Lab OrdersBill Bill PatientPlease select the tests needed .Speciality Test 36000 Insulin Resistance Test SST 82951 Glucose Tolerance Test SSTPanels 80051 Electrolyte Panel SST 80048 Basic Metabolic SST 80053 Comprehensive Metabolic SST 80061 Lipid Panel SST 80076 Hepatic Panel SST 80069 Renal Panel SST 80074 Hepatitis, Acute SST 80055 Prenatal Panel (120)Individual Test 82040 Albumin SST 84075 ALK Phos SST 84460 ALT (SGPT) SST 82150 Amylase SST 89600 ABO/RH PRPL 86850 Antibody Screen PRPL 86038 ANA with Reflex (2) SST 84450 AST (SGOT) SST 82248 Bilirubin, Direct SST 82247 Bilirubin, Total SST 84520 BUN SST 86304 CA-125 SST 85025 CBC w/Auto Diff PRPL 82465 Cholesterol, Total SST 82533 Cortisol SST 86140 C-Reactive Protein (CRP) SST 86141 CRP-High Sensitivity SST 82565 Creatinine SST 82575 Creatinine Clearance SST 82627 DHEA-S SST 83718 Direct HDL SST 82310 Calcium SST 83721 Direct LDL SST 85652 ESR - Sed Rate PRPL 82670 Estradiol SST 82728 Ferritin SST 82746 Folate/Folic Acid SST 83001 FSH SST 82947 Glucose SST 85014 Hematocrit PRPL 85018 Hemoglobin PRPL 83036 Hemoglobin A1C PRPL 86708 Hep A Total AB SST 86705 Hep B Core IgM AB SST 86317 Hep B Surfact AB SST 87340 Hep B Surface AG SST 86803 Hep C Antibody SST 86703 HIV SST 83090 Homocysteine SST 86677 H Pylori PRPL or Stool 86695 HSV-1 lgG SST 86696 HSV-2 lgG SST 82784 IgA, Total SST 83525 Insulin SST 83540 Iron, Total SST 83550 Iron Binding Capacity SST 80178 Lithium SST 83690 Lipase SST 83002 LH SST 83735 Magnesium SST 82043 Malb/Crea Ratio, Urine 83921 Methylmalonic Acid (MMA) SST 84100 Phosphorus SST 84132 Potassium SST 84702 Pregnancy HCG, Quant. SST 81025 Pregnancy HCG, Qual SST 84703 Pregnancy HCGUrine 84144 Progesterone SST 80197 Prograf (Tacrolimus) PRPL 84146 Prolactin SST 84153 PSA SST 83970 PTH SST 85610 Protime/INR BLUE 85730 PTT BLUE 86480 Quantiferon-TB Plus 86430 RF/Rheumatoid Factor SST 86762 Rubella SST 84270 SHBG SST 86592 Treponema (RPR) SST 84402 Testosterone Free SST 84403 Testosterone, Total SST 84432 Thyroglobulin SST 86800 Thyroglobulin AB SST 86376 Thyroid Peroxidase AB SST 84478 Triglycerides SST 84481 TTG, IgA SST 84443 TSH SST 84439 Free T3 SST 84436 Free T4 SST 84550 Total T4 SST 82340 Uric Acid SST 81003 Urine Calcium/Creat Ratio 81001 Urine Dip 87086 Urine Microscopic 84156 Urine Culture 82306 Urine Total Protein/Creat Ratio 80164 Valproic Acid 82652 Vit D, 1, 25-Dihydroxy 82607 Vitamin D25 Hydroxy SST 82607 Vitamin B12 SSTSource:Time:PATIENT INFORMATIONPatient NameSex Male FemaleDOBFasting Yes NoPatient AddressPatient PhoneReferring PhysicianEmailNPI#PLEASE LIST YOUR OFFICE / FACILITY / LOCATIONProviders Phone NumberFax NumberFull NameSubmit Form
