pH, Misc fluid by meter

Centralized Core Laboratory : Special 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. pH, Misc fluid by meter
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID/Workstation :

PHFLD SCMAN

Specimen Type:

Any fresh body fluid (pleural, synovial, drainages, etc)

Tube Type:

Syringe (Remove needle and cap specimen before sending to the laboratory)

Collection Volume:

10.0 mL (minimum 5.0 mL)

Storage:

Refrigerated

Availability:

Daily (0730-1600)

Methodology:

pH meter

Lab/Phone:

330-543-8484

TAT:

4 hours

Additional Info:

Reference range: Not established; Dr. interpretation only

CPT Code:

83986

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