Prothrombin Time

Laboratory - : Hematology

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.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

Test Workstation :

MACG1

Specimen Type:

Blood

Tube Type:

Lt. Blue top (sodium citrate) tube

Collection Volume:

2.7 mL (minimum 1.8 mL) Must use appropriated sodium citrate tube based on volume of blood drawn (1.8 mL or 2.7 ml tube)

Minimum Volume:

1.8 mL using appropriate 1.8 mL tube

Preferred Volume:

2.7 ml using appropriate 2.7 ml tube

Cause for Rejection:

Sample hemolyzed, clotted, diluted with IV fluid; contaminated with heparin; improperly filled; received > 24 hr. after collection.

Storage:

Ambient

Availability:

Daily, 24 hours; STAT

Methodology:

Optical Light Scatter Detection Clotting Assay

Lab/Phone:

330-746-9623

TAT:

4 hours

Additional Info:

Reference range: 8.5-14.0 secs.

Recommended Therapeutic Range for Oral Anticoagulant Therapy: Prophylaxis of venous thrombosis, Treatment of venous thrombosis, Treatment of pulmonary embolism, Prevention of systemic, 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

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Prothrombin Time

Laboratory - : Hematology

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