Glucose, 2HR Challenge
| 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. Glucose, 2HR Challenge | |
| 2. | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
GL2HR
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:
Storage: Room Temp: 8 hours; Refrigerated: 72 hours; Frozen: 3 days
Availability:
Mon-Fri, call for appointment
Methodology:
Roche UV test
Special Instructions:
Prior to drawing patient, see Specimen Collection Procedure Glucose Tolerance Testing.
For Outpatients, test should only be drawn in outpatient locations within Mahoning Valley hosptial.
Lab/Phone:
330-746-9623
TAT:
1 hour/draw
CPT Code:
82951
