INDOSEHAT 2003 CLINIC & MEDICAL CHECK-UP SURAT KE TO WHOM IT MAY CONCERN Dengan ini kami menerangkan bahwa : Here with acknowledge that : Name ANGGIT PRIADI Jenis Kelamin Gender/Sex PRIAIMALE: ‘Tempat / Tanggal Lahir Proce /bate oF th TEAL /JULY 07,1981 Perusahaan Company GREEN MARINDO ABADI Jabatan Occupation WORKER Benar telah melakukan Medical Check-Up di Indosehat 2003 Medical Centre. Have trully complete Medical Standart Check-Up in Indosehat 2003 Medical Centre. Dengan Hasil_: Sehat untuk Bertugas. With Final Result: FIT. Demikian surat keterangan ini kami sampaikan untuk dapat dipergunakan sebagaimana mestinya. hope this letter wil be found useful where necess. Jakarta, 11 July 2022 U dr. Widha Puji lsmayawati Examination Date Of Examination, July 11, 2022 Expiration Of Validity, July 11, 2024 RR eCON KC a ay BER ee Cen ety ROTM Kita Website https : //www.indosehat2003. Email : info@indosehat2003.iINDOSEHAT 2003 CLINIC & MEDICAL CHECK-UP MEDICAL EXAMINATION REPORT aH © ‘OMPANY GREEN MARINDO ABADI MCU No, Eee eee ANGGIT PRIADI ay PRIAIMALE DATE EXAMINE :11 Jul 2022 PLACE & DATE OF BIRTH TEGAL / 07 July 1981 NATIONALITY: INDONESIA MAILING ADDRESS OF EXAMINE JL SAPARUA RT 015/009 KEL. PANGGUNG KEC. TEGAL TIMUR -TEGAL pon WORKER PASSPORT: MEDICAL HISTORY (EXAMINE PERSONAL DECLARATION) CE ee Oe mea BLOOD PULSE] RESPIRATORY Seen ae cents WEIGHT | pressure | REGULAR RATE 1. ALCOHOL HISTORY No 2 ALLERGKS HISTORY i Bem Tkg 120770 mmHg | 83 X/min 20XImin 3. AMPUTATION No COLOR VISION 4. BLOOD DISORDER No Vl pono ere USIHARA'S METHOD) 5. BALANCE PROBLEM No [Right Eye 20750 6. BACK OR JOINT PROBLEM No | Lett Eye 20/35, 7. COLOUR BUNDNESS No [Both eve 20/30 aul 8, CANCER No ‘GENERAL APPEARANCE 9, DIABETES: No HEALTHY 20, DIGESTIVE DISORDER No aoe ee 11. DEPRESION No 12. EPILEPSY Te es . 13. EYE / VISION PROBLEM No |2.€ves Yes 14 EAR PROBLEM, No |2. EARS Yes 15. FRACTURE No |3. Nose Yes 16. GENITAL DISORDER No |4 Moura Yes 117. HEART SURGERY No |5. THROAT Yes 18, HEART DISEASE No |6.NECK Yes 19, HIGH BLOOD PRESSURE No | 7.THROID Yes 20. HERNIA No |8.LYMP NODE Yes 21. INFECTIOUS DISEASE No |. LUNGS Yes 22. KIDNEY PROBLEM No |10. HEARTS Yes 23. LUNG DISEASE No |11. ABDOMEN Yes 24, LIVER PROBLEM No | 12. UROGENITAL SYSTEM Yes 25. LOST OF MEMORY No |13. UPPER EXTREMITIES Yes 126, NARCOTIC HISTORY No |14. LOWER EXTREMITIES Yes 27. NEUROGICAL DISEASE No |25. BACK ABNORMALITY. Yes 28. OPERATION / SURGERY No |16. HERNIA Yes 29, PSYCHIATRIC PROBLEM No |17. CENTRAL NERVOUS SYSTEM Yes 30, RESTRICTED MOBILITY No. SKIN 6 NAILS Yes 31. SKIN PROBLEM No |19. SPEECH Yes 32, SLEEP PROBLEM No |20. OTHERS Yes 3. THYROID PROBLEM No 34, TUBERCULOSIS. No 35. SMOKING. Yes DENTAL EXAMINATION. HEARING abnormal, give details 7654321]12345678 WORMAL 87654321|12345678 Right Ear Yes Filing Caries ~:Root Rest | Left Ear Yes issing_V: Prothesa RN Re BOTT aren CCRC IL) ACM CIEE eee eee aa UC aC) UROL aE)