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 _______________