SURNAME FIRST NAME MIDDLE NAME
DATE OF BIRTH (MMM/DD/YYYY) GENDER AT BIRTH CONTACT NUMBER
M M M / D D / Y Y Y Y M /
NAME
MD
COLLECTED BY
DATE (MMM/DD/YYYY) TIME (HH:MM)
SPECIMEN TYPE
SPECIMEN SUBMITTED
F
REPORT DELIVERY DOCTOR CLINICAL IMPRESSION
PATIENT DETAILS CLINIC STAMP
TEST REQUISITION
RPP (RECOMMENDED
PATIENT PRICE)
PACKAGES
55009300 15500
n n
SINGLE TAG ON PARAMETERS3000 1500 1000 4000
n n n300 CBC (14 Parameters) n n
n n n n n
FOR LAB USE ONLY
n
7000ADDITIONAL TEST(S)
6300 7200 8400
n
n n n
240 Sodium n n1000 RENAL PROFILE n n n n
n
n n n n n240 Potassium n n
240 Chloride n n n n n
200 Creatinine w/ eGFR n n n
n200 Urea n n
n
n
Calcium (Total) n
n n n n n
n
nn n n n
n
n
n n n n n
240 Phosphorus n n n n n n n240
n
n
1000 LIVER PROFILE n n
n n n n n200 Uric Acid n n
n
400
n n n
240 Albumin n240 Total Protein n n n n
n nn n
n n n
400 A/G Ratio n n n n
n n n n n
n
n n n n n
Globulin n n
n n n
nn n n
200 AST (SGOT) n n n
n200 ALT (SGPT) n n n
n n n
240 ALP n240 GGT n n n n
nn
600 FASTING LIPID PROFILE n n n n n
n n n n n240 Total Bilirubin n n
n n n n
n
200 Triglycerides n n n
n n n n n n
n n n
200 Total Cholesterol n n
n n n Refer to the back page for300 HDL Cholesterol n n n n
n
n n n n n
commonly requested tests
600 VLDL Cholesterol n n n
n n n n n n600 LDL & Non-HDL Cholesterol n n
SPECIMEN DETAILS240 URINALYSIS (10 Parameters) n n n n n
n n n n400 Total Chol / HDL Ratio n n n n
n n n n n
nn n n n
n n n
200 Glucose n n n n
n900 DIABETIC SCREEN
n n
9000 HEART DISEASE SCREEN n
250 hsCRP n
n
800 350 HbA1c n n n
n n n n n
n
n n n
1600 800 Apolipoprotein A1
n n n n n500
1600 800 Lipoprotein a - Lp(a)
n n
1600 800 Apolipoprotein B nn n
n
2800 1400 hsTroponin
2400 1200 Homocysteinen
2000 HEPATITIS SCREENING
n2400 1200 BNP
n
400 150 Hepatitis B Surface Ab n
n
1000 500 Hepatitis A IgG
n n n
1200 600 Hepatitis C Ab
400 150 Hepatitis B Surface Ag n n n
n n n n n
n
n
n
n n n
1800 IRON STUDIES
240 120 Iron n n
n
800 400 Ferritin
800 400 TIBC
900
n
1500 THYROID FUNCTION TEST
1200 600 Transferrin
n
900 400 FT4
n n n n n
n
n
400 TSH n
n n n
n
3200 BONE & JOINTS
900 400 FT3
n n n
2800 1800 Vitamin D
600 300 Rheumatoid Factor n n n
n
FOR LAB USE1800 650 AFP(Liver, Germ Cell) n9000 CANCER
MARKERS
n
n n
n n n n
n1800 650 CA 125 (Ovarian)
n n n n n
n
1800 650 CA 19-9 (Colorectal) n
n n1800 650 CA 15-3 (Breast)
1800 650 Cyfra 21-1 (Lung Cancer) n
n1800 650 CEA (Colorectal, Thryoid)
nn n
n n
n nn n n
n n n
1800 650 HE4 (Ovarian)
650 PSA - Total (Prostate) n n n n n
n
1800 650 SCC Ag (Squamous Cell Carcinoma) n
n n1800
Mobile: (+63) 917-566-4137 www.singaporediagnostics.com
LABORATORY REQUEST FORM
Fasting Random
Others (Please Specify):
SST (Yellow)
EDTA (Purple)
Fluoride (Grey)
Pap Smear - LMP:_____________
Swab - Site:__________________
Others (Please Specify):
