SURNAME FIRST NAME MIDDLE NAME

DATE OF BIRTH (MMM/DD/YYYY) GENDER AT BIRTH CONTACT NUMBER

M M M / D D / Y Y Y Y M /

NAME

MD

COLLECTED BY

DATE (MMM/DD/YYYY) TIME (HH:MM)

SPECIMEN TYPE

SPECIMEN SUBMITTED

F

REPORT DELIVERY DOCTOR CLINICAL IMPRESSION

PATIENT DETAILS CLINIC STAMP

TEST REQUISITION

RPP (RECOMMENDED

PATIENT PRICE)

PACKAGES

55009300 15500

n n

SINGLE TAG ON PARAMETERS3000 1500 1000 4000

n n n300 CBC (14 Parameters) n n

n n n n n

FOR LAB USE ONLY

n

7000ADDITIONAL TEST(S)

6300 7200 8400

n

n n n

240 Sodium n n1000 RENAL PROFILE n n n n

n

n n n n n240 Potassium n n

240 Chloride n n n n n

200 Creatinine w/ eGFR n n n

n200 Urea n n

n

n

Calcium (Total) n

n n n n n

n

nn n n n

n

n

n n n n n

240 Phosphorus n n n n n n n240

n

n

1000 LIVER PROFILE n n

n n n n n200 Uric Acid n n

n

400

n n n

240 Albumin n240 Total Protein n n n n

n nn n

n n n

400 A/G Ratio n n n n

n n n n n

n

n n n n n

Globulin n n

n n n

nn n n

200 AST (SGOT) n n n

n200 ALT (SGPT) n n n

n n n

240 ALP n240 GGT n n n n

nn

600 FASTING LIPID PROFILE n n n n n

n n n n n240 Total Bilirubin n n

n n n n

n

200 Triglycerides n n n

n n n n n n

n n n

200 Total Cholesterol n n

n n n Refer to the back page for300 HDL Cholesterol n n n n n

n n n n n

commonly requested tests

600 VLDL Cholesterol n n n

n n n n n n600 LDL & Non-HDL Cholesterol n n

SPECIMEN DETAILS240 URINALYSIS (10 Parameters) n n n n n

n n n n400 Total Chol / HDL Ratio n n n n

n n n n n

nn n n n

n n n

200 Glucose n n n n

n900 DIABETIC SCREEN

n n

9000 HEART DISEASE SCREEN n

250 hsCRP n

n

800 350 HbA1c n n n

n n n n n

n

n n n

1600 800 Apolipoprotein A1

n n n n n500

1600 800 Lipoprotein a - Lp(a)

n n

1600 800 Apolipoprotein B nn n

n

2800 1400 hsTroponin

2400 1200 Homocysteinen

2000 HEPATITIS SCREENING

n2400 1200 BNP

n

400 150 Hepatitis B Surface Ab n

n

1000 500 Hepatitis A IgG

n n n

1200 600 Hepatitis C Ab

400 150 Hepatitis B Surface Ag n n n

n n n n n

n

n

n

n n n

1800 IRON STUDIES

240 120 Iron n n

n

800 400 Ferritin

800 400 TIBC

900

n

1500 THYROID FUNCTION TEST

1200 600 Transferrin

n

900 400 FT4

n n n n n

n

n

400 TSH n

n n n

n

3200 BONE & JOINTS

900 400 FT3

n n n

2800 1800 Vitamin D

600 300 Rheumatoid Factor n n n

n

FOR LAB USE1800 650 AFP(Liver, Germ Cell) n9000 CANCER MARKERS

n

n n

n n n n

n1800 650 CA 125 (Ovarian)

n n n n n

n

1800 650 CA 19-9 (Colorectal) n

n n1800 650 CA 15-3 (Breast)

1800 650 Cyfra 21-1 (Lung Cancer) n

n1800 650 CEA (Colorectal, Thryoid)

nn n

n n

n nn n n

n n n

1800 650 HE4 (Ovarian)

650 PSA - Total (Prostate) n n n n n

n

1800 650 SCC Ag (Squamous Cell Carcinoma) n

n n1800

Mobile: (+63) 917-566-4137 www.singaporediagnostics.com

LABORATORY REQUEST FORM

Fasting Random

Others (Please Specify):

