Alcohol
| PATIENT INFO |
| Patient Name: |
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| BD: / / Sex: F M |
| PHYSICIAN INFO |
| Physician Name : |
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| Ph: ( ) - Fax: ( ) - |
| Additional Report to: |
| Ph: ( ) - Fax: ( ) - |
| TESTS REQUESTED | |
| Test Name: | ICD9 Code: (required) |
| 1. Alcohol | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
ALCO
Test Workstation :
ACHM5
Specimen Type:
Blood
Tube Type:
Green top (lithium heparin) tube
Minimum Volume:
500 uL
Preferred Volume:
1.5 mL
Storage:
Shipping: Send Refrigerated; Storage Room Temp: 2 days; Refrigerated 2 weeks; Frozen 4 weeks
Availability:
24 hours/day, 7 days/week
Methodology:
Roche-Enzymatic with alcohol dehydrogenase
Special Instructions:
Do not use alcohol or other volatile disinfectants at the site of venipuncture. Levels obtained are for medical use only; not intended for legal use.
Deliver specimen to lab immediately.
If collected at an offsite location, send by a STAT Courier to Akron Children's lab
Lab/Phone:
330-543-8418
TAT:
1 hour
Additional Info:
Reference range:
50-100 mg/dL: Impairment
>100 mg/dL: Depression of CNS
>400 mg/dL: Fatalities reported
CPT Code:
82077
Synonyms:
Ethanol; ETOH
