Carnitine Plasma
| 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. Carnitine Plasma | |
| 2. | |
| 3. | |
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| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
CARN
Test Workstation :
SHIMZ
Specimen Type:
Blood
Tube Type:
Green top (sodium or lithium heparin) tube
Collection Volume:
1.0 mL (minimum 0.4 mL)
Storage:
Frozen
Methodology:
Liquid Chromatography Mass Spectrometry (LC-MS/MS)
Lab/Phone:
Metabolic Lab 330-543-0223
TAT:
3-5 days
Additional Info:
Reference range is available on patient report
CPT Code:
82379, 82017
Panel Includes:
Total Carnitine;
Free Carnitine;
Acylcarnitine;
AC/FC Ratio
