ST.

LOUISE DIAGNOSTIC CLINIC

2nd Flr., Josefina Bldg., Jose Corazon de Jesus T., Poblacion, Sta. Maria Bulacan
Clinic Hours : Mon. to Sat. – 7:00am – 5:00pm
Tel. No. (044) 641-1104

PATIENT NAME: AGE: SEX: CASE NO: DATE OF EXAM:

SPO4 SANTIANO, JOEL 46 M 10-493 March 28, 2011
ADDRESS: REFERRING PHYSICIAN:
Poblacion, Sta. Maria, Bulacan PNP Sta. Maria
EXAMINATION: ECG

ECG REPORT

Rate:_________ Axis___________ ST-Segments_____________

Rhythm:_________ P-waves____________ T-waves______________
QRS-complexes___________
Interpretation:_____________________________________________________________________________________
__________________________________________________________________________________________
_________________________________________________________________________________________.

M.D