Department of Pathology
and Laboratory Medicine

Akron Children's Hospital
One Perkins Square
Akron, OH 44308
Laboratory
Ph: (330) 543-8573
Fax: (330) 543-3659

LABORATORY TEST REQUISITION


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. Calcium, Urine   
2.   
3.   
4.   
5.   
6.   

SPECIMEN INFO
Collection Date & Time:
Collected By:
Test Information for Calcium, Urine
CPT Code: 82340

Specimen Type: Urine

Tube Type/Collection Container: Urine container

Collection Volume: Random 5.0 mL (minimum 1.0 mL) or a 24 hour urine collection

Cause for rejection: -

Storage: Refrigerated

Availability: Daily, 24 hours; STAT

Methodology: Ion selective electrode

Special Instructions: Specify whether the urine is random or a 24 hour collection. 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. Do not use urine preservatives. Mark each container with patient information and date and time collection started and finished. Deliver specimens promptly to lab.

TAT: 1 hour


Lab/Phone: 330-543-8417

Additional Info: Reference range: 100-300 mg/24 hours

Transport specimens to processing area of the laboratory in an appropriate container. Additional information is available from Cindy Maurer at (330)543-8689.

SHIP TO:
Department of Pathology and Laboratory Medicine
CCL
Akron Children's Hospital
One Perkins Square
Akron, OH 44308


Physician Signature: Date: