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Discharge Date:
Name: Sex: Male [ ] Female:0
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Department:
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No of Hospital days:
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Age: Admission Date: Ward No:

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REASON FOR ADMISSION ON EXAMINATION

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LAB INVESTIGATION ORDERS

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Blood urea I 2. I:> 15-45mg/dL SERUM ELECTROLYTES
Serum 0.6-1 .2 mg/dL Serum Na .. 135-145
O·b D· b 13 ~ 13 7
creatinine mEq/L
PCV 30 3'0 2(, ::2-'B 35-49% Serum K.. Li· I 3,' 3.5-5.5mEq/L
MCHC :2&1 32-36% Serum Ca .. 8.5-10.5mg/dL
ESR 0-20mm/hr Serum HCQ3· 21-28mEq/L
MCV 7q 76-96fl Serum Cl· 96-108mEq/L
MCH . .2-3 26-32Pg LIVER FUNCTION TEST
ROW 11-16% ALP 64-270U/L
Total RSC 3.8-5.6 SGOT 8-401U/L
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Platelet count 15Q-45Q X SGPT 5-351U/L
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TLC 4-11 X Bilirubin Total 0.2-1 .2mg/dL
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Random blood Io 'f 70-1S0mg/dL Direct Bilirubin 0-0.4mg/dL
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CRP 0-6mg/L Indirect Bilirubin _0.3-Q.8~19/d.!:_
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