MP MEDIKA PLAZA HENDRA WIRYA PRANATA ONE TIME CUSTOMER lesved Dato Doctor Name 20 July 2023, ( ShezarinaPratita INNOVATION CERTIFICATE OF HEALTH ASSESSMENT Fit with Medical Note CONCLUSION. ExpiedDate Door Name Vertes by 20 July 2024 fr Muhsmeadlyas, Sp. M Fees. the Paizo 40yo OTHER veges 1500 918 o~- @~-----M i MEDIKA PLAZA YEARS OF INNOVATION Kepada yang berkepentingan Thisis certify that today: Thursday, 20 July 2023, Medika Plaza Cliniches performed urine drug screening and/or breath alcohol test to Dengan ini menyataken bahwa, pada hari ini Thursday, 20 July 2023, Medika Plaza Clinic telah melakukan urine drug screening dar/atau breath alcohol est kepada With the resus areas follows ‘Dengan hasllsbagaiberikut Deugiest esl Ui obat Hasi URINE DRUGS SCREENING ~ Amphetamine T Non-Newative Neale NZA =Met-Amphetamine T Non-Negative Negative TF N/A | =cocain T Non-Negatve Negative N/A “THC ICanabia/ Marana T Non-Negative Negative TF N/A = Morphine/Ophiates T Non-Negative Negative TF NJA =P.CP/Phencycldine T Non:Negative Negative W N/A Borbiturate T Non-Negative Negative N/A [FEeenzosiazepin T Non-Negative Negative TF N/A [Methadone T Non:Nesative Negative W N/A | Propoxyphene T Non-Negative Negative N/A [oxycodone T Non-Newative Negative N/A =MDMA TNan-Negative Negative N/A =6MAM T Non-Newative Negative _W NIA BREATH ALCOHOL TEST [-Aleoho T Non-Negative 1 Negative NTA Jakarta Selatan, July 20,2023 MPs dr. Vii urfaningsh PK Clinical Patologist, ee CT a “5375 1500 918ss 4 nn MPP cecses nines a — YEARS OF INNOVATION HEALTH ASSESSMENT REPORT HENDRA WIRYA PRANATA 1122004493 Thursday, 20 July 2023 Noted: Medical Records Private Document “The results showing thehesth status base onthe assessment onthe date oncoming ~The patienthad been sing ainform consent form beforethe examination cuniewren wr meditaplazacom aera "aD Bede Hert 337 1500 918MPT MEDIKA PLAZA PATIENT DATA MecicalRecord No. 1122004499 Name HENDRA WIRYA PRANATA Employee No, . JobTitle ADMIN Company Name (One Time Customer Employee Status Active SUMMARY | meoicat rinoine ‘LLeueoeytess 2 Hypercholesterolemia 3 inresed GPT Non reactive Ant HBS 5. Decreasing of visual acuity of bath eyes 6 Sprometry: Md Restrictive Severe Obstrctive 7. Decreasing of hearing acultyon low and high frequency of bathers 8 Overwelaht 9. Hypertension rade 10.Cerumen obsturans on bathers {UL Leftrasalseotum deviated 12 Tensilar hypertrophy 15 Prosthesis radix and mssngteeth ‘Yourftnes status ifiwith mesial nate {LHyperchoesteroleris 2 spirometry: Severe Obstructive SUGGESTION fee enr renee 4L Repeat Leukocy examination after 1 month ndconsutation with an Internististil increase 2.Low fat det and exercise reglrWy minimal 3 times a week. Consultation with an internist fr further evaluation of hypercholesterclemia ‘Take enough rest minimal 8 hours/day Repeat SGPT examination 1 month ater anc consutto an Interistifstilincrease 4.Need toget HepattsB vaccination (booster) 5.You need to wear gasses forboth eyes vison = YEARS OF INNOVATION Place of Birth DEPOK Bicthday 32 January 1983, Sex Male Status Marcied Nationality 2 WN WORK EXPOSURE 4. Siting Continuously Over 4 Hours 2 ScreenTTime> 4 Hours /Day 5. Adminstration Werk 6 Repest spirometry examination, Avoid dust and fumes and use face mask file working at dusty area. Consuitation with a Pulmenolglt for further evaluation af Sprometry: Severe Obstructive 7d nosy envronment and use earpug properly while working at noy work environment to prevent further hearingimpaiment 8 Reduce body welght gradually 05 Kes/week, by doing regular exercise (aerobic oging,-¢x/veek, 20-45 minuts and reduce high lorie dit unt maximal body ‘weights 73 93 kgs present body weighs 88 5 Kgs. Consultation with a Nutritionist for evaluation