ESR

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. ESR
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

SRATE MMCHM

Specimen Type:

Blood

Tube Type:

Purple top (EDTA) tube: Whole Blood drawn in a vacutainer

Collection Volume:

1.5 mL

Cause for Rejection:

Clotted specimen. Specimens collected in microtainer tubes.

Storage:

Refrigerated

Availability:

Daily, 24 hours; STAT

Methodology:

Modified Wintrobe

Special Instructions:

Specimens must be collected by venipuncture in macro tubes; multiple microtainer tubes are NOT acceptable.

Lab/Phone:

330-746-9623

TAT:

2 hours

Additional Info:

Reference range:

Male: 0-9 mm

Female: 0-20 mm

Child: 0-13 mm

CPT Code:

85651

Synonyms:

Sedimentation Rate (Wintrobe)

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ESR

Laboratory : Chemistry

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