Blake Photo Time-Line

BRMH NEONATAL INTENSIVE CARE 17000 Medical Center Dr Baton Rouge LA 70816

Grondin, Blake John MRN: 12051461, DOB: 2/14/2020, Sex: M Acct #: 72010142213 Adm: 2/14/2020 02/14/2020 - Admission (Discharged) in O'Neal - NICU (continued)

Labs (continued)

Ordering provider: Myriam Ortiz-de Jesus, MD 02/14/20 0740 Order status: Completed Filed by: Edi, Soft Lab Interface 02/17/20 0936

Collected by: Rebekah E. Stout, RN 02/14/20 0800

Resulting lab: MAYO MEDICAL LABORATORY

Components Component Buprenorphine

Value

Reference Range Flag

Lab

Presumptive Positive

Cutoff: 5 ng/mL

—

MAYO

Comment: Drug confirmation to follow. Presumptive Positive means that the screening method is positive, but the test needs to be run by a confirmatory method. -------------------ADDITIONAL INFORMATION------------------- This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the U.S. Food and Drug Administration. Test Performed by: Mayo Clinic Laboratories - Rochester Superior Drive 3050 Superior Drive NW, Rochester, MN 55901 Lab Director: William G. Morice M.D. Ph.D.; CLIA# 24D1040592

Testing Performed By

Lab - Abbreviation Name

Director

Address

Valid Date Range

216 - MAYO

MAYO MEDICAL LABORATORY

William G Morice II, MD, PhD

200 1st St Southwest 530 Hilton Bldg ROCHESTER MN 55905

12/03/19 2138 - Present

Buprenorphine Confirm, Urine [498665681] (Final result) Electronically signed by: Edi, Soft Lab Interface on 02/14/20 0740

Status: Completed

Ordering user: Edi, Soft Lab Interface 02/14/20 0740

Ordering provider: Myriam Ortiz-de Jesus, MD

Authorized by: Myriam Ortiz-de Jesus, MD

Ordering mode: Standard

Frequency: Routine Once 02/14/20 0740 - 1 occurrence

Class: Normal

Quantity: 1

Lab status: Final result

Instance released by: (auto-released) 2/19/2020 9:26 AM

Specimen Information ID

Type

Source

Collected By

8614006645:8

—

—

STOUT,REBEKAH 02/14/20 0800

Buprenorphine Confirm, Urine [498665681]

Resulted: 02/19/20 0926, Result status: Final result

Ordering provider: Myriam Ortiz-de Jesus, MD 02/14/20 0740 Order status: Completed Filed by: Edi, Soft Lab Interface 02/19/20 0927

Collected by: STOUT,REBEKAH 02/14/20 0800

Resulting lab: MAYO MEDICAL LABORATORY

Components Component

Value

Reference Range Flag

Lab

Buprenorphrine Confirmation, Ur Norbuprenorphine Confirmation, Ur

25.0

Cutoff: 5.0 ng/mL Cutoff: 2.5 ng/mL

— —

MAYO MAYO

233.3

Comment: -------------------ADDITIONAL INFORMATION------------------- Testing performed by Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS). This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by

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