ZIOCLINIC &® MEDICAL FITNESS ASSESSMENT CERTIFICATE. (ANNUAL) MCU No. —: 2022040764 MCU Date : April 19, 2022 MCU Package : PREMIER OIL >35 Name ERWINSYAH Gender : Male Place & date of birth: MEDAN, 20 June 1982 IDNo. : 2171032006829021 tizen : Indonesia ‘Age 39 Year 9 Month 29 Day Marital Status 2 Married Home Address 1 TIBAN TAMAN SARI BLOK F NO. 123, BATAM, INDONESIA Mobile No. + 6285272737775 Company Name PT. BANGUN MAKMUR PERDANA, Employee No. ie ‘Company Address JL. BINTARA RAYA 12A NO.3B RT 003 RW 009, KEL BINTARA, BEKASI JAWA BARAT Job Tite ROPE ACCESS PAINTING Department PAINTING ‘Type & Shift work Field & Non Shift CONCLUSION Physical Examination Myopia ODS/near sightedness both eyes-corrected with eye glasses, Dental Calculus, Tonsil Hypertrophy & Hemorroid externa Laboratory Borderline Low HDL Narcotic & Drug Test : Negative Radiology Normal ‘Audiometry + Normal audiogram of both ears Spirometry ‘Normal Lung Function Treadmill + Negative ischemic response at 14.4 Mets FITNESS STATUS —; FIT TO WORK ADVICE ~ Consult a dentist for scaling ~ Consult ENT doctor for tonsil hypertrophy ~ Consult a company doctor for Hemorroid externa ~ Low fat diet. Increase the consumption of vegetables, fresh fruit and fiber. Set calorie input and output, Exercise regularly. Consult to company doctor for treatment if indicated ~ Do Spirometry examination annually ~ Do Audiometry examination annually Exercise regularly ~ Stop Smoking ‘The MCU Doctor Team are dr. Ade Dwi Lestat. M Kes, Sp. (Head of Occupational Heath & Mane Cig Spiramaty Reader & Audometry Reader) + dr. Eka Susy Apia, Sp Read Racfloge) +d Manang Rudy tanto, Sp JP, FINA, FASC (Tree xaminaon) ~ dt Yl En Wander (Genera Praestoner & MCU Tas) ‘3m17001-330/s0.1M/DPMPTSP-BTm]v]2020 ZIOMF-02-18-0'VSertikat Medical Check UpiRev.02122 Tio Clinic Occupational Health & Medicine arama Citra il Complex Block R No.17 11. Yos Sudarso, Batu Ampar, Batam, Indonesia 29432 Phone. +62 778 748 0697, Fax. +62 778 413 470ZIOCLINIC Occupational Health & Medicine MCU No, ; 2022040764 Date of Birth > 20 June 1982 MCU Date : 19 April 2022 Age 39 Year 9 Month 29 Day Name ERWINSYAH Gender Male ID No. 2171032006829021 Package No. : PREMIER OIL >35 ANAMNESA & RIWAYAT (HISTORY) 1. KELUHAN SAAT INI (PRESENT COMPLAINT) NA 2. KONSUMS! OBAT/ SUPLEMEN SAAT INI (PRESENT MEDICINE INTAKE) NA 3, RIWAYAT PENYAKIT (MEDICAL HISTORY) NA 4. RIWAYAT PENYAKIT KELUARGA (FAMILY HISTORY) NIA 5. KEBIASAAN HIDUP (LIFE STYLE) No. KEBIASAAN JAWABAN| FREKUENSI TAMA {Life Style) (Answer) (Frequency) (Duration) 1. | Merokok (Smoking) Yes | 12. | Batangihai (Cigaretterday) | 20 | Tahun vean 2. | Minum Alkohol (Alcohol intake) No - Gelas/hari (Glass/day) - ‘Tahun (Year) 3. | Minum