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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
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Nomor : 0203 / UKP / PHO / VIII / 2006
PSYSICAL EXAMINATION REPORT
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
Height : 176 cm / Weight : 85 kg / Blood Pressure : 120 / 90 mmHg
Pulse : 70 x / mnt / Respiration : 20 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 : M /M
This is to certify that a physical examination was given to : Mr. BI MINGJIE
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 : I.NYOMAN PUTRA, MD
Address : PORT HEALTH OFFICE OF TANJUNG PRIOK
Jl. Raya Pelabuhan No. 17 Jakarta Utara
Jakarta, July 31 th, 2006
Examining Physician
I. NYOMAN PUTRA, MD
Port Medical Officer
8/14/2019 Kir Asing(Freddy)+Labor
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Nomor : 0178 / UKP / PHO / VI / 2006
PSYSICAL EXAMINATION REPORT
Last Name of Applicant : LIU ZHAO ZHONG / First Name : -
Middle-Initial : - / Country : PRC
Date of Birth : 02-12-1972 / Place of Birth : SHANDONG
SEX : Male
MEDICAL EXAMINATION
Height : 171 cm / Weight : 65 kg / Blood Pressure : 110 / 70 mmHg
Pulse : 80 x / mnt / Respiration : 20 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 : 2 / O
This is to certify that a physical examination was given to : Mr. LIU ZHAO ZHONG
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 : dr. Endriana S.L
Address : PORT HEALTH OFFICE OF TANJUNG PRIOK
Jl. Raya Pelabuhan No. 17 Jakarta Utara
Jakarta, June 10 th, 2006
Examining Physician
dr. Endriana S. L
Port Medical Officer
8/14/2019 Kir Asing(Freddy)+Labor
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Nomor : 0179 / UKP / PHO / VI / 2006
PSYSICAL EXAMINATION REPORT
Last Name of Applicant : ZHANG YI JIN / First Name : -
Middle-Initial : - / Country : PRC
Date of Birth : 28-03-1950 / Place of Birth : JIANGSU
SEX : Male
MEDICAL EXAMINATION
Height : 170 cm / Weight : 80 kg / Blood Pressure : 130 / 80 mmHg
Pulse : 80 x / mnt / Respiration : 20 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 : R / O
This is to certify that a physical examination was given to : Mr. ZHANG YI JIN
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 : dr. Endriana S. L
Address : PORT HEALTH OFFICE OF TANJUNG PRIOK
Jl. Raya Pelabuhan No. 17 Jakarta Utara
Jakarta, June 10 th, 2006
Examining Physician
dr. Endriana S. L
Port Medical Officer
8/14/2019 Kir Asing(Freddy)+Labor
5/20
Nomor : 0180 / UKP / PHO /VI / 2006
PSYSICAL EXAMINATION REPORT
Last Name of Applicant : Mr. HUANG RUI / First Name : -
Middle-Initial : - / Country : PRC
Date of Birth : 13-03-1978 / Place of Birth : LIAONING
SEX : Male
MEDICAL EXAMINATION
Height : 175 cm / Weight : 74 kg / Blood Pressure : 110 / 80 mmHg
Pulse : 78 x / mnt / Respiration : 18 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 : 3 / E
This is to certify that a physical examination was given to : Mr. HUANG RUI
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 : dr. ENDRIANA S. L
Address : PORT HEALTH OFFICE OF TANJUNG PRIOK
Jl. Raya Pelabuhan No. 17 Jakarta Utara
Jakarta, JUNE 10 th, 2006
Examining Physician
dr. ENDRIANA S. L
Port Medical Officer
8/14/2019 Kir Asing(Freddy)+Labor
6/20
Nomor : 0181 / UKP / PHO /VI / 2006
PSYSICAL EXAMINATION REPORT
Last Name of Applicant : Mr. ZHU DA HAI / First Name : -
Middle-Initial : - / Country : PRC
Date of Birth : 26-10-1968 / Place of Birth : SHANDONG
SEX : Male
MEDICAL EXAMINATION
Height : 170 cm / Weight : 72 kg / Blood Pressure : 100 / 80 mmHg
Pulse : 70 x / mnt / Respiration : 20 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 : 4 / E
This is to certify that a physical examination was given to : Mr. ZHU DA HAI
