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WEST VISAYAS STATE UNIVERSITY MEDICAL CENTER

E. Lopez Street, La Paz, Iloilo City


CLINICAL LABORATORY
URINALYSIS
Patient_______________________________
Doctor_______________________________

Age___
Sex___
Date _______________
Room ________________________________________

PHYSICAL PROPERTIES
Color________________________________
Transparency_________________________
Reaction ____________________________
Specific gravity ________________________

MICROSCOPIC FINDINGS
Pus cells ______________________________/hpf
RBC _________________________________/hpf
Cast
hyaline _______________________/hpf
Fine granular__________________/hpf
Course granular _______________/hpf

CHEMICAL TESTS

Crystals

Sugar _______________________________
Albumin ____________________________
Ketone ______________________________
Others ______________________________
_____________________________
_____________________________

Amorphous _____________________________
______________________________________
Squamous epithelial cells __________________
Round epithelial cells______________________
Mucus threads __________________________
Others ________________________________
_______________________________

__________________________________
MEDICAL TECHNOLOGIST

_______________________________________
PATHOLOGIST

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