pH, Misc fluid by meter
| PATIENT INFO |
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| BD: / / Sex: F M |
| PHYSICIAN INFO |
| Physician Name : |
| Address: |
| Ph: ( ) - Fax: ( ) - |
| Additional Report to: |
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| TESTS REQUESTED | |
| Test Name: | ICD9 Code: (required) |
| 1. pH, Misc fluid by meter | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
PHFLD
Test Workstation :
SCMAN
Specimen Type:
Any fresh body fluid (pleural, synovial, drainages, etc)
Tube Type:
Syringe (Remove needle and cap specimen before sending to the laboratory)
Collection Volume:
10.0 mL (minimum 5.0 mL)
Storage:
Refrigerated
Availability:
Daily (0730-1600)
Methodology:
pH meter
Lab/Phone:
330-543-8484
TAT:
4 hours
Additional Info:
Reference range: Not established; Dr. interpretation only
CPT Code:
83986
