Histone IgG Antibody
| 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. Histone IgG Antibody | |
| 2. | |
| 3. | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
HISAB
Test Workstation :
CLEVE
Specimen Type:
Blood
Tube Type:
Gold top SST (serum separator tube, no anticoagulant)
Collection Volume:
2.5 mL (minimum 1.5 mL)
Storage:
Refrigerated
Availability:
Sent to reference lab
Methodology:
Enzyme- Linked Immunosorbent Assay (ELISA)
Special Instructions:
Days Performed: Thursday
Lab/Phone:
330-543-8418
TAT:
1-8 days
Additional Info:
Reference range:
Negative: < 1 Unit
Weak Positive: 1.0-1.5 Units
Moderate Positive: 1.6-2.5 Units
Strong Positive: >2.5 Units
CPT Code:
86235
