15.4 Buletin Analize Med Proteinograma

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Judeţul…………………………. Localitatea…………………….. Unitatea sanitară……………….. BULETIN DE ANALIZE MEDICALE Nr……. PROTEINOGRAMĂ/EX. DISPROTEINEMIE CNP Data a a a a

l l z z

Numele…………………………Prenumele…………… Sexul M ; vârsta………………………. F Domiciliul:judeţul,…………localitatea……………… Str………………..……………Nr……………………. Trimis de……………………………………………….. Produsul biologic şi examenul solicitat……………… ………………………………………………………… PROTEINOGRAMĂ Proteine totale………………………………………….. Albumine………………………………………………. Globuline………………………………………………. Raportul albumine/globuline…………………………... Globuline: α1………….……….β………………… α2 ………………γ……………………. Fibrinogen…………………………………………… Faţă 15..4 A6;t2

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continuare – EXAMENE DE DISPROTEINEMIE Thymol…………………………………………………. Takata Ara……………………………………………... Gross lim.rev. …………………………………………. Gross lim. Irev. ………………………………………. Sulfat de zinc………………………………………….. Sulfat de cadmiu……………………………………….. ALTE EXAMENE BIOCHIMICE ……………………………………………………… ………………………………………………………… ………………………………………………………… Lucrat de: ……………………………… Semnătura şi parafa medicului, ………………………………………………………….

verso

15..4 A6;t2

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