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. Arginine Vasopressin, Plasma   
2.   
3.   
4.   
5.   
6.   

SPECIMEN INFO
Collection Date & Time:
Collected By:
Test Information for Arginine Vasopressin, Plasma
Specimen Type: Blood- plasma

Tube Type/Collection Container: Purple top (EDTA) tube

Collection Volume: 5.0 mL (minimum 3.0 mL)

Storage: Frozen

Availability: Sent to Reference Laboratory

Methodology: Radioimmunoassay (RIA)

Special Instructions: Have patient fast and thirst for 6 hours

TAT: 3-11 days


Lab/Phone: 330-543-8418

Additional Info: Reference Values: Adults: <1.7 pg/mL Reference valeus were determined on platelet-poor EDTA plasma from individuals fasting no longer than overnight.

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: