Centralized Core Laboratory - Summa Akron City Hospital :
Send Out
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. Amphetamine Screen, Urine
2.
3.
4.
5.
6.
SPECIMEN INFO
Collection Date & Time:
Collected By:
Hospital:
Test ID :
AMPUR
Test Workstation :
SUMMA
Specimen Type:
Urine
Tube Type:
Urine Container
Collection Volume:
5.0 mL (minimum 3.0 mL)
Storage:
Refrigerated
Availability:
Sent to Reference Laboratory
Methodology:
Immunoassay
Lab/Phone:
330-543-8418
TAT:
-
Additional Info:
Reference Range: Negative
-
Amphetamine group have been screened for by
immmunoassay at 1,000 ng/mL threshold. The screening
assay provides only a preliminary test result. A more
specific alternative method must be used to confirm
preliminary positive results.
-
NOTE: These results are for medical treatment only.
Analysis performed using non-forensic procedures.
CPT Code:
-
Amphetamine Screen, Urine
Test ID/Workstation :
AMPUR
Specimen Type:
Urine
Tube Type:
Urine Container
Collection Volume:
5.0 mL (minimum 3.0 mL)
Storage:
Refrigerated
Availability:
Sent to Reference Laboratory
Methodology:
Immunoassay
Lab/Phone:
330-543-8418
TAT:
-
Additional Info:
Reference Range: Negative
-
Amphetamine group have been screened for by
immmunoassay at 1,000 ng/mL threshold. The screening
assay provides only a preliminary test result. A more
specific alternative method must be used to confirm
preliminary positive results.
-
NOTE: These results are for medical treatment only.
Analysis performed using non-forensic procedures.
CPT Code:
-
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