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***Example Report*** ARUP Laboratories 500 Chipeta Way – Salt Lake City, UT 84108 Patient Age/Gender: Unknown Unknown (800)522-2787 - www.aruplab.com Printed: 05-Dec-18 12:46:47 Julio C. Delgado, M.D. M.S., Director of Laboratories

Clinical Laboratory

Reported/ Procedure Result Units Ref Interval Accession Collected Received Verified , Quant, Urn 100 ng/mL 18-338-900164 04-Dec-18 04-Dec-18 04-Dec-18 15:42:00 15:43:00 15:47:23 , Quant, Urn 100 ng/mL 18-338-900164 04-Dec-18 04-Dec-18 04-Dec-18 15:42:00 15:43:00 15:47:23 Amitriptyline/Nortriptyline Total, Urn 200 ng/mL 18-338-900164 04-Dec-18 04-Dec-18 04-Dec-18 15:42:00 15:43:00 15:47:23 Quant, Urn 100 ng/mL 18-338-900164 04-Dec-18 04-Dec-18 04-Dec-18 15:42:00 15:43:00 15:47:23 Quant, Urn 100 ng/mL 18-338-900164 04-Dec-18 04-Dec-18 04-Dec-18 15:42:00 15:43:00 15:47:23 Imipramine/Desipramine Total, Urn 200 ng/mL 18-338-900164 04-Dec-18 04-Dec-18 04-Dec-18 15:42:00 15:43:00 15:47:23 Quant, Urn 100 ng/mL 18-338-900164 04-Dec-18 04-Dec-18 04-Dec-18 15:42:00 15:43:00 15:47:23 Quant, Urn 100 ng/mL 18-338-900164 04-Dec-18 04-Dec-18 04-Dec-18 15:42:00 15:43:00 15:47:23 Doxepin/Nordoxepin Total, Urn 200 ng/mL 18-338-900164 04-Dec-18 04-Dec-18 04-Dec-18 15:42:00 15:43:00 15:47:23 Quant, Urn 200 ng/mL 18-338-900164 04-Dec-18 04-Dec-18 04-Dec-18 15:42:00 15:43:00 15:47:23 Quant, Urn 200 ng/mL 18-338-900164 04-Dec-18 04-Dec-18 04-Dec-18 15:42:00 15:43:00 15:47:23 Quant, Urn 200 ng/mL 18-338-900164 04-Dec-18 04-Dec-18 04-Dec-18 15:42:00 15:43:00 15:47:23 Clomipramine/Norclomipramine Total, Urn 400 ng/mL 18-338-900164 04-Dec-18 04-Dec-18 04-Dec-18 15:42:00 15:43:00 15:47:23

04-Dec-18 15:42:00 Amitriptyline, Quant, Urn: Quant, Urine

Interpretive comments: Urine concentrations of Tricyclic antidepressants do not correlate with signs or symptoms of therapy or toxicity. Therapeutic ranges are not established. 100 ng/mL limit of quantification: Amitriptyline, Nortriptyline, Imimpramine, Desipramine, Doxepin, Nordoxepin, Protriptyline 200 ng/mL limit of quantification: Clomipramine, Norclomipramine

This test was developed and its performance characteristics determined by ARUP Laboratories. The U.S. Food and Drug Administration has not approved or cleared this test; however, FDA clearance or approval is not currently required for clinical use. The results are not intended to be used as the sole means for clinical diagnosis or patient management decisions.

See Compliance Statement B: www.aruplab.com/CS

* Abnormal, # = Corrected, C = Critical, f = Footnote, H = High, L = Low, t = Interpretive Text, @ = Reference Lab

Chart ID: 13157371 Page 1 of 1