Haptoglobin
| 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. Haptoglobin | |
| 2. | |
| 3. | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
HAP
Test Workstation :
SUMMA
Specimen Type:
Blood
Tube Type:
Red top (no anticoagulant) tube
Collection Volume:
5.0 mL
Minimum Volume:
1.5 mL
Cause for Rejection:
Hemolysis, lipemia
Storage:
Frozen
Availability:
Sent to reference lab
Methodology:
Nephelometry
Lab/Phone:
330-543-8418
TAT:
48 hours
Additional Info:
Reference range: Adults = 31.0-200.0 mg/dL
CPT Code:
83010
