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SUPREME CARE

MEDICAL DIAGNOSTIC & IMAGING CENTER INC.


T.Cloudio St. Brgy. San Juan, Morong Rizal

Name: Age:/Sex: Date:


Address:

URINALYSIS RESULTS
Date/Time-Collected: Date/Time-Received: Date/Time-Reported: Date/Time-
Repeated:
02/20/19- 9:00 A.M 02/20/19- 1:30 P.M 02/20/19-1:30 P.M 02/25/19- 10;00 A.M
Physical Examination: Chemical Examination: Microscopic Examination:
Volume : Proteins : Blood :
Color : Urobilinogen : WBC :
Appearance : Bilirubin : RBC :
Sp.Gravity : Ketones : Epithelial Cells :
Odour : Nitrite : Crystals :
pH : Glucose : Bacteria :
Casts :
Observation:

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