Hepatic Panel
| 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. Hepatic Panel | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
LIVER
Test Workstation :
ACHM5
Specimen Type:
Blood
Tube Type:
Green top (lithium heparin) tube
Minimum Volume:
500 uL
Preferred Volume:
1.5 mL
Storage:
Shipping- Send Refrigerated; Storage-Room Temp: 1 day; Refrigerated: 7 days; Frozen: 2 months
Availability:
24 hours/day, 7 days/week
Methodology:
See individual tests
Special Instructions:
Protect the specimen from direct light exposure. Ask that the bilirubin lights in the NICU be turned off while collecting.
Lab/Phone:
330-543-8418
TAT:
1 hour
Additional Info:
Reference ranges available under individual tests
CPT Code:
80076
Panel Includes:
Conjugated Bilirubin, Total Bilirubin, ALT, AST, Alkaline Phosphatase, Total Protein, Albumin
Synonyms:
Liver Function Test
