Bright Heart Health

New Laboratory Order

Oct, 28 2023 @ 2:31 PM

Scheduled Draw Patient Id Patient Name DOB Sex Accession#

10/28/2023 @ 14:45 153402407 JULIEN, LINDSAY 03/31/1987 F 23490023

Profiles / Test Status Ordering Provider Location Reflab

CBC (INCLUDES DIFF/PLT) Routine Vincent, Pamela Main Facility Quest - LA
Category Description
Sample Type BLOOD
Container EDTA (LAVENDER-TOP) TUBE
Draw Req WHOLE BLOOD FROM FULL EDTA (LAVENDER-TOP) TUBE INSTRUCTIONS: MAINTAIN
SPECIMEN AT ROOM TEMPERATURE. DO NOT REFRIGERATE. IF MULTIPLE DRAW, COLLECT
EDTA (LAVENDER-TOP) TUBE LAST. TRAUMATIC DRAW CAN INTRODUCE THROMBOPLASTIN
AND TRAP WBC AND PLATELETS. REFRIGERATION CAN PRECIPITATE FIBRIN AND TRAP WBC
AND PLATELETS.
Transport Mode ROOM TEMPERATURE
Transport Group RT
COMPREHENSIVE METABOLIC PANEL Routine Vincent, Pamela Main Facility Quest - Seattle
Category Description
Sample Type SERUM
Container Serum separator tube
Draw Req Patient Preparation: Fasting specimen is preferred 1 mL serum Instructions: Administration of
STRENSIQ may interfere in certain assays and may falsely elevate values. For patients receiving
STRENSIQ, consideration should be given to using alternate methods.
Transport Mode Room temperature
Transport Group RT
RPR (DX) W/REFL TITER AND Routine Vincent, Pamela Main Facility Quest - Seattle
CONFIRMATORY TESTING
Category Description
Sample Type SERUM
Container Transport tube
Draw Req 1 mL serum
Transport Mode Room temperature
Transport Group RT
DRUG MONITOR, BENZO, W/CONF, Routine Vincent, Pamela Main Facility Quest - Seattle
URINE
Category Description
Sample Type RANDOM
Container CLINICAL DRUG TEST TRANSPORT VIAL
Draw Req 20 ML URINE
Transport Mode ROOM TEMPERATURE
Transport Group RT
DRUG MONITOR, COCAINE METAB, Routine Vincent, Pamela Main Facility Quest - Seattle
W/CONF, URINE
Category Description
Sample Type RANDOM
Container CLINICAL DRUG TEST TRANSPORT VIAL
Draw Req 20 ML URINE
Transport Mode ROOM TEMPERATURE
Transport Group RT
DRUG MONITOR, FENTANYL, W/CONF, Routine Vincent, Pamela Main Facility Quest - Seattle
URINE
Category Description
Sample Type RANDOM
Container CLINICAL DRUG TEST TRANSPORT VIAL
Draw Req 30 ML URINE
Transport Mode ROOM TEMPERATURE
Transport Group RT
DRUG MONITOR, METHADONE METAB, Routine Vincent, Pamela Main Facility Quest - Seattle
W/CONF, URINE
Category Description
Sample Type RANDOM
Container CLINICAL DRUG TEST TRANSPORT VIAL
Draw Req 20 ML URINE
Transport Mode ROOM TEMPERATURE
Transport Group RT

