LifeGen Homecare & Laboratory Booking

Patient Information

PATIENT TYPE

Private Senior Citizen PWD

FULL PATIENT NAME *

EMAIL ADDRESS (OPTIONAL)

ADDRESS

CONTACT NUMBER *

REQUESTED BY / PHYSICIAN (optional)

Homecare Booking Details

Please provide your preferred schedule. All bookings are subject to confirmation by LifeGen.

SERVICES REQUESTED * (Select all that apply)

Doctor Home Visit Additional Family Member Consultation (same address, same visit) Follow-up Teleconsultation Home Laboratory Service (Blood Extraction)

Published service fees: Doctor Home Visit ₱2,500 • Additional family member ₱1,000/person • Follow-up teleconsultation ₱1,000 • Home laboratory service ₱600. Laboratory tests are separate.

PREFERRED DATE *

PREFERRED TIME *

SERVICE AREA *

ADDITIONAL FAMILY MEMBERS FOR CONSULTATION

BOOKING NOTES / LANDMARK / SPECIAL INSTRUCTIONS

Clinical Microscopy

Fecalysis₱120.00Micral Test₱650.00FOBT (FIT)₱720.00Pregnancy Test (Serum)₱500.00Pregnancy Test (Urine)₱250.00Urinalysis₱140.00

Hematology

ABO with Rh₱324.00CBC with PC₱400.00Complete Blood Count (CBC)₱240.00Platelet₱240.00Estimated Sedimentation Rate (ESR)₱250.00Hematocrit₱162.00Hemoglobin₱162.00Malaria Smear₱350.00Peripheral Blood Smear (PBS)₱400.00Reticulocyte Count₱350.00

Coagulation

Bleeding Time₱180.00Clotting Time₱180.00Prothrombin Time (INR)₱384.00Partial Thromboplastin Time (APTT)₱432.00

Routine Chemistry

Albumin₱260.00ALP (Alkaline Phosphatase)₱220.00ALT (SGPT)₱270.00Amylase₱520.00AST (SGOT)₱270.00Bicarbonate/Carbon Dioxide (CO2)₱420.00Bilirubin Direct₱350.00Bilirubin Total₱350.00Bilirubin Package (TB, DB, IB)₱1,050.00Creatine Kinase (CK)₱550.00CK TOTAL₱700.00CK MB₱750.00CK MMNWD ₱1,480.00Creatinine₱220.00Creatinine with GFR₱650.00GGT (Gamma Glutamyltransferase)₱550.00Glucose (RBS, FBS, 2HR)₱220.00HbA1c₱600.00Iron₱360.00Iron Studies (Ferritin, TIBC, Iron, Transferrin Saturation, CBC PC)₱4,080.00LDH (Lactate Dehydrogenase)₱450.00Lipase₱520.00CRP₱700.00OGTT 75g₱900.00OGTT 100g₱1,000.00Phosphorus₱264.00Total Protein₱192.00TPAG (Total Protein Albumin/Globulin Ratio)₱360.00Urea (BUN)₱240.00Uric Acid (BUA)₱240.00

Electrolytes

Calcium (Ionized)₱720.00Calcium (Total)₱200.00Chloride₱270.00Magnesium₱410.00Potassium₱270.00Sodium₱270.00

Lipid Studies

Apolipoprotein A₱2,160.00Apolipoprotein B₱2,160.00Cholesterol₱220.00HDL₱270.00LDL₱270.00VLDL₱220.00Triglyceride₱220.00

