17 Hydroxypregnenolone
| PATIENT INFO |
| Patient Name: |
| Medical Record #: |
| BD: / / Sex: F M |
| PHYSICIAN INFO |
| Physician Name : |
| Address: |
| Ph: ( ) - Fax: ( ) - |
| Additional Report to: |
| Ph: ( ) - Fax: ( ) - |
| TESTS REQUESTED | |
| Test Name: | ICD9 Code: (required) |
| 1. 17 Hydroxypregnenolone | |
| 2. | |
| 3. | |
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| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
HPREG
Test Workstation :
MAYO
Specimen Type:
Blood
Tube Type:
Red top (no anticoagulant) tube
Alternate Tube Type:
SST
Collection Volume:
2.5 mL
Minimum Volume:
1.5 mL
Storage:
Frozen
Availability:
Sent to reference lab.
Methodology:
Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)
Lab/Phone:
330-543-8418
TAT:
2-6 days
Additional Info:
Ref. range is age dependent; avail on patient report
CPT Code:
84143
