Basic Metabolic Panel
| 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. Basic Metabolic Panel | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
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Test ID :
BMP
Test Workstation :
MACH3
Specimen Type:
Blood
Tube Type:
Green top ( lithium heparin ) tube
Collection Volume:
500 uL mictrotainer; 1.5 mL macrotainer
Minimum Volume:
500 uL microtainer; 1.5 mL macrotainer
Preferred Volume:
500 uL microtainer; 1.5 mL macrotainer
Storage:
Shipping: Send Refrigerated: Storage: For full panel: RT 8 hours; Refrigerated 72hrs or 3 days; Frozen 3 days. See each test for individual stability.
Availability:
Daily, 24 hours; STAT
Methodology:
See individual tests
Special Instructions:
Deliver to lab immediately.
Lab/Phone:
330-746-9623
TAT:
1 hour
Additional Info:
Reference range available on patient report
CPT Code:
80048
Panel Includes:
Sodium, Potassium, Chloride, Carbon Dioxide, Urea Nitrogen, Glucose, Creatnine, Calcium
