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    MCU Adhe Setiawan-2019

    Uploaded by

    Adhe Setiawan
    sddsdsdsds

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    © All Rights Reserved
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    RAHASIA ICONFIDENTIAL MEDICAL ASSESSMENT REPORT No. MCU : 1904180012 Nama : Tn. Adhe Setiawan Umur : 28 Tahun 7 Bulan Perusahaan : SIGMA CIPTA UTAMA, PT AESCULAP MEDICAL CENTER Medical Services Provider ct Wis AESCULAP MEDICAL CENTER Modieel Services Provider VKAN 3 tssaaon Rene REGO, MS -TaNS02 1. INFORMASI PRIBADI / PERSONAL INFORMATION Tempat & tanggal lahir/ Place & Date of Birth 7 or Nama / Name of Employee | Jumur age Jenis Kelamin / Gender No. Karyawan / Number of employees Agama / Religion ‘Alamat / Address No. Telepon / Phone Number Tn. Adhe Setiawan Balikpapan, 08-09-1990 + 28 Tahun 7 Bulan + Laki-laki + Jl. Mulawarman Gg. Kacang RT. 011 082185547898, PERUSAHAAN / COMPANY Nama Perusahaan | Company name 1 Jabatan | Position SIGMA CIPTA UTAMA, PT Teknisi I Dopartemen / Departement ME Lokasi /Job Site : Portamina Paket MCU/ MCU package : MCU Berkala ‘Tanggal Pomeriksaan | Dato of examination 2 18-04-2019 Masa berlaku / Valid until : 12-04-2020 1904180012 Sere meh Trust, Duality & Ereetionce i nrakla (Strat 03) No. 17 Baikpapan, Telp. 0542 - 440404, 444055, Fax. 0542 - 415366 Email. fod ‘a AESCULAP MEDICAL CENTER NER | Ns Serr VKAN 3 tssaaon Rene REGNO.OMS-TaS202 2. RIWAYAT KESEHATAN / HEALTH QUESTIONARE WAtergi /Allergios Tidak 1 Nyeri dada / Chest Pain Tidak m Penyakit Jantung / Hearth Disease Tidak m Tekanan Darah Tinggi Hypertension Tidak WE Nyeri Punggung / Low back pain Tidak 1m Sakit kuning / Hepatitis Tidak 1 Masalah mata / Eye Problem Tidak 1 Kelainan kulit/ Skin Disorder Tidak 1 Kelainan Mental / Mental Disorder Asma / Asthma Tidak i Sesak nafas / Breathless Tidak mi Kencing Manis /Diabetes Mellitus Tidak Im Kejang, Epilepsi / Convulsion, Epilepsy Tidak i Radang Pant - pans / Tuberculosis Tidak Malaria / Mataria Tidak lm Masalah Telinga / Ear Problem Tidak m Kelainan Saraf / Neurology Disorder Tidak i Sakit kepala atau migrain / Headache or migraine Tidak Tidak I Masalah kelenjar/ Glandular Problem Hernia / Hernia Tidak Tidak I Masalah perut / Abdominal Problem I Masaiah Ginjal & Kandung Kemih / Renal & urinary tract problem Tidak Tidak 1 Penyakit akibat hubungan seks / I Diare berulang / Reccurent diarrhea ‘Sexuality Transmitted Disease Tidak Tidak Tumor / Tumor I Ambeien / Haemorrhoid Tidak Tidak © Pemahkah berkonsultasi dengan dokter 1 tahun terakhir/ Tidak Have you consulted in a doctor in the past 1 year @ Pemahkah anda dirawat di Rumah Sakit 1 tahun terakhir/ Tidak Have you been hospitalized in the past 1 year 1@ Pemahkah anda menjalani operasi bedah / Tidak Have You had any surgery operations © Pemahkah anda mendapat cedera/kecelakaan serius / Tidak ‘Have you had any serious injuries or accident '@ Pemahkah anda mendapat imunisasi. Sebutkan waktu dan jenis: Tidak Have you been immunised . Please elaborate clearly (mention date and what kind of inoculation) 1904180012 8 Sere meh Trust, Duality & Ereetionce —— ‘a ek AESCULAP MEDICAL CENTER = | Medic! Serica Provider Se ns POTENS| BAHAYA AKIBAT PEKERJAAN/ S| BAHAY AKIBAT Pl KEBIASAAN ABITS Kebishgan / Noiso :- Lama Pajanan _ janvhar (lah raga/ Spor: =, duras! 