Renal Panel
| PATIENT INFO |
| Patient Name: |
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| BD: / / Sex: F M |
| PHYSICIAN INFO |
| Physician Name : |
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| Ph: ( ) - Fax: ( ) - |
| Additional Report to: |
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| TESTS REQUESTED | |
| Test Name: | ICD9 Code: (required) |
| 1. Renal Panel | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
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Test ID :
RENAL
Test Workstation :
ACHM5
Specimen Type:
Blood
Tube Type:
Green top (lithium heparin) tube
Minimum Volume:
500 uL
Preferred Volume:
1.5 mL
Storage:
Shipping: Send Refrigerated; Storage Room Temp: 8 hours; Refrigerated: 3 days; Frozen: 3 days
Availability:
24 hours/day, 7 days/week
Methodology:
See individual tests
Lab/Phone:
330-543-8418
TAT:
1 hour
Additional Info:
Reference ranges available under individual tests
CPT Code:
80069
Panel Includes:
Sodium, Potassium, Chloride, Carbon Dioxide, Urea Nitrogen, Glucose, Creatinine, Albumin, Calcium, Phosphorous
