Anti-Enterocyte Antibodies
| 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. Anti-Enterocyte Antibodies | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
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Test ID :
EPICA
Test Workstation :
MAYO
Specimen Type:
Blood
Tube Type:
Red top (no anticoagulant)tube
Collection Volume:
3.0 mL
Minimum Volume:
2.5mL
Storage:
Frozen
Availability:
Sent to reference lab
Methodology:
Indirect Immunofluorescence
Special Instructions:
Must be accompanied by and AntiEnterocyte Clinical Form.
Lab/Phone:
330-543-8418
TAT:
4-8 weeks
Additional Info:
CPT Code:
88346, 88350 X2
Synonyms:
AntiGobletl Cell Ab
