| blood_date |
|
text |
Date |
|
| fbc_done |
FBC |
checkbox |
Please tick all tests that have been DONE |
1, Haemoglobin ; 2, WBC Count ; 3, Neutrophil Count ; 4, Lymphocyte Count ; 5, Eosinophils ; 6, Haematocrit ; 7, Platelets |
| haemo_less_greater |
|
dropdown |
Haemoglobin - Select if test result provided is not an exact value |
1, < (Less than) ; 2, > (Greater than) |
| haemo_result |
|
text |
Haemoglobin - Result (g/L) |
|
| haemo_other_unit |
|
text |
Haemoglobin - If using a different unit other than g/L |
|
| wbc_less_greater |
|
dropdown |
WBC Count - Select if test result provided is not an exact value |
1, < (Less than) ; 2, > (Greater than) |
| wbc_result |
|
text |
WBC count - Result (10^9/L) |
|
| wbc_other_unit |
|
text |
WBC count - If using a different unit other than 10^9/L |
|
| neutro_less_greater |
|
dropdown |
Neutrophil Count - Select if test result provided is not an exact value |
1, < (Less than) ; 2, > (Greater than) |
| neut_result |
|
text |
Neutrophil count - Result (10^9/L) |
|
| neut_other_unit |
|
text |
Neutrophil count - If using a different unit other than 10^9/L |
|
| lympho_less_greater |
|
dropdown |
Lymphocyte Count - Select if test result provided is not an exact value |
1, < (Less than) ; 2, > (Greater than) |
| lymp_result |
|
text |
Lymphocyte count - Result (10^9/L) |
|
| lymp_other_unit |
|
text |
Lymphocyte count - If using a different unit other than 10^9/L |
|
| eos_less_greater |
|
dropdown |
Eosinophils - Select if test result provided is not an exact value |
1, < (Less than) ; 2, > (Greater than) |
| eos_result |
|
text |
Eosinophils - Result (10^9/L) |
|
| eos_other_unit |
|
text |
Eosinophils - If using a different unit other than 10^9/L |
|
| haema_less_greater |
|
dropdown |
Haematocrit - Select if test result provided is not an exact value |
1, < (Less than) ; 2, > (Greater than) |
| haema_result |
|
text |
Haematocrit - Result (%) |
|
| haema_other_unit |
|
text |
Haematocrit - If using a different unit other than % |
|
| plat_less_greater |
|
dropdown |
Platelets - Select if test result provided is not an exact value |
1, < (Less than) ; 2, > (Greater than) |
| plat_result |
|
text |
Platelets - Result (10^9/L) |
|
| plat_other_unit |
|
text |
Platelets - If using a different unit other than 10^9/L |
|
| ues_done |
U&Es |
checkbox |
Please tick all tests that have been DONE |
1, Urea ; 2, Creatinine ; 3, Sodium ; 4, Potassium ; 5, eGFR |
| urea_less_greater |
|
dropdown |
Urea - Select if test result provided is not an exact value |
1, < (Less than) ; 2, > (Greater than) |
| urea_result |
|
text |
Urea - Result (mmol/L) |
|
| urea_other_unit |
|
text |
Urea - If using a different unit other than mmol/L |
|
| crea_less_greater |
|
dropdown |
Creatinine - Select if test result provided is not an exact value |
1, < (Less than) ; 2, > (Greater than) |
| crea_result |
|
text |
Creatinine - Result (μmol/L) |
|
| crea_other_unit |
|
text |
Creatinine - If using a different unit other than μmol/L |
|
| na_less_greater |
|
dropdown |
Sodium - Select if test result provided is not an exact value |
1, < (Less than) ; 2, > (Greater than) |
| na_result |
|
text |
Sodium - Result (mmol/L) |
|
| na_other_unit |
|
text |
Sodium - If using a different unit other than mmol/L |
|
| k_less_greater |
|
dropdown |
Potassium - Select if test result provided is not an exact value |
