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MCN Form 006

Lyceum of the Philippines University


College of Nursing

Name Age
Diagnosis Hospital No.
Ward/RM

LABORATORY EXAMINATION
Date
HEMATOLOGY

Laboratory Exam Normal Values Result Significance

Complete Blood Count

WBC

RBC

Hgb

Hct

MCV

MCH

MCHC

Platelet Count

Neutrophil

Lymphocyte

Eosinophil

Monocyte

Basophils
MCN Form 006

Lyceum of the Philippines University


College of Nursing

Name Age
Diagnosis Hospital No.
Ward/RM
LABORATORY EXAMS
Date
Urinalysis and Fecalysis
Laboratory Exam Normal Values Result Significance
Urinalysis

Date
Laboratory Exam Normal Values Result Significance
Fecalysis
MCN Form 006

Lyceum of the Philippines University


College of Nursing

Name Age
Diagnosis Hospital No.
Ward/RM

LABORATORY EXAMS
Date
HEMATOLOGY
Laboratory Exam Normal Values Result Significance
Blood Chemistry

BUN

Creatinine

SGPT/SGOT

Others:

Date
Laboratory Exam Normal Values Result Significance
Serum Electrolytes
Sodium
Potassium
Calcium
Others:

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