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. Angiotensin-1-Converting Enzyme   
2.   
3.   
4.   
5.   
6.   

SPECIMEN INFO
Collection Date & Time:
Collected By:
Test Information for Angiotensin-1-Converting Enzyme
CPT Code: 82164

Specimen Type: Blood

Tube Type/Collection Container: Red top ( no anticoagulant) tube

Collection Volume: 2.5 mL (minimum 1.25 mL)

Storage: Refrigerated

Availability: Sent to reference lab

Methodology: Spectrophotometry

Special Instructions: Days Performed: Mon-Sat The use of angiotensin converting enzyme (ACE) - inhibiting antihypertensive drugs will cause decreased ACE values.

TAT: 1-3 days


Lab/Phone: 330-543-8418

Additional Info: Reference range: > or = 18 years: 8-53 U/L The reference interval for pediatric patients may be up to 50% higher than that of adults.

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: