Glucose Whole Blood
| 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 Whole Blood | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
GLUWB
Test Workstation :
MBG1
Specimen Type:
Blood
Tube Type:
Heparinized syringe, Green top (lithium heparin) microtainer or macrotainer, or heparinized capillary tubes. NO GEL SEPARATOR TUBES.
Collection Volume:
0.5 mL microtainer or syringe; (2) 125 uL capillary tubes; 1.5 mL whole blood green top (lithium heparin) tube
Minimum Volume:
250 uL microtainer or 0.5 mL syringe; (2) 125 uL capillary tubes; 1.5 mL macrotainer.
Preferred Volume:
500 uL microtainer or 0.5 mL syringe; (2) 125 uL capillary tubes; 1.5 mL macrotainer.
Cause for Rejection:
Clotted, air bubbles, Gel separator tube if collected in a microtainer or macrotainer.
Storage:
Room Temperature
Availability:
Daily,24 hours; STAT
Methodology:
amperometric electrode
Special Instructions:
Deliver immediately to laboratory at room temperature. For Outpatients, test should only be drawn in outpatient locations within the Hospital on the Mahoning Valley campus.
Lab/Phone:
330-746-9623
TAT:
30 min.
Additional Info:
Reference range:
0-1 day = 40-60 mg/dL
2-28 days = 50-80 mg/dL
29 days to end of life 70-99 mg/dL
Criteria for Diagnosis of Diabetes(Effective 6/6/11): Fasting specimen (no caloric intake for at least 8 hours).<100 mg/dl Normal100-125 mg/dl Increased Risk for Diabetes>125 mg/dl Diagnostic for Diabetes Random Glucose (any time of day without regard to last meal).>=200 mg/dl plus Classic Symptoms of Diabetes
CPT Code:
82947
