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Lab - Result Form

The document contains medical test results for an individual from the Municipal Health Office in San Ildefonso, Bulacan, Philippines. It includes blood type, hematocrit, hemoglobin, blood sugar, urinalysis results, pregnancy test results, syphilis test results, and screening results for HIV, hepatitis B, dengue, and other clinical chemistry tests. The tests were performed by Patricia Glynn V. Sanchez, a licensed medical technologist.

Uploaded by

Errol Llanes
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
460 views

Lab - Result Form

The document contains medical test results for an individual from the Municipal Health Office in San Ildefonso, Bulacan, Philippines. It includes blood type, hematocrit, hemoglobin, blood sugar, urinalysis results, pregnancy test results, syphilis test results, and screening results for HIV, hepatitis B, dengue, and other clinical chemistry tests. The tests were performed by Patricia Glynn V. Sanchez, a licensed medical technologist.

Uploaded by

Errol Llanes
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Republic of the Philippines

Province of Bulacan
Municipal Government of San Ildefonso
MUNICIPAL HEALTH OFFICE

NAME:________________________________________ AGE:________ SEX:__________


ADDRESS:______________________________________ DATE ISSUED:_______________
BLOOD TYPE:______________ HEMATOCRIT:____________ HEMOGLOBIN:_________g/dL
BLOOD SUGAR:_______________ mg/dL __ FBS __ RBS

URINALYSIS
COLOR:________________________ WBC:_________/HPF
TRANSPARENCY:_________________ RBC:__________/HPF
PROTEIN:_______________________ CAST:_________________________
GLUCOSE:______________________ BACTERIA:_____________________
PH:____________________________ EPITHELIAL CELLS:_______________
SPECIFIC GRAVITY:________________ CRYSTALS:______________________
OTHERS:________________________
PREGNANCY TEST:_____________________________
SYPHILIS TEST:________________________________
HIV TEST/ SD BIOLINE HIV 1/ 2:__________________
HEPATITIS B SCREENING(HBSAg):______________

PATRICIA GILYN V. SANCHEZ,RMT


License No. 0070715
Medical Technologist

Republic of the Philippines


Province of Bulacan
Municipal Government of San Ildefonso
MUNICIPAL HEALTH OFFICE

NAME:________________________________________ AGE:________ SEX:__________


ADDRESS:______________________________________ DATE ISSUED:______________
BLOOD TYPE:______________ HEMATOCRIT:____________ HEMOGLOBIN:_________g/dL
BLOOD SUGAR:_______________ mg/dL __ FBS __ RBS

URINALYSIS
COLOR:________________________ WBC:_________/HPF
TRANSPARENCY:_________________ RBC:__________/HPF
PROTEIN:_______________________ CAST:_________________________
GLUCOSE:______________________ BACTERIA:_____________________
PH:____________________________ EPITHELIAL CELLS:_______________
SPECIFIC GRAVITY:________________ CRYSTALS:______________________
OTHERS:________________________

PREGNANCY TEST:_____________________________
SYPHILIS TEST:________________________________
HIV TEST/ SD BIOLINE HIV 1/ 2:__________________
HEPATITIS B SCREENING(HBSAg):______________

PATRICIA GILYN V. SANCHEZ,RMT


License No. 0070715
Republic of the Philippines
Province of Bulacan
Municipal Government of San Ildefonso
MUNICIPAL HEALTH OFFICE

Medical Technologist
DATE ISSUED:______________

NAME:_______________________________
ADDRESS: SAN ILDEFONSO, BULACAN____
AGE/GENDER:________

CLINICAL CHEMISTRY
NORMAL RANGE RESULT
BLOOD SUGAR
___ FBS ___RBS 70-104 mg/dL mg/dL
MALE: 3.0-7.2 mg/dL mg/dL
179-438 umol/L umol/L
BLOOD URIC ACID
FEMALE: 2-6 mg/dL mg/dL
119-357 umol/L umol/L

BLOOD CHOLESTEROL <200 mg/dL mg/dL


<5.2 mmol/L mmol/L

PATRICIA GILYN S. ANABO,RMT


License No. 0070715
Medical Technologist

Republic of the Philippines


Province of Bulacan
Municipal Government of San Ildefonso
MUNICIPAL HEALTH OFFICE

DATE ISSUED:______________

NAME:_______________________________
ADDRESS: SAN ILDEFONSO, BULACAN____
AGE/GENDER:________

CLINICAL CHEMISTRY
NORMAL RANGE RESULT
BLOOD SUGAR mg/dL
___ FBS ___RBS 70-104 mg/dL
MALE: 3.0-7.2 mg/dL mg/dL
179-438 umol/L umol/L
BLOOD URIC ACID
FEMALE: 2-6 mg/dL mg/dL
119-357 umol/L umol/L

