Building a new client's lab history before the first consultation
By Alina Radu, founder of Sera · November 10, 2026
Ask the client for every lab report they have, in the original file where possible, and the name of each lab. Then date each report by the day the blood was drawn, record what was going on at the time of each draw, and line the results up by marker so you can see what's missing. Done before the first session, this turns a pile of files into a history you can read in the consultation instead of assembling it there.
I build Sera, a lab-review workspace for practitioners, so read the last section with that in mind. Everything before it works with a folder and a spreadsheet.
What to ask the client for
Send the request with your intake form, not after it. Clients need time to dig things out, and the oldest results are often the most useful ones.
Ask for:
- Every report they can find, of any age. Not a summary from a doctor's letter, the report itself. A result from five years ago gives you a baseline nothing else can.
- The original files. A PDF downloaded from the lab or patient portal is better than a photo or a screenshot. Screenshots often cut off the units, the lab's range or the date.
- Portal exports. Many patient portals let you download a report or a full results history. Ask the client to check each portal they use, including old ones from a previous doctor or insurer.
- Which labs they used. Quest, Labcorp, a hospital lab, a lab abroad. It matters later, because ranges and methods differ between labs.
- Self-ordered tests. Clients don't always count a panel they bought themselves as "lab work". Ask directly.
- Other tests. Stool, urine, breath, saliva and hormone tests, even if you don't plan to use them.
It helps to say why. "I want to see how your results have changed over time" gets more out of a client than "send me your labs".
Date every report by the draw date
A lab report carries several dates: when the sample was collected, when it reached the lab, when it was reported, and sometimes when it was printed. Use the collection date. That's the day the result describes.
The report date can be days or weeks later, and a report printed from a portal may carry the day it was downloaded. If you file by those dates, two draws can swap order, or a result can land after a change it actually came before.
A naming pattern makes the folder sort itself:
2024-03-14_quest_cmp-lipids.pdf
Draw date first, in year-month-day order, then the lab, then a short description. If one report covers two draw dates, which happens with cumulative portal reports, note both, and file it under the earlier one.
Record the context of each draw
A result means less without the conditions it was taken under. For each draw, write down what you can find out. Some of it is on the report. The rest you'll need to ask the client, and for older draws they may not remember. A "don't know" is still worth writing down.
| Context | Why it matters |
|---|---|
| Fasting or not | A non-fasting sample runs higher for triglycerides, and fasting thresholds for glucose and insulin assume a fasting draw. |
| Time of day | TSH follows a daily rhythm and runs highest overnight and early morning. Morning cortisol ranges are for a sample taken at about 8 am. Serum iron varies through the day. |
| Cycle day, for female hormones | Estradiol, LH and FSH swing across the cycle, and progesterone is read against the luteal phase. A single value means little without the cycle day, or a note that the client is postmenopausal or on hormonal contraception. |
| Medications and supplements | Oral estrogen raises total cortisol, as the cortisol range note says. Biotin is a known problem: the FDA notes it can significantly interfere with certain lab tests. Record what they were taking at the time, with doses if they know them. |
| Recent illness or injury | Ferritin is an acute-phase protein that inflammation raises regardless of iron stores, and hsCRP can reflect any recent infection or injury. A cold the week before matters. |
| Anything else unusual | Hard training the day before, travel, pregnancy, a recent diagnosis. |
Keep this next to the results, not in a separate document. A note that says "on iron since January" is only useful if you see it when you look at the ferritin.
Tests you can't score
Stool, urine, breath and saliva reports don't line up with blood markers. They use their own units, their own scales and often their own interpretation. Don't try to force them into the same table as the blood work.
Do keep them in the same client file, dated by collection date like everything else, with a one-line note on what the test was and anything the report flagged. Even if you don't read a stool test in detail, knowing it was done in March, a month before a blood panel, changes how you read that panel. And if the client brings a test you aren't trained to interpret, the honest move is to say so and, where it matters, refer them to someone who is.
Spot the gaps
Once the reports are dated and labeled, list the markers down one side and the draw dates across the top, and fill in what you have. The gaps show up quickly:
- Markers tested once. A single TSH from three years ago is a data point, not a trend.
- Markers tested without their partners. Ferritin with no transferrin saturation or inflammatory marker is hard to read, as the ferritin range page explains. Free T4 with no TSH, or TSH with no antibodies, leaves a similar gap.
- Long stretches with nothing. Two years without a draw, often across a time the client says things changed.
- Lab changes. If the client moved from one lab to another, results before and after aren't always directly comparable. Check each one against the range printed on its own report, especially near a cut-off: TSH limits differ slightly by assay, and TPO antibody cut-offs differ by manufacturer.
- Unit changes. The same marker reported in different units by different labs. Write the unit as printed and don't mix them on one chart without converting carefully.
- Missing context. Draws where you don't know if the client fasted, or what they were taking.
The gap list becomes part of the first consultation. Some gaps you'll close by asking. Others become the reason for the first set of tests you order or suggest.
Before the first session
Check every value you typed against its page in the original report. Typing is where mistakes get in: a decimal in the wrong place, or a result next to the wrong marker. Then read the history once from oldest to newest, with the context notes beside it, and write down your questions for the client.
Where Sera fits
Sera does the filing part of this. You upload the client's digital lab PDFs, and it reads them and shows each value next to its page in the report so you can check it before anything is saved. A scanned report or a screenshot can be entered by hand. Results from different labs go onto one timeline per client, each kept in the unit the lab reported, with a flag when a marker arrives in two different units. Stool, urine, breath and hormone test reports sit in the same client record. They're stored, not scored. It doesn't diagnose or suggest treatment.
It's free for three clients, so you can try it on the next new client with a long history. There's a 3-minute tour if you'd rather watch first.
Alina Radu is the founder of Sera and a software engineer. The idea started with her own Hashimoto's tests, scattered across years without the big picture.