Specific gravity
| 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. Specific gravity | |
| 2. | |
| 3. | |
| 4. | |
| 5. | |
| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
SPGRU
Test Workstation :
AUA
Specimen Type:
Urine
Tube Type:
Urine container
Collection Volume:
12.0 mL (minimum 0.5 mL)
Cause for Rejection:
Specimen leaking from container, excessive delay in transport
Storage:
Refrigerated
Availability:
Daily, 24 hours; STAT
Methodology:
Refractometry
Special Instructions:
Transport specimen to the lab within 2 hours. Stable 24 hours refrigerated.
Lab/Phone:
330-543-8418
TAT:
1 hour
Additional Info:
Reference range is available on patient report
CPT Code:
81003
