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Laboratory Flow Sheet Form |
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Manual: Home Infusion Therapy Policy and Procedure Manual (Ver 4)
As the health care industry’s most comprehensive library of customizable policy and procedure templates, MCN Healthcare’s Home Infusion Therapy Policy and Procedure Manual includes this customizable template, Laboratory Flow Sheet Form. MCN’s policy library helps you meet compliance with Joint Commission and federal regulations including CMS, CDC, OSHA, OIG, HIPAA and more. MCN’s templates save you time, money and resources, rather than developing healthcare policy and procedure manuals from scratch. Here is some sample content from Laboratory Flow Sheet Form:
| | LABORATORY FLOW SHEET
Client Name:
DATES:
HEMATOLOGY TEST
WBC Count thous per mm3 3.8-10.1
RBC Count mil per mm3 3.9-5.2
Hemoglobin g per dl 12.0-15.6
Hematocrit % 35-46
MCV U3 80-100
MCH UUG 27-33
MCHC % 35-46
Platelet Count thous per mm3 130-400
RDW
DIFFERENTIAL
Segmented Neutroph % 40-75
Lymphocyte % 18-47
Monocyte % 0-10
Eosinophil % 0-6
Basophil % 0-2
CHEMISTRY
Sodium 135-145
Potassium 3.3-5.1
CO2 HCO3 22-32
Chloride 95-109
Calcium 8.5-10.5
Phosphorus 2.4-4.6
Glucose 70-105
BUN 8-25
Creatinine 0.6-1.4
Uric Acid M: 1-9; F: 2-8
LDH 90-200
SGPT ALT
Alkaline Phosphatase 30-130
Bilirubin... |
| Second excerpt: |
| | ...M: 1-9; F: 2-8
LDH 90-200
SGPT ALT
Alkaline Phosphatase 30-130
Bilirubin Total 0.1-1.3
Protein Total 6.0-8.0
Albumin 3.8-5.4
Cholesterol
Triglycerides
Iron Total
Bilirubin Direct 0.0-0.4
Magnesium 1.6-2.4
Globulins 1.5-3.8
PROTHROMBIN
Control sec.
Client sec.
Ratio
MD Notified
Results Reviewed By
??
??
??
??
1
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