Clinfos Institute of Health, Chennai, India
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Clinical Microbiology Report Form
Name
Age
Year
Month
Day
Hour
Gender
Pt. Gender
Male
Female
Unknown
UHID No.
Specimen
Ward
Select
Burns Ward
Casualty Ward
Children Ward
Dialysis Ward
ENT Ward
Female Ward
Female Ward II
Female Surg I
Female Surg II
Isolation Ward
Male Surg I
Male Surg II
Maternity Ward
Medical ICU
Medicine I
Medicine II
Special Ward
Ortho Ward
OPD
Other
Post Partum Unit
Psychiatry
SNCU
Surgical ICU
Special Ward
TB Ward
Ophthalm Ward
Lab ID
Date of Collection
Diagnosis
1. GRAMS STAIN
POLYMORPHS
Select
N-Numerous
M-Moderate
F-Few
0-Nil
EPITHELIAL CELLS
Select
N-Numerous
M-Moderate
F-Few
0-Nil
MONONUCLEAR CELLS
Select
N-Numerous
M-Moderate
F-Few
0-Nil
RBC
Select
N-Numerous
M-Moderate
F-Few
0-Nil
GRAM POSITIVE COCCI
Select
N-Numerous
M-Moderate
F-Few
0-Nil
GRAM POSITIVE BACILLI
Select
N-Numerous
M-Moderate
F-Few
0-Nil
GRAM NEGATIVE COCCI
Select
N-Numerous
M-Moderate
F-Few
0-Nil
YEAST
Select
N-Numerous
M-Moderate
F-Few
0-Nil
GRAM NEGATIVE BACILLI
Select
N-Numerous
M-Moderate
F-Few
0-Nil
FILAMENTOUS FUNGI
Select
N-Numerous
M-Moderate
F-Few
0-Nil
2. ACID FAST STAINING
3. WET MOUNT
Method/Medium
Select
10% KOH
SALINE
IODINE
INDIA INK
--------------
4. ANTIBIOTIC SENSITIVITY
ORGANISM ISOLATED:
CFU : 1 X
exp
AMPICILLIN
Select
S
R
AMOXY-CLAV
Select
S
R
AMIKACIN
Select
S
R
AMPHOTERICIN-B
Select
S
R
AZITHROMYCIN
Select
S
R
CEFIPIME
Select
S
R
CEFUROXIME
Select
S
R
CEFOTAXIME
Select
S
R
CEFTAZIDIME
Select
S
R
CEFTRIAXONE
Select
S
R
CEFOPERAZONE
Select
S
R
CHLORAMPHENICOL
Select
S
R
CIPROFLOXACIN
Select
S
R
CLINDAMYCIN
Select
S
R
COTRIMOXAZOLE
Select
S
R
CLOTRIMAZOLE
Select
S
R
COLISTIN
Select
S
R
CLARITHROMYCIN
Select
S
R
CEFTAROLINE
Select
S
R
ERYTHROMYCIN
Select
S
R
FLUCONAZOLE
Select
S
R
GENTAMYCIN
Select
S
R
ITRACONAZOLE
Select
S
R
IMIPENEM
Select
S
R
LEVOFLOXACIN
Select
S
R
LINEZOLID
Select
S
R
MEROPENEM
Select
S
R
NORFLOXACIN
Select
S
R
NITROFURANTOIN
Select
S
R
NYSTATIN
Select
S
R
OXACILLIN
Select
S
R
PENICILLIN
Select
S
R
POLYMYXIN B
Select
S
R
TEICOPLANIN
Select
S
R
TETRACYCLINE
Select
S
R
PIPERACILLIN/ TAZOBACTAM
Select
S
R
VANCOMYCIN
Select
S
R
VORICONAZOLE
Select
S
R
5. WIDAL
Dilution
S.Typhi Antigen 'O'
< 1:80
1:160
1:320
1:640
1:1280
> 1:1280
S.Typhi Antigen 'H'
< 1:80
1:160
1:320
1:640
1:1280
> 1:1280
S.Paratyphi A 'H'
< 1:80
1:160
1:320
1:640
1:1280
> 1:1280
S.Paratyphi B 'H'
< 1:80
1:160
1:320
1:640
1:1280
> 1:1280
6. RA FACTOR
7. C REACTIVE PROTEIN
NEGATIVE
POSITIVE
8. ASO
9. REPORT
MicroBio-Report Application developed at Dept. of IT and MRD. For tech support call +91-9840095372