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LABORATORIUM UPTD PUSKESMAS

" SINDANGRATU "


Jl. Raya Bungbulang-Garut Kecamatan Pakenjeng
Kode Pos 44164

HASIL PEMERIKSAAN LABORATORIUM


Nama : ................................ Tanggal : .................................
Umur : .......................... Thn / Bln. Kelamin L / P Dokter : .................................
Alamat : ................................ No. Reg. : .................................

HEMATOLOGI
HASIL SATUAN NILAI RUJUKAN
Hemoglobin g/dl P:12-16 / L:13-17
leukoosit /mm3 4.000 - 10.000
Erytrosit Juta/mm3 P:4,0 - 5,5 / L:4,5-6,0
Hematokrit % P:37-43 / L:40-48
Trombosit ribu/mm3 150 - 450
LED mm/jam P:<20 / L:<10
Retikulosit % 0,5 - 20
Waktu Perdarahan Menit 1-6
Waktu Pembekuan Menit 5 - 13
Gol Darah

Dif. Count

- Bas % 0-1
- Eos % 1-4
- NB % 2-6
- NS % 50 -70
- Lym % 20 - 40
- Mon % 2 -10

KIMIA PUSKESMAS
SATUAN NILAI RUJUKAN
Glukosa Puasa mg/dl 70 - 110
Glukosa 2 Jam Puasa mg/dl < 160
Glukosa Sewaktu mg/dl 70 - 150
Ureum mg/dl 10 - 50
Creatinin mg/dl P:0,5 - 0,9 / L:0,3 -1,1
Asam Urat mg/dl P:2,4 5-7 / L:3,4 - 7,0
SGOT U/I P:< 31 / L:<37
SGPT U/I P:< 37 / L :<41
Alkali Fosfastase U/I 60 -170
Gamma GT U/I P: 4-18 / L: 6-28
Protein g/dl 6,6 -8,7
Albumin g/dl 4,0 - 5,7
Globulin g/dl 1,5 -3,0
Cholesterol mg/dl < 200
Trigliserid mg/dl < 150
HDL-Cholesterol mg/dl P:45-65 / L: 35-55
LDL-Cholesterol mg/dl < 150
Bilirubin Total mg/dl < 1,00
Bilirubin Direk mg/dl < 0,25
Bilirubin Indirek mg/dl < 0,75

SEROLOGI URINE FAECES


Widal Warna Warna

- S.Thypi O PH Konsistensi

- Parthypi AO B.J lendir

- Parthypi BO Nitrit Darah

- Parthypi CO Protein Pus

- S.Thypi H. Glukosa Ery

- Parthypi AH Keton Leuko

- Parthypi BH Urobilinogen Amoeba

- Parthypi CH Bilirubin Telur Cacing

HBsAg Darah Samar

Anti HBsAg Sedimen LAIN-LAIN


VDRL - Leuko / lpb Prep. BTA
Anti TB lgG - Eritrosit / lpb PP Test
Dengue lgG / IgM - Epytel / lpb
Malaria Pv / Pf - Kristal

Gravind Test - Silinder

- Bakteri

Pemeriksa

NIP.
.....................
.....................
.....................
LABORATORIUM UPT PUSKESMAS
" SINDANGRATU "
Jl. Raya Bungbulang-Garut Kecamatan Pakenjeng. Kode Pos 44164
Email : puskesmasdtpsindangratu@gmail.com
HASIL PEMERIKSAAN LABORATORIUM
Nama : ................................ Tanggal : .................................
Umur : .......................... Thn / Bln. Kelamin L / P Dokter : .................................
Alamat : ................................ No. Reg. : .................................
HEMATOLOGI
HASIL SATUAN NILAI RUJUKAN
Hemoglobin g/dl P:12-16 / L:13-17
leukoosit /mm3 4.000 - 10.000
Erytrosit Juta/mm3 P:4,0 - 5,5 / L:4,5-6,0
Hematokrit % P:37-43 / L:40-48
Trombosit ribu/mm3 150 - 450
LED mm/jam P:<20 / L:<10
Retikulosit % 0,5 - 20
Waktu Perdarahan Menit 1-6
Waktu Pembekuan Menit 5 - 13
Gol Darah
Dif. Count
- Bas % 0-1
- Eos % 1-4
- NB % 2-6
- NS % 50 -70
- Lym % 20 - 40
- Mon % 2 -10

