Flunitrazepam, Screen 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. Flunitrazepam, Screen Urine | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
FLUNU
Test Workstation :
CLEVE
Specimen Type:
Urine
Tube Type:
Urine container
Collection Volume:
3.0 mL random urine
Minimum Volume:
1.5 mL Random Urine
Storage:
Refrigerated
Availability:
Sent to reference lab
Methodology:
High Performance Liquid Chromatography/Tandem Mass Spectrometry (LC/MS/MS)
Lab/Phone:
330-543-8418
TAT:
6-14 days
CPT Code:
80307
Synonyms:
Rohypnol
