Microalbumin
| 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. Microalbumin | |
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| 3. | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
MALB
Test Workstation :
ACHM5
Specimen Type:
Urine
Tube Type:
Urine container
Minimum Volume:
1 mL
Preferred Volume:
3 mL
Storage:
Shipping- Refrig.; Creat: R.T,: 2 days;Refrig, 6 days, Frozen 6 months; Microalb: 7 days RT; Refrig 1 month; Frozen 6 mos.
Availability:
24 hours/day, 7 days/week
Methodology:
Roche-Enzymatic Colorimetric, Turbidimetric
Lab/Phone:
330-543-8418
TAT:
4 hours
Additional Info:
Reference range is available on patient report
CPT Code:
82043