** Continued on next page **

 Bright Heart Health page 2
New Laboratory Order
Oct, 28 2023 @ 2:31 PM

Scheduled Draw Patient Id Patient Name DOB Sex Accession#

10/28/2023 @ 14:45 153402407 JULIEN, LINDSAY 03/31/1987 F 23490023

Profiles / Test Status Ordering Provider Location Reflab

DRUG MONITOR, OPIATES, W/CONF, Routine Vincent, Pamela Main Facility Quest - Seattle
URINE
Category Description
Sample Type RANDOM
Container CLINICAL DRUG TEST TRANSPORT VIAL
Draw Req 20 ML URINE
Transport Mode ROOM TEMPERATURE
Transport Group RT
DRUG MONITOR, OXYCODONE, Routine Vincent, Pamela Main Facility Quest - Seattle
W/CONF, URINE
Category Description
Sample Type RANDOM
Container CLINICAL DRUG TEST TRANSPORT VIAL
Draw Req 20 ML URINE
Transport Mode ROOM TEMPERATURE
Transport Group RT
DRUG MONITOR, ALCOHOL METAB, QN, Routine Vincent, Pamela Main Facility Quest - Seattle
URINE
Category Description
Sample Type RANDOM
Container CLINICAL DRUG TEST TRANSPORT VIAL
Draw Req 20 ML URINE
Transport Mode ROOM TEMPERATURE
Transport Group RT
DRUG MONITOR,AMPHETAMINE, W/DL, Routine Vincent, Pamela Main Facility Quest - Seattle
QN URINE
Category Description
Sample Type RANDOM
Container CLINICAL DRUG TEST TRANSPORT VIAL
Draw Req 9 mL urine
Transport Mode ROOM TEMPERATURE
Transport Group RT
DRUG MONITOR, BUP AND Routine Vincent, Pamela Main Facility Quest - Seattle
NALOXONE,QN,URINE
Category Description
Sample Type RANDOM
Container CLINICAL DRUG TEST TRANSPORT VIAL
Draw Req 20 ML URINE
Transport Mode ROOM TEMPERATURE
Transport Group RT
HCG, QL, URINE Routine Vincent, Pamela Main Facility Quest - Seattle
Category Description
Sample Type RANDOM
Container Transport tube
Draw Req 10 mL urine from a first morning voided specimen
Transport Mode Room temperature
Transport Group RT
HIV 1/2 ANTIGEN/ANTIBODY,FOURTH Routine Vincent, Pamela Main Facility Quest - LA
GENERATION W/RFL
Category Description
Sample Type
Container (%91431SB) HIV 1/2 ANTIGEN/ANTIBODY, FOURTH GENERATION W/RFL Submitted tubes must be
labeled with patient identifier and submitted only for HIV testing. (%SBHIV1) HIV FOURTH GEN
SCREEN Serum separator tube
Draw Req (%91431SB) HIV 1/2 ANTIGEN/ANTIBODY, FOURTH GENERATION W/RFL 3 mL serum Instructions:
Serum: Collect in a serum separator tube or red-top tube (no gel). The tube should be centrifuged after
clotting. Spun serum separator tubes may be submitted at room temperature or refrigerated unopened
without transfer to a plastic screw-cap vial. Red-top tube (no gel) serum should be transferred to a plastic
screw-cap vial and submitted for testing. Plasma: Collect in EDTA (lavender top) tube and centrifuge
tube within 24 hours of collection. Transfer plasma to a plastic screw-cap vial, label as plasma, and
submit for testing. Submitted tubes must be labeled with patient identifier and submitted only for HIV
testing. (%SBHIV1) HIV FOURTH GEN SCREEN 3 mL serum Instructions: Serum: Collect in a serum
separator tube or red-top tube (no gel). The tube should be centrifuged after clotting. Spun serum
separator tubes may be submitted at room temperature or refrigerated unopened without transfer to a
plastic screw-cap vial. Red-top tube (no gel) serum should be transferred to a plastic screw-cap vial and
submitted for testing. Plasma: Collect in EDTA (lavender top) tube and centrifuge tube within 24 hours of
collection. Transfer plasma to a plastic screw-cap vial, label as plasma, and submit for testing.
Submitted tubes must be labeled with patient identifier and submitted only for HIV testing.
Transport Mode (%91431SB) HIV 1/2 ANTIGEN/ANTIBODY, FOURTH GENERATION W/RFL ROOM TEMPERATURE
(%SBHIV1) HIV FOURTH GEN SCREEN ROOM TEMPERATURE
Transport Group RT

** Continued on next page **

 Bright Heart Health page 3
New Laboratory Order
Oct, 28 2023 @ 2:31 PM

Scheduled Draw Patient Id Patient Name DOB Sex Accession#

10/28/2023 @ 14:45 153402407 JULIEN, LINDSAY 03/31/1987 F 23490023

Profiles / Test Status Ordering Provider Location Reflab

HEPATITIS PANEL, GENERAL Routine Vincent, Pamela Main Facility Quest - LA
Category Description
Sample Type
Container (498SB=) HEPATITIS B SURFACE ANTIGEN W/REFL CONFIRM Serum separator tube (SST)
(499SB=) HEPATITIS B SURFACE ANTIBODY QL SERUM SEPARATOR TUBE (SST) (501SB=)
HEPATITIS B CORE AB TOTAL SERUM SEPARATOR TUBE (SST) (508SB=) HEPATITIS A AB,
TOTAL SERUM SEPARATOR TUBE (SST) (8472SB=) HEPATITIS C AB W/REFL TO HCV RNA, QN,
PCR Serum separator tube
Draw Req (498SB=) HEPATITIS B SURFACE ANTIGEN W/REFL CONFIRM 2 mL serum Instructions: Dietary
supplements containing biotin may interfere in assays and may skew analyte results to be either falsely
high or falsely low. For patients receiving the recommended daily doses of biotin, draw samples at least 8
hours following the last biotin supplementation. For patients on mega-doses of biotin supplements, draw
samples at least 72 hours following the last biotin supplementation. Note: When only a single test,
Hepatitis B Surface Antigen, is ordered to diagnose Hepatitis B in a pregnant woman, additional tests
such as liver enzymes should be ordered to confirm the diagnosis. (499SB=) HEPATITIS B SURFACE
ANTIBODY QL 1 ML SERUM (501SB=) HEPATITIS B CORE AB TOTAL 1 ML SERUM Instructions:
Dietary supplements containing biotin may interfere in assays and may skew analyte results to be either
falsely high or falsely low. For patients receiving the recommended daily doses of biotin, draw samples at
least 8 hours following the last biotin supplementation. For patients on mega-doses of biotin
supplements, draw samples at least 72 hours following the last biotin supplementation. (508SB=)
HEPATITIS A AB, TOTAL 1 mL serum Instructions: Dietary supplements containing biotin may interfere
in assays and may skew analyte results to be either falsely high or falsely low. For patients receiving the
recommended daily doses of biotin, draw samples at least 8 hours following the last biotin
supplementation. For patients on mega-doses of biotin supplements, draw samples at least 72 hours
following the last biotin supplementation. (8472SB=) HEPATITIS C AB W/REFL TO HCV RNA, QN,
PCR 4 mL serum
Transport Mode (498SB=) HEPATITIS B SURFACE ANTIGEN W/REFL CONFIRM Room temperature (499SB=)
HEPATITIS B SURFACE ANTIBODY QL ROOM TEMPERATURE (501SB=) HEPATITIS B CORE AB
TOTAL ROOM TEMPERATURE (508SB=) HEPATITIS A AB, TOTAL ROOM TEMPERATURE
(8472SB=) HEPATITIS C AB W/REFL TO HCV RNA, QN, PCR Room temperature
Transport Group RT

Insurance Diagnosis
F11.20 Opioid dependence, uncomplicated
Z79.899 Other long term (current) drug therapy

Sample Comment

** End of Order Report **

 78316545-23490023
eReq
Account# 78316545 Quest - LA
Bright Heart Health
2960 Camino Diablo, Suite 105
Walnut Creek, CA 94597
925-393-7729
Specimen/Provider Information
Collection Date: 10/28/2023 @ 14:45 Lab Reference#: 23490023

Ordering Provider: Vincent, Pamela UPIN / NPI: 1376544874

Patient Information
Patient Name: JULIEN, LINDSAY Address: 5817 Garibaldi St
Patient Id: 153402407 Gender: F City, St zip: Sacaramento, CA 95824
SSN: ***-**-7190 Home Phone:
DOB: 03/31/1987 Work Phone:

Billing Information Bill To: Patient

Primary Ins Code: Secondary Ins Code:
Primary Ins Name: Secondary Ins Name:
Address: Address:
City, St Zip: , City, St Zip: ,
Workers Comp: No Workers Comp: No
Policy#: Policy#:
Group#: Group#:
Emp / Group Name: Emp / Group Name:
Insured: , Insured: ,
Address: Address:
City, St Zip: , City, St Zip: ,
Relationship: Relationship:
Diagnosis Codes: F11.20, Z79.899

Guarantor Information
Name: JULIEN, LINDSAY Relationship: Self
Address: 5817 Garibaldi St
Sacaramento, CA 95824 Phone:
Comment:
Profiles / Tests
Order Code CPT Code Status Test Name Transport Requirements
6399 85025 Routine CBC (INCLUDES DIFF/PLT) RT: ROOM TEMPERATURE
91431 87389 Routine HIV 1/2 RT: (%91431SB) HIV 1/2 ANTIGE...
ANTIGEN/ANTIBODY,FOURTH
GENERATION W/RFL
6462 86704,.. Routine HEPATITIS PANEL, GENERAL RT: (498SB=) HEPATITIS B SURF...

