Cortisol, Saliva
| 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. Cortisol, Saliva | |
| 2. | |
| 3. | |
| 4. | |
| 5. | |
| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
SALCT
Test Workstation :
MAYO
Specimen Type:
Saliva
Tube Type:
Cortisol, Saliva Collection Kit (T514)
Collection Volume:
1.5 mL
Minimum Volume:
0.6mL
Storage:
Refrigerated
Availability:
Sent to reference lab
Methodology:
liquid Chromatography - tandem Mass Spectrometry (LC-MS/MS)
Special Instructions:
Collect between 11pm and midnight, and record collection time.
To use the Salivette: remove top cap of container to expose swab. Place swab directly into mouth by tipping container so swab falls into mouth. Do not touch swab with fingers. Keep swab in mouth for approximately 2 minutes. Roll swab in mouth, do not chew swab. Place swab back in its container without touching, and replace the cap. Record collection time and label specimen.
Can also collect 7am to 9am or 3pm to 5pm, however 11pm to midnight is preferred. Record collection time. If multiple specimens are collected, submit each vial under a separate order.
Lab/Phone:
330-543-8418
TAT:
2-4 days
Additional Info:
See reference lab report
CPT Code:
82533
Synonyms:
Nighttime Salivary Cortisol
Salivary Cortisol
Salivary Cushings
Salivary Hydrocortisone
