Sperm Freezing Report

{if $patientId} Show Reports {else} Show Reports {/if}

Edit

{if $patientId}

{else} {/if}

Ref. by Prof. Dr :

Visit Date:

Date:

Sperm Source

sperm_source eq 0}checked{/if}> Ejaculate

sperm_source eq 1}checked{/if}> Test. Aspiration

sperm_source eq 2}checked{/if}> Epid. Aspiration

sperm_source eq 3}checked{/if}> Test. Biopsy

Sperm Parameters

Count:

Motility:

Progressive motility:

Morphology(Abn.):

Comment:

No. Of Samples:

Freezing Media:

Freezing Protocol:

Purpose Of Freezing:

purpose_of_freezing eq 0}checked{/if}> IUI

purpose_of_freezing eq 1}checked{/if}> ICSI

purpose_of_freezing eq 2}checked{/if}> Preservation

{if $programesetting->tanks_view == 1 }

Locations
{foreach $cells as $cell} Can {$cell.location}{$cell.btn_no} ({$cell.rows_letter}{$cell.row_no} - {$cell.col_no} - cell{$cell.cell_no}) {/foreach}

{elseif $programesetting->tanks_view == 2 }

{foreach $tank_cells_3 as $cell} {/foreach}

Name of Tank	Level 1	Level 2	Level 3	Location	Date
{$cell.name}	{$cell.up_level_name}	{$cell.cell_name}	{$cell.cell_part_name}	{$cell.tank_txt}	{$cell.assign_at\|date_format:"%d/%m/%Y"}

{/if}

Color Of Pen:

Embryologist :

Embryologist II:

{if $patientId} Cancel {else} Cancel {/if}