Eligible participant has to fullfill all of the following items

Date

yyyy-mm-dd

Did you experienced any drug allergy?

Namy of the drug to be allergied

Date of drug allergy happened

yyyy-mm-dd/mm-dd

Current status

Date of birth:

yyyy-mm-dd

Gender

Nationality

Age

Years

Occupation

Systolic pressure (SP)

mmHg

Diastolic pressure

mmHg

Temperature

degree Celsius

Position of measurement

Pulse rate

次/分

Breath frequency

次/分

Hb

g/L

RBC

X10^9/L

%

WBC

X10*3/L

PLT

X10*9/L

%

Erythrocyte sedimentation rate

mm/h

Date of test

pH

Clinical judgement

WBC

/μl

Clinical judgement

ERY

/μl

Clinical judgement

GLU

mmol/L

Clinical judgement

PRO

g/L

Clinical judgement

Date of examination

yyyy-mm-dd

Prothrombin time

秒

Clinical significant

Thrombin time (TT)

秒

Clinical significant

Activated partial thromboplastin time (APTT)

秒

Clinical significant

Fibrinogen (FIB)

g/L

Clinical significant

ALT

IU/L

AST

IU/L

AST/ALT

γ-Glutamyltransferase

IU/L

GGT

U/L

Serum bilirubin

μmol/L

Indirect bilirubin

umol/L

Direct bilirubin

umol/L

Serum albumin

g/L

Serum globulin

g/L

Serum total protein

g/L

A/G

Date of test

yyyy-mm-dd

HbA1c

%

Blood glucose

mmol/L

Triglycerides

mmol/L

Total cholesterol

mmol/L

High density lipoprotein cholesterol

mmol/L

Low density lipoprotein cholesterol

mmol/L

NHDL

mmol/L

TCHO/HDL-C

%

Date of examination

yyyy-mm-dd

Date of examination

yyyy-mm-dd

Urea nitrogen

Clinical significant

Creatinine

umol/L

Clinical significant

Cystatin C

mg/L

Clinical significant

Uric acid

umol/L

Clinical significant

AST

U

LDH

IU

Lactic dehydrogenase isoenzyme

α-HBDH

U/L

Creatine Kinase, CK

U/L

Creatine kinase isoenzyme, CKMB

U/L

Date of tests

yyyy-mm-dd

Starting time

yyyy-mm-dd

Name of the drug

ALT

IU/L

AST

IU/L

AST/ALT

γ-Glutamyltransferase

IU/L

Serum bilirubin

μmol/L

Indirect bilirubin

umol/L

Direct bilirubin

umol/L

Serum albumin

g/L

Serum globulin

g/L

Serum total protein

g/L

A/G

Date of test

yyyy-mm-dd

Urea nitrogen

Clinical significant

Creatinine

umol/L

Clinical significant

Cystatin C

mg/L

Clinical significant

Uric acid

umol/L

Clinical significant

Date of examination

yyyy-mm-dd

Name of the drug

Indication

The form of a drug

Single dose

Dose unite

The way of giving drug

Frequency of giving drug

Starting time

yyyy-mm-dd

Does it current continue?

Time of completed the treatment

yyyy-mm-dd

WBC

×109 /L

NEUT%

%

LY%

%

MONO％

％

RBC

×10^12 /L

HGB

g/L

PLT

×10^9 /L

Researcher signature

Date

yyyy-mm-dd

Acidity and allkalinity

pH value

Urine protein

Urine red cell

Urine WBC

Urine glucos

Urine Bilirubin

Urine HCG

KET

SG

UBG

NIT

Date of test

yyyy-mm-dd

ALT

IU/L

AST

IU/L

AST/ALT

γ-Glutamyltransferase

IU/L

GGT

U/L

Serum bilirubin

μmol/L

Indirect bilirubin

umol/L

Direct bilirubin

umol/L

Serum albumin

g/L

Serum globulin

g/L

Serum total protein

g/L

A/G

Date of test

yyyy-mm-dd

Date of examination

yyyy-mm-dd

Urea nitrogen

Clinical significant

Creatinine

umol/L

Clinical significant

Cystatin C

mg/L

Clinical significant

Uric acid

umol/L

Clinical significant

AST

U

LDH

IU

Lactic dehydrogenase isoenzyme

α-HBDH

U/L

Creatine Kinase, CK

U/L

Creatine kinase isoenzyme, CKMB

U/L

Date of tests

yyyy-mm-dd