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Public Health Wales New Entrant Screening
Date: November 2015 Version: 1 Page: 1 of 18
Screening of New Entrants arriving via the
Syrian Vulnerable Persons Relocation
Scheme (VPRS):
a brief guide for service providers in Wales
Author: Dr Rhianwen Stiff, Consultant in Communicable Disease Control,
Health Protection Team, Public Health Wales
Date: 17 November 2015 Version: 1
Publication/ Distribution: (Delete as applicable)
NHS Wales Intranet
Public Health Wales Intranet
Health Boards
Local Authorities in Wales
Welsh Government
Review Date: September 2016
Purpose and Summary of Document:
The UK Government have proposed to increase opportunities for entry into
the UK of people from Syria and surrounding areas. A new programme
(Syrian Vulnerable Persons Relocation Scheme) has been established to
facilitate entry into the UK.
This document provides brief guidance for health boards, local authorities,
service providers and clinicians involved with the provision of health care to new entrants to Wales arriving via the Syrian VPRS programme. This
guidance provides an overview of the health care needs of new entrants to Wales, but concentrates on those aspects of new entrant health care
relating to screening for infectious diseases and the provision of vaccinations.
Public Health Wales New Entrant Screening
Date: November 2015 Version: 1 Page: 2 of 18
Content
Introduction ...................................................................................3
Principles underpinning new entrant healthcare provision .....................3
Audience ........................................................................................3
Definitions ......................................................................................4
The immediate needs of new entrants ................................................4
Health assessment of new entrants arriving via Syrian VPRS .................5
Specific public health concerns ..........................................................6
Vaccination status ...........................................................................8
References ...................................................................................11
Appendix A ...................................................................................12
Public Health Wales New Entrant Screening
Date: November 2015 Version: 1 Page: 3 of 18
Introduction
The UK Government have proposed to increase opportunities for entry
into the UK of refugees from Syria and surrounding areas, and a new programme (Syrian Vulnerable Persons Relocation Scheme, Syrian VPRS)
has been established to facilitate this. These individuals will therefore not enter the UK or Wales via established specific refugee or asylum seeker
routes or services.
This document provides brief guidance for health boards, local authorities,
service providers and clinicians involved with the provision of health care to new entrants to Wales arriving via the Syrian VPRS programme. This
guidance provides an overview of the health care needs of new entrants to Wales, but concentrates on those aspects of new entrant health care
relating to screening for infectious diseases and the provision of vaccinations.
As Wales will imminently be welcoming our first Syrian new entrants
arriving via the VPRS, the health care of this specific group is very topical. However, the principles outlined in this document could also be applied to
new entrants arriving in Wales via other routes including asylum seekers, refugees and reuniting families.
Principles underpinning New Entrant healthcare provision:
New entrants should have access to the same healthcare, with the
courtesy and dignity afforded to any other population group in Wales This does allow for selective screening based on risk profile, which is
also applied to other population groups in Wales
Testing based on symptoms, signs or clinical examination is diagnostic rather than for screening
Testing not prompted by clinical symptoms or signs is a form of screening and should, as far as possible, satisfy the UK criteria for a
screening programme (in particular availability of an appropriate test and opportunity for disease modification).
Audience
The intended audience for this guidance includes:
Health Boards and Local Authorities expecting the arrival of New
Entrants via the Syrian VPRS programme
Primary care clinicians registering New Entrants with their practice and/or having clinical contact with New Entrants
Specific services offering primary care provision for New Entrants only
Public Health Wales New Entrant Screening
Date: November 2015 Version: 1 Page: 4 of 18
Clinicians in other services (e.g. A&E, Child Health, Obstetrics) that
may be the first contact of New Entrant with NHS services in Wales.
Definitions
Asylum is when someone applies for protection from persecution or fear
of persecution in their own country. The UK Border Agency then decides whether the application is legitimate1.
An asylum seeker is someone who is waiting for their application to be
recognised as a refugee to be considered by the UK Government1.
A refugee is someone who has applied for asylum and has by law been granted refugee status1.
For the purpose of this document, a new entrant may be an asylum seeker or refugee, the spouse/child/family member of a person granted
refugee status (reuniting family), or an individual granted entry to Wales/UK via specific application to programmes such as the Syrian
Vulnerable Persons Relocation Scheme.
