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14 views

Result Form Ssa

Lab results form

Uploaded by

sasa bass
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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‫وزارة الصحة والية جنوب دارفور‬

‫ قسم المعمل و بنك الدم‬- ‫مستشـــــــــــفى نيــــــــاال التخصصي‬

........................................................................................:‫االسم‬
…………………………………………………………………………………………… BFFM
Hb : ………………………… g/dl Hb : ……………….. % ESR : …………mm/1h
./TWBCs : ……………………cells
..……………………………………………………………… : ICT for Malaria
..……………………………………………………………………… : ICT for H.pylori

…… ………:ICT HBsAg:………… ……ICT HIV………………… ICT HCV


Urine general Stool general

…………………………… …: Color ..………………………………………… : Color


.…….…………………………… : Reaction ………………………………… : Consistency
…..………………………………… : Sugar ....………………………………… : Reaction
…………………………………… : Acetone ………………………………………… : Mucus
…………………………………… : Albumin .………………………………………… : Blood
.……………………………………… : Bile ………………………………………… : Worm
…………………………… : Urobllinogen
Deposit Microscopical examination

Pus cells : …………………………./HPF Pus cells : …………………………./HPF


RBCs : ……………………… ………/HPF RBCs :…………………………………/HPF
..………………………………: Epith cells …..………………………… : Trophozoite
..………………………………… : Crystals …….…………………………………… : Cyst
….…………………………………… : Casts ….……………………………… : Flagellate
………………………………………… : Ova ..………………………………………… : Ova
…………………………………… : Others ..….………………………………… : Others
..….…………………………………………… ..….………………………………………………
..….…………………………………………… ……………………………………………………

RBG:………… ……mg/dl Uric Acid ………….. mg/dl


S.creatinine:……… … mg/dl B.urea………………… mg/dl

…………………………… : Date : ………………… Sign


‫وزارة الصحة والية جنوب دارفور‬

‫ قسم المعمل و بنك الدم‬- ‫مستشـــــــــــفى نيــــــــاال التخصصي‬

………:Blood group : …………. Rh typing

…………………………………………………………………………………………… BFFM
Hb : ………………………… g/dl Hb : ……………….. % ESR : …………mm/1h
./TWBCs : ……………………cells
..……………………………………………………………… : ICT for Malaria
..……………………………………………………………………… : ICT for H.pylori

…… ………:ICT HBsAg:………… ……ICT HIV………………… ICT HCV


Urine general Stool general

…………………………… …: Color ..………………………………………… : Color


.…….…………………………… : Reaction ………………………………… : Consistency
…..………………………………… : Sugar ....………………………………… : Reaction
…………………………………… : Acetone ………………………………………… : Mucus
…………………………………… : Albumin .………………………………………… : Blood
.……………………………………… : Bile ………………………………………… : Worm
…………………………… : Urobllinogen
Deposit Microscopical examination

Pus cells : …………………………./HPF Pus cells : …………………………./HPF


RBCs : ……………………… ………/HPF RBCs :…………………………………/HPF
..………………………………: Epith cells …..………………………… : Trophozoite
..………………………………… : Crystals …….…………………………………… : Cyst
….…………………………………… : Casts ….……………………………… : Flagellate
………………………………………… : Ova ..………………………………………… : Ova
…………………………………… : Others ..….………………………………… : Others
..….…………………………………………… ..….………………………………………………
..….…………………………………………… ……………………………………………………

RBG:………… ……mg/dl Uric Acid ………….. mg/dl


S.creatinine:……… … mg/dl B.urea………………… mg/dl

…………………………… : Date : ………………… Sign


‫وزارة الصحة والية جنوب دارفور‬

‫مستشـــــــــــفى نيــــــــاال التخصصي ‪ -‬قسم المعمل و بنك الدم‬

‫‪………:Blood group : ………….‬‬ ‫‪Rh typing‬‬

‫………………… ‪…………………………… : Date :‬‬ ‫‪Sign‬‬

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