1 : ‫ﺻﻔﺤﻪ‬ ‫ﺩﺍﻧﺸﮕﺎﻩ ﻋﻠﻮﻡ ﭘﺰﺷﮑﻲ ﺍﺳﺘﺎﻥ ﻓﺎﺭﺱ‬

1401/04/06 : ‫ﺗﺎﺭﻳﺦ‬
‫ﺁﺯﻣﺎﻳﺸﮕﺎﻩ ﺩﺭﻣﺎﻧﮕﺎﻩ ﺷﻬﻴﺪ ﻣﻄﻬﺮﻱ ﺷﻴﺮﺍﺯ‬
13:52 : ‫ﺳﺎﻋﺖ‬ 07136121134 ‫ ﻣﻴﺪﺍﻥ ﻧﻤﺎﺯﻱ ﺗﻠﻔﻦ‬-‫ﺷﻴﺮﺍﺯ‬

6489931052 : ‫ﻛﺪ ﻣﻠﻲ‬ ‫ ﻣﻬﺪﻱ ﺍﺳﮑﻨﺪﺭﻱ‬: ‫ﻧﺎﻡ ﺑﻴﻤﺎﺭ‬ 9019651 : ‫ﻛﺪ ﻗﺒﺾ‬ L0119 1401/04/01 8 : ‫ﻗﺒﺾ ﭘﺬﻳﺮﺵ‬
M : ‫ﺟﻨﺲ‬ ‫ ﻧﻌﻤﺘﻲ ﻟﻴﻼ‬: ‫ﭘﺰﺷﮏ‬ 23894 : ‫ﺳﺮﻳﺎﻝ‬ 14 / / 0 : ‫ﻗﺒﺾ ﺩﺭﺧﻮﺍﺳﺖ‬
‫ ﺭﻭﺯ‬25 ‫ ﻣﺎﻩ‬1 ‫ ﺳﺎﻝ‬36 : ‫ﺳﻦ‬ : ‫ ﻛﺪ ﺑﻴﻤﺎﺭ‬L0221 1401/04/01 10:19 : ‫ﻗﺒﺾ ﺟﻮﺍﺏ‬
urinalysis SampleNo: 16
Test Result Unit Normal Test Result
Urinanalysis
Color Yellow R.B.C/hpf 0-1
Appearance Clear W.B.C/hpf 1-2
S.G 1.033 Ep Cells 2-3
PH Acid Bacteria/hpf Not seen
Protein Negative Crystals/lpf Not seen
Glucose Negative Cast/lpf Not seen
Keton Negative Mucus Threads Not seen
Blood Negative
Bilirubin Negative
Urobilinogen Negative
Nitrite Negative
Leukocyte sterase Negative
‫ﺭﺿﺎﻳﻲ ﺩﻭﺳﺖ ﻓﺎﻃﻤﻪ‬
Digitally Signed By :
Reported By :

Chemistry SampleNo: 23
Test Result Unit Normal Test Result
FBS 92 mg/dL 70-99 (Impaired
Fasting Glucose:
100-125)
BUN 15 mg/dL 8-23
Creatinine 0.9 mg/dL 0.6-1.3
Na 142 mEq/L 135-145
K 4.33 mEq/L 3.5-5.5
Triglycerides 136 mg/dL 50-150
Cholesterol 189 mg/dL 125-200
HDL Cholesterol L 39 mg/dL 40-60
LDL Cholesterol 108 mg/dL 0-160 Acceptable:
<130
Borderline: 130-
159
High: >=160
AST (SGOT) 20 u/L 1-40
ALT (SGPT) 19 u/L 1-40