The immediate needs of New Entrants
Recommendations from expert interviews and literature reviews undertaken by the European Centre for Disease Prevention and Control1
highlighted the overall needs of New Entrants entering Europe from Syria and neighbouring areas:
Reception centres/systems for the newly arrived in order to assure health assessments immediately upon arrival
Adequate shelter to avoid crowding and ensuring good sanitation and hygienic conditions. These measures are particularly important to
prevent occurrence of louse-borne relapsing fever (LBRF), trench
fever, epidemic and endemic typhus, scabies, and other vector-, air-(meningococcal disease), and food-borne diseases.
Health education and health promotion emphasising the positive benefits of health assessment, screening, immunisation and other
measures Screening for communicable diseases according to their country of
origin and countries transited during migration Access to healthcare, free of charge, for the diagnosis and
treatment of communicable diseases including primary and emergency healthcare.
Some studies suggest that the average physical health status of asylum
seekers on arrival to the UK is not particularly poor compared to that of the general UK population2. However, many asylum seekers have much
Public Health Wales New Entrant Screening
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more complex health and social care needs. Pregnant women,
unaccompanied children, those with significant mental health problems, and those who have experienced traumatic events such as rape or torture
are likely to be particularly vulnerable3.
In general the main health needs of asylum seekers include3: Communicable diseases, e.g. Tuberculosis, Hepatitis B&C, HIV, etc.
Mental health problems e.g. PTSD, anxiety and depression are more prevalent in asylum seekers than the general population
Pregnancy – late presentation for antenatal care; Hepatitis B, diabetes, hypertension
Child protection issues Human trafficking and sexual exploitation
General health needs – chronic diseases management, child health surveillance, immunisation, contraception, dental health
In addition, several barriers to accessing healthcare are faced4,8,9, e.g.:
Lack of awareness of how to access the NHS or understanding of the model of care it provides –asylum seekers may have very different
expectations and experiences of primary healthcare Lack of accessible information about health and available services
Difficulty in registering with a local GP Language and communication difficulties – language issues are a key
barrier to accessing services, including healthcare. Lack of requested documentation e.g. ID, birth certificate, vaccination
records Concerns regarding confidentiality – fear and mistrust issues; stigma
related to some health issues e.g. rape, sexually transmitted diseases, mental illness
Lack of training for NHS staff regarding the needs and entitlements of
asylum seekers Misconceived ideas and ignorance about asylum seeker needs
Health assessment of New Entrants arriving via Syrian VPRS
New entrants to Wales via the Syrian VPRS are at risk of exposure to
infectious diseases in the same way as any other resident in Wales, but may be more vulnerable due to interruptions in public health programmes
(such as immunisation programmes) in Syria. In addition, this population may be subject to specific risk for infectious diseases in relation to their
country of origin, countries visited and the conditions experienced during their journey to Wales5.
New Entrants arriving in Wales via the Syrian VPRS will have undergone
an extensive health review as part of the programme application process (see outline of VPRS process and IOM form in Appendix A). This is in
Public Health Wales New Entrant Screening
Date: November 2015 Version: 1 Page: 6 of 18
contrast to new entrants arriving via conventional refugee, asylum
seeker, migrant or reuniting family routes.
Upon arrival in Wales it is recommended that the IOM form is reviewed and that new entrants undergo initial public health screening to allow
urgent health needs to be identified and addressed.
As a guide, it is suggested that initial screening includes: Obtaining medical history [to include, where relevant, acute
symptoms, medication, chronic conditions, obstetric needs, female genital mutilation, sexual health screening, history of forced
marriage/abuse/ trauma/torture] HIV status (disclosed in medical history and/or identification of risk
factors precipitating informed consent and testing; screening tests for HIV are not currently routinely offered to new entrants arriving via non
Syrian VPRS routes)
Hepatitis B and C (disclosed in medical history and/or identification of risk factors precipitating informed consent and testing; screening tests
for HIV are not currently routinely offered to new entrants arriving via non Syrian VPRS routes)
Identification of active and latent Tuberculosis (symptom history, clinical examination signs, vaccination history, country of birth, country
& circumstances (e.g. overcrowding/refugee camp) of residence prior to arrival in Wales and appropriate diagnostic or screening tests in line
with NICE recommendations) Review of immunisation status
Mini mental assessment and PTSD assessment
Specific public health concerns
Based on expert opinion ECDC recently concluded that refugees and migrants crossing the European Union’s southern or south-eastern
borders are most at risk from respiratory tract diseases, tuberculosis, gastrointestinal diseases, relapsing fever, trench fever, epidemic and
murine typhus, meningococcal disease, poliomyelitis, measles, mumps and rubella5,6,7.
While the risk of mosquito-borne diseases has been reduced as a result of
the approaching winter, the risk to refugees of diseases whose spread are facilitated by overcrowding and lower temperatures has increased5.
During initial assessment, consideration should be given to syndromes including: upper and lower respiratory tract disease, bloody and watery
diarrhoea, fever and rash, meningitis/encephalitis or encephalopathy / delirium, lymphadenitis with fever, sepsis or unexplained shock,
haemorrhagic illness, acute jaundice, cutaneous infection, and
unexplained death10.
Public Health Wales New Entrant Screening
Date: November 2015 Version: 1 Page: 7 of 18
Tuberculosis
The social and economic vulnerability of refugee population create favourable conditions for tuberculosis as well as the high proximity in
close setting5. Therefore, tuberculosis cases among refugees are not unexpected5.
MERS CoV
New entrants, presenting with respiratory symptoms, and recently arrived
from a country where MERS CoV is circulating, should undergo risk
assessment in line with current guidance
Ebola
New entrants recently arrived from a country where Ebola virus is
circulating, should undergo risk assessment in line with PHW Ebola
guidance
Influenza
New entrants are at risk of acquiring influenza in reception camps, during their journey, and after arriving in Wales. Vaccination is an option that
should be considered for individuals in high risk groups and in line with Wales’ flu vaccination policy.
Malaria, leishmaniasis and schistosomiasis
The risk for vector-borne diseases, such as malaria ranges from very
limited to non-existing in the Middle East and North African countries, but should be considered for persons originating from sub-Saharan African
countries or Asia (India, Pakistan)5,10.
Scabies
Outbreaks of scabies in refugee accommodation centres across Europe
have been reported5. Such outbreaks are not unexpected in the context of poor living conditions and the lack of access to proper water and
sanitation conditions during migration/within some accommodation centres across Europe5.
Typhoid fever
Cases of typhoid have been reported among new entrants to Europe from
Syria5. Appropriate diagnostic testing should be undertaken in anyone presenting with consistent symptoms.
Cholera
There is an ongoing cholera outbreak in Iraq which is reported to have affected 2,200 people, with six fatalities5. WHO at this stage is not
confirming that cases of cholera have been identified in Syria5, however it is probably only a matter of time before cases are confirmed in Syria,
Kuwait and Bahrain5. Despite the short incubation period (2 hours to 5 days) which would most likely prevent symptomatic cases being able to
Public Health Wales New Entrant Screening
Date: November 2015 Version: 1 Page: 8 of 18
complete their travel to Europe, asymptomatic carriers can excrete the
vibrio for 10 days5. Therefore, transmission originating from an asymptomatic carrier among refugee populations on their way to Europe
cannot be excluded5.
Cutaneous diphtheria
In July 2015, Denmark, Germany and Sweden reported seven cases of
toxigenic cutaneous diphtheria and two cases of non-toxigenic cutaneous diphtheria among refugees from Eritrea, Libya, Syria (1 case), Ethiopia
and Libya5. Most refugees who arrive in Europe are from endemic countries and have travelled under conditions that increase the risk of
acquiring cutaneous diphtheria5. In the event that cutaneous diphtheria is suspected in an individual presenting with symptoms, the clinician should
seek urgent advice from the local Infectious Diseases Consultant of Microbiology Consultant.
Louse borne diseases
As of 12 of November 2015, 27 case on louse borne relapsing fever
(LBRF) were reported in EU member states among refugees coming from countries of the Horn of Africa5. These include descriptions of cases who
have been living in crowded accommodation in Europe for several years and had seemingly acquired LBRF by transmission from a newly arrived
infected individual. Seek advice from local Infectious Disease Consultant or Microbiology Consultant with regard to hospital admission and
antibiotic therapy.
Other
Low coverage for some vaccines, along with low immunity for some
diseases, may result in susceptible new entrants developing diseases such
as measles and chicken-pox5.
