g/dL 31,0 - 37,0
% 11,0 - 16,0
Kesan : Saran :
21:55:07 dr. Okky Firmansyah -
mg/dl 70 - 200
Kesan : Saran :
21:30:13 dr. Okky Firmansyah -
mg/dl 70 - 200
Kesan : Saran :

mg/dl 3,4 - 7,2
mg/dl 16,6 - 48,5
mg/dl 0,6 - 1,1
mg/dl < 200
mg/dl < 200
Kesan : Saran :

10³/mm³ 4,00 - 10,00 H
10^6/mm³ 4,00 - 5,50
g/dL 13,0 - 18,0
% 40,0 - 54,0
10³/mm³ 150 - 450
% 50,0 - 70,0 H
% 20,0 - 40,0 L
% 3,0 - 12,0
% 0,5 - 5,0 L
% 0,0 - 1,0
fL 80,0 - 100,0
pg 27,0 - 34,0
g/dL 32,0 - 36,0
% 11,0 - 16,0
mg/dl 70 - 200
Kesan : Saran :

11:12:24 M.Kes., M.H Sp.PK
mg/dl 70 - 200 H
mg/dl 3,4 – 7,2
mg/dl 0 – 200 H
Kesan : Saran :

10:05:57 - Sp.PK
10³/mm³ 4,00 - 10,00
10^6/mm³ 3,50 - 5,00
g/dL 11,0 - 15,0

% 35,0 - 47,0
10³/mm³ 150 - 450
% 50,0 - 70,0 L
% 20,0 - 40,0 H
% 3,0 - 12,0
% 0,5 - 5,0 L
% 0,0 - 1,0
fL 80,0 - 100,0
pg 27,0 - 34,0
g/dL 32,0 - 36,0
% 11,0 - 16,0
- Negatif
- Negatif
- Negatif
- Negatif
Kesan : Saran :

10³/mm³ 4,00 - 12,00
10^6/mm³ 3,50 - 5,20
g/dL 12,0 - 16,0
% 35,0 - 49,0
10³/mm³ 150 - 450
% 50,0 - 70,0
% 20,0 - 40,0
% 3,0 - 12,0
% 0,5 - 5,0 L
% 0,0 - 1,0
fL 80,0 - 100,0
pg 27,0 - 34,0
g/dL 31,0 - 37,0
% 11,0 - 16,0
- Negatif
- Negatif
- Negatif
- Negatif
Kesan : Saran :


10³/mm³ 4,00 - 10,00
10^6/mm³ 3,50 - 5,00
g/dL 11,0 - 15,0
% 35,0 - 47,0
10³/mm³ 150 - 450
% 50,0 - 70,0 H
% 20,0 - 40,0 L
% 3,0 - 12,0
% 0,5 - 5,0 L
% 0,0 - 1,0
fL 80,0 - 100,0
pg 27,0 - 34,0
g/dL 32,0 - 36,0

% 11,0 - 16,0
- Negatif
- Negatif
- Negatif
- Negatif
Kesan : Saran :

19:34:32 M.Kes., M.H Sp.PK
Kesan : Saran :

19:12:15 M.Kes., M.H Sp.PK

mg/dl 70 - 200 H
Kesan : Saran :
mg/dl 70 - 200
Kesan : Saran :

Kesan : Saran :

20:17:38 M.Kes., M.H Sp.PK

- Negatif
Kesan : Saran :

20:16:18 M.Kes., M.H Sp.PK
- Negatif
Kesan : Saran :

10³/mm³ 4,00 - 12,00 H
10^6/mm³ 3,50 - 5,20
g/dL 12,0 - 16,0 L
% 35,0 - 49,0
10³/mm³ 150 - 450

% 50,0 - 70,0 H
% 20,0 - 40,0 L
% 3,0 - 12,0
% 0,5 - 5,0 L
% 0,0 - 1,0
fL 80,0 - 100,0 L
pg 27,0 - 34,0 L
g/dL 31,0 - 37,0
% 11,0 - 16,0
mg/dl 70 - 200
Kesan : Saran :

mg/dl 16,6 - 48,5
mg/dl 0,6 - 1,1
10³/mm³ 4,00 - 10,00
10^6/mm³ 4,00 - 5,50
g/dL 13,0 - 18,0
% 40,0 - 54,0
10³/mm³ 150 - 450
% 50,0 - 70,0 H
% 20,0 - 40,0 L
% 3,0 - 12,0
% 0,5 - 5,0 L
% 0,0 - 1,0
fL 80,0 - 100,0
pg 27,0 - 34,0
g/dL 32,0 - 36,0
% 11,0 - 16,0
mg/dl 70 - 200
Kesan : Saran :

15:01:06 Sp.A.K Sp.PK
10³/mm³ 4,00 - 12,00
10^6/mm³ 3,50 - 5,20
g/dL 12,0 - 16,0

% 35,0 - 49,0
10³/mm³ 150 - 450 H
% 50,0 - 70,0
% 20,0 - 40,0
% 3,0 - 12,0
% 0,5 - 5,0 L
% 0,0 - 1,0
fL 80,0 - 100,0
pg 27,0 - 34,0 L
g/dL 31,0 - 37,0
% 11,0 - 16,0
Kesan : Saran :

11:31:36 M.Kes., M.H Sp.PK
10³/mm³ 4,00 - 10,00 H
10^6/mm³ 3,50 - 5,00
g/dL 11,0 - 15,0
% 35,0 - 47,0
10³/mm³ 150 - 450
% 50,0 - 70,0 H
% 20,0 - 40,0 L
% 3,0 - 12,0
% 0,5 - 5,0 L
% 0,0 - 1,0
fL 80,0 - 100,0 L
pg 27,0 - 34,0 L
g/dL 32,0 - 36,0
% 11,0 - 16,0
- Negatif H
- Negatif
- Negatif H
- Negatif H
Kesan : Saran :

8:38:41 W., Sp.B Sp.PK
Menit 1-Jun
Menit Sep-15
10³/mm³ 4,00 - 12,00

10^6/mm³ 3,50 - 5,20 H
g/dL 12,0 - 16,0
% 35,0 - 49,0
10³/mm³ 150 - 450
% 50,0 - 70,0 H
% 20,0 - 40,0
% 3,0 - 12,0
% 0,5 - 5,0 L
% 0,0 - 1,0
fL 80,0 - 100,0 L
pg 27,0 - 34,0 L
g/dL 31,0 - 37,0
% 11,0 - 16,0
mEq/L 3,5 - 5,5
mEq/L 135 - 145
mEq/L 96 - 106
Kesan : Saran :
dr. Rr Widya
8:26:50 Kusumaningsih, Sp.DV -
mg/dl 70 - 200
Kesan : Saran :
mg/dl 70 - 200
Kesan : Saran :

mg/dl 70 - 200
Kesan : Saran :
mg/dl 70 - 200
Kesan : Saran :

mg/dl 16,6 - 48,5
mg/dl 0,6 - 1,1 H
Kesan : Saran :

- Negatif
Kesan : Saran :

10³/mm³ 4,00 - 12,00
10^6/mm³ 3,50 - 5,20
g/dL 12,0 - 16,0
% 35,0 - 49,0
10³/mm³ 150 - 450
% 50,0 - 70,0 H
% 20,0 - 40,0 L
% 3,0 - 12,0
% 0,5 - 5,0 L
% 0,0 - 1,0
fL 80,0 - 100,0 L
pg 27,0 - 34,0 L
g/dL 31,0 - 37,0
% 11,0 - 16,0
Kesan : Saran :

- Negatif
Kesan : Saran :


-
Kesan : Saran :

- Negatif
Kesan : Saran :

10³/mm³ 4,00 - 12,00
10^6/mm³ 3,50 - 5,20
g/dL 12,0 - 16,0 L
% 35,0 - 49,0
10³/mm³ 150 - 450

% 50,0 - 70,0 L
% 20,0 - 40,0 H
% 3,0 - 12,0
% 0,5 - 5,0
% 0,0 - 1,0
fL 80,0 - 100,0 L
pg 27,0 - 34,0 L
g/dL 31,0 - 37,0
% 11,0 - 16,0
- Negatif
- Negatif
- Negatif
- Negatif
Kesan : Saran :

11:36:58 M.Kes., M.H Sp.PK
10³/mm³ 4,00 - 12,00
10^6/mm³ 3,50 - 5,20
g/dL 12,0 - 16,0
% 35,0 - 49,0
10³/mm³ 150 - 450
% 50,0 - 70,0
% 20,0 - 40,0
% 3,0 - 12,0
% 0,5 - 5,0 L
% 0,0 - 1,0
fL 80,0 - 100,0 L
pg 27,0 - 34,0
g/dL 31,0 - 37,0
% 11,0 - 16,0
- Negatif H
- Negatif
- Negatif
- Negatif
Kesan : Saran :

10³/mm³ 4,00 - 12,00

10^6/mm³ 3,50 - 5,20
g/dL 12,0 - 16,0 L
% 35,0 - 49,0 L
10³/mm³ 150 - 450
% 50,0 - 70,0 L
% 20,0 - 40,0 H
% 3,0 - 12,0
% 0,5 - 5,0
% 0,0 - 1,0
fL 80,0 - 100,0 L
pg 27,0 - 34,0
g/dL 31,0 - 37,0
% 11,0 - 16,0
- Negatif
- Negatif
- Negatif
- Negatif
Kesan : Saran :

17:16:33 M.Kes., M.H Sp.PK
- Negatif
Kesan : Saran :

13:45:12 W., Sp.B Sp.PK
mg/dl 16,6 - 48,5
mg/dl 0,6 - 1,1

mg/dl 70 - 200
gr/dl 3,5 – 5,2
mEq/L 3,5 - 5,5
mEq/L 135 - 145
mEq/L 96 - 106
- Negatif
Kesan : Saran :

Kuning Jernih H
4,8 - 7,5
1,015 - 1,025
Negatif
Negatif
mg/dl Negatif
Negatif
Negatif
Positif ( 1 - 15 )/LPK H
Negatif
Negatif
Negatif
Kesan : Saran :

13:35:35 W., Sp.B Sp.PK
Menit 1-Jun
Menit Sep-15
10³/mm³ 4,00 - 10,00
10^6/mm³ 4,00 - 5,50
g/dL 13.0 - 18,0
% 40,0 - 54,0
10³/mm³ 150 - 450
% 50,0 - 70,0
% 20,0 - 40,0
% 3,0 - 12,0
% 0,5 - 5,0
% 0,0 - 1,0
fL 80,0 - 100,0
pg 27,0 - 34,0
g/dL 32,0 - 36,0
% 11,0 - 16,0
Kesan : Saran :

- Negatif
Kesan : Saran :
DATA PASIEN UMUM BULAN MEI 2023 BERDASARKAN SIM
178474 AMEERA
AZZAHRA
KHAIRUNNISA (Poli : Yuni Nurul Azizah,
2023/05/31/000145 LABORATORIUM) A. Md. 5/31/2023 21:43:00
203637 REYNALDI
SAKHA ADIWINATA
2023/05/31/000143 LABORATORIUM) A.Md.Kes 5/31/2023 21:12:21
030603 AGUNG ADI

BADRA (Poli : Abbas Herlan,
204267 QUINZA
MAYLAFAISHA
2023/05/31/000037 LABORATORIUM) A.Md. 5/31/2023 9:55:34
204267 QUINZA
MAYLAFAISHA
204267 QUINZA
MAYLAFAISHA
204257 ADINDA
ZHAFIRA SALMA
204254 NURUL
AGUSTINA (Poli : Ela Yulianti,
2023/05/30/000089 LABORATORIUM) A.Md.Kes. 5/30/2023 13:54:39
204247
MUHAMMAD
XHERDAN SHAQIRI
108447 MUHAMAD
IVAN MAHARDIKA
PUTRA (Poli : Ragil Pangestu W.,
203637 REYNALDI
SAKHA ADIWINATA
043409
RAMADHANDI
RAIHAN FATIH
WIJAYANTO (Poli : Ragil Pangestu W.,
204249 TRI
PRASETYO UTOMO
204246 ANAM
MAULANA (Poli : Ragil Pangestu W.,
203939
MUHAMMAD
NASHICH MACHFUD
204242
MUHAMMAD DWI
CAHYONO (Poli : Ragil Pangestu W.,
204241 WILDAN
IKSAN MAULANA
093327 BACHTIAR
AFFENDY (Poli : Mega Tri Wulandari,
204015
MUHAMMAD
FAHRHEL (Poli : Mega Tri Wulandari,
204231 HARIS NUR
IRFANI IKHSAN
203991 DZAKIY
AUFA RAHMAHIDA
203757 FITRA BAYU

PAMUNGKAS (Poli : Ragil Pangestu W.,
182021 MUWIRA
MARCHIA SIDNEY
203637 REYNALDI
SAKHA ADIWINATA
203991 DZAKIY
AUFA RAHMAHIDA
203757 FITRA BAYU

PAMUNGKAS (Poli : Ragil Pangestu W.,
204011 ARRIVAL
AKBAR (Poli : Ragil Pangestu W.,
204010 MUSA
ABDILLAH (Poli : Ragil Pangestu W.,
203948 SINDHU
ALAN BAHTIAR
108447 MUHAMAD
IVAN MAHARDIKA
PUTRA (Poli : Ragil Pangestu W.,
203956 CATHRIN
ANINDA (Poli : Ragil Pangestu W.,
043409
RAMADHANDI
RAIHAN FATIH
WIJAYANTO (Poli : Annies Fadhilah,
204216 ISTI
SULISTYORINI (Poli : Annies Fadhilah,
203939
MUHAMMAD
NASHICH MACHFUD
204212 ASEP
GUNAWAN (Poli : Abbas Herlan,
167129 YULIANTO
ADI KARYONO (Poli : Abbas Herlan,
204183
MUHAMMAD JAFAR
SHODIQ (Poli : Yuni Nurul Azizah,
010232 SRI REDJEKI

(Poli : Ela Yulianti,
196370 SITI DIYANI

LUDFIYANINGRUM
204193 ALIF HAFIDZ
SANTOSO (Poli : Annies Fadhilah,
200913
MUHAMMAD
HAZEL FULVIAN N
204190 SUGIYANTO
204183
MUHAMMAD JAFAR
SHODIQ (Poli : Yuni Nurul Azizah,
187791 ELISABETH
SCARLIETTA TARA
066286 INKA
JANUAR AN NADWA
153587 ZEANNISA
AZKADINA
PRASETYO (Poli : Ela Yulianti,
203281
NURLAILATUL
FITRIYAH (Poli : Ela Yulianti,
130822 REYHAN
MEIZA
DARUSSALAM (Poli : Abbas Herlan,
203743 EGIK
SUGIYARTO (Poli : Abbas Herlan,
204164 AYRA
ADREENA AZRA (Poli Abbas Herlan,
2023/05/23/000157 : LABORATORIUM) A.Md.Kes 5/23/2023 19:31:41
200913
MUHAMMAD
HAZEL FULVIAN N
(Poli : Yuni Nurul Azizah,
204140 CITRA
CAHYA MEYRANI
060402 TRI HASTUTI

090659 NOVIAN ADI

KENCANA (Poli : Mega Tri Wulandari,
165734 SALSABILLA
KAMILA PUTRI
201185 SATRIA
ARJUNA RASYIIQ
199811 FAEYZA
AFAF ALTHARIO
058254 NIZAR RAFI

PRADANA (Poli : Ela Yulianti,
186391 ARIF
YULIANTO (Poli : Abbas Herlan,
047633 BADEMI
193221 YOGA
RUDIANTO (Poli : Ela Yulianti,
166796 HJ.
MAEMUNAH (Poli : Ragil Pangestu W.,
204097 TITIN
FITRIYANI (Poli : Yuni Nurul Azizah,
118735 RUWANTI
204050 FAZEELA
MESHWA ATHARI
204079 JECONIA
167450 ANAYA
HUMAIRA RADITY
182953
ATHARRAZKA
PUTRA WIBOWO
203878 KASIYEM
204051 JASMITO
SIHOMBING (Poli : Yuni Nurul Azizah,
204037 SHAFANA
NASHITA ALMAHIRA
128917 AGUNG
PAMUJO (Poli : Mega Tri Wulandari,
204036 YESHA
DENNAYA (Poli : Abbas Herlan,
204030 ANAYA
PUTRI SIHOTANG
204031 CHELSI
SIHOTANG (Poli : Yuni Nurul Azizah,
108447 MUHAMAD
IVAN MAHARDIKA
PUTRA (Poli : Yuni Nurul Azizah,
203655 GARDA
AMRA YUDISTIRA
204029 ROSI
GAMURTA PUTRI
203637 REYNALDI
SAKHA ADIWINATA
197195 FAJAR TRI
KURNIAWAN (Poli : Yuni Nurul Azizah,
002827 SULISTYANI
204026
MUHAMMAD
IKHSAN AGUS
PRABOWO (Poli : Yuni Nurul Azizah,
203956 CATHRIN
ANINDA (Poli : Yuni Nurul Azizah,
203990 FARID
MAQBULLAH
AHNAF (Poli : Ragil Pangestu W.,
043409
RAMADHANDI
RAIHAN FATIH
WIJAYANTO (Poli : Ragil Pangestu W.,
203939
MUHAMMAD
NASHICH MACHFUD
204019
MUHAMMAD
CHALWANI AL
GHIFARI (Poli : Ragil Pangestu W.,
204018 DANANG
BAGAS SATRIA
203947 YUDHISTIRA
BHISMA INDRA
PUTRA ANANTA
204019
MUHAMMAD
CHALWANI AL
GHIFARI (Poli : Ragil Pangestu W.,
167177 RISKY AGIL

SETIYOKO (Poli : Ela Yulianti,
019078 NUSAIBA
DZATIRRAHMA
ADZKIYA (Poli : Yuni Nurul Azizah,
184514 FEBRIYAN
PANCA SAPUTRA
121764 REYHAN
FAJAR
BUDIYATMOKO (Poli Abbas Herlan,
2023/05/13/000102 : LABORATORIUM) A.Md.Kes 5/13/2023 21:25:11
108447 MUHAMAD
IVAN MAHARDIKA
PUTRA (Poli : Abbas Herlan,
043409
RAMADHANDI
RAIHAN FATIH
WIJAYANTO (Poli : Abbas Herlan,
203637 REYNALDI
SAKHA ADIWINATA
203757 FITRA BAYU

PAMUNGKAS (Poli : Abbas Herlan,
203991 DZAKIY
AUFA RAHMAHIDA
203990 FARID
MAQBULLAH
AHNAF (Poli : Abbas Herlan,
203989 ALESANDRA
TARUNA (Poli : Abbas Herlan,
035024 DUTA AJI

PAMUNGKAS (Poli : Abbas Herlan,
127684 JACKY
SEWAKOTTAMA
NUGRAHA (Poli : Abbas Herlan,
197195 FAJAR TRI

KURNIAWAN (Poli : Abbas Herlan,
203983 ARIESTA
CAHYANINGTYAS
053646 GHANIA
AFRIN FAZILA (Poli : Ragil Pangestu W.,
203092 AZALIANTY
AULIAH (Poli : Yuni Nurul Azizah,
203959 FANNY
OKTAVIA ARIANTO
200939 ADAM
RAMADHAN (Poli : Mega Tri Wulandari,
203956 CATHRIN
ANINDA (Poli : Mega Tri Wulandari,
034845 IDJANG
SOETIKNO (Poli : Mega Tri Wulandari,
066286 INKA
JANUAR AN NADWA
203948 SINDHU
ALAN BAHTIAR
203947 YUDHISTIRA
BHISMA INDRA
PUTRA ANANTA
203939
MUHAMMAD
NASHICH MACHFUD
151827
MUHAMMAD
AZKADRYANO
PUJAKA (Poli : Abbas Herlan,
130822 REYHAN
MEIZA
DARUSSALAM (Poli : Abbas Herlan,
203743 EGIK
SUGIYARTO (Poli : Abbas Herlan,
053646 GHANIA
AFRIN FAZILA (Poli : Abbas Herlan,
200913
MUHAMMAD
HAZEL FULVIAN N
165967 GISHA
SHAQEENA
ALMAHYRA
SETIAWAN (Poli : Mega Tri Wulandari,
026269
SUHANTARYANTI
109822 NURKHOLIS
082114 REZA RIFAI

FERDIANSYAH (Poli : Ragil Pangestu W.,
108447 MUHAMAD
IVAN MAHARDIKA
PUTRA (Poli : Ela Yulianti,
189388 ARDINA
HUDA MULYANA
197195 FAJAR TRI

KURNIAWAN (Poli : Abbas Herlan,
043409
RAMADHANDI
RAIHAN FATIH
WIJAYANTO (Poli : Mega Tri Wulandari,
203871
MUHAMMAD
MALIK ALGHUFRON
203863 ANASTASIA
BEHIRA LINTANG
KURNIAREZKY (Poli : Ragil Pangestu W.,
197723 DINI
REGINA PINGKAN
ALIF FAZIN (Poli : Ragil Pangestu W.,
203775 FAWWAZ
DWI NUGROHO
048421 SOERYANI
203858 BAYI
NYONYA BETTY
WURYANTI (Poli : Ragil Pangestu W.,
203823 SULISTIONO
033445 WIDARTI
167177 RISKY AGIL

SETIYOKO (Poli : Annies Fadhilah,
203853 WAGINAH
125930 NURUL
AFIDAH DINAR
MEUTIA (Poli : Ela Yulianti,
203849 TUMIYATI
203848
SUSENAWATI (Poli : Ela Yulianti,
203847 AHMAD
DANIYAL ALHUSNI
203845 RANGGA
SATRIA PUTRA
PRATAMA (Poli : Ela Yulianti,
175655 KEMAT (Poli Mega Tri Wulandari,

2023/05/06/000056 : LABORATORIUM) A.Md. 5/6/2023 10:50:11
175655 KEMAT (Poli Mega Tri Wulandari,

2023/05/06/000056 : LABORATORIUM) A.Md. 5/6/2023 10:29:26
002811 SITI
AMINAH (Poli : Mega Tri Wulandari,
203838 FADLOLI
203824 ANIS
SULISTYOWATI
196947 KARISMA
KUSUMA AYU (Poli : Ela Yulianti,
203822 MURTI DIA
AYU LESTARI (Poli : Ela Yulianti,
203826 BAYU DWI

UTOMO AJI (Poli : Ela Yulianti,
203799 MURSINI
203830 SARMINI
203828
SUPARMIASIH (Poli : Ela Yulianti,
203825
SUDARYONO (Poli : Ela Yulianti,
203827 SITI
ZULICHA (Poli : Ela Yulianti,
203829 MARINO
203823 SULISTIONO
203821 SHAZIA
FLORRY MICHELLA
EFENDI (Poli : Ela Yulianti,
110724 RUSMINAH
203814 BY NY
NURIDA WIDAYANTI
203812 AGUS
HERMANTO (Poli : Ela Yulianti,
203813 M SHOBARI
203815 HERSEKTI
ARWINDA LESTARI
203804 DIAN FITRI

RAHMADANI (Poli : Ragil Pangestu W.,
074384
MUHAMMAD
ASLIANTO, SE (Poli : Abbas Herlan,
190796 SUNENGSIH
190796 SUNENGSIH
190796 SUNENGSIH
168861 WAKHID
MIFTAKHUDIN
203804 DIAN FITRI

RAHMADANI (Poli : Yuni Nurul Azizah,
090647 NOAH AL
HAIBAT (Poli : Annies Fadhilah,
203798 FAUSTINA
MIRACLE (Poli : Annies Fadhilah,
203798 FAUSTINA
MIRACLE (Poli : Annies Fadhilah,
203774 FITRI ELSA

MAYASARI (Poli : Mega Tri Wulandari,
203774 FITRI ELSA

MAYASARI (Poli : Yuni Nurul Azizah,
203772 VERA
KRISTIYANTI (Poli : Ragil Pangestu W.,
032315 SOEHARDJO
DARTO SUMARTO
006946 NABIL
AZHAR DZULFIKAR
203757 FITRA BAYU
PAMUNGKAS (Poli : Yuni Nurul Azizah,
202304 DURROTUN
NIKHAYAH (Poli : Yuni Nurul Azizah,
203264 HERSEKTI
ARWINDA LESTARI
203264 HERSEKTI
ARWINDA LESTARI
084970 DONNY
MOCHAMAD
DHARMAWAN
053646 GHANIA
AFRIN FAZILA (Poli : Annies Fadhilah,
084883 FATIH
VALEVY KUMARA
PAKSI (Poli : Annies Fadhilah,
093327 BACHTIAR
AFFENDY (Poli : Abbas Herlan,
093327 BACHTIAR
093327 BACHTIAR
093327 BACHTIAR
098763 NOVAL DWI

PRASETYA (Poli : Abbas Herlan,
RDASARKAN SIM


M.Kes., M.H Sp.PK

- Sp.PK

Tamam. Sp.A.K Sp.PK

Tamam. Sp.A.K Sp.PK

Tamam. Sp.A.K Sp.PK


dr. Hernanda Sp.PK

- Sp.PK





M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK



Tamam. Sp.A.K Sp.PK








M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK

- Sp.PK

Tamam. Sp.A.K Sp.PK

M.Kes., M.H Sp.PK

dr. Hernanda Sp.PK
dr. Hernanda Sp.PK

M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK

Tamam. Sp.A.K Sp.PK

M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK

Sp.A Sp.PK


M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK
- Sp.PK

M.Kes., M.H Sp.PK


M.Kes., M.H Sp.PK

Tamam. Sp.A.K Sp.PK

Tamam. Sp.A.K Sp.PK




M.Kes., M.H Sp.PK
Sp.PD Sp.PK

M.Kes., M.H Sp.PK

- Sp.PK

- Sp.PK


Tamam. Sp.A.K Sp.PK

M.Kes., M.H Sp.PK


M.Kes., M.H Sp.PK


dr. Hernanda Sp.PK


M.Kes., M.H Sp.PK

Tamam. Sp.A.K Sp.PK

Tamam. Sp.A.K Sp.PK

M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK

- Sp.PK

M.Kes., M.H Sp.PK
M.Kes., M.H Sp.PK

- Sp.PK

M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK


Tamam. Sp.A.K Sp.PK

M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK
Tamam. Sp.A.K Sp.PK

M.Kes., M.H Sp.PK


M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK
M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK



M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK
M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK


Drestanta Ariandoko Sp.PK


- Sp.PK

- Sp.PK

M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK



- Sp.PK

- Sp.PK

- Sp.PK

- Sp.PK

M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK
M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK
M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK

Tamam. Sp.A.K Sp.PK
M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK



M.Kes., M.H Sp.PK

Tamam. Sp.A.K Sp.PK

- Sp.PK

Tamam. Sp.A.K Sp.PK


M.Kes., M.H Sp.PK

Tamam. Sp.A.K Sp.PK

Tamam. Sp.A.K Sp.PK

M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK
M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK




M.Kes., M.H Sp.PK

M.Kes., M.H Sp.PK

- Sp.PK

- Sp.PK

- Sp.PK
- Sp.PK

Dzakiy Sp.PK
DATA PASIEN UMUM BULAN JUNI 2023 BERDASARKAN SIM
204750 MARETA Abbas

2023/06/30/00 SALSABILLA (Poli : Herlan,
0166 IGD) A.Md.Kes 6/30/2023 20:21:59
Cara Bayar :
Umum Pemeriksaan Hasil Satuan
TLAB00033
URINE RUTIN
33,000
P.H. 0 6
B.J. 0 1.03
Protein 0 Negatif
Reduksi 0 Negatif
Urobilinogen
0 Negatif mg/dl
Bilirubin 0 Negatif
Keton 0 Negatif
Sedimen 0
Leukosit 0 17-18
Eritrosit 0 0-1
Epitel Sel 0 6-Jul
Silinder 0 Negatif
Kristal 0 Negatif
Lain-lain 0 Leucocyt (+)
Biaya
Periksa :
33,000
Abbas
2023/06/30/00 100273 WAGIMAN Herlan,
0160 (Poli : IGD) A.Md.Kes 6/30/2023 17:55:01
Cara Bayar :
TLAB00006
GLUKOSA
DARAH
SEWAKTU
28,000
Glukosa
Darah -
Sewaktu 0 149 mg/dl
0
TLAB00010
ASAM URAT
43,000
ASAM URAT
0 6.8 mg/dl
Biaya
Periksa :
71,000
204729 DEANDRA
ZIFA (Kamar : Ragil
2023/06/29/00 MLT.03-01, Pangestu W.,
0006 MELATI) A.Md. 6/30/2023 7:52:01
Cara Bayar :
TLAB00272
URINE RUTIN
38,000
P.H. 0 7,0
B.J. 0 1,015
Protein 0 Negatif
Reduksi 0 Negatif
Urobilinogen
0 Negatif mg/dl
Bilirubin 0 Negatif
Keton 0 Negatif
Sedimen 0
Leukosit 0 0-2
Eritrosit 0 0-1
Epitel Sel 0 0-1
Silinder 0 Negatif
Kristal 0 Negatif
Lain-lain 0 Negatif
Biaya
Periksa :
38,000
Yuni Nurul
2023/06/29/00 204736 TUKIMO Azizah, A.
0019 (Poli : IGD) Md. 6/29/2023 16:47:59
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Leukosit 0 16.06 10³/mm³
Eritrosit 0 4.32 10^6/mm³
Hemoglobin
0 12.1 g/dL
Hematokrit 0 35.2 %
Trombosit 0 410 10³/mm³
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 79.9 %
Limfosit 0 14 %
Monosit 0 6.1 %
Eosinofil 0 0%
Basofil 0 0%
INDEX
ERITROSIT 0
MCV 0 81.5 fL
MCH 0 28 pg
MCHC 0 34.3 g/dL
RDW-CV 0 13.3 %
NLR 0 5.71
TLAB00022
WIDAL
59,500
Salmonella
typhi O 0 Negatif -
Salmonella
typhi H 0 Negatif -
Salmonella
paratyphi A-
H0 Negatif -
Salmonella
paratyphi B-
H0 Negatif -
Biaya
Periksa :
149,500
204735 ONESIA
PRAMISIANTI Mega Tri
2023/06/29/00 (Poli : Wulandari,
0016 LABORATORIUM) A.Md. 6/29/2023 13:53:06
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Leukosit 0 28,70 10³/mm³
Eritrosit 0 3,98 10^6/mm³
Hemoglobin
0 11,8 g/dL
Hematokrit 0 34,3 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 88,1 %
Limfosit 0 8,1 %
Monosit 0 3,7 %
Eosinofil 0 0,1 %
Basofil 0 0,0 %
INDEX
ERITROSIT 0
MCV 0 86,2 fL
MCH 0 29,6 pg
MCHC 0 34,4 g/dL
RDW-CV 0 15,7 %
NLR 0 10,88
Biaya
Periksa :
90,000
204729 DEANDRA
ZIFA (Kamar : Mega Tri
2023/06/29/00 MLT.03-01, Wulandari,
0006 MELATI) A.Md. 6/29/2023 10:00:55
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 13,7 g/dL
Hematokrit 0 40,0 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 59,2 %
Limfosit 0 35,0 %
Monosit 0 4,8 %
Eosinofil 0 0,9 %
Basofil 0 0,1 %
INDEX
ERITROSIT 0
MCV 0 77,8 fL
MCH 0 26,6 pg
MCHC 0 34,1 g/dL
RDW-CV 0 12,3 %
NLR 0 1,69
TLAB00006
GLUKOSA
DARAH
SEWAKTU
28,000
Glukosa
Darah -
Sewaktu 0 98 mg/dl
0
TLAB00019
ELEKTROLIT
237,000
Kalium 0 4 mEq/L
Natrium 0 142 mEq/L
Clorida 0 104 mEq/L
Biaya
Periksa :
355,000
151623 ANIK Abbas
2023/06/28/00 SARMINI (Poli : Herlan,
Cara Bayar :
TLAB00010
ASAM URAT
43,000
ASAM URAT
0 8.7 mg/dl
Biaya
Periksa :
43,000
151623 ANIK Ns. Durrotun

2023/06/28/00 SARMINI (Poli : Nikhayah,
0112 IGD) S.Kep. 6/28/2023 20:11:06
Cara Bayar :
TLAB00006
GLUKOSA
DARAH
SEWAKTU
28,000
Glukosa
Darah -
Sewaktu 0 102 mg/dl
Biaya
Periksa :
28,000
Annies
2023/06/27/00 204715 SUYANTO Fadhilah,
0166 (Poli : IGD) A.Md. 6/27/2023 23:11:10
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 14,6 g/dL
Hematokrit 0 43,0 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 79,1 %
Limfosit 0 16,4 %
Monosit 0 4,3 %
Eosinofil 0 0,2 %
Basofil 0 0,0 %
INDEX
ERITROSIT 0
MCV 0 78,8 fL
MCH 0 26,7 pg
MCHC 0 33,8 g/dL
RDW-CV 0 13,1 %
NLR 0 4,82
Biaya
Periksa :
90,000
087126 AMIN Annies

2023/06/27/00 GUNARTO (Poli : Fadhilah,
0162 IGD) A.Md. 6/27/2023 22:06:34
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 15,1 g/dL
Hematokrit 0 44,3 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 71,5 %
Limfosit 0 21,4 %
Monosit 0 5,7 %
Eosinofil 0 1,3 %
Basofil 0 0,1 %
INDEX
ERITROSIT 0
MCV 0 84,7 fL
MCH 0 29,0 pg
MCHC 0 34,2 g/dL
RDW-CV 0 12,8 %
NLR 0 3,34
Biaya
Periksa :
90,000
155089 ALEX
GUNAWAN Annies
2023/06/27/00 SILITONGA (Poli : Fadhilah,
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 15,6 g/dL
Hematokrit 0 46,5 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 64,0 %
Limfosit 0 29,7 %
Monosit 0 5,2 %
Eosinofil 0 1,1 %
Basofil 0 0,0 %
INDEX
ERITROSIT 0
MCV 0 85,2 fL
MCH 0 28,6 pg
MCHC 0 33,5 g/dL
RDW-CV 0 12,7 %
NLR 0 2,15
Biaya
Periksa :
90,000
155089 ALEX
GUNAWAN Annies
2023/06/27/00 SILITONGA (Poli : Fadhilah,
Cara Bayar :
TLAB00033
URINE RUTIN
33,000
P.H. 0 6,0
B.J. 0 1,020
Protein 0 Negatif
Reduksi 0 Negatif
Urobilinogen
0 Negatif mg/dl
Bilirubin 0 Negatif
Keton 0 Negatif
Sedimen 0
Leukosit 0 0-1
Eritrosit 0 0-1
Epitel Sel 0 0-2
Silinder 0 Negatif
Kristal 0 Negatif
Lain-lain 0 Negatif
Biaya
Periksa :
33,000
070638 ANGKASA
VALENCIA YAFI Ragil
2023/06/27/00 PRATAMA (Poli : Pangestu W.,
Cara Bayar :
TLAB00002
GOLONGAN
DARAH
23,000
Golongan
Darah 0 B (+) -
Biaya
Periksa :
23,000
204703 WULAN
NENDY JUAN Annies
2023/06/26/00 SAPUTRI (Poli : Fadhilah,
0164 IGD) A.Md. 6/26/2023 21:51:31
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 13,0 g/dL
Hematokrit 0 37,7 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 45,7 %
Limfosit 0 48,5 %
Monosit 0 3,6 %
Eosinofil 0 2,2 %
Basofil 0 0,0 %
INDEX
ERITROSIT 0
MCV 0 77,9 fL
MCH 0 26,8 pg
MCHC 0 34,4 g/dL
RDW-CV 0 13,2 %
NLR 0 0,94
Biaya
Periksa :
90,000
202377 SUCI Abbas
2023/06/26/00 DIANTORO (Poli : Herlan,
Cara Bayar :
TLAB00010
ASAM URAT
43,000
ASAM URAT
0 4.1 mg/dl
Biaya
Periksa :
43,000
197597 IRVAN
DIKA WICAKSONO Abbas
2023/06/26/00 (Poli : Herlan,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
157222 ASSYFA
SEPTIANI (Kamar : Abbas
2023/06/24/00 ANGGREKBED1, Herlan,
0073 ANGGREK) A.Md.Kes 6/26/2023 17:33:33
Cara Bayar :
J002145
DENGUE NS1
AG 200,000
DENGUE NS1
AG 0 NEGATIF -
Biaya
Periksa :
200,000
204698 FERDI
RAHMAT BINTARO Abbas
2023/06/26/00 (Poli : Herlan,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
157222 ASSYFA
0073 ANGGREK) A.Md.Kes 6/26/2023 16:06:51
Cara Bayar :
J002112
DARAH
LENGKAP
90,000
Hemoglobin
0 10.5 g/dL
Hematokrit 0 31.3 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 44.3 %
Limfosit 0 43.4 %
Monosit 0 9.4 %
Eosinofil 0 2.9 %
Basofil 0 0%
INDEX
ERITROSIT 0
MCV 0 67.8 fL
MCH 0 22.7 pg
MCHC 0 33.4 g/dL
RDW-CV 0 12.2 %
NLR 0 1.02
Biaya
Periksa :
90,000
204643
MUHAMMAD
FIKRI RAMADHAN Abbas
2023/06/26/00 (Poli : Poli Herlan,
0107 Kesehatan Jiwa) A.Md.Kes 6/26/2023 15:11:33
Cara Bayar :
J002125
NARKOBA
150,000
Opiat /
Morphin 0 Negatif -
Ganja /
Canabis 0 Negatif -
Amphetamin
0 Negatif -
Methamphet
amin 0 Negatif -
Benzodiazepi
n0 Negatif -
Cocain 0 Negatif -
Biaya
Periksa :
150,000
204695 YUSAL
NOTARISA
SUGIYANTO (Poli : Abbas
2023/06/26/00 Poli Kesehatan Herlan,
0098 Jiwa) A.Md.Kes 6/26/2023 15:01:22
Cara Bayar :
J002125
NARKOBA
150,000
Opiat /
Morphin 0 Negatif -
Ganja /
Canabis 0 Negatif -
Amphetamin
0 Negatif -
Methamphet
amin 0 Negatif -
Benzodiazepi
n0 Negatif -
Cocain 0 Negatif -
Biaya
Periksa :
150,000
170239
DZAKIYYAH SALMA
RAFIDAZEN (Poli : Yuni Nurul
2023/06/26/00 Poli Kesehatan Azizah, A.
0092 Jiwa) Md. 6/26/2023 13:58:33
Cara Bayar :
J002125
NARKOBA
150,000
Opiat /
Morphin 0 Negatif -
Ganja /
Canabis 0 Negatif -
Amphetamin
0 Negatif -
Methamphet
amin 0 Negatif -
Benzodiazepi
n0 Negatif -
Cocain 0 Negatif -
Biaya
Periksa :
150,000
203990 FARID
MAQBULLAH Yuni Nurul
2023/06/26/00 AHNAF (Poli : Azizah, A.
0059 LABORATORIUM) Md. 6/26/2023 9:00:06
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 NEGATIF -
Biaya
Periksa :
80,000
204692 AISYAH
MUGHNI SHALIHA Yuni Nurul
2023/06/26/00 (Poli : Azizah, A.
0057 LABORATORIUM) Md. 6/26/2023 8:21:58
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 12.5 g/dL
Hematokrit 0 36.6 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 51.7 %
Limfosit 0 34.9 %
Monosit 0 13.2 %
Eosinofil 0 0.2 %
Basofil 0 0%
INDEX
ERITROSIT 0
MCV 0 80.6 fL
MCH 0 27.5 pg
MCHC 0 34.1 g/dL
RDW-CV 0 12.1 %
NLR 0 1.48
TLAB00022
WIDAL
59,500
Salmonella
typhi O 0 Negatif -
Salmonella
typhi H 0 Negatif -
Salmonella
paratyphi A-
H0 Negatif -
Salmonella
paratyphi B-
H0 Negatif -
Biaya
Periksa :
149,500
201981 YULINDA
SYAFIRA DEWI Abbas
2023/06/26/00 (Poli : Herlan,
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 8,7 g/dL
Hematokrit 0 23,6 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 58,0 %
Limfosit 0 38,0 %
Monosit 0 4,0 %
Eosinofil 0 0,0 %
Basofil 0 0,0 %
INDEX
ERITROSIT 0
MCV 0 86,1 fL
MCH 0 31,7 pg
MCHC 0 36,8 g/dL
RDW-CV 0 12,7 %
NLR 0 1,53
Biaya
Periksa :
90,000
204690 GEA
ARMELIA PUTRI Mega Tri
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 12,2 g/dL
Hematokrit 0 34,9 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 87,4 %
Limfosit 0 8,9 %
Monosit 0 3,6 %
Eosinofil 0 0,1 %
Basofil 0 0,0 %
INDEX
ERITROSIT 0
MCV 0 80,2 fL
MCH 0 28,0 pg
MCHC 0 34,9 g/dL
RDW-CV 0 16,3 %
NLR 0 9,82
TLAB00023
HBSAG
59,500
HBSAG 0 Negatif
Biaya
Periksa :
149,500
204572 MUCTY Ragil

2023/06/25/00 ALY (Poli : Pangestu W.,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
203939
MUHAMMAD
NASHICH Ragil
2023/06/25/00 MACHFUD (Poli : Pangestu W.,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
204532 ADENTA Ragil
2023/06/25/00 RIZKYANTO (Poli : Pangestu W.,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
204686 RIZAL
MAULANA RIZKI Ragil
2023/06/25/00 (Poli : Pangestu W.,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
204246 ANAM Ragil

2023/06/25/00 MAULANA (Poli : Pangestu W.,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
204685 RASYA Ragil

2023/06/25/00 TAQI ATHALLAH Pangestu W.,
0037 (Poli : IGD) A.Md. 6/25/2023 19:25:58
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 12.5 g/dL
Hematokrit 0 36.2 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 51.5 %
Limfosit 0 42.5 %
Monosit 0 6%
Eosinofil 0 0%
Basofil 0 0%
INDEX
ERITROSIT 0
MCV 0 74.2 fL
MCH 0 25.5 pg
MCHC 0 34.4 g/dL
RDW-CV 0 12.9 %
NLR 0 1.21
Biaya
Periksa :
90,000
108447
MUHAMAD IVAN
MAHARDIKA Ragil
2023/06/25/00 PUTRA (Poli : Pangestu W.,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
204465
MAHATMA
RANGGA GANDHI Ragil
2023/06/25/00 (Poli : Pangestu W.,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
197127 Ragil
2023/06/25/00 LUQMANUL Pangestu W.,
0035 HAKIM (Poli : IGD) A.Md. 6/25/2023 19:02:49
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 13.2 g/dL
Hematokrit 0 38.4 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 62.2 %
Limfosit 0 24.4 %
Monosit 0 13.3 %
Eosinofil 0 0.1 %
Basofil 0 0%
INDEX
ERITROSIT 0
MCV 0 79.9 fL
MCH 0 27.5 pg
MCHC 0 34.4 g/dL
RDW-CV 0 12.5 %
NLR 0 2.54
TLAB00022
WIDAL
59,500
Salmonella
typhi O 0 Negatif -
Salmonella
typhi H 0 Negatif -
Salmonella
paratyphi A-
H0 Negatif -
Salmonella
paratyphi B-
H0 Negatif -
Biaya
Periksa :
149,500
203140 NAJLA
WIDYAWASONO Ragil
2023/06/25/00 (Poli : Pangestu W.,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
204681
APRILANDO FAHRI
ADE NUGROHO Abbas
2023/06/25/00 (Poli : Herlan,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
204426 YOGA
ARTIKA BUCHORI Abbas
2023/06/25/00 (Poli : Herlan,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
204679 ZUMAR
DZAKIY QUSHOYYI Abbas
2023/06/25/00 (Poli : Herlan,
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 12.9 g/dL
Hematokrit 0 37 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 63.2 %
Limfosit 0 19.7 %
Monosit 0 16.8 %
Eosinofil 0 0.3 %
Basofil 0 0%
INDEX
ERITROSIT 0
MCV 0 79 fL
MCH 0 27.6 pg
MCHC 0 34.9 g/dL
RDW-CV 0 12.1 %
NLR 0 3.21
TLAB00002
GOLONGAN
DARAH
23,000
Golongan
Darah 0 O Rhezus (+) -
Biaya
Periksa :
113,000
204677 WAHYU
DWI PRASETYO Abbas
2023/06/25/00 (Poli : Herlan,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
204678 SANDI
PRANATA Abbas
2023/06/25/00 NUREGGITA (Poli : Herlan,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
157222 ASSYFA
0073 ANGGREK) A.Md.Kes 6/25/2023 10:14:49
Cara Bayar :
TLAB00152
URINE RUTIN
33,000
P.H. 0 6.5
B.J. 0 1.015
Protein 0 Negatif
Reduksi 0 Negatif
Urobilinogen
0 Negatif mg/dl
Bilirubin 0 Negatif
Keton 0 Negatif
Sedimen 0
Leukosit 0 1-Feb
Eritrosit 0 0-1
Epitel Sel 0 1-Feb
Silinder 0 Negatif
Kristal 0 Negatif
Lain-lain 0 Negatif
Biaya
Periksa :
33,000
204674 SARLA Dana

2023/06/25/00 MELANI PUTRI Krismonika,
0003 (Poli : IGD) A.Md.Kep. 6/25/2023 2:50:56
Cara Bayar :
TLAB00006
GLUKOSA
DARAH
SEWAKTU
28,000
Glukosa
Darah -
Sewaktu 0 104 mg/dl
Biaya
Periksa :
28,000
204673 ANIS
SWESTY (Kamar : Mega Tri
2023/06/25/00 BOUGENVBED4, Wulandari,
0002 BOUGENVILLE) A.Md. 6/25/2023 1:53:41
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 13,7 g/dL
Hematokrit 0 40,3 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 62,9 %
Limfosit 0 27,2 %
Monosit 0 8,7 %
Eosinofil 0 1,1 %
Basofil 0 0,1 %
INDEX
ERITROSIT 0
MCV 0 81,7 fL
MCH 0 27,7 pg
MCHC 0 33,9 g/dL
RDW-CV 0 13,5 %
NLR 0 2,31
TLAB00006
GLUKOSA
DARAH
SEWAKTU
28,000
Glukosa
Darah -
Sewaktu 0 81 mg/dl
Biaya
Periksa :
118,000
204671
MUHAMAD
KURNIA YUDHA Mega Tri
2023/06/24/00 RAMA RISTY (Poli : Wulandari,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
157222 ASSYFA
SEPTIANI (Kamar : Mega Tri
2023/06/24/00 ANGGREKBED1, Wulandari,
0073 ANGGREK) A.Md. 6/24/2023 21:06:40
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 10,9 g/dL
Hematokrit 0 33,1 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 65,0 %
Limfosit 0 27,8 %
Monosit 0 6,9 %
Eosinofil 0 0,3 %
Basofil 0 0,0 %
INDEX
ERITROSIT 0
MCV 0 67,5 fL
MCH 0 22,3 pg
MCHC 0 33,0 g/dL
RDW-CV 0 12,3 %
NLR 0 2,34
Biaya
Periksa :
90,000
175725 MORELLA Abbas

2023/06/24/00 PUTRI (Poli : Herlan,
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 12.8 g/dL
Hematokrit 0 38.7 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 70.3 %
Limfosit 0 21.2 %
Monosit 0 8.4 %
Eosinofil 0 0.1 %
Basofil 0 0%
INDEX
ERITROSIT 0
MCV 0 79.3 fL
MCH 0 26.2 pg
MCHC 0 33 g/dL
RDW-CV 0 12.7 %
NLR 0 3.32
TLAB00022
WIDAL
59,500
Salmonella
typhi O 0 Negatif -
Salmonella
typhi H 0 Negatif -
Salmonella
paratyphi A-
H0 Negatif -
Salmonella
paratyphi B-
H0 Negatif -
Biaya
Periksa :
149,500
203757 FITRA
BAYU
PAMUNGKAS Abbas
2023/06/24/00 (Poli : Herlan,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
204661 AQILA Annies

2023/06/24/00 PUTRI WIJAYA Fadhilah,
0025 (Poli : Poli Anak) A.Md. 6/24/2023 13:02:46
Cara Bayar :
J000622
GLUKOSA
DARAH
SEWAKTU
BAYI 43,000
Glukosa
Darah
Sewaktu Bayi
0 67 mg/dl
Biaya
Periksa :
43,000
120139 IRSYAD Annies

2023/06/24/00 HABIBIE (Poli : Fadhilah,
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Leukosit 0 10³/mm³
Eritrosit 0 10^6/mm³
Hemoglobin
0 g/dL
Hematokrit 0 %
Trombosit 0 10³/mm³
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 %
Limfosit 0 %
Monosit 0 %
Eosinofil 0 %
Basofil 0 %
INDEX
ERITROSIT 0
MCV 0 fL
MCH 0 pg
MCHC 0 g/dL
RDW-CV 0 %
NLR 0
TLAB00022
WIDAL
59,500
Salmonella
typhi O 0 -
Salmonella
typhi H 0 -
Salmonella
paratyphi A-
H0 -
Salmonella
paratyphi B-
H0 -
Biaya
Periksa :
149,500
145606 ANINDIA Yuni Nurul

2023/06/24/00 SHAKILA (Poli : Azizah, A.
0009 LABORATORIUM) Md. 6/24/2023 6:41:33
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 14.4 g/dL
Hematokrit 0 41.7 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 48.6 %
Limfosit 0 43.9 %
Monosit 0 7.4 %
Eosinofil 0 0.1 %
Basofil 0 0%
INDEX
ERITROSIT 0
MCV 0 76.9 fL
MCH 0 26.6 pg
MCHC 0 34.6 g/dL
RDW-CV 0 12.5 %
NLR 0 1.11
Biaya
Periksa :
90,000
145606 ANINDIA Yuni Nurul

2023/06/24/00 SHAKILA (Poli : Azizah, A.
0009 LABORATORIUM) Md. 6/24/2023 6:40:10
Cara Bayar :
TLAB00002
GOLONGAN
DARAH
23,000
Golongan
Darah 0 O RHESUS (+) -
Biaya
Periksa :
23,000
204647 HERI Yuni Nurul

2023/06/23/00 KUSTANTO (Poli : Azizah, A.
0155 IGD) Md. 6/23/2023 21:54:59
Cara Bayar :
J002045
FUNGSI
GINJAL 2
86,000
UREUM 0 35.2 mg/dl
CREATININ 0 0.7 mg/dl
Biaya
Periksa :
86,000
Yuni Nurul
2023/06/23/00 204656 ALIVAH Azizah, A.
0180 (Poli : IGD) Md. 6/23/2023 21:38:41
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 12.8 g/dL
Hematokrit 0 36 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 57.3 %
Limfosit 0 34.5 %
Monosit 0 4.9 %
Eosinofil 0 3.3 %
Basofil 0 0%
INDEX
ERITROSIT 0
MCV 0 91.4 fL
MCH 0 32.5 pg
MCHC 0 35.5 g/dL
RDW-CV 0 13.8 %
NLR 0 1.66
Biaya
Periksa :
90,000
066072 DEVIRA
2023/06/23/00 AZZAH ULYA (Poli : Ela Yulianti,
0179 LABORATORIUM) A.Md.Kes. 6/23/2023 20:59:54
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 13.2 g/dL
Hematokrit 0 38.2 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 56 %
Limfosit 0 34.1 %
Monosit 0 6.1 %
Eosinofil 0 3.8 %
Basofil 0 0%
INDEX
ERITROSIT 0
MCV 0 84.1 fL
MCH 0 29.1 pg
MCHC 0 34.6 g/dL
RDW-CV 0 12.1 %
NLR 0 1.64
TLAB00022
WIDAL
59,500
Salmonella
typhi O 0 Negatif -
Salmonella
typhi H 0 Negatif -
Salmonella
paratyphi A-
H0 Negatif -
Salmonella
paratyphi B-
H0 Negatif -
Biaya
Periksa :
149,500
204650 ANNAS
2023/06/23/00 FIRDAUS (Poli : Ela Yulianti,
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 16.5 g/dL
Hematokrit 0 48.5 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 55.8 %
Limfosit 0 34.4 %
Monosit 0 6.4 %
Eosinofil 0 3.4 %
Basofil 0 0%
INDEX
ERITROSIT 0
MCV 0 86.8 fL
MCH 0 29.5 pg
MCHC 0 34 g/dL
RDW-CV 0 12.4 %
NLR 0 1.62
Biaya
Periksa :
90,000
204650 ANNAS
2023/06/23/00 FIRDAUS (Poli : Ela Yulianti,
Cara Bayar :
TLAB00033
URINE RUTIN
33,000
P.H. 0 6.5
B.J. 0 1.02
Protein 0 Negatif
Reduksi 0 Negatif
Urobilinogen
0 Negatif mg/dl
Bilirubin 0 Negatif
Keton 0 Negatif
Sedimen 0
Leukosit 0 1-Feb
Eritrosit 0 0-1
Epitel Sel 0 1-Feb
Silinder 0 Negatif
Kristal 0 Negatif
Lain-lain 0 Negatif
Biaya
Periksa :
33,000
204642 RAHMA
2023/06/23/00 KHOIRINISA ZULFA Ela Yulianti,
0101 (Poli : Poli Umum) A.Md.Kes. 6/23/2023 18:53:03
Cara Bayar :
J002070 LFT
80,000
SGOT / ASTL
0 17 U/L
SGPT / ALTL
0 10 U/L
J002108 BTA
SPUTUM
PREPARAT 0
BTA Sputum
Pagi 0 NEGATIF -
BTA Sputum
Sewaktu 0 NEGATIF -
TLAB00033
URINE RUTIN
33,000
P.H. 0 6.5
B.J. 0 1.02
Protein 0 Negatif
Reduksi 0 Negatif
Urobilinogen
0 Negatif mg/dl
Bilirubin 0 Negatif
Keton 0 Negatif
Sedimen 0
Leukosit 0 2-Mar
Eritrosit 0 0-1
Epitel Sel 0 PENUH
Silinder 0 Negatif
Kristal 0 Negatif
Lain-lain 0 Bakteri (+)
TLAB00051
CRP Kualitatif
144,000
CRP Kualitatif
0 Negatif -
Biaya
Periksa :
257,000
204647 HERI
2023/06/23/00 KUSTANTO (Poli : Ela Yulianti,
0155 IGD) A.Md.Kes. 6/23/2023 18:38:00
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 14.9 g/dL
Hematokrit 0 43.3 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 78.1 %
Limfosit 0 7.9 %
Monosit 0 13.8 %
Eosinofil 0 0.2 %
Basofil 0 0%
INDEX
ERITROSIT 0
MCV 0 87.2 fL
MCH 0 29.9 pg
MCHC 0 34.3 g/dL
RDW-CV 0 14.3 %
NLR 0 9.89
Biaya
Periksa :
90,000
204647 HERI
2023/06/23/00 KUSTANTO (Poli : Ela Yulianti,
0155 IGD) A.Md.Kes. 6/23/2023 18:36:46
Cara Bayar :
J002086HV
Rapid Covid
19 Antigen
124,900
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
124,900
030478 ZAINAL Karla Kurnia

2023/06/23/00 ARIFIN (Poli : Oktaviani,
0107 Penyakit Dalam) A.Md.Keb 6/23/2023 16:38:43
Cara Bayar :
TLAB00006
GLUKOSA
DARAH
SEWAKTU
28,000
Glukosa
Darah -
Sewaktu 0 94 mg/dl
Biaya
Periksa :
28,000
204642 RAHMA
2023/06/23/00 KHOIRINISA ZULFA Ela Yulianti,
0101 (Poli : Poli Umum) A.Md.Kes. 6/23/2023 15:46:19
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 11.9 g/dL
Hematokrit 0 35.4 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 75.9 %
Limfosit 0 20.4 %
Monosit 0 3.2 %
Eosinofil 0 0.5 %
Basofil 0 0%
INDEX
ERITROSIT 0
MCV 0 83.3 fL
MCH 0 28 pg
MCHC 0 33.6 g/dL
RDW-CV 0 12 %
NLR 0 3.72
TLAB00023
HBSAG
59,500
HBSAG 0 NEGATIF
TLAB00026
ANTI HIV
59,500
REAGEN 1 0 NON REAKTIF -
Biaya
Periksa :
209,000
dr. Dyah
203138 SUNTARI Nuraini
2023/06/23/00 (Poli : Penyakit Widhiana,
0051 Dalam) Sp.S 6/23/2023 14:14:34
Cara Bayar :
TLAB00006
GLUKOSA
DARAH
SEWAKTU
28,000
Glukosa
Darah -
Sewaktu 0 173 mg/dl
Biaya
Periksa :
28,000
204424 INA
INDRIYANI
(Kamar : Mega Tri
0144 ANGGREK) A.Md. 6/22/2023 20:56:26
Cara Bayar :
J002112
DARAH
LENGKAP
90,000
Hemoglobin
0 9,5 g/dL
Hematokrit 0 29,0 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 82,7 %
Limfosit 0 13,0 %
Monosit 0 4,1 %
Eosinofil 0 0,2 %
Basofil 0 0,0 %
INDEX
ERITROSIT 0
MCV 0 83,5 fL
MCH 0 27,3 pg
MCHC 0 32,7 g/dL
RDW-CV 0 14,5 %
NLR 0 6,36
Biaya
Periksa :
90,000
204571
MUHAMAD
YANUAR Mega Tri
2023/06/22/00 NUGROHO (Poli : Wulandari,
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 15,7 g/dL
Hematokrit 0 44,8 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 44,3 %
Limfosit 0 37,4 %
Monosit 0 17,2 %
Eosinofil 0 1,1 %
Basofil 0 0,0 %
INDEX
ERITROSIT 0
MCV 0 87,0 fL
MCH 0 30,5 pg
MCHC 0 35,0 g/dL
RDW-CV 0 12,4 %
NLR 0 1,18
TLAB00022
WIDAL
59,500
Salmonella
typhi O 0 Negatif -
Salmonella
typhi H 0 Positif 1/80 -
Salmonella
paratyphi A-
H0 Negatif -
Salmonella
paratyphi B-
H0 Negatif -
Biaya
Periksa :
149,500
204626 ALESHA
KIRANA ADINDA Mega Tri
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 12,1 g/dL
Hematokrit 0 36,3 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 70,1 %
Limfosit 0 22,8 %
Monosit 0 6,9 %
Eosinofil 0 0,2 %
Basofil 0 0,0 %
INDEX
ERITROSIT 0
MCV 0 74,8 fL
MCH 0 25,0 pg
MCHC 0 33,4 g/dL
RDW-CV 0 13,1 %
NLR 0 3,07
TLAB00022
WIDAL
59,500
Salmonella
typhi O 0 Negatif -
Salmonella
typhi H 0 Negatif -
Salmonella
paratyphi A-
H0 Negatif -
Salmonella
paratyphi B-
H0 Negatif -
Biaya
Periksa :
149,500
203757 FITRA
BAYU
PAMUNGKAS Mega Tri
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
204623 NADRIFAH Mega Tri

Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 10,0 g/dL
Hematokrit 0 31,8 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 76,6 %
Limfosit 0 19,4 %
Monosit 0 3,1 %
Eosinofil 0 0,9 %
Basofil 0 0,0 %
INDEX
ERITROSIT 0
MCV 0 65,9 fL
MCH 0 20,8 pg
MCHC 0 31,6 g/dL
RDW-CV 0 16,3 %
NLR 0 3,95
TLAB00023
HBSAG
59,500
HBSAG 0 Negatif
Biaya
Periksa :
149,500
204439 PUTRA
AGUS
FADLYANSYAH
2023/06/22/00 (Poli : Ela Yulianti,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
204610
RADYANALA EZRA
2023/06/22/00 SASKARA (Poli : Ela Yulianti,
0060 Poli Anak) A.Md.Kes. 6/22/2023 13:32:30
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 12.9 g/dL
Hematokrit 0 37.4 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 34.7 %
Limfosit 0 51.5 %
Monosit 0 12.5 %
Eosinofil 0 1.3 %
Basofil 0 0%
INDEX
ERITROSIT 0
MCV 0 76.9 fL
MCH 0 26.5 pg
MCHC 0 34.5 g/dL
RDW-CV 0 12.8 %
NLR 0 0.67
TLAB00003
LED 20,000
LED I 0 11 mm/jam
LED II 0 27 mm/jam
Biaya
Periksa :
110,000
204613 ANIKA
MINERVA
2023/06/22/00 PRAMONO (Poli : Ela Yulianti,
Cara Bayar :
J002125
NARKOBA
150,000
Opiat /
Morphin 0 Negatif -
Ganja /
Canabis 0 Negatif -
Amphetamin
0 Negatif -
Methamphet
amin 0 Negatif -
Benzodiazepi
n0 Negatif -
Cocain 0 Negatif -
Biaya
Periksa :
150,000
016489
AWALINDA AULIA
2023/06/22/00 AZZAHRA (Poli : Ela Yulianti,
Cara Bayar :
J002125
NARKOBA
150,000
Opiat /
Morphin 0 Negatif -
Ganja /
Canabis 0 Negatif -
Amphetamin
0 Negatif -
Methamphet
amin 0 Negatif -
Benzodiazepi
n0 Negatif -
Cocain 0 Negatif -
Biaya
Periksa :
150,000
203947
YUDHISTIRA
BHISMA INDRA
PUTRA ANANTA
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
004859 AFRIDA
DINAWATI
(Kamar :
2023/06/22/00 BOUGENVBED2, Ela Yulianti,
0001 BOUGENVILLE) A.Md.Kes. 6/22/2023 10:04:47
Cara Bayar :
TLAB00152
URINE RUTIN
33,000
P.H. 0 6
B.J. 0 1.025
Protein 0 Negatif
Reduksi 0 Negatif
Urobilinogen
0 Negatif mg/dl
Bilirubin 0 Negatif
Keton 0 Negatif
Sedimen 0
Leukosit 0 Penuh
Eritrosit 0 1-Feb
Epitel Sel 0 > 25
Silinder 0 Negatif
Kristal 0 Negatif
Lain-lain 0 Bakteri (+2)
Biaya
Periksa :
33,000
199759 TITI
2023/06/22/00 PURNAWATI (Poli : Ela Yulianti,
Cara Bayar :
J002045
FUNGSI
GINJAL 2
86,000
UREUM 0 26.4 mg/dl
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 13.3 g/dL
Hematokrit 0 38.8 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 40.1 %
Limfosit 0 50.6 %
Monosit 0 7.1 %
Eosinofil 0 2.2 %
Basofil 0 0%
INDEX
ERITROSIT 0
MCV 0 88.3 fL
MCH 0 30.3 pg
MCHC 0 34.3 g/dL
RDW-CV 0 12.4 %
NLR 0 0.79
Biaya
Periksa :
176,000
199759 TITI
2023/06/22/00 PURNAWATI (Poli : Ela Yulianti,
Cara Bayar :
TLAB00033
URINE RUTIN
33,000
P.H. 0 6.5
B.J. 0 1.02
Protein 0 Negatif
Reduksi 0 Negatif
Urobilinogen
0 Negatif mg/dl
Bilirubin 0 Negatif
Keton 0 Negatif
Sedimen 0
Leukosit 0 3-Apr
Eritrosit 0 0-1
Epitel Sel 0 Penuh
Silinder 0 Negatif
Kristal 0 Negatif
Lain-lain 0 Bakteri (+)
Biaya
Periksa :
33,000
004859 AFRIDA
DINAWATI
(Kamar : Abbas
2023/06/22/00 BOUGENVBED2, Herlan,
0001 BOUGENVILLE) A.Md.Kes 6/22/2023 3:13:35
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 13.2 g/dL
Hematokrit 0 38.2 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 83.5 %
Limfosit 0 7.9 %
Monosit 0 8.5 %
Eosinofil 0 0.1 %
Basofil 0 0%
INDEX
ERITROSIT 0
MCV 0 84.1 fL
MCH 0 29.1 pg
MCHC 0 34.6 g/dL
RDW-CV 0 12.1 %
NLR 0 10.57
TLAB00006
GLUKOSA
DARAH
SEWAKTU
28,000
Glukosa
Darah -
Sewaktu 0 139 mg/dl
0
Biaya
Periksa :
118,000
204465
MAHATMA
RANGGA GANDHI Annies
2023/06/21/00 (Poli : Fadhilah,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
203939
MUHAMMAD
NASHICH Annies
2023/06/21/00 MACHFUD (Poli : Fadhilah,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
204246 ANAM Annies

2023/06/21/00 MAULANA (Poli : Fadhilah,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
108447
MUHAMAD IVAN
MAHARDIKA Annies
2023/06/21/00 PUTRA (Poli : Fadhilah,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
204424 INA
INDRIYANI
(Kamar : Annies
2023/06/21/00 ANGGREKBED5, Fadhilah,
0144 ANGGREK) A.Md. 6/21/2023 18:55:31
Cara Bayar :
J002065
HEMOSTASIS
30,000
Waktu
Perdarahan
( BT ) 0 1 Menit
Waktu
Pembekuan (
CT ) 0 11 Menit
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 10.1 g/dL
Hematokrit 0 30.9 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 68.6 %
Limfosit 0 25.3 %
Monosit 0 5%
Eosinofil 0 1%
Basofil 0 0.1 %
INDEX
ERITROSIT 0
MCV 0 84.1 fL
MCH 0 27.5 pg
MCHC 0 32.6 g/dL
RDW-CV 0 14.4 %
NLR 0 2.71
TLAB00006
GLUKOSA
DARAH
SEWAKTU
28,000
Glukosa
Darah -
Sewaktu 0 79 mg/dl
TLAB00023
HBSAG
59,500
HBSAG 0 Negatif
TLAB00026
ANTI HIV
59,500
REAGEN 1 0 Non Reaktif -
Biaya
Periksa :
267,000
158081
MUHAMMAD
WILDAN AL FATAH Ragil
2023/06/21/00 (Poli : Pangestu W.,
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 12.6 g/dL
Hematokrit 0 36.8 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 79.6 %
Limfosit 0 15 %
Monosit 0 4.8 %
Eosinofil 0 0.6 %
Basofil 0 0%
INDEX
ERITROSIT 0
MCV 0 78.8 fL
MCH 0 26.9 pg
MCHC 0 34.1 g/dL
RDW-CV 0 12.1 %
NLR 0 5.31
Biaya
Periksa :
90,000
204596 SUKSMA Ragil

2023/06/21/00 GUSTI ALHEMA Pangestu W.,
Cara Bayar :
TLAB00125
GLUKOSA
DARAH
SEWAKTU
28,000
Glukosa
Darah -
Sewaktu 0 84 mg/dl
Biaya
Periksa :
28,000
143679 HARSONO
WIRO PRODJO Abbas
2023/06/21/00 (Poli : Herlan,
Cara Bayar :
J000036
GLUKOSA
DARAH
PUASA
28,000
Glukosa
Puasa 0 102 mg/dl
J002029
PROFIL LIPID
139,000
CHOLESTERO
L0 129 mg/dl
TRIGLYCERID
A0 89 mg/dl
HDL
CHOLESTERO
L0 59 mg/dl
LDL
CHOLESTERO
L0 52 mg/dl
TLAB00010
ASAM URAT
43,000
ASAM URAT
0 6.3 mg/dl
Biaya
Periksa :
210,000
204597 NOVIA
TRIANATA WIDYA Yuni Nurul
2023/06/21/00 ASTUTI (Poli : Azizah, A.
0053 LABORATORIUM) Md. 6/21/2023 10:14:09
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 13.7 g/dL
Hematokrit 0 41 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 78.9 %
Limfosit 0 14.7 %
Monosit 0 6.3 %
Eosinofil 0 0.1 %
Basofil 0 0%
INDEX
ERITROSIT 0
MCV 0 81.8 fL
MCH 0 27.2 pg
MCHC 0 33.3 g/dL
RDW-CV 0 13.4 %
NLR 0 5.37
Biaya
Periksa :
90,000
204587 ROSYID Ragil

2023/06/20/00 HARTANTO (Poli : Pangestu W.,
0168 IGD) A.Md. 6/20/2023 19:26:36
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 15 g/dL
Hematokrit 0 44.9 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 78.9 %
Limfosit 0 12.6 %
Monosit 0 8.3 %
Eosinofil 0 0.2 %
Basofil 0 0%
INDEX
ERITROSIT 0
MCV 0 82.4 fL
MCH 0 27.5 pg
MCHC 0 33.4 g/dL
RDW-CV 0 13.5 %
NLR 0 6.26
TLAB00006
GLUKOSA
DARAH
SEWAKTU
28,000
Glukosa
Darah -
Sewaktu 0 96 mg/dl
Biaya
Periksa :
118,000
204586 BENETTA
VANIA ADIYANA Ragil
2023/06/20/00 (Poli : Pangestu W.,
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 11.3 g/dL
Hematokrit 0 33.1 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 55.7 %
Limfosit 0 35.6 %
Monosit 0 4.3 %
Eosinofil 0 4.4 %
Basofil 0 0%
INDEX
ERITROSIT 0
MCV 0 78.2 fL
MCH 0 26.7 pg
MCHC 0 34.1 g/dL
RDW-CV 0 13.2 %
NLR 0 1.56
TLAB00022
WIDAL
59,500
Salmonella
typhi O 0 Negatif -
Salmonella
typhi H 0 Negatif -
Salmonella
paratyphi A-
H0 Negatif -
Salmonella
paratyphi B-
H0 Negatif -
Biaya
Periksa :
149,500
169599 DISTY
DWIANA
ARUMNINGTYAS Ragil
2023/06/20/00 (Poli : Pangestu W.,
Cara Bayar :
TLAB00033
URINE RUTIN
33,000
P.H. 0 6.5
B.J. 0 1.01
Protein 0 Negatif
Reduksi 0 Negatif
Urobilinogen
0 Negatif mg/dl
Bilirubin 0 Negatif
Keton 0 Negatif
Sedimen 0
Leukosit 0 0-1
Eritrosit 0 0-1
Epitel Sel 0 0-1
Silinder 0 Negatif
Kristal 0 Negatif
Lain-lain 0 Negatif
Biaya
Periksa :
33,000
169599 DISTY
DWIANA
ARUMNINGTYAS Ragil
2023/06/20/00 (Poli : Pangestu W.,
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 11.1 g/dL
Hematokrit 0 33 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 77.4 %
Limfosit 0 19.5 %
Monosit 0 2.6 %
Eosinofil 0 0.5 %
Basofil 0 0%
INDEX
ERITROSIT 0
MCV 0 84.7 fL
MCH 0 28.6 pg
MCHC 0 33.7 g/dL
RDW-CV 0 11.8 %
NLR 0 3.97
TLAB00023
HBSAG
59,500
HBSAG 0 Negatif
Biaya
Periksa :
149,500
184781 ARUM Mega Tri

2023/06/20/00 NUR SAFITRI (Poli : Wulandari,
0072 Poli Umum) A.Md. 6/20/2023 12:44:04
Cara Bayar :
TLAB00023
HBSAG
59,500
HBSAG 0 Negatif
TLAB00043
BTA SPUTUM
PREPARAT
100,500
BTA Sputum
Pagi 0 Negatif -
BTA Sputum
Sewaktu 0 Negatif -
Biaya
Periksa :
160,000
204532 ADENTA Abbas

2023/06/19/00 RIZKYANTO (Poli : Herlan,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
204572 MUCTY Abbas

2023/06/19/00 ALY (Poli : Herlan,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
130822 REYHAN
MEIZA Abbas
2023/06/19/00 DARUSSALAM (Poli Herlan,
0134 : LABORATORIUM) A.Md.Kes 6/19/2023 19:45:09
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
147273
MUHAMMAD ARIF
YULDAN ASWIN Abbas
2023/06/19/00 (Poli : Herlan,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
203757 FITRA
BAYU
PAMUNGKAS Abbas
2023/06/19/00 (Poli : Herlan,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
204231 HARIS
NUR IRFANI Abbas
2023/06/19/00 IKHSAN (Poli : Herlan,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
204571
MUHAMAD
YANUAR Abbas
2023/06/19/00 NUGROHO (Poli : Herlan,
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 15.8 g/dL
Hematokrit 0 44.8 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 50.3 %
Limfosit 0 36.8 %
Monosit 0 11.1 %
Eosinofil 0 1.8 %
Basofil 0 0%
INDEX
ERITROSIT 0
MCV 0 87.9 fL
MCH 0 31 pg
MCHC 0 35.2 g/dL
RDW-CV 0 12.4 %
NLR 0 1.37
TLAB00022
WIDAL
59,500
Salmonella
typhi O 0 Negatif -
Salmonella
typhi H 0 Negatif -
Salmonella
paratyphi A-
H0 Negatif -
Salmonella
paratyphi B-
H0 Negatif -
Biaya
Periksa :
149,500
204246 ANAM Abbas

2023/06/19/00 MAULANA (Poli : Herlan,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
204388 ERI Abbas
2023/06/19/00 PRASTIANTO (Poli : Herlan,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
204570 AHMAD
AGUNG Abbas
2023/06/19/00 WICAKSONO (Poli : Herlan,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
030478 ZAINAL Abbas

2023/06/19/00 ARIFIN (Poli : Herlan,
0100 Penyakit Dalam) A.Md.Kes 6/19/2023 16:27:09
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 16.2 g/dL
Hematokrit 0 45.2 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 49.1 %
Limfosit 0 42 %
Monosit 0 8.1 %
Eosinofil 0 0.8 %
Basofil 0 0%
INDEX
ERITROSIT 0
MCV 0 90.3 fL
MCH 0 32.3 pg
MCHC 0 35.7 g/dL
RDW-CV 0 12.5 %
NLR 0 1.17
Biaya
Periksa :
90,000
197597 IRVAN
DIKA WICAKSONO Abbas
2023/06/19/00 (Poli : Herlan,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
132811 JOKO Annies

2023/06/19/00 TURCHAMIN (Poli : Fadhilah,
Cara Bayar :
TLAB00022
WIDAL
59,500
Salmonella
typhi O 0 Negatif -
Salmonella
typhi H 0 Negatif -
Salmonella
paratyphi A-
H0 Negatif -
Salmonella
paratyphi B-
H0 Negatif -
Biaya
Periksa :
59,500
204015
MUHAMMAD Annies
2023/06/19/00 FAHRHEL (Poli : Fadhilah,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
174292 BUDI Annies
2023/06/19/00 SETYAWAN (Poli : Fadhilah,
0058 IGD) A.Md. 6/19/2023 9:39:00
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 14,0 g/dL
Hematokrit 0 41,7 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 72,7 %
Limfosit 0 13,9 %
Monosit 0 10,4 %
Eosinofil 0 3,0 %
Basofil 0 0,0 %
INDEX
ERITROSIT 0
MCV 0 75,9 fL
MCH 0 25,6 pg
MCHC 0 33,7 g/dL
RDW-CV 0 14,5 %
NLR 0 5,23
TLAB00006
GLUKOSA
DARAH
SEWAKTU
28,000
Glukosa
Darah -
Sewaktu 0 120 mg/dl
TLAB00022
WIDAL
59,500
Salmonella
typhi O 0 Negatif -
Salmonella
typhi H 0 Negatif -
Salmonella
paratyphi A-
H0 Negatif -
Salmonella
paratyphi B-
H0 Negatif -
Biaya
Periksa :
177,500
204564 ASHEEQA
MEHRUNISSA
ALZHEA MECCA Annies
2023/06/19/00 (Poli : Fadhilah,
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 13,2 g/dL
Hematokrit 0 38,8 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 55,7 %
Limfosit 0 38,3 %
Monosit 0 5,8 %
Eosinofil 0 0,2 %
Basofil 0 0,0 %
INDEX
ERITROSIT 0
MCV 0 78,4 fL
MCH 0 26,7 pg
MCHC 0 34,0 g/dL
RDW-CV 0 11,6 %
NLR 0 1,45
TLAB00022
WIDAL
59,500
Salmonella
typhi O 0 Negatif -
Salmonella
typhi H 0 Negatif -
Salmonella
paratyphi A-
H0 Negatif -
Salmonella
paratyphi B-
H0 Negatif -
Biaya
Periksa :
149,500
127832 ANDHIKA
ANUGERAH PUTRA Annies
2023/06/19/00 (Poli : Poli Fadhilah,
0052 Kesehatan Jiwa) A.Md. 6/19/2023 8:09:33
Cara Bayar :
J002125
NARKOBA
150,000
Opiat /
Morphin 0 Negatif -
Ganja /
Canabis 0 Negatif -
Amphetamin
0 Negatif -
Methamphet
amin 0 Negatif -
Benzodiazepi
n0 Negatif -
Cocain 0 Negatif -
Biaya
Periksa :
150,000
203939
MUHAMMAD
NASHICH Abbas
2023/06/18/00 MACHFUD (Poli : Herlan,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
204556 ADHITIYA
ANNA
PRASETYOWATI Abbas
2023/06/18/00 WINOTO (Poli : Herlan,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
086449 ONG IVAN Abbas

2023/06/18/00 (Poli : Herlan,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
2023/06/18/00 204555 SITI

0123 SAIDAH (Poli : IGD) Rahmad 6/18/2023 15:08:39
Cara Bayar :
TLAB00006
GLUKOSA
DARAH
SEWAKTU
28,000
Glukosa
Darah -
Sewaktu 0 200 mg/dl
Biaya
Periksa :
28,000
203655 GARDA
AMRA YUDISTIRA Abbas
2023/06/18/00 (Poli : Herlan,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
204018 DANANG
BAGAS SATRIA Ragil
2023/06/18/00 (Poli : Pangestu W.,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
204552
NATHANAEL DIVA Ragil
2023/06/18/00 LISTIYAWAN (Poli : Pangestu W.,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 NEGATIF -
Biaya
Periksa :
80,000
204548 OKTI
MURNI
PURNAMASARI
(Kamar : Ragil
2023/06/18/00 BOUGENVBED1, Pangestu W.,
0117 BOUGENVILLE) A.Md. 6/18/2023 11:53:55
Cara Bayar :
J002045
FUNGSI
GINJAL 2
86,000
UREUM 0 16.4 mg/dl
TLAB00006
GLUKOSA
DARAH
SEWAKTU
28,000
Glukosa
Darah -
Sewaktu 0 88 mg/dl
TLAB00014
ALBUMIN
40,000
Albumin 0 4.2 gr/dl
TLAB00023
HBSAG
59,500
HBSAG 0 Negatif
TLAB00498
ELEKTROLIT
252,000
Kalium 0 3.8 mEq/L
Natrium 0 140 mEq/L
Clorida 0 105 mEq/L
Biaya
Periksa :
465,500
204548 OKTI
MURNI
PURNAMASARI
(Kamar : Ragil
0117 BOUGENVILLE) A.Md. 6/18/2023 11:53:23
Cara Bayar :
J002065
HEMOSTASIS
30,000
Waktu
Perdarahan
( BT ) 0 1 Menit
Waktu
Pembekuan (
CT ) 0 9 Menit
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 14.1 g/dL
Hematokrit 0 39.7 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 61.4 %
Limfosit 0 29.9 %
Monosit 0 7.2 %
Eosinofil 0 1.5 %
Basofil 0 0%
INDEX
ERITROSIT 0
MCV 0 79.7 fL
MCH 0 28.3 pg
MCHC 0 35.6 g/dL
RDW-CV 0 13 %
NLR 0 2.05
Biaya
Periksa :
120,000
204551 PRIMA
ADHI CHANDRA Ragil
2023/06/18/00 (Poli : Pangestu W.,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
052870 RINDO
BARIQ PRATAMA Ragil
2023/06/18/00 (Poli : Pangestu W.,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
104390 NUNUNG Ragil

2023/06/18/00 WINARSIH (Poli : Pangestu W.,
Cara Bayar :
J002029
PROFIL LIPID
139,000
CHOLESTERO
L0 182 mg/dl
TRIGLYCERID
A0 126 mg/dl
HDL
CHOLESTERO
L0 45 mg/dl
LDL
CHOLESTERO
L0 112 mg/dl
TLAB00010
ASAM URAT
43,000
ASAM URAT
0 6.3 mg/dl
Biaya
Periksa :
182,000
204547 TIKA DWI

LESTARI (Kamar : Ragil
0106 BOUGENVILLE) A.Md. 6/18/2023 8:05:04
Cara Bayar :
TLAB00152
URINE RUTIN
33,000
P.H. 0 7.5
B.J. 0 1.01
Protein 0 Negatif
Reduksi 0 Negatif
Urobilinogen
0 Negatif mg/dl
Bilirubin 0 Negatif
Keton 0 Negatif
Sedimen 0
Leukosit 0 1-Mar
Eritrosit 0 0-1
Epitel Sel 0 2-Mar
Silinder 0 Negatif
Kristal 0 Negatif
Lain-lain 0 Negatif
Biaya
Periksa :
33,000
204547 TIKA DWI
LESTARI (Kamar : Mega Tri
2023/06/17/00 BOUGENVBED2, Wulandari,
0106 BOUGENVILLE) A.Md. 6/17/2023 23:14:43
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 13,7 g/dL
Hematokrit 0 39,1 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 63,1 %
Limfosit 0 27,8 %
Monosit 0 7,7 %
Eosinofil 0 1,4 %
Basofil 0 0,0 %
INDEX
ERITROSIT 0
MCV 0 80,7 fL
MCH 0 28,2 pg
MCHC 0 35,0 g/dL
RDW-CV 0 13,6 %
NLR 0 2,27
TLAB00006
GLUKOSA
DARAH
SEWAKTU
28,000
Glukosa
Darah -
Sewaktu 0 83 mg/dl
0
TLAB00019
ELEKTROLIT
237,000
Kalium 0 3,6 mEq/L
Natrium 0 141 mEq/L
Clorida 0 105 mEq/L
Biaya
Periksa :
355,000
108447
MUHAMAD IVAN
MAHARDIKA
2023/06/17/00 PUTRA (Poli : Ela Yulianti,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
107622
QUEENYSHA RANA Annies
2023/06/17/00 ZHAFIRA (Poli : Fadhilah,
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 14,0 g/dL
Hematokrit 0 41,2 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 82,1 %
Limfosit 0 13,7 %
Monosit 0 3,8 %
Eosinofil 0 0,4 %
Basofil 0 0,0 %
INDEX
ERITROSIT 0
MCV 0 73,7 fL
MCH 0 25,1 pg
MCHC 0 34,0 g/dL
RDW-CV 0 14,5 %
NLR 0 5,99
TLAB00022
WIDAL
59,500
Salmonella
typhi O 0 POSITIF 1/80 -
Salmonella
typhi H 0 Negatif -
Salmonella
paratyphi A-
H0 Negatif -
Salmonella
paratyphi B-
H0 Negatif -
Biaya
Periksa :
149,500
138726 RADIKAN Annies

2023/06/17/00 (Kamar : MLT.02- Fadhilah,
0001 02, MELATI) A.Md. 6/17/2023 13:31:25
Cara Bayar :
J002047
FUNGSI
GINJAL 2
96,000
UREUM 0 38,4 mg/dl
CREATININ 0 0,8 mg/dl

J002067
HEMOSTASIS
40,000
Waktu
Perdarahan
( BT ) 0 1 Menit
Waktu
Pembekuan (
CT ) 0 11 Menit
TLAB00258
ELEKTROLIT
242,000
Kalium 0 3,7 mEq/L
Natrium 0 138 mEq/L
Clorida 0 102 mEq/L
Biaya
Periksa :
378,000
201754 ZADIKTA Annies

2023/06/17/00 ARKAN ARRASYAD Fadhilah,
Cara Bayar :
TLAB00033
URINE RUTIN
33,000
P.H. 0 6,0
B.J. 0 1,025
Protein 0 Negatif
Reduksi 0 Negatif
Urobilinogen
0 Negatif mg/dl
Bilirubin 0 Negatif
Keton 0 Negatif
Sedimen 0
Leukosit 0 2-Mar
Eritrosit 0 0-1
Epitel Sel 0 1-Feb
Silinder 0 Negatif
Kristal 0 Negatif
Lain-lain 0 Negatif
Biaya
Periksa :
33,000
138726 RADIKAN Annies

2023/06/17/00 (Kamar : MLT.02- Fadhilah,
0001 02, MELATI) A.Md. 6/17/2023 9:49:14
Cara Bayar :
TLAB00272
URINE RUTIN
38,000
P.H. 0 6,5
B.J. 0 1,020
Protein 0 Negatif
Reduksi 0 Negatif
Urobilinogen
0 Negatif mg/dl
Bilirubin 0 Negatif
Keton 0 Negatif
Sedimen 0
Leukosit 0 3-Apr
Eritrosit 0 1-Feb
Epitel Sel 0 1-Feb
Silinder 0 Negatif
Kristal 0 Ca Oxalat (+)
Lain-lain 0 Negatif
Biaya
Periksa :
38,000
201754 ZADIKTA Annies

2023/06/17/00 ARKAN ARRASYAD Fadhilah,
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 9,9 g/dL
Hematokrit 0 29,6 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 76,2 %
Limfosit 0 15,6 %
Monosit 0 8,1 %
Eosinofil 0 0,1 %
Basofil 0 0,0 %
INDEX
ERITROSIT 0
MCV 0 67,8 fL
MCH 0 22,5 pg
MCHC 0 33,3 g/dL
RDW-CV 0 18,1 %
NLR 0 4,88
Biaya
Periksa :
90,000
138726 RADIKAN Mega Tri

2023/06/17/00 (Kamar : MLT.02- Wulandari,
0001 02, MELATI) A.Md. 6/17/2023 2:13:31
Cara Bayar :
J002113
DARAH
LENGKAP
95,500
Hemoglobin
0 13,9 g/dL
Hematokrit 0 39,8 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 81,4 %
Limfosit 0 11,9 %
Monosit 0 6,4 %
Eosinofil 0 0,3 %
Basofil 0 0,0 %
INDEX
ERITROSIT 0
MCV 0 88,3 fL
MCH 0 30,9 pg
MCHC 0 35,0 g/dL
RDW-CV 0 12,7 %
NLR 0 6,84
TLAB00245
GLUKOSA
DARAH
SEWAKTU
33,000
Glukosa
Darah -
Sewaktu 0 151 mg/dl
0
Biaya
Periksa :
128,500
204536 BY NY
DELLA ANNISA
FITRI (Kamar : Mega Tri
2023/06/16/00 PERINABED1, Wulandari,
0204 PERINATOLOGI) A.Md. 6/16/2023 22:53:06
Cara Bayar :
J002104
DARAH
LENGKAP
NEONATUS 2
95,500
Hemoglobin
0 12,6 g/dL
Hematokrit 0 36,1 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 49,2 %
Limfosit 0 37,0 %
Monosit 0 13,2 %
Eosinofil 0 0,6 %
Basofil 0 0,0 %
INDEX
ERITROSIT 0
MCV 0 95,9 fL
MCH 0 33,5 pg
MCHC 0 35,0 g/dL
RDW-CV 0 14,4 %
NLR 0 1,33
TLAB00602
GLUKOSA
DARAH
SEWAKTU
BAYI 33,000
Glukosa
Darah
Sewaktu Bayi
0 129 mg/dl
Biaya
Periksa :
128,500
204534 RAFA DEA

2023/06/16/00 SAPUTRA (Poli : Ela Yulianti,
0199 IGD) A.Md.Kes. 6/16/2023 20:51:54
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 13.8 g/dL
Hematokrit 0 39.3 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 38 %
Limfosit 0 53.5 %
Monosit 0 6.1 %
Eosinofil 0 2.4 %
Basofil 0 0%
INDEX
ERITROSIT 0
MCV 0 78.9 fL
MCH 0 27.6 pg
MCHC 0 35 g/dL
RDW-CV 0 12.4 %
NLR 0 0.71
Biaya
Periksa :
90,000
199561 NAZA Ronggo Adi

2023/06/16/00 ALLIYAH FIRDAUS Saputro,
0200 (Poli : IGD) A.Md.Kep. 6/16/2023 20:47:28
Cara Bayar :
TLAB00006
GLUKOSA
DARAH
SEWAKTU
28,000
Glukosa
Darah -
Sewaktu 0 94 mg/dl
Biaya
Periksa :
28,000
177295 RAFI DEA

2023/06/16/00 TALLENTA (Poli : Ela Yulianti,
0195 IGD) A.Md.Kes. 6/16/2023 20:17:24
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 12.8 g/dL
Hematokrit 0 38.3 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 50.5 %
Limfosit 0 35.5 %
Monosit 0 11.6 %
Eosinofil 0 2.4 %
Basofil 0 0%
INDEX
ERITROSIT 0
MCV 0 72.2 fL
MCH 0 24.2 pg
MCHC 0 33.4 g/dL
RDW-CV 0 13.1 %
NLR 0 1.42
TLAB00022
WIDAL
59,500
Salmonella
typhi O 0 Negatif -
Salmonella
typhi H 0 Negatif -
Salmonella
paratyphi A-
H0 Negatif -
Salmonella
paratyphi B-
H0 Negatif -
Biaya
Periksa :
149,500
204532 ADENTA
2023/06/16/00 RIZKYANTO (Poli : Ela Yulianti,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
204529 ADENA
ALULA AHIRA
Cara Bayar :
TLAB00002
GOLONGAN
DARAH
23,000
Golongan
Darah 0 O Rhesus (+) -
Biaya
Periksa :
23,000
204530 TIARA NUR

