Glucose, 2HR Challenge

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

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

GL2HR ACHM5

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

Methodology:

Roche-UV Test

Special Instructions:

Separate plasma from cells ASAP - For Outpatients, test should only be drawn in outpatient locations within a Hospital (Akron or Beeghly).

Lab/Phone:

330-543-8417

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