Glucose by Meter

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 :

GLUME

Test Workstation :

MMCHM

Specimen Type:

Fresh Whole Peripheral Blood

Tube Type:

None

Collection Volume:

1 drop by capillary puncture at patient's bedside

Minimum Volume:

1 drop by capillary puncture at patient's bedside

Preferred Volume:

1 drop by capillary puncture at patient's bedside

Storage:

None

Availability:

Daily, 24 hours; STAT

Methodology:

Electrochemical principle of Biamperometry

Special Instructions:

Heparinzed 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 >450 mg/dL ( > 300 mg/dL for NICU patients) will be confirmed via a whole blood specimen analyzed on the EML.

Lab/Phone:

330-746-9623

TAT:

20 minutes

CPT Code:

82948

Panel Includes:

REFERENCE RANGE NEEDS MODIFIED TO 0-1 DAY 40-60, 2-28 DAYS, 50-80

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Glucose by Meter

Laboratory - : Chemistry

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