Electrolyte Panel

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. Electrolyte Panel
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

LYTES

Test Workstation :

ACHM1

Specimen Type:

Blood

Tube Type:

Green top (lithium heparin) tube

Collection Volume:

1.5mL

Cause for Rejection:

Hemolysis or incorrect anticoagulant tube

Storage:

Refrigerated

Availability:

Daily, 24 hours; STAT

Methodology:

Ion selective electrode indirect

Special Instructions:

It is recommended that plasma be physically separated from contact with the cells within two hours from the time of collection.

Lab/Phone:

330-543-8417

TAT:

1 hour

Additional Info:

Reference ranges available under individual tests

CPT Code:

80051

Panel Includes:

Sodium, Potassium, Chloride, Carbon Dioxide

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Electrolyte Panel

Centralized Core Laboratory - : Chemistry

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