Policy Manual sample

MDT Home Health Care Agency, Inc. Test Results Less Than Results Greater Than Benzoylecgonine 500 ng per mL Bupropion 100 ng per mL Caffeine 40 ug per mL Carbamazepine 12 mcg per mL Carbamazepine Unbound, 5 ug per mL Chlordiazepoxide and Metabolite 5000 ng per mL Chlorpromazine 750 ng per mL Clomipramine and Norclomipramine 900 ng per mL Clonazepam 100 ng per mL Clorazepate (Nordiazepam Assay) 2.5 mcg per mL Cocaine (Quantitative Serum) 500 ng per mL Cyclosporine 85 ng per mL 500 ng per mL Dextroamphetamine 300 ng per mL Dextromethorphan 40 ng per mL Digoxin 2.1 ng per mL (adult)s 3 ng per mL (pediatrics) Dimethadione 1200 ug per mL Disopyramide 7 ug per mL Doxepin and Metabolite 400 ng per mL Encainide 2500 ng per mL Ethanol 300 mg per dL (greater than 200 mg per dL pediatrics less than 6 years) Ethylene Glycol All results All results Free Phenytoin 1.9 mcg per mL Gentamicin Results - 15 mcg per mL Trough - 2.5 mcg per mL Imipramine/Desipramine Fractionation values 500 ng per mL Isopropanol All results All results Lidocaine 5 mcg per mL Lithium 1.4 mEq per L Meperidine and Metabolite 1500 ng per mL Mephenytoin and Metabolite 20 ug per mL Methadone 3000 ng per mL Methanol All results All results Normeperedine 1000 ng per mL Home Health Agency Nursing Care & Procedures K-151