Citric Acid, Urine 24 Hr
| 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. Citric Acid, Urine 24 Hr | |
| 2. | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
CITAC
Test Workstation :
MAYO
Specimen Type:
Urine
Tube Type:
Urine container
Collection Volume:
4 mL from a well-mixed 24 hour urine collection
Storage:
Refrigerated
Availability:
Sent to reference lab
Methodology:
Enzymatic
Special Instructions:
4.0 mL (minimum 1.0 mL) aliquot from a 24hour urine collection in a container without preservative. Instruct patient on 24 hour urine collection. To begin the urine collection, have the patient void. DISCARD THIS URINE SPECIMEN. This is done with the first morning specimen. Note the time and record on the requisition. From then on collect all that is voided and place in container. If more than one specimen is needed, please mark the first as #1 of 2 and retain on the floor until the collection is complete. The final void should be made 24 hours after the first void described earlier. The specimen should be included with the collection. Sample must be refrigerated during collection.
Notes: Boric acid is an acceptable preservative, but not required if specimen is kept refrigerated during collection.
Lab/Phone:
330-543-8418
TAT:
1-3 days
Additional Info:
Reference range: See Report
Days Performed: Mon-Sat
CPT Code:
82507
