Hemoglobin A1c
| PATIENT INFO |
| Patient Name: |
| Medical Record #: |
| BD: / / Sex: F M |
| PHYSICIAN INFO |
| Physician Name : |
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| Ph: ( ) - Fax: ( ) - |
| Additional Report to: |
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| TESTS REQUESTED | |
| Test Name: | ICD9 Code: (required) |
| 1. Hemoglobin A1c | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
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Test ID :
HBA1C
Test Workstation :
MACH3
Specimen Type:
Blood
Tube Type:
Purple top (EDTA) tube: Whole Blood
Collection Volume:
2.0 mL macrotainer; 500 uL microtainer
Minimum Volume:
2.0 mL macrotainer; 500 uL microtainer
Preferred Volume:
2.0 mL macrotainer; 500 uL microtainer
Storage:
Shipping - Send Refrigerated; Storage - Room Temp: 3 days; Refrigerated: 7 days; Frozen: 6 months
Availability:
24 hours/day, 7 days/week
Methodology:
Roche-TINA-Quant
Lab/Phone:
330-746-9623
TAT:
4 hours
Additional Info:
Reference range is available on patient report
CPT Code:
83036
Synonyms:
Glycosylated Hemoglobin; GHB; Fast Hemoglobins
