Amylase

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. Amylase
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

AMYL ACHM5

Specimen Type:

Blood

Tube Type:

Green top (lithium heparin) tube

Collection Volume:

Collect 1.5 mL

Storage:

Shipping-Refrigerated; Storage-Room Temp: 7 days; Refrigerated: 1 month

Availability:

24 hours/day, 7 days/week

Methodology:

Roche-Enzymatic Colorimetric

Lab/Phone:

330-543-8417

TAT:

1 hour

Additional Info:

Ref. range is age dependent; avail on patient report

CPT Code:

82150

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