SST (Yellow)

EDTA (Purple)

Fluoride (Grey)

Pap Smear - LMP:_____________

Swab - Site:__________________

Others (Please Specify):

Citrate (Blue)

Urine

Stool

Printed Copy Deliver to MD/ Clinic ___________

Email ___________________________________

HEMATOLOGY THYROID ASSAYS HEPATITIS VALUE PACKAGES PARTNER LABORATORIES

ROUTINE HEMATOLOGY Anti Thyroglobulin 3600 HBV-DNA 7000 HEPATITIS PACKAGE

ABO & Rhesus Type 240 Thyroglobulin 4400 Hepatitis A IgG 1000 Hepatitis 1 (Hepatitis B Screening) 290 NON-INVASIVE PRENATAL TEST (NIPT)

Complete Blood Count 300 Anti TPO 3600 Hepatitis A IgM 1000 HBsAg, HBsAb Igene NIPT Core 25,000

CD4 5000 FT3 900 Hepatitis B Core IgM 1200 Hepatitis 2 (Hepatitis B Profile) 1280 Igene NIPT Comprehensive 35,000

ESR 240 FT4 900 Hepatitis B Core IgG (Total) 800 HBsAg, HBsAb, HBeAg, HBeAb

Malarial Smear 400 TSH 900 Hepatitis B Envelope Ab 800 HBc IgM, HBc Total

Peripheral Blood Smear 500 T3 900 Hepatitis B Envelope Ag 800 Hepatitis 3 (Hepatitis AB Profile) 1800

Reticulocyte Count 400 T4 900 Hepatitis B Surface Ab 400 HBsAg, HBsAb, HBeAg, HBeAb

COAGULATION T-Uptake 1800 Hepatitis B Surface Ag 400 HBc IgM, HBc Total

Bleeding Time 180 HORMONES Hepatitis C Ab 1200 HAV IgM, HAV IgG

Clotting Time 180 ACTH* 5300 SEROLOGY Hepatitis 4 (Hepatitis ABC Profile) 2200

PT (INR) 500 Anti- Mullerian Hormone* 6500 CMV (IgG) 4000 HBsAg, HBsAb

PTT (APTT) 500 Cortisol 1400 CMV (IgM) 5500 HBeAg, HBeAb

IMMUNOCHEMISTRY DHEAS 1400 Dengue Ab (IgG/IgM) 1800 HBc IgM, HBc Total RT-PCR Covid 19 Swab 5,000

ROUTINE CHEMISTRY Estradiol 900 Dengue NS1 Ag 3000 HAV IgM, HAV IgG, HCV Ab Covid-19 Antigen Swab 2,000

Albumin 240 FSH 900 Dengue Ab/Ag Combo 4200 ROUTINE CHEMISTRY Covid-19 Total Antibody 1,000

ALP 240 HCG (Qualitative) 400 H. pylori Ab (Qualitative) 2200 Electrolytes 400 Covid-19 IgG/ IgM 1,500

ALT (SGPT) 200 HCG (Quantitative) 900 H. pylori Ag (Stool) 1400 Na, K, Cl, CO2

Amylase 240 Insulin 2400 HIV Ag/Ab 800 Renal Function Test (RFT) 500

AST (SGOT) 200 Intact PTH 3000 RPR (Qualitative) 600 Na, K, Cl, Urea,Creatinine with eGFR

Bicarbonate (HC03) 240 Lutenizing Hormone (LH) 900 RPR (Quantitative) 1000 Liver Function Test (LFT) 600

Bilirubin - Direct 240 Progesterone 1200 Rubella IgG 1600 AST, ALT, ALP, GGT, LDH, Total Bilirubin

Bilirubin - Total 240 Prolactin 1400 Rubella IgM 1600 Lipid Profile, Non Fasting 400

Bilirubin Package (TB, DB, IB) 400 SHBG 3200 Rubeola IgG 4000 Cholesterol, HDL-C, Non-HDL-C

Calcium 240 Testosterone (Total) 1400 Syphilis Ab 600 Cholesterol/HDL Ratio

Chloride 240 Testosterone (Free & Total) 5000 Toxoplasma IgG 1000 Lipid Profile, Fasting 600

