Cardiolipin ABS
| 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. Cardiolipin ABS | |
| 2. | |
| 3. | |
| 4. | |
| 5. | |
| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
CARDI
Test Workstation :
MAYO
Specimen Type:
Serum
Tube Type:
Gold top SST (Serum Separator) tube
Alternate Tube Type:
Red Top
Collection Volume:
1.5 mL
Minimum Volume:
1.0 mL
Storage:
Refrigerated
Availability:
Sent to Reference Laboratory
Methodology:
Enzyme Linked Immunosorbent Assay (ELISA)
Lab/Phone:
330-543-8418
TAT:
1-2 days
Additional Info:
Reference range:
IgG Cardiolipin Ab:
Negative: <10
Borderline: 10.0-14.9
Weakly Positive: 15.0-39.9
Positive: 40.0-79.9
Strongly Positive: > or = 80.0
CPT Code:
86147 (X2)
Panel Includes:
IgG Cardiolipin Ab
IgM Cardiolipin Ab
