We are experiencing exceptionally high volumes in our emergency rooms.
Every patient is important to us, and we are doing all we can to provide care quickly and efficiently.

Urinalysis, Chemistries

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. Urinalysis, Chemistries
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

UACHE MAUA1

Specimen Type:

Urine

Tube Type:

Urine Container

Collection Volume:

12.0 mL(minimum 1.0 mL)

Cause for Rejection:

Specimen leaking from container, excessive delay in transport

Storage:

Refrigerated

Availability:

Daily, 24 hours; STAT

Methodology:

Bayer Multistix 10 SG

Special Instructions:

12.0 mL of urine is the preferred volume. Transport to the lab within 2 hours. Stable 4 hours refrigerated.

Lab/Phone:

330-746-9623

TAT:

1 hour

Additional Info:

Reference ranges available under individual tests

CPT Code:

81003

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