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  • PBS PBS PBS: Lab No: - Lab No

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    Leah Bernardo
    12 views4 pages
    This document contains a laboratory form with fields to record patient information including name, age/sex, ward, dates, and names of preparers and verifiers for various laboratory tests including PBS, smears, and BSMP. The form has space to record information for 3 separate patients/tests.

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    PBS

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    This document contains a laboratory form with fields to record patient information including name, age/sex, ward, dates, and names of preparers and verifiers for various laboratory tests including PBS, smears, and BSMP. The form has space to record information for 3 separate patients/tests.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    12 views4 pages

    PBS PBS PBS: Lab No: - Lab No

    Uploaded by

    Leah Bernardo
    This document contains a laboratory form with fields to record patient information including name, age/sex, ward, dates, and names of preparers and verifiers for various laboratory tests including PBS, smears, and BSMP. The form has space to record information for 3 separate patients/tests.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    of 4

    LAB NO: _____________________ LAB NO: __________________ LAB NO: ____________________

    PBS PBS PBS


    NAME OF PX: NAME OF PX: NAME OF PX:

    A/S: A/S: A/S:

    WARD: WARD: WARD:

    DATE PREPARED: DATE PREPARED: DATE PREPARED:

    PREPARED BY: PREPARED BY: PREPARED BY:

    VERIFIED BY: VERIFIED BY: VERIFIED BY:

    FORWARDED & LOGGED BY: FORWARDED & LOGGED BY: FORWARDED & LOGGED BY:
    DATE PREPARED: ____________________ DATE PREPARED: ____________________ DATE PREPARED: ____________________

    SAVE SMEAR SAVE SMEAR SAVE SMEAR


    NAME: NAME: NAME:

    A/S: A/S: A/S:

    WARD: WARD: WARD:

    MTOD: MTOD: MTOD:


    DATE PREPARED: ____________________ DATE PREPARED: ____________________ DATE PREPARED: ____________________

    BSMP BSMP BSMP

    NAME: NAME: NAME:

    A/S: A/S: A/S:

    WARD: WARD: WARD:


    DATE PREPARED: ____________________ DATE PREPARED: ____________________ DATE PREPARED: ____________________

    SAVE SMEAR SAVE SMEAR SAVE SMEAR


    NAME: NAME: NAME:

    A/S: A/S: A/S:

    WARD: WARD: WARD:

    MTOD: MTOD: MTOD:

    DATE PREPARED: ____________________ DATE PREPARED: ____________________ DATE PREPARED: ____________________

    SAVE SMEAR SAVE SMEAR SAVE SMEAR


    NAME: NAME: NAME:

    A/S: A/S: A/S:

    WARD: WARD: WARD:

    MTOD: MTOD: MTOD:

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