Scribd Logo
Upload

Welcome to Scribd!

    • 54 views

    Form Report Mcu MMS Clinic

    Uploaded by

    MisterB Toba
    This document contains a health screening report for Obama, conducted on February 14, 2013 by Dr. Tongkil Tarigan at PT. Manpower Medical Services clinic. The report details Obama's personal information, medical history, clinical examinations, laboratory tests and certification that Obama is fit for duty as a forklift operator. Laboratory tests show normal results for blood count, urine analysis and breath alcohol level. Dr. Tarigan signs off that Obama passed the health screening.

    Copyright:

    © All Rights Reserved
    Download as XLS, PDF, TXT or read online from Scribd

    Form Report Mcu MMS Clinic

    Uploaded by

    MisterB Toba
    54 views4 pages
    This document contains a health screening report for Obama, conducted on February 14, 2013 by Dr. Tongkil Tarigan at PT. Manpower Medical Services clinic. The report details Obama's personal information, medical history, clinical examinations, laboratory tests and certification that Obama is fit for duty as a forklift operator. Laboratory tests show normal results for blood count, urine analysis and breath alcohol level. Dr. Tarigan signs off that Obama passed the health screening.

    Original Description:

    FORM REPORT MCU MMS CLINIC

    Original Title

    FORM REPORT MCU MMS CLINIC

    Copyright

    © © All Rights Reserved

    Available Formats

    XLS, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This document contains a health screening report for Obama, conducted on February 14, 2013 by Dr. Tongkil Tarigan at PT. Manpower Medical Services clinic. The report details Obama's personal information, medical history, clinical examinations, laboratory tests and certification that Obama is fit for duty as a forklift operator. Laboratory tests show normal results for blood count, urine analysis and breath alcohol level. Dr. Tarigan signs off that Obama passed the health screening.

    Copyright:

    © All Rights Reserved
    Download as XLS, PDF, TXT or read online from Scribd
    Download as xls, pdf, or txt
    54 views4 pages

    Form Report Mcu MMS Clinic

    Uploaded by

    MisterB Toba
    This document contains a health screening report for Obama, conducted on February 14, 2013 by Dr. Tongkil Tarigan at PT. Manpower Medical Services clinic. The report details Obama's personal information, medical history, clinical examinations, laboratory tests and certification that Obama is fit for duty as a forklift operator. Laboratory tests show normal results for blood count, urine analysis and breath alcohol level. Dr. Tarigan signs off that Obama passed the health screening.

    Copyright:

    © All Rights Reserved
    Download as XLS, PDF, TXT or read online from Scribd
    Download as xls, pdf, or txt
    of 4

    PT.

    MANPOWER MEDICAL SERVICES

    MMS CLINIC
    Air Mas Komplex Blok BI NO. 3 - 5 Batam Centre Phone : 0778 - 468 623 E - mail [email protected]

    HEALTH SCREENING REPORT Periodic Healt Examination

    A NO MEDICAL RECORD
    No. Medical Record : 007 Date : Februari 14,2013
    B PERSONAL DATA
    1 Name : Obama
    2 Birthday / Gender / Emp.ID : 12 Februari 1980 / Male
    3 Adress : Batam Centre Bi NO 7
    4 Occupations : Forklift Operator
    5 Father's Name : Obama Senior
    6 Employer / Agency : PT. PROSERV
    7 Employer / Agency Adress : BATU AMPAR - BATAM
    C MEDICAL HISTORY
    Yes No Yes No Yes No
    1 Hypertension x 4 Allergic Rhinitis
    ### x 7 Surgery x
    2 Bronchial Astma x 5 Peptic Ulcer
    ### x 8 Echolalia x
    3 Bloody Cough x 6 Epilepsy
    ### x 9 Others x

    D CLINICAL EXAMINATIONS
    1 Weight : 56 kg Height : 170 cm BMI : 19
    2 Vision Normal Abnormal Normal Abnormal

    a Distance Vision x 4 Respiratory System x


    ( Should be at least 6/12 in both eyes w/o glasses ) 5 Abdomen x
    b Near Vision x 6 Skin - Cronic Disease x
    ( Should be at least J2 in both eyes w/o glasses ) 7 Locomotor / Newrological x
    c Colour Vision x 8 Endocrine disorder x
    d Any Organic Eye Disease x 9 Mental State x
    3 Hearing x 10 Cardio Vasculer System
    ( Unable to hear ordinary vonversation at 2 m ) a Blood Pressure : x
    Systolic / Diastolic : 120 /80 mm Hg
    Pulse : 83 mm
    b Hear Disease x
    c Varicose Veins x
    E LABORATORY TEST F OTHER TEST
    ( Report enclose ) Normal Abnormal Normal Abnormal
    1 Blood Count x 1 Chest X - Ray x
    2 Urine Feme x 2 ECG ( if indicate) x
    3 Other Laboratory Test x 3 Audiometri x

