7543473906
w
s&L to“Q NEW Y0RK POST-GRADUATE MEDICAL SC1IOOL & HOSPITAL
REPORT ON EXAMINATION OF BLOOD
Chart No. ---Dr-----.LOjU^i____________________Spccimcn takcn
Room ... Rc|x)rt micie »<•»»>•»»»•»»
Clinic________________
Clinic No.... ...
/ K
Namc Erythrocytcs — Hemoglobin _ Color Indcx ... Rcticulocytcs ..
I
Agc..J
-----Grams per 100 cc.
Platclcts .O..i...£r&fłc cu. mm:
Blccding timc —:________________
Coagulation timc . Parasites-------
Morphology of red cclls:
Anisocytosis___________
Microcytosis _____________
Macrocytosis ________________Polychromasia
Achroniia
Poikilocytosis _________________Slippling_____
Avcragc diameter of red cclls_______
REMARKS:
Form 9 10M 19—41 H. S. P.
per cu. mm
Lcucocytcs ...
Polymorphonuclear neutrophiles . Polymorphonuclcar eosinophiles .
Polymorphonuclear basophiles____
Lymphoc) tes Monocytcs
Mctamyelocytcs .-.-----—--------
Myclocytcs -------------N......./—E..
Prcmyclocytcs----------------
DifTcrenti.il count of-----------
Normoblasts--------
Mcgaloblasts----
Mycloblasts
Scx 1^1 _______per cu. mm
■ • • ■ • •
...B____
............
________wbite cclls
.per 100 wbite cclls .per 100 wbite cclls per 100 wbite cclls
..micra
Examincd By Ju^ur^j
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