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Chart No.--

Clinic No___

NEW YORK POST-GRADUATE ME DI CAL SCUOOL & UOSP1TAL REPOfiTON EXAMINATION OF BLOOD

--------Dr.    ----------------Specimcn takcn

____Room ..JjLŚL___________________Report macic

Clinic

Marne ~~

Erythrocytcs —

Hemoglobin    .....Grams per 100 cc.

Color Indcx___________

per cu. mm

Reticulocyt es-

Platclcts---

Blccding timc__

Coagulation timc Parasites_____

~pcr cu

%

mm:

_____ Age.....(z> -I.......-.....

Lcucocytcs    ____________

Polymorphonuclcar neutrophiles — Polymorphonuclcar eosinophiles ....

Polymorphonuclcar basophiles___

Lymphocytes ~

Monocytcs —

—per cu. mm

-5 7-

........£.

t a

__

Mctamyclocytes Myclocylcs---

.N.......!

E    B

• .................

Morphology of red cclls:

Anisocytosis______

Microcytosis_____________

Macrocytosis_______

Poikilocytosis__________Stippling

Avcragc diameter of red cclls____

REMARKS:

Achromia___

...Polychromasia

Prcmyclocytcs DilTcrcntial count of Normoblasts Megaloblasts Mycloblasts ..

___whitc    cclls

-per 100 whitc cclls ...per 100 whitc cclls ~pcr 100 whitc cclls

micra

Form 0 10M 10—Cl II. S. P.

n Lab. No

^Examincd Juow,

{Jz-alSl- JL