| Question | Response |
|---|---|
| Date Collected | |
| Time Collected | |
| Was Sample Collected in a Fasting State? | Yes No |
| Potassium | |
| Sodium | |
| Chloride | |
| Bicarbonate | |
| Total Protein | |
| Albumin | |
| Calcium | |
| Magnesium | |
| Phosphorus | |
| Urea Nitrogen | |
| Urea | |
| Creatinine | |
| Total Bilirubin | |
| Direct Bilirubin | |
| Lipase | |
| Amylase | |
| LDH | |
| AST | |
| ALT | |
| Cholesterol | |
| HDL | |
| LDL | |
| Triglyceride | |
| GGT | |
| Derived Parameters: | |
| Glomerular Filtration Rate | |
| Estimated Creatinine Clearance | |
| Calcium Corrected | |
| Cholesterol/HDL-Cholesterol? |