Wellness 4 (Direct Access Testing)

Last Modified: 8/30/2023 1:01:19 PM


Medical Necessity Documentation:  
Client Notes:  
Patient Preparation:  
Specimen Requirements: 4.0 mL Serum in a SST Gold Top Tube

and
3.0 mL Whole Blood in a Lavender Top Tube - EDTA 
Collection Instructions:  
Transport & Storage: Temperature/Stability:  
Reference Range: Refer to Interpretive Results 
Critical Ranges:  
Test Comments:  
Methodology: Mutiple
Clinical Significance:  
Documentation:  
Custom Panel: No

PRODUCTION SCHEDULE

Days Performed: Sunday, Monday, Tuesday, Wednesday, Thursday, Friday, Saturday
Sites Performed: Parkview Dekalb Hospital, Parkview Huntington Hospital, Parkview LaGrange Hospital, Parkview Noble Hospital, Parkview Regional Medical Center, Parkview Southwest , Parkview Wabash Hospital, Parkview Warsaw , Parkview Whitley Hospital
PHL Test Code: DAW4
EPIC Test Code: LAB3283
Included Tests: Complete Blood Count (CBC) Hematocrit (Hct); Hemoglobin (Hgb); Mean Corpuscular Hemoglobin (MCH); Mean Corpuscular Hemoglobin Concentration (MCHC); Mean Corpuscular Volume (MCV); Platelet (PLT); Red Blood Cell Count (RBC); Red Cell Distribution Width Standard Deviation (RDWSD); Red Cell Distribution Width Coefficient Variation (RDWCV); White Blood Cell Count (WBC)

Comprehensive Medabolic Panel (CMP) Alanine Aminotransferase (ALT; SGPT); Alkaline Phosphatase; Aspartate Aminotransferase (AST; SGOT); Bilirubin, Total; Blood Urea Nitrogen (BUN); Calcium (Ca); Creatinine; Electrolytes [Carbon Dioxide (CO2); Chloride (CL); Potassium (K); Sodium (Na)]; Glucose; Protein Fractionation [A/G Ratio; Albumin;Globulin; Protein, Total]

Glycohemoglobin Estimated Average Glucose (eAG); Glycohemoglobin (HbA1C)

Lipid Profile Cholesterol; Cholesterol HDL; Cholesterol LDL (Calculated); Chol/HDL Ratio (Calculated); Triglycerides

Thyroid Stimulating Hormone (TSH)
CPT Coding: 80053; 80061 (Reflex 83721), 83036, 84443, 85027

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