Requisitions & Forms
Download Forms
Test requisitions, pathology documentation, pathology consultation kit instructions, and patient
billing forms are available to download here
1973
- PT. First Medipharma built the pharmacy factory at Jln. Kenjeran no. 83
1974
- The factory operated and launched their first products, such as: tecorin, sulfaguanidin tablets, vitamins, rivanol, carbo tablet, mandarin capsule, and so on.
1993
- The Government of Indonesia issued new regulations in applying CPOB (Cara Pembuatan Obat Yang Baik / Good Manufacturing Practice) for pharmacy industries
- Transferring the ownership to a new management
1995
- Move the initial factory to new plan at Sidoarjo
- Expand the factory area to fulfill CPOB’s Government Standards.
Laboratory Guidelines
Laboratory Forms
- Download General Test Request Form
- Download Molecular Diagnostics Laboratory Request Form
- Download Cytology Request Form (Gynaecology)
- Download Quantiferon TB Gold Request Form
Patient’s Documents
- Download Disclaimer Form (for Patient)
- Download HIV Testing Consent Form