Immunoelectrophoresis, Urine
| 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. Immunoelectrophoresis, Urine | |
| 2. | |
| 3. | |
| 4. | |
| 5. | |
| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
IMELU
Test Workstation :
SUMMA
Specimen Type:
Urine
Tube Type:
Urine container
Collection Volume:
5.0 mL urine
Storage:
Refrigerated
Availability:
Sent to reference lab
Methodology:
Electrophoresis
Special Instructions:
Instruct patient on 24 hour urine collection. To begin the urine collection, have the patient void. DISCARD THIS URINE SPECIMEN. This is best done with the first morning specimen. Note the time and record on the requisition. From then on collect all the urine that is voided and place in container. If more than one container is needed, please mark the first as #1 of 2 and retain on the floor until the collection is complete. The final void should be made 24 hours after the first void described earlier. The specimen should be included with the collection. Refrigerate 24 hour urines during collection. Do not use urine preservatives. Mark each container with patient information, including height and weight, and date and time collection started and finished. Deliver specimens promptly to lab.
Lab/Phone:
330-543-8418
TAT:
5 hours
Additional Info:
Reference range is available on patient report
CPT Code:
86325
Synonyms:
Bence Jones Protein
