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.

Bilirubin, Total

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. Bilirubin, Total
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

TBILI ACHM5

Specimen Type:

Blood

Tube Type:

Green top (lithium or sodium heparin) tube

Collection Volume:

1.5 mL

Storage:

Shipping- Send Refrigerated, protect from light; Storage-Room Temp: 1 day; Refrigerated: 7 days; Frozen: 6 months if protected from light exposure.

Availability:

24 hours/day, 7 days/week

Methodology:

Roche-Diazo Method

Special Instructions:

Protect specimen from light exposure. Ask that the blue bilirubin lights in the NICU be turned off while collecting.

Lab/Phone:

330-543-8418

TAT:

1 hour

CPT Code:

82247

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