Centralized Core Laboratory - Cleveland Clinic Laboratories :
Send Out
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. Pentobarbital
2.
3.
4.
5.
6.
SPECIMEN INFO
Collection Date & Time:
Collected By:
Hospital:
Test ID :
ZMSO
Test Workstation :
CLEVE
Specimen Type:
Blood
Tube Type:
Green top (sodium or lithium heparin)tube
Collection Volume:
5.0 mL
Minimum Volume:
0.6 mL
Cause for Rejection:
Do not use Serum separator tubes
Storage:
Refrigerated
Availability:
Sent to reference lab
Methodology:
High Performance Liquid Chromatography (HPLC)
Special Instructions:
Collect specimen immediately prior to next dose unless specified otherwise.
Days Performed SunSat.
Order as a Miscellaneous Sendout EAP LAB3064
Please Complete Order Questions as follows:
Test Name: Pentobarbital
Sendout Facility Name:Cleveland Clinic
Lab/Phone:
330-543-8418
TAT:
24 hours
Additional Info:
Therapeutic range: 25-35 ug/mL
CPT Code:
80345
Synonyms:
Nembutal
Pentobarbital
Test ID/Workstation :
ZMSO
Specimen Type:
Blood
Tube Type:
Green top (sodium or lithium heparin)tube
Collection Volume:
5.0 mL
Cause for Rejection:
Do not use Serum separator tubes
Storage:
Refrigerated
Availability:
Sent to reference lab
Methodology:
High Performance Liquid Chromatography (HPLC)
Special Instructions:
Collect specimen immediately prior to next dose unless specified otherwise.
Days Performed SunSat.
Order as a Miscellaneous Sendout EAP LAB3064
Please Complete Order Questions as follows:
Test Name: Pentobarbital
Sendout Facility Name:Cleveland Clinic
Lab/Phone:
330-543-8418
TAT:
24 hours
Additional Info:
Therapeutic range: 25-35 ug/mL
CPT Code:
80345
Synonyms:
Nembutal
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