KIMIA KLINIK
HASIL SATUAN NILAI RUJUKAN
Glukosa Puasa mg/dl 70 - 110
Glukosa 2 Jam Puasa mg/dl < 160
Glukosa Sewaktu mg/dl 70 - 150
Ureum mg/dl 10 - 50
Creatinin mg/dl P:0,5 - 0,9 / L:0,3 -1,1
Asam Urat mg/dl P:2,4 5-7 / L:3,4 - 7,0
SGOT U/I P:< 31 / L:<37
SGPT U/I P:< 37 / L :<41
Alkali Fosfastase U/I 60 -170
Gamma GT U/I P: 4-18 / L: 6-28
Protein g/dl 6,6 -8,7
Albumin g/dl 4,0 - 5,7
Globulin g/dl 1,5 -3,0
Cholesterol mg/dl < 200
Trigliserid mg/dl < 150
HDL-Cholesterol mg/dl P:45-65 / L: 35-55
LDL-Cholesterol mg/dl < 150
Bilirubin Total mg/dl < 1,00
Bilirubin Direk mg/dl < 0,25
Bilirubin Indirek mg/dl < 0,75

SEROLOGI URINE FAECES


Widal BJ Warna
- S.Thypi O PH Konsistensi
- Parthypi AO Leukosit lendir
- Parthypi BO Nitrit Darah
- Parthypi CO Protein Pus
- S.Thypi H. Glukosa Ery
- Parthypi AH Keton Leuko
- Parthypi BH Urobilinogen Amoeba
- Parthypi CH Bilirubin Telur Cacing
HBsAg Darah Samar
Anti HBsAg Sedimen LAIN-LAIN
VDRL - Leuko / lpb Prep. BTA
Anti TB lgG - Eritrosit / lpb PP Test
Dengue lgG / IgM - Epytel / lpb
Malaria Pv / Pf - Kristal
Gravind Test - Silinder
- Bakteri

Pemeriksa

..................................
LABORATORIUM UPT PUSKESMAS
" SINDANGRATU "
Jl. Raya Bungbulang-Garut Kecamatan Pakenjeng. Kode Pos 44164
Email : puskesmasdtpsindangratu@gmail.com

HASIL PEMERIKSAAN LABORATORIUM


Nama : ................................ Tanggal : ................................. Nama : .

Umur : ........................Thn / Bln. L/P Dokter : ................................. Umur : .

Alamat : ................................ No. Reg. : ................................. Alamat : .


HEMATOLOGI
HASIL SATUAN NILAI RUJUKAN
Hemoglobin g/dl P:12-16 / L:13-17
leukoosit /mm3 4.000 - 10.000
Erytrosit Juta/mm3 P:4,0 - 5,5 / L:4,5-6,0
Hematokrit % P:37-43 / L:40-48
Trombosit ribu/mm3 150 - 450
LED mm/jam P:<20 / L:<10
Retikulosit % 0,5 - 20
Waktu Perdarahan Menit 1-6
Waktu Pembekuan Menit 5 - 13
Gol Darah
Dif. Count
- Bas % 0-1
- Eos % 1-4
- NB % 2-6
- NS % 50 -70
- Lym % 20 - 40
- Mon % 2 -10
KIMIA KLINIK
HASIL SATUAN NILAI RUJUKAN
Glukosa Puasa mg/dl 70 - 110
Glukosa 2 Jam Puasa mg/dl < 160
Glukosa Sewaktu mg/dl 70 - 150
Ureum mg/dl 10 - 50
Creatinin mg/dl P:0,5 - 0,9 / L:0,3 -1,1
Asam Urat mg/dl P:2,4 5-7 / L:3,4 - 7,0
SGOT U/I P:< 31 / L:<37
SGPT U/I P:< 37 / L :<41
Alkali Fosfastase U/I 60 -170
Gamma GT U/I P: 4-18 / L: 6-28
Protein g/dl 6,6 -8,7
Albumin g/dl 4,0 - 5,7
Globulin g/dl 1,5 -3,0
Cholesterol mg/dl < 200
Trigliserid mg/dl < 150
HDL-Cholesterol mg/dl P:45-65 / L: 35-55
LDL-Cholesterol mg/dl < 150
Bilirubin Total mg/dl < 1,00
Bilirubin Direk mg/dl < 0,25
Bilirubin Indirek mg/dl < 0,75
SEROLOGI URINE FAECES
Widal BJ Warna
- S.Thypi O PH Konsistensi
- Parthypi AO Leukosit lendir
- Parthypi BO Nitrit Darah
- Parthypi CO Protein Pus
- S.Thypi H. Glukosa Ery
- Parthypi AH Keton Leuko
- Parthypi BH Urobilinogen Amoeba
- Parthypi CH Bilirubin Telur Cacing
HBsAg Darah Samar
Anti HBsAg Sedimen LAIN-LAIN
VDRL - Leuko / lpb Prep. BTA
Anti TB lgG - Eritrosit / lpb PP Test
Dengue lgG / IgM - Epytel / lpb
Malaria Pv / Pf - Kristal
Gravind Test - Silinder
- Bakteri

