Acylglycine, Urine
| PATIENT INFO |
| Patient Name: |
| Medical Record #: |
| BD: / / Sex: F M |
| PHYSICIAN INFO |
| Physician Name : |
| Address: |
| Ph: ( ) - Fax: ( ) - |
| Additional Report to: |
| Ph: ( ) - Fax: ( ) - |
| TESTS REQUESTED | |
| Test Name: | ICD9 Code: (required) |
| 1. Acylglycine, Urine | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
ACYLG
Test Workstation :
MAYO
Specimen Type:
Urine
Tube Type:
Urine container
Collection Volume:
10 mL
Minimum Volume:
4 mL
Storage:
Frozen
Availability:
Sent to reference lab
Methodology:
Gas Chromatography-Mass Spectrometry (GC-MS) Stable Isotope Dilution Analysis
Lab/Phone:
330-543-8418
TAT:
5-14 days
Additional Info:
Age specific Reference Values available on patient report
CPT Code:
82542
Panel Includes:
n-Acetylglycine;
N-Propionylglycine;
Isobutyrylglycine;
Ethylmalonic acid;
n-Butyrylglycine;
2-Methylsuccinic acid;
Isovalerylglycine;
Glutaric acid;
3-Methylcrotonylglycine;
n-Tiglylglycine;
3-Methylglutaconic acid;
n-Hexanoylglycine;
n-Octanoylglycine;
3-Phenylpropionylglycine;
trans-Cinnamoylglycine;
Suberyglycine;
Dodecanedioic acid;
Tetradecanedioic acid;
Hexadecanedioic acid;
