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Edited Labratory

The document is a laboratory request form from Arsho Health Center, detailing tests for hematology, urinalysis, serology, chemistry, and bacteriology. It includes sections for patient information, test results, and normal value ranges. The form is duplicated for two separate requests, indicating a structured approach to lab testing.

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Debebe Daniel
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11 views1 page

Edited Labratory

The document is a laboratory request form from Arsho Health Center, detailing tests for hematology, urinalysis, serology, chemistry, and bacteriology. It includes sections for patient information, test results, and normal value ranges. The form is duplicated for two separate requests, indicating a structured approach to lab testing.

Uploaded by

Debebe Daniel
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

ARSHO HEALTH CENTER ARSHO HEALTH CENTER

LABRATORY REQUEST LABRATORY REQUEST


Name-------------------Age-----sex------card no------------------Date-------- Name-------------------Age-----sex------card no------------------Date--------
Hematology Urinalysis Hematology Urinalysis
CBC------------------Color-------------Gui----------- CBC------------------Color-------------Gui-----------
Blood ----------------Rh--------------Appear------kct----------------- Blood ----------------Rh--------------Appear------kct-----------------
Blood film------------PH----------------bil--------------------------- Blood film------------PH----------------bil---------------------------
ESR---------------------SG-------------------Urobil-------------------- ESR---------------------SG-------------------Urobil--------------------
Prot------------Blood--------------- Prot------------Blood---------------
Serology microscopy Serology microscopy
UDRI------------- Epith Cell-------------- UDRI------------- Epith Cell--------------
HBSAG----------- WBC------------------ HBSAG----------- WBC------------------
HCV---------------- RBC------------------ HCV---------------- RBC------------------
RF------------------- Cast----------------- RF------------------- Cast-----------------
Well fellix------------- Bacteria------------ Well fellix------------- Bacteria------------
Wisal H:----------------- urine HCG Wisal H:----------------- urine HCG
O:---------------------- Stool Exam O:---------------------- Stool Exam
[Link](Ab)------------------ consistency------------------- [Link](Ab)------------------ consistency-------------------
Stool Ag------------------------- o/p---------------------------- Stool Ag------------------------- o/p----------------------------
Chemistry Chemistry
Result NL Value Result NL Value Result NL Value Result NL Value
FBS/RBS BUN SGOT FBS/RBS BUN SGOT
Creat Uric Acid SGPT Creat Uric SGPT
Other ALP Acid Other ALP
Bil(T) Bil(T)
Bil(D) Bil(D)
TG TG
[Link] [Link]
HDL HDL
LDC LDC

Bacteriology sputum for AFB Bacteriology sputum for AFB


Gm stain------------------------ 1st --------------------- Gm stain------------------------ 1st ---------------------
KOH---------------------------- 2nd -------------------- KOH---------------------------- 2nd --------------------
Wet film---------------------- 3rd --------------------- Wet film---------------------- 3rd ---------------------
Request by ------------------- Reported by ------------ Date-------------- Request by ------------------- Reported by ------------ Date--------------

ARSHO HEALTH CENTER ARSHO HEALTH CENTER


LABRATORY REQUEST LABRATORY REQUEST
Name-------------------Age-----sex------card no------------------Date-------- Name-------------------Age-----sex------card no------------------Date--------
Hematology Urinalysis Hematology Urinalysis
CBC------------------Color-------------Gui----------- CBC------------------Color-------------Gui-----------
Blood ----------------Rh--------------Appear------kct----------------- Blood ----------------Rh--------------Appear------kct-----------------
Blood film------------PH----------------bil--------------------------- Blood film------------PH----------------bil---------------------------
ESR---------------------SG-------------------Urobil-------------------- ESR---------------------SG-------------------Urobil--------------------
Prot------------Blood--------------- Prot------------Blood---------------
Serology microscopy Serology microscopy
UDRI------------- Epith Cell-------------- UDRI------------- Epith Cell--------------
HBSAG----------- WBC------------------ HBSAG----------- WBC------------------
HCV---------------- RBC------------------ HCV---------------- RBC------------------
RF------------------- Cast----------------- RF------------------- Cast-----------------
Well fellix------------- Bacteria------------ Well fellix------------- Bacteria------------
Wisal H:----------------- urine HCG Wisal H:----------------- urine HCG
O:---------------------- Stool Exam O:---------------------- Stool Exam
[Link](Ab)------------------ consistency------------------- [Link](Ab)------------------ consistency-------------------
Stool Ag------------------------- o/p---------------------------- Stool Ag------------------------- o/p----------------------------
Chemistry Chemistry
Result NL Value Result NL Value Result NL Value Result NL Value
FBS/RBS BUN SGOT FBS/RBS BUN SGOT
Creat Uric Acid SGPT Creat Uric SGPT
Other ALP Acid Other ALP
Bil(T) Bil(T)
Bil(D) Bil(D)
TG TG
[Link] [Link]
HDL HDL
LDC LDC

Bacteriology sputum for AFB Bacteriology sputum for AFB


Gm stain------------------------ 1st --------------------- Gm stain------------------------ 1st ---------------------
KOH---------------------------- 2nd -------------------- KOH---------------------------- 2nd --------------------
Wet film---------------------- 3rd --------------------- Wet film---------------------- 3rd ---------------------
Request by ------------------- Reported by ------------ Date-------------- Request by ------------------- Reported by ------------ Date--------------

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