Targeted Opioid Screen Urine

Centralized Core Laboratory - Mayo Clinic Laboratories : Send Out

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. Targeted Opioid Screen Urine
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

TOSUR

Test Workstation :

Mayo

Specimen Type:

Urine

Tube Type:

Urine container

Collection Volume:

1.0 mL

Minimum Volume:

0.5 mL

Cause for Rejection:

Gross hemolysis, Gross icterus

Storage:

Refrigerated

Availability:

Sent to Reference Laboratory

Methodology:

Liquid Chromatography-Tandem Mass Spectrometry, High Resolution Accurate Mass (LC-MS/MS HRAM)

Special Instructions:

Please list prescribed opioids.

Lab/Phone:

330-543-8418

TAT:

2-4 days

Additional Info:

Reference Interval: Not Detected

CPT Code:

80364, G0481 (if appropriate)

Panel Includes:

Codeine, Codeine-6-beta-glucuronide, Morphine, Morphine-6-beta-glucuronide, 6-monacetylmorphine, Hydrocodone, Norhydrocodone, Dihydrocodeine, Hydromorphone, Hydromorphone-3-beta-glucuronide, Oxycodone, Noroxycodone, Oxymorphone, Oxymorphone-3-beta-glucuronide, Noroxymorphone, Fentanyl, Norfentanyl, Meperidine, Normeperidine, Naloxone, Naloxone-3-beta-glucuronide, Methadone, EDDP, Propoxyphene, Norpropoxyphene, Tramadol, O-desmethyltramadol, Tapentadol, N-desmethyltapentadol, Tapentadol-beta-glucuronide,Buprenorphine, Norbuprenorphine, and Norbuprenorphine glucuronide

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Targeted Opioid Screen Urine

Centralized Core Laboratory - Mayo Clinic Laboratories : Send Out

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