AFP, Amniotic Fluid
| PATIENT INFO |
| Patient Name: |
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| BD: / / Sex: F M |
| PHYSICIAN INFO |
| Physician Name : |
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| Ph: ( ) - Fax: ( ) - |
| Additional Report to: |
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| TESTS REQUESTED | |
| Test Name: | ICD9 Code: (required) |
| 1. AFP, Amniotic Fluid | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
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Test ID :
MOMSO
Test Workstation :
MAYO
Specimen Type:
Amniotic fluid
Tube Type:
Fluid container
Collection Volume:
1.0 mL
Minimum Volume:
0.5 mL
Cause for Rejection:
Gestational age < 13 weeks or > 24 weeks
Storage:
Refrigerated
Availability:
Mon-Fri
Methodology:
AFP-Immunoenzymatic Assay;
Acetylcholinesterase-Polyacrylamide Electrophoresis
Special Instructions:
Order Mayo Miscellaneous Sendout (Epic LAB3065) for AFP, Amniotic Fluid.
See www.mayomedicallaboratories.com/test catalog for required form:
"Second Trimester Maternal Screening AlphaFetoprotein (AFP)/QUAD Screen Patient Information".
If alphafetoprotein (AFP) is positive, then acetylcholinesterase (AChE) will be performed at an additional charge.
Lab/Phone:
330-543-8418
TAT:
2-19 days
Additional Info:
Reference range: < or =2.0 multiples of median (MoM)
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The following information is required:
a. Date ultrasound performed
b. Estimated due date by ultrasound
c. Collection date
d. Gestational age must be between 13 and 24 weeks; 16 to 18 weeks preferred
CPT Code:
82106 (AFP); 82013-Acetylcholinesterase (if appropriate)
Synonyms:
AlphaFetoprotein, Amniotic Fluid