Authorization - Please sign and date Sst Red Lav Blu Grn Urn Swb Prb Pap Oth
I hereby authorize the release of medical information related to the services described hereon and authorize payment directly
to Quest - LA. I agree to assume responsibility for payment of charges for laboratory services that are not covered by my
healthcare insurer.

Vincent, Pamela 10/28/2023

Ordering Provider Electronic Signature Date Patient Signature Date
 78316545-23490023+1
eReq
Account# 78316545 Quest - Seattle
Bright Heart Health
2960 Camino Diablo, Suite 105
Walnut Creek, CA 94597
925-393-7729
Specimen/Provider Information
Collection Date: 10/28/2023 @ 14:45 Lab Reference#: 23490023+1

Ordering Provider: Vincent, Pamela UPIN / NPI: 1376544874

Patient Information
Patient Name: JULIEN, LINDSAY Address: 5817 Garibaldi St
Patient Id: 153402407 Gender: F City, St zip: Sacaramento, CA 95824
SSN: ***-**-7190 Home Phone:
DOB: 03/31/1987 Work Phone:

Billing Information Bill To: Patient

Primary Ins Code: Secondary Ins Code:
Primary Ins Name: Secondary Ins Name:
Address: Address:
City, St Zip: , City, St Zip: ,
Workers Comp: No Workers Comp: No
Policy#: Policy#:
Group#: Group#:
Emp / Group Name: Emp / Group Name:
Insured: , Insured: ,
Address: Address:
City, St Zip: , City, St Zip: ,
Relationship: Relationship:
Diagnosis Codes: F11.20, Z79.899

Guarantor Information
Name: JULIEN, LINDSAY Relationship: Self
Address: 5817 Garibaldi St
Sacaramento, CA 95824 Phone:
Comment:
Profiles / Tests
Order Code CPT Code Status Test Name Transport Requirements
10231 80053 Routine COMPREHENSIVE METABOLIC RT: Room temperature
PANEL
36126 86592 Routine RPR (DX) W/REFL TITER AND RT: Room temperature
CONFIRMATORY TESTING
39371 80307 Routine DRUG MONITOR, BENZO, RT: ROOM TEMPERATURE
W/CONF, URINE
39374 80307 Routine DRUG MONITOR, COCAINE RT: ROOM TEMPERATURE
METAB, W/CONF, URINE
39375 80307 Routine DRUG MONITOR, FENTANYL, RT: ROOM TEMPERATURE
W/CONF, URINE
39379 80307 Routine DRUG MONITOR, METHADONE RT: ROOM TEMPERATURE
METAB, W/CONF, URINE
39380 80307 Routine DRUG MONITOR, OPIATES, RT: ROOM TEMPERATURE
W/CONF, URINE
39381 80307 Routine DRUG MONITOR, OXYCODONE, RT: ROOM TEMPERATURE
W/CONF, URINE
39384 80321 Routine DRUG MONITOR, ALCOHOL RT: ROOM TEMPERATURE
METAB, QN, URINE
39386 80324 Routine DRUG RT: ROOM TEMPERATURE
MONITOR,AMPHETAMINE, W/DL,
QN URINE
39391 80348,.. Routine DRUG MONITOR, BUP AND RT: ROOM TEMPERATURE
NALOXONE,QN,URINE
396 81025 Routine HCG, QL, URINE RT: Room temperature

Authorization - Please sign and date Sst Red Lav Blu Grn Urn Swb Prb Pap Oth
I hereby authorize the release of medical information related to the services described hereon and authorize payment directly
to Quest - Seattle. I agree to assume responsibility for payment of charges for laboratory services that are not covered by my
healthcare insurer.

Vincent, Pamela 10/28/2023

Ordering Provider Electronic Signature Date Patient Signature Date