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- 求助：刚开展液基细胞学，制作申请单需要包括哪些内容？
这是马博文老师收集的申请单仅供参考:
宫颈/阴道涂片检查申请单
|
涂片取样日期： |
＿＿年＿＿月＿＿日 |
细胞学号：＿＿＿ | |
|
姓名：＿＿＿＿＿＿ |
＿＿＿＿＿＿＿＿ |
病历号：＿＿＿＿ | |
|
年龄：＿＿＿＿＿＿ |
族别：＿＿＿＿ |
科别：＿＿＿＿＿ | |
|
最后一次月经日期： |
＿＿年＿＿月＿＿日 |
绝经：□是 □否 | |
病史、症状、体征：
|
□ 下腹痛、腰痛 |
□ 宫颈癌术后 |
□ 卵巢肿物 |
|
□ 白带增多 |
□ 宫颈癌放疗后 |
□ 子宫切除 |
|
□ 不正常流血 |
□ 子宫肌瘤 |
□ 卵巢切除 |
|
□ 子宫环 |
□ 妊娠 |
□ 普查 |
妇检：
|
宫颈： |
□光滑 |
□息肉 |
□触血 |
□内陷 |
|
|
□糜烂（轻 中 重） |
□肥大 |
□萎缩 |
|
|
阴道： |
□白斑 |
□溃烂 |
□尖疣 |
□肿块 |
以往涂片检查日期、涂片编号及结果：
临床诊断： 医师签章：
＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿
For Laboratory Use Only
|
General Categorization: |
Inflammation: □Mild |
□Moderate □Severe |
|
□Within Normal Limits |
|
□Monilia Infection |
|
□Atypia of Squamous Cells |
□Atypia of Glandular Cells |
□Trichomonas Infection |
|
□Low Grade SIL |
□Suspicious for Adenoca. |
□Bacteria Overgrowth |
|
□High Grade SIL |
□Adenocarcinoma |
□Herpes Viral Infection |
|
□Invasive Squamous Ca. |
□ |
□HPV Infection ① ② |
Specimen Adequacy: Cellular Description:
|
□Sat. |
□Sat. But Limited By- |
Squamous Cells |
□Detected |
□Scanty |
|
|
□Unsatisfactory- |
Endocervical Cells |
□Detected |
□Not Detected |
|
|
□No Endocervucal Components |
Metaplastic Cells |
□Detected |
□Not Detected |
|
|
□Scanty Squamous Cells |
Inflammation / Obscuration: |
| |
|
|
□Inflammatory Exudates |
|
□Less than 50% | |
|
|
□Obscuring Blood |
|
□50% to 75% | |
|
|
□Thick Areas or Artifacts |
|
□Greater than 75% | |
Comments and Recommendations:
＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿
Reported By: ＿＿＿＿＿＿＿＿＿＿ Date: ＿＿＿＿＿＿