Blood Chemistry Packages

CHEM 5 — FBS, BUA, Creatinine, BUN, Chole₱900.00CHEM 10 (Routine Check Up) — FBS, BUA, Creatinine, BUN, Chole, TG, HDL, LDL, SGOT, SGPT₱1,600.00CHEM 12 — FBS, BUA, Creatinine, BUN, Chole, TG, HDL, LDL, SGOT, SGPT, TPAG₱2,000.00CHEM 23 (Executive Check Up) — FBS, BUA, Creatinine, BUN, Chole, TG, HDL, LDL, VLDL, SGOT, SGPT, ALP, LDH, CPK, Phosphorus, Amylase, Lipase, GGT, TPAG, Bilirubin Package, Na, K, Cl, iCal, Total Calcium, HbA1c₱3,500.00Lipid Profile — TC, TG, HDL, LDL, VLDL₱1,100.00Liver Profile — SGOT, SGPT, ALP, Bilirubin Package, TPAG₱1,800.00Kidney Function Test — BUN, Creatinine, BUA₱500.00

Special Chemistry

Anti Nuclear Antibody (ANA) Titer (QUANTITATIVE Elisa Method)HS ₱1,450.00Anti Cyclic Citrullated Peptide (CCP)₱4,200.00CD4 Count₱6,000.00Nesseria/ ChlamydiaNWD ₱4,400.00ANA (ELISA METHOD TITER) QUANTITATIVE₱1,450.00Complement 3₱720.00Complement 4₱720.00D-Dimer₱4,800.00Ferritin (Quantitative)₱1,560.00Folate / Folic Acid₱3,600.00Homocysteine₱2,400.00HsCRP (High Sensitive CRP)₱1,000.00IgE₱1,200.00TIBC + Fe₱1,000.00Vitamin B12₱5,900.00Vitamin D₱3,500.00

Urine Chemistry

Urine Albumin/Creatinine Ratio₱900.00Urine Amylase₱624.00Urine Calcium₱600.00Urine Chloride₱540.00Urine Creatinine₱420.00Urine Creatinine Clearance₱540.00Urine Glucose₱600.00Urine Magnesium₱600.00Urine Microalbumin₱900.00Urine Microalbumin/Creatinine Ratio₱1,920.00Urine Phosphorus₱600.00Urine Potassium₱540.00Urine Protein₱540.00Urine Sodium₱540.00Urine Uric Acid₱420.00IgE Serum (Total)NWD ₱2,500.00

Thyroid Assays

Thyroglobulin₱3,500.00Anti-Thyroglobulin₱2,500.00Anti TPO (Thyroid Peroxidase)₱3,000.00FT3₱600.00FT4₱600.00TSH Immuno₱600.00TSH IRMA₱2,500.00T3₱600.00T4₱600.00T-Uptake₱1,500.00

Hormones

Cortisol₱756.00DHEA-S (Dihydroepiandrosterone Sulfate)₱2,400.00Estradiol₱1,620.00FSH₱1,068.00HCG (Qualitative)₱530.00HCG (Quantitative)₱720.00Insulin₱1,440.00Intact PTH₱8,400.00Luteinizing Hormone (LH)₱1,080.00Progesterone₱1,680.00Prolactin₱1,080.00SHBG (Sex Hormone Binding Globulin)₱3,840.00Testosterone (Total)₱1,200.00Testosterone (Free & Total)₱3,000.00

Hepatitis

Hepatitis A IgG (Anti-HAV IgG)₱540.00Hepatitis A IgM (Anti-HAV IgM)₱540.00Hepatitis B Core IgG Total (Anti-HBc Total)₱480.00Hepatitis B Core IgM (Anti-HBc IgM)₱480.00Hepatitis B Envelope Ab (Anti-HBe)₱480.00Hepatitis B Envelope Ag (HBeAg)₱480.00Hepatitis B Surface Ab (Anti-HBs)₱360.00Hepatitis B Surface Ag (HBsAg)₱360.00Hepatitis C Ab (Anti-HCV)₱980.00

Tumor Markers

AFP (Immuno Titer)₱1,800.00B-HCG (Titer)₱1,680.00CEA (Colorectal)₱1,800.00CA 125 (Ovary)₱1,920.00CA 15-3 (Breast)₱2,040.00CA 19-9 (Pancreas)₱2,640.00CA 72-4₱3,600.00Cyfra 21-1₱1,200.00HE-4 (Ovarian)₱3,600.00PSA (Titer)₱2,160.00

