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Amikacin, trough

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. Amikacin, trough
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Test ID/Workstation :

AMTRO CLEVE

Specimen Type:

Blood

Tube Type:

Green top (lithium or sodium heparin) tube

Collection Volume:

2.5 mL (minimum 1.5 mL)

Storage:

Refrigerated

Availability:

Sent to reference lab

Methodology:

Fluorescence Polarization Immunoassay (FPIA)

Special Instructions:

Draw 5-90 minutes before next infusion. Freeze if storage/transport time will be longer than 48 hours.

Lab/Phone:

330-543-8418

TAT:

24 hours

Additional Info:

Reference range: Pre: 5.0-10.0 ug/mL

CPT Code:

80150

Synonyms:

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Amikacin, trough

Centralized Core Laboratory : Chemistry

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