2023/06/16/00 ANGGRAINI (Poli : Ela Yulianti,
Cara Bayar :
TLAB00002
GOLONGAN
DARAH
23,000
Golongan
Darah 0 O Rhesus (+) -
Biaya
Periksa :
23,000
171354 ADILA
2023/06/16/00 PUSPITASARI Ela Yulianti,
0136 (Poli : IGD) A.Md.Kes. 6/16/2023 16:14:21
Cara Bayar :
TLAB00033
URINE RUTIN
33,000
P.H. 0 6
B.J. 0 1.03
Protein 0 Negatif
Reduksi 0 Negatif
Urobilinogen
0 Negatif mg/dl
Bilirubin 0 Negatif
Keton 0 Negatif
Sedimen 0
Leukosit 0 1-Feb
Eritrosit 0 0-1
Epitel Sel 0 7-Aug
Silinder 0 Negatif
Kristal 0 Negatif
Lain-lain 0 Negatif
Biaya
Periksa :
33,000
204015
MUHAMMAD
2023/06/16/00 FAHRHEL (Poli : Ela Yulianti,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
204521 ACHMAD Yuni Nurul

2023/06/16/00 DANANG FAUZI Azizah, A.
0050 (Poli : IGD) Md. 6/16/2023 14:05:50
Cara Bayar :
J002070 LFT
80,000
SGOT / ASTL
0 27 U/L
SGPT / ALTL
0 34 U/L
TLAB00023
HBSAG
59,500
HBSAG 0 Non Reaktif
TLAB00026
ANTI HIV
59,500
0
TLAB00043
BTA SPUTUM
PREPARAT
100,500
BTA Sputum
Pagi 0 Negatif -
BTA Sputum
Sewaktu 0 Negatif -
TLAB00051
CRP Kualitatif
144,000
CRP Kualitatif
0 Negatif -
Biaya
Periksa :
443,500
204519 MUTIA
NANDA Yuni Nurul
2023/06/16/00 ANDRIYANI (Poli : Azizah, A.
0048 IGD) Md. 6/16/2023 14:05:11
Cara Bayar :
J002070 LFT
80,000
SGOT / ASTL
0 17 U/L
SGPT / ALTL
0 10 U/L
TLAB00023
HBSAG
59,500
HBSAG 0 Negatif
TLAB00026
ANTI HIV
59,500
0
TLAB00043
BTA SPUTUM
PREPARAT
100,500
BTA Sputum
Pagi 0 Negatif -
BTA Sputum
Sewaktu 0 Negatif -
TLAB00051
CRP Kualitatif
144,000
CRP Kualitatif
0 Negatif -
Biaya
Periksa :
443,500
204520 YOGA Yuni Nurul

2023/06/16/00 ALMUNAWAR (Poli Azizah, A.
0051 : IGD) Md. 6/16/2023 14:04:35
Cara Bayar :
J002070 LFT
80,000
SGOT / ASTL
0 21 U/L
SGPT / ALTL
0 9 U/L
TLAB00023
HBSAG
59,500
HBSAG 0 Non Reaktif
TLAB00026
ANTI HIV
59,500
0
TLAB00043
BTA SPUTUM
PREPARAT
100,500
BTA Sputum
Pagi 0 Negatif -
BTA Sputum
Sewaktu 0 Negatif -
TLAB00051
CRP Kualitatif
144,000
CRP Kualitatif
0 Negatif -
Biaya
Periksa :
443,500

0050 (Poli : IGD) Md. 6/16/2023 11:20:07
Cara Bayar :
TLAB00033
URINE RUTIN
33,000
P.H. 0 5,0
B.J. 0 1,025
Protein 0 Negatif
Reduksi 0 Negatif
Urobilinogen
0 Negatif mg/dl
Bilirubin 0 Negatif
Keton 0 Negatif
Sedimen 0
Leukosit 0 2-Apr
Eritrosit 0 0-1
Epitel Sel 0 3-May
Silinder 0 Negatif
Kristal 0 Negatif
Lain-lain 0 Negatif
Biaya
Periksa :
33,000

0050 (Poli : IGD) Md. 6/16/2023 11:10:42
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 14.6 g/dL
Hematokrit 0 42.8 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 49.6 %
Limfosit 0 41.2 %
Monosit 0 8.1 %
Eosinofil 0 1.1 %
Basofil 0 0.1 %
INDEX
ERITROSIT 0
MCV 0 84.7 fL
MCH 0 28.9 pg
MCHC 0 34.2 g/dL
RDW-CV 0 12.9 %
NLR 0 1.2
Biaya
Periksa :
90,000

0051 : IGD) Md. 6/16/2023 11:09:18
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 13.7 g/dL
Hematokrit 0 40.7 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 51.8 %
Limfosit 0 38.6 %
Monosit 0 7.9 %
Eosinofil 0 1.7 %
Basofil 0 0%
INDEX
ERITROSIT 0
MCV 0 82.4 fL
MCH 0 27.8 pg
MCHC 0 33.8 g/dL
RDW-CV 0 12.7 %
NLR 0 1.34
Biaya
Periksa :
90,000
204519 MUTIA
NANDA Yuni Nurul
0048 IGD) Md. 6/16/2023 11:05:18
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 13.7 g/dL
Hematokrit 0 41 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 60.7 %
Limfosit 0 28.4 %
Monosit 0 5.6 %
Eosinofil 0 5.3 %
Basofil 0 0%
INDEX
ERITROSIT 0
MCV 0 83.1 fL
MCH 0 27.8 pg
MCHC 0 33.5 g/dL
RDW-CV 0 11.9 %
NLR 0 2.14
Biaya
Periksa :
90,000
204519 MUTIA
NANDA Yuni Nurul
0048 IGD) Md. 6/16/2023 11:02:27
Cara Bayar :
TLAB00033
URINE RUTIN
33,000
P.H. 0 5,0
B.J. 0 1,030
Protein 0 Negatif
Reduksi 0 Negatif
Urobilinogen
0 Negatif mg/dl
Bilirubin 0 Negatif
Keton 0 Negatif
Sedimen 0
Leukosit 0 2-Mar
Eritrosit 0 0-1
Epitel Sel 0 3-May
Silinder 0 Negatif
Kristal 0 Negatif
Lain-lain 0 Negatif
Biaya
Periksa :
33,000

0051 : IGD) Md. 6/16/2023 10:54:37
Cara Bayar :
TLAB00033
URINE RUTIN
33,000
P.H. 0 7,5
B.J. 0 1,015
Protein 0 Negatif
Reduksi 0 Negatif
Urobilinogen
0 Negatif mg/dl
Bilirubin 0 Negatif
Keton 0 Negatif
Sedimen 0
Leukosit 0 0-2
Eritrosit 0 0-1
Epitel Sel 0 0-1
Silinder 0 Negatif
Kristal 0 Negatif
Lain-lain 0 Negatif
Biaya
Periksa :
33,000
204246 ANAM Yuni Nurul
2023/06/16/00 MAULANA (Poli : Azizah, A.
0054 LABORATORIUM) Md. 6/16/2023 10:14:36
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 NEGATIF -
Biaya
Periksa :
80,000
163331 FAIZZIA Yuni Nurul

2023/06/16/00 HIDAYA KIBRIA Azizah, A.
0044 (Poli : Poli Umum) Md. 6/16/2023 10:12:20
Cara Bayar :
TLAB00023
HBSAG
59,500
HBSAG 0 NEGATIF
TLAB00043
BTA SPUTUM
PREPARAT
100,500
BTA Sputum
Pagi 0 NEGATF -
BTA Sputum
Sewaktu 0 NEGATIF -
Biaya
Periksa :
160,000
204448 Yuni Nurul
2023/06/16/00 NGANTIASIH (Poli : Azizah, A.
0031 LABORATORIUM) Md. 6/16/2023 7:51:35
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 12,0 g/dL
Hematokrit 0 36,6 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 74,2 %
Limfosit 0 15,9 %
Monosit 0 7,7 %
Eosinofil 0 2,2 %
Basofil 0 0,0 %
INDEX
ERITROSIT 0
MCV 0 83,2 fL
MCH 0 27,4 pg
MCHC 0 32,9 g/dL
RDW-CV 0 13,4 %
NLR 0 4,67
TLAB00022
WIDAL
59,500
Salmonella
typhi O 0 Negatif -
Salmonella
typhi H 0 Negatif -
Salmonella
paratyphi A-
H0 Negatif -
Salmonella
paratyphi B-
H0 Negatif -
Biaya
Periksa :
149,500
Ragil
2023/06/15/00 204516 ZULIANA Pangestu W.,
0160 (Poli : IGD) A.Md. 6/15/2023 22:30:17
Cara Bayar :
J002045
FUNGSI
GINJAL 2
86,000
UREUM 0 63.1 mg/dl
CREATININ 0 1 mg/dl
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 14.8 g/dL
Hematokrit 0 42.9 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 78.2 %
Limfosit 0 18.5 %
Monosit 0 3%
Eosinofil 0 0.3 %
Basofil 0 0%
INDEX
ERITROSIT 0
MCV 0 87.9 fL
MCH 0 30.3 pg
MCHC 0 34.4 g/dL
RDW-CV 0 13.8 %
NLR 0 4.23
TLAB00006
GLUKOSA
DARAH
SEWAKTU
28,000
Glukosa
Darah -
Sewaktu 0 534 mg/dl
Biaya
Periksa :
204,000
151579 AZZAHRA Abbas

2023/06/15/00 AQILA NUHA (Poli : Herlan,
0151 IGD) A.Md.Kes 6/15/2023 19:06:26
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 13.3 g/dL
Hematokrit 0 38.9 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 55.6 %
Limfosit 0 37.3 %
Monosit 0 7%
Eosinofil 0 0.1 %
Basofil 0 0%
INDEX
ERITROSIT 0
MCV 0 79.7 fL
MCH 0 27.3 pg
MCHC 0 34.2 g/dL
RDW-CV 0 11.9 %
NLR 0 1.49
TLAB00022
WIDAL
59,500
Salmonella
typhi O 0 Negatif -
Salmonella
typhi H 0 Negatif -
Salmonella
paratyphi A-
H0 Negatif -
Salmonella
paratyphi B-
H0 Negatif -
Biaya
Periksa :
149,500
130822 REYHAN
MEIZA Abbas
2023/06/15/00 DARUSSALAM (Poli Herlan,
0137 : LABORATORIUM) A.Md.Kes 6/15/2023 16:16:51
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
147273
MUHAMMAD ARIF
YULDAN ASWIN Abbas
2023/06/15/00 (Poli : Herlan,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 NEGATIF -
Biaya
Periksa :
80,000
204508 DIEKE
MARSHA Mega Tri
2023/06/15/00 ANGELICA (Poli : Wulandari,
0066 Poli Umum) A.Md. 6/15/2023 14:25:27
Cara Bayar :
TLAB00043
BTA SPUTUM
PREPARAT
100,500
BTA Sputum
Pagi 0 Negatif -
BTA Sputum
Sewaktu 0 Negatif -
TLAB00051
CRP Kualitatif
144,000
CRP Kualitatif
0 Positif -
Biaya
Periksa :
244,500
204508 DIEKE
MARSHA Mega Tri
0066 Poli Umum) A.Md. 6/15/2023 12:18:15
Cara Bayar :
J002070 LFT
80,000
SGOT / ASTL
0 13 U/L
SGPT / ALTL
0 6 U/L
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 12,8 g/dL
Hematokrit 0 38,1 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 58,5 %
Limfosit 0 35,8 %
Monosit 0 4,4 %
Eosinofil 0 1,3 %
Basofil 0 0,0 %
INDEX
ERITROSIT 0
MCV 0 83,0 fL
MCH 0 27,9 pg
MCHC 0 33,6 g/dL
RDW-CV 0 12,8 %
NLR 0 1,63
TLAB00023
HBSAG
59,500
HBSAG 0 Negatif
TLAB00026
ANTI HIV
59,500
Biaya
Periksa :
289,000
204508 DIEKE
MARSHA Mega Tri
0066 Poli Umum) A.Md. 6/15/2023 12:16:02
Cara Bayar :
TLAB00033
URINE RUTIN
33,000
P.H. 0 5,0
B.J. 0 1,030
Protein 0 Positif
Reduksi 0 Negatif
Urobilinogen
0 Negatif mg/dl
Bilirubin 0 Negatif
Keton 0 Negatif
Sedimen 0
Leukosit 0 2-Apr
Eritrosit 0 > 25
Epitel Sel 0 18 - 20
Silinder 0 Negatif
Kristal 0 Negatif
TLAB00036
PROTEIN
URINE SEMI
KUANTITATIF
33,000
Protein Urine
Semi
Kuantitatif 0 Positif (1+) -
Biaya
Periksa :
66,000
204503 CATUR
WAHYU SUDIARTO Mega Tri
2023/06/15/00 (Poli : Penyakit Wulandari,
0028 Dalam) A.Md. 6/15/2023 8:19:36
Cara Bayar :
TLAB00010
ASAM URAT
43,000
ASAM URAT
0 8,7 mg/dl
TLAB00012
CREATININ
43,000
CREATININ 0 0,8 mg/dl
Biaya
Periksa :
86,000
203757 FITRA
BAYU
PAMUNGKAS Abbas
2023/06/14/00 (Poli : Herlan,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
204499 SIFFA DIVA Abbas

2023/06/14/00 FITRIANI (Poli : Herlan,
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 13.1 g/dL
Hematokrit 0 38.9 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 72.6 %
Limfosit 0 22.2 %
Monosit 0 4.7 %
Eosinofil 0 0.5 %
Basofil 0 0%
INDEX
ERITROSIT 0
MCV 0 76.6 fL
MCH 0 25.7 pg
MCHC 0 33.6 g/dL
RDW-CV 0 14 %
NLR 0 3.27
Biaya
Periksa :
90,000
204498 HAFIFAH
RINDA MAHESTI Abbas
2023/06/14/00 (Poli : Herlan,
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 12.4 g/dL
Hematokrit 0 36.8 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 86.1 %
Limfosit 0 11.4 %
Monosit 0 2.3 %
Eosinofil 0 0.2 %
Basofil 0 0%
INDEX
ERITROSIT 0
MCV 0 85.6 fL
MCH 0 28.7 pg
MCHC 0 33.6 g/dL
RDW-CV 0 13.1 %
NLR 0 7.55
TLAB00023
HBSAG
59,500
HBSAG 0 Negatif
Biaya
Periksa :
149,500
165361
CHOIRUNNISA Abbas
2023/06/14/00 FADILLA (Poli : Herlan,
0139 IGD) A.Md.Kes 6/14/2023 17:41:46
Cara Bayar :
J002086HV
Rapid Covid
19 Antigen
124,900
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
124,900
143076 MULYONO Yuni Nurul

2023/06/14/00 (Poli : Azizah, A.
0006 LABORATORIUM) Md. 6/14/2023 9:27:23
Cara Bayar :
J002002
GLUKOSA
(PUASA,2JPP)
56,000
Glukosa
Puasa 0 114 mg/dl
Glukosa 2JPP
0 90 mg/dl
Biaya
Periksa :
56,000
129936 NOVI Annies

2023/06/14/00 PRASTYAWAN Fadhilah,
0056 (Poli : IGD) A.Md. 6/14/2023 8:50:42
Cara Bayar :
TLAB00033
URINE RUTIN
33,000
Warna 0
P.H. 0 6.5
B.J. 0 1.03
Protein 0 Positif
Reduksi 0 Negatif
Urobilinogen
0 Negatif mg/dl
Bilirubin 0 Negatif
Keton 0 Negatif
Sedimen 0
Leukosit 0 10-Dec
Eritrosit 0 PENUH
Epitel Sel 0 14 - 15
Silinder 0 Negatif
Kristal 0 Ca Oxalat (+)
Lain-lain 0 Blood (+), Lekosit (+)
TLAB00036
PROTEIN
URINE SEMI
KUANTITATIF
33,000
Protein Urine
Semi
Kuantitatif 0 Positif (1+) -
Biaya
Periksa :
66,000
134921 SULIMAH Yuni Nurul

2023/06/11/00 (Kamar : Azizah, A.
0053 HCUBED3, HCU) Md. 6/14/2023 8:00:46
Cara Bayar :
TLAB00491
CREATININ
58,000
Biaya
Periksa :
58,000

2023/06/11/00 (Kamar : Azizah, A.
0053 HCUBED3, HCU) Md. 6/14/2023 6:33:38
Cara Bayar :
J002115
DARAH
LENGKAP
105,500
Hemoglobin
0 10.5 g/dL
Hematokrit 0 31 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 84.1 %
Limfosit 0 8.4 %
Monosit 0 7%
Eosinofil 0 0.5 %
Basofil 0 0%
INDEX
ERITROSIT 0
MCV 0 73.5 fL
MCH 0 25 pg
MCHC 0 33.9 g/dL
RDW-CV 0 14 %
NLR 0 10.01
TLAB00485
GLUKOSA
DARAH
SEWAKTU
43,000
Glukosa
Darah -
Sewaktu 0 112 mg/dl
0 JAM 06
Biaya
Periksa :
148,500
204488
MAFTUKHATUR
2023/06/13/00 RIANINGSIH (Poli : Ela Yulianti,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
204433 MAS YOGA

2023/06/13/00 MAULANA (Poli : Ela Yulianti,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
043409
RAMADHANDI
RAIHAN FATIH
2023/06/13/00 WIJAYANTO (Poli : Ela Yulianti,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
134921 SULIMAH
2023/06/11/00 (Kamar : Ela Yulianti,
0053 HCUBED3, HCU) A.Md.Kes. 6/13/2023 18:53:18
Cara Bayar :
TLAB00485
GLUKOSA
DARAH
SEWAKTU
43,000
Glukosa
Darah -
Sewaktu 0 146 mg/dl
0 GDS J 19
Biaya
Periksa :
43,000
091500 CITRASARI
2023/06/13/00 PUTRI MAHANANI Ela Yulianti,
0166 (Poli : IGD) A.Md.Kes. 6/13/2023 17:45:09
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 12.1 g/dL
Hematokrit 0 35.5 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 66.3 %
Limfosit 0 25.3 %
Monosit 0 8.3 %
Eosinofil 0 0.2 %
Basofil 0 0%
INDEX
ERITROSIT 0
MCV 0 82.5 fL
MCH 0 28.1 pg
MCHC 0 34.1 g/dL
RDW-CV 0 12.3 %
NLR 0 2.63
TLAB00022
WIDAL
59,500
Salmonella
typhi O 0 Negatif -
Salmonella
typhi H 0 Negatif -
Salmonella
paratyphi A-
H0 Negatif -
Salmonella
paratyphi B-
H0 Negatif -
Biaya
Periksa :
149,500
Mega Tri
2023/06/13/00 062900 KASMADI Wulandari,
0086 (Poli : IGD) A.Md. 6/13/2023 13:48:19
Cara Bayar :
TLAB00006
GLUKOSA
DARAH
SEWAKTU
28,000
Glukosa
Darah -
Sewaktu 0 187 mg/dl
Biaya
Periksa :
28,000
204476 SHEILA
HASINA
SURYANINGRUM Mega Tri
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 10,8 g/dL
Hematokrit 0 31,5 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 53,2 %
Limfosit 0 39,8 %
Monosit 0 6,5 %
Eosinofil 0 0,5 %
Basofil 0 0,0 %
INDEX
ERITROSIT 0
MCV 0 72,7 fL
MCH 0 25,0 pg
MCHC 0 34,4 g/dL
RDW-CV 0 13,1 %
NLR 0 1,34
Biaya
Periksa :
90,000
134921 SULIMAH Mega Tri

2023/06/11/00 (Kamar : Wulandari,
0053 HCUBED3, HCU) A.Md. 6/13/2023 9:01:26
Cara Bayar :
TLAB00512
URINE RUTIN
48,000
P.H. 0 5,0
B.J. 0 1,030
Protein 0 Positif
Reduksi 0 Negatif
Urobilinogen
0 Negatif mg/dl
Bilirubin 0 Negatif
Keton 0 Negatif
Sedimen 0
Leukosit 0 Dec-16
Eritrosit 0 Penuh
Epitel Sel 0 0-1
Silinder 0 Negatif
Kristal 0 Negatif
TLAB00515
PROTEIN
URINE SEMI
KUANTITATIF
48,000
Protein Urine
Semi
Kuantitatif 0 Positif (+) -
Biaya
Periksa :
96,000
153490
SULTANULLAH
JOSE MALIQUE Yuni Nurul
2023/06/13/00 (Poli : Azizah, A.
0046 LABORATORIUM) Md. 6/13/2023 7:59:32
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 13,0 g/dL
Hematokrit 0 38,4 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 71,9 %
Limfosit 0 22,3 %
Monosit 0 5,6 %
Eosinofil 0 0,2 %
Basofil 0 0,0 %
INDEX
ERITROSIT 0
MCV 0 79,4 fL
MCH 0 26,9 pg
MCHC 0 33,9 g/dL
RDW-CV 0 12,3 %
NLR 0 3,22
TLAB00022
WIDAL
59,500
Salmonella
typhi O 0 -
Salmonella
typhi H 0 -
Salmonella
paratyphi A-
H0 -
Salmonella
paratyphi B-
H0 -
Biaya
Periksa :
149,500

2023/06/11/00 (Kamar : Azizah, A.
0053 HCUBED3, HCU) Md. 6/13/2023 6:31:54
Cara Bayar :
TLAB00485
GLUKOSA
DARAH
SEWAKTU
43,000
Glukosa
Darah -
Sewaktu 0 115 mg/dl
0 GDS JAM 06
Biaya
Periksa :
43,000
204490 WIWIT Yuni Nurul

2023/06/13/00 MULYANAH (Poli : Azizah, A.
0202 LABORATORIUM) Md. 6/13/2023 0:01:04
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 12.7 g/dL
Hematokrit 0 37.4 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 79.7 %
Limfosit 0 15.2 %
Monosit 0 4.2 %
Eosinofil 0 0.9 %
Basofil 0 0%
INDEX
ERITROSIT 0
MCV 0 77.4 fL
MCH 0 26.3 pg
MCHC 0 34 g/dL
RDW-CV 0 15.1 %
NLR 0 5.24
TLAB00023
HBSAG
59,500
HBSAG 0 POSITIF
Biaya
Periksa :
149,500
Yuni Nurul
2023/06/12/00 204469 SUWARI Azizah, A.
0203 (Poli : IGD) Md. 6/12/2023 22:41:21
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 12.7 g/dL
Hematokrit 0 37.4 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 54.9 %
Limfosit 0 31.9 %
Monosit 0 11.3 %
Eosinofil 0 1.6 %
Basofil 0 0.3 %
INDEX
ERITROSIT 0
MCV 0 78.9 fL
MCH 0 26.8 pg
MCHC 0 34 g/dL
RDW-CV 0 13.4 %
NLR 0 1.72
TLAB00006
GLUKOSA
DARAH
SEWAKTU
28,000
Glukosa
Darah -
Sewaktu 0 131 mg/dl
0
TLAB00022
WIDAL
59,500
Salmonella
typhi O 0 Negatif -
Salmonella
typhi H 0 Negatif -
Salmonella
paratyphi A-
H0 Negatif -
Salmonella
paratyphi B-
H0 Negatif -
Biaya
Periksa :
177,500
204453 RASKA
TIRTA PRATAMA
(Kamar : Yuni Nurul
2023/06/12/00 ANGGREKBED3, Azizah, A.
0108 ANGGREK) Md. 6/12/2023 22:20:34
Cara Bayar :
TLAB00152
URINE RUTIN
33,000
P.H. 0 6
B.J. 0 1.02
Protein 0 Negatif
Reduksi 0 Negatif
Urobilinogen
0 Negatif mg/dl
Bilirubin 0 Negatif
Keton 0 Positif
Sedimen 0
Leukosit 0 2-Mar
Eritrosit 0 0-1
Epitel Sel 0 1-Mar
Silinder 0 Negatif
Kristal 0 Negatif
Lain-lain 0 Negatif
Biaya
Periksa :
33,000
111917 YUSTINUS
2023/06/12/00 DWI HARTONO
0200 (Poli : IGD) Sarah 6/12/2023 21:40:50
Cara Bayar :
TLAB00006
GLUKOSA
DARAH
SEWAKTU
28,000
Glukosa
Darah -
Sewaktu 0 185 mg/dl
Biaya
Periksa :
28,000
204468 AAN
2023/06/12/00 NASYRUDDIN SAM
0199 (Poli : IGD) Sarah 6/12/2023 21:22:07
Cara Bayar :
TLAB00006
GLUKOSA
DARAH
SEWAKTU
28,000
Glukosa
Darah -
Sewaktu 0 133 mg/dl
Biaya
Periksa :
28,000
204425 SHOVAN Abbas

2023/06/12/00 DHINAR (Poli : Herlan,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
204231 HARIS
NUR IRFANI Abbas
2023/06/12/00 IKHSAN (Poli : Herlan,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 NEGATIF -
Biaya
Periksa :
80,000
204465
MAHATMA
RANGGA GANDHI Abbas
2023/06/12/00 (Poli : Herlan,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
134921 SULIMAH Abbas

2023/06/11/00 (Kamar : Herlan,
0053 HCUBED3, HCU) A.Md.Kes 6/12/2023 19:03:07
Cara Bayar :
TLAB00485
GLUKOSA
DARAH
SEWAKTU
43,000
Glukosa
Darah -
Sewaktu 0 261 mg/dl
0 GDS JAM 19
Biaya
Periksa :
43,000
203939
MUHAMMAD
NASHICH Abbas
2023/06/12/00 MACHFUD (Poli : Herlan,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
204453 RASKA
TIRTA PRATAMA
(Kamar :
2023/06/12/00 ANGGREKBED3, Ela Yulianti,
0108 ANGGREK) A.Md.Kes. 6/12/2023 11:41:18
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 11.3 g/dL
Hematokrit 0 33.2 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 60.8 %
Limfosit 0 28.4 %
Monosit 0 10.8 %
Eosinofil 0 0%
Basofil 0 0%
INDEX
ERITROSIT 0
MCV 0 79.6 fL
MCH 0 26.9 pg
MCHC 0 33.9 g/dL
RDW-CV 0 13.6 %
NLR 0 2.14
TLAB00022
WIDAL
59,500
Salmonella
typhi O 0 Negatif -
Salmonella
typhi H 0 Negatif -
Salmonella
paratyphi A-
H0 Negatif -
Salmonella
paratyphi B-
H0 Negatif -
Biaya
Periksa :
149,500
134921 SULIMAH Annies

2023/06/11/00 (Kamar : Fadhilah,
0053 HCUBED3, HCU) A.Md. 6/12/2023 8:17:19
Cara Bayar :
J002049
FUNGSI
GINJAL 2
116,000
UREUM 0 205 mg/dl
TLAB00485
GLUKOSA
DARAH
SEWAKTU
43,000
Glukosa
Darah -
Sewaktu 0 479 mg/dl
0 JAM 06.00
TLAB00541
HBA1C
210,000
HBAIC 0 12,4 %
Biaya
Periksa :
369,000
Annies
2023/06/12/00 204449 WAHYU Fadhilah,
0005 NADITO (Poli : IGD) A.Md. 6/12/2023 4:28:08
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
Annies
2023/06/12/00 204449 WAHYU Fadhilah,
0005 NADITO (Poli : IGD) A.Md. 6/12/2023 3:09:41
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 13,5 g/dL
Hematokrit 0 39,0 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 67,0 %
Limfosit 0 17,6 %
Monosit 0 14,5 %
Eosinofil 0 0,9 %
Basofil 0 0,0 %
INDEX
ERITROSIT 0
MCV 0 76,5 fL
MCH 0 26,5 pg
MCHC 0 34,6 g/dL
RDW-CV 0 12,8 %
NLR 0 3,81
TLAB00019
ELEKTROLIT
237,000
Kalium 0 2,8 mEq/L
Natrium 0 138 mEq/L
Clorida 0 100 mEq/L
Biaya
Periksa :
327,000
Dana
2023/06/12/00 204449 WAHYU Krismonika,
0005 NADITO (Poli : IGD) A.Md.Kep. 6/12/2023 2:53:22
Cara Bayar :
TLAB00006
GLUKOSA
DARAH
SEWAKTU
28,000
Glukosa
Darah -
Sewaktu 0 111 mg/dl
Biaya
Periksa :
28,000
108447
MUHAMAD IVAN
MAHARDIKA Yuni Nurul
2023/06/11/00 PUTRA (Poli : Azizah, A.
0046 LABORATORIUM) Md. 6/11/2023 20:22:34
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 NEGATIF -
Biaya
Periksa :
80,000
195604 DENI Yuni Nurul

2023/06/11/00 ARIYANTI (Poli : Azizah, A.
0039 IGD) Md. 6/11/2023 19:19:25
Cara Bayar :
TLAB00033
URINE RUTIN
33,000
P.H. 0 6
B.J. 0 1.02
Protein 0 Negatif
Reduksi 0 Negatif
Urobilinogen
0 Negatif mg/dl
Bilirubin 0 Negatif
Keton 0 Negatif
Sedimen 0
Leukosit 0 >25
Eritrosit 0 3-Apr
Epitel Sel 0 4-May
Silinder 0 Negatif
Kristal 0 Negatif
Lain-lain 0 Blood (+) Leukosit (+)
Biaya
Periksa :
33,000
204439 PUTRA
AGUS
FADLYANSYAH Yuni Nurul
2023/06/11/00 (Poli : Azizah, A.
0032 LABORATORIUM) Md. 6/11/2023 17:10:58
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 NEGATIF -
Biaya
Periksa :
80,000
204436 IQLIMA
LAYYINATUSY Ragil
2023/06/11/00 SYIFA (Poli : Pangestu W.,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
147273
MUHAMMAD ARIF
YULDAN ASWIN Ragil
2023/06/11/00 (Poli : Pangestu W.,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
204433 MAS YOGA Ragil

