Blanko Permintaan Pemeriksaan Laboratorium

Blanko Permintaan Pemeriksaan Laboratorium Rumah Sakit Umum Kuningan Medical Center

 0o, %4  0ama Umur Alamat Dokter  0ama %uan H!MA"#L#$I □ !emo#lobin □ "eukosit □ !ematrokit □ Trombosit □ %etikulosit □ *ritrosit □ "*D □ +, Pendaraan Penda raan □ +, Pembekuan Pembek uan □ +, Protombin Protomb in □ !it -enis "eukosit □ Gol Dara. %esus □ Gambaran Dara Te/i Te/i □ □ MICR#BI#L#$I □ Pre/arat Gram □ Pre/arat BTA □ S/utum SPS □ !L!K"R#LI" □ 0atrium □ 1alium □ Clorida □

& (((((((,, Tan##al Tan##al & (((((( & (((((((((((((((((,,, (((((((((((((((((,,, & (((((((,, Taun "P & (((((((((((((((((( & (((((((((((((((((( & (((((((((((((((((( ((((((((((((((((((

URI%! □ Urine %utin □ Protein □ Glukosa □ 1eton □ Urobilino#en □ Bilirubin □ B,-, □ Sedimen □ "eko"PB □ *ri"PB □ Sele/"PB □ 1ristal S!R#L#$I □ +idal Test □ Tube3 Test □ 4aontuk 4aontu k Test □ !I5 □ !bsA# □ Tro/onin I □ Ck ck4B □ !bA6C □ sC%P □

KIMIA DARAH □ Glukosa Puasa □ Glukosa 2 jam PP PP □ Glukosa Sewaktu □ Protein Total □ Albumin □ Globulin □ Bilirubin Bilirub in Total □ Bilirubin Direct □ Bilirubin Indirect □ SGOT □ SGPT □ Ureum □ Creatinin □ Asam Urat □ Colesterol □ !D" □ "D" □ Tri#liserid A!C!S □ $aeces %utin □ "emak  □ Dara Samar  □ TTD &

S!PSIS □ Procalcitonin

' (((((((( )