D

R
A
Z Clinical Details (Essential)
A
H
O
BI
HOSPITAL NUMBER GP Practice: E81037 The De Parys Group
Antipsychotic Monitoring Non
Diabetic
NHS NUMBER 452 571 6347 GP Code Dr Maryam Tahmasebi – Non FASTING BLOODS
SURNAME Borley Category NHS PP Date : 13 06 2024
Y
OLOG FORENAME Jennifer Request Priority Routine Urgent
PATH
RY
Copy of report to (State)
DATO DOB 12 Sep 1952 GENDER Female High Risk? Yes Pregnant? Yes
ES
MAN
ARE SERVIC LMP / /
N ATORY
Name of requestor: Name of person taking sample(s): Samples Taken:
TAKE LABOR
TIME
AL
DATE/ Signature: Signature: Date: Time:
AND CLINIC
E ES CLINICAL BOCHEMISTRY HAEMATOLOGY COAGULATION IMMUNOLOGY
ATUR SCIENC
SIGN Blood CSF Random Urine 24hr Urine Other (State) LILAC TOP BLUE TOP ANTIBODIES: 2 X SST
BLOOD
LS, SPECIMEN FBC PT / APPT / TT Antinuclear
DETAI
CAL STANDARD: SST STANDARD: SST ENDOCRINE: SST URINE: EMU ESR INR Ds DNA Antibodies
Renal Profile Lipids Thyroid Profile Reticulocytes D-Dimer ENA
CLINI
S, ACR –
Diabetic Anti-phospholipid profile
BOXE Urea GREY TOP FSH / LH Paul Bunnel ANCA
2 x Citrated + Red Top
LFT ( Bili, ALP, Thrombophilia Screen
ED
Glucose (GP samples) FSH G6PD Thyroid Abs
SHAD Alb) ACR – 5 x Citrated + 1 Red Top
IN Non-Diabetic RA – Gastric Parietal
GGT HAEMATINICS: SST Oestradiol
ION 1 X Red Top Cell Antibodies
RMAT Bone Profile
INFO (Ca, alb, phos, Iron / Transferrin Prolactin Sickle Cell – Coeliac Screen
2 x EDTA + 1 x SST
ALL ALP)
Progesterone
Calcium & ALB Ferritin OTHER: (Haematology or Immunology) Acetyl Choline Rec Ab
D
R
A
day 21
Z Urate Folate PSA
A Lab Use Only
Magnesium PALE LILAC TOP OTHER:
H
O
BI
Amylase Diagnostic HBA1C eGFR

CRP

FIX ADDRESSOGRAPH LABEL ON EACH SHEET OR COMPLETE USING BALLPOINT PEN ONLY