We are experiencing exceptionally high volumes in our emergency rooms. Every patient is important to us, and we are doing all we can to provide care quickly and efficiently.
Complete Blood Count without Differential (CBC WITHOUT DIFF, aka hemogram)
Centralized Core 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. Complete Blood Count without Differential (CBC WITHOUT DIFF, aka hemogram)
2.
3.
4.
5.
6.
SPECIMEN INFO
Collection Date & Time:
Collected By:
Hospital:
Test ID/Workstation :
HEGRM AHEM1
Specimen Type:
Blood
Tube Type:
Purple top (EDTA) tube: Whole Blood
Collection Volume:
2.0 mL (minimum 0.3 mL)
Cause for Rejection:
Specimen hemolyzed, clotted, diluted with IV fluid, or collected in heparin; tubes improperly filled; specimen at RT > 8 hrs or 4-8C > 24 hrs
Storage:
Refrigerated
Availability:
Daily, 24 hours; STAT
Methodology:
Impedance measurement with Optical Flow fluorescence measurements and Spectrophotometry
Special Instructions:
Indicate clearly if a specimen has been drawn from an arterial line or from a line that has been rinsed with heparin.
Lab/Phone:
330-543-8416
TAT:
4 hours
Additional Info:
Reference ranges are available on patient report
CPT Code:
85027
Profile Includes:
WBC
Nucleated RBC
RBC
Hemoglobin
Hematocrit
MCV
MCH
MCHC
RDW
Platelets
MPV
Synonyms:
Blood Count Profile; Cell Profile; CBC WO Diff
Complete Blood Count without Differential (CBC WITHOUT DIFF, aka hemogram)
Test ID/Workstation :
HEGRM AHEM1
Specimen Type:
Blood
Tube Type:
Purple top (EDTA) tube: Whole Blood
Collection Volume:
2.0 mL (minimum 0.3 mL)
Cause for Rejection:
Specimen hemolyzed, clotted, diluted with IV fluid, or collected in heparin; tubes improperly filled; specimen at RT > 8 hrs or 4-8C > 24 hrs
Storage:
Refrigerated
Availability:
Daily, 24 hours; STAT
Methodology:
Impedance measurement with Optical Flow fluorescence measurements and Spectrophotometry
Special Instructions:
Indicate clearly if a specimen has been drawn from an arterial line or from a line that has been rinsed with heparin.
Lab/Phone:
330-543-8416
TAT:
4 hours
Additional Info:
Reference ranges are available on patient report
CPT Code:
85027
Profile Includes:
WBC
Nucleated RBC
RBC
Hemoglobin
Hematocrit
MCV
MCH
MCHC
RDW
Platelets
MPV
Synonyms:
Blood Count Profile; Cell Profile; CBC WO Diff
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