AI Doctor Laboratory Services

1200 Health Sciences Drive, Suite 300 • San Francisco, CA 94107 • (415) 555-0142
LABORATORY REPORT
CLIA #: 05D2081491
NPI: 1234567890
Patient Name
Maria Garcia
Date of Birth
11/03/1988
MRN
MRN-2024-0893
Ordering Physician
Dr. AI Doctor, MD
Report Date
March 11, 2026
Account #
ACC-20260311-0893
Thyroid Panel
Specimen: Serum  |  Collected: March 11, 2026 08:15 AM  |  Received: March 11, 2026 09:00 AM  |  Reported: March 11, 2026 01:30 PM
Test Name Result Units Reference Range Flag
TSH (Thyroid Stimulating Hormone) 6.8 mIU/L 0.4 – 4.0 H
Free T4 (Thyroxine) 0.7 ng/dL 0.8 – 1.8 L
Free T3 (Triiodothyronine) 2.1 pg/mL 2.3 – 4.2 L
Total T4 4.2 ug/dL 5.0 – 12.0 L