‫ﭘﻨﺠﺸﻨﺒﻪ ﺻﺒﺢ ﺁﺯﻣﺎﻳﺸﮕﺎﻩ ﻓﻌﺎﻝ ﺍﺳﺖ‬.‫ﺻﺒﺢ ﻣﻴﺒﺎﺷﺪ‬6 ‫ﺷﺮﻭﻉ ﻛﺎﺭﺁﺯﻣﺎﻳﺸﮕﺎﻩ ﺍﺯﺳﺎﻋﺖ‬

 2 : ‫ﺻﻔﺤﻪ‬ ‫ﺩﺍﻧﺸﮕﺎﻩ ﻋﻠﻮﻡ ﭘﺰﺷﮑﻲ ﺍﺳﺘﺎﻥ ﻓﺎﺭﺱ‬

1401/04/06 : ‫ﺗﺎﺭﻳﺦ‬
‫ﺁﺯﻣﺎﻳﺸﮕﺎﻩ ﺩﺭﻣﺎﻧﮕﺎﻩ ﺷﻬﻴﺪ ﻣﻄﻬﺮﻱ ﺷﻴﺮﺍﺯ‬
13:52 : ‫ﺳﺎﻋﺖ‬ 07136121134 ‫ ﻣﻴﺪﺍﻥ ﻧﻤﺎﺯﻱ ﺗﻠﻔﻦ‬-‫ﺷﻴﺮﺍﺯ‬

6489931052 : ‫ﻛﺪ ﻣﻠﻲ‬ ‫ ﻣﻬﺪﻱ ﺍﺳﮑﻨﺪﺭﻱ‬: ‫ﻧﺎﻡ ﺑﻴﻤﺎﺭ‬ 9019651 : ‫ﻛﺪ ﻗﺒﺾ‬ L0119 1401/04/01 8 : ‫ﻗﺒﺾ ﭘﺬﻳﺮﺵ‬
M : ‫ﺟﻨﺲ‬ ‫ ﻧﻌﻤﺘﻲ ﻟﻴﻼ‬: ‫ﭘﺰﺷﮏ‬ 23894 : ‫ﺳﺮﻳﺎﻝ‬ 14 / / 0 : ‫ﻗﺒﺾ ﺩﺭﺧﻮﺍﺳﺖ‬
‫ ﺭﻭﺯ‬25 ‫ ﻣﺎﻩ‬1 ‫ ﺳﺎﻝ‬36 : ‫ﺳﻦ‬ : ‫ ﻛﺪ ﺑﻴﻤﺎﺭ‬L0147 1401/04/01 14:47 : ‫ﻗﺒﺾ ﺟﻮﺍﺏ‬
Bilirubin
T.Bili 2.23 mg/dL 0.1-1.3
D.Bili 0.52 mg/dL 0-0.4

‫ﺭﺿﺎﻳﻲ ﺩﻭﺳﺖ ﻓﺎﻃﻤﻪ‬

Digitally Signed By : Mohammad Zadeh.MD Sahand
Reported By :

Hormone SampleNo: 19
Test Result Unit Normal Test Result
T4 9.9 ug/dl 4.4-10.8 4.8-11.6
TSH 0.92 µlU/ml 0.39-6.16
25 OH Vit D3 32.7 ng/mL 10-100 Deficiency:
<10
Suboptimal: 10-30
Optimal: 30-70
Overdose: 70-100
Toxic: >100

‫ﻣﻬﺮ ﺑﻬﺸﺘﻲ ﻧﺎﻫﻴﺪ‬

Digitally Signed By : Mohammad Zadeh.MD Sahand
Reported By :

Hematology SampleNo: 20
Test Result Unit Normal Test Result
CBC Diff
W.B.C 5.7 10^3/ul 4.5-11
R.B.C 5.17 10^6 /ul 4.5-6.5
Hb 16.1 g/dL 13.5-17.5
HCT 45.5 % 40-54
M.C.V 83.6 fL 81-98
M.C.H 31.1 pg 27-32
M.C.H.C 36.0 g/dL 32-36
R.D.W 12.3 % 11.5-14.5
Plat 175 10^3/ul 150-450
Neut% 45.2 %
Lymph% 45.0 %

