‫ﺍﻃﻼﻋﺎﺕ ﺗﺠﻮﯾﺰ ﮐﻨﻨﺪﻩ‬

‫‪91128‬‬ ‫ﺷﻤﺎﺭﻩ ﻧﻈﺎﻡ‪:‬‬ ‫ﺩﮐﺘﺮ ﺷﻬﻼ ﮐﺎﺭﮔﺮﻣﻄﻠﻖ )ﺯﻧﺎﻥ ﻭ ﺯﺍﯾﻤﺎﻥ ﻣﺘﺨﺼﺺ ﺯﻧﺎﻥ ﻭ ﺯﺍﯾﻤﺎﻥ(‬ ‫ﻧﺎﻡ ﺗﺠﻮﯾﺰ ﮐﻨﻨﺪﻩ‪:‬‬

‫‪32095‬‬ ‫ﺷﻨﺎﺳﻪ ﺭﻫﮕﯿﺮﯼ‪:‬‬ ‫‪1400/10/07‬‬ ‫ﺗﺎﺭﯾﺦ ﺗﺠﻮﯾﺰ‪:‬‬

‫ﺍﻃﻼﻋﺎﺕ ﺑﯿﻤﺎﺭ‬

‫‪1552091740‬‬ ‫ﮐﺪ ﻣﻠﯽ‪:‬‬ ‫ﻟﯿﺪﺍ ﻃﻠﻮﻋﯽ ﺧﺮﻣﺎﺯﺭﺩ‬ ‫ﻧﺎﻡ ﻭ ﻧﺎﻡ ﺧﺎﻧﻮﺍﺩﮔﯽ‪:‬‬

‫ﮐﺎﺭﮐﻨﺎﻥ ﺩﻭﻟﺖ‬ ‫ﻧﻮﻉ ﺻﻨﺪﻭﻕ‪:‬‬ ‫ﺑﯿﻤﻪ ﺳﻼﻣﺖ‬ ‫ﺳﺎﺯﻣﺎﻥ ﺑﯿﻤﻪ ﮔﺮ‪:‬‬

‫‪1404/10/06‬‬ ‫ﺗﺎﺭﯾﺦ ﺍﻋﺘﺒﺎﺭ ﺑﯿﻤﻪ‪:‬‬ ‫ﺳﺮﭘﺮﺳﺖ‬ ‫ﻧﺴﺒﺖ ﺑﺎ ﺳﺮﭘﺮﺳﺖ‪:‬‬

‫ﺗﻌﺪﺍﺩ ﺩﻓﻌﺎﺕ ﺗﮑﺮﺍﺭ‬ ‫ﻧﺎﻡ ﺧﺪﻣﺖ‬ ‫ﮐﺪ ﺧﺪﻣﺖ‬

‫‪1‬‬ ‫ﺍﻧﺪﺍﺯﻩﮔﯿﺮﯼ ﮐﻤّﯽ ﻣﺲ ﺳﺮﻡ‬ ‫‪800265‬‬

‫‪1‬‬ ‫‪ HBSAG‬ﺁﺯﻣﺎﯾﺶ‬ ‫‪803205‬‬

‫‪1‬‬ ‫ﺍﻧﺪﺍﺯﻩ ﮔﯿﺮﯼ ﮐﻤّﯽ ﺍﻭﺭﻩ ﺧﻮﻥ‪/‬ﺳﺮﻡ‪/‬ﭘﻼﺳﻤﺎ‬ ‫‪800415‬‬

‫‪1‬‬ ‫ﺍﻧﺪﺍﺯﻩ ﮔﯿﺮﯼ ﮐﻤّﯽ ﮐﺮﺍﺗﯿﻨﯿﻦ ﺧﻮﻥ‪/‬ﺳﺮﻡ‪/‬ﭘﻼﺳﻤﺎ‬ ‫‪800420‬‬

‫‪1‬‬ ‫ﺍﻧﺪﺍﺯﻩ ﮔﯿﺮﯼ ﮐﻤّﯽ ﮐﻠﺴﯿﻢ ﺳﺮﻡ‪/‬ﭘﻼﺳﻤﺎ‬ ‫‪800485‬‬

‫‪1‬‬ ‫ﺍﻧﺪﺍﺯﻩﮔﯿﺮﯼ ﮐﻤّﯽ ﺁﻫﻦ ﺳﺮﻡ‪/‬ﭘﻼﺳﻤﺎ‬ ‫‪800500‬‬

‫‪1‬‬ ‫)‪(TIBC‬ﺍﻧﺪﺍﺯﻩﮔﯿﺮﯼ ﻇﺮﻓﯿﺖ ﺍﺗﺼﺎﻝ ﺁﻫﻦ‬ ‫‪800505‬‬

‫‪1‬‬ ‫ﺩﺭ ﺳﺮﻡ‪/‬ﭘﻼﺳﻤﺎ ‪ ((AST SGOT‬ﺍﻧﺪﺍﺯﻩﮔﯿﺮﯼ ﮐﻤّﯽ ﻓﻌﺎﻟﯿﺖ ﺁﻧﺰﯾﻢ‬ ‫‪800530‬‬

‫‪1‬‬ ‫ﺩﺭ ﺳﺮﻡ‪/‬ﭘﻼﺳﻤﺎ ‪ ((ALT SGPT‬ﺍﻧﺪﺍﺯﻩﮔﯿﺮﯼ ﮐﻤّﯽ ﻓﻌﺎﻟﯿﺖ ﺁﻧﺰﯾﻢ‬ ‫‪800535‬‬

