1. S&wMEDICAL CENTRE
7 Gully Road, St Ann’s Bay, St. Ann
Tel: (876) 9728709, (876) 5773720, Fax: 5773720
Routine Bacteriology Lab No………
Name: ………………………………………………………………………………………………..
Doctor……………………… Signature………………... Address………………………………….
Clinical History………………………………………………………………………………………
Diagnosis……………………………………….. …………………………………………………...
Type of Specimen……………………………………… Date Collected…………………………..
Test Required………………………………………… …Antibiotic R …………………………….
Note: Above Information is essential to avoid Specimen rejection and for proper Interpretation of Results.
Chemical Analysis. Microscopy
Apperannce /colour…………………………………… Pus Cells……… RBC……… Epith.Cell……….
Spec. Grav…………… Reaction…………………….. Crystals……………………………………………...
Albumin………….. Sugar………….. Leuk…………. Cast…………………………………………………..
Others………………………………………………….. Abnormal Deposits…………………………………
Bact………………………… Mucus……………….
Others………………………………………………..
Date Specimen Received…………………………………… Date Reported ……………………..
Comments…………………………………………………………………………………………..
Technologist………………………………………………….Microbiologist……………………..
None ± 1+ 2+ 3+ 4+
Red Blood Cells Penicillin
White Blood Cells Ampicillin
Pus Cells Oxacillin
Epithelial Cells Erythromycin
Fungal Elements Clindamycin
Yeasts Gentamicin
Gram Positive Cocci Augmentin
Gram Negative Cocci Vacomycin
Gram Neg Diplo Cocci Cefuoxime
Gram Positive Bacilli Bactrim
Gram Negative Bacilli Cefotaxime
Acid Fast Bacilli Ceftriaxone
Vincent Organisms Ceftazidime
Organisms Isolated
1
Amikacin
Ciprofloxacin
2 Ofloxacin
3 Norfloxacin
4 Pip+Tazobactam
5 Cephalothin