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.
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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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