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Mg:_____ IV:____________________

HgB PT PTT Na Cl BUN Ca Pro AST LDH Abx:____________________________


WBC PLT Glu Bili
Hct K HCO3 Cr PO4 Alb ALT AlkP ____________________________
INR
ABG: ____/____/____/____/____/____
pH pCO2 pO2 HCO3 O2% Base+
Tmax: ______ Tc: _____ P:__________ R: _________ BP: _________/_________ O2: _______ on _________ AF VSS Flatus BM
UOP/Foley:_____/_____/_____ NG:_____/_____/_____ In:_____/_____/_____ Out:_____/_____/_____ Reg Full Clear Tube TPN
[________]: _____/_____/_____ [________]: _____/_____/______ [________]:_____/_____/_____ [________]:_____/_____/_____
__________________________________ __________________________________ __________________________________
__________________________________ __________________________________ __________________________________

Mg:_____ IV:____________________
HgB PT PTT Na Cl BUN Ca Pro AST LDH Abx:____________________________
WBC PLT Glu Bili
Hct K HCO3 Cr PO4 Alb ALT AlkP ____________________________
INR
ABG: ____/____/____/____/____/____
pH pCO2 pO2 HCO3 O2% Base+
Tmax: ______ Tc: _____ P:__________ R: _________ BP: _________/_________ O2: _______ on _________ AF VSS Flatus BM
UOP/Foley:_____/_____/_____ NG:_____/_____/_____ In:_____/_____/_____ Out:_____/_____/_____ Reg Full Clear Tube TPN
[________]: _____/_____/_____ [________]: _____/_____/______ [________]:_____/_____/_____ [________]:_____/_____/_____
__________________________________ __________________________________ __________________________________
__________________________________ __________________________________ __________________________________

Mg:_____ IV:____________________
HgB PT PTT Na Cl BUN Ca Pro AST LDH Abx:____________________________
WBC PLT Glu Bili
Hct K HCO3 Cr PO4 AlbALT AlkP ____________________________
INR
ABG: ____/____/____/____/____/____
pH pCO2 pO2 HCO3 O2% Base+
Tmax: ______ Tc: _____ P:__________ R: _________ BP: _________/_________ O2: _______ on _________ AF VSS Flatus BM
UOP/Foley:_____/_____/_____ NG:_____/_____/_____ In:_____/_____/_____ Out:_____/_____/_____ Reg Full Clear Tube TPN
[________]: _____/_____/_____ [________]: _____/_____/______ [________]:_____/_____/_____ [________]:_____/_____/_____
__________________________________ __________________________________ __________________________________
__________________________________ __________________________________ __________________________________

Mg:_____ IV:____________________
HgB PT PTT Na Cl BUN Ca Pro AST LDH Abx:____________________________
WBC PLT Glu Bili
Hct K HCO3 Cr PO4 AlbALT AlkP ____________________________
INR
ABG: ____/____/____/____/____/____
pH pCO2 pO2 HCO3 O2% Base+
Tmax: ______ Tc: _____ P:__________ R: _________ BP: _________/_________ O2: _______ on _________ AF VSS Flatus BM
UOP/Foley:_____/_____/_____ NG:_____/_____/_____ In:_____/_____/_____ Out:_____/_____/_____ Reg Full Clear Tube TPN
[________]: _____/_____/_____ [________]: _____/_____/______ [________]:_____/_____/_____ [________]:_____/_____/_____
__________________________________ __________________________________ __________________________________
__________________________________ __________________________________ __________________________________

Mg:_____ IV:____________________
HgB PT PTT Na Cl BUN Ca Pro AST LDH Abx:____________________________
WBC PLT Glu Bili
Hct K HCO3 Cr PO4 Alb ALT AlkP ____________________________
INR
ABG: ____/____/____/____/____/____
pH pCO2 pO2 HCO3 O2% Base+
Tmax: ______ Tc: _____ P:__________ R: _________ BP: _________/_________ O2: _______ on _________ AF VSS Flatus BM
UOP/Foley:_____/_____/_____ NG:_____/_____/_____ In:_____/_____/_____ Out:_____/_____/_____ Reg Full Clear Tube TPN
[________]: _____/_____/_____ [________]: _____/_____/______ [________]:_____/_____/_____ [________]:_____/_____/_____
__________________________________ __________________________________ __________________________________
__________________________________ __________________________________ __________________________________

Mg:_____ IV:____________________
HgB PT PTT Na Cl BUN Ca Pro AST LDH Abx:____________________________
WBC PLT Glu Bili
Hct K HCO3 Cr PO4 Alb ALT AlkP ____________________________
INR
ABG: ____/____/____/____/____/____
pH pCO2 pO2 HCO3 O2% Base+
Tmax: ______ Tc: _____ P:__________ R: _________ BP: _________/_________ O2: _______ on _________ AF VSS Flatus BM
UOP/Foley:_____/_____/_____ NG:_____/_____/_____ In:_____/_____/_____ Out:_____/_____/_____ Reg Full Clear Tube TPN
[________]: _____/_____/_____ [________]: _____/_____/______ [________]:_____/_____/_____ [________]:_____/_____/_____
__________________________________ __________________________________ __________________________________
__________________________________ __________________________________ __________________________________

General Surgery Lab Values/Scut Sheet- Created by Patrick S. Carroll 10/31/2010.