Citrate Excretion, Peds, Random, U

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. Citrate Excretion, Peds, Random, U
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

CITRU

Test Workstation :

MAYO

Specimen Type:

Urine

Tube Type:

Urine Container

Collection Volume:

4 mL (minimum 1 mL)

Storage:

Refrigerated

Availability:

Sent to Reference Laboratory

Methodology:

Enzymatic

Special Instructions:

Collect a random urine specimen, no preservative.

Lab/Phone:

330-543-8418

TAT:

1-3 days

Additional Info:

No established reference values