Histamine Plasma
| 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. Histamine Plasma | |
| 2. | |
| 3. | |
| 4. | |
| 5. | |
| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
HISTM
Test Workstation :
MAYO
Specimen Type:
plasma
Tube Type:
Purple top (EDTA)
Collection Volume:
3.0 mL (minimum 1.0 mL)
Storage:
Frozen
Availability:
Sent to Reference Laboratory
Methodology:
Enzyme Immunoassay (EIA)
Special Instructions:
Draw 3 mL blood in a lavender top (EDTA) tube(s). Cool immediately on ice.
The centrifugation should be performed within 20 minutes of collection.
Lab/Phone:
330-543-8418
TAT:
2-7 days
Additional Info:
Reference range is available on patient report
CPT Code:
83088
