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Office Lab Biochemistry and CP Tests

Clinic

Specimen Collected Date

General/NAP-ID

Plz put Patient's ID.

Fuchia ID {{ Auth::user()->FuchiaID }}

Plz put Patient's fuchia ID.

Requested Doctor

Counselor

Register Age

Plz put Patient's Age.

Register Age(Month)

Plz put Patient's Age.

Current Age

Plz put Patient's Age.

Current Age(Month)

Plz put Patient's Age.

Sex

Main-Risk

Patient's ID

Plz put Patient's ID.

Date(dd mm yyyy)

Plz put Patient's Visit Date.

Name of Test

Result

Unit

Reference Value

Total Bilirubin

mg/dl

M/F: 0.1-1.2 mg/dl

ALAT (SGPT)

U/L

Male: ≤ 45, Female: ≤ 34 U/L

AST (SGOT)

U/L

Male: < 35,Female: < 31U/L

ALP

U/L

Adult: 44-147U/L, Child: < 362U/L

GGT

U/L

Male: ≤ 55, Female: ≤ 38 U/L

Albumin

g/dl

3.5 - 5.5 g/dl

Total Cholesterol

mmol/ L

< 5.17 mmol/L

HDL Cholesterol

mmol/ L

M:0.77-1.81, F:0.77-2.19mmol/L

LDL Cholesterol

mmol/ L

< 3.36 mmol/L

Triglycerides

mmol/l

< 1.71 mmol/L

Urea

mg/dl

17 - 43 mg/dl

Creatinine

mg/dl

Male: 0.8-1.3,Female:0.6-1.2mg/dl

Calcium

mg/dl

8.6 - 10.3 mg/dl

Phosphorus

mg/dl

2.7 - 4.5 mg/dl

Uric Acid

mg/dl

Male:3.5-7.2,Female:2.6-6.0mg/dl

HbA1C

%

4.5 - 6.3 %

PT

sec

10-14

INR

Complete Picture (CP)

Bio Test's Comment

CD 4 and CD 4 %

CD4 Done/ Not Done

ART

ART Start Date

Test Requested

WHO Stage

CD 4 (cells/u) Resutl

CD 4% Resutl

Comment

Lab Technician

Issue Date(dd mm yyyy)

Determine Result

UNI-Gold Result

STAT-PAK Result

Result

Comment

Lab Technician

Issue Date(dd mm yyyy)

Test History Of the Patient

Plz put Patient's ID.

No.	Date	General ID

Choose Clinic

Form

To

Test Type

Noti::

Export

Office Lab

Laboratory Result Form

Patient ID :

Fuchia ID :

Gender :

Age(Y) :

Age(M) :

Req MD :

Clinic :

Counselor :

Specimen Collected Date:

HIV (Ab)(Verification)

Bio tests

Test

Result

Test Name

Result

Unit

Ref

Determine

Total Bilirubin

mg/dl

0.1 - 1.2 mg/dl

Uni-Gold

ALAT (SGPT)

U/L

Male:≤45, Female:≤34 U/L

STAT-PAK

AST (SGOT)

U/L

Male:<35,Female:<31U/L

Result

ALP

U/L

CD4 and CD4 % Result

GGT

U/L

Male: ≤ 55, Female: ≤ 38 U/L

CD4 result

Albumin

g/dl

CD4% result

Total Cholesterol

mmol/L

< 5.17 mmol/L

ART start Date

HDL Cholesterol

mmol/L

M:0.77-1.81, F:0.77-2.19mmol/L

WHO Stage

LDL Cholesterol

mmol/L

< 3.36 mmol/L

Triglycerides

mmol/L

< 1.71 mmol/L

Urea

mg/dl

Creatinine

mg/dl

Male:0.8-1.3,Female:0.6-1.2mg/dl

Calcium

mg/dl

8.6 - 10.3 mg/dl

Phosphorus

mg/dl

2.7 - 4.5 mg/dl

Uric Acid

mg/dl

Male:3.5-7.2,Female:2.6-6.0mg/dl

HbA1C

%

4.5 - 6.3 %

PT

sec

10-14

INR

Complete Picture

Comment

Lab Tech::

Issue Date::

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