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Republic of the Philippines

Department of Health
DR. JOSE RIZAL MEMORIAL HOSPITAL
Dapitan City

URINALYSIS

NAME: AGE: SEX: C.S.


WARD: BED NO. HOSPITAL NO.:

COLOR CHARACTER REACTION PPD_______________


ALBUMIN WBC/Hpf CREATININE
SUGAR RBC/Hpf LBS TEST
ACETONE EPITH-CELLS ADDIS COUNT
DIACETIC ACID CAST/LPF: SUGAR
BILE COARSELY GRANULAR CULTURE
HYALINE FINELY GRANULAR MISCELLANEOUS
MIXED RBC CA OXALATES CRYSTAL
BACTERIA WAXY URIC ACID CRYSTAL
AMORPHOUS WBC TRIPLE PHOSPHATE CRYSTAL
YEAST CELLS MUCUS THREADS

URO BILINOGEN: QUALITATIVE PREGNANCY TEST


BILIRUBIN QUANTITATIVE
KETONES OCCULT BLOOD
NITRITE

R.M.T
MEDICAL TECHNOLOGIST
DATE:__________________________

Republic of the Philippines


Department of Health
DR. JOSE RIZAL MEMORIAL HOSPITAL
Dapitan City

URINALYSIS

NAME: AGE: SEX: C.S.


WARD: BED NO. HOSPITAL NO.:

COLOR CHARACTER REACTION PPD_______________


ALBUMIN WBC/Hpf CREATININE
SUGAR RBC/Hpf LBS TEST
ACETONE EPITH-CELLS ADDIS COUNT
DIACETIC ACID CAST/LPF: SUGAR
BILE COARSELY GRANULAR CULTURE
HYALINE FINELY GRANULAR MISCELLANEOUS
MIXED RBC CA OXALATES CRYSTAL
BACTERIA WAXY URIC ACID CRYSTAL
AMORPHOUS WBC TRIPLE PHOSPHATE CRYSTAL
YEAST CELLS MUCUS THREADS

URO BILINOGEN: QUALITATIVE PREGNANCY TEST


BILIRUBIN QUANTITATIVE
KETONES OCCULT BLOOD
NITRITE

R.M.T
MEDICAL TECHNOLOGIST
DATE:__________________________
C.S.

SP. GR.

C.S.

SP. GR.