1, < (Less than) ; 2, > (Greater than) |
| k_result |
|
text |
Potassium - Result (mmol/L) |
|
| k_other_unit |
|
text |
Potassium - If using a different unit other than mmol/L |
|
| egfr_less_greater |
|
dropdown |
eGFR - Select if test result provided is not an exact value |
1, < (Less than) ; 2, > (Greater than) |
| egfr_result |
|
text |
eGFR - Result (ml/min/1.73m^2) |
|
| egfr_other_unit |
|
text |
eGFR - If using a different unit other than ml/min/1.73m^2 |
|
| lft_done |
LFTs |
checkbox |
Please tick all tests that have been DONE |
1, Total bilirubin ; 2, ALT (alanine transaminase) ; 3, ALP (alkaline phosphatase) ; 4, GGT (gamma-GT) ; 5, Albumin ; 6, Total protein |
| bili_less_greater |
|
dropdown |
Total Bilirubin - Select if test result provided is not an exact value |
1, < (Less than) ; 2, > (Greater than) |
| bili_result |
|
text |
Total bilirubin - Result (μmol/L) |
|
| bili_other_unit |
|
text |
Total bilirubin - If using a different unit other than μmol/L |
|
| alt_less_greater |
|
dropdown |
ALT (alanine transaminase) - Select if test result provided is not an exact value |
1, < (Less than) ; 2, > (Greater than) |
| alt_result |
|
text |
ALT (alanine transaminase) - Result (U/L) |
|
| alt_other_unit |
|
text |
ALT (alanine transaminase) - If using a different unit other than U/L |
|
| alp_less_greater |
|
dropdown |
ALP (alanine phosphatase) - Select if test result provided is not an exact value |
1, < (Less than) ; 2, > (Greater than) |
| alp_result |
|
text |
ALP (alanine phosphatase) - Result (U/L) |
|
| alp_other_unit |
|
text |
ALP (alanine phosphatase) - If using a different unit other than U/L |
|
| ggt_less_greater |
|
dropdown |
GGT (gamma-GT) - Select if test result provided is not an exact value |
1, < (Less than) ; 2, > (Greater than) |
| ggt_result |
|
text |
GGT (gamma-GT) - Result (U/L) |
|
| ggt_other_unit |
|
text |
GGT (gamma-GT) - If using a different unit other than U/L |
|
| alb_less_greater |
|
dropdown |
Albumin - Select if test result provided is not an exact value |
1, < (Less than) ; 2, > (Greater than) |
| alb_result |
|
text |
Albumin (g/L) |
|
| alb_other_unit |
|
text |
Albumin - If using a different unit other than g/L |
|
| prot_less_greater |
|
dropdown |
Total protein - Select if test result provided is not an exact value |
1, < (Less than) ; 2, > (Greater than) |
| prot_result |
|
text |
Total protein (g/L) |
|
| prot_other_unit |
|
text |
Total protein - If using a different unit other than g/L |
|
| crp_done |
CRP |
checkbox |
Please tick all tests that have been DONE |
1, CRP |
| crp_less_greater |
|
dropdown |
CRP - Select if test result provided is not an exact value |
1, < (Less than) ; 2, > (Greater than) |
| crp_result |
|
text |
CRP - Result (mg/L) |
|
| crp_other_unit |
|
text |
CRP - If using a different unit other than mg/L |
|
| bp_done |
Bone Profile |
checkbox |
Please tick all tests that have been DONE |
1, Adjusted calcium ; 2, Phosphate ; 3, Magnesium ; 4, 25-Hydroxyvitamin D (25-OH) |
| cal_less_greater |
|
dropdown |
Adjusted calcium - Select if test result provided is not an exact value |
1, < (Less than) ; 2, > (Greater than) |
| cal_result |
|
text |
Adjusted calcium - Result (mmol/L) |
|
| cal_other_unit |
|
text |
Adjusted calcium - If using a different unit other than mmol/L |
|
