Glucose

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
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

GLU ACHM5

Specimen Type:

Blood

Tube Type:

Green top (lithium heparin) tube

Collection Volume:

1.5 mL

Storage:

Shipping- Send Refrigerated; Storage-Room Temp: 8 hours; Refrigerated: 72 hours; Frozen: 3 days

Availability:

24 hours/day, 7 days/week

Methodology:

Roche-UV test

Special Instructions:

Prior to drawing patient, see Specimen Collection Procedure - Glucose Tolerance Testing. Separate plasma from cells ASAP

Lab/Phone:

330-543-8419

TAT:

1 hour

Additional Info:

Reference range:

0-1 day = 40-60 mg/dL

2-28 days = 50-80 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

Synonyms:

(Fasting) Blood Sugar or Glucose; Sugar