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  • Formulir Lab

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    ADMEN PAGELARAN
    100 vizualizări1 pagină
    This document is a laboratory test request form from RSUD Pagelaran. It lists over 100 different medical tests that can be requested, organized into categories such as hematology, chemistry, liver and kidney function, lipids, electrolytes, immunology, tumors, hormones, urine analysis, and bacteriology. The form includes fields for patient identification and diagnosis, tests requested, and doctor's signature.

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    This document is a laboratory test request form from RSUD Pagelaran. It lists over 100 different medical tests that can be requested, organized into categories such as hematology, chemistry, liver and kidney function, lipids, electrolytes, immunology, tumors, hormones, urine analysis, and bacteriology. The form includes fields for patient identification and diagnosis, tests requested, and doctor's signature.

    Drepturi de autor:

    © All Rights Reserved
    Descărcați ca DOC, PDF, TXT sau citiți online pe Scribd
    Indicator pentru conținut neadecvat
    100 vizualizări1 pagină

    Formulir Lab

    Încărcat de

    ADMEN PAGELARAN
    This document is a laboratory test request form from RSUD Pagelaran. It lists over 100 different medical tests that can be requested, organized into categories such as hematology, chemistry, liver and kidney function, lipids, electrolytes, immunology, tumors, hormones, urine analysis, and bacteriology. The form includes fields for patient identification and diagnosis, tests requested, and doctor's signature.

    Drepturi de autor:

    © All Rights Reserved
    Descărcați ca DOC, PDF, TXT sau citiți online pe Scribd
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    din 1

    LABORATORIUM

    RSUD. PAGELARAN

    No. ID :
    Nama Pasien : Nama Dokter :
    Tgl Lahir/Umur : Alamat :
    Alamat : Tanggal :
    Telp./Hp :
    Diagnosa Klinis : * = Puasa 8-10 jam ** = Urine 24 jam *** = Puasa 12 jam
    No. Lab : Permeriksaan yang diminta harap diberi tanda X

    HEMATOLOGI HEMOSTASIS
    o Rutin o Rumple Leede
    o Lengkap o Laju Endap darah (LED) o Masa Pendarahan
    o Hemoglobin o Hitung Jenis Leukosit o Masa Pembekuan
    o Eritrosit o Nilai Eritrosit (MCV, MCH, MCHC)
    o Leukosit o Golongan Darah (ABO)
    o Trombosit o Rhesus (Rh)

    KIMIA
    FUNGSI HATI FUNGSI GINJAL PROFIL LEMAK
    o SGOT o Ureum o Kolesterol Total ***
    o SGPT o Creatinin o Trigliserida ***
    o Bilirubin Total o Asam Urat o Kolesterol – HDL ***
    o Bilirubin Direct o Creatinin Clearance o Kolesterol – LDL ***
    o Bilirubin Indirect o Cystatin C o Lipid Total **
    o Protein Total o Apo A1
    o Albumin o Apo B
    o Gamma GT (GGT)
    FUNGSI JANTUNG KARBOHIDRAT ELEKTROLIT
    o CK o Glukosa Puasa * o Natrium
    o CK MB o Glukosa (2 jam PP) * o Kalium
    o LDH o Glukosa Sewaktu o Chlorida
    o Troponin T o HbA 1c o Paket Na, K, Cl
    o Troponin I o Tes Toleransi Glukosa (5x)* o Calsium Ion
    o GLDH o Tes Toleransi Glukosa (3X)* o Calsium Total
    o Fosfor Anorganik

    IMUNOLOGI
    o Anti HAV (Ig M) o Anti HBc (Ig M) o Anti Dengue Ig G
    o Anti HAV (Totl) o HbeAg o Anti Dengue Ig M
    o HbsAg o Anti Hbe o Anti HIV
    o Anti HBs (Titer) o Anti HCV Ig M o Anti HIV (Screening 3 tes)
    o Anti HBc (Total) o Anti HCV Total

    SEROLOGI PETANDA TUMOR TIROID


    o Widal o AFP (Hati) o T3 Total
    o TPHA o CEA o T4 Total
    o VDRL/RPR o CA 15-3 (Payudara) o Free T3
    o ASTO o CA 19-9 (Pankreas) o Free T4
    o Rheumatoid Factor (RF) o CA 125 (Ovarium) o TSHS
    o PSA (Prostat)
    o Free PSA
    o SCC ( Cervix)
    o NSE

    URINE NAPZA TINJA


    o Lengkap o Morphine/Opait o Rutin
    o Sedimen o Amphetamine/Shabu2 o Darah Samar
    o Glukosa o Mariyuana/THC o Analisa Feses Lengkap
    o Albumin o Benzodiazepin
    o Keton o Cocain
    o Protein
    o Test Pack
    CAIRAN TUBUH LAIN BAKTERIOLOGI Paraf Dokter
    o Analisis Sperma o Pewarnaan Gram
    o Cairan Pleura o Pewarnaan BTA
    o Cairan Cerebrospinal o Hapus Tenggorokan
    o Cairan ............... o Hapus Luka

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