Acylcarnitines, Plasma Quantitative
| 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. Acylcarnitines, Plasma Quantitative | |
| 2. | |
| 3. | |
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| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
ACP
Test Workstation :
SHIMZ
Specimen Type:
Blood
Tube Type:
Green top (sodium or lithium heparin) tube.
NO GEL Tubes.
Collection Volume:
1.5 mL (minimum 1.0 mL)
Cause for Rejection:
Specimen collected in a gel tube.
Storage:
Frozen
Availability:
Sent to reference lab
Methodology:
Flow Injection Analysis - Tandem Mass Spectrometry (FIA-MS/MS)
Special Instructions:
Patient's age is required on request form for processing.
Lab/Phone:
330-543-0223
TAT:
3-5 days
Additional Info:
Reference range is available on patient report
CPT Code:
82017
