Patient Name :

Address :

First M Last

1234 N. South St., The Big City, STZip-12345-1234

Sex : M

Age : 1

DOB : 1/1/2016

Specimen Number : 123456

Date Collected :Date Received :

12/4/201712/6/2017

Date Processed : 12/6/2017

Report Status : Complete

Physician Name : Dr. First Last

Account Number : Stated As Provided

Total IgE 592 kU/L 0 1000

Very Low Low Moderate High Very High

1-2 3-4 5-6 7-8 9-10Allergens ASU ClasskU/L

GRASS POLLENS 10

Bahia grass 6,837 610.25

Bermuda grass 0 00

Cocksfoot 0 00

Johnson grass 19,058 828.57

June grass 18,305 827.44

Meadow fescue 8 00.01

Rye-grass 24,219 836.31

Sweet vernal grass 716 31.07

Timothy grass 0 00

Velvet grass 62,846 994.22

WEED POLLENS 18

Alfalfa 35,061 952.57

Cocklebur 30,445 845.65

Common pigweed 9,124 713.68

Common ragweed 832 31.25

Dandelion 12,133 718.19

False ragweed 59,084 988.58

Firebush (Kochia) 0 00

Giant (tall) ragweed 62,460 993.64

Goosefoot Lamb's quarters 6,067 69.1

Mugwort 0 00

Nettle 13,558 720.33

Plantain (English) Ribwort 42,139 963.18

Redroot pigweed 32,829 949.22

Rough marshelder 1 00

Sagebrush (Wormwood) 21,071 831.59

Saltwort (prickly) Russian thistle 0 00

Sheep Sorrel Red 364 20.55

Western ragweed 9,124 713.68

©2018 PatientDataSolutions.com Form 20180411.01

This laboratory report is not a diagnosis. A diagnosis is only made by a clinician in conjunction with a physical examination and medical history.

Page 1 of 7

Patient Name :

Address :

First M Last

1234 N. South St., The Big City, STZip-12345-1234

Sex : M

Age : 1

DOB : 1/1/2016

Specimen Number : 123456

Date Collected :Date Received :

12/4/201712/6/2017

Date Processed : 12/6/2017

Report Status : Complete

Physician Name : Dr. First Last

Account Number : Stated As Provided

Total IgE 592 kU/L 0 1000

Very Low Low Moderate High Very High

1-2 3-4 5-6 7-8 9-10Allergens ASU ClasskU/L

FUNGI 21

Acremonium kiliense 6,495 69.74

Alternaria alternata 0 00

Aspergillus funigatus 61,507 992.21

Aureobasidium pullulans 3,800 55.7

Botrytis cinerea 32,829 949.22

Candida algicans 21,071 831.59

Chaetomium glogosum 43,950 965.89

Cladosporium herbarum 716 31.07

Culvularia lunata 46,710 970.03

Drechslera 17,993 826.98

Epicoccum purpurascens 17,962 826.93

Fusarium proliferatum 23,306 834.94

Mucor plumbeus 0 00

Mucor racemosus 27,538 841.29

Penicillium chrysogenum 61,507 992.21

Phoma betae 14,588 721.87

Phoma herbarum 62,844 994.22

Rhizopus nigricans 326 20.49

Setomelanomma rostrata 0 00

Stemphylium botryosum 34,860 952.26

Trichoderma viride 11,681 717.51

TREE POLLENS 37

Acacia 330 20.49

American beech 0 00

Australian pine 14,588 721.87

Bald cypress 42,139 963.18

Bayberry 644 30.96

Box-elder/Maple 326 20.49

Castor bean 0 00

©2018 PatientDataSolutions.com Form 20180411.01

This laboratory report is not a diagnosis. A diagnosis is only made by a clinician in conjunction with a physical examination and medical history.

