Glucose, 2HR Challenge

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. Glucose, 2HR Challenge
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

GL2HR

Test Workstation :

MACH3

Specimen Type:

Blood

Tube Type:

Green top (lithium heparin) tube

Collection Volume:

500 uL microtainer; 1.5 mL macrotainer

Minimum Volume:

500 uL microtainer; 1.5 mL macrotainer

Preferred Volume:

500 uL microtainer; 1.5 mL macrotainer

Storage:

Storage: Room Temp: 8 hours; Refrigerated: 72 hours; Frozen: 3 days

Availability:

Mon-Fri, call for appointment

Methodology:

Roche UV test

Special Instructions:

Prior to drawing patient, see Specimen Collection Procedure Glucose Tolerance Testing. For Outpatients, test should only be drawn in outpatient locations within Mahoning Valley hosptial.

Lab/Phone:

330-746-9623

TAT:

1 hour/draw

CPT Code:

82951

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Glucose, 2HR Challenge

Laboratory - : Chemistry

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