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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Chloride Urine, Random

Centralized Core Laboratory : Chemistry

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