FORMULIR PEMERIKSAAN LABORATORIUM
08.08 | 
Diposting oleh
Indra S.E.,Amd.Informatika
FORMULIR PEMRIKSAAN LABORATORIUM KLINIK
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HEMATOLOGI
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o Hematologi Rutin (Hb, Ht, Lekosit, Trombosit, Eritrosit)
o Hematologi Lengkap (Darah Rutin, LED, Retikulosit, MCV, MCH)
o Laju Endapan Darah (LED)
o Hemoglobin
o Hematokrit
o Feritin
o Eritrosit
o Eosinophil
o Retikulosit
o Hapusan Darah
o MCV
o MCHi
o MCHC
o Golongan darah Abo & Resus
o Le Sell
o Le Reaksi
o M. Pendarahan
o M. Pembekuan
o M. Rekalsifikasi
o Hitung Jenis Lekosit
o Eritrosit
o Retikulositit
o Antibodi Trombosit
o PAR
o Agregasi Trombosit
o Comb’s test Direk/indirek
o Cold Aglutinin
o Warm Antibody
o Resitensi Osmotik
o Retraksi Bekuan
o Gambaran Sumsum tulang
o Hams’ test
o Sugar Water Test
o Faal Hemostasis
o PPT
o APTT
o Protrombin Time (PT – INR)
o Fibrinogen
o Test Agregasi Trombosit (TAT)
o Trombotest Owren (TO)
o D-dimer
o Trombin Time (TT)
o Faktor VIII
o Protein S
o Protein C
o Anti Trombin 3
o AT III
o PCT Test
o Rumple LeedeTasferin
o Asam Folat
o Vitamin B-12
o G6 PDH
o Viskositas Darah
o Serum Iron
o TIBC
o Viscositas Plasma
o HB ELP
o HB F
o Malaria
o CD 4
o CD 8
o CD 4 – CD 8
o Analisa Hb ( HPLC)
o Panel Uji saring Anemia (retikulosit, gambaran darah tepi, Ferittin, besi, UIBC, TIBC, Asam Folat, Vitamin B 12, Asam Folat)
o Panel Thalassemia
o Panel Hemolitik
o Panel PNH
o Panel Uji Saring DIC
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KIMIA
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HATI
o SGOT
o SGPT
o Gamma GT
o Albumin
o Globulin
o Bilirubin total
o TTT
o Alkali Fosfatase
o Cholinesterase
o Bile Acid
o Elektroforesis Protein
o Amonia
o Index Ikterus
o Che
o LAP
o GLDH
PROFIL LEMAK
o Panel Profil lemak
o Cholesterol
o Trigliserida
o HDL Cholesterol
o LDL Cholesterol
o Kilomikron
o Total lipid
o Lp (a)
o Chol Apo A-1
o Chol Apo B
o Small dense LDL
DIABETES
o C-Peptide
o Anti GAD
o Glukosa Puasa
o Glukosa 2 JPP
o Glukosa Sewaktu
o Glukosa Kurva Harian
o Keton Darah
o A 1 c / Glyco Hb
o MAU ( Micro Albumin Urien )
o Insulin
o C Peptide
PANKREAS
o Amilase
o Lipase
GINJAL
o Ureum (BUN)
o Creatinin
o Asam Urat
o Creatinin Clearance
o Acid Phospatase
o P.A.P
o Cystatin C
ELEKTROLIT
o Natrium
o Kalium
o Chlorida
o Calsium
o Calsium Ion
o Phosphor Anorganik
o Magnesium
o CA Ion
o Bikarbonat
JANTUNG
o SGOT
o SGPT
o CPK
o CK MB
o LDH
o HBDH
o Trombotin T
o Trombotin I
o Hs-CRP
o Homocystein
o Pro BNP
DRUG MONITORING
o Phenytobital / luminal
o Theophilin / Amynophilin
o Phenobarin/Dilantin
o Digoxin
o Carbamazepin
o Cyclosporin
KIMIA LAIN
o B Crosslaps / CTx
o N-MID Osteocalsin
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IMMUNOLOGI
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HEPATITIS
o HBsag
o Anti HBs
