Urinalysis, Complete

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, Complete
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

UACOM

Test Workstation :

MAUA1

Specimen Type:

Urine

Tube Type:

Urine Container

Collection Volume:

12.0 mL

Minimum Volume:

1.0 mL

Preferred Volume:

12.0 mL

Cause for Rejection:

Specimen leaking from container, excessive delay in transport

Storage:

Refrigerated

Availability:

Daily, 24 hours; STAT

Methodology:

Siemens Multistix Strips with a manual urine microscopic

Special Instructions:

12.0 mL of urine is the preferred volume. Stable 24 hours refrigerated.

Lab/Phone:

330-746-9623

TAT:

1 hour

Additional Info:

Reference ranges available under individual tests

CPT Code:

81001

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Urinalysis, Complete

Laboratory - : Urinalysis

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