Kopi (Coffee intake) ‘Yes 2 Cangkirfhari (Cup/day) 8 ‘Tahun (Year) 4, | Olahraga (Exercise) Yes 1 | Kaiiminggu (Times! ween) [PVE JOSGING 6. PEKERJAAN SAAT INI (PRESENT WORK) Working at Height 7. RIWAYAT PAJANAN PEKERJAAN (WORK EXPOSURE) Noise, Heat Stress, Chemical Toxic, Dust & Manual Handling ‘8 RIWAYAT VAKSINASI (VACCINATION HISTORY FOR TRAVELLER) Covid-19 (2021) 9. KUESIONER KETIDAKNYAMANAN TUBUH (BODY MAP DISCOMFORT QUESTIONER) Depan (front): - Belakang (back): - ZIOIF-02-08-09/rasil Pemerksaan RiwayaRev O17 PT. ZIO PAKARTEK PROFESI Garama Citra Hill Complex Block R No. 17JI. Yos Soedarso, Batu Ampar, Balam, Indonesia 29432 Phone. +62 778 7480697 | Email, hrga@zioclinic.com | www.zioclinic.com, OM 0% Kp Surat 02122ZIOC LING Occupational Health & Medicine MCU No. : 2022040764 Date of Birth - 20 June 1982 MCU Date : 19 April 2022 Age 39 Year 9 Month 29 Day Name = ERWINSYAH Gender Male IDNo. — : 2171032006829021 Package No. : PREMIER OIL >35 PHYSICAL EXAMINATION REPORT 4. Vital sign Pulse 79 xImin Blood Pressure: 109/78 mmHg Pulse after = xin Temperature: 97 °C Fitness test category : — Breath 18min 2. Nutritional status Height 162 om ‘Abdominal atm Weight 608 kg circumference BMI 232 kgM2 Body shape Alhleticus 3. Consciousness and General Condition Consciousness General Condition : Good Walking Normat 4. Lymph Gland (Quantity, Shape, Consistency) Normal 5 Eye Vision Corection = eye glasses Eye Vision Right Lent Both Distant Near Distant Near Distant Near Unaided 201100 a 220/200 a 20/100 a Aided 2075 = 20/25 = 20/20, 7 Colour Perception » Normal Greyscale : ~ Visual Field R Normal ‘Abnormality Both Eyes Normat Thumbling E = L = Normal Bere Tonometi Rs — r LPS, ‘Both Ears Normat 3 ees 7. Nose Normal 17. Low Back Pain Test 8. Dental & Gum reel Dental Calculus 18. Vertebrae Normal a, “iti 19. Physiology Reflex Tonsil Hypertrophy Normal 10. Neck 20. Pathology Reflex Normal Normal 11, Chest 21. Skin & Mucous. Normal Normal 12. Lung & Heart 22. Romberg Normal Normal 18. Abdomen 23, Other Normal Hernia : Negative 14, Genitourinary Hemorroid externa 15. Upper Extremity Normat ZIOVF-02.08-02/Hasi Pemeriksaan FiskfRev.02/21 Examine opt dr. Ya Eos Wanda PT. ZIO PAKARTEK PROFES! Garama Citra Hill Complex Black R No. T7Jl. Yos Soedarso, Batu Ampar, Batam, Indonesia 29432. Phone. +62 778 7480697 | Email. hga@zioctinic.com | wwwy.zioclinic.comZIOCLINIC Occupational Health & Medicine MCU No. ; 2022040764 Date of Birth ; 20 June 1982 MCU Date : 19 Apri 2022 Age 39 Year 9 Month 29 Day Name ERWINSYAH Gender Male IONo, — : 2171032008829021 Package No. ; PREMIER OIL. >35 HEMATOLOGY LABORATORY REPORT WHOLE BLOOD: Examination Result Reference Range Unit Explanation HGB 159) M=13.2-17.3;F= 117-140 