of everweight Low sal cet and mortor your blood pressurregulaly minima nce intwe weeks, Consultation witha Carcilopst.if your beod pressure tendsto increase 10.Consultation with an ENT specialist fr corumenetraction {1 Consuitation with an ENT specialist fan complaint of Left nasal septum deviated 12.Consutstion with an ENT seca fay come ‘of Tonilarbypertrophy 413. Consuitation with Dontist or dental care, minimalonceayearor better onceinsicmenth je ResponsibieDoctor Come seco Shriaderechopracom aera RSET ine Sew perme Hides Habis Pater Hera 3375 1500918 Ore Qe Qe ©MEDIKA PLAZA MP*. ‘ynontcredtanzacom Cine Pane +2 20)29522618 Fae TGA ea Heel inwovanion dr.ShezarinaPratita, veces 1500918 eMpP* MEDIKA PLAZA ANAMNESA PRESENT COMPLAINT AND HISTORY OF PRESENT ILLNESS, VERIFIED BY RS OF INNOVATION HENDRA WIRYA PRANATA One Tine Customer Male MR : 1122008899 DOB : 12Janvary 1988 ‘ist Thursday 20 July2028 ‘CLINICAL EVALUATION 4r- Shani Qisthna Fuad RESULT 20 ly 2023 oe LUNES Present Complaint Nocomplaint MEDICAL HISTORY Alergy Yes Seafoe urticaria) Inmunzation Yes COMD-19 1tbooster Surzery No Hospitaliation No ‘Asthma tas occutrence: 1 week ag, controled Ventolin Disease Yes inhaler, Gates, Hypertension fontrolied with Iitestle raaifeation never tke mediation) Disbetes Melts No LesTYLe ‘cohol Intake No smoking Stopped Exsmoker stopped 9 years 350 Exercse Minor Exercise Walking, week or 30 minutes FAMILY MEDICALHISTORY Diabetes Melts No Hypertension Yes Parents HeaetDicease No LungTB No Asta Yes Parents children Mental Disease No Eplensy No Cancer No Color aindness No Stoke Yes Father ver Disease No Bone & Joint Disease No ‘other Diseases No Kidney Disease No WORK EXPOSURE PHYSICAL Nolse No Eee = Ss a we5555 1500 918 Qn Qiemicn @ wee Qn mtoenM +- MEDIKA PLAZA om Ws wo.cer cena ‘. ia ‘e siren ve soncntOur r ve vor ‘e veero.os “noe ih iad ‘ ‘we Otel ‘° cnt te Unter one te oe Vigan ote hai Ws nacre ve A resting "e ee a = YEARS OF INNOVATION 1500 918MP" MEDIKA PLAZA ie iivinon HENDRA WIRYA PRANATA Yo Many cea evo men aaron evel igonrnc cot orn ver vas snr sno ne raion tne suse en Ss sera re siemat____ Tolga Ts wou a — 75 1500918 e-- o -—-+- MP MEDIKA PLAZA YEARS OF INNOVATION Or Oo @ Gum Normal Dental ‘Abnormal Prosthesis ad and missingteeth NECK General Normal Thyroid Gland Normal Hest GENERAL Form Normal LNG Inspection Normal Palpation Normal Percussion Normal Auscultation Normal HEART Inspection Normal Palption Normal Percussion Normal Ausculation Normal ‘BREAST Inspection Normal Palation Not Examined Percussion Not Examined ‘Auseultation Not Examines ‘ABDOMEN Form Fat Palpation Supet Liver Not Palpable Spleen Not Palpable Kidney [Not Balloument HERNIA Inspection Notéxist Palption Noteaist Percussion Not Examined ‘Avscltation Not Examined [EXTRIMITIES, Bones, Joint Normal Muscles Torus Normal Finger, Nall Normal Hand Normal Feot Normal RECTAL EXAMINATION 1500 918MEDIKA PLAZA MP, YEARS OF INNOVATION Perianal and perineum area: noinflammtion, anal sphincter tone: parma [=[>[* =| [=| =[=[°|= ac 6 ac 5 ec ac Autiometry Resut 0: rontew 1c) : x: Ler ea (2c) Frequency) Conclusion Right Ear Hearing Theesshold = 225548 (wien Norma imi) With Decreasingan Frequency 250H, 2000, 6000Hz ConchsionteftEar Hearing Threshold = 21.25 8 {win Norms Li) ‘With Deereasingon Frequency 250H, SOOM, OOOH ce ree ree 3375 1500918 @ wines Qecinee wines Qo veeMP B- MEDIKA PLAZA YEARS OF iar ner INNOVATION HENDRA WIRYA PRANATA re Tne ster vale CARDIOLOGY DIAGNOSTIC vam azz 08 : 12sauays909 Visit: Thursday 20 July 2029, CLINICAL EVALUATION VERIFIEDBY dr. Adolf Hubertus Amahorseja,SpJP EXAMINATION ane Sinus Ryton Axis (1), P Wave (N }. PR nt 0.16, -T Segment (N), Arta) 20 July2023, ‘Comments 1 Nertmal ECS ECG REPORT = = cera