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Laboratory Tests Available Note: This listing of tests is not all inclusive. These are the tests performed at the Evans lab and the most commonly requested ship out tests. If you have specific questions about availability of a test please call Shipping at 526-7053. Click on a letter to take you to that section of the listing. You can also search this page by pressing Ctrl-F. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
ABO/RH - Routine Blood Type Lab: Blood Bank/7999 Request Form: SF 556 or CHCS Specimen: Purple top tube
Abscess Anaerobic Culture Lab: Microbiology/7677 Request Form: CHCS Specimen: Pus, tissue, etc. obtained from an abscess, biopsy, aspirate, drainage, exudate, lesion, or wound. To ensure proper growth of organisms, specimens for anaerobic culture should have an order for aerobic culture from same site. Container: Anaerobic Culturette available from MDS Reference Range: No growth of anaerobic bacteria 5 days
Abscess Culture, Routine Lab: Microbiology/7677 Request Form: CHCS Specimen: Pus from aspiration Reference Range: No growth 48 hours
Accutane Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST, protect from light Reference Range: See Lab Report
ACE (Angiotensin 1 converting enzyme) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: 1 Green Top Tube Reference Range: See Lab Report
ACEAB (Anti Centromere) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: Red Top/SST/2ml serum Reference Range: Negative
Acetaminophen, Serum (ACTMN) Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: SST Collection: Routine venipuncture, Toxicity, 4 hr post-ingestion should be drawn. Reference Range: Therapeutic: 10-20 mcg/ml; toxic: > 150 mcg/ml
Acetone, Serum (SKETO) Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: Blood Container: Red top/SST Reference Range: Negative in normal nutritional states
Acetylcholine Receptor Antibodies/Myasthenia Gravis (ACET) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST - Bring to Lab STAT Reference Range: See Lab Report
Acid-Fast Stain Synonyms: AFB Smear, AFB Stain, Atypical Mycobacterium Smear, Mycobacterium Stain, TB Stain. Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: Sputum, Tissue, CSF, Random Urine Reference Range: No mycobacteria identified
Acid Phosphates, Serum Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: Red Top/SST Has to be run within 1 hour of being drawn Reference Range: 0.0 - 0.8 IU/L
ACTH (Adrenocorticotropic Hormone) Lab: Shipping/ 7053 Request Form: Miscellaneous (SF 557) Specimen: 1 Lavender (4ml), Bring to Shipping STAT Reference Range: 9-52 pg/ml
Activated Partial Thromboplastin Test (APTT) Lab: Hematology/ 4-4097 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: Blue top tube. The specimen volume must be at least 90% of expected fill, but not more than 100% of expected fill. Fill to the level indicated by the black line on the collection tube. Collection: Routine venipuncture. If multiple tests are being drawn, draw coagulation studies last. Reference Range: Reported with patient results, Approx. 25-35 seconds. Established and rechecked periodically. Sent with report. Therapeutic range: Patients on heparin therapy is approx. 50-80 seconds. Recommended test for monitoring Heparin Therapy.
Acyclovir Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Reference Range: See Lab Report
A-DBL (Anti DNS double stranded) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Tube 2 ml serum Reference Range: < 100 IU/ml
Adrenocorticotricotropic Hormone - See ACTH AFB, Fluid Lab: Shipping/7053 Request Form: Micro 2 (SF 554) Specimen: Screw Top sterile tube Reference: Range Negative
AFB, ACID, Sputum Lab: Shipping/7053 Request Form: Micro 2 (SF 554) Specimen: Sputum in falcon collection kit or specimen cup, Refrigerate immediately, all cultures requesting AFB work-up get an Acid Fast Stain
Albumin, Serum (ALB) Lab: Chemistry/7064 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: SST Tube Reference Range: 3.4-5.0 G/dl Albumin, Prealbumin, Serum Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST/Serum Reference Range: See Lab Report
Alcohol, Blood Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: Red Top/SST (medical) or gray top tube (legal) Collection: DO NOT prepare venipuncture site with any alcohol containing swab, use iodine. Deliver specimen immediately to laboratory following collection. Reference Range: Negative. 0.00
Aldolase, Serum Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Reference Range: See Lab Report
Aldosterone, Serum Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Reference Range: See Lab Report
Aldosterone, Urine Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: 24 hour urine collection, no preservative, refrigerate during collection Reference Range: See Lab Report
Alkaline Phosphates, Serum Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: SST Reference Range: 35-100 IU/L
Alpha-1 Antitrypsin Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST, Fasting is required Reference Range: See Lab Report
Alpha-1 Antitrypsin Phenotyping Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST, Bring to Shipping STAT, Fasting required Reference Range: See Lab Report
Alpha Fetoprotein, Serum Maternal Lab: Chemistry Request Form: FC Meddac Form 412 (MSAFP) Specimen: SST/Red top Patient must be in the gestational window of 15-20 weeks. Reference Range: 0-15 ng/ml
Alpha-Tocopherol (Vitamin E) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST, Bring to shipping STAT Reference Range: See Lab Report
Amikacin (Peak and Trough) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Reference Range: See Lab Report
Amino Acid Screen (Blood, Urine) Lab: Shipping/7053 Request Form: Misc. Specimen: 1 lavender top or random urine; bring to Shipping STAT; fasting required Reference Range: Sent with results
Amiodarone (Cardarone) Lab: Shipping/7053 Request Form: Miscellaneous SF 557) Specimen: SST, collect 8-10 hours post dose of just before next dose Reference Range: See Lab Report
Amitriptyline (Elavil, Nortriptyline) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: Plain red top Reference Range: See Lab Report
Ammonia, Plasma Lab: Chemistry/6615 Request Form: Miscellaneous (SF 557) Specimen: Green top tube, Put on ICE immediately, bring to lab STAT. Patient should not clench fist. Reference Range: 11-35uMOL/L
Amniotic Fluid, OD Scan, Delta OD 450 Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: 5 ML Must have gestation on lab slip, protect from light Reference Range: See Lab Report
Amphetamines Lab: Chemistry/7064 Request Form: Miscellaneous (SF 557) Specimen: Urine Reference Range: Negative
Amylase, 24 Hour Urine Lab: Chemistry/7064 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: 24 hour urine, entire collection, keep specimen refrigerated Reference Range: Included with final report
Amylase, Urine, Random Lab: Chemistry/7064 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: Random urine or timed urine i.e. 2, 12, or 24 hour interval. A timed 2 hour urine collection is preferred Reference Range: No established ranges for random urine. 2Hour - 4-30 IU/2hrs
Amylase, Serum Lab: Chemistry/7064 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: SST/Red top tube Reference Range: 34 - 124 IU/L
Ampicillin Level Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST/Red top, use aseptic procedure, send to lab STAT to freeze Reference Range: Sent with results
ANA-C, ANA Complete or ANA Profile, Includes DNA, Sm., RNP, & SS-B Antibodies Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: 2 SST Reference Range: See Report
Anafranil Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: Plain Red Top Tube Reference Range: See Lab Report
Androstenedione Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST/Red top send to lab STAT Reference Range: See Lab Report
Angiotensin-1-Converting Enzyme (ACE) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: 1 green top Reference Range: See Lab Report
Anticardiolipin Antibodies (ACA) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Reference Range: See Lab Report
Antibody Identification Lab: Blood Bank/7999 Request Form: Miscellaneous (SF 557) Specimen: Purple top tube Reference Range: Report includes interpretation