Creatine Kinase (CK) 240 SPECIAL CHEMISTRY Toxoplasma IgM 1000 Cholesterol, Triglycerides, HDL-C, Non-HDL-C,

CK- MB 800 Acid Phosphatase* 700 TPHA 1000 LDL-C, VLDL-C, Chol/HDL Ratio

CK- MM 1000 Anti CCP* 2800 Salmonella IgG/IgM (Typhidot) 900 SPECIAL CHEMISTRY PACKAGE

Creatinine (with eGFR) 200 Anti Streptolysin O 1200 CULTURE & SENSITIVITY CHEM 12 1800

GGT 240 ANA (IF)* 3000 Abscess Fluid C&S 1400 Na, K, Cl ,Total Protein, Albumin, Calcium

Glucose (Fasting) 200 ANA (Quantitative) 2700 Blood C&S 3000 Alkaline Phosphatase, Total Bilirubin

HbA1c 800 BNP 2400 Blood C&S with ARD 3500 BUN, SGOT, CO2, FBS

Ionized Calcium* 650 Complement 3 600 Body Fluid C&S 1400 CHEM 15 2200

Iron 240 C-Peptide 2700 Fungal Culture 1400 Na, K, Cl, Total Protein, Albumin, Calcium

Lactate Dehydrogenase (LDH) 240 Cystatin C 1800 Sputum C&S 1400 Alkaline Phosphatase, Total Bilirubin

Lipase 800 D-Dimer 5500 Stool C&S 1400 BUN, SGOT, CO2, FBS

Magnesium 240 Ferritin 800 Surveillance Culture 1400 Creatinine with eGFR, Uric Acid, Cholesterol

OGCT 600 Folate 1200 Swab C&S 1400 CHEM 16 2800

OGTT (3 Point) 1000 Homocysteine 2400 Urine C&S 1400 Na, K, Cl, Total Protein, Albumin, Calcium

Phosphorus 240 hsCRP 500 MICROSCOPY Alkaline Phosphatase, Total Bilirubin

Potassium 240 hsTroponin 2800 AFB Stain 400 BUN, SGOT, SGPT, FBS

Sodium 240 IgA* 1400 Fecalysis 160 Creatinine with eGFR, Uric Acid, Cholesterol

Total Protein 240 IgE 1600 Gram Stain 400 CHEM M 3600

TPAG 400 IgM* 1400 India Ink (Cryptococcus) 400 Na, K, Cl, Total Protein, Albumin, Calcium

Urea 200 Procalcitonin 5700 iFOBT 800 Alkaline Phosphatase, Total Bilirubin

Uric Acid 200 Rheumatoid Factor 600 KOH Mount 400 BUN, SGOT, SGPT, FBS

LIPID STUDIES Serum Osmolality * 2400 Semen Analysis 400 Creatinine with eGFR, Uric Acid, Cholesterol

Apolipoprotein A 1600 TIBC 800 Stool Conc. Technique 400 Triglycerides, HDL, LDL, Non-HDL ,Chol/HDL

Apolipoprotein B 1600 Transferrin 1200 Urinalysis 240 CHEM 17 4300

Cholesterol 200 Troponin T 7000 URINE DRUG TESTING Na, K, Cl, Total Protein, Albumin, Calcium

HDL Cholesterol 300 Vitamin B12 1600 Barbiturates 300 Alkaline Phosphatase, Total Bilirubin,LDH

LDL Cholesterol 600 Vitamin D 2800 Benzodiazepines 300 BUN, SGOT, SGPT, Triglycerides, Phosphorus

Lipid Profile 600 URINE CHEMISTRY Cannabinoids 300 Uric Acid, Cholesterol, FBS ,CK

Lipoprotein a - Lp(a) 1600 Urine Albumin/ Creatinine Ratio 600 Cocaine 300 CHEM 19 4800

Non-Fasting Lipid Profile 400 Urine Amylase 600 Cotinine 300 Na, K, Cl, Total Protein, Albumin, Calcium,Triglycerides

Non-HDL Cholesterol 400 Urine Calcium 400 Ecstasy 300 Alkaline Phosphatase, Total Bilirubin,Phosphorus

