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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 SQ 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)

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Critical Values

Analyte

Unit

Low

High

Age

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CPT Codes

List associated CPT codes separated by commas 

LOINC Codes

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

Clinical Indications

Test usage/reason for ordering test if applicable

  • use 
  • bullet
  • points

Additional Information

Anything additional related to the test 

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) 

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

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

Methodology

Test methodology detail 

Synonyms/Keyword Search

Synonyms associated with test in list format 

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

Collection Instructions

Collect specimen per standard laboratory collection procedures. 

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

Last Review Date

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