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Pat. ________________ # ________________
ABG (Arterial Blood Gas)
Result
DOB______________
Normal
pH
7.34-7.44
pCO2
35-45 mmHg
pO2
75-100 mmHg
HCO3
22-26 mmol/L
O2 Sat.
95%-100%
SEX:
Comments
Blood Alcohol
Result
Normal
Comments
0.00 (grams/100ml)
BNP (brain natriuretic peptide)
Result
Normal
Comments
< 100 pg/mL
Cardiac Enzymes
Result
Normal
CPK
26-140 U/L
CK-MB
< 3% of total
Troponin I
0.00-0.04 ng/ml
CBC (Complete Blood Count)
Comments
M
F
Pat. ________________ # ________________
DOB______________
Result
Normal
WBC
/mm3
4,000 - 10,000 / mm3
RBC
/microliter
4.6-6.2/microliter
HGB
g/dL
13-16 g/dL
HCT
%
40-50%
MCV
fl
80-100 fl
MCH
pg
28-32 pg
MCHC
g/dl
32-36 g/dL
RDW
%
11 - 14%
Platelets
/mm3
140,000-150,000/mm3
SEX:
Comments
Differential WBC (White Blood Cells)
Neutrophils
%
40 - 60%
Lymphocytes
%
20 - 40%
Monocytes
%
2 - 8%
Eosinophils
%
1 - 4%
Basophils
%
0.5% - 1%
Band forms
%
0 - 10%
CMP (Comprehensive Metabolic Panel)
Result
Normal
Comments
M
F
Pat. ________________ # ________________
DOB______________
Sodium
135-145 mmol/L
Potassium
3.5-4.5 mmol/L
Chloride
98 - 106 mmol/L
CO2
22-29 mmol/L
BUN
7 - 18 mg/dL
Cr
0.6-1.2 mg/dL
Glucose
20-115 mg/dL
Calcium
8.4-10.2 mg/dL
Magnesium
1.3-2.1 mmol/L
Alk Phos
38-126 U/L
Albumin
3.5-5.5 g / dL
Total Protein
6 - 8 g/dL
AST
5 - 30 U/L
ALT
5 - 35 U/L
Bilirubin
< 1.0 mg/dL
SEX:
Coagulation Profile
Result
Normal
PT
11-15 s
aPTT
20-35 s
INR
1
Comments
D-Dimer
Result
D-Dimer
Normal
Comments
< 200 micrograms/L
Serum Osmolality
Result
Serum Osmolality
Normal
285-295 mOsmol/Kg
Comments
M
F
Pat. ________________ # ________________
DOB______________
SEX:
Serum Toxicology
Result
Normal
Acetaminophen
10-20 mg / dL
Salicylates
2-29 mg / dL
Comments
Troponin
Result
Troponin
Normal
Comments
0.00-0.04 ng/L
Thyroid Stimulating Hormone
Result
TSH
Normal
Comments
0.3-3.7 uIU/ml
UA (Urinalysis)
Result
pH
Normal
5-9
Comments
M
F
Pat. ________________ # ________________
DOB______________
Specific Gravity
1.010 - 1.060
Color
Light yellow / colorless
Turbidity
Clear
Protein
NEG
Glucose
NEG
Ketones
NEG
Bili
NEG
Blood
NEG
Leukocyte Esterase
NEG
Nitrite
NEG
WBC
No Cells
RBC
No Cells
SEX:
Crystals
Urine Osmolality
Result
Normal
Urine Osmolality
277-295 mOsmol/Kg
Urine Toxicology
Circle Result
Amphetamines
-
+
Benzodiazepines
-
+
Cannabinoids
-
+
Opiates
-
+
Tricyclic AD
-
+
Barbiturates
-
+
Cocaine
-
+
Comments
M
F
Pat. ________________ # ________________
DOB______________
SEX:
M
F
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