Antibody Screen (Coombs Indirect) Lab: Blood Bank/7999 Request Form: Miscellaneous (SF 557) or CHCS Specimen: Purple top tube Reference Range: Report includes interpretation
Anti ACL-70 (scl 70) Scleroderma antibody, serum Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Reference Range: See Lab Report
Anti Centromere (ACEAB) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Reference Range: See Lab Report
Anti DNA (A - DBL) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Reference Range: See Lab Report
Anti-Glomerular Basement Membrane Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Reference Range: Negative: < 1:4 IFA Titer
Anti - HAV (M) Antibody to Hepatitis A Antigen, IgM Specific - HAV Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Reference Range: Negative
Anti - HBC (Total) Convalescent Phase, Antibody to Hepatitis B Core Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Reference Range: Negative
Anti - HBC (IgM) Acute Phase Antibody to Hep B Core Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Reference Range: Negative
Anti - HBe (Hepatitis Be Antibody) HBeAB Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Reference Range: Negative
Anti - HBs, Antibody to Hep B Surface Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Reference Range: Negative
Anti - HCV, Antibody to Hep. C Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Reference Range: Negative
Anti - HD, Antibody to Hep D Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Reference Range: Negative
Anti - HTLV 1, Antibody to HTLV Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Reference Range: Negative
Antigliadin IgG & IgA Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST/Red top Reference Range: Negative
Anti - Hyaluronidase (AHT) Lab: Shipping/7053 Request Form: Misc. Specimen: SST Reference Range: See Lab Report
Antinuclear Antibody (ANA) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST/Red top Reference Range: Sent with Report
Antistreptolysin O Titer, Serum Lab: Chemistry/ 7064 Request Form: Miscellaneous (SF 557) Specimen: SST/Red top Reference Range: < 200 reported as negative
Anti-Neutrophilic Cytoplasmic Ab (ANCA) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Reference Range: C-ANCA: < 1:20 IFA Titer; P-ANCA: < 1:20 IFA Titer
Anti-Platelet Associated Antibodies (IgG, IgM) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: 2 Yellow (ACD Solution A); Collect Mon-Wed before 1400 ONLY Reference Range: See Lab Report
Anti-Straitional Antibody Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Reference Range: See Lab Report
Anti Thyroglobulin (Antibody) TGA Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: Plain Red top Reference Range: See Lab Report
Anti Thyroid Antibody Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Reference Range: See Lab Report
Antithrombin III (AT III) ATT 3 Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: 2 blue tops (citrate) Reference Range: See Lab Report
ASAB (Anti Striational Antibodies) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST/Red top Reference Range: See Lab Report
Aspergillus (Aspergillosis) Comp Fix (EPI - Fungal Profile) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Reference Range: See Lab Report Remarks: Done only if positive by immunodiffusion
Autologous Blood Collection Lab: Blood Bank /7999 Request Form: Penrose-St. Francis Physician Order Form Specimen: 450 ML, Blood bag, drawn by Blood Bank at Penrose Hospital
Autopsy Lab: 7349/7374/7895 Request Form: SF 523 (Authorization for Autopsy) Bacterial Antigen Screen, CSF/Urine
Synonyms: Directogen, Latex Agglutination, Bacterial Antigen Screen Lab: Microbiology/7677 Request Form: CHCS Specimen: CSF - 1 ml/Urine - 3 ml Reference Range: Negative
Benzodiazepine Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: Random Urine Reference Range: Sent with report
BHCG, Serum Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Request Form: Chemistry/misc. Specimen: SST/Red top tube Reference Range: Non-pregnant range < 2
Bile Acids Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST, bring to Shipping STAT, fasting required Reference Range: Fasting: < 0-60 mcg/dl; Postprandial values are approximately three times the fasting level
Bile, Urine (Ictotest) Lab: Urinalysis/6614 Request Form: Hematology/ SF 877 Specimen: Fresh random urine Reference Range: Negative
Bilirubin, Direct Lab: Chemistry/6615 Request Form: FC MEDDAC FORM 119 (Lab Requisition Form) Specimen: SST/Red top/1 bullet Reference Range: 0.0 - 0.5 mg/dl
Bilirubin, Neonatal Lab: Chemistry/6615 Request Form: FC MEDDAC FORM 119 (Lab Requisition Form) Specimen: 1 bullet Reference Range: 0-1 day=2-6 mg/dl; 1-2 days=6-10 mg/dl; 2-5 days=4-8 mg/dl
Bilirubin, Total (Adult) Lab: Chemistry/6615 Request Form: FC MEDDAC FORM 119 (Lab Requisition Form) Specimen: SST/Red top Reference Range: 0.0-1.5 mg/dl
Biopsy Culture, Routine Lab: Microbiology/7677 Request Form: SF 553 Specimen: Surgical tissue, bone marrow, biopsy material, etc. Collection: The surgical specimen should be separated whenever possible from portion submitted to Anatomic Pathology utilizing sterile technique, although the operative suite is the preferred site. Division of the specimen should be performed in consultation with the Pathology staff and performed by a pathologist on request. The specimen will be divided in the lab for fungal culture and KOH preparation, mycobacteria culture and smear, routine bacterial cultures and Gram stain only if specimen is accompanied by a requisition for each procedure and specimen has adequate volume for all tests. Specimens for anaerobic culture should be placed in a sterile container or anaerobic transport swab and brought to the laboratory within one half hour. Reference Range: No growth
Blastomyces Antibody Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Reference Range: Sent with report
Bleeding Time (Modified Ivy Bleeding Time) Lab: Hematology/6937 Request Form: FC MEDDAC FORM 119 (Lab Requisition Form) Specimen: Hematology performs on patient, Routine basis Reference Range: 2.5-9.5 Min. Standard deviation of approx. 1 min occurs between different laboratories.
Blood Culture Lab Microbiology/6618 Request Form: CHCS Specimen 5 ml/bottle, 2 ml/bottle for peds. Two sets/one hour interval. Collection Bottles: Bact/Alert. Blood cultures should be drawn prior to initiation of antimicrobial therapy. The time of collection must be indicated on the bottles and the lab slip. Strict aseptic technique is essential. Remove the plastic cap from the blood culture bottles, wipe the stoppers with a alcohol pad and allow to dry, collect 10 ML of blood in a sterile syringe, discard needle, replace with a needle and inoculate 5 ML of blood into each bottle, the first bottle should be the anaerobe, and the last bottle filled should be the aerobic. Reference Range: Negative - 5 days Blood Type - See ABO/RH
Body Fluid Culture, Routine Lab: Microbiology/6618 Request Form: CHCS Specimen: Aseptically aspirated body fluid, sterile tube or syringe Collection: Specimen must be transported to laboratory immediately after collection. Contamination with normal flora from skin, rectum, vaginal tract, or other body surface should be avoided. Reference Range: No Growth 72 hours
Body Fluids Analysis i.e. Pleural, Peritoneal, Pericardial, Synovial Lab: Hematology/4-4097 Request Form: FC MEDDAC FORM 119 (Lab Requisition Form) Specimen: 3-5 ml, Lavender top, mix well, Bring to Laboratory STAT Reference Range: See Lab Report
Bone Marrow Aspiration and Biopsy Lab: Hematology/Call 4-4097 to set time
Bone Marrow Culture, Anaerobic-Aerobic Lab: Microbiology/7677 Request Form: CHCS Specimen: Bone Marrow Reference Range: No growth
Bordetella Pertussis/Smear Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: 2 Smears/Nasopharyngeal or Throat swabs placed in transport media ++++Must be received at Penrose within 4 hours to set up++++ Reference Range: Negative
Bronchial Aspirate Culture Lab: Microbiology/7677 Request Form: CHCS Specimen: Tracheal aspiration, bronchoscopy specimen, or transtracheal aspirate Reference Range: No growth normally, Tracheal aspirate and bronchoscopy specimens usually are contaminated with normal flora.