2023/06/11/00 MAULANA (Poli : Pangestu W.,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
130822 REYHAN
MEIZA Ragil
2023/06/11/00 DARUSSALAM (Poli Pangestu W.,
0011 : LABORATORIUM) A.Md. 6/11/2023 9:35:34
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
203939
MUHAMMAD
NASHICH Ragil
2023/06/11/00 MACHFUD (Poli : Pangestu W.,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
204431 MILLA
BIAUNILLAH AL
BAROROH SINUNG Annies
2023/06/11/00 (Poli : Fadhilah,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
185291
MUHAMMAD
ABRISAM AL FATIH
(Kamar : Annies
0001 ANGGREK) A.Md. 6/11/2023 1:08:33
Cara Bayar :
J002066
HEMOSTASIS
30,000
Waktu
Perdarahan
( BT ) 0 1 Menit
Waktu
Pembekuan (
CT ) 0 11 Menit
TLAB00138
ELEKTROLIT
237,000
Kalium 0 4,7 mEq/L
Natrium 0 140 mEq/L
Clorida 0 105 mEq/L
Biaya
Periksa :
267,000
185291
MUHAMMAD
ABRISAM AL FATIH
(Kamar : Annies
0001 ANGGREK) A.Md. 6/11/2023 0:47:36
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 13,1 g/dL
Hematokrit 0 38,2 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 34,7 %
Limfosit 0 54,4 %
Monosit 0 6,8 %
Eosinofil 0 4,1 %
Basofil 0 0,0 %
INDEX
ERITROSIT 0
MCV 0 76,9 fL
MCH 0 26,4 pg
MCHC 0 34,4 g/dL
RDW-CV 0 13,3 %
NLR 0 0,64
TLAB00006
GLUKOSA
DARAH
SEWAKTU
28,000
Glukosa
Darah -
Sewaktu 0 98 mg/dl
Biaya
Periksa :
118,000

2023/06/11/00 (Kamar : Azizah, A.
0053 HCUBED3, HCU) Md. 6/11/2023 0:01:10
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 13,4 g/dL
Hematokrit 0 37,7 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 86,6 %
Limfosit 0 10,2 %
Monosit 0 3,2 %
Eosinofil 0 0,0 %
Basofil 0 0,0 %
INDEX
ERITROSIT 0
MCV 0 74,1 fL
MCH 0 26,3 pg
MCHC 0 35,5 g/dL
RDW-CV 0 14,0 %
NLR 0 8,49
TLAB00006
GLUKOSA
DARAH
SEWAKTU
28,000
Glukosa
Darah -
Sewaktu 0 HIGH mg/dl
Biaya
Periksa :
118,000
204426 YOGA
ARTIKA BUCHORI Yuni Nurul
2023/06/10/00 (Poli : Azizah, A.
0084 LABORATORIUM) Md. 6/10/2023 20:12:22
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 NEGATIF -
Biaya
Periksa :
80,000
055514 AGUSTINA Yuni Nurul

2023/06/10/00 MARTHA SARI (Poli Azizah, A.
0082 : IGD) Md. 6/10/2023 19:53:17
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 14.8 g/dL
Hematokrit 0 44.3 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 82 %
Limfosit 0 10.9 %
Monosit 0 6.8 %
Eosinofil 0 0.3 %
Basofil 0 0%
INDEX
ERITROSIT 0
MCV 0 82.2 fL
MCH 0 27.4 pg
MCHC 0 33.4 g/dL
RDW-CV 0 12.2 %
NLR 0 7.52
TLAB00022
WIDAL
59,500
Salmonella
typhi O 0 Negatif -
Salmonella
typhi H 0 Negatif -
Salmonella
paratyphi A-
H0 Negatif -
Salmonella
paratyphi B-
H0 Negatif -
Biaya
Periksa :
149,500
204425 SHOVAN Yuni Nurul

2023/06/10/00 DHINAR (Poli : Azizah, A.
0080 LABORATORIUM) Md. 6/10/2023 19:12:56
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 NEGATIF -
Biaya
Periksa :
80,000
204231 HARIS
NUR IRFANI Yuni Nurul
2023/06/10/00 IKHSAN (Poli : Azizah, A.
0079 LABORATORIUM) Md. 6/10/2023 19:12:49
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 NEGATIF -
Biaya
Periksa :
80,000
043409
RAMADHANDI
RAIHAN FATIH Yuni Nurul
2023/06/10/00 WIJAYANTO (Poli : Azizah, A.
0081 LABORATORIUM) Md. 6/10/2023 19:12:41
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 NEGATIF -
Biaya
Periksa :
80,000
204388 ERI Yuni Nurul
2023/06/10/00 PRASTIANTO (Poli : Azizah, A.
0073 LABORATORIUM) Md. 6/10/2023 18:33:11
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 NEGATIF -
Biaya
Periksa :
80,000
077721 SHABRINA Yuni Nurul

2023/06/10/00 SALMA SILMINA Azizah, A.
0072 (Poli : IGD) Md. 6/10/2023 17:20:14
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 12.5 g/dL
Hematokrit 0 38.3 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 72.4 %
Limfosit 0 17.3 %
Monosit 0 9.4 %
Eosinofil 0 0.9 %
Basofil 0 0%
INDEX
ERITROSIT 0
MCV 0 78.9 fL
MCH 0 25.8 pg
MCHC 0 32.7 g/dL
RDW-CV 0 13.9 %
NLR 0 4.18
TLAB00022
WIDAL
59,500
Salmonella
typhi O 0 POSITIF 1/80 -
Salmonella
typhi H 0 POSITIF 1/160 -
Salmonella
paratyphi A-
H0 NEGATIF -
Salmonella
paratyphi B-
H0 NEGATIF -
Biaya
Periksa :
149,500
119983 FIRDA Ronggo Adi

2023/06/10/00 NURUL AISYAH Saputro,
0066 (Poli : IGD) A.Md.Kep. 6/10/2023 15:16:57
Cara Bayar :
TLAB00006
GLUKOSA
DARAH
SEWAKTU
28,000
Glukosa
Darah -
Sewaktu 0 103 mg/dl
Biaya
Periksa :
28,000
204421 ROI
ROHARTA
SIMANJUNTAK
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
204419 YUDHA
2023/06/10/00 PRATAMA (Poli : Ela Yulianti,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
036574 TUTIAH
Cara Bayar :
J000036
GLUKOSA
DARAH
PUASA
28,000
Glukosa
Puasa 0 154 mg/dl
J002029
PROFIL LIPID
139,000
CHOLESTERO
L0 238 mg/dl
TRIGLYCERID
A0 170 mg/dl
HDL
CHOLESTERO
L0 65 mg/dl
LDL
CHOLESTERO
L0 139 mg/dl
TLAB00010
ASAM URAT
43,000
ASAM URAT
0 3.7 mg/dl
Biaya
Periksa :
210,000
204411 AINNUR
REZA NUGRAENI
(Kamar : Annies
2023/06/09/00 BOUGENVBED2, Fadhilah,
0141 BOUGENVILLE) A.Md. 6/9/2023 17:26:33
Cara Bayar :
J002065
HEMOSTASIS
30,000
Waktu
Perdarahan
( BT ) 0 1 Menit
Waktu
Pembekuan (
CT ) 0 10 Menit
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 14,9 g/dL
Hematokrit 0 43,9 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 45,8 %
Limfosit 0 44,7 %
Monosit 0 6,9 %
Eosinofil 0 2,6 %
Basofil 0 0,0 %
INDEX
ERITROSIT 0
MCV 0 83,0 fL
MCH 0 28,1 pg
MCHC 0 33,9 g/dL
RDW-CV 0 11,9 %
NLR 0 1,02
TLAB00006
GLUKOSA
DARAH
SEWAKTU
28,000
Glukosa
Darah -
Sewaktu 0 82 mg/dl
TLAB00023
HBSAG
59,500
HBSAG 0 Negatif
Biaya
Periksa :
207,500
119428 DINNA Annies

2023/06/09/00 NADLIFAH (Poli : Fadhilah,
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 12,4 g/dL
Hematokrit 0 35,7 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 75,2 %
Limfosit 0 20,7 %
Monosit 0 3,1 %
Eosinofil 0 1,0 %
Basofil 0 0,0 %
INDEX
ERITROSIT 0
MCV 0 87,7 fL
MCH 0 30,5 pg
MCHC 0 34,8 g/dL
RDW-CV 0 13,2 %
NLR 0 3,63
Biaya
Periksa :
90,000
108447
MUHAMAD IVAN
MAHARDIKA Ragil
2023/06/09/00 PUTRA (Poli : Pangestu W.,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
204395 LILA EKA Abbas

2023/06/08/00 LINGGA (Poli : Herlan,
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 10.6 g/dL
Hematokrit 0 31.7 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 72.4 %
Limfosit 0 22.6 %
Monosit 0 4.4 %
Eosinofil 0 0.6 %
Basofil 0 0%
INDEX
ERITROSIT 0
MCV 0 82.4 fL
MCH 0 27.5 pg
MCHC 0 33.3 g/dL
RDW-CV 0 14.1 %
NLR 0 3.2
TLAB00023
HBSAG
59,500
HBSAG 0 Negatif
Biaya
Periksa :
149,500
204392 AGUS Ragil

2023/06/08/00 PRIYONO (Poli : Pangestu W.,
0201 IGD) A.Md. 6/8/2023 20:49:35
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
204392 AGUS Ragil

2023/06/08/00 PRIYONO (Poli : Pangestu W.,
0201 IGD) A.Md. 6/8/2023 20:49:19
Cara Bayar :
J002045
FUNGSI
GINJAL 2
86,000
UREUM 0 41.3 mg/dl
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 15 g/dL
Hematokrit 0 43.7 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 58 %
Limfosit 0 31.5 %
Monosit 0 5.8 %
Eosinofil 0 4.6 %
Basofil 0 0.1 %
INDEX
ERITROSIT 0
MCV 0 85 fL
MCH 0 29.2 pg
MCHC 0 34.4 g/dL
RDW-CV 0 12.5 %
NLR 0 1.84
TLAB00006
GLUKOSA
DARAH
SEWAKTU
28,000
Glukosa
Darah -
Sewaktu 0 234 mg/dl
Biaya
Periksa :
204,000
043409
RAMADHANDI
RAIHAN FATIH Ragil
2023/06/08/00 WIJAYANTO (Poli : Pangestu W.,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
147273
MUHAMMAD ARIF
YULDAN ASWIN Ragil
2023/06/08/00 (Poli : Pangestu W.,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
200913
MUHAMMAD
HAZEL FULVIAN N Ragil
2023/06/08/00 (Poli : Pangestu W.,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
204389 ELFRIDA Ragil

2023/06/08/00 ROSALIA (Poli : Pangestu W.,
0176 IGD) A.Md. 6/8/2023 17:17:00
Cara Bayar :
TLAB00033
URINE RUTIN
33,000
P.H. 0 6
B.J. 0 1.01
Protein 0 Negatif
Reduksi 0 Negatif
Urobilinogen
0 Negatif mg/dl
Bilirubin 0 Negatif
Keton 0 Negatif
Sedimen 0
Leukosit 0 0-1
Eritrosit 0 0-1
Epitel Sel 0 1-Feb
Silinder 0 Negatif
Kristal 0 Negatif
Lain-lain 0 Negatif
Biaya
Periksa :
33,000
204389 ELFRIDA Ragil

2023/06/08/00 ROSALIA (Poli : Pangestu W.,
0176 IGD) A.Md. 6/8/2023 17:16:10
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 14 g/dL
Hematokrit 0 39.9 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 54.4 %
Limfosit 0 37.6 %
Monosit 0 6.3 %
Eosinofil 0 1.6 %
Basofil 0 0%
INDEX
ERITROSIT 0
MCV 0 88 fL
MCH 0 30.9 pg
MCHC 0 35.1 g/dL
RDW-CV 0 12.4 %
NLR 0 1.45
Biaya
Periksa :
90,000
066286 INKA
JANUAR AN Ragil
2023/06/08/00 NADWA (Poli : Pangestu W.,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
204388 ERI Ragil

2023/06/08/00 PRASTIANTO (Poli : Pangestu W.,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
197597 IRVAN
DIKA WICAKSONO Ragil
2023/06/08/00 (Poli : Pangestu W.,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
130822 REYHAN
MEIZA Ragil
2023/06/08/00 DARUSSALAM (Poli Pangestu W.,
0140 : LABORATORIUM) A.Md. 6/8/2023 14:44:20
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
193221 YOGA Mega Tri

2023/06/08/00 RUDIANTO (Poli : Wulandari,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
164342 ANEIRA
GEFFIE ABILLA Mega Tri
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 12,9 g/dL
Hematokrit 0 37,7 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 82,4 %
Limfosit 0 12,3 %
Monosit 0 5,2 %
Eosinofil 0 0,1 %
Basofil 0 0,0 %
INDEX
ERITROSIT 0
MCV 0 80,6 fL
MCH 0 27,6 pg
MCHC 0 34,3 g/dL
RDW-CV 0 11,7 %
NLR 0 6,70
TLAB00006
GLUKOSA
DARAH
SEWAKTU
28,000
Glukosa
Darah -
Sewaktu 0 90 mg/dl
TLAB00022
WIDAL
59,500
Salmonella
typhi O 0 Negatif -
Salmonella
typhi H 0 Negatif -
Salmonella
paratyphi A-
H0 Positif 1/80 -
Salmonella
paratyphi B-
H0 Negatif -
Biaya
Periksa :
177,500
048950 ISMA Mega Tri

2023/06/08/00 RAHAYU (Poli : Wulandari,
Cara Bayar :
TLAB00010
ASAM URAT
43,000
ASAM URAT
0 7,0 mg/dl
Biaya
Periksa :
43,000
204375 LAKSMI Abbas

2023/06/07/00 PUSPA DEWI (Poli : Herlan,
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 12.6 g/dL
Hematokrit 0 37.6 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 41.7 %
Limfosit 0 52.3 %
Monosit 0 5.4 %
Eosinofil 0 0.6 %
Basofil 0 0%
INDEX
ERITROSIT 0
MCV 0 89.8 fL
MCH 0 30.1 pg
MCHC 0 33.5 g/dL
RDW-CV 0 12.4 %
NLR 0 0.8
Biaya
Periksa :
90,000
167181
MUHAMMAD
HAFIZ AL Abbas
2023/06/07/00 MURSALIM (Poli : Herlan,
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 10.4 g/dL
Hematokrit 0 31.5 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 60.5 %
Limfosit 0 32.8 %
Monosit 0 4.9 %
Eosinofil 0 1.8 %
Basofil 0 0%
INDEX
ERITROSIT 0
MCV 0 71.7 fL
MCH 0 23.6 pg
MCHC 0 33 g/dL
RDW-CV 0 13.2 %
NLR 0 1.84
Biaya
Periksa :
90,000
079403 LISTIANA Yuni Nurul

2023/06/07/00 (Poli : Azizah, A.
0050 LABORATORIUM) Md. 6/7/2023 12:59:47
Cara Bayar :
J002045
FUNGSI
GINJAL 2
86,000
UREUM 0 7.1 mg/dl

J002070 LFT
80,000
SGOT / ASTL
0 12 U/L
SGPT / ALTL
0 5 U/L
Biaya
Periksa :
166,000
130822 REYHAN
MEIZA Yuni Nurul
2023/06/07/00 DARUSSALAM (Poli Azizah, A.
0033 : LABORATORIUM) Md. 6/7/2023 12:00:24
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 14.5 g/dL
Hematokrit 0 42.2 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 62.6 %
Limfosit 0 28.8 %
Monosit 0 4.8 %
Eosinofil 0 3.8 %
Basofil 0 0%
INDEX
ERITROSIT 0
MCV 0 87.5 fL
MCH 0 30.2 pg
MCHC 0 34.5 g/dL
RDW-CV 0 12.4 %
NLR 0 2.17
TLAB00003
LED 20,000
LED I 0 6 mm/jam
LED II 0 10 mm/jam
TLAB00023
HBSAG
59,500
HBSAG 0 NEGATIF
TLAB00026
ANTI HIV
59,500
REAGEN 1 0 NON REAKTIF -
0
Biaya
Periksa :
229,000
130822 REYHAN
MEIZA Yuni Nurul
0033 : LABORATORIUM) Md. 6/7/2023 11:04:22
Cara Bayar :
J000036
GLUKOSA
DARAH
PUASA
28,000
Glukosa
Puasa 0 90 mg/dl
J002029
PROFIL LIPID
139,000
CHOLESTERO
L0 116 mg/dl
TRIGLYCERID
A0 55 mg/dl
HDL
CHOLESTERO
L0 58 mg/dl
LDL
CHOLESTERO
L0 47 mg/dl
J002040
FUNGSI
GINJAL 1
129,000
ASAM URAT
0 5.7 mg/dl
UREUM 0 20.3 mg/dl
CREATININ 0 1 mg/dl
J002070 LFT
80,000
SGOT / ASTL
0 16 U/L
SGPT / ALTL
0 8 U/L
Biaya
Periksa :
376,000
130822 REYHAN
MEIZA Yuni Nurul
0033 : LABORATORIUM) Md. 6/7/2023 10:56:29
Cara Bayar :
TLAB00033
URINE RUTIN
33,000
P.H. 0 6
B.J. 0 1.03
Protein 0 Negatif
Reduksi 0 Negatif
Urobilinogen
0 Negatif mg/dl
Bilirubin 0 Negatif
Keton 0 Negatif
Sedimen 0
Leukosit 0 2-Apr
Eritrosit 0 1-Mar
Epitel Sel 0 >25
Silinder 0 Negatif
Kristal 0 Negatif
Biaya
Periksa :
33,000
130751 SUKAMDI Yuni Nurul

2023/06/07/00 (Poli : Azizah, A.
0028 LABORATORIUM) Md. 6/7/2023 8:41:42
Cara Bayar :
TLAB00010
ASAM URAT
43,000
ASAM URAT
0 7,4 mg/dl
Biaya
Periksa :
43,000
2023/06/07/00 015148 SUKIRNO

0012 (Poli : IGD) Rahmad 6/7/2023 6:48:48
Cara Bayar :
TLAB00006
GLUKOSA
DARAH
SEWAKTU
28,000
Glukosa
Darah -
Sewaktu 0 179 mg/dl
Biaya
Periksa :
28,000
114918 ANDHIKA
PATRIATAMA Annies
2023/06/06/00 WIBOWO (Poli : Fadhilah,
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 14,5 g/dL
Hematokrit 0 42,9 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 60,2 %
Limfosit 0 32,4 %
Monosit 0 5,8 %
Eosinofil 0 1,6 %
Basofil 0 0,0 %
INDEX
ERITROSIT 0
MCV 0 77,0 fL
MCH 0 26,1 pg
MCHC 0 33,9 g/dL
RDW-CV 0 13,2 %
NLR 0 1,86
TLAB00022
WIDAL
59,500
Salmonella
typhi O 0 Negatif -
Salmonella
typhi H 0 Negatif -
Salmonella
paratyphi A-
H0 Negatif -
Salmonella
paratyphi B-
H0 Negatif -
Biaya
Periksa :
149,500
203501 LILIK Annies

2023/06/06/00 MARYATI (Poli : Fadhilah,
Cara Bayar :
TLAB00087
PAP SMER
180,000
Biaya
Periksa :
180,000
182984 MEDINA
AZQILA Ragil
2023/06/06/00 KHAIRULLAH (Poli : Pangestu W.,
0203 IGD) A.Md. 6/6/2023 3:52:42
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 13 g/dL
Hematokrit 0 37.8 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 50.3 %
Limfosit 0 44.3 %
Monosit 0 5.3 %
Eosinofil 0 0.1 %
Basofil 0 0%
INDEX
ERITROSIT 0
MCV 0 74.6 fL
MCH 0 25.6 pg
MCHC 0 34.4 g/dL
RDW-CV 0 13.9 %
NLR 0 1.14
TLAB00022
WIDAL
59,500
Salmonella
typhi O 0 Negatif -
Salmonella
typhi H 0 Negatif -
Salmonella
paratyphi A-
H0 Negatif -
Salmonella
paratyphi B-
H0 Negatif -
Biaya
Periksa :
149,500
193221 YOGA Abbas

2023/06/05/00 RUDIANTO (Poli : Herlan,
Cara Bayar :
TLAB00032
Rapid Covid
19 Antigen
80,000
Rapid
Antigen SARS
Cov-2 0 Negatif -
Biaya
Periksa :
80,000
168719 ALFARIZY
2023/06/04/00 AKBAR (Poli : Ela Yulianti,
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 17.8 g/dL
Hematokrit 0 51 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 45.5 %
Limfosit 0 45.3 %
Monosit 0 6.4 %
Eosinofil 0 2.8 %
Basofil 0 0%
INDEX
ERITROSIT 0
MCV 0 73.1 fL
MCH 0 25.5 pg
MCHC 0 34.9 g/dL
RDW-CV 0 12.8 %
NLR 0 1
TLAB00022
WIDAL
59,500
Salmonella
typhi O 0 Negatif -
Salmonella
typhi H 0 POSITIF (1/80) -
Salmonella
paratyphi A-
H0 Negatif -
Salmonella
paratyphi B-
H0 Negatif -
Biaya
Periksa :
149,500
204236 SUSIYATI Abbas

2023/06/04/00 (Poli : Herlan,
Cara Bayar :
J002040
FUNGSI
GINJAL 1
129,000
ASAM URAT
0 3 mg/dl
UREUM 0 29.3 mg/dl
Biaya
Periksa :
129,000
204321 TESSA
KANAYA Mega Tri
2023/06/03/00 RAMADHANI (Poli : Wulandari,
0098 IGD) A.Md. 6/3/2023 21:09:58
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 11,4 g/dL
Hematokrit 0 32,8 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 77,9 %
Limfosit 0 15,2 %
Monosit 0 6,9 %
Eosinofil 0 0,0 %
Basofil 0 0,0 %
INDEX
ERITROSIT 0
MCV 0 76,4 fL
MCH 0 26,7 pg
MCHC 0 35,0 g/dL
RDW-CV 0 13,3 %
NLR 0 5,13
Biaya
Periksa :
90,000
192339 MECCA
2023/06/03/00 HAFIZA PUTRI (Poli Ela Yulianti,
0092 : LABORATORIUM) A.Md.Kes. 6/3/2023 18:35:57
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 11.2 g/dL
Hematokrit 0 32.4 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 39.9 %
Limfosit 0 51.9 %
Monosit 0 8.1 %
Eosinofil 0 0.1 %
Basofil 0 0%
INDEX
ERITROSIT 0
MCV 0 81.1 fL
MCH 0 28 pg
MCHC 0 34.5 g/dL
RDW-CV 0 13.7 %
NLR 0 0.77
TLAB00022
WIDAL
59,500
Salmonella
typhi O 0 Negatif -
Salmonella
typhi H 0 Negatif -
Salmonella
paratyphi A-
H0 Negatif -
Salmonella
paratyphi B-
H0 Negatif -
Biaya
Periksa :
149,500
204219 BY NY
BESTTA EKA Ragil
2023/06/03/00 PRATIWI (Poli : Poli Pangestu W.,
0045 Anak) A.Md. 6/3/2023 9:56:38
Cara Bayar :
TLAB00009
BILIRUBIN
T/D/I 75,000
Bilirubin
Total 0 11,6 mg/dl
Bilirubin
Direk 0 0,8 mg/dl
Bilirubin
Indirek 0 10,8 mg/dl
Biaya
Periksa :
75,000
114822 EDDY
ARISTIYANTO Abbas
2023/06/02/00 (Poli : Penyakit Herlan,
0182 Dalam) A.Md.Kes 6/2/2023 17:32:34
Cara Bayar :
TLAB00061
HBA1C
195,000
HBAIC 0 13.7 %
Biaya
Periksa :
195,000
114822 EDDY dr. Juene

2023/06/02/00 ARISTIYANTO Rosseneri,
0160 (Poli : Poli Mata) Sp.M 6/2/2023 17:00:47
Cara Bayar :
TLAB00006
GLUKOSA
DARAH
SEWAKTU
28,000
Glukosa
Darah -
Sewaktu 0 552 mg/dl
Biaya
Periksa :
28,000
117268 DJOKO
2023/06/02/00 PRASETIYA (Poli :
0082 Penyakit Dalam) Ns. Feby 6/2/2023 16:01:48
Cara Bayar :
TLAB00006
GLUKOSA
DARAH
SEWAKTU
28,000
Glukosa
Darah -
Sewaktu 0 151 mg/dl
Biaya
Periksa :
28,000
026200 Annies
2023/06/02/00 KADARYATI (Poli : Fadhilah,
Cara Bayar :
TLAB00010
ASAM URAT
43,000
ASAM URAT
0 4.1 mg/dl
Biaya
Periksa :
43,000
204290 ELI Annies

2023/06/02/00 ERMAWATI (Poli : Fadhilah,
Cara Bayar :
J000036
GLUKOSA
DARAH
PUASA
28,000
Glukosa
Puasa 0 98 mg/dl
TLAB00010
ASAM URAT
43,000
ASAM URAT
0 6,6 mg/dl
TLAB00015
CHOLESTERO
L 41,500
Cholesterol 0 195 mg/dl

Biaya
Periksa :
112,500
204257 ADINDA
ZHAFIRA SALMA Annies
2023/06/02/00 (Poli : Fadhilah,
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 14,2 g/dL
Hematokrit 0 41,5 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 51,8 %
Limfosit 0 40,0 %
Monosit 0 4,5 %
Eosinofil 0 3,7 %
Basofil 0 0,0 %
INDEX
ERITROSIT 0
MCV 0 83,9 fL
MCH 0 28,7 pg
MCHC 0 34,2 g/dL
RDW-CV 0 13,0 %
NLR 0 1,30
Biaya
Periksa :
90,000
204288
AYUNINDYA Annies
2023/06/02/00 MAHESTRI (Poli : Fadhilah,
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 12,9 g/dL
Hematokrit 0 38,2 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 61,6 %
Limfosit 0 34,7 %
Monosit 0 3,6 %
Eosinofil 0 0,1 %
Basofil 0 0,0 %
INDEX
ERITROSIT 0
MCV 0 77,1 fL
MCH 0 26,1 pg
MCHC 0 33,9 g/dL
RDW-CV 0 12,6 %
NLR 0 1,78
TLAB00022
WIDAL
59,500
Salmonella
typhi O 0 Positif 1/80 -
Salmonella
typhi H 0 Negatif -
Salmonella
paratyphi A-
H0 Negatif -
Salmonella
paratyphi B-
H0 Negatif -
Biaya
Periksa :
149,500
192790
MOCHAMMAD Ragil
2023/06/02/00 ISMAIL (Poli : Pangestu W.,
Cara Bayar :
J000036
GLUKOSA
DARAH
PUASA
28,000
Glukosa
Puasa 0 104 mg/dl
TLAB00010
ASAM URAT
43,000
ASAM URAT
0 5,7 mg/dl
Biaya
Periksa :
71,000
164634 HERLINA Abbas

2023/06/01/00 NURSEKHA (Poli : Herlan,
0037 IGD) A.Md.Kes 6/1/2023 19:41:58
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 15.7 g/dL
Hematokrit 0 46 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 88.3 %
Limfosit 0 8.2 %
Monosit 0 3.1 %
Eosinofil 0 0.4 %
Basofil 0 0%
INDEX
ERITROSIT 0
MCV 0 84.1 fL
MCH 0 28.7 pg
MCHC 0 34.1 g/dL
RDW-CV 0 12.5 %
NLR 0 10.77
TLAB00022
WIDAL
59,500
Salmonella
typhi O 0 Negatif -
Salmonella
typhi H 0 Negatif -
Salmonella
paratyphi A-
H0 Negatif -
Salmonella
paratyphi B-
H0 Negatif -
Biaya
Periksa :
149,500
Abbas
2023/06/01/00 002557 SUHADI Herlan,
0029 (Poli : IGD) A.Md.Kes 6/1/2023 18:17:20
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 13.5 g/dL
Hematokrit 0 40.4 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 75.1 %
Limfosit 0 14.3 %
Monosit 0 9.8 %
Eosinofil 0 0.8 %
Basofil 0 0%
INDEX
ERITROSIT 0
MCV 0 77.9 fL
MCH 0 26.1 pg
MCHC 0 33.6 g/dL
RDW-CV 0 13.3 %
NLR 0 5.25
TLAB00022
WIDAL
59,500
Salmonella
typhi O 0 Negatif -
Salmonella
typhi H 0 Negatif -
Salmonella
paratyphi A-
H0 Negatif -
Salmonella
paratyphi B-
H0 Negatif -
Biaya
Periksa :
149,500
Siti Assyifa
2023/06/01/00 157947 TRIMAN Innayah,
0020 (Poli : IGD) A.Md.Kep. 6/1/2023 12:22:54
Cara Bayar :
TLAB00006
GLUKOSA
DARAH
SEWAKTU
28,000
Glukosa
Darah -
Sewaktu 0 115 mg/dl
Biaya
Periksa :
28,000
204271 HALIZA
YOLANDA Ragil
2023/06/01/00 YUSTANTI (Poli : Pangestu W.,
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 11 g/dL
Hematokrit 0 32.2 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 47.9 %
Limfosit 0 38.2 %
Monosit 0 9.1 %
Eosinofil 0 4.8 %
Basofil 0 0%
INDEX
ERITROSIT 0
MCV 0 72.2 fL
MCH 0 24.7 pg
MCHC 0 34.2 g/dL
RDW-CV 0 12.9 %
NLR 0 1.25
Biaya
Periksa :
90,000
204243 ALFIA Ragil

