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.

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:

Hospital:

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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