o Anti HBs Titer
o Anti HBc
o IgM Anti HBc
o HBe Ag
o HBV – DNA
o HBV – RNA Kualitatif
o HBV – RNA Kuantitatif
o Anti HBe
o Anti HAV
o igM Anti HAV
o Anti HCV
o Anti HDV
o IgG HEV
o IgM Hev
o igM Anti HCV
TORCH & STD
o Panel TORCH I
o Panel TORCH II
o IgG Toxoplasma
o IgM Toxoplasma
o IgG Toxoplasma Avidity
o IgG Rubela
o IgM Rubela
o IgG CMV
o IgM CMV
o IgG CMV Avidity
o IgG / IgM HCV 1
o IgM / IgG HCV 2
o IgG Chlamydia
o IgM Chlamydia
o TPHA
o VDRL
o Anti HIV
HORMONTIROID / HORMON REPRODUKSI
o T3 Total
o T4 Total
o T3 Uptake
o Free T3
o Free T4
o Free T1
o T4
o FT4
o LH
o TSHs
o FSH
o Prolaktin
o Testosteron
o Estradiol
o Progresteron
o Cortisol
o Trigobulin
o Growth Hormon Basal
o Growth Hormon Excersice
o Beta HCG Kuantitatif
o 5-HIAA
o Anti TPO
o Cortisol, Free 24 hour Urine Ultraquant
o Gastrin
o Vitamin D, 1,25-Dihydroxy (Calcifidol)
o Vitamin D, 25-Hydroxy (Calciferol)
o IGF-1 (Insulin-Like Growth Factor-1)
o Renin (PRA)
o ACTH
o PTH
RHEUMATIK & PROTEIN SPESIFIK
o Rheumatoid Arthritis
o Rheumatoid faktor
o RF
o CRP Kuantitatif
o CRP Kuantitatif
o ANA Test
o ASO / ASTO
o Anti ds-DNA
o IgG ACA
o IgM ACA
o IgG
o IgM
o IgA
o C- 3 Complemen
o a-2 Makroglobulin
o C- 4 Complemen
o hsCRP
o a-1 Antitypsin
o ASTO
o ANA
o ANCA
o ASMA (SMA)
o Anti CCP IgG
TUMOR MARKER
o AFP
o CEA
o PSA Total
o Free PSA
o Ca 15-3
o Ca – 125
o Ca 19-9
o Ca 72-4
o NSE
o SCC
o PAP (Prostat)
o Cyfra 21-1
o Ratio PSA
ALERGI
o IgE Total
o IgE Rast Aspergillus
o IgE Rast Bulu Ayam
o IgE Rast Coklat
o IgE Rast Daging Ayam
o IgE Rast Debu Rumah
o IgE Rast Epitel Anjing
o IgE Rast Epitel Tikus
o IgE Rast Epitel Kucing
o IgE Rast Ikan
o IgE Rast Jamur Mucor
o IgE Rast kacang
o IgE Rast Kecoa
o IgE Rast Kepiting
o IgE Rast Kerang
o IgE Rast Penicillin
o IgE Rast Susu
o IgE Rast Kuning telur
o IgE Rast Putih telur
o IgE Rast Tungau
o IgE Rast dang
o IgE Rast Gandum
o IgE Rast Strawberry
o IgE Rast Aspergilus
o IgE Atopy
INFEKSI LAIN
o Widal Slide
o IgM Anti S.typhi (tubex TF )
o IgG Anti DHF
o IgM Anti DHF
o Anti IgG & IgM DHF (rapid)
o Dengue NS1 (Rapid)
o Seramoeba
o Anti M.tbc
o IgG Helicobacter pylori
o IgM Helicobacter pylori
o IgG & IgM Helicobacter pylori (rapid)
o Pro-Calcitonin (PCT)
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KLINIK RUTIN
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URINALISIS
o Urien Lengkap
o Sedimen
o Protein Urien
o Glukosa Urien
o Bilirubin Urien
o Keton
o Ph urinen
o Bj Urien
o Urobilin
o Chylus
o Urobilinogen
o Mikroalbumin Urien
o Bance Jones Protein
o Protein esbach
o Protein Kuantitatif
o Elekroforesis Urien
TES KEHAMILAN
o Plano Test
o Tes Pack
o Beta HCG Urien
NARKOBA
o Morphine
o Cocaine
o Amphetamine
o Opiate
o Benzodiazepin
o Cannabinoid
o Metamphetamine
FAECES
o Faeces Rutin
o Darah Samar
o Pencernaan
o Lemak
o Amuba
o Lekosit
o Eritrosit
o Telur cacing
o Darah samar / Hema Test
