BUN, Peritoneal Dialysate
| 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. BUN, Peritoneal Dialysate | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
BUNPD
Test Workstation :
ACHM5
Specimen Type:
Peritoneal Dialysate
Tube Type:
sterile container
Minimum Volume:
500 uL
Preferred Volume:
1.5 mL
Storage:
24 hours RT, 7 days Refrigerated, 30 days Frozen
Availability:
24 Hours/day, 7 days/week
Methodology:
Roche - Urease/ Glutamate
dehydrogenase (GLDH)
Special Instructions:
Deliver promptly to the lab
Lab/Phone:
330-543-8418
TAT:
1 hour
CPT Code:
84520