Page 2 of 7

Patient Name :

Address :

First M Last

1234 N. South St., The Big City, STZip-12345-1234

Sex : M

Age : 1

DOB : 1/1/2016

Specimen Number : 123456

Date Collected :Date Received :

12/4/201712/6/2017

Date Processed : 12/6/2017

Report Status : Complete

Physician Name : Dr. First Last

Account Number : Stated As Provided

Total IgE 592 kU/L 0 1000

Very Low Low Moderate High Very High

1-2 3-4 5-6 7-8 9-10Allergens ASU ClasskU/L

TREE POLLENS 37 Contd.

Cedar 62,780 994.12

Cedar elm 364 20.55

Common silver birch 22,424 833.62

Cottonwood/poplar 21,032 831.53

Date palm 19,366 829.03

Elm 24,589 836.87

Grey alder 0 00

Hackberry 2,893 54.34

Hazel 1,754 42.63

Locust 60,301 990.41

Maple leaf sycamore 0 00

Mesquite 0 00

Mountain juniper 76 00.11

Oil palm 6 00.01

Olive 4,090 66.13

Pecan/Hickory 7,514 611.26

Privet 644 30.96

Queen palm 0 00

Red cedar 0 00

Red mulberry 0 00

Russian olive 0 00

Shagbark hickory 62,603 993.86

Sweet gum 0 00

Virginia live oak 0 00

Walnut 33 00.05

White ash 22,424 833.62

White hickory 19,384 829.06

White oak 21,032 831.53

White pine 4,704 67.05

©2018 PatientDataSolutions.com Form 20180411.01

This laboratory report is not a diagnosis. A diagnosis is only made by a clinician in conjunction with a physical examination and medical history.

Page 3 of 7

Patient Name :

Address :

First M Last

1234 N. South St., The Big City, STZip-12345-1234

Sex : M

Age : 1

DOB : 1/1/2016

Specimen Number : 123456

Date Collected :Date Received :

12/4/201712/6/2017

Date Processed : 12/6/2017

Report Status : Complete

Physician Name : Dr. First Last

Account Number : Stated As Provided

Total IgE 592 kU/L 0 1000

Very Low Low Moderate High Very High

1-2 3-4 5-6 7-8 9-10Allergens ASU ClasskU/L

TREE POLLENS 37 Contd.

Willow 32,584 948.85

DUST MITES 5

Blomia tropicalis 0 00

D. farinae 30,294 845.42

D. microceras 62,016 992.98

D. pteronyssinus 17,314 825.96

Euroglyphus maynei 28,298 842.43

FRUITS & VEGETABLES 18

Apple 7,514 611.26

Avocado 62,844 994.22

Banana 241 10.36

Cantaloupe (melon) 22,866 834.28

Carrot 0 00

Celery 24,176 836.25

Coconut 33 00.05

Dates 39,271 958.88

Eggplant (Aubergine) 2,153 53.23

Garlic 14,428 721.63

Kiwi 894 31.34

Mango 62,393 993.54

Orange 9,935 714.9

Peach 548 30.82

Strawberry 2,040 53.06

Tomato 30,445 845.65

SEEDS LEGUMES & NUTS 27

Almond 548 30.82

Barley 3,522 55.28

Brazil nut 18,924 828.37

Buckwheat 1 00

©2018 PatientDataSolutions.com Form 20180411.01

This laboratory report is not a diagnosis. A diagnosis is only made by a clinician in conjunction with a physical examination and medical history.

Page 4 of 7

Patient Name :

Address :

First M Last

1234 N. South St., The Big City, STZip-12345-1234

Sex : M

Age : 1

DOB : 1/1/2016

Specimen Number : 123456

Date Collected :Date Received :

12/4/201712/6/2017

Date Processed : 12/6/2017

Report Status : Complete

Physician Name : Dr. First Last

Account Number : Stated As Provided

Total IgE 592 kU/L 0 1000

Very Low Low Moderate High Very High

1-2 3-4 5-6 7-8 9-10Allergens ASU ClasskU/L

SEEDS LEGUMES & NUTS 27 Contd.

