Centralized Core Laboratory - Mayo Clinic Laboratories :
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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. Bile Acids, Fractionated
2.
3.
4.
5.
6.
SPECIMEN INFO
Collection Date & Time:
Collected By:
Hospital:
Test ID :
BLACF
Test Workstation :
MAYO
Specimen Type:
Blood
Tube Type:
Red top (no anticoagulant) tube
Alternate Tube Type:
SST
Collection Volume:
1.5 mL
Minimum Volume:
1.0 mL
Storage:
Refrigerated
Availability:
Sent to reference lab
Methodology:
Liquid Chromatography Tandem Mass Spectrometry
Special Instructions:
Overnight fasting preferred.
Lab/Phone:
330-543-8418
TAT:
2-7 days
Additional Info:
Reference range:
Total Cholic Acid: < or = 5.00 nmol/mL
Total Deoxycholic Acid: < or = 6.00 nmol/mL
Total Chenodeoxycholic Acid: < or = 6.00 nmol/mL
Total Ursodeoxycholic Acid: < or = 2.00 nmol/mL
Total Bile Acids: < or = 19.00 nmol/mL
CPT Code:
82542
Panel Includes:
Cholic Acid, Chenodeoxycholic Acid, Deoxycholic Acid, Urodeoxycholic Acid, Total Fractionated Bile Acids
Bile Acids, Fractionated
Test ID/Workstation :
BLACF
Specimen Type:
Blood
Tube Type:
Red top (no anticoagulant) tube
Collection Volume:
1.5 mL
Storage:
Refrigerated
Availability:
Sent to reference lab
Methodology:
Liquid Chromatography Tandem Mass Spectrometry
Special Instructions:
Overnight fasting preferred.
Lab/Phone:
330-543-8418
TAT:
2-7 days
Additional Info:
Reference range:
Total Cholic Acid: < or = 5.00 nmol/mL
Total Deoxycholic Acid: < or = 6.00 nmol/mL
Total Chenodeoxycholic Acid: < or = 6.00 nmol/mL
Total Ursodeoxycholic Acid: < or = 2.00 nmol/mL
Total Bile Acids: < or = 19.00 nmol/mL
CPT Code:
82542
Panel Includes:
Cholic Acid, Chenodeoxycholic Acid, Deoxycholic Acid, Urodeoxycholic Acid, Total Fractionated Bile Acids
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