17 Hydroxyprogesterone
| 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 Hydroxyprogesterone | |
| 2. | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
OHP
Test Workstation :
SHIMZ
Specimen Type:
Blood
Tube Type:
Red top (no anticoagulant) tube
(Note: Gel tubes are not acceptable)
Collection Volume:
1.5 mL (minimum 0.75 mL)
Cause for Rejection:
specimen in gel tube, QNS
Storage:
Refrigerated
Methodology:
Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)
Lab/Phone:
330-543-0223
TAT:
3-5 days
Additional Info:
Reference range is age and sex dependent; available on patient report
CPT Code:
83498
