| Question | Response |
|---|---|
| Date Collected | |
| Time Collected | |
| Was Sample Collected in a Fasting State? | Yes No |
| RBC | |
| HGB | |
| HCT | |
| MCV | |
| MCH | |
| MCHC | |
| RDW | |
| Reticulocytes | |
| Platelets | |
| WBC | |
| Total Neutrophils | |
| Segmented Neutrophils | |
| Bands/Stabs | |
| Granulocytes | |
| Eosinophils | |
| Basophils | |
| Lymphocytes | |
| Monocytes | |
| Mid Cell Fraction | |
| Myeloblasts | |
| Promyelocytes | |
| Myelocytes | |
| Metamyelocytes | |
| Atypical Lymphocytes | |
| Blasts | |
| Nucleated RBC | |
| Derived parameters: | |
| Calculated Absolute Neutrophil Count |