Urinalysis
Date sample taken
date
Time sample taken
time
Laboratory Name
text
Address
For GSK use only
Result of dipstick
Urinalysis (Dipstick) Test
Specific gravity
Micro
pH
Glucose
Protein
Blood
Ketones
NOTE: Sedimentary microscpy should only be performed if any of the dipstick results are abnormal.
boolean
WBC
RBC
Hyaline casts
Granular casts
Cellular casts
Randomisation Number
Record randomisation number
integer
Regimen
Record below the treatment assignment for the subject participating in Part 1 of the study Mark one
Record below the treatment assignment for the subject participating in Part 2 of the study