Cod cerere

divizia laboratoare clinice

ANALIZE MEDICALE GENERALE

Date Pacient* Nr. card: ___________________________________________ F Recomandare medic* Nume: ___________________________________________ Sediu: ___________________________________________ Tel.: _____________________________________________ Semntur i paraf: _________________________________________________ Nume: ______________________________________________________ Sex M CNP: Adresa: ______________________________________________________________________ Localitate: _________________________________________ Tel.: ______________________ Rezultate pe email: Da Nu Acord newsletter: Da Nu Asistent recoltare: ________________________________ Cod asistent: ____________________________________ Data recoltare: ___/___/______ Ora: __________________
Cf. cerinelor RENAR, rubrica trebuie completat.

Prenume: ______________________________________________ Data naterii: __/__/____

Email: _______________________________________________________________________
Cod FG-4.4-03

Semntur pacient: __________________________________________ Diagnostic prezumtiv / Comentarii clinice: _________________________________________ _____________________________________________________________________________ HEMATOLOGIE HE032 Anticoagulant lupic HE034 Antitrombina 3 HE001 Celule lupice HE031 D-dimeri HE003 Examen pictur groas i frotiu de snge pentru malarie HE004 Factor Rh HE005 Fibrinogen HE006 Grup sanguin OAB HE008 Hemoleucograma cu formula leucocitar, Hb, Ht, indici i reticulocite HE007 Hemoleucograma cu formul leucocitar, Hb, Ht i indici HE010 Medulograma HE038 Porrine urinare HE035 Proteina C HE036 Proteina S liber HE011 Retracia cheagului HE039 Rezistena la Proteina C activat (APCR V) HE012 Teste Coombs direct HE015 Timp de protrombina Quick HE016 Timp de sngerare HE017 Timp de trombin HE018 Timp de tromboplastin parial activat cu caolin APTT HE014 Timpul de liz a cheagului euglobulinic HE019 VSH CHIMIE CH001 CH002 CH005 CH072 CH006 CH003 CH007 CH008 CH118 CH010 CH011 CH004 CH012 CH013 CH014 CH115 CH016 CH017 Acid uric seric Acid uric urinar Albumina seric Alcoolemie Alfa 1 antitripsina - AAT ALT/TGP Amilaza seric Amilaza urinar Amoniac Apolipoproteina A1 Apolipoproteina B AST/TGO Bilirubina direct Bilirubina indirect Bilirubina total Calciu ionic Calciu seric Calciu urinar CH089 CH019 CH020 CH120 CH021 CH025 CH026 CH027 CH028 CH029 CH031 CH032 CH034 Ceruloplasmina Clearance creatinina Clor seric Clor urinar Colesterol total Colinesteraz Creatinina seric Creatinina urinar Creatinkinaza (CK) Electroforeza hemoglobinei Electroforeza lipoproteinelor Electroforeza proteinelor serice Electroforeza proteinelor serice cu imunoxare Electroforeza proteinelor urinare cu imunoxare Feritina Fibromax FibroTest ActiTest Folai serici Fosfataza acid de origine prostatic Fosfataza acid total Fosfataza alcalin Fosfor seric Fosfor urinar GGT Glucoza seric Glucoza urinar HDL Colesterol Hemoglobina glicozilata Hb A1c LDH LDL colesterol Lipaza Lipide totale Litiu Magneziu seric Magneziu urinar Microalbuminurie Potasiu seric Potasiu urinar Procalcitonina Prol lipidic (LDL colesterol, HDL colesterol, colesterol total, trigliceride) Proteine totale serice Proteine urinare Screening diabet gestaional (50g) Sideremie Sodiu seric Sodiu urinar

CH056 CH057 CH055 CH105 L371 CH058 CH059 CH060 CH062 CH061 CH063

Transferina Trigliceride TTGO cu 2 glicemii (75g) TTGO cu 4 glicemii (75g) TTGO cu 5 glicemii (75g) Uree seric Uree urinar Urina biochimie Urina proba SW Urina sediment Vitamina B12

CH033 CH086 CH150 CH126 CH064 CH036 CH035 CH037 CH038 CH039 CH040 CH041 CH042 CH022 CH030 CH 43 CH023 CH044 CH067 CH045 CH046 CH047 CH048 CH049 CH050 CH083 CH066 CH051 CH097 CH104 CH052 CH053 CH054

