S/N˚

Tests

Results

201

ECB and CSF Chemistry

Normal: ____1; Abnormal: ____2; Undetermined: ___3

202

Thick drop

Positive: ____1;Negative: ____2; Undetermined: ____3

203

HIV Serology

Positive: ____1; Negative: ____2; Indetermined: ____3

204

Blood culture

Sterile: ____1; pathology: ____2; Indetermined: ____3

205

Ionogram

Normal: ____1; Abnormal: ____2; Indetermined: ____3

206

Other

Normal: _____1; Abnormal: _____2; Specify__________