ANALISA LAIN
o Analisa C. Otak/Liquor
o Analisa C. Pluera
o Analisa C. Pericard
o Analisa C. Abdomen
o Analisa C. Sendi
o Analisa Sperma
o Analisa Batu empedu
o Analisa Batu Ginjal
o Nonne
o Pandy
o Rivalta
o Manthoux Test (PPD)
o Colon Albumin (FOB)
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MIKROBILOGI & PCR
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PEPARAT DIREK
o Perwarnaan Gram
o Perwarnaan BTA
o Perwarnaan Kapsul
o Perwarnaan GO
o Perparat Cervix/Vagina
o Perparat Gram
o Perparat BTA
o Perparat GO
o Perparat Trichomonas
o Perparat jamur
o Perparat Sekret
o Perparat Diphteri
o Perparat Amuba
o Perparat Helminths / cacing
o Perparat Echinococcus
o Perparat giardia L
o Malaria
o Rapid Malaria
o Flaria
o Candida Albicans
KULTUR & RESISTENSI
o Kultur Darah
o Kultur Urein
o Kultur Gall
o Kultur Feases
o Kultur Sekret
o Kultur Pus
o Kultur Usap Tengorokan
o Kultur BTA
o Kultur Sputum
o Kultur Cairan Pleura
o Kultur Cairan Liquor
o Kultur MO Aerob
o Kultur Resistensi
o Tes MRSA
o Tes ESBL
o Shigella
o Vibrio Cholera
o Slmonela
BIOLOGI MOLEKULER (PCR)
o HBV DNA Kuantitatif
o HDV DNA Kuantitatif
o HCV RNA Genotyping
o Salmonella PCR
o M. TBC PCR
ELEKTROMEDIS
o ECG
o Tredmill
o Echocardiography
o Elektroencephalography (EEG)
o Autospirometri
o Audiogram
o Holter Monitoring
USG
o USG Upp & Low Abdomen
o USG Upper Abdomen
o USG Lower Abdomen
o USG Kandungan
o USG Mammae
o USG Testis
o USG Tyrooid
o USG Vasculer
o USG Carotis
o USG Kepala
o Nsamnmda
FOTO RONTGEN
o Waters
o Basis Cranii
o Cald Well
o Cervical AP
o Cervical Lat
o Skull AP
o Skull Lat
o Thorax PA (CR)
o Thorax Lat
o B.O.F/B.N.O/K.U.B
o Lumbo – Sacral AP
o Lumbo – Sacral Lat
o Top Lordotik
o Costae Dex
o Costae Sin
o Scapula Dex
o Scapula Sin
o Scapula AP
o Scapula Lat
o Ankle Dex
o Ankle Sin
o Shoulder Dex
o Shoulder Sin
o Bone Age
o Manus Dex
o Manus Sin
o Pedis Dex
o Pedis Sin
o Femur Dex
o Femur Sin
o Genu Dex
o Genu Sin
o Humerus Dex
o Humerus Sin
o Panoramic
o Cephalometri
o Dental
o Oclusal
FOTO KONTRAS
o UGI
o Colon In Loop
o IVP Foto
o HSG
o Urethrography
o Appendicogram
o Cystourethrography
o Oesophagus
“”” KETERANGAAN “””
| * | Puasa 10 – 12 Jam |
| ** | Puasa 12 Jam |
| *** | Urien 24 Jam |
| **** | Puasa Tidak Berhubungan Badan (abstinensia) Selama 2 – 7 Hari |
| ***** | Hubungi Laboratorium Terkait |
| *) | Puasa Minimal 6 Jam |
| **) | Tidak Boleh Makan-makan Yang Berlemak 6 Jam sebelumnya |
| ***) | Puasa Dan Minum Cairan urus-urus |
| ****) | Dilakukan Pada hari 10, 11 dan 12 dari menstruasi pertama |
| *****) | Pada saat tidak Menstruasi |
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JANGAN SALAH MEMILIH PEMERIKSAAN DAN BEROBAT LAH DULU KEPADA DOKTER UMUM, SPESIALIS DAN BARU DAPAT SURAT PEMERIKSAAN BARU PERIKSAAAA KE LABORATORIUM KLINIK
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