Pemeriksa

............................
LABORATORIUM UPT PUSKESMAS
" SINDANGRATU "
Jl. Raya Bungbulang-Garut Kecamatan Pakenjeng. Kode Pos 44164
Email : puskesmasdtpsindangratu@gmail.com

HASIL PEMERIKSAAN LABORATORIUM


Nama : ................................ Tanggal : .................................

Umur : ........................Thn / Bln. L/P Dokter : .................................

Alamat : ................................ No. Reg. : .................................


HEMATOLOGI
HASIL SATUAN NILAI RUJUKAN
Hemoglobin g/dl P:12-16 / L:13-17
leukoosit /mm3 4.000 - 10.000
Erytrosit Juta/mm3 P:4,0 - 5,5 / L:4,5-6,0
Hematokrit % P:37-43 / L:40-48
Trombosit ribu/mm3 150 - 450
LED mm/jam P:<20 / L:<10
Retikulosit % 0,5 - 20
Waktu Perdarahan Menit 1-6
Waktu Pembekuan Menit 5 - 13
Gol Darah
Dif. Count
- Bas % 0-1
- Eos % 1-4
- NB % 2-6
- NS % 50 -70
- Lym % 20 - 40
- Mon % 2 -10
KIMIA KLINIK
HASIL SATUAN NILAI RUJUKAN
Glukosa Puasa mg/dl 70 - 110
Glukosa 2 Jam Puasa mg/dl < 160
Glukosa Sewaktu mg/dl 70 - 150
Ureum mg/dl 10 - 50
Creatinin mg/dl P:0,5 - 0,9 / L:0,3 -1,1
Asam Urat mg/dl P:2,4 5-7 / L:3,4 - 7,0
SGOT U/I P:< 31 / L:<37
SGPT U/I P:< 37 / L :<41
Alkali Fosfastase U/I 60 -170
Gamma GT U/I P: 4-18 / L: 6-28
Protein g/dl 6,6 -8,7
Albumin g/dl 4,0 - 5,7
Globulin g/dl 1,5 -3,0
Cholesterol mg/dl < 200
Trigliserid mg/dl < 150
HDL-Cholesterol mg/dl P:45-65 / L: 35-55
LDL-Cholesterol mg/dl < 150
Bilirubin Total mg/dl < 1,00
Bilirubin Direk mg/dl < 0,25
Bilirubin Indirek mg/dl < 0,75
SEROLOGI URINE FAECES
Widal BJ Warna
- S.Thypi O PH Konsistensi
- Parthypi AO Leukosit lendir
- Parthypi BO Nitrit Darah
- Parthypi CO Protein Pus
- S.Thypi H. Glukosa Ery
- Parthypi AH Keton Leuko
- Parthypi BH Urobilinogen Amoeba
- Parthypi CH Bilirubin Telur Cacing
HBsAg Darah Samar
Anti HBsAg Sedimen LAIN-LAIN
VDRL - Leuko / lpb Prep. BTA
Anti TB lgG - Eritrosit / lpb PP Test
Dengue lgG / IgM - Epytel / lpb
Malaria Pv / Pf - Kristal
Gravind Test - Silinder
- Bakteri