Vaccination status
Obtaining an accurate vaccination history is crucial. Vaccinators should seek written documentation from New Entrants of
each individuals vaccination status
Written documentation of receipt of vaccinations may not always be
available: in such circumstances, vaccinators should provide
immunisations in line with Public Health England’s guidance on the
Vaccination of Individuals with Uncertain or Incomplete Vaccination
Status (PHE, September 2015)
Vaccinators should not use a proxy measure to estimate which
vaccines may have been given to an individual. Although the WHO
Vaccination Schedule by Country website
(http://apps.who.int/immunization_monitoring/globalsummary/schedul
Public Health Wales New Entrant Screening
Date: November 2015 Version: 1 Page: 9 of 18
es) is an extremely valuable resource, individuals may not have been
able to access usual healthcare services for example due to conflict,
displacement from home or lack of available vaccine.
All New Entrants should be offered vaccinations in line with the UK
schedule.
The European Centre for Disease Prevention and Control specifically
recommend provision of the following vaccinations1,5:
MMR, prioritising children up to the age of 15 years.
Poliomyelitis vaccination should be considered for children and adults
coming from countries currently exporting polio virus (such as
Afghanistan and Pakistan), infected countries (such as Nigeria and
Somalia), or countries which remain vulnerable to international spread
(including Cameroon, Equadorial Guinea, Ethiopia, Iraq, Israel and
Syria).
Vaccination against meningococcal serogroups A, C, W-135 and Y (or
against serogroups A and C if quadrivalent vaccine not available)
When provision of live vaccines is required, vaccinators should make reasonable attempts to clarify the immune status of the individual,
including checking HIV status. Vaccinators should explain the potential risk of administering live vaccine to an immunosuppressed person, and if
in doubt should consider offering testing e.g. for HIV.
For details advice on the vaccines and their administration, vaccinators should follow guidance within Immunisation Against Infectious Disease:
the green book https://www.gov.uk/government/publications/immunisation-against-
infectious-disease-the-green-book-front-cover-and-contents-page
Public Health Wales New Entrant Screening
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References
1. European Centre for Disease Prevention and Control. Expert Opinion on the public health needs of irregular migrants, refugees
or asylum seekers across the EU's southern and south-eastern borders. Stockholm: ECDC; 2015
2. British Medical Association. Asylum seekers: meeting their healthcare needs. London: British Medical Association; 2002.
3. McKay J. And Price S. Review of healthcare for asylum seekers in Wales. Public Health Wales; 2013.
4. Cardiff & Vale University Health Board. Cardiff Health Access Practice (CHAP) Practice Development Plan 2012-2014.
5. European Centre for Disease Prevention and Control.
Communicable disease risks associated with the movement of refugees in the winter season – 10 November 2015. Stockholm:
ECDC; 2015. 6. European Centre for Disease Prevention and Control (ECDC).
Expert Opinion on the public health needs of irregular migrants, refugees or asylum seekers across the EU's southern and south-
eastern borders [Internet]. Stockholm: ECDC; 2015. Available from:
http://ecdc.europa.eu/en/publications/_layouts/forms/Publication_DispForm.aspx?List=4f55ad51-4aed-4d32-b960-
af70113dbb90&ID=1377#sthash.1y0CWCyQ.dpuf. 7. European Centre for Disease Prevention and Control (ECDC). Risk
of importation and spread of malaria and other vector-borne diseases associated with the arrival of migrants to the EU.
Stockholm: ECDC; 2015. Available from:
http://ecdc.europa.eu/en/publications/_layouts/forms/Publication_DispForm.aspx?List={4F55AD51-4AED-4D32-B960-
AF70113DBB90}&ID=1393#sthash.spOKWHHk.dpuf. 8. United Nations High Commissioner for Refugees (UNHCR).
Ensuring access to health care. Operational guidance on refugee protection and solutions in urban areas. Geneva: UNHCR; 2011.
Available from: http://www.unhcr.org/4e26c9c69.pdf. 9. Morris MD, Popper ST, Rodwell TC, Brodine SK, Brouwer KC.
Healthcare barriers of refugees post-resettlement. J Community Health. 2009 Dec;34(6):529-38.
10. European Centre for Disease Prevention and Control (ECDC). Expert Opinion on the public health needs of irregular migrants,
refugees or asylum seekers across the EU's southern and south-eastern borders [Internet]. Stockholm: ECDC; 2015. Available
from:
http://ecdc.europa.eu/en/publications/_layouts/forms/Publication_DispForm.aspx?List=4f55ad51-4aed-4d32-b960-
af70113dbb90&ID=1377#sthash.1y0CWCyQ.dpuf.
