Amphetamine Screen, Urine
| 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
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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.
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NOTE: These results are for medical treatment only.
Analysis performed using non-forensic procedures.
CPT Code:
-
