Electrolytes Urine 24 hr
| 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. Electrolytes Urine 24 hr | |
| 2. | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
ULY24
Test Workstation :
ACHM5
Specimen Type:
Urine
Tube Type:
Urine container
Minimum Volume:
Entire 24 hour Collection.
See Special Instructions.
Preferred Volume:
Entire 24 hour Collection.
See Special Instructions.
Storage:
Shipping- Send Refrigerated; Storage-Room Temp: 7 days; Refrigerated: 7 days; Frozen: stable
Availability:
24 hours/day, 7 days/week
Methodology:
Roche- ISE Indirect
Special Instructions:
Instruct patient on 24 hour urine collection. Refrigerate 24 hour urines during collection. Do not use urine preservatives. Mark each collection container with the following information required for resulting: patient demographic information and date and time collection was started and finished. Deliver specimens promptly to the lab.
Lab/Phone:
330-543-8418
TAT:
1 hour
CPT Code:
84350, 84133, 82436
Panel Includes:
Sodium, Potassium, and Chloride
