Hemoglobin HPLC
| 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. Hemoglobin HPLC | |
| 2. | |
| 3. | |
| 4. | |
| 5. | |
| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
HHPLC
Test Workstation :
SCPUR
Specimen Type:
Blood
Tube Type:
Purple top (EDTA) tube: Whole Blood
Collection Volume:
2.0 mL (minimum 0.7 mL)
Cause for Rejection:
Specimen rejection: Clotted and denatured specimens
Storage:
Refrigerated
Availability:
Mon, Wed, Fri (0800-1600)
Methodology:
Ion Exchange High Performance Liquid Chromatography
Special Instructions:
Notify lab if patient has received a blood transfusion in the last 3 months.
Lab/Phone:
330-543-8484
TAT:
3 days
Additional Info:
Reference range is available on patient report
CPT Code:
83021
Synonyms:
Hemoglobin Electrophoresis; Hgb Identification
