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REQUEST ROUTINE II URGENT FAX

BIOCHEMISTR\
OCHEMISTRY DOCRINOTOGY HAEMATOTOGY IMMUNOTOGY MOI.ECUTAR BIOTOGY
' LIJIIGS,
- KIDNEYS & sKELI
SKELETON I.S H IDffrf' Blood Count + tPloielets + ESR E
E lmmunoolobulins
munoolobulins A+G+tu
A+G+M PCR AND OTHER METHODS
U&Er-Creotinine [] Free T4 EFFull Blooo Counl - Ploteiets tl loG Subiroctions
il Electrolvies E Free T3 f l Haomnnlnl^,in t] CRP
D Ureo []
_ Thyroid Function E Hb & Hoemolocrit E ASO + Anti_DNASe B
E Creotinine l Thvroicj Antihor-jie5
,,,1 E White Cell Counl + Differentiol fl Complement C3 + C4
! Creotinine Cleoronce f- l T\l-.1 Poe onlnr Ah D Pioielets
AUTOIMMUNE ANTIBODIES
E Blood Goses E i.'lertiiit-v:Mot"e i witn sperm Ab [l Reiiculocytes
E Colcium E Infertility-Femole E witn sperm nu COAGUTATION flArthritis Profile
E Moqnesium E Hirsutism fl Autoimmune Profile
E Pholphote E FSH E Prothrombin Time (rnn/erl E ANF
E Potossium ILH E Prothrombin Time + Dosooe [] ENA iL!ir.r'.ljrcr{) t.l!.. ecr A.lJ
E Uric Acid E 17;pOestrodiol (F2) fl Port Thromboplostin Time-ierr1 E Double Stronded DNA
E Renol stone onclysis E -P6oesterone E FDP tlCytoplosmic Ab
6 rred Testosterone E D-Dimer [] Cordiolipin Ab
c A R BO H YD RAlF,,trlETA BO Lr SM
f] ACIH E Plotelet Aqqreqotion Il Rheumoioio Foctor
Glr,coseElfoslino lRorrdom Corlisol Ll0Bh00 DRondonr E flolelel FurlcTron ff Kerotin Ab
Insylin -lFos1'nd []Rundon' Ll Growlh Horrrone D Bosic Bleedino Tendencv Screen " [] ANCA
lby cnno ntnrerit) D l7OFl Proqesterone E 'Full Bleeding-Tendencir Profile "
=t41I
ET HbAIC D Proloctin - D 'Full Thromb6tic Profile VIRUS ANTIBODIES
D Fructosomine f:l PTH (Porothorrnone) E DIC Screen Ll Hep. A+B+C (Acute Profite)
E Phospholipid Antibodies [l Hep. A*B (Acute Profirer
/uen METABor.rsM PREGNANCY
IMMUNOHAEMATOLOGY [f Hep. B {Acute Profile)
ffLipoqrom L.l Antenotol {Excr. Hrv) E Hep.lmmune Profile
[l Totofcholesterol E Antenotol [1 Blood Grouo + Rh l-J Hep. ,A, 1: ,r, ' ,r. r
E HDL-Cholesterol I Down's &
{rncr. Hrv)
NTD Screen E Rh Antibodies [l HeP. A 1i,:,,) 1lrrrrr".:'-v1
[l LDL Cholesterol tf AFP (NID) D Direct Coombs D Heo. Bs Ao
E Triolvcerides fl B HCG Quontitoiive OTHER tl fle!. Bs A5'r,",,'.,' r