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 : dr. ENDRIANA S. L
Address : PORT HEALTH OFFICE OF TANJUNG PRIOKJl. Raya Pelabuhan No. 17 Jakarta Utara
Jakarta, JUNE 10 th, 2006
Examining Physician
dr. ENDRIANA S. L
Port Medical Officer
8/14/2019 Kir Asing(Freddy)+Labor
7/20
Nomor : 0182 / UKP / PHO /VI / 2006
PSYSICAL EXAMINATION REPORT
Last Name of Applicant : Mr. CHEN YU LONG / First Name : -
Middle-Initial : - / Country : PRC
Date of Birth : 13-11-1962 / Place of Birth : JIANGSU
SEX : Male
MEDICAL EXAMINATION
Height : 170 cm / Weight : 65 kg / Blood Pressure : 120 / 80 mmHg
Pulse : 80 x / mnt / Respiration : 18 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 : CPO / O
This is to certify that a physical examination was given to : Mr. CHEN YU LONG
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 : dr. ENDRIANA S. L
Address : PORT HEALTH OFFICE OF TANJUNG PRIOKJl. Raya Pelabuhan No. 17 Jakarta Utara
Jakarta, JUNE 10 th, 2006
Examining Physician
dr. ENDRIANA S. L
Port Medical Officer
8/14/2019 Kir Asing(Freddy)+Labor
8/20
Nomor : 0183 / UKP / PHO /VI / 2006
PSYSICAL EXAMINATION REPORT
Last Name of Applicant : Mr. JIANG MAO HAI / First Name : -
Middle-Initial : - / Country : PRC
Date of Birth : 22-12-1963 / Place of Birth : SHANDONG
SEX : Male
MEDICAL EXAMINATION
Height : 173 cm / Weight : 75 kg / Blood Pressure : 100 / 70 mmHg
Pulse : 76 x / mnt / Respiration : 18 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 : S. G. I
This is to certify that a physical examination was given to : Mr. JIANG MAO HAI
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 : dr. ENDRIANA. S. L
Address : PORT HEALTH OFFICE OF TANJUNG PRIOKJl. Raya Pelabuhan No. 17 Jakarta Utara
Jakarta, JUNE 10 th, 2006
Examining Physician
dr. ENDRIANA. S. L
Port Medical Officer
8/14/2019 Kir Asing(Freddy)+Labor
9/20
Nomor : 0184 / UKP / PHO /VI / 2006
PSYSICAL EXAMINATION REPORT
Last Name of Applicant : Mr. LI LI / First Name : -
Middle-Initial : - / Country : PRC
Date of Birth : 13-05-1972 / Place of Birth : SHANDONG
SEX : Male
MEDICAL EXAMINATION
Height : 170 cm / Weight : 75 kg / Blood Pressure : 100 / 70 mmHg
Pulse : 80 x / mnt / Respiration : 20 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 : S. G . I
This is to certify that a physical examination was given to : Mr. LI LI
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 : dr. ENDRIANA S. L
Address : PORT HEALTH OFFICE OF TANJUNG PRIOKJl. Raya Pelabuhan No. 17 Jakarta Utara
Jakarta, JUNE 10 th, 2006
Examining Physician
dr. ENDRIANA S. L
Port Medical Officer
8/14/2019 Kir Asing(Freddy)+Labor
10/20
Nomor : 0185 / UKP / PHO /VI / 2006
PSYSICAL EXAMINATION REPORT
Last Name of Applicant : Mr. WANG HU / First Name : -
Middle-Initial : - / Country : PRC
Date of Birth : 04-07-1969 / Place of Birth : HUBEI
SEX : Male
MEDICAL EXAMINATION
Height : 180 cm / Weight : 75 kg / Blood Pressure : 120 / 80 mmHg
Pulse : 78 x / mnt / Respiration : 20 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 : S. G . I
This is to certify that a physical examination was given to : Mr. WANG HU
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 : dr. ENDRIANA S. L
Address : PORT HEALTH OFFICE OF TANJUNG PRIOKJl. Raya Pelabuhan No. 17 Jakarta Utara
Jakarta, JUNE 10 th, 2006
Examining Physician
dr. ENDRIANA S. L
Port Medical Officer
8/14/2019 Kir Asing(Freddy)+Labor
11/20
Nomor : 0186 / UKP / PHO /VI / 2006
PSYSICAL EXAMINATION REPORT
Last Name of Applicant : Mr. XU YI FENG / First Name : -
Middle-Initial : - / Country : PRC
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
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 : S. G . I
This is to certify that a physical examination was given to : Mr. XU YI FENG
