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.

Lipase

Centralized Core Laboratory : Chemistry

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. Lipase
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

LIPAS ACHM5

Specimen Type:

Blood

Tube Type:

Green top (lithium heparin) tube

Collection Volume:

1.5 mL

Storage:

Shipping- Send Refrigerated; Storage: Room Temp: 7 days; Refrigerated: 7 days; Frozen: 2 months

Availability:

24 hours/day, 7 days/week

Methodology:

Roche-Enzymatic colorimetric assay

Lab/Phone:

330-543-8417

TAT:

1 hour

Additional Info:

Reference range: 13-95 U/L

CPT Code:

83690

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