Occult Bld, Gastric
| 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. Occult Bld, Gastric | |
| 2. | |
| 3. | |
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| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
OCGAS
Test Workstation :
MMCHM
Specimen Type:
Gastric fluid or vomitus
Tube Type:
Fluid container
Collection Volume:
1.o mL ( minimum 0.5 mL)
Storage:
Refrigerated
Availability:
Daily, 24 hours; STAT
Methodology:
Guaiac
Lab/Phone:
330-746-9623
TAT:
1 hour
Additional Info:
Reference range:
Occ Bld= Negative
pH = <2.0
CPT Code:
82271
