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Report of Drug S Testing

This document contains two medical reports. The first is a drugs test report for an employee that includes their personal information and the results of a urine sample drug screening test for methamphetamine, opiates, marijuana, amphetamines, cocaine, and benzodiazepines. The second is an HIV test report with the same format providing personal information and blood test results for HIV antibodies. Both reports state they are provisional and for a specified use.

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elvinegunawan
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82 views

Report of Drug S Testing

This document contains two medical reports. The first is a drugs test report for an employee that includes their personal information and the results of a urine sample drug screening test for methamphetamine, opiates, marijuana, amphetamines, cocaine, and benzodiazepines. The second is an HIV test report with the same format providing personal information and blood test results for HIV antibodies. Both reports state they are provisional and for a specified use.

Uploaded by

elvinegunawan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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REPORT of DRUGS TESTING

No :
To whom it may concern,
By signing below, I :
Name
Employee ID
Position
Department

:
:
:
: Department of Psychiatry

Certify that :
Name
Medical Record Number
Place and date of Birth
Gender
Address

:
:
:
:
:

Based on the examination on .........................., .................................. with result :


1. Anamnesis
Found / No found symptoms of drug user
2. Physical Examination
Found / No found signs of drug user
3. Laboratorium examination : urine sample , on .........................., ..................................
(result was attached)
Methamphetamine
Reactive / Non Reactive
Opiate / Morphine
Reactive / Non Reactive
Marijuana
Reactive / Non Reactive
Amphetamine
Reactive / Non Reactive
Cocaine
Reactive / Non Reactive
Benzodiazepine
Reactive / Non Reactive
This report is provisional and used for.........................................................
Bandung,...................................

(...........................................)

REPORT of HIV TESTING


No :

To whom it may concern,


By signing below, I :
Name

Employee ID

Position

Department

: Department of Psychiatry

Certify that :
Name

Medical Record Number :


Place and date of Birth

Gender

Address

Based on the examination on .........................., .................................. with result:


1. Anamnesis
Found / No found symptoms of HIV infection
2. Physical Examination
Found / No found signs of HIV infection
3. Laboratorium examination : blood sample , on
attached)
Anti HIV

(result was
Reactive / Non Reactive

This report is provisional and used for.........................................................


Bandung,...................................

(...........................................)

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