MARKERI TUMORALI MT001 AFP (Alfa fetoproteina) MT003 CA 125 MT004 CA 15-3 MT005 CA 19-9 MT002 Calcitonina MT007 CEA Alte analize: __________________________________________ __________________________________________ __________________________________________
Puncte de recoltare analize de laborator REGINA MARIA
Bucureti - Call center: 021 9268 Laboratorul Clinic Bucureti / Policlinica Cotroceni - os. Cotroceni nr.20, S6 Policlinica Aviaiei - Calea Floreasca nr.169A, corp B, Cldirea Oracle, S1 Policlinica Bneasa - Str. Ion Ionescu de la Brad nr.5B, S1 Policlinica Bucharest Business Park - os. Bucureti - Ploieti nr.1A, corp A, parter, S1 Policlinica pentru aduli i copii Dorobani - Calea Dorobani nr.240, S1 Policlinica Enescu - Str. George Enescu nr.12, S1 Policlinica Floreasca** - Str. Hatmanul Arbore nr. 15-19, S1 Policlinica Lujerului - Bd. Iuliu Maniu nr.51, S6 Policlinica pentru copii Opera Center - Str. Costache Negri nr.1-5, S5 Policlinica Pipera - Str. Dimitrie Pompeiu nr.9-9A, cldirea 16, parter, S2 Policlinica Sema Parc - Splaiul Independenei nr.319, parter, S6 Policlinica Sun Plaza - Calea Vcreti nr.391, S4, birouri mall Sun Plaza, etaj 2 Policlinica Unirea - Bd. Unirii nr. 57, S3 Bacu - Campus Medical**: Calea Romanului nr.39, Bacu, Tel.: 0234 510 490 Centrul de recoltare Bacu**: Str. Ioni Sandu Sturdza nr.3, Tel.: 0234 514 955 Centrul de recoltare Buhui**: Str. Tineretului nr.14 Braov - Campus Medical**: Bd. Iuliu Maniu nr.49, Braov, Call center: 021 9268 Cluj - Policlinica Pasteur** - Str. Louis Pasteur nr. 24/72, et.1, Tel.: 0264 522 254 Centrul de Medicina Muncii - Calea Moilor nr.35, ap.2, Tel.: 0364 101 703 Constana - Policlinica Constana** - Bd. Mamaia nr.16A - 16B, Tel.: 0241 544 000
Gama noastr de analize depete lista de mai sus. Detalii ofert complet: www.reginamaria.ro

* CENTRUL MEDICAL UNIREA S.R.L., EUROCLINIC MEDICAL CENTERS S.A. i EUROCLINIC HOSPITAL S.A., societi funcionnd sub denumirea comercial REGINA MARIA, Reeaua privat de sntate, sunt nregistrate ca operatori de date cu caracter personal, conform Legii 667/2011 pentru protecia persoanelor cu privire la prelucrarea datelor cu caracter personal i libera circulaie a acestor date. Oferirea de date sau informaii cu caracter personal constituie consimmntul Dvs. expres i fr echivoc ca datele Dvs. personale s intre n baza de date a Societii i s e prelucrate, publicate i utilizate n scopul gestionrii dosarului medical, mbuntirea calitii serviciilor, statistici medicale i de raportare. Conform Legii 667/2001, avei dreptul de a interveni asupra datelor Dvs. personale (prin cerere scris sau la adresa ofce@reginamaria.ro) i v este recunoscut dreptul de a v adresa justiiei pentru aprarea oricror drepturi garantate prin aceast lege. ** Recoltare i pentru copii

www.reginamaria.ro Call Center: 021 9268

L_Me_01_VII2011

divizia laboratoare clinice

MT008 MT012 MT010 MT011 MI013 MT015 MT016

CYFRA 21-1 Free PSA NSE PSA S100 SCC (antigen tumoral) Tireoglobulin (TG)

MARKERI ENDOCRINI ME009 17-Cetosteroizi ME022 17-OH progesteron ME01 Acid vanilmandelic ME02 ACTH ME007 Cortizol ME003 Cortizol liber urinar ME008 DHEA-S ME041 Dublu test ME010 Estradiol ME011 Estriol neconjugat ME040 Free beta HCG ME012 FSH ME038 FT3 ME028 FT4 ME047 Gastrina ME014 HCG total ME015 HGH (Hormon uman de crestere) ME059 Hormon anti mullerian (AMH) ME016 IGF-I ME042 Inhibina B ME017 Insulina ME024 iPTH (parathormon intact) ME013 LH ME021 Progesteron ME023 Prolactina ME025 SHBG ME026 T3 ME027 T4 ME032 Testosteron ME033 Testosteron liber ME037 Triplu test ME029 TSH MARKERI VIRALI MV013 Ac HIV MV007 Ag HBe MV003 Ag Hbs MV010 Ag HDV (Antigen Hepatita D) MV001 Anti HAV MV002 Anti HAV Ig M MV005 Anti HBc MV006 Anti HBc-Ig M MV008 Anti HBe MV004 Anti HBs- cantitativ MV012 Anti HCV MV011 AntiHDV (Anticorpii anti-hepatita D total) IMUNOLOGIE I SEROLOGIE IM067 Anti receptor TSH (TRAb) IM069 Anti TPO IM064 Anticorpi anti - CCP IM063 Anticorpi anti - centromer IM001 Anticorpi anti ADN dublu catenar IM061 Anticorpi anti Jo - 1 IM062 Anticorpi anti Scl - 70 IM075 Anticorpi anti SLA/LP IM047 Anticorpi anti Sm ENA IM060 Anticorpi anti U - 1RNP IM066 Anticorpi anticardiolipina IgG IM002 Anticorpi antibra muscular neted (ASMA) IM049 Anticorpi anti-La(SS-B) IM003 Anticorpi anti-LKM1 IM083 Anticorpi anti-membran bazal glomerular

