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    This document is a lab request form containing the patient's name, registration number, age, sex, and doctor's name. It lists over 50 different lab tests across several categories including viral/serology tests, hematology, general endocrine, tumor markers, hepatitis viruses, bone turnover, glucose metabolism, iron studies, heart/muscle, pregnancy, and other infectious diseases. The form provides the essential information needed to request various medical lab tests for a patient.

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    This document is a lab request form containing the patient's name, registration number, age, sex, and doctor's name. It lists over 50 different lab tests across several categories including viral/serology tests, hematology, general endocrine, tumor markers, hepatitis viruses, bone turnover, glucose metabolism, iron studies, heart/muscle, pregnancy, and other infectious diseases. The form provides the essential information needed to request various medical lab tests for a patient.

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

    Request Form

    Uploaded by

    bgraphicle
    This document is a lab request form containing the patient's name, registration number, age, sex, and doctor's name. It lists over 50 different lab tests across several categories including viral/serology tests, hematology, general endocrine, tumor markers, hepatitis viruses, bone turnover, glucose metabolism, iron studies, heart/muscle, pregnancy, and other infectious diseases. The form provides the essential information needed to request various medical lab tests for a patient.

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    © All Rights Reserved
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    of 1

    LAB REQUEST FORM

    Surname ______________ Fist Name _____________

    Registra�on No ______________________________

    Age ____________________ Sex ________________


    Adn Care
    Health Center Doctor Name _________________________________
    P.O. Box 15212, Arusha- Tanzania
    Email: adncareclinic@gmail.com
    Tel:+255 738 360 008

    VIRAL /SEROLOGY HIV TESTS HORMONES


    Hep B Surface Ag Hiv T3
    Hep B Surface Ab CD4 –CD8 Count T4
    Hep a igM Ab PCR HIV (Viral Load ) TSH
    Hep B + c TUMOUR MARKET FSH
    Hep C Ab AFP LH
    HAEMATOLOGY CEA Prolac�ne
    CBS PSA Estradiol
    ESR Tree PSA Progesterone
    Platelets CA 125 Testosterone
    White cell count LIVER / PANCREASE BHCG (Urine)
    Haemoglobin Bilirubin BHCG Quant
    Blood group + Rhesus Direct bilirubin Cor�sol
    GENERAL ENDOCRINE Alkaline Phosphate GLUCOSE METABOLISM
    Testosterone Amylase
    Glucose Fas�ng
    E2 ALT
    Glucose Random
    Progesterone AST
    HbAlc Glycosylated Hb
    FSH Gamma GT
    IRON STUDIES
    LH LDH
    LIPID METABOLISM Ferro�n
    Prolac�n
    Growth hormone Total Cholesterol Vitamin B12
    Insulin HDL Folate Serum
    TUMOR MARKERS LDL HEART & MUSCLE
    CA 153 Triglycerides Troponin
    CA 125 PREGNANCY CKMB
    PSA BHeg Qualita�ve ( Pos / Neg ) CK
    HEPATITIS VIRUS BHeg Quali�ve Myoglobin
    Hepa��s B LDL Malaria thin & thick smear
    PARASITOLOGY
    Hepa��s C Triglycerides Stool
    BONE TURN OVER OTHER INFECTIOUS DISEASE Urine
    Vitamin D BHeg Qualita�ve ( Pos / Neg ) High Vaginal swab
    BHeg Quali�ve MRDT
    Malaria thin & thick smear

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