gia. ESR 5 Mz 0-15; F=0-20 mentor wee 99 60-100 1034. Lym 25.3 18-42 % MON ot 2-11 % BAS. 18 0-2 % Eos 2 1-3 % NET 62 50-70 % Her a7 Mz 40 - 52; % PLT 306 150-500 103ful RBC 5.34 M= 44-69; 238-62 fo6fuL. Mev 86 80-100 a MCH 30 26-34 Po MCHC 34 32-96 ol ROW 13.5 116-144 % Examiner ZIOIF-02-01-03/Hasil Pemerisaan DarahvRev.O1/17 A/F O01 ap Sarat 222 Jimmi M.Tarigan, A.Md.Kos. Laboratory Analyst PT. ZIO PAKARTEK PROFESI arama Citra Hill Complex Block R No. 17J1. Yos Soedarso, Batu Ampar, Batam, Indonesia 29432 Phone. 4162 778 7480697 | Email. hrga@zioclinic.com | www.zioclinic.comZIOCLINIC Occupational Health & Medicine MCU No. : 2022040764 Date of Birth ; 20 June 1982 MCU Date » 19 April 2022 Age 39 Year 9 Month 29 Day Name: ERWINSYAH Gender Male IDNo. — : 2171032006829021 Package No. : PREMIER OIL >35 BLOOD CHEMISTRY LABORATORY Examination Result Reference Range «Unit xplanation eiucose Fasting Glucose 0 < 100 mg/dl. Normal £100 mg Impaired Fasing Glucose 100. 128 mola Diabetes Melts! Suspect > 7126 male Lio Cholesterol 198 < 200 mg/dl. Normal < 200 mg Borderine 200 228 mgd. High >240 mode HL 45 >= 60 mg/dL Optimal >60 mold Borderine 40—59 mg/dl tow <40 mola Lo 180 mg/dl Optimal <130 ma. Bordorine 4130-159 mg/dl High 180-189 mia. Very High > 200 mgt Triglyceride 118 < 150 maid Optimal < 150 mg/dL Bordering 4150-198 mg/dl High >= 200 moat KIDNEY Ute Acid a7 Ma572;F2660 mol Ureum 38 Me19-44; 615-40 mg Creatinine 078 © MO724.25: FrOST-1.11 molal Liver ast scor 18 5-34 un ALT SGPT 20 0-55 un Gamma GT 2 8-61 ue Examiner Sop Jimmi M.Tarigan, Ad Kes Laboratory Analyst ZIOVF-02-02-02/Masil Pemeriksaan Darah Kimia/Rev.01/17 PT. ZIO PAKARTEK PROFESI Garama Citra Hill Complex Block R No. 17JI. Yos Soedarso, Batu Ampar, Batam, Indonesia 29432 Phone. +62 778 7480697 | Fax. +6278 413470 | Email, hrga@zioclinic.com | www.zioclinic.com. 201 0:0 Rap Sua 21ZIOCLINIC Occupational Health & Medicine MCU No. : 2022040784 Date of Birth : 20 June 1982 MCU Date : 19 April 2022 Age 39 Year 9 Month 29 Day Name ERWINSYAH Gender: Male IDNo. 2171032006829021 Package No. : PREMIER OIL. >35 URINALYSIS LABORATORY EXAMINATION REPORT Examination Result Reference Range Unit Explanation ROUTINE URINE Color Light Yellow Light Yellow - Dark Yellow Turbidity Clear Clear SpecificGravity 1.02 1.003 - 1.030 pH 6 45-8 Protein Negative Negative Glucose Negative Negative Ketone Negative Negative Bilirubin Negative Negative Blood Negative Negative Nitrite Negative Negative Urobilinogen 32 32-16 Molt. Esterase Negative Negative Leucooyte ‘SEDIMENT URINE Leucocyte 1 1-5.PB Erythrocyte 1 o2npe Epithelium Positive Positive/PK Cast Negative Negative/LPk Crystal Negative Negative Fungi Negative Negative Bacteria Negative Negative