Urinalysis Result Form Combur 5
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Urinalysis Report Form (For Combur 5) Patient Name: Gender: M / F Date of Birth/ Age: Collection Date: Physician Name: Test Date: Tester Name: Physical Examination Color: Colourless Yellow Amber Other Appearance: Clear Hazy Cloudy Turbid Chemical Examination (circle one) glucose (mg/dL) normal 50 100 300 500 1000 leukocytes neg trace + ++ +++ nitrite neg pos (any pink colour is considered positive) protein (mg/dL) neg trace + / 30 ++ / 100 +++ / 500 blood (ery/ µl) neg trace + ++ +++ ++++ haemoglobin (ery/ µl) + ++ +++ ++++ Comments:
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Transcript of Urinalysis Result Form Combur 5
Urinalysis Report Form(For Combur 5)
Patient Name: Gender: M / F
Date of Birth/ Age: Collection Date:
Physician Name: Test Date:
Tester Name:
Physical Examination
Color: Colourless Yellow Amber Other
Appearance: Clear Hazy Cloudy Turbid
Chemical Examination (circle one)
glucose (mg/dL) normal 50 100 300 500 1000
leukocytes neg trace + ++ +++
nitrite neg pos (any pink colour is considered positive)
protein (mg/dL) neg trace + / 30 ++ / 100 +++ / 500
blood (ery/ µl) neg trace + ++ +++ ++++
haemoglobin (ery/ µl) + ++ +++ ++++
Comments:
Urinalysis Report Form(For Combur 5)
Patient Name: Gender: M / F
Date of Birth/ Age: Collection Date:
Physician Name: Test Date:
Tester Name:
Physical Examination
Color: Colourless Yellow Amber Other
Appearance: Clear Hazy Cloudy Turbid
Chemical Examination (circle one)
glucose (mg/dL) normal 50 100 300 500 1000
leukocytes neg trace + ++ +++
nitrite neg pos (any pink colour is considered positive)
protein (mg/dL) neg trace + / 30 ++ / 100 +++ / 500
blood (ery/ µl) neg trace + ++ +++ ++++
haemoglobin (ery/ µl) + ++ +++ ++++
Comments:
