ST.LOUISE COOP. DIAG CENTER SUTHERLAND REQUEST FORM STO. DOMINGO, AMOR B. Surname Name M.I.

DATE: 2/15/2012_____

DATE OF BIRTH:10/13/1982_ (mmddyyyy)

AGE/GENDER: 29/F ADDRESS: NAGA CITY SUBD.,NAGA CITY CONTACT NO.: 0909-4736123 DIGITEL:8113734 BAYANTEL: 4722005 PACKAGE TEST: 1.CHEST XRAY (ROOM 206) 2.CBC (Complete Blood Count) 3.Urinalysis

4.Fecalysis (Stool exam) 5.Drugtest (ROOM 302) 6.Physical Exam

TEST PACKAGE ARE:

TEST PACKAGE ARE:

1. CHEST XRAY (ROOM 206) PRESENT THE BLUE CARD AND IF POSSIBLE COMPANY ID.

 JUST IN CASE YOU CANT SUBMIT ALL SPECIMENS OR ANY OF URINE AND STOOL SAMPLE TODAY, AS EARLY AS 7AM-4PM WE WILL ACCEPT YOUR SPECIMEN FOR URINE AND STOOL UNTIL APRIL 21, 2012. NO SUNDAY

PROPER COLLECTION OF STOOL AND URINE

STOOL: MONGO-SIZE OR PEA-SIZE URINE: MIDSTREAM COLLECTION(GITNANG IHI) HALF OF THE CONTAINER IF COLLECTED AT HOME,URINE AND STOOL SPECIMEN(S) SHOULD BE SUBMITTED WITHIN 1 HOUR UPON COLLECTION.

5. DRUG TEST
TO KNOW WHO ARE REALLY DRUG USERS, WE CONDUCT RANDOM DRUG TESTING

(ROOM 302) .
TEXT FROM ST. LOUISE CHIKKA ACCOUNT WILL BE RECEIVED BY YOU. SCHEDULE OF DT 10AM-4PM.

WHAT TO BRING :
> BALLPEN (BLACK PEN PLEASE) > BOTTLED WATER > COMPANY ID/ ID WITH CONTROL NO. BE READY: PICTURE TAKING BIOMATRIX (SCANNING OF FINGERPRINTS OF 10 FINGERS)

TESTS APPLICABLE TO THOSE WOMEN WITH MENSTRUAL PERIOD:

1. DRUG TEST 2. STOOL ANALYSIS 3. PHYSICAL EXAM ONLY IF TEST PACKAGE HAS BEEN COMPLETED

CLINICAL SIGNIFICANCE/RESULTS:
REASONS: FOR BLOOD TEST(CBC) RESULT WOULD BE ANEMIC. URINE TEST RESULTS MAY BE INTERPRETED WITH KIDNEY STONES BECAUSE OF PRESENCE OF BLOOD IN THE URINE SAMPLE.

WHAT TO EXPECT IN PHYSICAL EXAM:

1. BP OR BLOOD PRESSURE TAKING 2. LAB. TESTS AND CHEST XRAY INTERPRETATION OF RESULTS, IF WITH FINDINGS OR NOT. 3. HEALTH TIPS, HEALTH ADVICE,TREATMENT IF NECESSARY.

SINCE SUTHERLAND IS THE REQUESTING PARTY, OFFICIAL RESULTS WILL BE FORWARDED TO YOUR HR OR FINANCE DEPARTMENT. MANAGEMENT DECISION: 1. IF THEY WILL GIVE YOU A COPY OF YOUR RESULTS 2. TO THOSE EMPLOYEES WITH FINDINGS IF FOR DISCIPLINARY ACTION, EOC ETC.

TIP:
TO GIVE YOU AN IDEA OF YOUR LAB.TESTS AND XRAY RESULT: PLEASE COMPLETE ALL 5 TESTS ASK MAAM FAYE FOR THE SCHEDULE.

THE MOST EXCITING PART OR TEST: CBC (Complete Blood Count)

> blood test > diagnostic test for: blood disorder such as:
1. leukemia 2. anemia WHITE BLOOD CELLS RED BLOOD CELLS HEMOGLOBIN AND HEMATOCRIT

 You may now collect urine. >Reminder: Proper collection please.