Buprenorphine Screen, Urine

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. Buprenorphine Screen, Urine
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

BUPUR/SUMMA

Specimen Type:

Urine-Random

Tube Type:

Urine container

Collection Volume:

3.0 mL

Storage:

Refrigerated

Availability:

7 days a week on day shift and second shift only

Methodology:

Immunoassay

Lab/Phone:

330-543-8418

TAT:

1-2 days

CPT Code:

80307

Synonyms:

Suboxone

Specimen Collection Procedures:

Urines

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