Reducing Substances

Laboratory : Urinalysis

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. Reducing Substances
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

REDSU MMUA

Specimen Type:

Urine

Tube Type:

Urine container

Collection Volume:

12.0 mL (minimum 1.0mL)

Cause for Rejection:

Specimen leaking from container, excessive delay in transport

Storage:

Refrigerated

Availability:

Daily, 24 hours; STAT

Methodology:

(copper reduction) AimTab Reducing Substances Tablets, Germaine Laboratories

Special Instructions:

Transport specimen to the lab within 2 hours. Stable 4 hours refrigerated.

Lab/Phone:

330-746-9623

TAT:

1 hour

Additional Info:

Reference range: Normal = Negative

This test was developed and its performance characteristics determined by Children's Hospital Medical Center of Akron, Laboratory. It has not been cleared or approved by the FDA. The laboratory is regulated under CLIA as qualified to perform high-complexity testing. This test is used for clinical purposes. It should not be regarded as investigational or for research.

CPT Code:

81005