Others = Jimmi M.Tarigan, A.Md.Kes Laboratory Analyst ZIOIF-02:03-02IHasi Pemeriksaan UriniRev.02"18 PT. ZIO PAKARTEK PROFESI Garama Citra Hill Complex Block No. 17JI, Yos Soedarso, Batu Ampar, Batam, Indonesia 29432 Phone, +62 778 7480697 | Fax. #62778 413470 | Email. hrga@zioclinic.com | wwvk.zioclinic.com 20/71 0-01 Fop Sr 0121ZIOCLINIC Occupational Health & Medicine MCUNo. : 2022040764 Date of Birth: 20 June 1982 MCU Date: 19 April 2022 Age 38 Year 9 Month 29 Day Name ERWINSYAH. Gender Male ID No, 2171032006829021 Package No. : PREMIER OIL >35 DRUG LABORATORY EXAMINATION REPORT Examination Result Reference Range Explanation Methamphetami Negative ‘Negative Opiate/ Morphine Negative Negative Amphetamine Negative Negative Cannabis Negative Negative Benzodiazepine Negative Negative Cocaine Negative Negative Conclusion Drug exar tion negative result Examiner AP Jinn M-Tarigan, A.Md.Kes Laboratory Analyst ZIOIF-02:04-021Hasil Pemerksaan Narkoba/Rey 01/17 PT. ZIO PAKARTEK PROFES! Garama Citra Hill Complex Block R No. 17J1, Yos Soedarso, Batu Ampar, Batam, Indonesia 29432 Phone. +62 778 7480697 | Fax. +62 778 413470 | Email. hrga@zioclinic.com | www.zioclinic.com 20771 00/4 Sate 021ZNO NING Occupational Health & Medicine MCUNo. ; 2022040764 Date of Binh ; 20 June 1982 MCU Date: 19 April 2022 Age 39 Year 9 Month 29 Day Name: ERWINSYAH Gender Male ID No. 2171032006829021, Package No. : PREMIER OIL >35 IMMUNOLOGY LABORATORY REPORT Examination Result Reference Range Explanation HbsAg ‘Non-reactive Non-reactive Examiner “A Jimmi M.Tarigan, A.Md.Kes Laboratory Analyst ZIOIF-02-08-02Hasil Pemeriksaan tmunologiRev.01/17 PT. ZIO PAKARTEK PROFESI Garama Citra Hill Complex Block R No. 17J. Yos Soedarso, Batu Ampar, Batam, Indonesia 29432 Phone. +62 778 7480697 | Email. hrqa@zioclinic.com | www.zioclinic.com 0H 1 0 Kp Sue 22MCUNo. : 2022040764 ZIOCLINIC Occupational Health & Medicine Date of Birth ; 20 June 1982 MCU Date : 19 April 2022 Age 39 Year 9 Month 29 Day Name ERWINSYAH Gender: Male ID No, 2171032006820021 Package No. : PREMIER Ol. >35 RADIOLOGY EXAMINATION REPORT Expertise ‘Thorax PA, Sinus Both costophrenic recesses are sharp Diaphragm Normal Heart © Size and shape are normal, CTR<50% Lung Bone and soft tissue = There is no fibroinfitarte, Bronchovascular pattern are normal Bone and soft tissue appeared normal Conclusion, Norms Advice Examiner Doctor dr. Eka Susy Affiani, Sp.Rad Radiologist ZIOIF-02-09-01/Hasil Pemeriksaan Radiologi ThorawRev.01/17 PT. ZIO PAKARTEK PROFESI “OP 1 0 Kon ale 2/22 Garaima Citra Hill Complex Block R No. I7JI. Yas Soedarso, Batu Ampar, Batam, Indonesia 29432 Phone, +62 778 7480697 | Email. hrqa@zioclinic.com | www.zioclinic.comZIOCLINIC Occupational Health & Medicine MCUNo. : 2022040764 Date of Birth : 20 June 1982 MCU Date : 19 Aprit 2022 Age : 39 Year 9 Month 29 Day Name ERWINSYAH Gender Male 1D No. 2171032006829021 Package No. : PREMIER OIL >35 ‘TREADMILL EXAMINATION REPORT Conclusion : Negative ischemic response at 14.4 Mets Advicg Examiner Doctor, dr, Nanang Rudy Utantyo, Sp.JP, FIMA, FASCC Cardiologist ZIOIF-02-11-02Masil Pemerksaan TreadmilRev.0117 PT. ZIO PAKARTEK PROFES| Garama Citra Hill Complex Block R No. 171. Yos Soedarso, Batu Ampar, Batam, Indonesia 29432, Phone, +62 778 7480697 | Email. hrga@zioclinic.com | www.zioclinic.com 20/71 O10 fap Sct 2ZIOCLINIC Occupational Health & Medicine MCU No, 2022040764 Dale of Bith —: 20 June 1982 MCU Date: 19 Apri 2022 ge 39 Year 9 Month 20 Day Name ERWINSYAH. Gender Male 1D No. 2171032006829024 Race Indonesia Package No : PREMIER OlL.>35 Holght/ Weight: 162.0m/60.8 Kg ‘SPIROMETRY EXAMINATION REPORT oT Fae 8 Fa Item Measurement (It) Predicted Value (It) ‘%Prediction FvVe 376 3.98 1078 FEV 3.2 279 719.07 FEVIIFVE Ce wa3 Conclusion. No restrictive lung disease No obstructive lung disease Normal Lung Function ‘Advice = Do Splrometry examination annually Examiner Doctor, dr. Ade Dwi Lestari, M.Kes, Sp.0k Occupational Medicine Specialist ZIOIF-02-13-02/Hasl Pemenksaan Spirometty/Rev.01/17 PT. ZIO PAKARTEK PROFES! Garama Citra Hill Complex Block R No. I7JI. Yos Soedarso, Batu Ampar, Batam, Indonesia 29432 Phone. +62 778 7480697 | Email. hrga@ziocli 200 6-0-0 Fop Sat 0222ZVOC LINC Occupational Health & Medicine MCU No, : 2022040764 Date of Birth : 20 June 1982 MCU Date : 19 April 2022 Age 39 Year 9 Month 29 Day Name ERWINSYAH Gender Mate ID No. 2171032006829024 Package No, : PREMIER Ol. >35 AUDIOMETRY EXAMINATION REPORT Re es RE RigitEar a AC LeA Ear Fara] 280 | S00) ] 1000 | 2000 | 3000] 4000] 6000 | sooo |"hsx | [250 | soo | 1000 | 2000 | 2000] 4000] 6000 | eooo| res" (a) ‘) wpe] s [spapete>ota|tstsp>s pss eps tet is BORG EW mo) BC Lane or) E pe Freee 250 | 500° 1000 ] 2000 | 3000 ]4000 ] 6000 sooo | nas’ || 250 ] 00 | 1000 | 2000 | 3000 [4000 | e000 Joao | "ec¥ i) @ ses os es Po a = 5 = Right Ear Normal Right Ear with increasing hearing level in 6000 Hz dan 8000H2 Left Ear + Normal audiogram ft ear Advico ; Do Audiometry examination annual Examiner Doctor, dr, Ade Dwiestari, M.Kes, Sp.Ok Occupational Med 201 02-12c2ast Pemesksaan Aone Rev O17 PT. ZIO PAKARTEK PROFESI Garama Citra Hill Complex Block R No. 17JI. Yos Soedarso, Batu Ampar, Batam, Indonesia 29432 Phone. +62 778 7480697 | Email. hrga@zioclinic.com | www.zioclinic.com 201% 0-0 fo Surat 02/22ZIOCLINIC Occupational Health & Medicine MCUNe, : 2022040764 Date of Birth ; 20.June 1982 MCU Date : 19 April 2022 Age 39 Year 9 Month 29 Day Name ERWINSYAH Gender Male IO No. 2171032006829021 Package No. : PREMIER OIL >35 ULAR DISEASE (CVD) RISK PREDICTION ESTIMATION ‘A. Introduction Framingham Risk Functions ‘The Cardiovascular disease risk prediction estimation is based on Framingham Risk Functions within 10-year risk-prediction and maximum 12 years. “The risk-prediction of Cardiovascular Dieses (CVD) such as myocardial infarction, coronary insufficiency, angina, ischemic stroke, hemorthagic stroke, transient ischemic attack, peripheral artery disease, and heart failure. B. Personnel Data ‘The Cardiovascular disease risk prediction estimation is based on Framingham Risk Functions within 10-year risk-prediction and maximum 12 years. Risk Factor Result Units ‘Systolic Blood Pressure 709 mmHg ‘Treatment for Hypertension No ‘Smoking Yes Diabetes Ne. HDL 45 mg/dl Total Cholesterol 196 maya C. Cardiovascular Dieses (CVD) 10 Years Risk Prediction Estimation Optimum —Normal Value: 1,9%- 3.7% Your 10 Year Risk Prediction = 5.0% Your Heart/Vascular Age 46 Result + Your Risk Score More Than Optimal & Normal Scores (5.9% > 1.9% 8 3.7%) ‘The study of 10-year risk prediction of Cardiovascular Disease based on D'Agostino, Vasan, Pencina, Wolf, Cobain, Massaro, Kannel. ‘A General Cardiovascular Risk Profle for Use in Primary Care: The Framingham Heart Study and published at hitps://vawwframinghamheartstudy orgjtisk-functions/cardiovascular-disease/ 10-year-isk. php ZIOMF-02-02.04/Prediksi Riko CVD/Rev 00/18 Pic Zi0 PAKARTEK PROFESS Garama Citra Hill Complex Block R No. 17. Yos Soedarso, Batu Ampar, Batam, Indonesia 29432 Phone. +62 778 7480697 | Email. hrga@zioclinic.com | wwrw.zioctinic.com OV ep Surat eu 0272macs J REE cieties 12-L.BAD REPORT. = nwt | PRETEST BRUCE ar iat 80ms Post J (10mm/m¥) Patent ib 2171092006829021 80 bp SUPIN! Ookmh | | | (AR Pit ras | 0:21) 00% [iene Sen Leal Sine) a | ig VI TE cD nt ae Phe aa / eee RR | | GE Medic ee me IT I | CASR ATT hice ea take haha here wat Start of Test: 11:97:16 —srasamanerts LINKED MEDIANS. = ERWINSYAH | Pationt ID: 2171092006829021 96 bpm GET |) lat eal 19.04.2022 | 02:11 109/78 mmHg | 250 TO | | | I {et ST @ 10mm/mV { | 80 ms post J Raw Data I | | GE Medical Systems IT | | [ oe CASE 4.11 25 mm/s 10 mm/mV 50He 0.01 = 40H + HROVE.V6) | BRUCE “Computer Synthesized Rhythms. Start of Pest: 11:27:16 Lead | ST Level mm) ST Slope (mV/s)LINKD MISDIANS per 7 + 1 T NSA | | RXERCISE =———-BRUCE i | | | xi 2aiog2noas29021 STAGE 2 ae ! He ef Pp eae ey } i f st ol (mm) He lope (mV/s) i | i . Raw Data _ a | 1 | | | | i | | | | | *Computer Synthesized Rhythms | CE Medical Systems IT. t | | b+} | CASE 4.11 25 mm/s 10 mm/mV 50Hz 0.01 -40H2z + HR(V6,V6) aS 4 — Start of Test: 