Laboratory Request Form Date *Patient *Age *Sex *Please select an optionMaleFemaleAddress *LABORATORY REQUESTS *CBCURINALYSISSTOOL EXAMBLOOD CHEMISTRY *FBSSerum NaSGBTBUNSerum KSGOTCreatinineSerum CILDHUric AcidSerum CaAlk phosTotal CholesterolSerum MgTriglyceridesCTBTAlbuminHDLLDLPTPAGlobulinX-RAY / ULTRASOUND / CT SCAN EXAMINATIONChest X-rayUltrasoundCT ScanOthersDR. YOHANN KAE S. PANIS-LUZANO, MD, FPDSLIC. NO.PTR. NO.S2 NO.SUBMIT