Ap. 5.9. Ep.3 Form Hasil Pemeriksaan Lab

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DETASEMEN KESEHATAN WILAYAH 14.04.01
RUMAH SAKIT TK. IV 14.07.01 BONE
HASIL PEMERIKSAAN LABORATORIUM

Nama J/K
Dokter Pengirim Umur
Tgl Periksa Status
Diagnosa No. RM
Ruangan jam
HEMATOLOGY Kimia Klinik
Pemeriksaan Hasil Nilai Rujuk Pemeriksaan Hasil
Eritrosit (3.50-5.00 ) 10^6/uGDS
Hemoglobin 11.0-15.0 g/dl GDP
Hematokrit 37.0-48.0 % GD2PP
Leukosit (4.0-10.0) 10^3/uL Ureum
Trombosit 150.000-400.000 Creatinin
Segmen 50.0-70.00 % Asam Urat
Limfosit 20.0-40.0% SGOT
Monosit 3-9% SGPT
LED L: <10 mm/jam Kolesterol Total
P: <15 mm/jam Kolesterol HDL
CT 2-6 menit
BT 1-6 menit Kolesterol LDL
Golongan Darah Trigliserida
IMUNOSEROLOGI URINALISIS
Pemeriksaan Hasil Nilai Rujuk Leukosit
1. Plano Test Negatif Ketone
2. HIV Negatif Nit
3. HBsAg Negatif Uro
4. HCV Negatif Bilirubin
5. Malaria Negatif Protein
6. Anty Dengue Negatif Gluko
7. VDRL/SYP Negatif SG
8. Anti TB Negatif BLD
9. Pertanda Tiroid PH
TSH 0,4-5,5 mlU/L vc
Tinja
Widal Makro :
S.Thypi S.ParaThypi Mikro
O H AH BH
Analis Penanggung Jawab,
( ) ( )
mia Klinik
Nilai Rujuk
< 140 mg/dl
<110 mg/dl
<200 mg/dl
13-43 mg/dl
0,7-1,2 mg/dl
< 7,0 mg/dl
< 33 U/L
< 50 U/L
< 200 mg/dl
L: 35-55mg/dl
P: 45-65 mg/dl
< 100 mg/dl
<150 mg/dl
URINALISIS
Tinja
anggung Jawab,
)
RUMAH SAKIT TK.IV 07.07.02 BONE
RIKSAAN LABORATORIUM
NaSLex
DoU35Th
sia
TgNo LAB
Pemeriksaan
Pemeriksaan
Nilai
Nilai
Hasil
Hasil
Rujuk
Rujuk
HEMATOLOGI
KIMIA KLINIK
845.24
mg/dl
E(GDS
70-115 mg/dl
13.6
H1G<110 mg/dl
45.4%
H3G<140 mg/dl
18.700
L(U10-50 mg/dl
###
T(C0,6-1,4 mg/dl
LU2,4-7,0 mg/dl
L
PS8-38 U/L
S3-35 U/L
82.6%
S5A34-114 U/L
12.5%
L2K< 200 mg/dl
4.9%
M3L: 35-55mg/dl
Kolesterol HDL
H P: 45-65 mg/dl
C2K<130 mg/dl
B1T<200 mg/dl
A3,5-4,8 gl/dl
IMUNOSEROLOGI
URINALISIS
1:LP
2:KG
3:NS
4:UB
5:BP
6:V
7:8.Widal
S. Paratyphy
S.Typhy
O
AH
BH
H
TB Test
Spesimen
HasilDahak
S
PS
Sewaktu 2
Feces
FecesMakroskopis
Mikroskopis
Pemeriksaan
Nilai
Hasil
Rujuk
WN
KN
DN
LN
T
NaJL.Kelamin
DoU8sia
Th
TgNo
###LAB
Pemeriksaan
Pemeriksaan
Nilai
Nilai
Hasil
Hasil
Rujuk
Rujuk
HEMATOLOGI
KIMIA KLINIK
4.83
Eritrosit
(G70-115 mg/dl
12.5
Hemoglobin
1G<110 mg/dl
39.2%
Hematokrit
3G<140 mg/dl
6.700
