Glucose by Meter
| 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 by Meter | |
| 2. | |
| 3. | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
GLUME
Test Workstation :
MMCHM
Specimen Type:
Fresh Whole Peripheral Blood
Tube Type:
None
Collection Volume:
1 drop by capillary puncture at patient's bedside
Minimum Volume:
1 drop by capillary puncture at patient's bedside
Preferred Volume:
1 drop by capillary puncture at patient's bedside
Storage:
None
Availability:
Daily, 24 hours; STAT
Methodology:
Electrochemical principle of Biamperometry
Special Instructions:
Heparinzed whole blood can also be sent to lab if capillary puncture is not possible ( ex: burned extremities or patient has a line to avoid repeated punctures). Glucose by meter levels that are >450 mg/dL ( > 300 mg/dL for NICU patients) will be confirmed via a whole blood specimen analyzed on the EML.
Lab/Phone:
330-746-9623
TAT:
20 minutes
CPT Code:
82948
Panel Includes:
REFERENCE RANGE NEEDS MODIFIED TO 0-1 DAY 40-60, 2-28 DAYS, 50-80
