Centromere Ab
| 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. Centromere Ab | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
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Test ID :
CENTR
Test Workstation :
CLEVE
Specimen Type:
Blood
Tube Type:
Gold top SST (serum separator tube, no anticoagulant)
Collection Volume:
2.5 mL (minimum 0.5 mL)
Cause for Rejection:
Hemolysis, hyperlipemia or microbial growth
Storage:
Refrigerated
Availability:
Sent to reference lab
Methodology:
Indirect Immunofluorescence (IFA)
Special Instructions:
Useful in diagnosis of Crest Syndrome (Scleroderma)
Lab/Phone:
330-543-8418
TAT:
1-3 days
Additional Info:
Reference range: Negative
CPT Code:
86256
