Glucose, Misc fluid

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, Misc fluid
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Test ID/Workstation :

GLUMF ACHM1

Specimen Type:

Any fresh body fluid (pleural, synovial, drainages, etc.)

Tube Type:

Fluid container

Collection Volume:

0.3 mL (minimum 0.1 mL)

Cause for Rejection:

Storage:

Refrigerated

Availability:

Daily, 24 hours; STAT

Methodology:

Enzymatic reference method with hexokinase

Special Instructions:

Please specify type of fluid. Deliver to lab immediately.

Lab/Phone:

330-543-8417

TAT:

1 hour

Additional Info:

Reference range: Not Established; Dr. interpretation only

CPT Code:

82945

Synonyms:

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Glucose, Misc fluid

Centralized Core Laboratory : Chemistry

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