We are experiencing exceptionally high volumes in our emergency rooms.
Every patient is important to us, and we are doing all we can to provide care quickly and efficiently.

Ativan

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. Ativan
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

ATVAN CLEVE

Specimen Type:

Blood

Tube Type:

Red top (no anticoagulant) tube

Collection Volume:

5.0 mL (minimum 1.5 mL)

Cause for Rejection:

Storage:

Refrigerated

Availability:

Sent to reference lab

Methodology:

Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)

Special Instructions:

Do not use serum separator tubes.

Lab/Phone:

330-543-8418

TAT:

6-11 days

Additional Info:

Therapeutic range:

50-240 ng/mL

Toxic: >300 ng/mL

CPT Code:

80154

Synonyms:

Lorazepam

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