Alcohol

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. Alcohol
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

ALCO ACHM5

Specimen Type:

Blood

Tube Type:

Green top (lithium heparin) tube

Collection Volume:

1.5 mL

Storage:

Shipping: Send Refrigerated; Storage Room Temp: 2 days; Refrigerated 2 weeks; Frozen 4 weeks

Availability:

24 hours/day, 7 days/week

Methodology:

Roche-Enzymatic with alcohol dehydrogenase

Special Instructions:

Do not use alcohol or other volatile disinfectants at the site of venipuncture. Levels obtained are for medical use only; not intended for legal use. Deliver specimen to lab immediately. If collected at an offsite location, send by a STAT Courier to Akron Children's Hospital lab

Lab/Phone:

330-543-8419

TAT:

1 hour

Additional Info:

Reference range:

50-100 mg/dL: Impairment

>100 mg/dL: Depression of CNS

>400 mg/dL: Fatalities reported

CPT Code:

80301

Synonyms:

Ethanol; ETOH

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Alcohol

Centralized Core Laboratory : Chemistry

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