Drugs of Abuse, Urine

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. Drugs of Abuse, Urine
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Test ID/Workstation :

DRG ACHM1

Specimen Type:

Urine

Tube Type:

Urine container

Collection Volume:

10.0 mL (minimum 2.0 mL)

Storage:

Refrigerated

Availability:

Daily, 24 hours

Methodology:

Enzyme Immunoassay (EIA)

Special Instructions:

Specify which of the drugs, if any, are suspected.

Lab/Phone:

330-543-8418

TAT:

1 hour

Additional Info:

Reference range: None Detected

CPT Code:

80301

Synonyms:

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Drugs of Abuse, Urine

Centralized Core Laboratory : Chemistry

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