Potassium, Misc Fluid
| 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. Potassium, Misc Fluid | |
| 2. | |
| 3. | |
| 4. | |
| 5. | |
| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
KFLD
Test Workstation :
ACHM1
Specimen Type:
Any fresh body fluid (pleural, synovial, drainages, etc)
Tube Type:
Fluid container
Collection Volume:
0.5 mL
Storage:
Refrigerated
Availability:
Daily, 24 hours; STAT
Methodology:
Ion selective electrode indirect
Special Instructions:
Please specify type of fluid. Deliver to lab immediately.
Lab/Phone:
330-543-8417
TAT:
1 hour
Additional Info:
Ref. range: Not Established; Dr. interpretation only
CPT Code:
84113
