MEDICAL REPORT

No. Lab : 4587

Name : YENI SILFIA PERMADANI
Sex : FEMALE Date Issue : OKT 13 th 2017
Age : 24 Years Nationality : Indonesian
Adress : Komp.Mustika Griya Angkasa 111Blok. B. No.19
PUT MARK (V) NORMAL PUT MARK (X) ABNORMAL
History of Illnes
1. Height : cm 2. Weight : kg 3. Pulse : /min
4. Blood Pressure 5. Systolic : mmHg 6. Diastolic : mmHg
MEDICAL EXAMINATION
Eyes : Right Eye ( ) Skin Disease ( ) Serelogy :
Left Eye ( ) Blood Pressure ( ) HIV (V)

Ears : Right Ear ( ) HbsAg ( )

Left Ear ( ) Anti HbsAg ( )

Hematology :
Malaria ( )
Hb ( )
Internal Disease: Gol Darah
Leuco ( )
Heart ( ) Ery ( )
Lungs ( ) Tromb ( )
Liver ( ) Ht ( )
Spleen ( )
Kidney ( )

Chest X-Ray
Within normal limit

Above medical report of Mr/Mrs/Miss : Yeni Silfia Permadani

He/She is : FIT for employment Hospital Phsychian

Expire Date : NOV 13 th 2017

Stamp of Agencies dr. Fransiska Ria

 MEDICAL REPORT
No. Lab : -
Name : JUMIATI
Sex : FEMALE Date Issue : July30th 2015
Age : 19 Years Nationality : Indonesian
Adress : Dsn. Barat Jawai
PUT MARK (V) NORMAL PUT MARK (X) ABNORMAL
History of Illnes
1. Height : 161 cm 2. Weight : 43 kg 3. Pulse : 82 /min
4. Blood Pressure 5. Systolic : 120 mm Hg 6. Diastolic : 80mmHg
MEDICAL EXAMINATION
Eyes : Right Eye ( v ) Skin Disease ( v ) Kimia Klinik :
Left Eye ( v ) Blood Pressure ( v ) Creatinine (v)

Ears : Right Ear ( v ) Urea (v)

Left Ear ( v ) Hematologi: SGOT (v)

Hb ( v ) SGPT (v)
Internal Disease:
Leuco ( v )
Heart ( v )
Ery ( v )
Lungs ( v )
Tromb ( v )
Liver ( v )
Ht ( v )
Spleen ( v )
Difcount
Kidney ( v )
Lymph # ( v )
Mid # ( v )
Chest X-Ray
Gra # ( v )
Lymph ( v )
Within normal limit
Mid ( v )
Gra ( v )
 Above medical report of Mr/Mrs/Miss : JUMIATI

He/She is : FIT for employment Hospital Phsychian

Expire Date : Okt30th 2015

Stamp of Agencies dr. D A R Y L

NIK. 000322/RSSE