Bartonella PCR, Blood
| 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. Bartonella PCR, Blood | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
BAPCB
Test Workstation :
Mayo
Specimen Type:
Whole Blood
Tube Type:
EDTA (lavender)tube
Collection Volume:
1.0 mL
Minimum Volume:
0.5 mL
Cause for Rejection:
Icteric Specimens
Storage:
Refrigerated
Availability:
Sent to Reference Laboratory
Methodology:
Rapid Polymerase Chain Reaction (PCR)
Lab/Phone:
330-543-8418
TAT:
2-7 days
Additional Info:
CPT Code:
87801
