Kir Asing(Freddy)+Labor

8/14/2019 Kir Asing(Freddy)+Labor

1/20

Nomor : 0204 / UKP / PHO / VIII / 2006

PSYSICAL EXAMINATION REPORT

Last Name of Applicant : MR. QIAO RONGMEI / First Name : -

Middle-Initial : - / Country : PR. CHINE

Date of Birth : 1964.09.01 / Place of Birth : LIAONING

SEX : Male

MEDICAL EXAMINATION

Height : 170 cm / Weight : 72 kg / Blood Pressure : 120 / 80 mmHg

Pulse : 68 x / mnt / Respiration : 16 x / mnt / General Appearance : Normal

VISION HEARING

Without Glasses : NORMAL / Right Ear : NORMAL

With Glasses : - / Left Ear : NORMAL

COLOR TEST TYPE

Book : V Lantern : - / Check if Color Test Is Normal :

/ Jellow : + / Red : + / Green : + / Blue : +

HEAD and NECK : NORMAL / HEART (Cardio Vascular) : NORMAL

LUNGS : NORMAL / SPEECH : NORMAl

EXTREMITAS

Upper : NORMAL / Lower : NORMAL

EXAMINATION FOR DUTY AS : A.B

This is to certify that a physical examination was given to : MR. QIAO RONGMEI

He is found to be Fit for DUTY and NOT INDICATE WITH THE INFECTIOUS DESEASE.

This Certificate is valid for one years from date of issue .

Name and Degree Of Physician : KRIPTI HARTINI, MD

Address : PORT HEALTH OFFICE OF TANJUNG PRIOK

Jl. Raya Pelabuhan No. 17 Jakarta Utara

Jakarta, August 24 th, 2006

Examining Physician

KRIPTI HARTINI, MD

Port Medical Officer


2/20

Nomor : 0203 / UKP / PHO / VIII / 2006


Last Name of Applicant : Mr. BI MINGJIE / First Name : -

Middle-Initial : - / Country : PR. CHINA

Date of Birth : 1964-12-18 / Place of Birth : SHANDONG

SEX : Male

MEDICAL EXAMINATION



VISION HEARING

Without Glasses : Normal / Right Ear : Normal

With Glasses : - / Left Ear : Normal

COLOR TEST TYPE



HEAD and NECK : Normal / HEART (Cardio Vascular) : Normal

LUNGS : Normal / SPEECH : Normal

EXTREMITAS

Upper : Normal / Lower : Normal

EXAMINATION FOR DUTY AS : M /M

This is to certify that a physical examination was given to : Mr. BI MINGJIE


This Certificate is valid for one years from date of issue.

Name and Degree Of Physician : I.NYOMAN PUTRA, MD



Jakarta, July 31 th, 2006

Examining Physician

I. NYOMAN PUTRA, MD



3/20

Nomor : 0178 / UKP / PHO / VI / 2006


Last Name of Applicant : LIU ZHAO ZHONG / First Name : -

Middle-Initial : - / Country : PRC


SEX : Male

MEDICAL EXAMINATION



VISION HEARING



COLOR TEST TYPE





EXTREMITAS


EXAMINATION FOR DUTY AS : 2 / O

This is to certify that a physical examination was given to : Mr. LIU ZHAO ZHONG



Name and Degree Of Physician : dr. Endriana S.L



Jakarta, June 10 th, 2006

Examining Physician

dr. Endriana S. L



4/20

Nomor : 0179 / UKP / PHO / VI / 2006


Last Name of Applicant : ZHANG YI JIN / First Name : -


Date of Birth : 28-03-1950 / Place of Birth : JIANGSU

SEX : Male

MEDICAL EXAMINATION



VISION HEARING



COLOR TEST TYPE





EXTREMITAS


EXAMINATION FOR DUTY AS : R / O

This is to certify that a physical examination was given to : Mr. ZHANG YI JIN



Name and Degree Of Physician : dr. Endriana S. L



Jakarta, June 10 th, 2006

Examining Physician

dr. Endriana S. L



5/20

Nomor : 0180 / UKP / PHO /VI / 2006


Last Name of Applicant : Mr. HUANG RUI / First Name : -


Date of Birth : 13-03-1978 / Place of Birth : LIAONING

SEX : Male

MEDICAL EXAMINATION



VISION HEARING



COLOR TEST TYPE





EXTREMITAS


EXAMINATION FOR DUTY AS : 3 / E

This is to certify that a physical examination was given to : Mr. HUANG RUI



Name and Degree Of Physician : dr. ENDRIANA S. L



Jakarta, JUNE 10 th, 2006

Examining Physician

dr. ENDRIANA S. L



6/20

Nomor : 0181 / UKP / PHO /VI / 2006


Last Name of Applicant : Mr. ZHU DA HAI / First Name : -



SEX : Male

MEDICAL EXAMINATION



VISION HEARING



COLOR TEST TYPE

Book : V Lantern : - / Check if Color Test Is Normal : / Jellow : + / Red : + / Green : + / Blue : +



EXTREMITAS


EXAMINATION FOR DUTY AS : 4 / E

This is to certify that a physical examination was given to : Mr. ZHU DA HAI




Address : PORT HEALTH OFFICE OF TANJUNG PRIOKJl. Raya Pelabuhan No. 17 Jakarta Utara


Examining Physician

dr. ENDRIANA S. L



7/20

Nomor : 0182 / UKP / PHO /VI / 2006


Last Name of Applicant : Mr. CHEN YU LONG / First Name : -



SEX : Male

MEDICAL EXAMINATION



VISION HEARING



COLOR TEST TYPE




EXTREMITAS


EXAMINATION FOR DUTY AS : CPO / O

This is to certify that a physical examination was given to : Mr. CHEN YU LONG






Examining Physician

dr. ENDRIANA S. L



8/20

Nomor : 0183 / UKP / PHO /VI / 2006


Last Name of Applicant : Mr. JIANG MAO HAI / First Name : -



SEX : Male

MEDICAL EXAMINATION



VISION HEARING



COLOR TEST TYPE




EXTREMITAS


EXAMINATION FOR DUTY AS : S. G. I

This is to certify that a physical examination was given to : Mr. JIANG MAO HAI



Name and Degree Of Physician : dr. ENDRIANA. S. L



Examining Physician

dr. ENDRIANA. S. L



9/20

Nomor : 0184 / UKP / PHO /VI / 2006


Last Name of Applicant : Mr. LI LI / First Name : -



SEX : Male

MEDICAL EXAMINATION



VISION HEARING



COLOR TEST TYPE




EXTREMITAS


EXAMINATION FOR DUTY AS : S. G . I

This is to certify that a physical examination was given to : Mr. LI LI






Examining Physician

dr. ENDRIANA S. L



10/20

Nomor : 0185 / UKP / PHO /VI / 2006


Last Name of Applicant : Mr. WANG HU / First Name : -


Date of Birth : 04-07-1969 / Place of Birth : HUBEI

SEX : Male

MEDICAL EXAMINATION



VISION HEARING



COLOR TEST TYPE




EXTREMITAS



This is to certify that a physical examination was given to : Mr. WANG HU






Examining Physician

dr. ENDRIANA S. L



11/20

Nomor : 0186 / UKP / PHO /VI / 2006


Last Name of Applicant : Mr. XU YI FENG / First Name : -


Date of Birth : 04-06-1962 / Place of Birth : SHANGHAI

SEX : Male

MEDICAL EXAMINATION

Height : 177 cm / Weight : 89 kg / Blood Pressure : 130 / 80 mmHgPulse : 80 x / mnt / Respiration : 20 x / mnt / General Appearance : Normal

