M.G.M.

MEDICAL COLLEGE 38
HOSPITAL, JAMSHEDPUR
PHONE : 2432137/38, 2423010
Reg. No.99 % Date9 CLINICAL PATHOLOGY DEPARTMENT)
CI. Path No. ....gns.
... Date..sf Name.O
Address .Age... M/F
BLOOD
aemoglobin URINE
Erythrocyte
Platelets
gm/dl
PHYSICAL EXAM.
Total Count of Milllon/Cumm. Colour.
SP. Gravity
Leucocyte Cells/cumm. Sediments
Differential Count of Cells/curmm. CHEMICAL EXAM. Reacion (PH)..
LeuCOcyte Sugar...
Neutrophils. Phosphate. Albumin
Lymphocyte v...%
Bile Pigment Bile Salts
Eosinophil.. %
AcetCellone.. . EXAM. Urobilinogen
Occult Blood
Monocyte. ...%
MICROSCOPIC
Pus
Basophils. EpiCell /HPF
.JHPF
Casts
Reticulocyte ....
R.B.C.
*****.......HP
Crystals
Others
E.Bleeding
S.R.(WestTime.ergren's) mm/(1* hour) PHYSICAL EXAM. STOOL
Clotting Time
Mints
..Sec.
Consistency
Mucous Blood
Mints Reaction.
M.P./ M.F. ..sec. MICROSCOPIC EXAM.
SicklingTest Protozoa/ Cyst... RBC
Comments on P.B. Smear
Helminths (Ova/Cyst).... Pus Cell
Eryhrccyte Others
Pleuralfluid / Ascitic Fluid/C.s.F. ....

PHYSICAL :
Volume
Colour
Reaction Sp. Gr.
BICCHEMICAL:
Sugar.
Protein
BIOCHEMISTRY Chloride
Blood Sugar (Fasting) CYTOLOGY:
mg/dl Total Count of Cells
Bood Sugar (P.P/Rand) ...0.).. mg/dl
Blood Urea Differential Count.
S. Creatinine mg/dl
mg/dl
Total Bilirubin
mg/di Skin Slit Smear/Scraping
Direct Bilirubin
mg/dl SEMINAL FLUID ANALYSIS
Indirect Bilirubin PHYSICAL:
mg/dl
SGPT (ALT) Volume. .Colour
IUIL
Liquefaction time .Reaction(PH);..
SGOT (AST) IUL Total Count of Spermatozoa .milion/ml
Alk. Phosphatase U/L MOTILITY:
Total Protein gm/di Actively mtile %

Sodium.... m Mol/L Slugguish motile ..%

Non motile
Potassium m Mo/L
MORPHOLOGY :
Chloride m Mo/L

Signature of H.0.D. Clinical Pathology Dept.