Providers should request the addition, change, and/or removal of a critical value to the Laboratory Medical Director (CLIA Laboratory Director) by completing this SBAR – Request for Critical Values, Reflex Testing or Reference Range

Critical Value (Policy LabD.UPHDM.GEN.6: Laboratory Critical Values) and Reflex Testing (Policy LabD.UPHDM.GEN.15: Reflex Testing, Clinical Interpretations, and Panels)

• The UnityPoint Health – Des Moines Medical Executive Committee (MEC) will review and approve critical values and reflex testing as recommended by the Clinical Laboratory.
  • Pediatric and Newborn populations: Prior to approval by the Medical Executive Committee, the Blank Children’s Hospital Vice President/Medical Director will coordinate the review and approval by affected the Pediatric Services lines all changes for pediatric patients to the test list that qualify for critical values or reflex testing Documentation to be attached/included with SBAR to MEC.

Reference Ranges

• Reference Ranges are approved by the CLIA Laboratory Director overseeing the UPHDM Campus they oversee.
  • Pediatric and Newborn populations: Prior to approval by the CLIA Laboratory Director(s), the Blank Children’s Hospital Vice President/Medical Director will coordinate the review and approval by affected the Pediatric Services lines all changes for pediatric patients reference ranges. Documentation to be attached/included with SBAR prior to the laboratory approval.