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Laboratory Test Catalog Update FormSubmit this form for any changes or updates to the laboratory test catalog. Email completed form as an attachment to LabCatalogChangeReqTeam@ Complete all yellow highlighted sections in addition to any changes or additions requested. Location InformationLab Location: ?Request Date: ?Change Request Submitted by (Name):?Phone Number:Email Address: Test Information? Update to current test ? New TestTest Name: EPIC number:Alternate name (Synonyms): Sunquest test code: ???????Includes:(If test battery, list all tests)CPT Code (s)Reflex testing: Performing laboratoryOrdering location: Preferred sample type: Preferred sample volume: Other acceptable samples:Minimum volumeSpecial ordering instructions: Special collection instructions: Special processing instructions: Transport container:Transport temp:Sample stability (room temp.):Sample stability (refrigerated): Sample stability (frozen):Rejection criteria:Methodology:Setup schedule:Report available:Reference range:Critical value: Clinical Significance:Notes: ................
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