Pemeriksa

............................
LABORATORIUM UPT PUSKESMAS
" SINDANGRATU "
Jl. Raya Bungbulang-Garut Kecamatan Pakenjeng
Kode Pos 44164
Nomor. CM : Tanggal : Nomor. CM :
Nama Pasien : Dokter : Nama Pasien :
Umur : Thn. Lk. / Pr Alamat : Umur : Thn. Lk
Alamat : Alamat :

HEMATOLOGI FUNGSI HATI LEMAK HEMATOLOGI


1. Darah Rutin 1. SGOT 1. Cholesterol 1. Darah Rutin 1.
( Hb, Leko, Dif, Ery 2. SGPT 2. Triglyserid ( Hb, Leko, Dif, Ery 2.
2. Hemoglobin 3. G - GT 3. HDL - Cholesterol 2. Hemoglobin 3.
3. Leukosit 4. Protein Total 4. LDL - Cholesterol 3. Leukosit 4.
4. Erytrosit 5. Albumin 5. VLDL 4. Erytrosit 5.
5. Hematokrit 6. Globulin 6. Total Lipid 5. Hematokrit 6.
6. Trombosit 7. Bilirubin Total 7. ...................................... 6. Trombosit 7.
7. Hitung Jenis 8. Bilirubin Direk 7. Hitung Jenis 8.
8. LED 9. Bilirubin Indirek FUNGSI GINJAL 8. LED 9.
9. Gol. Darah & Rh. 10. Alkali Fosfatase 9. Gol. Darah & Rh. 10.
10. Gol. Darah 11. ....................................... 1. Ureum 10. Gol. Darah 11.
11. Rhesus Factor 2. Creatinin 11. Rhesus Factor
12. Waktu Pendarahan KARBOHIDRAT 3. Uric Acid 12. Waktu Pendarahan
13. Waktu Pembekuan 1. GDN 4. Urea Clearence 13. Waktu Pembekuan 1.
14. ......................................... 2. GD 2 pp 5. Creatinin Clearence 14. ......................................... 2.
3. GDS 6. ....................................................... 3.
URINE 4. ......................................... URINE 4.

1. Urine Lengkap ELEKTROLIT FAECES 1. Urine Lengkap


2. Urine Rutin 1. Na, K, CI ( Paket ) 2. Urine Rutin 1.
3. Protein 2. Natrium 1. Faeces Rutin 3. Protein 2.
4. Reduksi 3. Kalium 2. Benzidin 4. Reduksi 3.
5. Sedimen 4. Calsium 3. Lemak 5. Sedimen 4.
6. Uric Acid Urine 5. Magnesium 4. ....................................................... 6. Uric Acid Urine 5.
7. Tes Kehamilan 6. Phosfor 7. Tes Kehamilan 6.
8. .............................................. 8. ..............................................
9. .............................................. SEROLOGI LAIN - LAIN 9. ..............................................
1. Widal RONTGEN 1.
2. VDRL 1. Thorax 2.
3. Anti TB 2. BNO 3.
4. Dengue lgG/ lgM 3. ........................................................ 4.
5. ....................................... 4. ........................................................ 5.

Ttd. Dokter

...................................
LABORATORIUM UPT PUSKESMAS
" SINDANGRATU "
Jl. Raya Bungbulang-Garut Kecamatan Pakenjeng
Kode Pos 44164
Tanggal :
Dokter :
Thn. Lk. / Pr Alamat :

FUNGSI HATI LEMAK


SGOT 1. Cholesterol
SGPT 2. Triglyserid
G - GT 3. HDL - Cholesterol
Protein Total 4. LDL - Cholesterol
Albumin 5. VLDL
Globulin 6. Total Lipid
Bilirubin Total 7. ......................................
Bilirubin Direk
Bilirubin Indirek FUNGSI GINJAL
Alkali Fosfatase
....................................... 1. Ureum
2. Creatinin
KARBOHIDRAT 3. Uric Acid
GDN 4. Urea Clearence
GD 2 pp 5. Creatinin Clearence
GDS 6. .......................................................
.........................................