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 : dr. ENDRIANA S. L
Address : PORT HEALTH OFFICE OF TANJUNG PRIOK
Jl. Raya Pelabuhan No. 17 Jakarta Utara
Jakarta, JUNE 10 th, 2006
Examining Physician
dr. ENDRIANA S. L
Port Medical Officer
8/14/2019 Kir Asing(Freddy)+Labor
12/20
Nomor : 0187 / UKP / PHO /VI / 2006
PSYSICAL EXAMINATION REPORT
Last Name of Applicant : Mr. HU ZHI ZHONG / First Name : -
Middle-Initial : - / Country : PRC
Date of Birth : 08-03-1983 / Place of Birth : HENAN
SEX : Male
MEDICAL EXAMINATION
Height : 175 cm / Weight : 65 kg / Blood Pressure : 110 / 80 mmHgPulse : 70 x / mnt / Respiration : 20 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 : S. G . I
This is to certify that a physical examination was given to : Mr. HU ZHI ZHONG
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 : dr. ENDRIANA S. L
Address : PORT HEALTH OFFICE OF TANJUNG PRIOK
Jl. Raya Pelabuhan No. 17 Jakarta Utara
Jakarta, JUNE 10 th, 2006
Examining Physician
dr. ENDRIANA S. L
Port Medical Officer
8/14/2019 Kir Asing(Freddy)+Labor
13/20
Nomor : 0188 / UKP / PHO /VI / 2006
PSYSICAL EXAMINATION REPORT
Last Name of Applicant : Mr. HAO JIN BO / First Name : -
Middle-Initial : - / Country : PRC
Date of Birth : 07-09-1964 / Place of Birth : LIAONING
SEX : Male
MEDICAL EXAMINATION
Height : 172 cm / Weight : 60 kg / Blood Pressure : 110 / 80 mmHgPulse : 72 x / mnt / Respiration : 20 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 : M. G . I
This is to certify that a physical examination was given to : Mr. HAO JIN BAO
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 : dr. ENDRIANA S. L
Address : PORT HEALTH OFFICE OF TANJUNG PRIOK
Jl. Raya Pelabuhan No. 17 Jakarta Utara
Jakarta, JUNE 10 th, 2006
Examining Physician
dr. ENDRIANA S. L
Port Medical Officer
8/14/2019 Kir Asing(Freddy)+Labor
14/20
Nomor : 0189 / UKP / PHO /VI / 2006
PSYSICAL EXAMINATION REPORT
Last Name of Applicant : Mr. WANG MING SHUI / First Name : -
Middle-Initial : - / Country : PRC
Date of Birth : 13-11-1962 / Place of Birth : SHANDONG
SEX : Male
MEDICAL EXAMINATION
Height : 174 cm / Weight : 76 kg / Blood Pressure : 120 / 80 mmHgPulse : 80 x / mnt / Respiration : 18 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 : M. G . I
This is to certify that a physical examination was given to : Mr. WANG MING SHUI
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 : dr. ENDRIANA S. L
Address : PORT HEALTH OFFICE OF TANJUNG PRIOK
Jl. Raya Pelabuhan No. 17 Jakarta Utara
Jakarta, JUNE 10 th, 2006
Examining Physician
dr. ENDRIANA S. L
Port Medical Officer
8/14/2019 Kir Asing(Freddy)+Labor
15/20
Nomor : 0190 / UKP / PHO /VI / 2006
PSYSICAL EXAMINATION REPORT
Last Name of Applicant : Mr. ZHU PIN FA / First Name : -
Middle-Initial : - / Country : PRC
Date of Birth : 01-12-1948 / Place of Birth : SHANG HAI
SEX : Male
MEDICAL EXAMINATION
Height : 165 cm / Weight : 85 kg / Blood Pressure : 130 / 80 mmHgPulse : 76 x / mnt / Respiration : 20 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 : +( Mixed Color : - neg )
HEAD and NECK : Normal / HEART (Cardio Vascular) : Normal
LUNGS : Normal / SPEECH : Normal
EXTREMITAS
Upper : Normal / Lower : Normal
EXAMINATION FOR DUTY AS : C / CK
This is to certify that a physical examination was given to : Mr. ZHU PIN FA
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 : dr. ENDRIANA S. L
Address : PORT HEALTH OFFICE OF TANJUNG PRIOK
Jl. Raya Pelabuhan No. 17 Jakarta Utara
Jakarta, JUNE 10 th, 2006
Examining Physician
dr. ENDRIANA S. L
Port Medical Officer
8/14/2019 Kir Asing(Freddy)+Labor
16/20
Nomor : 0191 / UKP / PHO /VI / 2006
PSYSICAL EXAMINATION REPORT
Last Name of Applicant : Mr. LI BAI HE / First Name : -