Serology

Anti Streptolysin O (Immuno Titer)₱660.00CRP (Immuno Titer)₱696.00Dengue IgG/IgM₱1,350.00Dengue NS1₱2,050.00Dengue Duo₱2,200.00H. pylori Ag (Stool)₱1,680.00H. pylori Ab (Qualitative)₱1,320.00H. pylori IgG₱2,520.00H. pylori IgM₱2,520.00HIV 1&2₱1,300.00Leptospira₱1,032.00Mumps IgG (Titer)₱3,456.00Rheumatoid Factor (Immuno Titer)HS ₱720.00RPR/VDRL (Qualitative)₱360.00RPR/VDRL (Quantitative)₱950.00Rubella IgG (German Measles)₱1,560.00Rubella IgM (German Measles)₱2,160.00Rubeola IgG (Measles IgG)₱4,200.00Rubeola IgM (Measles IgM)₱4,200.00Troponin I (Qualitative)₱1,200.00Troponin I (Quantitative)₱2,880.00Typhidot₱1,320.00TORCH₱3,120.00TPHA (Treponema Pallidum Hemeagglutination)NWD ₱1,650.00

Bacteriology

AFB₱300.00Gram Stain₱300.00Sputum₱720.00Stool₱720.00Urine₱720.00

LifeGen Packages

I. Routine Work Up — CBC, Urinalysis, Chem 12₱3,200.00II. General Health Care — CBC, HbA1c, Urinalysis, Fecalysis, FOBT, HBsAg, Anti-HBs, CEA, Chem 18₱9,000.00III. Executive Check Up for Men's Health — CBC, Urinalysis, Fecalysis, ESR, HbA1c, FOBT, HBsAg, Anti-HBs, Anti-HAV IgM, Anti-HCV₱16,000.00Hepatitis ABC Profile — HBsAg, Anti-HBs, Anti-HAV IgM, Anti-HCV₱2,800.00Hepatitis A Profile — Anti-HAV IgM, Anti-HAV IgG₱1,000.00Hepatitis B Profile — HBsAg, Anti-HBs, HBeAg, HBc IgG, HBc IgM₱2,300.00Hepatitis B Profile – DIALYSIS — HBsAg, Anti-HBs, Anti-HCV₱1,600.00XI. Osteoarthritis Health Check — CBC, ESR, BUA, Total Calcium, hsCRP, RA with titer, ASO with titer₱3,800.00XII. Screening Test for Anemia — CBC, Iron Studies₱4,000.00XIII. Coagulation Panel — CBC, PT, PTT, Peripheral blood smear₱1,500.00XIV-A. Tumor Markers — Female: CEA, AFP, CA-19-9 (Pancreas), CA 125 (Ovary), CA 15-3 (Breast)₱8,950.00XIV-B. Tumor Markers — Male: CEA, AFP, CA-19-9, PSA₱7,350.00XV-A. Fertility/Hormonal Panel — Female: FSH, LH, Estradiol, Prolactin, Progesterone₱6,200.00XV-B. Fertility/Hormonal Panel — Male: FSH, LH, Testosterone₱5,200.00XVI. Screening Test for STD — CBC, Urinalysis, HBsAg, VDRL, HIV₱1,800.00XVII. STI PACKAGE — CBC PC, VDRL, HBsAg₱1,000.00XVIII. Comprehensive Test for STD — CBC, Urinalysis, TPHA, VDRL, HBsAg, HSV Type 1/2 IgG, HSV Type 1/2 IgM, Neisseria/Chlamydia, Anti-HCV, Anti-HAV IgM, HIV 1 and 2₱21,000.00XIX. RTPCR TEST₱2,600.00

Other Test / Request

NOTES

LIFEGEN LABORATORY AND DIAGNOSTIC CENTER