RS.

Premier Bintaro Pathology Service

Jl. MH Thamrin No.1 Sektor 7 Bintaro Jaya
. Tangerang Selatan 15224 – Indonesia
Consultant : Dr. July Kumalawati WIdyaharsana SpPK

M.R.N : 0057626 Sex : Male Lab No. : 202208302746

Age : 23 D.O.B : 23-06-1999 Patient Name : Muh Nur Said
Location : Drive Thru Clinic Requesting Dr : Dokter Lain

Report to : Dokter Lain

Collection Time & Date Received in Lab Specimens received

23:55 30-12-2022 23:55 30-12-2022
Cilinical Notes

Authorized by : Tri Joko G. Santoso

Date : 31-12-2022
Print Time/Date : 04:59 31/12/2022 ***FINAL REPORT***
Time : 04:59
Page : 1 of 1

LABORATORY / PHARMACY / RADIOLOGY / AMBULANCE 24 HRS

FRM/PPM/LAB/25 Rev.01