Middle-Initial : - / Country : PRC
Date of Birth : 10-09-1982 / Place of Birth : GUANGDONG
SEX : Male
MEDICAL EXAMINATION
Height : 167 cm / Weight : 53 kg / Blood Pressure : 110 / 80 mmHgPulse : 78 x / mnt / Respiration : 20 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 : M / B
This is to certify that a physical examination was given to : Mr. LI BAI HE
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 : dr. ENDRIANA S. L
Address : PORT HEALTH OFFICE OF TANJUNG PRIOK
Jl. Raya Pelabuhan No. 17 Jakarta Utara
Jakarta, JUNE 10 th, 2006
Examining Physician
dr. ENDRIANA S. L
Port Medical Officer
8/14/2019 Kir Asing(Freddy)+Labor
17/20
Nomor : 0194 / UKP / PHO /VI / 2006
PSYSICAL EXAMINATION REPORT
Last Name of Applicant : Mr. LI,GUANG YI / First Name : -
Middle-Initial : - / Country : PRC
Date of Birth : 10-09-1978 / Place of Birth : LIAO NING
SEX : Male
MEDICAL EXAMINATION
Height : 178 cm / Weight : 65 kg / Blood Pressure : 110 / 70 mmHg
Pulse : 70 x / mnt / Respiration : 17 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 : M M 1
This is to certify that a physical examination was given to : Mr. LI,GUANG YI
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 : I NYOMAN PUTRA,MD
Address : PORT HEALTH OFFICE OF TANJUNG PRIOK
Jl. Raya Pelabuhan No. 17 Jakarta Utara
Jakarta, JULY 16 th, 2006
Examining Physician
I NYOMAN PUTRA,MD
Port Medical Officer
78*
8/14/2019 Kir Asing(Freddy)+Labor
18/20
Nomor : 0195 / UKP / PHO /VI / 2006
PSYSICAL EXAMINATION REPORT
Last Name of Applicant : Mr. LEI, YI N CHENG / First Name : -
Middle-Initial : - / Country : PRC
Date of Birth : 30-06-1963 / Place of Birth : LIAO NING
SEX : Male
MEDICAL EXAMINATION
Height : 172cm / Weight : 64 kg / Blood Pressure : 120 / 80 mmHg
Pulse : 65 x / mnt / Respiration : 17 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 : S M 1
This is to certify that a physical examination was given to : Mr. LEI, YIN CHENG
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 : I NYOMAN PUTRA,MD
Address : PORT HEALTH OFFICE OF TANJUNG PRIOK
Jl. Raya Pelabuhan No. 17 Jakarta Utara
Jakarta, JULY 16 th, 2006Examining Physician
I NYOMAN PUTRA,MD
Port Medical Officer
8/14/2019 Kir Asing(Freddy)+Labor
19/20
Nomor : 0192 / UKP / PHO /VI / 2006
PSYSICAL EXAMINATION REPORT
Last Name of Applicant : Mr. ZHENG, DIAN YUAN / First Name : -
Middle-Initial : - / Country : PRC
Date of Birth : 14-04-1969 / Place of Birth : LIAO NING
SEX : Male
MEDICAL EXAMINATION
Height : 165 cm / Weight : 72 kg / Blood Pressure : 120 / 80 mmHg
Pulse : 70 x / mnt / Respiration : 20 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 : MSM
This is to certify that a physical examination was given to : Mr. ZHENG,DIAN YUAN
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 : I NYOMAN PUTRA,MD
Address : PORT HEALTH OFFICE OF TANJUNG PRIOK
Jl. Raya Pelabuhan No. 17 Jakarta Utara
Jakarta, JULY 16 th, 2006Examining Physician
I NYOMAN PUTRA,MD
Port Medical Officer
8/14/2019 Kir Asing(Freddy)+Labor
20/20
Nomor : 0194 / UKP / PHO /VI / 2006
PSYSICAL EXAMINATION REPORT
Last Name of Applicant : Mr. ZHOU YUE XING / First Name : -
Middle-Initial : - / Country : PRC
Date of Birth : 08-06-1962 / Place of Birth : JIANGSU
SEX : Male
MEDICAL EXAMINATION
Height : 170 cm / Weight : 64 kg / Blood Pressure : 110 / 70 mmHgPulse : 70 x / mnt / Respiration : 17 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 : C/E
This is to certify that a physical examination was given to : Mr. WANG,SHUN JUN
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 : I NYOMAN PUTRA,MD
Address : PORT HEALTH OFFICE OF TANJUNG PRIOK
Jl. Raya Pelabuhan No. 17 Jakarta Utara
Jakarta, JULY 18 th, 2006
Examining Physician
I NYOMAN PUTRA,MD
Port Medical Officer