Glucose
| 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 | |
| 2. | |
| 3. | |
| 4. | |
| 5. | |
| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
GLU
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; 1.5 mL macrotainer
Storage:
Shipping: Send Refrigerated; Storage: Room Temp: 8 hours, Refrigerated: 72 hours.
Availability:
24 Hours/day, 7 days/week
Methodology:
Roche-UV test
Special Instructions:
Prior to drawing patient, see Specimen Collection Procedure Glucose Tolerance Testing. Separate plasma from cells ASAP.
Lab/Phone:
330-746-9623
TAT:
1 hour
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
Synonyms:
(Fasting) Blood Sugar or Glucose; Sugar