Brucella Antibody Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Reference Range: See Lab Report
BUN, Serum Lab: Chemistry/6615 Request Form: FC MEDDAC FORM 119 (Lab Requisition Form) Specimen: SST/Red top tube Reference Range: 6-20 MG/DL
BUN, Urine Lab: Chemistry/6615 Request Form: FC MEDDAC FORM 119 (Lab Requisition Form) Specimen: 24 hour urine Reference Range: 15-24 G/24hrs
BUN/Creatinine Ratio Lab: Chemistry/6615 Request Form: FC MEDDAC FORM 119 (Lab Requisition Form) Specimen: SST/Red top Reference Range: 6-20 MG/DL
Caffeine, Serum Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Reference Range: Sent with results
Calcitonin Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST/Red top; Bring to Shipping STAT Reference Range: See Lab Report
Calcium, Ionized Lab: Shipping/7053; Chemistry does a calculated ionized CA Request Form: FC MEDDAC FORM 119 (Lab Requisition Form) Specimen: Patient should be fasting, Check with chemistry to see if a calculated ionized CA can be substituted. SST Reference Range: Sent with report
Calcium, Serum Lab: Chemistry/6615 Request Form: FC MEDDAC FORM 119 (Lab Requisition Form) Specimen: SST/Red top Reference Range: 8.6-10.7 MG/DL
Cannabinoids (THC) Lab: Chemistry/6615 Request Form: Miscellaneous (SF 557) Specimen: Random urine, 20 ML Reference Range: Negative
Carbamazepine (Tegretol) Lab: Chemistry/6615 Request Form: FC MEDDAC FORM 119 (Lab Requisition Form) Specimen: SST/Red top Reference Range: 4-12 MCG/ML
Carbon Dioxide, Total Lab: Chemistry/6615 Request Form: FC MEDDAC FORM 119 (Lab Requisition Form) Specimen: SST/Red top Reference Range: 23-33 MMOL/L Carbon Monoxide (Carboxyhemoglobin) Done in Respiratory Therapy
Carcinoembryonic Antigen (CEA) Lab: Chemistry/6615 Request Form: FC MEDDAC FORM 119 (Lab Requisition Form) Specimen: SST/Red top Reference Range: 0-5 NG/ML
Cardiac Enzyme Profile (CPK, LDH, CKMB, LDH1, Index) Lab: Chemistry/6615 Request Form: FC MEDDAC FORM 119 (Lab Requisition Form) Specimen: SST/Red top Reference Range: CPK - MALE = 61-224 IU/L; LDH - 96-176 IU/L; FEMALE 38-173 IU/L; CKMB - 0.0-4.7 mg/dl; LDH1 - 25-70 IU/L; Index - 0.0-2.5
Carnitine, Total & Free Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST, bring to Shipping STAT Reference Range: See Lab Report
Carotene Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST, protect from light, bring to Shipping STAT, fasting required Reference Range: See Lab Report
Catecholamines, Free (CATE) Includes Epinephrine, Norepinephrine, Dopamine Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: Various medications may alter the level in vivo. Also individuals with hypertension may show elevations up to twice normal. 24 hour urine needs preservative from lab. Reference Range: Sent with report
Catecholamines, Fractionated Plasma, Includes Dopamine, Epinephrine, & Norepinephrine Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: 2 green top tubes (heparin), patient to remain in supine position for 30 minutes prior to collection Reference Range: See Lab Report
Catheter Tip Culture, routine Lab: Microbiology/7677 Request Form: CHCS Collection: Avoid contamination with normal flora from skin or other body surfaces. Deliver specimen to lab within 2 HRS of collection. Make direct smear of any exudate from catheter site after catheter has been removed. Reference Range: No growth
C-DIFF (Clostridium Difficle Toxin) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: 10 grams of stool in sterile specimen container Reference Range: Sent with results
CEA See Carcinoembryonic Antigen Celontin (Methsuximide or Normethylsuximide) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: plain red top Reference Range: See Lab Report
Cerebrospinal Fluid CSF Lab: Hematology/4-4097; Microbiology/7677; Chemistry/6615 Request Form: For Hem and Chem, use FC MEDDAC FORM 119 (Lab Requisition Form); For Micro (gram stain/culture and sensitivity) use Micro I (SF 553) Specimen: CSF At least 1 ML in each of 3-4 sterile tubes BRING TO LAB STAT Reference Range: Hematology = See Lab Report, Microbiology - No organisms seen; Chemistry - Protein: 20-70 MG/DL; Glucose: 2/3 of serum value
Cerebrospinal Fluid CSF - Culture Lab: Microbiology/7677 Request Form: CHCS Specimen: 1.0 ML CSF, Contamination with normal flora from skin or other body surfaces must be avoided. Reference Range: No growth in 72 hours
Ceruloplasmin (Cerul) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST, fasting required Reference Range: See Lab Report
Chlamydia (Antibody) Lab: Shipping/7053 Request Form: CHCS Specimen: SST Reference Range: See Lab Report
Chlamydia (EIA) Lab: Microbiology/7677 Request Form: Miscellaneous (SF 557) Specimen: Chlamydia collection swab, urethral, eye, vaginal, cervical Reference Range: Non-reactive
Chlordiazepoxide (Librium) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: plain red top tube, protect from light Reference Range: Sent with results
Chloride, Serum Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: SST/Red top Reference Range: 101-111 MMOL/L
Chloride, 24 hour urine Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: 24 hour urine Reference Range: 110-250 MMOL/24 HRS
Chloramphenicol (Chloromycetin) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: Red Top Tube Only Reference Range: See Lab Report
Cholesterol Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: SST/Red top Reference Range: 120-200 MG/DL
Cholinesterase, RBC Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: 1 - 7 ML lavender top Reference Range: Sent with report
Chromosome Analysis, Blood Lab: Shipping/7053 Request Form: Miscellaneous (SF 557), Must give reason for testing Specimen: Adults: 1 green top; Infants: 1, 3ml green top, Bring to Shipping STAT Reference Range: See Lab Report
Clonazepam (Klonopin) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: Plain Red Top Reference Range: See Lab Report
Clostridium Difficle Toxin Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: 10 ml (10 grams) stool in sterile specimen container Reference Range: Sent with report
CMV Cultures (Cytomegalovirus) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Reference Range: See Lab Report Remarks: Must be sent in viral transport tube. (green cap) Specimen source must be included on lab slip. Body fluids including CSF and urine should be sent undiluted. Do not freeze any of the above. CMV profile, both IGG and IGM, are preferred. Clinical history not needed.
Cocaine, Urine Lab: Chemistry/6615 Request Form: Miscellaneous (SF 557) Specimen: Urine Reference Range: Negative
Coccidioides (Complement Fixation) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Reference Range: Negative Remarks: Done only if POSITIVE by immunodiffusion
C, Esterase Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Reference Range: See Lab Report
C-Peptide Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST, Bring to Shipping STAT Reference: See Lab Report
C-Reactive Protein (CRP) Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: SST/Red top Reference Range: < 0.5 MG/DL
C 3 Complement, Serum Lab: Chemistry/6615 Request Form: Miscellaneous (SF 557) Specimen: SST/Red top Reference Range: 75-135 MG/DL
C 4 Complement, Serum Lab: Chemistry/6615 Request Form: Miscellaneous (SF 557) Specimen: SST/Red top Reference Range: 10-40 MG/DL
CA 15-3 Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST, Bring to Shipping STAT Reference Range: See Lab Report
CA 19-9 Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST, Bring to Shipping STAT Reference Range: < 33 U/ml
CA - 125 Lab: Shipping Request Form: Miscellaneous (SF 557) Specimen: SST/Red top Reference Range: See Lab Report
Complement (CH-50) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST, Bring to Shipping STAT Reference Range: 189-420 units
Coccidioidomycosis (Coccidioides) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Reference Range: Sent with report
Colorado Tick Fever Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST tube Reference Range: Sent with report
Complement, Serum Lab: Chemistry/7064 Request Form: Miscellaneous (SF 557) Specimen: SST/Red top Reference Range: Comp. C3: 75-135 MG/DL Comp C4: 10-40 MG/DL
Complete Blood Count (CBC) Lab: Hematology/4-4097 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: Lavender top - Mix specimen well Reference Range: Sent with report, Changes with age & sex
Conjunctival Culture, Routine Lab: Microbiology/7677 Request Form: CHCS Collection: Specimen should be delivered to the lab within 2 hrs of collection. Collect the specimen by swabbing, pass moistened swab 2 times over lower conjunctiva. Avoid eyelid border and lashes. SCRAPINGS: Use local anesthetic and platinum spatula. Rub spatula with scrapping gently over small area on slide. If too dry use very small amount of sterile water. Indicate if it is the right eye or the left eye on the slide and slip.
