Ammonia
| 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. Ammonia | |
| 2. | |
| 3. | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Specimen Type:
Blood
Tube Type:
Purple top (EDTA) tube
Minimum Volume:
0.5 mL macrotainer
Preferred Volume:
1.5 mL macrotainer
Storage:
Collect and Ship on Ice
Special Instructions:
No finger or heel stick collections. Place specimen on ice and deliver to lab immediately. Specimens for Ammonia cannot be shared with any other test. For Outpatients, test should only be drawn in outpatient locations within the Hospital on the Akron or Mahoning Valley campus.
Lab/Phone:
330-746-9623
TAT:
1 hour
CPT Code:
82140
Synonyms:
NH3, AMON
