Centralized Core Laboratory - Cleveland Clinic Laboratories :
Send Out
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. Acid Phosphatase, Total
2.
3.
4.
5.
6.
SPECIMEN INFO
Collection Date & Time:
Collected By:
Hospital:
Test ID :
APHOS
Test Workstation :
CLEVE
Specimen Type:
Blood
Tube Type:
Red top (no anticoagulant) tube
Collection Volume:
4.0 mL
Minimum Volume:
1.5 mL
Storage:
Strict Frozen
Availability:
Sent to reference lab -Days Performed: Sun-Sat
Methodology:
Enzymatic
Special Instructions:
Separate serum from cells ASAP, Critical frozen
For Outpatients, test should only be drawn in outpatient locations within a Hospital (Akron or Beeghly)
Lab/Phone:
330-543-8418
TAT:
2-4 days
Additional Info:
Reference range: 0.0-4.3 U/L
CPT Code:
84060
Acid Phosphatase, Total
Test ID/Workstation :
APHOS
Specimen Type:
Blood
Tube Type:
Red top (no anticoagulant) tube
Collection Volume:
4.0 mL
Storage:
Strict Frozen
Availability:
Sent to reference lab -Days Performed: Sun-Sat
Methodology:
Enzymatic
Special Instructions:
Separate serum from cells ASAP, Critical frozen
For Outpatients, test should only be drawn in outpatient locations within a Hospital (Akron or Beeghly)
Lab/Phone:
330-543-8418
TAT:
2-4 days
Additional Info:
Reference range: 0.0-4.3 U/L
CPT Code:
84060
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