| Question | Response |
|---|---|
| Date Collected | |
| Time Collected | |
| Was Sample Collected in a Fasting State? | Yes No |
| Specific Gravity | |
| pH | |
| Calcium Urine | |
| Creatinine Urine | |
| Calcium Urine (24 hr) | |
| Creatinine Urine (24 hr) | |
| Derived parameters: | |
| Urine Calcium Creatinine Ratio | |
| Urine Calcium Creatinine Ratio (24 hr) | |
| Blood | 0 1+ 2+ 3+ 4+ Trace |
| Protein | 0 1+ 2+ 3+ 4+ Trace |
| Glucose | 0 1+ 2+ 3+ 4+ Trace |
| Bilirubin | 0 1+ 2+ 3+ 4+ Trace |
| WBC Urine | 0-4 5-50 >50 |
| RBC Urine | 0-4 5-50 >50 |
| Epithelial Cells Urine | 0-4 5-50 >50 |
| Bacteria Urine | 0-4 5-50 >50 |
| Casts Urine | 0-4 5-50 >50 |
| Crystals Urine | 0-4 5-50 >50 |