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M edika P lazaHealth & Medical Service

HEALTH ASSESSMENT REPORT

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M P M edica l Cente r KC Cl in icMena ra Kar t ika Chand ra 3rd F loor11. lend. Gatot Subroto Ka y . 18 -20l i a t a l E 6 0Med ika P laza

Health & Medical Servicereip : -raz z1 szs i zo r (h u n t in g )F a x : + 62 2 1 5 2 1 0 8 1 5www.med ikap laza .com

RADIANT UTAMA INTERINSCO TBK

ABDUL RAHMAN 49 Years Old INSPECTOR

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MEDIKA PLAZA CLINICKartika Chandra - O ffice Tower 3rd FloorJ1. Jend. Gatot Subroto, Ka y . 18-20 Jakarta Selatan 12940Tlp :(62-21) 525 1207, Fax :(62-21) 521 0815Appointment Hotline (62-21) 528 80088www.medikaplaza.comM e d i k a P la z aHealth & Medical service

MR No. : : 01032261 EMPLOY. STATUS :N A M E : Abdul Rahman BIRTHDATE : 24 Decembe r 1963E M P L O Y E E N o . SE X : MaleJOB TITLE : INSP E C T O R / S T A T US : MarriedC O M P . N A M E : PT. RADIANT UTAM A rNTERINSCO TBK N ASI ON ALI T Y : IndonesiaC O M P . A D D R :akartaI . Disl ipidemia with fatty l iver

USG : sugestive cholel i thiasis DD/ polypObesi ty4. Radix, calculus teethYour fitness status is fit with medical note :

Disl ipidem ia with fat ty l iverUSG : sugestive cholel i thiasis DD / polyp

Low fat and carbohyd rate diet , exercise regularly. See a n internist for further evaluation of disl ipidemia w ith fatty l iver and sugestive cholel ithiasis DD / pot

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MEDIKA PLAZA CLINICKartika Chandra - Office Tower 3rd FloorJ1. Jend. Gatot Subroto, Ka y . 18-20 Jakarta Selatan 12940Tlp :(62-2 I ) 525 1207, Fax :(62-21) 521 0815Appointment Hotl ine (62-21) 528 80088www.medikap laza .comM e d ik a P l a z a& Mcdical'mice

M R No. : : 01032261 E M P L OY . S T AT US :N A M E : Abdul Rahman BIRTHDATE : 24 December 1963E M P L O Y E E N o . : S EX : M a l eJO B TITLE : INSPECTOR / ST AT U S : MarriedC O M P . N A M E : PT. RADIANT UTAMA INTERINSCO TBK N A S I O N A L I T Y : IndonesiaC O M P . A D D R :akartaI. Disl ipidem ia with fatty l iver

USG : sugestive cholel i thiasis DD/ polypObesity

4. Radix, calculus teethYour fitness status is fit with medical note :

Disl ipidemia with fatty l iverUSG : sugestive cholel i thiasis DD/ polyp

Adol f Amahorseya , M D Cardiologist

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Name : Abdul Rahman S e x : Ma l eR No. : 01032261 Visit :7-Mar-2013Comp : RADIANT UTAMA INTERINSCO TBK DOB : December 24, 1963PHYSICAL EXAMINATION

MEDICAL HISTORY- Present Compla int None

PAST MEDICAL HISTORY- Surgery N o- Disease N o- Inpatient N o- A le rgy H istory N o- Imunizat ion recent ly N o

FAMILY MEDICAL HISTORY- Diabetes Me l i tus N o n e- Hy pertension N o n e- Heart Disease N o n e- L ung D ise a se /TBC N one- Kidney Disease N o n e- Asthma Bronchia l N o n e- M e n t a l D i so rd e r N o n e

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Name : A b d u l R a h m a nComp :RADIANT UTAMA INTERINSCO TBK

Sex :MaleDOB : December 24, 1963

MR No. : 01032261 Visit : 27-Mar-2013

GENERAL APPEARANCE- Pa l lor

Jaundice- Skin

EAR, NOSE, THROAT- Auricle

Nose (Septum, Conchae)- Sinuses

P h a ry n x- Tonsil

EY E

NoN o

N o rm a l

N o rm a lN o rm a lN o rm a lN o rm a lN o rm a l

- Lefto rm a l- Righto rm a lM O U T H- Toungeo rm a l- Gumormal- Dentit ionbnormal Radix , ca lcu lus tee th