Leukosit
(U10-50 mg/dl
###
Trombosit
C0,6-1,4 mg/dl
LU2,4-7,0 mg/dl
LED
PS8-38 U/L
S3-35 U/L
79.5%
Segmen
5A34-114 U/L
15.5%
Limfosit
2K< 200 mg/dl
5.0%
Monosit
3L: 35-55mg/dl
Kolesterol HDL
P: 45-65 mg/dl
C2K<130 mg/dl
B1T<200 mg/dl
A3,5-4,8 gl/dl
IMUNOSEROLOGI
URINALISIS
:LP Kehamilan
1.Tes :
2.
:KGHIV :
3.
:NSHBsAg :
:UBHCV
4.
:BPMalaria
5. :
:V DBD
6.
:8 VDRL/SYP
7.
S. Paratyphy
S.Typhy
O
AH
BH
H
TB1/40
Neg
Test
Neg
Neg
Spesimen
HasilDahak
S
PS
Sewaktu 2
Feces
FecesMakroskopis
Mikroskopis
Nilai
Hasil
Rujuk
WN
KN
DN
LN
NaJL.Kelamin
DoU45sia Th
TgNo
###LAB
Pemeriksaan
Pemeriksaan
Nilai
Nilai
Hasil
Hasil
Rujuk
Rujuk
HEMATOLOGI
KIMIA KLINIK
1145.40
Eritrosit
mg/dl
(GDS
70-115 mg/dl
14.4Hemoglobin
g/dl
1G<110 mg/dl
46.6%
Hematokrit
3G<140 mg/dl
25
8.200
mg/dl
Leukosit
(Ureum
10-50 mg/dl
0,7###
mg/dl
Trombosit
Creatin
0,6-1,4 mg/dl
5.1 mg/dl
LUric
2,4-7,0
Acidmg/dl
LED
27 PU/L
SGOT
8-38 U/L
22 U/L
SGPT
3-35 U/L
58.4%
Segmen
5A34-114 U/L
187 mg/dl
33.8%
Limfosit
2Kolesterol
< 200 mg/dlTotal
7.8%
Monosit
3L: 35-55mg/dl
45 mg/dl
Kolesterol HDL
P: 45-65 mg/dl
118 Cmg/dl
2Kolesterol
<130 mg/dl LDL
120 Bmg/dl
1Trigiserida
<200 mg/dl
A3,5-4,8 gl/dl
IMUNOSEROLOGI
URINALISIS
:LP Kehamilan
1.Tes :
2.
:KGHIV :
3.
:NSHBsAg :
:UBHCV
4.
:BPMalaria
5. :
:V DBD
6.
:8.Widal
7. VDRL/SYP
S. Paratyphy
S.Typhy
O
AH
BH
H
TB Test
Spesimen
HasilDahak
S
PS
Sewaktu 2
Feces
FecesMakroskopis
Mikroskopis
Nilai
Hasil
Rujuk
WN
KN
DN
LN
NaJL.Kelamin
DoU36siaTh
TgNo
###LAB
Pemeriksaan
Pemeriksaan
Nilai
Nilai
Hasil
Hasil
Rujuk
Rujuk
HEMATOLOGI
KIMIA KLINIK
1184.96
Eritrosit
mg/dl
(GDS
70-115 mg/dl
13.1Hemoglobin
1g/dl
G<110 mg/dl
43.0%
Hematokrit
3G<140 mg/dl
21
8.900
mg/dl
Leukosit
(Ureum
10-50 mg/dl
1.0###
mg/dl
Trombosit
Creatin
0,6-1,4 mg/dl
6.2 mg/dl
LUric
2,4-7,0
Acidmg/dl
LED
15PSGOT
U/I
8-38 U/L
19 SGPT
U/I
3-35 U/L
64.4%
Segmen
5A34-114 U/L
165 mg/dl
27.9%
Limfosit
2Kolesterol
< 200 mg/dlTotal
7.7%
Monosit
3L: 35-55mg/dl
46 mg/dl
Kolesterol HDL
P: 45-65 mg/dl
89 mg/dl
C2Kolesterol
<130 mg/dl LDL
146 Bmg/dl
1Trigiserida
<200 mg/dl
A3,5-4,8 gl/dl
IMUNOSEROLOGI
URINALISIS
:LP Kehamilan
1.Tes :
2.
:KGHIV :
3.
:NSHBsAg :
:UBHCV
4.
:BPMalaria
5. :
:V DBD
6.
:8.Widal
7. VDRL/SYP
S. Paratyphy
S.Typhy
O
AH
