Acylglycine, 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. Acylglycine, Urine
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

ACYLG MAYO

Specimen Type:

Urine

Tube Type:

Urine container

Collection Volume:

10.0 mL (minimum 4.0 mL)

Cause for Rejection:

Storage:

Frozen

Availability:

Sent to reference lab

Methodology:

Gas Chromatography-Mass Spectrometry (GC-MS) Stable Isotope Dilution Analysis

Special Instructions:

Lab/Phone:

330-543-8418

TAT:

5-14 days

Additional Info:

Age specific Reference Values available on patient report

CPT Code:

82542

Panel Includes:

n-Acetylglycine; N-Propionylglycine; Isobutyrylglycine; Ethylmalonic acid; n-Butyrylglycine; 2-Methylsuccinic acid; Isovalerylglycine; Glutaric acid; 3-Methylcrotonylglycine; n-Tiglylglycine; 3-Methylglutaconic acid; n-Hexanoylglycine; n-Octanoylglycine; 3-Phenylpropionylglycine; trans-Cinnamoylglycine; Suberyglycine; Dodecanedioic acid; Tetradecanedioic acid; Hexadecanedioic acid;

Synonyms: