Organic Acids Screen, Urine

PATIENT INFO

Patient Name:

Medical Record #:

BD: / / Sex: F M

PHYSICIAN INFO

Physician Name :

Address:

Ph: ( ) - Fax: ( ) -

Additional Report to:

Ph: ( ) - Fax: ( ) -

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

OASU

Test Workstation :

MAYO

Specimen Type:

Urine

Tube Type:

Urine container

Collection Volume:

10.0 mL (minimum 4.0 mL) random urine

Storage:

Frozen

Availability:

Sent to reference lab

Methodology:

Gas Chromatography-Mass Spectrometry (GC-MS)

Special Instructions:

Please include family history, clinical condition (acute episode or asymptomatic), diet, and drug therapy information.

Lab/Phone:

330-543-8418

TAT:

3-5 days

Additional Info:

Reference range is available on patient report

CPT Code:

83919