Pentobarbital
| 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. Pentobarbital | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
ZMSO
Test Workstation :
CLEVE
Specimen Type:
Blood
Tube Type:
Green top (sodium or lithium heparin)tube
Collection Volume:
5.0 mL
Minimum Volume:
0.6 mL
Cause for Rejection:
Do not use Serum separator tubes
Storage:
Refrigerated
Availability:
Sent to reference lab
Methodology:
High Performance Liquid Chromatography (HPLC)
Special Instructions:
Collect specimen immediately prior to next dose unless specified otherwise.
Days Performed SunSat.
Order as a Miscellaneous Sendout EAP LAB3064
Please Complete Order Questions as follows:
Test Name: Pentobarbital
Sendout Facility Name:Cleveland Clinic
Lab/Phone:
330-543-8418
TAT:
24 hours
Additional Info:
Therapeutic range: 25-35 ug/mL
CPT Code:
80345
Synonyms:
Nembutal