VISION HEARING



COLOR TEST TYPE





EXTREMITAS



This is to certify that a physical examination was given to : Mr. XU YI FENG







Examining Physician

dr. ENDRIANA S. L



12/20

Nomor : 0187 / UKP / PHO /VI / 2006


Last Name of Applicant : Mr. HU ZHI ZHONG / First Name : -


Date of Birth : 08-03-1983 / Place of Birth : HENAN

SEX : Male

MEDICAL EXAMINATION


VISION HEARING



COLOR TEST TYPE





EXTREMITAS



This is to certify that a physical examination was given to : Mr. HU ZHI ZHONG







Examining Physician

dr. ENDRIANA S. L



13/20

Nomor : 0188 / UKP / PHO /VI / 2006


Last Name of Applicant : Mr. HAO JIN BO / First Name : -


Date of Birth : 07-09-1964 / Place of Birth : LIAONING

SEX : Male

MEDICAL EXAMINATION


VISION HEARING



COLOR TEST TYPE





EXTREMITAS


EXAMINATION FOR DUTY AS : M. G . I

This is to certify that a physical examination was given to : Mr. HAO JIN BAO







Examining Physician

dr. ENDRIANA S. L



14/20

Nomor : 0189 / UKP / PHO /VI / 2006


Last Name of Applicant : Mr. WANG MING SHUI / First Name : -



SEX : Male

MEDICAL EXAMINATION


VISION HEARING



COLOR TEST TYPE





EXTREMITAS


EXAMINATION FOR DUTY AS : M. G . I

This is to certify that a physical examination was given to : Mr. WANG MING SHUI







Examining Physician

dr. ENDRIANA S. L



15/20

Nomor : 0190 / UKP / PHO /VI / 2006


Last Name of Applicant : Mr. ZHU PIN FA / First Name : -


Date of Birth : 01-12-1948 / Place of Birth : SHANG HAI

SEX : Male

MEDICAL EXAMINATION


VISION HEARING



COLOR TEST TYPE


/ Jellow : + / Red : + / Green : + / Blue : +( Mixed Color : - neg )



EXTREMITAS


EXAMINATION FOR DUTY AS : C / CK

This is to certify that a physical examination was given to : Mr. ZHU PIN FA







Examining Physician

dr. ENDRIANA S. L



16/20

Nomor : 0191 / UKP / PHO /VI / 2006


Last Name of Applicant : Mr. LI BAI HE / First Name : -


Date of Birth : 10-09-1982 / Place of Birth : GUANGDONG

SEX : Male

MEDICAL EXAMINATION


VISION HEARING



COLOR TEST TYPE





EXTREMITAS


EXAMINATION FOR DUTY AS : M / B

This is to certify that a physical examination was given to : Mr. LI BAI HE







Examining Physician

dr. ENDRIANA S. L



17/20

Nomor : 0194 / UKP / PHO /VI / 2006


Last Name of Applicant : Mr. LI,GUANG YI / First Name : -


Date of Birth : 10-09-1978 / Place of Birth : LIAO NING

SEX : Male

MEDICAL EXAMINATION



VISION HEARING



COLOR TEST TYPE




EXTREMITAS


EXAMINATION FOR DUTY AS : M M 1

This is to certify that a physical examination was given to : Mr. LI,GUANG YI



Name and Degree Of Physician : I NYOMAN PUTRA,MD



Jakarta, JULY 16 th, 2006

Examining Physician

I NYOMAN PUTRA,MD


78*


18/20

Nomor : 0195 / UKP / PHO /VI / 2006


Last Name of Applicant : Mr. LEI, YI N CHENG / First Name : -



SEX : Male

MEDICAL EXAMINATION

Height : 172cm / Weight : 64 kg / Blood Pressure : 120 / 80 mmHg


VISION HEARING



COLOR TEST TYPE





EXTREMITAS


EXAMINATION FOR DUTY AS : S M 1

This is to certify that a physical examination was given to : Mr. LEI, YIN CHENG






Jakarta, JULY 16 th, 2006Examining Physician

I NYOMAN PUTRA,MD



19/20

Nomor : 0192 / UKP / PHO /VI / 2006


Last Name of Applicant : Mr. ZHENG, DIAN YUAN / First Name : -



SEX : Male

MEDICAL EXAMINATION



VISION HEARING



COLOR TEST TYPE





EXTREMITAS


EXAMINATION FOR DUTY AS : MSM

This is to certify that a physical examination was given to : Mr. ZHENG,DIAN YUAN






Jakarta, JULY 16 th, 2006Examining Physician

I NYOMAN PUTRA,MD



20/20

Nomor : 0194 / UKP / PHO /VI / 2006


Last Name of Applicant : Mr. ZHOU YUE XING / First Name : -



SEX : Male

MEDICAL EXAMINATION


VISION HEARING



COLOR TEST TYPE





EXTREMITAS


EXAMINATION FOR DUTY AS : C/E

This is to certify that a physical examination was given to : Mr. WANG,SHUN JUN






Jakarta, JULY 18 th, 2006

Examining Physician

I NYOMAN PUTRA,MD


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Kir Asing(Freddy)+Labor

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