UNIVERSITY HOSPITAL
Telephone No.: (064) 572-2765, (064)572-2934
usmhospital1979@yahoo.com.ph
Kabacan, Cotabato
Philippines
HISTOPATHOLOGY REPORT
DATE: ____________
NAME: _______________________________________________________ AGE:______SEX:_____STATUS:______
(Surname) (First Name) (Middle Name)
ADDRESS:______________________________________________________________________________________
POST-OP DIAGNOSIS:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
__________________________
PHYSICIAN
HISTOPATHOLOGY REPORT
DATE: ____________
NAME: _______________________________________________________ AGE:______SEX:_____STATUS:______
(Surname) (First Name) (Middle Name)
ADDRESS:______________________________________________________________________________________
POST-OP DIAGNOSIS:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
__________________________
PHYSICIAN