Triglycerides 200 Urine Chloride 400 Meth/THC 300 BUN, SGOT, SGPT, Creatinine with eGFR

CANCER MARKERS Urine Creatinine 400 Opiates 300 Uric Acid, Cholesterol, LDH, CK, FBS

AFP 1800 Urine Creatinine Clearance 600 PCP 300 CHEM 23 5200

CA 125 1800 Urine Glucose 400 CYTOLOGY Na, K, Cl, Total Protein, Albumin, Calcium

CA 15-3 1800 Urine Magnesium 400 Pap Smear 800 Alkaline Phosphatase, Total Bilirubin, C02

CA 19-9 1800 Urine Micral Test 600 Fluid Cytology 2000 BUN, SGOT, SGPT, Creatinine with eGFR

CEA 1800 Urine Microalbumin 600 FNAB (per smear) 1000 Uric Acid, Cholesterol, LDH, Phosphorus

Cyfra 21-1 1800 Urine Osmolality 800 Urine Cytology 2000 CK , Amylase, FBS, GGTP, HDL, LDL,

HE4 1800 Urine Phosphorus 400 HISTOLOGY Non-HDL , Chol/HDL, Triglycerides

NSE call Lab Urine Potassium 400 0-5cm (small) 1400 COMPREHENSIVE METABOLIC PANEL 1800

PSA Profile 3600 Urine Pregnancy Test 400 5-7cm (medium) 2400 Creatinine (with eGFR), Na, K, Cl, C02

PSA - Free 1800 Urine Protein 400 7-15cm (large) 3200 BUN, Ca, Total Protein

PSA - Total 1800 Urine Sodium 400 >15cm (extra large) 4000 Total Bilirubin , Fasting Glucose

SCC-Ag 1800 Urine Uric Acid 400 Gastric Bx - H.Pylori 1600 ALB, ALT, AST, ALP

NOVEMBER 2020 Singapore Diagnostics

LOCATIONS

Price is subject to change without prior notice.

Tests marked with asterisk (*) are either batched

or referred out. For additional tests please call

our Core Lab.

ACCREDITED HMOs

QUALITY ASSURANCE

COVID-19 TESTS

ABOUT US

TEST MENU

www.singaporediagnostics.com

SERVICE DETAILS

Singapore Diagnostics is among the largest

laboratories in the Philippines. It services the laboratory

requirements of up to 300 different institutions

nationwide, from the hospitals, to the largest clinic

chains, to free-standing physician clinics. It is also the

only CAP Accredited tertiary laboratory in the

Philippines – putting it alongside the world’s best

laboratories.

When your laboratory tests are done at Singapore

Diagnostics, be assured of the highest standards of

quality, competence and safety.

Corporate Office:

Singapore Medical Laboratories, Inc.8F Sterling Centre131 Dela Rosa StreetLegaspi Village, Makati City 1229Philippines

Core Facility (Makati)4F Sterling Centre131 Dela Rosa StreetLegaspi Village, Makati City 1229

Angeles City Satellite LaboratoryAlta Claro BuildingMcArthur Highway cor. San Pablo St.Angeles City 2009

Cebu City Satellite LaboratoryAyala Access RoadCebu City 6000

Dagupan City Satellite LaboratoryARB Corporate CenterTapuac District, Dagupan City 2400

Davao Satellite Laboratory26 Sobrecarey St.Davao City 8000

Iloilo Satellite LaboratoryGF Plazuela Dos

Pison AvenueMandurriao, Iloilo City 5000

Singapore Diagnostics

@singaporediagnostics

Singapore Diagnostics

@sgdiagnostics

+63 917 566 4137

+63 917 566 4137

customercare@singaporediagnostics.com

Laboratory:

Singapore Diagnostics (SGD),now among the world’s best laboratories.

SGD is accredited by the College of American Pathologists (CAP), the gold standard in laboratory quality.

This makes SGD the first and only tertiary laboratory in the Philippines to achieve this milestone, and one of less than 500 international laboratories to meet the CAP standards of accuracy, competence and safety.

This proves that SGD is at par with the best hospitals, medical centres and reference laboratories in the world.