SHRAB1I—35
Format Referensi 1-3
it Re oe AR
Lembar Pemeriksaan Kesehatan Pribadi
se eee aa
reneeatl AY | #48
anges! anges
hoon 01 - 04 ; Sf
& & hanig periksalZol9 6 * 26
INA MAT Sonia le ol ow
: Sle ow oI
penis} Lata
us i a] 28 tahun
eetamin| —Bermpann
* % f]- Workshop at — |i £ (mmtig)
Riwayat kerja] Astra Izusu |reganan darah (mmig)| 10/70
- Metal painter
in Japan ame alm BRR CHO
Tes anemia|Level hemoglobin (g/d0)| 1448
aN Ti/mm)
Jumlah sel dara mera} 4,8,
(10,000/m)
W—__|___
a a miter [oo oT uo] 9.
Riwayat sebelumaya Tesfingita |G T Cr UL OD
No
oP T au
33
ort (iusty
h-e TP cue
4
r-GTP (ius)
oe # # sucbRiRteae [LDL 2 v A7 am Cmeiso|
Jocjata yang subjektit} No Pemerksaan | Kole LDL (mg/dl)
Nniddarsh. Tuto 3 AF ow (mws0] 45
Koleseol HDL (mg/d)
UVR E Cmglstd
Trighiserida (ma/eO] 85
f * © # 2 @ mp
Gejais odjettifl norma Pemeriksaan gua darah (g/d) 39
RR f *
Tes urine Glukosa oO
7 “ oO
(om) pa Tinggi badan (cm)| 167
x (ke) 49 oe wR #
Berat badan (kg) Pemeriksaanl Normal
Elektrokardiogra
2060 RB
[Pemeriksaan_lainnya
BMI moO
17,62
BML Diagnosis dokter
mw CoM) 66
Lingkar perut (em)
2 C >
RA Kanan | 6/6
Dee rE
= = « >
Kiri 6/6
a 1 WEL 2 iD
Kanan 1 Normal 2 Ganaguan
1oooHz = |1 FARel 2 DO fi 4
aa Keterangan
400082 [2 Normal 2.Gangguan
Daya
pendengaran 2 1 REL 2 RS”
Kitt 1 Normal 2 Gangguan
a Og
4.00082 [2 Normal 2.Gangguan
wee = [wmz>e a] ae me
TBC, all, | ae Langsung Tidak langsung
| Pemeriksaan we * AG
rouigen dade |Diomil tanggal ===
74045 IN,
No.fim No.
Pi FE
[remem Normal_chest
ce
1 BMIM, ROMMCSOMMTSCL. = BMI= fhi(es)
Sm
(RA) OME, RIEL TO ROME (INC, MEL TH SMe ( ) AEMATSCE.
Tima 7 Asie) DMC RMA SIU, SAR e SEO L. NHR EET SC ES
[ROO] OME, RAT, WHER, WiSeFORMOBM EATS E
RELRP ORD SECS, (EMOBM] OBC, WAM, RE REANC HET ~
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