EFTA00298596.pdf

Nacre AdrPess IITCHLLL KLIHE, 703 PARK AVE Rtli ?UR RI 10321 General Test Requisitioi 10101,25 ( Quest • Dii4JIICS:‹ Atiesdeinecemincoporse OreltricolP‘renty Teteturo,ELIEACe hwappoismitAi M M EirlitEritaC04Wappairt-mal te call IPS2Ti 4772 Telephone 212-517-6555 A4110wI1Numbe T92816- 8 1062 Patient1Hk - rust Ham) S ; RE- CsOER 1722002 I I ,t1 I I..... • • - I i I Timed UM. Cacti; Crest PISMO .. i l ' A !tie AP- 1-1 A t'l 6 , . 1 I Ono Collected Um Wetted O Am '• C] PM samara O Non fasting 0 VMume /mime/ Inwood s Andrea APE, Accession Numbs of of mechm Rows TtlY 'Stye 'Op Remote me Prim on Report: 'Mal e 'Gated Birth Monet, Day.Yead Please Bill To: J3 Paint e - iiiiiii% C] insinenCe ea. : O UNCertIlSelect --- EJ 'Frei Mt. 1 Inly-1 si. I I I I 1 f Mani i Nawfill OfferoMfflunPMkM4 Palen Rcilmondue to lowed Telephone WON 0 5 Pawl/ Mart L0 0 See O Spouse O OePeodem ( ) I I I ! J IM Poky limmeer Meals P asE or Suffixl Croups IOnNainellysician WOrmabila Ia. ' 114,,;i O4 --3.7- 414002Th -4 1-1-144807 1432136231 KURE MITCHELL ridiwyknume, Name end r; cep Nano BROWN Kam 1 ) 212374 1.20S9S2S15 -....h.:_ .maninittsx ( ) 1497049548 "Mrinlift" ( ) ( ) Oakes Submission MMus ( ) `Rem Memoriam Indlim or Najtimftkriu_I;;IMILLI$Ipilic ri week Cl White 'D 19,011195id 0709L---Sa ", ‘Un9"--- CIFAX ( ) _0 DUPIJICATE L Physican's Name and Address of Clued OtaignOMIce Am 0 I oNsicieWs Somme REPORT TO r ICD Diagnosis Codex ' II►0. (Enter All That Apply)6. - , L -1 ( ) 7, 1 s . . . . ." 1 I644'T NSV 1/ 2 1AS HERPESUCCT 1 /10643X SESP ALLERGY PROF REG I t 157S1E CULTURE,FURWSREAR,H,S,R t 11;271 LYME DISCASE,CIR HMI 118 E 117669X RHEMATOI0 ARTHRITIS HAG L 173028 THYROID A (W/8,7PM 14725 Cd/HC8/C8 1P4418 C4/C3/CBM .CHEHT CH50 1 7104928 AKA/SR.' IriESIUT-ARGAFURIC 0CIetnrontr RET/Sh, •am Plum 0304480 ProfilefelfTemleiles se slueselim he hes ussamses Theserseemesmeets MIPROMECOMPONUITIMY WORMED SIMMIELY MICROBIOLOGY / VIROLOGY Reim bison pertained et an adeitiosal dame. 141A • CIEC-PettleXPAIICReCli L 26013E O Magnesium S 660x LDMiceamiberim A RaW miler) U 396658 0 Pfiennoin (Nitwit(' SR 27171E O PhomINNus S 2622E O Potassium S 2814E 0 RENEsIA Total $ 28671E O PSA, Tote! $ 26F OPT (Prothromnin Ter 9) B 71711E O aPTI B 11577580 Rheumatoid Factor S 1156E O APR wrnellex to Tilt .410 F1A-Ab S 11483 O RPR *Males to It • S 29512E O Sodium S 706368 O 73, Total SR 30582E 013. Uptake S 3024N/024, Roe S 304918 O Triglycarides S 43562A O ISH *Reflex to Fre• T4 S 3019E O TSH $ MF O UA Complete (Mum 6 Mt, V WA O LIA, Microscopic U 86702A IDUA. IN/Reflex to Mi:roscopie U 309401 OUMe Nitirogim (BUN, S ASK Olkic Acid S 51031E [3Varicella Zoger k6 S 21709Wfl Vitamin 8•12 SR 9301A C] CU w mlMeued Swot W 0 Molten site ersourarno S. Ma C)Bwees Oita HS4Pimid ale! O Horses Culture. 