PH, Stool
| 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. PH, Stool | |
| 2. | |
| 3. | |
| 4. | |
| 5. | |
| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
PHSTL
Test Workstation :
MMCHM
Specimen Type:
Stool
Tube Type:
Stool container
Collection Volume:
1 gram stool specimen
Minimum Volume:
1.0 ml
Preferred Volume:
1.0 ml
Cause for Rejection:
Urine or barium contamination
Storage:
Frozen
Availability:
Daily (0730-1600)
Methodology:
ph paper
Special Instructions:
Patient should not take laxatives or have barium procedures one week prior to specimen collection.
Lab/Phone:
330-746-9623
TAT:
4 hours
Additional Info:
Reference range: 6.0 is normal stool pH
CPT Code:
83986