2023/06/01/00 YULIANA (Poli : Pangestu W.,
0016 IGD) A.Md. 6/1/2023 11:46:52
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Leukosit 0 5 10³/mm³
Hemoglobin
0 14.6 g/dL
Hematokrit 0 41.9 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 52.6 %
Limfosit 0 37.5 %
Monosit 0 8.4 %
Eosinofil 0 1.4 %
Basofil 0 0%
INDEX
ERITROSIT 0
MCV 0 85.9 fL
MCH 0 30 pg
MCHC 0 34.9 g/dL
RDW-CV 0 12.8 %
NLR 0 1.4
TLAB00022
WIDAL
59,500
Salmonella
typhi O 0 POSITIF (1/80) -
Salmonella
typhi H 0 Negatif -
Salmonella
paratyphi A-
H0 Negatif -
Salmonella
paratyphi B-
H0 Negatif -
Biaya
Periksa :
149,500
204280 WAHYU Siti Assyifa

2023/06/01/00 JOKO SANTOSO Innayah,
0011 (Poli : IGD) A.Md.Kep. 6/1/2023 8:59:44
Cara Bayar :
TLAB00006
GLUKOSA
DARAH
SEWAKTU
28,000
Glukosa
Darah -
Sewaktu 0 mg/dl
Biaya
Periksa :
28,000
204248
WULANDARI
(Kamar : Yuni Nurul
2023/05/31/00 BOUGENVBED3, Azizah, A.
0027 BOUGENVILLE) Md. 6/1/2023 7:44:56
Cara Bayar :
TLAB00152
URINE RUTIN
33,000
P.H. 0 6
B.J. 0 1.02
Protein 0 Negatif
Reduksi 0 Negatif
Urobilinogen
0 Negatif mg/dl
Bilirubin 0 Negatif
Keton 0 Negatif
Sedimen 0
Leukosit 0 4-May
Eritrosit 0 1-Feb
Epitel Sel 0 2-Mar
Silinder 0 Negatif
Kristal 0 Negatif
Biaya
Periksa :
33,000
125108 AI.BUDI Yuni Nurul

2023/06/01/00 AGUNG WIBOWO Azizah, A.
0006 (Poli : IGD) Md. 6/1/2023 6:30:27
Cara Bayar :
TLAB00006
GLUKOSA
DARAH
SEWAKTU
28,000
Glukosa
Darah -
Sewaktu 0 231 mg/dl
0 GDS IGD
Biaya
Periksa :
28,000
204278 BUDI Yuni Nurul

2023/06/01/00 TRISNANTO (Poli : Azizah, A.
0005 IGD) Md. 6/1/2023 6:27:21
Cara Bayar :
J002111
DARAH
LENGKAP
90,000
Hemoglobin
0 14.3 g/dL
Hematokrit 0 40.5 %
HITUNG
JENIS
LEUKOSIT 0
Neutrofil 0 52 %
Limfosit 0 39.3 %
Monosit 0 7.3 %
Eosinofil 0 1.4 %
Basofil 0 0%
INDEX
ERITROSIT 0
MCV 0 86.9 fL
MCH 0 30.6 pg
MCHC 0 35.2 g/dL
RDW-CV 0 12.4 %
NLR 0 1.32
TLAB00006
GLUKOSA
DARAH
SEWAKTU
28,000
Glukosa
Darah -
Sewaktu 0 141 mg/dl
0
Biaya
Periksa :
118,000
>> Total : 28,589,800

23 BERDASARKAN SIM

Nilai Rujukan Keterangan
Kuning Jernih
4,8 - 7,5
1,015 - 1,025
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Kesan : Saran :


70 - 200
3,4 – 7,2
Kesan : Saran :

Sp.A Sp.PK
Kuning Jernih
4,8 - 7,5
1,015 - 1,025
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Kesan : Saran :

4,00 - 10,00 H
4,00 - 5,50
13,0 - 18,0 L
40,0 - 54,0 L
150 - 450
50,0 - 70,0 H
20,0 - 40,0 L
3,0 - 12,0
0,5 - 5,0 L
0,0 - 1,0
80,0 - 100,0
27,0 - 34,0
32,0 - 36,0
11,0 - 16,0
Negatif
Negatif
Negatif
Negatif
Kesan : Saran :
M.Kes., M.H Sp.PK
4,00 - 10,00 H
3,50 - 5,00
11,0 - 15,0
35,0 - 47,0 L
150 - 450
50,0 - 70,0 H
20,0 - 40,0 L
3,0 - 12,0
0,5 - 5,0 L
0,0 - 1,0
80,0 - 100,0
27,0 - 34,0
32,0 - 36,0
11,0 - 16,0
Kesan : Saran :


4,00 - 12,00
3,50 - 5,20
12,0 - 16,0
35,0 - 49,0
150 - 450
50,0 - 70,0
20,0 - 40,0
3,0 - 12,0
0,5 - 5,0
0,0 - 1,0
80,0 - 100,0 L
27,0 - 34,0 L
31,0 - 37,0
11,0 - 16,0
70 - 200
3,5 - 5,5
135 - 145
96 - 106
Kesan : Saran :
2,4 – 5,7 H
Kesan : Saran :
dr. Y Andressa -
70 - 200
Kesan : Saran :

4,00 - 10,00
4,00 - 5,50
13,0 - 18,0
40,0 - 54,0
150 - 450
50,0 - 70,0 H
20,0 - 40,0 L
3,0 - 12,0
0,5 - 5,0 L
0,0 - 1,0
80,0 - 100,0 L
27,0 - 34,0 L
32,0 - 36,0
11,0 - 16,0
Kesan : Saran :

4,00 - 10,00 H
4,00 - 5,50
13,0 - 18,0
40,0 - 54,0
150 - 450
50,0 - 70,0 H
20,0 - 40,0
3,0 - 12,0
0,5 - 5,0
0,0 - 1,0
80,0 - 100,0
27,0 - 34,0
32,0 - 36,0
11,0 - 16,0
Kesan : Saran :

4,00 - 10,00 H
4,00 - 5,50
13,0 - 18,0
40,0 - 54,0
150 - 450
50,0 - 70,0
20,0 - 40,0
3,0 - 12,0
0,5 - 5,0
0,0 - 1,0
80,0 - 100,0
27,0 - 34,0
32,0 - 36,0
11,0 - 16,0
Kesan : Saran :

Kuning Jernih
4,8 - 7,5
1,015 - 1,025
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Kesan : Saran :

- Sp.PK

Kesan : Saran :

4,00 - 12,00
3,50 - 5,20
12,0 - 16,0
35,0 - 49,0
150 - 450
50,0 - 70,0 L
20,0 - 40,0 H
3,0 - 12,0
0,5 - 5,0
0,0 - 1,0
80,0 - 100,0 L
27,0 - 34,0 L
31,0 - 37,0
11,0 - 16,0
Kesan : Saran :
-- Sp.PK
2,4 – 5,7
Kesan : Saran :

M.Kes., M.H Sp.PK
Negatif
Kesan : Saran :

Sp.A Sp.PK

NEGATIF
Kesan : Saran :

M.Kes., M.H Sp.PK
Negatif
Kesan : Saran :

Sp.A Sp.PK
4,00 - 12,00
3,50 - 5,20
12,0 - 16,0 L
35,0 - 49,0 L
150 - 450
50,0 - 70,0 L
20,0 - 40,0 H
3,0 - 12,0
0,5 - 5,0
0,0 - 1,0
80,0 - 100,0 L
27,0 - 34,0 L
31,0 - 37,0
11,0 - 16,0
Kesan : Saran :

Sp.KJ Sp.PK
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Kesan : Saran :

Sp.KJ Sp.PK

Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Kesan : Saran :

Sp.KJ Sp.PK
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Kesan : Saran :
M.Kes., M.H Sp.PK
Negatif
Kesan : Saran :

Tamam. Sp.A.K Sp.PK
4,00 - 10,00
3,50 - 5,00
11,0 - 15,0
35,0 - 47,0
150 - 450
50,0 - 70,0
20,0 - 40,0
3,0 - 12,0 H
0,5 - 5,0 L
0,0 - 1,0
80,0 - 100,0
27,0 - 34,0
32,0 - 36,0
11,0 - 16,0
Negatif
Negatif
Negatif
Negatif
Kesan : Saran :

Nugraha Sp.PK
4,00 - 10,00 L
3,50 - 5,00 L
11,0 - 15,0 L
35,0 - 47,0 L
150 - 450
50,0 - 70,0
20,0 - 40,0
3,0 - 12,0
0,5 - 5,0 L
0,0 - 1,0
80,0 - 100,0
27,0 - 34,0
32,0 - 36,0 H
11,0 - 16,0
Kesan : Saran :

M.Kes., M.H Sp.PK
4,00 - 10,00 H
3,50 - 5,00
11,0 - 15,0
35,0 - 47,0 L
150 - 450
50,0 - 70,0 H
20,0 - 40,0 L
3,0 - 12,0
0,5 - 5,0 L
0,0 - 1,0
80,0 - 100,0
27,0 - 34,0
32,0 - 36,0
11,0 - 16,0 H
Negatif
Kesan : Saran :

Negatif
Kesan : Saran :

Negatif
Kesan : Saran :
Negatif
Kesan : Saran :

Negatif
Kesan : Saran :


Negatif
Kesan : Saran :

4,00 - 10,00
4,00 - 5,50
13,0 - 18,0 L
40,0 - 54,0 L
150 - 450
50,0 - 70,0
20,0 - 40,0 H
3,0 - 12,0
0,5 - 5,0 L
0,0 - 1,0
80,0 - 100,0 L
27,0 - 34,0 L
32,0 - 36,0
11,0 - 16,0
Kesan : Saran :
Negatif
Kesan : Saran :

Negatif
Kesan : Saran :


4,00 - 10,00
4,00 - 5,50
13,0 - 18,0
40,0 - 54,0 L
150 - 450
50,0 - 70,0
20,0 - 40,0
3,0 - 12,0 H
0,5 - 5,0 L
0,0 - 1,0
80,0 - 100,0 L
27,0 - 34,0
32,0 - 36,0
11,0 - 16,0
Negatif
Negatif
Negatif
Negatif
Kesan : Saran :
Negatif
Kesan : Saran :

M.Kes., M.H Sp.PK
Negatif
Kesan : Saran :

M.Kes., M.H Sp.PK

Negatif
Kesan : Saran :

Nugraha Sp.PK
4,00 - 12,00
3,50 - 5,20
12,0 - 16,0
35,0 - 49,0
150 - 450
50,0 - 70,0
20,0 - 40,0 L
3,0 - 12,0 H
0,5 - 5,0 L
0,0 - 1,0
80,0 - 100,0 L
27,0 - 34,0
31,0 - 37,0
11,0 - 16,0
Kesan : Saran :

M.Kes., M.H Sp.PK
Negatif
Kesan : Saran :

M.Kes., M.H Sp.PK
Negatif
Kesan : Saran :

Sp.A Sp.PK
Kuning Jernih
4,8 - 7,5
1,015 - 1,025
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Kesan : Saran :
dr. Okky Firmansyah -
70 - 200
Kesan : Saran :

dr. Okky Firmansyah Sp.PK
4,00 - 10,00 H
3,50 - 5,00
11,0 - 15,0
35,0 - 47,0
150 - 450
50,0 - 70,0
20,0 - 40,0
3,0 - 12,0
0,5 - 5,0
0,0 - 1,0
80,0 - 100,0
27,0 - 34,0
32,0 - 36,0
11,0 - 16,0
70 - 200
Kesan : Saran :

M.Kes., M.H Sp.PK
Negatif
Kesan : Saran :

Adhiutami Sp.PK
4,00 - 12,00
3,50 - 5,20
12,0 - 16,0 L
35,0 - 49,0 L
150 - 450
50,0 - 70,0
20,0 - 40,0
3,0 - 12,0
0,5 - 5,0 L
0,0 - 1,0
80,0 - 100,0 L
27,0 - 34,0 L
31,0 - 37,0
11,0 - 16,0
Kesan : Saran :

Tamam. Sp.A.K Sp.PK
4,00 - 12,00
3,50 - 5,20
12,0 - 16,0
35,0 - 49,0
150 - 450
50,0 - 70,0 H
20,0 - 40,0
3,0 - 12,0
0,5 - 5,0 L
0,0 - 1,0
80,0 - 100,0 L
27,0 - 34,0 L
31,0 - 37,0
11,0 - 16,0
Negatif
Negatif
Negatif
Negatif
Kesan : Saran :

M.Kes., M.H Sp.PK
Negatif
Kesan : Saran :

Sp.A.,M.Kes Sp.PK

50 - 80
Kesan : Saran :

Tamam. Sp.A.K Sp.PK
4,00 - 10,00
4,00 - 5,50
13,0 - 18,0
40,0 - 54,0
150 - 450
50,0 - 70,0
20,0 - 40,0
3,0 - 12,0
0,5 - 5,0
0,0 - 1,0
80,0 - 100,0
27,0 - 34,0
32,0 - 36,0
11,0 - 16,0
Negatif
Negatif
Negatif
Negatif
Kesan : Saran :

Adhiutami Sp.PK
4,00 - 12,00
3,50 - 5,20 H
12,0 - 16,0
35,0 - 49,0
150 - 450
50,0 - 70,0 L
20,0 - 40,0 H
3,0 - 12,0
0,5 - 5,0 L
0,0 - 1,0
80,0 - 100,0 L
27,0 - 34,0 L
31,0 - 37,0
11,0 - 16,0
Kesan : Saran :

Adhiutami Sp.PK
Kesan : Saran :

Adhiutami Sp.PK
16,6 - 48,5
0,6 - 1,1
Kesan : Saran :

Adhiutami Sp.PK
4,00 - 10,00
3,50 - 5,00
11,0 - 15,0
35,0 - 47,0
150 - 450
50,0 - 70,0
20,0 - 40,0
3,0 - 12,0
0,5 - 5,0
0,0 - 1,0
80,0 - 100,0
27,0 - 34,0
32,0 - 36,0
11,0 - 16,0
Kesan : Saran :

M.Kes., M.H Sp.PK
4,00 - 10,00
3,50 - 5,00
11,0 - 15,0
35,0 - 47,0
150 - 450
50,0 - 70,0
20,0 - 40,0
3,0 - 12,0
0,5 - 5,0
0,0 - 1,0
80,0 - 100,0
27,0 - 34,0
32,0 - 36,0
11,0 - 16,0
Negatif
Negatif
Negatif
Negatif
Kesan : Saran :

M.Kes., M.H Sp.PK
4,00 - 10,00
4,00 - 5,50 H
13,0 - 18,0
40,0 - 54,0
150 - 450
50,0 - 70,0
20,0 - 40,0
3,0 - 12,0
0,5 - 5,0
0,0 - 1,0
80,0 - 100,0
27,0 - 34,0
32,0 - 36,0
11,0 - 16,0
Kesan : Saran :

M.Kes., M.H Sp.PK
Kuning Jernih
4,8 - 7,5
1,015 - 1,025
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Kesan : Saran :

Dzakiy Sp.PK
0 - 32
0 - 33
Negatif
Negatif
Kuning Jernih
4,8 - 7,5
1,015 - 1,025
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Kesan : Saran :

4,00 - 10,00
4,00 - 5,50
13,0 - 18,0
40,0 - 54,0
150 - 450 H
50,0 - 70,0 H
20,0 - 40,0 L
3,0 - 12,0 H
0,5 - 5,0 L
0,0 - 1,0
80,0 - 100,0
27,0 - 34,0
32,0 - 36,0
11,0 - 16,0
Kesan : Saran :
Negatif
Kesan : Saran :
dr. Mohamad Arif,

Sp.PD -
70 - 200
Kesan : Saran :

Dzakiy Sp.PK
4,00 - 10,00
3,50 - 5,00
11,0 - 15,0
35,0 - 47,0
150 - 450
50,0 - 70,0 H
20,0 - 40,0
3,0 - 12,0
0,5 - 5,0
0,0 - 1,0
80,0 - 100,0
27,0 - 34,0
32,0 - 36,0
11,0 - 16,0
Negatif
Non Reaktif
Kesan : Saran :
dr. Sri Wahyuni, Sp.PD -
70 - 200
Kesan : Saran :
dr. Sapto Wiyono, dr. Dwi Retnoningrum,

Msi.Med.Sp.OG Sp.PK
4,00 - 10,00 H
3,50 - 5,00 L
11,0 - 15,0 L
35,0 - 47,0 L
150 - 450
50,0 - 70,0 H
20,0 - 40,0 L
3,0 - 12,0
0,5 - 5,0 L
0,0 - 1,0
80,0 - 100,0
27,0 - 34,0
32,0 - 36,0
11,0 - 16,0
Kesan : Saran :
M.Kes., M.H Sp.PK
4,00 - 10,00
4,00 - 5,50
13,0 - 18,0
40,0 - 54,0
150 - 450
50,0 - 70,0 L
20,0 - 40,0
3,0 - 12,0 H
0,5 - 5,0
0,0 - 1,0
80,0 - 100,0
27,0 - 34,0
32,0 - 36,0
11,0 - 16,0
Negatif
Negatif H
Negatif
Negatif
Kesan : Saran :

M.Kes., M.H Sp.PK
4,00 - 12,00
3,50 - 5,20
12,0 - 16,0
35,0 - 49,0
150 - 450
50,0 - 70,0 H
20,0 - 40,0
3,0 - 12,0
0,5 - 5,0 L
0,0 - 1,0
80,0 - 100,0 L
27,0 - 34,0 L
31,0 - 37,0
11,0 - 16,0
Negatif
Negatif
Negatif
Negatif
Kesan : Saran :

M.Kes., M.H Sp.PK
Negatif
Kesan : Saran :

M.Kes., M.H Sp.PK
4,00 - 10,00 H
3,50 - 5,00
11,0 - 15,0 L
35,0 - 47,0 L
150 - 450
50,0 - 70,0 H
20,0 - 40,0 L
3,0 - 12,0
0,5 - 5,0
0,0 - 1,0
80,0 - 100,0 L
27,0 - 34,0 L
32,0 - 36,0 L
11,0 - 16,0 H
Negatif
Kesan : Saran :

M.Kes., M.H Sp.PK
Negatif
Kesan : Saran :
Sp.A Sp.PK
4,00 - 10,00 H
4,00 - 5,50
13,0 - 18,0 L
40,0 - 54,0 L
150 - 450
50,0 - 70,0 L
20,0 - 40,0 H
3,0 - 12,0 H
0,5 - 5,0
0,0 - 1,0
80,0 - 100,0 L
27,0 - 34,0 L
32,0 - 36,0
11,0 - 16,0
0-15
0 - 20 H
Kesan : Saran :

M.Kes., M.H Sp.PK
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Kesan : Saran :

M.Kes., M.H Sp.PK
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Kesan : Saran :
M.Kes., M.H Sp.PK
Negatif
Kesan : Saran :

Sp.PD Sp.PK
Kuning Jernih
4,8 - 7,5
1,015 - 1,025
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Kesan : Saran :

M.Kes., M.H Sp.PK
16,6 - 48,5
0,5 - 0,9
4,00 - 10,00
3,50 - 5,00
11,0 - 15,0
35,0 - 47,0
150 - 450
50,0 - 70,0 L
20,0 - 40,0 H
3,0 - 12,0
0,5 - 5,0
0,0 - 1,0
80,0 - 100,0
27,0 - 34,0
32,0 - 36,0
11,0 - 16,0
Kesan : Saran :

M.Kes., M.H Sp.PK
Kuning Jernih
4,8 - 7,5
1,015 - 1,025
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Kesan : Saran :

4,00 - 10,00 H
3,50 - 5,00
11,0 - 15,0
35,0 - 47,0
150 - 450
50,0 - 70,0 H
20,0 - 40,0 L
3,0 - 12,0
0,5 - 5,0 L
0,0 - 1,0
80,0 - 100,0
27,0 - 34,0
32,0 - 36,0
11,0 - 16,0
70 - 200
Kesan : Saran :

M.Kes., M.H Sp.PK

Negatif
Kesan : Saran :

M.Kes., M.H Sp.PK
Negatif
Kesan : Saran :

M.Kes., M.H Sp.PK
Negatif
Kesan : Saran :
M.Kes., M.H Sp.PK
Negatif
Kesan : Saran :
dr. Sapto Wiyono, dr. Dwi Retnoningrum,

Msi.Med.Sp.OG Sp.PK
1-Jun
Sep-15
4,00 - 10,00
3,50 - 5,00
11,0 - 15,0 L
35,0 - 47,0 L
150 - 450
50,0 - 70,0
20,0 - 40,0
3,0 - 12,0
0,5 - 5,0
0,0 - 1,0
80,0 - 100,0
27,0 - 34,0
32,0 - 36,0
11,0 - 16,0
70 - 200
Negatif
Non Reaktif
Kesan : Saran :

dr. Hernanda Sp.PK

4,00 - 12,00 H
3,50 - 5,20
12,0 - 16,0
35,0 - 49,0
150 - 450 H
50,0 - 70,0 H
20,0 - 40,0 L
3,0 - 12,0
0,5 - 5,0
0,0 - 1,0
80,0 - 100,0 L
27,0 - 34,0 L
31,0 - 37,0
11,0 - 16,0
Kesan : Saran :

Sp.A.,M.Kes Sp.PK
70 - 200
Kesan : Saran :
70 - 126
< 200
< 200
> = 35
< 160
3,4 – 7,2
Kesan : Saran :

dr. Hernanda Sp.PK

4,00 - 10,00
3,50 - 5,00 H
11,0 - 15,0
35,0 - 47,0
150 - 450
50,0 - 70,0 H
20,0 - 40,0 L
3,0 - 12,0
0,5 - 5,0 L
0,0 - 1,0
80,0 - 100,0
27,0 - 34,0
32,0 - 36,0
11,0 - 16,0
Kesan : Saran :

dr. Hernanda Sp.PK
4,00 - 10,00 H
4,00 - 5,50
13,0 - 18,0
40,0 - 54,0
150 - 450
50,0 - 70,0 H
20,0 - 40,0 L
3,0 - 12,0
0,5 - 5,0 L
0,0 - 1,0
80,0 - 100,0
27,0 - 34,0
32,0 - 36,0
11,0 - 16,0
70 - 200
Kesan : Saran :

Tamam. Sp.A.K Sp.PK
4,00 - 10,00
3,50 - 5,00
11,0 - 15,0
35,0 - 47,0 L
150 - 450 H
50,0 - 70,0
20,0 - 40,0
3,0 - 12,0
0,5 - 5,0
0,0 - 1,0
80,0 - 100,0 L
27,0 - 34,0 L
32,0 - 36,0
11,0 - 16,0
Negatif
Negatif
Negatif
Negatif
Kesan : Saran :
dr. Budi Palarto, dr. Dwi Retnoningrum,

Sp.OG Sp.PK
Kuning Jernih
4,8 - 7,5
1,015 - 1,025
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Kesan : Saran :

Sp.OG Sp.PK
4,00 - 10,00 H
3,50 - 5,00
11,0 - 15,0
35,0 - 47,0 L
150 - 450
50,0 - 70,0 H
20,0 - 40,0 L
3,0 - 12,0 L
0,5 - 5,0
0,0 - 1,0
80,0 - 100,0
27,0 - 34,0
32,0 - 36,0
11,0 - 16,0
Negatif
Kesan : Saran :

Negatif
Negatif
Negatif
Kesan : Saran :

M.Kes., M.H Sp.PK

Negatif
Kesan : Saran :

M.Kes., M.H Sp.PK
Negatif
Kesan : Saran :

M.Kes., M.H Sp.PK
Negatif
Kesan : Saran :

M.Kes., M.H Sp.PK
Negatif
Kesan : Saran :

M.Kes., M.H Sp.PK
Negatif
Kesan : Saran :
M.Kes., M.H Sp.PK
Negatif
Kesan : Saran :

- Sp.PK
4,00 - 10,00
4,00 - 5,50
13,0 - 18,0
40,0 - 54,0
150 - 450
50,0 - 70,0
20,0 - 40,0
3,0 - 12,0
0,5 - 5,0
0,0 - 1,0
80,0 - 100,0
27,0 - 34,0
32,0 - 36,0
11,0 - 16,0
Negatif
Negatif
Negatif
Negatif
Kesan : Saran :

M.Kes., M.H Sp.PK
Negatif
Kesan : Saran :
M.Kes., M.H Sp.PK
Negatif
Kesan : Saran :

Negatif
Kesan : Saran :

Sp.PD Sp.PK

4,00 - 10,00
4,00 - 5,50
13,0 - 18,0
40,0 - 54,0
150 - 450
50,0 - 70,0 L
20,0 - 40,0 H
3,0 - 12,0
0,5 - 5,0
0,0 - 1,0
80,0 - 100,0
27,0 - 34,0
32,0 - 36,0
11,0 - 16,0
Kesan : Saran :

M.Kes., M.H Sp.PK
Negatif
Kesan : Saran :

M.Kes., M.H Sp.PK
Negatif
Negatif
Negatif
Negatif
Kesan : Saran :

M.Kes., M.H Sp.PK
Negatif
Kesan : Saran :
4,00 - 10,00
4,00 - 5,50
13,0 - 18,0
40,0 - 54,0
150 - 450
50,0 - 70,0 H
20,0 - 40,0 L
3,0 - 12,0
0,5 - 5,0
0,0 - 1,0
80,0 - 100,0 L
27,0 - 34,0 L
32,0 - 36,0
11,0 - 16,0
70 - 200
Negatif
Negatif
Negatif
Negatif
Kesan : Saran :

Tamam. Sp.A.K Sp.PK
4,00 - 12,00
3,50 - 5,20
12,0 - 16,0
35,0 - 49,0
150 - 450
50,0 - 70,0
20,0 - 40,0
3,0 - 12,0
0,5 - 5,0 L
0,0 - 1,0
80,0 - 100,0 L
27,0 - 34,0 L
31,0 - 37,0
11,0 - 16,0
Negatif
Negatif
Negatif
Negatif
Kesan : Saran :

Sp.KJ Sp.PK
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Kesan : Saran :
M.Kes., M.H Sp.PK
Negatif
Kesan : Saran :

M.Kes., M.H Sp.PK
Negatif
Kesan : Saran :

M.Kes., M.H Sp.PK

Negatif
Kesan : Saran :
dr. M Ramzy Ghifari -
70 - 200
Kesan : Saran :

M.Kes., M.H Sp.PK
Negatif
Kesan : Saran :
Negatif
Kesan : Saran :

Negatif
Kesan : Saran :

16,6 - 48,5 L
0,5 - 0,9
70 - 200
3,5 – 5,2
Negatif
3,5 - 5,5
135 - 145
96 - 106
Kesan : Saran :

W., Sp.B Sp.PK

1-Jun
Sep-15
4,00 - 10,00
3,50 - 5,00
11,0 - 15,0
35,0 - 47,0
150 - 450
50,0 - 70,0
20,0 - 40,0
3,0 - 12,0
0,5 - 5,0
0,0 - 1,0
80,0 - 100,0 L
27,0 - 34,0
32,0 - 36,0
11,0 - 16,0
Kesan : Saran :


Negatif
Kesan : Saran :

Negatif
Kesan : Saran :

< 200
< 200
> = 35
< 160
2,4 – 5,7
Kesan : Saran :

Sp.PD Sp.PK
Kuning Jernih
4,8 - 7,5
1,015 - 1,025
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Kesan : Saran :
4,00 - 10,00 H
3,50 - 5,00
11,0 - 15,0
35,0 - 47,0
150 - 450
50,0 - 70,0
20,0 - 40,0
3,0 - 12,0
0,5 - 5,0
0,0 - 1,0
80,0 - 100,0
27,0 - 34,0
32,0 - 36,0
11,0 - 16,0
70 - 200
3,5 - 5,5
135 - 145
96 - 106
Kesan : Saran :

M.Kes., M.H Sp.PK
Negatif
Kesan : Saran :

Adhiutami Sp.PK
4,00 - 12,00
3,50 - 5,20 H
12,0 - 16,0
35,0 - 49,0
150 - 450
50,0 - 70,0 H
20,0 - 40,0 L
3,0 - 12,0
0,5 - 5,0 L
0,0 - 1,0
80,0 - 100,0 L
27,0 - 34,0 L
31,0 - 37,0
11,0 - 16,0
Negatif H
Negatif
Negatif
Negatif
Kesan : Saran :

Sp.PD Sp.PK
16,6 - 48,5
0,6 - 1,1
1-Jun
Sep-15
3,5 - 5,5
135 - 145
96 - 106
Kesan : Saran :

Sp.A Sp.PK
Kuning Jernih
4,8 - 7,5
1,015 - 1,025
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Kesan : Saran :

Sp.PD Sp.PK
Kuning Jernih H
4,8 - 7,5
1,015 - 1,025
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif H
Negatif
Kesan : Saran :

Sp.A Sp.PK
4,00 - 12,00 H
3,50 - 5,20
12,0 - 16,0 L
35,0 - 49,0 L
150 - 450
50,0 - 70,0 H
20,0 - 40,0 L
3,0 - 12,0
0,5 - 5,0 L
0,0 - 1,0
80,0 - 100,0 L
27,0 - 34,0 L
31,0 - 37,0
11,0 - 16,0 H
Kesan : Saran :

