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    Medical LRF

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    Khrizha Grace Espinosa
    This laboratory request form from the Romblon State University Health Services Unit contains fields for the patient's name, age, sex, and date. It lists several common laboratory tests that can be requested including complete blood count, urinalysis, fecalysis, hepatitis and HIV tests, imaging exams, and blood chemistry panels. The attending physician must sign the form to authorize the specified tests.

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    Medical LRF

    Uploaded by

    Khrizha Grace Espinosa
    5 views1 page
    This laboratory request form from the Romblon State University Health Services Unit contains fields for the patient's name, age, sex, and date. It lists several common laboratory tests that can be requested including complete blood count, urinalysis, fecalysis, hepatitis and HIV tests, imaging exams, and blood chemistry panels. The attending physician must sign the form to authorize the specified tests.

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    Medical Lrf

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    This laboratory request form from the Romblon State University Health Services Unit contains fields for the patient's name, age, sex, and date. It lists several common laboratory tests that can be requested including complete blood count, urinalysis, fecalysis, hepatitis and HIV tests, imaging exams, and blood chemistry panels. The attending physician must sign the form to authorize the specified tests.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    5 views1 page

    Medical LRF

    Uploaded by

    Khrizha Grace Espinosa
    This laboratory request form from the Romblon State University Health Services Unit contains fields for the patient's name, age, sex, and date. It lists several common laboratory tests that can be requested including complete blood count, urinalysis, fecalysis, hepatitis and HIV tests, imaging exams, and blood chemistry panels. The attending physician must sign the form to authorize the specified tests.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
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    Republic of the Philippines

    Romblon State University


    HEALTH SERVICES UNIT
    Odiongan, Romblon

    LABORATORY REQUEST FORM


    Date: ____________
    Name:
    Age / Sex: ________________ / ____________

     CBC
     CBC with APC
     Urinalysis
     Fecalysis
     HBsAg
     Chest X-Ray with official reading
     Sputum AFB
     Ultrasound
     ECG
     Blood Chemistry
     BUN, CREA
     Lipid profile
     FBS
     Others ____________________

    _____________________________
    University Physician

    HSU-01-001 LRF No.: ________


    Creation Date: 2021-02-14
    Revision Date: 2022-01-20

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