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    Laboratory 2

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    api-3836762
    This document is a laboratory and radiology request form from Redoble Medical Clinic. It includes sections to fill in patient information and request various blood tests, urine tests, stool exams, blood chemistry tests, x-rays, and other radiological exams. The form is to be signed by the attending physician to authorize the requested tests.

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    Download as DOC, PDF, TXT or read online from Scribd

    Laboratory 2

    Uploaded by

    api-3836762
    63 views1 page
    This document is a laboratory and radiology request form from Redoble Medical Clinic. It includes sections to fill in patient information and request various blood tests, urine tests, stool exams, blood chemistry tests, x-rays, and other radiological exams. The form is to be signed by the attending physician to authorize the requested tests.

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    © Attribution Non-Commercial (BY-NC)

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    This document is a laboratory and radiology request form from Redoble Medical Clinic. It includes sections to fill in patient information and request various blood tests, urine tests, stool exams, blood chemistry tests, x-rays, and other radiological exams. The form is to be signed by the attending physician to authorize the requested tests.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    63 views1 page

    Laboratory 2

    Uploaded by

    api-3836762
    This document is a laboratory and radiology request form from Redoble Medical Clinic. It includes sections to fill in patient information and request various blood tests, urine tests, stool exams, blood chemistry tests, x-rays, and other radiological exams. The form is to be signed by the attending physician to authorize the requested tests.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    of 1

    Redoble Medical Clinic

    Buug, Zamboanga Sibugay

    Date:_________________

    Patient:.___________________________________ Age: _________ Sex: ________

    Address: ____________________________________________________________

    Laboratory Requests

    _____________CBC: ______________ URINALYSIS: ____________ STOOL EXAM

    BLOOD CHEMISTRY

    ____________ FBS _______________ Serum Na ______________ SGPT


    ____________ BUN _______________ Serum K ______________ SGOT
    ____________ Creatinine _______________ Serum Cl ______________ LDH
    ____________ Uric Acid _______________ Serum Ca ______________ Alk Phos
    ____________ Total Cholesterol _______________ Serum Mg ______________ Triglyceraes
    ____________ CT _______________ BT ______________ Albumin
    ____________ HDL _______________ LDL ______________ PTPA
    ____________ Globulin

    Others: _____________________________________________________________________________________

    X- RAY EXAMINATION

    ____________ Chest X-Ray ________________________View __________________ Barium Enema


    ____________ Cervical Spine Series __________________ UGI Series
    ____________ Lumbosacral Spine Series __________________ Complete Abdomen
    ____________ Thoracolumbar Spine Series __________________ KUB- IVP

    Others: ______________________________________________________________________________________

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

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