Folate
| 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. Folate | |
| 2. | |
| 3. | |
| 4. | |
| 5. | |
| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
FOLAT
Test Workstation :
E8011
Specimen Type:
Blood
Tube Type:
SST (serum separator tube,no anticoagulant)
Collection Volume:
1.5 mL
Minimum Volume:
1.5 mL
Preferred Volume:
1.5 mL
Storage:
Shipping- Send Refrigerated; Storage-Room Temp: 2 hours; Refrigerated: 48 hours; Frozen: 1 month
Availability:
24 hours/day, 7 days/week
Methodology:
Roche-ECLIA Competition principle
Lab/Phone:
330-543-8418
TAT:
4 hours
Additional Info:
Reference Interval:
> or = 4.8 ng/mL
CPT Code:
82746
Synonyms:
Folic Acid
