Glucose Whole Blood

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 Whole Blood
2.
3.
4.
5.
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SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

GLUWB MBG1

Specimen Type:

Blood

Tube Type:

Green top(Lithium Heparin), Heparinized syringe, 2 capillary tubes or microtainer(lithium heparin)no gel

Collection Volume:

0.5 mL(minimum 250 uL) or 4.0 mL Green Top Tube

Cause for Rejection:

Clotted, air bubbles

Storage:

Room Temperature

Availability:

Daily,24 hours; STAT

Methodology:

amperometric electrode

Special Instructions:

Deliver to lab immediately. For Outpatients, test should only be drawn in outpatient locations within the Hospital (Akron or Beeghly).

Lab/Phone:

330-746-9623

TAT:

30 min.

Additional Info:

Reference range:

0-1 day = 50-80 mg/dL

2-28 days = 40-60 mg/dL

29 days to end of life 70-99 mg/dL

Criteria for Diagnosis of Diabetes(Effective 6/6/11): Fasting specimen (no caloric intake for at least 8 hours).<100 mg/dl Normal100-125 mg/dl Increased Risk for Diabetes>125 mg/dl Diagnostic for Diabetes Random Glucose (any time of day without regard to last meal).>=200 mg/dl plus Classic Symptoms of Diabetes

CPT Code:

82947