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Order Form
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Insurance
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Diagnosis
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Other Dx
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Fasting Lab:
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CBC with Diff
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Thyroid Profile with TSH, Free T3, Free T4
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COMP/Chem 10/Metabolic Panel
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Lipid Panel
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Folate (Folic Acid)
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Vitamin B12
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Lithium Level
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Ammonia level
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Valproic Acid, Serum or plasma Level
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Drug Screen 12 w/Reflex Confirmation
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Clozapine, serum or plasma Level
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Clomipramine Level Clomipramine Level
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Homocysteine Level
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HIV Antigen/Antibody Combo w/ Reflex to Confirmation
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Ethanol, Whole Blood
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Syphilis Panel
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hCG, Total, Qualitative, Blood
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hCG, Urine
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Hemoglobin (Hb) A1C
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Prolactin Level
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Vitamin D, 25-Hydroxy
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Glutamyl Transferase (GGT)
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Drug Analysis profile, Comprehensive, Urine
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Urinalysis, Complete With Microscopic Examination With Reflex to Urine Culture, Routine
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Carbohydrate-deficient Transferrin (CDT), Adult
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Lamotrigine Level
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Paliperidone (as 9-Hydroxyrisperidone), Serum or Plasma
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Risperidone Level
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Iron Studies (Iron, TIBC, Ferritin) Level
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Transferrin Level
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Molecular Genetic Test-See Ordering Form
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Other Orders:
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Ordering Provider: Jennifer Durward APRN, PMHNP-BC
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