Allergic Bronchopulmonary Aspergillosis Panel II

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. Allergic Bronchopulmonary Aspergillosis Panel II
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

ABPA

Test Workstation :

MAYO

Specimen Type:

Blood

Tube Type:

Red top (no anticoagulant) tube

Collection Volume:

4.0 mL

Minimum Volume:

2.5mL

Storage:

Refrigerated

Availability:

Sent to reference lab

Methodology:

ImmunoCAP 1000, ImmunoCAP FEIA, Enzyme immunoassay (FEIA).

Lab/Phone:

330-543-8418

TAT:

3-9 days

CPT Code:

82785, 86003, 86001, 86331

Panel Includes:

Total IgE, Aspergillus fumigatus-specific IgE, Aspergillus fumigatus-specific IgG, and Aspergillus fumigatus mix Gel Diffusion.