Citrate (Blue)
Urine
Stool
Printed Copy Deliver to MD/ Clinic ___________
Email ___________________________________
HEMATOLOGY THYROID ASSAYS HEPATITIS VALUE PACKAGES PARTNER
LABORATORIES
ROUTINE HEMATOLOGY Anti Thyroglobulin 3600 HBV-DNA 7000
HEPATITIS PACKAGE
ABO & Rhesus Type 240 Thyroglobulin 4400 Hepatitis A IgG
1000 Hepatitis 1 (Hepatitis B Screening) 290 NON-INVASIVE PRENATAL
TEST (NIPT)
Complete Blood Count 300 Anti TPO 3600 Hepatitis A IgM 1000
HBsAg, HBsAb Igene NIPT Core 25,000
CD4 5000 FT3 900 Hepatitis B Core IgM 1200 Hepatitis 2
(Hepatitis B Profile) 1280 Igene NIPT Comprehensive 35,000
ESR 240 FT4 900 Hepatitis B Core IgG (Total) 800 HBsAg, HBsAb,
HBeAg, HBeAb
Malarial Smear 400 TSH 900 Hepatitis B Envelope Ab 800 HBc IgM,
HBc Total
Peripheral Blood Smear 500 T3 900 Hepatitis B Envelope Ag 800
Hepatitis 3 (Hepatitis AB Profile) 1800
Reticulocyte Count 400 T4 900 Hepatitis B Surface Ab 400 HBsAg,
HBsAb, HBeAg, HBeAb
COAGULATION T-Uptake 1800 Hepatitis B Surface Ag 400 HBc IgM,
HBc Total
Bleeding Time 180 HORMONES Hepatitis C Ab 1200 HAV IgM, HAV
IgG
Clotting Time 180 ACTH* 5300 SEROLOGY Hepatitis 4 (Hepatitis ABC
Profile) 2200
PT (INR) 500 Anti- Mullerian Hormone* 6500 CMV (IgG) 4000 HBsAg,
HBsAb
PTT (APTT) 500 Cortisol 1400 CMV (IgM) 5500 HBeAg, HBeAb
IMMUNOCHEMISTRY DHEAS 1400 Dengue Ab (IgG/IgM) 1800 HBc IgM, HBc
Total RT-PCR Covid 19 Swab 5,000
ROUTINE CHEMISTRY Estradiol 900 Dengue NS1 Ag 3000 HAV IgM, HAV
IgG, HCV Ab Covid-19 Antigen Swab 2,000
Albumin 240 FSH 900 Dengue Ab/Ag Combo 4200 ROUTINE CHEMISTRY
Covid-19 Total Antibody 1,000
ALP 240 HCG (Qualitative) 400 H. pylori Ab (Qualitative) 2200
Electrolytes 400 Covid-19 IgG/ IgM 1,500
ALT (SGPT) 200 HCG (Quantitative) 900 H. pylori Ag (Stool) 1400
Na, K, Cl, CO2
Amylase 240 Insulin 2400 HIV Ag/Ab 800 Renal Function Test (RFT)
500
AST (SGOT) 200 Intact PTH 3000 RPR (Qualitative) 600 Na, K, Cl,
Urea,Creatinine with eGFR
Bicarbonate (HC03) 240 Lutenizing Hormone (LH) 900 RPR
(Quantitative) 1000 Liver Function Test (LFT) 600
Bilirubin - Direct 240 Progesterone 1200 Rubella IgG 1600 AST,
ALT, ALP, GGT, LDH, Total Bilirubin
Bilirubin - Total 240 Prolactin 1400 Rubella IgM 1600 Lipid
Profile, Non Fasting 400
Bilirubin Package (TB, DB, IB) 400 SHBG 3200 Rubeola IgG 4000
Cholesterol, HDL-C, Non-HDL-C
Calcium 240 Testosterone (Total) 1400 Syphilis Ab 600
Cholesterol/HDL Ratio
Chloride 240 Testosterone (Free & Total) 5000 Toxoplasma IgG
1000 Lipid Profile, Fasting 600
Creatine Kinase (CK) 240 SPECIAL CHEMISTRY Toxoplasma IgM 1000
Cholesterol, Triglycerides, HDL-C, Non-HDL-C,
CK- MB 800 Acid Phosphatase* 700 TPHA 1000 LDL-C, VLDL-C,
Chol/HDL Ratio
CK- MM 1000 Anti CCP* 2800 Salmonella IgG/IgM (Typhidot) 900
SPECIAL CHEMISTRY PACKAGE
Creatinine (with eGFR) 200 Anti Streptolysin O 1200 CULTURE