Public Health Wales New Entrant Screening
Date: November 2015 Version: 1 Page: 13 of 18
Migration Health Assessment WORKSHEET Form 04MH_A
1. Assessment Date: 2. Program:
3. Ref. ID No:
4. Name :
(Last) (First) (Middle)
5. Gender: F M 6. DOB: 7. Principal Applicant: No Yes
8. Case No. 9. Country: 10. Nationality:
11. Exam Place: 12. Exam Country: 13. Doctor:
14. Health Assessment completed on:
15. Medical Conditions Identified
None Syphilis Physical impairment/disability
TB, active, infectious Other sexually transmitted
diseases Significant Mental health condition
TB, active, non-infectious Human immunodeficiency virus
Addiction(abuse) of specific substances
TB, inactive Other significant condition, specify:
16. Description of significant condition / Treatment / Recommendation ICD Code(s)
17. TREATMENT Administered: No Yes (pls. provide details in Remarks above, or attach the “IOM treatment form”)
Syphilis Anti-malaria De-worming
Dates: Drugs/Dosage: Dates: Drugs/Dosage: Dates: Drugs/Dosage:
1. 2. 3.
1. 2. 3.
1. 2. 3.
18. VACCINES Administered: No Yes
Dates: Vaccine: Dates: Vaccine: Dates: Vaccine:
1. 4. 7.
2. 5. 8.
3. 6. 9.
19. Travel Recommendations 20. Pregnancy No Yes
Fit to travel: Yes Conditionally No
a)To travel Before:
Special attention on pre-flight assessment: No
Yes b) Not to travel before:
Hospitalization required: Pre-depart. Post-arrival
21. Equipment / Medication 22. Escorts No Yes
Update
Public Health Wales New Entrant Screening
Date: November 2015 Version: 1 Page: 14 of 18
Ambulance Stretcher Bowel Prep. Med. Escort-POE Family escort
WCHR 3 seats Diapers Med. Escort-FD Operational Escort
WCHS Oxygen Urinary catheter Medical Escort By: Other, specify: WCHC Interflight Th
admin. Other Doctor Nurse
23. Post-travel recommendations 23.A Follow-up needed : No Yes
Special schooling/employment needs By whom: Within:
Consequences on daily living activities (Assistance Required)
by GP one week
Special housing requirements by Specialist, specify:
one month
Excessive demands for the health service 6 months
Remarks/Details:
Date: Examining physician’s name address and telephone number (stamp may be used):
Signature:
Form 04MH_B 1. Assessment Date:
MEDICAL HISTORY&PHYSICAL EXAM 2. Program:
3. Name:
4. Case No:
5. Date of Birth:
Yes No 1. Medical History
Illness or injury requiring hospitalization Recurrent fever (last 6 months)
Surgical interventions Coughing
Heart disease or high blood pressure Loss of weight (last 6 months)
Neurologic disease, incl. stroke or seizures Sexually transmitted diseases
Mental illness/problems Skin problems (rash, etc…)
Stomach or bowel disease (incl. recent diarrhea)
Tatoos, body piercing
Liver or kidney disease History of blood transfusions
Diabetes or other endocrine disorder History of torture/violence
Urogenital problems / conditions Displaced from home, number of months:
Hematologic disease Are you taking medications, specify below
Muscle, bone and joint problems Do you have any drug allergies?
