Centralized Core Laboratory - Summa Akron City Hospital :
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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. Coma Panel
2.
3.
4.
5.
6.
SPECIMEN INFO
Collection Date & Time:
Collected By:
Hospital:
Test ID :
COMA
Test Workstation :
SUMMA
Specimen Type:
Blood & Urine
Tube Type:
Red top (no anticoagulant) tube; Urine container
Collection Volume:
12.0 mL blood and
12.0 mL urine
Minimum Volume:
8.0 ml Blood, 6.0 ml urine
Storage:
Refrigerated
Availability:
Sent to reference lab
Methodology:
Gas Chromatography
Special Instructions:
Specify which of the drugs, if any, are suspected.
For the most ideal results the blood and urine specimens should be collected within 4 hours of each other, but must be collected within 24 hours of each other.
Lab/Phone:
330-543-8418
TAT:
24 hours
Additional Info:
Reference range: None Detected
CPT Code:
80301
Coma Panel
Test ID/Workstation :
COMA
Specimen Type:
Blood & Urine
Tube Type:
Red top (no anticoagulant) tube; Urine container
Collection Volume:
12.0 mL blood and
12.0 mL urine
Storage:
Refrigerated
Availability:
Sent to reference lab
Methodology:
Gas Chromatography
Special Instructions:
Specify which of the drugs, if any, are suspected.
For the most ideal results the blood and urine specimens should be collected within 4 hours of each other, but must be collected within 24 hours of each other.
Lab/Phone:
330-543-8418
TAT:
24 hours
Additional Info:
Reference range: None Detected
CPT Code:
80301
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