4,00 - 10,00 H
4,00 - 5,50
13,0 - 18,0
40,0 - 54,0 L
150 - 450
50,0 - 70,0 H
20,0 - 40,0 L
3,0 - 12,0
0,5 - 5,0 L
0,0 - 1,0
80,0 - 100,0
27,0 - 34,0
32,0 - 36,0
11,0 - 16,0
70 - 200
Kesan : Saran :

Sp.A Sp.PK
4,00 - 20,00
3,50 - 7, 00
17,0 - 20,0 L
38,0 - 68,0 L
150 - 450
40,0 - 80,0
10,0 - 60,0
3,0 - 13,0 H
0,5 - 5,0
0,1 - 1,0
95,0 - 125,0
30,0 - 40,0
30,0 - 34,0 H
11,0 - 16,0
50 - 80 H
Kesan : Saran :

4,00 - 12,00
3,50 - 5,20
12,0 - 16,0
35,0 - 49,0
150 - 450
50,0 - 70,0 L
20,0 - 40,0
3,0 - 12,0
0,5 - 5,0
0,0 - 1,0
80,0 - 100,0 L
27,0 - 34,0
31,0 - 37,0
11,0 - 16,0
Kesan : Saran :
dr. Y Andressa -
70 - 200
Kesan : Saran :

4,00 - 12,00
3,50 - 5,20 H
12,0 - 16,0
35,0 - 49,0
150 - 450
50,0 - 70,0
20,0 - 40,0
3,0 - 12,0
0,5 - 5,0
0,0 - 1,0
80,0 - 100,0 L
27,0 - 34,0 L
31,0 - 37,0
11,0 - 16,0
Negatif
Negatif
Negatif
Negatif
Kesan : Saran :
Dr. Akbar Kurniawan, dr. Dria Anggraeny Sutikno,

M.Kes., M.H Sp.RAD

Negatif
Kesan : Saran :

M.Kes., M.H Sp.PK
Kesan : Saran :

M.Kes., M.H Sp.PK
Kesan : Saran :

dr. Hernanda Sp.PK

Kuning Jernih
4,8 - 7,5
1,015 - 1,025
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Kesan : Saran :

M.Kes., M.H Sp.PK
Negatif
Kesan : Saran :

0 - 40
0 - 41
Negatif
Non Reaktif
Negatif
Negatif
Negatif
Kesan : Saran :


0 - 32
0 - 33
Negatif
Non Reaktif
Negatif
Negatif
Negatif
Kesan : Saran :

0 - 40
0 - 41
Negatif
Non Reaktif
Negatif
Negatif
Negatif
Kesan : Saran :

Kuning Jernih
4,8 - 7,5
1,015 - 1,025
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Kesan : Saran :

4,00 - 10,00
4,00 - 5,50
13,0 - 18,0
40,0 - 54,0
150 - 450
50,0 - 70,0 L
20,0 - 40,0 H
3,0 - 12,0
0,5 - 5,0
0,0 - 1,0
80,0 - 100,0
27,0 - 34,0
32,0 - 36,0
11,0 - 16,0
Kesan : Saran :

4,00 - 10,00
4,00 - 5,50
13,0 - 18,0
40,0 - 54,0
150 - 450
50,0 - 70,0
20,0 - 40,0
3,0 - 12,0
0,5 - 5,0
0,0 - 1,0
80,0 - 100,0
27,0 - 34,0
32,0 - 36,0
11,0 - 16,0
Kesan : Saran :


4,00 - 10,00
3,50 - 5,00
11,0 - 15,0
35,0 - 47,0
150 - 450
50,0 - 70,0
20,0 - 40,0
3,0 - 12,0
0,5 - 5,0 H
0,0 - 1,0
80,0 - 100,0
27,0 - 34,0
32,0 - 36,0
11,0 - 16,0
Kesan : Saran :

Kuning Jernih
4,8 - 7,5
1,015 - 1,025
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Kesan : Saran :

Kuning Jernih
4,8 - 7,5
1,015 - 1,025
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Kesan : Saran :
M.Kes., M.H Sp.PK
Negatif
Kesan : Saran :

Negatif
Negatif
Negatif
Kesan : Saran :
- Sp.PK
4,00 - 10,00 H
3,50 - 5,00
11,0 - 15,0
35,0 - 47,0
150 - 450
50,0 - 70,0 H
20,0 - 40,0 L
3,0 - 12,0
0,5 - 5,0
0,0 - 1,0
80,0 - 100,0
27,0 - 34,0
32,0 - 36,0
11,0 - 16,0
Negatif
Negatif
Negatif
Negatif
Kesan : Saran :

16,6 - 48,5 H
0,5 - 0,9 H
4,00 - 10,00 H
3,50 - 5,00
11,0 - 15,0
35,0 - 47,0
150 - 450
50,0 - 70,0 H
20,0 - 40,0 L
3,0 - 12,0
0,5 - 5,0 L
0,0 - 1,0
80,0 - 100,0
27,0 - 34,0
32,0 - 36,0
11,0 - 16,0
70 - 200 H
Kesan : Saran :

4,00 - 12,00 L
3,50 - 5,20
12,0 - 16,0
35,0 - 49,0
150 - 450
50,0 - 70,0
20,0 - 40,0
3,0 - 12,0
0,5 - 5,0 L
0,0 - 1,0
80,0 - 100,0 L
27,0 - 34,0
31,0 - 37,0
11,0 - 16,0
Negatif
Negatif
Negatif
Negatif
Kesan : Saran :

M.Kes., M.H Sp.PK
Negatif
Kesan : Saran :

M.Kes., M.H Sp.PK

Negatif
Kesan : Saran :

Negatif
Negatif
Negatif H
Kesan : Saran :

0 - 32
0 - 33
4,00 - 10,00
3,50 - 5,00
11,0 - 15,0
35,0 - 47,0
150 - 450
50,0 - 70,0
20,0 - 40,0
3,0 - 12,0
0,5 - 5,0
0,0 - 1,0
80,0 - 100,0
27,0 - 34,0
32,0 - 36,0
11,0 - 16,0
Negatif
Non Reaktif
Kesan : Saran :


Kuning Jernih H
4,8 - 7,5
1,015 - 1,025 H
Negatif H
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif H
Negatif H
Kesan : Saran :

Sp.PD Sp.PK
3,4 – 7,2 H
0.6 - 1.1
Kesan : Saran :

M.Kes., M.H Sp.PK
Negatif
Kesan : Saran :

4,00 - 12,00
3,50 - 5,20
12,0 - 16,0
35,0 - 49,0
150 - 450
50,0 - 70,0 H
20,0 - 40,0
3,0 - 12,0
0,5 - 5,0
0,0 - 1,0
80,0 - 100,0 L
27,0 - 34,0 L
31,0 - 37,0
11,0 - 16,0
Kesan : Saran :

- Sp.PK
4,00 - 10,00 H
3,50 - 5,00
11,0 - 15,0
35,0 - 47,0
150 - 450
50,0 - 70,0 H
20,0 - 40,0 L
3,0 - 12,0 L
0,5 - 5,0 L
0,0 - 1,0
80,0 - 100,0
27,0 - 34,0
32,0 - 36,0
11,0 - 16,0
Negatif
Kesan : Saran :

Negatif
Kesan : Saran :

- Sp.PK
70 - 126
70 - 180
Kesan : Saran :

dr. Hernanda Sp.PK
Kuning Jernih
4,8 - 7,5
1,015 - 1,025 H
Negatif H
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif H
Negatif H
Negatif H
Kesan : Saran :

Sp.PD Sp.PK

0.5 - 0.9 H
Kesan : Saran :

Sp.PD Sp.PK
4,00 - 10,00 H
3,50 - 5,00
11,0 - 15,0 L
35,0 - 47,0 L
150 - 450
50,0 - 70,0 H
20,0 - 40,0 L
3,0 - 12,0
0,5 - 5,0
0,0 - 1,0
80,0 - 100,0 L
27,0 - 34,0 L
32,0 - 36,0
11,0 - 16,0
70 - 200
Kesan : Saran :

M.Kes., M.H Sp.PK
Negatif
Kesan : Saran :

M.Kes., M.H Sp.PK
Negatif
Kesan : Saran :
M.Kes., M.H Sp.PK
Negatif
Kesan : Saran :

Sp.PD Sp.PK
70 - 200
Kesan : Saran :


4,00 - 10,00
3,50 - 5,00
11,0 - 15,0
35,0 - 47,0
150 - 450
50,0 - 70,0
20,0 - 40,0
3,0 - 12,0
0,5 - 5,0 L
0,0 - 1,0
80,0 - 100,0
27,0 - 34,0
32,0 - 36,0
11,0 - 16,0
Negatif
Negatif
Negatif
Negatif
Kesan : Saran :

dr. Hernanda Sp.PK
70 - 200
Kesan : Saran :

M.Kes., M.H Sp.PK
4,00 - 12,00 H
3,50 - 5,20
12,0 - 16,0 L
35,0 - 49,0 L
150 - 450
50,0 - 70,0
20,0 - 40,0
3,0 - 12,0
0,5 - 5,0
0,0 - 1,0
80,0 - 100,0 L
27,0 - 34,0 L
31,0 - 37,0
11,0 - 16,0
Kesan : Saran :
dr. Mohamad Arif,

Sp.PD dr. Dwi Wastoro, Sp.A
Kuning Jernih H
4,8 - 7,5
1,015 - 1,025 H
Negatif H
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif H
Negatif H
Kesan : Saran :
4,00 - 12,00 H
3,50 - 5,20
12,0 - 16,0
35,0 - 49,0
150 - 450
50,0 - 70,0 H
20,0 - 40,0
3,0 - 12,0
0,5 - 5,0 L
0,0 - 1,0
80,0 - 100,0 L
27,0 - 34,0 L
31,0 - 37,0
11,0 - 16,0
Negatif
Negatif
Negatif
Negatif
Kesan : Saran :

Sp.PD Sp.PK
70 - 200
Kesan : Saran :

- Sp.PK
4,00 - 10,00 H
3,50 - 5,00
11,0 - 15,0
35,0 - 47,0
150 - 450
50,0 - 70,0 H
20,0 - 40,0 L
3,0 - 12,0
0,5 - 5,0
0,0 - 1,0
80,0 - 100,0 L
27,0 - 34,0 L
32,0 - 36,0
11,0 - 16,0
Negatif H
Kesan : Saran :

4,00 - 10,00
4,00 - 5,50
13,0 - 18,0 L
40,0 - 54,0 L
150 - 450
50,0 - 70,0
20,0 - 40,0
3,0 - 12,0
0,5 - 5,0
0,0 - 1,0
80,0 - 100,0 L
27,0 - 34,0 L
32,0 - 36,0
11,0 - 16,0
70 - 200
Negatif
Negatif
Negatif
Negatif
Kesan : Saran :

Sp.A Sp.PK
Kuning Jernih
4,8 - 7,5
1,015 - 1,025
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Kesan : Saran :
dr. Erna Purwati S. -
70 - 200
Kesan : Saran :
dr. Y Andressa -
70 - 200
Kesan : Saran :

- Sp.PK
Negatif
Kesan : Saran :

- Sp.PK
Negatif
Kesan : Saran :

M.Kes., M.H Sp.PK
Negatif
Kesan : Saran :

Sp.PD Sp.PK
70 - 200 H
Kesan : Saran :

M.Kes., M.H Sp.PK

Negatif
Kesan : Saran :

dr. Hernanda Sp.PK
4,00 - 10,00
4,00 - 5,50
13,0 - 18,0 L
40,0 - 54,0 L
150 - 450
50,0 - 70,0
20,0 - 40,0
3,0 - 12,0
0,5 - 5,0 L
0,0 - 1,0
80,0 - 100,0 L
27,0 - 34,0 L
32,0 - 36,0
11,0 - 16,0
Negatif
Negatif
Negatif
Negatif
Kesan : Saran :

Sp.PD Sp.PK
16,6 - 48,5 H
0,5 - 0,9 H
70 - 200 H
< 5,7 H
Kesan : Saran :


Negatif
Kesan : Saran :

4,00 - 10,00
4,00 - 5,50
13,0 - 18,0
40,0 - 54,0 L
150 - 450
50,0 - 70,0
20,0 - 40,0 L
3,0 - 12,0 H
0,5 - 5,0
0,0 - 1,0
80,0 - 100,0 L
27,0 - 34,0 L
32,0 - 36,0
11,0 - 16,0
3,5 - 5,5 L
135 - 145
96 - 106
Kesan : Saran :
dr. Okky Firmansyah -
70 - 200
Kesan : Saran :

M.Kes., M.H Sp.PK
Negatif
Kesan : Saran :

Kuning Jernih H
4,8 - 7,5
1,015 - 1,025
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif H
Kesan : Saran :

M.Kes., M.H Sp.PK
Negatif
Kesan : Saran :
M.Kes., M.H Sp.PK
Negatif
Kesan : Saran :

M.Kes., M.H Sp.PK
Negatif
Kesan : Saran :

M.Kes., M.H Sp.PK

Negatif
Kesan : Saran :

M.Kes., M.H Sp.PK
Negatif
Kesan : Saran :


Negatif
Kesan : Saran :

M.Kes., M.H Sp.PK
Negatif
Kesan : Saran :

1-Jun
Sep-15
3,5 - 5,5
135 - 145
96 - 106
Kesan : Saran :

4,00 - 12,00
3,50 - 5,20
12,0 - 16,0
35,0 - 49,0
150 - 450
50,0 - 70,0 L
20,0 - 40,0 H
3,0 - 12,0
0,5 - 5,0
0,0 - 1,0
80,0 - 100,0 L
27,0 - 34,0 L
31,0 - 37,0
11,0 - 16,0
70 - 200
Kesan : Saran :

4,00 - 10,00 H
3,50 - 5,00 H
11,0 - 15,0
35,0 - 47,0
150 - 450 H
50,0 - 70,0 H
20,0 - 40,0 L
3,0 - 12,0
0,5 - 5,0 L
0,0 - 1,0
80,0 - 100,0 L
27,0 - 34,0 L
32,0 - 36,0
11,0 - 16,0
70 - 200 H
Kesan : Saran :

M.Kes., M.H Sp.PK
Negatif
Kesan : Saran :

4,00 - 10,00 H
3,50 - 5,00 H
11,0 - 15,0
35,0 - 47,0
150 - 450
50,0 - 70,0 H
20,0 - 40,0 L
3,0 - 12,0
0,5 - 5,0 L
0,0 - 1,0
80,0 - 100,0
27,0 - 34,0
32,0 - 36,0
11,0 - 16,0
Negatif
Negatif
Negatif
Negatif
Kesan : Saran :

M.Kes., M.H Sp.PK

Negatif
Kesan : Saran :

M.Kes., M.H Sp.PK
Negatif
Kesan : Saran :

M.Kes., M.H Sp.PK
Negatif
Kesan : Saran :
M.Kes., M.H Sp.PK
Negatif
Kesan : Saran :

4,00 - 10,00
3,50 - 5,00
11,0 - 15,0
35,0 - 47,0
150 - 450
50,0 - 70,0 H
20,0 - 40,0 L
3,0 - 12,0
0,5 - 5,0
0,0 - 1,0
80,0 - 100,0 L
27,0 - 34,0 L
32,0 - 36,0
11,0 - 16,0
Negatif H
Negatif H
Negatif
Negatif
Kesan : Saran :
70 - 200
Kesan : Saran :


Negatif
Kesan : Saran :

M.Kes., M.H Sp.PK
Negatif
Kesan : Saran :

70 - 126 H
< 200 H
< 200
> = 35
< 160
2,4 – 5,7
Kesan : Saran :

Utama, Sp.B Sp.PK
1-Jun
Sep-15
4,00 - 10,00
3,50 - 5,00 H
11,0 - 15,0
35,0 - 47,0
150 - 450 H
50,0 - 70,0 L
20,0 - 40,0 H
3,0 - 12,0
0,5 - 5,0
0,0 - 1,0
80,0 - 100,0
27,0 - 34,0
32,0 - 36,0
11,0 - 16,0
70 - 200
Negatif
Kesan : Saran :

M.Kes., M.H Sp.PK
4,00 - 10,00 H
3,50 - 5,00
11,0 - 15,0
35,0 - 47,0
150 - 450
50,0 - 70,0 H
20,0 - 40,0
3,0 - 12,0
0,5 - 5,0
0,0 - 1,0
80,0 - 100,0
27,0 - 34,0
32,0 - 36,0
11,0 - 16,0
Kesan : Saran :

Negatif
Kesan : Saran :

-- Sp.PK
4,00 - 10,00 H
3,50 - 5,00
11,0 - 15,0 L
35,0 - 47,0 L
150 - 450
50,0 - 70,0 H
20,0 - 40,0
3,0 - 12,0
0,5 - 5,0
0,0 - 1,0
80,0 - 100,0
27,0 - 34,0
32,0 - 36,0
11,0 - 16,0
Negatif
Kesan : Saran :

dr. Hernanda Sp.PK

Negatif
Kesan : Saran :

dr. Hernanda Sp.PK
16,6 - 48,5
0,6 - 1,1 H
4,00 - 10,00
4,00 - 5,50
13,0 - 18,0
40,0 - 54,0
150 - 450
50,0 - 70,0
20,0 - 40,0
3,0 - 12,0
0,5 - 5,0
0,0 - 1,0
80,0 - 100,0
27,0 - 34,0
32,0 - 36,0
11,0 - 16,0
70 - 200 H
Kesan : Saran :
dr. Dwi
Retnoningrum, Sp.PK -
Negatif
Kesan : Saran :


Negatif
Kesan : Saran :

Negatif
Kesan : Saran :

dr. Hernanda Sp.PK
Kuning Jernih
4,8 - 7,5
1,015 - 1,025
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Kesan : Saran :

dr. Hernanda Sp.PK
4,00 - 10,00
3,50 - 5,00
11,0 - 15,0
35,0 - 47,0
150 - 450
50,0 - 70,0
20,0 - 40,0
3,0 - 12,0
0,5 - 5,0
0,0 - 1,0
80,0 - 100,0
27,0 - 34,0
32,0 - 36,0
11,0 - 16,0
Kesan : Saran :
Negatif
Kesan : Saran :

Negatif
Kesan : Saran :


Negatif
Kesan : Saran :

Negatif
Kesan : Saran :

M.Kes., M.H Sp.PK
Negatif
Kesan : Saran :

4,00 - 12,00
3,50 - 5,20
12,0 - 16,0
35,0 - 49,0
150 - 450
50,0 - 70,0 H
20,0 - 40,0 L
3,0 - 12,0
0,5 - 5,0 L
0,0 - 1,0
80,0 - 100,0
27,0 - 34,0
31,0 - 37,0
11,0 - 16,0
70 - 200
Negatif
Negatif
Negatif
Negatif
Kesan : Saran :

M.Kes., M.H Sp.PK
2,4 – 5,7 H
Kesan : Saran :

dr. Hernanda Sp.PK
4,00 - 10,00
3,50 - 5,00
11,0 - 15,0
35,0 - 47,0
150 - 450
50,0 - 70,0 L
20,0 - 40,0 H
3,0 - 12,0
0,5 - 5,0
0,0 - 1,0
80,0 - 100,0
27,0 - 34,0
32,0 - 36,0
11,0 - 16,0
Kesan : Saran :

4,00 - 12,00
3,50 - 5,20
12,0 - 16,0 L
35,0 - 49,0 L
150 - 450 H
50,0 - 70,0
20,0 - 40,0
3,0 - 12,0
0,5 - 5,0
0,0 - 1,0
80,0 - 100,0 L
27,0 - 34,0 L
31,0 - 37,0
11,0 - 16,0
Kesan : Saran :

Sp.OG Sp.PK
16,6 - 48,5 L
0,5 - 0,9 L
0 - 32
0 - 33
Kesan : Saran :

M.Kes., M.H Sp.PK

4,00 - 10,00
4,00 - 5,50
13,0 - 18,0
40,0 - 54,0
150 - 450
50,0 - 70,0
20,0 - 40,0
3,0 - 12,0
0,5 - 5,0
0,0 - 1,0
80,0 - 100,0
27,0 - 34,0
32,0 - 36,0
11,0 - 16,0
0-15
0 - 20
Negatif
Non Reaktif
Kesan : Saran :
M.Kes., M.H Sp.PK
70 - 126
< 200
< 200
> = 35 H
< 160
3,4 - 7,2
16,6 - 48,5
0,6 - 1,1
0 - 40
0 - 41
Kesan : Saran :

M.Kes., M.H Sp.PK
Kuning Jernih H
4,8 - 7,5
1,015 - 1,025
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif H
Kesan : Saran :

3,4 – 7,2 H
Kesan : Saran :
dr. Redyaksa
Drestanta Ariandoko -
70 - 200
Kesan : Saran :

dr. Hernanda Sp.PK
4,00 - 10,00
4,00 - 5,50 H
13,0 - 18,0
40,0 - 54,0
150 - 450
50,0 - 70,0
20,0 - 40,0
3,0 - 12,0
0,5 - 5,0
0,0 - 1,0
80,0 - 100,0 L
27,0 - 34,0 L
32,0 - 36,0
11,0 - 16,0
Negatif
Negatif
Negatif
Negatif
Kesan : Saran :

Purwiandari, Sp.OG Sp.PK
Kesan : Saran :

Adhiutami Sp.PK

4,00 - 10,00
3,50 - 5,00 H
11,0 - 15,0
35,0 - 47,0
150 - 450
50,0 - 70,0
20,0 - 40,0 H
3,0 - 12,0
0,5 - 5,0 L
0,0 - 1,0
80,0 - 100,0 L
27,0 - 34,0 L
32,0 - 36,0
11,0 - 16,0
Negatif
Negatif
Negatif
Negatif
Kesan : Saran :

M.Kes., M.H Sp.PK

Negatif
Kesan : Saran :

M.Kes., M.H Sp.PK
4,00 - 10,00
4,00 - 5,50
13,0 - 18,0
40,0 - 54,0
150 - 450
50,0 - 70,0 L
20,0 - 40,0
3,0 - 12,0
0,5 - 5,0
0,0 - 1,0
80,0 - 100,0 L
27,0 - 34,0 L
32,0 - 36,0
11,0 - 16,0
Negatif
Negatif
Negatif
Negatif
Kesan : Saran :

2,4 - 5,7
16,6 - 48,5
0,5 - 0,9
Kesan : Saran :

4,00 - 12,00
3,50 - 5,20
12,0 - 16,0 L
35,0 - 49,0 L
150 - 450
50,0 - 70,0 H
20,0 - 40,0 L
3,0 - 12,0
0,5 - 5,0 L
0,0 - 1,0
80,0 - 100,0 L
27,0 - 34,0 L
31,0 - 37,0
11,0 - 16,0
Kesan : Saran :

4,00 - 12,00
3,50 - 5,20
12,0 - 16,0 L
35,0 - 49,0 L
150 - 450
50,0 - 70,0 L
20,0 - 40,0 L
3,0 - 12,0
0,5 - 5,0 L
0,0 - 1,0
80,0 - 100,0
27,0 - 34,0
31,0 - 37,0
11,0 - 16,0
Negatif
Negatif
Negatif
Negatif
Kesan : Saran :

Sp.A Sp.PK
< 1,2 H
< 1,0 H
< 1,0 H
Kesan : Saran :

Sp.PD Sp.PK
< 5,7 H
Kesan : Saran :
dr. Juene Roseneri,

Sp.M. -
70 - 200
Kesan : Saran :
dr. Mohamad Arif,

Sp.PD -

70 - 200
Kesan : Saran :

M.Kes., M.H Sp.PK
2,4 – 5,7
Kesan : Saran :

dr. Hernanda Sp.PK
70 - 126
2,4 – 5,7 H
0 – 200
Kesan : Saran :

M.Kes., M.H Sp.PK
4,00 - 10,00
3,50 - 5,00
11,0 - 15,0
35,0 - 47,0
150 - 450
50,0 - 70,0
20,0 - 40,0
3,0 - 12,0
0,5 - 5,0
0,0 - 1,0
80,0 - 100,0
27,0 - 34,0
32,0 - 36,0
11,0 - 16,0
Kesan : Saran :

Tamam. Sp.A.K Sp.PK
4,00 - 12,00
3,50 - 5,20
12,0 - 16,0
35,0 - 49,0
150 - 450
50,0 - 70,0
20,0 - 40,0
3,0 - 12,0
0,5 - 5,0 L
0,0 - 1,0
80,0 - 100,0 L
27,0 - 34,0 L
31,0 - 37,0
11,0 - 16,0
Negatif H
Negatif
Negatif
Negatif
Kesan : Saran :
70 - 126
3,4 – 7,2
Kesan : Saran :

4,00 - 10,00 H
3,50 - 5,00 H
11,0 - 15,0 H
35,0 - 47,0
150 - 450
50,0 - 70,0 H
20,0 - 40,0 L
3,0 - 12,0
0,5 - 5,0 L
0,0 - 1,0
80,0 - 100,0
27,0 - 34,0
32,0 - 36,0
11,0 - 16,0
Negatif
Negatif
Negatif
Negatif
Kesan : Saran :

4,00 - 10,00 H
4,00 - 5,50
13,0 - 18,0
40,0 - 54,0
150 - 450
50,0 - 70,0 H
20,0 - 40,0 L
3,0 - 12,0
0,5 - 5,0
0,0 - 1,0
80,0 - 100,0 L
27,0 - 34,0 L
32,0 - 36,0
11,0 - 16,0
Negatif
Negatif
Negatif
Negatif
Kesan : Saran :
70 - 200
Kesan : Saran :
- Sp.PK
4,00 - 10,00
3,50 - 5,00
11,0 - 15,0
35,0 - 47,0 L
150 - 450
50,0 - 70,0 L
20,0 - 40,0
3,0 - 12,0
0,5 - 5,0
0,0 - 1,0
80,0 - 100,0 L
27,0 - 34,0 L
32,0 - 36,0
11,0 - 16,0
Kesan : Saran :


4,00 - 10,00
3,50 - 5,00
11,0 - 15,0
35,0 - 47,0
150 - 450
50,0 - 70,0
20,0 - 40,0
3,0 - 12,0
0,5 - 5,0
0,0 - 1,0
80,0 - 100,0
27,0 - 34,0
32,0 - 36,0
11,0 - 16,0
Negatif H
Negatif
Negatif
Negatif
Kesan : Saran :

70 - 200
Kesan : Saran :

Kuning Jernih
4,8 - 7,5
1,015 - 1,025
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Negatif
Kesan : Saran :

70 - 200 H
Kesan : Saran :

4,00 - 10,00 H
4,00 - 5,50
13,0 - 18,0
40,0 - 54,0
150 - 450
50,0 - 70,0
20,0 - 40,0
3,0 - 12,0
0,5 - 5,0
0,0 - 1,0
80,0 - 100,0
27,0 - 34,0
32,0 - 36,0
11,0 - 16,0
70 - 200
Kesan : Saran :
DATA PASIEN UMUM BULAN JULI 2023 BERDASARKAN SIM
168789 SALBIYAH
2023/07/31/00 (Poli : Penyakit Amalia Ayu
0085 Dalam) Firmasari 7/31/2023 14:12:35
202232 AZIZ
RACHMAN
2023/07/28/00 PRIYADI (Poli :
0135 Penyakit Dalam) Ayu Aryani 7/28/2023 18:17:59
205148 BY NY Yuni Nurul

2023/07/27/00 NURI AFITASARI Azizah, A.
0274 (Poli : Poli Anak) Md. 7/27/2023 17:39:44
177537 ZELIKHA
PUSPITA
WIJAYANTI (Poli : Yuni Nurul
0135 Jiwa) Md. 7/24/2023 16:02:59
203138 SUNTARI
2023/07/24/00 (Poli : Penyakit Mudrik
0084 Dalam) Wulandari 7/24/2023 14:13:08
205040 AQIDATUL
MUNFARIQOH
2023/07/20/00 (Poli : Poli Ela Yulianti,
0098 Kesehatan Jiwa) A.Md.Kes. 7/20/2023 14:02:11
205039 TAZKIYATI
NUFUS AZ ZAHRO
2023/07/20/00 (Poli : Poli Ela Yulianti,
0095 Kesehatan Jiwa) A.Md.Kes. 7/20/2023 13:44:33
181082 MOFET
0085 Dalam) Firmasari 7/17/2023 15:16:37
204999 RIDWAN
HERSANTO (Poli : Yuni Nurul
0104 Jiwa) Md. 7/17/2023 14:31:22
170679 FAHREZA
ABIMANYU
2023/07/17/00 ALFAREZI (Poli : Ela Yulianti,
0095 Poli Anak) A.Md.Kes. 7/17/2023 13:53:33
204977 BY NY
ALVINA
NUGRAHENI Yuni Nurul
2023/07/15/00 AZZAHRA (Poli : Azizah, A.
0094 Poli Anak) Md. 7/15/2023 20:39:30
198160 AHMAD Ragil

2023/07/15/00 SYAMIL ASSABIQ Pangestu W.,
204971 RACHEL Ragil

2023/07/15/00 AYUDIA PUTRI Pangestu W.,
0059 (Poli : poli Vaksin) A.Md. 7/15/2023 9:28:44
204952 BY NY Mega Tri

2023/07/14/00 LISTIANA (Poli : Wulandari,
0047 Poli Anak) A.Md. 7/14/2023 7:45:28
204951 BY NY
2023/07/14/00 SINTA ROYATI (Poli Ela Yulianti,
0015 : Poli Anak) A.Md.Kes. 7/14/2023 6:35:53
204924 FADHILA Abbas

2023/07/13/00 RAZIANI (Poli : Poli Herlan,
0132 Kesehatan Jiwa) A.Md.Kes 7/13/2023 15:46:30
204933 RIGAL
BUDIONO (Poli : Annies
2023/07/13/00 Poli Kulit dan Fadhilah,
0058 Kelamin) A.Md. 7/13/2023 9:11:59
204923 RAUSYAN Mega Tri

