Electrolyte Panel
| PATIENT INFO |
| Patient Name: |
| Medical Record #: |
| BD: / / Sex: F M |
| PHYSICIAN INFO |
| Physician Name : |
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| Ph: ( ) - Fax: ( ) - |
| Additional Report to: |
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| TESTS REQUESTED | |
| Test Name: | ICD9 Code: (required) |
| 1. Electrolyte Panel | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
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Test ID :
LYTES
Test Workstation :
MACH3
Specimen Type:
Blood
Tube Type:
Green top ( lithium heparin ) tube
Collection Volume:
500 uL microtainer; 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; 7 days refrigerated, 40 hours room temperature
Availability:
24 Hours/day, 7 days/week
Methodology:
Ion selective electrode indirect
Special Instructions:
It is recommended that plasma be physically separated from contact with the cells within two hours from the time of collection.
Lab/Phone:
330-746-9623
TAT:
1 hour
Additional Info:
Reference ranges available under individual tests
CPT Code:
80051
Panel Includes:
Sodium, Potassium, Chloride, Carbon Dioxide
