Department of Surgery

Division of Bariatric & Minimally Invasive Surgery

Sinai Hospital of Baltimore Hoffberger Building, Suite 15

2435 West Belvedere Avenue

Baltimore, Maryland 21215-5271

Tel: 410-601-4486 Fax: 410-601-9014

Post-Operative Labs

To be done at 1 month post operative, then 2 weeks prior to 3 month, 6 month, 9 month, 12 month & annual visits

Prescribing Physician:

PATIENT: ______Christina Li M.D.

DOB: ______Cynthia Long, MD STANDING ORDERS

Please send duplicate report to:
Address: / Tel: / Fax:

LAB STAFF: PLEASE DRAW THE LABS ü’d Fasting for Test Preferred

Test / Belvedere Path
Hoffberger Suite 11 / Labcorp
Acct # 19518395 / Quest
Acct # 391554
POST-OPERATIVE LABS ICD - 9 Codes: 269.2, 269.9, 277.9, 579.9, 790.29, 244.9
ü / Prealbumin / SST / 016931 / 4847X
ü / 25 OH Vitamin D / Plain Red / 081950 / 17306X
ü / Folate / SST / 002014 / 466X
ü / Magnesium / SST / 001537 / 622X
ü / CMP / SST / 322000 / 10231X
ü / LFT / SST / 322755 / 10256X
ü / HbgA1C / SST / 001453 / 496X
ü / Lipid Panel / SST / 303756 / 7600X
ü / CBC w Diff / Plt / LAV / 005009 / 6399X
ü / Iron & IBC / SST / 001321 / 7573X
ü / Uric Acid / SST / 001057 / 905X
ü / Transferrin / SST / 004937 / 891X
ü / TSH / SST / 004259 / 899X
ü / Vit. B1 / L. LAV (Frozen) / Frozen WB 121186 / Frozen WB 5042X
ü / Vit. B6 / L. LAV (Plasma) / Plasma 004655 / Frozen 926X
ü / Vit. B12 / SST / 001503 / 927X
ü / Serum Vit. A / Plain Red / 017509 / 921X
ü / Serum Ferritin / SST / 004598 / 457X
ü / Serum Zinc / 001800 / Plasma 945X
ü / Serum Copper / 001586 / 363X
Other: Ceruloplasmin
(only when ü’d ) / 001560 / 326X
Other:

ICD 9 Codes:

269.2
Multi Vitamin
Deficiency / 269.9
Unspecified Nutritional Deficiency / 277.9
Metabolism
Disorder / 579.9
Intestinal
Malabsorption / 790.29
Hyperglycemia / 244.9
Hypothyroidism

Please take insurance card with you to the lab.

Note: This lab slip may also be downloaded from our website: www.lifebridgehealth.org

Please do not call the office for lab results. Results will be reviewed at office visits

You will be contacted only for abnormal results

Revised 4/7/11