Lab and Diagnostic Tests Form

**Please remember to check the lab and diagnostic tests normal values at each clinical facility
Complete Blood

Normal Values

Count (CBC)
RBC
Hgb
Hct
WBC
WBC w/differential
Bands
Segs
Neutrophil
Eosinophil
Basophil
Lymph
Monos
Platelets
Coagulation

Normal Values

Client

Normal/

Results

Abnormal

Client

Normal/

Results

Abnormal

Client

Normal/

Results

Abnormal

Bleeding Time
PT
PTT
INR
Chemistry
Na+
K+
ClCO2
Glucose
BUN
Creatinine
PO4
Mg+
Uric Acid
Total Bilirubin
Total Protein
Albumen
Cholesterol
Triglycerides
SGOT/AST
SGPT/ALT

Normal Values

CPK
CPK-MB
Lipase
Amylase
Alkaline Phos
Ammonia
TSH
T3
T4
Urinalysis
Color
Characteristic
Specific Gravity
pH
RBC
WBC
Protein
Glucose
Ketones
C&S Report
Bacteria
Biliubin

Normal Values

Client
Results

Normal/
Abnormal

(Clear,cloudy,hazy)

Arterial Blood
Gases
pH
PO2
PCO2
HCO3
SO2
Base Excess or
Deficit

Normal Values

Client
Results

Normal/
Abnormal

Diagnostic
Tests
Chest X-ray
EKG/EEG
Ultrasound
CT/MRI
Other

Normal Values

Client
Results

Normal/
Abnormal

ostic Tests Form

alues at each clinical facility

Explanation

Explanation

Explanation

Explanation

Explanation

Explanation