& SENSITIVITY CHEM 12 1800
GGT 240 ANA (IF)* 3000 Abscess Fluid C&S 1400 Na, K, Cl
,Total Protein, Albumin, Calcium
Glucose (Fasting) 200 ANA (Quantitative) 2700 Blood C&S 3000
Alkaline Phosphatase, Total Bilirubin
HbA1c 800 BNP 2400 Blood C&S with ARD 3500 BUN, SGOT, CO2,
FBS
Ionized Calcium* 650 Complement 3 600 Body Fluid C&S 1400
CHEM 15 2200
Iron 240 C-Peptide 2700 Fungal Culture 1400 Na, K, Cl, Total
Protein, Albumin, Calcium
Lactate Dehydrogenase (LDH) 240 Cystatin C 1800 Sputum C&S
1400 Alkaline Phosphatase, Total Bilirubin
Lipase 800 D-Dimer 5500 Stool C&S 1400 BUN, SGOT, CO2,
FBS
Magnesium 240 Ferritin 800 Surveillance Culture 1400 Creatinine
with eGFR, Uric Acid, Cholesterol
OGCT 600 Folate 1200 Swab C&S 1400 CHEM 16 2800
OGTT (3 Point) 1000 Homocysteine 2400 Urine C&S 1400 Na, K,
Cl, Total Protein, Albumin, Calcium
Phosphorus 240 hsCRP 500 MICROSCOPY Alkaline Phosphatase, Total
Bilirubin
Potassium 240 hsTroponin 2800 AFB Stain 400 BUN, SGOT, SGPT,
FBS
Sodium 240 IgA* 1400 Fecalysis 160 Creatinine with eGFR, Uric
Acid, Cholesterol
Total Protein 240 IgE 1600 Gram Stain 400 CHEM M 3600
TPAG 400 IgM* 1400 India Ink (Cryptococcus) 400 Na, K, Cl, Total
Protein, Albumin, Calcium
Urea 200 Procalcitonin 5700 iFOBT 800 Alkaline Phosphatase,
Total Bilirubin
Uric Acid 200 Rheumatoid Factor 600 KOH Mount 400 BUN, SGOT,
SGPT, FBS
LIPID STUDIES Serum Osmolality * 2400 Semen Analysis 400
Creatinine with eGFR, Uric Acid, Cholesterol
Apolipoprotein A 1600 TIBC 800 Stool Conc. Technique 400
Triglycerides, HDL, LDL, Non-HDL ,Chol/HDL
Apolipoprotein B 1600 Transferrin 1200 Urinalysis 240 CHEM 17
4300
Cholesterol 200 Troponin T 7000 URINE DRUG TESTING Na, K, Cl,
Total Protein, Albumin, Calcium
HDL Cholesterol 300 Vitamin B12 1600 Barbiturates 300 Alkaline
Phosphatase, Total Bilirubin,LDH
LDL Cholesterol 600 Vitamin D 2800 Benzodiazepines 300 BUN,
SGOT, SGPT, Triglycerides, Phosphorus
Lipid Profile 600 URINE CHEMISTRY Cannabinoids 300 Uric Acid,
Cholesterol, FBS ,CK
Lipoprotein a - Lp(a) 1600 Urine Albumin/ Creatinine Ratio 600
Cocaine 300 CHEM 19 4800
Non-Fasting Lipid Profile 400 Urine Amylase 600 Cotinine 300 Na,
K, Cl, Total Protein, Albumin, Calcium,Triglycerides
Non-HDL Cholesterol 400 Urine Calcium 400 Ecstasy 300 Alkaline
Phosphatase, Total Bilirubin,Phosphorus
Triglycerides 200 Urine Chloride 400 Meth/THC 300 BUN, SGOT,
SGPT, Creatinine with eGFR
CANCER MARKERS Urine Creatinine 400 Opiates 300 Uric Acid,
Cholesterol, LDH, CK, FBS
AFP 1800 Urine Creatinine Clearance 600 PCP 300 CHEM 23 5200
CA 125 1800 Urine Glucose 400 CYTOLOGY Na, K, Cl, Total Protein,
Albumin, Calcium
CA 15-3 1800 Urine Magnesium 400 Pap Smear 800 Alkaline
Phosphatase, Total Bilirubin, C02
CA 19-9 1800 Urine Micral Test 600 Fluid Cytology 2000 BUN,
SGOT, SGPT, Creatinine with eGFR
