Glucose, 2HR Challenge
| 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. Glucose, 2HR Challenge | |
| 2. | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
GL2HR
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: 72 hours; Frozen: 3 days
Availability:
Mon-Fri
Methodology:
Roche-UV Test
Special Instructions:
Separate plasma from cells ASAP. Prior to drawing patient, see Specimen Collection Procedure Glucose Tolerance Testing.
For Outpatients, test should only be drawn in outpatient locations within a Hospital (Akron or Beeghly).
Lab/Phone:
330-543-8418
TAT:
1 hour/draw
Additional Info:
Criteria for Diagnosis of Diabetes(2HR Challenge):
Fasting specimen (no caloric intake for at least 8 hours).
<100 mg/dl Normal
100-125 mg/dl Increased Risk for Diabetes
>125 mg/dl Diagnostic for Diabetes
2 Hour Specimen (post glucose administration).
<=139 mg/dl Normal
140-199 mg/dl Increased Risk for Diabetes
>=200 mg/dl Diagnostic for Diabetes
CPT Code:
82951