IM079 IM004 IM005 IM078 IM048 IM006 IM007 IM008 IM019 IM023 IM009 IM041 IM042 IM068 IM010 IM013 IM012 IM014 IM015 IM016 IM017 IM088 IM021 IM022 IM026 IM029 IM027 IM028 IM018 IM138 IM132 IM081 IM074 IM076

IM030 IM084 IM034 IM036 IM038 IM039 IM072 IM040 IM134 IM070 IM043 IM073 IM071 IM031 IM032 IM177

Anticorpi antimieloperoxidaza (pANCA) Anticorpi antimitocondriali (AMA) Anticorpi antinucleari (AAN) Anticorpi antiproteinaza 3 (cANCA) Anticorpi anti-Ro(SS-A) Anticorpi antispermatozoizi Anticorpi Borrelia burgdoferi Anticorpi Coxiella burneti Anticorpi Echinoccocus Granulosus IgG Anticorpi Helicobacter Pylori IgG Anticorpi heteroli (mononucleoza infecioas) Anticorpi VCA IgG Epstein Barr Anticorpi VCA IgM Epstein Barr Anti-tiroglobulina ASLO Chlamydia trachomatis: Antocorpi IgG Chlamydia trachomatis:Antocorpi IgA Citomegalovirus anticorpi IgG Citomegalovirus anticorpi IgM Complement C3 Complement C4 Complexe imune circulante (CIC) Factor reumatoid Factor reumatoid: Waaler Rose IgA IgE IgG IgM Crioglobuline Inhibitor C1 ESTERAZA (activitate) Inhibitor C1 ESTERAZA (dozare protein) Leptospire serologie Listeria monocytogenes Serologie Prol TORCH (anticorpii IgM si IgG pt Toxoplasma Gondii, Rubella, Citomegalovirus, Herpes Simplex 1 plus 2) Proteina C reactiv (CRP) Serologie silis cantitativ (Reagine RPR + Anticorpi specici TPHA) Test Celikey Screening boala celiac (anticorpi antitransglutaminaza tisular IgA i IgG) Toxocara canis Anticorpi IgG Toxoplasma Gondii Anti Toxo IgG Toxoplasma Gondii Anti Toxo IgM Toxoplasma Gondii Aviditate IgG Trichinella spiralis Anticorpi IgG Triptaza Virus herpetic 1 Anticorpi IgG Virus herpetic 1 i 2 Anticorpi IgG Virus herpetic 1 i 2 Anticorpi IgM Virus herpetic 2 Anticorpi IgG Virusul Rubeolei Anticorpi IgG Virusul Rubeolei Anticorpi IgM Yersinia anticorpi IgG,IgA

MI184 Spermocultur MI183 Spermogram MI018 Urocultur ALERGOLOGIE SCREENING ATOPIE AL061 PANEL 1 (mixt) AL015 PANEL 2 (respirator) AL054 PANEL 3 (alimentar) AL059 PANEL 4 (pediatric) AL002 Testul PHADIATOP AL001 Testul PHADIATOP Infant DETERMINRI lgE SPECIFICE Pneumoalergeni AL033 Aspergillus fumigatus AL010 Blatella germanica (gndacul de buctrie) AL034 Dermatophagoides farinae AL009 Dermatophagoides pteronyssimus AL011 Fungi amestec AL014 Pr cine AL013 Pr pisic AL006 Polen Artemisia vulgaris (Pelin) AL007 Polen Betulla verrucosa (mesteacn) AL003 Polen graminee amestec AL005 Polen ierburi amestec AL004 Polen Phleum pratense AL008 Praf de cas amestec Alergeni alimentari AL016 Albu de ou AL019 Alune AL047 Arahide AL043 Banane AL022 Cacao AL051 Capuni AL039 Carne de porc AL050 Carto AL046 Ceap AL021 Gluten AL018 Gru AL045 Kiwi AL017 Lapte de vac AL041 Mr AL040 Pete (Cod) AL038 Piper negru AL044 Portocale AL048 Roii AL020 Soia AL042 elin Alergen de insecte AL023 Venin albina Alergeni medicamentoi AL036 Cefaclor AL035 Penicilina G AL037 Penicilina V Alergeni profesionali AL029 Agenti dezinfectani AL030 Frunz de tutun AL052 Latex AL028 Reactivi chimici TOXICOLOGIE TOX003 Cadmiu n snge TOX004 Cadmiu n urin TOX007 Cupru n plasm TOX008 Cupru n urin TOX011 Mercur n snge TOX012 Mercur n urin TOX015 Plumb n snge TOX016 Plumb n urin TOX017 Zinc n plasm TOX018 Zinc n urin

BIOLOGIE MOLECULAR PCR BM001 ADN viral hepatit B (cantitativ) BM003 ARN viral hepatit C (cantitativ) BM009 HLA-B27 BM005 Mutaia factorului V Leiden BM006 Mutaia protrombinic ( factor II) MICROBIOLOGIE MI007 Coprocultur MI021 Examen coproparazitologic MI028 Examen exudatul farigian (bacteriologic, micologic) MI031 Examen secretia vaginal (bacteriologic) MI101 Secreie uretral (bacteriologic, micologic)

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