Urinalysis Form Urinalysis run by:*ECBKMSMRTKSPKMCSDWName* First Last Patient Name*Species*CanineFelineRabbitOther-Must SpecifyDate and Time Collected:*Date and Time Run:*Volume Tested:*<1ml1-3ml3-10ml>10mlColor:*ClearLight YellowStrawDark YellowAmberRed TingedDistinct RedBrownishGreenClarity*Transparent (Clear)Slightly CloudyMod. CloudyVery CloudyOpaqueMethod of Collection:*Free CatchCystoFrom Exam tableFrom FloorLitterbox PelletsGlucose g/dL*Neg10025050010002000Bilirubin*NegativeSmallModerateLargeKetones mg/dL*NegativeTraceSmallModerateLargeBlood*NoneHemolyzedNon-HemolyzedQuantity of BloodTraceModerateLargePH*5.06.06.57.07.58.08.5Protein*NegativeTrace30+100+300+2000+Urobilinogen*Normal0.21245Nitrate*NegativePositiveLeukocytes (Dogs Only)*NegativeTrace1+2+3+RBC/hpf* None Rare 0-2 3-5 6-10 11-25 TNTC Specific Gravity:*WBC/hpf* None Rare 0-2 3-5 6-10 11-25 TNTC Epithelial Cells Seen ?* None Rare Few Many Type/Number of Epithelial Cells/hpfSquamous 0-2Squamous 3-6Squamous 6-10Squamous 11-25Squamous TNTCTransitional 0-2Transitional 3-6Transitional 6-10Transitional TNTCRenal Cells/hpf* None 1-2 2-4 3-6 >6 Bacteria/hpf* None Rare (1+) Moderate (2+) Many (3+) Bacterial Type Rods Cocci Bacillus Spirochaetes Singles Diplococci Chains Clusters Yeast Any Crystal Seen ?NoYesList CrystalsAmorphous:* Amorphous Crystal Amorphous Debris Lipid droplets Crystals-Formed/hpf* 0-2 3-5 6-10 11-25 Type of Formed Crystals (Acid Urine)* Uric Acid Crystals Calcium Oxylate Amorphous Urate Calcium Sulfate Sodium Urate Hippuric Acid Cystine Leucine Tyrosine Cholesterol Sulfa Type of formed crystals (Alkaline Urine)* Triple Phosphate Crystals (Struvite) Calcium Phosphate Amorphous Phosphate Calcium Carbonate Amonium Biurate Cystine Type of formed crystals (Acid/Neutral/Alkaline Urine)* Amorphous Phosphate Amorphous Urate Amonium Biurate Calcium Sulfate Calcium Oxalate Calcium Carbonate Calcium Phosphate Cholesterol Cystine Hippuric Acid Leucine Sodium Urate Sulfa Triple Phosphate Crystals (Struvite) Tyrosine Uric Acid Any Casts Present ?*NoYesCasts Hyaline Cast Granular Cast Fatty Cast Cellular Cast Waxy Cast RBS Cast WBC Cast Urinalysis Form
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