it BA

The AO Khan Unive7sity Hbspital, KaraChi

BIOCHEMISTRY I p,.... w lc, ,
Patient Identification & Location

439-87-43
KHAN,IFFAT

HIM11
1011111 .
F 10101936 122020

Physician v Requested by
i 1000'7' .
Specimen ' •••::,2%,1, , YOate Time

4,17ure' , . d/ -Pager#:
Relevant nice! Information • tiA.
•

MNEMONICS X TEST REQUIRED

GLUF Glucose, Fasting
GLUR Glucose Random
CHO Cholesterol
TG ' Triglycerides
HDL HDL
LDL LDL -.
VLDL VLDL
BUN B.U.N.
CR Creatinine,
NA Sodium
K Potassium
CL Chloride
• BIC Bicarbonate
TB Bilirubin Total
DB ' • Bilirubin Direct
GGT Gamma-GT
SGPT SGPT
SGOT SGOT
AP Alkaline Phosphatase
LDH LDH
CPK CPK • , i
TPG Total Protein (T. Prot. Alb, Glob, Alt.) r
CA Calcium IIPF Ai&
PROS Phosphorus
UA ' Uric Acid -
GTT Glucose Tolerance Test
GCT Glucose Challenge Test
MG . Magnesium
AMY Amylase
LIPASE Lipase
AMMONIA .ammonia
•ACETONE Serum acetone

CORPORATE CLIENT ,
Company Name 1-initi'
I
—
Laboratory Copy •
j
 C4 The Aga Khan University Hospital 439 97 43

CULTURE & SENSITIVITY SAMPLE PROCESSING SHEET

2 (3932R OSPCS
02
Form #: LAB- MIC-PRO-001F1 Issuance Date: 01/01/2016 Revision Date: 01/01/2020
Section/Region: Clinical Microbiology Area/Bench: Bacteriology Year/ Month: 2020/2021 Page #: 1 of 2

Nugent Score(N-Score) Specimen No.:

Lactobacillus Gardnerella Mobiluncus N-Score Total Container: Sterile top, Syringe, Ntvab, Tra al tube, Bactec (Paeds/
Anaerobic/ Aerobic bottle)
Gram Positive bacilli Small gram variable bacilli Curved gram negative rods
Numerous (>30) N score =0 Numerous (>30) N score =4 Numerous (>30) score =2 Sample Vol: Appearance:
Moderate (5-30) N score = 1 Moderate (5-30) N score = 3 Moderate (5-30) N= score = 2
Media Inoculated:
Few (1-4) N score =2 Few (1-4)N score =2 Few (1-4) N score =1
Rare (<1) N score = 3 Rare (<1) N score =1 Rare (<1) N score = 1 co, cAoe 13Q11-A GC HBCNA SBA/HTM
Nil (0) N score = 4 Nil (0) N score = 0 Nil (0) N score = 0
37°C M3/4CV..."'" TRIPLATE CLED MSA XLD/TCBS
CM BHI APW SF BIGGY
42°C CAMP ,„yir ANAEAROBIC: SBA/
Initials: Date: '/-r
Microscopy: Moiphology

PUS RBC S(iU COCCI

i BACILLI NUGENT
\ SCORE
GRAM+ GRAM- GRAM- GRAM+

04 t- irli\ -ems C;- i-

Budding Yeast Cells ❑ eudohyphae:

Hyphae: Aseptate ❑ Sept. e:
Clue Cells: India t :
Wet Mount: KL,13-
Partial Acid Fast :
Positive Control: Negative Contro
Initials: Date:
Direct Sensitivities:

History:

Informed: Pager/ Ph#

Read Back: Ye No El

By: Date:
Objective Rare Few Moderate Numerous
100X Organism <1 1-5 6-30 >30
COMMENTS: 100X Cells <1 1-5 5-10 >10
10X Cells <1 1-9 10-25 >25

Initials: Consultant: Date

Technologist:
Item # 054860

Clinical Laboratories - Controlled Document

 " CJ The Aga Khan University Hospital

CULTURE & SENSITIVITY SAMPLE PROCESSING SHEET

Form #: LAB- MIC-PRO-001F1 Issuance Date: 01/01/2016 Revision Date: 01/01/2020 Revision #: 02

Section/Region: Clinical Microbiology Area/Bench: Bacteriology Year/ Month: 2020/2021 Page #: 2 of 2

Tech
CM/BIII SIC Tech
DATE CULTURE READING CM/BIII APP
A AN
riodl P•4_,..-Y.--016
ft CL/TR ArL'

14 nDe- (
( roqc
9-4 Ox —

DATE ORGANISMS CAT OX ID KB VK Tech

L...----
`IR 4 Kitf- -- SIMCUT —>,./
'Lef t__
Aerobic Subculture:
SIMCUT
Primary Anaerobe:

SIMCUT Anaerobic Subculture:

Final Identific tion

SIMC OF 1. 14.0f SPp>
PSP/PSF
2.

3.
C M P DCO2
4.

B.E/NACL 5.

6.

OP coz
Sensitivities:
KRON Gram's Mt,,,
-4
XV X V cm Vic (-L7150 I • Ct:1 30
s
Additional Work: AK 30
ATM

NA

Initials: Consultant: Date

Technologist:

Clinical Laboratories - Controlled Document