CarboxyHgb

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. CarboxyHgb
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

COHG

Test Workstation :

MBG1

Specimen Type:

Blood

Tube Type:

Heparinized syringe, Green top (lithium heparin) microtainer or macrotainer, or heparinized capillary tubes. NO GEL SEPARATOR TUBES.

Collection Volume:

0.5 mL microtainer or syringe; (2) 125 uL capillary tubes; 1.5 mL whole blood green top (lithium heparin) tube

Minimum Volume:

250 uL microtainer or 0.5 mL syringe; (2) 125 uL capillary tubes; 1.5 mL macrotainer.

Preferred Volume:

500 uL microtainer or 0.5 mL syringe; (2) 125 uL capillary tubes; 1.5 mL macrotainer.

Cause for Rejection:

Clotted, air bubbles, gel separator tubes

Storage:

Room Temp

Availability:

Daily, 24 hours; STAT

Methodology:

Spectrophotometric

Special Instructions:

Deliver immediately to laboratory at room temperature. For Outpatients, test should only be drawn in outpatient locations within the Hospital on the Mahoning Valley campus.

Lab/Phone:

330-746-9623

TAT:

30 minutes for STAT; 15 minutes for ICU STAT

Additional Info:

Reference range: Available on Patient Report.

CPT Code:

82375

Synonyms:

Carbon Monoxide

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CarboxyHgb

Laboratory - : Chemistry

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