Lab Requisition
Patient Name:
Physician Name: _________________________________________
Ordering Physician Signature: ________________________________
DOB:
STAT
Date:
PROFILES
FAX
Microbiology
Acute Hepatitis Panel
AHP
Hemaglobin AlC
Basic Metabolic
BMP
Hep A AB lgM
Comp Metabolic
Electrolytes
Hepatic Function
CMP
LYTES
HFP
Iron Profile
IRONSTDY
Lipid Panel
LIPID
BUN/Creatinine
CAL
TESTS
BUN/CREA
HGBA1C
HEPAIGM
Hep B Surface AB
Hep B Surface AG
Hep C AB w/rflx HCV/PCR
HIV
HBSAB
HBSAG
HEPC
HIIV12AB
Homocysteine
HOMOCYST
Iron Total
IRON
Lactate Dehydrogenase
(LDH)
LDH
Source:
Aerobic Culture
Anaerobic Culture
Lead
Albumin
ALB
Lipase
Amylase
AMY
Magnesium
Antinuclear Antibody ANA
aPTT OHeparin
Beta HCG, Serum (QUAL)
Beta HCG, Urine (QUAL)
ANASCR
PTT
HCGS
HCGUR
Bilirubin, Total
BILITL
Bilirubin, Direct
BILID
Blood Urea Nitrogen(BUN)
CA 125
BUN
CA125
CA 27.29
CA2729
CA 15-3
LEAD
LIPASE
BLCADULT
GC Culture
GCAMPPB
Rapid Strep Screen
Stool C Diff Toxin
Stool Culture
Crypto/Giardia
MICROALB
Mono Test
MONOSCR
Phosphorus
PHOS
Potassium
K
Protein, Total
TP
Coumadin
PSA
PTH, Intact
CA153
Sed Rate
ESR
CA 19-9
CA199
Sodium
Calcium
CA
CBC w Auto DIff
CBC w/ Manual Diff
CEA
Cholesterol
Cortisol AM PM
Creatine Phosphokinase
(CPK)
Creatinine
Creatinine Clearance
CRP (inflammation)
Ferritin
Folate
CBCD
CBCWMD
CEA
CHOL
CORTOT
CK
CREA
Syphylis Serology
T4, Free
Triglycerides
TSH
UA w/ Micro
UA DIP
Uric Acid
Vitamin B-12
Vitamin D 25 Hydroxy
Transfusion Medicine
ABO & RH
ABS
Direct Coombs
DAT
Additional Tests
SODIUM
RPR
T4FREE
TRIG
TSH
UA
ICD-10
UADIP
URIC
VITB12
VITAMIND
FOLATE
GLU
ABO/RH
Antibody Screen
CRP
GGT
O&P
THROAT
FERR
Glucose
GIARDIA
Throat Culture
CREACLR
Gamma GT
STLC
WBCFEC
PSA
PTHINT
RSV
CAION
CDIFF
Stool WBC
PT/INR
RSV, Source:
Calcium, Ionized
STREP
MG
Microalbumin
Protime
ANAER
Blood Culture
Stool Ova & Parasites
TESTS
AEROBIC
4401 College Dr. Rock Springs, WY 82901 P: 307-352-6940 F: 307-352-6945