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. B-Type Natr peptide   
2.   
3.   
4.   
5.   
6.   

SPECIMEN INFO
Collection Date & Time:
Collected By:
Test Information for B-Type Natr peptide
CPT Code: 83880

Specimen Type: Blood

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

Collection Volume: 3.0 mL

Storage: Refrigerate

Availability: Sent to Reference lab

Methodology: Immunoenzymatic Assay

Special Instructions: Available Daily, 24 hours Please send minimum 1.0 mL EDTA plasma and refrigerate within 24 hours

TAT: 1 Day


Lab/Phone: 330-543-8417

Additional Info: Reference range: 0-100 pg/mL

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: