CARR. # 2 KM 92.

9 MARGINAL BO MEMBRILLO CLIA : 40D0684599

License : 798
CAMUY,PR 00627 Telephone : 787-820-4722

Patient Lab. Number Lab. Date Order Number

ARBELO AMADOR, JOMAR J. 2217577 08/01/2022 30544948
PO BOX 278
QUEBRADILLAS PR 00678 Birthdate Age Sex
Tel: Cel: 787-356-8810 10/30/2007 14 year(s) M
Email: mamadorramirez@pucpr.edu Patient ID
Referred by
26811
ILIA J. HERNANDEZ
P.O. BOX 974
QUEBRADILLAS 00678 Lab. Director: LCDA. SAHUDY AMADOR LIC: 3011
Tel: 895-4121 License: LIC LAB: 798 #CLIA 40D0684599

Test Result H/L Rck Reference Range Units

HEMATOLOGY
SED RATE WESTERGREN 5 0 - 15 MM/HR
Comment
BY SEDIMAT 15 PLUS(AUTOMATED 15 MIN READER)
Received:08/01/2022 08:24 AM Processed:08/01/2022 09:00 AM Reported:
By:SANDRA GUILLAMA

[Sello CTMPR / $.05 / LEUT / 798]