pH, Stool

Centralized Core 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. pH, Stool
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

PHSTL

Test Workstation :

MCHM

Specimen Type:

Stool

Tube Type:

Stool container

Collection Volume:

1 gram stool specimen

Cause for Rejection:

Urine or barium contamination

Storage:

Frozen

Availability:

Daily (0730-1600)

Methodology:

pH paper

Special Instructions:

Patient should not take laxatives or have barium procedures one week prior to specimen collection.

Lab/Phone:

330-543-8418

TAT:

4 hours

Additional Info:

Reference range: 6.0 is normal stool pH

CPT Code:

83986

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pH, Stool

Centralized Core Laboratory - : Chemistry

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