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Date Name Age Ref. by Sex Hospital Name Lab No Specimen Investigation Result Method
Date Name Age Ref. by Sex Hospital Name Lab No Specimen Investigation Result Method
Middle
Last
Hospital No
Hospital Name
Dr. Name
Sample Type
1 2 3 4 5 6 7 8 9
H1 H2
H3
H4
H5
H6
Dr 1 Dr 2 Dr 3 Dr 4
Tracheotomy Secretion
INVESTIGATION
Salutation
Urine for Culture & Sensitivity Urine for Culture & Sensitivity Stool for Microscopic Examination & Culture Sensitivity Thorat swab for Gram stain, AFB, Culture & Sensitivity Pus for Culture & Sensitivity Stool for Culture & Sensitivity Stool for Culture & Sensitivity Tracheotomy Secretion for Culture & Sensitivity Blood for Dengue IgG & IgM Blood for Leptospira IgG & IgM Blood for WIDAL