EMEGENDX

Precision Diagnostics · Precise Insights, Treasured Help

Laboratory / Imaging Request Adabraka – Owegon Ave, GA-102-4130 · +233 24 101 7079
Nima – Okutu Street, GV-025-2083 · +233 24 101 6132
[email protected]

Laboratory & Imaging Request Form

Complete all patient information, select required tests, and submit.

Patient Information REQUIRED
Patient Name
Phone
Age / DOB
Facility
Address
Sex
Clinician
ID / File No.
Diagnosis
Specimen

Haematology

EDTA (Purple) ESR (Black/Westergren) Citrate (Blue) — Coag

Clinical Chemistry

SST / Gold (Serum) Plain Red (Serum) Heparin (Green) — Plasma EDTA (Purple) — HbA1c

Microbiology & Parasitology

Blood Culture bottle Swab / Sterile container Urine cup

Serology / Molecular

SST / Gold Plain Red EDTA — viral loads

Ultrasound / Imaging