Creatinine Clearance 24 hr

Centralized Core Laboratory : Chemistry

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. Creatinine Clearance 24 hr
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

UCC24 ACHM5

Specimen Type:

Blood and Urine

Tube Type:

Green top (lithium heparin) tube and Urine container

Collection Volume:

Collect 1.5 ml Green top (lithium heparin) tube and entire 12 hour urine collection. See Special Instructions.

Storage:

Shipping- Send Refrigerated; Storage- Plasma Room Temp and Refrigerated 7 days; Frozen: 3 months; Urine- Room Temp and Refrig. 6 days, Frozen: 6 mos.

Availability:

24 hours/day, 7 days/week

Methodology:

Roche-Enzymatic Colorimetric

Special Instructions:

Collect 1.5 mL Green top (lithium heparin) tube and 24 hour urine in an urine collection container. Due to compliance regulations blood creatinine must be collected during the 24 hours that the urine is being collected. Instruct patient on 24 hour urine collection. Refrigerate 24 hour urines during collection. Do not use urine preservatives. Mark each collection container with the following information required for resulting: patient demographic information, patient height (centimeters), patient weight (kilograms), and date and time collection was started and finished. Deliver specimens promptly to the lab.

Lab/Phone:

330-543-8417

TAT:

1 hour

Additional Info:

Ref. range is age dependent; avail on patient report

CPT Code:

82575