HEARING:
Audiometer
250

500

1000

2000

Right
Left

GENERAL LABORATORY TESTS:
CBC
FBS
2 Hour P,P,
SMAC
T-3
T-4
YORE
Glucose Tolerance {in Known diabetes cases)
Electrocardiogram

|

Chest X-ray (at disgression of examiner)
Urinalysis (complete)
GENERAL FINDINGS AND RECOMMENDATIONS:

14

“4000

6000

8000

Select target paragraph3