11:27:16 = 1 iLIVABY mSULAND , oe a mp pat ERWINSYAH i i xan BRUCE | i | t | i | | Patient ID: 217103200682 tt 16 bpm | 3| Pia {+4 | | fe thotataa 02:03 130/80 mmHg tae = ios | | | | ikea a + es | i i ST Level (mm) ca ST Slope (hV/s) i | | | *tantoser Sythe yt | | start of rest: 11:27:16 |LUND WLULAND iE T | i I I Ei ERWINSYAH t- ee EXERCISE BRUCE | Patient [D: 2171032006829021 151 | STAGE} be | 19.04.2022 ett 02:10 140/85 mmHg } 11:50 | 16.0% 1140.0 | | i | Lead | | | | ST Level (mm) | GE Medical Systems IT. CASE 4.11 | ST Slope (mV/s) | | | i | | 0,00 . 1.08, | LOT | g *Computer Synthesized Rhythms. 25 mm/s 10 mm/mV 50Hz 0.01-40Hx + HR(V5,V6) Start of TeLINKISD MEDIANS (PRANK BABKUIDE) ERWINSYAH | | EXERCISE BRUCE | Patient ID: 2171032006829021 162 bom STAGE 5 19 km/h | | 19.04. I | 1227 18.0% tT | Thad | 11:40:38 | | | St Level (mm) | | | ST Slope (mV/s) | 1.38 to) Sate | *Computer Synthesized Rhythms GE Medical Systems IT | CASE.4.11 25 mm/s. 10 mm/mV_ 60Hz 0.01-40Hz + HR(V5,V6) | Start of Test: 11:27:16LINKIGD MISDIANS I | i 1 T ERWINSYAH | | RECOVERY: Patient ID: 217103200682902: 155 bpm RECOVERY! 19.04.2022, | 00:15 | 11:40:53 | | | { | | [at 81'@ 10mm/i Tet | 1 | sr oun | | | ae Raw Data | i | I GE Medical Systems IT 1 t CASE 4.11 25 mm/s 10 mm/mV 60Hz 0.01-40H2 + HR(V5,V6) BRUCE pay 24 km/h at i | 1.2% I | Lead { | | ST Level (mm), | ST Slope (mV/s) “Computer Synthesized Rhythms Start of Test: 11:27:16| ane E --- oy anp paddoys sw $sey osio12x9 Ou -Spuut ¢/op] 4o amssaud pooyg wnumreeur 8 o} asox * Spy —/=- asnssaxd pooyg Sunsoy “eves uway ______-08e joueeut op Jo 9% 68 stuasesdar yorum widg Zot Jo ones treay “xeuL @ ot esos “Widq cg AjjeutUt Busou ‘OF PI 'SLAIN PIV J0 JonsI HOM ® Supengor ‘92-21 384 AOA eu 01 Suyproo9" pesio.s: agiowaxa. Assiawd Ldodaa LISAL ssTaLs ite coat E Pre EERWINSYAH, Patient ID 2171032006829021 19.08.2022" 30 112716 162 em, Meds: ‘Vest Reason: t Mita History: | Ref MD: Ordering MD: | ‘Technician: Test Type: © Comment: | | | BASEL PEAK EXERCISE EXERCISE oo 85 bpm nae re 0.70 mm ae 0 | 1.65 | 1AT | nae | 0.95 | 0.68 we 1.25 om | ‘GE Medical Systems IT CASE 4.11 1OmmimV SH = r | SBLEC LED MEDIANS KEPUKL . | ina a | BRUCE Total Exercise Time 12:26 = Max HR: 162 bpm_ 89% of max predicted 181 bpm | | | | Max BP: 140/85 Maximum Workload: 14.40 METS | | | | | | | t ‘TEST END. | PEAK EXERCISE TEST = | RECOVERY | | EXERCISE | RECOVERY t 0: i 1227 034 144 bpm 162.bpm 144 bpm | 14085 meg, 140085 mtg | iw vi | 065 O15 2.00 | js | 1 ve 1.90 OS 323 oaz 184 t m WY v | a 327 va 1,80) 2.91 vs | 150, 5S sys cs eee gS css pes = oo ps = 1.84 258, | { | | | Po - Lv | + i 1.25 0.10 aa 0.98 1.40 | 93. | 0.01-40Hz + Poufinhed by} ‘Attending MD: deNanang Rudy Utantyo, Spf