Tobacco Implementation Guide -Routine Laboratory- Local Processing
Laboratory
What was the name of the laboratory used?
Was the lab performed?	No  Yes
What was the date of the lab specimen collection?	01 Jan 2000
What was the (start) time of the lab specimen collection?	12:00
* Was the subject fasting?	No  Yes
Laboratory Tests
Lab Test Name
What was the result?
What was the lab test unitt?
What was the upper limit of the reference range for this lab test?
What was the lower limit of the reference range for this lab test?
Was this result clinically significant?	No  Yes

* Mandatory field