Originality Statement Form

This is to certify that the outset and intend of this work entitled
Health Profile (Glucose, Uric Acid, Cholesterol) in residents in Segunung Traditional Village,
Carangwulung Village, Wonosalam District, Jombang Regency, East Java Province.
and the analysis of the data, as well as writing of this manuscript, is an original work and truly
compiled by me. I have reviewed the final version of manuscript and approve it for publication
in Indonesian Journal of Medical Laboratory Science and Technology (IJMLST). All author/s
(if present) agree that above content of the manuscript will not be copyrighted, submitted, or
published elsewhere (either in print or electronic media), and is also not imitative from any
language elsewhere, while acceptance by IJMLST is under consideration.
I confirm that the data presented in the manuscript is authentic and in any circumstances, I/we
will responsible to face any dispute, pointed out by anyone in future.
Signature

Yetti Hernaningsih

Name of all author/s Signature Affiliation

1. Arifa Mustika ............................................ Master Program of Basic

Medical Science, Faculty of
Medicine, Universitas
Airlangga

2. Yetti Hernaningsih ............................................ Department of Clinical

Pathology, Faculty of
Medicine, Universitas
Airlangga

............................................ Department of Clinical

3. Puspa Wardhani
Pathology, Faculty of
Medicine, Universitas
Airlangga

............................................ Master Program of Basic

4. Teguh Satrio Medical Science, Faculty of
 Medicine, Universitas
Airlangga

............................................ Master Program of Basic

5. Nastasya Nunki Medical Science, Faculty of
Medicine, Universitas
Airlangga

6. Musholli Himmatun Nabilah ............................................

Master Program of Basic
Medical Science, Faculty of
Medicine, Universitas
Airlangga

............................................
7. Agil Saputra Master Program of Basic
Medical Science, Faculty of
Medicine, Universitas
Airlangga

............................................
8. Novi Ersanto Master Program of Basic
Medical Science, Faculty of
Medicine, Universitas
Airlangga

9. Baiq Nasha Islaeli ............................................ Master Program of Basic

Medical Science, Faculty of
Medicine, Universitas
Airlangga

10. Uli Mas’uliyah Indarwati ............................................ Master Program of Basic

Medical Science, Faculty of
Medicine, Universitas
Airlangga

............................................ Master Program of Basic

11. Rizka Khoirunnisa Medical Science, Faculty of
Medicine, Universitas
Airlangga

12. Fita Triastuti ............................................ Master Program of Basic

Medical Science, Faculty of
Medicine, Universitas
Airlangga

............................................ Master Program of Basic

13. Alfino Validita Sidiq
Medical Science, Faculty of
Medicine, Universitas
Airlangga
14. Mochammad Reza Desianto ............................................ Master Program of Basic
Medical Science, Faculty of
Medicine, Universitas
Airlangga

15. Widaninggar Rahma Putri ............................................ Master Program of Basic

Medical Science, Faculty of
Medicine, Universitas
Airlangga

16. Desty Indah Sari ............................................ Master Program of Basic

Medical Science, Faculty of
Medicine, Universitas
Airlangga

17. Ragil Surachman ............................................ Master Program of Basic

Medical Science, Faculty of
Medicine, Universitas
Airlangga

18. Harlis Soelistiyaningrum ............................................ Master Program of Basic

Medical Science, Faculty of
Medicine, Universitas
Airlangga

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