BH
H
TB Test
Spesimen
HasilDahak
S
PS
Sewaktu 2
Feces
FecesMakroskopis
Mikroskopis
Nilai
Hasil
Rujuk
WN
KN
DN
LN
NaJL.Kelamin
DoU23siaTh
TgNo
###LAB
Pemeriksaan
Pemeriksaan
Nilai
Nilai
Hasil
Hasil
Rujuk
Rujuk
HEMATOLOGI
KIMIA KLINIK
1255.20
Eritrosit
mg/dl
(GDS
70-115 mg/dl
12.5Hemoglobin
1g/dl
G<110 mg/dl
39.0%
Hematokrit
3G<140 mg/dl
19
6.500
mg/dl
Leukosit
(Ureum
10-50 mg/dl
1.1###
mg/dl
Trombosit
Creatin
0,6-1,4 mg/dl
3.5 mg/dl
LUric
2,4-7,0
Acidmg/dl
LED
19PSGOT
U/I
8-38 U/L
20 SGPT
U/I
3-35 U/L
61.4%
Segmen
5A34-114 U/L
156 mg/dl
34.5%
Limfosit
2Kolesterol
< 200 mg/dlTotal
4.1%
Monosit
3L: 35-55mg/dl
46 mg/dl
Kolesterol HDL
P: 45-65 mg/dl
93 mg/dl
C2Kolesterol
<130 mg/dl LDL
99 mg/dl
B1Trigiserida
<200 mg/dl
A3,5-4,8 gl/dl
IMUNOSEROLOGI
URINALISIS
:LP Kehamilan
1.Tes :
2.
:KGHIV :
3.
:NSHBsAg :
:UBHCV
4.
:BPMalaria
5. :
:V DBD
6.
:8.Widal
7. VDRL/SYP
S. Paratyphy
S.Typhy
O
AH
BH
H
TB Test
Spesimen
HasilDahak
S
PS
Sewaktu 2
Feces
FecesMakroskopis
Mikroskopis
Nilai
Hasil
Rujuk
WN
KN
DN
LN
NaJL.Kelamin
DoU35sia Th
TgNo
###LAB
Pemeriksaan
Pemeriksaan
Nilai
Nilai
Hasil
Hasil
Rujuk
Rujuk
HEMATOLOGI
KIMIA KLINIK
1045.39
Eritrosit
mg/dl
(GDS
70-115 mg/dl
14.1Hemoglobin
1g/dl
G<110 mg/dl
46.0%
Hematokrit
3G<140 mg/dl
30
7.600
mg/dl
Leukosit
(Ureum
10-50 mg/dl
0,9###
mg/dl
Trombosit
Creatin
0,6-1,4 mg/dl
5.4 mg/dl
LUric
2,4-7,0
Acidmg/dl
LED
19PSGOT
U/I
8-38 U/L
25 SGPT
U/I
3-35 U/L
67.0%
Segmen
5A34-114 U/L
160 mg/dl
26.1%
Limfosit
2Kolesterol
< 200 mg/dlTotal
6.9%
Monosit
3L: 35-55mg/dl
38 mg/dl
Kolesterol HDL
P: 45-65 mg/dl
96 mg/dl
C2Kolesterol
<130 mg/dl LDL
130 Bmg/dl
1Trigiserida
<200 mg/dl
A3,5-4,8 gl/dl
IMUNOSEROLOGI
URINALISIS
:LP Kehamilan
1.Tes :
2.
:KGHIV :
3.
:NSHBsAg :
:UBHCV
4.
:BPMalaria
5. :
:V DBD
6.
:8.Widal
7. VDRL/SYP
S. Paratyphy
S.Typhy
O
AH
BH
H
TB Test
Spesimen
HasilDahak
S
PS
Sewaktu 2
Feces
FecesMakroskopis
Mikroskopis
Nilai
Hasil
Rujuk
WN
KN
DN
LN

Ap. 5.9. Ep.3 Form Hasil Pemeriksaan Lab

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Ap. 5.9. Ep.3 Form Hasil Pemeriksaan Lab

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HASIL PEMERIKSAAN LABORATORIUM

Analis Penanggung Jawab,

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