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St. Clare Clinical Lab Test Form

REQUEST OF DOCUMENTS

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stclaredtl2
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18 views1 page

St. Clare Clinical Lab Test Form

REQUEST OF DOCUMENTS

Uploaded by

stclaredtl2
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

ST.

CLARE CLINICAL AND DRUG TESTING LABORATORY


J.P. Rizal St. Catarman N. Samar
Landline #: (055)500-1251
ST. CLARE CLINICAL AND DRUG TESTING LABORATORY
Date:____________________ J.P. Rizal St. Catarman N. Samar
Landline #: (055)500-1251
Name:______________________________________ Date:____________________
Age/Sex:_________Address:____________________
Name:______________________________________
BLOOD CHEMISTRY IMMUNOLOGY Age/Sex:_________Address:____________________

FBS Creatinine __ HBSAg BLOOD CHEMISTRY IMMUNOLOGY


RBS SGOT/AST __ Anti-HAV
HbA1c SGPT/ALT __ VDRL/Syphilis FBS Creatinine __ HBSAg
Lipid Profile Sodium __ Dengue Duo RBS SGOT/AST __ Anti-HAV
BUN Potassium __ H. Pylori Abs HbA1c SGPT/ALT __ VDRL/Syphilis
Uric Acid Chloride __ PSA Lipid Profile Sodium _ Dengue Duo
BUN Potassium __ H. Pylori Abs
ENDOCRINE HEMATOLOGY Uric Acid Chloride __ PSA
FT3 ___CBC
FT4 ___ Platelet Ct. ENDOCRINE HEMATOLOGY
TSH ___ Blood Typing FT3 CBC
Serum HCG FT4 Platelet Ct.
TSH Blood Typing
__ Urinalysis __ Fecalysis __ 12 ECG Serum HCG

OTHERS:_______________ __ Urinalysis __ Fecalysis __ 12 ECG

OTHERS:_______________
MARY YOLANDA L. GIMENA, MD
PRC No: 0121899
MARY YOLANDA L. GIMENA, MD
PRC No: 0121899

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