Administrative Data
patient's initials
text
patient number
integer
Number of Visit
number of visit
HEMATOLOGY
If not "Not Done", record the date of sample taking below.
If not "Not Done" above, fulfill this item.
date
Hemoglobin
result
unit
If result is clincally significant, enter a tickmark here. Otherwise leave this field empty.
PCV
RBC
MCH
MCHC
Platelets
WBC
DIFFERENTIAL: Neutrophils (segs)
DIFFERENTIAL: Neutrophils (bands)
DIFFERENTIAL: Lymphocytes
DIFFERENTIAL: Monocytes
DIFFERENTIAL: Eosinophils
DIFFERENTIAL: Basophils
Other