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.

Chloride Urine, Random

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. Chloride Urine, Random
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

CLUR ACHM5

Specimen Type:

Urine

Tube Type:

Urine container

Collection Volume:

1.0 mL Urine without preservatives

Storage:

Shipping- Send Refrigerated; Storage-Room Temp: 7 days; Refrigerated: 7 days; Frozen: stable

Availability:

24 hour/day, 7 days/week

Methodology:

Roche- Ion-Selective Electrodes (ISE) Indirect

Special Instructions:

Deliver specimens promptly to lab.

Lab/Phone:

330-543-8417

TAT:

1 hour

CPT Code:

82436

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