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:

Test ID/Workstation :

FLUNU CLEVE

Specimen Type:

Urine

Tube Type:

Urine container

Collection Volume:

3.0 mL (minimum 1.5 mL) random urine

Cause for Rejection:

Storage:

Refrigerated

Availability:

Sent to reference lab

Methodology:

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

Special Instructions:

Lab/Phone:

330-543-8418

TAT:

4-10 days

CPT Code:

80346

Synonyms:

Rohypnol

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Flunitrazepam, Screen Urine

Centralized Core Laboratory : Chemistry

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