Organic Acids Screen, Urine

Centralized Core 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. Organic Acids Screen, Urine
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

OASU 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:

3-6 days

Additional Info:

Reference range is available on patient report

CPT Code:

83919

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