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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