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.

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/Workstation :

GL2HR MACH3

Specimen Type:

Blood

Tube Type:

Green top (lithium heparin) tube

Collection Volume:

1.5 mL

Storage:

Shipping: Send Refrigerated; 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 a Hospital (Akron or Mahoning Valley).

Lab/Phone:

330-746-9623

TAT:

1 hour/draw

Additional Info:

Criteria for Diagnosis of Diabetes (2HR Challenge):
Fasting specimen (no caloric intake for at least 8 hours):
<100 mg/dl	Normal
100-125 mg/dl	Increased Risk for Diabetes
>125 mg/dl	Diagnostic for Diabetes
2 Hour Specimen (post glucose administration):
<=139 mg/dl	Normal
140-199 mg/dl	Increased Risk for Diabetes
>200 mg/dl	Diagnostic for Diabetes

CPT Code:

82951

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