eConsultation Reports

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Lab Orders for Standard Tests
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- How it works

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- Blood Test Report
e-Consultation Reports How it works

Check Test Results
- Single Test Score

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Doctors Annual Screening Report
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Date	Remarks	Status	Provider Name	Type	Report

1

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Report	Date	View	Download

1

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Questions / Comments

NOTE : Inquiries should be related to lab test results only. Doctors are not liable or responsible for any additional patient inquiries that are not relevant to their lab results.

Recommended Plan/Treatment:

Health Problem

Start Date

Height*
feet inches

Weight*
lbs

Smoking
Yes No

Daily Alcohol
Yes No

Drugs
Yes No

Allergies
Yes No

If Yes, Add Allergies:

Allergy to Medications
Yes No

If Yes, Add Allergy to Medications:

Diabetes/Sugar
Yes No

Thyroid
Yes No

Hypertension/BP
Yes No

Other Health Condition/Disease:
Yes No

If Yes, Add Health Condition/Disease:

Current Medications:
Yes No

If Yes, Add Current Medications:

Current Symptoms:

Fever:
Yes No

If Yes, Temperature:

Duration:
days

Chills:
Yes No

Vomiting:
Yes No

Diarrhea:
Yes No

Dizziness:
Yes No

Weakness:
Yes No

Runny Nose:
Yes No

Itchy eyes:
Yes No

Stuffy Nose:
Yes No

Cough:
Yes No

Stomach Pain:
Yes No

Left Right

Severity (1 to 10, 10 is high):

Number of Days:
days

Chest Pain:
Yes No

Left Right

Severity (1 to 10, 10 is high):

Number of Days:
days

Head Ache:
Yes No

If Yes, Severity (1 to 10, 1 is low, 10 is high):

Number of Days:
days

Throat Pain:
Yes No

If Yes, Severity (1 to 10, 1 is low, 10 is high):

Number of Days:
days

Body Pain:
Yes No

If Yes, Severity (1 to 10, 1 is low, 10 is high):

Number of Days:
days

Joints Pain:
Yes No

If Yes, Severity (1 to 10, 1 is low, 10 is high):

Number of Days:
days

Test Name	Units	Results	Remarks

1

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