Catecholamine Fractioned Free 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. Catecholamine Fractioned Free Urine | |
| 2. | |
| 3. | |
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| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
CATEC
Test Workstation :
MAYO
Specimen Type:
Urine
Tube Type:
24 hr Urine container with 25.0 mL of 50% acetic acid (15.0 mL of 50%
acetic acid for children < 5 years)
Collection Volume:
2.0 mL from a 24 hour collection
Storage:
Refrigerated
Availability:
Sent to reference lab
Methodology:
Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)
Special Instructions:
For Outpatients, test should only be drawn in outpatient locations within a Hospital (Akron or Beeghly)
2.0 mL aliquot from a 24 hour urine collection. Instruct patient on 24 hour urine collection. To begin the urine collection, have the patient void. DISCARD THIS URINE SPECIMEN. This is best done with the first morning specimen. Note the time and record on the requisition. From then on collect all the urine that is voided and place in container. If more than one container is needed, please mark the first as #1 of 2 and retain on the floor until the collection is complete. The final void should be made 24 hours after the first void described earlier. The specimen should be included with the collection. Refrigerate 24 hour urines during collection.
Lab/Phone:
330-543-8418
TAT:
2-4 days
Additional Info:
Ref. range is age dependent; available on patient report
CPT Code:
82384
