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  • REP13NOV2022@0038 1618653094445954575-New

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    Samwel Gachoka
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    This document is a laboratory request and report form from Molosub-County Hospital for patient Phelister Kemuma Momanyi. It includes details of the patient such as age, sex, and residence. It requests a urinalysis test and provides the results, which were within normal ranges except for trace amounts of protein and occasional red blood cells seen. The urinalysis was done on November 12th, 2022 and the report was printed and approved on November 13th, 2022.

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    REP13NOV2022@0038_1618653094445954575-new

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    This document is a laboratory request and report form from Molosub-County Hospital for patient Phelister Kemuma Momanyi. It includes details of the patient such as age, sex, and residence. It requests a urinalysis test and provides the results, which were within normal ranges except for trace amounts of protein and occasional red blood cells seen. The urinalysis was done on November 12th, 2022 and the report was printed and approved on November 13th, 2022.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    6 views1 page

    REP13NOV2022@0038 1618653094445954575-New

    Uploaded by

    Samwel Gachoka
    This document is a laboratory request and report form from Molosub-County Hospital for patient Phelister Kemuma Momanyi. It includes details of the patient such as age, sex, and residence. It requests a urinalysis test and provides the results, which were within normal ranges except for trace amounts of protein and occasional red blood cells seen. The urinalysis was done on November 12th, 2022 and the report was printed and approved on November 13th, 2022.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 1

    MOH 227 MINISTRY OF HEALTH LAB NO: 082382

    MOLO SUB-COUNTY HOSPITAL


    P.O.Box 156-20106
    MOLO
    LABORATORY REQUEST AND REPORT FORM
    NOTE: Incompletely filled forms will not be processed

    I. Patient Details II. Specimen Destination


    Name: Phelister Kemuma Momanyi Tick appropriate box

    Age: 29.00 Blood Bank [ ]


    Sex: Female Histology/Cytology [ ] Bacteriology [ ]
    Residence Serology [ ] Parasitology [ ]
    OP/IP No: 05385/21 Hematology/CD4 [ ] Biochemistry [ ]
    Report to(specify clinic/ward/clinician .................

    III Specimen Sputum New [ ] Follow up


    IV. Collection Date : 2022-11-12 1st [ ] 2nd [ ]
    V. Time : 2022-06-07 12:35:08.0 Others (Specify) [ ] .........................
    Print Date: 2022-11-13
    VI. Investigation Requested
    TEST: URINALYSIS
    VI. History (Including drugs used)
    VIII. Diagnosis
    IX. Requesting Clinician Name..
    Signature....................................................... Date............../................./...............................
    X. LAB REPORT
    Parameter Result
    Appearance turbid -
    Bilirubin nil -
    Blood +-
    Casts/Crystals nil -
    Deposit erythroctes 1-5/hpf -
    Glucose nil -
    Ketones nil -
    Leucocytes nil -
    Nitrite nil -
    Ph 5.0 -
    Protein trace -
    Red Blood Cells +-
    S.Gravity 1.025 -
    Urobilinogen nil -
    Yeast Cells nil -
    Comments:

    Test done by (initials) : sammy rono Sign..........................................Date.........../............/.....................


    Approved By Initials : Lab Lab Sign...........................................Date.........../............/.....................

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