| Patient No | : | [PatientNo] | Invoice No. | : | [InvoiceNo] |
| Name | : | [Name] | Invoice Date | : | [InvoiceDate] |
| Gender/ Age | : | [GenderAge] | Sample Date | : | [SampleDate] |
| Referred By | : | [RefBy] | Result Ready | : | [ResultReady] |
| [IP #] | [:] | [IpNo] | [Bed #] | [:] | [BedNo] |
| Dept./Unit | : | [Dept] | Result Verified | : | [ResultVerified] |
| Test | : [TestName] |
| Investigation | : [InvestigationName] |
| Specimen | : [SpecimenName] |
| Smear/Deposit | : [GramStain] |
|
Organisms Isolated :
[Organisms] |
Growth :
[Growth] |
| Antibiotic | Organism | Min.Zone | |||
| 1 | 2 | 3 | 4 | ||

|
[PrintedTime] PRINTED TIME |
[PrintedBy] PRINTED BY |
[PreparedBy] PREPARED BY |
[AuthorizedBy] AUTHORIZED BY |
[LabTechnician] LAB TECHNICIAN |