We are experiencing exceptionally high volumes in our emergency rooms.
Every patient is important to us, and we are doing all we can to provide care quickly and efficiently.

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:

-

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