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Ambien

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. Ambien
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Test ID/Workstation :

AMB MAYO

Specimen Type:

Blood

Tube Type:

Red top (no anticoagulant) or Green top (sodium heparin) tube

Collection Volume:

5.0 mL (minimum 1.0 mL)

Storage:

Refrigerated

Availability:

Sent to reference lab

Methodology:

Liquid Chromatography/Tandem Mass Spectrometry (LC/MS/MS)

Lab/Phone:

330-543-8377

TAT:

3-5 days

Additional Info:

Therapeutic range is available on patient report

CPT Code:

80368

Synonyms:

Zolpidem

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Ambien

Centralized Core Laboratory : Chemistry

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