Patient Name Here (Last 4)





Most Recent CBC

Test Result Unit Ref. Range Specimen Date
Hematocrit
Hemoglobin
RBCs
RDW
MCV
MCHC
MCH
Nucleated RBCs
WBCs
Neutrophils
Neutrophils
Lymphocytes
Lymphocytes
Monocytes
Eosinophils
Basophils
Immature granulocytes
Platelets
Mean platelet volume
Immature Platelet Fraction
Reticulocytes
Reticulocytes
Immature reticulocytes
Reticulocyte hemoglobin

Ancillary Labs

Test Result Unit Ref. Range Specimen Date
Transferrin
TIBC
Iron
Transferrin Saturation
Ferritin
B12
Folate
Homocysteine
Methylmelonic acid
Haptoglobin
Bilirubin, total
Bilirubin, indirect
LDH
Urine blood
Hemoglobin electrophoresis
AST
ALT
Creatinine
TSH
Free T4

Selected Medications

Medication Drug name Issued Status
Iron
Smear Findings
RBC Findings:

WBC Findings:

Plt. Findings:
Clinical Phrases

Interpretation