Glucose, Protein, CSF
| 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, Protein, CSF | |
| 2. | |
| 3. | |
| 4. | |
| 5. | |
| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
GLPRC
Test Workstation :
MACH3
Specimen Type:
CSF
Tube Type:
CSF Container
Collection Volume:
0.5 mL (minimum 0.3 mL)
Minimum Volume:
0.3 mL
Preferred Volume:
0.5 mL
Cause for Rejection:
Blood in a CSF specimen invalidates the protein value.
Storage:
Deliver immediately to lab. Analyze immediately.
Availability:
24 Hours/day, 7 days/week
Methodology:
Roche-UV Test, Turbidometric method
Special Instructions:
Sent to lab immediately. Samples collected at an offsite location should be sent via STAT courier.
Lab/Phone:
330-746-9623
TAT:
1 hour
Additional Info:
Reference ranges available under individual tests
CPT Code:
82945, and 84157
Panel Includes:
Glucose, CSF and Protein, CSF
