Occult Bld, Gastric

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. Occult Bld, Gastric
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

OCGAS MMCHM

Specimen Type:

Gastric fluid or vomitus

Tube Type:

Fluid container

Collection Volume:

1.o mL ( minimum 0.5 mL)

Storage:

Refrigerated

Availability:

Daily, 24 hours; STAT

Methodology:

Guaiac

Lab/Phone:

330-746-9623

TAT:

1 hour

Additional Info:

Reference range: Occ Bld= Negative pH = 1.3-7.8

CPT Code:

82271

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