Protein, Urine
| 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. Protein, Urine | |
| 2. | |
| 3. | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
PROQL
Test Workstation :
AUA
Specimen Type:
Urine
Tube Type:
Urine container
Collection Volume:
12.0 mL (minimum 1.0 mL)
Cause for Rejection:
Specimen leaking from container, excessive delay in transport
Storage:
Refrigerated
Availability:
Daily, 24 hours; STAT
Methodology:
"Protein Error of pH Indicators" Principle
Special Instructions:
Transport specimen to the lab within 2 hours. Stable 4 hours refrigerated.
Lab/Phone:
330-543-8418
TAT:
1 hour
Additional Info:
Reference range: Negative - Trace
CPT Code:
81003
