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In House Blood Work Order
Thyroid Panel
Thyroid Antibodies
Adrenal Panel
Full Sex Hormone Panel
Insulin
HbA1c
Vitamin D-25 Hydroxy
Homocysteine
Ash Center Labs Performed
Blood Work Order
• • •
Blood work Comments
Tests/Other Recommendations
NUTRITION/DIET
• • •
SONOGRAMS
• • •
IV PROTOCOLS
• • •
ALLERGY work-up
• • •
Comments:
Order Tests
LRA- All Inclusive Panel
LRA Prof. Choice Panel
LRA- Food Panel
Heidelberg
ION
SIBO Breathe Test
Stool Test
Heavy Metals Test
Comments
ORAL CHELATION Protocol
Allergy Testing
Skin Testing
Allergy Immunotherapy- Injections
IV Nutrition Therapy
Immunity 12.5gr Vitamin C
Immunity- 25gr Vitamin C
Immunity- 50gr Vitamin C
IV Comments
Weight Loss
Glutathione Add-on 1000mg
Glutathione Add-on 2000mg
Glutathione Add-on 3000mg
Glutathione Add-on 4000mg
Lysine Booster
ALA Booster
Taurine Booster
Glutathione Push 1000mg
Glutathione Push 2000mg
Glutathione PUSH 3000mg
GSH Push 4000mg
Energizer Push
Chelation
B12 Injection
Tests Performed
Tests Performed today
InBody
ION
LRA Food Panel
LRA Professional Choice Panel
LRA All Inclusive Panel
Heidelberg
Test Comments:
EKG
Thyroid Sonogram
Abdominal Sonogram
Echocardiogram
Carotid Doppler
SUPPLEMENTS
Start Thyroid Support- Healthy Choice
Start Hormone Support- Healthy Choice
Start Thyroid Support- VLS Pharm
Start Hormone Support- VLS
Comments:
Consent Forms
Referral: Dr Daniel Adler ( GI )
Referral: Dr. Cahill
Referral: Dr Rony Shimony ( Cardio)

Functional Medicine Plan- Dr Pidich Medical Form

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Sunnyvale, CA 94089

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