Blood Bank

Patient Details

Patient Code

Hospital File number

First Name

Last Name

Grand Father

Mother Name

Marital Name

Blood Group Close

First Determination

Blood Group

Date

Operator

Reagent

Tube #

Tube Date

Second Determination

Blood Group

Date

Operator

Reagent

Tube #

Tube Date

Batch

Id	Batch -A-	Batch -B-	Batch -D-
1
2

Phenotype

D

C

c

E

e

CW

K

JKa

Lea

Leb

Fya

Fyb

M

N

S

s

P

Kpa

Kpb

Lua

Lub

X0

X1

X2

X3

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