Digoxin

Centralized Core Laboratory - Summa Akron City Hospital : Send Out

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. Digoxin
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

DIGOX

Test Workstation :

SUMMA

Specimen Type:

Blood

Tube Type:

Red top (no anticoagulant) tube

Collection Volume:

3.0 mL

Minimum Volume:

2.0 mL

Storage:

Refrigerated

Availability:

Sent to reference lab

Methodology:

Multi point Immuno-Rate

Special Instructions:

Do not administer isotopes 24 hours prior to collection. Do not draw specimen close to the administration of Digiband. Note date, time, and amount of last dose.

Lab/Phone:

330-543-8418

TAT:

24 hours

Additional Info:

Therapeutic range: 0.8-2.0 ng/mL

CPT Code:

80162

Synonyms:

Lanoxin

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Digoxin

Centralized Core Laboratory - Summa Akron City Hospital : Send Out

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