LABORATORIUM KLINIK MEDIKA SEHAT

Nama................................................ No.Lab ...................... Umur................. Tahun..................Kamar........................................................ Status......................................................... Sex F/MDr.............................................................Tanggal........................................................................

Glukosa / Darah Darah

Gula Puasa: ................................................................................................. 76 - 110 mg/dlGula 2 JPP: ............................................................................................... up to 125 mg/dlGula Sewaktu: ................................................................................... Dewasa 76 125 mg/dl

Pemeriksa

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LABORATORIUM KLINIK MEDIKA SEHAT

Nama................................................ No.Lab ...................... Umur................. Tahun..................Kamar........................................................ Status......................................................... Sex F/MDr.............................................................Tanggal........................................................................

URINALISA

MakroskopisWarna: ........................................Blood Gross: ...........................................Kejernihan: ........................................Berat Jenis:.............................................Keasaman: .......................................pH: ............................................KimiaUrobilinogen: .......................................Glukosa: ..........................................Bilirubin: .......................................Protein: ...........................................Benda Keton: .......................................MikroskopisSedimen: .....................................Darah samar: .....................................

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LABORATORIUM KLINIK MEDIKA SEHAT

Nama................................................ No.Lab ...................... Umur................. Tahun..................Kamar........................................................ Status......................................................... Sex F/MDr.............................................................Tanggal........................................................................

HEMOSTASIS

Masa Perdarahan: ..................................................................................Masa Pembekuan: ..................................................................................Percobaan Pembendungan: ..................................................................................Golongan Darah ABO, Rh: ..................................................................................

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LABORATORIUM KLINIK MEDIKA SEHAT

Nama................................................ No.Lab ...................... Umur................. Tahun..................Kamar........................................................ Status......................................................... Sex F/MDr.............................................................Tanggal........................................................................

HEMATOLOGI

Hemoglobin (HGB): ............................................gr/dl (Lk 13-17 / Pr 12-15)Leukosit (WBC): ................................................./mm2 ( 5.000 10.000 )LED :........................................... mm ( Lk 0 15 / Pr 0 20)Erytrosit (RBC): ...........................juta/mm2 ( Lk 4,5 -6,0 / Pr 4,0 5,5 )Trombosit (PLT):............................................./mm2 ( 150.000 400.000)Retikulosit: ............................................................% ( 0,5 1,5 % )Eosinofil:............................................................/mm3 ( 50 300 )Pemeriksaan Sediaan Apus:......................................................................................Hitung Jenis / Diff. Count:......................................................................................

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LABORATORIUM KLINIK MEDIKA SEHAT

Nama................................................ No.Lab ...................... Umur................. Tahun..................Kamar........................................................ Status......................................................... Sex F/MDr.............................................................Tanggal........................................................................

MIKROBIOLOGI

MikroskopisFilaria: .....................................................................................................Malaria: .....................................................................................................Jamur: .....................................................................................................Corynebacterium sp: .....................................................................................................BTA: .....................................................................................................Pengecatan Gram: .....................................................................................................

Pemeriksa

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