Basic Metabolic Panel

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. Basic Metabolic Panel
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

BMP

Test Workstation :

MACH3

Specimen Type:

Blood

Tube Type:

Green top ( lithium heparin ) tube

Collection Volume:

500 uL mictrotainer; 1.5 mL macrotainer

Minimum Volume:

500 uL microtainer; 1.5 mL macrotainer

Preferred Volume:

500 uL microtainer; 1.5 mL macrotainer

Storage:

Shipping: Send Refrigerated: Storage: For full panel: RT 8 hours; Refrigerated 72hrs or 3 days; Frozen 3 days. See each test for individual stability.

Availability:

Daily, 24 hours; STAT

Methodology:

See individual tests

Special Instructions:

Deliver to lab immediately.

Lab/Phone:

330-746-9623

TAT:

1 hour

Additional Info:

Reference range available on patient report

CPT Code:

80048

Panel Includes:

Sodium, Potassium, Chloride, Carbon Dioxide, Urea Nitrogen, Glucose, Creatnine, Calcium

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Basic Metabolic Panel

Laboratory - : Chemistry

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