Comp Metabolic Panel
| 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. Comp Metabolic Panel | |
| 2. | |
| 3. | |
| 4. | |
| 5. | |
| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
CMP
Test Workstation :
ACHM5
Specimen Type:
Blood
Tube Type:
Green top (lithium heparin) tube
Minimum Volume:
500 uL
Preferred Volume:
1.5 mL
Storage:
Shipping- Send Refrigerated; Storage-Room Temp: 8 hours; Refrigerated 3 days; Frozen: 3 days
Availability:
Daily, 24 hours; STAT
Methodology:
See individual tests
Special Instructions:
Protect the specimen from direct light exposure. Ask that the bilirubin lights in the NICU be turned off while collecting.
Lab/Phone:
330-543-8418
TAT:
1 hour
Additional Info:
Reference ranges available under individual tests
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