2023/07/12/00 FIKRI (Poli : Poli Wulandari,
0051 Kulit dan Kelamin) A.Md. 7/12/2023 9:20:26
053386
2023/07/11/00 SUDIRMAN (Poli :
0147 Penyakit Dalam) Ayu Aryani 7/11/2023 17:03:37
053386
2023/07/11/00 SUDIRMAN (Poli :
0147 Penyakit Dalam) Ns. Feby 7/11/2023 16:56:09
204904 FAZ Ragil

2023/07/11/00 ALANO ALFARIZKI Pangestu W.,
204794 TUGIRAH Mega Tri

2023/07/03/00 (Poli : Penyakit Wulandari,
0025 Dalam) A.Md. 7/3/2023 7:57:52
23 BERDASARKAN SIM
dr. Mohamad Arif,

Sp.PD -

Sp.A Sp.PK

Sp.KJ Sp.PK

Sp.KJ Sp.PK

Sp.KJ Sp.PK

Sp.KJ Sp.PK

Sp.A Sp.PK
Sp.A Sp.PK

Sp.A Sp.PK

Dzakiy Sp.PK

Sp.A Sp.PK

Sp.A Sp.PK

Sp.KJ Sp.PK


dr. Mohamad Arif,

Sp.PD -
dr. Mohamad Arif,

Sp.PD -

Sp.A Sp.PK

Sp.PD Sp.PK
DATA PASIEN UMUM BULAN AGUSTUS 2023 BERDASARKAN SIM
205784 ADE
NIKMAH LATIFIANI Annies
2023/08/31/00 (Poli : Poli Fadhilah,
205790 HANA JULI

WIDIASTUTIK Ragil
2023/08/31/00 (Poli : Poli Pangestu W.,
205785 ADHI Ragil

2023/08/31/00 KURNIAWAN Pangestu W.,
0062 (Poli : Poli Umum) A.Md. 8/31/2023 11:14:24
205789 AHMAD Ragil

2023/08/31/00 SARIFUDIN (Poli : Pangestu W.,
0063 Poli Umum) A.Md. 8/31/2023 11:12:22
205721 SOFYAN
SOLEH NUR Yuni Nurul
2023/08/28/00 HIDAYATULLOH Azizah, A.
0095 (Poli : Poli Umum) Md. 8/28/2023 10:24:11
205718
KHOIRIYATUN Yuni Nurul
2023/08/28/00 WIDYASTUTI (Poli : Azizah, A.
0064 Poli Umum) Md. 8/28/2023 8:31:43
205711 BY NY
YULIA DIAN Ragil
2023/08/27/00 ANGGRAINI (Poli : Pangestu W.,
0036 Poli Anak) A.Md. 8/28/2023 7:14:56
203138 SUNTARI
2023/08/24/00 (Poli : Penyakit Devi Triana,
0201 Dalam) A.Md.Keb 8/24/2023 14:32:21
203758 SRI
NARDININGSIH
0154 Dalam) Firmasari 8/24/2023 6:56:25
021867 SUNARSIH
2023/08/24/00 (Poli : Penyakit Mudrik
0148 Dalam) Wulandari 8/24/2023 6:28:34
205642
MUHAMMAD
NAUFAL Mega Tri
2023/08/23/00 ABDURRAHMAN Wulandari,
205643
MUHAMMAD
FARHAN Mega Tri
2023/08/23/00 ABDURRAHMAN Wulandari,
121501 KENZO Ragil

2023/08/19/00 ALVARO (Poli : Poli Pangestu W.,
0050 Anak) A.Md. 8/19/2023 10:46:51
205466 GRACE
MATZELINA M.I. Annies
2023/08/14/00 WENGGI (Poli : Poli Fadhilah,
0078 Umum) A.Md. 8/14/2023 9:18:41
123576 PUJI Annies

2023/08/11/00 ASTUTI (Poli : Fadhilah,
0073 Penyakit Dalam) A.Md. 8/11/2023 17:36:09
205423 KUKUH Ragil

2023/08/11/00 JAMALUDIN (Poli : Pangestu W.,
0054 Poli Umum) A.Md. 8/11/2023 10:25:42
150116 SOENARTI
2023/08/09/00 MTH (Poli : Amalia Ayu
0133 Penyakit Dalam) Firmasari 8/9/2023 15:11:35
168525 SUPENO Karla Kurnia

2023/08/08/00 (Poli : Penyakit Oktaviani,
0037 Dalam) A.Md.Keb 8/8/2023 7:24:20
205340 HJ
AMINAH,SAG
2023/08/07/00 (Poli : Penyakit
0053 Dalam) Ayu Aryani 8/7/2023 8:52:18
205298 SRI KATON

2023/08/04/00 MUDIRINI (Poli :
0049 Penyakit Dalam) Sarah 8/4/2023 17:23:32
205297 HJ.
ENDANG
MUKTININGRUM
2023/08/04/00 (Poli : Penyakit
0046 Dalam) Sarah 8/4/2023 17:23:05
205280 BY NY EKA Yuni Nurul

2023/08/03/00 PUJI ASTUTI (Poli : Azizah, A.
0045 Poli Anak) Md. 8/3/2023 8:54:29
205276 BY NY
LATIFA ZAHRA Yuni Nurul
2023/08/03/00 ANIDYA WAHYUDI Azizah, A.
0022 (Poli : Poli Anak) Md. 8/3/2023 8:39:53
134879 ADITYA Annies

2023/08/02/00 FAJRI RAHMADANI Fadhilah,
2023 BERDASARKAN SIM

Sp.KJ Sp.PK

Sp.KJ Sp.PK





Sp.A Sp.PK
dr. Mohamad Arif,

Sp.PD -
dr. Mohamad Arif,
Sp.PD -

Dzakiy Sp.PK

Dzakiy Sp.PK

Sp.A Sp.PK


Sp.PD Sp.PK

dr. Mohamad Arif,

Sp.PD -
dr. Mohamad Arif,

Sp.PD -


Sp.A Sp.PK

Sp.A Sp.PK

Sp.A Sp.PK
DATA PASIEN UMUM BULAN SEPTEMBER 2023 BERDASARKAN SIM
206207 SITI
MAEMUNAH
(Kamar : Annies
2023/09/22/00 BOUGENVBED4, Fadhilah,
0154 BOUGENVILLE) A.Md. 9/23/2023 9:32:59
206207 SITI
MAEMUNAH
(Kamar :
206207 SITI
MAEMUNAH
(Kamar : Abbas
206185 AHMAD
NAFIS MAHFUDZ
(Kamar : Mega Tri
0103 ANGGREK) A.Md. 9/22/2023 9:29:12
206185 AHMAD
NAFIS MAHFUDZ
(Kamar :
0103 ANGGREK) A.Md.Kes. 9/21/2023 14:22:58
206116
MURSANAH
2023/09/17/00 (Kamar : Ela Yulianti,
0021 HCUBED4, HCU) A.Md.Kes. 9/21/2023 13:06:53
206116
MURSANAH Mega Tri
2023/09/17/00 (Kamar : Wulandari,
0021 HCUBED4, HCU) A.Md. 9/19/2023 8:26:30
206116
MURSANAH Annies
2023/09/17/00 (Kamar : Fadhilah,
0021 HCUBED4, HCU) A.Md. 9/18/2023 0:05:13
198364 YUDHIKA
GIBRAN AHMAD
RAMADHAN
(Kamar : Abbas
0018 ANGGREK) A.Md.Kes 9/17/2023 20:15:40
206116
MURSANAH Abbas
2023/09/17/00 (Kamar : Herlan,
198364 YUDHIKA
GIBRAN AHMAD
RAMADHAN
(Kamar : Abbas
0018 ANGGREK) A.Md.Kes 9/17/2023 15:51:46
206034
MURNIWATI
(Kamar : Annies
2023/09/17/00 TERATAIBED1, Fadhilah,
0002 TERATAI) A.Md. 9/17/2023 6:32:16
201109
MUHAMMAD
AHNAF MAULANA
NAFI (Kamar : Yuni Nurul
0007 ANGGREK) Md. 9/6/2023 5:03:39
R 2023 BERDASARKAN SIM




Sp.A Sp.PK

dr. Hernanda Sp.PK



Sp.A Sp.PK

dr. M Ramzy Ghifari Sp.PK



DATA PASIEN UMUM BULAN OKTOBER 2023 BERDASARKAN SIM
206890 NICOLAS
EDWARD
ANDREAS, S.KOM
(Kamar : Abbas
2023/10/30/00 BOUGENBED5, Herlan,
206890 NICOLAS
EDWARD
ANDREAS, S.KOM
(Kamar : Yuni Nurul
2023/10/30/00 BOUGENBED5, Azizah, A.
0167 BOUGENVILLE) Md. 10/30/2023 20:38:24
202717
SYAFA"ATUN NISA
(Kamar : Ragil
2023/10/29/00 TERATAIBED1, Pangestu W.,
0005 TERATAI) A.Md. 10/30/2023 8:32:14
202717
SYAFA"ATUN NISA
(Kamar : Ragil
0005 TERATAI) A.Md. 10/29/2023 20:02:11
202717
SYAFA"ATUN NISA
(Kamar : Abbas
2023/10/29/00 TERATAIBED1, Herlan,
0005 TERATAI) A.Md.Kes 10/29/2023 9:33:00
206826 HERLINA
PUTRI LESTARI
(Kamar : Mega Tri
0166 ANGGREK) A.Md. 10/26/2023 22:14:19
204037 SHAFANA
NASHITA
ALMAHIRA (Kamar Annies
2023/10/23/00 : ANGGREKBED1, Fadhilah,
0077 ANGGREK) A.Md. 10/24/2023 11:52:40
204037 SHAFANA
NASHITA
ALMAHIRA (Kamar Abbas
2023/10/23/00 : ANGGREKBED1, Herlan,
0077 ANGGREK) A.Md.Kes 10/23/2023 14:27:48
162054 ETHES
TSANIYA
NAILAFAZA
MUHTADIN
(Kamar : Mega Tri
2023/10/20/00 K0000159, Wulandari,
0227 ANGGREK) A.Md. 10/23/2023 9:46:04
162054 ETHES
TSANIYA
NAILAFAZA
MUHTADIN
(Kamar : Yuni Nurul
2023/10/20/00 K0000159, Azizah, A.
0227 ANGGREK) Md. 10/21/2023 16:46:08
206734 MOZES
ELVAN IVANDER
(Kamar : Yuni Nurul
0119 ANGGREK) Md. 10/21/2023 16:44:58
162054 ETHES
TSANIYA
NAILAFAZA
MUHTADIN
(Kamar : Annies
2023/10/20/00 K0000159, Fadhilah,
0227 ANGGREK) A.Md. 10/20/2023 22:17:43
206391 MARLIYAH
(Kamar : Yuni Nurul
2023/10/18/00 TERATAIBED4, Azizah, A.
0172 TERATAI) Md. 10/18/2023 18:23:01
164263 LUTHFI
RIDHO ARDHI
ALDAVA (Kamar : Ragil
0035 BOUGENVILLE) A.Md. 10/18/2023 8:18:53
206633 IVENA
YULIANI AYO
(Kamar : Abbas
2023/10/16/00 PERINABED1, Herlan,
0214 PERINATOLOGI) A.Md.Kes 10/17/2023 17:58:11
164263 LUTHFI
RIDHO ARDHI
ALDAVA (Kamar : Abbas
164263 LUTHFI
RIDHO ARDHI
ALDAVA (Kamar : Abbas
164263 LUTHFI
RIDHO ARDHI
ALDAVA (Kamar :
206633 IVENA
YULIANI AYO
(Kamar :
2023/10/16/00 PERINABED1, Ela Yulianti,
0214 PERINATOLOGI) A.Md.Kes. 10/16/2023 22:23:28
175392 WIDY
ADISTYA PUTRI
(Kamar : Mega Tri
2023/10/13/00 TERATAIBED6, Wulandari,
0009 TERATAI) A.Md. 10/13/2023 6:40:25
206565 AFIZA
GHANIA (Kamar : Mega Tri
0356 ANGGREK) A.Md. 10/12/2023 23:11:01
206459 HUMAIRA
SHAKILA NAJMA
(Kamar :
0002 ANGGREK) A.Md.Kes. 10/8/2023 6:21:22
206446 FARHAN
SAKHA ALFARIS
(Kamar :
0203 ANGGREK) A.Md.Kes. 10/7/2023 21:51:35
206391 MARLIYAH
(Kamar :
2023/10/04/00 TERATAIBED3, Ela Yulianti,
0155 TERATAI) A.Md.Kes. 10/7/2023 6:44:43
206446 FARHAN
SAKHA ALFARIS
(Kamar :
0203 ANGGREK) A.Md.Kes. 10/6/2023 22:33:43
206391 MARLIYAH
(Kamar : Yuni Nurul
0155 TERATAI) Md. 10/6/2023 19:02:47
206391 MARLIYAH
(Kamar : Abbas
0155 TERATAI) A.Md.Kes 10/6/2023 6:02:17
197272 AISYAH
AURORA
PRIYANJANI Abbas
2023/10/05/00 (Kamar : Herlan,
197272 AISYAH
AURORA
PRIYANJANI Abbas
2023/10/05/00 (Kamar : Herlan,
197272 AISYAH
AURORA
PRIYANJANI Yuni Nurul
2023/10/05/00 (Kamar : Azizah, A.
0058 HCUBED4, HCU) Md. 10/5/2023 11:00:31
197272 AISYAH
AURORA
2023/10/05/00 (Kamar : Azizah, A.
0058 HCUBED4, HCU) Md. 10/5/2023 11:00:18
197272 AISYAH
AURORA
2023/10/05/00 (Kamar : Azizah, A.
0058 HCUBED4, HCU) Md. 10/5/2023 9:54:50
206399 RATNA
MAYA SARI (Kamar Annies
2023/10/04/00 : MLTBBED1, Fadhilah,
0165 MELATI BERSALIN) A.Md. 10/4/2023 21:02:43
206391 MARLIYAH
(Kamar : Annies
0155 TERATAI) A.Md. 10/4/2023 19:26:29
206391 MARLIYAH
(Kamar : Annies
0155 TERATAI) A.Md. 10/4/2023 19:25:32
2023 BERDASARKAN SIM

Sp.PD Sp.PK
dr. Ilham dr. Dwi Retnoningrum,

Robbizaqtana Sp.PK




Nugraha Sp.PK

Sp.A Sp.PK
Robbizaqtana Sp.PK

Sp.A Sp.PK

Sp.A Sp.PK

dr. Rizkia Amal dr. Dwi Retnoningrum,

Ramadhani Sp.PK

Robbizaqtana Sp.PK

Sp.OG Sp.PK



Ramadhani Sp.PK

Ramadhani Sp.PK

Sp.OG Sp.PK

Ramadhani Sp.PK

Adhiutami Sp.PK
Sp.A Sp.PK

Utama, Sp.B Sp.PK

Dzakiy Sp.PK

Utama, Sp.B Sp.PK

Sp.PD Sp.PK

Sp.PD Sp.PK

Sp.PD Sp.PK

Sp.PD Sp.PK

Sp.PD Sp.PK

Sp.OG Sp.PK

Utama, Sp.B Sp.PK

Utama, Sp.B Sp.PK
DATA PASIEN UMUM BULAN NOVEMBER 2023 BERDASARKAN SIM
207345
HERRYANTO
(Kamar : Annies
2023/11/26/00 FLAMBOYAN3, Fadhilah,
0025 FLAMBOYAN) A.Md. 11/27/2023 13:50:25
207345
HERRYANTO
(Kamar : Yuni Nurul
2023/11/26/00 FLAMBOYAN3, Azizah, A.
0025 FLAMBOYAN) Md. 11/26/2023 20:03:14
039607 JUMIAH
(Kamar : Yuni Nurul
2023/11/26/00 PERINABED8, Azizah, A.
0028 PERINATOLOGI) Md. 11/26/2023 18:36:13
207345
HERRYANTO
(Kamar : Yuni Nurul
0025 FLAMBOYAN) Md. 11/26/2023 16:45:37
207345
HERRYANTO
(Kamar : Yuni Nurul
0025 FLAMBOYAN) Md. 11/26/2023 16:43:13
170822
SUDARLIYAH
(Kamar : Mega Tri
2023/11/23/00 TERATAIBED4, Wulandari,
0199 TERATAI) A.Md. 11/26/2023 6:12:19
170822
SUDARLIYAH
(Kamar : Annies
0199 TERATAI) A.Md. 11/25/2023 19:29:21
170822
SUDARLIYAH
(Kamar : Abbas
0199 TERATAI) A.Md.Kes 11/25/2023 6:04:31
170822
SUDARLIYAH
(Kamar : Ragil
0199 TERATAI) A.Md. 11/24/2023 19:34:59
170822
SUDARLIYAH
(Kamar : Abbas
0199 TERATAI) A.Md.Kes 11/24/2023 6:08:10
170822
SUDARLIYAH
(Kamar : Abbas
0199 TERATAI) A.Md.Kes 11/23/2023 21:44:15
170822
SUDARLIYAH
(Kamar : Yuni Nurul
0199 TERATAI) Md. 11/23/2023 19:20:12
170822
SUDARLIYAH
(Kamar : Yuni Nurul
0199 TERATAI) Md. 11/23/2023 15:09:12
170822
SUDARLIYAH
(Kamar : Annies
0199 TERATAI) A.Md. 11/23/2023 9:11:59
203173 ALISHA
RATTU HADI
WIJAYA (Kamar :
2023/11/17/00 EDWBED6, Ela Yulianti,
0214 EDELWEISS) A.Md.Kes. 11/18/2023 7:58:18
203173 ALISHA
RATTU HADI
WIJAYA (Kamar : Ragil
2023/11/17/00 EDWBED6, Pangestu W.,
0214 EDELWEISS) A.Md. 11/17/2023 19:52:42
207135 NINA
CHAERANI
(Kamar : Yuni Nurul
0219 ANGGREK) Md. 11/16/2023 7:00:48
207154 SITI Yuni Nurul
2023/11/15/00 ROHMAH (Kamar : Azizah, A.
0168 ICUBED2, ICU) Md. 11/16/2023 6:12:36
207154 SITI Yuni Nurul

2023/11/15/00 ROHMAH (Kamar : Azizah, A.
0168 ICUBED2, ICU) Md. 11/15/2023 21:48:26
207135 NINA
CHAERANI
(Kamar : Annies
0219 ANGGREK) A.Md. 11/14/2023 23:34:12
207098
SYALOOMITHA
MEIRIKA
MARANATA
(Kamar : Abbas
207033 KHAINOA
DHIAULHAQ
RAYYAN (Kamar : Annies
2023/11/11/00 EDWBED5, Fadhilah,
0004 EDELWEISS) A.Md. 11/12/2023 21:03:52
154585 MARYANI
(Kamar : Annies
0015 TERATAI) A.Md. 11/12/2023 14:55:32
207033 KHAINOA
DHIAULHAQ
RAYYAN (Kamar : Ragil
0004 EDELWEISS) A.Md. 11/11/2023 12:10:11
207033 KHAINOA
DHIAULHAQ
0004 EDELWEISS) A.Md. 11/11/2023 11:25:06
207033 KHAINOA
DHIAULHAQ
0004 EDELWEISS) A.Md. 11/11/2023 10:55:19
207033 KHAINOA
DHIAULHAQ
RAYYAN (Kamar :
2023/11/11/00 EDWBED5, Ela Yulianti,
0004 EDELWEISS) A.Md.Kes. 11/11/2023 6:39:53
206966
ALDAMARSA
ANDIAN PANDITA
BUANA (Kamar : Abbas
2023/11/05/00 FLAMBOYAN3, Herlan,
0026 FLAMBOYAN) A.Md.Kes 11/6/2023 18:41:56
206966
ALDAMARSA
ANDIAN PANDITA
BUANA (Kamar :
2023/11/05/00 FLAMBOYAN3, Ela Yulianti,
0026 FLAMBOYAN) A.Md.Kes. 11/5/2023 12:22:03
206966
ALDAMARSA
ANDIAN PANDITA
BUANA (Kamar :
206966
ALDAMARSA
ANDIAN PANDITA
BUANA (Kamar :
206895 SEVILA
ANGGIE AMBARA
SATYA (Kamar : Mega Tri
2023/11/03/00 CEMPAKABED03, Wulandari,
0036 CEMPAKA) A.Md. 11/3/2023 7:38:46
206895 SEVILA
ANGGIE AMBARA
0036 CEMPAKA) A.Md. 11/3/2023 7:30:21
206895 SEVILA
ANGGIE AMBARA
0036 CEMPAKA) A.Md. 11/3/2023 7:15:40
028110 DAVID
HERLAMBANG
(Kamar : Annies
0236 FLAMBOYAN) A.Md. 11/3/2023 6:20:42
028110 DAVID
HERLAMBANG
(Kamar : Annies
0236 FLAMBOYAN) A.Md. 11/2/2023 23:32:55

Utama, Sp.B Sp.PK

Utama, Sp.B Sp.PK











Robbizaqtana Sp.PK

Sp.A Sp.PK

Robbizaqtana Sp.PK

Sp.OG Sp.PK
Sp.PD Sp.PK

Robbizaqtana Sp.PK



Sp.A Sp.PK

Ramadhani Sp.PK

Sp.A Sp.PK

Sp.A Sp.PK
Sp.A Sp.PK

Sp.A Sp.PK

Sp.PD Sp.PK

Sp.PD Sp.PK




Ramadhani Sp.PK

W., Sp.B Sp.PK

Ramadhani Sp.PK
DATA PASIEN UMUM BULAN DESEMBER 2023 BERDASARKAN SIM
207814 BY NY
WAHYUNINGSIH Mega Tri
2023/12/25/00 (Kamar : MLT.02- Wulandari,
0045 01, MELATI) A.Md. 12/25/2023 20:46:17
207716 AL KHOIR
NURIL HAIDAR
(Kamar : Ragil
2023/12/19/00 PERINABED9, Pangestu W.,
206482 AVRIANI
(Kamar : Yuni Nurul
2023/12/21/00 BOUGENVBED4, Azizah, A.
0113 BOUGENVILLE) Md. 12/21/2023 17:32:36
090659 NOVIAN
ADI KENCANA
(Kamar : Ragil
2023/12/20/00 PERINABED12, Pangestu W.,
207701 GAFFI
ALIANDO ALVARO
(Kamar : Mega Tri
2023/12/19/00 EDWBED1, Wulandari,
0224 EDELWEISS) A.Md. 12/20/2023 0:10:36
207716 AL KHOIR
NURIL HAIDAR
(Kamar : Abbas
207701 GAFFI
ALIANDO ALVARO
(Kamar : Abbas
2023/12/19/00 EDWBED1, Herlan,
0224 EDELWEISS) A.Md.Kes 12/19/2023 19:39:50
207570 ADZHANI
PRAMUDIA
JAYAWARDANA
(Kamar : Ragil
0118 EDELWEISS) A.Md. 12/12/2023 6:46:24
207570 ADZHANI
PRAMUDIA
JAYAWARDANA
(Kamar : Yuni Nurul
2023/12/10/00 EDWBED4, Azizah, A.
0118 EDELWEISS) Md. 12/11/2023 7:12:52
207570 ADZHANI
PRAMUDIA
JAYAWARDANA
(Kamar : Ragil
0118 EDELWEISS) A.Md. 12/10/2023 19:25:31
207564 AQILA
ZAHRA ELSHANUM
(Kamar :
2023/12/10/00 PERINABED9, Ela Yulianti,
0103 PERINATOLOGI) A.Md.Kes. 12/10/2023 9:25:04
201037 NABILA
NAJWA (Kamar : Abbas
2023/12/09/00 EDWBED6, Herlan,
0078 EDELWEISS) A.Md.Kes 12/9/2023 15:47:44
173005 YUDITH
ARSYA PRADIEGNA
(Kamar : Abbas
2023/12/07/00 FLAMBOYAN2, Herlan,
0005 FLAMBOYAN) A.Md.Kes 12/7/2023 6:31:14
207416 RIZAL
DANI IKHYA
MAULANA
(Kamar : Annies
0024 FLAMBOYAN) A.Md. 12/1/2023 12:12:41


Sp.A.,M.Kes Sp.PK

Sp.OG Sp.PK

Utama, Sp.B Sp.PK

Sp.A.,M.Kes Sp.PK

Sp.A.,M.Kes Sp.PK

Nugraha Sp.PK

Sp.A.,M.Kes Sp.PK
Sp.A.,M.Kes Sp.PK

Ramadhani Sp.PK

Sp.A Sp.PK


dr. Wahyu Trianggono Sp.PK

Ramadhani Sp.PK
REKAPAN DATA PASIEN UMUM 2023
BULAN POLI JUMLAH PASIEN

JANUARI RI 69
RJ 14
IGD 40
MANDIRI 150
Total 273
FEBRUARI RI 79
RJ 13
IGD 44
MANDIRI 127
Total 263
MARET RI 62
RJ 19
IGD 60
MANDIRI 98
Total 239
APRIL RI 47
RJ 9
IGD 53
MANDIRI 98
Total 207
MEI RI 46
RJ 17
IGD 67
MANDIRI 191
Total 321
JUNI RI 32
RJ 15
IGD 61
MANDIRI 149
Total 257
JULI RI 36
RJ 22
IGD 39
MANDIRI 94
Total 191
AGUSTUS RI 33
RJ 24
IGD 30
MANDIRI 131
Total 218
SEPTEMBER RI 13
RJ 24
IGD 29
MANDIRI 94
Total 160
OKTOBER RI 35
RJ 27
IGD 52
MANDIRI 73
Total 187
NOVEMBER RI 36
RJ 37
IGD 53
MANDIRI 56
Total 182
DESEMBER RI 14
RJ 30
IGD 53
MANDIRI 78
Total 175

2023 - Data Pasien Umum Berdasarkan Sim

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2023 - Data Pasien Umum Berdasarkan Sim

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DATA PASIEN UMUM BULAN JANUARI 2023 BERDASARKAN SIM

NO. RAWAT NAMA PASIEN

JAM PERIKSA DOKTER PERUJUK PENANGGUNG JAWAB

NO. RAWAT NAMA PASIEN PETUGAS TANGGAL PERIKSA JAM PERIKSA

DOKTER PERUJUK PENANGGUNG JAWAB

dr. Dwi Retnoningrum,

NO. RAWAT NAMA PASIEN PETUGAS TANGGAL PERIKSA

116563 SAKIYEM (Poli Ragil Pangestu W.,

JAM PERIKSA DOKTER PERUJUK PENANGGUNG JAWAB

dr. Dwi dr. Dwi Retnoningrum,

Dr. Akbar Kurniawan, dr. Dwi Retnoningrum,

dr. Dwi Retnoningrum,

dr. Dwi Retnoningrum,

Dr. Akbar Kurniawan, dr. Dwi Retnoningrum,

DR. dr. Moedrik dr. Dwi Retnoningrum,

DR. dr. Moedrik dr. Dwi Retnoningrum,

dr. Dwi Retnoningrum,

dr. Dwi dr. Dwi Retnoningrum,

dr. Dyah Nuraini dr. Dwi Retnoningrum,

Dr. Akbar Kurniawan, dr. Dwi Retnoningrum,

Dr. Akbar Kurniawan, dr. Dwi Retnoningrum,

Dr. Akbar Kurniawan, dr. Dwi Retnoningrum,

Dr. Akbar Kurniawan, dr. Dwi Retnoningrum,

dr. Dwi Retnoningrum,

DR. dr. Moedrik dr. Dwi Retnoningrum,

dr. Prabu Giusti dr. Dwi Retnoningrum,

dr. Rahmawati dr. Dwi Retnoningrum,

Dr. Akbar Kurniawan, dr. Dwi Retnoningrum,

dr. Dwi Retnoningrum,

dr. Dwi Retnoningrum,

dr. Dwi Retnoningrum,

dr. Dwi Retnoningrum,

DR. dr. Moedrik dr. Dwi Retnoningrum,

DR. dr. Moedrik dr. Dwi Retnoningrum,

Dr. Akbar Kurniawan, dr. Dwi Retnoningrum,

dr. Wildana Aqila dr. Dwi Retnoningrum,

dr. Wildana Aqila dr. Dwi Retnoningrum,

Dr. Akbar Kurniawan, dr. Dwi Retnoningrum,

DR. dr. Moedrik dr. Dwi Retnoningrum,

DR. dr. Moedrik dr. Dwi Retnoningrum,

DR. dr. Moedrik dr. Dwi Retnoningrum,

dr. Dwi dr. Dwi Retnoningrum,

dr. Dwi Retnoningrum,

dr. Mohamad Arif, dr. Dwi Retnoningrum,

dr. Mohamad Arif, dr. Dwi Retnoningrum,

dr. Dwi Retnoningrum,

dr. Ayu Mekar Sumila, dr. Dwi Retnoningrum,

dr. Dwi Retnoningrum,

dr. Dwi Retnoningrum,

dr. Dwi Retnoningrum,

dr. Dwi Retnoningrum,

DR. dr. Moedrik dr. Dwi Retnoningrum,

dr. Redyaksa dr. Dwi Retnoningrum,

dr. Dwi dr. Dwi Retnoningrum,

dr. Redyaksa dr. Dwi Retnoningrum,

dr. Dwi Retnoningrum,

dr. Dwi Retnoningrum,

dr. Mohamad Arif, dr. Dwi Retnoningrum,

Dr. Akbar Kurniawan, dr. Dwi Retnoningrum,

Dr. Akbar Kurniawan, dr. Dwi Retnoningrum,

DR. dr. Moedrik dr. Dwi Retnoningrum,

dr. Dwi Retnoningrum,

dr. Dwi Retnoningrum,