wremumonae PT FREEPORT INDONESIA 2 Affliate of Freeport-McMoRan KLINIK PT FREEPORT INDONESIA Jl Irian Jaya Timur, Kuala Kencana, MimikaPapua - Indonesia Telp: +62 (0)901 301111; +62 (0)901 461111 Email: DG-GRS-RS-PT-Freeport-Indonesia@fmi.com SURAT KETERANGAN MEDIS L803/ADMK-SS/INTL-SOS/I/19 Yang bertanda tangan di bawah ini dokter KLINIK PT FREEPORT INDONESIA KUALA KENCANA menerangkan bahwa : Nama + Ririn Andriani Ibrahim Jenis Kelamin Perempuan Tanggal lahir Timika, 07 Januari 1996 Pekerjaan : Pelajar Alamat 131, Rambutan, Jalur 2, SP 2, Timika - Papua Telah dilakukan pemeriksaan kesehatannya pada tanggal 08 Januari 2019, Meliputi pemeriksaan fisik dan laboratorium ; * SEHAT” Demikian surat keterangan ini dibuat agar dapat digunakan seperlunya. Note : Untuk melanjutkan Sekolah Kuala Kencana, 09 Januari 2019 Dokter Pemeriksa dr, Rendy Dwi OscaLABORATORY EXAMINATION REPORT PATIENT INFORMATION MR No, 298110 Viet No 158-08-01.2010 PatentName IRIN ADRIAN! IBRAHIM Date 801-2019 Allergies None [No smoking "TB:158em LABORATORY EXAMINATION DETAIL 80) Result Noma ait 1 ao isez [Nae se-106FeraeseT0 | (10a ike ] =} sie =) as ] (asa0 «{o- | [es =| fs s{E0. ] fiz ae frac fear (Mae 44s0Feraese52 7h ] fae ] (lie SoaTS Fenee TOSS | fg ——] slice fox | [tit 20 52 Female 3547] [ 1 {ov } (res. } (e010 1 1 ofc 1 (zz | (aa38 J J nfpor fas soa roca Elecrites Result Nowa Unit a 1 | Ses | feat ie 1 (i af cecraa ] inet ale 05 b5-105 (neat Gucose Result Norma Unit Immunology - STD Norma nt 1 [RPA Kost Immunology -Urine Result Normal Unit =< SSS OS ut Result Nommal Unit ‘ase ——) (oes | eo 1 (oa [0 ganen ] (oa 1 a3 J (osig——] 3 [EBinon | (ose | a | (eoa——} « [Toataten ] fas ] (sear | » [aban 1 ] See | fe} 6 [Gbotn | (Be ] 50a | soca) 7 (SCOTAST ayia | (se O30 Fora Os | {a _—} o(Scrract ] ] (Male 050 Fema 35 | a——] * (kaine Poschaiae ) [95 = = S000 = — i | | a | pid profe Result ‘Normal Unit 1 [resetsesiora —] [ ] za } (nea) 2 (eR ) (Si 5 Fete 37 ——) (ois) sits | {68 tg fe «(loeSeaeaated —] [foe | (30 | fee} s(ChotesictReso —] [52 EI IL 1 RET Result Norma Yt 1 (an } (os | Pie C621 Fema 05075] (matt J (ies — fet — fos 1 es] Users rosea Printed Date: 0601-2079 [0090604] PagetLABORATORY EXAMINATION DETAIL pr as Usnalyis Dpstck Result vst em ] fare if j Pica | ze if 1 alba 1 | era) $e) faa frase Raabe) sir (Regaive (Negative) [Negative 6 [PRO [Neastive ] (Negati J [Negativel_) 7 Is | emt | ora | (aera —] sixer } eae | Rena )faenabes—) [ue } [Rema } [rer | [Nero —] 10 (BIL J (Negative | J (Negati J [Negatvet_) iE ‘ou Nessie (Beast) User sca Printed Date 06-07-2016 [080804] Page?