Urinalysis Form Name* First Last Patient Name*Species*CanineFelineRabbitOther-Must SpecifyDate and Time Collected:*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 TNTCBacteria/hpf* None Rare (1+) Moderate (2+) Many (3+) Bacterial Type Rods Cocci Bacillus Spirochaetes Singles Diplococci Chains Clusters Yeast Any Crystal Seen ?NoYesAmorphous:* 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 Any Casts Present ?*NoYesCasts Hyaline Cast Granular Cast Fatty Cast Cellular Cast Waxy Cast RBS Cast WBC Cast Urinalysis Form
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