Blood Test For Diarrhea Prescription

Please correct the errors described below.

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Patient's First Name

Last name

DOB

Fasting

Yes

Diagnosis

Chronic Diarrhea (K59.1)

Mal-Absortion (K90)

CBH (R19.4)

Other Diagnosis

Lab Test

Serotonin Level Blood

Pancreatic Polypeptide

Neuron Specific Enolase

Chromogranin A level

Substance P, EIA

Serum Gastric level

Serum Insulin level

5-HIAA, 24 hr Urine

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Date

**IT IS THE PATIENT’S RESPONSIBILITY TO USE A FACILITY COVERED BY THEIR INSURANCE**. ** If you are going to LABCORP, You need to call the draw station in advance and make sure they have a Z tube to perform all the necessary tests **

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