Glucose Peritoneal Dialysate

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 Peritoneal Dialysate
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

GLUPD/ACHM5

Specimen Type:

Peritoneal Dialysate

Tube Type:

sterile container

Collection Volume:

1 mL

Storage:

24 hours RT, 7 days Refrigerated, 30 days Frozen

Availability:

24 Hours/day, 7 days/week

Methodology:

Roche - UV Test

Special Instructions:

Deliver immediately to lab

Lab/Phone:

330-543-8417

TAT:

1 hour

CPT Code:

82945

While we are ranked among the best children's hospitals in the country, it's our compassionate approach to treatment that makes us truly exceptional. Through a combination of revolutionary treatments and extraordinary patient experiences, our care does more than heal. It brings the entire family together for emotional support and understanding across multiple locations to reach you in the community where you live. Learn more...