Lab No.
Date:
Patient Name:
Sex:
REF. BY DR.:
AGE:
SAMPLE COLL. AT:
SEAMEN ANALYSIS
TESTS RESULTS RANGE
Time Of Collection:
Specimen Produced at:
Period Of Abstenance:
Reaction PH:
PHYSICAL EXAMINATION
Color:
Volume:
Consistancy:
Time Of Liquification:
MICROSCOPIC EXAMINATION
TotalSperm Count:
Abnormal Form:
Pus Cells:
Epithelial Cells:
RBC:
Other:
Active Motile:
Sluggish Motile:
Non Motile:
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