Hemoglobin

Laboratory - : Hematology

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. Hemoglobin
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

HGB

Test Workstation :

MAHM1

Specimen Type:

Blood

Tube Type:

Purple top (EDTA) tube: Whole Blood

Collection Volume:

0.25 mL or 250 microliters minimum

Cause for Rejection:

Specimen hemolyzed, clotted, diluted with IV fluid; held at RT for more than 8 hours or at 4C for mor than 24 hours

Storage:

Refrigerated

Availability:

Daily, 24 hours; STAT

Methodology:

Flow Cell Spectrophotometry

Special Instructions:

Lipemic plasma or white count > 100,000/mm3 may falsely elevate the hemoglobin.

Lab/Phone:

330-746-9623

TAT:

4 hours

Additional Info:

Reference range is available on patient report

CPT Code:

85018

Synonyms:

HGB

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Laboratory Services

Hemoglobin

Laboratory - : Hematology

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