Total Protein Urine Random
| 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. Total Protein Urine Random | |
| 2. | |
| 3. | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
UTPR
Test Workstation :
ACHM5
Specimen Type:
Urine
Tube Type:
Urine container
Minimum Volume:
1 mL
Preferred Volume:
3 mL
Storage:
Shipping- Send Refrigerated; Storage- Room Temp: 1 day; Refrigerated: 7 days; Frozen: 1 month
Availability:
24 hours/day, 7 days/week
Methodology:
Roche-Turbidimetric
Special Instructions:
Deliver promptly to the lab
Lab/Phone:
330-543-8418
TAT:
1 hour
Additional Info:
Reference range:
Random = <12 mg/dL
CPT Code:
84156
