Health Facility Essental Lab Test Summary Template
Health Facility Essental Lab Test Summary Template
Health Facility Essental Lab Test Summary Template
Laboratory service d
Health Center essentail laboratory test a
Name of Zonal Health Office____
tick (√) if test available
TB smear
Distance from zonal Urinalysis
Woreda/Town microscopy
Name of Health Center town(KM) Stool microscopy
deder lagagaba 1 1 1
Oromia Health Bureau
Laboratory service directorate
essentail laboratory test availability assessment checlist
of Zonal Health Office_______________________
√) if test available
Differential
HGB Hematocrit CBC white cell ESR Gram Stain Blood film ASO RF KOH
count
1 1 0 1 0 0 1 0 0 1
Blood Group Widal test Welflex H.Pylori HBs Ag HCV
RPR/VDRL HIV-test RBS/FBS Indian Ink Ag
and Rh
1 1 1 1 0 1 1 1 1 0
Education status
others # of total
# Lab with 2nd
if any tests aval # BSc Lab # Lab Deploma degree Name lab head Phone#
16 0 0
Oromia Health Bureau
Laboratory service directorate
Primary Hospital essentail laboratory test availability assessment checlis
Name of Zonal Health Office ___________________________
tick (√) if test available
Distance Differential
TB smear
Name of from zonal Stool Urinalysis HGB Hematocrit CBC white cell ESR
microscopy
Woreda/T Hospital town(KM) microscopy count
ate
ty assessment checlist
_______________
Blood
Gram Stain Blood film ASO RF KOH RPR/VDRL HIV-test Group and RBS/FBS Indian Ink CSF
Rh analysis
Renal Liver Platelet
function function H.Pylori HBs Ag HCV Ag Salmonella Salmonella
count
Ascitic fluid Pleural fluid tests tests Typhi-O Typhi-H
Educational status
# Lab with
Proteus- Total test 2nd
OX19 HCG Genexpert others if any avail. # BSc Lab # Lab Dep degree #Data Clerk # Cleaner
Name lab hPhone#
Oromia Health Bureau
Laboratory service directorate
General Hospital essentail laboratory test availability assessment checlis
Name of Zonal Health Office ___________________________
tick (√) if test available
Distance Differential
TB smear
Name of from zonal Stool Urinalysis HGB Hematocrit CBC white cell ESR
Woreda/T Hospital microscopy
town(KM) microscopy count
ate
ty assessment checlist
_______________
Blood
Gram Stain Blood film ASO RF KOH RPR/VDRL HIV-test Group and RBS/FBS Indian Ink CSF
Rh analysis
Renal Liver
function function H.Pylori HBs Ag HCV Salmonella Salmonella Proteus-
Ascitic fluid Pleural fluid tests tests Typhi-O Typhi-H OX19 HCG
Serum Cardiac Platelet Bleeding Reticulocyte prothrombin Toxoplasma
Lipid profile electrolytes function tests Hormonal test count time count time latex
Bacterial
Culture and Occult EID HIV COVID-19 Total test
CRP DST blood Viral Load Test CD4 Agn test xpert test others if any avail.
Educational status
# Lab with
# BSc Lab # Lab Dep 2nd degree #Data Clerk # Cleaner Name lab hPhone#
Oromia Health Bureau
Laboratory service directorate
General Hospital essentail laboratory test availability assessment ch
Name of Zonal Health Office ____________________
tick (√) if test available
TB smear
Name of Com SP Distance from zonal Urinalysis HGB Hematocrit
microscopy
sr no Zone Hosp town(KM) Stool microscopy
1
2
reau
directorate
bility assessment checlist
_______________________
available
Differential
CBC white cell ESR Gram Stain Blood film ASO RF KOH RPR/VDRL HIV-test
count
Blood Renal Liver
Ziehl
Group and RBS/FBS Gram stain Indian Ink CSF function function
Nelson stain
Rh analysis Ascitic fluid Pleural fluid tests tests
Cardiac
H.Pylori HBs Ag HCV Salmonella Salmonella Proteus- Serum function
Typhi-O Typhi-H OX19 HCG Lipid profile electrolytes tests
Bacterial
Hormonal Platelet Bleeding prothrombin Toxoplasma Culture and Occult
test count time Reticulocyte count time latex CRP DST blood
Educational status
Hb Lupus
Fungal electrophore Erythematos EID HIV COVID-19 Total test
culture sis us Viral load CD4 count Test Agn test xpert test Others aval.
# Lab with
2nd
# BSc Lab # Lab Dep degree #Data Clerk # Cleaner Name lab hPhone#