Oxalate, 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. Oxalate, Urine 24 Hr | |
| 2. | |
| 3. | |
| 4. | |
| 5. | |
| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
OXUR
Test Workstation :
MAYO
Specimen Type:
Urine
Tube Type:
Urine container
Collection Volume:
24 hour urine collection
Cause for Rejection:
Specimen collected or sent in container with metal cap will be rejected. Avoid taking larger doses (>2 g orally/24 hours) of vitamin C during specimen collection.
Storage:
Refrigerated
Availability:
Sent to Reference Laboratory
Methodology:
Enzymatic Using Oxalate Oxidase
Special Instructions:
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. Indicate total 24hour volume.
Lab/Phone:
330-543-8418
TAT:
3-5 days
Additional Info:
Collection duration and urine volume are required. Laboratory will aliquot refrigerated 4.0 mL (minimum 1.0 mL) from a well-mixed 24 hour urine collection without preservative.
For outpatients, test should only be drawn in outpatient locations within a Hospital (Akron or Beeghly).
CPT Code:
83945
