> ## Documentation Index
> Fetch the complete documentation index at: https://docs.bizaxl.com/llms.txt
> Use this file to discover all available pages before exploring further.
# Laboratory
> How to manage pre-operative blood tests and other lab investigations at an eye care center - from ordering through sample collection, result entry, and approval.
At an eye care center, laboratory investigations are primarily used for pre-operative assessment and for monitoring patients with systemic disease that affects the eyes (diabetes, hypertension). The lab module tracks every step from when the doctor orders a test to when the approved result is available.
***
## When Lab Tests Are Needed at an Eye Care Center
| Situation | Tests Typically Ordered |
| -------------------------------------- | -------------------------------------------------------- |
| Pre-cataract surgery (standard) | Random blood glucose, Complete Blood Count (CBC) |
| Pre-cataract surgery (elderly patient) | Blood glucose, CBC, ECG, Serum creatinine, Urine routine |
| Diabetic patient (new presentation) | HbA1c, Fasting blood glucose |
| Diabetic retinopathy review | HbA1c (every 3-6 months) |
| Pre-LASIK | Blood glucose (to rule out uncontrolled diabetes) |
| Pre-intravitreal injection | INR / clotting time (if on blood thinners) |
| Suspected infective conjunctivitis | Conjunctival swab culture and sensitivity |
| Thyroid eye disease | Thyroid function tests (TSH, T3, T4) |
| Rheumatoid/autoimmune eye disease | ANA, ANCA, Rheumatoid Factor, ESR |
***
## Before You Start
* **Lab Test Templates** must be set up for each test.
* **Lab Test Samples** (Blood, Conjunctival Swab, Urine) must be configured.
* The **Laboratory User** role is required to process tests and enter results.
* The **LabTest Approver** role is required to release results.
***
## Step 1: Lab Tests Are Ordered from the Eye Examination
When the doctor adds a lab test in the Patient Encounter (eye examination):
1. Open the Patient Encounter
2. In the **Lab Tests** section, add the required tests (e.g., Blood Glucose, CBC)
3. Submit the encounter
If "Submit Orders on Save" is enabled, Lab Test records are created automatically.
***
## Setting Up Lab Test Templates (Admin Task)
Key templates for an eye care center:
| Template Name | Sample | Key Parameters |
| -------------------------- | ----------------- | ------------------------------------------ |
| Random Blood Glucose | Blood | Glucose (mg/dL), Normal: 70-140 mg/dL |
| Fasting Blood Glucose | Blood | Glucose (mg/dL), Normal: 70-100 mg/dL |
| HbA1c | Blood | HbA1c %, Normal: below 5.7% (non-diabetic) |
| Complete Blood Count (CBC) | Blood | Haemoglobin, WBC, Platelets, RBC count |
| Urine Routine | Urine | Albumin, Sugar, RBC, WBC, Casts |
| Thyroid Function Test | Blood | TSH, Free T3, Free T4 |
| Serum Creatinine | Blood | Creatinine (mg/dL), Normal: 0.6-1.2 |
| Conjunctival Swab Culture | Conjunctival Swab | Organism grown + antibiotic sensitivity |
| Prothrombin Time / INR | Blood | INR, Normal: 0.8-1.2 |
***
## Step 2: Sample Collection
The nurse or lab technician collects the sample and registers it:
1. Go to Healthcare workspace → Laboratory card → **Sample Collection** → New
| Field | What to Enter |
| -------------- | ------------------------------------- |
| Patient | The patient |
| Sample | Blood, Urine, Conjunctival Swab, etc. |
| Lab Test | Link to the lab test ordered |
| Collected Date | Date of collection |
| Collected Time | Time of collection |
| Practitioner | Staff member who collected the sample |
2. Save and Submit
***
## Step 3: Entering Results
Once the sample has been processed:
1. Go to Laboratory card → **Lab Test** → open the pending test
2. In the **Normal Test Result** table, enter values for each parameter
3. Record the Lab Technician and Result Date
4. Save
***
## Step 4: Approving and Releasing Results
If "Lab Test Approval Required" is on in Healthcare Settings:
1. The Lab Approver opens the completed test
2. Reviews results - specifically checking for values that affect surgical fitness (e.g., blood glucose over 200 mg/dL means the patient may not be fit for surgery)
3. Clicks Submit to approve and release
4. Result is now visible in Patient History and can be printed or emailed
***
## Pre-operative Fitness for Surgery
The lab results for surgical patients need to be reviewed before clearing the patient for surgery. Key thresholds for eye surgery:
| Test | Result Requiring Attention |
| ------------- | ---------------------------------------------------------- |
| Blood Glucose | Over 200 mg/dL random - surgery may need to be postponed |
| HbA1c | Over 9% - discuss with patient's physician before surgery |
| Haemoglobin | Below 10 g/dL - discuss with surgeon |
| INR | Over 2.5 - discuss anticoagulation management with surgeon |
| Creatinine | Elevated - flagged for anaesthesia team |
Add notes about surgical fitness in the Lab Test comments or the pre-operative assessment record.
***
## Lab Test Billing
Lab tests have their own **Invoiced** field. Billing options:
* Bill when the test is ordered (pre-payment)
* Bill after results are available
For pre-operative blood tests, billing is typically included in the pre-operative assessment fee or charged separately per test.
***
## Field Guide: Lab Test (Eye Care)
| Field | What It Contains |
| ----------------------- | ---------------------------------------- |
| Patient | The patient |
| Test Template | The test type (Blood Glucose, CBC, etc.) |
| Requesting Practitioner | The doctor who ordered it |
| Status | Pending, Completed, Approved |
| Sample ID | Linked Sample Collection record |
| Result Date | When results were entered |
| Normal Test Items | Result values with normal ranges |
| Invoiced | Whether the test has been billed |
***
## Troubleshooting
**The pre-op blood test was done but the patient says the doctor does not have the results**
Check that the Lab Test record has been submitted (approved). If still in Pending status, the Lab Approver needs to review and submit it.
**I cannot find the lab test for a patient ordered yesterday**
Check that the doctor submitted the Patient Encounter with the lab order. If the encounter is still in Draft, the lab test was not created. Ask the doctor to submit the encounter.
**The conjunctival swab result shows no organism but the patient has a severe infection**
Some organisms are difficult to culture. Check that the swab was taken before any antibiotic drops were started - antibiotics affect culture results. Note this in the lab test comments.
***
## Best Practices
* For pre-operative blood tests, check results at least 2-3 days before the surgery date - if results show the patient is unfit for surgery, you need time to postpone and rebook the surgical list
* For diabetic patients having intravitreal injections, check the blood glucose on the day of the injection - do not inject if glucose is critically high
* Set up the conjunctival swab culture template with antibiotic sensitivity options - an organism growing without sensitivity data is not clinically useful
* When ordering a full pre-op panel, add all tests in one Patient Encounter rather than ordering them one at a time - this links all tests to the same encounter and makes result review easier
* For patients on warfarin, always check INR within 48 hours of any planned intraocular surgery
***
## Related Features
* [Eye Examination](/health-wellness/eye-care-center/eye-examination): Lab tests are ordered from the Patient Encounter
* [Surgical Procedures](/health-wellness/eye-care-center/surgical-procedures): Pre-op blood tests must be cleared before surgery
* [Billing and Finance](/health-wellness/eye-care-center/billing-finance): Lab tests are billed separately