[HeaderStart]
[IPOPDIND]
Patient No : [PatientNo]   [MLC]   [Insured] Invoice No. : [InvoiceNo]
Name : [Name] Invoice Date : [InvoiceDate]
Gender/ Age : [GenderAge] Sample Date : [SampleDate]
Sample # : [SampleNo] Referred By : [RefBy]
Result Ready : [ResultReady] Result Verified [:] [ResultVerified]
[IP #] [:] [IpNo] [Bed #] [:] [BedNo]
Dept./Unit : [Dept] Patient Type : [PatientType]
[PatientSid] [:] [TokenNo] [Ward] [:] [WardName]
[HeaderEnd]
LABORATORY REPORT
[TestGroup]
Essential
Clinical Details:       [EsCliDetails]
Provisional
Diagnosis:      [ProDiagnosis]
Whether on
antibiotics or not;
if so 		[Antibiotics]
Specimen: [Specimen] Date & Time of
Collection: [DateCollection] 		Site:  [Site]
Test:  [Test]
Central Line:  [CentralLine] Nosocomial Infection:  [NosInfection]
Collection Date & Time:  [ColDateTime] Signature Of Medical Officer  [SigMedOfficer]
Organism isolated: Growth/Colony/ml:
1. [Organism1] 1. [Growth1]
2. [Organism2] 2. [Growth2]
3. [Organism3] 3. [Growth3]
4. [Organism4] 4. [Growth4]
ANTIBIOTIC SENSITIVITY

[AntibioticRanges]
Antibiotic Organism Min.Zone Antibiotic Organism Min.Zone
1 2 3 4 1 2 3 4
Sensitivity Code:   S=Sensitive  MS=Moderately Sensitive  R=Resistant
Comments:  [Comments]
End of Report
[PrintedTime]
PRINTED TIME 		[PrintedBy]
PRINTED BY 		[PreparedBy]
PREPARED BY 		[AuthorizedBy]
AUTHORIZED BY 		[LabTechnician]
[LabTechQualification]
[LabTechDesig]
LAB TECHNICIAN