PT by Monitor
| 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. PT by Monitor | |
| 2. | |
| 3. | |
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| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
PTMON
Test Workstation :
MNCOG
Specimen Type:
Fresh Whole Peripheral Blood
Tube Type:
None
Collection Volume:
0.05 mL Whole Blood
Cause for Rejection:
Specimen diluted with IV fluid or heparin; containing anticoagulants;
Storage:
None
Availability:
Daily, 24 hours; STAT
Methodology:
Electronic Optical Detection Clotting Assay; cartridge-based
Special Instructions:
Testing is done on unanticoagulated blood at the bedside. Plasma or serum can't be used. Prepare capillary puncture site by warming fingertips or heel with warm water and/or warm washcloth.
Testing can be drawn at Akron Campus only.
For Outpatients, test should only be drawn in outpatient locations within the Hospital on the Akron campus.
Lab/Phone:
330-543-8416
TAT:
30 minutes
Additional Info:
Reference range: PT = 12-14 secs
Only INR will be reported. This testing can ONLY be used for patients on stable oral anticoagulant therapy. There is no significant contribution to the diagnosis or treatment of patients whose Prothrombin Time is prolonged for other reasons.
CPT Code:
85610
