Vancomycin

Laboratory - : Chemistry

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. Vancomycin
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

VANCO

Test Workstation :

MACH3

Specimen Type:

Blood

Tube Type:

Green top ( lithium heparin ) tube

Collection Volume:

500 uL microtainer; 1.5 mL macrotainer

Minimum Volume:

500 uL microtainer; 1.5 mL macrotainer

Preferred Volume:

500 uL microtainer; 1.5 mL macrotainer

Storage:

Shipping- Send Refrigerated; Storage-Room Temp 48hrs: 2 days; Refrigerated: 2 weeks; Frozen: 1 year

Availability:

24 hours/day, 7 days/week

Methodology:

Kinetic, KIMS

Special Instructions:

For therapeutic monitoring, draw peak levels 30 minutes after the completion of a 60 minute IV infusion and trough levels immediately prior to the next dose. Please indicate whether the specimen is a peak, tough, or random level.

Lab/Phone:

330-746-9623

TAT:

1 hour

Additional Info:

Reference Range Therapeutic: Randon= 5-50 ug/mL

Peak = 20-40 ug/mL

Trough = 7-15 ug/mL

CPT Code:

80202

Synonyms:

Vancocin

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Vancomycin

Laboratory - : Chemistry

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