Triglycerides, Pleural Fluid

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. Triglycerides, Pleural Fluid
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

TRGPL

Test Workstation :

ACHM5

Specimen Type:

Pleural Fluid

Tube Type:

sterile container

Minimum Volume:

500 uL

Preferred Volume:

1.5 mL

Storage:

24 hours RT, 7 days Refrigerated, 30 days Frozen

Availability:

24 Hours/day, 7 days/week

Methodology:

Roche - GPO, Enzymatic colorimetric

Special Instructions:

Deliver promptly to the lab

Lab/Phone:

330-543-8418

TAT:

1 hour

CPT Code:

84478