3 Methylglutaconic Acid, Urine

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. 3 Methylglutaconic Acid, Urine
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

3METH MAYO

Specimen Type:

Random Urine

Tube Type:

Sterile Container

Collection Volume:

5.0 mL

Storage:

Frozen

Availability:

Sent to Reference Lab

Methodology:

Gas Chromatography Kennedy Kreiger Institute

Lab/Phone:

330-543-8418

TAT:

2 weeks

Additional Info:

Reference range available on patient report

Mayo Code ZW175; Referral Code 7

CPT Code:

83921

Specimen Collection Procedures:

Urines

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