Phosphorous, Ur Random

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. Phosphorous, Ur Random
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Test ID/Workstation :

PHOUR CLEVE

Specimen Type:

Urine

Tube Type:

Urine container

Collection Volume:

5.0 mL (minimum 3.0 mL) random urine

Storage:

Refrigerated

Availability:

Sent to Reference Laboratory

Methodology:

Ammonium Molybdate

Lab/Phone:

330-543-8418

TAT:

8 hours

Additional Info:

Reference range: 7-140 mg/dL

CPT Code:

84105

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Phosphorous, Ur Random

Centralized Core Laboratory : Chemistry

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