Coombs Direct Lab: Blood Bank/7999 Request Form: SF 556 Specimen: Lavender top tube, Cord blood preferred on newborns Reference Range: Negative
Coombs Indirect (Antibody Screen) Lab: Blood Bank/7999 Request Form: SF 556 Specimen: Lavender Top Tube Reference: Negative
Copper, Urine or Serum Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: 24 hour urine, Royal blue top (no additive) Reference Range: Sent with report
Cord Blood Work up Lab: Blood Bank/7999 Request Form: SF 556, mark ABO, Rh, Coombs direct Specimen: Purple top, cord blood Reference Range: Direct coombs Negative
Cortisol, Serum Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: Red top; draw at 0800 & 1600 to evaluate baseline diurnal variation. Reference Range: AM: 5.5-20.0 UG/DL PM: 2.0-10.0 UG/DL
Cortisol, Urine Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: 24 hour urine specimen Reference Range: See Lab Report
Creatine Phosphokinase - CPK, CK Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: SST/Red top Reference Range: MALE: 55-170 IU/L; FEMALE: 30-135 IU/L
Creatinine, Serum Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: SST/Red top tube Reference Range: 0.5-1.3 MG/DL
Creatinine Clearance - CrCl Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: Urine Reference Range: MALE: 97-137 ml/MIN; FEMALE: 88-128 ml/MIN
Cryofibrinogen (Qualitative) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: 1 Plain Red Top Tube Reference Range: Negative
Cryoprecipitate Call Blood Bank and notify, not stocked in house Lab: Blood Bank/7999 Request Form: SF 518 Specimen: Red top tube, must have date and time of collection on tube.
Cryptococcal - Antigen Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST/Spinal Fluid Reference Range: Negative
Cycloserine Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: Plain Red Top Tube Reference Range: See Lab Report
Cyclosporine Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: 5 ML Lavender top Reference Range: Sent with report
Cystine, Quantitative Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: 24 Hour urine Reference Range: 10-100 mg/24 hr Remarks: Needs 25ml of 6N HCL added to container Cytology: See Anatomic Pathology SOP.
Cytomegalo Virus (CMV Titre) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Reference Range: Sent with report
Dalmane (Flurazepam or Desalkylflurazepam) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: 1 Plain Red Top Tube Reference Range: See Lab Report
Darvon (Propozyphene & Norpropozyphene) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: plain red top tube or random urine Reference Range: See Lab Report
D-dimer (quantitative) Lab: Hematology/4-4097 Request Form: FC MEDDAC Form 119(Lab Requisition Form) Specimen: Glue top tube. the specimen volume must be at least 90% of expected fill, but not more than 100% of expected fill. Fill to the level indicated by the black on the collection tube line Reference Range: See Lab Report
Dengue Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST tube Reference Range: Sent with report
Desalkylflurazepam (Flurazepam or Dalmane) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: plain red top Reference Range: See Lab Report
Desipramine, Serum Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: Plain Red top tube, do not use barrier tube (SST) Reference Range: Sent with report
DHEAS Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST, fasting required Reference Range: See Lab Report
Dialysis Fluid, Peritoneal, Routine Culture Lab: Microbiology/7677 Request Form: CHCS Specimen: Peritoneal dialysis fluid Reference Range: No growth 72 hours
Diazepam (Valium) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: plain red top tube Reference Range: Sent with report
Digoxin, Serum Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: SST Reference Range: Adult - 0.8-2.0 NG/ML
Dilantin (PTN, Phenytoin) Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: SST Reference Range: 10-20 MCG/ML
Disopyramide (Norpace) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: plain red top tube Reference Range: See Lab Report
DNA Antibody Double - Stranded (Anti DNA Antibody) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Reference Range: See Lab Report
Doxepin (Sinequen Level) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: Red Top Tube Only Reference Range: See Lab Report
Drug Screen Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: Random urine Reference Range: Negative
Drug Screen (Medical/Legal) ALL AIR/LAND CRAFT ACCIDENTS GO TO AFIP Lab: Shipping/7053 Request Form : Chain of custody form Specimen: 2-15 ml Red tops, 2-7 ml Gray tops, 3-5 ml purple tops, 500-100 ml random urine
Ear Culture, Routine Lab: Microbiology/7677 Request Form: CHCS Collection: INTERNAL: Cleanse external canal with mild antiseptic. Insert sterile funnel and swab or aspirate specimen from eardrum or beyond. If eardrum is not perforated, the specimen should be collected by a physician trained in this procedure. EXTERNAL: Cleanse external canal with mild antiseptic, Swab, scrape, or aspirate specimen from active margin, including fresh secretion from deeper areas. Reference Range: No growth 48 hours
Elavil See Amitriptyline Electrolytes, Serum Lab: Chemistry/6615 Request Form: Miscellaneous (SF 557) Specimen: SST/Red top Reference Range: Sodium 135-145 MMOL/L, Potassium 3.6-5.0 MMOL/L, Chloride 101-111 MMOL/L, CO2 21-31 MMOL/L
Electrolytes, Urine Lab: Chemistry/6615 Request Form: Miscellaneous (SF 557) Specimen: 24 hr urine Reference Range: Sodium 40-220 MMOL/24 hrs, Potassium 25-120 MMOL/24 hrs, CL 110-250 MMOL/24 hrs
ENA (Extractable Nuclear Antibody) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Reference Range: Sent with report
Eosinophil Smear Lab: Hematology/4-4097 Request Form: Miscellaneous (SF 557) Specimen: Smear made from swab of nasal secretion, no fixation Reference Range: No eosinophil identified
Epstein Barr Virus, Antibodies (EBV) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Reference Range: Sent with report
Esterase (C1 Esterase) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: 1-15 ML Red top Reference Range: Sent with report
Estradiol/Estrogen/17 Beta Serum Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: plain red top tube Reference Range: Sent with report
Ethosuximide (Zarontin) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: Plain Red Top Tube Reference Range: See Lab Report
Extractable Nuclear Antibody (ENA) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Reference Range: Sent with report
Factor 5 or Factor VII, VIII Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: 1 blue top (citrate) for each factor ordered; Bring to Shipping STAT Reference Range: Sent with results
Febrile Agglutinins Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Reference Range: See Lab Report
Fecal Fat (Lipid, Quant.) 24hr, 48hr and 72hr Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: Obtain container and instructions from shipping. Reference Range: Sent with report
Fecal Leukocyte Stain, Wright Stain Lab: Hematology/4-4097 Request Form: Miscellaneous (SF 557) Specimen: A slide that has stool smeared on it Reference Range: No leukocytes present
Felbamate Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: Plain Red Top Tube Reference Range: See Lab Report
Ferritin, Serum Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: SST/Red top Reference Range: MALE: 30-284 NG/ML; FEMALE: Premenopausal 6-81 NG/ML; Postmenopausal 14-186 NG/ML
Fetal Maternal Hemorrhage (FMH or Kleihauer-Beteke) Lab: Shipping/7053 - NOTE: If ordered as part of an RhIG workup, test is done by Blood Bank 7999 Request Form: SF 556 Specimen: Lavender top Reference Range: Negative
Fibrinogen Lab: Hematology/4-4097 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: Blue top tube. The specimen vilume must be at least 90% of expected fill, but not more than 100% of expected fill, Fill to the level indicated by the black line on collection tube. Reference Range: Sent with report.
Fiorinal see Butalbital Fluorescent Treponemal Antibody, CSF (FTA) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: 3 ML spinal fluid Reference Range: Nonreactive
Florescent Treponemal Antibody, Serum (FTA) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Reference Range: Sent with report
Fluoride (ION-Selective Electrode) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: 1-15 ml plain red top Reference Range: See Lab Report
FMH - See Fetal Maternal Hemorrhage
Folate, Folic Acid Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Request Form: SST Tube Reference Range: Sent with report
Follicle Stimulating Hormone, Serum, FSH Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: SST Tube Reference Range: Male: 30-284 MIU/ml; Female: Follicular=3.6-16 MIU/ml; Mid- cycle=8.1-28.9 MIU/ml; Luteal=1.8-11.7 MIU/ml; Menopausal=22.9-167 MIU/ml
Free T4, (Free Thyroxine) Serum Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: SST Tube Reference Range: 0.7-1.85
Fresh Frozen Plasma - Call Blood Bank and notify Lab: Blood Bank/7999 Request Form: SF 518 - one for each unit Specimen: Red top tube, must have date and time of collection on tube.