‫ﺍﻧﺪﺍﺯﻩ ﮔﯿﺮﯼ ﮐﻤﯽ ﻣﻨﯿﺰﯾﻮﻡ ﺧﻮﻥ ﯾﺎ ﺳﺎﯾﺮ ﻓﻠﺰﺍﺕ ﺳﻨﮕﯿﻦ ﺑﻪ ﺭﻭﺵ‪CU,MG‬‬
‫‪1‬‬ ‫‪800810‬‬
‫ﺍﺳﭙﮑﺘﺮﻭﻓﻮﺗﻮﻣﺘﺮﯼ‬
‫‪1‬‬ ‫ﺍﻧﺪﺍﺯﻩﮔﯿﺮﯼ ﮐﻤّﯽ ﻣﻨﯿﺰﯾﻢ ﯾﻮﻧﯿﺰﻩ ﺧﻮﻥ ﺑﻪ ﺭﻭﺵ ﺍﺳﭙﮑﺘﺮﻭﻓﺘﻮﻣﺘﺮﯼ‬ ‫‪800815‬‬

‫‪1‬‬ ‫ﮔﻠﺒﻮﻝ ﻗﺮﻣﺰ‪/‬ﺳﺮﻡ‪/‬ﭘﻼﺳﻤﺎ )‪ B2‬ﺍﻧﺪﺍﺯﻩ ﮔﯿﺮﯼ ﮐﻤّﯽ ﺭﯾﺒﻮﻓﻼﻭﯾﻦ )ﻭﯾﺘﺎﻣﯿﻦ‬ ‫‪801120‬‬

‫‪1‬‬ ‫ﺍﻧﺪﺍﺯﻩ ﮔﯿﺮﯼ ﮐﻤّﯽ ﻓﻮﻟﯿﮏ ﺍﺳﯿﺪ ﺳﺮﻡ‪/‬ﭘﻼﺳﻤﺎ‬ ‫‪801125‬‬

‫‪1‬‬ ‫ﮔﻠﺒﻮﻝ ﻗﺮﻣﺰ‪/‬ﺳﺮﻡ‪/‬ﭘﻼﺳﻤﺎ )‪ B12‬ﺍﻧﺪﺍﺯﻩ ﮔﯿﺮﯼ ﮐﻤّﯽ ﺳﯿﺎﻧﻮﮐﻮﺑﺎﻻﻣﯿﻦ )ﻭﯾﺘﺎﻣﯿﻦ‬ ‫‪80113‬‬

‫‪1‬‬ ‫ﺍﻧﺪﺍﺯﻩ ﮔﯿﺮﯼ ﮐﻤّﯽ ﻓﺮﯾﺘﯿﻦ ﺳﺮﻡ‪/‬ﭘﻼﺳﻤﺎ‬ ‫‪801170‬‬

‫‪1‬‬ ‫ﺳﺮﻡ‪/‬ﭘﻼﺳﻤﺎ ‪ (THYROID STIMULATING HORMONE (TSH‬ﺍﻧﺪﺍﺯﻩ ﮔﯿﺮﯼ ﮐﻤّﯽ‬ ‫‪801415‬‬

‫‪1‬‬ ‫ﺳﺮﻡ‪/‬ﭘﻼﺳﻤﺎ ‪ FREET4‬ﺍﻧﺪﺍﺯﻩ ﮔﯿﺮﯼ ﮐﻤّﯽ‬ ‫‪801425‬‬

‫ﺩﺭ )‪ D (1,25-HYDROXY VITAMIN D‬ﺍﻧﺪﺍﺯﻩﮔﯿﺮﯼ ﮐﻤّﯽ ‪1‬ﻭ‪-25‬ﻫﯿﺪﺭﻭﮐﺴﯽ ﻭﯾﺘﺎﻣﯿﻦ‬
‫‪1‬‬ ‫‪801515‬‬
‫ﺳﺮﻡ‪/‬ﭘﻼﺳﻤﺎ‬
‫ﻫﻤﻮﮔﻠﻮﺑﯿﻦ‪ ،‬ﻫﻤﺎﺗﻮﮐﺮﯾﺖ‪ ،‬ﺷﻤﺎﺭﺵ ﮔﻠﺒﻮﻝ ﻗﺮﻣﺰ ﻭ ﺳﻔﯿﺪ ﻭ ﭘﻼﮐﺖ‪ CBC (،‬ﺁﺯﻣﺎﯾﺶ‬
‫‪1‬‬ ‫‪802000‬‬
‫ﺍﻧﺪﯾﺲﻫﺎﯼ ﺳﻠﻮﻟﯽ( ﻭ ﺷﻤﺎﺭﺵ ﺍﻓﺘﺮﺍﻗﯽ ﮔﻠﺒﻮﻟﻬﺎﯼ ﺳﻔﯿﺪ‬
‫‪1‬‬ ‫)ﻧﺎﺷﺘﺎ( ‪ -FBS‬ﺍﻧﺪﺍﺯﻩ ﮔﯿﺮﯼ ﮐﻤّﯽ ﮔﻠﻮﮐﺰ ﺧﻮﻥ‪/‬ﺳﺮﻡ‪/‬ﭘﻼﺳﻤﺎ‬ ‫‪8004000‬‬
‫ﻣﻬﺮ ﻭ ﺍﻣﻀﺎ‬
‫‪HID:2008GMDYXV‬‬