Quinidine
| 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. Quinidine | |
| 2. | |
| 3. | |
| 4. | |
| 5. | |
| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
QUINI
Test Workstation :
CLEVE
Specimen Type:
Blood
Tube Type:
Red top (no anticoagulant) tube
Alternate Tube Type:
Lithium or Sodium Heparin, EDTA Plasma
Collection Volume:
2.5 mL
Minimum Volume:
0.5 mL
Cause for Rejection:
Serum Separator tube
Storage:
Ambient
Availability:
Sent to reference lab
Methodology:
Immunoassay (IA)
Special Instructions:
Collect at trough concentration (i.e. within 30 minutes of next dose).
Lab/Phone:
330-543-8418
TAT:
2-3 days
Additional Info:
Reference range:
2.0-5.0 mg/L
CPT Code:
80194
Synonyms:
Cardioquin, Duraquin
