Comp Metabolic Panel
| PATIENT INFO |
| Patient Name: |
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| BD: / / Sex: F M |
| PHYSICIAN INFO |
| Physician Name : |
| Address: |
| Ph: ( ) - Fax: ( ) - |
| Additional Report to: |
| Ph: ( ) - Fax: ( ) - |
| TESTS REQUESTED | |
| Test Name: | ICD9 Code: (required) |
| 1. Comp Metabolic Panel | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
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Specimen Type:
Blood
Tube Type:
Lt. Green/Mint-LiHep
Minimum Volume:
0.5 mL
Preferred Volume:
0.5 mL microtainer; 1.5 mL macrotainer
Storage:
Refrigerate
Lab/Phone:
330-746-9623
TAT:
1 hour
Additional Info:
eGFR Calculations:
1-17 years old (Modified Schwartz Formula) =0.413*(Patient height (cm)/ Serum creatinine (mg/dL)).
>=18 years old (CKD-EPI(2021)) = 142 x min(Scr/κ, 1)α x max(Scr/κ, 1)-1.200 x 0.9938Age x 1.012 [if female]
where: Scr = standardized serum creatinine in mg/dL κ = 0.7 (females) or 0.9 (males) α = -0.241 (female) or -0.302 (male) min(Scr/κ, 1) is the minimum of Scr/κ or 1.0 max(Scr/κ, 1) is the maximum of Scr/κ or 1.0 Age (years)
CPT Code:
80053
Panel Includes:
Sodium, Potassium, Chloride, Carbon Dioxide, Urea Nitrogen, Glucose, Total Protein, AST, ALT, Alkaline Phosphatase, Calcium, Albumin, Creatinine, Total Bilirubin
Synonyms:
CMP, CMET, CHEM21
