Cystine, Urine Quant
| 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. Cystine, Urine Quant | |
| 2. | |
| 3. | |
| 4. | |
| 5. | |
| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
CYST
Test Workstation :
CLEVE
Specimen Type:
Urine
Tube Type:
Urine container
Collection Volume:
4.0 mL from a 24 hour urine collection
Minimum Volume:
3.0 mL from a well mixed 24 hour collection
Cause for Rejection:
Ambient specimens.
Storage:
Critical Frozen
Availability:
Sent to reference lab, days performed Monday-Friday
Methodology:
Liquid Chromatography - Tandem Mass Spectrometry (LC-MS/MS)
Special Instructions:
Aliquot from a wellmixed 24 hr. urine collection in a container without preservatives or other acids. Instruct patient on 24 hour urine collection. To begin the urine collection, have the patient void. DISCARD THIS URINE SPECIMEN. This is best done with the first morning specimen. Note the time and record on the requisition. From then on collect all the urine that is voided and place in container. If more than one container is needed, please mark the first as #1 of 2 and retain on the floor until the collection is complete. The final void should be made 24 hours after the first void described earlier. The specimen should be included with the collection. Sample must be refrigerated during collection. Patient must abstain from Vitamin C ingestion 48 hours prior to collection.
Provide clinical information along with age, gender, diet, drug therapy, and family history.
Lab/Phone:
330-543-8418
TAT:
4-8 days
Additional Info:
Reference range is available on patient report
CPT Code:
82131
Panel Includes:
Cystine, Urine; Cystine, Urine mg/dL; Cystine, 24 Urine; Creatinine, Urine mg/dL
