Laboratory

Redoble Medical Clinic Buug, Zamboanga Sibugay

Date:_________________ Patient:.___________________________________ Age: _________ Sex: ________ Address: ____________________________________________________________ Laboratory Requests _____________CBC:

______________ URINALYSIS:

____________ STOOL EXAM

BLOOD CHEMISTRY ____________ FBS ____________ BUN ____________ Creatinine ____________ Uric Acid ____________ Total Cholesterol ____________ CT ____________ HDL ____________ Globulin

_______________ Serum Na _______________ Serum K _______________ Serum Cl _______________ Serum Ca _______________ Serum Mg _______________ BT _______________ LDL

______________ SGPT ______________ SGOT ______________ LDH ______________ Alk Phos ______________ Triglyceraes ______________ Albumin ______________ PTPA

Others: _____________________________________________________________________________________

X- RAY EXAMINATION ____________ Chest X-Ray ________________________View ____________ Cervical Spine Series ____________ Lumbosacral Spine Series ____________ Thoracolumbar Spine Series

__________________ Barium Enema __________________ UGI Series __________________ Complete Abdomen __________________ KUB- IVP

Others: ______________________________________________________________________________________ _____________________,M.D LIC.NO.__________________ PTR.NO.__________________ S2 NO. ___________________ TIN NO. __________________