3 janiminggu Panas / Heat - Lama Pajanan jamvhari Merokok / Smoking va Perhat/ Amount day: 10 batangihan Debu/ Dust === Lama Pajanan_jamvhar bat rigs Raciasi/ Radiaons ;= Lama Pajanan —jamihar Minuman Kes ‘ono! Kimi / Chomical:- Lama Pajanan_jamvhar Ergononi(Poss| :- Lama Pejanan _jamvhar Kone) ergonomic RIWAYAT MENSTRUASI / MENSTRUATION HISTORY 1 Umur berapa anda mulai haid / I Datang haid anda teratur atau tidak / When was your first menstruation 1s your menstruation requir I Sakitkah wait haid / i Berapa lama anda haid / Is your menstruation painfull How long do you menstruate 1m Sudah berapa kali hamil / i Apakah anda memakai alat kontrasepsi / Is your menstruation painfull ‘Are you currently using any kind of contraceptive RIWAYAT KESEHATAN KELUARGA / FAMILY MEDICAL HISTORY ‘Ayah | Father Ibu Mother ‘Saudara Kandung / Brother or Sister 3. RIWAYAT PEKERJAAN / CAREER HISTORY No Nama Perusahaan Jabatan Lama Kerja 1904180012 i nrakla (Strat 03) No. 17 Baikpapan, Tp. 0542 - 440404, 4440 1415366 Email. nfo AESCULAP MEDICAL CENTER ~ | Modical Services Provider VKAN § tssaaon Rene REGO, MS -TaNS02 4. PEMERIKSAAN FISIK / PHYSICAL EXAMINATION KONDISI UMUM GENERAL CONDITION ANTROPOMETRI ANTROPOMETRY Tinggi badan / Height 170 om Tekanan darah / Blood Presure : 100/70 mmHg ‘98 ‘3 Berat badan / Weight 2 kg Nadi / Pulse 54 ximin BMI/ Body Mass Index 24.91 kai? Peratasan / Breathing rate: 20 x/min Lingkar Perut / Abdominal size: om Suu Badan Body Temperature: 96.2 ° C Lingkar Pinggang / Waist size: om PEMERIKSAAN FISIK MENYELURUH / HEAD TO TOE EXAMINATION 1 Kepala & Wajah / Head Normal, deformitas (-), luka (-), tumor (-) Nata (Eyes Normal ar, (©) plerygium (-), kecacatan (-) anemi ) stabimus(), katarak VISUAL ACTUITY / KEMAMPUAN PENGLIHATAN (Dengan atau tanpa kaca mata) 4 Kemampuan Penginatan/ Visual Actuity 20150 20/50 Mata Kanan & Kiri Right and Left Eyes 20/35 2 Visus Dekat/ Reading Test (Near Visus ) - Buta Wana / Colour Blindness Tidak ditemukan 4 Lapang Pandang / Feld of Vision Right Eyes Left Eyes Nasal : : Temporal : - Kedalaman Penglhatan | Depth of vision - Pengihatan Malam / Night vision - 7 Pemulhan Sitau / Glare recovery - 1904180012 Sere meh Trust, Duality & Ereetionce i nrakla (Strat 03) No. 17 Baikpapan, Telp. 0542 - 440404, 444055, Fax. 0542 - 415366 Email. fod AESCULAP MEDICAL CENTER Modieel Services Provider @. wTelinga /Ears Normal, cerumen ( Norma, gerumen () petorasimembran tympani ( PC) 1 Tenggorokan /Throat Normal, hiperemis (-), hipertrofi tonsil (-) i Leher / Neck Normal, Pembesaran kel. getah bening (-), pembesaran kel trod’) 90) Panu / Lung Normal, rhonchi (), wheezing (-) 1m Perut / Abdomen Normal. nyartekan (), pembesaran hati & ima ("), nyen Ketok kosto vertebrae (-) I Muskuloskeletal / Musculoskeletal Normal, defoits (tna ign), phalon test) Tasers toot (), patil teat) confapatrek ts () Urogenital / Genital Normal, hernia (-), hemoroid (-) varicocelle (-) 1 0012 190418 VKAN 3 tsshaaon RPT REGO, MS -TaNS02 1m Hidung / Nose Normal (.), hiperemis (-), deviasi septum (-), sekret (), ‘oedema () Wi Gigi & Mulut/ Teeth & Mouth Stomatis (caries), karang gil), ga tanggal (gg beritbang () ripe), al Bt) Dada / Chest Normal, deformitas (-), pigeon chest (-) barrel chest o 1 Jantung / Hoart Normal, Murmur (- ), Gallop (-) 1 Neurologi /Neurology Nara remer (paresis), roomberg test) reflek patologis Kult Skin Normal, dermatitis (-) finea / mikosis (-), infoksi(-), tato (-) Wi Lain- lain / Others Sere meh Trust, Duality & Ereetionce J ncrakla (Strat 03) No. 17 Baikpapan, Telp. 0542 - 440404, 444055, Fax. 0542 - 415366 Email nfogame-belapapan com. Website: wiw.ame-bakkpapan com € AESCULAP MEDICAL CENTER VKAN a RE = | Nes ses rntr eget OY EGNOS TS02 4. PEMERIKSAAN PENUNJANG / SUPPORTING EXAMINATION I Pomeriksaan Laboratorium / Laboratory Examination ‘Temuan utama (Major findings - I Pemeriksaan Radiologi - Thoraks PA /Radiological Examination - Thorax PA Kesimpulan / Conclusion Chest X-Ray Normal lm Pomeriksaan Radiologi - USG Abdomen / Radiological Examination - USG Abdoment Kesimpulan / Conclusion - lm Pemeriksaan EKG Istirahat / Resting EKG Examination Kesimpulan / Conclusion Normal ECG 1 Pemeriksaan Treadmill Stress Test / Treadmill Stress Test Examination Kesimpulan / Conclusion Response Ischemik Negative, kapasitas aeroblk 12 mets I Pomeriksaan Spirometri/ Spirometry Examination Kesimpulan / Conclusion Normal Spirometti lm Pemeriksaan Audiometti / Audiometry Examination Kesimpulan / Conclusion Normal Audiometr 0012 1904186 Serve mcth Trust. Buntity & Ercetionce I ndrakla (Strat 03) No. 17 Baikpapan, Telp. 0542 - 440404, 444055, Fax. 0542 - 415366 Email nfogame-belapapan com. Website: wiw.ame-bakkpapan com AESCULAP MEDICAL CENTER VKAN 4 ~ | Radel sents Pn Fateh Wie conan” reso ons 6. KESIMPULAN DAN SARAN/ SUMMARY AND SUGGESSTION KESIMPULAN (SUMMARY) SARAN (SUGGESTION) Mulailah berhenti merokok dan terapkan hidup sehat Jdengan menghindari kebiasaan buruk yang dapat Imengganggu Kesehatan REKOMENDASI (RECOMENDATION) X_[ Fit for the job Fit with note Unfit Temporary Unfit Uncomplete Result Dokter Pemeriksa ‘Alamat (Cap) Examiner Doctor Address ( Stamp ) J! Indrakita No. 17 (Strat 3) Kel. Gunung Samarinda Telp. (0542}440404,444055 Fax. (0542) 415366 Ballkpapan - Kalimantan Timur E-mail: amc_clinic@yahoo.com Name of the doctor dr. Sri Wahyuni Date of examination 18-04-2019 sP 025/1183A/SIP-D/x1/2016, Valid until 12.04.2020 SK KEMENAKER : 2002/PK3/C-G/64/2017 asil via online tidak memerlukan tanda tangan Karena dicetak secara elektronik, hasil sudah diverifikasi dan divalidasi 1 1904180012 Sere meh Trust, Duality & Ereetionce rat 03) No. 17 Balikpapan. Tap. 0542 - 440404, 444055, Fax. 0542 - 415366 Email: fo@ame-belkpapan.c Gas. AESCULAP MEDICAL CENTER NU Sense meth Trese. Quatiey & Ercettonce sn, Tp. 0542 - 440404, 444055. Fax. 0542 - 415966 Email: info@ame-belmpapen.com. Websile : www.ame-bafipapan.com Gas. AESCULAP MEDICAL CENTER VKAN : N Medical Services Provider oases SO -REGNO, ONS TSA Nama Pasien Tn, Ade Setiawan No.LabITal : 1904180012 18-04-2019 Jens Kelamin Lalla Dokter de. Sx Wah Tal. Lahir/ Umur — ; 08-09-1990 /28 Tahun 7 Bulan ‘Alamat JL Indra (Straat 3) No 17 RT 24 Alamat J Mulawarman Ga, Kacang RT. O11 Balkpapan PEMERIKSAAN HASIL NILAI RUJUKAN ‘SATUAN Utne Rutin Kina Bera Jenis 1020 1008-1030 pH 5 45-8 Leukosit Esterase Ngai Nit Negatit Negait Albumin Negatit Negait Glukosa Negati Noga Keton Negatit Negait Urobinogen Normal

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