FTA-ABS, CSF Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: 3 ML Spinal Fluid Reference Range: Nonreactive
FTA-ABS, Serum Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Tube Reference Range: Nonreactive
Fungal Culture: Check with Micro/7677
G6PD See Glucose 6 Phosphate Dehydrogenase
Gamma GlutamylTranspeptidase (GGT, GT) Lab: Chemistry/6615 Request Form: Miscellaneous (SF 557) Specimen: SST Tube Reference Range: 8-69 IU/L
Gastric Aspirate Culture Lab: Microbiology/7677 Request Form: CHCS Collection: Gastric aspirate must be obtained before feeding infant. Deliver specimen to the lab within 1 hour. Reference Range: Ng 72 hrs
Gastrin Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST, Bring to Shipping STAT, fasting is required Reference Range: See Lab Report
Gentamicin Lab: Chemistry/6615 Request Form: Miscellaneous (SF 557) Specimen: SST Tube Reference Range: Trough: <2.0 MCG/ML; Peak: 4-8 MCG/ML
Genital Culture, Routine Lab: Microbiology/7677 Request Form: CHCS Specimen: Swab of vagina, cervix, discharge, aspirated endocervical, endometrial, prostatic fluid, or urethral discharge. Collection: FEMALE: DO NOT use lubricant on speculum. Cervical mucous should be removed first before inserting swab from Culturette into endocervical canal, move swab from side to side allowing several seconds for absorption of organisms by the swab. Return swab to the transport tube, label and crush ampule to release transport media. MALE: Using small wire swab gently scrape the anterior urethral mucosa to collect specimen of urethral discharge.
Giardia Antigen Test (GAG) Lab: Microbiology/7677 Request Form: CHCS Specimen: Stool specimen collected in 10% formalin, Cary-Blair, clean vials (available through MDS) Reference Range: Negative
Glucagon Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: Lavender Top Tube, Bring to Shipping STAT, fasting required Reference Range: 20-100 pg/ml
Glucose 6 Phosphate Dehydrogenase Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: 1 Yellow top (ACD) Reference Range: See Lab Report
Glucose - Fasting, 2 hr PP, 1 hr, 24 hr urine, CSF Lab: Chemistry Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: SST Tube, 24 Urine, CSF Reference Range: Fasting: 65-115 MG/DL; 2 Hour PP: 70-140 MG/DL; 1 Hour: 65-135 MG/DL; 24 Hour urine: to 0.5 G/24 hrs; CSF: 2/3 of serum value
Glycosylated HGB See Hemoglobin A1C
Gram Stain Lab: Microbiology/7677 Request Form: Micro 1 (SF 553) Specimen: Duplicate of specimen appropriate for routine culture of the smear Reference Range: N/A
Haloperidol (Haldd) Lab: Shipping/7053 Request Form: CHCS Specimen: Plain Red Top Tube Reference Range: 1-30 ng/ml
Haptoglobin, Serum Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: Patient must be fasting, SST Tube Reference Range: See Lab Report
HAV (Anti-Hav, Hepatitis IGM Specific) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Tube Reference Range: Sent with report
HCG, Serum (Humanchorionic Gonadotropih) Lab: Urinalgsis/6614 Request Form: FC MEDDAC Form 119(lab requisition Form) Specimen: SST/Red Top Reference Range: Negative or Positive
HCG, Urine (Human Chorionic Gonadotropin) Lab: Urinalysis/6614 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: Random Urine Reference Range: Negative or Positive
Heavy Metal Screen (Mercury Urine) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: 24 Hour urine collection only Reference Range: Sent with report
HLA DB-2 Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: 2 Yellow Top Tube with ACD Saline Reference Range: See Lab Report
Hematocrit Lab: Hematology/4-4097 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: Lavender Top Reference Range: See Lab Report
Hemoglobin A1C (Glycosylated HGB A1C) Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: Lavender Top Reference Range: %GHB: 4.8-7.8 %A1C: 4.4-6.4
Hemoglobin Electrophoresis Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: 2 Lavender Tops Reference Range: Sent with report
Hemoglobin, Plasma Lab: Hematology/4-4097 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: Lavender Top Reference Range: See Lab Report
Hepatitis A - See Anti HAV
Hepatitis B Antigen (Surface Antigen) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Tube/Red top Reference Range: Negative
Hepatitis Be Antigen (HBeAG) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Reference Range: Negative
Hepatitis C - See Anti HCV
Hepatitis D (DOG) Also see Anti HD Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Tube/Red top Reference Range: Negative
Hepatitis Panel including Hep C Antibody and Hep B Antigen, Hep B Core Antibody and Hep B Surface Antibody Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Tube/Red top Reference Range: Negative
Herpes Culture Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: Obtain viral culturettes from MDS, not Laboratory. Write on request if patient is pregnant and source of specimen Reference Range: Sent with report
Herpes Titer Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Top Reference Range: Herpes I, II IgG <0.91 EU/ml & Herpes I, II IgM <1:5 IFA Titer
Heterophile Titer Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Reference Range: Negative
Hexosaminidase A (Tay-Sachs Screen) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST, Bring to Shipping STAT Reference Range: Sent with report
5-HIAA, QUANTITATIVE See Hydroxyindole Acetic Acid High Density Lipoprotein Cholesterol (HDL) Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: SST Tube, Patient must be fasting Reference Range: 30-85 MG/DL
Histology, Routine Lab: Histology/7308 Request Form: SF 515 Specimen: Use container of appropriate size, place biopsy specimen in 10% formalin solution. Use approximately 10 times as much formalin solution, making sure specimen is totally covered.
Histoplasma Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Tube Reference Range: Sent with report
HIV (Screen for Aids Antibody) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: 1 HIV Tube/SST Tube Reference Range: Negative
HLA-B27 (B27) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: 2 Yellow tubes (ACD); Bring to Shipping STAT Reference Range: Negative
Homocystine Qualitative (Cystine) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: 24 hour urine, needs preservative from lab (10g Boric Acid) Reference Range: Negative
Homogentisic Acid, Urine Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: 50 ML Random urine Reference Range: Negative
Homovanillic Acid (HVA) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: 24 Hour urine, needs preservative from lab (10g Boric Acid) Reference Range: 3-8 mg/24 hours
H. Pylori (Helicobacter) Lab: Microbiology/7677 Request Form: CHCS Specimen: SST/RT Reference Range: Negative
Human Growth Hormone (HGH) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Tube, Patient must be fasting Reference Range: Sent with report
Hydroxyproline Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: 24 Hour urine, needs preservative from lab (10g Boric Acid) Reference Range: See Lab Report
5 Hydroxyindole Acetic Acid (5-HIAA) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: Dietary Restriction - Pineapples, bananas, eggplant, kiwi fruit, plums, tomatoes, walnuts and grapefruit for 72 hours PRIOR to 24 hour urine collection, needs preservative from lab (10g Boric Acid) Reference Range: Sent with report
17-Hydroxy-Corticosteroids (17 OH) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: 24 hour urine, needs preservative from lab (10g Boric Acid) Remarks: Not valid during pregnancy or if patient is taking oral contraceptives. Reference Range: Sent with report
Ibuprofen Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: Red Top Tube Reference Range: See Lab Report
IgA Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: SST Tube Reference Range: MALE: 100-490 MG/DL; Female: 85-450 MG/DL
IgE Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Tube Reference Range: See Lab Report
IgG Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: SST Reference Range: 800-1700 MG/DL
IgG Subclass (1,2,3 & 4) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Tube Reference Range: Sent with report
IgM Lab: Chemistry/7053 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: SST Tube Reference Range: MALE: 5-320 MG/DL; FEMALE: 60-370 MG/DL
Imipramine (Tofranil, Presamine) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: Plain red top tube Reference Range: See Lab Report
Immunoelectrophoresis (IEP) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST, 24 hour urine collection Reference Range: See Lab Report
India Ink (CSF) ((not done see Cryptococcus. Antigen)) Lab: Microbiology/7677
Infectious Mononucleosis Lab: Microbiology/7677 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: Red top/SST tube Reference Range: Negative
Influenza A, B, Viral Isolation Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: Viral swab, throat washing, transtracheal aspirate, pleural fluid. Collect throat swab on patients with upper respiratory symptoms. Postmortem: lung Reference Range: Sent with report
INR Lab: Hematology/4-4097 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: Blue top tube. The specimen volume must be at least 90% of expected fill, but not more than 100% of expected fill. Fill to the level indicated by the black line on the collection tube. Reference Range: Coumadin Therapy 2.0 - 3.0 Heart valve replacement 2.5 - 3.5
Insulin, Serum Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Tube; Bring to Shipping STAT Reference Range: Sent with report
Insulin Antibodies (Bovine and Porcine) Serum or Plasma Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST; Bring to Shipping STAT Reference Range: See Lab Report
Iron Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: SST Tube Reference Range: MALE: 76-198 MCG/DL; FEMALE: 26-170 MCG/DL
Isopropyl Alcohol Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: 1-7 ML gray top (Unopened), Do not prepare venipuncture with alcohol Reference Range: See Lab Report
17-Ketosteroids, total (17-KS) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: 24 hour urine, needs preservative from lab (10g Boric Acid) Reference Range: Sent with report
Kleihauer-Betke (Fetal Maternal Hemorrhage) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: Lavender Top Reference Range: Sent with report
KOH Preparation Lab: Microbiology/7677 Request Form: Micro 2 (SF 554) Specimen: Physician should collect scrapings adequate to put in sterile container. Reference Range: No fungal elements identified
Lactic Acid Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: Grey top tube, draw without tourniquet, put on ice, bring to Chemistry STAT within 30 minutes. Reference Range: 0.5-2.2 MMOL/L
Lactate Acid Dehydrogenase (LDH) Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: SST Tube, draw without tourniquet, put on ice, bring to Lab STAT. Reference Range: 96-176 IU/L
Lactate Acid Dehydrogenase Isoenzymes #1 Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: SST/Red Top Tube Reference Range: 25-70 IU/L
LAP (Leukocyte Alkaline Phosphates) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: 2 green top tubes (heparin); Bring to Shipping STAT Reference Range: Sent with report
Lead (Graphite Farnace AA) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: Royal blue (metal free/heparin) Reference Range: See Lab Report
Lead (OSHA) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: Lavender top tube Reference Range: See Lab Report
Lead Urine Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: 24 Urine Reference Range: See Lab Report
Legionella Antibody Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Reference Range: < 1:64 titer
Leukocyte Alkaline Phosphates See LAP
LGV Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Reference Range: See Lab Report
Librium See Benzodiazepine
Lidocaine (Xylocaine) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: Plain red top tube Reference Range: Sent with report
Lipase, Serum Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: SST Tube Reference Range: 4-24 IU/DL
Lipid Profile Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: SST Tube, patient must be fasting 12-14 hrs Reference Range: Chol: < 200 MG/DL Trig: 38-190 MG/DL HDL: 30-85 MG/DL LDL-Chol: 50-130 MG/DL VLDL-Chol: 10-28 MG/DL
Lipoprotein Electrophoresis Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Tube Reference Range: Sent with report Remarks: Patient must be fasting 12-14 hours before test
Lithium, Serum Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: SST Tube Reference Range: 0.5-1.5 MEQ/L
Liver Profile Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: SST Tube Reference Range: ALB: 3.5-4.8 G/DL; TP: 6.0-8.0 G/DL; ALK PHOS: 37-107 IU/L; SGOT: (AST) 8-47 IU/L; SGPT: (ALT) 0-55 IU/L; LDH: 96-176 IU/L; GGT: 8-69 IU/L; TBIL: 0.0-1.5 MG/DL; DBIL: 0.0-0.6 MG/DL
L/S Ratio Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: 5-10 ML Amniotic Fluid, Specimen must be free of blood. Protect from light. Must be tested within 4 hrs. of aspiration. Note on lab slip gestational age. Reference Range: Sent with Report
Lupus Anticoagulant Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: 5 ml Blue Top (90% full) Reference Range: Sent with report
Luteinizing Hormone, Serum Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: SST Tube Reference Range: MALE: 0.9-10.9 MIU/ML; FEMALE: Follicular 1.1-11.1 MIU/ML; Mid-cycle 17.5-72.9 MIU/ML; Luteal 0.4-15.1 MIU/ML; Post-menopausal 6.8-46.6 MIU/ML
Lyme Disease Antibody Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Reference Range: Negative
Lysozyme, Serum Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: Plain red top tube, Bring to Shipping STAT Reference Range: 4.8 - 13.0 mcg/ml
Magnesium, Serum Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: SST Tube Reference Range: 1.5-2.3 MG/DL
Malaria Smear Lab: Hematology/4-4097 Request Form: Miscellaneous (SF 557) Specimen: Lavender Top Reference Range: No organisms present
Measles Antibody Titer IgG (Rubella Titer) Lab: Shipping/7053 Request Form: Misc. Specimen: SST Tube Reference Range: Sent with report
Mercury (HG) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: Dark blue tube (metal free/heparin) Reference Range: See Lab Report
Mercury, Urine (Heavy Metal Screen) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: 24 hour urine or random collection Reference Range: Sent with report
Metanephron Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: 24 hour urine, needs preservative from lab (10g Boric Acid) Reference Range: Sent with report
Methsuximide See Celontin
Methylphenidate (Ritalin) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: Plain Red Top Tube Reference Range: 5-23 ng/ml
Minimal Inhibitory Concentration (MIC) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: Isolation plate of organism, SST Tube, By Consult: Must know all antibiotics and all drugs patient is receiving Reference Range: Sent with report
Microsomal Antibody Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Tube Reference Range: Sent with report
Mitochondrial Antibodies Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Tube Reference Range: Negative
Mucopolysaccharides, Urine Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: 10 ML random urine Reference Range: See Lab Report
Multiple Sclerosis (Panel #2) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Tube, 3 ML CSF in 3 aliquots Reference Range: Sent with report
Mumps Titer Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Reference Range: Negative: < 1.0 Index; Positive: > 1.0 Index
Muramidase, Serum see Lysozyme
Mycoplasma Pneumoniae Lab: Microbiology/7677 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: Red Top Tube Reference Range: Negative
Myelin Basic Protein, CSF Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: 1 ml CSF, Bring to Shipping STAT Reference Range: 0-4.0 ng/ml
NAPA Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: SST/Red top tube Reference Range: 4-10 UG/ML
Neisseria Gonorrhoea Culture Lab: Microbiology/7677 Request Form: SF 553 Specimen: Body fluid discharge, pus, swab of genital lesions, urethral discharge. Thayer-Martin plate, Culturette is brought to laboratory as soon as possible for plating. Collection: Do not collect urethral specimens until at least one hour after urinating. Collection directly from male urethral discharge is desirable. Collect anorectal specimens from the crypts just inside the anal ring: anoscopy useful. Prostatic fluid yields fewer positives than does urethral culture. Urethra: Strip the urethra toward the orifice to express exudate. Use a sterile swab to obtain the specimen. Vagina: Use a speculum, moistened only with warm water, not lubricant. Obtain a specimen from the posterior vaginal vault or from the vaginal orifice if the hymen is intact.
