Drugs of Abuse Screen, Ur Mahoning Valley

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 Screen, Ur Mahoning Valley
2.
3.
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SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

DRGTM

Test Workstation :

MACH3

Specimen Type:

Urine

Tube Type:

Urine Container

Collection Volume:

10.0 mL

Minimum Volume:

2 mL

Preferred Volume:

10 mL

Storage:

Shipping: Send Refrigerated; Storage: Refrigerated and tested within 5 days

Availability:

24 Hours/day, 7 days/week

Methodology:

Roche-KIMS and Homogenous Enzyme Immunoassay

Special Instructions:

None

Lab/Phone:

330-746-9623

Additional Info:

Reference range: None Detected

CPT Code:

80307

Panel Includes:

Amphetamines, Barbiturates, Benzodiazepines, Cocaine, Methadone, Opiates, Oxycodone, PCP-Phencyclidine, and THC-50.

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Drugs of Abuse Screen, Ur Mahoning Valley

Laboratory - : Chemistry

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