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To enter more than one report use the same form.

Enter Kidney Profile Report Information * Indicates compulsary fields.

Date Of Checkup*

Normal Range
(Min. - Max.)

Total Serum Protiens

gms.%

Albumin

gms.%

Globulin

gms.%

A/G Ratio

S. Uric acid

mg.%

S.Creatinine

mg.%

Blood Urea

mg/dl

Blood Urea Nitrogen

mg/dl

S.Calcium

mg.%

S.Phosphorus

mg.%

Sodium

mEq/lt

Potassium

mEq/lt

Chlorides

mEq/lt

Any Other information

Warning: Please find and enter all the fields accurately from your report (Hard Copy)


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