A/G Ratio

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. A/G Ratio
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

A/G

Test Workstation :

ACHM1

Specimen Type:

Blood

Tube Type:

Green top (lithium or sodium heparin)

Collection Volume:

1.5 mL

Storage:

Frozen

Availability:

Daily, 24 hours; STAT

Methodology:

Timed-endpoint colorimetric and Biuret reaction

Special Instructions:

If possible, patient should be recumbent for at least one hour prior to specimen collection.

Lab/Phone:

330-543-8417

TAT:

1 hour

Additional Info:

Reference range: 1.1-1.8

CPT Code:

84155

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A/G Ratio

Centralized Core Laboratory - : Chemistry

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