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Glucose, Urine

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, Urine
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Test ID/Workstation :

GLUQL MAUA1

Specimen Type:

Urine

Tube Type:

Urine container

Collection Volume:

12.0 mL(minimum 1.0mL )

Cause for Rejection:

Specimen leaking from container, excessive delay in transport

Storage:

Refrigerated

Availability:

Daily, 24 hours; STAT

Methodology:

Glucose Oxidase- Double Enzymatic Reaction, Mutistix 10 SG

Special Instructions:

Transport specimen to the lab within 2 hours. Stable 4 hours refrigerated.

Lab/Phone:

330-746-9623

TAT:

1 hour

Additional Info:

Reference range: Normal = Negative

CPT Code:

81003

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Glucose, Urine

Laboratory : Chemistry

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