[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-203251-105":3,"detail-sidebar-cat-0-en-105":80,"doc-detail-203251-en":129},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":9,"keywords":10,"description":11,"schema_data":12,"social_meta":73,"head_meta":75,"extra_data":77,"updated_unix":79},105,"en","frm-21302","","Laboratory requisition form capturing ordering instructions for multiple clinical tests. It defines fasting requirements, references patient instruction sheets, and lists hematology/coagulation, endocrine, general chemistry, drug level monitoring, immunology/serology, cardiology/ECG, transfusion medicine links, urine drug testing panels, sterile body fluids, and additional miscellaneous investigations. Includes sample and source details, specimen selection, therapeutic drug regimen timing fields, and glucose tolerance test scheduling 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does the form specify for fasting-related testing?","Question",{"text":62,"@type":63},"It indicates a fasting test designation and includes an “Hours Fasting” field for relevant requests, referencing the patient instruction sheet for guidance.","Answer",{"name":65,"@type":60,"acceptedAnswer":66},"Which therapeutic drug monitoring fields are included?",{"text":67,"@type":63},"The form provides dose route (oral/IV/other), dose regimen, duration on the current regimen, and timing/date fields for last and next doses or IV completion/start.",{"name":69,"@type":60,"acceptedAnswer":70},"How does the form structure urine testing orders?",{"text":71,"@type":63},"It groups urine testing into panels and specific assays such as urinalysis, pregnancy test, random vs 24-hour collections, and related measurements like creatinine clearance and protein/albumin 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Test.\u003Cbr>I Refer to Patient Instruction Sheet.\u003Cbr>\u003Cbr>|  |  | Hours Fasting | o Third Party Bill Client   |\n| --- | --- | --- | --- | --- | --- |\n| Hematology/Coagulation | Endocrine |  |  | Clinical Information |  |\n| o CBC and Differential\u003Cbr>o CBC no Differential\u003Cbr>o D-dimer\u003Cbr>o INR\u003Cbr>o Reticulocyte Count | o Cortisol Random\u003Cbr>o Cortisol AM (0700-1000)\u003Cbr>o Cortisol PM (1500-1800)\u003Cbr>o Estradiol\u003Cbr>o Follicle Stimulating Hormone (FSH)\u003Cbr>o Luteinizing Hormone (LH)\u003Cbr>o Parathyroid Hormone (PTH)\u003Cbr>o Progesterone\u003Cbr>o Prolactin\u003Cbr>o Testosterone, Total\u003Cbr>o Thyroid Stimulating Hormone (TSH)\u003Cbr>o Progressive Thyroid Stimulating Hormone (TSH) |  |  |  |  |\n| General Chemistry |  |  |  |  |  |\n|  |  |  |  | Drug Levels/Monitoring |  |\n| o Albumin\u003Cbr>oAlkaline Phosphatase (ALP)\u003Cbr>o Alanine Aminotransferase (ALT)\u003Cbr>o Bilirubin, Total\u003Cbr>o Bilirubin, Total and Conjugated\u003Cbr>o Calcium\u003Cbr>o C-Reactive Protein (CRP)\u003Cbr>o Creatine Kinase (CK)\u003Cbr>o Creatinine (eGFR)\u003Cbr>o Sodium\u003Cbr>o Potassium\u003Cbr>o Ferritin\u003Cbr>o Fibrosis-4 Score (FIB-4)\u003Cbr>o Gamma Glutamyl Transferase (GGT)\u003Cbr>o Glucose Fasting F I\u003Cbr>o Glucose Random\u003Cbr>o Hemoglobin A1c\u003Cbr>o HCG, Serum (Quantitative)\u003Cbr>o IgA\u003Cbr>o IgG\u003Cbr>o IgM\u003Cbr>o Lipase\u003Cbr>o Magnesium\u003Cbr>o Phosphate\u003Cbr>o Prostate Specific Antigen (PSA)\u003Cbr>o Protein Electrophoresis, Serum\u003Cbr>o Total Protein\u003Cbr>o Urate\u003Cbr>|  |  |  |  |  |\n|  |  |  |  | o Ethanol Level, Blood\u003Cbr>Therapeutic Drug Monitoring\u003Cbr>Dose route o Oral o IV o Other\u003Cbr>Dose Regimen   How Long on Current Regimen?   Date of Last Dose or IV Complete   Time of Last Dose or IV Complete   Date of Next Dose or IV Start   Time of Next Dose or IV Start  o Carbamazepine o Phenytoin, Total\u003Cbr>o Cyclosporine pre dose o Sirolimus\u003Cbr>o Cyclosporine 2 h post o Tacrolimus\u003Cbr>o Digoxin o Theophylline\u003Cbr>o Lithium o Valproate\u003Cbr>o Phenobarbital o Other   Antibiotics\u003Cbr>Gentamicin o Pre o Post o Interval o Other Tobramycin o Pre oPost oInterval o Other Vancomycin o Pre o Other\u003Cbr>Anticoagulant\u003Cbr>o Anti-Xa-Heparin Level\u003Cbr>o Anti-Xa-Apixaban\u003Cbr>o Anti-Xa-Rivaroxaban |  |\n|  | Immunology/Serology |  |  |  |  |\n|  | o Epstein Barr Serology Panel\u003Cbr>o Hepatitis A Virus Acute Serology-IgM\u003Cbr>o Hepatitis A Virus Immunity Serology-IgG\u003Cbr>o Hepatitis B Surface Antigen\u003Cbr>o Hepatitis B Surface Antibody\u003Cbr>o Hepatitis C Virus Serology\u003Cbr>o HIV 1 and 2 Serology (Antigen and Antibody)\u003Cbr>o Mononucleosis Screen\u003Cbr>o Rheumatoid Factor\u003Cbr>o Rubella Immunity Serology-IgG\u003Cbr>o Syphilis screen |  |  |  |  |\n|  | Cardiology-Electrocardiogram (ECG) |  |  |  |  |\n|  | o Electrocardiogram to be read by panel\u003Cbr>o Electrocardiogram to be read by Other |  |  |  |  |\n|  | Transfusion Medicine |  |  |  |  |\n|  | See Transfusion Medicine Requisition 21448 Routine Pre-natal Red Cell Screening-use CBS Req |  |  |  |  |\n|  |  |  |  | Urine Drug Testing Panels |  |\n|  |  |  |  | Reason For Request   o Opioid Dependency Panel\u003Cbr>What is Treatment Regimen?\u003Cbr>o Buprenorphine o Methadone\u003Cbr>o Morphine o Hydromorphone\u003Cbr>o Other   OR\u003Cbr>o General Toxicology Panel |  |\n|  | Sterile Body Fluid |  |  |  |  |\n| o Lipid Panel\u003Cbr>o Cholesterol, Total\u003Cbr>o Triglycerides\u003Cbr>o Cardiovascular Disease Risk Assessment (Framingham Risk Score) includes Lipid Panel Required History\u003Cbr>Systolic Blood Pressure (mmHg)   o Yes o No Current Tobacco Use\u003Cbr>o Yes o No Treated for high Blood Pressure\u003Cbr>o Yes o No Diabetic\u003Cbr>o Yes o No Chronic Kidney Disease\u003Cbr>o Yes o No Atherosclerosis\u003Cbr>o Yes o No First-degree relative with CVD (M \u003C55Y / F \u003C65Y) |  |  |  |  |  |\n|  | o Fluid Type   Source:   Test(s)   |  |  |  |  |\n|  | Urine |  |  |  |  |\n|  | o Urinalysis\u003Cbr>o Pregnancy Test (HCG, Qualitative)\u003Cbr>o Albumin* o Random o 24 h\u003Cbr>o Creatinine o Random o 24 h\u003Cbr>o Cortisol o 24 h\u003Cbr>o Protein Total* o Random o 24 h\u003Cbr>o Protein Electrophoresis o Random o 24 h *includes creatinine ratio\u003Cbr>o Creatinine Clearance 24h Ht  cm Wt  kg |  |  |  |  |\n|  |  |  |  | Mi","cbCaisbHiogXJ6un","https://ap.wps.com/l/cbCaisbHiogXJ6un","pdf",522808,"English","# Test Categories\n## Hematology/Coagulation\n## Endocrine\n## General Chemistry\n## Drug Levels/Monitoring\n## Immunology/Serology\n## Cardiology (ECG)\n## Urine Drug Testing Panels\n## Sterile Body Fluid and Miscellaneous Tests\n## Glucose Tolerance Tests","[{\"question\":\"What does the form specify for fasting-related testing?\",\"answer\":\"It indicates a fasting test designation and includes an “Hours Fasting” field for relevant requests, referencing the patient instruction sheet for guidance.\"},{\"question\":\"Which therapeutic drug monitoring fields are included?\",\"answer\":\"The form provides dose route (oral/IV/other), dose regimen, duration on the current regimen, and timing/date fields for last and next doses or IV completion/start.\"},{\"question\":\"How does the form structure urine testing orders?\",\"answer\":\"It groups urine testing into panels and specific assays such as urinalysis, pregnancy test, random vs 24-hour collections, and related measurements like creatinine clearance and protein/albumin options.\"}]","frm-21302 | PDF",1788557595]