SRL PSC MAHANAGAR ( HOME COLLECTION )

INVOICE CUM RECEIPT

SHOP NO.2-CC, 525-A/V-148 LDA MARKET, MANDIR MARG
MAHANAGARVISTAR SCHEME,
LUCKNOW
226006
UTTAR PRADESH
INDIA
7800001229

Receipt No : CWD002152/1 Date : 02-04-2023 11:32:18 Receipt Date : 02-04-2023 11:45:12

Received with thanks from test : SOMA DEVI Gender: Female Age: 68 Years Client Code :C000080354

Prescribed by : DR. ABHISEK SRIVASTAVA Email : maneesh.knit12@gmail.com , Mobile No. : 9454830608

Test Code Test Description Amount

5110G CBC-5, EDTA WHOLE BLOOD 160

DXB1013 KIDNEY FUNCTION TEST- UREA, URIC ACID, CREATININE, 350

ELECTROLYTES, CALCIUM, PHOSPHORUS, PROTEIN- TOTAL,
ALBUMIN, GLOBULIN

3180 HBA1C (GLYCOSYLATED HEMOGLOBIN) 400

TPCD THYROID PANEL IV (T3, T4, TSH) 250

3020 VITAMIN B12 1300

8823D 25-HYDROXY VITAMIN D TOTAL 1200

1209AD LIPID PROFILE I-CHOLESTEROL, TRIGLYCERIDES, HDL, LDL, 350

HDL/CHOLESTEROL RATIO

Discount Amount(-) : 0.00

Other Charges : 100.00

Total : 4110.00
Balance : 0 Advance : 4110.00
Four Hundred Fifty Only
By Cash For SRL LTD
Your User ID is SOMAF0165316.
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Authorized Signatory
CALL our Customer Care on 91115 91115

CONDITIONS OF LABORATORY TESTING & REPORTING

1. Patient identity and demographic details are crucial for a 4. SRL is committed to deliver reports on time. However, in
correct report. Kindly check your Name / Age / Mobile unforeseen circumstances such as non-availability of kits /
number & Email ID on the test requisition form and receipt. equipment breakdown / natural calamities / technical
downtime or any other unforeseen event report may be
2. In case of collected specimen(s) referred to SRL / delayed. SRL aims to keep this to minimal.
collected by patient, it is presumed that the sample belongs
to the patient named or identified in the test requisition 5. Kindly share all clinical details along with the specimen for
form. The referring Lab /collection authority is responsible accurate diagnosis. SRL may request for additional
for appropriate sample collection as per pre-requisites, its information for clinical co-relation as & when required
labelling and transport.
6. Tests once registered cannot be CANCELLED!
3. A fresh sample may be requested if the Quality or
Quantity of received sample is unsatisfactory
SRL Limited
Fortis Hospital, Sector 62, Phase VIII,
Mohali 160062

Note: This receipt is issued on behalf of the Centre & SRL limited does not ratify the contents therein. (Applicable in case of
collected specimen(s) is referred to SRL)