Prothrombin Time
| 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. Prothrombin Time | |
| 2. | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
PT
Test Workstation :
ACOAG
Specimen Type:
Blood
Tube Type:
Blue top (sodium citrate) tube
Collection Volume:
2.7 mL (minimum 1.8 mL)
Must use appropriate sodium citrate tube based on volume of blood drawn (1.8 mL or 2.7 mL tube)
Cause for Rejection:
Sample hemolyzed, clotted, diluted with IV fluid; contaminated with heparin; improperly filled; received >24 hours after drawn
Storage:
Ambient
Availability:
Daily, 24 hours; STAT
Methodology:
Photometric/turbidometric
Special Instructions:
Indicate clearly if a specimen has been drawn from an arterial line or from a line that has been rinsed with heparin. Please indicate if the patient is currently receiving anticoagulant therapy.
Lab/Phone:
330-543-8416
TAT:
4 hours
Additional Info:
Reference range: 8.5-14.0 secs; INR: 0.7-1.3
Recommended Therapeutic Range for Oral Anticoagulant Therapy: Prophylaxis of venous thrombosis, Treatment of venous thrombosis, Treatment of pulmonary embolism, Prevention of systemic embolism, and Tissue heart valves - INR 2.0-3.0, Myocardial infarction (to prevent systemic embolism), Valvular heart disease, Atrial fibrillation, Mechanical prosthetic valves - INR 2.0-3.0
CPT Code:
85610
Synonyms:
PROTIME; PT; Protime with INR, PT/INR