115V.RIRI WTY0419 3251A CI 1.1,ct4ceila 022aSoutin Sas AM last Seam I 1740( [306 F +Riede Ag. SrA ' . • nen 1:10sRsts • MIX O CUM; 2102144:0600444trulochboal • 112111010 Sem Grow Allem PIM i • PANIEL/PROFILE OFFERINGS 92A ea RA Ifit RISCMCPL Om L 20396R Ca SR 20750E O Worlds S 20533E • CholesterolJotel S 715F OFNerolyte Pent/ BX 12296E O Hepatic Function Pane/ s inn, DUE Motabolic Panel Wean BX 19885R O G-Reedite Protein S 21600E 0 Creatinine edeGFR S 356348 0 Cligoxin SR 51577E El rev. CAPS1D AB, IgG S 51599w0 ESV• SAPS'S Aft IgM S 45377W C3 ESA, Westergren (See beck -) L 27764R O Fer6tin SR 72848W LI FiNale SR 2:2347W O Buctoomino S 7842E 0 GGT S 67777W O 6leCose GY 265E 0 H8sAgrotoirlimation S WI" 0 KG' 'Mimi al SR 11113E C3 NCO, Total, ON SR 24867W O MX. Cholesterol S 45443E O Hem/toe:ft 1 7181W C3 Hemoglobin L 45484R O Hemoglobin AIC L 51813E 0 Hepatitis A thus AB IgM $ 5IBAR O Hepatitis 8 Coe A8 NM S 6477X o Hemais c vivo AB S 2,281E O Hcomeysteine (Cannot 4* 74984R O Iron 0 Iron and TILIC S 751104 O LD (Lamm@ Deldromnasal S 20909W O LDL Cholesterol, Direct S 30463E O lipase S 9076E O Lyme Nom AtigGaigMW0 S iSMY C3 Lwm Oman SonmeditimoNS S 1$731A M Comp. Nlenbolic Pend einCRI BX gin Dupes Penh s 148515( O lipiJ Panel wiRenex DUX s 10706E EINeadts Flaw. viRtAcute SR •IIT OCHEMECREEN* Panel (Basic Pill) ex 551E OCHE/A.80CW Panel 8 HOE BX nn* OCHEMSCREEN. Pang 5 HOUTIESC BX 43476F OCHELI-SCREEN• ex stigunamitip Kr Igoe Ban 7SIA ? l ath Profile 1 BX, i III AMritis Profile III s. L 6531 Olivet Panel II s 5133A °Lymph Subsets Profile III L, GN mutt' OTherold Profile, Resit s ...,. Amplified Swims. T • (please Mack ens) El Endocereical LI Urethral ClUrine B$IX OChlonelneRNIATMs It CIL gonceitneeelGOFWA TMA 11SZI OEMs:nen &IX goonefieme WAWA INDICATE ADDEI I ONAL TESTS HERE OMEN TESTS 17517W O Albumin S 67686R O Alkaline Phosphates, $ 17NNR C3 ALT ISGPD S mmO Amylase, Serum S 249X O ANA IFA SCRveltell Tiler s 6041 O Apalipoprotoin Mai 8 S istfalW O AST (SCOT) S 19187W O Unita Deed S 19152E O Bahrein, Total S 113341E O CA125 s 29773E O CA27.29 sR 20101IN O Calcium s zaraw O Carbon Dioxkle s 101241 O Cards° CRP $ 1062 1062 T72816-8 T92814-8 11762 1062 192016-0 T92814-0 1062 1062 192816-8 T92816-8 - MICS081020BVVItOISSY SOURCE: #Addmoni charge wisficgpssain onsR Daiwa 601.4"c 0..4 SIMV O Wan GenitatCrois , Sep. e moiR O Cullum Urfreitetire . 4. 62842WEI BeLie, Bad Conn yis'ete ... -- -r lett - - . ........ ism. Marton ......It 0 Oa Oti omit lasnensa Ai man am se Pm 2! IIIMMI EFTA00298596