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.

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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