    Remark : 4 Spirometri x
    G CERTIFICATIONS
    I certify that I have examined the abovenamed person. In my opinion, this person is FIT for duties mentioned above

    Advice

    Dr. TONGKIL TARIGAN


    PT. MANPOWER MEDICAL SERVICES

    MMS CLINIC
    Air Mas Komplex Blok BI NO. 3 - 5 Batam Centre Phone : 0778 - 468 623 E - mail [email protected]

    HEALTH SCREENING REPORT Periodic Healt Examination


    A NO MEDICAL RECORD
    No. Medical Record : 007 Date : Februari 14,2013
    B PERSONAL DATA
    1 Name : Obama
    2 Birthday / Gender / Empp.ID : 12 Februari 1980 / Male
    3 Adress : Batam Centre Bi NO 7
    4 Occupations : Forklift Operator
    5 Father's Name : Obama Senior
    6 Employer / Agency : PT. PROSERV
    7 Employer / Agency Adress : BATU AMPAR - BATAM
    C LABORATORY REPORT

    1 BLOOD COUNT
    Test Name RESUTL UNIT Reference Range

    HGB 13.3 gr/dl 11.0- 16.5


    WBC 5,2 10 / mm 3,5 - 10
    RBC 4,76 10 / mm 3.8 - 5.8
    ESR 2 mm/hr 0 - 20
    HCT 40,3 % 35 - 50
    PLT 263 10 /mm 150 - 390
    Differential Count
    LYM 45,2 % 17 - 48
    MON 6,9 % 4 - 10
    GRA 47,9 % 43 - 76

    2 URINE FEME

    Macroscopy
    pH 6
    Spesicific Gravity 1.010
    Glucossa Negative
    Protein Negative
    Ketones Negative
    Bilirubin Negative
    Urobilinongen Negative
    Nitrit Negative
    Blood Negative
    Leucocoytes Negative

    3 X - RAY REPORT

    Show no Abnormalitis

    Dr. TONGKIL TARIGAN


    No signature required
    PT. MANPOWER MEDICAL SERVICES

    MMS CLINIC
    Air Mas Komplex Blok BI NO. 3 - 5 Batam Centre Phone : 0778 - 468 623 E - mail [email protected]

    HEALTH SCREENING REPORT Periodic Healt Examination


    A NO MEDICAL RECORD
    No. Medical Record : 007 Date : Februari 14,2013
    B PERSONAL DATA
    1 Name : Obama
    2 Birthday / Gender / Emp.ID : 12 Februari 1980 / Male
    3 Adress : Batam Centre Bi NO 7
    4 Occupations : Forklift Operator
    5 Father's Name : Obama Senior
    6 Employer / Agency : PT. PROSERV
    7 Employer / Agency Adress : BATU AMPAR - BATAM
    C LABORATORY REPORT

    Test Name RESUTL UNIT Reference Range

    1 URINE
    Cannabinoit Negative
    Methamphetamine Negative
    Opiates Negative
    2 OTHERS
    Benzodiazepine Negative
    Barbiturate Negative
    Cocain Negative

    Dr. TONGKIL TARIGAN


    No signature required
    PT. MANPOWER MEDICAL SERVICES

    MMS CLINIC
    Air Mas Komplex Blok BI NO. 3 - 5 Batam Centre Phone : 0778 - 468 623 E - mail [email protected]

    HEALTH SCREENING REPORT Periodic Healt Examination


    A NO MEDICAL RECORD
    No. Medical Record : 007 Date : Februari 14,2013
    B PERSONAL DATA
    1 Name : Obama
    2 Birthday / Gender / Emp.ID : 12 Februari 1980 / Male
    3 Adress : Batam Centre Bi NO 7
    4 Occupations : Forklift Operator
    5 Father's Name : Obama Senior
    6 Employer / Agency : PT. PROSERV
    7 Employer / Agency Adress : BATU AMPAR - BATAM
    C LABORATORY REPORT

    Test Name RESUTL UNIT Reference Range

    BREATH ALCOHOL TEST 0.000 % BAC < 0,02 BAC is negative


    >= 0.02 - 0, 039 BAC : Cannot Ferform Safety sensitive
    Function
    > = 0.04 % BAC is a violation of rule

    Dr. TONGKIL TARIGAN


    No signature required

    You might also like