Healberg Lifestyle Medical Center and Clinics, Inc.

,
Robinsons Cybergate Center, Araneta St., Brgy. Singcang,
Bacolod City, Negros Occidental, Philippines 6100
Contact no.: 0917-136-7835
LABORATORY SHEET Email us.: healbergbacolod@gmail.com

NAME:____________________________________________________ AGE:____ SEX: ( M F ) CIVIL STATUS: ( S M W )

SURNAME FIRST NAME MIDDLE NAME

ATTENDING PHYSICIAN:_____________________________ DIAGNOSIS: _____________________________________

DATE
CBC: Hematocrit
H
RBC
E
M Hemoglobin
A
WBC
T
O n/e/m/l
L
Platelet
O
G Protime
Y
Aptt
E Sodium
L
E
Potassium
C
T
Ionized Calcium
R Total Calcium
O
L Chloride
Y
T Magnesium
E
S Potassium
Uric acid
Creatinine
BUN
C
Albumin
H
E SGPT
M SGOT
I Total
S Cholesterol
HDL
T
R LDL
Y Triglycerides
Direct Bilirubin
Total Bilirubin
S T3
E T4
R
O HBsAg
L Anti-HBs
O
Anti-HCV
G
Y Anti-HIV
OTHERS: