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Test Name Alias
Test Name Alias | Cerner code | any other names
Ordering Instructions
Ordering Instructions
Panel Information
List components of the panel
- use bullet points
Collection Instructions
Specimen Collection: Blood, Urine, Tissue, Swab, etc.
Container(s): volume and color and any additives
Preferred Volume to Collect: in mL
Minimum Volume to Collect: in mL
Neonate Volume to Collect: FOR HDVCH NURSE COLLECTION
Capillary collect ok? yes or no
Microtainer acceptable: yes or no
Collection Instructions:
- put in bullet points
- if specimen must be processed within a certain amount of time
be sure to note
- "Specimen must be processed within 1 hour of collection - see Processing Instructions below"
Processing Instructions (Laboratory, Outpatient or Off-site collection)
Processed Specimen: Serum/Plasma/Platelet Poor Plasma/Urine with additive
Centrifuge/Spin: yes or no (can remove if processed specimen is not blood)
Aliquot: yes or no (can remove if processed specimen is not blood)
Processing Instructions
- List out
Transport Temperature: Ambient, Refrigerated or Frozen (can list more than one if needed)
Specimen Requirements
Do not use
Special Instructions
Do not use
Specimen Transport Temperature
Do not use
Rejection Criteria
List
Specimen Stability
Ambient: how long is the specimen good for at room temperature
Refrigerate: how long is the specimen good for at this temperature
Frozen: how long is the specimen good for at this temperature
Laboratory Retention: how long do we keep the specimen in the lab
Inpatient SIL: how long is the specimen good for in an inpatient setting to do an add-on
Test Frequency
Days of the week, TAT how many days
Reference Range
differentiate between age and sex and performing lab if needed
Hyperlink critical values table
Clinical Information
Clinical Information
Reflex Information
Reflex Infor or link to document
Performing Department
Department name only
Performing Department Laboratory Location
Advanced Technology Laboratory (ATL), Grand Rapids, MI
Spectrum Health Regional Laboratory (SHRL), Grand Rapids, MI
Spectrum Health Big Rapids Laboratory (SHBR), Big Rapids, MI
Spectrum Health Blodgett Laboratory (BIRL), Grand Rapids, MI
Spectrum Health Gerber Laboratory (SHGH), Fremont, MI
Spectrum Health Kelsey Laboratory (SHKH), Lakeview, MI
Spectrum Health Ludington Laboratory (SHLH), Ludington, MI
Spectrum Health Pennock Laboratory (SHPH), Hastings, MI
Spectrum Health Reed City Laboratory (SHRC), Reed City, MI
Spectrum Health United Laboratory (SHUH), Greenville, MI
Spectrum Health Zeeland Community Laboratory (SHZCH), Zeeland,
MI
Methodology
Methodology
CPT
CPT
CDM Code
From Billing Chargemaster
Interface Order Alias
##### From Cerner Order & Result Alias Spreadsheet
From pathnet
Interface Information
From IS
Cerner Order Code:
Cerner Result Code:
Questions if applicable
Mayo Access Build Information
From pathnet
Interface Information (EMR)
EMR build info - from IS
Mayo Access Code
From Mayo Access spreadsheet from PathNet
Hospitals that use Mayo Access
Munson
Holland
NOCH
Pennock
Ludington
Additional Test Codes
Only for send out tests
LOINC
Result name:####-#
From IS (PathNet)
Additional Information
Additional Information for laboratory staff.
Related test information
PolicyTech Reference #
Reviewed Date
Date of med tech review/updated date