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Name : Abdul RahmanComp : RADIANT UTAMA INTERINSCO TBK

MR No. : 01032261 Visit : 27-Mar-2013e x : Ma l eDOB : December 24, 1963

- Rectum/Anus/Per ianalUPPER AND LOWER EXTREMITIES

Bones / Jo int- Musc les / Tonus

Finger / Nai ls- Hand

FootNEUROLOGICAL EXAMINATION

N o rm a l

N o rm a lN o rm a lN o rm a lN o r m a lN o rm a l

M otoric Functiono rm a l- Sensoric Funct iono rm a lCoordinat ion Funct iono rm a l- Physio logic Reflexo rm a l- Pa to logic Reflexegative- Extra - Pyramidal Functiono rm a lWORK EXPOSURE- Toxic or i r r i tant chemicalso- Heavy Manual handlingo- Solvents , o i l s , greaseso

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N a m e : A B D U L R A H M A NComp : RADIANT UTAMA INTERINSCO TBK

DESCRIPTION

Sex : MaleDOB: 24 December 1963 / Age : 49

Right Left

M R No. :01032261 Visit : 27-Mar-2013

1

Previous Glasses A dd S +1 ,75dd S+1,75Without Glasses Distant 1,0 1,0Near - -

Correction Distant- -

Near J1 II

TonometryFunduscopy Good Good

I Colour Blind Test No r m a l

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Name : ABDUL RAHMANex : MaleC o m p : RAD I ANT UT AM A I NT E RINS C O T B K DOB : 24 Decembe r 1963 / Age : 49Rad/Reg. No. :D 01032261-1 M R No. : 01032261Visi t : 27-Mar-2013ExamtThorax P A No abnormality seen in both lungs.Normal bronchovascular markings in both hili.The heart is normal in size and shape.The mediastinum is not widened.Both sinus and diaphragms are good.No evidence of pleural effusion.

Impression : Normal chest.No evidence of specific process in both lungs.

Examining PhysicianA. Renowati Sp.Rad

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Name : A- 'JL R A H M A Nex : MaleC o m o : RAD I ANT UT AM A I NT E RI NS C O T B K DOB: 24 December 1963 / Age : 49Rad/Reg. No. :D 01032261-1 MR No. : 01032261Visi t : 27-M ar-2013Examinat ion g mUP PERLOWER ABDOMEN SONOGRAPHY LIVER:Liver tip is blunt, there are increase attenuation echoes structure parenchymewhich are homogenous. No sign of SOL.Intrahepatic vascularity and billiary tract are normal.GALL BLADDER:Normal in size, contour and surface.Multiple hyperechoic lesion was seen without shadowing at lumen gall bladder,diameter 7,6 mmBOTH KIDNEYS:Normal in size, contour and surface. No sign of obstruction/ stone/ SOL.PANCREAS:Normal in size, contour and surface. No sign of SOL.L IEN:Normal in size and contour, the echoes are homogenous. No sign of SOL.URINARY BLADDER:Normal in size, contour and surface. No sign of stone/ SOL.PROSTATE AND VESICULA SEMINALIS:Normal in size and contour which are homogenous echoes and no sign of focal lesion/ SOL.

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wirdiPiftit r .LatztvKartika Chandra - Office Tower 3rd Floor

Jend. Gatot Subroto, Ka y . 18-20 Jaka rta Selata n 12940Tlp :(62-21) 525 1207, Fax :(62-2I) 521 0815Appointment Hotline (62-21) 528 80088www.medikaplaza.comMedika PlazaHealth Medical Service

Name : ABDUL RAHMANex : MaleComp : RADIANT UTAMA INTERINSCO TBK DOB : 24 December 1963 / Age : 49Lab/Reg. No. :C.2703019D MR No. : 01032261Visit : 27-Mar-2013H E M A T O L O G IAutomated Blood Count- WBC- RBC- Hemoglobin- Hem atocrit- Thrombocytes- M C V- M C H- M C H CL ES R

Diff Count- Basophils- Eosinophils- Bands / Stab- Neutrophils

6.3 3.8 - 11.0 IC/u1 6.3 3.8 - 11.0 K/ul5.6 4.4 - 5.9 Mini 5. 6 4.4 - 5.9 MA1115.5 13.2 - 17.3 g/d1 15.5 132 - 173 g/L46 40 - 52 % 0.46 0.4 - 0.52

314 150 - 440 KJul 314 150 -440 K/ul82 80 - 100 fl 82 80 - 100 fl28 26 - 34 pg 28 26 - 34 pg

33.4 32 - 36 g/dI 334 32 - 36 g/d114 * 0 - 10 min/h 14 0 - 10 min/h

1 0- 1% 1 0- 1%2 2- 4% 2 2- 4%1 * 3 - 5 % t 3 - 5 %

57 50 - 70 % 57 50 - 70 %

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Name : ABDUL RAHMANe x : M a l eComp : RADIANT UTAMA INTERINSCO TBK DOB : 24 December 1963 / Age : 49Lab/Reg. No. :C.2703019D MR No. : 01032261Visit : 27-Mar-2013URINALYSISMACROSCOPIC

- Colour Yellow Yellow- Turbidity Clear Clear- Sp. Gravity 1.015 1.015 - 1.025 1.015-pH 6.5 4.8 - 7.4 6.5- Leucocytes ( Enzymatic ) Negative Negative Negative- Glucose Negative Negative Negative- Nitrites Negative Negative Negative- Bilirubin Negative Negative Negative- Blood Negative Negative Negative- Urobilinogen Normal Normal Normal- Proteins Negative Negative /

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N a m e : A B D U L R A H M A NComp : RADIANT UTAMA INTERINSCO TBK

MR No. : 01032261 Visit : 27-Mar-2013ex : MaleDOB : 24 Decem ber 1963 /Age : 49

FVC Resu l t :.36 L---> 88.2 %FEV1 Result :.96 L---> 89.7 %FEV1/FVC Result :8.10 %---> 119.9 %PEF Result :0.20 L/S---> 99.4 %Indonesian Standart Result :IndexSpirometry ResultNormal SpirometryImpression : -

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FVC .36 .81 8.2F EV1. 0 . 96 .30 9.7F EV6. 0 .36

SPIROMETRY TEST REPORT

NameBDUL RAHMANID No.3 ate7/ 3/2013 9 : 33 MISexaleacesian (100 %)Age9Height72 0 cmoom temp510 '0Weight8 0 k g umidity0.0 %BSA. 10 m2tm Pr013. 1 hPaPredictedSIA2Cal. Date7/ 3/2013 7:25 AMPhysicianComment

ITEMNI TEASREDPRED

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Itr)RI n3L - 5N a m e : A B D U L R A H M A NComp : RADIANT UTAMA INTERINSCO TBK

Visit : 27-Mar-2013ex : M ale M R N o. :01032261IDOB : 24 December 1963 / Age : 49

TREADMILLinus Rythm axis ( N ), P wave ( N ), P R int 0.16"readmil l Exercise Test : N egat iveST - T segm ent ( N ) , ar i tmia (-)ardiopulmonary Fi tness

Classsification : GoodM ETs : 10.1

Examining Physician : Adolf Amahorseya DSJP

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M edika P lazaHea l th & Med ica l S e rv iceMP Medica l Center KC C l in ic

M enara Kart ika Chandra 3rd FloorJI. lend. Gatot Subroto Ka y . 18-20, Jakarta 12060Telp : +62 21 525 1207 (hunting), Fax : + 6 2 2 1 5 2 1 0 8 1 5w w w . m e d i k a p l a z a . c o m

TREADMILL EXERCISE T E S T R E P O R TD a t eN o . M R .tk ) 1 / 4 LA VA Ma m eP h o n eR e fe r r e d b yLtO ec\-4- A g er s/ MW e i g h tkgeight : r iAmP r e v i o u s t e s ta t e / R e s u l t :

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S T A G E / GRADE /SPEED M I N H . Rb p m B . P .m m H g S . T .l e v e l SIMPROMS /S IGNS /A RRHY THMIA SRESTHYPERVENTILATION u 12AI .0 % 2 . 7 4 m p h 1 1 74 N o2 1 1 0

3 1 . 1 5I I .2%4.02. 0 2 m p h 4 13 ,_I ,b l .MC

: 1-24I I I .4 % 5 . 4 7 m p h 7 l%t k l I - A 1 . k 1 ( V8 1 e _9 1e *I V .6% 6.76 mph 1 0 11 1

1 2V .8 % 8 . 0 5. 0 5 m p h 1 31 41 5V I .0 % 8 . 8 5 m p h 1 6

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