Document pB4qv2OYLX2LavZrrDGK0XZM7

iSPGoodrich PHYSICAL EXAMINATION --UNIVERSAL FORM (1) SOC.SEC.NO. IS DATE Portend LA-, /^OCJ PART 4 DOCTOR--OMIT ( *) ITEMS ON PRE-PLACEMENT EXAMS DISTANT NEAR RIGHT 20/ RIGHT 201 WITHOUT CORRECTION D1*1 - LEFT 20/ LEFT 2(1/ COLOR VISION M* NOR ASN 45 1 45 ? ^ DEPTH PERCEPTION M* NOB ABN 46 1 46 2 VISUAL FIELO (**) * - NOR ABN 47 1 47 2 WITH CORRECTION RIGHT 20/ P cB PRIGHT 20/ INTRAOCULAR TENSION <*) * NOR 48 -r-.' AC- ASN 48 2 >LEFT / 20/ C. 4H >LEFT ,, 20/ / ^ ^RIGHT mmHg 43 ;p ' vir-s ' 4."v ^ ^LEFT mmHfl 52 USE FOR NEAR TEST IF NO EQUIPMENT? * NEAR--Can the applicant read the test sentence at 14 incites'' lest Sentence: "In modern Industry a knowledge pi the physical condition ot a prospective employee is o` great importance " (CIRCLE YES or NO) WO/GLASSES W/GLASSES R YES YES NO NO L YES YES NO NO SEQ038A MARK TEST USED AUDIOMETER IS IT BASELINE? AUDIOGRAM YES NO 21 Y 21 N to _ CONVERSATIONAL SPEECH _l AT 5 FEET. RIGHT EAR RECORD HEARING LOSS IN [JB Sub 1000 2000 3000 4000 6000 8000 3P Rtt? PD Up sis SEQ03SA FVC LITERS 21 PULMONARY FUNCTION FEV, LITERS FEV,/FVC V, ?4 27 CC66 = 1 FEV, URINE SP. GR SOO 1000 2000 LEFT EAR 3000 As sjo URINALYSIS MICROSCOPIC 4000 Cl NOR D NOR 6000 ABN ABN 6000 RACE CORRECTED CORRECTED PREDICTED NORMAL YES NO FVC LITERS FVC LITERS IF YES. ENTER CORRECTED FVC %, FEV, % AB OVE FEV, LITERS FEV, LITERS HEMATOCRIT LYMPH HEMOGLOBIN HEMATOLOGY W B.C MONO EOS IN BASO NEUTRO SEROLOGY VDRL NGC 04634 IVietpathl HI REGIONAL LABORATORY FACILITY 1355 Mittel Boulevard, Wood Dale, IL 60191 CORNING Clinical Laboratory 11 1 IMOI3 SI ATF UCFNSF. 1 34 2 5 MEDIC.YRC CERTIFICATE -,4-3229 1-800-323-5917 (Natrona!) 1-800-942-2342 (Illinois) 1-800-631-1390 (Client Services) & .lOSfcPH F. O'BRIFN. M D ()MANJU DHANDA. M.O L -L''' D DAX TAYLOR, M D. PATIENT _BOGNER, RICHARD SEX Miij | TaLi-NI l.1 " M 44 13363415B3 SPECIMEN NO HOSF NO 600423515 COMMRN 5 fORAWN DATE AND I'MC ilO/11/89 1 OOC10 _____ FINAL REPORT (_X ! PARTIAL REPORT T 1 RECEIVED DATE 10/11/89 ACCOUN:NO. R0UTE/3I0P 151324 900340 B. F. GOODRICH CHEM. CO, BOX 15 ' HENRY | IL 61537 REPORT DATE AND TIME 10/12/89 900A TEST NAME RESULTS WITHIN REFERENCE RANGE OUTSIDE REFERENCE RANGE] UNIT OF MEASURE REFERENCE RANGE PROFILE 261 CHEM-SCREEN COMMENTS SERUM APPEARS CLOUDY GLUCOSE 106 MG/DL SODIUM 140 MMOL/L PLEASE NOTE NEW REFERENCE RANGE EFFECTIVE DATE: 10/2/89 POTASSIUM 4. 7 MMOL/L CHLORIDE 103 MMOL/L PLEASE NOTE NEW REFERENCE RANGE EFFECTIVE DATE: 10/2/89 BUN 12 HG/DL CREATININE 1. 1 MG/DL BUN/CREATININE RATIO 10. 9 URIC ACID 6. 4 MG/DL PHOSPHATE 4. 3 MG/DL CALCIUM 9. 0 MG/DL MAGNESIUM 1. 76 MEQ/L TOTAL PROTEIN 7. 4 GM/DL ALBUMIN 4. 3 GM/DL GLOBULIN 3. 1 GM/DL ALBUMIN/GLOBULIN RATIO 1. 39 TOTAL BILIRUBIN 0. 38 MG/DL DIRECT BILIRUBIN 0. 06 MG/DL ALKALINE PHOSPHATASE 87 IU/L PLEASE NOTE NEW REFERENCE RANGE EFFECTIVE DATE: 10/2/89 GAMMA GLUT. TRANSPEPTIDASE 38 U/L PLEASE NOTE NEW REFERENCE RANGE EFFECTIVE DATE: TRANSAMINASE-SGO 23 TRANSAMINASE-SGP 17 LACTATE DEHYDROGENASE 182 IRON 97 TRIGLYCERIDES CHOLESTEROL CHOLESTEROL PERCENTILE 99 HDL AND LDL HIGH DENSITY LIPOPROTEIN LDL-CALCULATED L 25. 0 mI/&L MG/DL 1 9/AA BOGNER,RICHARD REPORT CONTINUED ON NEXT FORM 65-125 136-146 3. 6-5. 3 99-110 9-24 0. 8-1. 4 3. 6-8. 8 2. 2-4. 3 9. 0-10. 4 1. 60-2. 10 6. 4-7. 9 3. 8-4. B 2. 2-3. 5 1. 2-2. 1 0. 30-1. 40 0. 04-0. 20 39-117 9-50 NGC 04635 600423515