Cacao 0 00

Cashew nut 0 00

Chick pea 2,040 53.06

Gluten 3,606 55.41

Hazel nut 345 20.52

Lentil 476 20.71

Lupin seed 0 00

Macadamia nut 27,622 841.41

Maize corn 82 00.12

Mustard seed 61,758 992.59

Oat 2,213 53.32

Pea 35,061 952.57

Peanut 0 00

Pecan nut 0 00

Pistachio 6,837 610.25

Poppy seed 241 10.36

Rice 18,924 828.37

Rye 0 00

Sesame seed 0 00

Soybean 43,950 965.89

Sunflower seed 918 31.38

Wheat 832 31.25

EGG & FOWL 3

Chicken 918 31.38

Egg white 43,394 965.06

Egg yolk 27,595 841.37

MISC 2

Mushrooms 12,808 719.2

Yeast 46,710 970.03

©2018 PatientDataSolutions.com Form 20180411.01

This laboratory report is not a diagnosis. A diagnosis is only made by a clinician in conjunction with a physical examination and medical history.

Page 5 of 7

Patient Name :

Address :

First M Last

1234 N. South St., The Big City, STZip-12345-1234

Sex : M

Age : 1

DOB : 1/1/2016

Specimen Number : 123456

Date Collected :Date Received :

12/4/201712/6/2017

Date Processed : 12/6/2017

Report Status : Complete

Physician Name : Dr. First Last

Account Number : Stated As Provided

Total IgE 592 kU/L 0 1000

Very Low Low Moderate High Very High

1-2 3-4 5-6 7-8 9-10Allergens ASU ClasskU/L

MILK 4

Camel's Milk 24,219 836.31

Cheese cheddar type 34,860 952.26

Cow's milk 3,334 55

Goat's Milk 246 10.37

FISH & SHELLFISH 10

Clam 0 00

Crab 32,584 948.85

Fish (cod) 8,678 713.01

Flounder 0 00

Halibut 0 00

Lobster 16 00.02

Oyster 330 20.49

Salmon 22,866 834.28

Shrimp 24,176 836.25

Tuna 51,138 976.67

MEAT 3

Beef 0 00

Lamb 62,546 993.77

Pork 3,522 55.28

DRUGS 1

Penicilloyl G 3,800 55.7

OCCUPATIONAL ALLERGENS 1

Latex 282 20.42

INSECTS 5

Cockroach American 11,681 717.51

Cockroach German 51,138 976.67

Cockroach Oriental 62,846 994.22

Fire Ant 0 00

Mosquito 57,559 986.3

©2018 PatientDataSolutions.com Form 20180411.01

This laboratory report is not a diagnosis. A diagnosis is only made by a clinician in conjunction with a physical examination and medical history.

Page 6 of 7

Patient Name :

Address :

First M Last

1234 N. South St., The Big City, STZip-12345-1234

Sex : M

Age : 1

DOB : 1/1/2016

Specimen Number : 123456

Date Collected :Date Received :

12/4/201712/6/2017

Date Processed : 12/6/2017

Report Status : Complete

Physician Name : Dr. First Last

Account Number : Stated As Provided

Total IgE 592 kU/L 0 1000

Very Low Low Moderate High Very High

1-2 3-4 5-6 7-8 9-10Allergens ASU ClasskU/L

VENOMS 5

Common wasp (Yellow jacket) 19,384 829.06

Honey bee 9,570 714.35

Paper wasp 6,495 69.74

White-faced hornet 3,334 55

Yellow hornet 30,294 845.42

ANIMAL PROTEINS 10

Camel epithelium 0 00

Cat epithelium 62,603 993.86

Chicken epithelium 0 00

Cow epithelium 4,704 67.05

Dog epithelium 10,597 715.89

Goat epithelium 0 00

Goose feathers 0 00

Horse epithelium 432 20.65

Mouse epithelium 54,645 981.93

Sheep epithelium 62,780 994.12

This laboratory report is not a diagnosis. A diagnosis is only made by a clinician in conjunction with a physical examination and medical history.Antibody standard unit (ASU) measurements were converted computationally into kU/L units for ease of interpretation.

Page 7 of 7©2018 PatientDataSolutions.com Form 20180411.01