‫ﭘﻨﺠﺸﻨﺒﻪ ﺻﺒﺢ ﺁﺯﻣﺎﻳﺸﮕﺎﻩ ﻓﻌﺎﻝ ﺍﺳﺖ‬.‫ﺻﺒﺢ ﻣﻴﺒﺎﺷﺪ‬6 ‫ﺷﺮﻭﻉ ﻛﺎﺭﺁﺯﻣﺎﻳﺸﮕﺎﻩ ﺍﺯﺳﺎﻋﺖ‬

 ‫ﺻﻔﺤﻪ ‪3 :‬‬ ‫ﺩﺍﻧﺸﮕﺎﻩ ﻋﻠﻮﻡ ﭘﺰﺷﮑﻲ ﺍﺳﺘﺎﻥ ﻓﺎﺭﺱ‬

‫ﺗﺎﺭﻳﺦ ‪1401/04/06 :‬‬

‫ﺁﺯﻣﺎﻳﺸﮕﺎﻩ ﺩﺭﻣﺎﻧﮕﺎﻩ ﺷﻬﻴﺪ ﻣﻄﻬﺮﻱ ﺷﻴﺮﺍﺯ‬
‫ﺳﺎﻋﺖ ‪13:52 :‬‬ ‫ﺷﻴﺮﺍﺯ‪ -‬ﻣﻴﺪﺍﻥ ﻧﻤﺎﺯﻱ ﺗﻠﻔﻦ ‪07136121134‬‬

‫ﻛﺪ ﻣﻠﻲ ‪6489931052 :‬‬ ‫ﻧﺎﻡ ﺑﻴﻤﺎﺭ ‪ :‬ﻣﻬﺪﻱ ﺍﺳﮑﻨﺪﺭﻱ‬ ‫ﻛﺪ ﻗﺒﺾ ‪9019651 :‬‬ ‫‪L0119 1401/04/01‬‬ ‫ﻗﺒﺾ ﭘﺬﻳﺮﺵ ‪8 :‬‬
‫ﺟﻨﺲ ‪M :‬‬ ‫ﭘﺰﺷﮏ ‪ :‬ﻧﻌﻤﺘﻲ ﻟﻴﻼ‬ ‫ﺳﺮﻳﺎﻝ ‪23894 :‬‬ ‫‪14 / /‬‬ ‫ﻗﺒﺾ ﺩﺭﺧﻮﺍﺳﺖ ‪0 :‬‬
‫ﺳﻦ ‪ 36 :‬ﺳﺎﻝ ‪ 1‬ﻣﺎﻩ ‪ 25‬ﺭﻭﺯ‬ ‫ﻗﺒﺾ ﺟﻮﺍﺏ ‪ L0154 1401/04/01 08:50 :‬ﻛﺪ ﺑﻴﻤﺎﺭ ‪:‬‬
‫‪M.X.D%‬‬ ‫‪9.8‬‬ ‫‪%‬‬ ‫‪6-16.1‬‬

‫ﻃﺎﻫﺮي ﺳﻤﺎﻧﻪ‬
‫‪Digitally Signed By :‬‬ ‫‪Mohammad Zadeh.MD Sahand‬‬
‫‪Reported By :‬‬

‫‪Microbiology‬‬ ‫‪SampleNo: 6‬‬

‫‪Test‬‬ ‫‪Result‬‬ ‫‪Unit‬‬ ‫‪Normal‬‬ ‫‪Test‬‬ ‫‪Result‬‬
‫‪Urine Culture‬‬
‫‪Name Of Bacteria 1-‬‬ ‫‪No growth‬‬
‫ﺑﺎﻗﺮي ﺳﻴﺪﻩ ﺣﻤﻴﺪﻩ‬
‫‪Digitally Signed By :‬‬
‫‪Reported By :‬‬

‫ﺷﺮﻭﻉ ﻛﺎﺭﺁﺯﻣﺎﻳﺸﮕﺎﻩ ﺍﺯﺳﺎﻋﺖ ‪6‬ﺻﺒﺢ ﻣﻴﺒﺎﺷﺪ‪.‬ﭘﻨﺠﺸﻨﺒﻪ ﺻﺒﺢ ﺁﺯﻣﺎﻳﺸﮕﺎﻩ ﻓﻌﺎﻝ ﺍﺳﺖ‬