17 Ketosteroids

Centralized Core Laboratory : Chemistry

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. 17 Ketosteroids
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Specimen Type:

Urine

Tube Type:

Urine container

Collection Volume:

20.0 mL (minimum 10.0 mL)

Storage:

Refrigerated

Availability:

Sent to Quest Diagnostics Chantilly

Special Instructions:

*** Please order test ZMSO in the Laboratory Information System or LAB3064 in Epic *** 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, including height and weight, and date and time collection started and finished. Deliver specimens promptly to lab.

Lab/Phone:

330-543-8418

Additional Info:

Ref. range is age dependent; avail on patient report

CPT Code:

83586