Glucose by Meter

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 by Meter
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

GLUM MCHM

Specimen Type:

Fresh Whole Peripheral Blood

Tube Type:

None

Collection Volume:

1 drop by capillary puncture at patient's bedside

Storage:

None

Availability:

Daily, 24 hours; STAT

Methodology:

Electrochemical principle of Biamperometry

Special Instructions:

Heparinized whole blood can also be sent to lab if capillary puncture is not possible (ex: burned extremities or patient has a line to avoid repeated punctures). Glucose by meter levels that are <45 mg/dL or >450 mg/dL (>300 mg/dL for NICU patients) will be confirmed via a whole blood specimen analyzed on the Blood Gas Analyzer.

Lab/Phone:

330-543-8418

TAT:

20 minutes

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:

82948