Carbon Dioxide

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. Carbon Dioxide
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

TCO2 MACH3

Specimen Type:

Blood

Tube Type:

Green top (lithium heparin) tube

Collection Volume:

1.5 mL

Storage:

Shipping: Send Refrigerated; Storage: Room Temp: 40 hours; Refrigerated: 7 days

Availability:

24 Hours/day, 7 days/week

Methodology:

Roche- PEPC

Lab/Phone:

330-746-9623

TAT:

1 hour

Additional Info:

Reference range available on patient report

CPT Code:

82374

Profile Includes:

Remove Special Instructions

Synonyms:

CO2; Total CO2; Bicarbonate

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