Iodine, Urine 24 Hr
| 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. Iodine, Urine 24 Hr | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
IODUR
Test Workstation :
MAYO
Specimen Type:
Urine
Tube Type:
Urine container
Collection Volume:
10 mL (minimum 3.0 mL) urine from a well-mixed 24 hour collection
Storage:
Refrigerated
Availability:
Sent to reference lab
Methodology:
Inductively Coupled Plasma/Mass Spectrometry (ICP/MS)
Special Instructions:
10.0 mL (minimum 0.3 mL) urine aliquot from a wellmixed 24 hour urine collection in a plain preservative free container. 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. Refrigerate 24 hour urines during collection.
Lab/Phone:
330-543-8418
TAT:
1-4 days
Additional Info:
Reference range:
0-17 years: not established
> or = 18 years: 75-851 mcg/24 hour
CPT Code:
83789
