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Random Urine, Glucotetrasaccharides Epic Compendium  

▶ Desired Epic Build * = editable field  

Actual Epic Build 12/05/2025

PROCEDURE ID 115685
PDM 215299
ORDER DISPLAY NAME Random Urine, Glucotetrasaccharides
PROCEDURE NAME GLUCOTETRASACCHARIDES, RANDOM, URINE
PROCEDURE MASTER NUMBER LAB11693
SHORT PROCEDURE NAME GLUCOTETRASACCHARIDES, RANDOM, URINE
CATEGORY CODE 6.0
CATEGORY CODE RECORD NAME LAB URINE ORDERABLES
SYNONYMS GLUTETSACU
HEXOSE TETRASACCHARIDES
GLUCOSE TETRASACCHRIDES
HEX4
CLINICALLY ACTIVE Yes
ORDERABLE Yes
PERFORMABLE Yes
FILTER GENOMICS
REFERENCE LINK URL https://labs.northwell.edu/epic/test/115685
ORDERING INSTRUCTIONS
DEFAULT SPECIMEN TYPE Urine
SPECIMEN TYPE PICK LIST Urine
SPECIMEN TYPE LIST
OP SPECIMEN TYPE LIST
SPECIMEN SOURCE PICK LIST Urine, Catheter
Urine, Voided
Urine, Foley
Urine, Clean Catch
Kidney, Left
Kidney, Right
Ureter, Left
Ureter, Right
Bladder
SPECIMEN SOURCE DEFAULT - MALE Urine, Clean Catch
SPECIMEN SOURCE DEFAULT - FEMALE Urine, Clean Catch
SPECIMEN SOURCE LIST
OP SPECIMEN SOURCE LIST
IP LAB TEST COMPONENTS FOR REPORT GLUCTETU
HEX4INT
MPSREVBY
RSNREF
OP LAB TEST COMPONENTS FOR REPORT GLUCTETU
HEX4INT
MPSREVBY
RSNREF
ORDER QUESTIONS ["3048100000"]
ORDER QUESTIONS RECORD NAME NH IP REASON FOR REFERRAL
INPATIENT ORDER QUESTIONS ["3048100000"]
INPATIENT ORDER QUESTIONS RECORD NAME NH IP REASON FOR REFERRAL
ORDER SPECIFIC QUESTION OVERRIDE
INPATIENT QUESTION OVERRIDE
LOCATION RESTRICT LIST IP
LOCATION RESTRICT LIST IP RECORD NAME
LOCATION RESTRICT LIST INCLUDE IP
LOCATION RESTRICT LIST OP
LOCATION RESTRICT LIST OP RECORD NAME
LOCATION RESTRICT LIST INCLUDES OP
EDP AMB ORDER SPECIFIC QUESTIONS RECORD NAME
EDP IP ORDER SPECIFIC QUESTIONS RECORD NAME
EDP IP SPECIMEN SOURCE Urine, Clean Catch
Catheter
EDP OP SPECIMEN SOURCE
EDP IP SPECIMEN TYPE
EDP OP SPECIMEN TYPE Urine
DERIVED EDP IP BUTTONS S Urine, Clean Catch
DERIVED EDP IP BUTTONS T
DERIVED EDP OP BUTTONS S
DERIVED EDP OP BUTTONS T
IP ORDERABLE 1
OP ORDERABLE 1
STANDARD LAB COMPONENTS
STANDARD LAB COMPONENTS RECORD NAME
COMPONENT DATA REQUIREMENT
EPIC OP AOEs

Question IDQuestion NameQuestionResponse TypeResponse ListRequire Response
3048100000 NH IP REASON FOR REFERRAL Reason for Referral Custom List Rule out Pompe disease
Rule out GSDs other than Pompe disease
Follow-up of abnormal newborn screening
Follow-up of known Pompe patient
Not provided		 No
EPIC IP AOEs

Question IDQuestion NameQuestionResponse TypeResponse ListRequire Response
3048100000 NH IP REASON FOR REFERRAL Reason for Referral Custom List Rule out Pompe disease
Rule out GSDs other than Pompe disease
Follow-up of abnormal newborn screening
Follow-up of known Pompe patient
Not provided		 No
EPIC Components (results - crosswalked through Cerner)

Component IDComponent NameBase NameCommon NameExternal NameCerner Result PDM
3047802617.0 GLUCOTETRASACCHARIDES, U GLUCTETU GLUCOTETRASACCHARIDES, U Glucotetrasaccharides, U 215299A
3047805637.0 REVIEWED BY MPS MPSREVBY REVIEWEDBY, MPS Reviewed By 5912694G
3047804462.0 REASON FOR REFERRAL RSNREF REASON FOR REFERRAL Reason for Referral 5912694A
3047803084.0 INTEPRETATION (HEX4) HEX4INT INTEPRETATION HEX4 Interpretation (HEX4) 215299B