South Bend Medical Foundation - Your Community Laboratory

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Test Name:
Forensic Toxicology Panel SA, Sexual Assault

• SBMF No:
  31654
• Performance Lab Name:
  Forensic Toxicology
• Test Mnemonic:
  FTPSA
• CPT Code:
  80100; 80101x4; 82542x2; 82570; 83986; 84311

  ---

  Medicare: G0431; G0434; 82542x2; 82570; 83986; 84311
• LOINC Code:
  19270-8; 14316-4; 43198-1; 43197-3; 51777-1; 61033-7; 19565-1; 19568-5; 42242-8; 12327-3; 12327-3; 2161-8; 48767-8; 58400-3; 54247-2
• Test Includes:
  Barbiturates, Benzodiazepines, Ethanol, MDMA, GHB, Flunitrazepam, Ketamine, Oxidant Screen, pH, Creatinine
• Also Known As:
  Panel SA
• Spec Type:
  Urine, random
• Spec Container:
  Drug Abuse Test Kit, Single, OR
  Drug Abuse Test Kit, Split
• Pref Vol:
  Single Specimen Collection: At least 30.0 mL in specimen bottle "A"
  Split Collection: At least 30.0 mL in specimen bottle "A" plus at least 15.0 mL in specimen bottle "B"
• Spec Collect:
  Refer to instructions printed on the back of the Drug Testing Custody and Control Form
• Spec Store Transport:
  Room temperature or refrigerated
• Spec Remarks:
  Sample must be submitted with a NON-REGULATED DRUG TESTING CUSTODY AND CONTROL FORM
• Methodology:
  Alcohol Dehydrogenase (ADH)
  Enzyme Immunoassay (EIA)
  Gas Chromatography (GC)
  Gas Chromatography/Mass Spectrometry (GC/MS)
• Reference Range:
  

  DRUG	RESULT		EIA CUTOFF		GC/MS CUTOFF
  MDMA MDA Barbiturates Benzodiazepines GHB 7-aminoflunitrazepam   Ketamine     Ethanol	Negative Negative Negative Negative Negative Negative Negative     Negative		500 ng/mL 500 ng/mL 200 ng/mL 200 ng/mL NA       NA       NA         ADH CUTOFF 40 mg/dL		500 ng/mL   500 ng/mL   200 ng/mL   200 ng/mL   10 ng/mL   20 ng/mL   100 ng/mL     GC CUTOFF 40 mg/dL

• Additional Test Info:
  Screen-positive specimens are automatically confirmed by GC and/or GC/MS. Additional charges may apply.
• Test Type:
  TOX-TDM