| pho_less_greater |
|
dropdown |
Phosphate - Select if test result provided is not an exact value |
1, < (Less than) ; 2, > (Greater than) |
| pho_result |
|
text |
Phosphate - Result (mmol/L) |
|
| pho_other_unit |
|
text |
Phosphate - If using a different unit other than mmol/L |
|
| mg_less_greater |
|
dropdown |
Magnesium - Select if test result provided is not an exact value |
1, < (Less than) ; 2, > (Greater than) |
| mg_result |
|
text |
Magnesium - Result (mmol/L) |
|
| mg_other_unit |
|
text |
Magnesium - If using a different unit other than mmol/L |
|
| oh_less_greater |
|
dropdown |
25-Hydroxyvitamin D (25-OH) - Select if test result provided is not an exact value |
1, < (Less than) ; 2, > (Greater than) |
| oh_result |
|
text |
25-Hydroxyvitamin D (25-OH) - Result (nmol/L) |
|
| oh_other_unit |
|
text |
25-Hydroxyvitamin D (25-OH) - If using a different unit other than nmol/L |
|
| lp_done |
Lipid profile (fasting if feasible) |
checkbox |
Please tick all tests that have been DONE |
1, Cholesterol ; 2, Triglycerides ; 3, HDL cholesterol ; 4, LDL cholesterol |
| cho_less_greater |
|
dropdown |
Cholesterol - Select if test result provided is not an exact value |
1, < (Less than) ; 2, > (Greater than) |
| cho_result |
|
text |
Cholesterol - Result (mmol/L) |
|
| cho_other_unit |
|
text |
Cholesterol - If using a different unit other than mmol/L |
|
| tri_less_greater |
|
dropdown |
Triglycerides - Select if test result provided is not an exact value |
1, < (Less than) ; 2, > (Greater than) |
| tri_result |
|
text |
Triglycerides - Result (mmol/L) |
|
| tri_other_unit |
|
text |
Triglycerides - If using a different unit other than mmol/L |
|
| hdl_less_greater |
|
dropdown |
HDL cholesterol - Select if test result provided is not an exact value |
1, < (Less than) ; 2, > (Greater than) |
| hdl_result |
|
text |
HDL cholesterol - Result (mmol/L) |
|
| hdl_other_unit |
|
text |
HDL cholesterol - If using a different unit other than mmol/L |
|
| ldl_less_greater |
|
dropdown |
LDL cholesterol - Select if test result provided is not an exact value |
1, < (Less than) ; 2, > (Greater than) |
| ldl_result |
|
text |
LDL cholesterol - Result (mmol/L) |
|
| ldl_other_unit |
|
text |
LDL cholesterol - If using a different unit other than mmol/L |
|
| cp_done |
Cardiac Profile |
checkbox |
Please tick all tests that have been DONE |
1, Troponin - cTnT ; 2, Troponin - hs-cTnT ; 3, Troponin - cTnI ; 4, Troponin - hs-cTnI ; 5, BNP ; 6, Pro-NT-BNP |
| trop_ctnt_less_greater |
|
dropdown |
Troponin - cTnT - Select if test result provided is not an exact value |
1, < (Less than) ; 2, > (Greater than) |
| trop_ctnt_result |
|
text |
Troponin - cTnT - Result (ng/L) |
|
| trop_ctnt_other_unit |
|
text |
Troponin - cTnT - If using a different unit other than ng/L |
|
| trop_hsctnt_less_greater |
|
dropdown |
Troponin - hs-cTnT - Select if test result provided is not an exact value |
1, < (Less than) ; 2, > (Greater than) |
| trop_hsctnt_result |
|
text |
Troponin - hs-cTnT - Result (ng/L) |
|
| trop_hsctnt_other_unit |
|
text |
Troponin - hs-cTnT - If using a different unit other than ng/L |
|
| trop_ctni_less_greater |
|
dropdown |
Troponin - cTnI - Select if test result provided is not an exact value |
1, < (Less than) ; 2, > (Greater than) |
| trop_ctni_result |
|
text |
Troponin - cTnI - Result (ng/L) |
|
