Drug & Alcohol Test Report Generator

Clinic & Report Settings

Patient's Details

Test Details (Select to Include in Report)

Examiner's Details

Teratai Medik Sdn Bhd
Company Registration Number: 202201039090(1484787-V)
Address: No. 22 Jalan Enau 15 Taman Teratai Skudai
Email: Teratai.medik@gmail.com
Tel Number: +6012-6009137
DATE: DAY MONTH YEAR Serial No.: YYMMDD-HHMMSS

REPORT TITLE

Name:FULL NAME

NRIC/PASSPORT NO.:ID NO

PURPOSE:MEDICAL CHECKUP

RESULT:

NO.TYPE OF TESTCUT-OFF VALUERESULT

DONE AND REPORTED BY :

DR NAME

QUALIFICATIONS

Poliklinik Setia Logo
SETIA MEDICARE PLT (202404002572 (LLP0040073-LGN))
POLIKLINIK SETIA PASIR GUDANG
NO 25 (GF), JLN MAWAR MERAH 3/1, BUSINESS CENTRE II,
81700 PASIR GUDANG, JOHOR.
Tel: 07-2872386 / 011-15315150
DATE: DAY MONTH YEAR Serial No.: YYMMDD-HHMMSS

REPORT TITLE

Name:FULL NAME

NRIC/PASSPORT NO.:ID NO

PURPOSE:MEDICAL CHECKUP

RESULT:

NO.TYPE OF TESTCUT-OFF VALUERESULT

Report prepared by:

DR NAME

QUALIFICATIONS

Poliklinik Setia Logo
SETIA MEDICARE PLT (202404002572 (LLP0040073-LGN))
POLIKLINIK SETIA (MMHE EAST YARD)
PLO 336, JALAN SUASA, KAWASAN PERINDUSTRIAN PASIR GUDANG,
81700 PASIR GUDANG, JOHOR.
Tel: 011-10709133

REPORT TITLE

Name:FULL NAME

NRIC/PASSPORT NO.:ID NO

PURPOSE:MEDICAL CHECKUP

RESULT:

NO.TYPE OF TESTCUT-OFF VALUERESULT

Report prepared by:

DR NAME

QUALIFICATIONS

Poliklinik Setia Logo
SETIA MEDICARE PLT (202404002572 (LLP0040073-LGN))
MMHE CENTRE OF EXCELLENCE (COE)
NO 468, JALAN PEKELILING, KAWASAN PERINDUSTRIAN PASIR GUDANG,
81700 PASIR GUDANG, JOHOR.
Tel: 03-80844238 (HQ-EXT: 8008, JOHOR-EXT: 8014)

REPORT TITLE

Name:FULL NAME

NRIC/PASSPORT NO.:ID NO

PURPOSE:MEDICAL CHECKUP

RESULT:

NO.TYPE OF TESTCUT-OFF VALUERESULT

Report prepared by:

DR NAME

QUALIFICATIONS