ELEKTROLIT FAECES
Na, K, CI ( Paket )
Natrium 1. Faeces Rutin
Kalium 2. Benzidin
Calsium 3. Lemak
Magnesium 4. .......................................................
Phosfor

SEROLOGI LAIN - LAIN


Widal RONTGEN
VDRL 1. Thorax
Anti TB 2. BNO
Dengue lgG/ lgM 3. ........................................................
....................................... 4. ........................................................

Ttd. Dokter

...................................
LABORATORIUM KLINIK
" BINA WALUYA "
Jl. Raya Malangbong - Wado Km. 1,8
Ds. Cisitu Malangbong - Garut

Nomor. CM : Tanggal : Nomor. CM :


Nama Pasien : Dokter : Nama Pasien :
Umur : Thn. Lk. / Pr Alamat : Umur :
Alamat : Alamat :

HEMATOLOGI FUNGSI HATI LEMAK HEMATOLOGI

1. Darah Rutin 1. SGOT 1. Cholesterol 1. Darah Rutin


( Hb, Leko, Dif, Ery 2. SGPT 2. Triglyserid ( Hb, Leko, Dif, Ery
2. Hemoglobin 3. G - GT 3. HDL - Cholesterol 2. Hemoglobin
3. Leukosit 4. Protein Total 4. LDL - Cholesterol 3. Leukosit
4. Erytrosit 5. Albumin 5. VLDL 4. Erytrosit
5. Hematokrit 6. Globulin 6. Total Lipid 5. Hematokrit
6. Trombosit 7. Bilirubin Total 7. ...................................... 6. Trombosit
7. Hitung Jenis 8. Bilirubin Direk 7. Hitung Jenis
8. LED 9. Bilirubin Indirek FUNGSI GINJAL 8. LED
9. Gol. Darah & Rh. 10. Alkali Fosfatase 9. Gol. Darah & Rh.
10. Gol. Darah 11. ....................................... 1. Ureum 10. Gol. Darah
11. Rhesus Factor 2. Creatinin 11. Rhesus Factor
12. Waktu Pendarahan KARBOHIDRAT 3. Uric Acid 12. Waktu Pendarahan
13. Waktu Pembekuan 1. GDN 4. Urea Clearence 13. Waktu Pembekuan
14. ......................................... 2. GD 2 pp 5. Creatinin Clearence 14. .........................................
3. GDS 6. .......................................................
URINE 4. ......................................... URINE

1. Urine Lengkap ELEKTROLIT FAECES 1. Urine Lengkap


2. Urine Rutin 1. Na, K, CI ( Paket ) 2. Urine Rutin
3. Protein 2. Natrium 1. Faeces Rutin 3. Protein
4. Reduksi 3. Kalium 2. Benzidin 4. Reduksi
5. Sedimen 4. Calsium 3. Lemak 5. Sedimen
6. Uric Acid Urine 5. Magnesium 4. ....................................................... 6. Uric Acid Urine
7. Tes Kehamilan 6. Phosfor 7. Tes Kehamilan
8. .............................................. 8. ..............................................
9. .............................................. SEROLOGI LAIN - LAIN 9. ..............................................
1. Widal RONTGEN
2. VDRL 1. Thorax
3. Anti TB 2. BNO
4. Dengue lgG/ lgM 3. ........................................................
5. ....................................... 4. ........................................................

Ttd. Dokter

...................................................
LABORATORIUM KLINIK
" BINA WALUYA "
Jl. Raya Malangbong - Wado Km. 1,8
Ds. Cisitu Malangbong - Garut

Tanggal :
Dokter :
Thn. Lk. / Pr Alamat :

FUNGSI HATI LEMAK

1. SGOT 1. Cholesterol
2. SGPT 2. Triglyserid
3. G - GT 3. HDL - Cholesterol
4. Protein Total 4. LDL - Cholesterol
5. Albumin 5. VLDL
6. Globulin 6. Total Lipid
7. Bilirubin Total 7. ......................................
8. Bilirubin Direk
9. Bilirubin Indirek FUNGSI GINJAL
10. Alkali Fosfatase
11. ....................................... 1. Ureum
2. Creatinin
KARBOHIDRAT 3. Uric Acid
1. GDN 4. Urea Clearence
2. GD 2 pp 5. Creatinin Clearence
3. GDS 6. .......................................................
4. .........................................