BLOOD CHOLESTEROL <200 mg/dL mg/dL


<5.2 mmol/L mmol/L

PATRICIA GILYN S. ANABO,RMT


License No. 0070715
Republic of the Philippines
Province of Bulacan
Municipal Government of San Ildefonso
MUNICIPAL HEALTH OFFICE

Medical Technologist

DATE ISSUED:______________

NAME:_______________________________
ADDRESS: SAN ILDEFONSO, BULACAN____
AGE/GENDER:________

FECALYSIS
COLOR:________________________
CONSISTENCY:__________________
WBC:_____________/HPF
RBC:_____________ /HPF
INTESTINAL PARASITE: NO INTESTINAL PARASITE SEEN
OVA SEEN: __________________________

OTHERS:________________________

PATRICIA GILYN S. ANABO,RMT


License No. 0070715
Medical Technologist

Republic of the Philippines


Province of Bulacan
Municipal Government of San Ildefonso
MUNICIPAL HEALTH OFFICE

DATE ISSUED:______________

NAME:_______________________________
ADDRESS: SAN ILDEFONSO, BULACAN____
AGE/GENDER:________

FECALYSIS
COLOR:________________________
CONSISTENCY:__________________
WBC:_____________/HPF
RBC:_____________ /HPF
INTESTINAL PARASITE: NO INTESTINAL PARASITE SEEN
OVA SEEN: __________________________

OTHERS:________________________

PATRICIA GILYN S. ANABO,RMT


License No. 0070715
Medical Technologist
Republic of the Philippines
Province of Bulacan
Municipal Government of San Ildefonso
MUNICIPAL HEALTH OFFICE

DATE ISSUED:______________

NAME:_______________________________
ADDRESS: SAN ILDEFONSO, BULACAN____
AGE/GENDER:________

DENGUE TEST

DENGUE NS1 ANTIGEN:________________________


DENGUE DUO IgG:__________________
IgM:__________________

PATRICIA GILYN S. ANABO,RMT


License No. 0070715
Medical Technologist

Republic of the Philippines


Province of Bulacan
Municipal Government of San Ildefonso
MUNICIPAL HEALTH OFFICE

DATE ISSUED:______________

NAME:_______________________________
ADDRESS: SAN ILDEFONSO, BULACAN____
AGE/GENDER:________

DENGUE TEST

DENGUE NS1 ANTIGEN:________________________


DENGUE DUO IgG:__________________
IgM:__________________

PATRICIA GILYN S. ANABO,RMT


License No. 0070715
Medical Technologist
Republic of the Philippines
Province of Bulacan
Municipal Government of San Ildefonso
MUNICIPAL HEALTH OFFICE

NAME:________________________________________ AGE:________ SEX:__________


ADDRESS:______________________________________ DATE ISSUED:______________
BLOOD TYPE:______________ HEMOGLOBIN:____________ HEMATOCRIT:___________
BLOOD SUGAR:_______________ mg/dL __ FBS __ RBS

URINALYSIS
COLOR:________________________ pH:_____________________
TRANSPARENCY:________________ BLOOD:_________________
LEUKOCYTES:__________________ SPECIFIC GRAVITY:_________
NITIRTE:______________________ KETONE:_________________
UROBILINOGEN:_______________ BILIRUBIN:________________
PROTEIN:_____________________ GLUCOSE:_________________

NS1 ANTIGEN:___________________

PATRICIA GILYN V. SANCHEZ,RMT


License No. 0070715
Medical Technologist

Republic of the Philippines


Province of Bulacan
Municipal Government of San Ildefonso
MUNICIPAL HEALTH OFFICE

NAME:________________________________________ AGE:________ SEX:__________


ADDRESS:______________________________________ DATE ISSUED:______________
BLOOD TYPE:______________ HEMOGLOBIN:____________ HEMATOCRIT:___________
BLOOD SUGAR:_______________ mg/dL __ FBS __ RBS

URINALYSIS
COLOR:________________________ pH:_____________________
TRANSPARENCY:________________ BLOOD:_________________
LEUKOCYTES:__________________ SPECIFIC GRAVITY:_________
NITIRTE:______________________ KETONE:_________________
UROBILINOGEN:_______________ BILIRUBIN:________________
PROTEIN:_____________________ GLUCOSE:_________________

NS1 ANTIGEN:___________________

PATRICIA GILYN V. SANCHEZ,RMT


License No. 0070715
Medical Technologist

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