ED Stat 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. ED Stat Panel | |
| 2. | |
| 3. | |
| 4. | |
| 5. | |
| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
EDPAN
Test Workstation :
MBG1
Specimen Type:
Blood
Tube Type:
Heparinized syringe, Green top (lithium heparin) macrotainer. NO GEL SEPARATOR TUBES. NO MICROTAINER TUBES.
Collection Volume:
0.5 mL syringe; 4.0 mL whole blood green top (lithium heparin) tube
Minimum Volume:
0.5 mL syringe; 1.5 mL macrotainer.
Preferred Volume:
0.5 mL syringe; 1.5 mL macrotainer.
Cause for Rejection:
Clotted, air bubbles. Specimens collected in microtainers or gel separator tubes will not be accepted, >30 minutes from collection time.
Storage:
Room Temp
Availability:
Daily, 24 hours: STAT
Methodology:
Ion selective Electrode/ Calculations
Special Instructions:
Notify laboratory if patient's temperature is other than 37C to correct results (temperature dependent). Deliver immediately to laboratory at room temperature. Must be received in lab within 30 minutes of collection time.
Lab/Phone:
330-746-9623
TAT:
30 minutes
Additional Info:
Reference ranges available under individual tests.
Panel Includes:
Venous Gases, Whole blood analytes to include: Ionized Calcium, Chloride, Glucose, Potassium, Sodium, Lactate