El Lip-"oprotein {o} I B HCG Quoliicrtive it',r,,ifi{',rr

D Abnormol Hoemoglobin Screen
LJ Hep. Bc Ab
E Apolipoprotbin Al [l Amniotic Fluid: L/S Rotio
fl Hb Eleclroohoresis
E Hep. C Ab
E Aooliooorotein B E Foetol Lung Moturii! {onrr r'ir: i: c1)
E Mc*arro
fl Rubello loc + loM
CARDIAC & SKELETAL MUSCLE ANDROTOGY D)t6n Studies
fl Rubello ldG 1,,,in,,,,,'v)
EFFerritin E CMV (loG. crMJ
[] Cordioc Morkers E Spermioqrom (bv opp.ri,rlrrcnt) E EBV Antibodies
fl Sbernt cSunt iror' '.r!.(:ro!'r'i J {i.i)prl fl *6lafe
Soldble Tronferrirr Receptor
E Serum [1 RBC E Poul Bunnell
=CK
E CK-MB E Spernr Ab 1ec,r.:r; 4vit gtz E Coxsockie B Virus Ab
[l Troponin l/T [] Hgrpes Sjmplpx Virus Ab (l&ll)
D Mvpqlobin TUMOUR MARKERS D HIV Antibod;es P ,' . . :o
D 9fo BNP E AFP PHARMACOTOGY (see consenl srgnofure obovel
E h's-CRP D 82 Microcllobulin ANTI.CONVULSIVE DRUGS, OTHER
El Homocysteine flCc199- ANTIBIOTICS, ETC ORGANISMS/ANTIBODIES
[lTMX Profile (oool]
I!CEA Specify drug:
".-'
,jllrf.n, PANcREAS & oTHER .] Cq,lecholomines {r'\ip \n, r ::,r 1 ,rr
[l Widol 1Ty1rrr,.,l1
E Liver Functions without prot Erec. a)HIAA r ",,-,i , r, [] Brucello (i!c. + r,rMt
[) Proicin Electroohoresis trzlpsn ElWeil-Felix
El R. conorii (r,rc.
E BilifUbin (r.i. +,_.).t) [] Stool occult bloocl
E STD Profile (wrhout Hrv)
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f] ALP [] GGT [] Diqoxin E STD Profile (wnh Hrv)
E AST t-] ALT DRUGS OF ABUSE fl Theophylline Ll Herpes Simplex Virus | & ll
E LDH [] Alcohol E N. eonorrhoeoe Ab
E Totcrl Protein + Albumin f Anrphetonrine & Metomphelomines SEROTOGY pbllidum (RPRrEliso f-)o./vu €-',rr
D Amvlose Ll Benzodiozeoines ATLERGY & HYPERSENSITIVITY
I T.
D Lipose D Connobis
D Chlomydio Ab 1eerp. !(,r(.,ryf.xi:)
Chlomydio Ab ro' . ,.'.r '-.)
E Porohvrits. rr" " o :l
[] Cocoine SKIN TESTS
[] lnholonis + [l Nose Swcb
E
E mycoplosfilo 1r';r^, , qxl1
URINE PROTEINS fl Ecstosy Ll Foods E Leqionellcr Ab
D E
fl Totcl Protein E
LSD
Mondrox
Monloux E Q lever Ab
tl Mlcroclbumin t CAT {r.4.rf.iririorr
ll H. pyloriAb
D Amoebo Ab
E Bence Jones Protein D Methodone
rrci
BTOOD [l Toxoplcsmo (rqc] ' .rrrr)
D Opictes Ll Totol lqE [l Brlhorzio Ab
TOXTCOTOGY [1 PCP ,,t'c) ll
[] Borbiturotes
{Pr,r'n, 7,
l l Frnnn"rrnhana Phodiotop Screen: Inholonts ANTIGENS
O

ofl R an znr'lin zo n ino <

flQhlomydio DFA a ,, _ir'r tu
3fl
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Porocetomol RASTlSpecitic lgE) - Lisl ovoiloble from lob ll Pneumocyslis corinii DFA
Solicylote E Legioneilo Aq DFA (spuium)
J lnhc,onis-Specity'' N
N
;fl
o
Tricyclic Antldepressonts
Lf Food Specify" E Ledionello Ad r ' r
O

o [-] Gluten lgA + Endomysiurn Ab E Heipes DFA [&ll)r, ,"-'1 =

; [l CAST (rryAppi) sp--cify" U
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(Before I 2h00 weekdoys)
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@ Pleose specitv ony odditionol informolion required in lhe block ollowed for Olher Tesls c
Reportr ore only mode
ovolloble io lhe docfor. * Consull *ith Pirthologisl before requesling thii tesl # Pleose supply potient hisfory :