Neisseria Gonorrhoea Smear Lab: Microbiology/7677 Request Form: SF 553 Specimen: Smear made of discharge Reference Range: No gram-negative diplocci seen
Neurontin Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: Plain Red Top Tube Reference Range: See Lab Report
Nitrite, Urine Lab: Urinalysis/6614 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: Random clean catch urine Reference Range: Negative
Norpace Level (Disopyramide) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: Red Top Tube Only Reference Range: See Lab Report
Nortriptyline (Elavil, Amitriptyline) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: Plain red top tube Reference Range: Sent with report
Occult Blood, Fat detection, Hemoccult Lab: Microbiology/7677 Request Form: Parasitology SF 552 Specimen: Fresh stool Reference Range: Negative or trace
OD Scan (Delta OD 450) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: 5 ML amniotic fluid, must have on lab slip gestation, protect from light Reference Range: Sent with Report
Opiates, Urine Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: Urine Reference Range: Negative
Organic Acids, Urine Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: 20 ML random urine Reference Range: None detected
Osmolality, Serum Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: SST Reference Range: 275-295 MOSM/KG
Osmolality, Urine Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: Urine Reference Range: 300-750 MOSM/KG
Ova and Parasites, Stool Lab: Microbiology/661 Request Form: Parasitology SF 552 Specimen: Kits available from clinics, fill stool to line Reference Range: No ova or parasites seen
Oxalate/Citrate, Urine Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: 24 hour urine, needs preservative from lab (16 g. KBS) Reference Range: 0-40 MG/24 HOUR
Packed Red Cells, Transfusion Lab: Blood Bank/7999 Request Form: SF 518, 1 form for each unit Specimen: 6.5 mL purple top tube, must be labeled with a TYPENEX band
Parainfluenza Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST, acute & convalescent required Reference Range: < 1:8 titer
Parathyroid Hormone (PTH) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST, Bring to Shipping STAT Reference Range: Sent with report
Pepsinogen 1 Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Reference Range: Sent with Report
Pertussis Culture Lab: Shipping/7053 Request Form: Micro 1 (SF 553) or Miscellaneous (SF 557) Specimen: Culturette with source. Treat as STAT. Will not survive > 4 hours Reference Range: Sent with report
Pertussis, Serum (Bordetella Pertussis AB) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Reference Range: < 2
Phenobarbital, Serum Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: SST Reference Range: 15-40 MCG/ML
Phenylalanine Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST, Bring to Shipping STAT Reference Range: < 4 MG/DL
Phenytoin (PTN) See Dilantin
Phosphorus, Serum Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: SST Reference Range: 2.5-4.9 MG/DL
Phosphorus, Urine Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: 24 hour urine Reference Range: 0.3-1.3 G/24 HRS
Pinworm Preparation Lab: Microbiology/7677 Request Form: Parasitology SF 552 Specimen: Pinworm vials/paddles are supplied Collection: Specimen is best obtained few hours after the patient has retired or the first thing in morning before patient has moved. Pinworms migrate from anus during periods of rest and lay eggs around anal opening. Pinworm paddle, provided through MDS, must be used. Reference Range: No pinworms identified
Plague AB Titer Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Reference Range: Acute and Convalescent required - 14 days apart Platelet Aggregation Test cannot be done by our reference lab, see pathologist
Platelet Count Lab: Hematology/4-4097 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: Lavender top, mix gently Reference Range: 130-400
Platelet Concentrate (Apheresis platelets) for Transfusion call Blood Bank to notify, not stocked in lab Lab: Blood bank/7999 Request Form: One SF 518 for each dose of apheresis platelets (equivalent to 6-8 doses of random donor platelets) Specimen: 6.5 mL purple top tube - must be labeled with a TYPENEX band
Polio Virus AB (Comp Fix) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST, Acute and Convalescent required Reference Range: < 1:8 titer
Porphobilinogen, Urine (qual.) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: Three serial samples of first morning void. *** Protect From Light *** Reference Range: Negative
Porphyrin, Urine see Porphobilinogen, urine
Post Vasectomy (Semen) Lab: Microbiology/7677 Request Form: Misc (SF 557) or FC MEDDAC Form 119 (Lab Requisition Form) Specimen: Semen Reference Range: 0 Sperm Seen
Potassium, Serum Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: SST Reference Range: 3.5-5.3 MMOL/L
Potassium, Urine Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: Random or timed urine Reference Range: 80-200 MMOL/24 HRS
Primidone Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: Red Top Tube Only Reference Range: 5-15 MCG/ML
Procainamide, Serum Lab: Chemistry/6615 Request Form: Miscellaneous (SF 557) Specimen: SST Reference Range: 4-10 MCG/ML
Progesterone Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Reference Range: Sent with report
Prolactin, Serum Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: SST Reference Range: Male: 1.8-14.4 MIU/ML Female: 3.6-14.8 MIU/ML
Prostatic Acid Phosphates (PAP) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST, Bring to Shipping STAT Reference Range: 0-2.8 ng/ml
Prostatic Specific Antigen: PSA Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: SST Reference Range: 0.0-4.0 NG/ML
Protein, Body Fluid Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: Body fluid, i.e. pleural, synovial Reference Range: No reference ranges available.
Protein, Bence-Jones Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: 24 HOUR urine Reference Range: Sent with report
Protein C Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: 7 ml blue top; Bring to Shipping STAT Reference Range: 70-140%
Protein, Cerebrospinal Fluid Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: CSF Reference Range: Infant, < 1 month: 20-70 MG/DL Adult: 20-70 MG/DL
Protein Electrophoresis (SPEP) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Reference Range: Sent with report
Protein S Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: Blue Top (Citrate), Bring to Shipping STAT Reference Range: See Lab Report
Protein, Screening, Urine Lab: Urinalysis/6614 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: Urine Reference Range: Negative
Protein, Total, Serum Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: SST Reference Range: 6.0-8.0 G/DL
Prothrombin Time (PT) Lab: Hematology/4-4097 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: Blue top tube. The specimen volume must be at least 90% of expected fill, but not more than 100% of expected fill. Fill to the level indicated by the black line on the collection tube. Collection: Routine venipuncture. If multiple tests are being drawn, draw coagulation studies last. Reference Range: Approximately 9 - 12 seconds. Established and rechecked periodically and sent with report.
Protoporphyrin Zinc (ZPP) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: 7 ML lavender top, protect form light Reference Range: < 35 MCG/DL
Pyridoxal Phosphate (Vitamin B 6, plasma) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: Lavender top tube, protect from light, Bring to Shipping STAT Reference Range: 3.6-22.0 ng/ml
Pyruvate Kinase Screen Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: Call lab for specific instructions, or have lab draw blood Reference Range: Sent with report
Quinidine, Serum Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: SST Reference Range: 2-5 MCG/ML
Rabies Titer Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Tube Reference Range: Sent with report
RBC Folate Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: Lavender Top Tube, protect from light Reference Range: > 145 ng/ml cells
Red Blood Cells for Transfusion - See packed Red cells
Reducing Substance (Clinitest) Lab: Urinalysis/6614 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: Random clean catch urine Reference Range: Negative
Renin (Angiotensin) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: Pre-chilled EDTA tube, Bring to Shipping STAT Reference Range: See Lab Report
Respiratory Syncytial Virus (RSV) Lab: Microbiology/7677 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: Transtracheal nasal aspirate placed in viral transport vial Reference Range: Negative
Reticulocyte Count Lab: Hematology/4-4097 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: Lavender top tube Reference Range: See Lab Report
Rheumatoid Factor Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: SST Reference Range: < 20
Rh Immune Globulin, (Rhogam - Rh Negative Patient) ABO/Rh and antibody screen must also be requested Lab: Blood Bank/7999 Request Form: SF 556 Specimen: Purple top tube
Rh Typing - See ABO/Rh
Ritalin (Methylphenidate) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: Plain red top tube Reference Range: 5-23 ng/ml
Rocky Mountain Spotted Fever Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST, acute & convalescent recommended. Convalescent not required. Reference Range: Sent with report
Rotavirus Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: 1 Gram stool or rectal swab, Bring to Shipping STAT Reference Range: Negative
RPR Lab: Microbiology/7677 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: Red top/SST Reference Range: Nonreactive
Rubella Screen Lab: Microbiology/7677 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: Red top/SST Reference Range: Immune or not immune
Rubella Titer, IgG Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST, Acute and convalescent required; Draw conv. 14-21 days after acute. Reference Range: Sent with report
Salicylate Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: SST Reference Range: Therapeutic: 15-30 MG/ML Toxic: > 30 MG/DL
Salmonella Enteritidis Lab: Microbiology/7677 Request Form: Micro 1 (SF 553) or Miscellaneous (SF 557) Specimen: Stool Reference Range: Negative
Semen Analysis Lab: Microbiology/7677 Request Form: Miscellaneous (SF 557) Specimen: Fertility purposes needs appointment made through laboratory Reference Range: 50-150 million for fertility
Serum Aspartate Aminotransferase (AST, GOT, SGOT) Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: SST Reference Range: 8-42 IU/L
Serum Alanine Aminotransferase Reagent (GPT) Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: SST Reference Range: 0-55 IU/L
Sickle Cell Preparation Lab: Hematology/4-4097 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: Lavender top Reference Range: Negative
Sinequen Level See Doxepin
Smooth Muscle Antibody Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Reference Range: Negative
Sodium, Urine Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: 24 hour urine Reference Range: 80-200 MMOL/24 hrs
Sodium, Serum Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: SST Reference Range: 135-145 MMOL/L
Somatocedin C Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST, Bring to Shipping STAT Reference Range: 123-463 ng/ml
Specific Gravity, Urine Lab: Urinalysis/6614 Request Form: Miscellaneous (SF 557) Specimen: Random or timed urine Reference Range: 1.002-1.035
Spinal Fluid (Histology) Lab: Histology/7308 Request Form: SF 541 Specimen: 1-2 ML spinal fluid (No fixative) BRING TO SHIPPING STAT
Sputum Culture, routine Lab: Microbiology/7677 Request Form: 2-SF 553, one for gram stain Specimen: Sputum, first morning specimen preferred Collection: The patient should be instructed to brush his/her teeth and rinse well with water before attempting to collect the specimen to reduce the possibility of contamination. After the specimen has been collected, cap the cup. Specimen MUST be properly labeled and accompanied by properly completed Microbiology slip.
Stool Culture Routine/Campylobacter/E. Coli 0157.H7 Lab: Microbiology/7677 Request Form: SF 553 Specimen: Rectal swab, fresh random stool Reference Range: Negative for Salmonella, Shigella, Campylobacter, and E. Coli 0157.H7
Stone Risk Analysis Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: 24 hour urine, urine collection kits with instructions are provided by lab. Reference Range: Sent with report
Sweat Chloride - Test scheduled through Pathology Secretary, call 6-7303 for instructions.
Tay-Sachs Screen (Hexosaminidase A) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST, Bring to Shipping STAT Reference Range: Sent with report
Testosterone, Serum Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Reference Range: See Lab Report
THAT Antibody (Anti-Thyroid Antibody) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Reference Range: Negative
Theophylline, Serum Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: SST Reference Range: 10-20 MCG/ML
Throat Culture, Candida albicans Lab: Microbiology/7677 Request Form: Microbiology II SF 554 or Misc. Specimen: Throat swab, swab all suspicious lesions Reference Range: No growth Candida albicans
Throat Culture, Neisseria gonorrhoea Lab: Microbiology/7677 Request Form: SF 553 Specimen: Throat swab, eye swab, or rectal Collection: Specimen must be delivered to the lab within 2 hours of collection. Must not be refrigerated. Both tonsillar pillars and oropharynx should be swabbed. Reference Range: No Neisseria gonorrhoea isolated
Throat Culture, Routine Lab: Microbiology/7677 Request Form: SF 553 Specimen: Throat swab Collection: Depress tongue and rub swab vigorously over each tonsillar area and posterior pharynx. Any exudate should be touched and care taken to avoid the tongue and uvula. Place in Culturette, crush ampule to ensure proper preservation. Reference Range: Negative for group A beta-hemolytic streptococci
Thyroglobulin Antibody (TGA) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Reference Range: See Lab Report
Thyroid Stimulating Hormone, TSH, ultrasensitive TSH Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: SST Reference Range: 0.38-6.10 uIU/ML
Thyroxine T4 See Free T4
Thyroxin Binding Globulin (TBG) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Reference Range: See Lab Report
Tissue exam: See Anatomic Pathology SOP
Tobramycin Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: Plain Red Top Tube Reference Range: See Lab Report
Tofranil See Imipramine
Torch Screen (Includes: Toxoplasma IgM, Rubella IgM, CMV, Herpes, IgG I & II) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Reference Range: See Lab Report
Total T3 Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: SST, Put in comments any THY medications Reference Range: 80-200 NG/DL
Toxicology, Drug Screen, Urine Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: Random urine Reference Range: Negative
Transferrin Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: SST Reference Range: 230-430 MG/DL
Transfusion Reaction Work-up Lab: Blood Bank/7999 Request Form: Transfusion Reaction Report form (MCXE FORM LAB 40-2b MAY, 2002) Specimen: Red top tube, purple top tube, first voided urine Reference Range: No evidence of hemolytic incompatibility
Triglyceride Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: SST, patient must be fasting Reference Range: 38-190 MG/DL
Trypsin, Stool (Chymotrypsin) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: 10 g Stool, Bring to Shipping STAT Reference Range: Sent with report
Tularemia Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Reference Range: Sent with report
Type and Crossmatch Lab: Blood Bank/7999 Request Form: SF 518, one form for each unit. Specimen: 6.5 mL purple top tube - must be labeled with a TYPENEX band
Type and Screen Lab: Blood Bank/7999 Request Form: SF 518, one form for each unit. Specimen: 6.5 mL purple top tube - must be labeled with a TYPENEX band
Tyrosine Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: Green top tube (heparin), Bring to Shipping STAT, fasting required Reference Range: 0.9-2.9 MG/DL
Umbilical Culture Lab: Microbiology/7677 Request Form: SF 553 Collection: Cleanse site with soap and water; scrub with an alcohol swab and let dry, then swab the cord stump or cut edge Reference Range: No growth
Urea Nitrogen, Serum Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: SST Reference Range: 5-25 MG/DL
Urea Nitrogen, Urine Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: 24 hour urine Reference Range: 15-24 G/24hrs
Uric Acid, Serum Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: SST Reference Range: MALES: 3.9-7.8 MG/DL FEMALES: 2.4-5.1 MG/DL
Uric Acid, Urine Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: 24 Urine Reference Range: 250-750 MG/24 HRS
Urinalysis Lab: Urinalysis/6614 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: Random or Cath urine. When Cath is submitted, indicate on slip. Reference Range: Sent with report Collection Procedure: Thoroughly instruct patient for proper collection of "Clean Catch" specimen. Wash hands thoroughly, wash penis or vulva using downward strokes 4 times with 4 soapy sponges, then once with sponge wet with warm water. Urethral meatus and perineum must be washed. Each sponge must be discarded after one use. Urinate about 30ml (one ounce) directly into toilet or bedpan and then stop; position container and take middle portion of urine sample. Screw cap securely on container without touching inside rim. Apply completed patient label to patient cup, not lid.
Urine Anaerobic Culture, Suprapubic Puncture Lab: Microbiology/7677 Request Form: SF 553 Specimen: Suprapubic urine aspirate only Collection: Collect specimens from the prepared site using sterile techniques Reference Range: No growth of anaerobic bacteria
Urine Culture Lab: Microbiology/7677 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: Clean Catch, Cath urine. Early morning specimens are the best Collection: No growth
Urobilinogen Screen, Qualitative Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: 50 ML random urine, protect from light Reference Range: Sent with Report
Vaginal Cuff Culture Lab: Microbiology/7677 Request Form: SF 553 Specimen: Postoperative vaginal cuff specimen Collection: Contamination with normal flora from skin, rectum, vaginal tract or other body surfaces should be avoided Reference Range: Normal Flora
Valium See Diazepam
Valproic Acid Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: SST Reference Range: 50-100 MCG/ML
Vancomycin Lab: Chemistry/6615 Request Form: FC MEDDAC Form 119 (Lab Requisition Form) Specimen: SST Reference Range: TROUGH: 5-10 MCG/ML PEAK: 30-40 MCG/ML
Varicella IgG (Chicken Pox) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST Reference Range: Immune or Non-Immune
VDRL, CSF Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: 1.0 ml CSF Reference Range: Nonreactive
Viral Culture Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: Swab area where active lesion is with viral culturette, advise if pregnant. Reference Range: Sent with report
Vitamin B-12 (Cobalamin) Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST, Protect from light Reference Range: See Lab Report
Vitamin D, 1,25 Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST, Bring to Shipping STAT Reference Range: 12-40 pg/ml
Vitamin E Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST, Bring to Shipping STAT Reference Range: 0.5-2.0 mg/dl
VMA Vanilyl Mandelic Acid Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: Patient should be off meds for 72 hrs, list meds on lab slip. Needs preservative. 24 hour urine diet restrictions: pineapples, bananas, eggplant, kiwi fruit, plums, walnuts, tomatoes, and grapefruit. Reference Range: Sent with report
Watson Schartz Screen: See Porphobilinogen
Wound Culture Lab: Microbiology/7677 Request Form: SF 553 Specimen: Pus or other material properly obtained from a wound site or abscess Reference Range: No Growth
Xylocaine See Lidocaine
Yellow Fever Lab: Shipping/7053 Request Form: Miscellaneous (SF 557) Specimen: SST, acute and conv. required Reference Range: Sent with report
ZZP- ZNPP see Protoporphyrin zinc |