Myoglobin, Urine

Centralized Core Laboratory - : Urinalysis

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. Myoglobin, Urine
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

MYOGL

Test Workstation :

MUA

Specimen Type:

Urine

Tube Type:

Urine container

Collection Volume:

10.0 mL (minimum 5.0 mL)

Cause for Rejection:

Specimen leaking from container, excessive delay in transport

Storage:

Refrigerated

Availability:

Daily, 24 hours; STAT

Methodology:

Blondheim

Special Instructions:

Transport to the lab within 2 hours. Stable 4 hours refrigerated. A urine voided after exercise is also acceptable.

Lab/Phone:

330-543-8418

TAT:

1 hour

Additional Info:

Reference range: Normal = Negative

CPT Code:

83874

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Myoglobin, Urine

Centralized Core Laboratory - : Urinalysis

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