PAP SMEAR TEST
Name: CONSOLACION CONCEPCION Sex: _F_ Age: _19_ STATUS: _Single_ SLIDE NO. __26__
ADDRESS: ____LA PAZ, ZAMBOANGA CITY___ Hospital: ___________ZC MC____________
REQUESTING PHYSICIAN: ____________________________________ SPECIMEN: ______________
SPECIMEN BROUGHT BY: _____CONSOLACION CONCEPCION_______________________________
DATE EXAMINED: _____August 1, 2015______ DATE OF COLLECTION: _____August 1, 2015___
PLACE OF INCIDENT: ________________________ TIME OF COLLECTION: _____________________
NATURE OF INCIDENT: ______________________ DATE OF INCIDENT: _______________________
RESULT
FINDINGS:
Screening and confirmatory examination conducted on specimen A gave POSITIVE result to the test for presence of Semen.
CONCLUSION:
Specimen A contains Semen.
DATE REPORTED: ____August 1, 2015________ NOTED BY:
_____RICHARD N. TABUNIAR_______ MARIO P. ANGELO, MD
Cytotechnologist Medical Specialist IV
Date released: _______________
O.R. number _______________