15.5 Buletin Analize Med Uree Bilirubina

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Judeţul…………………………. Localitatea…………………….. Unitatea sanitară……………….. BULETIN DE ANALIZE MEDICALE Nr……. UREE/BILIRUBINA 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……………… ………………………………………………………… REZULTATUL Uree sanguină………………………………………….. Uree urinară……………………………………………. Acid uric………………………………………………. Creatinină………………………….………………….. Amoniac……………………………………………… ……………………………………………………….. Faţă

15.5 A6;t2

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continuare – Bilirubina totală……………………………………… ………………………………………………………. Bilirubina directă……………………………………. ………………………………………………………. Bilirubina indirectă…………………………………. ………………………………………………………. Aminoacizi………………………………………….. ALTE ANALIZE BIOCHIMICE ……………………………………………………… ………………………………………………………… ………………………………………………………… ………………………………………………………… ………………………………………………………… ………………………………………………………… ………………………………………………………..

Lucrat de: ……………………………… Semnătura şi parafa medicului, …………………………………………………………. verso

15..5 A6;t2

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