ELEKTROLIT FAECES
1. Na, K, CI ( Paket )
2. Natrium 1. Faeces Rutin
3. Kalium 2. Benzidin
4. Calsium 3. Lemak
5. Magnesium 4. .......................................................
6. Phosfor

SEROLOGI LAIN - LAIN


1. Widal RONTGEN
2. VDRL 1. Thorax
3. Anti TB 2. BNO
4. Dengue lgG/ lgM 3. ........................................................
5. ....................................... 4. ........................................................

Ttd. Dokter

...................................................
LABORATORIUM KLINIK
" BINA WALUYA "
Jl. Raya Malangbong - Wado Km. 1,8
Ds. Cisitu Malangbong - Garut

HASIL PEMERIKSAAN LABORATORIUM


Nama : ................................ Tanggal : .................................
Umur : .......................... Thn / Bln. Kelamin L / P Dokter : .................................
Alamat : ................................ No. Reg. : .................................
HEMATOLOGI
HASIL SATUAN NILAI RUJUKAN
Hemoglobin g/dl P:12-16 / L:13-17
leukoosit /mm3 4.000 - 10.000
Erytrosit Juta/mm3 P:4,0 - 5,5 / L:4,5-6,0
Hematokrit % P:37-43 / L:40-48
Trombosit ribu/mm3 150 - 450
LED mm/jam P:<20 / L:<10
Retikulosit % 0,5 - 20
Waktu Perdarahan Menit 1-6
Waktu Pembekuan Menit 5 - 13
Gol Darah
Dif. Count
- Bas % 0-1
- Eos % 1-4
- NB % 2-6
- NS % 50 -70
- Lym % 20 - 40
- Mon % 2 -10

KIMIA KLINIK
HASIL SATUAN NILAI RUJUKAN
Glukosa Puasa mg/dl 70 - 110
Glukosa 2 Jam Puasa mg/dl < 160
Glukosa Sewaktu mg/dl 70 - 150
Ureum mg/dl 10 - 50
Creatinin mg/dl P:0,5 - 0,9 / L:0,3 -1,1
Asam Urat mg/dl P:2,4 5-7 / L:3,4 - 7,0
SGOT U/I P:< 31 / L:<37
SGPT U/I P:< 37 / L :<41
Alkali Fosfastase U/I 60 -170
Gamma GT U/I P: 4-18 / L: 6-28
Protein g/dl 6,6 -8,7
Albumin g/dl 4,0 - 5,7
Globulin g/dl 1,5 -3,0
Cholesterol mg/dl < 200
Trigliserid mg/dl < 150
HDL-Cholesterol mg/dl P:45-65 / L: 35-55
LDL-Cholesterol mg/dl < 150
Bilirubin Total mg/dl < 1,00
Bilirubin Direk mg/dl < 0,25
Bilirubin Indirek mg/dl < 0,75

SEROLOGI URINE FAECES


Widal SGOT Warna
- S.Thypi O PH Konsistensi
- Parthypi AO Leukosit lendir
- Parthypi BO Nitrit Darah
- Parthypi CO Protein Pus
- S.Thypi H. Glukosa Ery
- Parthypi AH Keton Leuko
- Parthypi BH Urobilinogen Amoeba
- Parthypi CH Bilirubin Telur Cacing
HBsAg Darah Samar
Anti HBsAg Sedimen LAIN-LAIN
VDRL - Leuko / lpb Prep. BTA
Anti TB lgG - Eritrosit / lpb PP Test
Dengue lgG / IgM - Epytel / lpb
Malaria Pv / Pf - Kristal
Gravind Test - Silinder
- Bakteri

Pemeriksa

.........................................................
NIP.