HCG, Urine

Laboratory - : Urinalysis

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

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

HCGUR

Test Workstation :

MMUA

Specimen Type:

Urine

Tube Type:

Urine Container

Collection Volume:

2.0 mL (minimum 1.0 mL)

Minimum Volume:

1.0 mL

Preferred Volume:

2.0 mL

Storage:

Refrigerated

Availability:

Daily, 24 hours; STAT

Methodology:

Antibody Reaction by Chromatographic Immunoassay

Special Instructions:

First Morning void (preferred) or random

Lab/Phone:

330-746-9623

TAT:

1 hour

Additional Info:

Reference range is not applicable

CPT Code:

81025

Synonyms:

Urine Pregnancy Test

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