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 CSF

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 CSF
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

GLCSF/ACHM5

Specimen Type:

CSF

Tube Type:

CSF container

Collection Volume:

0.5 mL (minimum 0.3 mL)

Storage:

Refrigerated

Availability:

Analyze immediately

Methodology:

Roche - UV Test

Special Instructions:

Send to laboratory immediately. Samples collected at an offsite location should be sent via STAT courier.

Lab/Phone:

330-543-8417

TAT:

1 hour

Additional Info:

Reference range is available on patient report

CPT Code:

82945

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