CEA 1800 Urine Microalbumin 600 FNAB (per smear) 1000 Uric Acid,
Cholesterol, LDH, Phosphorus
Cyfra 21-1 1800 Urine Osmolality 800 Urine Cytology 2000 CK ,
Amylase, FBS, GGTP, HDL, LDL,
HE4 1800 Urine Phosphorus 400 HISTOLOGY Non-HDL , Chol/HDL,
Triglycerides
NSE call Lab Urine Potassium 400 0-5cm (small) 1400
COMPREHENSIVE METABOLIC PANEL 1800
PSA Profile 3600 Urine Pregnancy Test 400 5-7cm (medium) 2400
Creatinine (with eGFR), Na, K, Cl, C02
PSA - Free 1800 Urine Protein 400 7-15cm (large) 3200 BUN, Ca,
Total Protein
PSA - Total 1800 Urine Sodium 400 >15cm (extra large) 4000
Total Bilirubin , Fasting Glucose
SCC-Ag 1800 Urine Uric Acid 400 Gastric Bx - H.Pylori 1600 ALB,
ALT, AST, ALP
NOVEMBER 2020 Singapore Diagnostics
LOCATIONS
Price is subject to change without prior notice.
Tests marked with asterisk (*) are either batched
or referred out. For additional tests please call
our Core Lab.
ACCREDITED HMOs
QUALITY ASSURANCE
COVID-19 TESTS
ABOUT US
TEST MENU
www.singaporediagnostics.com
SERVICE DETAILS
Singapore Diagnostics is among the largest
laboratories in the Philippines. It services the laboratory
requirements of up to 300 different institutions
nationwide, from the hospitals, to the largest clinic
chains, to free-standing physician clinics. It is also the
only CAP Accredited tertiary laboratory in the
Philippines – putting it alongside the world’s best
laboratories.
When your laboratory tests are done at Singapore
Diagnostics, be assured of the highest standards of
quality, competence and safety.
Corporate Office:
Singapore Medical Laboratories, Inc.8F Sterling Centre131 Dela
Rosa StreetLegaspi Village, Makati City 1229Philippines
Core Facility (Makati)4F Sterling Centre131 Dela Rosa
StreetLegaspi Village, Makati City 1229
Angeles City Satellite LaboratoryAlta Claro BuildingMcArthur
Highway cor. San Pablo St.Angeles City 2009
Cebu City Satellite LaboratoryAyala Access RoadCebu City
6000
Dagupan City Satellite LaboratoryARB Corporate CenterTapuac
District, Dagupan City 2400
Davao Satellite Laboratory26 Sobrecarey St.Davao City 8000
Iloilo Satellite LaboratoryGF Plazuela Dos
Pison AvenueMandurriao, Iloilo City 5000
Singapore Diagnostics
@singaporediagnostics
Singapore Diagnostics
@sgdiagnostics
+63 917 566 4137
+63 917 566 4137
[email protected]
Laboratory:
Singapore Diagnostics (SGD),now among the world’s best
laboratories.
SGD is accredited by the College of American Pathologists (CAP),
the gold standard in laboratory quality.
This makes SGD the first and only tertiary laboratory in the
Philippines to achieve this milestone, and one of less than 500
international laboratories to meet the CAP standards of accuracy,
competence and safety.
This proves that SGD is at par with the best hospitals, medical
centres and reference laboratories in the world.