Form 2 Year ________

Laboratory Register
Lab Serial No. Date Name Sex M/F Age Reason for examination Diagnosis (tick) Month of follow up 1 Results of specimen 2 3

Field
Serno

Field label
Lab serial number

Field Field Field values type length

I 4 1-9000 9001, 9002 01/01/2000-31/12/2005 01/01/1800 1 2 9 0-125 999 0 1

Value labels

comment
Serial number starting with 1 each year. Enter 9001, 9002, if serial number is not unique or missing, and write a data entry note (use F5 to open a note file) Range of legal registration dates. Enter 01/01/1800 if no date recorded

Regdate

Registration date Examinees sex Examinees age in years Examination reason

10

Sex

Female Male Sex not recorded Range of legal years Age not recorded Diagnosis Follow-up

Age Reason

1 I

3 1

Res1

Result of specimen 1

2 0 1 2 0 1 2 0 1 2

Reason not recorded Negative Positive Result not recorded Negative Positive Result not recorded Negative Positive Result not recorded

Res2

Result of specimen 2

Res3

Result of specimen 3