Problems with eyes or ears Smoking habits: Years: No/day:
Cancer or tumors Alcohol habits: Years: Units/week:
Public Health Wales New Entrant Screening
Date: November 2015 Version: 1 Page: 15 of 18
TB, pneumonia, or other lung disease
Illicit drug use? Specify past or present, name of the drug(s), quantity, period, when stopped (if in the past), any treatment
Household member with significant. inf. disease (or TB contact in general)
2. Reproductive history Number
Pregnancies: LM Period :
Deliveries: Are you pregnant? No Do not know Yes
Babies born alive: Gestation (what week?):
3. Physical Examination: (repeat if abnormal)
Height cm Vital sign Initial Repeated Units
Weight Kg BP mmHg
BMI Kg/m2 Pulse /min
Head circumference (< 18months) cm Resp.rate /min
Visual Acuity Uncorrected Corrected Correction (if available)
Left/ Right / / / N Abn ND N Abn ND N Abn ND
General appearance
Endocrine Extremities
Visible disabilities
Respiratory Skin (incl. scars)
Mental state
Abdominal/GIT Neurologic
EENT (incl. hearing)
Musculo-skeletal Lymph nodes
Teeth
Genito-urinary Breasts
Cardiovascular
Hernial sites Pregnant: Yes No Fundal height (cm):
Remarks/Notes:
Public Health Wales New Entrant Screening
Date: November 2015 Version: 1 Page: 16 of 18
Migration Health Assessment CXR&TB LAB WORKSHEET Form 04MH_CXR
1. Assessment Date: 2. Program:
3. Ref. ID No:
4. Name:
(Last) (First) (Middle)
5. Case NO:
6. Date of Birth:
7. Chest X-Ray Done on Normal Abnormal F/U needed Abnormal no F/U
Not Done due to: Age Pregnancy Other, Specify
8. From the Medical file:
TB signs or symptoms Contact with TB patient History of TB
9. Chest X-ray Interpretation by the Radiologist
Can suggest Active TB (need smears)
Can suggest INACTIVE TB (need smears if symptomatic)
Other X-ray findings
Infiltrate or consolidation Discrete fibrotic scar or linear opacity Musculoskeletal
Any cavitary lesion Discrete nodule(s) without calcification Cardiac or major vessels
Nodule with poorly-defined margins (such as tuberculoma)
Discrete fibrotic scar with volume loss or retraction
Pulmonary
Linear, interstitial markings (children only)
Discrete nodule(s) with volume loss or retraction
Other Pleural effusion Upper lobe retraction or volume loss
Hilar/Mediastinal adenopathy
Other (such as bronchiectasis) Other (such as miliary
findings)
Date: Radiologist’s Name: Radiologist’s Signature:
10. IOM Physician’s Comments on CXR
11. TB Smears and Cultures
Date: Smears Done Not Done Cultures Done Not DST Done Not
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Date: November 2015 Version: 1 Page: 17 of 18
Done Done
Neg Scanty AFB
count 1+ (1-9 /10F)
2+ (1-10 /F)
3+ (>10/F) Neg Pos Cont Non Diagn.
12. TST Done Not Done
Date taken
Date read: Result, mm:
History of BCG
No Yes Unknown
Form 04MH_LAB 1. Assessment Date:
LAB WORKSHEET 2. Program:
3. Name
4. Case No
5. Date of Birth:
6. HIV Test Done Not Done
Type: Date: Test kit: Test Results: Test Notes:
Screening Neg Pos Indt.
Screening Neg Pos Indt.
Screening Neg Pos Indt.
Confirmatory Neg Pos Indt.
7. Syphilis Test Done Not Done
Type: Date: Test kit: Test Results: Titer: Test Notes:
Screening Neg Pos
Confirmatory Neg Pos
8. Urinalysis Done Not Done Microscopy: Date: 12-Dec-2007
Blood Neg Pos Repeat Date: 04-Dec-2007
Blood Neg Pos
Albumin Neg Pos Albumin Neg Pos
Sugar Neg Pos Sugar Neg Pos
9. CBC Done on Not Done
Name: Result: Unit Ref. range:
Name: Result: Unit Ref. range:
WBC x 103/mm3 5.0-10.0
Eosinophils, % Percent 0-4
RBC x 106/mm3 4.1-5.3
Basophils, % Percent 0-2
Hemoglobin g/dL 12.0-18.0
Neutrophils, abs x 103/mm3 1.8-7.8
Hematocrit Percent 37.0-52.0
Lymphocytes, abs x 103/mm3 0.7-4.5
Platelets x 103/mm3 140-390
Monocytes, abs x 103/mm3 0.1-1.0
Neutrophils, % Percent 45-76
Eosinophils, abs x 103/mm3 0.0-0.4
Lymphocytes, % Percent 17-44 Basophils, abs x 0.0-0.2
Public Health Wales New Entrant Screening
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103/mm3 Monocytes, % Percent 3-10
10. Other tests with Numeric Results
Date: Test name: Result: Unit: Ref. Range: Test Notes:
Select the test
Select the test
Select the test
Select the test
Select the test
Select the test
Select the test
Select the test
Select the test
Select the test
11. Other tests with Neg/Positive Results
Date: Test name: Test kit: Test Results: Test Notes:
Hep B Neg Pos
Select the test Neg Pos
Select the test Neg Pos
Select the test Neg Pos
Select the test Neg Pos
Select the test Neg Pos
Select the test Neg Pos
Lab Remarks:
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