Complete Blood Count without Differential (CBC WITHOUT DIFF, aka hemogram)
| PATIENT INFO |
| Patient Name: |
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| 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. Complete Blood Count without Differential (CBC WITHOUT DIFF, aka hemogram) | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
HEGRM
Test Workstation :
MAHM1
Specimen Type:
Blood
Tube Type:
Purple top (EDTA) tube: Whole Blood
Collection Volume:
300 ul microtainer, 2.0 ml macrotainer
Minimum Volume:
300 ul microtainer; 1.0 ml mactrotainer
Preferred Volume:
300 ul microtainer, 2.0 macrotainer
Cause for Rejection:
Specimen hemolyzed, clotted, diluted with IV fluid, drawn with heparin or contaminated with heparin; tubes improperly filled; specimen at RT for more than 8 hours or 4C for more than 24 hours
Storage:
Refrigerated
Availability:
Daily, 24 hours; STAT
Methodology:
Impedance measurement with Optical Flow fluorescence measurements and Spectrophotometry
Special Instructions:
Indicate clearly if a specimen has been drawn from an arterial line or from a line that has been rinsed with heparin.
Lab/Phone:
330-746-9623
TAT:
4 hours
Additional Info:
Reference ranges are available on patient report
CPT Code:
85027
Profile Includes:
Synonyms:
Blood Count Profile: Cell Profile: CBC WO Diff:
