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Test Code AAA Name as displayed in EPIC

Important Note

If needed for specialized tests, leave blank if not applicable

Will appear as a yellow band at the top of the test page

Specimen and Container/Tube

Specimen Type: Whole blood, serum, plasma, random urine, body fluid, CSF, stool, swab, 24 hour urine, etc.

(if subheader is not applicable, leave subheader and comment "not applicable")

Preferred Specimen: Single preferred specimen type, prints on specimen label, example: red top, gold top, lavender top, lithium heparin mint top, sterile container, yellow top urine, 24 hour urine container, swab

Other Acceptable specimens: list additional acceptable specimen types (use list above for wording)

Volume

Preferred Volume: volume with units (example 1.0 mL) 

Minimum Volume: volume with units (example 1.0 mL) 

Specimen Stability

Storage Temperature

Stability

Room temperature

Insert acceptable time limit, if not acceptable indicate "not acceptable" 

Example: 2 hours, 2 days

Refrigerated

Insert acceptable time limit,

Example: 2 hours, 2 days

Frozen

Insert acceptable time limit,

Example: 2 hours, 2 days

Collection Instructions

Collect specimen per standard laboratory collection procedures. 

Include any specific collection instructions such as notifying lab, timed collection, etc. 

Specimen Handling and Transport Instructions

UCMC Onsite Instructions: detailed handling, processing, and transport for UCMC Hyde Park collected specimen 

Collect specimen per standard collection procedure and send to laboratory immediately. 

 

UCMC Offsite and UC MedLab Outreach Instructions: detailed handling, processing, and transport for non-Hyde Park collected specimen. If not available for offsite locations, indicate not available for offsite/outreach locations. 

Rejection Criteria

  • Common specimen rejected situations include: incorrect specimen type, insufficient volume, missing or incomplete specimen identifiers, incorrect specimen transport, or specimens outside stability limits. 
  • List of rejection reasons outside of specimen, volume, stability, or transport
  • Reasons specific to test code example: hemolysis, clotted, not protected from light, etc. 

Reference Values

 

Test

Age

Sex

Reference Range

Test component

Age range/phase

Male, Female, or all

Insert range

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Turnaround Time

Turnaround times are relative to the time the specimen is received in the test laboratory. 

STAT Turnaround Time: TAT in minutes/hours/days

Routine Turnaround Time: TAT in minutes/hours/days

Testing Schedule: detail testing schedule (24/7, Monday - Friday, days and times) 

Clinical Indications

Test usage/reason for ordering test if applicable

  • use 
  • bullet
  • points

Methodology

Test methodology detail 

CPT Codes

List associated CPT codes separated by commas 

LOINC Codes

List associated LOINC codes or refer to specific test components separated by commas 

Synonyms/Keyword Search

Synonyms associated with test in list format 

A.A.A TEST, TEST, A.A.A, TRIPLE A TEST

Last Review Date

insert date of last review or modification (MM/DD/YYYY) 

Additional Information

Anything additional related to the test 

Test Components

List individual test components if multiple

 

EXAMPLE: CPNL

Glucose, Sodium, Potassium, Chloride, Carbon Dioxide, Anion Gap (IGAP) Calculation, Urea Nitrogen, Creatinine, Glomerular Filtration Rate (GFRE/GFREA), Calcium, Total Bilirubin, Total Protein, Albumin, Alkaline Phosphatase, Aspartate Aminotransferase, Alanine Aminotransferase

Critical Values

Analyte

Unit

Low

High

Age