| trop_ctni_other_unit |
|
text |
Troponin - cTnI - If using a different unit other than ng/L |
|
| trop_hsctni_less_greater |
|
dropdown |
Troponin - hs-cTnI - Select if test result provided is not an exact value |
1, < (Less than) ; 2, > (Greater than) |
| trop_hsctni_result |
|
text |
Troponin - hs-cTnI - Result (ng/L) |
|
| trop_hsctni_other_unit |
|
text |
Troponin - hs-cTnI - If using a different unit other than ng/L |
|
| bnp_less_greater |
|
dropdown |
BNP - Select if test result provided is not an exact value |
1, < (Less than) ; 2, > (Greater than) |
| bnp_result |
|
text |
BNP - Result (ng/L) |
|
| bnp_other_unit |
|
text |
BNP - If using a different unit other than ng/L |
|
| pnbnp_less_greater |
|
dropdown |
Pro-NT-BNP - Select if test result provided is not an exact value |
1, < (Less than) ; 2, > (Greater than) |
| pnbnp_result |
|
text |
Pro-NT-BNP - Result (ng/L) |
|
| pnbnp_other_unit |
|
text |
Pro-NT-BNP - If using a different unit other than ng/L |
|
| hp_done |
Haematology Profile |
checkbox |
Please tick all tests that have been DONE |
1, D-Dimer ; 2, Fibrinogen ; 3, INR ; 4, Ferritin |
| ddi_unit |
|
radio |
D-Dimer - Unit of measurement |
1, ug/mL or mg/L ; 2, ng/mL or ug/L |
| ddi_assay |
|
radio |
D-Dimer - Unit of measurement |
1, FEU ; 2, DDU |
| ddi_less_greater |
|
dropdown |
D-Dimer - Select if test result provided is not an exact value |
1, < (Less than) ; 2, > (Greater than) |
| ddi_result |
|
text |
D-Dimer - Result |
|
| ddi_other_unit |
|
text |
D-Dimer - If using a different unit other than mg/L |
|
| fib_less_greater |
|
dropdown |
Fibrinogen - Select if test result provided is not an exact value |
1, < (Less than) ; 2, > (Greater than) |
| fib_result |
|
text |
Fibrinogen (g/L) |
|
| fib_other_unit |
|
text |
Fibrinogen - If using a different unit other than g/L |
|
| inr_less_greater |
|
dropdown |
INR - Select if test result provided is not an exact value |
1, < (Less than) ; 2, > (Greater than) |
| inr_result |
|
text |
INR - Result |
|
| inr_other_unit |
|
text |
INR - If using a different unit |
|
| fer_less_greater |
|
dropdown |
Ferritin - Select if test result provided is not an exact value |
1, < (Less than) ; 2, > (Greater than) |
| fer_result |
|
text |
Ferritin - Result (μg/L) |
|
| fer_other_unit |
|
text |
Ferritin - If using a different unit other than μg/L |
|
| dp_done |
Diabetes Profile (FASTING glucose & Insulin results only) |
checkbox |
Please tick all tests that have been DONE |
1, HbA1C ; 2, Glucose ; 3, Insulin |
| hba1c_less_greater |
|
dropdown |
HbA1C - Select if test result provided is not an exact value |
1, < (Less than) ; 2, > (Greater than) |
| hba1c_result |
|
text |
HbA1C - Result (%) |
|
| hba1c_other_unit |
|
text |
HbA1C - If using a different unit other than % |
|
| glu_less_greater |
|
dropdown |
Glucose - Select if test result provided is not an exact value |
1, < (Less than) ; 2, > (Greater than) |
| glu_result |
|
text |
Glucose - Result (mmol/L) |
|
| glu_other_unit |
|
text |
Glucose - If using a different unit other than (mmol/L) |
|
| ins_less_greater |
|
dropdown |
Insulin - Select if test result provided is not an exact value |
1, < (Less than) ; 2, > (Greater than) |
| ins_result |
|
text |
Insulin - Result (uIU/mL) |
|
| ins_other_unit |
|
text |
Insulin - If using a different unit other than uIU/mL |
|