[ ] 1. Negative [ ] 2. Positive Cervical cancer _ _/_ _/_ _ _ _/_ _/_ _ [ ] 99. NA screen (VIA) Result Test Date of sample Date of result Recommended Ranges drawn received day/month/year 7 to 55 units per liter (U/L) U/L Liver function (ALT) _ _/_ _/_ _ _ _/_ _/_ _ [ ] 99. NA 8 to 48 units per liter (U/L) U/L Liver function (AST) _ _/_ _/_ _ _ _/_ _/_ _ [ ] 99. NA Kidney function 0.6-1.2 milligrams per deciliter mg/dL (mg/dL) (serum creatinine) _ _/_ _/_ _ _ _/_ _/_ _ [ ] 99. NA Albumin _ _/_ _/_ _ _ _/_ _/_ _ [ ] 99. NA Urine Routine Sugar _ _/_ _/_ _ _ _/_ _/_ _ [ ] 99. NA Microscopy _ _/_ _/_ _ _ _/_ _/_ _ [ ] 99. NA Ova _ _/_ _/_ _ _ _/_ _/_ _ [ ] 99. NA Stool Cyst _ _/_ _/_ _ _ _/_ _/_ _ Routine [ ] 99. NA Occult blood _ _/_ _/_ _ _ _/_ _/_ _ [ ] 99. NA Fat globules _ _/_ _/_ _ _ _/_ _/_ _ [ ] 99. NA 12.0 to 15.5 grams per deciliter g/dL (g/dL) Hemoglobin _ _/_ _/_ _ _ _/_ _/_ _ [ ] 99. NA Blood draw for drug levels (10% sample) Date of sample Date of result received Result Notes Test drawn day/month/year TDF levels _ _/_ _/_ _ 99. NA
Cervical cancer screen (VIA) _ _/_ _/_ _ _ _/_ _/_ _ [ ] 1. Negative [ ] 2. Positive [ ] 99. NA Test Date of sample drawn Date of result received day/month/year Result Recommended Ranges Liver function (ALT) _ _/_ _/_ _ _ _/_ _/_ _ U/L [ ] 99. NA 7 to 55 units per liter (U/L) Liver function (AST) _ _/_ _/_ _ _ _/_ _/_ _ U/L [ ] 99. NA 8 to 48 units per liter (U/L) Kidney function (serum creatinine) _ _/_ _/_ _ _ _/_ _/_ _ mg/dL [ ] 99. NA 0.6-1.2 milligrams per deciliter (mg/dL) Urine Routine Albumin _ _/_ _/_ _ _ _/_ _/_ _ [ ] 99. NA Sugar _ _/_ _/_ _ _ _/_ _/_ _ [ ] 99. NA Microscopy _ _/_ _/_ _ _ _/_ _/_ _ [ ] 99. NA Stool Routine Ova _ _/_ _/_ _ _ _/_ _/_ _ [ ] 99. NA Cyst _ _/_ _/_ _ _ _/_ _/_ _ [ ] 99. NA Occult blood _ _/_ _/_ _ _ _/_ _/_ _ [ ] 99. NA Fat globules _ _/_ _/_ _ _ _/_ _/_ _ [ ] 99. NA Hemoglobin _ _/_ _/_ _ _ _/_ _/_ _ g/dL [ ] 99. NA 12.0 to 15.5 grams per deciliter (g/dL) Blood draw for drug levels (10% sample) Test Date of sample drawn Date of result received day/month/year Result Notes TDF levels _ _/_ _/_ _ 99. NA
ashodaya_followup.docx