We are experiencing exceptionally high volumes in our emergency rooms.
Every patient is important to us, and we are doing all we can to provide care quickly and efficiently.

Flunitrazepam, Screen 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. Flunitrazepam, Screen Urine
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

FLUNU CLEVE

Specimen Type:

Urine

Tube Type:

Urine container

Collection Volume:

3.0 mL (minimum 1.5 mL) random urine

Storage:

Refrigerated

Availability:

Sent to reference lab

Methodology:

High Performance Liquid Chromatography/Tandem Mass Spectrometry (LC/MS/MS)

Lab/Phone:

330-543-8418

TAT:

6-14 days

CPT Code:

80346

Synonyms:

Rohypnol

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