ALPS Panel by Flow Cytometry
| PATIENT INFO |
| Patient Name: |
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| BD: / / Sex: F M |
| PHYSICIAN INFO |
| Physician Name : |
| Address: |
| Ph: ( ) - Fax: ( ) - |
| Additional Report to: |
| Ph: ( ) - Fax: ( ) - |
| TESTS REQUESTED | |
| Test Name: | ICD9 Code: (required) |
| 1. ALPS Panel by Flow Cytometry | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
ALPSP
Test Workstation :
CINCI
Specimen Type:
Whole Blood
Tube Type:
Purple top (EDTA) tube or Green top (Sodium heparin)tube
Collection Volume:
2.0 mL
Minimum Volume:
1.0 mL
Cause for Rejection:
Frozen, clotted, hemolyzed or centrifuged specimens. Specimen collected in an unacceptable anticoagulant.
Storage:
Ambient
Availability:
Sent to Reference laboratory
Methodology:
Flow Cytometry
Special Instructions:
Send to laboratory at room temperature. Do NOT refrigerate. Draw specimen Monday through Thursday only. Specimen must be received by laboratory by 14:00. Specimen stable for 24 hours
Lab/Phone:
330-543-8418
TAT:
2 days
Additional Info:
Include current CBC report
CPT Code:
88184, 88185 x 10, 88188
