Ethosuximide (Mayo)

Centralized Core Laboratory - Mayo Clinic Laboratories : Send Out

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. Ethosuximide (Mayo)
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

ETSXM

Test Workstation :

MAYO

Specimen Type:

Blood

Tube Type:

Red top tube

Collection Volume:

1.5 mL

Minimum Volume:

0.6 mL

Cause for Rejection:

Gross hemolysis

Storage:

Refrigerated

Availability:

Sent to reference lab

Methodology:

Enzyme-Multiplied Immunoassay Technique (EMIT)

Special Instructions:

Send to Laboratory ASAP. Serum must be removed from cells within 2 hours.

Lab/Phone:

330-543-8418

TAT:

1-2 days

Additional Info:

Reference range:

40-100 mcg/mL

Critical Value: > or equal to 150 mcg/mL

CPT Code:

80168

Synonyms:

Zarontin

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Ethosuximide (Mayo)

Centralized Core Laboratory - Mayo Clinic Laboratories : Send Out

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