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  • Lembar Laboratorium Praktikum Klinik

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    Makbruri Abdul Aziz
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    This document is a request form from Klinik Sapta Marga Medika for laboratory testing. It lists the patient's name, age, sex, doctor requesting, and date. It also includes checkboxes to indicate which tests are requested, covering categories like blood tests, urine tests, stool tests, diabetes tests, liver tests, kidney tests, heart tests, lipid tests, infection tests, and others. The form provides spaces for the clinical diagnosis and the patient's address and phone number. It asks the doctor to indicate any sample preparation needed, such as fasting or an 8 hour fast.

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    lembar lab klinik

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    This document is a request form from Klinik Sapta Marga Medika for laboratory testing. It lists the patient's name, age, sex, doctor requesting, and date. It also includes checkboxes to indicate which tests are requested, covering categories like blood tests, urine tests, stool tests, diabetes tests, liver tests, kidney tests, heart tests, lipid tests, infection tests, and others. The form provides spaces for the clinical diagnosis and the patient's address and phone number. It asks the doctor to indicate any sample preparation needed, such as fasting or an 8 hour fast.

    Copyright:

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

    Lembar Laboratorium Praktikum Klinik

    Uploaded by

    Makbruri Abdul Aziz
    This document is a request form from Klinik Sapta Marga Medika for laboratory testing. It lists the patient's name, age, sex, doctor requesting, and date. It also includes checkboxes to indicate which tests are requested, covering categories like blood tests, urine tests, stool tests, diabetes tests, liver tests, kidney tests, heart tests, lipid tests, infection tests, and others. The form provides spaces for the clinical diagnosis and the patient's address and phone number. It asks the doctor to indicate any sample preparation needed, such as fasting or an 8 hour fast.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
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    KLINIK SAPTA MARGA MEDIKA

    Jl.Sapta Marga Komplek Griya Sapta Permai No.2 Kelurahan Bukit Sangkal,

    Kecamatan Kalidoni, Palembang 0851-07886611

    LEMBAR PERMINTAAN PEMERIKSAAN


    LABORATORIUM
    Nama : Dokter Pengirim :
    Umur : Thn Sex : Tanggal :
    L/P
    Alamat : Telp : Diagnosa Klinis :

    Pemeriksaan yang diminta harap diberi tanda v


    DARAH HEMATOLOGI URINE FAECES
    Darah Rutin Rumple Leede Urinalisis Rutin Faeces
    (Hb, leukosit, Bleeding Time analisis rutin
    diff count, Clotting Time Kuantitatif
    Eritrosit, LED Protrombin Protein Esbach Lain-lain
    Trombosit Time Pregnancy Benzidine
    Hematokrit Fibrinogen Test Test
    Retikulosit Thrombo Test Amuba
    Morfologi Cacing
    Eritrosit
    Golongan
    Darah
    DIABETES LIVER GINJAL JANTUNG
    Gula darah SGOT Ureum CK
    puasa SGPT Creatinin CK-MB
    Gula darah 2 Gamma GT Uric Acid LDH
    jam PP Alkali Creatinin
    Gula darah Fosfatase Clearance
    sewaktu Cholin
    HbA1c Esterase
    C-peptide Bilirubin Total
    Bilirubin Direk
    Bilirubin
    Indirek
    LEMAK SEROMARKER ELEKTROLIT HORMON
    HEPATITIS TIROID
    Total HbsAg Na T3
    Cholesterol Anti HBs K T4
    HDL IgM anti HAV Ca TSH
    Cholesterol Anti HBc Mg
    LDL Anti HCV
    Cholesterol
    Trigliserida
    INFEKSI LAIN-LAIN
    Kultur Gall Darah Malaria Sekret Vagina
    Widal Test Darah Tipis Sekret Uretra
    VDRL Darah Tebal
    TPHA Sputum BTA
    3x
    PERSIAPAN Tanda tangan Dokter
    Pasien tidak perlu puasa
    Pasien puasa 8 jam sebelumnya

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